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exam 2 Flashcards

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1
Q

ventilation

A

movement of gases into and out of lungs
➺ the process of inspiration and expiration

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2
Q

perfusion

A

process in which the cardiovascular system pumps oxygenated blood to the tissues and returning deoxygenated blood to the lungs

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3
Q

diffusion

A

process of exchange for respiratory gases between alveoli (lungs) and capillaries (body tissue)

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4
Q

factors that affect oxygenation (PHYSIOLOGICAL)

A

➺ decreased oxygen carrying capacity (anemia)
➺ hypovolemia
➺ decreased inspired oxygen-concentration (obstruction, high altitude, hypoventilation)
➺ increased metabolic rate (increased O2 demands; pregnancy, exercise)

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5
Q

factors that influence oxygenation (3)

A

developmental, environmental, and LIFESTYLE
➺ nutrition, hydration, exercise, smoking, substance abuse, stress

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6
Q

respiratory assessment

A

NURSING HX
➺ health risks, pain, fatigue, dyspnea, cough, environmental exposures, smoking, respiratory infections, allergies, medications
PHYSICAL (steps)
➺ inspection; touch (RR, clubbing, skin)
➺ palpation (tenderness, edema, pulse, temperature)
➺ percussion (air, fluids v. solids)
➺ auscultation (heart + lung sounds)
DIAGNOSTIC TESTS
➺ TB skin test, ECG, blood work, ABG, pulmonary function test, sputum

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7
Q

appropriate NANDAs (OXYGENATION)

A

➺ impaired cardiac output
➺ acute pain
➺activity intolerance
➺ risk for activity intolerance
➺ impaired airway clearance

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8
Q

hypovolemia

A

“low volume”; decrease of circulating blood volume

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9
Q

conditions that affect gas exchange (HEART)

A

➺ disturbances in conduction; dysrhythmia (AFIB)
➺ altered cardiac output (L/R sided heart failure)
➺ impaired valvular function (stenosis, ischemia)
➺ myocardial ischemia (angina, MI)

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10
Q

conditions that affect gas exchange (PHYSICAL)

A

➺ pregnancy, obesity
➺ musculoskeletal abnormalities (pectus excavatum, scoliosis)
➺ trauma
➺ neuromuscular diseases (muscular dystrophy), CNS alterations
➺ influences of chronic lung disease (COPD, cystic fibrosis)

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11
Q

nursing interventions (OXYGENATION)

A

➺ sit up!!!
➺ dyspnea management (medication + O2 administration)
➺ mobilization of pulmonary secretions (reposition + suction)
➺ hydration (1500-2000 mL fluid/day)
➺ humidification
➺ nebulization
➺ C, DB techniques
➺ chest physiotherapy
➺incentive spirometer (lung expansion)

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12
Q

O2 delivery systems

A

*REMEMBER! O2 is combustible + needs a prescription
➺ nasal cannula (2L - 6L O2)
➺ high flow nasal cannula (100% humidified, 6L - 60 L O2)
➺ oxygen masks (simple mask for 6L - 10L O2; rebreather mask for 10L - 15L O2)

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13
Q

health

A

➺ a state of complete physical, mental, and social well-being, not merely the absence of a disease of infirmity
➺ state of being that are defined to individual values, personality, and lifestyle

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14
Q

health beliefs

A

the reasons behind the decisions that people make regarding health (rewards + benefits); they are explained by models that describe complex concepts or ideas like health and illness

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15
Q

variables that influence health beliefs

A

INTERNAL
➺ developmental stage (cognitive levels, awareness), intellectual background (education), perception of function (what do WE feel; subjective), emotional and spiritual factors
EXTERNAL
➺ family roles + practices, social determinants of health (where you live, work, etc.; modifiable)

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16
Q

illness

A

a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

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17
Q

health promotion

A

helps individuals maintain or enhance their present health

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18
Q

health education

A

helps people develop a greater understanding of their how + how to better manage their health risks

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19
Q

illness prevention

A

protects people from actual or potential threats to health

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20
Q

levels of ILLNESS prevention

A

PRIMARY
➺ true prevention that lowers the chances a disease will DEVELOP (reducing incidents; education, vaccines, immunizations)
➺ this is BEFORE the disease
SECONDARY
➺ focuses on those who HAVE health problems or illnesses and are at risk for developing complications/worsening conditions
➺ we look at the diagnosis and interventions; high risk
TERTIARY
➺ occurs when a defect or disability is permanent or irreversible
➺ this is permanent, seek to minimize effects

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21
Q

types of risk factors

A

a risk factor is a variable that increases the vulnerability of an individual/group to an illness or incident
NONMODIFIABLE
➺ age, gender, ethnicity
MODIFIABLE
➺ obesity, activity, rest
ENVIRONMENT
➺ water, pollution, occupation

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22
Q

Maslow’s hierarchy of needs

A

used to understand the interrelationships of basic human needs
*from bottom to top
PHYSIOLOGICAL
➺ oxygen, fluids, nutrition, body temperature, elimination, shelter, sex
➺ take priority!
SAFETY AND SECURITY
➺ physical and psychological
LOVE AND BELONGING NEEDS
SELF ESTEEM
SELF ACTUALIZATION

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23
Q

transtheoretical model of change

A

this is used to describe the stages of patients changing their health behaviors
PRECONTEMPLATION
➺ has not crossed mind/not willing to think about
CONTEMPLATION
➺ chance of consideration, has concerns and wants to talk about it
PREPARATION
➺ preparing, ready to “change” and alter lifestyle
ACTION
➺ actually participating in making the change
MAINTENANCE
➺ maintained action for more than or equal to 6 months

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24
Q

variables that influence urination (SYSTEMS)

A

➺ growth and development (neuro system is not fully developed until 2-3 y/o; older adults have decreased bladder capacity and increased bladder irritability)
➺ habits
➺ fluid intake
➺ medications (diuretics)
OTHER CONDITIONS
➺ diabetes mellitus
➺ BPH (benign prostatic hypertrophy)
➺ spinal cord injury, multiple sclerosis
➺ UTIs; retention
➺ diversions (stoma)

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25
micturition
URINATION / VOIDING! the process in which the brain gives the bladder permission to empty, which contracts the bladder, relaxes the sphincter, and urine is released
26
urinary retention
an accumulation of urine due to the inability of the bladder to empty
27
UTI
URINARY TRACT INFECTION results from an infection, typically from the bacteria E. Coli, caused by catheterization or a procedure * 4th most common HAI
28
urinary incontinence
involuntary leakage of urine ➺ may be caused by urge (overactive bladder, obstruction) or stress (cough, sneeze)
29
CAUTIs
catheter-associated UTI
30
how can nurses promote normal micturition?
➺ maintain elimination habits ➺ maintain adequate fluid intake ➺ pt education ➺ promote emptying bladder completely ➺ prevent infection! *for normal micturition, try to have pt urinate while standing
31
collecting urine and its characteristics
COLLECTION ➺ urine is collected via a "toilet hat" / "urination collection hat", this is a normal part of intake and output assessment CHARACTERISTICS ➺ color ➺ clarity ➺ odor
32
lab tests and diagnostics (URINE)
LAB + DIAGNOSTICS ➺ label all specimens ➺ preserve according to lab protocol ➺ infection control policies * we look at WBC for possible infection and glomerular filtration rate (GFR) as a kidney functional marker
33
ostomy placement (URINARY)
UROSTOMY ➺ surgically connects the ureters to the outside of the abdomen ➺ collected in a pouch MAINTENANCE ➺ clean with mild soap and water ➺ pouching system must be changed every 3-7 days ➺ properly fitted to prevent leakage that may cause skin irritation or damage
34
nursing interventions for elimination
➺ assess bowel and bladder patterns (frequency, consistency, difficulties) ➺ encourage adequate fluid intake ➺ provide toilet schedules ➺ administer stool softeners, laxatives, or enemas (solutions inserted into the rectum to stimulate peristalsis) for constipation ➺ provide catheter care and monitoring output ➺ peri-care and protect skin integrity
35
function and role of GU structures (4)
KIDNEYS ➺ filtering waste products like urea, creatinine, and uric acid from the blood and excreting them in urine URETERS ➺ transport urine from the kidneys to the urinary bladder BLADDER ➺ to store and hold urine temporarily until it can be expelled from the body during urination URETHRA ➺ to serve as the tube that carries urine from the bladder out of the body during urination
36
function and role of GI structures (5)
MOUTH ➺ mechanically and chemically breaks down food into smaller particles and a form that can be swallowed ESOPHAGUS ➺ transports food and liquids from the mouth to the stomach STOMACH ➺ stores and digests food SMALL INTESTINE ➺ completes the digestion of food and absorb nutrients into the bloodstream ANUS ➺ controls the expulsion of solid waste from the body
37
defecation
BOWEL MOVEMENTS! the physiological process of expelling solid waste from the body through the anus
38
variables that influence bowel (SYSTEMS)
➺ age ➺ diet / fluid intake ➺ physical activity ➺ psychological activity / personal habits ➺ position during defecation ➺ pregnancy (slows down peristalsis) ➺ surgery and anesthesia ➺ medications (OPIOIDS, laxatives, stool softeners)
39
constipation
*this is a symptom, not a disease ➺ this is secondary to impaction, which is unrelieved constipation that results in blockage
40
diarrhea
unformed liquid feces
41
flatulence
accumulation of gas
42
hemorrhoids
dilated, engorged veins in rectum lining
43
ostomy placement and care (BOWEL)
COLOSTOMY ➺ a surgically created opening in the abdominal wall where a portion of the colon is brought through and sutured to allow for the elimination of stool into an external pouching system *may be located around different portions of the colon (sigmoid, transverse, or ascending) CARE ➺ empty pouch when 1/3-1/2 full; assess the stoma ➺ irrigate the colostomy bag ➺ when pouching ostomies, ensure the protection of the skin and that it is odor free ➺ CONSIDER NUTRITIONAL AND PSYCHOLOGICAL IMPACT
44
what can nurses do for health promotion of defecation?
➺ promote a seating position while defecating ➺ slightly inclining the head of the bed if the pt is on a bedpan
45
types of exercise (3)
ISOKINETIC ➺ type of exercise that involves moving at a constant speed while the resistance adjusts to match the force of the muscles (elliptical) ISOTONIC ➺ a type of physical activity that involves moving a joint through a range of motion while a muscle attached to the joint contracts and shortens (dumbbells) ISOMETRIC ➺ a type of exercise that involves contracting a muscle or group of muscles without changing the length of the muscle or moving the joint (planks) for 10 sec., then relax
46
physical activity (PA)
any movement produced by skeletal muscles that results in energy expenditure
47
physical exercise
subset of PA; planned, structured, and repetitive and has a final / intermediate objective
48
the effects of exercise on major body systems
➺ elevates mood and attitude ➺ enables physical fitness ➺ helps to quit smoking + tobacco-free ➺ boosts energy ➺ helps in stress management ➺ promotes better quality of sleep ➺ improves self-image + confidence * helps a lot with, but not limited to, heart diseases (CAD, hypertension, COPD, DM)
49
pathological influences on body alignment, mobility, and activity
➺ congenital defects (osteogenesis imperfecta, scoliosis) ➺ disorders of bones, joints, and muscles (osteoporosis) ➺ CNS damage (trauma to brain / SCI) ➺ musculoskeletal trauma (bone fracture, sprain) ➺ obesity (osteoarthritis, lower back pain, gait disturbances, pain)
50
safe patient handling and mobility (SPHM)
* most importantly, know the patient's and your limitations ➺ involves improved assessment, use of mechanical equipment, and safety procedures to lift and move patients ➺ these techniques are a standard of the best practices in moving, handling, and transfer of patients
51
NANDAs for mobility
➺ activity intolerance ➺ risk for injury ➺ impaired mobility in data ➺ impaired mobility ➺ acute or chronic pain
52
care planning for mobility/activity/exercise
GOAL PLANNING ➺ improve or maintain the pt's motor function and independence SET PRIORITIES ➺ consider pt's most immediate needs TEAMWORK AND COLLAB ➺ work with PTs + OTs ➺ discharge planning AMBULATION ➺ assess pt's ability to walk safely; determine a need for ambulatory devices ➺ this may include the gait belt, walkers, canes, crutches
53
effects of immobility on body systems
METABOLIC CHANGES ➺ decreased endocrine metabolism, calcium reabsorption, and GI function RESPIRATORY CHANGES ➺ risk of atelectasis ➺ hypostatic pneumonia CARDIO CHANGES ➺ orthostatic hypotension ➺ blood clots MSK CHANGES ➺ muscle atrophy URINARY CHANGES ➺ increased UTIs, stasis INTEGUMENTARY CHANGES ➺ pressure injury / ulcer risk *also consider psychosocial effects
54
NANDAs for immobility
➺ risk for disuse syndrome ➺ impaired mobility ➺ impaired airway clearance ➺ impaired sleep ➺ risk for impaired skin integrity ➺ risk for constipation ➺ social isolation
55
subjective data
patient's verbal descriptions of their health problems; includes feelings, perceptions, and self-report
56
objective data
findings resulting from direct observation
57
medical diagnosis v. nursing diagnosis
MEDICAL ➺ identifies a specific disease or condition based on a patient's signs, symptoms, medical history, and diagnostic tests NURSING ➺ describes a patient's actual or potential response to health problems or life processes; a clinical judgement
58
types of nursing diagnostic statements (3)
PROBLEM-FOCUSED (3 PT) ➺ there is an actual problem present ➺ nursing diagnosis followed by etiology/cause (related factors) then followed by defining characteristics EX: acute pain r/t biological injuring aeb pain scale 7/10, grimacing * most important RISK DIAGNOSIS (2 PT) ➺ there is susceptibility, but NO problem EX: r/f surgical site infection r/t exposure to increased environment pathogens HEALTH PROMOTION (2 PT) ➺ no potential problem, prevent future problems and maintain / improve health ➺ pt shows "readiness for education", followed by defining characteristics
59
what is the nursing process?
ADPIE ASSESSMENT ➺ gather information about the pt's condition (data collection) DIAGNOSE ➺ identify the pt's problems (NANDAs) PLAN ➺ set goals of care and desired outcomes and identify appropriate nursing actions IMPLEMENT ➺ perform the nursing actions identified in plannin EVALUATE ➺ determine if goals and expected outcomes are achieved
60
assessment (ADPIE)
TYPES ➺ pt-centered interview (conducted during nursing hx) ➺ periodic assessments (conducted during ongoing contact with pts) ➺ physical exam (conducted during a nursing hx and at any time a pt presents a symptom) TYPES OF DATA ➺ subjective and objective COMPONENTS OF HEALTH HX ➺ may include biographical information, CC, pt expectations, HPI or health concerns, past health hx, family hx, psychosocial hx, spiritual health, review of systems, observation of pt behavior, diagnostic and lab data PROCESS ➺ data collection leads to interpretation of assessment data (look for cues / inferences) which leads to validation (comparison of data with another source)
61
data clustering
a set or grouping of assessment findings with similar, defining characteristics
62
planning (ADPIE)
SETTING PRIORITIES ➺ the ordering of nursing diagnoses or pt problems to establish a preferential order for nursing intervention; establish in relation to their ongoing clinical importance ➺ high importance: NANDAs that if left untreated result in harm (think of Maslow's hierarchy) ➺ intermediate importance: NANDAs that are nonemergent and not life-threatening ➺ low importance: not always directly related to specific illness, but affect pt's future well-being *review each time you see pt; their collaboration is needed for prioritization GOALS ➺ keep them SMART ➺ specific, measurable, achievable, relevant, and time-bound ➺ focus on more short term goals for shifts EX: pt will self report pain level equal to or less than 4 using numerical self-report pain scale during my shift SELECTING INTERVENTIONS ➺select interventions that are designed to help pts with the present level of health described in the goal and measured by expected outcomes ➺ can depend on desire outcome, characteristics of diagnosis, research base knowledge for intervention, feasibility, acceptability, and nurse's competency ➺ may be selected from nursing interventions classification (NIC)
63
implementing (ADPIE)
*first intervention will always be assessing/asking the pt DIRECT CARE INTERVENTIONS ➺ treatments nurses provide through interactions with pt or groups of pts (self-report pain scale, administering meds, reposition, etc.,) INDIRECT CARE INTERVENTIONS ➺ treatments performed away from a patient but on behalf of the pt or group of pts (consultation with pain management therapist, dietician, etc.,) STANDARD INTERVENTIONS ➺ allow nurses to act more quickly and appropriately (prn orders) STANDING ORDERS ➺ preprinted documents containing medical orders; directs pt care in a specific clinical setting CLINICAL PRACTICE GUIDELINES AND PROTOCOLS ➺ a systematically developed set of statements about appropriate health care for specific health care problems or clinical situations
64
evaluation (ADPIE)
*there are two parts to an evaluative statement MET/UNMET ➺ indicates whether the desired patient outcome or goal was achieved or not achieved based on the evaluation data RATIONALE ➺ provides the evidence and reasoning behind determining if the outcome was met or unmet EX: Outcome met: Patient verbalizes understanding of prescribed medication regimen and importance of adherence, demonstrating knowledge deficit related to medication management has been resolved
65
levels of health care
*remember these are not the same as the levels of prevention PREVENTATIVE ➺ prevent disease, rule out risk factors (can take place at a primary care provider's office) PRIMARY ➺ health education, diet, promotion; takes place with a primary care provider SECONDARY ➺ specialist or referral from the PCP (ER; focuses on diagnosis and treatment) TERTIARY ➺ higher level of care within a referral (ICU; also focuses on diagnosis and treatment) RESTORATIVE ➺ serves pts recovering from an acute or chronic illness; reduces the complications, focus on recovery and rehabilitation (MAXIMAL FUNCTION) CONTINUING HEALTH CARE ➺ closer to end of life, disabled, functionally dependent, or prolonged care (adult day care, nursing home)
66
what should nurses be prepared and work toward in all different types of healthcare settings?
➺ improving access of health care ➺ maintain quality and safety of health care ➺ lessening health care costs ➺ work hard to improve pt experience and engagement while delivering high quality care ➺ improve outcomes ➺ control costs ➺ acquire the knowledge, skills, and values necessary to practice competently and effectively
67
respite care
provides short-term relief or "time off" for people providing home care to an individual who is ill, disabled, or frail; enable family caregivers to leave the home for errands and/or social time
68
palliative care
patient and family-centered care approach with a goal of improving the quality of life of patients and families who are experiencing problems related to life-threatening illnesses
69
hospice care
focuses on palliative (COMFORT), NOT curative care; this form of care is typically time associated
70
strategies to reduce health care costs
AS NURSES ➺ support reforms that incent hospital value-based purchasing, hospital readmissions reduction program, bundled payments for care improvements, and hospital acquired condition reduction program OTHER STRATEGIES ➺ social security act ➺ cms innovation center ➺ the affordable care act
71
theory and its relationship with research and practice
theory: the foundation for the art and science of nursing metatheory: looks at the relationships of various component that make up the knowledge of a discipline nursing theory: the conceptualization of some aspect of nursing; describes, explains, predicts, and prescribes nursing care ➺ theory, research, and practice are bound together in a continuous, interactive relationship ➺ theory helps explain events by defining ideas / concepts, explaining relationships, and predicting outcomes
72
phenomenon
an idea or response about an event, situation, and process events / group of situation
73
concepts
abstract; emotions or physical objects
74
assumptions
things we take for granted
75
domain and its aspects
the perception / territory of a discipline ➺ paradigm: pattern of beliefs used to describe the domain; a conceptual framework ➺ nursing paradigm: focuses on the person, health, environment / situation, and nursing
76
types of theory
GRAND ➺ abstract, broad in scope, complex MIDDLE-RANGE ➺ limited in scope and less abstract PRACTICE ➺ narrow in scope and focus DESCRIPTIVE ➺ describe phenomena and identify circumstances in which phenomena occur PRESCRIPTIVE ➺ address nursing interventions for a phenomenon, guide practice change, predict the consequences
77
nursing knowledge
derived from basic and nursing sciences, experiences, aesthetics, nurses' attitudes, and standards of practice' goal is to explain the practice of nursing as different and distinct from other health care disciplines ➺ theory generates this; supports evidence based practice THEORETICAL KNOWLEDGE ➺ goal is to stimulate thinking and create a broad understand of nursing science + practice EXPERIENTIAL KNOWLEDGE ➺ the "art"; based on experiences in providing care to patients
78
select nursing theories (4)
NIGHTINGALE'S ENVIRONMENTAL THEORY ➺ environment as the focus of nursing (grand) PEPLAU'S INTERPERSONAL THEORY ➺ focus on interpersonal relations between nurse, pt, and family (middle-range) ➺ preorientation, orientation, working, and resolution OREM'S SELF-CARE DEFICIT NURSING THEORY ➺ focuses on pt self-care needs; continually asses how much self-care pt is able to perform (grand) LEININGER'S CULTURE CARE THEORY ➺ cultural care diversity and universality; integrates pt's traditions, values, and beliefs into care plans (middle-range)
79
evidence based practice
looks for the best scientific and clinical evidence for treating and managing a problem; best evidence comes from well-designed systematically conducted researched ➺ improves quality, safety, and pt outcomes ➺ increases nursing satisfaction ➺ reduces costs
80
rationale for EBP
enhances the patient experience, decreases costs, empowers clinicians, and improves patient outcomes by ensuring care is guided by the most current and relevant scientific knowledge
81
implementation of EBP
➺formulating a clear clinical question ➺ searching and appraising the most relevant evidence ➺ integrating that evidence with clinical expertise and patient values/preferences ➺ applying the evidence in making practice decisions or changes ➺ evaluating the outcomes of the EBP process formulating a clear clinical question
82
quantitative v. qualitative research
QUANTITATIVE ➺ experimental and nonexperimental research ➺ surveys ➺ evaluation research ➺ think numbers! QUALITATIVE ➺ ethnography ➺ phenomenology ➺ grounded theory ➺ think descriptive!
83
scope and standards of nursing
the american nurses association (ANA) develops the standards for nursing practice ➺ they define nursing and reflects the values of the nursing profession ➺ standards of nursing care reflect the knowledge and skill ordinarily possessed and used by nurses *there is a standard of proof, describing what a reasonably prudent nurse would do under similar circumstances in the geographic area
84
health insurance portability and accountability act (HIPAA)
establishes pt rights regarding privacy of their health care information and records, including the right to consent and the right to inspect, copy, and/or amend incorrect medical record *an extension of this would be the health information technology act, which must ensure that protective health information is protected on platforms such as social media
85
nurse practice act
state laws that intend to protect CITIZENS, make nurses accountable and assure that care is consistent with best practice within the scope and standards of nursing ➺ backed by licensure (NCLEX, BRN, enhanced nurse licensure compact)
86
legal safeguards for nursing
GOOD SAMARITAN LAWS ➺ limit liability and offer legal immunity if a nurse helps at the scene of an accident PUBLIC HEALTH LAWS ➺ laws affect individuals, populations, and communities that are intended to improve the health of people THE UNIFORM DETERMINATION OF DEATH ACT ➺ determines actual death
87
intentional, unintentional, and quasi-intentional torts
TORTS ➺ wrongful acts or omissions made against person or property INTENTIONAL ➺ assault: the fear of harmful, imminent, or unwelcome contact (threats count) ➺ battery: intentional, offensive touching without consent or legal justification ➺ false imprisonment: restrain without legal reason QUASI-INTENTIONAL ➺ may not intend to cause harm, but does ➺ invasion of privacy UNINTENTIONAL ➺ when a person is harmed and the inflicting person knew or should have known ➺ negligence: conduct falls below standard of care of reasonably prudent person ➺ malpractice: type of negligence; RN did not carry out duty and injury to pt. occurred
88
informed consent
an explanation of the procedure or treatment ➺ the names and qualifications of people performing or assisting in the procedure must be made available ➺ a description of the serious harm, including death, that may occur as a result of the procedure + anticipated pain / discomfort ➺ the pt is made aware they have the right to refuse the tx
88
nursing workforce issues
BEGINNING AND END-OF-LIFE ➺ termination of pregnancy (Roe v. Wade) ➺ death with dignity, physician assisted suicide NURSING STUDENTS ➺ liability if actions exceed scope of practice and cause harm STAFFING + NURSE-TO-PT RATIO ➺ CA mandates by law NURSING ASSIGNMENTS ➺ "floating" to another unit PT ABANDONMENT ➺ refusal to provide care after establishing nurse + pt relation NURSE DELEGATION ➺ RN can have a non-nurse do a specific task, but the RN retains responsibility
89
risk management for nurses
➺ identify possible risks ➺ analyzing risks ➺ acting to reduce risks ➺ evaluating the steps take to reduce risks
90
quality improvement for nurses
➺ patient safety and improved care are the goals

nurs 200 (1 decks)

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