Nursing 2700 Fundamentals: Exam Three Flashcards
Define diabetes mellitus
A chronic multi system disease related to abnormal insulin production, impaired insulin utilization, or both
What are some primary prevention measures that can be taken as pertains to alterations in cellular regulation?
Not smoking
Healthy diet
Using sunscreen
Removing at risk tissues like moles or polyps
What are some secondary prevention strategies to prevent alterations in cellular regulation?
Mammograms
Prostate exams
Colonoscopies
PSA tests
The processes of biochemical reactions occurring in the body’s cells that are necessary to produce energy, repair, and facilitate growth of cells and maintain life is known as…
Metabolism
What is glucose regulation?
The process of maintaining optimal blood glucose levels
What is normal blood glucose for a random sampling?
Between 70 and 140 mg/dL
What would be considered hyperglycemia in a fasting state?
Greater than 100 mg/dL
What would be considered hyperglycemia in a normal, non-fasting state?
Greater than 140 mg/dL
What is hypoglycemia?
Insufficient/low blood glucose, usually defined as less than 70 mg/dL
What are the parameters for severe hypoglycemia?
Less than 50 mg/dL
What are the parameters for severe hyperglycemia?
Greater than 180 mg/dL
What are the signs and symptoms of hypoglycemia?
Reduced cognition Tremors Diaphoresis Weakness Hunger Headache Irritability Seizures
What are the signs and symptoms of hyperglycemia?
Polyuria Polydipsia (excessive thirst) Polyphagia (excessive hunger) Dehydration Fatigue Fruity breath odor Kussmaul breathing Weight loss Poor wound healing
Where is glucagon released from and what does it do?
Released from the pancreas, and targets the liver to release stored glucose into the blood to raise blood glucose levels
Where is insulin secreted from and what does it do?
Released from the pancreas, and targets body cells to take up glucose, reducing blood glucose levels
What are some genetic risk factors for the development of diabetes?
Family history of diabetes
Obesity
Low level of HDL cholesterol
Which populations are most at risk for developing T2DM?
African American
Hispanic/latinos
Native Americans
Which specific community has the highest incidence of T2DM in the world?
The Pima Indians of the Gala River community
What are some lifestyle risk factors for the development of diabetes?
Poor diets with high fat intake Excess calorie intake leading to obesity Low fiber intake Too many carbohydrates Lack of exercise Being very old Gestational diabetes
Why does being very old increase diabetes risk?
Reduction in lean muscle mass and insulin production, reducing the body’s capacity to regulate and metabolize glucose
What medical conditions are associated with impaired glucose regulation?
GI problems Vitamin D deficiency Infection, injury, cancer, surgery (all increase need for insulin) Hypothyroidism Cardiovascular disease Cushing syndrome Pancreatitis Cystic fibrosis Corticosteroid use
What is metabolic syndrome?
A clustering of at least three of these conditions: central obesity, hypertension, high blood sugar, high serum triglycerides, and low serum HDL cholesterol
What does metabolic syndrome increase the risk of?
Cardiovascular disease and T2DM
What random blood sugar level is considered pre-diabetes?
Over 140 mg/dL
What is type one diabetes?
The pancreas produces no insulin due to viral or autoimmune destruction of parts of the pancreas
What is the treatment for type one diabetes mellitus?
Insulin injections are necessary, and balanced food intake and healthy lifestyle choices to reduce complications
What are the other health risks of type one diabetes?
Heart disease
Kidney disorders
Retinal damage
What are the three main signs and symptoms of type one diabetes?
Polyuria
Polydipsia
Polyphagia
What is the defining characteristic of T2DM?
Pancreas producing insufficient or defective insulin for the body’s needs
What are the top signs and symptoms of T2DM?
Fatigue
Recurrent infections
Prolonged wound healing
Visual changes
When is gestational diabetes most likely to begin manifesting?
After the 20th week of gestation
What are the negative effects of GDM (during pregnancy and later in life)?
Hypertension during pregnancy Premature birth Large for gestational age baby Congenital abnormalities Future obesity Mother developing diabetes later in life
What are some risk factors for a newborn developing hypoglycemia?
Gestational diabetes mellitus Large for gestational age by weight Small for gestational age by weight Born earlier than 37 weeks APGAR score less than 5
Why are babies born to mothers with diabetes/GDM at risk for hypoglycemia right after birth?
Because maternal glucose crosses the placenta but insulin doesnt, so when the baby is born, they suddenly dont have the glucose levels they are used to and can become hypoglycemic
What are some signs and symptoms of hypoglycemia in infants?
Jitters Irritability Cyanosis Tachypnea Apnea Temperature instability Lethargy Seizures
How soon should blood sugar be screened in infants born to diabetic mothers?
By one hour of age
How soon should infants at risk for hypoglycemia (but not born to diabetic mothers) be screened?
Between one to two hours of age, or when signs of hypoglycemia are observed
What are nursing actions if blood glucose is less than 40 mg/dL in a newborn?
Feed immediately
Confirm blood glucose
Check blood glucose one hour after feeding
What should the nurse do if the infants blood glucose is greater than or equal to 40 mg/dL?
Feed at least every three hours
Assess risk factors to determine screening intervals
All blood glucose screening intervals are every three hours for infants at risk after initial assessment!
However, depending on risk factors, the amount of time this continues for can vary!
Another name for A1C is
Glycated hemoglobin
What does an A1C test tell you?
Average blood sugar level for the past two to three months
What is considered a normal A1C level?
Below 5.7
What A1C score is considered prediabetes?
Between 5.7 and 6.4
How is diabetes confirmed through A1C testing?
An A1C level of 6.5 percent or higher on two separate tests
What random blood sugar level suggests diabetes?
Higher than 200 mg/dL
What fasting blood sugar level is considered prediabetes?
Between 100-125 mg/dL
How is diabetes confirmed though fasting blood sugar levels?
Blood sugar of 126 mg/dL or higher on two separate tests
When an oral glucose tolerance test is done, a score of what after what time period indicates diabetes?
A reading of over 200 mg/dL after two hours
What are the five components of diabetes management?
Nutrition Exercise to maintain proper body fat Self-monitoring of blood glucose Medication Education
What are primary strategies to prevent diabetes?
Avoid excess calorie intake
Exercise for 30-60 minutes at least 3 or 4 times a week
Eat whole grains, fruits, vegetables, lean meats
Low sodium diet
Education about cultural influences
What are secondary prevention strategies for those with diabetes?
Blood pressure and cholesterol management
Keep A1C below 7%
Annual dental, foot, and eye exams
What are the four main factors influencing labor?
Passenger
Passageway
Primary and secondary powers
Position of the mother
What are some determining factors for how the passenger moves through the birth canal?
Fetal head size
Fetal presentation
Fetal lie
Fetal position
How does the fetal head adapt during labor?
The skull bones squish together and come to more of a point to fit through the birth canal
What are the three different types of fetal presentation?
Cephalic
Breech
Shoulder
What is fetal lie?
Relationship of maternal longitudinal axis (spine) and fetal longitudinal axis (spine)
What is the difference in appearance between caput and cephalhematoma? Why?
Caput will cross suture lines, causing more uniform swelling of the head. The blood in a cephalhematoma will not cross suture lines, resulting in more localized swelling
What is the most common pelvis shape in women?
Gynecoid (round)
What is the second most common pelvis shape in women? How does it affect labor?
Anthropoid. It will lead to a longer and harder labor, but it is still possible to have a vaginal birth with this pelvis shape
What is the common term used to describe primary powers?
Contractions
What does the nurse note when assessing primary powers?
Frequency
Duration
Intensity
Where do contractions start in the uterus?
At the top of the fundus, and then they radiate down and in
Which marker determines the fetal station?
Ischial spine
When does effacement happen?
During the first stage of labor
What is effacement?
Shortening, opening up, and thinning of the cervix
What is meant by dilation?
The enlargement/widening of the cervical canal once labor has begun
What is measured with Bishops score?
Dilation: in cm Effacement: percentage score Station: -3 to +3 in relation to ischial spine Position: posterior or anterior Consistency: firm or soft
What bishops score indicates favorability for birth?
Above 5
How is a bishops score given?
Each item can be given a score of 0, 1, or 2 for a maximum of 10
Do dilation and effacement happen simultaneously?
If a woman has had a child before, yes.
If not, effacement happens before dilation
What is meant by secondary powers?
Voluntary bearing down/pushing efforts
What is encompassed in the first stage of labor?
Onset of regular contractions to complete dilation
What are the three phases of the first stage of labor?
Latent phase
Active phase
Transition phase
What characterizes the latent phase of the first stage?
Dilated 0-4 cm
Contractions irregular, mild/moderate, occurring every 5-30 minutes for 30-45 seconds
What characterizes the active phase of stage one of labor?
4-7 cm dilated
Contractions are more regular, moderate to strong, occurring every 3-5 minutes and lasting for 40-70 seconds
What characterizes the transition phase of the first stage of labor?
Dilated 7-10 cm
Strong contractions every 2-3 minutes for 45-90 seconds
When do women need to go to the hospital in the labor process?
It depends for each woman, but if the membranes are broken, she should go (infection risk). Women should go when in true labor, but potentially sooner if a multipara
When does amniotic fluid rupture?
Can occur anytime, but usually happens during the transition phase
How do you test for amniotic fluid?
Nitrazine paper
What is a normal nitrazine paper reading?
Blue from an alkaline pH
What is concerning in a nitrazine paper reading?
Yellow coloring from acid in urine
What is show?
Vaginal discharge
What is encompassed in the second stage of labor?
Full dilation to the delivery of the baby
What happens in the second stage of labor before the baby is born?
Full dilation and intense contractions every 1-2 minutes
What can impact the length of the second stage of labor?
Use of epidural Mother’s age BMI Emotional state Support system Fetal size/position/presentation
What happens in the third stage of labor?
Delivery of the placenta
How long should the third stage of labor last?
Between 15 and 30 minutes
What do nurses worry about as the third stage of labor gets longer?
Postpartum hemorrhage and anemia
How long is the fourth stage of labor?
The first two hours after the delivery of the placenta
What complications are most likely in the fourth stage of labor?
Hemorrhage and sub-involution of the uterus
What are some non-pharmacological methods for pain management during labor?
Lamaze/Bradley techniques Hypno-birthing relation technique Breathing and visualization Water therapy Position changes Massage
What are some pharmacological methods for pain control during labor?
Systemic analgesia Opioids Opioid agonist-antagonist Inhaled analgesia Epidural and intrathecal anesthetic
What is the biggest concern with systemic analgesia?
Neonate respiratory depression
What is the most common inhaled analgesia?
Nitrous oxide
What assessments need to be done on a woman in labor?
Vital signs
Complete assessment upon admission
Focused assessments: vaginal exams
When monitoring the fetus during labor, what is the biggest concern being monitored for?
Perfusion through the placenta to the fetus
What four elements are monitored for the fetus during labor?
Baseline heart rate
Variability
Accelerations
Decelerations
What are the two ways to monitor the fetus externally?
Contractions and ultrasound
How is baseline heart rate for the fetus determined during labor?
The average rate over a 10 minute segment of monitoring is the baseline
When looking at a fetal heart rate strip, what is something you want?
Variability
What could lack of variability indicate?
Lack of oxygen to the fetus
What are some good shapes versus bad shapes on a fetal HR strip?
A V shape, indicating a HR dip, is okay. A shape of a U or W is bad, and might indicate lack of oxygen or problems with the placenta
What are some things that can be determined using Leopold maneuvers?
Number of fetuses
Presenting part of the fetus
Fetal station
Expected location for fetal heart rate
What are hypercontractions?
Contractions that are less than one minute apart
What will help calm down hypercontractions?
Giving fluid (helps the uterus calm/relax)
How many RNs will be present during and immediately after delivery?
Two
What will the primary/mom nurse do during the birth process?
Record times Assist doctor/midwife Monitor for complications Assist with episiotomy/laceration repair Clean up the patient Monitor vitals, fundus, and bleeding Encourage bonding and breastfeeding Give pitocin
What will the baby RN do in the L/D process?
Observe baby for complications
Assess APGAR at one and five minutes
May do baby cares (vaccines, weight, length)
Vital signs every 30 minutes or per policy
Suction mouth and nares
Call NICU if necessary
What will the circulating nurse do during a cesarean birth?
Record times
Observe for breaks in sterility
Helps with patient recovery
What will the baby nurse do during a cesarean birth?
Follow policies
Assess APGAR
Vitals every 30 minutes or as ordered
What must be occurring for labor to be considered true labor?
Cervical dilation bishops score
Regular contractions that are increasing in intensity and frequency
treat all pain, even if the patient is barely dilated
It still hurts
What are some sources of pain during the labor process?
Dilation Effacement Fetal descent and pressure Lacerations Expulsion of placenta
What can the nurse do to support a woman emotionally during labor?
Be present
Get loved ones involved if possible
Listen when the patient verbalizes pain
What are some primary postpartum cares/focuses?
Pain relief
Bladder emptying
Preventing hemorrhage
Bonding/breastfeeding support
What are the two types of episiotomy cuts and what is involved in each?
Midline: cuts only through tissue
Lateral: cuts through muscle and tissue
What are some cultural considerations for labor and delivery?
Culture and involvement of family members/spouse
Beliefs about pain and pain control
Patient autonomy vs cultural expectation and decision making
When should a woman empty her bladder in the labor and delivery process?
Before, during, and after delivery
What is being tested for with the infant heel prick test?
PKU and 50+ other metabolic conditions
When is blood pressure checked on a newborn?
After 24 hours
Define genetics
The study of heredity
Define genomics
The study of the structure of the genome through the mapping and sequencing of DNA
Define epigenetics
The environment’s role in activating and deactivating genes
What is responsible for gene regulation and all cellular activities?
An individual’s DNA sequence
What is the important key point to remember when considering things like epigenetic changes, chemical tags, and cellular reproduction?
There are many ways and many points where things can go wrong genetically, leading to disease
Why is it virtually impossible for there to be genetically identical individuals?
Because such a vast amount of chromosome exchange happens during cell division
What happens when a change in gene DNA nucleotides is caused by incorrect translation in the mRNA?
Disease
What are causes that can lead to cell mutations after conception?
Environmental chemicals Drugs Diet Stress Trauma Aging **can be problems in mother during pregnancy or just factors throughout a person’s lifespan that affect**
Germline mutations
Mutations from inherited DNA in gametes/sex chromosomes that are duplicated in every cell
Somatic mutations
Acquired genetic alterations within cells that may be passed to future progeny of that cell, but are NOT in sperm or egg cells (will not affect future generations)
Define pharmacogenetics
The study of how a person metabolizes medications based on genetic makeup
What are some examples of the use of pharmacogenetics in personalized medicine?
Psychiatry: drug choice and response
Pain management: addition potential
General: minimizing drug side effects
Why is genetic makeup important to consider when a medication is prescribed?
Because genetics plays a role in how the body metabolizes medications
What are some drugs/classes that we currently know have a genetic influence component?
Opioids Antidepressants Statins (cholesterol) Warfarin Folate
What does the ANA Genetics and Genomics Nursing Curricular Guidelines and Outcomes challenge nurses to do?
Recognize personal attitudes about genetics
Advocate for genetic services and patient autonomy
Incorporate genetics/genomics into practices
Tailor genetic info to the specific patient (culture, literacy, etc)
What must a nurse understand when assessing genetic risk?
The relationship of genetics and genomics to health, prevention, screening, treatment, and monitoring
What must the nurse consider when completing physical assessments, collecting personal/family histories, and analyzing information relating to genetics?
Genetic, environmental, and genomic influences and risks
Patient’s knowledge and perceptions of genetics
In the clinical setting, where does the identification of hereditary risk begin?
With the primary care nurse
What information is collected when doing a family history to identify individual and family genetic risk factors?
3 generation family history with names, DOBs, health status of each person, cause of death, medical condition and ages of diagnosis, racial and ethnic backgrounds
What is meant by adult-onset monogenic disorders?
Single-gene disorders that usually manifest in adulthood but can begin in childhood. These are totally hereditary conditions
What is an example of an adult-onset monogenic disorder?
Huntington’s disease
What are multifactorial disorders?
Disorders that stem from a combination of genetic and environmental factors
What are some examples of multifactorial disorders?
Cancer
Heart disease
What might a red flag in a patient’s personal or family history indicate?
Potential for inherited susceptibility to disease or genetic condition
What has a significant influence on distribution, incidence, and prevalence of many genetic diseases?
Ethnicity and race
What are some red flags that can be identified during a family history?
Known genetic disorder in the family with multiple generations affected
Early onset disease in first or second degree relatives
Sudden cardiac death of individual believed to be healthy
Ethnic predisposition to genetic disorder
What should be the next step when a red flag is identified?
Referral to a genetic specialist
What information should a nurse provide to patients and families so they can make informed decisions regarding going to a genetic specialist?
Reasons for testing
Types of tests
Benefits and risks
What are the benefits of genetic testing?
Definitive diagnosis
Information about familial risk
Identifying prevention, treatment, and management options
What are the risks of genetic testing?
Potential for discrimination based on results
Anxiety
Psychological impacts of findings
Ambiguous findings/variations of unknown significance
Unexpected revelations about family relationships
What are some potential barriers to genetic technology and services?
Culture Language Family values Traditions Religion Health beliefs Money
Diagnostic testing
Confirms or rules out a diagnosis
Carrier testing
Determines if someone carries a recessive or x-linked disorder
Predictive or presymptomatic testing
Tells whether a person is likely to develop a condition
Prenatal or antenatal testing
Looking for genetic or chromosomal disorders like Down syndrome before a baby is born
Susceptibility testing
Looking for genetic risk for a complex disorder involving multiple risk factors
Pharmacogenetic testing
Looking for genetic variants to determine medication responses
How long might the genetic testing process take?
Four weeks or more
What is the nurses role while the patient waits for genetic test results?
Emotional support
Discussion of strategies for when results are learned
What is the role of the nurse once testing results are learned?
Clarify information
Explore implications
Recommend health promotion and prevention practices
Collaborate with other healthcare providers
Why should a nurse understand what genetic test results mean?
To be able to explain them, provide support, and connect patients to resources
What does a positive result mean/indicate in genetic testing?
Change in gene/chromosome/protein
Confirm diagnosis
Provide options for prevention and management
What can a positive result in a genetic test not tell you?
Course or severity of disease
What does a negative test result for a genetic test mean?
No change, disorder is ruled out
What can a negative result in a genetic test not guarantee?
That a mutation in another gene wouldn’t cause that same disorder later on
What does a variant of unknown significance mean?
Abnormal DNA variation not yet associated with a disorder
Why are variants of unknown significance hard to evaluate?
Because everyone has natural variations in their DNA that are not harmful
What is precision medicine?
Medical treatment tailored to the individual patient
How many genes have alterations that are linked to breast cancer?
17
“Whatever the person says it is, and existing whenever the person says it does,” is one definition of…
Pain
Define acute pain
Pain with a short duration and rapid onset, may last up to 6 months
Define chronic pain
Pain that lasts for 6 months or longer and interferes with ADLs
Define intractable pain
Chronic pain that is highly resistant to relief
What are some emotions that can influence pain?
Fear Anxiety Sadness/grief Depression Anger
What are some signs that an infant is in pain?
Crying Grimacing Twitching Poor feeding Fluctuation in temperature Skin mottling Decreased o2 sats
What are some signs that an adult with cognitive or communication impairment is in pain?
Grimacing
Withdrawal
Labored breathing
Decreased activity or mobility
How can sociocultural factors influence pain expression and pain treatment options?
Some cultures may believe pain is to be endured stoically
They might be resistant to pain relief medications for this reason or other cultural beliefs
Cutaneous stimulation for pain relief operates under what theory?
The gate-control theory
What is a TENS or PENS unit?
Transcutaneous (or percutaneous) electrical nerve stimulator
Interferes with pain perception
How is acupuncture believed to relieve pain?
Believed to stimulate the endogenous analgesia system
How does accupressure help relieve pain?
It stimulates specific pressure points for the release of endorphins
How does massage help to reduce pain?
It involves cutaneous stimulation and muscle relaxation to reduce pain
What are some cognitive non-pharmacologic pain relief tactics?
Distraction Relaxation Guided imagery Hypnosis Therapeutic touch Humor
How does sequential muscle relaxation work?
Client tenses their muscles for 15 seconds, then relaxes them while exhaling
How does hypnosis work?
It is the induction of a deeply relaxed state and then the introduction of therapeutic suggestions
How does therapeutic touch work?
Practitioner uses hands to direct energy fields around the body
What is a common side effect for NSAIDs?
Gastric irritation and bleeding
What can reduce the side effects of NSAIDs?
Taking them with food and using pills with enteric coating
Codene/hydrocodone is also known as..
Vicodin
Morphine/hydromorphone is also known as
Dilaudid
Pentazocine is also known as..
Talwin
Nalbuphine is also known as
Nubain
Define tolerance
Body becoming adjusted to drug and needing increasing doses for the same effect
Define physical dependence
Need for a drug that causes withdrawal because the body gets used to it
Define psychological dependence
Addiction
What is psychoneuroimmunology?
A branch of medicine that deals with the influence of emotional states and nervous system activities on immune function (especially pertaining to onset and progression of disease)
Define stress
Physical, psychological, social, or spiritual effect of life’s pressures and events
Define stressor
Psychological, social, environmental, physiological, or spiritual stimulus that disrupts ability to maintain internal stability
Define distress
Chronic or excessive stress that prevents the body from achieving and maintaining homeostasis
Define eustress
Stress that can be challenging and useful
External stressors
An external stressful situation, such as death of a loved one
Internal stressors
Stressful presence within someone, such as anxiety or negative self-talk
Developmental stressors
Stressors that can be predicted at various life stages (going to college stress, retirement, etc)
Situational stressors
Unpredictable stressors, such as sudden illness/catastrophe/accident
Physiological stressors
Stressors that affect body structure or function
Psychosocial stressors
Stressors that arise from work, family dynamics, living situation, relationships, etc.
What are adaptive coping strategies? Give examples
Healthy choices that reduce the effects of stress
Examples: exercise, healthy eating, talking to a friend
Define maladaptive coping strategies and give examples
Choices that don’t promote adaptation to the stressful situation
Examples: overeating, working too much, substance abuse, excessive sleeping
What are some common coping approaches?
Altering the stressor
Adapting to the stressor
Avoiding the stressor
What are some personal factors that influence adaptation?
Perception Overall health status Support system Hardiness Age Developmental level Life experiences
How is hardiness defined?
Thriving despite overwhelming stressors (takes commitment + control + view of stress as a good challenge)
What are the three stages of general adaptation syndrome?
Alarm stage
Resistance stage
Exhaustion or recovery stage
What happens in the alarm stage of the GAS?
fight or flight stage
Shock phase: lasting usually less than 24 hours, high levels of epinephrine
Counter shock phase: shock phase reversed
What happens during the resistance stage of the GAS?
Body tries to cope, protect against the stressor, and maintain homeostasis
What happens in the exhaustion or recovery stage of GAS?
Exhaustion: stress continues, adaptation unsuccessful, body cannot maintain resistance, ends in injury, illness, or death
Recovery: successful adaptation leading to recovery/continuing
What are some physiological responses to stress?
Muscle tension Headaches Nausea Weight changes Chest pain Increased heart rate
What are some emotional and behavioral responses to stress?
Anger Anxiety Depression Fear Lethargy Illness Crying Aggression Rebellion
What are some cognitive responses to stress?
Poor judgement
Forgetfulness
Decreased accuracy
Decreased problem solving
What are some health promotion activities for stress prevention/reduction?
Nutrition Exercise Sleep and rest Leisure activities Good time management skills
How does relaxation work to reverse some stress responses?
Elongating muscle fibers reduces neural impulses to that area and reverses some stress responses
How does exercise help to reduce stress?
Releases muscle tension
Expresses emotions
Releases endorphins
When is the best time to exercise to enhance sleep?
At least two hours before going to bed
What types of foods promote sleep? Why do they help?
Milk, cheese, and other animal products because of the tryptophan and adenosine
What types of foods may hinder sleep?
Saturated fats
How might alcohol contribute to restless/disruptive sleep?
While it hastens the onset of sleep, it disrupts REM/slow wave sleep and can cause spontaneous waking
How do hypnotics affect sleep?
Increase sleep amount but decrease sleep quality
How does ambien affect sleep?
Promotes normal REM
How do amphetamines affect sleep?
Reduce REM sleep
What are some environmental factors that promote or hinder sleep?
Temperature
Noise
Presence or absence of others
Light
What are dyssomnias?
Sleep disorders
Insomnia
Inability to fall asleep, remain asleep, or go back to sleep
Sleep-wake schedule disorders
Abnormalities in sleep due to things like traveling, shift work, or large changes in total sleep time
Restless leg syndrome
CNS disorder characterized by uncontrollable leg movements while resting or before sleeping
Sleep apnea
Periodic interruption of breathing while sleeping
What are the two types of sleep apnea?
Obstructive sleep apnea (OSA)
Central sleep apnea (CSA)
Hypersomnia
Excessive sleeping, especially during the day
Narcolepsy
Condition where the brain cannot regulate sleep/wake cycles, leading to spontaneous sleep episodes
Parasomnias
Patterns of waking behavior that appear during sleep (such as sleepwalking)
What are some nursing interventions to create a restful environment for sleep?
Dry, clean, irritant free linens
Good body alignment for patient
Dark and quiet room
Temperature controlled room
What are some common bedtime rituals and routines?
Reading, watching tv, praying/meditating
For children: having a favorite toy, blanket, or bedtime story
What are some good recommendations (and things to avoid) when it comes to bedtime stories?
Complex carbs and maybe a small amount of protein
Avoid: alcohol and caffeine
Beyond gender, what does sexuality encompass?
How we perceive ourselves, relate to others, and express ourselves sexually
According to the WHO, “a central aspect of being human throughout life that encompasses sex, gender identity and role, orientation, eroticism, pleasure, intimacy, and reproduction” is a definition of..
Sexuality
How does the WHO define sexual identity?
A person’s perception of his or her own gender, gender identity, gender role, and sexual orientation
Androgyny
A blending of masculine and feminine traits and roles
Why is androgyny considered a positive trait?
Because it gives individuals greater adaptability in life situations
Define gender identity
The image we have about ourselves as a man or a woman
At its broadest definition, what does it mean to be transgendered?
Forming a gender identity that is not the same as one’s biological gender
What does it mean to be transsexual or transgendered?
Identifying with gender opposite of biological sex
What are some early indicators of being transsexual?
Dissatisfaction with gender from a young age
Believing one will grow up to be opposite gender
Dressing and playing like opposite gender
What has a person undergone when they are a postoperative transsexual patient?
Genitalia change and legal gender change
What is another name for being Inter sexed?
Hermaphrodite
What does it mean to be intersexed?
To be born with ambiguous sex organs
How do issues of sexual differentiation occur in utero?
Sex organs differentiate at around seven weeks in utero. Sometimes this happens incorrectly or not fully
What are some key components of sexuality that develop in the birth through preschool period?
Children frequently touch their genitalia, enjoy nudity, and enjoying holding hands, hugging, snuggling, etc
What are some key components of sexuality in school age children through puberty?
Most identify with same sex parent and have same sex friends
Gender roles develop
Secondary sex characteristics develop
First attraction and masturbation may take place
What are key components of sexuality that develop/occur in adolescence?
Heightened sexual interest and activity
Hormone changes
Sexual exploration
What are some components of sexuality that develop/occur in young adulthood?
Sexual identity and self concept exploration
Development of intimate relationships and long term commitments as part of sexual maturity
What are some components to remember about sexuality in middle adulthood?
May have more time for sex
May be hindered by menopause and other health concerns
What are some components to remember about older adults and sexuality?
Most are still sexually active and enjoy sexual activity
Problems may arise due to failing health and medication side effects
Why is it important for the nurse to understand cultural influences on sexuality?
Because culture influences our views on everything related to sex and gender
What does it mean to be ethnocentric as related to sexuality?
It means you believe your culture and sexual behaviors and beliefs are the norm
What must the nurse be mindful of when it comes to patients and their sexual knowledge?
We cannot assume adequate sexual knowledge in our patients
How does the WHO define sexual health?
A state of physical, emotional, mental, and social well-being related to sexuality, not just the absence of disease, dysfunction, or infirmity
What is required for sexual health?
Positive and respectful mindset
Openness
Opportunity
What is necessary for sexual health attainment and maintenence?
Sexual rights of all being respected, protected, and fulfilled
What are paraphilias? Give examples
Sexual deviations, like exhibitionism, sadism, pedophilia, fetishism)
Chlamydia trachomatis
Most common and treatable STI
Caused by bacteria and treated with antibiotics
May not have symptoms, may cause pain during sex, vaginal discharge, and eye discharge
Gonnorrhea
Caused by bacterium and treated with antibiotics
Causes painful urination and abnormal discharge, can lead to infertility if left untreated
Syphilis
Bacterial infection that is diagnosed with blood test and occurs in stages
Starts with painless sores and a rash, then has a latent phase, then causes damage to brain, eyes, and heart over the course of years
Treated by penicillin
HPV
Human papillomavirus
Viral infection that causes warts on skin and mucous membranes
Has no cure, but may go away on its own
Herpes simplex virus
Viral infection transmitted orally or by genital contact
Characterized by blister groups or cold sores
Which STIs are often tested for and treated together?
Chlamydia and gonorrhea
What are the best ways to prevent STIs?
Abstinence
Sexual monogamy with someone who has never had an STI
What is sexual harassment?
A person in power making unwanted sexual advances, which often leverage the success or employment of the other person
What are some important statistics regarding rape?
One in six women and one in 33 men are victims of attempted or completed rape
In what situations should a nurse do a focused sexual assessment?
Someone with an STI or illness that affects sexual function
Pregnancy/infertility cases
Abnormal menstruation
Urinary problems
What are some interventions for PMS?
Balanced diet Exercise Adequate sleep Avoid tobacco Limit alcohol/caffeine Drink water
What are some planned parenthood guidelines for safer sex?
Be honest about sexual practices and history Avoid exchange of bodily fluids Avoid contact with genital sores Get routine checkups Accept responsibility for your actions
What are the steps of PLISSTI that a nurse can use to counsel for sexual problems?
Ask permission
Supply limited information
Give specific suggestions
Refer for intensive therapy
What are some effective responses to inappropriate sexual behaviors towards a nurse?
Tell them it is inappropriate
Tell them to stop
Clearly state expected behavior
Refocus their attention
What should you do if you feel you’ve been sexually harassed?
Confront the harasser, if possible
Keep a written record
Report concerns
What are some guidelines to remember for taking a sexual history?
Privacy and confidentiality Be relaxed Use eye contact Use an inviting opening Don’t use conversation stoppers Use good non-verbal cues Use their terminology Recognize that they may be embarrassed Make them comfortable Start with less sensitive topics first
What are some good guidelines for condom use?
Use latex
Handle gently
Use water-based lubricants
Check expiration dates
What are some things to avoid when using condoms?
Don’t store in wallet
Don’t open with a sharp object
Don’t reuse
Don’t use with lotions or oils
What are some factors that affect sexuality?
Culture Religion Lifestyle Knowledge about sex Health status Social context
What are some factors that sexual problems can be related to?
Fatigue Impaired mobility Pain Fear Low self esteem Self care deficits Disturbed body image STIs Sexual harassment or rape Dysfunctional intimate relationship
What increases the risk for STIs?
Alcohol and drug use
Having many sexual partners
What are some teaching topics pertaining to sexuality?
Self-examination of testicles and breasts
STI prevention
Contraception use
Which age group accounts for half of all new STI cases?
People ages 15-24
Who suffers from more serious and frequent STI complications?
Women
The body’s attempt at self-protection is…
Inflammation
What are the classic symptoms of inflammation?
Pain Heat Swelling Redness Loss of function in the area
There can be no healing without..
The inflammatory response
What kind of inflammation can lead to diseases and other conditions?
Chronic inflammation
What are the four components of the inflammatory response?
Vascular response
Cellular response
Exudate response
Healing
Inflammatory process: vascular response
Immediate vasoconstriction to minimize bleeding (short time period), the vasodilation from histamine release to allow leukocytes and clotting factors into the area
Inflammatory process: cellular response
Phagocytes (WBCs) go to injury site to engulf bacteria, foreign particles, and cellular debris. Also ward off potential invading pathogens
Inflammatory process: exudate response
Fluid and white blood cells moving from circulation to injury area. Causes release of pus, which is a protein rich substance, to get the gross stuff out of the wound
Inflammatory process: healing
Replacement of tissue by regeneration (replacement of damaged cells) or repair (scar tissue replacing original tissue)
What tissue type regenerates easiest?
Skin
What are some common changes in coloration of the skin?
Pallor
Jaundice
Ecchymosis
Petechiae
Ecchymosis
Discoloration of skin from bleeding underneath the skin
Petechiae
Brown purple spots on the skin, usually from minor trauma and blood clotting disorders
Nevus simplex is also known as
Stork bites (normal birthmarks)
Capillary hemangiomas
Flat or raised non-cancerous red or pink tumors on the face. Usually caused by overgrown small blood vessel
Cafe-au-lait spots
Light brown birthmarks
Mottling
Blue/pale, blotchy, webbed looking pattern on skin. Normal in babies, also present when someone is dying
How does the nurse assess skin temperature by palpación?
Using the dorsum of the hands or the fingers
What are some words that could be used to document moisture level?
Diaphoretic Dry Rough Oily Well-hydrated
What are some factors that affect skin texture?
Exposure Age Impaired circulation Hyperthyroidism Endocrine disorders
Where should a nurse assess skin turgor in infants?
On the abdomen
Where should the nurse assess skin turgor in adults?
Collarbone area
Where should the nurse assess skin turgor in older adults?
Back of hand
What are some illnesses that contribute to edema?
Kidney disease CHF Peripheral vascular disease Low albumin Protein energy malnutrition
Milia
White raised areas that look like whiteheads. Usually on the face, especially on infants. Caused by keratin trapped under the skin
Nevi
Freckles/moles/birthmarks
Can develop in adulthood even into ones 50s
Skin tags
Tiny buds of skin around the skin creases
Striae
Stretch marks caused by pregnancy or other drastic weight changes
What are the warning signs of malignant lesions/skin marks?
Asymmetry Border irregularity Color variation (not just one solid color) Diameter greater than 0.5 cm Elevated Changing over time
What are some things to be assessed when looking at hair?
Type Color Distribution Thickness Texture
Alopecia
Usually describes hair loss along temples and mid-scalp (male-pattern baldness), but can also describe any random hair loss in patches
Hirsutism
Excess hair on the face or trunk
Describe half and half nails and what usually causes them
The reddish pink band at the bottom of the nails covers 20-60% of the nail instead
Often occurs in renal disease or with low albumin levels
Describe Mees Lines and what causes them
Transverse white lines in nail beds (of all nails). Caused by severe illness, nutritional deficiencies, or heavy metal poisoning
What are splinter hemorrhages? What causes them?
Small vertical lines in the nail bed caused by hemorrhages under the nail bed.
Can be caused by endocarditis or trauma to the nail
What causes black nails?
Blood under the nails due to trauma
What causes white spots on the nails?
Zinc deficiencies
What might thickened nails indicate?
Poor circulation
What might cause thick, yellow nails?
Fungal infection (onychomycosis)
What might cause brittle nails?
Hyperthyroidism, malnutrition, calcium or iron deficiency, harsh nail products
What might cause soft, boggy nails?
Poor oxygenation
What is clubbing? Where is most commonly seen?
Enlargement of the ends of the fingers and a downward slope of the nails
Common in COPD patients
Why are infants more prone to skin breakdown?
Thinner skin and more permeable
Less subcutaneous fat
Why are aging adults more prone to skin breakdown?
The skin is drier
Subcutaneous tissue layer is thinner
Loss of collagen
How does impaired mobility make one prone to skin breakdown?
More weight is on certain areas of the body for longer, and that pressure can lead to skin breakdown
What are some general factors that affect skin integrity?
Age Impaired mobility Nutrition Diminished sensation or cognition Impaired circulation Medications Moisture Fever Contamination or infection Lifestyle
What nutrients are needed to maintain skin integrity?
Adequate protein, calories, and cholesterol
What is the role of protein in maintaining healthy skin?
Maintains the skin
Repairs minor defects
Preserves/contains intravascular volume
What is the role of cholesterol in maintaining healthy skin?
Fuel for wound healing and maintaining a waterproof barrier
Why can high cholesterol cause issues for skin integrity?
It can block blood flow to areas of the body, making that skin more susceptible
How can insufficient calories lead to skin breakdown?
The body will use protein for energy, and then the skin cannot use it for repair
How do vitamin C, zinc, and copper aid in wound healing?
They aid in collagen formation, which is crucial to wound healing
Why are individuals with decreased sensation at risk for skin injury?
They are less able to feel pain and pressure, so sores and wounds may go untreated
Why is an individual with impaired cognition at risk for skin breakdown?
They are not aware of the need to reposition or unable to communicate pain/pressure
What are two forms of impaired circulation?
Arterial insufficiency
Venous insufficiency
How does venous insufficiency manifest?
Normal color and temperature of skin, but lots of edema in the extremities
How does arterial insufficiency mainifest?
Pale, dusky, cool skin with decreased or absent pulses. No edema present
When it comes to skin integrity, both arterial and venous insufficiency cause what problem?
Delayed wound healing
What are some medications that may impact skin integrity?
BP meds NSAIDS Steroids Anticoagulants Chemo Some antibiotics
What is maceration?
Softening of the skin due to excessive moisture, which puts someone at risk for skin breakdown
What are the two most common sources of excessive skin moisture?
Incontinence and fever
Why does fever predispose someone to skin breakdown?
Sweating increases moisture level and increased metabolic rate increases tissue demand for oxygen
What are some lifestyle habits that impact skin health?
Tanning Hygiene habits Exercise Diet Smoking Body piercings and tattoos
What is the universal assessment tool for pressure ulcers?
The Braden scale
What factors does the Braden scale look at?
Sensory perception Moisture Activity Mobility Nutrition Friction and sheer
What Braden scale score indicates pressure ulcer risk?
18 or lower
What does the Norton scale look at?
Physical condition Mental state Activity Mobility Incontinence (Also for pressure ulcers)
What are some ways the nurse can promote optimal skin integrity?
Inspection
Managing moisture
Optimizing nutrition and hydration
Minimizing pressure by repositioning regularly
What part of the brain controls the balance between heat production and heat loss?
The hypothalamus
What are the compensatory mechanisms involved in decreasing body temperature?
Vasodilation
Sweating
Inhibition of heat production
What does the body do to increase temperature?
Shivering
Releasing epinephrine to increase metabolic rate
What three factors interact to produce body heat?
Metabolism
Skeletal muscle movement
Non-shivering thermogenesis (metabolism of brown fat)
Radiation
Loss of heat through waves emitting from a surface
How much body heat is lost through radiation?
60%
Convection
Transfer of heat through air or water currents
How much body heat is lost through convection?
15%
Evaporation
Water evaporating from skin or mucous membranes to cool the body
How much body heat is lost through evaporation?
About 20%
Conduction
Heat transferring by direct contact with a surface or body
How much body temperature is lost through conduction?
About 3%
Why is maintaining body heat harder for the elderly?
Slower metabolism
Decreased vaso motor control
Loss of subcutaneous tissue
What are some additional factors that influence body temperature?
Environment Gender (menstrual cycle and hot flashes) Exercise Emotions/stress Circadian rhythm
Why does hyperthermia happen?
The body cannot promote heat loss fast enough to balance heat production or environmental heat
What temperature range can indicate heat exhaustion?
Between 98.6 and 103
What are warning signs of heat exhaustion?
Weakness Nausea Vomiting Syncope Tachycardia Tachypnea Muscle aches Headaches Diaphoresis Flushed skin
What temperature range is considered heatstroke?
Above 103
What are the symptoms of heat stroke?
Rapid and strong pulse Throbbing headache Delirium Confusion Lethargy Red/hot/dry skin Dizziness Seizures Coma
What is hypothermia?
Abnormally low core temperature (less than 95 degrees)
What are early signs of hypothermia?
Shivering
Cyanosis of lips and fingers
Poor coordination
What temperature indicates severe hypothermia?
Below 82.4 degrees
What are the signs of severe hypothermia?
Unconsciousness
Shivering ceases
Pulse and respirations are irregular and hard to detect
How soon upon admission must a skin assessment be done?
Wishing 24 hours
Are pressure ulcers reportable/punishable offenses in hospitals?
Yes, as mandated by the joint commission
How many stages of pressure ulcers are there?
Four
What characterizes an unstagable (or stage 5) pressure ulcer?
Severity cannot be determined because so many things are going on. No more pain in the area due to nerve death
What characterizes a stage four pressure ulcer?
Extensive damage extending into the muscle or bone, often no more pain in the area
What is crucial to promote healing in pressure ulcers?
Follow up care
How long does the pre-embryonic stage last?
From conception to day 14
What does the ectoderm develop into?
Epidermis Glands Nails/hair CNS/PNS Lenses of eyes Tooth enamel
What does the mesoderm develop into?
Bones Teeth Muscles Dermis CT Cardiovascular system Spleen Urogenital system
What does the endoderm develop into?
Epithelial lining in respiratory, digestive, and reproductive tracts, roof of the yolk sac
How long does the embryonic stage last?
From 15 days to 8 weeks after conception
What is the major accomplishment during the embryonic stage?
All organ systems and external features develop
What is the difference between the amnion and the chorion?
Chorion covers the fetal side of the placenta and contains the umbilical blood vessels
Amnion forms the amniotic sac (more on the outside)
What are the functions of amniotic fluid?
Maintain fetal body temperature Waste repository Cushion Maintain electrolyte homeostasis Provide infection barrier Aids in lung development and symmetric growth
What is the purpose of the placenta?
Metabolic exchange Hormone production Respiration Nutrition Storage Excretion
How many arteries and veins does an umbilical cord have?
Two arteries and one vein
How long does the fetal stage last?
From 9 weeks to the end of pregnancy
What is the defining feature of the fetal stage?
Viability and the fetus being recognizable as human
What do urine pregnancy tests look for?
Human chorionic gonadotropin
How does Nagel’s rule work and what does it calculate?
Calculates due date
Take the first day of the last menstrual cycle, subtract three months, and add seven days (plus a year)
What causes nausea and vomiting during pregnancy?
Hormonal changes
Increased abdominal pressure
Delayed gastric emptying
What is some helpful teaching for a pregnant client with nausea and vomiting?
Eat crackers or toast before getting out of bed
Avoid spicy/greasy/gas forming foods
Drink fluids between meals, not with meals
Eat small frequent meals
Avoid caffeine
Ginger tea
How is nausea and vomiting treated medically?
Vitamin C and B6
What causes heartburn in pregnancy?
Stomach being displaced by uterus
Slower GI motility
Hormones causing relaxation of sphincter
What are some helpful teachings for heartburn?
Small frequent meals
Don’t get too hungry
Check with doctor before taking antacids
What are some helpful teachings for the pregnant client who is constipated?
High fiber diet
Lots of fluid
Regular exercise
When is urinary frequency most common in pregnancy?
First and third trimesters
What should the nurse instruct the pregnant patient regarding urinary frequency?
Void when the urge is present, or every 2-3 hours
Drink 10-12 glasses of water daily
Monitor for s/s of UTI
What causes breast tenderness in pregnancy?
Hormone changes and breast enlargement
What teaching is appropriate for the patient regarding breast tenderness?
Wear a well supportive bra
What are hemorrhoids?
Swollen veins in the rectal/vaginal/anal area
What causes hemorrhoids in pregnancy?
Pressure on the veins in the perineum from the weight of the fetus and the stress of pushing during labor
What teaching is helpful for the pregnant or postpartum woman with hemorrhoids?
Warm sitz baths
Witch hazel baths
Topical ointments
Why does uterine cramping happen during pregnancy?
Preparation of uterus for labor
What kind of uterine cramping should a woman worry about?
Cramping increasing in frequency and intensity before 37 weeks gestation
When do women need to call their provider regarding vaginal bleeding?
If there is any present. The provider will tell her what to do
Which lab tests are done during the first OB visit?
UA and C&S CBC Hemoglobin Hematocrit Blood type and Rh Rubella TB BMP/CMP Hep B HIV Gonorrhea and syphilis
What assessment activities are done during the first OB visit?
Health history Active history Herpes screening Complete physical exam Breast and pelvis exam Intimate personal violence screening Teaching
Which fetal tests are sometimes done during the first OB visit or first trimester?
Alpha fetalprotein and chorionic villus sampling (both for chromosomal abnormalities)
When are fetal heart sounds first heard and seen during an ultrasound?
As early as six weeks
When can fetal HR be heard via Doppler?
10-12 weeks
Why does back pain often occur in pregnancy?
Exaggerated lumbar and cervical thoracic curves in the spine develop
How can the woman minimize/prevent back pain during pregnancy?
Good posture Good body mechanics Relaxation techniques Firm mattress Abdominal support Back rubs Ice and heat
When is back pain concerning in pregnancy?
When accompanied by vaginal bleeding, contractions, or when the pain is cyclical (indicating contractions)
Why does bleeding gums happen during pregnancy?
Increased vascularity and proliferation of connective tissue
How can pregnant women minimize bleeding gums?
Eat a balanced diet with protein, fruits, and vegetables
Practice good dental hygiene
Why do congestion and nosebleeds often happen during pregnancy?
Hyperemia of mucous membranes due to estrogen levels
What is quickening?
Fetal movement
When is quickening first able to be felt?
Between weeks 16 and 25 of pregnancy
What are some genetic tests available for pregnant women?
Maternal serum alpha fetoprotein Amniocentesis Cordocentesis Chorionic villus sampling Quad marker screening
What to fetal genetic tests look for?
Down syndrome
Neural tube defects
Chromosomal abnormalities
What is the purpose of a screening ultrasound?
Measuring the clear space at the back of the baby’s neck (looking for Down syndrome)
When is gestational diabetes testing done?
Second trimester
What assessments and tests are done during the second trimester?
BP UA Fundal height Fetal heart tones All genetic testing Gestational diabetes Rh antibodies CBC
How often does a woman go to the doctor during the second trimester?
Monthly
Glucose challenge test
One hour glucose test, done first, no fasting needed
Glucose tolerance test
Three hour GTT, done if glucose challenge abnormal, fasting required
What weeks are most crucial for fetal development?
Weeks 10-15
What should a woman do if she feels Braxton-Hicks contractions?
Rest
Change positions
Do deep breathing
When does a woman need to call her doctor regarding Braxton-Hicks contractions?
If they don’t go away and become more intense and frequent
Why does shortness of breath occur during the third trimester of pregnancy?
Diaphragm is restricted by the enlarged uterus
When is swelling normal in pregnancy?
Late in pregnancy
In hot weather
With excessive sitting/standing/poor posture
When wearing constrictive clothing
When is swelling abnormal during pregnancy?
When it becomes generalized edema and is accompanied by signs and symptoms of preeclampsia
What is a mucus plug?
A barrier that seals the cervix during pregnancy
When doing a fetal kick count, what is considered normal/good?
10 movements in two hours
When does a fetal kick count need further evaluation?
Less than 3 movements in one hour
If further evaluation is needed after a fetal kick count, what is the next step?
A non-stress test
What is being assessed/monitored for with a non stress test?
Intact fetal CNS and to rule out fetal death
What does a reactive/good non-stress test look like?
Before 32 weeks: 2 accelerations in 20 minutes lasting 10 seconds with HR going 10 BPM above baseline
After 32 weeks: 2 accelerations in 20 minutes lasting 15 seconds with HR going 15 BPM above baseline
If a non-stress test is non-reactive, what is the next step in evaluating the fetus?
Biophysical profile (BPP)
What elements are assessed in a BPP?
Fetal heart rate Fetal breathing Fetal tone Fetal movement Amniotic fluid volume
How is a BPP scored?
Each element is scored 0, 1, or 2 for a max score of 10
What is it called when the amniotic fluid volume is low?
Oligohydramnios
What might cause Oligohydramnios?
Hypertension
PROM
Drugs
What is amniotic fluid made from?
Mom’s plasma
How is a group B streptococcus test done?
Vaginal or anal swab at 35-37 weeks gestation
When is a pregnancy considered post-dates?
After 40 weeks (40-42)
What are presumptive pregnancy signs? Give examples
Symptoms that could accompany pregnancy or something else, like fatigue, nausea, and vomiting
What are some probable pregnancy signs?
Fetal movement Breast tenderness Uterine growth Lack of menses Positive urine pregnancy test
What is the only positive sign of pregnancy?
Ultrasound verification
When might the provider decide to strip a pregnant woman’s membranes?
When they are not going into labor and should be
The uterus switches from what cavity to what cavity during pregnancy?
Pelvic to abdominal cavity
By what point do you want the baby to be in a vertex position?
33-34 weeks
What changes happen to blood pressure during pregnancy?
Systolic will stay the same or decrease
Diastolic will/should decrease
Why does BP go down during pregnancy?
Because progesterone should have a relaxing effect on the vessels
What changes happen in the urinary system during pregnancy?
System gets larger and more relaxed
Increased urinary frequency
Lag time between urine formation and when it reaches the bladder
What are some common skin changes during pregnancy?
Hyperpigmentation
Línea nigra from belly button to symphysis pubis
Cholasma
At what point in pregnancy do Braxton hicks contractions usually start?
Around 28 weeks
The hormone of pregnancy
Progesterone
What does progesterone do during pregnancy?
Endometrial development
Relaxes uterine muscle and pelvic girdle
Breast tissue growth
Increases prolactin and oxytocin
How much weight should be gained in the first trimester?
2-5 pounds
How much weight should be gained in the second trimester?
One pound per week
How much weight should be gained in the third trimester?
One pound per week
How much fish should a pregnant woman consume during pregnancy?
No more than 12 ounces
Which fish should be avoided during pregnancy?
Swordfish
Shark
King mackerel
Tilefish
Heart rate during exercise should be kept below what during pregnancy?
140 BPM
How much water is needed per day during pregnancy to prevent UTIs and maintain amniotic fluid?
2 liters
What are some tips for UTI prevention during pregnancy?
2 L water per day
No bubble baths
Cotton underwear
Avoid tight pants (increases heat and infection risk)
What are warning signs/signs of preterm labor?
Regular contractions before 37 weeks
Vaginal bleeding
Water leaking
Heartburn with headache
What are some maternal emotional changes during pregnancy?
Accepting pregnancy Identifying with mother role Reordering relationships Establishing relationship with baby Preparing for birth
What are some paternal emotional adaptations while the mom is pregnant?
Accepting it
Pregnancy like symptoms
Establishing a relationship with the baby
Identifying with father role
What are some cultural factors that can influence pregnancy and delivery?
Diet Religion Beliefs and folklore Cultural practices and modesty beliefs Pain/expression/management Touch and eye contact Others present during birth (father, doula, etc)
Explain the GTPAL terminology
Gestations: total # of pregnancies T: # of term babies P: # of preterm babies A: # number of abortions/miscarriages L: # of living children
Primagravida
First pregnancy
Multigravida
More than two pregnancies
Grandmultigravida
Greater than or equal to 5 live births
What are some considerations for the pregnant adolescent?
Extra prenatal care
Alcohol/smoking/drugs
Weight gain concerns
Need to involve social worker, psychologist, school system
Active immunity
Immunity developed through exposure to a disease
What are the two types of active immunity? Give examples of each
Natural (getting sick and developing antibodies that way)
Artificial (getting a vaccine and developing antibodies from that)
Passive immunity
Immunity given by antibodies being transferred
What are the two types of passive immunity? Give examples
Natural (passed through placenta or breast milk)
Artificial (anti-serum or immune globulin)
What are benefits and drawbacks to passive immunity?
Immediate action, no need for antibodies to be created. But usually only provide short term immunity
What is an example of a passive immunity injection that can be given?
Hepatitis B immune globulin
At what age should infants begin receiving an annual influenza vaccine?
6 months old
What are some reasons why parents might choose to not vaccinate?
Religious beliefs Conflicting or lack of information Beliefs that vaccines cause autism or other issues Limited healthcare access Cultural values
What are two additional vaccines recommended for the 7-18 age group?
Meningococcal vaccine and HPV
Which vaccine is contraindicated during pregnancy?
Rubella
Discuss the risks of contracting rubella during pregnancy
Can cause birth defects or miscarriage
If a pregnant woman has not receive the rubella vaccine, when will she receive it?
As soon as the baby is born
What vaccine is recommended for all adults at age 65?
Pneumonia
What additional vaccine does the CDC recommend for those over 60 years old?
Shingles vaccine
What are some things the nurse should assess prior to vaccine administration
Allergies (especially to eggs), any immune contraindications
What should be done if a child is behind on their vaccine schedule?
Give as many as possible to start catching the child up
What should be documented after a vaccine is given?
Injection site, lot number, and expiration date of vaccine
What information should the nurse provide to patients/caregivers prior to giving a vaccine?
Vaccine information sheet for every vaccine to be given
What does the nurse evaluate following vaccine administration?
Site of administration for an allergic reaction
Development of fever (tell parents that fever is normal but notify them of when it is considered serious)
What are some age-related considerations when administering a vaccine?
Muscle tone Pain tolerance Skin thickness Fear of needles Administration site
What are some barriers that may prevent a patient from receiving recommended immunizations?
Language barriers Cultural beliefs Lack of education Lack of insurance or healthcare access Lack of transportation Immunosuppressed child Religious or personal beliefs
Which barriers to immunization are the hardest to overcome?
Religious or personal beliefs against vaccination
What can the nurse do to eliminate some other barriers to immunization?
Educate about benefits
Get materials in their native languages
Connect them to resources (such as health institutions with reduced cost immunizations or public health nurses that will come to you)
TDaP vaccine
Tetanus, diphtheria, and pertussis original vaccine given earlier than 7 years to build up immunity
Tdap vaccine
Booster vaccine given at age 11 to offer continued protection. Contains full dose of tetanus and reduced doses of diphtheria and pertussis
What four factors integrate together to contribute to health?
Social
Psychological
Spiritual
Biological
Self concept
One’s overall view of oneself
What does it mean to have a healthy self-concept?
Having a mostly positive perception when making self evaluations (in things like appearance, sexual performance, intelligence, success, friendship, etc)
Self concept influences social functioning
Self concept is also influenced by social functioning
Describe the idea of the dynamic self
Who we are is subject to change through the influence of society and environment
How does concept of self develop in infancy?
Infant learns that the physical self is different from the environment
How does self-concept develop in childhood?
Children internalize other’s attitudes about them and use that to shape self-concept
How does self-concept develop in childhood and adulthood?
Children and adults internalize societal standards and evaluate to see how they compare
How does self concept develop throughout adulthood?
Adults come to a point of self actualization and continuing self-adjustment (“this is who i am and who I will continue to be”)
In childhood, what factors influence the formation of self-concept?
Gender and gender role expectations
Friends and media
Family and peer relationships
Internal locus of control and self concept
Inner voice influences self-concept. Belief that one can control their own life
External locus of control and self-concept
Attribute control to factors outside of oneself (like people, institutions, or God)
What are the four interrelated components of self-concept?
Body image
Role performance
Personal identity
Self-esteem
What predicts a positive body image?
A close match between one’s ideal body image and sensory input about one’s body
How do gradual vs sudden body changes impact body image?
Gradual changes, like aging, are usually easier to adapt to, while sudden changes, like injury/deforming accident, are much harder to accept
What health problems can occur because of negative body image?
Depression Smoking Increased unplanned pregnancies Increased STIs Increased bullying risk
How does positive body image influence health?
Leads to much higher overall life happiness
Define role performance
Actions and behaviors demonstrated in fulfilling a role (the reality of it, not the expectation)
What is role strain?
Mismatch between role expectation and role performance
Interpersonal role conflict
When your expectations for a role are different from how others expect you to fill that role
Personal identity
Your view of yourself as a unique person, separate from all others
How is personal identity determined and learned?
It develops over time and is influenced by those around us. It is relatively constant and consistent
What marks a strong sense of personal identity?
Valuing oneself and others, and being less likely to compare or be overly influenced by others
What marks a weak sense of personal identity?
Difficulty distinguishing boundaries and taking things too personally
What could cause an impaired sense of identity?
Serious or chronic illness
Self esteem
How well a person likes himself. The meeting of the ideal self and the real self
What are symptoms of anxiety?
Nervousness Fearfulness Uneasiness Nausea Trembling Sweating
Differentiate between fear and anxiety
Fear: specific, cognitive response to a known threat
Anxiety: vague, emotional response to an unknown threat
Is anxiety common?
Yes, mild anxiety is normal and necessary for survival
Normal anxiety
Essential reaction to realistic danger. Allows us to survive and move on
Abnormal anxiety
Anxiety out of proportion to the threat that lasts long after the threat is over
Adaptive coping strategies (list)
Exercise Talking Fun/leisurely activities Relaxation Deep breathing
Maladaptive coping strategies
Excess sleeping Excess eating Smoking Excessive crying Drinking Cursing Nail biting
Define defense mechanisms
Unique patterns of coping with anxiety
Give two examples of defense mechanisms
Denial
Displacement
What can overused defense mechanisms lead to?
Becoming maladaptive or development of psychological disorders
What are some myths about depression?
One can just “get on with life”
Everyone likes to talk about their feelings
Medications cure depression
Once cured, depression won’t return
According to the APÁ, what are the characteristics of major depressive disorder?
Depressed mood most of the day every day for two weeks Insomnia or hypersomnia Loss of energy Feelings of worthlessness Difficulty concentrating Recurrent thoughts of death
How is sadness different from depressed mood?
Sadness is linked to specific situational elements, while depressed mood is characterized by feelings of emptiness
What are two age groups that are more likely to suffer from depression?
Older adults
Those in their 40s
Physiological depression theory
Depression caused by biochemical imbalances
Psychodynamic depression theory
Depression is related to loss, abandonment, or detachment
Cognitive depression theory
Depression is caused by negative thinking
Social or environmental depression theory
Depression is caused by family/social relationships or environmental factors
What are some (research supported) depression risk factors?
Family history Hormone or nutrition imbalance Inability to externalize anger Low self esteem Negative thinking Traumatic loss Catastrophe Chronic disease Being female Learned helplessness/hopelessness
What is the prevailing depression theory? What treatment is normally associated with it?
Physiological theory
Treatment with antidepressants
What are some strategies for effective communication when collecting psychosocial information?
Be aware of your biases and discomforts Use active listening Proceed from general to specific information Follow the patient’s cues Keep it focused on the patient
How can a nurse help hospitalized patients maintain a sense of personhood?
Introduce yourself Listen actively Speak to the patient, not about the patient, when they are in the room Use eye contact and touch Explain Be gentle Provide privacy
What are some behaviors associated with low self-esteem?
Avoiding eye contact Slouched posture Slow movement Speaking hesitantly Frequent apologizing
What are two guidelines to keep in mind when analyzing self-esteem data?
Avoid seeking simplistic cause and effect relationships
Avoid confusing low self concept with clinical emotional or behavioral psychiatric diagnoses
What are some key nursing actions to promote self-esteem in patients?
Encourage independence
Monitor for and discourage negative self talk and self-criticism
Use positive, reaffirming language
Establish a therapeutic nursing relationship
Help the client with realistic goals
How can parents promote self-esteem in their children?
One on one time Frequent touch Refrain from negative criticism Establish routines Treat child with respect Set realistic expectations Be a role model
What can a nurse teach a patient about positive body image?
Healthy does not mean perfect
Focus on being active and eating healthy
Accept compliments
When does anxiety become a problem?
When it interferes with ability to meet basic needs
What are anxiety assessments that warrant immediate intervention by a mental health professional?
Suicidal thoughts and plans
Assaultive or homicidal thoughts/plans
Loss of touch with reality
Significant or prolonged inability to care for oneself or family
Why is a physical assessment important for clients with anxiety?
To treat underlying disease or disorder
What are some specific nursing actions to reduce anxiety in patients?
Calm, safe environment Establish a trusting relationship Be present and stay with the patient Identity client triggers Encourage non-stressful activities
What is the most vital intervention when caring for a depressed patient?
A good nurse-patient relationship
What are specific depression risk factors for older adults?
Dementia Cancer Substance abuse MI Functional disability Being widowed Being a caretaker Isolation
What are some feelings s/s of depression?
Flat affect Difficulty concentrating Loss of interest in activities Feelings of worthlessness/guilt Suicidal thoughts
What are some cognitive s/s of depression?
Preoccupation with loss Guilt Self blame Confusion Ambivalence
What are some behavioral s/s of depression?
Sleep issues Eating issues Fatigue Restlessness Agitation Withdrawal Substance abuse
What are some lifestyle s/s of depression?
Isolation
Self-medicating
Reckless behavior
Why might physiological effects manifest with depression?
To mask the depression with a more “legitimate” complaint
What are some symptoms of depression in older adults?
Difficulty concentrating Forgetfulness Reduced alertness Saying “I dont know” a lot Slow to speak and respond to verbal stimuli Daytime sleeping
What are some s/s of dementia (but not depression) in older adults?
Difficulty finding words, especially nouns Short term memory loss Difficulty with calculations “Near miss” answers Disorientation Fragmented sleep
How does a nurse determine when to refer someone to a mental health specialist for depression symptoms?
Personal history of depression or bipolar disorder
Family history
Recurrent depression within one year of stopping effective treatment
Major depression before age 20
Life threatening depressive episode
What are risk factors for suicide?
Substance abuse
Family history
Family violence
Recent losses
What are warning signs of suicide?
Risky behavior Changes in routine Giving away stuff Personality changes Talking about death and suicide
Discuss medication and depression/suicide risks with older adults!
There is one successful suicide for every four attempts among older adults!
What is the most important intervention to prevent suicide?
Assessment
What are some other important interventions to prevent suicide?
Evaluate medications and side effects Do not avoid talking to the patient out of fear of saying the wrong thing Know your own feelings/anxieties/biases Ask patient if they are suicidal Monitor patient DOCUMENT PROPERLY
