Exam 3 Flashcards
(130 cards)
1
Q
Pain scales
A
Children: Wong’s Faces
Adults: numerical 0-10
2
Q
Who should not receive PCAs?
A
People who are not cognitively intact or little kids
3
Q
What does the nurse need to do more often when a pt is on a PCA?
A
Assess vitals signs because of the risk of respiratory depression
-O2, BP, RR
4
Q
What is a big side effect of PCA?
A
Constipation
5
Q
Who determines if a pt needs a PCA?
A
anesthesiologist
6
Q
How much Tylenol can be given to the elderly in one day?
A
1g/day
7
Q
Alternative methods to ease pain
A
- Sleep
- drink lots of water
- thermal treatments
- acupuncture
- acupressure
- exercise
8
Q
What do you document with pain patches?
A
Must mention that the old patch was removed and disposed of properly
9
Q
PQRST pain assessment
A
P=provokes (what causes the pain) Q=quality (what does it feel like) R=radiates (where does the pain radiate) S=severity (scale of 0-10) T=time (time pain started)
10
Q
Where are epidurals administered?
A
in the epidural space
11
Q
Factors affected by cognitive disorders
A
Orientation Attention Memory Vocabulary Calculation ability Abstract thinking
12
Q
What is the most common psychiatric syndrome in hospitals?
A
Delirium
-50% of occurrence in elderly inpatients
13
Q
What is the priority care for patients experiencing delirium?
A
Safety
14
Q
Delirium
A
Usually results from an acute disruption in the homeostasis of the brain
15
Q
Dementia
A
-Results from primary brain pathology that usually is irreversible, chronic, and a slow progression
16
Q
Diagnostic criteria for delirium
A
- Disordered cognition
- attention deficit
- disturbed consciousness
- disturbed sleep-wake cycles
- abnormal psychomotor behaviors
17
Q
How many Americans are affected by Alzheimer’s? Prevalence in ages >65 and >85?
A
- 5 million
- occurs in 10% of people >65 years
- almost 50% of people >85
18
Q
Deficits related to dementia
A
- impaired learning
- compromised ability for complex tasks
- impaired reasoning
- compromised spatial ability and orientation
- language deficits
- behavioral problems
19
Q
Apraxia
A
inability to perform motor tasks despite intact motor function
20
Q
Aphasia
A
loss of language
21
Q
Sundowning
A
change in behavior after sunset
22
Q
Agnosia
A
inability to recognize familiar objects
23
Q
Risk factors for delirium
A
- aging
- postop status
- metabolic disorders
- drug withdrawal
- toxicity secondary to drugs or other exogenous substances
24
Q
How is dementia characterized?
A
- several cognitive deficits that result from a general medical condition, use of substance, or multiple biologic etiologies
- gradual onset
25
Hallmark sign of Alzheimer's
Post-mortem findings of beta-amyloid plaques in the brain
26
What does forensic mean?
Law
27
T or F:
| You will always be in a forensic milieu even if you aren't a forensic nurse.
True
28
Forensic nursing environments
- community based outpatient clinics
- secure units in general hospitals
- state psych hospitals
- forensic psych hospitals
- custodial type setting
29
Who has the highest population of incarcerated people in the western world?
The U.S.
30
Factors contributing to growing forensic population
- more drug-related activities
- rising interpersonal & urban violence
- anticrime & antidrug legislation
- poor economic conditions and associated homelessness
- criminalization of the mentally ill
31
T or F.
Correctional facilities have become the country's front-line mental health providers representing the mental health institutions of the 21st century.
True
32
Approaches to prevent incarceration of the mentally ill
- Forensic assertive community treatment
| - Sequential intercept model
33
Forensic assertive community treatment
integrates assertive community treatment and community justice intitiatives
34
Sequential intercept model
Envisions 5 points of interception, from law enforcement to community corrections and support, to prevent people from entering the criminal justice system
35
Characteristics of forensic clients
- demonstrate poor judgment
- have limited reasoning
- have a history of not learning from mistakes
- report an exceptionally high level of substance abuse at the time of arrest
36
Role of forensic nurse
To come up with alternatives to incarceration of offenders with mental illness
37
T or F
| People with substance use disorders are at increased risk for mental illness
True
38
Forensic Populations
- suspects or convicts
- sentenced or unsentenced
- not guilty by reason of insanity
- incompetent to stand trial
- not criminally responsible because of mental disorders
39
What percentage of any prison or jail population has a mental disorder?
15%
40
Types of offenders in the prison population
- mentally ill
- violent
- juvenile
- female
- older adult
- offenders with HIV/AIDS or hepatitis
- offenders with terminal illness
41
Expressive violence
interpersonal altercations, usually with people known to the assailant and of similar age, ethnicity, and cultural background
42
Instrumental violence
usually involves premeditated, motive-driven acts
43
Gang violence
associated with group alliances and committed for retaliation or revenge
44
Custody vs caring
Doing what is beneficial for the community while advocating for the client
45
Characteristics of skilled forensic nurses
- Good communicators
- wide range of physical and psychosocial assessment skill
- solid critical thinking and decision making
- social maturity, adaptability, professionalism, and analytical skills
- confidence
- nonjudgmental attitudes
- ability to work independently and within teams
- decisiveness
- ability to work in a secure environment
46
A forensic psychiatric nurse performs crisis intervention for an inmate in a prison setting. What level of prevention does this action reflect?
Secondary
47
Factors affecting the provision of forensic psychiatric nursing care
- context of care
- number of clients
- lengths of stay
48
Recurring themes dominating therapeutic intervention
- power
- control
- negotiation
- trust building
49
when can children go back to regular activities after loss of function in a limb?
when they regain strength in that limb
50
how do you manage shoulder dislocation?
sling
51
difference between sprain and strain
- strain effects the muscles and tendons and could happen over time
- sprains effect the ligaments and happen immediately
52
therapeutic management of soft tissue injuries
RICE:
```
Rest
Ice
Compression
Elevation
Immobilization and support
```
53
how do you diagnose fractures?
xray
54
5 Ps of fracure assessments
```
Pain and point of tenderness
Pulse
Pallor
Paresthesia
Paralysis
```
55
DDH
developmental dysplasia of the hip
| -test if child isn't walking by 12 months
56
talipes carus
inversion, or bending inward
57
talipes valgus
eversion, or bending outward
58
talipes equinus
plantarflexion with the toes lower than the heel
59
talipes calcaneus
dorsiflexion with the toes higher than the heels
60
osteogenesis imperfecta
- excessive fragility and bone defects
- defective periosteal bone formation and reduced cortical thickness of bones
- hyperextensibility of ligaments
61
therapeutic management of osteogenesis imperfecta
- primarily supportive care
- caution with handling to prevent further fractures
- family education
- occupational planning and genetic counseling
62
most common spinal deformity
scoliosis
63
at what age should kids be screened for scoliosis?
girls 10-12 years
| boys 13-14 years
64
hematocrit values
36-52%
65
erythrocyte sedimentation rate values
0-30
66
calcium values
3.9-4.6 mg/dl
67
When would C-reactive protein be elevated?
in RA
68
fracture definition
an interruption and/or disruption in the normal continuity of a bone that results from excessive force or stress
69
6 different directions of force for fractures
tensile, compressive, shearing, torsion, pulling, greenstick
70
causes of fractures
traumatic, pathologic, stress
71
closed vs open fractures
closed- skin is intact; open- skin is broken
72
complete vs incomplete fractures
- complete- both cortices are penetrated, producing two bone fragments
- incomplete- only one of the cortices are penetrated
73
clinical manifestations of fractures
- pain (immediate, severe, aggravated)
- loss of or unusual function (crepitus)
- structure, malalignment/ deformity
- exessive motion at sight
- local changes: edema, warmth, ecchymosis
- bleeding
- discoloration
- loss of sensation
- signs of shock
- evidence on xray
74
goal of fracture therapy
- reduce fracture by aligning the fragments
- maintain fragments in correct alignment
- restore function and prevent loss of mobility and muscle tone
75
optimal reduction treatment for fractures
(reduction: replacing bone fragments in their correct anatomical position)
- traction
- manual manipulation: moving fragments into position by applying traction and pressure to distal fragment (closed fractures only)
- open reduction (surgery)
76
immobilization treatments for fractures
- external fixation
- internal fixation
- traction
77
most common external fixation device
casts
78
plastic/fiberglass casts
- lightweight, dry quickly (30 mins), may feel warm during application, can get wet
- skin integrity is a major issue regardless of cast type
79
plaster of paris casts
cannot get wet- cover for bathing
80
traction
a pulling force applied to a part of the body while a counter traction pulls in the opposite direction
81
when would you use traction?
- to reduce a fracture
- immobilize a limb while healing
- overcome muscle spasm
- stretch adhesion
- correct deformities
82
5 types of traction
- Bucks and Russel: skin traction used to align a lower extremity fracture
- Skeletal: ex. crutchfiled tongs to correct cervial spine
- Bryants
- Pelvic
- Cervical: ex. halo- heavy and requires education regarding balance
83
weights and pulleys
should always be free hanging- no one should touch them
84
surgical management of fractures
- external
| - internal
85
fat embolism syndrome
most frequently seen after long-bone fx., multiple fx, or pelvic fx., or surgery to these sites
86
clinical manifestations of fat embolism syndrome
look up
87
compartment syndrome
- high pressure in the muscle compartment in the close fascial space
- causes capillary blood perfusion to be reduced below the level of tissue viability
88
causes of compartment syndrome
- external compression (tight dressing, cast, brace)
- increased compartment content trauma
- bleeding
89
6 Ps of compartment syndrome
pain, paresthesia, paresis, pressure, pallor, pulse
90
hallmark signs of compartment syndome
- unrelenting pain (even with opioids)
| - pain on passive stretch
91
what is often the FIRST sign of compartment syndrome
sensory deficit- feeling of "pins and needles"
92
most common surgical procedure in adults over 85
surgery for hip fractures
93
s/s of hip fracture
pain, immobility, *external rotation, *one leg shorter than the other
94
hip fracture treatment
pins or hip replacement
95
discharge teaching for post-hip replacement
advice to get an elevated toilet seat
96
knee trauma
cartilage (meniscus) or ligament
97
dx/tx of knee injuries
arthroscopy
98
meniscetomy
surgery for damaged cartilage
99
release surgery
for knee malalignment
100
osteotomies
surgery for joint restructuring
101
total knee replacement
metal/ polyethylene prostheses
102
post-op care of total knee replacement
- narcotic analgesics
- anti-infectives for the first 24hrs
- anticoagulants
- leg elevation
- hemovac
- CPM machine
- early ambulation with progression from non-weight bearing to partial weight bearing
103
amputation
removal of a limb/ appendage for ischemia, trauma, malignancy, infection
104
types of amputation
- closed or "flap"
| - guillotine
105
post-op amputation
- pressure dsg
| - elevate stump 24 hrs; after 24 hrs position prone
106
pathophysiology of gout
the overproduction of uric acid and the underexcretion (renal) of uric acid
107
prevention of renal calculi in pts with gout
2-3 liters of fluid per day
108
Risk factors for aggression
- impulsivity
- unfair application of rules
- unjust practice
- discrimination
- shaming
- humiliation
109
Manifestations of Negative Emotionality
- irregularity in biologic function
- behavioral inhibition
- slow adaptability
- intense and negative mood
110
Contributing factors to problems with anger and violence
- psychiatric illness
- medical conditions
- traumatic life events
- biologic factors and temperament
- social environmental factors
111
Staff behavior contributing to anger in clients
- rules that prevent clients from leaving activities
- power disputes over medications
- blocked access to phones, televisions, or rooms
- denials of requests in general
- physical restraint
- ignoring clients
- ordering clients to do or not to do something
112
Criteria for involuntary outpatient commitment
There must be imminent danger to themselves or others
113
T or F
Regarding the rights of clients in hospitals and clinics, voluntary clients may refuse any treatment, although staff at the facility may then ask clients to leave
True
114
Which of the following is a result of the Tarasoff decision?
Mandatory reporting of threats with intent to harm people
115
Overall goal for aggressive or violent clients
- not threatening or harming anyone
| - gaining insight into, and skill at, managing aggressive impulses
116
5 steps to communication
- Making personal contact
- Discovering the source of distress
- Relieving the distress
- Keeping everyone safe
- Assisting with alternative behaviors and problem solving
117
Diagnoses relevant to aggression
- Risk for self directed violence
- Risk for other directed violence
- Ineffective coping r/t psychopathology
- Poor impulse control
118
Goals of therapy
- impulse control
- aggression control
- abusive behavior self-restraint
- coping
119
Treating pain in the elderly
- start low
- be careful with ice packs because of vasoconstriction in already-low areas of blood flow, could cause ischemia
- may need more time between doses of medication
120
Who might have problems being on a PCA (of those who are eligible)?
People with sleep apnea
121
hallmark sign of dementia
aphasia
122
perioperative nursing diagnoses
- risk for imbalanced fluid volume
| - risk for perioperative positioning injury
123
preoperative nursing diagnoses
- anxiety
| - risk for infection
124
postop assessments for early detection of complications
- frequent vitals
- respiratory status
- BP
- wound
- temp
- CNS status (alertness, movement, shivering)
- fluid status
- GI status (N/V, movement of bowels)
125
signs of thrombophlebitis
- pain on the calf or thigh of the involved extremity
| - redness, swelling in effected area, elevated temp and increased diameter of the extremity
126
safety measures during intraoperative period
-positioning: body alignment is a must, lifting rather than sliding to prevent shearing
127
DIC (disseminated intravascular coagulation)
phenomenon where the patient is clotting and bleeding at the same time; all the clotting factors get sent to the site of damage and leave no clotting factors in the rest of the body
128
malignant hyperthermia s/s
- muscle stiffness
- hypercarbia (increase in CO2), tachycardia, tachypnea, hypoxia,
- temp will rise 1-2 degrees Celsius every 5 minutes
129
treatment of hyperthermia
DISOCONTINUE the agent, stop surgery, 100% oxygen, and administer DANTROLENE SODIUM stat
-COOL the patient (ice lavage open cavities)
130
alkaline phosphatase values
adults 25-100 U/L
