Exam 2 Flashcards
1
Q
What Is Confidential information?
A
- All information about patients written on paper, spoken aloud, saved on computer
- Name, address, phone, fax, social security
- Reason the person is sick
- Treatments patient receives
- Information about past health conditions
2
Q
Chart only things ___ do
A
you
3
Q
Do Not Chart
A
- Administrative problems like “short of staff” etc.
- Equipment problems (“glucometer display hard to read”)
- Judgmental words “has an abrasive voice” “obnoxious and manipulative”
- Meaningless expressions like “pt had a good night” use specific examples.
4
Q
Institute of Medicine (2004) indicates that ___ deaths occur each year to hospitalized patients that are not attributed to the disease process but due to health care errors.
A
98,000
5
Q
What is SBAR?
A
- S = Situation
- B = Background
- A = Assessment
- R = Recommendation
6
Q
Acronym for documentation: FACT
A
- F - factual
- A - accurate
- C - complete
- T - timely
7
Q
SOAP: for problem-oriented medical records
A
- subjective
- objective
- assessment
- plan
8
Q
PIE charting:
A
- Problem, Intervention, Evaluation are planned and charted
- You state the problem, you do an intervention, and then evaluate
9
Q
Focus charting:
A
- brings care back to patient, incorporates many aspects of patient care
- Three columns are usually used in Focus Charting for documentation:
- Date and Hour
- Focus
- Progress Notes
- The progress notes are organized into:
- (D) data, (A) action, and (R) response, referred to as DAR (third column).
- The progress notes are organized into:
10
Q
With regards to patient teaching: essential component of the process that needs to be documented is ___
A
TEACHBACK - returned demonstration, verbalized understanding
11
Q
majority of patient errors occur because of
A
ineffective communication between providers or shift change, or transitions of care
12
Q
Working with interdisciplinary teams, communication needs to be ____, NOT aggressive
A
assertive
13
Q
Non-verbal Communication (5)
A
- Facial Expressions
- Posture and gait
- Personal appearance
- Gestures
- Touch
14
Q
Verbal communication
A
- Vocabulary
- Pace
- Tone of voice
- Timing
- Humor
- Be credible
15
Q
Using silence allows the client to
A
take control of the discussion, if he or she so desires.
16
Q
“Accepting” as a Therapeutic Communication Technique, conveys
A
positive regard
17
Q
Giving broad openings allows the client to
A
select the topic
18
Q
Offering general leads encourages the client to
A
continue speaking
19
Q
Restating lets the patient know
A
whether an expressed statement has been understood or not
20
Q
Reflecting questions or feelings are referred back to the pt so they may
A
be recognized
21
Q
Requesting an explanation is a non-therapeutic communication technique because asking “Why?” implies that
A
the client must defend his or her behavior or feelings
22
Q
The _________ is the basic structural and functional unit of the kidneys.
A
nephron
23
Q
Nocturnal ___________, known as nighttime bedwetting, usually subsides by 6 years of age.
A
enuresis
24
Q
Incontinence that results from weakness of the pelvic floor muscles can be treated by teaching the patient to perform ___________ exercises.
A
Kegel
25
A urinary _________ involves the surgical creation of an alternative route for excretion of urine.
diversion
26
The specific __________ of urine is a measure of the density of urine compared with the density of water.
gravity
27
A nurse documents that a patient has anuria when the 24-hour urine output is less than 400 mL. True or False?
False - that's oliguria
28
Nephrons remove the
end products of metabolism – urea, uric acid, creatinine from the blood and regulate fluid balance through the mechanism of reabsorptions and secretion of water and electrolytes
29
What is the function of the nephrons?
* Remove end products of metabolism
* Regulate fluid balance
30
Kidneys and Ureters maintain composition and volume of body fluids by \_\_\_\_\_
Filter and excrete blood constituents not needed and retain those that are
31
The urinary bladder is composed of three layers of muscle tissue called
detrusor muscle
32
The sphincter guards opening between the
urinary bladder and urethra
33
Urethra conveys urine from
bladder to exterior of body
34
The Formation of Urine (5 steps)
1. Urine is made in the kidneys
2. Urine is stored in the bladder
3. The sphincter muscles relax
4. The bladder muscle (detrusor) contracts
5. The bladder is emptied through the urethra and urine is removed from the body.
35
Specific Gravity should be between
1.015 – 1.025
hi=dehydration,
low=over hydration
36
pH of urine should be between
4.6 – 8.0 ~6
37
Organic constituents of urine
urea, uric acid, creatinine, nitrogen
38
Inorganic constituents of urine
ammonia, sodium chloride, traces of iron
39
Normal volume urinary output in 24hrs
1,200-1,500 ml in 24hours
40
adult kidney continuously produces urine at the rate of
50 – 120ml/hr
41
What is the normal volume of urine output in 24hrs?
1.2 – 1.5 liters
42
Anuria
* failure of the kidneys to produce urine.
* less than 50 milliliters of urine in a day
43
Oliguria
* the production of abnormally small amounts of urine.
* urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children, and less than 400 mL daily in adults
44
Glycosuria
sugar in the urine
45
Dysuria
painful or difficult urination
46
Nocturia
awakening at night to urinate.
47
Polyuria
excessive urine output.
48
Incontinence
involuntary loss of urine
49
Proteinuria
the presence of abnormal quantities of protein in the urine, which may indicate damage to the kidneys.
50
Pyuria
pus
51
Stress incontinence
involuntary loss of urine when coughing etc
52
Which term describes a condition in which 24-hour urine output is less than 50 mL?
A. Dysuria
B. Glycosuria
C. Pyuria
D. Anuria
D
53
Color variations in urine
* Anticoagulants: red urine
* Diuretics: pale yellow urine
* Pyridium: orange to orange-red urine
* Elavil: green or blue-green urine
* Levodopa: brown or black urine
54
Your patient’s urine is blue-green in color. What action may you the nursing student take to determine the cause?
* Review the patient’s current medications
* Because you know that Elavil causes the urine to become blue-green.
55
Transient urinary incontinence:
appears suddenly and lasts 6 months or less
56
Mixed urinary incontinence:
urine loss with features of two or more types of incontinence
57
Overflow urinary incontinence:
over distention and overflow of bladder
58
Functional urinary incontinence:
caused by factors outside the urinary tract
59
Reflex urinary incontinence:
emptying of the bladder without sensation of need to void
60
Total urinary incontinence:
continuous, unpredictable loss of urine
61
Interventions for Age-Related Incontinence
* Fluid intake should be 1,500 -2,000ml daily
* Avoid or limit caffeine, alcohol, sweeteners
* Ensure safe and easy access to bathroom
* Use assistive devices- raised toilet seat, grab bars, bedside commode, urinal
* Remove throw rugs in bed and bathroom
* Wear non slip footwear
* Practice Kegel exercises several times per day
62
Urinary tract infections are the leading cause of
morbidity and healthcare expenditure in persons of all ages.
63
\_\_\_\_ bladder is not palpable.
empty
64
Why to use Catheterization: Indwelling/Straight
* Emptying bladder before, during, or after surgery
* Monitoring critically ill patients
* Increasing comfort for terminally ill patients
* Relieving urinary retention
* Obtaining a sterile urine specimen
* Obtaining a urine specimen when usual methods can’t be used
65
Managing Chronic Renal Failure (3)
1. Hemodialysis
2. Peritoneal Dialysis
3. Renal Transplant
66
A-V Fistula is an abnormal connection or passageway between
an artery and a vein.
It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm
67
Rights of medication administration
* Right medication
* Right patient
* Right dosage
* Right route
* Right time
* Right reason
* Right assessment data
* Right documentation
* Right response
* Right to education
* Right to refuse
68
Chemical name identifies
drug’s atomic and molecular structure
69
Trade name is
brand name copyrighted by the company that sells the drug
70
Generic name is
assigned by the manufacturer that first develops the drug
71
official name is
name by which the drug is identified in official publications USP and NF
72
1 milligram (mg) = ___ micrograms (mcg)
1000
73
Reconstitution
adding a specific amount of diluent to the vial to change a power to a liquid
74
Six Steps of dimensional analysis
1. What is ordered?
2. What is the question asking?
3. What do you have on hand?
4. Establish the unit path or conversion factors needed
5. Set up the problem to allow for cancellation of unwanted units
6. Multiply the numerators, multiply the denominators, and divide the numerator by the denominator.
75
1 gram (g) = ____ milligrams (mg)
1000
76
1 kilogram (kg) = ____ grams (g)
1000
77
1 kilogram (kg) = ____ pounds (lbs)
2.2
78
1 milliliter (mL) = ____ cc
1
79
1 liter (l) = ____ milliliters (mL)
1000
80
rounding up heuristics for dosage
.5 and above = round up .4 and below = round down
81
1 liter (l) = ___ quart or ___ ounces (oz)
1 quart or 32 ounces
82
1 teaspoon (tsp) = ___ milliliters (mL)
5
83
3 teaspoons (tsp) = ___ tablespoons (tblsp or tbsp)
1
84
1 tablespoon (tbsp) = ___ milliliters (mL)
15
85
1 ounce (oz) = ___ milliliters (mL)
30
86
1 grain (gr) = ___ milligrams (mg)
65
87
in 3 factor med dose problems, the numerator is
dosage of the medication
88
in 3 factor med dose problems, the denominator is
weight of the patient AND time required to administer the medication
89
1000 mcg = __ mg
1
90
1000 mg = ___ g
1
91
1000 grams = ___ kg
1
92
2.2 pounds = __ kg
1
93
1 cc = ___ mL
1
94
1000 mL = __ L
1
95
1 quart or 32 oz = ___ L
1
96
5 mL = ___ tsp
1
97
1 tbsp = ___ tsp
3
98
15 mL = ___ tbsp
1
99
30 mL = ___ oz
1
100
65 mg = \_\_\_gr
1
101
Chemical name of a drug identifies
drug’s atomic and molecular structure
102
Trade name of a drug is the
brand name copyrighted by the company that sells the drug
103
Generic name of a drug is
assigned by the manufacturer that first develops the drug
104
Official name of a drug is
name by which the drug is identified in official publications USP and NF
105
The prescriber conveys medication plans to others by an order called a prescription. After the pharmacist prepares the medication, the nurse
administers the medication to the patient.
106
If an error is made when the order is written, the ___ or ____ administering the medication has the opportunity to note the discrepancy
pharmacist ; nurse
107
Types of orally administered medications
* Capsule
* pill
* tablet
* extended release
* elixir
* suspension
* syrup
108
Types of topically administered medications
* Liniment
* lotion
* ointment
* suppository
* transdermal patch
109
3 top methods of administration
1. oral
2. topical
3. injectable
110
What are the first and second identifiers for checking the identity of a patient?
* First: Validating the patient’s name
* Second: Validating the patient’s identification number, medical record number, and/or birth date
111
6 factors affecting drug absorption
1. Route of administration
2. Lipid solubility
3. pH
4. Blood flow
5. Local conditions at site of administration
6. Drug dosage
112
teratogenic
developmental considerations - means it may be passed from mother to fetus and cause a birth defect
113
Therapeutic range
the concentration of a drug within the blood stream that does not produce toxicity
114
Peak level
highest concentration of a drug within the plasma when absorption is complete
115
Trough level
when the drug is at its lowest concentration
116
Adverse drug effect
undesirable effect other than the intended therapeutic effect. i.e. constipation 2/2 morphine use
117
Allergic effect
an immune system response that occurs when the body interprets the administered medication as a foreign substance and forms antibodies against the drug
118
Idiosyncratic effect
Also known as paradoxical effect is any unusual or peculiar response to a drug that may manifest itself by over response, under response, or even opposite of the expected response.
119
PRN order
as needed
120
Stat order
carried out immediately
121
Standing order (routine order)
carried out until cancelled by another order
122
Antagonist effect of drug interactions (example)
* A drug-drug interaction is one that the combined effect of the two drugs is less than the effect of the one drug alone.
* Example: tetracycline and calcium supplements or calcium products. (calcium chelates)
123
Synergistic effect (example)
* A drug-drug interaction that the combined effect of the two drugs are greater than that of the two drugs alone.
* Example: alcohol and barbiturates when taken together have a unbeneficial synergistic effect for increased nervous system depression
124
True or false: Only pain medications may be give to patients without a medication order from a licensed practitioner.
False
125
PRN
Pro Re Nata- : as the circumstances arises. More commonly “as needed”
126
PR
per rectum
127
NPO
Nil Per Os: nothing through the mouth
128
Medication Types
* Oral (PO tablets, capsules, liquid)
* Enteral- NGT/PEG (liquids, check crushability of meds, warm oil based liquids.)
* Intramuscular (IM), Subcutaneous (SQ), Intradermal (skin prep, location, rotation)
129
Oral administration of meds means that they are intended for absorption in the
stomach and small intestine
130
Why would oral meds be contraindicated?
ex. NPO, difficulty swallowing, patient is comatose, actively vomiting, trach
131
Hard-coated pills don’t release until
after they pass through the stomach — going to have some type of substance that may irritate the stomach muscoa
132
Buccal administration
placing drug between tongue and cheek
133
Enteral route
* involves the esophagus, stomach, and small and large intestines (i.e., the gastrointestinal tract).
* Methods of administration include oral, sublingual (dissolving the drug under the tongue), and rectal
* Parenteral routes do not involve the gastrointestinal tract.
134
Medications via tube
* stop feeding
* bring patient’s head up to semi-fowler’s
* insert medication premixed with 15-30mL water
* then insert more water through after administration
* if multiple medications, flush every time, document Ins and Outs is very important
* After you give medication, you don’t want to connect them to suction or feeding for about 30 min so that medication is absorbed
* ALWAYS remember to go back and turn on the feeding
135
Parenteral means
* “Outside of intestines or alimentary canal”
* Ex:
* Intradermal injection- administered into dermis
* Subcutaneous injection—administered into adipose tissue
* Intramuscular injection—administered through skin and subcutaneous tissue into certain muscles
136
Luer lock on the syringe is
a screw connection on a syringe that creates a leak-free seal
137
Always want to have the Bevel ___ when giving medications
UP
138
SQ (subcutaneous) needle and syringe size:
26-30G, 3/8inch-1 inch needle, 1-3mL syringe
139
IM (intramuscular) needle and syringe size:
20-25G, 1-3 inch needle, 3-5mL syringe
140
Longer needle required for IM injection than for
intradermal or SQ injection
141
Large-lumen needle required for
higher viscous drugs
142
Larger amount of medication requires greater capacity of
syringe
143
Ampule
* usually glass, contains a single dose of medication
* to access it you have to break it
* would typically use a filter needle to obtain the medication from the ampule itself
* then would switch needle and put in one that you would use to administer it to a patient
144
Vial
* must be cleaned with an alcohol swab every time after using and before (if it has multiple doses) - must be labeled with date and time that you used it
* you can mix multiple medications into a syringe at a time, this comes into play with Insulin
145
Intramuscular injection angles:
72, 90
146
subcutaneous injection angles:
90, 45
147
Intradermal injection angles:
5-15 degrees
148
vaccines are an example of when the deposit of medication creates a depot that's designed to be delivered over
days, weeks, months
149
Examples of Intramuscular injections
vaccines, hormones and antibiotics
150
Volume of medication varies with injection site. Generally
1-4mL
151
Ventrogluteal site is recommended for
adults
152
Vastus lateralis site is recommended for
infants, toddlers, and children
153
Deltoid muscle site can take __ mL max
1 mL
154
For the Deltoid injection site, use the ___ as your landmark
acronmium process
155
For the Ventrogluteal injection site, put your left palm over the
greater trochanter and have tip of fingers touching over iliac spine
156
Z-track Method of IM Injections is recommended for
all intramuscular injections
157
Z-track method for IM injections: steps
1. Fill syringe with medication
2. Attach clean needle to syringe
3. Pull skin down or to one side about 1 inch with non-dominant hand
4. While holding position, insert needle and inject medication slowly
5. Withdraw needle steadily and release displaced tissue
6. DO NOT massage site
158
Possible complications of IM injections
* Abscesses
* Cellulitis
* Injury to blood vessels, bones, and nerves
* Lingering pain
* Tissue necrosis
* Periostitis
159
For intradermal injections, medication is administered into the
dermis just below the epidermis
160
The intradermal route has the longest ____ of all parenteral routes
absorption time
161
Sites used for intradermal injections
forearm, upper back, under scapula
162
What size/gauge needle and syringe is for intradermal injections? what's the normal dosage?
25-27 G, ¼-1/2 inch needle
normal dose: Small dosage, usually
163
Examples of subcutaneous injections
Insulin, Heparin, Lovenox
164
Process of Bowel Elimination (5 steps)
1. Fecal material reaches rectum
2. Stretch receptors initiate contraction of sigmoid colon/rectal muscles
3. Internal anal sphincter relaxes
4. Sensory impulses cause voluntary “bearing down”
5. External sphincter relaxes
165
Type I feces on the Bristol Stool Chart, separate hard lumps, indicates
Very constipated
166
Type II feces on the Bristol Stool Chart, lumpy and sausage-like, indicates
Slightly constipated
167
Type 3 feces on the Bristol Stool Chart, a sausage shape with cracks in the surface, indicates
Normal
168
Type 4 feces on the Bristol Stool Chart, like a smooth soft sausage or snake, indicates
normal
169
Type 5 feces on the Bristol Stool Chart, soft blobs with clear-cut edges, indicates
Lacking fibre
170
Type 6 feces on the Bristol Stool Chart, mushy consistency with ragged edges, indicates
inflammation
171
Type 7 feces on the Bristol Stool Chart, liquid consistency with no solid pieces, indicates
inflammation
172
Direct visualization diagnostic tests for bowel include (2)
1. Colonoscopy
2. Sigmoidoscopy
173
BRAT diet for managing Diarrhea
Bananas, rice, applesauce, toast
174
Antidiarrheal medications are ___ recommended for acute diarrhea
not
175
Fleet enemas
saline enema
176
Ostomy is
surgery to create an opening (stoma) from an area inside the body to the outside
177
The \_\_\_\_, with their larger lumina, are the most likely sites for perforation of the colon
cecum and ascending colon
178
The RN takes responsibility and accountability for the provision of
nursing practice.
179
The RN directs care and determines the appropriate utilization of any assistant involved in providing
direct patient care.
180
The RN may delegate components of care but does not delegate the
nursing process itself
181
The practice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be
delegated
182
Chief Nursing Officers are accountable for
establishing systems to assess, monitor, verify and communicate ongoing competence requirements in areas related to delegation.
183
The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is:
1. The right task
2. Under the right circumstances
3. To the right person
4. With the right directions and communication; and
5. Under the right supervision and evaluation.
184
4 Steps of Delegation:
1. Assessment and Planning
2. Communication
3. Surveillance and Supervision
4. Evaluation and Feedback
185
Intravenous Route goes ____ and has an ____ effect. It's most commonly used in \_\_\_
directly into the bloodstream; immediate; emergency situations
186
Intravenous Bolus
a relatively large volume of fluid or dose of a drug or test substance given intravenously and rapidly to hasten or magnify a response
187
With IV push or bolus, a syringe is connected to the ____ and the medication is injected \_\_\_
IV access device; directly (slowly, if it might irritate the vein or cause a too-rapid effect)
188
PCA
Patient controlled anaesthesia
189
minimum assessment of IV is
once every hour
190
potassium can cause a ___ in an IV
really bad infiltrate
191
phlebitis
inflammation of the vein
192
Nebulizer is a way to deliver an
aerosolized medication
193
Spacers
* Also known as aerosol-holding chambers, add-on devices and spacing devices,
* spacers are long tubes that slow the delivery of medication from pressurized MDIs.
194
Examples of controlled substances
Heroin, Opium, Oxycontin, Oxycodone, Hydrocodone, Hydromorphone, Fentanyl
195
urea, uric acid, creatinine, nitrogen
Organic constituents of urine
196
ammonia, sodium chloride, traces of iron
Inorganic constituents of urine
197
* failure of the kidneys to produce urine.
* less than 50 milliliters of urine in a day
Anuria
198
* the production of abnormally small amounts of urine.
* urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children, and less than 400 mL daily in adults
Oliguria
199
sugar in the urine
Glycosuria
200
painful or difficult urination
Dysuria
201
awakening at night to urinate.
Nocturia
202
excessive urine output.
Polyuria
203
involuntary loss of urine
Incontinence
204
the presence of abnormal quantities of protein in the urine, which may indicate damage to the kidneys.
Proteinuria
205
pus
Pyuria
206
involuntary loss of urine when coughing etc
Stress incontinence
207
appears suddenly and lasts 6 months or less
Transient urinary incontinence:
208
urine loss with features of two or more types of incontinence
Mixed urinary incontinence:
209
over distention and overflow of bladder
Overflow urinary incontinence:
210
caused by factors outside the urinary tract
Functional urinary incontinence:
211
emptying of the bladder without sensation of need to void
Reflex urinary incontinence:
212
continuous, unpredictable loss of urine
Total urinary incontinence:
213
an artery and a vein.
It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm
A-V Fistula is an abnormal connection or passageway between
214
drug’s atomic and molecular structure
Chemical name of a drug identifies
215
brand name copyrighted by the company that sells the drug
Trade name of a drug is the
216
assigned by the manufacturer that first develops the drug
Generic name of a drug is
217
name by which the drug is identified in official publications USP and NF
Official name of a drug is
218
the concentration of a drug within the blood stream that does not produce toxicity
Therapeutic range
219
highest concentration of a drug within the plasma when absorption is complete
Peak level
220
* A drug-drug interaction is one that the combined effect of the two drugs is less than the effect of the one drug alone.
* Example: tetracycline and calcium supplements or calcium products. (calcium chelates)
Antagonist effect of drug interactions (example)
221
* A drug-drug interaction that the combined effect of the two drugs are greater than that of the two drugs alone.
* Example: alcohol and barbiturates when taken together have a unbeneficial synergistic effect for increased nervous system depression
Synergistic effect (example)
222
Pro Re Nata- : as the circumstances arises. More commonly “as needed”
PRN
223
per rectum
PR
224
Nil Per Os: nothing through the mouth
NPO
225
* usually glass, contains a single dose of medication
* to access it you have to break it
* would typically use a filter needle to obtain the medication from the ampule itself
* then would switch needle and put in one that you would use to administer it to a patient
Ampule
226
* must be cleaned with an alcohol swab every time after using and before (if it has multiple doses) - must be labeled with date and time that you used it
* you can mix multiple medications into a syringe at a time, this comes into play with Insulin
Vial
227
72, 90
Intramuscular injection angles:
228
90, 45
subcutaneous injection angles:
229
5-15 degrees
Intradermal injection angles:
230
25-27 G, ¼-1/2 inch needle
normal dose: Small dosage, usually
What size/gauge needle and syringe is for intradermal injections? what's the normal dosage?
231
Insulin, Heparin, Lovenox
Examples of subcutaneous injections
232
Bananas, rice, applesauce, toast
BRAT diet for managing Diarrhea
233
saline enema
Fleet enemas
234
surgery to create an opening (stoma) from an area inside the body to the outside
Ostomy is
235
1. Assessment and Planning
2. Communication
3. Surveillance and Supervision
4. Evaluation and Feedback
4 Steps of Delegation:
236
a relatively large volume of fluid or dose of a drug or test substance given intravenously and rapidly to hasten or magnify a response
Intravenous Bolus
237
IV access device; directly (slowly, if it might irritate the vein or cause a too-rapid effect)
With IV push or bolus, a syringe is connected to the ____ and the medication is injected \_\_\_
238
Patient controlled anaesthesia
PCA
239
inflammation of the vein
phlebitis
240
aerosolized medication
Nebulizer is a way to deliver an
241
* Also known as aerosol-holding chambers, add-on devices and spacing devices,
* spacers are long tubes that slow the delivery of medication from pressurized MDIs.
Spacers
242
Heroin, Opium, Oxycontin, Oxycodone, Hydrocodone, Hydromorphone, Fentanyl
Examples of controlled substances
