Sleep Stages and Requirements, Exams of Public Health

Download Sleep Stages and Requirements and more Exams Public Health in PDF only on Docsity! NSG Exam 4- ALL Download to pass!!!! QUIZ :loss - ANSWER :- when someone or something of value experiences change or is no longer accessible resulting in diminishing or removing of its value - Actual, perceived, anticipatory, necessary, developmental/maturational, and situational QUIZ :actual loss - ANSWER :recognizable to the person experiencing the loss, as well as, other people. Ex. Death QUIZ :perceived loss - ANSWER :recognizable to the person experiencing the loss but not to others. Ex. older person with loss of independence QUIZ :anticipatory loss - ANSWER :when a person experiences a reaction to a loss that has not occurred yet. Ex. terminal news (grieve a loss that hasnt happened yet) QUIZ :necessary loss - ANSWER :related to changes in the life cycle that can be anticipated. QUIZ :developmental/maturational - ANSWER :normal and expected, results from the normal life transitions in the developmental process of life, and results in the development of coping skills QUIZ :situational loss - ANSWER :unanticipated and caused by an external event. Ex. car wreck QUIZ :grief - ANSWER :- an internal emotional reaction to loss - types: normal/uncomplicated, dysfunctional/complicated, anticipatory, and disenfranchised QUIZ :mourning - ANSWER :the act of grieving and expressing grief QUIZ :bereavement - ANSWER :a state of grieving due to loss of a loved one QUIZ :normal/uncomplicated grief - ANSWER :- may show negative emotions, such as hopelessness, withdrawal, anger, resentment, and guilt - over time, negative emotions will change to acceptance with some acceptance being evident by 6 months following the loss - may demonstrate physical complaints, such as fatigue, change in sleeping patterns, chest pain, palpitations, nausea and headaches QUIZ :dysfunctional/complicated grief - ANSWER :- also called unresolved grief - difficult progression through the usual grief stages - usually prolonged grieving - may result in decreased self esteem, intense guilt, and suicidal ideation - physical complaints may continue for an extended time QUIZ :anticipatory grief - ANSWER :the process of starting to "let go" of someone or something before the loss actually occurs QUIZ :disenfranchised grief - ANSWER :grief for a loss that may not be considered socially acceptable or cannot be shared publicly (Ex. someone dying from overdose, do not want to share due to societal views on this) QUIZ :Kübler-Ross' Theory of Grief - ANSWER :- denial: difficult accepting the reality of a diagnosis, death or loss. "I'm fine", "I cant believe they are gone" - anger: expression of rage and hostility. Ex. blaming god - bargaining: an attempt to negotiate for a cure or more time. Ex trying to bargain with god - depression: a period of grief - acceptance: the reality of the diagnosis, death, or loss is accepted, and the person feels tranquil and prepared and moves forward to prepare for the future QUIZ :palliative care - ANSWER :- appropriate for anyone with a chronic disease or illness regardless of disease stage - interventions focus on the relief of physical, emotional, spiritual, and psychosocial aspects of the disease - provided by an interdisciplinary team - goal is to aggressively manage symptoms in clients with life-threatening illnesses to provide the best quality of life possible QUIZ :hospice - ANSWER :- comprehensive care provided in various settings, often the home - indicated when a client's life expectancy is 6 months or less - focus of treatment is shifted from a cure to quality of life and support for the client as they approach death QUIZ :urinary incontinence management at end of life - ANSWER :-nearby bedpan - absorbant pads - hygiene care QUIZ :urinary retention management at end of life - ANSWER :- catheterization QUIZ :diarrhea/bowel incontinence management at end of life - ANSWER :- nearby bedpan - absorbant pads - hygiene care QUIZ :constipation management at end of life - ANSWER :- laxatives - enemas QUIZ :dehydration management at end of life - ANSWER :- sips of water and/or ice chips QUIZ :end of life care - ANSWER :- prioritize management of sx causing the most discomfort. Administer meds as ordered to manage sx - perform ongoing assessments of sx to determine the effectiveness of tx and need for changes in tx plan - manage medication adverse effects - reposition frequently to maintain comfort, airway patency, and skin and mucus membrane integrity - maintain an environment that promotes the patient's self esteem and dignity - promote patient control by encouraging patient decision making in healthcare, foods, and activities - encourage and assist the patient to perform activities of daily living as they are able and wish to do so - encourage relaxation techniques if indicated - use therapeutic touch as appropriate - provide care and support to patient and family - utilize therapeutic communication to develop and maintain communication among the patient, family and healthcare team - assist with the understanding of information about progression of disease and options for tx - assist the patient in clarifying personal goals to assist in effective decision- making - support the use of coping mechanisms the patient has had success with in the past as appropriate - support the pt in participation in religious practices that provide strength and comfort as appropriate - be aware of comments in the presence of unconscious clients as hearing is the last sensation lost QUIZ :support for the family - ANSWER :- allow expression of feelings - encourage the family to plan visits so that the patient has time to rest - provide appropriate information when there are changes in the treatment plan - assess family members' desire to perform patient care and provide education as needed - monitor caregiver fatigue - provide privacy for the family to communicate and share feelings outside of the patient's presence - provide education about physical changes that occur as the patient approaches death if desired QUIZ :clinical signs of approaching death - ANSWER :- labored breathing - collection of mucus in large airways - decreased level of consciousness - relaxation of facial muscles - inability to swallow - slow and weak pulse - decreased blood pressure - bowel and/or bladder incontinence - decreased urine output -cool, mottled (cyanotic) extremities - perspiration - diminished sensation of touch - difficulty speaking - nausea, abdominal distention, and/or flatus - agitation or restlessness - loss of movement and reflexes QUIZ :euthanasia - ANSWER :means "good dying" QUIZ :active euthanasia - ANSWER :taking measures or doing something to cause a client's death QUIZ :assisted suicide - ANSWER :- can be considered a type of active euthanasia - legal in certain situations in the District of Colombia, California, Colorado, Oregon, Vermont, Washington, Montana and New Mexico QUIZ :passive euthanasia - ANSWER :- withdrawal of medical treatment (not doing something) with the intention of allowing a client's death - most societies have held the belief that this is legally and morally justified while active euthanasia has been considered illegal and immoral, although this distinction is being questioned today QUIZ :Code of Ethics on End of Life Care - ANSWER :ANA Code of Ethics statement says that the nurse "should provide interventions to relive pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life" QUIZ :Child-Life Services - ANSWER :if desired by the family of children experiencing loss, these services may be able to speak with family and/or children about coping with loss and grief, provide information about resources, and assist in memory-making activities QUIZ :therapeutic communication techniques for end of life - ANSWER :- silence - offering self - active listening - asking questions - asking open ended questions - clarifying: may accomplish this through restating, reflecting, paraphrasing, or exploring - offering broad opening statements or general leads - demonstrating recognition and acceptance - focusing - giving information - summarizing - touch QUIZ :displacement - ANSWER :a defense mechanism that moves emotions from one object/person to another QUIZ :introjection - ANSWER :- a defense mechanism that incorporates qualities/values of another into their ego - ex. older sibling teaching younger sibling QUIZ :projection - ANSWER :a defense mechanism that attributes own thoughts/impulses to another QUIZ :rationalization - ANSWER :- defense mechanism that gives logical/socially acceptable reasoning for questionable behaviors - Ex. "I'm okay; you're okay" QUIZ :reaction formation - ANSWER :defense mechanism that exhibits behaviors and attitudes that are the opposite of what he/she would normally do QUIZ :regression - ANSWER :- defense mechanism that exhibits returning to earlier behaviors; seen in children QUIZ :repression - ANSWER :- defense mechanism that chooses to remove an event that produces anxiety from conscious awareness QUIZ :sublimation - ANSWER :- defense mechanism that substitutes good/positive behavior or goal for one whose usual method of expression is not socially acceptable or is blocked QUIZ :undoing - ANSWER :- defense mechanism that makes up for previous bad acts QUIZ :adapting to acute and chronic illness - ANSWER :Adaptation involves 2 types of tasks - General tasks such as maintaining self esteem and personal relationships and preparing for the future. - Illness-related tasks, such as handling disability and pain, performing the medical regimen as prescribed, and losing control and independence QUIZ :family stressors - ANSWER :- changes in family roles and structure - feelings of anger, guilt and helplessness - loss of control over usual routines - concern for future financial stability - family structure determines ability of family to cope - rigid family structure is strict and dictatorial - open family structure has few or no boundaries, consequences, or consistent behaviors - both structures can result in outcomes that are positive or negative - function is the course of action that the family uses to attain its goals, including family members problem solving abilities, communication skills, and available resources. QUIZ :caregiver burden - ANSWER :- results from the accumulation of stress experienced by a patient's family members after providing care for the patient for a period of time - may include difficulty sleeping, fatigue, and illnesses such as elevated blood pressure and psychiatric illnesses QUIZ :holism - ANSWER :belief that all living organisms are continually connecting/interacting with the environment and each other. Belief that a person is more than the sum of his parts, but is dynamic, unified whole (mind/body/spirit). A change in any part of the whole impacts all the other parts QUIZ :holistic nursing - ANSWER :nursing practice with the goal of healing (not necessarily curing) the whole person. May incorporate CAT QUIZ :alternative therapies - ANSWER :health therapies not generally practiced/accepted by allopathic medicine (biomedicine). Used in place of medical tx QUIZ :complementary therapies - ANSWER :may be same as alternative therapies, but used in conjunction with medical management QUIZ :use of CAT - ANSWER :about 38% of adults and 12% of children use CAT yearly - more women and higher educated pts and a large percentage of seniors - many do not inform HCP of use of therapies - typical uses are to promote well being or treat chronic illnesses or sx QUIZ :beliefs underlying CAT - ANSWER :- mind, body and spirit together influence health - health is a balance of systems and illness is manifestation of imbalance - systems reflect instability. Restoring balance will reduce sx. Healing may take time - healing is done by the pt and facilitated by the caregiver QUIZ :whole medical systems (CAM) - ANSWER :Ayurveda, Traditional Chinese Medicine, Shamanism, Homeopathy, Naturopathy QUIZ :Mind-Body Modalities - ANSWER :meditation, relaxation/imagery, prayer, humor, aromatherapy QUIZ :energy medicine - ANSWER :Therapeutic and healing touch, sound, Reiki QUIZ :biologically based - ANSWER :herbals, nutritional supplements QUIZ :manipulative/body based practices - ANSWER :various types of massage and body therapy treatments QUIZ :Ayurveda - ANSWER :- whole medical systems - Ancient Indian medicine - focus on balance for the person's "type" (dosha). Includes diet, exercise, herbs, meditation, purification. - Requires formal training but no licensure in US - Yoga is one practice used in Ayurveda: postures used with breathing and centering to promote health and reduce sx QUIZ :Concept of Chakras - ANSWER :- energy centers - originated in India - pts may wish to follow special diets or take herbal supplements during hospitalizations; need to coordinate with meds and plan of care QUIZ :Traditional Chinese Medicine - ANSWER :- requires formal training- doctor of traditional Chinese medicine training takes several years - QI (chee) is energy flowing through 12 meridians (energy circuits) in body - composed of Yin and Yang: when out of balance lead to poor health - use acupuncture, diet, herbs, massage, exercise, and breathing to restore health - intercessory prayer by others, prayer use by pt QUIZ :energy healing - ANSWER :- based on belief of vital life force within and around body and illness is a result from an imbalance in the energy field - Chakras: energy centers (crown, brow, throat, heart, solar plexus, sacrum, coccygeal) - etheric body (aura): surrounds body in 7 layers QUIZ :therapeutic touch - ANSWER :- energy therapy - Kriger - use of hands on or near body to promote healing/wellbeing QUIZ :healing touch - ANSWER :- energy therapy - Mentgen - similar to therapeutic touch, more specific techniques based on condition/ailment QUIZ :Reiki - ANSWER :- energy therapy - similar to therapeutic touch - for beginning use, a training workshop is used. Takes years of practice to be a master/teacher QUIZ :Acupuncture - ANSWER :- energy therapy that includes insertion of fine needles along energy meridians to restore balance and unblock energy flow - demonstrated effective in chronic pain, N/V reduction, reduction of substance abuse, and other conditions - not generally used for acute/traumatic conditions (infection, fracture, MI, etc) - formal training- usually 2 years or more QUIZ :acupressure - ANSWER :- energy therapy that uses the same principles/placement as acupuncture but with finger pressure instead of needles (human contact) -specific training in clinical acupressure available only via 2 organizations, unless do TCM training QUIZ :herbs/supplements - ANSWER :- biologically based therapies used to promote health and treat conditions - herbs not well controlled in the US; FDA considers them nutrit. supplements - some demonstrated effective (Zinc for resp sx; ginkgo for memory; ginger for GI sx), while many others not well documented - may have significant side effects/interactions with other meds: licorice with high BP and Ginkgo with anti-platelet meds - informal training, or TCM/integrative med training QUIZ :Body work - ANSWER :- body based practice that uses hands on therapy to promote comfort and healing - includes a variety of methods (Rolfting, shiatsu, deep massage, etc) - training through massage schools and schools specific to bodywork types - licensure - ex. lymphatic massage and A-stem QUIZ :nursing implications for holistic nursing - ANSWER :- acknowledge importance of relationship, environment, and energy as promoting healing - be "present" in the moment and with the patient: focus on "how can I be with the pt to facilitate the best outcome" vs "what do i need to do" - recognize you are in the pt's private space - center self prior to pt encounter, "energy flows where attention goes" - focus on pt alone; listen carefully and non judgmentally - be "with" the pt: facilitate the pt access to his/her own strengths (in all dimensions of health) - use unconditional regard, empathy, genuineness, therapeutic communication QUIZ :Nursing indications for CAM - ANSWER :- need to become familiar with CAM therapies used by pt population - assess client for use of alternative therapies, many pts dont inform HCP of CAM use - investigate with client whether any therapies might be beneficial, use resources - discuss use with other providers - discuss use of reputable therapy provider (Accupuncture, herbalist) - provide therapy tools as needed - evaluate effectiveness of therapy - all nurses can ask what pts do to relax and encourage those behaviors - can suggest use of music to relax - can encourage breathing and muscle relaxation - can ask about environmental sensitivity and organize environment accordingly QUIZ :herbal supplements - ANSWER :- aloe = wound healing - chamomile = anti-inflammatory, calming - echinacea = enhances immunity - garlic = inhibits platelet aggregation, BLEEDING - ginger = antiemetic - ginkgo= improves memory - ginseng = increases physical endurance - Valerian = promotes sleep, reduces anxiety QUIZ :rest - ANSWER :refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed QUIZ :sleep - ANSWER :- a state of rest accompanied by altered consciousness and relative inactivity - a part of the sleep/wake cycle (wakefullness= time of mental activity and energy expenditure) - period of inactivity and restoration of mental and physical function QUIZ :Physiology of Sleep - ANSWER :- reticular activating system (RAS): facilitates reflex and voluntary movements. Controls cortical activities related to state of alertness - Bulbar synchronizing region - Hypothalamus: control center for sleeping and waking - work together to control the cyclic nature of sleep QUIZ :non rapid eye movement (NREM) Sleep stages - ANSWER :- 75-80% of sleep - consists of 4 stages - stages I and II = 5%-50% of sleep, light sleep - stages III and IV = 10% of sleep, deep sleep states (delta sleep) QUIZ :stage I of NREM sleep - ANSWER :light sleep, only a few minutes long, can be awakened easily, feels relaxed and drowsy QUIZ :stage II of NREM Sleep - ANSWER :deeper sleep 10-20 minutes, VS and metabolism diminish, can still be awakened easily, increased relaxation QUIZ :Stage III of NREM sleep - ANSWER :Deep sleep, 15-30 min long, difficult to awaken, VS decrease further, relaxation is such that the person seldom moves - observed apnea and associated health disorders - CPAP is treatment QUIZ :idiopathic hypersomnia - ANSWER :- central disorder of hyper somnolence - characterized by excessive sleep, particularly during the day QUIZ :narcolepsy - ANSWER :- characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep - up to 70% of people with narcolepsy also experience cataplexy, the sudden, involuntary loss of skeletal muscle tone lasting from seconds to one or two minutes QUIZ :Chronic or recurrent pattern of sleep-wake rhythm disruption - ANSWER :- primary causes are an alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep- wake schedule desired or required, a sleep- wake disturbance (insomnia or excessive sleepiness), or an associated distress or impairment lasting for a period of at least.3 months (except for jet lag disorder) - treatment: behavioral therapy, light therapy, avoiding naps, and keeping to a regular sleep schedule QUIZ :Parasomnias - ANSWER :- Somnambulism: sleep walking - REM sleep behavior disorder (RBD): acting out dreams while asleep - sleep terrors: occur in the deepest stage of sleep, screaming, sitting up in bed - nightmare disorder: vivid and disturbing dreams - sleep enuresis: bedwetting. Most common in males over the age of 3 - sleep related eating disorder: arise from sleep to eat, have no memory of doing this QUIZ :Sleep related movement disorders/Restless Legs Syndrome (RLS) - ANSWER :- also known as Willis-Ekbom disease (WED), is a common sleep related movement disorder that affects up to 15% of the population, most often middle aged and older adults - people with this cannot lie still and report unpleasant creeping, crawling, or tingling sensations in the legs - nonpharmacologic treatments: eliminate caffeine, tobacco and alcohol, mild analgesic at bedtime, heat or cold on the effected extremity, and relaxation techniques QUIZ :treatment for dyssomnias - ANSWER :- pharmacologic = sedatives, hypnotics - nonpharmacologic = cognitive behavioral therapy (CBT). Progressive muscle relaxation measures, stimulus control, sleep restriction, sleep hygiene measures, biofeedback and relaxation therapy QUIZ :sleep deprivation - ANSWER :- decrease in the amount, quality or consistency of sleep - increases in occurrence when no sleep for 30 or more hours - loss of concentration, inattention, impaired thought process QUIZ :obtaining a sleep history - ANSWER :nature of problem, cause of problem, related s/sx, when the problem began and how often it occurs, how the problem affects everyday living, severity of the problem and how it can be treated, and how the pt is coping with the problem and success of treatments attempted QUIZ :what are the sleep characteristics to assess - ANSWER :restlessness, sleep postures, sleep activities, snoring, and leg jerking QUIZ :information recorded in a sleep diary - ANSWER :time pt retires, time pt tries to fall asleep, approximate time pt falls asleep, time of any awakening during the night and resumption of sleep, time of awakening in morning, presence of any stressors affecting sleep, record food/drink/medication affecting sleep, record of physical and mental activities, record of activities performed 2-3 hours before bedtime, and presence of worries or anxieties affecting sleep QUIZ :nursing interventions to promote sleep - ANSWER :- prepare a restful environment - promote bedtime rituals - offer appropriate bedtime snacks and beverages - promote relaxation and comfort - respect normal sleep-wake patterns - schedule nursing care to avoid disturbances - use medications to produce sleep - teach about rest and sleep QUIZ :senses involved in sensory reception - ANSWER :- visual = vision - auditory = hearing - olfactory = smell - gustatory = taste - tactile = touch - stereognosis = perception of solidity of objects - kinesthetic and visceral = basic internal orienting systems - proprioception = movements and body positions QUIZ :four conditions to receive data - ANSWER :- stimulus - receptor - nervous pathway to the brain - functioning brain to receive and translate impulse into a sensation QUIZ :reception - ANSWER :person receives the data via the senses QUIZ :stimulus - ANSWER :agent or act that initiates a response by the nervous system; a receptor must be present to receive the stimulus QUIZ :sensory perception - ANSWER :the ability to receive and interpret sensory impression. Ex. consciousness, arousal/awareness, memory, affect, judgement, awareness of reality, language QUIZ :adaptation - ANSWER :how the person acts on the stimuli QUIZ :factors affecting sensory stimulation - ANSWER :- developmental considerations: NICU babies, decline with aging - culture: ethnic norms/cultural stimuli (noise, music in the home) - personality and lifestyle: ER nurse vs dialysis nurse - stress and illness: decrease ability to tolerate stressors/stimuli - medications: CNS, ototoxic QUIZ :Reticular Activating System (RAS) - ANSWER :- poorly defined network - extends from hypothalamus to medulla - mediates arousal - optimal arousal state: sensoristasis - monitors and regulates incoming sensory stimuli, maintaining, enhancing, or inhibiting cortical arousal - the body learns how to adapt to stimuli QUIZ :macular degeneration - ANSWER :loss of central vision from deterioration of the center of the retina QUIZ :caring for visually impaired patients - ANSWER :- teach pt self care behaviors to maintain vision and prevent blindness - acknowledge your presence in pt's room - speak in normal tone of voice - explain the reason for touching the pt before doing so - keep call light within reach - orient the pt to sounds in the environment - describe the arrangement of the food on the tray before leaving the room QUIZ :hearing loss - ANSWER :- difficulty hearing or interpreting speech and other sounds due to a problem in the middle or inner ear QUIZ :conductive hearing loss - ANSWER :an alteration in the middle ear that blocks sound waves before they reach the cochlea of the inner ear QUIZ :sensorineural hearing loss - ANSWER :an alteration in the inner ear, auditory nerve, or hearing center of the brain QUIZ :mixed hearing loss - ANSWER :a combination of conductive and sensorineural hearing loss QUIZ :hearing aids - ANSWER :- amplify sounds, but do not help pts interpret what they hear - amplification of sound in a loud environment can be distracting and disturbing QUIZ :patient education for hearing aids - ANSWER :- use lowest setting that allows hearing without feedback - to clean ear mold, use mild soap and water while keeping the hearing aid dry - when hearing aid is not in use, turn it off or remove the batteries to conserve battery power - keep replacement batteries on hand QUIZ :ototoxic medications - ANSWER :- antibiotics: gentamicin, metronidazole - diuretics: furosemide - NSAIDs: aspirin, ibuprofen - chemotherapeutic agents: cisplatin QUIZ :communicating with a patient who is confused - ANSWER :- use frequent face to face contact to communicate the social process - speak calmly, simply, and directly to the patient - orient and reorient the patient to the environment - keep a clock in the room; post a calendar, or write the date where it is visible - orient pt to time, place and person - communicate that the pt is expected to perform self care activities - offer explanations for care - reinforce reality if pt is delusional QUIZ :communicating with a patient with aphasia - ANSWER :- greet pts and call by name - make sure only one person speaks at a time - speak clearly and slowly using short sentences and simple words - do not shout - pause between statements to allow time for pts to understand - check for comprehension - tell pts when you do not understand them - ask questions that require simple answers - reinforce verbal with nonverbal communication (gestures, body language) - allow plenty of time for patients to respond - use methods speech therapists implement, such as picture chart, to improve communication - acknowledge frustration in communicating QUIZ :older adult considerations - ANSWER :- presbyopia - cataracts - glaucoma - diabetic retinopathy: damage, spotty vision - presbycusis: high frequency hearing loss - conductive hearing loss - sensorineural hearing loss is an alteration in the inner ear, auditory nerve, or hearing center of the brain - mixed hearing loss is a combination of conductive and sensorineural hearing loss - tinnitus: ringing in the ears - Meniere's disease: hearing loss, dizziness, tinnitus - Burning mouth syndrome: may be caused by Vit B deficiency - peripheral/diabetic neuropathy - phantom limb pain - acute sensory loss QUIZ :communicating with an unconscious pt - ANSWER :- be careful what is said in the pt's presence, hearing is the last sense that is lost - assume that the pt can hear you and talk in a normal tone of voice - speak to the pt before touching - keep environmental noises at low level QUIZ :In which stage of NREM sleep does the person fall into a stage of sleep but can be aroused with relative ease? - ANSWER :Stage II Rationale: In stage II of NREM sleep, the person falls into a stage of sleep but can be aroused with ease. In stage I, the person is in a transitional stage between wakefulness and sleep. In stages III and IV, the depth of sleep increases, and arousal becomes increasing difficult. QUIZ :Tell whether the following statement is true or false. Barbiturates, amphetamines, and antidepressants increase REM sleep. - ANSWER :False rationale: they decrease REM sleep QUIZ :In which of the sleep disorders does the patient have an uncontrollable desire to sleep? - ANSWER :Narcolepsy Rationale: In narcolepsy, a person can literally fall asleep while performing ADLs. Insomnia is characterized by difficulty falling asleep. Sleep apnea is a condition in which a person experiences the absence of breathing during sleep between snores. Restless leg syndrome is a crawling or tingling sensation in the legs. QUIZ :Tell whether the following statement is true or false. Somnambulism is a parasomnia in which the person walks in his or her sleep - ANSWER :True QUIZ :Tell whether the following statement is true or false. In the drive state of RAS known as sensoristasis, nerve impulses from all the sensory tracts reach the RAS, which then allows certain impulses to reach the cerebral cortex and be perceived. - ANSWER :True QUIZ :altruism - ANSWER :concern for welfare and well being of others - common in health care, and nurses must apply ethical theory and decision making to ethical problems - involves a conflict between two moral imperatives - review of scientific data is NOT enough to solve it - answer will have a profound effect on the situation and the client QUIZ :ethical distress - ANSWER :occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action QUIZ :using the nursing process to make ethical decisions - ANSWER :- assess the situation (gather data) - diagnose (identify) the ethical problem - plan: identify options, think ethical problem through, make a decision - implement decision - evaluate decision QUIZ :****examples of ethical problems - ANSWER :- paternalism (parent makes decisions for child), deception (telling someone something false in order to make them do something, like go on a diet), privacy, confidentiality, allocation of scarce nursing resources, valid consent or refusal, conflicts concerning new technologies - Caring for an adolescent patient who has to decide whether to undergo an abortion even though her parents believe it is wrong - Discussing options with a parent who has to decide whether to consent to a blood transfusion for a child when his religion prohibits such treatment. - Assigning staff nurses a higher patient load than previously because administration has reduced the number of nurses per shift - Witnessing a surgeon discussing only surgical options with a patient without mentioning more conservative measures - Unprofessional, incompetent, unethical, or illegal physician practice - Unprofessional, incompetent, unethical, or illegal nurse practice - Short staffing and whistle-blowing - Beginning-of-life issues - End-of-life issues QUIZ :functions of ethics committees - ANSWER :education, policy making, case review, consultation, and occasionally research QUIZ :advocacy in nursing practice - ANSWER :- primary commitment to pt - prioritization of good individual pt rather than society in general - evaluation of competing claims of pt's autonomy and pt well being QUIZ :areas of concern for pt advocates - ANSWER :- representation of pts - promoting self determination - whistle blowing - being politically active QUIZ :litigation - ANSWER :process of brining and trying a lawsuit QUIZ :plaintiff - ANSWER :person bringing lawsuit QUIZ :defendant - ANSWER :person being accused of a crime. Presumed innocent until proven guilty QUIZ :public law - ANSWER :government is directly involved. regulates relationships between individuals and government QUIZ :private law - ANSWER :- civil law - regulates relationships among people QUIZ :criminal law - ANSWER :- concerns stage and federal criminal statutes - defines criminal actions (murder, theft, etc) QUIZ :constitutions - ANSWER :- source of law that serves as guides to legislative bodies QUIZ :statutory law - ANSWER :source of law enacted by a legislative body QUIZ :administrative law - ANSWER :- source of law empowered by executive officers QUIZ :common law - ANSWER :source of law that involves a judiciary system that reconciles controversies, creates body of common law QUIZ :Crime - ANSWER :wrong against a person or the person's property as well as the public - misdemeanor: punishable by fines or less than 1 year imprisonment - felony: punishable by imprisonment for more than 1 year QUIZ :tort - ANSWER :a wrong committed by a person against another person or that person's property; tried in civil court. Intentional and unintentional QUIZ :Intentional torts - ANSWER :- assault and battery - defamation of character (slander and libel) - invasion of privacy (confidentiality and HIPAA) - false imprisonment (restraints, coercion) - fraud (acting outside of the practice act) QUIZ :HIPAA ensured patient rights - ANSWER :- to see and copy their health record - to update their health record - to request correction of any mistakes - to get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment and healthcare operations - to request a restriction on certain uses or disclosures - to choose how to receive health information QUIZ :unintentional torts - ANSWER :- negligence: performing an act that a reasonably prudent person, under similar circumstances, would NOT do; failing to perform an act - malpractice: negligence by a medical professional QUIZ :categories of malpractice claims - ANSWER :- failure to follow standards of care - failure to use equipment in responsible manner - failure to assess and monitor - failure to communicate - failure to document - failure to act as a patient advocate QUIZ :four elements of liability - ANSWER :liability: must be established to prove malpractice or negligence - duty, competency, what should be done - breach of duty, it was not done - causation, failure to use appropriate safety measures - damages, the pt was harmed QUIZ :safeguards to competent practice - ANSWER :- developing interpersonal communication skills - respecting legal boundaries of practice - following institutional procedures and policies - owning personal strengths and weaknesses - evaluating proposed assignments - keeping current in nursing knowledge and skills - respecting pt rights and developing rapport with pts - keeping careful documentation - working within agency for management policies QUIZ :types of risk management programs - ANSWER :safety program, products safety program, and quality assurance programs QUIZ :laws affecting nursing practice - ANSWER :- occupational safety and health - national practitioner data bank - reporting obligations - controlled substances - discrimination and sexual harassment - HIPAA; Restraints - People with disabilites - legal issues related to death and dying (Wills, advance directives) QUIZ :advanced directives - ANSWER :- purpose is to communicate a patient's wishes regarding end of life care should the client become unable to do so - all pts must be asked on admission to healthcare facility whether they have this - staff should give pts who do have advanced directives written information that outlines their rights related to healthcare decisions and how to formulate advance directives - a healthcare representative should be available to help with this process QUIZ :living will - ANSWER :- a legal document that expresses the pt's wishes regarding medical tx in the event the client becomes incapacitated and is facing end of life issues - most state laws include provisions that protect healthcare providers who follow a living will from liability QUIZ :durable power of attorney - ANSWER :a document in which clients designate a healthcare proxy to make healthcare decisions for them if they are unable to do so. May be any competent adult the client chooses QUIZ :mandatory reporting - ANSWER :healthcare providers have a legal obligation to report their findings in accordance with state law with the following situations: abuse and communicable diseases QUIZ :prior to delegating client care, nurses should consider the - ANSWER :- predictability of the outcome: routine/new tx for client, will it have a predictable outcome, potential for harm, is the client unstable - complexity of care: complex tasks, does the delegatee have necessary skills? - need for problem solving and innovation: is judgement essential during the task, does it require nursing assessment or data collection skills? - level of interaction with the client: does the delegatee need psychosocial support or education during performance of task? QUIZ :delegatee factors - ANSWER :- education, training and experience - knowledge and skill to perform the task - level of critical thinking the task requires - ability to communicate with others as it pertains to the task - demonstration of competence - the facility's policies and procedures - licensing legislation (state's nurse practice acts) QUIZ :ANA principles for delegating care - ANSWER :- the nursing profession determines the scope of nursing practice - nursing profession defines and supervises UAPs involved in providing direct nursing care - RN is responsible and accountable for nursing practice - RN supervises any assistant providing direct patient care - the purpose of UAP is to work in supportive role to the RN QUIZ :5 rights - ANSWER :- right task: repetitive, requires little supervision, relatively non invasive. Ex. dressing change - right circumstance: appropriate settings, resources are available, if it is too complicated, should NOT be delegated - right person: the right person is delegating the right task to be performed on the right person - right direction: clear, concise, description of the task. VERY clear, specific directions are the best - right supervision: nurse remains accountable for all delegated tasks QUIZ :delegating - ANSWER :state nurse practice act states RN is - responsible and accountable - cannot delegate the care related to the nursing process (5 rights) QUIZ :tasks to delegate to LPN - ANSWER :- monitoring physical assessment such as urine output - reinforce teaching from the care plan - skills: insertion of catheters, tube feedings, NG tube care, verify placement - med administration: in some states LPNs cannot push IV meds nor hang particular meds/fluids QUIZ :tasks to unlicensed assistive personnel - ANSWER :- ADLs (bathing, grooming, dressing, toileting, bed making) - ambulation - glucose monitoring - feeding pt without swallowing complications - positioning - specimen collection - I/O - VS of uncomplicated pts QUIZ :what is continuity of care - ANSWER :- Appropriate, uninterrupted care delivery - Smooth transition between settings - Establishing a nurse-patient-family relationship upon admission to the acute care setting, ambulatory care setting, or community care setting is essential for continuity of care QUIZ :ambulatory care settings - ANSWER :- Patient receives healthcare services but does not remain overnight. - In most offices and clinics, patients complete a short health history. - In same-day surgery facilities, screening tests, teaching, and admission take place before patients enter the setting. QUIZ :acute care admission - ANSWER :- Admission sheet becomes part of the medical record. A child is born with values and forms new values during a lifetime from information from the environment, family, and culture. - ANSWER :Answer: False Rationale: A child is not born with values, but rather forms values during a lifetime from information from the environment, family, and culture. QUIZ :Which value involves acting in accordance with an appropriate code of ethics and accepted standards of practice? - ANSWER :Answer: Integrity Rationale: Integrity involves acting in accordance with a code of ethics and accepted standards of practice. Altruism is a concern for the welfare of others. Autonomy is the right to self-determination. Human dignity is respect for the worth and uniqueness of individuals and populations. Social justice is upholding moral, legal, and humanistic principles. QUIZ :Tell whether the following statement is true or false. A nurse who is dedicated to providing culturally competent care to her patients finds herself without the resources to communicate with a patient who speaks a different language. This problem may result in an ethical dilemma for the nurse. - ANSWER :Answer: False Rationale: This problem may result in ethical distress for the nurse. Ethical distress occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Ethical dilemma occurs when two (or more) clear moral principles apply but support mutually inconsistent courses of action. QUIZ :A nurse attempts to obtain an order for a feeding tube for an anorexic teenager who refuses to eat. What is the term for the ethical problem this nurse is experiencing? - ANSWER :Answer: Paternalism Rationale: Paternalism occurs when a nurse acts for a patient without consent to secure good or prevent harm. Deception occurs when a nurse deceives a person for a perceived benefit. Patient confidentiality is questioned when a patient confidence may lead to harm. Allocation of scarce nursing resources and advocacy in market-driven environment involve patient harm due to inadequate staffing/finances. QUIZ :Tell whether the following statement is true or false. A good example of explicit power is a class bully who gets his way by intimidating his classmates. - ANSWER :Answer: False Rationale: A good example of implied power is a class bully who gets his way by intimidating his classmates.