Exam 3 Flashcards

Question

Postural drainage

Answer 1

Drainage, positioning, and turning to improve secretion clearance and oxygenation -position depends on which lobe is drained; position so side that needs draining is up

Answer 2

* Unable to clear secretions by expectoration * Gurgling respirations * Sputum collection if patient unable to cough productively * Do not suction regularly because foreign objects can increase secretions, risk for infection

Answer 3

* Oral (Yankauer) suction tube (clean technique) Other suctioning techniques (sterile technique and do first): - Oropharyngeal and nasopharyngeal - Orotracheal and nasotracheal- no artificial airway present - Tracheal- through artificial airway

Answer 4

* Ambulation-increases general strength and lung expansion * Positioning 45 degree-reduces stasis of secretions and decreased chest wall expansion; Promotes adequate ventilation and oxygenation * Incentive Spirometry- voluntary deep breathing IN via visual feedback to patients about inspiratory volume; reserved for those with atelectasis or at risk after surgery * Positive expiratory pressure (PEP): airway clearance requiring exhalation against resistance to get air behind mucus

Answer 5

* Endotracheal is short-term, removed within 14 days * Tracheostomy is surgically or percutaneous inserted for prolonged mechanical ventilation which may interfere with vocalization

Answer 6

* CPAP (continuous positive airway pressure)-benefits those with sleep apnea, heart failure, preterm with underdeveloped lungs * BiPAP (Bilevel positive airway pressure)-provides assistance during inspiration and prevents alveolar closure during expiration

Answer 7

* Flow rates at least 10 L/min * FiO2 24-100% * Provides high humidification with O2 delivery * Medication delivery * Put it back on the oxygen flow amount and device after treatment -IMPORTANT

Answer 8

1. Set up yellow marker 2. Patient exhales completely 3. Patient seals mouth and inhales slowly and deeply 4. Patient should inhale until they cannot anymore then hold for 6 seconds 5. Then takes mouth off and exhales At least 4 times a day, 10 times an hour

Answer 9

* Elevate HOB- Position (45-degree semi-Fowler’s) * Change positions often and prevent sliding down bed * If lung collapse, put good lung down * If abscess or hemorrhage, put bad lung down

Answer 10

- Use humidification if above 4 L to avoid drying out nose - Need order since therapeutic gas (device, number of liters of oxygen and/or sat to maintain)-- - Monitor respiratory rate and pattern, LOC, SpO2, ABGs and notify provider as necessary - Provide oxygen therapy at the lowest liter flow rate that manages hypoxia - Takes 5 minutes for change in O2 sat to be noticed - Decrease the FiO2 as the client’s SpO2 improves - Can delegate nasal cannula or face mask but nurse still assess response

Answer 11

- Nonproductive cough - Sternal pain - Nasal stuffiness - Sore throat - Hypoventilation

Answer 12

* No smoking * Keep at least 10 feet from open flames * Ensure working smoke detectors * Do not use oil-based products (petroleum products, Vaseline) * Use water-soluble gel to prevent dry nares * When using oxygen cylinders, secure them so they do not fall over. * Check oxygen level of portable tanks before transporting a patient should be 75% full * Ensure patient has adequate oxygen tubing

Answer 13

- CPR (Chest compression, Earl defibrillation, Establish airway and rescue breathing) - Rescue Breathing - Manual Ventilation

Answer 14

- Flow rate 8-12 L/min - FiO2: highly variable; 28% - 100% - Purpose: controlled concentration of oxygen and increase moisture for patients who have facial burn or broken nose, or who are claustrophobic - Notes: Covers the nose and mouth; Does not create a seal around the nose

Answer 15

- Flow rate 6-12 L/min; Minimum flow 5 L/min - FiO2 35-50% - Purpose: short-term use - Disadvantages: Therapy interrupted with eating and drinking; Increased risk of aspiration, Comfortable unless claustrophobic, contraindicated for pts who retain CO2

Answer 16

- Most common - Low flow O2 (1-6 L/min) - FiO2 24-44% - Concern: Skin - 3 tips to address concern: Pad pressure points; Lubricate nares; Humidify > 4 L/min - Advantages: safe, simple, does not impede talking or eating

Answer 17

- Flow rates 10-15 L/min to keep the reservoir bag 2/3 full during inspiration and expiration - FiO2 60-90% - Valve between mask and reservoir bag-prevents mixing of exhaled air with oxygen administered - Advantages: Useful for short period, does not dry mucous membranes - Disadvantages: Contraindicated for COPD, may irritate skin; hot, confining

Answer 18

- Flow rates 4-12 L/min - FiO2 24-50% - Benefits: High-flow delivery system; Delivers the most precise oxygen concentration; Good for COPD who need low, constant O2

Answer 19

- Diaphragmatic Breathing: Increases tidal volume and decreases respiratory rate; useful for those with dyspnea secondary to heart failure -> belly out, inhale, belly in, exhale - Pursed-lipped breathing: deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse

Answer 20

1. Viral --nonproductive cough or clear sputum 2. Bacterial- productive cough of white, yellow, or green sputum 3. Fever 4. Chills 5. dyspnea on exertion 6. sharp, stabbing chest pain upon inspiration 7. Rhonchi or crackles may be heard on auscultation. 8. Children may have retractions and nasal flaring. 9. Older Adults may have confusion

Answer 21

* Inflammation of terminal bronchioles and alveoli is triggered by infectious organisms and inhalation of irritating agents * WBCs go to area of infection, causing local capillary leak, edema, and exudate * Reduces GAS EXCHANGE and leads to hypoxemia (need blood culture)

Answer 22

- older adult - never received the pneumococcal vaccination or received it more than 5 years ago - Did not receive the influenza vaccine in the previous year - chronic health problem or other coexisting condition that reduces immunity - Recent exposure to respiratory viral or influenza - Use of tobacco or alcohol or exposed to high amounts of secondhand smoke

Answer 23

* Most common bacterial agents: streptococcus pneumoniae, HIB--- empirical antibiotics * Most common viral: influenza, RSV * Treatment length: minimum five days

Answer 24

- Is an older adult - chronic lung disease - presence of gram-negative colonization - altered LOC - Recent aspiration event - IV therapy, wound care, antibiotics in past 30 days - poor nutritional status - reduced immunity - Usage of drugs that increase gastric pH (histamine [H2] blockers, antacids) or alkaline tube feedings - in hospital >48 hrs in past 90 days

Answer 25

- Provide adequate hydration - Assess risk for aspiration using evidence-based tool - Monitor for early signs of sepsis - Hand hygiene - Provide vigorous oral care

Answer 26

- 48-72 hrs after trach - presence of ET tube increases risk by bypassing protective airway mechanisms and allowing aspiration of secretions from oropharynx and stomach - dental plaque also increases risk

Answer 27

* Elevate HOB 30 degrees * Daily sedation and weaning assessment * DVT prophylaxis * Oral care regimen * Stress ulcer prophylaxis * suctioning

Answer 28

- Collapse of alveolar lung tissue which prevents normal exchange of O2 and CO2 - Incomplete expansion of a lung or portion of the lung

Answer 29

* Airway obstruction (mucus plug in airway or by compression by fluid, tumor mass, exudate) * Lung compression (pneumothorax or pleural effusion) * Increased recoil of the lung due to loss of pulmonary surfactant * Breathing high concentrations of oxygen increases the rate gases are absorbed from the alveoli * Hypoventilation (reduced volume of O2)

Answer 30

* Rapid, shallow breathing/ tachypnea * Dyspnea * Cough * Fever * Decreased chest expansion on affected area * Leukocytosis * Breath sounds (Crackles over involved lobes of lungs, decreased or absent breath sounds, Wheezing) * Trachea shift to affected side may be present if the collapsed area is large * Use of accessory muscles causing fatigue

Answer 31

-unplanned/informal (nurse-patient on age-specific screenings, medication, discharge teaching) -formal classes (smoking cessation, diabetes education ) -self-directed (internet sources and instructional videos; nurse role to answer questions, review materials for accuracy, and assist patient to locate high quality info)

Answer 32

* Cognitive: increases knowledge of subject, thinking processes; may include reading materials, lectures, Q/A session, role-play * Psychomotor: requires patient to manipulate and simulate manual or physical skills; may include demonstrations, practices; may include demonstration, practice, return demonstration, independent projects * Affective: changes in attitudes, valued and beliefs; focus is receiving and characterizing; may include role-play, one-to-one or group discussion

Answer 33

three primary points of this model are: 1. The individual’s perception of his/her susceptibility to and the severity of the disease are the primary motivators to learn and change behavior. 2. A belief must exist that the illness can be avoided, and that taking action can reduce the risk. 3. The individual must also believe that he/she can make the necessary changes to improve their health - Modifiable factors demographics, social, psychological variables must exist

Answer 34

1. Focus is on optimizing wellness versus avoiding disease. 2. Patient motivation is influenced by social support and competing priorities. 3. Patient perceptions of benefit and the ability to succeed can impact outcomes.

Answer 35

* Empower Patient (collaborate) * Assist the patient in developing mutual and relevant goals and learning objectives * Assess patient readiness/needs, environment, motivation, and ability (Consider their background, culture when making goals) * Plan educational interventions to achieve goals * Evaluate patient outcomes toward goal attainment

Answer 36

Speak up about questions or concerns Pay attention to the care you get. Educate Yourself about your illness Ask others to be your advocate Know about your medicine Use a quality health care organization Participate in all decisions

Answer 37

- Motivation (values) - Ability (Physical symptoms, anxiety) - Environment - Readiness (attitude, grief)--biggest

Answer 38

Lower-level needs must be met before attempting to address higher-level needs. * Self-actualization * Self-esteem/ego * Social / love and belonging * Security (comfort) * Physiological (pain)

Answer 39

cognitive and social skills that determine ability of individual to gain access to, understand and use info to promote and maintain good health; Strong predictor of health status; stronger that SES, age, race, educational level * Assess by asking patient to read medication label, brochure * If patient unable to read, nurse needs alternate methods

Answer 40

* loss, grief, health status (Patients cannot learn when they are unwilling or unable to accept a loss or their illness) * Impaired Attentional set: mental state that allows a learn to focus on and comprehend a learning activity * Physical discomfort, anxiety, confusion, and environmental distractions

Answer 41

Consider patient’s size, strength, coordination, sensory acuity, energy level

Answer 42

* Number of people included in the session—max 5-6 * Noise level- low * Privacy-close cubicle curtains * Room Temperature- good ventilation * Furniture in room-arrange groups so individuals face one another * Lighting in room- well-lit

Answer 43

* Lack of social support systems * Lack of financial resources * Time * Frequent interruptions * Distractions, noise

Answer 44

* Change tone and intensity of voice * Make eye contact * Use gestures that accentuate key points of discussion * Move around room * Use relaxation and deep breathing if patient anxious * Active participation

Answer 45

* Teach information in limited time frame * Outlines task with clear, concise instructions * No opportunity for feedback Ex. Preparing for emergency surgery

Answer 46

* Collaborative with nurse and patient * Patient has opportunity for discussion, feedback, mutual outcome setting, revision of teaching plan

Answer 47

* Patient takes accountability for their learning * Nurse is available for support and to observe patient’s progress without introducing new info

Answer 48

* Use of stimulus to Increase probability of desired response * More likely to repeat behavior with reinforcement * Positive > negative b-c negative can discourage participation or lead to withdrawal

Answer 49

* Goal: assist smokers to stop their use of cigarettes and other forms of tobacco. (Formal teaching) * Teaching topics: dangers, risks, complications of tobacco use * Interventions: Nicotine replacement, Behavior modification, Counseling, Support, Relapse prevention, cessation plan

Answer 50

Goal: ensure patient transitions to the setting in which health care needs can be appropriately met (informal teaching) Nurse role: Begins on admission and provided consistently so learning is reinforced; know plan of care ASAP, inform patient and family Patients require the following instruction before they leave health care facilities: * Safe and effective administration of medications and any equipment * Counseling on nutrition and modified diets * Access to available and appropriate community resources including referrals * When to notify the healthcare provider for changes in functioning of new symptoms * Post-hospital destination (determined by case manager)

Answer 51

* Goal: to increase the patient’s ability to self-manage this endocrine disorder (formal teaching) * Facilitated through group classes and one-on-one teaching in hospital or community Teaching topics: * Physiological alterations present in the disease * Diet * Medication management * Monitoring of blood glucose * Risk reduction * Psychosocial impact

Answer 52

* Includes information taught and to who i.e., patient, family * Document patient’s motivation, ability to learn, patient’s response, and resources. * Include detailed plan and goal progression for other health care providers to reinforce if the education is to be continued across care settings.

Answer 53

* Observe patient’s performance * Ask evaluative questions, phrased carefully to guide patient to identify or describe info * Surveys and questionnaires for affective behavior change * Teach back technique (with nonjudgmental language, ownership of insufficient teaching) * Return demonstration for psychomotor

Answer 54

* Active participation * Consider patient’s learning styles, literacy, and culture * Use diagrams and pamphlets

Answer 55

* Most economical * small group (<6) effective * Involves instruction and discussion * Leads to deeper understanding, longer retention, increased peer support * Not all patients benefit so individualize

Answer 56

* Usage of psychomotor skills * Most effective when educator does skill then return demonstration

Answer 57

* Useful to teach complex ideas and concepts * Acknowledge patient’s background, experience, and culture to keep analogies relevant * Keep simple and clear

Answer 58

* Apply knowledge in safe controlled environment * Rehearsing desired behavior to enhance patient comfort with it

Answer 59

1. Education level 2. Literacy level 3. Social support 4. Resources 5. Developmental level 6. Generational differences 7. Culture

Answer 60

Look for reversible causes Notify healthcare provider

Answer 61

1. Adequate lighting in bathroom, 2. Mobility aids (raised toilet, walker, etc) 3. Elastic waist pants with no zipper or button 4. Use of incontinence containment product 5. Keep call light in reach

Answer 62

1. Timed void 2. double void 3. monitor post void residual 4. intermittent catheterization if severe retention

Answer 63

Instruct patient to do pelvic floor exercises (Kegel exercises)- squeeze anus as if to hold in gas

Answer 64

1. Ask patient about symptoms of UTI 2. Avoid bladder irritants, caffeine, artificial sweeteners 3. Do pelvic floor exercises 4. bladder training

Answer 65

1. Follow a prescribed regimen of emptying the bladder – either through voiding or intermittent catheterization. 2. Place urine containment devices such as pads, condom catheters, purewix 3. Monitor for signs and symptoms of UTI 4. Monitor for autonomic dysreflexia; life threatening.

Answer 66

Caused by delirium, urinary tract infection, medications, hyperglycemia, CHF, mobility impairment Happens suddenly, unusual for patient and reversible

Answer 67

Causes outside the urinary tract or patient control, related to functional deficits (mobility), manual dexterity, cognitive impairment, poor motivation, environmental barriers, can be result of caregiver not responding

Answer 68

Caused by overdistended bladder which may happen with urinary retention, poor bladder emptying due to pelvic floor weakness, weak bladder contractions Symptoms: distended bladder, high postvoid residual, nocturia

Answer 69

Small volumes of urine loss due to increased intraabdominal pressures, trauma after childbirth, weakness of urinary structures. Usually does not happen at night

Answer 70

Urgency, frequency, nocturia, difficulty holding urine, leaks on the way to bathroom Leaks larger volume, strong urges like when one hears water running, drinks liquids

Answer 71

Diminished or absent awareness of the bladder filling, leakage of urine without awareness, may not completely empty the bladder due to Synergia At risk for autonomic dysreflexia- affects people who are para or quadriplegic.

Answer 72

- Collect during normal voiding or from an indwelling catheter or urinary diversion collection bag. - Use a clean specimen cup. - In some health care settings, you may be responsible for testing urine with reagent strips. Follow manufacturer instructions when performing and reading the strips. Dip the reagent strip into fresh urine, then observe color changes on the strip. Compare the color on the strip with the color chart on the reagent strip container.

Answer 73

- Urine may be collected by the patient after detailed instruction on proper cleansing and collection technique - Always use a sterile specimen cup. - Patient performs perineal care first (females hold labia open) - Patient urinates a bit into toilet - Patient then urinates in cup - Remove cup before urine stops and before releasing labia

Answer 74

- If the patient has an indwelling catheter, collect a sterile specimen from special sampling port found on the side of the catheter. Never collect the specimen from the drainage bag. - Clamp the tubing below the port for 10-15 minutes, allowing fresh, uncontaminated urine to collect in the tube. - After wiping the port with an antimicrobial swab, insert a sterile syringe hub and withdraw at least 3–5 mL of urine - Patients with a urinary diversion need to have the stoma catheterized to obtain an accurate specimen. - A preliminary report will be available in 24 hours, but usually 48–72 hours is needed for bacterial growth and sensitivity testing.

Answer 75

- The timed period begins after the patient urinates and ends with a final voiding at the end of the time period. - In most 24-hour specimen collections, discard the first voided specimen and then start collecting urine. - Patient voids into a clean receptacle, and the urine is transferred to the special collection container, which often contains special preservatives. - Depending on the test, the urine container may need to be kept cool by setting it in a container of ice. - Each specimen must be free of feces and toilet tissue. - Missed specimens make the whole collection inaccurate.

Answer 76

immediate and strong desire to void that is not easily deferred - Full bladder - Urinary tract infection - Inflammation or irritation of the bladder - Overactive bladder

Answer 77

Pain or discomfort with voiding - Urinary tract infection - Inflammation of the prostate - Urethritis - Trauma to the lower urinary tract - Urinary tract tumors

Answer 78

- High volumes of fluid intake - Bladder irritants (e.g., caffeine) - Urinary tract infection - Increased pressure on bladder (e.g., pregnancy) - Bladder outlet obstruction (e.g., prostate enlargement, pelvic organ prolapse) - Overactive bladder

Answer 79

Delay in start of urinary stream when voiding - Anxiety (e.g., voiding in public restroom) - Bladder outlet obstruction (e.g., prostate enlargement, urethral stricture)

Answer 80

Voiding excessive amounts of urine - High volumes of fluid intake - Uncontrolled diabetes mellitus - Diabetes insipidus - Diuretic therapy

Answer 81

Diminished urinary output in relation to fluid intake - Fluid and electrolyte imbalance (e.g., dehydration) - Kidney dysfunction or failure - Increased secretion of antidiuretic hormone (ADH) - Urinary tract obstruction

Answer 82

Awakened from sleep because of urge to void - Excess intake of fluids (especially coffee or alcohol before bedtime)—avoid 2 hours before bedtime - Bladder outlet obstruction (e.g., prostate enlargement) - Overactive bladder - Medications (e.g., diuretic taken in the evening) - Cardiovascular disease (e.g., hypertension) - Urinary tract infection

Answer 83

Leakage of small amounts of urine despite voluntary control of micturition - Bladder outlet obstruction (e.g., prostatic enlargement) - Incomplete bladder emptying - Stress incontinence

Answer 84

- Gross hematuria (blood is easily seen in urine) - Microscopic hematuria (blood not visualized but measured on urinalysis) - Causes o Tumors (e.g., kidney, bladder) o Infection (e.g., glomerular nephritis, cystitis) o Urinary tract calculi o Trauma to the urinary tract

Answer 85

- Bladder outlet obstruction (e.g., prostatic enlargement, urethral obstruction, perineal trauma after childbirth) - Absent or weak bladder contractility (e.g., neurological dysfunction such as caused by diabetes, multiple sclerosis, lower spinal cord injury) - Side effects of certain medications (e.g., anesthesia, anticholinergics, antispasmodics, antidepressants)

Answer 86

Acute retention: Suddenly unable to void when bladder is adequately full or overfull Chronic retention: Bladder does not empty completely during voiding, and urine is retained in the bladder

Answer 87

* painful, stretched bladder, feelings of pressure * Backflow to the upper urinary tract * Dilation of the ureters and renal pelvis * Pyelonephritis and renal atrophy * Overflow incontinence

Answer 88

Causes: ignoring urge, decreased peristalsis, blockage Effects: hardened and dry stool, constipation, impaction

Answer 89

- Hydration (water softens stool; increases urine volume to reduce bladder irritation; avoid excess) - Adequate dietary fiber (prevent stool retention; 25 g a day) - Regular and timely toileting practices (prevents constipation and urinary incontinence or retention; holding urine can lead to UTI) - Regular exercise (increases peristalsis) - Avoidance of environmental contamination (parasites in water and food that is not prepared properly)

Answer 90

-begins at 50 and stops at 75 - Stool-based tests (guaiac-based fecal occult blood test, fecal immunochemical test, or multitargeted stool DNA test) are recommended annually at rectal exam - Direct visualization tests include colonoscopy or sigmoidoscopy allow direct visualization of the colon and removal of precancerous lesions, averting the development of colon cancer. These are recommended every 10 years (or more often with certain risk factors).

Answer 91

- periodic prostate-specific antigen (PSA)-based screening of men ages 55 to 69 is individual decision - USPSTF recommends against in above 70 years

Answer 92

* Bladder or bowel retraining * Biofeedback to help gain control * Timed and prompted voiding (great for dementia) * Use of protective pads (great for dementia) * Skin care (great for dementia) * Fluid intake management * Avoid medications that contribute to problem * Avoid indwelling catheter

Answer 93

- Colectomy: removing a portion of the bowel and reattach colon - Colostomy/ileostomy: Diversion of the intestines (colon or small intestine) through a stoma on the due to injured or diseased intestine, colon, or rectum. - Rectal prolapse repair: when the rectum falls into or through the anal opening due to weak muscles or excess straining; surgical repair if regularly occurs or significant discomfort. most common among young children and the elderly. - Hemorrhoidectomy: excision of hemorrhoids if topical treatments and changes in diet do not eliminate their associated discomfort. T - Fecal collection systems. a flexible tube inserted into the rectum that is used to collect liquid stool in patients with incontinence who are not candidates for bowel retraining or have Clostridium difficile

Answer 94

- Urinary catheterization: placement of tube through urethra into bladder to drain urine; invasive and required medical order and aseptic technique - Stents: rigid tubes that provide an opening that is not normally present, used internally in the urethra and externally as part of anastomosis procedures performed for bladder cancer; maintain the patency of pathways for urinary elimination. - Removing renal calculi: lithotripsy (fragmentation of the stones through sound waves); endourologic procedures (crushing the stones); or open procedures in which an incision is made, and the stone is surgically removed. - Prostate surgery. An enlarged prostate can cause significant urinary obstruction; transurethral resection of the prostate or Prostatectomy refers to the removal of the prostate and is usually performed among younger men diagnosed with prostate cancer, particularly if diagnosed in early disease stage. - Bladder surgeries: laser surgery, transurethral resection, and partial or total cystectomy. - Urinary diversion: diverting the ureters to a urinary stoma on the skin (usually on the abdomen)

Answer 95

Most common for UTI: ciprofloxacin, trimethoprim with sulfamethoxazole, nitrofurantoin Purpose: treatment or prophylaxis of infection or urinary retention Precaution: decrease intestinal bacterial flora leading to diarrhea

Answer 96

Common types: loop (furosemide), thiazide, potassium-sparing Caution with renal disease

Answer 97

Common types: Loperamide/Imodium (for diarrhea), oxybutynin Purpose: anticholinergics that relieve smooth muscle spasms in urinary incontinence, IBS, diarrhea Precaution: may increase risk for urinary retention

Answer 98

Common types: bulk-forming agents, bowel stimulants, lubricants, stool softeners, laxatives (docusate sodium, bisacodyl), enemas Precaution: bowel can become dependent on laxatives and stimulants for impulse to defecate; discontinue as soon as elimination achieved

Answer 99

Conditions: UTI, kidney stones, cystitis, bladder spasms, hemorrhoids, rectal fissures Main: phenazopyridine (changes urine orange, for uti) Precaution: hypnotics and sedatives may reduce ability to recognize urge to void; opioids may lead to constipation

Answer 100

* Readiness for toilet training includes ability to recognize the feeling of bladder fullness, hold urine for 1 to 2 hours, and communicate the sense of urgency usually around 18-24 months * Pregnant women have increased frequency and reduced capacity due to hormonal changes and pressure of fetus on bladder * Older adults have decrease in bladder capacity, increased bladder irritability, and an increased frequency of bladder contractions during bladder filling. * Older adults are at increased risk for urinary incontinence because of chronic illnesses and factors that interfere with mobility, cognition, and manual dexterity.

Answer 101

* Americans expect toilet facilities to be private, whereas some cultures accept communal toilet facilities. * Social expectations (e.g., school recesses, work breaks) can interfere with timely voiding. * The need for privacy and adequate time to void can influence the ability to empty the bladder adequately. (close doors, ask visitors to leave) * Left hand for unclean procedures in some cultures

Answer 102

* Diabetes mellitus, multiple sclerosis, and stroke can alter bladder contractility and the ability to sense bladder filling (bladder overactivity or deficient bladder emptying) * Arthritis, Parkinson's disease, dementia, and chronic pain syndromes can interfere with timely access to a toilet. * Spinal cord injury or intervertebral disk disease can cause the loss of urine control because of bladder overactivity and impaired coordination between the contracting bladder and urinary sphincter. * Prostatic enlargement (e.g., benign prostatic hyperplasia [BPH]) obstructs bladder outlet

Answer 103

* Local trauma during lower abdominal and pelvic surgery can obstructs urine flow and cause ileus (stop peristalsis for 24-48 hrs) * Anesthetic agents and other agents given during surgery can decrease bladder contractility and/or sensation of bladder fullness and peristalsis, causing urinary retention and constipation * Cystoscopy may cause localized trauma of the urethra and transient (1 to 2 days) dysuria and hematuria. * Colonoscopy: required empty bowel and may lead to increased gas or loose stools until normal eating pattern resumed

Answer 104

Normal Amount: 2300 mL in 24 hrs Minimum Amount: 30 mL/ hr (if less, may be sign of impending death, bladder or kidney dysfunction, or fluid imbalance) Normal timing: every 3-6 hours; if longer urinary retention

Answer 105

* Ammonia in nature (more ammonia smell the longer it stands) * Foul odor may be UTI; garlic, asparagus * More concentrated the stronger the odor (more concentrated in morning or with ECF deficit)

Answer 106

* Transparent unless pathology is present * Cloudy if urine stands for several minutes or early in morning * Thick and cloudy with bacteria or WBCs * Foamy urine indicates protein in urine caused by high blood pressure or renal disease

Answer 107

-Normal: pale straw to amber color - Red: beets, rhubarb, blackberries - Bright red: bleeding from bladder, urethra, or prostate w/ catheter - Dark red: bleeding from kidneys or ureters - Dark amber: high concentration of bilirubin in patients with liver disease - Bright orange: phenazopyridine

Answer 108

- 2000 mL collection bag for urinary catheter - Foley catheter with a urometer- has a box and bag-used to collect hourly outputs or more precise measurement of urine - Urinal-used for men who can void on their own-might need help with emptying it-can measure - Nuns cap-used for patient who can go to bedside commode or commode in room for measuring-turn backwards in toilet for a stool sample; Monitor-record and empty frequently

Answer 109

- Specific gravity-concentration of particles in urine - High= Dehydration, increased ADH secretion, reduced renal blood flow - Low= Overhydrated, early sign of renal disease, inadequate ADH secretion - pH- usually acidic; if urine stands for a while---becomes more alkaline; - WBC- if over 4 indicates infection or inflammation - Casts-cylindrical bodies not normally present, types are hyaline, RBCs, WBCs, granular cells, and epithelial cells which all indicates renal disease

Answer 110

- Leukocyte esterase-key with kidney stones - Crystals- kidney stones or high uric acid (gout) - RBC/hematuria- damage to glomeruli or tubules, presence of catheter, period may have leaked into it, surgery, cancer

Answer 111

- Protein- indicates kidney function (damage to glomeruli allows large molecules to seep through) or from high blood pressure - Ketones- dehydration, excess aspirin, starvation, and diabetic ketoacidosis - Glucose- diabetes or high ingestion of carbs or steroids cancer

Answer 112

* Do they sit or stand * Daily voiding patterns (frequency, time of day, normal volume, hx of changes) * Assess Patient’s perceptions of urinary alterations including effects on self-concept or body image * Be sensitive and ask questions in straightforward manner

Answer 113

1. Assess kidney for flank pain (light karate chop lower back)- flank pain indicated kidney infection or pyelonephritis or hydronephrosis 2. Palpate and assess fullness and tenderness of bladder—bladder should not be palpable; if it is it should be like a tangerine (300-500 mL); if you touch and patient is in pain an intervention is needed 3. Assess perineal skin and urethral meatus (no drainage or inflammation)

Answer 114

- Do bladder scan before calling HCP - Maintain normal voiding - Cholinergic medication (Bethanechol chloride to stimulate bladder contraction) - Crede’s method - Catheterization if high postvoid residuals

Answer 115

- Drink 8 glasses water daily - More frequent voids - Keep bowels regular (can irritate bladder and cause frequency and urgency) - Void after intercourse - Peri-care (front to back) - Avoid tight clothes and nylon underwear - Avoid bubble baths, harsh soaps, sprays - Showers rather than baths - Avoid carbonated beverages and caffeine

Answer 116

- Women: Sit well back on the toilet seat, avoid “hovering” over the toilet, and make sure that the feet are flat on the floor. - Men void best while standing - Avoid straining when voiding or moving the bowels. - Double voiding: wait until the urine flow completely stops when voiding then attempt a second void - Timed voiding: voiding according to the clock, not the urge to void; helpful when the bladder does not fully empty - Crede method: manual compression of the bladder, a technique by which the hands are placed for the bladder and compress the bladder to assist in emptying, should not be implemented until consultation with the HCP

Answer 117

* Drink six to eight glasses of water a day (3. 7 L for men; 2L for women). Spread it out evenly throughout the day. * Avoid or limit drinking beverages that contain caffeine (coffee, tea, chocolate drinks, soft drinks). * To decrease nocturia, avoid drinking fluids 2 hours before bedtime. * Do not limit fluids if you experience incontinence. Concentrated urine may irritate the bladder and increase bladder symptoms. * Constipation with reduced fluid due to hardened stools

Answer 118

* Single-lumen catheters: used for intermittent/straight catheterization (i.e., the insertion of a catheter for one-time bladder emptying). * Double-lumen catheters: indwelling catheters, provide one lumen for urinary drainage while a second lumen is used to inflate a balloon that keeps the catheter in place. * Triple-lumen catheters: continuous bladder irrigation or when it becomes necessary to instill medications into the bladder. One lumen drains the bladder, a second lumen is used to inflate the balloon, and a third lumen delivers irrigation fluid into the bladder. * Condom catheter is safe, noninvasive alternative

Answer 119

- Assess catheter for drainage and obvious occlusions - Maintain closed sterile system that maintains direction of gravity and remains unclamped - Maintain bag below level of bladder and empty when half full (Never let bag touch floor to prevent contamination) - Remove promptly - usually within 24 hours post-op - Monitor voiding after removal (should be within 4 hrs; if not nurse needs to intervene)

Answer 120

- Infants have a smaller stomach capacity, less secretion of digestive enzymes, and more rapid intestinal peristalsis and no ability to control until 2-3 - Adolescents experience rapid growth of large intestine and gastric acids and increased metabolic rate. - Older adults may have decreased chewing ability; Peristalsis declines, and esophageal emptying slows; Muscle tone in the perineal floor and anal sphincter weakens - Size of the fetus increases, and pressure is exerted on the rectum in pregnancy which can impair passage of feces; Slowing of peristalsis during the third trimester often leads to constipation; hemorrhoids if frequent straining during defecation or delivery

Answer 121

- Fiber key to bulk fecal material - Bulk-forming foods i.e whole grains, fresh fruits, and vegetables help remove the fats and waste product - Cabbage, broccoli, or beans produce gas, which distends the intestinal walls and increases colonic motility

Answer 122

1. Increased respirations 2. fever 3. Dark-colored urine or decreased output 4. Dry skin 5. Decreased BP 6. Rapid thready pulse (diminished peripheral pulses) 7. Decreased LOC (dizziness, light headedness, fatigue)

Answer 123

1. Dry mouth and tongue 2. No tears when crying 3. No wet diapers for 3 hours or more 4. Sunken eyes or cheeks or soft spot in the skull 5. High fever 6. Listlessness or irritability

Answer 124

- Physical activity promotes peristalsis, whereas immobilization depresses it - Encourage early ambulation as illness begins to resolve or as soon as possible after surgery -

Answer 125

- Stress accelerates digestive process is accelerated, and peristalsis is increased so diarrhea and gaseous distention - Stress increases incidence of ulcerative colitis, IBS, certain gastric and duodenal ulcers, and Crohn's disease. - In depression, ANS slows impulses that decrease peristalsis leading to constipation. - Pain from hemorrhoid, rectal and abdominal surgery, anal fissures cause person to suppress urge

Answer 126

- use (bulk forming)fiber laxative then osmotic laxative then stimulant (bisacodyl) last since most likely to cause dependence - Bisacodyl is a cathartic and they have stronger and faster effect than laxatives

Answer 127

- Antiflatus- simethicone - Fiber supplements –psyllium fiber

Answer 128

1. need gloves, water soluble lubricant, absorbent pad, bed pan 2. lie person on left side with right leg flexed 3. monitor vital signs (want to see heart rate to avoid vagal response) 4. lubricate gloved index finger 5. Put full finger and feel for impaction; if there is impaction; you need order to remove 6. Digitally remove impaction by pushing against bowel wall to loosen stool and put in bedpan 7. Ask patient to take deep breath each time you go in 8. Stop if you see blood, patient says they feel light headed, heart rate drops *no need for order to check for impaction but you need order to remove it*

Answer 129

Enemas: instillation of a solution into the rectum and sigmoid colon to promote defecation by stimulating peristalsis. It works by breaking up the fecal mass, stretching the rectal wall, and initiating the defecation reflex - Used for immediate relief of constipation, emptying the bowel before diagnostic tests or surgery, and beginning a program of bowel training. (ALWAYS check for impaction first)

Answer 130

promote the complete evacuation of feces from the colon by stimulating peristalsis through the infusion of a large volume of solution or through local irritation of the mucosa of the colon; patient should hold as long as they can Types: tap water, normal saline, soapsuds solution, and low-volume hypertonic saline.

Answer 131

* Irregular bowel habits and ignoring the urge to defecate * Chronic illnesses (e.g., Parkinson's disease, multiple sclerosis, rheumatoid arthritis, chronic bowel diseases, depression, eating disorders) * Low-fiber diet high in animal fats (e.g., meats and carbohydrates); low fluid intake * Stress (e.g., illness of a family member, death of a loved one, divorce) * Physical inactivity * Medications, especially use of opiates * Changes in life such as pregnancy, aging, and travel * Neurological conditions that block nerve impulses to the colon (e.g., stroke, spinal cord injury, tumor) * Chronic bowel dysfunction (e.g., colonic inertia, irritable bowel)

Answer 132

- hypotonic and exerts an osmotic pressure lower than fluid in interstitial space so after infusion it escapes from bowel lumen to interstitial spaces - Use caution if ordered to repeat tap-water enemas because water toxicity or circulatory overload develops if the body absorbs large amounts of water.

Answer 133

- Safest because same osmotic pressure as fluid in interstitial spaces so no fluid shift - Only enema allowed for infants and children

Answer 134

- osmotic pressure that pulls fluids out of interstitial spaces, so colon fills with fluid, and the resultant distention promotes defecation - Best for patients unable to tolerate large volumes of fluid benefit (120-180 mL effective usually) - Contraindicated for patients who are dehydrated and young infants.

Answer 135

- add soapsuds to tap water or saline to create the effect of intestinal irritation to stimulate peristalsis - Use only pure castile soap that comes in a liquid form - Use with caution in pregnant women and older adults because they could cause electrolyte imbalance or damage to the intestinal mucosa.

Answer 136

-lubricates feces in rectum and sigmoid colon -feces absorb oil and become softer and easier to pass -patient should try to retain for several hours

Answer 137

-relief from gaseous distention - ex is MGW solution with 30 mL magnesium, 60 mL glycerin, and 90 mL water

Answer 138

- gas accumulates and stretches and distends causing abdomen causing fullness, pain, and cramping due to reduced intestinal motility from opiates, immobilization, general anesthetics, abdominal surgery - Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus).

Answer 139

- Hemorrhoids are dilated, engorged veins in the lining of the rectum. - External hemorrhoids are clearly visible as protrusions of skin, purplish discoloration - Internal hemorrhoids occur in the anal canal and may be inflamed and distended - Causes: Increased venous pressure from straining at defecation, pregnancy, heart failure, and chronic liver disease causes hemorrhoids.

Answer 140

- Measures amount of blood in feces; screens for colon cancer; positive tests followed up with colonoscopy or flexible sigmoidoscopy - Only need 3 cm of formed stool or 15-30 mL of liquid stool but 3 different samples Patient education - instruct patient to avoid red meat 3 days before test b-c can cause false positive - avoid aspirin, ibuprofen, naproxen and other NSAIDs for 7 days b-c can cause false positive - Avoid vitamin C supplements and citrus fruits and juices for 3 days before test because can cause false negative

Answer 141

- Most likely in patients who are debilitated, confused, or unconscious who are dehydrated, too weak or unaware of the need to defecate, and the stool becomes too hard and dry to pass. - Signs: inability to pass a stool for 3 days; continuous oozing of liquid stool (liquid stool from higher in colon seeps around mass), loss of appetite (anorexia), nausea and/or vomiting, abdominal distention and cramping, and rectal pain

Answer 142

- high and low refer to the height from which, and hence the pressure with which, the fluid is delivered. - High enemas cleanse more of the colon. After the enema is infused, ask the patient to turn from the left lateral to the dorsal recumbent, over to the right lateral position. The position change ensures that fluid reaches the large intestine - Low enema cleanses only the rectum and sigmoid colon.

Answer 143

- Pattern of people considered to be family members; whatever patient says it is; more complex with more people * Nuclear family: consists of two adults (and sometimes one or more children) * Extended family: relatives (aunts, uncles, grandparents and cousins) in addition the nuclear family. * Single-parent family: formed when one parent leaves the nuclear family because of death, divorce, or desertion or when a single person decides to have or adopt a child. * Blended family: formed when parents bring children from previous marriages or other parenting relationships into a new joint-living situation. * Alternative family: relationships include multi-adult households, grand families (grandparents caring for grandchildren), communal groups with children, ”nonfamilies” (adults living alone), and cohabiting partners

Answer 144

-Nurses view family as a unit and observe interactions among family and between family and the illness rather than studying each individuals 1. A family system is part of a larger supersystem and is composed of many subsystems, 2. Family as a whole is greater than the sum of its individual members, 3. Change in one family member affects all family members, 4. Family is able to create a balance between change and stability 5. Family members' behaviors are best understood from a view of circular rather than linear causality.

Answer 145

-family is a social system -Family have specific roles and equilibrium is maintained with complementary roles -If family has rigid boundaries, their resources may be inadequate in times of crisis if the person with that role is unavailable and others are not able or allowed to take on that role - If family has too flexible a structure, automatic actions during crisis can cause rapid change

Answer 146

- Family passes through stages and transitions - Main value of families is the relationships are irreplaceable - Children grow and develop within the family and expand the cycle of their relationships through play groups, school, church, and social club activities.

Answer 147

- Expanding family (dynamics change) - Family caregivers (provide most of physical and emotional care for patients at home - Poverty/ Change in economic status - Homelessness from poverty, illness, lack of affordable housing - Cancer diagnosis/life-threatening illness - Intimate partner violence (impacted by pregnancy, drugs use, mental illness, sexuality, abuse incidence) - Substance abuse/addiction (codependent behavior) - Death and dying (grief takes many forms)

Answer 148

- What a family does - How family reproduces, interacts, cooperates financially and relates to society

Answer 149

- Clear communication enhances problem solving and conflict resolution - Nurturing children to know right and wrong - Social buffers (friends, spirituality, community) - Goal setting - Use of crisis for growth - Commitment to one another and the family unit

Answer 150

- Primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient's family). - Assess how much the family provides the individual's basic and psychological needs

Answer 151

- Primary focus is the family processes and relationships (e.g., parenting or family caregiving) - Focus your nursing assessment on family patterns and processes vs. characteristics of individual members - Plan care to meet not only the patient's needs but also the changing needs of the family.

Answer 152

* When you care for a family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. * When viewing a family as system, you use elements from both previous perspectives, but you also assess the resources available to the family. * Using the knowledge of the family as context, patient, and system, individualize care decisions based on the family assessment and your clinical judgment.

Answer 153

* Flexibility- allows different family members to complete tasks and accepts help from outside the family system; Flexible enough to allow adaptability but not so flexible that the family lacks cohesiveness or a sense of stability. * Hardiness- internal strengths and durability of the family unit; commitment to meaning and knowledge that events are controllable and predictable * Resiliency- ability to respond in healthy ways to stressful events; requires protective factors such as family cohesion, self-efficacy, and peer acceptance

Answer 154

* Begins on admission * The nurse is responsible for an accurate assessment of what will be needed for care in the home at the time of discharge, along with any shortcomings in the home setting. * Consult HCP about necessary home resources such as PT, case management, home health

Answer 155

- Structural assessment (family form, relationships, and context) - Developmental assessment (consider life cycle of members, determine how they adapt during predictable and unpredictable changes and challenging times) - Functional assessment (behavior among individuals including Instrumental (ADLs) and Expressive (communication, problem solving, coping, power, values, and beliefs)

Answer 156

- relationship between a patient and family and a nurse = optimal patient outcomes - Integrate professional knowledge and skills to meet family needs

Answer 157

Impact: family feels powerlessness and vulnerable because trauma is unplanned and life-threatening; it may bring up previous conflicts Nursing care - use presence and supportive care - the more you know about a patient’s family, how they interact with one another, their strengths, their weaknesses, the better - Provide realistic reassurance; false hope breaks nurse-patient trust and affects how family can adjust to bad news - Provide information and answer questions

Answer 158

Infectious agent (bacteria, virus, fungi, protozoa) Reservoir (location where microorganisms survive; chosen based on presence of nutrients, pH, light, temp; includes humans, animals, water, objects, etc.) Portal of Exit (reason for precautions; may be respiratory, GI, GU, blood, skin) Portal of Entry (may be same as exit) Modes of Transmission Susceptible host (degree of resistance i.e. age, nutrition, immunity, pregnancy)

Answer 159

Contact (indirect, direct, droplet (within 3 feet), airborne (suspended in air)) Vehicle (non-living; contaminated items i.e .sharps, drugs, solutions, blood, water, food) Vectors (living; flies, mosquitos, ticks)

Answer 160

Direct: person-to-person via physical contact; unwashed hands Indirect: contact with contaminated object of susceptible host (needles, sharps, dressings, soiled linen, environment)

Answer 161

-normal flora (normal microbes in mucus membranes that protect body; disrupted by antibiotics and cause infections) -body system defenses (skin, mouth, eye, respiratory, GU, GI) -inflammation (protective vascular)

Answer 162

-Age (very young (immature defenses); older (decreased vascularity, immune response, cough and gag reflexes)) -Nutrition (inadequate macros impair wound healing; need more with burns and febrile conditions) -Stress (increased glucose and reduced immunity due to cortisol) -Immunocompromising or chronic Diseases -impaired skin integrity (surgery, break in skin) -poor hygiene (or poor hand hygiene of providers) -Impaired circulation (hypoxia) -Environment (crowded, vectors, travel, homeless, conjugate living)

Answer 163

White Blood Cell (WBC): increased in acute infection, but decrease in overwhelming infection Differential: a. Neutrophils: increased in acute infection; pus infection; decreased in overwhelming bacterial infection b. Lymphocytes: increased in chronic bacterial and viral infections, decreased in sepsis c. Monocytes: increased in protozoa and tuberculosis infections d. Eosinophils: increased in parasitic infection e. Basophils: no change (normal during infection)

Answer 164

ESR and C-reactive protein increase with inflammatory process Iron decreases in chronic infection

Answer 165

* Skin or mucous membrane breakdown such as surgical and traumatic wounds, pressure ulcers, and oral lesions, and abscesses. * Redness, warmth, swelling, pain, loss of function caused by inflammation * Infections may be yellow, green or brown * Drainage from open wounds * Tenderness and pain at site

Answer 166

* Fever, fatigue, nausea/vomiting, anorexia, and malaise * Enlarged, swollen, and tender lymph nodes * ↑ heart rate * ↑ respiratory rate * ↓ blood pressure Specific symptoms (UTI has pain and foul smelling urine; pulmonary has cough, sputum, dyspnea, adventitious breath sounds)

Answer 167

* Aging process -> reduced inflammatory and immune response so longer to detect illness * Diminished pain sensitivity * Reduced or absent fever response * Atypical symptoms: Confusion (esp in UTI), Incontinence, Agitation, Generalized fatigue

Answer 168

-Proper diet -Hygiene (front to back for women) -Immunizations (14 by 24 months) -Standard precautions (Medical Asepsis) -Adequate rest and exercise (exercises increases lung capacity, endurance and energy)

Answer 169

Clean technique Purpose: reduce number, growth, and spread of microorganisms Includes: hand hygiene, clean environment, isolation, PPE (gown, gloves, mask, face shields) Used: oral medications, NG tubes, personal hygiene

Answer 170

- Before & after contact with skin or body fluids (excretions, mucus membranes, non-intact skin, wound dressings) - Before eating - When moving from a contaminated body site to clean body site - After contact with inanimate objects in area of client - After removing gloves - Before and after care of any kind (esp immunosuppressed patients or indwelling device)

Answer 171

* No artificial nails * Keep nails trimmed ¼ inch * Avoid wearing rings * Push wristwatch and long uniform sleeves above wrists.

Answer 172

* Soap and water when hands are visibly soiled or possible contact with spore ( C. diff, norovirus) * Use warm water, lather entire hand (palm, back, fingers fingertips, and wrist) with friction for at least 20 seconds, dry with paper towel, turn off faucet with towel if not automated * Alcohol-based waterless antiseptic if hands are not visibly soiled * Use enough product to cover both hands, rub palms, fingers, back of hands until product is completely dry (20-30 seconds)

Answer 173

* Use with ALL clients EVERYTIME!!! * Wear clean gloves when touching blood, body fluids, secretions, and contaminated items * Wear a mask, eye protection, or a face shield if splashes or sprays are expected * Wear a clean, non-sterile gown if sprays or splashes or contact with blood or body fluids are expected * Clean soiled equipment carefully * Wrap soiled linen clean side out and handle as little as possible (not on floor) * Place sharps in appropriate containers. DO NOT recap needles!

Answer 174

Sterile technique Purpose: eliminate ALL microorganisms from object or area Used: parenteral medications, insertion of catheters, surgical procedures, sterile dressing changes, trach care

Answer 175

1. Sterile only sterile if touches sterile 2. Only sterile objects may be placed in a sterile field. 3. Sterile is contaminated if leaves field of vision or below waist 4. Sterile is contaminated if prolonged exposure to air (Avoid excess movements, talking, laughing, sneezing etc over sterile field) 5. Fluid flows in the direction of gravity. (sterile contaminated if contaminated liquid flows over surface of object; hold hands up to avoid contamination after washing) 6. When a sterile surface touches a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. 7. The edges of a sterile field are contaminated (1 inch border). So place everything inside this border

Answer 176

- Isolation (don out, doff inside unless immunocompromised; limit patient movement outside room; place sign on outside of door to communicate to other workers) - Screenings (STD, PAP smears, TB screening)

Answer 177

Spread: Direct client or environmental contact (indirect contact with intermediate object such as equipment or hands) Precautions: Private room, gown and gloves, Use disposable or dedicated equipment on single client Diseases: MRSA, VRE, C. diff, major wound infections, scabies, herpes simplex, RSV

Answer 178

Spread: Focuses on large droplets ( >5um) that are expelled into the air 3-6 feet Precautions: Private room (or cohort), surgical mask or respirator, Dedicated-care equipment Diseases: influenza, adenovirus, group A streptococcus, pertussis, pneumonia, RSV, rubella, mumps, diphtheria

Answer 179

Spread: smaller droplets (<5um) that remain in the air for long periods of time Precautions: Negative air flow and air exhausted to the outside (airborne infection isolation room), N-95 mask required Diseases: measles, chickenpox, TB, rubeola

Answer 180

* Feel contaminated or dirty * Feel rejected, lonely, or guilty so be warm and accepting * Assess need for stimulation i.e clean room, open drapes * Provide repositioning, sponge bath, back massage * Provide regular communication and diversionary activities (tv, telephone) * Education about the situation (nature, purpose, duration, steps to follow i.e. hand hygiene and proper PPE)

Answer 181

- keep skin well lubricated with lotion or water-soluble ointment - turn and position to prevent reddening - frequent oral hygiene to prevent drying of mucus membranes (saliva has enzymes to promote digestion) - Daily perineal care with bowel movements

Answer 182

* Only open to empty * Keep below level of entrance (indwelling urinary catheters keep drainage back below level of bladder) * Do not raise unless clamped

Answer 183

* Use plastic biohazard bags (red) to bag contaminated items or large amounts of blood * Use laundry bags to transport soiled linens * Do not place any items on the floor, even laundry * Do not shake soiled linens to avoid spread of micro-organisms into the air * Don’t touch soiled linens or items to your clothing * Place sharps in puncture proof containers * Date bottled solutions at bedside and do not leave open

Answer 184

* Skin contact: skin or parenteral contact with blood or other potentially infectious materials through sharps - For puncture, allow bleeding but don’t squeeze. Wash with soap and water. * Mucous membranes of eyes, mouth, nose - For mucous membranes, flush with water or saline for 5-10 minutes

Answer 185

* It is a bacteria that causes symptoms ranging from diarrhea to inflammation of the colon (large intestine) which can lead to colon dysfunction and cell death from sepsis * Spread by indirect contact with inanimate objects (i.e. medical equipment and commodes)

Answer 186

* Advanced age * Complicated medical care * Extended stays in health care settings * Inappropriate antibiotic use (Destroys normal bowel flora and causes moderate to severe diarrhea) * Weakened immune system * Previous infection with C. diff * Gastrointestinal surgery

Answer 187

Stool culture (best if stool liquid or unformed) Toxin Testing

Answer 188

* Mild to moderate infection- watery diarrhea (distinct smell and odor), mild abdominal cramping and tenderness, 3 or more liquid stools for 2 or more days * Severe infection- dehydration, increased heart rate, fever, nausea, blood or pus in the stool

Answer 189

* Hand-washing-Use soap and warm water not alcohol-based hand sanitizers * Contact precautions * Thorough cleaning with chlorine bleach to disinfect surfaces since sporicidal * Monitor for hypernatremia and hyperkalemia (may indicate dehydration)

Answer 190

* Antibiotics: oral metronidazole (Flagyl), vancomycin, fidaxomicin (Dificid), teicoplanin * Fecal microbiota transplantation (Place normal flora into lower GI system of infected person who does not respond to antibiotics or has recurrent disease) - Donors should not have impaired immunity, hx of drug abuse, chronic GI disorders, or recent exposure to pathogens from tattoos or travel to endemic areas

Answer 191

Highly contagious acute viral respiratory infection that can occur at any age caused by several virus categories: A, B, and C. Contagious for 24 hrs before symptoms and 5 days after symptoms Major complications: pneumonia or death; may people treated at home

Answer 192

Headache High fever Runny, stuffy nose (or watery discharge) Sore throat Fatigue (may persist 1-2 weeks) Muscle or Joint Aches Vomiting Coughing

Answer 193

* Age (older than 50 years) * Living and working conditions * Chronic illnesses(lung disorders) * Weakened immune system * Living in institutions (long-term care facilities)

Answer 194

- Vaccinations change every year depending on strains prevalent - IM- Fluvirin, Fluzone (Recommended for all adults esp over 50, chronic illness, immunocompromised, live in institutions, live with others at high risk, health professional with direct contact) - Intranasal spray- FluMist

Answer 195

* Rapid influenza diagnostic tests (RIDTs)--high false-negative rates so treat symptomatic even if negative * droplet precautions

Answer 196

-Cough etiquette (hand washing, stay home, cover with tissue or arm, discard tissue) -Saline Gargles ease sore throat -Rest and increase fluid intake -Antihistamines for rhinorrhea Pharmacology -For Influenza A, amantadine and rimantadine -For Influenza B, ribavirin -For Influenza A and B, Zanamivir, oseltamivir, peramivir (prevention and treatment within 24-48 hrs)

Answer 197

Highly contagious disease caused by varicella-zoster virus spread by direct contact, inhalation of aerosols from vesicle fluid of skin lesions Contagious 1-2 days before development of rash until all lesions crusted Risk factors: age, pregnancy, immunocompromised 5 main complications: brain infection, bacterial infections of skin and soft tissues for children, pneumonia, sepsis, dehydration, eye infections, bell palsy

Answer 198

1. Itchy, blister-like rash (first appears on chest, back, and face, and then spreads over the entire body) 2. Deep pain and paresthesia precede rupture 3. Weeping and crusting lesions which follow pathway of spinal or cranial nerve 4. Fever 5. Tiredness 6. Loss of appetite 7. Headache

Answer 199

Primary: Chickenpox vaccine (safe and effective and prevents almost all severe illness) Secondary: blood test/culture, lesion samples; airborne/contact precautions

Answer 200

- minimize scratching - Use compresses, calamine lotion, baking soda, cool bath Pharmacological: antiviral (Acyclovir, Valacyclovir, famciclovir—best in first 72 hrs) Others: Analgesic (Acetaminophen) and Antihistamine (diphenhydramine)

Answer 201

Purpose: for protection of immunocompromised patients (cancer, transplant, HIV, iatrogenic (glucocorticoids, antineoplastic)) Precautions: positive air flow filtered with HEPA room, no dried or fresh flowers or potted plants, take off PPE after leaving room

Answer 202

Cause: Invasive procedures (bypass body defenses), antibiotic administration, the presence of multi-drug resistant organisms (MDROs i.e VRE or MRSA), Breaks in infection prevention and control activities Major sites for HAIs: surgical or traumatic wounds, urinary (UTI most common site-CAUTI) and respiratory tracts, and the bloodstream. At risk population: older adults, patients with multiple illnesses, poorly nourished, immunocompromised

Answer 203

- number of health care employees having direct contact with a patient - type and number of invasive procedures and therapy received - the length of hospitalization further influence the risk of infection

Answer 204

- Hospital-acquired/health care-acquired infections: result from the delivery of health services in a health care setting - Community acquired infection: an infection acquired in the community. Defined as infections manifesting and diagnosed within 48 hours of admission in patients without any previous encounter with healthcare

Answer 205

Don: gown, mask, goggles, gloves Doff: gloves, goggles, gown, mask

Answer 206

* Ischemia- an inadequate blood supply to an organ or part of the body, especially the heart muscles. * Transient Ischemic Attack- warning of stroke * Infarction-obstruction of the blood supply to an organ or region of tissue/ severe ischemia, typically by a thrombus or embolus, causing local death of the tissue. (e.g. Myocardial infarction (heart attack))

Answer 207

Infants- high HR, low BP, large and weaker heart Older adults- Atherosclerosis (narrowing of arteries (plaque) after arteriosclerosis), Arteriosclerosis (stiffening of arteries), Cardiac output decreases, BP increases, orthostatic hypotension (drop in 20mm Hg systolic or 10mm Hg diastolic within 3 minutes of standing)

Answer 208

* Maintained by blood flow pumped by the heart (central- cardiac output or blood pumped by heart (CO =SV x HR) * Disturbances in cardiac output will result in decreased central perfusion (disorders with increased SVR will decrease perfusion (can become shock); increased perfusion with decreased SVR) * Disorders on Cardiac cycle, Valvular disorders, Cardiomyopathies

Answer 209

* Maintained by the volume of blood reaching targeted cells (tissue- actual blood available) * Disturbance in blood flow from arteries through capillaries will result in decreased tissue perfusion * Arteries tough and tensile; may constrict, dilate, or narrow (atherosclerosis due to plaque) * Veins less sturdy (presence of valves)

Answer 210

- Smoking: Nicotine vasoconstricts - Elevated serum lipids: Contribute to atherosclerosis - Sedentary lifestyle: Contributes to obesity - Obesity: Increases risk for type 2 diabetes and atherosclerosis - Diabetes mellitus: Increases risk of atherosclerosis - Hypertension: Increases work of myocardium

Answer 211

* Age: Increases with age * Gender: Men > women * Genetics: Family history

Answer 212

Pulses- bilateral equal pulses, heart sounds Urine output- >30 mL/hr, I& O, daily weights Moist-crackle lung sounds, assess O2, peripheral edema, tachypnea Pain-chest, leg pain Skin color-pale or pink, cool or warm

Answer 213

- Position- elevated HOB, if tolerated - Evaluate VS, pulses, edema (compare L & R), lung sounds - Report urine output if <30mL/hr or trending down - Fluids- monitor amount, maintain patent IV (conservative fluids with heart failure) - Use clusters to perform activities together to conserve energy - Support stockings or SCDs (Sequential Suppression Devices (not on leg of DVT)) - Encourage ambulation and ROM exercises to increase circulation

Answer 214

* Creatine kinase (CK)- present in myocardium (CK-MB), muscle, and brain; high if damage * Natriuretic peptides (brain-type natriuretic peptide) BNP- detect heart failure; positive if > 100 and indicates congestive heart failure and it increases each visit * C-reactive protein- produced by liver during acute inflammation * Serum lipids- used to detect hyperlipidemia (LDL, HDL, total); serum lipid level is wrong unless patient has been fasting--- total above 200 is bad; high LDL is bad, low HDL is bad

Answer 215

Electrocardiogram (ECG/EKG) - Detects electrical waveform through heart; Detects Dysrhythmias - Nurse’s read 2 leads but may recommend 12 lead if patient having arrhythmias Exercise cardiac stress test - Noninvasive; exercise on treadmill increasing speed and elevation - Monitor EKG with exercise - How heart reacts to activity Pharmacological stress test - Administration of pharmacological agents that simulate exercise - Done with patient unable to perform exercise

Answer 216

* Chest x-ray (CXR)- Can visualize size of heart and lung fields;Nurse cannot read a chest x-ray * Echocardiogram -Uses sound waves to produce images of your heart. Gel on chest and microphone to see how heart beating and pumping blood. HCP can use to identify heart disorders * Arteriogram-Visualization of artery by injecting radiopaque contrast dye to see if any blocked vessels

Answer 217

Normal Sinus Rhythm is from SA node (automaticity) to AV node to bundle of His to Purkinje Fibers

Answer 218

You need patch (electrode you put in specific place), lead (wire with clip) White (on right) Green (snow over grass; under white on right) Brown (middle; poop in the middle) Black (black billing, left over nipple) Red (smoke over fire, left under nipple)

Answer 219

-big box is 0.20 sec -little box is 0.04 sec -6 second strip needed with 30 big boxes or 3 dark black lines on top to read correctly

Answer 220

- P Wave- atrial contraction (depolarization); deformity = problem with atrium - QRS Complex- ventricular contraction (depolarization); deformity = problem with ventricles - T Wave- ventricular repolarization

Answer 221

- P wave (hump before QRS) - PR Interval = 0.12-0.20 seconds (start of P to start of Q) - QRS complex = 0.08-0.12 seconds (start of Q to end of S; w shaped) - QT interval = less than 0.44 seconds (start of Q to end of T) - R to R interval (Heart rate) is 60-100 (sharp, count number on 6s strip and multiply by 10) - T wave (hump after QRS) - Baseline

Answer 222

- Pre-hypertension: SBP 120-139mm Hg or diastolic 80-89mm Hg - Stage 1: SBP 140-159mm Hg or diastolic 90-99mm Hg - Stage 2: SBP =/>160mm Hg or diastolic =/>100mm Hg

Answer 223

Persistent (>3 times) SBP of 140mm hg or greater, a persistent (>3 times) DBP of 90mm hg or greater, or current use of antihypertensive medication Effect: increased workload of heard can damage endothelium and lead to atherosclerosis Goal of treatment: reduce BP to <120/80 and MAP (mean arterial pressure which measures blood flow to essential vital organs) under 65

Answer 224

-caused by environmental or genetics Risk Factors 1. Family history 2. African American 3. Hyperlipidemia 4. Smoking and alcohol 5. older than 60 or post-menopausal 6. excess sodium, caffeine intakes 7. low potassium, calcium, magnesium intake 8. Obesity 9. Excess stress

Answer 225

-caused by treatments or diseases Risk factors - Kidney disease - Primary aldosteronism - Pheochromocytoma ( tumor of adrenal medulla) - Cushing disease - Coarctation of the aorta - Brain tumors or Encephalitis - Sleep apnea - Pregnancy - Drugs (estrogen, glucocorticoids, mineralocorticoids, sympathomimetics)

Answer 226

* Postural changes (orthostatic hypotension) * Retinal and visual changes * Evaluate risk factors and family history * Sodium (Na+) and potassium (K+)- monitor * Symptoms headaches, especially occipital headaches in AM; “silent killer” or facial flushing, dizziness, fainting * Urine evaluation (catecholamines), nocturia, monitor for increase in BUN & CR (renal involvement) * Report increase in blood glucose and increase in triglycerides * Evaluate if taking any OTC medications (Sympathomimetic/Decongestants can raise BP)

Answer 227

1. Eat a healthy diet. - Choose foods low in sodium, saturated fat, and trans fats. - Eat plenty of fruits, vegetables, fiber-rich whole grains, legumes, nuts. (DASH diet) - Choose fish, skinless poultry, lean meats, avoid red meat 2. Participate in physical activity. - Adults >20 years of age should engage in 150 min of moderate-intensity activity/week or 75 min of vigorous intensity activity every week. - Children 12–19 years of age at least 60 min of moderate intensity activity every day. 3. Achieve and maintain desirable weight. - Adults >20 years of age: 18.5–24.9 BMI - Children 12–19 years of age: <85th percentile

Answer 228

DVT: blood clot that forms in one or more deep veins in the body, usually the legs and big risk of PE; most common thrombophlebitis Thrombus: blood clot from endothelial injury, venous stasis, hypercoagulability Thrombophlebitis: thrombus associated with inflammation

Answer 229

- Active cancer - Previous VTE - Reduced mobility - Recent trauma or surgery - Older adult - Cardiac and respiratory failure - Acute MI, ischemic stroke, infection, rheumatologic disorder - Obesity - Ongoing hormonal treatment (oral contraceptives) - Smoking

Answer 230

Move the patients- assist to ambulate, sit, turn, ROM Oxygen- check pedal pulses, color & warmth of extremities (unilateral swelling or induration of blood for warmth and edema) Vital signs- monitor, evaluate trends for altered oxygenation (Shortness of breath, chest pain, acute confusion (in older adults)) Eliminate pain- patients do not want to deep breathe or move Aspirin (low dose) Subcutaneous heparin (anticoagulant) Sequential Compression Devices

Answer 231

Primary: AHA diet, exercises, nonsmoking Secondary: BP and lipid Screening

Answer 232

* Heart-healthy diet * Activity, exercise, and positioning (DO NOT massage to prevent PE) * Smoking cessation * Pharmacotherapy (IV heparin and oral warfarin OR dabigatran (DTI)) * Surgical interventions (Cardioversion (synchronized counter shock), CABG/Transplant, Revascularization/Endarterectomy)

Answer 233

Natural Necessary Restorative and healing (for physiological and neurological activity after period of wakefulnness) Not inactivity

Answer 234

-disturbed nighttime sleep with lack of restorative sleep; abnormal movements or sensations during sleep, or excess day time sleepiness -most common is insomnia

Answer 235

-each NREM stage is 5-15 minutes -REM is 20 minutes and gets longer throughout night producing more deep sleep -Total cycle is 90-110 minutes (75% NREM, 20% REM)

Answer 236

- Stage of lightest level of sleep, lasting a few minutes. - Gradual fall in vital signs and metabolism. - Sensory stimuli such as noise easily arouses sleeper. - If awakened, person feels as though daydreaming has occurred; may feel like you’re falling

Answer 237

- Stage of sound sleep during which relaxation progresses. - Arousal is still relatively easy. - Brain and muscle activity continue to slow.

Answer 238

- Deepest stage of sleep. - Sleeper is difficult to arouse and rarely moves. - Brain and muscle activity are significantly decreased. - Vital signs are lower than during waking hours. - Brain releases human growth hormone for repair and renewal of brain and epithelial cells

Answer 239

- Vivid, full-color dreaming occurs. - Stage usually begins about 90 minutes after sleep has begun. - Typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating blood pressure. - Loss of skeletal muscle tone occurs. - Gastric secretions increase. - important for cognition, memory and early brain development-increased blood flow to areas of brain is important for memory storage and learning.

Answer 240

Infants: 14-16 hours each day (50% REM) Toddlers: 9-10 hours at night plus 2-3 hours of naps (less REM than infant; may briefly awake with crying, walking, unintelligible speech) School-age children: 9-11 hours Teenagers: 9 hours; causes of poor sleep: stress, technology, relationship and future worries, anxiety and depression Adults: 7-9 hours (increased in pregnancy) Older adults: less than 7 hrs is okay with no health problems (may report more sleep problems)

Answer 241

- Hypertension - Heart disease and heart failure - Stroke - Obesity (due to sleep apnea) - Developmental disorders i.e. alterations in growth hormone or ADHD - Reproductive disorders due to disruption in hormonal regulation (night sweats esp in pregnant and perimenopausal) - Increased mortality (greater risk than smoking, hypertension, heart disease b-c can impair immune system) - Excessive daytime sleepiness

Answer 242

- chronic difficulty in falling asleep, frequent awakenings from sleep, and/or a short sleep or nonrestorative sleep -Associated with poor sleep hygiene, signals underlying physical or psychological condition Risk: women at greater risk, depression, stress (transient insomnia and can become chronic)

Answer 243

-mostly symptomatic with improved sleep hygiene -biofeedback -cognitive and relaxation techniques

Answer 244

- treatment of choice is benzodiazepine-like drugs i.e zolpidem (ambien for short term use Other: melatonin, ramelteon, tasimelton, valerian; Trazodone (serotonin antagonist and reuptake inhibitor; antidepressant for depression, anxiety, and insomnia; good alt to benzos for older adults) - Herbals: lavender, passionflower, chamomile

Answer 245

- Dysfunction of mechanism that regulate sleep and wake states were person feels overwhelming wave of sleepiness and REM sleep in 15 minutes of falling asleep - EDS and sleep paralysis are most common complaints - Big problem: Falls asleep at inappropriate times and may be mistaken for laziness, drunkenness, disinterest

Answer 246

-stimulants (Modafinil (Provigil), armodafinil, methylphenidate, sodium oxybate) -Antidepressants (suppress cataplexy

Answer 247

- Brief daytime naps no longer than 20 minutes to reduce subjective feelings of sleepiness - Regular exercise and good sleeping habits - Chewing gum and vitamins - Deep breathing - Avoid situations that increase drowsiness (alcohol, heavy meals, heavy exercise, long periods of sitting)

Answer 248

-Epworth Sleep scale -sleep journal (summary of daily activities, dietary intake, bedtime, discussion of night activities, time of awakening; quality of sleep)

Answer 249

-most important sleep test by registered tech -EEG-type electrodes to monitor sleep patterns, stages, muscle activity, respiratory effort belt, pulse oximetry, nasal and oral airflow

Answer 250

-main diagnostic test for epilepsy; also can diagnose tumor, damage, encephalopathy, encephalitis, stroke, brain death in coma -determines changes in brain activity -continuous EEG used to find right level of anesthesia for medically induced coma

Answer 251

Eight questions on likeliness of patient being sleepy during daytime activities (watching tv, reading, sitting inactive, sitting and talking with someone, as passenger in car, rest in afternoon) over time - Scale of 0 (never doze or sleep) to 3 (high chance of doze or sleep) - 0-5 = lower normal daytime sleepiness (4.4 -4.6 is average) - 6 to 10 higher than normal daytime sleepiness - If over 10, refer to sleep specialist, neurologists, or pulmonologist (11 or 12 mild EDS, 13-15 moderate EDS, 16-24 severe EDS)

Answer 252

-good sleep hygiene and environment -consistent bedtime and awakening -avoid napping more than 30 minutes -avoid alcohol, stimulants, heavy meals, spicy foods, sugary foods 3 hours before bed -avoid exercise too close to bedtime -Avoid antihistamines that may disrupt sleep

Answer 253

- sudden muscle weakness during intense emotions such as anger, sadness, or laughter during day - symptoms of narcolepsy type 1 - lasts for few seconds but if sever patient can lose voluntary muscle control and fall to floor

Answer 254

-practices that patient associates with sleep -Consider ventilation, noise, light, temp, alone or with someone (whichever is typical), size, firmness, position of bed (consider bedding and blankets) - comfortable, well ventilated, quiet (turn alarms down), and as dark as possible, slightly cool temp

Answer 255

-exercise daily in morning or afternoon, no exercise within 2 hrs of bedtime -avoid long hours of sleep on weekends and holidays to prevent disturbance of cycle -only use bedroom for sleep and sex (get out of bed if can’t sleep within 30 minutes) -More than 1-2 alcoholic drinks disrupt sleep -avoid electronics 30 minutes before bedtime -small snack prior to sleep -use sound machine or fan

Answer 256

- Lifestyle (biological clock can be disturbed by night shift, heavy work, late-night social activities, changes in evening mealtime) - Emotional Stress (tension and frustration lead to difficulty sleeping, staying asleep, or oversleeping) - Exercise and Fatigue - Food and Caloric Intake (large, heavy, spicy meal cause indigestion; milk allergy can cause nighttime waking and crying or colic in infants; Weight loss may reduce sleep)

Answer 257

Hypnotics/Benzos * Interfere with reaching deeper sleep stages and REM * Provide only temporary (1-week) increase in quantity of sleep * Eventually cause “hangover” during day; excess drowsiness, confusion, decreased energy * may worsen sleep apnea in older adults Antidepressants and Stimulants * Suppress REM sleep * Decrease total sleep time Alcohol (CNS depressant) * Speeds onset of sleep * Reduces REM sleep * Awakens person during night and causes difficulty returning to sleep Tryptophan: protein found in milk, cheese, meats which promotes sleep

Answer 258

- Beta-Adrenergic Blockers Cause nightmares, insomnia - Nicotine, Caffeine Decreases total sleep Decreases REM sleep time Causes awakening from sleep Causes difficulty staying asleep - Opiate s and Anticonvulsants Suppress REM sleep Cause increased daytime drowsiness

Answer 259

-Ptosis, blurred vision -Fine motor Clumsiness -decreased reflexes -slowed response time -decreased reasoning and judgment -decreased auditory and visual alertness -cardiac arrythmias

Answer 260

-confused/disoriented -increased pain sensitivity -withdrawn, apathetic -agitated, irritable -hyperactive -decreased motivation

Answer 261

-sleep problems more likely in children that are usually benign and child outgrows -if adults have these, it may be serious problem Types: confusional arousal, somnambulism, night terrors/nightmares, nocturnal enuresis, body rocking, bruxism Treatment: sleep study then 2 week period of medication to re-regulate sleep cycle

Answer 262

-Disorder where individual unable to breathe and sleep at same time; lack of airflow through nose and mouth for 10 seconds to 1-2 minutes Main symptoms: EDS, insomnia, snoring If patient has sleep apnea, need to bring CPAP to hospital and receive ventilator support in post-op period b-c increased respiratory complication risk

Answer 263

Risk factor: brainstem injury, stroke, obesity, muscular dystrophy, encephalitis

Answer 264

Predisposition: deviated septum, nasal polyps, narrow lower jaw, enlarged tonsils (children), large neck Major risk factors: obesity, hypertension, smoking/alcohol, older age, men at higher risk until women reach menopause Unique symptoms: hypertension headache, depression, decreased libido

Answer 265

-CPAP (opens airways) -BPAP -weight reduction - hypoglossal nerve stimulation -prone position or pillows to prevent supine -elevate HOB

Answer 266

Central: dysfunction in respiratory control center of brain so impulse to breath fails temporarily and nasal airflow and chest wall movement cease Obstructive: most common, cessation of airflow despite effort to breath when muscles or soft structures of the oral cavity or throat relax during sleep which blocks upper airway and can lead to snoring (b-c person still tries to breath; chest movements don’t stop) or hypoxia Mixed: obstructive and central

Answer 267

Primary is due to CNS disorder (dopamine dysfunction); late onset due to anemia, pregnancy, uremia, renal failure, stress Characteristics: recurrent, rhythmical movements (parathesias) of feet and legs with irresistible urge to move; patient may describe intense burning or crawling; worse in evening

Answer 268

- Family history - Type 2 Diabetes - Chronic kidney disease - Iron or vitamin D deficiency - Stress - Peripheral neuropathy or parkinsons disease - Drugs: caffeine, CCB, lithium, neuroleptics, withdraw from sedatives

Answer 269

-treat underlying cause -lifestyle modification (walking, stretching, exercise, warm bath)

Answer 270

- Dopamine agonists (ropinirole, pramipexole) - antiepileptics (gabapentin, carbamazepine) - iron and magnesium supplements (levodopa and carbidopa) - Benzos (diazepam) or Opioids are last results

Answer 271

Linked to self-efficacy and refers to having the knowledge, skills, abilities, and willingness to actively participate in one’s health and healthcare

Answer 272

Patient takes responsibility for their health or chronic condition and the provider serves as a vehicle through which optimal self-management occurs

Answer 273

* Maintaining a normal body mass index (BMI) * Eating a healthy diet * Regular physical activity * Sufficient sleep * Stress management * Reducing unintentional injuries * Start low-dose medication (in Predisease/ disease promotion)

Answer 274

Thoughts create feelings Feelings create behavior Behavior reinforces thoughts

Answer 275

* Individuals’ expectations influence their behaviors * Individuals with high self-efficacy are more likely to view difficult tasks as things to be mastered instead of avoided so improves management of health * Self-management education helps to promote self-efficacy by improving knowledge of the disease and tasks

Answer 276

a state in which individuals do not meet full diagnostic criteria for a diagnosis, but they have one or more clinical markers that indicate they are not completely healthy either” Nurse’s role -assess patient’s ability to make changes -understand social and environmental context of patient

Answer 277

* Provide education regarding the disease and its management * Education about causes and consequences of the disease * Respect patients wishes and desires about care

Answer 278

* New medications and treatment regimens * Changes in lifestyle behaviors * health care utilization (monitoring, specialty care, and ancillary health services such as dietitian)

Answer 279

* Insufficient consumption of enough healthy nutrients to achieve adequate nutrition and has an abnormal or excessive amount of fat accumulation * Major public health problem which is leading cause of preventable death due to association with increased health risks * Overweight: body mass index (BMI) of 25 to 29 * Class I—BMI of 30 to <35 * Class II—BMI of 35 to < 40 * Class III—BMI of 40 or higher (sometimes called “extreme” or “severe” obesity)

Answer 280

-predictor of CAD Over 0.95 in men or 0.8 in women is android obesity

Answer 281

* Waist circumference (WC): a stronger predictor of CAD than BMI * WC more than 35 in in women or more than 40 in men is central obesity * Central obesity is a major risk factor for CAD, brain attack, type 2 diabetes, some cancers (e.g., colon, breast), sleep apnea, and early death

Answer 282

* Cardiovascular: coronary artery disease (CAD), hypertension, hyperlipidemia * Endocrine: insulin resistance, type II diabetes, metabolic syndrome * Gastrointestinal: cholelithiasis (gall stones) * Genitourinary/Reproductive: menstrual irregularities, urinary incontinence, erectile dysfunction

Answer 283

* Integumentary: delayed wound healing, susceptibility to infections * Musculoskeletal: chronic back/joint pain, early onset of osteoarthritis * Neurologic: stroke * Psychiatric: depression or other mental health/behavioral health problems * Respiratory: obstructive sleep apnea, hypoventilation

Answer 284

* High-fat and high-cholesterol diets (High saturated fat increases LDL; Trans fats saturated fats, and cholesterol linked to higher risk of heart disease) * Physical inactivity (can be as little as 20 min/day; Barriers: lack of time, comfort level in sedentary lifestyle, decreased mobility) * Genetics * Medications * Stress

Answer 285

Corticosteroids, estrogens and progestins, NSAIDs, antihypertensives, antidepressants, antiepileptics, some oral antidiabetic

Answer 286

1. Reducing the proportion of adults with obesity 2. Increasing the proportion of adults with obesity who receive counseling or education regarding weight reduction, nutrition, or physical therapy 3. Increasing the consumption of whole grains 4. Decreasing the consumption of calories from added sugars

Answer 287

History: appetite, attitudes about foods, medication Physical: get height and weight; examine skin for reddened or open areas; lift skinfold areas, such as pendulous breasts and abdominal aprons (panniculus), to observe for infections like candida Psychosocial: Assess patient’s circumstances and emotional factors that might prevent successful weight loss; Ask about the perception of current weight and weight reduction.

Answer 288

* Calculates the percentage of ideal body weight (% IBW) and the body mass index (BMI) * Measure the waist circumference * Calculate the waist-to-hip ratio * Determine arm and calf circumference

Answer 289

- Do not respond to traditional interventions - BMI of 40 or greater - Have a BMI of 35 or greater, with other health risk factors - Weight more than 100% above ideal body weight

Answer 290

* May include journal with eating and exercise patterns plus triggers * Stimulus control * reinforcement techniques * cognitive restructioning

Answer 291

-acupuncture -acupressure -Ayurveda -Hypnosis

Answer 292

Short-term fasting programs and very-low-calorie diets: usually 200 to 800 calories/day - Require initial cardiac evaluation and supervision - Ketosis is risk of short-term fasting Nutritionally balanced diets: 1200 to 1800 calories/day with a conventional distribution of carbohydrate, protein, and fat. - Vitamin and mineral supplements may be used including Vitamin D, B-Complex, iron, and calcium. Unbalanced low-energy diets, such as the low-carbohydrate diet, restrict one or more nutrients. - Protein and vegetables are encouraged, but certain carbohydrates and high-fat foods are not.

Answer 293

- Liraglutide (suppresses appetites) - Naltrexone-bupropion (opioid antagonist and antidepressant) - Orlistat (inhibits lipase so fats only partially digested and absorbed) - Phentermine-topiramate (short-term weight loss and anticonvulsant)

Answer 294

* Diet progression: clear to full to pureed (1 week) to soft (several weeks) to solid, nutrient dense (8th week post op), * Nutrition: Avoid reliance on appetite reducing drugs and reduce overall fat intake * Drug therapy: Analgesics and antiemetic drugs, if needed; drugs for other health problems * Wound care: Clean procedure for open or laparoscopic wounds; cover during shower or bath * Activity level: Restrictions, such as avoiding lifting; activity progression * Follow-up care: clinic, support groups and other community resources, counseling for patient * Continuing education: Nutrition and exercise classes; follow-up visits with RDN

Answer 295

* Fever * excessive nausea or vomiting * epigastric, back, chest or shoulder pain * red, hot, and/or draining wound(s) * pain, redness, or swelling in legs * difficulty breathing (priority) * Bowel changes

Answer 296

MI is often the first sign Risk Factors 1. Atherosclerosis (plaque build up)-primary factor 2. Metabolic syndrome (insulin resistance) 3. Age (most important esp older women) 4. Hypertension 5. Smoking 6. high cholesterol (high LDL, triglycerides, and low HDL) high fasting glucose 7. large waist size

Answer 297

* Smoking/tobacco cessation * Diet: Avoid severely restrictive diets; 5-6% saturated fats, no trans fats; less than 200 mg cholesterol; sodium less than 1500 mg (low sodium) * Physical activity: 40 minutes long with 10 minute warm up and 5 minute cool down; walk 30 minutes if unable to exercise or do what you can do * Manage Cholesterol, Diabetes, Hypertension, Obesity

Answer 298

Admit patient to telemetry unit for continuous monitoring or critical care unit if hemodynamically unstable Delay full assessment Obtain ECG within 10 minutes of presentation of chest pain

Answer 299

* History: alcohol, smoking, collab with dietitian * Laboratory: high troponins T and I for MI and cardiac necrosis; lipid panel * Imaging: Echocardiogram, chest x-ray (not diagnostic but rules out aortic dissection), thallium scan (use radioisotope imaging to assess ischemia of tissue), contrast-enhanced CV MRI (noninvasive to detect CAD) * Key: ECG to examine heart and identify location and occurrence of ischemia and infarction

Answer 300

- chest, epigastric area, jaw, back, shoulder/arm pain - associated symptoms: nausea, vomiting, dizziness, weakness, palpitations, shortness of breath, jugular vein distention, peripheral edema

Answer 301

- Vital signs: RR may increase b-c anxiety and pain - Heart: dysrhythmias; Sinus tachycardia with premature ventricular contractions common in hrs after MI; S3 gallop may indicate heart failure - ECG: ST elevation or NSTEMI; wider Q wave - Lungs: Crackles or wheezes may be left-sided heart failure - Pulses: diminished or absent pulses - Temp: cool, diaphoretic skin

Answer 302

- Nitroglycerin for episodic anginal pain - Morphine sulfate for pain unresponsive to nitroglycerin

Answer 303

- Dietary: avoid adding salt to meals; AHA booklets and cookbooks with recipes with reduced fats, oils, and salt - Begin by walking the same distance at home as in the hospital (usually 400 feet) three times each day and gradually increase - Carry nitroglycerin - Instruct patient to pulse before, during, and after the exercise. (Stop exercise if target pulse rate exceeded or dyspnea or angina develops) - Sex is unlikely to damage heart so it is safe for those who can climb stairs w/o symptoms

Answer 304

- Progressive muscle relaxation, guided imagery, music therapy, pet therapy, and therapeutic touch may decrease anxiety, reduce depression, and increase adherence after heart surgery - Omega-3 fatty acids from fish and plant sources: helps to reduces lipid levels, stabilizing atherosclerotic plaques, and reducing sudden death from an MI.

Answer 305

-tissue plasminogen activator (tPA, alteplase) to dissolve thrombi in coronary arteries and restore myocardial blood flow (reperfusion therapy) -Goal: give within 30 minutes of arrival to hospital for STEMI -Contraindications: intracranial hemorrhage, active bleeding, significant trauma within 3 months - Signs of success/ lysis of clot: cessation of pain, sudden ventricular dysrhythmias, resolution of ST change or T wave inversion, peak at 12 hrs markers

Answer 306

- invasive but nonsurgical treatment of choice to reopen clotted coronary artery involves clot retrieval, coronary angioplasty, and stent placement - Goal is to perform PCI within 90 minutes of acute STEMI diagnosis - Dual antiplatelet therapy with aspirin and platelet inhibitor required

Answer 307

* Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs): prevent ventricular remodeling and the development of heart failure; continue indefinitely if started * Monitor for decreased urine output, hypotension, cough, hypokalemia

Answer 308

* Low–dose, non–enteric-coated aspirin (81 mg) daily unless contraindicated for all CAD patients (If patient has new onset angina at home, chew 4 baby aspirins and call 911) * Statin therapy(atorvastatin and rosuvastatin): reduces the risk of developing recurrent MI, mortality, and stroke) * Clopidogrel or ticagrelor (P2Y12 platelet inhibitors): prevent platelets from aggregating (clumping) together to form clots; given with initial loading dose then daily dose for 12 months after diagnosis

Answer 309

(metoprolol, carvedilol): prolong the period of diastole and increase myocardial perfusion while reducing the force of myocardial contraction Monitor for bradycardia, hypotension, decreased LOC, chest discomfort, bronchospasm (wheezes), heart failure (crackles), hypoglycemia (masks this), depression, nightmares, forgetfulness

Answer 310

Role: promote vasodilation and myocardial perfusion Use: Only if beta blocker contraindicated Monitor hypotension and peripheral edema

Answer 311

Sodium polystyrene sulfonate (Kayexalate): used to treat patients with dangerously high serum potassium levels. Neomycin solution: an antibiotic used to reduce bacteria in the colon before bowel surgery. Cortisone: An enema containing steroid medication may be used for acute inflammation in the lower colon.

Answer 312

Listen in each quadrant and go clockwise. You should hear 5-30 clicks/minute or 3-15 clicks/30 sec. If you listen for 5 minutes and no clicks, you should contact provider Hypoactive bowel sounds (<5/minute) may be constipation, depression, or anesthesia Hyperactive bowel sounds (>30/minute) may be diarrhea, bleeding, or stress

Exam 3 Flashcards

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