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Nursing > Term 1 Fundamentals > Flashcards

Term 1 Fundamentals Flashcards

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1
Q

The pts right to make their own decisions regarding their care even if the nurse disagrees

A

autonomy

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2
Q

What are the 5 components of swansons Theory of caring

A

Knowing, being with, doing for, enabling, and maintaining belief

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3
Q

A communication tool used to ensure accurate and concise information for transfer of patient

A

Isbar

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4
Q

What is nurses role in advocacy

A

To protect patient rights, support their decisions, advocate for them to the provider

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5
Q

Why is perineal care important for patients bedridden

A

To prevent infections skin breakdown, and promote comfort, and hygiene

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6
Q

Define clinical judgement in nursing

A

Ability to assess patient conditions and make decisions about care interventions

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7
Q

What is critical thinking in nursing?

A

Process of analyzing information, and making evidence-based decisions in patient care

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8
Q

5 steps of the nursing process

A

Assessment, diagnosis, planning, implementation, evaluation

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9
Q

Results inclient death or permanent severe harm

A

sentinel event

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10
Q

What are the modes of transmission?

A

Contact (touch), droplet(respiratory, coughs sneeze), airborne(tuberculosis)

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11
Q

What are the 5 rights of delegation?

A

Right task, right circumstance, right person, right direction & communication, right supervision & evaluation

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12
Q

What are stages of pressure injury

A

Redness, skinloss, subcutaneous layer exposed, bone

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13
Q

What does systolic represent in blood pressure

A

How hard heart is working

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14
Q

What does the diastolic number in blood pressure represent

A

When the heart is relaxed

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15
Q

What is normal pulse

A

60 -100bpm

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16
Q

Where can you find pts aypical pulse.

A

Left, 5th intercostal space(between ribs), true pulse

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17
Q

Requires 2 nurses radial and aypical pulse taken at same time

A

Pulse deficit

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18
Q

What are the grading pulses

A

O( absent/ nonpalble), +1 weak/ diminished, +2 normal, +3 increased, strong, +4 bounding

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19
Q

How should you document pulse taking.

A

Location of pulse, left or right , and grading number

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20
Q

Actions guided by compassion and kindness

A

beneficence

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21
Q

Telling the truth

A

veracity

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22
Q

Keeping promises

A

Fidelity

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23
Q

To do something or act for the sake of benefiting someone.(ex. Holding door open, donating money)

A

altruism

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24
Q

Individual carries out an act or fails to carry one out and results in injury or harm to patient.(ex. Nurse forgets to give seizure medication

A

Tort law

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25
Q

What is infectious agent?

A

Bacteria, fungi, virus, parasite

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26
Q

Where infectious agent lives and grows(ex.food/water, people, dirty surfaces & equipment)

A

Reservoir

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27
Q

Susceptible host

A

A person. Required for infectious agent to take hold

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28
Q

Type of white blood cell that help the body fight infection & disease by engulfing pathogen (pacman)

A

Phagocytes

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29
Q

Protective protein produced by immune system and attatch to bacteria
To destroy them

A

Antibodies

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30
Q

Incubation

A

Bacteria enters host and begins to multiply

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31
Q

Prodromal stage

A

Pt begins having symptoms

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32
Q

Acute illness

A

Sickness is obvious and severe

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33
Q

Decline stage

A

When symptoms start to decrease and host feels a little better

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34
Q

Convalescence

A

Client returns to normal state of health

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35
Q

What color should mucous membranes be?

A

Pink & moist

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36
Q

Epidermis

A

Top layer of skin

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37
Q

Dermis

A

Middle layer of skin

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38
Q

Subcutaneous layer

A

Beneath dermis, made up of fat

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39
Q

Acuity

A

Complexity of patients condition (stable to highrisk)

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40
Q

Ideal discharge planning

A

Include, discuss, educate, assess, listen

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41
Q

Main type of sugar in the blood and is major source of energy for body’s cells

A

Glucose

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42
Q

Glycogen

A

Stored sugar/ stored glucose

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43
Q

Normal blood pressure

A

120/80

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44
Q

Normal body temp

A

97 to 99 (98.6 is normal)

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45
Q

Respiratory rate

A

12-20bpm

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46
Q

O2 level

A

95% to 100%

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47
Q

Triage

A

Prioritization (level 1 most urgent, level 5 least urgent )

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48
Q

Acute pain

A

Last seconds to 6 months

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49
Q

Indicators of pain

A

Elevation in vitals, veins pop out, pallor

50
Q

Severe pain

A

Decrease in bp,decrease in heart rate, nausea & vomiting fainting, restlessness

51
Q

Nonpharmological pain interventions

A

Positioning, heat/cold therapy, massage, acupuncture, hypnosis, tens unit

52
Q

Opioid analgesics

A

Morphine, hydrocodone, oxycodone, fentanyl codeine

53
Q

Circadian rhythm

A

Cycle in body controls sleep-wake cycle

54
Q

Stage I sleep

A

Light sleep, lasts 5-10 minutes

55
Q

Stage 3 sleep

A

Deep sleep difficult to wake up stage is crucial for physical recovery and overall health.

56
Q

REM sleep brain becomes active dream stage breathing irregular, heart rate B blood pressure increase

A

Stage 4 sleep

57
Q

Surfactant

A

Lines the lungs keeps lungs from collapsing on itself. Mucousy substance

58
Q

Hypoxemia

A

Low oxygen in blood

59
Q

Hypoxia

A

Low oxygen in tissues

60
Q

Macronutrients

A

Protein, carbs, and fat, provide energy to function

61
Q

Micronutrients

A

Vitamin and minerals

62
Q

COPD

A

Chronic airflow obstruction - decrease in oxygen increase in carbon dioxide

63
Q

6 rights of medication administration

A

Right client,right medication,right dose, right route, right time of delivery, right documentation

64
Q

Poritis

A

Itchy

65
Q

Hormone made by pancreas, helps sugar from food you eat move into body’s cells where its used for energy

A

Insulin

66
Q

Not enough insulin

A

Sugar stays in bloodstream causing high blood sugar

67
Q

Glycemia

A

Blood sugar

68
Q

Alveoli

A

Air sacs in lungs where exchange of oxygen and carbon dioxide take place

69
Q

Pain caused by nerve damage or dysfunction

A

neuropathic pain

70
Q

Phantom pain

A

Pain felt in area that has been amputated

71
Q

Hormone produced by pineal gland that regulates sleep-wake cycle

A

Melatonin

72
Q

Pulmonary artery

A

Artery carrying deoxygenated blood from right ventricle to lungs

73
Q

Pulmonary vein

A

Vein carrying oxygenated blood from lungs to left atrium of the heart

74
Q

Protein in red blood cells that carries oxygen, essential for oxygen transport throughout body

A

Hemoglobin

75
Q

Mineral critical for hemoglobin production

A

Iron

76
Q

Water soluble vitamin

A

Vitamin B&C excreted through urine

77
Q

Prevents neural tube defects, critical during pregnancy

A

Folic acid

78
Q

Risk factors for pressure injuries

A

Poor nutrition immobile, decreased level of conciousness spinal injury, diabetics, urine or stool incontinence, activities that cause pressure injury

79
Q

Pressure injury sites

A

Heels, ankles, hips,sacral area, elbows, shoulders , ears, inside of knees

80
Q

Stage l pressure injury

A

Nonblanchable redness

81
Q

Stage 2 pressure injury

A

Skin visibly damaged, exposed dermis

82
Q

Stage 3 pressure injury

A

Full loss of skin through subcutaneous layer

83
Q

Stage 4 pressure injury

A

Full loss of skin that exposes bone, muscle, tendon, ligaments

84
Q

Unstageable pressure injury

A

Yellow or brown covering full skin loss

85
Q

Deep tissue injury

A

Purple,blackish areas over skin, usually when people pass

86
Q

Too much CO2, shortness of breath, hypoxia

A

Respiratory acidosis

87
Q

What is CO2

A

Acidic/waste product

88
Q

Respiratory alkalosis

A

Not enough CO2, hyperventilation

89
Q

What is normal blood PH

A

7.35 - 7.45

90
Q

Too many acids in body, affects kidneys, diarrhea

A

Metabolic acidosis

91
Q

Metabolic alkalosis

A

Tool little acids, kidneys, vomiting

92
Q

First intention wound healing

A

Sutured closed

93
Q

Second intention wound healing

A

Wound left open to heal

94
Q

Delayed primary closure wound healing( tertiary intention)

A

Wound left open 5-10 days then closed with sutures

95
Q

Penrose drain

A

Tube inserted into wound that drains on gauze pad

96
Q

Jackson Pratt drain

A

drain that collects fluid from wound (like Jessie)

97
Q

Symptoms of sepsis

A

Fever(not always),hyperglycemia,hypotension, confused, high WBC , tachycardia, tachypnea

98
Q

When giving eyedrops what should you do?

A

Press on lacrimal duct

99
Q

Peripheral vision loss, pressure build up on optic nerve

A

Glaucoma

100
Q

Progressive eye disease that affects the macula of the retina leading to central vision loss

A

Macular degeneration

101
Q

Diabetic retinopathy

A

Vision loss, floaters

102
Q

Involve the clouding of the lens of the eye, which leads to a decrease in vision clarity

A

Cataracts

103
Q

What is PCO2 and range

A

Respiratory 45-35

104
Q

HCO3 /bicarb

A

Metabolic 22-26

105
Q

Hormone regulates amt of glucose in body Helps with high blood sugar levels , glucose attaches to it and takes inside cell

A

Insulin

106
Q

Sugar, body needs it to survive fuels cells in body

A

Glucose

107
Q

Diabetes mellitus

A

Body can not get access to glucose your eating which means no insulin present ( type 1) or body is resistant to insulin(type 2) - overweight sedentary, poor diet, genetic

108
Q

Elevated blood sugar(glucose) in body that’s just hanging out and this affects major organs

A

Hyperglycemia

109
Q

Film dressing

A

Small superficial wounds, non absorbant, iv sites , stitches

110
Q

Alginate dressing

A

Made from fibers that turn into gel when it comes into contact with wound exudate, for moderate to heavily exuding wounds, pressure ulcers,venous ulcers, post op wounds

111
Q

Hydrofiber dressing

A

Turns into gel when comes into contact with wound exudate. Absorbs more fluid, pressure ulcers, diabetic foot ulcers, venous ulcers

112
Q

Foam dressing

A

Soft, absorbent, moderate to heavy exudate pressure ulcers, burns

113
Q

When bones have become thinner weaker as a result from prolonged bed rest

A

Disuse osteoporosis

114
Q

Decrease in blood pressure upon standing , dizziness

A

Orthostatic hypotension

115
Q

Acts as physical barrier blocking pathogens from invading the body, moist, inner-lining nose, mouth , lungs, and stomach

A

Mucous membranes

116
Q

Medications commonly prescribed for the relief of pain have risk of sedation and respiratory depression

A

opioids

117
Q

Used along with other medication help make pain relief move effective, like antidepressants

A

Adjuvant analgesics

118
Q

phase where the body responds to the injury by sending blood cells and proteins to the area to control bleeding and prevent infection

A

Inflammatory phase

119
Q

New tissue growth occurs as fibroblasts produce collagen to fill the wound and blood vessels form to supply nutrients

A

Proliferative phase

120
Q

Collagen fibers model and strengthen, and the wound gradually closes as the tissue matures

A

Maturation phase

121
Q

Vitamin C enhances?

A

Iron

122
Q

Inflammation of vein, caused by irritation from the IV catheter. Signs include redness warmth, pain, palpable cord along the vein

A

Phlebitis

Nursing (4 decks)

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