Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NUR 325 > Exam 1 > Flashcards

Exam 1 Flashcards

(324 cards)

Start Studying
1
Q

Stress definition

A

response to challenges (it doesn’t have the resources for), different for everyone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stress neutral

A

coping effective, ex. a paper cut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Challenge/manageable stress

A

coping effectively but may need new coping skills, ex. big cut on your leg and learn to apply pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stress not manageable

A

ex. degloving skin (comes off hand), need outside help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chart of stress response starts with a ____, triggering ______ to release _____

A

stressor
hypothalamus response
corticotropin releasing factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stress response goes down what three paths

A

Sympathetic nervous system
Anterior Pituitary gland
Posterior Pituitary gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

sympathetic nervous sys activation path of stress

A

norepinephrine, epinephrine, dopamine (flight or flight) –>

increasing: HR, BP, CO, blood glucose, blood perfusion to muscle; bronchial dilate, pupils dilate,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

anterior pituitary path of stress

A

ACTH –> adrenal cortex –> aldosterone (increase Na and water) or cortisol (increase: protein synthesis, blood glucose, BP, CO, anti-inflammatory, immunosuppression)
prolonged response, at risk to be sick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

posterior pituitary path of stress

A

ADH –> water retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

General Adaptation Syndrome stages and info

A

alarm, resistance, and exhaustion

several body systems respond immediately to the stressor
goal to return to homeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

alarm stage

A

CNS aroused, fight or flight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

resistance stage

A

PNS, try to go back to normal, resist stress, repair damage,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

exhaust stage

A

no resources left, high BP, depression (health issues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

positive stress called

A

eustress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

negative stress called

A

distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Transactional Theory of Stress and Coping

A

two stages of appraisal (primary and secondary) before responding

primary: does it pose a threat (stop if no)
secondary: can we cope? do we have resources?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sources of stress

A

Physiological

Psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Physiological stress ex.

A

car accident, chronic illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Psychological stress ex.

A

divorces, family problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Types of Stress

A

Acute Stress
Episodic acute stress
Chronic Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Acute Stress

A

most common, brief, pos or neg, fight or flight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Episodic acute stress

A

frequent episodes of acute stress, affects relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chronic Stress

A

constantly wears on pt, uses all the resources up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cognitive appraisal meaning

A

what/how you view stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cognitive appraisal aspects
``` Age Developmental level Maturation Environment Life experiences General mental and physical health status ```
26
Consequences of Chronic Stress on CNS
continuous activation, headache, irritable, anxiety
27
Consequences of Chronic Stress on Cardiovasc
incre HR, BP
28
Consequences of Chronic Stress on Immune sys
lower WBC, asthma, arthritis
29
Consequences of Chronic Stress on Musculoskel
knots in neck/shoulders
30
Consequences of Chronic Stress on GI
IBS, ulcerative colitis
31
Consequences of Chronic Stress on Integumentary
hair loss, acne
32
Consequences of Chronic Stress on Reproductive
ED, decrease sperm | menstrual issues
33
Risk for psychological stress
``` Problems w/relationships Strained family relationships Financial strain Job stress/insecurity Food insecurity ```
34
Risk for physiologic stress
Significant injury or illness | Chronic pain
35
Acute stress s/s
headache, trouble focus, GI issue, irritable, increase HR, dilate pupils
36
Chronic stress s/s
infections, slow wound heal, unintentional weight loss, increase blood glucose, depression, high BP, change in sleep
37
Denial
Refusal to accept reality to avoid the emotional impact
38
Rationalization
Justify/explain bad behaviors to avoid emotional discomfort or save face
39
Projection
Attribute negative feeling onto someone else
40
Repression
Conceal bad thoughts or memories to try to forget about them
41
Regression
Movement back to a more comfortable developmental time in life
42
Compartmentalization
Categorize life experiences to avoid facing the anxieties while in that mindset
43
Clinical Management: Primary Prevention
try to prevent illness as a result of stress promote effective coping, nutrition, exercise, social support, self-esteem
44
Problem- focused coping
try to eliminate stressor
45
Emotion- focused coping
control our emotional response to it | ex. journal, walk
46
Meaning- focused coping
find meaning behind stress | ex. religion
47
Common positive coping strategies
``` Education Social support Exercise Therapeutic lifestyle change Music therapy Relaxation strategies Alternative therapies ```
48
Ineffective and maladaptive coping responses
``` Appropriate but insufficient Use or abuse of alcohol or other substances Smoking Overeating Denial Avoidance ```
49
Pharmacologic Therapy used for stress do what
treat the s/s not the stress
50
Crisis
threatening situation trigger by an event causing a body response
51
Situational stressors
personal, family, work-related ex. chronic illness, financial strain, motor vehicle accident, death of a loved one, change in marital status, unwanted pregnancy
52
Developmental stressors
occurs as the person moves through the stages of life ex. Kids (physical appearance, family, friends, school) Adolescents (friendships, belong, identity formation, leaving home) Adults (marriage, family, career, aging) Older adults (health problems, mobility, cognition)
53
Adventitious stressors
disaster events, rare and unexpected ex. natural disasters, physical/sexual assault, terrorism
54
Socioeconomic stressors
stressors that occur from poverty, SES, and homelessness
55
Cultural stressors
living in a society they do not fit in culturally or receiving care that ignores their cultural beliefs
56
Nursing process
Assess, Diagnosis/Analyze, Plan, Implement, Evaluate
57
A nurse is caring for a client who has migraine headaches and reports that they are "getting worse". Which of the following questions should the nurse ask the client to determine if the headaches are stress-related disorders (select all that apply) What is the intensity of your migraines How often do the migraines occur Are you eligible for workers compensation due to the migraines What type of support is available to you when you have a migraine What coping strategies do you use when you experience a migraine
What is the intensity of your migraines How often do the migraines occur What type of support is available to you when you have a migraine What coping strategies do you use when you experience a migraine
58
A nurse is caring for a client who has delivered a healthy newborn. The client is tense, refuses to hold the baby, and tells the nurse, "I have no idea how to handle having a baby. I wish this pregnancy had never happened". Which of the following statements should the nurse make Becoming a parent is a new experience for you. Let's talk about your concerns You should be thrilled about having a newborn. I would be Why don't you hold the baby? I'm sure it will make you feel better How can you think that way? This is a joyous occasion and should be celebrated
Becoming a parent is a new experience for you. Let's talk about your concerns
59
A nurse is talking about implementing self-care strategies to cope with the stress of caregiving with the partner of a client who has dementia which of the following strategies reported by the partner should the nurse identify as an example of effective coping Practicing deep breathing while sitting outside Sitting by the clients bedside and drinking coffee Going out onto the patio to smoke a cigarette when feeling stressed Drinking a glass of wine every night before falling asleep
Practicing deep breathing while sitting outside
60
A nurse is planning care for a client who recently divorced with two young children. the client reports difficulty sleeping, feeling hopeless, and being estranged from the family. the nurse should plan to monitor the client for which of the following potential manifestations of chronic stress. Systemic infection Exaggerated startle response Recurring nightmares Suicide
Suicide
61
A nurse in a community clinic is interviewing a client who is in distress and reports being unable to sleep following a neighborhood fire several days ago. The client has hypertension, tachycardia, and is diaphoretic. The nurse should identify that the client is experiencing which of the following types of stress Acute stress PTSD Episode acute stress Chronic stress
Acute stress
62
A nurse is caring for a client who has been charged with partner violence against their spouse. The client is angry, pacing, and yells out, "I wouldn't lose my temper If my spouse would just leave me alone. It's their fault. " the nurse would identify the client is displaying which of the following defense mechanisms Projection Compartmentalization Repression Regression
Projection
63
A nurse is conducting an educational session for client to report experiencing stress-related disorders. A client asks the nurse which part of the body activates the stress response. Which of the following responses should the nurse provide Sympathetic nervous system Adrenal glands Hypothalamus Adrenocorticotropic hormone
Hypothalamus
64
A nurse is interviewing a client who is in distress and tell the nurse, "my ex-partner is suing for full custody of my children. I am so worried and don't know what to do." which of the following questions should the nurse asked to evaluate the client coping skills can you describe your relationship with your ex partner what happens when you feel worried like this what do you believe with your contribution to the relationship break up what strategies have you used in the past to do with stress
what strategies have you used in the past to do with stress
65
A nurse is providing discharge teaching about health promotion to a client who has a new diagnosis of type 2 diabetes mellitus. which of the following instructions should the nurse include. (select all that apply) ``` Practice mindful breathing Start each day with a to-do list Include simple carbohydrates in the diet Develop habits to mitigate stress Preserve energy by reducing physical activity ```
Practice mindful breathing Start each day with a to-do list Develop habits to mitigate stress
66
A nurse is caring for a client who has delivered a healthy newborn. The client tells the nurse that while they are somewhat stressed about being a new parent, they are thrilled by the birth of their child. The nurse should identify that the client is experiencing which of the following types of stress Allostatic load Distress Eustress Fight or flight response
Eustress
67
A nurse is caring for a client who is in crisis following the Break-Up of a long-term relationship. The client tells the nurse, “I might as well just die. My life is over.” Which of the following actions should the nurse take first explore past positive coping strategies establish a follow-up plan of care conduct a suicidal risk evaluation display a neutral attitude
conduct a suicidal risk evaluation
68
A nurse is caring for an older adult client who reports being stressed about their health status due to problems with short-term memory oh, slow reaction times when driving, and urinary frequency. The nurse should recognize that the client is experiencing which of the following types of stressors developmental stressors situational stressors adventitious stressors socioeconomic stressors
developmental stressors
69
A nurse is assessing a client who is working at home due to covid-19 restrictions. The client reports abdominal cramping and bloating diarrhea and states, "I'm completely stressed out from working at home." the nurse should identify that the client is experiencing manifestations of which of the following stress related conditions irritable bowel syndrome food poisoning panic disorder major depressive disorder
irritable bowel syndrome
70
A nurse is caring for a college student admitted for acute alcohol intoxication. The client reports feeling overwhelmed and expresses an inability to cope with stressors at school. Which of the following statements should the nurse make Drinking too much alcohol is not the best choice. I suggest you stop I can see why you're using alcohol to cope; you've got a lot going on Let's talk about the coping methods that have worked for you in the past I've been stressed before too but I tell myself that I can handle it
Let's talk about the coping methods that have worked for you in the past
71
A nurse is interviewing a client who recently experienced in Act of workplace violence when an armed person how the workers at gunpoint before the police intervened. The client now reports being anxious and fears the gunman might return. The nurse should identify that the client is experiencing which of the following types of crisis Situational Cultural Maturational Adventitious
Adventitious
72
A nurse is caring for a client who reports experiencing stress over an upcoming surgical procedure. Which of the following statements describe the characteristics of stress Stress is an easily defined phenomenon regardless of viewpoint and discipline Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one state of equilibrium Stress only affects the individual and does not affect the person's family, friends, or other associates The lack of definition regarding stress does not pose a problem for the client or the nurse
Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one state of equilibrium
73
A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurse asked how they are feeling, they respond with, "great I'm going to beat this cancer." which of the following defense mechanisms is the client using Regression Projection Repression Denial
Denial
74
A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurse asked how they are feeling, they respond with, "great I'm going to beat this cancer." which of the following defense mechanisms is the client using Regression Projection Repression Denial
Denial
75
A nurse in a health clinic Is interviewing a client who is upset and reports that their stress is "too much to handle." The client is unemployed, a single guardian to young children, and has periodic asthma attacks. Which of the following stress related conditions is the client experiencing PTSD Allostatic load Chronic illness Alarm stage
Allostatic load
76
A nurse is caring for a client whose partner was recently hospitalized with covid-19. The client is experiencing manifestations related to the alarm stage of General Adaptation Syndrome. For which of the following manifestations should the nurse monitor (select all that apply) ``` hypertension dilated pupils increase state of arousal bradycardia lethargy ```
hypertension dilated pupils increase state of arousal
77
A nurse is assessing a client who was sexually assaulted six months ago and has been diagnosed with PTSD. Which of the following manifestations should the nurse expect (select all that apply) ``` intrusive memories of the event flashbacks of the event poor work relationships exaggerated startle response when reminded of the event frequent episodes of diarrhea ```
intrusive memories of the event flashbacks of the event exaggerated startle response when reminded of the event
78
What are some reasons it is important to understand the med that we are administering
Can question an order if you think it is wrong (pt safety) Providers are humans and can make mistakes Can answer pt questions
79
Drug categories
Similar: act, therapeutic effects, ADR, contraindications, precautions Allergic to one, likely allergic to all Sometimes have outliers though
80
Generic name
Given by company who created it | Not capitalized
81
Brand name
Drugs commercial name | Capitalized
82
Rates of absorption of oral med (quickest to slowest)
``` liquid, suspension, powder, capsule, tablet, coated tablet, enteric-coated tablet ```
83
Enteric-coated (EC)
released in the intestine
84
Extended-release (ER) or Sustained-release (SR/XR)
doesn't release right away, slow
85
Immediate-release (IR)
released right away
86
Scored tablet
line that goes across pill to cut it in half | has to have the line to cut it
87
Parenteral meaning
Injectable drugs
88
Parenteral routes
IV, IM, sub-Q
89
Intravenously (IV)
Absorption: immediate Onset of action: immediate used when they already have an IV in pt
90
Intramuscular (IM)
Absorption: varies (rapid if water-soluble, rapid if good circulatory flow) Onset of action: varies a little faster than sub-Q cause of increase blood flow
91
Subcutaneously (sub-Q)
Absorption: varies (rapid if water-soluble, rapid if good circulatory flow) Onset of action: varies
92
Transdermal routes/places
skin, eyes, ears, nose, rectum, vagina, lungs
93
Transdermal info
fast constant amount of drugs over an extended time slow onset long duration of action
94
Pharmacokinetics
describes the absorption, distribution, metabolism, excretion of the drug
95
Absorption
movement of administration site to various tissues
96
Distribution
movement of a drug by the circulatory system to the intended site of action depends on blood flow
97
Metabolism
a change in the drug that may make it more or less potent, soluble, or inactive usually occurs in the liver if liver problems, build-up of toxins
98
Excretion
elimination ex. feces, urine, sweat, exhaled air if kidney problems, can't rid of it and build-up of toxins
99
First pass effect
Before it is in the blood in circulation, some drug is lost | Oral drugs
100
Drug half-life
Takes time for a drug to decrease in amount by half Med with a long half-life don't give often since they last long Half-life won't be as fast if pt has liver/kidney problems
101
Drug half-life
Takes time for a drug to decrease in amount by half Med with a long half-life don't give often since they last long Half-life won't be as fast if pt has liver/kidney problems
102
Onset
Amount of time it takes to demonstrate a therapeutic response Starts to help
103
Peak
Amount of time to achieve a full therapeutic effect | Completely helps with the issue
104
Duration
Amount of time the drugs therapeutic effects last | The whole time the med last
105
Peak vs Trough
Peak- highest level | Trough- lowest level
106
Therapeutic level
Space between peak and trough
107
Drug levels needed in pt
Need to be in a therapeutic level so you can help with the issue If too low can lead to resistance If too high can injury body
108
When is peak lab drawn
1hr and a half after administration
109
When is trough lab drawn
30 mins before administration
110
Pharmacodynamics
biochemical changes that occur in the body as a result of taking a drug
111
Agonists
drugs that bind with a receptor and increase the typical response works with what the body is doing and increases it
112
Antagonists
drug that binds with a receptor and either blocks or inhibits a typical response like an umbrella, blocks most of the receptors but not all
113
Expected action
What we expect to happen in response to a specific drug | Ex. give acetaminophen which will reduce pain, fever, fatigue
114
Therapeutic uses
Why we are giving the pt the med | Ex. give to reduce headache (even though it helps with other s/s as well)
115
Adverse drug reactions (ADR)
nontherapeutic and unintended
116
Ex. of mild and severe ADR
mild- nausea, itchy, dizzy | severe- anaphylaxis, convulsions
117
Drug tolerance
decreased response to a drug over time or repeated use | may need to increase dose to get the same body response as before
118
Drug cumulative effect/drug sensitivity
body can't excrete existing dose before another dose is given can lead to toxicity may be caused by a metabolic change in the body (liver/kidneys)
119
Liver lab test
AST- 0-35 ul | ALT- 4-36 ul
120
Liver lab test
AST- 0-35 ul | ALT- 4-36 ul
121
Kidney lab test
BUN- 10-20 mL/deciL | Creatine- male 0.6-1.2 mg/deciL or female 0.5-1.1 mg/deciL
122
Drug toxicity
excessive doses resulting in a negative physiologic effect can be a result of impaired excretion important to monitor drug serum levels
123
Drug toxicity
excessive doses resulting in a negative physiologic effect can be a result of impaired excretion important to monitor drug serum levels
124
What to do to avoid drug toxicity
Prescribe lowest dose that achieves therapeutic effect
125
Precautions
Use drug when benefits outweigh risk Know why pt is taking it, precautions that go with it, diet restrictions, physical assessments that need to be done
126
Contraindications
potential to cause serious ADR in relation to a specific factor ex. specific foods, combination of certain meds, certain populations
127
Interactions
can change the action of the drug in the body (absorption, metabolism) can be drug-drug or drug-food
128
Types of drug interactions
additive synergistic antagonistic
129
Additive effect
Effects add together and cause the same action, do not influence each other
130
Synergistic effect
Effect of one drug are greater w/another, increase each other
131
Antagonist effect
Effects of one drug are decreased or stopped w/another, counteract
132
Grapefruit juice does what to certain drugs
slows down metabolism of some drugs | decreases enzymatic activity
133
Dark greens (vit k) does what to certain drugs
counteracts anticoagulant effects of warfarin
134
Considerations for breast feeding (with drugs)
baby weight, will it pass through milk, will it negatively affect baby
135
Considerations for infants (with drugs)
weight, big head, large surface area, less acidic stomach
136
Considerations for older (with drugs)
body doesn't work as well, slow stomach
137
Considerations for pregnancy (with drugs)
affects baby, teratogenic (harm to the fetus in utero)
138
Client instructions for drugs
purpose, generic vs. brand name, need to know the route, administration schedule, potential ADR (to know what to expect), precautions (ex. don't drive while using)
139
Prescription drugs
drugs that are prescribed by a provider and can be harmful without supervision
140
Nonprescription drugs/Over the counter (OTC)
drugs that are relatively safe to talk without supervision
141
A patient talking SMZ/TMP asks the nurse what the name means. The nurse replies sulfamethoxazole is combined with trimethoprim in SMZ/TMP to help drug effectiveness. How does this work? SMZ has a synergistic effect with TMP against gram pos and neg SMZ acts along with TMP as an anesthetic SMZ increases the excretion of TMP thereby increasing the response in the bladder SMZ is highly protein bound and displaces TMP
SMZ has a synergistic effect with TMP against gram pos and neg
142
When a drug binds to a receptor to produce a pharmacologic effect, the drug may be called Agonist Accelerator Antagonist Blocker
Agonist
143
Which organ does drug metabolism usually occur in? Heart Stomach Liver Brain
Liver
144
The peak is the amount of time the drug Needs to produce an initial response Needs to reach its highest effective concentration Need to change into active metabolites Is in the therapeutic range
Needs to reach its highest effective concentration
145
A patient requires a high dose of a new antihypertensive medication because the new medication has a significant first-pass effect. What does this mean? The med passes through the renal tubules and is excreted in large amounts The med is extensively metabolized in the pt liver The med must pass through the pt bloodstream several times to generate a therapeutic effect The med is ineffective following the first dose and increasing effective with each subsequent dose
The med is extensively metabolized in the pt liver
146
Which of the following circumstances will increase the rate of drug absorption for a subcutaneous injection Large surface area Large muscle mass Low blood flow Lipid solubility
Large muscle mass
147
Which is safer to use when referring to a drug generic or brand
generic (only one generic name vs multiple brand names)
148
When performing an assessment to determine which med can be used, which of the following elements is most important? Presence of illness Allergies Physical examination Weight
Allergies
149
When two drugs given together have an effect equal to the sum of their respective effects, the interaction is Antagonized Additive Agonist Potentiated
Additive
150
An unintended effect of the drug is Toxic reaction Side effect Allergic reaction Adverse effect
Adverse effect
151
Indications (drugs)
information on condition and diseases for which the drug is used for
152
1
153
2
154
3
155
4
156
5
157
6
158
7
159
8
160
9
161
10
162
11
163
12
164
13
165
14
166
15
167
16
168
17
169
18
170
19
171
20
172
21
173
22
174
23
175
24
176
25
177
Pain definition
whatever the experiencing person says it is most reliable indicator of pain issue when someone is unable to verbalize it
178
Acute pain
``` short term (less than 3 months) usually know what caused it try to minimize side effects ```
179
Chronic pain
long term (more than 3 months or longer than it should be for the specific injury) may not know what caused it (etiology) want people to be lowest possible level
180
Nociceptive
normal pain or response to injury (protective) tissue injury dull, aching, poorly localized
181
Somatic pain
bone, joint, muscle, connective tissue
182
Visceral pain
organ, (could also mean emotional)
183
Cutaneous pain
skin
184
Transduction
noxious stimuli cause cell damage which releases chemicals (prostaglandins, bradykinin, serotonin, substance P, histamine) activates nociceptors causing action potential
185
Transmission
Action potential goes from injury, spinal cord, brainstem, thalamus, cortex to processing
186
Perception
the conscious experience of pain
187
Modulation
neurons in brainstem go down spinal cord and release substances (ex. endorphins, enkephalins) to stop nociceptive impulses
188
Neuropathic
pathology or disease of the somatosensory system, communication issue, not processing sensory input shooting, tingling, burning, numbness
189
Mixed pain
combination between nociceptive and neuropathic
190
Psychosocial consequences of untreated pain
fear, anger, depression, anxiety, difficulty maintaining relationships
191
Cardiovascular response and s/s to untreated pain
increase: HR, CO, peripheral vascular resistance, myocardial O2 consumption, coagulation HTN, unstable angina, MI, DVT
192
Endocrine and Metabolic response and s/s to untreated pain
increased: ACTH, cortisol, ADH, epinephrine, norepinephrine, renin, aldosterone decreased: insulin gluconeogenesis, glycogenolysis, muscle protein catabolism weight loss, increases RR and HR, shock, glucose intolerance, hyperglycemia, fluid overload, HTN, urinary retention, decrease urine output (f/f s/s)
193
GI response and s/s to untreated pain
decreased gastric and intestinal motility constipation, anorexia, paralytic ileus
194
Immunologic response and s/s to untreated pain
decreased immune response infection
195
Musculoskeletal response and s/s to untreated pain
muscle spasm, impaired muscle function immobility, weakness, fatigue
196
Neurologic response and s/s to untreated pain
impaired cognitive function confusion, impaired ability to think, reason, and make decisions
197
Renal and urologic response and s/s to untreated pain
decrease urine output, urinary retention fluid imbalance, electrolyte disturbance
198
Repiratory response and s/s to untreated pain
decreased: tidal volume, cough, sputum retention hypoxemia atelectasis, pneumonia
199
Infants and kids at risk for pain because
cant communicate, immune system might not be fully developed, people don't always listen to them
200
Older adults at risk for pain because
cognitive decline, cant verbalize or choose not too, don't want to lose independence, more health issues
201
Gender info related to pain
women more likely to report pain, have a lower threshold
202
SES info related to pain
might not have access/be able to afford care
203
Cultural info related to pain
some may feel pain is necessary (suppose to feel a lot), some may feel it is not acceptable to admit they are in pain
204
Substance abuse risk factors in related to pain
providers may not want to prescribe them meds, might have a tolerance to meds
205
Individual risk factors that place pt at a higher risk for pain
chronic conditions, acute or traumatic injury, medical procedures
206
fatigue affecting pain experience
more pain when tired
207
cognitive function pain experience
not understanding what is going on, may experience more pain
208
prior experiences affecting pain experience
if pt had bad pain w/ an issues before, next time they have that issue they may be very worried and in more pain
209
anxiety and fear affecting pain experience
if a pt is already worried about the pain, may be experience more
210
Elements of pain assessment
location, intensity (scale), quality, onset and duration (and what were you doing), relieving factors, function goal (what number show the pain be at to function)
211
Pain scale info to know
use the same pain scale every time (not always true in practice) faces scale for 3yr and younger and cognitive impaired number scale for 8yr and older
212
Behavioral signs of pain
facial expressions (grimace), restlessness (cant sleep, changes spots a lot), change in activity (usually decrease), crying, assessment tool
213
Nonpharm strategies to help treat pain
massage, repositioning and body alignment, splinting (hold pillow against incision), thermal interventions, mind-body therapies, exercise, TENS, acupuncture
214
Can non pharm strategies replace pharmacology strategies
usually they don't
215
Nursing care to treat pain
schedule pain interventions PRN, review orders for analgesia, give pain meds before pain levels get very high, have pt report pain, create plan w/ more pharm and non pharm interventions
216
Meds do target what to deal with pain
Target opioid receptors
217
Types of opioid receptors
mu, kappa, delta
218
Mu receptors
stimulated by opioid drugs pos effects: analgesia neg effects: euphoria, sedation, decrease RR, physical dependence
219
Kappa receptors
stimulated by a lesser extent to opioid drugs pos effects: some analgesia neg effects: sedation, hallucination, delusion
220
Types of analgesics
NSAIDs (1st and 2nd gen), acetaminophen, opioids, centrally acting nonopioids
221
COX (Cyclooxygenase)
produces inflammatory response | enzymes convert arachidonic acid into prostaglandins and other compounds
222
COX-1
homeostasis | protects gastric mucosa, enhance platelet aggregation, renal perfusion
223
COX-2
response to injury | inflammation, pain, fever
224
Types of 1st gen NSAIDs
aspirin (ASA), ibuprofen (Advil, Motrin), naproxen, aleve, indomethacin, ketorolac
225
1st gen NSAID Pharm Action
COX-1 and COX-2 inhibitor decrease: pain, inflammation, temp anticoagulant, impairs renal perfusion, gastric mucosa not protected
226
1st gen NSAIDs ADR
gastric upset, heartburn, nauseas, gastic ulcers, bleeding tendencies, renal dysfunction, Reye's syndrome (swelling in liver and brain in kids after viral infection
227
1st gen NSAIDs Interventions
monitor s/s of bleeding and easy bruising petechiae, may need to use proton pump inhibitor, monitor I&O, do labs: BUN and creatine, monitor tinnitus, dizzy, headache abd pain, hematemesis, coffee-ground emesis red, black or tar stool
228
1st gen NSAIDs Admin
``` swallow whole (enteric-coated or SR) stop 1 week before surgery ```
229
1st gen NSAIDs Client Instructions
``` take w/ food or milk avoid alcohol report s/s bleeding changes in urination sudden weight gain, edema stop taking if: ringing in ears, dizzy, unwarranted sweat ```
230
1st gen NSAIDs Contraindication/Precaut
pregnancy, peptic ulcer disease, bleeding disorder, pre-op, older adults, ETOH abuse, H. pylori, HTN, kids w/viral infection, heart fail, renal dysfunc
231
1st gen NSAIDs Interactions
aspirin and anticoagulants (both incre bleed), aspirin and NSAID, ACE inhibitors (both incre renal dysfunc)
232
2nd Gen NSAIDs name
celecoxib (Celebrex)
233
2nd Gen NSAIDs Pharm Action
COX-2 inhibitor, suppress pain inflammation and fever, decrease gastric effects, increase risk for CV issues (vasoconstrictor and platelet aggregation)
234
2nd Gen NSAIDs Intervention
``` monitor s/s of GI bleed may need proton pump inhibitor monitor I&O monitor lab: BUN, creatine monitor s/s for MI (left arm hurt, impending doom, jaw pain) and CVA (slur speech, face droop) ```
235
2nd Gen NSAIDs Client Instructions
take a w/low dose of ASA, and food or milk avoid alcohol report s/s GI bleed changes in urination sudden weight gain report: chest pain, short of breath, severe headache, s/s stroke give 2 hours away from Mg or Al antacids
236
2nd Gen NSAIDs Contraindication/Precaut
pregnancy, kidney or liver impairment, GI bleeds, anemia, ETOH abuse, asthma
237
2nd Gen NSAIDs Interactions
Lasix (decre the diuretic effect of Lasix), fluconazole (can incre its levels), anticoagulants (both)
238
Acetaminophen Pharm Action
nonopioid analgesic (mild to moderate pain), COX inhibitor, fever reducer,
239
Acetaminophen ADR
``` liver damage (if take too much) HTN (mainly in women or those taking it daily) ```
240
Acetaminophen Admin
can be given oral, rectal, IV | max 4g per day
241
Acetaminophen Interventions/Client Instructions
avoid more than 4g a day report/monitor: abd discomfort, N/V/D, sweating take BP
242
Acetaminophen Contraindication/Precau
ETOH abuse | use w/ caution: anemia, hepatic or renal disease, immune suppression (may mask infection)
243
Acetaminophen Interactions
alcohol | warfarin (incre risk of bleed)
244
Centrally Acting Nonopioid name and pharm action
tramadol (Ultram), for moderate to moderately severe pain binds to select opioid receptors, blocks reuptake of norepinephrine and serotonin
245
Centrally Acting Nonopioid ADR
sedation, dizzy, headache, nausea, constipation, seizure, urine retention
246
Centrally Acting Nonopioid Interventions
monitor ambulation (dizzy) give w/food and antiemetic (nausea) measure VS and give opioid antagonist when RR falls Monitor s/s seizures, have suction equipment ready monitor for urinary retention fluid, fiber, movement (constipation)
247
Centrally Acting Nonopioid Admin
onset is 1 hr (give before pain is high level) | ER so swallow whole
248
Centrally Acting Nonopioid Client Instructions
Avoid before driving Sit if lightheaded/change positions slowly fluid, fiber, movement when constipated Only take PRN
249
Centrally Acting Nonopioid Contraindication/Precau
acute ETOH, opioids, psychotics drugs (both depress) seizure disorder respiration depression
250
Centrally Acting Nonopioid Interactions
MAOIs risk for hypertensive crisis SSRI Tricyclic antidepressants CNS depressants
251
Opioid Agonist vs Opioid Agonist-Antagonist
increase response, mimic action of natural opioids | decrease mu and increase kappa
252
Opioid Agonist types
morphine, fentanyl, demerol, methadone
253
Opioid Agonist Pharm action
analgesia | binds with mu receptor
254
Opioid Agonist ADR
respiration depression, sedation, dizzy, lighthead, drowsy, constipation, N/V, euphoria, risk for abuse
255
Opioid Agonist Interventions
``` monitor VS/RR (give opioid antagonist if RR too low) monitor during ambulation monitor bowel function hydration, encourage urination lowest dose, short term ```
256
Opioid Agonist Admin
get VS before oral, IM, IV, subcut, rectal, epidural swallow whole SR IV slow push 4-5 min
257
Opioid Agonist Client Instructions
only take PRN do not drive get up slow/slow position change incre fluid, fiber, activity
258
Opioid Agonist Contraindication/Precau
pregnancy, renal failure, careful admin to old and young
259
Opioid Agonist Interactions
CNS depressants anticholinergics (both urine retention) anti-hypertensives (both incre BP)
260
Opioid Agonists-Antagonists names
butorphanol and pentazocine (Talwin)
261
Opioid Agonist-Antagonist Pharm Action
analgesic | mu antagonist, kappa agonist
262
Opioid Agonists-Antagonists ADR
respiration depression, sedation, dizzy, ligthead, headache, nausea, inre cardiac workload, abstinence syndrome
263
Opioid Agonists-Antagonists Interventions
ask about opioid use monitor VS monitor ambulation do not give to MI or cardiac insufficiency
264
Opioid Agonists-Antagonists Admin
IM, IV, intranasal, oral measure VS don't discontinue abruptly
265
Opioid Agonists-Antagonists Client Instructions
``` take PRN, short term don't drive caution when changing positions don't take with w/opioid don't use for heart pain ```
266
Opioid Agonists-Antagonists Contraindication/Precau
acute MI, cardiac sufficient opioid dependency history of drug abuse
267
Opioid Agonists-Antagonists Interactions
CNS depressants | opioids (decre effects)
268
Opioid Antagonists name and Pharm Action
naloxone (Narcan) block opioid receptors reverse effects of opioids
269
Opioid Antagonists ADR
``` ventricular arrhythmias abstinence syndrome HTN vomit tremor ```
270
Opioid Antagonists Intervention
monitor BP, VS, heart rhythm
271
Opioid Antagonists Admin
``` IM, IV, subcut IV: monitor VS every 5 min effects last 60-90 mins respiratory depression and pain can occur prepare to give every 2-3 mins ```
272
Opioid Antagonists Client Instructions
warn them of ADR and pain
273
Opioid Antagonists Contraindication/Precaut
opioid dependent respiratory depression not from opioid caution w/cardiac irritability and seizure
274
Opioid Antagonists Interactions
decrease opioid effect
275
Cognition definition
mental action or process of acquiring knowledge and understanding through thought, experience, and the senses
276
Six domains of cognition
perceptual motor function, language, learning/memory, social cognition, complex attention, executive function
277
Perceptual motor function
take in outside environment and recognize it, then react
278
Social cognition
processes, stores, and acts in a social situation
279
Executive function
self-regulation, being adaptive, higher thinking, flexible
280
Perception
how you interpret info around you
281
Memory
ability to retain and recall what you know
282
Scope of cognition
ranges from intact to impaired | impairment can range from mild, moderate, or severe
283
Main places in the brain where cognition takes place
cerebrum, diencephalon, brain stem, cerebellum
284
Optimal brain function depends on
continuous perfusion of oxygenated and nutrient-rich blood
285
Delirium
sudden, acute, caused by an underlying condition, usually if you can treat the cause it goes away
286
Cognitive Impairment Not Dementia
will not see a decrease in ADLs/functional ability
287
Focal cognitive disorders
an example amnesia, can still understand the environment
288
Intellectual disability
below-average intelligence (IQ score “70), | limitations in conceptual skills, social skills, and ADL
289
Learning disability
Have average to above average intelligence | Issue with taking in new info
290
Consequences of cognitive impairment
Increased risk for injury (don't understand danger) Complicates disease management (may not help w/care) Decreased ability to care for self and act in social interactions Financial hardship Caregiver burden
291
Risk factors for cognitive impairment
Personal behavior (substance abuse, high-risk activities, injuries) Environmental exposure Congenital factors: maternal (substance abuse), birth injuries Genetic conditions Health-related conditions: acute/chronic treatments
292
Assessment for cognitive impairment (history)
can ask pt if you can speak to family/friends ``` patterns/behaviors history of substance abuse/meds family history how independent pt is brain injuries ```
293
Assessment for cognitive impairment (examination)
main points: general appearance, behavior, assess cognitive function clothes and hygiene, do they pay attention, how they move, bruises from falling, facial expressions and responses, alert and orientated
294
Mini-Mental State Exam (MMSE)
use to check for cognitive impairment | higher numbers mean they are fine
295
Aphasia/Dysphasia
language impairment, may have difficulty w/production or comprehension of language
296
Agraphia/Dysgraphia
inability to write
297
Agnosia
impaired ability to recognize objects or persons through the five senses
298
Alexia
impaired reading ability
299
Apraxia
inability to perform purposeful movements or manipulate objects (even though sensory/motor ability is intact)
300
Confabulation
making up answers w/o regard to fact
301
Diagnostic tests for cognitive impairment
``` Lab tests (ex. WBC, blood glucose, electrolytes) Brain imaging (can ID brain abnormalities) Neuropsychometric testing ```
302
Clinical management primary prevention
Promote healthy life Education on substance abuse, risky activities, healthy pregnancy and aging Genetic counseling (risk for abnormalities) Practices to reduce risk for delirium (ex. lose dose/time for meds, have family visit, manage pain and infections)
303
Collaborative interventions for cognitive impairment (main points)
Treatment depends on cause Safety measures Interdisciplinary treatment (work w/medicine, nutritious, speech and language, home health, etc.)
304
Collaborative interventions for cognitive impairment (general management strategies)
``` promote general health and comfort reorientation (items from home) pain management regulation of stimulation (ex. lighting, clutter, noise) behavioral management (give activities) sensory aids caregiver support ```
305
Pharm for cognitive impairment
treat s/s, diseases, or control behavior | cholinesterase inhibitors and glutamate receptor antagonist
306
Is dementia a normal part of aging?
No!
307
Dementia is characterized by | and general adverse effects and risk
decline in one or more of the six domains of cognition adverse effects on work, ability to perform ADLs risk for injury, impaired nutrition, social isolation
308
Dementia etiology
Caused by treatable and untreatable issues (need to treat early) Most common causes: neurodegenerative or vascular disorders
309
Dementia onset
Neurologic degeneration is gradual Vascular dementia may appear abruptly or in a stepwise progression
310
Dementia diagnosis
``` Focused on determining the cause First step: medical, neurologic, and psychosocial history (cognitive/behavior changes, include family, rule out other conditions) Then neuroimaging (rule out other conditions) ```
311
Nursing and interprofessional management of dementia
treat risk factors to try to prevent it: HTN (BV constrict), diabetes (BV damage), smoking (BV constrict), hypercholesterolemia (plaque build up), dysrhythmias (need blood flow & O2)
312
Alzheimer's disease (AD) background info
Chronic, progressive, neurodegenerative brain disease Most common type of Dementia Cannot be prevented/cured, cannot slow progression Use only live 4-8 years after diagnosis (but can live longer)
313
Alzheimer's disease health disparities
women more likely (live longer) | blacks and hispanics more likely (SES risk, education, lifestyle, CV disease, diabetes)
314
Alzheimer's disease etiology
age 65 yr+ (biggest risk factor) family history diabetes mellitus (high levels insulin & glucose, insulin resistance, risk to not be able to break down protein) head trauma
315
Retrogenesis
Process where degenerative changes occur in the reverse order in which development occurred
316
Behavioral problems w/Alzheimer's
``` Repetitiveness; asking same questions Delusions, Hallucinations Agitation, Aggression Altered sleep patterns Wandering Hoarding Resisting care ```
317
Neuropsychologic testing tool for Alzheimer's
Mini-Cog | Mini-mental state examination (MMSE)
318
Nursing Interventions for Alzheimer's
Maintain function for as long as possible Maintain safe environment Educating/supporting the caregiver(s) Awareness that hospitalization can worsen disease Behavioral problems (Redirect, distract and reassure, validate) Infection prevention Skin Care Elimination problems
319
Sundowning and interventions
Patient becomes more confused and agitated in late afternoon or evening Stay calm, maximize daylight, limits naps and caffeine, evaluate meds
320
Alzheimer’s Disease Safety
Injury: fall, Ingesting dangerous substance, Wandering, Inability to respond to crisis Minimize risks in home environment Supervision GPS
321
Alzheimer’s Disease Safety
Injury: fall, Ingesting dangerous substance, Wandering, Inability to respond to crisis Minimize risks in home environment Supervision GPS
322
Alzheimer’s Disease Eating and Swallowing Difficulties
Remind patients to chew/swallow; offer liquids frequently Provide quiet and unhurried environment Easy-grip utensils and finger food for self-feeding Offer liquids frequently
323
When chewing and swallowing become difficult, use:
Pureed food Thickening liquids Nutritional supplements
324
Orthostatic hypertension
patient moves from a supine to standing position, and there is a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in the HR of 20 beats/min dizzy, lightheaded

NUR 325 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions