Exam 3 Fundamentals Flashcards
What is PICOT?
format to state a foreground question, the more focused your question, the easier it becomes to search for evidence in the scientific literature.
P: pt population of interest (identify pt age, gender, ethnicity, disease or health problem)
I: intervention or area of interest (which intervention is worthwhile to use in practice.. treatment/diagnostic test/prognostic factor)
C: Comparison intervention or area of interest (what is the usual standard of care or current intervention used now in practice??
O: Outcome
T: Time
what are the levels of research?
Level 1: systematic review or meta-analysis of randomized controlled trials (RCTs). evidence based clinical practice guidelines based on systematic reviews (top of pyramid)
Level 2: a well designed randomized controlled trial (RCT)
Level 3: controlled trial without randomization (quasi experimental study(
Level 4: Single non experimental study (case control, correlational, cohort studies)
Level 5: systematic reviews of descriptive & qualitative studies
Level 6: single descriptive or qualitative study
Level 7: opinion of authorities and/or reports of expert committees (bottom of period)
Which level of research is a systematic review or meta-analysis of randomized controlled trials (RCTs). evidence based clinical practice guidelines based on systematic reviews (top of pyramid)
Level 1
which level research is a well designed randomized controlled trial (RCT)
Level 2
which level of research is a controlled trial without randomization (quasiexperimental study)
Level 3
Which level of research is a single non experimental study (case control, correlational, cohort studies)
Level 4
which level of research is systematic reviews of descriptive & qualitative studies
Level 5
Which level of research is a single descriptive or qualitative study
Level 6
Which level of research is an opinion of authorities and/or reports of expert committees (bottom of period)
Level 7
what can change a pt’s oxygen level?
-anxiety
-hypoventilation
-smoking / COPD
-sleep apnea
-nutrition / low iron (anemic)
-hypovolemia (bleeding out)
what is a s/s of decreased oxygen?
confusion, drowsiness, air hungry aka anxious … so check pulsox!
how to position unconscious vs conscious pt when suctioning?
conscious pt: make sure they are not lying down. Have them sit in upright position.
unconscious: have pt lay on their side
commonly used to promote deep breathing & prevents/treats atelectasis (collapse of alveoli) in a post op pt
incentive spirometer
how to prevent respiratory infection after post op?
use incentive spirometer, get up & moving
collection of air in the pleural space, collapse of lung
pneumothorax
how to prevent alveoli collapse?
teach pursed lip breathing to pts which involves deep inspiration and prolonged expiration (blowing out candle)
what to do if pt has orthopnea?
elevate bed to 45 degree
early signs of hypoxia?
restlessness
signs of hypoxia?
clubbing, cyanosis, O2 stat dropping, increased HR and RR at first then declines as it worsens
modifiable sleep factors?
adjust temperature, decrease lights, no alcohol, no spicy food, reduce noise by closing door in the hospital & cluster pt care
How to promote sleep across all age groups?
maintain a sleep wake cycle (inside & outside of hospital), establish a nightly routine and maintain it.
what to monitor for in a pt w/ narcolepsy?
SAFETY!!!
what causes difficulty sleeping?
alcohol, blue light (computer/phone), exercising before sleep, stress, nicotine
therapeutic communication
never ask the pt “why”… use open ended questions
who will be the best source of info regarding sleep assessment?
the patient! unless it involves snoring, then the partner will be a better source
How can you tell if a pt is resting well?
slow & even RR, pt’s eyes will be closed, pt will be still (not tossing/turning)
major sleep center of body?
hypothalamus (controls body temp)
before sending a pt to get a pyelogram, what should you check?
their allergies, see if they’re allergic to shellfish/iodine because the test test uses iodine dye
what does a pt need to do after a pyelogram test?
drink fluids!!! it will flush the dye out
what is a pyelogram? (IVP = intravenous pyelogram)
x-ray that uses dye to take pics of urinary tract
how to prevent UTIs
-clean front to back
-good hygiene
-stay hydrated 6-8 glasses of water per day
how to care for a urinary indwelling catheter?
-insert using sterile technique & use smallest size
-Peri care once a shift
-keep bag below bladder
-maintain unobstructed flow/no kinks in tubing
how to prevent CAUTIs?
remove foley as soon as it’s no longer needed, use securing device, no kinks in tubing, keep bag below bladder
how to help pt urinate?
give privacy so ease the anxiety so their muscles can relax to urinate
how to insert foley in uncircumcised pt?
retract foreskin for insertion then unretract the foreskin back over
what do you do if a pt is unable to empty bladder within 6 hrs of foley removal?
bladder scan!
what does incontinence put a pt at risk for?
skin breakdown/irritation due to moisture
how to prevent or help stress incontinence?
pelvic muscle exercises AKA Kegels
what info do we need to report for a UA?
-glucose in urina
-ketones in urine
-bacteria in urine
-RBC/WBC in urine
-crystals in urine
-protein (up to 8mg/100mL can be normal) but not usually present in urine
What to do for a pt that needs to use a bed pan?
Change HOB to 30-45 degrees
signs of dehydration?
-thirst
-less frequent urination, -dark-colored urine
-dry skin
-fatigue
-dizziness
-light-headedness
common causes of constipation?
-ignoring the urge to defecate
-chronic illnesses (Parkinson’s, MS, RA, depression, eating disorders, chronic bowel diseases)
-low-fiber diet high in animal fats (meats, carbs)
-low fluid intake
-stress
-physical inactivity
-meds, like opiates
-changes in routine or life (pregnancy, aging, travel)
-neurological conditions that block nerve impulses to colon (stroke, spinal cord injury, tumor)
what causes a pt to be at risk for bowel incontinence?
confused/disoriented pt
stool will be more liquid in which type of ostomy? (colostomy or ileostomy)
ileostomy because of location (right side aka stool doesn’t have enough time to fully form yet due to location)
**this makes it harder for meds to absorb so pts w/ an ileostomy cannot have coated tablets bc there is not enough time for med to absorb
a pt w/ an ileostomy cannot have what?
coated tablets or extended release meds
when to empty an ostomy?
when it’s 1/3 to 1/2 full
what should the stoma look like?
pinkish red, moist (bc it’s the inside of intestine!)
what type of NG tube will help with stomach DECOMPRESSION for post op abdominal surgery?
Salem sump, Levin, Miller-Abbott
what type of NG tube is for enteral feeding?
Duo, Dobhoff, Levin
what type of NG tube is for compression? (pressure to prevent internal esophageal or GI hemorrhage)
Sengstaken-Blakemore
what type of NG tube is used for lavage? (irrigation of stomach)
Levin, Ewald, Salem Sump
what is a pt at risk for w/ diarrhea?
fluid and electrolyte imbalances
how to position a pt during enema?
lying on left side aka left sims position
what is a complication for pt’s with an ileostomy?
at risk for dehydration due to liquid stool
this is a common cause of abdominal fullness, pain, cramping. AKA gas.
flatulence
what 4 things must be in an APA reference?
author, book title, date, publisher
signs of constipation?
-infrequent bowel movements (fewer than 3 per week)
-hard, dry stools that are difficult to pass
carries out gas exchange
alveoli
Collection of air in the pleural space causing lung to collapse
pneumothorax
collection of blood and fluid in the pleural space preventing full lung expansion
hemothorax
2 inhalers
-budesonide w/ formoterol (Symbicort)
-salmeterol w/ fluticasone (Advair)
Sudden muscle weakness during intense emotions (anger, laughter), can occur at any time during day. Sleep paralysis is a symptom of this.
cataplexy
Dysfunction of the processes that regulate sleep/waking states. During the day a person suddenly feels overwhelming wave of sleepiness & falls asleep; REM sleep occurs within 15 mins. Take meds such as modafinil to keep person awake
narcolepsy
Abnormal events occurring during sleep, found to be more common in children than adults.
parasomnias
type of parasomnia that is sleep walking
Somnambulism
type of parasomnia that is night time bedwetting
nocturnal enuresis
type of parasomnia that is teeth grinding
bruxism
QSEN
Quality & Safety Education for Nurses
2 sleep aids for insomnia
- eszopiclone (Lunesta)
- zolpidem (Ambien)
the act of urinating voluntarily
micturition
excessive urine output
polyuria
decreased urine output
oliguria
no urine output
anuria
an increased rate of formation & excretion of urine
diuresis
An irritated bladder causing a frequent and urgent sensation of the need to void
cystitis
life threatening bloodstream infection
Bacteremia
bacteria in urine
Bacteriuria
medication that relaxes the bladder, treats OAB
VESIcare (solifenacin)
this medication is a loop diuretic that can decrease edema in lungs and decrease BP. used to treat pulmonary edema, CHF, ascites (extra fluid in abdomen), HTN, etc. **Potassium can drop when taking this, so usually take a potassium supplement
Lasix (Furosemide)
this has 3 sections: duodenum, the jejunum, and the ileum.
small intestine
duodenum, jejunum, ileum (small intestine)
-duodenum: continues to process chyme from the stomach
-jejunum: absorbs carbohydrates and protein.
-ileum: absorbs water, fats, certain vitamins, iron, and bile salts.
these parts of the small intestines absorb most of the nutrients and electrolytes
duodenum & jejunum
this intestine has the ascending, transverse, and descending colon
large intestine
this intestine absorbs water, sodium, chloride from digested food that has passed from the other intestine
large intestine
primary organ of bowel elimination
large intestine
what helps with flatulence? (gas)
massaging, lying on left side, moving around, warm compress
this is a method people use to “bear down” to assist in stool passage
(pts w/ cardiovascular disease, glaucoma, increased intracranial pressure, or new surgical wounds are at greater risk fro cardiac dysrhythmias and high bp with this method so they should NOT use this method)
valsalva maneuver
what your Diet should be like for bowel elimination
high fiber (spinach, salads, apples, beans) and staying hydrated! hot fluids are good as well to help w/ constipation/diarrhea
what is the greatest danger from diarrhea?
fluid & electrolyte imbalances!!!
drugs that are used to promote bowel evacuation.
laxatives/cathartics
the introduction of a solution into the rectum for therapeutic or diagnostic reasons
enema
this might occur after the bowel is manipulated during surgery. It is the temporary stop of peristalsis.
ileus (blockage in bowel)
medications that slows everything in the GI tract
GLP-1s (ozempic, monjaro,etc) & opiates
causes of constipation
-Irregular bowel habits
-ignoring the urge to defecate
-Chronic illness
-Diet: low fiber, high animal fats, low fluid intake
-Stress
-Physical inactivity
-Meds, especially opiates, GLP-1
-Changes in life; pregnancy (told to take iron which gives you constipation), travel,
-aging
-Neuro conditions that block nerve impulse to the colon
-Chronic bowel dysfunction
signs of dehydration
Thirst (you are already 10% dehydrated when you think to take a sip of water
Less urine than usual
Dark colored urine
Dry skin
Fatigue, Dizziness, Light-headedness
Due to location, _______ will contain loose stool and a _________ will contain formed stool.
ileostomy loose stool
colostomy formed stool
pts with these need to be monitored due to loss of fluids & sodium
ileostomies (pts w/ colostomies do not have a fluid/sodium loss)
how to asses the abdomen
- inspect
- auscultate
- percuss
- palpate
**must listen for 5 mins in each quadrant to say no bowel sounds heard
this can cause black stools
iron
what should a pt do before taking stool softeners?
increase fluids and fiber!
how to give enema
Use the Left Sims position so the enema solution goes down into the sigmoid section and does not have to fight gravity and go uphill. (sodium polystyrene sulfonate aka kayexalate is a medicated edema)
how to see if NG tube is in the right location
use X-ray, listen to sounds, check fluid!
preferred NG tube for stomach decompression
Salem sump
how to care for pt w/ NG tube
maintain comfort, perform good oral care due to mouth breathing, keep HOB elevated to prevent aspiration
when should you poop to maintain normal elimination pattern in the hospital?
1 hr after meal bc mass colonic peristalsis occurs at this time
this medication is used to treat GERD
Nexium (esomeprazole)
medications used to treat constipation
-colace (docusate sodium)
-ex-lax (Senna) which can increase HR so be careful w/ cardiac pts
-metamucil (psyllium): bulk forming
when to obtain stool species for fecal occult?
routine exam for colon cancer for ppl over 50
which meds causes GI bleeding?
NSAIDS
ASPIRIN
why do nurses discourage straining?
hemorrhoids & dysrhythmia (abnormal heart beat)
this is a method used to help poop by holding breath and bearing down. ***can result in life threatening dysrhythmia!! so avoid in stroke/cardiac pts
valsalva maneuver
GI bleeds (upper and lower)
upper GI bleed: more black
lower GI bleed (red)
the most important thing to look for w/ pts w/ diarrhea
dehydration
bulk forming laxative (high fiber absorbs water & increases intestinal bulk which stretches the intestinal wall to stimulate peristalsis. Also used to mild diarrhea)
psyllium (Metamucil)
this is a type of emollient or wetting aka stool softeners that are detergent and lower surface tension of fevers allowing water to be absorbed
docusate (colace)
these pull fluid into the bowel to help soften aka osmotics
Saline
Magnesium citrate
Magnesium hydroxide
Sodium phosphate (fleet)
s/s of GI bleed
dark, black tarry stool, vomit will look like used coffee grounds (partially digested blood)
