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1470 Lecture Review Exam # 1

Culture:
1. Know cultural difference in health-care, & why they are important?
In the health-care context, cultural differences can result in
different explanations for illness. For example in the western
culture , explanation for illnesses might include natural causes,
the social world, or supernatural causes.
Nurses who provide culturally competent care, bridge cultural
gaps in health care.
Folk healing in Native American, AA, Hispanic,Asian
two lactose intolerant groups are : Hispanic & Asian
Enculturation: Process by which a person learns norms, values,
and behaviors of another culture.
Acculturation: Process of acquiring new attitudes, roles,
customs and behaviors. Nurse tends to a lot of pregnant
Koreans. Nurse starts to give other pts. who are pregnant (not
Korean) seaweed soup.
Assimilation: Process by which a person gives up his/her
original identify & develops a new cultural identity by becoming
absorbed into the dominant cultural group. Give up your beliefs
entirely. Example: A Native American loses his Native identify
after living in Chicago for 10 years
1. Know role of female in health-care in different cultures.
most females tend to sick and elderly
Egyptians value female modesty and gender-congruent care, the
nurse would encourage female relatives to help the patient meet
her needs for personal hygiene.
In African American culture the female would assume the
position as a mambo, which is a healer with combination of
herbs, drums, etc.
Among traditional Muslims pregnancy out of wedlock sometimes
results in the family's imposing severe sanctions against the
female member .
Female circumcision is common among some African and Muslim
groups
1. Know the difference between cultures that think of healthcare(or health) in the short vs. long term
Long-term oriented cultures favor thrift, perseverance, and
adapting to changing circumstances. Among the most long-term
oriented countries are China, Hong Kong, Taiwan, and Japan.
Ex: These patients like to do routine checkups and take
preventives to not get to bad health. Long term knows it will be
a slow healing process if there is a problem.
Short-term oriented cultures are oriented to the present or past
and emphasize quick results; they favor respect for tradition and
fulfillment of social obligations, although status is not a major

issue in relationships and leisure time is important. United


States, Great Britain, Canada, and the Philippines are among the
most short-term oriented countries.
Ex: They are
only going to the doctor if there is a problem. They will want
quick results.
1. Why is there an emphasis on understanding cultural
differences in health-care?
Cultural competency is at the core of high quality, patientcentered care, and it directly impacts how care is delivered and
received.
Culture is an essential aspect of health care because of the
increasing diversity of the US and cultural health disparities for
more competent care
Culture has a direct effect on health behaviors. Beliefs, values,
and attitudes that are culturally acquired may influence
perceptions of illness, health care seeking behaviors and
response to treatment. Cultures view disease differently. It is
important to understand how the culture views the cause and
treatment of the condition and how traditional Western medicine
may or may not fit with that understanding a persons cultural
background influences the meaning of pain and how it is
expressed.
1. What are/is the interrelated construct of culture?
1.Cultural self-awareness: recognize bias, prejudice, and
assumptions about other groups.
2.Cultural knowledge: obtaining sufficient comparative knowledge of
diverse groups.
3.Cultural skills: Able to assess cultural, social, and biophysical factors
influencing treatment in care.
4.Culture encounters: engaging in cross-cultural interactions that
provide learning.
5.Cultural desire: motivation and commitment to caring that moves
individual to learn from others; accepting learning from others.
1. What is the role of the interpreter in health-care?
To provide safe and effective patient care, you need to develop
and use transcultural communication skills and be able to work
with interpreters . Interpreters are more effective when they
have knowledge of the culture of the patient. They provide
accurate accounts of what is said and, just as important, offer
information regarding the cultural beliefs of the patient and
family. Interpreters tactfully formulate culturally sensitive
questions that provide the health care provider with needed
information .
Interpret medical terminology in other languages that way
patient teaching is affective to other ethnicities and races. You
must be certified. If there are only English speaking children in

the room, make them leave and get a real translator. Look at pt.
not translator.
1. Know the definition of Culture
Culture is defined as a pattern of shared attitudes, beliefs, selfdefinitions, norms, roles and values that can occur among those
who speak a particular language, or live in a defined
geographical region
1. 3 questions on: Prioritize care related to culture (prioritizing
which patient to see first)
ABCs
o Assimilation- adopt new and get rid of old culture
o Enculturation- learn new and keep other
o Acculturation- developing new and keep other.
o Biculturation- two cultures.
Concept elements- shared beliefs, values and behaviors
White 20-30 year old standard clinical trial.
Thermoregulation:
1. What are the significant risks of a newborn in hypothermia?
large body surface area in relation to mass. Limited insulating
subcutaneous fat. Loses 4x more heat than adult. Poor thermal
stability. Under developed T regulation. Inability to correct
independently take measures to correct changes in temperature.
30% heat loss through heat.
particular risk for fluid volume deficit because they can quickly
lose large amounts of fluids in proportion to their body weight
Reduction in body temperature below normal range, Slow
capillary refill, Cool skin, Increased respiratory rate, Tachycardia
Immediately after birth, infants are particularly susceptible to
hypothermia because of low birth weight and poorly nourished
bodies; requiring immediate measures to provide warmth.
1. Know priority in nursing intervention pertaining to hypothermia.
The priority treatment for hypothermia is to prevent a further
decrease in body temperature. Removing wet clothes, replacing
them with dry ones, and wrapping patients in blankets are key
nursing interventions. In emergencies away from a health care
setting, have the patient lie under blankets next to a warm
person. A conscious patient benefits from drinking hot liquids
such as soup and avoiding alcohol and caffeinated fluids. It is
also helpful to keep the head covered, place the patient near a
fire or in a warm room, or place heating pads next to areas of
the body (head and neck) that lose heat the quickest.
The goal is to raise the temperature to the normal range.
Active core rewarming measures include infusion of warm intravenous
solution, gastric lavage with warm water, and warmed oxygen.

The nurse's role in primary prevention is through patient education.


Avoidance of exposure to temperature extremes is an obvious way to
prevent problems associated with thermoregulation.

1. Know strategies in treating older adults in hypothermia.


Assessment
External warming devices: warm blankets, administer warm oral fluids
Active core warming: warm intravenous fluids, heated humidified
oxygen, warm fluid lavage
Asses remove wet clothing, watch urine output, less able to maintain
to core temperature, avoid alcohol and caffeine.
1. What is the most appropriate method in checking temperature?
the most common way is the oral route or using a temporal
thermometer.
however if an individual has hyperthermia or hypothermia the most
reliable way is to take the rectal temperature
1. What are the signs and symptoms of hypothermia?
Mild- 34-36 Celsius; fatigue, slurred speech, clumsiness, confusion and
poor judgment. Shivering, tachycardia, tachypnea, and muscle rigidity.
Moderate- 30-34 Celsius; depressed mental state, no shivering,
depressed respiration, slow pulse/irregular heart rate,
hypotension, pale/cyanotic skin, hallucinations, and coma.
Severe- <30 Celsius; absence of respiration/pulse,
ventricular/atrial fibrillation, dilated and unresponsive pupils,
and coma.
1. 2-3 questions on: Know the temperature ranges and signs and
symptoms for each
Hypothermia: 30-34 C , shivering lack of coordination, slurred speech,
poor decision making, low energy and drowsiness
Hyperthermia: >37.2 C, heat stroke, muscle cramps, fatigue, dizziness,
headache, nausea, vomiting, and weakness, mental changes, heat
rash, sweating
Normal: 36.5 - 37.2 C
neonates core temp is between 36.5 and 37.6 C
1. Know the risks in neonate pertaining to hypothermia
low birth weight and poorly nourished infants
inability to take measures to correct changes in temperature as
removing or adding clothing
low birth weight, malnutrition, can lead to hypoxia, stock and
metabolic acidosis.
o Symptoms- Reduction in body temp, slow capillary refill,
cool skin, increase respiratory rate, & tachycardia.
1. 3 questions on: caring for elevated temperature patients

minimize heat production, limit physical activity, underlying cause


should be identified (fever, etc.), place cool packs on axil and groin
area(ice baths). (Dantrolene sodium can reverse effects of malignant
hyperthermia)

1. Know the signs and symptoms of an infant in hypothermia.


low birth weight, malnutrition, can lead to hypoxia, stock and
metabolic acidosis.
Symptoms- Reduction in body temp, slow capillary refill, cool
skin, increase respiratory rate, & tachycardia.
Reduction in body temperature below normal range, Slow
capillary refill, Cool skin, Increased respiratory rate, Tachycardia
Know that neonates are mostly at risk for hypothermia
Mobility
1. Know body alignment between musculoskeletal and nervous systems
Correct body alignment reduces strain on musculoskeletal
structure, promotes comfort, contributes to balance, and
conservation of energy
Damage to any component of the central nervous system that
regulates voluntary movement results in impaired body
alignment, balance, and mobility. Trauma from a head injury,
ischemia from a stroke or brain attack (cerebrovascular accident
[CVA]), or bacterial infection such as meningitis can damage the
cerebellum or the motor strip in the cerebral cortex.
1. Know nursing interventions for a bed ridden patient
the patient should be positioned with appropriate body alignment, this
is important to prevent injury
Patients with adequate cognition are encouraged to use an incentive
spirometer every hour to maintains ventilator capacity
bed exercises should be encouraged ( flexion, and extension) every 2
hours
if tolerated, patient should be encouraged to stand at side of bed
reposition every two hours. ROM to prevent
DVT/contraction/atrophy. Skin assessment every hour for
pressure ulcers/edema. Elevated to prevent statis pneumonia.
Promote coughing and deep breathing. Prevention of
constipation (sit them up/ .
1. 5 questions on: proper body alignment/re positioning in patient and
nurse
no twist when turning/ bend knees/ feet apart/ lower center of gravity/
close to patient/ face direction of movement/ rolling, turning, and
pivoting less work than lifting/ USE LEGS NOT BACK/ use abdominal
muscles.

1. Know the physical activity programs for older adults related to


mobility
ROM/ PT/ OT/ stand on side of bed just to get energy/slowing start
activities with warm ups and cool downs.
1. Know nursing interventions for hip fracture patients
Bucks traction temporarily immobilized the affected extremity
Consider patient history, meds/proper positioning and adjusted
traction/ post op skin assessment healing with no complication/
rest and comfort.
1. VS and neurovascular assessment
2. I & O
3. Respiratory
1. Know the roles of unlicensed personnel in caring for an immobile
patient
Encourage patient to do leg exercise/ cough deep breathe/ turn and
position and apply elastic stocking/ ice/ notify nurse of pain and
discomfort
1. Know the major risk factors in mobility and pressure ulcers
The greater the surface area of the object that is moved, the
greater the friction.
skin breakdown happens in 3hrs/ stops circulation/ Check
pressure points
A pressure ulcer is an impairment of the skin as a result of
prolonged ischemia (decreased blood supply) in tissues .The
ulcer is characterized initially by inflammation and usually forms
over a bony prominence. Ischemia develops when the pressure
on the skin is greater than the pressure inside the small
peripheral blood vessels supplying blood to the skin.
Lack of protection for pressure points at the ear, shoulder,
anterior iliac spine, trochanter, and ankles
1. Know the nursing interventions in caring for a stroke patient
pertaining to mobility
after a stroke or brain attack, a patient likely receives gait
training from a physical therapist; speech rehabilitation from a
speech therapist; and help from an occupational therapist for
ADLs such as dressing, bathing and toileting, or household
chores. T Equipment frequently used to help patients adapt to
mobility limitations includes walkers, canes, wheelchairs, and
assistive devices such as toilet seat extenders, reaching sticks,
special silverware, and clothing with Velcro closures
1. Know the relationship between DVT vs. Mobility
DVT- disorder involving a thrombus (blood clot) in a deep vein, most
common in the iliac and femoral veins.

DVT is essentially a blood clot, long periods of immobility often lead to


DVT. leads to damage to vessel and alteration of blood
Prolonged immobility, especially when seated, can lead to pooling of
blood in the legs, which in turn may cause swelling, stiffness and
discomfort.

1. Know the nursing interventions pertaining to immobility and skin


assessment
repositions every two hours, skin clean dry and
protected/regularly monitored **every hour**, sitting is limited
to one hour (patient needs to shift every 15 min when sitting)

skin care is a priority for immobilized patients, skin should be kept


clean, dry, and protected to prevent skin breakdown . it should be
regularly monitored and examined for evidence of adequate circulation

1. 5 questions on : re positioning
Document repositioning or turn and observations during
procedure (e.g., condition of skin, joint movement, patient's
ability to assist with positioning) in nurses notes.
Skin shows areas of erythema and breakdown. Increase
frequency of turning and repositioning; place turning schedule
above patient's bed.
1. Know patient history in caring for an immobile patient ( what we
need to know about patient)
presence of pain with movement, recent changes in mobility or
problems with balance, presence of fatigue, recent falls, recent
changes in ability to complete daily living activities
previous falls/ surgery, level of social support, job activity,
medications/ pain tolerance/
1. High priority for older adult in immobility.
stress the importance of adequate calcium and vitamin D intake
Monitor pt for depression and mood. They cant move therefore
they may be grumpy. Lesions/ulcers. Fall prevention. DVT.
Encourage self-care. Implementing a plan for body alignment and
mobility. Having items within reach. Monitor physiological for ADLs.
1. Know the prevention's and education for hip fractures
public should be taught/ encourage moderate exercise; use
pillow between legs to ensure proper alignment/ method of
exercise/ do not bring knees together/ keep legs apart/ needs to
be <90 angle in knees.
Bucks Traction boot is a type of skin traction that is used to
immobilize a fracture, prevent hip flexion contractures, and
reduce muscle spasms.

1. Know nursing interventions for post op care for hip fracture patient
after surgery
In the initial postoperative period assess vital signs, intake, and
output; monitor respiratory function and deep breathing and
coughing; administer pain medication; and observe the dressing
and incision for signs of bleeding and infection.
Use an elevated toilet seat. Place chair inside shower or tub and
remain seated while washing.
Use pillow between legs for first 6wk after surgery when lying on
nonoperative side or when supine.
1. 3 questions on: Know the difference of osteoporosis vs.
osteoarthritis
Osteoporosis-wearing down of bones/bone deterioration: Chronic,
progressive/ more common in woman over 65/ You can get shorter/ low
bone mass/ bone fragility/ need vitamin C. (p. 1554 from Lewis)
Reason 1: woman have lower Calcium intake
Reason 2: lower bone mass
Reason 3: bone reabsorption starts at lower age and accelerate
at menopause.
Reason 4: pregnancy and breastfeeding deplete a womans
skeletal reserves.
Reason 5: longer living in woman increases likelihood of OP.
Osteoarthritis- wearing down of joints: Noninflammatory
disorder/most common form of joint disease In US./prevention
not possible. ***** Only type of arthritis that isnt an
autoimmune disease.
Osteoporosis, a well-known and well-publicized disorder of
aging, results in the reduction of bone density or mass.
Patient teaching needs to focus on limiting the severity of the
disease through diet and activity
These metabolic bone diseases involve the deterioration of bone
tissue (osteoporosis) and the destruction of cartilage
(osteoarthritis).
In osteoporosis genetic factors contribute to osteoporosis by
influencing not only bone mineral density but also bone size,
bone quality, and bone turnover.
1. 4 questions on: prioritizing which patient you see first regarding
mobility ( mentioned it twice)
ABCs. Maslows hierarchy (1. Physiological 2. Safety 3. Love/belonging
4.esteem 5.self-actualization)
Multiple Choice
No all that apply questions
Do NOT add anything to question.
Always pick highest priority/what to do first.
Bring ID to exam