Final Flashcards
Blood Pressure Ranges
Normal: less 120 and less 80
Elevated: 120-129 and less 80
I: 130-139 or 80-89
II: greater or equal to 140 or greater and equal to 90
Crisis: Greater 180 and/or greater or equal t 120
Vital Sign Ranges
Temperature: 35.9-38C (96.7-100.5F)
Pulse: 60-100 bpm
RR: 12-20 bpm
BP: less than 120 / less than 80
Temperature Range
35.9-38C or 96.7-100.5F
Pulse Deficit
2 nurse check:
apical - radial pulse
MAP and Pulse Pressure
MAP = (DP+ (1/3(SP-DP))
PP: SBP - DBP
PERRLA
CN 3
Pupils are equally round, reactive to light, and accommodation
Physical Assessment Techniques Order
Inspection
Palpation
Percussion
Auscultation
GCS
Max: 15
Eye Open: 4
Verbal Response: 5
Motor Response: 6
Less than 8 = comatose
Positioning
Fowler’s position: breathing
Trendelenburg: fluid
Program Learning Outcomes
Leadership
Teamwork and Collaboration
Professional
Communication
Evidence-Based Practice
Informatics
Patient-Centered Care
Quality Improvement
Safety
Systems-Based Practice
Medicare
65 and older
A: inpatient hospital cost with no premium
B: outpatient preventative; premium
C: A+B including vision, hearing, and gym; premium
D: outpatient and drug coverage; premium
Levels of Healthcare
Primary: clinic with PCP or NP
treat common health problems and provide preventative measures
e.g. sore throat, HTN, DM, vaccinations, mammograms
Secondary: community centers with specialized physicians
Diagnose disease and disease management
e.g. hospital care for MI or stroke
Tertiary: medical centers with subspecialized like pediatric hematologist
Rare and complex disease management
e.g. pituitary tumor
Delegations to LPN Only
Apical Pulse
Oxygen Administration
Nasal Swab and NP Collections
Sputum Specimen Collection
Wound Culturing
IM, ID, SubQ
Medications
Enemas
Bladder Scanner
Change stoma appliance
Collect data
What can you not delegate to LPN
U EAT
Unstable patient: new admission, post-op, sudden changes
Evaluation: trending or interpreting data
Assessment: initial, first, primary
Teaching: initial, first, primary education
Informatic Terms: Data, Information, Knowledge, Wisdom
Data: discrete entities described without interpretation
Information: data interpret, organized, structured
Knowledge: synthesized information to identify relationships
Wisdom: appropriate use of knowledge to manage and solve human problems
Research Journal Article
Abstract: summary of article and purpose
Intro: specific purpose and lit review
Method: subject, research design, data collected and how it was analyzed
Results
Discussion/Conclusion: what results mean in regard to purpose of study and lit review including suggestions for future research and application to nursing practice
EBP Steps
- PICOT format question
- search and collect most relevant best evidence
- analyze previous research
- implement practice
- evaluate outcome
- disseminate outcomes
System Dev Lifecycle
- Analyze and Plan
- Design and Dev
- Test
- Train - superuser
- Implement
- Maintain
- Evaluate - stage nurses are needed
PICOT
P: patient, population, problem of interest
I: intervention of interest (independent var)
C: comparison of interest (control)
O: outcome of interest
T: time
Hierarchy of Evidence
Level I: systematic review
Level II: randomized controlled trials
Level III: controlled cohort studies
Level IV: uncontrolled cohort studies
Level V: case studies, qualitative, EBP implementation
Level VI: expert opinion
Quantitative
Number; Objective
Descriptive: describe relationships
Correlation: relationship between two variables
Quasi-experimental: clinical setting
Experimental: lab setting
Independent: manipulating
Dependent: variable being studied
Quantitative Research Process (Scientific Method)
- research problem usually a question
- define the study purpose
- review literature
- hypothesis and variables
- research design
- population and sample
- collect data
- analyze data
- communicate findings
Qualitative
words and narrative; subjective
perception, experience, views
Phenomenology: description of experience of subject
Grounded theory: how people describe their own realities
Ethnography: cultural issues
Historical: examine past events
Medicare 4 Parts
65 and older
A: inpatient hospital cost; no premium
B: outpatient: voluntary and monthly premium
C: Advantage Plus (A+B) also includes vision, hearing and gym. Premium
D: outpatient and drug coverage; premium
Levels of Healthcare
Facilities
Primary: clinic (PCP & NP)
treat common health problems and preventative measure
Sore throat, HTN, DM, vaccination, screenings
Secondary: community centers (specialties like peds; neuro)
diagnose dz and management
hospital care for MI or stroke
Tertiary: medical centers
subspecialities like pediatric hematologist
rare and complex dz management
pituitary tumor
AZBoN
apply to take NCLEX to become RN
apply for licensure
scope of practice for RN, LPN, CNA
Nurse Practice Act
Prioritization
Safety first
ABC: airway, breathing/brain, circulation (heart)
acute > chronic
actual > potential
least invasive first
Maslow’s: physiological needs first
Source of Law: Administrative and Statutory
Administrative: enforcing - Board of Nursing
Statutory: Nurse Practice Act
safe nursing practice
disciplinary process
professionalism
scope of practice
delegation
board responsibilities
Levels of Preventive Care
Primary: promoting health
Secondary: early detection
screening
Tertiary: know the disease and rx
Health, Wellness, Illness, Dz
Health: holistic - physical, mental, social
Wellness: promotion of holistic health
Illness: response to dz
Dz: pathologic change
Care Based Approach Bioethics
nurse-patient relationship is the center
promotion of dignity and respect for patient
attention to ind pt
virtues: kindness, attentiveness, empathy, compassion, reliability
Principle-Based Approach Bioethics
Autonomy: respect patient rights
Nonmaleficence: do no harm
Beneficence: benefit outweigh risk
Justice: act fairly
Fidelity: keep promises
Veracity: truth and fact
Accountability, Privacy, Confidentiality: HIPPA
Common Nursing Malpractice
failure to ensure safety
improper treatment
failure to monitor and report
med errors and reactions
failure to follow facility procedure
failure to document
equipment use
adverse incident not reported
lawsuit with HIV patients
Beliefs and Values
Beliefs about worth of something that act as standard to guide behaviors creating a value system (code of conduct)
Professional values:
altruism: concern well being of others
autonomy: respect pt rights
human dignity: value and respect others
integrity: honest and ethical framework
social justice: equal rights and rx
Signs of Impending Death
Difficulty talking or swallowing
Nausea, flatus, and abdominal distention
Urinary or bowel incontinence or constipation
Loss of movement, sensation, reflexes
Decreasing body temperature with cold or clammy skin
Weak, slow, irregular pulse
Decreasing BP
Noise, irregular or Cheyne-Stokes respiration
Restlessness or agitation
Cooling, mottling, cyanosis of extremities and dependent areas
Five Stages of Dying
Denial: deny reality of death
Anger: rage and hostility and adopt why me attitude
Bargaining: barter for more time
Depression: period of grief before death
Acceptance: accepted reality of death and prepared to die
Concepts of death and dying
irreversible cessation of circulatory and respiratory functions (cardiac death)
irreversible cessation of all functions of the entire brain, including the brainstem (brain death)
Most protocols require two separate clinical examinations. The medical criteria used to certify a death are as follows:
○ Breathing cessation
○ No response to deep painful stimuli
○ Lack of reflexes (such as the gag or corneal reflex) and spontaneous movement
○ Flat encephalogram (brain waves)
Concepts of Spirituality
Spirituality: relationship with nonmaterial life force or higher power
Faith: confident belief where there is no proof or evidence
Religion: organized system of beliefs about higher power
Hope: ingredient in life responsible for positive outlook
Love: connectedness with others
Suffering: specific state of distress
Five Models of Health:
Health Belief Model
Health promotion
Health Illness Continuum
Agent-Host-Environment Model
Stages of Change Model
Health Belief Model: personal perception of their health
perceived susceptibility to dz
perceived seriousness of dz
perceived benefits of actions
Health promotion: what they do to promote healthy behaviors
Health Illness Continuum: health is constantly changing state with high level of wellness and death on opposite sides
Agent-Host-Environment Model:
external agent, susceptible host, and environment as causes of dz
Stages of Change Model: addiction to change their behavior
Diagnosis Related Groups (DRGs) were instituted by the federal government mainly to reduce
Cost of health care
Isotonic, Isometric, Isokinetic
Isotonic: muscle shortening and active movement
Isometric: muscle contraction without shortening
Isokinetic: muscle contraction with resistance
Stages of Pressure Injuries
Stage 1: nonblanchable erythema of intact skin
Stage 2: partial-thickness of skin loss with exposed dermis
Stage 3: full-thickness skin loss not involving underlying fascia
Stage 4: full-thickness skin and tissue loss
Unstageable: obscured full-thickness skin and tissue loss
Deep tissue pressure injury: persistent nonblanchable deep red, marron, or purple discoloration
