Critical-thinking Homework

Directions: Answer the followin" rel="nofollow">ing questions usin" rel="nofollow">ing critical-thin" rel="nofollow">inkin" rel="nofollow">ing. All answers must be typed in" rel="nofollow">into the document Chapter 1 1. Describe role of the rapid response team (RRT). Describe three patient changes where it would be appropriate for the nurse to notify the RRT. Answers: 2. QSEN identified patient-centered care as a nursin" rel="nofollow">ing competency. Describe one way in" rel="nofollow">in which nurses can encourage patients and their family members to become empowered. How will this make the healthcare experience safer? Answers: Chapter 2 3. Discuss the role of activity/mobility in" rel="nofollow">in the older adults’ life. Discuss implications of poor physical functionin" rel="nofollow">ing. Answers: 4. For each of the SPICES categories/conditions, describe one physiological age-related change that may be responsible for the condition. Answers: Chapter 3 5. Discuss the implications of treatment of pain" rel="nofollow">in with an opioid: side effects, adverse effects, nursin" rel="nofollow">ing assessment. Answers: 6. Discuss the followin" rel="nofollow">ing concepts: a. Neuropathic vs. nociceptive pain" rel="nofollow">in Answer: b. Referred vs. radiatin" rel="nofollow">ing pain" rel="nofollow">in Answer: Please answer the questions from those key poin" rel="nofollow">ints. No citation,no outside sources,and no references.Instructor stated " Summarize on your own english without copy from key poin" rel="nofollow">int" Ignatavicius: Medical-Surgical Nursin" rel="nofollow">ing, 8th Edition Chapter 01: Introduction to Medical-Surgical Nursin" rel="nofollow">ing Practice Key Poin" rel="nofollow">ints • One of the most successful IHI in" rel="nofollow">initiatives was the creation of the Rapid Response Team (RRT), also called the Medical Emergency Team (MET). o Rapid Response Teams are one in" rel="nofollow">initiative to save lives and decrease the risk for patient harm before a respiratory or cardiac arrest occurs. o Members of such a team are critical care experts who are on-site and available at any time to respond to calls for assistance. o Early clin" rel="nofollow">inical changes in" rel="nofollow">in condition occur in" rel="nofollow">in most patients for up to 48 hours before a “Code Blue.” o Therefore, observe for, document, and communicate early in" rel="nofollow">indicators of patient declin" rel="nofollow">ine, in" rel="nofollow">includin" rel="nofollow">ing decreasin" rel="nofollow">ing blood pressure, in" rel="nofollow">increasin" rel="nofollow">ing heart rate, and changes in" rel="nofollow">in mental status. Quality and Safety Education for Nurses Core Competencies • The six core competencies for health care professionals based on research by the Institute of Medicin" rel="nofollow">ine (IOM; http://iom.edu/) and Quality and Safety Education for Nurses (QSEN; http://www.qsen.org/) are: PATIENT-CENTERED CARE, TEAMWORK AND COLLABORATION, EVIDENCE-BASED PRACTICE, QUALITY IMPROVEMENT, INFORMATICS, and SAFETY. • Nurses, as advocates for the patient and family, teach them how to be empowered and have more control over their care. • The Join" rel="nofollow">int Commission recently started a Speak Up™ campaign to provide in" rel="nofollow">information to patients and families to in" rel="nofollow">increase their empowerment. • The three ethical prin" rel="nofollow">inciples to consider when makin" rel="nofollow">ing clin" rel="nofollow">inical decisions are self-determin" rel="nofollow">ination, beneficence, and justice. • Respect for people is one of six basic ethical prin" rel="nofollow">inciples that nurses and other health care professionals should use as a basis for clin" rel="nofollow">inical decision makin" rel="nofollow">ing. • Respect implies that patients are treated as autonomous in" rel="nofollow">individuals capable of makin" rel="nofollow">ing in" rel="nofollow">informed decisions about their care. • Patient autonomy is referred to as self-determin" rel="nofollow">ination or self-management. • The second ethical prin" rel="nofollow">inciple is beneficence, which emphasizes the importance of preventin" rel="nofollow">ing harm and assurin" rel="nofollow">ing the patient’s well-bein" rel="nofollow">ing. • Nonmaleficence follows the QSEN core competency of safety, ensurin" rel="nofollow">ing patient SAFETY and preventin" rel="nofollow">ing harm. Chapter 02: Common Health Problems of Older Adults Key Poin" rel="nofollow">ints Priority concepts applied in" rel="nofollow">in this chapter in" rel="nofollow">include NUTRITION, MOBILITY, SENSORY PERCEPTION, COGNITION, ELIMINATION, and TISSUE INTEGRITY. • Learnin" rel="nofollow">ing about the special needs of older adults is important for health care professionals in" rel="nofollow">in a variety of settin" rel="nofollow">ings. • The percentage of people older than age 65 years in" rel="nofollow">in the United States is about 13%. • The four subgroups of the older adult population are the young old, middle old, old old, and elite old. • The fastest growin" rel="nofollow">ing subgroup is the old old, sometimes referred to as the “advanced older adult” population. Members of this subgroup are sometimes referred to as the “frail elderly,” although a number of 85- to 95-year-olds are very healthy. • Frailty is a clin" rel="nofollow">inical syndrome in" rel="nofollow">in which the older adult has unin" rel="nofollow">intentional weight loss, weakness and exhaustion, and slowed physical activity, in" rel="nofollow">includin" rel="nofollow">ing walkin" rel="nofollow">ing. Frail elders are also at high risk for adverse outcomes. • The vast majority of older adults live in" rel="nofollow">in the community at home or within" rel="nofollow">in an environment that offers assistance. Only 5% are in" rel="nofollow">in long-term care (LTC). • Considerations of multiple older adult health issues in" rel="nofollow">in other types of in" rel="nofollow">institutions (prisons) in" rel="nofollow">include alcohol and substance abuse and poor NUTRITION. • The number of homeless older adults, in" rel="nofollow">includin" rel="nofollow">ing veterans of war, contin" rel="nofollow">inues to rise. These in" rel="nofollow">individuals are often faced with chronic health problems, in" rel="nofollow">includin" rel="nofollow">ing mental/behavioral disorders. HEALTH ISSUES FOR OLDER ADULTS IN COMMUNITY-BASED SETTINGS • Health status can affect the ability to perform daily activities and participate in" rel="nofollow">in social activities. • Increased dependence on others may have a negative effect on morale and life satisfaction. • Loss of autonomy is a pain" rel="nofollow">inful event with far-reachin" rel="nofollow">ing effects. • Older adults often experience personal losses that can affect their sense of control over their lives. • Many older adults are not prepared for retirement in" rel="nofollow">in view of in" rel="nofollow">increased expenses and in" rel="nofollow">income that is not adequate to meet basic needs, health care treatments, and medications. • Many are discharged from health care facilities and require home health services or live in" rel="nofollow">in long-term care settin" rel="nofollow">ings. • Coordin" rel="nofollow">inate care by collaboratin" rel="nofollow">ing with members of the health care team when providin" rel="nofollow">ing care to older adults in" rel="nofollow">in the community or in" rel="nofollow">inpatient settin" rel="nofollow">ing. • Provide in" rel="nofollow">information regardin" rel="nofollow">ing community resources for older adults to help them meet their basic needs. • Common health issues and geriatric syndromes affectin" rel="nofollow">ing the older adults in" rel="nofollow">include decreased nutrition and hydration, decreased mobility, stress and loss, accidents, drug use and misuse, mental health/cognition problems (in" rel="nofollow">includin" rel="nofollow">ing substance abuse), and elder neglect and abuse. • Decreased NUTRITION and hydration are two health problems experienced by older adults. o Reduced in" rel="nofollow">income, chronic disease, fatigue, and decreased ability to perform activities of daily livin" rel="nofollow">ing are other factors that contribute to in" rel="nofollow">inadequate nutrition among older adults. o Some older adults are at risk for geriatric failure to thrive (GFTT)—a complex syndrome in" rel="nofollow">includin" rel="nofollow">ing under-nutrition, impaired physical functionin" rel="nofollow">ing, depression, and cognitive impairment. o Many older adults are at risk for under-nutrition, most often protein" rel="nofollow">in-calorie malnutrition, also known as protein" rel="nofollow">in-energy malnutrition. o Older adults may respond to lonelin" rel="nofollow">iness, depression, and boredom by not eatin" rel="nofollow">ing. o Dimin" rel="nofollow">inished senses of taste and smell often result in" rel="nofollow">in a loss of desire for food, and poor dental status can affect their ability to chew. o The risk for dehydration is greater in" rel="nofollow">in older adults because of many factors, in" rel="nofollow">includin" rel="nofollow">ing diuretics, in" rel="nofollow">incontin" rel="nofollow">inence concerns, and decreased thirst mechanism. • Decreased MOBILITY o Exercise and activity are important for older adults as a means of promotin" rel="nofollow">ing and main" rel="nofollow">intain" rel="nofollow">inin" rel="nofollow">ing health. o Teach older adults about the benefits of regular physical exercise. • • Stress and Loss o Stress can speed up the agin" rel="nofollow">ing process over time, or it can lead to diseases that in" rel="nofollow">increase the rate of degeneration. It can also impair the reserve capacity of older adults and lessen their ability to respond and adapt to changes in" rel="nofollow">in their environment. o Relocation stress syndrome is the physical and emotional distress that occurs after the person moves from one settin" rel="nofollow">ing to another and may cause sleep disturbance and physical symptoms, such as GI distress. • Accidents o The biggest concern regardin" rel="nofollow">ing accidents among older adults in" rel="nofollow">in both the community and in" rel="nofollow">inpatient settin" rel="nofollow">ing is falls. • Older adults need to be aware of safety precautions to prevent accidents, such as falls. • Incapacitatin" rel="nofollow">ing accidents are a primary cause of decreased mobility in" rel="nofollow">in old age. • Changes in" rel="nofollow">in vision, touch, and motor ability can create challenges for older adults in" rel="nofollow">in any environment. o Motor vehicle accidents are the most common cause of in" rel="nofollow">injury-related death in" rel="nofollow">in the young old population, those between 65 and 74 years of age. • Health care professionals play a major role in" rel="nofollow">in identifyin" rel="nofollow">ing driver safety issues. • Sin" rel="nofollow">ince 1996, the Hartford Institute for Gerontological Nursin" rel="nofollow">ing has worked to ensure that all hospitalized patients 65 years of age and older be given quality care. • The Fulmer SPICES framework was developed as part of the NICHE project and identifies six serious “marker conditions” that can lead to longer hospital stays, higher medical costs, and even deaths. These conditions are: o Sleep disorders o Problems with eatin" rel="nofollow">ing or feedin" rel="nofollow">ing o Incontin" rel="nofollow">inence o Confusion o Evidence of falls o Skin" rel="nofollow">in breakdown • Use the SPICES assessment tool for identifyin" rel="nofollow">ing serious health problems that can be prevented or managed early. • Follow The Join" rel="nofollow">int Commission’s National Patient Safety Goals (NPSGs) and best practice guidelin" rel="nofollow">ines to prevent agency-acquired pressure ulcers. • Physical and chemical restrain" rel="nofollow">ints should not be used for older adults until all other alternatives have been tried. If necessary, use the restrain" rel="nofollow">int that is least restrictive first. • The most common accident among older patients in" rel="nofollow">in a hospital or nursin" rel="nofollow">ing home settin" rel="nofollow">ing is fallin" rel="nofollow">ing. A fall is an unin" rel="nofollow">intentional change in" rel="nofollow">in body position that results in" rel="nofollow">in the patient’s body comin" rel="nofollow">ing to rest on the floor or ground. • Main" rel="nofollow">intain" rel="nofollow">inin" rel="nofollow">ing TISSUE INTEGRITY is a major safety goal in" rel="nofollow">in the care of older adults. Prevention is key! The nurse uses evidence-based treatment for pressure ulcers, shear in" rel="nofollow">injuries, and skin" rel="nofollow">in tears. Supervisin" rel="nofollow">ing unlicensed assistive personnel in" rel="nofollow">in protectin" rel="nofollow">ing fragile skin" rel="nofollow">in and coordin" rel="nofollow">inatin" rel="nofollow">ing in" rel="nofollow">interventions with the health care team is necessary to prevent harm and promote healin" rel="nofollow">ing. Chapter 03: Assessment and Care of Patients with Pain" rel="nofollow">in Key Poin" rel="nofollow">ints DEFINITIONS OF PAIN • PAIN is what the patient says it is. Self-report is always the most reliable in" rel="nofollow">indication of PAIN. • Factors that affect PAIN and its management in" rel="nofollow">include age, gender, genetics, and culture. • Three major types of PAIN have been identified—acute, chronic cancer, and chronic non-cancer. CATEGORIZATION OF PAIN BY DURATION • The two major types of PAIN are acute and chronic. • Acute pain" rel="nofollow">in often results from sudden, accidental trauma (e.g., fractures, burns, lacerations) or from surgery, ischemia, or acute in" rel="nofollow">inflammation. As in" rel="nofollow">injured tissue heals, SENSORY PERCEPTION changes. • Chronic pain" rel="nofollow">in or persistent pain" rel="nofollow">in is further divided in" rel="nofollow">into two subtypes. o Chronic cancer PAIN is associated with cancer or another progressive disease such as acquired immune deficiency syndrome (AIDS). The cause of PAIN is usually life threatenin" rel="nofollow">ing. o Chronic non-cancer PAIN is associated with tissue in" rel="nofollow">injury that has healed or is not associated with cancer, such as arthritis or chronic back pain" rel="nofollow">in. This type of pain" rel="nofollow">in is the most common. • Acute PAIN serves as a warnin" rel="nofollow">ing to the body, causin" rel="nofollow">ing sympathetic responses such as in" rel="nofollow">increased heart rate, in" rel="nofollow">increased blood pressure and pulse, dilated pupils, and sweatin" rel="nofollow">ing. • Both types of chronic PAIN do not cause sympathetic reactions. Therefore, some patients do not appear to be in" rel="nofollow">in pain" rel="nofollow">in, even when they are. CATEGORIZATION OF PAIN BY UNDERLYING MECHANISMS • Pain" rel="nofollow">inful stimuli often origin" rel="nofollow">inate in" rel="nofollow">in the periphery of the body. o To be perceived, the stimuli must be transmitted from the periphery to the spin" rel="nofollow">inal cord and then to the central areas of the brain" rel="nofollow">in. • Nociceptive Pain" rel="nofollow">in o Normal pain" rel="nofollow">in processin" rel="nofollow">ing, believed to be sustain" rel="nofollow">ined by tissue damage or in" rel="nofollow">inflammation. Duration can be acute and/or chronic. o The gate control theory in" rel="nofollow">involves a gatin" rel="nofollow">ing mechanism in" rel="nofollow">in the spin" rel="nofollow">inal cord. When the gate is opened, pain" rel="nofollow">in impulses ascend to the brain" rel="nofollow">in; when closed, the impulses do not get through and PAIN is not perceived. o Nociception has four processes, in" rel="nofollow">includin" rel="nofollow">ing SENSORY PERCEPTION (in" rel="nofollow">involves the conscious awareness of PAIN). o Somatic PAIN arises from the skin" rel="nofollow">in and musculoskeletal structure. o Visceral PAIN arises from organs. • Neuropathic Pain" rel="nofollow">in o Sustain" rel="nofollow">ined from abnormal processin" rel="nofollow">ing of stimuli and can occur in" rel="nofollow">in the absence of either tissue damage or in" rel="nofollow">inflammation. o Difficult to treat and often resistant to first-lin" rel="nofollow">ine pain" rel="nofollow">in agents. o PAIN descriptors in" rel="nofollow">include “burnin" rel="nofollow">ing,” “shootin" rel="nofollow">ing,” “stabbin" rel="nofollow">ing,” and feelin" rel="nofollow">ing “pin" rel="nofollow">ins and needles.” • Tolerance implies that the patient has adapted to a drug and, over time, its effects declin" rel="nofollow">ine. • Physical dependence is manifested by a withdrawal reaction. • Addiction is a primary, chronic disease that occurs over a long period. Behaviors in" rel="nofollow">in addiction in" rel="nofollow">include cravin" rel="nofollow">ing, compulsive drug use, and contin" rel="nofollow">inued use despite harm. • The opioid full agonists are most effective for both acute and chronic PAIN management. They bin" rel="nofollow">ind to mu receptors and block pain" rel="nofollow">in transmission. o Equianalgesic charts are useful when changin" rel="nofollow">ing from one opioid to another. A morphin" rel="nofollow">ine dose of 10 mg is the standard dose again" rel="nofollow">inst which other opioids are measured. o Morphin" rel="nofollow">ine and similar mu agonists are the gold standard drugs for both acute and chronic pain" rel="nofollow">in and are available in" rel="nofollow">in many forms, both short actin" rel="nofollow">ing and long actin" rel="nofollow">ing. o Other commonly used mu agonists in" rel="nofollow">include oxycodone, hydromorphone, and fentanyl. o Meperidin" rel="nofollow">ine is an outdated drug and is rarely used. Its toxic metabolite (normeperidin" rel="nofollow">ine) can accumulate, especially in" rel="nofollow">in the older adult or someone with decreased renal clearance, and can cause seizures and confusion. o Observe for and prevent common side effects of opioids, in" rel="nofollow">includin" rel="nofollow">ing nausea and vomitin" rel="nofollow">ing, constipation, sedation, and respiratory depression.