Exam 1 Flashcards
(130 cards)
1
Q
Role
A
person’s unique function in relation to others’ functions
2
Q
Role development
A
growth that occurs when you learn the functions, expectations and behaviors for a role
3
Q
Ascribed roles
A
not chosen
genetic
social
4
Q
Acquired roles
A
role taken on over lifetime
sometimes by choice
ex: person, societal, professional roles
5
Q
Role of the RN
A
provider and manager of care
member of the discipline
Plan and implement care
Health promotion and prevention
6
Q
SBAR
A
situation
background
assessment
reccomendation
7
Q
ANA standards of care
A
assessment diagnosis outcome identification planning implementation evaluation
8
Q
Assessment
A
The nurse collects patient health data
9
Q
Diagnosis
A
The nurse analyzes the assessment data in determining diagnoses
10
Q
Outcome identification
A
The nurse identifies expected outcomes individualized to the patient
11
Q
Planning
A
The nurse develops a plan of care that prescribes interventions to attain expected outcome
12
Q
Implementation
A
The nurse implements the interventions identified in the plan of care
13
Q
Evaluation
A
The nurse evaluates the patient’s progress toward attainment of outcomes
14
Q
ANA standards of professional performance
A
quality of care performance appraisal education collegiality ethics collaboration research resource utilization
15
Q
Types of conflict
A
role communication goal personality ethical or value
16
Q
Role conflict
A
clash between two or more of a person’s roles or incompatible features within the same role
most common is work/family
17
Q
1st priority
A
airway, breathing, cardiac status circulation and vital signs (ABC plus V)
18
Q
2nd priority
A
changes in mental status, untreated medical issues, acute pain, acute elimination problems, abnormal lab results
19
Q
3rd priority
A
more long term care issues - health education, rest, coping, spirituality
20
Q
5 rights of delegation
A
Right Task Right Circumstances Right Person Right Direction/Communication Right Supervision/Evaluation
21
Q
Research
A
A systematic inquiry to describe, explain, predict and control the observed phenomenon
22
Q
Inductive reasoning
A
examine phenomenon and identify general principles, structures, or processes underlying
develops explinations
23
Q
Deductive reasoning
A
verify the hypothesized principles through observations
tests validity of explanations
24
Q
Qualitative research
A
studies the whole
subjective
collects words, images or objects
groups are smaller and not random
25
Quantitative research
tests hypothesis
larger random groups
objective
collects numbers and statistics
26
Bias
Any tendency that prevents unprejudiced consideration of a question
causes error
27
Case study
The collection of detailed information about a particular participant or small group, frequently including the accounts of subjects themselves
28
Hypotheses
Predictions about the relationships between variables
29
Probability
The chance that a phenomenon has a of occurring randomly. As a statistical measure, it shown as p (the "p" factor)
p<0.05 to be valid
30
Variable
Observable characteristics that vary among individuals
31
Dependent variable
The variable or outcome that is influenced or caused by the independent variable
change you want to see
32
Independent variable
The variable that is influencing the dependent variable or outcome
treatment given
33
Confounding variable
variables or factors that interfere with the relationship between the independent variable and the dependent variable
you must control for these variables
34
Research process
```
Make a prediction: hypothesis
Define the study
Defining population
Selecting a sample
Data collection plan
Checking reliability and validity
Collect data
Interpret the results
Communicating the results
```
35
Evidence based practice
uses current evidence with clinician expertise in decision making
not the same as research but is based on research
36
Steps for EBP
Asking the right question (PICO)
Searching the evidence
Evaluating the evidence
Integrating findings with clinical expertise
Implementing the change Evaluating performance
37
"FINER"
```
F= Feasible
I=Interesting
N= Novel
E= Ethical
R=Relevant
```
38
PICO
```
P = patient or problem
I = intervention
C= comparison intervention
O = outcome
```
39
Reasons for conducting a literature review
To direct the planning and execution of a specific research study
To define the state of the science in a given area of nursing practice
40
Barriers to EBP
```
time
lack of database understanding
lack of research
lack of computer skills
difficulty understanding research articles
```
41
Levels of evidence
levels 1-6 rank evidence
42
Level 1 evidence
systematic reviews, integrative analysis, large clinical trials
43
Level 2 evidence
single experimental study
44
Level 3 evidence
quasi-experimental studies
45
Level 4 evidence
non-experimental studies
46
Level 5 evidence
case reports, program evaluations, narrative literature reviews
47
Level 6 evidence
opinions of respected authorities
48
Clinical practice guidelines
official recommendation
| preliminary evidence to answer a clinical question
49
Models for implementing EBP
Iowa model
Ready and Tavernier model
ARCC model
50
Iowa model
goal is to help healthcare professionals use evidence to improve patient outcomes
51
ARCC model
advancing research and clinical practice through close collaboration
52
EBPI
evidence based practice improvement
| uses PDSA
53
PDSA
plan
do
study
analysis
54
Body weight from fluid
50-60%
55
Intracellular fluid weight
40%
56
Extracellular fluid weight and breakdown
20%
14% interstitial
5% plasma
1% transcellular
57
Osmosis
water molecules move from an area of high concentration to low concentration
58
Hydrostatic pressure
pressing of water molecules on cell membranes
59
gradient
difference in pressure
60
Osmolarity
of miliosmoles per L
61
Osmolality
of miliosmoles per Kg
62
Natriuretic peptides (regulate sodium)
Hormone produced in response to fluid overload.
| Increased renal blood flow & GFR, decreased sodium resorption & diuresis
63
Lymph
controlled with skeletal muscle
| fluids moving into and out of the vascular compartment
64
Arterial end of capillary
fluid movement out of the vascular compartment
65
Venule end of capillary
fluid movement into the vascular compartment
66
CBC Hgb lab
Male 14-18 g/dL
| Female 12-16 g/dL
67
CBC HCT lab
Male 42-52%
| Female 37-47%
68
CMP
NA 136-145 mEq/L
| BUN 10-20 mg/dL
69
UA Specific gravity
1.005-1.030
70
Urine osmolality
used in kidney failure PT's
| Random specimen 50-1200 mOsm/kg H20
71
S/Sx for dehydration
```
pallor
increased RR
increased HR
decreased BP
dry membranes
poor turgor
```
72
S/Sx for overhydration
SOB
increase bounding pulse
weight gain
73
Endocrine system
helps control fluid and electrolyte balance using aldosterone, ADH and naturinic peptide
74
Aldosterone
secreted by the adrenal cortex
prevents water and sodium loss through kidney re- absorption
prevents blood K+ from getting too high
75
Angiotensin receptor blockers
ARB's
BP drug
disrupts the renin-angiotensin II pathway by blocking receptors that bind with angiotensin II
76
Isotonic dehydration
most common type
fluid only lost in ECF
causes decreased blood volume (hypovolemia)
77
Crystalloids
IV fluid for replacement and maintenance
| can see through them
78
Colloids
IV fluid
volume expanders
ex: dextran, plasmanate
79
Lipids
nutritional IV fluid
80
Hypertonic solution
> 300mOsm
| pulls fluid from the cell
81
Isotonic solution
270-210 mOsm
82
Hypotonic solution
<270 mOsm
puts fluid into cell
can cause lysis
83
Lab changes seen in hypovolemia
elevated H&H, serum osmolarity, protein and BUN
84
Fluid overlaod symptoms
edema, weight gain, bounding pulse, crackles, neck vein distention
specific gravity < 1.005
85
Fluid overload causes
HF
CRF
Cirrosis
Steroids
86
Fluid overload tx
I&O, diuretics, diet
87
Sodium
```
Na+
135-145 mEq/L
found in ECF
maintains ECF osmolarity
determines if water is excreted or retained
stored in kidneys
```
88
Hyponatremia causes
diuretics and Na+ restrictions
89
Hyponatremia S/Sx
```
increased motility causing nausea, diarrhea and cramping
BP changes
tachycardia
confusion
weakness
decreased deep tendon reflexes
```
90
Hyponatremia interventions
D/C diuretic
IV Na+ or nutrition therapy
do not increase Na+ levels by more than 1 mOsm per hour to avoid complications
91
Hypernatremia causes
kidney failure
excessive ingestion
steroids
cushing's syndrome
92
Hypernatremia S/Sx
```
muscle twitching
confusion
weakness
decreased deep tendon reflexes
decreased heart contractility
increased BP and HR
```
93
Hypernatremia interventions
treated with medication and diet
diuretics
fluid replacement
94
Potassium
```
K+
3.5-5 mEq/L (ECF)
mostly in ICF (about 140 mEq/L)
ICF and ECF levels are different to keep tissues excitable and generate action potentials
found in meat, fish vegetables and fruit
```
95
Hypokalemia causes
```
diuretics
corticosteroids
diarrhea/vomiting
kidney disease
increased aldosterone secretion
```
96
Hypokalemia S/Sx
```
Respiratory changes
muscle weakness
weak, thready pulse
hypo-tension
neurological changes
```
97
Hypokalemia interventions
K+ IV in severe cases
oral K+ replacements
D/C diuretics that cause K+ excretion
monitor muscle weakness and respiratory status
98
Hyperkalemia causes
Over ingestion of K+ foods
kidney disease
whole blood transfusion
99
Hyperkalemia S/Sx
palpitations
muscle twitching/weakness
tingling in hands, feet or face
increased GI motility
100
Hyperkalemia interventions
use K+ excreting diuretics
insulin may help move K+ from ECF to ICF
cardiac monitoring
101
Calcium
```
Ca2+
steep gradient between ICF and ECF
9-10 mg/dL
ionized=free form
bound=attached to serum proetins
```
102
Hypocalcemia causes
inadequate Ca2+ intake
diarrhea
kidney failure
103
Hypocalcemia S/Sx
Trousseau and Chvostek's signs
muscle spasms
increased paristalsis
chronic=osteoperosis
104
Hypocalcemia interventions
increased Ca
seizure precautions
increase Ca intake
105
Hypercalcemia causes
increased Ca intake
increased vitamin D intake
kidney failure
thiazide diuretics
106
Hypercalcemia S/Sx
```
excitable tissues become less excitable
increased BP and HR in mild case
decreased HR in severe case
blood clots
constipation, anorexia, N/V
muscle weakness
```
107
Hypercalcemia interventions
D/C thiazide and replace w/ lasix
dialysis
cardiac monitoring
108
Phosphorus
Much higher levels in ICF than ECF
3-45 mg/dl
found in meat fish dairy and nuts
P and Ca2+ have an inverse relationship
109
Hypophosphatemia causes
malnutrition
kidney failure
hyperglycemia
alcohol abuse
110
Hypophosphatemia S/Sx
```
no impairment in rapid changes
decreased energy
decreased stroke volume and CO
rhabdomyolysis: muscle breakdown
chronic: decreased bone density
```
111
Hypophosphatemia interventions
oral P suppliment and vitamin D
IV P when level is <1mg/dl
diet teaching
112
Hyperphosphatemia causes
kidney disease
cancer tx
hypoparathyroidism
increased P intake
113
Hyperphosphatemia S/Sx
high levels tolerated well
increased membrane excitability
problems come from hypocalcemia
114
Hyperphosphatemia interventions
need to manage hypocalcemia in conjunction with hyperphosphatemia
115
Magnesium
```
Mg+
mostly in ICF
1.3-2.1 mg/dl
found in most foods
regulated by kidneys and intestines
```
116
Hypomagnesemia causes
```
malnutrition
diarrhea
celiac disease
crohn's disease
diuretics
```
117
Hypomagnesemia S/Sx
```
increased membrane excitability
common with Ca2+ and P imbalance
hyperactive deep tendon reflexes
numbness/tingling
painful muscle contractions
CNS changes
skeletal muscle weakness
```
118
Hypomagnesemia interventions
Mg replaced by IV
oral causes diarrhea
IM causes pain/damage
119
Hypermagnesemia causes
decreased kidney excretion
| increased Mg intake
120
Hypermagnesemia S/Sx
```
usually seen in levels >4mg/dl
bradycardia
hypotension
peripheral vasodilation
decreased or absent deep tendon reflexes
drowsiness/lethagry
```
121
Hypermagnesemia interventions
IV fluids and diuretics
122
Chloride
Cl-
mainly in ECF
98-106 mEq/L
sourced from the diet
123
Cl- functions
works with Na+ to maintain ECF osmotic pressure
| helps form HCl in the stomach
124
Cl- imbalance interventions
usually occur as a result of imbalances in other electrolytes
use interventions to correct other imbalances to treat
125
Mg functions
```
skeletal muscle contraction
carbohydrate metabolism
ATP formation
vitamin activation
cell growth
```
126
P functions
provide mineral strength to bone
DNA and RNA component
found in ATP
buffer in bone, serum and urine
127
Na2+ functions
high ECF and low ICF levels cause skeletal muscle contraction, cardiac nerve conduction and nerve impulse transmission
normalize osmolarity and volume of ECF
128
Ca 2+ functions
```
maintain bone strength and density
activation of enzymes
cardiac and skeletal muscle contraction
controlling nerve impulse transmission
blood clotting
```
129
K+ functions
generate action potentials to keep tissues excitable
| large differance between ECF and ICF to allow for depolarization
130
Anti-diuretic hormone
```
AKA Vasopressin
produced in brain
stored in posterior pituitary
release controlled by hypothalamus
increased blood osmolarity triggers release
```
