Exam 3 Flashcards
(104 cards)
1
Q
What are 5 reasons we need sleep?
A
- Sleep affects the tissues and our brains.
- Sleep regulates energy metabolism.
- Sleep improves learning and adaptation.
- Reduces stress and anxiety.
- Sleep, rest, and illness are related
2
Q
How many hours of sleep do young adults, middle aged adults, and older adults need?
A
young adults: 8-10 hours
middle-aged: 7-9 hours
older adults: 5-7 adults
3
Q
What is the day and night pattern in a 24 hour period, that is regulated by an internal clock, allowing us to respond to changing levels of light?
A
Circadian Rhythm
4
Q
How long is the normal sleep cycle?
A
90 minutes
5
Q
What is the difference between NREM and REM sleep?
A
NREM: nonrapid eye movement, 3 stages, restful phase of sleep, and includes muscle relaxation, in addition to the decrease in body temp, HR, Respirations, and BP
REM: rapid eye movement, spontaneous awaken, brain is highly active like when an individual is awake, dreams occur
6
Q
What are the 4 stages of the sleep cycle in order?
A
- NREM Stage 1: transition to sleep lasting about 5-10 minutes
- NREM Stage 2: body temp drops, heart rate begins to slow, brain begins to produce sleep spindles, lasts about 20 minutes
- NREM Stage 3: muscles relax, BP and respirations drop, the deepest sleep occurs here
- REM: brain becomes more active, body becomes relaxed and immobilized, dreams occur, eyes move rapidly
7
Q
What are examples of some lifestyle factors that affect sleep? (7 examples)
A
- Diet
- Nicotine and Caffeine
- Physical Activity
- Alcohol
- Medications
- Illness
- Environment
8
Q
What are 6 examples of different types of sleep disorders?
A
- Insomnia
- Circadian Disorder
- Sleep Apnea/Obstructive Sleep Apnea
- Snoring
- Narcolepsy
- Parasomnia- sleep walking, sleep talking, night terrors, bruxism (teeth grinding)
9
Q
What are some important interview questions to ask when doing a sleep assessment?
A
- What is your usual sleeping pattern?
- What is your sleeping environment?
- What is your bedtime routine?
- Do you use any sleep aids?
- Have there been any changes or problems in your sleep recently?
10
Q
What is the disorder characterized by breathing that repeatedly starts and stops while sleeping?
A
Sleep Apnea or Obstructive Sleep Apnea
11
Q
What is the disorder characterized by excessive falling asleep during different and inappropriate times throughout the day?
A
Narcolepsy
12
Q
What are 7 key things you can do to promote good sleep?
A
- Eat healthy- whole foods and plenty of water
- Moderate alcohol use- stop drinking at least 3 hours before bed (effects REM)
- Get Exercise- helps boost energy and supports more restful sleep
- Get regular sunlight- helps with internal clock
- Keep a regular sleep schedule- consistency is helpful for regulating circadian rhythms
- Time caffeine right- caffein lasts up to 12 hours in the body, so consuming after lunch time could effect sleep
- Set your bedroom for success- supportive and comfortable mattress, keep room cool and dark, give the electronics the boot
13
Q
What is the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions?
A
Health Literacy
14
Q
What 3 things are low-health literacy associated with?
A
- poor communication
- poor health outcomes
- higher health costs
15
Q
What is the strongest predictor of a person’s health over age, income, employment status, education level, and race?
A
Poor health Literacy
16
Q
What is the most often cited root cause of sentinel events?
A
poor communication
17
Q
What are the 5 most affected populations in regard to health literacy?
A
- Adults over the age of 65
- Recent refugees and immigrants
- Having less then a high school degree
- Lower incomes, below poverty level
- Non-native speakers of English
18
Q
What is the patient’s RIGHT in regard to health education based on health literacy?
A
Patients and caregivers MUST receive AND UNDERSTAND information about their disease and management of illness
19
Q
What are the 3 Domains of Nursing and what do they entail?
A
- Cognitive- thinking, gaining knowledge
- Psychomotor- learning skills, doing the skill
- Affective- feelings, changes in attitudes and values
20
Q
What are the 5 Rights of Teaching?
A
Time
Context
Goal
Content
Method
21
Q
What does the acronym “SMART” stand for when creating learning outcomes/goals for a patient?
A
Specific
Measurable
Attainable
Relevant
Timely
WHO will (the patient)
DO what (specify behavior)
HOW well (criteria for evaluation)
WHEN (specific condition or time)
22
Q
What are 4 main factors that affect learning?
A
- Psychomotor- coordination, energy, visual impairment
- Environment- lack of privacy
- Rapport- empathetic and supportive relationship between teacher and learner
- Feedback to reinforce learning- positive reinforcement vs. criticism, connect new information to past experiences
23
Q
What are some examples of formats used for patient teaching? (8 examples)
A
- Lecture
- Group Discussion
- Demonstration and Return
- Demonstration
- One-to One Instruction
- Printed Materials
- Role Modeling
- Online Sources of Information
24
Q
What is the correct teaching process when using the nursing process (ADPIE)?
A
- Assessment of learner- you know the patient’s readiness and level of understanding and ability to comprehend
- Determining education needs- teaching strategies that will promote the level of knowledge and understanding
- Planning appropriate teaching strategies
- Imparting information- methods of teaching the patient charts, videos, pictures, handling of equipment
- Evaluating learning- list foods high in sodium, demonstrate the skill, develop a plan for rehab activities, or plan a meal
25
What does "SPEAK UP" stand for in regard to the joint commissions initiative that a patient has a right to informed decisions about their health care?
Speak upif you have questions or concerns
Pay attention to the care you receive. Do not assume you are getting the right care, medication.
Educate yourself about your illness, medical tests and treatment plan.
Ask a trusted family member/ friend to be your advocate.
Know which medications you take and why
Use a hospital, clinic or surgery center that is approved by TJC
Participate in all decisions about your care
26
What are the 3 most important things you should document in regard to teaching a patient?
1. What content was taught?
2. What method was used?
3. What did the patient learn?
27
When mixing different insulins into one syringe what is the correct order and steps needed to be taken?
Push air into cloudy
Push air into clear
Draw up the clear
Draw up the cloudy
cloudy, clear, clear, cloudy
28
What are the injection sites for a subcutaneous injection?
Abdomen, fatty part on back of upper arm, and upper buttocks
29
When administering a subcutaneous injection into the abdomen, what is the exact correct location?
2 inches (5cm) away from the umbilicus
30
When cleaning the injection site with alcohol what is the correct method?
Apply at center of site and rotate outward in circular direction for approximately 2 inches
31
When administering heparin, how long should you inject it over?
30 seconds
32
When would you administer a subcutaneous injection at a 45-degree angle vs 90-degree angle?
45 degrees for someone with minimal fat
90 degrees for someone who is obese
33
When do you pinch the skin vs. spread when giving an injection?
Subcutaneous- pinch
Intramuscular- spread
34
What are the CDC recommendations for needle size and length for a subcutaneous injection?
Gauge- 23-25
Length- 1/2 inch, 5/8 inch, 3/8 inch
35
What are the CDC recommendations for needle size and length for an intramuscular injection? What is the largest size needle that can go in the deltoid?
Gauge- 22-25
Length- 1-3 inches
Deltoid- only 1 inch or less
36
If a non-insulin volume of medicine is less than 1mL what type of syringe should you use?
a tuberculin syringe (TB)
37
How do you find the deltoid injection site for an IM injection?
1. Palpate lower edge of acromion process
2. Place two fingers across the acromion process, with the top finger along the acromion process
3. Make a V, and inject in center of the V
38
How do you find the ventrogluteal injection site for an IM injection?
1. Place palm of hand over the greater trochanter of hip
2. Move thumb towards groin and index finger towards anterior superior iliac spin
3. Move middle finger towards iliac crest
4. Inject in center of V between middle and index finger
39
How do you find the vastus lateralis injection site for an IM injection?
1. Position one hand against the greater trochanter and the other against the lateral femoral condyle.
2. Move two hands length inward until hands meet
3. Inject in center of where the hands meet
40
When a solution is less than 1mL where do you administer the injection? If it is more than 1mL where do you administer the injection?
less than 1mL- deltoid
1mL-3mL- ventrogluteal or vastus lateralis
41
At what angle do you administer an IM injection?
90-degree angle
42
What do you label your syringe with?
patient name, the medication, and the dose
43
What inflammatory skin infection is defined as a localized, contagious, caused by group A strep and presents manifestations of vesicles, pustules, and honey crusted sores?
Bacterial Impetigo
44
What bacterial infection is caused by s. aureus of the hair follicle?
Bacterial Folliculitis
45
What is the name for an infection of the hair follicle that goes into the deeper layers of the skin that is caused by staphylococcus aureus and creates a small pocket of pus?
Bacterial Furuncle aka "Boil"
46
What is the name for a cluster of painful, pus-filled bumps (boils), that form a connected area of infection under the skin?
Bacterial Carbuncle
47
What is the name of the infection of the dermis and SQ tissue, caused by Group A strep, showing manifestations of painful, edematous, warmth, and erythema with or without fever?
Bacterial Cellulitis
48
What is the name of the vaccine for shingles and at what age should you get it?
Shingrix and people who are 50 years and older
49
What infection causes a painful rash with burning, numbness, tingling, is sensitive to touch, and involves fluid-filled blisters that break open and crust over?
Shingles
50
What are the two different types of fungal infections?
1. dermatophytes (aerobic fungi)- feed on dead keratin of skin, hair, and nails
example- tinea
2. Yeast (Candida)- oral or vaginal thrush
51
What are the different types of tinea and what areas of the body do they infect?
1. Tinea corporis- ringworm of the body
2. Tinea capitis- ringworm of the scalp
3. Tinea pedis- athletes foot
4. Tinea Unguium- fungus of the fingernails and toenails
5. Tinea cruris- Jock Itch
6. Tinea versicolor- fungal infection of the skin causing discolored patches
52
What parasitic skin infection is caused by hookworm larvae that is transmitted by walking barefoot?
Cutaneous Larva Migrans
53
What are the 2 different types of eczema?
1. Atopic dermatitis- internal skin condition
2. Contact dermatitis- results from external factors
54
What skin disorders causes skin cells to multiply up to 10 times faster than normal?
Psoriasis
55
What skin disorder is characterized by different areas resulting in the discoloring of the skin, due to the skin losing its pigment cells?
Vitiligo
56
What type of malignant skin lesion is commonly seen on the neck, head, and upper back and presents as a pearly, shiny papule or nodule, with a raised or rolled border?
Basal cell carcinoma
57
What type of malignant skin lesion commonly starts as as actinic keratosis and presents as a scaling or ulcerated, reddish brown nodule?
Squamous cell carcinoma
58
What type of cancer is defined as "a cancer of the melanocytes which arises generally from the skin but may be seen less commonly in the eyes, ears, GI tract, CNC, oral and genital mucosa?
Malignant melanoma
59
What does the acronym "ABCDE" stand for in regard to skin cancer assessments?
Asymmetry
Border
Color variations
Diameter
Evolving or changing
60
What two classification systems are used to grade malignant melanoma?
Breslow staging and Clark level of Invasion
61
When preforming a wet to dry dressing change, what are the 7 main things you are going to assess?
1. Color
2. Edema
3. Exudates (type of drainage)
4. Amount of drainage
5. Length and width of wound
6. Undermining
7. Tunneling
62
.What are you going to document at the end of preforming a wet to dry wound care dressing change? (8 examples)
1. change of dressing
2. pain assessment
3. wound dimensions in cm
4. characteristics of wound
5. how much you irrigated with
6. drainage type and amount
7. what supplies you used and took out
8. patient tolerance
63
What are the 3 types of wounds by depth?
1. Superficial: Involves only the epidermal layer of the skin
2. Partial Thickness: Confined to epidermis and dermis
3. Full Thickness: Involves epidermis, dermis, subcutaneous tissue, possibly tendons, ligament, and bones
64
What are the 4 phases of wound healing?
1. Hemostasis- This process designed to essentially seal the wound
Injured blood vessels constrict
Platelets gather to stop the bleeding
Clots form a fibrin matrix
2. Inflammatory- Usually lasts 24 hours
Histamine secreted resulting in vasodilation
White cells rush to injured area (phagocytosis)
Collagen is formed
3. Proliferative- Lasts 3-24 days. Main activity is filling of the wound bed with granulation tissue & contraction of the wound bed
4. Remodeling- Collagen scar continues to reorganize & gain strength for several months. New collagen tissue is deposited
Scar becomes a flat, thin, white line.
65
What are the 3 types of wound healing?
1. Primary Intention- Occurs when there is little, or no tissue loss and skin edges approximated (close together)
2. Secondary Intention- Involves loss of tissue that prevents would edges from approximating or should not be closed because of infection
3. Tertiary Intention- Occurs when two surfaces of granulation tissue are brought together after initially being left to heal by secondary intention.
66
What are the 4 types of wound drainage?
1. Serous drainage- Straw colored. watery consistency. Contains very little cellular matter.
2. Sanguineous Drainage- Bloody drainage
3. Serosanguineous Drainage- Combination of bloody and serous drainage
4. Purulent drainage- Thick yellow, pus-like drainage seen in infected wound
67
What are the 5 types of wound complications?
1. Hemorrhage- rapid blood loss that can be internal or external
2. Infection- swollen, erythematous, warm to touch, increased drainage, foul odor
3. Dehiscence- layers of skin and tissue separate and begin to open
4. Evisceration- Internal viscera through incision (intestines pop through wound)
5. Fistulas- An abnormal passage connecting two body cavities
68
What is the color code in regard to wound assessment?
R = Red- reflects color of normal healing
Y = Yellow- needs to be cleansed
B = Black- cover with thick eschar, requires debridement
69
What are the 4 stages of pressure injuries?
Stage 1- Localized, intact skin, non-blanchable redness discoloration
Stage 2- Partial thickness loss of dermis, open but shallow
Stage 3- Deep crater, full thickness skin loss, undermining
Stage 4- Full thickness skin loss with extensive destruction, exposed bone / tendon, undermining, eschar tissue may be present
70
What are the 3 different types of drains used in wound care?
1. Penrose drain
2. Jackson-Pratt drain
3. Hemovac
71
What is the term for the "removal of nonviable, dead tissue to rid wound of a source of infection"?
Debridement
72
What type of dressing is "wafer type that contains gel-forming agents in an adhesive compound laminated onto a flexible, water-resistant layer"?
Hydrocolloid dressings
73
What type of dressing "contains 90% water in a gel base and helps regulate fluid exchange from the wound surface"?
Hydrogel dressings
74
What type of dressing "are a non-woven absorbent dressing derived from seaweed and help absorb exudates"?
Alginates
75
How long does the nurse have to administer mixed insulin?
5 minutes
76
Blood glucose has to be less than _____ amount to be considered "hypoglycemia"?
65mg/dL
77
What are the beta cell and alpha cells responsible for in the pancreas?
Alpha- glucagon which raises blood sugar
Beta- insulin which lowers blood sugar
78
What are the 4 different types of diabetes?
1. Type 1
2. Type 2
3. Gestational
4. Secondary
79
What are the 3 biggest signs/symptoms of diabetes? What are other common symptoms?
1. Polyuria, Polydipsia, Polyphagia
2. Fatigue, weight loss, glucosuria (sugar in urine), slow healing wounds, blurred vision, numbness and tingling in extremities
80
What are the levels for normal, prediabetes, and diabetes in a fasting blood glucose test?
Normal- less than 100
Prediabetes- 100-125
Diabetes- greater than 126
81
What are the levels for normal, prediabetes, and diabetes in a oral glucose test?
Normal- less than 140
Prediabetes- 140-199
Diabetes- greater than 200
82
What are the levels for normal, prediabetes, and diabetes in a Hemoglobin A1C test?
Normal: 4-5.6%
Prediabetes: 5.7-6.4%
Diabetes: greater than 6.5%
83
What is the level to be diagnosed for diabetes in a random blood glucose test?
Greater than 200 with additional symptoms of the 3 P's
84
What are the 3 main goals of treatment/management of diabetes?
1. Maximize glycemia control
2. Maintain normal blood glucose levels
3. Prevent the complications of hyperglycemia
85
What are the different types of rapid-acting insulin? What is the onset, duration, and peak of this type of insulin?
1. Lispro, Aspart, glulisine
Onset- 15 minutes
Peak- 1-2 hours
Duration- 3-4 hours
86
What are the different types of short-acting insulin? What is the onset, duration, and peak of this type of insulin?
1. Regular (Humulin R & Novolin R)
Onset- 30-60 minutes
Peak- 2-4 hours
Duration- 5-7 hours
87
What are the different types of intermediate-acting insulin? What is the onset, duration, and peak of this type of insulin?
1. NPH (Humulin N & Novolin N)
Onset- 2-4 hours
Peak- 4-10 hours
Duration- 10-16 hours
88
What are the different types of long-insulin? What is the onset, duration, and peak of this type of insulin?
1. Glargine (U100 & U300)
Onset- 3-4 hours
Peak- "peakless"
Duration- 24 hours
89
What are some examples of the benefits in using an insulin pump? ( 5 examples)
1. less needle sticks
2. convenience
3. precise doses
4. better quality of life
5. able to track trends
90
What type of insulin is used in a sliding scale?
rapid-acting
91
What are the signs and symptoms of hypoglycemia?
Anxiety
Palpations
Numbness around the lips
Sweating
Shakiness
Irritability
If hypoglycemia is severe and lasts a long time then: (resembles drunk person)
Difficulty thinking
slurred speech
dizziness
lack of coordination
weakness
seizures, coma, death
92
How many grams of oral glucose do you give a patient who is conscious and hypoglycemic?
15-20mg
93
How much juice should you give a patient that is hypoglycemic? How many lifesavers should you give?
4 oz of juice
6-7 lifesavers
94
If patient who is hypoglycemic is unable to swallow what do give?
25-50mL of 50% dextrose IV
95
If patient is hypoglycemic, unconscious, and you can not access an IV, what is the next best thing to give?
IM injection of 1mg glucagon
96
What is the difference between the somogyi effect and the dawn phenomenon?
Somogyi effect- blood glucose low at 2-3AM, and high in morning (took too much insulin)
Dawn phenomenon- blood glucose is normal at 2-3AM, and high in the morning (did not take too much insulin)
97
What are the 5 risk factors of metabolic syndrome? How many have have to be present to be diagnosed with it?
1. Fasting blood glucose (FBS) greater than 100 mg/dL
2. Hypertension greater than or equal to 130/85 mm Hg
3. Increased serum triglycerides greater than or equal to 150 mg/dL
4. Central Obesity
5. (HDL) less than or equal to 40 mg/dL in men and less than or equal to 50 mg/dL in women
*3 Must Be Present*
98
What are the 2 most important patient teaching regarding sick days with someone who is a diabetic?
1. STILL TAKE MEDS
2. SIP ON COKE, GINGER ALE, OR GATORADE
99
What are the 6 most important patient teachings regarding foot care with someone who has diabetes?
1. Podiatrist regularly (every 3 months)
2. well-fitting shoes
3. Wash feet daily and dry thoroughly
4. Do not soak feet
5. Do not put feet in hot water
6. Never walk barefoot
7. Check feet everyday for wounds and sores
100
How many minutes of exercise or steps should a person with diabetes try and do?
150 minutes per week or 10,000 steps per day
101
What is a normal blood glucose range?
70-100
102
What are the only 2 insulins that can be given IV?
Rapid-acting and short-acting
103
What type of exercise is best for a diabetic patient?
Aerobic and weight resistant
104
What precautions should be taken to prevent hypoglycemia in a diabetic patient prior to exercising?
Eat and check sugar levels prior to exercising, if sugar is less than 100, ingest 15 grams of simple carb
