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concepts 1 > midterm 2.0 > Flashcards

midterm 2.0 Flashcards

1
Q

Prejudice

A

A hostile attitude toward others simply because their apart of a certain group with objectionable characteristics

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2
Q

Stigma

A

Negative attitude, discrimination, rejecting attitudes and behaviours towards people

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3
Q

Stereotype

A

Over-generalized beliefs about a particular category of people

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4
Q

Dorthy Dix

A

Advocated for humane treatment, helped make mental health hospitals and humane prisons (social reform)

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5
Q

What was the first antimanic drug?

A

Lithium

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6
Q

What was the first anti-psychotic drug?

A

Chlorpromazine

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7
Q

What was the first anti-depressant?

A

Maoi & Tricyclic

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8
Q

discrimination

A

negative differential treatment of others becayse they are members of a certain group or identified as being negatively different

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9
Q

discrimination can include and arises from

A

ignoring, derogatory name-calling, denying services, and threatening

lack of understanding and appreciation of differences among people

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10
Q

3 levels of stigma

A

self, public, structural

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11
Q

What was the first mental health treatments?

A
  1. Lobotomy
    2.Malaria Fever
    3.Hydrotherapy
    4.Insulin coma therapy
    5.Electro shock therapy
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12
Q

What is projection?

A

falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object (ex. it’s your fault that I failed)

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13
Q

What is transference?

A

When the client unconsciously transfers assets of a past relationship to someone else onto you as a nurse (ex. abandonment issues - get’s mad when you leave the room)

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14
Q

What are the 4 main concepts (meta-paradigms)

A
  1. The Person
  2. The Environment
  3. Nursing Role
    4.Health
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15
Q

what is self-awareness

A

process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognizing how they affect self and others

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16
Q

What was Jean Watson’s theory?

A

Theory of Human Caring: transpersonal model: care valued over cure, patients need for dignity comes b4 tasks

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17
Q

What was Dorothea Orem’s Theory & descirbe

A

Self-Care Theory: promotes active engagement in care

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18
Q

florence nightingale theory and describe

A

environmental theory: made clear difference in roles b/w medicine & nursing, healing rather than disease & disease prevention

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19
Q

virginia henderson theory & describe

A

needs theory: promote client’s independence by understanding needs & assisting needs until they can themselves

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20
Q

Hildegard Peplau

A

Theory of Interpersonal Relations - to form therapeutic relationships

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21
Q

What was Sister Roach’s theory?

A

The human act of caring - The 6 C’s

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22
Q

betty neuman theory & explain

A

neuman’s system model - client system - holistic focused on prevention

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23
Q

sister callista roy

A

adaptation theory & how ppl cope & respond to stressors, patient adaptive being constantly interacting w/ environment

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24
Q

What were the 6 C’s in Sister Roach’s theory?

A
  1. Compassion
  2. Confidence
  3. Commitment
  4. Conscious
  5. Comportment
  6. Competence
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25
Q

What is compassion?

A

caring/spending/gather info/listening time with patients, EMPATHY (understanding situation), trust their nurse

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26
Q

What is competence?

A

having knowledge/skills/energy/experience required to respond adequately to demands/responsibilities

specific knowledge to interact w/ clients

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27
Q

What is confidence?

A

quality which fosters trusting relationships, trusting in own ability to provide care, knowing you can make differences

Physical appearance, the way you walk, talk, behave

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28
Q

What is conscience?

A

State of moral awareness, ethical practice, accountability and responsibility, moral&ethical decisionmaking

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29
Q

What is commitment?

A

Having good intentions and devoting yourself to your patients

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30
Q

What is comportment?

A

Having the appropriate attitude and dressing appropriately (how you present yourself)

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31
Q

philip bakers model of recovery

A

tidal model: assisting patients w/ reclaiming lives after setback, emphasises own personal story

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32
Q

What is the definition of a nursing process?

A

The nursing process is a problem solving approach to identifying, diagnosing and treating the health issues of the clients.

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33
Q

What are the 5 steps to the nursing process and explain

A
  1. Assess: gather info about pt condition
  2. Diagnose: identify the pt problems
  3. Plan: set goals of care and desired
    outcomes and identify nursing actions
  4. Implement: perform the nursing actions identified in planning
  5. Evaluation: determine if goals and expected outcomes are achieved
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34
Q

What is the purpose of STEP 1: ASSESSMENT?

A

Collection of data to determine the clients health and functional status & coping patterns

To establish a database about the clients health problems

-Identify priorities
-Recognize significant data/patterns
-Identify strength & problems

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35
Q

What does the DC conceptual framework consist of?

A
  1. Physiological variable (physical)
  2. Psychological variable (mental state)
  3. Developmental variable (age & stage)
  4. Sociocultural variable (relationships)
  5. Spiritual variable (beliefs/purpose in life)
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36
Q

What are some sources of assessment data?

A
  1. Client during interview
  2. Family/friends
  3. Charts
  4. Direct observation
  5. Measurements/ test results
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37
Q

What is the difference between objective data & subjective data?

A

Objective: observations or measurements of clients health status
Ex: BP of 120/70 or temp of 36.5

Subjective: clients reports ONLY
Ex: i feel dizzy right now

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38
Q

What is the purpose of STEP 2: NURSING DIAGNOSIS?

A

You prioritize what is most important which is done in colab with pt

Purpose: conclusion about the ways in which the illness is most impacting your pt and how you as the nurse will intervene to reduce this impact

holistic & patient centered

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39
Q

What are the characteristics of a nursing diagnosis using PNUR taxonomy?

A

Variance in __________ ( specific behaviour from assessment data) related to stressor

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40
Q

What is NANDA?

A

North American Nursing Diagnosis Association

Professional organization of nurses who standardized nursing terminology for the purpose of nursing diagnosis

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41
Q

What is the purpose of STEP 3: PLANNING?

A

Purpose: to set priorities and goals

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42
Q

what is SMART

A

specific, measurable, achievable, realistic, time frame

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43
Q

What is a nursing care plan

A

Legal document that is individualized and client centered which documents each stage of the nursing process

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44
Q

What is the purpose of STEP 4: IMPLEMENTATION?

A

Purpose: performance of nursing actions and documenting activities/responses

Assess & reassess through out implementation
Prevent, reduce or resolve health problems

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45
Q

What are the steps to intervention as prevention?

A

Primary:
Health promo & disease prevention
Before stress impacts baseline health
Maintain & promote health

Secondary:
Symptoms are present
Stressor has impacted baseline
Regain health

Tertiary:
Rehab & recovery
Prevent reoccurrence

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46
Q

What is the purpose of STEP 5: EVALUATION?

A

Purpose: measure the degree to which goals and desired outcomes have been achieved

Determine whether to continue, modify or terminate the plan of care

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47
Q

PHILOSOPHY

A

Considered as a science

Study of the fundamental nature of knowledge reality and existence

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48
Q

Nursing philosophy

A

Pertains to what we believe in correlation to our job

Who are we? What do we believe in? Nature of nursing? Morality?

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49
Q

Theory

A

System of ideas intended to explain something
Based on expert opinion/experience

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50
Q

Conceptual framework

A

Visual representation/organization of concepts and explains their relations

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51
Q

Concepts

A

abstract ideas or general notions that occur in the mind, in speech, or in thought

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52
Q

Metaparadigm concepts of nursing

A

Person
Health
Environment
Nursing

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53
Q

Ethics

A

The study of good conduct, character & motives.
In nursing, involves accountability

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54
Q

College of Registered Psych Nurses of BC

A

Primary purpose: protect the public

Defines/provides RPNs with practice standards
Defines/provides RPNs with a Code of Ethics
Is governed by the Health Processions Act

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55
Q

BCCNM Professional standards

A

Therapeutic Relationships
Theory/knowledge base
Professional Accountability
Ethical Practice

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56
Q

Health care ethical principles

A

Autonomy
Beneficence
Non-maleficence
Dignity
Justice
Truthfulness, informed consent & confidentiality

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57
Q

HC ETHICAL PRINCIPLES: Autonomy

A

Relates to someones independents & being able to make decisions without others influences

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58
Q

HC ETHICAL PRINCIPLES: Beneficence

A

Promoting good choice for others

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59
Q

HC ETHICAL PRINCIPLES: Non-maleficence

A

Avoidance of harm

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60
Q

HC ETHICAL PRINCIPLES: Dignity

A

Maintaining someones integrity & privacy
Protecting them from experiences where they feel less than.

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61
Q

HC ETHICAL PRINCIPLES: Justice

A

Refers to fairness

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62
Q

HC ETHICAL PRINCIPLES: Truthfulness, informed consent & confidentiality

A

Obligation to be 100% truthful
Respecting confidentiality

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63
Q

Mental health care ethical issues

A

Behaviour control & restraint
Relational engagement & boundaries
Confidentially
Ethical practice environment
Social justice

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64
Q

Behaviour control & restraint

A

Ex:
Physical restraining a patient in a safe position which could look like restraint

Chemical restraint to slow their behaviour down

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65
Q

Relational engagement & boundaries

A

Ex:
Receiving & giving gifts
When patient only wants you to help them

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66
Q

Confidentiality

A

Sharing all what is needed to know
Sharing only what is relevant

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67
Q

Critical thinking

A

The art of analyzing and evaluating thinking with a view to improving it

Encompasses both cognitive processes and attitudes

Consciously examining our own thought process

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68
Q

problematic thinking

A

egocentric & sociocentric

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69
Q

Egocentric thinking

A

Results from out tendency to be self centered and to view situations/info from our own point of view with the assumption it is right

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70
Q

Sociocentric thinking

A

Looking into the lens that the group norms opinion is right without questioning it

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71
Q

How do our personal traits impact our thinking

A

Autonomy
Fair mindedness
Humility
Courage
Integrity
Perseverance
Confidence
Empathy

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72
Q

Autonomy CHECK

A

think for yourself based on rational thinking aware of your biases

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73
Q

Fairmindedness CHECK

A

Open to opposing views, treat all viewpoints fairly

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74
Q

Humility CHECK

A

admitting mistakes

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75
Q

Courage CHECK

A

Courage to look at issues or sides that we have strong feelings against

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76
Q

Integrity

A

Be true to ones thinking
Sticking to it

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77
Q

Perseverance

A

finding solutions
We dont give up

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78
Q

Confidence

A

We trust our decision

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79
Q

Empathy

A

Genuinely trying to understand and put yourself in someone elses shoes

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80
Q

Critical thinking standard: Clarity

A

Can you elaborate on that?
Could you express that in another way?
Making sure we clearly understand what is going on

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81
Q

Critical thinking standard: Accuracy

A

Is the info true
Does it represent the truth?
Is the info accurate

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82
Q

Critical thinking standard: Precision

A

Could you be more specific?
Give me more details
Specific

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83
Q

Critical thinking standard: Relevance

A

How is the info relevant to the question?

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84
Q

Critical thinking standard: Depth CHECK

A

Does the answer to the question address all the complexity of the situation

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85
Q

Critical thinking standard: Breadth

A

Have we taken all points of views?
Have we considered alternate decisions

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86
Q

Critical thinking standard: Logic

A

Does it make sense?

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87
Q

elements of critical thinking

A

purpose of thinking (goal), question at issue (what qts am i raising), information, concepts (what theory guide thinking), assumptions (what biases impact thinking), inferences (reasoning to explain conclusion), points of view (sensitivity to other perspectives), implications (consequences of thinking)

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88
Q

Problem solving process

A

Clarify the nature of a problem & suggest possible solutions

Evaluate solutions & choose the best one to implement

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89
Q

What are the 3 types of problem solving questions

A
  1. There is a correct answer- requires knowledge
  2. No “right” answer -calls for subjective opinion/preference
  3. Multi “right” answers- clinical judgement must be made
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90
Q

Open ended questions vs closed ended questions

A

Open ended questions:
Allows us opportunity to hear the clients perspective and will provide more detailed info

Example: What has it been like for you since your husband left?

Closed ended questions:
Used when only a yes or no answer is required. They give us factual info but limited detail.

Example: Do you have a history of high blood pressure?

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91
Q

Summary of Neuro Assessment: Health history

A

Asking about past seizures, substance use, head injuries, behavioural changes, numbness, dizziness, medications

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92
Q

Summary of Neuro Assessment: Glasgow Coma scale

A

Eye response 1-4
Verbal response 1-5
Motor response 1-6

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93
Q

summary of neuro assessment: neurological assessment form/neurovitals

A

PERRLA, GSC, MOTOR STRENGTHS (bilateral equality) & SENSATION, VITAL SIGNS

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94
Q

Summary of Neuro Assessment: LOC vs orientation

A

Level of consciousness = alert/ drowsy

orientation = Date, place, time, name, situation

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95
Q

Summary of Neuro Assessment: eyes

A

glasses, cataracts, PERRLA

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96
Q

Summary of Neuro Assessment: ears

A

hearing aids, cerumen

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97
Q

Summary of Neuro Assessment: swallowing reflex

A

impaired, delay, pocketing, coughing with food bolus

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98
Q

Summary of Neuro Assessment: pain

A

LOTTAARP, scale out of 10 (0 = none, 10 = worst)

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99
Q

Summary of Neuro Assessment: analgesics and alternate pain treatments

A

hot blankets, ice packs, guided meditation

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100
Q

Summary of Neuro Assessment: seizure activity

A

grand mal

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101
Q

What does the INITIAL neuro assessment include? (7)

A
  1. Substance abuse?
  2. History of headaches, numbness, change in speech or senses
  3. Recent behavioral changes
  4. Past trauma to head
  5. History of seizures or lost of consciousness
  6. Vital signs
  7. Allergies & medication history
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102
Q

What is PERRLA?

A

Pupils: presense of pupils in both eyes
Equal: observe size of BOTH pupils
Round: BOTH pupils should be round
Reactive to
Light and pupils constrict immediately to light
Accomodation: look at eye movement and pupil size as eyes accommodate to object moved from far to close

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103
Q

balance and coordination can indicate

A

damage to cerebellum, disease process (parkinsons, huntingtons), deconditioning

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104
Q

gait

A

person’s walking pattern

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105
Q

ataxia

A

presence of uncoordinated, abnormal movements

collection of symptoms affecting balance, coordination, speech, fine motor control

106
Q

Reflexes: What is it? Why do we test it? How do we test?

A

Automatic response of the body to stimulus

Tests to see if sensory and motor pathways are intact which can indicate spinal cord injury

Rated on 0-4+ scale
0: no response
1+: sluggish
2+: expected response
3+: more hyperactive
4+: brisk and hyperactive

COMPARE BOTH SIDES

107
Q

MMSE

A

(7-8mins) used in hospital to assess progression of dementia (scores outta 30) lower score = severity

108
Q

MoCA

A

montreal cognitive assessment (10-12 mins) commonly used in hospital. toassess for cognitive impairment

used to see if baseline is getting worse

109
Q

Mental status exam: abstract thinking

A

“Is the glass half full/empty?”

110
Q

Mental status exam: intellectual function

A

Listen and focus on their vocab

111
Q

Mental status exam: attention span

A

Observe their attention span

112
Q

Mental status exam: memory

A

Ask easy, basic questions they should remember

113
Q

Mental status exam: judgement

A

Are they making good choices?

114
Q

Mental status exam: knowledge

A

Do they know general knowledge

115
Q

Pain assessment

A

5th vital sign
Use LOTTAARP

Rmr that pain can impact all 5 variables so we need to take holistic view: “How has your pain impacted your..”

116
Q

LOTTAARP

A

L: location
O: onset
T: type
T: timing
A: associated symptoms
A: alleviating factors
R: radiating
P: precipitating

117
Q

What are the different types of pains?

A

Acute
Chronic
Neuropathic pain

118
Q

Factors impacting pain perception: age

A

Older adults tend to under report pain or may be less sensitive to pain

119
Q

Factors impacting pain perception: fatigue

A

Heightens pain perception and intensifies pain

120
Q

Factors impacting pain perception: heredity

A

may determine pain tolerance

121
Q

Factors impacting pain perception: neurological functioning

A

MS spinal cord injury

122
Q

Factors impacting pain perception: attention

A

More you attend or focus on pain the more intense the pain feels

123
Q

Factors impacting pain perception: beliefs

A

Thoughts, feelings all impact pain perception- thinking errors like “this will never get better”

124
Q

Factors impacting pain perception: spiritual factors

A

Beliefs about pain and how to treat it, how you attribute meaning to your pain has a influence of pain perception

125
Q

Factors impacting pain perception: culture

A

They follow their cultural norms which shapes how cope & think about pain & how its reported

126
Q

Factors impacting pain perception: stress

A

stress can lower a persons pain tolerance, low mood triggers flight or fight which can lead to depression/anxiety

127
Q

Nursing role (9)

A

Build trust so patients feel comfortable talking about their pain

Believe your patient when they tell you about their pain

Be aware of your own biases around pain & coping

Recognize that a history of chronic pain, depression/anxiety can lead to more severe experience of pain

Be culturally sensitive & aware

Use rating scales that fit for your patients

Administer pain medication as ordered

Be aware of other pain relief measure

Assess pain frequently both pre/post med

128
Q

phaarmacological interventions for pain

A

NSAIDs & nonopoids (advils), opoids (morphine), co-analgesics (gabapentin)

129
Q

Health history: Respiratory

A

Pain
Fatigue
Smoking history
Dyspnea
Cough
Shortness of breath
Environmental exposure
Past history of respiratory infection
Health risks
Self care behaviour

130
Q

What does Aphasia mean?

A

When there is an injury to cerebral cortex which can lead to loss of understanding & speech

131
Q

What does AVPU mean?

A

Alert
Responds to Verbal
Responds to Pain
Unresponsive

132
Q

summary of resp assessment: airway assessment

A

patent vs obstructed

133
Q

summary of resp assessment: chest auscultation

A

posterior & anterior
5 lobes (2 R & 3 L)
assess apex, midlung, base (bilateral comparison)
listen for adventitious sounds (wheezes, crackles)

134
Q

summary of resp assessment: respirations

A

RR (12-20)
easy or regular
laboured, effortful/irrgular cheyne stokes
accessory msucles

135
Q

summary of resp assessment: O2 delivery system

A

room air, nasal prongs, simple masks

136
Q

summary of resp assessment: O2 saturation

A

assesses diffusion and perfusion via pulse oximetry

137
Q

summary of resp assessment: cough

A

frequent, intermittent, occasional
productive vs nonproductive
sputum characteristics

138
Q

summary of resp assessment: mental alertness

A

assess LOC in relation to oxygenation

139
Q

summary of resp assessment: activity tolerance

A

any SOB or SOBOE noted

140
Q

summary of resp assessment: environmental factors

A

smoker, TB, asbestos

141
Q

Hypoxia

A

Inadequate tissue oxygenation, present as apprehension, restless, confusion, cyanosis

142
Q

hypoxia can result from

A

inadequate delivery of O2 to tissues either from low blood supply or from low amount of O2 in the blood (hypoxemia)

143
Q

Tachypnea

A

Rapid rate but with no blood gas abnormality

144
Q

Bradypnea

A

Slowed breathing rate

145
Q

Dyspnea

A

Shortness of breath

146
Q

Apnea

A

Absence of breathing

147
Q

diffusion

A

movement of O2 & CO2 b/w alveoli and blood across a membrane

main purpose of breathing is for this gas exchange to occur

148
Q

perfusion

A

the distribution of oxygen rich red blood cells to tissues

149
Q

ventilation

A

mechanical process of inspiration and expiration

150
Q

Vital signs: oxygen saturation

A

Assessing diffusion & perfusion

Pulse oximeter estimates a clients arterial blood oxygen saturation by attaching a sensor to the persons finger

Purpose: to detect hypoxemia

151
Q

conduction system

A

responsible for contraction of the heart using electrical current

152
Q

conduction system order

A

SA node, atria, AV node, bundle of his, right & left bundle branches, ventricles

153
Q

What is normal pulse rate?

A

60-100 bpm

154
Q

What is tachycardia?

A

Over 100 bpm

155
Q

What is bradycardia?

A

Under 60 bpm

156
Q

quality of pulse

A

thready/weak, bounding

157
Q

Apical heart sounds: S1

A

“LUB”
Close of tricuspid & bicuspid valves

Signals that beginning of systole

158
Q

Apical heart sounds: S2

A

S2
“DUB”
Closure of pulmonary & aortic valves

Signals the end of systole

159
Q

common alterations in cardiac functioning (conduction issues)

A

dysrhythmias: deviation from sinus rhythm
atrial fibrillation
ventricular tachycardia
ventricular fibrillation
asystole

160
Q

common alterations in cardiac funcitoning (valve issues)

A

stenosis, regurgitation

161
Q

common alterations in cardiac functioning (ischemic issues)

A

angina, MI, ACS

162
Q

Blood pressure: systole

A

Occurs when the heart is contracting and blood is being squeezed out of the heart and into the body

represents the time between S1 & S2

163
Q

Blood pressure: diastole

A

Occurs when blood is refilling from the atria into the ventricles

Represents the time between the last “DUB” and the next “LUB”

164
Q

systolic range

165
Q

diastolic range

166
Q

What is systemic blood pressure?

A

Cardiac output(CO) x Peripheral resistance (PR)

167
Q

Cardiac output

A

Volume pumped bu each ventricle per minute

168
Q

Peripheral resistance

A

Determined by a change in the diameter of the arterioles

169
Q

What impacts BP? (5)

A

Volume of blood (CO)
Heart rate (CO)
Diameter of arteries (PR)
Elasticity of arteries (PR)
Viscosity of blood (PR)

170
Q

What is hypotension?Why does it occur?

A

Abnormally low BP
Systolic blood pressure falls to 90mm Hg or below
Occurs due to dilation of arteries, loss of blood or failure of heart to pump adequately

171
Q

What is hypertension? Why does it occur?

A

140/90mm Hg or above
Heart must continually pump against greater peripheral vascular resistance
Thickening and loss of elasticity of arterial walls

172
Q

What is orthostatic hypotension?

A

Systolic pressure suddenly falls greater than 15mm Hg then a fall in diastolic pressure occurs during sitting or standing

assess: dizziness, lightheadedness

Causes:
ANS diseases, dehydration, blood loss, anemia, beta blockers, anti-hypertensives

173
Q

What are risk factors of hypertension?

A

Family history
Smoking
Obesity
Age
High fat/sodium diet
Stress
Excessive alcohol consumption
Diabetes
Menopause
Use of oral contraceptives

174
Q

What are some subjective health history questions you would ask? (respiration/cardio)

A

Have you had any of the following….
Chest pain
Dyspnea
Orthopnea
Cough
Fatigue
Cyanosis
Edema
Cardiac history
Family cardiac history

175
Q

What are some objective data that you would collect?

A

Inspection:
Color, edema

Palpation:
Temperature of skin
Pulses (carotid and peripheral)
Extremities for pitting edema

Auscultate:
Apical pulse
BP

176
Q

Lymphatic system: Veins

A

Returns blood to heart visa low pressure using:
-skeletal muscles
-breathing pressure gradients
-intraluminal valve & calf pump

177
Q

arteries

A

carry oxygenated blood from heart

designed to withstand the pressure created with each heartbeat

elastic fibres: stretchy, strong, tough

178
Q

What does adequate blood circulation depend on?

A

Efficient heart pumping action of the heart
Responsive blood vessels
Adequate blood volume

179
Q

What is a blood vessel?

A

Any vessel that conveys/carries blood:
Arteries, arterioles, capillaries, venules, veins

180
Q

Vascular system: what are subjective data you would collect?

A

History of problems w circulation
Leg pain or cramps
Skin changes in arms or legs
Swelling in arms or legs
Lymph nodes enlargement
Skin ulcers
Blood clots
Medication

181
Q

Vascular system: what are some objective data you would collect?

A

Inspection:
Colour
Size
Swelling
Edema
Ulcer
Varicose vein

Palpation:
Temperature
Moisture
Cap refill
Varicosities
Pulse

Auscultation:
Listen for femoral and abdominal aortic bruits

182
Q

What is Arteriosclerosis?

A

Peripheral blood vessels loose elasticity- grow rigid

Increase blood pressure

183
Q

What is atherosclerosis?

A

Deposit of fatty materials in vessels/blockages

184
Q

What are the main functions of the lymphatic system? (3)

A
  1. Maintain fluid balance
  2. Immune system function
  3. Absorption of fat
185
Q

Lymphatic system: what are subjective data you would collect?

A

Lymph node enlargement?
Recurrent infection?
History of chronic illness?
Swelling?
Delayed healing?
Family history?

186
Q

Lymphatic system: what are some objective data you would collect?

A

Inspect & palpate
Assess lymph nodes

Compare each side for size, consistency, tenderness, warmth

Enlarged, hardened tender nodes reveal potential sites of infection or disease

187
Q

Lymphatic system: What should we keep in consideration when working with older adults?

A

Number & size of nodes decrease w age
Nodes are more fibrotic and fatty than in younger person, resulting in an impaired ability to resist infection

188
Q

assessment is

A

purposeful, systematic, and dynamic process, involves collection, validation, analysis, synthesis, organization, and documentation, identify health problems, response to stressors and provides foundation for care

189
Q

guiding principles

A

critical thikning to geather relevant and valid assessment data, be mindful of uncovering hard/sensitive information, guided by theory and a compassionate understanding of client

this is why we do re-interaction phase to fact check to see relability

190
Q

Type of health assessment: Complete health assessment

A

Detailed health history & physical exam

191
Q

Type of health assessment: Episodic/problem centered assessment

A

Focused on particular problem

192
Q

Type of health assessment: Follow up assessment

A

Follow up about change or about specific area

193
Q

Type of health assessment: emergency assessment

A

Quick focused, based on safety

194
Q

What are the 8 components of a health history?

A
  1. Biographical/demographic data: DOB, name
  2. Chief concern/reason for visit
  3. History of present illness
  4. Past health history
  5. Family history
  6. Holistic assessment (using 5 variables
  7. Perception of health
  8. Mental status exam
195
Q

Mental status exam: Appearance/psychomotor

A
  1. Appearance/psychomotor: how they look like & body image
196
Q

Mental status exam: Mood/affect

A
  1. Mood/affect: how they feel & physical observations expressed in comparison
197
Q

Mental status exam: Speech

A
  1. Speech: fast, slow, clear, slurred
198
Q

Mental status exam: Thought form

A
  1. Thought form: how someone is thinking (process)
199
Q

Mental status exam: Thought content

A
  1. Thought content: what someone is thinking
200
Q

Mental status exam: Perception

A
  1. Perception: issues w perception: hallucinations etc 5 senses
201
Q

Mental status exam: Cognition

A
  1. Cognition: ability to use memories, Cant concentrate
202
Q

Mental status exam: Insight/judgement

A
  1. Insight/judgement: Insight describes a person’s understanding of a set of circumstances. It reflects awareness of his or her own thoughts and feelings and an ability to compare them with the thoughts and feelings of others

ability to reach a logical decision about a situation and to choose a reasonable course of action after examining and analyzing various possibilities. Throughout the interview, the nurse evaluates the person’s problem-solving abilities and capacity to learn from past experience.

203
Q

Mental status exam: risk assessment

A
  1. Risk assessment: any safety concerns
204
Q

Physical exam: Vital signs

A

Blood pressure
Temp
Heart rate

205
Q

Physical exam: Head (5)

A

Hair
Eyes
Ears
Mouth
Cranial nerves

206
Q

Physical exam: Neck (4)

A

Lymph nodes
Trachea
Thyroid glands
Carotid glands

207
Q

Physical exam: Upper extremities (6)

A

Skin, nails
Muscle strength
Range of motion
Brachial/radial pulses
Bicep Tendon reflex
Senstation

208
Q

Physical exam: Chest back (6)

A

Skin
Breast
Armpit
Lungs
Heart
Spinal column

209
Q

Physical exam: Abdomen

A

Skin
Abnormal sounds
Specific organs

210
Q

Physical exam: Genitals (3)

A

Testicles
Vagina
urethra

211
Q

Physical exam: lower extremities

A

Skin
Toe nails
Range of motion
Femoral, popliteal, dorsalis pedis, posterior tibial pulses
Reflexes
Sensation

212
Q

What are the assessment techniques?

A

Inspection: Looking
Auscultation: listening to sounds
Palpation: feeling
Percussion: assess vibrations
Olfaction: smell

213
Q

What are conceptual models good for?

A

Map for problem solving process
Draws different concepts together
Foundational framework

214
Q

Who is Betty Neuman?

A

Emphasizes holistic nature
Person is seen as a whole

215
Q

CONCEPT: PERSON

A

Viewed as a client system- not one individual
open system interacting with environment

  • physiological variable
  • psychological variable
  • sociocultural variable
  • developmental variable
  • spiritual variable
216
Q

CONCEPT: ENVIRONMENT

A

All internal & external and interpreted influences surrounding a person

Internal: influences within the person

External: influences outside of the person

Interpreted: the sum of total of the persons interpretation of the internal and external environments

217
Q

whats a stresssor

A

Any stimuli that have the potential to create instability in a person

218
Q

What is an intrapersonal stressor?

A

Arises from within a person

219
Q

What is an interpersonal stressor?

A

Occurs between two people

220
Q

What is an extrapersonal stressor?

A

Arises from our environment

221
Q

What is the person to environment relationship?

A

Dynamic

Client impacts environment, environment impacts client

Continuous feedback loop: stress & reaction

222
Q

CONCEPT: HEALTH

A

Viewed on a continuum from wellness to illness

Wellness: harmonious balance between person and environment

Illness: Stressor has disrupted baseline health

223
Q

What does recovery mean?

A

Represents the return and maintenance of system stability following treatment for stressor reactions

224
Q

CONCEPT: NURSING

A

Pysch nurse works towards assisting the client system to attain, retain and maintain optimal wellness

225
Q

What does renal failure lead to ?

A

Electrolyte imbalance, hypertension, pitting edema, low urine production, metabolic acidosis & uremia

226
Q

What are kidney stones?

A

Build up of minerals or waste product inside kidneys that clump together

Small stones: move through urinary tract with no symptoms

Large stones: cause pain during urination, blood in urine, nausea, sharp pain

227
Q

What is Pyelonephritis?

A

A kidney infection which often is a complication of UTI

Patient will experience flank pain, fever, chills, dysuria & foul smelling urine

228
Q

What is proteinura?

A

Presense of protein in the urine, can be a sign of kidney disease

229
Q

What is urinary incontinence?

A

Involuntary loss of urine
Can lead to significant psychological impairment
Can lead to skin breakdown, pressure ulcers, and social isolation

230
Q

What is a neurogenic bladder?

A

A problem in which person lacks bladder control due to brain, or spinal cord damage

231
Q

What is urinary retention?

A

Inability to empty the bladder and becomes more alkaline which leads to UTI

232
Q

What is nocturia?

A

Waking at night to empty bladder (2 or more times)

Related to old age, prostate issues

233
Q

What is hematuria?

A

Blood in urine

234
Q

What is obliguria?

A

Low urine output
Feels like renal failure
minimum hourly output we want to see is 30cc/hr

235
Q

What is polyuria?

A

Large amount of urine output
Seen in diabetes

236
Q

What subjective data would be collected? (Urination)

A

interview = TR skills
Patterns of urination, symptoms, degree of thirst
Diet: diuretics ex: alcohol/caffiene inhibits ADH
Assess impact on self concept, sexuality & beliefs
Assess px primary concerns to ensure goals align
Be culturally sensitive

237
Q

What objective data would be collected? (urination)

A

Skin (hydration status & skin breakdown)
Kidneys (Flank pain or tenderness)
Bladder (tenderness, distended?)
Female perineum (rash)
Male (discharge, inflammation of urethral opening)
Characteristics of urine
Measurement of fluid intake vs output

238
Q

Urine testing

A

Routine urinalysis- collect during normal voiding
Check results ASAP within 2 hrs or refrigerate
Urea is normal waste product in urine

239
Q

What are normal urine results?

A

95% water
Normal pH (4.6-8.0)
No protein
No glucose
No blood
No ketones
No bacteria

240
Q

What are some factors affecting normal bowel elimination?

A

Inadequate water intake
Inadequate fibre
Physical activity
Medication
Hemerroids
Infections
Food intolerance
Age: elasticity gets weaker

241
Q

What are common alternations in bowel elimination?

A

Bowel incontinence: cant control bowel movements

Constipation: have to know that they are at higher risk after surgery bc of sedation

Diarrhea: more than 5x a day unformed feces

Fecal impaction: large volume of poop from chronic constipation

Flatulence: gas in intestinal tract-leads to abdominal distention

Hemorroids: swollen veins in anus

242
Q

What subjective data would be collected? (Defecating)

A

Assess:

patients normal bowel patterns & habits
patients description of stool characteristics
medication history including use of laxatives etc
patients diet history
patients fluid intake
any unplanned weight gain/loss
any recent surgery or GI related illness
any pain or discomfort around elimination
any nausea or vomiting

243
Q

What objective data would be collected? (Defecating)

A

Exam mouth for concerns w chewing
Inspect 4 quadrants of abdomen
List for bowel sounds
Palpate all 4 quadrants
Inspect feces for color, odor, consistency, frequency, shape

244
Q

What is sexual orientation?

A

Who you want to be in bed with
Heterosexual, homosexual, bisexual, etc

245
Q

reproductive and sexual health

A

physical, mental, and social well-being in all matters relating to sexuality

246
Q

reproductive and sexual health relates to

A

healthy and safe sex life
infertility issues
access to contraception and family planning
HIV & STI screening and treatment
safe pregnancy, prenatal care and child birth
postpartum depression, testicular/breast/prostate cancer

247
Q

What is gender presentation?

A

How we present ourselves to others

Feminine, masculine, androgynous

248
Q

What is gender dysphoria?

A

When a person doesnt see or feel themselves to be the same gender they were born into

Not considered a disorder unless this causes them significant distress or social emotional impairment for atleast 6 month duration

249
Q

What is infertility?

A

Inability to conceive a child, can lead to feelings of failure and worthlessness

250
Q

What is sexual abuse?

A

Includes domestic violence, often presents with physical symptoms leads to shame and inadequacy

251
Q

What is sexual dysfunction?

A

Can be related to other health problems or medication side effects, illness or disability

252
Q

What is chlamydia?

A

Most common bacterial STI
Presents with genital discharge and burning on urination

253
Q

What is gonorrhea? What happens if left untreated?

A

Second most common bacterial infection; leads to pain during sex or urination

If left untreated can lead to infertility.

254
Q

What is human papilloma virus?

A

Causes cervical/reproductive cancer & warts

255
Q

What is syphilis?

A

Bacterial infection, easily treated
Diagnosed with blood test often misdiagnosed can cause impaired neurological functioning

256
Q

What is hep C?

A

Viral infection attacks liver

257
Q

What is herpes? HSV

A

High prevalence, high stigma, incurable

258
Q

How is sexual health screening done?

A

Gathering a complete sexual health history
Swab for culture and bacteria
Blood work
Pelvic exam
Inspection of symptomatic area

259
Q

What is permissive questioning?

A

What do you need to ask about?

First you need to establish rapport and ask about less sensitive topics in order to gain trust

260
Q

angina

A

pain caused due to supply and demand oxygen in heart (pain due to lack of oxygen)

261
Q

we create therapeutic relationships

A
  • core of psych nursing
  • communication skills to develop rapport, trust, and respect
  • privacy and confidentiality
  • non-judgmental attitude & empathy
  • be self aware to avoid projecting feelings, thoughts, beliefs
  • establish & negotiate professional boundaries

concepts 1 (3 decks)

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