Final Examination Flashcards
Actual loss
can be recognized by others
-loss of spouse or money
Perceived loss
felt by person but is intangible to others
-loss of beauty/youth
Maturational loss
experienced as a result of natural developmental process
-adding children to the family
Situational loss
experienced as a result of an unpredictable event
-terror attack, natural disaster
Anticipatory loss
Loss has not yet taken place
-family member on hospice
Grief
emotional reaction to loss ( no time frame )
Bereavement
state of grieving; person goes through grief reaction.
Mourning
acceptance of loss; person learns to deal with loss
Engel’s Six Stages of Grief
- shock and disbelief
- developing awareness
- restitution
- resolving the loss
- idealization
- outcome
Definitions of death
- Traditional heart-lung
2. Brain
Clinical signs of impending death
- inability to swallow
- pitting edema
- decreased gi and urinary tract activity
- loss of motion, sensation, reflexes
- change in temp, cold/clammy skin, cyanosis
- lowered bp
- noisy or irregular respirations “death rattle”
- cheyne-stokes respirations
Kubler-Ross’ Five stages of grief
- denial and isolation
- anger
- bargaining
- depression
- acceptance
Components of a good death
- pain and sx management
- clear decision making
- preparation for death
- completion
- contributing to others (giving things away)
- affirmation of the whole person
5 principles of palliative care
- respect goals of dying person and loved ones
- look after all needs of dying person
- support needs of family members
- help gain access to providers
- build ways to provide excellent care at end of life
Special orders
- DNR or no-code
- comfort measures only
- do not hospitalize
Postmortem care of the body
place identification tags on the body
< 24 hours = coroner case
situational death = very hard for family
Functions of the musculoskeletal system
- protect vital organs
- mobility and movement
- facilitate return of blood to the heart
- production of blood cells (hematopoiesis)
- reservoir for immature blood cells
- reservoir for vital minerals (98% Ca++ is in bones)
Synarthrosis
immovable joints
-skull sutures
amphiarthrosis
allow limited movement
-vertebral joints, symph. pubis
diarthrosis
freely movable
- ball/socket: hip, shoulder
- hinge: elbow, knee
- saddle: thumb
- pivot: radius/ulna; turn door knob
- gliding: carpal tunnel bones in wrist
Muscles
- attached to bones an other structures by tendons
- encased in a fibrous tissue called fascia
- contraction of muscle causes movement
Osteoblasts
function in bone formation
Osteocytes
- mature bone cells that function in bone maintenance
- located in the lacunae
Osteoclasts
-multinuclear cells function in destroying, resorbing, and remodeling bone
Osteogenesis
bone formation
ossification
process of formation of the bone matrix and deposition of minerals
Bone regulating factors
- stress and weight bearing
- Vit D: deficiency = bone demineralization
- parathyroid hormone and calcitonin
- blood supply
Musculoskeletal Neurovascular Check
- skin color
- skin temperature
- capillary refill (blanch test)
- edema
- pulses
- sensation
- ability to move
Clonus
rhythmic contraction of a muscle
Ballottment test
+ when you have patella rebound
Used to test for fluid in the knee
Fasciculation
involuntary twitching of muscle
Bone densitometry
Determines bone mineral density. Estimates extent of osteoporosis.
Bone lab studies
-serum calcium
-serum phosphorus
also thyroid, PTH, vitamin D
Cast
- a rigid, external immobilizing device
-only a dry cast has full strength. 24-72 hours
-immobilize a reduced fracture
-correct a deformity
Materials:
-plaster: exothermic reaction x 15 min, wet: dull gray color, dull on percussion, feels damp, smells musty; dry: white, shiny, resonance, odorless, firm
-fiberglass: hard, stiff, w or w/o water
Signs to report with a cast
persistent pain or swelling, changes in sensation, movement, skin color, or temperature, signs of infection or pressure areas.
Cast removal
Extremity will take 3 more months to recover to “normal.”
Volkmann’s Contracture
- upper extremity problem
- form of compartment syndrome that occurs in fingers and wrists.
- results from obstructed arterial blood flow to forearm & hand
- cannot extend fingers, decreased circulation, abnormal sensation
Compartment syndrome
Unrelieved pain = s/s of compartment syndrome
-lower extremities
Normal cast discomfort
-relieved with meds, elevation, ice, and rest
External Fixation Devices
- discomfort is usually minimal, and early mobility may be anticipated with these devices
- provide pin care
- patient teaching (neuro check, s/s infection, pin care)
Traction
Skin traction: Buck’s; can be interrupted
Skeletal traction: cannot be interrupted
Skin traction
- Buck’s extension traction; most common type; lower leg
- 5-8 pounds
- cervical head halter (neck pains)
- pelvic traction (treat back pain); 10-20 pounds
- takes 2 nurses to apply
Skeletal traction
- is continuous to immobilize and reduce fractures
- is never interrupted
- 15 - 25 pounds
Hip joint replacement
- place in abduction to prevent joint from dislocating
- drainage 200-500mL x 24 hrs then <30 mL q 8 hrs
- never flex more than 90 degrees use fx bedpan
Goals of orhto. surgery
- Improve function by restoring motion
2. Stability, relieve pain and disability
S/S of hip dislocation
- pain at surgical site, edema, immobilization
- acute groin pain in affected hip
- shortening of the leg
- abnormal rotation
- restricted or inability to move the leg
- pt reports popping sensation or sound
Acute low back pain
- proper body mechanic techniques
- relief of pain
Carpal Tunnel Syndrome
Entrapment neuropathy; median nerve is compressed
- Tinel’s Sign
- tingling, numbness, pain
Dupuytren’s Contracture
Deformity - slowly progressive
-usually causes flexion of 4/5 digit..sometimes 3rd as well.
S/S: dull,a ching, stiffness, numbness, cramping
Tx: rest
starts as nodule in palmar fascia.
Hallux Valgus
- bunion
- great toe deviates laterally
Morton’s Neuroma
Swelling 3rd branch of median plantar nerve
Tx: intersoles and metatarsal pads
Osteoperosis
- loss of total bone mass
- white, over 40, post menopausal
- increase Ca, Vit D, wt baring exercise
- fx common
- bones weak
Osteomalacia
- inadequate bone mineralization
- bowed legs, pathologic fractures
- low calcium, low phosphorus
tx: calcium - 3rd world countries
Paget’s Disease
-“hat doesn’t fit”
-Men more then women; 2-3%, over age 50
-also called osteitis deformans
-pt at risk for fx, arthritis, hearing loss
-cranial nerve compression and dysfunction
-waddling gait
-Incidious: happens gradually
Tx: nsaids, calcitonin, bisphosphonates, pilcamycin
Osteomyelitis
-infection of the bone
-open or closed fx
- caused 70-80% of time by s. aureus
-use preventive antibiotics
s/s: pain, edema, fever, redness, drainage, low grade fever (pm),
Bone Tumors
- osteogenic sarcoma: most common, often fatal
- monitor for hypercalcemia
Fat embolism
S/S: hypoxia, tachypnea, tachycardia, pyrexia.
Usually occur in men under age 40 with multiple fx.
Onset of s/s is usually rapid
S/S usually present 12/48 hours of injury
S/S may present up to 10 days after injury
Rotator cuff tear
S/S: pain, limited ROM, joint dysfunction, muscle weakness. Night pain, cannot sleep on torn side.
Ca++ requirements
9-19…..1300mg
20-50…..1000 mg
51+…..1200mg
Comminuted fx
produces many bone fragments…aka loose bodies
Complications of fx
- *avascular necrosis
- fat embolism
Aims of nursing
- to promote health
- to prevent illness
- to restore health
- to facilitate coping with disability or death
Nurses meet the aims of nursing by….
C.T.I.E.
cognitive, technical, interpersonal, and ethical/legal skills.
Nursing Process
A.D.P.I.E. assessment diagnosis planning implementation evaluation
Current trends in nursing
nursing shortage evidence-based practice community-based nursing decreased length of hospital stay aging population increase in chronic care conditions
culture
shared system of beliefs, values, behavioral expectations
culture assimilation (acculturation)
minorities living within a dominant group lose the characteristics that made them different.
ethnicity
identification with a collective group
race
specific characteristics
Caucasian, negroid, mongoloid
stages of illness behavior
experiencing symptoms
assuming the sick role
assuming a dependent role
achieving recovery and rehabilitation
Levels of preventive care
primary: diet, exercise, immunizations, seat belts, safe sex
secondary: screenings, pap, HIV test
tertiary: medications, surgery
Sources of knowledge
Traditional: passed down ex: bed making
Authoritative: from expert ex: F/E lecture
Scientific-arrived: scientific method ex: research
Reasoning
Deductive: general —> specific
Inductive: specific—> general
Goal of theoretical frameworks
- holistic patient care
- individualized care to meet needs of pts
- promotion of health
- prevention of treatment of illness
Common concepts in nursing theories
PERSON (pt)
environment
health
nursing
Four functions of ethics committees
education
policy making
case review
consultation
Types of law
public: gov’t directly involved
private: regulates relationships among people
criminal: state/federal criminal statues
Four sources of law
Constitutions
Statutes: nurse practice act
Administrative: Board of nursing
Common:
Standards
Two types:
- voluntary
- legal
Tort
wrong committed by a person against another person or his or her property
Defamation
oral –> slander
written –> liable
Four elements of liability
duty
breech of duty
causation
damages
Legal safeguards for nurses
- competent practice
- documentation
- pt record
Characteristics of the nursing process
systematic dynamic interpersonal outcome oriented universally applicable
Four phases of a nursing interview
preparatory phase
introduction
working phase
termination
Formulation of a nursing dx
Problem: identifies what is unhealthy (NANDA)
Etiology: factors maintaining the unhealthy state
Defining characteristics: “as manifested by”
Types of nursing diagnoses
actual risk possible wellness syndrome
Act of micturition
urination
Basic structure and function unit in the kidneys
nephrons
Fluid intake
2000-2400 mL per day
w/ fiber increase to 3000 mL per day
Post void residual
50 or less is normal
150 or more needs cath.
post operative void should be at least 30 mL per hour
illeal conduit
surgical diversion of ureters to ileum as opposed to the bladder
Types of enemas
Hypotonic: tap water
Isotonic: NaCl
Hypertonic: fleets
Post operative stool
Colostomy: stool in 2 to 5 days
Illeostomy: stool in 24 to 48 hours
Who was the 1st trained nurse in the U.S.?
Linda Richards
Who was the founder of modern nursing?
Florence Nightingale (19th century)
Who was the first African American nurse?
Mary Elizabeth Mahoney
Who founded the American Red Cross?
Clara Barton (1882)
What was the Benedictine Order?
The entry of men into nursing
What was the Goldmark Report?
Concluded that nursing education needed financial support.
What was the Lysaught Report?
Called for clarification of nursing roles and responsibilities.
Who was Harriet Tubman?
A nurse and an abolitionist; active in the Underground Railroad movement before joining the Union Army during the civil war.
Who was Lavinia Dock?
A nursing leader and women’s rights activist; instrumental in the constitutional amendment giving women the right to vote.
What 2 nurses opened up Henry Street Settlement?
Mary Burster & Lillian Wald
Which nurse is considered the founder of Public Health Nursing?
Lillian Wald
Who was the 1st professor of Nursing?
Mary Nutting
What are the 5 functions of the family?
physical economic reproductive affective and coping socialization
