Module 1: Introduction to Med-Surg Nursing

CNL

-a certified nurse generalist with a master's degree in nursing -help patients navigate the complex health care system

what is the most accurate determinant of a patient's pain?

-the patient's report of the pain

analgesics: non-opioid

1. Acetaminophen: tylenol *can be given by multiple routes of administration, including oral, rectal, and IV *Oral acetaminophen has a long history of safety in recommended doses in all age groups. *one of the safest, best tolerated, and most cost effective of the analgesic agents *hepatotoxicity (liver damage) as a result of overdose *should be avoided when consuming alcohol because the combination can result in serious liver damage *should also be avoided when warfarin is prescribed because it can inhibit metabolism of warfarin resulting in toxicity with bleeding risk 2. NSAIDS: ibuprofen, naproxen, celecoxib *adverse effects: ~gastric toxicity and ulceration being the most common ~GI adverse effects are also related to the dose and duration of NSAID therapy; the higher the NSAID dose and the longer the duration of NSAID use, the higher the risk of GI toxicity *risk factors: ~advanced age (older than 60 years), presence of prior ulcer disease, and cardiovascular (CV) disease and other comorbidities *these are both analgesic agents used for a wide variety of painful conditions* *can be mixed with other medicine*

Peripheral Mechanisms: Allodynia & Hyperalgesia

1. Allodynia, or pain from a normally non-noxious stimulus (touch), is one such type of abnormal sensation and a common feature of neuropathic pain *In patients with allodynia, the mere weight of clothing or bedsheets on the skin can be excruciatingly painful 2. Hyperalgesia is an increased response of pain sensation from a stimulus which at a usual pain threshold produces a less intense pain response

A nurse is reviewing the medical record of a client to determine his eligibility for home care services. Which of the following would alert the nurse to a potential problem in this area? a. Client requires sterile dressing changes to an abdominal wound. b. Client attends social groups at a senior center three times a week. c. teaching about insulin administration d. Discharge after open heart surgery

Client attends social groups at a senior center three times a week (b) -Attending social activities at a senior center three times a week suggests that the client may not be homebound.

Which of the following would be least helpful in ensuring the safety of a home care nurse? a. Making visits in the late evening hours b. Being familiar with exits from the home c. carry a charged cell phone d. park near the client's home

Making visits in the late evening hours (a) -To ensure safety, the home care nurse should schedule visits only during the daylight hours.

what is the main reason people seek health care?

PAIN

A group of nursing students are preparing for a class presentation that describes community-based nursing. Which of the following would they most likely include? a. Practice on all the three levels of preventive care b. Caring for the needs of individual clients as the primary focus c. Delivery of nursing care with direct on-site supervision d. Care delivered by nurses functioning in limited roles

Practice on all the three levels of preventive care (a) -Community-based care involves nurses providing care at all three levels of prevention, that is, primary, secondary, and tertiary levels. There is a focus on community needs as well as on the needs of individual clients. Nurses often deliver care without direct on-site supervision or support of other health care personnel. Community health nurses assume many different roles such as epidemiologist, case manage, service coordinator, direct care provider, and educator.

true or false: High waist circumferences put patients at risk for diabetes, dyslipidemia, hypertension, heart attack, and stroke

TRUE -men: greater than 40 inches -women: greater than 35 inches

true or false: The frequency of pain reassessment depends on the stability of the patient and the timing of the peak effect of the medication administered.

TRUE At a minimum, pain should be reassessed with each new report of pain, and before, and after the administration of analgesic agents. General rules include, if the medication is parenteral administration reassess between 15 and 30 minutes, if oral administration reassess between 1 and 2 hours

The Trajectory Model: the comeback phase

The comeback phase is the period in the trajectory marked by recovery after an acute period.

The Trajectory Model: the downward phase

The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

The Trajectory Model: the pre-trajectory phase

The pre-trajectory phase is characterized by genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition.

The Trajectory Model: the trajectory phase

The trajectory onset phase is characterized by the appearance or onset of noticeable symptoms associated with a chronic disorder and includes a period of diagnostic workup and announcement of diagnosis. It may be accompanied by uncertainty as the patient awaits a diagnosis and begins to discover and cope with the implications of the diagnosis.

A patient who is at risk for developing a chronic condition because of genetic factors is said to be in which phase of the Trajectory Model? a. Pretrajectory b. Trajectory c. Unstable d. Acute

a. Pretrajectory

The nursing student is working with three other students on a transcultural nursing project. They have been tasked with naming examples of groupings that can be used to identify subcultures. Which of the following would be included in their list? Select all that apply. a. Religion b. Occupation c. Sexual orientation d. Educational level

a. Religion b. Occupation c. Sexual Orientation

presbyopia

begins in the fifth decade of life and requires the person to wear reading glasses to magnify objects

how do NSAIDS decrease pain?

by inhibiting cyclooxygenase (enzyme involved in production of prostaglandin)

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: a. "Start rubbing her shoulders and her back." b. "Play quiet music that your grandmother may like." c. "You need to remain calm during the outbursts." d. "What precipitates the outbursts?"

d. "What precipitates the outbursts?" A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.

A male client recovering from a stroke is receiving anticoagulant therapy. Which item will the nurse instruct the client to use for self-care? a. loofah sponge b. electric razor c. long handle shoe horn d. hard-bristled toothbrush

electric razor (b) -will decrease the risk of causing bleeding while shaving

The Katz Index of Independence in Activities of Daily Living (Katz Index)

is used to assess six areas of ADLs (i.e., bathing, dressing, toileting, transferring, continence, feeding) and rate them as done independently or done with assistance

what is impairment?

loss or abnormality of psychological, physiological, or anatomical structure or function at the organ level

acquired disability

may occur as a result of an acute and sudden injury (e.g., traumatic brain injury [TBI]; spinal cord injury; and traumatic amputation due to traffic crashes, falls, burns, or acts of violence such as intimate partner violence and war and military conflicts), acute nontraumatic disorders (e.g., stroke, myocardial infarction), or progression of a chronic disorder (e.g., arthritis, multiple sclerosis, Parkinson's disease, chronic obstructive pulmonary disease, heart disease, blindness due to diabetic retinopathy)

Peripheral Mechanisms: maladaptive neuroplasticity

nerve endings in the periphery can become damaged, leading to abnormal reorganization in the nervous system

BMI of 30 or more

obese

BMI between 25-29.9

overweight

what is disability?

restriction or lack of ability to perform an activity in a normal manner

what do opioid analgesics act on?

they act on the CNS to inhibit activity of ascending nociceptive pathways

What do local anesthetics block?

they block nerve conduction when applied to nerve fibers

A student nurse asks the nursing instructor, "What will my role as a nurse encompass after I graduate?" What is the best response by the nursing instructor? a. "You will take care of clients who are ill in a hospital or long-term care facility." b. "You will care for individuals and families and play a role in health education, illness prevention, and promotion." c. "You will care for a variety of clients of all ages when they are ill." d. "It will all depend on where you want to work when you graduate. Nurses do different things in healthcare."

"You will care for individuals and families and play a role in health education, illness prevention, and promotion." (b) -Nursing is concerned with caring for individuals, families, or groups. Nurses not only care for clients when they are ill but also play a significant role in health education, illness prevention, and promotion. Nurses attend to client needs related to hygiene; activity; diet; the environment; medical treatment; and physical, emotional, and spiritual comfort. Therefore, nurses care for clients in a variety of nursing settings, not just hospitals or long-term care facilities. Though nurses may choose to specialize in a certain area of healthcare, all these areas involve health education and promotion and illness prevention.

Peripheral Mechanisms: peripheral sensitization

-Changes in ion channels can occur, such as increased sodium channel activity in sensory nerves resulting in heightened excitability, increased transduction, and release of neurotransmitters -which is thought to contribute to the maintenance of neuropathic pain and is thought to be reflected in allodynia and hyperalgesia

The Trajectory Model: the stable phase

-In the stable phase of the Trajectory Model of Chronic Illness, the nurse reinforces positive behaviors -indicates that the symptoms and disability are under control or managed

Functional Independence Measure (FIM)

-One of the most frequently used tools to assess the patient's level of independence -a minimum data set, measuring 18 self-care items including eating, bathing, grooming, dressing upper body, dressing lower body, toileting, bladder management, and bowel management -addresses transfers and the ability to ambulate and climb stairs and also includes communication and social cognition items

Models of Disability

-Several models of disability have been used to address or explain the issues encountered by people with disabilities -The Interface Model (Goodall, 1995), developed by a nurse, promotes care designed to be empowering rather than care that promotes dependency *It takes into account the disabling condition and its disabling effects *it promotes the view that people with disabilities are capable, responsible people who are able to function effectively despite having a disability *refer to chart 7-2*

multimodal analgesia

-The recommended approach for the treatment of all types of pain in all age groups -intentionally and simultaneously combines medications with different underlying mechanisms, along with nonpharmacologic interventions, which allows for lower doses of each of the medications in the treatment plan, reducing the potential for adverse effects -result in comparable or greater pain relief with fewer adverse effects than can be achieved with any single analgesic agent

ketamine

-a dissociative anesthetic with dose-dependent analgesic, sedative, and amnestic properties -At high doses, this medication can produce psychomimetic effects (hallucinations, dreamlike feelings); however, these are minimized when low doses are given -A benefit of the medication is that it does not produce respiratory depression -given most often by the IV route but can also be given by the oral, rectal, intranasal, and subcutaneous routes -has been used for the treatment of persistent neuropathic pain, but its adverse effect profile makes it less favorable than other analgesic agents for long-term therapy -used as a third-line analgesic agent for refractory acute pain among patients who are very opioid-tolerant or for patients who are not able to be treated with opioids

pseudoaddiction

-a mistaken diagnosis of substance use disorder that occurs when a patient's pain is not well controlled; the patient may begin to manifest symptoms suggestive of SUD -In an effort to obtain adequate pain relief, the patient may respond with demanding behavior, escalating demands for more or different medications, and repeated requests for opioids on time or before the prescribed interval between doses has elapsed

what can you do for a patient that is taking morphine but ends up with respiratory depression?

-administer naloxone (narcan) -this is a narcotic antagonist that will reverse the effects of the morphine & relieve the respiratory depression

developmental disabilities

-are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care -Examples of developmental disabilities include spina bifida, cerebral palsy, Down syndrome, muscular dystrophy, dwarfism, and osteogenesis imperfecta -Some developmental disabilities occur as a result of birth trauma or severe illness or injury at a very young age, whereas many developmental disabilities are genetic in origin -Some developmental disabilities overlap with cognitive and/or intellectual disabilities that affect intellectual functioning and adaptive behavior.

sensory disability

-characterized by impairment of the sense of sight, hearing, smell, touch, and/or taste -Sensory disabilities most commonly affect hearing or vision; however, they also include learning disabilities that affect the ability to learn, remember, or concentrate; disabilities that affect the ability to speak or communicate; and disabilities that affect the ability to work, shop, and care for oneself, or access health care -Risks associated with sensory disabilities include isolation, reduced cognitive function, poor physical and psychological health, and increased risk of falls and hospitalization

what are the two opioids to avoid?

-codeine: *inactive when given (pro-drug) *must be metabolized to morphine for the patient to experience pain relief -meperidine: *been removed to improve patient safety *causes neurotoxicity

what are the adverse effects of opioids?

-constipation -nausea/vomiting -pruritis (itching) -respiratory depression*** ~the most serious~ -sedation** -hypotension

psychiatric disabilities

-defined as a mental illness or impairment that substantially limits one's ability to complete major life activities, such as learning, working, and communicating

anticonvulsants: gabapentin & pregabalin

-first-line analgesic agents for neuropathic pain -Initial doses of gabapentin may not provide analgesia; titration to effective dosing may take up to 2 months -Pregabalin has a more rapid onset of action with expected maximum effect typically reached in 2 weeks -Primary adverse effects of anticonvulsants are sedation and dizziness, which are usually transient and most notable during the titration phase of treatment

antidepressants: TCAs (tricyclic antidepressants) = desipramine, nortriptyline & SNRIs (serotonin and norepinephrine reuptake inhibitors) = duloxetine, venlafaxine

-first-line options for neuropathic pain treatment -initiated with low doses and titrated according to patient response -Primary adverse effects of TCAs are dry mouth, sedation, dizziness, mental clouding, weight gain, and constipation ~Orthostatic hypotension is a potentially serious TCA adverse effect ~The most serious adverse effect is cardiotoxicity & patients with significant heart disease are at high risk -SNRIs are thought to have a more favorable adverse effect profile & to be better tolerated than the TCAs ~Due to the side effects, including delirium and confusion, amitriptyline is not indicated for use in older adults ~adverse effects are nausea, headache, sedation, insomnia, weight gain, impaired memory, sweating, and tremors

substance use disorder (SUD)

-historically known as addiction or addictive disease, and defined as a chronic, relapsing, treatable neurologic disease -use of the opioid is for nontherapeutic reasons and is thus independent of pain relief

barthel index

-is used to measure the patient's level of independence in ADLs, continence, toileting, transfers, and ambulation (or wheelchair mobility) -this scale does not address communicative or cognitive abilities

case managers

-may be nurses or may have backgrounds in other health care professions such as social work -they coordinate the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies

physical dependence

-normal response that occurs with repeated administration of the opioid, with intensity and duration dependent upon the half-life of the medication and how long it has been used -It is manifested by the occurrence of withdrawal symptoms when the opioid is suddenly stopped or rapidly reduced, or an antagonist such as naloxone is given

intellectual disabilities

-occurs before 18 years of age and is characterized by significant limitations in both intellectual functioning as well as in adaptive behavior, including many everyday social and practical skills.

withdrawal

-occurs when a medication or substance to which the body has become dependent is abruptly reduced or discontinued -exhibited by a cascade of unpleasant symptoms including anxiety, nausea, vomiting, rhinitis, sneezing, chills, hot flashes, abdominal cramping, tremors, diaphoresis, hyperreflexia, diarrhea, piloerection, and/or insomnia

local anesthetics: lidocaine patch 5%

-placed directly over or adjacent to the painful area for absorption into the tissues directly below -This medication produces minimal systemic absorption and adverse effects -The patch is left in place for 12 hours and then removed for as long as 12 hours (12 hours on, 12 hours off regimen)

nurse navigators

-registered nurses employed by hospitals & health networks who work with a given population of patients with a common diagnosis or disease -they help patients & the patients family transition through different levels of care (from hospital to a skilled nursing facility

neuropathic (pathophysiologic) pain

-results from abnormal processing of sensory input by the nervous system as a result of damage to the peripheral or central nervous system (CNS) or both -caused by either a lesion or a disease involving the somatosensory nervous system 1. Centrally Generated Pain a) Deafferentation pain: Injury to either the peripheral or central nervous system; burning pain below the level of a spinal cord lesion reflects injury to the central nervous system *Example: Phantom pain as a result of peripheral nerve damage; poststroke pain; pain following spinal cord injury b) Sympathetically maintained pain: Associated with dysregulation of the autonomic nervous system *Example: Complex regional pain syndrome 2. Peripherally Generated Pain a) Painful polyneuropathies: Pain is felt along the distribution of many peripheral nerves. *maladaptive neuroplasticity: nerve endings in the periphery can become damaged, leading to abnormal reorganization in the nervous system *Examples: Diabetic neuropathy; postherpetic neuralgia; alcohol-nutritional neuropathy; some types of neck, shoulder, and back pain; pain of Guillain-Barré syndrome b) Painful mononeuropathies: Usually associated with a known peripheral nerve injury; pain is felt at least partly along the distribution of the damaged nerve *Examples: Nerve root compression, nerve entrapment; trigeminal neuralgia; some types of neck, shoulder, and back pain Pharmacologic Treatment: -Co-analgesic agents, such as antidepressants, anticonvulsants, and local anesthetics, but there is wide variability in terms of efficacy and adverse-effect profiles -ex: table (9-2 & 9-3) & a youtube video if you need extra teaching

Nociceptive (physiologic) pain

-the normal functioning of physiologic systems that leads to the perception of noxious stimuli (tissue injury) as being painful -This is the reason why nociception is described as "normal" pain transmission -Somatic pain: Arises from bone joint, muscle, skin, or connective tissue. It is usually described as aching or throbbing in quality and is well localized *Examples: Surgical, trauma; wound and burn pain; cancer pain (tumor growth) and pain associated with bony metastases; labor pain (cervical changes and uterine contractions); osteoarthritis and rheumatoid arthritis pain; osteoporosis pain; pain of Ehlers-Danlos syndrome; ankylosing spondylitis -Visceral Pain: Arises from visceral organs, such as the GI tract and pancreas. This may be subdivided: •Tumor involvement of the organ capsule that causes aching and fairly well-localized pain •Obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain *Examples: Organ-involved cancer pain; ulcerative colitis; irritable bowel syndrome; Crohn's disease; pancreatitis Pharmacologic Treatment: -Most responsive to nonopioids, opioids, and local anesthetics *table 9-2)*

biochemical assessment

-they can test the level of a given nutrient and reflect abnormalities of metabolism in relation to the utilization of nutrients. -tests of serum and urine are done to determine whether the values are within an acceptable range. Some of these tests, while reflecting recent intake of the elements detected, can also identify a long-term deficiency (below-normal levels) even when there are no clinical symptoms of deficiency.

opioid-induced hyperalgesia (OIH)

-when increasing doses of an opioid result in increasing sensitivity to pain

analgesics: opioid

1. Mu Agonist (morphine-like): Morphine, hydromorphone, fentanyl, oxycodone -designated as first line (morphine, hydromorphone, fentanyl, and oxycodone) because they bind primarily to the mu-type opioid receptors 2. Agonist-Antagonist: buprenorphine, nalbuphine, butorphanol -designated as "mixed" because they bind to more than one opioid receptor site. They bind as agonists, producing analgesia, at the kappa opioid receptor sites, and as weak antagonists at the mu opioid receptor sites. 3. Antagonists: naloxone, naltrexone, naloxego -are medications that also bind to opioid receptors but produce no analgesia -if an antagonist is present, it competes with opioid molecules for binding sites on the opioid receptors and has the potential to block analgesia and other effects -antagonists are used most often to reverse adverse effects, such as respiratory depression *look at chart 9-5

what are the different types of pain?

1. acute pain: result of tissue damage, surgery, trauma, burns *pain that happens right away & short duration 2. chronic/persistent pain: can be time limited or last a lifetime *cancer *non-cancer: peripheral neuropathy from diabetes, back or neck pain after injury, and osteoarthritis pain from joint degeneration. *chronic pain may be intermittent, occurring with flares, or it may be continuous 3. breakthrough pain: can produce both acute and chronic pain *EX: some patients with cancer have continuous chronic pain and also experience more intense acute exacerbations of pain periodically

what are some common opioid analgesic agents?

1. morphine: *the standard opioid *produces analgesia for up to 48 hours following epidural administration *a hydrophilic medication (readily absorbed in aqueous solution), which accounts for its slow onset and long duration of action when compared with other opioid analgesic agents *the first medication to be given intraspinally and remains a first-line choice for long-term intraspinal analgesia. 2. fentanyl: *lipophilic (readily absorbed in fatty tissues) opioid and has a fast onset and short duration of action *most commonly used IV opioid when rapid analgesia is desired, such as for the treatment of severe, escalating acute pain & for procedural pain when a short duration of action is desirable *good choice for patients with end-organ failure because it has no clinically relevant metabolites *often preferred in patients who are hemodynamically unstable, such as the critically ill *ideal for medication delivery by transdermal patch for long-term opioid administration = When the first patch is applied, 12 to 18 hours are required for clinically significant analgesia to be obtained ~when the patch is removed, the serum levels of fentanyl remain for a minimum of 16 hours, so it is important to not administer additional long-acting opioids during that time ~heat (e.g., heating pads, hot water blankets, hot tubs, fever) may increase the rate of absorption leading to serious adverse events ~the patch is changed every 48 to 72 hours depending on patient response. 3. hydromorphone: *less hydrophilic than morphine but less lipophilic than fentanyl, which contributes to an onset and duration of action that is intermediate between morphine and fentanyl *used as an alternative to morphine 4. oxycodone: *oral only *treats all type of pain *can help with cancer & non cancer pain *when combined with acetaminophen the dose is limited by the acetaminophen dose to avoid exceeding the max. dose 5. oxymorphone: *short acting and immediate release *it MUST be taken on an empty stomach (1 hour before or 2 hours after a meal) *no ingestion of alcohol; food & alcohol can increase the serum concentration up to 300% 6.hydrocodone: *commercially available with non-opioids *commonly prescribed 7. methadone: *synthetic opioid *usually given orally *great treatment for substance abuse *look at table 9-3, 9-4*

what are the different measures you can use for assessing pain for specific population?

1. the hierarchy of pain measures: nonverbal patient 2. FLACC: young children 3. PAINAD: patients with advanced dementia 4. CPOT: patients in critical care units

what is the nociception (feeling pain) process?

1. transduction: refers to the processes by which noxious stimuli, such as a surgical incision or burn, activate primary afferent neurons called nociceptors, located throughout the body in the skin, subcutaneous tissue, and visceral (organ), and somatic (musculoskeletal) structures *prostaglandins: are lipid compounds that initiate inflammatory responses that increase tissue swelling and pain at the site of injury 2. transmission: -Effective transduction generates an action potential that is transmitted along the lightly myelinated rapid conducting A-delta fibers and the unmyelinated slower impulse conducting C fibers -The endings of A-delta fibers detect thermal and mechanical injury, allow relatively quick localization of pain, and are responsible for a rapid reflex withdrawal from the painful stimulus 3. perception: -the result of the neural activity associated with transmission of noxious stimuli -it requires activation of higher brain structures for the occurrence of awareness, emotions, and impulses associated with pain 4. modulation: -Modulation of the information generated in response to noxious stimuli occurs at every level from the periphery to the cortex and involves many different neurochemicals -EX: serotonin and norepinephrine are inhibitory neurotransmitters that are released in the spinal cord and the brain stem by the descending (efferent) fibers of the modulatory system *figure 9-1 & look at video on slide if you need extra teaching*

what is the difference between ADL's and IADL's?

ADL's: (Activities of Daily Living) self-care activities that the patient must accomplish each day to meet personal needs (personal hygiene, bath, dressing, grooming) IADL's: (instrumental activities of daily living) complex skills needed for independent living (meal preparation, grocery shopping, household, finances)

The Trajectory Model: the acute phase

The acute phase is characterized by severe and unrelieved symptoms or the development of illness complications necessitating hospitalization, bed rest, or interruption of the person's usual activities to bring the illness course under control -characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management

The Trajectory Model: the unstable phase

The unstable phase is characterized by an exacerbation of illness symptoms, development of complications, or reactivation of an illness in remission. It is a period of inability to keep symptoms under control or reactivation of illness in which the person has difficulty in carrying out everyday life activities. It may require more diagnostic testing and trial of new treatment regimens or adjustment of the current regimen, with care usually taking place at home.

Presbycusis

a gradual sensorineural loss that progresses from the loss of the ability to hear high-frequency tones to a generalized loss of hearing

tolerance

a normal physiologic response that can occur with regular administration of an opioid and consists of a decrease in one or more effects of the opioid (decreased analgesia, sedation, or respiratory depression) -It may be treated with increases in dose to attain the previous effect

critical care nursing

a specialty area of practice that provides nursing services to critically ill patients across the lifespan, traditionally delivered in acute care settings (ICU)

Medical-Surgical Nursing

a specialty area of practice that provides nursing services to patients from adolescence through the end of life in a variety of inpatient & outpatient clinical settings

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? a. Administering the analgesics on a regular basis b. Administering the analgesics intravenously c. Administering the analgesics on an as-needed per client request d. Administering analgesics with increased dosage

a. Administering the analgesics on a regular basis Routine scheduling of the administration of analgesics, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.

In which situation is the nurse providing appropriate discharge planning? a. Assessing the client's support system at home during the admission assessment b. Contacting the client's insurance company 24 hours before discharge to review the client's medical coverage c. Providing take-home medication education to the client before discharge d. Contacting a home care agency by the third hospital day

a. Assessing the client's support system at home during the admission assessment To prepare for early discharge and the possible need for follow-up in the home, discharge planning begins with the patient's admission. Discharge planning requires identification of patient needs and anticipatory guidance. Discharge planning requires the nurse to provide medication education; however, medication teaching begins when the medication is added to the treatment regimen. Discharge planning may require involvement of personnel and agencies in the planning process and is not relegated to a specific day of hospital stay.

The nurse case manager is planning care for a 5-year-old client recently diagnosed with asthma. The client's mother informs the nurse that her child had shown similar symptoms in the past and was diagnosed with asthma at age 2 years. The nurse noted the client's symptoms and medical history. What information is appropriate for the case manager to share with the client's mother related to community resources and referrals? Select all that apply. a. Community support groups for parents of children with asthma b. Asthma camp enrollment age requirements c. The Web address to the Allergy & Asthma Network Mothers of Asthmatics d. A list of pharmaceutical company assistance programs that may help pay for EpiPens e. A Web link to a popular free encyclopedia page related to asthma f. Phone numbers for other parents of asthmatic children

a. Community support groups for parents of children with asthma b. Asthma camp enrollment age requirements c. The Web address to the Allergy & Asthma Network Mothers of Asthmatics d. A list of pharmaceutical company assistance programs that may help pay for EpiPens

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause? a. Early detection and treatment of diseases b. An increased mortality rate from infectious diseases c. Shorter lifespans d. Lowered stress and increased physical activity lifestyles

a. Early detection and treatment of diseases Improved screening and diagnostic procedures enable early detection and treatment of diseases, resulting in improved outcomes of management of cancer and other disorders.

A novice nurse is learning the difference between community-based nursing and community-oriented nursing. Which scenario does the nurse recognize as a role of the community-oriented nurse? a. Nurse working a booth at a health fair performing blood pressure and glucose screenings b. Occupational health nurse immobilizing a fractured extremity of an injured employee c. Pediatric nurse teaching a group of parents on the treatments for cystic fibrosis d. Nurse working at a wound care clinic performing irrigation of a chronic wound

a. Nurse working a booth at a health fair performing blood pressure and glucose screenings

A client with paraplegia for the past 12 years is hospitalized with pneumonia. It would be best for the nurse to a. Place the client's wheelchair next to the bed for independent transfer. b. Move the wheelchair to a corner of the room to keep out of the way. c. Raise the bed slightly to ease the client's transferring to the wheelchair. d. Obtain the assistance of the nursing aide to lift the client to the wheelchair.

a. Place the client's wheelchair next to the bed for independent transfer. Clients with paraplegia may be able to independently transfer to a wheelchair. The nurse promotes activities that will encourage client independence, such as placing the wheelchair next to the bed.

A community nurse is working to decrease the incidence of cardiac disease in Nicaragua. The nurse should plan educational health promotion activities around which element? a. Smoking cessation b. Vaccinations c. Birth control d. Breastfeeding

a. Smoking cessation Chronic conditions are increasing rapidly in low-income countries because of the adoption of unhealthy lifestyles. Modifiable health behaviors responsible for the high incidence of chronic disease such as cardiac disease include lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. By focusing on smoking cessation programs, the nurse is appropriately addressing a modifiable risk factor of a chronic condition.

A client reports abdominal pain as "8" on a pain intensity scale of 0-10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses a. That the client's past experiences with pain may influence her perception of current pain b. That based on her past experiences the client's perception of pain should be less c. That the client has become dependent on drugs from her previous experience of burns d. That the client is experiencing pain relating to the burn injuries from several years ago

a. That the client's past experiences with pain may influence her perception of current pain Clients who have had previous experiences with pain are usually more frightened about subsequent painful events, as in the client who experienced partial-thickness burns to more than 60% of her body. The clients in these situations are less able to tolerate pain. Insufficient data in the stem support that the client is dependent on drugs or that this current pain is related to the client's previous burn injuries.

The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction? a. The survival of people with severe trauma, chronic disorders, and early-onset disabilities b. The decrease in risk factors for early-onset disabilities that are genetic in cause c. The ability to cure chronic disorders that are acquired d. The decrease in the number of people with early-onset disabilities

a. The survival of people with severe trauma, chronic disorders, and early-onset disabilities

Central Mechanisms: Central sensitization

abnormal hyperexcitability of central neurons in the spinal cord, which results from complex changes induced by incoming afferent barrages of nociceptors, which also can result in allodynia and hyperalgesia

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin and exenatide and reports adhering to a diet. The glycohemoglobin is 5.9%. According to the stable phase of the Trajectory Model of Chronic Illness, how should the nurse respond? a. Responds, "There are some adjustments to your medications that need to be made" b. Acknowledges that the client is performing satisfactorily c. States, "The glycohemoglobin is too high" d. Advises the client that changes must be made to the diet

b. Acknowledges that the client is performing satisfactorily

The client, newly admitted to the hospital, is unsure of home medications and is wearing a transdermal fentanyl patch. What is most important for the nurse to do first? a. Remove the old patch b. Check the dose c. Teach about adverse reactions d. Ask about constipation

b. Check the dose The dosage of any medication should be checked for correctness. This is basic medication administration to prevent error.

A client is hospitalized with a traumatic brain injury following an automobile accident. The client has difficulty processing information and needs information to be repeated. A consulting physician enters the room. The nurse a. Leaves the room b. Turns off the television c. Removes unnecessary items from the beside table while the physician meets with the client d. Communicates with the daughter while the physician talks with the client

b. Turns off the television The nurse minimizes distractions so the client can focus on one thing, such as the physician who may impart important information. Distractions are having the television on, cleaning the room, and talking with someone else in the room. The nurse does not leave the room. The nurse remains so she can repeat information provided by or to the client.

A client is being treated for injuries resulting from a skateboarding accident and is very agitated as the nurse cleans several gashes on the client's head. Which of the nursing responsibilities outlined by the American Nurses Association is the nurse fulfilling? a. providing health promotion, counseling, and education b. administering medications, wound care, and numerous other personal interventions c. interpreting client information and making critical decisions about needed actions d. performing physical exams and health histories

b. administering medications, wound care, and numerous other personal interventions

The nurse is caring for an older adult client who lives alone and who has a BMI of 17. What risk does this client likely face? a. Low risk of chronic disease b. Anorexia c. Increased incidence of falls d. High risk of diabetes

b. anorexia People who have a BMI lower than 18.5 (or who are 80% or less of their desirable body weight for height) are at increased risk for problems associated with poor nutritional status such as anorexia, diarrhea, mouth problems, or dry, brittle hair. In addition, a low BMI is associated with a higher mortality rate among hospitalized clients and community-dwelling elderly.

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in? a. Pretrajectory b. Stable c. Acute d. Comeback

c. Acute In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required.

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience? a. Structural barrier b. Barrier to health care c. Attitudinal barrier d. Transportation barrier

c. Attitudinal barrier Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.

A nurse prepares a diabetes prevention health seminar for community residents. Her teaching points should emphasize the most important factor influencing metabolic syndrome (pre-diabetes). What is that factor? a. Sedentary lifestyle b. Smoking c. Obesity d. Stress

c. Obesity Obesity, caused by an improper diet and physical inactivity, is the major cause of pre-diabetes.

A client with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the client and her family to establish goals for care. What is likely to be a first priority in goal setting for the client? a. Promotion of spirituality b. Social interaction c. Pain control d. Maintenance of activities of daily living

c. Pain control Pain control is essential for clients who have a terminal illness. If pain control is not achieved, all activities of daily living are unattainable.

A nurse is describing and demonstrating the technique for emptying a client's surgical drain, knowing that the client will soon be discharged home with the drain in place. As the nurse is explaining, the client laughs at times that appear unrelated to what the nurse is saying or doing. How should the nurse best understand the client's behavior? a. The client's sense of humor is culturally mediated and may be unfamiliar to the nurse. b. The client has sufficient knowledge and skill to empty the drain. c. The client may be unable to fully comprehend the information the nurse is trying to convey. d. Individuals from the client's culture may not normally explain and demonstrate at the same time.

c. The client may be unable to fully comprehend the information the nurse is trying to convey.

what's the difference between chronic disease & chronic illness?

chronic disease: Chronic disease refers to noncommunicable diseases (conditions not caused by an acute infection or injury), chronic conditions, or chronic disorders chronic illness: refers to the human experience of living with a chronic disease or condition -Definitions of chronic disease or chronic illness share the characteristics of being irreversible, having a prolonged course, and remaining unlikely to resolve spontaneously -The specific chronic condition may be a result of illness, genetic factors, or injury; it may be a consequence of conditions or unhealthy behaviors that began during childhood and young adulthood.

Which prompt by the nurse is most appropriate to obtain educational or occupational information? a. "What college did you attend?" b. "Are you a blue-collar worker?" c. "Do you have any financial concerns at this time?" d. "Tell me about your job."

d. "Tell me about your job."

A patient who has bone cancer has a new order for a Fentanyl patch. She has previously been receiving morphine for pain. When administering a Fentanyl patch, the last dose of sustained-release morphine should be administered: a. There are no administration requirements b. 1 hour after c. 1 hour prior d. At the same time the first patch is applied

d. At the same time the first patch is applied Because it takes 12 to 24 hours for the Fentanyl levels to gradually increase from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied.

Which is a cause related to the increasing number of people with chronic conditions? a. Shorter lifespans b. A tendency for these conditions to develop in younger people c. An increase in mortality from infectious disease d. Improved screening and diagnostic procedures

d. Improved screening and diagnostic procedures The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious disease has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons

Which capability corresponds with home health care? a. Uses a wide variety of supplies and equipment b. Retains maximal control over the client's lifestyle c. Is unable to care for those living in substandard conditions d. Improvises when providing care

d. Improvises when providing care

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate? a. Downward b. Comeback c. Acute d. Stable

d. Stable

The nurse is completing a physical examination of a group of clients. What client situation is the nurse most likely to use percussion during the assessment? a. The client who reports increased sensitivity to cold, dry skin, and thinning hair b. The client who presents with a mild pruritic rash on trunk and oral temperature of 101.1°F (38.4°C) c. The client who reports numbness and tingling in three fingers on each hand upon awakening in the morning d. The client who presents with a respiratory rate of 22 and a productive cough and reports shortness of breath when climbing stairs

d. The client who presents with a respiratory rate of 22 and a productive cough and reports shortness of breath when climbing stairs The assessment technique of percussion is most beneficial with clients suspected of disease processes in the chest and abdomen. It is a skill requiring practice and yields much information about disease processes in the chest and abdomen

Which specialty in nursing involves providing nursing care in the context of the client's culture? a. Multilingual nursing b. Biocultural nursing c. Multicultural nursing d. Transcultural nursing

d. Transcultural nursing Transcultural nursing, founded by Leininger (1977), is considered a specialty in nursing. It refers to nursing care that is provided within the context of another's culture. Multiculturalism is a philosophy that recognizes ethnic diversity within a society; it is not a nursing specialty.

A client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination. When percussing the client's chest wall, the nurse expects to elicit: a. flat sounds. b. dull sounds. c. hyperresonant sounds. d. resonant sounds.

d. resonant sounds. When percussing the chest wall of a client with allergy-induced asthma, the nurse should expect to elicit resonant sounds - low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they're louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: a. fill out the menu for the client. b. give the client privacy during meals. c. help the client fill out his menu. d. stay with the client and encourage him to eat.

d. stay with the client and encourage him to eat Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat.

cognitive disabilities

defined as limitations in mental functioning and difficulties with communication, self-care, and difficulty with social skills.

opioid naïve person

has not recently taken enough opioid on a regular basis to become tolerant to the effects of an opioid