Quiz 24

Disaster Planning Interventions: Action (Rationale) 1. Planning a. Review facility disaster plan frequently to update k__________________. The development of the disaster preparedness plan is an evolving and ongoing process. The purpose of disaster preparedness planning is to prepare the facility and health care workers for external and internal disasters. (Information helps health care workers anticipate their roles in the event of a disaster.) b. Know your o____ particular responsibilities in a disaster emergency. (Valuable time is saved and overall performance improved.) c. Participate, when possible, in disaster d________. Learning experiences are provided through disaster drills and formal critiques of the responses. (Drills are helpful in evaluating the overall safety program and are required by accrediting agencies.) Disaster drills may be initiated on a particular nursing unit, facility wide, community wide, or even statewide. d. Participation in a crisis support g_________ is desirable if directly involved in a disaster or a disaster response. Individuals often experience some level of emotional or critical incident stress. (Crisis support teams or groups encourage staff to share thoughts and feelings related to the experience [debriefing].) 2. Follow facility disaster p_______ in the event of a disaster. (Disaster plan outlines procedures to follow and is most effective when personnel respond appropriately.)a. Identify the type of disaster emergency by recognizing the code that is used to announce it. (Unfamiliarity with the codes tends to result in loss of valuable time and injury to patients or personnel.)b. Identify each patient's age, sensory i_____________________, level of mobility, ability to comprehend instructions, and overall need for protection. (Helps you to protect and assist patients in interpreting environmental stimuli relevant to safety.)c. If indicated, assess patients for possible discharge or transfer. Protection of inpatients, and casualties from a disaster, is a top priority. (Space may be needed for disaster victims.)d. Provide clear e___________________ to patients and visitors in a calm manner. (The amount of information patients and families have about the situation [drill, disaster event] affects their ability to cooperate and participate in any planned or unplanned activity.)e. If a disaster occurs when you are off duty, follow your facility protocols for r_______________ in (i.e., some facilities require you to report for duty at your regularly scheduled times, whereas others require you to contact your manager for instruction). Community agencies and resources are incorporated into the overall plan. (Additional personnel [e.g., student nurses and clinical faculty] in some cases assist with inpatient care to free staff for more critical disaster victims.)f. If an internal disaster occurs, assist with planned evacuations as needed. (Some disasters necessitate moving patients to a safer area.)g. Listen for the "All ________" announcement after a disaster drill. (This indicates that the drill is over.) 3. E______________. Compare actual outcomes and performances with disaster preparedness plan (usually a critique session is held). (Evaluation allows facility to examine whether plan accomplished goals and objectives; permits necessary changes to be made.)

knowledge, own, drills, group, plan, impairments, explanations, reporting, clear, Evaluation

Regulation of Practice: Standards of care define acts whose performance is required, permitted, or prohibited. These standards of care derive from federal and state l_______, rules, and regulations and codes that govern other professional agencies and organizations such as the A_______________ Nurses Association (ANA) and the Canadian Nurses Association (CNA). These organizations regularly e_____________ existing standards and revise them as needed. Standards of care coupled with the scope of nursing practice give direction to the practicing nurse. They define the obligations of the nurse, including those activities that are obligatory and those that are p_______________. Failure to adhere to these standards gives rise to l__________ liability. Ignorance of the requirements and limitations does not absolve liability

laws, American, evaluate, prohibited, legal

Typical Services Offered by Adult Daycare Centers • Transportation • Social services • M________ • Limited nursing care • Personal care • C_______________ • Therapeutic activities • R___________________ _________________ • Crafts • Recreational a______________

Meals, Counseling, Rehabilitation therapies, activities

Patients' Rights Patients have expectations regarding the health care services they receive. In 1972 the American Hospital Association (AHA) developed the Patient's B_____ of Rights. Since its inception, the Patient's Bill of Rights has undergone revisions; the modified version of 200____ is called The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities (see Box 1.1). The AHA encourages health care institutions to adapt the template bill of rights to their particular environments. This involves considering the cultural, religious, linguistic, and educational backgrounds of the population the institution serves. In 1980 the M_________ Health Patient's Bill of Rights and the Pregnant Patient's Bill of Rights were adopted into law. The goal of the AHA is to promote the public's understanding of their rights and responsibilities as consumers of health care. Failure of the nurse to embrace the outlined rights of the patient can promote b_____________ in the relationship between the nurse and the patient. The J_________ Commission is an independent accrediting agency responsible for accrediting and certifying more than 19,000 facilities in the United States. The Joint Commission has developed a brochure titled Know Your Rights, which is a statement on the rights and responsibilities of patients. The Patient Self-Determination Act (included in the Omnibus Budget Reconciliation Act of 1990, U.S. Code vol. 42, sec. 1395 cc[a][1]) regulates any institution that receives f_____________ funding. The Patient Self-Determination Act requires that institutions maintain w_________ policies and procedures regarding advance directives (including the use of life support if the patient is incapacitated), the right to accept or refuse treatment, and the right to participate fully in health care-related decisions. The Health Insurance Portability and Accountability Act (HIPPA) was passed into legislation in 1996. In the years that followed there were modifications. Then, agencies and facilities had until 2003 to become compliant with the mandates. Health care providers who maintain and transmit health care information must provide reasonable and appropriate administrative, technical, and physical safeguards on a patient's health information. The law sets rules and limits on who has permission to look at and receive health information and assigns penalties for wrongful disclosure of individually identifiable health information. All health care providers must be knowledgeable about the HIPAA standards and protect the privacy rights of patients and residents

Bill, 3, Mental, breaches, Joint, federal, written,

MEXICAN AMERICANS: Family Roles F_____________ sometimes expect to help care for patient. M_______ family members usually are consulted before health care decisions are made. Only a w_______ is permitted to give care to husband at home if g_____________ are touched.

Families, Male, wife, genitalia

Jehovah's Witness Baptism: _____ infant baptism is practiced. Baptism with complete immersion of adults is done as a symbol of dedication to Jehovah because Jesus was baptized. Birth control and abortion: Use of birth control is a p_____________ decision. Abortion is opposed based on Exodus 21:22-23. Blood transfusions: Blood transfusions v____________ God's laws and therefore are not allowed. Patients do respect physicians and accept alternatives to blood transfusions. These include the possible use of n________________ plasma expanders, careful surgical techniques to decrease blood loss, use of autologous transfusions, and autotransfusion through use of a heart-lung machine. Be sure to check u___________________ patients for medical-alert cards or bracelets that state that the person does not want a transfusion. Because Jehovah's Witnesses are prepared to die rather than break God's law, you need to be sensitive to the spiritual as well as the physical needs of the patient. Death: Autopsy is a p___________ matter to be decided by the persons involved. Burial and cremation are acceptable. Dietary habits: Use of alcohol and tobacco is d__________________ because these harm the physical body. Organ transplants: Use of organ transplant is a private decision; if used, it is required that the organ be cleansed with a nonblood solution.

No, personal, violate, nonblood, unconscious, private, discouraged

Home Health Care Defined Home health care preserves individual independence and integrity and keeps families together. The following are definitions of home health care as viewed from four different perspectives: • O____________: A component of comprehensive health care in which individuals and their families receive s___________ in their place of residence for the purpose of promoting, maintaining, or restoring health, or of minimizing the effects of illness and disability. • P____________: Skilled and compassionate care provided on a o____-to-one basis in the comforting and familiar surroundings of the home. Providers base care on individual needs and personalized schedules and do so over a given period to enable adjustment, change, and learning to take place effectively. • F____________: A means to keep the family t______________ as a functioning, integrated unit. The goals are learning to adapt to change, preventing dysfunctional patterns from setting in, and attaining family wellness within the scope of an individual member's illness or disability. It provides needed emotional support and linkage with the larger community support systems. • P____________: Challenges all disciplines involved to provide excellent care in often less-than-excellent c_______________ and surroundings. Independence, creativity, communication, and excellent clinical skills are integral aspects of daily practice. It is an opportunity for nurses to demonstrate the best of their profession and themselves in cooperation with the health care team to patients and families with physical and psychological needs.

Official, services, Patient, one, Family, together, Provider, conditions

Informed Consent The Patient Care Partnership establishes the patient's right to make decisions regarding his or her health care. The doctrine of informed consent refers to full disclosure of the facts the patient needs to make an intelligent (informed) decision before any invasive treatment or procedure is performed (Fig. 2.1). The patient has the right to accept or r__________ the proposed care but only after understanding fully what is being proposed—that is, the benefits of the treatment, the risks involved, any alternative treatments, and the consequences of refusing the treatment or procedure. The explanation of the procedure must be in n_________________ terms and in a language the patient can understand. Failure to secure informed consent may result in civil liability for battery. Civil battery (also called technical battery) is the unlawful touching of a person; an intent to harm is not necessary. Consent must be given freely. C____________ negates the spirit of informed consent. Patients who seek treatment sign forms to indicate acceptance of care interventions. Additional consent for treatment may be needed for further i____________ actions. Patients may withdraw or limit consent at a____ time.

Partnership, doctrine, intelligent, reject, nontechnical, Coercion, invasive, any

Admission The ______ makes the initial evaluation and admission visit within 24 to 48 hours of the referral. In some instances, if nursing is not necessary at the start of care, the physical therapist may be the one completing this admission process. The physician often gives general orders before this visit, but agencies sometimes make an evaluation visit without orders if agency policy permits. The evaluation and admission process generally includes at least the following: 1. Complete patient evaluation, including physical and p________________ factors 2. E_____________________ assessment relating specifically to safety and ability to provide services effectively in the home 3. Identification of primary functional i____________________ 4. Identification of the impact of the disease or disability on the patient and the family 5. Assessment of the support system of the f_________ or the significant other 6. Determination of knowledge and adherence to treatments and medications 7. Determination of d_________ for care and services 8. Involvement of the patient and the family in the development of the plan of care and goals 9. Notification of the patient of r__________as a patient, along with information on costs, payment sources, and billing practices 10. Explanation of the patient's right to self-determination, including information and implementation policies for advanced directives 11. Provision of initial nursing interventions (obtain an initial set of orders from the health care provider and proceed with providing the specific interventions ordered) The admission process typically takes a minimum of ____ hour. It takes longer if the patient is disoriented or in need of nursing interventions. Some hospital-based agencies initiate an abbreviated evaluation visit while the patient is still in the hospital.

RN, psychosocial, Environmental, impairments, family, desire, rights, 1

Services to Support Home Care Providers for Older Adults • R____________ care: Scheduled stays for the older adult who needs care at a long-term care facility to give the caregiver a break from the responsibility of providing care. • D____________: A setting that provides structured age-appropriate activities during the day; frequently used by family members and caregivers who work during the day. • H_______ health care: Includes homemakers, shoppers, respite care workers, personal care attendants, home health aides, and nursing care staff. • N___________ programs: Community programs, such as senior centers, or home delivery of one hot meal per day (Meals on Wheels); some programs are funded by the community, and others charge a small fee for services. • Senior c____________: Government or community-funded centers that provide recreational activities, lunch, health screening, exercise classes, educational classes, and transportation to and from the site if needed. • T____________________ services: Community or government funded service to grocery shopping or medical appointments. Some of these services may charge a fee.

Respite, Daycare, Home, Nutrition, centers, Transportation

Consent may be communicated in a variety of ways. Patients may imply consent by their a___________. Patients may v_____________ their acceptance of treatment interventions. I_______________ procedures may require a w_________ consent document to be completed. Consent must be provided by the appropriate person. To provide consent, the patient must be at least _____ years of age. Minors under the age of 18 years may consent for treatment if they meet certain criteria, including the following: • M_____________ • Court-approved emancipation • Living apart from parents or guardians for at least 60 days and independent of parental support • Service in the a__________ forces In some situations, a minor may consent for care, including treatment for sexually transmitted infections, drug and alcohol abuse, sexual assault, and family planning. There also must be c________________ to consent for care. Competence requires that the patient be of sound mind to accept the treatment. In addition, consent cannot be obtained from one who is impaired or under the influence of alcohol or drugs. If the patient is deemed incompetent to provide consent, a l_________ process exists for the determination of the individual legally eligible to provide the consent. In many cases, consent is provided by the s_________. In the absence of the spouse, this role may be passed to another legally identified individual. It is the duty of the physician or n________ practitioner who is performing the procedure or treatment to provide the needed information to the patient. The nurse often has the responsibility to w___________ the patient signing the consent. In this case, the nurse's responsibility is limited to the actual witnessing of the signature, not provision of information. The nurse does not discuss with the patient the elements of disclosure that the physician or the nurse practitioner are required to make. Involvement in providing this type of information to the patient potentially places the nurse in a position of l____________. Answers to any unanswered questions that the patient has about the procedure are the responsibility of the health care provider who will perform the procedure. Certain situations may require consent for treatment to be obtained over the t_______________. Health care facilities have policies that govern telephonic consent. This type of consent traditionally is needed in management of emergency procedures.

actions, verbalize, Invasive, written, 18, Marriage, armed, competence, legal, spouse, nurse, witness, liability, telephone

The long-term care facility industry is large and will continue to grow as the population a_______, although it is changing. Fewer, but larger, long-term care facilities are found today. The greatest population growth is occurring in the o_________ adult group, the oldest-old or frail elderly, those older than age 85. The philosophy in a long-term care facility is to maintain and restore health and f______________ abilities to the resident's h____________ level and to provide a homelike atmosphere, promoting dignity, independence, restoration, maintenance, and assistance in ADLs, and skilled nursing interventions

ages, older, functional, highest

Home health care services enable individuals of a____ ages to remain in the comfort and security of t________ home while receiving health care. Family support, familiar surroundings, and participation in the care process contribute to feelings of worth and dignity. Possible services include s_____________ nursing, physical therapy, psychiatric therapy, pain education and management, speech and l______________ therapy, occupational therapy, social services, intravenous therapy, nutritional support, respiratory therapy, acquisition of medical supplies and equipment, home health aide, homemaker, pet care assistance, and companion care. Patients most often receive r_______________ for home health services on discharge from the hospital. However, the patient, the family, or the health care provider can request home health care at other times.

all, their, skilled, language, referrals

Precautions to Promote Safety • Assist patients when they get out of b_____ if they have had surgery, have received narcotics for analgesia, have an unsteady gait, or have been in bed for an extended period. • Demonstrate the proper use of emergency call b______________ or cords. • Encourage patients to wear n_____________ slippers or shoes when ambulating. • Encourage the use of hand r_______ in the bathrooms and halls. • Follow facility policies regarding the use of side rails. • If bed is equipped with an alarm, turn on for the restless, disoriented patient. • Instruct patient to use the call b_____ for assistance. • Keep adjustable beds in the l______ position except when giving care. • Keep environment free of c_____________ because such items as books, magazines, and shoes sometimes cause the patient to trip and fall. • L_______ wheels on beds, wheelchairs, and gurneys. • Orient patient to the environment to provide familiarity. • Place bedside table and overbed table within r_________. Ensure that frequently used items, such as the telephone, eyeglasses, or other personal belongings, are easily accessible. • Provide adequate l_________________ • Some institutions have adopted "fall precaution" policies in which every patient is evaluated on admission to determine the degree of likelihood for a potential fall (see Box 10.2). • Wipe or mop up spilled liquids promptly. Personnel and patients must be alert to signs warning of wet or slippery floors.

bed, buttons, nonslip, rails, bell, low, clutter, lock, reach, lighting

Respite Care Is care provided to give family members or c________________ a "break" from the responsibility of care to patients who are u_________ to care for themselves. Respite care is available for as little as 1 h______ to as much as days. The service is available in various settings, including the person's home, long-term care facilities, and respite care facilities. Respite care is r_________________ by some private and some government-sponsored insurance.

caregivers, unable, hour, reimbursed

Two c_______________ of residents generally are found in a long-term care facility. The first category is the s______-term resident, sometimes called the short-stay resident. Typically, these residents have been transferred from an acute care facility to which they had been admitted for an a_________ illness or the worsening of a chronic illness. The residents are admitted principally for rehabilitation and are expected to be discharged within 6 months. These residents and the residents of a subacute unit have many similarities. The second category is the traditional type of resident who lives in the facility on a l____-term basis. Such residents usually stay in the facility until they d___ or are transferred to an acute care facility. These residents have numerous nursing intervention n_________ and are sometimes cognitively impaired. Most residents in the typical long-term care facility are of the traditional category, although the trend is toward admitting more short-term residents. As a result, the overall nursing interventions of long-term care residents have become increasingly complex.

categories, short, acute, long, die, needs

Legal Relationships Legal liability for alleged harm may be held solely or shared between multiple parties. The patient or family may choose to pursue c____________ against the facility, nursing personnel, medical staff, or ancillary departments. Each may be charged s________________ or in a group. In the past, nurses did not hold legal l_____________ for alleged harm suffered by a patient while receiving medical care, but the physician and/or the hospital did. As nurses gained recognition for their expertise and gained more a_____________, dissatisfied patients (and their attorneys) began to look at nurses as potential defendants and to seek to hold nurses accountable under the law. Accountability (being responsible for one's own actions) is a concept that gives rise to a legal d_______, and thus liability (legal responsibility), in nursing. Indeed, the nurse is not immune from liability in the practice of nursing. An analysis of statistics shows sharp increases in the amount of litigation against nurses by patients. A variety of reasons explain the increases (Boxes 2.4 and 2.5). Nurses are facing increased responsibilities in the health care arena. T____________________ advances require more knowledge and competence. Staffing shortages and budgetary constraints also may play a role. High levels of patient acuity and an emphasis on early discharge may result in the need for more comprehensive referrals and improved discharge teaching. Flaws in either may result in litigation. Finally, i______________ experts believe that some responsibility may rest with the large payout to litigants. Legal findings against nurses can be categorized. The most common areas of litigation against nurses involve performance failures in the following areas: standards of care, use of equipment, documentation, and patient advocacy

charges, separately, liability, autonomy, duty, Technological, insurance

Community Resources: Adult Daycare Adult d______________ services are community-based programs designed to meet the needs of functionally or cognitively i____________ adults through supervised health care and social and recreational activities. These structured, comprehensive programs provide a variety of services, including physical care, mental stimulation, socialization, assistance with health maintenance, and health referrals, during any part of the day, but for less than _____ hours a day (Box 38.2). These centers generally operate during r______________ business hours, with the patient returning home to family or caregivers at night, although some offer services during evening and weekend hours.

daycare, impaired, 24, regular

Most residents of long-term care facilities have more than one health d__________ when they are admitted. The most common disorders on admission include c_________________ disease, hypertension, depression, dementia, and type 2 diabetes. It is a common misconception that most older adults live in long-term care facilities. As noted in the previously mentioned statistics the vast number of the population over the age of 65 do n_____ live in long-term care facilities.

disorder, cardiovascular, not

Cultural Competence and Transcultural Nursing Most people look at the world from their own cultural viewpoint. They often believe that the beliefs and practices of their particular culture are best. This belief is called e________________. The nurse must learn to value the beliefs of others and realize that practices of other cultures can be valuable in health care. In the care of patients from many different cultures, the licensed practical/vocational nurse (LPN/LVN) must develop cultural competence: the a___________________ of one's own cultural beliefs and practices and their r_______________ to those of others, which may be different. One way to identify these beliefs and practices is through a self-assessment. This self-assessment is important. Personal beliefs and practices influence, and sometimes put some limitations on, the ability to care for those from other cultures. Understanding personal b___________ enables one to respond to those from different cultures with openness, understanding, and acceptance of cultural differences. The nurse needs to accept that it is not possible to act the same with all patients and still give effective, individualized, holistic care. Rather than ignore the differences, the nurse should include questions about cultural practices during the nursing process. This information is critical and is important in developing a plan of care to meet patient needs. Box 6.2 gives some guidelines for cultural information that can be gathered in the patient assessment.

ethnocentrism, awareness, relation, beliefs

Institutional Settings: Subacute Unit The subacute unit is a type of institutional setting that has become extremely popular since the late 1980s, when the advantage became clear of a less e_______________ alternative to a_________ care for patients with high-acuity medical and nursing intervention needs. The subacute unit is possible to view as a bridge between acute care and long-term care. Most subacute units are located ______ long-term care facilities, which provide skilled nursing care; others are former hospital units that have been reclassified to provide subacute care. Subacute units have a stronger r________________ focus and shorter length of stay than a long-term care facility. The level of care that subacute units provide is at nearly the same acuity as in the hospital. In fact, the typical older adult in a subacute unit today corresponds to some medical-surgical patients. Subacute care has become necessary because of our increased l_______________ as well as changes in hospital reimbursement. Modern medicine now saves lives that, before technological advances, were unable to be saved. This has led to a ripple effect. The intensive care unit (ICU) cares for patients whose condition is so critical that they formerly would not have survived. Patients whose condition is so serious that they formerly would have been cared for in the ICU are now on the medical-surgical unit. Patients who would have been on the medical-surgical units are now discharged out of the h___________l, but often their conditions are too complicated for home care, hence the evolution of the subacute unit.

expensive, acute, in, rehabilitative, lifespan, hospital

Judaism, Observant (Orthodox Judaism and Some Conservative Groups) Birth: For observant Jews, babies are named by the f___________. Male children are named 8 days after birth, when ritual c___________________ is done. A mohel performs the circumcision. Circumcision is often postponed if the infant is in poor health. Female babies usually are named during the reading of the holy T________. Nurses need to be sensitive to the wishes of the parents when caring for babies who have not yet been named. Birth control and abortion: Artificial methods of birth control are not e_______________. Vasectomy is not allowed. Abortion is permitted only to save the mother's life. Care of women: A woman is considered to be in a ritual state of impurity whenever b_________ is coming from her uterus, such as during menstrual periods and after the birth of a child. During this time, her husband does not have p_______________ contact with her. When this time is completed, she bathes herself in a pool called a mikvah. Nurses need to be aware of this practice and be sensitive to the husband and wife because the husband does not touch his wife. He cannot assist her in moving in the bed, so the nurse has to do this. An Orthodox Jewish man does not touch any woman other than his w______, daughters, and mother. Home health care workers need to be aware of these practices. Death: Judaism defines death as occurring when respiration and circulation are irreversibly s____________ and no movement is apparent. (1) Euthanasia is strictly forbidden by Orthodox Jews, who advocate the strict use of life-support measures. (2) Before death, Jewish faith indicates that visiting of the person by family and friends is a religious duty. The Torah and Psalms are often read, and prayers are recited. A witness must be present when a person prays for health so that if death occurs God protects the family and the spirit is committed to God. Extraneous talking and conversation about death are not encouraged unless initiated by the patient or visitors. In Judaism, the belief is that people should have someone with them when the soul leaves the body, so allow family and friends to stay with dying patients. After death, the body is not to be left alone until burial, usually within 24 hours. (3) When death occurs, the body is to remain untouched for 8 to 30 minutes. Medical personnel are not to touch or wash the body; only an Orthodox person or the Jewish Burial Society is permitted to care for the body. Handling of a corpse on the Sabbath is forbidden to Jewish persons. If need be, the nursing staff is permitted to provide routine care of the body while wearing gloves. Water receptacles in the room must be emptied, and the family often requests that mirrors be covered to symbolize that a death has occurred. (4) Orthodox Jews and some conservative Jews do not approve of autopsies. If an autopsy is necessary, all body parts are required to remain with the body. (5) For Orthodox Jews, the body is required to be buried within 24 hours. No flowers are permitted. A fetus is required to be buried. (6) A 7-day mourning period is required by the immediate family. They stay at home except for Sabbath worship. (7) Ensure that organs or other body parts such as amputated limbs are made available for burial for Orthodox Jews because they believe that all of the body must be returned to the earth. Dietary rules: (1) K___________ dietary laws include the following: no mixing of milk and meat at a meal; no consumption of food or any derivative thereof from animals not slaughtered in accordance with Jewish law; use of separate cooking utensils for meat and milk products; and if for medical reasons a patient requires milk and meat products for a meal, the dairy foods should be served first, followed later by the meat. (2) During Yom Kippur (Day of Atonement), a 24-hour fast is required, but exceptions are made for those who cannot fast because of medical reasons or age. (3) During Passover, no leavened products are eaten. (4) Observant Jewish patients often wish to say prayers over the bread and wine before meals. Time and a quiet environment should be provided for this. Head covering: Orthodox men wear s____________ at all times, and women cover their hair after marriage. Some Orthodox women wear wigs as a mark of piety. Conservative Jews cover their heads only during acts of worship and prayer. Organ transplants: Donor organ transplants generally are not p_______________ by Orthodox Jews but with rabbinical consent are sometimes allowed. Prayer: Praying directly to God, including a prayer of confession, is required for Orthodox Jews. Provide quiet time for prayer. Sabbath: Observed from sunset Friday until sunset Saturday. Orthodox law prohibits riding in a car, smoking, turning lights on and off, handling money, and using television and telephone. Nurses need to be aware of this when caring for observant Jews at home and in the hospital. Medical or surgical treatments should be postponed if possible. Shaving: The beard is regarded as a mark of piety among observant Jews. For very Orthodox Jews, shaving is never done with a razor, but with scissors or an electric razor, because no blade is to contact the skin.

father, circumcision, Torah, encouraged, blood, physical, wife, stopped, Kosher, skullcaps, permitted,

Culture Defined is a set of ___________ values, beliefs, customs, and practices that are shared by a group and are passed from one g________________ to another. Because of the influx of diverse cultures, the United States rapidly is becoming m_______________ and multilingual. Many i_________________ have come from areas of the world devastated by wars, natural disasters, famine, and poverty. They have had little preparation or time to learn English or American culture before arriving. Many of these immigrant populations have formed s__________________ in US society. Often separate subcultures exist w_________ a given group. A subculture shares many characteristics with the p______________ culture but has characteristic patterns of behavior and ideals that d_______________ it from the rest of a cultural group. Even among Americans who have lived here for several generations, these subcultures exist. For example, a person who grew up in the mountains of Appalachia has very different cultural practices than a person from New York City. Understanding of these variables and acceptance of each person as an individual are the first steps in giving holistic care to patients. Although cultures often differ considerably from one another, they share certain basic characteristics.

learned, generation, multicultural, immigrants, subcultures, within, primary, distinguish

Box 6.1 Common Characteristics of Cultures: identifies four common characteristics of all cultures • Culture is l____________, beginning at birth, through language and s________________. Behaviors, values, attitudes, and beliefs are learned within the cultural family system. • Culture tends to be d_____________ and ever changing. Language, traditions, and norms of customs may act as stabilizers for a culture. • Members of the same cultural group may share patterns that are present in every culture. These include communication, means of economic and physical survival, transportation systems, family systems, social customs and mores, and religious systems. (Morals are accepted traditional customs, moral attitudes, or manners of a particular social group.) • Culture is an adaptation to specific f___________ or conditions in a specific l____________, such as the availability of natural resources. When people are removed from that location, their customs continue even though they are no longer called for in the new setting.

learned, socialization, dynamic, factors, location

Institutional Settings: Subacute Unit cont2 In the acute care setting, strict rules about l________ of stay and limitations in cost r_____________________ limit the amount of time an adult can be hospitalized. The reimbursement rules for acute care are different from those that apply to subacute care provided in a skilled nursing facility setting. Therefore, cost s_____________ are an important reason for the growth of subacute care.

length, reimbursement, savings

Physical Therapy A qualified and licensed physical therapist is required to provide services. A physical therapy assistant under the supervision of the l_____________ therapist is permitted to deliver limited services. The goals of treatment have to be r______________ for Medicare reimbursement but in some cases are for maintenance or prevention for other payer sources. The therapist completes a detailed a______________ of the patient and then determines treatment, education, and assistive devices needed for rehabilitation. These are included as a part of the physician-approved plan of treatment. Treatments range from muscle strengthening to transcutaneous n________ stimulation and ultrasound treatments, which also may aid in pain management. Patients who have orthopedic conditions, such as repair of a fractured hip or a total hip or total k_______ replacement, frequently receive physical therapy services in the h________ care setting. Other common reasons for home health physical therapy include wound care, h________ failure complications, and diabetes medication teaching. The therapist actively teaches the patient and the family the rehabilitation plan to promote self-care and independence. Communication with the physician and the RN is mandatory and promotes continuity of care.

licensed, restorative, assessment, nerve, knee, home, heart

Hospice agencies provide services to patients and families as the end of l_____ approaches. These services are available to any age g_________, not just older adults. Medical c______________ is required for terminal care. Hospices care for terminally ill c__________ patients and a growing number of patients with other chronic, life-threatening illnesses, such as end-stage heart and lung disease, and amyotrophic lateral sclerosis (ALS) The philosophy of the overriding value of maintaining c_________ as death approaches is central to hospice care. P____________ care extends the principles of hospice care to a broader population that has the possibility to benefit from comfort care e__________ in an illness or disease p___________. This agency provides nursing interventions to meet basic needs, ADLs, pain and symptom management, and spiritual and psychosocial support for the patient, the family, and significant others. Care providers include CNAs, HHAs, LPN/LVNs, and RNs for case management. V______________ provide respite relief for caregivers and socialization and companionship for the patient. If the patient belongs to a religious community, parish nurses sometimes serve as an adjunct to hospice care to assist the patient and family with psychosocial concerns and bereavement issues. Hospice or terminal care is possible to provide in the h_________ setting; in an inpatient hospice unit located in an institutional setting, such as a long-term care facility; and in a stand-alone hospice facilities. Patients enter an inpatient hospice unit generally for one of the following reasons: pain or symptom management, respite for the family, or terminal care. If hospice care is given in the home setting, family members or loved ones are the primary caregivers with hospice staff making regular visits while available 24 hours a day

life, group, certifications, cancer, comfort, Palliative, earlier, process, Volunteers, home

Characteristics of Criminal Law • Conduct at issue is o____________ to society in general. • Conduct at issue is d_________________ to society as a whole. • The ______ involves public offenses (such as robbery, murder, assault). • The law's purpose is to p____________ for the crime and deter and prevent further crimes.

offensive, detrimental, law, punish

Although cardiovascular disorders are the most common diagnoses on admission, they are not necessarily the m_______ reasons why an older adult enters into long-term care. C____________ impairment, incontinence, inability to perform ADLs, and the state of being s_________ or widowed and unable to care for oneself are also important factors that determine placement into a long-term care facility. Patients with cognitive disorders, such as Alzheimer's disease, pose a challenge to manage at home or in other less restrictive care environments because of the patient's short-t______ memory loss, confusion, disorientation, restlessness, wandering, and hallucinations. A major s_________ event, such as forgetting to turn off the stove, is often the precipitating event in long-term care facility placement. As patients with Alzheimer's disease advance in age, their ability to participate in their ADLs d__________ and eventually they become totally dependent on others for care. In the final stages of the disorder, they often have impaired mobility.

main, Cognitive, single, term, safety, declines

Nursing liability falls into several areas: practice, m_______________, and communication. The legal test is the comparison with the h___________________ actions under similar circumstances of a reasonably prudent (careful, wise) nurse of similar education and experience. The standards of care follow those l________ of the individual state. In reality, application of the standards is not always easy. Nursing s_______________ in some states have led to a need for individual nurses to take on increased responsibilities and work more hours. Personnel c____________ often leave units short staffed, and nurses feel pressure to take on expanded duties; this increases their risk for liability considerably. In addition, special challenges face entry-level licensed nurses when they enter the workforce. O________________ programs often fail to adequately cover all the skills needed to be a competent practitioner. It is the nurse's responsibility to seek additional i______________ and supervision when faced with an unfamiliar practice or procedure. Remember that it is not possible for the nurse to meet every patient's needs. The laws that formally define and limit the scope of nursing practice are called nurse p_____________ acts. All state, provincial, and territorial legislatures in the United States and Canada have adopted nurse practice acts, although the specifics they contain often vary. It is the nurse's responsibility to know the nurse practice act that is in effect for the g_______________ region. A free copy of the state's nurse practice act can be obtained by writing to the board of nursing in a given state or accessing its website. In addition to the boundaries made by the state's nurse practice act, the employing i_____________ often places limitations on practice. The institution has the right to establish policies and procedures for nursing activities within the confines of the state's nurse practice act. When a question comes before the court regarding whether the standard of care was met in a particular situation, the court uses a variety of resources to answer the question

monitoring, hypothetical, laws, shortages, cutbacks, Orientation, instruction, practice, geographic, institution

Institutional Settings: Subacute Unit cont.3 Patients with n______________ disorders make up much of the population in a s______________ facility. Patients are able to receive numerous therapies, including intravenous medication administration via peripheral or central venous catheters, complex dressing changes, peritoneal dialysis, and even mechanical ventilation. Some of the most common patient care needs in subacute care are physical r__________________, stroke rehabilitation, wound care, and recovery from hip fracture. The nurse employed in a subacute unit needs to have a variety of assessment, rehabilitative, medical-surgical, and leadership skills. The assessment and technical skills of a m___________-surgical nurse are required, along with the knowledge about reimbursement and interdisciplinary team skills of a long-term care nurse.

numerous, subacute, rehabilitation, medical

Long-Term Care Facility Commonly known as a n____________ home or e______________-care facility, this institutional setting mostly provides services to adults, primarily o_________ adults (older than age 65), although a person of any age can be cared for in a long-term care setting. Long-term care facilities provide _____-hour care to individuals who do not need expensive inpatient hospital services but who do not have options for care at home or by other community agencies or services. Because the long-term care facility becomes a h______ for the adult, on either a long-term or a short-term basis, the adult is referred to as a r___________ rather than a patient. As of 2015 approximately 43 million people age 65 and older live in the United States (Statista, 2018). In 2014 the number of residents of the age of 65 and older in long-term care was 1.4 million (CDC, 2017). With the projected increase in the elderly population, these numbers are expected to grow.

nursing, extended, older, 24, home, resident

Occupational Therapy Occupational therapy services deal with life's p_____________ tasks. T_________________ have the opportunity to earn the occupational therapist, registered (OTR) designation if they meet the registration requirements of the National Occupational Therapy Association. The certified occupational therapy assistant is permitted to provide some services under the supervision of the OTR. On the basis of a complete evaluation of functional level, the therapist chooses and teaches therapeutic activities designed to restore functional levels. Services include the following: 1. Techniques to increase i________________________ 2. Analysis of a_____________ as they relate to patients' skin, their environment, their families, and their routines 3. Expanding the d___________ management approach into a lifestyle management approach 4. Design, fabrication, and fitting of orthotic or self-help devices 5. Assessment for vocational training Occupational therapists assist patients to improve in their performance of ADLs, and their sensory-motor, cognitive, and neuromuscular functioning. Patient-centered education is an integral part of attaining independence in self-care

practical, Therapists, Association, independence, activities, disease

Health care institutions are obligated to uphold the patient's rights to (1) access to health care without any p_______________ (2) treatment with respect and d____________ at all times, (3) privacy and c______________ (4) personal safety, and (5) complete i________________ about one's own condition and treatment Patients' responsibilities to the health care institution include (1) providing a____________ information about themselves, (2) giving information regarding their known c________________ (3) participating in decision making regarding treatment and care

prejudice, dignity, confidentiality, information, accurate, conditions

Long-Term Care Variations for Safety Reminder Devices Legislation has affected greatly the use of safety r____________ devices (SRDs) in the long-term care facility. Under the Omnibus Budget Reconciliation Act (OBRA) of 1987, residents' rights are addressed specifically in terms of SRDs. This act, effective October 1, 1990, mandates specific guidelines and prohibits routine use of SRDs in long-term care facilities. The act regulates the use of extremity SRDs, hand mitts, safety v________, and wheelchair safety bars. SRDs may be used only to ensure the physical safety of the resident or other residents. A written order by the physician must detail the d____________ and circumstances under which the SRDs are to be used. OBRA states the following as acceptable reasons for the use of physical restraints: • All other i___________________ have been attempted before the use of restraints. • Other disciplines have been c_____________ for their assistance. • Supporting d__________________ has been completed. Essentials of SRD Documentation • Reason for the physical restraint • Explanation given to p____________ and family • Date and time of the patient's response to treatment • Duration • Frequency of o______________ and patient's response • Safety • Release the physical restraint at least every 2 hours • Routine exercise of extremities, including range-of-motion exercises • Assessment for c________________ and skin integrity • Assessment for continued need for the physical restraint • Patient o______________

reminder, vests, duration, interventions, consulted, documentation, patient, observation, circulation, outcome

Fire Prevention Guidelines for Nurses • Keep the phone number for reporting fires v__________ on the telephone at all times. • Know the agency's fire drill and evacuation plan. • Know the location of all fire alarms, exits, and fire extinguishers. • Use the mnemonic RACE to set priorities in case of fire: R R____________ and remove all patients in immediate danger. A A____________ the alarm. Always do this before attempting to extinguish even a minor fire. C C_______________ the fire by closing doors and windows and turning off all oxygen and electrical equipment. E E______________ the fire using an extinguisher. • Memorize the mnemonic PASS to operate the fire extinguisher: P P______ the pin to unlock the handle. A A_____ low at the base of the fire. S S____________ the handle. S S__________ the unit from side to side.

visible, Rescue, Activate, Confine, Extinguish, Pull, Aim, Squeeze, Sweep

Ethical Principles in Nursing Practice Several common ethical principles are important for consideration when health care professionals are confronted with an ethical question. The first, most fundamental principle is r____________ for people. This principle leads us to view all human life as sacred, with each individual having inherent worth as a person. To the nurse, this principle means that no one person is more important than another; each patient has the same worth and always is entitled to respect. Autonomy is another ethical principle; it refers to freedom of personal choice, a right to be independent and make decisions freely. Frequently the patient may ask the nurse for opinions or assistance in making decisions. The nurse does not have the authority to make decisions for the patient. B__________________ means doing good or acting for someone's good; this principle is one of primary importance to nurses. The nurse has an ethical duty to protect life and promote the well-being of all patients. Another ethical principle is n__________________, which means to do no harm. It is paramount to nursing practice to act in the patient's best interest and an ethical and legal duty to do nothing that has a harmful effect on the patient. Finally, there is the principle of j____________, or the concept of what is fair. In the context of nursing, justice means that all patients have the same right to nursing interventions. It is a great challenge to the nurse to balance these ethical principles when they seem in conflict. Rarely are options clear or black and white. Decisions often come down to choosing what seems more right and less wrong, more good and less bad.

respect, Beneficence, nonmaleficence, justice

Characteristics of Civil Law • Conduct at issue v_____________ a person's rights. • Conduct at issue is detrimental to that i_________________ • The law involves an offense that is against an individual. • The law's purpose is to make the a________________ person whole again, to restore the person to where he or she was.

violates, individual, aggrieved