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PNUR 2101 CONCEPTS > FINAL (SHAWNA) > Flashcards

FINAL (SHAWNA) Flashcards

1
Q

4 basic elements of mobility

A

Body alignment
Joint mobility (ROM)
Balance
Coordination

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2
Q

What does ROM refer to? What is it varied by?

A

Maximum movement possible for joint

Active or Passive

Age, activity level, genetic can impact

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3
Q

What is Active ROM

A

done first as it’s less intrusive​

Uses patients own strength to create the movements through the joints​

Ask the patient to slowly move each joint through it’s full ROM (flexion, extension, etc.)​

Tell patient to stop the movement and tell you if they experience any pain​

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4
Q

What is Passive ROM

A

more intrusive as you manipulate the person’s joints for them​

Tell the patient to relax and then support the joint and move it through its range of motion.​

Observe and compare each side of the body for symmetry, pain, inflammation or stiffness​

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5
Q

Factors that impair mobility? (8)

A

Congenital or acquired postural abnormalities eg. scoliosis​

Damage to the CNS as it regulates voluntary movement​

Impaired muscle development eg. MS ​

Direct trauma to the musculoskeletal system eg. fracture​

Inflammatory diseases eg. Rheumatoid Arthritis​

Bed rest or reduced activity tolerance​

Pain​

Medications​

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6
Q

Rheumatoid Arthritis overview

A

Chronic, inflammatory disease

Primarily impacts synovial membrane but can impact organs ex. lung

Cause is unknown

Symptoms are related to inflammation
- Objective: heat
- Subjective: pain

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7
Q

Osteoarthritis overview

A

Chronic degenerative joint disease

Risk factors: older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.

Symptoms: pain that worsens with activity, joint stiffness and loss of function, decreased ROM

Signs: limited joint motion

encourage weight bearing exercises, increase vitamin C & D

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8
Q

Osteoporosis Overview

A

“Brittle bones” Decreased density of bones and deterioration of bone tissue, leading to bone fragility and increased risk for fractures ​​

Commonly seen in hip, wrist and spine​

Risk Factors: ​
Gender- female​
Age (65+)​
Post-menopausal (early menopause) ​
Ethnicity- Caucasian, Asian​
History of fractures (from minor falls/injuries)​
Family history​
Bone structure/body weight- thin, “small boned”​
Smoking​
Alcohol abuse​
​
Health Promotion/Prevention​
Diet, exercise​
Fall prevention​

​

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9
Q

What can immobility cause?

A

Stiffness and pain in the joints ​

Cardiovascular changes e.g. orthostatic hypotension​

Metabolic changes e.g. loss of calcium, constipation​

Respiratory complications e.g. atelectasis, pneumonia​

Urinary changes eg. increased risk for urinary stasis or renal calculi​

Poor hygiene r/t immobility can lead to skin breakdown, and sustained pressure on joints can lead to pressure ulcers​

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10
Q

Components of Hair Assessment

A

Uniformity/thickness​

Color​

Amount of hair (alopecia)​

Body hair (lanugo)​

Texture (oily/dry)​

Scalp is free of lesions ​

Parasites (lice etc.)​

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11
Q

Components of Nail Assessment

A

Texture- smooth, thick/thin​

Color- capillary refill, cyanosis​

Cleanliness​

Length eg. nail biting​

Shape & curvature

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12
Q

Wound assessment and documentation

A

Size, shape and texture​

Colour​

Location/Distribution​

Surrounding skin​

Elevation ​

Exudate/discharge​

Odour​

Measure height, width and depth​

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13
Q

Skin Assessment Methods (2) - Objective

A

Inspection
- Colour
- Edema
- Bruising
- Markings
- Irritation

Palpation
- Temperature
- Moisture
- Turgor
- Edema
- Texture

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14
Q

What does S.M.A.R.T goals stand for?

A

Specific, Measurable, Attainable, Realistic, Timely

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15
Q

Overview of medication administration?

A

preparing, giving, and evaluating the effectiveness of prescription and non-prescription drugs

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16
Q

What are the 7 rights of medication administration?

A
  1. right med
  2. right pt
  3. right dose
  4. right time
  5. right route
  6. right reason
  7. right documentation
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17
Q

Some practice setting have 10 rights. What are the additional 3?

A
  1. right to refuse
  2. right pt education
  3. right evaluation
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18
Q

What is pharmacology and why does the RPN have to be familiar with it?

A
  • pharmacology: the study or science of drugs
  • the RPN needs to know this so they can understand how each drug will affect the pt
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19
Q

What are the 3 names a medication might be known as?

A
  1. generic name: name given by the developer of the medication/official name (ex; ibuprofen)
  2. trade name: brand name, given by the manufacturer and can vary in diff countries (ex; advil)
  3. chemical name: describes the med’s molecular structure
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20
Q

What is drug classification? (2)

A

the desired effect on the body system

the type of drug it is

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21
Q

What do medication forms tell you?

A

indicates route

must ensure correct form is used as this affects absorption and metabolization

ex; tablet, ointment, suppository

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22
Q

What are pharmacodynamics?

A

the study of what the drug does to the body

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23
Q

What is the therapeutic effect? (pharmacodynamics)

A
  • intended or expected effect on the body
  • ex; tylenol will relieve a headache
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24
Q

What is a side effect? (pharmacodynamics)

A
  • unintended secondary effects
  • ex; morphine may cause a rash
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25
Q

What are toxic effects? (pharmacodynamics)

A
  • an accumulation of meds in the body to the point where it is poisonous
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26
Q

What is a contraindication? (pharmacodynamics)

A
  • any characteristic of the pt that makes the use of the med dangerous
  • ex; pregnancy, other meds
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27
Q

What is pharmaceutics?

A
  • how various med forms/routes influence the way the body metabolizes a drug and the way the drug effects the body
  • ex; oral, sublingual, inhalation etc
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28
Q

What is pharmacokinetics?

A
  • how the medication moves into, through, and out of the body
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29
Q

What is absorption? (pharmacokinetics)

A

the movement of a drug from its site of administration into the blood

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30
Q

What is distribution? (pharmacokinetics)

A

transport of a drug in the body by bloodstream to its site of action

31
Q

What is metabolism? (pharmacokinetics)

A

the biological transformation or metabolic breakdown of a drug in the body (most commonly done in the liver)

32
Q

What is excretion? (pharmacokinetics)

A
  • the elimination of drugs from the body
  • kidneys are the primary way
  • bowel and liver are responsible to a lesser extent
33
Q

What is parenteral admin? (pharmacokinetics)

A
  • IV
  • IM
  • subcutaneous (SC)
34
Q

What is inhalation admin? (pharmacokinetics)

A
  • nebulizers
  • nasal sprays
35
Q

What is transmucosal admin? (pharmacokinetics)

A

sublingual

36
Q

What is gastroenteral admin? (pharmacokinetics)

A
  • PO
  • suppositories
37
Q

Transdermal/topical admin (pharmacokinetics)

A
  • patches
  • creams
  • ointments
38
Q

What is onset of action? (pharmacokinetics)

A
  • time is takes for the drug to elicit a therapeutic response
39
Q

What is peak effect? (pharmacokinetics)

A
  • time needed for a drug to reach it’s maximum therapeutic response
40
Q

What is duration of action? (pharmacokinetics)

A
  • length of time that the concentration is sufficient to elicit a therapeutic response
  • time it lasts before it wears off
41
Q

What is a half life? (pharmacokinetics)

A
  • the time it takes for one half of the drug to be eliminated from the body
42
Q

What is a drug schedule?

A
  • determined by Health Canada
  • whether or not a drug requires a prescription; regulates access
  • based on its medicinal ingredients and puts the drug on the Prescription Drug List
  • schedule I, IA, II, III, IV must be sold from pharmacies
43
Q

What is a schedule I drug?

A
  • need a prescription
  • ex; amoxicillin, sertraline
44
Q

What is a schedule IA drug?

A
  • abuse potential, requires triplicate/duplicate prescription in order to sell for tracking and forgery purposes
  • ex; Tylenol #3, (30 mg codeine) fentanyl
45
Q

What is a schedule II drug?

A
  • no prescription req but pharmacist supervises sale
  • ex; Tylenol #1 (8 mg codeine)
46
Q

What is a schedule III drug?

A
  • drugs that can be sold without a prescription (locked after closure, if no pharmacist on duty, cannot sell)
  • hydrocortisone topical cream
47
Q

What is a schedule IV drug?

A

prescription by pharmacist

48
Q

What is a unscheduled drug?

A
  • no restriction, can be sold anywhere
  • ex; Tylenol, Tums
49
Q

Natural health product advantages:

A

adjunct therapy to support conventional pharmaceutical therapies

50
Q

Natural health product disadvantages:

A
  • drug-drug interactions
  • allergic reactions
  • adverse side effects
  • people believe they are safe
51
Q

Common OTC meds:

A
  • NSAIDS: ASA, ibuprofen
  • Non-opioid analgesics: acetaminophen
  • Anti-emetics: dimenhydrate
  • Antihistamines: diphenhydramine
  • natural health products (NHPs)
52
Q

Nursing process: assessment (med admin)

A
  • gather comprehensive medication profile including:
  • all meds pt takes on regular basis
  • hx of allergies
  • use of OTC and NHPs
  • intake of alcohol, tobacco, caffeine
  • illicit drug use
53
Q

Nursing process: dx (med admin)

A
  • developed from assessment data through critical thought
  • nursing dx r/t medication therapy:
  • variance in knowledge base
  • variance in protection
  • variance in health beliefs
54
Q

Nursing process: planning (med admin)

A
  • goals are pt focused
  • they include a time frame
55
Q

Nursing process: interventions (med admin)

A
  • interventions are based on evidence-based practice
  • interventions are done as independent nursing functions or collaborative interdisciplinary care
  • nurse to discuss with pt the risks of not taking meds as prescribed
  • have pharmacist discuss side effect profile
  • provide education on long term consequences stopping
56
Q

Nursing process: evaluation (med admin)

A
  • include monitoring whether or not the pt goal has been met or not
  • includes observing for therapeutic effect, adverse effects, toxicity of a medication
  • if the goal is not met then nursing care plan will need to be revised
57
Q

Administering medication overview:

A
  • read the DRs orders and check it against the MAR
  • DRs order are transcribed onto the MAR by either the nurse or a unit clerk
  • contact the doctor the pharmacy to clarify any unclear or questionable orders prior to adminstering
  • never leave poured medications unattended
  • plan your time wisely so that the medication is giving within 30 mins of the ordered time
  • don’t let yourself multi task or be distracted while pouring or admin meds
  • provide adjuctive interventions as indicated
  • ensure 3 med checks
  • dientify client by name and check write band against MAR
  • inform the client about what medication you’re giving listen to them if they express a concern
  • don’t forget to ask about allergies
  • admin drug
  • record drug admin on MAR
  • evaluate and document the client’s response to drug
58
Q

when and how many safety checks are there?

A

Before taking out med
During pouring out med
After med is poured
3 checks

59
Q

Patient medication adherance:

A
  • have you ever stopped taking a prescribed medication? why did you stop?
  • when pts stop their medication we need to be curious open to their reasons
60
Q

What do regulatory bodies do?

A
  • protect the public
  • grant your license
61
Q

Regulation: (5)

A
  1. registration
  2. educational programs
  3. enforce/regulate/monitor standards of practice
  4. inquiry + discipline
  5. try to promote interprofessional collaboration
62
Q

Who protects the nurses?

A
  • BCCNM
  • BC nurses union
63
Q

What is involve in the duty to report:

A
  • if you have knowledge of a nurse who is incompetent or impaired, you have a duty to report
  • ex; drug use, sexual relations, untx MH conditions
64
Q

What are the 4 main documents of the BCCNM?

A
  1. code of ethics
  2. scope of practice
  3. professional standards: broad; how you shld behave as a professional
  4. standards of practice: narrower; baseline req. for specific actions; documentation, duty to report, indigenous safety, etc.
65
Q

Scope of practice triangle:

A
  • bottom: Health Practitioner’s Act (HPA)
  • bottom middle: standards, limits, conditions
  • top middle: employer, health authority
  • top: RPN; individual competence
66
Q

What is considered documentation?

A
  • any written or electronically generated information about a client that describes the care or service provided to that client
  • a nursing action that produces a written account of pertinent pt data, nursing clinical decisions and interventions, and pt responses in a health record
67
Q

Key purposes of documentation: 3

A
  1. communication
  2. safe and appropriate nursing care
  3. professional and legal standards
68
Q

BCCNM professional standards: documentation
Standard 2, #7, #8

A
  • Standard 2: competent, evidence- informed practice
  • # 7: documents the application of the clinical decision-making process in a responsible, accountable, and ethical manner
  • # 8: applies documentation principles to ensure effective written/electronic communication
69
Q

Legal issues of documentation:

A
  • client’s record is a permanent, legal document
  • may be req. to provide evidence in court and/or coroner’s inquests
  • must clearly document all nursing care given, that care decisions were based on assessment, and that the nurse cont. to monitor, document, and report pt responses
  • in court: care not documented = care not given
  • FOIPPA
70
Q

Ethical issues of documentation:

A
  • RPN code of ethics:
  • # 8: protects the confidentiality of all info gathered in the context of the professional relationship
  • # 9: practices within relevant legislation that governs privacy, access, use
71
Q

Ways to Keeping records confidential:

A
  • use computer passwords, log out when finished
  • be mindful of screens and papers and that they are not viewable
  • be aware of agency policies re: documenting sensitive info
  • ensure all written documentation is secured
  • it is up to the RPN to safeguard the privacy, security, and confidentiality of health records
72
Q

Common principles of documentation

A
  • Only use agency-approved abbreviations
  • Never use pencil, only dark blue or black ink
  • Document ASAP in chronological order, not prior to giving care
  • Follow proper protocol for errors, no erasing or white out is permitted
  • Documentation must be clear, concise, factual, objective, timely and legible
  • RPN’s must add their signature and designation in a clear, legible manner (F. Nightingale DCSPsycN)
73
Q

What do we chart?

A
  • status and health concerns of the client (assessment data)
  • changes in status
  • nursing care, interventions
  • advocacy by nurse on behalf of thee client
  • client responses and effectiveness of the care provided
  • effectiveness of meds and PRN meds
74
Q

Problem-oriented/charting by exception:

A
  • DARP, SOAP(IE)
  • focusing on documenting only deviations from the norm, narrative format

PNUR 2101 CONCEPTS (4 decks)

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