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NUR 240 > NUR 240 Exam 3 > Flashcards

NUR 240 Exam 3 Flashcards

1
Q

What is altruism

A

Caring for others

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2
Q

What is autonomy

A

self-determination; making your own choices

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3
Q

What is human dignity

A

Respect for people

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4
Q

What is integrity

A

Acting according to ethics and standard of care

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5
Q

What is social justice

A

Upholding rights of people

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6
Q

What is the purpose of a code of ethics

A

A standard set of rules that we can refer to if a practice brings up an ethical question

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7
Q

What are the seven tenets of the Bill of Rights for nurses:
RNs must be able to…

A
  1. Practice for the good of the patient and society
  2. Practice in an environment that allows them to do their jobs legally
  3. work in an environment that promotes ethical practice
  4. advocate for themselves and their patients without fear of retribution
  5. receive fair compensation for their work
  6. work in a safe environment for themselves and their patients
  7. negotiate the conditions of their employment
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8
Q

What is moral distress

A

When you know what you’re supposed to do, but your employer tells you to do something else

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9
Q

What is an ethical dilemma

A

When two or more principles support two opposing options

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10
Q

What are some theories of aging

A

genetic
immunity
cross-linkage (damage to DNA and cell death)
free radicals

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11
Q

What are some common causes of death in middle age adults

A

cancer
cardiovascular disease
unintentional injuries (MVA, falls, accidents)
Diabetes
chronic lower respiratory diseases
cerebrovascular disease

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12
Q

What are the most common major health concerns for middle aged adults

A

Rheumatoid arthritis
obesity
alcoholism
depression

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13
Q

What are some causes of accidental injuries in older adults

A

changes in vision and hearing
loss of strength
slower reflexes
decreased sensory ability
chronic illness/medications
economic factors

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14
Q

What are some mental impairments in older adults

A

dementia
Alzheimer’s
sun downing
cascade iatrogenesis (a cascade of decline)

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15
Q

What is a good tool for assessing older adults

A

S- sleep disorders
P- problem eating
I- incontinence
C- confusion
E- evidence of falls
S- skin breakdown

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16
Q

Which respiratory tissue is the site of gas exchange

A

alveoli

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17
Q

What is perfusion

A

Blood flow to body tissues

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18
Q

What is the difference between myocardial ischemia and myocardial infarction

A

ischemia: tissue death in the heart
infarction: heart attack

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19
Q

What does the respiratory function look like in an older adult

A
  • increased risk for disease, especially pneumonia
  • airways become rigid
  • diaphragm moves less efficiently
  • kyphosis and barrel chest changes amount of space in chest cavity
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20
Q

What do wheezes sounds like

A

musical sounds due to narrowing of airways

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21
Q

What do crackles sound like

A

crunchy, popping noises due to air passing through liquid in the lungs

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22
Q

What is tidal volume

A

The amount of air that moves in or out of the lungs during respiration

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23
Q

What is an incentive spirometer

A

a tool that helps patients take deep breaths in order to improve lung expansion and functioning

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24
Q

What is chest physiotherapy

A

smacking the lungs with a cupped hand in order to move mucus out of the lungs

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25
Q

What is a non-rebreather mask

A

A mask that covers the mouth and nose
(it guarantees that you are breathing in pure oxygen and not exhaled CO2)

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26
Q

What is the difference between a cuffed and cuffless tracheostomy

A

cuffed has a balloon filled with air to keep the trach in place
cuffless does not (just a tube)

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27
Q

Where would you expect to see cyanosis in a patient who has poor gas exchange in the lungs

A

around the mouth (sometimes in the fingers)

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28
Q

What are the three phases of perioperative care

A
  • preoperative
  • intraoperative
  • postoperative
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29
Q

What is the preoperative phase

A

Begins when the surgery is decided, and last until the patient goes to the OR or is transferred to the operative bed

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30
Q

What is the intraoperative phase

A

Begins when patient is transferred to the OR bed and ends when patient is transferred to the post anesthesia care unit (PACU)

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31
Q

What is the postoperative phase

A

Begins when transferred to PACU and ends after the last follow up appointment

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32
Q

What are the classifications of surgical procedures

A
  • urgency
  • risk
  • purpose
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33
Q

What are the three types of urgency related to surgical procedures

A
  • elective (no problem when delayed)
  • urgent (done within 24-48 hours)
  • emergency (done immediately)
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34
Q

What are the two types of risks when classifying surgical procedures

A
  • minor (usually elective)
  • major (may be elective, urgent, or emergent)
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35
Q

What are the types of purposes when classifying surgical procedures

A

diagnostic (biopsy)
curative (removes illness)
preventive (removes risk of issue)
ablative (removal of diseased part appendix)
palliative (doesn’t fix problem but reduces suffering)
reconstructive (restore function)
transplantation (replace diseased organ)
constructive (congenital anomalies cleft palate)

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36
Q

What are the different types of anesthesia

A

General (full body)
moderate sedation/analgesia (short term, conscious sedation)
regional (applied to nerves in the area)
topical/local (mucous membranes, burns)

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37
Q

What are the three phases of general anesthesia

A

induction (administration to incision)
maintenance (incision to near completion)
emergence (wake up and ready to leave)

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38
Q

What are the states of general anesthesia

A

Loss of consciousness
Amnesia
Analgesia
Relaxed skeletal muscles
Depressed reflexes

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39
Q

What are the types of regional anesthesia

A

nerve block
spinal
epidural
local - lidocaine

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40
Q

What is informed consent

A

The patient agrees to the procedure after being told the risks and benefits

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41
Q

What are advanced directives

A

Living will
Durable power of attorney

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42
Q

What are some benefits of outpatient surgery

A
  • low stress
  • reduces risk of infection
  • reduces cost of procedure
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43
Q

What are some medications that are important to ask about before a patient goes into surgery

A
  • anticoagulants (risk of hemorrhage)
  • diuretics (electrolyte imbalance, respiratory depression)
  • tranquilizers (increases hypotensive events)
  • adrenal steroids (abrupt withdrawal may cause heart problems)
  • mycin antibiotics (respiratory paralysis)
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44
Q

What are some physical activities that are encouraged after surgery

A

deep breathing
coughing
incentive spirometry
leg exercises (promotes venous return)
turning in bed
early ambulation

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45
Q

Joint commission protocols to prevent surgical errors

A
  • pre-op patient identification
  • mark the operation site
  • final verification before procedure starts
    (everyone on the team must agree to these before the operation can be performed)

prevents wrong site, wrong procedure, wrong person

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46
Q

What are the post-op interventions and how often are they performed

A

every 10-15 minutes
- respiratory status
- cardiovascular status
- temperature
- CNS status (mental status/shivering)
- fluid status
- wounds status
- GI status
- General condition

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47
Q

What are the levels of return to conciousness

A
  • unconscious
  • response to touch and sound
  • drowsiness
  • awake but not oriented
  • awake and oriented
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48
Q

What is atelactasis

A

incomplete expansion or collapsed lung

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49
Q

What functions does water have in the body

A

transport
metabolism
solvent
thermoregulation
digestion
elimination
lubricant

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50
Q

What are the two compartments of water in the body

A

intracellular (70%)
extracellular (30%)

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51
Q

What is a solvent

A

liquids that solids are dissolve into (water)

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52
Q

What is a solute

A

The substance that is dissolved in a liquid (salt)

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53
Q

What are the major electrolytes

A

sodium
potassium
calcium
magnesium
chloride
bicarbonate
phosphate

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54
Q

What is the chief function of sodium in the body

A

regulates volume of body fluids

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55
Q

What is the chief function of potassium in the body

A

chief regulator of cellular enzyme activity and water content

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56
Q

What is the chief function of calcium in the body

A

nerve impulse
blood clotting
muscle contraction
B12 absorption

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57
Q

What is the chief function of magnesium in the body

A

metabolism of carbohydrates and proteins
vital actions involving enzymes

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58
Q

What is the chief function of chloride in the body

A

maintains osmotic pressure in blood
produces hydrochloric acid

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59
Q

What is the chief function of bicarbonate in the body

A

body’s primary buffer system

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60
Q

What is the chief function of phosphate in the body

A

involved in important chemical reactions in the body
cell division
hereditary traits

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61
Q

What are the ways that body fluids are transported in the body

A
  • osmosis
  • diffusion
  • active transport
  • capillary filtration
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62
Q

What is osmosis

A

movement of water from low solute concentration to high solute concentration

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63
Q

What is diffusion

A

movement of solute from high concentration to low concentration

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64
Q

What is active transport

A

movement against the gradient and uses energy to do so

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65
Q

What is capillary filtration

A

movement of fluid through a permeable membrane from an area of high pressure to an area of lower pressure

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66
Q

What is hydrostatic pressure

A

positive pressure pushes fluid out of an artery

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67
Q

What is colloid osmotic pressure

A

negative pressure pulls fluid through veins towards the heart

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68
Q

Which organs are key in homeostasis

A

kidneys- urine
cardiovascular system- pump water and nutrients
lungs- O2 and CO2 circulation
adrenal glands- conserve water, Na, and Cl and excrete K
pituitary gland- releases ADH
thyroid- blood flow
nervous system- fluid balance
parathyroid- regulates Ca
GI tract- absorbs water and nutrients

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69
Q

What is the ideal body pH

A

7.4

70
Q

What are some acidic and basic body fluids

A

acidic- gastric juice
basic- pancreatic juice

71
Q

What are three buffer systems found in the body

A

carbonic acid-sodium bicarbonate
phosphate in kidney tubules
protein in RBCs

72
Q

What are the three ways our bodies regulate the acid-base homeostasis

A

buffer systems
respiratory system
renal mechanism

73
Q

How does the respiratory system regulate pH

A

CO2 stimulates respiration
- high CO2 causes acidosis
- high CO2 increases rate and depth in respirations

74
Q

How does the renal mechanism regulate pH

A

kidneys release H+ or bicarbonate in response to blood pH
- slower than respiratory mechanism or buffer system
- takes about 3 days
- urine pH varies 4.5- 8.2

75
Q

What are the three volume deficit balancing mechanisms

A
  • hypovolemia
  • dehydration
  • third-space shift
76
Q

What are the four volume excess balancing mechanisms

A
  • hypervolemia
  • overhydration
  • edema
  • interstital-to-plasma shift
77
Q

What is the target range for potassium in the ECF

A

3.5-5 mEq/L

78
Q

What is the target range for calcium in the ECF

A

4.5-5.1 mg/dL

79
Q

What is the target range for magnesium in the ECF

A

1.3-2.3 mEq/L

80
Q

What is the target range for chloride in the ECF

A

97-107 mEq/L

81
Q

What is the target range for phosphate in the ECF

A

2.5-4.5 mg/dL

82
Q

What is the target range for sodium in the ECF

A

135-145 mEq/L

83
Q

What are the four acid-base imbalances that happen in the body

A

respiratory (carbonic acid)
- acidosis (increase)
- alkalosis (decrease)
metabolic (bicarbonate)
- acidosis (decrease)
- alkalosis (increase)

84
Q

What are some risk factors for fluid/electrolyte imbalances

A
  • chronic or acute illness (DM, CHF, renal failure)
  • abnormal fluid loss
  • burns
  • trauma
  • surgery
  • therapies that change electrolyte concentration
85
Q

What is the normal range for PCO2

A

35-45

86
Q

What is the normal range for HCO3

A

22-26

87
Q

How do you determine metabolic acidosis/alkalosis vs respiratory acidosis/alkalosis

A

increased pH = alkalosis
decreased pH = acidosis

ROME (respiratory opposite, metabolic equal)
If pH and PCO2 are going in OPPOSITE directions, its respiratory
If pH and HCO3 are going in the SAME direction, its metabolic

88
Q

Which labs are included in a complete blood count (CBC)

A
  • RBC
  • neutrophils
  • eosinophils
  • basophils
  • lymphocytes
  • monocytes
  • platelets
89
Q

What does the white blood cell labs test for and what does it mean when the values are higher or lower than normal

A

number of white blood cells in the blood (neutrophils, eosinophils, basophils, monocytes, and lymphocytes)

high = infection
low = neutropenic (low immunity)

90
Q

What does the hemoglobin lab test for and what does it mean if its higher or lower than normal

A

tests the amount of hemoglobin in your blood

high = higher O2 needs in the body
low = anemia (low RBC count)

91
Q

What does the hematocrit lab test for and what does it mean if its higher or lower than normal

A

measures the percentage of a persons blood that is made up of red blood cells

high = severe fluid deficit/shock
low = acute blood loss, fluid overload

92
Q

What does the BUN lab test for and what does it mean if its higher or lower than normal

A

measures the amount of urea nitrogen in your blood
(urea nitrogen is a waste product usually eliminated by the kidneys)

high = impaired kidney function, heart failure, diabetic ketoacidosis, burns
low = malnutrition, liver failure, lack of protein in diet

93
Q

What does the Cr lab test for and what does it mean if its higher or lower than normal

A

Measures the amount of creatinine in the blood
creatinine is a waste product made by the muscles and eliminated by the kidneys

high = kidney dysfunction, heart failure, dehydration
low = muscle loss, severe liver disease, not enough protein in diet

94
Q

What does is mean if urine pH is high/low

A

High = respiratory alkalosis, hypokalemia, renal failure
Low = metabolic acidosis, diabetic ketoacidosis, diarrhea

95
Q

What does urine specific gravity measure and what does it mean if the level is high/low

A

measures the concentration of all chemical particles in the urine

High = dehydration (caused by vomiting or diarrhea), heart failure
Low = usually a good thing (means you are well hydrated), could be an indicator of diabetes or kidney failure

96
Q

What does the ABG test measure

A

Arterial blood gas - Tests the acidity of blood as well as the concentration of O2 and CO2 in the blood

97
Q

How much does 1 Liter weigh

A

2.2 pounds

98
Q

What are the different types of IVs

A

peripheral venous catheter
Midline peripheral catheter
central venous access device

99
Q

What are some central venous access devices

A

PICCs (peripherally inserted central catheter)
Nontunneled percutaneous
tunneled
ports

100
Q

What is Hypercapnea

A

increased CO2

101
Q

What does PACU stand for

A

Post anesthesia care unit

102
Q

What is the role of the PACU nurse

A
  • assess pt as they recover from anesthesia
  • assess for N/V
  • assess until pt is back to baseline
103
Q

When does the PACU nurse remove the artificial airway after surgery

A

When the gag reflex is reinstated

104
Q

What is the primary nursing goal in the immediate postoperative period

A

maintenance of pulmonary function and prevention of hypoxemia and hypercapnia.

105
Q

What are some potential cardiovascular issues when recovering in the PACU

A
  • hypotension
  • hypertension
  • shock
  • hemorrhage
  • arrhythmia
106
Q

What are some signs of hypovolemic shock

A
  • pale
  • cool, moist skin
  • rapid respirations
  • cyanosis
  • rapid, weak, thready pulse
  • decreasing pulse pressure
  • low blood pressure
  • concentrated urine
107
Q

What is primary wound healing

A

When the physician closes the wound using stitches, staples, or glue

108
Q

What is secondary wound healing

A

When the wound cannot be closed due to round edges, cover uneven surfaces, or are in places where movement makes stitches impossible

109
Q

What is tertiary wound healing

A

Delayed wound closure in order to let it drain or to avoid trapping infectious debris in the wound. Let it heal or drain a bit and then close it up with stitches, staples, or glue.

110
Q

What are some postoperative complications

A
  • pulmonary infection
  • hypoxia
  • Deep vein thrombosis
  • Pulmonary embolism
  • hematoma
  • hemorrhage
  • infection
  • wound dehiscence
  • evisceration
111
Q

What is the purpose of the upper respiratory tract

A

warms and filters air

112
Q

What is the purpose of the lower respiratory tract

A

gas exchange (includes the lungs)

113
Q

what is the difference between respiration and ventillation

A

vent- movement of lung structures and diaphragm
resp- movement of air in and out of the lungs

114
Q

What is pulmonary diffusion

A

Gas exchange from tissues to blood or blood to tissues

115
Q

What is pulmonary perfusion

A

Circulation of blood in the lungs surrounding the alveoli
(measured to determine if the patient has a PE [ventilation>perfusion = PE])

116
Q

What are the 7 pulmonary function tests

A
  1. forced vital capacity
  2. forced expiratory volume
  3. ratio of timed forced expiratory volume: forced vital capacity
  4. forced expiratory flow
  5. forced midexpiratory flow
  6. forced end-expiratory flow
  7. maximum voluntary ventilation
117
Q

What is forced vital capacity and what does it measure

A

FVC

The maximum amount of air that can be forcefully exhaled after taking a deep breath in

this is usually reduced in patients with COPD due to air trapping

118
Q

What is forced expiratory volume and what does it measure

A

FEV(t) [t = 1 second usually]

amount of air that can be forcefully exhaled in (t) seconds

measures the severity of expiratory obstruction in patients with COPD

119
Q

What is ratio of timed forced expiratory volume: forced vital capacity and what does it measure

A

FEV(t)/FVC% [t = 1 second usually]

forced expiratory volume expressed as a percentage of forced vital capacity

way of expressing the presence and severity of COPD

120
Q

What is forced expiratory flow and what does it measure

A

FEF(200-1200)

mean of forced air exhaled between 200 and 1200mL of forced vital capacity

An indicator of a large airway obstruction

121
Q

What is forced midexpiratory flow and what does it measure

A

FEF(25-75%)

mean of forced air exhaled during the middle half of the forced vital capacity

slowed in small airway obstructions

122
Q

What is forced end-expiratory flow and what does it measure

A

FEF(75-85%)

mean of forced air exhaled during the end portion of the forced vital capacity

slowed in the obstruction of the smallest airways

123
Q

What is maximal voluntary ventilation and what does it measure

A

MVV

The amount of air that can be forcefully inhaled and exhaled during a specific time period (usually 12 seconds)

measures exercise tolerance

124
Q

What is epistaxis

A

A nosebleed

125
Q

What are some upper respiratory infections

A

Rhinitis
Rhinosinusitis
pharyngitis
tonsillitis
adenoiditis
peritonsillar abscess
laryngitis

126
Q

Untreated upper respiratory infections can lead to

A

meningitis
sepsis

127
Q

What do you do when you have epistaxis

A

pinch the bridge of the nose and sit upright (lean forward slightly) for 5 to 10 minutes

128
Q

What are some things to avoid after severe epistaxis

A

spicy food
smoking
strenuous exercise
nasal trauma and nose picking
forceful blowing

129
Q

What is the prevalence of laryngeal cancer

A

50% of all head and neck cancers
men 4X more likely than women

130
Q

What disorder causes low albumin

A

Laryngeal cancer

131
Q

What is atelectasis

A

closed or collapsed alveoli
most common is acute seen in postop patients

132
Q

Two main nursing interventions to prevent atelectasis

A

Cough and deep breathe
incentive spirometry

133
Q

What are the signs and symptoms of atelectasis

A

tachycardia
tachypnea
pleural pain
central cyanosis if large areas of the lung are affected
cough
sputum production

134
Q

What is CPT

A

Chest physiotherapy

lay patient prone then use a cupped hand and beat them across the lung fields in order to move around the mucus. Put in PD position and hold food for a hour before the procedure so they don’t vomit

135
Q

What is PD

A

postural drainage

lower the head and raise the feet in order to drain secretions from lungs. Usually done with CPT and encourage them to take deep breaths and cough

136
Q

What is acute tracheobronchitis

A

Inflammation of the mucous membranes of the trachea usually after a viral infection

starts as a dry cough and then as it progresses: dyspnea, stridor, wheezes, and purulent sputum

137
Q

What is pneumonia

A

Inflammation of the lung parenchyma caused by bacteria, mycobacteria, fungi, or viruses

138
Q

What are the three types of pneumonia

A

community acquired (CAP)
hospital acquired (HAP)
ventilator associated (VAP)

139
Q

What is the most common cause of community acquired pneumonia

A

S. Pneumoniae

140
Q

What are the characteristics of hospital acquired pneumonia

A
  • developed 48 hours after admitted to the hospital
  • high mortality rate
  • high fever
  • tachycardia
  • common with debilitated patients
  • lots of potential organisms
141
Q

What are the characteristics of ventilator associated pneumonia

A

Same as hospital acquired but patient has been on a vent for 48 hours

142
Q

What are some risk factors for pneumonia

A

Heart failure
Diabetes
Alcoholism
COPD
AIDS
Influenza
Cystic fibrosis

143
Q

What are the symptoms that you will see in a patient with streptococcal pneumonia

A

Sudden onset of chills
fever
pleuritic chest pain
tachypnea
respiratory distress

144
Q

What are the symptoms that you will see in a patient with pneumonia caused by a virus, mycoplasma, or Legionella

A

bradycardia

145
Q

What symptoms could you see in a patient with pneumonia regardless of cause

A

Respiratory tract infection
headache
low-grade fever
pleuritic pain
myalgia
rash
pharyngitis
Orthopnea
crackles
increased tactile fremitus
purulent sputum

146
Q

What are the two vaccines for pneumonia

A

vaccinations

PCV-13 (pneumococcal vaccine)
covers 13 stains of pneumonia

PPSV-23 (pneumococcal polysaccharide vaccine)
covers 23 strains of pneumonia

Can get both vaccines but must wait 1 year and 1 day after getting PCV-13 to receive PPSV-23

147
Q

Who do we encourage to get the pneumonia vaccines

A
  • 65+
  • Immunocompromised individuals
  • CKD (chronic kidney disease)
  • HIV
  • Leukemia
  • asplenia (removed spleen)
  • asthma
  • sickle cell disease
148
Q

What are the symptoms of COVID-19

A

asymptomatic to severe viral pneumonia
- Fatigue
- myalgia
- congestion
- sore throat
- diarrhea
- anosmia (loss of smell)
- ageusia (loss of taste)

149
Q

What complications can we see in a patient with pneumonia

A

sepsis
respiratory failure
atelectasis
pleural effusion
delirium

150
Q

What is aspiration

A

inhaling foreign material into the lungs
can lead to broncho or lobar pneumonia

151
Q

How do you prevent aspiration

A
  • raise head of bed
  • small bites
  • no straws
  • soft diet
152
Q

What are some aspiration risk factors

A
  • seizure
  • stroke
  • alcohol/drug intoxication/overdose
  • sedation
  • swallowing disorders
153
Q

What is TB and how is it transmitted

A

Mycobacterium tuberculosis bacillus

airborne transmission through droplets
moves to the kidneys, bones, and cerebral cortex

154
Q

How do you test for TB

A

TB skin test (Mantoux method)
TB blood test
Sputum culture
Sputum testing
Chest X ray

155
Q

How do you treat TB

A

6-12 months of treatment with antibiotics
very resistant to drugs

156
Q

What is a lung abscess

A

a complication of bacterial pneumonia
a collection of pus in the lung
Can lead to empyema and bronchopleural fistula

157
Q

What are the symptoms of lung abscess

A

productive cough
foul sputum
leukocytosis
pleurisy
dyspnea
weakness
anorexia
weight loss

158
Q

What is pleurisy

A

inflammation of both layers of pleura

159
Q

What is pleural effusion

A

Fluid collection in pleural space
usually secondary to heart failure, TB, pneumonia, pulmonary infections

160
Q

What is empyema

A

Accumulation of thick, purulent fluid in pleural space
a complication of lung abscess

161
Q

What is the difference between tracheotomy and tracheostomy

A

otomy - procedure to place the tube
ostomy - the hole that is made for the tube

162
Q

What is the mortality rate of acute respiratory distress syndrome

A

27-50%

163
Q

What is acute respiratory distress syndrome

A

sudden, progressive pulmonary edema
increasing bilateral lung infiltrates visible on chest x-ray
absence of an elevated left atrial pressure

164
Q

What are the three pulmonary vascular disorders

A

pulmonary edema
pulmonary embolism
pulmonary hypertension

165
Q

What is the leading cause of cancer death in the united states

A

Lung cancer

166
Q

How do you stage tumors

A

stage I: small, hasn’t spread to nearby tissues
stage II: bigger, still no spread
stage III: bigger, spread to lymph nodes and nearby tissues
stage IV: spread to other organs or body systems

167
Q

What is the leading cause of lung cancer

A

Smoking (>85%)
small cell (SCLC) - 13%
non small cell (NSCLC) - 84%

168
Q

What is a thoracotomy

A

surgical procedure used to remove lung cancer tumors

169
Q

What are the different types of chest trauma

A

blunt trauma
penetrating trauma
pneumothorax

170
Q

What is a chest tube used for

A

draining air or fluid from pleural space

NUR 240 (4 decks)

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