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NRSG 126 > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

older adult

A

anyone over the age of 65

young old -> 65-74
middle old -> 75-84
old old -> 85+

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2
Q

geriatrics

A

medical specialty focusing on the elderly

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3
Q

life expectancy in canada

A

81.75 years

living over 80 -> wealth, healthy diet, education, health care

less than 60 years -> HIV/AIDS, public health, medical care, diet

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4
Q

baby boomers

A

born between 1946 and 1964

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4
Q

increased life expectancy

A

due to medical advancements and better treatment for chronic diseases

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5
Q

changes with aging

A
  • retirement (income)
  • social isolation
  • body appearance and function
  • sense of usefulness
  • sexuality
  • housing and environment
  • death
  • elder abuse
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6
Q

primary aging

A

inevitable loss of function that occurs no matter what we do

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7
Q

secondary aging

A

loss of function accelerated by lifestyle and other factors

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8
Q

neurological changes

A

as aging occurs organs shrink and harden

decrease in brain weight and volume, decrease in white matter, and ventricular system enlarges -> all of this is considered atrophy

brain generates fewer neurotransmitters

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9
Q

integumentary and musculoskeletal changes

A

wrinkles, grey hair, age spots

muscle atrophy

loss of bone mass

fragile skin -> easily broken

misconceptions -> disables, functionally dependent, slow

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10
Q

respiratory and cardiovascular changes

A

blood vessels harden and thicken -> the heart has to work harder

chest wall hardens

alveoli change

increased risk for infection -> are unable to cough forcefully to clear bacteria

increased blood pressure

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11
Q

gastrointestinal and genitourinary changes

A

atrophy of kidneys and other organs

incontinence

reflux

oral hygiene

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12
Q

sensory changes

A

decreased balance

worsened eye sight and hearing

presbyopia-> gradual loss of eyes ability to focus on nearby objects

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13
Q

reproductive and endocrine changes

A

decreased estrogen

decreased sperm count

impacts immune system and ability to fight off infections

weight control

temp control

changes in the inflammatory response

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14
Q

immune system changes

A

normal defences are decreased

change in cough reflex

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15
Q

leading health challenged in older adults

A

chronic diseases -> noncommunicable (NCDs), persistent and generally slow in progression, cannot be cured

leading cause of death = cancer

2nd leading cause = heart disease

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16
Q

ageism

A

discrimination based on the age of a person

society values attractiveness, energy, youth -> undervalues older persons

nurses must be aware of ageism and address it -> advocate and question negative attitudes and stereotypes

treat older adults as independent, dignified persons

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17
Q

age-specific approach

A

be aware of atypical signs and symptoms

altered response and manifestations of disease

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18
Q

normal defences against infection

A

normal flora (microorganisms)

body system defences -> inflammation = vascular and cellular responses
- inflammatory exudate -> fluid and leukocytes move to site of injury in response to local inflammation
- tissue repair
- histamine release

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19
Q

risk of infection : susceptibility

A

age -> very young and older persons

stress

nutritional status

disease processes -> chronic illness

medical therapy-> meds that suppress the immune system

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20
Q

incubation

A

first stage of infection -> pathogen enters the body, no symptoms present

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21
Q

prodromal

A

second stage of infection -> mild or non specific signs/symptoms

transmission may occur between this stage and the illness stage

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22
Q

illness stage

A

the third stage of infection -> specific signs and symptoms present

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23
Q

convalescence

A

fourth stage of infection -> acute symptoms disappear, homeostasis returns and the body replenishes

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24
Q

localized infection

A

limited to a specific part of the body and has local symptoms

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25
Q

systemic infection

A

pathogen is distributed throughout the body

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26
Q

WBC count

A

high = something infectious

low= susceptible to infections

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27
Q

CRP

A

a protein whose levels rise in response to inflammation

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28
Q

cardinal signs of inflammation

A

these are local inflammation/infection S+S

heat, redness, swelling, pain, immobility, fever(sometimes)

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29
Q

S+S of systemic infection

A

drop in BP
increased HR and RR
altered mental status
sepsis

blood work needed -> blood cultures, lactate (>4), WBC (high or low)

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30
Q

older adult S+S of infection

A

may not show typical signs and symptoms

-delirium -> change in mental status
-falls
-dehydration
-decreased appetite
-loss of function/incontinence
-dizziness

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31
Q

healthcare associated infection (HAI)

A

also known as nosocomial (disease originating in the hospital)

lungs
surgical/open wounds
urinary tract
blood stream

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32
Q

endogenous

A

infection that occurs when some of the flora already in the body is altered

ex. enterococci, yeasts

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33
Q

exogenous

A

an infection that arises from microorganisms external to the individual

ex. salmonella, clostridium tetani

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34
Q

protecting patients from HAI

A

routine practices -> hand hygiene, proper ppe

isolation precautions

break the chain of infection

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35
Q

contact precautions

A

gown and gloves

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36
Q

droplet precautions

A

surgical mask/eye protection

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37
Q

airborne precautions

A

N95 mask/ eye protection

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38
Q

C diff

A

bacteria -> normal flora is interrupted

diarrhea

treat with antibiotics

cdiff and flu -> gown and gloves -> contact precaution

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39
Q

flu

A

respiratory illness

viruses - nose, throat, lungs
mild to severe

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40
Q

CVA

A

stroke, cerebral vascular accident

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41
Q

functional status

A

refers to the capacity and safe performance of ADLs and is an indicator of health or illness in older adults

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42
Q

polypharmacy

A

concurrent use of many medications

increase the risk for adverse reactions

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43
Q

palliative care

A

improving overall quality of life for persons with life-limiting illness and for their families

includes symptom management, achieving goals and expectations of illness management

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44
Q

restorative care

A

consists of two types of ongoing care -> continuing the convalescence from acute illness or surgery that began in acute care
-> addressing chronic conditions that affect day to day functioning

both types take place in private homes and LTC

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45
Q

cognitive impairment

A

is not normal in older adults and needs investigation and intervention

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46
Q

acute care settings

A

increases older adults risk for delirium, dehydration, malnutrition, HAI’s, falls, urinary incontinence

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47
Q

pathogens

A

a microorganism that can cause disease

infection = entry and multiplication of a pathogen

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48
Q

communicable disease

A

can be transmitted from one person to another

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49
Q

gender equity

A

equal treatment of all, regardless of gender

no gender discrimination

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50
Q

cultural safety

A

recognizing power and resource distribution

awareness of institutional discrimination

be aware of personal biases

insurance doesnt often cover alternative medicine -> leads to fear of discrimination and lack of trust in health care system -> interventions are prolonged and client suffer

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51
Q

cultural humility

A

life long learning

interpersonal respect and reflection

self awareness -> personal and professional

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52
Q

health equity

A

elimination of systematic health disparities

associated with social advantage/disadvantage

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53
Q

implicit bias

A

unknowingly

influenced by factors from growing up

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54
Q

explicit bias

A

knowingly/ recognized bias

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55
Q

ethnocentrism

A

i’m right and you’re wrong
pushing beliefs onto others

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56
Q

Trauma informed practice (TIP)

A

prevent -> prevent more harm and triggers
safety-> take down barriers and reduce stigma

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57
Q

4 R’s of TIP

A

realize
recognize
respond
resist

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58
Q

6 guiding principles of TIP

A

safety
trust/transparency
peer support
cultural/historical/gender issues
collaboration and mutuality
empowerment, voice, choice

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59
Q

therapeutic relationships

A

individualized care
safety, trust, caring
good nursing care

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60
Q

the nursing process (communication)

A

perception
perceptual bias -> knowing the way we talk/present ourselves
reflexivity
contextual knowledge

61
Q

the communication process

A

sender -> message -> channel -> receiver -> feedback

62
Q

metacognition

A

body language 55%
tone 38%
actual spoken word 7%

be aware of how you are conducting yourself

63
Q

verbal communication

A

written, oral, or sign language

be aware of different meanings -> may be perceived in a way you didn’t intend

pacing

tone

pitch

timing

64
Q

nonverbal communication

A

personal appearance
facial expression
posture
eye contact
personal space
touch, gestures, sound

can be impacted by PPE

may supplement, reinforce or undermine verbal communication

65
Q

personal space and touch

A

intimate -> 0-1.5 ft
personal -> 1.5-4ft
social -> 4-12ft
public ->12+ ft

consent and privacy is essential for touch

66
Q

therapeutic communication techniques

A

share observations
paraphrase and clarify
summarize
provide information

ineffective communication=poor outcomes, miscommunication, decreases nurse credibility

dont ask why
give false reassurance
personal opinions
defensive responses

67
Q

active listening -> SOLER

A

s= sit facing pt
o= open posture
l= lean forward
e= eye contact
r= relax

68
Q

aphasia

A

inability to produce/understand language

cannot speak clearly
cognitively, visually, or hearing impaired
speak a different language
unresponsive

69
Q

cognitive changes

A

structural and physiological changes within the brain are normal with aging

disorientation, loss of language, poor judgment, are NOT normal changes with aging -> something is wrong

70
Q

3 Ds

A

dementia
delirium
depression

71
Q

Delirium

A

an acute, reversible state of disorientation, inattention, and confusion

rapid onset -> hrs-days

MEDICAL EMERGENCY

72
Q

S+S of delirium

A

days/nights mixed up
visual hallucinations
more alert/more tired
different behaviour/personality

older persons tend to experience hypoactive delirium -> might seem like depression

73
Q

CAM+

A

if a client is CAM+ they have delirium

if the client is CAM+ complete PRISME

74
Q

causes of delirium

A

infection, low sodium, dehydration, nausea, constipation

75
Q

management of delirium

A

find and treat underlying cause
include family
keep routine simple
encourage healthy eating/drinking
dont argue with pt

76
Q

dementia

A

broad term for a set of symptoms that affect the brain

gradual deterioation

umbrella term for memory loss and other thinking abilities

77
Q

warning signs of dementia

A

impaired judgment
problems with language
memory loss affecting day to day activities (ADLs)
disoriented to time and place

78
Q

Alzheimers disease

A

cause = genetics, lifestyle, environmental factors

gradual decline

decreased cognitive function

79
Q

vascular dementia

A

cause = stroke, TIA, blood supply issue

rapid decline

decreased cognitive function following a stroke of TIA

CT or MRI for diagnosis

80
Q

lewy body

A

cause = abnormal build up of proteins

gradual decline

common in men and those with parkinsons

81
Q

mini-mental (MMSE)

A

score of 23 or less = cognitive impairment

determine dementia

82
Q

depression

A

mood disorder characterized by feeling of sadness or despair -> longer than 2 weeks

not a normal part of aging

83
Q

S+S of depression

A

loses interest
sleep changes
change in ADL’s
lethargy
suicide ideation

84
Q

GDS

A

geriatric depression scale

85
Q

depression management

A

diet
exercise
manage stress
medications

86
Q

the nursing process (ADPIE)

A

assessment
diagnosis
planning
implementation
evaluation

87
Q

assessment

A

supplement, confirm, or refute data obtained from hx

confirm/identify nursing diagnosis

make judgments about health status and management

look at chart/my days/ nursing documentation
pt specific needs
family history

88
Q

types if assessments

A

interview
emergency/primary assessment
focused assessment
H2T assessment

88
Q

subjective data

A

feelings, perceptions, self report

89
Q

primary data sources

A

client

89
Q

objective data

A

observations, measurements, verifiable facts

90
Q

secondary data sources

A

family, physician, allied health, chart

91
Q

tertiary data sources

A

nurse experience, literature

92
Q

primary assessment

A
  • QPA and POCRA (ABCDE)
  • first assessment you do when you meet a client
  • is repeated whenever you suspect or recognize a change in the clients status -> or they are becoming unstable
93
Q

Safety assessments

A

-POCRA
-infection control practices
-falls preventions -> call button in reach, bed at correct height, declutter room
- scope of practice

94
Q

Inspection

A
  • visual check
    -ensure all surfaces can be viewed
  • look for size, symmetry, colour, position, abnormalities
    -compare both sides
95
Q

auscultation

A
  • use stethoscope
  • identify sounds -> normal or abnormal
  • determine characteristics of the sounds -> frequency, loudness, quality
96
Q

palpation

A

get consent first

  • touch
    -assess for tenderness, distension, masses
  • tender areas are palpated last
97
Q

diagnose

A

support the diagnosis through assessment findings

consider risk factors, etiology, definition of the label of the diagnosis and the diagnostic label

98
Q

nursing diagnosis

A

a clinical judgment about client responses to an actual or potential health problem

99
Q

medical diagnosis

A

the identification of a disease or condition on the basis of specific evaluation of S+S

100
Q

collaborative problem

A

an actual or potential complication that nurses monitor to detect a change in client status

101
Q

plan

A

goals and outcome are created that directly impact client care

set priorities
select nursing interventions
write plan of care
establish client centred goals/outcomes

102
Q

implementation

A

carrying out or delegating nursing interventions

treat symptoms
promote health
facilitate coping

103
Q

TID

A

three times a day

104
Q

evaluation

A

reassess
evaluate
determine if outcomes have been met
continue, modify, or terminate plan of care

105
Q

avoiding errors

A

CRITICALLY THINK

do i understand the data?
do i need guidance?
have i considered other diagnoses?

106
Q

pain

A

pain is NOT normal with aging

most common reason people will seek medical care

its the 6th vitial sign

an activation of the nervous system

purpose = defence

107
Q

older adults experiencing pain

A

may have atypical presentation

pain or pain treatments can have increased negative effects

108
Q

nociception

A

perception or sensation of pain

transduction
transmission
perception
modulation

109
Q

transduction

A

first phase -> injury and response initiation

damages cells -> chemical release -> nociceptor activation (sensory nerve cells)

110
Q

transmission

A

second phase -> pain moves from the PNS to the CNS

pain-sensitizing/inflammatory substances spread the message via nerve fibres -> transmission of pain in the dorsal horn -> transmitted through the spinothalamic tract to the brain

111
Q

nociceptors

A

sensory nerve cells that react to noxious stimuli by sending signals to the spinal cord and brain

112
Q

A-delta fibres

A

a fibre in a peripheral nerve

myelinated, sharp, well localized, short in duration

113
Q

C fibers

A

unmyelinated, dull, aching, diffuse nature, slow onset, relatively long duration

114
Q

perception

A

the third phase-> conscious awareness of pain and interpretation

pain interpretation (intensity, location, character, quality) -> somatosensory cortex (location and intensity)-> association cortex (how do we feel about the pain -> limbic system)

115
Q

modulation

A

fourth phase -> altered signals and response

pain increased or decreases

body reacts

116
Q

mobility

A

ROM -> passive or active
gait (how they walk)
exercise
activity tolerance

117
Q

proprioception

A

awareness of body position and its parts

proprioceptors are in muscles, bones, joints

118
Q

balance

A

controlled by the cerebellum and inner ear

119
Q

skeletal system

A

206 bones

support
protection
movement
mineral storage
hematopoiesis

characterized by shape

long -> femur
short -> carpels
flat -> sternum
irregular -> vertebrae

120
Q

joints

A

connections between bones

121
Q

synarthortic joint

A

bone on bone

122
Q

cartilaginous joint

A

joints with little movement, cartilage found in between bones

123
Q

fibrous joint

A

a joint where 2 bony surfaces meet with a ligament

124
Q

synovial joint

A

freely moving joint covered by articular cartilage and connected by ligaments

125
Q

ligament

A

fibrous tissue that connects bones and cartilage/ bones and bones

126
Q

tendon

A

fibrous bands of tissue that connect bone to muscle

127
Q

cartilage

A

supporting connective tissue, used for shock absorption

128
Q

skeletal muscles

A

made from fibres that contract when stimulated by nerve impulses that travel from one nerve to the muscle across the neuromuscular junction

functions -> moving, stabilizing, posture, heat, circulation, organ protection

129
Q

Isotonic contraction

A

muscles contract and change length

130
Q

acute pain

A

sudden and typically resolves

cause = injury, illness, trauma, surgery, infection

131
Q

chronic pain

A

lasts over 3 months and often not resolved

cause = illness or injury, cancer, RA, OA

vitals may appear in normal ranges as the body has adapted to the pain

132
Q

nociceptive pain

A

somatic -> bones, joints, connective tissues, muscles

visceral -> organs- heart, liver, pancreas, gut

133
Q

neuropathic pain

A

deafferentation

sympathetic maintained

peripheral

caused by damage of dysfunction of the nervous system

is often burning or shooting pain, tingling, electrical, or prickling

not localized

usually chronic

134
Q

somatic pain

A

nociceptive pain

superficial burn, tibia fracture, arthritis

described well -> throbbing, sharp, achy

localized

135
Q

visceral pain

A

nociceptive pain

myocardial infarction (MI), appendicitis, menstrual cramps

not as easy to describe -> may radiate

not localized

136
Q

deafferentation pain

A

neuropathic pain

spinal cord injury, shingles, phantom limb pain, spinal tumor

injury to the CNS or PNS

137
Q

sympathetic pain

A

neuropathic pain

raynaud’s disease, complex neuropathic pain (CRPS)

disregualtion of the ANS

138
Q

peripheral pain

A

neuropathic pain

diabetic neuropathy, trigeminal neuralgia

injury to the peripheral nerves

139
Q

non-pharmacological intervention

A

cold/heat
massage
positioning
visualization/imagery
distraction
prayer
relaxation techniques
deep breathing

140
Q

pharmacological interventions

A

non-opioids -> mild to moderate pain (tylenol)

NSAID -> mild to moderate pain (advil)

opioids -> moderate to severe pain (codeine, morphine, hydromorphone)

co-analgesics -> not initially intended for pain (anticonvulsants, corticosteriods)

141
Q

tolerance

A

opioid use-> stimulation of opioid receptors in brain -> upregulation of opioid receptors-> receptors demand more opioids

142
Q

withdrawal

A

72 hours physical symptoms at their peak

1 week symptoms start to lessen

2 weeks psychological and emotional symptoms

1 month cravings and depression

143
Q

osteoarthritis

A

chronic disease that commonly affects hips and knees, causes lots of main and impacts mobility

wear and tear on the joint

most common type of arthritis

progressive breakdown of cartilage and underlying bone

x-ray or mri

NSAIDS or non opioid
mobility aids
surgery

144
Q

osteoporosis

A

a chronic disease that is primarily age associated
major impact on mobility and safety and increases risks for fracture

porous bones = decreased bone mass

dual energy x-ray (bone density)

medications
vitamins/minerals
physiotherapy

145
Q

pathological fracture

A

an injury that occurs from a chronic condition that weakens bones

causes = osteoporosis, cancer

x-ray

surgery
pain control
palliative care

146
Q

rheumatoid arthritis

A

an autoimmune disorder that affects joints

occurs in hands and affects independence with ADLs

injury to the joint lining

147
Q

OPQRSTUV (pain assessment)

A

onset
precipitating/palliating
quality/quantity
region/radiation
severity
timing
understanding of the pain and impact on ADLs
values of the pt

NRSG 126 (3 decks)

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