CRRN Exam 652 Questions with Verified Answers
Ethical dilemma - CORRECT ANSWER When a person or group is forced to choose between 2 equally difficult
... [Show More] actions because they are both right or they are both wrong, or both contain uncertainty
Code of Ethics - CORRECT ANSWER Established by ANA; Provides a framework for nurses to use in ethical analysis and decision making; 9 provisions
living will - CORRECT ANSWER Legal document that allows a person to make his or her wished regarding medical care, illness or conditions that result in incompetence known before he or she becomes hospitalized or ill
Virtue ethics - CORRECT ANSWER places less emphasis on learning specific rules and more emphasis on developing good character that leads to making proper decisions
Duty ethics - CORRECT ANSWER the obligation of individuals towards a higher power, oneself and to others; focuses on avoiding wrong doing and treating everyone as equals
Utilitarianism - CORRECT ANSWER Form of ethics that assumes that the end justifies the means. This is the belief that the best course of action is that what which results in the most good for the most people and has the most utility or usefulness.
Situation ethics - CORRECT ANSWER Acknowledges the unique characteristics of each individual and promotes making the best decision given the specific circumstances
Nonmaleficence - CORRECT ANSWER do no harm
Beneficence - CORRECT ANSWER doing good
Ethical Subjectivism - CORRECT ANSWER Individuals create their own morality and there is no absolute moral truths. There is only individual opinion.
moraltiy - CORRECT ANSWER principles concerning the distinction between right and wrong or good and bad behavior.
Ethical Objectivism - CORRECT ANSWER There are universal or objective moral truths and it is not up to the individual to determine moral truths
Concussion - CORRECT ANSWER Mild TBI; Injury to head resulting from blunt trauma or acceleration or deceleration forces
Contusion - CORRECT ANSWER Bruising to the brain cortex
Most common tool for assessing pain level - CORRECT ANSWER One that will assess the intensity (scale 1 - 10), quality, location and radiation of pain. It will then identify the factors that increase or decrease pain
How to minimize contractures that impact function and pain - CORRECT ANSWER Maintain a regular program of passive stretching of the muscles and joints, walking, splinting and proper positioning; Avoid static positioning
static positioning - CORRECT ANSWER sitting, standing, sleeping; staying in one position too long
ASIA Impairment Scale AKA - CORRECT ANSWER American Spinal Injury Association Impairment Scale
ASIA Grade A - CORRECT ANSWER Complete lack of motor and sensory function below the level of injury (including anal area)
ASIA Grade B - CORRECT ANSWER Some sensation below the level of the injury (including anal sensation); but no motor function
ASIA Grade C - CORRECT ANSWER Some muscle movement is spared below the level of injury, but 50 percent of the muscles below the level of injury cannot move against gravity.(Muscle grade less than 3/5); Sensory function intact
ASIA Grade D - CORRECT ANSWER Most (more than 50 percent) of the muscles that are spared below the level of injury are strong enough to move against gravity. (Muscle grade greater than or equal to 3/5); Sensory function intact
ASIA Grade E - CORRECT ANSWER All neurologic function has returned
4 types of brain injuries - CORRECT ANSWER Concussion; Contusion; Penetrating injury; Anoxic brain injury
TBI - CORRECT ANSWER alteration in brain function or other evidence of brain pathology caused by an external force
Apraxia - CORRECT ANSWER the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement.
What are communication issues with ALS pts - CORRECT ANSWER r/t impairment of muscles of speech
Receptive (Wernicke's) Aphasia - CORRECT ANSWER Pt can produce verbal language but the language content is meaningless and words may be incorrect or inappropriate; CANNOT deter their own errors.
Expressive (Broca's) Dysphagia - CORRECT ANSWER Inability to form or find (or difficulty forming or finding) words; Difficulty writing; Inability to read letters, numbers or written material
Therapeutic communication - CORRECT ANSWER a type of communication that health care providers consciously use when talking with residents in order to influence residents or help residents to a better understanding
PTSD symptoms - CORRECT ANSWER Experiencing the traumatic event in one or more of the following ways: flashbacks, repetitive dreams/nightmares, excessive verbalization of the event, survival guilt, etc.
Stressors for men with SCI - CORRECT ANSWER Physical abilities, health, finances
Kempson's treatment of PTSD - CORRECT ANSWER Suggested specific body-oriented therapies to facilitate the return to normal neurobiological functioning, thereby enhancing efficacy of talk therapies
efficacy - CORRECT ANSWER effectiveness; the ability to produce a desired or intended result.
Multidimensional Acceptance of Loss Scale - CORRECT ANSWER Ability of a pt to enlarge the scope of values, contain the disability, subordinate the physique, and change comparative status values to asset values
APC - CORRECT ANSWER Assessment Instrument for Problem-Focused Coping
What does the APC do? - CORRECT ANSWER Self-reporting tool that focuses on a persons own assessment in coping with ADL's and personal problems
Factors that enhance the coping of parents with school-aged children with disabilities - CORRECT ANSWER Spiritual support
Passive appraisal - cognitive distraction that allows the individual to accept and minimize reaction to difficult situations
Reframing - look at the same situation in a new way that highlights possibilities rather than the "threats" involved
Mobilizing the family to accept help
Least common methods for coping of parents with school-aged children with disabilities - CORRECT ANSWER Maintaining family integration
Understanding the child's health condition
Physical manifestations of stress - CORRECT ANSWER Headaches
Sleeplessness
problem-focused coping - CORRECT ANSWER Efforts directed at lowering or eliminating threats
emotion-focused coping - CORRECT ANSWER Efforts directed at decreasing negative motion
2 most common sleep disorders - CORRECT ANSWER Sleep apnea
Narcolepsy
Why we need sleep - CORRECT ANSWER Restore energy
Support anabolic processes
Characteristics of REM - CORRECT ANSWER Rapid eye movement
Lack of muscle movement
Vivid dreams
Melatonin production and function - CORRECT ANSWER Produced in pineal gland
Has a role in the sleep-wake cycle
Goal of pulmonary rehab - CORRECT ANSWER Reduce or minimize triggers or symptoms
Restore functional ability
Improve quality of life
vertigo - CORRECT ANSWER dizziness
Presyncope - CORRECT ANSWER a light-headed, swimming sensation or feeling of fainting or falling caused by decreased blood flow to brain or heart irregularity causing decreased cardiac output
Disequilibrium - CORRECT ANSWER a loss or lack of equilibrium or stability,
Nursing assessment of functional mobility includes which 4 major areas: - CORRECT ANSWER Bed mobility
Transfers
Wheelchair mobility
Ambulation
goal of cardiac rehab - CORRECT ANSWER * Reduce or minimize further complications from cardiac disease
* Promote a healthy heart lifestyle (diet, exercise, stress management
* Improve cardiac function
Spasticity management - CORRECT ANSWER - Achieved thru oral antispasticity medications such as Valium, Baclofen, Klonopin, Benzos
- May also be managed thru exercise, stretching, Baclofen pump implantation and Botulinum toxic injections
Botulinum toxic (Botox) injections - CORRECT ANSWER protein that stops muscle spasms - a spasm is when your muscle contracts or moves on its own
Transfer process for pt with impaired weight-bearing mobility of one side of the body - CORRECT ANSWER - Place wheelchair on the strong (unaffected) side
- Stand client with strong (unaffected) foot forward toward the wheelchair
- Have pt place strong (unaffected) hand on the armrest on opposite side of chair and rotate body on strong (unaffected) foot
- Lower into chair once body is square to the chair
Normal gait - CORRECT ANSWER - Erect balance
- Foot lift
- Push off with alternate foot
- Ride-over
- Heel strike of opposite foot
Medications that contribute to bladder incontinence - CORRECT ANSWER - Diuretics
- Sedatives
- Anticholinergics
- Antihypertensives
Using bladder scanner to control incontinence - CORRECT ANSWER Cath for PVR > 150, or PVR > 300 if pt unable to void
Piaget's Sensorimotor Stage of Development - CORRECT ANSWER - Occurs from 0 - 2 years of age
- Development proceeds from reflex activity to sensorimotor
- Sucking and touching actions by infants are innate at first
- Infants begin to understand how personal behavior affects the world and become involved in trial and error
6 steps in Newman's System Model Nursing Process - CORRECT ANSWER 1. Assessment of pt
2. Diagnosis by interpreting the data
3. Set goals
4. Create plan
5. Implement plan
6. Evaluate
Piaget's Preoperational Stage of Development - CORRECT ANSWER - Occurs from 2 - 7 years old
- Development proceeds from sensorimotor to prelogical thought
- Child begins to fantasize and use symbols to represent objects and feelings
Piaget's Concrete Operational Stage of Development - CORRECT ANSWER - Occurs from 7 - 11 years old
- Development proceeds from prelogical to logical, concrete thoughts.
- Rules are devised to govern behavior
- Train and error is replaced by the ability to problem solve
Piaget's Formal Operational Stage of Development - CORRECT ANSWER - Occurs from 11 - 15 years old
- Development proceeds from logical, concrete thought to logical solutions to all kinds of categories of problems
-Reasoning and abstract conceptualizations are used to help guide future actions.
- The ability to walk in another's shoes is gained
Imogene King: Open system theory of adjustments to stressors - CORRECT ANSWER Shows that individuals are in constant interaction with their environment and one another
Health Promotion Model (Nola Pender) - CORRECT ANSWER Assumes that people seek to regulate their own behavior and that health professionals play an influential role throughout the pts lifespan
- The personal belief in one's own capacity to control life event's is a tenet of the theory
5 core self-management concepts that promote self-efficacy to the Health Promotion Model - CORRECT ANSWER Problem solving
Decision making
Resource use
Collaboration
Action
Stage 1 of Erickson's Theory - CORRECT ANSWER Trust vs Mistrust
* Birth - 12-18 months
Views the universe as reliable
See relationships as stable and available
Stage 2 of Erickson's Theory - CORRECT ANSWER Autonomy vs. Shame and Doubt
* 18mo - 3 yrs
Understanding control over one's body and thinking.
Understanding disappointment in self and others
Stage 3 of Erickson's Theory - CORRECT ANSWER Initiative vs. Guilt
* 3 - 5 years old
Deals with genital issues
Stage 4 of Erickson's Theory - CORRECT ANSWER Industry vs. Inferiority
* 5 - 12 years old
Dealing with relationships outside the family
Stage 5 of Erick6son's Theory - CORRECT ANSWER Identity vs. Confusion
* 12 - 19 years old
Clarifying personal identity
Stage 6 of Erick6son's Theory - CORRECT ANSWER Intimacy vs. Isolation
* 18 - 40 years old
Develop mature bonding
Stage 7 of Erick6son's Theory - CORRECT ANSWER Generativity vs. Stagnation
* 40 - 65 years old
Being creative and productive and carrying out parental responsibilities
Stage 8 of Erick6son's Theory - CORRECT ANSWER Integrity vs. Despair
* Age 65+
Central neuropathic pain - CORRECT ANSWER caused by lesion or dysfunction in brain or spinal cord (CNS)
Peripheral neuropathic pain - CORRECT ANSWER Caused by lesion or dysfunction in the peripheral nervous system
Integral nursing - CORRECT ANSWER It shifts our consciousness to deeper levels of meaning and understanding about our knowing, doing, and being.
Middle-range theory - CORRECT ANSWER People change over time, especially after incurring a disability. Their environment also changes over time.
These changes affect the person-environment interaction
Self-concept vs. Self-esteem - CORRECT ANSWER self concept is how we view ourselves whereas self esteem refers to how much we value ourselves
Stigma - CORRECT ANSWER a mark of disgrace associated with a particular circumstance, quality, or person.
Attitudes about and stereotypes of people with disabilities
Six Sigma - CORRECT ANSWER a process for reducing costs, improving quality, and increasing customer satisfaction
ICF acronym - CORRECT ANSWER International Classification of Functioning, Disability, and Health
OASIS acronym and function - CORRECT ANSWER Outcome and Assessment Information Set
Home health agency client assessment instrument
Hopelessness - CORRECT ANSWER SUSTAINED subjective emotional state in which a person sees no choices available to solve their problems or achieve what is desired
self-efficacy - CORRECT ANSWER An individual's belief that he or she is capable of performing a task.
The sense of control over one's life
Maslow's Hierarchy of Needs - CORRECT ANSWER (level 1) Physiological Needs,
(level 2) Safety and Security (shelter, job security)
(level 3) Relationships, Love and Affection,
(level 4) Self Esteem,
(level 5) Self Actualization
4 most important human needs (Maslow) - CORRECT ANSWER Air
Water
Food
Sex
Kohlberg's Theory of Moral Development (1976) - CORRECT ANSWER Developing children progress through a predictable sequence of stages of moral reasoning (preconventional, conventional, postconventional).
He focused on male children
Gilligan's theory of moral development - CORRECT ANSWER males base morality on individual rights and justice while women base morality on care and responsibility
She focused on female children
Freud's Psychoanalytic Theory - CORRECT ANSWER Focus on the influences of early childhood
Emphasis on unconscious motives/conflicts
Primary focus on sexual and aggressive urges
Holistic concept of Wellness - CORRECT ANSWER Self-directed quest for optimal well-being, along with a multidimensional continuum of mind, body and spirit
Social interaction and environment, such as social support from family and friends, influence wellness
Holistic concept of Client - CORRECT ANSWER -The client is seen as being one with the universe
-The client is an energetic being manifested as frequencies or energy waves
-Nurse can preserve client's dignity by practicing self-awareness of verbal/non-verbal communication and engaging the client's participation in care through active listening and acknowledging the client's input
Holistic concept of Environment - CORRECT ANSWER Environment includes: physical surroundings of client and the things that are present in that environment
Physical environment that is conducive to healing has calming/healing colors, no noxious sounds but soft ambient sounds
CAM acronym - CORRECT ANSWER Complementary and alternative medicine
NCCAM acronym and function - CORRECT ANSWER National Center for Complementary and Alternative Medicine
Federal agency that funds research on complementary and alternative medicine
Integrative medicine - CORRECT ANSWER Combination of conventional biomedicines used in conjunction with complimentary approaches
Most common CAMs - CORRECT ANSWER Natural products
Deep breathing
Meditation
Chiropractic care
Energetic touch - CORRECT ANSWER Based on the interaction of the human energy fields between the provider and client with the purpose of removing blockages in the energy field to promote healing
Benefits of therapeutic touch - CORRECT ANSWER Decrease pain
Reduce stress/anxiety
Improve well-being and quality of life
Accelerated healing
Decreased use of medicine
CAM practices for mental health - CORRECT ANSWER Breathing techniques
Meditation/yoga
Living in the present moment
Acupuncture - to identify and treat the underlying cause or imbalance that is contributing to the depression
Taking supplements: St. John's Wort, omega 3 fatty acids, SAM-e
The integral nursing theory - CORRECT ANSWER a multifaceted approach to the metaparadigm of a person described within four domains.
1. Individual interior
2. Individual exterior
3. Collective interior
4. Collective exterior
Individual exterior of Integral Nursing Theory - CORRECT ANSWER Known as the "IT" or objective space
Includes:
1. The material body (physiology, biochemistry, chemistry or physics)
2. Integral pt care plans, skill development (health, fitness, nutrition, exercise)
3. Behaviors
4. Leadership skills
5. Anything we can touch or observe in time and space
Individual interior of Integral Nursing Theory - CORRECT ANSWER Known as the "I" or subjective space
Involves:
1. The individuals inner experiences (thoughts, emotions, memories, perceptions, etc.)
2. The individuals state of mind (fears, values, etc.)
functional incontinence - CORRECT ANSWER Loss of urine/stool that is NOT caused by the GU/GI system and is caused by something outside these systems
Often d/t cognitive impairment or the loss of ability to perform behaviors needed for independent toileting
How to manage functional incontinence - CORRECT ANSWER Provide prompt voiding schedule
Ensure adequate fluid intake
3 classifications of neurogenic bladder - CORRECT ANSWER 1. Spastic bladder dysfunction
2. Flaccid bladder
3. Overactive bladder
Spastic bladder dysfunction - CORRECT ANSWER UMN SCI
Failure to store urine
Flaccid bladder - CORRECT ANSWER LMN SCI
Failure to empty urine
Overactive bladder - CORRECT ANSWER a condition that occurs when the muscles of the bladder contract involuntarily even though the bladder is not full
Detrusor hyperreflexia without sphincter dyssynergia
Sensory paralytic bowel impairment - CORRECT ANSWER -Afferent nerve root loss/damage
-Occurs subsequent to diabetes or tabis dorsalis (slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain)
-Produces diminished/absent ability to distinguish the need or time to defecate but rarely produces incontinence because the motor function of the rectum is still active
Motor paralytic bowel impairment - CORRECT ANSWER -Efferent nerve root loss damage
- Occurs subsequent to poliomyelitis, invertebral disc disease, tumor or trauma
- Results in inability to assist with defecation and is associated with incontinence only if there is widespread disease d/t the innervation of the intestines
Changes in the elderly that affect bowel function - CORRECT ANSWER 1. Changes that occur in the striated and smooth muscle strength
2. Less activity
3. Less consumption of roughage and poorer dentition
4. Self-limiting hydration d/t concerns of urinary incontinence or nocturia
5. Comorbidities begin, along with increased medication use
Stress incontinence - CORRECT ANSWER Small losses of urine that occurs when intra-abdominal pressure is increased by activities such as coughing, laughing, exercising or sneezing
Caused by a weak external sphincter, weak pelvic floor musculature, and secondary effects of smoking and/or obesity
How to treat stress incontinence - CORRECT ANSWER 1. Pelvic floor Kegel exercises
2. Provide toilet assistance and bladder training
3. Pharmacological therapy
4. Surgery
urge incontinence - CORRECT ANSWER Loss of urine d/t abnormal detrusor contractions and is sometimes associated with urinary retention
Characteristics: strong urge to void, frequency and nocturia
A major component of overactive bladder
Causes: detrusor hyperreflexia, uninhibited bladder contraction and suprapontine lesions
How to treat urge incontinence - CORRECT ANSWER 1. Bladder training/retraining
2. If cog intact and pt is motivated, teach urge inhibition
3. Pelvic floor muscle exercises
4. Pharmacological therapy
overflow incontinence - CORRECT ANSWER Loss of urine d/t bladder overdistention or retention
Characteristics: urgency, frequency, dribbling, stress and urge incontinence
Causes: reflex or neurogenic components, external sphincter dyssynergy, weak detrusor
How to treat overflow incontinence - CORRECT ANSWER 1. Allow sufficient time for voiding
2. Check PVR
3. Double voiding
4. Crede maneuver (exerting manual pressure on the abdomen at the location of the bladder, just below the navel.)
5. Intermittent I/O cath
6. Pharmacological therapy
7. Surgery
Difference between health and wellness - CORRECT ANSWER Health = state of physical, mental and social well-being. It doesn't just mean the absence of disease.
Wellness = a journey that everyone takes in our quest for well-being of mind, body and spirit. Key components are: personal responsibility, balance thru all phases of health; body-mind-spirit connectedness, relationships with self, others and the environment.
Health promotion - CORRECT ANSWER the process of enabling people to increase control over, and to improve, their health
Benefits of pt education - CORRECT ANSWER 1. Better outcomes for pt and family
2. Improved pt and family satisfaction
3. Continuity of care
4. Cost containment
5. Improved staff satisfaction
Ineffective health maintenance - CORRECT ANSWER The inability to identify, manage, and /or seek out help to maintain health.
Medications that contribute to sexual dysfunction - CORRECT ANSWER 1. Antidepressants
2. Antihypertensives
3. Anticholinergics
4. Anticonvulsants
5. Histamine 2 blocking agents
6. Lipid lowering agents
7. Digoxin
8. Opioids
What is PLISSIT model used for - CORRECT ANSWER Sexual counseling
PLISSIT Model; IT - CORRECT ANSWER Intensive therapy--which is indicated when the individual requires intervention for long-standing relationship problems and/or enduring sexual problems
EX: marriage counseling, medical management of impotence, infertility, childbirth
PLISSIT model, P - CORRECT ANSWER Permission--which requires the hcp to create an atmosphere which gives the individual permission to raise concerns about his/her sexuality and sexual activities
PLISSIT model; SS - CORRECT ANSWER Specific Suggestions-- assisting with problem identification, providing specific suggestions to resolve a problem
EX: suggestions to deal with erectile dysfunction, bowel and bladder concerns, positioning, contraception
PLISSIT; LI - CORRECT ANSWER Limited information--providing some specific information to questions raised or concerns expressed and allowing the person to pursue the issue further if they are comfortable
Sexual problems - CORRECT ANSWER 1. Desire
2. Excitement phase disorders
3. Orgasm phase disorders
Or a combo of the 3
What 3 things guide rehab nursing as a specialty practice? - CORRECT ANSWER 1. Philosophy
2. Theory
3. Research
What is Imogene King's goal of nursing - CORRECT ANSWER To help individuals maintain health so they can function in their roles
What are the 3 interrelated parts of Lydia Hall's theory - CORRECT ANSWER 1. Care
2. Core
3. Cure
What are the 3 stages of prevention in Neuman's model? - CORRECT ANSWER 1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
Orem's theory of the nursing process - CORRECT ANSWER A method to determine the self-care deficits of a pt and then defines the nurse or caregivers role in helping the client meet their self-care demands
What are the 3 parts of Orem's self-care theory? - CORRECT ANSWER 1. Theory of self-care
2. Theory of self-care deficit
3. Theory of nursing system
What is Martha Roger's Unitary Theory - CORRECT ANSWER When nurses promote change and facilitate order during rehab of sick and disabled people.
Which theorist encouraged the use of one's own powers? - CORRECT ANSWER Florence Nightingale
She believed nurses help pts obtain the best condition possible so nature can cure
Locus of control theory - CORRECT ANSWER People who believe they are in control of their health are more likely to change their behavior than those who believe outside forces are in control.
Self-efficacy model - CORRECT ANSWER Influences how much effort a pt puts in rehab therapy by helping pts maintain a positive attitude toward rehab and confidence to attain new goals.
Model for Children and Families - CORRECT ANSWER Anne Casey
Age-specific nursing theory that is helpful when practicing rehab across the lifespan
Collective exterior of Integral Nursing Theory - CORRECT ANSWER Known as the "Its" or interobjective space
Includes: social systems and structures, networks, IT, etc.
The structure that can be enhanced to create more integral awareness and partnerships to achieve health and healing both locally and globally
Collective Interior or Integral Nursing theory - CORRECT ANSWER Known as the "WE" or intersubjective space.
Involves how we come together to share our cultural background, stories, values, meanings, vision, etc., and how to form partnerships to achieve a healing missions.
Braden score - CORRECT ANSWER 19-23 - not at risk
15-18 - preventative interventions
13-14 - moderate risk
10-12 - high risk
6-9 - very high risk
A scale made up of six subscales, which measure elements of risk that contribute to either higher intensity and duration of pressure, or lower tissue tolerance for pressure. These are: sensory perception, moisture, activity, mobility, friction, and shear.
How does accreditation affect pt safety and quality of care - CORRECT ANSWER 1. Increases accountability
2. Establishes metrics for benchmarking
3. Reduces liability insurance costs
4. Provides a competitive edge in the marketplace
Structure measure - CORRECT ANSWER Tracks whether a particular mechanism or system is in place
Process measure - CORRECT ANSWER Tracks performance of a particular action
Outcome measure - CORRECT ANSWER Considers the end results of care, such as morbidity and mortality resulting from disease
Failure Mode and Effects Analysis (FMEA) - CORRECT ANSWER Systematic, proactive approach to evaluating a process
Steps of FMEA - CORRECT ANSWER 1. Identify all steps of a process
2. Identify when and how the steps might fail
3. Assess the impact of each potential failure
4. Identify which steps are in most in need of change
NQF acronym/function - CORRECT ANSWER National Quality Forum
Voluntary consensus standard-setting organization
Mission: to improve quality of healthcare by setting national priorities for performance improvement, publicly reporting on performance, education, etc.
Diagnostic tests/data to determine nutritional status - CORRECT ANSWER 1. Serum albumin - available protein stores
2. Hemoglobin - ability to transport oxygen
3. HA1C - average blood glucose the past 3 mos.
4. Prealbumin level - nutritional status, protein synthesis, and catabolism
Frazier Water Protocol - CORRECT ANSWER Allows pts with dysphagia to drink water 30 minutes before and after meals.
Rationale: small amounts of water, even when aspirated, do not contribute to aspiration PNA, provided pt practices good oral hygiene before drinking each time
The 30 minutes allows them to swallow completely and clear the oral cavity of food residue.
Oral preparatory phase of swallowing - CORRECT ANSWER Voluntary action
Food is prepared, smelled, and salivation occurs.
Food is put in mouth, manipulated to form a bolus, and pushed posterior toward the oropharynx
Oral phase of swallowing - CORRECT ANSWER Voluntary action
Tongue is elevated to the roof of the mouth (palate)
Lips close to contain oral contents
Buccal and facial tone are necessary for chewing
Phases of swallowing - CORRECT ANSWER Oral preparatory
Oral
Pharyngeal
Esophageal
SMART goal acronym - CORRECT ANSWER S = Specific
M = Measurable
A = Appropriate
R = Realistic
T = Timely
open-ended questions - CORRECT ANSWER Helps facilitate a conversation regarding the pts feelings
pharyngeal phase of swallowing - CORRECT ANSWER Involuntary
Bolus carried by the swallowing reflex thru the pharynx
Soft palate and uvula elevate to close the nasal pharynx
Hyoid and larynx elevate so food is less likely to enter trachea
esophageal phase of swallowing - CORRECT ANSWER Involuntary
Bolus enters stomach via peristalsis and gravity
Lower esophageal sphincter opens
Dysphagia - CORRECT ANSWER Difficulty swallowing during the passage of a solid or liquid bolus from mouth to stomach
Strategies for dysphagia pt - CORRECT ANSWER 1. Sit upright 90 degrees
2. Minimize distractions (no TV or talking)
3. Correct texture and consistency
4. Place food on unaffected side
5. Small bites
6. Chin tuck
7. Remain upright for 20-30 min post eating
multidisciplinary team model - CORRECT ANSWER Professionals work in parallel towards their disciplines specific goals with very little overlap between the disciplines.
Goals are set by team representative
Takes on a pyramid-like shape with a physician or nurse at the top. The leader controls team activities and communication is vertical. This model is effective when there are different team members for different patients.
interdisciplinary team - CORRECT ANSWER Decisions are determined by the group working directly with the pt.
Goal setting is accomplished by the team
transdisciplinary team - CORRECT ANSWER Primary care provider directs the care from the information received from the team members by gathering the information and disseminating the compiled information
Functional measurement tool - CORRECT ANSWER Documented the first 3 days and last 3 days of hospitalization by all disciplines
Barriers of community re-entry - CORRECT ANSWER Societal
Internal
Transportation
Housing
Financial
Societal barriers for community re-entry - CORRECT ANSWER Reimbursement issues
Ineligibility for services
Cultural or attitudinal prejudices
Social stigmas
Internal barriers for community re-entry - CORRECT ANSWER Poor self-esteem
Lack of motivation
Poor self-image
Insecurity
Unrealistic expectations
Family-focused therapy - CORRECT ANSWER Addresses complex issues presented by returning military personnel or others with TBI's
Social support - CORRECT ANSWER 1. Instrumental support - equipment and services
2. Affective support - concern, being loved, feeling important
3. Cognitive support - education, advice, counseling
How to promote social support - CORRECT ANSWER 1. Encourage problem and emotion focused coping skills
2. Encourage attendance in support groups
helplessness - CORRECT ANSWER the belief that a person is dependent on others for support for a situation that seems to be impossible to change.
Non-Rapid Eye Movement (NREM) Sleep - CORRECT ANSWER Quiet sleep
Fully regulating brain
Fully moveable but inactive body
sleep cycle stage 1 - CORRECT ANSWER Lightest stage of sleep (1-7 min)
Breathing, heart rate and eye movements start to slow down
Muscles begin to relax
sleep cycle stage 2 - CORRECT ANSWER Light stage of sleep (10-25 min)
Breathing, heart rate and eye movements start to slow down even more
Muscles begin to relax even more
Body temp drops
sleep cycle stage 3 - CORRECT ANSWER Deep sleep (20-40 min)
Breathing, heart rate and brain waves slow down even more
Tissues repair and regrow
sleep cycle stage 4 - CORRECT ANSWER Deepest of sleep - REM - (20-40 mins)
Eyes move rapidly behind eyelids
Breathing, heartrate and BP increases
Sleep disturbance with Myasthenia Gravis - CORRECT ANSWER Sleep apnea caused by skeletal muscle weakness
Skeletal and intercostal muscles are necessary to expand and relax the thoracic cage. Without this exchange, breathing slows, periods of apnea result, and the patient becomes restless.
Sleep medication affects - CORRECT ANSWER Interfere with REM
TBI and Stroke pt sleep patterns - CORRECT ANSWER Initially have reversal of day-night cycles
Rancho Los Amigos Functioning Scale - CORRECT ANSWER Interprets the cognitive recovery process after a brain injury
1 - 10 levels
The lower the score, the more severe the impairment
Rancho Los Amigos - Level I - CORRECT ANSWER No response to stimuli
Total assist
Rancho Los Amigos - Level II - CORRECT ANSWER Generalized response - inconsistent/non-purposeful responses
Total assist
Rancho Los Amigos - Level III - CORRECT ANSWER Localized response - inconsistent/purposeful
Total assist
Responds more to familiar people
Rancho Los Amigos - Level IV - CORRECT ANSWER Confused/Agitated
Max Assist
Bizarre, non purposeful behavior
No short term memory
Agitated behavior d/t confusion
Rancho Los Amigos - Level V - CORRECT ANSWER Confused/Non-Agitated/Inappropriate
Max assist
Follow simple commands
Rancho Los Amigos - Level VI - CORRECT ANSWER Confused/Appropriate
Mod assist
Consistently follows simple commands
Rancho Los Amigos - Level VII - CORRECT ANSWER Automatic/Appropriate
Min assist with ADLs d/t safety precautions
Rancho Los Amigos - Level VIII - CORRECT ANSWER Purposeful/Appropriate
SBA
Rancho Los Amigos - Level IX - CORRECT ANSWER Purposeful/Appropriate
SBA on request
Rancho Los Amigos - Level X - CORRECT ANSWER Purposeful/Appropriate
Mod I
CN I - CORRECT ANSWER Olfactory
Smell
CN II - CORRECT ANSWER Optic
Visual acuity
CN IV - CORRECT ANSWER Trochlear
Eye movement (down/lateral)
CN III - CORRECT ANSWER Occulomotor
Opening eyelids
Eye movement: (up/medial) (down/lateral)
CN V - CORRECT ANSWER Trigeminal
Facial sensation
Chewing
CN VI - CORRECT ANSWER Abducens
Lateral eye movement
CN VII - CORRECT ANSWER Facial
Facial movement
Eyelid closing
Taste from anterior 2/3 of tongue
CN VIII - CORRECT ANSWER Vestibulocochlear
Hearing
Balance
CN IX - CORRECT ANSWER Glossopharyngeal
Taste on posterior 1/3 of tongue
CN X - CORRECT ANSWER Vagus
Uvula (palate muscles)
Swallowing
Contracts muscles in pharynx and larynx
CN XI - CORRECT ANSWER Accessory
Shoulder shrug
Contracts skeletal muscles of the soft palate, pharynx, and larynx
CN XII - CORRECT ANSWER Hypoglossal
Tongue movement
Dysphasia diet (least restrictive to most restrictive) - CORRECT ANSWER 1. Regular diet - Level 4
2. Dysphagia advanced - reg food expect no hard, sticky or crunchy food - Level 3
3. Dysphagia mechanically soft - soft, moist food - Level 2
4. Dysphagia pureed - puddling consistency - Level 1
5. NPO
If younger than 65, who can get Medicare - CORRECT ANSWER 1. Permanent disability eligible AFTER receiving 24 months of SSDI
2. ESRD and Lou Gehrig's (ALS) - eligible as soon as they begin receiving SSDI; no 24 month waiting period
SSDI - CORRECT ANSWER Social security disability insurance benefits are provided to qualified individuals who cannot engage in substantial gainful work activity because of a disability and who have paid into the system or has a parent who has paid into the Social Security system.
When did Medicare and Medicaid begin? - CORRECT ANSWER 1965
Medicare - Title XVIII
Medicaid - Title XIX
Who manages Medicare - CORRECT ANSWER CMS - Center for Medicare and Medicaid services
Who manages Medicaid - CORRECT ANSWER Each state through a state agency with oversight from CMS
CARF acronym/function - CORRECT ANSWER Commission on Accreditation of Rehab Facilities
Mission is to promote the quality, value, and optimal outcomes of services thru a consultative accreditation process that centers on enhancing the lives of the people served
NOT mandatory for those practicing in outpt settings
Rehabilitation Act - CORRECT ANSWER 1973
Guidelines for nondiscrimination in employment, and promoted community access by reducing or eliminating physical barriers.
Minimum Data Set (MDS) - CORRECT ANSWER Mandated by CMS for use in long-term, subacute or postacute settings
Data collection instrument for prospective payment systems
Pt info is sent for reimbursement and MDS information is sent to the state survey and certification agencies
Prospective Payment System (PPS) - CORRECT ANSWER -The nationwide payment schedule that determines the Medicare payment for each inpatient stay of a Medicare beneficiary based on DRGs
DRG - CORRECT ANSWER diagnostic related group
IRFs get a pre-determined payment for goods and services furnished during each Medicare patient's stay in the IRF
ADA Titles - CORRECT ANSWER 1. Employment
2. Public services/transportation
3. Public accommodation and services operated by private entities
4. Telecommunication
5. Miscellaneous provision
Title IV of ADA - CORRECT ANSWER Telecommunications
Requires telephone companies to establish telecommunication relay services for callers with hearing and speech disabilities
Also requires closed captioning of federally funded public service announcements
Title I of the Americans with Disabilities Act of 1990 - CORRECT ANSWER 1992
Prohibits discrimination in the workplace against people with disabilities
Title II of ADA - CORRECT ANSWER Transportation
Prohibits discrimination in transportation provided by state and local govt entities such as buses, railways, subways and other ground transportation
Rehabilitation Act, Section 504 - CORRECT ANSWER Requires all buildings and facilities that are designed, constructed or altered with federal funds or leased by federal agencies, comply with federal standards to accommodate physical disability
Medicare eligibility from IRF to SNF - CORRECT ANSWER 1. Must have a hospital stay of at least 3 days to be eligible for SNF
2. SNF benefits cover skilled nursing care, therapy services, and other goods and services for up to 100 days
The following are NOT criteria used by Medicare for SNF eligibility: being homeward bound, able to tolerate 3 hrs. of therapy, and receiving SS payments
Medicare and persons under 65 with disabling conditions - CORRECT ANSWER The only covered conditions that do not require a 24 month waiting period is ESRD and ALS
Other conditions may qualify after 24 months of receiving SSDI: end stage liver disease, acquired brain injury, heart failure
National Guideline Clearinghouse - CORRECT ANSWER Provides a collection of evidence-based clinical practice guidelines.
Medicare Part A - CORRECT ANSWER Inpatient services:
Hospital
Inpatient Rehabilitation
Hospice
Home health
DME
SNF - for first 100 days after a 3 day hospitalization
Medicare Part B - CORRECT ANSWER Outpatient services:
Physician visits (outpatient including preventative services)
Medicare Part C - CORRECT ANSWER Medicare Advantage Plans
Optional private plans such as PPO, provider-sponsored organizations, fee for service plans, etc.
Medicare Part D - CORRECT ANSWER Prescription drug coverage
Available to anyone with Medicare and covers outpatient prescription drugs offered thru private companies
Requires a monthly premium, and most plans have annual deductibles before Medicare pays
Who administers Medicare - CORRECT ANSWER CMS
Federal agency responsible for administering the Medicare program and designates Medicare Administrative Contractors to process claims
Delirium - CORRECT ANSWER Acute onset of confusion, short attention span, impaired memory
Fluctuates during the course of the day
Long-term goals - CORRECT ANSWER Changes in the pt over a time period > 1 week
Reflex bowel in SCI - CORRECT ANSWER UMN
Associated with SCI above T12 - S1
Bowel is capable of reflexive emptying without cortical awareness of the need to defecate
When the rectal vault is full of stool, it will increase the pressure and then stool will be pushed out.
Bowel dysfunction associated with LMN - CORRECT ANSWER 1. Autonomous
2. Areflexic
3. Flaccid
4. Tonal
Associated with SCI below T12 - S1
Lack of tone in internal and external sphincter with frequent oozing of stool caused by damage to reflex arc
Acute consitpation - CORRECT ANSWER Recent onset of symptoms
Large amount of stool in rectum or colon
chronic constipation - CORRECT ANSWER Symptoms lasting > 3 months
Enlargement of descending colon
Dependency on laxatives, or enemas
severe constipation - CORRECT ANSWER Causes sympathetic systemic problems (e.g., sweating, nausea, irritability, acute abdominal discomfort, and elevated BP).
Causes of autonomic dysreflexia - CORRECT ANSWER SCI above T6 (especially cervical injuries)- occurrence is 48-90%
More common in males
Caused by stimulation below the level of injury, often in sacral segments or even lower, such as over distended bladder, fecal impaction, pressure ulcers, ingrown toe nails, DVT, kidney stones, sex, fractures, etc
Treatment of autonomic dysreflexia - CORRECT ANSWER Reduce the associated stimulus (i.e. empty bladder)
Lower BP - raise HOB
Administer antihypertensive [Show Less]