fscj nursing term 1 exam 2 – Flashcards

use of technology to manage Health Data discipline in which Healthcare data is stored analyzed and disseminated

short-term. One incident within one Health Care Facility

long-term. Shared among facilities and agencies. whole life. Big picture

application of information period hardware and software that deals with storage retrieval and sharing of healthcare data.

integrates nursing science with multiple information management. identify Define manage and communicate data information knowledge and wisdom in nursing practice.

a question to which the respondent replies in her or his own words period elicits elaboration and allows the nurse to clarify anything mentioned

independent from nurses opinion . Restating. Active listening. Silence . clarifying techniques. Paraphrasing. Having open posture. Reflection . Asking open ended questions . Nurse expresses attitudes of concern, kindness, and compassion period examples include silence back rub humor addressing the patient by name.

ignoring the patient period not maintaining eye contact . asking why questions changing the subject giving advice approval disapproval or comparing

The sharing of information between individuals by using speech.

communication that does not use words. facial expressions. Body movement.

respect. Advocacy. Collaboration

defense mechanism that focuses on strength instead of weaknesses

Defense mechanism by which people refuse to accept reality.

defense mechanism redirecting negative emotions. Example boss yells at a man the man yells at wife wife yells at the child

overthinking a challenging situation or impulse to avoid dealing with the emotions defense mechanism

disguising one's own threatening impulses by attributing them to others. blaming. example husband is hostile and says that the wife has anger management problems.

explaining personal actions in a way that enhances self image. If fence mechanism. Example everybody cheats so why shouldn't I?

return to an earlier or less advanced condition . defense mechanism

blocking unacceptable thoughts from consciousness

Conscious, intentional pushing of unpleasantness from one's mind. you press

channeling unacceptable emotions or impulses to acceptable actions and responses period example a man with hostile feelings becomes a butcher.

orientation is the introduction observing and identifying period working is the assessment and health history labs. termination is the initial goodbye before going to analyze the data collected. This is all a part of the assessment phase in the nursing process

obtain name. Provide privacy. Advocacy. Provide health information.

narrative- traditional time-consuming lengthy. soap - subjective objective assessment planning. ad pie - assessment diagnosis planning implementation evaluation. sbar - situation background assessment recommendation response period charting by exception - just charting the abnormalities.

situation, background, assessment, recommendation. use when talking to a provider handoff reporting sharing clear information period situation - current status of patient. background - the patient's background history what they came in with what led to situation period assessment - identify the problem period recommendation - what actions or interactions should be initiated to solve the problem.

Pros - automatically identifies you period multiple people can access it simultaneously. Improves safety more accurate. cons - unable to assess during downtime software failure no texting lingo

Pros - no power outages narrative format period cons - difficult to locate Single usage paper candy grade handwriting legibility storage period only use blue or Black Ink No blank spaces one line through an error sign name date and credentials are needed.

direct, face-to-face communication between two or more people

communication you have with yourself

SBAR, Documentation, Reporting information to other staff, effective listening period between two professional persons

For many visual problems, especially those associated with decreased visual acuity, corrective lenses (glasses and contact lenses) are a relatively easy and inexpensive treatment. Surgery There are a number of surgical procedures performed to treat conditions of the eye. Laser-assisted in situ keratomileusis (LASIK) is a surgical procedure that involves cutting a small flap in the cornea and then retracting the flap. Pulses from a computer-controlled laser then remove small parts of the cornea, permanently reshaping its surface. The reshaped cornea can better focus light onto the eye and onto the retina, allowing for improved vision.35 The most common treatment for cataract is surgical removal, which may be an option for macular degenerative disease although not curative. In addition to surgery, those with macular degeneration also have the option of injectable drug treatments and photodynamic therapy.31 Microsurgical procedures and laser procedures are also available to treat many other visual disorders and are being done more frequently.43 Pharmacotherapy Certain visual disorders can be initially treated with ?-adrenergic eye drops, which decrease production of aqueous humor. Other types of eye drops prescribed include prostaglandin analogs, adrenergic agonists, and carbonic anhydrase inhibitors. In addition, oral forms of carbonic anhydrase inhibitors can also be prescribed. In addition to surgery, those with macular degeneration also have the option of injectable drug treatments and photodynamic therapy.44 Other common forms of ophthalmic pharmacotherapy include antibiotic, steroidal, and analgesic agents.

assessment - Gathering analyzing data subjective objective Labs test and reassessing. diagnosis- clustering data to identify patient problems. planning - goal centered prioritized diagnosis establish short-term and long-term goals must be smart. implementation - hands on period evaluation- our goals met.

Healthcare is available to all people however it is more important for the vulnerable society. This includes disadvantaged frail young and elderly patients

The assessment techniques of inspection, palpation, percussion, and auscultation are performed one at a time in this order for each body system except during assessment of the abdomen. During abdominal assessment, auscultation precedes palpation and percussion. The altered sequence of abdominal assessment avoids stimulation of the bowel before auscultation of bowel sounds. Inspection Inspection involves the use of vision, hearing, and smell to closely scrutinize physical characteristics of a whole person and individual body systems. Distinguishing between normal and abnormal findings for patients of different age groups begins the moment the nurse first observes and meets the individual, and it continues throughout the examination. Symmetry should be assessed by comparing the right and left sides of the body. Because the human body is usually anatomically symmetric, observing for abnormalities on both sides is important for detecting anatomic deviations. After inspection, further examination is performed using palpation and percussion. Palpation Palpation uses touch to assess body organs and skin texture, temperature, moisture, turgor, tenderness, and thickness. Palpation can determine organ location and size against the expected anatomic norm, any distention or masses, and vibration or pulsation associated with movement. Palpation is used to affirm details observed during inspection. Only light palpation should be applied to areas described by patients as sensitive or painful. Deep palpation is performed by physicians or advanced practice nurses to determine organ size and variation. Percussion Percussion involves tapping the patient's skin with short, sharp strokes that cause a vibration to travel through the skin and to the upper layers of the underlying structures. Vibration is reflected by the tissues, and the character of the sound heard depends on the density of the structures that reflect the sound. Knowing how the various densities reflect or absorb sound helps to determine the approximate size, shape, and borders of organs, masses, and fluid. An abnormal sound implies that an organ or area is possibly compromised with another substance, such as air, blood, or other bodily fluids. Percussion is typically performed by an advanced practice nurse or physician. Auscultation Auscultation is a technique of listening with the assistance of a stethoscope to sounds made by organs or systems such as the heart, blood vessels, lungs, and abdominal cavity. The characteristics of auscultated sounds depend on the body tissue or organ being assessed. Breath sounds, heart sounds, and bowel sounds are routinely assessed through auscultation. Practice is required to be able to differentiate normal from abnormal findings.

things a person tells you about that you cannot observe through your senses; symptoms. can be from a primary source which is the patient or a secondary source which is the patient's family medical chart

Observable, measurable information that can be validated or verified period also known as a sign. examples are the physical assessment lab test vital signs that are compared with normal levels

Skin Inspection The major portion of the skin assessment can be conducted while the patient is sitting on an examination table or bed. To properly inspect the skin of the buttocks and dorsal aspects of the legs or lower torso, the nurse can ask the patient to stand or can position the patient on the side or abdomen. During skin assessment, privacy is maintained by exposing only the body part being examined. If abnormalities are noticed during inspection, the involved areas should be palpated. A mental note should be made of the distribution and symmetry of hair, skin coloring, markings, and lesions. Observations of each part of the body are precisely documented, including pressure areas, skin breakdown, skin odors, unusual position of leg folds, condition of axillae skin and the area under the breasts, and any lesions or incision sites. For patients at risk for development of pressure ulcers, the Braden scale is used by nurses and other health care professionals to reliably score the potential for this complication. Refer to Chapter 29 for the complete Braden scale. Absence of Pigment Albinism is a congenital loss of pigmentation characterized by a generalized lack of melanin pigment in the eyes, skin, and hair or, in rare instances, in the eyes alone. It is a hereditary trait that causes the affected person to have pale skin, pinkish eyes, and almost white hair from birth. Cyanosis Cyanosis is a blue discoloration of the skin, nail beds, or mucous membranes that results from vasoconstriction or deoxygenated hemoglobin in blood vessels near the skin's surface. Central cyanosis is often due to cardiac or respiratory conditions that lead to poor blood oxygenation. Peripheral cyanosis, causing blue discoloration in the fingers or extremities, is most often due to local vasoconstriction or inadequate peripheral circulation. All factors contributing to central cyanosis also can lead to peripheral symptoms; however, peripheral cyanosis is most often observed in the absence of heart or lung conditions, such as exposure to cold for an extended period of time. Erythema and Purpura Erythema is redness of the skin caused by congestion or dilation of the superficial blood vessels in the skin, signaling circulatory changes to an area. It can occur with any skin injury, sunburn, infection, fever, or inflammation and disappears when pressure is applied. A temperature elevation may accompany erythema if the redness is associated with dilation of blood vessels in the deeper layers of the skin. Erythema is not easily detected in dark-skinned people but may be present in an area of the skin that is edematous (swollen) or warmer than the surrounding skin. Purpura (bleeding underneath the skin) and red pigmentation that does not blanch with pressure are nonspecific signs. Purpura may indicate vascular, coagulation, or platelet disorders. Jaundice Jaundice is a yellow hue to the skin, mucous membranes, or eyes seen in both light- and dark-skinned people. The yellow pigment results from excess bilirubin, a by-product of red blood cell destruction, or liver failure. The best site for evaluation of the patient for jaundice is the sclera or, in darker-skinned people, the hard palate. Pallor Pallor, a pale or lightened skin tone, usually is uniformly disseminated throughout the skin surface. Pallor can be caused by illness, emotional shock or stress, decreased exposure to sunlight, or anemia or may be a genetic trait. It is most evident on the face, nail beds, lips, and palms. Pallor can develop suddenly or gradually, depending on the cause. Localized pallor usually is not clinically significant unless it is accompanied by general pallor that is not typical of the patient's normal skin tone. It should be noted as unique from conditions such as vitiligo. Vitiligo Vitiligo is a loss of skin pigment. It is thought to result from an autoimmune response. Patches of depigmented skin most 344often are noted on the hands, face, and genital areas. Although vitiligo may occur in people of all skin types, it is most noticeable in dark-skinned people. Skin Lesions Benign, age-related skin conditions include age spots, skin tags, cherry angiomas (ruby red, often slightly raised papules), keratosis (thickened patches of skin), warts, and freckles. Inspection and palpation evaluates for lesions or disruptions in continuity of the skin. Skin lesions appear in a variety of shapes, sizes, and colors. When a lesion is identified, it is inspected for size, shape, color, location, and distribution. Measure skin lesions with a clear, flexible ruler, documenting the breadth, circumference, and height, as appropriate. Measure a lesion's depth if it extends below the skin's surface. Any type of exudate associated with a lesion is documented in terms of color, approximate amount of drainage, consistency, and odor. Pressure ulcers that develop as a consequence of poor circulation, inactivity, infection, or traumatic injury require extensive assessment and treatment, which is discussed in Chapter 29, in the context of wound care. Skin lesions are classified as primary lesions (arising from normal skin) or secondary lesions (resulting from changes in primary lesions due to scratching, trauma, infection, or the healing process). Primary skin lesions include petechiae (tiny, dark red spots that indicate hemorrhage under the skin), warts, psoriasis, poison ivy, or insect bites. Examples of secondary lesions are pressure ulcers, scars, and wound dehiscence. Table 20-2 presents a review of skin lesions, with illustrations, as they appear both above and below the skin's surface.

A = ASYMMETRY B = BORDER C = COLOR D = DIAMETER E = EVOLVING One half of lesion does not match the other half Irregular, uneven, or notched borders Variable in color Ranges from tan, brown, or black to white, red, or blue Typically exceeds size of pencil eraser: ;6 mm Looks different from other moles Changes in size, shape, or color

elderly - subcutaneous and sweat gland decreased elasticity decrease. infants - lack of pigment decrease sebaceous glands low ability to regulate temperature

Palpation is performed to assess the patient's skin for texture, warmth, turgor, edema, and moisture. helps to identify the characteristics of lesions with consideration to the contour (flat, raised, or sunken), stability, and consistency (soft or firm). Use gentle pressure to palpate both over and around the lesion. Edema (swelling) is caused when there is a buildup of fluid in underlying tissues. Common causes of edema are localized trauma to an area and impairment of venous return. Edema secondary to poor venous return usually is most prominent in the lower extremities or dependent areas of the body (e.g., the feet, ankles, and lower legs). Edematous skin usually appears stretched and glossy, depending on the amount of fluid in the underlying tissues and the elasticity of the skin. In older patients, edematous skin can have more subtle changes, often appearing boggy as a result of decreased underlying muscle tone and loss of skin elasticity. Edematous areas should be palpated to determine pain, image

swelling related to fluid retention beneath the skin. it appears stretched and glossy it is usually and the lower extremities like the feet ankles and lower legs normally related to trauma period check for pain and pitting

after blanching nail bed, color should return to normal withing <3 secs. related to perfusion

related to oxygenation. 180 degrees Plus. abscess, malignancy, congenital heart disease, hypoxia COPD congenital heart failure. nail beds are raised

infants - head is larger than chest. Fontanel closes between 9 and 18 months also known as soft spot period adults - prominent facial orbits due to loss of subcutaneous fat lower face appear smaller with teeth Los

Head Inspection and Palpation Begin examination of the head and neck by inspecting the patient's head position. The patient's head should be held upright, in a midline to trunk position, and remain motionless during inspection. Tremors or other neurologic disorders may be present if jerking movements are noted. Inspect the skull contour for size, shape, and symmetry. Make note of any abnormal lesions, incisions, masses, or nodules that are distinct in appearance, texture, or contour from the skin nearby. Gently palpate the skull in a circular pattern, progressing systematically from front to back. The adult skull should feel smooth and seamless, with the bones indistinguishable from one another. Overall, the scalp should move freely over the skull without tenderness, swelling, or depressions. Enlargement of the skull due to hydrocephalus (accumulation of cerebrospinal fluid in the ventricles of the brain) in children most often is a congenital condition, whereas in adults it may occur as a result of tumor growth. In adults with disorders of the adrenal glands that cause excessive growth hormone secretion, enlarged jaws and facial bones may result in acromegaly in both male and female patients. The size, shape, and contour of the head and eye and ear location should be mostly symmetric. Inspection of the eyes, eyebrows, and mouth should yield consistency and overall uniformity in the shape and contour of the features during rest, movement, and expression. If facial asymmetry is present, note whether all features on one side or portion of the face are affected and whether there are any accompanying abnormalities, such as edema, swelling, pallor, or pigmentation. Suspect facial nerve paralysis when an entire side or hemisphere of the face is involved. Facial nerve weakness is seen primarily in cases in which the lower half of the face is symptomatic. When only the mouth is involved, consider peripheral trigeminal nerve damage as the causative factor. Spasmodic muscular contraction or tics noted in the face, head, or neck of the patient are often associated with varying amounts of pressure on facial nerves and/or with psychogenic or degenerative changes to underlying facial structures. Examples are nerve damage caused by cosmetic procedures, traumatic injury from airbag deployment, and varicella-zoster virus infection.

cranial nerve 11 and 12.

cranial nerve five for facial sensation and expressions period lymph nodes. TMJ.

temporomandibular joint. it is anterior to the tragus. motion should be smooth. should not make a clicking a snapping sound when mouth opens.

nose should be midline. ability to smell. Nares should be patent. allergies signs are a dark line transverse on the nose. Swelling or redness of the eyes.

lymph is found on the neck axilla arm in inguinal area. they are palpable in infants. In adults they should be movable non palpable no pain or tenderness.

Pupillary reflexes are evaluated in a darkened environment using a penlight. To check for light reflexes, approach the patient's eyes from one side while asking the patient to focus straight ahead into the distance (Figure 20-11). Ask the patient to avoid looking directly into the light. The pupil closer to the light should constrict immediately in response to exposure to the indirect light, followed by constriction of the opposite pupil (consensual constriction) more distant from the light. Repeat the procedure on the opposite eye.

left side has two lobes due to Heart period right side has 3 lobes. children's owned loud and harsh. regular breathing uses the diaphragm and intercostal. Stressed breathing uses Nick and trapezoid muscles

Paroxysmal nocturnal dyspnea (PND) occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically the person awakens after 2 hours of sleep with the perception of needing fresh air. Orthopnea is the need to assume a more upright position to breathe. Note the exact number of pillows used. or stand to breathe.

The heart is a hollow, cone-shaped organ. It is normally in the center area of the chest known as the mediastinum and rests on the diaphragm. The size of the heart varies but usually is about 9 cm wide and 14 cm long (Shier, Butler, and Lewis, 2012). The heart is composed of four chambers divided into the right and left sides (Figure 38-1). The chambers on the top are atria. The lower chambers are ventricles. The wall of the heart is composed of three layers. The epicardium also is known as the visceral pericardium. This outer layer protects the heart and secretes serous fluid. The second layer is the myocardium, which is the cardiac muscle that contracts to push the blood out of the heart chambers. The third layer is the endocardium, which is the innermost layer that provides a protective lining in the chambers and valves of the heart . Blood returns from the body in the venous system to the heart, where it enters the right atrium (Figure 38-2). It passes through the tricuspid valve to enter the right ventricle during diastole. During systole, the pressure in the right ventricle exceeds the pressure in the pulmonary artery, and the blood passes through the pulmonic valve into the pulmonary artery. From there it flows into the capillary system, where oxygen is picked up by the red blood cells and carbon dioxide is released 950to the alveoli of the lungs. The oxygenated blood then flows into the pulmonary vein and enters the left atrium. The blood flows from the left atrium across the mitral valve into the left ventricle during diastole. During systole, the blood is pumped from the left ventricle past the aortic valve into the aorta and then distributed to the rest of the body (McKinley, O'Loughlin, Harris, and Pennefather-O'Brien, 2015). The Cardiac Cycle animation depicts the flow of blood through the heart..

SVC IVC - right atrium - tricuspid valve - right ventricle - pulmonary valve - pulmonary artery - lungs - left atrium - left ventricle - aorta- body

tip of the heart pointing down toward the 5th left intercostal space left side

broader area of heart's outline located at the 3rd right and left intercostal spaces

SA node

bluish coloration of the skin caused by a deficient amount of oxygen in the blood

Paleness

redness of the skin

A yellowing of the skin and eyes hard palate mucous membranes

smoking, chronic alcohol use, obesity, lack of exercise, diet) play a significant role in the acquisition of heart disease. Note any extracardiac or cardiac signs that may indicate heart disease: poor weight gain, developmental delay, persistent tachycardia, tachypnea, DOE, cyanosis, and clubbing. Note that clubbing of fingers and toes usually does not appear until late in the first year, even with severe cyanotic defects.

The carotid arteries, which provide blood supply to the head, are assessed for patency of blood flow. The nurse inspects the carotid arteries to see whether bounding pulses are visible. One at a time, palpate each carotid artery. It is vital to palpate only one carotid artery at a time, to avoid limiting blood flow to the brain and causing the patient to experience syncope and pass out. After completion of palpation, each carotid artery is auscultated (Figure 20-23) for the presence of a bruit (abnormal "swooshing" sound). Bruits are audible during auscultation when blood flow is partially or significantly obstructed.

African Americans are more susceptible to hypertension

1. Temporal 2. Carotid 3. Apical or PMI: at the apex of the heart, and PMI, at the fifth intercostal space, midclavicular line; 4. Brachial: At the inner aspect of the arm 5. Radial: On the thumb side of the inner aspect 6. Femoral: alongside the inguinal ligament; used in cases of cardiac arrest and for assessing circulation to the leg 7. Popliteal: Behind the knee where 8. Posterior tibial: Medial surface of the ankle 9. dorsalis pedis: top of the foot; used to determine circulation to the foot

View the index finger at its profile and note the angle of the nail base; it should be about 160. The nail base is firm to palpation. Curved nails are a variation of normal with a convex profile.. 160 degrees or Clubbing of nails occurs with congenital cyanotic heart disease, lung cancer, and pulmonary diseases. In early clubbing the angle straightens out to 180 degrees, and the nail base feels spongy to palpation. Then the nail becomes convex as the digit grows late clubbing Inner edge of nail elevates; nail bed angle is greater than 180 degrees. Distal phalanx looks rounder, wider, and shiny. Clubbing may result from increased platelet-derived growth factor.Diseases that disrupt normal pulmonary circulation (chronic lung inflammation, bronchial tumors, heart defects usually develops slowly over years; if the primary disease is treated, clubbing can reverse.

0 Absent pulse 1+ Weak and thready pulse, difficult to palpate 2+ Normal pulse, able to palpate with normal pressure 3+ Bounding pulse, may be able to see pulsation

1. central perfusion -normal HR and BP. 2. Cerebral tissue perfusion- patient's orientation to time, place, person, and situation. normal movement and sensation; clear speech; the presence of carotid pulses; and the absence of carotid bruit. 3. Peripheral tissue perfusion- extremities are warm with color appropriate for race and the radial and dorsalis pedis pulse rates are between 60 and 100 beats per minute with regular rhythm, easily palpable upstroke, and smooth, rounded contour. capillary refill time is less than 3 secs. no pain in fingers and toes or leg pain when walking. swelling edema dizziness and fainting do the lack of oxygen

decreases perfusion

allows a nurse to assess the patient skin integrity. enables blood flow is circulation. makes the patient feel better

wash from distal to proximal to increase blood flow circulation

Providing the patient with a clean, dry bed that is free of wrinkles is a basic nursing measure. Bed linens may be changed after a bed bath. If the bed is not soiled, the nurse may wait until the patient is sitting in a chair or off of the nursing unit for testing. A lift may be used to temporarily lift the patient off the bed surface if the patient is on bed rest. Making an unoccupied bed is easier on the nurse or UAP and the patient. If it is not possible to move the patient out of bed, the nurse can change the linens with the patient lying in bed. When making an occupied bed, the nurse should have all linens in the room before beginning the procedure. Making the bed can be done during or after the bath or after perineal care for incontinence.

three parts, whereas risk nursing diagnoses and health-promotion nursing diagnoses contain only two parts. Three-part nursing 76diagnosis statements include (1) the patient's identified need or problem using NANDA-I nursing diagnostic label(2) the etiology or underlying cause (i.e., related to [r/t]), and (3) signs and symptoms (i.e., as evidenced by [AEB] or as manifested by [AMB]). Sleep Deprivation related to frequent sleep interruption as evidenced by patient complaint of diarrhea 10 times throughout the night and feeling fatigued is an example of a three-part nursing diagnosis statement. Sometimes the acronym PES (problem, etiology, symptoms) is used to remind nursing students of how to structure an actual nursing diagnosis statement. A two-part risk nursing diagnostic statement contains only (1) the patient's identified need or problem (i.e., NANDA-I nursing diagnostic label) and (2) factors indicating vulnerability (i.e., risk factors). This is an example of a two-part risk nursing diagnostic statement: Risk for Injury with the risk factor of impaired cognitive awareness. This risk nursing diagnosis might be appropriate for a patient coming out of anesthesia after surgery. In some cases, nurses may write a risk for nursing diagnosis using the words related to rather than with the risk factors of. Specific institutional guidelines should be followed. A two-part health-promotion nursing diagnostic statement contains (1) the nursing diagnostic label and (2) defining characteristics. It always begins with the words Readiness for Enhanced. A health-promotion nursing diagnosis may state the following: Readiness for Enhanced Self-Health Management as evidenced by (as manifested by) expressed desire to manage illness more effectively.

care coordination can be defined as a set of activities purposefully organized by a team of personnel that includes the patient to facilitate the appropriate delivery of the necessary services and information to support optimal health and care across settings and over time.

High-Risk Pregnancy Pregnant women who have a high-risk pregnancy are often stressed and often require more monitoring to promote the best possible outcome. Care coordination may include patient education, dietician or nutritionist referral, and coordination of specialty testing. A social work consult may be necessary for Women, Infants, and Children (WIC) and Medicaid program initiation. Preterm Infants Preterm infants typically have a myriad of needs. Depending on gestational age, preterm infants may be born with problems associated with breathing, feeding, temperature regulation, heart, brain, blood, and immunity. Care coordination may include specialty care, home health nursing or private duty nursing, family teaching, and social support. Special Needs Children Children with special needs "require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families."9, e1451 Common conditions include autism, cerebral palsy, cystic fibrosis, Down syndrome, epilepsy, learning disabilities, intellectual disabilities, hearing loss, speech disabilities, and visual disabilities. Frail Elderly The frail and elderly spend the most health care dollars per capita. According to the Centers for Disease Control and Prevention, more than three-fourths of the geriatric population has at least one chronic disease, and half has two or more.29 The frail and the elderly are vulnerable to negative outcomes following falls and serious illness, making this population ideal for care coordination to prevent such events. Transitional Care Preventing hospital readmissions through incentivized transitional care coordination is a targeted area for improvement across government initiatives and strategies, including the Affordable Care Act, the U.S. Department of Health and Human Services, and the CMS.30 Effective communication of treatment plans and goals is essential for continuity of care. Kaiser Permanente Southern California recommends a standardized discharge summary, medication reconciliation, postdischarge hotline, postdischarge phone call within 72 hours, and timely primary care or specialist follow-up less than 7 days after discharge to reduce readmission rates.31 Mental illness According to the National Alliance on Mental Illness, patients with mental illness are at increased risk of early death from treatable chronic diseases and substance use conditions; however, integrated care is lacking in the primary care setting.32 Care coordination is beneficial for integrating behavioral health with medical care through screening, referral, and follow-up. End of Life End-of-life care espouses many aspects of care, including physical, psychosocial, spiritual, and cultural needs of both the patient and the family. Hospice and palliative care can take place in all health care settings, as well as in the home. Clinical guidelines of care established by the National Consensus Project for quality palliative care recommend care coordination as a key element to ensure quality communication between interdisciplinary team members and continuity of care during times of transition.33

• Interorganizational and interprofessional team that includes the patient • Communication and information exchange • A proactive plan of care with goals • A targeted set of purposeful activities • Outcomes and proactive follow-up

During the orientation phase of the interview, the nurse should establish the name by which the patient prefers to be addressed. Some individuals prefer formal titles of respect (e.g., Dr., Mr., Ms., Professor) and the use of surnames, whereas others are comfortable with less formality. How a patient is addressed is the patient's choice. The nurse should provide a personal introduction and state the purpose for the interview. This introductory phase is essential for establishing trust between the nurse and the 85patient, which affects all future interactions. Demographic data should be collected by asking focused or closed-ended questions. More general information can be gathered by open-ended communication techniques. Identifying patient needs and determining the extent to which patients want to be involved in care planning are important aspects of the introductory phase. • Making introductions, establishing professional role boundaries (formally or informally) and expectations, and clarifying the role of the nurse • Observing, interviewing, and assessing the patient, followed by validation of perceptions • Identifying the needs and resources of the patient

During the working phase of the interview, the nurse must stay focused on the purpose of the interaction. The nurse needs to individualize the process on the basis of the health of the patient and concerns that emerge during the course of the interview. Active, engaged listening is imperative during this process. The nurse must stay alert to what the patient says and how information is presented. Sometimes, how the patient shares information is more important than what the patient says. The nurse should watch for emotional cues indicating fear or painful experiences and the appropriateness of verbal and nonverbal cues. Educational needs are assessed during the patient interview (Patient Education and Health Literacy box). The nurse should document gaps in patient knowledge and areas in which clarification of disease processes or treatment would be beneficial. Knowing a patient's level of education and professional background is often helpful in designing appropriate patient teaching. A variety of communication techniques can be incorporated into the interview process. Open-ended questions encourage narrative responses from patients. Closed-ended, focused, and direct questions elicit specific information, such as the exact location of a patient's pain. It is appropriate to use direct questions to gather data about a patient's health history or during the review of body systems, when a yes or no answer is adequate. Direct questions can be expanded on with open-ended questions if more extensive information is needed. Chapter 3 provides in-depth discussion on therapeutic communication techniques that are helpful during the patient interview. During an admission interview, a thorough health history and review of systems should be conducted. If a patient being admitted to the hospital is too ill to interact for an extended period, the interview can be broken into smaller segments. Interviews with patients already hospitalized or established in the health care system are less extensive and more focused on newly identified patient concerns or problems. • Development of a contract or plan of care to achieve identified patient goals • Implementation of the care plan or contract • Collaborative work among the nurse, patient, and other health care providers, as needed • Enhancement of trust and rapport between the nurse and the patient • Reflection by the patient on emotional aspects of illness • Use of therapeutic communication by the nurse to keep interactions focused on the patient

The health history includes demographic data, which is collected during the orientation phase of the interview; a patient's chief complaint or reason for seeking health care; history of current illness; allergies; medications; adverse reactions to medications; medical history; family and social history; and health promotion practices

asking the patient questions pertaining to each body system, completes the health history. collects subjective, patient-reported data. inquire about the normal function of each.

As the end of the interview approaches, care is taken to review key findings and prepare the patient for the conclusion of the discussion. This can be done effectively by summarizing and validating the information covered with the patient. By reviewing the information with the patient, a consensus is established. As the interview concludes, the patient should be allowed an opportunity to interject additional pertinent information. The session is concluded with the nurse acknowledging the patient's participation and describing the next steps that the patient should expect. • Alerting the patient to impending closure of the relationship • Evaluating the outcomes achieved during the interaction • Concluding the relationship and transitioning patient care to another caregiver, as needed

1. referent -event or thought initiating the communication 2. sender -person who initiates and encodes the communication 3. receiver -person who receives and decodes, or interprets, the communication 4. message-information that is communicated 5. channel -method of communication 3. feedback- response of the receiver

techniques, such as active listening, open posture, and reflection, nurses encourage patients to explore personal concerns. Patients often respond with open, honest sharing to nurses, enhances relationships and helps to achieve positive outcomes. Consistent use demonstrates empathy and concern for patients. includes active listening silence therapeutic touch

comprehensive or complete assessment includes a thorough interview, health history, review of systems, and extensive physical head-to-toe assessment, including evaluation of cranial nerves and sensory organs. A complete physical examination may be conducted on admission to a hospital, during an annual physical at the office of a physician or nurse practitioner, or on initial interaction with a specialist. Comprehensive assessments often include a variety of laboratory and diagnostic tests that are ordered by the primary care provider. focused or clinical assessment is a brief individualized physical examination conducted at the beginning of an acute care-setting work shift to establish current patient status or during ongoing patient encounters in response to a specific patient concern. A focused assessment may be conducted when signs indicate a change in a patient's condition or the development of a new complication. This type of assessment is the most common type conducted by a nurse. Vital signs are assessed during each focused examination, which includes assessment of the pain level and pulse oximetry readings. The nurse examines the head, eyes, ears, nose, throat, neck, thorax (including lung and heart sounds), abdomen (including bowel sounds), and extremities. During a focused examination, the edema, peripheral pulses, capillary refill, skin turgor, and muscle strength are routinely identified. Wounds, intravenous sites, supplemental oxygen levels and delivery systems, nasogastric tubes, cardiac monitoring, and urinary catheters are assessed and documented. While assessing extremities, the nurse evaluates edema, pulses, capillary refill, and strength. Intake and output levels are documented, as well as any unique concerns of the patient at the time of the assessment. After completion of the basic head-to-toe assessment, attention turns to any health concerns raised by the patient. Emergency Assessment Emergency assessment is a physical examination done when time is a factor, treatment must begin immediately, or priorities for care need to be established in a few seconds or minutes. Patient treatment is based on a quick survey of accident or illness onset, followed by a narrowly focused physical examination of critical injuries or symptoms and signs. Patient responsiveness is determined in an attempt to establish the potential extent of injury to vital organs. Attention is paid to the patient's airway, breathing, and circulation. Other concerns in the emergent setting are noticeable deformities such as compound fractures, contusions, abrasions, puncture wounds, burns, tenderness, lacerations, bleeding, and swelling. During an emergency, the nurse may never have time to do a complete assessment and may work to stabilize one body system at a time. In this event, the nurse must remember to continually reassess every 5 to 15 minutes, depending on the stability of the patient.

person who works in the field of informatics

hardware and software

support the share of Health Data across Healthcare institutions. Data warehouses that are repositories for store data and communication Networks

test visual Acuity from 20 feet away

nearsightedness the ability to see close but not far distances

rapid shaking involuntary movement of eyes on Extreme gazes left or right normal period abnormal happens irregularly

six cardinal gazes indicate cranial nerves 3 4 and 6 are intact

pupils equal, round, reactive to light and accommodation

sound associated with closure of AV valves period the start of systole the lub sound of the heart period same as the Carotid pulse S1 is louder at the Apex which is the bottom of the heart

loudest at the base or or top of the heart. Closure of the semicircular valves

Abnormal or unusual heart beat because blood is flowing backwards. sounds like blowing or Swoosh

cardiac output to organs from arteries Returns the blood through veins. normal output is 4 - 6 liters per minute

The amount of blood ejected from the heart in one contraction.

blood in the ventricles at the end of diastole

tissue volume of blood flowing to capillaries to peripheral extremities