CRRN Test 1
L2
Mid anterior thigh
Maslow presented confidence, achievement, respect of others and respected by others as examples of which need
Esteem
Sleep deprivation causes
Psychosis
Functional Incontinence
Pt is aware he needs to void due to dementia altimerz / need to remove environmental barriers
How often should clients be repositioned in bed to maintain skin integrity?
Q 2 hours
How often should clients be repositioned in a chair to maintain skin integrity?
Q15 minutes
The cure for Autonomic Dysreflexia is
Quickly assess the stimulus causing the hyperreflexia, then alleviate the cause. i.e., over distended bladder-catherize, fecal impaction-manually disimpact, decubitus ulcer-alleviate pressure, restrictive shoes or clothes-loosen.
What are the two separate stages in the sleep cycle?
REM (rapid eye movement) & NREM (non-rapid eye movement)
You dream the most during
REM (rapid eye movement) cycle
Semantic language or substantive word stage is at what age?
18 - 36 months
What year did Clara Barton form the red cross
1877
1 st rehab act was formed in what year
1920
Vocational rehab act was formed in what year
1943
Alice Morrissey first book of rehab was formed
1951
Medicaid was Enacted in what year
1965
Medicare began with the SSA in what year
1965
ANA published first guidelines on the need for rehab nursing in what year forming CARF
1966
Rehab Act
1973
When was Association of Rehab nursing started?
1974
Balance Budget Act
1997 -which required pps( is prospective payment system) required used of resource utlization groups (RUGS)
Eyes open to verbal command
3
Flexes abnormally (Decorticate Posturing) (Motor Response)
3
Uses inappropriate words (Verbal Response)
3
A client at this Rancho Los Amigos level will respond to discomfort by pulling tubes or restraints, is inconsistent in responses to simple commands, and may respond to some people (family friends) but not others.
3 localized response
Female puberty begins at what age?
8 to11
how likely is it that you will have a recurrance after a TIA within a year?
80%
ischemic stroke
87% of strokes, vessel occulsion where focal areas of the brain receive diminshed or no blood supply
American Nurse's Association Code of Ethics has ____ provisions
9
Male puberty begins at what age?
9 - 15
A client at this Rancho Los Amigos level is able to shift back and forth between tasks and completes them independently for at least 2 consecutive hours. Uses assistive memory devices to recall daily schedules and "to do" lists. Initiates and carries out steps to complete familiar personal, household, work and leisure tasks with assistance when requested.
9 Purposeful, appropriate: standby assistance
Diarrhea, dependent edema, diuretics, diabetes insipidus, wound exudate, excessive sweating are all causes of?
Extracellular fluid loss
Where do most stokes lesions occur
Middle cerebral artery
Which drug classes can suppress desire and sexual function?
SSRI's, tranquilzers, tricyclic antidepressants, diuretics, antihistamines, narcotics, street drugs, horrmones, H2 antagonists
Untreated dehydration/hypovolemia progresses to what?
Shock
Metformin
Shuts off the liver glucose production
A multifaceted concept that includes instrumental support, affective support, and cognitive support.
Social support
The enrichment of the patient's life through interactions with family, friends, and society
Support System Enhancement - have friends visit, peer support groups
Initial recognition of pain and temp
Thalamus
Pleasant vs unpleasant feelings
Thalamus
Relay Station
Thalamus
What act required all public buildings and transportation be made accessible to all. Which also prohibits discrimination against people with disabilities in the workplace.
The Americans with Disabilities Act of 1990.
What prohibits employment discrimination against qualified people with disabilities in the private sector and in state and local governments.
The Americans with Disability Act (ADA)
What prohibits employment discrimination base on race, color, religion, sex or national origin?
The Civil Rights Act of 1964
What act defined the term " developmental disability"
The Developmental Disablities Assistance and Bill of Rights Act of 2000
The purpose of energetic touch is to remove
blockages in the energy field to promote healing.
Affective support as part of social support includes
concern, being loved, feeling important and support presence
muscular dystrophy
genetic disesases that cause degeneration of muscle fibers
cystic fibrosis
genetic disese that affect exocrine glands
cystic fibrosis
genetic disorder of the exocrine gland that produces abnormal thick mucus
middle child hood 6-12 years old
give child task to do to help lead to sense of accomplishment and purpose allow contact to see peers
Consolidated Omnibus Budget reconcilation Act
gives people in specific categories the right to continue health coverage for up to 18 months after they quite or have been fired
The goal of rehab nursing
" assisting the individual with a disability or a chronic disease toward maximal health through health restoration, maintenance, and promotion.
What is a mechanical embolus clot removal and in what time period must it be done?
"cork screw" removal of a embolus must be done 8 hours post onset
A state in which an individual or family experiences a natural human response involving psychosocial and physiologic reactions to actual or perceived loss is termed
"grief associated with disability"
Rehabilitation definition
"the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems relative toaltered funtional ability and lifestyle." (ARN, 2000, pg4)
Rehab nursing is defined as
'the diagnsosis and treatment of human responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle"
State the defining characteristics of Ineffective Family Therapeutic Regimen Management
- Acceleration of family member's illness symptoms - Failure to take action to reduce risk factors - Participation in inappropriate family activities for meeting health goals - Lack of attention to illness - Verbalization of difficulties with therapeutic regimen
Websites for health information should be evaluated using the following criteria:
- Accuracy - Authority - Objectivity - Currency - Coverage
What are the risk factors for Risk of Falls?
- Age (adults age 65 and older) - history of falls, - lower limb prosthesis, - use of assistive devices, - impaired sensation or perception (temperature, touch, positive sense, vision and hearing), - unmet elimination need or urinary incontinence, - use of chemical or physical restraints, - environmental hazards, - lack of knowledge related to safety, and - impaired mobility
Assessment for ineffective health maintenance depends on which client aspects?
- Client's self-management abilities and knowledge - emotional and spiritual state, and - social support system
What are the defining characteristics of Ineffective Community Therapeutic Regiment Management?
- Deficits of advocates for the aggregates, - deficits in community activities for prevention, and - insufficient healthcare resources
State some of the nursing interventions for Ineffective Family Therapeutic Regimen Management.
- Determine the types of equipment, supplies, and services that are lacking. - Identify who in the client's support system is willing to develop the strategies necessary to improve management of therapeutic regimen - Foster the client's advocate in promoting the client's wellness and health management - Educate the client and the client's primary advocate on their learning level
State some of the interventions for ineffective health maintenance.
- Educate the client at their learning level - Determine readiness to learn - Use memory aids - Help the client identify and begin to resume family role responsibilities - Identify adaptation strategies - Assist client and family develop stress management skills
In what ways can the rehabilitation nurse promote good nutrition to patients?
- Helping the client understand the importance of diet and encouraging dietary compliance; - assisting those who need help with the eating process; - taking and recording client weight and calorie counts: - observing clinical signs of poor nutrition and reporting them; - serving as a communication link between the client, dietician, physician, and other members of the healthcare team.
State the nursing roles in community-based rehabilitation settings.
- Partner - Educator - Planner - Coordinator - Resource manager - Evaluator of client outcomes - Client advocator
Name the five core self-management concepts around which outcomes and interventions are developed to promote self-efficacy in the Health Promotion Model.
- Problem solving - Decision making - Resource use - Collaboration - Action
List some interventions that should be incorporated wen feeding a dysphagia client.
- Seat client upright (preferably 90 degrees) - minimize distractions (such as no TV or talking) - select appropriate food consistency and texture and progress to less restrictive measures as appropriate. - place food on the unaffected side of the mouth, small bites, chin tuck, head turn, or fluids by spoon or cup only. - tongue sweep, double swallow, small sips of water between bites, adaptive equipment for self-feeding, and remain upright for 20-30 minutes after eating a meal.
What are the diagnostic tests/data that help in determining a client's nutritional status?
- The serum albumin indicates available protein stores - Hemoglobin indicates the ability to transport oxygen - Glycohemoglobin (hemoglobin A1C) indicates average blood glucose during the last 3 months - Prealbumin level indicates nutritional status, protein synthesis and catabolism
What are unmodifiable risk factors for stroke?
- age - being male is greater likelihood - having had a previous stroke or TIA (BEST PREDICTOR) - family history
How to put advocacy in action?
- assessment - planning and - implementation
What factors affect the artery walls putting them at a greater risk of stroke?
- atherosclerotic plaques - dissecting walls - damage leading to pressure on the walls, leading to rupture - congenital abnormalities
How do you diagnose dysphagia?
- bedside assessment - video fluoroscopic swallow study - endoscopic evaluation of swallowing - other signs (pocketing, leakage, delayed or prolonged swallowing, frequent pneumonia, malnutrition, and weight loss)
What are the benefits of client education?
- better outcomes for client and family - improved client and family satisfaction - continuity of care - cost containment and, - improved staff satisfaction
What is a lacunar infarction
- blocks vessels going to deep brain centers - leads to vascular cognitive impairment
4 preventative measures of recurrent stroke?
- exercise - anticoagulants - lipid lowering agents - lifestyle change
What are interventions that can be used to maintain skin integrity?
- good nutritional support - use supplement if needed (protein or calorie malnutrition inhibits wound healing by reducing fibroblast and collagen synthesis). - manage tissue loads by repositioning every 2 hours in bed and weight shift every 15 minutes in chair. - Cushion bony prominence, provide adequate support, avoid placing the client on an existing ulcer, protect skin from friction and shearing, elevate heels off the mattress, and maintain the head of bed at or below 30 degrees unless contraindicated. - other inventions: overhead trapeze for increased bed mobility and appropriate pressure redistribution mattress.
What are the modifiable risk factors of stroke?
- hypertension - CVD - DIabetes - Cholesterol - Smoking - Obesity - cocaine use - oral contraceptives (with smoking - may cause hemorage strokes)
what venous factors pose a risk of stroke?
- inflammation of the inner lining - slow blood flow - poor return, inactivity - DVT - inactivity, surgery, damage
Causes of dysphagia?
- radiation treatment - stroke, - worsening dementia, - myasthenia gravis and - amyotropic lateral sclerosis (ALS)
What are the 5 sypmtoms of a brain attack?
- sudden dizziness/ balance issues - sudden visual problems - sudden disturbance of speech - sudden numbness or weakness of the face, arm or leg (on one side of the body)
hospitalized/rehab of toddler of 1-3yrs old
-distressed child since can not follow routine sleep, eating and may regress -loss of control is frightening -seperation anxiety, lack of time perception,coping mechanism may be lost
significance of family on rehab
-needs of the family can be anticipated depending on the stage of family -caution when nurses assess and assist nontraditional families -support from families influence feelings of well-being when attachment promote security
Anomia
...
If a stroke is ignored the prognosis is worse
...
Piaget's sensorimotor stage of development occurs at what age?
0-2 years of age
measurement in key muscle
0=total paralysis 5=normal active movmement
No motor response (Flaccid Coma) (Motor Response)
1
No response (Eye Opening)
1
No response (Verbal Response)
1
motor/sensory paralytic neurogenic
1 disruption of sacral reflex in cord at s-2,3,4 2. causes-trauma, tumors,diabetic neuropathy,ms-sensory 3.absent bulbocavernous 4, males have problem starting stream, need to strain, overflow incontinence 5. absent saddle sensation 6. variable sensation 7. lack of pain, fullness, temp, lrg voids, overflow
Olfactory
1 or I smell
Put in correct order for extracellular fluid deficit process: Rise in Serum Sodium Level, Kidneys Retain Water, Increased concentration of dilutes in blood, Loss of Body Fluids, Increased Water Intake, H2O molecules shift out of cells, Thirst
1)Loss of Body Fluids 2)Increased concentration of dilutes in blood 3)Rise in Serum Sodium Level 4)H2O molecules shift out of cells 5)Kidneys retain water 6)Thirst 7)Increased water intake
Elderly are at risk for dehydration because?
1)Lower body/water content 2)decreasing kidney function 3)Diminished ability to sense thirst
Name 3-4 strategies to address Uninhibited Neurogenic Bowel
1)avoiding constipation 2)insuring an adequate intake of fluids and fiber (bulk) 3)facilitating adequate exercise 4)weaning from bowel medications if possible 5)using bathroom schedule based on the pt's usual time of defecation 6)using suppositories or mini enemas to stimulate emptying at a predictable time, if bathroom scheduling is ineffective 7)making sure it is easy for the pt to get to the bathroom in a timely manner
Features of Uninhibited Neurogenic Bowel are:
1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal or hyperactive bulbocavernous reflex 4)sudden defecation with or without urgency 5)hard stool with smearing
Name 3-4 features of Uninhibited Neurogenic Bladder
1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal to hyperactive bulbocavernous reflex 4)sudden voiding with our without urgency, frequency or nocturia 5)decreased bladder capacity
Name 3-4 strategies for Uninhibited Neurogenic Bladder.
1)maintain adequate fluid intake, but avoid exceeding 2000ml/24 hrs 2)decrease fluid intake early in the evening to avoid nocturia 3)use timed voiding, prompted voiding or habit training to increase continence based on the pt's cognitive abilities 4)use bathroom schedules based on the pt's usual time of voiding 5)use anticholinergic meds to decrease detrusor contractility and to increase bladder capacity 6)make sure it is easy for pt to get to the bathroom in a timely manner
Common interventions for constipation in rehab are:
1)manage causative factors (diet, fluids, exercise) 2)utilize gastrocolic reflex to stimulate emptying 3)encourage regular evacuation time 4)place on toilet instead of bed pan
Lab values in untreated hypovolemia/dehydration may indicate what?
1)normal to elevated serum sodium levels (varies w/ the amt of fluid and sodium loss) 2)increased or normal hematocrit levels 3)elevated blood urea nitrogen levels 4)elevated urine specific gravity
Name 3 interventions for functional incontinence
1)respond promptly to requests to void 2)alter clothing and provide adaptive equipment 3)remove environmental barriers
Gilligan's theory
1,individuals define themselves in terms of their ability to from meaningful relationships 2,define themselves in terms of their ability to care for others 3. responsiveness to others in the context of their situation and their own terms
The most common pain assessment tool is
1-10 pain intensity scale, where 1 is barely any pain and 10 is the worst pain ever.
What is the time period for sparing a stroke victim?
1-3 hours - if taken to the hospital within this time period they may receive TPA
Rehab Nursing standards of Care
1. Collection of comprehensive data pertinent to pt.'s health 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation of pt. progress
Standards of professional performance
1. Evaluation of quality of care 2. performance appraisal/ internal evaluation as related to standards and regulations 3. Education, maintaining current knowledge and competency 4. Collegiality 5. Ethics and Advocacy 6. Collaboration with patient, family,& other healthcare providers in providing care 7. Research 8. Resource Utilization 9. Leadership
How does the nurse assess for Risk for Injury?
1. Identifying factors that affect safety needs such as - changes in mental status, - fatigue, - medications, and - motor or sensory deficits 2. Identify environmental factors that create risk for falls; check the client for presence of constrictive clothing, cuts, burns, or bruises.
goals and intervention for MS
1. Improve mobility and NIM fuction 2. Conserve Energy 3. Maintain indep in ADL 4. Improve bladder function and prevent complication 5. improve knowledge
diabetes oral meds
1. Sulfonlureas stimulate insulin prodcution(glyburide,glipazide,glimperide) 2, Biguanides-decrease hepatic glucose production (metformin) 3. Alpha Glucosidase inhib-slow carb/sugar absorption(migiitrol,acarbose) 4.Thiazolidinediones increase insulin sensitivity(Actos) 5. Meglitinides -stimulate insulin production (repaglinide) 6. Dipeptidyl pepidase-improve insulin syntheisis
Social Learning Theories
1. Trust vs mistrust (birth to 1 year) 2. Autonomy vs Shame (1-2 years) 3. Initiative vs Guilt (3-5 years) 4.Industry vs Inferiority (6-12) 5. Intimacy vs Isolation 6. Generativity vs Stagination 7. Integrity vs Despair
Nolan and Nolan described 6 roles of the rehab nurse
1. assessment of patient's physical condition and delivery of needed care 2. Teach and counsel patient 3. be sensitive to and understand patient moods and coping mechanisms 4. Understand family dynamics, 5. deal with issues related to sexuality6. health care liason role and knowledge in health care delivery systems.
areflexic neurogenic
1. damage to pns below L1 2. loss of sphincter control flaccid 3,trauma, spin bifida, herinated disc 4. absent saddle and bulbcavernaus sensation 5. overflow incontinence,weak sensation of fullness 6 stool leakage 7. hard stool impactions
reflex neurogenic
1. disruption of cns system 2. loss if coertica and voluntary spincter 3. damage to umn above t12 4.resulting from trauma, tumor,infection, infarct,MS 5. absent saddle sensation 6.hyperactive bulbcavenous 7. high residual, external reflex will not relax 8. rare sudden incontience due to full rectal vault
long term planning : community services for children and youth
1. school program-IDEA-Individual with disabilites education Act-ensures that all children 3-21 receive free and appropriate public education 2. early intervention services 3. home health care when neede from birth to 3 years old
unhibited neurogenic
1. disrutpion of inhibitory fiber in the brain 2. impaired cortica awareness of urge 3. stroke, tbi, ms, tumore 4. damage to upper motor neuron 5, intact : saddle nerve reflex,intact bulbocavernous 6. uncontrolled voiding, smaller volumes, nocturia, urgency, frequency 7. sudden incontience, hard stool with smearing
criteria for diagnostic of diaberes
1. hbA1c greater than 6.5 2. non-fasting b/s greater than or =200mg/dl 3. Fasting bs greater than 126 4. 2 hr glucose tolerance greater than 200
What are the two types of stroke?
1. ischemic (thrombus, embolic, lacunar) 2. hemoragic (aneurysm, A-V malformation)
Nursing Theory can be viewed as tree with roots and branches
1. metaparadigm of person, environment, health, and nursing represents the roots 2. Florence Nightingale's work froms the trunk of the tree 3. Branches are shaped by 3 theory types interactive-Henderson and Peplau Systems-Neuman and Roy Development-Rogers,Leininger and Watson
s/s of stroke
1. numbness or wekness/paralysis in face/arm or leg 2. sudden confusion, trouble speaking, or understanding 3. trouble seeing 4. sudden ataxia,dizziness, loss of balance 5. sudden severe headache
types of pulmonary diseases
1. obstructive lung disease 2. restrictive lung disease
What are the six weighted elements in the Braden scale to determine the pressure ulcer risk?
1. sensory (ability to respond meaningfully to pressure-related discomfort) 2. moisture (degree to which skin is exposed to moisture) 3. activity (degree of physical activity) 4. mobility (ability to change and control body position) 5. nutrition (usual food intake), and 6. friction and shear (stability of movement in a relaxed position, such as in a bed or chair) The total risk status of the client is determined according to the sum of all the elements on the scale
types of spina bifida
1. spina bifida occult-mildest form posterior lamina does not fuse 2. menigocele-herniation contains no neural tissue 3. myelmeningocele-lesion contains spinal fluid,meinges,spinal nerves and possibly spinal cord.
s/s of MI
1.crushing,squeesing,stabbing chest pain 2, radiation of discomfort down one or both arms or back 3.neck,jaw,teeth pain 4.epigastric pain,n/v 5diaphoresis,weakness,apprehension,lightheadedness,syncope,dyspnea and pallor 6.htn,hypotension
medications for chd
1.diuretics-lasix,hctz,burmex 2,Ace inhibitors-reduce blood volume(captopril,monopril) 3.Arbs-dilate great veins(vasotec,avapro,diovan,cozar 4.calicum channel blockers-reduce blood volume(Norvac,Procardia,Veraparmil) 5.alpha-blockers-dilate vessels-(cardura,hytin,clondine)
gate control theory on pain
1.gating mechanism in spinal cord 2.travel via large A-delta or small c-fibers to spinal cords 3.cells of substantia gelatinosa are gate keeper 4.Large A-delta fibers close the gate 5.Small C-fibers open the gate
4 parts of growth and development for children
1.physical -move and manipulate environment 2. cognitive-communication and solve problems 3. social-establish relationship 4. psychological-develop a sense of awareness,self-image and self confidence
A client with this Rancho Los Amigos level is able to handle multiple tasks simultaneously in all environments but may require periodic breaks. Is able to independently procure, create, and maintain own assistive memory devices. Independentley initiates and carries out all steps to complete familiar and unfamiliar personal, household, community, work, and leisure tasks, but may require more than reasonable time to complete them.
10 Purposeful, appropriate: modified independent.
A client with this Rancho Los Amigos level anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and or compensatory strategies to select the appropriate action. Social interaction behavior is consistently appropriate.
10 Purposeful, appropriate; Modified independent.
Vagus
10 or X swallowing, voice production, heart rate, rate of peristalsis, sensation in throat, thoracic and abdominal viscera
Peripheral Nervous System
11 cranial nerves except CNII, peripheral nerves, connects cns to organs and muscles, no protective coating
Spinal Accessory
11 or XI shoulder and head movement
At what age does Piaget's Formal Operational Stage of development occur?
11-15 years of age
Hypoglossaal
12 or XII tongue movement
On average how much sleep does an 8 month old infant get?
13 hours a day.
The Functional Measurement tool (FIM) is a numeric measure of
13 motor and 5 cognitive functions.
What amendment to the US constitution guarantee the right to die and to decline medical treatment?
14th amendment
Full consciousness receives what score?
15
Extends abnormally (Decerebrate Posturing) (Motor Response)
2
Eyes open to pain
2
Makes incomprehensible sounds (Verbal Response)
2
Optic
2 or II vision
Piaget's Preoperational Stage of development occurs at what age?
2-7 years of age
What percent of stroke victims become permanently disabled?
20%30%
A patient with dysphagia should remain upright (preferably 90 degrees) during the meal and for how long afterwards?
20-30- minutes.
How long do the deficits of a TIA last?
24 hours
At this Rancho Los Amigos score the client's responses are directly related to the type of stimulus, they demonstrate withdrawal or vocalization to painful stimuli, will turn towards auditory stimuli, and blink when strong light enters the visual field.
3 localized response
Oculomotor
3 or III eye movement eyes moving in and out, constricting pupils, accommodating for light
First screening Swallow test
3 ounces of water
How likely is it that you will have a significant stroke within a month after a TIA?
30%
A client is alert with a heightened state of activity. Purposeful attempts to remove restraints or tube or get out of bed. This client can sit, reach and walk but without apparent purpose or upon another person's request....What is his Rancho Los Amigos score?
4
Disoriented/Confused, converses (Verbal Response)
4
Flexes and withdraws from pain (Motor Response)
4
Spontaneous Eye Opening
4
Vygotsky theorical framework
4 basic principles 1. children construct their knowledge. 2. development cannot be seperated from social context 3. learning leads to development 4. language has a major role in mental development
This client has absent short term memory, may cry out or scream out of proportion to stimulus even after the stimuli are removed. May exhibit aggressive or flight behavior. Mood shifts are common from euphoric to hostile with no apparent relationship to environmental events. What is the Rancho Los Amigos score?
4 confused and agitated
This client is unable to cooperate with treatment efforts, makes frequent verbalizations that are incoherent and/or inappropriate to activity and environment. What is the Rancho Los Amigos score?
4 confused and agitated
Trochlear
4 or IV eye movement down and outward.
Emotional lability
Characterized by uncontrollable, fluctuating emotional behaviors (Gaiety, somberness and crying)
How many stages of NREM (non-rapid eye movement) sleep are there and in what stages of NREM sleep do respirations decrease?
4, respirations begin to decrease in the second stage and continues through stages 3 & 4.
Oriented, converses (Verbal Response)
5
To localized pain (Motor Response)
5
A client at this Rancho Los Amigos level is able to respond appropriately to simple commands fairly consistently with external structure and cues. Verbalizations about present events become inappropriate and confabulatory when external structure and cues are not provided.
5 Confused, inappropriate non agitated; maximum assistance.
A client at this Rancho Los Amigos level is alert, not agitated, but may wander randomly or with a vague intention of going home. May become agitated in response to external stimulation and or lack of environmental structure.
5 Confused, inappropriate non agitated; maximum assistance.
A client at this Rancho Los Amigos level is not oriented to person place or time. They demonstrate a severely impaired recent memory, with confusion of past and present in reaction to ongoing activity. This individual is absent goal-directed, problem solving, self monitoring behavior.
5 Confused, inappropriate non agitated; maximum assistance.
A client at this Rancho Los Amigos level often demonstrates inappropriate use of objects without external direction. May be able to previously learned tasks when structured and cues provided. They are unable to learn new information.
5 Confused, inappropriate non agitated; maximum assistance.
Trigeminal
5 or IV chewing, sensations of the face, scalp and teeth
What % of stroke victims recover?
50%
Obeys Verbal Commands (Motor Response)
6
A client at this Rancho Los Amigos level can demonstrate an emerging awareness of appropriate response to self, family, and basic needs. Needs moderate assist to problem solve barriers to task completion. Is supervised for old learning and shows carryover for relearned familiar tasks (e.g., self care).
6 Confused but appropriate needing moderate assistance.
A client at this Rancho Los Amigos level can demonstrate more depth and detail to remote memories than recent memories, has vague recognition of staff, is able to use assistive memory aid with maximum assistance.
6 Confused but appropriate needing moderate assistance.
A client at this Rancho Los Amigos level is inconsistently oriented to person, time and place. They are able to attend to highly familiar tasks in non distracting environments for 30 minutes with moderate redirection.
6 Confused but appropriate needing moderate assistance.
A client at this Rancho Los Amigos level needs maximum assistance for new learning with little or no carryover. Unaware of impairments, disabilities and safety risks. Consistently follows simple directions, and verbal responses are appropriate in highly familiar and structured situations.
6 Confused but appropriate needing moderate assistance.
Abducens
6 or VI outward eye movements
Home plans must be established and reviewed by a physician every _____ days
60
What % of stroke victims require institutional care?What age group does stroke mostly affect?
65+
Requirements for medicare
65, receiving SS for 24 months or those with chronic diseases requiring dialysis or a transplant.These patient are not required to wait the 24 months .
A client with this Rancho Los Amigos level has a superficial awareness of his/her conditin but is unaware of specific impairments and disabilitiesand the limits they place on his/her ability to safely, accurately, and completely carry out his/her household, community, work and leisure ADLs. They are unable to think about consequences of a decision or action. Overestimate abilities, and can be oppositional and uncooperative.
7 Automatic, appropriate: minimal assistance.
A client with this Rancho Los Amigos level is consistently oriented to person & place within highly familiar environments. Requires moderate assistance to orient to time. Is able to attend to highly familiar tasks in a nondistraction environment for at least 30 minutes with minimal assist to complete the tasks.
7 Automatic, appropriate: minimal assistance.
A client with this Rancho Los Amigos level requires minimal supervision for new learning, initiates and carries out steps to complete familiar personal and household routines, but has shallow recall of what he/she has been doing.
7 Automatic, appropriate: minimal assistance.
Facial
7 or VII facial expression, taste, salivation, crying
A comatose client would receive what score?
7 or less
Piaget's Concrete Operational stage of development occurs at what age?
7-11 years of age
A client at this Rancho Los Amigos level is able to record critical information for later use with standby assist, they are able to initiate and carry out steps to complete familiar personal, household, community, work, and leisure routines with standby assist and can modify the plan when needed with minimal assistance.
8 Purposeful, appropriate; standby assist.
A client at this Rancho Los Amigos level is consistently oriented to person, place, and time. Independently attends to and completes familiar tasks for 1 hour in distracting environments and is able to recall and integrate past and recent events. They use assistive memory devices to recall daily schedule and "to do" lists.
8 Purposeful, appropriate; standby assist.
A client with this Rancho Los Amigos level requires no assistance once new tasks or activities are learned. they are aware of and acknowledge impairments and disabilities when they interfere with task completion.
8 Purposeful, appropriate; standby assist.
At what age can an infant understand a few words and has partially intelligible speech?
8 months to 1 year
Acoustic
8 or VIII hearing and equilibrium
Duvalls Life Cycle
8 stage division that allows differential of the family cjamges ad individuals development 1.marriage and the joining of the families 2.families with infants 3. families with preschool-age children 4.families with school-age children 5.families with teenagers 6.families as launching center 7.families of middle years(empty nest) 8. families in retirement
A client at this Rancho Los Amigos level is aware of and acknowledges impairments and disabilities when they interfere with task completionand takes appropriate corrective actions. Acknowledges others' needs and feelings and responds appropriately with standby assistance. Depression may continue. May be irritable and have a low frustration tolerance.
9 Purposeful, appropriate: standby assistance
Glossopharyngeal
9 or IX secretes saliva, swallowing, controls gag reflex, sensation in the throat, and taste
What % of risk factors for stroke are modifiable?
90
Handicap
A disadvantage for a given individual resulting from impairment or disability that limits or prevents fulfillment of a role that is normal for that individual. (Societal level)
Developmental task
A growth responsibility that arises at a certain time in the course of development
What is Wellness?
A journey that each of us takes in our quest for a well-bein of body mind & spirit. Key component s include personal responsibility, body-mind-spirit connectedness; and relationships with self, others, and the environment (Miller 2008)
medical home concept
A medical home is not a building , or hospital, but rather an approach to providing health care services in a high-quality and cost effective manner
Interdisciplinary model
A model in which communication is lateral. Effective when team members are stable (in patient rehab unit). Decision determined by group.
Rehabillitation is
A philosophy An attitude An approach
Definition of Rehabilitation
A process of helping a person to reach the fullest physical, psychological,social, vocational,avocational and educational potential consistent with his/hers physical or anatomic impairment,environmental limitation and desires and life plans.
Disability
A restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. (Level of person)
Self efficacy
A sense of control that is composed of coping with appraising and managing one's life (ex: if I don't believe I can do it I likely will not be able to do it)
What is Health?
A state of complete physical, mental, and social well being and not merely the absence of disease of infirmity (WHO, 1948)
Urge incontinence is characterized by
A strong urge to void, frequency, and nocturia.
The oral preparatory phase of swallowing
A voluntary action where food is prepared, smelled and then salivation occurs. Food is put into the mouth manipulated to form a bolus and then pushed posterior toward the oropharynx.
The oral phase of swallowing
A voluntary action where the tongue is elevated to the roof of the mouth. Lips close to contain oral contents. Buccal and facial tone are necessary for chewing.
Hormone involved in regulation of intracellular fluids. Produced by pituitary gland. Stimulates reabsorption of fluids. Secretion of it increases when blood is concentrated like in dehydration.
ADH Antidiuretic Hormone
Stage Three of Neal's Home Health Theory
AFter approximately two years, the nurse moves into this stage and feels autonomous with regard to logistical and clinical aspects of community centered nursing
Nursing process for cardiac pts
APIE-Assessment,Plan including goals, Implement(interventions), Evaluation
Complete injury without preservation of sensation or motor function in S4-5.
ASIA-A
Incomplete injury with preservation of sensation throughout the cord, including S4-5.
ASIA-B
Incomplete injury with motor function intact below the level of the lesion, though the muscle strength is a grade 2 or lower, functional gain may not be significant due to weakness.
ASIA-C
Incomplete injury with motor function intact below the level of the lesion, muscle strength is a grade 3 or higher, functional gains are usually significant.
ASIA-D
Normal motor and sensory function.
ASIA-E
Above T12 - L1 Injury
Absence of sensation and voluntary control
Defining characteristics of Ineffective Family Therapeutic Regimen Management include:
Acceleration of family member's illness symptoms, Failure to take action to reduce risk factors, Participation in inappropriate family activities for meeting health goals, lack of attention to illness, verbalization of difficulties with therapeutic regimen.
How do you evaluate community accessibility?
Access the transportation for medical care, pharmacy, grocery store, and recreation - Access the outpatient and community services - Limitations and barriers of the home and community - Funding for attendant care - Independent living arrangements
Community accessibility refers to
Access to transportation, outpatient and community services, funding for attendant care, independent living arrangements, and limitations and barriers in the home or community.
Name the 5 crucial types of quality measurements according to the National Quality Measures Clearinghouse
Access, evaluation of effect, ability to provide suitiable care such as nurse to patient ratio, health care process, patient experience
Health information websites should be evaluated based on:
Accuracy, authority , objectivity, currency, and coverage.
Rem Sleep
Acetylcholine and Norepinepherine
Setting-centered care
Actue, long-term, outpatient, home care and community, A newer category of setting-focused is subacute care provides rehab for those requiring substantial medical care and who are slower to progress. (usually inpatient)
Setting Centered Care
Acute Care, Long Term Care,Out Patient Care, focused on where care is taking place,
This type of pain stems from tissue damage, is rapid in onset, and protective in nature
Acute pain
This type of pain varies from mild to severe, but should resolve when the underlying cause is resolved.
Acute pain
Roy Theory
Adaptation Model ,Goals are mutually defined , Family highly involved.
What is essential to maintain health, strength, endurance, and cognitive functioning?
Adequate and restful sleep.
Briefly explain the importance of nutrition particularly for people with disability or chronic interest.
Adequate nutrition and hydration are vital for the proper functioning of all the systems in the body. They provide the strength, energy, and endurance clients need to participate in therapeutic exercises and relearn daily activities. The goal for a rehabilitation client is to have adequate nutritional intake to support healing and meet metabolic demands. and to modify the diet as needed during acute and chronic illness or disability.
What is a document that indicates a person' s preference and medical treatment plan if he becomes incapacitated?
Advanced Directive
Delayed development
Advancement through the normal sequence of milestones at a rate slower than that of peers of the same chronological age
What type of nerve root loss or damage results in Sensory Paralytic bowel impairment?
Afferent nerve root loss or damage subsequent to diabetes mellitus or tabes dorsalis.
WHat are the ABCDs of Risk for stroke?
Age (1 point > 60) Blood pressure (1 point >140, or >90) Clinical Features (2 points - hemiparesis, 1 point - speech issues) Duration (2points > 60 mins, 1 point < 60 mins)
What are the risk factors for "Risk for Falls"
Age (greater than 65), history of falls, lower limb prosthesis, use of assistive devices, impaired sensation or perception (temperature, touch, positive sense, vision, and hearing), unmet elimination need or urinary incontinence, use of chemical or physical restraints, environmental hazards, lack of knowledge related to safety and impaired mobility.
At what age can children able to understand syntax
Age 3
According to Abraham Maslow what are the four most important physiological human needs?
Air, water, food, and sex.
One of the major hormones involved in regulation of extracellular fluids. Promotes reabsorption of water (water follows sodium). Assists in maintenance of blood volume and pressure.
Aldosterone
The FIM (Functional independence measure) should be scored & filled out by...
All interdisciplinary team members.
Sensory Paralytic bowel impairment is defined as
An absent ability to distinguish the the need or time of defecation but rarely produces incontinence because the motor function of the rectum is intact.
Which cranial nerves are involved in the swallowing process?
CN I CN V CN VII CN IX CN X CN XI CN XII
What is evidenced based practice?
An effort to integrate teh best research evidence with the client's expertise, the client's values (preferences), and the need to provide high quality and cost effective health care.
Insufficient healthcare resources, deficits in community activities for prevention, and deficits of advocates for the aggregates indicate....
An ineffective Community Therapeutic Regiment Management.
The pharyngeal phase of swallowing
An involuntary event that carries the bolus by swallowing reflex through the pharynx. The soft palate and uvula are elevated to close the nasal pharynx. The hyoid and larynx are elevated so food is less likely to enter the trachea.
The esophageal phase of swallowing
An involuntary event where the bolus enters the stomach via peristalsis and gravity. The lower esophageal sphincter opens.
Knowles learning theory
Andragogy and pedagogy
Which part of neuroanatomy relates visual impressions to the spoken word?
Angular gyrus located at the temporoparietal occipital intersection
This age-specific nursing theory is helpful when practicing rehabilitation across the lifespan.
Anne Casey's Model for children and families.
Any type of linguistic deficit precipitated by brain damage
Aphasia
Functional communication problems that can affect sexual relationships include
Aphasia or dysarthria, concrete functioning and disinhibition or impulse control.
Guardianship
Appointment have decision-maker for persons who is incapacitated
What act mandates adherence to accessiblity standards in federally financed housing?
Architectural Barriers Act
Nursing assessment to transition to community for the eldery
As a rehab nurse: concerns are resp status, motor function,altered sensory issues,nutrition, bowel/bladder, focus on ability, quality of life not longevity.
Lydia Hall's theory
Aspects of Nursing are Core, Care and Cure
Sleep promotes healing and endurance, what should rehabilitation nurses do to promote sleep?
Assess disruptions in client's sleep and apply specific interventions to restore restful sleep patterns.
Nursing interventions for bowel management programs include
Assess prior level of function, and adapt the program to accommodate the previous routine. Increase fluid, bulk, and fiber intake. Monitor bowel sounds and abdominal distention. Avoid gas causing foods. Encourage sitting up on toilet to promote defecation reather than bedpans, provide appropriate medications such as softeners, laxatives, suppositories, or enemas. Encourage loose clothing and good hygiene.
Nursing interventions for bladder management programs include
Assess prior level of function, provide adequate lighting for clients with nocturia. Timed voiding to prevent incontinence. Assess medications that contribute to incontinence (diuretics, sedatives, anticholinergics, or antihypertensives). Provide adequate hydration.
When assessing for ineffective health maintenance...
Assess the client's self-management abilities and knowledge, emotional and spiritual state, and social support system .
Durable power of attorney
Assign another person to act on the patient behalf
1974
Association of Rehabilitation Nurses was created
Health Belief Model
Attempts to explain differences among individuals
The most basic level of language which includes routine responses such as prayers or curse words is called
Automatic language
The basic idea and timeframe of Erik Erikson's second stage of psychosocial development is
Autonomy vs shame and doubt (toddlerhood). Understanding control over one's body and thinking. Understanding disappointment in self and others.
Nurses must be able to provide educational materials regarding sexuality and reproduction after disability. These should include
Available methods and aids to enhance sexual expression and contraception.
Name 4-5 common interventions for dehydration
Avoiding hypertonic IV solutions, encouraging increased oral fluid intake, administering salt-free fluids, supplementing with D5W, administer fluids slowly to avoid cellular edema, monitoring vitals, tracking I & O's, monitoring weight, monitoring lab results, maintaining integrity of skin and mucous membranes are interventions for what?
Grab bars, shower chairs or bath seats, and wash mitts are adaptive devices for
Bathing and hygiene.
Functional Mobility assessments include
Bed mobility transfers, wheelchair mobility, and ambulation.
Dysphagia is diagnosed by
Bedside assessment, video fluoroscopic swallow study, or endoscopic evaluation of swallowing.
External locus of control
Belief that one's life is controlled by feet, chance, events or other people
Internal locus of control
Believe that outcomes are influenced by one's choices and actions. Use more problem-solving approaches to cope
Benefits of client education include:
Better outcomes for client and family, improved client and family satisfaction, continuity of care, cost containment, and improved staff satisfaction.
Potential effects of bladder dysfunction problems as related to sexual relationships include
Bladder accidents decrease the appeal of sexual activity, presence of foley catheter may hinder sexual activity, and presence of urostomy may hinder sexual enjoyment.
Learning domains
Bloom
A person's subjective picture of his or her own appearance that is based on observations, comparisons, and reactions by others
Body image
Which sexual position is best for people at risk for MI?
Bottom position and heart rate should be monitored for about a quarter hour after intercourse
Which sexual position is best for spasticity due to spinal cord injuries?
Bottom position due to lack of control
Potential effects of bowel dysfunction problems as related to sexual relationships include
Bowel accidents decrease the appeal of sexual activity, and presence of a colostomy or ileostomy may hinder sexual activity.
Which tool should be used in the nursing assessment of pressure ulcer risk?
Braden Scale
Central Nervous System
Brain and Spine
Ascending and descending tracts go through
Brain stem
Contains respiratory control center
Brain stem
Cranial nerves arise from here
Brain stem
Which part of the brain is responsible for maintenance of arousal?
Brainstem, paricularly the hypothalmic-pituitary axis
An example of Expressive aphasia is
Broca's aphasia
Individuals who do not have fluent speech, and impaired ability to read, write, repeat, and name objects have what type of aphasia?
Broca's aphasia
Learning a second language would utilize which brain region?
Broca's area
Which spinal cord injury syndrome causes paralysis and loss of position sense on the same side as the injury and loss of pain and temperature sensations on the opposite side?
Brown-Sequard syndrome
How is Martha Rogers Adaptation Model used in rehabilitation therapy?
By transmitting nursing knowledge, therapeutic touch and hands on education teaching the client to adapt and live as they wish.
Reflex neurogenic Bladder
C8-T1 injury / absent voluntary control / sensation /
Lydia Hall's theory shows three interrelated parts. What are they?
Care, Core, Cure
A bladder scanner should be used to assess post void residuals (PVR). At what PVR should you catheterize?
Catheterize for PVR >150ml generally or greater than 300ml if unable to void.
Three of the main regulatory bodies for health care quality are
Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP)
This type of pain is initiated or caused by a primary lesion or dysfunction in the central nervous system.
Central neuropathic pain.
Kurt Lewin
Change is both a function of personality and environment there are 3 stages of change : unfreezing ,movement, refreezing.
Factors that increase a client's "Risk for Injury"
Changes in mental status, fatigue, medications, and motor or sensory deficits.
What are 5 changes that occur in the older adult that affect bowel function?
Changes in striated and smooth muscle strength, less activity, less consumption of roughage and poorer dentition, self limiting hydration due to concerns of urinary incontinence or nocturia, and comorbidities begin with increased medication use.
This type of pain occurs when acute pain persists beyond the expected healing period, or may be present without noticeable past injury.
Chronic pain
The periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss.
Chronic sorrow
What Ranchos Los Amigos Scale would someone be if they demonstrate a generalized reflex response to painful stimuli?
Cognitive level II, generalized response
What Ranchos Los Amigos Scale would someone be if when stimulated they have generalized gross body movement, and or no purposeful vocalization? Responses may significantly delayed.
Cognitive level II, generalized response
What level Ranchos Los Amigos Scale would an individual be who responds the same regardless of type and location of stimulation?
Cognitive level II, generalized response
Bloom learning theory
Cognitive, affective and psychomotor
CIRRIE, Center of National Rehabilitation Research Information and exchange
Collects research information
Does not respond to continuous or painful stimulus; no movement except for reflex actions and does not verbalize.
Coma
Katherine Kolcaba (1990)
Comfort Theory
Home health agencies are accredited through which agencies
Community Health Accreditation Program or Home Care Accreditation Program (associated with Joint Commission)
The development of a mutually beneficial relationship between the patient who has trouble relating and health care workers
Complex relationship building - goal to establish rapport
Trial and error are replaced by the ability to problem solve in this stage of Piaget's developmental theory
Concrete operational stage of development
Watson learning theory
Conditioning or reinforcement of behaviors motivation. Repetitive learning
Caregivers who provide care only when necessary and encourage the patient to participate in decisions are considered what type of caregiver?
Conflicted
Pt's with diabetes insipidus and the elderly are at risk of dehydration. Who else is at risk?
Confused or dependent patients, pt's with dysphagia, any other on highly concentrated enteral feelings without supplemental water.
1)manage causative factors (diet, fluids, exercise) 2)utilize gastrocolic reflex to stimulate emptying 3)encourage regular evacuation time 4)place on toilet instead of bed pan Common interventions for what?
Constipation
Common bowel elimination problem in rehab is:
Constipation due to decreased fluid intake, diet and decreased mobility
Maintaining a regular program of passive range of motion (ROM) & stretching, splinting and proper positioning, and avoiding static positions can help minimize _________
Contractures.
The process of dealing with difficult problems or situations is
Coping
The method of helping the patient to adapt to stressors, changes, or threats to his lifestyle
Coping enhancement
This spinal accessory nerve innervates the skeletal muscles of the soft palate, pharynx and sensory impulses from taste buds of the poset
Cranial Nerve XI
This cranial nerve transmits sensation of smell to olfactory area of the cerebral cortex.
Cranial nerve I
This cranial nerve innervates muscles of mastication and sensory impulses from teeth, gums and lips.
Cranial nerve V also called the trigeminal nerve.
This Facial nerve receives sense of taste from anterior two thirds of the tongue and provides sensation of the oropharynx.
Cranial nerve VII
This nerve causes a motor innervation of the muscles of the tongue necessary for food manipulation, swallowing, and speech.
Cranial nerve XII
Obstructive "C-BABE
Cystic fibrois Bronchitis Asthma Bronchiectasis Emphysema
Dysarthria
D
Brown-Sequard Syndrom
Damage to one side of spinal cord
What symptom is a lacunar stroke strongly associated with?
Decreased cognition
Frequent causes of constipation in rehab pt's is:
Decreased fluid intake, diet, decreased mobility, pain meds
Martha Rogers
Defines integrality as the concept that humans and the environment are intertwined and irreducible
Dorothea Orem
Defines people outside the healthcare system upon whom the client may depend to meet self care demands as "dependent care agents"
Avoiding hypertonic IV solutions, encouraging increased oral fluid intake, administering salt-free fluids, supplementing with D5W, administer fluids slowly to avoid cellular edema, monitoring vitals, tracking I & O's, monitoring weight, monitoring lab results, maintaining integrity of skin and mucous membranes are interventions for what?
Dehydration
Isotonic fluids IV, vasopressors to raise blood pressure-both may be needed for what?
Dehydration
Lab values: 1)normal to elevated serum sodium levels (varies w/ the amt of fluid and sodium loss) 2)increased or normal hematocrit levels 3)elevated blood urea nitrogen levels 4)elevated urine specific gravity Signs of what?
Dehydration
Pt's with diabetes insipidus are at risk for?
Dehydration because brain fails to secrete ADH resulting in excessive diuresis. Easy to miss because they will have plentiful dilute urine (instead of decreased urine) until situation is advanced.
Deterioration in mental status, thirst, tachycardia, longer capillary refill times, orthostatic hypotension, dropping urine output, cool pale skin on arms and legs, rapid weight loss are s/s of what?
Dehydration/hypovolemia
Stage One of Neals Home Health Theory
Dependence on others for help with clinical and logistical aspects of community centered care
3-D's
Depression delirium and dementia none of these are normal aging we treat and manage them
Name 3-4 s/s of dehydration
Deterioration in mental status, thirst, tachycardia, longer capillary refill times, orthostatic hypotension, dropping urine output, cool pale skin on arms and legs, rapid weight loss are s/s of what?
Pt's with dehydration/hypovolemia will demonstrate the following signs and symptoms
Deterioration in mental status, thirst, tachycardia, longer capillary refill times, orthostatic hypotension, dropping urine output, cool pale skin on arms and legs, rapid weight loss.
Nursing Interventions for Ineffective Family Therapeutic Regiment Management include:
Determine the supplies and services that are lacking, Identify the client's support system and who in it can improve the management of the therapeutic regimen, foster the advocate to promote the client's wellness and health management, and educate at the client and advocates learning level.
Medical conditions that represent an increased risk factor for loss of skin integrity include
Diabetes, peripheral vascular disease, peripheral neuropathies,
C4
Diaphragm
Name 5 nursing diagnosis related to a patient's sprituality
Difficulty making decisions, dysfunctional grieving, hopelessness, spiritual distress, readiness for enhanced spiritual well-being
WHO classification in 1980 of a restriction or lack resulting from impairment, inability to perform activity in manner within normal range.Occurs at the individual level Ex-neuropathy -
Disability
Deviant development
Disruption in the normal development sequence secondary to unevenly developed or neurologically impaired process
Caregivers who make the person being cared for primarily responsible for his own care and decisions are what type of care giver?
Distanced
Which nursing theorist views the person as a biological, symbolic, and social unit?
Dorothea Orem
Which nursing theorist wrote the "self-care theory"?
Dorothea Orem's theory is known as the self care theory. The three related parts of this theory include the theory of self care, theory of self care deficit, and the theory of nursing system.
L5
Dorsal of foot
Long handled shoe horns, reachers, and velcro closures are adaptive devices for
Dressing
Part D
Drugs
family development and function theoris
Duvall's Stages of Family Development Family LIfe Cycle Theory by Stevenson
Autonomous, areflexic, flaccid, or atonal bowel disorders involves
Dysfunction in the Lower Motor Neurons (LMN), there is no cortical control, lack of tone in the internal and external sphincters with frequent oozing of stool, caused by damage to the reflexic arc.
Reflexic neurogenic bowel disorder related to spinal cord injury involves
Dysfunction in the Upper Motor Neuron (UMN), the bowel is capable of reflexive emptying of the rectum without cortical awareness of the need to defecate.
1975
Education Of all Handicapped Children
What act required states to provide education free of cost to any school-aged child
Education for all handicapped Children Act of 1975
What type of nerve root loss or damage results in Motor Paralytic bowel impairment?
Efferent nerve root loss and damage subsequent to poliomyelitis, intervertebral disc disease, tumor or trauma.
theories of aging from Erickson's
Ego vs despair Developmental tasks:to gain the ability to find meaning in old age and to accept death as part of life
The U.S. Equal Employment Opportunity Commision enforces laws related to
Employment discrimination against a person with a disability
Name the 2 issues that address the Title I of ADA
Employments State and local governmental programs and services - forbids discrimination in providing public benefit and services ,,, ,
American with Disabilities ACT
Enacted in 1990 has 5 titles of legislation that oversee the accommodations to disability needed for Employment (Title I), Public Services (Title II), Public accommodations and services operated by private entities (Title III), Telecommunications (Title IV), and miscellaneous provisions (Title V).
Nursing interventions for "grief associated with disability" include
Encourage the client and family to seek psychological counseling, help the client build a support network, help the client cultivate a positive realistic outlook. Allow time for adjustment.
Interventions to promote social support for a disabled client include
Encouraging problem-and emotion- focused coping skills; social networking, social roles for identity, power, adn family position. Encourage the client to engage in meaningful, rewarding activities and attend support group meetings.
Caregivers who deliver care skillfully and supportively are considered what type of caregiver?
Engaged
What is utilitarian ethics
Ethics of consequences - concentrating on the outcome perceived to be good
What is EBP?
Evidence-based practice Research creates the foundation for evidence-based practice, EBP promotes the use of the best current evidence in important day-to-day patient care.
A way of getting information about the most up-to-date practice into the hands of the clinicians. Founded in research, that promotes the use of the best current evidence in important day to day patient care.
Evidenced based practice.
Myasthenia Gravis
Excessive muscle fatigue
CN VII
Facial nerve receives sense of taste from anterior two-thirds of tongue. Provides sensation of oropharynx
What act prohibitis inequities related to any type of housing?
Fair Housing Act
This therapy modality is often utilized with military personnel returning from war with traumatic brain injury (TBI)
Family Focused therapy
Name some after effects of post traumatic stress disorder (PTSD)
Fear of failure, lack of resources, lack of support, role loss or ambiguity.
Neurogenic bladder
Fecreased capacity and involuntary voiding as soon as urge is perceived.
weighted utensils, built up handles, plate guards are all examples of adaptive devices for
Feeding
Clients experiencing post traumatic stress disorder (PTSD) may re-experience the event in one or more of the following ways:
Flashbacks, nightmares, excessive verbalization of the event, survival guilt, self blame, shame, fear of repetition, anger outbursts, psychological or emotional numbness, and alteration in lifestyle.
Which nursing theorist encouraged the use of one's own powers?
Florence Nightingale believed that nurses help clients obtain the best condition possible so nature can cure.
Development proceeds from logical, concrete thought to logical solutions to all kinds of categories of problems during this stage of Piaget's developmental theory
Formal Operational stage of development.
OSEP, Office of Special Education Programs
Foster r/t special education, vocational training, and research
Stevenson's Family Life Cycle
Four stages 1.The emerging Family (1-10) 2.the crystallizing family (11-24) 3.The integrating family (26-40) 4. The actualizing family (more than 40 years)
intrapyschic theories
Freud 4 phases 1.oral phase-(first year) exploring the world 2.anal phase-(18months to 3 years)-build up and release of tension in the orifices 3.Phallic phase-(3-6 years) 4. latent &mental phase(6-12yrs old)-learns social rules while experiencing sexual gratification
Name 4 standardized tools for measurement of quality
Functional Independence Measure (FIM), Minimum Data Set (MDS), Medicare Outcomes Trust health status questionnaires, Rating scales, Outcome and Assessment Information Set (OASIS)
Interventions for what problem: 1)respond promptly to requests to void 2)alter clothing and provide adaptive equipment 3)remove environmental barriers
Functional incontinence
Occurs when functional impairments limit the person's ability to use facilities in a timely or effective manner
Functional incontinence
This type of incontinence is often associated with cognitive impairment, or loss of ability to perform needed toileting behaviors independently.
Functional incontinence.
moderate brain injury
GCS 9-12 abn CT coma lasting <24hrs
Physiological signs of stress include
GI distress, cardiac palpatations, anxious facial expressions, or tremors.
The basic idea and timeframe of Erik Erikson's seventh stage of psychosocial development is
Generativity vs stagnation (middle adulthood). Being creative and productive. Carrying out parental responsibilities.
Marked incapacity to comprehend verbal and written language or write
Global or total aphasia
CN IX
Glosspharyngeal nerve sends motor impulses to the muscles of the pharynx and sensory impulses from taste buds of posterior one-third of toungue
King Theory
Goal attainment
Barnum (1998) divided (nursing) theories into those that describe and those that explain nursing phenomena.
Grand theories provide the broadest scope and present general concepts and prepositions. Middle-range theories offer concepts and prepositions at a lesser level of abstraction.
Weaning a person off a ventilator
Graudually with periods of complete rest on the ventilator.
A long handled comb is an adaptive device for
Grooming
WHO classification in 1980 disadvantage of a given person resulting from impairment or disability that limits or prevents fulfillment of a role that is normal for a human being. Occurs at the society level ex-amputation
Handicap
Inherent ability to withstand adversity
Hardiness
The process of making it easier for a person to develop a positive outlook
Hope instillation
The internal and conscious process of releasing negative attitudes and patterns and reestablishment of a feeling of wholeness
Healing
Neuman Theory
Health Care System Model :Physical,social/cultural,psychological,spiritual
What is health?
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1948).
What is the difference between health and wellness?
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1948). Wellness is a journey that each of us takes in our quest for well-being of body, mind, and spirit. Key components include - personal responsibility - balance through all phases of health - body-mind-spirit connectedness and, - relationships with self, others, and the environment (Miller, 2008). Wellness is a choice to assume responsibility for the quality of your life. It begins with a conscious decision to shape a healthy lifestyle.
Imogene King's model is about goal attainment. The goal of nursing is to ________.
Help individuals to maintain their health so they can function in their roles.
Theory of health treatment that incorporates physical, psychological, and social aspects to achieve health and well-being.
Holism
Faith in improvement
Hope
A sustained subjective emotional state in which a person sees not alternatives or personal choices available to solve problems or to achieve what is desired and cannot mobilize energy on his or her own behalf to establish goals.
Hopelessness.
Part A medicare
Hospitals, SNF's,Homehealth, hospics and is automatic at age 65 and financed by SS
Name the 3 issues in Title II of of the Americans with Disabilities Act
Housing, Education, Travel and transportation
What are effective tools for diffusing tension and grief momentarily?
Humor and laughter
Signs and symptoms of Autonomic dysreflexia include
Hypertension 20-40 mm hg above baseline, bradycardia, flushing, perspiration above the level of injury, gooseflesh (pimply state of the skin with the hairs erect) above the level of the lesion, nasal congestion, and an impending sense of doom.
CN XII
Hypoglossal nerve causes a motor innervation of te muscles of the tongue, allowing for coordinated contraction of the tongue muscles necessary for food manipulation, swallowing, and speech.
Contains Satiety Center
Hypothalamus
Controls vegetative functions
Hypothalamus
Pituitary gland
Hypothalamus
Secretion of ADH
Hypothalamus
Secretion of several hormones
Hypothalamus
Thirst and hunger
Hypothalamus
prepartion
I am getting ready
The basic idea and timeframe of Erik Erikson's fifth stage of psychosocial development is
Identity vs role confusion (adolescence). Clarifying personal identity. Depersonifying internal representations.
Dynamic life experiences and adjustment to stress
Imogene King's definition of health
Which nursing model shows that individuals are in constant interaction with their environment and one another?
Imogene King's open system model.
WHO classification in 1980 which is the loss or abnormal of a pyschological or antomical sructure and function. Ex- organ
Impairment
R Side stroke
Impulsive behavior / spatial deficts / L visual defects
Agnosia
Inability to process specific senses:difficulty distinguishing doorbell and phone ring
1990 American Disability Act
Increased accessibility, increased opportunity for employment,education and healthcare
C7
Index and middle finger
Team
Individual and family
Which act allows children with disabilities appropriate education, transition services, assistive technology, and rehab counseling?
Individuals with Disabilities Education Act
The basic idea and timeframe of Erik Erikson's fourth stage of psychosocial development is
Industry vs inferiority (school age) Dealing with latency, school, and family relationships outside the family.
What is the right to information about treatments and procedures before he/she gives permission for them?
Informed Consent
T12
Inguinal ligament
The basic idea and timeframe of Erik Erikson's third stage of psychosocial development is
Initiative vs guilt (preschool years) Dealing with predominantly genital issues.
Brown-Sequard Spinal Injury
Injury to one side of cord
Piaget's Sensorimotor stage of development states that feelings and actions are
Inseparable.
Lewis learning theory
Insight provides as a guide, model behavior, demonstrations
What are IADLs?
Instrumental activities of daily living include meal preparation, housekeeping, financial management, and transportation.
The basic idea and timeframe of Erik Erikson's eighth stage of psychosocial development is
Integrity vs despair (older adulthoood) Feeling a sense of completeness based on an integrated philosophy of one's unique life.
Which artery commonly accumulates atherosclerotic plaques?
Internal Carotid
W.H.O. Classification
International classification of -impairment -disability -handicap
The basic idea and timeframe of Erik Erikson's sixth stage of psychosocial development is
Intimacy versus isolation (young adulthood). Rediscovering attachment. Developing mature bonding.
S/S dehydration to look for?
Irritability and confusion, dizziness, weight loss, thirst, fever, poor skin turgor, decreased urine output
S3
Ischial tuberosity
Briefly describe the Frazier water protocol.
It allows clients with dysphagia to drink water 30 minutes before and after meals. The rationale is that small amounts of water even when aspirated, do not contribute to aspiration pneumonia, provided the client practices good oral hygiene before drinking each time. The 30 minutes allows the client to swallow completely and clear the oral cavity of food residues. Medications are administered whole or crushed with a spoonful of applesauce, pudding, yogurt, or thickened liquid, never with thin water. Additional compensatory measures may be recommended such as chin tuck, head turn, or fluids by spoon or cup only.
Melatonin is produced in the pineal gland, what is its purpose?
It has a role in regulating the sleep-wake cycle.
What is included in successful rehabilitation nursing?
It includes the transfer of knowledge and accountability for healthcare needs from nurses to clients and their families in a manner that promotes health and wellness for the person with a disability. Strategies are best conceived when developed in a nursing theory framework that provides education and training to address weaknesses and maximize strengths to meet the needs of clients and families to promote health in the community.
What is a nursing theory?
It is a body of knowledge used for nursing practice.
Explain the Health Promotion Model theory.
It is a nursing theory by Dr. Nola Pender that assumes that people seek to regulate their own behavior and that health professionals play an influential role throughout their client's lifespan. The personal belief in one's own capacity to control life events is a tenet of the theory.
What is evidence based practice?
It is an effort to integrate the best research evidence with the client's expertise, the client's values (preferences), and the need to provide high-quality and cost-effective health care. It is a way of getting information about the most up-to-date practice into the hands of the clinicians.
What is dysphagia?
It is swallowing difficulty during the passage of a solid or liquid bolus from the mouth to the stomach.
Define health promotion.
It is the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment.
What is the Oral Preparatory phase of swallowing?
It is the voluntary action. Food is prepared, smelled, and the salvation occurs. Food is put in the mouth, manipulated to form a bolus, and pushed posterior toward the oropharynx.
Discuss what the Braden scale is used for and each component of the scale.
It is used to determine the pressure ulcer risk and consists of six weighted elements.
Explain the role of The Americans with Disability Act (ADA).
It protects the 54 million Americans with physical or mental impairments that limit their daily activities, such as working, walking, talking, seeing, hearing, or caring for oneself.
S1
Lateral heel
These exercises can be taught to clients experiencing stress incontinence.
Kegel, pelvic floor exercises.
Adult learning
Knowles
levels of moral development
Kohlbery 1.Preconvential-obedience/punishment 2.Convential Good- good boy/girl society 3. Post-conventional- social contract and principles
moral theories
Kohlbery theories Gilligan theories
severe brain injury
LOC >days, months, years GCS<8 permanent residul deficits
Assessment of your patients when monitoring fluid regulation should include?
Lab values, weight, vital signs, breath sounds, fluid intake, elimination patterns
C5
Lateral side of antecubital fossa
Public Law 94-142
Law passed in 1970 for disabiled children to receive educaion through mainstream or inclusion. Includes yearly IEP-Individual Education Plan Includes Head Start program
Damage to Substantia Nigra
Leads to parkinson like gait and movement
Rogers learning theory
Learner formulates own objectives, South motivated, learning contracts
Cognitive theories are closely related to
Learning and Behavioral theories.
Drowsy state, Pt can awaken, but not completely to stimulation, may also follow commands but his responses may be slow and inattentive
Lethargy
Cognitive
Lewin
Contains Amygdala and Hippicampus
Limbic System
Fight/flight response
Limbic System
Interprets sensory messages
Limbic System
Memory
Limbic System
Capped Medicare Part B
Limit for theraphy,PT and speech share same cap, OT own cap and must be medically necessary
A legal document for medical decision in case he or she become incapable to make decision
Living will
Lydia Hall
Loeb Center in NY, Nurse-run center. Three interlocking circles represent Hall's theory: the person "core", the body "care", and the disease "the cure". Different types of care in each circle. She believe people achieve their maximum potential through learning; however, because people behave according to their feeling, inattention to the person while teaching will not change their behavior. Learning within limitations. (Learning and motiviation)
What are settings for provision of Community-Based Rehabilitation nursing concepts?
Long term care facilities Subacute centers Outpatient programs Community and faith-based organizations and private homes
The settings for the provision of Community-based rehabilitation nursing include:
Long term care facilities, subacute centers, outpatient programs, community and faith based organizations, and private homes.
Estate planning
Long-term planning of the use of resources for future care and expenses
Anosmia
Loss of smell
Flaccid bladder (failure to empty urine) is often associated with
Lower Motor Neuron spinal cord injuries.
What artery is the most common site for stroke?
MCA
Effects of aging (heart)
MI, CHF, arrhythmia, peripheral vascular disease, orthostatic hypotension
A process of cost containment in which non-medical administrators such as insurance companies dictate the provision of services and medications
Managed care
What are the mandates of the Rehabilitation Act of 1973?
Mandate affirmative action and nondiscriminatin regarding employment in executive branch federal agencies
1973 Rehab Act
Mandated affirmative action and nondiscrimination regarding employment with Federal agencies
Carefully assess to determine which bowel problem you are dealing with because?
Many elderly may present with both constipation and uninhibited neurogenic problems.
Which nursing theorist views health as a value-laden term imposed by society?
Martha Rogers
Defines health as a value laden term imposed by society
Martha Rogers "definition" of health
Provider-Center Care
Maximizes use of human resource, tasks are divided
L3
Medial femoral condyle
L4
Medial malleolus
Reimbursement for homecare is primarily paid through
Medicare Part A
The utilization of any resources, people, or events in the patient's setting that can enhance psychosocial functioning
Milieu Therapy
Part C
Miscellaneous i.e ESRD
additional tmt for MS
Mitoxantrone -supressing the activity of Tcells and B cells STERIOD-shortens the duration of acute attacks BACLOFEN_treats spasms and tremors
Collaborative model
Model for provision of services that is assumed in all rehab models
Rogers Theory
Model of Science of Unitary Human Beings (Patient and Environment)
Roper Theory
Model's for living and Nursing and Gordon's Functional Health Patterns. Based on the ability to form ADL's.
State the progressive dysphagia diet in order from most to least restrictive.
NPO (nothing by mouth) Dysphagia pureed (pudding-like consistency) Dysphagia mechanically-altered (soft, moist food) Dysphagia advanced (regular food except very hard, sticky, or crunchy foods) Regular diet
The most common vitamin supplements include
Multivitamins, vit-C, vit-E, B-complex and calcium.
Keystone to Imogene King's theory
Mutuality achieved through perceptional congruence
Sleep apnea caused by skeletal muscle weakness is a common sleep pattern disturbance noticed in clients with
Myasthenia Gravis.
This National Dysphagia Diet (NDD) is least restrictive
NDD4, regular diet
Is the pyramidal system (cortico-spinal tracts) plastic?
NO
Transdisciplinary model
Newer, in which the client has a primary therapist from the team and then is guided y the team in caring for the client. Ex: Primary therapist is a nurse who provide physical, speech, and OT therapy based on advice and counsel he or she receives from team members in those disciplines. Requires flexibility
T4
Nipple line
Rehabilitation act 0f 1973
Non-discrimination for people w/ disability
Stage Two of Neals Home Health Theory
Nurses in this stage are moderately independant but still need help with office procedures, reimbursement issues and factors that restrict their autonomy
The assessment for helplessness in a disabled client should include
Observance of inactivity, non-participation, self isolation, and withdrawal.
Assessing for independence in a disabled client involves
Observe for initiation of ADLs and participation in academic and vocational activities. Assess the client's level of functional independence (FIM); cognitive abilities; initiation of recreational activities.
What are the legal responsibilities of rehab nurse?
Obtaining voluntary informed consent Maintaining the confidentiality Evaluation of pt competence to make decisions
Pt is difficult to arouse and needs constant stimulus to follow commands; may verbally respond to stimuli with a few words but drifts back to sleep when stimulus is removed
Obtundation
Definition of functional incontinence
Occurs when functional impairments limit the person's ability to use facilities in a timely or effective manner
CN I
Olfactory nerve transmits sensation of smell to olfactory area of the cerebral cortex
How often should skin assessment be done on patients?
On admission, and daily, (every shift if required by the facility
Multidisciplinary model
One in which professional work in parallel, each discipline works toward toward particular client goals with little overlap between disciplines. Communication more vertical than lateral.
Interdisciplinary Model
One is a matrix, lateral communication is predominate, team'goal setting is important.
Medicare Social Security act of 1965
Operates under the department of health and human services and is managed by the centers of Medicare and Medicaid. Eligibility must be a worker or spouse of a worker greater than 65 years of age or disabled >2years. Or ESRD. Eligible for SS are automatically enrolled
The expectation of a favorable outcome.
Optimism
Describe the nursing process behind Orem's theory of self care deficits.
Orem's theory presents a method to determine the self care deficits of a pathient and then defines the nurse or caregiver's role in helping the patient meet his or her self- care demands.
nursing process theory theorist
Orlando
Rehabilitation Services Administration (RSA)
Oversees grant program r/t rehab
PLISSIT sexual counseling acronym stands for
P = permission, LI = discussion and limited information SS = specific suggestions, IT = intenstive therapy if needed
assessment tools for mobility and function
PED-pediatric Evaluation fo Disability Inventory WEEfim Instrument
Nursing roles in community based rehabilitation settings include:
Partner, educator, planner, coordinator, resource manager, evaluator of client outcomes, client advocator
A lack of accidental injuries as a result of medical errors or avoidable adverse events
Patient Safety
classical condition theory
Pavlov-conditioning occurs when a once neutral stimulus becomes analogous with a response after they have been associated with each other -internal response can be changed by modifying behavior -automatic responses evoked by a stimulus
National Institute on Disability Rehabilitation Research define area of interest and funds grants r/t rehabilitation based on .....
Peer review
Self concept, as explianed by the middle range theory states
People change over time, particularly after incurring a disablity. The person's environment changes over
Sigmund Freud's intrapsychic theory states
People experience conflict between their natural instincts and society's restrictions on them. Conflict experienced in childhood influences one's adult personality. Four phases occur within set timeframes. Fixation (oral, anal, phallic) may result if phases are not achieved successfully.
S2-4
Perianal area
This type of pain is initiated or caused by a primary lesion or dysfunction in the peripheral nervous system.
Peripheral neuropathic pain.
According to the PLISSIT model of sexual counseling the "P" stands for
Permission, giving the client permission to openly talk about the subject allowing questions and fears to be raised.
The PLISSIT model for sexual counseling includes
Permission, limited information, specific, suggestions, and intensive therapy.
Person Body and Disease in Halls theory
Person is core, body is care, and disease is cure
Rehabilitation nursing is viewed as a specialty practice guided by what three things?
Philosophy, theory, and research.
Medical Model
Physician centered all directed by physician.
Part B medicare
Physician services financed by Federal taxes and monthly premiums . You must Enroll.
What five areas of assessment should the nurse consider when assessing a client for stress?
Physiological symptoms, emotional, intellectual, spiritual and social manifiestations
Development proceeds from prelogical thought to logical, concrete thought during this stage of development as described in
Piaget's Concrete Operational stage of development
During this stage of development Children begin to fantasize and use symbols to represent objects and feelings. By maintaining stable and consistent images children are able to create a representational world.
Piaget's Preoperational Stage of Development.
Development proceeds from reflex activity to representation and sensory motor learning in this theory of development.
Piaget's Sensorimotor Stage of Development.
Sucking and touching are innate actions for infants, but understanding how personal behavior affects the world and becoming involved in trial and error actions is a process of development described in
Piaget's Sensorimotor Stage of Development.
cognitive theories
Piaget's stages of development Vyotsky's Theoretical framework
Effects of aging (lungs)
Pna, influenza
What nursing intervention can help with snoring or sleep apnea?
Position the patient to a side-lying position and use pillows to retain that position.
When establishing a bladder program what are the main factors to assess?
Premorbid level of function, past voiding habits and use of assistive devices, fluid intake, age, activity, prior bladder problems, mobility impairments, sensory and motor status, neuromuscular status, impaired communication, and medications.
Development proceeds from sensorimotor represntation to prelogical thought during this stage of development according to Piaget's theory.
Preoperative stage of development.
The primary role of the nurse in regards to spirituality is
Presencing or just being there for support or through touch.
What three stages of prevention are in Neuman's model?
Primary, secondary prevention, and tertiary prevention; helps clients maximize their defenses.
Primary, secondary and Tertiary prevention
Primary-Interventions that promote optimal health and provides special protection to prevent illness, disabilities, or injuries (Eating healthy, exercising) Secondary- Interventions that limit disabilities and are done primarily by early identification (Symptoms of high blood sugar or hypertension Tertiary prevention- interventions that decrease disability and impairments caused by illness or injury (Taking aspirin to prevent another MI)
The Health promotion model promotes self efficacy with these core self management concepts
Problem solving, Decision making, Resource use, Collaboration and action.
The Civil Rights Act of 1964
Prohibits employment discrimination based on race, color, religion, sex or national origin.
Name the 2 issues in Title I of the Americans with Disabilities Act
Prohibits workplace discrimination and forbids discrimination in providing public benefits and services
Cushioning bony prominences, providing adequate support, avoiding pressure on existing ulcers, protecting skin from friction and shearing, and elevating the heels off the bed are all nursing measures to
Promote and maintain skin integrity.
Nursing interventions for functional incontinence include:
Prompted voiding or timed voiding schedules, ensuring adequate fluid intake, referrals to PT & OT. Modify environment to be conducive to maintaining independence.
What is the minimal time frame that a skin assessment should be performed?
Proper skin assessment is required on admission and on a daily basis
The minimum data assessment (MDS) is mandated by the CMS for use in long term, subacute, or postacute care. It serves as the data collection instrument for this payment system
Prospective Payment system.
Medicaid Social Security act of 1965
Provides federal grants to states for medical assistance programs. reimbursement is usually lower than cost. Determined by states definition of medically needy and is variable state to state
Intensive Therapy as defined in the PLISSIT model of sexual counseling would incude
Providing expert assistance for intensive discussion and intervention. (e.g., Psychotherapy for marriage and relational counseling, medical management of impotence, infertility, child birth, or previous abuse)
This medication is used to improve wakefulness in adults with a diagnosed sleep disorder.
Provigil-modafinil
Primary nursing delivery model
RNs are utilized to care for a smaller group of patients
This is used to interpret the cognitive recovery process after brain injury, it has levels from 1-10 with lower scores indicating more severe impairment of consciousness.
Ranchos Los Amigos level of Cognitive functioning.
REM
Rapid Eye Movement lack of muscle movement and vivid dreams
Bibliotherapy
Reading
Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of death in the USA, what are the goals of pulmonary rehabilitation for these clients?
Reduce or minimize triggers and symptoms, restore functional ability, and improve the quality of life.
Test ability to protect airway
Reflex cough test
National Dysphagia Diet(NDD3), Dysphagia advanced allows clients to eat
Regular foods except very hard, sticky, or crunchy foods.
Explain the theoretical structure of rehabilitation nursing.
Rehabilitation nurses help individuals affected by chronic illness or physical disability to - achieve their greatest potential, - adapt to their disabilities, and - work toward leading productive, independent lives. Rehabilitation nurses take a holistic approach to meeting clients - medical, - vocational, - educational, - environmental, and - spiritual needs
Explain the theoretical structure of rehabilitation nursing
Rehabilitation nurses help individuals affected by chronic illness or physical disability to achieve their greatest potential, adapt to their disabilities, and work toward leading productive independent lives. Rehabilitation nurses take a holistic approach to meeting client's medical, vocational, educational, educational, environmental, and spiritual needs.
Nursing interventions for post traumatic stress disorder (PTSD) include
Reinforce prior successful coping methods. provide crisis management. Encourage the client to appraise stressors, responses to stress, and approaches to problem solving. Set limits on activities that lead to stress and use guided imagery, spiritual counseling or prayer to decrease stress.
Using various strategies to invoke previous pleasant memories
Reminiscence therapy
Capacity for speedy recovery
Resilience
Parkinson's Disease
Rigidity , tremor ,and slow movement = bradykinesia
C8
Ring and little finger
Transdisciplinary Model
Rn controls providers for client for home health
Humanist
Rogers
Which spinal cord level must be intact for sexual response in either male or female?
S2 to S4
One of the best spiritual assessment tools is
SIBS - Spiritual Involvement and Beliefs Scale which has patient evaluate 34 statements from strongly disagree to strongly agree
interactional model
Schaie -focused on development from young adulthood to older ages -concept of goodness of fit(consonance)vs dissonance(poorness of fit) -adult outcomes may be influenced by childhood events and adolescent experiences
Martha Rogers
Science of Unitary Human Beings theory that focuses on people and their worlds in a pandimensional universe.
Bandura's Theory
Self -Efficacy ,cognitive Theory
Dorothea Orem
Self Care AGency, Self Care Demands make up the Self Care Theory
Orem theory
Self Care Model
According to Maslow's Heirachy of needs an individual who represents morality, creativity, spontaneity, ability to problem solve, lack of prejudice, and acceptance of facts is
Self actualized.
Dorothea Orem
Self care is essential for health, well being and life itself. Theory focuses on individlas self care needs or demands and the ability of the person to meet those needs. Three groups of self-care Universal, development, and health-care. A wholeness of body and mind Nurse helps meet therapeutic self-care demands
Client-centered care
Serves specialized populations such as specific developmental stage (Peds, elderly) or type of impairment (SCI, head injury). Providers can focus their resources and gain expertise through experience
Dantrolene
Side effect : hepatotaxicity
Which sexual position is best for arthritic hip joints?
Side lying with supportive pillows
environmental consequences of behavior theory
Skinner -learning is influenced by the effect of individuals' behaviors -behavior is shaped with positive or negative re-inforcers
Why are pain medications preferred over sleep medications?
Sleeping medications can interfere with REM sleep and often produce artificial sleep.
Is recovery after a subcortical infarction fast or slow? why?
Slow Because it is mainly white matter, thus the cortex (higher up) needs to reorganize to facilitate the improvement of the subcortical regions
The non-physical aspects of a person that shape his relationships and emotions and includes memories, understanding and will.
Soul (related to spirituality)
Client centered Care
Specialized care such as SCI,TBI, Cerebral palsy
CN XI
Spinal accessory innervates the skeletal muscles of the soft palate, pharynx, and larynx, which contracts reflexively.
Intangible life force of an individual
Spirit
An inner awareness and a relationship with a higher force
Spirituality
Martha Rogers
States that humans and environment are energy fields that are intertwined and irreducible
Margaret Newman
States that the pattern of the whole contains the individual as an open system, the family as an open system and the community as an open system...all systems are interacting with one another
Clients should avoid _____________to promote restful sleep.
Stimulants 4-6 hours before bedtime
Glipizide
Stimulates pancreas to make more insulin
Effective Health Management
Strategies necessary in order to achieve and maintain an optimal quality of life in a population of people who live longer and need long term health promotion interventions to prevent further loss of function and prevent secondary complications related to disability.
SSI means
Supplemental Security income and includes NEEDY blind or disabled persons - amended in 1972
Types of urinary incontinence
Stress / Urge / Mixed / Overflow / Total / Functional
What is the third leading cause of death in Canadians?
Stroke
Name two diagnosis that cause temporary disrupted sleep patterns and initial reversal of day-night cycles.
Stroke and traumatic brain injury
Uninhibited Neurogenic Bladder is common in what disease processes affecting the cortex?
Stroke, Brain Injury, Brain Tumors, Multiple Sclerosis
Uninhibited Neurogenic Bowel is common to what disease processes affecting the cortex?
Stroke, Brain Injury, Brain Tumors, Multiple Sclerosis
Definition of Ethics
Study of moral standards and how they affect conduct
Moral decision making involves...
Studying similar cases Conferring with other people involved Decisions falls within legislative and organizational parameters Evaluating the level of comfort a pt has with making particular decision
Pt arouses to vigorus and continuous stimulation which is typically painful in nature; may moan briefly but does not follow commands; only response may be withdrawal from the painful stimulus
Stupor
interpersonal theories
Sullivan 7 stages 1.infancy 2. Childhood 3.Preadolescence juvenile 4. Preadolesence 5. Early adolescence 6. Late adolescence 7. Adulthood
What type of language is the highest form and involves independent creative intention and application of rules?
Symbolic Language
Imogene King
Systems Framework Theory is the personal, interpersonal and social systems
Imogene King
Systems Theory: 3 interacting systems: Personal (individual), interpersonal and social systems. Major concepts include perception, self, growth, image, development, time and space Adjusting to stressors. Nurse and client share perceptions and mutually identify goals and means to obtain those goals
Autonomous, areflexic, flaccid, or atonal bowel disorders originate from spinal cord injuries at or below this level
T12-S1
Reflexic Bowel disorders are associated with Spinal Cord Injury (SCI) above this level
T12-S1 or damage to the cerebral cortex.
Autonomic Dysreflexia occurs in 48-90% of those with spinal cord injuries at or above this level
T6
What is TPA
TPA (tissue plasminogen activator) breaks up clots and is very effective but it is only used about 5% of the time because people don't get to the hospital within 3 hours
What is the best acute treatment for ischemic stroke?
TPA - tissue plasminogen Activator - dissolves clots by digesting fibrin strands (does NOT work for hemorrhagic stroke)
Levine's Conservation Theory
Teaches patient ways to limit energy expenditure during activities of daily living and assisting them in planning rest breaks
Name the issue in Title IV of of the Americans with Disabilities Act
Technology and telecommunications - mandates telephone companies has special relay services for people with hearing and speech impediments, closed captioning of federally sponsored public announcements
Clients with dysphagia may drink water 30 minutes before or after meals. The rationale is that small amounts of water, when when aspirated do not contribute to aspiration pneumonia, provided that good oral hygiene is practiced prior to drinking each time.
The Frazier water protocol.
This nerve sends motor impulses to the muscles of the pharynx and sensory impulses from taste buds of the posterior one-third of tongue.
The Glossopharyngeal nerve, Cranial nerve IX
What theory believes that an individual's behavior controls his or her outcomes?
The Locus of Control Theory. People who believe they are in control of their health are more likely to change their behavior than those who believe outside forces are in control.
The AHA published a Patient's Bill of Rights in 1973 and revised it in 1992, in 2008 published a simplified phamphlet called
The Patient Care Partnership listing 12 patient entitlements
The Americans with Disabilities Act of 1990 is an expansion of which previous law?
The Rehabilitation Act of 1973
Which agency enforces federal laws related to employment discrimination against a person with a disability?
The U.S. Equal Employment Opportunity Commission
Which agency enforces federal laws related to employment discrimination against a person with a disability?
The U.S. Equal Employment Opportunity Commission.
SDH
The bleeding in a subdural hematoma is under the skull and outside the brain, not in the brain itself. As blood accumulates, however, pressure on the brain increases.
The North American Nursing Diagnosis Association (NANDA) defines ineffective health maintenance as
The inability to identify, manage, and /or seek out help to maintain health.
Define ineffective health maintenance by the North American Nursing Diagnosis Association (NANDA) .
The inability to identify, manage, and/or seek out help to maintain health.
Potential effects of impaired memory or judgement problems related to sexual relationships include
The injured partner may perseverate (repeat a response without stimulus) on a sexual activity or request or pressure partner for frequent sex. Contraceptive use should not rely on the memory of the injured partner.
Confabulation
The invention of detail or life experiences in an attempt to compensate for memory deficits
Dr. Nola Pender is credited with the Health Promotion Model. What is this theory?
The personal belief in one's own capacity to control life events is a tenet of the theory. This theory assumes that people seek to regulate their own behavior and that health professionals play an influential role throughout their client's lifespan.
In the transdisciplinary team model
The primary care provider directs the care from the information received from the team members.
Health Promotion is
The process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental, and social well being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment.
How does the self-efficacy model impact rehabilitation nursing?
The self-efficacy model influences how much effort a client puts in rehabilitation therapy by helping clients maintain a positive attitude toward rehabilitation and confidence to attain new goals.
SAH
The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pia and arachnoid membranes
Successful Rehabilitation nursing includes:
The transfer of knowledge and accountability for healthcare needs from nurses to clients and their families in a manner that promotes health and wellness for the a disability. Strategies are best conceived when developed in a nursing theory framework that provides education and training to address weaknesses and maximize strengths to meet the needs of clients and families to promote health in the community.
Neal theory of Home Health Nursing
Theory that states "In the practice of community centered care, nurses proceed through a three stage process toward autonomy in the role
Interventions for the client with disinhibition or impulse control function problems related to sexual relationships include
The uninjured partner should give feedback to partner about responses and provide suggestions for better alternatives, enforce privacy and a consistent routine. Do not reinforce inappropriate behaviors, and may need to implement social skills retraining in matters related to sexual behaviors with the opposite sex of their partners.
OSERS, Office of Special Education and Rehabilitative Services
Their mission is to integrate people with disabilities into society
Dorothea Orem
Theorist that state that nurses form a supportive-educational system during rehabilation
Neal
Theorist who believes the ability to adapt is necessary to move through stages
Dorothea Orem
Theorist who states that when self care demands exceed self care agency, nursing may intervene
Margaret Newman
Theorist whose theory focuses on community and family centered rehabiliation nursing
Lab values indicative of dehydration are:
These 3 together: Elevated serum osmolality of >300, elevated serum sodium >145, urine specific gravity >1.030.
Why must rehabilitation clients use effective health management strategies?
They are necessary in order to achieve and maintain an optimal quality of life. People with disabilities are living longer and needing long-term health promotion interventions to prevent further loss of function and prevent secondary conditions.
What is the Oral Phase of swallowing?
This is a voluntary action. The tongue is elevated to te roof of the mouth (palate). Lips close to contain oral contents. Buccal and facial tone are necessary for chewing.
What is the Pharyngeal Phase of swallowing?
This is an involuntary event. The bolus is carried by the swallowing reflex through the pharynx. The soft palate and uvula are elevated to close the nasal pharynx. The hyoid and larynx are elevated so food is less likely to enter the trachea.
What is the Esophageal Phase of swallowing?
This is and involuntary event. The bolus enters the stomach via peristalsis and gravity. The lower esophageal sphincter opens.
Lydia Hall
Three interlocking circles: person, body and disease
C6
Thumb
The ADA's five titles
Title I: oversees legislation in employment Title II: public services Title III: public accommodations and services operated by private entities Title IV: telecommunication Title V: miscellaneous provision
Why do our bodies sleep?
To restore energy and support anabolic processes.
Nursing interventions for clients with stress incontinence include
Toileting assistance, bladder training, and referrals to MD for pharmacological management.
Title II of the American with Disabilities Act prohibits discrimination in
Transportation provided by state and local government
CN V
Trigeminal nerve innervates muscles of mastication and sensory impulses from teeth, gums, and lips.
True or False: Healthcare costs for the disables is at least 4 times the amount for other patients
True
True or False: Many of the factors that impace the coping process are related to the person's sense of self and her abilities.
True
Erik Erikson's first stage of Psychosocial development emphasized
Trust vs mistrust. Viewing the universe as reliable and seeing relationships as stable and available.
diabetes Types
Type1,Type2,gestational, specific genetic defects,Pre-diabetes
Uninhibited Neurogenic Bladder results from:
UMN damage in the brain which fails to suppress reflexive contraction of the detrusor.
Uninhibited neurogenic bowel problems result from?
UMN damage in the brain, limiting recognition of signals from the bowel that it is full.
T10
Umbilicus
Disinhibition
Uncontrolled behaviors considered inappropriate
What are the keys to developing advocacy skills?
Understanding and knowledge - of one's self personally and professionally, - of the treatment and intervention options, - of the healthcare system, and - how to put advocacy in action
Lewins theory of changes
Unfreezing is the need for change. Movement is increased level of behavior. Refreezing is change and set, new status quo. Forces can be either driving a restraining forces
Cause if what problem: UMN damage in the brain which fails to suppress reflexive contraction of the detrusor.
Uninhibited Neurogenic Bladder
Features of what problem: 1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal to hyperactive bulbocavernous reflex 4)sudden voiding with our without urgency, frequency or nocturia 5)decreased bladder capacity
Uninhibited Neurogenic Bladder
Most common neurogenic bladder problem following stroke
Uninhibited Neurogenic Bladder
Strategies for what problem? 1)maintain adequate fluid intake, but avoid exceeding 2000ml/24 hrs 2)decrease fluid intake early in the evening to avoid nocturia 3)use timed voiding, prompted voiding or habit training to increase continence based on the pt's cognitive abilities 4)use bathroom schedules based on the pt's usual time of voiding 5)use anticholinergic meds to decrease detrusor contractility and to increase bladder capacity 6)make sure it is easy for pt to get to the bathroom in a timely manner
Uninhibited Neurogenic Bladder
Common strategies for what type of bowel problem: 1)avoiding constipation 2)insuring an adequate intake of fluids and fiber (bulk) 3)facilitating adequate exercise 4)weaning from bowel medications if possible 5)using bathroom schedule based on the pt's usual time of defecation 6)using suppositories or mini enemas to stimulate emptying at a predictable time, if bathroom scheduling is ineffective 7)making sure it is easy for the pt to get to the bathroom in a timely manner
Uninhibited Neurogenic Bowel
Features of what bowel problem? 1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal or hyperactive bulbocavernous reflex 4)sudden defecation with or without urgency 5)hard stool with smearing
Uninhibited Neurogenic Bowel
Most common neurogenic bowel problem following stroke is:
Uninhibited Neurogenic Bowel
UMN damage in the brain, limiting recognition of signals from the bowel that it is full...results in what bowel problem?
Uninhibited Neurogenic Bowel
Neurogenic bowel
Uninhibited or reflexive typem sudden involuntary defecation
Persevation
Unintentional repetition of a word or phrase
Martha Rogers
Unitary Human Beings focuses on people and their worlds in pandimensional universe. Human beings are whole, not parts. The human and environment are energy fields that intertwine and are unitary field. Rogers calls this integrality. Change is fundamental to life, its never the same. Health-individually defined; an expression of the life process. Nursing-a learned profession; a science and art of promoting health.
Spastic bladder dysfunction (failure to store urine) is often associated with
Upper motor neuron spinal cord injuries.
What are advocacy skills in Rehabilitation nursing?
Using the Nursing process (assessment, planning, and implementation) to empower a client to choose treatment and intervention options available within a healthcare system.
CN X
Vagus nerve causes contractions of muscles of pharynx and larynx.
This nerve causes contractions of muscles of pharynx and larynx
Vagus nerve, Cranial nerve X
Dorothea Orem
Views health as a state of wholeness or integrity
Behavioral
Watson
In dehydration pt may complain of what?
Weakness, dry mouth
What is wellness?
Wellness is a journey that each of us takes in our quest for well-being of body, mind, and spirit. Key components include - personal responsibility - balance through all phases of health - body-mind-spirit connectedness and, - relationships with self, others, and the environment (Miller, 2008). Wellness is a choice to assume responsibility for the quality of your life. It begins with a conscious decision to shape a healthy lifestyle.
Ability to speak with ease and use proper syntax but use incorrect words, nonsense words and phrases and have loss of visual fields.
Wernicke's aphasia
An example of Receptive aphasia is
Wernicke's aphasia
Which part of neuroanatomy is responsible for sound pattern recognition?
Wernicke's area
Problems during pharyngeal phase of swallowing
Wet or gurgly sounding voice after eating / frequent throat clearing , c/o food sticking to throat
physics
What Martha Rogers theory is based on
Functional Reorganization
When one area of the brain is damaged, another area takes over
When are physical restraints allowed under federal law?
When used to treat a specific medical condition.
Lydia Hall
Who asserted that only wholly professional nursing care would hasten recovery?
Lydia Hall
Who asserted that setting goals for clients that do not reflect the clent's own goals is countertherapeutic?
Lydia Hall
Who assets that nurses should focus teaching and learning on the client?
Lydia Hall
Who defined rehabilitation as the process of learning to live within limitations?
Lydia Hall
Who's view of health asserts that people behave according to feelings rather than knowledge?
Dorothea Orem's view of the person
a biological, symbolic and social unit
hemorrhagic stroke
a blood vessel breaks/bursts, interrupting blood flow
A nursing theory is
a body of knowledge used for nursing practice.
atherosclerosis
a build up of plaque in the inner lining of the artery, causes it to narrow or become blocked
Kurt Lewin's Change theory includes three stages of change. Stage 2 "movement" includes
a change in thoughts, feelings, and behaviors.
The definition of case management as defined by the Case Management Society of America is
a colloborative process of assessment, planning, facilitation, and advocacy for options and services that meet an individual's health needs through communication and available resources to promote quality cost -effective outcomes.
What is an IMPORTANT condition that must be present for a team to be successful?
a commitment to a common purpose and specific goals
According to the World Health Organization (WHO) Handicap is
a disadvantage from an impairment or disability that limits or prevents normal function.
Handicap
a disadvantage resulting from impairment or disability that limits or prevents the person from filling a role that would be normal for them. (societal level)
asia impairment scale
a for absent motor and sensory function b for incomplete sensory but no motor function below injury c incomplete some motor function below injury but is NON-functional D incomplete Functional motor funcion belwo the level of injury E Normal Sensory and motor function are Normal
The Code of Ethics for Nurses as established by the ANA provides
a framework for nurses to use in ethical analsyis and decision making composed of nine provisions that establishes a standard for the profession.
Community re-entry and integration allows the transition to community through
a gradual acquisition of community skills, self care, leisure and vocational activities, and psychosocial integration.
A client experiencing powerlessness may exhibit
a lack of initiative in goal planning and achievment; passivity; withdrawal from family, social, and vocational decisions and interactions.
What are the characteristics of rapid eye movement (REM) sleep?
a lack of muscle movement, and vivid dreaming.
Impairment
a loss or abnormality of a psychological, physiological, or anatomical structure and function (Organ level)
The integral nursing theory provides
a multifaceted approach t the metaparadigm of a person described within four domains.
An ethical dilemma is when
a person is forced to choose between two equally difficult actions because they are both right, or uncertain.
According to the World Health Organization (WHO) Disability is
a restriction or lack of ability to perform an activity in a normal manner.
The Wong-Baker FACES scale is
a scale with drawings or pictures that clinicians use to assess pain in the cognitively impaired client.
The Assessment instrument for Problem focused Coping (APC) is
a self report instrument that focuses on a person's own assessment of competence in coping with activities of daily living (ADLs), personal problems, and level of satisfaction with ADLs.
Self efficacy is
a sense of control that consists of coping with, appraising, and managing one's life.
Diane Kempson suggests this type of treatment for complex post traumatic stress disorder (PTSD)
a specific focus on body-oriented therapies to facilitate the return to normal neurobiological functioning, thereby enhancing efficacy of talk therapies in the resolution of complex PTSD.
What causes a brain attack?
a stroke or a TIA
What is Narcolepsy?
a syndrome characterized by sudden sleep attacks, sleep paralysis, and visual or auditory hallucinations at the onset of sleep.
Cognitive strategic control
ability to sustain attention over a period of time
Hemoglobin
ability to transport O2
Hemoglobin indicates
ability to transport oxygen.
The Americans with Disabilities Act (ADA) mandates
accessible public transportation and bans potential employers from asking questions about disability.
What are ADLs?
activities required to maintain a daily life existence. This is primarily eating, dressing, and bathing or grooming.
anterior cord syndrome
acute flexion to cervical area, damage to anterior spinal artery affecting anterior 2/3 of cord,produces paralysis, loss of pain and temperature sensation below the injury, preservation of position sense
pain classification
acute, chronic
The ethics committee is an interdisciplinary group of healthcare professionals who
address ethical dilemmas that occur in a particular setting.
Day Treament care programs
adult day services, health , social support, promotes sense of control and self determaination,
The last 4 provisions of ANA Code of Ethics address
advancement of the nursing profession and its values, specifically the use of individual collective actions, general contribution to nursing improvement, participation in community and national efforts and collective assertion of nursing values
C3 - C5 spinal injury
affect diaphragm
Psychosocial characteristics of nurturing families include
affection, genuineness, honesty, open communication and love.
AMyotrophic Lateral Sclerosis
affects both upper and lower motor neurons
Cauda Equina Spinal Injury
affects lower motor neurons bowel, bladder and sexual function
post polio syndrome
affects survivors 10-40 yrs after acute attack, s/s-fatigue, pain in muscles and joints, sleep, breathing and swallowing difficulties, may experience muscle atrophy or wasting
emphysema
air gets caught in thhe lungs because they lose elasticity making it difficult to exhale caused by smoking,recurrent infections, alpha 1-antitripsin
The Functional Measurement tool (FIM) documents the 1st 3 days and last 3 days of hospitalization by
all disciplines involved in patient care.
In the holistic nursing concept the environment is
all physical surroundings, people and things that are present.
How does an independent living program support an individual with a disability?
allows pts. to remain in their own dwellings while offering support services
Compression Spinal Fracture
also know as wegde
Hope is
an anticipation of a future that is good and is based on relationships with others, purpose, meaning in life, and a sense of the possible.
Apathy
an attitude characterized by bland affect lethargy and decreased motivation
Low self esteem and low self worth manifest as
an expectant deprecation, often accompanied by a "victim mentality"
In the holistic nursing concept illness is
an imbalance in the human energy field.
Why is leg motor and sensory function often preserved after stroke?
anastomoses between ACA and MCA
hematological problems of the elderly
anemia- d/t less eating less meat/protein, and blood loss further reduces reserve capacity.
Autonomy
anothers right to self determine a course of action
When educating a client on sexuality and reproduction the rehab nurse should
answer all questions, promote an atmosphere of permission and acceptance, and separate your own values and attitudes regarding sexuality to address the issue objectively.
The following drug classifications can contribute to sexual dysfunction
antidepressants, antihypertensives, anticholinergics, anticonvulsants, histamine 2 blocking agents, lipid lowering agents, digoxin and opiods.
What types of drugs would be MOST likely to cause male ejaculation and impotence problems?
antihypertensives, antispasmodics, calcium channel blockers, tranquilizers, anticonvulsants, alcohol, and analgesics
Emotional signs of stress include
anxiety, emotional lability, restlessness, or fright.
Megace (megestrol) or Oxandrin (Oxandrolone) is prescribed for client's whos oral intake is less than 25%. What type of medication are these meds?
appetite stimulants.
types of exercise for ms
aquatic,yoga, tai chi
Autonomy is the ethical principle that individual actions
are independent of the actions and will of others.
Latent error
are those that have consequences observable only over time, such as admin policies, inadequate staff, poor equipment
risk factors for ischemic stroke
arterial hypertension, smoking, dm, insulin resistance, thrombocythemia and polycythemia, impaired cardiac function, hyperhomocysteinemia, post-menopausal women, advanced age, oral contraceptives, age, previous stroke
Discharge planning should begin
as soon as the patient is admitted
When assessing client mobility the nurse should
assess ROM (range of motion), balance, bed mobility, transfer ability, wheelchair ability, ambulation, neuromuscular problems, coordination and proprioception, cognition, patient expectations, growth and development, and comorbidities.
When faced with an ethical dilemma what must the rehab nurse do FIRST?
assess her own personal values
management of chf
assessment of heart and lung, treat the cause,decrease the workload-pace activity,energy conservation,rest periods am and pm, fluid restriction,salt restriction,daily weights,accurate intake and output,monitor of pulse and bp
Specific Suggestions as it relates to the PLISSIT model of sexual counseling would include
assisting people with problem identification, providing specific suggestions to resolve a problem.
Rehabilitation nursing goals
assisting the individual with a disability or chronic disease toward maximal health through health restoration
Poikil - Thermia
assuming the temperture of the enviornment
Myasthenia Gravis
auto immune disease, presence of abnormal thymus glandmuscle fatigue,drooping eyelid, speech/swallowing difficulties,extremity weakness, resp weakness,
Above T6 Spinal Injury
autonomic dysrelexia / orthostatic hypotention
Which of the following is a barrier to independent living for the C4 spinal cord injured patient?
availability of affordable, accessible housing
Serum Albumin
available protein stores
Revenue is related to the following
average daily census, Functional independence measure (FIM) of typical patients which determines the case mix group (CMG), Length of stay, number of discharges
nonmaleficence
avoidance of harm or hurt
Section 188 of the Workforce Investment Act
bans discriminination against disabled persons in federally funded employment service centers
What is the most common site of hemorragic stroke?
basal ganglia
diagnosis of GBS
based on clinical presentaion, recent viral infection, lumbar puncture shows csf proteins increase, emg-decrease nerve conduction
Why is a stroke in the corona radiata so significant?
because so many tracts are in this area - particularly more caudal in the corona radiata
nusing process theory
behavior of individual the nurses reaction, and subsequent nurses
Personal competence with coping in regards to relationships involves
being content with self and others.
Margaret Newman
believes that changes in the health status of an individual or family result in changes in the pattern as related to the whole community
Imogene King
believes that goal setting is not a one time event but rather an ongoing process
When comparing one facility's selected outcomes with those of another facility's outstanding outcomes this is considered which process?
benchmarking
Participants in health care have combined widely shared human beliefs about health and illness into four major ethical principles. What obligation requires health care providers to help people in need?
beneficence
diagnosis of muscular dystrophy
biopsy,emg,blood enzymes
Educational topics for clients with urge incontinence include:
bladder training/retraining, Urge inhibition if the client is cognitively intact, pelvic floor muscle exercises (Kegels)
Pathology of MS
blood brain barrier is breached as activated T-cells migrate into cns, triggering antibody-antigen reaction resulting in inflammation, loss of myelin, loss of oligodendrocytes and proliferation of astrocytes that remove damaged myelin, forms scar tissure over affected area
ischemic stroke
blood clot blocks a blood vessel or artery
hemoglobin A1c indicates
blood glucose during the last 3 months.
myeloma
bone marrow cancer
sarcoma
bone, cartilage canncer
Diabetes Insipidus
brain fails to produce ADH = voids often , dehydration
Uninhibited Neurogenic Bowel
brain is not able tell when bowel is full.
What is the worst area of the CNS to experience a hemmoragic stroke?
brainstem
Which techique allows the user to determine the volume of pts. required for a progam to be financially self-sufficient?
break-even analysis
treatment of uninhibited neurogenic
bulk fiber and fluids, avoid gas producing foods, check medications, bowel and bladder programs
treatment of areflexic
bulk fiber, maintain intake to 2000ml/day, some pts get ostomy to resolve problem
dysphagia in esophegeal phase
burping, indigestion,substernal pain from esophgeal reflux, c/o of bad taste in mouth,bad breath,coughing, wheezing, high indidence of dental cavities
leukemia
cancer that affects the blood forming elements of bone marrow
One lump sum payment made to the provider for each patient's treatment during a month or year is referred to as:
capitation payment
treatment for chd
cardiac catherization,ptca,athrectomy,ablation,cabg,pacemaker,aid
Dysphagia clients may use these techniques to prevent aspiration.
chin tuck, head turn, tongue sweep, double swallow & small sips of water between bites via spoon or cup.
neuropathic
central,peripheral
Cogenital Condition of children
cerebral palsy,spinal bifida,muscular dystrophy,cystic fibrosis
cancer warning signs
changes in size,color,shape, or thickness of a wart, mole,oral sore, repeated infections,persisten cough or hoarseness, lumps or thickened area anywhere on the body, changes in bowel/bladder habits
Mutiple Sclerosis
characterized by inflammation,demyelization and plaues in the white matter of the CNS & scarring of the myelin sheath in the CNS. Affects areas in the brain, optic nerve and spinal cord
To assess for cognitive ability and function...
check mental status for confusion, disorientation, and executive functioning.
To assess for impairments in self care ability,
check motor function, sensory perception, cognitive ability, and level of pain.
To assess for sensory impairments....
check the visual field and acuity, tactile loss or deficit, and hearing.
Anxiolytics, sedatives, and antipsychotics can be considered what type of restraint?
chemical.
s/s of cm
chest pain,exertional dyspnea, s/s of chf and pulmonary edema
Oral Phase
chewing / making a bolus / moving bolus to back of mouth
Behavioral theories
classical conditioning theory-pavlov environmental consequences of behavior theory-skinner Interactional Model-Schaie
Nurse wellness coaching involves the use of
coaching and mentoring competencies in order to improve patient care and the patient experience.
What ilicit drugs cause hemoragic strokes?
cocaine
Coping is defined as
cognitive and behavioral efforts directed at managing demanding and stressful situations
Psychosocial characteristics of troubled families include
coldness, rigidity, control, secrecy, guarded communication and tolerance rather than love
injury to brain stem at reticular formation
coma
Case Management
common provider-centered model within rehab,goal is provide high-quality, individualized,cost-effective care through the process of assessing, planning, organizing ,coordinating, implementing,monintoring,and evaulating their services and resources needed for an individual
Workers compensation is a government sponsored and employee financed system for
compensating employees who incur an injury or illness in connection with their employment.
Some suggestions for the client with bowel dysfunction problems related to sexual relationships include
complete the bowel regimen before sexual activity; avoid positions that place pressure on the bowels; cover ostomy.
Section 504 of the Rehabilitation Act of 1973 addresses
compliance with federal standards for physical disability in facilities Bans housing discrimination in public accommodations or private housing Prohibits unfairness in federally funded school Proscribes descrimination in privately operated transportation services
Martha Rogers
considers nursing to be an abstract body of knowledge
cerebrum
consists of two hemispheres, left side logic and logic, right side abstract, front motor, back sensory
The Joint Commission (JC) is an accrediting body of most healthcare institutions that's mission is to
continuously improve health care for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care.
Injury C3 , C4, C5
control diaphram, At C5 will be able to breath independently but cannot cough due to lost of diaphram control
temporal lobe
controls hearing taste, smell,Wernicke area,sequencing,memory
Integrative medicine is the combination of
conventional biomedicines used in conjunction with complimentary approaches.
Interventions for post traumatic stress disorder (PTSD) include
counseling, anxiety reduction, emotional support, support system enhancement, coping enhancement, active listening, presence, grief work facilitation and referral.
Interventions to assist a client with effectively managing post traumatic stress disorder (PTSD) include
counseling, anxiety reduction, emotional support, support system enhancement, coping enhancement, active listening, presence, grief work facilitation, and referral .
75% to 60% Rule
created in 1984,TEN catergories for admission for rehab, 2003-increased to THIRTEEN
diagnostic test for stroke
ct scan, mri, blood tests, angiogram,ekg, chest x-ray,ecg,lp,carotid studies
cerebrospinal fluid
cushions,protects,circulates within subarachnoid space,carries nutrients to and from the cns
source of pain
cutaneous,somatic,visceral
cauda equina syndrome
damage below conus to lumbar-sacral nerve toos, areflexxic bowel,bladder, areflexic lower extrem
conus medullaris syndrome
damage to conus and lumbar nerve roots, areflexic(flaccid) bowel,bladder, sexual function and lower limbs, areflexic lower extremities
brown-sequard syndeom
damage to on one side of cord, ipsilateral paralysis and loss of touch, pressure,vibration and proprioception on same side of injury Contralateral-loss of sensitivity of pain and temp on opposite side associated with penetrating injuries
Parkinson's Disease
damage/destruction of dopamine producting neurons in the substantia nigra w/in basal ganglia which causes trmor,rigidit,bradykinesia, postural instability
Suggested interventions for clients with attention or concentration problems related to sexual relationships include
decrease external distraction during sexual play; use of relaxation, imagery, or guided fantasy by uninjured partner.
injury to cerebellum
deficits on the same side of body as injury, hypotonia movement,postural changes and wide-based gait,ataxia
Imogene King
defines health as a dynamic life cycle
dysphagis in pharyngeal phase
delayed or absent swallowing, coughing, hx of aspiration pneumonia, weight loss, fear of eating/drinking, wet sounding voice while eating or drinking, freq clearing of throat, c/o something sticking or burning the back of the throat
coronary arteries
deliver blood to the heart muscle
Martha Rogers
describes nursing as a learned profession with the goal of promoting health and well being
Most sexual problems are classified as problems of
desire, excitement, or orgasm phase disorders. Combinations of the three may exist.
Self efficacy leads to the conviction that the person can
determine behaviors that lead to desired outcomes
The Functional Measurement tool (FIM) documents and evaluates performance improvement to
develop and maintain a plan of care.
goals and interventions for PD
develop coping stragies, improve knowledge, maintain indep in ADL, maintain safety
Marjory Gordon
developed a data collection system comprised of 10 functional health patterns necessary for assessment of a patients life experiences
Betty Neuman
developed a health care systems model in which the person is viewed as an open system in interaction with the environment
Variables that influence coping efforts include
developmental age, severity of disability, visibility of disability,
Plissit Model
dialogue about sexuality, Permission giving, Limited Information, Specific Suggestion, Intensive, Therapy
Examples of methods to assist in coping enhancement include
didactic exercises, feedback, counseling, boundary setting, detail planning, recognition of coping sabotage
A healthy heart lifestyle includes
diet, exercise and stress management.
Intellectual signs of stress include
difficulty in concentration and memory
visceral
diffuse pain,slow c-fibers
Title I of the American Disabilities Act was enacted in 1992 to prohibit
discrimination in the workplace against people with disabilities.
cardiomyopathy
disease of the heart muscle 1. dilated cm 2.hypertrophic cardiomyopathy 3.restrictive cm
insulin resistance
disorder in which cells do not use insulin properly,causes the pancreas to produce larger amounts of insulin in an attmpt to normalize blood glucose levels, fat cells are broken down and release free fatty acids, leads to metabolic syndrome and type 2 diabetes
Anterior cord syndrome
disruption of blood supply to anterior 2/3 of spinal cord
How does a TPA help?
dissolves clots which salvages penumbral tissue
Personal competence with coping in regards to differentiation involves
distinguishing between self and others
meperidine
do not use for persistent pain because of buildup of toxic metabolic,causes seizures and dysphoria,not reversible with naloxone
What is beneficience?
doing good
What is non maleficence?
doing no harm
beneficence
done for the benefit of others
Sister Calista Roy
drew her theory from the adaptation theory
dysphagia in oral phase
drooling on weak side, asymmetry of face, pocketing of food, altered lip closure and inability to close lips, wak or absent gag reflex, extended periods of time required to finish eating, chewing problems
injury to basal ganglia
dyskinesias,muscle tone alteration,rigidity, bradykinesia,tremors,athetosis,chorea
Interventions for ineffective health maintenance include:
educate the client at their learning level, determine readiness to learn, use memory aids, help the client identify and begin to resume family role responsibilities, identify adaptation strategies, and assist client and family to develop stress management skills.
Cognitive support as part of social support includes
education, advice, information, role modeling and counseling.
cancer interventions for acute stage
education,diagnosis prognosis,treatment with side effects,nutritional needs, risk of infection, pain relief,
Roles of a rehabilitation staff nurse include
educator, advocate, caregiver, and collaborator.
Characteristics of communication skills include
effective listening, self awareness, and conflict resolution
Emotion Focused coping involves
efforts directed at decreasing negative emotions.
Problem focused coping involves
efforts directed at lowering or eliminating threats.
Medicare is the federal health program for
elderly or disabled under the U.S. Department of Health and Human Services (DHHS).
The most successful leaders are
emotionally intelligent which means they are driven by qualities such as empathy, self - awareness, self-control, the desire to achieve, and social adeptness.
frontal lobe
emotions, personality,problem solving,judgement, voluntary motor movements, broca's area
The patterns of knowing as expressed in the practice of integral nursing are
empirical knowledge, personal knowledge, ethical knowledge, aesthetic knowledge, sociopolitical knowledge and not knowing.
Interventions to promote family integrity include
encourage family therapy, provide training in communication skills, provide the means for lifetime planning for continued care, and help the client and family identify and cope with changes in roles and responsibilities.
Nursing interventions for the client feeling powerless include
encourage the client and family to make decisions, promote environmental predictability and emotional support. Enable the client and family to recognize and mobilize their strengths and resources & utilize effective coping skills.
The rehabilitation Act of 1973
encouraged efforts to hire people with disabilities and prohibited unfair treatment of individuals with disabilities in activities supported in any way by federal funds.
therapeutic touch, healing touch, and comfort touch are all forms of
energetic healing through touch.
To reduce the risk of falls
ensure a safe environment free from barriers and hazards, and institute protective devices.
The rehabilitation nurse promotes good nutrition by:
ensuring the client understands the importance of diet, and encouraging dietary compliance. Assisting those who need help with the eating process. Taking and recording client weight and calorie count. Advocating and communicating between disciplines of physician, dietician, and other health care team members with patient and family preferences.
justice
equal and fair distribution of resources
The American with Disabilities Act (ADA) allows people with disabilities
equal opportunities, accessibility, and accommodations in imployment, transportation, and public access.
Instrumental support as part of social support includes
equipment and services
Capital requirements include
equipment, furniture, construction
The normal gait involves six components, name them
erect balance, a foot lift, a push off with the alternate foot, a heel strike, a ride over, and a heel strike of the opposite foot. Contralateral arms may swing to provide stability and balance.
What are the 4 categories of ethical theories
ethics of divine commands selfishness duty and respect consequences
The SLP (speech language pathologist) is a specialist in
evaluating and treating communication and swallowing problems.
chronic bronchitis
excessive mucus obstructs airway causing chronic cough and scarring of bronchial tissue
Active error
executed by nurse or other health care provider whose consequences are immediately observable.
Spasticity management may be achieved through...
exercise, stretching, oral medications like valium, baclofen, klonopin, and benzodiazepines. It may also be managed through direct botox injections at the site or implantation of a baclofen pump to provide intrathecal medication.
What areas does the Glascow Coma Scale test?
eye response, motor response, and verbal response
Flaccid Bladder
failure to empty, associated with lower motor neuron spinal cord injury
Spastic Bladder / Neurogenic bladder
failure to store urine, associated with upper motor neuron spinal cord injuries
Characteristics of "Grief associated with disability" may include
fatigue, apathy, appetite loss, low self esteem, sadness, guilt
Personal competence with coping in regards to self esteem involves
feeling worthy about ones self
Which ethical principle is exemplified by the rehab nurse who spends numerous hours in the preparation of a teaching plan for the pt, and future family caregivers?
fidelity
Sympathetic nervous system
fight or flight / slows peristalsis /
treatment for autonomic dysreflexia
find cause/stimulus, monitor bp and pulse, sit pt up, raise head of bed to encourage orthostatic, adminster appropriate medication, look for cause and remove stimuli such as empty bladder, empty bowel, check skin to prevent pressure ulcers
The basis of nursing staff development is
further education
management of ALS
focus on pallative care and comfort,key managment decisions discussed in advance of crisis, education on symptom management
Complimentary and alternative medicine (CAM) may include
folk medicine, herbal medicine, homeopathy, faith healing, massage therapy, energy healing, acupuncture
The Rehabilitation Act of 1973 included guidelines
for dondiscrimination in employment, and promoted community access by reducing or eliminating physical barriers.
When the Rehab nurse checks for spasticity, flaccidity, paralysis, contractures, tremors, rigidity, energy, endurance, strength, safety, and balance they assessing....
for motor impairments.
Acute Care units for Elders (ACE units)
for older adults, homelike physical environment, client and family centered, units located in acute care hospitals, goal is to transfer to a rehab unit
One crucial component toward healing is
forgiveness (pardoning oneself and others)
Nursing interventions to prevent a client from feeling helpless include
foster voluntary responses and independence. Encourage learning and reinforce successes. encourage the client to take personal inventory and affirm his/her feelings and expressions of hope.
How do we assess functional upper limb recovery in stroke?
fractionated movement of the fingers (it shows that the corticospinal tract is still in tact)
xenografts
from another species / pig
Allografs
from the same species / cadaver
Expressive aphasia
frontal lobe damage / comprehension intact
Awake, alert, atentive, can follow commands
full consciousness
The major focus of King's nursing theory is:
goal attainment through interaction
Community Base Rehab (CBR)
goal to enhance the quality of life for people with disability, meeting basic needs, ensuring inclusion, and participation. health, education, livelihood, social, and employment
lateral descending motor nerve tract
goes own the spine to the reflex arc s2-4 and triggers the bulbocaverbisis reflex to open the external spincter muscle and allow the urine to leave the bladder
Virture ethics places emphasis on developing
good character that leads to proper decisions
obesity
grade 1-bmi 25-29.9 over weight grade 2-bmi 30-39 obese grade 3 bmi 40 morbidly obese
Interpersonal psychotherapy focuses on
grief, interpersonal role disputes and role transitions.
What is the biggest risk for stroke?
having had a previous stroke or TIA
Which strategy, when implemented prior to discharge, promotes communication, defines the roles of each party, clearly outlines expected outcomes, defines the limitations of care, and establishes home health care agency liability?
health contract
Autograf
healthy skin graft of unburned area
The philosophy of rehab nursing is
helping a person to reach the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with the client's potential.
non-modified risk factor for chd
heredity,race,gender,age
Some medications that represent an increased risk for loss of skin integrity are
high dose steroids & immunosuppressants
Patients with which diagnoses would be likely to have restrictive lung disease?
high level spinal cord injury
nutrition for ms
high protein, low fat, low cholestrol
The National Database for Nursing Quality Indicators include
hospital acquired pressure ulcers, safely administered medications, prevention of hospital acquired infections, rate of falls
Per diem payments
hospital is pain one amount for all services delivered during one day
Per discharge payments
hospital is pain one amount for all services delivered during one stay
total person systems theory
how individuals react to stress through defense and resistance
The collective interior domain of the integral nursing theory is known as the "We" space. It involves
how we can come together to share our cultural background, stories, values meanings, vision, language, relationships and how to form partnerships to achieve the healing mission.
rogers science of unitary Human being theory
human beings and environment are energy fields. Energy fields, openness, pattern, pan dimensionality
Energetic touch is based on the interaction of the
human energy fields between teh provider and the client.
rapid acting insulin
humaolg,novlog,apidra
action
i'm doing it, but it takes work
Jacqueline Fawcett
identified four central concepts that provide the foundation for nursing theories: person, environment, health and nursing
The admission liaison nurse
identifies clients who meet program criteria and will benefit from program services through screening, education, and recommendations.
general theory of nursing
identify needs, plan delivery of care manage care
What would be the BEST approach for the rehab nurse with a new interest in political activism?
identify one issue of interest and act on it
goal and intervention for MG
identify s/s of disease distingusidh type of crisis, uses energy conservation, resp support, main nutrition choices require less work to chew, manage medication s/e, manage energy output throughout the day
Ataxi
impaired ability to coordinate movement / intentional tremeors / jerky movments
interventions and goals for pps
implement energy conservation, maintain funcion in affected limbs and limit atrophy, maintain breathing patterns& oxygenation, maintain nutritional support, prevent dvt, maintain B&B elimination, provide psycologial and emotiona support
R side brain stroke
impusive / denial of deficits /
Broca's aphasia is marked by the
inability to form or difficulty forming words, difficulty writing, and impaired ability to read letters numbers or written material.
chf
inability to increase cardiac output to meet body's metabolic need, decreased myocardial contractility,increased myocardial workload,cogential heart disease
Bradykinesia
inability to initiate movement or change momevment / Rigidity , tremor, and slow movements / symptoms of Parkinson's disease
Asterognosis
inability to sense objects by touch
The serum albumin
indicates available protein stores.
Hemoglobin A1c
indicates average blood glucose during the past 3 months
The four domains of the integral nursing theory are
individual interior, individual exterior, collective interior, and collective exterior.
maslow's hierachy of individuals
individuals needs 1. self-actualization 2. esteem 3.belonginess 4.safety 5.physiologial needs
What 2 coping styles indicate nursing interventions are needed?
ineffective and defensive
use of pain scale for child
infant and young children use FLAAC 3-7 use face scale 8 and older use number scale
Name the tenets of the Nuremburg code
informed voluntary consent expectation of benefit design principles based on animal studies Prior knowledge regarding the problem evaluated no expected harmful outcomes greater probability potential good rather than endangerment Prevention of patient suffering Protection of patient
Positive self esteem is fostered by
integrity, honesty, responsibility, compassion, and competence.
Who is responsible for developing, implementing, documenting and evaluating the treatment plan?
interdisciplinary team
treatment for MS
interfeeron beta products, glatiramer acetate(CoPaxone),Monoclonal antibody(Tysabri)
vascular supply to brain
internal cartoid left and right provides 80% blood to brain, vertebral arteris right and left supply 20% to brain
Nursing interventions for defensive coping should include:
interventions related to self-awareness, fostering relationships.
developmental theories
intrapyschic theories-Freus intrapersonal theories-sullivan social learning-Erickson
Which statement is incorporated in Orem's self care theory?
investigation/decision making where the pt. has control and input regarding activity
myasthenia crisis
involes resp and accessory muscles escalates requiring mech ventilation CAUSE: infection,fever, adverse reaction to med and insufficient med
limbic system
involved in emotions,motivation, memory,deep inside the brain,primitive emotions,fight or flight response,runs on serotonin
The team nursing approach for patient care delivery
involves an RN being responsible for a large group of patients and other personnel
Holistic Approach
involving mind, body and spirit
obstructive asthma
irritants inflame the lining of the trachea and bronchial tubes causing vasoconstriction of the smooth muscles of the airway passages,increased mucus secretion int eh airway, pt is unable to recive oxygen into the blood and carbon monoxide is trapped inside
Medical model
is the traditiponal way of providing healthcare services. Not consistent with rehab philosophy or goals and uncommon in rehab practice
Overall goal of rehabilitation
is to improve quality of life and to help a person "reach the fullest physiological, social, vocational, avocational, and educational potential consistent with his or her physiologic or anatomic impairment, environmental limitation, and desires and life plans." (Delia, Currie, & Martin, 1988)
Functional outcome measurement data collection
is used to communicate client progress, defines the quality of the rehab progress, and
what has a worse prognosis, hemoragic or ischemic stroke?
ischemic (hemorrhagic patients tend to be younger and healthier)
major types of strokes
ischemic and hemorrhagic
maintenance
it's almost routine
middle cerebral artery occlusion
known as MCA, most common stroke, largest branch in internal carotid artery, supplies lobes-frontal,temporal,parietal for primary motor and sensory areas for face,throat, hand, arm,aphasia,dyphagia, dyslexia,visual field deficits
restrictive lung disease
known as interstitital lung disease -damage lung tissue causes walls of the air sacs to become inflammed-leads to scarring-causes lungs to become stiff-making difficult to GET AIR INTO the lungs
type of ischemic stroke
lacunar infarct is clot in small cerebral arteries deep, results in a stroke pure motor, pure sensory, or ataxic hemiparetoc deficits
A person with Amyotrophic Lateral Sclerosis (ALS) may need augmentative communication devices. These include
language boards, paper and pen, computers or smart aps.
peakless insulin
lantus
theories of aging from Havighurst
later maturity task -disengagement from the task of middle age. This allows involvement in new roles such as grandparent and friend, Adjust to changes in health, retirement, loss of spouse, affiliation with one's own group, new living arrangements.
At 4 months old, an infant can
laugh, voice vowel and some consonants, repetitive babble
The chief nurse manager role is to provide
leadership through a vision of the potential capabilities of the unit
Which hemisphere of the brain controls language functions or linguistics?
left hemisphere
clincial manifestation of right hemisphere stroke
left-side paralysis, DIFFICULTY WITH;depth perception, impulsivity, geographic memory,balance,unilateral neglect, somatagnosia, inappropriate behabior, figure ground deficits, dressing problems,egocentricity
central cord syndrome
lesion in cervical region, damage to central part of spine, greater weakness in ue comapted to le, sacral sensory sparing, hyperextension or flexion in cervical region, bladder dysfunction
adolescence 13-9 years old
let them make decisions about their care, respect privacy, encourage friends and peers to visit
pharm interventions for parkinsons
levodopa,antiviral,anticholernig and catechol-0-methyltransderase inhibitor
Milieu therapy includes
light-hearted atmosphere among the rehab nurses and patients, availability of resources and activities, pleasant use of sounds such as piped in music, tone of voice
goals and interventions for gbs
limit pain and discomfort, maintain function in unaffected limb and limit atrophy to affect limbs, maintain oxygen and effective breathing, manage autonomic dysfunction, maintain nutritional support,effective communication, maintain skin integrity,prevent dvt, maintain B&B, provide environmental control, NOTE-strength returns in descending pattern
acute
localized pain,fast a-delta fibers
Skilled nursing facility (SNF)
long tern care, clients called residents,
change in weight
loss in type 1 gain in type 2
Ataxia
loss of ability to coordinate muscle movement
Complete spinal cord injury
loss of both motor and sensory function in the lowest sacral segment / 2-3 segments below lesion retain partial function
Mild brain injury
loss of concious <30min GCS 13-15 negative neuroimaging
Subluxation
loss of normal muscle tone in deltoid and supraspinatus, painless but when manipulated in improper position will cause pain
hyperphagia
loss of satiety / feeling full
Inadequate intake of protein, vitamin C, thiamine, and zinc (poor nutrition) place the client at risk for
loss of skin integrity
Asnomia
loss of smell
Impairment
loss or abnormality of psychological, physiological or anatomical structure or function
Maslow presented family, work, and community involvement as examples of which need
love/belonging
Medicaid is the health insurance program for certain individuals and families with
low income
Subacute Care
lower cost option for rehab care, for pt who cannot tolerate 3 hours of therapy per day,
fidelity
loyality fairness, truthfulness, advocacy, and dedication to our pateints
nursing intervention for swallowing problems
lung assessment before and after meals, seat upright position 90degrees, mininal distractions, discourage talking during meals, stay with one food and texture at a time, do not mix solids and liqids, teach alternate and solid mouthfuls,meds in pudding or yogurt
lymphoma
lympahtic system cancer
Independence can be fostered when people with disabilities are
made responsible for self care and expected to participate in family roles.
Nurse managers respsonsibilities include
maintaining standards of practice, competency, care, accreditation, operating budgets, staff developement, human resources
Quality is defined as
maintenance of the highest and finest standards
Situation ethics promotes
making the best decision given the specific circumstances.
treatment of dilated cm
management of hf, anticoagulation, heart transplantation
What is included in the American with Disabilities Act of 1990?
mandates 24 hour relay services by telephone companies so that individuals with telecommunication devices for the deaf could communicate with those who do not have those devices
Personal competence with coping in regards to productivity involves
manifesting competence
hypothalamus
master controller for the ANS, produces two hormoneswhich are stored an released from the pituitary gland( ADH and Oxycontin)
Multidisciplinary model
may be seen in rehab is one that takes on a pyramid-like shape. Physician at tip, however Lydia Halls model implemented at the Loeb center put nurses at top. Communication more vertical than lateral with leader controlling team conferences. Effective when team is not stable (different team members for different clients)
contemplation
maybe next month
Which team model is UNCOMMON in rehab practice?
medical
The National Quality Forum (NQF) states the major areas of concern in the health care setting are
medical errors, overtreatment, undertreatment.
treatment/mangement for asthma
medicatiions,maximize breathing,pace activities,reduce airway secretions,inflammation&bronchospams,maintian/improve nutritional status,identify irritants,smoking cessation, mechanical ventilation,peak flow meter, education
treatment of hypertrophic cardiomyopathy
medication-beta blockers,calicum channel blockers, anti-dysrythmic therapy, myotomy,pacemaker,automatic implntable cardioverter defibrillator
types of cancers that are increasing
melanoma,non Hodgkins lymphoma,childhood cancers,leukemia anc cancers of the kindney,thyroid,pancreas, liver, testis and esophagus
Rancho V
memory starts to improve
Holistic nursing takes the whole person into account including
mind body and spirit.
Lawrence Kohlberg & Carol Gillgan both developed theories of
moral development
3 and 4th ventricle
more centrally located, allows csf to continually flow from the brain to the spinal cord
symptoms of MS
motor loss resulting in weakness,tremors,knee locking,contractures,gait issues ataxia,Uhtoffs phenomenon,facial palsy, hyperactive brain stem-double vision, decreased vision field, dysphagia Elimination-urine freq,
Gullain-barre syndrome
motor weakness that ascendidng, symmetrical,flaccid paralysi,respiatory insufficieny, cranial nerve involvement,loss of nerlogical funcion and deep tendon reflex,weakness/fatigue in face,arms,neck,back and thoracic muscles
shearing
movement of muscles,tissue downward and compression against the bony skeleton / occurs when client sits in bed and slides down.
In which rehabilitaitonteam model is communication more vertical than lateral, with the leader controlling team conference?
multidisciplinary model
What is a major difficulty with mechanical embolus clot removal?
must be in an accessible location
1990 Self Determination Act
must have Advance Directive copy in charts, Educate pts on their rights
mg crisis
myasthenia crisis,cholinergic crisis
The most popular complimentary and alternative medicines (CAMs) are
natural products, deep breathing/meditation, and chiropractic.
What area of the body is at risk of occlusion of two major arteries?
neck - internal carotid and vertebral
Internal barriers for community reentry include
negative attitudes, poor self esteem, lack of motivation, poor self image, and feelings of dependence.
total person systems
neuman
secondary symptoms
neuropathy,renal dysfunction, esrd,erectile dysfunction,retinopath, peripheral vascuale disease in capillary beds
Exacerbation
new or worsening symptoms lasting more than a week
vegetative state
no distinct evidence of conscious awareness of self/environ eyes open spontaneously, SW, no intentional, purposeful, reproducible reponses to stimuli
NPO is the most restrictive diet, it means
nothing by mouth
intermediate acting
nph or L
medications or HIV
nucleoside analog reverse transcriptase,non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, fusion inhibitors,HAART therapy
The four concepts considered as the broadest perspective of the nursing profession include
nurse, patient, health, and environment.
Pre Albumin
nutritional status
When assessing a client's social support the nurse should
observe for barriers such as fatigue, isolation, lack of self confidence. Note the frequency of contact with family and friends, and the participation in leisure and physical activities. Patterns of behavior such as alcohol use after injury should be assessed.
Assessment of a family's psychological health includes
observing the family members' communication, cohesiveness, planning strategies, actions and behaviors
Upper Motor Neurological Bladder and Bowel
occurs at central nervous system from c1-t12, spastic paralysis and relexive muscles
lower motor neuron bladder and bowel
occurs below L1 and affects the peripheral nervous system, faccid spincters, no reflexes
Case management is the process
of assessing, planning, organizing, coordinating, implementing, monitoring, and evaluating the services and resources needed to respond to an individuals healthcare needs.
Problems related to sexual disinhibition or impulse control include
offending the uninjured partner, increasing the number of sexual partners, or show inappropriate public displays of sexual impulses or activity.
2 lateral ventricles
one in each hemisphere,csf formed
HIV
onset 0-12 weeks,virus infects wbc cd4+T cells, tests-Elisa,antigen,viral loads
What is the ideal time to involve the external case manager?
onset of the disability
Independent living
opportunity to share activities of daily living with other residents,
Phases of Swallowing
oral preparatory phase, oral propulsive phase, pharyngeal phase, esophageal phase
general theory of nursing theorist
orem
The Case manager acts in the best interest of the client to
organize, coordinate, and promote services and obtain client goals.
Injury T6 and above
orthostatic hypotension / temperature regulation / AD
treatment of chf
pacemaker,Lvad,cardiac transplantation,medication-diuretics,ace inhibibitors,digoxin,oxygen
nurse view on pain
pain is whatever the experiencing person say it is, exisiting wherever he says it does,
surgery options for parkinson
pallidotomy &thalamotomy deep brain stimulators which have electrical pulses in the brain
impact of disability on parents when a infant to 1year old is hospitalized
parents dream of having a perfect child is affected parents deal with seperation and bonding is interruped. parents feel guilt and sorrow BUT child adjust fairly well
reasons for incontience
pathological factors, anatomical factors, postmenopausal women, men with bph, cognitive dysfunction, MS,Parkinson, Stroke
3 Important concepts for rehab nursing
patient centered, goal-oriented, outcome-based
Ineffective community therapeutic regimen
pattern of regulating and integrating into community processes programs for treatment of illness that are unsatisfactory for meeting health related goals
Ineffective family therapeutic regimen management
pattern of regulating and integrating into family process that is unsatisfactory
Prospective payment system
payment rate to the healthcare facility is predetermined based on the medicare diagnosis
Bandura's Learning Theory of Self Efficacy
people learn from one another, via observation, imitation, and modeling.
Expected client outcomes related to sexual function include
personal satisfaction with sexual function, avoidance of sexually transmitted diseases, pregnancy when desired and possible or the avoidance of if not desired, and the ability to plan and carry out parenting roles if appropriate.
This branch of psychology investigates human nature and individual differences.
personality theory
Community reentry and assisted care living facilities
personalized 24 hours assistance and support,
Cardiac Rehabilitation Four phases
phase 1-inpatient telemetry unit, goal is the minimize damage phase 2-restoration day1 thru discharge goal-hemodynamic stability,regulate meds,educate,exercise, monitor phase3-outpt supervised program 2-12 weeks gaol-increase endurance,home exercise program,educate, decrease risk factors,resume sex phase 4-life long changes to improve endurance and fitness
neuromatrix theory
phathom pain, no cause, cns-built in body self neuromatrix generate nervee impulses that represnt the multidimensional somatosensery experience activate peripheral ssensory stimulation or by brain process to produce persistent pain
Stressors that affect men after a spinal cord injury (SCI) include
physical abilities, health and finances.
A device or equipment that the client cannot remove easily and that restricts his or her freedom of movement
physical restraint.
Lap belts, vests, geri-chairs, trays, bed rails, and door alarms all may be classified as
physical restraints.
The effects of stress are expressed...
physically, emotionally, intellectually, spiritually and socially.
Maslow's Heirachy of needs consists of 5 categories, name them.
physiological, safety, love/belonging, esteem, self actualization.
layers that protect the brain
pia mater,archnoid mater,dura mater
Symptoms of dysphagia include
pocketing food, leakage, delayed or prolonged swallowing, frequent pneumonia, malnutrition & weight loss.
primary s/s of diabetes
polyuria polydipsia polyphagia also poor healing, freq infections, fatigue
The best way to prevent pressure ulcers is by
positioning and repositioning the client's body, encouraging weight shifts every 15 minutes & providing proper seating.
s/s of autonomic dysreflexia
pounding headache,hypertension, bradycardia, flushing and profuse sweating above level of injury, piloerection, nasal congestion above level of injury, below injury-cold,pallor impending sense of doom
What is deontological theory
practice based on the ethics of duty and respect is more oriented toward what is defined as right in a legal sense.
Interventions for Diabetes
practice insulin admin,skin checks, exercise,150 min/wk moderate aerobic exercise,
Transtheoretcial model of change
pre-contemplation, contemplation, preparation, action, maintenance, transformation
incomplete injury
prescence of partial preservation of sensory or motor function below the level of injury
The Braden scale is used to assess
pressure ulcer risk
The nurse should encourage good skin care, manage incontinence, and encourage healthy nutrition to help prevent
pressure ulcers
In assessing an individual's coping effectiveness, the nurse should ask about the person's
previous lifestyle
Apraxia
problem with motor movement, motor planning
liver
produces albumin
Syndrome of inappropriate diuretic hormone (SIADH)
produces too much ADH = fluid retention and edema / meds = high salt diet
Wernicke's aphasia is marked by
production of verbal language, but the language is meaningless; fluent speech that may have incorrect words& context and the client is unable to detect errors.
Rehabilitation Act of 1973
prohibits discrimination on the basis of disability in programs conducted by Federal agencies, in programs receiving Federal financial assistance, in Federal employment, and in the employment practices of Federal contractors.
The nurse manager is responsible for
promoting and disseminating information about the values and objectives of the nurses.
Which method of paying health care providers shifts part of the financial risk to hospitals by paying a fixed amount based on admission diagnosis?
prospective payment
tissue cells release chemicals that stimulate pain process
prostaglandins,histamine, bradykinin,serotonin, substance p
meinges
protective coating for the brain and spinal cord
Nursing interventions for ineffective coping should include:
providing support that enhances the ability to cope, make decisions, control anger, build self esteem and enlarge support system
What are the two PRIMARY goals of the interdisciplinary team in pediatric rehabilitation?
provision of care and self-maintenance
cultural negotiation model
pt is seen as the expert in the knowledge of their condition. the rn interacts with the patient to develop to manage their pain
National Dysphagia Diet (NDD1), Dysphagia pureed allows clients to eat
pudding like consistency foods.
dysphagia pureed
pudding like no chunks, avoid lumpy foods and small pieces
Pupil response
pupils < or = 8 is coma;
Three things to include in any pain assessment are
quality, location and radiation
The commission on Accreditation of Rehabilitation Facilities (CARF) seeks to promote
quality, value and optimal outcomes of services through a consultative accreditation process.
Quality measure
quantification of the degree to which a desired healthcare process or outcome is achieved
short acting
r insulin
Dysphagia can be caused by
radiation treatment, stroke, dementia, myasthenia gravis, and Amyotrophic lateral sclerosis (ALS).
Amyotrophic Lateral Sclerosis (ALS)
rapid destruction of motor neurons in the brainstem and spinal cord
What is the role of an interdisciplinary team?
reach a common goal thru team meetings and go beyoud their respective disciplines
What is a SMALL number of people with complementary skills who are equally commited to a common purpose, goals, and working approach known as?
real team
parietal lobe
receives and inteprets sensory input,pain temp, pressure,size,shape,spatial orientation
occupital lobe
receives and interprets visual,depth perception
Personal competence with coping in regards to love involves
receiving affection, and being compassionate, accepting and giving.
Which member of the rehab team has the PRIMARY responsibility for assisting pts. in gaining skills for community reentry?
recreational therapist
treatment for chronic bronchitis and emphysema
reduce airway secretions,reduce inflammation, decrease bronchospasm,medications,hest physiotherapy
CARF accredits which type of programs?
rehab programs
Societal barries for community reentry may include
reimbursement issues, ineligibility for services, cultural or attitudinal prejudices, and social stigmas.
Factors that influence personal competence with coping are
relationships, differentiation, autonomy, self-esteem, power, productivity, and love.
Self-hypnosis, prayer recitation, deep-breathing, muscle relaxation are types of
relaxation exercises
Personal competence with coping in regards to autonomy involves
relying on self separate and distinct form others.
Prospective memory
remembering to do something in the future
Education for all Handicapped Children Act 1975
required public schools accepting federal funds to provide equal access to education for children with physical and mental disabilities
Affordable Care act
requires people to have health care insurance
The National Center for Complimentary and Alternative Medicine (NCCAM) is a federal agency that funds
research on complementary and alternative medicine (CAM)
A closely knit group of patients sharing support services is a
residential facility
Which initiative was developed by Medicare to reimburse physicians under the Omnibus Budget Reconciliation Act of 1989?
resource-based relative value reimbursement
Pharyngeal Phase
respiration is inhibited . trachea is coved by epiglottis
Goal of rehabilitation
restore,maintain, and promote maximal health
The goal of rehabilitation is
restoring, maintaining, and promoting maximal health.
Interventions to assist clients with sexual relationships if they experience bladder dysfunction include
restrict fluids before sexual activity and complete toileting. if foley catheter present it can be taped to the side (for men a condom may be placed over the shaft of the penis) avoid positions
Disability
restriction of the ability to perform and activity in the manor considered to be normal. (personal level)
cholinergic crisis
resulsts from excessibe dosage of cholinergic treatment meds s/s-salvation, lacrimation, urinary incont, GI upset,miosis, flaccid paralysis, resp failure
To assess the client's fall risk....
review the fall history, medications, assess gait and balance, identify mobility aids needed
clinical manifestation of left hemisphere stroke
right side paralysis, DIFFICULTY WITH :math problems , symbolic interpretation, speech and language deficits, analytic thinking, hesistant behavior,
Social manifestations of stress include
role conflict, status incongruity, withdrawal, antagonism, or role rigidity.
hemmorrhagic stroke
rupture of blood vessel in brain
Maslow presented shelter, job security, and monetary security as examples of which need
safety
concerns of using opiods
safety concerns, n/v, constipation,drwsiness with sedation, interactions with other medications
Expenses include
salaries, fringe benefits, staffing requirements, supplies, rental equipment
Deep tendon relex
score of 2+ is normal
In the holistic nursing concept a client is
seen as one with the universe and is an energetic being manifested as frequencies or energy waves.
Imogene King
sees nursing as an interactive endeavor in which nurse and client share information in the nursing situation
Positive thinking, satisfaction at small successes, and interest in appearance are all evidence of
self -concept adjustment
Avoiding, neglecting, or refusing to recognize personal assets are evidence of
self -diminution
A person's sense of personal value and ability to consider himself/herself with dignity, love, and reality. It affects the inner person and the person's relationships with others. It is based on a personal evaluation of self worth and competence.
self esteem.
A person's perception of himself/herself as related to others and the environment that addresses all aspects of the person is referred to as
self-concept.
Negative thinking, and expectations of failure are evidence of
self-criticism
wellness is defined by the holistic concept as a
self-directed quest, for optimal well-being along a multidimensional continuum of mind body and spirit.
Which attribute or trait is a characteristic of a change-resilient person?
self-discipline
Which theory did Bandura deveklop to guide the assessment of the individual's ability to promote health and reduce risk?
self-efficacy
Piaget's stages of development
sensorimotor-up to 2 years in which senses guide the child preoperational-2 to 7 ears child and fantasy concrete operations-starts at age 7 formal operations-age 12-18,lack of judgement and are egocentric
The six components of the braden scale include
sensory (ability to respond meaningfully to pressure related discomfort), moisture (the degree to which skin is exposed to moisture), activity (degree of physical activity), mobility (ability to change change and control body position), nutrition (usual food intake), and friction and shear (stability of movement in a relaxed position, such as in a bed or chair).
What blood tests indicate nutritional status?
serum albumin, hemoglobin, hamoglobin A1c, and prealbumin.
Components of individual goal setting include
set on admission, individualized & realistec, reviewed and updated regularly.
Which christian sect maintains Saturday as the holy day?
seventh day adventist
Americans With Disabilities Act 1990
signed into law under President George H W Bush. It applies to all private and state-run businesses, employment agencies to make sure that no person with a disability is turned down for a job or promotion, or refused entry to a public-access area.
carcinoma
skin cancer
The two most common sleep disorders in the Rehabilitation client are
sleep apnea and narcolepsy
Parasympathetic Nervous System
slows heart rate / lowers BP / increase GI activity / shunts blood to major internal organs
Stress incontinence is defined as
small lossess of urine that occurs when the intra-abdominal pressure is increased by activities such as coughing, laughing, exercising, or sneezing.
modified risk factors for chd
smoking,htn,cholestrol,dm,sedentary lifestyle,alcohol,obesity
In the integral nursing theory the collective exterior domain is known as the "Its" space. It includes
social systems and structures, networks, organizational structures and systems, information technology, regulatory structures.
National Dysphagia Diet (NDD2), Dysphagia mechanically altered allows clients to eat
soft moist foods
mechanical soft
soft moist ground meats and soft vegetables and bread, cakes and rice
dysphagia mechanically altered
soft moist ground meats and soft vegetables, no breads, peas or corn, avoid skins and seeds
Limited information as defined in the PLISSIT model of sexual counseling would include
some specific information related to questions raised or concerns expressed and allowing the person to pursue the issue further if her or she is comfortable.
precontemplation
someday
Multiple Sclerosis
spacticity ans spastic paralysis / upper motor neuron disorder / demyelination / cranial nerve II (optical) / cranial nerve III (occulomotor) / blurred vision / blind spots / double vision
Name three classifications for neurogenic bladder
spastic bladder, flaccid bladder, and overactive bladder.
sci
spinal cord injury
spina bifida
spine does not closee properly known as neural tube deficit
NON -Rem Stages
stage 1 bried transitonal sleep, stage 2 is deeper sleep, stage 3 a&4 is the deepest sleep
Rebound occurs when an individual spends insufficient time in certain stages of sleep. For which of the following stages is rebound an IMPORTANT concept?
stage 4
Rancho VI
start using memory systems such as cueing and repetition
Medicaid is federally funded but
state administered.
Imogene King
states that a person has intrinsic worth
Imogene King
states that the goal of nursing is to help individuals maintain their health so they can function in their roles
The application of set attitudes about and stereotypes of people with disabilities.
stigma
Autonomic Dysreflexia is caused by
stimulation below the level of injury, also known as hyperreflexia.
Inpatient Rehab Facility
stoke, trauma, tbi, spinal cord, CARF, 3 hours of skilled rehab therapy a day for 5 days,
What is the leading cause of adult long term disability in Canadians?
stroke
persons who may have swallowing difficulties
stroke,brain injury,parkinson's, MS,ALS, MD, pollomyelitis,radiation treatment, worsening dementia
SAH
subarachnoid hemorrhage-rupture of blood vessel w/in subarachnoid space
Rehabilitation clients need adequate nutrition to
support healing and meet metabolic demands as the diet changes during acute and chronic illness or disability.
treatment of reflex neurogenic
suppository,digital simulation,sit on commode
Overactive bladder (detrusor hyperreflexia without detrusor sphincter dyssynergia) is often seen with
suprapontine lesions from other cerebrovascular diseases.
Dysphagia is
swallowing difficulty during the passage of a solid or liquid bolus from the mouth to the stomach.
diagnosis of cystic fibrosis
sweat test
s/s of chf
swelling of the legs,ankles and abd d/t to build up of fluid s.o.b. during rest or exercise,persisent cough-often produces mucus or blood-tinged sputum,decreased ability of kidney to remove sodium abd water, fatigue, weight gain,loss of appetite and nausea
non-insulin injectables
symlin,byetta
Severe constipation is defined as constipation that causes
sympathetic systemic problems (e.g., sweating, nausea, irritability, acute abdominal discomfort, and elevated blood pressure.)
Chronic constipation is defined as
symptoms lasting longer than 3 months, with enlargement of the descending colon and dependency on laxatives, cathartics, or enemas.
type of ischemic stroke
system hypoperfusion-known as watershed stroke, caused by inadequate cardiac output with system
cancer staging methods
t-tumor n-node involvement m-metatistic
A partner of a client with neglect or denial of deficits related to sexual relations should
take a more active role and gently redirect the injured partner, use positioning with pillows or alternate positions.
Holistic nursing includes any form of nursing that
takes the whole person into account including mind, body, and spirit. In holistic nursing this is the bio-psycho-social-spiritual framework
In the interdisciplinary team model
team decisions are determined by the group working directly with the client.
What is the process of aligning and developing the capacity of a team to create the results its members desire?
team learning
Global Aphasia
temporal lobe damage / impaired reception and expression of speech / written info is limited
Which level of wellness views rehabilitation activities and the monitoring of health care processes to prevent complications or further illness, injury or disability?
tertiary prevention
Section 504 of the Rehabilitation Act requires
that all buildings and facilities are designed, constructed, or altered to accommodate physical disability.
Provisions 1,2,and 3 of the ANA Code of Ethics says
that the nurse should provide services in a manner that respects human dignity, that the nurse's main committment is to the patients and should act as an advocate
The structure that can be enhanced to create more integral awareness and partnerships to achieve health and healing both locally and globally is known by the integral nursing theory as
the "Its" of the collective exterior domain
Barbara M Dossey is credited with developing
the Integral Nursing Theory to support holistic nursing.
The multidimensional acceptance of loss scale developed by James Ferrin evaluates
the ability of a client to enlarge the scope of values, contain the disability, subordinate the physique, and change comparative status values to asset values.
Helplessness is
the belief that a person is dependent on others for support for a situation that seems to be impossible to change.
Stress is defined as
the cognitive awareness of any external or internal unmet demands that unbalance a person's equilibrium.
Self-efficacy is an important concept in relation to changing health behaviors. Which statement BEST describes self-efficacy?
the degree of confidence a person has about his or her ability to perform a specific activity
The ARN definition of rehab nursing is
the diagnosis and treatment responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle.
What is nonmaleficence?
the duty to do no harm
Duty ethics is a form of ethics that believes
the end justifies the means.
Motor Paralytic bowel impairment is defined as
the inability to assist with defecation and is associated with incontinence only if there is widespread disease due to the innervation of the intestines.
Define disability
the inability to perform some key life function
In the integral nursing theory the individual interior domain is known as the "I" space. It includes
the individual's inner experiences, and states of mind.
Define handicap
the interaction of a person with a disability with the environment
Which ascending spinal cord tracts is responsible for transmitting pain and temperature sensations?
the lateral spinothalamic tract
The assessment for how well a client is coping with diagnosis should include
the level and sources of stress expressed by the client and family, the client's ability to solve problems, changes in the client & families ability to meet their needs.
what is diaschisis
the loss of brain function in regions connected to, but at a distance from the infarction
Define functional limitation
the loss of the ability to perform self-care tasks and is the result of an impairment
Functional incontinence is defined as
the loss of urine and/or stool that is not caused by the GU/GI system, but rather something outside these systems.
Urge incontinence is defined as
the loss of urine caused by abnormal detrusor contractions, sometimes associated with urinary retention.
Overflow incontinence is defined as
the loss of urine caused by bladderoverdistention or retention.
According to the World Health Organization (WHO) Impairment is
the loss or abnormality of a psychological, physiological, or anatomical structure and function.
In the integral nursing theory the individual exterior domain is known as the "it" space. It includes
the material body, integral patient care plans, skills development, behaviors, leadership skills, integral life practices, and anything we can touch or observe in time and space.
Knowledge of a client's cultural practices includes
the meaning of touch, personal spatial and distancing, and the use of eye contact.
Provision 5 of ANA Code of Ethics says
the nurse has a committment to self as well as in terms of maintenance of integrity and personal and professional growth
Provision 4 of ANA Code of Ethics says
the nurse is responsible and accountable for individual nursing decision and actions
Homebound status means
the patient is unable to easily leave home alone or with assistance,requires skilled care at home and has no other readily accessible options to address these needs.
Acute constipation is defined as
the recent onset of symptoms, a large amount of stool in the rectal ampulla, colon, or rectum.
Which of the following defines impairment?
the residual limitation that results from disease, injury, or a congenital defect
Post traumatic stress disorder (PTSD) is defined as
the state in which an individual experiences a sustained painful response to one or more overwhelming traumatic events for more than 1 month and is unable to assimilate the memory of the event.
transformation
there is no going back
risks factors affecting fall in the eldery
think Crashed C for cords, carpets,cracks R for Rx-drugs A-affect( depression) S- for Sickness H for Hypotension E for Eyes D for Dizziness
What is the purpose of the Glascow Coma Scale?
to access for LOC
Why was the Nuremburg Code established after WWII
to address human medical experimentation and is now the basis for clinical research guidelines
Why should arms be positioned correctly with splints a
to avoid subluxation
The general goals of Cardiac Rehabilitation are
to reduce or minimize further complications, promote a healthy heart lifestyle, and improve cardiac function.
complete injury
total loss of sensation and motor function below the level of injury
management gbs
total plasma exchange,IV Immunoglobulin, medication to assist with complication
Nonverbal communication is the
transmission of message without the use of words.
clinical manifestation of Parkinson Disease
tremors,pill rolling of thumb and finger, muscle rigidity,fressing episodes, abnormal muscle stifffness, inability to change movement, slowness, no arm swing, shuffling gait, drooling and swallowing problems,small handwriting
Required components necessary for self-maintenance of a team include
trust, knowledge, shared responsibility, mutual respect, communication, cooperation and coordination and optimism.
long acting
ultralente (u) insulin
kurt Lewins
unfreezing, change, refreezing Motivation to change, change sense of stability
Overflow incontinence is characterized by
urgency, frequency, dribbling, and both stress and urge incontinence.
stepwise approach to pain
use mild apprach using nsaid then moderate to severe pain uses opiod
multimodal analgesic approach
use of aduvant medication- anticonvulsants,nsaidsand antidepressants for neuropathic pain
early childhood 3-6 years old
use play therapy, focus on abilites not disabilites
posterior spinothalmic tract ascending
used for bladder fullness pain and temp which sends message to cerebral cortex to the sensory strip then to the inhibitory center in the temporal/frontal making the brain aware of the full bladder
A chemical restraint is a medication
used to subdue or quiet behavior
Personal competence with coping in regards to power involves
using energy to initiate and guide behaviors
Polypharmacy
using two or more drugs to treat the same condition / using more medications than are clinically indicated in a given client
Spiritual signs of stress include
value conflicts
What is ischemic penumbra?
vessels nearby a blocked vessel will immediately start to sprout new capillaries to try and salvage tissue and maintain blood supply
The adaptation of an existing family intervention for a chronic condition that focuses on enhancing both individual and family functioning is useful for working with
veterans and others with traumatic brain injury (TBI)
Martha Rogers
views human beings as wholes not parts
Martha Rogers
views nursing as "knowing rather than doing"
Margaret Newman
views the meaning of life and health in terms of an evolving process of expanding consciousness
Imogene King
views the person as an open system
ways to rate pain
visual analog scale(VAS),numeric rating scale (NRS),Wong Baker-Face Scale
Nonverbal communications may include
vocal tone, eye contact, physical appearance, gestures, and posture.
Stress incontinence is caused by
weak external sphincter, weak pelvic floor musculature, and secondary effects of smoking and obesity.
nursing interventions for wounds and pressure ulcers
weight shifting, float heels,manage incontience, cushions, minize moisture
Factors of social interaction with family and friends as well as environment can influence
wellness of the mind, body, and spirit.
Rebound occurs:
when an individual is deprived of Stage 4 sleep
Kurt Lewin's Change theory includes three stages of change. Stage 3 " refreezing" includes
when the change is established.
Kurt Lewin's Change theory includes three stages of change. Stage 1 "Unfreezing" includes
where one lets go of old patterns
The Frazier water protocol administers medications
whole or crushed in applesauce, pudding, yougurt, or thickened liquid, never thin water.
Overactive Bladder
without detusor sphincter dyssynergia
In a multidisciplinary team model professionals
work in parallel towards their disciplines specific goals with very little overlap. Goals are set by a team representative.