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76 Cards in this Set

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Who are the Stakeholders in Healthcare?
Physicians, Nurses, Corporateions, Profit & Not For Profit Insurance Companies, Hospital Administrators, Hospital Boards, The Public
Why is Funding Important?
It pays for everything, even the Nurses Salary.
What is Healthcare Reform?
It tries to address the situation that some people in our contry have great Healthcare, while others have none.

This needs to be fixed. America spends billions on healthcare in this state. Other countries don't have this same type of problem.
What Role do Nurses Play in Reform?
Acting as Member with the discipline and helping with lobbying.

Providing good quality care, but don't waste.

Only put Biohazard materials into Biohazard Containers.

Only use Sharps containers for Sharps.

Don't waste. Linner or even Tissue add up.

Be a total Advocate. Start at the bedside, unit, facility, community, state and Federal levels.
What is the requirement for an R.N. in a LTCF?
One RN has to be on duty for 8 Consecutive Hours, seven days each week.
When must an initial assessment be done in a LTCF?
Within 14 days of admission, or when status changes.
Describe the origins of LTCF.
In 1935 Nurses began to board people in their homes. Many of these were run by relidious organization, and were not for profit.
Discuss Growth of Nursing Home Residents in the 20th Century.
Year # Nursing Homes Residnets (000)
1940 1200 25
1960 9582 290
1970 22004 1076
1980 30111 1396
1990 14744 1558
1999 18000 1965

Basically a Dip in the early 1990's
What is the ratio of Women to Men in LTCF?
3:1
Are LTCF inspected with or without an appointment?
Inspections are Unannounced.
Are Hospitals given notice of upcomming JHACO Inspections?
Yes
What age ranges of people are in LTCF?
All ages, not just the elderly.
What are the average characteristics of a LTCF Resident?
83 / Single and a Widow / Female / White
Is admission to a LTCF always as a result of a change of health of the client?
No, sometimes the caregiver has a change of health, or is no longer able to care for the new resident.
What is the primary role of the RN in a LTCF?
Assessments.

They are done within 14 days of admission, with @ in condition, when using alert charting, as needed, and anually.
What is the primary role of the LPN in a LTCF?
Primarily to Pass Medications.
What is an MDS?
Minimum Data Sheet. Extensive data about the client. Usually does not contain Psycho Social information about the client.
Who is responsible for the Careplan in a LTCF?
The RN.

-It is based on needs in the MDS.
-Contains goals and actions to address current needs.
-States realistic, clear, specific and measurable goals.
-Is accessible and utalized by all caregivers
-Is evaluated at least quarterly & revised as necssary, especially when significan change in condition occurs.
What is one of the major issues that residents in LTCF face?
Loss
List some of the types of Loss that LTCF residents face?
Family
Pets
Privacy
Control
Favorite Teapot
Window on the World
Who deals with LTCF Losses?
Both the resident, and the family.
Discuss the importance of Communication in a LTCF.
Many tasks are delegated to AP like CNA or LPN. It is very important for the RN to maintain good, TWO WAY communication with these AP.
Define Mobility and Immobility.
The ability to move about freely is mobility. The opposite, or inability to move about freely is immobility.

It is a continium from 0 (Immobility) to 100 (Mobility)
Define some of the things that mobility allows.
Self Defense, Recreation, Performance of ADl's, and functions of normal physiologies.
What is Bedrest?
Restrict movement for Theraputic Reasons.
Why is bedrest prescribed?
Lessens 02 demands.

Allows body to regain strength

Prevents Further Injury
How long does it take for muscle to begin to deterioriate?
It can be seen in a matter of days.
How much strength loss can be seen daily during bedrest?
3% Per Day.
What are some of the conditions that would cause mobility restrictions?
MI
Sprains
Strains
Cancer
Obisity
Dislocation
Fractures
What are the metabolic complications that Immobility can cause?
Appatite
BMR
Bone Re-Absorption
GI Distress and Constipation
What are the Respiratory complications that Immobility can cause?
Lung Expansion
Increased Secretions
Atelectasis leading to Pneumonia
What are the Cardiac complications that Immobility can cause?
Orthostatic HTN
Thrombus Formation
What are the Musc Skell complications that Immobility can cause?
Loss of Endurance
What are the Urinary complications that Immobility can cause?
Formation of Calculi
What are the Psycho/Social complications that Immobility can cause?
Depression
Behavior Changes
Altered Sleep/Wake Cycles
Decreased Coping
Increased Isolation
Sensory Deprivation
What are two key things to remember about pressure ulcers in Acute Care?
Reposition q.2h

Use Correct Transfer Techniques
What are threee main reasons people are in acute care?
Respiratory
Orthopedic
Skin Issues
What are the three types of Restraints?
Mechanical

Physical

Medicinal
Define Restraints
Used to Immobiliae a client.

Restrains freedom of movement or normal access to body and not part of treatment plan.
What are some alternative to restraints?
Orient clients and families to surroundings.

Encourage family and friends to stay and help.

Assign confused and disoriented clients near station.

Provide appropriate A/V stimuli

Eliminate bothersome treatments ASAP.

Use relaxation techniques

Institute exercise and relations

Provide scheduled toileting, especially during peak fall times

Consult with PT and OT to enhance client ADL pursuits
Are restraints always without advsere affects?
No, sometimes they cause more harm than good.
What is a key rule to remember about restraints when a family member is present?
Untie the client, and get the family members help. Also, client less likely to pull at tubes when family members are present.
What, in addition to state regulations must be considered when using restraints?
Agency/Facility policies.
How can you clinicially justify restraints?
Chart reasons leading to restraints.

Chart Goals and objectives of restraints

Chart Client Responses.
Name some Key Restraint Points
-Use Proper Body Alignment
-Pad Bony Prominences
-Attach to Frame/Not Siderail
-Use Quick Release Tie
-Allow two fingers space
-Check q.30 minutes
-Remove q.2h for 30 minutes
Deinfe Tissue Ulcers.
Impaired Skin integrity from pressure which leads to tissue necrosis.

"Soft Tissue compressed between bony prominence and external surface for a prolonged period of time."
Name 3 Factors Affecting Pressure Ulcer Formation.
Pressure Intensity
Pressure Duration
Tissue Tolerance
Caused by decreased capillary
closing pressure. Tissue Ischemia
Define Reactive Hyperemia
The increased presence of blood in an area after restoration of blood flow, following decreased supply.

Like the spot on your knee when your legs have been crossed.
Name three Systemic Factors that can help prevent pressure ulcers.
-Intact Immune System
-Keep well hydrated
-Maintain Good Nutrition (Elders tend to eat less)
Name Five risks for pressure ulcers
Impaired Sensory Inputs

Impaired Mobility

Sheer (Slow - Overtime)

Friction

Moisture
With regard to Pressure Ulcers, what are some examples of Impared Sensory Input?
Neuro Problems

Aging
With regard to Pressure Ulcers, what are some examples of Sheer.
It is force exerted paralell to skin.

Often seen in improper transfer.
With regard to Pressure Ulcers, what are some examples of Friction.
Mechanical Action during dragging. Affects the epidermis.
With regard to Pressure Ulcers, what are some examples of Moisture.
Incontinence
Sweating
How does Moisture relate to risk of pressure ulcers?
Moisture causes skin to become soft, like wrinkly fingers in the bath tub.
Define some ways to classify Pressure Ulcers.
Stage-Depth
Type & Percent in Wound Bed
Dimenstions
Excudate
What does it "Look Like"
What does it "Smell Like"
What is the condition of surrounding skin.
What is Black Eschar
Dead matter that is cast off from the surface of the skin, esp. after a burn.
What problems does Eschar cause with a Pressure Ulcer?
The wound cant' be staged.
What might a physician order when a pressure ulcer is covered with Eschar?
An enzyme that can be applied to the border of the wound. It "eats" the dead tissue, while leaving healthy tissue inteact.
What are the characteristics of a Stage I Pressure Ulcer?
Reactive Hyperemia.

Skin is intact. There is persistant temperature, and redness (or blueness in POC)
What are the characteristics of a Stage II Pressure Ulcer?
Partially open to the dermis, or epidermis.

Superficial

Blisters, abrasian, or shallow crater.
What are the characteristics of a Stage III Pressure Ulcer?
Full thickness of skin loss involving damage or necrosis of SQ tissue which my extend down to, but not through the underlying fascia.

May go to muscle or bone, but no tunneling.
What are the characteristics of a Stage IV Pressure Ulcer?
Extensive, tunneling hyas begun. Extensive damage to muscle, bone, or supporting structors such as tendon, joint capsule.
Define Blanching
Test of the integrigty of the circulation performed by applying and then quickly releasing pressure to an area exhibiting hyperemia.
If skin blanches over an area of Reactive Hyperemia, what is it called?
Transient.
If skin does not blanche then what is it called?
Abnormal Reactive Hyperemia. An early sign of a pressure ulcer.
When client is recovering from a pressure ulcer, what type of food is important?
Protein.
What is the term for removing dead (necrosied) tissue from a pressure ulcer?
Debridement

The removal of foreign material and dead or damaged tissue, esp. in a wound.
What are some different ways to débride a wound?
Mechanical
Wet -> Dry Dressings
Hydro Therapy
Irrigation
Enzematic
Autolitic
What key nuring manamgnet issue must be taken into consideration when debriding a wound?
It is VERY PAINFUL and proper pain management is necessary.
What is dysphagia
DIfficulty Swallowing
What are the Water Soluable Vitamins?
B and C
What are the Fat Soluable Vitamins?
A D E K
What is Anthropometry?
Measurement system of the size and makeup of the body.
Define Strain.
Trauma to muscle body or to the attachment of a tendon from overstretching, overextension, or misuse.

Characterized by muscle spasm and discomfort.
Define Sprain.
Injury to a ligiment resulting from overstress that damages ligament fibers, or their attachment to a bone.