Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Nursing Fundamentals > Exam 4 > Flashcards

Exam 4 Flashcards

(71 cards)

Start Studying
1
Q

Isometric Exercise

A

Muscle contraction without motion
(Hand against the wall)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Isotonic Exercise

A

Movement of the joint during muscle contraction
(Weight training, push ups)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aerobic Exercise

A

Uses large muscle groups, continuously
(Jogging, brisk walking, cycling)
Increases ♥️ rate and respiratory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Adults should get _______ min per week of moderate-intensity exercise

A

150 - 300 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Factors affecting mobility

A

Developmental stage
Nutrition
Chronic disease
Lifestyle
Environmental
Diseases & abnormalities (trauma)
Diseases of other bone systems (respiratory, bedrest, fatigue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prolonged immobilization causes ________ changes in almost every body system- as well as ________ changes

A

Physiological

Psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common complications of prolonged immobility

A

Skin breakdown
Pressure injury
Constipation
Atrophy
DVT
Orthostatic hypotension
Pooling in lower lungs
Atelectasis
UTI
Balance
Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prolonged immobility interventions

A

Support…..
Oxygenation
Nutrition
Skin Integrity
Cardiovascular function
Musculoskeletal system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Factors affecting skin integrity

A

Age (elasticity)
Nutrition (dehydration)
Mobility (friction & shearing)
Sensation level (-sensation = +pressure)
Impaired Circulation
Medications
Infection
Moisture
Fever
Lifestyle (obesity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Classification of wounds

A

-Skin integrity (open/close)
-Healing time (acute/chronic)
-Contamination (clean/clean-contam/contaminated/infected)
-Depth (superficial/partial/thickness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types of wounds

A

Abrasions, abscess, contusion, crushing, incision, laceration, penetrating, puncture, tunnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Signs of an infected wound

A

Redness & swelling
Worsening pain
Pus or discharge
Warmth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Phases of wound healing

A
  1. Hemostasis (clotting)
  2. Inflammatory (WBC)
  3. Proliferative (granulation/collagen)
  4. Maturation/ Remodeling
    (collagen cont/4-5wks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Granulation Tissue

A

Beefy red
3rd of 4 stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Serous exudate

A

Straw colored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sanguineous

A

Bloody drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Serosanguineous

A

Mix of bloody and straw colored fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Purosanguineous exudate

A

Contains blood and pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Complications of wound healing

A

Hemorrhage (internal/external)
Infection (trauma2-3d or surf 4-5d)
Dehiscence (opens)
Evisceration (coming out)
Fistula (extra tunnel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Blanchable erythema good or bad?

A

There’s still blood supply to area…
However, at risk for skin breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Definition of Shear

A

Friction + the force of gravity
(sliding in bed)
Not visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Moisture does what with wounds

A

Increased moisture reduces resistance of the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What scale is used for Ulcer risk factors

A

Braden scale-
Sensory
Moisture
Activity
Mobility
Nutrition
Friction and shear
Lower # the higher the risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Focused skin assessment

A

Color, temp, texture, turgor, moisture
Medical device in area
Obesity (pannus)
Bony prominences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Wound assessment
Location, type, size Periwound (around) Undermining (open under wound/side) Epiboly (edge) Tunneling Drainage Pain Nutritional status
26
Pressure injuries are caused by unrelieved pressure to an area, resulting in ________
Ischemia
27
Stage 1 pressure injury
No blanching Damaged tissue No adequate blood flow to area Not open
28
Stage 2 pressure injury
Partial thickness loss with exposed dermis (open) Can have a blister Pink, red, moist
29
Stage 3 Pressure injury
Full thickness skin loss Adipose tissue Granulation can be present Slough and eschar (yellow/black)
30
Stage 4 pressure injury
Full thickness skin loss Muscle, tendon, ligament, bone (Deeper) Slough/eschar
31
Deep Tissue Injury DTI
Necrosis in underlying tissue Non-blanchable Purple “boggy” feel Intact skin
32
Unstageable Pressure Injury
Obscured full thickness skin and tissue loss (Open) slough/eschar
33
Extrinsic factor for pressure injury
Friction Pressure Shearing Moisture
34
Intrinsic factor for pressure injury
Immobility Impaired sensation Poor nutrition Dehydration Aging Fever, infection Edema
35
How often should you reposition a patient who is immobile
Every two hours
36
Nutritional Intervention for ulcers
1.2 to 1.5 g of protein per kg/day
37
What is the main regulator of fluids and electrolytes
Kidneys (1500ml/day)
38
Third Space
Blood is in a 3rd compartment Peritoneal Pericardial Vesicles (blisters)
39
How much should fluid intake be?
1500-2000 ml Non-caffeinated No sugar drinks
40
1st symptom of dehydration?
Thirst
41
Signs of Hypovolemia
-cap refill -low BP -Orthostatic -Tachycardia, weak pulse -Confused, HA (neuro) -dry skin, pale -clear lungs -S.G of 1.030
42
Signs of Hypervolemia
weight gain Edema skin- no hair, shiny Tachycardia- bounding Elevated BP Pulmonary edema Lungs- adventitious (moist) JVD (jugular)
43
What do you assess with Edema?
Visual Measure Finger pressure Daily weights I&O
44
Responsible for bone health
Calcium
45
What is low, mostly in alcoholics?
Magnesium
46
Key electrolyte in cellular metabolism (arrhythmias)
Potassium
47
Grade edema
0= no edema 1= slight 2 mm, rebound’s immed. 2= pitting 4mm, 15 sec rebound 3= 6mm deep, 30 sec rebound 4= 8mm, +30 sec to rebound
48
It is impossible to know about every culture, but….
….It is important to learn about those you will encounter most often
49
Ethnicity key point
Reference ethnicity vs Hispanic (Mexican American, Puerto Rican, Cuban)
50
Race key point
You can’t determine a persons race by appearance. Ask them! (White, African American)
51
Take a trip to BALI
-Be aware of cultural heritage -Appreciate uniqueness -Learn about cultural group -Incorporate cultural values in care plan
52
Cultural intervention
Ask pt what matters the most to them in their illness treatment
53
Physical changes hours/days before death
Surge of energy Weakness & fatigue Sleeping a lot Restlessness, confusion, agitation Dysphasia low gag reflex Vision blurs- hallucinations Mottling (webbing) Hot/cold temp Decreased urine output -BP, +HR Death rattle Cheyne-stokes breathing
54
Actively dying occurs over a period of…
10-14 days
55
Palliative Care
Care treatment that reduces symptoms Doesn’t have to be dying Slow/progressive disease
56
Hospice
-Must have Dr determine less than 6m -Must chose comfort care -Quality of life is as important as length of life
57
Euthanasia
Active/passive Cocktail
58
Physician assisted suicide/death
6m to live 3 requests in 15 days Self administer
59
Rigor mortis
2-4 hours after death Disappears 96 hours after death
60
Livor mortis
Bluish and mottled
61
SBAR
Situation (symptoms, change, observations, evaluation) Background (Med hx) Assessment (vitals, pain, focused) Recommendations
62
Adaptive (effective) coping
Making healthy choices
63
Maladaptive (ineffective) coping
Unhealthy style, temporary fix Other harmful Substance abuse
64
Outcome of stress
Heart disease, IBS, HAs, +BS, Alzheimers, cold, obesity, pain, depression
65
Self concept consists of
Physical appearance Sexual performance Intellectual abilities Success in the workplace Friendships Problem solving Unique talents
66
Factors affecting self concept
Gender Developmental level Socioeconomic status Family Peer relationships Illnesses and hospitalizations Out of control
67
Severe anxiety
Person only focuses on self & need to relieve anxiety Difficulty doing tasks HA, tachycardia, insomnia, dizziness, urinary frequency, diarrhea
68
Panic
Person becomes irrational, hallucinations Screaming, dilated pupils, trembling, palpitations
69
Displacement
Transferring feelings from one target to another
70
What percentage of RNS have EtOH or drug dependence
14-20%
71
A persons well being depends on a balance of
Physical Psychological Sociological Cultural Developmental Spiritual

Nursing Fundamentals (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions