Funda midterm (lectures) Flashcards
Patient Quality and Safety
A fundamental concern of nurses, which extends from the bedside to the home to the community, is preventing injuries and assisting the injured
Safety
Factors Affecting Safety are
-Age and Development
- Lifestyle
- Mobility and Health Status
- Sensory and Perpetual alterations
- Emotional State
- Cognitive awareness
- ability to communicate
- safety awareness
- environmental factors
What are the Joint Commission’s 2019 National Patient Safety Goals for Hospitals and Nursing Care Centers
- Improve the accuracy of patient identification
- Improve the effectiveness of communication among caregivers
- Reduce the harm associated with clinical alarm systems
- reduce the risk of healthcare-associated infections
- Reduce the risk of patient and resident harm resulting from falls
- prevent healthcare-associated pressure ulcers
- the hospital identifies safety risks inherent in its patient population
- universal protocol for preventing wrong site, wrong procedure, and wrong person surgery
Give an Adult Safety Measures in the given situation:
In reinforcing motor vehicle safety , if alcohol is consumed use the method
Designated drivers
Give an Adult Safety Measures in the given situation:
Avoiding excessive sun radiation by limiting _____, using ______, wearing _______.
exposure, sun-blocking agents, protective clothing
Is a single temporary event that consists of uncontrolled electrical neuronal discharge of the brain that interrupts normal brain function
Seizure
Are devices used to reduce or prevent physical activity of a client or a part of the body when the client is unable to remove the device
Restraints
Identify the Restraint type:
Use of an intervention or device that hinders the client from moving or restricts the individual from contact with his or her body
Physical
Identify the Restraint type:
Using a medication to control behavior or to restrict the client’s freedom of movement and is not a standard treatment for the client’s medical or psychologic condition
Chemical
Identify the Restraint type:
Involuntary confinement of a client alone in a room or area from which the client is physically prevented from leaving
Seclusion
Infection Prevention and Control
Collective vegetation in a given area
Resident Flora
Microbial species that can be cultured from body surfaces under certain circumstances
Transient Flora
What are the four major mo’s causing infections in humans
Bacteria, viruses, fungi, parasites
Growth of MO’s in body tissue where they are not usually found
Infection
Detectable alteration in normal tissue function
Disease
No clinical evidence of disease
Asymptomatic/Subclinical
Ability to produce disease
Pathogenicity
Can be transmitted to an individual
Communicable Disease
Cause disease only in susceptible individuals
Opportunistic pathogen
Freedom from disease-causing microorganisms
Asepsis
Identify the type of Asepsis:
Practices intended to confine a specific MO to a specific area
Medical
Identify the type of Asepsis:
practices that keep an area or object free from all MOs
Surgical
Identify the type of infection:
Process by which strains of microorganisms become resident flora
Colonization
Identify the type of infection:
Limited to specific part of the body where to MO’s remain
Local infection
Identify the type of infection:
MO’s spread and damage different parts of the body
Systemic infection
Identify the type of infection:
Culture of the individuals blood reveals MO’s
Bacteremia
Infections that originate in any healthcare setting
Healthcare-associated infections
Infection origination from the client themselves
Endogenous
Infection from the hospital environment and hospital
Exogenous
Serious infection that occurs when MOs enter the bloodstream through a large catheter placed in a large vein
Central line-associated blood stream infection (CLABSI)
Any infection involving any part of the urinary system
Catheter-associated urinary tract infection (CAUTI)
An infection that occurs after surgery in the part of the body where the surgery took place
Surgical site infection
(SSI)
A lung infection that develops in a person on a machine used to help the client breathe
Ventilator Associated pneumonia (VAP)
Chain of infection steps
- Etiologic agent
- Reservoir
- Portal of Exit
- Mode of Transmission
- Portal of Entry
- Susceptible Host
Identify the step of chain infection based on the factors:
*Number of organisms present
*Virulence and potency
*Ability to enter the host’s body
*Susceptibility of the host
*Ability to live in the host’s body
Etiologic agent
Identify the step of chain infection based on the factors:
*Sources of MO’s such as:
*Humans/ Carriers
*Plants
*Animals
*Medical equipment
*General environment
Reservoir
What are the direct modes of transmission
Direct contact and Droplet spread
What are the indirect modes of transmission
Airborne, vehicle-borne, vector borne
Occurs through skin-to-skin contact, kissing, and sexual intercourse
Direct contact
Spray with relatively large, short-range, aerosols produced by sneezing, coughing, or even talking
Droplet Spread
Occurs when infectious agents are carried by dust or droplet nuclei suspended in air
Airborne
Indirectly transmit an infectious agent include food, water, biologic products, and fomites
Vehicle
Such as mosquitoes, fleas, and ticks may carry an infectious agent through purely mechanical means or may support growth or changes in the agent
Vector
A break in the skin can readily serve as a ______
Portal of entry
Is any individual who is at risk for infection
Susceptible host
Is someone at increased risk, an individual who for one or more reasons is more likely than others to acquire an infection
Compromised host
What are the factors affecting susceptibility?
- impairment of immune system
- age
- clients receiving immune suppression treatment
- immune deficiency conditions
Body defense against infection that protect the individual against all MOs
Non-specific
Body defense against infection directed against identifiable infectious agent
Specific
First line of non specific defense
Intact skin and mucous membranes
Local and nonspecific defensive response of the tissues to an injurious/ infectious agent
Inflammatory response
Injurious agents are classified as?
- Physical agents
- Chemical Agents
- Microorganisms
What are the 3 stages of Inflammatory Response?
- Vascular and Cellular responses
- Exudate production
- Reparative Phase
Substance that induces a state of sensitivity or immune responsiveness
Antigen
Originate from own body
Autoantigen
Also called humoral immunity as it resides in the B lymphocytes and mediated by antibodies produced by B cells
Antibody mediated
Also called immunoglobulins are part of the body’s plasma proteins
Antibodies
Antibodies are produced by the body in response to an antigen
Active
Type of Active antibody that are formed in the presence of active infection in the body
Active Natural
Type of Active antigen that are administered to stimulate antibody production
Active Artificial
Antibodies are produced by another source, animal, or human
Passive
Type of Passive antibody that are transferred naturally from an immune mother to her baby through the placenta or in colostrum
Passive Natural
Type of passive immune serum from an animal or another human is injected
Passive Artificial
This testing involves measurement of several hepatitis B virus HIBV-specific antigens and antibodies.
Hepatitis B serologic testing
Occurs through T cell system
Cell-mediated
3 types of Cell-mediated
- Helper
- Cytotoxic T cells
- Suppressor T cells
Is considered one of the most effective infection prevention measures
Hand hygiene
Is a chemical preparation used on skin or tissue
Antiseptic
Is a chemical preparation, such as phenol or iodine compounds, used on inanimate objects
Disinfectant
Preparation destroys bacteria
Bactericidal
Preparation prevents the growth and reproduction of some bacteria
Bacteriostatic
Process that destroys all microorganisms including spores and viruses
Sterilization
Steam under pressure to attain temp higher than boiling point
Moist Heat
Ethylene oxide destroys MOs by interfering with metabolic process
Gas
Most practical and inexpensive, some spores and viruses are not killed. Min 15 mins for disinfection at home
Boiling Water
Ionizing and non-ionizing, rays do not penetrate deeply
Radiation
Used for clients known to have or suspected of having serious illnesses transmitted by airborne droplet nuclei smaller than 5 microns. Ex. Measles, varicella, and tuberculosis
Airborne precaution
Used for clients known to have or suspected of having serious illnesses transmitted by particle droplets larger than 5 microns. Ex. Diphteria, mycoplasma pneumonia, pertussis, mumps, rubella
Droplet precaution
Used for clients known to have or suspected of having serious illnesses easily transmitted by direct client contact or by contact with items in the client’s environment
Contact precaution
A specific type of aseptic technique with a unique theoretical and clinical practice framework based upon the original concept of key-part and key-site protection.
Aseptic non-touch technique
The critical part of equipment that comes into contact with a key site
Key part
A part of the body that is at risk of contamination if ANTT is not used
Key site
ANTT
A – Always ensure hands are decontaminated effectively prior to
the procedure
N – Never contaminate key parts of sterile materials/equipment or
the patient’s susceptible key sites
T – Touch non-key parts with confidence
T –Take appropriate infection prevention and control precautions
e.g. use of PPE, safe waste management
Vital Signs
Vital signs include what?
- body temp
- pulse
- respiration
- blood pressure
What is commonly assessed alongside vital signs
- pain
- oxygen saturation
Reflect the balance between heat produced and heat lost from the body
Body temperature
Temperature of the deep tissues of the body
Core body temperature
Temperature of the skin, subcutaneous tissue and fat
Surface temperature
What are the factors affecting body temperature
- Age
2, Diurnal Variations - Exercise
- Hormones
- Stress
- Environment
What is the normal temperature
36-37.5 C
Temperature above the usual range
Pyrexia
Very high fever
Hyperpyrexia
Normal temperature
Afebrile
Alternates at regular interval normal and fever
Intermittent fever
Fluctuating above normal temperature
Remittent fever
Short febrile periods with 1 or 2 days of normal temperature
Relapsing
Result of excessive heat and dehydration
Heat exhaustion
Core body temperature below lower limit of normal
Hypothermia
What are the different sites of body temperature measurements
- oral
-rectal
-axillary
-tympanic membrane
-temporal artery
Wave of blood created by contraction of the left ventricle of the heart
Pulse
Is the ability of the arteries to contract and expand
Compliance
Volume of blood pumped into the arteries by heart and equals the result of the SV x HR/min
Cardiac output
Excessively fast heart rate >100
Tachycardia
Less than 60bpm
Bradycardia
Pattern of beats and intervals between beats
Pulse rhythm
Irregular rhythm
Arrhythmia/ Dysrhytmia
Refers to breathing out or the movement of gases from the lungs to the atmosphere
Ventilation
Involves the external intercostal muscles and other accessory muscles and observed through the movement of the chest
Costal breathing
Involves the contraction and relaxation of the diaphragm and observed by the movement of the abdomen
Diaphragmatic breathing
Normal rate and depth of breathing
Eupnea
Abnormally slow respiration
Bradypnea
Abnormally fast respiration
Tachypnea
Absence of breathing
Apnea
Measure of the pressure exerted by the blood as it flows through the arteries
Arterial blood pressure
Pressure of the blood as a result of contraction of the ventricles
Systolic pressure
Pressure when the ventricles are at rest
Diastolic pressure
Difference between the diastolic and systolic pressures
Pulse pressure
Represents the pressure actually delivered to the body’s organs
Mean arterial pressure
Persistently above normal blood pressure
Hypertension
Blood pressure below normal
Hypotension
Blood pressure that decreases when the client changes from a supine to sitting/standing position
Orthostatic hypotension
Phases of the Korotkoff sounds
- PHASE I Clear tapping or thumping sounds are heard.
First tapping sound is the systolic blood pressure - PHASE II period when the sounds are muffled
- PHASE III period when the blood flows freely through
thumping but softer than phase I - PHASE IV muffled and have a soft blowing quality
- PHASE V when the last sound is heard. The last sound
indicates the diastolic pressure
Med ad
Describes the drug’s chemical structure
Chemical Name
Official, nonproprietary name, not owned by any company and universally accepted
Generic name
Proprietary name, chosen by the drug company and registered as trademark
Trade/brand name
10 rights to medication
Important five
1. Right patient
2. Right route
3. Right time
4. Right drug
5. Right dose
Other five
1. Right documentation
2. Right education
3. Right to refuse
4. Right assessment
5. Right evaluation
This is the preferred and expected effect for which medication is administered to a specific client.
Therapeutic effect
These are usually expected and inevitable when a medication is given at a therapeutic dose
Side effects
These are undesired, inadvertent, and unexpected dangerous effects of the medication
Adverse effects
Medications can have specific risks and manifestation of toxicity
Toxic effects
Therapeutic actions of drugs:
Relieves the symptoms of a disease but does not affect the disease itself
Palliative
Therapeutic actions of drugs:
Cures a disease or condition
Curative
Therapeutic actions of drugs:
supports body function until other treatments or the body’s response can takeoover
Supportive
Therapeutic actions of drugs:
Replaces body fluids or substances
Substitutive
Therapeutic actions of drugs:
destroys malignant cells
Chemotherapeutic
Therapeutic actions of drugs:
Returns the body to health
Restorative
Immunologic reaction to drug
Drug allergy
Severe allergic reaction that occurs immediately after administration of the drug
Anaphylactic reaction
Drug effect:
Exists in a client who exhibit an unusually low physiologic response to a drug and requires increases in the dosage to maintain a given therapeutic effect
Drug tolerance
Drug effect:
When the administration of one drug before, at the same time or after another drug alters the effects of one or both drugs. Can be synergistic or antagonistic
Drug interaction
Drug effect:
Disease caused unintentionally by medical therapy
Iatrogenic Disease
Drug use:
Improper use of common medications that lead to acute or chronic toxicity
Misuse
Drug use:
Inappropriate intake of substances, either continually or periodically
Abuse
Drug use:
Reliance on or need to take a drug or substance. Can either be Physiologic or Pschologic dependence
Dependence
Drug use:
Mild form of psychologic dependence, developing a habit of taking substance and feeling better after
Habituation
Drug use:
Also called street drugs, sold illegally
Illicit drug
Medications can interact with each other resulting in desired or undesired effects
Medication interactions
Medications may be contraindicated for a client who has a specific disease or condition
Precautions/Contraindications
Drugs found to be safe and appropriate for use without supervision of the HCP
Over the counter drugs
SAFER
S – speak up
A - ask questions
F – find the facts
E – evaluate your
choices
R – read labels
PRN
Pro re nata
Pro re nata - latin phrase meaning?
As needed
AC
Antecibum - before meals
Bid
bis in die - twice a day
q3h
quaque 3 hora - every three hours
qd
Quaque die - every day
Also known as compliance is defined as the extent to which a patient’s behavior coincides with medical advice
Patient Adherence
Study of the movement of the drug throughout the body
Pharmacokinetics
Pharmacokinetics derived from two greek words pharmakon and kinesis meaning
Drug or poison, motion
4 processes of Pharmacokinetics
- Absorption
- Distribution
- Metabolism
- Excretion
Transmission of medications from the location of administration to the bloodstream
Absorption
Identify the angle of injection technique:
Intramuscular
90
Identify the angle of injection technique:
Subcutaneous
45
Identify the angle of injection technique:
Intravenous
25
Identify the angle of injection technique:
Intradermal
10-15
Enteral route of administration pass from the intestinal lumen to the liver via the portal vein
First pass effect
Refers to the percentage of administered drug available for activity
Bioavailability
Transporatation of medications to sites of action by bodily fluids
Distribution
Changes medications into less active/inactive form by the action of enzymes
Metabolism/ biotransformation
Compound that is metabolized into an active pharmacologic substance
Prodrug
Time it takes for the amount of drug in the body to be reduced by half
Half life
Plateau drug level, amount of drug administered is equal to the amount being eliminated
Steady state
Giving a large initial dose so therapeutic effect is achieved while a steady state is reached
Loading
Dose needed to maintain drug concentration at a steady state, consistent dosing and interval
Maintenance
Elimination of drugs from the body
Excretion
Study of the effects of the drugs on the body
Pharmacodynamics
Body’s physiologic response changes in drug concentration at the site of action
Dose-response relationship
Refers to the amount of drug to elicit a specific response to a drug
Potency
Increasing a drug dosage no longer increases the response
Maximal efficiency
Describes the relationship between the therapeutic dose of the drug and the toxic dose of a drug
Therapeutic index
No need for routine serum drug level monitoring
High TI has a wide safety margin
Serum drug levels should be monitored
Low TI has a narrow safety margin
Time it takes for a drug to reach MEC
Onset
amount of drug required for drug effect
MEC - Minimum effective concentration,
Drug reaches its highest concentration in the blood
Peak
Length of the time the drug exerts a therapeutic effect
Duration
Medication that can mimic the receptor activity regulated by endogenous compounds
Agonist
Medication that can block normal receptor activity regulated by endogenous compounds
Antagonist
Limited affinity to receptor sites
Partial Agonist
Drugs that affect multiple receptor sites
Nonspecific
Drugs that affect multiple receptor
Nonselective
Mechanism of Action includes?
- Stimulation
- Depression
- Irritation
- Replacement
- Cytotoxic action
- Antimicrobial
- Modification of immune status
Degree of detrimental effects caused by excessive drug dosing
Toxicity
Sensitization of immune system
Allergic reaction
Uncommon drug response genetic predisposition
Idiosyncratic Effect
Opposite of the intended drug response
Paradoxical effect
Disease caused by drugs
Iatrogenic disease
State in which the body has adapted to drug exposure, will cause abstinence syndrome if discontinued
Physical dependence
Cancer-causing
Carcinogenic
Drug-induced birth defect
Teratogenic
Organ toxicities
Hepatotoxic/
Ototoxicity/
Nephrotoxicity
Factors affecting medication action
- Developmental factors
- Gender
- Genetic and Cultural
Factors - Diet
- Environment
- Illness and Disease
- Time of Administration
Medication prescription:
Medications are given on a regular schedule with or without a termination date
Standard prescription
Medication prescription:
one time prescription
Single Prescription
Medication prescription:
Given only once and given immediately
Stat Prescription
Medication prescription:
stipulates at what dosage, what frequency and condition a medication ma be given
PRN
Medication prescription:
Written for specific circumstance, may or may not have a termination date and carried out until an order to cancel it is given
Standing prescriptions
Components of a prescription order
- client’s name
- date and time of prescription
- name of medication
- dosage of medication
- route of administration
- time and frequency of medication
- signature of prescriber
Medication prescriptions are written in the chart by the provider or nurse who takes a verbal or telephone prescription
Telephone order
- Republic Act No. 6675 - The
Generics Act Of 1988 - Republic Act No. 9502 –
Universally acceptable cheaper
and quality medicines act of 2008
(amendment of RA 5921) - Republic Act No. 9165 –
Comprehensive Dangerous Drugs
Act of 2002
Parts of the needle
- bevel
- shaft
- gauge number
- hub
Used when rapid effect is required. Appropriate when medications are too irritating to tissues to be given through other routes
Intravenous medications
Method of administering a medication mixed with small amount of IV solution
Intermittent IV infusion
Second set connect the second container to the tubing of the primary container at the upper port
Piggyback
Such sets are small fluid containers attach below the primary infusion container so that the medication is administered through the client’s IV line
Volume Control Infusions
Bolus is the IV administration of an undiluted drug directly into the systemic circulation. Is used when a medication cannot be diluted or in an emergency
IV push
Applied locally to the skin or to mucous membranes in areas such as the eye, external ear canal, nose, vagina, and rectum
Topical medications
This system administers sustained-action medication via multi-layered films containing the drug and an adhesive layer
Transdermal patch
Instillations or irrigations of the external auditory canal are referred to as
Otic medication
Is a suspension of minute liquid droplets or fine solid particles suspended in a gas. Delivers the pulmonary medication to its immediate site of action
Aerosol
Metered Dose inhaler (MDI) is disinfected how?
Disinfected weekly by soaking for 20 mins in 1 pint of water with 2 ounces of vinegar added
Complementary, alternative, and integrative therapies
Therapies used together with conventional treatment recommended by a person’s HCP
Complementary therapies
Other term for Complementary therapies
Integrative health care programs
Therapeutic touch
Hypnotherapy
Chiropractic therapy
Guided imagery
Breathwork
Complementary therapies
Non-pharmacological therapies used in place of conventional therapies. Exercise, and chiropractic herbal supplements
Alternative therapies
Nonsteroidal anti-inflammatory drugs
Alternative therapies
Interventions done by a licensed health care providers. Emphasizes the importance of the relationship between practitioner and patient
Integrative therapies
A way of being-knowing-doing that advances the health and well-being of a person’s, families, and communities through caring-healing relationships
Integrative therapies
Identify the type of Complementary therapies:
Dietary supplements
Herbal medicines
Macrobiotic diet-vegan diet
Mycotherapies-fungi-based products
Orthomolecular medicine
Probiotics-live microorganisms
The Zone dietary program
Biologically based therapies
Identify the type of Complementary therapies:
Acupuncture
Healing touch
Reiki therapy
Therapeutic touch
Magnet therapy
Energy Therapy
Identify the type of Complementary therapies:
Acupressure
Chiropractic medicine
Massage therapy
Simple touch
Manipulative and Body-based methods
Identify the type of Complementary therapies:
Art Therapy
Biofeedback
Breathwork
Guided imagery
Meditation
Mind-body interventions
Identify the type of Complementary therapies:
Dance therapy
Feldenkrais method-establishment of good self-image
Pilates
Complementary therapies
Identify the type of Complementary therapies:
Traditional Chinese Medicine
Native American traditional healing-asking spirits to ask direction
Whole Medical System
Identify the type of Complementary therapies:
Thoughts and feelings influence the production of chemicals
Relaxation Therapy
Mind modifies the biochemical functions of the major organ systems in response to feedback
Stress response
Ability to identify, differentiate, maintain attention
Focusing
Ability to stop unecessary goal-directed and analytic activity
Passivity
Ability to tolerate and accept experiences that are uncertain, unfamiliar
Receptivity
Meditari meaning
To pay attention
4 components of Meditation
- Quiet Space
- Comfortable position
- Receptive attitude
- Focus attention
Is a mind-body therapy that used the conscious mind to create mental images to stimulate physical changes in body, improved perceived well-being and or enhance self-awareness
Imagery/visualization
Mind-body technique that uses instruments to teach self-regulation and voluntary self-control over physiologic responses
Biofeedback
Identify the type of Training specific therapy:
Regulates of realigns the vital energy and modifies the response of the body to pain and how pain is processed by central neural pathways and cerebral function
Acupuncture
Identify the type of Training specific therapy:
Placing a practioner’s open palms either on or close to the body of a person
Therapeutic touch
Identify the type of Training specific therapy:
Views health as life in balance which manifests as lustrous hair, a radiant complexion, engaged interactions, a body that functions wihtout limitations and emotional balance
TCM chinese medicine
Identify the type of Training specific therapy:
Is a chemical compound or substance produced by a living organism and includes herbal medicines, dietary supplements, vitamins, minerals, essential oils and probiotics
Natural products and herbal therapies
Oxygenation
A process in oxygenation where movement of gases into and out of the lungs during inspiration and exhalation
Ventilation
A process in oxygenation and is the ability of the cardiovascular system to pump oxygenated blood to the tissue and return deoxygenated blood to the lungs
Perfusion
A process in oxygenation and is the movement of respiratory gases from one area to another by concentration gradient
Diffusion
State the cardiopulmonary physiology
Deliver of deoxygenated blood - right side of the heart- right side of the lungs(oxygenate) -
delivery of oxygenated blood - left side of the lungs - heart - tissues - removal of cellular
metabolism waste products - blood flow to body systems (respiratory, digestive, - right ventricle
- pumps deoxygenated blood through the pulmonary circulation - left ventricle pumps oxygenated
blood through systemic circulation - as blood passes through the circulatory system - exchange
of respiratory gases, nutrients, and waste products.
The amount of blood ejected from the left ventricle each minute
Cardiac output
The volume of blood ejected from the ventricles during systole
Stroke volume
Measurement of the electrical activity of the conduction system
Electrocardiogram
Factors affecting oxygenation
Physiological factors
Decreased oxygen- carrying
Anemia
Inhalation of toxic substance
What is the normal value of PaCO2
35-45 mmhg
What is the normal value of PaO2
80-100 mmhg
Decreased in the amount of arterial oxygen
Hypoxemia
Alveolar ventilation is inadequate to meet oxygen demand
Hypoventilation
Lungs remove carbon dioxide faster
Hyperventilation
Inadequate tissue oxygenation
Hypoxia
Hygiene
Serves several functions including protection, excretion, body temperature regulation, and
cutaneous sensation
Skin
Consists of the lips surrounding the opening of the mouth, cheeks running along the
sidewalls of the cavity, the tongue & its muscles & the hard & soft palate
Oral Cavity
Dry mouth
Xerostomia
Inflammation of the gums
Gingivitis
Tooth decay
Dental caries
Practices focus on care of the scalp, axilla, and pubic areas
Hair
Factors influencing hygiene
Social practices
Personal preferences
Body image
Socioeconomic status
Health beliefs and motivation
Cultural variable
Developmental stage
Physical condition
Inflammation of oral mucous membranes
Mucositis
