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Health/Complementary Therapies + Ethics/Legal/HIPAA + Sleep/Stress

Terms in this set (17)

Define health (2 ways). What does healthy people 2020 provide? Identify? 3030 will promote? What is Maslow's hierarchy of needs? What does it help nurses do?

What influences health beliefs and practices? What are the internal variables?External? What do negative or positive beliefs influence?
a state of complete physical, mental, and social well-being and not just the absence of disease
state of being in relation to values, personality, and lifestyle
10 year objectives for promoting health and preventing disease
Leading health indicators
Holistic approach

Relationships between basic human needs (physical, safety, love, self-esteem, self actualization-bottom to top)
Set priorities

How someone thinks and acts
Internal and external variables
Internal-developmental stage, emotions (like stress, depression, anxiety), spiritual (connectedness to God and illness), knowledge (about health and illness), perception of function (pain and SOB)
External-family beliefs, culture, and social determinants of health

Health behavior/practices
What does health promotion do? Education? Illness prevention? What are passive and active strategy examples for health promotion?

What are the levels of prevention? What are the risk factors that increase the vulnerability of an individual to illness/disease?

Define illness. What is the difference between acute and chronic illness? What are internal and external variables that affect illness behavior?

What are the impacts on patient and family?
Helps people maintain or improve health
Helps people understand health
Helps people prevent a threat to health
Passive-fluoridation of city water
Active-smoking cessation and weight loss

Primary (prevention)-occurs before disease and will truly lower chances of disease (vaccines, screenings)
Secondary (slows)-the early stage of the disease and will delay advancing of it
Tertiary (treats)-late stage of disease and focus on rehab

Genetics, age, gender, family history, lifestyle, environment

State where physical, emotional, social (etc) wellbeing is diminished
Acute-short, severe, and reversible
Chronic-longer than 6 months and irreversible

Internal-perception of illness and seriousness
External-visibility of symptoms, culture, SES, social group, accessibility of health care

Emotional, behavioral, self-concept, body image, family roles (stress and coping), family dynamics (role conflict)
What is the difference between complementary and alternative therapies? What are reasons people seek out CAT? Are there combinations of both? What does integrative health care focus on?

What are the types of relaxation therapy? What are the benefits and negatives? What do you do in meditation + what does this cause? What are the benefits and negatives? For imagery, when you make mental images what are you doing? What are the benefits and negatives?

Recall the fight or flight body responses due to cortisol release. What is biofeedback? What are the benefits and negatives?
C-in addition to allopathic
A-instead of allopathic
Less invasive, more satisfaction, desire to be involved, beliefs, research, desire to combine treatments
Yes
Whole person

Progressive and passive
Lower BP, tension, distress
Increase sensitivity and too much focus
DIrect attention to one stimulus-increase awareness and lower stimulus
Lower blood pressure, substance relapse, mood issues (distress/anxiety/depression)
Increase drug effects and high blood pressure
Stimulating physical change, improved well-being, and increased self-awareness
Lower pain, nightmares, and improve sleep
Anxiety (for those with PTSD and anxiety), airway constriction (for those with COPD)

Teach self-regulation/control over physiological responses
Stroke, smoking, ADHD, epilepsy, headache, Gi, urinary
repressed emotions
What does healing touch do? Magnet therapy? Reiki therapy? Therapeutic touch? What are the benefits and negatives?
What does Chinese medicine focus on? What are the types? What are the benefits and negatives?

What does acupuncture do? What are the benefits and contraindications/precautions?

What is a natural products/herbal medicines produced by? Are they regulated by FDA? What mark should you look for? Is this the oldest medicine form? What are negatives?

What are the benefits and negatives of chiropractic therapy? What does yoga focus on?
Bring balance to body fields
Release pain with bagments
Transfer energy through hands placed over area (Buddhist)
Transfer energy by touching patient
Positive-pain, dementia, trauma, anxiety
People who don't like touch or energy alteration

Balance
Acupuncture, ingested herbs, moxibustion (burning herbs), cupping, tai chi, (moving meditation) gi gong (manipulating qi thru movement)
Fibromyalgia and menopause
Safety concern because not regulated

Realign qi in meridians
pain, hot flashes, headache, sinusitis, GI disorders
Bleeding disorders and skin infection
Blood disease like HIV or hepatitis, pregnancy

Living organism
No
USP seal
Yes
Might not be safe and can cause interactions

Benefits-subluxation, bone pain, joint pain, asthma, headache, dysmenorrhea, vertigo, tinnitus, visual disorders
Negative-risk for injury
Contraindicated in infections, myelopathy, fractures, dislocation, rheumatoid arthritis, osteoporosis

Muscles, posture, breathing, consciousness
What is the difference between morals and ethics? Define autonomy, beneficence, non-maleficence, justice, fidelity, and bioethics. What are the dimensions of the Professional Nursing Code of Ethics? What does it help professionals do? Access to care is what type of issue?

What is deontology? Utilitarianism? Casuistry? Feminist ethics? Ethics of care? What is an ethical dilemma? Moral distress?

Define value. Ethical dilemmas almost always occur in the presence of what? How do we resolve?

What is concensus building?
Morals-individual judgment about behaviors based on beliefs (guiding principles)
Ethics-The study of/creation of rules of conduct (what should I do)-morals in action
Autonomy-letting patients make decisions
beneficence-Positive actions to help others
Nonmaleficence-avoiding harm
Justice-being fair
Fidelity-keeping promises
Bioethics-Ethics in healthcare
Advocacy, responsibility, accountability, and confidentiality
Settle questions about behavior
Ethical issues of justice

Defines actions as right or wrong based on adheres to things like fidelity, justice, truth
Value of something determined by usefulness
"it depends" reasoning
Involves the nature of relationships to guide decision making
Understanding things with an emphasis on the decision-maker
When both sides of an argument can be deemed ethical
Feeling the need to side with one argument even though it may be wrong

Deeply held belief of the value of something
Conflicting values
Distinguish between values, facts, and opinions

Collective wisdom guides group to best possible decision
What are the purposes of ethics committees? Who can request these services? Quality of life is central to what? What enhances the economic security for those with a physical, mental, or emotional disability? What is care at the end of life? What is Health Care Reform? A. risk of genetic screening? Social Media a risk for?

To provide culturally competent care and end-of-life, we should do the following:
Acknowledge'respect ______
Be willing to _____ when views differ
Be aware of ones own ___ and ___
Use communication skills that enhance _____
Learn ____ of patient groups that are regularly seen
Do not ____ someones views based on their ethnic group

Older people aren't as familiar with the concept of what?
AS people age, they gain conditions that affect what? Don't mix this up with cognitive issues!
Some elders become incapacitated by what?
Consensus about what is hard to achieve?
Some elders defer to who?
Some elders will not ___ providers.
Education, policy recommendations, case consultations
Any healthcare provider, plus patients and family members
cancer therapy decisions, DNR, physician-assisted suicide, and end-of-life care
Antidiscrimination laws
Interventions unlikely to produce benefit
Help give access to care for uninsured Americans
Learning about a disease that has no cure/no symptoms currently
Patient privacy

Cultural differences
Compromise
Values, biases
Empathy
Cultural practices
Assume

Autonomy
Communication
Stroke, disease, medications
Medical goals
Family
Contradict
What is the difference between constitutional law and statutory law? Criminal + what they do and civil + what they do? What is the difference between felony and misdemeanor? What are the consequences of civil law violations + what is a common civil law violation for nurses? What does the Nurse Practice Act of each state do?

What do standards of care define? This is compared to nurses conduct in what? The best known version comes from where? Are these set by state or federal? What does the Joint Commission require?

What are some federal statutory laws + what they do?
Constitutions (federal or state)
State law
Criminal (felonies or misdemeanors)-prevents societal harm
Felony-a serious offense that causes serious harm-nursing without a license or misuse of a controlled substance
Misdemeanor-cause harm but not as serious-simple patient assault or exposure
Civil-protect individuals and ensure fair treatment
Fines and public service
Negligence or malpractice
Define scope and education requirements of nursing

Nursing practice and minimum acceptable care
Malpractice lawsuit
ANA
Both
Policies and Procedures

ADA-protects rights of people with physical or mental disability
EMTALA-must be treated if entering ED
Mental Health Parity Act under ACA-strengthen mental health services and decreases discrimination
What is the Patient Self-Determination Act? In order for these to occur, a patient must be declared what? DNR cannot be placed without what? True or false, HCP perform CPR on someone unless their chart says DNR?

What is the Uniform Anatomical Gift Act + where does it need to be stated? If decision making isn't possible, what is the sequence of decision making in family? What two things does this act state?

What does the ACA do? HIPAA? HITECH + what nurses must ensure?

What committees have placed rules on restraints? When can restraints be used? What must occur after?
Advance directives such as living wills, health care proxies, or durable power of attorney
legally incompetent (unable to make own decisions)
Talking to patient/family/decision-maker
True

Organ donation from 18 yr old or older in writing
Spouse, adult children, parent, adult subling, grandparent, guarding
Cannot sell organs and donors estate is protected from liability

Prohibit denial of coverage or limit on the amount of care based on preexisting conditions, affordable healthcare coverage, increased access to care without copays or deductibles for preventative services, and stronger medicare

Rights to patients and protects employees, protects people from losing insurance when changing jobs, creates right to inspect ones medical record/amend mistakes/consent to disclose health information, confidentiality, and limits who can access

Expands HIPAA when breach of PHI occurs-nurses must ensure PHI isn't on social media and data isn't disclosed unless allowed by patient

ANA, CMS, and JC
Ensure the safety of the patient or others, when less restrictive interventions are unsuccessful, or written order of HCP
Dcumentation and follow up assessments
Who licenses RNs and what are the requirements? What do Good Samaritan laws do? When are you liable? What do public health laws do? What must you report? What is the Uniform Determination of Death Act? Who can autopsies be requested by? For Death with Dignity of Physician-Assisted Suicide, when can this be done? What does the ANA say about this? AACN?Are these all statutory or constitutional?

Informed consent means what? What does the nurse's signature mean? They must know that they can do what?

What does malpractice insurance provide? Nurses are covered when? Nurses are investigated by who?
State Board, education and NCLEX
Protects nurses who help in off duty emergency
If you exceed your scope or leave before adequate help arrives
Protect people, advocate rights, regulate care and financing, and ensure accountability for care
Child abuse/neglect
Cardiopulmonary determination of death or cessation of brain function
Patient/family
Competent and have a terminal, irreversible illness
Violates nursing code of ethics
Support mandate to ensure a peaceful end of life
Statutory

Allowing care based on full disclosure of treatment, people and qualifications who are performing, risks, benefits, alternatives, and consequences of refusal
the patient voluntarily gave consent, the patient's signature is authentic, and the patient is competent enough to give consent
Refuse

Defense when a nurse is in a negligence or malpractice lawsuit
When working
State Board or Commission
Are nursing students liable for harm they cause? What must you do before engaging in a new skills? How must you represent yourself? Perform? Separate student role form?

When can you refuse a patient assignment? What occurs with short staffing and what does the ANA require? Floating based on? What is the exception to following HCP orders?

What do nurse experts do? What do they determine before accepting a case?

What are the steps involved in risk management? What is one tool in risk management and what does it serve as/alert? What are the Joint committee protocols? What are the never events?

What are torts? Explain intentional, quasi-intensional, and unintentional..
Yes
Talk to preceptor/faculty
Student
Professional
CNA

Don't have the skill required
Care exceed Nurse Practice Act scope
The health of nurse is at risk
Not oriented
Moral/ethical/religious
Fatigue impairing judgment

Legal issues-55% direct-care nurses
Patient load and acuities
Error/harmful

Testifies about the standards of nursing care in a case
No conflict of interest present

Identify possible risks
Analyze risks
Act to reduce risks
Evaluate
Incidence/occurrence report
Database for further investigation, alerts risk management team

preop verification of documents, marking the operative site, and time-out for final verification (patient procedure site implants)
Preventable errors such as UT from caths, falls, pressure ulcers

Civil wrong against person/property

Intentional-assault (intentional threat towards person causing fear or harm-no contact is required), battery (intentional offensive touching without consent), false imprisonment (intentional unjustified restraint of a person without legal reason)
Quasi-intentional-invasion of privacy, defamation of character (slander or llibel)
Unintentional-malpractice or negligence
What are circadian rhythms + what are they affected by? The rhythm of sleep becomes synchronized with what? What is sleep regulated by + what are the locations? What changes is sleep associated with?

How many stages of NREM sleep are there? How long is one sleep cycle? How many cycles per night? What is the cycle order? Older people spend more time in what stages?

What are the purposes of sleep + what declines in the first + what hormone is involved in the second + what stage for the third? What does the loss of REM sleep cause? When do dreams occur and which are more vivid? What are they important for?

What does rest contribute to? Does it guarantee that ou will feel rested? What can physical illness cause and what are examples?
Hypothalamic control of the sleep-wake cycle, affected by social activities/work/temperature/light
Other body functions
Physiological states integrated by the CNS-hypothalamus, RAS, and Process S
PNS, endocrine, cv, respiratory, and muscular systems

4, 90-100 minutes, 4-5, 1-4, then backward 3 2 and REM, lighter stages

Body/mind restoration (decrease HR BP RESP and muscle tone), maintenance of bio functions (GH), and body tissue restoration (NREM)
Confusion/suspicion
NREM and REM, but REM are more vivid
Learning, memory, stress adaptation

Mental relaxation, freedom from anxiety, state of mental/physical/spiritual activity
No
Pain, anxiety, depression, sleep issues-HTN, resp disorders, nocturia, and RLS
What is sleep apnea? Is Central SA common or relatively uncommon? Where is dysfunction occurring? What fails? What falls? What happens during the night and what are complaints as a result? What is also present?

Is Obstructive SA common or relatively uncommon? TWo risk factors? What occurs? What is the most common complaint? When is sleepness the most common? What falls?

What are two sleep-related movement disorders? How many hours of sleep do the following groups need? Neonates/infants, toddlers/preschoolers, school-age to 12 years, adolescents, young adults, middle/older adults?

What are the types of sleep disorders?
Lack of airflow through the nose and mouth for 10 seconds or longer
Relatively uncommon
The respiratory control center of the brain
Impulse to breathe
O2 sats
Waking up-insomnia and EDS (excessive daytime sleepiness)
mild, intermittent snoring

Common
Obesity and hypertension
Structures of the oral cavity or throat relax and block the upper airway (partially or completely) which slows or stops airflow through the nose for up to 30 seconds
EDS
Awakening, before sleep, 12 hours after midsleep
O2sats-severe decline

RLS-agitation and movement of the leg, described as the sensation of bugs crawling in/n skin
Bruxism-grinding teeth
15-16 hours, 12 hrs, 9-10, 7.5, 6-8.5, and total number declines

insomnia-acute, behavioral, sleep hygiene, and medical condition
Sleep apnea-central, obstructive, mixed-EDS
Narcolepsy-sudden onset sleep, cataplexy (muscle weakness when emotional), sleep paralysis
Sleep deprivation-stress, medication, environment
Parasomnias-sleepwalking, nightmares, bed-wetting, rocking, bruxism
Sleep-related movement disorders
What factors influence sleep?

Who is a good source for sleep assessment? A poor night's sleep starts a cycle of what? For their sleep history/sleeping problems, what is a good tool. What kind of questions to ask? overall, what thinsg do we ask about?
WHat could we create for goals and outcomes? For priorities, sleep disturbances are often the result of what?

Define stress, appraisal, and trauma. What effects does stress have on the immune response? What do the medulla oblongata, RAS, and pit gland do for the SNS?

What is general adaptation syndrome + where it starts? What are the stages? Chronic arousal causes wear and tear, which is called what? Persistent allostatic load can cause what?
Drugs (alcohol nicotine caffeine beta blockers Benzes anticonvulsants hypnotics opiates antidepressants diuretics), lifestyle, emotional stress, exercise/fatigue, sleep patterns, environment, food/calorie intake

Patient and family
Anticipatory anxiety
OLDCART
open-ended and specific
Sleep pattern
Sleep history, sleep pattern, sleep problems, illness, life events, mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation
Other health issues

Stress-a process that evokes tension/anxiety, Appraisal-how a person interprets a stressor, TRauma-symptoms present beyond the stressor
Decrease
medulla-control vitals, RAS-involved in alert status, Pit gland-adjusts hormones for adaptation such as cortisol/thyroid/parathyroid/gonadal

3-stage reaction to stress which starts at pit gland
Alarm-arouse CNS and cause EPI which increases HR, blood flow, alertness, oxygenation
Resistance-stabilization, attempt to conserve and repair
Exhaustion-progressive breakdown of compensatory mechanisms of RECOVERY ISNT ACHIEVED

Allostatic load
long-term health problems
What are reactions to psychological stress? Factors that influence the first? What are types of stress? What can cause stress? Is PTSD acute or chronic? What can it include and what does it often occur with? THis disorders occurs when someone ___, ____, or _____ with a traumatic event. How is Acute Stress Disorder different?

What are types of crises?
What factors influence stress and coping?
Coping-Cognitive and behavioral efforts to manage stressors
Appraisal, social support, coping mechanisms
Ego-defense-unconscious attempts to regulate distress and provide protection
Chronic-occurs in stable conditions and comes from stressful roles
Acute-momentary stress
Work, family, daily hassles, trauma, long-term illness
Acute, flashbacks, depression
Experiences, witnesses, or is confronted with
Shorter symptom duration

Developmental-crisis as you move through stages of life (with normal transition times)
Situational-external sources like a job change, accident, death, severe illness
Adventitious-natural or man-made disaster/violent crime

Situational-like described before
Maturational/developmental-life stages
Sociocultural-environmental, social culture-gender roles, family relationships, religious beliefs, geographical locations, time orientation, access, disparities, language differences
How should we assess? What type of findings? What are things that we can implement for health promotion + explain the first one.

What three things are written about in documentation? Accurate documentation helps a lot in what situation? What aspect is very important in documentation and care needs to be based on what? What mistakes common result in malpractice? What are the 6 purposes of the medical record?:Quality of care depends on what?

What are the components of the medical record? What are the 5 characteristics of qulity documentation? Should we document who we informed?
Through patient eyes
Subjective and objective
health promotion (decreases stressful situations and increases stress resistance), exercise and rest, support systems, time management, guided imagery, muscle relaxation, assertiveness training, journaling, MBSR, and stress management in the workplace

Patient data, interventions, and patient response
Legal
Time
nursing assessment
Failure to record health or drug info, interventions taken, meds administered, COC, discontinuation of meds, and completeness/legibility
Communication, reimbursement, research, legal document, education, auditing/monitoring
Communication

Patient info
Medical DX
Advance directives
Informed consent
Admission data
nursing DX
Orders
Code status
Progress notes
Assessment findings
Lab results
Patient education
Operative Summary
DC plan

Factual, Accurate, Complete, Current/Timely, and Organized
Yes
Should we use terms like appears/seems/apparently? What should we include in all entries? What are the methods of documentation? Explain examples. What is charting by exception? Case management plan/critical pathway? What are acuity rating systems used for? What are they based on? The higher the number the more _____?

What type of communication do you need to document each time? For telephone and verbal orders, what do you need to do? Do you document incident or occurrence reports in health records?

What does medicare do (2 things)? What is the OASIS assessment + what does it do? Documentation is the quality control and justification for reimbursement for what insurance?

Who is the MDS mandated by and what two things does it impact?
No
Date/time
Narrative-story like (not good)
POMR ( problem-oriented medical record)-database, problem list, care plan, progress notes
Progress notes-SOAP (subjective objective assessment plan)
SOAPIE (subjective objective assessment plan interventions evaluation), PIE (problem intervention evaluation), focus charting/DAR (data action response)

Record deviations (patient is normal unless recorded otherwise)
A multidisciplinary approach to care

Determining hours of care and number of staff required every shift or every day
Type and number of nursing interventions required
Acute

Phone
Repeat back and get confirmation
No

Determines eligibility for home care and serve as the basis for documentation of home health nurses
Collect/report assessment/outcomes and justified reimbursement
ALL

Federal govt, plan of care and reimbursement
What did HITECH do and why? Implementing what will decrease cost and improve quality of care? What is IT? Health informatics? What is TIGER? What did this transform to? Is informatics competency the same as computer competency?

What is CPOE for? CDSS? Do errors occur? What does nursing informatics include? Is this a specialty area in nursing?

What does the admission nursing history form help do? Flowsheets/graphic records? What are two more common record-keeping forms?
What is ROS?

True or false: protecting information is a top priority. What are the logical and physical security measures? What happens when this is violated? What are the two steps to disposing of information?

What do nursing clinical information systems allow? What are the two design options? What do you select for the second one? What is automatically included?
Promote meaningful use of HIT to improve the quality and value of care, EHR/EMR
Management and processing of information
Applying computers to help with health-related data
Prepares clinical workforce to use tech and informatics to improve care
HIMSS

Computerized provider order entry-new tests/meds, supplies, and reminders/alerts
Clinical decision support systems-help with decision making, if then, allergy alert
Yes

Using tech and informatics to support all areas of nursing
Yes

Complete assessment to identify nursing diagnoses
See the patient's trends over time to limit writing narrative notes
Care plans
Care summary-care provided each shift
Final care summary at discharge/death

True
Firewall, antivirus, spyware detection
technology in restricted areas, motion sense/alarms, and privacy filters on the screen
Disciplinary action

Redact then destroy

Nurses to access information at the bedside, share care plan with patient, and check on lab results
Nursing process-most common
Protocol/critical pathway-multidisciplinary
Select protocols that apply
Standard orders
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