💉- Ethics, Pain & Pressure Ulcer Test Flashcards
Moral outrage
Belief that others are acting immorally
Powerlessness:
- can’t prevent a “wrong”
- respond with “whistleblowing”
What is moral distress
Inability to carry out a moral decision
Perceived constraints: Physicians Administrators Other nurses Law/threat of lawsuit
List 5 factors that affect moral decisions
Developmental stage Values Ethical framework Ethical principals Professional guidelines
List 3 things that affect ethical decisions
Values , attitudes , beliefs
What is moral or ethical agency
For nurses is the ability to base their practice on professional standards of ethical conduct and to participate in ethical decision making
Values
Belief about the worth of something
Freely chosen; often learned
Attitudes
Feelings toward person, object, idea
What a person thinks
Beliefs
Something that one accepts as true
Not always bases on fact
Name the 5 principles of ethics
Nonmaleficence Beneficence Fidelity Veracity Justice
Nonmaleficence
Do no harm
Beneficence
Duty to do good
Fidelity
Loyalty
Veracity
Tell the truth
Justice
Be fair
List the 5 professional nursing values
Altruism Autonomy Human dignity Integrity Social justice
Altruism
Being concerned about well being of others
Autonomy
Right to choose what they do/informed consent
Human dignity
Having respect for people
Integrity
Nursing code of ethics
Social justice
Treating everybody fairly
What does it mean to be an advocate
You work to protect and support another persons rights
- commitment is always to patient not co worker or institution
- promoting the patients dignity
- evaluating the patients autonomy
- acting as the patients voice when they can’t
What does HIPAA stand for
The health insurance portability and accountability act
EMTALA
Emergency medical treatment and active labor act
Requires healthcare facilities to provide emergency medical treatment to patients regardless of ability to pay and citizenship status
PSDA
Patient self determination act
Recognizes the patients right to make decisions regarding his own healthcare
ADA
Americans with disabilities act
Provides protection against discrimination of individuals with disabilities
What do nurse practice acts do
Statutory laws passed by EACH STATE’s legislative body that define the practice of nursing ; scope of practice
Where can the nursing practice acts he located
On the state board of nursing website
American nurses association code of ethics
Describes the standards of professional responsibility for nurses and provides insight into ethical and acceptable behavior
Is not a law
The ANA guarantees the patient the right to
Dignity, privacy and safety
What is criminal law
Wrongs or offenses against society
Ex: felonies and misdemeanors
What is civil law
Disputes between individuals
Ex: contact law and tort law
What are tort laws
Wrongs done to one person by another person that do not involve contracts
What are Quasi-intentional torts ? And give 2 examples
Involve actions that injure a persons reputation
Ex: libel or slander
Libel
Is the written or published form of defamation of character
Slander
Is the spoken or verbal form of defamation of character
What are Intentional torts ? And list 4 examples
An action taken by one person with the intent to harm another person
Ex:assault/battery, false imprisonment, invasion of privacy and fraud
Fraud
Is the false representation of significant facts by words or by conduct
What are unintentional torts ? And give 2 examples
Negligence and malpractice
Malpractice
Failure to act as a ‘reasonable and prudent’ nurse / failure to do what a reasonable and prudent nurse would do in the same situation
Plaintiff
The person bringing the lawsuit
Defendant
The person who must defend against the lawsuit
To win and recover damages (money) in a malpractice lawsuit , the plaintiff must prove what 4 things
Duty
Breach of duty
Causation
Damages
Where would find national patient safety goals
On the joint commission website
List 5 safety risks in the healthcare facility
- falls
- equipment failure/accidents
- fire
- restraints
- never events
What are NEVER events
Can cause serious injury or death to a patient and should never happen in a hospital
List 8 examples of NEVER events
1 foreign objects 2 air embolism 3 wrong blood 4 pressure ulcers 5 infections from urinary or IV catheters 6 uncontrolled blood sugar 7 surgical site infections 8 vte (deep vein thrombosis)
What does the acronym RACE stand for
R- rescue
A- activate
C- confine
E- extinguish
What does the acronym PASS stand for
P- pull
A- aim
S- squeeze
S- sweep
What is a restraint
Anything that restricts a patients freedom to move
List 5 hazards to healthcare workers
1 biological hazards (infectious diseases/biological weapons) 2 back/neck/body injuries 3 needle stick injuries 4 radiation exposure 5 violence
What are the 3 domains of learning
Cognitive , psychomotor , affective learning
What is cognitive learning
Is storing and recalling information in the brain
Ex: asking a question over something you just said / lecture and test questions
What is psychomotor learning
Is learning a skill that requires both mental and physical activity
Ex: demonstrating how to perform an action, like an insulin injection / skill lab and check offs
What is affective learning
Is changes in feelings, beliefs, attitudes and values
Ex: how do you feel about a diagnosis? What are your fears / clinical experiences and reflective journaling
How can you determine that learning occurred
You must document your teaching and the clients verbalized response
Body mechanics
Is the way we move our bodies
What are the 4 components of body mechanics
Body alignment (posture)
Balance
Coordination
Joint mobility (bend, sit, move, etc)
What is isometric exercise
Muscle contraction without motion
What is isotonic exercise
Movement of joint with muscle contraction (free weights)
What is isokinetic exercise
Using equipment to provide resistance against movement (weight machines)
Aerobic exercise
The amount of oxygen taken in during activity meets the bodies needs (walking, jogging, bicycling)
Anaerobic exercise
Amount of oxygen taken in during activity doesn’t meet the bodies needs (lifiting, sprinting)
List 4 nursing measures to promote activity and exercise
- promote exercise
- positioning patients
- helping the client out of bed
- assisting with ambulation
What is a trochanter roll
Goes from top of the hip to knee; to prevent external hip rotation
What is orthopneic position
Sitting at a 90degree angle with tray over bed and elbows laying on top in a triangle
What is fowlers position
Is a semi sitting position, in which the head of the bed is elevated 45-60 degrees
Semi-fowlers position
Head of the bed is elevated only 30 degrees
High fowlers position
Head of the bed is elevated to 90degrees
What is lateral position
Side-lying position with the top hip and knee flexed and placed in front of the rest of the body
Prone position
That patient lies on his abdomen with his head turned to one side
Sims position
Is a semi prone position
Used to give enemas
Supine position
Patients lies on his back with head and shoulders elevated on a small pillow
What are conditioning exercises
Things that you have the patient do to make sure they can stand before ambulation
Health
Could be considered as the highest level of physical, emotional and social functioning possible for any given individual
Health
Could be considered as the highest level of physical, emotional and social functioning possible for any given individual
Illness
Could be considered anything that prevents an individual from achieving their highest possible level of health
Illness
Could be considered anything that prevents an individual from achieving their highest possible level of health
Meaningful work
Is doing something that you enjoy
That contributes to health
Meaningful work
Is doing something that you enjoy
That contributes to health
Competing demands
Is when life still goes on even though you’re sick
A factor that disrupts health
Competing demands
Is when life still goes on even though you’re sick
A factor that disrupts health
Acute
Nature of illness
Sudden onset and lasts short time
Ex: cold
Acute
Nature of illness
Sudden onset and lasts short time
Ex: cold
Chronic
Nature of Illness
6 months or greater
Ex: diabetes , AIDS
Chronic
Nature of Illness
6 months or greater
Ex: diabetes , AIDS
Remission
Symptoms are minimal to none
Remission
Symptoms are minimal to none
Exacerbation
Symptoms ‘flare-up’
Exacerbation
Symptoms ‘flare-up’
Hardiness
Ones ability to survive, will to live, adapting to change
Hardiness
Ones ability to survive, will to live, adapting to change
Burn-out
Too many demands over too long a period
Burn-out
Too many demands over too long a period
What is psychosocial health
Includes our mental health, emotions and how we interact with those around us
What is psychosocial health
Includes our mental health, emotions and how we interact with those around us
Self-concept
Who YOU think you are
Self-concept
Who YOU think you are
Development level
Is the part of self-concept where the older you get the less you’re concerned about what others think
Development level
Is the part of self-concept where the older you get the less you’re concerned about what others think
Role performance
Is a component of self concept ; things that we do (behavior and actions) to fulfill a certain role
Role performance
Is a component of self concept ; things that we do (behavior and actions) to fulfill a certain role
True or false: low levels of anxiety are necessary
True
True or false: low levels of anxiety are necessary
True
Depressed mood is typically marked by
A sense of emptiness
Depressed mood is typically marked by
A sense of emptiness
List 6 signs of depression
- depressed mood most of the day nearly everyday for at least 2 weeks/diminished interest or pleasure in activities the person previously enjoyed
- insomnia or hypersomnia
- loss of energy
- feelings of worthlessness
- diminished ability to concentrate
- recurrent thoughts of death
List 6 signs of depression
- depressed mood most of the day nearly everyday for at least 2 weeks/diminished interest or pleasure in activities the person previously enjoyed
- insomnia or hypersomnia
- loss of energy
- feelings of worthlessness
- diminished ability to concentrate
- recurrent thoughts of death
What is depersonalization
The feeling that people are doing things ‘to’ you instead of ‘with’ you
Lack of control over what’s being done to them
What is depersonalization
The feeling that people are doing things ‘to’ you instead of ‘with’ you
Lack of control over what’s being done to them
List 9 warning signs of suicide
1 withdrawal 2 desire to be left alone 3 risk-taking behavior 4 changes in routine 5 changes in eating 6 giving away belongings 7 personality changes 8 saying goodbye 9 talking about suicide
List 9 warning signs of suicide
1 withdrawal 2 desire to be left alone 3 risk-taking behavior 4 changes in routine 5 changes in eating 6 giving away belongings 7 personality changes 8 saying goodbye 9 talking about suicide
Affect
Feelings
Affect
Feelings
Anhedonia
A loss of interest or pleasure in previously enjoyable activities
Anhedonia
A loss of interest or pleasure in previously enjoyable activities
What are the 4 health and illness roles of the nurse
Promote health
Prevent illness
Restore health
Facilitate coping
What are the 4 health and illness roles of the nurse
Promote health
Prevent illness
Restore health
Facilitate coping
What is health promotion
“A desire to increase your well being”
Finding ways to help ourselves, or our patients, heal or maintain a state of physical, spiritual and mental well-being
What is health promotion
“A desire to increase your well being”
Finding ways to help ourselves, or our patients, heal or maintain a state of physical, spiritual and mental well-being
What is Primary prevention ? And give examples
Activities are designed to prevent or slow the onset of disease
Ex: diet, exercise, wearing sunscreen etc
What is Primary prevention ? And give examples
Activities are designed to prevent or slow the onset of disease
Ex: diet, exercise, wearing sunscreen etc
What is secondary prevention ? And give examples
Involves screening activities and education for detecting illnesses in the early stages
Ex: screenings (breast, testicular exams) BP and diabetes screening, tb skin test
Education
Family counseling
What is secondary prevention ? And give examples
Involves screening activities and education for detecting illnesses in the early stages
Ex: screenings (breast, testicular exams) BP and diabetes screening, tb skin test
Education
Family counseling
What is Tertiary prevention ? Give examples
Focuses on stopping the disease from processing and returning the individual to the pre-illness phase
Ex: medications: Lipitor (treats high cholesterol) , surgical/rehab/PT
What is Tertiary prevention ? Give examples
Focuses on stopping the disease from processing and returning the individual to the pre-illness phase
Ex: medications: Lipitor (treats high cholesterol) , surgical/rehab/PT
Stratum corneum
The outermost layer of skin
Stratum corneum
The outermost layer of skin
Stratum germinativum
The innermost layer is the epidermis, continually produces new cells pushing the older cells towards the skin surface
Stratum germinativum
The innermost layer is the epidermis, continually produces new cells pushing the older cells towards the skin surface
Partial thickness
Loss of epidermis
Caused by trauma
Not caused by ischemia
Partial thickness
Loss of epidermis
Caused by trauma
Not caused by ischemia
Full thickness
- total loss of epidermis and dermis
- may extend to subcutaneous, fascia, muscle, bone
Full thickness
- total loss of epidermis and dermis
- may extend to subcutaneous, fascia, muscle, bone
Clean wounds
Uninflected wounds with minimal inflammation
Don’t involve gi, gu or respiratory tract
Clean wounds
Uninflected wounds with minimal inflammation
Don’t involve gi, gu or respiratory tract
Clean-contaminated wounds
Surgical incisions involving gi, gu or respiratory tract
Clean-contaminated wounds
Surgical incisions involving gi, gu or respiratory tract
Contaminated wounds
Include open, traumatic wounds or surgical incisions in which a major break in asepsis occurred
Contaminated wounds
Include open, traumatic wounds or surgical incisions in which a major break in asepsis occurred
Infected wounds
Bacteria present and causing damage
Infected wounds
Bacteria present and causing damage
Primary intention healing
When a wound involves minimal or no tissue loss and has edges that are well approximated
Primary intention healing
When a wound involves minimal or no tissue loss and has edges that are well approximated
Secondary intention healing
Occurs when a wound involves extensive tissue loss, which prevents wound edges from approximating or should not be closed
Left open to heal
Secondary intention healing
Occurs when a wound involves extensive tissue loss, which prevents wound edges from approximating or should not be closed
Left open to heal
Tertiary intention healing
Initially healed through secondary intention
Later closed to approximate edges
Tertiary intention healing
Initially healed through secondary intention
Later closed to approximate edges
Stage I of the healing process
Inflammatory Phase (cleansing)
Last from 1 to 5 days and consists of: hemostasis and inflammation
Stage I of the healing process
Inflammatory Phase (cleansing)
Last from 1 to 5 days and consists of: hemostasis and inflammation
Stage II of the healing process
Proliferation Phase (granulation)
Occurs from days 5 to 21. Healthy cells work to replace lost tissue
Granulation tissue is formed, but is very friable
Stage II of the healing process
Proliferation Phase (granulation)
Occurs from days 5 to 21. Healthy cells work to replace lost tissue
Granulation tissue is formed, but is very friable
Friable
Easily crumbled
Friable
Easily crumbled
Stage III of the healing process
Maturation Phase (epithelialization)
Granulation tissue becomes scar tissue
Scar tissue is stronger than granulation, but never as strong as the original tissue
Stage III of the healing process
Maturation Phase (epithelialization)
Granulation tissue becomes scar tissue
Scar tissue is stronger than granulation, but never as strong as the original tissue
Serous exudate
Straw colored (yellow) clear and watery drainage from clean wounds
Serous exudate
Straw colored (yellow) clear and watery drainage from clean wounds
Sanguineous exudate
Bloody drainage , that indicates damage to capillaries
From full thickness wounds
Sanguineous exudate
Bloody drainage , that indicates damage to capillaries
From full thickness wounds
Serosanguineous exudate
Combination of serous and sanguineous
Typically from fresh wounds
Serosanguineous exudate
Combination of serous and sanguineous
Typically from fresh wounds
Purulent exudate
Thick, foul odor, pus; yellow or blue/green
WBC’s ,bacteria, debris
Purulent exudate
Thick, foul odor, pus; yellow or blue/green
WBC’s ,bacteria, debris
What could the presence of blue-green purulent exudate mean
Pseudomonas aeruginosa is present
What could the presence of blue-green purulent exudate mean
Pseudomonas aeruginosa is present
Purosanguienous exudate
Combination of sanguineous and purulent
Infected wound that is causing vascular damage
Purosanguienous exudate
Combination of sanguineous and purulent
Infected wound that is causing vascular damage
Hematoma
Red-blue collection of blood under the skin, which forms as a result of bleeding that can’t escape to the surface
Hematoma
Red-blue collection of blood under the skin, which forms as a result of bleeding that can’t escape to the surface
Dehiscence
Separation of wound layers
Dehiscence
Separation of wound layers
Evisceration
Total separation of the layers of a wound with internal viscera protruding through the incision
Evisceration
Total separation of the layers of a wound with internal viscera protruding through the incision
Fistula
An abnormal passage connecting two body cavities or a cavity and the skin
Fistula
An abnormal passage connecting two body cavities or a cavity and the skin
How long can it take a pressure ulcer to form
Can occur after only 2 hours
How long can it take a pressure ulcer to form
Can occur after only 2 hours
Friction
Damages the outer protective epidermal layer, decreasing the amount of pressure needed to develop skin lesions
Friction
Damages the outer protective epidermal layer, decreasing the amount of pressure needed to develop skin lesions
Shearing
Occurs when the epidermal layer sliders over the dermis, causing damage to the vascular bed
Shearing
Occurs when the epidermal layer sliders over the dermis, causing damage to the vascular bed
List 4 Intrinsic factors creating a risk for pressure ulcers
Internal factors that alter skin and tissue integrity or oxygen delivery capabilities
Immobility
Impaired sensation
Poor nutrition
Dehydration
List 4 Intrinsic factors creating a risk for pressure ulcers
Internal factors that alter skin and tissue integrity or oxygen delivery capabilities
Immobility
Impaired sensation
Poor nutrition
Dehydration
List 4 extrinsic factors that can create a risk for pressure ulcers
External factors that contribute to the development of pressure ulcers
Friction
Shearing
Exposure to moisture
Compression
List 4 extrinsic factors that can create a risk for pressure ulcers
External factors that contribute to the development of pressure ulcers
Friction
Shearing
Exposure to moisture
Compression
Pressure Ulcer Stage I
Intact skin, non blanchable redness
Pressure Ulcer Stage I
Intact skin, non blanchable redness
Pressure ULCER stage II
Partial thickness; affecting the epidermis or partial dermis
No slough or Eschar present
Pressure ULCER stage II
Partial thickness; affecting the epidermis or partial dermis
No slough or Eschar present
Pressure ulcer stage III
Full thickness; subcutaneous fat is visible , but no muscle tendon or bone
Slough or eschar may be present
Pressure ulcer stage III
Full thickness; subcutaneous fat is visible , but no muscle tendon or bone
Slough or eschar may be present
Pressure ulcer stage IV
Full thickness; muscle tendon and/or bone exposed
Pressure ulcer stage IV
Full thickness; muscle tendon and/or bone exposed
Suspected deep tissue injury
Intact skin that appears purple or maroon; blood filled blister
Suspected deep tissue injury
Intact skin that appears purple or maroon; blood filled blister
Unstageable
Base of wound is covered with slough or eschar
Unstageable
Base of wound is covered with slough or eschar
Venous stasis ulcers
Irregularly shaped lesions caused by venous congestion, often from damage to valves in the veins
Occurs usually between the inside ankle and the knee ; not necessarily over a bony prominence
Venous stasis ulcers
Irregularly shaped lesions caused by venous congestion, often from damage to valves in the veins
Occurs usually between the inside ankle and the knee ; not necessarily over a bony prominence
Diabetic foot ulcers
Occur when diabetes causes the narrowing of arteries, decreasing oxygenation to the feet that result in delayed healing and tissue necrosis
Diabetic foot ulcers
Occur when diabetes causes the narrowing of arteries, decreasing oxygenation to the feet that result in delayed healing and tissue necrosis
Arterial ulcers
Occur when there is a non-pressure-related blockage of arterial blood to an area causing ischemia and tissue necrosis
Usually occurs over the lower leg, ankle robbing areas of the foot
Arterial ulcers
Occur when there is a non-pressure-related blockage of arterial blood to an area causing ischemia and tissue necrosis
Usually occurs over the lower leg, ankle robbing areas of the foot
The Braden scale
Is used to identify persons at risk for developing pressure ulcers
The Braden scale
Is used to identify persons at risk for developing pressure ulcers
Periwound
Is the skin surrounding the wound
Periwound
Is the skin surrounding the wound
Maceration
Is caused by excessive moisture for periods of time
Maceration
Is caused by excessive moisture for periods of time
Epiboly
Closed or rolled wound edges
Epiboly
Closed or rolled wound edges
Debridement
Is the removal of devitalized tissue or foreign material from a wound
Debridement
Is the removal of devitalized tissue or foreign material from a wound
Senescent
Cells that are alive but not functioning
That can be removed by debridement
Senescent
Cells that are alive but not functioning
That can be removed by debridement
List 9 points to include in client teaching about wound care
1 characteristics of healthy skin
2 appearance of skin that has experienced unrelieved pressure
3 skin care and hygiene
4 protection of the skin and prevention of pressure ulcers
5 importance of adequate nutrition
6 techniques for turning and positioning
7 importance of frequent position changes
8 use of pressure-redistributing devices
9 skin changes that should be reported to healthcare professionals
List 9 points to include in client teaching about wound care
1 characteristics of healthy skin
2 appearance of skin that has experienced unrelieved pressure
3 skin care and hygiene
4 protection of the skin and prevention of pressure ulcers
5 importance of adequate nutrition
6 techniques for turning and positioning
7 importance of frequent position changes
8 use of pressure-redistributing devices
9 skin changes that should be reported to healthcare professionals
The acronym WOUND stands for what as a teaching tool for wound care
Wet --> dry it Open --> cover it Unclean --> clean it Necrotic --> don't scrub it Dry --> moisten it
The acronym WOUND stands for what as a teaching tool for wound care
Wet --> dry it Open --> cover it Unclean --> clean it Necrotic --> don't scrub it Dry --> moisten it
Sensory deprivation
Is a state of RAS depression caused by a lack of meaningful stimuli
RAS
Reticular activating system - located in the brain stem, controls consciousness and alertness
Sensory overload
Develops when either environmental or internal stimuli - or a combination of both - exceed a higher level than the patients sensory system can effectively process
List 4 nursing interventions for sensory deprivation
- focus on prevention
- support senses (glasses, hearing aids)
- orientation (calendar, view of environment)
- provide stimuli (regular contact, touch, tv, radio etc)
Nursing interventions for sensory overload
Minimize stimuli
Less light , noise Less tv, radio Calm tone Reduce noxious odors Provide rest Teach stress reduction
What is pain
Whatever the patient says it is, existing whenever the patient says it does
It’s the 6 origins of pain
The site where pain is felt; and not necessarily the source of pain
Superficial Visceral Somatic Radiating/referred Phantom Psychogenic
Superficial pain
Arises in the skin or the subcutaneous tissue
Ex: touching a hot object or getting a paper cut
Visceral pain
Caused by the stimulation of deep internal pain receptors
Most often in the stomach, brain or thorax - described as tight, pressure, or crampy pain
Deep somatic pain
Originates in the ligaments tendons, nerves, blood vessels and bones
Ex: fracture or sprain, arthritis and bone cancer can cause deep somatic pain - described as achy or tender
Radiating pain
Starts at the origin but extends to other locations
Referred pain
Occurs in an area that is distant from the original site
Ex: the pain from a heart attack may be experienced down the left arm
Phantom pain
Is pain that is perceived to originate from an area that has been surgically removed
Psychogenic pain
Refers to pain that is believed to arise from the mind
Ex: the patient perceives the pain despite the fact that no physical cause can be identified
Acute pain
- short duration rapid in onset
- varies in intensity
- lasts up to 6 months
Chronic pain
- last 6 months or longer
- interferes with daily activities
- can be related to a progressive disorder
Intractable pain
- both chronic and highly resistant to relief
- should be approached with multiple methods of pain relief
Transduction
Activation of nociceptors by stimuli
-mechanical, thermal, chemical
Nociceptive pain
Occurs when pain receptors, called nociceptors respond to stimuli that are potentially damaging
May occur as a result of trauma, surgery or inflammation - it is mostly commonly described as aching
Ex: visceral and somatic
Neuropathic pain
Chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli
Described as burning, numbness, itching and “pins and needles” prickling pain
Mechanical stimuli
External forces that result in pressure or friction against the body
Ex: surgical incisions, friction or skin shearing from sliding down in bed, etc
Thermal stimuli
Result from exposure to extreme heat or cold
Chemical stimuli
Can be internal or external
Ex: lemon juice in a cut or chest pain experienced during a heart attack
Transmission
Conduction of pain message to spinal cord
A-delta fibers
Myelinated fibers that Transmit fast pain impulses from acute, focused mechanical and thermal stimuli
C fibers
Unmyelinated fibers that transmit slow pain impulses from mechanical, thermal or chemical stimuli
Ex: bump your knee, the lingering ache in the tissue will be carried by C fibers
Substance P
Neurotransmitter which carries pain impulses across the synapses
- some pain messages enter the reticular formation of the brain stem
- others are transmitted to the thalamus where they are directed to 3 regions of the brain (somatosensory, limbic system, frontal)
Somatosensory
Physical sensations
Limbic system
Emotional reactions to stimuli
Frontal cortex
Thought and reason
List 3 nonverbal signs of pain
Elevated pulse/blood pressure
Crying, moaning
Grimacing
What 3 words are universally used to describe pain
Pain , hurt and ache
