NURS270 Final Review Flashcards
what is cultural sensitivity
- recognizes and respects the unique cultural background of each patient
- acknowledges the impact of culture on a persons beliefs, values, customs and lifestyle
what is cultural competence
- process where we recognize the need for knowledge and skills to modify assessment and intervention strategies in order to achieve equity
cultural saftey
- focuses on social and political power that redefines the provider-patient relationship with emphasis on self-determination
what framework is used to define cultural competence
ABCDE framework
what does the A stand for (ABCDE Framework)
affective domain
affective domain (ABCDE Framework)
- an awareness of and sensitivity to cultural values, needs and bias
what does the B stand for (ABCDE Framework)
behavioural domain
behavioural domain
- the possesion of skills that are necessary to be effective in cross cultural encounters
what does the C stand for (ABCDE Framework)
cognitive domain
cognitive domain
involves cultural knowledge (theory, research, and cross cultural approaches to care)
what does D stand for (ABCDE Framework)
dynamic of difference
dynamic of difference
differences in worldview’s exists and can be the basis for discrimination and racism towards minority groups and social power imbalances
what does the E stand for (ABCDE Framework)
equity
equity (ABCDE Framework)
highlights the needs for equity in care and for attending to the practice environment (including support for clinicians)
what are the 3 levels of dynamic of difference
- nurse patient level
- patient health system level
- patient society level
nurse patient level (dynamic of difference)
nurses are aware of won biases and recognize that patients have their own biases aswell
- build trust, respect patients right an autonomy, recognize where margilization or exculsion can occur
patient health system level (dynamic of difference)
the extent to which patients/families feel understood and supported
patient society level (dynamic of difference)
considering the effect of systemic oppression and institutional racism
what is asthma
asthma triggers
- excersize
- pollen
- bugs in home
- chemical fumes
- cold air
- fungus spores
- dust
- smoke
- strong odors
- pollution
- anger
- stress
-pets
mild-moderate asthma symptoms
- frequent coughing
- night waking to cough or early morning cough
- increased wheezing
- gradula increase in activity intolerance
servere asthma symptoms
- rescue medication not effective
- significant difficulty with breathing, increased wheezing, uncontrolled cough
- cyanosis
life threatening asthma symptoms
- retractions seen in chest intercostal muscles, severe distress,
- rapid breathing no wheezing (minimal to no air exchange)
- medications are not effective
medications for non-emergent management of asthma
preventative action: Leukotriene modifier
- montelukast (singulair)
rescue/reliever action: SABA
- salbutamol
Preventative action: leukotriene modifier
(example + adverse effects)
motelukast (singulair)
- headache, GI upset
rescue action: SABA
- salbutamol (ventolin)
- tremors, nervousness, tachycardia
medications for macitence of asthma
- Anticholinergics/SAMA
- LABA
- Inhaled corticosteriod
anticholinergics / SAMA (example + adverse effects)
- ipratropium bromide (atrovent) and Tiotropium bromide (spirvia)
- dry mouth, cough
LABA (example + adverse effects)
- formoterol (foradil) and salmeterol (servent)
- tremor, nervousness, tachycardia
inhaled corticosteriod (example + adverse effects)
- fluticasone (flovent) and budesonide (pulmicort)
- increased appetite, mood skin or menstraul irregularities, immunosupression
combination inhalers examples
- budesonide and formoterol (symbicort)
- fluticasone and salmeterol (Advair)
why should you take your short/long acting inhaler prior to your inhaled corticosteroid (asthma)
what action should be preformed after taking a dry powder inhaler, such as some combination inhalers and inhaled corticosteroids
- why?
rinse mouth and spit
why -
what is instrumental functioning
how family members interact and behave with one another
- Activities of daily living (with illness can become a challenge; role changes, caregiver burden)
what is expressive functioning
- emotional, verbal, and nonverbal communication
- circular communication
- problem solving
- roles
- influence and power
- beliefs
- alliances and coalitions
BMI
uses height to weight ratios
<18.5
underweight
18.5-24.9
normal
25.0-29.9
overweight
30-34.9
obese (class I)
35-39.9
obese (class II)
> 40.0
obese (class III)
“b=morbidly obese”
how to claculate waist to hip ratio
waist circ. / hip circ. (in cm)
what is optimal wiast to hip ratio for women
less than 0.80
what is optimal waist to hip ratio for a male
less than 0.95
abdominal obesity is called
android obesity
android obesity
- higher triglyceride and lipid levels
- greater risk for metabolic syndrome
- greater risk for other pathologies (cardiovascular health problems)
- easier to lose than gluteofemoral fat (gynoid obesity)
what are the 5 A’s of obesity management
- ASK permission to discuss weight
- ASSESS risk and potential causes of weight gain
- ADVISE on risks, benefits, and options
- AGREE on wight loss goals and plans
- ASSITS with education, resources, and follow-up care
as a nurse when planning for weight reduction the following factors should be taken into consideration:
social, emotional, behavioural influences
signs and symtoms of COPD
- intermittent cough (gradually worsening)
- sputum production
- increasing dyspnea (especially on exhalation)
- weight loss is common
- may develop Cor Pulmonale
potential complications of COPD
- cachexia
- Cor Pulmonale
- Acute exacerbations of COPD
- acute respiratory failure
- depression and anxiety
how to asses for cor pulmonate
jugular venous distention and pedal edema
over time, people with COPD may develop cardiac complicationsWhich of the following may occur as a complication of COPD
a) left venticular heart failure
b) right ventricular heart failure
c) mitral stenosis
d) myocardial infraciton
B. right ventricular heart failure
what are some signs and symptoms of right ventricular heart failure? select all that apply
a. clubbing of the fingers
b. dependent pedal edema
c. distended neck veins
d. hepatomegaly
b,c,d
what is heart failure
- abdnormal condition involving impaired cardiac pumping/filling
- heart is unable to produce an adequate cardiac output to meet metabolic need s
left sided heart failure symtoms
pulmonary edema/ congestion, (increased resp rate, crackles, decreased PaO2, pink forthy sputum)
right sided heart failure causes
left sided heart failure, cor pulmonale, right ventricular MI
right sided heart failure symtoms
- jugular venous distention, hepatomegly, splenomegly, vascular congestion of GI tract, peripheral edema
what are the primary risk factors of heart failure
- coronary artery disease
- hypertension
- failty heart valves (stenosis, infection, regurgitation)
-arrythmias (afib and tachycardia) - family history, congeitial
contributing factors for heart failure
- diabetes
- tobacco, alcohol, cocaine use
- obesity
- high serum cholesterol
what symtoms are seen in both LS and RS heart failure
- tachycardia
- fatigue
- nocturia
- weight gain
mixede heart failure
left and right heart failure
signs and symtoms of mixed heart failure
- poor EF < 35%
- high pulmonary pressure
- biventricular failure (both ventricles)
what triggers exacerbation of heart failure
- high sodium and fluid intake
- infection
- uncontrolled Afib
- renal failure
what is the first line of treatment for heart failure
ACE inhibitors
medication management of heartfailure
- beta-adrenergic blockers
- anticoagulants
- vasodilators
- digoxin (cardiac glycoside)
ischemia
inadequate blood flow
stroke
ischemia to a part of the brain from wither blockage or hemorrhage into the brain
- results in death of brain cells
what can be lost after a stroke
- movement, sensation, or emotions that were controlled by the affected area
what is vital for stroke treatment
early recognition
- reduce disability and prevent death
types of ischemic stroke
- thrombotic
- embolic
thrombolic stroke is more commone in
men
oldest median age
thrombolic stroke is assoicated with
hypertension and diabetes mellitus
what is the most common type of stroke
thrombotic
thrombotic stroke warning
transient ischemic attack (TIA)
thrombolic stoke onset
often during or after sleep
thrombolic stroke course
stepwise progression, signs and symptoms develop slowly
embolic stroke occurs more in
men
what is the second most common stroke
embolic
embolic stroke occurs when
embolus (often originates in the heart -Afib) lodges in and occludes a cerebral artery
embolic stroke warning
TIA is uncommon
embolic stroke onset
not always related to activity, sudden onset
embolic stroke course
single event, signs and symtoms, usually some improvement, recurrence common without aggressive treatment of underlying disease
what are the two types of hemorrhagic stroke
- intercerebral
- subarachnoid
hemorrhagic stroke is often related to
hypertension
intercerebral stroke
bleed into brain parenchyma
intercerebral stroke occurance
slightly higher in women
intercerebral stroke warning
headache
intracerebral onset
often related to activity
intracerebral course
progression over 24 hours; fatality more likely with presence of coma
subarchanoid stroke
bleed into subarchanoid space
subarachoid occurance
higher in women
- youngest median age
subarachonoid warning
headaches
subarchanoid onset
often related to activity, sudden onset
subarachoid course
acute, onset, usually single sudden event described as the “ worst headache of the patients life” fatality more likely with presence of coma
what are the signs of stroke
- dropping face
- can you raise both arms
- speech slurred or jumbled
medical mediation for vessel ischemia
- recombinant tissue plasminogen activator (tPA)
- dissolves clot
- must be administered 3-4.5 hours of onset of clonical signs of ischemic stroke
Dm type 1 was formerly known as
“juvenile onset” or “ insulin dependent” diabetes
type 1 DM most often occurs in
people under the age of 30
type 1 diabetes
insulin PRODUCTION problem
- progressive destruction of pancreatic B cells by the bodys own T cells
type 1 diabetes must always be managed with
insulin
type 1 diabetes symptoms
- presents as a short history of weight loss, polydipsia, polyuria, polyphagia, weakness and fatigue, gential thrush, blurred visiion
what is the msot prevelent type of diabetes
type 1 diabetes
type 2 diabetes
- insulin PRODUCTION and UTILIZATION problem
type 2 DM onset
gradula
type 2 diabetes symptoms
polydipsia (excessive thirst), polyuria (excess urination), weakness and fatigue, genital thrush, blurred vision, weight loss, slow healing wounds
treatment for gestational diabetes
first route: nutritional management and physical activity
second route: insulin injections
secondary diabetes can occur
because of another medical condition or treatments and medications use that cause abnormal blood glucose levels
secondary diabetes examples
- schizophrenia
- cystic fibrosis
- hyperthrodism
- use of parenteral nutrition
self care practices to minimize complications
- deep breathing and coughing techniques (incentive spirometer)
- splinting insisions on the torso when moving or coughing
- avoding strain for bowel movements
- hand washing
- ambulation during recovery (arm and leg exercise)
- avoiding pressure ulcers
post op pain management after surgery
- importance of taking pain medication
- pain scale use
- side effects of pain medication and how to counter-act them
- body position strategies
- non pharmacologic pain management
discharge teaching for self care at home
- restrictions on lifting objects of a certain weight
- driving limitation
- diet suggestions
- ambulation/exercise recommendations
- medication adherence
- pain management at home
- follow up visits or tests
when should a patient express need for pain medication
instruct patient to request pain medication before the pain becomes severe
in patient pre op nursing assessment
- psychosocial assessment and coping with surgery
- health history questions
- medication list (including herbal supplements)
- alcohol, tobacco, cannabis and drug use
- allergies
- review of systems and physical assessment
- nutritional status and fluid and electrolytes
immediate / emergency procedure consent form
2 physicians consent
incompetent patient consent form
- someone with power of attorney
enhanced recovery after surgery principle
patients are active participants in pre and post-op care and recovery
- want to avoid insulin resistance
ERAS includes evidence based guidlines for
- nutrition
- mobility
- fluid management
- anesthesia
- pain and nausea control
ERAS protocol
general post op nursing care
- vital signs routine
- nursing post op assesment and ongoing post op care
- patient teaching
- nursing interventions to treat and prevent potential alterations in functioning
- preparing patient for discharge to home
5 common precipitating factors for deliriun in older adults
- use of physical restraints
- low serum albumin levels, indicative of malnutrition
- prescription of more than three new medications
- use of urinary catheter
- an iatrogenic event (infections, injury, and complications caused by medications or diagnostic or therapeutic procedures
type of felirium
- hyperactive
- hypoactive
- mixed
hyperactive delirium
hypoactive delirium
mixed delirium
Diagnostic tools for diagnosising delirium
- Recoginzing Acute Delirium As part of your Routine (RADAR)
- Confusion assesment Method (CAM)
Delirium Index (DI)
RADAR
- drosy
- trouble following directions
- slowed movement
considerations for delirium
- physical exam findings (infection)
- medications
- lab results
- sleep deprivation
- enviormental risk factors (noise, lighting)
what are the 5 stages of greif
denial
anger
bargaining
depression
acceptance
what is the last sense to disappear
hearing
