Exam 1 Flashcards
1
Q
Recommended separation of education from hospital service. Increase admission standards, and strengthen collegiate nursing schools
A
Goldmark report
2
Q
Stated that nursing education should be in colleges with the right accreditation, not in hospitals. Encourage recruitment of men and minorities.
A
the Brown Report
3
Q
Minimum preparation for beginning professional nursing practice is baccalaureate degree education.
A
ANA position paper
4
Q
• People couldn’t afford hospital costs, so they opted for private duty nurses because it was cheaper or free if provided by nursing students
• After the closure of hospital-based nursing schools, many nurses faced unemployment. Government cope by;
o Forming Federal Healthcare Programs: hospital hired started to paid minimal wages to nurses
o Nurses’ performance lead to a greater respect for the profession
A
The great depression on nursing
5
Q
What are the four factors that changed nursing?
A
- Religious Ideals and Humanitarian Aims
- Technology & Advancements in Medicine
- War:
- Traditional Role of Women and Feminism
- Religious Ideals and Humanitarian Aims
6
Q
What nursing theory did Florence Nightingale?
A
environmental thery
7
Q
What nursing theory did Jean Watson have?
A
caring theory
8
Q
what nursing theory did hildegard pelau have?
A
interpersonal theory
9
Q
what nursing theory did Virginia Henderson?
A
need theory
10
Q
what nursing theory did betty neuman have?
A
systems theory
11
Q
what nursing theory did sister callista roy have?
A
adaptive model
12
Q
what nursing theory did madeleine leininger?
A
transcultural care
13
Q
Focuses on the environment alterations; ventilation, warmth, light, diet, cleanliness, noise.
A
environmental theory
14
Q
Effective caring promotes health and individuals & family growth.
A
caring theory
15
Q
The relationship between nurse, patient, and family is necessary to meet goals
A
interpersonal theory
16
Q
Assist patient with their 14 human needs while they recover and achieve independence
A
need theory
17
Q
If one area does NOT work, it can affect the whole system because everything is connected
A
systems theory
18
Q
Environmental stimuli results in human response, which could be adaptive or ineffective
A
adaptive model
19
Q
Patient should always be provided with cultural-specific nursing care
A
Transcultural Care
20
Q
The activity used to minimize the spread of pathogens
A
infection control
21
Q
Applies to contact with infected patients or their environment. Must wear gloves and gown.
A
contact isolation
22
Q
Applies to patients infected with a pathogen (respiratory infections- pneumonia, influenza, whooping cough, bacterial meningitis) that is transmitted by droplets (3-6 fee). Must wear gloves, gown, & mask. Patient with mask when out of room.
A
droplet isolation
23
Q
Applied to patients infected with an airborne pathogen (Measles, Varicella, Tuberculosis, chikenpox). Must wear gloves, gown, and N95 respirator. Patient with a mask when out of the room. Room equipped with negative air flow.
A
airborne isolation
24
Q
(clean technique) measures taken to control and reduce the number of pathogens.
A
medical aseptic technique
25
(sterile technique) measures used to eliminate any pathogens from the area.
surgical aseptic technique
26
Underlying soft tissue & blood vessels damage without edges or epidermis torn (bruises/contusion, suspected deep issue injury)
closed wound
27
There is a break in the skin or mucous membrane.
open wound
28
tearing injury, irregular edges
laceration
29
superficial, involving scraping or rubbing of superficial layers of skin
abrasion
30
penetrating injury due to pointed object
puncture
31
Wounds are shallow, involving loss of epidermis, and partial loss of dermis
o Heals by regenerations
partial thickness wound
32
Wound extends into the dermis and into deeper tissues (subcutaneous fat and muscle)
o Heals by scar formation b/c deeper structures do not generate
full thickness wound
33
what are the stages of the full thickness wound healing?
* homeostasis
* inflammation phase
* proliferation phase
* remodeling
34
Injured blood vessels constrict, platelets stop bleeding, clot forms
homeostasis
35
begins in 3 min after injury, last up to 3 days. Damage tissue and mast cells secrete histamine, results in vasodilatation of capillaries where WBC get to damaged tissue.
inflammation phase
36
from the 3rd to the last 24 days; filling of the wound with granulation tissue and contraction of the wound.
proliferation phase
37
(maturation) the final stage of healing, which could take up to a year. The collagen scar continues to gain strength (but will never return to the original strength).
remodeling
38
Wound with NO pathogenic organisms. Are primeval closed wounds.
clean
39
Wound made under aseptic conditions (medical surgery), which involves a body cavity that normally harbors microorganism like the respiratory tract, gastrointestinal tract, the genital or urinary tract.
clean contaminated
40
Open wound, traumatic or surgical wounds involving a major break in sterile technique. Shows evidence of inflammation
contaminated
41
Old, traumatic wounds containing dead tissue, bacteria, and evidence of clinical infection (i.e. purulent drainage)
infected
42
Multiple organisms in wound. Not necessarily a bad thing.
colonized
43
Skin edges are approximated or closed together. Wound closure restores barrier against infection.
primary intention
44
Skin layers are NOT approximated. Wound left open until scar tissue or granulation tissue forms. Wound closure takes time, these wounds lack protective epidermal barrier, and are more subject to infection.
secondary intention
45
Healing occurs when a wound surface begins to granulate and then it is closed at a later time. May be used when wounds are deep or until no more signs of infections.
tertiary intention
46
total or partial disruption in wound edges
• Dehiscence
47
Protrusion of viscera through a wound opening
evisceration
48
abnormal tube like, passageway that form between 2 organs, or 1 organ and the skin
fistula
49
clear, watery plasma. This is what the body should be doing.
serous drainage
50
capillary damage, larger number of RBC, severe inflammation, bright red indicates active bleeding
sanguineous drainage
51
Drainage in mixture of serous and some blood. Pale pink, watery mixture of clear and red fluid
o Purulent: “pus”, severe inflammation with infection, contains leukocytes, liquefied dead cells, and dead/living bacteria. Is thick, yellow, green, tan, brown (it also smells).
serosanguineous drainage
52
closed suction drainage system, empty when ½ full
JP drain
53
closed suction drainage system. Bigger than the J.P. Drain
hemovac
54
Rubber type tube with opening on both ends, drainage accumulates on gauze.
penrose
55
redness develop from pressure, skin is unbroken
Treatment/dressing:
Transparent film or Hydrocolloid, can be left on for up to 7 days
stage 1 pressure ulcer
56
(partial thickness) broken skin involving the epidermis & dermis with a shallow open ulcer without slough or the formation of blisters
Treatment/dressing:
Hydrogen and foam dressing
*If shallow (partial thickness) without eschar use Hydrocolloid for 7 days
stage 2 pressure ulcer
57
(full-thickness) subcutaneous fat may be visible, slough may be present, bone, tendon and muscle are not exposed
Treatment/dressing:
*Irrigation of wound to remove debris
*If dry, hydrogel covered with foam dressing
*if heavy drainage, Calcium Laginate and gauze
stage 3 pressure ulcer
58
(full-thickness) tissue and muscle loss where bone or tendons can be seen. Slough or eschar (black/brown necrotic tissue) may be present. Includes tunneling or undermining
stage 4 pressure ulcer
59
Treatment/dressing:
* Debridement: -Both eschar and slough are removed by chemicals, or surgical procedure. May require reconstructive surgery.
* If dry, hydrogel covered with foam dressing
* If heavy drainage, calcium alginate and gauze
* If very deep, use gauze to fill dead-space
stage 4 pressure ulcer
60
full-thickness) base of wound obscured by slough, and depth is unknown.
unstageable pressure ulcer
61
Intact skin or blood filled blister caused by damage to soft tissue. Purple and maroon areas
Suspected Deep Tissue Injury (SDTI):
62
Closes a wound and prevents it from being exposed to the air.
occlusive dressing
63
Provides moisture to the wound yet allows drainage by absorbing it.
gauze dressing
64
It is shiny, non-adherent surface, does NOT stick to incision, and allows drainage to pass through the gauze topper. It is used over clean wounds. Ex. surgical incisions with little to no drainage.
tefla-gauze dressing (non-adherent)
65
It adheres to undamaged skin trapping moisture over wound for a faster healing. Also, serves as a barrier.
transparent film
66
Absorbs wound’s exudate and provides a barrier. It molds to uneven surface, easy peel back and replace, and permits easy access to assess a wound without causing damage
mepilex
67
It is impregnated with water/glycerin based amorphous gel. It hydrates dry wound, soften dry necrotic tissue, and relieving pain. It does not adhere to the wound bed
hydrogen
68
Absorbs exudates, maintains moisture, & break down necrotic tissue by liquefying it. It is adhesive and occlusive.
hydrocolloid
69
Provides soft support and barrier to prevent further damage to the wound Ex. stage 1 pressure ulcer, skin tears.
foam dressing
70
combine with wound drainage to form a gel in the moist wound bed.
calcium alginate
71
Due to prolonged use, bacterial species
which synthesize enzyme – counteracts
effects of PCN.
penicillinase
72
PCN indicated for the treatment of:
```
Streptococcal infections – pharyngitis, tonsillitis, scarlet
fever, endocarditis
Pneumococcal infections
Staphylococcal infections
Fusospirochetal infections
```
73
Adverse effects:
Nausea, vomiting, diarrhea, abdominal pain, glossitis,
stomatitis, gastritis, sore mouth, furry tongue
Superinfections – yeast (very common)
Hypersensitivity reactions – rash, fever, wheezing,
anaphylaxis
Penicillins & Penicillinase resistant Antibiotics
74
Powerful antibiotics used to treat serious infections caused
by GRAM-NEGATIVE AEROBIC BACILLI
Used to treat serious gram-negative infections such as:
E. coli, Klebsiella-Enterobacter-Serratia group, Staphylococcus
species such as S. aureus.
Gentamycin, Neomycin, Streptomycin, Tobramycin
Aminoglycosides
75
Serious adverse effects:
Ototoxicity with possible irreversible deafness
Nephrotoxicity – may progress to renal failure
Superinfections
Aminoglycosides
76
```
Assess for possible contraindications or cautions
such as:
Allergies to this drug
Increase fluid intake
Monitor labs
Use sun block
Daily assessments
Monitor for s/s superinfections
```
Aminoglycosides
77
Both bactericidal AND bacteriostatic, similar to
PCN’s in structure and activity
Interfere with ability of bacterial cell wall-building
How med is chosen from this class depends on:
the sensitivity of the organism; route of choice; cost
cephalosporins
78
Adverse effects:
Nausea, vomiting, diarrhea, anorexia, abdominal pain,
flatulence
D/C immediately with signs of violent, bloody diarrhea
or abdominal pain
CNS – h/a, dizziness, lethargy, paresthesias,
nephrotoxicity
Superinfections-C. diff
cephalosporins
79
Assess for possible contraindications or cautions
such as:
Allergies to this drug or penicillin
Monitor labs
Monitor INR – decrease blood clotting time
Cephalosporins
80
Synthetic class of broad-spectrum antibiotics
Commonly used to treat UTI, respiratory tract infections,
skin infections
Treats infections caused by susceptible strains of gramnegative
bacteria such as: E.coli, P. mirabilis, K.
pneumoniae, Enterobacter cloacae, H. influenzae, H.
parainfluenzae, S. aureus, Staphylococcus epidermidis,
some Neisseria gonorrhoeae, and group D strep.
(Cipro, Levaquin, Maxaquin, Avelox, Moroxin, Floxin)
Fluoroquinolones
81
Assess for possible contraindications or cautions
such as:
Allergy to drug
Give with full glass of water
No driving or operating machinery
Caution patient about risk of photosensitivity
reactions
Teach patient med absorption is decreased with
antacids
Nursing implications: Fluoroquinolones
82
Inhibit bacterial synthesis of folic acid
Used to treat gram-negative & gram-positive
bacteria such as: Chlamydia trachomatis,
Nocardia, H. influenzae, E. coli (Gantrisin, Septra,
Bactrim)
No longer used much
Inexpensive & effective tx for UTIs and trachoma
(leading cause of blindness) in developing
countries & when cost is an issue
Sulfonamides (sulfa drugs)
83
Adverse effects:
Nausea, vomiting, diarrhea, abdominal pain,
anorexia, stomatitis, hepatic injury, renal failure,
thrombocytopenia
Superinfections
Sulfonamides (sulfa drugs)
84
Assess for possible contraindications or cautions
such as:
Allergy to drugs
Instruct patient to report bruising or bleeding
Check labs
Take with full glass of water
Use sun block
Nursing implications: Sulfonamides
85
Developed as semi-synthetic antibiotic; 1st broadspectrum
abx
Inhibit protein synthesis and prevent bacteria from
multiplying
Used to treat: Rickettsiae, H. influenzae, E. coli,
Spirochetes, Klebsiella, S. aureus, Chlamydia
Tetracyclines
86
Adverse effects:
Hepatotoxicity
Nephrotoxicity
Superinfections
Tetracyclines
87
```
Assess for possible allergy
Caution women that it may make
oral contraceptives ineffective
Give 1 hour before meals or 2 hours after with a
full glass of water
Use sun block, sun glasses and wear protective
clothing
Monitor for GI effects
```
NURSING INTERVENTIONS: TETRACYCLINE
88
Interfere with protein synthesis in susceptible
bacteria
Used to treat: Mycoplasmal pneumoniae,
Legionnaire’s disease, PID (Erythromycin,
Azithromycin, Clarithromycin)
Macrolides
89
Adverse effects:
Hepatotoxicity
Anaphylaxis
Superinfections
Macrolides
90
Assess for possible allergy
Give PO med 1 hour before meals or 2 hours after
If GI upset take with food
Monitor labs
Carefully monitor pts on digoxin and anticoagulants
when taking this anti-infective
Nursing interventions: Macrolides
91
a Glycopeptide antibiotic. These antibiotics are large, rigid molecules that inhibit a late stage in bacterial cell wall synthesis.
• Used to treat:
• Staphylococcal infections
• Methicillin-resistant staphyloccal aureus (MRSA)
• C. diff
• Cellulitis if allergic to PCN or MRSA suspected/confirmed
Vancomycin
92
* Adverse reactions:
* Ototoxicity
* Nephrotoxicity
* Red-man syndrome
Vancomycin
93
Assess for allergies
Monitor lab levels
Peak action is 30 minutes after the END of the
infusion
Carefully observe for hypersensitivity reactions:
Red-man syndrome: s/s that would appear 4-10
minutes after initiation of infusion or soon after
completion: pruritus (erythematous rash) of the
face, neck, upper torso
Anaphylaxis
Nursing interventions: Vancomycin
94
acute bacterial infection of the dermis
and subcutaneous tissue
Is an “opportunistic” infection, commonly occurring
through breaks in the skin
Most often caused by streptococci or
staphylococci
Diagnosis is by appearance
cultures are sometimes helpful, but awaiting these
results should not delay empiric therapy
Affects people of all races and ages; men and
women equally affected
Most common in middle-aged and elderly people
Is NOT contagious
Cellulitis
95
Risk factors: skin abnormalities, trauma, ulceration,
fungal infection, pts with chronic venous
insufficiency, lymphedema, insect bites,
microscopic cracks in skin
Appears near ulcers or surgical wounds
Frequently
Cellulitis
96
S/S include: pain, rapidly spreading erythema,
edema; fever may occur, regional lymph nodes
may enlarge
Presenting site: lower leg, (tibia, shinbone, foot), is
unilateral; bilateral - extremely rare (stasis dermatitis
closely mimics cellulitis but is usually bilateral)
Cellulitis
97
Mild infections: treatment for cellulitis
PCN
98
If allergic to PCN use, for cellulitis treatment
Macrolides – Clarithromycin, Azithromycin
99
For patients who are unlikely to adhere to multiple
| daily dosing schedules:
Fluoroquinolones – Levofloxacin, Moxifloxacin
100
For serious infections requiring hospitalization:
Penicillinase-resistant antibiotics – Nafcillin, Oxacillin
| Cephalosporins – Cephalexin
101
For penicillin-allergic patients or those with
| suspected or confirmed MRSA:
Glycopeptide - Vancomycin
