NUR 109 Exam 3

A patient asks a nurse what the patient-centered care model for the hospital means. What is the nurse's best answer?

"In this model you and the health care team are full partners in decisions related to your health care." Patient- and family-centered care is based on the development of mutual partnerships among the patient, family, and health care team to plan, implement, and evaluate the patient's health care. The patient and the family are at the center of the care and are full partners in decision making.

A patient's family member is considering having her mother placed in a nursing center. The nurse has talked with the family before and knows that this is a difficult decision. Which of the following criteria does the nurse recommend in choosing a nursing center?

*Adequate staffing is available on all shifts. *Social activities are available for all residents. *Staff encourage family involvement in care planning and assisting with physical care. Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat and when it is served. A nursing center should be clean, but it should look like a person's home rather than a hospital.

A nurse who has recently graduated has been assigned to be a primary nurse on a geriatric unit. After completing a review of development and aging, the nurse recalls that changes for the older adult include: A. a transition from young adulthood. B. the ability of the older adult to achieve sexual arousal. C. a time when cognitive performance begins to peak. D. adjusting to decreasing health and physical strength

*D • Older adults have many physiological and psychological changes. It is important for the nurse to know these changes, and to be able to distinguish whether changes are normal or abnormal for the older adult.

A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable at 130/70. The patient does not exercise regularly and states that he experiences weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient?

*Impaired vision *Leg weakness *Exercise history Risk factors for falling include sensory changes such as visual loss, musculoskeletal conditions affecting mobility (in this case weakness), and deconditioning (from lack of exercise). The mere presence of a chronic disease is not a risk factor unless it is a condition such as a neurological disorder that alters mobility or cognitive function. The patient's blood pressure is stable, and there is no report of orthostatic hypotension. A one-floor residence should not pose risks.

physiological changes of older adults

*Integumentary system • Skin: epithelial layer thins, Subcut tissue lost, wrinkles • Lesions: age spots, carcinomas *Head and neck • Facial features: more pronounced (loss of elasticity) • Visual acuity declines •Presbyopia common (can't see close up) • Auditory changes: loss of hearing • Salivary secretion decreases, taste buds lose sensitivity

nurse's attitudes toward older adults

*Nurses must assess their own attitude toward older adults and their own aging, the aging of your family, friends and patients. *Nurses attitudes come from personal experiences, and attitudes of co-workers and employing institutions. *Nurses need to gain knowledge about aging and health care needs of older adults: Respect Dignity Involvement in care decision and activities

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read. His family caregiver will be visiting before discharge. What can the nurse do to facilitate the patient's understanding of his discharge instructions?

*Sit facing the patient so he is able to watch your lip movements and facial expressions. *Present one idea or concept at a time. *Include the family caregiver in the teaching session. Teaching and communication are more effective with older adults when you sit and face the patient and present one idea or concept at a time. This requires planning. Speaking loudly can distort sound. Speak in a normal tone. Sending instructions is helpful but will not directly facilitate the patient's own understanding. Sharing information with a caregiver provides someone to clarify instructions.

During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings place him at risk for an adverse drug event?

*Taking a total of eight different medications during the day *Patient's health history of renal disease The patient is at risk for an adverse drug event (ADE) because of polypharmacy and his history of renal disease, which affects drug excretion. Taking two medications for hypertension is common. Having one physician review all medications and involving a family caregiver are desirable and are safety factors for preventing ADEs.

A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are the major concerns for this patient?

*The loss of his work role *How the wife expects household tasks to be divided in the home in retirement The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time nor is the age of the patient.

A nurse is participating in a health and wellness event at the local community center. A woman approaches and relates that she is worried that her widowed father is becoming more functionally impaired and may need to move in with her. The nurse inquires about his ability to complete activities of daily living (ADLs). ADLs include independence with:

*toileting *bathing *eating ADLs are self-care tasks that measure function and are markers for the ability to live independently. Although driving and daily exercise are important to quality of life and health maintenance, they would not necessarily impact a person's ability to live independently.

Steps to Effective Delegation

-Assess the knowledge and skills of the delegatee. -Match tasks to the delegatee's skills. -Communicate clearly: •Task, outcome, time -Listen attentively. -Evaluate and provide feedback. -NO DELEGATION WITHOUT SUPERVISION

•Nursing manager supports staff through:

-Establishing nursing practice through problem-solving committees or professional shared governance councils -Interprofessional collaboration among nurses and health care providers: helps identify, clarify, and solve complex problems -Interprofessional rounding -Staff communication: same message to all -Staff education: ongoing process in nursing

Nurse executives support managers in...

-Establishing structure to achieve organizational goals -Providing appropriate support to care delivery staff

Leadership-Evaluation

-Evaluate process. -Evaluate patient response. -Evaluate therapy efficacy. -Evaluate patient and expected outcomes.

Risk Factors for Falls in Older Adults-Intrinsic factors

-History of a previous fall -Impaired vision -Postural hypotension or syncope -Conditions affecting mobility/balance/gait -Alterations in bladder function -Cognitive impairment -Adverse medication reactions -Slowed reaction times -Deconditioning

Decision making encompasses

-Responsibility: duties and activities an individual is employed to perform -Autonomy: independent decisions about patient care (maintain standards of practice) -Authority: legitimate power to give commands and make final decisions specific to a given position -Accountability: answerable for the actions

The Five Rights of Delegation

-Right Task -Right Circumstance -Right Person -Right Direction -Right Supervision

decision making-staff involvement

-Transformational leadership -All staff benefit from knowledge and skills of entire work group -Requires skilled communication

Which example demonstrates a nurse performing the skill of evaluation? A. The nurse explains the side effects of the new blood pressure medication ordered for the patient. B. The nurse asks a patient to rate pain on a scale of 0 to 10 before administering the pain medication. C. After completing the teaching, the nurse observes a patient draw up and administer an insulin injection. D. The nurse changes a patient's leg ulcer dressing using aseptic technique

C. After completing the teaching, the nurse observes a patient draw up and administer an insulin injection. Evaluation is one of the most important aspects of clinical care coordination, involving the determination of patient outcomes. Observing a patient do a return demonstration of teaching is evaluation to ensure that patient has understood teaching. Asking a patient to rate their pain on a scale is not evaluation but rather an assessment of the patient's pain because it occurs before administering a pain medication. The other options are interventions.

Health Promotion in older adults-Chronic Lung Disease

COPD 3rd leading COD. Teach smoking cessation, use of inhalers, energy conservation

The nurse sees a 76-year-old woman in the outpatient clinic. She states that she recently started noticing a glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. The nurse suspects that the woman may have:

Cataract(s). Cataracts normally result in blurred vision, sensitivity to glare, and gradual loss of vision. Presbyopia is a common eye condition resulting in a person having difficulty adjusting to near and far vision. The symptoms are not reflective of depression since her vision affects her ability to interact. She has not chosen to avoid her friends.

four concepts for patient-centered care

1. respect and dignity, ensuring that the care provided is given on the basis of a patient's and family's knowledge, values, beliefs, and cultural backgrounds 2. information sharing, meaning that health care providers communicate and share information so patients and families receive timely, complete, and accurate information to effectively participate in care and decision making 3. participation, whereby patients and families are encouraged and supported in participating in care and decision-making 4. collaboration, demonstrated by the health care leaders collaborating with patients and families in policy and program development , implementation, and evaluation and patients who are fully engaged in their healthcare.

three key points to ensure an age-specific approach

1. the interrelation between physical and psychosocial aspects of aging 2. the effects of disease and disability on functional status 3. tailoring the nursing assessment to an older person

The nurse manager from the surgical unit was awarded the nursing leadership award for practice of transformational leadership. Which of the following are characteristics or traits of transformational leadership displayed by award winner? CORRECT A. The nurse manager regularly rounds on staff to gather input on unit decisions. B. The nurse manager sends thank-you notes to staff in recognition of a job well done. C. The nurse manager sends memos to staff about decisions that the manager has made regarding unit policies. D. The nurse manager has an "innovation idea box" to which staff are encouraged to submit ideas for unit improvements. E. The nurse develops a philosophy of care for the staff.

A,B,D

2. Which of the following might be a cause of stress for the older adult? A. Financial security B. Planned retirement C. Housing D. Adjusting to decreasing health and physical strength

A,C,D

As a nurse, you are assigned to four patients. Which patient do you need to see first? A. The patient who had abdominal surgery 2 days ago who is requesting pain medication. B. A patient admitted yesterday with atrial fibrillation with decreased level of consciousness. C. A patient with a wound drain who needs teaching before discharge in the early afternoon. D. A patient going to surgery for a mastectomy in 3 hours who has a question about the surgery.

B. A patient admitted yesterday with atrial fibrillation with decreased level of consciousness This patient is of high priority. The patient is experiencing the physiological problem of decreased level of consciousness, which is an immediate threat to his or her survival and safety. The nurse must intervene promptly and notify the health care provider of the life-threatening problem.

Elder Mistreatment-Financial exploitation

illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder. ex: cashing check without authorization or permission, forging a signature, stealing money or possessions, coercing a signature on a financial document, forcing improper use of guardianship or power of attorney, unpaid bills.

The staff on the nursing unit are discussing implementing interprofessional rounding. Which of the following statements correctly describe interprofessional rounding? A. Allows team members to share information about patients to improve care B. Provides an opportunity for early patient discharge planning C. Improves communication among health care team members D. Allows each of the health care team members to identify separate patient goals E. Allows each health care provider an opportunity to delegate a task.

A,B,C

A nurse asks a nursing assistive personnel (NAP) to help the patient in room 418 walk to the bathroom right now. The nurse tells the NAP that the patient needs the assistance of one person and the use of a walker. The nurse also tells the NAP that the patient's oxygen can be removed while he goes to the bathroom but to make sure that it is put back on at 2 L. The nurse also instructs the NAP to make sure the side rails are up and the bed alarm is reset after the patient gets back in bed. Which of the following components of the "Five Rights of Delegation" were used by the nurse? A. Right task B. Right circumstances C. Right person D. Right direction/communication E. Right supervision/evaluation

A,B,C,D

While administering medications, a nurse realizes that a prescribed dose of a medication was not given. The nurse acts by completing an incident report and notifying the patient's health care provider. The nurse is exercising:

Accountability. Accountability is nurses being answerable for their actions. It means that nurses accept the commitment to provide excellent patient care and the responsibility for the outcomes of the actions in providing it. Following institutional policy for reporting medication errors demonstrates the nurse's commitment to safe patient care.

The nurse is completing an admission assessment with an 80-yearold man who experienced a hip fracture following a fall. He is alert, lives alone, and has very poor hygiene. He reports a 20-pound weight loss in the last 6 months following his wife's death, as well as estrangement from his only child. He admits to falls before this most recent fall. What should the nurse suspect?

Alcohol abuse. Hallmarks of alcohol abuse include frequent falling, self-neglect, and poor nutrition, which could result in weight loss and may accompany depression and loss.

Sexuality is maintained throughout our lives. Which of the following answers best explains sexuality in an older adult?

All older adults, whether healthy or frail, need to express sexual feelings. Sexuality is normal throughout the life span, and older adults need to be able to express their sexual feelings.

A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. She notes that the patient is very thin and unkempt, has a stage 3 pressure ulcer to her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son who accompanied her to the hospital. The nurse's next step is to:

Ask the son to step out of the room so she can complete her assessment. The assessment leads you to suspect elder mistreatment, but the nurse needs more information directly from the patient before calling social services or the adult protective services. She will best get this information by asking the son to leave so she can ask the patient direct questions privately. If the son refuses to leave, this will be another indication that elder mistreatment may be occurring. Cognitive testing will be important but is not the priority.

A travel nurse has taken an assignment at a health care facility where nurses assume responsibility for a caseload of patients over a period of time. This type of nursing exemplifies: A. team nursing. B. primary nursing. C. functional nursing. D. decentralized management.

B The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members. Primary nursing supports a philosophy regarding nurse and patient relationships.

A newly graduated nurse is assigned to care for a team consisting of herself and a certified nursing assistant. When delegating skills, she needs to: A. assign only bed-making and feeding skills. B. assess the knowledge of the certified nursing assistant. C. remind the staff member that she is working under the license of the RN. D. allow the staff member to perform only skills that the RN is able to teach certified nursing assistants to perform.

B • The reason for ascertaining the nursing assistant's knowledge and skills is because the nurse does not want to delegate tasks that the assistant may not be able to do, thus, putting the patient's care in jeopardy.

At 1200 the registered nurse (RN) says to the nursing assistive personnel (NAP), "You did a good job walking Mrs. Taylor by 0930. I saw that you recorded her pulse before and after the walk. I saw that Mrs. Taylor walked in the hallway barefoot. For safety, the next time you walk a patient, you need to make sure that the patient wears slippers or shoes. Please walk Mrs. Taylor again by 1500." Which characteristics of positive feedback did the RN use when talking to the nursing assistant? A. Feedback is given immediately. B. Feedback focuses on one issue. C. Feedback offers concrete details. D. Feedback identifies ways to improve E. Feedback focuses on changeable things. F. Feedback is specific about what is done incorrectly only.

B,C,D,E

Which of the following are components of interprofessional collaboration? A. Interprofessional education does not impact the collaboration among interprofessional team members. B. Nurses are often viewed as the team leader because of their coordination of patient care. C. Effective interprofessional collaboration requires mutual respect and trust from all team members. D. Open communication improves the collaboration among the interprofessional team members. E. The goal of interprofessional collaboration is to improve the quality of patient care.

B,C,D,E

A nurse assesses patients and uses assessment findings to identify patient problems and develop an individualized plan of care. The nurse is displaying:

Clinical decision making. Clinical decision making depends on the application of the nursing process. You first complete a patient assessment so you are able to make accurate judgment about the patient's nursing diagnoses and health problems. The next step is to complete a plan of care for the patient. You use critical thinking in the clinical decision process.

A nurse who has recently graduated has been assigned to be a primary nurse on a geriatric unit. After completing a review of development and aging, the nurse recalls that changes for the older adult include: A. a transition from young adulthood. B. the ability of the older adult to achieve sexual arousal. C. a time when cognitive performance begins to peak. D. adjusting to decreasing health and physical strength.

D • Older adults have many physiological and psychological changes. It is important for the nurse to know these changes, and to be able to distinguish whether changes are normal or abnormal for the older adult.

The nurse is completing a health history with the daughter of a newly admitted patient who is confused and agitated. The daughter reports that her mother was diagnosed with Alzheimer's disease 1 year ago but became extremely confused last evening and was hallucinating. She was unable to calm her, and her mother thought she was a stranger. On the basis of this history, the nurse suspects that the patient is experiencing:

Delirium Hallmark characteristics of delirium are acute confusion, hallucinations, and agitation. It is not a new onset of dementia since she already has a diagnosis of Alzheimer's disease and, as dementia worsens, we see a gradual rather than sudden changes in memory usually not accompanied with hallucinations. Depression does not present with acute confusion and agitation.

Health Promotion in older adults-dental problems

Dental caries, gingivitis, broken or missing teeth, and ill-fitting or missing dentures affect nutritional adequacy, cause pain, and lead to infection

A nurse conducted an assessment of a new patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing:

Depression. Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation.

ageism

Discrimination based on age

Older adults frequently experience a change in sexual activity. Which best explains this change?

Frequency and opportunities for sexual activity may decline. As a result of loss of a loved one or a chronic illness in themselves or their partner, opportunities for sexual activity may decline. Aging does not change the need for touch, and older adults are diverse.

A registered nurse (RN) is providing care to a patient who had abdominal surgery 2 days ago. Which task is appropriate to delegate to the nursing assistant?

Helping the patient ambulate in the hall Helping the patient with activity is within the scope of nursing assistive duties. The other activities require the skill and knowledge of the RN.

Which task is appropriate for a registered nurse (RN) to delegate to a nursing assistant?

Helping the patient to the bathroom before leaving for the operating room. Assisting the patient with toileting activities is within the scope of nursing assistive duties. The other activities require the skill and knowledge of the RN.

Health Promotion in older adults-exercise

Helps maintain functional abilities

The nurse is working with an older adult after an acute hospitalization. The goal is to help this person be more in touch with time, place, and person. Which intervention will likely be most effective?

Reality orientation Reality orientation is a communication technique that can help restore a sense of reality, improve level of awareness, promote socialization, elevate independent functioning, and minimize confusion.

Team Communication

Respect others' ideas. Share information. Stay informed. Strive to improve your communication. Share expectations of communication. Use structured communication techniques

Health Promotion in older adults-Smoking

Risk factor for many diseases, encourage cessation

case management

• a care-management approach designed to coordinate and link health care services across all levels of care for patients and their families while streamlining costs and maintaining quality • Focused on achieving patient outcomes within effective time frames and with available resources.

Nursing care delivery models

Team nursing Primary nursing Case Management Nursing total patient care patient centered care

A nursing student is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature was 37.1° C (98.8° F). The student reports her recent assessment to the registered nurse (RN): the patient's temperature is 37.2° C (99° F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend first?

Tell the student that he will notify the patient's health care provider of the findings and recommend a urine culture The patient may have subtle symptoms of a urinary tract infection, as evidenced by a slight increase in body temperature, development of confusion, and the dark-colored urine. Temporary confusion is not a normal condition in older adults. Increasing the fluid intake is acceptable but not a recommendation for the set of symptoms the patient presents. The presenting set of symptoms is not normal.

Polypharmacy

The use of many different drugs concurrently in treating a patient, who often has several health problems.

After a nurse receives a change-of-shift report on his assigned patients, he prioritizes the tasks that need to be completed. This is an example of a nurse displaying which practice?

Time management Completing a priority to-do list is a useful time-management skill. Change-of-shift report can help you sequence activities on the basis of what you learn about the patients' conditions and the care the patient has received.

Patient-and family-centered care

a model of nursing care in which mutual partnerships among the patient, family, and health care team are formed to plan, implement, and evaluate the nursing and health care delivered

Committed nurse executive + excellent manager +empowered staff =

an enriched work environment where nursing practice thrives

Elder Mistreatment-self neglect

behavior of an older adult that threatens his or her own well being or safety; disregard of one's personal health or environment, causing unmet needs.

Stereotypes of and myths about older people

ill, disabled, physically unattractive, forgetful, confused, rigid, bored, unfriendly, unable to understand and learn new information, poor,

Elder Mistreatment-sexual abuse

consensual sexual contact or activity of any kind; coercing an elder to witness sexual behaviors ex: unwanted touching, rape, sodomy, forced watching of pornography, coerced nudity, sexually explicit photography.

Elder Mistreatment-abandonment

desertion of vulnerable elder by anyone who has assumed the responsibility for care or custody of that person. ex: desertion at a hospital, nursing facility, or public location such as a shopping center.

Health Promotion in older adults-sensory impairment

glasses and hearing aids

Elder Mistreatment-Physical abuse

inflicting or threatening to inflict physical pain or injury on a vulnerable older adult or depriving him or her of a basic need. ex: hitting, beating, physical restraint, untreated injuries

Elder Mistreatment-caregiver neglect

refusal or failure by those responsible to fulfill caregiving activities, duties, protection, or obligations, may be intentional or unintentional because of lack of resources or education. ex: refusal or failure to provide basic necessities such as food, water, clothing, shelter, personal hygiene, or medication, unsafe and unclean living conditions, soiled bedding, animal or insect infestation

Decentralized management in health care organizations means that decision making occurs at what level?

the level of the staff

Elder Mistreatment-Psychosocial/emotional abuse

verbal and nonverbal acts that inflict mental pain, anguish, and distress ex: insults, threats, humiliation, intimidation, harassment, social isolation

A registered nurse performs the following four steps in delegating a task to a nursing assistant. Place the steps in the order of appropriate delegation. 1. Do you have any questions about walking Mr. Malone? 2. Before you take him for his walk to the end of the hallway and back, please take and record his pulse rate. 3. In the next 30 minutes please assist Mr. Malone in room 418 with her afternoon walk. 4. I will make sure that I check with you in about 40 minutes to see how the patient did.

• 3, 2, 4, 1 This is the sequence for effective delegation. The nurse delegated the task of walking a patient to the nursing assistant, which is in the scope of the nursing assistant's duties and responsibilities and matched to his skill level. The nurse provided clear directions by describing the task (the walk, taking and recording the pulse), the desired outcome (walk to the end of the hallway and back), and the time period (within the next 30 minutes). The nurse then told the nursing assistant that she would follow up with him to check how the patient did. By asking the nursing assistant if he had any questions, the nurse provided him an opportunity to ask questions for clarification.

Health Promotion in older adults-Stroke

• 4th leading COD • Teach risk factors and early warning signs

developmental tasks for older adults

• Adjusting to decreasing health and physical strength • Adjusting to retirement and reduced or fixed income • Adjusting to death of a spouse, children, siblings, friends • Accepting self as aging person • Maintaining satisfactory living arrangements • Redefining relationships with adult children and siblings • Finding ways to maintain quality of life

Clinical Decisions

• Apply the nursing process • Know your patient • Use clinical decision-making practices • Accurate clinical decision-making keeps you focused on the proper course of action • Inaccurate decisions can result in poor outcomes

Use of Resources

• Appropriate use of resources is an important aspect of clinical care coordination. -Delegate appropriately -Consulting with an experienced RN confirms findings •Administration of patient care occurs more smoothly when staff members work together. -Ask for assistance with complicated procedures -A leader knows his or her limitations and seeks professional colleagues for guidance and support.

Health Promotion in older adults-Falls

• Can result if hip, leg, spine pelvic fractures • Assess home environment for risks, OT and PT consults for strengthening, encourage cane or walker as appropriate

Health Promotion and Maintenance: Physiological Concerns for older adults-Cancer

• Cancer second most common cause of death • Nurses educate older adults about early detection, treatment, and cancer risk factors. • Non-healing skin lesions • Unexpected bleeding, • Change in bowel habits • Nagging cough • Lump in breast or another part of body • Change in a mole • Difficulty swallowing, and unexplained weight loss

Leadership Skills for Nursing Students

• Clinical Care Coordination • Team Communication • Delegation • Knowledge Building

primary nursing

• developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members. • it was popular in the 70s and 80s • typically not practiced today because of cost.

Clinical Care Coordination

• Clinical care coordination includes clinical decision making, priority setting, use of organizational skills and resources, time management, and evaluation. • The activities of clinical care coordination require use of critical reflection, critical reasoning, and clinical judgment. • They are important first steps in developing a caring relationship with a patient. • Use a critical thinking approach, applying previous knowledge and experience to the decision-making process.

Risk Factors for Falls in Older Adults-extrinsic factors

• Environmental hazards outside and within the home such as poor lighting, slippery or wet flooring, items on floor that are easy to trip over, furniture placement and other obstacles to ambulation, sidewalks and stairs in poor repair. • inappropriate footwear • unfamiliar environment of a hospital room that contains barriers to movement (e.g., clutter, equipment, poor lighting at night) • improper use of assistive devices.

Polypharmacy Application to Nursing Practice

• Have patients and family caregivers ensure that one provider knows all medications that a patient is prescribed. This is especially important if a patient sees several physicians. • consider a possible ADE when a patient develops a new behavior or clinical change; consult the physician and a clinical pharmacist. • reconcile medications at the time of hospital admission and discharge to identify potentially inappropriate prescriptions • review herbal supplements, vitamins, and OTC medications in combination with prescription drugs for potential ADEs • review medication sin older adults' medications in long-term settings routinely (monthly) • use non-pharmacological treatments known to be effective when possible.

Responsibilities of a Nurse Manager

• Help staff in establishing annual goals for the unit and systems needed to accomplish goals • Monitor professional nursing standards of practice on the unit • Develop an ongoing staff development plan, including one for new employees • Recruit new employees (interview and hire) • Conduct routine staff evals • Establish self as a role model for positive customer service. • Submit staffing schedules for the unit • Conduct regular patient rounds and problem solve patient or family complaints • Establish and implement a unit quality improvement plan • Review and recommend new equipment for the unit • Conduct regular staff meetings • Make rounds with health care providers • Establish and support staff and interdisciplinary committees

educating older adults

• Inadequate health literacy disproportionately affects older adults in the United States, causing misunderstanding of health information and subsequent non-adherence. • Nurses must use more than words when teaching older adults • Assist in selecting, understanding, and using health-related information about medications

Healthy People 2020 goals for older adults

• Increase the number of older adults with one or more chronic conditions who report confidence in maintaining their conditions. • Reduce the proportion of older adults who have moderate-to-severe functional limitations. • Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-term physical activities. • Increase the proportion of older adults who receive diabetes self-management benefits. • Increase the proportion of the health care workforce with geriatric certification.

A nurse is teaching a patient about wound care that will need to be done daily at home after the patient is discharged. This is which priority nursing need for this patient?

• Intermediate priority Teaching patients wound care for discharge is an intermediate priority. Intermediate priorities are non-emergency, non-life threatening, actual or potential needs that the patient and family members are experiencing.

Health Promotion in older adults-Nutrition

• Many situational factors will affect • Often malnourished • Home-delivered meals are an excellent source of nutrition for older adults.

Health Promotion in older adults-Alcohol abuse

• May result from depression, loneliness, lack of support • Assess risk, educate RE treatment options

Health Promotion in older adults-medication use

• Med teaching • Assess for polypharmacy-review med list at each visit • Med reconciliation after acute care discharge

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient?

• Provide only the information that the patient needs to go home • This patient is in denial; thus it is appropriate to give her only information that is needed immediately.

total patient care

• Registered nurse works directly with patient, family, and health care team members. • RN is responsible for patients during shift of care, although care can be delegated. • Approach may not be cost-effective owing to high number of registered nurses needed. • Patient satisfaction is high. • original care delivery model of Florence Nightengale

psychosocial changes in older adults

• Retirement: fixed incomes, requires letting go of old habits, developing new interests • Role changes can be stressor for spouse and family • Social Isolation: • Experienced by many elderly •Vulnerability increases when elderly are alone • Housing and Environment: •Ability to live independently determines housing choices •Need to assess if patient's home environment is safe prior to discharge

Health Promotion and Maintenance: Physiological Concerns for older adults

• To increase the desire for older adults to participate in health promotion, use an individualized approach, taking into account a person's beliefs about the importance of staying healthy and remaining independent. • Limitations in ADLs limit the ability to live independently. • Most older adults want to remain independent and prevent disability. • Heart disease: leading cause of death in US • Nursing interventions for hypertension and coronary artery disease address

Nursing interventions for hypertension and coronary artery disease address

• Weight reduction and exercise • Dietary changes (limiting salt and fat intake) • Stress management, and smoking cessation. • Patient teaching: information about medication management, blood-pressure monitoring, and the symptoms indicating the need for emergency care.

Selection of a Nursing Center or Home-desirable features

• does not feel like a hospital, it is a home, a place where people live. Residents are encouraged to personalize their rooms. Privacy is respected. • is Medicare and Medicaid certified • has adequate, qualified staff members who have passed criminal background checks • provides quality care, in addition to assistance with basic ADLs. Staff regularly help residents with social and recreational activities. • offers quality food and mealtime choices • welcomes families when they visit the facility. Whether families wish to provide information, ask questions, participate in care planning, or help with social activities or physical care, staff always encourage family involvement. • is clean. There are no pervasive odors in the facility. The environment feels homelike • attends quickly to resident requests. Staff are actively involved with assisting the residents. They focus on the person, not on the task.

team nursing

• the RN is the leader who leads a team of other RN's, practical nurses, and nursing assistive personnel who provide direct patient care. • developed in response to the severe nursing shortage following

Time Management

•A skill you will develop over time -Anticipate the activities of the day and combine activities when possible •Remain goal oriented. -Don't rest at work until all care delivery and tasks completed -You never know what will happen next •Identify priorities. -"To do" list (organizational tool)

Priority Setting

•Determine which patient's needs should be addressed first: -High priority: immediate threat to patient survival or safety (Emergent) -Intermediate priority: nonemergent, non-life threatening (Urgent) -Low priority: actual or potential problems may or may not be directly related to patient's illness or disease (non-urgent) -Know frameworks and apply appropriately

Organizational skills

•Have an organizational tool and use it •Do the right things. •Do things right. •Inform and prepare patient. •Gather all needed equipment. •Clean and organize work area. •Keep patient's needs at the center of attention. •Document assessments and interventions in a timely manner

Knowledge Building

•Remaining competent provides the foundation for further skill building. •Lifelong learning allows you to continuously provide safe, effective, quality care. •In-service programs, workshops, professional conferences, professional reading, and collegiate courses offer innovative and current information on the rapidly changing world of health care. •Ongoing development of skills in delegation, communication, and teamwork helps maintain and build competency!

delegation

•Transfers responsibility while remaining accountable for outcomes •Requires knowing which skills are transferable •Results in improved quality, safe patient care, improved efficiency, increased productivity, an empowered staff, and skill development of others