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Fundamentals > Final(plus All Other Decks) > Flashcards

Final(plus All Other Decks) Flashcards

0
Q

Full liquid purpose

A

transition from clear to soft, short term low nutrients

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1
Q

Clear liquid purpose

A

Minimal digestion, short term not a lot of nutrients

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2
Q

Soft bland low fiber diet purpose

A

Decrease fiber for GI stress, can be long term unless calcium is limited

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3
Q

Criteria for diet progression

A

No N/V, eat 3/4 of current diet, no choking diarrhea or cramping

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4
Q

Barriers and risk factors for lifestyle change involving nutrition

A

Money, aspiration (secretions weakness diminished sensory), deficient knowledge

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5
Q

Nurse role as caregiver

A

Promote health, prevent illness, restore health, facilitate coping

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6
Q

Health is

A

More than just absence of disease

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7
Q

Illness is the ____ to a disease

A

Response of a person

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8
Q

Health belief model (3)

A

Individuals perception of susceptibility of an illness, individuals perception of the seriousness of the illness, and the individual’s perception of the benefits of an barriers to taking action

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9
Q

Health promotion should result in

A

Improving health, enhanced functional ability, better quality of life in all stages of development

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10
Q

Primary prevention

A

Precedes disease or dysfunction, health education programs, immunization

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11
Q

Secondary prevention

A

Focus on individuals who are expecting health problems, those at risk for developing complications, ex screenings

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13
Q

Tertiary prevention

A

Occurs when defect is permanent, minimize effects of long term disease, ex rehab pt surgical treatment

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14
Q

components of urinary system

A

kidneys, ureters, bladder, urethra

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15
Q

kidneys function

A

regulate fluids electrolytes and acid base balance, produces hormones that control RBC formation BP and vitamin D activation

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16
Q

glomerular filtration

A

when SBP t compensate and filtration stops

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17
Q

tubular reabsorption

A

tubules reabsorb >99% of all filtered water back into the body

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18
Q

Aldosterone

A

promotes Na reabsorption= water reabsorption

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19
Q

renin production

A

regulates BP

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20
Q

Erythropoietin

A

stimulates RBC production in bone marrow

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21
Q

Vitamin D activation

A

important for absorption of calcium in GI

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22
Q

function of ureters

A

peristaltic contractions of smooth muscle moves urine along

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23
Q

Rest

A

Condition where the body is in a decreased state of activity….leads to feeling refreshed

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24
Q

sleep

A

altered state of consciousness where the persons perception of and reaction to the environment are decreased. Complex rhythmic state involving a progression of repeated cycles……illness and hospitalization can interfere with ability to sleep

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25
Q

how does sleep restore body systems?

A

Preserves cardiac function, releases growth hormones, conserves energy-decreases metabolic rate, protein and synthesis and cell division

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26
Q

Purpose of sleep

A

restores body function, releases growth hormone, helps immune function, psychological restoration (memory, learning and cognitive)

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27
Q

RAS (reticular activating system)

A

located in brain steam. contains special cell that maintain alertness &wakefulness. wakefulness occurs when RSA receives visual, auditory, pain and tactile sensory stimuli

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28
Q

neurotransmitters involved in wake behavior

A

norepinephrine, dopamine, histamine and serotonin

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29
Q

sleep promoting neurotransmitters

A

melatonin, adenosine and growth hormone

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30
Q

circadian rhythms- biological clock

A

influenced by internal and external factors, regulate certain biologic and behavioral functions. one full cycle every 24 hrs

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31
Q

circadian synchronization

A

when persons sleep-wake cycle follows inner biologic clock….this does not happen when you work night shift

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32
Q

Stages of sleep

A

four stages of NREM( non rapid eye movement) which comprises 75% of sleep. and one stage of REM( rapid eye movement)

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33
Q

NREM stage 1

drowsiness

A

last 5-10 min, eyes move slowly under the eyelids, muscle activity slows down, involuntary muscle jerking can occur, easily awakened

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34
Q

NREM stage 2

light sleep

A

eye movement stop, HR slows, body temp decreases, relaxation progresses, can be awaken with touch or shaking

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35
Q

NREM stage 3

A

depth of sleep increases, arousal becomes difficult, composes 10% of sleep

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36
Q

NREM stage 4

A

arousal is difficult, blood flow decreases to the brain and redirects itself to the muscles, restoring physical energy. parasympathetic nervous system dominates( HR, BP, RR drop.) composes 10% of sleep.

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37
Q

REM sleep

dream sleep

A

constitutes 20-25% of nightly sleep. associated with processing emotions, retaining memories and relieving stress. essential for mental and emotional equilibrium. Breathing is rapid, irregular and shallow. HR, BP, RR, metabolic rate and temp increase!

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38
Q

sleep cycle

A

NREM 1-2-3-4-3-2-REM-2-3-4-3-2-REM. Usually repeated 4-5 times a night. each cycle lasts 90-100 mins. if awaken at anytime the person returns to stage 1 on NREM

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39
Q

Factors affecting sleep

A

developmental considerations, motivation, culture( rituals, co-bedding) lifestyle and habits( shift work, stressors) Physical activity( increases REM and NREM sleep) Dietary habits( alcohol, caffeine, and smoking are stimuli’s) environment, psychological stress, illness, medications.

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40
Q

developmental considerations….how much sleep does everyone need?!?!?

A 
infant- 20hrs
toddler( 1-4 yr) -12hr, two naps
school age (5-12 yr) -10-11
adolescent (teenager) 9-10 hr 
young adult and older adult- 7-8 hr
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41
Q

dyssomnias

A

sleep disorders characterized by insomnia or excessive sleepiness

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42
Q

parasomnias

A

patterns of waking behaviors that appear during sleep

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43
Q

Insomnia- dyssomnias

A

difficulty falling asleep, intermittent sleep or early awakening. Most common of all sleep disorders. common in people > 60, women after menopause, and people with a history of depression.

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44
Q

transient insomnia

A

occur due to situational stress…. like before a wedding

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45
Q

sleep hygiene, treatment for chronic insomnia

A

restrict caffeine, nicotine, alcohol. Avoid stimulating activities after 5 pm. Avoid naps, eat light before bed, sleep in cool dark room and take a warm bath.

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46
Q

stimulus control, treatment for chronic insomnia

A

use bedroom for sex and sleep only, get out of bed if unable to fall asleep after 15-30 mins, get up at the same time every day no matter what time you fall asleep at night.

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47
Q

relaxation, treatment for chronic insomnia

A

progressive muscle relaxation, imagery, medication

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48
Q

Narcolepsy-Dyssomnia

A

uncontrollable desire to sleep, caused from lack of hypocretin, REM sleep occurs in 15 mins, sudden onset “sleep attack”.
Tx- stimulant drugs, brief daytime naps

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49
Q

Obstructive sleep apnea- Dyssomnia

A

condition in which a person experiences apnea or diminished breathing efforts during sleep. apnea may last 10-20 seconds, up to 2 mins. Oxygen levels drop, pulse becomes irregular, BP increases.

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50
Q

Obstructive sleep apnea-risk factors, cause, treatment

A

Risk factors-obesity, males and old age. Airway is occluded from the collapsing of the hypopharynx or other structural abnormalities. OSA can lead to cardiovascular problems, death occurs in 38,000 Americans. Treatment-remove tonsils, wearing and oral appliance, CPAP(continuous positive airway pressure)

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51
Q

Restless leg syndrome-dyssomina

A 
feeling of creeping, crawling or tingling sensations in the legs.  Treatment- leg massage, heat/cold and medications. 
U-urge to move legs
R-rest induces
G-gets better with activity 
E-evening symptoms are more severe
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52
Q

sleep deprivation- dyssomina

A

decrease in amount, consistency and quality of sleep. decreased REM & NREM. can cause irritability, loos of concentration to total disintegration of personality. Effect apparent after 30 hrs of wakefulness

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53
Q

Parasomnias

A

waking behaviors that appear during sleep. somnambulism- sleep walking, sleep talking, night terrors, bruxism- grinding of teeth. MAJOR CONCERN-safety. common in children but they usually outgrow it by adulthood.

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54
Q

role

A

specific task, action or function specific to one’s position

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55
Q

social role

A

set of rights, duties, expectations, norms and behaviors Examples- wife mother daughter, student teacher, nurse patient

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56
Q

role norms

A

when people approve of a social role, they will conform to role norms. anticipation of rewards/ punishments and satisfaction of behaving in a pro-social way makes people conform to a role

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57
Q

nurse aide role

A

functions under supervision of licensed nurses. care given is related to hygiene, comfort, exercise, safety and elimination needs

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58
Q

LPN role

A

provide nursing care and health promotion under direction of the RN, physician or dentist. technical college of at least one year of full time study. take the NCLEX-PN

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59
Q

Associate degree nursing

A

through university, college and community colleges. requires 2 years of full study time

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60
Q

bachelors of science degree in nursing

A

through colleges and universities, requires four years of study, half year of general education.

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61
Q

Masters of science degree in nursing

A

concentrated study such as administration, education, nurse practitioners ( peds, family, gerontology, midwife, ect…)

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62
Q

Melatonin

A

Natural chemical released from the brain at night, decreases wakefulness, promotes sleep

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63
Q

Function of the bladder

A

Temporary storage of urine, adults can hold 200-300 cc (children 100-200cc) before feeling the urge to void, can expand to 4 L of fluid

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64
Q

Urethra

A

Tubelike structure that carries urine from the bladder to exit the body, men:6-8 inches long, women: 1.5-2.5 inches long, function is for elimination and reproduction

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65
Q

The ____ void of the day is the most concentrated

A

First

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66
Q

Incontinence

A

Involuntary release of urine, causes are damage to spinal cord stress on renal system or poor muscle control

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67
Q

Urinary Retention

A

When urine is not excreted properly but is produced normally, bladder not responding to micturition reflex

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68
Q

Nocturia

A

Night urination

69
Q

Polyuria

A

Large amounts of urine

70
Q

Anuria

A

No urine

71
Q

Oliguria

A

Little amount of urine

72
Q

Diuresis

A

Excessive urine from Meds

73
Q

How much urine output for an hour should equal

A

weight in Kg

74
Q

Older age affecting urination

A

Decreased ability to concentrate urine (leads to Nocturia) decrease muscle tone(leads to decrease capacity to hold urin) decreased contractility (leads to urine retention, UTIs)

75
Q

Alcohol and caffeine have

A

Diuretic effect, increase urine production

76
Q

High sodium food and drink

A

Decrease urine production

77
Q

Urinary tract infections

A

Common cause of HAIs in the US, women are more susceptible

78
Q

Lower urinary tract infections

A

Cystitis- inflammation of the bladder, urethritis-inflammation of the urethra, 90% from E. Coli

79
Q

Lower urinary tract infections signs and symptoms

A

Normal: Fever, chills, not feeling relieved after urination, burning
In elderly: confused, increased falls, sudden incontinence, trachycardia, trachypnea, hypotension

80
Q

Diagnosis of UTI

A

Bacteria WBC RBC, identified organism and effective antibiotic

81
Q

Treatment of a UTI

A

Increase fluids to 2-3L, (cranberry juice 300cc a day for 3-4 weeks), pain: analgesics

82
Q

Continence

A

Control over the time and place of urination, usually between ages 2-5

83
Q

Stress incontinence

A

Involuntary loss of urine with abdominal pressure (cough sneeze exercise) usually only small amounts of urine are lost

84
Q

Urge incontinence

A

Strong desire to urinate, can’t suppress signal from the bladder to the brain, may have loss of large amount of urine

85
Q

Overflow incontinence

A

Loss of urine associated with an over distended bladder, side effect of med enlarged prostate or urinary retention, causes constant dribbling of urine

86
Q

Functional incontinence

A

Loss of urine caused by something other than disease (loss of cognitive function, Meds, restraints)

87
Q

Treatments for incontinence

A

Medicines (anticholinergics, antispasmodics: ditropan), kegel exercises, post void residuals (PVRs), surgical (elevates urethral position or supports the bladder neck)

88
Q

ILeal conduit/ urinary diversion

A

Ureters transplanted to an isolated section of the small intestine (small portion of small intestine brought through surface of abdomen resulting in a stoma)

89
Q

Continent urostomy– kock ileal reservoir

A

Pronounced “coke”, uses section of the intestine to create a pouch which will hold the urine, client will need to catheterize the stoma to drain urine

90
Q

Serum creatinine

A

Main indicator of kidney problem, blood test with normal range of 0.5- 1.2 mg/dl, measures end product of muscle and protein metabolism, 50% renal function can be lost before it shows in level

91
Q

Blood urea nitrogen (BUN)

A

Normal range from 10-20 mg/dl, measures renal excretion of urea nitrogen, increase may be from liver or kidney disease dehydration infection, decrease may be from malnutrition fluid volume excess severe liver damage

92
Q

Normal range for serum creatinine, BUN, and specific gravity

A

0.5-1.2 mg/dl, 10-20 mg/dl, 1.005- 1.035

93
Q

Specific gravity

A

Normal range is 1.005- 1.035, measures concentration of urine, increase may be from dehydration decreased kidney perfusion, decrease may be from over hydration diuretic Meds or diabetes

94
Q

There should be no _____ (5) in urine

A

Blood (except with uti trauma disease) glucose (except with diabetes) ketones (except with diabetes) protein or sediment

95
Q

Ph of urine normal range

A

4.6-8

96
Q

Length of catheter insertion

A

Male 8 inches female 2 inches

97
Q

Indwelling urethral catheter

A

Foley catheter

98
Q

Intermittent urethral catheters

A

Straight catheter

99
Q

Suprapubic catheter

A

For long term management of urinary incontinence

100
Q

How to prevent infection in catheter clients

A

Hang bag on bed frame, keep bag lower than bladder, assess tube for kinks, strict aseptic technique per protocol, and proper catheter care

101
Q

ages for young- old, middle-old, and old-old

A

60-74, 75-84, 85 and up

102
Q

current life expectancy

A

78.7

103
Q

genetic theory of aging

A

“genetic clocks” determine the occurrence and rate of metabolic processes

104
Q

wear and tear theory of aging

A

organisms wear out from increased metabolic functioning, cells become exhausted from continual energy depletion

105
Q

immunity theory of aging

A

decline in the function of the immune system, thymus loses size and function, leads to increased infections immune disorders and cancer

106
Q

cross linkage theory of aging

A

chemical reaction that produces damage to the DNA and cell death, accumulates with age which interferes with cell function

107
Q

Free radical theory of aging

A

free radicals (molecules with separated high energy electrons) have adverse effects on adjacent molecules , over time irreversible damage results from the accumulated effects of this damage

108
Q

Ageism

A

prejudice of the elderly, view that older people are ‘different’ and don’t have the same needs or desires, also view they have ‘outlived their usefulness’ and ‘are childlike, unable to learn new things, or too old for sex’

109
Q

chronic illness ___ have at least one ____ have at least two

A

80% and 60%

110
Q

physical changes to integumentary system with age

A

diminished subcutaneous tissue, loss of collagen, wounds heal slow, sweat and sebaceous glands decrease in number and function, dermis thins and flattens, fewer melanocytes= pale

111
Q

senile lentigo

A

common skin lesion, smooth brown irregular shape

112
Q

cherry angiomas

A

common skin lesion, small round red or brown spots on truck

113
Q

keratoses

A

common skin lesion, raised thickened pigmentation scaly and crusty

114
Q

hair with aging

A

men: balding is common, women: thinning occurs more facial hair, both: lose pigmentation (graying) ear and nose hair thicken

115
Q

nails with aging

A

grow more slowly, become more brittle and yellow

116
Q

changes to the musculoskeletal system with aging

A

mobility slows, muscle mass and strength decrease, bone demineralization, joints stiffen, narrowed vertebral spaces (loss of height), kyphosis (curving of spine)

117
Q

falls in the elderly

A

1 out of 3 fall each year, primary cause for accidental death, results in injuries, leads to increased hospital costs, loss of independence

118
Q

common causes for falls

A

accident (fall from bed), gait disturbance (arthritis), vertigo, polypharmacy, acute illness, confusion and cognitive impairment, orthostatic hypotension, visual disorders

119
Q

Physical changes to the nervous system with aging

A

CNS responds more slowly to multiple stimuli, slower responses (especially in unfamiliar settings), decreased reflex response

120
Q

Short term memory _____ with age

A

Decreases

121
Q

Long term memory with aging

A

Remains intact, temperature regulation and pain/ pressure perception become less efficient

122
Q

Sleeping patterns with aging

A

Sleep at night shortens, increase night awakenings, more naps, decrease sleep in stages 3 & 4

123
Q

Cardiac changes with age

A

Loss of elasticity in blood vessels (increased BP), fatty plaque deposits continue to occur in blood vessels, venous return less efficient, cardiac output decreases (HR increases with stress exercise an illness and takes longer to return to baseline)

124
Q

Pulmonary changes with age

A

Lungs become smaller, decreased effectiveness of cilia, lack of basilar inflation (decreased lung sounds in bases), ribs less mobile, decreased exchange of o2 and co2

125
Q

GI changes with aging

A

Teeth poor condition, many wear dentures, decreased saliva, dry mucus membranes, decreased esophageal mobility, decreased gastric secretions and nutrient absorption, decreased gastric mobility and peristalsis

126
Q

Changes to genitourinary with aging

A

Decrease blood flow to kidneys, functioning nephrons and bladder capacity decrease by 50%, waste is filtered and excreted more slowly, voiding is more frequent, decreased bladder and sphincter control

127
Q

Male specific changes in genitourinary with aging

A

Enlarged prostate (benign prostatic hypertrophy BPH), bladder contractions dribbling retention hesitancy and Nocturia

128
Q

Presbyopia

A

Inability to focus or accommodate properly due to decreased elasticity of lens, often need corrective lenses to see close up or detailed work

129
Q

Prebycusis

A

Gradual sensorineural loss caused by nerve degeneration in the inner ear, loss of high frequency sounds, difficulty hearing s sh and ch

130
Q

Eriksons theory

A

Begins around age 60, ego integrity vs despair, begin to reflect on life and search for meaning, search for acceptance of the past and present w/o the fear of death

131
Q

Ego integrity

A

Use life review or reminiscence (tell stories of the past) looks back on life with pride and without regret, looks forward with optimism and enthusiasm

132
Q

Despair

A

Has regrets about the past, sees current problems as insurmountable, view life as a series of unresolved problems and missed opportunities, may feel worthless or helpless

133
Q

What is loss

A

A situation in which something of value is changed or no longer present

134
Q

Actual loss

A

Others can see/ feel this loss

135
Q

Perceived loss

A

Felt by the individual

136
Q

Maturational loss

A

Results from the developmental process (puberty or aging)

137
Q

Situational loss

A

Loss from a life changing (illness death job loss)

138
Q

Anticipatory loss

A

Occurs before actual loss happens (may ease actual loss)

139
Q

Grief

A

Response to the experience related to loss

140
Q

Bereavement

A

Subjective, experienced by surviving loved ones

141
Q

Mourning

A

behavior associated with grief, aides in altering or resolving grief

142
Q

Normal/ uncomplicated grief response

A

Not prolonged may be abbreviated, less than 6 months

143
Q

Complicated grief response

A

Considered unhealthy last longer than 6 months may never accept the loss

144
Q

Elisabeth Kubler Ross

A

Studied grief process and stages of grief, said no 2 people grieve the same, stages may overlap or not happen, may never reach acceptance

145
Q

Stages of grief

A

Denial, anger, bargaining (with higher power), depression, acceptance (not everyone gets here)

146
Q

Definitions of death

A

1) Exhibiting irreversible cessation or RR Apical pulse and BP also called heart lung death
2) exhibited irreversible loss of brain function called cerebral or higher brain death

147
Q

Palliative care

A

Approach that improves quality of life of clients and their families facing the problem associated with life threatening illness, provides holistic care, focus is quality of life and management of symptoms

148
Q

Hospice care

A

Aiding patient and family when death appears imminent, may be final stage of palliative care, less than 6 months to live, focus on symptom management and bereavement services

149
Q

Advanced directives (definition and two types)

A

Allows patient to state in advance of illness their specific wishes, types: living will (gives healthcare providers direction regarding care) durable power of attorney (allows an appointed person to make healthcare decisions in the event the patient is unable to do so)

150
Q

DNR/ no code

A

must be an order in pt record, no resuscitation will be attempted once order is in, comfort measures only, can be a DNR with exceptions

151
Q

signs of impending death

A

inability to swallow, pitting edema, decrease GI and urinary function, incontinence, loss of mobility/sensation, elevated temp, decreased BP and HR, noisy irregular RR, may loss consciousness

152
Q

postmortem care for the patient

A

physician must pronounce death, must follow facility policy, know any cultural or religious factors, prepare body for the release from the facility (supine position, remove tubes, clean body, cover appropriately, place proper ID tags),know if organ donor, autopsy may be preformed(decided by coroner physician or family)

153
Q

postmortem care for the family

A

listen to them, honor their grief, determine if they would like to see loved one, offer spiritual care, nurse may also need to comfort other patients that realize a death has happened, need to make sure death certificate is signed by appropriate staff

154
Q

Stages of competence

A

Novice(student), Advance beginner (1st year of practice), competent (2-3 years of practice), proficient (4 years), the expert (5 +years)

155
Q

role as a care provider

A

traditional most essential role, provides direct care and client comfort, shows sensitivity and concerns for the client

156
Q

role as a teacher

A

provides information and helps client to have knowledge and skills, promotes healthy lifestyle, need to know physiological processes pharmacology and nutrition, also need the ability to communicate effectively with pt

157
Q

role as a counselor

A

provide emotional intellectual and psychological support, helps client to cope, encourage alternative behaviors recognize choices and develop sense of control, need to be aware of own beliefs and how to conceal them and how to appropriately interact with each level

158
Q

role as change agent

A

assist client to make changes to improve health, need the ability to motivate guide and teach

159
Q

role as client advocate

A

acts on behalf of the client to bring about change, promotes what is best for the client, protects clients rights wishes and supports their decisions, needs professional communication skills

160
Q

role as research consumer

A

engages in evidence-based practice, identifies significant researchable problems and participates in research activities

161
Q

role as a manager

A

plans and directs care, coordinates activities, needs the skill of delegation and ability to assess health systems implement changes and evaluate outcomes

162
Q

classic leadership theory

A

autocratic (my way is the only way), democratic (lets vote), laissez- faire (do whatever), Bureaucratic (control, focus on procedure), situational

163
Q

contemporary leadership theory

A

charismatic, transactional (focus on supervision and group performance), transformational (teaching and mentoring), shared, delegation

164
Q

delegation regulations

A

nurse is still responsible to make sure the task is complete, must know who can do the tasks, cannot delegate tasks of the nursing process (assessment and evaluation)

165
Q

five rights of delegation

A

task (caregiver is trained and competent), circumstance (appropriate setting resources and supplies), person (best person for client), direction/communication (clear concise), supervision (appropriate monitoring evaluations intervention and feedback)

166
Q

RN only duties

A

tasks involving nursing judgment, assessing pt’s response to care, interventions that require independent nursing knowledge or skill

167
Q

do NOT delegate to LPN

A

hang IV meds (certain states), IVBP or IVP (certain states), plan of care (may be checked by RN), unstable pt, transcribe orders, take verbal orders from MD, assessments, develop or preform initial teaching, 1st of anything, check advanced directives, complete discharge teaching

168
Q

do NOT delegate to Nurse Aide

A

Charting, treatments (except soap suds), Medications (except OTC topical), Assessments (except VS and Blood sugar), interpretation of data, nursing care plan, care of invasive lines, client education, MAY do ADLs

Fundamentals (4 decks)

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