CLASS 1 - Introduction to Pathophysiology, Health Assessment, and the Pharmacotherapy System Flashcards
What is assessment?
the collection of data about an individual’s health state
What is functional assessment?
measuring a patient’s self-care ability (general physical health and absence of illness, ADLs+ IADLs, social relationships and resources, self-concept and coping, home environment)
What is a cue?
A cue is a client response that enables the nurse to form patterns in order to formulate or support a diagnosis
What is diagnostic reasoning?
The process of analyzing health data and drawing conclusions to identify diagnoses
describe relational practice
- Accounts for the fact that health, illness, and the meanings they hold for a person are shaped by the person’s gender, age, ability, and other indiv contexts.
- Relational approaches focus nurses’ attention on what is significant to people in the context of their everyday lives and how capacities and socioenvironmental limitations shape peoples’ choices.
Define reflectivity
A central skill of relational practice. Process of continually examining how you view and respond to patients on the basis of your own assumptions, cultral and social orientation, past experiences, and so on.
What are the 5 phases of the nursing process?
assessment, diagnosis, planning, implementation, evaluation
Describe the assessment phase
collect, organize, validate, and document data
Describe the diagnosis phase
analyze data, identify health problems, risks, and strengths, and formulate diagnostic statements
Describe the planning phase
prioritize problems and diagnosis, formulate goals and designated health outcomes , and identify nursing interventions
Describe the implementation phase
reassess the patient, determine the nurse’s need for assistance, implement nursing interventions, supervise delegated care, and document nursing activites
Describe the evaluation phase.
collect data related to outcomes, complete data w outcomes, relate nursing actions to patient goals / outcomes, draw conclusions about problem status and continue, modify, or end the patient’s care plan
Describe Inspection as an assessment technique
Looking.
Concentrated watching; close and careful scrutiny of the patient as a whole and then of each body system; always performed first.
Describe Palpation as an assessment technique
Feeling.
Applying sense of touch to assess patient.
Describe Percussion as an assessment technique
Tapping.
Tapping the patient’s skin w short, sharp strokes to assess underlying structures.
The strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ.
Describe Auscultation as an assessment technique
Listening
most body sounds are v soft and must be channeled w a stethoscope
What information is included in Complete Health History Data?
Biographical data, reason for seeking care, current health, PMHx (resolved and ongoing comorbids), family health history, Functional assessment, H2T/ROS
Biographical data
Ask patient to self-identify these characteristics, do not assume you know.
- Patient’s name, age, birthdate, birthplace, other recent countries of residence, sex, gender, relationship status, and usual and current occupation or daily activity pattern
- Primary + preferred language
- Patient’s authorized representative
How would you document the source of history for a patient?
Record who provided the info, whether its a patient, caregiver, parent, etc.
Judge how reliable the informant seems and how willing / able the person is to communicate
Note any special circumstances such as the use of an interpreter.
Ex. Patient herself, who seems reliable
Ex. patient’s son, Billy Bob, who seems reliable
Ex. Mr. R. Fuentes, interpreter for Theresa Catillo, who does not speak English.
What is a patient’s reason for seeking care?
Brief, spontaneous statement in the patient’s own words that describes the reason for the visit. States one or two symptoms or signs and their duration.
How would you document a patient’s reason for seeking care? What should you avoid?
Whatever the patient says is their reason for seeking care is recorded and enclosed in quotation marks to indicate their exact words.
“Chest pain” for 2 hrs
“My child has an earache and was fussy all night”
“I need a yearly physical examination for work”
“I want to start jogging, and I need a checkup”
“I would like to cut down the amount of ciagarettes I smoke”
Avoid using the patient’s reason for seeking care as a diagnosis; do not translate the patient’s statement into the terms of a medical diagnosis.
What are the components of PMHx?
Childhood illnesses, accidents + injuries, serious or chronic illnesses, hospitalizations, operations, obstetricial history, immunizations, most recent examination dates, allergies, current medications
How do you document Current Health for the ill patient?
Chronilogical record of the reason for seeking care from the time the symptoms first started until now.
Your final summary of any symptom the patient has should include the OPQRSTU assessment
What does OPQRSTU stand for?
Onset + duration Precipitation / Palliation Quality Region / Radiation Severity (can also include quantity) Timing (freq + duration) Understanding (patient's own)
What questions would you ask a patient about the Onset of their symptoms?
When did this first occur?
Was this sudden, gradual or an ongoing problem?
Has it happened before?
Give specific date + time or state specificallt how long ago the symptom atarted PTA
What questions would you ask a patient about the Precipitation / Palliation of their symptoms?
Do believe something precipitated the event or ‘brought this on’? Describe.
Is there anything that makes it better or helps it to ‘go away’? (palliation)
What makes it worse?
Examples: rest, an activity, cold, heat, medications, eating, stress, etc.
What questions would you ask a patient about the Quality of their symptoms?
Describe the problem or symptom in detail e.g. Describe the pain.
Can you describe it to me?
Examples: dull, sharp, crushing, burning, constant, throbbing, shooting, etc.
Use similes – does blood in the stool look like sticky tar? Does blood in vomitus look life coffee grounds?
What questions would you ask a patient about the Region / Radiation of their symptoms?
Does this occur in a specific location on the body and does it radiate out to other areas?
Examples: Pain in the shoulder radiation to the jaw.
Is the pain localized to this site or radiating? Is the pain superficial or deep?
Example: Numbness in L arm, then 10 minutes later numbness began in the L leg.
What questions would you ask a patient about the Severity of their symptoms?
This can be a single estimate of severity or a comparison (did it get worse or better?).
Attempt to quantify the sign or symptom (ex - profuse menstrual flow, soaking 5 pads per hour)
If “0” is not pain and “10” is the worst pain you can imagine…
Ask how it affects daily activities - When you walk up a flight of stairs does your breathing feel like you have been walking for a while or like you have been running?
What questions would you ask a patient about the Timing (freq + duration) of their symptoms?
How long does the symptom last? Is it constant? Does it come and do (intermittent)? Does it resolve and reappear?
Is there a pattern you have noticed?
Examples: Does it always start at the same point in an activity? Does it always go away with 2 minutes of rest?
How long has this been going on? (duration)
What questions would you ask a patient about their understanding of their symptoms?
What do you think causes this? This is the patient’s understanding of the event – not necessarily accurate but can be helpful in diagnosis. Patient’s usually know their symptoms quite well and notice small differences/changes.
How does it affect your daily activities?
What do you think it means?
Example: Does this feel like your arthritic pain or do you think it is something else?
Is this headache different from your usual migraine?
What is the difference between Evidence Based Practice and Evidence Informed Practice?
EIP includes more than the use of the best practice techniques to treat patients - includes patient preferences and values as a form of evidence
Define the SOAPIE Acronym (for documentation)
Subjective date Objective data Assessment Plan Intervention Evaluation
Describe the Biomedical Model of Health.
Predominant model of the Canadian Healthcare System
Health = absensce of disease
Focus on the diagnosis and treament of pathogens + curing disease
Describe the Behavioural Model of Health
Healthcare extends beyond treating disease
Emphasis on changing behaviours + lifestyles (eat healthy, exercise, quit smoking)
Describe the Socioenvironmental Model of Health
Views health as a resouce for living; the abilities to realize goals + aspirations, meet personal needs, and change or cope w everyday life.
Includes sociological + environmental aspects in addition to behavioural ones
According to the Socioenvironmental Model of Health, what are the prerequisites to health?
Peace, shelter, food, education, food, income, stable ecosystem, sustained resources, equity
Define Social Determinants of Health
The social, economic, and political conditions that shape the health of individuals, families, and communities
What is Health Promotion?
A comprehensive social and political process of enabling people to increase control over the determinants of health and thereby improve their health
What are the 4 types of data collected by examiners in clinical situations?
complete
episodic / problem-centered
follow-up
emergency
Describe complete data collection
Includes a complete Hx and results of a full physical examination, describes current and past health states
Forms a baseline against which all future changes can be measured.
primary care + acute hospital care
describe episodic / problem centered data collection
used for a limited or short-term problem
“mini-database” - meaning that it is smaller in scope + more focused than the complete database
concerns mainly 1 problem, 1 cue complex, or 1 body system
used in all settings.
Describe follow-up data collection
Used in all settings to monitor short-term or chronic health problems
Status of any identified problems should be evaluated at regular and appropriate intervals
- what change has occurred? is the problem getting better or worse? what coping strategies are used ?
Describe emergency data collection
Rapid collection of data is required, often compiled while life-saving measures are occurring
diagnosis must be swift + sure
Ex - in a hospital emergency dept, a person is brought in w a suspected substance overdose
–> “what did you take?”
–> “how much did you take?”
–> “when did you take it?”
patient is questioned simultaneously while their airway, breathing, circulation, LOC, and disability are being assessed
Define client safety
delivery of responsible healthcare
freedom from accidental injury, ensuring patient safety involves the establishment of operational systems + processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur
What are Active Errors?
Active errors are made by HCP providing patient care and responding to patient needs -
mistakes at the “sharp end” (point of care)
What are Latent Errors?
Flaws in the healthcare system that do not immediately lead to accidents but establish situations in which a triggering event may lead to an error
What are Diagnostic Errors?
Result of a delay in diagnostics, failure to employ indicated tests, use of outmoded tests, or failure to act on results of monitoring or testing.
What are Treatment Errors?
Occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in avoidable delays in treatment or in responding to an abnormal test.
What are Preventative Errors?
Occur when there are failures to provide prophylactic treatment and inadequate monitoring or follow-up of treatment.
Define prophylactic treatment
intending to prevent disease
What are Communication Errors?
Lack of communication or a lack of clarity in communication.
What is an error of commission?
What is an error of omission?
Error of commission - did not provide care correctly
Error of omission - did not provide care
What are the 3 levels of error severity?
Adverse Event
Near Miss
Sentinel Event
Describe Adverse Events
events that result in unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient
Describe Near Misses
errors of commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance, prevention, or mitigation.
ex - chance: patient received a contraindicated drug but did not experience an adverse rxn
ex - prevention: potentially lethal overdose was prescribed, but a nurse identified the error before administering the medication
ex - mitigation: a lethal dose was administered but discovered early and countered w an antidote
Describe Sentinel Events
Unexpected occurrences resulting in death or serious physical or psychological injury (ex - loss of limb or function) or the risk thereof.
A sentinel event signals the need for an IMMEDIATE investigation or response
Define Pathology
study + diagnosis of disease through examination of organs, tissues, cells + bodily fluids
Define Physiology
study of the mechanical, physical, and biochemical functions of living organisms
Define Pathophysiology
study of abnormalities in the physiological functioning of living beings
Define Etiology
Study of the causes or reasons for a disease
What does it mean if a disease is idiopathic?
A disease is considered to be idiopathic when its cause is unknown
What does it mean if a disease is iatrogenic? Give an example.
A disease is considered to be iatrogenic when it is caused by the unintended/unwanted result of a medical treatment.
Ex - A patient receiving chemotherapy might get an unwanted result such as heart failure from that therapy.
What is a risk factor? Give an example.
A link btwn an etiological factor and the development of disease is increased due to the presence of another factor.
Ex - HTN and the dvlpmt of R-sided HF
Define Pathogenesis
the dvlpmnt / evolution of a disease from the initial stimulus to the ultimate expression of the manifestations of the disease
ex - cancer. small cellular changes –> wider tissue changes –> organ dysfunction
Define Clinical Manifestations
Also called symptoms
Manifestations of the disease that are observed (subjective and objective)
Define Epidemiology
The study of patterns of disease in human populations
Describe: Primary care? Secondary care? Tertiary care? Quaternary care?
Primary care - doctor’s office, nurse practitioner, experiencing initial symptoms of a disease
Secondary care - patient referred to a specialist (ex - cardiologist)
Tertiary care - hospitalization
Quaternary - linked to tertiary care, requires specialized unit (ex - ICU / surgery)
What is a drug?
A drug is any chemical that can affect living processes
What is pharmacology?
What is clinical pharmacology?
The study of drugs and their interactions w living systems.
The study of drugs in humans
Define pharmacotherapeutics
the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy
What are the 3 properties of an ideal drug?
Effectiveness - elicits the response for which it is given
Safety - cannot produce harmful effects even if administered in high doses for a long period of time
Selectivity - elicits only the response for which it is given.
What is a wholly selective drug?
There is no such thing as a wholly selective drug because all drugs cause side effects.
What are the 10 Rights of Drug Administration?
Right Drug Right Patient Right Dose Right Route Right Time + Freq Right Documentation Right History + Assessment Right to Refuse Right Drug-Drug interaction + evaluation Right Education + Information
What is the first pass effect?
Phenomenon in which a drug gets metabolized at a specific location in the body (ex - liver) that results in a reduced concentration of the active drug upon reaching its site of action or systemic circulation.
Which routes of drug admin have the first pass effect?
Oral, NG, GT
Describe the parenteral route of drug administration
Injecting a medication into body tissues
No first pass effect
What are the 4 major sites of parenteral injection?
ID (intradermal)
subcut
IM
IV
Describe the epidural route of drug administration (parenteral)
drug is administered in the epidural space by a catheter
Describe the intrathecal route of drug administration (parenteral)
drug is administered through a catheter that has been placed in the spinal column or a ventricle in the brain
Describe the intraosseous route of drug administration (parenteral)
infusion of meds directly into bone marrow
Describe the intraperitoneal route of drug administration (parenteral)
into peritoneal cavity
Describe the intrapleural route of drug administration (parenteral)
injection or chest tube used to administer medications directly into the pleural space
Describe the intra-arterial route of drug administration (parenteral)
drug administered directly into arteries
Describe the sublingual route of drug administration. Is there a first pass effect?
Enteral route
No first pass effect
drug placed under the tongue + dissolved in saliva. no swallowing.
Describe the buccal route of drug administration. Is there a first pass effect?
Enteral route
No first pass effect
drug places against mucous membranes of cheek + dissolved in saliva. no swallowing.
