Chapter 2 Patient Assessment and Communication

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1

Patient Dignity

Earn their respect

Be professional
Be organized

Earn their respect - never assume their respect

2

Personal understanding

Critical thinking
act like you know what you are doing

develop effective methods of patient communication

3

Maslows Hierarchy

Physiologic
Safety & security
Love & belonging
Self Esteem
Acheivement

4

Patient Needs

Desire empathy - they can be at the worst place in life

They are making the best out of a bad situation

They often receieve callous disreguard and the runaround

5

We remove the patients dignity

pelvic exam

what to eat and how much to drink

6

Critical thinking

ability to evaluate what a patient needs

analyze

7

Models of thinking

Eventually you will get to a point of knowing what to do (habit)

Recall
Habit
Inquiry
creativity

8

Patient Assessment

Data collection

Data analyse

Planning & implementation

Evaluation

9

Data Collection Process

Objective Data
*seen
*heard
*felt

Subjective Data
*patients perception

10

Patient Expectation

Is patient fasting - ask, exam can not be done otherwise

Be well groomed
sensitive to needs

11

Patient Right

Advance healthcare directives

DNR???
calling code rules

12

Comunication

self concept / self esteem
non-verbal communication
cultural variation
gender factor
feedback

13

Self-concept

Who am I?

the idea or mental image one has of oneself and one's strengths, weaknesses, status, etc.; self-image.

14

Self-esteem

How one feels about themselves

15

Verbal skills

tone
wordage
pitch
volume
pauses / speech rate
humor

non-english speaking - don't need loud tone

16

Non-verbal skills

The unspoken messages can often indicate how the patient feels more quickly than any words spoken

paralanguage
body language
touch
professional appearance
physical presence
visual contact

17

body language

read body language to see how patient feels

various forms of nonverbal communication, wherein a person may reveal clues as to some unspoken intention or feeling through their physical behavior. These behaviors can include body posture, gestures, facial expressions, and eye movements.

18

communication impaired

follow hospital policy for translator

19

Developing harmonious working relationships

the patient should be made to feel that he or she is a partner in the examination process. Indeed, the patient is the most important member of the health care team and should be made to feel that he or she is sharing in the process.

Be as nice as you can
explain what you are doing

20

Blocks of Therapeutic Comnuication

Judgmental Statements
Cliche statements
False reassurance
Defending
Changing the subject
Giving advice
Disagreeing
Probing
Demanding an explanation

21

Judgmental statements

Judgmental statements place the patient in the position of feeling that he or she must gain the approval of the health care worker in order to receive care.

22

Questioning skills

Use open ended questions
facilitate
Use silence
ask probing questions
avoid leading questions
reword for claification
summarize

23

Interaction with patients

Patients may need reassurance, understanding and guidance to help them adjust to their situation

proper communication and interaction is important and rewarding

24

Consider when interacting with patients

use simple terms
explain the procedure
gear patient toward having realistic expectations

25

Avoid Dehumanization

Do not think of a patient in abstract terms

patients may be anxious about exam

treat patients with respect for their individuality and physical condition

26

Coping Sequence

Denial
Anger
Bargaining
Depression
Acceptance

27

Nosocomial infections

Infections are acquired in hospitals and other healthcare facilities. To be classified as a nosocomial infection, the patient must have been admitted for reasons other than the infection. He or she must also have shown no signs of active or incubating infection.

28

Standard Precautions are also called

Universal precautions

29

What is the most common Nosocomial infections?

Urinary tract infections

30

Microorganisms

Bacteria
Fungi
Protozoa
Algae
Viruses

31

Bacteria

Colorless, minute, one-celled organisms with a typical nucleus

32

Fungi

Cells that require an oxygenated environment to live; may be either yeasts or molds

33

Protozoa

One-celled organisms; often parasitic and are able to move by pseudopod formation, by action of flagella, or by cilia

34

Viruses

Minute microbes that cannot be visualized under an ordinary microscope; the smallest microorganism known to produce disease

35

Characteristics of Infectious Agents

Virulence
Pathogenicity
Invasiveness
Specificity

36

Virulence

Extremely toxic - the ability to infect, acess to the body, over come host defense, produce toxin or hypersensitivity

37

Pathogenicity

The ability to cause disease, cell injury, or death

38

Qualities of a suitable reservoir

organic material that is suitable for the life processes of the organism

39

portals

nose
mouth
urinary tract
intestines
wound

ingestion
inhalation
injection
across mucous membranes
placenta

40

...

Fomites - indirect contact
Droplets
Vehicles
Airborne
Vectors

41

Fomites

inert surfaces that have live organisms on or in them

42

Droplets

involves contact with infectious secretions that come from the conjunctiva, nose, or mouth of a host or disease carrier as the person coughs, sneezes, or talks.

Droplets can travel from approximately 3 to 5 feet

43

Vehicles

Vehicle route of transmission includes food, water, drugs,or blood contaminated with infectious microorganisms

44

Airborne

indicates that residue from evaporated droplets of diseased microorganisms are suspended in air for long periods of time. This residue is infectious if inhaled by a susceptible host.

45

Vectors

insect or animal carriers of disease.They deposit the diseased microbes by stinging orbiting the human host.

46

Lines of Defense #1

Non-specific
-skin
-hair
-cilia
-acid lining
-flowing fluids
-coughing & sneezing

specific resistance

indigenous micoroflora

47

Lines of Defense #2

Inflammation

increased blood flow

fever

leukocytosis
-malaise
-lymph nodes
-vomiting & diarrhea

48

Lines of Defense #3

Antibodies
-response to antigens
-produced when an antigen is detected
-remain afterwards decreasing future occurances
-found in tears, saliva, colostrum

Vacines

49

Disease stages

Incubation

Prodromal

Full Disease

Convalescense

50

Incubation stage

The pathogen enters the body and may lie dormant for a short period, then begins to produce nonspecific symptoms of disease.

51

Prodromal stage

More specific symptoms of the particular disease are exhibited. The microorganisms increase, and the disease becomes highly infectious.

52

Full disease stage

The disease reaches its fullest extent or, in some cases, produces only vague, sub-clinical symptoms; however, the disease continues to be highly infectious.

53

Convalescent stage

The symptoms diminish and eventually disappear. Some diseases disappear, but the microbe that caused the disease goes into a latent phase.

Examples of these diseases are malaria, tuberculosis, and herpes infections.

54

The biggies

HIV

Hepatitis B & C

Tuberculosis

Drug resistant organism - MERSA

Antrax

55

HIV

HIV is a retrovirus.

This means that it converts itsviral material from RNA to DNA after it penetrates thehost cell. Retroviruses have an enzyme complex called reverse transcriptinase which boosts their ability to replicate and destroy the host cell.

56

Hepatitis B

Health care workers most often contract hepatitis B from needle-stick injuries.

Persons who share contaminated needles orhave multiple sex partners and hemophiliacs are mostsusceptible to blood-to-blood methods of contracting

57

Hepatitis C

Health care workers most often contract hepatitis B from needle-stick injuries.

prevalent in persons who share contaminated needles Persons who have multiple sexual partners, IV drug users, and persons needing multiple transfusions are most apt to contract this disease.

58

Tuberculosis

Tuberculosis is a recurrent, chronic disease caused by the spore-forming Mycobacterium tuberculosis. This disease most commonly affects the lungs, but is capable of infecting any part of the body. With the increasing immigrant population from third-world countries into the United States and the increase of HIV, tuberculosisis increasing in incidence in the United States.

59

MRSA

Methicillin-resistant Staphylococcus aureus(MRSA): Shortly after penicillin was used to treat S. aureus it became resistant to it. The newer semi-synthetic penicillin (methicillin) was used success-fully for a time to treat these infections, but the war against S. aureusis being lost as it becomes resistant to this drug.

60

Antrax

...

61

Prevention through Asepsis

Medical Asepsis - clean technique
Surgical Asepsis - sterile technique

62

Breaking the chain of infection

breaking any link in the chain of infection and you have stopped the transmission of the disease

-decrease the microrganism
-eliminate the modes of transmission
eliminate the susceptible host

63

How do we break the chain of infection?

Handwashing
Proper cleaning of surfaces
Early identification of potential hosts
Use personal protective Equipment
isolation
Maintain your physical and mental health

64

Personal Protective Equipment

Gloves
masks
gown
patient care equipment
environmental controls
linen

65

Inhibiting the growth of microorganisms

Antiseptics
Disinfectants
Sterilants

66

Antiseptics

Only bacteriostatic (inhibit growth) eg. 70% ETOH

67

Disinfectants

Destroy most bacteria and viruses eg. 10% solution of bleach, quaternary ammonia products, enzymatic cleaners

68

Sterilants

Destroys all microorganisms

69

Lifting

Nurses can risk musculo-skeletal disorders from lifting incorrectly

lift as (or close to) the center of gravity

Use thigh muscles

70

Center of Mass/gravity

is the point at which the mass can be imaged to act

pelvic region near the base of the spine

for stability the force should act inside the base of support.

71

Assessing Mobility

You must plan for the amount of assistance needed to complete the move safely

Be cautious - make sure the patient has orders to leave for exam

Lock all wheels before any transfer

give short and simple commands

72

Transfers

Sheet transfers

sliding board transfer

73

Wheelchair

Check chart
non skid shoes
explain the move
ask the patient to help you
ask for help from a colleagues when you reach your destination