IM1-- EXAM 6 Flashcards
1
Q
What does the Texas Administrative code Title 22 examining board chapter 217
Rule 217.11 state
A
Provide without discrimination, nursing services regardless of age, disability, economic status, national origin, race, religion, health problems or sexual orientation of the client served.
2
Q
What does the ANA code of ethic for nurses state:
A
The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems
3
Q
What is spirituality?
A
- Complex concept that is unique to each individual and is dependent upon a person’s culture, development, life experiences, beliefs and ideas about life
4
Q
Spirituality encompasses what?
A
- Connectdness
- Transcendence and self transcendence
- Faith and hope
- Inner strength and peace
- Meaning and purpose in life
- Person
5
Q
Spiritual wellness is….
A
- Awareness of one’s inner self
- Connection to a higher being, nature
- Values
- Highly individualized
6
Q
What are some attributes to spiritual wellness
A
- Harmony
- Purpose
- Self acceptance
- Clear values
- Positive outlook
- Peace
- Balance
- Growth
7
Q
Spiritual wellness maintenance includes….
A
- making time to relax
- Make time for quiet reflection
- Do my values guide my decisions and actions?
- Am I accepting of the views others?
- Do I have a source of hope?
- Attempting to offer forgiveness to others
8
Q
True or false: Spiritual wellness has a positive effect on health?
A
True
9
Q
True or false: Spiritual wellness can enhance a patient’s quality of life
A
True
10
Q
Can spiritual wellness help a patient accept hardship and even mortality?
A
Yes
11
Q
What are the 2 types of spirituality?
A
- Religious
- non-Religious
12
Q
When it comes to spirituality and religion what should we know….
A
- Spirituality is found in all human cultures
- Expressed differently in religious faith
- Spirituality does not have to include religion
- Being spiritual does not mean practicing religion
- Congruency (spirituality outside of religion)
13
Q
When it comes to Spirituality and Health and the benefits it provides what should we know….
A
- Reduces stress
- Improved health outcomes with chronic conditions
- Helps with pain management
- Comfort for the dying and bereaving
- Enhances recovery from illness and surgery
- Decreases anxiety, depression, anger, discomfort, and feelings of isolation
- decreases alcohol and drug abuse
- decreases blood pressure and risk of heart disease
- increases the ability to cope
- Increases feeling of hope, optimism, freedom from regret, inner peace, and satisfaction with life.
14
Q
How does spirituality help in the healing process
A
- enhances comfort
- Provides inner peace
- Helps patients come to terms with disability and death
15
Q
In spirituality the “relationship” includes
A
- self, family, friends, loved ones
16
Q
What are aspects of relationships that effect spirituality?
A
- Love
- Trust
- Communication
- Hurt
- Mistrust
17
Q
What are some examples of spiritual wellness…
A
Despite suffering
1. Feeling connected to others who are suffering
2. Feeling support love and room in my heart for others
3. Keep up the fight to endure, pushing beyond limitations
4. Transform this world into a place of wholeness and mutual support
18
Q
What is spiritual distress?
A
- “The state in which the individual experiences or is at risk for experiencing a disturbance in his belief system that is the source of his strength and hope”
19
Q
What are some characteristics of spiritual distress?
A
- Concern with the meaning of life, suffering and/or death
- Concern about belief system
- Anger toward God/religious representatives
- No longer participates in religious practices
- Concern about his/her relationship with God
- Question meaning of own existence
- Feels, guilt, shame, remorse
- Feels helpless and hopeless
- seeks spiritual assistance
- Demonstrates gallows humor
- Suffers from sleep disturbances
- Alterations in mood or behavior
20
Q
What is some of the information we gather when we do a spiritual assessment?
A
- Faith/belief
- life and self-responsibility
- Connectedness to God or higher power and others
- Life satisfaction
- Culture
- Fellowship and community
- Ritual and practice
- Vocation
21
Q
What nursing actions can we perform in regards to spirituality
A
- Offer to contact the pastoral care dept
- Plan activities to promote healing of body, mind, spirit
- offer to teach relaxation, guided imagery, and meditation technique
22
Q
True or false: Religion is organized beliefs and worship….”state of doing”
A
True
23
Q
What is agnostic religion?
A
A person who believes that nothing is known or can be known of the existence or nature of God or of anything beyond material phenomena; a person who claims neither faith nor disbelief in God.
24
Q
What is atheism?
A
An atheist is a person who disbelieves or lacks belief in the existence of God or gods and an ultimate reality
25
What are some things we should know about roman Catholicism?
1. May desire Eucharist or mass daily
2. Sacrament of the anointing of the stick
3. Last rites
4. Baptism of infants if prognosis is grave
5. Praying the rosary
6. Meat free diet on Friday during lent
7. Brith control may be prohibited
8. Confession
26
What religions do not eat meat on friday?
1. Roman Catholicism
27
What are some things we should know about Mormonism/church of latter-day saints
1. Joseph Smith-Prophet
2. Healthful living (no tea, alcohol, coffee or tobacco)
3. Believe in Jesus
4. Forgiveness of sins
5. Baptism for newborn
6. Last rites
7. Communion
28
What are some things we should know about Jehovah's Witness's
1. Do not celebrate birthdays or holidays
2. Refusal of blood products/ no blood in food
3. Does not believe in immediate afterlife
4. Jehovah is God - there is no trinity
29
What are some things we should know about Mennonites
1. Christian
2. Pacifism
3. Many speak low German and/or Spanish
4. Modest apparel for women
5. Caps indicate submission and headship
-God>Man> women
30
What are some things we should know about Islam (muslim) religion
1. May engage in prayer 3-5 times a day facing mecca
2. Face, hands and feet are washed before prayer
3. Right hand used for everything but elimination
4. No pork or alcohol
5. Gender concordant care
6. Modesty
31
What are some things we should now about Judaism and religion?
1. Kosher certified foods
2. Sabbath is from sunset Friday to sunset Saturday
3. Sabbath may not want to use call light
4. Cremation is prohibited or highly discouraged
5. Daily prayers are valued
6. Circumcisions
32
What are some things we should know about buddhism?
1. No belief in a personal creator/God
2. Mindfulness and mental clarity
3. Quiet and peaceful environment
4. May be vegetarian
5. Prefer family to bathe, toileting, feed...
6. Suffering is a part of life
7. Karma
33
What should we know about hinduism?
1. Reincarnation
2. Personal hygiene important and must be daily
3. cremation common on day 2 after death
4. Right hand for eating, left hand for toileting
5. Many are vegetarians
6. accept death and illness as part of life
7. Elders have a strong influence on decision making
34
What is diversity?
1. The unique variations between individuals informed by genetics and cultural background, refined by experience and person choice.
35
What are some variations in diversity?
1. Race
2. Gender
3. Sexual orientation
4. Age
5. Education
6. Abilities/disabilities
7. Life experiences
8. Geographic
9. Parental status
10. Language
11. Profession/occupation.
36
What is culture?
1. Learned and shared beliefs involving: knowledge, behaviors, ideas, attitudes, values, habits, work and lifestyle practices, traditions, languages, symbols, rituals,, expression of thoughts and emotions, ceremonies and practices that are unique to a particular group of people
37
What is transcultural nursing
A comparative study of cultures to understand similarities and differences across human groups
38
What is cultural sensitivity
Is being aware of cultural similarities and differences of others with out assigning them value based on similarities or differences.
39
What is cultural competence
Requires acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care.
40
What is cultural awareness
Self-exam of one's bias
41
What is cultural knowledge
Sound education base about diversity
42
What is cultural skills
1. Gathering information through a cultural assessment and being aware of physical findings that are based on race/ethnicity
43
What is cultural encounters
engage face to face
44
What is cultural desire
want to engage with diverse populations
45
What are the ANA standard 8 cultural congruent care
13 competences----
1. Demonstrates respect, equity and empathy
2. Participates in lifelong learning to understand cultural preferences
3. Creates an inventory of one's own values, beliefs and cultural heritage
4. Applies knowledge of variations in health beliefs, practices and communication patterns
5. Respects decisions based on age, tradition, belief and family influences
6. Promotes equal access to services, tests, interventions, health promotions
7. educates nurse colleagues and other professionals about cultural similarities and differences.
8. Considers the effects and impact of discrimination.
46
What are some barriers to culturally competent care?
1. Bias (unconscious and implicit)
2. prejudices
3. Ethnocentrism
4. cultural imposition
5. Cultural stereotype
6. discrimination
47
What is bias
One sidedness, tendency to learn a certain way. Lack of impartiality
48
What is prejudices
Negative attitudes towards others based on race, gender, sexual orientation...
49
What is ethnocentrism
1. Believing your way of living is superior to others. cause of biases and prejudices
50
What is cultural imposition
Use their own values and lifestyles and the absolute guide in dealing with patients
51
What is cultural sterotype
all people of a certain racial or ethnic group are alike in certain aspects
52
What is discrimination
Behavior manifestation of prejudices
53
What are some culture and life transitions?
1. Pregnancy
2. Childbirth
3. Newborn
4. Grief and loss
54
What is included in cultural assessment?
1. Family structure
2. Communication patterns
3. Foods with cultural significance
4. time orientation
5. Space
6. Control
55
What are some things to ask/consider during cultural assessments?
1. how do you prefer to be addressed?
2. Where were you born, your parents, your grandparents?
3. How long have you been in the US
4. Are you more comfortable reading materials in your native language if other than English?
5. How are important healthcare decisions made in your family?
6. Are there certain health care procedures and tests that your culture prohibits?
56
What is ethnicity?
A cultural group's shared identity such as values, language, geographical space, racial characteristics
57
What is "race"
1. the grouping of people based on biological similarities and attributes
58
How can you improve your relationships with different kinds of people
1. Honestly assess your attitudes
2. Put yourself in perspective with others
3. Respect differences but don't overlook similarities
4. search for more knowledge
5. treat people as individuals rather than stereotyping
59
Review slide 60 in spirituality
review slide 60 in spirituality
60
What is an etic perspective?
Outsider perspective
61
What is an emic perspective
insider perspective
62
What is a health disparities
A health difference because of a social, economic or environmental disadvantage or part of marginalized groups (people of color, gay, lesbian, bisexual, transgender, physically or mentally challenged and people not college educated)
63
Black males have a higher incidence of colorectal cancer than white males.... is an example of....
health disparities
64
What are stressors and stress?
Physical, emotional or psychological perceived demands that may lead to growth, personal development or a crisis
65
True or false: Stress is the result of an exposure to a stressor?
True
66
What are some potentially stressful objective events?
A major exam, big date, trouble with one's boss or a financial setback, which may lead to frustration, conflict, change or pressure
67
What are some subjective cognitive appraisal stressors
Personalized perceptions of threats, which are influenced by familiarity with the event, its controllability its predictability and so on
68
Stress can lead to what responses?
1. Emotional responses--> annoyance, anger, anxiety, fear, dejection, grief
2. Physiological response--> autonomic arousal, hormonal fluctuations, neurochemical changes, and so on
3. Behavioral response ---> coping efforts, such as lashing out at others, blaming oneself, seeking help, solving problems, and releasing emotions
69
Stress can alert our ___ or ___ response
Flight or fight
70
True or false: Stress can cause the arousal of the sympathetic nervous system?
True
71
Selye's general adaptation syndrome is any event (stressor) that threatens an individual.
leads to a 3-stage response which are as follows
1. Alarm
2. Resistance
3. Exhaustion
72
True or false: Stress is highly variable
True
73
Review slide 70 on spirituality
Review slide 70 on spirituality
74
What does our overall assessment of spirituality include?
History
1. Medical
-general state of health
- illnesses
- surgeries
- medications
- tx
- use of alcohol, tobacco and/or drugs
- changes in sleep, eating, sexual patterns
2. Perception of threat
3. Past coping patterns
4. Social
- family dynamics
- work/recreation
- living environment
- financial
5 general examination (observable)
-general description and appearance
- behavior
-communication/speech
- mood, affect and feelings
-judgement/insight
6. physical exam
75
What are some cognitive S/S of stress?
Decreased concentration, comprehension, & memory
76
What are some signs of behavioral S/S of stress?
Irritability, withdrawal, violence
77
What are some signs of emotional S/S of stress?
Fear, anxiety, depression, fatigue
78
What are some signs of physiological S/S of stress
increased bp, hr, respirations, etc
somatic symptoms
decreased immune response
79
What is coping
Coping mechanisms are ways to which external or internal stress is managed, adapted to or acted upon.
80
What are some coping skills?
1. Regular excercise
2. support systems
3. Time management
4. guided imagery/visualization
5. progressive music relaxations
6. assertiveness training
7. journal writing
8. positive affirmations
9. massage
10. Pets
11. Prayer/meditation
12. Music
13. Singing
14. Laughter
15. Aromatherapy
16. sleep
17. healthy eating
18. decrease use of phone/internet
19. organization
20. b vitamins
21. sex
22. hugging
81
What are some key points of coping
1. coping can apply to an individual a family, or an entire community
2. coping occurs along a spectrum from effective/adaptive response to ineffective/maladaptive responses
3. coping may be problem focused or emotion focused
4. all individuals use coping mechanisms regardless of race, sex, or gender
5. Outcomes of coping range from resolution to acceptance
82
What is elimination? (bowel definitions)
Excretion of waste products from kidneys and intestines
83
What is defecation?
Process of elimination of waste
84
What is feces?
Semisolid mass of fiber, undigested food, inorganic matter
85
What is incontinence?
Inability to control urine or feces
86
What is void (urinary elimination definitions)
To urinate
87
What is Micturate
To urinate
88
What is dysuria?
Painful or difficult urination
89
What is hematuria?
Blood in urine
90
What is nocturia?
Frequent night urination
91
What is polyuria?
Large amounts of urine
92
What is urinary frequency?
Voiding at frequent intervals
93
What is urinary urgency
The need to void all at once
94
What is proteinuria?
Presence of larg protein in the urine
95
What is proteinuria?
Presence of large protein in the urine
96
What is hesitancy?
Difficulty initiating urination
97
What is dribbling? (urinary eleimination definitions)
Leakage of urine despite voluntary control of urination
98
What is retention?
Accumulation of urine in bladder without the ability to completely empty
99
What is residual?
Urine remaining post void > 100 ml
100
What are the steps of the bowel elimination process?
1. Fecal material reaches the rectum and causes it to distend
2. Stretch receptors are stimulated to initiate contraction of the sigmoid colon/rectal muscles
3. Internal anal sphincter relaxes
4. At the same time, Sensory impulses transmitted to the CNS produce a conscious urge to defecate---causing voluntary diaphragmatic and abominal muscles to increase downward "bearing down"
5. While at the same External sphincter relaxes allowing stool to pass through
101
What is the Valsalva maneuver?
When a person increases the pressure to expel feces by contracting the abdominal muscles (straining) while maintaining a closed airway (holding breath)
102
What are some ways we can stimulate the body to urinate for patient experiencing hesitancy?
1. Pour warm water over leg or genital area
2. Drink warm fluid
3. Turning on water
103
How can we detect urinary retention in patients?
By using a bladder scanner
104
True or false: Dribbling occurs more often in women due to women having a shorter urethra?
True
105
True or false: Pregnancy is not a cause for dribbling?
False
106
True or false: It is not normal to have to urinate alot at night?
True
107
People with heart failure are more prone to? (urinary)
Nocturia
108
In what situations would we want a patient to avoid valsalva maneuver?
1. Any surgery that might manipulate the bowel
2. Patients with potential neurological disorders/problems
109
If the signal to defecate is ignored what will happen?
The reflexive contraction will ease for a few mins, until mass peristalsis occurs again.
110
What are factors that affect bowel elimination?
1. Developmental stages
2. Personal factors
3. sociocultural factors
4. Nutrition/Hydration
5. Activity
6. Medications
7. Surgery/procedures
8. Pregnancy
9. Pathological conditions
111
How is developmental stage a factor in bowel elimination?
1. Bowel elimination patterns change throughout the life span.
For example: Babies do not recognize the urge to use the bathroom until later in life
112
How can personal factors affect bowel elimination?
1. Privacy is important to most, as sufficient time.
- Some patients/people will only use the bathroom at home and may be very hesitant to go Infront of others or away from home
2. Fast-paced jobs may cause a person to ignore the need to defecate.
Remember when you ignore the need, it promotes bowel dysfunction.
113
How can sociocultural factors affect bowel elimination?
1. stress has a major influence and can cause diarrhea or constipation.
2. Stress is a primary risk factor in the development of IBS
114
Irritable bowel syndrome can be associated with what symptoms?
1.Bloating
2. Pain
3. Altered bowel function
115
How can Nutrition/Hydration be a factor in bowel elimination?
1. Regular intake of food promotes peristalsis
2. Regular intake schedule =regularity
3. Irregular schedule = irregularity
4. High fiber: promotes peristalsis and defecation by increasing bulk, bulky foods absorb fluids and increase stool mass
5. Fluid intake- (6 to 8) 8oz glasses of water/day, is what we should promote, inadequate fluid intake can lead to dry hard stools that are difficult to pass.
116
How does activity affect bowel elimination?
1. Can stimulate peristalsis
2. Sedentary people have weaker abdominal muscles
3. Patients with limited activity often experience constipation
117
How do medications affect bowel elimination
1. All oral medications have the potential to affect function of the GI tract (can cause nausea, vomiting, diarrhea and constipation)
118
How can surgery and procedures affect bowel elimination?
1. Bowel manipulation can lead to a paralytic ileus thus #2 can happen as a result
2. Nasogastric (NG tube) on low or intermittent suction until peristalsis returns
119
What is paralytic ileus?
Cessation of bowel peristalsis, bowel continues to produce secretions which remain stagnant causing distention and discomfort. AKA bowel obstructions.
120
How can pregnancy affect bowel elimination?
1. Morning sickness
2. Slowing of intestinal motility
3. Risk of hemorrhoids
Mrs. Stunkards note FYI--Morning sickness can happen at any time, growing uterus crowds and displaces intestines, increase in progesterone slows motility, often experience constipation, decreased appetite, irregular food intake, hemorrhoids occur due to pressure of uterus and increased blood volume.
121
How does pathological conditions affect bowel elimination?
1. Neurological disorders that affect innervation (stimulating) of lower GI tract
2. Cognitive conditions that limit the ability to sense "the urge"
3. Pain or immobility that leads to sluggish peristalsis
122
True or false: Opioids can affect bowel elimination?
True- Can cause them to be slow
123
What is the general overall goal for GI elimination?
For the patient to have a soft, formed, regular bowel movement and be free of nausea, vomiting and bloating.
124
How can we promote regular defecation?
1. Privacy
2. Correct position (seated upright or squatting)
3. Timing (often after meals and the patient may need assistance)
4. Fluid intake (at least 6-8 8oz glasses)
5. Proper diet (fresh fruits/veggies, whole grains, fiber)
6. Exercise (3-5 times a week, ROM for pts on bedrest, positioning, encourage exercise)
125
Review the Bristol Stool chart
Review the Bristol Stool Chart
126
What does severe constipation look like?
Separate hard lumps
127
What does mild constipation look like?
Lumpy and sausage like
128
What do the two ideal stools look like?
1. Sausage shape w/cracks
2. Smooth soft sausage
129
What does a lacking fiber stool look like?
1. Soft blobs w. clear edges
130
What does mild diarrhea look like?
1. Mushy consistency
131
What does severe diarrhea look like
1. Liquid consistency
132
What are the seven types of stool according to the Bristol chart
1. severe constipation
2. Mild constipation
3. Ideal
4. Ideal
5. Lacking fiber
6. Mild diarrhea
7. Severe diarrhea
133
What do we need to know about fluid balance?
1. The kidneys maintain fluid balance in the body by regulating the amount of make-up of the fluid inside and around the cell
2. This is done by the kidneys maintaining the volume and composition of extracellular and to a lesser extent, intracellular fluid by continuously exchanging water and solutes like hydrogen, sodium, potassium, chloride, bicarbonate, sulfate, and phosphate ions, across their cell membranes.
3. The kidneys role in fluid balance is partially controlled by hormones
134
What are the two hormones involved in fluid balance?
1. Antidiuretic hormone (ADH) produced by the pituitary gland
2. Aldosterone, produced by the adrenal glands
135
In terms of fluid intake what should we know about the hormone ADH (antidiuretic hormone)
1. If ADH is high- causes more water to be absorbed creating a high concentration but small volume of urine
2. If ADH is low it causes more water to be excreted creating a larger volume of urine and smaller concentration.
3. Produced by the pituitary gland
136
In terms of fluid intake what should we know about the hormone Aldosterone?
1. Regulates water reabsorption and changed in urine concentration by increasing sodium reabsorption
2. Helps control secretion of potassium
3. Produced by the adrenal gland
137
What do normal urinary patterns look like?
1. Kidneys produce approximately 50-60mL per hour or 1500 mL per day.
2. Normal voiding is typically 5-6 times per day, depending on fluid intake.
138
What are the characteristics of normal urine
Specific gravity-measure of dissolved solutes in a solution
1. If urine solutes increase--specific gravity INCREASES
2. Normal specific gravity in urine is 1.002 to 1.003
3. Fluid intake increases urine becomes more diluted and lighter in color
4. Fluid intake decreases urine becomes darker and specific gravity rises
139
What colors can urine be and what could they indicate?
1. Dark yellow- less water, more waste--> dehydration
2. Red/Pink- Blood in urine
3. Brown- liver conditions, gallbladder(bile) fava beans, rhubarb
4. Orange- TB drugs, carrots (beta carotene)
5. Milky white- WBC's, purine rich foods like anchovies, herring, red meat
6. Blue- methylene blue (dye in diagnostic tests)
7. Green- Drugs (tagamet, elavil)
8. Purple-- "Purple urine bag syndrome" colonized bacteria in a catheter or collection
140
How can we promote normal urination?
1. Provide privacy
2. Assist with positioning
- Men prefer to stand, women like to be upright seated (semi-fowler's) or squatting
3. Facilitate toileting routines- times, patterns etc.
4. promote adequate fluids and nutrition
5. Assist with hygiene as needed
141
What are normal characteristics of urine?
1. Normal urine should be very pale yellow, clear and without smell
142
What could color in urine indicate?
Can indicate some form of intake or lack of fluid
143
What could clarity in urine indicate?
1. Urine will appear cloudy if a pathogen is present
144
What could odor in urine indicate?
Pathogen can change odor, as well as intake (asparagus)
145
What are types of specimen collection devices?
1. urinal
2. Hat
3. Bedpan
4. bedside commode
5. Pure wick
6. Condom cath.
146
True or false: Depending on how much help the patient needs will determine which urine/fecal collection device to use?
True
147
True or false: When collecting urine you want to use a sterile collection process
True- make sure to clean area and avoid touching the syringe to lid of collection cup
148
Intake fluids include what?
1. Semi-liquid foods
2. Ice chips
3. Fluids
4. IV fluids
5. Tube feeding
6. Irrigations instilled and not immediately removed
149
Output fluids include?
1. Fluid loss via emesis
2. Urine output
3. Diarrhea
4. Drainage from suction or wounds
150
True or false: As nurses we should teach patient and family about I & O
True
151
True or false: Use measured collection devices to get accurate counts of output?
True
152
What is immunity?
1. Immunity is a physiologic process that provides an individual with protection or defense from disease
153
Immunity responds to threats on an _______ basis
Individualized basis
154
Innate immunity is...
Genetically determined (what you are born with)- no prior exposure or antibody production involved
155
Acquired immunity is....
Produced by prior exposure or antibody production
156
Acquired immunity leads to what two types of immunity?
Do not use
157
What is active immunity
Produced by antibodies that develop in response to antigens (Immune response)
158
What is passive immunity
Produced by transfer of antibodies from another person
159
Active immunity branches into what other types of immunity?
1. Naturally acquired immunity
2. Induced active immunity
160
What is naturally acquired immunity
Develops after exposure to antigens in environment
example you get the flu--> 1month later you are exposed again. This time it isnt as bad
161
What is induced active immunity
Develops after administration of antigen to prevent disease
162
Passive immunity branches into what other type of immunities
1. Induced passive immunity
2. Conferred by transfer of maternal antibodies across placenta or in breath milk
163
What is induced passive immunity
conferred by administration of antibodies to combat infection
example-- during covid--> blood transfusions passed on antibodies
164
What is natural passive immunity
Conferred by transfer of maternal antibodies across placenta or in breast milk
165
True or false: Nutrition is vital to our immunity?
True
166
True or false: Lots of foods we eat can help provide us with innate immunity, anti-inflammation, anti-ageing anti-cancer properties?
True
167
What are some normal attributes of immunity
1. Normal WBC and deferential counts
2. Negative bacterial and viral cultures
3. Soft, non-tender lymph nodes
4. Recognition of self
5. Recognition of foreign protiens
168
Social isolation, grieving, finances, mistreatment, hospitalization and changes in lifestyle can contribute to what malnutrition factors
1. Psychological
2. Social
3. Environmental
169
Poorly fitted dentures, mouth dryness, poor dental status, taste disorders and oral mucosa disorders can contribute to what malnutrition factors?
Oral and dental disorders
170
Dysphagia can contribute to what malnutrition factors?
1. Swollowing disorders
171
Eating and depressive disorders can contribute to what malnutriton factors?
Pschiatric disorders
172
Confusion... can contribute to what malnutrition factors?
Changes in mental status
173
A stroke can contribute to what malnutrition factors?
other neurological disorders
174
Loss of appetite, dry mouth, drowsiness... can contribute to what malnutrition factors?
1. Long-term drug therapy/polymedication
175
Pain, constipation and disability contribute to what malnutrition factor
1. Acute/chronic disease
176
Needing assistance with cooking, eating and mobility may contribute to what malnutrition factor?
1. Dependency of ADL's
177
Physican orders diets or slimming diets which could contribute to what malnutrition factor?
Restrictive diet.
178
What are some factors of malnutrition? list 10
1. Phycological, social and environmental
2. Oral and dental disorders
3. Swallowing disorders
4. Psychiatric disorders
5. Changes in mental status
6. Other neurological disorders
7. Long-term drug therapy/Polymedication
8. chronic/acute disease
9. dependency of ADL's
10. Restrictive diets
179
What is an antigen?
Proteins that induce an immune response when they enter the body.
180
Antigens can be found within...
1. Microorganisms
2. Vaccines
3. Transplanted organs
4. Allergens (animal dander, pollen, foods)
181
What is inflammation
1. Cellular response to injury, infection, or irritation
182
What are localized S/S of inflammation?
1. Redness
2. Swelling
3. heat
4. Pain
5. Loss of functionality
183
What are systemic S/S of inflammation?
1. Fever
2. Increased WBC
3. Malaise
4. Anorexia
5. Nausea/vomiting
6. Lymph node tenderness/enlargement
7. Organ failure
184
True or false: Inflammation is a non-specific response to something that is harmful to the body (infection, injury, or allergen)
True
185
What are some things we should know about chronic inflammation?
1. Cause of inflammation remains active
2. Tissue destruction continues
3. Scar tissue may continue to form rather than normal functional tissue
4. Response to infections is inadequate
5. Patient experiences chronic symptoms (pain)
186
True or false: Inflammation does not play a role in many chronic diseases
False
187
What is an allergic response?
1. Hypersensitive immune reaction to a substance that normally is harmless or would not cause an immune response in everyone. Can be mild or life threatening
188
True or false: during a allergic response, histamines are released, and the body produces antibodies to the substance
True
189
What are factors that increase the host susceptibility to infection? list 9
1. developmental stage
2. Breaks in the first line of defense (skin)
3. Illness or injury/chronic disease
4. Smoking
5. Substance abuse
6. Multiple sex partners
7. Environmental factors (pollution/dirty water)
8. Invasive procedures
9. Suppressed immune system/medications
190
Malnutrition can lead to...
1. Frequent and chronic infections
2. If left without Protein for long periods it can lead to - energy malnutrition that results in thymus changes
3. Micronutrient deficiencies affect inate and adaptive immune responses
191
Micronutrients include.... list 5
1. Iron
2. Zinc
3. Copper
4. Selenium
5. Vitamins
192
Which vitamins are important to our immune system?
1. Vitamin c
2. Vitamin D
3. Vitamin a
4. Vitamin e
5. Vitamin B6
6. Vitamin b12
7. Folate
8. Zinc
9. Copper
10. Selenium
193
What things could lead to a compromised immune function and increase your risk for infection? list 10
0.Poor diet which leads to suboptimal nutritional status
1. hectic, stressful lifestyle
2. fast food, energy-dense but micronutrients poor food
3. Low income, lack of fresh nutrients
4. restricted diets
5. pollution, cigarette smoke
6. chronic stress (physical and psychological)
7. Sleep disturbances/deprevation
8. excessive alcohol consumption
9. Prolonged excessive exercise
194
What is corticosteriod
Stress hormone that suppresses the immune system
195
What happens when you stress?
1. Decrease in T cells
2. Corticosteroid released
3. Unhealthy coping strategies develop
-- drinking
-- smoking
-- insomina
196
What happens in the body when you excercise
1. Increase t-cell production
2. Lowers levels of inflammation
3. Causes WBC to circulate more rapidly
4. Greater response to vaccines
5. flushes out toxins from the body through sweat, urine and respiratory tract
197
What are things we should know about older adults and immune responses?
1. Less able to distinguish self from non-self
2. Macrophages destroy antigens more slowly
3. T-cells respond less quickly to antigens
4. White blood cells are fewer therefore the body is less able to remember and defend itself
5. antibodies become less able to attach to antigens
6. decrease in thirst therefore an increase in UTIs
198
What are nursing interventions for immunity?
1. Encourage and promote healthy nutrition
2. Hygiene/Hand hygiene promotion
3. Immunization promotion and education
4. Adequate rest and exercise promotion
5. Education promotion and
199
True or false: The secondary mediator of type I hypersensitivity reaction is immunoglobulin E(igE)
False- primary mediator
200
What are some things you should know about allergy type I?
1. Allergy
2. Deleterious effects of hypersensitivity to exogenous antigens
3. Most common allergies are type 1
4. Pollen, mold, fungi, foods, animals, dust and almost anything we encounter in our environment
5. Atopic- genetic predisposed
201
What are some S/S of allergies?
1. Water, runny eyes
2. Runny nose
3. Sneezing
4. Nasal congestion
5. An itchy rash or hives
202
What are things we should know about anaphylaxis?
1. Immediate type 1 hypersensitivity
2. Rapid release of IgE- mediated chemicals
3. Induces severe, life threatening allergic reactions
4. Food, drug and insect bites are causes.
203
What are some lung anaphylaxis signs and symptoms?
1. Trouble breathing or nosey breathing (stridor)
2. Coughing, wheezing
3. Sneezing
4. Congestion
5. Tightness in lungs
6. Hoarseness
7. Tachypnea
8. Respiratory arrest
9. Sensation of narrowed airway
204
What are some S/S of anaphylaxis in skin?
1. Pale or flushed skin
2. Hives or welts
3. Itchy skin
4. Sweating
5. Angioedema (swelling in face)
205
What are some S/S of anaphylaxis in the heart and blood vessels?
1. Chest pain
2. Low blood pressure (hypotension)
3. Weak, rapid pulse, dysthymias (tachycardia)
4. Dizziness, fainting
5. Cardiac arrest
206
What are some S/S of anaphylaxis in the mouth?
1. Swelling of throat, face, lips, or tongue
207
What are some S/S of anaphylaxis in the stomach and digestive tract?
1. Abdominal pain
2. Nausea, vommiting
208
What are some S/S of anaphylaxis in the stomach and digestive tract?
1. Abdominal pain
2. Nausea, vomiting,
3. Diarrhea
4. Cramping
209
What are mast cells known for during an allergic reaction?
Releasing histamine
210
True or false: Mast cells can detect and respond to foreign substances?
True
211
What is the first line of treatment for a patient experiencing anaphylaxis?
Epinephrine.
Benadryl is good for much milder cases
212
When does an anaphylactic reaction occur?
If not immediate than within 5-10mins.
213
True or false: the feeling of impending doom is a symptom of anaphylaxis?
True
214
What should we know about an EPI-pen?
1. Dosage: 0.3mg IM, one time use (do not need to know dosage for exam)
2. Light sensitive, keep in storage tube
3. Admin in thigh
4. Very expensive
215
What action does epinephrine produce?
1. Adrenergic response
216
What routes can epinephrine be given?
1. SQ
-Onset: 5-10mins
-Peak: 20 mins
-Duration 1-4 hours
(0.1-0.5mg not to exceed 1mg)- may repeat every 10-15 mins
2. IM
-Onset: 6-12mins
-Peak: Unkown
-Duration 1-4 hours
(0.1-0.5mg not to exceed 1mg)- may repeat every 10-15 mins
3. IV
-Onset: rapid
-Peak: 20mins
-Duration 20-30mins
(0.25mg every 5-15 mins)- may be followed by 1-4mcg continuous infusion
217
What action does benadryl have?
Antagonizes the effects of histamine at the receptor site
218
What routes can Benadryl be given?
1.PO:
-Onset 15-60 mins
-Peak 2-4 hrs
-Duration 4-8 hrs
(PO: 25-50mg every 4-6 hrs, not to exceed 300mg/ day)
2. IM:
-Onset 20-30 mins
-Peak 2-4 hrs
-Duration 4-8 hrs
(25-50mg every 4 hrs, not to exceed 400mg/day)
3.IV:
-Onset Rapid
-Peak Unknown
-Duration 4-8 hrs
(25-50mg every 4 hrs, not to exceed 400mg/day)
