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Exam #2 2381
Suicide.Bill of Rights.Reproduction&Pregnancy
| Question | Answer |
|---|---|
| What is the 3rd leading cause of death in 14-24 year olds, 65+, and white males? | suicide |
| What ethnic groups are more vulnerable? 2 | European-American and Native Americans |
| What is the most common method to carry out a suicide? | firearms |
| Suicide is LARGELY______! | Preventable |
| Who commonly ignores the S&S of a person with suicide? | Family and friends |
| Explain covert vs. overt in how a person gives clues about their suffering | either they are open (overt) with S&S or they are covered-up (covert) |
| How big of a percentage is it when an individual actually follows up their plan with a real suicide attempt? | only 1% |
| Does genetics have anything to do with depression/suicide? | Yes, it predisposes one to suicide |
| What physiologic concern could determine susceptibility to suicide? | brain structure |
| What neurotransmitter has to do with anxiety? | GABA |
| What does serotonin affect? | mood/affect |
| ** What is the BIGGEST fallacy of communication by the nurse with a patient who may be suicidal? | that asking someone if they're thinking of suicide gives the person that idea |
| Why is talking about suicide with the patient good? | b/c it leads to a decrease in isolation |
| What are some good questions to ask a patient about suicide? | "Do you ever feel like life isn't worth living?" or "Do you have a plan, and what is it?" |
| Give an example of a low risk, high risk, and vulnerable patient for suicide? | using a gun; pills/cutting wrists; depressed or experiencing hallucinations |
| Explain each letter in the SAD PERSONS scale assessment for suicide. | Sex, Age, Depression, Previous attempy, Ethanol use, Rational thinking loss, Social support lacks, Organized plan, No spouse, Sickness |
| What action should be done with a person who scores 7-10 on the SAD PERSONS scale? | hospitalize or commit |
| What action should be done with a person who scores a 3-4 on a SAD PERSON scale? | closely follow up; consider hospitalization |
| What places a person at a VERY HIGH risk for suicide? | history of attempts, intent/lethality/injury |
| History of a family member who committed suicide, hopelessness, helplessness, and lethality (low/high) are all risk factors for...? | suicide |
| ** What is the BIGGEST red flag to indicate the a person is going to commit suicide? | patient goes from being sad to suddenly feeling very happy |
| What are some other risk factors associated with suicide? | age, social support, medical diagnosis (terminal?), or psychiatric diagnosis |
| ** What is the HIGHEST priority nursing diagnosis when dealing with a patient? | Risk for suicide! |
| What two neurotransmitters are involved with mood/affect? | serotonin and norepinephrine |
| What disease is dopamine associated with? What types of things does it integrate? | schizophrenia; emotions/thoughts/pleasure |
| What are some things a nurse can do to control the "mileu" for a patient who is at a suicidal risk? 7 things | 1:1; maintain arm's length; document client's whereabouts, statements, mood/behavior every 15-30 min.; make sure no meal trays have glass or silverware; hands should always be in view; watch the patient swallow each med; always explain to the patient |
| What should the nurse do about the patient's room and belongings when the patient is at a suicidal risk? | make sure room is FREE from anything potentially dangerous, lock all doors/windows, watch at all times; go through all of clients belongings with the client and take away harmful objects/gifts |
| What is the suicide contract? | its a contract between a nurse and client where the client will not hurt themself in any way in a specific time period |
| What type of relationship needs to be present in order to develop a suicide contract? | a therapeutic one! |
| Should you rely on a suicide contract? | no |
| Give an example of a statement made by the patient in a suicidal contract | "I will not, for any reason, accidentally/purposefully harm myself in anyway by 10am tomorrow" |
| What should the nurse teach to the suicidal pt. about psychiatric diagnosis? | that depression will change |
| What should the nurse teach to the suicidal pt. about medications? | that they will help them feel better |
| What should the nurse teach to the suicidal pt. about age-related crisis? | Erickson's stages - where are they at? |
| What should the nurse teach to the suicidal pt. and their family/friends about community resources? | day programs, foster care, give them places for help, crisis hotline |
| What should the nurse teach to the suicidal pt. about communication skills? | how to express anger and ask for help |
| What are some suggestions that the nurse can make to the patient to create happiness and make them grounded? 3 things | physical recreational activities, family/friends, spiritual support system |
| Explain these psychological interventions: SSRI; lithium; antipsychotic second generation; antianxiety; ECT | they're aggressive antidepressants; bipolar; risperdahl; benzos; good for depressed clients |
| How should the nurse intervene for survivors of family/friends that have committed suicide? | Do a follow up! Give them resources. Intervene within 24 hours and continue until 1st anniversary of death |
| How should the nurse continually monitor the anniversary of a suicidal patient? | monitor family/friends and even the person who may have attempted it and is still living! |
| Explain "information disclosure" in the Consumer bill of rights | The patient has the right to receive "easy" information about any aspect of their healthcare so they can make informed decisions |
| Explain "choice of providers and plans" in the pts bill of rights | Pt. has the right to choose their provider |
| Explain "access to emergency services" in the pts bill of rights | The pt. has the right to participate in decisions about their care and to know ALL TREATMENT OPTIONS. designated individuals by the patient also have the right to make decisions |
| Explain "respect and nondiscrimination" in the pts bill of rights | pt. has the right to equal and respective care by all health care members |
| Explain "confidentiality of health information" in the pts. bill of rights | The pt. has the right to talk in confidence to health care members and to have their information protected (HIPAA). pt. also has the right to copy their health chart and to amend it if it has false information |
| Explain "complaints and appeals" information in the pts bill of rights | The pt has the right to express their complaints and to have a fair review of it towards any of the health care team |
| What do you have to do in order to share pt.'s information? | Need written consent of patient or legal guardian |
| Can the confidentiality consent be withdrawn at any time? | yes! only by the patient or legal guardian |
| Confidentiality may be violated if there is a "direct threat" - explain | if the patient has threatened to kill/harm someone - report to physician |
| Confidentiality may be violated if there is "actual of suspected abuse" - explain | If there is a child <18 yrs. or a vulnerable adult UNDER your care, you have the responsibility to inform |
| What would a nurse do if she/he suspected neglect of a minor child? | inform to the child protection agency |
| Confidentiality may be violated if you have a situation with "commitment documents" - explain | only the judge could put a court order to "unseal" the papers - very hard to do! |
| Confidentiality may be violated if there is a "subpoena" situation - explain | where the court orders for information to be in a testimony |
| What do you need to obtain each time before you use restraints or seclusion? | a written MD's order |
| What is a standard time limit for physical restraints and seclusion? | 2-4 hrs; then you need a new order |
| What do you need to document when they are in restraints/seclusion and how often? | their attitude, time, behavior leading to restraint, assessments, and when the client is released from; document every 15-30 min. |
| How can a nurse use least restrictive restraints for the shortest duration? | interventions: 1:1, medications, documentation, talk with the pt, relaxation techniques |
| When a 72 hr. hold is done, who must examine the pt.? | a psychiatrist |
| How soon must the psychiatrist complete the exam when a pt. is on a 72 hr. hold? | within 24 hours |
| What type of days does the 72 hr. hold not include? | weekends and holidays |
| Who can put a 72 hr. hold on someone? | anybody |
| What three things must the patient have in order for them to be put on a 72 hr unvoluntary hold? | must need psychiatric treatment, is a danger to themselves or others, and they are unable to meet their basic needs |
| Describe the rold of a certified registered nurse | a nurse who is specialized or an expert |
| Which two types of nurses can be considered as primary caregivers? | nurse practitioner and certified nurse midwife |
| Define gestation | weeks since LNMP (last normal menstrual period) |
| Define gravida | the number of pregnancies regardless of the outcome including current one |
| Define para | number of pregnancies regardless of outcome that are longer than 20 wks |
| TPAL makes up para, what do the letters stand for? | terms, pre-mature babies, abortions, and living |
| Define antepartum | period between conception and labor |
| Define intrapartum | labor |
| Define postpartum | between birth and involution (the uterus returning to the normal size) |
| Which ethnic group has a 2.4x higher risk for infant mortality? | non-hispanic black women |
| What type of assessment data would you gather on the past pregnancies of the mom? 4 | how many, outcome, types of birth, and prenatal hx |
| Define ectopic pregnancy | its where the baby is not grounded in the uterus and cannot survive to term |
| What are 5 things you need to find out right away about the current pregnancy? | LNMP, attitude about pregnancy, bleeding or pain (ectopic), conception date, and pregnancy test |
| What are some things you would like to know about the mom's GYN hx? 6 things | pelvic/cervical surgery, last physical exam with pap, contraceptives, STDs/PID, infertility problems, menstrual cycle problems |
| What are some current health issues that you would want to ask the mom about? 7 things | SES (socioeconomic status), age, weight, family hx, blood type and Rh, chronic diseases and medications, substance abuse |
| What are three initial prenatal assessments that are completed? | pelvic exam, VS, and weight |
| What kind of labs would you expect to be done on a prenatal assessment? 5 | UA, STDs, Rh and blood type, HGB, and rubella |
| Why does a rubella tests need to be completed during pregnancy | b/c rubella virus can cause fatal affects on the baby! if mom is not immune, she needs to be vaccinated AFTER pregnancy |
| How often do prenatal visits need to be scheduled? from 1-28 wks, 28-36 wks, and 36 wks +? | every 4 weeks; every 2 wks; every week after 36 wks. |
| How do you measure fetal height in pregnancy? How accurate is it? | by measuring the big mom's big belly; not very accurate, but fetal height normally coincides with gestational age |
| ***Why should moms always pay attention to fetal movement? | because a decrease in fetal movement is the FIRST SIGN OF HYPOXIA in a baby!!! |
| What is a FHT prenatal assessment? | fetal heart tones |
| How do you measure fetal height in pregnancy? How accurate is it? | by measuring the big mom's big belly; not very accurate, but fetal height normally coincides with gestational age |
| When should an alpha-feto-protein test be done? What is it? What does it mean if the results are low or high? And how it is done? Is this test reliable? | 14 wks; its testing of the predominant protein in fetal plasma; if low = chromosomal abnormalities, if high = associated with open neural tube defects (NTD); its done by ultrasound or amnoicentesis; not really recommended |
| When is glucose screening done, and why? | its done at 28 wks and checks the mom for chances of gestational diabetes |
| What should a nurse teach the mom in a prenatal assessment about changes, signs, and self-care measures? | teach the mom healthy vs. abnormal! be sure to tell mom that discomfort is normal, but never minimize her complaints! teach some comforting measures |
| What should the nurse teach a prenatal mom about avoiding heart burn? | it's somewhat normal b/c of decrease in gastric motility and relaxed cardiac sphincter; take low sodium antacids, sit upright pc, and stay away from foods that cause that |
| What should a nurse teach a prenatal mom about changes in genitourinary status? | yeast infections are common b/c of increase in glucose (do not self-treat); urgency/frequency will gradually increase b/c of blood volume and decrease space for bladder; burning/itching = not normal! |
| What should the nurse teach a prenatal mom about changes in GI status? | avoid constipation (sm, frequent meals), drink fluids between meals, no fatty foods, and sit upright after meals. nausea & vomiting are normal but abnormal if consistent and losing weight |
| What should the nurse teach a prenatal mom about avoiding heart burn? | it's somewhat normal b/c of decrease in gastric motility and relaxed cardiac sphincter; take low sodium antacids, sit upright pc, and stay away from foods that cause that |
| **Why are there cardiac changes in pregnancy? What should you teach the prenatal mom about them? | decrease in venous return, pressure on vena cava, and increase in blood volume; don't stand too long, best position is laying on side (not back - supine hypotension), elevate legs, use supporting nylons |
| What should the prenatal mom do when starting OTC meds or herbs? | always check with provider!! |
| Is it ok to exercise during pregnancy? | yes - but don't start vigorous exercising when pregnant and prevent HYPERTHERMIA! |
| Teen pregnancy: which age groups is more likely to be egocentric and only aware to present time? which age group starts thinking abstractly and aware of consequences? which group is capable and can be active participant in health care? | age 11-15; ages 15-18; ages 17/18-20 |
| What does the Emancipated law state? | that an emancipated minor can make their own health care choiced for themselves without their parent's involvement |
| **What is the #1 key in working with a teenage pregnancy? | trusting relationship! |
| How should the nurse communicate with a pregnant teen? | focus on the things that they need RIGHT; make it a welcoming/nonjudgmental environment; focus on their needs and problems; promote self-esteem |
| What is a good way for a nurse to try and help a pregnant mom to stop smoking? | by telling them WHY is it bad for the baby (low birth weight; carbon monoxide poisoning)! let them know about 2nd hand smoking too if they start is back up after pregnancy |
| Is any decrease in smoking good? | yes! |
| How should a nurse intervene on a pregnant women (or thinking about becoming pregnant) about alcohol? | let them know the affects on the baby (FAS - mental retardation, birth defects)! also include women who are thinking about becoming pregnant because risk is greatest during 28-52 weeks! |
| What should a nurse do in the 1st trimester about bleeding? What should the nurse do first? | the cervix is highly vascular, so any irritation can cause bleeding (sex, stools); however, always assess the mom to make sure she's stable 1ST!!! If spontaneous aborption, be sensitive to loss |
| What are some risk factors for an ectopic pregnancy? 5 | pelvic/tubal surgery; PID (pelvic inflammatory disease); previous one; IUD (birth control - intrauterine device); and endometriosis |
| What is the only definitive way to find an ectopic pregnancy? What manifestations will you see (3)? | surgery; pain, dizziness, and bleeding |
| In placental problems what are the major differences in the S&S between previa and abruption? | previa has a soft abdomen, no pain, and diagnosed as "low lying" in early pregnancy; whereas abruption has pain, rigidity,uterine irritability, can happen abruptly |
| What are the similarities in previa and abruption with placental problems? | both bleed, and have varibale affects on VS |
| In mild preeclampsia, what kinds of differences would you see in these vitals: BP, proteinuria, serums creatinine, platelets and liver enzymes; symptoms? | BP increase (different with everyone), 2+ proteinuria, increase in serum creatinine, no change in platelets and liver, and usually no symptoms |
| What kinds of changes would indicate severe preeclampsia in these vitals: BP, proteinuria, serum creatinine, platelets and liver enzymes, symptoms | BP INCREASING, serum creatinine INCREASING, platelets and liver enzymes DECREASING, and symptoms |
| What would you tell a women with risk factors for preeclampsia to report? What is the first sign of it? | headaches, visual disturbances, epigastric pain in RUQ (liver edema); hypertension |
| What is preeclampsia? | a generalized vasospasm that decreases circulation to all organs. |
| When treating preeclampsia, how many pts does the nurse have? | 2 |
| What is the definitive treatment of preeclampsia? | birth! |
| What two types of meds are they normally on, and what should their activity be when diagnosed with preeclampsia? | on antihypertensive meds and anticonvulsants; reduced activity/bedrest |
| What is the goal in treatment of preeclampsia? | is to prevent eclampsia or serious complications which maintaining pregnancy |
| What is HUGE in preeclampsia? There are 6 of them | assessments! establish how long hypertension has been, document mom's symptoms, assess baby for distress, monitor lab values, maintain a restful environment, and education! |
| What are some risk factors for placental abruption? 7 | cocaine, smoking, short cord, multiple births, previous abruptions, abdominal trauma, and hypertension |
| Why do you want to maintain a nonstressful environment for a mom with preeclampsia? | b/c a stressful environment could increase her risk of having seizures by excessive visual or auditory stimulus |
| Why would a nurse give antihypertensive meds to a preeclampsia pt.? | to lower the risk of the mom having a stroke or CHF; increases blood flow to baby |
| Why would a nurse give an anticonvulsant med to a pt. with preeclampsia? Signs of siezures? | to prevent and control seizures; RUQ epigastric pain and vomiting |
| How would you explain to the pregnant mom why she is getting Rhogam at 28 wks? | b/c if the mom is Rh-, and the baby may be Rh+, then the mom could develop antibodies that would destroy the RBCs in the baby and further prevent Rh+ poregnancies |
| How would you explain to the pregnant mom why she is NOT getting Rhogam after birth? | If she had a baby who was Rh-, no antibodies will develop for the next pregnancy |
| Which ultrasound is the most common? | transabdominal |
| What is the purpose of an ultrasound? | to rule our ectopic pregnancies and to estimate gestational age |
| Why would a pregnant mom undergo a chrionic villi sampling? How is it done? When? | To analyze chromosomes for anomalies; use an intravaginal ultrasound; done at 10-13 wks. |
| Why is amniocentesis done? When? How? | its done to analyze amniotic fluid for chromosomal anomalies; done at 15-20 wks; you obtain a sample of the fluid |
| Why might chromosomal testing might not be done in pregnant women? | if they are over the age of 35, marked family hx, risks increase! |
| What is the purpose of a non stress test for the baby? | to see the heart rate and match it with baby's activity |
| How is non stress test done? | mom had button and presses it when she feels the baby move |
| What does a "reactive" outcome mean during a non stress test? | it means that the baby is healthy b/c its heart rate increased as the baby's activity increased; at least 2 episodes of increased rate by >15 bpm and lasting at least 15 sec. |
| Which assesses fetal risk better, non stress test or the contraction stress test? | non stress test |
| Is nonstress test necessary? Why or why not? | if breathing, body movements, muscle tone, and amniotic fluid volume is ok - no need for it |
| Contraction stress test is AKA? | oxytocin stress test |
| How is the contraction stress test performed? | oxytocin stimulates uterine contractions and they monitor the baby's heart rate to see how the baby responses to it |
| When is the contraction stress test done? | 27-28 wks |
| What is the purpose of the contraction stress test? | identify the baby who is at risk for uterine asphyxia (no O2) and to evaluate the respiratory response |
| Define a negative result for the contraction stress test | no decelerations in FHR |
| Define a positive result for the contraction stress test | FHR decelerations |
Created by:
MeganThomp
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