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Nursing Fundamentals > Unit V > Flashcards

Unit V Flashcards

1
Q

reception

A
  • receptor (nerve cell) is stimulated
  • nerve impulse travels from receptor to spinal cord or directly to brain
  • sensory experience
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2
Q

perception/awareness

A

receiving region of the cerebral cortex interprets the quality and nature of sensory stimuli

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3
Q

level of consciousness (LOC)

A

influences how well stimuli is received and interpreted

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4
Q

reaction to sensory stimuli

A
  • action taken by the person after the meaning has been given (perceived)
  • usually only react to stimuli that are most meaningful
  • continual reception of the same stimulant causes cessation of the response: it goes unnoticed
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5
Q

sensory deficit

A
  • impairment of sight, hearing, taste, touch (including pain and pressure), smell or sense of position
  • may be torn with or develop
  • successful compensation is often possible
  • sudden loss makes adjustment harder
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6
Q

sensory deprivation

A
  • inadequate quality of quantity of sensory stimulation
  • may be physiologic
  • may be due inadequate amount or variety of stimuli
    ex. bed rest
  • may be experience CNS changes such as impaired judgement, confusion, hallucinations
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7
Q

sensory overload

A
  • when stimuli in the environment are excessive or beyond the person’s ability to absorb or comprehend
  • stressful
  • high anxiety
  • sleeping pattern
  • confusion
  • aggression
  • sights, smells, sounds
  • can lead to sensory perceptual alterations
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8
Q

physiologic

A
  • tumors
  • vascular
  • stroke
  • rupture
  • trauma to head
  • metabolic
  • DM
  • vitamins deficiency
  • degenerative diorders
  • Alzheimer’s
  • medication side effects
  • chemotherapy/radiation
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9
Q

vision

A
  • visual acuity using Snellen chart
  • distance at which patient holds materials to read
  • burred vision, blind spots, double vision, halos around lights, floaters
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10
Q

hearing

A
  • acuity in normal conversation, whispering, watch, tuning fork
  • speech and language development in kids
  • presence of tinnitus
  • ask significant other if patient is responding appropriately
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11
Q

taste

A
  • ability to taste
  • decrease in appetite
  • increased use of seasonings to make food taste good
  • difficulty swallowing
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12
Q

smell

A
  • ability to distinguish odors

- ask about ability to smell food

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13
Q

touch

A
  • ability to distinguish between sharp and dull
  • ability to feel light touch
  • ability to differentiate between hot and cold
  • ask about numbness, tingling or prickling sensations
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14
Q

position (proprioception)

A
  • assess ability to walk in a straight line
  • assess ability to stand still with feet together
  • ask about dizziness, motion sickness, nausea, change in steadiness and/or gait
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15
Q

level of consciousness (LOC)

A
  • time
  • place
  • person
  • president
  • year
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16
Q

environment

A
  • hazards at home

- hazards in hospital

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17
Q

hazards at home

A
  • stairs
  • clutter
  • furniture
  • stimuli
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18
Q

hazards in hospital

A
  • furniture

- equipment

19
Q

stimuli

A
  • pets
  • radio/TV
  • clock/calendar
  • pictures
  • tubes
  • noise
20
Q

assessment

A
  • speech
  • listening (hearing)
  • verbal/nonverbal
  • posture
  • readiness to communicate
21
Q

nursing diagnoses

A
  • alteration in communication

- impaired verbal communication

22
Q

planning

A
  • what is needed to be done to enhance the communication process
  • what can the patient do
  • what will the nurse do
  • review resources
23
Q

implementation

A
  • safety is top priority
  • maintain stimulating environment
  • health promotion
  • acute care
  • continuing care
24
Q

health promotion

A

better diet/choices

25
Q

evaluation

A
  • patient/client care
  • was goal met?
  • patient/client expectations
  • did nursing meet your expectations?
26
Q

gerontological nursing

A
  • treatment of older people and all aspects of the aging process and its consequences
  • health promotion
  • education
  • disease prevention
27
Q

geriatrics

A
  • branch of health care dealing with physiology and psychology of aging
  • diagnosis and treatment of diseases affecting older adults
28
Q

ageism

A
  • prejudices, sterotypes and myths that are applied to older people based solely on their age
  • old people are sick and disabled
  • most old people are in nursing homes
  • senility comes with old age
  • intelligence decreased with age
  • not interested in sex
  • few satisfactions
29
Q

vital signs

A
  • temperature
  • pulse
  • respiration
  • cardiac
30
Q

temperature

A
  • extremities cooler

- less perspiration

31
Q

pulse

A
  • peripheral pulse easy to palpate

- pedal pulses diminished

32
Q

respirations

A

rate increases

33
Q

cardiac

A
  • B/P rate 140-160/80-90

- related to decreased cardiac output

34
Q

hearing

A
  • presbycussis

- decreased pitch discrimination

35
Q

presbycussis

A

progressive loss of hearing acuity

36
Q

vision

A
  • presbyopia
  • depth in perception difficulties
  • delayed glare recovery time
  • decreases light/dark adaptation, impaired night vision
  • decreased color discrimination
37
Q

presbyopia

A

progressive loss of visual acuity

38
Q

taste

A
  • decreased acuity of taste; decreased saliva flow
  • diminished in most people over 60
  • smoking may atrophy taste buds sooner
39
Q

smell

A
  • diminished ability to smell
  • diminished ability to discriminate smells
  • affects taste as well
  • declines in persons over 70
40
Q

neurological

A
  • slower reflexes
  • decreased ability to respond to multiple stimuli
  • insomnia
  • shorter sleeping periods
41
Q

reproductive

A
  • female

- male

42
Q

female

A
  • decreased estrogen
  • vaginal dryness
  • decreased secretions
43
Q

male

A
  • decreased testosterone

- decreased sperm count

44
Q

teaching

A
  • keep living areas well lighted, free of clutter, keep eyeglasses in good condition, avoid night driving
  • proper working assistive devices (canes, rails in tub and bathroom, elevated seats) nonskid strips in bathtub
  • avoid smoking in bed, lower thermostats on water heaters, avoid overloading electrical outlets, install and maintain smoke and carbon monoxide detectors
  • drive only short distances and in the daylight, avoid driving in inclement weather (fog, heavy rain, snow), use side and rear view mirrors, look behind them toward their blind spot before switching lanes, keep window rolled down in order to hear sirens and horns
  • proper handling and storage of medications and safe methods of scheduling and taking medications
  • drug interactions, signs and symptoms of drug toxicity to report to their health care provider
  • ways to meet expectations with the patient’s capabilities, how to incorporate earlier life skills and interests, provide calm, caring, and structured environment

Nursing Fundamentals (6 decks)

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