ch. 9 chronic illness and disability
Among deaths due to chronic disease, what percentage occurs in low- and middle-income countries? 90 80 60 70
80 Explanation: Eighty percent of deaths due to chronic disease occur in low- and middle-income countries.
The nurse is performing an initial assessment of a client with a disability. The nurse should assess for which condition? Select all that apply. Depression Abuse Bipolar disorder Psychosis
Abuse Depression Explanation: Clients with a disability are at increased risk for physical, emotional, financial, and sexual abuse. The assessment should also include a screening for depression. The initial assessment of a client with a disability would not include an assessment for psychosis or bipolar disorder unless there client was exhibiting signs/symptoms or had a history of these disorders.
Myocardial infarction is an example of which type of disability? Developmental Acute nontraumatic Age-related Acquired
Acute nontraumatic Explanation: Spinal cord injury is an example of an acquired disability. Age-related disabilities would include hearing loss, osteoporosis, and osteoarthritis. An acute nontraumatic injury is a stroke or myocardial infarction. A developmental disability would include cerebral palsy and muscular dystrophy.
A client has a tentative diagnosis of lung cancer following computed tomography (CT) scanning. He is scheduled for a fiberoptic bronchoscopy with biopsy. In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse Answers the client's questions about the bronchoscopy procedure Provides postprocedure care following the bronchoscopy Administers the preoperative medication for the bronchoscopy Obtains the signature of the client on the consent form
Answers the client's questions about the bronchoscopy procedure
The nurse is working with a client with a chronic condition. The nurse includes which elements in the plan of care? Select all that apply. Interventions to prevent complications Interventions to manage symptoms Assessment for spontaneous resolution Assessment for identity changes
Assessment for identity changes Interventions to manage symptoms Interventions to prevent complications Explanation: The nurse should assess for identity changes, plan interventions to manage the client's symptoms, and prevent complications of the chronic condition. Chronic conditions do not resolve spontaneously.
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? Attitudinal barrier Transportation barrier Barrier to health care Structural barrier
Attitudinal barrier
The nurse provides corrective instruction to the nursing assistant when the assistant refers to the client as the Blind diabetic patient Woman who has multiple sclerosis Person who is disabled Man with a stroke
Blind diabetic patient Explanation: It is important to use "people-first" language, which means referring to the person first. Examples include person who is disabled, man with a stroke, and woman who has multiple sclerosis. Using "blind diabetic patient" conveys that the illness or disability is of greater importance than the person.
Which of the following is a true statement regarding characteristics of chronic conditions? Managing chronic conditions is becoming less costly. Difficult ethical issues arise in the care of people with chronic conditions. Managing chronic conditions must be an individual process. Keeping chronic conditions under control requires occasional adherence to therapeutic regimens.
Difficult ethical issues arise in the care of people with chronic conditions. Explanation: Many ethical issues arise in the care of people with chronic conditions. Managing chronic conditions must be a collaborative process. Keeping chronic conditions under control requires persistent adherence to therapeutic regimens. The management of chronic conditions is becoming more costly.
A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as Crisis Stable Downward Acute
Downward Explanation: The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.
The nurse is caring for a client in the unstable phase of the Trajectory Model of Chronic Illness. The nurse should focus on providing which type of care? Emotional Direct Rehabilitation Guidance
Guidance Explanation: During the unstable phase of the Trajectory Model of Chronic Illness, nursing care should focus on providing guidance and support, as this stage is characterized by exacerbation of symptoms. This may require additional testing and/or adjustment to a treatment regime requiring guidance by and support from the nurse.
Which disability model is most appropriate for the nurse to use as a guide for planning care? Interface Model Biopsychosocial Model Social Model Medical and Rehabilitation Model
Interface Model Explanation: Several models of disability have been used to address or explain the issues encountered by people with disabilities (Drum, 2009; Phelan, 2011; Smeltzer, 2007a). These include the medical and rehabilitation models, the social model, the biopsychosocial model, and the interface model. Chart 9-4 briefly describes these models of disability. Of these, the interface model (Goodall, 1995) may be one of the most appropriate for use by nurses to provide care that is empowering rather than care that promotes dependency.
Empowering the client with a disability will better serve him or her than will promoting dependency. This type of approach is seen in which type of model of disability? Medical model Social model Interface model Rehabilitation model
Interface model Explanation: In the interface model of disability, the client seeks or directs solutions toward the problem. The interface model may be most appropriate for use by nurses to provide care that is empowering rather than care that promotes dependency.
Nursing care of patients with chronic illness is varied and occurs in a variety of settings. Care must be direct and supportive. To provide supportive care, a nurse would do which of the following? Make referrals for additional care. Provide treatments. Manage the medication regime. Assess the patient's physical status.
Make referrals for additional care. Explanation: Nursing care of patients with chronic illnesses is varied and occurs in a variety of settings. Care may be direct or supportive. Direct care may be provided in the clinic or health provider's office, the hospital, or the patient's home, depending on the status of the illness.
A nurse is assigned to care for a client with an acute exacerbation of chronic obstructive pulmonary disease. During the shift, the nurse discovers that the client lives alone and holds a full-time job. Which type of disability would the nurse state the client has? acquired age-related developmental acute nontraumatic
acquired Explanation: The nurse would label the disability as acquired from the chronic pulmonary disease. Developmental disabilities occur anytime from birth to 22 years and result in impairment of physical or mental health, cognition, speech, language, or self-care. Age-related disabilities are changes in health from the aging process. Examples of acute nontraumatic disabilities include those brought on by stroke or myocardial infarction.
The nurse recognizes which disorder as a developmental disability in a patient? Stroke Osteoarthritis Cerebral palsy Spinal cord injury
Cerebral palsy Explanation: 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 are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy.
The nurse is caring for a client who communicates via sign language. What should the nurse do to promote communication? Direct conversation to a family member. Provide a sign language interpreter. Ask a family member to act as interpreter. Communicate only in written format.
Provide a sign language interpreter. Explanation: Communication strategies to ensure quality health care for people with disabilities include provision of accommodations that enable clients to participate fully in conversations relating to their health care. The nurse should provide a sign language interpreter. Family members should not be asked to act as an interpreter. Communicating only in written format limits communication. Reference:
Evidence-based medical and nursing research has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following? Make certain that the patient was aware of the signs of coronary artery disease. Teach the patient how to assess his blood pressure weekly. Write a prescription for a serum cholesterol level. Suggest activity modifications and treatments to help minimize the physical limitations of dyspnea.
Write a prescription for a serum cholesterol level. Explanation: Hypercholesterolemia is the most prevalent chronic disease in the United States, with 33.6% of all adults affected.
A nurse is preparing to provide discharge teaching for a hospitalized 19-year-old client who is hearing impaired with functioning hearing aides. The television is on, and several of the client's fraternity brothers are present. What are potential teaching barriers for the nurse? Select all that apply. gender fraternity brothers client's age client's hearing impairment television in use
television in use fraternity brothers Explanation: Barriers to learning include the television and visitors, which are both potential distractions. Visitors in the room do not promote privacy and confidentiality. The client's age, gender, and hearing impairment should not inhibit the nurse's ability to provide discharge teaching.
A nurse is caring for a client with multiple chronic conditions and some physical disabilities. The nurse is using "people-first" language with the following statement during end-of-shift report: "Mr. Rudd is a 44-year-old diabetic patient who was admitted last evening." "A new diabetic admit came to the floor last night during my shift. He is 44 and his name is Mr. Rudd." "Last evening, Mr. Rudd, a 44-year-old patient with diabetes was admitted to the unit." "I admitted another diabetic patient last evening; his name is Mr. Rudd."
"Last evening, Mr. Rudd, a 44-year-old patient with diabetes was admitted to the unit." Explanation: It is important to all people, both those with and those without disabilities, that they not be equated with their illness or physical condition. Therefore, it is important to refer to all people using "people-first" language.
The nurse is conducting a community education program on chronic illness. The nurse evaluates that additional education is needed when the participants make which statement? "Out-of-pocket expenses for chronic illness are low." "Most people with chronic illness have health insurance." "Chronic illness is increasing in developing countries." "Chronic illness is a leading cause of death."
"Out-of-pocket expenses for chronic illness are low." Explanation: The nurse determines that additional education is needed when the participants state that out-of-pocket expenses for chronic illness are low. Although the majority of clients with chronic illness have health insurance, out-of-pocket expenses are high and are increasing. Chronic illness is a leading cause of death and is on the rise in developing countries.
A client has been hospitalized with heart failure multiple times. The home health nurse is visiting the client with the overall goal of decreasing the frequency of hospitalizations. Using the nursing process, outline the steps the nurse would do in the correct order from 1 to 5. 1Establishes the nursing diagnosis as Excess Fluid Volume 2Assesses the client's weight as 88 kg, 117% of ideal body weight 3Intervenes by teaching the client about weighing self every day 4Evaluates the client's weight as 86 kg 1 week later 5Identifies a goal for the client to weigh 86 kg within 1 week
2Assesses the client's weight as 88 kg, 117% of ideal body weight 1Establishes the nursing diagnosis as Excess Fluid Volume 5Identifies a goal for the client to weigh 86 kg within 1 week 3Intervenes by teaching the client about weighing self every day 4Evaluates the client's weight as 86 kg 1 week later The nurse uses the nursing process when providing care for clients, including clients with chronic health problems such as heart failure. The order of the nursing process is assessment, diagnosis, planning, implementation, and evaluation.
A 65-year-old client was diagnosed with multiple sclerosis 10 years ago. The client has difficulty ambulating and is seeking a prescription for a wheelchair. The nurse assesses the type of disability the client has is Developmental Sensory Age-associated Acquired
Acquired Explanation: Acquired disabilities may be progression of a chronic disorder, such as multiple sclerosis. Developmental disabilities are those disabilities that occur any time from birth to 22 years and may result in impairment of physical or mental health, cognition, speech, language, or self-care. Age-associated disabilities in the elderly population result from the aging process. Sensory disabilities affect hearing or vision.
A client has a tentative diagnosis of lung cancer following computed tomography (CT) scanning. He is scheduled for a fiberoptic bronchoscopy with biopsy. In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse Answers the client's questions about the bronchoscopy procedure Administers the preoperative medication for the bronchoscopy Provides postprocedure care following the bronchoscopy Obtains the signature of the client on the consent form
Answers the client's questions about the bronchoscopy procedure Explanation: In the trajectory phase of the Trajectory Model of Chronic Illness, the nurse provides explanations of diagnostic tests and procedures, such as the bronchoscopy with biopsy. The nurse will reinforce information and explanations provided by the physician.
A client had a previous myocardial infarction and has been experiencing angina from occluded coronary arteries. What teaching should the nurse provide in the stable phase of the Trajectory Model of Chronic Illness? Encourage the family to support the client's exercise plan. Discuss aortocoronary bypass surgery techniques. Collaborate with health care providers for medication therapy. Encourage discussion of end-of-life preferences.
Encourage the family to support the client's exercise plan. Explanation: The focus for the nurse in the Trajectory Model of Chronic Illness phase should be to provide explanations of diagnostic tests and procedures, reinforce information and explanations given by the primary provider, and provide emotional support to the patient and the patient's family. Discussion of surgical techniques, collaboration with the health care team, and discussion of end-of-life preferences are activities in other phases of the Trajectory Model of Chronic Illness. Reference:
A nursing instructor is lecturing to the junior students about common misconceptions of chronic illness. The instructor asks the students to write down and share some misconceptions with one another. Which of the following are common misconceptions? Select all that apply. Chronic diseases mainly affect people who are rich. Incidence of chronic illness is increasing worldwide. Chronic diseases cannot be prevented. Chronic diseases affect mostly in countries of the developing world. Everyone has to die of something and so chronic illness should not be treated.
Everyone has to die of something and so chronic illness should not be treated. Chronic diseases cannot be prevented. Chronic diseases mainly affect people who are rich. Explanation: Some common misconceptions about chronic illness include that because everyone has to die of something, there is nothing that can be done anyway; chronic diseases cannot be prevented; and chronic diseases mainly affect people who are rich (affluent). One truth about chronic illness is that 80% of deaths from them occur in low- and middle-income countries.
A nursing instructor is preparing a class on pressure ulcers. Which of the following would the instructor most likely include as a possible risk factor? Select all that apply. Enhanced sensory perception Increased moisture Increased tissue perfusion Anemia Immobility
Immobility Anemia Increased moisture Explanation: Risk factors associated with pressure ulcer development include immobility, decreased sensory perception, anemia, decreased tissue perfusion, and increased moisture.
Which statement provides accurate information related to chronic illness? Most chronic conditions are easily controlled. Chronic conditions do not result from injury. Most people with chronic conditions do not consider themselves sick or ill. Most people with chronic conditions take on a sick role identity.
Most people with chronic conditions do not consider themselves sick or ill. Explanation: Most people with chronic conditions do not consider themselves sick or ill and try to live as normal a life as possible. Research has demonstrated that some people with chronic conditions may take on a "sick role" identity, but they are not the majority. Chronic conditions may be due to illness, genetic factors, or injury. Many chronic conditions require therapeutic regimens to keep them under control.
A client who is blind is hospitalized for hip surgery. The nurse notices that the containers on the client's lunch tray are unopened, the client is fumbling with items, and food is on the front of the client's gown. The nurse assists the client by Opening containers and orienting the client to placement of items on the tray Sitting down in a chair and feeding the client Obtaining help from a nursing assistant to feed the client Contacting a family member to assist with feeding the client at meal times
Opening containers and orienting the client to placement of items on the tray Explanation: During hospitalization clients with pre-existing disabilities may require assistance with activities of daily living that they may be able to manage at home. For clients who have impaired vision, it is necessary to orient them to the environment to assist with their independence. The option that best meets these criteria is the nurse opening containers for the client and telling the client where items are found on the tray.
The nurse is planning a community education program on disabilities. The nurse plans to include which statement? Less than 5% of people in the United States have a disability. People with disabilities are most likely to work part time. Fifty percent of people with disabilities are employed. Greater than 10% of children have a disability.
People with disabilities are most likely to work part time. Explanation: People with disabilities are more likely than those without disability to work part time. The employment rate for people with disabilities is 18.6-23.4%. Approximately 20% of the U.S. population has a disability and 5% of children have a disability.
A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to Plan with the client how to incorporate the regimen into the client's activities of daily living. Instruct the client what he or she must do. Refer the client to physical therapy for ambulation exercise two times a week. Assist the family in obtaining equipment that would help the client to walk.
Plan with the client how to incorporate the regimen into the client's activities of daily living. Explanation: The nurse should work with the client and family to identify ways to implement the treatment regimen. The nurse does not tell the client what the client must do. The other options may be appropriate interventions for this client, but these would not be the next step.
A nursing student shares that he read that chronic conditions are costly to people, families, and society, and that one of the major goals of nursing today should be the prevention of chronic conditions and the care of people with them. The student asks the instructor what can nurses do to help. Which of the following is a correct answer given by the instructor? Teach avoidance of immunizations. Promote wearing seat belts. Promote dependence on health care professionals. Begin teaching prevention and promotion of health near mid-life.
Promote wearing seat belts. Explanation: Prevention of chronic conditions and the care of people with them requires promoting healthy lifestyles and encouraging the use of safety and disease-prevention measures, such as wearing seat belts and obtaining immunizations. Prevention should also begin early in and continue throughout life.
An older adult in the hospital with a fractured hip is being prepared for surgical repair. The bilateral hearing aids were forgotten at the client's home and the client is having difficulty hearing. To promote communication, which of the following actions should the nurse perform? Select all answers that apply. Use a deeper tone of voice. Speak in a loud voice. Allow the television to remain on while talking to the client. Talk directly to the client. Ask the client to repeat what was stated.
Talk directly to the client. Use a deeper tone of voice. Ask the client to repeat what was stated. Explanation: Actions that a nurse can take to help a client with hearing loss include the following: talk directly to the client; use a deep tone rather than a high tone; and ask the client to repeat what was stated to ensure understanding. The nurse does not speak in a loud voice, because in doing so, the nurse would use a higher tone, which is more difficult to hear. The nurse should minimize background noises in the room by turning off the television.
A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness: The client does not believe that the illness threatens self identity and body image. The client and family do not allow the chronic illness to be the focal point of their lives. The client adheres to the prescribed therapeutic regimen. The client stops taking some medications due to side effects that are disturbing to the client.
The client stops taking some medications due to side effects that are disturbing to the client. Explanation: Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.
The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction? The survival of people with severe trauma, chronic disorders, and early-onset disabilities The ability to cure chronic disorders that are acquired The decrease in the number of people with early-onset disabilities The decrease in risk factors for early-onset disabilities that are genetic in cause
The survival of people with severe trauma, chronic disorders, and early-onset disabilities Explanation: The number of people with disabilities is expected to increase over time as people with early-onset disabilities, chronic disorders, and severe trauma survive and have normal or near-normal lifespans. There has not been a decrease in the number of people with early-onset disabilities. Acquired chronic disorders still cannot be cured. Genetic risk factors for early-onset disabilities have not decreased.
Chronic illness can be monitored using the Trajectory Model. In what phase can the nurse's nursing diagnosis help in care planning? Downward course Crisis Pretrajectory Trajectory
Trajectory Explanation: The pretrajectory phase is characterized by genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition. 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. The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The downward phase is characterized by rapid or gradual worsening of a condition, including physical decline accompanied by increasing disability or difficulty in controlling symptoms. It requires biographical adjustment and alterations in everyday life activities with each major downward step.
The nurse forms a nursing diagnosis during which phase of the trajectory model of chronic illness? Pre-trajectory Stable phase Phase of crisis Trajectory onset
Trajectory onset Explanation: During the trajectory onset phase, a diagnosis is formulated and the patient begins to cope with the implications of the diagnosis.
A client who will undergo emergency surgery suffers from chronic depression. The nurse is performing client teaching prior to the surgery. To make the client more comfortable, which of the following actions should the nurse take? Select all answers that apply. Face the client when speaking to the client. Omit teaching if the client does not appear to be listening. Address the client by title and last name. Allow extra time for this client. Wait for the client to complete speaking even when answers are slow.
Wait for the client to complete speaking even when answers are slow. Face the client when speaking to the client. Address the client by title and last name. Allow extra time for this client. Explanation: Nursing interventions to promote communication with clients who have mental health challenges include allowing them extra time to provide answers and waiting for them to finish speaking. Nurses address clients by titles and last names and use first names only if doing so with other people who may be present. Nurses face clients and speak directly to them. Even though a client may not appear to be listening, this symptom may be related to the chronic depression. The nurse provides preoperative teaching.
A client has been diagnosed with diabetes and has received instructions about managing the disease. The client has undertaken an activity to improve quality of life and maintain functional status. The nurse recognizes this activity as Checking blood glucose level twice a day Ingesting foods with low caloric value Taking medications as prescribed Walking at least one mile 5 days each week
Walking at least one mile 5 days each week Explanation: Behaviors, such as exercise or walking, are essential to quality of life and maintaining functional status for a client who has a chronic illness. The other activities, such as ingesting low caloric foods, taking medications, and checking blood glucose level, relate to managing symptoms and avoiding complications.
Empowering the client with a disability will better serve him or her than will promoting dependency. This type of approach is seen in which type of model of disability? Social model Interface model Medical model Rehabilitation model
Interface model Explanation: In the interface model of disability, the client seeks or directs solutions toward the problem. The interface model may be most appropriate for use by nurses to provide care that is empowering rather than care that promotes dependency.
A public health nurse reviews data on chronic illness in the community over time and notes that chronic illness rates are climbing. Which factors may contribute to the increased chronic illness rates? Select all that apply. A decrease in mortality from infectious diseases An increase in obesity rates An increase in infectious disease rates A decrease in global awareness of chronic illness A decrease in client education regarding chronic illness
A decrease in mortality from infectious diseases An increase in obesity rates Explanation: Chronic illness rates are climbing due in part that there is a decrease in mortality from infectious diseases and an increase in obesity rates. There is not an increase in infectious disease rates, a decrease in client education about chronic illness, or a decrease in global awareness of chronic illness.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Despite various medication regimes, the client's symptoms are gradually increasing. The nurse realizes that this client is which phase of the Trajectory Model of Chronic Illness? Unstable Acute Dying Downward
Downward Explanation: The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management. The unstable phase is characterized by development of complications or reactivation of the illness. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The dying phase is characterized by gradual or rapid shutting down of life-maintaining functions.
After multiple treatment plans, a client with cancer has been told that the tumors continue to grow and have metastasized. The nurse is assisting with arranging hospice care for the client. The nurse assesses the client is in which phase of the Trajectory Model of Chronic Illness? Unstable Downward Comeback Dying
Dying Explanation: In the dying phase of the Trajectory Model of Chronic Illness, the nurse provides direct care to the client and family through hospice programs. The other options are geared more toward the client who will respond to other treatments.
The nurse is working with a coalition that is creating a global strategy to prevent and control diabetes. The nurse suggests which strategies? Select all that apply. Partnering with the American Diabetes Association Focusing on healthy lifestyle programming Monitoring incidence and prevalence rates Creating policies for diabetes prevention
Focusing on healthy lifestyle programming Monitoring incidence and prevalence rates Creating policies for diabetes prevention Partnering with the American Diabetes Association Explanation: Diabetes is a chronic condition. Global action plans for the prevention and control of chronic illness include interventions such as programs to promote healthy lifestyles to reduce modifiable risk factors for chronic illness. Global action plans should also include monitoring incidence and prevalence rates, creating policy for prevention of chronic illness, and developing partnerships to prevent and control chronic illness.
A client with paraplegia for the past 12 years is hospitalized with pneumonia. It would be best for the nurse to Move the wheelchair to a corner of the room to keep out of the way. Place the client's wheelchair next to the bed for independent transfer. Obtain the assistance of the nursing aide to lift the client to the wheelchair. Raise the bed slightly to ease the client's transferring to the wheelchair.
Place the client's wheelchair next to the bed for independent transfer. Explanation: 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. Moving the wheelchair away from the bed inhibits client independence. Raising the bed will not aid in independent transferring. The nurse should not lift the client if the client can transfer to the wheelchair independently. Facilities are now establishing "no lift" policies to prevent injuries to staff.
An older adult in the hospital with a fractured hip is being prepared for surgical repair. The bilateral hearing aids were forgotten at the client's home and the client is having difficulty hearing. To promote communication, which of the following actions should the nurse perform? Select all answers that apply. Ask the client to repeat what was stated. Talk directly to the client. Use a deeper tone of voice. Speak in a loud voice. Allow the television to remain on while talking to the client.
Talk directly to the client. Use a deeper tone of voice. Ask the client to repeat what was stated. Explanation: Actions that a nurse can take to help a client with hearing loss include the following: talk directly to the client; use a deep tone rather than a high tone; and ask the client to repeat what was stated to ensure understanding. The nurse does not speak in a loud voice, because in doing so, the nurse would use a higher tone, which is more difficult to hear. The nurse should minimize background noises in the room by turning off the television.
Which phase in the trajectory model of chronic illness is characterized by the reactivation of an illness in remission? Crisis Unstable Pretrajectory Stable
Unstable Explanation: The unstable phase is characterized by an exacerbation of illness symptoms, development of complications, or reactivation of an illness in remission. The pretrajectory phase is described as the genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition. In the stable phase the course and symptoms of illness are under control, as symptoms, resulting disability, and everyday life activities are being managed within the limitations of the illness. The crisis phase is a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed.
Which chronic illness directly related to an unhealthy lifestyle does the nurse understand is increasing rapidly? Diabetes mellitus Colorectal cancer Breast cancer Emphysema
Diabetes mellitus Explanation: The increasing prevalence of obesity has increased the incidence of heart disease, strokes, diabetes, and hypertension. Obesity also affects one's self-esteem, achievement, and emotional state (Galuska & Dietz, 2010).
A nursing instructor is lecturing to the junior students about common misconceptions of chronic illness. The instructor asks the students to write down and share some misconceptions with one another. Which of the following are common misconceptions? Select all that apply. Incidence of chronic illness is increasing worldwide. Chronic diseases affect mostly in countries of the developing world. Chronic diseases cannot be prevented. Chronic diseases mainly affect people who are rich. Everyone has to die of something and so chronic illness should not be treated.
Everyone has to die of something and so chronic illness should not be treated. Chronic diseases cannot be prevented. Chronic diseases mainly affect people who are rich. Explanation: Some common misconceptions about chronic illness include that because everyone has to die of something, there is nothing that can be done anyway; chronic diseases cannot be prevented; and chronic diseases mainly affect people who are rich (affluent). One truth about chronic illness is that 80% of deaths from them occur in low- and middle-income countries.
A client is lethargic with a systolic blood pressure of 74, heart rate of 162 beats/min, and rapid, shallow respirations. Crackles are audible in the lungs. The nurse assesses frequently for which of the following? Select all answers that apply. Loss in consciousness Increased paCO² levels Reports of chest pain Ecchymoses and petechiae Decreases in liver enzymes
Increased paCO² levels Reports of chest pain Loss in consciousness Ecchymoses and petechiae Explanation: The client is in the progressive stage of shock. Continuation of shock leads to organ systems decompensating. The client will retain and exhibit increased levels of carbon dioxide. Because of the dysrhythmias and ischemia, the client may experience chest pain and suffer a myocardial infarction. As the client's lethargy increases, the client will begin to lose consciousness. Metabolic activities of the liver are impaired, and liver enzymes will increase. Reference:
Which model of disability is the most appropriate for use by nurses to provide care that empowers clients? Social model Interface model Medical model Rehabilitation model
Interface model Explanation: The interface model is based on the life experiences of the person with a disability and views disability at the intersection of the medical diagnosis of disability and environmental barriers. It promotes care designed to be empowering rather than care that promotes dependence. The social model views disability as socially constructed and as a political issue resulting from the social and physical barriers in the environment. The medical model equates disabled people with their disability and views disability as a problem of the person, directly caused by disease or trauma that requires medical care. The rehabilitation model regards disability as a deficiency that required a rehabilitation specialist or other helping professional to fix the problem.
Chronic illness can be monitored using the Trajectory Model. In what phase can the nurse's nursing diagnosis help in care planning? Pretrajectory Trajectory Downward course Crisis
Trajectory Explanation: The pretrajectory phase is characterized by genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition. 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. The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The downward phase is characterized by rapid or gradual worsening of a condition, including physical decline accompanied by increasing disability or difficulty in controlling symptoms. It requires biographical adjustment and alterations in everyday life activities with each major downward step.
