Final Exam: NR571/ NR 571 Complete Review (Latest 2023/ 2024 Update) Complex Diagnosis & Management in Acute Care |Questions and Verified Answers|100% Correct – Chamberlain
Final Exam: NUR571/ NUR 571 Complete
Review (Latest 2023/ 2024 Update) Complex
Diagnosis & Management in Acute Care
|Questions and Verified Answers|100%
Correct – Chamberlain
Q: Challenges the providers
Answer:
Lack of familiarity with gender modification surg- eries
Failure to use gender-neutral terms such as significant other, partner, personal pro- nouns, Lack
of sensitivity when addressing sexual practices unique to the LGBTQ+ community, Lack of
understanding of cultural behavior
Patient distrust in the medical system or prior traumatic experience with healthcare providers,
Lack of sensitivity toward individuals that may engage in relationships with multiple partners are
challenges for
Q: Challenges that LGBTQ+ patients
Answer:
Use of excessive precautions or refusal to touch them
Blame for their sexual preference or health status
Use of harsh or abusive language, Harassment by providers or other patients in a healthcare
setting, Denial of medical services are challenges for
Q: common challenge by both
Answer:
lack of understanding regarding the acceptable use of terminology is a challenge for
Q: independent characteristics.
Answer:
sexual orientation AND a gender identity which are
Q: Sexual orientation
Answer:
refers to one’s emotional and sexual attraction to others.
Q: Gender identity
Answer:
on the other hand, refers to a person’s sense of their own gender.
Q: non-binary individual
Answer:
does not identify themselves exclusively as male or female.
Q: Gender-affirming surgery
Answer:
include: Feminizing vaginoplasty, Orchiectomy, Masculinizing phalloplasty, scrotoplasty,
Masculinizing chest surgery, Mastectomy, Facial feminization procedures are
Q: hormone therapy
Answer:
estrogen, androgen blockers, and testosterone these are
Q: Common health disparities
Answer:
LGBTQ+ people are less likely to be offered routine preventive screenings, Transgender people
have a higher prevalence of HIV, STDs, and mental health issues
Transgender men are less likely to have regular cervical cancer screening, Gay men, especially
of color, are at higher risk for HIV and STDs, LGBTQ+ youth are two to
three times more likely to attempt suicide, Lesbian and bisexual females are more likely to be
overweight or obese, Elderly LGBTQ+ people face additional barriers to health because of
isolation these are common
Q: adolescents and or teens
Answer:
physical transformation, and physical changes often precede emotional and social development,
areas of rational judgment, impulsivity, executive functioning, and social skills these are care for
Q: adolescents
Answer:
should have access to behavioral health specialists while hospi- talized and upon discharge,
especially if hospitalization was due to intentional or risky behavior.
Q: Physiological Changes with Aging
Answer:
slowed reaction time, hearing loss, de- creased visual acuity
steady decline in GFR, reduce bone and muscle mass decrease in lung elasticity, decreased
maximal CO and HR
increased systolic BP, reduced response to beta-adrenergic stimulation, impaired bladder
emptying, lower affinity of antibodies, chronic low-grade inflammation, in- creased procoagulant
states are
Q: Chief complaint of elderly
Answer:
Ask open ended questions, allow patients time to elaborate on the current illness.
Q: History of present illness in elderly
Answer:
May need to corroborate stories with caregivers, family, friends, nursing facility staff, especially
in patients with dementia, delirium, or altered mental status.
Q: Past medical history in elderly
Answer:
Ask about complications from previous hospi- talizations, functional impairments from
comorbid conditions is
Q: Medications in elderly
Answer:
Elderly patients are at an increased risk for polyphar- macy, their medication list should be
confirmed with the outpatient pharmacy and they should be asked about medication compliance.
Q: Family history in the elderly
Answer:
Genetic predisposition to certain conditions are less important in the care of the elderly than
younger patients, ask about the health of those with which the patient lives.
Q: Social history in elderly
Answer:
What kind of social support system does the patient have, what are their goals of care?
Q: Review of systems in the elderly
Answer:
Ask about difficulty with ADLs, IADLs, mobility, hearing or vision, Inquire about depressive
symptoms this is
Q: Falls
Answer:
consequences of sustaining a ? include intrabdominal bleeding, head or orthopedic injuries, and
death.
Q: mechanical fall
Answer:
describe a fall due to an external force or object, such as tripping on an uneven floor surface.
Q: non-mechanical causes of falls
Answer:
cardiac arrhythmias, postural hypotension, HTN
Parkinson’s disease, dementia, visual impairment, muscle weakness, decondition- ing, vitamin D
deficiency, effect of medication (sedatives, antihypertensives, and psychotropic drugs) are
considered
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Transgender Woman Goals Stimulate development of female secondary sex characteristics are goals of
Transgender Woman estrogen, antiandrogens, gonadotropin-releasing hormone (GnRH) agonists, or others is the treatment
Transgender Woman Estradiol, Testosterone, Prolactin, TriglyceridesPotassium if spironolactone used as antiandrogen this we monitor in
Transgender Woman Risks Thromboembolic events (small risk) are risk
Transgender Man Stop menstruation, Stimulate development of male secondary sex characteristics are goal of
Transgender Man testosterone as would be done in hypogonadism is the treatment for
Transgender Man Monitoring needs Serum testosterone levels every 3 months until optimal, then 1-2 times a year, Hematocrit, Hemoglobin, Serum cholesterol needs to be monitored for
Transgender Man risk Acne Possible, male-pattern hair loss, PolycythemiaHypercholesterolemia, Liver impairment, Thromboembolic disorders with increased risk of myocardial infarction and stroke are risk for
elderly Added stress, Inconvenience, Feeling tied to the regimen are impacts on quality of life for
nitrate-free interval Tolerance can occur when there are no
To prevent GI upset why medications be taken with food
Contin and Zine considerations related to Beer’s Criteria what meds
Statin and Contin ? should be administered at least 2 hour before or after ?
Nitrate should not be taken after 4 pm to ensure a nitrate free interval what med
Dronate should be taken 30 minutes before eating with a full 8-ounce glass of water. Do not lie down for 30 minutes after taking this medication what is it
Pharmacokinetic Interactions when one medication systemically alters the potency of another medication.
Absorption Interaction result of a change due to one medication’s effect on another medication’s route of entry into the body.
Distribution Interaction caused by the amount of unbound/free medications available at the various target sites.
Metabolism Interaction concentration of the medication after biotransformation into active and inactive metabolites in higher or lower than expected.
Elimination Interaction the body’s ability to eliminate medications in pure form or by altering a metabolite from the body.
Pharmacodynamic Interactions does not alter or impact absorption, distribution, metabolism, or elimination because of the one medication’s ability to manipulate the effect of another medication at its site of action.
Distribution Warfarin (Coumadin) being sensitive to protein-bound displacement is an example of a(n) interaction.
Elimination Litium (Lithobid) unchanged medication concentration is increased due to the amount of sodium concentration. This is a key contributor to a(n) __ interaction.
Challenges the providers Lack of familiarity with gender modification surgeriesFailure to use gender-neutral terms such as significant other, partner, personal pronouns, Lack of sensitivity when addressing sexual practices unique to the LGBTQ+ community, Lack of understanding of cultural behaviorPatient distrust in the medical system or prior traumatic experience with healthcare providers, Lack of sensitivity toward individuals that may engage in relationships with multiple partners are challenges for
Challenges that LGBTQ+ patients Use of excessive precautions or refusal to touch themBlame for their sexual preference or health statusUse of harsh or abusive language, Harassment by providers or other patients in a healthcare setting, Denial of medical services are challenges for
common challenge by both lack of understanding regarding the acceptable use of terminology is a challenge for
independent characteristics. sexual orientation AND a gender identity which are
Sexual orientation refers to one’s emotional and sexual attraction to others.
Gender identity on the other hand, refers to a person’s sense of their own gender.
non-binary individual does not identify themselves exclusively as male or female.
Gender-affirming surgery include: Feminizing vaginoplasty, Orchiectomy, Masculinizing phalloplasty, scrotoplasty, Masculinizing chest surgery, Mastectomy, Facial feminization procedures are
hormone therapy estrogen, androgen blockers, and testosterone these are
Common health disparities LGBTQ+ people are less likely to be offered routine preventive screenings, Transgender people have a higher prevalence of HIV, STDs, and mental health issuesTransgender men are less likely to have regular cervical cancer screening, Gay men, especially of color, are at higher risk for HIV and STDs, LGBTQ+ youth are two to three times more likely to attempt suicide, Lesbian and bisexual females are more likely to be overweight or obese, Elderly LGBTQ+ people face additional barriers to health because of isolation these are common
adolescents physical transformation, and physical changes often precede emotional and social development, areas of rational judgment, impulsivity, executive functioning, and social skills these are care for
adolescents should have access to behavioral health specialists while hospitalized and upon discharge, especially if hospitalization was due to intentional or risky behavior.
Physiological Changes with Aging slowed reaction time, hearing loss, decreased visual acuitysteady decline in GFR, reduce bone and muscle massdecrease in lung elasticity, decreased maximal CO and HRincreased systolic BP, reduced response to beta-adrenergic stimulation, impaired bladder emptying, lower affinity of antibodies, chronic low-grade inflammation, increased procoagulant states are
Chief complaint of elderly Ask open ended questions, allow patients time to elaborate on the current illness.
History of present illness in elderly May need to corroborate stories with caregivers, family, friends, nursing facility staff, especially in patients with dementia, delirium, or altered mental status.
Past medical history in elderly Ask about complications from previous hospitalizations, functional impairments from comorbid conditions is
Medications in elderly Elderly patients are at an increased risk for polypharmacy, their medication list should be confirmed with the outpatient pharmacy and they should be asked about medication compliance.
Family history in the elderly Genetic predisposition to certain conditions are less important in the care of the elderly than younger patients, ask about the health of those with which the patient lives.
Social history in elderly What kind of social support system does the patient have, what are their goals of care?
Review of systems in the elderly Ask about difficulty with ADLs, IADLs, mobility, hearing or vision, Inquire about depressive symptoms this is
Falls consequences of sustaining a ? include intrabdominal bleeding, head or orthopedic injuries, and death.
mechanical fall describe a fall due to an external force or object, such as tripping on an uneven floor surface.
non-mechanical causes of falls cardiac arrhythmias, postural hypotension, HTNParkinson’s disease, dementia, visual impairment, muscle weakness, deconditioning, vitamin D deficiency, effect of medication (sedatives, antihypertensives, and psychotropic drugs) are considered
such as balance and gait testing, event monitoring, tilt-table, EEG, etc.
Atelectasis higher risk, common occurrence post-operatively and with prolonged inactivity,
Atelectasis treatment in elderly early mobilization, BiPAP and CPAP are
Pneumonia leading cause of hospitalization among the elderly, to the natural decline in the immune system and respiratory defense function
Risk factors for pneumonia age > 65, chronic underlying conditions (COPD, CHF, DM, stroke, malnutrition, immune compromise), viral respiratory tract infections, tobacco and alcohol use are risk factors for
aspiration Pneumonia living in long-term care facilities are at higher risk, neurologic disease (dysphagia), Coughing or choking while eating, consider
Immobility can lead to pain, disability, and decreased quality of life.
Common causes of immobility in the elderly stroke, Parkinson’s disease, osteoarthritis, osteoporosisbone fractures, Alzheimer’s disease are common causes of
Adverse effects of prolonged immobility skin breakdown, pressure ulcers, muscle weakness & atrophy, DVT/PE, atelectasis, venous stasis, urinary retention, constipation, and orthostatic hypotension are adverse effect
Physical and occupational therapy consultation often helpful in identifying any deficits that may be contributing to a patient’s immobility.
Stress Gastritis/Ulcer Disease among hospitalized patients aged 65 and older, there is a higher prevalence of
Stress Gastritis/Ulcer Disease Symptoms nausea, vomiting, coffee-ground emesis or output from NG/OG tube, and melena
prevent stress gastritis and/or ulcers PPI prophylaxis in all critically ill patients at risk for GI bleeding to prevent
Nosocomial & Drug-Resistant Infections Risk factors include: age greater than 70, prolonged hospital admissiondecreased function of the immune system, frequent use of antibiotics, residing in a long-term care facility are risk factors for
Common source of nosocomial infections C. difficile colitis from antibiotic administration, catheter-associated urinary tract infections, central line-associated septicemia, ventilator-associated pneumonia, and surgical site infections, these are common
Elderly patients are at great risk for colonization with multi-drug resistant organisms (MDROs).
Examples of MRDOs MRSA, vancomycin-resistant enterococcus, carbapenem-resistant enterococcus, extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae, and penicillin-resistant streptococcus pneumoniae are examples of
Sensory Deprivation hearing loss, vision loss, or diminished senses of taste, smell, and touch and can cause social isolation, depression, and a decrease in overall quality of life these are a form of
Vision issues in the elderly glaucoma, macular degeneration, cataracts, diabetic retinopathy, pupils are slower to adjust to changes in lighting are
hearing issues in elderly tinnitus, hearing loss (caused by ear wax blockage, ototoxic medications, perforated TM, chronic noise exposure, underlying diseases such as HTN, heart disease, and diabetes) are
Loss of taste /smell issues in the elderly Parkinson’s Disease, Alzheimer’s medications, head/neck radiation, oral hygiene or dental issues are
touch issues in elderly Peripheral neuropathy is the most common cause of the decreased sense of touch, Can lead to difficulty with walking, opening pill bottles, or writing this is
Hospital Efforts for the elderly encouraging the use of glasses, hearing aids, and other assistive devices as needed this is
optimize sensory functions balance and gait training, weight training and exerciseuse of assist devices (wheelchair, walker, cane) for stabilityminimize medications and dosages, prevent and treat osteoporosis, recommend proper footwear, encourage a well-lit environment and use of motion detector lightsraised toilet seats, removal of home hazards such as throw rugs and clutter, installation of grab bars in bathroom and shower, ensuring handrails are available at entrances to the home are all
HIPPA, patient has assured rights the ability to see or receive a copy of their health recordshaving corrections added to their health information,receiving a notice that tells the patient how their health information may be used and shared, deciding to give permission before health information can be used or shared for certain purposes, such as marketing, receiving a report outline when and why their health information was shared for certain purposes, filing complaints with a patient’s healthcare provider, health insurer, and/or the U.S. government if their rights are being denied or if their health information is not being protected are under
Sharing of Health Information to ensure proper treatment and coordination of care,to pay for healthcare services (np, physicians, hospitals, etc.)the patient identifies specific people (family, friend, or others) that are allowed to receive healthcare information,to maintain quality and transition of care (interfacility transfers, home health, etc.), to protect the health of the public (reporting disease outbreaks), to make required reports to the authorities (reporting violent crimes, abuse, etc.) reason for
Treat a patient such as in a code blue situation or when emergency surgery is necessary
Protect the public such as in times of declared national or state emergency
Notify individuals who may be at risk for disease (HIPAA) a hospital can disclose a patient’s coronavirus diagnosis to the county and state department of health without the patient’s consent is
Protect persons in imminent danger such as those whose behavior is a danger to themselves or others, most often occurs in those with psychiatric conditions
In emergencies in effort to identify, locate, or notify the patient’s family only
Duty to Warn if a patient’s condition may endanger others or be a threat to themselves this is called
“””invasion of privacy””” Failure to protect one’s privacy or share information without the patient’s explicit permission may constitute a legal claim known as
Informed Consent must receive adequate instruction or information regarding aspects of their care to make prudent, personal choices for such treatment this is
Two-Physician Consent If a surrogate decision-maker for a patient who lacks the capacity to make decisions cannot be identified or reached
Competence (Decisional Capability) criteria for includes the ability to understand, reason, differentiate between good and bad, and communicate.
impaired medical decision-making capacity less than 18 or greater than 85-years-old, language or cultural barriers, chronic psychiatric or neurologic conditions, low education levels are reasons for
Right to Refuse Care Under the Danford Amendment (1991), all patients must be advised at the time of admission to a hospital of their
Do Not Resuscitate (DNR) orders “also referred to as “”no code order”” or “”allowing natural death”” are written instructions to healthcare providers to withhold life-saving measures for the patient in the event of cardiac arrest this is”
Do Not Intubate (DNI) “mandate that a patient may receive basic and advanced cardiac life support but may not be intubated “”partial DNR this is called”
Do Not Resuscitate Comfort Care (DNRCC) no chest compressions, no cardiac defibrillation or cardioversion, no insertion of an artificial airway, no resuscitative drugs (vasopressors, antiarrhythmics, etc.) this is
Cardiac arrest occurs when there is no palpable pulse can be identified
respiratory arrest occurs when agonal breathing or no spontaneous breathing occurs.
DNRCC – Arrest All resuscitative therapies will be given before an arrest but not during an arrest.
Prevention strategies in central line infections 1. Hand hygiene 2. Maximal barrier precautions 3. Chlorhexidine skin antisepsis 4. Optimal catheter site selection, with avoidance of the femoral vein for central venous access in adult patients 5. Daily review of line necessity, with prompt removal of unnecessary lines