Exam 1 Flashcards
1
Q
Describe the steps of the EBP process
A
- ask the clinical question
- search for evidence
- appraise & synthesize the evidence
- integrate w/ clinical expertise, pt values, & preferences for implementation
- evaluate
2
Q
Define the health-illness continuum
A
- dynamic movement between optimal wellness & premature death
- position on continuum based on adaptions internal & external stressors
- multiple opportunities for enhancement (levels of prevention)
3
Q
Distinguish between the characteristics of acute & chronic illness
A
ACUTE:
- occurs often
- comes quick
- short duration
- HAS a cure
- affects MOST aspects of life
- goal= restore health
CHRONIC ILLNESS:
- symptoms slowly start showing
- lasts over 6 months
- NO cure
- affects ALL aspects of life
- goal= maintain/attain wellness
4
Q
Compare genetics & genomics
A
GENOMICS:
- study of ALL genes making up a human genome
- interaction w/ each other & the environment
GENETICS:
- study of INDIVIDUAL genes & their effect on single gene disorders
5
Q
Review teaching implication regarding adult learning principles
A
- independence
- readiness: when is a good time to learn?
- past experiences: figure out what they already know
- immediate value: whats the most important change?
- problem solve
- lean by doing: hands on
- self concept: can pt perform the task?
6
Q
Discuss health promotion models
A
7
Q
Examine characteristics of the sick role
A
variables that influence behaviors
- perceived seriousness: of their illness
- inconvenience
- visibility of symptoms
- chronic vs acute: did they just find out?
- culture: how does it affect the pt?
- economics: what can they afford?
8
Q
Define stress
A
- RESPONSE TO DEMANDS placed on one’s body and/or in mind
- VARIES between individuals
9
Q
Define stressor
A
- environmental DEMAND THAT REQUIRES an individual TO ADAPT
10
Q
Describe the physiologic response to stress
A
- exhaustion
- alarm (fight or flight)
- resistance (autonomic system turns on)
11
Q
Contrast community-based & community-orientated nursing
A
COMMUNITY ORIENTED:
- primary prevention
- public health nursing
- individuals, families & groups
- health promotion of populations
COMMUNITY BASED:
- secondary & tertiary prevention
- illness oriented care across the LIFESPAN
- assist pts to manage acute & chronic health changes
12
Q
Distinguish differences in nociceptive & neuropathic pain
A
NOCICEPTIVE PAIN:
- somatic & visceral TISSUE DAMAGE
- responsive to opioids & non-opioids (NSAIDS)
NEUROPATHIC PAIN:
- peripheral nerve or CNS damage (pinched nerves or nerve pain)
- requires adjuvant therapies & opioids (analgesics)
13
Q
Discuss pain assessment
A
0-10 scale
- subjective: whenever wherever
- individualized: can mean different things to different ppl
- multidimensional
- objective signs are unreliable: vitals, facial grimacing, guarding
- chronic pain suffers may increased sensitivity: moans & groans
14
Q
List pharmacologic therapies for pain management
A
- opioids
- non opioids
- antidepressants
- anti-epileptic drugs
- local anesthetics
- medical marijuana
15
Q
List non pharmacologic therapies for pain management
A
- massage
- acupuncture
- heat or cold therapy
- exercise
- distraction
- relaxation techniques ( deep breathing or exercise)
16
Q
Water functions to…
A
- regulate temp
- lubricate joints
- aid in food digestion
17
Q
What is the avg amt of water in adults?
A
60%
18
Q
Describe intracellular fluid
A
- fluid WITHIN cells
- majority of fluid (40%)
19
Q
Describe extracellular fluid
A
- INTERSTITIAL fluid
- plasma
- transcellular
EX: edema or spinal fluid
20
Q
Describe Simple Diffusion
A
- solutes move to a low concentration
- goal= equal concentration
- permeable membrane
- no energy require
21
Q
Describe Facilitated Diffusion
A
- solutes move to low concentration
- no energy required
- requires carrier molecule such as protein
22
Q
Describe Active Transport
A
- movement against concentration gradient
- requires ATP (energy)
- Sodium-Potassium pump: to move against the concentration
EX: heart contraction & muscle movement
23
Q
Explain osmosis
A
- water moves to high solute concentration
- semipermeable membrane: passive
- osmotic pressure
24
Q
Explain hydrostatic PUSH pressure
A
- fluid force within a compartment (EX: BP)
- gradually decreases through a vascualr system
- pushes water out at arterial end of capillaries
25
Explain oncotic (colloidal osmotic) PULL pressure
- proteins attract water
- pull fluid toward greater protein concentration
26
What is First Spacing
- normal distribution of fluid in the ICF & ECF compartments
27
What is Second Spacing
- abnormal accumulation of interstitial fluid
EX: edema
28
What is Third Spacing
- trapped fluid
- not easy for it to go back
29
Interprofessional Management: HYPERnatremia
- replace fluids: hypotonic IV, free water flushes (make corrections SLOWLY)
- restrict dietary sodium
- monitor sodium levels
30
Interprofessional Management: HYPOnatremia
- identify cause
- monitor sodium levels
- restrict free water
- increased salt in water
- hypertonic IV fluids (slowly correct over a few days)
31
Interprofessional Management: HYPERkalemia
- ECG, telemetry
- hold patassium source
- increasing renal elimination by increasing fluids & use of diuretics
- Kayexalate-resin that binds K+ & removes via feces
- IV insulin, dextrose to drive K+ into cell
- calcium gluconate: stabilizes cardiac cell membrane
- dialysis
32
Interprofessional Management: HYPOkalemia
TX:
- stop loss
- monitor pt: blood level, S&S
REPLACEMENT:
- foods: fruit, especially dried
ORAL MED:
- GI irritant therefore take w/ food
IV THERAPY:
- irritating to the vein
- no IV push
- 20 mEq per hr IVPB
33
Interprofessional Management: HYPERcalcemia
- identify & stop underlying cause
- encourage low dietary calcium & weight-bearing exercises
- encourage PO fluids, 3-4L/day
- for more severe: IV saline, Calcitonin or Biphosphonate
34
Interprofessional Management: HYPOcalcemia
- identify & treat underlying cause
- calcium supplements (oral or IV)
- assess for potential hypocalcemia: assess head/neck surgical pts
35
Interprofessional Management: HYPOphosphatemia
- mild deficiency: oral supplement, increased intake of dairy products
- severe deficiency: sodium phosphate pr Potassium phosphate IV
36
Interprofessional Management: HYPERphosphatemia
- identify & treat cause
- restrict dairy products
- correct hypocalemia & provide hydration
- renal pts: calcium supplements, phosphate binding agent, phosphate dietary restrictions
37
Interprofessional Management: HYPERmagnesemia
- prevention is key (check OTC labels)
- calcium chloride or calcium gluconate
38
Interprofessional Management: HYPOmagnesemia
- mild-oral supplement, increased intake of magnesium rich foods
- severe or IM supplement
39
Discuss the role of nurses & their legal responsibilities in the preparation of the pt for surgery
- witness signature on informed consent
40
Describe measures taken pre-operatively to ensure the safety of the pt
- nursing assessment, pt history
- informed consent
- surgical site marked (from doc)
- pre op meds administered
-SBAR
41
Describe the different levels of restriction in the OR dept
UNRESTRICTED:
- point of entry, holding area, staff locker rooms
SEMI-RESTRICTED: surgical attire & covering of facia/hair
RESTRICTED: surgical attire plus masks/ surgical PPE
42
Describe role of the surgeon
- directs the process
- dependent on other team members (b/c they have to stay sterile)
- site verification (informed consent)
- surgical procedure
43
Describe role of assistant surgeon or RN first assist
- works collaboratively w/ surgeon
- prepares & uses instruments
- assist as needed during the procedure within scope of practice
44
Describe role of Anesthesia Provider
- physician or certified registered nurse anesthetist
- administer anesthesia
- monitors BP, breathing (ABCs), airway (open)
45
Describe role of Circulating RN
- NOT sterile
- must be an RN or have access to RN
- manages OR
- protects pt safety
- verifies consent
- monitors aseptic technique
- documents
46
Describe role of Scrub RN aka First Assist RN
- STERILE
- performs surgical hand scrub
- sets up sterile tables
- anticipates & hands sterile equipment to surgeon
- verifies sponge & instrument counts w/ circulator
- could be surgical tech or LPN
47
Distinguish among the types of anesthesia: general, moderate, monitored, regional & local
GENERAL: VERY deep sedation
- severe CNS depression by pharmacologic agents (bc of all the meds)
- inhalation or IV - combo most common
- IV allows for rapid induction/quick intubation
MONITORED: deep sedation
- airway monitoring by anesthesia provider
- won't usually remember even having surgery
- less intense than general
EX: colonoscopy or dental procedures
MODERATE: conscious sedation
- sedation per procedure
- RN can be trained to provide
- less risky ADRs
EX: ketamine, fentanyl, versed - at the bedside
REGIONAL:
-EPIDURAL
> sensory block
> SENSORY block
> less sensation= less motor
- SPINAL
> autonomic, sensory & motor block
> pt awake but cant FEEL
EX: GI procedures, foot or knee procedures
LOCAL:
- topical or infiltration of tissues
- still injected
-fewer systemic ADRs
- before suturing/stitches
48
Which meds are used during the pre-induction phase of anesthesia?
- Benzodiazepines
- Opioids
- Antibiotics
- Zantac
- Reglan
- Scopolamine
49
Which meds are used during the induction phase of anesthesia?
- Benzodiazepines
- Opioids
- Barbiturates
- Hypnotics
- Volatile Gases
50
What meds are used during the maintenance phase of anesthesia?
- Benzodiazepines
- Opioids
- Barbiturates
- Hypnotics
- Volatile Gases
- Neuromuscular
- blocking agents
51
Which meds are used during the emergence phase of anesthesia?
REVERSAL AGENTS:
- anticholinergics
- anticholinesterase
SYMPATHOMIMESTICS:
- opioid antagonist
- Benzodiazepines antagonist
SUPPLEMENTAL:
- opioids
- antiemetics
52
Describe the goals & principles of surgical asepsis
- prevent site infections
- prevent contamination of the open surgical would by isolating the wound
53
Describe nursing management of the pt post-op from PACU
AIRWAY: stays open
- patency
BREATHING: ascultate
- effort, breath sounds, pulse ox, oxygen
CIRCULATION
-apical HR, NIBP, temp (distal extremities) , color (cap refill)
NEUROLOGIC:
- LOC, orientation, PERRLA, sensory/motor
SURGICAL SITE:
- dressings, drainage, wound drains
PAIN:
- grimacing, restless, PCA pump
GASTROINTESTINAL:
- nausea, vomiting (worried about aspiration)
GENITOURINARY:
- foley catheter (emptying if needed)
54
Describe nursing management of the pt from admission from PACU
- prepare the room
- transports & gives report on the following...
> procedure
> anesthesia used
> intraoperative & PACU I&O
> unexpected events
> vital sign trends
55
Describe nursing management of the pt discharge from PACU
- awake
- stable vital signs
- bleeding controlled
- adequate respiratory status (SaO2 > 90%)
56
Describe possible complications of surgery
- respiratory effort increased or absent
- accessory muscle use= breathing issue
- restlessness or agitation
- muscle twitching
- vital sign changes
- delayed cap refill
- cyanosis
57
Describe informed consent
- legal document
- voluntary, non coerced
- info about the procedure, risks, benefits & alternative treatments
- witnessed signature (RN or surgeon)
- can be withdrawn at any time
58
Assessment for Pre-Op patients
- priority is to identify risk factors such as...
- determine psychological readiness
- assess physiologic readiness
- establish baseline data for comparison
- identify med red flags (BP meds, blood thinners, insulin)
- ensure appropriate labs/diagnostics obtained
- identify cultural/ethnic influences
- determine pt's understanding of procedure
59
Explain causes, clinical manifestations & treatments for fluid volume deficit
CAUSES:
- abnormal fluid loss, inadequate fluid intake or plasma to interstitial fluid shifts
CLINICAL MANIFESTATIONS:
- lethargy, dry mucous membranes, decreased turgor, decreased urine output, tachycardia, hypotension
TX:
- correct underlying cause & replace fluid & electrolytes
EX: IV lactated ringers, NS, blood
60
Explain causes, clinical manifestations & treatments of fluid volume excess
CAUSES:
- excessive intake, abnormal retention, shift from interstitium to plasma
CLINICAL MANIFESTATIONS:
- lethargy, peripheral edema, dyspnea, distended neck veins, weight gain, hypertension
TX:
- identify & correct cause, remove fluid & maintain electrolyte balance
EX: diuretics, fluid restriction, sodium restriction
61
Describe RN interventions for fluid volume excess or deficit
- monitor i&O
- monitor vital signs
- respiratory assessment
- neuro assessment
- daily weights
- skin turgor
- presence of edema
62
What are the treatments for Fluid Volume Deficit
- correct underlying cause & replace fluid & electrolytes
- IV LR, NS, blood
63
What are the treatments for Fluid Volume Excess?
- identify & correct cause, remove fluid & maintain electrolyte imbalance
- diuretics, fluid restriction, sodium restriction
64
Function of Sodium
- regulates acide/base balance
- muscle contractility
- transmission of nerve impulses
65
HYPERnatremia clinical manifestations
- restlessness
- agitation
- seizures
- coma
- weight loss
- weakness
- intense thirst
- dry swollen tongue
66
Causes of HYPERnatremia
- decreased water intake
- comatose
- NPO
- hypertonic tube feeding
- watery diarrhea
- increased water output
67
Causes of HYPOnatremia
- increased water intake
- decreased water output
- excessive NA+ loss
- skin losses
- vomiting
- diarrhea
- renal disease
- fasting diets
68
HYPOnatremia clinical manifestations
- irritability
- apprehension
- confusion
- cold clammy skin
- dry mucus membranes
69
Function of Potassium
- transmission of nerve impulses having to do with cardiac & skeletal muscles
- carrier for glucose & insulin
70
Causes of HYPERkalemia
- decreased loss
- adrenal insufficiency
- renal failure: decreased output
- ACE inhibitors
- acidosis
- massive tissue damage: crushing & burns
71
HYPERkalemia clinical manifestations
- irritability
- anxiety
- abdominal cramping
- irregular pulse
- cardiac arrest
- EKG changes
- ventricular fibrillation
- paresthesias
72
Causes of HYPOkalemia
- decreased intake
- incerased loss
- renal losses
- diuretics
- failure to replace losses
- decreased food & liquid intake
- metabolic alkalosis
- tissue repair
- vomiting & diarrhea
- dialysis
73
Functions of Calcium
- blood clotting
- formation of teeth & bone
- balance controlled by parathyroid hormone, calcitonin & vitamin D
74
Causes of HYPERcalcemia
- hyperparathyroidism
- vitamin D overdose
- prolonged immobilization
- malignancy
75
HYPERcalcemia clinical manifestations
- depressed reflexes
- bone pain
- fractures
- renal canniculi
76
Function of Phosphorus
- function of muscle, RBCs, & nervous system
- cellular glucose uptake & use
- metabolism
77
Where does phosphorus come from
- majority from bone but also dietary like dairy
78
Causes of HYPERphosphatemia
- renal failure
- chemotherapy
- excessive milk ingestion
- vitamin D excess
79
Causes of HYPOphosphatemia
- malnutrition
- decreased intake
- alcohol withdrawal
- antacids
80
HYPOphosphatemia clinical manifestations
- asymptomatic if mild
- CNS depression
- confusion
- muscle weakness
- pain
- dysthymias
81
Function of Magnesium
- metabolism of cabs & protein
82
Cause of HYPERmagnesemia
- increased intake w/ decreased renal function
83
HYPERmagnesemia clinical manifestation
- lethargy
- drowsiness
- early nausea & vomiting
- arrest
84
Causes of HYPOmagnesemia
- starvation
- prolonged fasting
- chronic alcoholism
- NG suction
- diabetes mellitus
- diarrhea
85
HYPOmagnesemia clinical manifestations
- confusion
- hyperreflexia
- tremors
- seizure
- cardiac dysrhymias
86
Describe hypotonic solutions
- provides more water than electrolytes
- water moves from ECF ---> ICF
EX: 0.45% saline, 5% dextrose in water (D5W)
87
Describe isotonic solutions
- expand ECF only
EX: LR, 0.9% NS
88
Describe hypertonic Solutions
- increases ECF osmolality & volume
- use for hypovolemia & hyponatremia
EX: 3% saline, dextrose & saline solutions (D5 1/2 NS, D5NS)
