Ambulatory Exam 2

What are the five Social Determinants of Health (SDOH)?

Education Access & Quality, Economic Stability, Neighborhood & Built Environment, Health Care Access & Quality, Social & Community Context.

What is one assessment for Education Access & Quality?

Ask about educational background and preferred learning style.

What is one intervention for improving Education Access & Quality?

Use plain language at a 5th-6th grade reading level.

What should be assessed under Economic Stability?

Income stability, employment status, and food insecurity.

What is a recommended intervention for Economic Stability?

Provide referrals to SNAP/WIC and local assistance programs.

What is an assessment question for Neighborhood & Built Environment?

Ask about access to green spaces and transportation.

What intervention can be made for Neighborhood & Built Environment?

Advocate for sidewalks and community gardens.

What is one assessment for Health Care Access & Quality?

Identify insurance status and transportation barriers.

What is a key intervention for Health Care Access & Quality?

Help patients access preventive care and routine follow-up.

What should be assessed regarding Social & Community Context?

Screen for social support and community engagement.

What intervention can improve Social & Community Context?

Connect patients to support groups and youth programs.

Define intersectionality in healthcare.

Overlapping social identities that shape privilege or disadvantage.

What are the five Healthy People 2030 Leading Health Indicators that have worsened?

Drug overdose deaths, homicides, household food insecurity, tobacco use among adolescents, fourth-grade reading skills.

What is one assessment to improve health literacy?

Ask about education level and preferred learning style.

What is a recommended intervention to improve health literacy?

Use visuals and teach at a 5th-6th grade reading level.

What are the categories of food insecurity?

High Food Security, Marginal Food Security, Low Food Security, Very Low Food Security.

What does Medicare Part A cover?

Hospital insurance covering inpatient care.

What does Medicare Part B cover?

Medical insurance covering provider visits and outpatient care.

What is Medicaid?

A program for low-income individuals and families based on federal poverty guidelines.

What is the leading cause of death for ages 1 to 44?

Unintentional injuries.

What is a key intervention to decrease tobacco use among adolescents?

Provide school-based education addressing vaping and e-cigarettes.

What is the #1 cause of death from drug overdose in the US?

Fentanyl.

What role does the nurse care coordinator play?

Helping patients navigate the complex health system.

What is the leading cause of death from drug overdose in the US?

Fentanyl

What is the most common OTC medication associated with unintentional overdose?

Tylenol (4g/24 hours)

What role does a nurse care coordinator play?

Helps patients navigate the health system, ensures continuity of care, facilitates communication, and advocates for patient needs.

What are the symptoms of heat exhaustion?

Moist skin, temperature >100.4F/38C, nausea, vomiting, diarrhea, muscle cramps, headache, fatigue.

What is the treatment for heat exhaustion?

Assess temperature, remove excess clothing, apply cool clothes, and provide a sports drink.

What are the symptoms of heat stroke?

Warm, dry skin, temperature >104F/40C, nausea, vomiting, confusion, elevated heart rate.

What is the treatment for heat stroke?

Remove excess clothing, apply cool clothes, provide IV fluids, and call 911.

What are the symptoms of frostbite?

Cold, waxy skin, numbness, pain, burning, and possible blisters.

What increases the risk of frostbite?

Being unhoused, diabetes, and alcohol consumption.

What is the treatment for frostbite?

IV iloprost for vasodilation and to increase blood flow.

What are the symptoms of hypothermia?

Shivering, confusion, irregular heart rate, blue skin, unresponsiveness.

What is the treatment for hypothermia?

Warm slowly, wrap in blankets, and provide small sips of hot, non-caffeinated drinks.

What health issues are related to climate change?

Heat-related illnesses, vector-borne diseases, and respiratory issues from air pollution.

What are common vector-borne diseases linked to climate change?

Dengue, Zika, Lyme disease, West Nile virus, and malaria.

What is lead poisoning and its sources?

Lead poisoning can come from leaded gasoline, lead paint, and water pipes.

What is the serious level of lead exposure?

>5 µg/dL

What is the treatment for lead poisoning?

Chelation therapy and increasing dietary iron and calcium.

What are the sources of mercury poisoning related to seafood?

Mercury from rocks, mining, and coal usage.

What seafood is recommended to avoid high mercury levels?

Shark and Swordfish.

What is PM 2.5?

Particulate matter 2.5 microns in size that can embed in lungs and enter the bloodstream.

What is the Air Quality Index (AQI) range for good air quality?

0-50

What are strategies to reduce medical waste?

Policy changes at the institutional level.

What indoor activities can promote clean air?

Avoid wood-burning stoves, use exhaust fans, and maintain low humidity.

How can exposure to microplastics be decreased?

Avoid non-stick cookware, use foil instead of plastic wrap, and choose natural fiber clothing.

What is a hospital readmission?

When a patient returns to any hospital within 30 days of discharge for a related problem.

Why do hospitals track 30-day readmissions?

Because CMS reduces reimbursement for preventable readmissions.

Why do hospitals track 30-day readmissions closely?

Because CMS (Centers for Medicare & Medicaid Services) reduces reimbursement for preventable readmissions.

What are common causes of preventable readmissions?

Poor understanding of discharge instructions, medication errors, lack of follow-up care, poor symptom management, and lack of support or care coordination.

What are the most common conditions leading to readmissions?

Heart failure, myocardial infarction, CABG, COPD, pneumonia, total knee replacement (TKA), and total hip replacement (THA).

What is one intervention to prevent readmissions?

Strong discharge education, including teaching about medications and using 'teach-back' to verify understanding.

What should a clear follow-up plan include?

Scheduling follow-up appointments before discharge and ensuring the patient knows who to contact and when.

What is self-management support in the context of preventing readmissions?

Teaching patients to monitor symptoms and providing disease-specific red flags.

What is medication reconciliation?

Ensuring the final medication list is accurate, explained thoroughly, and that patients obtain their medications after discharge.

What is the role of care coordination in preventing readmissions?

Collaboration among nurses, pharmacists, case managers, and primary care providers to ensure continuity of care.

What conditions warrant a visit to the Emergency Department (ED)?

Life-threatening or serious conditions such as chest pain, shortness of breath, stroke signs, seizures, severe trauma, and altered mental status.

What conditions are appropriate for urgent care?

Non-life-threatening conditions like sore throat, mild to moderate cuts, sprains, and rashes without fever.

What is the daily self-management practice for heart failure patients?

Daily weights, reporting a gain of 2-3 lbs in 24 hours or 5 lbs in a week.

What dietary restrictions are typically recommended for heart failure patients?

A low-sodium diet, usually less than 2g sodium per day.

What are healthy blood pressure numbers?

A goal of less than 120/80 mmHg is preferred.

What A1c level indicates normal blood sugar?

An A1c level of less than 5.7%.

What A1c level indicates diabetes?

An A1c level of 6.5% or greater.

What is the correct way to use a cane?

The cane goes on the stronger side, and the cane and weak leg move together.

What are safety precautions for home oxygen care?

No smoking near oxygen, keeping tanks away from flames, and avoiding oil-based products.

What should caregivers recognize as signs of burnout?

Irritability, exhaustion, sleep disruption, and depression.

What are the basic requirements for telehealth?

Stable chronic condition, ability to monitor vitals at home, and internet access.

What is the importance of teaching caregivers about dementia?

To help them recognize signs of burnout and utilize community resources for support.

What is the significance of medication adherence in cardiac patients?

To ensure proper management of conditions and prevent complications.

What are the recommended actions when a heart failure patient experiences increased shortness of breath?

They should call their healthcare provider.

What is the purpose of teaching patients about symptom monitoring?

To empower them to manage their health and recognize when to seek help.

What is a key aspect of cancer patient education regarding chemotherapy?

Safe handling practices, including wearing gloves and washing hands after contact.

What is the recommended action for caregivers when a dementia patient shows signs of agitation?

Maintain routines to reduce agitation and simplify tasks.

What are the two leading causes of death for persons living in rural areas?

Stroke and unintentional injuries.

What are the leading causes of death for veterans?

Cardiac disease and cancer.

Differentiate between modifiable and non-modifiable risk factors for chronic disease.

Modifiable: cholesterol, exercise, blood pressure, diet, smoking. Non-modifiable: age, family history, sex.

What are common sequelae after a cerebrovascular accident (CVA)?

Aphasia, hemiparesis, dysphagia, personality changes, and depression.

What is the recommended treatment for preventing future strokes?

Aspirin and clopidogrel (Plavix) to prevent platelet aggregation.

What are the signs and symptoms of Lyme disease?

Bull's eye rash (erythema migrans) and joint erosion.

What is the treatment for Lyme disease?

Oral antibiotics (doxycycline) for 14-21 days; IV antibiotics if disease progresses.

Which animals are at the highest risk for rabies?

Mammals like raccoons.

What actions should be taken if bitten by a potentially rabid animal?

Wash the wound, administer human rabies immunoglobulin, and receive the rabies vaccine.

What are the steps for caring for a finger or toe amputation?

Wash the amputated part, wrap in moist gauze, place in a plastic bag, and keep on ice.

What is the best practice for upper or lower limb amputation care at home?

Use an elastic stump shrinker to reduce edema and prevent contractures.

What is MOUD in the context of opioid use disorder?

Medication for opioid use disorder, including Methadone and buprenorphine.

What are common risk factors for suicide?

Pain, sleep problems, relationship issues, hopelessness, and access to firearms.

Differentiate between primary, secondary, and tertiary health prevention strategies.

Primary: prevent disease; Secondary: early detection; Tertiary: manage existing conditions.

What are common signs of hearing loss?

Difficulty understanding conversations, asking for repetition, and needing higher volume.

How can communication be improved with patients experiencing hearing loss?

Face the patient, speak clearly, and minimize background noise.

What is presbycusis?

Hearing loss due to aging.

What are the safety risks for patients who are blind?

Increased risk of traffic accidents and elder abuse.

What are the best practices for safe wheelchair use?

Position wheelchair correctly, lock brakes, and prevent skin breakdown.

What should be prioritized during sick calls in a correctional facility?

Suicidal risk, homicidal risk, and risk for verbal/physical abuse.

What are common health concerns among the unhoused population?

Higher mortality from chronic diseases and mental health conditions.

What is the role of a nurse in trauma response in a correctional facility?

Act as an EMT and provide immediate care.

What is the significance of spontaneous motor recovery after a stroke?

Occurs within the first 3-6 months, with most patients having some deficits.

What is dysphagia?

Difficulty eating or swallowing, with a risk of aspiration.

What are the psychological effects of untreated hearing loss?

Increased risk of social isolation, depression, and cognitive decline.

What is the importance of patient-centered care for blind patients?

Enhances communication and safety, reducing risks of isolation and accidents.