Exam Two Flashcards
1
Q
What is spirituality defined as?
A
a dynamic aspect of humanity through which humans seek ultimate meaning and purpose.
2
Q
How is spirituality expressed?
A
Through beliefs, values, traditions, and practices
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
4
Q
Components of Judaism
A
keep kosher
avoid pork and shellfish
don’t mix meat and dairy
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
6
Q
components of Catholicism
A
have the anointing of the sick by a priest
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
8
Q
components of buddhism
A
prefer eastern medicine
believe most illness can be cured holistically
many are vegetarian
value meditation
9
Q
components of Jehova Witness
A
decline blood products, but may discuss other techniques
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
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
12
Q
Sunscreen application rules
A
apply 30 minutes before exposure
reapply every 2 hours or after swimming
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
14
Q
Conductive hearing loss causes
A
primary cause is impacted cerumen
smoking
history of middle ear infections
tumors
15
Q
Sensorineural hearing loss causes
A
aging
exposure to excessive noise
noise-induced hearing loss
ototoxic medications
tumors
presbycusis
Meniere’s disease
16
Q
What medications are ototoxic?
A
aminoglycosides
loop diuretics
aspirin
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
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
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
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.
21
Q
Conductive hearing loss treatment
A
Ear irrigation
Medications: corticosteroids, antibiotics, pseudoephedrine
22
Q
Corticosteroids
A
decrease inflammation
avoid grapefruit juice
avoid live vaccines
23
Q
antibiotics
A
educate patient to finish entire course
get adequate fluid intake
monitor hepatic and liver function
no grapefruit juice
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.
25
Sensorineural Hearing Loss treatment
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
26
Changes in vision risk factors
age
smoking & alcohol
obesity
diabetes, hyperlipidemia, HTN
eye trauma
exposure to UV rays
use of corticosteroids
genetics
27
Cataracts Assessment, symptoms
opacities of lenses
symptoms: blurry vision, glare, halos around objects, double vision, difficulty sensing contrasting colors, poor night vision
28
Cataract Surgery Management
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
29
What causes glaucoma?
the nerve connected the eye to the brain is damaged d/t high eye pressure
can be open angle or angle closure
30
Open-angle glaucoma
flow of the aqueous humor is slowed
it is painless and gradual
31
angle-closure glaucoma
obstructive flow of aqueous humor, occurs suddenly! It's an ophthalmic emergency!
32
open-angle glaucoma intervention
goal is to lower IOP
medications:
beta-blockers
prostaglandin analogs
miotics/cholinergic agonists
alpha 2 adrenergic agonists
33
beta blockers
(lol)
decrease production of aqueous humor
can cause hypotension, bradycardia, SOB - contraindicated with respiratory patients!
34
Prostaglandin Analongs
(prost)
increase drainage of aqeous humor
can cause eye pain, itching, burning, stining, and redness
35
Miotics/Cholinergic agonists
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
36
Alpha 2 adrenergic agonsits
(dine)
decrease aqueous humor production and increase drainage
contraindicated in acute angle-closure glaucoma, HTN, CAD, and dysrhythmias
37
Angle-closure intervention
Laser surgery to increase flow of aqueous humor
38
Age-Related Macular Degeneration
degenerative disorder of macula affecting ventral vision and visual acuity
can be non-exudative (dry) or exudative (wet)
39
Non-Exudative (dry) form ARMD
result of atrophy, retinal pigment degeneration, drusen accumulation
most common
slow progression
there is NO treatment
40
Exudative (wet) form ARMD
blood/serum leak from blood vessels beneath retina, cause scar formation and vision problems
less common
treatment: laser treatment, photodynamic therapy, injections
41
ARMD planning and intervention
UV protection
smoking cessation
limit alcohol
diet high in antioxidants -(sweet potato), C, E, lutein, and zeaxanthin especially in dry form
42
Menopause
occurs in ages 48-55
it is the permanent cessation of menses
diagnosed when no menses for 12 months
43
What can cause earlier menopause?
surgery (ovary removed)
medical (chemo)
44
Menopause S/S
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
45
menopause diagnostic test
FSH
this will increase with menopause
46
menopause treatment
bazedoxifene/duavee
ospemifene/Osphena
hormone replacement therapy
47
bazedoxifene/Duavee
decrease risk of osteoporosis
increase risk of endometrial cancer & DVT
48
ospemifene/Osphena
decrease vaginal dryness
increase risk of endometrial cancer & DVT
49
hormone replacement therapy
manages symptoms of menopause but has risks:
CHF, breast cancer, pulmonary edema/embolism, stroke
50
Goal of menaopause treatment
decrease symptoms associated with menopause and increase quality of life
51
Normal fasting blood glucose - diabetes
<100
52
Normal hemoglobin A1C
<6.5%
53
Diabetes sick day management
Instruct client to take medications as normal
54
Diabetes excercise
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
55
Diabetes skin integrity
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
56
Addison's Disease
caused by damage to the adrenal gland d/t TB, infection, autoimmune disorder, cancer, pituitary damage.
Does not produce ENOUGH cortisol
57
What do cortisol and aldosterone do?
cortisone converts food to energy and helps with immune and stress response
aldosterone balances Na & K to regulate BP
58
Addison's Disease S/S
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
Addison's Disease Lab Tests
Na, K, cortisol, ACTH
ACTH stimulation test
xray, CAT scan, MRI
60
Addison Disease Intervention
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
Addison's Crisis S/S
severe hypotension
hypoglycemia
hyperkalemia
hyponatremia
62
Addison Crisis Intervention
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
Cushing's Syndrome
D/T too MUCH cortisol
cause by corticosteroid use, autoimmune disease, cancer
64
Cushing's syndrome S/S
moon face
pink or purple striae
thinning, fragile skin
slow healing
hypertension
bone loss
diabetes
fatigue
sexuality (decreased libido, ED, irregular menses)
65
Cushing's Diagnosis
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
Cushing Intervention
limit use of corticosteroids
radiation/surgery if tumor
medications:
ketoconazole
mitotane
metyrapone
mifepristone
pasireotide
67
ketoconazole
controls excess cortisol
side effects: liver damage, irregular heart rhythms, syncope, seizure, death
68
mifepristone
controls excess cortisol
used in patients with diabetes type II
side effects: anemia, angioedema, fever, tachycardia, hypotension
69
hypothyroidism patho
insufficient thyroid hormone
caused by autoimmune (Hashimoto), hereditary
decreased metabolic rate
70
hypothyroidism risk factors
women
age 30-60
congenital
treatment of hyperthyroidism
71
Hypothyroidism Lab Tests
TSH >5.5
T3 & T4 decreased
72
Hypothyroidism S/S
decreased mental status
bradycardia
fatigue
constipation
hypotension
memory impairment
73
Hypothyroidism Intervention
levothyroxine
surgery
monitor cardiac output
prevent constipation
maintain skin integrity
74
levothyroxine
increase T4 levels, decrease TSH
educate: best absorbed 1 hr before meal or 2 hours after. Will be lifelong
75
Myxedema Coma Assessment
hyponatremia
hypoglycemia
lactic acidosis
hypothermia
cardiovascular collapse
impaired mentation
coma
76
Myxedema Coma Intervention
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
hyperthyroidism patho
increased thyroid hormone levels
increased metabolic rate
increased SNS response
cause: groves disease, excess secretion, excessive thyroid meds
78
hyperthyroidism risks
women
genetic
age 20-40
79
hyperthyroidism S/S
insomnia, increased anxiety, blurred vision, HTN, tachycardia, palpitation, N/V, diarrhea, abdominal pain, hair loss, increased perspiration, hunger, hyperthermia, weight loss
80
hyperthyroidism lab values
TSH <0.35
T3 & T4 increased
81
hyperthyroidism intervention
medication:
methimazole
radiocative iodine therapy
surgery
monitor cardiac output
promote visual health - can cause proptosis
promote balanced nutrition
82
methimazole
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
radioactive iodine therapy
administer at the same time each day with meals
monitor for increased bleeding if also on anticoagulant
84
Thyroid Storm Symptoms
hyperthermia
tachycardia
systolic hypertension
GI symptoms
cognitive
seizures
85
Thyroid Storm intervention
stabilize cardiovascular - beta blocker pratanalol
decrease body temperature without aspirin NO aspirin
fluids and electrolytes
reduce thyroid level with meds
treat rapidly!
86
BMI normal, overweight, and obese
Normal: 18.5-24.9
Overweight: 25-29.9
Obese: 30 +
87
Metabolic Syndrome
*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
Obesity intervention
lifestyle modifications first
medication:
lipase inhibitor
anorexiants
surgery (gastric bypass)
89
Lipase Inhibitors
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
Anorexiants
supresses appetite
diethylpropion
may produce confusion, insomnia, tremors, palpitations, tachycardia
has abuse potential
91
gastric bypass red flags
increase or decrease in BP
tachycardia
decreased urine output
anxiety
decreased pulse ox
left shoulder pain
uncontrollable pain
92
Gastric Bypass Complications
leakage with peritonitis (L shoulder pain, uncontrolled pain, changes in vital signs)
abdominal wall herniation
gallstones
infections (pneumonia)
DVT
nutritional deficiency
dumping syndrome
93
dumping syndrome
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
Risk for hepatitis
recent travel
poor sanitation (undercooked food, contaminated water A&E)
exposure
high-risk behavior
male
tattoo/piercing
healthcare worker
95
hepatitis S/S
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
Hepitits A
inflammation mild, liver not significantly damaged
97
hepatitis B & C
inflammation severe, liver failure, liver cancer
98
stages of hepatitis
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
post-exposure prophylaxis
for A & B
Hepatitis A: must be given within 2 weeks of exposure
Hepatitis B: must be given within 24 hours
100
anti-retroviral
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
interferon Alfa
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
hepatitis nonpharmacological management
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
QSEN Components
better prepare nursing students for patient care
1. patient centered care
2. quality improvement
3. EBP
4. teamwork & collaboration
5. informatics
6. safety
104
Quality improvement Process
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
Benchmarking
compare performance of individual or organization to industry standards
use statistics
must be measurable, objective, sensitive to change & performance
106
Breach of Care
nurse deviates from standard of care
107
sentinel events
unexpected occurrence that involves death or harm
immediate review - must do a root cause analysis
108
near miss
No harm, did not reach patient
must still report
109
Influenza risks
> 50
congregate care setting
chronic conditions
weakened immune function
healthcare provider
pregnant women
110
Flu symptoms
chills
fever
malaise
muscle aches
headache
respiratory involvement if progresses
111
flu treatment
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
zanamivir
inhaled powder 2x day/5 days
contraindicated in respiratory patients d/t bronchospasm
113
osteltamivir
oral 2x day for 5 days
most common
side effect N/V
114
peramivir
IV
2+ years old
115
baloxavir
oral single dose for those 12 + years old
116
pneumonia risks
age >50
chronic conditions
weakened immune
smoking
alcohol/drug use
117
pneumonia S/S adult
cough
excess mucus
SOB
chest pain
fever
malaise
loss of appetite
118
pneumonia S/S older adult
new onset incontinence
tachycardia
decreased appetite
change in mental status
no fever
non-productive cough
119
pneumonia treatment
medication: antibiotic, bronchodilators
rest
adequate fluid (2 L)
adequate nutrition
when to notify physician
vaccines when fever gone
120
TB risks
immigrants
compromised immune
alcohol, drug abuse
homeless
malnutrition
121
TB S/S
hemoptysis
night sweats
weight loss
fever
122
TB diagnosis
< 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
Ethambutol
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
Isoniazid
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
Rifabutin
for active TB
monitor CBC, liver function tests, monitor for bleedings - evidence of toxicity
avoid alcohol and substances damaging to liver
126
Rifampin
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
Rifapentine
not a daily medication, titrated dose
monitor CBC, liver function test, renal function test
128
Streptomycin
antibiotic to help with mycobacterium infection
given deep IM
monitor urine output and renal function panel, ototoxic, nephrotoxic
metabolized in kidney
129
Amikacin
metabolized by kidney
risk for nephrotoxicity and ototoxicity
monitor I&O, daily weights, renal function panel
130
Pyrazinamide
side effect gout
monitor liver function test, uric acid level
metabolized by liver
notify HCP of N/V, jaundice, gout, loss of appetite
131
TB non pharmacologic treatment
education
adherence
minimize transmission
132
HIV RIsk
sexual contact
IV drug use
healthcare provider
133
HIV Pharmacological treatment
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
HIV non-pharmacological management
standard precautions
education (no needle sharing, safe sex, abstinence)
135
HPV vaccine
prevents cervical and penile cancer
age 11-26 (2-3 doses)
if age 27-45 ask HCP if it'll benefit them
136
Influenza vaccine
6 months +
137
Pneumonia vaccine
65 + unless contraindicated
can be given younger if cardiac/respiratory problem
138
Meningococcal vaccine
ages 16-23 recieve
139
zoster vaccine
50 +
prevents shingles
