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fundamentals of nursing > exam1 > Flashcards

exam1 Flashcards

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1
Q

4 aspects of clinical judgement

A

noticing
interpreting
responding
reflections

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2
Q

what is critical thinking

A

a combination of reasoned thinking, openness to alternatives, ability to reflect, and desire to seek truth

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3
Q

EBP

A

most efficient. based around scientific evidence, clinical experience, and patient values

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4
Q

florence nightingale

A

founder of modern nursing. started the first nursing school

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5
Q

patricia benner

A

noves to expert nurse

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6
Q

noves

A

task oriented nurse. don’t see whole picture

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7
Q

advanced beginner

A

thinks more about what makes the most sense

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8
Q

competent nurse

A

recognize patterns

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9
Q

proficient nurse

A

looking more holistically

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10
Q

expert nurse

A

sees and fixes a problem before it becomes one

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11
Q

Marlowe hierarchy of needs from most to least

A

physiological
safety
love and belonging
esteem
self actualization

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12
Q

CRAAP acronym

A

currency
relevance
authority
accuracy
purpose

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13
Q

health

A

state of complete physical, mental, and social well being

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14
Q

5 stages of illness behavior

A

experience symptoms
sick role behaivor
seeking professional care
dependance on others
recovery

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15
Q

spirituality

A

a journey, subjective experiences.

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16
Q

religion

A

has beliefs and practices

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17
Q

best to measure intake

A

graduated cup

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18
Q

best to measure outtake

A

gradient cylinder

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19
Q

positive in fluid balance

A

input greater than output

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20
Q

negative in fluid balance

A

output greater than input

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21
Q

NPO

A

nothing per oral

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22
Q

I/o q hour

A

input and out take every hour

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23
Q

strict I/o

A

measure everything

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24
Q

enteral

A

directly to GI

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25
Q

CC

A

another word for milligrams

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26
Q

void

A

urine

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27
Q

EHR

A

electronic health record

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28
Q

measuring food

A

percentage as whole

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29
Q

how does infection spread

A

pathogen must exit reservoir

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30
Q

indirect contact

A

contact with fomite- contaminated object

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31
Q

common infection portal of entry

A

wounds, surgical sites, insertion sites of tubes and needles

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32
Q

systemic infection

A

pathogens invade blood or lymph

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33
Q

bacteremia

A

bacteria in blood

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34
Q

exogenous infection

A

pathogen acquired from healthcare enviroment

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35
Q

endogenous infection

A

pathogen arises from patients normal flora, with some treatment cause the microbe to multiply

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36
Q

stages of infection

A

incubation
prodrome
illness
decline
convalesence

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37
Q

primary defense

A

Normal flora of the body
skin
Respiratory tree
eyes
mouth
GI tract
Anus and urethra

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38
Q

secondary defense

A

Phagocytosis
Complement cascade
Inflammation
Fever

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39
Q

active immunity

A

body makes its own antibodies or T lymphocytes

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40
Q

passive immunity

A

when a person receives antibodies from someone else. like vaccine

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41
Q

bronchodilators

A

Relax the smooth muscles lining the airways.

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42
Q

can assessment be delegated

A

no

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43
Q

activities that dont need assessment

A

mobility, transfer, bathing, dressing, feeding, toileting, continence

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44
Q

diagnosing involves

A

critical thinking and logical reasoning

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45
Q

risk diagnosing

A

no signs or symptoms but pieces come together that patient could have it

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46
Q

prioritizing problems
top-bottom

A

transcendence (least), self actualization, aesthetic, cognitive, self-esteem, love and belonging, safety and security, physiological

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47
Q

when writing quality statement

A

avoid using medical diagnosis and treatments for etiology
be sure the etiology doesn’t restate the problem
be descriptive

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48
Q

outcome

A

specific observable measure, must include target time

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49
Q

goal

A

broad, nonspecific statement about desired result

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50
Q

direct care

A

counseling
observing
interactions
physical care
ADLs
teaching

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51
Q

indirect care

A

advocacy
delegating
evaluating

52
Q

empathy

A

You understand peoples pain

53
Q

sympathy

A

you feel bad for people, but you dont understand their pain

54
Q

concrete

A

clear and confident

55
Q

aphasia

A

unable to speak

56
Q

are you able to tell the patients everything will be okay?

A

no

57
Q

safety

A

basic human need for patients, us and other workers

58
Q

how many patients die a year due to mistakes in care

A

161K

59
Q

Factors affecting patient safety

A

lifestyle, cognition, developmental stage, balance, gait, mobility, ability to communicate, visual acuity, emotional health, safety awareness

60
Q

never events

A

things that should never happen in the hospital due to protocols

61
Q

whats the most common safety concern in healthcare

A

falls

62
Q

Sentinel event

A

events that can lead to death or a lot of harm. Ex- medication error, delay in treatment

63
Q

safety hazards for workers

A

workplace violence, disease, back injury, radiation, needlestick injury

64
Q

improving safety in workplace

A

follow protocols, speak up, communicate, taking care of yourself, continuing caring, don’t assume

65
Q

restraints

A

device or method use for restricting to help keep patient from hurting themselves. You must have an order for this. If they have one, monitor them every 2 hours.

66
Q

why hourly rounding?

A

meet patients need instead of waiting for them to need. Also reduce call button times

67
Q

scale for fall risk

A

morse

68
Q

what to do if someone falls on your shift

A

document findings and look for injuries. Identify actions to prevent recurrence

69
Q

moral distress

A

you know what the right thing to do is but you are unable to do it

70
Q

ethical principles

A

autonomy, nonmalefinence, beneficence, fidelity, veracity, justice

71
Q

autonomy

A

respecting the patients right to choose. Patient needs all the info to choose

72
Q

nonmaleficence

A

do no harm. benefits need to outweigh

73
Q

beneficence

A

doing the right thing

74
Q

fidelity

A

keeping promises

75
Q

veracity

A

telling the truth

76
Q

justice

A

treat everyone equally, everyone gets equitable care for their case

77
Q

nurse practice act is determined by

A

state board of nursing

78
Q

patient bill of rights

A

States they will get care, they have the right to know there problems

79
Q

PSDA (patient self determination act)

A

advanced directives. General term to indicate what a person wants or don’t want.. Ex- DNR, ADA (Allow natural death), living will, organ donation, health power of attorney

80
Q

HIPPA

A

privacy and portability act

81
Q

EMTALA ( emergency medical treatment and active labor act)

A

Patient that comes to ER must be triaged

82
Q

ADA

A

American disability act. Specialized needs

83
Q

Mandatory reporting

A

must report if we see experience or think could be present. Ex- abuse, infectious diseases

84
Q

Patient confidentiality

A

only the people who need to know can know
Informed consent- got to have all the info

85
Q

FALSE IMPRISONMENT

A

lead patient to believe they couldn’t do something

86
Q

Assault and battery

A

assault- threat
battery- actually did something

87
Q

Slander and libel

A

slender is spoken against the patient
libel is written against

88
Q

AIDET

A

Acknowledge
Introduce- name role
Duration- brief idea of how long you’ll be in there
Explanation- briefly explain what your going to do and warn about pain
Thank you- thank for time and cooperation

89
Q

SBAR

A

Situation- general overview. Ex- code, race, allergies, etc
Background- past history. Explain what has been done so far and how patient is responding
Assessment- quick head to toe summary
Recommendation- summarize plan of care, recommendations that will help, test results

90
Q

subjective data

A

what patient says

91
Q

objective data

A

what can be seen, only facts

92
Q

initial assessment

A

when patient first comes in, gives a baseline

93
Q

ongoing assessment

A

every other encounter with patient after first

94
Q

comprehensive assessment

A

head to toe, look at everything

95
Q

focused assessment

A

aimed at one specific area in general. What problem specifically is.

96
Q

what must we check for in every single assessment

A

safety

97
Q

what should we do after hearing info from a patient

A

validate it with them

98
Q

clinical reasoning through use of

A

critical thinking

99
Q

actual nursing diagnosis

A

has evidence for support

100
Q

risk nursing diagnosis

A

a tendency for it to happen but hasn’t happened yet. No evidence yet

101
Q

prioritizing patient needs

A

use ABC
1- airway, breathing
2. circulation
3. pain

102
Q

why is shelter a physiological need

A

protects from elements like heat, and is important for body temp

103
Q

critical thinking you need

A

education
reflection
experience

104
Q

SMART

A

Specific
Measurable
Attainable- can they do this in this amount of time?
Relatable- does it relate to what’s going on with patient
timely - what’s the time goal?

105
Q

STANDARDIZED nursing care plan

A

everyone has it

106
Q

individualized care plan

A

fits need of specific patient

107
Q

interventions

A

things we do to help

108
Q

independent intervention

A

nurse can do it on there own. Need no order

109
Q

dependent intervention

A

doctors order for intervention

110
Q

interdependent intervention

A

working with other departments

111
Q

implementation

A

putting intervention into affect

112
Q

direct implementation

A

things I do

113
Q

indirect implementation

A

things I was told to do

114
Q

delegation

A

Right task
Right circumstance
Right person
Right direction/ communication
Right supervision

115
Q

evaluation

A

Did intervention work?
Determines what comes next
-discontinue interventions
-continue interventions
-revise interventions
most forgotten phase

116
Q

physiological needs

A

food, air, water, shelter, sleep, clothing, reproduction

117
Q

safety needs

A

personal security, employment, resources, health, property

118
Q

love and belonging

A

friendship, intimacy, family, sense of connection

119
Q

esteem

A

respect, self esteem, status, recognition, strength, freedom

120
Q

self actualization

A

desire to become the most one can be

121
Q

Who can i use SCD on

A

bed bound patients who do not have blood clots or compartment syndrome

122
Q

who to use a TED on

A

patients that are more mobile

123
Q

biggest disadvantage to oxygen

A

fire hazzard

124
Q

protective precautions

A

protecting the patient

125
Q

Analytical reasoning

A

Interventions are based on likelihood of desired outcome.
Rely heavy on textbook info

126
Q

Intuitive reasoning

A

Used by experienced nurses based on their in depth knowledge to intuitively grasp the info and know how to respond

127
Q

Narrative reasoning

A

Helps the nurse to use info based on clients illness experience, coping ability and vision of future to develop client center plan of care

fundamentals of nursing (4 decks)

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