Nur 6512 Midterm Exam With Complete Solutions

NUR 6512 MIDTERM EXAM WITH COMPLETE SOLUTIONS What soothes or aggravates the problem? SOAP Notes - S Subjective data—the information, including the absence or presence of pertinent symptoms, that the patient tells you O Objective data—your direct observations from what you see, hear, smell, and touch and from diagnostic test results A Assessment—your interpretations and conclusions, your rationale, the diagnostic possibilities, and present and anticipated problems P Plan—diagnostic testing, therapeutic modalities, need for consultants, and rationale for these decisions Ethical Considerations - • Autonomy: The patient's need for self-determination. Autonomy suggests that choices exist, and a patient may choose between alternatives. Uncertainty exists when the patient is a child or is cognitively impaired. Parents, guardians, family, or other significant persons should then be included, and the boundaries of that participation must be clearly set. In some cases, the boundaries are established by an advance directive from the patient. Competency is not always easily determined, and there may be disagreement. Both the mental status examination (see Chapter 7) and consultation with individuals who know the person well can assist. • Beneficence: Do good for the patient. This may be too eagerly pursued and may result in a paternalism that might preclude autonomy of the patient. However, paternalism may have some benefit when used with constraint and respect for autonomy. • Nonmaleficence: Do no harm to the patient. • Utilitarianism: Consider appropriate use of resources with concern for the greater good of the larger community. Choose wisely. • Fairness and justice: Recognize the balance between autonomy and competing interests of the family and community. • Deontologic imperatives: Our dutiful responsibilities for offering care are established by tradition and in cultural contexts. Because cultures vary, these may not be universally binding for all patients. Ethical principles can come into conflict in any given circumstance. Cultural Awareness and Diversity - The stereotype, a fixed image of any group that denies the potential of originality or individuality within the group, must be rejected. When this occurs, the beliefs and feelings (prejudices) come to mind about what members of that particular group are like. Socioeconomic, spiritual, and lifestyle factors affecting diverse populations - Chapter 2: Cultural Competency Functional Assessments - Functional assessments are an attempt to understand a patient's ability to achieve the basic activities of daily living. This assessment should be made for all older adults and for any person limited by disease or disability, acute or chronic. Growth, Development and Measurements in Children and Adults - • Standing height • Weight • Calculate the BMI (lbs/inches x 703) • Waist circumference • Calculate waist-height ratio and waist-to-hip circumference ratio Infants: Head/Chest circumference Communication techniques used to obtain a patient's health history - Courtesy, Comfort, Connection, Confirmation Courtesy Communication Technique - • Knock before entering a room. • Address, first, the patient formally (e.g., Miss, Ms., Mrs., Mr.) It is all right to shake hands. • Meet and acknowledge others in the room and establish their roles and degree of participation. • Learn their names. • Ensure confidentiality. • Be in the room, sitting, with no effort to reach too soon for the doorknob. • If taking notes, take notes sparingly; note key words as reminders but do not let note-taking distract from your observing and listening. • If typing in the electronic medical record, type briefly and maintain eye contact with patient, if possible. • Respect the need for modesty. • Allow the patient time to be dressed and comfortably settled after the examination. Follow-up discussion with the patient still "on the table" is often discomfiting. Comfort Communication Technique - • Ensure physical comfort for all, including yourself. • Try to have a minimum of furniture separating you and the patient. • Maintain privacy, using available curtains and shades. • Ensure a comfortable room temperature or provide a blanket—a cold room will make a patient want to cover up. • Ensure good lighting. • Ensure necessary quiet. Turn off the television set. • Try not to overtire the patient. It is not always necessary to do it all at one visit. Confirmation Communication Technique - • Ask the patient to summarize the discussion. There should be clear understanding and uncertainty should be eased. • Allow the possibility of more discussion with another open-ended question: "Anything else you want to bring up?" • If there is a question that you cannot immediately answer, say so. Be sure to follow up later if at all possible. • If you seem to have made a mistake, make every effort to repair it. Candor is important for development of a trusting partnership. Most patients respect it. Connection Communication Technique - • Look at the patient; maintain good eye contact if cultural practices allow. • Watch your language. Avoid professional jargon. Do not patronize with what you say.