317 Final Flashcards
1
Q
types of grief
A
normal, prolonged, anticipatory, disenfranchised, complicated, exaggerated, delayed, masked, ambiguous
2
Q
normal grief
A
common universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual response to loss and death.
3
Q
prolonged grief
A
causes distress and intrusive thoughts
4
Q
anticipatory greif
A
when a person experiences an unconscious process of disengaging or letting go before the actual loss of death occurs, especially in a situation of predicted or prolonged loss.
5
Q
disenfranchised grief
A
occurs when the relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance (her examples were death of a gay partner or ex-partner).
6
Q
complicated grief
A
prolonged significantly difficult time moving forward after the loss. It is a chronic and disruptive yearning for the deceased. It is characterized by trouble accepting death. It might be seen when the loss is from homicide, suicide, or accident
7
Q
exaggerated grief
A
self destructive or maladaptive behavior, obsession, or psychiatric disorder
8
Q
delayed grief
A
may be caused by loss being so overwhelming that the person must avoid the full realization of the loss
9
Q
masked grief
A
interferes with the normal functioning but the person is unaware of the disruptive behavior as a result of the loss or ineffective grief resolution.
10
Q
ambiguous grief
A
loss occurs when the lost person is [physically present, but not psychologically available (kidnap, brain injury, dementia).
11
Q
mourning
A
time in which the outward social expression of grief takes place
12
Q
bereavement
A
encompasses both grief and mourning and includes the emotional responses and outward behaviors of the person experiencing loss
13
Q
patient symptomology in the last few hours of life
A
Noisy breathing Urinary incontinence or retention Pain Restlessness Dyspnea nausea/ vomiting Sweating Twitching/ jerking Confusion
14
Q
4 goals of symptom management at end of life
A
comfort, dignity, quality of life, and support
15
Q
admission criteria for hospice
A
pt desires service and only has 6 months or less to live
16
Q
palliative care
A
for a person suffering from a life threatening illness and the care aims to prevent and relieve suffering by early identification, assessment, and pain treatment
17
Q
goal of palliative care
A
decrease severities of symptoms and focus on trying to help family cope
18
Q
hospice
A
curing measures and further medical care are stopped. focus is to enhance quality of life
19
Q
kubler ross’s stages of grief
A
denial, anger, bargaining, depression, acceptance
20
Q
describe the criteria for coroner’s case
A
cases in which the patient dies after 12 hours of being admitted into the hospital, in surgery, procedure, or if thought to be caused by malpractice. Also patients that seem to be neglected, malnutrienced, or under 18
21
Q
what cannot happen if a patient dies and is on a coroner’s case?
A
nothing can be removed from the body until the body is released
22
Q
dementia
A
decline in brain function and difficulties with skills such as memory and attention, orientation, place or person, and regulating emotions
23
Q
delirium
A
is a sudden deterioration of mental functioning, due to an acute illness
24
Q
depression
A
a low mood and or loss of interest in activities
25
cognitive impairment vs dementia
dementia has a much worse severity. example cognitive impairment person might forget where they put their keys but a dementia patient may put their keys in the freezer
26
nursing care for patients with dementia
safety! protect wandering and falling, protect others from inappropriate behaviors, help them use their brain, assist with ADLs, sticky notes
27
nursing diagnosis of patient with dementia
Ineffective coping related to changes in life situation as evidenced by inattention to personal hygiene, and health seeking behaviors.
28
A's of dementia
Anogosnia - ignorance of the presence of disease
Agnesia - inability to recognize objects using the senses
Aphasia - loss of the ability to speak or understand spoken, written, or sign language
Apraxia - inability to make purposeful movements
Altered perception - misinterpretation of information from senses
Amnesia - memory loss
Apathy - lack of interest in activities
29
sundown phenomenon
Sundowning syndrome is a set of symptoms that can be seen in patients with dementia in which they become confused and agitated late afternoon and in the evenings. The closer to evening the “sundown,” the more confused and agitated the client becomes. Causes can be fatigue, unfamiliar environment, noise, medications, lighting, and disruption of circadian rhythms.
30
understand the use of diversion with a patient with cognitive changes
You do not want to make the patient get more agitated about the situation with arguing. In order to help, one must divert this by giving them something to do with their hands. Validate, reassure, and distract them with something that promotes comfortability.
31
relationship between aging and chronic illness
aging does not automatically lead to disability and dependence. most older people remain functionally independent despite the fact that most older adults have at least one chronic disease
32
identify safety measures that are appropriate to put in place for aging client
prevent falling by wearing nonslip foot wear, encourage them to use cane, walker... keep medication in original container, buy special alarm necklace incase of falls
33
3 top causes of death
heart disease, neoplasm (tumor/cancer), lower respiratory disease
34
theories of aging
biological - stochastic and nonstochastic.
| psychosocial - disengagement, activity, and continuity/developmental
35
stochastic
views the effects of biological aging as results from random cellular damage that occurs over time from both the internal and external environment; nurture
36
non stochastic
views biological aging as the result from complex, genetic, and predetermined processes within the body; nature
37
disengagement theory
Aging individuals withdraw from customary roles and engage in more introspective, self-focused activities.
38
activity theory
older people continue to live healthy and satisfying lives when they continue to be actively engaged in social roles and exercise their physical and mental capacities.
39
continuity/developmental theory
suggests that as people age, personality remains stable and behavior becomes more predictable.
40
difference between men and women as they age
men are more likely to live with spouse, have health insurance, fewer chronic health problems, and less likely to be involved with caregiving
woman more likely to live alone, have loss of spouse, and more likely to suffer from chronic illness
41
how is dementia diagnosed
if a pt can not perform two ADLs and possibly on CAT scan or MRI
42
most types of dementia can only be
found on autopsy
43
brain death shows as
ventilator dependent and no brain stem reflexes
44
brain death test and procedures
multimodality evoked potentials (MEP), electroretinography (ERG), and the use of an EEF
45
2 interventions to decrease chance of developing pneumonia
IS and early ambulation
46
a pt with DKA or HHNS will be
severely dehydrated
47
Hemoglobin A1C levels
the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.
48
microvascular complication of diabetes in eyes
retinopathy
49
What is the upper limit of PNA vaccines a pt should get in their lifetime
2
50
NG feeding, what type of PNA is he at risk for
aspiration
51
Has PNA, needs antibiotics, what do we do first?
sputum culture
52
Cold and clammy
need some candy - hypoglycemic
53
Receive report that patient is having nightmares and flashbacks after a car accident what is wrong with them
PTSD
54
Betty Neuman’s primary prevention promotes patient’s wellness by stress prevention and reduction of _____ _____
risk factors
55
3 assessments that you would observe during ALARM stage of GAS
Increased HR, BP and respirations, glucose levels, oxygen requirements
56
patient with Stroke on comfort care, has distended abdomen and pressure on lungs. patient dies. is this a coroner’s case?
no
57
Deontological
People are worthy of respect
58
Fidelity
Faithfulness to responsibilities
59
Values
Personal belief about worth of given idea or behavior
60
Rules with Title IV ACT of 1964 and related antidiscrimination ACT of 2003
Free translator, verbal and written notification of right to receive services
61
patient on pain meds, muscle relaxer and sleep aide; becomes confused and combative; what caused it?
medication interaction
62
Total knee replacement, 2 days post op and still needs oxygen, why is he still requiring oxygen?
Decreased chest expansion
63
Nociceptive pain that can be superficial or deep
somatic
64
Nonpharmacological treatment with electrical stimulation
TENS unit
65
Screening test is useful in determine presence of neurological impairment
clock test
66
what do patients want from health care and providers
access, safety, outcomes, and respect
67
never events and examples
serious and preventable events that should never occur in hospital setting. example: pressure ulcer or wrong site surgery
68
sentinel events and examples
unexpected outcomes or risk involving death or serious physical or psychological injury. example is patient suicide, medication error, or delay in treatment
69
dependent nursing actions
doing something in guidance of the physician. example: medication administration
70
independent nursing action
part of the nursing process. you challenge the ways others think and look for rational and logical answers to problems.
71
domain
It is the knowledge of nursing practice and nursing history, nursing theory, education, and research. Gives nurses a comprehensive perspective that allows you to identify and treat patients’
72
theory
a set of concepts,definitions,and assumptions in order to explain a particular phenomenon.
73
paradigm
is a pattern of beliefs used to describe the domain of a discipline
74
Henderson's theory
there are 14 basic life activities a patient needs assistance with, help with these needs until patient is able to do them alone.
75
Leininger's theory
focusing on culture
76
Nightingale's theory
based on bringing patient closer to nature
77
Orem's theory
teaching patients to be self sufficient, practice self care, Goal: teaching patient to manage own health problems
78
Neuman's theory
role of nurse is to stabilize patient, identify stressors, and assess the whole
79
Roger's theory
unitary beings. Nurses role is to be truly present with patient and accept the patient’s view on reality
80
Watson's theory
Caring
81
Roy's theory
adaptation
82
Roy's theory
adaptation
83
4 Cs
comfort, connection, confirmation, courtesy
84
maslows hierarchy of basic needs
```
At the base is physiological needs
Then safety
Then love/beloging
Esteem
And at the top (which means it is the least important) is self actualization
```
85
dreyfus model
shows how students acquire skills through formal instruction and practicing. students move through 5 stages.
86
karaoke-yahiro and saylor model
three levels of things as you grow as a nurse from a beginner to expert
87
respite care
provides short term relief or time off for people providing home care to an individual who is ill, disabled, or frail.
88
enculturation
experiences, observations, and norms that an individual learns and develops as their primary culture.
89
acculturation
adoption of a second culture which replaces the primary culture
90
multiculturalism
being aware of the different cultures, and has an impact due to cultural values, health beliefs and practice
91
ethnocentrism
a person’s belief that their own culture is superior over others
92
emic worldview
is an insider’s perspective into their own native culture
93
etic worldview
An etic worldview is an outsider's perspective. In other words, an etic perspective is the perspective from an observer
94
morals vs ethics vs values
morals- standard of right and wrong, ethics- behavior, values - beliefs
95
altruism
a concern for the welfare and well being of a patient
96
autonomy
is the right to self determination. A person’s right to choose and ability to act on that choice (based on respect for human dignity), even when it is not in their best interest
97
justice
being fair to all people
98
fidelity
the obligation to be loyal to commitments made to oneself and to others
99
paternalism
occurs when health care providers decide what is “best” for clients. Can be a negative outcome of beneficence
100
veracity
the duty to tell the truth
101
nonmaleficence
the obligation of the health care provider to do no harm
102
AIDET
acknowledge, introduce, duration, explanation, thank you
103
using LAST in conflict resolution
Listen, advice/apologize, solve, thank you
104
4 Ps
4 P's pain, potty, position, and possessions
105
CUS
I am concerned. I am uncomfortable. Stop there is a safety issue
106
medicare part A
hospital insurance
107
medicare part B
covers some preventative and primary care
108
medicare part C
medicare advantage plan
109
five rights of delegation
right person, right task, right supervision, right communication, and right circumstance
pneumonic - please take sue cold cuts
110
Compare and contrast the values associated with blood pressures
Normal SBP <120 and DBP <80
Prehypertension 120-139 or 80-89
Hypertension, stage 1: 140-159 or 90-99
Hypertension, stage 2: ≥160 or ≥100
111
primary vs secondary hypertension
primary is an unknown cause and secondary is resulting from a cause
112
first line therapy for stage 1 hypertension includes
diuretics, calcium channel blockers, ace inhibitors, and ARBs
113
DASH diet
consists of lowering salt intake, increasing potassium, calcium, magnesium, and fiber. The diet should have low concentrated carbohydrates and be low calorie.
114
how to figure out the MAP
((systolic) + (diastolic x2))/3
115
6 Ps with peripheral arterial disease
pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
116
poikilothermia
loss of temperature regulation
117
Bp highest at what part of the day
10 am - 6 pm
118
BP lowest at what part of the day
between midnight and 3 am
119
LDL
bad cholesterol - promote formation of atherosclerosis. want it less than 100
120
HDL
good cholesterol - associated with coronary artery disease want it higher than 35
121
total cholesterol
want less than 200
122
Two risk factors for coronary artery disease
hypertension and smoking
123
ejection fraction of systolic heart failure
is lower because the ventricle loses the ability to generate enough pressure to eject blood forward. EF usually less than 45% and can go as low at 10%
124
FACES
fatigue, limitation in activity, chest congestion, chest congestion, cough, edema, SOB
125
electron beam computed tomography (EBCT
locates and measures coronary calcification
126
Coronary Computed Tomography Angiography (CCTA)
using IV contrast and radiation, CCTA can detect calcified and noncalcified plaques in the artery
127
diagnosis of acute myocardial infarction
12-lead ECG, Serum Cardiac Biomarkers, Coronary Angiography
128
Serum Cardiac Biomarkers
Cardiac specific troponin, creatine kinase MB, and myoglobin are released into blood from necrotic heart muscle after an MI and can be tested fo
129
Interpersonal communication
exchange of information between two or more people. uses verbal and nonverbal cues to accomplish personal and relational goals.
130
Transpersonal communication
specific responses that encourage the expression of feelings and ideas and convey acceptance and respect.
131
feedback in communication
Feedback is a response to the message. Feedback can be positive, negative,verbal, or nonverbal.
132
intimate zone of space
(0- 18 inches): holding a crying infant, performing physical assessment, bathing, grooming, dressing, feeding, and toileting a patient
133
personal zone
(18 inches to 4 ft): sitting at a pt’s bedside, taking a pt’s nursing history, teaching an individual pt
134
socio-consultative zone
(4-12ft): giving directions to visitors in the hallway, asking if families need assistance from the pt doorway, giving verbal report to a group of nurses.
135
public zone
(12ft. and more): speaking at a community forum, lecturing to a class of students, testifying at a legislative hearing
136
social zone
(permission not needed): hands, arms, shoulders, back
137
consent zone
(permission needed): mouth, wrists, feet
138
vulnerable zone
(special care needed): face,neck, front of body
139
intimate zone of touch
(permission and great sensitivity needed): genitalia, rectum
140
SOLER
```
s- sitting posture
o- observe an open posture
l- lean toward the patient
e- establish and maintain eye contact
r- relax
```
141
methods of delivery of O2
Nasal cannula (1-6L/min), Simple mask (5-10 L/min), Partial rebreather (8-12 L/min), Non-rebreather (10-15 L/min), and the Venturi mask (4-12 L/min).
142
Betty Neuman’s Systems Theory
used to describe the concepts of stress and reaction to stress. views a patient, family, or community as constantly changing in response to the environment and stressors.
143
Intellectual indicator
someone setting unreasonable standards for perfection
144
maturational crisis
Varies with life stages
In preadolescents: puberty, school, and sex
In adults: major life changes including starting a family, losing their parents, and accepting physical changes
145
situational crisis
external sources such as job changes, car crash, illness, caregiver stress
146
General Adaptation System and the responses within the body
alarm stage, resistance stage, exhaustion stage
147
alarm stage
flight-or-fight reaction, Rising hormone levels result in increased blood volume, blood glucose levels, epi and NE amounts, HR, blood flow to muscles, oxygen intake
148
resistance stage
body stabilizes by normalizing and repairing damage, Hormone levels, HR, BP, and cardiac output should return to normal
149
exhaustion stage
body is no longer able to resist effects of stressor and has depleted the energy to maintain adaptation
150
symptoms of hyperglycemia
dry mouth, extreme thirst, frequent urge to urinate, drowsiness, frequent bed wetting, abdominal pain
151
symptoms of hypoglycemia
“Cold and clammy, patient needs some candy.”
| sweating, trembling, dizziness, mood changes, hunger, headaches, blurred vision, extreme tiredness and paleness
152
somogyi effect
High blood sugar in early morning- low blood sugar at night causes rebound high blood sugar in the morning
153
Dawn phenomenon
High blood sugar early in morning. A decrease in insulin with an increase in glucagon and cortisol cause hyperglycemia in morning
154
Basal
mimics what pancreas does to keep blood sugar in normal range when a person’s not eating - Lantus/Levemir
155
Bolus
mimics the increase of insulin the pancreases sends out in response to food - Humalog/Novolog
156
CLABSI
central line associated bloodstream infection. Microorganisms can enter the bloodstream and contaminate CVCs through 2 mechanisms: extraluminally or intraluminally.
157
HAIs
hospital acquired infection. primary cause of preventable death and disability among hospitalized patients.
158
CAUTION
C- Close system catheter selection consider alternatives
A- Aseptic management
U- Universal standard precautions
T- Tie secure catheter to patient tubing to bed
I- Indication for use and to discontinue
O- Obstruction free specimen from sampling port
N- No dependent loops
159
FEV1
FEV1 is the maximal amount of air you can forcefully exhale in one second. low in COPD patients
