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N221 Scott Gardner Winter 2006 Unit 1


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What percentage of elderly patients have at least one chronic illness?
What outcomes will the success of management of a chronic illness dictate?
a. A Satisfying lifestyle in which control of the illness is but one routine component
b. A life controlled by the demands of the illness.
Define Healing as described by Eliopoulos.
The mobilization of the body, mind and spriit to control symptoms, promote a sense of well being, and enhance the quality of life.
Name some ways in which a nurse can stimulate a patients self healing capabilities?
-Creating a therapeutic human and physical environment
-Reinforcing, Affirming, and Validating
-Removing Barriers to self-care and self-awareness.
What is the focus of care measures in chronic illness?
Helping patients effetively live in harmony with, rather than cure, conditions.
List 7 general goals that are appropriate in chronic care.
1. Maintain or Improve self-care capacity.
2. Manage the condition effectively.
3. Boost the bodies healing abilities.
4. Prevent complications.
5. Delay deterioration and decline.
6. Achieve the highest possible quality of life.
7. Die with comfort and dignity.
What must the nurse impart to the dying patient according to Eliopoulous?
The RN must be sensaive to the importance of listening and talking to the dying person, anticipating their needs, and most imporantly, instilling a feeling that the nurse can be depended on for support through this period.
Where will a majority of people with chronic conditions receive their care?
In the community setting.
In addition to assessing the clients ability to fulfill their own care demands, what else must the RN take into consideration, and why?
The ability of the family or other care givers to give adequate support during the care of a chronic illness. Because most people who will die at home, do so with the support of friends or family members.
How does Eliopoulous define family?
Not limited only to relatives, but also to significant others.
What is important to remember when identifying care needs?
That the needs are identified jointly, ie: one family member will take care of bathing, another transportation, another calling to remind to take medications on time.
Discuss managing expectations of family members of a chronically ill patient.
It may take time and considerable nursing support for families to come to the understanding that the patients physical or mental status WILL decline over time. A realistic sense of what the future will hold should be presented, while still trying not to destroy hope.
What role does the nurse play in helping a client choose their providers?
The nurse may assist the patient by providing the names of specialists for the client to consider.
What is the role of a Chronic Care Coach?
They provide support, encouragement, reinforcement, assistance and feedback to a client with a chronic condition.
What recommendations can be given to a chronically ill client about staying abreast of their disease?
They should be encouraged to obtain as much information as they can and to maintain a file on their condition.
Can clients with chronic conditions simply be given their discharge instructions and then forgotten?
No, they will need periodic contact and reevaluation of their capacity, resources, and motivation to manage their condition.
Name four defense mechanisms:
Describe how a client uses Denial as a defense mechanism.
Making statements or taking actions that are not consistent with the realities of the illness such as abandoning a special diet, discontinuing medications independently, committing to responsibilities that cannont be fulfilled.
Describe how a client uses Anger as a defense mechanism.
Acting in a hostile manner or having violent outbursts.
Describe how a client uses Depression as a defense mechanism.
Making statements regarding the hopelessness of a situation, refusing to engage in selfcare actions, withdrawing, questioning the purpose of life.
Describe how a client uses Regression as a defense mechanism.
Becoming increasingly dependent unnecessarily, abandoning self-care behaviors.
According to Northouse, Why would we say people engage in this model 'as avoidance behavior'?
Patients' would use this model to avoid getting ill. If they feel that the benefits of preventative action are not surpassed by the barriers to those actions, they can avoid getting ill by taking the proposed recommendations.
According to Northouse what are the three individual perceptions of the Health Belief Model?
(1) an individual's perception of susceptibility to and severity of the disease
(2) an individual's perception of the benefits and barriers to taking a preventive health action to prevent disease
(3) the cues available to an individual that would stimulate him or her to engage in preventive health activity
According to Northouse how can the Health Belief Model be used in cases of non-compliance?
Patients' failure to comply has been found to be related to communication patterns in which the health professional is described as formal, rejecting, or controlling; the professional strongly disagrees with the patient; the professional interviews the patient at length without allowing for feedback, or engages in nonreciprocal interaction; and the health care worker fails to make clear the purpose of treatment. The provider should use an interactive approach, allowing for feedback and participation on the part of the client.
According to Strauss Why do people attempt to normalize symptoms, and give an example.
Patients' who do not wish to be seen as different tend to normalize their symptoms. This can be done by hiding the symptom all together (Like hiding an ostomy appliance with clothing, or putting a trembling Parkinson’s hand beneath a table. If the symptom cannot be hidden then various tools might be used to distract the attention such as encouraging visitors to continue their conversation when a person has an absence seizure, only offering her a glass of water at its completion.
When considering rehabilitative care, what balance must be focused upon?
The emphasis on saving lives must be balanced with an emphasis on on preserving the quality of the lives that have been saved.
What must focused upon when establishing the direction of rehabilitative needs? Diagnosis or Functional Needs?
Functional Status.
Define Disability.
Inability to perform an activity in a normal manner.
Define Fraility.
Three or more of the following:
-Unplanned Weight loss of => 10 lbs in past year
-Slow Walking Speed
-Low Grip Strenght
-Fatigue or Poor Endurance
-Low Levels of Activity
Define Impairment.
Phycological, physiologic, or anatomic loss or abnormality.
Define Handicap
Limitations in ability to fulfill a roll. Possible consequence of disability or impairment.
Why is early recognition of fraility important?
It can prevent or delay some of the fraility older adults face.
What is most important, the Severity of the Disability, or the attitude and coping ability of the client and their families?
The attitude is more important. A client with a minor cardiac issue might confine themselves to bed, while a hemiplegia patient might make great efforts with rehabilitation, social interactions, and even finding a job.
What are of the the psychologic factors that impact a clients reactions to a disability?
Previous attitudes, personal experiences, and lifestyle influence.
Describe some of the losses that accompany a disability.
Loss of Function, Role, Income, Status, independence, a body part.
If a client is making unrealistic plans, and not complying with their care plan, what might that indicate?
When acting or doing "for" a patient, what must the Nurse consider?
What could be done to enable the client to do this action independently.
How does attitude of the Nurse affect patient progress.
Demonstration of hope and optimism, along with a sense of humor on the part of the nurse will impact a client in a positive way, while a discouraged, or disinterested caregiver will adversely affect the clients attitudes.
What is an IADL?
Instrumental Activity of Daily Living. Function that enables the client to interact with their community.
What are some examples of IADL?
Prepare Meals, Shop, Use the Telephone, Safely use Medications, clean, travel in the community, maintain personal finaces.
In what ways does correct boy alignment help a client?
It facilitates optimal respiration, circulation, comfort, and prevents contracturs and pressure ulcers.
What is the focus of the assessment of ROM with an older client?
The degree to which ROM is sufficient to partcipate in ADLs.
If a mobility aid is available, should it always be used?
NO. Focus needs to be given to seeing that these aids are used correctly, or they might cause in increased saftey risk. Also, if a client is able to perform a task safely without the aid, it should not be used. A client who has a wheelchair for periods of joint swelling should be encouraged to ambulate when there is not an exacerbation of the joints.
Are canes used for weight bearing?
No, they are used to provide a wider base of support, and should not bear weight.
How are canes used?
They should be used on the unaffected side. A client with a weak right leg should hold the cane in the left hand, and advance it along with the challenged right limb.
How are walkers used?
They can be used for a broader range of support than canes, and can be sued for weight bearing.
What resource should the Nurse refer to with questions about mobility aids?
The Physical Therapist.
Discuss consistency in nursing interactions.
All staff, on all shifts need to adhere to the care plan for a client when it comes to things such as bowel and bladder training, and reality orientation of a client.
What are some positioning tips to take into account with regard to encouraging urination during bladder training.
-Have the client rock back and forth or prop feet on a stool to increase intra-abdominal pressure.
-Run water.
-Reinforce positive behavior, and discuss incontinent episodes in a non threatening way to deterime the reason for incontinence.
What is reminiscense? What is an important skill for a nurse to use with this technique?
A life review used to validate existence, resolve past conflicts, find meaning in remaining life. Listening is the key element for the RN to practice
How might a Nurse practice reality orientation with a client?
Use a total approach to keeping a client oriented. Rather than passing meds, an RN might say..."Hello Mr. Smith, My name is Scott and I am your nurse on this Sunny Day in January. I have your medication. It is very warm for January 10th here in Tacoma"
What is the focus of the wellness illness continium this quarter.
That as percieved by the client.
What is the focus of the Nursing Process with regard to Chronic Care.
Evaluation, the focus is on the outcome, rather than how we got there.
What is the focus of Pathology in Chronic Disease.
It needs to be patient focused, with emphasis on what the client knows about their disease, and how they can cope with the long term chronic effects.
What consitutes chronic illness?
-Typically condition lasting 3 months or longer.
-A condition that is irreversible
-A condition that is not curable
-Requires adjustment to the condition & adaptation to the physical & mental changes.
What are the three ways that disease pathology and treatment can progress?
-Increase in Function
-Maintain Function
-Decline in Function
In chronic illness, what is the first in the series of losses?
The first is the loss of the healthy state.
What is the main reason for non-compliance with interventions of a Chronic Illness?
Poor Adaptation. When a client relishes in the sick-role, this is considered mal-adaptive.
List seven goals in Chronic Care.
-Maintain Self Care
-Manage the Disease
-Promote Self Healing
-Prevent Complication
-Delay Decline
-Promote Qulity of Life
-Die with Dignity
What are some Nursing Interventions that should be implemented during care of a Chronic Illness?
-Create a Therapuetic environment using the nurses self
-Educate the client on thier disease
-Empower them to make decisions in their care
-Reinforce their learning
-Validate positive actions
-Remove barriers to wellness.
Can a client who is receiving tertiary preventions be healed?
No, they can not be cured.
Define Teriary Prevention
-Prevention of further disability and decreased function
-Minimize complications and the enhancement of a return to a higher level of function.
What is another term for Tertiary Prevention?
In a chronic illness how are physical vs emotional interventions defined?
The physical is focused on increasing function, or minimizing decreased function. Psychological focus is on a higher state of wellness, especially when we can not influence the physical.
What are the four interventions that we will focus on in dealing with chronic illness?
-Stop/Manage Disease prevention with a goal of remission.
-Provide Symptom Managment of therapies.
-Promote self care strategies
-Advocate for the individual atomomy.
What are the components in the Health Seeking Process?
-Symptom Defination
-Lay Consult
-Role Shift
-Treatment Action
-Treatment Adhearance
Defne Sx Defination.
The subjective data indicating a change
Define Lay Cons.ult.
Validate the symtoms with another.
Define the Role Shift.
Do others allow you to change your role?
Define the Treatment Action
The recommend treatment for a disease process
Define Adhearance.
The degree to which someone follows a treat course.
Differentiate between a Sign and a Symptom.
A Symptom is that which the patient feels or describes.
A Sign is that observed by others or the HCP.
What is Secondary Gain?
The new attention that a sick person receives that they did not have while healthy.
Is Normal a Constant?
No, as chronic illness creates decline in a persons health, they adapt to the changes, and the resulting function becomes the "New Normal".
How is Health defined by the TCC Nursing Program?
It is defined by the Illness-Wellness Continium.
Is Health Physical or Perceptual?
It is both, Hense the Mind Body Connection.
Describe Health According to Parsons.
-Adequatly carry out social roles
-Have an undistorted perception of reality
-Having an ability to adapt to and environment
-Being able to survive creatively
What two question must you ass to plot a place on the continium?
-Is there Pathology, this gives the Y Axis of Health and Disease.
-What is the Patients Perception of Health. This gives the X Axis between Wellness and Illness.
Define Health.
Being Free of Pathology.
Define Disease.
The Presence of Pathology.
Define Well-Health
Someone who is free of Pathology, and considers themselves Healthy.
Define Well-Disease.
Pathology is present, but the client believes themselves as well. Such as someone living a well rounded and managed life with chronic DM.
Define Ill-Health.
No Pathology is present, but the client percieves themselves as ill.
Define Ill-Disease.
There is Pathoology, and the client also percieves themselves as ill.
What are sick role behaviors.
-Self Defining Internal Signs and Symptoms
How do people initiate the Health Seeking Process?
The client experiences Symptoms which can be defined, and they are validated by either a HCP or a Lay Person.
Differentiate between the Cognative and the Affective Domines in the Health Seeking Process.
-The Cognitive is what the perons knows about their disease, and where they are coming from.
-The affective is acknowledging their understanding of how Western Medicine can facilitate a return to wellness.
What leads to a motivation to comply.
A percieved need.
Define Cues to Action.
The communication methods used by others to influence our decisions one way or another.
Give some examples of Cues to Action.
TV Ads
Bill Boards
Mass Media
Seat Belt Warning
What usually is the deciding factor when a client decides to follow a treatment regime?
It is based on the clients perception of the risks. The the benefits ourweigh the risks associated with a particular task.
What problems come with a client who fails to recognize symptoms?
They will not seek care. (Until someone else points the problem.)
Define Psychomotor.
Can the client "DO" the task? (Demonstration)
Define Cognitive.
Does the client "Understand" the concept.
Define Affective.
Can the client "Appreciate" the need.
Name the three types of Interventions.
Diagnostic (Assessment)
Therapeutic (Interventions)
Educational (Teaching)

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