Community HESI Study Guide latest updated

Scopolamine (Transderm-V) - ANSWER-Medication used to control motion sickness. Must be taken prior to the onset of nausea and vomiting. Most effective if taken 12 hours before expected travel or activity. Skin patch is applied behind the ear. Indirect transmission - ANSWER-Involves the spread of infection through an intermediate source, such as vehicles, fomites, or vectors. Example: contracting malaria following exposure in a mosquito-infested area. Direct transmission - ANSWER-The spread of an infection through person-to-person contact and is characterized by portals of exit and entry. Windshield survey - ANSWER-Making systematic observations from a moving vehicle. The nurse drives through neighborhoods viewing homes, stores, churches, air quality, etc. which gives the nurse the best initial overview of the residents and a sense of their community. Gives nurse impression of the type of housing, the approximate age of the housing, and the condition of the housing and yards. Secondary Prevention - ANSWER-Health screenings are a mainstay of this type of prevention which focuses on health promotion. Screenings aid in early detection/diagnosis and treatment of disease. Implementing interventions aimed at a cure or reducing the progress of a disease. Focuses on reducing the intensity and duration of a crisis. Example: PAP Smear Primary prevention - ANSWER-Health-promoting activities (immunizations, wearing protective devices to prevent injury, education about health promotion activities) designed to reduce the potential for illness before it occurs, such as immunizations. Keeping the crisis from occurring. Examples: Use of barrier contraceptives, vaccinations. Tertiary prevention - ANSWER-Includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Minimizes the consequences of a disorder or illness once it has developed through aggressive management or rehabilitation. Also applies to disaster relief efforts involving the reduction of the amount and degree of disability, injury, and damage after a crisis. Home health visits - ANSWER-Scheduled during daylight hours to ensure safety of the client and the nurse, identification name tag are required to be worn during client care, visits can be made with another home care provider. Health conditions related to the growth of industrial workforce - ANSWER-Asthma and lung cancer are triggered or worsened by airborne substances, such as tobacco smoke, ozone, and other particles and/or chemicals. Goals - ANSWER-Intended to be expressed in specific outcomes that provide direction toward interventions and determine change in measurable terms. Outcome statements - ANSWER-Include past or present events with specific quantitative expectations with a time frame. Example: Within 2 years, students with a body mass index greater than 95% will be reduced by 50%. Lillian Wald - ANSWER-Known for her work in public health. She developed the first nursing service for occupational health, established The Associated Alumnae of Training Schools for Nurses-later developed into the ANA and the NLN, and instituted a sliding scale fee for service. Low-birth weight infants - ANSWER-The incidence is twice as high for African-American births than Caucasian births. This is an example of a non-modifiable risk factor of ethnicity. Modifiable risk factors - ANSWER-Examples are cigarette smoking, poor nutritional status, and limited education. Data useful in developing community healthcare plans - ANSWER-Census data, risk management, budgeting process information, client satisfaction surveys, and data about changes in the community's demographics. Health People 20/20 - ANSWER-Leading health indicators: reduced cigarette smoking, exercising for 30 minutes a day, access to health services, improving social determinants (graduating high school). Risk factors for cardiovascular disease - ANSWER-Include nonmodifiable variables, such as gender, family history, and race, and modifiable variables, such as underlying diseases as hypertension, diabetes mellitus, hyperlipidemia, and obesity, smoking, sedentary lifestyle, and stress. Lifestyle changes to manage hypertension - ANSWER-In order of effectiveness: Weight loss, DASH diet, salt restriction, and avoiding alcohol. Physical characteristics of aging that contributes to developing decubitus ulcers - ANSWER-Thinning of the skin with loss of elasticity. Transtheoretical Model - ANSWER-Assesses an individual's readiness to act on a new healthier behavior, and provides stategies, or processes of change to guide the individual through the stages of change: Pre-contemplation, Contemplation, Preparation, Action, Maintenance, and Termination. Pre-contemplation - ANSWER-Not yet acknowledging there is a problem. Contemplation - ANSWER-Acknowledgment that there is a problem, but not ready to change. Preparation - ANSWER-Getting ready to make the change. Action - ANSWER-Making the change. Maintenance/Relapse - ANSWER-Maintaining the changed lifestyle or reverting back to previous lifestyle. Domain of nursing theory - ANSWER-The person, health, the environment or situation, and nursing. Priority of the community health nurse when suspecting physical abuse of client - ANSWER-Follow agency protocols to report suspected abuse. Hepatitis B - ANSWER-Virus transmitted by sharing needles or unprotected sex. Incubation period is 75 days. Suicide risks and prevention - ANSWER-A topic to be included in a primary prevention class for adolescents. Primary prevention focuses on health promotion and prevention of injury and illness. Suicide is a leading cause of death in adolescents. Communicable bioterrorism diseases - ANSWER-Pneumonic plague and smallpox can be transmitted person to person via respiratory droplets. Variance - ANSWER-Any event that may alter a client's progress through the clinical pathway, such as remaining on a ventilator for an additional amount of time. Standard - ANSWER-Used to provide guidance in implementing and evaluating procedural processes. Outcome - ANSWER-The end result of the interventions of the healthcare team and is based on the client's goal. Nosocomial infection - ANSWER-An infection that was not present or incubating at the time of admission. Medical asepsis helps prevent this type of infection from occurring. TeamSTEPPS - ANSWER-An evidence-based framework to optimize team performance across the health care delivery system. Has 5 key principles. It is based on team structure and four teachable-learnable skills: Communication, Leadership, Situation, Monitoring, and Mutual Support. According to this framework, two attempts should be made to notify a health care provider before proceeding through the chain of command. Critical pathways - ANSWER-Management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency. They are developed based on appropriate standards of care. They are developed through the collaborative efforts of members of the health care team. They provide an effective way for monitoring care and for reducing or controlling the length of hospital stay for the client. Client and family should be aware of all options available for the client's care. These are not specifically nursing care plans; however, they can take the place of a nursing care plan and actually map out the desired clinical progress of a client during acute care admission. Reality shock - ANSWER-Term often used to describe the reaction experienced when one move after several years of educational preparation, which occurs in a familiar, idealistic educational environment, into a new role in the work force where the expectations are not clearly defined in a realistic setting. Red tag - ANSWER-Immediate. Clients with life-threatening injuries and a respiratory rate greater than () 30 receive immediate treatment. Also used for clients with injuries to two or more body systems and unconscious. Black tag - ANSWER-Expectant. Clients with catastrophic injuries and no respiratory rate have minimal chance of survival and receive no treatment. Example: Client's respiratory rate is 4 per minute with a blood pressure of 70 mm Hg over palpation = death is imminent. Yellow tag - ANSWER-Observation. Clients whose injuries have systemic effects and complications, but whose respiratory rate, capillary refill (normal circulation), and mental status are WNL should receive treatment within 30-60 minutes. Used for clients with injuries to one body system. Example: Young adult with minor abrasions on the forehead who is unable to move the legs. Green tag - ANSWER-Wait. "Walking wounded." Clients with no systemic complications are removed to a separate area and treatment can be delayed for several hours. White tag - ANSWER-Dismiss. Clients with minor injuries for whom a doctor's care is not required. Informed consent not needed - ANSWER-In general, there are two situations that apply: when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death of the client; when the client waives the right to give informed consent. Floating - ANSWER-An acceptable legal practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Calling the hospital lawyer is a premature action. Co-worker abusing medication - ANSWER-Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Hospitalized client needing witness signature for living will - ANSWER-Living wills, also known as natural death acts in some states, are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding living wills vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. The nurse should seek the assistance of the nursing supervisor. Accurate Nursing Documentation - ANSWER-Needs to be factual; containing descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. Battery - ANSWER-A criminal offense involving the unlawful physical acting upon a threat. Example: Performing a procedure without consent is an example. Assault - ANSWER-The act of creating apprehension (verbally) of a physical attack. Example: Threatening to give a client a medication. False imprisonment - ANSWER-The state of being imprisoned without legal authority. Example: Telling a client that the client cannot leave the hospital. Slander - ANSWER-A verbal defamation, false communication, or careless disregard for the truth that causes damage to someone's reputation. Libel - ANSWER-A written defamation, false communication, or careless disregard for the truth that causes damage to someone's reputation. Negligence - ANSWER-Involves the actions of professionals that fall below the standard of care for a specific professional group. Triage priority 1 - ANSWER-Clients with trauma, chest pain, severe respiratory distress or cardiac arrest, limb amputation, and acute neurological deficits, or who have sustained chemical splashes to the eyes, are classified as emergent and are the number 1 priority. Triage priority 2 - ANSWER-Clients with conditions such as a simple fracture, asthma without respiratory distress, fever, hypertension, abdominal pain, or a renal stone have urgent needs and are classified as a number 2 priority. Triage priority 3 - ANSWER-Clients with conditions such as a minor laceration, sprain, or cold symptoms are classified as non-urgent and are a number 3 priority. Team nursing - ANSWER-A registered nurse leads nursing personnel in providing care to a group of clients. Autocratic leader - ANSWER-A leader that is focused, maintains strong control, makes decisions, and addresses all problems. One that dominates the group and commands, rather than seeks suggestions or input. Example: the manager addresses a problem (quality improvement) with the staff, designs a plan without input, and wants all problems reported directly back to her. Task oriented and directive. Situational leader - ANSWER-A leader who uses a combination of styles, depending on the needs of the group and the tasks to be achieved (depends on the situation and events). This leader would work with the group to validate that the information that the leader gained as a new employee was accurate and that a problem existed. Then, the leader would take the time to get to know the group and determine which approach to change (if needed) would work best according to the needs of the group and the nature and substance of the change that was required. Democratic leader - ANSWER-A leader who is participative and would likely meet with each staff person individually to determine the staff member's perception of the problem. This leader would also speak with the staff about any issues and ask the staff for input with developing a plan. This style empowers staff toward excellence because this style of leadership allows nursed an opportunity to grow professionally. Laissez-faire leader - ANSWER-A leader who is passive and nondirective. This leader would state what the problem was and inform the staff that the staff needed to come up with a plan to "fix it." Allows staff to work without assistance, direction, or supervision. Circulatory overload - ANSWER-Signs and symptoms: tachycardia, bouding pulses, pounding headache, dyspnea, crackles, wheezes, chills, and apprehension. Interventions: Slow the IV infusion, sit the client up in bed (high Fowler's) to aid in breathing, notify the HCP. Transfusion reaction - ANSWER-Interventions: stop the transfusion, infuse normal saline at a keep-vein-open rate to maintain a patent IV access line and maintain the client's intravascular volume. Hand restraints - ANSWER-When used, the skin integrity, neurovascular, and circulatory status of the extremity should be checked every 30 minutes. Devices should be removed every 2 hours to permit muscle exercise and to promote circulation. Snake bite - ANSWER-Priority interventions: the first priority is to move the victim to a safe area away from the snake and encourage the victim to rest to decrease venom circulation. Next, jewelry and constricting clothing are removed before swelling occurs. Immobilizing the extremity and maintaining the extremity below heart level would be done next; these actions limit the spread of the venom. The victim is kept warm and calm. Stimulants such as alcohol or caffeinated beverages are not given to the victim because these products may speed the absorption of the venom. The victim should be transported to an emergency facility as soon as is possible. Voluntary admission client - ANSWER-Voluntary clients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the client. Many states require that the client submit a written release notice to the facility staff members, who reevaluate the client's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the client. Client secrets - ANSWER-The nurse should never promise to keep a secret. Secrets are never appropriate in a therapeutic relationship. The nurse needs to be honest and tell the client that a promise cannot be made to keep the secret. Involuntarily committed clients - ANSWER-Clients who are admitted involuntarily do not lose their right to informed consent. Clients must be considered legally competent until they have been declared incompetent through a legal proceeding. The best determination for the nurse to make is to obtain the informed consent from the client. Good Samaritan Law - ANSWER-A law that is passed by a state legislature to encourage nurses and other HCPs to provide care to a person when an accident, emergency, or injury occurs without fear of being sued for the care provided. Its protection lies in the inability to sue the nurse or other HCP for negligence in the care provided at the scene of the accident or during the emergency, even if further injury occurred because of the HCP's care. Called immunity from suit, this protection usually applies only if all the conditions of the law are met, such as that the HCP received no compensation for the care provided and the care given was not willfully and wantonly negligent. Room assignment for autistic child - ANSWER-Autistic disorder is a complex childhood disorder that involves abnormalities in behavior, social interactions, and communication. Autistic children are unable to relate to persons or respond to social and emotional cues. Characteristically these children engage in repetitive behaviors, including head banging, twirling in circles, biting themselves, and flapping their hands or arms. Abnormal communication patterns include verbal and nonverbal communication. A child with autism needs decreased stimulation, with limited visual and auditory distractions. A private room would be the best environment, allowing for control of visual and auditory distractions. Case management - ANSWER-Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources; its aim is to maximize hospital revenues while providing for optimal outcomes of care. Case management manages client care by managing the client care environment. Activation of the agency disaster plan - ANSWER-In an external disaster many people may be brought to the emergency department for treatment. The initial nursing action must be to activate the disaster plan. Nurse as a client advocate - ANSWER-A person who speaks