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Exam 3 Flashcards

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1
Q

What are 5 reasons we need sleep?

A
  1. Sleep affects the tissues and our brains.
  2. Sleep regulates energy metabolism.
  3. Sleep improves learning and adaptation.
  4. Reduces stress and anxiety.
  5. Sleep, rest, and illness are related
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2
Q

How many hours of sleep do young adults, middle aged adults, and older adults need?

A

young adults: 8-10 hours

middle-aged: 7-9 hours

older adults: 5-7 adults

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3
Q

What is the day and night pattern in a 24 hour period, that is regulated by an internal clock, allowing us to respond to changing levels of light?

A

Circadian Rhythm

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4
Q

How long is the normal sleep cycle?

A

90 minutes

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5
Q

What is the difference between NREM and REM sleep?

A

NREM: nonrapid eye movement, 3 stages, restful phase of sleep, and includes muscle relaxation, in addition to the decrease in body temp, HR, Respirations, and BP

REM: rapid eye movement, spontaneous awaken, brain is highly active like when an individual is awake, dreams occur

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6
Q

What are the 4 stages of the sleep cycle in order?

A
  1. NREM Stage 1: transition to sleep lasting about 5-10 minutes
  2. NREM Stage 2: body temp drops, heart rate begins to slow, brain begins to produce sleep spindles, lasts about 20 minutes
  3. NREM Stage 3: muscles relax, BP and respirations drop, the deepest sleep occurs here
  4. REM: brain becomes more active, body becomes relaxed and immobilized, dreams occur, eyes move rapidly
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7
Q

What are examples of some lifestyle factors that affect sleep? (7 examples)

A
  1. Diet
  2. Nicotine and Caffeine
  3. Physical Activity
  4. Alcohol
  5. Medications
  6. Illness
  7. Environment
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8
Q

What are 6 examples of different types of sleep disorders?

A
  1. Insomnia
  2. Circadian Disorder
  3. Sleep Apnea/Obstructive Sleep Apnea
  4. Snoring
  5. Narcolepsy
  6. Parasomnia- sleep walking, sleep talking, night terrors, bruxism (teeth grinding)
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9
Q

What are some important interview questions to ask when doing a sleep assessment?

A
  1. What is your usual sleeping pattern?
  2. What is your sleeping environment?
  3. What is your bedtime routine?
  4. Do you use any sleep aids?
  5. Have there been any changes or problems in your sleep recently?
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10
Q

What is the disorder characterized by breathing that repeatedly starts and stops while sleeping?

A

Sleep Apnea or Obstructive Sleep Apnea

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11
Q

What is the disorder characterized by excessive falling asleep during different and inappropriate times throughout the day?

A

Narcolepsy

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12
Q

What are 7 key things you can do to promote good sleep?

A
  1. Eat healthy- whole foods and plenty of water
  2. Moderate alcohol use- stop drinking at least 3 hours before bed (effects REM)
  3. Get Exercise- helps boost energy and supports more restful sleep
  4. Get regular sunlight- helps with internal clock
  5. Keep a regular sleep schedule- consistency is helpful for regulating circadian rhythms
  6. Time caffeine right- caffein lasts up to 12 hours in the body, so consuming after lunch time could effect sleep
  7. Set your bedroom for success- supportive and comfortable mattress, keep room cool and dark, give the electronics the boot
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13
Q

What is the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions?

A

Health Literacy

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14
Q

What 3 things are low-health literacy associated with?

A
  1. poor communication
  2. poor health outcomes
  3. higher health costs
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15
Q

What is the strongest predictor of a person’s health over age, income, employment status, education level, and race?

A

Poor health Literacy

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16
Q

What is the most often cited root cause of sentinel events?

A

poor communication

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17
Q

What are the 5 most affected populations in regard to health literacy?

A
  1. Adults over the age of 65
  2. Recent refugees and immigrants
  3. Having less then a high school degree
  4. Lower incomes, below poverty level
  5. Non-native speakers of English
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18
Q

What is the patient’s RIGHT in regard to health education based on health literacy?

A

Patients and caregivers MUST receive AND UNDERSTAND information about their disease and management of illness

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19
Q

What are the 3 Domains of Nursing and what do they entail?

A
  1. Cognitive- thinking, gaining knowledge
  2. Psychomotor- learning skills, doing the skill
  3. Affective- feelings, changes in attitudes and values
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20
Q

What are the 5 Rights of Teaching?

A

Time

Context

Goal

Content

Method

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21
Q

What does the acronym “SMART” stand for when creating learning outcomes/goals for a patient?

A

Specific
Measurable
Attainable
Relevant
Timely

WHO will (the patient)
DO what (specify behavior)
HOW well (criteria for evaluation)
WHEN (specific condition or time)

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22
Q

What are 4 main factors that affect learning?

A
  1. Psychomotor- coordination, energy, visual impairment
  2. Environment- lack of privacy
  3. Rapport- empathetic and supportive relationship between teacher and learner
  4. Feedback to reinforce learning- positive reinforcement vs. criticism, connect new information to past experiences
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23
Q

What are some examples of formats used for patient teaching? (8 examples)

A
  1. Lecture
  2. Group Discussion
  3. Demonstration and Return
  4. Demonstration
  5. One-to One Instruction
  6. Printed Materials
  7. Role Modeling
  8. Online Sources of Information
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24
Q

What is the correct teaching process when using the nursing process (ADPIE)?

A
  1. Assessment of learner- you know the patient’s readiness and level of understanding and ability to comprehend
  2. Determining education needs- teaching strategies that will promote the level of knowledge and understanding
  3. Planning appropriate teaching strategies
  4. Imparting information- methods of teaching the patient charts, videos, pictures, handling of equipment
  5. Evaluating learning- list foods high in sodium, demonstrate the skill, develop a plan for rehab activities, or plan a meal
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25
Q

What does “SPEAK UP” stand for in regard to the joint commissions initiative that a patient has a right to informed decisions about their health care?

A

Speak upif you have questions or concerns

Pay attention to the care you receive. Do not assume you are getting the right care, medication.

Educate yourself about your illness, medical tests and treatment plan.

Ask a trusted family member/ friend to be your advocate.

Know which medications you take and why

Use a hospital, clinic or surgery center that is approved by TJC

Participate in all decisions about your care

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26
Q

What are the 3 most important things you should document in regard to teaching a patient?

A
  1. What content was taught?
  2. What method was used?
  3. What did the patient learn?
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27
Q

When mixing different insulins into one syringe what is the correct order and steps needed to be taken?

A

Push air into cloudy

Push air into clear

Draw up the clear

Draw up the cloudy

cloudy, clear, clear, cloudy

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28
Q

What are the injection sites for a subcutaneous injection?

A

Abdomen, fatty part on back of upper arm, and upper buttocks

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29
Q

When administering a subcutaneous injection into the abdomen, what is the exact correct location?

A

2 inches (5cm) away from the umbilicus

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30
Q

When cleaning the injection site with alcohol what is the correct method?

A

Apply at center of site and rotate outward in circular direction for approximately 2 inches

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31
Q

When administering heparin, how long should you inject it over?

A

30 seconds

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32
Q

When would you administer a subcutaneous injection at a 45-degree angle vs 90-degree angle?

A

45 degrees for someone with minimal fat

90 degrees for someone who is obese

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33
Q

When do you pinch the skin vs. spread when giving an injection?

A

Subcutaneous- pinch

Intramuscular- spread

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34
Q

What are the CDC recommendations for needle size and length for a subcutaneous injection?

A

Gauge- 23-25

Length- 1/2 inch, 5/8 inch, 3/8 inch

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35
Q

What are the CDC recommendations for needle size and length for an intramuscular injection? What is the largest size needle that can go in the deltoid?

A

Gauge- 22-25

Length- 1-3 inches

Deltoid- only 1 inch or less

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36
Q

If a non-insulin volume of medicine is less than 1mL what type of syringe should you use?

A

a tuberculin syringe (TB)

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37
Q

How do you find the deltoid injection site for an IM injection?

A
  1. Palpate lower edge of acromion process
  2. Place two fingers across the acromion process, with the top finger along the acromion process
  3. Make a V, and inject in center of the V
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38
Q

How do you find the ventrogluteal injection site for an IM injection?

A
  1. Place palm of hand over the greater trochanter of hip
  2. Move thumb towards groin and index finger towards anterior superior iliac spin
  3. Move middle finger towards iliac crest
  4. Inject in center of V between middle and index finger
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39
Q

How do you find the vastus lateralis injection site for an IM injection?

A
  1. Position one hand against the greater trochanter and the other against the lateral femoral condyle.
  2. Move two hands length inward until hands meet
  3. Inject in center of where the hands meet
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40
Q

When a solution is less than 1mL where do you administer the injection? If it is more than 1mL where do you administer the injection?

A

less than 1mL- deltoid

1mL-3mL- ventrogluteal or vastus lateralis

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41
Q

At what angle do you administer an IM injection?

A

90-degree angle

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42
Q

What do you label your syringe with?

A

patient name, the medication, and the dose

43
Q

What inflammatory skin infection is defined as a localized, contagious, caused by group A strep and presents manifestations of vesicles, pustules, and honey crusted sores?

A

Bacterial Impetigo

44
Q

What bacterial infection is caused by s. aureus of the hair follicle?

A

Bacterial Folliculitis

45
Q

What is the name for an infection of the hair follicle that goes into the deeper layers of the skin that is caused by staphylococcus aureus and creates a small pocket of pus?

A

Bacterial Furuncle aka “Boil”

46
Q

What is the name for a cluster of painful, pus-filled bumps (boils), that form a connected area of infection under the skin?

A

Bacterial Carbuncle

47
Q

What is the name of the infection of the dermis and SQ tissue, caused by Group A strep, showing manifestations of painful, edematous, warmth, and erythema with or without fever?

A

Bacterial Cellulitis

48
Q

What is the name of the vaccine for shingles and at what age should you get it?

A

Shingrix and people who are 50 years and older

49
Q

What infection causes a painful rash with burning, numbness, tingling, is sensitive to touch, and involves fluid-filled blisters that break open and crust over?

A

Shingles

50
Q

What are the two different types of fungal infections?

A
  1. dermatophytes (aerobic fungi)- feed on dead keratin of skin, hair, and nails
    example- tinea
  2. Yeast (Candida)- oral or vaginal thrush
51
Q

What are the different types of tinea and what areas of the body do they infect?

A
  1. Tinea corporis- ringworm of the body
  2. Tinea capitis- ringworm of the scalp
  3. Tinea pedis- athletes foot
  4. Tinea Unguium- fungus of the fingernails and toenails
  5. Tinea cruris- Jock Itch
  6. Tinea versicolor- fungal infection of the skin causing discolored patches
52
Q

What parasitic skin infection is caused by hookworm larvae that is transmitted by walking barefoot?

A

Cutaneous Larva Migrans

53
Q

What are the 2 different types of eczema?

A
  1. Atopic dermatitis- internal skin condition
  2. Contact dermatitis- results from external factors
54
Q

What skin disorders causes skin cells to multiply up to 10 times faster than normal?

A

Psoriasis

55
Q

What skin disorder is characterized by different areas resulting in the discoloring of the skin, due to the skin losing its pigment cells?

A

Vitiligo

56
Q

What type of malignant skin lesion is commonly seen on the neck, head, and upper back and presents as a pearly, shiny papule or nodule, with a raised or rolled border?

A

Basal cell carcinoma

57
Q

What type of malignant skin lesion commonly starts as as actinic keratosis and presents as a scaling or ulcerated, reddish brown nodule?

A

Squamous cell carcinoma

58
Q

What type of cancer is defined as “a cancer of the melanocytes which arises generally from the skin but may be seen less commonly in the eyes, ears, GI tract, CNC, oral and genital mucosa?

A

Malignant melanoma

59
Q

What does the acronym “ABCDE” stand for in regard to skin cancer assessments?

A

Asymmetry
Border
Color variations
Diameter
Evolving or changing

60
Q

What two classification systems are used to grade malignant melanoma?

A

Breslow staging and Clark level of Invasion

61
Q

When preforming a wet to dry dressing change, what are the 7 main things you are going to assess?

A
  1. Color
  2. Edema
  3. Exudates (type of drainage)
  4. Amount of drainage
  5. Length and width of wound
  6. Undermining
  7. Tunneling
62
Q

.What are you going to document at the end of preforming a wet to dry wound care dressing change? (8 examples)

A
  1. change of dressing
  2. pain assessment
  3. wound dimensions in cm
  4. characteristics of wound
  5. how much you irrigated with
  6. drainage type and amount
  7. what supplies you used and took out
  8. patient tolerance
63
Q

What are the 3 types of wounds by depth?

A
  1. Superficial: Involves only the epidermal layer of the skin
  2. Partial Thickness: Confined to epidermis and dermis
  3. Full Thickness: Involves epidermis, dermis, subcutaneous tissue, possibly tendons, ligament, and bones
64
Q

What are the 4 phases of wound healing?

A
  1. Hemostasis- This process designed to essentially seal the wound
    Injured blood vessels constrict
    Platelets gather to stop the bleeding
    Clots form a fibrin matrix
  2. Inflammatory- Usually lasts 24 hours
    Histamine secreted resulting in vasodilation
    White cells rush to injured area (phagocytosis)
    Collagen is formed
  3. Proliferative- Lasts 3-24 days. Main activity is filling of the wound bed with granulation tissue & contraction of the wound bed
  4. Remodeling- Collagen scar continues to reorganize & gain strength for several months. New collagen tissue is deposited
    Scar becomes a flat, thin, white line.
65
Q

What are the 3 types of wound healing?

A
  1. Primary Intention- Occurs when there is little, or no tissue loss and skin edges approximated (close together)
  2. Secondary Intention- Involves loss of tissue that prevents would edges from approximating or should not be closed because of infection
  3. Tertiary Intention- Occurs when two surfaces of granulation tissue are brought together after initially being left to heal by secondary intention.
66
Q

What are the 4 types of wound drainage?

A
  1. Serous drainage- Straw colored. watery consistency. Contains very little cellular matter.
  2. Sanguineous Drainage- Bloody drainage
  3. Serosanguineous Drainage- Combination of bloody and serous drainage
  4. Purulent drainage- Thick yellow, pus-like drainage seen in infected wound
67
Q

What are the 5 types of wound complications?

A
  1. Hemorrhage- rapid blood loss that can be internal or external
  2. Infection- swollen, erythematous, warm to touch, increased drainage, foul odor
  3. Dehiscence- layers of skin and tissue separate and begin to open
  4. Evisceration- Internal viscera through incision (intestines pop through wound)
  5. Fistulas- An abnormal passage connecting two body cavities
68
Q

What is the color code in regard to wound assessment?

A

R = Red- reflects color of normal healing

Y = Yellow- needs to be cleansed

B = Black- cover with thick eschar, requires debridement

69
Q

What are the 4 stages of pressure injuries?

A

Stage 1- Localized, intact skin, non-blanchable redness discoloration

Stage 2- Partial thickness loss of dermis, open but shallow

Stage 3- Deep crater, full thickness skin loss, undermining

Stage 4- Full thickness skin loss with extensive destruction, exposed bone / tendon, undermining, eschar tissue may be present

70
Q

What are the 3 different types of drains used in wound care?

A
  1. Penrose drain
  2. Jackson-Pratt drain
  3. Hemovac
71
Q

What is the term for the “removal of nonviable, dead tissue to rid wound of a source of infection”?

A

Debridement

72
Q

What type of dressing is “wafer type that contains gel-forming agents in an adhesive compound laminated onto a flexible, water-resistant layer”?

A

Hydrocolloid dressings

73
Q

What type of dressing “contains 90% water in a gel base and helps regulate fluid exchange from the wound surface”?

A

Hydrogel dressings

74
Q

What type of dressing “are a non-woven absorbent dressing derived from seaweed and help absorb exudates”?

A

Alginates

75
Q

How long does the nurse have to administer mixed insulin?

A

5 minutes

76
Q

Blood glucose has to be less than _____ amount to be considered “hypoglycemia”?

A

65mg/dL

77
Q

What are the beta cell and alpha cells responsible for in the pancreas?

A

Alpha- glucagon which raises blood sugar

Beta- insulin which lowers blood sugar

78
Q

What are the 4 different types of diabetes?

A
  1. Type 1
  2. Type 2
  3. Gestational
  4. Secondary
79
Q

What are the 3 biggest signs/symptoms of diabetes? What are other common symptoms?

A
  1. Polyuria, Polydipsia, Polyphagia
  2. Fatigue, weight loss, glucosuria (sugar in urine), slow healing wounds, blurred vision, numbness and tingling in extremities
80
Q

What are the levels for normal, prediabetes, and diabetes in a fasting blood glucose test?

A

Normal- less than 100

Prediabetes- 100-125

Diabetes- greater than 126

81
Q

What are the levels for normal, prediabetes, and diabetes in a oral glucose test?

A

Normal- less than 140

Prediabetes- 140-199

Diabetes- greater than 200

82
Q

What are the levels for normal, prediabetes, and diabetes in a Hemoglobin A1C test?

A

Normal: 4-5.6%

Prediabetes: 5.7-6.4%

Diabetes: greater than 6.5%

83
Q

What is the level to be diagnosed for diabetes in a random blood glucose test?

A

Greater than 200 with additional symptoms of the 3 P’s

84
Q

What are the 3 main goals of treatment/management of diabetes?

A
  1. Maximize glycemia control
  2. Maintain normal blood glucose levels
  3. Prevent the complications of hyperglycemia
85
Q

What are the different types of rapid-acting insulin? What is the onset, duration, and peak of this type of insulin?

A
  1. Lispro, Aspart, glulisine

Onset- 15 minutes

Peak- 1-2 hours

Duration- 3-4 hours

86
Q

What are the different types of short-acting insulin? What is the onset, duration, and peak of this type of insulin?

A
  1. Regular (Humulin R & Novolin R)

Onset- 30-60 minutes

Peak- 2-4 hours

Duration- 5-7 hours

87
Q

What are the different types of intermediate-acting insulin? What is the onset, duration, and peak of this type of insulin?

A
  1. NPH (Humulin N & Novolin N)

Onset- 2-4 hours

Peak- 4-10 hours

Duration- 10-16 hours

88
Q

What are the different types of long-insulin? What is the onset, duration, and peak of this type of insulin?

A
  1. Glargine (U100 & U300)

Onset- 3-4 hours

Peak- “peakless”

Duration- 24 hours

89
Q

What are some examples of the benefits in using an insulin pump? ( 5 examples)

A
  1. less needle sticks
  2. convenience
  3. precise doses
  4. better quality of life
  5. able to track trends
90
Q

What type of insulin is used in a sliding scale?

A

rapid-acting

91
Q

What are the signs and symptoms of hypoglycemia?

A

Anxiety
Palpations
Numbness around the lips
Sweating
Shakiness
Irritability

If hypoglycemia is severe and lasts a long time then: (resembles drunk person)

Difficulty thinking
slurred speech
dizziness
lack of coordination
weakness
seizures, coma, death

92
Q

How many grams of oral glucose do you give a patient who is conscious and hypoglycemic?

A

15-20mg

93
Q

How much juice should you give a patient that is hypoglycemic? How many lifesavers should you give?

A

4 oz of juice

6-7 lifesavers

94
Q

If patient who is hypoglycemic is unable to swallow what do give?

A

25-50mL of 50% dextrose IV

95
Q

If patient is hypoglycemic, unconscious, and you can not access an IV, what is the next best thing to give?

A

IM injection of 1mg glucagon

96
Q

What is the difference between the somogyi effect and the dawn phenomenon?

A

Somogyi effect- blood glucose low at 2-3AM, and high in morning (took too much insulin)

Dawn phenomenon- blood glucose is normal at 2-3AM, and high in the morning (did not take too much insulin)

97
Q

What are the 5 risk factors of metabolic syndrome? How many have have to be present to be diagnosed with it?

A
  1. Fasting blood glucose (FBS) greater than 100 mg/dL
  2. Hypertension greater than or equal to 130/85 mm Hg
  3. Increased serum triglycerides greater than or equal to 150 mg/dL
  4. Central Obesity
  5. (HDL) less than or equal to 40 mg/dL in men and less than or equal to 50 mg/dL in women

3 Must Be Present

98
Q

What are the 2 most important patient teaching regarding sick days with someone who is a diabetic?

A
  1. STILL TAKE MEDS
  2. SIP ON COKE, GINGER ALE, OR GATORADE
99
Q

What are the 6 most important patient teachings regarding foot care with someone who has diabetes?

A
  1. Podiatrist regularly (every 3 months)
  2. well-fitting shoes
  3. Wash feet daily and dry thoroughly
  4. Do not soak feet
  5. Do not put feet in hot water
  6. Never walk barefoot
  7. Check feet everyday for wounds and sores
100
Q

How many minutes of exercise or steps should a person with diabetes try and do?

A

150 minutes per week or 10,000 steps per day

101
Q

What is a normal blood glucose range?

A

70-100

102
Q

What are the only 2 insulins that can be given IV?

A

Rapid-acting and short-acting

103
Q

What type of exercise is best for a diabetic patient?

A

Aerobic and weight resistant

104
Q

What precautions should be taken to prevent hypoglycemia in a diabetic patient prior to exercising?

A

Eat and check sugar levels prior to exercising, if sugar is less than 100, ingest 15 grams of simple carb

Nursing Final Exam (5 decks)

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