NURS 288 - Quiz 3

Conflict Management in Nursing

Conflict management is a skill that nurses can sustain and develop which in turn will contribute to effectiveness in nursing practice

Conflict management is a skill that managers look for in new hires.

What are the 6 impacts of effective conflict management?

-Minimize the negative impacts of conflict
-Help to create a trusting and healthy workplace
-Improve interpersonal relationships and team work
-Improve job satisfaction & staff retention
-Inspire innovation and creative strategies to address challenging issues
-Improve quality of patient care delivery and patient outcomes

Rahim & Bonoma's Five Dimensions of Conflict Management Styles

Collaborating, accommodating, dominating, avoiding, and compromising

Collaborating

Direct and cooperative management with aim to reach a solution collaboratively
-Everyone contributes tot he solution and the solution is more than the sum of the parts

High assertation and high collaboration

Accmomdating

Passive and accommodating, follower
-Everything they wanted and nothing from you

Low assertation and high collaboration

Dominating

Force behaviours on others, self-concerned

High assertation and low collaboartion

Avoiding

Tendency to sidestep conflicts

Low assertation and low collaboration

Compromising

Aim to reach a mutually agreed decision
-50/50, meet halfway

Mid-way in assertation and collaboration

What are strategies to address relational conflict?

Speak up, check-in meetings

What are strategies to address task conflicts?

"What did we agree to last time?"

What are strategies to address process conflict?

A group that eats together lasts

Strategy to Support Team Functioning - Create Interdependence

Perform meaningful group tasks that are complex, that require members to collaborate in order to succeed

Ensure team members are using project management tools with major milestones and accountabilities

Strategy to Support Team Functioning - Group Functioning and Feedback

Build on opportunities for structured monitoring of group functioning and feedback
-Set clear goals and expectations
-Review what went well?
-What areas could we improve?
-Keep short accounts

What does U=U mean?

Undetectable = utransmittable

PrEP

HIV pre-exposure prophylaxis

Prevents HIV infection

CaSP Characteristics (7)

-Capitalize on strengths
-Decrease the potential of encountering stressors
-Limit the impact or effect of stressors
-Build the capacity of the community
-Integrates public health and nursing
-Involves the principles of primary care
-Partnership and participation

Groups Inequitably Impacted by HIV (5)

-gbMSM
-PWID
-Indigenous people
-ACB communities
-Transgender populations

What are the 7 DoH related to HIV risk?

-Race
-Sexuality
-Gender identity
-Income and social status
-Education
-Health services
-Personal health practices & coping skills

Community Engagement Characteristics (5)

Empowerment - increasing ability of community members to influence community circumstances

Participation - supporting community members to take part in decision making about their community

Inclusion - recognizing that some community members have less influence than others

Self-determination - supporting the rights of citizens to make their own choices

Partnership - agencies can contribute and work together to make the most of the available resources

In relational to the establishment of PrEP, what was the CaSP analysis?

Need for additional harm reduction strategies at multiple levels

Community Diagnosis for the Risk of HIV Infection (Etiology and Manifestations)

Etiology - financial barriers in accessing PrEP, high risk behaviours

Manifestations - disproportionate rates of new HIV infections among target groups

Considerations When Prioritizing Community Diagnoses (6)

-Magnitude of concern expressed by members of the community
-Political will to address the concern
-Extent of existing resources to deal with the concern
-Potential for success in solving the problem with existing resources
-Need for specialized education or training
-Extent of additional resources and policies needed for equitable, cost-effective, and efficient response

Goal of HIV PrEP Intervention

Make PrEP more accessible to adults who are at high, ongoing risk of HIV infection

How do we plan for this intervention?

Ottawa Charter Action Areas
-Build healthy public policy, create supportive environments, develop personal skills, reorient health services

What are the 3 guiding principles of the Alberta HIV PrEP program?

Equitable access to the full range of HIV prevention strategies (including PrEP) for people at risk of HIV infection

PrEP should be discussed and considered for all patients who fit the eligibility criteria and wish to optimize their HIV prevention strategies

PrEP should be accessible to all Albertans at risk of HIV regardless of geographic location

What are 3 common concerns about PrEP?

PrEP can lead to antiviral drug resistance
-HIV screening

PrEP will lead to condomless sex and increase in STI incidence
-Education
-Regular STI testing of PrEP patients
-Immunizations

PrEP can cause life-threatening flare of chronic HBV infection
-Consult with hepatologist

What are the interventions of the PrEP Program? (8)

-Research and evaluation
-Building coalitions & networks
-Policy development and implementation
-Community development
-Building capacity
-Outreach care/counselling and harm reduction
-Communication, surveillance, screening
-Case management, referral and follow up, health education

3 Phases of PrEP Implementation

Phase 1: Prepare HCP with knowledge
Phase 2: Shadowing opportunities and PrEP processes in service
Phase 3: PrEP appointments available, increased involvement of nurses and MD

PrEP and Risk Reduction (+What type of prevention is PrEP?)

Goal: risk reduction within an at risk population

PrEP targets clients who are most at risk, is risk reduction, is secondary prevention

Risk Assessment

The systematic process for describing and quantifying the level of expose to a substance that will result in increased risks to health

E.g., risk questionnaire

Risk Management

Interventions to reduce risk such as enhancing public awareness through to legislation

Risk Communication

Getting the word out about precautions

What are the 4 aspects of PrEP evaluation at SRH?

-Are we reaching the highest risk populations
-Medication adherence?
-Service delivery?
-Dissemination of evaluation data

PrEP Future Directions + Barriers

It is possible that by 2025 there may be at least one option for long-acting PrEP

Potential barriers include race and socioeconomic status

Pharmacology

The study of drugs and their interactions with the body

What is a drug? (4)

Any chemical that has an influence on the physiological processes of a living organism

Exogenous (produced outside organism)

Non-nutritive substance that influences body function

Used interchangeably with medication

Pharmacodynamics

The mechanism of drug action (what the drug does to the body) and the relationships between drug concentration and the body's response

Concerned with alterations of normal physiological functioning by the influence of medications

Therapeutic Effect

Therapeutic effect of a drug = creates a positive change when the physiological system is flawed

3 Types of Drug Mechanism of Action (+what can a dug not do?)

Through receptors, through enzymes, through non-selective interactions

Cannot cause a cell or tissue to perform a function not part of its natural physiology

What does a drug modify at the site of action?

At site of action, can modify at which the cell or tissue functions - increase or decrease; or can modify the strength of function

Receptor

A drug's specific target
-Usually a protein located on the surface of a cell membrane or within the cell

Most drugs exert their effects by chemical binding with receptors at a cellular level

Cell membrane is like a light socket

Agonist

A drug that binds with a receptor and elicits an appropriate response (active or induce)
-Can be partial or full

Activates the cell to do something

Antagonist

A drug that binds to a receptor and inhibits cell function by blocking the receptor (inhibit)
-Can be partial or full

Affinity

The degree to which the drug attaches and binds with the receptor

The stronger the affinity the greater the response from the cell or tissue

Pharmacodynamics and Enzymes (Selective Interaction)

Enzymes catalyze biochemical reactions in a cell

Selective interaction - drug inhibits or enhances the action of a specific enzyme

The drug binds to the enzyme and alters the enzyme's interaction with its normal target molecules in the body

Non-Selective Interactions (+Examples)

Does not interact with receptors or enzymes to alter a physiological or biological function of the body

Target to alter cell membranes and cellular processes

Example:
-Cancer drugs, antibiotics

Pharmacokinetics

The study of what the body does to the drug

The movement of the drug into, through, and out of the body

Drug absorption into, distribution and metabolism within, excretion out from a living organisms (ADME)

What is pharmacokinetics dependent on? (3)

Patient factors (renal function, hepatic function, genetic makeup, age, ethnicity, etc.)

Route of administration

Chemical properties of drug
-Molecule size, lipid solubility, ionization of molecule

Absorption + what is rate of absorption determined by?

The movement of the drug from the site of administration into the bloodstream for distribution to the tissues

Rate is determined by form of drug and heavily by the route of administration: Correct - Aligned

Bioavailability (+what is it determined by?)

Extent/amount of drug absorbed

Influenced by route of administration

Enteral Route (+what influences it?)

Drug is absorbed through the GI tract (oral, buccal, sublingual, rectal, nasogastric, gastronomy tube)

Influenced by form of drug, presence of food/liquid ingested with drug, acidity of stomach, motility of GI tract, status of absorptive surface, rate of blood flow

First-Pass Effect (+what does it reduce?)

Initial metabolism of the drug absorbed from the GI tract, in the liver, before it reaches the systemic circulation through the bloodstream
-Oral route especially

Reduces bioavailability
-Reduces how much med is available

Topical Route

Med applied to skin or mucous membrane - local effect (skin, eyes, nose, ears, respiratory tract, urinary tract, vagina, rectum, transdermal patch)
-Absorption rate differs between routes

Avoids 1st-past effect

Medication applied to a circumscribed area of the body
-Intended to only affect area applied to

What are the 3 types of topical applications?

Dermatological preparations (skin)

Instillations and irrigations (body cavity or orifice)

Inhalation (resp. tract)

Parenteral (+Benefit)

Routes other than enteral and topical
-IM, IV, SC, ID
-Less commonly intra-arterial, intraosseous, intrathecal, or intracardiac

Bypasses 1st-past effect - benefit
-Drugs administered by IV enter directly into systemic circulation and have direct access to the rest of the body

What influences the rate of absorption? (4)

Drug concentration and dose (higher dose, higher response)

GI tract (motility, food, gut health)

Blood flow to site of absorption

Drug interactions

Distribution (+Drugs in the Bloodstream)

Transport of drug in the body by the bloodstream to intended site of action
-Drugs are not passive agents - interact with blood and can be chemically and physically changed before reaching target

As soon as drug enters circulation, metabolism and excretion begin: kidney and liver

What is distribution influenced by? (4)

Blood flow to tissues

Tissue storage

Drug solubility

Drug protein binding

What areas is there rapid and slow distribution? +Where will the drug be attracted?

Areas well-supplied with blood vessels have rapid distribution (heart, lungs, kidney, liver, brain)
-Areas not as well-supplied have slower distribution (skin, muscle, fat)

Chemical and physical properties of a drug will largely determine the area of the body to which the drug will be attracted

Special Barriers

Limit distribution

Blood-brain barrier and fetal-placental barrier

Distribution and Drug Solubility

Physical properties of a drug influence how it moves through the body

Lipid solubility is an important characteristic because it determines how quickly a drug is absorbed, mixes within the blood stream, crosses membranes, and becomes localized in body tissues
-Lipid soluble drugs absorb more rapidly than water soluble drugs because they are not limited by the barriers that normally stop water-soluble drugs
-Thus, they are more completely distributed to body tissues

Distribution and Protein Binding of Drugs

Many drugs bind reversibly to plasma proteins (albumin) to form drug-protein complexes that are too large to cross capillary membranes

The bound drugs continue to circulate in the bloodstream and are unavailable to their site of action until they become unbound.
-Only unbound or free drugs can reach their target or be excreted by the kidneys

The number of binding sites on a plasma protein is limited
-Drugs may be highly protein bound or not

Metabolism (what are drugs changed into?)

Biotransformation or detoxification

Process of chemically changing a drug molecule into:
-Inactive metabolite by enzymes (usually in liver) (less pharmcoactivity)
-Into more soluble compounds (to excrete in urine) (most cases)
-Less commonly into more potent pmetabolites

What does metabolism involve? +What is the primary site?

Involves hundreds of complex biochemical pathways and reactions that alter the structure and function of drugs, nutrients, vitamins, and minerals.

Primary site of drug metabolism is the liver, though the kidney and intestinal tract also have high metabolic rates
-The types of metabolic reactions are specific to the type of cell

Importance of Medical History W/ Metabolism

If a patient has liver or kidney disease, they may not metabolize the medication adequately and the medication may reach toxic levels.

You need to be aware of your patient's medical history AND how medications are metabolized

Excretion (what does the rate determine, pathological states, and route of excretion)

Elimination of drugs
-Drugs will continue to act on the body until they are either metabolized to an inactive form or removed from the body by excretion

The rate of excretion determines its concentration in the blood and its duration of action

Pathological states, especially liver or kidney disease, often increase the duration and intensity of drug action in the body because they interfere with excretion

Drugs are excreted via the kidneys, liver, lungs, and glandular secretions (e.g. saliva or breastmilk)

What is the ultimate goal of pharmacology and time?

The goal is to achieve consistent levels of drug in the body

Onset, Peak, Duration of Action, and Half-Life

Describe the reactions of the body to the drug, the drug's effects

Onset - time required for the drug to elicit a therapeutic response

Peak - time required for a drug to reach its maximum therapeutic response

Duration of Action - length of time that the drug concentration is sufficient (without more doses) to elicit a response

Half-Life - time it takes for 1/2 of a given amount of medication in the body to be removed

Med Concentration Terms (Peak vs. Trough Level, Toxcitiy)

Peak Level - Highest blood level of a drug (strongest effect of med)

Trough Level - Lowest blood level of a drug (lowest effect)

Minimum Effective Cncentration

Toxicity - Peak blood level is too high; drug becomes poisonous

Half-Life (what does it measure + what is it used to determine?)

Time it takes for 1/2 of a given amount of medication in the body to be removed

Measures rate at which drug is eliminated from the body

Used to determine the steady state (when the drug eliminated is equal to the drug absorbed per dose

Adverse Drug Effects vs. Side Effects

Although every drug has the potential to produce adverse events, most pharmacotherapy can be conducted without significant undesirable effects

Adverse drug effects are undesirable, unfavorable, unintended and potentially harmful reaction caused by the administration of a medication

Side effects are types of drug effects that are predictable, secondary to the intended purpose and may occur even at therapeutic doses

Difference is severity, predictability, and potential harm

What are the 5 types of med orders?

STAT (immediate)

Single order (one time dose)

Standing order: may or may not have a termination date.

PRN: permits nurse to give medication when needed (in nurse's judgement)

Protocol order: set of criteria or orders under which medication is to be given (re: insulin)

Abbreviations

Know accepted ones, be aware of dangerous ones

PO

Per oral (by mouth)

NPO

Nothing by mouth (nil per os)

OD

Once daily (not acceptable although still used)

BID

Twice daily

TID

Three times a day

QID

Four times a day

HS

Before bed

Q2H

Every 2 hours

STAT vs. PRN

Immediately vs. when needed

AC

Before meals (ante cibum)

PC

After meals (post cibum)

What do you need to know before administering a med? (10)

-Name of medication (generic and brand name)
-Purpose for taking the medication - indication
-Drug action
-Intended effect - therapeutic effect
-Pharmacokinetics - ADME
-Is there a reason they should not take the medication? (contraindications, allergies)
-What should I watch out for? (adverse reactions/side effects
-Route? Dose? Safe dose?
-Onset, peak, duration
-Is there anything I need to monitor? Assess for? Evaluate? (nursing Implications)

What are the three checks?

1. Compare the medication label to the MAR as you remove the drug from the storage area
2. Compare the medication label to the Mar as you prepare each drug
3. Compare the medication label to the MAR at the patient beside before administering each drug

What are the ten rights of medication administration?

-Right patient/client
-Right medication
-Right dose
-Right time
-Right route
-Right client education
-Right documentation
-Right to refuse
-Right assessment
-Right Evaluation

Why is it important to build trusting relationships with clients?

So they will share what OTC medications, herbal remedies, and substances they are using (e.g., drug interactions)

Use resources such as the Natural and Non-prescription Health Products Directorate (NNHPD) to find up to date information
-Vitamins and minerals
-Herbal remedies
-Homeopathic medicines
-Traditional medicines such as traditional Chinese medicines
-Probiotics

What are 12 individual factors that influence drug action?

-Income and Social Status
-Social Support Networks
-Social Environments
-Education
-Working Conditions
-Physical Environments
-Biology and Genetics
-Personal Health Practices and Coping Skills
-Healthy Childhood Development
-Health Services
-Culture
-Gender

Similar to SeDoHs

Lifespan Considerations - Pregnancy

Awareness that certain medications are harmful to the fetus

Lifespan Considerations - Infants and Children

Require smaller dosages due to smaller body size and immaturity of organs; may not tolerate certain medications

Increased susceptibility to drug reactions and toxicity

Dosage calculations are required and are based on age, weight and body surface area (BSA)

Lifespan Considerations - Adolescents/Adults

Adolescents: may have adverse reactions to previously tolerated medications

Adults: may develop new allergic reactions to previously tolerated medications

Awareness that chronic illnesses have potential to alter functioning of certain organs/systems that may influence individual's reaction to certain medications

Lifespan Considerations - Older Adults

65 years of age or olde

Consume a larger proportion of all medications than do other population group

Lower blood protein levels (metabolism)

Kidneys do not work as effectively (excretion)

Combination of prescription, Over-the-Counter (OTC) medications, Herbals, Vitamins

At risk for polypharmacy

Polypharmacy

Administration of more medications than clinically indicated, representing unnecessary drug use

"Prescribing cascade"- the development of adverse effects from one or more of the medications taken for which another drug is prescribed

Individual takes prescription medications for disease conditions—usually comorbidities such as CHF, HTN, DM, HTN— requiring multiple medications

Increased risk for ADR

OTC drugs, Herbals, Vitamins, Minerals and Laxatives

No prescription needed--self-medication

Most commonly used OTCs: Analgesics, Laxatives, Nonsteroidal anti-inflammatory drugs (NSAIDs)

Patient education required

Analgesics

Response is individual—what works for one person may not work for another

Beware of side effects

Beware of similar products in different medications

Should not be used for extended length of time—have recommendations on packages

Acetaminophen—fever, headaches, common aches and pains

NSAIDs—pain and fever relief, reduce inflammation (swelling) from muscle strains and arthritis

Laxitives

Relieve and prevent constipation

Overuse can lead to bowel dependency and decreased function of bowels

Can interfere with absorption of some medications and nutrients; electrolyte imbalance

Encourage fiber-rich foods, fluids, exercise

Natural is best
-May be required along with opioid script

Herbals, Vitamins, Minerals

Beware of interactions with other medications, interference with diet
Under the Natural Health Products Regulations, natural health products (NHPs) are defined as:
-Vitamins and minerals
-Herbal remedies
-Homeopathic medicines
-Traditional medicines such as traditional Chinese medicines
-Probiotics
-Other products like amino acids and essential fatty acids

Communicable Diseases

Illness caused by an infectious agent or resulting from direct or indirect transmission of the infectious agent or its products from an infected individual or via an animal, vector or the inanimate environment to a susceptible animal or human host

What are factors key to controlling infection?

Understanding the infectious agents, the host and the environment (epidemiological triangle