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Nursing 101 > Exam 5 > Flashcards

Exam 5 Flashcards

*Professionalism *Informatic *Cellular Regulation *Acid Base *Fluid & Electrolyte *Intracranial Reg *Sensory Preception

1
Q

Professionalism-Accountability

A
  • Knowing what i am capable and knowing my limitation
  • Responsibility
  • Self-examination
  • State board of Nursing:*NC *NCSBN(oversees all of the states)
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2
Q

Professionalism-Collaboration

A

Being able to work with others and provide the patient with the best care

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3
Q

Professionalism-Advocacy

A
  • Being able to defend patients

- Code of ethics plays a big part in this.

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4
Q

Professionalism-Caring/ Compassion Intervention

A

Caring interventions of attitude and compassion key to nursing professionalism

  • Attitude: mental state involving values, beliefs, feelings and mood
  • Compassion: awareness of/ concern about others individual’s suffering
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5
Q

Professionalism- Appearance

A
  • Neat
  • Clean
  • Organized
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6
Q

Professionalism-Teaching (Patricia Benner)

A

5 Progressions in Learning

  1. Novice 2.Advance beginner 3.competent 4.Proficient
  2. Expert
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7
Q

Professionalism- Ethics

A
  • soft skills (drive passion and communication)
  • Friendly/ Culturally competent
  • Problem solving
  • Involve integrity( Never work outside scope of practice)
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8
Q

Professionalism*Buzz words for unprofessionalism

A
  • Harassment
  • “power”
  • Bullying
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9
Q

Informatics- Benefits

A
  • Specialized care
  • accessed to care
  • Quick/ Real time Access to your health recordserrors are decreased*Records can be transferred anywhere
  • Quality improvement
  • Apps for health care * monitor prescription
  • Social media
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10
Q

Informatic- EMR (electronic medical record)

A
  • Doctors use them

- nontransferable

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11
Q

Informatics- EHR (Electronic Health Record)

A

-“paper chart” -Has history - Portable - more ppl have access by only with health relation -has to use the same language; med abbrev. -similar templates - reduces cost
improve care - decrease errors - clients have access

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12
Q

Imformatics- Ergonomics

A
  • How things are set up to decrease injuries
  • Ex. carpal tunnel, back injures, eye strain, requires rest to treat, glasses sometimes, good postures, frequent breaks and better lighting
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13
Q

Cellular regulation -Alterations

A
  • Hyperplasia(increase in cell production; Dna controls it)
  • metaplasia(change in pattern, DNA controlled)
  • Dysplasia(Different variations in size, shape, apperance; DNA controlled)
  • Anaplasia(immature, goes through regression; not controlled by DNA & not reversible)
  • Anything different that the normal can cause cancer; anaplasia tells the degree of cancer.
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14
Q

Cell regulation-Prevalance

A
  • Cancer: 39% of americans will be diagnosed with cancer
  • genetic *socioeconomic that is low put you at risk for cancer
  • Anemia: depends on cause of why RBCs are being loss
  • Sickle Cell: has to have genetic trait *Blacks are at higher risk
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15
Q

Cell Regulation- Intervention (independent)

A
  • Pt education - nutrition -increase physical activity
  • managing side effects:ie. chemo -Psycho social support
  • How to prevent complication ie. falls, bleeding and infections
  • Promoting coping to diagnoses. ie anxiety, etc
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16
Q

Cellular Regulation- Collab interventions

A
  • Surgery - Radiation(localized)/Chemotherapy(doesnt just target cancer cells) -nutrition;CBD oil; antimetics,IV, tube feeds/TPN
  • neutropenic precaution - no contact sports - CAM Therapies
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17
Q

Cellular regulation- Prevention

A
  • family history of cancer

- Screenings: Breast exam, testicular exam, pap smear

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18
Q

cellular regulation- Diagnostic Test

A
  • X ray -CT -MRI -U/S -PET -Lumbar Puncture test
  • CBC w/Diff -Tumor Markers -Urinalysis
  • Temp shows signs of infection
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19
Q

Cellular Regulation- Assessment

A
  • Early Warning Signs
    1. Changes on bowel/bladder habits
    2. Sores do not properly heal
    3. Any unusual bleeding/discharge
    4. Lumps anywhere
    5. Any constant indigestion/trouble swallowing
    6. Any changes in moles
    7. Any nagging cough/hoarseness
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20
Q

Cellular Regulation- Health Promotion

A
  • No smoking/tobacco products -Poor diet/Process food
  • Lack of exercise -Infection w/certain disease; HIV, HPV
  • UV exposure (skin cancer) - Certain cancer treatment change cells - hormone replacement therapy -exposure to chemicals - living in areas w/high exposures of air pollution
  • exposure to radon
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21
Q

Acid Base Concept- Normal Range Values

A 
pH: 7.35-7.45 (acidosis or alkalosis)
*Below 7.35 is acid, above 7.45 is base
CO2: 35-45 (respiratory)
*Below 35 base, above 45 acidic (opposite from pH)
HCO2: 24-28 (metabolic)
*Below 24 is acid, above 28 is base
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22
Q

Acid Base Concept- pH

A

It is the indirect measurement of hydrogen ion concentration

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23
Q

Acid Base Concept- Buffers

A
  • Are substance that prevent major changes in pH by releasing hydrogen ions
  • Binds with hydrogen ions when excess acid present
  • Release hydrogen if body fluids are too basic
  • Act quickly
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24
Q

Acid base concept- systems

A

Three systems work together to maintain pH

  1. Buffer system
  2. Respiratory system
  3. Renal system
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25
Q

Acid base concept- Respiratory System

A
  • Regulates carbonic acid by eliminating or retaining CO2
  • CO2, is potential acid, when conbined with water it becomes carbonic acid
  • Increased in CO2 or H stimulates respiratory center in the brain, increases rate and depth of respirations
  • Depression of the respiratory center of the brain, decreases rate and depth of the respirations.
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26
Q

Acid Base Concept- Renal System

A
  • Long term regulation of acid-base balance
  • Kidneys eliminate nonvolatile acids
  • Regulates bicarbonate (HCO3) in ECF
  • Slower
  • Selectively excrete or retain H to maintain pH
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27
Q

Acid Base concept- Measurements

A
  • PaCO2 measures pressure of dissolved CO2 in blood, normal value is 35-45
  • PaCO2 less than 35 is hypcapnia
  • PaCO2 greater than 45 is hypercapnia
  • PaO2 measures pressure of the O2 dissolved in plasma, normal value is 75-100
  • PaO2 less than 80 is hypoxemia
  • Serum bicarbonate(HCO3) reflects renal regulation of acid-base balance, normal value is 24-28
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28
Q

Acid base concept- Alteration& Manifestation

A
  • Metabolic Acidosis:Abnormal HCO3 losses, excess nonvolatile acids in body
  • Metabolic Alkalosis: Excess of HCO3 in relation to hydrogen.
  • Respiratory Acidosis: Retention of CO2 and increast of carbonic acid
  • Respiratory Alkalosis: Excess loss of carbon dioxide
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29
Q

Acid base Concept- Risk Factor

A
  • Many underlying disorders
  • acid-base imbalances occur in critically ill pts
  • Metabolic acidosis: occurs in pts with insulin dependent diabetes and chronic renal failure.
  • Metabolic alkalosis:Occurs in pts in acute care
  • Respiratory acidosis: pts of all ages are at risk when alevolar hypoventilation occurs; pts with COPD are higher risk
  • Respiratory alkalosis: Older adults/Young children ar risk w/large-dose salicylate ingestion
  • Starvation
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30
Q

Acid Base concept- Nursing Assessment

A
  • Health History; current Meds and CAM therapy
  • Physical assessment: Vital signs, LOC, Pulse Ox, ABG results
  • Daily weights
  • Monitor I/Os
  • Assess neurological functions
  • Monitor cardiac function
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31
Q

Acid base concept- Diagnostic test

A
  • ABGs

- Serum electrolytes

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32
Q

Acid base concept- interventions

A
  • Reduce risk for injury
  • Monitor neuro functions
  • Initiate safety precaution
  • orient to time, place. and circumstances as needed
  • Keep familiar objects nearby and allow significant others to stay w/pt
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33
Q

Fluid and electrolytes- Fluids that the body needs for homeostatsis

A
  • Blood -Serum
  • Water: 60% and it transport, lubricate, insulates and regulates cell heath
  • Urine -Albumin -CSF -Hormones -Bile
34
Q

Fluid and electrolyte- Movement of body fluids

A
  • Osmosis: movement of water across cell membrane from less concentrated solution -> more concentrated
  • Diffusion: Intermingling of molecules in liquids, gasses or solids
  • Filtration: Movement of fluids and solutes together across a membrane from compartment to another
  • Active transport: Substances that moves across membrane; needs bigger energy to transport
35
Q

Fluid and Electrolyte- osmosis

A
  • Solutes: crystalloids and colloids
  • Solvent: Component of solution to dissolve solute
  • osmolality: Concentration of solutes
  • isotonic: Normal saline 0.9% *Lactated Ringer
  • hypertonic:increase osmolality that body Concentration *3%NS *Dextrose 5% LR D5 NS
  • Hypotonic: decrease osmolality less than body concentration *.45%NS D5 .5NS
  • *Takes fluid in veins and move them into cells
36
Q

Fluid and Electrolytes-Diffusion

A

Gasses, liquids and solid are intermingled

37
Q

Fluid and electrolytes- Flitration

A

movement of fluids and solutes together across a membrane from one compartment to another
-Goes from higher to lower

38
Q

Fluids and electrolytes- Active transport

A

Substances move across a membrane using a bigger source of energy to transport

39
Q

Fluid and electrolytes- Regulating body fluids

A

-Fluid intake: Everyone needs 2500mL/day
(which can include anything we consume through IV,Drink or tube feed)
-Fluid Output: urinates 1400-1500 mL/day; also includes fluid loss through sweat, feces and obligatory losses

40
Q

Fluids and electrolytes- Maintaining Homeostasis

A
  • Kidneys are primary regulators: Waste, Acid/base, volume
  • Hormones *antiduretic hormones: Regulates water secretions from kidneys
  • Renin-angiotensins: Works on diuretic and BP
  • Atrial natriuretic factor: works on thirst/helps bot waste Na, also works as a strong diuretic in body
41
Q

Fluid and electrolytes- Regulating electrolytes

A
  • Electrolytes are important for:
  • Maintaining fluid balance
  • Contributing to acid-base regulation
  • Facilitaing enzymes reactions
  • Transmitting neuromuscular reactions
  • Most electrolytes enter through dietary intake, IV and excrete through urine
42
Q

Fluid and electrolyte- Sodium Na

A
  • Most abdundant cation in ECF
  • Normal serum level: 135-145 mEq/L
  • Controls and regulate water balance
  • Found in foods including bacon etc
  • suggested intake: 1500-2300 mg/day
43
Q

Fluid and electrolyte- Potassium (K+)

A
  • Major cation in ICF and small amount in plasma, ECF
  • Normal serum level: 3.5-5.3 mEq/L
  • Normal ICF level: 125-140 mEq/L
  • Vital for skeletal, cardiac and smooth muscle function
44
Q

Fluid and electrolyte- Calcium (Ca2+)

A
  • Most is found in skeletal system
  • Vital in regulating muscle contraction and relaxation, neuromuscular function and cardiac function
  • Ca levels are reported 2 ways
  • Normal serum level: 9-11 mEq/L (normal BMP)(Bound ionized serum)
  • Normal ionized serum: 4.25- 5.25 (unbound)
  • Someone who has trouble absorbing CA needs Vitamin D
  • thyroid regulates
45
Q

Fluid and Electrolyte- Magnesium (Mg2+)

A
  • Found in skeletal system
  • Second most abdunant ICF cation
  • Normal serum level: 1.5-2.5 mEq/L
  • Important for intracellular metabolism
  • Protein and DNA synthesis
46
Q

Fluid and electrolyte- Chloride (Cl-)

A
  • Major anion of ECF
  • Normal serum level: 95-105 mEq/L
  • with Na, regulates serum osmolality
  • Major component of gastric juice (HCl)
  • Buffer in oxygen-carbon dioxide exchange in RBCs
  • Found in the same foods as Na
47
Q

Fluid and electrolyte- Phosphate (PO4 3-)

A
  • Major anion of ICF
  • Normal serum level: 2.4-4.5 mg/dl
  • Much higher in children
  • essential for functioning of muscles, nerves and RBCs
  • involved in metabolism of protein, fat and carbs
  • Found in meats, fish, poultry, milk products and legumes
48
Q

Fluid and electrolytes- Bicarbonate (HCO3-)

A
  • Found in both ICF and ECF
  • Primarily function: regulating acid-base balance
  • Produced through metabolic processes in sufficient amounts to meet body needs
  • Changes in fluid VL when there is too much/less
  • Helps w/enzyme reaction and neuromuscular
49
Q

Fluids and electrolytes- Alterations

A
  • Fluid volume deficit:Dehydration
  • Fluid volume excess
  • Elevated electrolyte level
  • Low electrolyte level
  • Chronic kidney disease
  • Acute Kidney injury
  • S/S: Excessive sweat, clammy, fatigue, HA, GI symptoms and N/V
  • Body constantly tries to compensate for fluid/electrolyte imbalance
50
Q

Fluid and electrolyte-Prevalence

A

-Mostly seen in young/elderly: Kidneys doesn’t filtrate properly
-Diabetes/HTN
-Low electrolytes
-Meds that are given to lower electrolyte balance
*Diuretics *benzodiazepines
\

51
Q

Fluid and electrolyte - Health promo

A
  • *Modifiable risk factors
  • Stress can increase cellular metabolism, blood glucose concentration andcarecholamine levels
  • Stress can increase production of antidiuretic hormones
  • Promotes fluid retention, decrease urine output
  • *Health Related illness
  • Limit outdoor activities during the hottes part of the day
  • Frequently breaks for rest and H2O
  • wear light weighted clothes
  • Work or exercise with others when engaging in activites outside
52
Q

Fluid and electrolyte- Diagnostic test

A

-serum electrolytes
CBC: hematocrit affected by plasma volume
-osmolality: serum and urine
-Urine specific gravitye

53
Q

Fluid and electrolyte - How to assess for imbalance

A

-V/S -Skin turgor -Oral mucosa - Neuro Checks - I/Os -Daily weights

54
Q

Fluid and electrolyte- collab intervention

A
  • Educate on appropriate use of electrolyte replacements
  • Oral replacements/ initiation of IV therapy for significan fluid loss
  • electrolyte supplements
  • Diuretics
  • Phamacologic therapy
55
Q

Fluid and electrolyte- Lifespan consideration

A
  • Infant and young children: more vulnerable because of physiological differences *Infants lose more fluid through kidneys which are less able to conserve water
  • School-age children +Aldolescents: gastroenteritis, diarrhea
  • Pregnant women: n/v most common, hyperemesis gravidarum, nausea that requires hospitilization
  • Older adults:normal aging process increase chaces of dehydration
56
Q

intracranial regulation- definition

A

The processes that affect intra cranial compensaion and adaptive neurolgical function
-regulates and integrates all body functions, muscle member, mental abilities and emotions

57
Q

intracranial regulation-Pathophysiology

A

Neurological system is made of 2 parts

  • CNS (consit of the brain and spinal cord)
  • Peripheral nervous system (cranial and spinal nerves)
58
Q

Intracranial regulation- CNS

A
  • Meninges coverthe brain and nourish the CNS
  • Skull protects the brain and is cushion by CSF
  • Brain consist of 4 parts
  • cerebrum: is divided into four regions called lobes that control senses, thoughts, and movements.
  • cerebellum: muscle movement, balance and control
  • Brainstem: control relflexes &10 of the cranial nerves
  • Diencephalon:(hypo) thalamus; control endocrine system
  • Spinal Cord:transmit impulses to and form the brain
59
Q

Intracranial regulation- PNS

A
  • Consist of the cranial nerves, 31 pairs of spinal nerves

- Reflexes

60
Q

Intracranial regulation-Neuron

A
  • Neurons are highly specialized cells that send impulses
  • Sensory neurons transmit impulses to the CNS
  • Motor neurons transmit impulses from the CNS
  • Myelin sheath covers larger, longer nerves
  • White matter of nervous system
61
Q

Intracranial regulation- Lifespan Considerations

A
  • Neonate has primitive reflexes at birth
  • Sucking -babinski -Stepping -startle(moro) -Rooting
  • assessment of newborn includes: cry of newborn and the head circumference
  • Assess child’s fine and gross motor skills
  • Reflexes start to disappear after 6 months, except babinski
62
Q

Intracranial regulation- Level of consciousness

A

*consciousness: condition in which individual aware of self and environment
-able to certain stimuli - arousal - cognition
*Causes of LOC includes, lesions/injuries to cerebral
metabolic disorders such as hypoglycemia
-Fluid and electrolyte imbalance,med or liver and renal failure

63
Q

intracranial regulation- Progression of deteriorating brain function

A
  • is pt alert and oriented x4
  • arousable
  • Decerebrate posturing (rigid extension of limbs)
  • Coma ( pupils fixed and nonreactive)
64
Q

Intracranial regulation- Outcome of altered LOC

A
  • Full recovery with no long term affects
  • recovery with residual damage
  • Vegetative state
  • Locked-in syndrome
  • Brain dead
65
Q

Intracranial regulation- Assessment

A
  • Focus on chief complaint (use Glascow scale)
  • Development considerations
  • Neurological funtions -Cranial Nerve functions
  • Mental status
66
Q

Intracranial Regulation- Independent Nursing interventions

A

-Airway -assess LOC - Monitor I/O -Reduce enviromental stimuli -Position pt - Seizure Precaution -Monitor intracranial pressure -assess pupil for response to light -Measure V/S

67
Q

intracranial regulation- RAS system

A

-Network of neurons extending from the top of the spinal cord to the thalamus; filters incoming sensory stimuli and redirects them to the cerebral cortex, activating the cortex and and influencing our state of physiological arousal and alertness.

68
Q

Sensory Perception- External Stimuli

A
  • Visual
  • Auditory
  • Olfactory (smell)
  • Tactile (feel)
  • Gustatory (taste
69
Q

Sensory Perception- Internal stimuli

A
  • Kinesthetic( sensation of movement)
  • Sterognosis (ability to perceive of material qualities, tactile recognition)
  • Visceral (felt in the internal organs of body;deep down feeling)
70
Q

Sensory Perception - education

A
  • Screening -organize/process stimuli
  • Learn how to manage deficit (glasses and hearing aide)
  • organize, have objects closer to them
  • clear walkway
  • sign language/ lip read and write
71
Q

Sensory Perception- Safety/ injury pervention

A
  • PPE
  • decrease sensory overload
  • turn tv off/on, dim lights, quiet time
  • ear plugs -glasses -tactile things (weighted blanket)
  • relaxation -soft object -flowers/aromatherapy
  • white noise machine
  • Simulations encouragement
  • TV -audiobooks -vistors/have social time
  • Music -click
72
Q

Sensory Perception- Ppl who are at risk (nonmodifieable)

A
  • Older adults -Infants( most likely are congential/ born with it) -Diseases (rubella, HTN: eye sight probs, Diabetes:uncontrolled, stroke, atherosclerosis)
  • otitis media
73
Q

Sensory Perception- modiefieable risk factors

A
  • smoking (changes smell, taste)
  • stress (diet) -UV light exposure (not wearing sunglasses)
  • Isolation (not having sunlight) -Injuries -Occupational
74
Q

Sensory Perception- wellness promo

A
  • Screening - vaccines - free clutter
  • for hearing impaired: have flash light phones
  • for someone who is tactile impaired
  • permanently adjust water heater
  • At risk for pressure sores/burns
  • for someone who is gusatory/olfactory impaired
  • check expiration dates
  • smoke alarms
75
Q

Sensory Perception- Screening/diagnostic test

A
  • hearing test (whisper test, tuning fork, otoscope)
  • are done when babies are born and every 3-5 years after til they are 10 yo
  • ppl grater than 50 every 3 years
  • Vision test (every year)
  • snelling test (distance) -Rosenhaulm test - cardinal fields of vision -opthalmascope
  • any other test is taken when there is a complaint
76
Q

Sensory Perception- assessment

A
  • 6 Components that must be assesed
    1. observation & Pt interview
    2. mental status exam
    3. what pts area at risk
    4. pts enviroment
    5. pts social support netowkr
    6. physical exam
77
Q

Sensory Perception/ Hearing impairment

*Severity of hearing loss

A
  • Partial
  • total
  • acquired
  • congenital
  • frequency
78
Q

Sensory Perception/ Hearing impairment

-etiology

A
  • Conductive (obstructive)
  • works on transmition of sound; most common to affect is ear infection and earwax blockage
  • sensorinural hearing loss
  • affects the inner ear, auditory nerve/pathway; cause exposure to noise, rubella, aging
  • also by congenital, acquired or genetic
  • Presbycusis (hair cells of cochela degenerates w/age
  • converations are losss - Higher-pitch loss
79
Q

Sensory Perception/ Hearing impairment

-Prevention

A
  • PPE (ear plugs)
  • Educate about ear buds and loud music
  • Meds (asprin, chemo, loop diuretics, aminoglucosides which causes ototoxicity)
  • some meds can not be discontinued despite ototoxcity
80
Q

Sensory Perception/ Hearing impairment

-Lifespan

A
  • Catch it early to prevent further research
  • no meds can help with permanent heating loss
  • Most elderly do no but hearing aids because medicare dosen’t cover it
81
Q

Sensory Perception/ Hearing impairment

-Surgery

A

Stapedectomy

  • Tympanoplasty
  • myringotomy
  • cochlear implant
82
Q

Sensory Perception/ Hearing impairment

-Meds

A
  • decongestants
  • hearing can be loss due to upper respiratory infection
  • Steriods
  • Sudden sersorineural hearing loss
  • Antibiotics
  • Ear infections

Nursing 101 (4 decks)

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