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NRS 210A final Questions and answers With
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(Wk 5) evidence based practice - Correct Answers the use of evidence to guide practice while incorporating key elements of patient involvement and the expertise of nurses How do we do EBN? - Correct Answers 1.Develop an answerable question
- search the literature to uncover evidence to answer the question
- evaluate the evidence found
- apply the evidence to the practice situation
- evaluate the outcome JHEBP Process (PET) - Correct Answers - Practice Question
- Evidence
- Translation JHEBP: Practice Question steps - Correct Answers 1. recruit interdisciplinary team
- Develop and refine the EBP question****
- Define the scope of the EBP question and identify stakeholders
- Determine responsibility for project leadership
- Schedule team meeting JHEBP: Evidence - Correct Answers 6. conduct internal and external search for evidence
- appraise the level of quality of each piece of evidence
- summarize the individual evidence
- synthesize overall strength and quality of the evidence
- develop recommendations fro change based on evidence synthesis
JHEBP: Translation - Correct Answers 11. determine fit, feasibility, and appropriateness of recommendations for translation path
- create action plan
- secure support and resources to implement action plan
- implement action plan
- evaluate outcomes
- repsort outcomes to stakeholders
- identify next steps
- disseminate findings PICO - Correct Answers - Patient, population or problem
- Intervention
- Comparison with other interventions, if applicable
- Outcomes Health education goal - Correct Answers achieve optimal states of health; guide through problem solving and decision making health literacy - Correct Answers capacity to read, comprehend, and follow through on health information Teach - back method - Correct Answers ask the patients to explain in their own words what they need to know or do. Its a chance to check understanding and re-teach info if needed Why do nursed need to be culturally competent? - Correct Answers - growing diversity/ inclusivity
- effective communication
- effective health promotion
- eliminating health disparities
physical abilities are in peak condition, full growth women:17 men: 21, intimacy vs. isolation nursing goals for young adults - Correct Answers prolonging optimal physical energy, developing the mental, emotional, spiritual, and social potential, encouraging proper health habits, anticipating and screening for onset of disease at an early state and treat when appropriate Young adults topic of discussion - Correct Answers health behaviors, safety practices, diet, exercise, weight control, sexuality, addiction Young adult infertility - Correct Answers 10-15% of couples in u.s. causes of death among young adults - Correct Answers 72% of all deaths among children and young adults are from:
- MVA (30%),
- All other non intentional injuries, homicide, suicide Middle aged adult - Correct Answers 35-65 years Middle aged adult health promotion needs - Correct Answers healthy lifestyle, screening, intervention consideration Middle aged adult health promotion topics - Correct Answers - obesity, physical activity and nutrition management, injury prevention, pain, std, stress management, substance abuse, depression, vaccines, safe and thriving home and work environment mental health determinants - Correct Answers - healthy communities, skill development, social and emotional competence suicide - Correct Answers 10th leading cause of death in US, 2nd in 25-34 3rd in 15- 24
substance use - Correct Answers 38 million US adults drink to excess, 1-6 adults talk with a health professional about their drinking military health care issues - Correct Answers environmental exposures, traumatic brain injury, polytrauma, military sexual trauma, behavioral health issues Nursing role in military health care issues - Correct Answers - culturally competent care, military health history assessment, referrals, resources, education Physical wellness - Correct Answers a healthy body maintained by eating right, exercising regularly, avoiding harmful habits, making informed and responsible decisions about health, seeking medical care when needed, and participating in activities that help prevent illness. Emotional wellness - Correct Answers understanding & expressing a range of emotions and coping with problems that arise in everyday life. Mental/Intellectual wellness - Correct Answers involves having a mind open to new ideas and concepts. Such as gathering information on a new diagnosis or seeking a second opinion. Appreciating your role in learning compared to faculty role. Spiritual wellness - Correct Answers the state of harmony between you and others. Or an understanding of your place in the greater universe. Environmental wellness - Correct Answers Refers to an appreciation of the external environment and the role individuals play in preserving, protecting, and improving environmental conditions. AND understanding the effects of your living and working environment on your health. Social wellness - Correct Answers refers to the ability to perform social roles effectively, comfortably, and without harming others. Includes introversion vs extroversion preferences. Occupational wellness - Correct Answers wellness an ability to enjoy what you are doing to earn a living or to contribute to society
Gerontology - Correct Answers Scientific studies of processes associated with aging Geriatrics - Correct Answers the study of the medical aspects of old age and the application of knowledge related to the biological , biomedical, behavior, and social aspects of aging to prevention, diagnosis, treatment, and care of older persons. Definitions of Old - categories - Correct Answers Young old = 65- 74 Old = 75- 84 Old old = > Ageism - Correct Answers refers to the discrimination of and stereotyping of people solely based on their age. older adults: Promotion of Function - Correct Answers Maintain Mobility Avoid Falls / Risk Reduction Maintain Independence in IADL & ADLs older adults: Promotion of Social Supports - Correct Answers Avoid Social Marginalization/Isolation Appropriate Housing Minimize Caregiver Stress & Burden older adults: Preventive Care -- Screening - Correct Answers Annual Blood Pressure Height & Weight Colon Cancer - Highly sensitive (FOBT) Prostate Cancer - digital rectal exam >50 years with life expectancy of at least 10 years Vision Hearing
Pap Smear: no screening > 65 if previous 3 consecutive normals within a 10 yr period Mammography: Every 2 yrs up to 74yrs Lipids: Every 5 years until 65 Sigmoidoscopy: Every 3-5 years up to 75 Colonoscopy: Every 10 years up to 75 older adults: Exercise Recommendations - Correct Answers Moderate to vigorous aerobic activity: 3- 5 times per week ● Weight training or resistance exercises to maintain strength ● Flexibility activities to maintain range of motion ● Balance training to improve stability and prevent falls Vaccines for older adults - Correct Answers - Influenza (Flu) vaccine: Annually >50yrs
- Pneumoccal: @ age 65 yrs
- Tetanus-diptheria: Every 5-10 years
- Herpes Zoster vaccine for > 60yrs- 1 time The goal of a functional assessment screening is to - Correct Answers - restore or improve health
- monitor changes
- enhance independence
- identify disabilities
- screen for issues needing further assessment and referral
- evaluate the need for community resources and equipment Activities of Daily Living - Correct Answers - Bathing and grooming
- Ambulation
- Transfers
- Toileting
Sexual Violence - Correct Answers - Rape, sex trafficking, any coercive sexual act, unwanted sexual comments or advances.
- Can occur across lifespan.
- Victims are predominantly female What is Mental Health? - Correct Answers 1. Positive Affect
- Absence of Negative Affect
- Satisfaction with Life Social and Emotional Competence - Correct Answers The ability to deal with and express appropriately one's thoughts and feelings. Components of Wellness - Correct Answers 1. Emotional
- Financial
- Social
- Spiritual
- Occupational
- Physical
- Intellectual
- Environmental Where is suicide ranked as cause of death in the U.S. population overall? - Correct Answers 10th Where is suicide ranked as cause of death in the U.S. population age 25-34? - Correct Answers 2nd Where is suicide ranked as cause of death in the U.S. population age 15-24? - Correct Answers 3rd From 1999-2010, what was the increase in suicide in Americans age 35-64? - Correct Answers Nearly 30% to 17.6/100,
For a person with a mood disorder, what is the increase of risk for suicide? - Correct Answers 20X Percent of time that suicide attempt with firearm succeeds - Correct Answers 90% Number of US adults that drink to excess - Correct Answers 38 million What can nurses do about IPV? - Correct Answers - Secondary prevention (screening)
- Report incidents of suspected child/elder abuse
- Refer victims to resources
- Provide therapeutic conversation Obvious injuries related to IPV - Correct Answers Bruising Cuts Fractures Damage to eardrums Abrasions Trauma from being punched, shot, choked, dragged, burned Vaginal/anal trauma Concussions "Shaken baby" syndrome Behaviors related to IPV - Correct Answers Depressed Anxious Withdrawn Passive Fearful Hesitant to talk, especially if partner/parent present Partner speaks for patient
State Nurse Practice Acts - Correct Answers Describe nursing standards of practice, scope of care, distinguish b/w nursing and medical practice, and establish requirements for education and licensure.
- Nurses individually responsible for knowing the provision of the Nurse Practice Act for the state they live in When does Medicare begin? - Correct Answers At age 65; apply 3 months prior to turning 65 What is ethics? - Correct Answers - Standards of "right" and "wrong" that prescribe human behavior or decisions
- E.g., rights, obligations, benefits to society, fairness, etc.
- Ethics in healthcare: moral responsibilities towards individuals and society to facilitate health and wellbeing Professional Code of Conduct - Correct Answers What is "right" in your profession (e.g., ANA Code of Ethics) OHSU Patient Care: Guiding priniciple - Correct Answers "OHSU is committed to providing compassionate, appropriate, high-quality, cost effective care in a manner that is sensitive to our patients' individuality, personal beliefs, and culture, and protects patient rights, privacy, and confidentiality."
- Care: compassionate, appropriate, high-quality, cost effective
- Conduct: respects individuality, personal beliefs, culture Ethical Dilemma - Correct Answers Ethical problems that challenge your values, where a decision must be made b/w two or more equally undesirable options Autonomy - Correct Answers an individual's freedom of action, or self-governance Veracity - Correct Answers devotion to, or telling, the truth (e.g., informed consent) Organizational Code of Conduct - Correct Answers What is "right" for everyone, regardless of profession or position (e.g., OHSU Code of Conduct)
Nursing contains both ethical dilemmas and legal obligations - Correct Answers Scope of practice
- Ethics: ANA Code of Ethics
- Legal: Scope of Practice, State statutes, mandatory reporting, licensing Ethical Concerns in Nursing
- Coping with staffing patterns that limit patient access or short staffing
- Prolonging the living/dying process
- Not considering the quality of client's life or wishes
- Policies that threaten quality of care
- Working with unethical/impaired colleagues
- Discrepancies b/w patient and family wishes
- Withholding information or care
- Identifying existing or likely violence Licensure in Oregon - Correct Answers - Apply to OSBN, background check and fingerprinting, take NCLEX, receive license
- Renewal: must work 960 hours in a 5 year period Standards of Care - Correct Answers Legal requirements for minimum acceptable nursing care State Board of Nursing - Correct Answers - Enacts rules and regulations that define the practice of nursing
- Specifically licenses nurses in their state of practice; requirements vary
- Able to suspend or revoke licenses
- Licenses are a property right, as well as public record, and due process must be followed What it the Triple Aim of healthcare? - Correct Answers 1. improving health of defined population 2. enhancing pt. care experience (quality, access and reliability) 3. reducing or at least controlling the per capita cost of care.
- Time & place to pray
- Eye contact Community of inclusion - Correct Answers Ethical duty to be fair, open, and accepting to people with various background Challenges... issues are deeply rooted involving belief system, history Can an individual seek care in the emergency dept. of any hospital and have confidence that basic screening tests and interventions needed to stabilize him or her condition will be provided because of EMTALA (Emergency Medical Trtmt. and Labor Act? - Correct Answers No, EMTALA applies only to emergency depts. in hospitals that accept Medicare funds. Who defines the scope of practice and licensing for nurses? - Correct Answers defined by state process - Correct Answers medical care, surgical care, therapeutic choices, nursing practices, provider interactions, Joint Commission, clinical research, clinical judgment process Assessing for IPV - Correct Answers Don't be afraid to ask specific questions about abuse in your assessment! When intimate partner abuse is suspected/identified - Correct Answers Become familiar with referral resources Confer with colleagues and the interdisciplinary team to steer victim toward available assistance Assess safety and whether victim needs escape plan, temporary shelter, care for children MA Physical changes - Correct Answers - Body image
- Vision (presbyopia, glaucoma, decreased visual sensitivity and peripheral vision, cataracts, diabetic retinopathy)
- Hearing (presbycusis)
- Perimenopause and menopause
- Mood swings, nervousness, fatigue, depression
- Osteoparosis risk
- Bone strengthening Healthcare resides in the context of what? - Correct Answers society (culture, resources, etc.) that continues to change healthcare outcomes - Correct Answers quality, safety, mortality, morbidity, improvement in diagnosis, survival rates, cost Cognitive function - older adults - Correct Answers - Delirium - onset hours to days
- depression - onset weeks to months
- dementia - onset months to years *** REMEMBER *** if an older adult was not confused a few hours or days ago, his or her confusion usually indicates an acute problem that requires PROMPT evaluation US cultural values - Correct Answers having choices, inclusivity, "not giving up", "legal" status (wk 9) methods of containing cost for healthcare in America - Correct Answers Fee-for-service Diagnosis-Related-Groups (DRGs) Focus on prevention Challenges... More demand for higher quality service (technology, efficiency, effectiveness) Respecting individuality & options How to think about context of care? - Correct Answers social policy, healthcare policy, access to care, private & gov't. heath ins., economics (non-traditional market) affordability/cost
in 2014 - establishing a new coverage pathway for millions of uninsured adults who were previously excluded from the program, effective January 1, 2014. The law also provided for 100% federal funding of the expansion through 2016, declining gradually to 90% in 2020 and future years. (wk 9 ) Additional results of the expansion of the Medicaid program? - Correct Answers The law required that states simplify and modernize their enrollment processes and create a new coordinated enrollment system for Medicaid, the Children's Health Insurance Program (CHIP), and coverage through the new Marketplaces. The ACA also established an array of new authorities and funding opportunities for delivery system and payment reform initiatives in Medicare, Medicaid, and CHIP, designed to promote better models of care and cost-effective care, particularly for those with high needs and high costs. older adult preventative care practice - Correct Answers Older adults are screened for same conditions as younger persons, but patient preference and life expectancy are important factors to consider. Oral screening - older adults - Correct Answers inspect the oral cavity and check:
- condition of teeth
- condition and fit of dentures
- for oral lesions or infections such as candidiasis Ask:
- problems eating or swallowing?
- when was last dental appt? upper extremities (func. assessment) - older adults - Correct Answers can the individual:
- touch the palms of the hands to back of head?
- reach up over head?
- touch the hands together behind the waist? upper mobility is needed for:
- older adults - Correct Answers - combing and washing hair
- getting items off shelf
- putting on a shirt Old - Correct Answers 75- 84 considerations in use of touch - older adult sexuality - Correct Answers - recognize importance of older adults giving, as well as receiving
- touch must be met on an individual basis
- learn to touch therapeutically
- ask: what does my touch say? when does person primarily receive touch?
- negative behavior can be result of reaching out to be touched
- touch may be misinterpreted
- be aware of "safe zones" factors affecting sexual expression - older adult sexuality - Correct Answers - no available partner/widowhood
- health problems
- medical interventions
- medications/drugs
- psychosocial factors
- personal history
- societal attitudes
- ignorance
- environment (wk 9 ) Medicare changes with ACA - Correct Answers ~Your Medicare coverage is protected. Medicare isn't part of the Health Insurance Marketplace ~ You get more preventive services, for less. Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly "Wellness" visit.
