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PNUR 2101 CONCEPTS > MIDTERM (SHAWNA) > Flashcards

MIDTERM (SHAWNA) Flashcards

1
Q

What is a theory?

A

a set of assumptions that identifies the relationship(s) b/t concepts

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2
Q

What is a nursing theory?

A

Articulates nursing knowledge w/ the goal of guiding nursing practice

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3
Q

What does nursing theory do?

A
  • systematically organize
  • formalizes knowledge and nursing practice into professional knowledge
  • used to inform nursing practice
  • explains, describes, predicts, prescribes nursing care
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4
Q

Why did nursing theory evolve?

A
  • the need for nurses to delineate their role w/i HC team
  • nursing education was changing
  • HC system was changing
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5
Q

Nursing theory vs. conceptual framework (CF):

A

theory: linking of concepts to provide broad overviews. AKA paradigms

CF: use core concepts to organize/synthesize knowledge; aim of applying said knowledge

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6
Q

What are the 4 metaparadigm concepts of nursing?

A
  1. person
  2. environment
  3. health
  4. (psychiatric)nursing
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7
Q

What does a person mean in DCCF?

A
  • person is viewed as a client system (family, group, or community)
  • open system that constantly interacts w/ environment
  • five interconnecting variables
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8
Q

What are the 5 interconnecting variables of a person?

A
  1. sociocultural
  2. psychological
  3. physiological
  4. developmental
  5. spiritual
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9
Q

What does an environment mean in DCCF?

A
  • person and environment in reciprocal, dynamic relationship
  • consists of internal, external, and interpreted influences
  • intra/extrapersonal stressors can disrupt balance
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10
Q

What does health mean in DCCF?

A
  • 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
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11
Q

What does psychiatric nursing mean in DCCF?

A
  • 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
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12
Q

Who created the environmental theory? What did she do?

A
  • Florence Nightingale
  • Made clear the diff b/t medicine and nursing
  • Focus on healing rather than disease and disease prevention
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13
Q

Who was responsible for the Needs Theories?

A

Virgina Henderson

Dorothea Orem

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14
Q

What was Virginia Henderson’s theory and what did it say?

A
  • Needs theory
  • promote client’s independence by understanding their needs and assisting in meeting their needs until they can do it themselves
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15
Q

What was Dorothea Orem’s theory and what did it say?

A
  • 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
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16
Q

What was Hildegard Peplau’s theory and what did it say?

A
  • 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.
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17
Q

Who was responsible for the Systems Theories?

A
  • Betty Neuman
  • Sister Callista Roy
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18
Q

What was Betty Neuman’s theory and what did it say?

A
  • Neuman’s Systems Model
  • views patient as client system; holistic nursing focused on prevention
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19
Q

What was Sister Callista Roy’s theory and what did it say?

A
  • focuses on how people cope and respond to stressors
  • views patient as adaptive being, constantly interacts w/ environment
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20
Q

What was Jean Watson’s theory and what did it say?

A
  • 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
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21
Q

Who created the 6 C’s of Caring and what were they

A

Sister Simone Roach (Theory of Human Caring)

  1. compassion
  2. competence
  3. confidence
  4. conscience
  5. commitment
  6. comportment
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22
Q

What is compassion? (6 C’s of caring)

A
  • 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
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23
Q

What is competence? (6 C’s of caring)

A

“having the knowledge, judgement, skills, energy, experience ad motivation req. to respond adequately to the demand of one’s professional responsibilities”

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24
Q

What is confidence? (6 C’s of caring)

A

“the quality which fosters trusting relationships”

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25
Q

What is conscience? (6 C’s of caring)

A
  • state of moral awareness guiding the HCW’s attentiveness to ethical issues
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26
Q

What is commitment? (6 C’s of caring)

A

“the loyal endeavour to devote ourselves to the welfare of the patients

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27
Q

What is comportment? (6 C’s of caring)

A
  • how you present yourself as a caring professional
  • appropriate attitude, dress, appearance, language
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28
Q

Who created the Tidal Model and what is it?

A

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
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29
Q

What is the nursing process?

A

Problem-solving approach to identifying, diagnosing, and treating the health issues of clients

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30
Q

What are the steps in the nursing process? (ADPIE)

A
  1. Assessment
  2. Diagnosis
  3. Planning
  4. Implementation
  5. Evaluation
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31
Q

What is assessment?

A

systematic gathering of relevant and important patient data to establish a database of client’s health problems

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32
Q

What are the sources of assessment data?

A
  • client (interview questions)
  • family/friends
  • other HCP (charts)
  • direct observation (MSE, physical exam)
  • measurements/test results
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33
Q

What is subjective data?

A

Client reports

ex; nausea, dizziness, pain

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34
Q

What is objective data?

A

Data obtained from measurements

ex; BP, HR, temp

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35
Q

What is a nursing diagnosis?

A
  • 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
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36
Q

What is NANDA?

A
  • North American Nursing Diagnosis Association
  • organization who standardized nursing terminology for dx
  • dx categorized under 13 domains
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37
Q

What is planning?

A
  • creating client centered goals in tx
  • short term goals (0-3 mo)
  • long term goals (3-6 mo)
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38
Q

What does S.M.A.R.T stand for?

A
  • specific
  • measureable
  • achievable
  • realistic
  • time frame
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39
Q

What is a nursing care plan?

A
  • individualized and client centered
  • documentation of each stage of nursing process
  • legal document/health record
  • outlines goals, rationales, and evaluation
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40
Q

What is implementation?

A
  • 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
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41
Q

What are the three methods of prevention?

A

primary, secondary, tertiary

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42
Q

What is primary prevention?

A
  • health promotion and illness prevention/maintenance
  • enacted B4 stressor has disrupted baseline health
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43
Q

What is secondary prevention?

A
  • sx are already present
  • stressor has disrupted baseline health
  • goal: regain system balance
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44
Q

What is tertiary prevention?

A

Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disability. Associated w/ longterm goals

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45
Q

What is evaluation?

A
  • 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
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46
Q

What information are you gathering for health hx in neuro assessment?

A

ex; pain, headaches, seizures, alcohol/drug hx, head injuries, behavioural changes, dizziness, vision changes, medications

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47
Q

What are the neurovitals?

A
  • PERRLA
  • GCS
  • motor strengths and sensation
  • vital signs
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48
Q

What is LOC?

A

Level of consciousness - are they alert? Unconscious? What does it take to wake them if they wake at all?

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49
Q

What does PERRLA stand for?

A

pupils equal, round, reactive to light and accommodation

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50
Q

What is the GCS?

A

Glascow coma scale. Standardized scale to assess patients arousal and cognition. 3-15. Eye opening, verbal response, motor response

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51
Q

What can balance and coordination indicate?

A
  • damage to cerebellum (CVA)
  • disease process (ex; Parkinson’s/ Huntington’s)
  • deconditioning
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52
Q

What is ataxia?

A
  • presence of uncoordinated, abnormal movements
  • collection of sx affecting balance, coordination, speech, fine motor control
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53
Q

What is the MMSE?

A
  • mini mental status exam (7-8 mins)
  • usually used in hospital setting to assess progression of dementia in elderly clients
  • scores out of 30
54
Q

What is MoCA?

A
  • Montreal Cognitive Assessment (10-12 mins)
  • commonly used in hospital setting to assess for cognitive impairment
  • may capture info missed by MMSE
55
Q

What does the Mental Status Exam measure?

A
  • intellectual functioning, made up by:
  • judgement
  • abstract thinking
  • attention span
  • memory
  • knowledge
56
Q

Pain is considered the ______

A

5th vital sign

57
Q

What is the “gold standard” for pain assessment? How would you do this?

A
  • Patient self-report
  • use of appropriate measuring scales
58
Q

What does LOTTAARP stand for/what does it do?

A
  • 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
59
Q

What is pain perception influenced by?

A
  • age
  • culture
  • anxiety/stress lvls
60
Q

How does age impact pain perception?

A

older adults tend to under report pain

  • may be less sensitive or learned to be more stoic
  • effects of pain may lead to confusion
61
Q

How do beliefs impact pain perception?

A
  • thoughts and feelings
  • ex; “this will never get better’
62
Q

What is the nurse’s role in dealing with pain?

A
  • 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
63
Q

What are the pharmacological interventions for pain?

A
  • NSAIDs and nonopioids
  • opioids
  • co-analgesics
64
Q

What health hx are you gathering for resp assessment?

A
  • smoker, cough, difficulty breathing, pain, meds, hx of rep illnesses, drug misuse, risk factors, exposure to disease (ex; TB)
65
Q

What are the steps in resp assessment?

A
  • 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
66
Q

What is the flow of the heart’s conduction system?

A

SA node –> Atria –> AV node –> Bundle of His –> R + L bundle branches –> Ventricles

67
Q

What is the normal pulse rate (HR)?

A

60-100 bpm

68
Q

What is tachycardia?

A

fast heart rate (greater 100 bpm)

69
Q

What is bradycardia?

A

slow heart rate (less than 60 bpm)

70
Q

What do you measure when assessing pulse?

A
  • rate
  • rhythm (regular/irregular)
  • quality (thready/weak, bounding)
71
Q

Where is the apex of the heart?

A

5th intercostal space

72
Q

What are the apical heart sounds?

A

S1 (Lub) and S2 (dub)

73
Q

What is the S1 apical heart sound?

A
  • “lub”
  • closure of mitral and tricuspid valves
  • signals beginning of systole
74
Q

What is the S2 apical heart sound?

A
  • “dub”
  • closure of pulmonary and aortic valves
  • signals end of systole
75
Q

What are the 4 common alterations in heart functioning?

A
  1. conduction issues
  2. heart failure
  3. valve issues
  4. ischemic issues
76
Q

What are some examples of conduction issues?

A
  • dysrhythmias
  • a-fib
  • v-tach
  • v-fib
  • asystole
77
Q

What are two examples are valve issues?

A
  • stenosis
  • regurgitation
78
Q

What is angina?

A

Insufficient oxygen to the heart muscle causing sudden, severe substernal pain radiating to the left arm. Sx of coronary artery disease

79
Q

What are examples are ischemic heart issues?

A
  • angina
  • myocardial infarction (heart attack)
  • acute coronary syndrome (sudden reduced BF to heart)
80
Q

Difference b/t MI and angina:

A

MI: complete blockage of coronary arteries

Angina: narrowing of coronary arteries; doesn’t cause permanent damage

81
Q

What occurs during systole?

A

heart contracts and blood is squeezed into the body (time bt S1 and S2)

82
Q

What occurs during diastole?

A

blood is refilling from aorta into ventricles (time bt last S2 and next S1)

83
Q

Systolic/diastolic range:

A

systolic: 100-139

diastolic: 60-89

84
Q

What is the optimal BP?

A

120/80, but be familiar w/ patient baseline (100-139-60-89)

85
Q

Systemic BP is:

A

cardiac output (CO) X peripheral resistance (PR)

86
Q

What is cardiac output?

A

volume of blood pumped by each ventricle in one minute

87
Q

What is peripheral resistance?

A

resistance of the arteries to blood flow. determined by a change in diameter of arterioles

88
Q

What are 10 factors that impact BP?

A
  1. vol of blood
  2. HR
  3. diameter of arteries
  4. elasticity of arteries
  5. viscosity of blood
  6. time of dat
  7. stress
  8. emotional state
  9. exercise
  10. age - gradual increase in systolic
89
Q

Systolic pressure is especially affected by:

A

CO (LV pumping)

90
Q

Diastolic pressure is especially affected by:

A

PR (heart @ rest)

90
Q

What is hypotension?

A
  • abnormally low BP
  • systolic falls below 90 mm Hg (<90/60)
90
Q

What can cause hypotension?

A
  • dilation of arteries
  • loss of blood
  • inadequate pumping of the heart
  • dehydration
  • anemia
91
Q

What is hypertension?

A

high blood pressure 140/90 or above

92
Q

What is orthostatic hypotension?

A
  • systolic pressure suddenly falls >15 mm Hg
  • occurs upon sitting or standing
93
Q

S/S of orthostatic hypotension: what would you assess?

A
  • dizziness
  • lightheadedness, weakness
  • unsteady/falls
  • blurred vision
  • measure bp lying down, sitting, standing waiting 1-3 mins b/t
94
Q

What are some causes of orthostatic hypotension?

A
  • ANS disease
  • dehydration
  • blood loss
  • anemia
  • beta blockers
  • anti-hypertensives
95
Q

What are some risk factors of hypertension?

A
  • family hx
  • smoking
  • race
  • obesity
  • age
  • high fat and sodium diet
  • stress
  • excessive alcohol consumption
  • diabetes
  • menopause
  • sedentary lifestyle
  • oral contraceptives
96
Q

Subjective health hx for CV issues:

A

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)

97
Q

What objective data would you collect in the CV physical exam?

A
  • inspect: colour, edema
  • palpate: temp, pulses, extremities for pitting edema
  • auscultate: apical pulse, BP
98
Q

Structure and function of arteries:

A
  • carry oxygenated blood away from heart
  • can withstand pressure from heart
  • elastic fibres
99
Q

Structure and function of veins:

A
  • return deoxygenated blood to heart via low pressure using: skeletal muscles, breathing pressure gradients, intraluminal valve and calf pump
100
Q

What do you ask in vascular subjective assessment?

A
  • 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
101
Q

What do u assess in vascular objective assessment? (inspection)

A
  • colour (pallor, rubor, cyanosis
  • size: bilateral comparison
  • swelling
  • edema (pitting or non-pitting)
  • ulcers
102
Q

What do u assess in vascular objective assessment? (palpation)

A
  • temp
  • moisture
  • cap refill
  • pulses
103
Q

What is arteriosclerosis?

A
  • peripheral blood vessels lose elasticity; grow rigid
  • increase BP
104
Q

What is artherosclerosis?

A
  • deposit of fatty materials in vessels
  • blockages
105
Q

What are the 3 main functions of the lymphatic system?

A
  1. maintain fluid balance
  2. immune system function
  3. absorption of fat
106
Q

What do u ask in subjective lymphatic assessment?

A
  • 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
107
Q

What system are assessed in a vascular assessment?

A
  • vascular system/ peripheral vascular
  • lymphatic system
  • neurovascular assessment (ortho patients) CWMS, pulses, edema to affected extremity
108
Q

What do you do when performing an objective assessment of the lymphatic system?

A
  • inspection and palpation
  • region by region during head to toe assessment
  • compare each side for size, consistency, tenderness, warmth
109
Q

What are older adult considerations for lymphatic assessment?

A
  • # 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
110
Q

What is the sequence in head to toe assessment? (10 steps)

A
  1. general appearance
  2. skin, hair, nails (done throughout assessment)
  3. head/face/neck
  4. chest
  5. abdomen
  6. extremities
  7. back area
  8. tubes, drains, assessment, IV
  9. mobility
  10. report/document/assess findings
111
Q

What do the kidneys do?

A
  • filter blood (remove toxins) and produce urine
  • regulate BP
  • regulate pH
  • make RBC
  • maintains healthy bones
112
Q

3 common kidney alterations:

A
  1. renal failure
  2. kidney stones
  3. pyelonephritis
113
Q

What does renal failure cause?

A
  • electrolyte imbalance
  • hypertension
  • pitting edema
  • low urine production
  • metabolic acidosis
114
Q

pyelonephritis

A

kidney infection, often after complication of UTI

sx: flank pain, fever, chills, dysruria, foul smelling urine

115
Q

What is dysuria?

A

painful or difficult urination

116
Q

What are 6 alterations in urinary elimination?

A
  1. urinary incontinence; neurogenic bladder
  2. UTI
  3. urinary retention
  4. nocturia
  5. hematuria
  6. polyuria
  7. oliguria
117
Q

What info do you gather in GU subjective data assessment?

A
  • 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
118
Q

What info do you gather on GU physical exam? (objective data)

A

inspection: skin of perineal area (breakdown, rash, discharge, inflammation)

Palpation: bladder (tender, distended?)

Obtain urine sample; assess characteristics

Measure fluid intake vs. output

119
Q

What is normal urine?

A

95% water

pH (4.6-8.0)

no protein, glucose, blood, ketones, bacteria

Specific gravity = 1.010 - 1.025

120
Q

What are 6 common alterations in bowel elimination?

A
  • incontinence
  • constipation
  • diarrhea
  • fecal impaction
  • flatulence
  • hemorrhoids
121
Q

What info do you gather for a health hx (elimination problems)?

A
  • 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
122
Q

What are you assessing during a physical exam (bowel elimination)?

A

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

123
Q

What are you looking for when inspecting the 4 quadrant of the abdomen?

A
  • masses
  • shape
  • symmetry
124
Q

How often do bowel sounds occur?

A

every 5-15 seconds

125
Q

What is reproductive and sexual health?

A

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
126
Q

What are 4 alterations in sexual health?

A
  1. gender dysphoria
  2. infertility
  3. sexual abuse
  4. sexual dysfunction
127
Q

What are the 6 STIs discussed in lecture?

A
  1. chlamydia (most common): bacterial, genital discharge, burning unrination
  2. gonorrhea (2nd most common): bacterial, pain during sex/urination. Can lead to infertility if not tx
  3. human papilloma virus (HPV): warts, cervical/reproductive cancer
  4. syphilis: bacterial, easily tx, dx w/ blood test, can cause impaired neuro functioning
  5. Hep C: viral; attacks liver
  6. Herpes (HSV): high prevalence, high stigma, incurable
128
Q

What occurs during a sexual health screening?

A
  • sexual health hx
  • swab for cultures/bacteria
  • bloodwork
  • pelvic exam
  • inspection of symptomatic area
129
Q

Taking a sexual health hx:

A
  • 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.
130
Q

Common Conduction Issues

A

Dysrhythmias
Atrial Fibrillation
Ventricular Tachycardia (Electrical impulse in ventricle)
Ventricular Fibrillation (Rapid, irregular contraction of fibrielle)

PNUR 2101 CONCEPTS (4 decks)

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