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Flashcards in Exam 2 Deck (242):
1

What Is Confidential information?

  • 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

Chart only things ___ do

you

3

Do Not Chart

  • 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

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.

98,000

5

What is SBAR?

  • S = Situation
  • B = Background
  • A = Assessment
  • R = Recommendation

6

Acronym for documentation: FACT

  • F - factual
  • A - accurate
  • C - complete
  • T - timely

7

SOAP: for problem-oriented medical records

  • subjective
  • objective
  • assessment
  • plan

8

PIE charting:

  • Problem, Intervention, Evaluation are planned and charted
  • You state the problem, you do an intervention, and then evaluate

9

Focus charting:

  • 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).

10

With regards to patient teaching: essential component of the process that needs to be documented is ___

TEACHBACK - returned demonstration, verbalized understanding

11

majority of patient errors occur because of

ineffective communication between providers or shift change, or transitions of care

12

Working with interdisciplinary teams, communication needs to be ____, NOT aggressive

assertive

13

Non-verbal Communication (5)

  1. Facial Expressions
  2. Posture and gait
  3. Personal appearance
  4. Gestures
  5. Touch

14

Verbal communication

  •  Vocabulary
  • Pace
  • Tone of voice
  • Timing
  • Humor
  • Be credible

15

Using silence allows the client to

take control of the discussion, if he or she so desires.

16

"Accepting" as a Therapeutic Communication Technique, conveys

positive regard

17

Giving broad openings allows the client to

select the topic

18

Offering general leads encourages the client to

continue speaking

19

Restating lets the patient know

whether an expressed statement has been understood or not

20

Reflecting questions or feelings are referred back to the pt so they may

be recognized

21

Requesting an explanation is a non-therapeutic communication technique because asking “Why?” implies that

the client must defend his or her behavior or feelings

22

The _________ is the basic structural and functional unit of the kidneys.

nephron

23

Nocturnal ___________, known as nighttime bedwetting, usually subsides by 6 years of age.

enuresis

24

Incontinence that results from weakness of the pelvic floor muscles can be treated by teaching the patient to perform ___________ exercises.

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