MIDTERM (SHAWNA) Flashcards
What is a theory?
a set of assumptions that identifies the relationship(s) b/t concepts
What is a nursing theory?
Articulates nursing knowledge w/ the goal of guiding nursing practice
What does nursing theory do?
- systematically organize
- formalizes knowledge and nursing practice into professional knowledge
- used to inform nursing practice
- explains, describes, predicts, prescribes nursing care
Why did nursing theory evolve?
- the need for nurses to delineate their role w/i HC team
- nursing education was changing
- HC system was changing
Nursing theory vs. conceptual framework (CF):
theory: linking of concepts to provide broad overviews. AKA paradigms
CF: use core concepts to organize/synthesize knowledge; aim of applying said knowledge
What are the 4 metaparadigm concepts of nursing?
- person
- environment
- health
- (psychiatric)nursing
What does a person mean in DCCF?
- person is viewed as a client system (family, group, or community)
- open system that constantly interacts w/ environment
- five interconnecting variables
What are the 5 interconnecting variables of a person?
- sociocultural
- psychological
- physiological
- developmental
- spiritual
What does an environment mean in DCCF?
- person and environment in reciprocal, dynamic relationship
- consists of internal, external, and interpreted influences
- intra/extrapersonal stressors can disrupt balance
What does health mean in DCCF?
- viewed on a wellness-illness continuum
- protective factors are a person’s resistance to stressors
- baseline health is a person’s normal range of responses to stressors
What does psychiatric nursing mean in DCCF?
- RPN works w/ client to maintain/restore system stability
- Conducts holistic assessment to create nursing dx, care plans, and evaluate the care collaboratively with the patient
- Primary, secondary, and tertiary prevention
Who created the environmental theory? What did she do?
- Florence Nightingale
- Made clear the diff b/t medicine and nursing
- Focus on healing rather than disease and disease prevention
Who was responsible for the Needs Theories?
Virgina Henderson
Dorothea Orem
What was Virginia Henderson’s theory and what did it say?
- Needs theory
- promote client’s independence by understanding their needs and assisting in meeting their needs until they can do it themselves
What was Dorothea Orem’s theory and what did it say?
- Self-care theory
- nurse promotes active engagement of patient. Shift from passivity to patient responsibility
- nurse only acts for patient when they cannot do it themselves
What was Hildegard Peplau’s theory and what did it say?
- theory of interpersonal relations
- focus on nurse/patient relationship
- views nursing as healing art w/ communication and interviewing skills as fundamental tools
- nurse can have diff roles: teacher, counsellor, surrogate, etc.
Who was responsible for the Systems Theories?
- Betty Neuman
- Sister Callista Roy
What was Betty Neuman’s theory and what did it say?
- Neuman’s Systems Model
- views patient as client system; holistic nursing focused on prevention
What was Sister Callista Roy’s theory and what did it say?
- focuses on how people cope and respond to stressors
- views patient as adaptive being, constantly interacts w/ environment
What was Jean Watson’s theory and what did it say?
- Theory of Human Caring
- care is valued over cure
- patient’s need for dignity comes before tasks
- caring is both an art and a science
Who created the 6 C’s of Caring and what were they
Sister Simone Roach (Theory of Human Caring)
- compassion
- competence
- confidence
- conscience
- commitment
- comportment
What is compassion? (6 C’s of caring)
- spending time, listening and talking, gathering info, showing interest and concern
- developing understanding of patient’s situation (empathy)
- patients depend on the nurses doing what they cannot do themselves
- patients place trust in their nurses
What is competence? (6 C’s of caring)
“having the knowledge, judgement, skills, energy, experience ad motivation req. to respond adequately to the demand of one’s professional responsibilities”
What is confidence? (6 C’s of caring)
“the quality which fosters trusting relationships”
What is conscience? (6 C’s of caring)
- state of moral awareness guiding the HCW’s attentiveness to ethical issues
What is commitment? (6 C’s of caring)
“the loyal endeavour to devote ourselves to the welfare of the patients
What is comportment? (6 C’s of caring)
- how you present yourself as a caring professional
- appropriate attitude, dress, appearance, language
Who created the Tidal Model and what is it?
Philip Barker
- focus on assisting patients w/ reclaiming their lives after a setback
- philosophical approach to MH (MH theory)
- emphasizes patient’s own personal story
- uses metaphors of water
What is the nursing process?
Problem-solving approach to identifying, diagnosing, and treating the health issues of clients
What are the steps in the nursing process? (ADPIE)
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
What is assessment?
systematic gathering of relevant and important patient data to establish a database of client’s health problems
What are the sources of assessment data?
- client (interview questions)
- family/friends
- other HCP (charts)
- direct observation (MSE, physical exam)
- measurements/test results
What is subjective data?
Client reports
ex; nausea, dizziness, pain
What is objective data?
Data obtained from measurements
ex; BP, HR, temp
What is a nursing diagnosis?
- differs from medical dx (ex; diabetes)
- conclusion about the ways in which the illness is most impacting your patient and how plan to intervene
- holistic and patient centered
- variance in variable/system (assessment data) r/t stressor
What is NANDA?
- North American Nursing Diagnosis Association
- organization who standardized nursing terminology for dx
- dx categorized under 13 domains
What is planning?
- creating client centered goals in tx
- short term goals (0-3 mo)
- long term goals (3-6 mo)
What does S.M.A.R.T stand for?
- specific
- measureable
- achievable
- realistic
- time frame
What is a nursing care plan?
- individualized and client centered
- documentation of each stage of nursing process
- legal document/health record
- outlines goals, rationales, and evaluation
What is implementation?
- putting care plan into action
- documenting activities and patient response
- carrying out Drs orders
- assess and reassess throughout implementation process
- support client strengths
- prevent, reduce, resolve
What are the three methods of prevention?
primary, secondary, tertiary
What is primary prevention?
- health promotion and illness prevention/maintenance
- enacted B4 stressor has disrupted baseline health
What is secondary prevention?
- sx are already present
- stressor has disrupted baseline health
- goal: regain system balance
What is tertiary prevention?
Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disability. Associated w/ longterm goals
What is evaluation?
- determining if and how well the goals have been achieved
- identifying factors that positively or negatively influence goal achievement
- decide if need to continue, modify, or terminate plan of care
- revise care at any stage of nursing process
What information are you gathering for health hx in neuro assessment?
ex; pain, headaches, seizures, alcohol/drug hx, head injuries, behavioural changes, dizziness, vision changes, medications
What are the neurovitals?
- PERRLA
- GCS
- motor strengths and sensation
- vital signs
What is LOC?
Level of consciousness - are they alert? Unconscious? What does it take to wake them if they wake at all?
What does PERRLA stand for?
pupils equal, round, reactive to light and accommodation
What is the GCS?
Glascow coma scale. Standardized scale to assess patients arousal and cognition. 3-15. Eye opening, verbal response, motor response
What can balance and coordination indicate?
- damage to cerebellum (CVA)
- disease process (ex; Parkinson’s/ Huntington’s)
- deconditioning
What is ataxia?
- presence of uncoordinated, abnormal movements
- collection of sx affecting balance, coordination, speech, fine motor control
What is the MMSE?
- mini mental status exam (7-8 mins)
- usually used in hospital setting to assess progression of dementia in elderly clients
- scores out of 30
What is MoCA?
- Montreal Cognitive Assessment (10-12 mins)
- commonly used in hospital setting to assess for cognitive impairment
- may capture info missed by MMSE
What does the Mental Status Exam measure?
- intellectual functioning, made up by:
- judgement
- abstract thinking
- attention span
- memory
- knowledge
Pain is considered the ______
5th vital sign
What is the “gold standard” for pain assessment? How would you do this?
- Patient self-report
- use of appropriate measuring scales
What does LOTTAARP stand for/what does it do?
- helps you remember what to ask the patient
- location
- onset
- Timing: is it worse at certain times of the day/how long does it last?
- Type of pain
- Associated sx: nausea, fever, etc
- Alleviating factors
- Radiating
- Precipitating event
What is pain perception influenced by?
- age
- culture
- anxiety/stress lvls
How does age impact pain perception?
older adults tend to under report pain
- may be less sensitive or learned to be more stoic
- effects of pain may lead to confusion
How do beliefs impact pain perception?
- thoughts and feelings
- ex; “this will never get better’
What is the nurse’s role in dealing with pain?
- est rapport so patient feels comfortable discussing pain
- believe your patient
- recognize that hx of chronic pain, depression/anxiety can lead to more severe experience
- be culturally sensitive and aware
- use rating scales that fit your patient
- admin meds as ordered
- awareness of other pain relief measures
- assess pain frequently pre/post meds
What are the pharmacological interventions for pain?
- NSAIDs and nonopioids
- opioids
- co-analgesics
What health hx are you gathering for resp assessment?
- smoker, cough, difficulty breathing, pain, meds, hx of rep illnesses, drug misuse, risk factors, exposure to disease (ex; TB)
What are the steps in resp assessment?
- airway: patent vs obstructed
- chest auscultation: listen for adventitious sounds
- respirations: rate, depth, rhythm, use of accessory muscles
- O2 delivery system
- SpO2: diffusion and perfusion and inspection of skin colour
- cough: frequency, productive vs dry, sputum characteristics
- mental alertness/LOC
- activity tolerance
What is the flow of the heart’s conduction system?
SA node –> Atria –> AV node –> Bundle of His –> R + L bundle branches –> Ventricles
What is the normal pulse rate (HR)?
60-100 bpm
What is tachycardia?
fast heart rate (greater 100 bpm)
What is bradycardia?
slow heart rate (less than 60 bpm)
What do you measure when assessing pulse?
- rate
- rhythm (regular/irregular)
- quality (thready/weak, bounding)
Where is the apex of the heart?
5th intercostal space
What are the apical heart sounds?
S1 (Lub) and S2 (dub)
What is the S1 apical heart sound?
- “lub”
- closure of mitral and tricuspid valves
- signals beginning of systole
What is the S2 apical heart sound?
- “dub”
- closure of pulmonary and aortic valves
- signals end of systole
What are the 4 common alterations in heart functioning?
- conduction issues
- heart failure
- valve issues
- ischemic issues
What are some examples of conduction issues?
- dysrhythmias
- a-fib
- v-tach
- v-fib
- asystole
What are two examples are valve issues?
- stenosis
- regurgitation
What is angina?
Insufficient oxygen to the heart muscle causing sudden, severe substernal pain radiating to the left arm. Sx of coronary artery disease
What are examples are ischemic heart issues?
- angina
- myocardial infarction (heart attack)
- acute coronary syndrome (sudden reduced BF to heart)
Difference b/t MI and angina:
MI: complete blockage of coronary arteries
Angina: narrowing of coronary arteries; doesn’t cause permanent damage
What occurs during systole?
heart contracts and blood is squeezed into the body (time bt S1 and S2)
What occurs during diastole?
blood is refilling from aorta into ventricles (time bt last S2 and next S1)
Systolic/diastolic range:
systolic: 100-139
diastolic: 60-89
What is the optimal BP?
120/80, but be familiar w/ patient baseline (100-139-60-89)
Systemic BP is:
cardiac output (CO) X peripheral resistance (PR)
What is cardiac output?
volume of blood pumped by each ventricle in one minute
What is peripheral resistance?
resistance of the arteries to blood flow. determined by a change in diameter of arterioles
What are 10 factors that impact BP?
- vol of blood
- HR
- diameter of arteries
- elasticity of arteries
- viscosity of blood
- time of dat
- stress
- emotional state
- exercise
- age - gradual increase in systolic
Systolic pressure is especially affected by:
CO (LV pumping)
Diastolic pressure is especially affected by:
PR (heart @ rest)
What is hypotension?
- abnormally low BP
- systolic falls below 90 mm Hg (<90/60)
What can cause hypotension?
- dilation of arteries
- loss of blood
- inadequate pumping of the heart
- dehydration
- anemia
What is hypertension?
high blood pressure 140/90 or above
What is orthostatic hypotension?
- systolic pressure suddenly falls >15 mm Hg
- occurs upon sitting or standing
S/S of orthostatic hypotension: what would you assess?
- dizziness
- lightheadedness, weakness
- unsteady/falls
- blurred vision
- measure bp lying down, sitting, standing waiting 1-3 mins b/t
What are some causes of orthostatic hypotension?
- ANS disease
- dehydration
- blood loss
- anemia
- beta blockers
- anti-hypertensives
What are some risk factors of hypertension?
- family hx
- smoking
- race
- obesity
- age
- high fat and sodium diet
- stress
- excessive alcohol consumption
- diabetes
- menopause
- sedentary lifestyle
- oral contraceptives
Subjective health hx for CV issues:
Have you had any of the following?
chest pain, dyspnea, orthopnea, cough, fatigue, edema
Ask about:
cardiac hx, fam cardiac hx, personal habits (risk factors)
What objective data would you collect in the CV physical exam?
- inspect: colour, edema
- palpate: temp, pulses, extremities for pitting edema
- auscultate: apical pulse, BP
Structure and function of arteries:
- carry oxygenated blood away from heart
- can withstand pressure from heart
- elastic fibres
Structure and function of veins:
- return deoxygenated blood to heart via low pressure using: skeletal muscles, breathing pressure gradients, intraluminal valve and calf pump
What do you ask in vascular subjective assessment?
- hx circulation problems
- leg pain or cramps
- skin changes in arms/legs
- swelling in arms/legs; edema
- lymph node enlargement; lumps
- skin ulcers
- blood clots
- meds
What do u assess in vascular objective assessment? (inspection)
- colour (pallor, rubor, cyanosis
- size: bilateral comparison
- swelling
- edema (pitting or non-pitting)
- ulcers
What do u assess in vascular objective assessment? (palpation)
- temp
- moisture
- cap refill
- pulses
What is arteriosclerosis?
- peripheral blood vessels lose elasticity; grow rigid
- increase BP
What is artherosclerosis?
- deposit of fatty materials in vessels
- blockages
What are the 3 main functions of the lymphatic system?
- maintain fluid balance
- immune system function
- absorption of fat
What do u ask in subjective lymphatic assessment?
- lymph node enlargement: swollen glands, where are they, how long have you had them?
- recurrent infections
- hx of chronic illness
- swelling/edema
- delayed healing
- fam hx; malignancy
What system are assessed in a vascular assessment?
- vascular system/ peripheral vascular
- lymphatic system
- neurovascular assessment (ortho patients) CWMS, pulses, edema to affected extremity
What do you do when performing an objective assessment of the lymphatic system?
- inspection and palpation
- region by region during head to toe assessment
- compare each side for size, consistency, tenderness, warmth
What are older adult considerations for lymphatic assessment?
- # and size of lymph nodes decreases w/ age
- some lymphoid elements are lost
- nodes = more fibrotic and fatty than in younger ppl = impaired infection resistance
What is the sequence in head to toe assessment? (10 steps)
- general appearance
- skin, hair, nails (done throughout assessment)
- head/face/neck
- chest
- abdomen
- extremities
- back area
- tubes, drains, assessment, IV
- mobility
- report/document/assess findings
What do the kidneys do?
- filter blood (remove toxins) and produce urine
- regulate BP
- regulate pH
- make RBC
- maintains healthy bones
3 common kidney alterations:
- renal failure
- kidney stones
- pyelonephritis
What does renal failure cause?
- electrolyte imbalance
- hypertension
- pitting edema
- low urine production
- metabolic acidosis
pyelonephritis
kidney infection, often after complication of UTI
sx: flank pain, fever, chills, dysruria, foul smelling urine
What is dysuria?
painful or difficult urination
What are 6 alterations in urinary elimination?
- urinary incontinence; neurogenic bladder
- UTI
- urinary retention
- nocturia
- hematuria
- polyuria
- oliguria
What info do you gather in GU subjective data assessment?
- gather health hx thru interview:
- normal patterns of urination, sx, thirst
- hx of oliguria, polyuria, diabetes, fever, surgeries, meds
- diet
- impact on self-concept, sexuality, beliefs
- patient’s primary concerns to ensure goals align
- be culturally sensitive
What info do you gather on GU physical exam? (objective data)
inspection: skin of perineal area (breakdown, rash, discharge, inflammation)
Palpation: bladder (tender, distended?)
Obtain urine sample; assess characteristics
Measure fluid intake vs. output
What is normal urine?
95% water
pH (4.6-8.0)
no protein, glucose, blood, ketones, bacteria
Specific gravity = 1.010 - 1.025
What are 6 common alterations in bowel elimination?
- incontinence
- constipation
- diarrhea
- fecal impaction
- flatulence
- hemorrhoids
What info do you gather for a health hx (elimination problems)?
- assess normal bowel patterns/habits
- assess patient’s description of stool characteristics
- assess med hx
- assess diet hx
- assess fluid intake
- assess any unplanned weight gain/loss
- ask about recent surgery/GI related illness
- assess pain/discomfort around elimination
- assess for any nausea or vomiting
What are you assessing during a physical exam (bowel elimination)?
inspection: mouth (concerns w/ chewing), 4 quadrants of abdomen, feces (Bristol Stool Chart)
Auscultate: B4 palpation, 4 quadrants; bowel sounds
Palpation: all 4 quadrants; distension, tenderness
What are you looking for when inspecting the 4 quadrant of the abdomen?
- masses
- shape
- symmetry
How often do bowel sounds occur?
every 5-15 seconds
What is reproductive and sexual health?
WHO: “a state of physical, mental, and social well-being in all matters relating to sexuality”
Relates to:
- healthy & safe sex life
- infertility issues
- access to contraception & fam planning
- HIV and STI’s screening/tx
- safe pregnancy, prenatal care, childbirth
- postpartum depression, testicular/breast/prostate cancers
What are 4 alterations in sexual health?
- gender dysphoria
- infertility
- sexual abuse
- sexual dysfunction
What are the 6 STIs discussed in lecture?
- chlamydia (most common): bacterial, genital discharge, burning unrination
- gonorrhea (2nd most common): bacterial, pain during sex/urination. Can lead to infertility if not tx
- human papilloma virus (HPV): warts, cervical/reproductive cancer
- syphilis: bacterial, easily tx, dx w/ blood test, can cause impaired neuro functioning
- Hep C: viral; attacks liver
- Herpes (HSV): high prevalence, high stigma, incurable
What occurs during a sexual health screening?
- sexual health hx
- swab for cultures/bacteria
- bloodwork
- pelvic exam
- inspection of symptomatic area
Taking a sexual health hx:
- routinely as part of holistic assessment prior to physical exam
- est. rapport 1st
- clients/nurses may feel embarrassment/discomfort discussing
- nurses: convey openness, use appropriate language, remain “matter of fact”, suspend judgements
- be aware of cultural sensitivities
- self awareness
- nurses: manage own anxiety
- may need to frame questions differently depending on client’s age/culture etc.
Common Conduction Issues
Dysrhythmias
Atrial Fibrillation
Ventricular Tachycardia (Electrical impulse in ventricle)
Ventricular Fibrillation (Rapid, irregular contraction of fibrielle)
