5.2.3: FRAME 3- Prioritize Hypothesis

CORRECT Answer

Question Type: Matrix Multiple Choice

Scoring: 0/1

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

What interventions are relevant in Stanley’s initial pulmonary assessment?

Intervention	Relevant	Not Relevant
Assess Stanley for additional signs of hypoxia	X
Ask Stanley to apply oxygen via nasal cannula	X
Inquire when Stanley last used his inhaler and nebulizer	X
Call the provider to report symptoms		X
Encourage Stanley to walk across the room to assess if he has increased shortness of breath upon exertion		X
Assess for signs of confusion and restlessness	X
Review medication lists	X
Observe self-administration of inhaler and nebulizer treatments	X
Assess psychosocial support	X
Inquire about immunizations	X

RATIONALE

An initial pulmonary assessment should begin with a detailed history of chronic respiratory conditions, acute respiratory illnesses, hospitalizations, cardiovascular health, and immunization history. The nurse should assess for respiratory cues such as rate, rhythm, audible wheezing, or dyspnea, pulse, pulse ox, and blood pressure. The nurse should observe for abnormalities in the shape of the client’s chest, posture, signs of hypoxia, confusion, or restlessness. The nurse should perform a physical examination with auscultation and percussion of lung and heart sounds.

A holistic assessment includes evaluation of the client’s medications list, self-management of symptoms, ADL’s, medication and treatment administration, and the client’s psychosocial support system. Home health nurses have autonomy in practice and would not be required to report symptoms unless they were concerned about a change and requests consultation. The nurse would not ask Stanley to walk across the room to assess if he has increased shortness of breath upon exertion. Home health nurses have autonomy in practice and would not be required to report symptoms unless they were concerned about a change and requests consultation. The nurse would not ask Stanley to walk across the room to assess if he has increased shortness of breath upon exertion.

Being familiar with resources in your community that can bridge the health care gap and inequities will decrease disparities for individuals who are uninsured. Community options to consider are community or free clinics, sliding fee clinics, shelter-based care, and veteran services. Encourage clients to look into federal and state programs (Medicaid and Medicare). There are also specialty federal programs such as the National Breast and Cervical Cancer Early Detection Program, provides screening and diagnostic services for women in every state, children’s health insurance programs, 211 is a local resource hub to get information and referrals on mental health resources, financial assistance programs to help pay for prescriptions, and medical emergencies.

FOCUSED GUIDE

Healthy People 2030 address poverty as a priority area. Healthy People 2030 objectives targeted to reduce poverty include reducing the proportion of people living in poverty (SDOH-01), increase employment in working-aged people (SDOH-02) and to reduce the proportion of families that spend more than 30 percent of their income on housing (SDOH-04).

Healthy people 2030 provide evidenced based resources and a literature summary stating poverty often occurs in concentrated areas and endures for long periods of time. Some communities, such as certain racial and ethnic groups, people living in rural areas, and people with disabilities, have a higher risk of poverty for a myriad of factors that extend beyond individual control. Residents of impoverished communities often have reduced access to resources that are needed to support a healthy quality of life, such as stable housing, healthy foods, and safe neighborhoods. Poverty can also limit access to educational and employment opportunities, which further contributes to income inequality and perpetuates cyclical effects of poverty (Healthy People 2030).

Unmet social needs, environmental factors, and barriers to accessing health care contribute to worse health outcomes for people with lower incomes. For example, people with limited finances may have more difficulty obtaining health insurance or paying for expensive procedures and medications. In addition, neighborhood factors, such as limited access to healthy foods and higher instances of violence, can affect health by influencing health behaviors and stress (Healthy People 2030).

Across the lifespan, residents of impoverished communities are at increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy. Children make up the largest age group of those experiencing poverty. Individuals who experience childhood poverty are more likely to experience poverty into adulthood, which contributes to generational cycles of poverty (Healthy People 2030).