Skin/Integumentary
Name two teaching points for decreasing the risk of sunburns
•Wear protective clothing
•Wear sunscreen
•Avoid sun exposure between 10 am and 2 pm
Define DNR
Do not resuscitate – withholding life-saving measures (CPR) if a patient’s heart stops or patient is apneic
Most common cause of large bowel obstruction
Colorectal cancer
Define ageism
Ageism = negative perceptions toward older adults based on age
(Emphasis on youth in modern culture – many older adults feel invisible)
This is usually the last of the 5 senses to disappear as death is approaching
Hearing
3 risk factors for developing skin cancer
having fair skin, blonde or red hair with blue eye color
history of outdoor sunbathing
living near the equator or at high altitudes
family or personal history of skin cancer
having an outdoor occupation
spending a lot of time in outdoor recreation activities
indoor tanning
This was a common fear relating to death in the 18th and 19th centuries
Being buried alive
Classic patient symptom/complaint with a hernia (not assessment finding)
Pain
Define paternalism
Paternalism = healthcare professional makes choices for a patient based on the healthcare professional’s beliefs about what is in the best interest of the patient or what is best for the patient’s own good
When/why a hernia might require surgery
A hernia that cannot be moved back into place with gentle palpation is considered irreducible and requires immediate surgical evaluation.
In a hernia that is strangulated, blood supply is cut off to a portion of the bowel, increasing the risk for obstruction, necrosis, and perforation
Type of skin cancer with highest mortality rate
Melanoma
A common cardiovascular manifestation at EOL
•Increased heart rate (Later slowing and weakening of pulse)
•Irregular rhythm
•Decreased BP
Cause of mechanical bowel obstructions
blockage in the bowel (ex. adhesions, fecal impactions)
Define medical futility
Medical futility = The unacceptably low chance of achieving a therapeutic benefit for the patient
Describe the ABCDE rule for examining skin lesions
Asymmetry
Border irregularity
Color change
Diameter greater than 6 mm
Evolving in appearance
Most common type of skin cancer
Basal cell carcinoma
Difference between hospice and palliative care
Hospice is a subcategory of palliative care. All hospice is palliative care, but not all palliative care is hospice.
Palliative care:
Allows for curative and palliative treatment simultaneously
Management of symptoms
Hospice Care:
Six months or less to live
No further curative treatments
Cause of nonmechanical bowel obstructions
diminished peristalsis in the bowel (paralytic ileus)
This is a living will.
Written directions stating what medical care is to be provided if an individual can longer communicate or no longer has the mental capacity to make decisions
Name 3 nursing actions for a patient with an NG tube
Maintain intermittent suction as prescribed
Assess NG tube patency and placement. Irrigate every 4 hours, or as prescribed
Monitor and assess gastric output
Monitor nasal area for skin breakdown
Provide oral hygiene every 2 hours
Monitor vital signs, skin integrity, weight, and I & O
Intervention to reduce bruising/swelling after minor skin surgery/procedure
Apply cold packs
Name 4 of the stages in the Kubler-Ross Grief Model
Denial = The client has difficulty believing in an expected or actual loss.
Anger = The client directs anger toward self, others, a deity(God), objects, or the current circumstances.
Bargaining = The client negotiates for more time or a cure.
Depression = The client is overwhelmingly saddened by the inability to change the situation.
Acceptance = The client acknowledges what is happening and plans for the future by moving forward
Name 3 common clinical manifestations with a small bowel obstruction
Severe fluid and electrolyte imbalance
Metabolic alkalosis
Visible peristaltic waves
Epigastric or upper abdominal distension
Abdominal pain, discomfort
Profuse, sudden projectile vomiting with fecal odor
According to May, this is why elders need virtue.
To enhance the quality of their lives
Term for twisting of the bowel
Volvulus