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NUR-354 > Exam 1 > Flashcards

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
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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)
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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

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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

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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?
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6
Q

Discuss health promotion models

A
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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?
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8
Q

Define stress

A
  • RESPONSE TO DEMANDS placed on one’s body and/or in mind
  • VARIES between individuals
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9
Q

Define stressor

A
  • environmental DEMAND THAT REQUIRES an individual TO ADAPT
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10
Q

Describe the physiologic response to stress

A
  • exhaustion
  • alarm (fight or flight)
  • resistance (autonomic system turns on)
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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

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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)
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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
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14
Q

List pharmacologic therapies for pain management

A
  • opioids
  • non opioids
  • antidepressants
  • anti-epileptic drugs
  • local anesthetics
  • medical marijuana
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15
Q

List non pharmacologic therapies for pain management

A
  • massage
  • acupuncture
  • heat or cold therapy
  • exercise
  • distraction
  • relaxation techniques ( deep breathing or exercise)
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16
Q

Water functions to…

A
  • regulate temp
  • lubricate joints
  • aid in food digestion
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17
Q

What is the avg amt of water in adults?

A

60%

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18
Q

Describe intracellular fluid

A
  • fluid WITHIN cells
  • majority of fluid (40%)
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19
Q

Describe extracellular fluid

A
  • INTERSTITIAL fluid
  • plasma
  • transcellular
    EX: edema or spinal fluid
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20
Q

Describe Simple Diffusion

A
  • solutes move to a low concentration
  • goal= equal concentration
  • permeable membrane
  • no energy require
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21
Q

Describe Facilitated Diffusion

A
  • solutes move to low concentration
  • no energy required
  • requires carrier molecule such as protein
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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

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23
Q

Explain osmosis

A
  • water moves to high solute concentration
  • semipermeable membrane: passive
  • osmotic pressure
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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
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25
Q

Explain oncotic (colloidal osmotic) PULL pressure

A
  • proteins attract water
  • pull fluid toward greater protein concentration
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26
Q

What is First Spacing

A
  • normal distribution of fluid in the ICF & ECF compartments
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27
Q

What is Second Spacing

A
  • abnormal accumulation of interstitial fluid
    EX: edema
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28
Q

What is Third Spacing

A
  • trapped fluid
  • not easy for it to go back
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29
Q

Interprofessional Management: HYPERnatremia

A
  • replace fluids: hypotonic IV, free water flushes (make corrections SLOWLY)
  • restrict dietary sodium
  • monitor sodium levels
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30
Q

Interprofessional Management: HYPOnatremia

A
  • identify cause
  • monitor sodium levels
  • restrict free water
  • increased salt in water
  • hypertonic IV fluids (slowly correct over a few days)
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31
Q

Interprofessional Management: HYPERkalemia

A
  • 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
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32
Q

Interprofessional Management: HYPOkalemia

A

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

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33
Q

Interprofessional Management: HYPERcalcemia

A
  • 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
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34
Q

Interprofessional Management: HYPOcalcemia

A
  • identify & treat underlying cause
  • calcium supplements (oral or IV)
  • assess for potential hypocalcemia: assess head/neck surgical pts
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35
Q

Interprofessional Management: HYPOphosphatemia

A
  • mild deficiency: oral supplement, increased intake of dairy products
  • severe deficiency: sodium phosphate pr Potassium phosphate IV
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36
Q

Interprofessional Management: HYPERphosphatemia

A
  • identify & treat cause
  • restrict dairy products
  • correct hypocalemia & provide hydration
  • renal pts: calcium supplements, phosphate binding agent, phosphate dietary restrictions
37
Q

Interprofessional Management: HYPERmagnesemia

A
  • prevention is key (check OTC labels)
  • calcium chloride or calcium gluconate
38
Q

Interprofessional Management: HYPOmagnesemia

A
  • mild-oral supplement, increased intake of magnesium rich foods
  • severe or IM supplement
39
Q

Discuss the role of nurses & their legal responsibilities in the preparation of the pt for surgery

A
  • witness signature on informed consent
40
Q

Describe measures taken pre-operatively to ensure the safety of the pt

A
  • nursing assessment, pt history
  • informed consent
  • surgical site marked (from doc)
  • pre op meds administered
    -SBAR
41
Q

Describe the different levels of restriction in the OR dept

A

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
Q

Describe role of the surgeon

A
  • directs the process
  • dependent on other team members (b/c they have to stay sterile)
  • site verification (informed consent)
  • surgical procedure
43
Q

Describe role of assistant surgeon or RN first assist

A
  • works collaboratively w/ surgeon
  • prepares & uses instruments
  • assist as needed during the procedure within scope of practice
44
Q

Describe role of Anesthesia Provider

A
  • physician or certified registered nurse anesthetist
  • administer anesthesia
  • monitors BP, breathing (ABCs), airway (open)
45
Q

Describe role of Circulating RN

A
  • NOT sterile
  • must be an RN or have access to RN
  • manages OR
  • protects pt safety
  • verifies consent
  • monitors aseptic technique
  • documents
46
Q

Describe role of Scrub RN aka First Assist RN

A
  • 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
Q

Distinguish among the types of anesthesia: general, moderate, monitored, regional & local

A

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
Q

Which meds are used during the pre-induction phase of anesthesia?

A
  • Benzodiazepines
  • Opioids
  • Antibiotics
  • Zantac
  • Reglan
  • Scopolamine
49
Q

Which meds are used during the induction phase of anesthesia?

A
  • Benzodiazepines
  • Opioids
  • Barbiturates
  • Hypnotics
  • Volatile Gases
50
Q

What meds are used during the maintenance phase of anesthesia?

A
  • Benzodiazepines
  • Opioids
  • Barbiturates
  • Hypnotics
  • Volatile Gases
  • Neuromuscular
  • blocking agents
51
Q

Which meds are used during the emergence phase of anesthesia?

A

REVERSAL AGENTS:
- anticholinergics
- anticholinesterase

SYMPATHOMIMESTICS:
- opioid antagonist
- Benzodiazepines antagonist

SUPPLEMENTAL:
- opioids
- antiemetics

52
Q

Describe the goals & principles of surgical asepsis

A
  • prevent site infections
  • prevent contamination of the open surgical would by isolating the wound
53
Q

Describe nursing management of the pt post-op from PACU

A

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
Q

Describe nursing management of the pt from admission from PACU

A
  • prepare the room
  • transports & gives report on the following…
    > procedure
    > anesthesia used
    > intraoperative & PACU I&O
    > unexpected events
    > vital sign trends
55
Q

Describe nursing management of the pt discharge from PACU

A
  • awake
  • stable vital signs
  • bleeding controlled
  • adequate respiratory status (SaO2 > 90%)
56
Q

Describe possible complications of surgery

A
  • respiratory effort increased or absent
  • accessory muscle use= breathing issue
  • restlessness or agitation
  • muscle twitching
  • vital sign changes
  • delayed cap refill
  • cyanosis
57
Q

Describe informed consent

A
  • 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
Q

Assessment for Pre-Op patients

A
  • 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
Q

Explain causes, clinical manifestations & treatments for fluid volume deficit

A

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
Q

Explain causes, clinical manifestations & treatments of fluid volume excess

A

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
Q

Describe RN interventions for fluid volume excess or deficit

A
  • monitor i&O
  • monitor vital signs
  • respiratory assessment
  • neuro assessment
  • daily weights
  • skin turgor
  • presence of edema
62
Q

What are the treatments for Fluid Volume Deficit

A
  • correct underlying cause & replace fluid & electrolytes
  • IV LR, NS, blood
63
Q

What are the treatments for Fluid Volume Excess?

A
  • identify & correct cause, remove fluid & maintain electrolyte imbalance
  • diuretics, fluid restriction, sodium restriction
64
Q

Function of Sodium

A
  • regulates acide/base balance
  • muscle contractility
  • transmission of nerve impulses
65
Q

HYPERnatremia clinical manifestations

A
  • restlessness
  • agitation
  • seizures
  • coma
  • weight loss
  • weakness
  • intense thirst
  • dry swollen tongue
66
Q

Causes of HYPERnatremia

A
  • decreased water intake
  • comatose
  • NPO
  • hypertonic tube feeding
  • watery diarrhea
  • increased water output
67
Q

Causes of HYPOnatremia

A
  • increased water intake
  • decreased water output
  • excessive NA+ loss
  • skin losses
  • vomiting
  • diarrhea
  • renal disease
  • fasting diets
68
Q

HYPOnatremia clinical manifestations

A
  • irritability
  • apprehension
  • confusion
  • cold clammy skin
  • dry mucus membranes
69
Q

Function of Potassium

A
  • transmission of nerve impulses having to do with cardiac & skeletal muscles
  • carrier for glucose & insulin
70
Q

Causes of HYPERkalemia

A
  • decreased loss
  • adrenal insufficiency
  • renal failure: decreased output
  • ACE inhibitors
  • acidosis
  • massive tissue damage: crushing & burns
71
Q

HYPERkalemia clinical manifestations

A
  • irritability
  • anxiety
  • abdominal cramping
  • irregular pulse
  • cardiac arrest
  • EKG changes
  • ventricular fibrillation
  • paresthesias
72
Q

Causes of HYPOkalemia

A
  • decreased intake
  • incerased loss
  • renal losses
  • diuretics
  • failure to replace losses
  • decreased food & liquid intake
  • metabolic alkalosis
  • tissue repair
  • vomiting & diarrhea
  • dialysis
73
Q

Functions of Calcium

A
  • blood clotting
  • formation of teeth & bone
  • balance controlled by parathyroid hormone, calcitonin & vitamin D
74
Q

Causes of HYPERcalcemia

A
  • hyperparathyroidism
  • vitamin D overdose
  • prolonged immobilization
  • malignancy
75
Q

HYPERcalcemia clinical manifestations

A
  • depressed reflexes
  • bone pain
  • fractures
  • renal canniculi
76
Q

Function of Phosphorus

A
  • function of muscle, RBCs, & nervous system
  • cellular glucose uptake & use
  • metabolism
77
Q

Where does phosphorus come from

A
  • majority from bone but also dietary like dairy
78
Q

Causes of HYPERphosphatemia

A
  • renal failure
  • chemotherapy
  • excessive milk ingestion
  • vitamin D excess
79
Q

Causes of HYPOphosphatemia

A
  • malnutrition
  • decreased intake
  • alcohol withdrawal
  • antacids
80
Q

HYPOphosphatemia clinical manifestations

A
  • asymptomatic if mild
  • CNS depression
  • confusion
  • muscle weakness
  • pain
  • dysthymias
81
Q

Function of Magnesium

A
  • metabolism of cabs & protein
82
Q

Cause of HYPERmagnesemia

A
  • increased intake w/ decreased renal function
83
Q

HYPERmagnesemia clinical manifestation

A
  • lethargy
  • drowsiness
  • early nausea & vomiting
  • arrest
84
Q

Causes of HYPOmagnesemia

A
  • starvation
  • prolonged fasting
  • chronic alcoholism
  • NG suction
  • diabetes mellitus
  • diarrhea
85
Q

HYPOmagnesemia clinical manifestations

A
  • confusion
  • hyperreflexia
  • tremors
  • seizure
  • cardiac dysrhymias
86
Q

Describe hypotonic solutions

A
  • provides more water than electrolytes
  • water moves from ECF —> ICF

EX: 0.45% saline, 5% dextrose in water (D5W)

87
Q

Describe isotonic solutions

A
  • expand ECF only
    EX: LR, 0.9% NS
88
Q

Describe hypertonic Solutions

A
  • increases ECF osmolality & volume
  • use for hypovolemia & hyponatremia

EX: 3% saline, dextrose & saline solutions (D5 1/2 NS, D5NS)

NUR-354 (3 decks)

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