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NURS123 > MIDTERM > Flashcards

MIDTERM Flashcards

1
Q

OPQRSTUV

A

Onset
Palliative (What helps and aggrevates)
Quality (How would you describe the pain)
Region: Where would you describe the pain to be
Severity: How would you rate this pain?
Treatment: What has worked in the past?
Understanding: Is the pain acceptable, intolerable
Values: Any more pain, emotional, spiritual etc.

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2
Q

SBAR

A

Situation
Background
Assessment
Recommendations

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3
Q

3 types of clinical reasoning modules

A

Diagnostic reasoning
Nursing process
Critical thinking

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4
Q

Cue

A

a piece of information, sign or symptom, or lab data.

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5
Q

diagnosis of health problems iswho’s job

A

in the realm of advance practice

NPs and physicians

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6
Q

Nursing process

A

Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation

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7
Q

First-level priority problems

A

emergent, life threatening, immediate respnose required

ABCDEF assessment

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8
Q

Second level priority problems

A

Urgent, necessitating prompt intervention

Acute pain, abnormal results, mental status change

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9
Q

Third level priority problems

A

Important, addressed after more urgent problems

Lack of knowledge, family coping, lack of activiity, rest

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10
Q

What is a collaborative problem

A

Treatment invlovles multiple disciplines

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11
Q

Relational approach to health assessment allows professionsal to approach nursing situations from waht perspective

A

A perspective of inquiry

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12
Q

DARP charting stands for:

A

Data
Action
Response
Plan

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13
Q

Communication skills

A

Unconditional positive regard
Empathy
Active listening

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14
Q

Traps of interviewing

A

Providing false assurance or false reassurance
2. Giving unwanted advice
3. Using authority
4. Using avoidance language
5. Engaging in distancing
6. Overusing professional jargon or casual language
7. Using leading or biased questions
8. Talking too much
9. Interrupting
10. Using “why” questions

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15
Q

Are notes a good idea during interview?

A

Impedes eye contact
Shifts attention away from patient
Interrupts patient’s narrative flow
Impedes observation of nonverbal behaviour
Can be threatening during discussion of sensitive issues

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16
Q

LOTTAARRPP

A

Location
Onset
Type
Timing
Aggravating
Alleviating
Radiating
Related symptoms
Personal perception
Precipitating event

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17
Q

Purpose of LOTTAARRPP

A

Describe any symptoms reported by an individual

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18
Q

Health history questions

A

Childhood illnesses
Accidents or injuries
Serious or chronic illnesses
Hospitalizations
Operations
Obstetrical history
Immunizations
Most recent examination date
Allergies
Current medications
Age and health or cause of death of blood relatives
Health of close family members

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19
Q

Difference bw ADLS and IADLS

A

ADLS a patient’s self-care abilities in the area of bathing, dressing, toileting, eating, and walking

Instrumental activities of daily living: assess ability for independent living, such as housekeeping, shopping, cooking, doing laundry, using the phone, managing finances, nutrition, social relationships, self-concept, coping, and home environment.

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20
Q

Skills of physical examination

A

inspection,
palpation,
percussion
auscultation

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21
Q

What is the exception to the order of the physical examinatoini assessment

A

Abdominal assessment

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22
Q

Which part of body is best for feeling temperature of patient

A

Back of hand

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23
Q

Best part of body with which to discern vibration

A

Tip of fingers

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24
Q

Purpose of percussion

A

Assess underlying structures

A trained ear can detect sounds that are characteristic of a solid or hollow structure and can be used to detect the location, size, and density of an underlying organ.

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25
Q

Percussion sound descriptions

A

Resonant
Hyperresonant
Tympany
Dull
Flat

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26
Q

What sort of things are observed in a general survey

A

Physical appearance
Body structure
Mobility
Behaviour (Dress, heigiene etc.)

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27
Q

Narrative Charting

A

charting reads like a story, may include assessments, interventions, and outcomes in chronological order. Often referred to as progress notes.

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28
Q

What does focus charting using DARP concerned abt?

A

centers on a patient’s concern, behavior, change in status, significant event. It includes data, analysis/action, response, plan

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29
Q

purpose of ISBARR

A

to prevent miscommunication and adverse patient events. This is used to organize information/data for verbal communication within the health care team (ie. Calls to physicians, nursing shift reports, patient transfers to other units). Critical assessment findings communicated in a structured manner ensure that team members are well aware of the patient status that requires an action response.

extra I is identify self and client
Extra R is repeat back for clarity

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30
Q

ABC

A

Appearance: what are they doing, behavior, posture/positioning, level of consciousness, ability to interact

Work of Breathing: listen for obvious sounds of abnormal breathing (those heard without a stethoscope) and look at their body position.

Circulation (colour): skin color, obvious bleeding.

DO NOT proceed with assessment if any abnormal findings within ABC assessment

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31
Q

ABCDE

A

Airway
Breathing
Circulation
Disability
Exposure

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32
Q

What is the focused examination?

A

performed after both the initial assessment and primary survey reveal the patient is stable enough for you to proceed with a thorough review of body systems

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33
Q

What is included in the initial assessment

A

Appearance
Work of Breathing
Circulation (color)

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34
Q

What is included in the primary survey (safety check)

A

A-B-C-D-E-F
Vital Signs

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35
Q

What is included in the focused physical examination

A

Body System(s)
Subjective & Objective Data

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36
Q

What is the order of assessments?

A

Initial Assessment
Primary survey
Focused Physical examination

Do not progress if anything is abnormal in any of the first assessments

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37
Q

Number one priority in ABCDE

A

A clear airway

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38
Q

Examples of airway interventions

A

Reposition – head tilt/chin lift or jaw thrust
Suction – secretions, emesis
Airway – adjunct, endotracheal intubation

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39
Q

What would be a concerning number of respirations?

A

> 20 Respirations per minute
<12 Respirations per minute

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40
Q

Apnea

A

Not breathing for 20 seconds or more

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41
Q

SBO2 Sat should be

A

96 or higher on room air

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42
Q

Breathing interventions

A

Elevate head of bed or position of comfort
Apply oxygen – nasal prongs, face mask
Assist ventilation – bag-valve mask

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43
Q

Things to assess for circulation

A

Heart rate and rhythm
Quality of pulses
Skin color, temperature, capillary refill
Blood pressure
Signs of bleeding
Intravenous access
Urine output

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44
Q

Abnormal signs for circulation

A

HR <50 or >90
Absent or poor quality pulses
Skin pale, cyanotic, grey
Cap refill >3 sec
BP less than 90 systolic
Hemmorhage
Urine output <0.5 ml/kg/hr

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45
Q

circulation interventions

A

Chest compressions
Control of bleeding
IV access
Fluids, medications, blood transfusion

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46
Q

What is assessed regarding disability

A

AVPU/GCS
Pupil response
Blood glucose/dextrose
Pain

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47
Q

3 elements of a disability assessment

A

: level of consciousness, pain, and blood sugar level (dextrose) .

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48
Q

AVPU

A

is the patient alert,
or responds only to verbal stimulus,
painful stimulus,
or is unresponsive

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49
Q

GCS

A

Glasgow Coma Scale is a more detailed assessment and scoring of how your patient responds in these three categories: eye opening, motor response, verbal response. Score out of 15

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50
Q

Warning signs of a disability problem

A

Any decrease in level of consciousness
Change in pupil response – sluggish, non-reacting, unequal
Blood glucose < 4 mmol/L
Sudden or uncontrolled pain

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51
Q

What level of blood glucose is considered hypoglycemic

A

glucose less than 4 mmol/l is considered hypoglycemia and needs to be treated rapidly

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52
Q

Fastest way to check glucose levels

A

glucometer

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53
Q

dextrose

A

Low glucose levels

common cause of decreased LOC

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54
Q

Disability interventions

A

Attempt to elicit a response – verbal, then painful stimulus
If unresponsive, obtain help and check breathing and pulses, repeat vital signs
Administer glucose
Treat pain

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55
Q

What is often referred to as the 5th vital sign

A

Pain

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56
Q

What is entailed in the exposure assessment

A

Face and head
Torso (front and back)
Extremities
Skin
Temperature
Incontinence

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57
Q

Exposure abnormalities

A

Bleeding, burns, unusual markings
Petechiae, purpura
Temperature less than 36.1 or greater than 38.0 degrees

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58
Q

Petechiae and purpura

A

non-blanchable red or purplish rashes that may signal internal bleeding or a bleeding disorder

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59
Q

Exposure interventions

A

Control bleeding, investigate signs of abuse, maintain a normal temperature.

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60
Q

Full set of vital signs includes:

A

HR
BP
RR
SBO2
Temp

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61
Q

Abnormal vital signs

A

HR < 50 or >90
RR <8
BP systolic <90 or >180
Temp <36.0 or >38.0
O2 Sat <95%

62
Q

Functions of the skin

A

Protection – waterproof, resilient; protection from physical, chemical, thermal, light wave injury.
Prevention of penetration – a barrier that keeps out micro-organisms, prevents loss of water and electrolytes.
Perception – sensory end organs for touch, pain, temperature, and pressure all reside in the skin.
Temperature regulation – sweat glands and subcutaneous insulation for heat dissipation and storage.
Identification – unique facial characteristics, hair, skin color, fingerprints.
Communication – face and body posture signal emotional states (ie. Blushing).
Wound repair – allows for cell replacement.
Absorption and excretion – some excretion of metabolic wastes (ie. Minerals, sugars, amino acids, cholesterol, uric acid, urea).
Production of vitamin D – UV light converts cholesterol into vitamin D on the surface of the skin.

63
Q

Pruritis

A

= itching; the most common skin symptoms

64
Q

Seborrhea

A

Oily

65
Q

Xerosis

A

Dry

66
Q

How does the aging process effect skin

A

Epidermis Flattens, thins (easier entry of microorganisms)
dermis experiences a loss of connective tissue (collagen) = risk of shearing and tearing.
- the subcutaneous layer decreases = less cushioning from physical injury
- decrease in amount of sweat and sebaceous glands = skin is dry, less thermoregulatory response.
- psychological impact of a loss of youthful appearance, linked to self-esteem

67
Q

What aspects of skin are you palpating for

A

Thickness
Texture
Edema
Mobility and Turgor
Vascularity
Temperature
Moisture

68
Q

When does clubbing of the nails occur

A

Nails can be a source of information on self-care ability/habits, and certain diseases. For example, clubbing of nails occurs with

69
Q

ABCDE. rule for skin lesion examination

A

A: asymmetry
B: border irregularity
C: colour variation
D: diameter
E: elevation and enlargement

70
Q

Stages of pressure ulcer

A

Stage 1 – intact skin appears red, but unbroken. Localized erythema, blanchable (turns light with pressure, then back to skin color).
Stage 2 – partial thickness, loss of epidermis +/- dermis. Looks like an abrasion or open blister.
Stage 3 – full-thickness, extends into the subcutaneous tissue. Looks like a crater, may see subcutaneous tissue.
Stage 4 – full-thickness, involves all skin layers and extends into supporting tissue; muscle, tendon, bone may be exposed, black or brown necrotic tissue (eschar).

71
Q

What do non-blanchable rashes indicate?

A

may signal a bleeding disorder, such as thrombocytopenia (abnormal clotting) or septicemias (infection in the blood stream

72
Q

Braden risk scale assesses

A

moisture, activity, mobility, nutrition, frictino and shear

low score is higher risk

73
Q

Four phases of nociception

A

Transduction – a noxious stimuli is inflicted upon the individual.

Transmission – the impulse moves along the spinal cord to the brain, if not interrupted by the opioid receptors.

Perception – the noxious stimuli is interpreted as pain.

Modulation – the pain impulse may be slowed down by neurotransmitters that act like analgesia (ie. Serotonin, norepinephrine, endorphins, etc).

74
Q

3 types of pain

A

Somatic = may be superficial (ie. Skin) or deep (ie. Muscles, tendons).
Visceral = internal organs (ie. Gallbladder, kidney, intestine, pancreas).
Neuropathic = caused by damage or disease of the somatosensory nervous system (ie. Spinal cord injury, infectious or metabolic diseases, medication-induced).

75
Q

A consideration when assessing pain in children

A

children experience pain in the same way as adults but are not able to describe it in the same way

76
Q

Most reliable indicator of a persons pain

A

self report

77
Q

Initial pain assessment

A

Onset: When did the pain start?
Provocative or palliative: What makes your pain worse? Does anything make it better/relieved?
Quality of pain: Words to describe pain?
Region of body: Where? Does it radiate or move to other areas?
Severity: How do you rate the pain on an intensity scale?
Treatment and Timing of pain: What treatments have worked for you? Is it a constant, dull, or intermittent pain? Pain-free periods or changed over time?
Understanding of pain: What do you believe is causing the pain? Goal for comfort?
Values. Acceptable level of pain? Any other stressors or spiritual pain?

78
Q

NVPS

A

Adult NonVerbal Pain Scale

judged on:

Face
Activity
Guarding
Phsyiology (VS)
Respiratory

0 - 2 (0 being normal, 2 being excessively abnormal)

79
Q

Signs of an unconuscious patient being in pain

A

Grimacing, wincing, moaning, rigidity, arching, restlessness, shaking, pushing to indicate pain
Critical-Care Pain Observation Tool

80
Q

Major two muscles of the neck

A

Sternomastoid – for head rotation and flexion
- Trapezius – moves the shoulders and extends/turns the head.

81
Q

Thyroid Gland

A

important endocrine gland with a rich blood supply on either side of the trachea
responsible for cellular metabolism; normally not palpable behind the trachea.

82
Q

Subjective data for the head

A

dizziness, headache, head injury, history

83
Q

normocephalic

A

Normal size and shape of the head

84
Q

Temporal artery may be palpated

A

Bw cheek bone and eye

85
Q

What neck artery and how do you assess it?

A

Auscultate carotid artery before palpation (so not to dislodge plaque). Listen for a bruit (blowing, swishing sound) on both sides. Could indicate narrowed arteries

Do not assess both at same time

86
Q

If trachea is not midline

A

May have an airway problem, intervene immediately

87
Q

How many muscle attatch to eye

A

6

88
Q

What tool do advanced nurses use to examine the ey?

A

opthalmoscope

89
Q

Subjective data regarding eyes

A

Vision difficulty
Pain
Crossed eyes (When does this occur)
Redness or swelling
Watery Discharge
Ocular problems
Glasses or Contacts
Self Care behaviours
Medication
Vision Loss

90
Q

Diplopia

A

Crossed eyes

91
Q

Sudden onset of eye pain, blurred vision, floarers in visual field or loss of peripheral vision is what?

A

a medical emergency

92
Q

PERRLA

A

Common eye exam performed by nurses in acute care settings

pupils are equal, round, react to light and accommodation

93
Q

Normal Pupil size

A

3-5mm

94
Q

Diopter

A

Unit of strength in the lenses of an ophthalmoscope

95
Q

Some normal findings of the ocular fundus

A
  • optic disc
  • retinal vessels
  • general background
  • macula
96
Q

How many posiitions of gaze must be checked to reveal any ocular muscle weaknesses?

A

6

97
Q

Nystagmus

A

a fine oscillating movement around the iris, may indicate weakness or disease

98
Q

Ptosis

A

drooping upper lid

99
Q

Miosis

A

constriction of pupi

100
Q

Mydriasis

A

dilation of pupil

101
Q

Vertigo

A

inflammation of the semicircular canals of the inner ear that result in a spinning, whirling sensation.

102
Q

What is the external ear also called

A

auricle or pinna

103
Q

Subjective data for ears

A

Earaches
Infections
Discharge
Hearing loss
Enbironmental noise
Vertigo
Self care behaviours

104
Q

What determines whether you have dry or wet ceremun

A

Genetics

105
Q

Most common chronic condition in older adults - normal part of agin

A

Hearing loss

106
Q

Cues of possible hearing loss

A

Frowning or straining to hear
Acting irritable or starteld when u raise your voice
Inappropriately loud voice
Flat monotonous tone
Garbelled. speech

107
Q

60 60 rule reccomendation

A

No more than 60 minutes of listening at no more than 60% maximum volume in earbuds to prevent hearing damage

108
Q

Position of ear during ear exam

A

Pull pinna up and back on adults or older children (pull pinna down on infants and < 3yrs of age).

109
Q

Watery drainage out of ear canal following head trauma could indicate

A

CSF and therefore a skull fracture

110
Q

Subjective questions regarding mouth and throat

A

Discharge, colds, sinus pain, trauma, allergies, altered smell, sores or lesions
sore throat, bleeding gums, toothaches, hoarseness, dysphagia

111
Q

Epistaxis

A

Nosebleeds for >20 minutes is a medical emergency

112
Q

Strategies for dealing with dysphagia

A

sitting in high fowler’s, remain upright for 30 min following meals, perform good oral hygiene, thickened fluids, take time to assist with feed, lessen distractions

113
Q

Indicators of brain disfunctions

A

Partial or complete paralysis.
Muscle weakness.
Partial or complete loss of sensation.
Seizures.
Difficulty reading and writing.
Poor cognitive abilities.
Unexplained pain.
Decreased alertness.
Head injuries (falls)
Headaches
Dizziness/vertigo/fainting
Tremors
Weakness (usually one-sided)/paralysis
Incoordination
Numbness/tingling sensation
Dysphagia
Aphasia
Falling
Confusion
Visual disturbances

114
Q

What does aging cause in relation to the brain?

A

Atrophe

115
Q

Syncope

A

Temporary LOC
(Fainting)

116
Q

Sizures

A

involuntary movements with altered consciousness.

117
Q

Tremors

A

Tremors = involuntary movements (shaking, vibrating, trembling) while conscious.

118
Q

Subjective brain quesitons

A

Incoordination
Numbness or Tingling Sensation
Difficulty Speaking or swallowing
Significant Past History
Environmental or Occupational Hazards
Head ache
Head Injury
Dizziness or Vertigo
Seizures
Tremors
Weakness

119
Q

type of neuro assessment depends on ?

A

Your role and the sympotms being displayed by the patient

Screening neuro exam – health history in otherwise healthy patient
Complete neuro exam – neuro concerns, most detailed and thorough exam
Neuro re-check - those with deficits and require frequent rechecks

120
Q

A change in ____ is the earliest and most sensitive index of change in neuro status

A

LOC

121
Q

3 questions we ask patients to determine whether they ar ealert and oriented

A

Person (first, last name, DOB, occupation, names of others)
Place (building, city, province, country)
Time (date, month, year, day of week, season)

122
Q

Increasing stimulus for impair LOC least to greatest

A

Calling of name
Light touch on patient’s arm
Vigorous shake of patient’s shoulder
Pain applied (pinch nail bed, squeeze trapezius muscle, sternal rub)

123
Q

Levles of consciousness

A

Alert
Lethargic: More than sleepy, multiple tries to wake up or loud verbal stimuli
Obtunded – severe drowsiness, may rouse for brief periods with repeated painful stimuli
Stupor – mostly unresponsive, will only rouse with vigorous repeated painful stimuli and will immediately lapse back into unresponsiveness
Coma – unresponsive, cannot be roused with any stimuli, eyes remain closed
Acute delirium – a fast-developing type of confusion, often caused by an illness or environmental factors that disrupt brain function

124
Q

PERRL vs PERRLA

A

PERRL is routinely documented on all patients in the acute care setting as an indicator of neurological status. Does not always include “A” = accommodation (test for ability of eyes to focus more of an eye exam). So important to know your patient’s baseline status in case something changes.

125
Q

Sudden, unilateral dilation and non-reactivity (pupil is “blown”) is a sign of

A

A rise in intercranial pressure

126
Q

Motor movement of the face is assessed

A

bilaterally

127
Q

Acronym for identifying a storke

A

Face
Arms
Slurred or jumbled speech
Time to call 911

128
Q

Who is at risk for a stroke

A

CAD, cardiac failure, PAD, hypertension, smoker, diabetes, irregular cardiac rhythms, diet and nutrition, obesity, physical inactivity, history of TIA

129
Q

Pronator drift

A

Often first sign of motor weakness
Suggests mild hemiparesis and lesion on opposite side

130
Q

Muscle stregth grading scale regarding neuro testing?

A

0-5 (No contraction to normal contraction)

131
Q

GCS amd what it assesses

A

Glasgow coma scale

Assesses 3 aspects
Eyes opening (PERRL)
Verbal response conversation appropriate, confused, inappropriate, incomprehensible, none.
Motor Response Obeys verbal command, localizes pain, withdraws, abnormal flexion, abnormal extension, none.

Score is 3-15

13-15= Mild impairment
9-12= Moderate impairment
3-8 = severe impairment or coma

132
Q

When assessing a GCS scale, when would u intubate?

A

GCS less than 8

133
Q

What is the Katz scale of independence in ADLs

A

Grading someone’s independence

a 1 or 0 for the six categories of daily living (eating, dressing, bathing, continence, transferring, toileting)

134
Q

Glaucoma

A

Group of eye disease causing vision problems through damaged optic nerve

135
Q

Cerumen

A

Wax substance secreted by glands in external ear canal

136
Q

Perforation

A

Hole that develops through wall of body organ

137
Q

Supine

A

Lying on the back with face upward

138
Q

Entropion

A

An inversion or turning inward of an edge; i.e margin of lower eyelid

139
Q

Photophobia

A

Unusual intolerance of light

Occurs in measles, rubella, meingitis, and inflammatino of the eyes

140
Q

Epiphora

A

Abnormal overflow of tears down the cheeks by excess excretion of tears or obstruction of lacrimal ducts

141
Q

Conjunctivitis

A

Pink eye - inflammation of the conjunctiva from infection or allergies

142
Q

Strabismus

A

Condition in which one eye is turned in another direction than the other

143
Q

Blepharitis

A

Inflammatory swelling of one of the sebacous glands of theeylid

144
Q

Vestibulor neuronitis or labyrinthitis

A

Inflammation of the inner ear may cause vertigo

145
Q

Otitis edema

A

infection of the external auditory canal

146
Q

VIsual firled

A

Area within where objects may be seen when the eye is fixed on something

147
Q

Distortion

A

distortion of shapes

148
Q

nyctalopia

A

night blindness

149
Q

Exophthalamas proptosis

A

Protrusion of one or two eyes

150
Q

nystagmus

A

involuntary eye movement appearing jerky

151
Q

Tinnitus

A

Subjective ringing, buzzing, tinkling or hissing sound in the ear

152
Q
A

NURS123 (13 decks)

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