Test 1 Flashcards
What is the safest and easiest route for medications
Oral
With a swish and spit what does the patient not do
Swallow
What position should a patient be in when taking pills
Semi fowler so or side lying
What pills should you never crush
Enteric coated or time released
What does enteric coated mean
Thick coating makes it so a pill does not dissolve in your stomach but it dissolves in your bowel. Could cause ulcers or GI bleeding if not enteric coated
What should you do when giving medication to skin
Wear gloves because you do not want to absorb medication through your skin
Drops flow from _______ to __________
Inner to outer
Away from tear duct
How long should you press and hold on tear duct after giving a eye med? Why do you do this?
30 to 60 seconds do this so medicine doesn’t get into tear duct
Where do you place an eye med?
Not here _______?
Place in conjunctival sac not on cornea
How should you pull ear for a child under 2?
Anybody over 2?
2 and under- down and back
2 and over- up and back
What is important to do when giving a ear drop
Warm to at least room temperature because ears are sensitive to temperature
Once you give ear drop how long should person remain on side
2-3 minutes
When giving a nose medicine what does patient need to do
Inhale through nose as medicine enters
How should a vaginal medication be given
Supine position with knees bent insert 3-4 inches, remain on back at least 10 min, best if done overnight
How do you give a rectal medication
Side lying position, insert 4 inches, remain flat at least 5 minutes
You are about to give a rectal med why do you carry it in a cup
To prevent melting
What should be your needle selection for the arm
1”
What should be your needle selection for major muscles and average length
1 1/2 “
To take off the cap what should you do
Rock away with thumbs
What is the #1 spot for an intramuscular injection?
VG (ventrogluteal)
-side of hip, large muscle, free of major nerves
For children under 2 what is the only intramuscular site used for injections
Vastus lateralis (VL) Middle 1/3 of muscle between the trochanter and knee "Between pleat and seam"
What are the disadvantages to Vastus Lateralis (VL)
Hurts if person is athletic
Patient looks at you as you give it
What is the least preferred site for general injections,but required for most vaccinations
Deltoid site
Where should you give an injection in the arm
Center of the deltoid muscle
Where should you not give an injection? Why?
Dorsogluteal
High risk for sciatic nerve damage
When? Why? How?
Z-track injections
When? When medicine would burn or stain the skin
Why? To lock into the muscle
How? Stretch skin, give it, come out, let go
What does aspiration mean
Pulling back on the plunger
Why do you aspirate
Checking to see the tip of the needle is in a vein
What do you tell patient if syringe turns bright red
I wasn’t able to give you your med and when patient ask why say as nurses we pull back syringe and it was in vein so I pulled it back to protect you
What is difference between tier 1 and tier 2
Tier 1 is used for everybody and only certain people get tier 2
What do standard precautions include? What is not included?
Includes blood and body fluids and sweat and tears are not included
What must patient with contact isolation have?
Private room
Nurse wears a cover gown and gloves when in room
What is droplet isolation?
Focuses on diseases transmitted by large droplets that are expelled 3-6 feet
Standard precautions if nurse within 3 feet
Examples: flu, pneumonia, mumps
Must have private room
If you sneeze it goes ____ to _____ feet
3-5 feet
What are airborne precautions
Diseases that are transmitted by smaller droplets that remain in the air for longer periods of time
Examples: TB, measles, chicken pox
Private negative pressure rooms required
What is a negative pressure room
Room is like a vacuum , air flows into room but can’t flow out
What is protective (reverse) isolation
Focuses on protecting patients who are immuno compromised from coming in contact with our germs
Ex: HIV, neutropenic cancer patients
Private positive pressure
What does a positive pressure room mean
When you open door air can come out but can’t come in
What order do you put on PPE
Gown
Mask
Eye protection
Gloves
How do you protect a patients safety before giving care
Need 2 patient identifiers and check allergies
How long do you do routine hand washing?
Contaminated hand washing?
Routine- 15 seconds
Contaminated- 1 full minute
After how many hand gels must you wash hands
4
Is it ok to write 3.0 ml ?
No. No trail zeros after a whole number
You should just write 3 ml
Legal guidelines for defining nursing practice and identifying the minimum acceptance of nursing care
Standards of care
Who sets the standards if care?
Every state
Nurse who does not meet appropriate standards of care can be held liable for …
Negligence
Commitment to include client in decisions
Autonomy
Taking positive actions to help others
Beneficence
Avoidance of harm or hurt
Nonmaleficence
Being fair, taking care of clients in the order they should be cared for
Justice
Agreement to keep promises
Fidelity
aspect of reality that people consciously sense or experience. In nursing, this includes caring, self-care, and client response to stress.
Phenomenon
can be simple or complex. They can related to an object or an event as a result of individual experiences. They are ideals. They are mental images.
Concept
Communicate the general meaning of a concept. Describe the activity necessary to measure concepts.
Definitions
Are taken for granted statements that explain the nature of the concepts, definitions, purpose, relationships and structure of a theory.
Assumptions
Are broad in scope, complex, and require specification through research. Does not provide guidelines for specific nursing interventions but provides the structural framework for broad and abstract ideas related to nursing.
Grand theories
More limited in scope and less abstract
They address a specific phenomenon and reflect practices of administration, clinical interventions, or teaching.
These types of theories cross different nursing fields and reflect a wide variety of nursing care situations such as uncertainty, incontinence, social support, quality of life, and caring.
Middle-ranged theories
The first level of theory development.
They describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena.
These theories do not direct specific nursing activities but help to explain client assumptions.
Descriptive theories
Address nursing interventions for a phenomenon and predict the consequence of a specific nursing intervention.
In nursing, this type of theory designates the nursing intervention, the condition under which the nursing intervention occurs, and the consequences of the intervention.
These theories guide nursing research to develop and test specific nursing interventions.
Prescriptive theories
the study of phenomena that are difficult to quantify or categorize. The information obtained is from written transcripts or interviews
Qualitative research
The three most common types of qualitative research are :
1) Ethnographic
2) Phenomenological
3) Grounded theory.
approaches offer precise measurement. Acceptable types of research
1) Historical
2) Exploratory
3) Evaluative
4) Descriptive
5) Experimental
6) Correlational.
Quantitative research
What does PICOT stand for
Patient population Intervention Comparison Outcomes Time period
Five steps to evidence-based practice
- Ask the clinical question
- Collect the best evidence
- Critique the evidence
- Integrate the evidence
- Evaluate the practice decision or change
The most reliable and objective means of acquiring and conducting research
Scientific method
What are the 4 components of evidence-based practice
- Evidence from research, evidence-based theories, clinical experts , and opinion leaders
- Evidence from assessment of clients history and physical and available health care resources
- Clinical expertise
- Information about client preferences and values
Explain a phenomenon
Theory
What do nursing theories provide nurses with
- Perspective to view clients situations
- A way to organize data
- A method to analyze and interpret information
3 components of a theory
Concepts
Definitions
Assumptions or propositions
What are the 5 C’s
Compassion Competence Confidence Conscience Commitment
Leininger
All cultures being aware of different cultures boundaries
Transcultural caring
Watson
Being a person
Transpersonal caring
Swanson
You take the things that will help the patient become well and also have knowledge about patient, QSEN
Nurturing care
What is QSEN
Quality and safety education for nurses
Keeping patient safe enabling a patient to gain knowledge. Maintaining a belief and working with their belief system
The nurse doesn’t look at the patient as CHF in 205 , the nurse looks as them as a whole. What theory of caring is this?
Transpersonal caring
Watson
What is something the nurse could do to give the patient some control
Give patient choices
What does comorbidities mean
More or more disease that are occurring with the primary disease
Nursing process paper can also be called what
Care plan
What is adequate urine output per hour
30 ml/hour
A statement that describes the clients actual or potential response to a health problem that the nurse can treat
Nursing diagnosis
aeb
As evidenced by
Common language for understanding the clients need
NANDA
Goals must be __________
Measurable
What can physicians and advanced practice nurses do
Prescribe meds
What does a standing order mean
Carried out until cancelled by the physician
PRN orders
Means give as needed
STAT order
Immediate, emergency
Now order
Within 90 minutes; very important
If a nurse takes a verbal order what needs to be done
Nurse writes order and reads it back to physican, must be signed within 24 hours by physician
What should you do if you get a order and it is not complete
Not give it. All components must be present
Patients full name and ID number, date and time when written, medication name, medication dose, route of administration, frequency, specific instructions, signature
Six rights
Right patient Right route Right time Right medication Right dose Right documentation
When are medications discontinued
After surgery, transfer to another unit, or discharge from hospital
Must have a new order to continue!
How many time should you check label
3
When taking from drawer
During preparation
Before returning to drawer or throwing package away at bedside
What does “on time” mean
Within 90 minutes of scheduled time
Can a patient refuse a medication
Yes!
Nurse determines reason, tries to facilitate taking med, document and inform appropriate person
Should you put in chart you filled a incident report?
NEVER!
You should just file the report within 24 hours
Chemical or official name
Generic name
Brand- manufacturer choices
Trade name
What is Islets of Langerhans
Hormone secreting portion of the pancreas
What converts glycogen to glucose
Glucagon
Primary regulator of metabolism and storage carbohydrate, fats, proteins
Insulin
Responds to low level of blood glucose; protein indigestion; exercise
Glucagon
What is secreted in conjunction of insulin in response to food intake
Amylin
What is normal blood glucose
70-110 mg/dl
What does insulin do
Takes glucose out of blood and into a cell
What are 3 stimulus for release of insulin
High blood glucose
Vagal stimulation
Increased amino acid levels
What does blood glucose do during exercise
Decreases
What is hypokalemia
Low potassium in the blood
Won’t want insulin made because insulin will pull potassium back into the cell.
Why are we concerned about a low hypokalemia?
Hypokalemia- potassium in the blood
Concerned because we can start getting dysrhythmias
What are counter regulatory hormones
Oppose the effect of insulin
Are sugar cells big or small
Big
What is ketosis
Body begins to metabolize fats-ketones
What is it called when hydrogen ions replace sodium
Acidosis
What are the 3 Ps
Polyuria
Polydipsia
Polyphagia
What is BUN ?
What does it have to deal with?
What’s normal?
Blood urea nitrogen
Has to do with kidney function
7 to 20 mg/dL
What does the lack of insulin have on protein
Increased protein breakdown
Increased amino acids
Increased BUN
Increased phosphate and sodium LOSS
What does lack of insulin have on fats
Increased fat breakdown
Hyperlipidemia
Increased ketones
Ketonuria
What are the symptoms of prediabetes
Usually NO symptoms
What is fasting glucose range for prediabetes
100-125 mg/dl
What are the 3 preventive measures for prediabetes
Diet
Exercise
Weight control
How do you increase your HDL
Exercise
What are the components of metabolic syndrome
Waist circumstance greater than ____ in women and _____ in men
Triglycerides greater than ______ mg/dl or ___________
HDL less than _____ mg/dl in women and _____ mg/dl in men
BP greater than ______ mm/Hg diastolic or ______ mm/Hg systolic
Fasting glucose greater than ______ mg/dl or ___________
UNDERLYING FACTOR=_________________
Waist circumstance greater than 35 inches in women and 40 inches in men
Triglycerides greater than 150 mg/dl or taking drug to treat
HDL less than 40 mg/dl in women and 50 mg/dl in men
BP greater than 130 mm/Hg diastolic or 85 mm/Hg systolic
Fasting glucose greater than 110 mg/dl or taking drug to treat
UNDERLYING FACTOR=insulin resistance
What is diabetes?
Inability of body to use insulin or inability of body to produce insulin
Characteristics of Type 1 diabetes
Not making insulin Onset when less than 30 Long preclinical period with sudden onset Autoimmune process that destroys B-cells Always treat with insulin Also treat with diet and exercise
Characteristics of type 2 diabetes
Body making some insulin
Slow onset- vague symptoms
Affected by obesity
Treat with diet, exercise, oral agents, sometimes with insulin
Usually complications start happening before patient even knows they are diabetic
Annual cost of diabetes ________
Total prevalence __________
174 billion dollars
23.6 million adults and children
What is a normal Anion gap?
What does it mean if it is above normal?
Normal between 1-17
If greater than 17 means DKA
What is Kussmaul respiration
Rapid, deep breathing
Trying to blow off acidity
What are clinical manifestations of DKA
Dehydration, tachycardia, orthostatic hypotension(depleted blood volume), abdominal pain-anorexia, Kussmaul respirations, acetone breath
pH less than 7.3, bicarb less than 15 mEq/L, + ketones in urine and blood
What is HbgA1C
Looks at blood glucose over past 3 months
What is diabetic ketoacidosis
Profound lack of insulin leading to profound hyperglycemia
-ketosis, acidosis, dehydration
Generally caused by something else (stress,illness, infection, etc)
What does blood sugar do with infection
Increases
Why are IV fluids a treatment of diabetes at times
Glucose are large molecules in the blood that pull water and sodium from cells
How long does a patient need to fast for a fasting blood glucose
4-6 hours
How to diagnose diabetes
Fasting blood glucose greater than 126 mg/dL
Random BS > 200
3 P’s
Unexpected weight loss- body can’t use what you are taking in
Other test to diagnosis diabetes
Oral glucose tolerance test =
HbgA1C=
Oral glucose tolerance test where glucose of 200 mg/dl 2 hours after 75 gram glucose overload
HbgA1C greater than 6.5%
What is HHNS
Symptoms?
Treatment?
Hyperosmolar hyperglycemic nonketotic syndrome
Sx: Hyperglycemia greater than 400
Osmotic dieresis greater than 330
Extracellular fluid depletion- severe dehydration
No acetone
Tx:FLUIDS and insulin
What is the best way to know what is going on with diabetic patient?
Check blood glucose!
What is hypoglycemia?
Symptoms?
What happens if not treated?
Imbalance of food-insulin
Sx: HA, headache, dizziness, restlessness, cool-clammy skin, diaphoresis
If not treated can lead to cerebral hypoxia and death
What is hypoglycemia treatment
If alert?
If unresponsive or unable to swallow?
Alert- 10-15 grams simple carbohydrate
4 oz OJ, 8 oz whole milk, crackers
If unresponsive or unable to swallow-
- glucagon injection
- 50% dextrose IVP ( 10-30% in children)
Which type is a large vessel disease ?
What are causes?
Type 2
Increased incidence of arteriosclerosis
Causes cardiac, peripheral vascular, and cerebrovascular disease
What type of diabetes is a small vessel disease?
Complications?
Type 1 and type 2
Retinopathy, neuropathy, renal failure
What should you feel for around the heel of a diabetic patient
Mushy if you feel if get pressure off
How long does it take a diabetic foot ulcer to start
Within 1 day if not checked
This is why you should look at a diabetics feet everyday without socks
What is OPA
Onset
Peak
Action
What is MOA
Mechanism of action
Different ways they work on your body
Can you take insulin orally
No, not effective
What should you look at when thinking about giving someone a insulin pump
Are the cognitively able
Best place for a insulin injection
In abdomen because best absorption
What does blood glucose do when body is under stress
Increases
Two types of diabetic neuropathy and what falls in each
Sensory
- sensory loss in extremity
- paresthesia
- ulceration
Autonomic
- GI motility changes (food just sits in stomach which causes abdominal pain )
- neurogenic bladder, incontinence, UTI
- silent MI
- inability to perceive low blood sugars
What are the cultural variations that should be considered in order to be culturally competent
Health care
Birth
Death
Other life experiences
The use of information technology a communication and gathering tool that supports clinical decision making and scientifically based nursing practice
Informatics
Three domains of learning
Cognitive
-knowledge, comprehension, application, analysis, synthesis, evaluation
Affective
-expression of learning by role play or group discussions
Psychomotor
-acquisition of new skills , viewing a demonstration or practicing new skills
What domain of leaning are you using when practicing giving an injection?
Psychomotor
What are three appropriate sources for an evidenced based care plan?
CINAHL, MedlinePlus, OVID
Source of body’s insulin
pancreatic B cells
Within how many years will somebody with prediabetes develop type 2 diabetes if no preventive measures are taken
10 years
How is insulin most commonly given
Subcutaneous injection
What type route of insulin should be used if immediate onset action is desired
IV of regular insulin
What may occur if the same injection site is used frequently
Lipodystrophy
What May increased morning glucose levels be due to
Somogyi effect
This is a rebound caused by hypoglycemia during the night that stimulates a counter regulatory response
What is caused by hyperglycemia that is present on awakening in the morning
Dawn phenomenon
Counter regulatory hormones are released in the predawn hours
Rapid acting insulin Names Starts: Peaks: Lowers: Finishes:
Humalog/Novolog
Starts: 5-15 mins (huma) , 10-20 (novo)
Peaks: 45-60 min (huma), 60-90 (novo)
Lowers: blood glucose most in 45-90 min (huma) , 1-3 hours (novo)
Finishes: 3-4 hours (huma), 3-5 hours (novo)
Short acting insulin Name Starts: Peaks: Lowers: Finishes:
Regular Starts: 30 mins Peaks: about 2 hours Lowers:blood glucose about 2-5 hours Finishes: 3-5 hours
Intermediate acting insulin
Lente
Starts:
Peaks:
Lowers:
Finishes:
Starts: 1-3 hours
Peaks: about 4-6 hours
Lowers: blood glucose most 6-12 hours
Finishes: 16-24 hours
Intermediate acting insulin
NPH
Starts:
Peaks:
Lowers:
Finishes:
Starts: 1-3 hours
Peaks: about 4-6 hours
Lowers: blood glucose most 6-12 hours
Finishes: 12-16 hours
Long acting insulin
Names
Starts:
Peaks:
Lowers:
Finishes:
Lantus/Levemir Starts: 1-2 hours Peaks: no peaks Lowers: blood glucose evenly 24 hours Finishes: 24 hours
How does a subcutaneous injection absorb
Slowly
How is a subcutaneous injection given
Above muscle layer in fatty tissue
Average adult: 90* angle, 5/8 “ needle
Thin adult: 45* angle, 5/8 “ needle
Heavy adult: 90* angle, 1” needle
General subq injection
What should you remember?
Isolate fat layer
90* angle
NO ASPIRATION- very few blood vessels not necessary
NO MASSAGE- want to be absorbed slowly
What is Heparin subq injection
Site?
Only place?
Anticoagulant
LOWER ABDOMEN
can be given somewhere else of needed
NO aspiration, NO massage
Why do you pick the lower abdomen as the site for Heparin?
Vulnerable to bleed in area you inject so that is why you pick lower abdomen because it is protected
What is Lovenox injection?
Subq injection
Anticoagulant
Special syringes prefilled and air bubble not removed
What must you do before and after meal before giving insulin
Check blood glucose
Should you orate areas each time for an insulin injection?
No
You should stay in same site area and rotate within until you’ve used all the area and then you should rotate site
What is the lower abdomen reserved for
Heparin
How is a insulin syringe marked
Units not ml
Should you aspirate and massage within insulin injection?
No you want it to be absorbed slowly
Order for mixing insulins
Air in modified
Air in regular
Draw back regular
Draw back modified
What must be done after mixing insulin
Another RN must check!
Regular insulin=
Modified insulin=
Regular insulin= clear
Modified insulin= cloudy ( must rotate in hand to mix)
What is sliding scale
Extra shot of insulin given when blood sugar increases unexpectedly
** only use Regular insulin
What should you remember about a insulin pen
Mix and rotate it several times
What is a Intradermal injection (ID)
Use Tuberculin (1ml) syringe 15* angle Bevel up Insert until bevel can't be seen Slow injection Create a wheal No massage! TB test is an example
What are ampules
Glass
Protect fingers when breaking with alcohol pad
Draw up with FILTER NEEDLE
then attach injection needle
To waste part of a narcotics dose what must you do
You have to be seen doing it
Find another RN to sign off with you
What should you check with PRN meds
Check when last dose was given
Check frequency allowed
Record on medication record
In nurses notes record:
- why did you give it
- what was patients response
If you stick yourself with a used needle in clinical what should you do
Wash area immediately
Report immediately to you clinical faculty person
Fill out agency incident repot immediately
Fill out Nursing Dept incident report within 24 hours
What is treatment of HHNS
Fluids, fluids, fluids, and insulin
AC
Before meals
HC
Before bedtime
PMH
Past medical history
PES
Problem
-Actual or potential
Etiology
Signs and symptoms (if patient has signs and symptoms then it is a ACTUAL problem
Does DKA occur with type 1 or type 2
Type 1
HHNS occurs most often with somebody with …
Type 2
What is the major difference between DKA and HHNS?
Ketosis and acidosis do not occur with HHNS, enough insulin is present with HHNS to prevent the breakdown of fats for energy, which prevents ketosis
Normal AMGs pH= PaO2= PaCO2 HCO3=
Normal AMGs pH= 7.35-7.45 PaO2= 80-100 PaCO2= 35-45 HCO3= 22-26
What are 2 anticoagulant SC injections
Heparin and Lovenox
What type of insulin do you give when blood sugar rises unexpectedly
Regular
The 3 Ps are classic symptoms of what
Hyperglycemia
What is the tx choice way or giving regular insulin to treat DKA
IV route
When should pt on insulin be instructed to avoid exercise when ? Why?
Peak insulin time because that is when hypoglycemic reaction is likely to occur
What is the honeymoon period of type 1 DM
Insulin works real well at first but then you may need more insulin over time
What oral hypoglycemic agent stimulates the release of insulin
Sulfonylureas
In which theory would QSEN fall under
Nurturing care
Swanson
A civil wrong made against a person or property is known as
Tort
Which type of theory addresses nursing interventions for the phenomenon
Prescriptive
How does dehydration lead to tachycardia
The heart has to work harder to circulate blood
Insulin can not be given what way
Orally
Hoyle meal times be adjusted based on glucose levels?
No they should be at the same time each day
Shakiness, palpations, and lightheadedness are signs of _______? Indicate_______?
Signs of hypoglycemia and indicate need for food or glucose
Polyuria, blurred vision, and fruity breath odorants are signs of ________
DKA
Best known standards of care come from the ______
ANA
