112 Test 3

Front 1

managed care systems

Back 1

- controls cost while maintaining quality of care
- "gatekeeper"
-limits the choice of care providers
-requires approval for specialty care

*most cost effective

Front 2

case management

Back 2

-coordinates care
- method used by some systems to coordinate a patient's healthcare to maximize positive outcomes and contain costs

Front 3

primary healthcare

Back 3

essentical healthcare based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community

Front 4

primary care

Back 4

the DELIVERY of healthcare services, including the initial contact and ongoing care.

Front 5

HMO

Back 5

patient does not have a choice of healthcare providers

Front 6

PPO

Back 6

allow members to choose an outside physician for an additional cost, aka will pay more.

Front 7

Home Healthcare

Back 7

-most rapidly growing area of the healthcare system
-driven by payment system of reimbursement.. early discharge from the hospital
-serves inc numbers of older people with chronic illnesses
-provides for a dignified death at home

Front 8

community nurses

Back 8

be: self directed, flexible, critical thinkers, independent decision makers, culturally competent.

have: basic nursing competencies, excellent assessment skills, good abilities to provide health education

(community based care focuses on the community needs)

Front 9

cognition

Back 9

mental processing of information

Front 10

cognitive disorder

Back 10

significant impairment of cognition or memory that represents a marked deterioration from a pervious level of functioning

Front 11

Physical Assessment

Back 11

know normal s/s of aging: bone loss, wrinkly skin, hair loss, weight loss, kephosis,osteoporosis

ADLS-BATTED

Front 12

Behaivor Assesment

Back 12

mood- angry, happy, depressed,anxious
affect- blunted/flat
personality changes- family members notice

Front 13

(Affect) Blunted Affect & Flat Affect

Back 13

blunted- greatly dec emotional response
flat- virtual absent emotional response, no reaction.

Front 14

cognitive assessment

Back 14

loc,attention,orientation,memory,calculation,abstract thinking, reasoning & judgement (mini mental state exam)

Front 15

confabulation

Back 15

person telling you a story about memory that he just made up b/c he can't remember memory. Verify w/family if it sounds wrong.

Front 16

delirium

Back 16

acute, reversible state of agitated confusion
-occurs over short period of time
-medical emergency, can lead to irreversible brain damage
-can occur @ any age

Front 17

dementia

Back 17

-not a part of normal aging
-often not noticed at first, progresses slowly to very obvious

**** decline in physical and cognitive function and personality changes****

Front 18

causes of delirium

Back 18

drug/alcohol withdrawal, medication side effects,infections, pain, surgery, trauma, HYPOXIA, electrolyte&acid/base imbalance, sensory deprivation/overload, hospitalization, depression, fecal impaction

Front 19

clinical manifestations of delirium

Back 19

confusion,changes in LOC, disorganization thought/speech, dec attention span, impaired memory, fear, anxiety, paranoia, sleep-wake disturbances,sundowning, illusions, delusions, agitation, hallucinations

Front 20

treatment of delirium

Back 20

determine the cause of the delirium & remove or resolve it

ex)give oxygen, antibiotic, fluids

Front 21

causes of dementia

Back 21

many illnesses, AIDS, chronic alcoholism,Alzheimer's disease, vitamin b 12 deficiency, carbon monoxide poisoning, cerebral anoxia,hypothyroidism, subdural hematoma, multiple brain infarcts

Front 22

clinical manifestations of dementia

Back 22

memory impairment deficits in reasoning, judgement, abstract thinking,registration, comprehension,learning, task execution & use of language

Front 23

treatment of dementia

Back 23

limited benefit is obtained in some patients treated with oral meds: donepezil, gingko, biloba

Front 24

sundowning (delirium)

Back 24

oriented during the day, confused at night

Front 25

illusions (delirium)

Back 25

inaccurate perception of sensory stimulation. stimulus is a real object. IV line- a snake. garbage can- a dog. can be explained and clarified.

Front 26

delusions (delirium)

Back 26

a false belief held with conviction despite overwhelming evidence to the contrary. ex) belief of being poisoned- will not eat; delusion of persecution, delusions of grander.

Front 27

hallucinations (delirium)

Back 27

false sensory stimulation. See or feel things (bugs,rats) that others do not see.

Front 28

three most common forms dementia

Back 28

-Alzheimer's disease
- vascular/multi infarct dementia
- dementia with lewy bodies

Front 29

Dementia with Lewy Bodies

Back 29

-second most common late onset dementia
- lewy bodies = abnormal concentration of protein in brain's nerve cells
-rather like Parkinson's, but in reverse ( righty, musculoskeletal problems after dementia)
-lewy bodys - don't get tremors

Front 30

Vascular/Multi Infarct Dementia

Back 30

-affects 60-75 y/o men>women
-abrupt onset with multiple remissions
- STEPWISE decline in mental functioning

signs=problems handling $
** stroke symptoms, blood getting to brain.

Front 31

risk factors vascular dementia

Back 31

htn, dm, cardio disease, smoking.

therapeutic interventions = treat above disorders early. may prevent progression

Front 32

Alzheimers Disease

Back 32

-early onset Alzeimers Disease (rare)
- - - - - - - - - - - -
-** late onset ( 65+)
-95 % all cases
- > 65 y/o
-many possible causative factors
-not a fatal disease in itself
- autopsy = only way to recognize it

Front 33

Warning signs of Alzheimer's

*remember there are "a's of Alzheimer's"

Back 33

memory loss that disrupts daily life, challenges in planning or solving problems, difficulty completing familiar tasks, confusion with time or place, trouble understanding visual images and spatial relationships, new problems with words in speaking/writing, misplacing things and unable to retract steps, decreased or poor judgement, withdrawal from work or social activities, changes in mood and personality

Front 34

Anomia

Back 34

difficulty finding words,remembering words & names of objects

Front 35

Aproxia

Back 35

loss of purposeful movement, inability to use objects appropriately, difficulty carrying out learned skills

ex) opening doors, getting dressed, using fork
ex)using fork to comb hair

Front 36

Agnosia

Back 36

loss of sensory comprehension. loss sensory ability recognize objects

late stages> doesn't recognize family or themselves.

Front 37

Amnesia

Back 37

loss of memory

Front 38

Aphasia

Back 38

inability to speak or understand. loss of language ability.

Front 39

Agraphia

Back 39

inability to express thoughts in writing. can't get thoughts on paper.

Front 40

Alexia

Back 40

inability to understand written language, can't read what was written.

Front 41

Stage One- Mild Alzheimer's

Back 41

- 2 to 4 years
-minimal assistance (2-3 hours per day)
-losing objects,getting lost,checkbook mistakes, personality changes

HIPPOCAMPUS HAS SHRUNK 50%

Front 42

Stage Two- Moderate Alzheimer's

(most difficult,longest)

Back 42

-2 to 10 years, longest stage.
-moderate supervision (4-8 hrs)
-getting lost in familiar places such as in own house, may pace & wander, powerful delusional beliefs & hallucinations in all 5 realms (sense)

Front 43

Stage Three- Severe Alzheimer's

Back 43

-1 to 3 years
-loss of sense of self and self awareness
-24 hr nursing care & supervision
- death is usually from secondary cause such as aspiration pneumonia (forgot how to swallow)

symptoms: extreme confusion & disorientation, inability to communicate affectively, severe visual spatial deficits, inability of ADLS

ONLY 10% OF HIPPOCAMPUS REMAINS

Front 44

Aricept ( donepezil )

Back 44

drug of choice to improve cognitive function, inhibits the enzyme that stops acetylcholine

Front 45

other drugs to help slow disease

Back 45

-namenda(mematine): dec abnormal brain activity causing clearer thinking
- cognex (hydrochloride) & exelon(rivatigmine) : inc levels of acetylcholine in the cps by inhibiting its breakdown
razadyne (galantamine): inhibits the enzyme that blocks acetylcholine

Front 46

nurses attitude ( unconditional acceptance )

Back 46

= single most effective tool in caring for demented patients!!!!!

Front 47

nurses need to..

Back 47

-facilitate the highest level of functioning a person is capable of
- set realistic goals
- find satisfaction in small accomplishments
-participate in research to increase knowledge about care & give a sense of purpose to work

Front 48

pain

Back 48

physical/mental suffering that causes stress/agony to the one experiencing it

affects include: immune system, coagulation, hyperglycemia, GI, urinary retention, dec lung volume

jacho=pain rating scale & goal

Front 49

past experiences & learned behavior..

Back 49

may influence sensory overload, stimuli interpreted by brain and regulate behavioral responses to pain

Front 50

cutaneous(superficial) pain

Back 50

involves skin/subq tissue. ex = paper cut

Front 51

somatic

Back 51

diffuse/scattered. originiates in tendons,ligaments,bones,nerves,blood vessels. ex= sprain

Front 52

visceral

Back 52

poorly localized and originates in body organs as organs are stretch, distended, ischemic, inflamed. ex= guarding/abdominal pain

Front 53

Adjunctive, Opiod, Nonopiod (Analgesics)

Back 53

adjunctive -anticonvulsants,antidepressants,multipurpose drugs

opiod-
all controlled substances (morphine, codeine,meperidine,hydromorphone,mathadone)

non opiod-
acetaminophen & non steroidal anti-inflammatorydrugs

Front 54

Gate Control Theory

Back 54

-small diameter=stimuli to brain
-large diameter=inhibit pain by blocking excitatory pain stimuli from small diameter nerve fibers

* to much info in the gating mechanism in the substantial gelatinosa causes the dorsal horn of the spinal cord to "CLOSE"
*affected by past experiences & learned behaviors

Front 55

psychogenic pain

Back 55

physical cause for the pain can not be determined

Front 56

acute pain

Back 56

seconds to less than 6 months. localized

Front 57

chronic pain

Back 57

lasts more than six months, lasts beyond normal healing period

remission:no symptoms(asymptomatic)
exacerbation: symptoms reappear

Front 58

neuropathic pain

Back 58

abonormal functioning of peripheral nerves or cns, cause unknown. burning/stabbing sensation

Front 59

allodynia

Back 59

neuropathic pain in response to non painful stimuli or normally weak stimuli

ex) ice cream, pain after light touch, pain after cold drink

Front 60

referred

Back 60

percieved in area distant from point of origin

Front 61

intractable

Back 61

resistant to therapy, ex back pain

Front 62

phantom

Back 62

pain receptors and nerves are absent ex) amputation

Front 63

psychologic (affective) responses

Back 63

exaggerated weeping&restlessness, withdrawl, anxiety, stoicism, anxiety,depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness

Front 64

behavioral (voluntary) responses

Back 64

-moving away from painful stimuli
-grimacing, moaning, crying
- restlessness
-protecting the painful area & refusing to move

Front 65

physiological (involuntary) responses

Back 65

-moderate and superficial sympathetic
-severe and deep parasympathetic

Front 66

moderate & superficial sympathetic

Back 66

- inc blood pressure
- inc pulse and reps rates
- pupil dilation
-muscle tension & rigitidy
-pallor
-peripheral vasoconstriction
-inc adrenaline output
-inc blood glucose

Front 67

sever & deep parasympathetic

Back 67

-nausea & vomiting
-fainting or unconsciouness
- dec blood pressure
-dec pulse rates
-prostration
-rapid & irregular breathing

Front 68

most reliable indicator of pain

Back 68

patients self report

Front 69

breakthrough pain (btp)

Back 69

temp flare up of moderate to severe pain that occurs even hen the patient is taking ATC medicine for persistent pain. Not diagnoses correctly & frequently under treated.

incident pain- caused by movement
idiopathic pain- spontaneous pain due to unknown cause
end of dose pain-pain occurs before next dose of analgesic is due

Front 70

placebo

Back 70

related to physiologic response (release of endorphins)

Front 71

non pharmacological

Back 71

biofeedback, cutaneous stimulation

Front 72

adjuvant

Back 72

used to enhance the effects of opiods by providing additional pain relief, may dec side effects from prescribed opiods/ lessen anxiety about pain experience

Front 73

pain tolerance

Back 73

increasing doses are needed

Front 74

addiction

Back 74

less than 1%, compulsive use other than for pain relief

Front 75

physical dependence

Back 75

withdrawal when dose is reduced

Front 76

numerical sedation scale

Back 76

1) awake & alert. No action
2) drowsy but easy to awake, no action
3) drifts off to sleep during condo; dec opiod use
4) no response to stimuli, discontinue opiod & use NALOXONE

Front 77

very thin & very obese =

Back 77

more susceptible to injurt

Front 78

immune response

Back 78

inflammatory response; protective mechanism to eliminate invading pathogen and allow tissue repair to occur

Front 79

allergic response

Back 79

inappropriate and harmful response of immune system

Front 80

intentional wound

Back 80

planned (surgical)

ex) incision

* HEALS BY PRIMATY INTENTION

Front 81

unintentional wound

Back 81

trauma,injury,accident

ex: bruising,contusion

Front 82

open wound

Back 82

skin surface is broken. ex a scrape,abrasion

Front 83

closed wound

Back 83

ex blister/contusion. no break in skin surface, interstitial results from a blow,force,strain,trauma. soft tissue is damaged and hemorrhage may occur resulting in ecchymosis and hematomas.

Front 84

what delays healing?

Back 84

corticosteriod drugs & postoperative radiation therapy

Front 85

surgical asepsis with wounds!

Back 85

minimizes infection risk!!

Front 86

hemostasis phase of wound healing

Back 86

-immediately after initial injury
-blood vessels constrict;blood clotting
-exudate formed, causes pain & swelling
-perfusion, results in heat & redness
-platelets stimulate other cells to migrate to injury

Front 87

inflammatory stage of wound healing

Back 87

-follows hemostasis, lasts 4-6 hours
-wbc move to wound!
-macrophages enter wound & ingest debris and attract fibroblasts to fill in wound
-patient has a generalized body response

Front 88

proliferation phase of wound healing

Back 88

-2/3 days of injury and may last 2/3 weeks
-new tissue built
-capillaries grow across wound
-epithelia cells form across wound
-granulation tissue forms a foundation for scare tissue development

Front 89

maturation stage of wound healing

Back 89

-final stage; @ weeks to 6 mo after injury
-collagen is remodeled& new collagen is deposited
-scar becomes flat thin white line

Front 90

wound dehiscence

Back 90

wound edges separate, can see granulation tissue, bleeds easily (hemmorage)

Front 91

wound evisceration

Back 91

wound is opened (dehiscence) and you can see internal organs

*elderly & obese

Front 92

fistula

Back 92

after surgery fluid in tissue and the body heals around the fluid, can ooze serous fluid for rest of life

Front 93

wound assessment

Back 93

always want to palpate!!!!!

sight & smell
palpate appearance,drainage,pain
sutures, drains/tubes & manifestation of complications

Front 94

dressing purpose

Back 94

-maintain moist wound environment
-absorb drainage
-protect skin surrounding wound