Wilkes University FNP NSG554 Exam 1 |85 questions and answers.

New model for primary care collaborative health care, NPs, Pas, patient coordination. Policy to reduce adverse events associated with care transitions -Hospital Readmissions Reduction Program (HRRP) - provides hospitals with an incentive to improve their communication and care coordination and work more successfully with patients and caregivers on post-discharge planning IDEAL -I- include the patient and family as full partners in the discharge planning proces -D- discuss with the patient and family five key areas to prevent problems at home: 1. describe what home life will be like 2. review medications 3. highlight warning signs and problems 4. explain test results 5. make follow up appointments -E- educate the patient and family in plain language about the patient's condition, discharge process and next steps at every opportunity -A- Asses how well doctors and nurses explain the diagnosis condition and care to the patient and family -L- listen to and honor the patient and families goals, preferences observations and concerns Accountable Care Organization designation Accountable care organization (ACO) are groups of doctors, hospitals and other health care providers that come together voluntarily to give coordinated high-quality care to the medicare patients that they serve. Advisory Board survey (2014) findings patients' preferences for low-acuity complaints in primary care included 24/7 access to care, a walk-in setting with the ability to be seen within 30 minutes, and close proximity to home Health literacy test PEMAT, REALM-SF, Ask Me 3, Newest Vital Sign · A person’s capacity to find, discuss, and comprehend health info · To be able to use that knowledge to make informed decisions about all aspects of health. · Individuals with low health literacy = risk for poor health outcomes. · Health literacy assessments are available for primary care settings. -(REALM-SF) - seven-item instrument that has been validated to be used with a variety of populations, medical word recognititon, -Ask Me 3 - encourages patients/caregivers to ask 3 questions: what is my main problem? What do I need to do? Why is it important for me to do this? Culturally responsive care care that is centered on the client's cultural point of view and integrates the client's values and beliefs into the plan of care · An individual's cultural context determines how, when, and to what degree he or she will seek care and what interventions are considered acceptable. · Guidelines for Delivery of Culturally Responsive Care Ø Address Cultural Variations Among Diverse Patient Groups Ø Create a Patient-Centered Friendly Environment Ø Minimize Clinician Bias Ø Overcome Patient Language Barriers Adolescence behaviors. · Early (10-14): challenge authority, mood swings, reject activities, ideation of childhood, argumentative, disobedient, more privacy. · Middle (15-17): strong influence from peers, "tired teenager", increased sex drive, fad behaviors. · Late (18-21): assimilate adult roles, abstract thinking matures, realistic goals, understand consequences. Signs of puberty in adolescents (Sexual Maturation Scale (SMS) or Tanner Stages). · Girls: breast development, menarche, complete body development. · Boys: testicular enlargement, wet dreams, voice changing, arm pit and facial hair. Medical diagnostic terms to diagnose LGBTQ+ Lesbian- Women who form romantic and/or sexual relationships with other women Gay - Men who form romantic and or sexual relationships with people of the same sex Bisexual -- People with the capacity for romantic and or sexual relationships with both men and women Asexual - a person who does not feel sexual atraction towards others Transgender - a person whose gender identity differs from their assigned biological sex Cisgender - A person whose gender identity is the same as their biological sex intersex - a person who has discordance in their sexual organs Outdated/inappropriate terms: Homosexual, dyke, queen, fag, sexual preference, transvestite, cross-dresser, transsexual, hermaphrodite Pregnant and breast feeding women vaccine recommendations When caring for a patient that is planning to become pregnant, I would recommend that they make sure all their vaccinations are up to date prior to becoming pregnant, as the MMR and varicella vaccines are not recommended during pregnancy. Generally, live vaccines are not recommended during pregnancy because they can cause fetal viremia or bacteremia When caring for a patient that is in their third trimester of pregnancy, I would recommend that they should receive their annual flu shot and COVID booster in addition to the TDAP vaccine. Receiving the TDAP vaccine in the third trimester of pregnancy can help protect the baby from whooping cough once they are born through passive immunity Human trafficking symptoms to watch for · Avoids eye contact · Younger than stated age · Submissive · Disoriented to time/place · Incongruent expensive items · Inconsistent story · Controlling CG · Fearfullness · S/S of abuse · Substance use · Unusual tattoos Vulnerable Populations: Business employees in ethnic communities (e.g., massage) History of childhood abuse/neglect Justice system involvement Learning disabilities Mental health No address Poverty Runaway or throwaway youth Once a provider has potentially identified a trafficked victim, a complete screening needs to occur. Healthy People goals 1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages. International travel recommendations 1. Ensuring up-to-date vaccinations, such as hepatitis A, hepatitis B, yellow fever, and others depending on the destination. 2. Checking travel advisories and requirements for specific countries, including any mandatory vaccinations or medications. 3. Considering travel health insurance to cover any medical expenses during the trip. 4. Taking necessary precautions for COVID-19, such as getting a PCR test before travel and following local guidelines and restrictions. 5. Taking appropriate malaria prophylaxis if traveling to regions with a risk of malaria. Assessment requirements for obese patients provide sensitivity and confidentiality Physical Measure BMI in all adults. Assessment (Assess PCOS, neck circumference (OSA), hypothyroid, mobility limitation Diagnostics UA, serum glucose, uric acid, BUN, creatinine concentration, CBC, TSH, lipid profile, LFTs, alkaline phosphatase level (2-hour postprandial glucose; for hyper-insulinemic or insulin-resistant patients) Differential Diagnoses Common causes: sedentary lifestyle, changes diet, energy supplements, smoking cessation, pharmaceuticals. Red flags Other causes should be established based on diagnostic evaluation. Medications associated with weight gain. · Diabetic meds o Insulin, thiazolidinediones · Antidepressants, Neuroleptics, and Seizure Medications o Effect leptin's effect on the hypothalamus—stimulating appetite (Valproic acid increases insulin levels.) · Antihistamines o Mediated by the blockade of H1 receptors effect on increasing appetite. · Hormonal preparations o Progesterone-only contraceptive o Medroxyprogesterone injections and levonorgestrel-releasing intrauterine system, megestrol, corticosteroids · Cardiac meds o β-blockers (increase insulin resistance and serum triglycerides) o Central-acting α2-adrenergic receptor agonists Preplacement screening for hiring persons with comorbidities. · Physical and psychological evaluation, pre-employment testing, functional testing. Ensure employee can safely perform job without injury to themselves or others. Previous employment history i.e., time off, health issues, exposure to chemicals, noise, radiation, etc. Emergency contraception · Levonorgestrel (Plan B): (Progestin-only) 1.5mg 50% effective taken within 72 hrs. efficiency drops significantly if taken 72-120 hrs after. SE: bleeding irregularity, n/v, headaches, abd pain. Can be taken as one or 2 doses no prescription needed · Ulipristal acetate (UA) (Ella): single dose, 30 mg same efficiency up to 72 hrs, more effective 72-120 hrs. Same SE. (can be taken up to 5 days after) prescription needed. · Copper intrauterine device (IUD): most effective if there is no established pregnancy. Spermicidal environment can be inserted up to 5 days post intercourse not recommended in those with a STI or HX of cervicitis Notes: These medications do not disrupt a established pregnancy or cause risk to a fetus if it fails pregnancy test should be obtained if there is no menstrual period in 3-4 weeks Eating disorder patients, risk factors, warning signs, and recommendations for screening. Risk factors for eating disorders- family history of eating disorders, history of dieting, perfectionism, body image dissatisfaction, weight stigma, teasing or bullying, limited social networks warning signs of an eating disorder- preoccupation with with weight, food, and dieting, food rituals, skipping meals, extreme concern with body size and shape, and extreme mood swings ALL adolescents should be screened for eating disorders by determining BMI, and asking about body image and dieting patterns. Treatment involves psychological and nutritional counseling along with medical and psychiatric monitoring Recommendations for Pulmonary Function Studies. Sports physical, when to refer · Family history o sudden death before age 50 o Disabling cardiac disease in family member <50 o Cardiomyopathy, long QT, ion channelopathies, Marfan syndrome, signifiant arrhythmias. · Personal history or physical finding o Abd organomegaly, absence of (eye, kidney, testicle), systemic infection, uncontrolled asthma, asymmetrical femoral pulses, antoaxial instability, heart murmur, bleeding disorder, HTN, heart disease, detached retina, <20/40 vision in both eyes, uncontrolled DM, down syndrome, eating disorder, exercise induced fatigue or dyspnea, fever, inability to perform duck walk, lymphadenopathy, Marfan syndrome stigmata, neck pain or cervical stenosis, neurologic deficit, obesity, palpitations/dysrhythmias, convulsive disorder, shoulder asymmetry, joint tenderness, pain with ROM, syncope unexplained. Consultaation/referral Indicated and medical clearance deferred if there is a family history of sudden unexpected death age 50 years or younger. ØCardiomyopathies, long QT syndrome, Marfan syndrome, ØAbsence of an eye, kidney, or testicle ØAcute systemic infection, abdominal organomegaly ØAsthma—uncontrolled ØBleeding disorder ØEating disorder ØExercise-related chest discomfort ØFever ØAdditional complications and conditions grade 2/6 early to midsystolic ejection murmur that dissapears from supine to standing- aortic regurgitation AS in young asymptomatic PT, likely the result of a congenital defect. Prior rheumatic fever is a risk factor for AS mild AS with normal cardiac output and exercise tolerance usually includes periodic monitoring with ECG and echo murmur of MR should not affect participation in sports Acute bronchospasm A sudden constriction of the muscles of the bronchial walls leading to a temporary narrowing of the bronchi Subsequent muscle tightening and inflammation occurs leading to cough, wheezing, shortness of breath, and thicker mucus development. Occurs when hyperactivity of the airways caused by inflammatory substances produces airway bronchoconstriction, edema, and obstruction Presentation o Vary from mild anxiety to resp distress o Most common symptom: wheezing o Acute bronchospasm: breathlessness, chest tightness, coughing (repetitive spasmatic cough) Findings: Skin color normal, flushed, or pale Pruritus/rash suggests an allergic etiology Tachypnea, tachycardia, and a normal or slightly elevated blood pressure Hypotension occurs in an allergic reaction with anaphylaxis. Pulsus paradoxus of greater than 25 mm Hg is a uniform indicator of severe respiratory compromise. Accessory muscle use + silent chest = severe bronchospasm Diagnostics o Pulse ox <92% RA, peak flow <80% of predicted o ABGs - if indicated o Chest radiograph - if indicated Initial management Labs: -Eosinophilia -Elevated immunoglobulin E levels o O2 via NC or mask o Beta agonist via MDI or neb o Albuterol: 4-10 puffs q 20 min for 1 hour o Short actin B agonist: albuterol, levalbuterol, metaproterenol, pirbuterol. After resolution o Oral prednisone 40 - 60 mg daily or divided BID for 5-10 days