Exam 4 Flashcards
(125 cards)
1
Q
What is a problem-solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinician’s expertise, patient preferences and values, and available health care resources in making decisions about patient care.?
A
Evidence-Based Practice
2
Q
What is Nursing Research?
A
A way to identify new knowledge that can improve nursing practice, professional education and practice, and the use of nursing and health care resources effectively
3
Q
What does the acronym “PICOT” stand for when asking an evidence-based research question?
A
P- Patient Population
I- Intervention or area of interest
C- Comparison intervention of area of interest
O- Outcome
T- Time
4
Q
What is the precise, systematic, and objective examination of specific concepts whose main purpose is to gather data to generalize results to a similar population? What are some key characteristics of it?
A
Quantitative Data
- Numerical data and statistical analysis to answer research questions
- Large numbers of participants
- Hypothesis
- Controlled environment
- Objective Data
5
Q
What is the term for “studies phenomena that are difficult to quantify or categorize; information obtained in a nonnumeric form. Main purpose to not generalize but share participant’s experience”?
A
Qualitative Data
- Data in words, observations, written documents
- Small number of participants
- No hypothesis
- Natural setting
- Subjective data
6
Q
What pain is caused by a lesion or disease of the somatosensory nervous system (peripheral nerve injury)?
A
Neuropathic Pain
7
Q
What is the protective physiological series of events that brings awareness of actual or potential tissue damage. (tissue injury)?
A
Nociceptive Pain
8
Q
What are the four physiological processes of nociceptive pain?
A
- Transduction- Nociceptors are activated by stimuli (mechanical, thermal, chemical)
- Transmission- conduction of pain messages to the spinal cord
- Pain Perception- brain interprets quality of pain
- Pain Modulation- Pain perception is changed (endorphins are released and pain decreases or increases)
9
Q
What type of pain is pain that will not go away even after all possible care has been used/tried to manage the pain?
A
Intractable Pain
10
Q
What type of pain is described as “protective, short-term, identifiable cause, limited tissue damage, patients often feel anxious and afraid”?
A
Acute Pain
11
Q
What type of pain is described as “not protective, prolonged (3-6 months or longer), doesn’t always have identifiable cause, patients feel physical and mental exhaustion”?
A
Chronic Pain
12
Q
What are some words that are used to describe the quality of pain?
A
dull, aching, throbbing, stabbing, burning, ripping, tingling, etc.
13
Q
What are some examples of modifiable and non-modifiable factors that influence pain?
A
Modifiable- Attention, fear, anxiety, coping styles (nursing interventions target modifiable factors)
Non-Modifiable- Age, Genetics, Culture, Neurological Function
14
Q
What type of pain is described as rapid onset or short duration of pain occurring when the patient is receiving an analgesic for pain and creates a spike out of range?
A
Breakthrough Pain
15
Q
What are some examples of non-verbal signs of pain?
A
Vital signs, posture, facial expressions, crying, restlessness, sounds
16
Q
When should you not use heat in regards to pain?
A
Low sensation, areas treated with radiation, bleeding sites, injury within 24 hours, only apply for 20 minutes
17
Q
When should you not use cold or ice in regards to pain?
A
low circulation, areas treated with radiation, open wounds, no bare skin and always use protective cloth.
18
Q
What are the 7 origins of pain?
A
- Cutaneous
- Deep somatic
- Visceral
- Radiating
- Referred
- Phantom
- Psychogenic
19
Q
What type of pain is described as pain on your skin? What are some examples?
A
Cutaneous Pain
Burn, Paper cut, Scrape
20
Q
What type of pain is described as pain below skin level? What are some examples?
A
Deep Somatic Pain
ligaments, tendons, and bones
21
Q
What type of pain is described as having an origin within the smooth muscles and organs? What are some examples?
A
Visceral Pain
bladder, Intestines
22
Q
What type of pain is described as beginning in one area and spreads to another?
A
Radiating Pain
23
Q
What pain is described as pain felt in an area completely different than the area of of injury?
A
Referred Pain
24
Q
What pain as described as pain felt in an area where the body part has been removed?
A
Phantom Pain
25
What type of pain is described as pain not occurring from injury but a pain disorder associated with psychological factors; And mental/emotional problems can cause, increase, or prolong pain?
Psychogenic Pain
26
What are the 3 key characteristics when assessing a patient's pain?
1. Timing
2. Location
3. Severity
27
What are the 3 key questions to ask when assessing the timing of pain for a patient?
1. Onset- when did it start?
2. Duration- for how long?
3. Pattern- Is it constant? Does anything make it go away? Does anything make it worse or start?
28
What law states that a patient’s right to consent to the use and disclosure of protected health information (PHI), to inspect and copy one’s medical record, amend mistaken or incomplete information, and the right to privacy and confidentiality regarding their health care information?
Health Insurance Portability and Accountability Act (HIPAA)
29
What is a document is based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over the dying process?
A living will
30
What is the term used for a person who is delegated to makes decisions for an individual when such person is unable to do so?
Health Care Proxy
31
What is the name of the civil rights statute that protects the rights of people with physical or mental disabilities and prohibits discrimination and ensures equal opportunities for people with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation?
Americans with Disabilities Act (ADA)
32
What are the name of the laws that limit liability and offer legal immunity if a nurse helps at the scene of an accident but if you perform a procedure exceeding your scope of practice and for which you have no training, you are liable for injury that may result from that act?
Good Samaritan Laws
33
What is the name of the state laws intended to protect citizens, make nurses accountable, and ensure that care is consistent with best practices within the scope and standards of nursing?
Nurse Practice Acts
34
What is the Nurse Licensure Compact?
A license in which an RN is licensed in more than one state
35
What was authorized by legislation to provide an alternative to disciplinary action for nurses who are unsafe to practice due to substance abuse or a psychological or physical condition that interferes with practice?
Intervention Project for Nurses (IPN)
36
What is the obligation to be fair called?
Justice
37
What is the duty to tell the truth called?
Veracity
38
What is the duty to keep promises called?
Fidelity
39
What is "the duty to do or promote good" called?
Beneficence
40
What term refers to "do no harm and to prevent harm"?
Nonmaleficence
41
What term refers to "refers to freedom from external control and the commitment to include patients in decisions about all aspects of care"?
Autonomy
42
What provides a database to determine deviations from standards of care, to identify corrective measures needed to prevent recurrence, and to alert risk management to a potential claim?
Incidence or Occurrence Reports
43
What are civil wrongful acts or omissions of care made against a person or property? What are the 3 different types?
Torts
intentional, quasi-intentional, unintentional
44
What is an intentional tort? What are some examples of intentional torts?
Deliberate acts against a person or property that may result in both civil and criminal actions.
Assault, Battery, false imprisonment, trespass
45
What are quasi-intentional torts? What are some examples of them?
Acts in which a person may not intend to cause harm to another but does and alleges a person should have known that harm to another person could occur.
defamation of character (slander or libel), invasion of privacy, transferred intent
46
What are unintentional torts? What are some examples?
When a person is harmed and the person inflicting the harm knew, or should have known, that these actions were less than the accepted scope and standard of practice.
negligence, malpractice
47
A type of negligence in which the person liable must be a professional? (lawyer, doctor, public official)
Malpractice
48
What is the term for conduct that falls below the generally accepted standard of care, of a reasonably prudent person, who had a duty of care that was breached, and their patient was physically harmed?
Negligence
49
What is it called when the publication of false statements results in damage to a person's reputation?
Defamation of Character
50
What is the difference between slander and libel?
Slander- occurs when one speaks falsely about another
Libel- written defamation of character
51
What is the term for an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact?
Assault
52
What is the term for any intentional offensive touching without consent or lawful justification that can be harmful to the patient and cause an injury, or it merely can be offensive to the patient’s personal dignity?
Battery
53
What are the 4 criteria that needs to be met in order to qualify for malpractice?
(1) the nurse (defendant) owed a duty of care to the patient (plaintiff)
(2) the nurse did not carry out or breached that duty
(3) the patient was injured because of the breach in duty
(4) damages or remedies are allowed under state law to “make the person whole” in the eyes of the court.
54
What does breach of duty mean?
Failure to meet the standards of care
55
What is the difference between informed consent and implied consent?
Informed Consent- is a patient’s agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal
Implied Consent- consent indicated by actions, and law that assumes that the patient would wish to be treated.
56
What are some examples of common causes of malpractice? (6 examples)
1. Failure to respond- not intervening to care for specific symptoms or expressed request of care by patient.
2. Failure to educate- not educating thoroughly prior to discharge
3. Failure to follow standards of care
4. Failure to Communicate
5. Failure to document
6. Failure to advocate
57
What involves several components, including identifying possible risks, analyzing them, acting to reduce the risks, and evaluating the steps taken to reduce them?
Risk Management
58
What places emphasis on human performance, work processes, and organizational structure?
Performance Improvement & Quality Improvement
59
What are the 4 key principles in the American Nurses Association Code of Ethics?
1. Advocacy
2. Responsibility
3. Accountability
4. Confidentiality
60
What is a neurological deficit of sudden onset accompanied by focal dysfunction and symptoms lasting more than 24 hours that are presumed to be of non-traumatic vascular origin?
A stroke
61
What are the 4 lobes of the brain and what are they each responsible for?
1. Frontal- Reasoning, motor control, emotion, and language.
2. Parietal- processing information from the body’s senses.
3. Temporal- hearing. Memory, emotion, and some language.
4. Occipital- interpreting incoming visual information.
62
What people are most at risk for having a stroke?
1. Age over 55
2. Black people
3. Males
4. Pregnant Women
5. Women taking oral contraceptives
6. Cigarette smokers and drug use
7. Hypertension, high cholesterol, diabetes
63
What is the difference between Wernicke's Aphasia and Broca's Aphasia?
Wernicke’s Aphasia (Receptive)- speaking fine but not comprehending others talking or words written
Broca’s Aphasia (Expressive)-comprehension remains intact but can not speak or write. Trouble expressing thoughts and feelings.
64
What does the acronym "FAST" stand for in regard to strokes?
acronym used for determining whether a person may be experiencing a stroke
Face- Ask person to smiling; will identify numbness or weakness
Arm- Ask person to raise both arms; notice if one arm drifts lower than other
Speech- Ask person to repeat simple phrase; indicate if person is having trouble speaking or understanding
Time- Call 911 immediately if person has evidence of any one of these signs
65
What are the 2 different types of strokes and the difference between the 2?
1. Ischemic: occurs when a blood clot, known as a thrombus, blocks or plugs an artery leading to the brain
2. Hemorrhagic: due to bleeding into the brain by the rupture of a blood vessel
66
What are the two different types of ischemic strokes?
1. Thrombotic
2. Embolic
67
What is the difference between a thrombotic stroke and embolic stroke?
Thrombotic Stroke- Caused by a blood clot that forms in an artery that supplies blood to your brain and usually develops at night while sleeping
Embolic Stroke- Caused when a slot forms somewhere else in your body and travels through the blood vessels to your brain. It gets stuck there and stops the flow of blood and can occur at ANY TIME
68
What are the two different types of hemorrhagic strokes?
1. Subarachnoid
2. Intracerebral
69
What is the difference between a subarachnoid hemorrhage and an intracerebral hemorrhage?
Subarachnoid: happened in the area between your brain and skull and is described as "worst headache of entire life"
Intracerebral: bleeding INSIDE the brain
70
What term is used to describe ACTIVE, ONGOING bleeding from a ruptured blood vessel?
Hemorrhage
71
What term is used to describe bleeding which has more or less clotted? What are the two types?
Hematoma
Epidural Hematoma and Subdural hematoma
72
What is the difference between an epidural hematoma and a subdural hematoma?
Epidural hematoma- bleeding between dura matter and skull
Subdural hematoma- bleeding between arachnoid matter and the dura matter
73
What is the GOLD STANDARD test used to which other brain imaging studies are compared?
NON-Contrast CT Scan
74
Within how many hours does TPA need to be administered?
within 3 hours of symptom ONSET
75
What does "Time Zero" refer to in regard to a stroke?
The time the patient was last known as symptom free
76
What are the specific time-frame goals for patients who are candidates for TPA?
1. Assessed by qualified professional within 10 minutes
2. Complete non-contrast CT within 20 minutes
3. Door to interpretation time of 45 minutes
4. Door to t-PA is 60 minutes
77
What are some examples of common exclusion criteria for TPA? (8 examlples)
1. Prior stroke in the previous 3 months
2. Arterial puncture at noncompressible site in previous 7 days
3. Intracranial neoplasm (brain tumor)
4. Elevated BP (above 185/110)
5. Low platelet count (less than 100,000)
6. Heparin received within 48 hours and aPTT above (25-35 seconds)
7. INR greater than 1.7 or PT greater than 15 seconds
8. Blood Glucose concentration less than 50mg/dl
78
What is the number one prehospital intervention when someone is having a stroke?
Support the patient's airway
79
What is an abnormal tangle of blood vessels connecting arteries and veins, which disrupts normal blood flow and oxygen circulation called?
Arteriovenous malformation
80
What is the left side of the brain responsible for or what are key characteristics of people who are considered "left brained"? (8 examples)
Rational Side
1. understanding and use of language
2. detailed analysis of info
3. responds to verbal instruction
4. planned and structured
5. prefers established info,
6. prefers talking and writing
7. prefers multiple choice tests
8. controls feelings
81
What is the right side of the brain responsible for or what are key characteristics of people who are considered "right brained"? (9 examples)
Intuitive Side
1. Knowing body position
2. remembering things we see or do
3. putting info together for big picture
4. responds to demonstration
5. fluid and spontaneous
6. prefers elusive and uncertain info
7. prefers drawing
8. prefers open-ending questions
9. free with feelings
82
How do you get Cardiac Output? What is considered a normal range of cardiac output?
Stroke Volume x Pulse
4L-8L
83
When is blood pressure typically highest? And when is blood pressure typically lowest?
Highest in the early morning
Lowest at night
84
What is is defined as the peak pressure exerted against arterial walls as the ventricles contract and eject blood?
Systolic Blood Pressure
85
What is defined as the minimum pressure exerted against arterial walls, between cardiac contractions when the heart is at rest and allows for the filling of the ventricles?
Diastolic Blood Pressure
86
What is the difference between primary hypertension and secondary hypertension?
Primary= increase in blood pressure with no known cause; 90-95% of cases
Secondary- Elevated blood pressure with a specific cause
87
What are some examples of causes for secondary hypertension? (6 examples)
kidney disease, diabetic complications, thyroid diseases, pregnancy, medications, obesity
88
What are the 3 key characteristics in diagnosing orthostatic hypertension?
1. Drop of 20mm Hg SBP
2. Drop of 10mm Hg DBP
3. Pulse increases by greater than or equal to 20-30 beats per minute
89
What are some examples of modifiable risk factors regarding hypertension? (7 examples)
1. Smoking
2. Sedentary Lifestyle
3. High sodium intake
4. Excessive Alcohol Intake
5. Stress
6. Obesity
7. Oral contraceptives
90
What are some non-modifiable risk factors regarding hypertension? (5 examples)
1. Race
2. Age
3. Family History
4. Gender
5. Prior Medical History
91
How many minutes per week does the American Heart Association recommend to help with hypertension?
90-150 minutes a week
92
What medication do African Americans typically not respond to when trying to treat for hypertension?
ACE Inhibitors
93
What are the different stages of hypertension and the levels that are associated with each?
Elevated- SBP of 120-129 **AND** DBP less than 80
Stage 1- SBP of 130-139 **OR** DBP of 80-89
Stage 2- SBP of 140 or higher **OR** DBP of 90 or higher
Hypertensive Crisis- SBP higher than 180 **AND/OR** DMP higher than 120
94
What are the 3 layers of tissue that form the heart wall?
1. Epicardium- outer layer
2. Myocardium- middle layer
3. Endocardium- inner layer
95
What are the 5 locations to auscultate the heart? Where are they located?
1. Aortic- right 2nd ICS
2. Pulmonic- left 2nd ICS
3. Erb's Point- left 3rd ICS
4. Tricuspid- left 4th ICS
5. Mitral- left, midclavicular line, 5th ICS
96
What are the 9 common sites for palpating arteries?
1. Carotid
2. Apical
3. Brachial
4. Radial
5. Ulnar
6. Femoral
7. Popliteal
8. Posterior tibial
9. Dorsalis pedis
97
What is the correct route of blood flow through the heart for both deoxygenated blood and oxygenated blood? (6 steps each)
Deoxygenated blood from body
1. superior vena cava (upper body) & inferior vena cava (lower body)
2. right atrium
3. tricuspid valve
4. right ventricle
5. pulmonic valve
6.pulmonary arteries (back to lungs)
Oxygenated blood from lungs
1. into pulmonary veins-
2. left atrium
3. mitral valve
4. left ventricle
5. aortic valve
6. Aorta- back out to body
98
What is the term for the amount of blood ejected from the ventricle with each heart beat?
Stroke Volume
99
What is the term for the amount of blood pumped by each ventricle in 1 minute?
Cardiac Output
100
What is the term for the volume of blood in the ventricles at the end of diastole, before the next contraction?
Preload
101
What is the term for the peripheral resistance against which the left ventricle must pump?
Afterload
102
What is the Pulse Pressure?
The difference in SBP and DBP
(SBP - DBP)= pulse pressure
103
What is Mean Arterial Pressure (MAP)? How do you calculate it?
Perfusion pressure felt by the organs
(SDD/3) = MAP
104
What is the electrical conductivity of the heart?
1. SA node- send electrical impulses to atriums causing them to contract and expel volume of blood to ventricles
2. AV node- gets same electrical impulse moving to...
3. Bundle of His, down to the
4. Bundle Branches, ending in the
5. Purkinje Fibers- causes ventricles to contract, forcing them to expel volume of blood out into general circulation
105
What is the normal or dominant pacemaker of the heart? What is the normal impulse rate?
Sinoatrial Node (SA Node)
60-100 beats per minute
106
What is the secondary pacemaker and connects the atria and ventricles electronically? What is the normal impulse rate?
Atrioventricular Node (AV Node)
40-60 beats per minute
107
What is the tertiary pacemaker that penetrates the atrioventricular valves and then bifurcates into the left and right side? What is the normal impulse rate?
Bundle of His and Purkinje Fibers
20-40 beats per minute
108
How many seconds does each individual large box equal?
How many large boxes equals 1 second?
0.20 seconds
5 boxes
109
What are the different waves on an EKG strip and what do they stand for?
P wave- atrial depolarization
QRS Complex- ventricular depolarization
T wave- ventricular repolarization
110
What does the S1 sound in the heart represent?
Closure of the AV valves (tricuspid/mitral); signifies beginning of systole.
111
What does the S2 sound in the heart represent?
Closure of the SL valves (aortic/pulmonic); signifies beginning of diastole
112
What is the term for a humming vibration felt during palpation of the heart that signifies abnormal turbulent blood flow?
Thrill
113
What is the term for an abnormal and forceful cardiac contraction, that causes a slight to vigorous movement of the sternum and rib?
Lift or Heave
114
What are the signs and symptoms of left cardiac failure?
Lung issues, respiratory issues, orthopnea
115
What are the signs and symptoms of right cardiac failure?
bulging eyes, JVD, ascites (fluid build up in abdomen), liver enlargement, peripheral edema
116
What does a murmur indicate and what are the four classifications?
May be from a narrowed valve, malfunctioning valve, or defect in the wall of the heart
Class 1- no manifestations w/ activity
Class 2- manifestations w/ ordinary exertion
Class 3- manifestations w/ minimal exertion
Class 4- manifestations at rest
117
When should a patient be concerned about weight gain?
More than 2 pounds a day or 5 pounds in one week
118
A nurse should not administer digoxin if the heart rate is below what?
less than 60 beats per minute
119
What does elevated levels of Creatine Kinase (CK) indicate?
non-specific muscle injury
120
What does elevated creatinine kinase myocardial band (CKMB) indicate?
specific cardiac muscle injury
121
What is myoglobin? What do elevated myoglobin levels indicate?
protein found in skeletal and heart muscles
indicates non-specific muscle break down
122
What do elevated C-reactive protein levels indicate?
non-specific inflammation
123
What does elevated brain natriuretic peptide (BNP) levels indicate? why does this indicate that?
used in diagnosing and predicting prognosis of heart failure
when the heart has to work harder to pump blood, it makes more BNP
124
What do elevated levels of troponin indicate? What is the range of normal levels?
indicates cardiac injury
normal levels = 0 - 0.4ng/ml
125
What are the different lab levels of BNP and what does each one indicate?
Normal- less than 100pg/ml
HF present- 100-300pg/ml
Mild HF- greater than 300pg/ml
Moderate HF- greater than 600pg/ml
Severe HF- greater than 900pg/ml
