Nokea
The community nurse is caring for a patient who has paraplegia following a farm accident when he was an adolescent. This patient is now 64 years old and has just been diagnosed with congestive heart failure. The patient states, Im so afraid about what is going to happen to me. What would be the best nursing intervention for this patient?
- A. Assist the patient in making suitable plans for his care.
- B. Take him to visit appropriate long-term care facilities.
- C. Give him pamphlets about available community resources.
- D. Have him visit with other patients who have congestive heart failure.
Correct Answer: A
Rationale: The nurse should recognize the concerns of people with disabilities about their future and encourage them to make suitable plans, which may relieve some of their fears and concerns about what will happen to them as they age. Taking him to visit long-term care facilities may only make him more afraid, especially if he is not ready and/or willing to look at long-term care facilities. Giving him pamphlets about community resources or having him visit with other patients who have congestive heart failure may not do anything to relieve his fears.
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A nurse is planning the care of a patient who has been diagnosed with renal failure, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply.
- A. Diseases that resolve slowly
- B. Diseases where complete cures are rare
- C. Diseases that have a short, unpredictable course
- D. Diseases that do not resolve spontaneously
- E. Diseases that have a prolonged course
Correct Answer: B,D,E
Rationale: Chronic conditions can also be defined as illnesses or diseases that have a prolonged course, that do not resolve spontaneously, and for which complete cures are unlikely or rare.
The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patients condition has continued to deteriorate. What is the nurses best response to this clinical information?
- A. Recognize that death will most likely occur in the next week.
- B. Recognize that the patient is in the trajectory phase of chronic illness and should be kept pain-free.
- C. Recognize that the patient is in the downward phase of chronic illness and should be reassessed.
- D. Recognize that the patient should immediately be admitted into the hospital.
Correct Answer: C
Rationale: The downward phase occurs when symptoms of chronic illness worsen despite attempts to control the course through proper regimen management. A downward turn does not necessarily lead to death. A downward trend can be arrested and the trajectory reestablished at any point, depending on the condition and the treatment. A patient who is palliative may not desire hospitalization and aggressive treatment.
You are the case manager who oversees the multidisciplinary care of several patients living with chronic conditions. Two of your patients are living with spina bifida. You recognize that the center of care for these two patients typically exists where?
- A. In the hospital
- B. In the physicians office
- C. In the home
- D. In the rehabilitation facility
Correct Answer: C
Rationale: The day-to-day management of illness is largely the responsibility of people with chronic disorders and their families. As a result, the home, rather than the hospital, is the center of care in chronic conditions. Hospitals, rehabilitation facilities, clinics, physicians offices, nursing homes, nursing centers, and community agencies are considered adjuncts or back-up services to daily home management.
The nurse is reviewing the importance of preventative health care with a patient who has a disability. The patient states that she will not have the money to pay for her annual gynecologic exams or mammograms due to the cost of this hospitalization. What information would be appropriate for the nurse to share with the patient?
- A. Limited finances are a common problem for patients with a disability. Since you were hospitalized this year, you can likely forego the gynecologic exam and mammogram.
- B. These are very important health preventative measures, so you will need to borrow the money to pay for the exam and mammogram.
- C. Ill look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions.
- D. These preventative measures should likely be tax deductible, so you should consult with your accountant and then make your appointments.
Correct Answer: C
Rationale: Several federal assistance programs provide financial assistance for health-related expenses for people with some chronic illnesses, acquired disabling acute and chronic diseases, and diseases from childhood. Lack of financial resources, including health insurance, is an important barrier to health care for people with disabilities. Each of the other responses is inappropriate and inaccurate.
A 39-year-old patient with paraplegia has been admitted to the hospital for the treatment of a sacral ulcer. The nurse is aware that the patient normally lives alone in an apartment and manages his ADLs independently. Before creating the patients plan of care, how should the nurse best identify the level of assistance that the patient will require in the hospital?
- A. Make referrals for assessment to occupational therapy and physical therapy.
- B. Talk with the patient about the type and level of assistance that he desires.
- C. Obtain the patients previous medical record and note what was done during his most recent admission.
- D. Apply a standardized care plan that addresses the needs of a patient with paraplegia.
Correct Answer: B
Rationale: Patients should be asked preferences about approaches to carrying out their ADLs, and assistive devices they require should be readily available. The other listed actions may be necessary in some cases, but the ultimate resource should be the patient himself.