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EXAM 1 Flashcards

1
Q

______ is the systemic collection of information about clients present health status

A

Assessment

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2
Q

Nurses can collect data during what kind of assessments?

A
  • Initial assessment (baseline)
  • Focused assessment
  • Ongoing assessment
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3
Q

What are some methods of data collection?

A
  • Client interviews
  • Medical history
  • Comprehensive/focused physical examination
  • Diagnostic
  • Lab reports
  • Collaboration
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4
Q

When should data be collected for an assessment?

A

Prior to interventions

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5
Q

During the ______ phase of the nursing process, we identify the patients problems which provide direction for nursing care

A

Diagnose

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6
Q

During this phase of the nursing process, we establish priorities, set goals/desired outcomes and plan our nursing interventions

A

Planning

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7
Q

When does discharge planning begin?

A

During admission

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8
Q

During this phase in the nursing process, we perform the nursing actions identified during the planning phase, delegate tasks, supervise and document care

A

Implementation

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9
Q

During this phase, we determine if our goals and expected outcomes were achieved

A

Evaluation

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10
Q

Before assessing a patient, what is the first thing you must do?

A

Build rapport

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11
Q

What are the different types of assessment?

A
  • Initial
  • Focused
  • Emergency
  • Time lapsed
  • Patient centered assessment method
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12
Q

When does your initial assessment begin?

A

Upon first glance of the client

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13
Q

What is a focused assessment?

A

Assessing specific body systems

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14
Q

What is an emergency assessment?

A

Assessing the ABCs during an emergency procedure

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15
Q

What is a time-lapsed assessment?

A

An assessment scheduled to compare a patient’s current status to baseline data obtained earlier

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16
Q

What is the patient centered assessment method?

A

A tool nurses can use to assess how patients engage and respond in managing their health while others with similar health conditions do not experience the same outcomes

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17
Q

During _____ we determine the risk factors that must be managed and identify resources, strengths and area for health promotion

A

Diagnosis

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18
Q

_____ is never a priority, nurses must focus on actual conditions

A

Risks

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19
Q

A ________ diagnosis identifies conditions, focuses on illness, injury or disease processes and remains constant until a cure is obtained

A

Medical

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20
Q

A ________ diagnosis identifies situations, focuses on patient responses to health issues and changes with the patients response or health/life problems

A

Nursing

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21
Q

What are the 3 types of a nursing diagnosis?

A
  • Problem-focused
  • Risk
  • Health promotion
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22
Q

Care plans include what 3 parts in a nursing diagnosis?

A
  • Problem
  • Etiology
  • Defining characteristics
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23
Q

A broken femur is an example of what type of diagnosis?

A

Medical diagnosis

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24
Q

A lack of mobility is an example of what type of diagnosis?

A

Nursing

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25
Q

An alteration in urination is an example of what type of diagnosis?

A

Nursing

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26
Q

Chronic kidney failure is an example of what type of diagnosis?

A

Medical

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27
Q

What does an “at risk” patient mean?

A

They do not have it yet but have the potential to develop it

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28
Q

The etiology in a nurses plan of care is the ______ behind why something is occursing

A

Patho

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29
Q

A proper nursing diagnosis statement would look like:

A

Problem r/t Etiology as evidenced by Defining characteristics

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30
Q

Bathing self care deficit R/T fear of falling in the tub and obesity AEB strong body and urine odor, unclean hair: “I’m afraid ill fall in the tub and break something” (5 ft 4 in, 170 Ibs) is an example of a:

A

Nursing diagnosis statement

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31
Q

The defining characteristics in a nursing statement include _______ and ________ data

A

Objective and subjective

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32
Q

What NANDA component suggest the appropriate nursing measures?

A

Etiology

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33
Q

What NANDA component suggest the patient outcomes?

A

Problem

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34
Q

What NANDA component suggest evaluative criteria?

A

Defining characteristics

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35
Q

The physiological needs of the maslow hierarchy include:

A

Breathing, food, water, sex, sleep, homeostasis and excretion

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36
Q

SMART goals stands for:

A
  • Specific
  • Measurable
  • Achievable
  • Relevant
  • Time-bound
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37
Q

Nursing action can be:

A
  • Physician initiated
  • Nurse initiated
  • Collaborative
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38
Q

Who is legally responsible during physician initiated actions?

A

Doctors and nurses

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39
Q

A prescription of medication is a _________ action:

A

Physician initiated

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40
Q

The implementation of a catheter or oxygen is a _________ action

A

Nurse initiated

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41
Q

All nursing interventions must be appropriate to:

A

NANDA and SMART goals

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42
Q

________ is the process of transferring the performance of a task while retaining accountability for the outcome

A

Delegation

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43
Q

_________ is the process of directing, monitoring and evaluating the performance of tasks by other team members

A

Supervision

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44
Q

Who can RNs delegate tasks to?

A
  • Other RNs
  • PNs
  • CNAs/PCTs
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45
Q

What are the 5 rights of delegation?

A
  • Right task
  • Right circumstance
  • Right person
  • Right direction and communication
  • Right supervision and evaluation
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46
Q

Delegate an AP to assist Mr. Martin in room 312 with morning hygiene is an example of the:

A

Right direction and communication

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47
Q

Delegating an AP to assist with ambulating a client prior to the RN performing an admission assessment is an example of the:

A

Wrong supervision

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48
Q

What can RNs NOT delegate?

A
  • The nursing process
  • Client education
  • Tasks requiring nursing judgement
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49
Q

What can APs do?

A
  • ADLs
  • Make beds
  • Specimen collection
  • I/O
  • Vital signs
  • Reapply condom catheter
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50
Q

_______ care should always be prioritized over _______ care

A

Acute; chronic

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51
Q

Actual losses are:

A

Tangible

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52
Q

What will help you better serve your patients when they are dealing with grief and death?

A

Understanding of your own feelings about grief and death

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53
Q

________ is the inner emotional response to loss and exhibited through thoughts, feelings and behaviors

A

Grief

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54
Q

________ includes both grief and mourning and is the outward display of loss

A

Bereavement

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55
Q

This type of care attempts to meet the clients physical, spiritual and psychosocial needs

A

Palliative or end of life care

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56
Q

This is a loss related to change that is part of the cycle of life and is anticipated but still intensely felt. It can be replaced by something different or better.

A

Necessary loss

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57
Q

This is the loss of a valued person, item, or status that others can recognize

A

Actual loss

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58
Q

This loss is anything the client defines as loss but is not obvious or verifiable to others

A

Perceived loss

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59
Q

This loss is normally expected due to the developmental processes of life and are associated with normal life transitions which aid in coping skills

A

Maturational or developmental loss

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60
Q

This loss is unanticipated and caused by an external event

A

Situational loss

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61
Q

This loss is experienced before the loss happens

A

Anticipatory loss

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62
Q

A child leaving home for college is an example of what kind of loss?

A

Maturational or developmental loss

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63
Q

A family loosing their home during a tornado is an example of what kind of loss?

A

Situational loss

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64
Q

A baby that died before birth or was born with an abnormality can be considered as what kind of loss?

A

Perceived loss

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65
Q

Perceived losses are:

A

Intangible

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66
Q

What factors increase a persons risks for dysfunctional grieving?

A
  • Being dependent on the deceased
  • Unexpected death at a young age through violence or socially unacceptable manner
  • Inadequate coping skills
  • Lack of hope or social support
  • Preexisting mental health issues
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67
Q

This grief is uncomplicated, can be negative or positive, acceptance should be evident by 6 months after the loss and may result in chest pain, palpitations, headache, nausea, changes in sleep pattern and fatigue

A

Normal grief

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68
Q

This grief is chronic, exaggerated, masked and delayed which could result in depression or disorders and the person can become suicidal, have intense feelings of guilt or low self-esteem

A

Complicated grief

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69
Q

This grief implies letting go before the actual loss occurs and the person has the opportunity to start grieving before the actual loss

A

Anticipatory grief

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70
Q

This grief entails an experienced loss that cannot be publicly shared or is not socially acceptable

A

Disenfranchised grief

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71
Q

If a person says that a loss “should not have happened” what kind of grief are they experiencing?

A

Complicated grief

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72
Q

What is the Kubler Ross stages of Dying?

A

DABDA

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
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73
Q

T/F Clients might not experience DABDA in order and the length of each stage varies from person to person

A

True

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74
Q

This portion of Bowlbys attachment theory is when a person minimizes the impact of a loss and is protected from the full impact of loss

A

Numbing

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75
Q

This portion of Bowlbys attachment theory is when a person experiences outburst of tears, chest tightness, lethargy, insomnia, sobbing and acute distress

A

Yearning and seeking

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76
Q

This portion of Bowlbys attachment theory is when a person examines loss and expresses anger

A

Disorganization and despair

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77
Q

This portion of Bowlbys attachment theory is when a person accepts loss/change, new role or skills

A

Reorganization

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78
Q

What are the tasks in the Wordens grief tasks model?

A
  • Task I: accept the reality of the loss
  • Task II: experience the pain of grief
  • Task III: adjust to a world in which the deceased is missing
  • Task IV: emotionally relocate the deceased and move on with life
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79
Q

Grief as a series of processes instead of stages or tasks is which theory?

A

Rando’s R process model

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80
Q

What are the 6 R’s in the randos R process model?

A
  • Recognize the loss
  • React to the pain
  • Reminisce
  • Relinquish old attachments
  • Readjust to life after loss
  • Reminiscence again
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81
Q

What model moves back and forth between loss-oriented and restoration-oriented activities

A

Dual process model

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82
Q

What factors influence loss and grief?

A
  • Human development
  • Personal relationships
  • Nature of loss
  • Coping strategies
  • Socioeconomic status
  • Culture and ethnicity
  • Spiritual and religious beliefs
  • Hope
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83
Q

What do care plans for dying patients focus on?

A
  • Comfort
  • Dignity
  • Emotional, social and spiritual support for family members
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84
Q

Federal and state law apply to which events after death?

A
  • Documentation
  • Organ and tissue donation
  • Autopsy
  • Postmortem care
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85
Q

_______ is the way people feel and view themselves

A

Self-concept

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86
Q

Is self concept subjective or objective?

A

Subjective

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87
Q

What stressors can affect self-concept?

A
  • Unrealistic expectations
  • Surgery
  • Chronic illness
  • Changes in role
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88
Q

What stressors affect body image?

A
  • Amputation
  • Mastectomy
  • Hysterectomy
  • Loss of body function
  • Unattainable body ideal
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89
Q

_______ is an inner sense of individuality that implies the persons uniqueness as compared with others

A

Identity

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90
Q

T/F Self-esteem is the same thing as self concept

A

False

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91
Q

When is the sense of self often negatively affected?

A

In older adulthood

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92
Q

How long is the development of self-concept?

A

Lifelong

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93
Q

This component of self-concept involves the internal sense of individuality, wholeness, and consistency of self

A

Identity

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94
Q

This component of self-concept involves attitudes related to physical appearance, structure or function

A

Body image

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95
Q

This component of self-concept is how people carry out their significant roles

A

Role performance

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96
Q

The adolescent self-concept includes:

A
  • Identity confusion
  • Disturbed body image
  • Self-esteem
  • Role conflict
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97
Q

Nursing interventions aimed at enhancing _______ and ______ in older adults are essential

A

Self-concept and self-esteem

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98
Q

What should a nurse always ask patients in order for them to gain a stronger sense of self?

A

What they think is important

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99
Q

When setting priorities, nurses should focus on:

A

Adaptations to stressors

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100
Q

What are some expected outcomes for a patient with a self-concept disturbance?

A
  • Nonverbal behaviors showing positive self-concept
  • Statements of self-acceptance
  • Acceptance of change
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101
Q

Self-concept stems from:

A

Development

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102
Q

Self concept includes:

A
  • Identity
  • Body image
  • Role performance
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103
Q

Role ______ is vaguely defined responsibility that creates confusion

A

Ambiguity

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104
Q

Role _____ is when a person takes on multiple roles with limited resources and cannot manage them all

A

Overload

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105
Q

Role ______ develops when a person assumes opposing roles with incompatible expectations; they require opposing actions

A

Conflict

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106
Q

Role ______ results in frustration and anxiety when a person feels inadequate for assuming the role

A

Strain

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107
Q

Caring for a parent with dementia can result in:

A

Role strain

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108
Q

Assuming the role of a student, employee and parent can result in:

A

Role overload

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109
Q

What are some factors that can cause stress?

A
  • Sociocultural
  • Substance abuse
  • Lack of education
  • Poverty
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110
Q

Stress is:

A

Developmental

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111
Q

_______ is the behavioral and cognitive efforts of a person to manage stress

A

Coping

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112
Q

What factors can influence a persons ability to cope?

A
  • Number of stressors
  • Duration of stress
  • Intensity of stressors
  • Past experiences
  • Support system
  • Resources
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113
Q

This mechanism assists a person during a stressful situation or crisis by regulating emotional distress

A

Ego defense mechanism

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114
Q

Symptoms of role strain include:

A
  • Fatigue
  • Difficulty sleeping
  • Illness
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115
Q

______ is evaluating an event for its personal meaning

A

Primary appraisal

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116
Q

_______ focuses on possible coping strategies

A

Secondary appraisal

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117
Q

_______ is someones effort to manage psychological stress

A

Coping

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118
Q

Level of personal control, presence of social support system and feelings of competence are examples of:

A

Personal characteristics that influence response to a stressor

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119
Q

What are the three different types of stress?

A
  • Chronic
  • Acute
  • PTSD
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120
Q

This stress occurs in stable conditions and results from stressful roles

A

Chronic stress

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121
Q

This stress is time-limited and threatens a person for a relatively brief period

A

Acute stress

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122
Q

What are the different types of crises?

A
  • Developmental
  • Situational
  • Adventitious
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123
Q

This crisis occurs as a person moves through the stages of life

A

Developmental

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124
Q

This crisis comes from external sources such as a job change, car crash, death, illness, etc

A

Situational

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125
Q

This type of crisis results from a major natural or man-made disaster or a crime of violence effecting the public

A

Adventitious

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126
Q

This model is for prevention and is based on the concepts of stress and reaction to stress

A

Neuman systems model

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127
Q

The _______ phase of the neuman system model states prevention promotes patient wellness by stress prevention and reduction of risk factors

A

Primary

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128
Q

The _______ phase of the neuman system model states prevention occurs after symptoms appear

A

Secondary

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129
Q

The _______ phase of the neuman system model states prevention begins when the patients system becomes more stable and recovers

A

Tertiary

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130
Q

Having a patient screened for disease would be an example of:

A

Secondary prevention

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131
Q

When do situations become a crisis?

A

When stress overwhelms a persons usual coping mechanism and demands mobilization of all available resources

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132
Q

Grimacing, moaning, flinching and guarding are behavioral responses to what kind of pain?

A

Acute

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133
Q

Depression, fatigue and a decreased level of functioning is behavioral responses to what kind of pain?

A

Chronic

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134
Q

How can you relieve chronic pain?

A

Administering opioids and analgesics around the clock rather than PRN

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135
Q

This pain arises from a noxious stimuli that triggers nociceptors and causes pain

A

Nociceptive pain

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136
Q

This pain is throbbing, aching and localized, responding well to opioids and non-opioids

A

Nociceptive pain

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137
Q

What are the different types of Nociceptive pain?

A
  • Somatic
  • Visceral
  • Cutaneous
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138
Q

This pain is in the bones, joints, muscles, skin or connective tissue

A

Somatic

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139
Q

This pain is in internal organs and can cause referred pain in other body locations

A

Visceral

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140
Q

This pain is in the skin or subcutaneous tissue

A

Cutaneous

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141
Q

This pain includes phantom limb pain, pain below the spinal cord, and is common in diabetics

A

Neuropathic pain

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142
Q

How does neuropathic pain feel?

A

Intense, shooting, burning, pins and needles

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143
Q

What medicines respond best to neuropathic pain?

A
  • Antidepressants
  • Antispasmodic agents
  • Muscle relaxants
  • Topical medications
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144
Q

What are the 4 phases of nociceptive pain?

A
  • Transduction
  • Transmission
  • Perception
  • Modulation
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145
Q

In this phase, conversion of painful stimuli to an electrical impulse are transferred via peripheral nerve fibers

A

Transduction

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146
Q

In this phase, electrical impulses travel along the nerve fibers where neurotransmitters regulate it

A

Transmission

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147
Q

The point at which a person feels pain is there:

A

Pain threshold

148
Q

The amount of pain a person can bear is their:

A

Pain tolerance

149
Q

At this phase, the brain is influenced by thoughts and emotional processes that register the pain

A

Perception

150
Q

During this phase, muscles contract reflexively, moving the body away from a stimuli

A

Modulation

151
Q

What substances increase pain tolerance and causes an inflammatory response?

A
  • Substance P
  • Prostaglandins
  • Bradykinin’s
  • Histamine
152
Q

What substances decrease pain transmission and produce no pain?

A
  • Serotonin

- Endorphins

153
Q

What effect does physical pain have on the body?

A

Increases BP, pulse, RR, etc.

154
Q

What effect does emotional pain have on the body?

A

Fatigue and anxiety

155
Q

What effect does cognitive pain have on the body?

A

Nonverbal cues

156
Q

Pain is always:

A

Subjective and individualized

157
Q

In the gate control theory of pain, pain impulses are blocked and an open gate means:

A

Pain is going to the brain

158
Q

In the gate control theory of pain, pain impulses are blocked and a closed gate means:

A

No pain or pain is regulated and not going to the brain

159
Q

How long does acute pain last?

A

Less than 3 months

160
Q

This pain lacks identity of origin, can be persistent and non-cancer related, has psychological and physiological side effects

A

Chronic pain

161
Q

This pain can be acute or chronic and adjunct therapies are used to manage the pain

A

Cancer pain

162
Q

In a heart attack, pain can be felt in the left arm. This is an example of:

A

Referred pain

163
Q

This pain is treatable, protective and a warning of damage. Once healed, the pain leaves

164
Q

This pain serves no purpose, is treatable but long term there is no cure; treatment is from trial and error

165
Q

What allows us to understand the progression of cancer pain?

A

WHO cancer ladder

166
Q

T/F We always want to start with opioids in the treatment of cancer pain

167
Q

What factors influence pain?

A
  • Attitudes/beliefs
  • Age and gender
  • Fatigue
  • Genes
  • Spiritual
  • Anxiety
  • Behavioral and coping
  • Culture
  • Religion
168
Q

What is the ABCDE method of pain assessment and management?

A 
A: Ask about pain level 
B: Believe the rating 
C: Choose appropriate therapies
D: Deliver 7 rights and 3 checks
E: Empower the patient
169
Q

What is a major side effect of pain?

170
Q

We always want to be ______ not _______ to pain

A

Proactive; reactive

171
Q

What are some non-verbal pain cues?

A
  • Vocalizations
  • Facial expressions
  • Body movements
  • Social interactions
  • Rhythmic/rubbing motions
172
Q

What are some barriers to pain management?

A
  • Physical dependence
  • Addiction
  • Drug tolerance
  • Cultural
  • Medication side effects and risks
  • Non-compliance
  • Bravery/stoic
  • Financial limitations
173
Q

What does it mean to have drug tolerance?

A

Reduced reaction to a drug following its repeated use

174
Q

Why is medication side effects and risks important in the clinical setting?

A

Because the patient needs to be educated on what to expect when taking the drug so they know what to expect and what they need to report

175
Q

What would be some reasons for non-compliance with patients?

A
  • Forgetful
  • Don’t like side effects
  • Too expensive
176
Q

Planning of care should be patient centered, meaning:

A

We are basing our plan off of the patients wants and needs

177
Q

Before and after the administration of medication, nurses should:

A

Assess prior to ambulating

178
Q

Nurses should always assess patients for what when analgesic administration?

A
  • Allergies
  • Medication response
  • Side effects
179
Q

Nurses should always have knowledge of patients what before analgesic administration?

A
  • Current and past medical history
  • Medication and selection
  • Medication accuracy and dosage
180
Q

What are the 3 types of analgesics?

A
  • Non-opioids
  • Opioids
  • Adjuvants
181
Q

What does SBAR stand for?

A
  • Situation
  • Background
  • Assessment
  • Recommendation
182
Q

What is the purpose of epidural anesthesia?

A

To treat severe pain

183
Q

Can epidural anesthesia be administered by a RN

184
Q

Can someone who has received epidural anesthesia have mobility?

A

No, they cant feel anything below the administration site

185
Q

T/F Patient who have been administered a epidural anesthesia will have a catheter

186
Q

T/F The ANA supports aggressive treatment of pain and suffering even if it hastens a patients death

187
Q

Who are pain centers good for?

A

People with chronic pain

188
Q

What does palliative care promote?

A

Comfort and autonomy

189
Q

What will happen to vital signs after prolonged acute pain?

A

They will stabilize despite the persistence of the pain

190
Q

Are vital signs good indicators for the measurement of pain

191
Q

Who is at an increased risk for under-treatment of pain and adverse events following analgesia administration

A

Older adults

192
Q

What medication route is the best for immediate short term relief of acute pain?

A

Parental route

193
Q

What route is the best for chronic, non-fluctuating pain?

A

Oral route

194
Q

What is appropriate for treating mild to moderate pain?

A

Non-opioid analgesics

195
Q

What is appropriate for treating moderate to severe pain?

196
Q

What is the typical order of adverse effects of opiods?

A
  • Sedation
  • Respiratory depression
  • Orthostatic hypotension
  • Urinary retention
  • Nausea/vomiting
  • Constipation
197
Q

What enhances the effects of non-opioids and are useful in treating neuropathic pain?

A

Adjuvant analgesics

198
Q

Clients self-administer safe doses of opioids in small frequent dosing, which ultimately decreases the amount of medication they need. What device is this?

199
Q

A PCA pump holds what type of opioids?

A
  • Morphine
  • Hydromorphone
  • Fentanyl
200
Q

T/F The client is the only person who can push the PCA pump?

201
Q

Additional pharmacological pain interventions include:

A

Local and regional anesthesia and topical analgesia

202
Q

When should you administer naloxone?

A

When RR is below 8 and shallow or the client is difficult to arouse

203
Q

During this phase of surgery, the patient and surgeon meet and agree on surgery, informed consent is signed and education is provided

204
Q

During this phase the actual surgery is performed and the phase ends when the patient goes to the PACU

205
Q

During this phase, the patient is discharged from the OR and it starts when they enter the PACU

206
Q

This type of surgery is considered as outpatient, requiring no hospital stay and option availability depends on severity of patient health history:

A

Ambulatory

207
Q

What are some pros of ambulatory surgery?

A
  • Huge cost savings

- Decreased risk of HAI

208
Q

What are some cons of ambulatory surgery?

A
  • Home recovery
  • Risk for non-compliance
  • Risk for infection
  • Risk for re-admittance
209
Q

This type of surgery requires a hospital stay and major surgeries such as trauma, cardiac, brain, emergency

210
Q

Inpatient surgery increases the risk for:

A
  • HAIs

- Hefty medical bill

211
Q

Surgeries based on urgency are:

A
  • Elective
  • Urgent
  • Emergent
212
Q

______ surgery is based on patients choice and it being delayed will not cause harm to the patient

213
Q

_____ surgery is not life threatening but you want to do it ASAP to preserve health

214
Q

_______ surgery needs to be done immediately to preserve life, limb or function

215
Q

This surgery can be elective, urgent or emergency

216
Q

This surgery is usually elective

217
Q

What is the purpose of a diagnostic or explorative surgery?

A

To make or confirm a diagnosis

218
Q

What is the purpose of a ablative surgery?

A

To remove diseased body part

219
Q

What is the purpose of a palliative surgery?

A

Not a cure but reduces the intensity of illness

220
Q

What is the purpose of a reconstructive surgery?

A

To restore function

221
Q

What is the purpose of a organ procurement surgery?

A

To donate organs

222
Q

What is the purpose of a transplant?

A

To transfer deceased or living persons organs to another person

223
Q

What are the different classification of a patient before surgery?

A

P1: Healthy patient
P2: Mild systemic disease
P3: Non-controlled severe systemic disease
P4: Life threatening severe systemic disease
P5: Patient is terminal w/o surgery
P6: Brain dead patient - organ donation

224
Q

For an assessment during an elective surgery, the nurse should cover:

A
  • Allergies
  • Lab values
  • Patient knowledge
  • Medication history
225
Q

What happens if blood glucose is too high in a patient due for surgery?

A

Surgery is cancelled because patient will not heal

226
Q

Why is coagulation lab values important before surgery?

A

Because we do not want abnormal bleeding

227
Q

If a urinalysis shows a patient due for surgery has a UTI, what will happen?

A

Surgery will be cancelled

228
Q

An assessment during an urgent/emergent surgery should be:

A

A focused assessment only because we want to rescue the patient from injuries that deprive them of their life

229
Q

Patient with a latex allergy will always be:

A

The first surgery of the day

230
Q

NPO status means:

A

Nothing by mouth, not even water because of aspiration risks

231
Q

Garlic, Vitamin E and Girko can cause:

232
Q

Vitamin K can cause:

233
Q

What should the nurse assess after surgery?

A
  • Maintain respiratory function
  • Prevent circulatory complications
  • Achieve rest and comfort
  • Temperate regulation
  • Maintain neurological function
  • Maintain fluid and electrolyte balance
  • Promote normal bowel elimination and nutrition
  • Promote urinary elimination and wound healing
  • Maintain/enhance self-concept
234
Q

Respiratory function includes:

A
  • Patency
  • Rate, rhythm and symmetry
  • Breath sounds
  • Color of mucous membranes
  • POX
235
Q

Circulatory complications include:

A
  • HR, rhythm
  • BP
  • Capillary refill
  • Nail beds
  • Peripheral pulses
  • Vitals
236
Q

Temperature regulation monitors for:

A
  • Malignant hyperthermia
  • Hypothermia
  • Shivering
237
Q

Neurological function includes:

A
  • LOC

- Gag and pupil reflexes

238
Q

Fluid and electrolyte influence includes:

A
  • IV
  • I/O
  • Blood loss
239
Q

How soon does urinary function return after surgery? What is the expected amount to void?

A

6-8 hours later; 30mL

240
Q

The nursing diagnosis may alter after:

A

Each phase of the preoperative care

241
Q

What does the planning phase of the nursing process require?

A

Acquired assessment data

242
Q

What is the aldrete score?

A

A screening tool used in the PACU that determines the stability of a patient before transfer or discharge

243
Q

When do you assess a patient using the aldrete score?

A

At 5, 15, 30, 45 and 60 minutes

244
Q

What criteria is evaluated using the aldrete score (max. 2 points/ea.)?

A
  • Activity
  • Respiratory
  • Circulation
  • Consciousness
  • Oxygen saturation
245
Q

How many points are required for a passing aldrete score?

A

8 points to get discharged from PACU because anything lower increases risks for infection

246
Q

What are the pressure ulcer stages?

A

Stage I: Intact skin-non blanchable redness
Stage II: Partial thickness and skin loss (epi, dermis or both)
Stage III: Full thickness and skin loss with visible fat and tunneling may be present
Stage IV: Full thickness and skin loss with exposed bone, tendon and muscle
Unstageable: Full thickness with skin loss, slough and eschar

247
Q

T/F Anesthesia requires consent

248
Q

What is Anesthesia dependent on?

A
  • Surgery type
  • Length of surgery
  • Positioning during surgery
  • Patient comorbidities
249
Q

What are the 3 phases of Anesthesia?

A
  • Induction (chemical agents)
  • Maintenance (begins with positioning and throughout case)
  • Emergence (awaken from agents)
250
Q

This anesthesia causes loss of consciousness, relaxes skeletal muscles, results in full immobility with no reflexes and airway management is required

A

General anesthesia

251
Q

This anesthesia does not put the patient totally under and they can respond to verbal commands and should be easy to wake. It is short term for minimally invasive procedures; the patient can keep their airway open

A

Conscious sedation

252
Q

This anesthesia blocks transmission of sensory stimuli to CNS receptors and reflexes may also be lost but no loss of consciousness

A

Regional anesthesia

253
Q

This anesthesia requires the numbing of an area for minor procedures

A

Local anesthesia

254
Q

What happens when a time out is called?

A

It is a patient safety step to check that all materials are available, everyone on the team is on the same page and is one of the last steps before an incision is made

255
Q

What happens when a bug out is called?

A

We are making sure that all safety mechanisms occurred and all ordered antibiotics have been given to the patient before incision is made

256
Q

Someone with this life threatening genetic condition cannot process anesthesia and has symptoms such as muscle rigidity and hyperthermia

A

Malignant Hyperthermia

257
Q

What is the treatment for Malignant Hyperthermia?

A
  • 2.5 mg/kg of Dantrolene initially with 50 ml of sterile H2O
  • Cool patient with ice
  • Administer diuretics
  • Correct acid base and electrolyte imbalances
258
Q

Atelectasis is:

A

Partial or complete collapse of the lung as a result of airways obstruction caused by accumulation of secretions; may occur 1-2 days post-op

259
Q

Pneumonia is:

A

An infection that inflames the air sacs in one or both lungs; may occur 3-5 days post-op

260
Q

Pulmonary embolism:

A

Occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung

261
Q

Pulmonary edema is caused by:

A

Excess fluid in the lungs

262
Q

Laryngospasm is:

A

A spasm of the vocal cords that temporarily makes it difficult to speak or breathe

263
Q

Laryngeal edema is:

A

A frequent complication of intubation and is caused by trauma to the larynx

264
Q

Thrombus is:

A

A blood clot formed in situ within the vascular system of the body and impeding blood flow

265
Q

An emboli is:

A

A blood clot, air bubble, piece of fatty deposit, or other object which has been carried in the bloodstream to lodge in a vessel and cause an embolism.

266
Q

Paralytic ileus is the condition where:

A

The motor activity of the bowel is impaired

267
Q

Hemorrhage is:

A

Loss of a large amount of blood externally or internally in a short time period

268
Q

Hypovolemic shock is an emergency condition in which:

A

Severe blood or other fluid loss makes the heart unable to pump enough blood to the body

269
Q

______ is an example of uncontrolled prescription medications

A

Antibiotics

270
Q

These orders are on a regular schedule w/o a termination date:

A

Routine or standing order

271
Q

This order is once at a specific time or ASAP

A

Single or one time oder

272
Q

This prescription is only for administration once and immediately (ex: IV bolus)

A

Stat order

273
Q

This prescription is only for administration once but up to 30 minutes from when the nurse received the order

274
Q

This prescription specifies at what dosage, frequency, and conditions a nurse can administer the medication

275
Q

What information should you collect during an OTP order?

A

Clients name, medication, dosage, time to give, frequency, route

276
Q

What do you do after collecting an OTP order?

A

Verify the provider will sign order and enter prescription in clients medical record

277
Q

When should you give non-time critical medications prescribed once daily, weekly or monthly?

A

Within 2 hours of the prescribed time

278
Q

When should you give non time critical medication prescribed more than once daily?

A

Within 1 hour of the prescribed time

279
Q

When do you document administration of medication?

A

After giving it

280
Q

Where is medicine metabolized?

A

In the liver

281
Q

Medications are metabolized into a:

A

Less potent or an inactive form

282
Q

When does biotransformation occur?

A

Under the influence of enzymes that detoxify, break down and remove active chemicals. Most occur in the liver

283
Q

Where do medications exit the body?

A
  • Kidneys
  • Liver
  • Bowel
  • Lungs
  • Exocrine glands
284
Q

What determines the organ of excretion for medication?

A

The chemical make up of the medicine

285
Q

______ are predictable, unavoidable secondary effects

A

Side effects

286
Q

_____ is the accumulation of medication in the bloodstream

A

Toxic effects

287
Q

______ is an overreaction or under-reaction or different reaction from normal

A

Idiosyncratic reaction

288
Q

______ occurs when one medication modifies the action of another

A

Medication interaction

289
Q

During this phase, medication has no effect at all

290
Q

During this phase, medication concentration is highest

291
Q

What are the 7 patient rights nurses must check before giving meds?

A
  • Right patient
  • Right medication
  • Right dose
  • Right route
  • Right time
  • Right documentation
  • Right indication
292
Q

What are the 3 checks for medication?

A
  • Pyxis
  • MAR
  • Bedside
293
Q

A patient has the right to:

A
  • Refuse meds
  • Have medication history
  • Not receive unnecessary meds
294
Q

Who can prescribe medicine?

A
  • Physician
  • NP
  • PA
295
Q

What are the components of an accurate medication order?

A
  • Name
  • Date/time
  • Dose
  • Route
  • Frequency/time
  • Provider signature
  • Pain scale is applicable
296
Q

What are the different medication routes?

A
  • Oral
  • Topical
  • Inhalation
  • Irrigation
  • Parenteral
  • Injection
297
Q

Sublingual medication is placed where?

A

Under the tongue

298
Q

Buccal medication is placed where?

A

Between the cheek and gum

299
Q

How long does it take to absorb oral medication?

300
Q

These meds are easy, fast but take longer to work and are effected by food. They also increase risk for other drug interactions

A

Oral medications

301
Q

This type of medication is placed on the skin, eyes and ears

302
Q

This type of medication can be given via IV, is fast working, hard to reverse and can be painful

A

Parenteral

303
Q

Higher the number, smaller the _____

304
Q

What precautions should we take when giving topical medications?

A
  • Wear gloves
  • Place on smooth skin surface with no hair
  • Use sterile technique for open womb
305
Q

How do you instill eye medications?

A
  • Avoid the cornea and eyelids

- Instill into lower conjunctival sac

306
Q

How do you instill ear medication?

A
  • At room temperature with sterile solutions

- Pull pinna up and back and check ear for rupture or drainage

307
Q

What is the most important thing to do when administering medications by inhalation?

A
  • Use a spacer to make sure full effect on medication is feasible
308
Q

Why do we pump air into a vile?

A

To create pressure which helps the medication draw back

309
Q

For an ampule, what type of needle is used?

A

Red filter needle that must be used to drawback meds and then discarded

310
Q

What type of meds is the Z-track method used for?

311
Q

Intradermal injections are used for:

A
  • TB skin test

- Allergy skin test

312
Q

Angle insertion for intradermal injections are?

A

5 - 15 degrees with bevel up

313
Q

This is unrelieved pressure over bony prominences that results in ischemia and damage to tissue

A

Pressure injury

314
Q

When assessing the skin, you want to consider:

A
  • Health history
  • Color
  • Texture/turgor
  • Moisture
  • Temperature
  • Lesions
  • Braden scale
315
Q

What are the risk factors on the Braden scale?

A
  • Sensory perception
  • Moisture
  • Activity
  • Mobility
  • Nutrition
  • Friction and shear
316
Q

On a Braden scale, the lower the score:

A

The higher the risk

317
Q

A severe risk for sore on a Braden scale would be a score of:

A

Less than or equal to 9

318
Q

A high risk for sore on a Braden scale would be a score of:

A

Total score 10-12

319
Q

A moderate risk for sore on a Braden scale would be a score of:

A

Total score of 13-14

320
Q

A mild risk for sore on a Braden scale would be a score of:

A

Total score of 15-18

321
Q

What is debridement?

A

Removal of nonviable, necrotic tissue

322
Q

Mechanical debridement is:

A

wet to dry dressing changes (large syringe with needle on the end)

323
Q

Autolytic debridement is:

A

A synthetic dressing

324
Q

Chemical debridement is:

A

Dressing or topical enzyme that breaks down tissue exudate and absorbs bacteria

325
Q

Surgical debridement is:

A

Removal of eschar

326
Q

What is the purpose of a wound dressing?

A
  • Protect womb from microorganisms
  • Aid in homeostasis
  • Promote healing
  • Support/splint wound site
  • Protect patients from seeing it
  • Promote thermal insulation
327
Q

This healing process has little or no tissue loss, edges are approximated, healing is rapid, theres a low risk for infection and no/minimal scarring

A

Primary intention

328
Q

This healing process has loss of tissue, wound edges are widely separated and unapproximated, its a longer healing time with increase risk for infection, scarring and heals by granulation

A

Secondary intention

329
Q

What is the preferred cleansing agents for wounds?

A

Isotonic solutions

330
Q

This absorbs exudate from the wound

A

Woven gauze

331
Q

This is a temporary second skin for small superficial wounds

A

Film dressing

332
Q

This forms a seal at the wounds surface to prevent evaporation of moisture and surface contamination; it is occlusive or semi-occlusive, limits exchange of oxygen between wound and environment, provides minimal to moderate absorption of drainage, maintains a moist wound environment, and may be left in place for three to seven days, thus resulting in less interference with healing?

A

Hydrocolloid

333
Q

This is mostly water and maintains a moist surface to support healing; are best for partial or full-thickness wounds

334
Q

This is a negative pressure suction that speeds tissue generation, decreases swelling and enhances healing in a moist, protected environment

A

Wound vacuum

335
Q

What are some complications that can occur with wounds?

A
  • Infection
  • Hemorrhage
  • Hematoma
  • Dehiscence
  • Evisceration
336
Q

This is a partial or total rupture of a sutured wound usually with separation of underlying skin layers

A

Dehiscence

337
Q

This is a dehiscence that involves the protrusion of visceral organs through the wound opening

A

Evisceration

338
Q

This is a collection of blood into a clot that appears as a red or blue bruise

339
Q

What are the nursing interventions for evisceration and dehiscence?

A
  • Cover wound and any organs with sterile towels or dressings soaked with sterile normal saline solution to decrease chance of bacteria invasion and drying of the tissues
  • Position the client in supine position with knees and hips bent
  • Observe for shock
  • Maintain calm environment
  • Keep client NPO
340
Q

What labs are important to consider regarding wound care?

A
  • Albumin levels

- WBC

341
Q

Examples of bacteria:

A
  • C.Diff
  • E. coli
  • Staph
  • TB
342
Q

Examples of viruses:

A
  • Hep. B
  • Flu
  • HIV
  • Herpes zoster
  • COVID
343
Q

Examples of fungi:

A

Candida albicans

344
Q

Examples of parasites:

345
Q

This is the ability of a pathogen to invade and injure a host

346
Q

Nonspecific innate is:

A

Temporary immunity (passive = antibodies from external source)

347
Q

Nonspecific innate includes:

A
  • Intact skin
  • Mucous membrane
  • Vascular response
  • Cellular response
348
Q

Specific adaptive immunity:

A

Permanent immunity. Allows the body to make antibodies in response to a foreign organism

349
Q

Specific adaptive immunity includes:

A
  • B and T cells

- Immunoglobulins

350
Q

Patient at greater risk for HAIs include:

A
  • Immunocompromised
  • Elderly/infants
  • Poor nutrition
  • Comorbidities
  • Multiple drugs
351
Q

How soon should a IV be removed?

A

After 72 hours

352
Q

Major sites for HAIs include:

A
  • Urinary tract
  • Bloodstream
  • Surgical site
  • Trauma wounds
  • Respiratory tract
353
Q

Different types of HAIs:

A
  • Iatrogenic
  • Exogenous
  • Endogenous
354
Q

What are the modes of transmission?

A
  • Droplet
  • Airborne
  • Contact
  • Vector
355
Q

What are the different types of precautions?

A
  • Isolation
  • Standard
  • Transmission
356
Q

What viruses fall under standard precautions?

A
  • CMV
  • HIV
  • Hep. B and C
  • Aspergillosis
357
Q

What viruses fall under contact precautions?

A
  • MRSA
  • VRE
  • Adenovirus
  • Diarrhea
  • C.Diff
  • Rotavirus
  • E. Coli/Enterovirus
  • Salmonella
  • Shigella
  • Hep. A
  • Herpes Zoster/Simplex
  • Parainfluenza
  • RSV
  • Lice/Scabies/Chicken pox
358
Q

What viruses fall under droplet precautions?

A
  • Pertussis
  • Neissera meningitides
  • Coxsackie
  • Bacterial meningitis
  • Mumps
  • Rubella
359
Q

What viruses fall under airborne precautions?

A
  • Disseminated herpes zoster
  • Measles
  • SARS
  • Avian flu
360
Q

How should you wash your hand after caring for someone on extended contact?

A

With soap and water

361
Q

Droplet precautions include standard precautions plus a:

A

Surgical mask

362
Q

Airborne precautions include standard precautions plus a:

A
  • N95

- Pressure negative room

363
Q

What is the proper process to donn PPE

A
  • Gown
  • Mask
  • Goggles
  • Gloves
364
Q

What is the proper process to doff PPE

A
  • Gloves
  • Goggles
  • Gown
  • Mask
365
Q

Stridor, wheezing or a crowing sound indicates:

A

Partial obstruction, bronchospasm or laryngospasm

366
Q

Crackles and rhonchi indicate:

A

Ateletasis, pneumonia or pulmonary edema

367
Q

Vomiting post-op, abdominal distention and absence of bowel sounds may be signs of:

A

Paralytic ileus

ADULT 1 (9 decks)

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