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NURS300 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

STRESS: physiologic stressors

A

pain
excessive noise
starvation
infection

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2
Q

STRESS: emotional/psychologic stressors

A

diagnosis of chronic disease
death of spouse
caring for disabled child/parent
marital problems

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3
Q

STRESS: GAS

A

generalized adaptation syndrome

there are 3 stages: alarm, resistance and exhaustion

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4
Q

STRESS: GAS- alarm stage

A

perceives a stress physically or mentally
“fight or flight” response initiated
may result in disease or death if prolonged or severe
sympathetic nervous stimulation
pt. complaints of anxiety, rapid heart rate, nausea, and anorexia

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5
Q

STRESS: fight or flight response: sympathetic nervous system

A

the hypothalamus: activates sympathetic
nervous system>impulses activate glands and smooth muscles; activates adrenal medulla>releases norepinephrine and epinephrine into the bloodstream> neural activity combines w/ hormone in the bloodstream to constitute fight-or-flight response

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6
Q

STRESS: fight or flight response: adrenal-cortical system

A

hypothalamus: activates adrenal-cortical system by releasing corticotropin-releasing factor [CRF]> pituitary gland secretes hormone adrenocorticotropic hormone [ACTH]> ACTH arrives at adrenal cortex and releases approx. 30 hormones into the bloodstream> neural activity combines with hormones in the bloodstream to constitute fight-or-flight response

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7
Q

STRESS: GAS: resistance stage

A

pt. moves quickly into this stage [ideally]
physiological reserves are mobilized to handle stress
amount off resistance depends on levels of functioning [i.e. health, exercise, etc.]
very few physiological signs
if resistance is successful, the pt. will recover
- if it is unsuccessful, pt. will move to the last stage

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8
Q

STRESS: GAS: exhaustion stage

A

all energy has been expended
pt. may die if resources are not available
physical s/s of alarm stage may reappear
can be reversed by external sources such as med.’s and counseling

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9
Q

STRESS: factors that affect the impact of stress

A 
attitude
previous experience
timing of stressors
resilience
sleep status
optimistic/pessimistic
culture
spiritual influences
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10
Q

STRESS: optimism vs. pessimism

A 
optimism
- cope more effectively with stress
- reduces the chance of stress-related illness
- when ill, tend to recover sooner
pessimism
- likely to deny problems
- allow stress to interfere with goal achievement
- focus on stressful feelings
- report more health problems
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11
Q

ENDOCRINE: regulation of hormones: simple feedback

A

based upon blood levels of a particular substance

i.e. low levels of a particular element which stimulates a body reaction

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12
Q

ENDOCRINE: regulation of hormones: negative feedback

A

gland responds by increasing or decreasing the secretion of a hormone
i.e. inhibition of a decrease or increase of an hormone

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13
Q

ENDOCRINE: regulation of hormones: positive feedback

A

increases target organ beyond normal

i.e. sending hormone to an organ to intensify its role

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14
Q

ENDOCRINE: regulation of hormones: complex feedback

A

usually involves several glands

i.e. a coalition of hormones being released by varying glands

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15
Q

ENDOCRINE: hypothalamus

A

produces and secretes release and inhibit hormones

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16
Q

ENDOCRINE: anterior pituitary gland

A

“master gland” located under and regulated by the hypothalamus
larger portion
- receives stress and growth hormones from the hypo.
growth hormone [GH]
- effect on all body tissue
- growth and development of skeletal muscles and long bones
- role in protein, fat and CHO metabolism
prolactin
- breast development and lactation
tropic hormones
- control the secretion of hormones by other glands
- TSH [thyroid stimulating hormone], ACTH [adrenocorticotropic hormone], FSH [follicle stimulating hormone; pushes the egg through Fallopian tubes], LH [luteinizing hormone; lubrication for sex], MSH [melanocyte stimulating hormone; for skin pigmentation]

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17
Q

ENDOCRINE: posterior pituitary gland

A

“master gland” located under and regulated by the hypothalamus
smaller portion
composed of nerve tissue and is an extension of the hypothalamus
ADH [antidiuretic hormone] and oxytocin
- hormones produced in hypothalamus but travel down nerve tracts to P.P.
- stored in pituitary until it is released into body

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18
Q

ENDOCRINE: ADH

A

antidiuretic hormone
stored in the posterior pituitary gland
regulated by fluid volume and plasma concentration
when stimulated the renal tubules reabsorb water creating a concentrated urine

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19
Q

ENDOCRINE: oxytocin

A

stored in the posterior pituitary gland
stimulates the production of milk into mammary ducts
contracts uterine smooth muscle
released by stimulation of touch receptors in the nipples of lactating women

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20
Q

ENDOCRINE: gigantism

A

a pituitary disorder where there is an excess of growth hormone
excessive secretion of the hormone before the closure the epiphyses, which occurs before the child reaches adulthood

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21
Q

ENDOCRINE: acromegaly

A

a pituitary disorder where there is an excess of growth hormone
excessive secretion after the closure of the epiphyses which occurs after the child has reached adulthood

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22
Q

ENDOCRINE: SIADH

A

syndrome of inappropriate antidiuretic hormone
a pituitary disorder where there is an excess of antidiuretic hormone
fluid retention
dilutional hyponatremia- diluted sodium levels
concentrated urine

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23
Q

ENDOCRINE: DI

A 
diabetes insipidus
a pituitary disorder where there is a lack of antidiuretic hormone
this is not actual diabetes
increased urine output
dilute urine
increase thirst
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24
Q

ENDOCRINE: thyroid gland

A

produces, stored, and releases T4 [thyroxine] and T3 hormones
produces and releases calcitonin

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25
Q

ENDOCRINE: parathyroid glands

A

2 glands embedded on each side of the thyroid gland [total of 4]
secretes PTH

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26
Q

ENDOCRINE: PTH

A

parathormone
secreted by the parathyroid glands
increases bone resorption [breakdown, resulting in calcium release into blood, and promotes the reabsorption of calcium and excretion of phosphorous
activates vit. D which enhances the intestinal absorption of calcium

27
Q

ENDOCRINE: T4 & T3

A

produced, stored, and released by the thyroid gland
the increased or decreased production of the hormone is stimulated by the anterior pituitary gland
iodine is necessary for T4 and T3 hormone production
- too little or too much iodine will cause thyroid to not produce T3 or T4
affects metabolic rate, growth and development, CHO and lipid metabolism, etc.

28
Q

ENDOCRINE: calcitonin

A

produced and released by the thyroid gland
produced in response to high levels of calcium in the blood
inhibits resorption [breakdown] of bone out of the blood, increases calcium in the bone, increases renal exrretion of calcium

29
Q

ENDOCRINE: adrenal glands

A

small, paired, highly vascular
located on top of kidneys
consists of two parts: medulla and cortex
medulla releases catecholamines
cortex releases more than 50 sterioid hormones, including glucocorticoids [cortisol], mineralcorticoids [aldosterone], and androgens

30
Q

ENDOCRINE: catecholamines

A

released by the adrenal gland medulla
includes glucal and mineral corticocoids
effects all body systems

31
Q

ENDOCRINE: glucocorticoids

A

cortisol
released by adrenal gland cortex
effect on glucose metabolism/mobilization
anti-inflammatory action
stress response
released by negative feedback [CRH and ACTH (adrenocorticotropic hormone)]

32
Q

ENDOCRINE: mineralcorticoids

A

aldosterone
released by the adrenal gland cortex
acts on organs such as the kidney and the colon to increase the amount of salt (sodium) reabsorbed into the bloodstream and the amount of potassium removed in the urine
alters blood pressure

33
Q

ENDOCRINE: cushing’s syndrome

A

an adrenal cortex disorder

effects related to an excess of glucocorticoids

34
Q

ENDOCRINE: addison’s disease

A

an adrenal cortex disorder

effects related to a deficiency of all three corticosteroids

35
Q

ENDOCRINE: pheochromocytoma

A

disorder of the adrenal medulla
effects related to an excess of mineralcorticodes [aldosterone]
tumor of adrenal gland medulla
causes severe hypertension

36
Q

ENDOCRINE: pancreas

A

produces glucagon [alpha cells] and insulin [beta cells]

37
Q

ENDOCRINE: tests for thyroid function

A 
TSH [thyroid stimulating hormone]
serum T4/T3 
ultrasound
- checks for nodules on the thyroid 
thyroid scan
RAI [radioactive iodine uptake]
38
Q

ENDOCRINE: goiter

A

a thyroid disorder
hypertrophy and enlargment of the thyroid
caused by excessive TSH stimulation from inadequate thyroid hormones
can be caused by goitrogens [foods or drugs that suppress gland function]
- enlargement of gland
- interferes with iodine uptake
surgery may be necessary if there is an obstruction of the airway
primary nursing concern: airway
secondary: swallowing

39
Q

ENDOCRINE: nodules on the thyroid

A

thyroid disorder
palpable deformity
may be benign or malignant
major sign of thyroid cancer is a hard, painless, nodule on an enlarged gland
ultrasound, CT scan, thyroid scan, MRI, fine needle aspiration [FNA]

40
Q

ENDOCRINE: thyroiditis

A

thyroid disorder
inflammation of the thyroid
can be viral, bacterial, fungal, or autoimmune
can lead to hypothyroidism [Hashimoto’s] if the disorder goes on unnoticed due to wearing out
usually thyroid hormones are elevated but then may become depressed
TSH low, then elevated
treatment depends on cause and manifestations

41
Q

ENDOCRINE: hyperthyroidism

A

thyroid disorder
thyrotoxicosis- s/s resulting from excessive circulating T4 and T3 or both
more common in women
highest frequency is 20-40 years of age
most common form is Graves disease [autoimmune disorder]
s/s: weight loss, increased appetite, diarrhea, fatigue, diaphoretic, tachycardic, hypertensive, exopthalmia [caused by an excess of fluid build up behind the eye; pt. may lose ability to close their eye lids]
nutritional therapy
- foods high in calories, protein, and CHO
- vitamins
- anti-diarrheal med.’s
- daily weights/ I&O

42
Q

ENDOCRINE: thyrotoxic crisis

A 
thyroid disorder
"thyroid storm"
manifestations are heightened
- severe tachycardia, heart failure, shock, fever [>105], restlessness [initial sign of hypoxia], seizures, delirium, coma, NVD
life threatening emergency
treatment aimed at reducing circulating hormones, manifestations and decreasing effects of metabolic rate 
drug therapy
radioactive iodine therapy
surgical therapy
43
Q

ENDOCRINE: drug therapy for hyperthyroidism or thyroid storm

A 
antithyroid drugs
iodine
- [esp. given for pt.'s a week away form surgery to decrease the size of thyroid and to force t3 and t4 to go out of the blood and into storage 
B-adrenergic blockers 
- a cardiac med. that decreases BP and heart rate
sedatives 
- to reverse the restlessness
insulin
oxygen
- ordered first b/c it is high priority
44
Q

ENDOCRINE: nursing care in a post-op thyroidectomy

A

airway
-have trach. care/suctioning kit at bedside
assess for bleeding
- first indicator: increased heart rate
- check the back of the neck for blood
position: Semi-Fowler’s
monitor vital signs and calcium imbalance [b/c the parathyroid came out along with the thyroid which is active in the resorption and reabsorption of Ca; primary sign: tremors]
diet: permitted to take fluid as soon as tolerated and soft diet the next day

45
Q

ENDOCRINE: hypothyroidism

A

thyroid disorder
insufficient circulating T4 and T3 hormones
one of the most common disorders in US
all infants in US are screened at birth
primary or secondary etiology
s/s: weight gain, bradycardia, decreased BP, tired, intolerance to cold
treatment: mechanical ventilation, IV thyroid supplements, isotonic fluid [if the pt. is hyponatremic, deliver hypertonic solution], IV glucose, monitor for heart failure
nutritional therapy: foods low in calories, high in fiber, and adequate fluids

46
Q

ENDOCRINE: myxedema

A

thyroid disorder
medical term for hypothyroidism
life-threatening
hypothyroidism not treated or stressed hypothyroidism
observe for hypoglycemia and hyponatremia

47
Q

ENDOCRINE: hyperparathyroidism

A

thyroid disorder
caused by overproduction of parathyroid hormone by the parathyroid glands
characterized by bone decalcifecation [calcium out of the bones and into the blood] and the development of renal stones containing calcium
asymptomatic w/ manifestations of hypercalcemia
tests: PTH levels, derum calcium and phosphorous [decreases as calcium increases] levels, dexa scan [checks for bone break down]
ultrasound [kidney stones], ECG
may need surgery along with delivery of fluids, limitation of Ca and phosphorous and calcitonin [decreases calium levels]

48
Q

ENDOCRINE: hypoparathyroidism

A

thyroid disorder
inadequate PTH [uncommon]
most common cause is the result of removal w/ thyroid surgery
low serum calcium levels seen
care: treat acute tetany. maintain normal serum Ca levels, oral calcium supplements, vit. D supplement [aids the GI tract to absorb calcium], adequate rest period, monitor EKG and cardiac complications [HF], long-term drug therapy and nutrition [high in calcium, low in phosphorous]

49
Q

PRIORITY AND DELEGATE: Maslow’s hierarchy of needs

A
  1. air, water, food
  2. safety and security needs
  3. love and belonging, friendship, love, social relationships
  4. self-confidence, achievement, self-worth
  5. self-actualization
50
Q

PRIORITY AND DELEGATE: ABC’s

A

Airway
- i.e. obstruction or risk of obstruction
Breathing
- i.e. wheezing, low pulse ox reading
Circulation
- i.e. hemorrhaging, low/high blood pressure

51
Q

PRIORITY AND DELEGATE: s/s of a stroke

A 
rapid onset of s/s
confusion
facial drooping
slurred words
blurred vision
52
Q

PRIORITY AND DELEGATE: emergent vs. urgent vs. non-urgent

A

emergent
- pt.’s w/ highest priority due to life-threatening problems
- pt. requires basic survival needs
urgent
- pt.’s w/ medium/low priorities of potentially impairing functioning or normal growth and development
- pt. requires early resolution of their problems but it is not to impede medical treatment
non-urgent
- pt.’s that do not require immediate attention

53
Q

PRIORITY AND DELEGATE: acute vs. chronic illness

A

acute
- an illness w/ an abrupt onset and usually a short course
- death is a possibility
chronic
- an illness that persists for a long period of time or for the rest of the pt.’s life
- pt. can present with an acute episode of a chronic disease

54
Q

PRIORITY AND DELEGATE: delegation

A

a process that transfers, usually verbal, to a competent individual the authority to perform a selected nursing task in a specific situation
the responsibility for the task is transferred but accountability remains with the person who is delegating tasks

55
Q

PRIORITY AND DELEGATE: assigning tasks

A

the RN may assign staff members who have the appropriate level of expertise that is necessary to deliver the pt. care and perform the activities
the RN may assign a more skilled individual to perform specific tasks
- i.e. an expert in starting IV’s to help you, a novice
the RN may not assign an individual to perform a task that is outside the individual’s job description or scope of practice

56
Q

PRIORITY AND DELEGATE: 5 rights of delegation

A 
right task
right circumstance/concern
right person
right direction/communication
right supervision
57
Q

PRIORITY AND DELEGATE: directions for delegation

A

priority of activity
expected timeliness
reportable conditions
guidelines for reporting task completion
use of written and visual resources may be used to reinforce direction
* never assume the staff you’re delegating tasks to know the info. above w/o your say so

58
Q

PRIORITY AND DELEGATE: AACN key factors to consider before ddelegating

A 
potential for harm
- great or small
complexity of task
- simple or difficult
problem solving needed
minimal or maximum
unpredictability of outcome
- stable or unstable
level of interaction required w/ client
- simple or complex

assessments, invasive procedures, administration of blood may not be delegated to non-RN staff

59
Q

PRIORITY AND DELEGATE: tasks the RN is responsible for

A

initial assessment of client and assessment whenever status changes
planning of care
implementation of nursing and other medical orders
evaluation of care
pt. teaching
procedures requiring sterile administration

60
Q

PRIORITY AND DELEGATE: tasks the LPN/LVN can perform

A

perform routine assessments and skills
deliver basic care
perform routine tasks w/ predictable outcomes
perform routine wound care/dressing changes
perform uncomplicated sterile procedures
perform specialized “skills” with proper training in stable situations
observe and report
reinforce teaching

61
Q

PRIORITY AND DELEGATE: tasks the UAP can perform

A

provide basic care/ADL’S
routine clinical tasks
- vital signs, collecting urine/stool samples, I&O
room preparation
pt. ambulation and transport
can only participate in stable situations w/ predictable outcomes

62
Q

PRIORITY AND DELEGATE: can delegate in cases of…

A

stable pt.’s
requirements w.i care-givers job description and legal constraints
adequate supervision available
w/i skill and competencies of individual caregiver
minimal potential for harm

63
Q

PRIORITY AND DELEGATE: can not delegate in cases of…

A 
unstable pt.'s w/ unpredictable outcomes
condition requires complex assessment
problem solving and critical thinking required
nursing judgment required
potential for ham exists
64
Q

PRIORITY AND DELEGATE: factors to consider when assigning rooms to pt.’s

A 
bed availability
LOC 
pt. acuity
age, gender, special needs/equipment
medical dx
infectious disease
staffing
attending physician pt. who is dying

NURS300 (4 decks)

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