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Apathy The answer is: Lack of feeling or emotion; lack of interest; indifference What are signs of burnout? The answer is: Anxiety, apathy, feeling drained, loss of appetite, mental exhaustion, persistent/recurrent illness, persistent physical exhaustion, sleeplessness What are factors that lead to...

Apathy The answer is: Lack of feeling or emotion; lack of interest; indifference What are signs of burnout? The answer is: Anxiety, apathy, feeling drained, loss of appetite, mental exhaustion, persistent/recurrent illness, persistent physical exhaustion, sleeplessness What are factors that lead to burnout? The answer is: Workload (STAFFING, STAFFING, STAFFING) Poor systems/processes Leadership Ethical dilemmas Moral distress Work culture Idealism No work-life alignment What is resilience? The answer is: The ability to survive and thrive in the face of adversity. Resilience can be developed and internalized as a measure to improve retention and reduce burnout. Building positive relationships, maintaining positivity, developing emotional insight, creating work-life balance, and reflecting on successes and challenges are effective strategies for resilience building What are components of building resilience? The answer is: Support system, mentoring, hope, faith, humor, self-awareness, perseverance, purpose, flexibility, curiosity, forgiveness, courage, positive emotions, competence, self-efficacy, self-compassion Resilience The answer is: Bouncing back from adversity; stretching oneself to overcome adversity - a process of personal growth that allows us to maintain well-being when experiencing adversity What are characteristics of resilience? The answer is: Acceptance, flexible, willing to learn, solutions focused, resourceful, creative, realistic Cognitive function The answer is: Processes involved in human thought; extent to which one can receive, process, store, retrieve and use sensory information Sensory function The answer is: Extent to which one receives sensory information via five senses and accurately interprets sensory information What are factors to be considered about cognitive function? The answer is: Motor function, language, learning/memory, social cognition, complex attention, executive function, memory What are factors to be considered about sensory function? The answer is: Requires intact nervous system and sensory receptors Function ranges from normal to impaired Sensory deprivation vs. overload Psychiatric conditions What are risk factors for sensory deficits? The answer is: Age, genetics, medications, injury, illness (i.e, stroke) What are common impairments? The answer is: - Delirium - Neurocognitive disorders (dementia) - Cognitive impairment (not dementia) - Focal cognitive disorders - Intellectual disability - Learning disability __________ is a transient, reversible, and acute condition caused by issues like infections The answer is: Delirium ________ is an umbrella term that encompasses different types of progressive neurocognitive declines The answer is: Dementia How do you care for clients with aphasia? The answer is: - Call clients by their name - Use short sentences, simple words - Speak slowly and clearly - Pause between statements - Check of understanding - Allow clients time to reply - Use a picture chart - Collaborate with speech therapy What are examples of cognitive function abnormalities? The answer is: Amnesia, aphasia, alexia, agraphia, agnosia, apraxia, hemispatial neglect, dyscalculia, conceptual concreteness, flight of ideas, confabulation, circumstantiality, echolalia, pressured speech, word salad Amnesia The answer is: Loss of memory Aphasia The answer is: A language disorder that makes it difficult to understand language, speak, read, or write; common with stroke Alexia The answer is: A language disorder that makes it difficult or impossible to read or understand written language Dysphasia The answer is: Difficulty speaking Dysphagia The answer is: Difficulty swallowing Agraphia The answer is: A language disorder that results in a partial or complete loss of the ability to write Agnosia The answer is: A rare neurological disorder that prevents a person from recognizing objects, people, or sounds using one or more of their senses Apraxia The answer is: Inability to perform purposeful movements (i.e, from a spinal cord injury) Hemispatial neglect The answer is: A neuropsychological condition in which, after damage to one hemisphere of the brain (e.g. after a stroke), there is a deficit in attention and awareness towards the opposite I.e, if you have a stroke on the right side of the brain, you "can't see" and forget your left side Dyscalculia The answer is: a learning disability that affects a person's ability to work with numbers/math Flight of ideas The answer is: a thought disorder that involves a rapid succession of ideas that are loosely connected and difficult for others to follow Confabulation The answer is: a memory error where someone creates false or distorted memories about themselves or the world Circumstantiality The answer is: a way of thinking, writing, or speaking that includes unnecessary details and digresses from the main point Echolalia The answer is: Repetition of words spoken by others Word salad The answer is: a confused or unintelligible mixture of seemingly random words and phrases How should you assess cognitive function? The answer is: Developmental stage LOC Speech pattern Logic Judgment Trauma Mental status Behavior What are assessment tools for cognitive function? The answer is: Mini-Mental State Examination Severe Impairment Battery Controlled Oral Word Association Test Behavioral Dyscontrol Scale Hand Tapping Test Three Word Three Shapes Test Fuld Object Memory Evaluation Global Deterioration Scale What assessment tool for cognitive function is used most often in practice? The answer is: Mini-mental state examination What are clinical management strategies for cognitive function? The answer is: Health promotion Genetic counseling Screening Maintaining a safe environment Assessing medications Pharmacotherapy What are some strategies for nursing care of the disoriented client? The answer is: Reorientation, making sure they are safe, making sure the environment is safe, etc. Vision requires: The answer is: normal function of eyes, option muscles, and cranial nerves II, IIII, IV and VI At 1 years old, your vision is __/__ The answer is: 20/50 At 5 years old, your vision is ___/___ The answer is: 20/20 Presbyopia is common starting in _____ age The answer is: middle What are common visual impairments? The answer is: Presbyopia Decreased visual acuity Blindness Cataracts Glaucoma Retinal detachment Macular degeneration Diabetic retinopathy Congenital cataracts Injury or infection Corneal abrasion Malignancy (choroidalmelanoma &retinoblastoma) Glaucoma The answer is: Intraocular pressure builds up to above 20 around the optic nerve, causing damage to the nerve and affecting vision, especially peripheral vision - can cause blindness What are some strategies for managing vision problems? The answer is: Primary prevention: prevent injury, illness, disease, protectiveeyewear Assessment: vision screen, visual acuity tests, visual field acuity Diagnostic tests: ophthalmoscopy, intraocular pressure Corrective lenses Surgery: ie., LASIK, surgical removal of cataract, for maculardegeneration Medications Hearing requires: The answer is: normal function of the auditory system Is hearing fully developed at birth? The answer is: Yes Is vision fully developed at birth? The answer is: No Presbycusis is common starting in _____ age The answer is: older What are some common hearing impairments? The answer is: Presbycusis Sensorineural hearing loss Conductive hearing loss Tinnitus What are some causes of common hearing impairments? The answer is: Cerumen impaction Infection TM perforation/rupture Congenital Trauma ______ hearing loss is related to your auditory nerve not functioning properly The answer is: Sensorineural ______ hearing loss is related to soundwaves not being conducted properly The answer is: Conductive _______ is when you get ringing in your ears The answer is: Tinnitus How can infection cause hearing loss? The answer is: Infection causes scarring which makes the tympanic membrane stiffer -> less able to transmit soundwaves What are examples of "ototoxic" medications that can cause hearing loss? The answer is: Lasix / Furosemide - a diuretic Vancomycin - an antibiotic What are strategies for the management of hearing problems? The answer is: Primary prevention: prevent injury, illness, disease Assessment, screening Hearing evaluation Referral to audiologist Diagnostic tests: audiometry, tympanogram, otoscopy Hearing aids, cochlear implants Surgery: ear tubes Stopping medications that might be the cause Taste requires: The answer is: normal function of the gustatory system, smell, and cranial nerves VII, IX, and X. When do you develop taste differentiation? The answer is: 3 months old The sense of taste ______ with age The answer is: decreases What are common causes of taste impairments? The answer is: Xerostomia Injury/trauma Congenital abnormalities Medications Head & neck surgery Radiation Dental issues Chemicals Xerostomia The answer is: Dry mouth (not enough saliva) What are strategies for management of problems with taste? The answer is: Primary prevention: prevent injury, illness, disease Assessment: tongue & oral cavity, smell Diagnostic tests: taste tests Surgery: oral/dental surgery Assess medications Smell requires: The answer is: normal function of cranial nerve I, sensory receptors in mucous membranes Smell is needed to promote ______ The answer is: eating The sense of smell starts to decrease around age ___ The answer is: 60 The sense of smell and ability to distinguish between smells _______ with age The answer is: decreases What are common causes of smell impairments? The answer is: Sinus infections/URI Chemo Injury/trauma to olfactory ciliary receptor sensory/neural pathways Congenital Medications Parkinson's Alzheimer's Radiation Tumors in the nasal cavity What are common strategies for the management of problems with smell? The answer is: Primary prevention: prevent injury, illness, disease Assessment: PMH, nasal polyps, breathing Surgery: removal of nasal polyps Assess medications Medications to treat intranasal inflammation, allergies Avoiding allergens Touch requires: The answer is: normal function of sensory receptors Touch involves: The answer is: fine & crude touch,vibration, pressure, temperature, itch, and pain Is touch well developed at birth? The answer is: Yes Touch ______ with age The answer is: decreases Touch decreases with age, especially on the: The answer is: toes and fingertip What is an example of an impairment with touch? The answer is: Peripheral neuropathy What are some common causes of touch impairments? The answer is: Aging Injury/trauma Peripheral artery disease Raynaud's disease Stroke 3rd degree burns Spinal cord injury What are common strategies for the management of problems with touch? The answer is: Primary prevention: prevent injury, illness, disease Assessment: neurologic condition, balance, gait, cranial nerve VIII Adaptive devices Anticipatory guidance If you have an altered balance/gait, you are a ____ risk The answer is: fall Are Spiritual Health Clinicians a part of Emory Healthcare's Spiritual Health Department? The answer is: Yes What are the requirements to become a Spiritual Health Clinician? The answer is: Master's of Divinity from the SHC's religious affiliation At least 5 units of Clinical Pastoral Education (CPE) through a program recognized by the Association of Clinical Pastoral Education True/False: Spiritual Health Clinicians are ordained, endorsed, and board certified or board eligible The answer is: True What does outpatient palliative care at Emory Healthcare look like? The answer is: - Supportive Care Clinic at EUH and ESJ - Patients are mostly referred through inpatient team and Winship Cancer Institute - Interdisciplinary Team: MD, NP, RN, LCSW, dedicated SHC, pharmacist, fellows What does inpatient palliative care at Emory Healthcare look like? The answer is: - All Emory hospitals - Patient added through physician referalls - Interdisciplinary team: MD, NP, RN, APP, SW, SHC that is not dedicated and unit/on-call, fellows Who are palliative care patients? The answer is: Patients with cancer, transplants, chronically ill, EOL What do you see in palliative care? The answer is: - Pain management - Symptom management - Emotional, mental, existential, spiritual distress - EOL planning - Refer to home palliative care / hospice care What does the word "palliative" come from? The answer is: The verb "palliate," which means to soothe, to comfort, to alleviate, or to lessen someone's pain and suffering What is the typical approach of palliative providers? The answer is: - Who is this and how can we help? INSTEAD OF "what is this and how can we fix it?" - Seeing the patient as a whole person: body, mind, soul - Using a holistic approach with diversified resources: medical, social, spiritual Whole health includes: The answer is: - Body, mind, soul - Body, mind, spirit - Mental, emotional, physical, spiritual How does spiritual support help patients? The answer is: Patients are: - able to articulate their medical and non-medical concerns - offered space to explore feelings and emotions - provided spiritual support as needed What is the role of the spiritual health clinician? The answer is: - To provide spiritual support and resources based on an assessment - Consult with the interdisciplinary team to ensure the needs of the patient and/or family are being met - Assist with completion of Advance Directives - Provide bereavement support to families/friends of patients Spiritual Health Assessment The answer is: An evolving dialogue, established with a compassionate encounter with the patient regarding those issues that most concern that patient Involves diagnosing an individual's primary unmet spiritual need and devising a plan about how to address that need through a process of particular interventions aimed at a healing outcome Spiritual assessment _______ a scripted or generic set of questions asked in the same way of each patient The answer is: is NOT Spiritual support comes through: The answer is: Reminding - presence of divine; what has been meaningful/helpful; past spiritual experiences and practices Reframing - despair -> hope; impossible -> doable; normalize experience Reflecting - thoughts/words back to the patient by prayer, hope, etc. Spiritual thoughts often focus on: The answer is: The meaning and purpose of life and mortality Is it natural for patients to consider their mortality during a health crisis or end of life? The answer is: Yes True/False: People who are spiritual rely on their spirituality for support The answer is: True What are examples of "positive" spiritual thoughts? The answer is: - God is in control of my life - I feel confident about where I will go when I die - I find purpose within my illness What are examples of "negative" spiritual thoughts? The answer is: - I don't know why I'm still alive - I don't know my purpose when I can't do anything - God must be punishing me for something I did Palliative care is about alleviating _______ The answer is: suffering When spiritual thoughts are "negative," they often lead to: The answer is: An additional layer of suffering True/False: Spiritual Health Clinicians are trained to listen for and help alleviate spiritual suffering The answer is: True AMEN: Strategy for Challenging Conversations The answer is: Affirm - affirm the patient's belief and validate their position - "I am hopeful too" Meet - Meet the patient or family where they are - "I join you in hoping/praying for a miracle" Educate - educate from your role as a medical provider - "And I want to speak to you about some medical issues" No matter what - no matter what, assure the patient and family you are committed to them - "No matter what happens, I will be with you every step of the way" The locus of death has shifted from the _____ to the ______ The answer is: home, hospital _______ has kept people living longer The answer is: Technology The medical focus of dying is focused on preserving what? The answer is: Body function Death has shifted from a natural event to: The answer is: An avoidable event that is a failure if it happens Death has shifted from a spiritual transition to a: The answer is: Medical event The control of death has shifted from ________ to the ________ The answer is: family members, healthcare team True/False: Nurses are challenged with shifting focus from cure to end of life care in the critical care setting The answer is: True What limits "dying well?" The answer is: The sterile environment Lack of time, training, and resources What is a good death? The answer is: - Minimal suffering - Surrounded by family - Peaceful environment - Preferred place varies ____% of patients die in a hospital setting The answer is: 35 Palliative services The answer is: - Paid by insurance or self - For any stage of disease - Occurs at the same time as curative treatment - Typically happens in the hospital Hospice services The answer is: - Paid by Medicare, Medicaid, and insurance - For prognosis of 6 months or less - Excludes curative treatment - Wherever patient calls home What do palliative and hospice services have in common? The answer is: - Comfort care - Reduce stress - Offer complex symptom relief related to serious illness - Physical and psychosocial relief In hospice, do you have to agree to a DNR? The answer is: NO In hospice, does every patient die within 6 months? The answer is: NO In hospice, can you change your mind and try curative therapy? The answer is: YES In hospice, can you undergo palliative chemo or radiation? The answer is: YES In hospice, do you have to stop dialysis? The answer is: NO Does hospice hasten death? The answer is: NO - it actually prolongs life Does hospice support physician aid in dying? The answer is: No Symptom management during dying includes: The answer is: Pain, dyspnea, death rattle, delirium, anxiety, agitation, depression, N/V, constipation, anorexia/cachexia, insomnia, and spiritual distress Acute Pain The answer is: - Associated with an increase in HR, RR, and BP - Break through pain necessary to assess progress - Patient usually appears in distress Chronic Pain The answer is: - Vital signs may be unchanged - Goal is to minimize break through pain - Patient may not show visible signs of distress What is the half-life of morphine? The answer is: 2 - 4 hours What are the pros of morphine? The answer is: Gold standard, comes in multiple forms What is the half-life of dilaudid? The answer is: 2 - 4 hours What are the pros of dilaudid? The answer is: Potent What is the half-life of fentanyl? The answer is: 20 - 30 minutes What are the pros of fentanyl? The answer is: Good for PCA; also available in a patch for longer relief (72 hours) What is the half-life of methadone? The answer is: 12 - 24 hours What are the pros of methadone? The answer is: Long acting and cheap Can you give two opioids together? The answer is: Yes, if one is long acting and one is short acting How can you alleviate a patient's dry mouth during the dying process? The answer is: - Offer liquids and ice chips - ACT spray or chewing gum - Lemon glycerin swabs - Lip moisturizer What are examples of spiritual and existential distress a dying patient may experience? The answer is: - Question meaning or purpose - Fear of being forgotten - Hopelessness and despair - Anger at God or a higher power - Question their belief system - Afraid to fall asleep or other fears What are the 2 paths to death? The answer is: Usual path Difficult path Usual path to death The answer is: Normal -> sleepy -> lethargic -> obtunded -> semicomatose -> comatose -> dead Difficult path to death The answer is: Normal -> restless -> confused -> tremulous -> hallucinations -> mumbling delirium -> myoclonic jerks -> seizures -> semicomatose -> comatose -> dead What are some physical changes associated with dying? The answer is: - Decreased appetite - Decreased urine appetite - Cooling of the extremities - Cyanotic digits - Increased sleep - Decreased mobility - Loss of swallow reflex - Fever What are some tips for caring for a dying patient? The answer is: - Don't force feed - Ice chips in small amounts PO - Oral hygiene - Moisten lips - Frequent turning What are some mental changes associated with dying? The answer is: - Separation from family and friends - Withdrawal - Less communication - Agitation (consider sources) - Demand to be moved - Complaints of discomfort - Accusations - Stores/hallucinations - Repetitive actions What are some potential sources of agitation during the dying process? The answer is: Pain, infection, tumor, medications, or emotional distress What anticipatory guidance can you provide families about the dying process? The answer is: - Changes in vital signs - Cheynes Stokes respirations - Changes in LOC - Assume the patient can hear - The last "hurrah" - The last breath Cheynes Stokes respirations The answer is: Agonal breathing (gasping and then apnea) that occurs near death and is often distressing to family members The Last Hurrah The answer is: When a patient seems to "improve" or gets a burst of energy shortly before death When does rigor mortis occur? The answer is: 2 - 12 hours after death What are some tips for post-mortem care? The answer is: - Clean up and remove IV tubes (unless autopsy) - Lay flat and position hands - Close eyes and mouth - Rigor mortis 2 - 12 hours - Allow time with family - Cultural considerations Grief The answer is: The emotional response (pain and suffering) we experience after a loss that is physical, psychological, and spiritual Grieving The answer is: How grief changes over time Bereavement The answer is: The state or act of being deprived of a loved one; a change in status (i.e, suddenly becoming a widower) Mourning The answer is: A period of time after a loss in which internal and external symptoms of grief are expressed; influenced by religious beliefs, culture, and customs What are some examples of mourning? The answer is: Shivah, Buddhist customs, Day of the Dead What are physical and emotional signs of grief? The answer is: - Insomnia - Loss of appetite - Crying - Anxiety - Memory Loss - Relief/Guilt - Depression - Somatic complaints Prefrontal cortex The answer is: The "thinking" center of the brain Anterior cingulate cortex The answer is: The emotional regulation center of the brain Amygdala The answer is: The fear or fight/flight center of the brain The prefrontal cortex is _________ during grief The answer is: underactive The anterior cingulate cortex is _________ during grief The answer is: underactive The amygdala is _________ during grief The answer is: overactive Attachment neurobiology The answer is: The belief that the nature of a bond doesn't change after a loved one dies What are some key points about attachment neurobiology and grief? The answer is: When a relationship is created, the bond is encoded in the brain. A person has 2 streams of information: the memory of reality vs. the belief they are still out there. This causes distress. They may have intrusive thoughts (could've, should've), but most decline over time. Ask them: What are you learning? What has changed since your loss? What type of loss is perceived as a threat to survival? The answer is: Traumatic loss What part of the brain is like the "smoke detector," on high alert and vigilance? The answer is: Amygdala What part of the brain is like the "watch tower," responsible for objective appraisal, analysis, and judgment? The answer is: Cerebral cortex Stress leads to: The answer is: Memory loss, brain fog, and decreased processing speed True/False: Grief leads to an imbalance between the amygdala and cerebral cortex The answer is: True True/False: After loss, the brain rewires itself The answer is: True True/False: Grief is a normal protective process The answer is: True Dissociation The answer is: Loss of awareness, feeling dazed, and trouble focusing - triggered when the brain reaches max capacity to process input "What If's?" The answer is: Focusing on alternatives to reality, which distracts from the pain of reality that the person isn't coming back How is grieving a protective process? The answer is: It helps us survive in the face of emotional trauma Kubler-Ross Stages of Grief The answer is: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Is grief linear? The answer is: No Is grief deeply personal and unique? The answer is: Yes Does grief lend itself to generalizations? The answer is: No Is grief the same thing as depression? The answer is: No Depression The answer is: Absence of joy and interest in things Can grief overlap with anxiety, depression, and sleep disorders? The answer is: Yes True/False: Grief affects our hormones, immune function, and sleep The answer is: True Normal grief The answer is: Grief that stays within the bounds of a particular culture Traumatic grief The answer is: Severe and disabling responses to sudden and often violent death Anticipatory grief The answer is: How people cope with expected loss Disenfranchised grief The answer is: A grief that is not openly acknowledged, socially validated, or publicly mourned; society fails to recognize their right to grieve What are examples of disenfranchised grief? The answer is: Unmarried partners, extra-marital lovers, stillborn babies, miscarriages, pets, nurses How long should one grieve? The answer is: Grief, which can lasts weeks, months, or years, is a normal phenomenon that is healthy and adaptive. It's not about the time/duration. It's about the severity and impact in one's life. What are some common symptoms of complicated grief? The answer is: - A persistent, intense yearning for the person who died - Withdrawal from friends and family - Intrusive thoughts/preoccupation with memories - Strong emotions that are difficult to control - Troubling thoughts related to death - Avoidance of situations that evoke reminders of loss Complicated grief increases your risk of developing: The answer is: - Cancer - HTN - Cardiac event - Alcohol and substance abuse - Suicidal ideation - Functional compromise - Decreased QOL What are risk factors for complicated grief? The answer is: - A sudden or unanticipated death - Death from a prolonged illness - Death that could have been prevented - Unresolved conflict with the deceased - Other losses or stressors that are not accommodated or mental health problems on the part of the bereaved - Lack of support What are some key aspects about moving forward after loss? The answer is: - Cleaning the room - All the firsts - When it hits you - Not getting over it or moving on What is some grief work related to subconscious/conscious integration? The answer is: Gradually surface painful experiences to restore memory and reintegrate into one's life story What is some grief work related to immersion/distraction? The answer is: Address the pain: journaling, therapy, social interactions Then rest and rejuvenate What is some grief work related to opening the mind to possibilities? The answer is: Gradual process of rebuilding personal identity and thinking about the options for the future What are some common signs in children who experience loss? The answer is: - Decrease in school performance - Psychosomatic complaints - Drugs and alcohol use - Promiscuity What are some behaviors seen in siblings dealing with bereavement? The answer is: - Guilt that they caused the child's death - Survivor's guilt - Poor school performance - Eating/sleeping disorders - Regressive behavior - Somatic symptoms What are some key concepts of death? The answer is: Irrevocability, nonfunctionality, causality, universality Irrevocability The answer is: Death is permanent Nonfunctionality The answer is: Cessation of function Causality The answer is: Causes of death Universality The answer is: Everyone will die, even me At what age do most children understand all 4 concepts of death? The answer is: 5 - 6 years old What do children in preschool think about death? The answer is: - Egocentrism - Magical thinking - Death seen as reversible What do school-age children think about death? The answer is: - Concrete thought based on experience - Increased awareness of body and how it works - Increased fear of body mutilation - Death may be seen as final What do adolescents think about death? The answer is: - Identity formation - Capable of abstract thinking - Spiritual and psychological issues - Death seen as final and universal What are some common pitfalls to AVOID when talking about death and dying with children? The answer is: - Avoid comparing death to sleep - Religious explanations can be risky - Deception is never a good idea - Avoid euphemisms True/False: You should use little losses to prepare children for bigger losses The answer is: True What are some behaviors that bereaved parents show? The answer is: - Fear of loving surviving childrne - Wish that surviving child had died instead - Grief over loss of legacy and future - Guilt over not being able to save their child - Stopping family celebrations - Hearing or smelling the child - Refusing to change the child's room - Looking for a sign that the child is okay What are some things to say to someone who has experienced loss? The answer is: - I am so sorry - I am just thinking about ____ and how much I loved ____ - I would like to be with you if that's okay - Tell me more about _______ - Witnessing can facilitate healing What should you do with your grief as a nurse? The answer is: - Take time to process your loss - Journal, listen to music, and meditate - Rely on and support your coworkers - Find ways to decompress - Be intentional about self care - Funerals are complex / debatable if you should go - Rituals and memories Fluid and electrolyte balance is essential for: The answer is: homeostasis allowing effective cell function and physiological processes like signaling and muscle contraction What are the major electrolytes? The answer is: Sodium (Na+), Potassium (K+), Calcium (Ca2+), Magnesium (Mg2+) The major electrolytes are responsible for regulating: The answer is: fluid distribution, blood volume, nerve function, and muscle contractions Body fluids are divided into ________ and ___________ compartments with balance critical for cellular function and stability The answer is: intracellular, extracellular Fluid movement is regulated by ______, ______, and _________ maintaining equilibrium based on electrolyte concentration and osmotic pressure The answer is: osmosis, diffusion, filtration Fluid movement is regulated by osmosis, diffusion and filtration, maintaining equilibrium based on ___________ and ____________ The answer is: electrolyte concentration, osmotic pressure Body fluids are divided into _______ and _________ fluid The answer is: intracellular, extracellular Fluid movement occurs via ______ and _______ maintaining homeostasis The answer is: diffusion, osmosis Nurses must identify fluid imbalances including _______ and __________ The answer is: dehydration, fluid volume excess Dehydration can result from: The answer is: Low fluid intake or excessive loss with actual and relative dehydration types Hypovolemia involves: The answer is: Decreased water and electrolytes leading to lowered blood volume and compensatory responses Severe dehydration can cause critical issues like: The answer is: seizures and hypovolemic shock, particularly in older adults The normal range for sodium is: The answer is: 136 - 145 mEq/L The normal range for calcium is: The answer is: 9 - 10.5 mg/dL The normal range for potassium is: The answer is: 3.5 - 5 mEq/L The normal range for magnesium is: The answer is: 1.3 - 2.1 mEq/L The normal range for chloride is: The answer is: 98 - 106 mEq/L The normal range for phosphorus is: The answer is: 3 - 4.5 mg/dL True/False: Electrolyte values are critical for assessing and monitoring various physiological functions and health conditions The answer is: True What are key indicators of dehydration? The answer is: Dry mucous membranes, tachycardia, hypotension, decreased urine output, and poor skin turgor True/False: Early recognition of dehydration is vital to prevent complications The answer is: True What is the physiological impact of dehydration? The answer is: Dehydration reduces organ perfusion, potentially causing acute kidney injury, decreased cardiac output, and altered mental status What are risk factors for dehydration? The answer is: Older adults face increased risk due to diminished thirst response, comorbidities (i.e, hypertension), and medication side effects (i.e, diuretics) What are the goals of dehydration treatment? The answer is: Restoring fluid balance, stabilizing vital signs, preventing further fluid loss, and using oral rehydration or IV fluids for severe cases Hyponatremia The answer is: Characterized by sodium levels below 135 mEq/L What are the symptoms of hyponatremia? The answer is: Confusion, fatigue, muscle cramps Hypokalemia The answer is: Characterized by potassium levels below 3.5 mEq/L What are the symptoms of hypokalemia? The answer is: Muscle weakness, cardiac arrhythmias, fatigue What causes hyponatremia? The answer is: Excessive fluid loss (vomiting, diarrhea) - leads to low sodium levels and neurological symptoms like confusion/seizures What causes hypokalemia? The answer is: Gastrointestinal losses or inadequate dietary intake - affects muscle and nerve function, especially in the heart, leading to increased risk of arrhythmias What are some nursing interventions for electrolyte imbalances? The answer is: Monitor lab values, replace electrolytes, and adjust fluid therapy to maintain balance. Early intervention is crucial to prevent complications. Excessive fluid loss can lead to low sodium, causing confusion and fatigue. This is known as _________ The answer is: hyponatremia A 65-year-old female patient, Mary, has been admitted with symptoms of dehydration and lab values indicating hyponatremia (Sodium 130 mEq/L). Which of the following nursing interventions is the most appropriate to address Mary's hyponatremia? The answer is: Initiate IV fluids with 0.9% normal saline as ordered by the healthcare provider. Describe oral rehydration to treat electrolyte imbalances The answer is: Encourage oral rehydration, if the patient can tolerate it, to replace fluids lost due to vomiting and diarrhea. Oral rehydration solutions (ORS) containing electrolytes are preferred. Describe IV fluid administration to treat electrolyte imbalances The answer is: Initiate intravenous fluid therapy, such as 0.9% normal saline, to restore fluid volume rapidly in cases of significant dehydration. IV fluids are essential when oral intake is not sufficient. Describe electrolyte replacement to treat electrolyte imbalances The answer is: Administer electrolyte replacements as needed, based on laboratory values. For example, replace potassium to address hypokalemia and sodium to correct hyponatremia. Describe monitoring vitals to treat electrolyte imbalances The answer is: Closely monitor vital signs, including blood pressure, heart rate, and respiratory rate, to assess the patient's response to interventions and detect any signs of worsening dehydration or electrolyte imbalances. What are some social determinants of health to consider with fluid and electrolytes? The answer is: - Living situation - Access to resources - Health literacy What is the nursing role in addressing electrolyte imbalances? The answer is: Nurses monitor fluid and electrolyte status, assess imbalances, and intervene as needed, including evaluating intake/output and recognizing signs like dehydration and muscle weakness. What are priority actions for a patient showing severe signs of electrolyte imbalance? The answer is: ⚬Assess Vital Signs: Measure BP, heart rate, respiratory rate, oxygen saturation, and mental status. Identify the severity of hypotension. ⚬Immediate Response: Initiate fluid resuscitation as per protocol, considering bolus administration if indicated ⚬Consider Electrolyte Re-assessment: Obtain follow-up labs to check sodium, potassium, and other relevant electrolytes to identify any worsening imbalances. ⚬Monitor for Complications: Watch for signs of hypovolemic shock or other complications. How should a care plan be adjusted for a patient showing severe signs of electrolyte imbalance? The answer is: ⚬Escalate Fluid Therapy: Adjust IV fluid type, rate, and volume according to current guidelines for hypotension and dehydration. ⚬Electrolyte Management: Prioritize correcting imbalances, especially if they contribute to the patient's hypotension. ⚬Close Monitoring: Increase frequency of vital signs and electrolyte monitoring, observe for any signs of improvement or further decline. ⚬Consult with Interdisciplinary Team: Notify the physician and consider consulting a dietitian or pharmacist for input on the patient's hydration and electrolyte needs. What teaching should be provided to a patient with an electrolyte imabalance or their family? The answer is: ⚬Educate on symptoms of electrolyte imbalance, dehydration, and hypotension. ⚬Emphasize the importance of adherence to hydration and follow-up lab checks. Prepare family members for possible interventions if the patient's condition does not improve What are some key points about fluids and electrolytes? The answer is: 1. Recognizing fluid and electrolyte imbalances, nursing interventions, and care plan development ensure patient safety through accurate assessment and timely evaluation. 2. Applying clinical reasoning and the nursing process (Assessment, Diagnosis, Planning, Implementation, Evaluation) is vital for managing fluid and electrolyte imbalances, prioritizing care, and adapting interventions for the best outcomes. 3. Teamwork and communication with healthcare professionals (physicians, dietitians, pharmacists) enhance patient outcomes, particularly in complex cases. Comfort The answer is: A state of ease and freedom from pain. Pain The answer is: An unpleasant sensory and emotional experience associated with actual or potential tissue damage. True/False: NURSES ARE ETHICALLY OBLIGATED TO MANAGE PAIN AND ALLEVIATE SUFFERING. The answer is: TRUE True/False: Pain is subjective and unique to each individual The answer is: True The physiological basis of pain includes ______, ______, _______, and ________ The answer is: transduction, transmission, perception, modulation Transduction The answer is: Conversion of painful stimuli into electrical signals at the site of injury. Transmission The answer is: Pain signals travel from the peripheral nerves to the spinal cord and brain. Perception The answer is: The brain interprets the signals as pain Modulation The answer is: The body's natural response to suppress or amplify pain through chemicals like endorphins. Acute/Transient Pain The answer is: Short-term pain, usually related to injury or surgery Chronic/Persistent Noncancer Pain The answer is: Ongoing pain not related to cancer, lasting more than 3 - 6 months Chronic Episodic Pain The answer is: Pain that occurs sporadically over time (i.e, migraines) Cancer Pain The answer is: Related to tumor progression, procedures, or treatment Idiopathic Pain The answer is: Pain with no identifiable cause What physiological factors influence pain? The answer is: Age, fatigue, genes, neurological function How does age influence pain? The answer is: Pain perception changes with age How does fatigue influence pain? The answer is: Fatigue increases pain perception How do genes influence pain? The answer is: Genes can influence pain sensitivity How does neurological function influence pain? The answer is: Any interference can alter pain perception What social factors influence pain? The answer is: Previous experiences - can influence current pain response Family and social network - support can help manage pain Spiritual factors - beliefs can influence pain perception and coping What psychological factors influence pain? The answer is: Attention Anxiety and fear Coping style How does attention influence pain? The answer is: Focusing on pain can increase its intensity How does anxiety and fear influence pain? The answer is: Anxiety and fear can exacerbate the experience of pain How does your coping style influence pain? The answer is: It influences how individuals handle pain True/False: Different cultural backgrounds can influence how pain is expressed and managed The answer is: True True/False: You should consider a patient's trauma history and the impact of trauma on pain perception on response The answer is: True How can pain impact a patient's quality of life? The answer is: Chronic pain can diminish overall well-being How can pain impact a patient's self-care? The answer is: Pain may interfere with daily activities and self-care How can pain impact a patient's work and school? The answer is: Pain can lead to absences and decreased productivity How can pain impact a patient's social support? The answer is: Pain can strain relationships and reduce social interaction How can pain impact a patient's mental health? The answer is: Chronic pain can lead to depression, anxiety, and decreased motivation Assessment of Pain (Nursing Process) The answer is: Use tools like the Numeric Rating Scale (0 - 10), Faces Pain Scale, and FLACC Scale for non-verbal patients. Assess for verbal and non-verbal cues as well as pain history. Utilize EHR to document pain assessments accurately. ______ pain is related to physical injury or procedures The answer is: Acute ________ pain is related to underlying health conditions The answer is: Chronic Diagnosis of Pain (Nursing Process) The answer is: Acute pain: related to physical injury or procedure Chronic pain: related to underlying health conditions Planning of Pain (Nursing Process) The answer is: Set goals such as "Patient will report pain at a level of 3 or lower within 24 hours" What are some pharmacologic interventions for pain? The answer is: Opioids, NSAIDs, adjuvant medications What are some non-pharmacologic interventions for pain? The answer is: Relaxation techniques, distraction, heat/cold therapy What is a trauma-informed approach to pain? The answer is: Provide a safe environment and acknowledge past trauma Intervention of Pain (Nursing Process) The answer is: Pharmacologic interventions Non-pharmacologic interventions Trauma-informed approach Evaluation of Pain (Nursing Process) The answer is: Reassess pain levels and adjust interventions accordingly What is important to know about opioids for pain management? The answer is: Consider the risk of dependency and misuse Non-opioids for pain management include: The answer is: NSAIDs and acetaminophen for mild to moderate pain Adjuvants for pain management include: The answer is: Antidepressants or anticonvulsants for neuropathic pain Relaxation techniques for pain management include: The answer is: Breathing exercises and guided imagery Distraction for pain management includes: The answer is: Music, games, and conversation Massage and heat/cold therapy for pain management is used to: The answer is: Reduce muscle tension and inflammation Technology use for pain management includes: The answer is: mobile apps for pain diaries and self-management techniques What is the first step in pain transmission? The answer is: Transduction Chronic pain lasts _______ than 6 months The answer is: longer Which of the following factors can increase pain perception? The answer is: Both fatigue & attention What are some key points to remember about pain? The answer is: Complex Nature of Pain - pain is a complex, subjective experience that is influenced by various factors Nursing Responsibility - nurses have an ethical duty to manage pain effectively and advocate for all patients Comprehensive management - effective pain management includes both pharmacologic and non-pharmacologic interventions Technology and Collaboration - use technology and interprofessional collaboration to enhance pain management Rest The answer is: The condition in which the body is inactive or engaging in mild activity resulting in relaxation Sleep The answer is: A naturally recurring state of mind characterized by altered consciousness and reduced sensory activity leading to physiological rest and restoration What are the functions of sleep? The answer is: 1. Physical Restoration 2. Emotional stability 3. Cognitive function How does sleep promote physical restoration? The answer is: Increases tissue growth and repair, immune system support, and energy conservation How does sleep promote emotional stability? The answer is: Helps regulate emotions and reduce stress How does sleep promote cognitive function? The answer is: Supports memory consolidation, learning, and problem-solving skills Sleep decreases the risk of ________ after age 65 The answer is: dementia What are the two major stages of the sleep cycle? The answer is: NREM (Non-Rapid Eye Movement) REM (Rapid Eye Movement) Stage 1 of NREM Sleep The answer is: Light sleep, easy to awaken; transition between wakefulness and sleep Stage 2 of NREM Sleep The answer is: Slightly deeper sleep; heart rate slows, body temperature drops Stage 3 of NREM Sleep The answer is: Deep sleep; crucial for physical restoration, immune function Stage 4 of NREM Sleep The answer is: Deepest sleep; essential for energy restoration and muscle repair REM Sleep The answer is: The stage of the sleep cycle that is associated with dreaming and is important for cognitive function and emotional balance Circadian rhythm The answer is: The body's internal clock, regulated by the suprachiasmatic nucleus (SCN) of the hypothalamus, which responds to light and darkness What neurotransmitters play a role in promoting or inhibiting sleep? The answer is: Serotonin, norepinephrine, and GABA How much sleep do neonates need per day? The answer is: 16 hours How much sleep do infants need per day? The answer is: 15 hours with naps How much sleep do toddlers need per day? The answer is: 12 hours with a nap How much sleep do preschoolers need per day? The answer is: 12 hours How much sleep do school-age children need per day? The answer is: 9 - 12 hours How much sleep do adolescents need per day? The answer is: 8 - 10 hours How much sleep do young adults need per day? The answer is: 6 - 8.5 hours How much sleep do middle adults need per day? The answer is: 7 - 9 hours How much sleep do older adults need per day? The answer is: Varies Neonates get mostly _______ sleep The answer is: REM At what age stage do NREM and REM sleep cycles develop? The answer is: Infants What is important about sleep for toddlers? The answer is: Routine is important to reduce bedtime resistance What is important about sleep for preschoolers? The answer is: Nightmares may start; encourage bedtime rituals What is important about sleep for school-age children? The answer is: A consistent sleep schedule is important to support growth and development What is important about sleep for young adults? The answer is: They are often sleep-deprived due to lifestyle and technology use What is important about sleep for middle adults? The answer is: Sleep quality may decline due to work stress and lifestyle changes What is important about sleep for older adults? The answer is: Sleeping difficulties increase with age - increased incidence of sleep disorders/fragmentation What are stimulants that interfere with sleep onset? The answer is: Caffeine, nicotine What substance disrupts REM sleep and can lead to fragmented sleep? The answer is: Alcohol What medications affect sleep? The answer is: Diuretics -> nighttime urination Beta-blockers -> interfere with sleep quality What are some factors influencing sleep? The answer is: - Drugs and substances - Lifestyle - Usual sleep patterns - Emotional stress - Environment - Exercise and fatigue - Food and caloric intake How can irregular sleep patterns impact sleep? The answer is: Shift work and jet lag can disrupt circadian rhythms How can bedtime routines impact sleep? The answer is: A lack of a regular sleep routine affects sleep quality How can usual sleep patterns impact sleep? The answer is: Changes in sleep schedule can lead to sleep disorders How can emotional stress impact sleep? The answer is: Anxiety and depression can cause difficulties falling asleep or staying asleep What is the ideal sleep environment? The answer is: Cool, dark, and quiet The comfort of the sleep surface, such as ______ and _________, affect sleep quality The answer is: Mattress and pillow comfort Moderate exercise _________ if done several hours before bedtime The answer is: promotes sleep Excessive fatigue may make it ________ to fall asleep The answer is: difficult Should you have caffeine or heavy meals close to bedtime? The answer is: NO - avoid having them close to bedtime because they can interfere with sleep onset What are some foods that promote sleep? The answer is: Milk Turkey - contain tryptophan What are some sleep disorders? The answer is: insomnia Sleep apnea Narcolepsy Restless leg syndrome (RLS) Insomnia The answer is: Difficulty falling or staying asleep; can be short-term or chronic What are nursing interventions for insomina? The answer is: Encourage relaxation techniques, maintain a sleep diary, avoid caffeine Sleep apnea The answer is: Episodes of blocked breathing during sleep; often associated with obesity What are nursing interventions for sleep apnea? The answer is: Weight management, CPAP machine use, sleep position adjustments Narcolepsy The answer is: Sudden, uncontrollable episodes of sleep during daytime What are nursing interventions for narcolepsy? The answer is: Safety education, regular sleep schedule, prescribed stimulants Restless leg syndrome The answer is: Unpleasant sensations in the legs, urge to move them What are nursing interventions for restless leg syndrome? The answer is: Encourage stretching, medications as prescribed, reducing caffeine Nursing Process: Assessment of Sleep/Rest The answer is: Collect patient history (sleep habits, disturbances, contributing factors) Use sleep assessment tools (i.e, Pittsburgh Sleep Quality Index) Assess lifestyle factors, emotional health, and environmental conditions Nursing Process: Diagnosis of Sleep/Rest The answer is: Sleep deprivation - related to lifestyle or medical condition Disturbed sleep pattern - related to environmental factors or stress Fatigue - related to inadequate sleep, physical conditions Nursing Process: Planning of Sleep/Rest The answer is: Set goals such as improving sleep quality and duration Example: "Patient will report sleeping 6 - 7 hours per night within 1 week" What are some relaxation techniques to promote sleep? The answer is: Guided imagery, progressive muscle relaxation, deep breathing exercises Nursing Process: Implementation for Sleep/Rest The answer is: Sleep Hygiene Education - encourage consistent sleep schedule, minimize screen time before bed Environmental Modification - adjust lighting, temperature, noise levels Relaxation Techniques - guided imagery, progressive muscle relaxation, deep breathing exercises Nursing Process: Evaluation of Sleep/Rest The answer is: Assess patient's improvement in sleep patterns through sleep diaries and follow-up Evaluate patient's self-reported quality of sleep What are some non-pharmacologic interventions to improve sleep? The answer is: Sleep schedule consistency: go to bed and wake up at the same time each day Bedtime routines: develop and follow a relaxing bedtime routine (i.e, reading and warm bath) Environmental adjustments: use blackout curtains, white noise machines Relaxation techniques: teach patients to use mindfulness meditation and yoga Avoid stimulants: minimize caffeine and alcohol before bedtime What are some pharmacologic interventions to improve sleep? The answer is: Sleep aids: short-term use only; be mindful of dependency and side effects Melatonin supplements: can be useful for circadian rhythm disorders Sleep aids are for ______ term use The answer is: short _______ supplements can be useful for circadian rhythm disorders The answer is: Melatonin What are some key points to remember about sleep/rest? The answer is: 1. Importance of sleep - sleep is essential for physical, emotional, and cognitive well-being 2. Sleep quality influencers - drugs, lifestyle, emotional stress, and environment all impact sleep quality 3. Nursing role - assess sleep habits, identify sleep disturbances, and develop evidence-based interventions to improve sleep Personal hygiene needs vary depending on: The answer is: Health status, cultural practices, and routine _______, _______, and ______ are essential for preventing infection and maintaining skin integrity The answer is: Bathing, oral care, foot care Mobility The answer is: Freedom and independence in movement Immobility increases risks for complications such as: The answer is: Pressure injuries, respiratory issues, and muscle atrophy Pressure injuries occur due to: The answer is: Unrelieved pressure on the skin, particularly over bony prominences What should you use to assess a patient's risk for pressure injuries? The answer is: Braden Scale You should use the Braden Scale to assess risk for pressure injuries and implement preventative measures, such as: The answer is: Repositioning and specialized mattresses Your client has been sitting in a chair for 1 hour. What is the greatest risk? The answer is: Pressure injury You should encourage ________ to promote recovery and prevent complications of immobility The answer is: Movement _______ guidelines outline how to prevent pressure ulcers in hospitals through repositioning, support surfaces, and staff education The answer is: AHRQ According to the AHRQ guidelines, how should you prevent pressure ulcers in hospitals? The answer is: Through repositioning, support surfaces, and staff education The ________ has guidelines on preventing pressure injuries with hospital policies The answer is: Joint Commission How can diabetes increase your risk of getting pressure ulcers? The answer is: High blood sugar -> issues with blood flow and oxygenation of the peripheral system -> increased risk of skin breakdown When lying supine, pressure injuries are common on the: The answer is: Sacrum and hip How often should you give patients clean sheets? The answer is: Typically every day Place _________ clients near the nurses' station The answer is: high-risk To minimize fall risks, how often should you perform rounding? The answer is: Every houry To minimize fall risks, what position should the bed be in? The answer is: Low position with brakes locked What strategies should be implemented to minimize fall risks in clients? The answer is: 1. Conduct regular fall-risk assessments 2. Create individualized care plans 3. Educate clients on using call lights and respond promptly 4. Use color-coded wristbands for alerts 5. Assist clients with cognitive impairments and ensure proper lighting 6. Place high-risk clients near the nurses' station 7. Perform hourly rounding and keep essentials within reach 8. Maintain low bed positions and lock brakes 9. Use side rails appropriately for compromised clients 10. Provide nonskid footwear and bath mats 11. Utilize gait belts for movement assistance 12. Keep floors clean and free of clutter 13. Ensure assistive devices are accessible and used safely 14. Educate clients and families on safety risks 15. Lock the wheels on beds and wheelchairs during transfers 16. Use electronic monitoring for at-risk clients 17. Report and document incidents to prevent further occurrences Seizure precautions are crucial for clients with: The answer is: Generalized seizures or unconsciousness What rescue equipment should be at the bedside for patients at risk of seizures? The answer is: Oxygen, oral airway, suction, padding Should you put anything in a client's mouth during a seizure? The answer is: NO Should you restrain a client during a seizure? The answer is: NO What should you document about a seizure? The answer is: Duration, movements, and mental status What are key safety measures for clients at risk of seizures? The answer is: 1. Have rescue equipment (oxygen, oral airway, suction, padding) at the bedside; use a saline lock for IV access in high-risk patients 2. Ensure airway patency during a seizure 3. Remove hazardous items from the client's environment 4. Assist at-risk clients with mobility to prevent injury 5. Instruct caregivers not to put anything in the client's mouth or restrain them during a seizure; instead, lower them safely, protect their head, remove nearby furniture, provide privacy, and position them on their side if possible You should use a ________ for IV access in patients at high-risk for seizures The answer is: Saline lock What position do you want to put clients in if possible during a seizure? The answer is: On their side What should you do during a seizure? The answer is: 1. Stay with the client and call for help 2. Maintain airway, suction as needed, and administer medications 3. Document the seizure details (duration, movements, mental status) and report to the provider. Afterward, ensure the client is comfortable and in a quiet environment for recovery. _____ are preferred when working with older adults The answer is: Showers What are developmental safety concerns for infants and toddlers? The answer is: Suffocation Poisoning Aspiration Falls MVA Burns What are developmental safety concerns for preschoolers and school-age children? The answer is: Drowning (big concern) MVA (big concern) Begin sex education for school-age children Firearms Burns, poison When should you begin sex education? The answer is: Around school-age What are developmental safety concerns for adolescents, young adults, and aging adults? The answer is: Fire safety Passive smoking Carbon monoxide Food poisoning Does smoke stay on your clothes? The answer is: Yes Can you smell carbon monoxide? The answer is: NO - it is odorless Can you taste carbon monoxide? The answer is: NO - it is tasteless Why may older adults have issues with food safety/poisoning? The answer is: They have declined eyesight and senses -> they may not be able to detect if the food is expired Body mechanics The answer is: The use of muscles to maintain balance, posture, and body alignment when performing a physical task When do nurses use body mechanics? The answer is: When providing care to clients by lifting, bending, and assisting clients with the activities of daily living ____________ keeps the center of gravity stable, which promotes comfort and reduces strain on the muscles The answer is: Body alignment How does body alignment promote comfort and reduce strain on muscles? The answer is: By keeping the center of gravity stable True/False: Good body mechanics reduces the risk of injury The answer is: True True/False: Whenever possible, use mechanical lift devices to lift and transfer clients The answer is: TRUE - many facilities have "no manual lift" and "no solo lift" policies Nurses should not lift beyond __ lbs The answer is: 35 Do you have a legal right to refuse to lift a client without the proper equipment? The answer is: YES What are situational risks while lifting? The answer is: Twisting, kneeling, long shifts What client factors affect lifting safety? The answer is: Physical conditions affecting mobility or uncooperative behavior When lifting, you should ______ the abdominal muscles to prevent back strain The answer is: tighten When lifting, you should keep the object ______ the body The answer is: close to What are the general lifting safety guidelines? The answer is: - Use major muscle groups and tighten abdominal muscles to prevent back strain - Distribute weight between arms and legs to reduce strain - For lifting from the floor: flex hips, knees, and back - Keep the object close to the body - Use assistive devices when possible and seek help as needed - Use assistive devices for lifting over 15.9 kg (35 lbs) Should you include assistance or mobility aids in the plan of care for safe transfers and ambulation? The answer is: YES What should you evaluate / assess for regarding transfers and the use of assistive devices? The answer is: - Evaluate each situation and use an algorithm to determine the safest method to transfer or move the client. Answer these questions: Can the client bear weight? Can they assist? Are they cooperative? - Determine the client's ability to help with transfers (balance, muscle strength, endurance, use of a trapeze bar) - Evaluate the need for additional staff or assistive devices (transfer belt, hydraulic lift, sliding board) - Assess and monitor the use of mobility aids (canes, walkers, crutches) - Include assistance or mobility aids in the plan of care for safe transfers and ambulation When lifting/moving clients, you should bend at the ______ The answer is: Knees What are guidelines for preventing injuries while lifting/moving clients? The answer is: - Have staff assist with client positioning to prevent back pain - Plan for lifting and transferring activities, ensuring help is available. - Use assistive equipment for safe lifting. - Rest between heavy tasks to reduce muscle fatigue. - Maintain good posture and exercise to strengthen muscles. - Keep head and neck aligned with pelvis to avoid nerve impingement. - Use smooth movements for lifting to prevent injury. - Avoid repetitive hand and wrist movements; stretch regularly. - Refrain from twisting the spine or bending at the waist to reduce injury risk. Supine position The answer is: Lying flat on the back, arms at the sides What is supine position used for? The answer is: Post-surgery recovery, assessments, and rest Fowler's position The answer is: Semi-sitting position with the head of the bed elevated 45 - 60 degrees What is Fowler's position used for? The answer is: Promotes breathing, comfort for patients with respiratory or cardiac conditions High Fowler's position The answer is: Head of the bed elevated at 90 degrees What is high Fowler's position used for? The answer is: Facilitates breathing, feeding, and reduces aspiration risks Prone position The answer is: Lying flat on the stomach with the head turned to the side What is prone position used for? The answer is: Helps with drainage and lung function; used in some COVID-19 patients for respiratory support Lateral (side-lying) position The answer is: Lying on the side with a pillow between the knees for support What is lateral (side-lying) position used for? The answer is: Reduces pressure on the back, useful for unconscious patients to prevent aspiration Sims' position The answer is: Semi-prone position on the left side, with the right knee bent What is Sims' position used for? The answer is: Enemas, rectal exams, and to relieve pressure from bony prominences Trendelenburg position The answer is: Lying on the back with the bed tilted so the head is lower than the feet What is Trendelenburg position used for? The answer is: Enhances venous return, used in some cases of shock Reverse Trendelenburg position The answer is: Lying on the back with the bed tilted to the feet are lower than the heard What is reverse Trendelenburg position used for? The answer is: Promotes gastric emptying, reduces aspiration risk Why do we calculate medications? The answer is: To determine how much medication to give (oral, parenteral, IV) Oral medications include: The answer is: tablets, liquid Parenteral medications include: The answer is: IM, IV, SQ Medication doses can be expressed in _____________ and ___________ The answer is: Concentration, volume Medication doses can be expressed in ________, such as mcg, mg, g, and units The answer is: concentration Medication doses can be expressed in ________, such as mL, L, tsp, tbsp The answer is: volume If the number to the right is >= 5, how should you round? The answer is: You round up If the number to the right is < 5, how should you round? The answer is: You round down For dosages less than 1.0, you should round to: The answer is: The nearest hundredth For dosages greater than 1.0, you should round to: The answer is: The nearest tenth What do you need to know to calculate medication doses? The answer is: Prescription (how much is to be given / desired dose) Available (how the medication is supplied) Conversions Weight Rounding rules What are the 3 approaches to calculations? The answer is: Desired Over Have Ratio & Proportion Dimensional Analysis 1 mg = ________ mcg The answer is: 1000 ______ g = 1000 mg The answer is: 1 1 kg = __________ g The answer is: 1000 1 oz = ___ mL The answer is: 30 1L = ___________ mL The answer is: 1000 1 tsp = ____ mL The answer is: 5 1 tbsp = ____ mL The answer is: 15 1 tbsp = _____ tsp The answer is: 3 1 kg = ______ lb The answer is: 2.2 1 gr. (grain) = ___ mg The answer is: 60 What are the steps to performing dosage calculations? The answer is: 1. Review medication order (desired dose) 2. Read drug label carefully (have) 3. Select method/formula to use to calculate 4. Do conversions 5. Calculate 6. Round 7. Evaluate: Is this an appropriate dose? You have a(n) ________ need for most nutrients once in adulthood The answer is: decreased The nutrients _____ and _______ are especially important for young adult women The answer is: calcium, iron Do older adults need the same amount of most vitamins and minerals as younger adults? The answer is: Yes In old age, metabolism ________ The answer is: slows In old age, thirst __________ The answer is: decreases _______ is an important nutrient for GI health The answer is: Fiber What are examples of objective data related to nutrition? The answer is: - BMI - Skin fold measurement - Lab values (glucose, cholesterol, triglycerides, hemoglobin, hemoglobin A1c, electrolyts, albumin, prealbumin, transferrin) - Muscle strength - Skin - Hair/nails - SQ fat - Dental/oral health - Eyes - GI function - Mental status - Liver and spleen Normal BMI The answer is: 18.5 - 24.9 Underweight BMI The answer is: < 18.5 Overweight BMI The answer is: 25 - 29.9 Obese BMI The answer is: > 30 What nutrient is the earliest marker for nutritional deficit? The answer is: Prealbumin Transferrin is a lab value that shows your intake of ______ The answer is: iron ________ is a sign of ACUTE protein deficiency and is the earliest marker for nutritional deficit, decreasing after 14 days of consuming a diet with 60% of the necessary protein The answer is: Prelabumin What are examples of subjective data related to nutrition? The answer is: - # of meals/day - Fluid intake - Food preferences (cultural/religious/restrictions) - Access - Food allergies - Appetite - Nausea - Constipation or change in bowel pattern What signs should you look at when assessing oral health and function? The answer is: Mucous membranes, tongue, dentition, swallowing Central adiposity The answer is: Adiposity around the umbilicus; can alter glucose metabolism Yellow sclera is a sign of _________ issues The answer is: liver In old age, appetite ________ The answer is: decreases What color should your urine be normally? The answer is: Straw-colored or light yellow What are some medical diagnoses with fluid/nutrition implications? The answer is: Heart failure, kidney failure, COPD/respiratory disorders, failure to thrive, malnutrition, eating disorders, diabetes, gastrointestinal disorders, cerebrovascular accient, myocardial infarction, anemia, kidney stones, wounds, operative procedures What are tips of patient-centered care for nutrition? The answer is: - Eating is a social activity - Foods can hold an important place in memory - Dietary restrictions impede autonomy - Allow for maximum choice among available options - Loss and grief What is a nursing goal for a patient who has imbalanced fluid volume? The answer is: The patient's fluid status will become balanced What is a nursing goal for a patient who has fluid volume deficit? The answer is: The patient will have a positive fluid balance over the next 24 hours What is a nursing goal for a patient who has fluid volume excess? The answer is: The patient will have a negative fluid balance over the next 24 horus What is a nursing goal for a patient who has inadequate nutrition? The answer is: The patient will consume adequate nutrition over the next 48 hours What is a nursing goal for a patient who has nausea/vomiting? The answer is: The patient's nausea will resolve over the next 2 hours. What is a nursing goal for a patient who has impaired swallowing? The answer is: The patient will not experience adverse outcomes related to swallowing throughout the shift Fluid intake includes: The answer is: Oral liquids, foods that liquefy at room temperature (Jello, ice), IV fluids (flushes, fluids, medications), enteral feedings, etc. Fluid output includes: The answer is: urine, blood, emesis, diarrhea, and any drainage How do you calculate fluid balance? The answer is: Add up all intake Add up all output Find intake - output A ________ fluid balance means more fluid has been taken in than put out The answer is: positive A _________ fluid balance means more fluid has been put out than taken in The answer is: negative When should you take daily weights of patients? The answer is: At the same time of day, generally in the morning after the first void and before any intake How should you use a bed scale to weigh a patient? The answer is: - Make sure it is zeroed before the patient gets in - Make sure that minimal bedding is on the bed: one sheet, one blanket, one pillow in a case A ________ fluid balance means you are at risk for fluid overload The answer is: positive A _________ fluid balance means you are at risk for dehydration The answer is: negative Regular diet The answer is: no restrictions NPO diet The answer is: nothing by mouth, not even ice chips Clear liquid diet The answer is: You should be able to see through it; no dairy or orange juice - coffee without creamer is OK Full liquid diet The answer is: Dairy and all juices Pureed diet The answer is: Meats, fruits, vegetables, scrambled eggs Mechanical soft diet The answer is: Small diced or ground foods Soft/Low-residue diet The answer is: Low fiber, easily digestible High-fiber diet The answer is: Whole grains, raw/dried fruits Low sodium diet The answer is: No added salt, 1 to 2 g sodium Low cholesterol diet The answer is: No more than 300mg/day of dietary cholesterol Diabetic diet The answer is: Balanced, around 1,800 calories Dysphagia diet The answer is: Pureed foods and thickened liqudis What are the different types of thickened liquids? The answer is: Thin (Level One) Nectar (Level Two) Honey (Level Three) Pudding (Level Four) Thin (Level One) Fluid The answer is: Thicker than water; can be drunk from a cup or through a straw; similar to single cream Nectar (Level Two) Fluid The answer is: Pours quickly from a spoon, but more slowly than water; can be drunk from a cup; can be drunk through a straw with some effort Honey (Level Three) Fluid The answer is: Drips slowly through the prongs of a fork in dollops; can be drunk from a cup; more difficult to drink through a straw Pudding (Level Four) Fluid The answer is: Holds it shape and cannot be poured; cannot be drunk from a cup or through a straw; usually taken with a spoon You _______ a PO diet when you are in a nutritional deficit The answer is: encourage You _______ a PO diet when you are in a nutritional excess The answer is: restrict What are examples of feedings that use the gut? The answer is: NG, PEG/PEJ, G/J tubes True/False: You should provide good oral care if the patient needs enteral fluids and nutrition The answer is: True! A PEG tube is an enteral feeding tube that is inserted into the _____ The answer is: stomach A PEJ tube is an enteral feeding tube that is inserted into the ______ The answer is: jejunum NG tubes are for _____ term feeding The answer is: short Enteral feeding The answer is: Feeding used if the GI tract is working (relies on the GI tract to absorb some nutrients) Standard (Polymeric) Enteral Feeding Formula The answer is: 1 - 2 kcal/mL; milk-based, blenderized foods - whole nutrient formulas, standardized commercial formulas, or customized formulas per dietician - only for patients who can absorb whole nutrients What kind of enteral feeding formula is only for patients who can absorb whole nutrients? The answer is: Standard (Polymeric) Enteral Feeding Formula Modular Enteral Feeding Formulas The answer is: 2.8 - 4 kcal/mL; single-macronutrient preparations (not complete) - used as a supplement Elemental Enteral Feeding Formulas The answer is: 1 - 3 kcal/mL; predigested nutrients for partially dysfunctional GI tracts Specialty Enteral Feeding Formulas The answer is: Used for meeting specific nutritional needs - common for patients with hepatic/liver failure, respiratory disease, or HIV infection During enteral feeding, the head of the bed should be at a minimum of ___ degrees to avoid aspiration The answer is: 30 What are the steps for providing enteral feeding? The answer is: - Inspect for secure placement and address skin irritation - Water for flushing - Chux pad, towel - Auscultate Bowel Sounds Intermittent/Gravity - turn stopcock, connect syringe - aspirate for residual volume, inspect, return contents - flush -> administer formula -> flush - don't instill air Continuous/By pump - check for residuals as directed What are some adverse effects of enteral feeding? The answer is: Diarrhea (no fiber) Nausea/vomiting Aspiration How should you evaluate enteral feeding? The answer is: Monitor fluid status Monitor labs if electrolytes are being replaced Monitor/address adverse effects (diarrhea, N/V, aspiraiton) How should you monitor and address nausea/vomiting from enteral feeding? The answer is: - Keep the HOB up and have suction ready - Administer PRN antimetics if available - Notify provider and recommend slowly rate/x-ray - Aspirate as directed and report volume How should you monitor and address aspiration from enteral feeding? The answer is: - Suction mouth and airway - Auscultate bowel sounds - Notify provider and recommend chest x-ray - Monitor for increased temp/RR or decreased SaO2 Total parental fluid (TPN) The answer is: Fluid that must be infused via a central line unless designated as peripheral parenteral fluid (PPN) - provides nutrients and bypasses the GI tract Total parenteral fluid might be supplemented with ______ The answer is: lipids What are important tips for parenteral nutrition? The answer is: - IV fluids for maintenance or replacement - TPN might be supplemented with lipids and must be infused via a central line unless PPN - Provide good oral care! What are possible causes of redness, warmth, erythema, leaking, and pain at an IV site? The answer is: Infiltration, extravasation, phlebitis, thrombophlebitis, cellulitis What should you use with intermittent flushes to avoid clotting? The answer is: IVs (saline lock, INT) Bolus The answer is: Giving fluid or medication by direct and usually rapid IV infusion IV push The answer is: Direct infusion into IV line via a syringe - look up the meds in Nursing Central for the rate What are tips for IV therapy? The answer is: - Choose a catheter size appropriate for vein and for planned therapy - Monitor IV site for redness, warmth, erythema, leaking, pain - Use infusion pump for safety - Know compatbility/incompatibility - Scrub the hub - Replace tubing per policy What do you NEVER give via IV push because it is corrosive and will kill your patient? The answer is: Potassium (K) How do you evaluate IV therapy? The answer is: - Monitor fluid status, especially for fluid overload - Monitor for therapeutic effects of medication Eating disorder The answer is: Mental health conditions with an unhealthy focus on food, body image, and weight What are types of eating disorders? The answer is: Anorexia Nervosa Bulimia Nervosa Binge-eating disorder Anorexia nervosa The answer is: A type of eating disorder with low body weight, intense fear of weight gain, and distorted self-image Bulimia nervosa The answer is: A type of eating disorder with binge eating with purging and feeling of loss of control Binge-eating disorder The answer is: A type of eating disorder with binge eating without purging; often linked to obesity What are key characteristics of eating disorders? The answer is: - Preoccupation with food and body weight - Severe disturbances in eating and self-perception - Physical/psychological impacts, common in adolescents What is early intervention so important for eating disorders? The answer is: - High morbidity and mortality - Multidisciplinary treatment is essential