question

Erectile dysfunction/impotence (4)

answer

-neurologic/vascular/endocrine disorders -drugs -alcohol -psychologic factors

question

Premature ejaculation

answer

can be related to performance demands

question

Orgasmic dysfunction(5)

answer

-drugs -alcohol -aging -genital anatomic abnormalities -FGM

question

Vaginismus(2)

answer

-painful involuntary muscle/sphincter contraction with insertion -inhibition, trauma, pain

question

Dyspareuria(2)

answer

-painful intercourse -inadequate lubrication, endometriosis, trauma, hormone imbalance

question

Vulvodynia(2)

answer

-burning -rawness in perineum

question

Holism(3)

answer

-Belief that all living organisms are continually connecting/interacting with the environment and each other -Belief that a person is more than the sum of his parts, but is dynamic, unified whole (mind/body/spirit) -A change in any part of the whole impacts all the other parts

question

Holistic Nursing(2)

answer

-nursing practice with the goal of healing (not necessarily curing) the whole person -May incorporate CAT

question

Categories of CAM (5)

answer

-Whole Medical systems: Ayurveda, Traditional Chinese Medicine, Shamanism, Homeopathy, Naturopathy -Mind-Body Modalities: meditation, relaxation/imagery, prayer, humor, aromatherapy -Energy Medicine: Therapeutic & healing touch, sound, Reiki, -Biologically based: herbals, nutritional supplements -Manipulative/Body Based Practices: various types of massage and body therapy treatments,

question

Ayurveda(5)

answer

-Ancient Indian medicine -Focus on balance for the person's "type" (dosha) -Includes diet, exercise, herbs, meditation, purification. -Requires formal training but no licensure in US -Yoga is one practice used in Ayurveda: postures used with breathing and centering to promote health and reduce symptoms

question

Concept of Chakras (Energy Centers)(2)

answer

-Originated in India -Patients may wish to follow special diets or take herbal supplements during hospitalization—need to coordinate with meds and plan of care

question

Traditional Chinese Medicine- Qi(chee)(3)

answer

-is energy flowing through 12 meridians (energy circuits) in body -is composed of Yin ; Yang—when out of balance lead to poor health -use acupuncture, diet, herbs, massage, exercise, breathing to restore health

question

Traditional Chinese Medicine(4)

answer

-Balance between yin (female, damp, dark properties) and yang (make, dry, bright, airy properties) is essential for health -TCM treatments seek to balance Qi and yin/yang health components -Patients may ask for TCM treatments in hospital—need to assure are compatible with plan of care -Requires formal training—doctor of traditional Chinese medicine training takes several years. Some therapies are used routinely/incorporated into culture (foot massage, acupressure points)

question

Homeopathy(2)

answer

-Rather than using an opposing medicine to treat illness, treat with a miniscule amt of something that causes same sx in a well person (like immunization concept). -Not terribly well researched. There is formal training, but no formal licensure.

question

Naturopathy(3)

answer

-More like modern medicine but with focus on pt empowerment ; disease prevention, and following natural laws. -May use complementary therapies in conjunct with care. Focus on treating cause of condition rather than symptoms -No standardized training or licensure

question

Shamanism(4)

answer

-belief that illness/distress originates in spirit world -practiced by indigenous people in many areas -Shaman is spirit leader and healer—goal is to return the person's right relationship with the spirit world -Incorporate herbal treatments, rituals and purification ceremonies

question

Chiropractic Medicine(3)

answer

-Concentrates on relationship between spinal structure & body function. -Spinal adjustments restore balance in CNS and body. -Formal accreditation of training programs and licensure—several years of training.

question

Mind-Body Modalities-Psychoneuroimmunology(4)

answer

-found that neuropeptides are the messenger molecules that connect mind and body -they travel throughout body -explain connection of emotions with GI distress and other symptoms -many alternative therapies are based on this connection between mind/spirit and body

question

Mind-Body Modalities-relaxation therapies(2)

answer

-Decrease SNS dominance, allowing inc peripheral circ, relaxation of muscles, dec pulse, dec BP, perceived wellbeing. -Includes: Meditation/hypnosis, Progressive relaxation/imagery (visualization), Biofeedback/autogenic training

question

Mind-Body Modalities-Humor

answer

Laughter/play improve immune function

question

Mind-Body Therapies- aromatherapy(3)

answer

-use of essential oils to promote wellbeing -Olfactory sense is very powerful. -Use caution—oils potent. Workshop-type training

question

Mind-Body Therapies-prayer

answer

When included in CAT, is the most widely used domain. Intercessory prayer by others, prayer use by patient.

question

energy healing(4)

answer

-based on belief of vital life force w/in & around body -Chakras: energy centers (crown, brow, throat, heart, solar plexus, sacrum, coccygeal) -Etheric body (aura): surrounds body—7 layers -For beginning use, a training workshop is used. Takes years of practice to be a master/teacher

question

energy therapies-Therapeutic Touch (Kriger)

answer

use of hands on or near body to promote healing/wellbeing

question

energy therapies-Healing Touch (Mentgen)

answer

-similar to TT -more specific techniques based on condition/ailment.

question

energy therapies-Reik

answer

also similar to TT

question

energy therapies-acupuncture(4)

answer

-Insertion of fine needles along energy meridians to restore balance and unblock energy flow -Demonstrated effective in chronic pain, N & V reduction, reduction of substance abuse, and other conditions. -Not generally used for acute/traumatic conditions (infection, fracture, MI, etc). -Formal training—usually 2 years or more

question

energy therapies-acupressure(2)

answer

-use same principles as acupuncture, but with finger pressure instead of needles. -Specific training in clinical acupressure available only via 2 organizations, unless do TCM training

question

Herbs/supplements(5)

answer

-used to promote health and treat conditions -Herbs not well controlled in the US; FDA considers them nutrit. supplements -Some demonstrated effective (Echinacea, Zinc for resp sx; ginko to assist with memory; Ginger for GI sx, etc), while many others not well documented -May have significant side effects/ interactions with other meds—see teaching tips p. 744 -Informal training, or TCM/Integrative med trng

question

Bodywork(3)

answer

-hands-on therapy to promote comfort, healing. -Includes a variety of methods (Rolfing, shiatsu, deep massage, etc.) -Training through massage schools and schools specific to bodywork types. Licensure.

question

Users of which of the following CAM therapies should look for a specially certified practitioner?

answer

-Reiki -Herbalism -Hypnosis

question

SPIRITUALITY**

answer

Anything pertaining to a person's relationship to a nonmaterial life-force or higher power

question

Relationship between spirituality and health(2)

answer

-Ancient times: Spirituality ; Health interwoven. Often the HCP was the spiritual leader as well -Later, spirituality and medicine developed separately

question

Currently, there are 2 holistic views on connection of spirituality to health

answer

-1. Biophysio-psycho-social-spiritual dimensions are equally important in health -2. Spiritual dimension grounds other three dimensions

question

Spiritual well-being involves meeting of these needs(3)

answer

-Need for meaning and purpose -Need for love and belonging -Need for forgiveness

question

Attributes of Spirituality(5)

answer

-Provide meaning: significance of life -Guide daily living -Provide a source of support during difficult times -Seen as a source of strength and healing -Includes characteristics of faith and hope

question

Spirituality(4)

answer

-Seen as unifying force, the essence of being, experienced through connectedness with nature and others -Spirituality permeates life, providing purpose ; meaning -Spiritual beliefs can promote love of self ; others, cultivate wisdom ; meaning, and promote generosity -Religion different from spirituality, but is often a source of comfort ; strength, and provides guidelines for behaviors/lifestyle.

question

What is Palliative Care?(5)**

answer

-Care provided to a patient who has a life limiting, or non-curative condition for the management of symptoms related to that illness -Focus on quality of life -Focus is not on death but on improving the life the patient has -Focus on managing the symptoms(shortness of breath, fatigue, pain, nausea/vomiting etc) -Focus on Patient and family/caregiver as a unit

question

What about Hospice?(3)**

answer

-Hospice is a benefit of Medicare, Medicaid and most private insurance companies -It is a benefit that pays for palliative care when a patient reaches the terminal end (6 months to live or less) of their disease process -Hospice is not a place and is not an organization it is a benefit

question

Hospice(2)**

answer

-There are many different organizations that provide hospice services......they form, get certified by Medicare, and then provide the care to patients -Hospice services include care that is focused on quality of life and symptom control and is therefore not focused on cure

question

What diseases qualify a patient for Hospice?**

answer

-Cancer -COPD -CAD(Coronary Artery Disease) -CHF(Congestive Heart Failure) -Dementia(including Alzheimer's) -CVA(Stroke) -AFTT(Adult Failure to Thrive) -Renal Failure -Liver Failure

question

What is the Nurses Role on the Hospital floor in Palliative Care?(3)**

answer

-Identifying those patients who might benefit from palliative care -Working with the team to make a palliative care consult or hospice consult -Working with the family during this transition

question

What is the Nurses Role as a nurse working in Hospice?(4)**

answer

-Assessing the patient to determine if they qualify for hospice -Admitting the patient to hospice service and providing them with the hospice services that they need -Developing a plan of care that includes meeting the needs of the patient and family -Working as a member of the interprofessional team

question

Summary of Palliative Care

answer

-Palliative care is the care provided to patients who have a life limiting disease for which curative treatment is not the goal -Hospice is a benefit that pays for palliative care but only when the disease has reach the terminal level(6 months left to live or less) and the patient is NOT hospitalized -The nurse in the hospital setting is at the patient's bedside and is often able to determine when a patient's symptoms have progressed to where they need more supportive care. -The nurse should then discuss a palliative care or hospice referral with the team, patient and family -The nurse in the hospice setting receives the referral and must make sure the patient meets the Medicare guidelines to qualify for hospice, and then admits and provides care for the patient and family!

question

Crisis**

answer

-A crisis is an overwhelming reaction to a threatening situation in which a person's usual problem solving strategies fail to resolve the situation resulting in a state of disequilibrium. -Crises are acute, time-limited, and constitute more than just stress, an emergency, or a mental d/o

question

Risk factors for Crisis

answer

-Intensity of exposure to the event -Preexisting psychiatric condition -Prior history of trauma -Family history of psychiatric conditions -Early separation from parents -Childhood abuse -Poverty -Stoic cultures -Degree of threat to life

question

Developmental(4)**

answer

-maturational -Occur at predicted times of stress in everyone's life -occur in response to a transition from one stage to another in the life cycle. -Examples: puberty, pregnancy, retirement

question

Situational (3)**

answer

-Occurs in response to a sudden unexpected event in a person's life -The critical life event tends to lead to experiences of grief and loss. -Examples: job loss, death of loved one, divorce, abortion, severe illness

question

Adventitious(3)**

answer

-Not part of everyday life -They are unplanned and accidental -- resulting in traumatic experiences. -Examples: Natural disasters, National disasters, Violent crime

question

Common Characteristics of Crises(4)

answer

-Experienced as sudden -Communication with significant others decreased or cut off -Perceived or real displacement from familiar surroundings -Experienced as life-threatening whether realistic or not

question

What is Crisis Intervention?(3)**

answer

-Crisis intervention is a conceptual framework for intervention that calls for **short-term, action oriented assistance focused on problem solving** -the goal of restoring equilibrium and returning pt to pre-crisis state -Most crisis interventions are time limited to brief period of 4-6 weeks, except in the case of death (may take longer)

question

Crisis Intervention(9)**

answer

1.Assess for suicidal/homicidal thoughts 2.Provide safety 3.Lower client anxiety 4.Listen 5.Facilitate verbalization of thoughts 6.Encourage support systems 7.Promote healthy activities (rest, exercise, nutrition) 8.Relaxation, Imagery 9.Develop new coping mechanism

question

ABCs of crisis counseling(3)**

answer

? Achieve contact (safety and security) ? Boil down the problem (ventilate and validate) ? Cope with the problem (predict, prepare, and prevent)

question

Crisis Response(2)

answer

-Not necessarily pathological, may encourage growth and change -Increased competence, better social network, new problem solving methods, improved self image

question

Communication Strategies in Crisis Work(5)**

answer

Using silence Using nonverbal communication Paraphrasing Reflecting feeling Allowing expression of emotions

question

Nightengale

answer

-established the first theoretical base ; philosophy of health ; nsg. -Increased focus on nursing education, theory and research since 1950's

question

Watson

answer

-Watson theory of caring -practice of love and caring -Respect the person and show them that you care

question

Benner(3)

answer

-altered the dreyfus model -5 stages or levels of skill competency -1. Novice 2. competence 3. proficiency 4. expertise 5. mastery

question

Nightengale(3)

answer

-environmental theory- altering patient's environment to improve health -Environmental sanitation and cleanliness -Designed infection prevention

question

Roy(2)

answer

-Internal and external locus of control -Adaptation theory- what are characteristics of patients that are able to adapt vs those that havetrouble adapting to situations

question

King(2)

answer

-dynamic interpersonal relationship to help people meet goals -Patient should be involved in the making of these obtainable goals... gives them a sense of success when these goals are met

question

Orem(4)

answer

-Self care theory -1. theory of self care -2. theory of self care deficit -3. theory of nursing system- how the nurse involves herself in the care

question

Delegation terminology - from WVRN Board document: Accountability

answer

being responsible or answerable for action or inactions of self or others in the context of delegated or assigned work

question

Delegation terminology - from WVRN Board document: Assignment

answer

designating nursing activities to be performed by another nurse or assistive personnel that are consistent with their scope of practice

question

Delegation terminology - from WVRN Board document: Competence

answer

possessing verifiable knowledge and skill to perform an activity/task safely and effectively

question

Delegation terminology - from WVRN Board document: Delegation

answer

transferring to a competent individual the authority to perform a selected task in a selected situation

question

Criteria for delegation(4)

answer

• Define the issue - Clarify issue - Assessment of skills and knowledge - Identification of options

question

Criteria for delegation(3)

answer

- Review existing laws, policies and standards of nursing practice - For example: the WV rule clearly places responsibility for the analysis of data on the RN (not LPN or NA) - The LPN has a more dependent role and provides care only at the direction of the RN, MD, DDS etc (also WV law)

question

DELEGATING CARE: ANA PRINCIPLES

answer

• Nsg profession determines scope of nsg practice • RN supervises unlicensed assistive personnel (UAP) involved in direct care • RN is responsible/accountable for nsg practice

question

5 RIGHTS OF DELEGATION

answer

• Right task • Right circumstances • Right person • Right communication • Right supervision

question

RN is responsible for(4)

answer

• Clinical decision making regarding nursing care • Assuring that care is provided in a safe and competent manner • Determining which nursing acts in the implementation of care can be safely and legally delegated and to whom • Providing direction and assistance, observation and evaluation of acts performed by those under their supervision

question

RN'S SHOULD NEVER DELEGATE THE FOLLOWING TO UNLICENSED STAFF

answer

• Initial and ongoing patient assessment • Developing implementing and evaluating the plan of care for the patient • Supervision of nursing personnel • Patient teaching requiring assessment of pt ed. Needs • Other interventions requiring professional nsg knowledge, skill or judgment

question

Delegation(4)

answer

-The state nurse practice act must permit delegation of the task -Person making the delegation must have appropriate qualifications -Person receiving the take must have appropriate qualifications -Delegated task (to non licensed personnel) must NOT require critical thinking, professional judgment or assessment

question

Incident/Sentinal Event Reports(4)

answer

-Factual account of incident—outside of medical record -Pertinent characteristics of person involved and any equipment/resources used -Documentation of any actions taken -Names of witnesses and any individuals involved in incident

question

isotonic(3)

answer

-has same osmolarity as blood plasma -Will not cause movement of fluids or lytes -solution stays in IV compartment

question

hypertonic(2)

answer

-greater osmolarity than plasma -Causes water to shift from cells to vascular space, causing cells to shrink

question

hypotonic(2)

answer

-Lower concentration of particles than plasma -Causes water to move from vascular area to cells, causing cells to swell

question

isotonic IV solutions (3)

answer

-D5W -0.9% NS -Lactated Ringers

question

D5W(3)

answer

-supplies calories and glucose -only use for short term because it has no electrolytes -will dilute serum Na causing brain swelling (hyponatremic encephalopathy)

question

0.9% NS (2)

answer

-no calories, but good for expanding ECF -should not be used as maintenance b/c can give too much Na and Cl

question

Lactated Ringers(2)

answer

-same electrolytes as plasma -good for treating hypovolemia, burns, and GI fluid losses

question

hypotonic IV solutions (3)

answer

- 0.225% NS (1/4 strength) -0.33 % NS (1/3 strength saline) -0.45% NS (1/2 strength saline)

question

0.225% NS (1/4 strength)(2)

answer

-provides Na and Cl and free H20 -allows kidneys to select and retain needed amounts of lytes

question

0.33 % NS (1/3 strength saline)(2)

answer

-provides Na and Cl and free water -allows kidneys to select and retain needed amounts

question

0.45% NS (1/2 strength saline)(3)

answer

-also provides Na and Cl and free water -it is used to treat hypernatremia -dilutes the plasma sodium without dropping it too rapidly

question

hypertonic IV solutions(3)

answer

-D5/.45 NS -D10W -D5/.9NS

question

D5/.45 NS(2)

answer

-used to treat hypovolemia -good maintenance IV

question

D10W(2)

answer

- a lot of calories -used for PPN

question

D5/.9NS(2)

answer

-replaces nutrients and electrolytes -temporary treatment of hypovolemia

question

Hypertonic fluids hypotonic fluids isotonic fluids

answer

-treat hypovolemia -treat hypernatremia -maintain balance and/or provide calories

question

acidosis(2)

answer

-there is an excess of hydrogen ions in the extracellular fluids -The hydrogen ions exchange for potassium ions, increasing the extracellular potassium level

question

alkalosis

answer

-there will be a lack of hydrogen ions in the extracellular fluid

question

Respiratory acidosis(4)

answer

-caused by retention of CO2 -COPD or other hypoventilation -body increases RR to remove excess CO2 -kidneys retain more bicarbonate and excrete more H+ to counteract acid state

question

Respiratory alkalosis(4)

answer

-caused by a deficit of CO2 -as in hyperventilation -body decreases RR to retain CO2 and cessation of respirations can occur -Kidneys try to compensate by increasing bicarbonate excretion and H+ retention

question

Metabolic acidosis(4)

answer

-caused by decreased HCO3 in plasma -due to renal failure, toxins, diabetic ketoacidosis -RR increases to compensate -kidneys retain bicarb and excrete H+

question

Metabolic alkalosis

answer

-excess bicarbonate in plasma (overuse of antacids) -or excess acid loss (due to vomiting, GI suction) -RR decreases to compensate -kidneys excrete bicarb and retain H+

question

Fidelity

answer

fulfillment of promises

question

4 components for malpractice

answer

duty, breach of duty, causation, and damages

question

Nurse Involvement in Legal Issues

answer

Nurses can be involved as defendants in a suit, as witnesses to an event, or as expert witnesses Student nurses are held to same std as licensed nurses in r/t pt care—should not attempt skills/procedures that are unfamiliar with, as puts you at legal risk Other legal issues for nurses May be asked to witness a will or adv. directive Issues r/t resuscitation sometimes become legal matters

question

Areas of potential liability for nurses

answer

Incomplete database collected Failure to recognize and report changes in conditions Failure to diagnosis Failure to document Not following standard of care Patient abandonment Medication diversion Patient discharged while unstable or with unmet goals

question

trendelenburg (2)

answer

- used with lower abdominal and pelvic surgeries - helps to move intestines up and out of the way

question

lithotomy

answer

used in perineal, vaginal and rectal surgeries

question

sims/lateral

answer

used in renal surgery

question

reverse trendelenburg

answer

used in neurosurgeries

question

Fluid Volume Deficit: (hypovolemia) Decreased water & lytes in ECF (intravascular & interstitial spaces) (4)

answer

-Causes fluid shift from interstitial fluid to intravascular space and then from cells to interstitial fluid, eventually shrinking cells -Measure by wt loss: loss of 5% is pronounced and 8% is severe, 15% life threatening -Infants & elderly at risk. Use of diuretics increase risk. -3rd space shift: fluids become trapped in "potential spaces" (pleural, joint capsules, bowel, interstitial) causes decrease intravascular volume (no corresponding decrease in body weight)

question

Fluid volume excess: retention of water and sodium (hypervolemia) in the ECF (2)

answer

-Can be due to kidney malfunction or cardiac problems, or overload with fluid replacement -If extra ECF accumulates in tissue spaces = EDEMA!

question

Sodium (Na+)(5)

answer

-Main cation of ECF, most abundant electrolyte -Controls H2O balance & fluid volume, helps generate and transmit nerve impulses -Take in excess in food, but excreted by kidneys -Hypernatremia: Usually occurs only in dehydration, where H2O can't balance sodium -Hyponatremia: From excess H2O intake, GI or GU loss, diabetic acidosis or extreme sweating

question

Chloride (Cl-)(4)

answer

-main anion of ECF -Works with Na to maintain osmotic pressure ; acid-base balance -Essential for production of HCL/gastric juices. -Is paired with Na, excreted ; conserved same as Na

question

Potassium (K+)(6)

answer

-Main cation of ICF -Regulates cell enzyme activity ; H2O content -vital for electrical impulse transmission -assists with acid-base balance -Generally take in enough via diet and Excess excreted by kidneys. -Works in opposition with Na ; H, meaning an excess of either would cause a decrease in K and vice versa.

question

Bicarbonate (HCO3-)(5)

answer

-anion that is a major buffer in ECF ; ICF - acts as a base to neutralize acid -Levels regulated by kidney; available in body as result of -CO2 formation during metabolism -Arterial levels in ABG's slightly lower -Levels lower in pregnancy due to lower CO2 level

question

Hypokalemia(5)

answer

-K+ deficit in the ECF -K+ then moves from cell to ECF -Start to see muscle weakness and leg cramps (all skeletal and cardiac muscle cells can be affected) -caused by steroids -Aldosterone overproducing (excreting too much K+)

question

Hyperkalemia(4)

answer

-K+ excess in ECF -Transmission of stimuli through heart muscle is slowed and can = cardiac arrest -too much potassium in diet/burn/renal failure -Aldosterone is not functioning properly (not excreting K+)

question

Electrolyte Disturbances(3)

answer

-Increase and decrease in Chloride parallel inc. & dec. in Na. No specific sx for inc. or dec. in chloride. -When kidney resorbs K+ or Na+, it must also resorb an anion (Cl- or bicarb), in order to maintain electrical neutrality of serum. -Bicarbonate is a buffer, so change in the level of HCO3 is either a cause of acid-base disturbance or a body response/compensation to an acid-base disturbance

question

Hypomagnesium(2)

answer

-Caused by ETOH, malnutrtion, chemo, meds -Sx: muscle twitching, confusion, tachy arryhthmias

question

Hypermagnesium(2)

answer

-Caused by over use of replacements/supplm, kidney failure -Sx: decreased DTR, weakness, lethargy, brady arryhthmias

question

Phosphorous(2)

answer

-Related inversely to Ionized Calcium -Needed for muscle function, RBC's function, CNS function, metabolism, and formation of teeth and bones

question

hypophosphate vs hyperphosphate

answer

-Sx: irritability, confusion, seizures, numbness/tingling -Sx: tetany, EKG changes, decreased b/p

question

FVD

answer

-Neuro: Disorientation, lethargy, change LOC -CV: Postural hypotension, syncope, wk. pulse, inc. HR -GI: N;V, anorexia, thirst -Resp: lungs clear -Integ: Dry skin ; mucous membranes, dec. turgor, inc. temp. -GU: dec. output, conc. Urine, inc. SG (;1.030) -Labs: H;H inc., BUN/Creat inc., Protein inc. -Hx: dec. wt, emesis, diaphoresis, meds (diuretics, laxatives), palpitations, weakness -Tx: isotonic saline/LR, reverse cause

question

FVE

answer

-Neuro: Change LOC, seizures -CV: Inc BP, inc. periph pulse, neck vein distent., pitting edema -GI: no sig. effects -Resp: Inc. rate, SOB, cough, crackles/rales -Integ: Warm, moist skin, sternal fingerprinting, periorbital edema -GU: output;intake, low SG (;1.010) -Labs: H;H nml to dec., BUN nml to dec., Protein nml to dec. -Hx: inc. wt, tight shoes ; rings, H/A, muscle cramps, parasthesias, Dec. alertness -Tx: restrict fluids/Na, diuretics, reverse cause

question

hyponatremia vs. hypernatremia

answer

hypo- cell swells as water is pulled in from ECF hyper- cell shrinks as water is pulled out into ECF

question

in hyperkalemia

answer

switch from potassium sparing diuretic to loop diuretic

question

Study labs and diagnostics notecards

answer

- Pt/PTT and meds, conditions, values, and treatments -Abnormal labs and meaning (basic)

question

Study op notecards

answer

- Principles of surgical asepsis - Priorities in the PACU - Surgery risk factors/assessment for surgical risks -Post-op complications

question

serous

answer

clear, thin

question

serosanguinous

answer

blood-tinged, thinner than blood

question

sanguinous

answer

bloody

question

purulent

answer

white/yellow, pus

question

primary intention wound healing (2)

answer

- well approximated wound with small amounts of tissue lost - sutured wound

question

secondary intention wound healing (4)

answer

- wound edges far apart - cannot suture - increased scarring - burn, trauma, decubitus, tramatic wounds

question

secondary intention wound healing (2)

answer

- delayed primary - wound left open to decrease edema or infection and then closed/sutured

question

Maslow level of human needs

answer

1. survival- physiologic 2. safety and security 3. love and belonging 4. self-esteem 5. self- actualization

question

preload(3)

answer

- degree of stretch of muscle fibers in ventricle at end of diastole - depends on amount of blood returning to heart - increased blood return causes increased stretch and increased contraction

question

afterload(3)

answer

- the resistance the ventricle pumps against to eject blood - vascular resistance - inc. with resistance such as vasoconstriction, HTN, plaque, etc.

question

loading dose(3)

answer

- larger than normal dose - given when pt is in acute distress - max therapeutic effect is desired quickly

question

maintenance dose(2)

answer

- usual or daily dose - dose that achieves the desired therapeutic effect without causing undesirable effects

question

portal of entry

answer

-skin -GU and GI tracts -respiratory system -invasive procedures (catheterization, IV insertion, surgery)

question

portal of exit

answer

-point of escape -mouth -respiratory system (cough or sneeze) -body fluids -broken skin -draining wound

question

reservoir

answer

-habitat that promotes growth -humans-most significant -plants or animals -environment-food, water, contaminated material, equipment

question

infections difficult to treat

answer

-MRSA-common nosocomial wound/skin infection -VRSA -VRE-common bacteria in GI tract, can live on side rails a long time

question

Contact Isolation(4)

answer

-those infected with multi-drug resistant organisms -use gown and gloves -VRE and MRSA -if contact agent in lungs (MRSA), then use a face shield (don't necessarily need mask though)

question

virus(3)

answer

-smallest pathogens -can't be treated with antibiotics -need antivirals

question

bacteria(3)

answer

-gm pos-thick wall, stain purple and dont decolorize -gm neg-complex wall, can be decolorize -categorized by shape, gram stain, aerobic/aneurobic

question

infectious agents

answer

-bacteria -virus -fungus- plant-like organism

question

transmission

answer

-contact with susceptible host -direct (touching, kissing, sexual contact) -indirect

question

Airborne Isolation(4)

answer

-Infections spread through the air -use respirator, gown, and gloves -TB, varicella, measles, SARS -negative air pressure room

question

Droplet Isolation(4)

answer

-infection spread by large particle droplets -use gown, gloves, and surgical mask -rubella, mumps, diptheria -keep visitors 3 ft. from pt

question

signs of hyperglycemia

answer

-SOB -slowness -N;V -fruity breath -fatigue -thirst -dry mouth

question

signs of hypoglycemia

answer

-shakiness -dizziness -sweating -confusion -headache -hunger -tingling around mouth -behavior changes

question

Incubation(2)

answer

-from entry of pathogen to onset of symptoms -hours to months

question

Prodromal(2)

answer

-from onset of nonspecific sx to appearance of specific sx -most infectious state

question

Illness

answer

specific sx present

question

Covalescence

answer

-from time sx begin to abate until normal health returns

question

toddler teaching(2)

answer

-learn from parents -play

question

infant teaching(2)

answer

-learns by interacting with environment -most teaching directed at parents

question

preschool teaching(2)

answer

-learns from imitation, play, and by asking questions -give basic facts and concrete examples

question

school-age teaching(4)

answer

-eager to learn -formal setting and discovery -needs to know alternatives and consequences -use logical reasoning and clear explanations

question

adolescents/adults teaching(2)

answer

-learning must be practical and applied -abstract concepts can be included

question

decubitus (pressure ulcers)

answer

-wound with tissue necrosis -caused by -pressure resulting in dec. blood flow, ischemia -friction-skin rubbing against another surface -shearing-one layer of skin pulled away from another

question

Phases of wound healing

answer

-hemostasis -inflammation -proliferation -maturation

question

hemostasis(4)

answer

-almost immediate -platelet activation -clotting -scab formation

question

inflammatory(6)

answer

-4-6 days -clotting is initiated/continues -blood vessels contract then expand -WBCs migrate to area -pain, redness, heat, swelling -systemic response

question

proliferative(5)

answer

-several weeks -new granulation tissue forms -collagen begins to accumulate -capillary growth -need good nutrition here

question

maturation(3)

answer

-3 weeks to 1 yr or more -collagen continues to form -scar is the top avascular tissue of prior wound-strong but not elastic-may limit movement if large

question

small intestine(2)

answer

-continues chyme digestion (from stomach) and nutrient absorption -waste moves to ileocecal valve`

question

large intestine(4)

answer

-about 5 ft long -absorbs 800-1000ml water, Na, chloride -secretes mucus, protecting intestinal wall -transports flatus/feces by peristalsis (small waves q 3-12 min; mass waves 1-4 x/day after eating)- requires ANS functioning

question

functional

answer

-cause by factors outside urinary system -cognitive impairment, etc

question

reflex

answer

-loss due to reflexive emptying of bladder -neurological injuries

question

stress

answer

-urine loss r/t inc. intra-abd. pressure -cough, sneeze -can be due to childbirth, obesity, straining

question

urge

answer

urine loss r/t abrupt urge to void

question

overflow

answer

loss of urine r/t overdistention of bladder

question

transient

answer

-reversible -can be related to UTI, meds, psych disorders, dec. mobility

question

What is COPD(4)

answer

-chronic bronchitis -emphysema -asthma -Inflammation in airways (narrowing), air trapping, and mucus production dysfunction in respiratory process

question

COPD and the use of O2(3)

answer

-O2 should be 2L or less -lowered 02 levels drives respiration -O2 humidified if ;2L

question

COPD signs and symptoms(4)

answer

SOB with exertion productive cough wheezing hypoxia

question

improve breathing

answer

positioning deep breathing and coughing spirometer abd breathing and pursed lips (COPD pts) adequate fluids

question

hypoxia and symptoms

answer

decreased O2 to cells. Sx: dyspnea, restlessness/apprehension, fatigue, dizziness, inc. P, R, ;BP, pale/cyanotic

question

Dyspnea

answer

difficulty breathing due to air hunger or shortness of breath

question

Orthopnea

answer

labored breathing that is position dependant

question

NC (low flow)

answer

1-6 L/min; 24-44% FIO2—inc 4%/L

question

Airway obstruction, partial or total

answer

use Heimlich Maneuver if conscious or abdominal thrusts if unconscious

question

No breathing or pulse

answer

perform CPR and defibrillate

question

Lack of or ineffective breathing

answer

may need to manually ventilate (bag ; mask, or put on ventilator)

question

Principles of Trach care

answer

assessment: breath sounds, RR, O2 sats, cough/sputum, cyanosis (irritability and restlessness can be sx of a need to sxn

question

Trach care: suctioning(4)

answer

-sterile process -Pre-oxygenate -insert cath up to 8 in (adult) -use intermittent suction for ;15 sec. and may need to repeat process

question

Trach care

answer

also sterile (in hosp): removes dried mucus, cleans area around stoma; usually replace inner cannula, or can clean

question

Assessing before NG tube insertion(5)

answer

-ask them to breath in/out -assess nares -asses gag reflex (no gag inc risk for aspiration) -ascultate/palpate bowels -high fowlers, towel over chest

question

inserting NG tube(5)

answer

-Lubricate the tip 2-4 inches with lubricant -ask pt to hyperextend head back -pt gags at pharynx (tip chin to chest) - guides to stomach -have swallow water as inserting -rotate if you meet resistance

question

Gastric placement of NG tube(2)

answer

-Measure tip of the nose to the ear and then ear to the xiphoid process -For DUODENAL or JEJUNAL placement add another 20-30 cms. ( MD order)

question

assessing NG tube placement(7)

answer

-ask pt to talk -CO2 detector -Aspirate for pH: 5.5 or ; in stomach -visualize aspirate: GI-green/yellow/tan -X-ray: INITIAL ASSESSMENT -air bolus is not acceptable -Verify placement every 4 hours

question

If NG tube NOT in stomach

answer

advance 5 more cm and repeat placement check

question

NG tube feedings(5)

answer

-verify placement -Flush tube with 30-50ml of water/ NS before and after feeding -Check residuals before feeding and q 4 hours -Elevate head of bed for @ 30 degrees during feeding and at least 1 hour after feedings ( bolus) -replace container/equipment every 24 hours

question

1. Desiccation 2. maceration 3. Dehiscence 4. Evisceration

answer

1. wound too dry 2. wound too moist 3. disruption of surgical incision (separation of wound edges at suture line) 4. protrusion of wound contents

question

Treating dehiscence and evisceration(4)

answer

-prevent with ab binder -Low Fowlers position - Cover protruding tissue with sterile saline gauze - Notify surgeon immediately - this is an emergency!!

question

Principles of surgical asepsis

answer

-Necessary for all invasive procedures and when touching areas with non-intact skin - Free from living organisms or microorganisms - Surgical asepsis = Sterile/aseptic technique - Prevention of microbial contamination of living tissues or sterile materials by excluding, removing, or killing micro- organisms including pathogens and spores

question

nutrition and healing

answer

need vit A, B, C, K ; protein

question

proper steps for foley catheterization: before starting field

answer

• Collect supplies: Cath kit, leg strap, peri care supplies • Verify order • Explain to the patient ; PRIVACY • Bath blanket or towel to cover • Assess for allergies.. Betadine/ Iodine/ Shellfish and LATEX! • Bed up to good working height • Peri care first -position: female- knees bent, apart, raise butt old women: SIMS, side lying male: supine thighs apart

question

principles of asepsis

answer

-Don't turn back**/ Reach over/ DROP HANDS BELOW WAIST! -1 inch around the sterile field is considered contaminated, add things to the center -Add from 6 inches above field -If a sterile item touches a non sterile item = non sterile -Cover the field w/ sterile drape if you need to walk away -Wet field is contaminated -no sneezing/coughing -open away -When in doubt, throw it out

question

foley cath male

answer

male: clean the lubricate (circular motion downward) insert 10ml lube or lube cath 5-7 inches - insert to the Y or 6- 8 inches

question

foley cath female

answer

female: lubricate cath 1-2inches, then clean (1 downward stroke each cottonball - side furthest closest, middle) - insert 2-3 inches (urine) then 1- 2 inches more

question

inserting foley

answer

-ask pt to bear down on insertion -after inserted, inflate balloon and pull back gently -place drainage bag below pt not on side rail

question

cath care(4)

answer

-gloves -peri-care 3 times a day -wipe away from urethra - down the cath -empty bag for I and O

question

principles of chest tubes(3)

answer

-water seal: at least 2cm - drop in level on exhalation - increase on inhalation (tidaling-normal) -wet suction: 20cm - applies -20 cm of suction to lungs - more water in suction chamber the more pressure on lungs (more water, more suction) -bubbling in water seal chamber is abnormal - air leak- emphysema

question

chest tube care(4)

answer

-HOB 30 degrees -position every 2 hours -ambulate 4 -6 hrs -keep chest tube BELOW level of pt at all times

question

state's nurse practice act

answer

- permits delegation of tasks -is the most important law affecting your nursing practice. Nurse practice acts list the violations that can result in disciplinary action against a nurse

question

Legal Standards(2)

answer

state laws/nurse practice acts defines the legal scope of nursing practice.

question

Voluntary standards(2)

answer

developed by nursing and used as guideline for peer review (ANA Stds of Practice)

question

Controls disciplinary procedure for RN's

answer

state boards of nursing

question

Credentialing

answer

ways of ensuring professional competence

question

Accreditation

answer

process of evaluating educational programs

question

Licensure

answer

process by which the state determines a candidate meets minimum requirements to practice, and then issues them license to do so

question

Certification

answer

process by which person meets standard by non-governmental body and is granted specialty recognition (usually by passing exam)

question

delegation of a task

answer

(to non licensed personnel) must NOT require critical thinking, professional judgment or assessment

question

Incident/Sentinal Event reports

answer

-factual account of incident (outside of medical record) -pertinent characteristics of person involved and any equipment/resources used -documentation of actions taken -names of witnesses/individuals invoolved

question

4 components of malpractice (unintentional tort)

answer

prove liability: -duty -breach of duty -causation -damages

question

role of nurse in lawsuit

answer

-Nurses can be involved as defendants in a suit, as witnesses to an event, or as expert witnesses - student nurse can be held to same

question

principles of restraint use(4)

answer

-safest method: jacket, wrist(child) -always tie with clove-hitch knot -release every 2 hrs, assess, toilet -can NOT be ordered PRN

question

bed safety

answer

-lowest position -everything in reach -non-skid socks -clear walkways -lighting -orient pt to room

question

safety during pt transfer

answer

-paralyzed or very immobile - consider hydraulic lift. No draw sheet -moving post-op: use straps and side rails -always ask pt how well they move - ability to move first! -always move to strong side -secure tubes, drains, etc -dangle first

question

cardiac output

answer

amount of blood pumped in 1 min. It is stroke volume (amt pumped per contraction) X heart rate

question

Nitroglycerin(3)

answer

-vasodilates via relaxation of systemic and cardiac smooth muscle, used to treat angina (chest pain) and during MI -monitor BP!! -decreases cardiac output - causes hypotension

question

CAD(2)

answer

-Narrowing or obstruction of coronary arterial lumina that interferes with cardiac perfusion -luminal narrowing=decreased oxygen delivery to heart muscle=ishemia=infarction

question

CAD sx

answer

radiating chest pain (angina), sweating (diaphoresis), SOB, weakness, anxiety, cool extremities

question

heart failure

answer

As stress on the heart muscle increases, it "poops" out. It overworks to the point of exhausation and cannot "squeeze" effectively enough to supply the body with oxygenated blood

question

heart failure sx

answer

DOE, PND, cough, orthopnea, tachcardia, fatigue, weakness, weight gain, edema, gallop or murmur, JVD

question

preventing dumping syndrome(4)

answer

-enteral intestinal feedings should be CONTINUOUS (not intermittent) -bolus can causes bc it delivers food quickly -dumping syndrome happens when food moves from stomach to intestines too quickly -occurs with bolus feeds, hypertonic food and enter jejunum and cause fluid shifts

question

assessing pt pain

answer

-believe pt pain is real -become involved in pt pain experience -location, quality, timing, precipitating factors, alleviating factors, associated sxms, physiological responses, behavioral responses, personal meaning -OPQRST

question

principles of PCA therapy(4)

answer

-Patient determines when analgesia is administered (predetermined safety limits) -no one pushes button but pt -lockout intervals prevent overdose -assess RR

question

liquid med principles

answer

-palm label, cap top side down, pour to meniscus -do not return extra to the bottle -if less the 5ml, use syringe - cannot drink from cup -faster absorption than pills -consider fluid restrictions if any

question

intradermal(5)

answer

-slowest absorption -leaves wheal -angle: 10-15 degree -Dose: 0.5 mL -26-27 guage

question

subcutaneous(6)

answer

-heparin, lovenox, insulin -do not aspirate -pinch skin, dart like -smaller needle -Angle: 45 degree, 90 degree for obese -Dose: no more than 1.5 mL

question

intramuscular(5)

answer

-z-track method -larger needle -painful -angle:90 degress -Dose: 1-3mL

question

urinary elimination alteration s/sx

answer

-oliguria (<30 cc/hour) -urinary retention -UTI -Can occur from anesthetics, anti-cholinergics, opioids and/or fluid retention or deficit -requires immediate intervention: Palpate the bladder for distention if your suspect retention is the reason for low output -cath order if no void 8-12 hrs post-op -check PVR to ensure emptying in post-op!!!

question

Infants & older adults are at a greater risk

answer

Infants: lower TBV, lower glomerular filtration rate - slower metabolism of drugs elderly >65: decreased cardiac output, respiratory decreased, decreased sensory, skin,

question

Increases risk for surgical complications in all ages

answer

-chronic illness -malnutrition, dehydration, obesity -alcohol, drug use -respirations - stop smoking 2 mnths prior -cardiac (HTN, MI, CAD, CHF, phlebitis) -liver/kidney function -hyper/hypoglycemia

question

circulating nurse

answer

Must be an RN Verify consent Coordinating the team Ensure asepsis Ensure room temp Coordinate availability of supplies Documentation!

question

scrub nurse

answer

May or may not be RN Surgical hand scrub Setting up sterile table/supplies Preparing sutures and setting up equipment (cameras) Assisting the surgeon with retraction Handing the surgeon equipment Counting Helping to close wound and place dressing

question

intra-op nursing role

answer

Environmental safety Enhance pt coping Ensure safe patient positioning Equipment monitoring Protection of pt dignity Surgical asepsis

question

role of anesthesiologist

answer

Pre-op Assessment Selects anesthesia Places IVs and Lines Intubates the patient Administer the anesthesia Supervises and responds to VS, blood loss

question

priorities in PACU

answer

-ABCs, CNS, Surgical site, normothermia, pain and N/V -VS Q15, ECG, Pulseox, Q15 assessment

question

hypotension can result from

answer

o Blood loss (usually > 500 ml) o Side effects of meds ? Low B/P ? Dizziness ? Treatment: IV fluid, Blood, Meds to > BP

question

shock can result from: hypovolemia

answer

o Fall in venous pressure o Pallor, cool moist skin o > RR o Cyanosis o Rapid, weak pulse o Concentrated urine o Treatment: IV (LR), Blood, Oxygen, Warm Blankets, Trendelenburg

question

hemorrhage secondary to blood loss at surgical site

answer

o Restlessness, thirst o Cold, moist, pale skin o >HR (rapid and weak), >RR, < Temp o <BP and <HGB o TREATMENT:Transfuse, Elevate surgical site to level of heart, Trendelenburg, May have to Return to OR to stop bleeding

question

shock/hemorrhage

answer

? Weak, thready, rapid pulse ? BP ? urine output/oliguria ? Deep, rapid respirations ? Apprehension/restlessness ? Cold, clammy skin ? Thirst

question

Thrombophelbitis

answer

? Pain/cramping in calf or thigh ? Redness/swelling ? diameter of calf/thigh ? Warmth/heat over affected part ? TX: Hydration, Leg exercises/ambulate, Assess homan's sign early, Administer Heparin as ordered, Venodynes, Prevent leg constriction

question

Pulmonary Embolism

answer

? Sudden chest pain ? Dyspnea ? Cough ? Cyanosis ? Tachypnea ? Tachycardia ? Hypotension ? Anxiety ? TX: Hydration, Leg exercise/ambulation, Heparin/Lovenox, Prevent clot formation

question

malignant hyperthermia

answer

Due to anesthetics, intra-op medications S/Sx include tachycardia, dysrhythmias, flushing, mottling, rigidity, highly elevated temperature is a late sign Treat as a emergent situationprocainamide, dantrolene, ice

question

infection

answer

o Surgical site infection #1 nonsocomial infx ? May not present until day 5 ? Usually already discharged ? Must educate pts about s/sx of wound infection ? ;HR ? ;temp ? ;WBC ? Swelling, warmth, tenderness, purulent d/c, pain ? ***Can treat with I;D, antibiotics, dressing changes, drain

question

learning domains: cognitive psychomotor, affective

answer

-Compare, define, explains, identifies, states, prepares, gives examples -Changes, shows, demonstrates, adapts, starts -Chooses, gives, uses, shares, selects, values

question

pt education materials

answer

-graphics/videos instead of printed -large print -emphasize desired behavior rather than medical facts -concise - less is more -clear headings and bullets rather than paragraphs -short, purposeful -pictures examples

question

teaching plan for older adults

answer

-allow extra time -plan short teach sess -accommodate for sensory deficits -reduce environmental distractors

question

"TEACH"

answer

T: tune into the patient E: edit patient information A: act on every teaching moment C: clarify often H: honor the patient as a partner

question

using interpreters

answer

correct language, understanding of med terms, not family, same gender, introduce, direct questions toward pt still, confirm understanding

question

nonsocomial

answer

-hospital acquired -Exogenous source: hospital environment or personnel -Endogenous source: from pathogens pt. harbors himself -Iatrogenic source: as a result of treatment or procedure

question

on musculoskeletal

answer

Disuse osteoporosis, muscle atrophy, contractures, stiffness/pain in joints

question

on cardiovascular

answer

Increased valsalva maneuver, orthostatic hypotension, venous vasodilatation/stasis, dependent edema, thrombus formation, inc cardiac workload secondary to decreased lower extremity blood return

question

on respiratory

answer

Decreased ventilatory effort and increased secretions, pooling of secretions, atelectasis, hypostatic pneumonia, decreased resp depth

question

on metabolic

answer

Decreased metabolism, negative nitrogen balance from breakdown of body's protein stores "catabolism," anorexia, negative calcium balance

question

on urinary

answer

Stasis, renal calculus, retention, infection

question

on gastrointestinal

answer

constipation

question

on integumentary

answer

reduced turgor, breakdown

question

on psychoneurologic

answer

Lower self-esteem, apathy/withdrawal, regression, anger/aggression, external l.o.c. with anxiety, deterioration of problem-solving skills

question

pain med side effects

answer

-Respiratory Depression (^ with age, other CNS meds) -Circulatory Depression -Constipation (dose related, occurs frequently with long term use, ^ after surgery secondary to immobility and decreased fluid intake) -N/V (try to increase hydration, can administer anti-emetics) -Urinary retention (esp. with epidural) -Pruritis (does not = allergy, can give antihistamines) -Physical Dependence (w/d symptoms) -Tolerance (need increased dosing pattern for same effect) -Addiction (psyc/behav pattern; taking drug for euphoric effects) -Inadequate pain relief (may be to changing route, ie. If switch from IV to PO will need 3x dose)

question

Sensory deprivation

answer

• results from decreased sensory input or monotonous or meaningless input. Can be due to: decreased environmental stimuli, impaired ability to receive or process stimuli Examples: Blind patient in hospital, preemie infant in incubator

question

Sensory overload

answer

Excessive stimuli over which an individual feels little control. The brain is unable to respond to or ignore. Can be due to: Internal Stimuli (pain, invasive tubes), External Stimuli (unfamiliar environment, unfamiliar groups of people, etc), Physiologic inability to selectively ignore stimuli cause-- confusion, agitation, withdrawal

question

interventions for sensory changes

answer

Correct sensory impairments as much as possible (hearing aids, glasses, etc) Ensure periods of rest, activity, & mobility Implement plan to inc. stimulation (touch, use of music, taped family voices, communication, pictures, pet visits, etc). Do this 5-10 min several times/day Or plan to dec. stimulation (lower lights, assist client to focus, remove confusing stimuli, replicate home envir. as possible, limit visitors, explain stimuli, allow rest)

question

maintaining airways

answer

Oropharyngeal/nasopharyngeal: keep tongue up, maintain upper airway; nurses can insert Endotracheal or nasotracheal tube: used if pt. being ventilated or if obstruction Tracheostomy: artificial opening into trachea for long term ventilation or obstruction ET, NT or trachs used to maintain airway if injury/swelling, to deal prevent obstruction from copious mucus, or to provide ventilation

question

bowel assessment

answer

inspect, auscultate, percuss, palpate

question

nursing code of ethics

answer

A statement of the ethical obligations and duties of every individual who enters the profession Nonnegotiable ethical standards Expression of nursing's own understanding of its commitment to society Includes concepts of confidentiality, advocacy, nondiscrimination, dignity, ethical decision making

question

Common components of nsg. Theories

answer

person, environment, health, nursing

question

LEWIN'S CHANGE THEORY: STEPS

answer

Unfreezing: need for change is accepted: influenced by degree of threat, lack of understanding, Moving: initiation of change: influenced by tolerance for change, fear, preparation, etc. Refreezing: change becomes fully incorporated: influenced by commitment, difficulty

question

Developmental theory

answer

orderly and predictable growth and development from conception to death

question

Adaptation theory

answer

living things adapt/adjust to changes in other living things or the environment

question

General systems theory

answer

looks at how parts of a whole work together in systems

question

Nasal cannula(4)

answer

-low flow -1-6 l/min -24-44% -F1O2-increase 4% L

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