NUR 240 Exam 3 Flashcards
1
Q
What is altruism
A
Caring for others
2
Q
What is autonomy
A
self-determination; making your own choices
3
Q
What is human dignity
A
Respect for people
4
Q
What is integrity
A
Acting according to ethics and standard of care
5
Q
What is social justice
A
Upholding rights of people
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
7
Q
What are the seven tenets of the Bill of Rights for nurses:
RNs must be able to…
A
- Practice for the good of the patient and society
- Practice in an environment that allows them to do their jobs legally
- work in an environment that promotes ethical practice
- advocate for themselves and their patients without fear of retribution
- receive fair compensation for their work
- work in a safe environment for themselves and their patients
- negotiate the conditions of their employment
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
9
Q
What is an ethical dilemma
A
When two or more principles support two opposing options
10
Q
What are some theories of aging
A
genetic
immunity
cross-linkage (damage to DNA and cell death)
free radicals
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
12
Q
What are the most common major health concerns for middle aged adults
A
Rheumatoid arthritis
obesity
alcoholism
depression
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
14
Q
What are some mental impairments in older adults
A
dementia
Alzheimer’s
sun downing
cascade iatrogenesis (a cascade of decline)
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
16
Q
Which respiratory tissue is the site of gas exchange
A
alveoli
17
Q
What is perfusion
A
Blood flow to body tissues
18
Q
What is the difference between myocardial ischemia and myocardial infarction
A
ischemia: tissue death in the heart
infarction: heart attack
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
20
Q
What do wheezes sounds like
A
musical sounds due to narrowing of airways
21
Q
What do crackles sound like
A
crunchy, popping noises due to air passing through liquid in the lungs
22
Q
What is tidal volume
A
The amount of air that moves in or out of the lungs during respiration
23
Q
What is an incentive spirometer
A
a tool that helps patients take deep breaths in order to improve lung expansion and functioning
24
Q
What is chest physiotherapy
A
smacking the lungs with a cupped hand in order to move mucus out of the lungs
25
What is a non-rebreather mask
A mask that covers the mouth and nose
(it guarantees that you are breathing in pure oxygen and not exhaled CO2)
26
What is the difference between a cuffed and cuffless tracheostomy
cuffed has a balloon filled with air to keep the trach in place
cuffless does not (just a tube)
27
Where would you expect to see cyanosis in a patient who has poor gas exchange in the lungs
around the mouth (sometimes in the fingers)
28
What are the three phases of perioperative care
- preoperative
- intraoperative
- postoperative
29
What is the preoperative phase
Begins when the surgery is decided, and last until the patient goes to the OR or is transferred to the operative bed
30
What is the intraoperative phase
Begins when patient is transferred to the OR bed and ends when patient is transferred to the post anesthesia care unit (PACU)
31
What is the postoperative phase
Begins when transferred to PACU and ends after the last follow up appointment
32
What are the classifications of surgical procedures
- urgency
- risk
- purpose
33
What are the three types of urgency related to surgical procedures
- elective (no problem when delayed)
- urgent (done within 24-48 hours)
- emergency (done immediately)
34
What are the two types of risks when classifying surgical procedures
- minor (usually elective)
- major (may be elective, urgent, or emergent)
35
What are the types of purposes when classifying surgical procedures
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*)
36
What are the different types of anesthesia
General (full body)
moderate sedation/analgesia (short term, conscious sedation)
regional (applied to nerves in the area)
topical/local (mucous membranes, burns)
37
What are the three phases of general anesthesia
induction (administration to incision)
maintenance (incision to near completion)
emergence (wake up and ready to leave)
38
What are the states of general anesthesia
Loss of consciousness
Amnesia
Analgesia
Relaxed skeletal muscles
Depressed reflexes
39
What are the types of regional anesthesia
nerve block
spinal
epidural
local - lidocaine
40
What is informed consent
The patient agrees to the procedure after being told the risks and benefits
41
What are advanced directives
Living will
Durable power of attorney
42
What are some benefits of outpatient surgery
- low stress
- reduces risk of infection
- reduces cost of procedure
43
What are some medications that are important to ask about before a patient goes into surgery
- 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)
44
What are some physical activities that are encouraged after surgery
deep breathing
coughing
incentive spirometry
leg exercises (promotes venous return)
turning in bed
early ambulation
45
Joint commission protocols to prevent surgical errors
- 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
46
What are the post-op interventions and how often are they performed
every 10-15 minutes
- respiratory status
- cardiovascular status
- temperature
- CNS status (mental status/shivering)
- fluid status
- wounds status
- GI status
- General condition
47
What are the levels of return to conciousness
- unconscious
- response to touch and sound
- drowsiness
- awake but not oriented
- awake and oriented
48
What is atelactasis
incomplete expansion or collapsed lung
49
What functions does water have in the body
transport
metabolism
solvent
thermoregulation
digestion
elimination
lubricant
50
What are the two compartments of water in the body
intracellular (70%)
extracellular (30%)
51
What is a solvent
liquids that solids are dissolve into (water)
52
What is a solute
The substance that is dissolved in a liquid (salt)
53
What are the major electrolytes
sodium
potassium
calcium
magnesium
chloride
bicarbonate
phosphate
54
What is the chief function of sodium in the body
regulates volume of body fluids
55
What is the chief function of potassium in the body
chief regulator of cellular enzyme activity and water content
56
What is the chief function of calcium in the body
nerve impulse
blood clotting
muscle contraction
B12 absorption
57
What is the chief function of magnesium in the body
metabolism of carbohydrates and proteins
vital actions involving enzymes
58
What is the chief function of chloride in the body
maintains osmotic pressure in blood
produces hydrochloric acid
59
What is the chief function of bicarbonate in the body
body’s primary buffer system
60
What is the chief function of phosphate in the body
involved in important chemical reactions in the body
cell division
hereditary traits
61
What are the ways that body fluids are transported in the body
- osmosis
- diffusion
- active transport
- capillary filtration
62
What is osmosis
movement of water from low solute concentration to high solute concentration
63
What is diffusion
movement of solute from high concentration to low concentration
64
What is active transport
movement against the gradient and uses energy to do so
65
What is capillary filtration
movement of fluid through a permeable membrane from an area of high pressure to an area of lower pressure
66
What is hydrostatic pressure
positive pressure pushes fluid out of an artery
67
What is colloid osmotic pressure
negative pressure pulls fluid through veins towards the heart
68
Which organs are key in homeostasis
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
69
What is the ideal body pH
7.4
70
What are some acidic and basic body fluids
acidic- gastric juice
basic- pancreatic juice
71
What are three buffer systems found in the body
carbonic acid-sodium bicarbonate
phosphate in kidney tubules
protein in RBCs
72
What are the three ways our bodies regulate the acid-base homeostasis
buffer systems
respiratory system
renal mechanism
73
How does the respiratory system regulate pH
CO2 stimulates respiration
- high CO2 causes acidosis
- high CO2 increases rate and depth in respirations
74
How does the renal mechanism regulate pH
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
What are the three volume deficit balancing mechanisms
- hypovolemia
- dehydration
- third-space shift
76
What are the four volume excess balancing mechanisms
- hypervolemia
- overhydration
- edema
- interstital-to-plasma shift
77
What is the target range for potassium in the ECF
3.5-5 mEq/L
78
What is the target range for calcium in the ECF
4.5-5.1 mg/dL
79
What is the target range for magnesium in the ECF
1.3-2.3 mEq/L
80
What is the target range for chloride in the ECF
97-107 mEq/L
81
What is the target range for phosphate in the ECF
2.5-4.5 mg/dL
82
What is the target range for sodium in the ECF
135-145 mEq/L
83
What are the four acid-base imbalances that happen in the body
respiratory (carbonic acid)
- acidosis (increase)
- alkalosis (decrease)
metabolic (bicarbonate)
- acidosis (decrease)
- alkalosis (increase)
84
What are some risk factors for fluid/electrolyte imbalances
- chronic or acute illness (DM, CHF, renal failure)
- abnormal fluid loss
- burns
- trauma
- surgery
- therapies that change electrolyte concentration
85
What is the normal range for PCO2
35-45
86
What is the normal range for HCO3
22-26
87
How do you determine metabolic acidosis/alkalosis vs respiratory acidosis/alkalosis
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
Which labs are included in a complete blood count (CBC)
- RBC
- neutrophils
- eosinophils
- basophils
- lymphocytes
- monocytes
- platelets
89
What does the white blood cell labs test for and what does it mean when the values are higher or lower than normal
number of white blood cells in the blood (neutrophils, eosinophils, basophils, monocytes, and lymphocytes)
high = infection
low = neutropenic (low immunity)
90
What does the hemoglobin lab test for and what does it mean if its higher or lower than normal
tests the amount of hemoglobin in your blood
high = higher O2 needs in the body
low = anemia (low RBC count)
91
What does the hematocrit lab test for and what does it mean if its higher or lower than normal
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
What does the BUN lab test for and what does it mean if its higher or lower than normal
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
What does the Cr lab test for and what does it mean if its higher or lower than normal
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
What does is mean if urine pH is high/low
High = respiratory alkalosis, hypokalemia, renal failure
Low = metabolic acidosis, diabetic ketoacidosis, diarrhea
95
What does urine specific gravity measure and what does it mean if the level is high/low
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
What does the ABG test measure
Arterial blood gas - Tests the acidity of blood as well as the concentration of O2 and CO2 in the blood
97
How much does 1 Liter weigh
2.2 pounds
98
What are the different types of IVs
peripheral venous catheter
Midline peripheral catheter
central venous access device
99
What are some central venous access devices
PICCs (peripherally inserted central catheter)
Nontunneled percutaneous
tunneled
ports
100
What is Hypercapnea
increased CO2
101
What does PACU stand for
Post anesthesia care unit
102
What is the role of the PACU nurse
- assess pt as they recover from anesthesia
- assess for N/V
- assess until pt is back to baseline
103
When does the PACU nurse remove the artificial airway after surgery
When the gag reflex is reinstated
104
What is the primary nursing goal in the immediate postoperative period
maintenance of pulmonary function and prevention of hypoxemia and hypercapnia.
105
What are some potential cardiovascular issues when recovering in the PACU
- hypotension
- hypertension
- shock
- hemorrhage
- arrhythmia
106
What are some signs of hypovolemic shock
- pale
- cool, moist skin
- rapid respirations
- cyanosis
- rapid, weak, thready pulse
- decreasing pulse pressure
- low blood pressure
- concentrated urine
107
What is primary wound healing
When the physician closes the wound using stitches, staples, or glue
108
What is secondary wound healing
When the wound cannot be closed due to round edges, cover uneven surfaces, or are in places where movement makes stitches impossible
109
What is tertiary wound healing
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
What are some postoperative complications
- pulmonary infection
- hypoxia
- Deep vein thrombosis
- Pulmonary embolism
- hematoma
- hemorrhage
- infection
- wound dehiscence
- evisceration
111
What is the purpose of the upper respiratory tract
warms and filters air
112
What is the purpose of the lower respiratory tract
gas exchange (includes the lungs)
113
what is the difference between respiration and ventillation
vent- movement of lung structures and diaphragm
resp- movement of air in and out of the lungs
114
What is pulmonary diffusion
Gas exchange from tissues to blood or blood to tissues
115
What is pulmonary perfusion
Circulation of blood in the lungs surrounding the alveoli
(measured to determine if the patient has a PE [ventilation>perfusion = PE])
116
What are the 7 pulmonary function tests
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
What is forced vital capacity and what does it measure
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
What is forced expiratory volume and what does it measure
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
What is ratio of timed forced expiratory volume: forced vital capacity and what does it measure
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
What is forced expiratory flow and what does it measure
FEF(200-1200)
mean of forced air exhaled between 200 and 1200mL of forced vital capacity
An indicator of a large airway obstruction
121
What is forced midexpiratory flow and what does it measure
FEF(25-75%)
mean of forced air exhaled during the middle half of the forced vital capacity
slowed in small airway obstructions
122
What is forced end-expiratory flow and what does it measure
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
What is maximal voluntary ventilation and what does it measure
MVV
The amount of air that can be forcefully inhaled and exhaled during a specific time period (usually 12 seconds)
measures exercise tolerance
124
What is epistaxis
A nosebleed
125
What are some upper respiratory infections
Rhinitis
Rhinosinusitis
pharyngitis
tonsillitis
adenoiditis
peritonsillar abscess
laryngitis
126
Untreated upper respiratory infections can lead to
meningitis
sepsis
127
What do you do when you have epistaxis
pinch the bridge of the nose and sit upright (lean forward slightly) for 5 to 10 minutes
128
What are some things to avoid after severe epistaxis
spicy food
smoking
strenuous exercise
nasal trauma and nose picking
forceful blowing
129
What is the prevalence of laryngeal cancer
50% of all head and neck cancers
men 4X more likely than women
130
What disorder causes low albumin
Laryngeal cancer
131
What is atelectasis
closed or collapsed alveoli
most common is acute seen in postop patients
132
Two main nursing interventions to prevent atelectasis
Cough and deep breathe
incentive spirometry
133
What are the signs and symptoms of atelectasis
tachycardia
tachypnea
pleural pain
central cyanosis if large areas of the lung are affected
cough
sputum production
134
What is CPT
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
What is PD
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
What is acute tracheobronchitis
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
What is pneumonia
Inflammation of the lung parenchyma caused by bacteria, mycobacteria, fungi, or viruses
138
What are the three types of pneumonia
community acquired (CAP)
hospital acquired (HAP)
ventilator associated (VAP)
139
What is the most common cause of community acquired pneumonia
S. Pneumoniae
140
What are the characteristics of hospital acquired pneumonia
- developed 48 hours after admitted to the hospital
- high mortality rate
- high fever
- tachycardia
- common with debilitated patients
- lots of potential organisms
141
What are the characteristics of ventilator associated pneumonia
Same as hospital acquired but patient has been on a vent for 48 hours
142
What are some risk factors for pneumonia
Heart failure
Diabetes
Alcoholism
COPD
AIDS
Influenza
Cystic fibrosis
143
What are the symptoms that you will see in a patient with streptococcal pneumonia
Sudden onset of chills
fever
pleuritic chest pain
tachypnea
respiratory distress
144
What are the symptoms that you will see in a patient with pneumonia caused by a virus, mycoplasma, or Legionella
bradycardia
145
What symptoms could you see in a patient with pneumonia regardless of cause
Respiratory tract infection
headache
low-grade fever
pleuritic pain
myalgia
rash
pharyngitis
Orthopnea
crackles
increased tactile fremitus
purulent sputum
146
What are the two vaccines for pneumonia
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
Who do we encourage to get the pneumonia vaccines
- 65+
- Immunocompromised individuals
- CKD (chronic kidney disease)
- HIV
- Leukemia
- asplenia (removed spleen)
- asthma
- sickle cell disease
148
What are the symptoms of COVID-19
asymptomatic to severe viral pneumonia
- Fatigue
- myalgia
- congestion
- sore throat
- diarrhea
- anosmia (loss of smell)
- ageusia (loss of taste)
149
What complications can we see in a patient with pneumonia
sepsis
respiratory failure
atelectasis
pleural effusion
delirium
150
What is aspiration
inhaling foreign material into the lungs
can lead to broncho or lobar pneumonia
151
How do you prevent aspiration
- raise head of bed
- small bites
- no straws
- soft diet
152
What are some aspiration risk factors
- seizure
- stroke
- alcohol/drug intoxication/overdose
- sedation
- swallowing disorders
153
What is TB and how is it transmitted
Mycobacterium tuberculosis bacillus
airborne transmission through droplets
moves to the kidneys, bones, and cerebral cortex
154
How do you test for TB
TB skin test (Mantoux method)
TB blood test
Sputum culture
Sputum testing
Chest X ray
155
How do you treat TB
6-12 months of treatment with antibiotics
very resistant to drugs
156
What is a lung abscess
a complication of bacterial pneumonia
a collection of pus in the lung
Can lead to empyema and bronchopleural fistula
157
What are the symptoms of lung abscess
productive cough
foul sputum
leukocytosis
pleurisy
dyspnea
weakness
anorexia
weight loss
158
What is pleurisy
inflammation of both layers of pleura
159
What is pleural effusion
Fluid collection in pleural space
usually secondary to heart failure, TB, pneumonia, pulmonary infections
160
What is empyema
Accumulation of thick, purulent fluid in pleural space
a complication of lung abscess
161
What is the difference between tracheotomy and tracheostomy
otomy - procedure to place the tube
ostomy - the hole that is made for the tube
162
What is the mortality rate of acute respiratory distress syndrome
27-50%
163
What is acute respiratory distress syndrome
sudden, progressive pulmonary edema
increasing bilateral lung infiltrates visible on chest x-ray
absence of an elevated left atrial pressure
164
What are the three pulmonary vascular disorders
pulmonary edema
pulmonary embolism
pulmonary hypertension
165
What is the leading cause of cancer death in the united states
Lung cancer
166
How do you stage tumors
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
What is the leading cause of lung cancer
Smoking (>85%)
small cell (SCLC) - 13%
non small cell (NSCLC) - 84%
168
What is a thoracotomy
surgical procedure used to remove lung cancer tumors
169
What are the different types of chest trauma
blunt trauma
penetrating trauma
pneumothorax
170
What is a chest tube used for
draining air or fluid from pleural space
