Test 1 Flashcards
What is the nursing metaparadigm?
What is the 4 nursing metaparadigms?
A relationship between 4 main theories of nursing.
PHEN
1. Person (patient)
2. Health (patients health)
3. Environment (patients environment)
4. Nursing - nurse providing care
What is health?
What is wellness?
What is well-being?
What is disease?
What is illness?
Health - overall condition
Wellness - lifestyle choices for health, diet, exercise (subjective)
Well-being- how good you feel about your health
Disease - objective scientifically in “physical”
Illness - subjective experience of mental, emotional, physical illness
What are some different ways people conceptualize health?
-Absence of disease
-Good health is natural
-A resource for living, not the object of living
What are the 3 major historical approaches to health in Canada?
- Medical - medical intervention 1970s
- Behavioural - lifestyle 1970s-1980s
- Socio-environmental - social and physical environment 1980s-present
What are 3 key documents to Canadian health?
-Ottawa charter - health is a human right (socioeconomic approach)
-Population health promotion (actions improving populations health)
-Toronto charter (social determinants of health)
What is the truth and reconciliation commission of Canada call to action document?
What does it ask for in terms of health?
A document to reduce harm done to natives.
It asks for:
-healing centres for natives
-natives in healthcare jobs
-Medical students take courses on aboriginal issues
How are indigenous health beliefs like Eurocentric views?
Indigenous believe wheel of spiritual, mental, emotional and physical aspects
-balance needed for healing
Eurocentric is social and environmental health
What are the key health determinants?
What are some social determinants of health?
Social
Economic
Environment
Income
Social support network
Physical environment
Biology and genetics
Education
Healthy childhood
Gender
Culture
Social environment
Employment
Health services
Healthy lifestyle
What is health promotion?
What is disease prevention?
Health promotion - broad social change, long term, reduce overall risk
Disease prevention- specific efforts to avoid or delay disease, immediate and long term, individual needs
What is primary health care (PHC)?
What are the 4 pillars of primary health care?
-canadas health care system rooted in social justice
-health promotion and disease prevention
- Teams
- Access
- Information
- Healthy living
What is the Canada health act?
Canadian healthcare system (publicly funded health care for all citizens)
What is family, family nursing, family centred care and family forms?
Family- connected by blood
Family nursing - healthcare for the whole family
Family centred care - healthcare that respects and involves the entire family
Family forms - blended, nuclear, single parent families
What are the 4 nurse theorist concepts of health?
Nightingale - clean environment
Roy - adapting to changing environments
Watson - mind body spirit universe connection
Leininger- health is culture
What does a nurses “ways of knowing” mean?
What are some ways of knowing?
The way they know what they know: nurses know more than just science
Empirical science (research)
Aesthetic knowing (the art of knowing)
Ethics
Personal experience
Critical thinking
Sociopolitical knowledge
What are the phases of the helping relationship?
- Preorientation - get ready for patient
- Orientation - introduction, consent, goals
- Working - work with the patient
- Termination - discharge plans, summarize goals
What is an illness narrative?
Patients personal experience of their illness
What is critical thinking?
the objective analysis and evaluation of an issue in order to form a judgment.
What is the relationship between primary health care and community health nursing?
Primary healthcare is basic healthcare that provides to everyone things like vaccines, treat illnesses, etc.
Community health nursing helps a specific group in a community stay healthy and promote specific health practices for this group.
What is intraprofessional practice?
What is interprofessional practice?
Intraprofessional - inside nursing (RPNs and RNs)
Interprofessional - between different professions ex: physio, nurse, doctor
What is the expectation for nurses working with unregulated care providers (UCPs)?
To supervise and delegate tasks to them
What are the levels of critical thinking?
-Level 1: basic thinking – checklist, policy, concrete
-Level 2: Complex – analyze and examine choices independently
-Level 3: Commitment – choosing an action or belief
What is the nursing process?
ADPIE
A continuous loop
- Assess – gather info about the patient (creating a database, systematic, subjective and objective data)
- Diagnose – identify patient problems
- Plan – set goals of care
- Implement – perform nursing actions
- Evaluate – determine if goals helped the client
What is evidence informed knowledge?
What are clinical decision making processes?
How do these relate to critical thinking?
knowledge from research or experience
Uses the knowledge to make decisions for the patient
Critical thinking ties them together by ensuring patient has best care from research or experience
What are some different sources of data a nurse can use when assessing a patient ? (3)
True or false: these data sources must be objective
-Primary (patient)
-Secondary sources (family, lab report),
-Tertiary (literature, nurses experience)
FALSE - They can be:
1. objective
2. subjective
3. data sources (tests)
How can you collect data from a patient? (3)
- Ask them (interview)
- Seeing them (observation)
- Examine them (examination)
Why do we validate data before starting a nursing care plan?
to avoid making incorrect inferences about the patient
why do nurses do a physical assessment of the patient?
What four skills can they use on the patient?
To develop a care plan
- Inspection (seeing and hearing body)
- Palpitation (touching)
- Percussion - (tapping for sound)
- Auscultation - (listening to body sounds)
When do nurses diagnose in the nursing process?
after validating the data from step 1 (assessment)
What is a data cue from the patient?
What is a data inference?
Data clusters?
Data patterns?
information obtained from the 5 senses
Ones judgement or interpretation of those cues
A bunch of related data cues pointing towards a problem
Patterns are reoccuring trends
Discuss the correlation between critical thinking and the nursing diagnostic process.
critical thinking helps nurses gather the right information, figure out what’s really going on, and choose the best solution for the patient’s problem.
what is a nursing diagnosis?
what is a medical diagnosis?
what is a collaborative problem?
Nusing diagnosis - patients experieince or response to a treatment
Medical diagnosis - identifies a disease
Collaborative problem - issue that requires both nursing and medical interventions (e.g., managing blood sugar for diabetes).
What are the four types of nursing diagnosis according to NANDA?
1.actual diagnoses
2. risk diagnoses
3. health promotion diagnoses (lifestyle changes)
4. wellness diagnoses (enhance wellness like coping with cancer survivorship)
What are the benefits of using NANDA international nursing diagnosis in practice?
-uses universal language
-universal diagnosis
-encourages evidence based practice
-
What are some errors that might occur in the nursing diagnosis?
-assumptions
-misunderstanding patterns
-incomplete information from patient
What is the planning step of the nursing process?
When do we plan? (3)
Create a plan to address the patients issues
-initial
-on going
-discharge
What is a standard care plans?
What are individual care plans?
What is an informal care plan and what is a formal care plan?
What are instituitional care plans?
Standard care plans are general guidelines for common conditions
Individual care plans are tailored to meet the specific needs of a patient
Informal care plans are nurses “thinking on their feet” and formal is the written plan used by all nurses
Institutional care plans are part of patients legal record
What is the difference between client short term and long term goals?
short term goals are acheived quickly and long term goals take more time. All goals should be SMART goals.
What are SMART goals?
Specific
Measurable
Achievable
Realistic
Timeframe
What is the implementation step of the nursing process?
-actions that the nurse will do to
-puts the nursing care plan into action
-targets clients outcomes
-supported by nursing diagnosis, research, best practices etc.
What is a nursing intervention?
Anything that enhances patient outcomes
What are independent interventions?
What are dependent interventions?
What are collaborative interventions?
How do we know which intervention is needed?
Independent interventions are actions nurses can take on their own (e.g., teaching).
Dependent interventions - directions from a doctor (e.g., administering medication).
Collaborative interventions involve working with other healthcare professionals.
Depends on the patients needs
What kind of nursing intervention is standard practice guidelines/protocols?
What kind of nursing intervention is a medical directive/ standing order?
evidence-based recommendations
medical directives/standing orders outline specific actions to take in certain situations
Describe and compare direct and indirect nursing care activities.
Direct care - direct actions with patient (e.g., administering medication),
Indirect care - performed away from the patient (e.g., documentation)
What is the goal of the nurse when educating patients on their health?
To empower them to manage their health effectively
Define the evaluation step of the nursing process.
This step assesses whether the patient has met their goals and determines if the care plan needs to be modified or end.
Should you involve the client when establishing priorities of care?
Yes because it ensures that their preferences, values, and goals are respected.
What are high, intermediate, and low priorities of care?
High priority: Life-threatening issues (e.g., respiratory distress).
Intermediate priority: Health threatening non emergency (e.g., dressing changes, mobility assistance).
Low priority: needs that can be addressed later (e.g., teaching about lifestyle changes).
What is the purpose of a health care record?
Tracks patient care, communicates between team members, supports legal/insurance needs, and improves care.
What is growth?
What is development?
Growth: Physical changes, measurable, quantitative (e.g., height, weight), social determinants.
Development: Learning skills, emotions, behaviors, difficult to measure.
Describe major factors that influence growth and development with implications
(1) genetic, hereditary, temperment (disposition)
(2) the environment in which the person lives (family, nutrition, rest, exercise)
(3) the interaction that takes place between these two groups of factors
what are the 5 traditional ways of thinking about how we develop?
-Organicism - biology
-Psychoanalytic and Psychosocial - development personality, thinking, behaviour, and emotions
-Mechanistic Tradition - organism is machine
-Contextualism - social context (we are adapting to social setting)
-Dialecticism -all theories are interacting together
What are the four developmental theories related to lifespan development ( Freud, Piaget, Kohlberg and Erikson)?
Piaget - cognitive environment
Kohlberg - morals
Sigmund freud - psychosexual
Erikson - psychosocial conflict
Give an example of mental and social well-being.
Mental: meditation, positive outlook, mindfullness.
Social: support network, healthy relationships, volunteering.
The Ottawa Charter points out what 5 ways to improve health promotion?
Policies
Environment
Community Action
Personal Skills
Health Services
What are the different types of health care settings in Canada? (3)
Provide examples of each delivery
setting.
Institutional facilities.
Example: Hospitals, nursing homes, rehab centers.
Community Services
Example: Public health clinics, home care, mental health support.
Private Sector – For-profit healthcare services.
Example: Private clinics, dental offices, physiotherapy.
What are the 5 levels of healthcare?
- Promotive (healthy policies)
- Preventative (vaccines)
- Diagnosis and treatment (primary, secondary, tertiary)
- Rehabilitation
- Supportive (chronic long term)
What is acute illness?
What is chronic illness?
Acute: short term illness (appear quickly and subside quickly)
Chronic illness: long term illness (6 months, disapearing and reappearing symptoms)
How does the World Health Organization (WHO, 1947) define health?
What did they update it too?
physical, mental, & social well-being
change or cope with the environment. Health a resource for everyday life.
What is the chain of infection? (6)
Agent (germs)
Reservioir (where germs live)
Portal of exit
Mode of transmission (germs getting around)
Portal of entry
host
What is vehicle born transmission?
What is vector born transmission?
Eating food not cooked properly
Being bitten by a mosquito
When should you wash hands?
When should you sanitize hands?
Wash hands when their dirty, sweaty, after bathroom
Sanitize hands when hands don’t look dirty but cleanliness is important
What is asepsis?
When there are no disease microorganisms around (clean environment)
What is the difference between sterile and aseptic?
Sterile - 100% germ free
Aseptic - minimize germs as much as possible
When would you use a N95 instead of a regular mask?
To protect against airborne infections
At what body sites do we measure temperature? (6)
Temple
Ear
Mouth
Armpit
Rectum
Skin
What is the normal temperature range?
Above what temperature is considered fever?
At different body sites how would the temperature range?
36-37 C
38C
By 1C
What are some other names for fever?
Hyperthermia, febrile, and pyrexia
What is hypothermia?
Lowered body temperature (usually from the environment)
What are the pulse sites? (7)
Temporal (temple)
Carotid (neck)
Radial (wrist)
Brachial (elbow)
Femoral (groin)
Popliteal (behind the knee)
Dorsalis pedis (top of foot)
Which pulse site is mostly used?
Why?
Neck (carotid)
Because it’s close to the heart
What is the acceptable pulse range for adults?
60/100 beats per minute
What is hypovolemia?
Fluid loss in the body
What is apical rate?
A pulse on your left side that is like listening directly to the heart
What is the scale used to assess pulse strength?
1 - weak
2 - normal
3 - strong
4 - bounding
How is pulse rhythm described?
Regular or irregular
What is ROM?
What is active and passive ROM?
Range of motion - how can the joints move in different directions
Active - patient is doing the work
Passive - assisting the patient
Why should you be careful to reduce friction when repositioning a patient?
Skin damage from friction
What is the trendelenburg position?
When feet are higher then head
What does logrolling a client mean?
How many people should be involved?
Turning the patient like a log (keeping them aligned)
3 or 4
What are the 7 common body positions used in patient care?
Fowlers (45-60 degrees)
High Fowlers (90 degrees)
Supine (straight on back)
Prone (on stomach)
Lateral (side lying)
Sims (frog sleeping position)
Orthopneic (pillows on table in front)
What position should patient be before you help them sit on the side of bed?
Supine position (lying flat on their back)
Or
Lateral (side lying)
How many people are needed to transfer a patient from bed to a stretcher?
2 - one for upper body and 1 for lower body
How often do you reposition a patient in a wheel chair?
How often do you reposition a patient in a bed?
15 mins
2 hours max
What is orthostatic hypotension?
What can help prevent it?
When blood pressure drops from suddenly standing up
Sitting up slowly
Dangling feet over edge of bed
Hydration
Assist them in standing
Which side should a person hold a cane?
Strong leg side
How should you measure crutches?
1 or 2 inches below armpit and handgrips at wrist level
What is the difference between a patient transfer and a lift?
Transfer is when patient can bear weight on at least 1 leg
Lift they cannot on both legs
What are the 2 types of breathing?
Quiet (unconscious)
Forced (conscious)
What is an acceptable respiratory rate in adults?
12 to 20 breaths per minute
What are the different respiratory rates across the lifespan?
Babies breath the fastest (40-60 bpm)
Adults 12-20 bpm
Old breath the slowest
What are the 4 evaluations we look at when monitoring respirations?
What do you look at to assess it?
What do you use to assess it?
Rhythm
Rate
Effort
Depth
Their chest
A watch and stethoscope
What is the range for oxygenation saturation in a healthy person?
What might interfere with the reading?
What is the device reader called?
Where is it clipped?
95-100%
Nail polish, cold hands, etc.
Pulse oximeter
Finger, ear, or toe
