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Alcoho
Consider moving video from 4.4 to here to maintain consistency with including videos with skills checklists. (or find another video for here)
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Sanitizer
all throughout the chapter this is referred to as ABHR rather than sanitizer.
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Soap and
Consider moving video from 4.4 to here to maintain consistency with including videos with skills checklists. (or find another video for here)
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sepsis protocol:
NA's are not going to know what this means.
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Malodorous
careful using too technical terms with audience- may not know what this means.
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perature over 1
also advise to report low temps as these are signs of potential sepsis.
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feeling of being uneasy or
discomfort, illness, or lack of well-being
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tient’s blood or body fluids, another part of OSHA’s “Bloodborne Pathogen Standard” is to complete a postexposure assessment to determine if additio
I think it would be beneficial to include a statement about what to do if the NA is exposed- flush/wash the area, notify the supervising nurse, etc.
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risk of infection transmission
Not just this, but it is labor intensive to put on/take off PPE all the time to go into rooms. I would include this as well as social isolation/ loneliness from less frequent interactions, risk for caregiver neglect is higher, and failure to rescue from missing cues that something is wrong.
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wearer.
Include that this is used when N95s don't fit properly due to facial hair or inability to create a tight seal.
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“Donning/Doffing PPE With a Mask and Face Shield or Googles” checklist for more details.
insert link to checklist
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laundered
to be laundered (the NA is not doing the laundering).
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fluids. Gl
and to protect patients from coming into contact with potential contaminants on healthcare worker's hands during certain procedures and treatments.
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sonal
I think it would make more sense for students to switch this section with section 4.4 so all the PPE are discussed prior to the isolation precautions requiring them.
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respirator
will students know what this is?
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climb
get into bed or are assisted into bed
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coughing
sneezing too.
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is wo
For the ABHR steps above- provide option to show answers. They all were marked wrong for me even after adjusting answers, so double check their order. I found the key at the end- Perhaps change the second step to Ensure hands don't have visible soil. I kept putting this at the end due to it saying ensure they are clean, which should be done at the end.
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ork is a
Great video- there is no sound- not sure if there's supposed to be, but it seems like there should be explanations prior to each question.
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as
at
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gher le
Recommend giving a brief description and explanation of how to use the activity below.
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This H5P activ
These are nice activities. It would be helpful to provide a brief set of instructions tying it to this text and explaining the activity.
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gent.
or when there are changes in their immune system defenses.
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n of medical equi
it's not just medical equipment- include mucous membranes, skin breaks, etc.
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ing c
maybe give an example, such as MRSA in nares?
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Extinguish
extinguish/evacuate is generally used.
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Evidence of falls.
add "skin breakdown"
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an occu
I would recommend this video instead as it shows the provider using gloves, etc. Additionally, it aligns with the recommended video for the unmade bed in the previous section. https://youtu.be/cx5G1VdC9UA
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ke mitered corners: Tuck the entire end of the sheet under the foot of the bed. Facing the foot
spacing
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linen bag
include not to place linens on the floor.
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noccupie
I would recommend this video instead as it shows beginning to end process, including how to remove linens, hand hygiene, etc. https://youtu.be/WEB_vNsTcX8
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Point your feet and body in the direction you are moving. Do not twist at the waist. Base of support: Creating a good base of support improves one’s balance, whereas imbalance creates awkward positioning that can lead to injury. To create a strong base of support, one should place one’s feet about shoulder width apart or just slightly wider than their hips. Center of gravity: A person’s center of gravity is where most of one’s weight is concentrated. For a person standing, the pelvis is the center of gravity. Ma
keep terminology consistent with either using "one's" or "your" throughout.
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one should place one’s
place your feet
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nd slightly apart. Follow these guidelines to use proper alignment to prevent lifting injuries: Maintain correct body alignment when lifting or carrying an object. Keep
spacing is off here
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are
is
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what n
which resident care needs
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size
privacy, size, and...
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issues
breakdown
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their
residents
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provide
empathize with and provide peace...
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he Heimlich man
This video is not accurate- it states to continue abdominal thrusts after the patient is unconscious and lying on the ground. Correct technique is CPR. Here is one from Mayo that is accurate: https://youtu.be/wVnGWqqe-6M
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injury death
injury and death
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Figure 3.3
Figure 3.3 shows RACE, not PASS.
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Extinguish
E = extinguish/evacuate. If the fire can't be extinguished, they will need to evacuate the patients and themselves from the area.
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motor activity
A lot of this info may be above the level of a NA. It's important for them to recognize symptoms to report, but maybe using more lay terms would be better for this level? For motor activity maybe "abnormal muscle movements"?
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neuronal activity
will students understand this? Maybe "abnormal signals in the brain"?
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future stroke in the future
delete one or the other future. Also include a sentence on why it's important to report these "transient" symptoms also.
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,
delete
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in male patients beneath the sternum. This pain often radiates down the left arm or into the jaw. However, female patients may not experience severe pain but instead experience symptoms that feel like indigestion.
I would be careful with this. It's true that females may have atypical chest pain, but they also may have crushing chest pain. Males may have atypical chest pain as well, especially if they are diabetic. The way this is worded makes it seem like all males have chest pain and all females have indigestion symptoms, which is not accurate and if we want NA's to cue in on these being important things to notify the nurse, this will be confusing.
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die
are starved of oxygen and begin to die (ischemia causes angina)
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Heart Attack
Add an introductory paragraph prior to MI to tie concepts of the chapter together.
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Fire Safety
E= evacuate/extinguish
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,
delete
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sell yourself to a potential
I would re-word this as it may not make sense in other cultures or just eliminate this sentence all together.
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impact
positively impact
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ivities
Great activities! I would recommend shuffling the nursing process matching items as they go in the order of the nursing process as is. This would make them a bit more challenging.
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dults wh
This is for those in substance abuse recovery as well.
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Advocates
is it advocate or associate?
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all
many or various rather than using "all" which is absolute.
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an effective
a different, more effective alternative
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the nursing
their delegated interventions in the nursing care plan. (I think this is important to distinguish here because the NA won't be able to implement all the interventions due to scope)
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demonstrates
I'm not sure demonstrates is appropriate here- perhaps describes or outlines works better since it is a written document rather than a "procedure". If you update this, be sure to update the glossary and "hover over" definition too.
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nurse they
that
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transfer
maybe specify interfacility transfer needs vs bed to chair transfer needs.
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o
Caps?
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this response
that you do not know and...
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is
are
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the nurse.
Unfortunately sometimes it is the nurse- maybe let students know it is ok to go to others as well such as the charge nurse or administration in this event.
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Being dependent on a caregiver for completing one’s ADLs can be difficult for clients to accept. A feeling of dependency can cause them to lose self-esteem or even lead to depression. Refer back to the exercise in the “Managing Clients’ and Family Members’ Stress” subsection in Chapter 1 to recall how to empathize with residents.
This seems out of place unless there is some kind of direct link between these concepts.
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on
related to
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Because of this history of inadequate care,
For this reason, (or "as a result, etc.)
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unnecessarily
delete
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Military Time
this is a bit confusing. Perhaps a chart comparing the numbers would make it more clear. Perhaps something like this: https://www.doctemplates.net/wp-content/uploads/2019/05/Military-Time-Chart-Excel-10.jpg instead of the clock below.
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Examples may
Examples that require immediate notification of the nurse include... (otherwise this makes it look like this can wait until handoff, etc.)
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a private
add empty
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draw only one line through the entry.
draw only one line through, write error and initials
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completed patient care
patient care was completed
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A nurse can make a re
Maybe a statement that the NA can suggest the nurse calls chaplain or the NA can just do this? (since it's an NA text). I see this is addressed in the next to last paragraph, so rather than change the sentence, maybe just move this sentence down there.
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HIPAA
write out what this is as it hasn't been mentioned.
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. Validation therapy i
Should this be added to the TCT table? Would be very pertinent to NA's.
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them
the client
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nurse
? nurse in NA text?
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nurse
NA
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Communicating With Empathy
Add this paragraph to the table and change the heading to Barriers to Communication or Nontherapeutic Responses.
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with
using
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Patients often ask health care professionals for advice about what they should do about particular problems. Instead of offering advice, health care professionals can ask patients what they think they should do, which encourages them to be accountable for their own actions and helps them come up with solutions themselves.
reflecting is mirroring what the provider thinks the patient's feelings are behind their words so their feelings can be explored further.
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Accepting
Acceptance
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Listening Actively
Active listening
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nurse
more applicable if NA
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Nurses
NA's
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empathy
compassion is the act here.
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Communicating With the Client, Families, and Loved Ones
This is a good section, but should it be more related to ther. comm in relation to the NA rather then the nurse to make it more applicable?
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g)
add end parenthesis to hover over definition.
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g.
end parenthesis
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Patients should feel as if they are the center of your attention when you are with them, no matter how many other things you have going on.
This is a great sentence!!!
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and
reword to "resulting in your message not being perceived..."
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i
spacing
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sick, injured, or
"sick, injured, debilitated, cognitively impaired, or need assistance..." Also, compassion and empathy are not the same. Empathy is putting oneself in another's shoes. Compassion is the emotional response to empathy, and includes the desire to help based on this emotional response. Maybe re-word the sentence?
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Nursing assistants have one of the highest rates of injuries and illnesses of all occupations from lifting and moving patients and other physically demanding tasks.
This sentence seems out of place here, since this section is talking about becoming a NA. It would fit better in the next section under "physical stamina".
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Nursing assistants were employed in 1.4 million jobs in 2020 in many types of health care facilities.
Revise sentence structure. Perhaps "In 2020 there were 1.4 million nursing assistant jobs in variety of health care facilities..." or something similar.
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r/t in
New guidelines have at risk dx being AMB rather than r/t.
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and if they are poor, they are often not covered by Medicaid.
suggest removing "if they are poor"
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nsider hospice care.
rather than undergo invasive surgeries or procedures that likely will have no impact on recovery from disease.
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As community health nurses strive to promote health equity, they assess SDOH, health disparities, and health inequities that are present in communities. Th
review spacing between lines throughout this section.
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prevention.[1] Examples of current community health initiatives include public educational health sessions, blood pressure screenings, immunization clinics, and crisis intervention related to mental health care. See Figure 16.1[2] for an image of a community blood pres
why do some lines include hyphens and break up words and others just shift the words to keep a full word on each line?
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15.
Adverse childhood experiences slide should be (ACEs). Safety plan slide- check wording on definition: ...help lower a person's risk of being hurt...
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If bitten
same with hair pulling- don't pull away- instead pull the client's hand toward your head and push up on the hand bending back the wrist to increase the likelihood of the patient having to let go from pain.
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illness
such as infection (UTI is classic here)
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midazolam
see comment above. In my experience lorazepam is associated with CIWA tx, etc.
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midazolam
is this used on a general or BH floor? seems risky. In my experience it's used in the ICU, maybe ED but ativan seems safer on the floor.
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If chest restraints
also note never to apply pressure to the client's chest or back while holding them down to apply restraints due to asphyxiation risk.
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The restraint team should
it would be fantastic to have a simulated video of this process included.
Also many facilities require Non-violent crisis intervention training and refresher sessions to practice de-escalation and restraining techniques. might be worth mentioning here or somewhere in this section.
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illustration related to stopping work
Reminder to check on permission and remove highlighting from below the image.
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Patient violence
this is ambiguous. violence committed by patients or family members towards health care workers can occur...
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with
undergoing
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solicitous
concerned
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urgent
urgent care visits
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,
delete comma
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When making a repor
albeit rare, it may be a good idea to include a statement about some diseases that mimic abuse, such as osteogenesis imperfecta where there may be broken bones in various stages of healing through natural means. This can be devastating for families if they are incorrectly reported as suspected abusers.
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Signs of physical
It's important to note that some injuries are not visible as in shaken baby syndrome
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inflicted on a child by other than accidental means.
awkward wording. ... in an intentional manner is clearer.
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Failure to thrive
this is listed twice
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An organiza
This is kind of randomly placed here and not described in enough detail. How does it help? what is the purpose? I'd include details such as not requiring identifying info of the parent, parent's won't get in trouble for leaving there newborns here, Safe Haven Laws, etc.
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activated
it would help to be consistent with either using "triggered" or "activated" thoughout.
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possibly
possible dissociating (bold/ add to glossary)
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your role
name or role
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should be provided
who is going to provide it? Perhaps re-word to ...psychological safety measures should be considered by the reader.
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Activities
the definition on the "tolerance" slide is very difficult to follow. the SUD slide should be all caps
Drag and drop for med schedules are all in order from I-V perhaps mix it up for more difficult activity.
for the FITB where it says "type the number" it would clarify more if it said write out the number. I misread this and entered for example "5" when it should have been "five". for the question about Xiong, recovery position is the correct answer but nowhere in this chapter is side-lying referred to as recovery position. This is the correct terminology, so be sure to go back to where it talks about turning a person on their side in the chapter and denote this as being "recovery position" or change the answer selection to "side lying" or lateral recumbent
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syndrome diagnosis, defining characteristics are related nursing diagnoses
Syndromes are tricky for students to write out the proper form. Perhaps link to the syndromes part of the Fundamentals OER?
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Indicated Interventions
Indicated Prevention Interventions
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refusal skills of substances.
awkward wording
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sexually transmitted infections
Not just STI's but also bloodborne pathogens like HIV/AIDS/hepatitis as well as bacterial endocarditis from IV drug abuse/needle sharing.
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Alcoholics Anonymous
I would provide links to find AA, NA, etc meetings as well as Al-Anon and Alateen groups- they are everywhere but not everyone knows about them. As a valuable resource, this may help students as well. I know I personally have spoke with students about Al-anon and provided links to find meetings when they have confided in me. This link allows searches for both al-anon and alateen: https://al-anon.org/al-anon-meetings/find-an-al-anon-meeting/ https://www.aa.org/find-aa
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Review th
It's great that all these interactive tools are embedded throughout this chapter!
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on
pertaining to an individual's alcohol use.
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Adverse Childhood Experiences
link
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and
delete "and". Actually this would be better as bullet points rather than such a long sentence.
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Negative Stage
Negative Affect Stage
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These are the three stages of addiction:
font
-
ubstance taking. Two subregions of the basal ganglia are particularly important in substance use disorders: The nucleu
check line spacing
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or depression or feel physically ill.
delete or. ..., depression, or the individual may feel physically ill.
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Treatment
why not mention antibuse? I know it's not for withdrawal but is an important part of abstinence for some people. https://www.addictioncenter.com/alcohol/disulfiram/
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supervision
because of the risk of...
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Buprenorphine
No mention of Buprenorphine/Naloxone (suboxone)- I would inlcude this and would mention this can be used in the outpt setting as an opioid blocker similar to antibuse for ETOH.
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Methadone is
synthetic opioid. Important to mention that.
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Overdose with methadone
Again, this can be used in the outpt setting in methadone clinics. Would mention due to the extremely long half-life of methadone clients are at risk for OD if the dose is titrated up too quickly or if the client's starting dose is too much compared to their tolerance level of opioids.
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methadone
and suboxone tx
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Clients may undergo detoxification for these reasons
Some clients undergo detox to get and stay clean. Not all go to residential tx programs. Some just do the detox and then go to NA or outpt tx, some go to detox followed by a few week inpt tx, etc. These are valid reasons as well.
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Benzodiazepines
It would be important to list IV thiamine here again as well as it is a standard treatment.
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potassium levels
sodium levels would put at risk for seizures. potassium levels risk for cardiac dysrhythmias/ arrest, whereas low platelet levels would put clients at risk for bleeding/ head bleed. This sentence doesn't make sense specifically to risk for seizures.
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vomiting.
diarrhea also. I'd mention high fall risk as often patients are trying to get up alone to get to the bathroom or as a result of hallucinations/ dilerium.
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mulant intoxicati
add hallucinations/psychosis to list
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that
which
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Use and Intoxication
I think it's important to mention synthetic cannabinoids here as well as this seems to have a bigger risk of psychosis, toxicity, etc. https://www.cdc.gov/nceh/hsb/chemicals/sc/default.html
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medicinal purposes,
give examples- pain control, increase appetite in chemo patients, etc.
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illicitly manufactured fentanyl
I think it is important to mention that there is increasing risk with other street drugs being laced with fentanyl resulting in higher overdose/death rates. 150 people die a day. Often people taking these laced drugs have no idea they have fentanyl in them. This is a great addition from the CDC: https://www.cdc.gov/stopoverdose/fentanyl/pdf/fentanyl_fact_sheet_508c.pdf
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contracting HIV, hepatitis B
as well as bacterial endocarditis.
-
obtained.[
to assess for head injuries.
-
enced
experience
-
have also
delete
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Substances used
Substance use
-
a group of physical and mental symptoms that can range from mild to life-threatening.
that can occur when an individual stops taking a substance.
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Activities Case Study:
double check the answer for "Angela with bulimia" below.
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pplication
perhaps give a few thought provoking questions in this as well.
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the
delete
-
refeeding syndrome is
mention in the definition/glossary that it is specifically related to negligible food intake.
-
“Basic Concepts”
link
-
Specific signs and symptoms associated with the eating disorder, as outlined in the previous “Basic Concepts” section, should be assessed.
I would either link back to that section or just put the s/sx here for reinforcement.
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Partial Hospitalization: The client is medically stable. The eating disorder impairs functioning but is without immediate risk. The client requires daily assessment of
Spacing throughout this section needs to be looked at and made consistent.
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a
that a
-
run in families
are hereditary
-
pisodes of binge eating. A binge eating episode is characterized by both of the following: Eating in
spacing
-
he binge eating episodes are associated with three (or more) of the following: E
spacing
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heart attack
not really heart attack but cardiac dysrhythmias and cardiac arrest.
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restraint
restraints
-
restraint
a restraint
-
The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) define seclusion as the involuntary confinement of a client alone in a room or area from which the client is physically prevented from leaving and restraint as any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move their arms, legs, body, or head freely.
break this up into two sentences- one for seclusion and one for restraint definitions.
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used
use
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ACEs
Link to ace's to stay consistent?
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arts
art
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Some individuals with autism and their parents
This wording sounds funny. Recommend "Parents of children with ASD may use complementary or alternative treatments such as special diets...
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]:
Add a heading or label after this sentence. For example: Treatment categories include:
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fragile X syndrome
Should this be in caps?
-
echolalia
bold and add to glossary
-
These
Below are some examples of behaviors with ASD.
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devising
devise
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.
Didn't previous sections specify some pretty nasty side effects from Clonidine and that is why it's not first-line? Perhaps write about that here.
-
boxed
black box warning
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They
SNRIs
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Because
delete and re-structure into two sentences. "ADHD affects a child's ability to pay attention and sit still at school as well as relationships with family and other children due to disruptive behaviors. Psychotherapy can improve...
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checklist completed by parents, teachers, and the child that rates ADHD symptoms.[6]
a checklist rating ADHD symptoms completed by parents, teachers, and the child.
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including
delete
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2018-2019
It would be interesting to see stats post covid.
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or
for
-
similar to how medical conditions are diagnosed by trained medical professionals.
this was addressed in the last chapter as well.
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some types of medications
give a few examples. Repeated exposure helps students remember.
-
od sugar,
add infection here also
-
ive or distressing or in the backgrou
too many "or's". Either break each up into a sentence or separate with commas.
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Suicidal or homicidal ideation that can result from command hallucinations or defensive actions in response to paranoia
bold this to remain consistent with critical findings in other chapters. Also put a rationale for immediate provider notification as in other chapters.
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a pronounced increase or decrease in the rate and amount of movement, where excessive movement is purposeless
this does not match the glossary definition
-