Exam 1 & 2 G&D, Teaching & Learning Flashcards
Why do nurses need teaching skills?
ANA standard related to promoting health demands skills in teaching clients.
What is the no. 1 priority of what nurses do?
Safety is the underpinning of what you do.
What does teaching involves?
Planning and implementing instructional activities that allow clients to learn.
What is the goal of teaching?
To meet learner outcomes.
When is the prime time to do teaching and learning?
When the patient asks a question!
What is key to master a skill?
Repitition!
Active process involving more than just giving information.
What are the 3 domains of learning?
Cognitive
Psychomotor
Affective
What is an example of cognitive learning?
Storage & recall of info.
i.e- Facts about disease
What is an example of psychomotor learning?
involves “hands-on” skill.
thinking and doing.
i.e- self administration of insulin/medicine, etc.
What is an example of affective learning?
changing feelings, beliefs, attitudes, and values.
i.e- changing a belief about diet.
Driven by emotions from grief/loss
i.e- disease driven-> causes emotions to want to learn more
What are the 5 stages of illness in death and dying?
- Denial
- Anger
- Bargaining
- Resolution
- Acceptance
What is “present tense” teaching and in what stages?
“REALITY”- Stages 1-4.
i.e- engage with pt: talk with them while administering meds. Not LT, its what is going on now. Provide support.
What stage do you do both present and future teaching?
Stage 5. Acceptance.
What is the study of drugs (chemicals) that alter functions of living organisms?
Pharmacology
What kind of information is it if a physician or nurse observes/sees?
Objective
What kind of information is if the patient states, sees, or describes to nurse?
Subjective
What is the Food and Drug Administration responsible for?
*Ensuring safety & efficacy of drugs before they can be marketed.
Approves many new drugs annually (OTC & prescription)
May change status from prescription to OTC
What law regulates the manufacture, distribution, advertising and labeling of drugs?
The food, drug, and cosmetic act of 1938.
What law designates drugs that must be prescribed by a licensed physician or NP & dispensed by a pharmacist? Who enforces the law?
The Durham-Humphrey Amendment
The FDA is in charge with enforcing the law.
What act regulates the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids?
The Controlled Substance Act
How are controlled substance dugs categorized?
According to therapeutic usefulness & potential for abuse & are labeled as “control substance”.
What are examples of controlled substances?
Morphine, CII or schedule II drug.
What is the use of drugs to prevent, diagnose, or treat s and sx and disease processes?
Drug Therapy
What are medications?
Drugs given for therapeutic purposes
What is the difference between local and systemic effects of medication?
Local acts mainly @ site of application.
Systemic is circulated via the bloodstream to sites of action and eventually eliminated from the body (in order to work).
Examples of local effects of medication?
Topical ointments or creams
What are the 4 drug sources?
Plants- primary source for meds (Digoxin from digitalis fox plant) for CVD pts
Animals- Insulin: pork or beef derived
Minerals- Mg, Fe,
Synthetic Compounds- constitutes a lot of meds that are synthetically derived
What is an example of a prototype?
Morphine- represents opioid analgesics
Penicillin- represents antibacterial drugs
What is the prototype?
Individual drugs that represent groups of drugs. Often the first drug of a particular group to be developed.
What are the 3 drug names?
Trade or Brand name
Generic Name
Chemical Name
What is the difference between brand and generic drug?
Brand names come out first.
Both drugs are bioequivalent= some constants, chemicals and dosage. Difference might be “MATRIX” in which the way chemicals break down.
Manufactured differently
What are scheduled meds?
Drugs that can pose additive (abuse potential) type of meds.
What are the 5 categories of controlled substances?
Schedule I- not approved for medical use and have high abuse potentials. (LSD, crack, shrooms, heroin) illegal
Schedule II- drugs that are used medically and high abuse potential (opioid analgesics, morphine, oxy)
Schedule III- drugs with less potential for abuse, but also may lead to psychological or physical dependents (androgens, anabolic steroids)
Schedule IV- Diazepam
Schedule V- moderate amts of controlled sub. (Lomotil, b/c atropine assoc with LSD)
If a medication is not lipid soluble (lipid bilayer) what do you need in order for the med to go into the cell?
ATP. Medications are either lipid or h2o soluble, need receptor to get in.
What are the 4 processes involved in pharmacokinetics?
Absorption Distribution Metabolism Excretion "what the body does to the drug" to reach ^.
What two processes are grouped as drug elimination or clearance mechanisms?
Metabolism and Excretion
What involves drug actions on target cells and the resulting alteration s in cellular biochemical reactions and functions?
Pharmacodynamics!
“what the drug does to the body”.
What is absorption?
The process of time it takes for the med to be absorbed in the blood stream. Onset of drug action is determined by rate of absorption.
What factors affect rate and extent of drug absorption?
dosage, route of administration, administration site blood flow and GI function
What is distribution?
The process in which drugs are carried by blood and tissue fluids to action sites, metabolism sites, and excretion sites.
Drugs are now in blood stream and will have its effects.
What meds bypass absorption?
IV meds, they go straight to distribution because directly in blood stream.
What factors affect distribution?
Blood flow, dehydration, blood disorder, and impaired circulation affects rate b/c of body circulation.
What two proteins carries meds to the site?
Globulin, and mostly Albumin
What is the metabolic process?
method by which drugs are inactivated or biotransfromed by the body. After the med reaches it’s active site, need to remove residuals from med.
Where are drug metabolizing enzyme located?
Within the organs.
What is the prime organ to filter/metabolize meds?
Liver!
Skin meds- breathe out
H20 soluble- excrete by Kidneys.
What is excretion?
Elimination of a medication from the body. Turn to metabolites so body can excrete.
Excretion requires adequate functions of what organs?
Liver- circulatory system
Kidneys- urine/bowel. convert lipid sol to h20 sol b/c kidneys c/n excrete fat and needs to be h20 sol, for urine excretion (metabolism).
Lungs and skins-
What is the serum drug level?
A lab measurement of the amount of drug in the blood at a particular time.
Drug absorption
Bioavailabilty, halflife
Rate of metabolism and excretion
What is the serum drug level used for?
To prevent toxicity= excessive level of med in blood stream
MEC- minimum effective concentration must be present for efficacy
Receptor theory of drug action?
Drugs exert their effects by chemically binding with receptor cells via:
activation, inactivation or alteration of intracellular enzymes, changes in permeability of cell memb, modification of the syntheysis of neurohormones.
What drugs do not need/act on receptor sites?
Antacids, osmotic diuretics, several anticancer drugs, and metal chelating agents.
What is dosage?
Refers to the frequency, size, and number of doses. Major determinant of drug actions and responses both therapeutic and adverse.
What characteristics does dosage depend on?
Recipient, age, weight, state of health, funct of cardiovascular, renal, and hepatic systems.
What are two outcomes of drug-diet interactions?
- Some drugs are used therapeutically to decrease food absorption in intestinal tract (fat, cholesterol).
- Some foods contain certain substances that react with certain drugs.
What foods does Tyramine interact with?
Cheese, sauerkraut, shoyu, beer, and red wines.
Interact with MAO inhibiters and causes norepinephrine release= vasoconstriction inactivated by MAO.
MAO inhibitor drugs precent inactivation of norepinephrine (antidep, antiparkinson drugs)
Resulting: sever HTN, intracranial HEMORRHAGE= death.
What drug does grapefruit interact with?
Statin group of cholesterol lowering drugs because grapefruit contains substance that inhibits drug metabolism, resulting TOXICITY.
Tetracyline (TCN) and dairy products?
Combines with Ca++ and excreted in feces. Antibiotic + dairy = combines with Ca== to form a nonabsorbable compound, excreted in feces.
What happens with a drug-drug interaction?
The action of a drug may be increased or decreased by its interaction with another drug in the body.
Additive effects
occur when two drugs with similar pharmacologic actions are take (e.g ethanol+sedative drug increases sedative effects)
Synergism
occurs when to drugs with different sites or mechanisms of action produce greater effects when taken together. (e.g acteminophen [nonopioid analgesic] + codeine [opioid analgesic] increase analgesic effects
Interference
By one drug with the metabolism of a second drug may result in intensified effects of the second drug. Result toxicity b/c blood levels of drug s are higher. (large dose action)
Displacement
(e.g- a drug with a strong attraction to protein binding sites may displace a less tightly bound drug of one drug from plasma protein binding sites by a 2nd drug increases effects of displaced drug.
What are 3 drug related variables that decrease the effects of a drug?
- Antidote- drug can be given to antagonize the toxic effects of another drug.
- Decreased intestinal absorption- occurs when drugs combine to produce nonabsorbable compounds.d
- Activation of drug metabolizing enzymes in lover, increases the metabolism rate of any drug metabolized mainly by that group of enzeymes and therefore decreases the drug’s effects
What is the most common way a drug is administered and why?
ORAL route because it the most economical, efficient, least invasive way, efficient, and most route prescribed.
What is the antidote for Morphine?
Naloxone- NARCAN is the opioid antagonist to relieve CNS and respiratory depression induced by an opioid.
What are the 8 different routes of administration?
- Tablets/capsules
- Sublingual
- SubQ
- IM
- IV
- Ear/eye drops
- Suppository
- Nebulizer
Why can’t thick coding tables be scored?
Coding provides safety so pt take it and does not absorb it until it hits the small intestines.
Onset
when drug hits MEC. start to see therapeutic effect. when drug onsets. i.e insulin has different types with different onsets- fast, long, etc.
Duration
How long drug will be in the body? Needs to be in the body for 4-5 half lifes to perform quality therapeutic effects.
What are the 6 R’s (rights)?
- Right medication
- Right dose
- Right client
- Right route
- Right time
- Right documentation
When should you check all R’s?
At critical times, ALWAYS.
Right reason
right to know
right to refuse
How do you verify client’s identity BEFORE administering medications?
- Identify pt before administering drugs
- Ask and validate client’s name
- Check and match with arm band
- Confirm DOB (at hospital)
What are the 5 R’s in action?
- pull med list and pt profile
- check 5 R’s for each med
- when done, do WHOLE check again
- at bedside, check and pt teach
- administer meds, wrap up sequence
What are the 4 nurses’ legal responsibilities?
- Safe, accurate med administration
- Recognizing & questioning erroneous orders
- Refusing to administer unsafe meds. “pts rights”
- Delegating incompliance with the law. Notify doc. the refusal and circle initial did not give med. (circle is universal sign)
First pass effect or presystemic metabolism
when drugs are given orally, they are absorbed from the GASROINTESTINAL TRACT and carried to the LIVER through the PORTAL CIRCULATION. Some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the systemic circulation for distribution to sites of action.
What is the serum half life?
The time required for the serum concentration of a drug to decrease to by 50%.
*Determined by drugs rate of metabolism and excretion
What would you do if a drug has a short half life?
A short half life requires more frequent administration versus one with a long half life.
What is the peak?
When drug level increases as more drug is absorbed..until it reaches HIGHEST CONCENTRATION.
What is duration?
Time during serum drug levels are at or above MEC.
What is the goal for drug therapy?
To maintain serum drug levels in the therapeutic range and avoid toxic ranges.
What should you pt teach about Digoxin?
abnormal heart rhythm risk so teach HOW TO TAKE RADIAL PULSE. if <50 bpm because digoxin slows heart rate down, and increases force of heart contraction (CHF)
What are 4 parenteral routes of administration?
Injected:
- Sub Q
- IM
- IV
- Intradermal
What are topical routes of administration?
Creams, solutions, suppositories- freq used for local treatment applied directly to skin or mucous membrane.
What is disruptive behavior?
Behavior that interferes with effective communication among healthcare providers and negatively impacts perfromance and outcomes. Not suppportive of a culture of safety.
What are the 3 common disruptive behaviors among nurses?
- Incivility
- Bullying
- Lateral Violence
How long does bullying need to be going on in order to be taken into consideration?
2x a week or more for at least 6 mo.
Targeted at an individual who cannot defend him or herself
Nurse and health care provider communication: SBAR
- Situation- what calling Dr. about?
- Background- info. pertinent to current sit.
- Assessment- what does nurse think is going on?
- Recommendation- to resolve the prob or what do you need from doc?
Why must nurses CT?
Pts are unique, complex with comorbidities, culturally diverse, diff age and gender.
Alfaro-Le Fevres’s 4 circle CT model?
- CT characteristics- attitudes and behaviors
- Theoretical and experiential knowledge- intellectual skills
- Interpersonal skills
- Technical skills- monitor pt is more imp versus worrying about technical skills
What is the nursing process and what is its purpose?
A systematic rational method of planning and providing individualized nursing care.
To help the nurse provide goal-directed client-centered care.
What are the 5 steps in the nursing process?
A-assessment "collecting Data" D-diagnosing P-planning I-implementation E-evaluation
What is the nursing assessment?
focuses on the client’s responses to a health problem. How does it affect the pt? Not a med. dx- disease/pathology
What are the 5 types of nursing assessment?
- Initial
- Problem-focused
- Emergency
- Time-lapsed reassessment
- Special needs- (functional as in stroke pts)
Which is the #1 source of data?
#1= CLIENT! client record- folder/doc to clinical care map support people family and nursing report
What is the purpose of a graphic flow sheet?
looking for patterns and change and trends!
–graph vitals, I&Os. look at big pic on pt to order drugs/give care.
What is the best time to document?
Document as soon as possible. Just facts. Put words in “ “.
Process for a nurse to do when working with a pt? AIDET.
A- acknowledge- as a pt/name I- introduce- nurse name D- duration- how long procedure E- explanation- explains as if pt is unconscious T- thank them- for giving their time
Moral principles: What is autonomy?
Your own beliefs.
Moral principles: What is nonmaleficence?
Do no harm.
Moral principles: What is beneficence?
Do good.
Moral principles: What is fidelity?
You are loyal, don’t make promises you can’t keep. DWYSYWD.
Moral principles: What is veracity?
Truthfulness, documentation/reportings need to be true.
Moral principles: What is justice?
treat governor and bum as the same. Care give is equal for everyone.
What is slander?
verbal abuse, orally stated
What is libel?
Written, in a note, be careful what you doc.
What is Defamation?
false communication to a third person
What is growth?
quantification, numeric value. Head circumference, height, weight.
During first 20 years.
What is development?
Looks at behavior. “Milestones” that are normal to be met.
Regardless of time baby developed a skill–>sequence is still the same for everyone.
throughout lifespan
What does cephalocaudal mean?
Growth occurs head->down & proximodistal->inwards out.
What are 4 international torts?
- Assault and battery- performing a procedure without consent.
- False imprisonment- restraining a client against her/his will
- Fraud- falling to provide essential information for informed consent
- Invasion of privacy- breach of confidentiality
What kind of theorist was Sigmund Freud?
PSYCHOSEXUAL/PSYCHOANALYTIC theory
unconscious mind
defense/adaptive mechanisms
id, ego, superego
Oral Stage (birth to 1.5 years)
sexual drive “labido” causing person in his theory to act a certain way.
baby nursing, oral gratification, security–>weining off.
baby gains security by oral source of pleasure
Anal Stage (1.5 to 3 years)
potty training
autonomy
anus is central gratification
Phalic stage (4-6 years)
genitals- exploring, masturbation may exist
oedipus- boy likes mom
electra- girl likes dad
Latency Stage (6-12 years)
Same gender relationships important.
Engage in sports/activities with same gender peers.
Genital Stage (13-20 years)
adult genetilia is a part of persons role and identity
energy directed toward full sexual maturity and function
What kind of theorist was Erikson?
PSYCHOSOCIAL theory
G&D focuses on development as a function of ENVIRONMENT
each stage involves a task that must be resolved.
What Erikson stage is from birth to 18 months?
Trust vs. Mistrust
What and when is Erikson’s stage 2?
18 mo-3 years. Autonomy vs. Shame and Doubt
What and when is Erikson’s stage 3?
3-5 years. Initiative vs. Guilt
What and when is Erikson’s stage 4?
6-11 years. Industry vs. Inferiority
What and when is Erikson’s stage 5?
12-21 years. Identity vs. Role confusion
What and when is Erikson’s stage 6?
21-40 years. Intimacy vs. Isolation
What and when is Erikson’s stage 7?
40-65 years. Generativity vs. Stagnation
What and when is Erikson’s stage 8?
> 65 years. Integrity vs. Despair
Who was a humanism theorist?
Maslow- “human behavior is guided by needs”
What was Maslow’s 5 levels in Hierarchy of Needs?
- Biological integrity
- Safety and security
- Belonging
- Self esteem
- Self actualization
Who was the cognitive theorist?
Piaget
What were Piaget’s 4 stages of development?
- Sensorimotor: 0-2 years
- Peroperational: 2-7 years
- Concrete operations: 7-11 years
- Formal operations
Who was the moral theorist?
Kohlberg and Gilligan.
A neonate is within?
The first 28 days, lunar calendar, menstrual cycle
Rooting reflex?
stroke cheek, head turn, ready to feed
Moro reflex?
all 4 limbs extend out & in…BOOM=startle baby
Stepping reflex?
stepping motion on table as you hold baby
What would you teach parents for neonates?
place on back to go sleep
no fluffy/thick bedding to prevent SIDS
on crib 2 3/4 in. not wider b/c accidental death
What is the leading cause of death from neonates to young adults?
ACCIDENTS.
Death from injuries…
What development theory is a neonate experiencing?
Oral, Trust vs. Mistrust, Sensorimotor
An infant is within?
First 12 mo./ 1st year of life
What should you educate for infant care?
- Never leave baby unattended near any amount of h20 and alone on changing table
- maintain routine, structure, and boundaries
- Give a lot of love, cuddle, promote TRUST!
What are 3 nursing assessments for infants?
- listen for baby coos
- parent interaction
- ADL’s- intake adequate amounts, normal rest and elimination patterns
What are the motor development benchmarks for an infant?
1 mo- lifts head when prone, head lag present
4 mo- minimal head lag
6 mo- sits without support
9 mo- reach, grasp, transfer object from hand to hand
12 mo- fine motor skills begin to develop
What are nursing implications in infants?
- Iron supplementation
2. Baby should produce 8 wet diapers per day.
When can food allergies be indicated?
Within the baby’s first year of life.
When does a child’s first tooth show and what might it convey to the parent?
about 6-7 months. May convey as flu b/c first tooth mimics cold/flu symptoms.
What is the primary take for a toddler (1-3 years)?
2 year old, potty training
Freud’s anal stage
What foods should you avoid for toddlers and why?
Small toys, grapes, and hot dogs because they can choke/aspirate
What 3 things does a toddler need in order to potty train?
- physically ready
- detect urge/be able to know one needs to go
- notify parent that one needs to go (pleasing parents).
If a toddler is hospitalized and a habit has regressed should you be concerned?
No because everyone’s anxiety rises and a toddler may be in a stressful setting therefore becomes incontinent again (regress) is common.
For a toddler, how do their VS change?
VS begin to come into normal range like adult VS. Versus at birth everything is increased.
When are the 3 growth spurts?
- In womb at 3rd trimester
- First year of life
- Adolescence
What age group experiences risky behavior?
ADOLESCENCE because staying out late, achieving economic standing, driving fast, going out more, live forever mentality, engaging in sex.
What is important for a young adult?
- Career
- Family
- Establishing financial security
- Starting civic responsibilities
What is important for adulthood?
Leaving a legacy for upcoming generation is their task/goal.
Helping kids/making a difference to the younger
What is the leading cause of death in adulthood?
Mortality and Morbidity= DISEASE!
What is the leading cause of death in an older adult?
CA, CVA (stroke).
When should you be concerned if a baby is not reaching or grabbing for something?
if baby is 10 months+
What is a safety concern for school age children?
2 wheel bike safety
What should you do to promote trust in an infant?
Cuddling
What is a toddler trying to establish?
Autonomy
What might an older adult be experiencing/feeling?
Lost…negative feelings
Congenital versus Inherited?
Congenital is present at birth and Inherited means genetics from mom/dad
Autosome versus chromosome?
autosome is genetics reference link (for genetic disorders) and chromosome is the sex determinate= X or Y
What are 4 types of inheritance patterns?
- Autosomal dominant- one carrier needed, single allele is needed for mutation: Marfan Syndrome, Huntington’s Disease
- Autosomal recessive-2 carriers needed, pair must be abnormal for the disorder to be expressed: PKU, Sickle cell anemia, cystic fibrosis
- X- linked recessive- sex link seen in men. rare/few in women. Transexuals- female with link.
- Multifactoral Inherited conditions- with family predisposition (health care dominant probs: HD, Diabetes, HTN, obesity, ADHD, schizo, bi polar, post pardon, etc.
What is euploidy?
normal. 46 chromosomes or 23 pairs.
Polypoidy is?
exact multiple of haploid. multiplied exactly, 23 more.
Aneuploidy is?
division not equal. (e.g- down syn. 21) leading cause of mental retardation, leading known cause of pregnancy loss.
What is monosomies?
embryo never survives. 45 chromosomes in each cell. Leading known reason for pregnancy loss, blighted ovum, AB imcompatibility, or unknown previous miscarriage of Rh incompatibility.
What is trisomies?
47 chromosomes in each cell. Most common form is Trisomy 21 (Down syn), risk increase with maternal age, 80% are born to mothers younger than 35 years old.
When should discharge teaching occur?
day 1 of admission and happens immediately!
What is the difference between first pass effect and serum half life?
FPE: reduction of concentration of drug through absorption by the liver. VERSUS SHL: duration of time before serum level reaches half of its given initial value.
What is the free form/floating?
is the ACTIVE form and available.
Bound?
are taken and used.
African Americans do not respond to what kind of drugs?
ACE inhibitors
If a patient has liver disease what can happen?
It will alter the way that pt metabolizes and excretes drugs. (e.g kidney disease)
If a pt is nauseated and has difficulty swallowing, what nursing implication would you consider?
Not giving medication ORALLY. Find if there is a different route. Risk for aspiration/choking.
What are the 3 levels of health prevention?
- Primary- prevent/slow onset of disease
- Secondary- detect and treat illnesses in early stages
- Tertiary- stopping disease progression; return to pre-illness state
What is assault and battery?
Performing a procedure without consent
What is negligence?
- failure to perform as a reasonable, prudent person would
- failure to follow standards of practice
- no intent to harm is present
Hearing development milestones
Intact at birth- moro reflex to loud noises
2-3 mo- vocalize to sounds and voices
3-6 mo- looks for sounds, pause to listen, responds to angry/happy voices
6-9 mo- may look at named objects/people
9-12 mo- understands some words, uses gestures, say one or two words
12 mo- responds to simple commands
