Nursing Process - Chapter 9
The interface model of disability is being used to plan the care of a patient who is living with the effects of a stroke. Why should the nurse prioritize this model?
It promotes the idea that patients are capable and responsible.
A patient who is recovering from a stroke expresses frustration about his care to the nurse, stating, "It seems like everyone sees me as just a problem that needs fixing." This patient's statement is suggestive of what model of disability?
Rehabilitation model
A patient who is legally blind is being admitted to the hospital. The patient informs the nurse that she needs to have her guide dog present during her hospitalization. What is the nurse's best response to the patient?
"Arrangements can be made for your guide dog to be at the hospital with you during your stay."
A patient tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be a "chronic condition." She asks the nurse what "chronic condition" means. What would be the nurse's best response?
"Chronic conditions are defined as health problems that require management of several months or longer."
You are presenting patient teaching to a 48-year-old man who was just diagnosed with type 2 diabetes. The patient has a BMI of 35 and leads a sedentary lifestyle. You give the patient information on the risk factors for his diagnosis and begin talking with him about changing behaviors around diet and exercise. You know that further patient teaching is necessary when your patient tells you what?
"There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented."
During the care conference for a patient who has multiple chronic conditions, the case manager has alluded to the principles of the interface model of disability. What statement is most characteristic of this model?
"This patient can be empowered and doesn't have to be dependent."
A man and woman are in their early eighties and have provided constant care for their 44-year-old son who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have what concerns around what question?
"Who will care for our son once we're unable?"
Research has corroborated an experienced nurse's observation that the incidence and prevalence of chronic conditions is increasing in the United States. What health promotion initiative most directly addresses the factor that has been shown to contribute to this increase?
A community-based weight-loss program
A 19-year-old patient with a diagnosis of Down syndrome is being admitted to your unit for the treatment of community-acquired pneumonia. When planning this patient's care, the nurse recognizes that this patient's disability is categorized as what?
A developmental disability
A case manager is responsible for ensuring that patients meet the criteria for diagnoses of chronic conditions in order to ensure their eligibility for federal programs. Which of these definitions may not apply for legal purposes?
A person who is temporarily disabled but later return to full functioning.
A patient who has recently been diagnosed with chronic heart failure is being taught by the nurse how to live successfully with her chronic condition. Her ability to meet this goal will primarily depend on her ability to do which of the following?
Adapt her lifestyle to accommodate her symptoms.
The community nurse is caring for a patient who has paraplegia following a farm accident when he was an adolescent. This patient is now 64 years old and has just been diagnosed with congestive heart failure. The patient states, "I'm so afraid about what is going to happen to me." What would be the best nursing intervention for this patient?
Assist the patient in making suitable plans for his care.
A nurse knows that patients with "invisible" disabilities like chronic pain often feel that their chronic conditions are more challenging to deal with than more visible disabilities. Why would they feel this way?
Despite appearances, invisible disabilities can be as disabling as visible disabilities.
A major cause of health-related problems is the increase in the incidence of chronic conditions. This is the case not only in developed countries like the United States but also in developing countries. What factor has contributed to the increased incidence of chronic diseases in developing countries?
Developing countries are simultaneously coping with emerging infectious diseases.
A 37-year-old woman with multiple sclerosis is married and has three children. The nurse has worked extensively with the woman and her family to plan appropriate care. What is the nurse's most important role with this patient?
Help the patient develop strategies to implement treatment regimens
You are caring for a young woman who has Down syndrome and who has just been diagnosed with type 2 diabetes. What consideration should you prioritize when planning this patient's nursing care?
How her developmental disability influences her health management
An international nurse has noted that a trend in developing countries is a decrease in mortality from some acute conditions. This has corresponded with an increase in the incidence and prevalence of chronic diseases. What has contributed to this decrease in mortality from some acute conditions?
Improved nutrition
You are the case manager who oversees the multidisciplinary care of several patients living with chronic conditions. Two of your patients are living with spina bifida. You recognize that the center of care for these two patients typically exists where?
In the home
A nurse is aware that the number of people in the United States who are living with disabilities is expected to continue increasing. What is considered to be one of the factors contributing to this increase?
Increased survival rates among people who experience trauma
A home care nurse is making an initial visit to a 68-year-old man. The nurse finds the man tearful and emotionally withdrawn. Even though the man lives alone and has no family, he has been managing well at home until now. What would be the most appropriate action for the nurse to take?
Reassess the patient's psychosocial status and make the necessary referrals
A 39-year-old patient with paraplegia has been admitted to the hospital for the treatment of a sacral ulcer. The nurse is aware that the patient normally lives alone in an apartment and manages his ADLs independently. Before creating the patient's plan of care, how should the nurse best identify the level of assistance that the patient will require in the hospital?
Talk with the patient about the type and level of assistance that he desires.
You are the nurse caring for a young mother who has a longstanding diagnosis of multiple sclerosis (MS). She was admitted to your unit with a postpartum infection 3 days ago. You are planning to discharge her home when she has finished 5 days of IV antibiotic therapy. With what information would it be most important for you to provide this patient?
The same information you would provide to a patient without a chronic condition
You have admitted a new patient to your unit with a diagnosis of stage IV breast cancer. This woman has a comorbidity of myasthenia gravis. While you are doing the initial assessment, the patient tells you that she felt the lump in her breast about 9 months ago. You ask the patient why she did not see her health care provider when she first found the lump in her breast. What would be a factor that is known to influence the patient in seeking health care services?
Unfavorable interactions with health care providers
The nurse is reviewing the importance of preventative health care with a patient who has a disability. The patient states that she will not have the money to pay for her annual gynecologic exams or mammograms due to the cost of this hospitalization. What information would be appropriate for the nurse to share with the patient?
"I'll look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions."
The staff development nurse is presenting a class on the importance of incorporating "people-first" language into daily practice as well as documentation. What is an example of the use of "people-first" language when giving a verbal report?
"The patient with schizophrenia"
A man with a physical disability uses a wheelchair. The individual wants to attend a support group for the parents of autistic children, which is being held in the basement of a church. When the individual arrives at the church, he realizes there are no ramps or elevators to the basement so he will not be able to attend the support group. What type of barrier did this patient encounter?
A structural barrier
A patient has recently been diagnosed with type 2 diabetes. The patient is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help the patient increase his activity level?
Identify barriers with the patient that inhibit his lifestyle change.
The nurse is caring for a young adult male with a traumatic brain injury and severe disabilities caused by a motor vehicle accident when he was an adolescent. Where does the nurse often provide care for patients like this young adult?
Medical-surgical units
A patient with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the patient and her family to establish goals for care. What is likely to be a first priority in goal setting for the patient?
Pain control
During their prime employable years between ages 21 and 64, 77% of those with a nonsevere disability are employed. What has research shown about this employed population?
People with disabilities earn less money than people without disabilities.
The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patient's condition has continued to deteriorate. What is the nurse's best response to this clinical information?
Recognize that the patient is in the downward phase of chronic illness and should be reassessed.
A patient who undergoes hemodialysis three times weekly is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355-mL (12 ounce) soft drink after the patient has already reached the maximum intake of fluid for the day. What action should the nurse take?
Reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid
A medical-surgical nurse is teaching a patient about the health implications of her recently diagnosed type 2 diabetes. The nurse should teach the patient to be proactive with her glycemic control in order to reduce her risk of what health problem?
Renal failure
A community health nurse has drafted a program that will address the health promotion needs of members of the community who live with one or more disabilities. Which of the following areas of health promotion education is known to be neglected among adults with disabilities?
Sexual health
You are caring for a patient with a history of chronic angina. The patient tells you that after breakfast he usually takes a shower and shaves. It is at this time, the patient says, that he tends to experience chest pain. What might you counsel the patient to do to decrease the likelihood of angina in the morning?
Shower in the evening and shave before breakfast.
A patient with a spinal cord injury is being assessed by the nurse prior to his discharge home from the rehabilitation facility. The nurse is planning care through the lens of the interface model of disability. Within this model, the nurse will plan care based on what belief?
The patient has the potential to function effectively despite his disability.
An initiative has been launched in a large hospital to promote the use of "people-first" language in formal and informal communication. What is the significance to the patient when the nurse uses "people-first" language?
The person is of more importance to the nurse than the disability.
An elderly patient has presented to the clinic with a new diagnosis of osteoarthritis. The patient's daughter is accompanying him and you have explained why the incidence of chronic diseases tends to increase with age. What rationale for this phenomenon should you describe?
With age, biologic changes reduce the efficiency of body systems.
