Health and Wellness Studyguide
Health and Wellness Studyguide 379
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This 16 page Bundle was uploaded by Ally Marcello on Thursday April 28, 2016. The Bundle belongs to 379 at Catholic University of America taught by Degnan, K. in Winter 2016. Since its upload, it has received 56 views. For similar materials see Life Span Development in Psychlogy at Catholic University of America.
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Date Created: 04/28/16
Lecture #9: Physical Inactivity: The Problem ● Definition: Bodily movement that is produced by the contraction of skeletal muscle and that increases energy expenditure above the basal level. Physical activity can be categorized in various ways, including type, intensity, and purpose. ○ Differs from exercise in that exercise is a subset of physical activity that is planned, structures and repetitive and has as a final or intermediate goal to improve or maintain physical health ● Coronary heart disease (CHD) is the leading cause of death and disability in the U.S. ● Physically inactive people are almost twice as likely to develop CHD as persons who engage in regular physical activity.(HP 2010, p. 223) ● Current public health recommendations call for moderate physical activity to reduce risks of chronic disease and to improve overall health. ● Yet over 60% of Americans do not participate in any regular physical activity!(HP 2010) ● > 80% of adults do not meet guidelines for aerobic & muscle strengthening activities (HP 2020) ● Physical Inactivity: benefits ● Men, women, & children of all ages benefit from physical activity. ○ So encourage even your older adult clients to be physically active ● Benefits for adults and Older adults ○ Moderate physical activity can lower the risk of: ○ Early death, Coronary heart disease, Stroke, High blood pressure, Type 2 diabetes, Breast and colon cancer, Falls, and Depression ● Benefits for children and adolescents ○ Improve bone health. ○ Improve cardiorespiratory and muscular fitness. ○ Decrease levels of body fat. ○ Reduce symptoms of depression. ● What kind of PA should I recommend to patients? ○ Activities that use large muscle groups and are at least equivalent to brisk walking. In addition to walking, activities may include swimming, cycling, dancing, gardening and yardwork, and various domestic and occupational activities ■ Classified as Moderate physical activity ● Good for disease prevention benefits, and more easily adopted and maintained than vigorous PA ■ Recommended to do this PA on most, if not all, days of the week. ● Examples: ○ 30 minutes of brisk walking (walking as though you are trying to catch a bus or are late for an appointment). ○ 30 minutes of raking leaves ○ 15 minutes of running ○ 45 minutes of playing volleyball ● Adults need 150 minutes/week of cardiorespiratory activity (at least 10 minutes at a time). ○ Aerobic activity makes you breathe harder and make your heart beat faster. ○ Strengthening activities should be done two or more days a week. ● Physical Inactivity Disparities ○ Physical inactivity (sedentary lifestyle) is more common among ■ Women as compared with men ■ African Americans and Hispanics as compared with whites ■ Older adults as compared with younger adults ■ Lower income/education ○ Adults in the Northeastern and Southern states tend to be more sedentary than residents of the North Central and Western states. ○ People with physical disabilities and certain health conditions tend to be more sedentary than people without disabilities. ■ multiple variables in a person’s decision to be physically active : individual (physical capacity, time, attitude), the built environment (land use), and the social context (social norms) ● Physical Inactivity Measurement Issues ○ Using measures of leisuretime physical activity, women have profiled as being significantly more sedentary than men. ○ The health benefits of household and childcare responsibilities have not been firmly established… ○ But when these activities are included in a measure, the energy expenditure of women exceeds that of men ● Older adults conditions.○ People are living longer with chronic diseases, producing disabling ■ Any type of activity may prolong life. ■ Strength and flexibility training is particularly important for older adults. ● There is a demonstrated relationship between muscle strength and physical function. ○ Strength training has also been shown to preserve bone density in postmenopausal women. ● PA Levels are positively affected by ○ Structural environments (availability of sidewalks, bike lanes, trails, and parks) ○ Legislative policies that improve access to facilities that support physical activity ● Factors positively associated with PA in adults ○ Postsecondary education/Higher income, Enjoyment of exercise, Expectation of benefits, Belief in ability to exercise (selfefficacy), Social support from peers, family, or spouse, Access to and satisfaction with facilities, Safe neighborhoods ● Factors negatively associated with PA in adults ○ Advancing age, Low income, Lack of time, Low motivation, Rural residency, Perception of great effort needed for exercise, Overweight or obesity, Perception of poor health, Being disabled ○ Time barrier seems to be the biggest battle ● Factors positively associated with PA in children 412yrs ○ Gender (boys), Self efficacy, parental support ● Factors positively associated with PA in adolescents ○ Parental education, Gender (boys), Personal goals, Physical education/school sports, Belief in ability to be active (selfefficacy), Support of friends and family Lecture #10: Gender and Culture: implications for Healthcare Communications ● Sexual Identity ○ Sexual identity refers to biology: you are either male (XY) or female (XX) (excepting individuals born with an intersex condition) ○ Gender identity is “one’s selfconcept with respect to being male or female; a person’s sense of his or her true sexual identity.” ● Gender and communication ○ Research has shown that there are gender differences in communication ■ Greatest differences are in use and interpretation of nonverbal cues ● Girls ○ tend to use more nonverbal communication, but this does not mean they use it more effectively ○ Women use more facial expressiveness, Smile more often, Touch more often, Nod more often, Gesture less ○ Girls also tend to use more tones signifying surprise and cheerfulness ○ Women tend to view conversation as a connection to others. (this is the purpose) ● Men ○ Men prefer a greater interpersonal distance. ○ Use gestures more often. ○ Overall, use less eye contact. ○ Maintain eye contact in a negative encounter. ○ Use less verbal communication. ○ Use conversation as a contest for status ■ Communication in the workplace (men often interpret questions as objections so…) ● Women can be more direct. question. ● Men can verify the meaning of the ● Men and women should frame a question so the other knows how to interpret it. ● Cultural differences in communication ○ Definitions of Culture according to the Office of Minority Health, DHHS: the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ○ Culture “a complex social concept that encompasses the entirety of socially transmitted communication styles, family customs, political systems, and ethnic identity held by a particular group of people.” ○ generalization in communication can lead to stereotyping ○ Stereotyping: an oversimplified opinion about a group of people ○ Consider intraethnic differences (strong withingroup variation) due to acculturation in varying degrees. ○ Cultural issues in communication ■ “Culture defines how health care information is received, ■ how rights and protections are exercised; ■ what is considered to be a health problem; ■ how symptoms and concerns about the problem are expressed; ■ who should provide treatment for the problem; and ■ what type of treatment should be given.” ○ Cultural competence ■ A set of cultural behaviors and attitudes integrated into the practice methods of a system, agency, or its professionals that enables them to work effectively in cross cultural situations ■ In nursing: ● Cultural competence starts with self awareness – reflection on attitudes. ● helps close the gap in healthcare disparities ● nurse’s competence will prevent cultural differences from hindering healthcare. ● Cultural competence increases positive health outcomes ○ Cultural Assessment in Nursing ■ General assessment ■ Problemspecific assessment ■ Culturespecific assessment* ● Analyze the meaning of behaviors ● Incorporate cultural preferences into treatment plan ○ Has meaning for client and enhances health outcomes ○ Assessing Client preferences with intercultural client ■ Explanatory models of illness: ■ Can you tell me a little about how your illness developed? ■ What do you think caused your health problem? ○ Assessing traditional or spiritual healing practices ■ “Can you tell me something about how this problem is handled in your country? ■ Are you currently using any medications or herbs to treat your illness? ■ Is there a spiritual practice that is important to you that you would like incorporated into your care plan? ○ Assessing lifestyle ■ Seeing what their culture does to stay healthy, and what do they personally do to stay healthy ○ Assessing types of family support ■ Asking who in their family should be involved in their care ○ Assessing Rituals and Religious ceremonies at time of death ■ Different cultures have different death rituals ○ National standards for cultural competence ■ The CLAS created 14 standards organized by themes in which a hospital has to instil at least 2 ○ Barriers to providing interpretation/translation services ■ Cost ■ Lack of access to qualified individuals with the desired language capacity as well as professional training ■ Need to find someone in a timely manner to meet communication needs ● Translator should never be a family member because 1. They are’nt professional 2. They may get info wrong, may be embarrassed to hear words, etc. Lecture #11: HIPPA and the Impact of Privacy Laws ● provide consumers with greater access to health care insurance, to protect the privacy of health care data, and to promote more standardization and efficiency in the health care industry ● Has 4 Prongs ○ Privacy requirements ○ Security requirement ○ Electronic transactions and code sets standards requirements ○ National identifier requirements ● Patients have the right to expect their medical information will not be shared with anyone not taking care of them unless they give permission for it to be shared ● Key Confidentiality Concerns ○ D▯ iscussion Rooms – Private location ○ F▯amily issues – not everyone has a “right” to know ○ W ▯ ritten Release ○ S▯tudies – what you take back to class ○ B▯usiness Agreements – C ontract Help ○ C▯ omputer/ Chart access – Need to Know ○ H▯ allway discussions – Be Aware of who is Around you ● Ways to respect a patient’s privacy ○ C▯ lose Curtains & Doors, ▯peak in low voice ▯ook in the chart to see who has permission before you start to talk to someone about the patient, K▯eep chart closed when not using, Ask visitors to leave before giving care or discussing health ○ D▯ o Not go home and say “guess who I saw in the hospital…” ○ S▯hred any patient information you find in public location ○ R▯ emind others to respect privacy ○ S▯hare any privacy concerns with the Privacy Officer ● PHI is Personal Health Information ○ Demographic, DOB, MR number, SSN, Telephone # ● What can you report without the permission of the patient ○ D▯ epartment of Social Services ▯buse, ▯ eglec ▯tate Reportable Diseases, Harmful to Others, Department of Health Investigations, D▯ rug Enforcement Agency ■ Transmit this information through the use of phone, fax, and email ● HIPPA vs. JCAHO ○ ▯ JCAHO – requires that family members be involved in the care of the patient (if the patient agrees) ○ ▯ HIPAA requires you to ask permission (and document it) before disclosing health issues Lecture #12: ● Cigarette Smoking facts ○ Tobacco use is responsible for over 443,000 deaths per year among U.S. adults. ○ Cigarette smoking remains the leading preventable cause of death and disease ■ It causes cancer in nearly every organ in the body ○ Health costs and loss of productivity related to smoking total at least $193 billion/year ■ puts body at risk for cancers, CVD, pulmonary disease, and reproductive and developmental defects. ● Effects of Cigarette Smoking during Pregnancy and Postpartum ○ Spontaneous abortions (miscarriage) ○ Low birth weight ○ Sudden infant death syndrome ■ Evidence accumulating for an association with mental retardation and birth defects such as oral clefts in newborns whose mothers smoked while pregnant. ● Second hand smoke ○ Each year approx. 3,000 nonsmokers die of lung cancer because of exposure to secondhand smoke. ■ Secondhand smoke also causes heart disease. ■ Asthma and other respiratory conditions are worsened by exposure to smoke. ■ 150,000 – 300,000 infants and children under age 18 months experience lower respiratory tract infections related to ETS ● Third hand smoke ○ When the chemicals from the smoke land on soft materials such as carpet or clothing, and then someone breathes in/consumes the chemicals ■ Babies crawl around on the floor and can get the chemicals on their hands and put their hands in their mouths, can breath it in when they are held ● Smokeless Tobacco ○ Other forms of tobacco are not safe alternatives to smoking cigarettes. ■ Marketed as safer and healthier. ○ Chewing tobacco causes cancer of the mouth and gums, periodontitis, and tooth loss. ○ Cigar use causes cancer of the larynx, mouth, esophagus, and lung. ● Pathophysiology of Smoke ○ Researchers have identified over 7,000 chemicals in tobacco smoke. ○ At least 69 of these chemicals cause cancer in humans and animals. 69 carcinogenic chemicals. ○ Nicotine, a stimulant, is a highly addictive chemical. Why? ■ Nicotine is similar in addictiveness to heroin and cocaine)because it reaches the brain in seconds. It: ● Increases heart rate and blood pressure ● Increases clotting ● Constricts blood vessels ○ Carbon monoxide drives the oxygen out of red blood cells, thus depriving the tissues of needed oxygen. Levels of carbon monoxide in smokers are constantly elevated, sometimes 15X that of nonsmokers. ○ Tars are sticky particles that adhere to cells in the respiratory system and paralyze the cilia. Also cause cancerous changes in cells. ○ Damage from smoking results from DNA damage, inflammation and oxidative stress ● CO Management ○ Levels of carbon monoxide in smokers are constantly elevated, sometimes 15X that of nonsmokers. ● Gender Differences ○ Men are more likely to smoke than women (22% vs. 18%) but the gap has been narrowing. ○ Lung cancer has surpassed breast cancer as the leading cause of cancer deaths among women in the U.S. ● Racial and Ethnic Disparities ○ American Indians or Alaska Natives (35?%) are more likely to smoke than other racial and ethnic groups, with considerable variation by tribe. ○ African Americans and whites have similar rates of cigarette smoking (21.2 – 22%) ○ Among Hispanics, 15.8% smoke cigarettes ● Nurses and smoking ○ About 3 in 20 nurses (15%) smoke. ○ Highest rate of smoking among health care professionals. ■ But lower than the general population. ○ Encounter friction from nonsmoking colleagues ● Benefits of quitting ○ 20 minutes after quitting Your heart rate and blood pressure drop. ○ 12 hours after quitting The carbon monoxide level in your blood drops to normal. ○ 2 weeks to 3 months after quitting Your circulation improves and your lung function increases. ○ 1 to 9 months after quitting Coughing and shortness of breath decrease; cilia (tiny hairlike structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. ○ 1 year after quitting The excess risk of coronary heart disease is half that of a continuing smoker’s. ○ 5 years after quitting Risk of cancer of the mouth, throat, esophagus, and bladder are cut in half, Cervical cancer risk falls to that of a non smoker, Stroke risk can fall to that of a nonsmoker after 25 years. ○ 10 years after quitting The risk of dying from lung cancer is about half that of a person who is still smoking, The risk of cancer of the larynx (voice box) and pancreas decreases. ○ 15 years after quitting The risk of coronary heart disease is that of a nonsmoker’s! ● Other Benefits of Quitting ○ lowers the risk of diabetes ○ lets blood vessels work better ○ helps the heart and lungs. ○ quitting while you are younger will reduce your health risks more, but … ○ quitting at any age can give back years of life that would be lost by continuing to smoke. ○ ● Nursing intervention for the individual client ○ Remember the 5 “A’s”: ■ ASK about tobacco use at every visit. ■ ADVISE tobacco users to quit. ■ ASSESS readiness to quit. ■ ASSIST tobacco users with a quit plan. ■ ARRANGE followup visits. Lecture # 13: Legal Issues ● Goals of documentation ○ R▯ educe redundancy ○ I▯ crease time efficiency ○ R▯ educe cost ○ D▯ ecrease data errors ○ F▯orce compliance with standards and policies ● Why do patients file lawsuits? ○ P▯rimary Reason: Lack of Communication! ○ H▯ ow do you avoid this? ■ I▯ clude patient as a partner in the care plan. ○ S▯econdary Cause: ■ L▯ittle or NO followup to a patient question ● What are the basic elements of a Malpractice ○ Duty, breach of duty, proximate cause, damages ● Charting basics ○ S▯TATE OBJECTIVE, FACTUAL INFORMATION. AVOID CONCLUSORY STATEMENTS LIKE "WELL", "GOOD", "FINE", "NORMAL". ○ R▯ ECORD ACCURATE AND COMPLETE INFORMATION. IF THERE IS AN ABNORMALITY, CHART YOUR APPROPRIATE ACTIONS. ○ DOCUMENT CLEARLY AND IN CHRONOLOGICAL ORDER. IF YOU NEED TO GO BACK, CHART A "LATE NOTE". IF THERE IS A LENGTHY DELAY IN CHARTING, EXPLAIN WHY ○ ▯ IF YOU MAKE AN ERROR, DRAW 1 LINE THRU IT AND EXPLAIN WHY. ■ NEVER USE WHITE OUT OR A STICKER OVER AN ERROR. ○ NEVER ALTER OR FALSIFY A CHART ○ K▯EEP RECORDS IN A SAFE, CONFIDENTIAL MANNER. ○ SIGN YOUR LEGAL NAME AND TITLE ○ USE ACCEPTED ABBREVIATIONS. YOUR AGENCY SHOULD HAVE A RECENT/ UPDATED LIST ● Your patient falls. What should you do first? ○ STATE OBJECTIVE, FACTUAL INFORMATION. AVOID CONCLUSORY STATEMENTS LIKE "WELL", "GOOD", "FINE", "NORMAL". ○ RECORD ACCURATE AND COMPLETE INFORMATION. IF THERE IS AN ABNORMALITY, CHART YOUR APPROPRIATE ACTIONS. ○ DOCUMENT CLEARLY AND IN CHRONOLOGICAL ORDER. IF YOU NEED TO GO BACK, CHART A "LATE NOTE". IF THERE IS A LENGTHY DELAY IN CHARTING, EXPLAIN WHY. ● Lynch Trial ○ Pertinent nursing protocol read: “Check patient’s ID band for name and medical record number against MAR/TAR. Administering nurse must witness medication consumption. Never leave medications unattended at the bedside ■ Also do bedside observation for when patients have to take medications Lecture #14 ● Overweight and Obesity in Adults ○ ▯ Overweight & Obesity are labels for body weight > generally considered healthy for height. ○ ▯ Overweight & Obesity are defined in terms of body mass index ○ BMI is a relationship between weight and height: ○ O ▯ verweight: Body Mass Index (BMI) of 25 29. ■ B▯MI but does not define or directly measure body fat but correlates with direct measures of body fat such as underwater weighing ■ High BMI is associated with health risks. ○ O ▯ bese: BMI of 30 or higher. ● Overweight and Obesity for Children and Teens Ages 219 ○ B▯MIforage: age and sexspecific since body fat changes with age. ○ R▯ eliable correlation with true body fat for most children. ■ Only a screening tool! Further nursing assessment involves: ● skinfold measures, H & P, family hx ○ Underweight: Less than the 5th percentile ○ Healthy weight: 5th percentile to less than the 85th percentile ○ Overweight: 85th to less than the 95th percentile ○ Obese: Equal to or greater than the 95th percentile ○ Apple shape (abdominal fat) is more at risk for: ■ Type 2 Diabetes ■ high blood cholesterol ■ high triglycerides ■ high blood pressure ■ coronary artery disease ● Psychological Issues ○ N▯ egative selfimage and possibly depression ○ S▯ocial or workrelated discrimination ○ M ▯ edia images contribute to psychological issues ● Disparities ○ Obesity is more common in women than men. ○ Obesity is particularly common among Hispanic, African American, Native American, and Pacific Islander women ○ For all racial and ethnic groups combined, women of lower SES are @ 50% more likely to be obese than those of higher SES. ○ The ethnic variation among women is much greater than among men ● Using therapeutic communication, specifically motivational interviewing ○ Apply the Stages of Change concept ○ The nurse should then use the principles of Motivational Interviewing with a patient trying to lose weight ○ Recall for MI (OARS):use these techniques Openended questions [O], Affirmation [A], Reflection [R], Summarizing [S]) Lecture #15 Injury and Violence Prevention ● Goal: Reduce injuries, disabilities and deaths due to unintentional injuries and violence. ● More than 400 Americans die each day from injuries due primarily to ○ Motor vehicle crashes (due to distracted driving), firearms, poisonings ○ Suffocation, falls, fires and drowning ● Deaths from injury; unintentional vs. intentional: ● 63% unintentional and 34% intentional ● Objectives to measure progress: ○ Reduce deaths caused by motor vehicle crashes. ○ Reduce homicides. ● Progress has been made on these two objectives. ● Toddler care ○ Products and meds out of reach, locked cabinets ○ Childproof caps ○ Use original containers ○ No poisonous plants ○ Supervise activity at all time ○ Call 18002221222 for Poison control ● Motor vehicle crashes ○ Death rates associated with motor vehicletraffic injuries are highest in the and group:1524 years. ○ 2 highest rate of motor vehicle related deaths:Those aged 75 years & older ● MV crash Prevention seatbelts ○ There is strong research evidence that safety belt use laws, primary enforcement laws, and enhanced enforcement programs are effective in increasing safety belt use. ○ Communitybased approaches to alcohol control and DUI prevention also helpful. ● Disparities in Violence: Homicide ○ Homicide rates have been dropping among all groups over the past two decades, but not dramatically among youth. ○ Males died from homicide at a rate three times greater than females. ○ Males are most often the victims and the perpetrators of homicide ● Fall prevention for older Adults ○ White men highest fall rate, then white women, black men, black women ○ Causes: neuromuscular dysfunction, osteoporosis, stroke, sensory impairment ○ Falls can lead to fractures, decubitus ulcers, pneumonia, death ● Emerging Issues: Violence ○ Bullying, dating violence, and sexual violence among youth ○ Elder maltreatment, particularly with respect to quantifying and understanding the problem Lecture #16: Disaster Nursing ● Disaster: An occurrence, either natural or manmade, that causes human suffering and creates human needs that victims cannot alleviate without assistance ○ Manmade: terrorism, shootings, hazardous spills, etc. ● Natural disasters: “events caused by nature or emerging diseases … can have serious consequences” → caused by nature or emerging diseases ○ Mass Casualty event has 100 or more casualties ○ Multiple casualty event has more than 2 but less than 100 ● Emergency Response Plan ○ Identify which client(s) to recommend for discharge in a disaster situation ○ Identify nursing roles in disaster planning ○ Use clinical decisionmaking/critical thinking for emergency response plan ○ Implement emergency response plans (e.g., internal/external disaster)* ○ Participate in disaster planning activities/drills ● Preparedness ○ Nurses should respond to a disaster incident only through an established agency/organization. ○ Nurses need to be prepared themselves in advance (family disaster plan) ■ prevents personal/professional conflict ■ prevents becoming a direct/indirect victim ○ ● Stages of disaster response ○ Nondisaster ■ Threat of disaster still in future ■ Activities: ● Planning and preparation ● Vulnerability analysis in community ● Capability inventories ● Prevention, preparedness, and mitigation: “actions taken to prevent harmful effects of a disaster on human health or property” ● Alternative communication methods should be set up! ○ Predisaster (preimpact) ■ Knowledge about an impending disaster ■ Disaster has not yet occurred ■ Activities: ● Warning ● Preimpact mobilization ● Evacuation if necessary or shelter in place ● Activate disaster plan ○ Impact Stage ■ Disaster event has occurred or is still occurring ■ Community experiences immediate effect ■ Activities: ● Rapid assessment of damage ● Injuries – types and extent (see Disaster Triage below) ● Immediate needs of the community ○ Emergency (PostImpact) ■ Immediate response to effects of disaster ■ Activities: ● Immediate community provides assistance ● Later: outside assistance ● search & rescue ● Mass communications restoration or establishment ● Transportation ● Assessment of infectious diseases, mental health ○ Reconstruction ■ Restoration, reconstruction, and mitigation occur ■ Activities: ● Rebuilding, replacing property ● Returning to work/school ● Continuing life without those killed in disaster ● Final stage: Mitigation – future oriented activities to prevent subsequent disasters or minimize effects ○ Disaster Triage ■ Focus: “to do as little as possible, for the greatest number, in the shortest period of time ● Green: Nonurgent; “walking wounded” ● Yellow: Urgent; evaluate and treat ASAP ● Red: Critical; require immediate care (transportation priority) ● Black: Deceased or dying; medical treatment will not change outcome ○ Individual Casualty Assessment ■ Brief systematic assessment ■ Head to toe ■ Gloves & eye protection for providers ■ Neck: spinal or tracheal injury? ■ Look, feel, listen, & smell ■ Communication: do not elicit details of the situation except as needed for assessment (ie, exposure) ● Communication During Impact stage ○ Promote adaptive functioning and stabilization ○ Focusing on the Present: What do you need to do to get through today? (client begins to take control) ○ Assess resources/coping strategies: what has helped you get through tough times in the past? ○ Provide verbal and written followup instructions Lecture #17: Oral Health ● Why is Oral Health Important? ○ Good oral health allows a person to: ■ Speak, smile, smell, taste, touch, chew, swallow, make facial expressions to show feelings and emotions. ○ Poor oral health can lead to: ■ Dental caries (cavities) ■ Periodontal (gum) disease ■ Oral and facial pain ■ Oral and pharyngeal (mouth and throat) cancers ● It is important to look for sign of Periodontal (gum) disease because it is associated with diabetes, heart disease, and stroke ○ For HD: Bacteria from the mouth gets into the bloodstream, setting up atheroma formation ○ Also, in pregnant women, gum disease is also associated with premature births (by setting up inflammation in cervix & uterus) and low birth weight. ● Role of the Nurse is in assessment ○ Inspect your patient’s mouth and gums for any lesions. Look for painless, white spot. ■ Red, swollen, tender gums ■ Persistent bad breath or bad taste in mouth ○ Ask about daily dental routine. ■ Do they brush and floss? Gums bleed with brushing or flossing? ○ Ask about healthy eating habits. ○ Ask when the patient last saw his/her dentist and how often they usually see the dentist. ○ For pts who are hospitalized, perform oral care for them if they are unable! ● Process of Tooth Decay ○ Begins with bacteria from food remaining on teeth and gums. ○ Bacteria ferment dietary sucrose & produce acids. ○ Placque (buildup of bacteria) accumulates & becomes dental calculus (tartar) in 10 days. ○ Placque demineralizes tooth surface→ dental caries. ○ Gum inflammation (gingivitis) also begins. ○ Gingivitis leads to periodontitis and tooth loss. ● Caring for your child’s teeth ○ Clean them daily with a soft child’s toothbrush, especially after feeding. ○ Around age 4 or 5, kids can start to brush their own teeth – twice a day! ○ Make sure they brush all surfaces, and only use a peasized amount of fluoride toothpaste. ○ Teach your child not to swallow the toothpaste, but to rinse with water. Lecture #18: Communication for a Safe Environment ● Goals of communication ○ Improve the accuracy of patient identification. (Give an example) ○ Improve the effectiveness of communication among caregivers. ○ Improve the safety of using medications. ○ Reduce the risk of health care–associated infections. ○ The hospital identifies safety risks inherent in its patient population. ● SBAR used in handoff transfer of patients (whether it is between shifts or to a new unit) ○ Situation what’s happening at the present time ○ Background what are the relevant circumstances/history leading up to the situation ○ Assessment what do you think the problem is ○ Recommendation What you should you do to correct the problem ■ R step is the most important, but difficult part. Also requires assertive communication ● Why the recent emphasis on patient safety? ○ The IOM study found that preventable health care errors responsible for about 98,000 deaths/yr in U.S. ■ 70% of reported errors are “preventable” because of medical intervention; not client’s illness ● Role of Nurses in Preventing this error ○ Last line of defense; prevent, intercept, or correct errors ○ Ethical imperative ○ Communicate clearly; ○ Question authorities ○ Ex of errors: medication errors, client injuries from falls, clinical outcomes rel to client adherence to treatment, & rehospitalization ● Approximately 80% of medication errors are due to communication. ○ Use the 5 Rights right drug, right patient, right dose, right route, right time. Lecture #19: Workplace Health Promotion and Occupational Health Nursing ● Adults with multiple risk factors (smoking, high blood pressure, sedentary behavior) are more likely be highcost employees (Ee) in terms of ○ Healthcare use ○ Disability ○ Absenteeism ■ All 3 Affect the bottom line; the objective in a for profit setting! ○ Overall productivity ● The Problem ○ 75% of chronic disease and 75% of medical costs caused by 3 lifestyle behaviors: ■ tobacco use ■ Inactivity ■ poor nutrition ● Reasons for worksite health promotion (WHP) programs ○ Adults spend most of their waking hours at work. ○ WHP programs: ■ reduce risks for disease ■ improve Ee health, productivity, & morale ■ can offer tailored programs to meet business needs ■ serve as recruiting & retention tools ● Reasons for WHP Programs: ROI ○ Return on investment (ROI): Evidence ○ “The range of costeffectiveness estimates from three studies (two involving weightloss competitions and one involving a physical fitness program) varied from $1.44 to $4.16 per pound of loss in body weight” ○ (Suggested to watch) What does this clip say about ROI: ■ https://www.youtube.com/watch?v=2UFxoK3aty4 ■ = video about corporate wellness (2:52 min.) ○ **“For every $1 spent on wellness, $3 are saved in healthcare costs.”** ● Occupational Health Nurses ○ Occupational Health Nurses (OHN)s are registered nurses who independently ○ observe and assess the worker's health status with respect to job tasks and hazards. Using their specialized experience and education, these registered nurses ○ recognize and prevent health effects from hazardous exposures and treat workers' injuries/illnesses. ○
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