Care Of Chronic Exam 1 Flashcards
Routine physical examinations should be done generally how often
1-3 yes females. 5 years males. More often after 40 yrs age
TB screening is done when
Every 2 years for skin test. Health care workers screened annually
Blood pressure testing should be done at least how often
Every 2 years Or annually if elevated
Blood cholesterol screening starts at what age
- Minimum every 5 years
Blood glucose screening starts at what age
45, minimum every 3 years
What domain of learning involves knowledge, comprehension, application, analysis, synthesis and evaluation. It required intellectual behaviors and focuses on thinking
Cognitive learning
What domain of learning involves feelings beliefs and values.
Affective learning
What domain of learning is gaining skills that require mental and physical activity?
Psychomotor learning
Teaching in small groups of 6 people or less often increases learning and learner satisfaction. T/f?
True
A nurse in a providers office is collecting data from the caregiver of a 12- mo old infant who asks if the child is old enough for toilet training. Following an educational session with the nurse, the client agrees to postpone toilet training until the child is older. Learning has occurred in which domain?
Affective. Because the clients ideas about toilet training changed.
Piaget’s developmental stage for the first two years old life and 3 essential component
Sensorimotor stage
Separation
Object permanence
Mental representation
Serving size for toddlers should be what for solid food?
1Tbsp solid food per year of age
Which theory of development includes assimilation, accommodation, and adaptation
The cognitive theory
What universal Princeton human growth and development is described as following a head to toe progression. Infants gain control over their neck and head before controlling extremities?
Cephalocaudal principle
What human development principle is based on the progression from center of the body in an outward direction? The spine first, extremities, then fingers and toes?
Proximodorsal principle
What human development principle is described as infants accomplishing head control before they are able to crawl?
Simple to complex
What human growth process is characterized by periods of growth spurts and periods of steady, slow growth?
Continuous process
“Human development occurs from large muscle movement to more refined muscle movement “ is a description of what universal principal?
General to specific
“Human development varies from individual to individual. Each person has their own growth timetable and rate of development “ is a description of what universal principal?
Individualized rates
What uses 5 indicators (appearance, pulse, grimace, activity, and respirations) to quickly asses whether a newborn requires immediate medical care at 1minute & 5 minutes post birth?
Apgar scoring
What is considered a normal apgar score?
7 or higher
A newborn with pink body & blue extremities; pulse over 100/min; minimal response to stimulation; active arms and legs, and a vigorous cry would score what on apgar ?
A= 1
P=2
G=1
A=2
R= 2
Total=8
At 6 months of age an infant has tripled his birth weight. Is this normal or concerning?
Concerning. An infants weight is not expected to triple until 12 months of age.
At 6 months of age the infant’s anterior fontanel (soft spot) is still present. Is this expected or concerning?
Expected. It will be present until after the first year of life due to the growth of brain
An infant should sit while unsupported at what age?
10 months
What is climacteric
Menopause in women
Decreased testosterone and sperm count in men
Happens during middle adulthood.
What is the Piaget stage of development where children use symbols to represent objects and learn to express themselves through language and symbolic gestures, but do not yet reason logically.
Preoperational stage at 2-6 years old
What is HCO3-
Concentration of bicarbonate in arterial blood
What is SaO2
Percentage of oxygen bound to hgb as compared with the total amount that can be possibly carried.
How do you obtain ABG
Arterial puncture or arterial line
Prior to arterial puncture what should be done to verify patency of radial and ulnar circulation?
Allen’s test
Expected blood ph
7.35-7.45
Expected PAO2 range
80-100 mmHg
Expected PACO2 range
35-45 mmHg
Expected HCO3- range
21-28 mEq/L
Expected SAO2 measurement
95%-100%
During a thoracentesis, client education would be what?
Remain absolutely still during the procedure. Do not cough or talk unless directed to by provider.
During thorancentesis, what is the amount of fluid removed limited to at a time to prevent re-expansion pulmonary edema?
1 Liter
Complications of thorancentesis
Mediastinal shift (shift of thoracic structures to one side of the body)
Pneumothorax (collapsed lung)
Bleeding.
Infection
A nurse is caring for a client who is scheduled for a thorancentesis. Prior to the procedure, how is the client positioned?
Upright position, leaning over bedside table.
In a 3- chamber chest tube system, what are the chambers for.
1st- drainage collection
2nd- water seal
3rd- suction control (wet or dry)
To maintain the water seal with the chest tube system, what does the nurse need to do?
Keep chamber upright and below the chest tube insertion at all times
Monitor the water level due to possible evaporation
Add fluid if needed to maintain seal
What is the typical suction pressure prescribed with chest tube systems?
-20cm H2O
Indications for chest tube insertions
Pneumothorax
Hemothorax
Postoperative chest drainage
Pleural effusion
Pulmonary empyema (accumulation of pus in pleural space)
When the chest tube is inserted to drain fluid from the lung, where is it inserted.
The tip of tube is inserted near the base of the lung on the side.
When the chest tube is inserted to remove air from the pleural space, where is it inserted?
The tip of tube will be near the apex of the lung
FiO2 rate of nasal cannula
24-44% at flow rates of 1-6 L/min
FiO2 of simple face mask
40-60% at flow rates of 5-8 L/min.
Minimum flow rate is 5 L/min. To ensure flushing of CO2 from the mask
FiO2 of partial rebreather mask
40-75% at flow rate of 6-11 L/min
Non rebreather mask FiO2 rate?
80-90% at flow rates of 10-15 L/min
To keep reservoir bag 2/3rds full during inspiration and expiration
High flow oxygen delivery systems.
Venturi mask.
Aerosol mask, face tent, and tracheostomy collar.
T-piece
Examples of noninvasive positive pressure ventilation
Continuous positive airway pressure
Bi-level positive airway pressure
Transtracheal oxygen therapy
Mechanical ventilation can be delivered via….
ET tube
Tracheostomy tube
Pressure support ventilation (PSV) mode does what?
Allows preset pressure delivered during spontaneous ventilation to decrease the work of breathing
How often should the nurse assess breath sounds for a patient receiving mechanical ventilation?
Every 4 hrs
Nursing priority for clients who have a cute respiratory distress is what
Maintain a patent airway to promote oxygenation
Mild intermittent asthma diagnosis means symptoms occur how often?
Less than twice a week
Mild persistent asthma occurs how often?
More than twice a week but not daily
Anticholinergic medications such as ipratropium, work how?
By blocking the parasympathetic nervous system to prevent bronchospasms.
Methylxanthines, such as theophylline, is used only when other treatments are ineffective why?
They require close monitoring of blood medication level due to a narrow therapeutic range.
For nasotracheal suctioning, how far do you advance the catheter for an adult
16-20 cm (6-8 in)
For nasopharyngeal suctioning of an adult, how far do you advance the catheter
13-16 cm ( 5-6.5 in)
How long is the recommended time you would suction nasotracheal or nasopharyngeal?
No more than
10-15 seconds at a time
Waiting at least 1 minute between passes. Some facilities limit to no more than 2-3 passes at a time.
Hypocarbia (hypocapnia) co2 levels
Less than 35mmHg
Hypercarbia(hypercapnea) CO2 levels
Greater than 45mmHg
Laboratory test ordered for COPD
Hematocrit levels will be low.
Sputum cultures and WBC to test for infection
ABG- decreased PaO2 = hypoxemia
Increased PaO2 = hypercarbia.
Blood electrolytes
In COPD patients, the the oxygen levels should be maintained at what percentage
88-92%
What is the v/q ratio
V=ventilation
Q= perfusion
The amount of air that reaches the alveoli per minute/ the amount of blood that reaches the alveoli per minute.
Optimum would be v/q ration= 1.0
High ratio would mean more ventilation and less perfusion as seen in pulmonary embolism.
Low ratio means opposite as seen in atelectalis. Normal perfusion but decreased ventilation
Pneumothorax
Air in the pleural space leading to a collapsed lung. Builds up of co2 due to decreased o2
A patient is presenting with deep rapid exhalations. You know this is what kind of breathing and can mean what?
Kussmaul breathing can occur in metabolic acidosis
A patient presents with deep rapid breathing and slow shallow breathing, with periods of apnea. You know this is what kind of breathing pattern and means what?
Cheyne-strokes breathing and can occur in congestive heart failure, increased intracranial pressure, and drug od
Shallow breathing with periods of apnea is what
Boot breathing. Can occur in cns disorders
A patient presents with increased restlessness, irritability, unexplained sudden confusion. Has a rapid heart rate and respiratory rate. What are these signs of?
Hypoxia
examples of pulmonary function tests
Incentive spirometry
peak expiratory flow rate (PERF)
Neonatal period is when
Birth to 28days
