NSG 201 Final exam QA Graded A

Immigration peaks in the US - ANSWER Influx from Ireland during the potato famine (~1900s), dropped off during the Depression era, and now it is peaking again present day Standard of care - ANSWER -Effective care (thi ...

Immigration peaks in the US - ANSWER Influx from Ireland during the potato famine (~1900s), dropped off during the Depression era, and now it is peaking again present day Standard of care - ANSWER -Effective care (things like passing meds) -Respectful care -Cultural and linguistic competence (may involve use of an interpreter and figuring out beliefs/preferences) Who cannot be used as interpreters? - ANSWER Family; only use professional interpreters Idioms - ANSWER A group of words established to have a meaning that does not match up to literal definition (e.g. "kill two birds with one stone) Worldview - ANSWER the way people tend to look out upon their world or their universe to form a picture or value stance about life or the world around them Building Rapport with the culturally diverse patient - ANSWER -Pronounce name correctly -Speak clearly and spend needed time with them -Validation to know what they're saying -Be a co-learner -Ask what they think is important for their care? -What have they done in the past for medical care? -explain procedures and the system -Ask permission Heritage Assessment - ANSWER -Do you typically participate in social activities with your family? -Do you mostly have friends with similar cultural background? -Do you mostly eat foods of your family's tradition? -Do you mostly participate in the religious traditions of your family? Traditional causes of illness - ANSWER -BE aware of evidence based nursing -Biomedial -Naturalistic -Magicoreligious -Healing and culture-- folk healing Steps to cultural competency - ANSWER Understand yourself Identify meaning of health to the other person Understand the health care delivery system Malnutrition - ANSWER -Found in about 1/3 of hospital patients -Associated with delayed wound healing, suppression of immune system, functional loss, increased risk for falls, pressure ulcers Easiest nutrition screening tool - ANSWER 24-hour recall Most valid form of nutritional screening - ANSWER direct observation Malnutrition Screening tool - ANSWER -Have you lost weight without trying? -Have you been eating poorly due to a decreased appetite? Advantages of 24 hour recall - ANSWER Easy and simple Disadvantages of 24 hour recall - ANSWER -Patient may not be truthful -Ability to recall -Accuracy (forgot snacking) -Sauces, gravy, toppings -Altered short term diet Advantages of food diary - ANSWER -Have a list -easy Disadvantages of food diary - ANSWER Might alter what they eat when they know they have to write it down- might not have a good idea of what they're eating the rest of the time Advantages of direct observation - ANSWER -Observe intake -Observe need for help in cutting, eating, quantity of food, etc. Disadvantages of direct observation - ANSWER Do we know if the patient actually ate the food? Comprehensive nutritional assessment - ANSWER -Dietary history -Clinical exam -Anthropometric measures -Laboratory tests Clinical exam for nutrition - ANSWER General appearance- are they obese? muscle wasting? edematous? Clinical signs of malnutrition Anthropometric measures - ANSWER measurement of the size and proportion of the human body (BMI, waist-hip ratio, skin fold thickness, height and waist) Arm span test - ANSWER Helpful to estimate height of someone who cannot stand Measure distance from sternal notch to longest finger on dominant hand- multiply by 2.8 for height Waist to hip ratio - ANSWER measures body fat distribution Android obesity - ANSWER carries more fat in the abdomen or upper body- higher risk for disease Laboratory values - ANSWER To assess nutritional status (e.g. albumins will tell you how quickly a patient will recover from injury/illness) Marasmus - ANSWER generalized malnutrition where child is severely underweight Kwashiorkor - ANSWER Protein-deprived, edema in the swollen abdominal cavity Upper arm circumference - ANSWER Used to assess nutritional status in children Overt behaviors - ANSWER Disruptive behavior; rudeness, verbal abuse, intimidation Covert behaviors - ANSWER Disruptive behavior; Passively aggressive, need to know info, withholding help, condescending speech Interpersonal sources of conflict; barriers to communication - ANSWER -Different expectations -threat to self -differences in role hierarchy -clinical situation constraints Steps to conflict resolution - ANSWER -Identify sources of conflict -Set goals -Obtain factual info -Intervene early (be assertive) -Avoid negative comment (use "I" comments, not "you" comments; "I think that we aren't communicating well) -Consider others' viewpoints CG-WIPER - ANSWER Check chart, Gather supplies, Wash hands, ID and introduce, Provide privacy, Explain procedure, raise the bed Vital signs - ANSWER Pulse, BP, Resp, temp, O2 sat, PAIN (PQRST) PQRST - ANSWER Provocation/palliation, Quality, Radiation, Severity, Timing General Survey/JOMACS - ANSWER Judgment, Orientation, Memory, Affect, Consciousness, Speech; Nutritional Status; Personal Hygiene Skin exam - ANSWER Color Moisture Temperature Texture Turgor Lesions/ scars/ etc. Edema Head/face exam - ANSWER Size Shape Contour Symmetry (CN VII)- facial Expression Involuntary movements (tics) Hair/Scalp - ANSWER Inspect and Palpate Hair and Scalp Distribution Thickness Texture Lubrication Presence of vermin Lesions Scales Nails - ANSWER Inspect and palpate Nails Shape Color Thickness Curvature (Jarvis p. 613) Capillary refill Eyes/Ears/Nose/Mouth - ANSWER Inspect and palpate the eyes (eyebrows, sockets, lids) Lacrimal apparatus Conjunctiva and sclera Pupils (PERRLA) Visual Acuity (CN II- Optic) Six cardinal gazes (CN III Occularmotor, IV Trochlear, VI Abducens Inspect and palpate ears Auricles, Canals Whisper test Nose- Symmetry, Mucous membrane, shape, patency, Smell (CN I- olfactory) Sinuses Mouth- lips, mucosa, gingiva, Tongue (CN XII- Hypoglossal) (light, tight, dynamite), Palate and uvula (CN IX Glossopharyngeal, X Vagus), Pharynx, Dentation, TMJ- palpate (CN V Transgeminal- clench jaw) Neck - ANSWER Inspect and palpate neck- symmetry, lymph nodes, thyroid, trachea, carotid pulse, Muscle strength (CN XI- spinal accessory) Lymph nodes - ANSWER preauricular, posterior auricular, occipital, submental, submandibular, jugulodigastric, superficial cervical, deep cervical chain, posterior cervical, supraclavicular Respiratory - ANSWER Location of 5 lobes, Inspect: Posterior thorax (deformities, A/P diameter, position of the spine retraction of intercostal spaces) Anterior thorax (accessory muscles, rate and rhythm) Face- distressed, nasal flaring Percussion- "S" pattern of percussing Auscultation- normal and abnormal sounds- "S" pattern of listening Cardiovascular - ANSWER Location of the heart (between 2nd and 5th interstitial space, midclavicular line) Auscultate (APE To Man), S1 and S2 physiology, peripheral pulses, Edema assessment S1 and S2 physiology - ANSWER S1 = beginning of systole; AV valves closing (aortic and pulmonic) S2 = end of systole; SL valves closing (tricuspid and mitral) Neurovascular assessment - ANSWER Sensation (5 P's), Movement (gravity and resistance) Abdominal - ANSWER Position: Supine with knees slightly bent Privacy Inspect: shape and symmetry; scars, venous patterns, lesions, striae, hernias, peristalsis Auscultate: RLQ first Percuss: ID tones Palpate: ID structures Costovertebral angle Musculoskeletal - ANSWER Inspect: Symmetry of joints, muscles, and extremity length; posture, scoliosis; overall gait ; balance test, rapid alternating