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NURSING ADULT HEALTH II Spring 2016 > EXAM 1 > Flashcards

EXAM 1 Flashcards

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1
Q

Nursing

A

The Protection, Promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. We are going to give the best care, safely and competently as possible and advocate for our clients.

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2
Q

Standards of Professional Nursing Practice

A

Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. Basically uphold standards and ethics and do it safely.

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3
Q

Standards of Practice

A 
= the nursing process
*Assessment
*Diagnosis
*Outcomes Identification
*Planning
*Implementation
     *Coordination of care
     *Health teaching
     *Consultation (Above graduate level                      
                                 advanced practice)
     *Prescriptive authority & treatment
*Evaluation
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4
Q

Standards of Professional Performance

A
  • Ethics
  • Education
  • Evidence-Based Practice and Research
  • Quality of Practice
  • Communication
  • Leadership
  • Collaboration
  • Professional Practice Evaluation
  • Resource utilization
  • Environmental Health
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5
Q

Code of Ethics

A
  • It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession.
  • It is the professions non-negotiable, ethical standards. The true black or white part of nursing.
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6
Q

The body is comprised of _____% of water. Elderly is ______%.

A
  • 60

* 50

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7
Q

Intracellular Fluid (ICF)

A
  • Fluid inside cells.
  • It is the largest body compartment
  • It accounts for about 2/3 of the total body fluid.
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8
Q

Extracellular Fluid (ECF)

A
  • Fluid outside of the cell
  • Accounts for about 1/3 of the total body fluid.
  • Consist of plasma, interstitial fluid (ISF), and transcellular water.
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9
Q

Acid

A

A substance that releases hydrogen ions when dissolved in water. The strength of an acid is measured by how easily it releases hydrogen ions in a solution

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10
Q

Acidosis

A

An acid-base imbalance in which blood pH is below normal

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11
Q

Alkalosis

A

An acid base balance in which blood pH is above normal

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12
Q

Base

A

A substance that binds (reduces) free hydrogen ions in a solution. Strong bases bind hydrogen ions in a solution. Strong bases bind hydrogen ions easily; weak bases bind less readily.

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13
Q

Bicarbonate

A

HCO3

A salt of carbonic acid, containing HCO3-1 group; an acid carbonate as sodium bicarbonate, NaHCO3.

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14
Q

Cations

A

ions that have a (+) positive charge

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15
Q

Chvostek’s Sign

A

Tape the face just below and in front of the ear. (over the facial nerve) to trigger facial twitching of one side of the mouth, nose and cheek. Facial muscle response is indicative.

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16
Q

Diffusion

A

The spontaneous, free movement of particles (solute) across a permeable membrane down a concentration gradient; this is from an area of higher concentration to an area of lower concentration.

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17
Q

Extracellular fluid (ECF)

A

The portion of total body water (about 1/3rd) that is in the space outside the cells. This space also includes interstitial fluid, blood, lymph, bone, and connective tissue water, and the transcellular fluids.

  • Plasma is found int eh intravascular space
  • ISF occupies spaces between cells
  • TSW found in specalized compartments: ocular, cerebrospinal, pleural, synovial fluid, gastric juices.
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18
Q

Hemoconcentrartion

A

Elevated plasma levels of hemoglobin, hematocrit serum osmolarity, glucose, protein, blood urea nitrogen, and electrolytes that occur when only the water is lost and other substances remain.

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19
Q

Homeostasis

A

The narrow range of normal conditions: body temperature, blood electrolyte values, blood pH, blood volume in the human body; the tendency to maintain a constant balance in normal body states.

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20
Q

Hypertonic

A

Describes fluid with osmolarities (solute concentrations) greater tha 300. Hyperosmotic fluids have a greater osmotic pressure than do isomotic fluids and tend to pull water from the isosmotic fluid space into the hyperosmotic fluid space until an osmotic balance occurs.

21
Q

Hypodermoclysis

A

the slow infusion of isotonic fluids into subcutaneous tissue

22
Q

Hypotonics

A

describes fluids wth osmolality’s of less than 270. Hypo-osmolar fluids have a lower osmotic pressure than isosmotic fluids, and water tends to be pulled from the hypo-osmotic fluid space into the isosmotic fluid space until an osmotic balance occurs

23
Q

Insensible water loss:

A

water loss from the skin, lungs, and stool that cannot be controlled

24
Q

Interstitial fluid (ICF)

A

a portion of this extracellular fluid that is between cells, sometimes called the ‘third space’

25
Q

Ions:

A

a substance found in body fluids that carries an electrical charge; also called electrolyte

26
Q

Isotonic:

A

having the same osmotic prssures

27
Q

Osmolality

A

the number of millimoles in a kilogram of slution

28
Q

Osmolarity

A

the number of milimoles in a liter of solution

29
Q

Transcellular fluid

A

any of the fluids in special body spaces, including cerebrospinal fluid, synovial fluids, peritoneal fluid, and pleural fluid

30
Q

Trousseau’s signs

A

To test for trousseau’s sign, place a blood pressure cuff around the upper arm, inflate the cuff to greater than the patients systolic pressure, and keep the cuff inflated for 1-4 minutes. Under the hypoxic conditions, a positive Trousseaus’s sign occurs when the hand and fingers going to spasm in palmar flexion. Palmar flexion indicates a positive sign, and hypocalcemia.

31
Q

Viascous

A

of thick consistency

32
Q

Intravascular

A

within the blood vessels

33
Q

There needs to be the right balance of ____, _____, and ____ in the intracellular, extracellular, intravascular, and interstitial spaces for the body to function correctly.

A

Oxygen (O2), Sodium (Na), and Potassium (K)

34
Q

What can upset the balance of Oxygen (O2), Sodium (Na), and Potassium (K) in the intracellular, extracellular, intravascular, and interstitial spaces of the body?

A

Heat, cold, trauma, and illness.

35
Q

What can correct Oxygen (O2), Sodium (Na), and or Potassium (K) imbalances in the body.

A

The bodies defense system or medical intreventions

36
Q

Who are the most susceptible to F/E imbalances?

A

The very young and the very old

37
Q

Osmosis

A

Movement of water ONLY from higher concentrate to lower concentrate.

38
Q

Diffusion

A

higher concentration moves to a lower concentration (electrolytes)

39
Q

What are the major electrolytes

A

Sodium (Na), Potassium (K), Chloride (Cl), Magnesium (Mg), and Phosphate (PO4)

40
Q

What are the systems a nurse should assess with ALL fluid and electrolyte issues?

A
  • Renal
  • Respiratory
  • Cardiac
  • Neuromuscular
  • Neurological
  • Musculoskeletal
  • Gastrointestinal
41
Q

Isotonic fluids

A

Have the same osmolality as plasma

 * Cells neither shrink nor swell with fluid movement
 * 0.9% NaCl, Ringers solution, Lactated Ringer's, 5% dextrose in water.
42
Q

Hypotonic Fluids

A

Have a lower osmolality than plasma.

 * Draws water into the cells from the Extracellular fluid (ECF)-cell swells
 * 0.45% NaCl, 0.33 NaCl
 * Caution: fluid shift can cause cardiovascular collapse and IICP if fluid given too quickly
43
Q

Hypertonic Fluids

A

Have a higher osmolality than plasma

 * Osmotic pressure draws water out of the cells and into the Extracellular fluid (ECF) and cause the cells to shrink. 
 * 10-15 dextrose in water, 3.0% NaCl, Sodium bicarbonate 5%, 5% dextrose in 0.9% saline
44
Q

Macrodrip

A

Delivers 10, 12 or 15 drops per mililiter (mL)

*Should be used if rapid administration is needed

45
Q

Microdrip

A

Delivers 60 drops per mililter (mL); should be used when fluid volume needs to be smaller or more controlled,
*e.g. clients with compromised renal or cardiac status, clients “keep open” rates, pediatric clients.

46
Q

How many pounds/Kilograms is 1 liter of fluid

A

2.2 pounds

1 kilogram

47
Q

How many liters of fluid are in the average body

A

42 liters

an average of 92 pounds of fluid

48
Q

What is the first thing and the highest and most dependable indicators that we have in fluid balance?

A

Weight gain or weight loss

*because a change in weight directly correlates to water content within the body.

NURSING ADULT HEALTH II Spring 2016 (1 decks)

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