NUR 243 Quiz 2 Study Guide: Health Disparities - PDF

**[NUR 243 Quiz 2 Study Guide: ]** **Health Disparities & Cultural Competence** **What Are Healthcare Disparities?** - **Gaps in the quality of health and healthcare** among different population groups. - Involves **socioeconomic status, race/ethnicity, and education level**. - **...

**[NUR 243 Quiz 2 Study Guide: ]** **Health Disparities & Cultural Competence** **What Are Healthcare Disparities?** - **Gaps in the quality of health and healthcare** among different population groups. - Involves **socioeconomic status, race/ethnicity, and education level**. - **Not related to access alone**---includes differences in quality of care. **Definitions of Health Disparities** ✔ **Whitehead's View**: Disparities are **avoidable, unavoidable, unfair, and unjust**.\ ✔ **Carter-Pokras**: Health disparities involve **differences in health status between disadvantaged groups** and those with more **social justice and equity**.\ ✔ **Dahlgren & Whitehead Rainbow Model**: - **Social determinants of health** (environment, education, employment, healthcare access). - **Predicts health inequities** between communities. - **Prevention-focused approach**. **Scope of Health Disparities** **Category** **Example** **Nursing Concern?** -------------------------------- ------------------------------------------------------------------------------- -------------------------------- **Unavoidable & Acceptable** A more significant number of elderly people visit the ED **No concern for nurses** **Unavoidable & Unacceptable** **High diabetes risk in Hispanic populations, but lack of proper management** **Nursing concern** **Avoidable & Acceptable** Natural disasters causing temporary health access issues **Rare occurrences** **Avoidable & Unacceptable** **Lack of healthcare access, bias in clinical decision-making** **Most concerning for nurses** **Common Health Disparities** ✔ **Lack of health insurance →** Delayed diagnosis, no access to meds.\ ✔ **Ineffective provider-patient communication →** Medical errors, poor outcomes.\ ✔ **Bias in clinical decision-making →** Disparities in care based on sex, race, or ethnicity.\ ✔ **Lack of transportation →** Missed follow-ups, poor chronic disease management.\ ✔ **Language barriers →** Medication errors, non-compliance.\ ✔ **Patient mistrust/refusal →** Late-stage disease diagnosis. **Examples of Health Disparities** ✔Unequal receipt of early and adequate prenatal care ✔Unequal receipt of recommended immunizations ✔Unequal pain management ✔Unequal breast cancer screening ✔Unequal quality of palliative care ✔Lack of mental health services **Health Disparity Impact on Specific Diseases** **Condition** **Disparity** ---------------------------- ---------------------------------------------------------------------------------- **Cardiovascular Disease** Higher mortality in minority populations **Diabetes** Higher rates in Hispanic & Black populations, but **lower access to management** **Obesity** More prevalent in lower-income populations **Mental Health** **Limited access to services** in minority communities **Cancer Screenings** **Lower rates** of **Pap smears, mammograms, prostate exams** **Consequences of Health Disparities** ✔ **Decreased patient satisfaction**\ ✔ **Increased miscommunication**\ ✔ **Decreased adherence to treatment** 🔴 **Delays in healthcare access caused by:** - Poor doctor-patient communication - Lack of insurance - Doctor refusal of service - Lack of transportation **Interpreters & Language Barriers** **Key Qualities of an Interpreter** ✔ **Understands medical terms & can simplify them**\ ✔ **Provides patient advocacy**\ ✔ **Uses verbal & nonverbal cues**\ ✔ **Delivers clear teaching instructions** **Dangers of Using an Unqualified Interpreter (e.g., Family)** ❌ **Miscommunication → Increased medical errors**\ ❌ **Violation of patient rights**\ ❌ **Lack of proper follow-up care** **Best Practices When Working With an Interpreter** ✅ **Speak slowly & clearly**\ ✅ **Maintain eye contact with the patient**\ ✅ **Use simple, non-medical language**\ ✅ **Speak in short sentences for easy translation**\ ✅ **Use the teach-back method to ensure understanding**\ ✅ **Plan for the visit to take twice as long**\ ✅ **Document translator use in the medical record** **Practice Questions** 1. **A Chinese patient with cancer refuses pain medication. What type of health disparity is this?** - **Avoidable and Unacceptable** 2. **An experienced nurse says, \"Most Hispanic immigrants live in unsanitary conditions but are hard workers.\" This is an example of:** - **Stereotyping** 3. **What type of health disparities are most common in clinical settings?** - **Avoidable and Unacceptable** 4. **A 30-year-old immigrant who does not speak English would be considered part of what group?** - **Potential health disparity group** 5. **What is the best strategy for reducing healthcare disparities in a hospital setting?** - **Increase interpreter availability** 6. **A new nurse needs further education when they fail to recognize which as a health disparity?** - **Frequent fast-food meals** 7. **Before working with a diverse patient population, what should the nurse do first?** - **Improve self-awareness of personal biases** **Liver Cirrhosis** **Definition** - End-stage liver disease with **progressive degeneration and scarring** of liver tissue, leading to **impaired liver function**. **Causes** - **Most Common**: Chronic hepatitis C, Alcoholic liver disease - **Other Causes**: - Malnutrition - Obesity - Biliary cirrhosis (autoimmune bile duct damage) - Cardiac cirrhosis (from right-sided heart failure) **Early Symptoms** - Fatigue - Enlarged liver - **Lab values may be normal early in the disease** **Late Symptoms** - **Jaundice** (from bilirubin buildup) - **Peripheral edema & ascites** - **Skin changes**: Petechiae, spider angiomas, palmar erythema - **Endocrine problems**: Gynecomastia, menstrual changes - **Neurological**: Altered mental status **Complications** **Portal Hypertension** - Increased venous pressure in liver circulation → **Splenomegaly, varices, ascites** **Varices (Esophageal & Gastric)** - **High risk of rupture → life-threatening bleeding** - **Signs of bleeding**: - Hematemesis - Black, tarry stools (melena) **Ascites** - Accumulation of fluid in the peritoneal cavity - **Signs**: Abdominal distention, weight gain, dehydration, hypokalemia - **Management**: - **Sodium restriction** - **Diuretics** - **Paracentesis** (temporary relief) - **TIPS (transjugular intrahepatic portosystemic shunt) if refractory** **Hepatic Encephalopathy** - **Cause**: Ammonia buildup due to liver failure - **Symptoms**: Confusion, behavior changes, asterixis (flapping tremor) - **Treatment**: - **Lactulose** (removes ammonia via stool) - **Antibiotics** (reduce ammonia-producing bacteria) **Hepatorenal Syndrome** - Kidney failure due to severe liver disease - **Signs**: Oliguria, azotemia, intractable ascites - **Definitive Treatment**: **Liver transplant** **Modifiable vs. Non-Modifiable Risk Factors** **Category** **DIC** **Cirrhosis** -------------------- ---------------------------------------------------------------------------------- ----------------------------------------------------------------------------- **Modifiable** \- Managing underlying conditions- Preventing infections- Early cancer treatment \- Alcohol cessation- Weight management- Hepatitis prevention (vaccination) **Non-Modifiable** \- Cancer- Sepsis- Tissue trauma \- Genetic predisposition- Chronic hepatitis C/B **Key Treatments & Nursing Considerations** **DIC** - **Bleeding precautions** - **Heparin** (chronic DIC only) - **Blood products** (for life-threatening hemorrhage) **Cirrhosis** - **Avoid NSAIDs, alcohol, aspirin** (increase bleeding risk) - **Monitor ammonia levels** (hepatic encephalopathy) - **Monitor for signs of infection** (peritonitis risk with ascites) **Practice Questions** 1. **Which lab value should be checked for a patient with 4+ pitting edema and cirrhosis?** - **Albumin level** 2. **Most important teaching for a patient with early alcoholic cirrhosis?** - **Avoid all alcohol** 3. **A cirrhotic patient has a K+ level of 3.2 and is on spironolactone and furosemide. What should the nurse do?** - **Administer spironolactone, hold furosemide** 4. **How to assess effectiveness of lactulose in a cirrhotic patient with hepatic encephalopathy?** - **Assess alertness & orientation** 5. **Which nursing action is most important for a patient with balloon tamponade for esophageal varices?** - **Monitor for shortness of breath** 6. **What is the priority action before a paracentesis?** - **Ask the patient to empty their bladder** 7. **Which cirrhosis patient requires immediate assessment?** - **A patient with ascites and fever of 102°F (risk for peritonitis)** **Venous Thromboembolism (VTE)** **Definition** - **VTE** is an umbrella term for **Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)**. - **Pathophysiology**: Formation of a thrombus (blood clot) in a deep vein, causing inflammation and potential embolization. **Virchow's Triad (3 Major Risk Factors for VTE)** 1. **Venous Stasis** (Slow or pooled blood flow) - Risk factors: **Obesity, pregnancy, chronic heart failure (CHF), atrial fibrillation (A-fib), immobility**. 2. **Endothelial Damage** (Vessel wall injury) - Causes: **Surgery, trauma, chemotherapy, diabetes**. - Triggers **platelet activation & clot formation**. 3. **Hypercoagulability of Blood** (Increased clotting tendency) - Risk factors: **Cancer, polycythemia, anemias, sepsis, estrogen use (oral contraceptives, pregnancy), smoking**. **Risk Factors for VTE** **Non-Modifiable Risk Factors** - **Genetics (coagulation disorders)** - **Age (\>60 years old)** - **Cancer (increased clot risk)** - **History of VTE** - **Major surgery or trauma** **Modifiable Risk Factors** - **Obesity** - **Smoking** - **Oral contraceptive or hormone therapy** - **Sedentary lifestyle** - **Dehydration** - **Prolonged immobility (travel, hospitalization)** **Signs & Symptoms of VTE** **Type** **Location** **Signs & Symptoms** --------------------------------- ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------- **Superficial Vein Thrombosis** **Leg or arm veins (varicose veins)** Tenderness, redness, warmth, pain, **cord-like appearance** **Deep Vein Thrombosis (DVT)** **Deep veins of legs, arms, vena cava, pulmonary system** **Unilateral** swelling, tenderness, pain, **redness**, **dilated veins**, warmth, fever (\>100.4°F) **Pulmonary Embolism (PE)** **Lungs (embolized clot from DVT)** **Sudden SOB, chest pain (pleuritic), coughing blood (hemoptysis), anxiety, tachycardia, hypotension** **Complications of VTE** **1. Post-Thrombotic Syndrome (PTS)** - **Occurs in 8-70% of VTE patients** due to **chronic venous inflammation**. - **Symptoms**: **Pain, swelling, fatigue, cramps, itching, tingling**. - **Manifestations**: **Persistent edema, spider veins, venous ulcers, skin discoloration**. **2. Phlegmasia Cerulea Dolens (PCD)** - **Severe complication of lower extremity VTE** causing **total venous occlusion**. - **Symptoms**: **Massive swelling, deep pain, major cyanosis**. - **If untreated → gangrene**. **Important Labs & Diagnostic Tests** **Test** **Purpose** **Normal Range** -------------------------------------------------- ------------------------------------------------- ------------------------------------------------------ **D-Dimer** **Detects clot breakdown** (\>250 possible VTE) \< 250 ng/mL (Hondros village) **aPTT (Activated Partial Thromboplastin Time)** **Monitors heparin therapy** 30-40 seconds (therapeutic range: **1.5-2x normal**) **INR (International Normalized Ratio)** **Monitors warfarin therapy** Normal: **0.8-1.2**, therapeutic range: **2-3** **ACT (Activated Clotting Time)** **Monitors clotting ability** 70-150 seconds **Hgb (Hemoglobin)** **Low in anemia (increased clot risk)** 12-18 g/dL **Platelet Count** **Elevated in clotting disorders** 150,000-400,000 cells/mcL **Diagnostic Imaging** **Test** **Purpose** -------------------------------------- ------------------------------------------------- **Duplex Ultrasound** **First-line test for DVT** **CT Venography (CTV)** **Detects clots in pelvis, thighs, and calves** **MRI Venography** **Highly accurate for pelvic & proximal veins** **Pulmonary Angiography** **Gold standard for diagnosing PE** **Ventilation-Perfusion (V/Q) Scan** **Detects PE when CT is contraindicated** **Treatment Plan for VTE** **1. Non-Pharmacological Treatment** ✅ **Early & aggressive mobilization** - Bed rest: **Flex & extend feet, knees, hips every 2 hours**. - **Walk 4-6x/day**. - **Use compression stockings unless DVT is present**. ✅ **Inferior Vena Cava (IVC) Filter** - **Prevents emboli from traveling to lungs** in **high-risk patients**. **2. Pharmacological Treatment** +-----------------------+-----------------------+-----------------------+ | **Medication** | **Purpose** | **Key | | | | Considerations** | +=======================+=======================+=======================+ | **Warfarin | **Long-term | - Monitor **INR | | (Coumadin)** | anticoagulation** | (2-3)** | | | | | | | | - **[Antidote: | | | | Vitamin | | | | K!!!] | | | | ** | +-----------------------+-----------------------+-----------------------+ | **Enoxaparin | **Prevention & | - Do **not expel | | (Lovenox)** | treatment of VTE** | air bubble** | | | | | | | | - **Monitor CBC** | | | | | | | | - **Avoid in renal | | | | disease** | +-----------------------+-----------------------+-----------------------+ | **Heparin (IV or | **Initial treatment | - Monitor **aPTT** | | SQ)** | of DVT/PE** | | | | | - **[Antidote: | | | | Protamine | | | | sulfate!!!]{.unde | | | | rline}** | +-----------------------+-----------------------+-----------------------+ | **tPA (Tissue | **Thrombolytic (clot | - **Used in | | Plasminogen | buster)** | high-risk PE** | | Activator)** | | | | | | - **Contraindicated | | | | in high bleeding | | | | risk patients** | +-----------------------+-----------------------+-----------------------+ **3. Surgical & Interventional Procedures** ✅ **Thrombectomy**: **Surgical removal of clot** (used in massive DVT cases).\ ✅ **Vena Cava Filter**: **Prevents clot migration to lungs** (PE prevention).\ ✅ **Catheter-Directed Thrombolysis**: **Direct administration of clot-dissolving drugs**. **Nursing Care & Patient Education** **1. Prevent VTE** ✅ **Mobilization (gold standard)**\ ✅ **Compression stockings (TED hose, IPC devices)**\ ✅ **Avoid prolonged sitting, crossing legs**\ ✅ **Encourage hydration to prevent blood thickening** **2. Monitor for Bleeding While on Anticoagulants** ❌ **No IM injections**\ ❌ **Avoid NSAIDs, aspirin, fish oil, garlic, ginkgo biloba**\ ❌ **Report signs of bleeding (bruising, black stools, gum bleeding, nosebleeds)** **3. Educate on Lifestyle Modifications** ✅ **Smoking cessation**\ ✅ **Weight loss**\ ✅ **Exercise regularly**\ ✅ **Avoid prolonged immobility (frequent movement on long trips)**\ ✅ **Limit vitamin K intake if on warfarin (green leafy vegetables, broccoli, liver)**