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LPN to RN > x N109 - Foundations in Nursing Practice > Flashcards

x N109 - Foundations in Nursing Practice Flashcards

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1
Q

Stage 1

A

Trust vs Mistrust

Infants. trust world? safe?
if fear = doubt, mistrust

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2
Q

Erikson’s 8 stages of Development: Stage 1

A

Trust vs Mistrust (infant 1-2yr)

Infants. trust world? safe?
if fear = doubt, mistrust

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3
Q

Erikson’s 8 stages of Development: Stage 2

A

Autonomy vs Shame/Doubt (early child 2-4)

Is it ok to be me? If yes, confidence, if not, shame/self doubt

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4
Q

Erikson’s 8 stages of Development: Stage 3

A

Initiative vs Guilt (pre school 4-5)

Pre School- Ok to do what I do? If so, follow interest, if not supported, guilt

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5
Q

Erikson’s 8 stages of Development: Stage 4

A

Industry vs Inferiority (5-12)

If recognized = industrious
if neg feedback = inferior, lose motivation

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6
Q

Erikson’s 8 stages of Development: Stage5

A

Identity vs Role Confusion (adolescence 13-19)

Go out and find our identity. If stifled, lost and confused.

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7
Q

Erikson’s 8 stages of Development: Stage 6

A

Intimacy vs Isolation (young adults 20-40)

can we love? long term commitment? if yes = happy, if not = lonely, isolated

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8
Q

Erikson’s 8 stages of Development: Stage 7

A

Generatively vs Stagnation (adulthood 40-65)

Able to lead next generation? Happy. If not, stagnant.

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9
Q

Erikson’s 8 stages of Development: Stage 8

A

Ego Integrity vs Despair (maturity 65 - death)

go over lives. if happy = integrity, if not happy = bitter, despair

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10
Q

Freud’s 5 Stages of Psychosexual Development

A
  1. Oral
  2. Anal
  3. Phallic
  4. Latency
  5. Genital
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11
Q

Oral

A

(I0-1)
Breastfeeding
pleseure in mouth

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12
Q

Anal

A

(2-3)
child discovers feces
learn to control bowel mvmts

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13
Q

Phallic

A

(3-6)

Discover genitals and pleasure that comes from them

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14
Q

Genital

A

(12+)

stage of sexual maturity. puberty. experiment, discover.

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15
Q

Healthy People 2020 Determinants

A
  1. Biological/Genetic Makeup
  2. Individual Behaviors
  3. Social Interactions and Norms
  4. Physical Environment
  5. Access to Healthcare Services
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16
Q

Piaget Cognitive Development

A

Sensorimotor Stage (baby)

experience world by touch.

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17
Q

Piaget Cognitive Development

A

Sensorimotor Stage (baby)

experience world by touch.

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18
Q

Sensorimotor Stage

A

(o-2)

baby

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19
Q

Pre-operatoinal Stage

A 
(2-6)
language foundational
lack logical reasoning
egocentrism
unlimited imagination
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20
Q

ormal Operational Stage

A

(12+)
know bad vs good
moral reasoning

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21
Q

ormal Operational Stage

A

(12+)
know bad vs good
moral reasoning

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22
Q

Adolescence

A

10 - 19

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23
Q

Babinski Reflex

A

Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus.

The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.

This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.

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24
Q

Babinski Reflex

A

Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus.

The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.

This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.

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25
Q

Healthy People 2020 Overreaching goals

A
  1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
  2. Achieve health equity, eliminate disparities, and improve the health of all groups.
  3. Create social and physical environments that promote good health for all.
  4. Promote quality of life, healthy development, and healthy behaviors across all life stages.
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26
Q

Healthy People 2020 Overreaching goals

A
  1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
  2. Achieve health equity, eliminate disparities, and improve the health of all groups.
  3. Create social and physical environments that promote good health for all.
  4. Promote quality of life, healthy development, and healthy behaviors across all life stages.
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27
Q

Piaget: The child is better able to think about things and events that aren’t immediately present. She has difficulty conceptualizing time. Her thinking is influenced by fantasy. The child begins to think about death.

A

Intuitive Thought phase

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28
Q

Piaget: As the child learns to talk and communicate with others, he begins to use symbols to represent objects. Early in this stage he also personifies objects.

A

Preconceptual or Preoperational phase

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29
Q

Piaget: The child begins to cooperate and is less egocentric. The child develops the ability to think abstractly and to make rational judgments about concrete or observable phenomena.

A

Concrete Operations phase

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30
Q

Piaget: At this stage the individual is capable of hypothetical and deductive reasoning.

A

Formal Operations phase

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31
Q

Piaget: The child learns about his environment and himself through motor and reflex actions. Thought derives from sensation and movement.

A

Sensorimotor phase

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32
Q

Levels of Prevention/Care

A
  • Primary: pre-dx, prent disease from occuring. health teach, immunizations, lifestyle changes
  • Secondary: early detection, screenings, pap, montoux
  • Tertiary: reduce complications once dx made
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33
Q

Loss

A

something/one w value and meaning permanently gone, taken from you or changed.

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34
Q

Anticipatory Loss

A

feels of loss before actual death. Sickness. Lengthy dying process.

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35
Q

Actual Loss

A

loss of individual/object that is obvious to others

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36
Q

Perceived Loss

A

experience can not be verified

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37
Q

Developmental Loss

A

empty nest, menopause, off to college

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38
Q

Situational Loss

A

alteration of life situation

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39
Q

Sources of Loss

A

.aspect of self
.object outside of oneself (theft)
. separation from familiar envt
.loss of loved ones

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40
Q

Grief Response

A

temporary/emotional repose to loss

Bereavement: overall reaction to loss
Mourning: cultural process enabling resolve of grief.

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41
Q

SS Grief

A 
. talk about loss
. crying
. bad sleep
. loss apetite
. diff concentrating
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42
Q

Types of Grief

A

.Abbreviated
.anticipatory
.disenfranchised
.delayed

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43
Q

Dysfunctional Grieving

A

.Unresolved (unusual length and severity)

.Inhibited (not accepting it)

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44
Q

Somatic Response

A

physical canges

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45
Q

men have more difficulty coping with loss

A

.

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46
Q

Therapeutic Relationship

A 
Helping Relationship:
.trust
.professionalism
.mutual respect
.caring
.partnership

Intro phase: establish rapport
working phase: achieve goals
termination phase: eval

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47
Q

Kubler-Ross

A

DABDA

denial, anger, bargaining, depression, acceptance

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48
Q

Egel

A

shock and disbelief, developing awareness, restitution, resuscitation, recovery

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49
Q

Lindeman

A

shock disbelieve, acute mourning and resolution

'Grief Work' 
typical grief reactions
1. somatic
2. preoccupy w image of diseased
3. guilt
4. hostile reactions
5. loss
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50
Q
  • Bowlby’s Stages of Mourning
A

4 stages of Mourning

  1. shock / numbness
  2. yearning / searching
  3. Despair / Disorganization
  4. Reorganization / recovery
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51
Q

worden

A

4 tasks to deal w loss

.accept
.experience
.adjust
.reinvest

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52
Q

Rando’s 6 R’s

A 
.recognize loss
.react
.recollect and re-experience
.relinquish
.readjust
.reivest
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53
Q

Martocchio’s 5 stages of Grief

A 
.shock/disbelief
.yearning/protest
.anguish/disorganization/despair
.identification
.reorganization/restitution
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54
Q

Sanders Integrative Theory of Bereaement

A 
.Shock
.Awaremess of Shock
.Conservation-withdrawal
.Healing
.Renewal
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55
Q

Factors influencing grief

A 
.age/develop level
.significance of loss
.culture
.spiritual beliefs
.gender (mean don't cope as well)
.socioeconomic status
.support system
.cause of loss
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56
Q

Death and Dying

A

developmental

infant-5: can't relate
5-9: death is final
9-12: higher level
12-18: feel invincible
18-45: a perceived future event
45-65: accepts own mortality
65+: fear prolonged illness. prefer to poor quality of life.  lots of death around you
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57
Q

Death

A

cessationof apical pulse, repration and bp.

lack of response to external stim,
no breathing or musc mvmt, no reflexes, flat EKG

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58
Q

Cerebral Death

A

cerebral cortex destroyed

  1. Apnea
  2. absence of cephalic reflexes
  3. absence of purposeful responses to external stimuli
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59
Q

Dying Trajectory

A

. Sudden, unexpected
. steady decline w short terminal phase
. slow decline

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60
Q

Physiological needs of dying pt

A

airway clearance: fowlers/conscious, lateral/unconscious
. bathing/hygiene
. physical mobility
. nutrition
.constipation (fiber, colace)
.urinary fx
.sensory/perceptual changes (room lighting, touch, pn mgmt)

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61
Q

Cheyne Stokes breathing

A

see diagram

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62
Q

Care after Death

A 
. treat body w respect and dignity
.bath and put clean gown on body
. remove dressings, tubes
. place body in alignment
. put dentures in
. comb clients hair
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63
Q

Care after Death

A 
. treat body w respect and dignity
.bath and put clean gown on body
. remove dressings, tubes
. place body in alignment
. put dentures in
. comb clients hair
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64
Q

Body Changes after Death

A

Rigor Mortis: rigid 2-4hrs after death

Algor Mortis - gradual decrease in body temp. 1.8F until body temp

Livor Mortis: discoloration of tissue due to blood settling

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65
Q

Hospice

A

6mos or less to live

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66
Q

Palliative Care

A

care of whole person. goal: quality of life

enhances comfort and improves quality

available any time throughout illness. not only end of life, hospice.

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67
Q

Barriers to Hospice/Palliative

A

. medicine focus on cure and prolonging life
. insurance reimbursement
. public lack of understanding
. lo training of health prof

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68
Q

Edmonton Symptom Assessment Scale

A

1-10 various questions.

used to assess and track level of SS pts are experiencing on scale of 0-10

Admin by nurse first visit, then every 2 weeks.

Pt completes daily.

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69
Q

Symptom Assessment

START HERE slide 50

A

Brief Pain Inventory: completed by pt, details of pain

bedside confusion scale: simple tool for reassessing delirium and confusion

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70
Q

IMS Impaired Mental Status

A
  1. Hypoactive IMS (w/drawal, somnolence)
  2. Hyperactive IMS (anger, agitation)
  3. Possibly combative behaviour
  4. Restlessness
  5. Delirium
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71
Q

deal w patients experience loss

A 
silence
.attentive listening
.open/closed listening
.paraphrasing
.clarify
.summarize
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72
Q

Nurse facilitates the work of grieving

A

Respect
Educate
Encourage

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73
Q

Effective measures for providing comfort

A 
acupuncture
massage
music
art
aroma
relaxation
guided imag
pet
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74
Q

Do NOT SAY to dying patient

A
  1. I dont think things are really that bad.
  2. you don’t really mean that
  3. God will take you when he wants you
  4. you are doing so well
  5. let’s talk about something more positive
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75
Q

physiological needs

A 
respiration
fluid/nutrition
mouth, eyes, nose
 mobility
skin care
elimination
comfort
physical envt
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76
Q

Somatic Pain

A

direct stimulation of intact nocicepters ad elec signals normally transmitted along fxing nerves

occus w tissue damage (i.e. bone metastasis, fractures, skin lesions

PAIN is dull, aching, gnawing, throbbing, localized and constant or intermittent

Tx: opioids, anti inflam agents, steroids, radiotherapy

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77
Q

pain syndromes: visceral gut pain sydrome:

A

stim of autonomic ns which provides connection to all organs

PAIN is sharp, aching, squeezig, cramping, pulling

TX:Opioids, anticholinergics

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78
Q

WHO Analgesic Ladder

A

Nurse: determine type of pain
pt description

TX for Cancer Pain
MILD: non opioids
MOD: opioids w or w/out steroids
SEVERE: opioids w/wout ster

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79
Q

Breakthrough doses for Pain Mgmt

A

BTD Breakthrough dose

pain mgmt best before pain reaches an intolerable level

mod to severe pain treated w immed release opiod q1-4hrs prn. then sustained release med

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80
Q

Breaktough Dose

A

Rescue Dose: 10% of total 24hr dose

Should be available q HR prn for oral meds and q 20m prn for SQ meds.

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81
Q

Dyspnea

A 
-lo dose immediate release opioids
.morphine drug of choice at end of life tx
.expectorants
.diuretics
.corticosteroid
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82
Q

Anxiety

A

.Benzodiazepine
.Tranquilizers

Situational Anxiety: worry about physical condition, finances, fam, uncertain future

Drug related anxiety: worry about therapy use in palliative care, drug induced effects, withdrawal

Organic anxiety: result fr uncontrolled SS, pain, dyspnea, insomnia, hypoglycemia

Phsychologic anxiety: hoplessness, fears, death thoughts

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83
Q

Meds for N/V

A 
.Decadron
.Ativan
.Benadryl 25mg
.Metoclopramide 10mg / Haldol 1mg suppository
.Octreotide per persistent vomiting
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84
Q

Lysaught Report (1970)

A

Lysaught Report (1970) prompted research-based education of nurses and research into nursing education. Now the Carnegie Foundation for the Advancement of Teaching has funded another watershed study: Educating Nurses: A Call for Radical Transformation (Benner, Sutphen, Leonard, & Day, 2010) finds that, although the U.S. nurse educators are very effective in teaching ethics and professionalism and are often successful when they integrate theory and clinical courses, they are “not generally effective in teaching nursing science, natural sciences, social sciences, technology, and humanities” (p. 12). At each turning point in the history of nursing education, nurse educators, have assessed learning outcomes and the methods used to achieve them with the same critical eyes that they apply to evidence-based clinical nursing practice. Today nurse educators are examining the field’s signature pedagogies, like clinical rotations and simulation, and are turning to new approaches, like narrative and problem-based pedagogies or study-abroad experiences.

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85
Q

Brown Report (1948)

A

In one of the seminal reports on nursing education, Esther Lucille Brown (1948) observed that the extant system of nursing education was totally inadequate to meet the needs of society for nursing care. … The public and professional response to the Brown report was business as usual.May 31, 2002

86
Q

Chronic Illness

A

Illness permanent, leaves residual disability.
.6mos - life
.most common in older, possible in any age group.
.85% of 65yr old have at least 1 chronic condition
.slow onset
.periods of exacerbation and remission

87
Q

Acute Illness

A

.SS occur suddenly, short course

. i.e Cough, cold, flu, appendicitis, acute MI, trauma

88
Q

Chronic Illness, I.e.

A 
.DM
.Heart Disease
.HTN
.Visual Impairment
.Osteoporosis/hop fractures
.Alzheimer's Disease/Mem impairment
.stroke
.incontinence
.depression
.parkinson's
.HIV
89
Q

in 2010 48% or adult deaths from…

A

heart disease and cancer

90
Q

health risks

A 
.lack exercise
.poor nutrition
.smoking
.ETOH
.HBP
.Hi LDL
91
Q

Primary care

A

-pre-dx via education, immunizations, lifestyle

92
Q

Secondary care

A

.early detection while ASYMTOMATIC and Tx can effect cure (ie. screenings, pap, Mantoux tests)

93
Q

Tertiary Care

A

reduce complications once Dx made.

94
Q

Trajectory Model of Chronic ILlness

A

.Corbin/Strauss
.IDs diff phases that client goes through
.anticipate potential probs that w need specific interventions

95
Q
  • 8 Phases of Trajectory Model of Chronic Illness
A
  1. Pre-trajectory (at risk, lifestyle, genetics, GOAL prevent onset)
  2. Trajectory onset (Dx, GOAL develop plan)
  3. crisis (GOAL remove threat)
  4. acute
  5. Stable (GOAL maintain)
  6. Unstable (GOAL return to stable)
  7. Downward (GOAL acceptance/address current issues)
  8. Dying (GOAL acceptance, peaceful death)
96
Q

Chronic Care Model

A

Wagner - created HMO.

MD too busy to care about preventing illness and treating chronic dx. HMO creates team of professionals to manage health.

97
Q

Signs of Imminent death

A
  1. skin becomes cool, mottled
  2. disorientation
  3. incontinence
  4. dyspnea, cheyne stokes breathing
  5. decrease in appetite/thirst
  6. loss of muscle tone
  7. decrease in consiousness
98
Q

Off Label Drugs

A

Drugs approved for one prob but used for another

.Methadone for pain relief
.Valproic Acid and Gabapentin for neuropathic pain
.Ritalin to improve opioid analgesia andreduce sedaition
.Thalidomide for anorexia
.Paxil for pruritis
.Baclofen for hiccups

99
Q

pain syndromes: Neuropathic Pain

A

probs w peripheral nervous system and may result of shingles, diabetic neuropathy

PAIN is burning, stabbing, shooting, tingling, numbness, radiating, electric like

TX: opioids, tricyclic antidepressants, anticonuvlsants

100
Q

pain syndromes: Neuropathic Pain

A

probs w peripheral nervous system and may result of shingles, diabetic neuropathy

PAIN is burning, stabbing, shooting, tingling, numbness, radiating, electric like

TX: opioids, tricyclic antidepressants, anticonuvlsants

101
Q

Meds for Constipation

A

.Corticosteroids
.Stool Softeners or laxatives
.docusate 100mg bid po, reduces cramping more than stimulant laxatives
.Senna (1-2 tabs hs)
.Fleet Enema or biscacodyl suppository if no BM in 3 days

102
Q

Meds for Constipation

A

.Corticosteroids
.Stool Softeners or laxatives
.docusate 100mg bid po, reduces cramping more than stimulant laxatives
.Senna (1-2 tabs hs)
.Fleet Enema or biscacodyl suppository if no BM in 3 days

103
Q

Assessment for pt w breathing diff

A

BREATH AIR

.bronchospasms
.rales
.effusions
.airway obstruction
.thick secretions
.hemoglobin (low)
.anxiety
.interpersonal issues
.religious concerns
104
Q

Engel’s 5 stages of grieving

A
  1. Shock and Disbelief - a stunned/numb feeling; refusal to acknowledge loss
  2. Developing Awareness - begins to acknowledge loss; may feel helpless and angry
  3. Restitution - conducts rituals of mourning
  4. Resolution - preoccupied with the loss and will often idealize the person, object or skill that was lost
  5. Recovery - goes on with life while accepting the loss
105
Q

Engel’s 5 stages of grieving

A
  1. Shock and Disbelief - a stunned/numb feeling; refusal to acknowledge loss
  2. Developing Awareness - begins to acknowledge loss; may feel helpless and angry
  3. Restitution - conducts rituals of mourning
  4. Resolution - preoccupied with the loss and will often idealize the person, object or skill that was lost
  5. Recovery - goes on with life while accepting the loss
106
Q

Types of Loss

A 
.anticipated
.perceived
.situational
.actual
.developmental
.physical
.psychological
107
Q

Types of Loss

A 
.anticipated
.perceived
.situational
.actual
.developmental
.physical
.psychological
108
Q

Euthenasia

A

.Active euthanasia: doing something which directly/ intentionally leads to person’s death; act of commission with specific end in mind

.Passive euthanasia: act of omission; death allowed to occur by either withdrawing or withholding tx that might prolong life; intentional

.Voluntary euthanasia: when dying individual desires some control over the time and manner of death

.Involuntary euthanasia: 1994 Oregon approved the right to die law: physician-assisted suicide law

109
Q

Pain Syndromes

A

SOMATIC pain: direct stimulation of intact nociceptors and electrical signals which are transmitted along normally functioning nerves
occurs with tissue damage (bone metastasis, fracture, skin lesion)
pain is dull, aching, gnawing or throbbing; localized and constant or intermittent
opioid therapy, anti-inflammatory agents, steroids, radiotherapy

VISCERAL gut pain syndrome: stimulation of the autonomic nervous system which provides the nervous system connection to all the organs
pain is sharp, aching or squeezing, cramping or pulling
opioids, anticholinergics

NEUROPATHIC pain: problem with the peripheral nervous system and may be the result of shingles, diabetic neuropathy
pain is burning, stabbing, shooting, tingling, numbness, radiating or electric like
opioids, tricyclic antidepressants, anticonvulsants

110
Q

The Patient Self-Determination Act (1990)

A

intended to provide individuals with legal means to determine the circumstances under which life sustaining treatment should or should not be provided to them

111
Q

Sensory Impairments

Unit 5, Class 4

A

.

112
Q

Blindness

A

Clinical def of absolute blindness: absence of light perception
.BCVA from 20/400 to no light perception (NLP)
.Legal blindness BCVA does not exceed 20/200 in better eye adn widest visual field diamerter is 20degrees or less

113
Q

Common causes of blindness

A

. Diabetic retinopathy
. macular degeneration
. glaucoma
. cataracts

114
Q

Macular Degeneration

A

AMD, age related macular degeneration

associated w aging, gradually destroys sharp, central vision.

.leading cause of blindness in elderly

SS: blurry vision, distortion, gradual loss of central vision, decreased ability to distinguish colors

AMSLER grid, monitors progression of disease

Wet or Dry (most common) AMD

115
Q

Dry AMD

A

Dry Age related Macular Degenration

light sens cells in macular break down, gradually blurring central vision.

Most common type

Tx: delay disease, HI Antioxidants and Zinc

116
Q

Wet AMD

A

abnormal BV behind retina start to grow under macula, damages

Tx: may progress despite tx. injections to eye

117
Q

Cataracts

A

.clouding of lens
.related to aging
.affects focus of sharp image on retina

SS: cloudy/blurry vision, poor night vision, increased glare, change i color values (blue/yellow), halo around light, double vision

Risk Factors:
.women
.exposure to UV light/Hi dose radiation
.corticosteroids
.phenothiazines
.poor controlled DM
.trauma to eyes
.chemo agents
Tx:
.new glasses
.brighter light
.anti-glare sunglasses
.magnifying lenses
.Sx to remove cloudy lens. replace with artificial
118
Q

Types of Cataract Evaluation

A

.split-lamp exam
.binocular microscope mounted on table
.magnification 10-40x real image
.cataracts eval by changed angle of light

119
Q

Retinopathy

A

any disease of retina

Cause: complications vascular disease, uncontrolled HTN, DM, Arteriosclerosis

SS: progressive loss of vision

Tx: treat underlying cause, stringent glucose control most effective for preventing /limiting disease.

120
Q

4 stages of Diabetic Retinopathy

A

Mild nonproliferative retinopathy:
At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the tiny blood vessels of the retina.

Moderate nonproliferative retinopathy:
As the disease progresses, some blood vessels that nourish the retina are blocked.

Severe nonproliferative retinopathy:
Many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative retinopathy:
At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. (See diagram above.)

By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can occur.

121
Q

Glaucoma

A

group of eye conditions lead to damage of optic nerve

Cause: increased intraocular pressure (IOP)

NORMAL:10-21mm Hg
.IOP fluctuations w time of day, exertion, meds, diet
.IOP increase w blinking, tight lid squeeze, upward gaze
.Incrased IOP damages optic nerve by damaging retinal layer as it passes thru optic nerve head

122
Q

4 types of Glaucoma

A

.Open-Angle
.angle-closure
.congenital
.secondary

123
Q

Stages of Glaucoma

A

. Initiating events (long term use corticosteroids, congenital narrow angles, use of mydriatics
.Structural Alterations in aqueous outflow system
.Fx alteration, increased IOP or impaired blood flow
.Optic Nerve Damage, atrophy of optic nerve
.Vision Loss

124
Q

Open-Angle Glaucoma

A 
.chronic
.most common cause
.IOP pressure up over time
.SS: 
-non until loss of peripheral vision begins
-halos around lights
Late SS: -central blindness

Tx: eye drops, BP meds to lower.

125
Q

Angle-Closure Glaucoma

A

.acute
.w aqueous humour fluid is suddenly blocked
.quick, severe, painful rise in IOP

SS: sever pain, cloudy, colored halos around lights, N/V, decreased vision, enlarged fixed pupils, red eye

Permanent Blindness if IOP elevated for 24-48hrs

Tx: drops, pills, IV meds to lower pressure, iridotomy

126
Q

Congenical Glaucoma

A

.hereditary (at birth)
.SS: cloudiness on front of eye, excessive tearing, enlarged eye

Tx: Sx to open outflow channels of the angle

127
Q

Secondary Glaucoma

A

Causes: some drugs, other eye diseases, some systemic disease.

128
Q

Glaucoma meds

A 
Miotics: Pilocarpine, Carbachol
◦ Constrict pupil
Cholinesterase Inhibitors: Humorsol, Eserine
lowers intraocular pressure
Beta Adrenergic Antagonists: Timoptic
decrease intraocular pressure
Carbonic Anhydrace Inhibitors: Diamox
decrease aqueous humour production
129
Q

Eye Drops Tx

A

constrict pupil and draw iris away from cornea

1.Osmotic agents such as Urea or Mannitol
2. Glycerol given systemically to lower
intraocular pressure
3. Acetazolamide (Carbonic anhydrase
inhibitor) to reduce fluid formation

130
Q

Eye Drops:

Cholinergics

A

contrict pupil

. pilocarpnie and carbachol

SE: periorbital pain, blurry vision, bad night vision

131
Q

Meds

Beta Blockers

A

.betaxolol / timolol
. decrease aqueous humor production

SE: bradychardia, pulmonary dx worse, hypotension

Contraindicated: pt w asthma, COPD, 2/3rd degree heart block, bradycardia, heat failure

132
Q

Carbonic Anhydrase Inhibitors

A

lower aqueous humor prod

Actetazolamide, methazolamide

SE: anaphalactic reaction, electrolyte loss, depression, lethargy, gatsro upset, imptence, weidht loss

DO NOT GIVE pt =w Sulfa allergies, MONITOR electrolytes

133
Q

Meds topical

Dorzolamide

A

topical allergy

134
Q

Timolol

A

beta adrenergic blocking agent

135
Q

Opthammic Meds

A 
Myotic: constricts the pupil
 Mydriatics: dilate the pupil
 Analgesics
 Steroids
 Lubricants
 Anti-inflammatory
136
Q

Retinal Detachment

A

not painful

seperation of retina from choroid because of hole in retina that allow liquid to lead between choroid and retina.

SS: painless, bridht flashes of light, floaters, blurry, partial visual field blidness

Tx: Sx reattachment. it not leads to blindness

137
Q

Eye Sx Post Op care

A 
.keep client in lowest position, side rails up.
.assist w initial ambulation
.admin cough meds and antiemetic
.avoid staring, sneezing, cough, vomit
.wear eye shield when sleeping
.SS infections?
.sterile technique eye care
.admin abx  eye drops.
138
Q

Posterior Vitreous Detachment

A

.liquefaction and shrinkage of vitreous body
.May lead to retinal tears and detachment
.light lashes, cobwebs, floaters

139
Q

Conjunctivitis

A

‘pink eye’

. inflammation of conjunctiva

Cause: viral/bac/allergies/chem exposure, contacts
. HIGHLY CONTAGIOUS
.SS: red eyes, thick discharge, sticky eyelids in am, eye pain, blurry, gritty, itchy, photophobia, tearing

Tx: Abx, corticosteroids

140
Q

Enucliations

A

.removal of entire eye

141
Q

Presbyopia

A

elasticity of lens slowly lost w age

.diff to see up close

142
Q

Hyperopia

A

farsightedness; vision beyond
20 feet is normal, near vision is poor;
treatment is corrective lenses

143
Q

Myopia

A

nearsightedness; near vision is
normal, distance is poor; treatment is
corrective lenses

144
Q

Strabismus

A

inability of the eyes to focus in

the same direction

145
Q

Photophobia

A

eye discomfort in bright
light; usually symptom of another eye
disorder; treat underlying disorder

146
Q

Extracapsular Extraction

A

anterior portion of lens capsule and capsule contents are removed. leaves posterior lens capsule intact

147
Q

Phacoemulsification

A

uses smaller incision with one

or two stitches

148
Q

Intracapsular extraction

A

removal of entire lens and
its surrounding capsule using a freezing probe
(RARE)

149
Q

Hyphema

A

.hemorrhage into anterior chamber of eye

150
Q

Retinoblastoma

A

.malignant tumor in retina in children
.rare, 3% cancrs
.can spread to optic nuerve and invade brain, lymph, bond, facial bone

WW: whiteish/yello pupil (leukocoria, cat’s eye, instead of normal red reflex), visual acuity disturbances, inflammation, pain, hyphema

151
Q

PERRLA

A 
P-pupils
E-equal in size
R-round symmetrically
R-reactive
L-reacts with constriction to light
A-pupils accommodate equally
152
Q

Snellen Chart

A

visual acuity chart. (letters)

153
Q

Air puff tonometer:

A

does not touch the eye, records
deflections of the cornea from the puff of
pressurized air

154
Q

Schotz impression and tonometers

A

record the
pressure needed to indent or flatten the corneal
surface. Elevated pressure reveals glaucoma.

155
Q

Deafness

A

.Moderate-severe loss 56-70dB range
.Severe loss 70-90dB range
.Profoundly deaf have greater than 91dB

156
Q

Rinne Test

A

Compares air- and bone-conduction hearing;
tuning fork of 512 Hz is placed against the base
of your mastoid bone until sound no long heard
and then moves the tuning fork near the auditory
canal until sound is no longer heard

157
Q

Rinne Test

A

Normal: air-conduction time is twice as long as boneconduction
◦ Sensorineural hearing loss: air-conduction is heard
longer than bone-conduction, but not twice as long
◦ Conductive hearing loss: the bone-conduction sound is
longer than or equal to the air-conduction sound

158
Q

Weber Test

A

Method of assessing auditory acuity; the stem
of a vibrating 512 Hz tuning fork is placed on
the cent

159
Q

Weber Test

A

Normal: loudness of sound is equal in both ears
◦ Sensorineural hearing loss: the unaffected ear
perceives the sound as louder
◦ Conductive hearing loss: sound is louder in the
affected ear

160
Q

Myringotomy

A

Sx making incision in tympanic membrane thru which fluid may be suctioned.

161
Q

Romberg Test

A

Indicatos loss of sense of position (proprioception)

162
Q

Falls

A

second leading cause of accidental death in elderly

163
Q

Culture and Diversity

A

set 5

164
Q

Acculturation

A

process of adopting cultural traits of another group as result of prolonged contact w them

165
Q

Ethnocentrism

A

belief in superiority of one’s own ethnic group

166
Q

Cultural Blindness

A

not able to empathize with other cultures in specific situations

167
Q

Cultural Competence

A

the nurse’s ability to
interact effectively with people of different
cultures and backgrounds;

168
Q

Madeleine Leininger

A

saw importance of Transcultural Nursing

169
Q

Spirituality

A

anything to do with one’s personal relationship with a higher life source.

170
Q

Spiritual Health

A

universal spiritual needs for
purpose and meaning, love and belonging, and
forgiveness are met

171
Q

Spiritual Distress

A

alteration in spiritual health
displayed by anxiety, guilt, loss, despair, anger,
spiritual pain or alienation

172
Q

Role of RN

A

.Provider of Care
.Mgr of Care
.Teacher
.Client Advocate

173
Q

Cultural Care Repartterning

A

i.e. Navajo have risk of heart disease – eat
fried bread (staple of diet); change – hang bread to
drain fat or place on paper towels

174
Q

Community-Based Nursing Care

A

Section 6

175
Q

Community

A

cluster of people with at least
one common characteristic such as location,
occupation, ethnicity, housing condition,
shared interests

176
Q

William Rathbone

A

established modern concept of visiting nurses

177
Q

Lillian Ward/Mary Brewster

A

established Visiting Nurses in NYC

Henry Street Settlement

178
Q

1910 Nursing

A

90% care provided in home

179
Q

1917, 1918

A

WWI sick began to go to the hospital

180
Q

1950s

A

increase need for hospital care due to increased complexity in healthcare

181
Q

1960-70s

A

pt stay 7-10 days in hospital for uncomplicated conditions and sx

182
Q

1980s

A

health care costs UP = change in helath care delivery system and financing

183
Q

1980s

A

nursing care back to the home

184
Q

Ntl League of Nursing 1999 Trends (10)

A
  1. change in demographics and UP diversity
  2. tech explosion
  3. globalization of world economy and society
  4. Era of educated consumer, alt tx, palliative care
  5. shift to populations based care and UP complexity of pt care
  6. cost of health care
  7. Impact of health policy and reg
  8. growing need for intrdisciplinary educ for collab practice
  9. Current nursing shortage/opportunities for
    lifelong learning and workforce
    development
  10. Significant advances in nursing science and
    research
185
Q

Acute Care

A

.ppl receiving intensive hospital care
.ambulatory clinic or day sx unit
. for very sick w life-threatening conditions

186
Q

Healthy People 2020

A

Mission:

.Identify nationwide health improvement priorities.
 Increase public awareness and understanding of
the determinants of health, disease, and disability
and the opportunities for progress.
 Provide measurable objectives and goals that are
applicable at the national, state, and local levels.
 Engage multiple sectors to take actions to
strengthen policies and improve practices that are
driven by the best available evidence and
knowledge.
 Identify critical research, evaluation, and data
collection needs.

187
Q

Health Protection

A 
.envt regulatory measures
.food/drug safety
.Envt Health
.Occ Safety/Health
.Seat belt /car seat restraints
.no smoking laws
.pollution control
188
Q

Secondary Prevention

A

.early detection
.screening
.

189
Q

Tertiary Prevention

A

.rehab

190
Q

Medicare

A

federally funded health insurance

for those over 65 or disabled

191
Q

Medicaid

A

joint federal and state program

that provides assistance to lower income

192
Q

Epidemiologic Triad

A

.Host
.Agent
.Environment

193
Q

Dever’s Epidemiologic Model

A

.Human biological factors
◦ Environmental factors
◦ Lifestyle factors
◦ Health care system factors

194
Q

Endemic

A

constant presence in certain geo location

195
Q

Epidemic

A

rate of disease in excell than usual

196
Q

Pandemic

A

worldwide

197
Q

Mortality

A

risk of death

198
Q

Morbidity

A

prevalence and incident rates

199
Q

DTP

A

(diphtheria, tetanus, pertussis): 2, 4, 6 and 18

months

200
Q

IPV

A

(trivalent inactivated poliovirus vaccine): 2, 4, 6, 18

months, and 4-6 years old; immunocompromised children

201
Q

MMR

A

(measles, mumps, rubella): 12-15 months, booster

at school entry; don’t give to pregnant women

202
Q

HiB

A

(haemophilus influenzae type B): 2, 4, 6 months,

booster at 15 months

203
Q

HBV

A

(Hepatitis B vaccine): birth, 1 month, 6 months,

health care workers, prostitutes; injection drug users

204
Q

Varicella

A

one dose at 12-18 months or one dose
from 19 months to 12 years or 2 doses, 4-8 weeks apart
for persons 13 years and older

205
Q

Influenza vaccine

A

annually; children 6
months and older; 2 separate doses, 2 weeks
apart in first time recipients younger than 8
years old

206
Q

Pneumococcal vaccine (PVC)

A

2-23 months
given at 2, 4 and 6 months with a 4th dose at
12 months; 24-59 months for those who
attend day care

207
Q

Pneumonia vaccine

A

persons over 65 and

those with debilitating illness

208
Q

Lead Poisoning SS

A 
 Burning in the mouth and esophagus
 Colic
 Constipation
 Diarrhea
 Mental disturbances
 Paralysis of extremities
 Convulsions
 Extreme irritability, anorexia and anemia: CHRONIC
encephalopathy
209
Q

Lead Poisoning: TX

A

 Gastric lavage with magnesium or sodium
sulfate
 Fluid therapy
 Chelation
 IM injections of calcium disodium edentate or
British antilewisite

210
Q

Pew Commission

A

21 competencies that are required of healthcare

professionals in the 21st century

LPN to RN (13 decks)

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