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NURS 713 Fundamentals of Nursing > Exam 4 Material > Flashcards

Exam 4 Material Flashcards

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1
Q

What does AIDET mean?

A

Acknowlege
Introduce
Duration
Explanation
Thank you

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2
Q

What dose SBAR mean?

A

Situation
Background
Assessment
Recommendation

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3
Q

What does CUS mean?

A

I am Concerned about my pts saftey
I am Uncomfortable wtih my pts condition
I believe in the Safety of my pt.

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4
Q

What are the steps to calling a provider?

A

-Personally assess pt.
-Verify abnormal VS or POC readings
-Discuss with charge nurse
-Review progress notes/previous assessments
-Pull up chart
-Call correct provider

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5
Q

A patient hand off occurs when?

A

A transition in care occurs

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6
Q

What does I PASS THE BATON mean?

A

Indroduction
Patient
Assessment
Situation
Saftey
Background
Actions
Timing
Ownership
Next

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7
Q

What are the components of the affective learning domain?

A

Emotional
Integration of new concepts and knowledge

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8
Q

What are the compenents of the psychomotor learning domain?

A

Physical movement
Skills acquisition that involves integration of mental and muscular activity

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9
Q

What reading levels should patient education materials be written, and why?

A

Education materials should be written for a 4th-6th grade reading level

Average adults read at an 8th grade level, and the average medicare beneficiary reads at a 5th grade reading level

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10
Q

The best method to apply for patient education is?

A

The teach back method

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11
Q

What does DISCHARGE stand for in terms of patient education?

A

-Do refer/collaborate for physiological complications
-Interdisiplinary care
-Saftey (home care)
C-Community resources
H-Health promotion activities
A-Activity
R-Routine follow up care
G-Guidelines for medications
E-Equipment education

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12
Q

An occurrence reporting is?

A

Used for communicating with risk management, administration, and other departments and is NOT part of the medical record.

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13
Q

What are the 3 main categories of surgical classifications?

A

Seriousness
Urgency
Purpose

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14
Q

Surgery classifications: Seriousness
Major

A

A serious major surgery classification involves extensive reconstruction or alteration in body parts and poses great risk to wellbeing

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15
Q

What are examples of serious major surgery classifications?

A

Coronary Artery Bypass
Colon resection
Removal of larynx
Resection of lung lobe

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16
Q

Surgery classifications: Seriousness
Minor

A

Involves minimal alteration in body parts
Often designed to correct deformities
Minimal risk compared to other major procedures

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17
Q

What are some examples of a serious minor surgery?

A

Cataract extraction
Facial plastic surgery
Tooth extraction

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18
Q

Surgery classifications: Urgency
Elective

A

Performed on basis of a patient’s choice
Not essential and is not always necessary for health

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19
Q

What are some examples of elective surgeries?

A

Bunionectomy
Facial plastic surgery
Hernia Repair
Breast Reconstruction

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20
Q

Surgery classifications: Urgency
Urgent

A

Necessary for patient’s health
Often prevents development of additional problems
Not necessarily an emergenvy

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21
Q

Surgery classifications: Urgency
Emergent

A

Must be done to immediately save life or preserve function of body part

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22
Q

What are some examples of emergent surgeries?

A

Repair of perforated appendix
Traumatic amputation
Control of internal hemorrhaging

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23
Q

Surgery classifications: Purpose
Diagnostic

A

Surgical exploration to confirm diagnosis
Often involves removal of tissue

Ex: Ex lap

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24
Q

Laparotomy and laproscopy are different how?

A

Laparotomy is where they open up the abdomen and laproscopy is where they use small cameras

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25
Q

Surgery classifications: Purpose
Ablative

A

Excision or removal of a diseased body part

EX: Amputation or removal of organ

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26
Q

Surgery classifications: Purpose
Pallative

A

Relieves or reduces intensity of disease symptoms but does not cure

Ex: Debridement of necrotic tissue

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27
Q

Surgery classifications: Purpose
Reconstructive or Restorative

A

Restores function or appearance to traumatized or malfunctioning tissues

Ex: Joint replacement, scar revision

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28
Q

Surgery classifications: Purpose
Constructive

A

Restores function lost or reduced as a result of congenital abnormalities

Ex: Repair of cleft pallate

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29
Q

Surgery classifications: Purpose
Cosmetic

A

Performed to improve personal appearance

Ex: Rhinoplasty

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30
Q

What is considered adequate food intake post op?

A

1500 k/cal

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31
Q

Why is obstructive sleep apnea considered a surgical risk factor?

A

Upper airway obstruction can cause death

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32
Q

Why are coagulopathies considered a surgical risk factor?

A

A DVT post op won’t be reimbursed by insurance if it develops post op

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33
Q

Why are fluid inbalances considered a surgical risk factor?

A

Hypovolemia can be exacerbated by PONV (post-op nausea and vomiting)

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34
Q

Medication Reconcilation should occur at what points through the surgery process?

A

Pre-op to Intra-op to Post-op

*There is a medication shut down before a transfer between each phase

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35
Q

What are the Pre-op Labs/Testing?

A

BMP
CBC
Clotting Studies
LFTs
CXR

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36
Q

Pre-op Labs/Testing:
What are the lab values for the BMP?

A

K=3.5-5.1
Glucose =<120
BUN=10-20
Creatine=0.5-1.2
WBC=3.7-11

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37
Q

Pre-op Labs/Testing:
What are we looking for in the BMP?

A

Indicators of cardiac and hemodynamic stability
Kidney function
Drug elimination
Infection

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38
Q

Pre-op Labs/Testing:
What are the lab values for in the CBC?

A

Hemoglobin=12-16
Hematcrit=36-48%

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39
Q

Pre-op Labs/Testing:
What are we looking for in the CBC?

A

Indicators of volume status
O2 carrying capacity
Hemodynamic stability

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40
Q

Pre-op Labs/Testing:
What are the values of clotting studies (PT, INR, PTT, PLT) and what are we looking for?

A

Platelets 150-400
Indicators of liver function and possibly bleeding dificulties

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41
Q

Pre-op Labs/Testing:
What are the values for LFTs and what are we looking for?

A

AST<48
ALT<55
Drug metabolism/clotting

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42
Q

Pre-op Labs/Testing:
What are we looking for on the chest xray?

A

Clear lungs
No cardiomyopathy
No Atelectasis
-Id-ing potentially sig. risks for complications

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43
Q

Who determines which meds to stop and when and which meds continue?

A

The surgeon

Ex: ace inhibitors might be stopped due to a drop in BP

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44
Q

Who on the surgical team explains the procedure, risks, benefits, alternitives and prognosis if no surgery?

A

The Provider ONLY

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45
Q

Who on the surgical team obtains consent for anesthesia?

A

Anesthesiologist or CRNA

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46
Q

Who on the surgical team obtains consent for blood products?

A

Surgeon

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47
Q

What is the role of the RN on the surgical team?

A

Witness that informed consent was obtained and confirm that pt questions where answered

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48
Q

What are TED hoses or SCDs?

A

Anti-embolism devices that prevent DVTs during surgery

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49
Q

What is site marking?

A

Eliminating wrong sight and wrong procedure, marking esp. with left and right distinction

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50
Q

Patients with a latex allergy are normally?

A

Scheduled as early as possibly and latex free cart is available

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51
Q

What is the purpose of a time out?

A

An opportunity to slow down, verify and avoid medical error that involves verifing:
Right-
Pt.
Procedure
Site
Side

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52
Q

Anesthesia:
General

A

Unconscious, no sensation, reflexes, or perception of stimuli

Combination IV and Gas

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53
Q

Anesthesia:
What are the risks of general anesthesia?

A

Intubation-protect the airway
Aspiration
Dysrythmias
Hypotension
Hypothermia
Hypoxemia
Malignant hyperthermia

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54
Q

Anesthesia:
Regional

A

Loss of sensation in area/region of body

Nerve blocks, spinals, or epidurals

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55
Q

Anesthesia:
What are the risks of regional anesthesia?

A

Requires monitoring of motorsensory function along distal and nerve tracts:

Hypotension
Hypothermia
Spinal cord injury
Respiratory distress
CSF Leak=HA

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56
Q

Anesthesia:
Local

A

Loss of sensation at localized site by inhibiting nerve conduction

Injection or topical

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57
Q

Anesthesia:
What are the risks of local anesthesia?

A

Hives
Rash
Anaphylaxis

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58
Q

Anesthesia:
Moderate sedation

A

“Conscious sedation”
-decreased LOC
-IV sedative
-Rention of consciousness but induces amnesia

59
Q

Where is an epidural inserted as opposed to a spinal?

A

Epidural-into the epidural space
Spinal-Into the spinal space (subarachnoid space) containing cerebrospinal fluid

60
Q

Post Op:
How often is pt monitored in the PACU?

A

Every 15 minutes

61
Q

Why is there a standardized scoring tool for assessment and discharge readiness in the PACU?

A

A patient must be able to meet these criteria before moving on

62
Q

What are the priorities in the PACU or ICU?

A

ABCs
Preventing harm
Pain management

Tracing of all lines and labels

63
Q

A post op patient in an ambulatory setting will need to do what before going home?

A

Eat and drink a small amount and void

64
Q

What are the signs and symptoms of Malignant Hyperthermia?

A

Tachypnea
Hypercapnia
High fever
Muscle rigidity
Spasms
Tachycardia
Hyperkalemia
Muscle breakdown

Tim Hates How ManyBad Spasms He Really Tolerates.

65
Q

How fast is the onset of malignant hyperthermia?

A

Onset within 35 minutes to 2 hours from anesthesia induction

66
Q

What is the intervention for malignant hyperthermia?

A

Dantrolene and cooling

67
Q

What are the early signs of a post op hemorrage?

A

Restlessness
Increased HR and RR

68
Q

What are the late signs of a post op hemorrhage?

A

Lethargic
Rapid decrease in HR, RR, BP, and Sp02

69
Q

What are the two main priority interventions if a patient is experiencing a post op hemorrhage?

A

Notify provider stat
Prepare for immediate transfer to the OR

70
Q

How long do neonates sleep?

A

16 hrs

71
Q

How long do infants sleep?

A

15 hrs total with naps

72
Q

How longs do toddlers sleep?

A

12 hours total with naps

73
Q

How long do preschoolers sleep?

A

12 hrs per night

74
Q

How long do school age children sleep?

A

Varies 9-12hr

75
Q

How long do adolescents sleep?

A

8-10 hrs

76
Q

How long do young adults sleep?

A

6-8.5 hrs per night

77
Q

How long do middle adults sleep?

A

7-9 hr

78
Q

How long do older adults sleep?

A

Varies, many have sleep problems

79
Q

What is narcolepsy?

A

Dysfunction in processes that regulate sleep and wakefulness=excessive daytime sleepiness and rapid falling asleep with quick entry into REM sleep; uncontrollable ‘sleep attacks’

80
Q

What are parasomnias?

A

Occur during NREM and REM sleep
Confused arousals, sleepwalking, nigh terrors, nightmares, bruxism

81
Q

What are the signs and symptoms of sleep apnea?

A

Loud snoring
Gasping
Snorting
Choking sounds with periods of silence lasting 10 seconds to 1-2 minutes
Daytime sleepiness

82
Q

What causes sleep apnea?

A

Throat muscles relax
Soft palate and tongue drop
Upper airway collapses
Partial or complete blockage
Diminished or cessation of airflow
Periods of apnea
Hypoxic
Brief awakening
Airway reopened

83
Q

What are the risk factors of sleep apnea?

A

Obesity
Large neck circumfrence
ETOH
Narrowed airways
Smoking

Only Large Elephants Never Smoke

84
Q

What are the consequences of sleep apnea?

A

Hypoxic periods=SNS activation
HTN
HLB
MI
CVD
CVA
Metabolic synrome
Type 2 Diabetes
Non-alcoholic fatty liver disease
Deprived sleeping partners

85
Q

What is the diagnosis and treatment of sleep apnea?

A

Sleep studies
Weight loss
Smoking cessation
CPAP at night
Oral appliances

86
Q

What is aphasia?

A

inability to produce or understand language

87
Q

What is Broca’s (Expressive) Aphasia?

A

Typically due to damage in motor cortex and Brodmann’s Area 44

Difficulty expressing speech
Problems with naming objects
Better with comprehension

88
Q

What is Wernickes (Receptive Aphasia)?

A

Easier time understanding speech
Comprehension is largely impaired (both spoken and written)

89
Q

What is global aphasia?

A

Produce few recognizable words and understand little to no spoken nor written language
Cannot read or write
Fully preserved intellectual and cognitive abilities unrelated to speech

90
Q

What are complementary therapies?

A

Used together with conventional biomedical treatment

Ex: Chronic pain pt taking NSAIDs and practicing yoga

91
Q

What are alterntive therapies?

A

Non-pharmaclogic therpies used in place of conventional pharm or medical procedures

92
Q

Which herbal remedies increase bleeding risks when also using warfarin and anticoagulants

A

Ginseng
Ginko
Ginger
Garlic

93
Q

What are the contraindicated drugs when a patient is using echinacea to stimulate immune system?

A

Anti-rejection drugs
Hepatotoxic drugs
Immunosuppressants
Antiretrovirals

94
Q

What are the contraindicated drugs when a patient is using ginseng to increase physical endurance by enhancing adrenal and immune function?

A

BLEED risk with warfarin
MAO inhibitors
Anti-diabetic drugs
Aspirin
NSAIDs
Simulant drugs

95
Q

What are the contraindicated drugs when someone is using Ginko to improve blood flow and memory?

A

BLEED risk with warfarin
Aspirin
NSAIDs
Many Psych drugs

96
Q

What are some of the contraindications when someone is using Ginger to decrease GI spasms and cramps and decrease nausea and vomiting?

A

BLEED RISK with warfarin
Aspirin
NSAIDs

97
Q

What are some of the contraindications when someone is using Ginger to decrease GI spasms and cramps and decrease nausea and vomiting?

A

BLEED RISK with warfarin
Aspirin
NSAIDs

98
Q

What are the contraindicated drugs when someone is using garlic to increase an antitumor effect and platelet aggregation?

A

BLEED risk with warfarin
Caution with anti-HIV drugs

99
Q

What does glucosamine do and what are the safety concerns?

A

Slows osteoarthritis by stimulating cartilage

-Shellfish allergy
antagonizes anti-diabetic drugs some chemo
NO COUMADIN (warfarin-Increased effect)

100
Q

What does goldenseal do and what are the safety concerns?

A

GI disorders and gastritis
Acts as cardiac stimulant

Watch for hear arrbythmias and don’t give with anticoagulants or hypertensive drugs

101
Q

What is saw palmetto and what are the safety concerns?

A

Used for BPH

Watch for bloody urine

102
Q

What is St. John’s wart and what are the safety concerns?

A

Photosensitivity
Warfarin interaction
Don’t take with MAOs or SSRIs

103
Q

What is chamomile and what are the safety concerns?

A

Anti-inflammatory and interacts with drugs that cause drowsiness such as:
EtOH
Benzos
Narcotics
Antidepressants

Can’t drink chammomile if your already drowsy.

104
Q

Anyone who is immunocompromised should not receive what type of integrative healthcare?

A

Acupuncture or dry needling

105
Q

What is spirituality?

A

Awareness of one’s inner self and sense of connection to a higher being, nature, or purpose greater than oneself

106
Q

What is self transcendence?

A

Authentically connecting to one’s self

107
Q

What is connectedness?

A

Being interpersonally connected with one’s self, interpersonally connected with others and enviroment and transpersonally connected to god or an unseen power

108
Q

What is faith?

A

Faith allows people to have firm beliefs despite lack of physical evidenve

109
Q

What are the 5 subsets of spirituality?

A

Self transcendence
Connectness
Faith and Hope
Inner Strength and Peace
Meaning and purpose in life

110
Q

In regards to spirituallity, what is the joint commission’s stance?

A

The joint commission requires acknowledging patient rights to spiritual care, to assess for and provide spiritual needs

111
Q

What does FICA stand for?

A

Faith or belief (Does pt identify with any?)
Importance and Influence (How important is this to pt)
Community (Who does the pt find to be a comfort)
Address (Interventions to address)

112
Q

If signs and symptoms persist past the duration of the stressor, what is this considered?

A

A trauma

113
Q

What is primary appraisal in regards to a stressor?

A

Evaluating an event in terms of personal meaning

114
Q

What is secondary appraisal in regards to a stressor?

A

Process in which a person considers possibly available coping mechanisms or resources

115
Q

What are the physiological manifestations of a stress response?

A

SNS activation: Increased HR, RR, BP
HPA axis activation: hypothalamus increases CRH -> anterior pituitary gland to increase ACTH ->adrenal cortex to increase cortisol levels

116
Q

What are the manifestations of increased cortisol levels?

A

Protein and fat catabolism
Immunosuppression
Hyperglycemia

117
Q

A disheveled patient is a sign of?

A

Ineffective or maladaptive coping

118
Q

What is General Adaptation Syndrome (GAS)

A

A 3 stage physiological process that prepares and adapts the body for danger so an indivdual is more likely to survive.

119
Q

What are the 3 stages of General Adaptation syndrome?

A

Alarm stage-fight or flight
Resistance stage-body attempts to compensate and stabilize
Exhaustion stage

120
Q

What is allostatic load?

A

Excessive activation of hormone response with minimal adaptation response = wear and tear on organs

121
Q

What are some of the symptoms of compassion fatigue?

A

Irritation, restlessness, unable to focus, difficulty engaging, cynicism, anxiety, feelings of inadequacy, poor decision making

122
Q

What is second victim syndrome?

A

Effect on a healthcare provider when a medical error causes harm to a patient

123
Q

Normal grief is?

A

A response to death or loss

124
Q

Anticipatory grief is?

A

Grief before is actually occurs

125
Q

Disinfrancized grief is?

A

When a relationship is not socially sanctioned and grief cannot be shared openly or seems less significant

126
Q

What is ambigous loss?

A

A type of disinfranchized grief were the person is physically present but not psychologically

127
Q

What is complicated grief?

A

Person has a prolonged or significantly difficult time mourning or moving forward after a loss

128
Q

What is chronic grief?

A

a normal response for a long period

129
Q

What is exaggerated grief?

A

Person exhibits self-destructiev or maladaptive behaviors

130
Q

What is palliative care?

A

Care that focuses on pain, symptoms, and stress of serious illness to increase QOL and is for any patient with a serious illness regardless of life expectancy or prognosis

131
Q

What is hospice care?

A

Care that focuses on providing comfort through pain and symptom management, psychosocial and spiritual support and is for patients with terminal prognosis measured in months <6 months to live if illness runs its natural course

132
Q

Hospice care encompasses what?

A

Patient and family’s holistic needs

133
Q

A DNR has special complications regarding surgery, what are they?

A

A DNR has to be re-activated and dated each time a person is admitted to the hospital and after surgery

134
Q

Who initiates organ donation with the family?

A

A specifically trained professional and not a member of the healthcare team

135
Q

What is a durable power of attorney?

A

A designated person a patient wants to make health decisions on their behalf in the even they no longer can make decisions themselves

136
Q

What is a living will?

A

Direct treatment according to the patient’s wishes, able to declare which medical procedures are desired and those not desired when ill or in vegetative state

137
Q

The biggest signs of death are?

A

Pallor, mottling and cyanosis

138
Q

Why is it important to raise the bed 30 degrees after a person has died?

A

To avoid blood pooling in the face q

139
Q

What supplies are should be gathered after a patient has died?

A

Shrout kit
Clean patient gown and linens
Extra chuck pads
Paper tape
4 by 4 gauze
Clamps
Sissors

140
Q

What is included in a shroud kit?

A

White vinyl zippered bad to wrap the body in
Another bag for pts personal effects
A chinstrap
Tape
Ties
Tags

141
Q

When does rigor morits occur?

A

30 minutes after death

142
Q

What is important to remember when preparing a body for family viewing?

A

Do not remove lines or tubes unless hosptial policy requires you to do so

143
Q

What are reportable deaths?

A

Homicide, suicide, accident, violent death
Sudden death not caused by readily recognized disease
Suspicious circumstances death
Death unattended by physician
Death as result of a stillbirth unattended by physician
Death in H.F w/in 24hrs of entering
Death w/in 24hrs after undergoing an invasive procedure in H.F

NURS 713 Fundamentals of Nursing (4 decks)

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