Textbook of Basic Nursing 11th Edition : Chapter 98 and 100

The ___________________ care hospitalization measure of the Outcome and Assessment Information Set (OASIS) aims to reduce the number of home care clients readmitted to hospitals.

Acute

What are the criteria an agency should meet to be called a hospice ?

An agency should meet the following criteria to be called a hospice: •It must be a centrally administered, autonomous program. •The goal should be symptom control. •The client and his or her family should be the major unit of care. •Interdisciplinary care should be practiced, under the direction of a qualified healthcare provider. •Support for hospice staff and the client's caregivers should be available. •Hospice services must be available during the time of bereavement. - Services should be based on a client's physical needs rather than financial resources. •It should allow for follow-up with the primary caregivers for 1 year after the client's death.

A client admitted to a hospice program for mesothelioma is constipated and is given a "colon cocktail" by the home nurse. What are the constituents of a "colon cocktail"?

Answer: Applesauce, prune juice, and Millers bran RATIONALE: A "colon cocktail" is a mixture of 1 cup of applesauce, 1 cup of prune juice, and 1 cup of unprocessed bran. This cocktail is very effective in providing relief from constipation. Strawberries and pasteurized milk are not constituents of a "colon cocktail."

A nurse is assisting a family caregiver in providing home care to a client. What should the nurse do ?

Answer: Assess whether the family caregiver needs respite from caring. RATIONALE: A nurse should assess whether the caregiver is stressed due to continuous caring for the client and provide respite for the caregiver. The nurse must assist the family caregiver in preparing the home for the client's arrival rather than just providing instructions. The nurse must report any emergencies or troubling situations to the healthcare provider rather than to the family caregiver. The nurse must also evaluate the relationship between the client and the family caregiver, not that between the healthcare provider and the family caregiver.

A nurse is appointed to provide short-term care to a new mother. Which is an important measure the nurse should implement ?

Answer: Avoid visiting the client's home too frequently. RATIONALE: A nurse providing short-term home care for a new mother must make a limited number of visits to the client's home. This helps the new mother in caring for the child herself and bonding with the child. A new mother can be provided with a list of medications and doses she needs to take rather than setting up medications in organizers. The new mother should be educated on feeding procedures before being discharged from the healthcare facility. Hence, it is not necessary to re-educate the client; instead, the nurse could clarify any issues the mother may have when caring for her child. The nurse must telephone and inform the client of the approximate time of the next visit rather than informing the care-providing agency. The agency members make the visit schedule and therefore are aware of the approximate time of the visit.

A client is diagnosed with Ewing sarcoma who is under hospice care complains of constipation. Which should be evaluated before treating constipation with laxatives ?

Answer: Bowel obstruction RATIONALE: It is necessary to determine whether a bowel obstruction exists before constipation is treated with laxatives. If laxatives are given in the presence of a bowel obstruction, bowel perforation can occur, which is a life-threatening condition. The presence of diabetes mellitus, hypertension, or peptic ulceration need not be determined, because these conditions are not a contraindication to laxative use.

A nurse is providing home care to a client. Which safety measure should the nurse implement when going on home visits ?

Answer: Call and inform the client of the time of visit. RATIONALE: A nurse going on a home visit when providing home care to a client must call and inform the client or family members about the approximate time of visit. When using a vehicle on home visits, the nurse should ensure that nobody is in the back seat and only then get into the vehicle. A nurse should use the main routes to the client's home rather than taking shortcuts. A nurse should knock at the door or ring the doorbell and be acknowledged before entering the client's home.

A nurse is providing home care to a terminally ill child. A third-party payor is funding the treatment. Which is an important nursing duty to be implemented ?

Answer: Call the client when visits are not scheduled. RATIONALE: A nurse providing home care must call up the client on days when visits are not scheduled. This helps in providing constant support to the client and in reassuring the client. When caring for a client with a terminal illness, the nurse must concentrate on providing palliative care rather than on curing the disease. The nurse must document all teachings. All the necessary documents and records must be completed and submitted to the third-party payor rather than to the healthcare provider.

A client is admitted to a hospice program with carcinoma of the colon. The nurse observes a reddened area that does not return to its normal hue after pressure is removed on the client's lower back. What action should the nurse take ?

Answer: Change client's position frequently. RATIONALE: The nurse should change the position of the client frequently, because the area of redness indicates an impending pressure wound. Massaging an already reddened area will promote further skin breakdown. Application of antifungal powder will not help in preventing pressure wounds. Application of a wet cloth should not be done, because external moisture is a risk factor for pressure wound development.

A nurse caring for a client with end-stage AIDS observes that the client has a dry mouth and is dehydrated. Which is a complication of dehydration ?

Answer: Constipation RATIONALE: Constipation is a complication of dehydration. When fluid is retained, feces may become hard and impacted. Dehydration dries secretions, reduces choking, and also reduces nausea and ascites.

A nurse is providing hospice home care for an older client with dementia. What is a nursing consideration when caring for this client ?

Answer: Encourage the client to interact and to recollect memories. RATIONALE: A nurse caring for an aging adult with dementia should encourage the client to interact with family members and friends and to recollect memories. This helps in improving cognitive functions in the client and improves alertness. Although the nurse is required to be able to make decisions independently, he or she must work in coordination with the healthcare provider to decide on the combination of medications for the client, and not decide this alone. The nurse must consult a dietician and a healthcare provider before making any changes in the client's diet. The nurse should not provide false assurances to the client, because doing so may lead to the client's losing confidence in the nurse as the disease progresses. The nurse may comfort the client by providing assurance of pain control rather than providing assurance of a complete cure.

A nurse is providing short-term home care to a child with special needs. Which should the nurse do during her visit to the client's home ?

Answer: Evaluate changes in the client's behavior. RATIONALE: A nurse providing short-term care for a child with special needs must evaluate any change in the behavior of the child. This helps the nurse to evaluate whether the child has any other health problems or is having trouble adjusting to the home environment. A nurse must evaluate whether the caregivers are providing all of the prescribed medications to the client and whether any side effects are occurring due to medications. However, the healthcare provider, not the nurse, will make any changes in medications. A nurse must not evaluate the financial status of the family or the expenditures for the client. A nurse must evaluate the relationship between the client and the family caregiver rather than the relationship between the child's parents.

A nurse is providing short-term home care to an elderly client. Which action should the nurse take ?

Answer: Observe the client for signs of possible abuse. RATIONALE: Family members frequently subject older clients to abuse. A nurse providing home care to an elderly client must observe for any signs of possible abuse to the client by the family members and report any case of abuse to the authorities. A caregiver must be referred to a healthcare provider for poor nutritional status rather than being instructed to take vitamin supplements. A nurse must place or assist the caregivers in setting up medications in organizers for the client rather than placing them near the bedside. This helps the client in taking prescribed medications on time in correct doses. A nurse should consult a healthcare provider and a dietician before deciding on any dietary changes.

A nurse is caring for an older adult in his home. Which of the following are the important nursing measures to be implemented ?

Answer: Provide care for the client on weekdays or holidays, provide transportation when going to a healthcare provider, and evaluate the client's home for safety issues. RATIONALE: A nurse working for home care services must be ready to work on all weekdays or on holidays. The nurse must also be able to take on responsibilities such as providing transportation to the client when going to the healthcare provider. A nurse providing home care must assess or evaluate the client's entire house for safety. Any changes required must be suggested to the family members. A nurse may not always work along with a home care team. He or she may be given the individual responsibility of caring for a client. A nurse should always interact with the client's family members and educate them on the client's health conditions to improve his living conditions at home.

A client in home care hospice with terminal-stage cervical cancer complains of watery diarrhea. What action should the nurse take ?

Answer: Provide good skin care around the rectum RATIONALE: The nurse should provide good skin care around the rectum to avoid skin breakdown. The nurse should encourage a low-residue diet, not a high-residue diet, to lessen stimulation. The client should be encouraged to drink a variety of fluids to prevent electrolyte imbalance, not only water. Specific foods causing gas or cramps should be restricted from the diet

A hospice nurse is caring for a client with a diagnosis of acute leukemia who has undergone chemotherapy and in complaining of nausea. What action should the nurse take ?

Answer: Provide ice chips for a soothing effect. RATIONALE: The nurse should provide the nauseated client with ice chips, because they have a soothing effect. Nauseated clients should lie on the right side, not in a supine position. Clients may drink carbonated beverages and eat dry foods such as popcorn, because such foods may be helpful.

A client who has been admitted to a hospice program with a diagnosis of metastatic prostate carcinoma is unable to eat because of a decreased appetite. Which will improve intake in this client ?

Answer: Providing soft foods that are easy to swallow RATIONALE: Soft, easily swallowed foods can improve intake in this client. High-protein, high-calorie supplements, not low-calorie supplements, should be provided to improve nourishment. Clear fluids are usually more appealing than milk, and hence are preferred. Frequent small meals and snacks are preferred to large-quantity meals. Clients and caregivers should be reassured that small amounts of food are adequate.

A client with a diagnosis of small cell carcinoma of the lung, who has been admitted to a home care hospice, complains to the home nurse that he has a bowel movement only once every 2 days. What action should the nurse take ?

Answer: Reassure the client that it is normal. RATIONALE: The nurse should reassure the client that having a bowel movement every 2 days is normal and is not due to constipation. This is because hospice clients have lowered intake and activity and often have a bowel movement only every 2 to 3 days. Because this is a normal occurrence, referring the client to a specialist is unnecessary. Increasing dietary fiber or fluid intake is indicated only if the client is constipated.

A hospice nurse is ordered to give a client diagnosed with metastatic liver disease more than the usual dose of analgesic medication because of the considerable liver damage that has occurred. Which of the following can also necessitate a higher dose of pain relieving medications ?

Answer: Substance abuse, cigarette smoking, and kidney damage RATIONALE: A higher dose of pain-relieving medications is needed if the client smokes, abuses drugs or other substances, has liver or kidney damage, or is very athletic. Substance abuse builds up the tolerance to any medication. Liver or kidney damage slows down the metabolism of medications. Cognitive impairment does not hamper the medication in any way. A higher dose of pain relieving medications is needed in very athletic clients rather than clients with a sedentary lifestyle, because exercise increases the production of endorphins, which are natural pain relievers. Endorphin production decreases when these athletic clients become less active.

A nurse is providing short-term home care to a client whose primary caregiver is a family member. Which should the nurse implement when providing respite to the caregiver ?

Answer: Suggest that the caregiver reduce salt intake. RATIONALE: A nurse assisting a caregiver in taking respite from caring for the client must suggest that the caregiver reduce his intake of salt. This helps in preventing an increase in blood pressure due to stress. The nurse should recommend that the caregiver eat several small meals each day to maintain a constant energy level, rather than increase the intake of food, which may lead to obesity. The nurse should suggest that the caregiver reduce his intake of coffee, because this increases the amount of caffeine and the risks associated with it. The caregiver must be told to increase his intake of all fluids, not only plain water.

A nurse is providing home care for a client who recently underwent surgery. Which guideline should the nurse follow ?

Answer: Transmit information on the wound to the healthcare provider via computer. RATIONALE: When a nurse is providing home care to a client with surgical wounds, the information on the condition of the wound should be transmitted to the healthcare provider via computer. A photograph of the wound should be taken with a digital camera and the image transmitted to the healthcare provider for observation and discussion on treatment changes to be made. The nurse should change the dressings once or twice a day for about 2 weeks after the surgery and monitor the signs of infection in and around the surgical wound, rather than educating the family members on monitoring the infection. The nurse should administer intravenous antibiotics and not instruct the family caregivers to administer them.

A client with gastric carcinoma who is receiving morphine for pain management appears to be somnolent. What action should the nurse take ?

Answer: Withhold the opioid medications, consult the healthcare provider. and provide naloxone after healthcare provider consultation RATIONALE: The home nurse should withhold the medication and consult the healthcare provider. An antidote, such as naloxone, may be given on healthcare provider's order if the client does not respond when told to breathe deeply. Providing relaxation techniques or making the client lie in a lateral position will not help in this situation.

Medication: Alprazolam

Anxiety

LV/ LPN

Assists clients in learning appropriate self-care techniques.

What is meant by the term bereavement ?

Bereavement or grieving is part of the process of dealing with a loved one's death.

A licensed practical nurse serves as a team member under the supervision of a ____________________ manager.

Case

Medication: Bisacodyl

Constipation

What does durable medical equipment include ?

Durable medical equipment includes hospital beds, bedside commodes, overbed tables or trapezes, and high-tech equipment, such as intravenous pumps or oxygen concentrators.

Medication: Furosemide

Edema

Case Manager

Evaluates the safety of the home and the adequacy of available family caregivers.

The Centers for ______________________________ Nurses serve as consultants to the staff nurse from the local home care agency.

Excellence

A client is assigned to a Home ___________________________ Resource Group for 60 days of care during prospective payment system assessment.

Health

A nurse is providing short-term care to a new mother. What does the new mother learn from home care visits ?

Home care provides the following advice to the new mother: •Dedicating the entire time to the baby •Concentrating on proper feeding and caring for the baby •Getting adequate rest after delivery •Maintaining proper nutrition •Maintaining overall good health

The _________________________ movement acknowledges that not all illnesses are curable and emphasizes the management of uncomfortable symptoms.

Hospice

Which areas of human needs does hospice care focus on ?

Hospice care focuses on the following areas of human needs: physical, psychological/emotional, social/cultural, and spiritual.

________________________ is the surgical removal of the pituitary gland.

Hypophysectomy

A client who has undergone spinal surgery is being shifted from hospital care to home health care. The client is on a patient-controlled analgesia (PCA) pump to self-deliver analgesics as needed. What outcome measures of the services of the home care agency does Medicare look for from the OASIS when deciding on the payments ?

Medicare looks for the status of the surgical wound when providing payment to the home care service provider.

Medication: Cyclizine

Nausea

Permanent nerve block is achieved with a ____________________ agent.

Neurolytic

Parish Nurse

Provides spiritual support to the client to help in holistic healing.

Centers for Medicare and Medicaid contracts ____________________________ Improvement Organizations to work with home care agencies.

Quality

Medication: Carbamazepine

Seizures

Belladonna suppositories are used to relieve bladder ___________________________________.

Spasm

A hospice nurse assists with postmortem care. What support is available for hospice staff members ?

Support groups or other outlets are available for the hospice staff members to deal with their grief after the death of a client for whom they were caring.

What are the advantages for a nurse working for home care services ?

The advantages for a nurse working for home care services include providing care for a small number of clients, an opportunity to know the client better, an opportunity to know the client's family, flexibility in planning the work for the day, and assisting the client to be comfortable at home.

What are the benefits of the prospective payment system (PPS) ?

The benefits of PPS in home care reimbursement include payment to care providers based on the quality of care provided to clients, reduced costs of treatment to clients, improved quality of treatment of clients, and hospital and medical insurance for clients.

What are the characteristics of a long-term home care service ?

The characteristics of long-term home care include periodic nursing assessment and case management; housekeeping; personal care service; "restorative nursing," in which the nurse may assist the client with exercises; and providing care for 24 hours or 8 to 12 hours a day.

What is the expertise of a Center of Excellence (COE) team ?

The expertise of a COE team may include continence care, wound care, intravenous and other technology care, psychiatric management and crisis intervention, pediatric high technology, maternity consultation, and maternal and child healthcare.

A hospice nurse assists with postmortem care. How do hospice staff members give bereavement care ?

The hospice staff members give bereavement care to family members of the client by attending funeral services, encouraging family members to share their feelings, encouraging them to attend grief support groups, and making home visits to evaluate how they are coping and help in their adjustment.

What are the measures to manage odor in terminally ill clients?

The measures to manage odor in terminally ill client are aerosol sprays, wintergreen oil, charcoal filter dressings, and mechanical air filters.

A nurse is caring for a client with gastric carcinoma who is experiencing abdominal pain. What activities can the nurse suggest to divert the client's attention from the pain ?

The nurse could suggest activities such as the following to distract the client's attention from pain: visit family and friends, play with pets, read, sew, watch television, listen to music, or pursue other hobbies.

A nurse is caring for a client with gastric carcinoma who is experiencing abdominal pain. What points should a nurse consider when administering pain relief medications to hospice clients ?

The nurse should consider the following points when administering pain relief medications to hospice clients: •The dose of a narcotic should be increased gradually. •The dosages of narcotics must be decreased slowly. •When the route of administration changes, the dosages usually change as well. •The client's tolerance to other medications must be considered. •The client's history of use of alcohol and street drugs must also be considered.

A nurse is caring for a client with gastric carcinoma who is experiencing abdominal pain. How should the nurse evaluate the client's pain ?

The nurse should evaluate the client's pain using the client's own description of pain; the level of interference of pain with activities, rest, and general comfort; the location, intensity, and severity of the pain; and aggravating and relieving factors.

What are the nursing duties to be followed when providing home care to a client ?

The nursing duties when providing home care to a client include the following: •Working in coordination with the medical staff providing care for the client •Educating the client and family members on the procedures that must be followed during treatment •Educating the client and family members on the prescribed medications, their doses, and the possible side effects of medications •Monitoring the client's progress and reporting any troubling symptoms to the healthcare provider •Assessing the client's home for safety issues; evaluating the home situation and the care provided by the family caregivers •Completing all the required documents on providing home care to the client

A client who has undergone spinal surgery is being shifted from hospital care to home health care. The client is on a patient-controlled analgesia (PCA) pump to self-deliver analgesics as needed. What are the nursing guidelines to be implemented when providing care for the client ?

The nursing guidelines to be followed when caring for a client with a PCA pump include the following: •Go through the equipment brochure and learn how to operate the pump and clean it. •Educate the client and family members on operating the pump. •Assist the family members in cleaning the pump. •Educate the client and family members on evaluating any signs of infection. •Educate the client and family members on the diet and exercises to be followed. •Document all teachings and procedures followed when caring for the client. •Consult the case manager or the healthcare provider in case of any emergencies or concerns.

A hospice nurse assists with postmortem care. What is the nursing responsibility when a client dies ?

The nursing responsibility after a client's death is to assist in the process of final care and preparations and to encourage caregivers to participate in the process as much as possible.

What are the qualities that a nurse must possess when providing home care ?

The qualities that a nurse should possess when providing home care include the ability to get along well with people, self-direction, ability to make sound decisions, ability to make clinical judgments, and good communication skills.

What are the services provided by home care service agents ?

The services provided by home care agencies vary from one agency to the other. The services range from total physical care to housekeeping or simple assistance in shopping. Some of the other services offered include mental health counseling, hospice care, speech therapy, administration of intravenous medications, and drawing blood. Some agencies offer respite care for family caregivers.

The _____________________________ electrical nerve stimulation (TENS) units applies electrical stimulation directly to nerves and interrupts transmission of pain sensations.

Transcutaneous

A nurse is providing short-term care to a new mother. What are the nursing duties to be followed when providing care for the client ?

•Contacting the mother a day or two after her arrival home •Answering any questions the mother has •Making an appointment with the mother for a home visit •Checking the health conditions of both the mother and the baby •Educating the mother and the family on caring for the baby (e.g., feeding, sleeping, monitoring any signs of illness) •Educating the mother and the family on needed vaccinations and on contacting the healthcare provider when necessary