NRSG200 > QUIZ 8 > Flashcards
QUIZ 8 Flashcards
P
pulse
pc
after meals
p
after
PAC
premature atrial contraction
PACU
post anesthesia care unit
PCA
patient controlled analgesia or patient care assistant
PE
pulmonary embolus or pulmonary edema
PERRLA
pupils equal, round, and reactive to light and accommodation
PEG
percutaneous endoscopic gastrostomy
Periph.
peripheral
pH
used to express acidity and alkalinity
PICC
peripherally inserted central catheter
PID
pelvic inflammatory disease
PIV
peripheral intravenous
PLT
platelet
PMH
past medical history
PMI
point of maximal impulse
PND
paroxysmal nocturnal dyspnea
PO
by mouth (per os)
POC
point of care
POD
post-op day
pos/+
positive
Post.
posterior
ppd
packs per day
PPD
purified protein derivative (TB skin test) or percussion and postural drainage
PPN
peripheral parenteral nutrition
PPV
Pneumococcal polysaccharide vaccine
PR
per rectum
prn
when necessary
PROM
passive range of motion
PSA
prostate-specific antigen
PT
prothrombin time or physical therapy
PTA
prior to admission
Pt
patient
PTT
partial thromboplastin time
PUD
peptic ulcer disease
PVR
peripheral vascular resistance
PWB
partial weight bearing
activity tolerance
the type and amount of exercise or ADLs an individual is able to perform without experiencing adverse effects
atrophy
unused muscles decrease in size, losing most of their strength and normal function
contracture
when the muscle fibers are not able to shorten and lengthen, eventually a permanent shortening of the muscle (contracture) forms, limiting joint mobility.
this process eventually involves the tendons, ligaments, and joint capsules: it is irreversible except by surgical intervention. joint deformities such as foot drop, wrist drop, external hip rotation occur when a stronger muscle dominates the opposite muscle
crepitation
palpable or audible crackling or grating sensation produced by joint motion and frequently experienced in joints that have suffered repeated trauma over time
embolus
object that has moved from its place of origin (like breaking loose from the wall of a vein to enter general circulation), causing obstruction to circulation elsewhere
flaccid
without muscle tone
Fowler’s position
semisitting position, head and trunk raised 45-60 degrees relative to bed. knees may or may not be flexed.
nurses may need to clarify the meaning of Flowers in a particular setting - typically, fowlers is 45 degrees angle of elevation of upper body
gait
the characteristic pattern of a person’s walk.
assessed to determine the client’s mobility and risk for injury due to falling.
two phases of normal gait: swing and stance. one leg is in swing phase, other is in stance. (in stance, heel of one foot strikes ground and body weight is spread over ball of foot while the other heel pushes off and leaves the ground. in swing, leg from behind moves in front of body)
high Fowler’s position
head and trunk are raised 60-90 degrees, most often the client is sitting upright at a right angle to the bed.
lateral position
side lying position.
flexed top hip and knee, placing this leg in front of body to create a wider, triangular base of support and achieve greater stability. greater the flexion of top hip and knee, greater the stability.
flexion reduces lordosis, promotes good back alignment.
lateral position helps to relieve pressure on sacrum and heels in people who sit for much of day or are confined to bed and rest in fowlers or dorsal recumbent positions most of day.
in lateral, most of body weight is borne by lateral aspect of lower scapula, lateral aspect of ilium, and greater trochanter of femur.
people with sensory/motor deficits on one side of body usually find lying on uninvolved side more comfortable.
log rolling
technique used to turn client whose body must at all times be kept in straight alignment like a log.
ex: client with back surgery or spinal injury, considerable care must be taken to prevent additional injury.
this technique requires 2 nurses or if client is large, 3. for client with cervical injury, one nurse must maintain head/neck alignment.
lordosis
exaggerated anterior/inward curvature of the lumbar spine.
osteoporosis
condition in which the bones become brittle and fragile due to calcium depletion. common in older women and primarily affect the weight bearing joints of lower extremities and anterior aspects of spinal bones, causing compression fractures of vertebrae and hip fx. gait becomes wide based, short stepped, shuffling. regular activity helps older adults maintain and regain strength, flexibility, cardiovascular fitness, bone density.
paresis
when muscle groups are weakened, paralyzed
prone position
client lies on abdomen with head turned to one side. hips are not flexed. the only bed position that allows full extension of hip and knee joints. periodically, this helps to prevent flexion contractures of hips and knees, thereby counteracting a problem caused by other bed positions. prone also promotes drainage from mouth and esp useful for unconscious clients recovering from surgery of mouth/throat.
disadvantages: pull of gravity on trunk produces marked lordosis, neck is rotated laterally to a certain degree so not good for ppl with cervical/lumbar spine problems. prone also needs plantar flexion. some clients with cardiac/resp problems find prone confining and suffocating because chest expansion is inhibited. prone is only for short periods. it is not often used.
renal calculi
with immobility and resulting excessive amounts of calcium in urine, balance between calcium and citric acid is no longer maintained. urine becomes more alkaline, calcium salts precipitate out as crystals, forming renal calculi (kidney stones). immobile client in a horizontal position with the renal pelvis filled with stagnant alkaline urine is the ideal location for calculi. pass through ureters from renal pelvis into the bladder. stones passing thru long, narrow ureters cause extreme pain/bleeding, sometimes causing obstruction.
range of motion - active and passive
active ROM: isotonic exercises in which the client moves each joint in body through its complete range of movement, maximally stretching all muscle groups within each plane over joint. these exercises maintain or increase muscle strength and endurance and help to maintain cardiorespiratory function in an immobilized client. also prevent deterioration of joint capsules, ankylosis, and contractures.
passive: another person moves each of the client’s joints through its complete range of movement, maximally stretching all muscle groups within each plane over each joint. passive are of no value in maintaining muscle strength but are useful in maintaining joint flexibility. should be performed only when client is unable to accomplish movements actively.
Semi-Fowler’s position
head and trunk are raised 15-45 degrees. sometimes called low fowler’s, typically means 30 degrees of elevation.
spastic
too much muscle tone
supine position
aka dorsal.
head and shoulders are not elevated.
client’s forearms may be elevated on pillows or placed at client’s sides.
tripod position
the proper standing position with crutches.
crutches are placed about 6in in front of feet and out laterally about 6 in, for wide base of support. feet are slightly apart. tall client needs wider base than short client. hips and knees are extended, back is straight, head is straight and high.
thrombus
clot
particularly dangerous if it becomes an embolus
urinary retention
immobile clients may suffer this accumulation of urine in the bladder.
valsalva maneuver
refers to holding breath and straining against a closed glottis.
clients tend to hold their breath when attempting to move up in bed or sit on a bedpan. this builds up sufficient pressure on the large veins in the thorax to interfere with the return blood flow to the heart and coronary arteries. when the client exhales and the glottis opens, pressure is suddenly released, and a surge of blood flows to the heart. cardiac arrhythmias can result if the client has preexisting cardiac disease
circadian rhythm
biologic rhythm.
a sort of 24 hr internal biologic clock.
circa dies is latin for about a day.
sleep and waking are best known of the circadian rhythms, but body temp, blood pressure, and many other phsyiological functions also follow a circadian rhythm.
hypersomnia
conditions when the affected individual obtains sufficient sleep at night but still cannot stay awake during day. can be caused by medical conditions like CNS damage and certain kidney/liver/metabolic disorders such as diabetic acidosis and hypothyroidism. it rarely has psychological origin.
insomnia
instability to fall asleep or remain asleep.
these ppl do not awaken feeling rested.
most common sleep complaint in USA.
acute insomnia = 1 to several nights (caused by stress or worry).
chronic, intermittent insomnia = diff. sleeping for a few nights, with few nights of adequate sleep, then trouble sleeping again.
2 main risk factors: old age, female. (hormonal changes for women and other medical conditions that come with aging)
narcolepsy
disorder of excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the CNS that regulates sleep. clients with narcolepsy have sleep attacks/excessive daytime sleepiness. their sleep at night usually begins with a sleep onset REM. majority of ppl with this also have cataplexy, sleep paralysis, hallucinations, fragmented sleep.
cns stimulants ie ritalin or amphetamines reduce excess daytime sleepiness. also caffeine increases alertness.
NREM sleep
non rapid eye movement sleep.
NREM and REM sleep cycles alternate.
NREM=activity in RAS is inhibited. nrem = 75-80% of sleep. has 3 stages:
1. very light sleep for a few mins. person is drowsy, relaxed, eyes roll side to side, heart rate and RR drop slightly. can be readily awakened and may deny they were asleep. low voltage brain waves.
stage 2. body processes slow down more. eyes are still, heart/RR decrease slightly, body temp falls. require more stimuli than stage 1 to wake up like touching them or shaking them.
3. deepest sleep stage. difference is that in this stage HR and RR drop 20-30% below waking hours. difficult to wake up. person is not bothered by sensory stimuli, muscles are relaxed, reflexes diminished, snoring likely. essential stage for energy and releasing important growth hormones. more delta waves recorded.
REM sleep
rapid eye movement sleep.
NREM and REM sleep cycles alternate.
recurs about every 90 mins for 5-30 mins. dream state. most dreams not remembered unless person arouses briefly.
brain is highly active here, with brain metabolism increasing as much as 20%. acetylcholine and dopamine increase. aka paradoxical sleep because in this stage EEG activity resembles awake state.
distinct eye movements occur in REM: voluntary muscle is decreased, deep tendon reflexes absent.
sleep is diff to arouse but can also wake spontaneously.
gastric secretions increase, HR/RR are irregular. regions of brain for learning, thinking, organizing info are stimulated during REM.
parasomnia
behavior that may interfere with sleep and may occur during sleep.
characterized by physical events like movements or experiences that are displayed as emotions, perceptions, or dreams. three classes:
1. non-rapid eye movement: confusion upon arousal, sleep tremors, sleep walking
2. rapid eye movement: arousal disorders like sleep paralysis, nightmare disorder with exaggerated REM sleep.
3. miscellaneous: not associated with any stage of sleep. may produce nocturnal enuresis or hallucinations. often related to meds, substance abuse, or medical disorder.
examples or parasomnias: bruxism (occuring most in stage 2 NREM, clenching/grinding teeth), enuresis (bed wetting, NREM stage 3), periodic limb movement, sleep walking, sleep talking
sleep apnea
characterized by frequent short breathing pauses during sleep.
all ppl have occasional periods of this, but more than 5 episodes or 5 breathing pauses longer than 10 seconds per hour = abnormal, should be evaluated by sleep medicine specialist.
symptoms = loud snoring, frequent nocturnal waking, excess daytime sleepiness, difficulties falling asleep at night, morning headaches, memory/cognitive problems, irritability.
mostly dx in men/postmenopausal women, but can occur in childhood.
periods of apnea last 10 sec-2 mins during REM or NREM. frequency of episodes 50-600/night.
3 common types: obstructive (structures of pharynx/oral cavity block airflow), central (defect in respiratory area of brain), mixed (.
sundown syndrome
some older clients with dementia may experience this.
although not a sleep disorder directly, it refers to a pattern of symptoms(agitation, anxiety, aggression, sometimes delusions) that occur in late afternoon (thus the name). these symps can last the night, disrupting sleep.
anemia
decrease in red blood cells
anorexia nervosa
characterized by prolonged inability or refusal to eat, rapid weight loss, and emaciation in individuals who continue to believe they are fat. ppl with anorexia may also induce vomiting or abuse laxatives or diuretics to remain thin.
body mass index
indicates whether weight is appropriate for height.
kg/m^2.
normal: 18.5-24.9
overweight: 25-29.9
obese: stage 1: 30-34.9, stage 2: 35-39.9
extreme obesity: (stage 3): 40
bulimia
uncontrollable compulsion to consume enormous amounts of food (binge) and then expel it by self induced vomiting or by taking laxatives (purge).
these illnesses are most effectively treated with psychotherapy. hospitalization necessary if they are starving and life is threatened.
cholesterol
fatlike substance both produced by body and found in foods from animals. most of body cholesterol is made in liver, however some from diet (milk, egg, organ meats). needed to create bile acids and synthesize steroid hormones.
large quantities of cholesterol are in cell membranes and other cell structures.
complete proteins
contain all essential amino acids plus many nonessentials.
most animal proteins (meat, poultry, fish, dairy, eggs) are complete. some animal proteins contain less than the required amount of one or more essential amino acids and therefore alone cannot support continued growth. these are referred to as partially complete. ex: gelatin, casein
dysphagia
difficulty swallowing
possibly due to painfully inflamed throat or stricture of esophagus
enteral nutrition
aka total enteral nutrition (TEN).
provided when client cannot ingest foods or upper GI tract is impaired and transport of food to small intestine is interrupted. enteral feedings are administered thru ng and small bore feeding tubes, or thru gastrostomy/jejeunostomy tubes.
fat soluble vitamins
VIT A, D, E, K.
body can store these, but there is limit to amounts of Vit E and K body can store. daily supply is not absolutely necessary. vitamin content is highest in fresh foods consumed soon after harvest.
fiber
complex carb derived from plants. supplies roughage/bulk to diet. cannot be digested by humans. satisfies appetite and helps digestive tract function and eliminate waste. present in outer layer of grains, bran, and in skin, seeds, pulp of veggie/fruits.
gastrostomy tube
used for long term nutritional support, generally more than 6-8 wks. placed surgically by laparoscopy thru abd wall into stomach. -percutaneous endoscopic gastrostomy (PEG) uses endoscope to view inside of stomach, making puncture thru skin and subq tissues of abd into stomach, inserting PEG thru puncture. surgical opening sutured tightly around tube to prevent leakage. care requires surgical asepsis. catheter has external bumper and internal inflatable retention balloon to maintain placement. when established (about 1 month), tube or catheter can be removed and reinserted for each feeding. or, a skin level tube can be used to remains in place and a feeding set is attached when needed.
ideal body weight
(IBW). optimal weight recommended for optimal health.
to determine, consult standardized tables or quickly calculate using Rule of 5 for women and rule of 6 for men.
many tables/formulas were developed many yrs ago and based on limited samples.
nurse should use great caution in suggesting these weights apply to all clients.
jejunostomy tube
device used for long term nutrition support. generally more than 6-8 wks. placed surgically or by laproscopy thru abd wall into jejunum. -percutaneous endoscopic jejunostomy uses endoscope to view inside of stomach, making puncture thru skin and subq tissue of abd into stomach, inserting PEJ catheter thru the puncture. surgical opening is sutured tightly around tube to prevent leakage. care requires surgical asepsis. catheter has external bumper and internal inflatable retention balloon to maintain placement. when established (about 1 month), tube or catheter can be removed and reinserted for each feeding. or, a skin level tube can be used to remains in place and a feeding set is attached when needed.
minerals
found in organic compounds as inorganic compounds and as free ions.
calcium/phosphorus = 80% of all mineral elements in body.
2 categories: maco/microminerals.
macro: require daily over 100mg. ex: calcium, phosphorus, sodium, potassium, magnesium, chloride, sulfur.
micro: require daily less than100 mg. ex: iron, zinc, manganese, iodine, fluoride, copper, cobalt, chromium, selenium
nasogastric tube
inserted thru one nostril, down nasopharynx, and into alimentary tract.
traditional large bore ones (larger than 12 Fr diameter) are placed into stomach. ex: levin tube, salem sump tube.
NG tubes are for feeing clients who have adequate gastric emptying but need short term feedings. not advised for feeding clients without gag and cough reflex (risk of accidental placement of tube into lungs is higher).
obese
BMI >30kg/m^2
overweight
BMI between 25 and 29.9kg/m^2
parenteral nutrition
aka total parenteral nutrition (TPN), or IV hyperalimentation.
is the IV infusion of 50% dextrose, 10% water, fat, protein, electrolytes, vitamins, and trace elements (amino acids, minerals). additives are modified by clients needs. because TPN solutions are hypertonic, they are injected only into high flow central veins, where they are diluted by clients blood.
is a means of achieving an anabolic state in clients unable to maintain normal nitrogen balance like pts with severe malnutrition, burns, bowel diseases, acute renal failure, hepatic failure, metastatic cancer, major surgeries where they are NPO for more than 5 days.
do infection control!! use surgical asepsis when changing tube, dressings, filters. increased risk of fluid, electrolyte, glucose imbalance.
start TPN gradually to prevent hyperglycemia. decrease rate slowly to discontinue to prevent hyperinsulinemia or hypoglycemia. weaning takes6-48 hours (client must receive adequate carbs orally or IV).
refeeding syndrome
rare, potentially fatal complication of tube feeding. it is a combination of fluid and electrolyte shifts that can occur after lengthy period of malnutrition or starvation. this syndrome can occur when starving body converts from creating glucose from carbs to creating it from protein stores since carbs were unavailable. body’s reaction to sudden presence of glucose and synthesis or protein leads to shifts.
people at high risk: chronic alcoholism, anorexia nervosa, massive weight loss, cancer clients with chemo, anyone who has gone 7-10 days without food.
must examine lab data indicating malnutrition: albumin, prealbumin, serum K/Ca/P/Mg. must be within normal before feeding.
sugars
simplest of all carbs. water soluble and produced naturally by both plants and animals. may be monosaccharides or disaccharides.
of the three mono (glucose, fructose, galactose), glucose is most abundant in simple sugar.
mostly in plants: fruits, sugar cane, sugar beets, but also in animal milk (lactose) or processed/refined like table sugar, syrup.
starches
insoluble nonsweet forms of carbs.
they are polysaccharides, composed of branched chains of dozens (or hundreds) of glucose molecules. nearly all exist naturally in plants, ie grains, legumes, potatoes. other foods like cereals, breads, flour, puddings are processed starches.
water soluble vitamins
VIT C, B complex (b1 thiamine, b2 riboflavin, b3 niacin or nicotinic acid, b6 pyridoxine, b9 folic acid, b12 cobalamin), pantothenic acid, biotin. body cannot store water soluble so much get a daily supply thru diet. water solubles can be degraded by food processing, storage, preparation.
