Foundations Exam Four Flashcards
A person who lives as a member of a gender other than expected based on sex or gender assigned at birth;
Transgender
An identity label sometimes adopted by male-to-female trans people to signify that they are women while still affirming their transgender history
Trans Women
An identity label sometimes adopted by female-to-male trans people to signify that they are men while still affirming their transgender history
Trans Man
A political statement, as well as sexual orientation, which advocates breaking binary thinking and seeing both sexual orientation and gender identity as potentially fluid. The term is a simple label to explain a complex set of sexual behaviors and desires
Queer
An individual who is unsure of and/or exploring their gender identity and/or sexual orientation
Questioning
A set of medical conditions that feature congenital anomaly of the reproductive and sexual system. Born with sex chromosomes or external genitalia that are not considered standard for either male or female
Intersex
An attraction to people regardless of their gender; may be attracted to their own gender as well as other genders
Pansexual
Prejudice against individuals and groups who display non-heterosexual behaviors or identities, combined with the majority power to impose such prejudice; usually used to the advantage of the group in power.
Heterosexism
Someone who feels comfortable with the gender identity assigned to them based on their sex assigned at birth
Cisgender
Gender identity not exclusively male or female
Nonbinary
Examples of hormone therapy as medical intervention
Estrogen
Testosterone
Gonadotropin-Releasing hormones (block puberty)
Suprellin implant (block puberty)
Normal Cognitive Functions
Perception
Consciousness
Thought
Memory
3 things required for perception to occur?
- A functionary sensory system
- Neurotransmission: receive a stimuli and then a neural impulse is sent to the brain to be interpreted
- Processing
Three types of sensory receptors?
- Exteroceptors
- Proprioceptors
- Interoceptors
The sensory receptor responding to stimuli from external environment (vision, hearing, pain, and somatic receptors)
Exteroceptor
The sensory receptor related to body’s physical state, position, and sensation of movement (inner ear, muscles, tendons, and joints)
Proprioceptor
The sensory receptor related to change in internal environment (blood pressure, O2 level, viscera and deep tissues)
Interoceptor
Consciousness
State of awareness and responsiveness
Orientation
Person, place, time, situation
Judgement
Insight - process of reasoning (determine the stimuli’s meaning)
Memory
Ability to store and recall
Comprehension
One’s ability to understand
Life span considerations
Newborn - Infant for
Cognitive Processes
Sensorimotor
Language not developed
Life span considerations
Toddler - Preschool
Cognitive Processes
Object permanence
Verbal language and reasoning develop
Egocentric view
Concrete thinking
Life span considerations
School-age to Adolescent
Cognitive Processes
School-age develops abstract thinking
Adolescents being to perform complex mental processes
Life span considerations
Adult-older adult
Rational thinking
Increased age - higher likelihood of neurological problems
Cognitive impairments are not considered a normal sign of aging
Factors affecting cognitive function
Oxygenation/circulation Nutrition Fluid and electrolyte balance Medications Medical Enviornment
What percentage of oxygen is required for brain functioning?
20%
What is the most vital factor affecting cognitive function?
Oxygen to the brain
What step comes first in CPR?
Circulation - so you can have perfusion of oxygen
What percent of glucose is used by the brain?
25% of glucose
What mineral is needed for hemoglobin?
Iron
What electrolyte has the biggest influence on water?
Sodium
What do you use to remove excess ammonia?
Lactulose –> poop out extra ammonia
- Binds with the ammonia n the blood leading to loose bowel movements
Which medications act directly on the CNS?
Anticonvulsants, opiates, antipsychotics
Medical factors affecting cognition
- Head trauma
- Degenerative processes
- Infectious processes
(Cancer)
Examples of environmental factors affecting cognition
Hearing problems, vision problems, pain, discomfort, no sleep
Acute changes in mentation, consciousness, or the ability to maintain attention
Delirium
Where is delirium most common?
ICU (but preventable)
Three impacts of delirium
- Increases mortality risk
- Increases hospital length of stay
- Can cause long term cognitive impairment
3 Types of Delirium
Hyperactive
Hypoactive
Mixed
Hyperactive Delirium
the easiest to assess; patient is disruptive and active
Hypoactive Delirium
most common form of delirium; patient is sleepy and has highest mortality risk
Risk Factors for delirium
Medications Anesthesia ICU on ventilator Stroke Dementia Respiratory Failure Sepsis Drug/Alcohol abuse Isolation
How do you assess a patient’s cognitive baseline when experiencing delirium?
Use the family members or past medical charts
Nursing Management of Delirium
- Early ambulation
- Promote adequate sleep
(close blinds, prevent noise) - Frequent reorientation
(remind them of time) - Enhance sensory stimuli
(glasses and hearing aids)
Progressive impairment of intellectual function and memory
Dementia
- Gradual decline and permanent *
Dementia - cerebral atrophy or shrinking of cortex
Alzheimer’s Dementia
Dementia - inadequate blood flow due to plaques or arterial brain lesions (stroke patients higher risk)
Vascular Dementia
Dementia - nerve cell loss and impairment of frontal and anterior temporal lobes
Frontotemporal Dementia
Dementia - clumps of protein causing neurodegeneration
Lewy Body Dementia
Dementia - if dementia occurs greater than 1 year after Parkinson’s
Parkinson’s Disease Dementia
Causes of Dementia
Trauma Circulation Genetics Alteration in neurotransmitteres Infectious agents
Some experiences the aging person may experience that could lead to depression
Loss Agism Chronic Pain Decreased independence (retirement/unable to work) Decreased health
Symptoms of depression in the elderly
Forgetfulness
Fatigue
Changes in behavior or mood
Impaired speech related to motor control, weakness, paralysis, or incoordination of the oral musculature
Can write or select words appropriately/ Hearing not impacted
Dysarthria
Complete or partial loss of language abilities
Aphasia
Unable to say what they want to say
Expressive aphasia
Inability of retrieving words
Anomia
Speech is articulated well, but hard time understanding what others are saying or what is written in front of them
Receptive Aphasia (Wernicke)
Functional skills, reading, writing, language areas impaired
Speech very poor, meaningless recurrent sounds
Global aphasia
What can the nurse use to assess alterations in cognitive function?
- Mini-mental status exam
- Pfeiffer
What is the Pfeiffer exam?
10 questions
A correct response gets a 1
Score of 7 or less indicates cognitive impairment
First neurological signs of reduced oxygen?
Confusion
What assessment to check reduced oxygen?
Pulse Ox & ABGs
What electrolyte is linked to cognitive impairment
Sodium
What can you use to orient the patient to date and time?
Large calendar and write on white board
- Point out date/time on their own devices
What do we do to help orient patient to day and night?
Keep windows and blinds open, lights on
Stimulation during the day to mimic daytime behavior
What sort of recommendation for family support should you give those experiencing progressive cognitive impairment?
Educate family members
Observe for signs of caregiver burnout
Observe for signs of elder abuse
Complex process that alters our psychological and physiological systems
Stress
Good stress?
Eustress
Initial reaction to potential stress; interpretation of situation and determination if it is a stressor
Appraisal
Managing stress; can mitigate or reduce the stress of emotion it causes (how stress is handled)
Coping
Outcome of coping; when a person successfully adjusts or adapts to stress
Adaptation
If a person is unable adapt, what may occur??
Pathological manifestations
What does homeostasis balance?
- Blood pressure
- Glucose regulation
- Temperature regulation
- Acid-base balance
- All vital processes
Restoration of balance in response to stress, through physiological mediators
Allostasis
When allostasis is stained and homeostasis is not achieved
Allostatic load
Which division of the ANS secretes norepinephrine and epinephrine
Sympathetic
Which division of the ANS secretes acetylcholine
Parasympathetic
Examples of excitatory actions
Pupil dilation, increased heart rate, bronchial dilation, increased glucose
Examples of inhibitory actions
Decrease digestive function, inhibit insulin secretion, prevent urination
Where does cortisol come from
Adrenal glands on top of kidneys
Does cortisol come before or after SNS response
After the initial SNS response
Two physiological affects of cortisol
Metabolism &
Immune function
Acute cortisol
Protective
Chronic cortisol
contributes to problems
What does prolonged stress lead to?
Anxiety, depression, and other alterations in health
Neuro reaction to stress
pupils dilate
Cardiac reaction to stress
tachycardia, hypertension, angina, dysrhythmia
Lung reaction to stress
increased RR, hyperventilation
GI reaction to stress
loss of appetite, N/V, increased hydrochloric acid production
Skin reaction to stress
diaphoresis, contraction of arrestor pili muscles
Musculoskeletal reaction to stress
increased muscle tension in large muscles, tremor/shakiness in smaller
Problem focused coping
deals with the issue/stress
Emotion focused coping
controls emotions during stress
Adaptability to adversity
resistance
Ability to move forward despite adversity
Resilience
increase in resiliency and resistance from experiencing and evolving from the past
vulnerability
Coping across the life span
Newborn and Infant
Dependent on care of others to survive
Stressors are typically quickly resolved
Infants need the stress of a nurturing environment
Coping across the life span
Toddler and preschooler
Still dependent on adults
Social and familial interaction and behavior impacting coping
Stressful issues are perceived more intensely at this age in comparison to adults and may have an impact later in life
Coping across the life span
School-age - adolescent
Social environment begins to expand
influenced by a balance of home support and an internal sense of self-worth
Younger children may have a hard time distinguishing reality from imaginative thinking
Adolescent children capable of rationalization and are able to utilize more coping mechanisms, but also may use negative coping skills
Coping across the life span
Adult-older adult
In adulthood, the ability to cope with stress is partly dependent upon how coping developed through the formative years
Life changes and physiological changes compound and add to stress
Where is the line drawn for when a legal substance becomes maladaptive coping pattern?
The line is drawn when cognitive status is altered and the use of the substance is consistent to get that alteration in cognitive function
Refusing to believe or accept something
Denial
Attributing one’s own thoughts onto another
Projection
Concealing the motive for behavior by giving a socially acceptable reason for the action
Rationalization
Consciously dismissing something from the mind and thoughts
Suppression
Immersing something in the subconscious or unconscious level of thought
Repression
Nursing Assessment (stress) identification
- Previous experience with coping strategies
- Is it effective?
- Identify RF that may affect coping
- Identify strengths and challenges
- Educational opportunities related to coping
Measurement tools for stress
Everyday Hassles scale
Coping self-efficacy scale
Some stress management techniques
visualization imagery affirmations meditation biofeedback therapeutic touch massage yoga deep breathing journaling
Framework that consists of a set of concepts related to individuals, groups, situations, and events
conceptual framework
Nursing concepts (4)
person
environment
health
nursing
provides the foundation for nursing knowledge and gives direction to nursing practice
nursing theory
a process to guide decision making during a person’s life / helps to determine what is rights or wrong in a given situation
values
disposition towards an object or subject
attitude
ideas that one accepts as true
belief
values held by a group that determines appropriate conduct for members of the group
professional ethics
each person has the right to autonomy and the ability to make their own decision
respect for persons
what is a person’s ability to make decisions based on
assessment of their mental and physical functioning
doing good / actions should promote an optimal outcome
beneficence
examples of beneficence
giving pain medication
dressing changes to promote wound healing
avoid doing harm or remove from harm
nonmaleficence
examples of nonmalficence
medications to stop seizures
teaching a pt how to use a cane when walking to avoid falling
nurses providing each patient the same resources they would offer any other patient / fairness with resources
justice
examples of things offered to provide justice to pts
time service education supplies care
three things pts are entitled to recieve
privacy and confientiality
veracity
fidelity
being honest
veracity
patient health information is not shared
privacy and confiendtiality
honoring commitments
fidelity
group of individuals that are separate from the incident that help make a ruling
ethics committee
legally what do nurses have to have
a nursing license
types of research -
measurable numeric data under conditions of considerable control with statistical procedures to analyze data
quantitative
types of research -
focuses more on subjective or lived experience; less control and little statistical analysis involved
qualitative
when the person who collects the data directly is the one who writes up the study on the topic
primary research
when the initial data is collected by someone else and is analyzed or interpreted by a second person
secondary research
Scientific process
problem identification research a solution develop an implementation plan implement the plan evaluate the effectiveness of the solution
PICOT method
P = patient or problem I = intervention C = comparison O = outcome of interest T = time of interest (not always)
sources reviewed by a panel of experts related to the field to determine if they study has used reliable methods for conducting the study
peer reviewed resources
preventing adverse outcome for patient
safety
viewed on a continuum from poor to high / measure of excellence
quality
6 components of quality
safe effective patient-centered timely efficient equitable
why does safety matter
third leading cause of hospital-related deaths in 2017 was preventable medical errors
why is root cause analysis (RCA) used
to determine the underlying cause of an event / helps determine if errors are active or latent
error that results in death or serious injury
sentinel event
safety issues in healthcare?
medication safety
healthcare worker risks
environmental safety
examples of healthcare worker risks
needle sticks
back injuries
exposure to toxic chemicals
poor staffing ratios can increase this
who measures for quality and safety outcomes
centers for medicare and medicaid services (CMS)
what does the center for medicare and medicaid service do
collects info from every facility and unit to develop benchmarks for hospital to achieve
diverse practices that are not considered as part of conventional allopathic medicine
complementary and alternative medicines
system in which medical doctors and other healthcare professionals treat symptoms and diseases using drugs, radiation or surgery (western medicine)
allopathic medicine
integrative health combines allopathic medicine, CAM, nutrition, exercise and stress reduction
holistic care
the mind, body, and spirit are all separate and joining parts that function in the overall environment
holism
an impaired ability to perform activities of daily living
self-care deficit
what is the nursing goal
interventions focus on reducing risk factors or targeting contributing factors
examples of CAM
herbs and natural products
massage, relaxation, yoga, mindfulness, progressive muscle relaxation, meditation and guided imagery
acupuncture and chiropractic care
what is the primary focus for mindfulness-based stress reduction
meditation
what does mindfulness-based stress reduction do for the body
increases self-awareness
permits a nonjudgemental attitude
how does CAM impact nursing
initial assessment (what does the pt use and how will it interact with whats prescribed) recommendation for non-pharmacological therapy for pts
what do nurses need
nonjudgemental attitude and to be aware of their own beliefs
california poppy (what does it do)
pain relief, sedation, anxiety relief
what should you not mix California poppy with
monoamine oxidase inhibitors
what is ginkgo biloba used for
alzheimers or memory problems
warnings for ginkgo biloba use
do not handle or eat fruit/seed
caution when using aspirin or other blood-thinning drugs
what is ginseng used for
energy increse
ginseng warnings
may increase glucose and blood pressure
increase tumor growth in estrogen dependent cancer
butterbur warnings
can contain pyrrolizide alkaloids (PA) that cause liver damage
look for types labeled PA free
what can st johns wort be used for
depression
warnings for st johns wort
may interfere with HIV tx
light sensitivity
dangerous w SSRIs, tricyclics, and MAOIs
can lower effects of meds
valerian use
anxiety and insomnia
valerian warnings
do not combine with other sedation meds
when should you avoid feverfew
pregnancy
processes herbal remedies go through (3)
standardization
regulatory
credentialing
standardization of herbal remedies
consistent amount per dose
practice based on the intentional and compassionate use of energy to promote balance and wellbeing through touch
therapeutic touch
unpleasant sensory or emotional experience associated with actual or potential tissue damage
pain
how often should pain be checked
as often as vital signs
pain that lasts up to 6 months due to actual or threatened damage; considered a protective mechanism
acute pain
what is present with acute pain
inflammatory and (sometimes, not always) sympathetic nervous system reaction
example of inflammatory component with acute pain
redness, swelling, tenderness
example of sympathetic nervous system reaction with acute pain
tachycardia, hypertension, tachypnea
how is acute pain treated
common analgesia and opioids
pain lasting longer than 6 months; no longer a protective mechanism and considered. a disease or a condition
chronic pain
acute pain from surgery, injury, or active disease process
nociceptive pain
four phases of nociceptive pain
transduction
transmission
perception
modulation
transduction (nociceptive pain)
prostaglandins are released to potentiate an action potential
tx of transduction phase
NSAIDS or steroids
transmission (nociceptive pain)
substance P is released: a significant pain messenger
tx of transmission phase
opioids
perception (nociceptive pain)
interpret or process pain
modulation (nociceptive pain)
norepinephrine or serotonin sent to areas of distress and receptors down regulate and pain is reduced
aching, throbbing pain in bones, joints or skin
somatic pain
organ related, poorly localized, cramping, squeezing or heavy
visceral pain
caused by damage to the somatosensory nervous system
neuropathic pain
what can cause neuropathic pain (3)
nerve damage
chemo
radiation
symptoms/ description of neuropathic pain
tingling
electric-like
pins and needles
numb characteristic
things that cause pain that normally wouldn’t cause pain
allodynia
heightened feeling of pain
hyperalgesia
treatment of neuropathic pain
antidepressants
SSRIs
anticonvulsants (gabapentin, pregabalin)
similar to nociceptive pain that does not have a discernible source
nociplastic or central pain
example of nociplastic pain
fibromyalgia
tx for nociplastic pain
complex
focused on restoring sleep or activity tolerance
not opioids
pain lifespan consideration
newborn and infant
neonatal pain, agitation, and sedation scale (N-PASS)
or FLACC behavioral pain scale is used
pain is undertreated
pain lifespan consideration
toddler and preschooler
Wong-baker FACES scale
Pain causes distrust
pain lifespan consideration
School-age and adolescent
persistent pain can cause developmental regression
adolescents may hide pain
numeric rating scale (0-10)
pain lifespan consideration
older adult
associated with conditions like arthritis
checklist of nonverbal pain indicators (CNPI)
critical care pain observation tool (CPOT)
when is N-pass used
premature infants (1st 100 days of life)
FLACC
face, legs, activity, cry, countability
greater than 1 indicates pain but not intensity
which tool can measure intensity
Wong-Baker
when is CPOT used
18 years or older who are unable to report pain (0-8)
score greater than one indicates potential pain
what increases with pain
blood pressure HR RR (quality diminished - depth/shallow) blood glucose oxygen consumption lactate ketones
what decreases with pain
immune response
ability to think, learn, make decisions,
RR quality
non-pharmacological pain management Physical ex (4)
heat (no longer than 30 mins)
cold
transcutaneous electrical nerve stimulation
massage
considerations for non-pharm pain management
ensure no signs of skin irritation
when is heat contraindicated as tx
over areas of bleeding, topical ointments, and over burned or irritated skin
when is cold contraindicated as tx
areas of poor circulation, Raynaud phenomenon, or irritated skin
examples of cognitive and behavioral pain management
distraction
relaxation
imagery
mindfulness
examples of relaxation for pain management
meditation and rhythmic breathing
safety parameters for PCA
minimum time interval between doses
maximum dose allowed over time period
specific dosing in milligrams or micrograms
what monitoring may be added to patients w PCA
end-tidal carbon dioxide
oxygen sat and respirations
what type of drug scheduling used after a procedure a few days ago
PRN - working towards discharge
Considerations for Spinal Analgesia
Medications given into epidural or intrathecal space
Lower dosage needed
HTN common side effect
Continuous = monitoring what?
- End tidal carbon dioxide
What side effects occur from opioids
sedation
resp depression
constipation
vasodilation and htn
who is at risk for SE from opioids
opioid- naive patients
elders
use of other sedation meds
obstructive sleep apnea
Pasero Opioid Induced Sedation Scale
S = sleep, easy to arouse 1 = awake and alert 2 = slightly drowsy, easily aroused 3 = frequently drowsy, arousable, drifts to sleep during convo 4 = somnolent, minimal or no response tp physical stimulation
