test Flashcards
Who were the first to study the causes of disease?
Greeks
who developed a high degree of sanitation and personal hygiene?
Romans
What is a Deaconess?
women who cared for the sick and homeless
who is florence nightingale
changed form and direction of nursing
set standards for nursing education
made a respected occupation for women
what significant recommendations did florence nightingale help with?
hospital management
health and illness (maintaining health or helping when pt is sick)
nursing as separate from medicine
What did florence nightingale observed that helped pt success when it comes to care?
noise, colors, light, music, nutrition
Mary Breckenridge
Started one of the first nurse midwife schools
What is the required educational level for a nurse practitioner?
Masters
In all practices of nursing, what do you HAVE to do other than school?
Take board exams and keep up with CEU’s to stay up to date with practice.
How many hours do RNs need of continuing education every two years?
30 hours every 2 years
Female Chromosomes
XX
Male chromosomes
XY
What is your sex?
What you were born with
what is a gender that is an example of Gender diversity
non bionary
Gender dysphoria
when there is stress or disorder (mental disorder) about their assigned gender at birth
Cisgender
gender roles that match societys expectations
Genderfluid
gender expression (today im a male, tomorrow im a female)
Transgender
sex assigned at birth but it doesnt decide who you are. Can take medication that can pause or stop puberty and change genders
Homosexual is a outdated term, what is the new term
Gay, bisexual, asexual, questioning (unsure of orientation)
what are ways sexual expression and sexuality can be expressed
masturbation, sexual intercourse, abstinence
all types of sexual intercourse
vaginal, anal, oral-genital
what are factors affecting sexuality
intellectual developmental disabilities, culture, religion, ethics, lifestyle
What are the phases of sexual response cycle?
excitement, plateau, orgasm, resolution
What is the excitement cycle?
foreplay
What is the plateau cycle?
increasing tension
What is the orgasm cycle?
involuntary climax and release of sexual tension
What is the resolution cycle?
person returns to non-aroused state
what are alternative form of sexual expression and sexuality
pedophile, fetishes, voyarism, etc.
What are physical changes that affect sexual health
sexual dysfunctions, medical conditions, surgical conditions
male sexual dysfunctions
erectile dysfunction, premature ejaculation, delayed ejaculation
Female sexual dysfunction
orgasmic dysfunction/ inhibited sexual desire, vaginismus, vulvodynia, dyspareunia
what is vaginismus
when vagina suddenly tightends up when trying to insert something into it
what is vulvodynia
chronic condition characterized by persistent pain or discomfort in the vulva
what is dyspareunia
painful sexual intercourse
what is a mastectomy
surgical procedure to remove all or part of a breast
what is hysterectomy
surgical procedure to remove the uterus
what is a prostatectomy
surgical prcedure to remove all or part of the prostate gland
what is a ostomies
surgical opening in the abdomen that allows waste to exit the body
what are things that can affect a persons sexual health
body structure/function
-insecure about adjusted body
medications
-can make someone unable to orgasm
chronic pain
-can make sex painful
mental illness
-can limit someones mental ability which makes them unable or dificult for sex to happen
what is sexual harassment, give an example
unwelcome behavior that is based on a persons sex or gender
ex: quid pro quo
what are nursing strategies that nurses can impliment for sexual harassment?
self awareness, confronts, set limits, enforce limits, and report
what is the typical nursing role model characteristics regarding sexual topics
self knowledge/ comfort, knowledge of sexual issues and sexual health, communication, professional level, nonjudgemental
who needs to be assessed for sexual history when preforming an assessment?
inpatient or outpatient pregnancy patient
patient experiencing sexual dysfunction
patient experiencing an illness that may affect sexual functioning or behavior in any way
what topics are you covering when assessing sexual history?
reproductive history
history of STIs
history of sexual dysfuntion
sexual self-care behaviors
sexual self-concept
sexual functioning
the “better” mdoel
what are nursing interventions that one can implement when it comes to sexual topics
BETTER model
promote health literacy (facts that refute sexual myths)
addressing age-related changes in sexuality and sexual functionig
advocating for pts sexual needs
confronting health disparities in the LGBTQ population
what is the “BETTER” model
B Bring up topic
E Explain
T Telling
T Timing
E Education
R Recording
AKA a patients bill of rights
Patient care partnership
What does the pt bill of rights do?
outlines expectations,rights, responsibilities of pts during hospital stay
what are key principles and give info on each principle of a patients bill of rights
high quality care: right to skillful, compassionate, and respectful
clean safe environment: free from abuse or neglect
involvement in care: ability to chose what happens to you
Discussing of treatment plan: with complex procedures that need to be done, discussion of treatment respects pt autonomy
protection of privacy: respect pt confidentiality
help prepare you and family post hospital wiht documentation, right teaching, diet etc
what are the 3 fundemental aspects of pt hospital experience
disclosure of info, respect for autonomy, shared decision making
what are nurses ethical responsibilites
Nurses have an ethical duty to protect patient privacy as part of providing good, person-centered care. This is linked to respecting patient values and maintaining professional integrity
what can help guides nurses to advocate for and protect patients’ rights, including confidentiality
The ANA Code of Ethics
whats nurses legal responsibility and give examples
The law also requires nurses to keep patient information confidential. This is part of privacy rights and is protected by state laws
•All patient information is private, whether it’s written down, spoken, or electronic
•HIPAA (Health Insurance Portability and Accountability Act) is a key law that gives patients rights over their health records6 . It says who can see their information and how it must be protected . You generally need a patient’s permission to share their health information unless it’s for treatment, payment, or routine health operations
How to Prevent Breaches (Key Actions):
Don’t talk about patients with anyone who doesn’t need to know, including family or friends without the patient’s okay
•Be careful with electronic records: Don’t share passwords, log off computers, and follow facility rules for using technology
•Never share patient information on social media, even if you don’t use names
Don’t take pictures or videos of patients at work6
Know and follow your hospital’s privacy policies
•If you think there might have been a privacy breach, report it
Define the four components of Informed Consent
Disclosure
comprehension
competence
voluntariness
in informed consent, explain disclosure
Person doing procedure informs pt about procedure
pt MUST be told about what procedure is
benefits of having procedure
other options, like not having it done
no guarantees about outcome
in informed consent, explain comprehension
The patient must understand the information they’ve been given. They should be able to explain it in their own words
in informed consent, explain competence
The patient must be able to make a decision. This means they understand the information, can think about it based on their values, and can communicate their choice
In informed consent, explain voluntariness
The patient must give their consent freely, without anyone forcing or unfairly influencing their decision
what is the nurses legal role in informed consent
nurses legally need to make sure the paperwork is there
-(consent in chart)
, answer patient questions within their scope,
-cant answer questions about procedure but can about recovery process
witness the signing,
-sign as witness
and speak up if they think the patient doesn’t understand or isn’t giving consent freely
-nurses job to notify person who obtained consent if there is confusion from pt
Explain the concepts of nursing liability
legal responsibility a nurse has for their actions or lack of action when caring for patients1 . If a nurse doesn’t provide care as a reasonably careful nurse would, and a patient is harmed as a result, the nurse can be held legally liable
what are key points about nursing liability
safe care
*lead to lawsuits
*Standards of care guide what is considered negligent
*Student nurses are held to the same standard as registered nurses
*Nurses can be liable for following a provider’s order if it should have been questioned
explain concepts of nursing accountability
This is a broader concept about being responsible and answerable for your nursing practice2 . It includes your legal responsibilities but also your ethical and professional duties
explain key points about nursing accountability
Nurses are accountable for their decisions and actions in patient care
follow professional, ANA’s Code of Ethics
*Nurses are accountable for maintaining their competence and continuing to learn
*RNs are accountable for the care they delegate to others11
*Accountability means being willing to report errors and concerns to ensure patient safety
what is nursing practice act (NPA)
is the law in your state that defines what you can do as a nurse.
state law that tells nurses their scope
•Facility Policies are the specific rules at your job that tell you how to do things.
what is facility policies and procedure sources of standards
specific rules and ways of doing things within healthcare setting you work
how to do certain tasks the way they want you to do it
basef on legal and prof. standards but tailored to specific work place
if not followed correctly, can be held liable
what describes expected level of care nurses need to provide
not always laws but guidelines for good practice
guidelines developed by nursing professional groups like ANA
What is malpractice
specific type of negligence committed by a professional, including nurses
what 4 elements constitutes malpractice
duty
duty to provide care to the patient, established by the standards of nursing practice
Breach of Duty:
The nurse failed to meet the applicable standard of care.
Causation:
There must be a direct link between the nurse’s breach of duty and the patient’s injury. MUST CAUSE DMG
Damages:
The patient must have suffered actual harm or injury as a result of the nurse’s negligence
Give me examples of a breach of duty when it comes to malpractice
failure to accurately assess a patient, failure to report
give me examples of damages (malpractice)
This can include physical injury, pain and suffering, financial loss, or emotional distress
how can you prevent malpractice
consistently adhering to standards of nursing practice and employing legal safeguards
give me 5 examples of ways to prevent malpractice
5 rights of pt administration of meds
knowing and following facility policies and procedures
accurate and detailed documentation
reporting adverse accidents
maintain prof liability insurance
A nurse is caring for Chengyu Zhang, a 32-year-old in the ICU who wants to be removed from the ventilator despite understanding the high likelihood of death. This situation primarily highlights the ethical principle of: a. Beneficence b. Nonmaleficence c. Autonomy d. Justice
c
Marissa Sandoval, a postoperative cancer patient, and her family report that their questions are not being answered by the oncology nurse practitioner, and her fears are being dismissed . This situation demonstrates a potential lack of which professional nursing value?
a. Altruism b. Human Dignity c. Integrity d. Autonomy
B
Values are developed over a person’s lifetime through various influences . Which of the following is an example of value transmission through modeling?
a. A parent lecturing their child on the importance of honesty.
b. A teacher rewarding students who demonstrate kindness.
c. A nurse demonstrating compassionate care to a patient.
d. A friend allowing another to make their own choices without interference.
C
According to the American Association of Colleges of Nursing (AACN), which of the following exemplifies the professional value of integrity in nursing practice?
a. Advocating for vulnerable patients.
b. Respecting a patient’s decision to refuse treatment.
c. Providing culturally sensitive care.
d. Acting in accordance with the ANA Code of Ethics.
D
A nurse overhears a colleague making derogatory remarks about a patient’s lifestyle in the break room. This could potentially lead to a charge of:
a. Battery b. Assault c. Defamation of character d. False imprisonment
C
Which of the following is the most accurate definition of nursing negligence?
a. An intentional act that causes harm to a patient.
b. Failure to perform an act that a reasonably prudent nurse under similar circumstances would do.
c. Performing a nursing task outside the legal scope of practice.
d. Causing harm to a patient despite following all facility policies.
B
To prove nursing malpractice, which of the following elements must be established?
a. Breach of duty and intent to harm.
b. Duty owed to the patient and dissatisfaction with care.
c. Duty, breach of duty, causation, and damages.
d. Breach of duty and failure to follow a physician’s order.
C
A nurse administers a medication to a patient despite the patient stating they are allergic to it. The nurse did not check the patient’s medication history. This is an example of:
a. Following an improper treatment correctly.
b. Breach of the duty of care.
c. Practicing within the legal scope of nursing.
d. An unavoidable adverse drug reaction.
B
Which of the following actions by a nurse is a crucial legal safeguard to prevent medication errors and potential liability?
a. Administering medications based solely on the physician’s order. b. Relying on memory for patient allergies.
c. Verifying the patient’s name and date of birth before administering medication.
d. Assuming the pharmacy has prepared the correct dose.
C
A patient who is alert and oriented refuses a prescribed medication. The nurse, believing it is in the patient’s best interest, administers the medication against the patient’s will. This could be considered: a. Beneficence b. Nonmaleficence c. Battery d. Negligence
C
A nurse observes a colleague exhibiting signs of possible substance use disorder while on duty. According to the resources, the nurse should prioritize:
a. Directly confronting the colleague in front of other staff.
b. Ignoring the signs if patient care has not yet been directly affected.
c. Reporting their observations to the nurse manager or appropriate authority.
d. Attempting to provide personal counseling to the colleague.
C
What is the primary purpose of an incident report in a healthcare setting? a. To assign blame for errors in patient care.
b. To document disciplinary actions taken against staff.
c. To identify risks and improve quality of care.
d. To serve as the primary legal defense in case of a lawsuit.
C
A patient with a severe infection demands that the nurse remove their IV antibiotic line, stating they want to leave the hospital against medical advice. The nurse should:
a. Physically prevent the patient from leaving.
b. Administer a sedative to calm the patient.
c. Explain the potential risks of leaving and the process for signing an “against medical advice” form
d. Immediately call security to manage the situation.
C
The state’s Nurse Practice Act is the most important legal document that:
a. Provides detailed policies and procedures for all healthcare facilities.
b. Defines the legal scope of nursing practice.
c. Is developed and enforced by professional nursing organizations.
d. Outlines specific medical treatments that nurses are allowed to perform.
B
Which of the following statements accurately reflects the relationship between a nurse’s personal values and their professional nursing practice?
a. A nurse’s personal values should always take precedence over professional ethical codes.
b. Personal values have no impact on a nurse’s ability to provide patient care.
c. Nurses should critically examine their personal values to ensure they align with essential professional values.
d. Professional nursing values are innate and do not need to be developed.
C
Which circumstance would exempt the nurse form professional negligence following error in drug admin to pt
a. not knowing drug was contraindicated for pt
b. lack of harm to pt as result of errant drug admin
c. confirmation by coworker that dosage was correct
d. dose was inaccurately dispensed by pharmacy
a. not knowing drug was contraindicated for pt
-not a valid excuse
b. lack of harm to pt as result of errant drug admin
-to sue, need to show that it harmed me or dangered me in some way
c.confirmation by coworker that dosage was correct
-if there are questions about a drug, its up to you to check and use resources
d. dose was inaccurately dispensed by pharmacy
-should have checked dosage, need to check (5 rights)
nurse is reviewing orders for new pt. what activity is most appropriate for nurse to delegate to a CNA
a. infuse 500ml normal saline over 3 hours for dehydration
b. obtain portable x ray to rule out pneumonia
c. collect routine vitals after nurse completes initial assessment
d. titrate 2L NC because o2 sat is 90%
c. collect routine vitals after nurse completes initial assessment
an ANOx4 pt thats a jehovahs witness refuses life saving blood transfusion. his wife that doest practice says he needs to blood and to give it to him anyways. what is most appropriate action
a. respect pt right to refuse
b honor wife request because pt will die without it
c. contact hospital admin and take protective custody of pt
d. see if pt has advanced directive prior to making decision
a. respect pt right to refuse
-pt is ANOx4 so he is in sound mind so he gets to choose (autonomy)
c. contact hospital admin and take protective custody of pt
-pt is anox4, can not take protective custody
d. see if pt has advanced directive prior to making decision
-only if pt can not speak for themselves but pt is anox4
nurse admins wrong meds to pt. after assessment and completing a incident report, what is nurses priority
a. report incident to nursing regulatory agency
b. complete an adverse drug reaction report (ADR)
c. anticipate suspension from facility due to error
d. report incident to risk management
a. report incident to nursing regulatory agency
-not primary concern, nurse wouldnt report this typically
b. complete an adverse drug reaction report (ADR)
-no adverse drug reaction, just wrong dosage
c. anticipate suspension from facility due to error
-do not anticipate suspension because of human error. if ppl get fired cuz of 1 mistake, people will stop reporting errors and policies wont be made
d. report incident to risk management
-so risk management can see gaps and help prevent this from happening again
at shift change, a departing nurse smells of alcohol on arriving nurses breath. what should the departing nurse do
a. immediately report finding to nurse supervisor
b. observe night-shift nurse for other signs of intoxication
c. leave note for nurse manager to read in morning
d. ask night shift nurse if she has been drinking
a. immediately report finding to nurse supervisor
pt learns shes pregnant and asks nurse for names of abortion clinics. the nurse doesnt beleive abortion is a moral alternative. what is most appropriate response by nurse
a. remind pt that abortion stops a beating heart
b. tell pt that she will have to ask the health care provider
c. encourage pt to wait and think about it
d. give pt the avaliable preprinted list of clinics
d. give pt the avaliable preprinted list of clinics
-leave opinions at the door. your opinion does not matter with pt autonomy
whats nurses priority action in caring for pt who has had liver biopsy
a. assess level of pain
b. monitor vitals
c. assess for feeling about body image
d. tell pt to avoid alcohol in future
b. monitor vitals
-MASLOWS HIERARCHY OF NEEDS
health care provider is legally and ethically required to disclose certain info. which confidential info should nurse disclose?
a. single male pt HIV status to family members
b. pt pancreatic cancer diagnosis to significant other
c. taxi drivers diagnosis of an uncontrolled seizure disorder to licensing agency
d. pt is 32 weeks pregnant with twins and is legally separated
c. taxi drivers diagnosis of an uncontrolled seizure disorder to licensing agency
-seizure disorder= you cant drive, need documentation to show you are seizure free to get license back. (public welfare problem)
nurse on maternity unit sees a mother slapping the face of her crying baby. what is nurses prio action
a. take baby to nursery, inform health care provider and notify social services
b. leave room without baby, notify nursing supervisor
c. ask mother why she was slapping her baby
d. take baby to nursery, tell coworkers to overserve mother for future incidents
a. take baby to nursery, inform health care provider and notify social services
what are elements of disclosure
description of procedure
purpose of procedure
risks and benefits of procedure
alternatives
consequences of not having it done
core ethical ideas for nurses
autonomy: respecting choices
nonmaleficence: avoiding harm
beneficence: doing god
justice: fair
fidelity: loyal
advocacy: speaking up
what is a value
a belief about the worth of something such as a person,an idea, or an action. Values often guide behavior.
whats a value system
Organization of values into a personal or organizationalcode of conduct
what is value development
Happens over a lifetime through value transmission
what is altruism
concern for well-being of others
what is autonomy
right to make own decisions
whats human dignity
Respect for the inherent worth ofpatients
whats integrity
acting honestly and ethically
whats social justice
ensuring equal treatment
what is value clarification
A process of coming to understand our ownvalues and value systems◦ Important to know and understand our ownvalues in order to understand the values of thosein our care
what is a utilitarian perspective
The rightness or wrongness of an action depends on theconsequence of the action
what is deontologic perspective
An action is right or wrong independent of itsconsequences
what are 4 as to rise above moral distress
ask, affirm, assess, act
Identify and summarize normal patterns ofurinary elimination in the adult
how often depends on fluid
healthy output should roughly equal input
normal urine is pale yellow, staw colored, or amber
Identify and summarize normal patterns of fecal
BM frequency varies from 2-3 a week to 2-3 a day
can have routine of BM like always after meals
stool should be soft and easy to pass
what are factors that affect basic physiologic mechanisms with pee and pooing
age
diet
medications
stress
personal habits
what can be considered urinary abnormalities?
increased frequency: r/t ^fluid intake, diuretic use, diabetes, decreased bladder capacity
urgency and pain when peeing: r/t UTI or bladder irritation
leaking urine when coughing/sneeze: r/t urin incontinence
hard to start or stop peeing: may show urine retention
change in usual patterns: can show various underlying ussues
history of past UTI or kidney/bladder problems: increases likelyhood of recurring issues
what are specific physical assessment findings that can be correlated with abnormalities associated with urine
distended bladder=urinary retention
Reddened skin in the perineal area = incontinence-associated dermatitis (IAD)
cloudy urine, foul odor, presence of sediment, or reported blood in the urine (hematuria) = UTIs, kidney stones, or other urinary tract problems.
Increased or decreased urine output
= fluid imbalances or kidney dysfunction.
what BM history findings correlate with abnormailities
Changes in frequency = constipation or diarrhea
hard, dry stools or difficulty= constipation3
loose, liquid stools= diarrhea
Reports of blood or mucus in the stool = gastrointestinal bleeding, inflammation, or infection .
Narrow or ribbon-like stool= bowel obstruction
need for aids to elimination= chronic bowel problems.
fecal incontinence= loss of voluntary control.
what physical assessment findings are correlated with abnormalities (BM)
Abdominal distention19= constipation, fecal impaction , gas
absent or hyperactive bowel sounds= decreased or increased bowel motility,
Abdominal tenderness = inflammation, infection, or other gastrointestinal disorders.
For patients with bowel diversions, a stoma that is not bright red and moist or signs of skin breakdown around the stoma
what are normal parameters for body fluid intakeand output (I&O) and its relationship to hydrationstatus
Normal adult fluid intake ≈ 1500-2000 mL/day
Intake ≈ Output = balanced hydration
what are interventions you can do with urinary
Promote normal voiding: scheduled toileting, respond to urge1 .
•Ensure easy access2 .
•Encourage fluid intake2 .
•Catheterization (intermittent, indwelling, suprapubic) if needed3 …. Use aseptic technique3 .
Monitor for UTI
I&O assessment
document
trend
safety
teamwork
what are interventions for BM
Promote regular habits: timing, positioning, privacy11 .•Encourage fluid and fiber intake11 .•Encourage exercise11 .•Manage constipation/diarrhea (diet, medications as ordered, enemas, ostomy care)12
I&O Assessment
document
trend
teamwork
safety
liquid stool enters large intestine where fluid is removed, results in what stool?
formed stool
characteristics of normal stool
brown, formed, semisolid, evacuates without difficulty
peristalsis
rhythmic muscle contractions that propel substances through tubular organs
Defecation
emptying large intestine BM
what can help in aiding to expell feces
contracting ab musc, diaphram, or valsalva maneuver can increase intraabdominal pressure to aid in expelling poo
consitpation
is defined as dry, hard stool; infrequent difficult passage of stool; and/or the incomplete passage of stool
impaction =
constipation prevents normal stool passage; hard fecal mass blocks rectum.
Gastrocolic reflex
= eating stimulates urge to defecate
whats recommended daily fluid intake to help normal BM
2000-3000 mL
what are causes of diarrhea or constipation or flatus problems
often use of laxitives
lack of fiber
lack of hydration
lack of exercise
food poisoning
gas forming foods
meds like opioids
on assessment of BM what topics are you covering
normal pattern
Description of stool
Changes in pattern
Past/present problems
Use of laxatives
Diet
Exercise
Fluid intake
Medications
Stress
if stool is black, bleeding is located in
upper GI
what is melena
thich black tarry stool caused by upper GI bleed
if my patient has had several days of diarrhea and IV fluids have not been given at all, what should I be thinking? how do i check for it
dehydration, check skin turgor
why are enemas administered
Enemas are administered to:•Remove feces
•Administer medications
•Ease defecation
Enemas treat:
•Constipation or fecal impaction
•Gaseous distention (flatus)
•Stool softening (oil-retention)
Enemas prep patients for:
•Surgery (bowel evacuation)
•Radiographic or endoscopic examination (promote visualization)
what are types of enemas
cleansing, retention, harris flush
tell me about cleaning enemas
removes feces from colon
to relieve constipation or fecal impaction
promote visualization of GI
uses tap water (hyptonic) to increases peristalsis
normal saline: softens stool, increase peri
soap solution: irritates mucosa, softs stool
hypertonic: draws water in colon, stimulates defecation reflex
tap water enema
pain hypotonic water
increases volume
soften stool
large volume
be aware of potential fluid/elec imbalance
normal saline enema
isotonic solution
gentle, doesnt affect fluid balance as much
large volume
soap solution enema
castile soap to irritate bowel which can help stimulate movement and increase volume and softening stool
hypertonic solution
small volume of solution that draws water into colon
be cautious with pt who have sodium or water retention or kidney issues
avoid with older adults
oil retention enema
soften hard stool and make it slippery so its easier to pass
need to hold enema longer at least 30 min to work best
sometimes regular cleansing enema given after
carminative enema
helps get rid of gas for bloating or discomfort
solution of milk and molasses or soap solution
irritate bowel enough to relieve trapped gas
medicated enema
medication in liquid form put in rectum
when pt cant take orally
can provide local treatment in rectal area
Anthelmintic enema
enema specifically designed to kill parasitic worm infections
harris flush enema
gentle in and out action to help release trapped air in bowels
what position will nurse put pt in for enema
left side AKA sims
which pts would most need I&O monitoring (select all)
a. pt in renal failure
b. pt with fractured femur
c.pt w cardiac failure
d. pt w liver failure
e. pt w dysphagia
d. pt w pneumonia
a,c,d
what can cause fluid loss
diarrhea, vomiting, sweating
what are ways of intake of fluid
oral: jello, popsicles, water
IV
irrigation: enema
what are ways of output
urine
emesis
drainage
what does your eGFR tell you
how much kidney function you have. As kidney disease gets worse, eGFR goes down
oliguria
over 24 hours, urine output less than 400 mL
Anuria
24 hour urine output less than 50 mL
normal urinary output
60-120 mL/Hr
what can cause oliguria
lack of fluid intake
abnormal fluid losses
impaired BF to kidneys
what can cause oliguria
lack of ___ intake
abnormal ___ lossess
impaired ___ to the ___
fluidfluidblood flow, kidneys
acute renal failure
kidneys suddenly stop working properly, happens over a few hours or within a day
Chronic renal failure
speed at which the kidney function declines
main differences between ARF and CRF
acute RF can happen quickly while CRF develops gradually
what can affect urination
decreased urine concentration
decreased bladder tone
decreased bladder contractility
muscle weakness interfering with reaching toilet in time
increased medication with side effects
what are general factors that affect urination
psychological: embarrassment, stress
immobility: incontinence, poor muscle tone
pathologic conditions: abnormalities within physiologic structure of body system
post of effects of anesthesia:
what diagnostic test can affect urine
cytoscopy can cause dysuria post scope
where do you palpate on bladder. what do you check for
between symphysis pubis and umbilicus, check for distention
abnormal characteristics of urine
high or low SG
blood, protein, glucose, nitrates, WBC in urine
change in color not due to meds or food
Pyelonephritis
UTI that affects kidneys
whats a clean catch urine sample
less likely to have germs in urine which makes testing done on urine most accurate
sterile specimen contailer
no toilet paper in container
wear gloves
whats SG (specific grav)
urinary concentration
what are some tests that can be done to test urinary tract
KUB/flat plate
ivp
ct
renal US
cystoscopy
renal biopsy
angiogram
blockage of the urethra due to BPH (benign prostatic hyperplasia) causes urinary ___
retention
what can kegal exercises do
improve voluntary control of urination
select all, what are proper goals for your pt to work towards
maintain normal voiding pattern
restrict fluid intake to minimize need to void often
Consider oliguria as acceptable long term output
limit fluid intake if pt experiences incontinence
regain normal urine output
toilet dependently
prevent associated risks
maintain normal voiding patternregain normal urine outputprevent associated risks
what can you do to stimulate micturition
assume normal position
sound of running water
stroke inner thigh
hands in warm water
pour warm water over perineum
who is at risk of UTI
sexually active women
whomen who use diaphragms for contraception
postmenopausal women
anyone w indwelling urinary catheter
pt w diabetes mellitus
how can you prevent infection
wipe front to back (female)
acidifying urine
voiding and washing after sex
cotton underwear
what are some reasons for catheterization
relieving urinary retention
getting sterile urine specimin
obtaining urine spec when usal methods cant be used
empting bladder before,during, after surgery
monitoring ill patients
what should you do to take care of foley catheter care
protect tubing when pt is OOB
clean catheter/ perineum when bathing
empt bag frequently
keep bag below level of bladder and off floor
secure catheter to thigh to prevent trauma
pt is to collect a specimen for stool guaiac test. which direction should be given to pt?
a. “Be sure to use a sterile container to collectthe specimen.”B. “Be sure to take a laxative 2 days prior tocollecting the stool.”C. “Do not eat red meat for at least 3 days beforecollecting the specimen.”D. “Do not drink carbonated beverages for 8hours before collecting the specimen.”
C
A hospitalized patient with possiblerenal insufficiency after coronaryartery bypass surgery is scheduledfor a creatinine clearance test. Whichequipment will the nurse need toobtain?a. Urinary catheterb. Cleaning towelettesc. Large container for urine for 24 hour urined. Sterile urine specimen cup
C
nurse determines that nursing diag stress urinary incontinence rt decreased pelvic musc tone. What is most appropriate for oriented adult fem pt.
a. apply adult diapers
b. cath the pt
c. admin urecholine
d. teach kegel exercises
D
nurse suspects pt has bladder infection based on pt exhibiting an early sign or symptom like
a. chills
b. hematuria
c. flank pain (pain on sides between lower ribs and hip)
d. incontinence
B. early sign of a bladder infection
pt having chills is sign of systemic system
flank pain
-sign of pylonephritus, bacteria went up ureters and go to kidneys, would be considered late sign
incontinence
-not a sign of infection
immediately after intravenous pyelogram (IVP) nurse should observe pt of which following?
a. infect of urinary bladder
b. allergic reaction to contrast
c. urinary suppression caused by injury to kidney tissues
d. incontinence as result of paralysis of urinary sphincter
b. IVP uses contrast. usually when something has gram at the end may indicate contrast is used. So, do they have allergies to iodine? or shellfish? need to look at BUN or Creatinin. if they elevate, kidneys in trouble
pt with lots of alcohol intake has reduced amount of ADH. nurse expects what
a. hematuria
b increase bp
c dry mucous membrane
d low serum sodium level
dry mucous membranes
ADH helps urine retention/ fluid retention. if a pt has low ADH, there will be excessive fluid expelling which can cause dehydration which cause dry mucous membranes
unit manager evaluates care of new nursing staff. which following appropriate technique for nurse to implement in order to obtain clean voided urine specimine?
a. use of sterile gloves for procedure
b. restrict fluids before specimen collection
c. place specimen in clean urinalysis container
d. collect specimen after initial stream of urine has passed
d. by letting the initial stream pass, bacteria is lessened. and if theres still bacteria in urine, bacteria is in bladder
RN knows pt with chronic alterations in kidney funct suffers from insufficient amounts of
a. vit a
b. vit d
c. vit e
d. vit k
a. vit a
-used for vision
b. vit d
-kidneys activate vit D to something we can use. if pt has problems w kidneys, there will be decrease in vit D metabolism
c. vit e
-antioxidant, immunity
d. vit k
-coumadin (anticoagulant)
nurse is caring for pt who is getting closed cath irrigation of 950 mLs of NS irrigation during shift. theres a total of 1725mL in drainage bag. nurse calculates client urinary output for shift to be:
a. 775 mL
b. 950 mL
c. 1725 mL
d. 2675 mL
A. by subtracting 950 mLs from 1725mLs to get total urine output
pt is having urinary retention and health care provider is contacted. nurse anticipates a medication that will be ordered to promote emptuing of the bladder is:
a. oxybutynin chloride (ditropan)
b. Bethanechol (Urecholine)
c. Propantheline (pro-banthine)
d. Nystatin (mycostatin)
a. oxybutynin chloride (ditropan)
-anticolonergic: decrease incontinence
b. Bethanechol (Urecholine)
-increases contraction of bladder
-when you increase contractability, the bladder muscles contract over and over again until the urine comes out
c. Propantheline (pro-banthine)
-anticolonergic: decreases incontinence
d. Nystatin (mycostatin)
-antifungal
Urinary elim may be altered due to dif patho conditions. for client w diabetes, nurse antiicpates the initial urinary s/s is
a. urgency
b. dysuria
c. hematuria
d. polyuria
a. urgency
b. dysuria
c. hematuria
d. polyuriaexcessive production and passage of urine. one of the first initial sign
nurse is assessing pt admitted w complaints rt Chronic kidney dysfunction. Nurse recognizes pt most likely to present what symptom
a. anemia
b. hypotension
c. diabetes mellitus
d. clinical depression
a. anemia
kidneys create erythroporicin, that stimulates production of RBCs in bone, if pt has decreased funct of kidneys, erythroporicin goes down = rbc production goes down= hemoglobin goes down= O2sat goes down= anemia
whcih of following statements made by pt experiencing chronic kidney dysfunction shows best understanding of physio effects on body.
a. “im tested regularly for anemia”
b. my diet is restricted because of this problem
c. diabetes runs in my family, so i get tested often
d. i can get rlly depressed if i think too much about this shit
a. “im tested regularly for anemia”
which of the following pt will most benefit from pt/ parent education regarding prevention of renal infection via proper hygiene habits?
a. male age 35-65
b. male 3-16
c. female 3-12
d. female 20-50
would not be male choices because males have long urethras so one of the female choices.
c. female 3-12
-this is because pts this age have shorter urethras than 20-50
-still learning to clean themselves so proper education is required
-not wiping front to back so it can introduce bacteria up urethra into bladder into kidneys
nurse is interviewing pt with hx of benign prostatic hypertrophy (BPH) in light of dx, nurse should include info regarding which of the following in order to assess chronic effects of renal disorder?
a. # of times he usually urinates in 24 hour period
b. what medications he is currently taking for condition
c. results from latest prostate specific antigen test
d. whether he usually experiences a complete emptying of bladder
d. whether he usually experiences a complete emptying of bladderonly males have prostate, encircles neck of bladder and when pt has BPH, the prostate squeezes the neck so much that makes it difficult to get any urine out. and, if pt can urinate, its dribbles but never empty whole bladder
nurse discusses s/s of both upper and lower UTI with pt who has hx of both. which of the following statements by pt reflects understanding of differing symptomatology?
a. “when i get cloudy urine, i figure i have an infection”
b. “burning when I urinate is usually the first symptom i notice”
c. “I have a big problem when I feel like i have the flu but with back pain too”
d. when I see blood in my pee, I need to call my health care provider”
c. “I have a big problem when I feel like i have the flu but with back pain too”
if pt knows the differences between a lower and upper UTI.pt will have urgency, dysurea, and it turns to something systemic like body aches and body pain, thats when it is not localized but generalized, if pt has back pain it means that the bacteria that floated to bladder to ureters to kidneys
whcih of the following would RN expect as normal changes in BM as person ages?
a. absorptive process are increased in intestinal mucosa
b. esophageal emptying time incrased
c. changes in nerve innervation and sensation cause diarrhea
d. mastication processes are less efficient
d. mastication processes are less efficientas pt gets older, wear and tear of body slows eating and that process down
8 mth old baby has severe diarrhea. RN knows that major problem associated w diarrhea is:
a. pain in abdominal area
b. electrolyte and fluid loss
c. presence of excessive flatus
d. irritation of pernial and rectal area
b. electrolyte and fluid loss
-MASLOWS HEIRCHY OF NEEDS, severe diarrhea (fluid and electrolyte) smaller the body less fluid there, more at risk for imbalances
pt has stool test for occult blood, RN is instructing CNA in the correct procedure for the test. the CNA is correctly informed that:
a. sterile technique is used for collection
b. stool should be collected over 3 day period
c. stool specimen needs to be kept warm
d. a 1 inch sample of formed stool is needed
d. a 1 inch sample of formed stool is needed
pt who just went under for surgery and now has a colostomy is instructed by nurse that for next few weeks pt diet includes food such as:
a. vegetables
b. fresh fruit
c. whole grain breads
d. poached eggs and rice
a. vegetables
b. fresh fruit
c. whole grain breads
all other options were high in fiber which is not what the pt needs. do not need to create large stool because it will stretch walls of GI and disrupt healing
d. poached eggs and ricewant to give bowels a break and rest
pt admitted to a acute care unit w dx of biliary disease. nurse suspects feces will appear:
a. bloody
b. pus filled
d. black and tarry
d. white or clay colored
d. white or clay colored
-bile is missing which makes stool a dark color
pt asks nurse to recommend bulk forming foods that can be put in diet. whcih of the following should pt be recommended?
a. whole grains
b. fruit juice
c. rare meat
d. milk product
a. whole grains
-high in fiber to create more mass in stool
pt taking meds to promote defecation. what following instructions should be included by RN in teaching plan for pt?
a. increase laxative use can cause hyperkalemia
b. salt tablets should be taken to increase solute concentration of ECF
c. emollient solutions may increase amount of water secreted into bowel
d. bulk forming additives may turn the urine pink
a. increase laxative use can cause hyperkalemia
-no it causes HYPOKALEMIA
b. salt tablets should be taken to increase solute concentration of ECF
-false
c. emollient solutions may increase amount of water secreted into bowelcan cause the pt to have watery stoold. bulk forming additives may turn the urine pink
-false
when undergoing a soapsuds enema, pt complains of ab cramping. RN should:
a. immediately stop infusion
b. lower the height of enema container
c. advance enema tubing 2-3 inches
d. clamp tubing
b. lower the height of enema containerwe expect some cramping but, if it becomes too much just lower it because the pt needs the enema. the higher the bag the faster it goes in, the lower the bag, the slower. so not as fast not as harsh.
nurse who is caring for post op client on surgical unit she knows that for 24 hr to 48 hr postoperatively, pt who undergone general anesthesia may experience:
a. colitis
b. stomatitis
c. paralytic ileus
d. gastrocolic reflex
c. paralytic ileus
-when parastalsis of GI tract stops completely, it comes back as meds are eliminated from body
for pt w hypocalcemia, RN implemet measures to prevent:
a. gastric upset
b. malabsorption
c. constipation
d. fluid secretion
c. constipationwill see this in pt w hypocalcemia, can have musc. cramps as well
appropriate amount of fluid to prepare for an enema given to average size school age child is:
a. 150 to 250 mL
b. 250-350 mL
c. 300 to 500 mL
d. 500 to 750 mL
a. 150 to 250 mL
infant
b. 250-350 mL
toddler
c. 300 to 500 mL
school age
d. 500 to 750 mL
which of following is correct nursing intervention for pt with NG tube in place?
a. tape tube up and around ear on side of insertion
b. securre the tubing to bed by pt head
c. mark tube where it exits the nose
d. change tubing daily
c. mark tube where it exits the nose
-after xray confirms placement in stomach and you mark to know if displacement happens
RN instructs pt that before fecal occult blood test, she may eat:
a. whole wheat bread
b. t bone steak
c. veal
d. salmon
a. whole wheat bread2,3,4 all have protein in common, eating protein before the test can cause false positives
concept of sexuality
key part of who you are and how you experience the world as a sexual being
what is involved with sexuality
biological sex
sexual activities
gender identity
gender expression
gender
sexual orientation
what is sexual identity?
broader term that includes how you see yourself in terms of your biological sex, your gender identity, how you express your gender, and your sexual orientation
what is sexual behavior
refers to the ways people experience and express their sexuality physically, emotionally, and mentally
ex: kissing, beating ur dick, kinks (pain and shit idk)
what is gender identity
inner sense of being who you are. It may not align with biological sex
ex: i am biologically born a girl but i think im a guy.
what is gender expression
how you show your gender to the world through clothing and behavior
ex: ashlees gender expression is that she is a man
what is gender
different from biological sex and sexual orientation.
its how you feel inside
biological sex
body at birth
gender
how you feel inside
gender expression
how you show gender
sexual orientation
who you are attracted to
when should you discuss components of taking a sexual history assessment?
pts receiving care for pregnancy, STIs, infertility, or contraception, pt experiencing sexual dysfynction, whose illness will affect sexual functioning and behavior
what would conducting sexual history include?
assessing reproductive hist : BC? fertility concerns? menstruation? pregnant?
questions about hist of STI
asking about sexual dysfunction
exploring sexual self care behaviors
understanding sexual self concept: body image, self esteem, role performance
assess sexual funct.
what is the BETTER model
Bring up the topic,
Explain concern,
Tell about dysfunction,
Timing, Educate,
Record
what is sexual dysfunction
problems with sexual function or enjoyment
what are male sexual dysfunction examples
ED
Ejaculation problems
what are female issues w sexual dysfunction
low desire/arousal
orgasm issues
painful sex
muscle spasms
vulvar pain
how can surgery affect sexual funct
Can change body image and sexual function depending on the procedure (e.g., cancer removal, ostomy)
how can meds effect sexual funct.
drugs have lots of side effects that can cause sexual dysfunction
what does a patient need to know about sexual funct
whats normal/not
how illness/treatment affects sex
potential med side effects
how to communicate w partners
where to get help
what can a nurse do about sexual function
assess sexual history using BETTER model
educate
counsel
help w communication
suggest comfort measures
review meds
address misinfo
respect privacy and dignity
refer to specialists if needed
what are appropriate behaviors that the RN can take when dealing w pt sexual behaviors
know yourself and feelings about sex.
assess behavior if its appropriate
respond to whats not okay
be opeb
communicate
help with issues
ask for help
document/ report
refer if needed
ALWAYS PRIO pt dignity and safety while being professional
what are the 3 general changes that can affect sexual health
sexual dysfunction
medical conditions
surgical conditions
what medical conditions can cause sexual problems
MI, diabetes mellitus (DM), hyper tension (HTN), spinal cord injury (SCI), rheumatoid arthritis or osteoarthritis (RA/OA)
what surgical conditions can cause sexual problems
mastectomy, hysterectomy, prostatectomy, ostomies
whats self concept
is basically how you see and feel about yourself1 …. It’s your internal picture of who you are and plays a big role in your well-being
self knowledge
Knowing who you are – your qualities, beliefs, etc.
self expectations
what you hope to be like
self evaluation (self esteem)
how much you like yourself
what can influence self concept
if basic needs are being met
what stage of life you are in
culture
personal strength
history of success and failure
stressful life or crises
experinces w aging, illness, disability, trauma
how other ppl treat you
tough experiences had as a child
Self Concept is composed of
identity, body image androle performance
what are adaptive responses to lifeexperiences (such as aging, loss of body part, loss ofjob) that affect self-esteem and self-concept
good reactions
accepting changes with age, finding new things to do
loss of a body part: feel sad but start to figure out how to live differently
loss of job: look for new work
Discuss maladaptive responses to lifeexperiences (such as aging, loss of body part, loss ofjob) that affect self-esteem and self-concept
aging: feel useless and focus on what youve lost
loss of body part: pretend it didnt happen, feel like you arent a whole person anymore (damaged goods)
loss of job: isolate yourself, feel like a failure
what are appropriate questions and observations to assess selfconcep
nurses figure out who you are by talking and watching their pt
by asking questions and hearing pt answers, they can watch if your behavior matches with what you are saying.
Identify, discuss and implement therapeutic patienteducation to promote positive self-concept
RNs help pt feel better about themselves but first understand how they see themselves right now
they can
help pt realize how feelings about themselves matter
talk about current situation
find ou what their good at and how theyve coped in the past
point out when they are being too hard on themselves
work together to set some goals for feeling better about themselves
how can a RN implement a therapeutic pt education to promote positive self concept
remind them of strengths
help them set goals that are realistic
teach them to be kinder and understanding towards self
explain how negative self talk can make them see things in a bad way
talk about ways they can find help if struggling with roles
identity diffusion
state where an individual hasn’t developed a strong or stable sense of self, values, or beliefs, and isn’t actively exploring or committing to an identity.
self actualization
need for people to reach full potential
what responsiblilites can a LVN do with proper supervision
administer meds, perform treatments under supervision of RN or MD
What does a CNA do
basic patient care and help with ADLs
What does a RN do
assess pt, develop care plan, coordinate pt care
t/f LVNS have a larger scope of practice than CNAs
T
what is stress
when your body and mind react to changes or challenges
define stressors
things that cause stress
define adaptation
how you change or adjust in response to stressful situation
what is local adaptation system (LAS)
involves a specific body part
reflex pain response
inflammatory response
general adaptation syndrome (GAS)
biochemical model of stress
alarm reaction
stage of resistance
stage of exhaustion
when can balance be achieved with stress?
when the perception of the stressful event is realistic and supporting and coping mechanisms are adequate
what is an alarm reaction
person perceives stressor and mechanisms are activated
fight or flight
hormone levels rise
shock/ counter shock phase
what is stage of resistance
body attempts to adapt to stressor
vitals and hormones go to normal
homeostasis regains or adaptive mech. fails
whats stage of exhaustion
results when adaptive mechanisms are exhausted
body rests or dies
whats mild anxiety
everyday nervousness, may help with foxus
ex: feeling nervous for a test tom may make u study harder
whats moderate anxiety
focus narrows, mostly thinking about immediate problem, shaky voice
ex: nervous before a big speech
severe anxiety
focus is very narrow and you want feelings to stop, hard to concentrate and may have strong physical reactions
ex: worried so much you get a headache, nausea, and your heart races
panic anxiety
most extreme form, completely out of control and terrified, may have extreme physical reactions like SOB chest pain.
what contributes to psychological homeostasis
love and belonging, safety and security needs, self esteem needs
what are coping mechanisms with stress?
crying, laughing, sleeping, cursing
exercise
substance abuse
lack of eye contact
isolation
what is a maturational crises
occurs during developmental events that require a role change
grade school to high school
whats a situational crises
life event disrupts psychological equilibrium
ex: loss of family member
whats an adventitious crises
accidental or unexpected event
ex: house flood
what are personal warning signs that a situation is stressful?
rapid eye movement
tapping foot
nonverbal comunication
rapid verbal responses
stuttering
panic
anxiety
what can you do to help decrease stress
talk slowly
create therapeutic relationship w pt
teach and encourage relaxation
ask what you can do to help
who founded red cross
clara barton
who is lilian wald
She is recognized as the founder of public health nursing
who is florence nightingale
founder of modern nursing
