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321 assessment of clients > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Factors essential to normal functioning of the respiratory system

A
  • integrity of the airway system to transport air to and from lungs
  • Properly functioning alveolar system
  • properly functioning cardiovascular and hematologic system (blood)
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2
Q

How does the alveolar system work

A

Oxygenates venous blood
Removes CO2 from blood

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3
Q

How cardiovascular and hematologic system work

A

Carry nutrients and waste to and from body cells

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4
Q

Thorax

A

Extends from the base of the neck superiorly to the level of the diaphragm inferiorly
Lungs, diagram portion of the trachea, bronchi

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5
Q

Sternum

A

Lies in the center of the chest anteriorly
3 parts

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6
Q

3 parts of sternum

A

Manubrium, the body, xiphoid process

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7
Q

Thoracic cage

A

12 pairs of ribs

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8
Q

Mediastinum

A

Central area in the thoracic cavity

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9
Q

Lungs

A

Two cone shaped, elastic structures
3 lung lobes on right and 2 left b/c of heart

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10
Q

Pleura

A

Thin, double-layered serous membrane that lines the thoracic cavity

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11
Q

Function of the upper airway

A

Warm, filter, humidify inspired air

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12
Q

Components of the upper airway

A

Nose
Pharynx
Larynx
Epiglottis

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13
Q

Epiglottis

A

Opens and closes helping with stopping unwanted particles

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14
Q

Estacian tubes

A

Connect upper air way to ears and release pressure

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15
Q

Function of the lower airway

A

Conduction of air, mucociliary clearance, production of pulmonary surfactant

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16
Q

Components of the lower airway

A

Trachea
Right and left main stem bronchi
Segmental bronchi
Terminal bronchi

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17
Q

Cilla

A

Little hairs that act as a filter
Killed by outside factors like smoking

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18
Q

Anatomy of the lungs

A

Main organ of respiration
Extend from the base of the diaphragm to the apex above the first rib
The right lung has three lobes
The left lung has 2 lobes
The lungs are composed of elastic tissue (alveoli, surfactant, pleura)

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19
Q

Checking the lungs

A

Front: 2,4,6, and 6 lateral
Back: T1, 4, 7, 10 and lateral 5 and 9

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20
Q

Pulmonary ventilation inspiration

A

The active phase of ventilation
Involves movement of muscles and the thorax to bring air into the lungs

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21
Q

Pulmonary ventilation expiration

A

The passive phase of ventilation
Movement of air out of the lungs

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22
Q

Process of ventilation

A
  • the diaphragm contracts and descends, lengthening the thoracic cavity
  • the external intercostal muscles contract, lifting the ribs upwards and outwards
  • the sternum is pushed forward, enlarging the chest from front to back
  • increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lung) to lesser pressure (inside lungs)
  • the relaxation of these structures results in expiration
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23
Q

Gas exchange

A

Refers to the intake of oxygen and release of CO2
Made possible by respiration and perfusion
Occurs via diffusion (movement of O2 and CO2 between the air and blood)

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24
Q

Factors influencing diffusion of gases in the lungs

A

Change in surface area available
Thickening of alveolar-capillary membrane
Partial pressure
Solubility and molecular weight of gas

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25
Q

Transport of respiratory gases

A

O2 is carried in the body via plasma and RBC
Most O2 is carried by RBCs in the form of oxyhemoglobin
Hemoglobin also carries CO2 in the form of carbohemoglobin
Internal respiration between the circulating blood and tissue cells must occur

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26
Q

Hypoxia

A

Inadequate amount of O2 available to the cells

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27
Q

Dyspnea

A

Difficulty breathing

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28
Q

Hypoventilation

A

Decreased rate or depth of air movement into the lungs

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29
Q

Cardiovascular system

A

Vital for exchanges of gases
Composed of the heart and the blood vessels

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30
Q

Heart

A

Cone shaped, muscular pump, divided into four hollow chambers

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31
Q

Upper chambers

A

The atria receives blood from the veins

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32
Q

Lower chambers

A

The ventricles force blood out of the heart through the arteries

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33
Q

Gas exchange

A

The intake of O2 and release of CO2
Made possible by respiration and perfusion
Occurs via diffusion

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34
Q

Factors influencing diffusion of gases in the lungs

A

Change in surface area available
Thickening of alveolar capillary membrane
Partial pressure
Solubility and molecular weight of gas

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35
Q

Transportation of respiratory gases

A

O2 is carried in the blood via plasma and RBC
Internal respiration between the circulating blood and tissue cells must occur

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36
Q

How O2 is carried in blood

A

Most by RBCs in form of oyxhemoglobin

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37
Q

How CO2 is carried in blood

A

Form of carboxyhemoglobin

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38
Q

Hypoxia

A

Inadequate amount of O2 available to the cells

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39
Q

Dyspnea

A

Difficulty breathing

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40
Q

Hypoventilation

A

Decreased rate or depth of air movement into the lungs

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41
Q

Cardiovascular system

A

Vital for exchange of gases
Composed of the heart and the blood vessels

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42
Q

Heart

A

Cone shaped, muscular pump, divided into four hollow chambers

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43
Q

Upper chambers of heart

A

Arita receive blood from the veins

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44
Q

Lower chambers of heart

A

Ventricles force blood out of heart through the arteries

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45
Q

Altercations in cardiovascular system

A

Dysrythmia/arrhythmia
Myocardial ischemia
Angina
Myocardial infarction
Heart failure

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46
Q

Factors affecting cardiopulmonary functioning and oxygenation

A

Level of health
Developmental considerations
Medication considerations (painkillers)
Lifestyle considerations
Environmental considerations
Psychological health considerations

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47
Q

Respiratory activity in the infant

A
  • Lungs are transformed from fluid filled structures to air filled organs
  • the infant’s chest is small, airways are short and aspiration is a potential prob
  • res rate is rapid and res activity is primarily abdominal
    Synthetic surfactant can be given to infants to reopen alveoli
    Crackles heard at end of deep respiration are normal
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48
Q

Respiratory activity in the child

A
  • some subcutaneous fat is deposited on the chest walls making landmarks less prominent
  • Eustachian tubes, bronchi, and bronchioles are elongated and less angular
  • average # of routine colds and infections decreases until child enter daycare/school
  • good hand hygiene and tissue encouraged
  • by end of late childhood immune system protects from most infections
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49
Q

Prevalent diseases in children

A

RSV, Croop, ear infections
Proven coordination with smoking parents

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50
Q

Respiratory functioning in the older adult

A
  • bony landmarks are more prominent die to loss of subcutaneous fat
  • kyphosis contributes to appearance of leaning forward (contributes to lungs bc of compressing)
  • barrel chest deformity may result in ^ anteroposterior diameter
  • tissues and airways become more ridged; diaphragm moves less efficiently
  • ^ risk for disease, especially pneumonia
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51
Q

Physiological changes with age respitory

A
  • decreased in stretching and compliance of chest wall
  • decrease rib mobility and tone
  • decrease in strength and function of resp muscles
  • decrease depth and oxygenation
  • decreased ability to cough
    -** ^ risk for accumulation do secretions = pneumonia
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52
Q

Guidelines for obtaining a nursing history

A
  • determine why need care
    Determine kind of care to mailing a sufficient intake of air
  • identify current/potential health deviations
  • identify actions performed for meeting respiratory needs
  • make use of aids to improve air intake and effects on lifestyle and relationships
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53
Q

Cardiac coronary catherization

A

Measures heart
Assess cardiopulmonary function

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54
Q

Cardiac exercise stress test

A

Testing heart using meds or exercise
Assess cardiopulmonary function

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55
Q

Echocardiogram

A

Measures heart
Assess cardiopulmonary function

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56
Q

Endoscopic studies

A

Broncoscopy, someone w/ reflux or aspiration
Assess cardiopulmonary function

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57
Q

Holter monitor

A

Heart test
Assess cardiopulmonary function

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58
Q

Lung scan

A

Simple test
Assess cardiopulmonary function

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59
Q

Skin tests

A

TB or allergy
Assess cardiopulmonary function

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60
Q

Radiography

A

X-ray of chest
Assess cardiopulmonary function

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61
Q

ABGs

A

Arterial blood graphs
Measurement of arterial oxygenation and CO2 levels
Used to assess adequacy of alveolar ventilation and the ability of the lungs to provide O2 and remove CO2
Also assess accident base balance

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62
Q

Sputum Collection and Analysis

A

Culture and sensitivity, cytology
Boogers/phlem
Best results in morning

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63
Q

Pulmonary function tests

A

Measure inspiration and expiration rates and ratios

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64
Q

Other diagnostic procedures and tests

A

Chest X-rat, CT, MRI, O2 sat

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65
Q

Nursing interventions promoting adequate respiratory function

A

Teaching about pollution free environment
Promoting:
- optical function
- comfort
- proper breathing
- coughing (and controlling)
Managing chest tubes
Suctioning airways
Meeting oxygenation needs with meds

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66
Q

Promoting proper breathing

A

Deep breathing
Using incentive spirometry (at least 10x an hour)
Pursed lips breathing
Diaphragmatic breathing (extra deep)

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67
Q

Managing chest tubes

A

-assist with insertion and removal
- monitor the patient’s respiratory status and vital signs
- Check dressing
- Maintain latency and integrity of drainage site

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68
Q

Promoting respiratory comfort

A

Positioning
Maintaining adequate fluid intake
Providing humidified air
Performing chest physiotherapy

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69
Q

Bronchodialtors

A

Open narrowed airways

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70
Q

Nebulizers

A

Disperse fine particles of liquid medication into the deeper passages of the respiratory tract

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71
Q

Meter-dose inhalers

A

Deliver a controlled dose of meds with each compression of canister

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72
Q

Dry powder inhalers

A

Breath-activity delivery on medication

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73
Q

Oxygen delivery systems

A

Nasal cannula
Nasopharyngeal catheter
Transtracheal catheter
Simple mask
Partial rebreather mask
Nonrebreather mask
Venturi mask
Tent

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74
Q

Precautions for O2 admin

A

Avoid open flames
No smoking sign (nicotine patches if needed)
Check electrical equipment in room is in good working order
Avoid wearing and using synthetic fabrics
Avoid using oils in area

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75
Q

Anterior chest landmarks

A

Midsternal lines
Midclavicular lines
Anterior axillary lines

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76
Q

Posterior chest landmarks

A

Seventh cervical vertebra
T1 4 7 10
Veterbral line
Scapular lines
Posterior axillary lines

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77
Q

Vesicular sounds

A

Low pitched, soft sound during expiration heard mostly over the lungs
Longer inhale shorter exhale

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78
Q

Bronchial

A

High pitched and longer, heard primarily over trachea
Longer exhale shorter inhale

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79
Q

Bronchovesiclar

A

Medium pitch and sound during expiration, heard over the upper anterior chest and intercostal are
Equal inspiration and expiration

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80
Q

Crackles

A

Intermittent sounds occurring when air moves through airways that contain fluid
Heard at end of inspiration
All not cleared by coughing
Classified as fine, medium or coarse

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81
Q

Wheezes

A

Continuos sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions or tubes
Classified as sibilant or sonorous

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82
Q

Pleural friction rub

A

Dry rubbing, grating inflammation of pleural surfaces loudest lateral anterior surface

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83
Q

Stridor

A

High pitched whistling or gasping with harsh sound quality
Seen in airway obstruction

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84
Q

Esophagus

A

Peristalsis

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85
Q

Stomach

A

Mixes food with enzymes to continue the process of digestion

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86
Q

Pancreas

A

Secretes digestive enzymes into the duodenum to break down proteins, fats, and carbohydrates
Behind the liver (mid-epigastric region)

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87
Q

Liver

A

Processes absorbed nutrients from the small intestine, produces bile secreted into the small intestine to help digest fats, detoxifies

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88
Q

Gallbladder

A

Stores and concentrates bile
within the liver connected to the small intestine

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89
Q

Parts of the small intestine

A

Duodenum: breaks down nutrients
Jejunum: absorbs nutrients
Ileum: absorption of neutrients

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90
Q

Physiology of the small intestine

A

22 foot long muscular to be
Breaks down food with the help from pancreas and liver

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91
Q

Peristalsis

A

Moves food alone

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92
Q

Contents of the small intestine

A

Semi solid to liquid

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93
Q

where does B12 absorb

A

The ileum

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94
Q

Appendix

A

Job is to “reboot” the digestive system with bacteria safely harbored in it
Located just below the normal one-way flow of food and bacteria in the large intestine

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95
Q

Anatomy of the large intestine

A

6 foot long muscular tube
Cecum
Ascending (right) colon
Transverse (across) colon
Descending (left) colon
Sigmoid colon (storage)
Rectum

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96
Q

Job of large intestine

A

Absorbs water, forms stool

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97
Q

Stool

A

Mostly food debris and bacteria
Bacteria: synthesize vitamins, process waste products and food particles, and protects against harmful bacteria

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98
Q

Rectum

A

8 inch chamber that connects colon to the anus
Where gas or stool enters the rectum, neurological sensors message the brain
The brain then decided - empty or not - if not sensation temp goes away

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99
Q

Infants and children abdominal (not just pot belly)

A

First stool is meconium
Liver takes up more space than adults
Abdominal wall thinner
Organs palpable
Bladder located higher than adults

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100
Q

Pregnant women abdominal

A

Morning sickness 50-70%
Heartburn
Constipation
Hemorrhoids
Bowel sounds diminished
Appendix displaced up and right

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101
Q

Hospice/end of life abdominal

A

Pain meds are constipating
Disease process might cause diarrhea or constipation
Limited oral intake
Incontinuence (muscles around anus lost -> just comes out)
Circulation shunting to vital organs

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102
Q

Visceral pain

A

Organ
Dull, diffuse pain

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103
Q

Parietal pain

A

Lining
Sharp pain

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104
Q

Referred pain

A

Pain felt in area away from source

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105
Q

Hernias

A

Epigastric
Umbilical
Incisional
Inguinal
Femoral

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106
Q

RUQ contains

A

Gallbladder
Liver
Duodenum
Head of pancreas
Right adrenal gland
Portion of R kidney
Some of ascending/transverse colon

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107
Q

Pain in RUQ indicts

A

Cardio: MI, angina
Pulmonary: pneumonia
GF: cholecystitis, cholelithiasis
Hepatic: hepatitis, C , A
Intestine: duodenal ulcer, appendicitis

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108
Q

LUQ contains

A

Spleen
Left lope of liver
Stomach
Pancreas body
Left adrenal glad
Portion of left kidney
Potion of the transverse/descending colon

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109
Q

Pain in LUQ

A

Cardio: MI, angina
Pulmonary: PE, pneumonia
Spleen: ruptured
Stomach: GERD, gastric ulcer,hiatal hernia

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110
Q

RLQ contains

A

Ovaries
Right spermatic cord
Ascending colon
Lower part of the adrenal
Portion of right kidney
Right ureter
Appendix

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111
Q

Pain in RLQ

A

Ovary/uterus: ectopic preg, ovarian cyst, pelvic
Inflammatory disease
Intestines: perforation, constipation, diverticulitis
Hernia
Kidney: nephrolithiasis, infection

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112
Q

LLQ contains

A

Ovaries
Left spermatic cord
Descending colon
Lower part of adrenal
Potion of left kidney
Left ureter

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113
Q

Pain in LLQ

A

Ovary/uterus: ectopic preg, ovarian cyst, pelvic
Inflammatory disease
Intestines: perforation, constipation, diverticulitis
Hernia
Kidney: nephrolithiasis, infection

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114
Q

Pain in shoulder (referred pain)

A

Ruptured spleen, ectopic preg, pancreatitis, perforated duodenal ulcer

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115
Q

Scapular pain (referred)

A

Cholecystitis, MI, angina, pancreatitis

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116
Q

Pain in thighs, genitals (referred)

A

Renal

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117
Q

Pain in lower back (referred)

A

Pancreatitis, rectal lesion, abdominal aortic aneurysm

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118
Q

Umbilical are (referred)

A

Small intestine, appendix, colon

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119
Q

Positive murphys sign

A

Cholecystitis

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120
Q

Blumberg’s sign

A

Rebound tenderness

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121
Q

Obturator test

A

Appendicitis

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122
Q

McBurney’s sign

A

Press on RLQ with release of hand = pain =
Appendicitis

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123
Q

Obturator test

A

Appendicitis
Holds client’s right ankle in their right hand
Use left hand, the examiner rotates the hip by moving the right knee to and away from body
This is flexion and internal rotation of the hip
Pain in RLQ could indicate appendicitis

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124
Q

Special considerations with infant./children abdomen

A

Contour is protuberant “pot belly”
Umbilical hernia

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125
Q

Special considerations of pregnant women’s abdomen

A

Protuberant
Constipation common
Sounds are different

126
Q

Special considerations elderly abdomen

A

Increased abdominal fat
Less musculature
Organs may be easier to palpate

127
Q

…oscopy

A

Visualization with lighted instrument
Esophag…
Gastr…
Colon…
Sigmoid…
Biopsy mucous and lesions
Remove lesions
Cauterize bleeding

128
Q

Colonoscopy

A

Examines the entire length of the colon

129
Q

Sigmoidoscopy

A

Examines lower third of the colon

130
Q

Contrast medium studies

A

Use barium
Barium swallow

131
Q

Esophagus

A

Upper gastrointestinal
Barium enema

132
Q

Esophagus, stomach, small intestine

A

Barium Enema

133
Q

Barium

A

Like cement
Can cause constipation and blockages
Need lots of fluids and movement after
Turns stool white

134
Q

Occult Blood test

A

Large intestine
Checks for blood in stool
Must avoid red meat, raw fruits and veggies, aspirin, vitamin C for up to 3 days before
May cause false +/-

135
Q

Occult Blood test

A

Large intestine
Checks for blood in stool
Must avoid red meat, raw fruits and veggies, aspirin, vitamin C for up to 3 days before
May cause false +/-

136
Q

NPO

A

Non per Orum
Nothing by mouth
If client is well nourished, can tolerate for short time
Consider health he: diabetes hypoglycemia

137
Q

When NPO is used

A

Prior to surgeries, GI abnormalities, N&V, L&D, prior to some lab work or tests & when comatose

138
Q

NPO keep in mind

A

Keeping mouth moist
Good oral care
Irritable due to lack of intake

139
Q

Clear Liquid

A

Considered any liquid you can see through at room temp
Broth, coffee, carbonated bevs, ice pops, gelatin, clear juices, tea usually written as “clear diet,advance as tolerable”
Long term would require IV nutritional sub

140
Q

When clear liquid diet is used

A

1st step after surgery
Allows nurse to assess tolerance to PO intake

141
Q

Clear Liquid look outs

A

Watch for N/V, full feeling , diarrhea, abdominal pain and distinction
Want client to feel hungry, have +BS, passing flats, able to eat 1/2-3/4 tray before advancing

142
Q

Full Liquid

A

Includes all of clear diet contents plus
Milk and milk drinks, puddings, custards, plain frozen desserts, pasteurized eggs, veggie juices, milk and egg substitutes
Better nutrition can go a few days with out other supplementation

143
Q

Soft diet

A

Regular diets that are modified to remove foods that are more difficult to digest and chew
- no high fiber (salads,roughage)
- no high fat
- no highly seasoned
AKA: bland diet or low fiber diet
nutritional satisfactory

144
Q

Problems with soft diet

A

Constipation

145
Q

Puréed diet

A

Foods are blended to liquid form - meat veggies etc
Foods are blended with broths, gravy, cream soups, cheese, milk, tomato juice and fruit juice to increase calorie/nutritional value

146
Q

Uses of purred diet

A

Clients with difficulty chewing/swallowing and facial/oral surgery

147
Q

Problems with puréed diet

A

Refusal by patient

148
Q

Mechanical soft diet

A

Foods are modified for texture
Chopped,ground or puréed
Masked soft ripped fruits
Cooked mashed soft veggies

149
Q

Uses of mechanical soft diet

A

Patients with difficulty chewing, surgery to head, neck, mouth

150
Q

Regular (or house) diet

A

Anything goes
Patient can generally order what they want depending on health care facility’s dietary system

151
Q

Problems with regular diet

A

Patient might not like the food provided and will want to bring in their own

152
Q

NAS

A

no added salt or sodium restricted

153
Q

Uses of NAS

A

Clients with heart disease, hypertension, kidney disease, ascites

154
Q

Intake measurements

A

By mouth
IV fluids/TPN/PPN
Antibiotics
External feedings
Flushes

155
Q

Output measurements

A

Urine
Stool
Drains
Sweat (rare)
Wound drainage (rare)

156
Q

Challenges in nutrition

A

Impaired appetite
Eating alone
Culture
Religion
Serving times
State of health
Oral cavity
Restrictions

157
Q

Thrush

A

White coating on tongue

158
Q

Thrush

A

White coating on tongue

159
Q

Enteral feeding

A

Feeding administered directly into the stomach
Oral gastric or nasogastric
PEG tube percutaneous gastrostomy or jejunostomy tube

160
Q

Nasogastric tube

A

Enteral feeding
Inserted through nose and down into stomach
Short term (<6 weeks)
Risk for aspirating the tube feeding solution into the lungs

161
Q

Aspiration looks like

A

Sudden increase in HR, RR, anxiety, auscultate rhonchi, committing solution, decreased O2 sat
Avoid by having client sit in 30 degree or higher or right side if comatose when tube feeding is running and for one hour after

162
Q

Points to consider for nasogastric tube

A

Room temp
Assess residuals prior to feeding and evaluate absorption
Residuals < 100-150cc it’s okay to administer, >150 hold feeding
Check for placement with x-ray
Assess bowel sounds prior and hold feeding and notifying if absent
Look for signs of dumping syndrome
Flush tube with water

163
Q

Intermittent enteral feeding

A

300-500 ml administered several times a day
Preferred method

164
Q

Bolus intermittent enteral feeding

A

Bag hanging by gravity to a syringe is used to relieve the formula into the stomach
Quick delivery may not be tolerated

165
Q

Continuous feedings enteral feedings

A

An infusion pump administered feedings in constant flow 24 hours a day
Stomach never gets a rest
Keep patient up at 30 degrees at all times

166
Q

Cyclic feedings enteral feedings

A

Continuous feedings relieved over less than 24 hours (usually at night)

167
Q

Parenteral feedings

A

Relievers nutrients directly into the bloodstream, bypassing the GI tract
Duration for treatment is generally < 14 days

168
Q

Solutions in parenteral feeding

A

Dextrose, amino acids, electrolytes, vitamins, and trace elements in sterile water

169
Q

Uses of parenteral feedings

A

When clients can not meet nutritional needs orally or enterally
Comatose, non functioning GI tracts, extensive burns, extensive surgery, extensive cancer treatments, premature infants

170
Q

TPN

A

Total parenteral nutrition
Highly concentrated, hypertonic nutrient solution
Prefer a central IV line, peripheral line increases risk of infection and phlebitis

171
Q

TPN and neonates

A

Most commonly administered through a peripheral IV, sometimes central like

172
Q

PPN

A

Peripheral parenteral nutrition
Not as nutrient sense as TPN
Less caustic to the veins

173
Q

Complications of parenteral nutrition

A

Liver damage
Hyperglycemia
Sepsis
Phlebitis/infiltration
Complications of central line placement (infection, catheter fracture, clotting)

174
Q

Bowel eliminations

A

Frequency varies from person to person not everyone has daily

175
Q

Assessment of bowel eliminations

A

Color: concern is for blood in the stool
Odor: c-diff distinct
Amount: small, medium or large
Consistency: watery, soft, hard
Frequency: how often

176
Q

Bristol stool chart

A

Type 1: sever constipation
Type 2: mild constipation
Type 3: normal
Type 4: normal
Type 5: lacking fiber
Type 6: mild diarrhea
Type 7: severe diarrhea

177
Q

Anesthesia and bowel function

A

Slows normal colonic movement
Ileus

178
Q

Pathological factors and bowel function

A

Spinal cord injury
Cancers

179
Q

Pain and bowel function

A

Discomfort when defecating
Constipation

180
Q

Medication and bowel function

A

May increase or decrease GI motility
May affect appearance
Laxative

181
Q

Ostomy

A

Term for a surgically formed opening from the inside of an organ to the outside of the body

182
Q

Fecal ostomies

A

Intestinal mucosa is brought to the abdominal wall and a stomach is formed by suturing the muscle to the skin

183
Q

Ileostomy

A

Bowel stoma
allows liquid fecal content from the ileum of the small intestine to be eliminated through the stoma

184
Q

Colostomy

A

Bowel stoma
Permits formed feces in the colon to exit through the stoma

185
Q

Why use colostomy

A

Bowel blocked or perforated
Cancer
Trauma
Diversion for wound management
Inflammatory bowel disease exacerbation

186
Q

Temporary colostomy

A

Used if allowing bowel to heal

187
Q

Permanent colostomy

A

Rectal cancer or portion removed, ulcerative colitis, Chrohn’s

188
Q

Stoma assessment

A

Healthy stomach is red or pink and moist
Bleeding should be minimal
Stomach fresh post op is swollen
Note size - stabilizes in 6-8 weeks
Most protrude 1/2-1 inch
Keep peristomal skin intake and healthy

189
Q

Pale stoma

A

Anemia or nutritional deficits

190
Q

Pale stoma

A

Anemia or nutritional deciliters

191
Q

Dark purple/blue stoma

A

Ischemia or compromised circulation

192
Q

Brown stoma

A

Slough from diseased bowel

193
Q

Black stoma

A

Tissue death

194
Q

Ostomy nursing interventions

A

Change pouch/clean stoma when due or leaking
Keep skin around clean and dry
Measure I and O ***
Educate
Encourage to participate in care
Name your Ostomy

195
Q

Enemas

A

For constipation management or to administer meds
Introduction of a solution into the rectum and large intestine
When using for treatment the solution is given to treat area directly ask to hold as long as possible

196
Q

Enemas

A

For constipation management or to administer meds
Introduction of a solution into the rectum and large intestine
When using for treatment the solution is given to treat area directly ask to hold as long as possible

197
Q

How enemas work

A

Act by distending the intestine and sometimes irritating the intestinal mucosa thereby increasing peristalsis expulsion of feces and flatus

198
Q

How enemas work

A

Act by distending the intestine and sometimes irritating the intestinal mucosa thereby increasing peristalsis expulsion of feces and flatus

199
Q

Purpose of enemas

A

Relieve constipation or fecal impaction
Promote visualization of intestinal tract during x ray
Recent escape of feces during surgery
Treatment for infections

200
Q

Types of enemas

A

Cleansing enema
Retention
Carminative - relieves gas
Return-flow

201
Q

Enema administration

A

Position on left side (sim) so fluid flows down to sigmoid on left side
Raise the solution to increased the force of flow if applicable
Admin fluid slowly
If pain or cramping clamp tube for 30 sec and restart at slower rate
Instruct client to hold for 10-15 minutes or as long as possibly
Document intervention and results

202
Q

Promoting bowel elimination

A

Promote regular defecation
Provide privacy
Schedule
Lots of fluid and fiber
Provide as normal position as possible with bedpan

203
Q

Pain

A

Unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage or both
Pain is whatever the experiencing person says it is, existing whenever he says it does

204
Q

Pain process

A

Transduction
Transmission
Perception of pain
Modulation

205
Q

Transduction

A

Activation of pain receptors

206
Q

Transmission

A

Coduction along pathways
A-deltas and C fibers

207
Q

Perception of pain

A

Awareness of the characteristics of pain

208
Q

Modulation

A

Inhibition or modification of pain

209
Q

Gate control theory of pain

A

Small and large diameter never fibers conduct and inhibit pain stimuli towards the brain
Gating mechanism determines the impulses that reach the brain
**putting counter pressure on the are in pain can decrease the pain

210
Q

Gate control theory describes

A

The transmission of painful stimuli and recognizes a relationship between pain and emotions

211
Q

Acute pain

A

Rapid onset, lasts less than 6 months
Caries in intensity and duration
Protective in nature

212
Q

Chronic pain

A

Maybe limited, intermittent or persistent
Last longer than 6 months
Last beyond the normal healing time period
Periods of remission or exacerbation are common

213
Q

Psychological pain

A

Emotional or mental pain

214
Q

Psychosomatic or psychogenic pain

A

Psychological pain becomes physical

215
Q

Nociceptive pain

A

Nerve receptors detecting harmful stimuli

216
Q

Neuropathic pain

A

Damage or dysfunction of any level of nervous system

217
Q

Inflammatory pain

A

Two aspects - inflammatory and immune responses accompanying and causing both nociceptive and neurogenic pain and inflammatory pain syndromes

218
Q

Somatic pain

A

Stimuli in tissues activates nerve receptors and produces sensation of pain

219
Q

Visceral pain

A

Nerves in internal organs are stimulated

220
Q

Radicular pain

A

Generated by stimuli at nerve root at connect to spinal nerves

221
Q

Phantom pain

A

Pain in part of body that has been removed

222
Q

Cancer pain

A

Little to no pain, a true, chronic, nerve, bone, tissue, referred, phantom, inflammatory

223
Q

Cutaneous pain

A

Pain that originates from skin, muscle or peripheral nerves
Pain from shot

224
Q

Cutaneous pain

A

Pain that originates from skin, muscle or peripheral nerves
Pain from shot

225
Q

Referred pain

A

Sensation of pain distant from actual source
Heart attack

226
Q

Terms describing pain

A

Quality: sharp, dull, diffuse, shifting
Severity: severe or excruciating, moderate, slight/mild
Periodicity: continuous, intermittent, brief or transient

227
Q

General assessment of pain

A

Verbalization and description
Onset and duration
Etiology or mechanism
Location
Quality, character and intensity
Aggravating or causal factors
Alleviating or causal factors
Effect on function
Pain management goal

228
Q

basic methods of assessing pain

A

Self reply
Identify pathologic conditions or procedures that could cause
Consider physiologic measure (BP pulse)
Report of family member or caregiver
Nonverbal behaviors
Protecting painful area
Attempt an analgesic trial and monitor results

229
Q

PAINAD

A

Pain assessment in advances dementia scare
Observe and score on breathing, negative vocalization, facial expression, body language, consolability

230
Q

NRS

A

Numberic rating scale
1-10

231
Q

Wong-Baker FACES

A

Pain scape based on facial expression
Usually 6 faces

232
Q

NIPS

A

Neonatal infant pain scale
Behavioral tool
Facial expression, breathing, crying, motor activity, state of arousal

233
Q

Diagnosing pain

A

Type
Etiologic factors
Behavior, physiological, affective response
Other factors affecting pain process

234
Q

Nursing intervention for pain

A

Trusting relationship
Manipulating factors affecting pain experience
Initiating complementary health approaches and integrative health care
Managing pharmacological relief
Ensuring ethical and legal responsibility to relieve
Understanding placebo controversy

235
Q

Cutaneous stimulation

A

Alternative way to relief pain
Holding hand and rubbing it

236
Q

Analgesic administration

A

Opioid
Adjuvant
Non-opioid

237
Q

Principals of analgesic admin

A

Ongoing assessment
Management of breakthrough pain
Concern about prescription analgesic abuse

238
Q

Numeric Sedation Scale

A

S: sleep, easy to arouse, no action necessary
1: awake and alert, no action necessary
2: occasionally drowsy, but easy to arouse, no action necessary
3: frequently drowsy, drifts off to sleep during conversation, reduce dosage
4: somnolent with minimal or no response to stimuli, discontinue opioid, consider use of naloxone (narcan)

239
Q

Pain management regimens for cancer or chronic pain

A

Give meds orally if possible
Admin meds ATC (around the clock) rather than PRN (as needed)
Adjunct the dose to achieve maximum benefit with minimum side effects
Allow patient as much control as possible over the regimen

240
Q

Pain treatment in children

A

No aspirin under 18
<4000 mg of Tylenol in 24 hrs

241
Q

Pain treatment in older adults

A

Communication difficulties
Denial of pain
Metabolism rate is lower so it takes longer to begin working and to leave their system

242
Q

Methods for admin of analgesics

A

Patient controlled analgesia (PCA)
Epidurals analgesia and peripheral nerve blocks
Topical anesthesia

243
Q

Ageism

A

Discrimination based on age

244
Q

The three Ds

A

Dementia
Delirium
Depression

245
Q

Dementia

A

Progressive, chronic decrease in cognitive function
Characterized: slow, progressive onset, memory loss, confusion, difficulty solving problems, long term, permanent

246
Q

Delirium

A

Acute, often sudden disturbance in mental status that can lead to confusion, disorientation and difficulty focusing
Characterized: fluctuates, temporary and reversible
UTI? Could cause if resolve goes away

247
Q

Depression

A

Mood disorder marked by persistent feeling of sadness, hopelessness and lack of motivation
Characterized: gradual or sudden, often treatable with therapy and meds

248
Q

Gerontology

A

Scientific study of aging

249
Q

Gerotranscendence

A

Psychosocial theory erkison and Maslow
Shift of perspective with age -> increase life satisfaction and more cosmic/ spiritual understanding of life

250
Q

Polypharmacy

A

Lots of meds for one person

251
Q

Sacropenia

A

Wasting of the muscle, trouble walking, falling a lot

252
Q

Sacropenia

A

Wasting of the muscle, trouble walking, falling a lot

253
Q

Sundowning

A

Alert and oriented during the day but as it goes on gets increasingly more confused and disoriented

254
Q

Gerontological

A

Related to field of gerontology including study, research and application of knowledge of the aging adult

255
Q

Sandwich generation

A

Usually between ages of 40-50
Trying to take care of their family and also their aging parents

256
Q

Biological and psychological theories of aging

A

Maslow and Erkison
Combination of the two neither is 100% right
Also effected by genetics life experiences and choices

257
Q

Roles of the nurse

A

Promote health
Prevent illness
Promote independence
Promote gerotranscendence

258
Q

Nursing assessment

A

Physical
Psychological
Emotional
History
Medication reconciliation

259
Q

Changes in body contour in older adults

A

Bony prominence show
Weight distributed (to waist and hips)
Subcutaneous tissue leaves the face and arms and moves to abdomen/hips
Height decreases

260
Q

Musculoskeletal changes in older adults

A

Wide base gait
Weight decreased (sacrcopeia)
Lead to decreased: physical endurance, physical activity, loss of activity

261
Q

Older adult composition

A

Decrease in total body water
- due to the decrease in muscle cell mass
Unintentional weight loss NOT part of aging
- older adults experience early satiety - feeling of being full-change in gastric hormone

262
Q

Older adult temp regulation

A

Less likely to have a fever
Less fat reserves
More likely to have hypothermia
Slower metabolism - the capacity for endotherms to regulate temp declines
Produce less body hear
Thermoregulatory impairment
Median temp 96.8
Swear glads diminish in size and function

263
Q

Causes of hypothermia

A

Decrease activity
Severe hypothyroidism
Hypoglycemia
Malnutrition
Acute illness (preserve organs)
Medications

264
Q

Meds that can cause hypothermia

A

Beta blockers neuroleptics and anesthetic

265
Q

Meds that can cause hypothermia

A

Beta blockers neuroleptics and esthetics

266
Q

Epidermis older adults

A

Regeneration slows
Reduced barrier protection

267
Q

Dermis older adults

A

A supportive layer a 20% loss causes older skin to look more transparent and frail

268
Q

hypodermis older adults

A

Contains connective tissues, blood vessels and less adipose tissue
Dry skin (xerosis) and accompanied by itchy skin (pruitus)

269
Q

Hair older adults

A

Loss melanin (color)
Alopecia may occur

270
Q

Hair older adults

A

Loss melanin (color)
Alopecia may occur

271
Q

Nails older adults

A

Thicken (onychorrhexis)
Brittle, flat
Vertical ridges
Onycholysis (nails separating from nail bed)

272
Q

Head and neck older adults

A

Bones are more prevalent
Great vessels may have bruits (atherosclerosis)
Neck shortens r/t osteoporotic changes
Thyroid usually not palpable
Loss of subcutaneous tissue

273
Q

Eyes older adults

A

Decreased eyelid elasticity
- ectropion, entropion
Conjunctiva become thinner and yellow with increased risk to infection
Pingucula
- overgrowth of conjunctiva
Lacrimal glands and ducks (blocked)
Tears decrease

274
Q

Physiologic changes in eyes

A

Eyeballs sit deeper in sockets
Cornea flattens and iris fades
Pupils become smaller, scleras become thick and ridged

275
Q

Presbyopia

A

Decreased ability to adjust near/far vision

276
Q

Vision impairments with age

A

Decreased visual acuity (especially near)
Narrowing of visual field
Difficulty gazing upward and maintaining convergence, adapting to light changes

277
Q

Glaucoma

A

Black faded right around field of view

278
Q

Cataract

A

Blurred vision

279
Q

Factors affecting hearing

A

Cerumen build up
Corgi (hearing receptor) and the auditory nerve atrophy
Tympanic membrane thickening
Tinnitus

280
Q

Presbycusis

A

Hearing loss

281
Q

Hearing impairment

A

Decreased tine discrimination
Decreased ability to discern constants ( L, M, N,P)
Decreased equilibrium due to vestibular changes

282
Q

Signs and symptoms of hearing loss

A

Increased TV volume
Tilting head towards person speaking
Cupping hard around ear
Watching lips
Speaking loudly
Not responding

283
Q

Smell perception and Agee

A

Declines after age 60
Rapid decline at age 80
Cell loss
- olfactory bulb
- sensory cells
Decrease in appetite and smell

284
Q

Mouth and teeth and age

A

Teeth loose enamel and dentin
- become more vulnerable to tooth decay
- incident of periodontal disease
Dentures

285
Q

Taste perception and age

A

Decrease taste gradually decline
- taste buds atrophy
- amylase decreased in saliva-enzyme aids in digestion
- accelerated by meds or smoking
- Decreases appetite

286
Q

Musculoskeletal structure age

A

Discs become thin-lose height
Posture adjustment

287
Q

Bones and age

A

Decrease in bone density

288
Q

Joints, tendons, and ligaments and age

A

Cartilage changes
Tendons mat shorten- contractures

289
Q

Muscles and age

A

Atrophy of muscle tissue - weakness

290
Q

Heart and age

A

Valves - calcification may produce murmurs
Conductivity - SA node, pacemaker of the heart

291
Q

Blood vessels and age

A

Arteries - atherosclerosis = PVD (caused by build up of plaque in arterial walls)
Veins - insufficiency = poor venous return

292
Q

Other cardiovascular changes with age

A

Atrial Fibrillation can occur from fibrosis or SA node blood clots
More likely to show s/s of cardiovascular changes r/t dependent postitions

293
Q

Respiratory system and age

A

Limited chest expansion
Senile emphysema - increase in size of alveolar
Alveolar Duct Ectasia - widens/thickens
Loss of elastic recoil deep breaths
Stiffening of chest wall - COPD
Retaining CO2
Less responsive cilia
Diminished cough
Less mobility

294
Q

Kidneys and age

A

Loss of nephrons
Decreased kidney mass

295
Q

Renal vessels and age

A

Decreased renal blood flow

296
Q

Ureters bladder urethra and age

A

Decreased tone and elasticity
Decreased bladder holding capsity
Urgency and frequency increase
Nocturia

297
Q

Glomerular Filtration Rate

A

Rate the kidneys are filitering
Linear decline with age

298
Q

Thyroid gland and age

A

Incidence of hypothyroidism
Usually requires lower doses of thyroid replacement

299
Q

Parathyroid gland and age

A

Changes in it may be cause of alteration in calcium
Due to bone loss

300
Q

Pancreas and age

A

Secretion does NOT decrease
Tissue may level decrease sensitivity to insulin

301
Q

Esophagus and age

A

Contraction increases
Propulsion is decreased

302
Q

Stomach and age

A

Decreased motility
Increase risk for aspiration
Reduction secretion of bicarbonate and gastric mucous

303
Q

CNS and age

A

Neurons shrink
Neurotransmitters - dopamine/serotonin declines 10% per decade

304
Q

PNS

A

Motor sensory and reflex’s decrease

305
Q

Female reproductive system and age

A

Decreased estradiol
Breast size decreased
Breast lumps more evident
Post-menopause
Cessation menses, atrophy of ovaries

306
Q

Female reproductive system and age

A

Decreased estradiol
Breast size decreased
Breast lumps more evident
Post-menopause
Cessation menses, atrophy of ovaries

307
Q

Male reproductive system and age

A

BPH (benign prostatic hypertrophy)
- dripping/difficulty initiating urine stream
May see an increase in breast fatty tissue

308
Q

Immune system and age

A

Decrease in T-cell function
Decrease in response to foreign antigen
- flu shot

309
Q

Sleep and age

A

Interrupted REM episodes
Increased total daily sleep - naps
Increased awakening after sleep onset
- wake up feeling tired

310
Q

Mood and behavior and age

A

Depression
Anxiety
Irritability
Fear
Despair
Risk for suicide

321 assessment of clients (7 decks)

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