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Exam Two Flashcards

1
Q

What is spirituality defined as?

A

a dynamic aspect of humanity through which humans seek ultimate meaning and purpose.

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2
Q

How is spirituality expressed?

A

Through beliefs, values, traditions, and practices

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3
Q

What is religion defined as?

A

a system of beliefs that offer explanations and practices that allow one to cope with life’s questions and challenges

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4
Q

Components of Judaism

A

keep kosher
avoid pork and shellfish
don’t mix meat and dairy

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5
Q

Components of Islam

A

value cleanliness and modesty

we should provide same gender nurses especially for females

touch them only when medically necessary

a male family member may wish to be present - protector role

avoid alcohol & pork

Ramadan is period of fasting during daylight hours - there are exemptions for those who are sick

pray 5 times a day

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6
Q

components of Catholicism

A

have the anointing of the sick by a priest

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7
Q

components of Hinduism

A

do not eat beef or much meat

may not want medications derived from animals

believe in more than one life, so they may choose to not donate organs

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8
Q

components of buddhism

A

prefer eastern medicine

believe most illness can be cured holistically

many are vegetarian

value meditation

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9
Q

components of Jehova Witness

A

decline blood products, but may discuss other techniques

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10
Q

What are the risks for skin cancer?

A

males

pale skin

blonde hair

blue eyes

a close relative diagnosed with skin cancer

too much UV light

> 50

past history of melanoma

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11
Q

How do you prevent skin cancer?

A

avoid sun exposure when possible

avoid tanning beds

use SPF 30 or higher when in sun

use a hat in the sun

wear sunglasses

do a self skin exam monthly

get an annual skin exam by a doctor

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12
Q

Sunscreen application rules

A

apply 30 minutes before exposure

reapply every 2 hours or after swimming

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13
Q

Skin Cancer Assessment

ABCDE Rule

A

ABCDE rule

A: asymmetrical
B: border is irregular
C: color variation
D: diameter > 6 mm
E: evolving changes

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14
Q

Conductive hearing loss causes

A

primary cause is impacted cerumen

smoking

history of middle ear infections

tumors

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15
Q

Sensorineural hearing loss causes

A

aging

exposure to excessive noise

noise-induced hearing loss

ototoxic medications

tumors

presbycusis

Meniere’s disease

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16
Q

What medications are ototoxic?

A

aminoglycosides

loop diuretics

aspirin

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17
Q

What part of the ear is affected in conductive hearing loss? What is the outcome?

A

external or middle ear canal, tympanic membrane, bones in outer/middle ear, or ossictes

sounds cannot be transmitted to the inner ear

potential hearing loss in all ranges

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18
Q

What part of the ear is affected in sensorineural hearing loss? What is the outcome?

A

inner ear

sound transmitted but distortion occurs d/t problems with cochlea & auditory nerve

high-pitched tones are affected

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19
Q

Weber Test

A

A tuning fork is placed on top of the head - the sound should be heard equally in both ears

If the sound is louder in the effected ear, it is conductive hearing loss

If the sound is louder in the unaffected ear, it is sensorineural hearing loss

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20
Q

Rhinne Test

A

ONLY for conductive hearing loss

The tuning fork is placed on the mastoid process. The patient will let you know when they stop hearing a noise, then move it to the front of ear. Air conduction should be 2 x longer than bone conduction - if not, they have conductive hearing loss.

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21
Q

Conductive hearing loss treatment

A

Ear irrigation

Medications: corticosteroids, antibiotics, pseudoephedrine

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22
Q

Corticosteroids

A

decrease inflammation

avoid grapefruit juice

avoid live vaccines

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23
Q

antibiotics

A

educate patient to finish entire course

get adequate fluid intake

monitor hepatic and liver function

no grapefruit juice

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24
Q

pseudoephedrine

A

causes vasoconstriction to decrease inflammation

use cautiously in patients with hyperthyroidism, HTN, and heart disease

educate patient to limit caffeine intake.

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25
Q

Sensorineural Hearing Loss treatment

A

hearing aids

proper medication administration

reduce noise exposure - when using earbuds keep volume < 60% for short times or it could damage cilia

get frequent hearing exams

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26
Q

Changes in vision risk factors

A

age

smoking & alcohol

obesity

diabetes, hyperlipidemia, HTN

eye trauma

exposure to UV rays

use of corticosteroids

genetics

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27
Q

Cataracts Assessment, symptoms

A

opacities of lenses

symptoms: blurry vision, glare, halos around objects, double vision, difficulty sensing contrasting colors, poor night vision

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28
Q

Cataract Surgery Management

A

it removes the effected lens with insertion of artificial lens or interocular lens

antibiotic and anti-inflammatory eye drops prescribed

educated patient to avoid activities that increase IOP: coughing, sneezing, bending at the waist, lifting greater than 5 lbs, straining with BM

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29
Q

What causes glaucoma?

A

the nerve connected the eye to the brain is damaged d/t high eye pressure

can be open angle or angle closure

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30
Q

Open-angle glaucoma

A

flow of the aqueous humor is slowed

it is painless and gradual

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31
Q

angle-closure glaucoma

A

obstructive flow of aqueous humor, occurs suddenly! It’s an ophthalmic emergency!

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32
Q

open-angle glaucoma intervention

A

goal is to lower IOP

medications:
beta-blockers

prostaglandin analogs

miotics/cholinergic agonists

alpha 2 adrenergic agonists

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33
Q

beta blockers

A

(lol)

decrease production of aqueous humor

can cause hypotension, bradycardia, SOB - contraindicated with respiratory patients!

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34
Q

Prostaglandin Analongs

A

(prost)

increase drainage of aqeous humor

can cause eye pain, itching, burning, stining, and redness

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35
Q

Miotics/Cholinergic agonists

A

constrict pupil allowing decreased pressure on outflow channels & promotes drainage of aqueous humor

rare d/t potential for retinal detachment

can cause headaches, eye pain, decreased vision in low light

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36
Q

Alpha 2 adrenergic agonsits

A

(dine)

decrease aqueous humor production and increase drainage

contraindicated in acute angle-closure glaucoma, HTN, CAD, and dysrhythmias

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37
Q

Angle-closure intervention

A

Laser surgery to increase flow of aqueous humor

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38
Q

Age-Related Macular Degeneration

A

degenerative disorder of macula affecting ventral vision and visual acuity

can be non-exudative (dry) or exudative (wet)

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39
Q

Non-Exudative (dry) form ARMD

A

result of atrophy, retinal pigment degeneration, drusen accumulation

most common

slow progression

there is NO treatment

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40
Q

Exudative (wet) form ARMD

A

blood/serum leak from blood vessels beneath retina, cause scar formation and vision problems

less common

treatment: laser treatment, photodynamic therapy, injections

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41
Q

ARMD planning and intervention

A

UV protection

smoking cessation

limit alcohol

diet high in antioxidants -(sweet potato), C, E, lutein, and zeaxanthin especially in dry form

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42
Q

Menopause

A

occurs in ages 48-55

it is the permanent cessation of menses

diagnosed when no menses for 12 months

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43
Q

What can cause earlier menopause?

A

surgery (ovary removed)

medical (chemo)

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44
Q

Menopause S/S

A

insomnia

increased vaginal pH

increase in infections

painful intercourse d/t decreased lubrication

headache, palpitations d/t Vaso instability

hot flash

osteoporosis d/t decreased estrogen

fluctuating estrogen causes cognitive changes

increased risk for atherosclerosis, CVD d/t increased LDL to HDL ratio

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45
Q

menopause diagnostic test

A

FSH

this will increase with menopause

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46
Q

menopause treatment

A

bazedoxifene/duavee

ospemifene/Osphena

hormone replacement therapy

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47
Q

bazedoxifene/Duavee

A

decrease risk of osteoporosis

increase risk of endometrial cancer & DVT

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48
Q

ospemifene/Osphena

A

decrease vaginal dryness

increase risk of endometrial cancer & DVT

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49
Q

hormone replacement therapy

A

manages symptoms of menopause but has risks:

CHF, breast cancer, pulmonary edema/embolism, stroke

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50
Q

Goal of menaopause treatment

A

decrease symptoms associated with menopause and increase quality of life

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51
Q

Normal fasting blood glucose - diabetes

A

<100

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52
Q

Normal hemoglobin A1C

A

<6.5%

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53
Q

Diabetes sick day management

A

Instruct client to take medications as normal

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54
Q

Diabetes excercise

A

do LOW impact aerobic (mild-moderate)

HIGH impact exercise can cause mild hyperglycemia

PROLONGED exercise can cause hypoglycemia

do NOT exercise during peak action of medication

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55
Q

Diabetes skin integrity

A

Check feet daily

go to a podiatrist to cut toenails

if cut toenails at home cut straight across, NOT rounded

wear hard sole shoes at all times even inside

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56
Q

Addison’s Disease

A

caused by damage to the adrenal gland d/t TB, infection, autoimmune disorder, cancer, pituitary damage.

Does not produce ENOUGH cortisol

57
Q

What do cortisol and aldosterone do?

A

cortisone converts food to energy and helps with immune and stress response

aldosterone balances Na & K to regulate BP

58
Q

Addison’s Disease S/S

A

extreme fatigue

weight loss & decreased appetite

darkening of skin

hypotension

salt craving

hypoglycemia

N/V, diarrhea

abdominal pain

muscle/joint pain

irritability

depression

body hair loss or sexual dysfunction in women

59
Q

Addison’s Disease Lab Tests

A

Na, K, cortisol, ACTH

ACTH stimulation test

xray, CAT scan, MRI

60
Q

Addison Disease Intervention

A

take corticosteroids lifelong

educate client to minimize triggers for Addison Crisis (stress, infection, injury, lack of taking cortisol as prescribed)

wear medical alert bracelet at all times

61
Q

Addison’s Crisis S/S

A

severe hypotension

hypoglycemia

hyperkalemia

hyponatremia

62
Q

Addison Crisis Intervention

A

hydrocortisone IV to replace cortisone

saline to help with hypotension

dextrose to help with hypoglycemia and to pull K+ back into cell to be excreted with saline

63
Q

Cushing’s Syndrome

A

D/T too MUCH cortisol

cause by corticosteroid use, autoimmune disease, cancer

64
Q

Cushing’s syndrome S/S

A

moon face

pink or purple striae

thinning, fragile skin

slow healing

hypertension

bone loss

diabetes

fatigue

sexuality (decreased libido, ED, irregular menses)

65
Q

Cushing’s Diagnosis

A

symptoms

24 hour urine to measure cortisol levels (usually decreases during day)

cortisol levels

saliva - cortisol remains elevated in evening

imaging (CT, MRI, XRay)

66
Q

Cushing Intervention

A

limit use of corticosteroids

radiation/surgery if tumor

medications:

ketoconazole

mitotane

metyrapone

mifepristone

pasireotide

67
Q

ketoconazole

A

controls excess cortisol

side effects: liver damage, irregular heart rhythms, syncope, seizure, death

68
Q

mifepristone

A

controls excess cortisol

used in patients with diabetes type II

side effects: anemia, angioedema, fever, tachycardia, hypotension

69
Q

hypothyroidism patho

A

insufficient thyroid hormone

caused by autoimmune (Hashimoto), hereditary

decreased metabolic rate

70
Q

hypothyroidism risk factors

A

women

age 30-60

congenital

treatment of hyperthyroidism

71
Q

Hypothyroidism Lab Tests

A

TSH >5.5

T3 & T4 decreased

72
Q

Hypothyroidism S/S

A

decreased mental status

bradycardia

fatigue

constipation

hypotension

memory impairment

73
Q

Hypothyroidism Intervention

A

levothyroxine

surgery

monitor cardiac output

prevent constipation

maintain skin integrity

74
Q

levothyroxine

A

increase T4 levels, decrease TSH

educate: best absorbed 1 hr before meal or 2 hours after. Will be lifelong

75
Q

Myxedema Coma Assessment

A

hyponatremia

hypoglycemia

lactic acidosis

hypothermia

cardiovascular collapse

impaired mentation

coma

76
Q

Myxedema Coma Intervention

A

maintain airway D/T swelling

maintain fluid and electrolyte balance

increase body temperature

increase thyroid levels

determine cause to provide education on what to avoid

77
Q

hyperthyroidism patho

A

increased thyroid hormone levels

increased metabolic rate

increased SNS response

cause: groves disease, excess secretion, excessive thyroid meds

78
Q

hyperthyroidism risks

A

women

genetic

age 20-40

79
Q

hyperthyroidism S/S

A

insomnia, increased anxiety, blurred vision, HTN, tachycardia, palpitation, N/V, diarrhea, abdominal pain, hair loss, increased perspiration, hunger, hyperthermia, weight loss

80
Q

hyperthyroidism lab values

A

TSH <0.35

T3 & T4 increased

81
Q

hyperthyroidism intervention

A

medication:

methimazole

radiocative iodine therapy

surgery

monitor cardiac output

promote visual health - can cause proptosis

promote balanced nutrition

82
Q

methimazole

A

more common d/t less side effects

administer at the same time each day with meals

monitor for increased bleeding if also on anticoagulant

83
Q

radioactive iodine therapy

A

administer at the same time each day with meals

monitor for increased bleeding if also on anticoagulant

84
Q

Thyroid Storm Symptoms

A

hyperthermia

tachycardia

systolic hypertension

GI symptoms

cognitive

seizures

85
Q

Thyroid Storm intervention

A

stabilize cardiovascular - beta blocker pratanalol

decrease body temperature without aspirin NO aspirin

fluids and electrolytes

reduce thyroid level with meds

treat rapidly!

86
Q

BMI normal, overweight, and obese

A

Normal: 18.5-24.9

Overweight: 25-29.9

Obese: 30 +

87
Q

Metabolic Syndrome

A

must include three +

large waistline (> 35” females, >40” males)

high triglycerides (>150)

low HDL (<50 for females, <40 males)

HTN (> 130/85)

elevated fasting blood glucose (>100)

88
Q

Obesity intervention

A

lifestyle modifications first

medication:

lipase inhibitor

anorexiants

surgery (gastric bypass)

89
Q

Lipase Inhibitors

A

block absorption of diteray fats in small bowel

must have 2+ comorbidities

decrease the absorption of fat soluble vitamins and some medications

limit intake of fatty foods

may experience flatulence, diarrhea, stool urgency, and greasy stool

90
Q

Anorexiants

A

supresses appetite

diethylpropion

may produce confusion, insomnia, tremors, palpitations, tachycardia

has abuse potential

91
Q

gastric bypass red flags

A

increase or decrease in BP

tachycardia

decreased urine output

anxiety

decreased pulse ox

left shoulder pain

uncontrollable pain

92
Q

Gastric Bypass Complications

A

leakage with peritonitis (L shoulder pain, uncontrolled pain, changes in vital signs)

abdominal wall herniation

gallstones

infections (pneumonia)

DVT

nutritional deficiency

dumping syndrome

93
Q

dumping syndrome

A

stomach contents move rapidly through small intestine drawing fluid by osmosis

S/S: Nausea, bloat, abdominal pain, weakness, syncope

minimize risk through dietary changes to increase protein & fiber and decrease sugar & fluid with meals

94
Q

Risk for hepatitis

A

recent travel

poor sanitation (undercooked food, contaminated water A&E)

exposure

high-risk behavior

male

tattoo/piercing

healthcare worker

95
Q

hepatitis S/S

A

RUQ pain, N/V, joint or muscle pain

skin and sclera yellow

liver enzymes (AST, ALT, bilirubin elevated)

hepatitis panel - anti-hepititis virus antibodies

96
Q

Hepitits A

A

inflammation mild, liver not significantly damaged

97
Q

hepatitis B & C

A

inflammation severe, liver failure, liver cancer

98
Q

stages of hepatitis

A

prodromal: 2 weeks post exposure, initial symptoms. Mirror influenza

icteric phase: onset of jaundice (5-10 days after initial symptoms), dark urine

convalescent phase: recovery, symptoms resolve

99
Q

post-exposure prophylaxis

A

for A & B

Hepatitis A: must be given within 2 weeks of exposure

Hepatitis B: must be given within 24 hours

100
Q

anti-retroviral

A

for B & C

inhibit synthesis of viral DNA

monitor for baseline and periodic renal function tests, CBC, blood chemistry, and serum electrolytes

risk for lactic acidosis - monitor ABG

take as prescribed

may cause abdominal pain, N/V, jaundice, recurrent hep. B symptoms - if occur notify HCP

101
Q

interferon Alfa

A

for B & C

antiviral immunosuppression & antineoplastic interruption with viral replication

short & long acting form

short acting: several times a week

long acting: more severe side effects

administer sub Q

monitor for symptoms of hypersensitivity (angioedema, bronchoconstriction)

monitor CBC, platelet, renfal function, and liver function

may cause flu like symptoms

notify HCP if suicidal thoughts, difficulty breathing, chest pain, severe stomach/back pain

102
Q

hepatitis nonpharmacological management

A

comfort/rest

small, high calorie, high protein meals

at least 2 L fluids

anti-emetics 30 mins prior to meals

minimize spread - prophylactic treatment of all household members and sex partners

standard precaution

contact precaution for A&E

safe sex

no sex during acute infection

don’t use others personal care items

103
Q

QSEN Components

A

better prepare nursing students for patient care

  1. patient centered care
  2. quality improvement
  3. EBP
  4. teamwork & collaboration
  5. informatics
  6. safety
104
Q

Quality improvement Process

A

analysis of current process and outcomes
-interdisciplinary assessment (1 + discipline)
-intradisciplinary assessment (group of individuals with similar position)

benchmarking

areas for improvement (breach of care, sentinel events, near miss)

105
Q

Benchmarking

A

compare performance of individual or organization to industry standards

use statistics

must be measurable, objective, sensitive to change & performance

106
Q

Breach of Care

A

nurse deviates from standard of care

107
Q

sentinel events

A

unexpected occurrence that involves death or harm

immediate review - must do a root cause analysis

108
Q

near miss

A

No harm, did not reach patient

must still report

109
Q

Influenza risks

A

> 50

congregate care setting

chronic conditions

weakened immune function

healthcare provider

pregnant women

110
Q

Flu symptoms

A

chills

fever

malaise

muscle aches

headache

respiratory involvement if progresses

111
Q

flu treatment

A

medications within 48-72 hours of symptoms - goal is to decrease severity

(ir) drugs
zanamivir
osetamivir
peramivir
baloxavir

nonmedication:
bedrest
fluid (2L)
hygiene interventions vaccine when fever gone

112
Q

zanamivir

A

inhaled powder 2x day/5 days

contraindicated in respiratory patients d/t bronchospasm

113
Q

osteltamivir

A

oral 2x day for 5 days

most common

side effect N/V

114
Q

peramivir

A

IV

2+ years old

115
Q

baloxavir

A

oral single dose for those 12 + years old

116
Q

pneumonia risks

A

age >50

chronic conditions

weakened immune

smoking

alcohol/drug use

117
Q

pneumonia S/S adult

A

cough

excess mucus

SOB

chest pain

fever

malaise

loss of appetite

118
Q

pneumonia S/S older adult

A

new onset incontinence

tachycardia

decreased appetite

change in mental status

no fever

non-productive cough

119
Q

pneumonia treatment

A

medication: antibiotic, bronchodilators

rest

adequate fluid (2 L)

adequate nutrition

when to notify physician

vaccines when fever gone

120
Q

TB risks

A

immigrants

compromised immune

alcohol, drug abuse

homeless

malnutrition

121
Q

TB S/S

A

hemoptysis

night sweats

weight loss

fever

122
Q

TB diagnosis

A

< 5 mm negative for all, but does not completely rule out

5-9 mm - positive for severe immunocompromised or exposure from close contact

10-15 mm positive for congregate populations, malnutrition, and diabetes

> 15 mm - positive for those with no risk

123
Q

Ethambutol

A

added to initial TB treatment or treatment with Isoniazid

can cause optic neuritis - baseline visual exam and eye exam during treatment

can give with meals

monitor: neuro, renal function panel, liver function tests

educate: read newspaper to monitor for changes in vision

124
Q

Isoniazid

A

drug of choice with active TB

take on an EMPTY stomach 1 hour before meals

give with vitamin B6 to prevent neuropathy

avoid alcohol and acetaminophen (metabolized by liver)

side effect is peripheral neuropathy

125
Q

Rifabutin

A

for active TB

monitor CBC, liver function tests, monitor for bleedings - evidence of toxicity

avoid alcohol and substances damaging to liver

126
Q

Rifampin

A

used with isoniazid or other TB drug

take on empty stomach

monitor CBC, renal function tests, liver function test

decrease effectiveness of oral contraceptives, corticosteroids, warfarin, digoxin, hypoglycemics, quinidine, and methadone

turns body fluids orange

if dose are missed may experience flu-like symptoms

do not take with aspirin!

metabolized by liver and kidney

127
Q

Rifapentine

A

not a daily medication, titrated dose

monitor CBC, liver function test, renal function test

128
Q

Streptomycin

A

antibiotic to help with mycobacterium infection

given deep IM

monitor urine output and renal function panel, ototoxic, nephrotoxic

metabolized in kidney

129
Q

Amikacin

A

metabolized by kidney

risk for nephrotoxicity and ototoxicity

monitor I&O, daily weights, renal function panel

130
Q

Pyrazinamide

A

side effect gout

monitor liver function test, uric acid level

metabolized by liver

notify HCP of N/V, jaundice, gout, loss of appetite

131
Q

TB non pharmacologic treatment

A

education

adherence

minimize transmission

132
Q

HIV RIsk

A

sexual contact

IV drug use

healthcare provider

133
Q

HIV Pharmacological treatment

A

pre-exposure prophylaxis (tenofovir and emtricitabine) - give for HIV negative people but high risk

postexposure prophylaxis (zidovudine) - begin within 72/hours, it’s 2-3 meds up to 8 days for those exposed

134
Q

HIV non-pharmacological management

A

standard precautions

education (no needle sharing, safe sex, abstinence)

135
Q

HPV vaccine

A

prevents cervical and penile cancer

age 11-26 (2-3 doses)

if age 27-45 ask HCP if it’ll benefit them

136
Q

Influenza vaccine

A

6 months +

137
Q

Pneumonia vaccine

A

65 + unless contraindicated

can be given younger if cardiac/respiratory problem

138
Q

Meningococcal vaccine

A

ages 16-23 recieve

139
Q

zoster vaccine

A

50 +

prevents shingles

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