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Adult Health Nursing II > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Evidence Based Practice

A

Description of best practice that has been derived from review of research

Considers the setting, patient preferences and values, and clinical judgment

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2
Q

Pay for Performance

A

Reimburses providers for meeting or exceeding demonstrations of cost efficient and quality care

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3
Q

Nursing Care Center National Patient Safety Goals

A

Prevent infection (use proven guidelines to prevent infections of the urinary tract that are caused by catheters)

Improve staff communication (get important test results to the right staff person on time)

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4
Q

Core Measures

A

Sets of performance measures for hospitals

Gauge how well hospital gives care compared to evidence based guidelines and standards

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5
Q

Evidence Based Practice Tools

A

Bundles (sets of 3-5 EPB)

Clinical guidelines

Algorithms

Care mapping

Multidisciplinary action plans (MAPs)

Clinical pathways

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6
Q

Chronic Diseases

A

Most common causes of death in the US

7/10 leading causes of death

Include cardiovascular, chronic lung disease, cancers, diabetes

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7
Q

Primary Prevention

A

Health promotion

Specific protection

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8
Q

Secondary Prevention

A

Early diagnosis and prompt treatment

Disability limitation

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9
Q

Tertiary Prevention

A

Rehabilitation

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10
Q

Management of Chronic Illness

A

Live with symptoms or disabilities

Identity changes may occur (complications can interfere with ADLs)

Lifestyle changes (learn to manage their chronic diseases and change their schedule and ADLs accordingly)

Emotional reactions such as shock, anger, resentment

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11
Q

Chronic Illness Pre-Trajectory

A

Genetic or lifestyle predisposition

Encourage genetic counseling

Primary prevention would be helped with by the nurse

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12
Q

Chronic Illness Trajectory Onset

A

Appearance of noticeable symptoms

Diagnosis work up

Nurse must explain exams and procedures, help with emotional space

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13
Q

Chronic Illness Stable

A

Illness is under control

Nurse gives positive reinforcement, encourages health screenings

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14
Q

Chronic Illness Unstable

A

Inability to control symptoms

May have problems with ADLs, may need more diagnostic tests

Nurse reinforces previous education, educates on new additions

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15
Q

Chronic Illness Acute

A

Severe or unrelieved symptoms

Management in hospital or acute care facility

Nurse provides direct care and emotional support

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16
Q

Chronic Illness Crisis

A

Critical or life-threatening situation

Nurse will be providing direct care and emotional support

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17
Q

Chronic Illness Comeback

A

Gradual return to acceptable way of life

Presence of some disabilities

Nurse provides positive support

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18
Q

Chronic Illness Downward

A

Progressive (rapid or gradual) decline in health

Increasing physical disability

Continually readapting to illness

Home-care, community-based care

Nurse helps to identify and encourage end-of-life preferences and planning

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19
Q

Chronic Illness Dying

A

Final weeks before death

Disengagement and closure

No longer able to make end-of-life preferences

Nurse provides direct and supportive care to the patient and family

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20
Q

Disability

A

Lack of ability to complete an activity in a normal manner

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21
Q

Severe Disability

A

Unable to perform one or more activities, uses an assistive device for mobility or needs help from another person to accomplish basic activities, receives federal benefits because of an inability to work

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22
Q

Impairment

A

Loss or abnormality in body structure or function, including mental function

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23
Q

Categories of Disabilities

A

Developmental (birth-22 years old)

Acquired

Sensory, Learning, Communication, Limit Participation, Visible vs. Invisible

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24
Q

Acquired Disabilities

A

Acute Traumatic: traumatic brain injury, spinal cord injury

Acute Non Traumatic: stroke, heart attack

Chronic Progressive: arthritis, rheumatoid arthritis, multiple sclerosis

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25
Q

Endocrine Effects of Pain

A

Increase: ACTH, cortisol, ADH, catecholamines, GH, renin, angiotensin II, aldosterone, glucagon, interleukin-1

Decrease: insulin, testosterone

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26
Q

Metabolic Effects of Pain

A

Hyperglycemia, muscle protein catabolism

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27
Q

Cardiovascular Effects of Pain

A

Increase: HR, cardiac workload, PVR, SVR, HTN, coronary vascular resistance, myocardial oxygen consumption, hypercoagulation, DVT

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28
Q

Respiratory Effects of Pain

A

Decrease: flow in volumes, hypoventilation, can cause atelectasis, leads to hypoxemia, decreased cough, retention of sputum

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29
Q

Genitourinary Effects of Pain

A

Decrease: urine output, urinary retention, fluid overload, hypokalemia

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30
Q

Gastrointestinal Effects of Pain

A

Decrease motility

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31
Q

Musculoskeletal Effects of Pain

A

Muscle spasms, impaired muscle functioning, fatigue, resistance to movement

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32
Q

Cognitive Effects of Pain

A

Confusion

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33
Q

Immunological Effects of Pain

A

Depression in immune response

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34
Q

Developmental Effects of Pain

A

Increased responses to pain

Changes in temperament

Vulnerable to stress disorders, addictive behavior, and anxiety states

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35
Q

Future Pain Effects of Pain

A

Phantom pain

Post-herpetic neuralgia (pain along the nerve tract affected by herpes)

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36
Q

Quality of Life Effects of Pain

A

Sleeplessness, anxiety, fear, hopelessness, thoughts of suicide

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37
Q

Nociceptive Pain

A

Normal physiological pain, normal nerve impulse

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38
Q

Neuropathic Pain

A

Related to abnormal sensory input, occurs when nerves are damaged

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39
Q

Acute Pain

A

Short duration

Decreases as healing occurs

Usually recent onset

Indicates damage

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40
Q

Chronic Pain

A

Prolonged duration

Persists past expected healing

Poorly defined onset and difficult to treat

Recurrent pain

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41
Q

Preoperative Phase

A

Begins with decision for surgery and ends when client goes into the OR

Focuses include obtaining consent, identifying risk factors, physical/psychological assessments, and education

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42
Q

Intraoperative Phase

A

Begins when admitted to the OR and ends when admitted to PACU

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43
Q

Post Operative Phase

A

Begins immediately after surgery with admission to PACU and ends with complete recovery from surgery

Two phases: PACU and Inpatient Setting

Focus on protecting patient and preventing post operative complications

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44
Q

Respiratory Post Op Complications

A

Airway obstruction, hypoxia/hypoxemia, atelectasis, pneumonia

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45
Q

Cardiovascular Post Op Complications

A

Hypotension/shock, hypertension, dysrhythmias, DVT/thrombophlebitis/PE

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46
Q

Fluid and Electrolytes Post Op Complications

A

Fluid overload, fluid deficit, electrolyte imbalances, acid-base imbalances

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47
Q

Psychologic Post Op Complications

A

Emergence delirium, delayed emergence, anxiety, postoperative cognitive dysfunction, alcohol withdrawal delirium

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48
Q

Temperature Post Op Complications

A

Hypothermia/shivering, fever

Low-grade fever post-op is typically an indication that the patient needs to TCDB and requires ambulation

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49
Q

Gastrointestinal Post Op Complications

A

Nausea/vomiting, ileus/obstruction, delayed gastric emptying, hiccups, constipation

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50
Q

Urinary Post Op Complications

A

Retention, oliguria, infection

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51
Q

Surgical Site Post Op Complications

A

Infection

Dehiscence: when the wound falls apart

Evisceration: insides fall out of the wound

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52
Q

Primary Intention

A

Wound edges are approximated

No complications such as infection, necrosis, or abnormal scar formation

Heal with minimal scarring after 4-14 days

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53
Q

Secondary Intention

A

Wound edges are not closely approximated

Wounds have greater tissue loss usually from excessive trauma

Granulation tissue fills the wound slowly, long healing time, large scars

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54
Q

Tertiary Intention

A

Wound left open to allow edema and/or infection to resolve

Wound is surgically closed later

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55
Q

Wound Healing Phase 1

A

Inflammatory

Characterized by erythema, edema, heat, and pain

Time frame: injury to 4-6 days post injury

Histamines and prostaglandins are released in response to injury

Small vessels dilate, plasma and electrolytes leak into interstitial spaces

Bacteria are destroyed by leukocytes

Platelets form a clot and fibrin slowly bridges the wound edges

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56
Q

Wound Healing Phase 2

A

Proliferative

Lasts 4-24 days

Characterized by granulation tissue, should be red, beefy, and shiny

New blood vessels form, collagen adds strength and margins contract

Epithelialization occurs resulting in a scar

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57
Q

Wound Healing Phase 3

A

Maturation

Lasts 24 days to 2 years

Collagen fibers reorganize, mature, and gain strength

Wound shrinks, metabolic demands decrease, surface capillaries regress and the scar pales

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58
Q

Factors that Impede Healing

A

Pressure (blood supply to capillary network is disrupted)

Moist environment (wounds heal 3-5 times faster in dry environment)

Trauma (wounds heal slowly or not at all)

Edema (interferes with oxygen transport and cellular nutrition)

Necrosis (dead/devitalized tissue)

Incontinence (alters skin integrity)

Infection

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59
Q

Slough

A

Hydrated, loose, stringy tissue that is typically yellow

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60
Q

Eschar

A

Dehydrated, thick, leathery, black

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61
Q

Systemic Factors that Impede Healing

A

Age (geriatrics heal slower)

Body build (bariatric and emaciated clients are poor healers, adipose has poor blood supply, lack of oxygen and nutritional stores)

Chronic diseases (CAD, PVD, cancers, diabetes, alcoholism)

Nutritional status (watch albumin, prealbumin, lymph counts, and transferrin)

Electrolyte imbalance

Vascular insufficiencies (decreased/impaired blood supply and pressure lead to lower extremity ulcers)

Immunosuppression/radiation

Long OR or immobility times

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62
Q

Wound Classifications

A

Cause (surgical or nonsurgical, acute or chronic)

Depth of tissue affected (superficial, partial thickness, full thickness)

Color (red, yellow, black)

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63
Q

Superficial Wound

A

Involves only the epidermis

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64
Q

Partial-Thickness Wound

A

Extends into the dermis

65
Q

Full-Thickness Wound

A

Deepest layer of tissue destruction because they involve the subcutaneous tissue and sometimes even extend into the fascia and underlying structures such as the muscle, tendon, or bone

66
Q

Wound Drainage

A

Sanguineous, serosanguineous, serous, and purulent

67
Q

T-Tube

A

Drains from the gallbladder/liver

68
Q

Red Wounds

A

Protect the wound

Gentle cleaning if needed

Use dressing material that keeps the wound surface clean and slightly moist to promote epithelialization

69
Q

Yellow Wounds

A

Use a dressing that absorbs exudate and cleanses the wound surface

Hydrocolloid dressing/DuoDerm (left in place for 7 days)

70
Q

Black Wounds

A

Debridement of nonviable, eschar tissue

71
Q

Wound Cleansing

A

Antiseptics should not be used as a cleaning agent

Avoid peroxide, betadine, and general soaps

Commercial wound cleansers and normal saline are best

72
Q

Dressings for Dry Wounds

A

Use hydrogel

73
Q

Dressings for Infected Wounds

A

Silver-based products

74
Q

Dressings for Draining Wounds

A

Use absorptive dressings

75
Q

Dressings for Necrotic Wounds

A

Honey products

76
Q

Dressings for Wounds with Potential Delayed Healing

A

VAC

77
Q

Hydrogels

A

Add moisture to dry wounds/to debride necrotic tissue

Use Skin Prep to reduce chance or periwound maceration

Need cover dressing

78
Q

Hydrocolloids

A

Help with debridement

Do not use with infected wounds, highly draining wounds, or fragile skin

79
Q

Transparent Films

A

Used for partial thickness wounds with low drainage

80
Q

Honey Products

A

Leptopermum or Manuka Honey

Lowers pH of wound which is beneficial for chronic wounds

81
Q

Negative-Pressure Wound Therapy

A

Suction removes drainage and speeds healing

Must monitor serum protein levels, fluid and electrolyte balance, and coagulation studies

Wound types suitable include acute or traumatic wounds, surgical wounds that have dehisced, pressure ulcers, and chronic ulcers

82
Q

Hyperbaric Oxygen Therapy

A

Delivers oxygen at an increased atmospheric pressure, allows oxygen to diffuse into serum

Stimulates angiogenesis, kills anaerobic bacteria, and increases the killing power of WBCs and certain antibiotics

83
Q

Becaplermin (Regranex)

A

Recombinant human platelet-derived growth factor gel that actively stimulates wound healing and should only be used when the wound is free of devitalized tissue and infection

84
Q

Nutritional Therapy for Wound Healing

A

Diet high in protein, carbohydrates, and vitamins with moderate fat

Vitamin C: needed for capillary synthesis and collagen production

B-Complex Vitamins: necessary as coenzymes for metabolic reactions

Vitamin A: aids in the process of epithelialization

85
Q

Shear

A

Causes skin to be separated from underlying tissue

86
Q

Friction

A

Abrades to top layer of skin

87
Q

Stage I Pressure Ulcer

A

Nonblanchable erythema of intact skin

88
Q

Stage II Pressure Ulcer

A

Partial thickness skin loss involving epidermis, dermis, or both

89
Q

Stage III Pressure Ulcer

A

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia

90
Q

Stage IV Pressure Ulcer

A

Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures

91
Q

Suspected Deep Tissue Injury

A

Purple or maroon localized area of discolored intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/or shear

Area may be preceded by tissue that is painful, firm, mushy, boggy, warmer/cooler as compared to adjacent tissue

92
Q

Unstageable Pressure Ulcer

A

Full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar

93
Q

Kennedy Terminal Ulcer

A

Pressure ulcer that occurs in a dying patient, usually on coccyx or sacrum

Sudden onset, rapidly develop in size/depth

Borders are irregular with a pear or butterfly shape

94
Q

Braden Scale Scoring

A

Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction and Shear

23 points possible, < 16 indicates risk and interventions should be initiated

95
Q

Incontinence Associated Dermatitis

A

Skin damage caused by exposure to stool and/or urine

“Top-Down Injury”

Do not classify as a pressure ulcer

Prevent by using gentle cleansing with a no-rinse cleanser, moisturize, and apply moisture barrier product

96
Q

Skin Tears

A

Directly related to lack of internal hydration and topical moisturization

Infants and elderly are at risk

Most frequently on upper extremities

Identify cause and address

97
Q

Category I Skin Tear

A

No tissue loss, tear can be fully approximated

98
Q

Category II Skin Tear

A

Partial tissue loss (epidermal loss)

99
Q

Category III Skin Tear

A

Complete tissue loss (epidermal flap is absent)

100
Q

Prevention of Skin Tears

A

Prevention is best (padding, long clothes, uncluttered environment, short nails)

Silicone mesh recommended

Avoid hydrocolloids, transparent films and steri-strips (can cause further damage to skin)

101
Q

Venous Stasis Ulcers

A

Usually found between knee and ankle

Moderate to heavy exudate

Irregular shape

Beefy red

Calcification in wound base

Pain improves with elevation

102
Q

Arterial Insufficiency Ulcers

A

Occurs distal to area of impaired arterial supply

Pale, gray or yellow in color

Commonly accompanied by eschar

Minimal exudate

Shape is smooth, even, and regular

Pain increases with elevation and ambulation

103
Q

Diabetic Ulcer

A

Any site on the foot and lower limb that is subjected to constant pressure, friction, or trauma

Often a deep necrotic area that may be dry with infection present

Minimal to moderate exudate

Smooth and even

No sensation

104
Q

Sexuality Includes…

A

Perception of self, quality of sexual relationships, and concerns

105
Q

Sexual Assessment

A

Why: to open up discussion of sexual matters, address health holistically, clear up myths

When: usually at the end of the interview, when talking about GU system

Be nonjudgmental, remove biases, use language appropriate to the background and culture of the patient

106
Q

Sexual Concerns of Young Women

A

Irregular periods, STIs, contraception, tampons, emergency contraceptive, pregnancy

107
Q

Sexual Concerns of Post Menopausal Women

A

Vaginal dryness, discomfort with intercourse, relationships and sexual satisfaction, orgasm, masturbation

108
Q

Sexual Concerns of Men

A

Relationships and sexual satisfaction, orgasm, masturbation, erectile dysfuction

109
Q

Cancer and Sexuality

A

Physiological problems, treatments, psychosocial implications, problems especially with breast cancer and genital cancer

110
Q

Diabetes and Sexuality

A

Impotence for men caused by neuropathy, decreased libido, prone to UTIs and vaginitis, difficulty with orgasm

111
Q

Prostatectomy and Sexuality

A

Difficulty with erection

112
Q

Cerebrovascular Accident and Sexuality

A

Neurological implications, include assessment about sexual history before the stroke, assess medications

113
Q

Multiple Sclerosis and Sexuality

A

Need for position changes, bladder and bowel incontinence, plan for sex when partner is least fatigued

114
Q

Cardiovascular Disease and Sexuality

A

Scared for sex post-heart attack, depression is common, check into medications

115
Q

Aging and Sexuality: Men and Women

A

Longer to become sexually aroused, longer to complete intercourse, longer before arousal can occur again, less intense response to sexual stimulation, decline in sexual activity BUT DOES NOT DISAPPEAR

116
Q

Aging and Sexuality: Female

A

Vaginal narrowing and decreased elasticity

Decreased vaginal secretions, slower sexual response

S/S include painful intercourse and bleeding, vaginal itching and irritation, delayed orgasm

Nursing: vaginal estrogen replacement, gyn/uro follow up and use lubricant

117
Q

Aging and Sexuality: Males

A

Less firm testes and decreased sperm production

Delayed erection and achievement of orgasm

Slower sexual response

Erectile dysfunction likely related to other health problems, not aging

Nursing: monitor for medication side effects and other health problems

118
Q

Erectile Dysfunction Medications

A

Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)

DO NOT USE THESE ED MEDICATIONS IF YOU TAKE NITRATES SUCH AS NITROGLYCERIN AS THIS CAN CAUSE DANGEROUSLY LOW BLOOD PRESSURE

CALL DOCTOR IF YOU EXPERIENCE VISION LOSS

119
Q

Reasons for Urinary Diversions

A

Removal of bladder from cancer

Neurogenic bladder, congenital anomalies, strictures, trauma to the bladder, and chronic infections with deterioration of renal function

120
Q

Incontinent Urinary Diversions

A

Ileal Conduit

Cutaneous ureterostomy

Nephrostomy

121
Q

Ileal Conduit

A

Most common type

Ureters implanted into a segment of the ileum that has been resected

No valve or voluntary control

Advantages: good urine flow with few physiologic alterations

Disadvantages: surgical procedure is complex, must wear an external collecting device, must care for stoma and drainage bag

122
Q

Cutaneous Ureterostomy

A

Ureters are excised from the bladder and brought through the abdominal wall to form a stoma

Advantages: not considered a major surgery

Disadvantages: external collecting device must be worn, possibility of stricture or stenosis of small stoma

123
Q

Nephrostomy

A

Catheter inserted into pelvis of the kidney

Most frequently done in advanced disease as a palliative measure

Advantage: no need for major surgery

Disadvantages: high risk of renal infection, predisposition to calculus formation, may have to be changed every month

Catheter should remain open

124
Q

Kock Pouch

A

Loops of intestine are anastomosed together and then connected to the abdomen via the stomal segment

Ureters are attached to the pouch above a valve, which prevents urine reflux

Second valve is placed in the intestinal segment leading to the stoma

125
Q

Indiana Pouch

A

Ureters are anastomosed to the colon portion of the reservoir in a manner to prevent reflux

Ileocecal valve is used to provide continence and the section of ileum that extends from the intestinal reservoir to the skin is made narrower to prevent urine leakage

126
Q

Continent Urinary Diversions

A

Stoma is usually flush with the skin and placed lower on the abdomen than the ileal conduit stoma

Patient will need to self-catheterize every 4-6 hours and will need to irrigate the internal reservoir to remove mucus

Will not need to wear an external collection device

127
Q

Complications of Urinary Diversions

A

Breakdown of the anastomoses in the GI tract

Leakage from the uteroileal or uterosigmois anastomosis

Paralytic ileus

Obstruction of ureters

Wound infection

Mucocutaneous separation

Stomal necrosis

128
Q

Pre-Op Care for Urinary Diversions

A

Patient will require a complete bowel clean-out, assist as needed with a bowel prep

129
Q

Post-Op Care for Urinary Diversions

A

Stents placed in ileal conduit for 7-10 days to promote urinary drainage. If continent urostomy, will have catheter or stent in stoma (sutured in place) to allow drainage from reservoir

Drain tube in pelvic area for drainage of blood and surgical fluids

May have NG tube until effective intestinal peristalsis returned. May then start on clear liquids to advance as tolerated

Monitor urine output carefully

Greater risk for UTI

Strive to keep urine acidic

High fluid intake is encouraged

130
Q

Ascending Colostomy

A

Semi-liquid stool consistency, increased fluid requirements, needs appliance and skin barriers, cannot be irrigated

Indications for surgery: perforating diverticulitis in lower colon, trauma, inoperable tumors of colon rectum or pelvis, rectovaginal fistula

131
Q

Transverse Colostomy

A

Semi-formed stool consistency, possibly increased fluid requirement, uncommon bowel regulation, requires appliance and skin barrier, cannot irrigate

Indications for surgery: same for ascending colostomy, may also be performed in children who are born with imperforate anus

132
Q

Sigmoid Colostomy

A

Formed stool consistency, no change in fluid requirements, bowel regulation possible with irrigations and/or diet, need for appliances and barriers dependent on regulation

Indications for surgery: cancer of the rectum or rectosigmoid area, perforating diverticulum, trauma

133
Q

Ileostomy

A

Opening from the ileum or small intestine through the abdominal wall.

Bypasses the entire large intestine.

Stool is liquid to semiliquid consistency and contains preoteolytic enzymes.

Increased fluid requirement. No bowel regulation or irrigation. Requires wearing an appliance and skin barrier.

Indications for surgery: ulcerative colitis, Crohn’s disease, trauma, cancer, birth defect, familial polyposis

134
Q

Loop Stoma

A

Closure of colostomy is anticipated. One stoma with a proximal (drains stool) and distal (drains mucus) opening and an intact posterior wall that separates the two openings.

135
Q

End Stoma

A

One stoma formed from the proximal end of the bowel with the portion of the GI tract either removed (permanent) or sewn closed (Hartmann’s pouch) and left in the abdominal cavity

136
Q

Double-Barrel Stoma

A

Bowel is surgically severed and two ends are brought out onto the abdomen as two separate stomas.

Proximal is functional stoma, distal is nonfunctioning/mucus fistula

Temporary diversion in cases where resection is required due to perforation or necrosis

137
Q

Ileoanal Pull-Through

A

Continent diversion

Colon is removed and ileum is anastomosed or connected to an intact anal sphincter

138
Q

Ileoanal Reservoir

A

Continent diversion

Internal pouch created from ileum. End of pouch sewn or anastomosed to the anus.

139
Q

Special Considerations for Patients Who Have Ileoanal Reservoirs

A

Kegel exercises will help to strengthen the pelvic floor

May have mucus discharge from the rectum

May have frequent stools

Increase fiber and decrease sugars

May need Metamucil, antidiarrheals

May have night incontinence

140
Q

Assessing a Stoma

A

Volume

Color

Consistency

141
Q

Diet on Colostomy

A

No restrictions

142
Q

Foods to Avoid with Ileostomy

A

Celery, coconut, corn, coleslaw, peas, popcorn, spinach, dried fruits, nuts, pineapple, seeds

143
Q

Palliative Care

A

Prevents and relieves suffering and supports the best possible quality of life for patients and their families REGARDLESS OF THE STAGE OF THE DISEASE OR THE NEED FOR OTHER THERAPIES

Concentration of symptom management

144
Q

Hospice

A

Usually performed on those with terminal prognoses, concentration on comfort care

145
Q

Advance Health Care Directives

A

Living will
Durable power of attorney for health care
POLST form

146
Q

Pain Management during Death

A

Opioids such as morphine given

Atypical pain medications such as steroids, neurontin, tramadol, lidocaine patches

147
Q

Dyspnea Management during Death

A

Assess RR, O2 Sat, ABG

Manage with bronchodilators, corticosteroids, opioids, oxygen, positioning, energy conservation, glycopyrolate

148
Q

Nutrition and Hydration Management during Death

A

May lose the appetite/taste for food

Kidney/Liver failure unable to metabolize and eliminate nutrients

Cytokines trigger immune response which leads to catabolism –> cachexia

149
Q

Delirium/Confusion During Death

A

Reversible in 50% of cases, may be result of disease

Benzodiazepines, haloperidol

May be the result of under-treated pain

150
Q

Ethnocentrism

A

The belief in the inherent superiority of one’s own culture or ethnic group

151
Q

Urinary Catheter

A

Catheter with a hollow flexible tube that lets urine come out of the bladder for collection

GOES IN THE DIRECTION OF LEAST RESISTANCE/PRESSURE

152
Q

Catheters require…

A

A physician’s order

Aseptic technique in an institutional setting

153
Q

Inserting a Catheter in a Female

A

Dorsal recumbent position

Clean out out in in and then down the middle

154
Q

Inserting a Catheter in a Male

A

Laying down, spread legs slightly

Continue if they have an erection

Clean in a bull’s eye fashion

155
Q

Factors in Risk for Infection with Catheters

A

Poor technique

Inadequate fluid intake

Poor hygiene

Trauma

Retrograde urine flow

156
Q

Bladder Irrigation

A

Must have an order

Clamp drainage tube

Run in amount

Wait time ordered

Unclamp

Leave open to drain

Record irrigate as intake

157
Q

Nonopioid Analgesics

A

Aceteminophen

NSAIDs

Neurontin

158
Q

Gerontologic Pain Considerations

A

Low and slow

Risk for NSAID-induced GI toxicity

159
Q

TENS

A

Transcutaneous Electrical Nerve Stimulation used for small nerves

Nonpharmacologic pain management technique

Adult Health Nursing II (22 decks)

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