Chronic Test 2

Have a basic understanding of the different modalities offered

Relaxation, medication, guided imagery, yoga, tai chi, acupuncture, sound healing, healing touch (ETC)

Understanding of the role of herbs and potential to interfere with other medications

Herbal medicines are not approved for use as drugs and are not regulated by the FDA, although many herbs are safe and effective “Natural” does not equal say. Some interact with prescription and over the counter medications, look for us pharmacopeia (USP) dietary supplement mark

Why do people seek complimentary modalities?

Seeking ways to improve health and well-being or relieve symptoms associated with chronic, even terminal illness or the side effects of conventional treatments for them.
Having a holistic health philosophy, transformational experience, greater control over own health

What is meant by complimentary modalities, alternative modalities, and integrative health?

Complimentary: interventions that can be used with conventional medical interventions, thus complimentary.
Alternative: if there is non-mainstream practice that is used instead of conventional medical care; it is rare people use only alternative approaches
Integrative: combination of allopathic and complimentary and alternative modalities

Role of insulin in blood glucose control

Insulin is secreted by the beta cells of the pancreas, the stimulus for insulin is HIGH blood glucose, signals cells to take in glucose from the blood and this glucose is used for energy

The importance of maintaining good glycemic control

Review medications given for DM, teaching a patient how to self- administer insulin, meds that are given as a result of side effects of DM, i.e., peripheral neuropathy

Normal blood fasting blood glucose values, normal A1C values

Post prandial blood glucose, what is it, would you expect it to be high or low?

Diabetic foot care/assessment related to peripheral neuropathy

Review DKA, HHS

Have an understanding of the ethical principles, i.e., beneficence, nonmaleficence, autonomy etc.

Autonomy: respect rights of patients make health care decisions
Nonmaleficence: avoid causing harm
Beneficence: benefit the patient
Justice: give each his/her due and act fairly
Fidelity: keep promises
Veracity: accountability, privacy, confidentiality

Have an understanding of professional values important to nursing

Altruism: concern for welfare and well-being of others
Autonomy: right to self-determination
Human dignity: respect for the inherent work and uniqueness of individuals and populations
Integrity: acting according to code of ethics and standards of practice
Social justice: upholding moral, legal, and humanistic rights

What is advocacy, how might it be demonstrated

Primary commitment to the patient
Prioritization of good of individual patient rather than society in general
Evaluation of competing claims of patients autonomy and patient well being

Areas of concern for patient advocates: representation of patient, promoting self-determination, whistle blowing, being politically active

Ethical responsibilities, i.e, maintaining confidentiality

Nurses should: cultivate the virtues of nursing; understand ethical theories and dictate and justify professional conduct; be familiar with codes of ethics for nurses and standards for professional nursing conduct

What is values classification? How can we clarify what is important?

A process by which people come to understand their own values and value system

What is an ethical dilemma, how might one be resolved?

Ethical problems:
paternalism, deception, privacy and social media, confidentiality, allocation of resources, valid consent or refusal, conflicts with technology, unprofessional incompetent unethical or illegal physician/nursing practice, short staffing issues, beginning-of-life and end-of-life issues

Ethical dilemmas: a situation where a nurse must decide between competing values and know that no matter what choice they make, there are consequences.

Have an understanding of what legal issues nurses may face, i.e., negligence, defamation of character, invasion of privacy etc.

Duty: the ability to prove the defendant owed you a duty of care not to cause you or others harm.
Breach: the ability to prove that a violation of standard care resulted in an injury for you or a family member.
Cause in fact: the ability to prove a correlation between the negligent or harmful action that took place and the negative consequence you suffered.
Proximate cause: the ability to prove a direct link between a negligent act and the injury that resulted from that action.
Damages: the ability to prove you suffered injuries, loss, or other expenses because of someone else’s negligence.

Legal/rules of conduct for nurses

Nurse practice acts, standards, credentialing ?

Competent practice

What is meant by battery, assault?

- An assault is when a person commits an act that puts a victim in reasonable apprehension of harmful or offensive contact.
- Battery, on the other hand, is when someone commits an act that actually inflicts harmful or offensive contact on the victim.

What is a tort?

A tort is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability.
Can be intentional (assault, battery) or unintentional (ommision)

What is an incident report?

A report that details an event where a person is injured or property is damaged

Interventions to meet spiritual needs

Familiarize the patient with religious services within the institution
Respect the patients need for privacy during prayer
Assist the patient to obtain devotional objects and protect them from loss or damage
Arrange for the patient to receive sacrament if desired
Attempt to meet dietary restrictions
Arrange for a priest, minister, or rabbi to visit if the patient wishes

What is religion, what is spirituality

Religion: term used to describe cultural or institutional religion
Spirituality: anything that pertains to the person’s relationship with a nonmaterial life force or higher power

Diagnosis applied to spirituality

Readiness for enhanced spiritual well-being
Spiritual distress

Know terms associated with religion and spirituality, i.e., hope, faith etc.

Faith: a confident belief in something for which there is no proof or evidence
Hope: ingredient in life responsible for a positive outlook
Love: connectedness with others
Spiritual health and healing: spiritual needs are met
Spirituality and everyday living: in health and illness

What is an atheist, agnostic?

Atheists: no belief in a higher power
Agnostic: you do believe in a higher power, but there is no proof so it is an uncertain belief

Left-sided HF – physiology and expected findings, i.e., respiratory problems

Formerly known as congestive hart failure - typically caused by hypertension, CAD, and valvular disease
Not all cases involve fluid accumulation
Two types: systolic and diastolic
Clinical manifestations: weakness, fatigue, dizziness, acute confusion, pulmonary congestion, oliguria, orthopnea

Right-sided HF – physiology and expected findings, i.e., peripheral edema

Causes: left sided HF, right ventricular MI, pulmonary hypertension
Right ventricle cannot empty completely
Increased volume and pressure in venous system and peripheral edema
Clinical manifestations: JVD, increased abdominal girth, ascites, hepatomegaly, dependent edema

Pulmonary edema

A condition of too much fluid in the lungs, causes shortness of breath, wheezing, coughing up pink frothy sputum, can be life threatening, caused typically by heart conditions
Assess for early signs (crackles in bases), high fowlers position, oxygen therapy, rapid acting diuretics, continual assessment

Importance of daily weights

Weight is the most reliable indicator of fluid gain/loss
500 ml of retained fluid is one pound of weight gain

How to we assess a patient’s degree of weakness/fatigue?

Can you walk up a flight of stairs without become out of breath? Can you perform ADLs?

Digoxin, what is it, why is it given, considerations for administering?

Used to treat heart failure, typically in combination with a diuretic. It is a cardiac glycoside. It enhances contractility, reduces HR, slows conduction through the AV node, inhibits sympathetic activity
Tolerated well and used often (tried and true drug)
Can be given through IV
Should assess apical pulse for a full minute before giving it

What is Lasix, when would it be administered. What are the effects of Lasix?

Lasix is a loop diuretic, lasix is used to treat fluid retention from heart failure, it works to get rid of excess water so it is important to monitor electorlyte levels (mainly potassium)

What do we teach our patients regarding home maintenance of HF

Diet, taking medications properly, signs of worsening heart failure