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NUSA 401: EXAM 1
| Question | Answer |
|---|---|
| Cultural Competency | who are you meeting, where do they come from, what is their heritage, cultural background, language patient understands, speaks and reads in; health and illness beliefs and practices |
| elder cultural beliefs | very steadfast and true to their beliefs; may not have assimilated |
| health | balance of a person is a complex, interrelated phenomenon; within one's being-physical, mental, spiritual; outside world-natural, communal, metaphysical; everything that makes up a person, makes up their health |
| illness | loss of a person's balance; within one's being- physical, mental, spiritual; in outside world- natural, communal, metaphysical |
| demographic profile of the US | upwards of 300 million; 1 out of 3 people are in a group other than single-race, non-hispanic white; minority or emerging majority populations total 98 million people |
| hispanics | largest and fastest growing group in the US |
| blacks | second largest population in US |
| asians, american indians, Alaska natives, native hawaiians and other pacific isanders | make up the third largest part of the population in the US |
| emerging majority groups tend to be | younger, lower median ages, higher populations under 18 yo |
| dominant, non-hispanic, single-race, white population is | older median age; smaller proportion under 18 yo |
| young old | 65-74 yo |
| middle old | 74-85 yo |
| old old | 86-100 yo |
| elite old | above 100 yo |
| in US one birth every | 8 sec |
| in US one death every | 13 sec |
| in US one international migrant(net) every | 30 sec |
| net gain of one person every | 11 sec |
| categories of interest to health care providers: immigration | legal permanent residents; naturalized citizens; undocumented aliens; refugees, aslyees, parolees; legal nonimmigrant residents; |
| immigrants | minimal working knowledge of our health care system; mostly go to the ER, don't have a doctor or insurance and cant speak the language; care given is about their perceieved needs |
| many new immigrants have only minimal understanding of | modern health care delivery system; modern medical and nursing practices and interventions; english language |
| immigrants perceived needs and the nurse's care | people with limited ability to speak, read, write, and understand English encounter countless barriers that limit access to critical public health, hospital and other medical and social services to which they are legally entitled. |
| title VI of civil rights act of 1964 | services cannot be denied to people of limited english proficiency; some states(including CA) require providers to offer language assistance in health care settings |
| culturally sensitive | possessing basic knowledge of and constructive attitudes toward diverse cultural populations |
| culturally appropriate | applying underlying background knowledge necessary to provide the best possible health care |
| culture | thoughts, communications, actions, beliefs, values and institutions of racial, ethnic, religious, or social groups; how have your ideals changed, how you will adapt; how you grew up will affect how you care for others |
| ethnicity | racial background, common geographical region, food pref, etc. |
| religion | who to bring in to give comfort, how to approach issues |
| indicators of heritage consistency | connection with your heritage, pride in your heritage, anything in common with your heritage |
| health- related behaviors affected by religion | meditation; exercising; vaccinations; what kind of physical exam their allowed, genetic screening, birth control |
| transcultural expression of pain | pain is universal; but it is expressed or perceived differently; highly personal; very cultural |
| culture bound syndromes | condition that is culturally defined; some have no equivalent in a biomed, scientific perspective; anorexia and bulimia are examples |
| steps to cultural competence | understand one's own heritage-based values, beliefs, attitudes and practices; know what health means to you and the patient; understand how the health care system works(fluctuating) |
| R- RESPECT | REALIZE you must know heritage of yourself and patient |
| E-RESPECT | EXAMINE patient within cultural context |
| S-RESPECT | SELECT simple questions and speak slowly |
| P-RESPECT | PACE questioning throughout exam |
| E(second)-RESPECT | ENCOURAGE patient to discuss meaning of health and illness with you |
| C-RESPECT | CHECK patients understanding and acceptance of recommendations |
| T-RESPECT | TOUCH patient within boundaries of his or her heritage |
| Goals- Why do we need to interview the patient? | record complete health history; optimal health for patient; collect data, subjective and objective |
| subjective data | what the patient is saying; put in quotes |
| objective data | what your observing; vital signs; what you see; things that are measurable |
| Sending | communication is behavior, conscious and unconscious, verbal and nonverbal; body language |
| Receiving | awareness of messages you send is only part of process; health problems intensify communication because patients depend on you to get better; |
| communication | can be learned and polished when you are a beginning practitioner; is a tool as basic to quality health care as tools of inspection or palpation |
| maximized communicating skill | awareness of internal and external factors and their influence |
| internal factors of communication | liking others; empathy; ability to listen |
| external factors of communication | ensure privacy' refuse interruptions; physical environment; dress; note taking may be unavoidable; tape and video recording |
| challenges of note-taking | breaks eye contact too often; shifts attention away from person, diminishing sense of importance; interrupts patients narrative flow; impedes observation of patients nonverbal behavior; may be threatening to patients discussion of sensitive issues |
| working phase | data-gathering phase; verbal skills include questions to patient and your responses |
| two types of questions | open-ended; closed; each has a different place and function in interview |
| responses | assisting the narrative; facilitation encourages patients to say more an shows you are interested and will listen further |
| silent attentiveness | gives patient time to think and organize what to say without interruption from you; gives you a chance to observe person unobtrusively and note nonverbal cues |
| reflection | echoes patients words, repeating what person has just said; focuses further attention on a specific phrase; and helps person continue in his or her own way |
| empathy | recognizes a feeling and puts it into words; names the feeling and allows expression of it |
| clarification | use when persons words are ambiguous or confusing |
| confrontation | frame of reference shifts from patient's perspective to yours; dont project feelings and beliefs onto the patient |
| interpretation | based on your inference or conclusion; it links events, makes associations, implies cause, ascribes feelings; often older patients dont want to be a bother |
| ten traps of interviewing | providing false assurance or reassurance; giving unwanted advice; using authority; using avoidance language; engaging in distancing; using professional jargon; using leading or biased questions; talking too much or interrupting; using "why" questions |
| cross-cultural care | probability of miscommunication increases with two people from different cultural backgrounds |
| cross-cultural communication | cultural perspectives on professional interactions; etiquette; space and distance; gender; sexual orientation |
| intimate zone(0- 1 1/2 ft) | visual distortion occurs; best for assessing breath and other body odors |
| personal distance (1 1/2 to 4 ft) | perceived as an extension of the self similar to a bubble; voice is moderate; body odors inapparent; no visual distortion; much of the physical assessment occurs at this distance |
| social distance ( 4 to 12 ft) | used for impersonal business transactions; perceptual information much less detailed; much of the interview occurs at this distance |
| public distance ( 12ft+) | interaction with others impersonal; speaker's voice must be projected; subtle facial expressions imperceptible |
| overcoming communication barriers | working with and without interpreters; nonverbal cross-cultural communication; touch |
| five types of nonverbal behaviors convey info about a person | vocal cues; action cues; object cues; personal space; touch |
| the health history: adult | biographical data; source of history; reason for seeking care; present health or history of present illness; past health; family history; review of systems; functional assessment including ADLS |
| biographical data | name; address and phone number; age and birth date; birthplace; sex; marital status; race; ethnic origin; occupation; primary language and authorized representative |
| source of history | who furnishes info; how reliable is this person; how willing is he/she cooperate; special circumstances(interpreter) |
| reason for seeking care | why; what are symptoms; subjective; objective data |
| present health or history of present illness | location; character or quality; quantity or severity; timing; setting; aggravating or relieving factors; associated factors; patients perception |
| PQRSTU | Provactive/palliative; Quality/Quantity; Region/Radiation; Severity scale(1 to 10); Timing or onset; Understand patient's perception of problem |
| past health | childhood illnesses; accidents or injuries; serious or chronic illnesses; hospitalizations; operations; OB history; immunizations; last exam date; allergies; current meds; co-morbidities |
| co-morbidity | one or more chronic illnesses |
| family history | age and health or cause of death of relatives; health of close family members; any diseases that may be important to health of patient; genogram |
| cross cultural care health history | assess if certain procedures cannot be done; immunizations; taboo foods or food combos; spiritual resources and religion; health perception; nutrition |
| functional assessment, including ADLs | self-esteem; self-concept; activity and exercise; sleep and rest; nutrition and elimination; interpersonal relationships and resources; spiritual resources; coping and stress management; alcohol intake |
| what is perception of health | concerns; goals; expectations of you and us |
| older adult: past health | general health in past five years; accidents or injuries, serious or chronic illnesses, hospitalizations, operations; last exam |
| older adult: family history | not always accurate or relevant; who is going to help them when they go home |
| older adult: functional assessment including ADLs | interpersonal relationships, sexual relationships |
| health assessment and physical exam | helps with the care of the patient; how well you assess effects how well you can care for your patient; assess pain and how they feel first so they arent uncomfortable during assessment |
| purposes of physical exam | triage for emergency care; routine screening to promote health and wellness; to determine eligibility for health insurance, military service, a new job; to admit a patient to a hospital or long term care facility |
| use physical exam to | gather baseline data about patient's health; support or refute subjective data obtained in the nursing history; ID and confirm nursing diagnosis; make clinical decisions about a patient's changing health status and mangement; evaluate the outcomes of care |
| cultural sensitivity | culture influences a patients behavior; consider health beliefs, use of alternative therapies, nutritional habits, relationships with family and personal comfort zone; avoid stereotyping; avoid gender bias |
| prep for exam | infection control; environment; equipment; physical prep of patient(positioning; psych prep; assessment of age groups; always have steth, pen lgiht, pen, scissors, gloves; keep mind of allergies |
| organization of the exam | assessment of each body system; follows the nursing history; systematic and organized; head-to-toe approach; looking for symmetry; bedside; focused |
| inspection | looking around at everything; enviro; patient; position and expose body parts as needed so all surfaces can be viewed but privacy can be maintainted |
| palpation | feeling; pulses; poking around skin; temp of skin; diaphoresis; edema; ecchymosis |
| percussion | tapping the persons skin with short, sharp strokes to assess underlying structures; wont do a whole lot of unless an advanced practitioner; abnormla size suggests mass or air or fluid within an organ/cavity |
| ausculatation | listening; requires a good stethoscope, concentration and practice |
| diaphoresis | sweating |
| edema | swelling |
| ecchymosis | bruise |
| by looking at your patient, you will be able to assess | gender, race, age, signs of distress, body type, posture, gait, body movements, hygiene, grooming, dress, body odor, affect and mood, speech, signs of patient abuse and signs of substance abuse |
| general survey | assess appearance and behavior; assess vital signs; assess height and weight |
| skin | integument; color; moisture; temperature; texture; tugor; helps assess oxygen levels; vascularity, edema and lesions |
| turgor | don't assess top of hand; test forearm; chest around sternum; back of neck; if it stays up= tenting--> dehydration |
| bony prominences | make sure no pressure ulcers are forming in older patients or see skin breakdown |
| erythema | redness; older patients more at risk due to less adipose tissue present |
| color of skin | pigmentation; cyanosis; jaundice; erythema |
| vascularity | capillaries more fragile; petichiae |
| petichiae | normal change in aging; non blanching, very small |
| ABCD skin trama/abnormalness | asymmetry, border irregularity, color, diameter |
| hair and scalp | color, distribution, quantity, thickness, texture, lubrication; |
| hair loss | often due to genetics or is age related(less in men) |
| nails condition reflects | general health; state of nutrition; occupation; level of self care; age |
| nail beds | circulation; capillary refill; color should come back in 3 sec if normal |
| eyes | visual acuity; extraocular movements; visual fields |
| history for eyes | any diseases; glasses; ring around eye= aging |
| pstosis | drooping of the eye |
| pinpoint eyes | due to medications like morphine; wont be able to see any changes; be aware of meds, if not on meds could be a neuro problem |
| PERRLA | Pupils Equal Round React to Light Accommodation |
| External eye structure | position and alignment; eyebrows; eyelids; lacrimal apparatus; conjunctivae and sclerae; corneas; pupils and irises |
| auricles(ears) | texture; tenderness; lesions; color; pain; cerumen |
| older adults and ears | ears and nose dont stop growing; hearing changes(cant hear high tone); hearing aids--> be aware |
| redness of ears | sign of inflammation or fever |
| Weber's test | vibrating fork on midline vertex of head; have patient report if they hear the sound in both ears or if its better in one ear; normal= can hear it in both equally |
| Rinne test | vibrating fork at mastoid process and then later 1 to 2 in from ear canal; patient reports when they no longer hear it; time; checks for bone conduction and hearing loss |
| nose and sinuses | excoriation and polyps; breathing; drainage |
| mouth and pharynx: lips | color, texture, hydration, contour, lesions; anemia; cyanosis; cherry colored(CO poisoning) |
| mouth and pharynx | buccal mucosa; gums; teeth |
| tongue | can be indicator of medication or infection |
| swollen lymph nodes at back of their ears | flu, cold, or strep |
| older adults lungs and muscles | not as much elasticity; more rigid breathing |
| exam of thorax and lungs | watch them as sleeping; rising and falling easily or not, breathing rapidly or slowly; listen after listening to heart |
| tactile fremitus | created by vocal cords; transmitted through lungs to chest wall; palpation |
| need to look at subjective and objective | patients may not realize something is abnormal because it has been going on for so long; its become their normal |
| anterior thorax | observe accessory muscles; palpate muscles and skeleton; assess tactile fremitus; compare right and left sides; auscultate for bronchial sounds |
| auscultation of heart | detects normal heart sounds; extra heart sounds and mumurs |
| dysrhythmia | failure of the heart to beat at regular successive intervals; some are life threatening |
| blood pressure | readings tend to be higher in right arm; always record highest reading |
| carotid arteries | reflect heart function better than peripheral arteries; commonly auscultated |
| carotid bruit | narrowed blood vessel creates turbulence, causes blowing/swishing sound |
| jugular veins | most accessible; right internal follows more direct path to right atrium; note distention; assess pressure |
| peripheral arteries and veins | blood flow; condition of skin and nails; integrity of venous system; pulses/sufficiency of arterial circ |
| lymphatic system | upper and lower extremities; assess drainage; palpate |
| abdomen/ bowel sounds | start at ascending; listen to for up to a minute; cant feed a patient after surgery until you hear bowel sounds; important to know bowel pattern |
| borborygymi | gurgling; hyper bowel sounds; growling sounds when hungry |
| musculoskeletal system general inspection | gait; postural abnormalities; age-related changes; level of activity before hospital; how well do they walk; do they have/need assisted device |
| older person muscle changes | reduced height as they age |
| atrophy | waste away of an organ/muscle; typically due to degeneration of cells |
| neurological system | responsible for many functions; full assessment requires time and attention to detail; many variables must be considered during evaluation: level of consciousness, physical status, chief complain |
| aphasia | cant verbalize but understand |
| intellectual function | memory, knowledge, abstract thinking, association, judgement |
| motor function | coordination; higher extremity/fine-motor control; lower extremity; balance; gross-motor function |
| at the end of the exam | record findings; give patient time to dress, assist if needed; if findings are serious, consult health care provider before informing the patient; delegate cleaning of exam area; record complete assessment; review for accuracy and thoroughness;communicate |
| baseline assessment findings reflect | a patients functional abilities and serve as the basis for comparison with subsequent assessment findings |
| integrate patient teaching throughout exam to... | help patients learn about health promotion, disease prevetntion and skills to help with any current health issue |
| normal resting heart rate | 50 to 90 bpm |
| aging adult temperature | less likely for fever, more likely for hypothermia; less reliable of persons health state; sweat gland activity diminished |
| aging adult pulse | rhythm might be slightly irregular; radial may feel stiff, rigid, tortuous, not necessarily vascular disease; easier to palpate |
| aging adult respirations | decrease in vital capacity; decreased inspiratory reserve volume; shallower inspiratory phase and increase respiratory rate |
| aging adult blood pressure | aorta and arteries tend to harden; often bp increases; difficult to distinguish between hypertension and normal aging |
| pain and the aging adult | not a normal process of aging; although many older adults report pain; |
| poorly controlled pain in aging adult | sudden onset of acute confusion |
| dementia and pain | pain signals could be misinterpreted with alzheimers/dementia; less able to ID and describe pain over time even though it is still present and destructive; often communicate pain through behavior--> agitation, pacing, yelling |
| optimal nutrition status | achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy or illness |
| undernutrition | occurs when nutritional reserves are depleated and/or when nutrient intake is inadequate to meet day-to-day needs to added metabolic demainds |
| people having optimal nutrition status | more active; have fewer physical illnesses, and live longer than persons who are malnourished |
| people who are undernutritioned are at risk | for impaired growth and development; lowered resistance to infection and disease, delayed wound healing, longer hospital stays and higher health care costs |
| overnutrition | caused by the consumption of nutrients in excess of body needs |
| overnutrition leads to | obesity, heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, osteoarthritis |
| nutrition and the aging adult | at risk for undernutrition or overnutrition(poor nutrition); poor physical or mental health, social isolation, alcoholism, limited functional ability, poverty, and polypharmacy |
| normal physiologic changes in aging adults that directly affect nutritional status include | poor dentition, decreased visual acuity, decreased saliva production, slowed gastrointestinal motility, decreased gastrointestinal absorption and diminished olfactory and taste sensitivity |
| aging adult and skin | slow atrophy; loses elasticity; folds and sags; parchment thin, lax, dry and wrinkled; loss of collagen; sweat glands and sebaceous glands decrease in number= dry |
| loss of collagen in skin | increases the risk for shearing, tearing injuries |
| aging adult increased risk of heat stroke because of | decreased response of the sweat glands to thermoreg. demand |
| senile purpura | minor trauma that may produce dark red discolored areas due to diminished vascularity of the skin |
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