NURS 272 - Funds Quiz #1

List some of the different team roles in the health care profession

nurses, physicians, nurse practitioners, physician assistant, licensed vocational nurses, unlicensed assistive person, social workers, pharmacists, occupational therapist, physical therapist, speech pathologist, nutritionist, dietitian, respiratory therapist

nurses

formulate care plan, organizing patients schedule, and utilizing the nursing process.
follow healthcare provider orders however assess and analyze orders to ensure they are appropriate for the patient.

physicians

real leader of the team.
responsible for the medical diagnosis and treatment plan, with orders to give to nurses.
hold a medical degree (MD or DO)

doctorate of osteopathy

also physicians but has a more wholistic approach.

nurse practitioner

mid level provider. interact with patients and nurses similar to physicians, and are considered health provider. has full prescriptive authority, but CA recommends collaborating with physicians

came to fill increasing demand of primary care providers when majority of physicians went into specialties, with little preventing illness. NP went from general medicine to now specialties as well. some masters program, but mainly now doctorate level

physician assistant

Mid-level provider, works alongside physician. that physician then reviews the assistants work and double checks their work
came after the war, where veterans had training and experience but no education. now masters prepared with restrictions

licensed vocational nurse (LVN or LPN)

not registered but licensed.
do not have full training that a nurse has as they are more skills based than critical thinking
can insert catheters, NG tubs, IV, and etc., can execute care plans but cannot develop it, nor do initial assessments on the patient
can go into program after highschool

unlicensed assistive personnel (CNA)

are unable to do invasive procedures, assess patients, teach (but can reinforce)
1st semester skills ( bed baths, vitals, and etc)

social workers

case managers
look at overall picture, looking at discharge, looking into setting up appoints, PT, home health visits, insurance, bills
depending on overall need, has a masters

pharmacist

doctoral degrees in pharmacology
know everything about drugs (interactions, routes, etc.)
often catches physicians errors in treatment plans.

occupational therapist

works on mobility (right sided weakness -\> how to use that arm to do everyday things)

physical therapist

works on strengthening (right sided weakness -\> works on strengthening arm)

speech pathologist

help with improving speech impediments, delayed speech, difficulty speaking
do swallow assessments (dysphagia, aspiration risk) looking into ways their food can be altered to ensure they dont choke (honey-thick foods)

nutritionist

anybody can say they are a nutritionist. no regulation on title
are certifications they can get, but not required for title
can help with dietary restrictions, to look into nutrition requirements, and looking into developing a plan that takes into account food preferences and culture.

dietitians

registered and has a degree in dietary science
can help with dietary restrictions, to look into nutrition requirements, and looking into developing a plan that takes into account food preferences and culture.

respiratory therapist

technician trained in breathing treatments
deals with ventilators, masks, oxygenation therapy
(nurses can assist)

5 rights of delegation

right task, right circumstance, right person, right directions & communication, and right supervision & evaluation

right task

is this task within the scope of the person I am asking

right circumstance

while the task may be appropriate, is the situation right for the task, and is this situation better to be handed off to someone else or to do by yourself
(ex. BP machine vs. manual BP --\> better to do yourself)

Right person

has this person been trained on this task? some UAP or LVN are not trained the same and have different skill sets

right directions and communication

being sure to communicate clearly directions for your team, with tasks you want them to execute and when

right supervision and evaluation

after assigning tasks, making sure the tasks were done and evaluating the work

minorities vs people of color

"minorities" - falling out of favor, implies only two groups

people of color - preferable as it indicates more variety, be specific when possible

Black vs African American

term preference dependent of the person

black indigenous person of color vs person of color

Bipoc used to highlight the difficulties black people went through before historically

Hispanic vs Latino, Latina, Latinx (non-gendered)

depends on person.
Hispanic vs Latino, Spanish speaking vs Latin America (ex. Portuguese)

Native American vs American Indian

east vs west
depends on preference

color blind

person who chooses not to see color, however is not preferable as they are negating differences and ignoring culture

pronouns

ask up front how they would like to be addressed

Racism in the U.S

Incidences of slavery, Indian slaughter, Indian removal, Chinese Immigration exclusion, Emancipation Proclamation, Black codes, Kim Crow laws, 1942 executive order 9066m voter suppression, and housing discrimination

Black codes

unable to vote and other rights like employment are limited

1942 executive order 9066

Japanese camps, after being considered the enemy after war

voter supression

For black individuals, random laws or acts aimed to exempt their voting rights

housing discrimination

redlining, housing act, Banks drawing the line where to give loans and where not to. government then allocating less funding to impoverished areas compared to wealthier areas

Systemic (institutional) racism

less perceptible because of its less overt, and subtle nature"

originates in the operation of established and respected forces in society and receives less condemnation than individual racism

epigenetics

the study of environmental influences on gene expression that occur without a DNA change

poverty rates

higher poverty rates in African American, Hispanic communities compared to Asian and white communities

incarceration rate

more African Americans incarcerated than whites, Hispanic, and other

college enrollment rate

higher in Asian communities followed by white, black and then Hispanic

education attainment

Higher in Asian communities followed by Whites, Blacks, and then Hispanics

Adverse Childhood Experiences

ACEs are common, and preventing ACE can reduce health conditions.

adverse experiences that can impact child's development and their response to stress

can include different forms of physical, sexual, or emotional abuse or neglect

how many aces lead to an increase in risk

just one super impactful ACE can be super harmful
typically 4 or more ACEs lead to increases in risk of health problems like heart disease, type 2 diabetes, imprisonment, criminal activity, and etc.

Which of the following best describes Adverse Childhood Experiences
A. Aces are traumatic or stressful events that occur in childhood that will have a negative effect
B. Aces are traumatic or stressful events that occur in childhood that can be stopped with a few protective factors
C. Aces are traumatic or stressful events that occur in childhood that can potentially have a negative impact across the life course in the absence of resilience and supportive relationships

Aces are traumatic or stressful events that occur in childhood that can potentially have a negative impact across the life course in the absence of resilience and supportive relationships

importance of healthy brain development and the impacts of toxic stress

constant positive experiences lead to children having opportunities to learn and explore as it forms neurological pathways and a sturdy foundation --\> secure attachment
adverse events make the child feel left alone in a unsafe place where they are insignificant/

toxic stress

the experience of overwhelming levels of stress without support from adults to help mitigate the effects of that stress

insecure attachment

weaker bonds the inhibit brain development. The child feels that the world is dangerous and are unable to rely on relationships to support them

insecure attachment styles

ambivalent, avoidant, disorganized attachment

Why is attachment important
A. Secure attachment formed within a safe and stable relationship with any caregiver provides children with a secure base to take appropriate risks and support healthy brain development
B. It makes children feel important which helps them develop a positive sense of self
C. In order to experience healthy brain development a child needs a good relationship with their parent

A. Secure attachment formed within a safe and stable relationship with any caregiver provides children with a secure base to take appropriate risks and support healthy brain development

With regards to toxic stress, which of the following statements do you think is the most accurate
A. A normal part of brain development is exposure to levels of stress and adversity
B. Without protective relationships toxic stress and adversity disrupts the healthy development of the brain
C. Toxic stress damages children's brains

B. Without protective relationships toxic stress and adversity disrupts the healthy development of the brain

what are the 3 types of stress

positive, tolerable, and toxic stress

How do ACEs lead to early death? (9 steps_)

experience of adversity and trauma --\> disrupted brain development --\> Getting or showing signs of social, emotional, and cognitive problems --\> Adopting risks or challenging behaviors --\> Increased lieklihood of physical or mental ill health, --\>dying earlier than expected --\> Death

How do ACEs impact across a life course
A. Those with 4 or more ACEs will experience significant negative outcomes across their life
B. People who have experienced ACEs are at increased risk of potential negative impacts across their life course
C. ACEs only affect children

B. People who have experienced ACEs are at increased risk of potential negative impacts across their life course

How can building resilience mitigate the impact of ACEs

protective factors have a reverse effect where they enhance the likelihood of positive outcomes and lessen the likelihood of negative consequences from exposure to risk. Like a shield that helps to build resilience

protective factor impact on stress

teaches children how to respond to aggressive behavior, learn how to manage their needs and fears, feel support and care, staying healthy despite stress, and etc

What are examples of good protective factors
A. A supportive relationship with a trusted adult
B. Hobbies and interest
C. Parents or caregivers who are resilient
D. All of the above

D. All of the above

Looking at Aches through a trauma informed lens

allows recognition of the presence of trauma symptoms and acknowledge the role it may play in a person's life.

strategies to help build resilience

key building blocks to help build resilience is...
secure base
self-efficacy
thinking positive
being equipped to manage your behaviors and emotions
good self-esteem
being involved with others and feeling connection

How to support someone with a history of ACES that feels uncomfortable

offer a consistent physician who is aware of the patient's needs, offer breaks for the patient to relax, give a safe word that the patient can use at anytime to cease all activity, note symptoms that the patient is overwhelmed like a clenched fist

5 principles of adversity and trauma informed care

safety, trust, collaboration, choice, and empowerment

How do you build resilience
A. Supportive relationships with trusted adults who are resilient themselves
B. Supporting children to engage in physical exercise, healthy diet, hobbies and interest
C. Supporting children to take managed risks and develop problem solving skills
D. All of the above

D. All of the above

social determinants of health

economic stability, neighborhood/physical environment, education, food, community and social context, and health care system

increase in what comorbidities in people of color

diabetes mellitus, pregnancy related deaths, hypertension, infant mortality, hospitalization and death rate of covid-19

doctors in emergency care are less likely to

classify POC children as requiring emergency care,
admit POC children to the hospital after visiting the ED,
order blood tests, CT scans, or x-rays for POC children

What are some of the leading causes of death?

heart disease, cancer, Covid 19, accidents, stokes, chronic lower respiratory disease, Alzheimer's, diabetes, flu and pneumonia, kidney disease, and suicide

palliative care

Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.
interdisciplinary collaboration given at any stage of illness

settings for palliative care

hospitals, skilled nursing facilities, and outpatient

A family is asking why their father with end-stage COPD is being referred to hospice care. The best response from the nurse would be:
A. Hospice care provides complete pain control
B. Hospice assists the family and patient to prepare for death
C. Hospice will follow the patient's choice for DNR status
D. Hospice is provided in the home and will allow the family to be involved in the decisions for care

B. Hospice assists the family and patient to prepare for death

principles of hospice care

- death must be accepted (patient willingly stop treatment to focus on palliative care, done by proxy if patient is unable to)
- pain and other symptoms must be managed (to improve quality of life)
-patient/family should be viewed as a single unit of care (bereavement care for everybody included'
-research and education should be ongoing (evidence-based care on symptom management)

barriers to hospice care

- difficulties in making a terminal prognosis
- the strong association of hospice with death
- hospice care perceived as "giving up"
- advances in "curative" treatment options (might not be available in their lifespan)
- financial pressures (hospitals want pts. to stay for $$)

advanced directives include

living will, durable power of attorney, POLST, and code status

living will

A legal notarized document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.

durable power of attorney

a legal agreement that allows an agent or representative of the patient to act on behalf of the patient

what happens when a durable power of attorney was not established prior

next of kin, spouse, parents, or children then become the proxy for the patient

cons of having a durable power of attorney

proxy may be unable to make decisions emotionally. As well as disagreement between the proxy, and family/friends.
While there can only be one in the document, when defaulted, there can be multiple next of kins assigned the responsibility which can complicate the situation

POLST

portable order for life sustaining treatment.
code status carried across facilities, to ensure directive stays true

code status

formally written status of the type and scope of care that should be provided in the event of a cardiac arrest, other catastrophic organ failure, or terminal illness.
not just resuscitation, is individualized

if there is no code status established prior

default \= full code

what happens when a patient wants to change their code status

the patient may bring it up to the physician or care team, where the nurse may assess the patients mental status before telling the physician, who will carry on the procedure

What is one of the most common and feared responses by patients to terminal illness
A. anorexia
B. Cachexia
D. Dyspnea
D. Pain

D. Pain

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

pain relief lader

bottom :
for mild pain : non-opioid and maybe a adjuvant
for moderate pain: potential opioid (hydrocodone, etc.), non-opioid, and adjuvant
for severe pain: opioid (morphine, diladid), and adjuvant, and non-opiod

what pain is ranked first in pain relief ladder

cancer pain

why is it important to follow pain schedule

following the pain schedule ensures the pain stays at a consistent tolerable level. Once the pain increases its hard to bring down.
especially with PRN missed doses

The nurse is part of the health care team at an oncology center. A client has been diagnosed with leukemia and the prognosis is poor, but the client is not yet aware of the prognosis. How can the bad news best be conveyed to the client?
A. Family should be given the prognosis first
B. The prognosis should be delivered with the client at eye level
C. The physician should be deliver the news to the client alone
D. The appointment should be scheduled at the end of the day

B. The prognosis should be delivered with the client at eye level

why should the patient not be delivered news alone or at night.

if the patient wants to receive news without family that is okay, but they still need to have a nurse or a social worker with them.
News, when applicable should not be delivered at night because that is when the patient is most tired.

therapeutic communication

Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.

how to facilitate therapeutic communication

assess understanding of diagnosis and prognosis
exploratory questions (keep them open ended, without no/yes questions)
ask about patient's values, preferences, concerns, and beliefs
assess coping and support system
questions for loved ones if patient is unable to

NURSE acronym for communication

N - Name the emotion
U - understand the emotion
R - Respect (or praise) the patient
S - Support the patient
E - Explore the emotion

What is the role of the nurse in a family meeting

- advocate for the patient based on values shared between patient and family
- act as interpreter when medical jargon is not clearly understood
- respond to emotion expressed in the meeting
- prior to meeting, encourage and assist in question development with interdisciplinary team during meeting
express concerns
- share clinical nursing updates

months before death, the patient may be feeling

gradual generalized weakness, fatigue, social isolation, and decreased appetite

what should we do when the patients have a decreased appetite

do not push them to eat, but do let them now food is there

weeks before death

- neurologically : lethargic, possible delirium, and dulled senses (but not hearing)
- cardiopulmonary: increase in pulse, respiratory rate, but with a decreased blood pressure. periodic apnea or agonal breathing, and inability to clear secretions
- renal: decreased urine excretion and incontinence, or retention (potentially use catheter)
- Skin : feverish or cold, possible perspirations or pallor

days before death

- neurologically : SOMNOLENCE, RESTLESSNESS, and FURTHER dulled senses (but not hearing) (bursts in energy do not mean improvement, explain to family)
- cardiopulmonary: increase in pulse, INCREASE OR DECREASE in respiratory rate, but with a decreased blood pressure. MORE periodic apnea or agonal breathing, and inability to clear secretions
- renal: decreased urine excretion and incontinence, or retention (potentially use catheter)
- Skin : feverish or cold, MOTTLING OF EXTREMITIES (marbled appearance), pallor

hours before death S/Sx

- neurologically : OBTUNDED, NONRESPONSIVE (but hearing may still be present)
- cardiopulmonary: increase in pulse (MAY BE IRREGULAR AND DIFFICULT TO PALPATE), INCREASE OR DECREASE in respiratory rate, but with a decreased blood pressure. periodic apnea or agonal breathing
- renal: OLIGURIA/ANURIA
- Skin : WORSENING MOTTLING OF EXTREMITIES

morphine/fentanyl is used for

pain and for agonal breathing

lorazepam is used for

breathing, anxiety, and mild nausea

haloperidol is used for

anti-psychotic

prochlorperazine is used for

antiemetic, for serious nausea

antidepressants is used for

for depression and as a adjunct medication