NU 301 Exam 4 Flashcards
What is intersectionality?
Belonging simultaneously to multiple social groups
What can be some determinants of health disparities?
Race and ethnicity, gender, disability status or special health needs, geographic location.
What is a health disparity?
A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.
Define some social determinants of health
Conditions in which people are born, grow, live, work, and age.
What is cultural competence?
Meaningful and useful strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care.
- Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by:
A. Bias
B. Stereotyping
C. Prejudice
D. All of the above.
D. All of the above
What are the goals of a cultural encounter?
Communicate in a way that generates a wide variety of responses.
Interact to validate, refine, or modify existing values, beliefs, and practices about a cultural group.
What is cultural desire?
Having the motivation to engage patients so that you understand them from a cultural perspective
List the LEARN model in order
Listen with sympathy and understanding to the patient’s perception of the problem
Explain your perceptions of the problem
Acknowledge and discuss the differences and similarities
Recommend treatment
Negotiate agreement
What is health literacy?
The degree to which individuals have the capacity to obtain, process, and understand basic health information.
What does a health literacy score of 0 indicate?
Third grade and below education.
Will need repeated oral instructions,
Materials composed primarily off illustrations/audio/video tapes
Will not be able to read most low-literacy
What does a health literacy score of 1-3 indicate?
4th-6th grade
Will need low-literacy materials
May not be able to read prescriptions
What does a health literacy score of 4-6 indicate?
7th to 8th grade
Will struggle with most patient education materials
Will not be offended by low-literacy materials.
What does a health literacy score of 7 indicate?
High school
Will be able to read most patient education materials
What does the teach-back method do?
Confirms patient understands teaching
Changing what can guide our thinking?
Demographics
What is culturally congruent care?
Emphasizes the need to provide care based on an individual’s cultural beliefs, values, and practices
What is implicit bias?
We are aware the bias is present
What is unconscious bias
Bias we are unaware of and that happens outside of our control
What is cultural awareness?
A self-examination of one’s biases toward other cultures and in-depth exploration of one’s own culture and backgroun
What is cultural knowledge
The process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups. They most focus on three specific issues: health-related beliefs and cultural values, care practices, and disease incidence and prevalence.
What is cultural skill?
The ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment.
What is a cultural encounter
A process that encourages health care professional to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. Main goal is to generate a wide variety of responses and modify beliefs about a group to prevent stereotyping
What are the 12 domains of culture?
Overview, inhabited localities (country of origin and current residence
- Communication
- Family roles and organization
- Workforce issues
- Bicultural ecology
- High-risk behaviors
- Nutrition
- Pregnancy and childbearing practices
- Death rituals
- Spirituality
- Health care practices
- Health care providers
What is plain language?
Makes any info you provide easy to read, understand, and use. Is still grammatically correct language that uses complete sentence structure and accurate word usage.
How to approach a cultural nursing history and physical assessment
Developing a cultural or physical history depends on your knowledge of a patient and their culture. An example physically would be if a patient you know has asthma, you may want to focus more on the lungs than a patient that comes in for a standard check-up. Culturally, if you have an Asian patient who participates in cupping, then you know that the marking/bruising on their skin are not a sign of abuse.
How do you work with an interpreter?
You must notify the patient verbally and in writing of their rights to receive the language assistance. Interpreters must be competent. Start with first person “I” statements, talking directly to the patient. Have interpreter sit next to or slightly behind the patient. Look at the patient. Avoid using things like jargon, jokes, etc. Ask patient for feedback and clarification. Observe nonverbal and verbal behaviors. Thank both the patient and interpreter at the end.
What are s/s of hyperkalemia?
My Cheese Pizza
-Muscle twitches
Cramps
Paresthesia
High potassium affects the what and what?
Heart and muscle groups
s/s of hypokalemia? (A SIC WALT)
-alkalosis
-shallow respirations
- irritability
- confusion and drowsiness
- weakness and fatigue
- arrhythmias (tachycardia, irregular rhythm, and or bradycardia)
- lethargy
- thready pulse
- lower intestinal motility, nausea, vomiting, and ileus
S/s of hypocalcemia?
numbness to fingers and toes
- hyperactive reflexes
- dysrhythmias
- postive chvostek’s and trousseau’s signs
- s/s of tetany (give foods high in calcium and vitamin D)
- bleeding in gums and mucous membranes
- irritability at IV site
S/s of hypercalcemia?
nausea and vomiting
- constipation
- fatigue
- decreased deep tendon reflexes
- decreased level of consciousness
- cardiac arrest
S/s of hypomagnesemia
Hyperactive deep tendon reflexes
- muscle cramps
- twitching
- dysphagia
- tachycardia (dysrythmias)
- hypertension
S/s of hypermagnesemia
Lethargy
- Hypoactive DTR’s
- Bradycardia
- Hypotension
Magnesium is a?
Smooth muscle relaxer (decreased DTR’s)
What do you collect in a patient’s history?
- Linguistic competence
- Provide language assistance resources
- Inform all of the availability of language assistance
- Ensure competence of those providing language assistance
- Provide print/multimedia materials in local languages
What is plain language/what does it do?
Makes any info you provide easy to read, understand, and use. Is still grammatically correct language that uses complete sentence structure and accurate word usage.
You can check electrolyte values via?
CMP or complete metabolic profile
s/s of infiltration?
pallor, edema, cool to touch, damp dressing, slow IV rate
s/s of phlebitis?
edema, throbbing, redness, red line up arm, slowed rate. Treat by stopping infusion, elevating site, applying warm or cold compress, and restarting in different location
s/s of cellulitis?
pain, warmth, edema, induration, red streaking, chills. Treat by stopping infusion, elevating site, apply warm or cold compress, restart in different location, may need antibiotic
s/s of fluid overload?
distended neck veins, HTN, SOB, crackles, edema. Treat by raising HOB, monitoring vitals, and diuretics
How do you prevent IV complications?
monitor site
use pump
rotate site every 72 hrs
good infection control measures
Monitor I&O
What is peak concentration?
this is the highest serum level of a medication and usually occurs just before the last of the med is absorbed (30-60 minutes after administration).
What is trough concentration?
-the lowest amount of a drug detected in the serum. Occurs just prior to the time in which the medication is to be given again.
What are some general things to know about blood transfusion?
- 2 nurses verify prior to admin
- You always draw blood and check vitals prior
- The patient has a blood band
- You have 30 min to start the transfusion and 4 hours to complete
- A lot of patients report a spike in temp
- 18 gauge is best size angio for blood
- First 15 min is the highest rxn time (usually start at 75 ml/hr)
- Biohazard bag for blood bag; angio goes to garbage
When calculating intake and output, what is the formula we need to focus on?
volume/time
If there is a saline lock instead of a continuous running IV, what would you need to add in your calculations?
The flushes; you would flush before and after applying medications
Minimum urine output expected of a patient?
30-60 ml/hr
Why are daily weights important for I and O?
- indicator of fluid status
- use same conditions
What is I and O?
24 hr I&O: compare I&O
Intake includes all liquids eaten, drunk, or received through IV
Output= urine, vomitus, gastric suction, wound drainage
What factors influence sleep?
-drugs and substances
-lifestyle
-usual sleep patterns
-emotional stress
-environment
-exercise and fatigue
-food and caloric intake
What physical illnesses influence sleep?
Respiratory disease
Heart disease, HTN
Nocturia
Restless Leg Syndrome (RLS)
GI disorders
What are some sleep disorders?
Insomnia
Sleep Apnea
Narcolepsy
Sleep Deprivation
Parasomnias
Name some ways to promote sleep
Environmental controls
Bedtime routines
Safety
Comfort
Activity before bed
Stress reduction
Bedtime snacks
Pharmacological approaches
What are some components to assessing pain?
Patient’s expression (pain is individualistic)
- Physical exam
- Characteristics of pain (timing, location, severity)
What are the different types of pain scales?
-Visual Analogue Scale (VAS)
-Numeric Rating Scale (NRS)
-Simple descriptor scale
-Wong-Baker Faces Pain Rating Scale
What are three types of non pharmacological pain management
- Cutaneous stimulation
- Immobility and rest
- Cognitive-Behavioral Interventions
Give examples of cutaneous stimulation non pharmacological pain management
- Based on “gate control” theory
- Transcutaneous electrical nerve stimulation (TENS)
- Acupuncture
- Acupressure
- Massage
- Heat and Cold (cold causes vasoconstriction to prevent edema and bleeding; heat promotes circulation)
- Contralateral stimulation (stimulate skin opposite painful site)
Give examples of cognitive-behavioral non pharmacological pain management
Distraction
- Progressive muscle relaxation
- Guided imagery
- Hypnosis
- Therapeutic touch
- Humor
- Journaling
What are the side effects of narcotics?
-nausea/vomiting
-constipation
- CNS depression
- Respiratory depression
What is the antidote for induced respiratory despression?
Naloxone (narcan)
What is a PCA used for?
- Allows patient to self-administer with minimal risk of overdose
- Maintains a constant plasma level of analgesic
What are characteristics of body fluids?
the fluid amount (volume), concentration (osmolality), composition (electrolyte concentration), and degree of acidity (pH).
Why are body fluids important?
Fluid, electrolyte, and acid-base balances within the body maintain the health and function of all body systems
Name the electrolytes
K+, Ca2+, Mg+, Cl, and phosphate (Pi)
How do you treat cellulitis?
: stop infusion; elevate site; warm or cold compress; restart in different location; may need ANTIBIOTIC
How do you treat phlebitis?
stop infusion; elevate site; warm or cold compress; restart in different location
- A senior student nurse delegates the task of intake and output to a new nursing assistant. The student will verify that the nursing assistant understands the task of I&O when the nursing assistant states,
A. “I will record the amount of all voided urine.”
B. “I will not count liquid stools as output.”
C. “I will not record a café mocha as intake.”
D. “I will notate perspiration and record it as a small or large amount.”
A. “I will record the amount of all voided urine.”
Why is sleep important?
What abilities does it affect?
the ability to concentrate, make judgments, and participate in daily
activities decreases, and irritability increases
What are the functions of sleep?
What happens during sleep?
A time of restoration, memory consolidation, and
preparation for the next period of wakefulness
Restores biological processes
Protein synthesis and cell division for the renewal of
tissues occurs
Dreams
When do dreams occur?
REM and NREM sleep
What are dreams important for?
Important for learning, memory, and adaptation to stress
During rounds on the night shift, you note that a patient stops breathing
for 1 to 2 minutes several times during the shift. This condition is known
as:
A. cataplexy.
B. insomnia.
C. narcolepsy.
D. sleep apnea
D. sleep apnea
What does rest contribute to?
Different mental states
Mental relaxation
Freedom from anxiety
State of mental, physical, and spiritual activity
A 4-year-old pediatric patient resists going to sleep. To assist this
patient, the best action to take would be:
A. adding a daytime nap.
B. allowing the child to sleep longer in the morning.
C. maintaining the child’s home sleep routine.
D. offering the child a bedtime snack.
C. maintaining the child’s home sleep routine.
Copyright © 2021, Elsevier Inc. All Rights Reserved.
- A patient suffers from sleep pattern disturbance. To
promote adequate sleep, the most important nursing
intervention is:
A. administering a sleep aid.
B. synchronizing the medication, treatment, and vital signs
schedule.
C. encouraging the patient to exercise immediately before
sleep.
D. discussing with the patient the benefits of beginning a long
-term nighttime medication regimen
B. synchronizing the medication, treatment, and vital signs
schedule.
Copyright © 2021, Elsevier Inc. All Rights Reserved.
14
What would a sleep history look like?
Not just sleep related factors
Description of sleeping problems
Usual sleep pattern
Physical and psychological illness
Current life events
Emotional and mental status
Bedtime routines
Bedtime environment
Behaviors of sleep deprivation
What are some nursing diagnoses for sleep?
Not sleep disorders
Adequate Sleep
Fatigue
Impaired Sleep
Reduced Fatigue
Sleep Deprivation
What are the normal sodium values?
Sodium- 136-145
What are the normal potassium values?
Potassium- 3.5-5.0
What are the normal chloride values?
Chloride- 98-106
What are the normal magnesium values?
Magnesium- 1.3-2.1
What are the normal calcium values?
9.0-10.5
T or F, you can give potassium via IV push
False; you will kill them
What is added to blood infusions as an anticoagulant?
Sodium Citrate
What are blood infusions used to treat?
Anemia
How many mL is 1 unit of RBCs?
250-300mL
What is the fluid the RBCs are suspended in?
Fresh Frozen Plasma (FFP)
How many mL is 1 unit of FFP?
150-300mL
HOw many mL is 1 unit of platelets?
50mL
How do we infuse platelets?
Free flow (no pump)
What are platelet infusions used for?
Thrombocytopenia, emergent surgeries (with platelet inhibitors), massive transfusion protocol.
What is albumin?
special protein in blood plasma responsible for blood’s viscosity
What is albumin used for?
Volume expander- pull fluid from extravascular space to intravascular space
Treats low protein
What is cryoprecipitate (cryo)?
precipritate collected from centrifuged plasma
What is cryoprecipitate used for?
Anticoagulant reversal, r-tPa reversal, and when any of cryo’s components are lacking
Typically used to stop bleeding
What is cryoprecipitate composed of?
fibrinogen, factor VIII, vWF, factor XIII, and fibronectin
What is prothomben concentrat complex?
Further processed plasma.
There are 3 and 4 factor variants
What is prothrombin concentrate complex used for?
Vitamin K deficiency (coumadin reversal)
Post surgical trauma
massive transfusions
What are crystalloids?
Water + electrolytes
Water soluble molecules
What are colloids?
Large insoluble molecules
Give some traits for crystalloids?
Simple
Cost-effective
Different combinations
no immune response
What are traits of colloids?
Higher osmotic pressure
expensive
What is an isotonic solution?
Same osmolarity
What is a hypotonic solution?
Less osmotic concentration
What is a hypertonic solution?
Higher osmotic cocnentration
What electrolytes are in 0.9% normal saline?
Sodium and Chloride
(can lead to hypercholoremic metabolic acidosis)
What is in Lactated Ringers?
Sodium, Chloride, Potassium, Calcium, Lac
What is in plasmolyte?
Sodium, Chloride, Potassium, Magnesium, Acet, Gluconate
What is 3% normal saline used for?
Treatment of cerebral edema, treats severe symptomatic hyponatremia
What is 0.45% normal saline used for?
Treats hypernatremia, replace free water deficit
What can 0.45% normal saline result in via rapid administration?
Lysis of RBC, deplete intravascular volume= CV collapse
What are the isotonic IV fluids?
Plasmolyte, Lactated Ringers, and 0.9% normal saline.
What is the hypertonic IV fluid?
3% normal saline
What is the hypotonic IV fluid?
0.45% normal saline
What happens as 5% Dextrose-Water is metabolized?
The dextrose is metabolized and it becomes free water. (isotonic)
What do dextrose solutions do?
Add calories (should not replace normal nutrition)
What happens when the dextrose from 5% dextrose-0.45% normal saline is metabolized?
0.45% normal saline is left (becomes hypotonic)
What happens when the dextrose from 5% dextrose-normal saline is metabolized?
Normal saline is left (becomes isotonic)
What happens when the dextrose from 5% dextrose-lactated ringers is metabolized?
lactacted ringers is left (isotonic solution)
What can albumin be used for? (IV fluid)
Retain renal function
Adjunct to other fluids for hypovolemia
Replace low levels
Normal C02 range in the body
22-30mEq
normal HCO3 range in the body
21-28
What is the normal phosphate range in the body?
3.0-4.5
What is the normal pH range in the body?
7.35-7.45
What is the normal PaCO2 range in the body?
35-45mm Hg
What is the normal PaO2 range in the body?
80-100mm Hg
What is the normal 02 sat in the body?
95%-100%
What are sources of potassium?
fruits,potatoes,molasses,instant coffee
What are sources of calcium?
Dairy products, canned fish, broccoli, oranges
What are sources of magnesium?
dark green leafy veggies, whole grains
What are sources of phosphates?
milk, processed foods
During rounds on the night shift, you note that a patient stops breathing for 1 to 2 minutes several times during the shift. This condition is known as:
A. Cataplexy
B. Insomnia
C. Narcolepsy
D. Sleep apnea.
D. Sleep Apnea
A 4-year old pediatric patient resists going to sleep. To assist this patient, the best action to take would be:
A. Adding a daytime nap.
B. Allowing the child to sleep longer in the morning.
C. Maintaining the child’s home sleep routine.
D. Offering the child a bedtime snack.
C. Maintaining the child’s home sleep routine.
When a smiling and cooperative patient complains of discomfort, nurses caring for this patient often harbor misconceptions about the patient’s pain. Which of the following is true?
A. Chronic pain is psychological in nature
B. Patients are the best judges of their pain.
C. Regular use of narcotic analgesics leads to drug addiction.
D. Amount of pain is reflective of actual tissue damage.
B. Patients are the best judges of their pain.
A patient has just undergone an appendectomy. When discussing with the patient several pain-relief interventions, the most appropriate recommendation would be:
A. adjunctive therapy
B. Nonopioids
C. NSAIDS
D. PCA pain management
D. PCA pain management.
A postoperative patient is using PCA. You will evaluate the effectiveness of the medication when
A. You compare assessed pain w/baseline pain
B. Body language in incongruent with reports of pain relief
C. Family members report that pain has subsided
D. Vital signs have returned to baseline
A. You compare assessed pain w/baseline pain.
What is acute/transient pain?
Protective, identifiable, short duration, limited emotional response
What is chronic/persistent non-cancer pain?
Not protective, has no purpose, may or may not have cause
What is chronic episodic pain?
Occurs sporadically over an extended duration
What is cancerous pain?
Can be acute or chronic
What is idiopathic pain?
Chronic pain without identifiable physical or psychological cause
