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Exam 5 Flashcards

*Professionalism *Informatic *Cellular Regulation *Acid Base *Fluid & Electrolyte *Intracranial Reg *Sensory Preception (82 cards)

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1
Q

Professionalism-Accountability

A
  • Knowing what i am capable and knowing my limitation
  • Responsibility
  • Self-examination
  • State board of Nursing:*NC *NCSBN(oversees all of the states)
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2
Q

Professionalism-Collaboration

A

Being able to work with others and provide the patient with the best care

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3
Q

Professionalism-Advocacy

A
  • Being able to defend patients

- Code of ethics plays a big part in this.

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4
Q

Professionalism-Caring/ Compassion Intervention

A

Caring interventions of attitude and compassion key to nursing professionalism

  • Attitude: mental state involving values, beliefs, feelings and mood
  • Compassion: awareness of/ concern about others individual’s suffering
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5
Q

Professionalism- Appearance

A
  • Neat
  • Clean
  • Organized
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6
Q

Professionalism-Teaching (Patricia Benner)

A

5 Progressions in Learning

  1. Novice 2.Advance beginner 3.competent 4.Proficient
  2. Expert
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7
Q

Professionalism- Ethics

A
  • soft skills (drive passion and communication)
  • Friendly/ Culturally competent
  • Problem solving
  • Involve integrity( Never work outside scope of practice)
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8
Q

Professionalism*Buzz words for unprofessionalism

A
  • Harassment
  • “power”
  • Bullying
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9
Q

Informatics- Benefits

A
  • Specialized care
  • accessed to care
  • Quick/ Real time Access to your health recordserrors are decreased*Records can be transferred anywhere
  • Quality improvement
  • Apps for health care * monitor prescription
  • Social media
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10
Q

Informatic- EMR (electronic medical record)

A
  • Doctors use them

- nontransferable

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11
Q

Informatics- EHR (Electronic Health Record)

A

-“paper chart” -Has history - Portable - more ppl have access by only with health relation -has to use the same language; med abbrev. -similar templates - reduces cost
improve care - decrease errors - clients have access

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12
Q

Imformatics- Ergonomics

A
  • How things are set up to decrease injuries
  • Ex. carpal tunnel, back injures, eye strain, requires rest to treat, glasses sometimes, good postures, frequent breaks and better lighting
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13
Q

Cellular regulation -Alterations

A
  • Hyperplasia(increase in cell production; Dna controls it)
  • metaplasia(change in pattern, DNA controlled)
  • Dysplasia(Different variations in size, shape, apperance; DNA controlled)
  • Anaplasia(immature, goes through regression; not controlled by DNA & not reversible)
  • Anything different that the normal can cause cancer; anaplasia tells the degree of cancer.
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14
Q

Cell regulation-Prevalance

A
  • Cancer: 39% of americans will be diagnosed with cancer
  • genetic *socioeconomic that is low put you at risk for cancer
  • Anemia: depends on cause of why RBCs are being loss
  • Sickle Cell: has to have genetic trait *Blacks are at higher risk
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15
Q

Cell Regulation- Intervention (independent)

A
  • Pt education - nutrition -increase physical activity
  • managing side effects:ie. chemo -Psycho social support
  • How to prevent complication ie. falls, bleeding and infections
  • Promoting coping to diagnoses. ie anxiety, etc
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16
Q

Cellular Regulation- Collab interventions

A
  • Surgery - Radiation(localized)/Chemotherapy(doesnt just target cancer cells) -nutrition;CBD oil; antimetics,IV, tube feeds/TPN
  • neutropenic precaution - no contact sports - CAM Therapies
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17
Q

Cellular regulation- Prevention

A
  • family history of cancer

- Screenings: Breast exam, testicular exam, pap smear

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18
Q

cellular regulation- Diagnostic Test

A
  • X ray -CT -MRI -U/S -PET -Lumbar Puncture test
  • CBC w/Diff -Tumor Markers -Urinalysis
  • Temp shows signs of infection
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19
Q

Cellular Regulation- Assessment

A
  • Early Warning Signs
    1. Changes on bowel/bladder habits
    2. Sores do not properly heal
    3. Any unusual bleeding/discharge
    4. Lumps anywhere
    5. Any constant indigestion/trouble swallowing
    6. Any changes in moles
    7. Any nagging cough/hoarseness
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20
Q

Cellular Regulation- Health Promotion

A
  • No smoking/tobacco products -Poor diet/Process food
  • Lack of exercise -Infection w/certain disease; HIV, HPV
  • UV exposure (skin cancer) - Certain cancer treatment change cells - hormone replacement therapy -exposure to chemicals - living in areas w/high exposures of air pollution
  • exposure to radon
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21
Q

Acid Base Concept- Normal Range Values

A 
pH: 7.35-7.45 (acidosis or alkalosis)
*Below 7.35 is acid, above 7.45 is base
CO2: 35-45 (respiratory)
*Below 35 base, above 45 acidic (opposite from pH)
HCO2: 24-28 (metabolic)
*Below 24 is acid, above 28 is base
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22
Q

Acid Base Concept- pH

A

It is the indirect measurement of hydrogen ion concentration

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23
Q

Acid Base Concept- Buffers

A
  • Are substance that prevent major changes in pH by releasing hydrogen ions
  • Binds with hydrogen ions when excess acid present
  • Release hydrogen if body fluids are too basic
  • Act quickly
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24
Q

Acid base concept- systems

A

Three systems work together to maintain pH

  1. Buffer system
  2. Respiratory system
  3. Renal system
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25
Acid base concept- Respiratory System
- Regulates carbonic acid by eliminating or retaining CO2 - CO2, is potential acid, when conbined with water it becomes carbonic acid - Increased in CO2 or H stimulates respiratory center in the brain, increases rate and depth of respirations - Depression of the respiratory center of the brain, decreases rate and depth of the respirations.
26
Acid Base Concept- Renal System
- Long term regulation of acid-base balance - Kidneys eliminate nonvolatile acids - Regulates bicarbonate (HCO3) in ECF - Slower - Selectively excrete or retain H to maintain pH
27
Acid Base concept- Measurements
- PaCO2 measures pressure of dissolved CO2 in blood, normal value is 35-45 - PaCO2 less than 35 is hypcapnia - PaCO2 greater than 45 is hypercapnia - PaO2 measures pressure of the O2 dissolved in plasma, normal value is 75-100 - PaO2 less than 80 is hypoxemia - Serum bicarbonate(HCO3) reflects renal regulation of acid-base balance, normal value is 24-28
28
Acid base concept- Alteration& Manifestation
- Metabolic Acidosis:Abnormal HCO3 losses, excess nonvolatile acids in body - Metabolic Alkalosis: Excess of HCO3 in relation to hydrogen. - Respiratory Acidosis: Retention of CO2 and increast of carbonic acid - Respiratory Alkalosis: Excess loss of carbon dioxide
29
Acid base Concept- Risk Factor
- Many underlying disorders - acid-base imbalances occur in critically ill pts - Metabolic acidosis: occurs in pts with insulin dependent diabetes and chronic renal failure. - Metabolic alkalosis:Occurs in pts in acute care - Respiratory acidosis: pts of all ages are at risk when alevolar hypoventilation occurs; pts with COPD are higher risk - Respiratory alkalosis: Older adults/Young children ar risk w/large-dose salicylate ingestion - Starvation
30
Acid Base concept- Nursing Assessment
- Health History; current Meds and CAM therapy - Physical assessment: Vital signs, LOC, Pulse Ox, ABG results - Daily weights - Monitor I/Os - Assess neurological functions - Monitor cardiac function
31
Acid base concept- Diagnostic test
- ABGs | - Serum electrolytes
32
Acid base concept- interventions
- Reduce risk for injury - Monitor neuro functions - Initiate safety precaution - orient to time, place. and circumstances as needed - Keep familiar objects nearby and allow significant others to stay w/pt
33
Fluid and electrolytes- Fluids that the body needs for homeostatsis
- Blood -Serum - Water: 60% and it transport, lubricate, insulates and regulates cell heath - Urine -Albumin -CSF -Hormones -Bile
34
Fluid and electrolyte- Movement of body fluids
- Osmosis: movement of water across cell membrane from less concentrated solution -> more concentrated - Diffusion: Intermingling of molecules in liquids, gasses or solids - Filtration: Movement of fluids and solutes together across a membrane from compartment to another - Active transport: Substances that moves across membrane; needs bigger energy to transport
35
Fluid and Electrolyte- osmosis
- Solutes: crystalloids and colloids - Solvent: Component of solution to dissolve solute - osmolality: Concentration of solutes - isotonic: Normal saline 0.9% *Lactated Ringer - hypertonic:increase osmolality that body Concentration *3%NS *Dextrose 5% LR D5 NS - Hypotonic: decrease osmolality less than body concentration *.45%NS D5 .5NS * *Takes fluid in veins and move them into cells
36
Fluid and Electrolytes-Diffusion
Gasses, liquids and solid are intermingled
37
Fluid and electrolytes- Flitration
movement of fluids and solutes together across a membrane from one compartment to another -Goes from higher to lower
38
Fluids and electrolytes- Active transport
Substances move across a membrane using a bigger source of energy to transport
39
Fluid and electrolytes- Regulating body fluids
-Fluid intake: Everyone needs 2500mL/day (which can include anything we consume through IV,Drink or tube feed) -Fluid Output: urinates 1400-1500 mL/day; also includes fluid loss through sweat, feces and obligatory losses
40
Fluids and electrolytes- Maintaining Homeostasis
- Kidneys are primary regulators: Waste, Acid/base, volume - Hormones *antiduretic hormones: Regulates water secretions from kidneys * Renin-angiotensins: Works on diuretic and BP * Atrial natriuretic factor: works on thirst/helps bot waste Na, also works as a strong diuretic in body
41
Fluid and electrolytes- Regulating electrolytes
- Electrolytes are important for: * Maintaining fluid balance * Contributing to acid-base regulation * Facilitaing enzymes reactions * Transmitting neuromuscular reactions - Most electrolytes enter through dietary intake, IV and excrete through urine
42
Fluid and electrolyte- Sodium Na
- Most abdundant cation in ECF - Normal serum level: 135-145 mEq/L - Controls and regulate water balance - Found in foods including bacon etc - suggested intake: 1500-2300 mg/day
43
Fluid and electrolyte- Potassium (K+)
- Major cation in ICF and small amount in plasma, ECF - Normal serum level: 3.5-5.3 mEq/L - Normal ICF level: 125-140 mEq/L - Vital for skeletal, cardiac and smooth muscle function
44
Fluid and electrolyte- Calcium (Ca2+)
- Most is found in skeletal system - Vital in regulating muscle contraction and relaxation, neuromuscular function and cardiac function - Ca levels are reported 2 ways * Normal serum level: 9-11 mEq/L (normal BMP)(Bound ionized serum) * Normal ionized serum: 4.25- 5.25 (unbound) - Someone who has trouble absorbing CA needs Vitamin D - thyroid regulates
45
Fluid and Electrolyte- Magnesium (Mg2+)
- Found in skeletal system - Second most abdunant ICF cation - Normal serum level: 1.5-2.5 mEq/L - Important for intracellular metabolism - Protein and DNA synthesis
46
Fluid and electrolyte- Chloride (Cl-)
- Major anion of ECF - Normal serum level: 95-105 mEq/L - with Na, regulates serum osmolality - Major component of gastric juice (HCl) - Buffer in oxygen-carbon dioxide exchange in RBCs - Found in the same foods as Na
47
Fluid and electrolyte- Phosphate (PO4 3-)
- Major anion of ICF - Normal serum level: 2.4-4.5 mg/dl - Much higher in children - essential for functioning of muscles, nerves and RBCs - involved in metabolism of protein, fat and carbs - Found in meats, fish, poultry, milk products and legumes
48
Fluid and electrolytes- Bicarbonate (HCO3-)
- Found in both ICF and ECF - Primarily function: regulating acid-base balance - Produced through metabolic processes in sufficient amounts to meet body needs - Changes in fluid VL when there is too much/less - Helps w/enzyme reaction and neuromuscular
49
Fluids and electrolytes- Alterations
- Fluid volume deficit:Dehydration - Fluid volume excess - Elevated electrolyte level - Low electrolyte level - Chronic kidney disease - Acute Kidney injury * S/S: Excessive sweat, clammy, fatigue, HA, GI symptoms and N/V * Body constantly tries to compensate for fluid/electrolyte imbalance
50
Fluid and electrolyte-Prevalence
-Mostly seen in young/elderly: Kidneys doesn't filtrate properly -Diabetes/HTN -Low electrolytes -Meds that are given to lower electrolyte balance *Diuretics *benzodiazepines \
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Fluid and electrolyte - Health promo
* *Modifiable risk factors - Stress can increase cellular metabolism, blood glucose concentration andcarecholamine levels - Stress can increase production of antidiuretic hormones * Promotes fluid retention, decrease urine output * *Health Related illness - Limit outdoor activities during the hottes part of the day - Frequently breaks for rest and H2O - wear light weighted clothes - Work or exercise with others when engaging in activites outside
52
Fluid and electrolyte- Diagnostic test
-serum electrolytes CBC: hematocrit affected by plasma volume -osmolality: serum and urine -Urine specific gravitye
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Fluid and electrolyte - How to assess for imbalance
-V/S -Skin turgor -Oral mucosa - Neuro Checks - I/Os -Daily weights
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Fluid and electrolyte- collab intervention
- Educate on appropriate use of electrolyte replacements - Oral replacements/ initiation of IV therapy for significan fluid loss - electrolyte supplements - Diuretics - Phamacologic therapy
55
Fluid and electrolyte- Lifespan consideration
- Infant and young children: more vulnerable because of physiological differences *Infants lose more fluid through kidneys which are less able to conserve water - School-age children +Aldolescents: gastroenteritis, diarrhea - Pregnant women: n/v most common, hyperemesis gravidarum, nausea that requires hospitilization - Older adults:normal aging process increase chaces of dehydration
56
intracranial regulation- definition
The processes that affect intra cranial compensaion and adaptive neurolgical function -regulates and integrates all body functions, muscle member, mental abilities and emotions
57
intracranial regulation-Pathophysiology
Neurological system is made of 2 parts - CNS (consit of the brain and spinal cord) - Peripheral nervous system (cranial and spinal nerves)
58
Intracranial regulation- CNS
- Meninges coverthe brain and nourish the CNS - Skull protects the brain and is cushion by CSF - Brain consist of 4 parts * cerebrum: is divided into four regions called lobes that control senses, thoughts, and movements. * cerebellum: muscle movement, balance and control * Brainstem: control relflexes &10 of the cranial nerves * Diencephalon:(hypo) thalamus; control endocrine system - Spinal Cord:transmit impulses to and form the brain
59
Intracranial regulation- PNS
- Consist of the cranial nerves, 31 pairs of spinal nerves | - Reflexes
60
Intracranial regulation-Neuron
- Neurons are highly specialized cells that send impulses - Sensory neurons transmit impulses to the CNS - Motor neurons transmit impulses from the CNS - Myelin sheath covers larger, longer nerves - White matter of nervous system
61
Intracranial regulation- Lifespan Considerations
* Neonate has primitive reflexes at birth - Sucking -babinski -Stepping -startle(moro) -Rooting - assessment of newborn includes: cry of newborn and the head circumference * Assess child's fine and gross motor skills * Reflexes start to disappear after 6 months, except babinski
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Intracranial regulation- Level of consciousness
*consciousness: condition in which individual aware of self and environment -able to certain stimuli - arousal - cognition *Causes of LOC includes, lesions/injuries to cerebral metabolic disorders such as hypoglycemia -Fluid and electrolyte imbalance,med or liver and renal failure
63
intracranial regulation- Progression of deteriorating brain function
* is pt alert and oriented x4 - arousable - Decerebrate posturing (rigid extension of limbs) - Coma ( pupils fixed and nonreactive)
64
Intracranial regulation- Outcome of altered LOC
- Full recovery with no long term affects - recovery with residual damage - Vegetative state - Locked-in syndrome - Brain dead
65
Intracranial regulation- Assessment
- Focus on chief complaint (use Glascow scale) - Development considerations - Neurological funtions -Cranial Nerve functions - Mental status
66
Intracranial Regulation- Independent Nursing interventions
-Airway -assess LOC - Monitor I/O -Reduce enviromental stimuli -Position pt - Seizure Precaution -Monitor intracranial pressure -assess pupil for response to light -Measure V/S
67
intracranial regulation- RAS system
-Network of neurons extending from the top of the spinal cord to the thalamus; filters incoming sensory stimuli and redirects them to the cerebral cortex, activating the cortex and and influencing our state of physiological arousal and alertness.
68
Sensory Perception- External Stimuli
- Visual - Auditory - Olfactory (smell) - Tactile (feel) - Gustatory (taste
69
Sensory Perception- Internal stimuli
- Kinesthetic( sensation of movement) - Sterognosis (ability to perceive of material qualities, tactile recognition) - Visceral (felt in the internal organs of body;deep down feeling)
70
Sensory Perception - education
- Screening -organize/process stimuli - Learn how to manage deficit (glasses and hearing aide) - organize, have objects closer to them - clear walkway - sign language/ lip read and write
71
Sensory Perception- Safety/ injury pervention
- PPE * decrease sensory overload - turn tv off/on, dim lights, quiet time - ear plugs -glasses -tactile things (weighted blanket) - relaxation -soft object -flowers/aromatherapy - white noise machine * Simulations encouragement - TV -audiobooks -vistors/have social time - Music -click
72
Sensory Perception- Ppl who are at risk (nonmodifieable)
- Older adults -Infants( most likely are congential/ born with it) -Diseases (rubella, HTN: eye sight probs, Diabetes:uncontrolled, stroke, atherosclerosis) - otitis media
73
Sensory Perception- modiefieable risk factors
- smoking (changes smell, taste) - stress (diet) -UV light exposure (not wearing sunglasses) - Isolation (not having sunlight) -Injuries -Occupational
74
Sensory Perception- wellness promo
- Screening - vaccines - free clutter * for hearing impaired: have flash light phones * for someone who is tactile impaired - permanently adjust water heater - At risk for pressure sores/burns * for someone who is gusatory/olfactory impaired - check expiration dates - smoke alarms
75
Sensory Perception- Screening/diagnostic test
* hearing test (whisper test, tuning fork, otoscope) - are done when babies are born and every 3-5 years after til they are 10 yo - ppl grater than 50 every 3 years * Vision test (every year) - snelling test (distance) -Rosenhaulm test - cardinal fields of vision -opthalmascope * any other test is taken when there is a complaint
76
Sensory Perception- assessment
* 6 Components that must be assesed 1. observation & Pt interview 2. mental status exam 3. what pts area at risk 4. pts enviroment 5. pts social support netowkr 6. physical exam
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Sensory Perception/ Hearing impairment | *Severity of hearing loss
- Partial - total - acquired - congenital - frequency
78
Sensory Perception/ Hearing impairment | -etiology
* Conductive (obstructive) - works on transmition of sound; most common to affect is ear infection and earwax blockage * sensorinural hearing loss - affects the inner ear, auditory nerve/pathway; cause exposure to noise, rubella, aging - also by congenital, acquired or genetic * Presbycusis (hair cells of cochela degenerates w/age - converations are losss - Higher-pitch loss
79
Sensory Perception/ Hearing impairment | -Prevention
- PPE (ear plugs) - Educate about ear buds and loud music - Meds (asprin, chemo, loop diuretics, aminoglucosides which causes ototoxicity) * some meds can not be discontinued despite ototoxcity
80
Sensory Perception/ Hearing impairment | -Lifespan
- Catch it early to prevent further research - no meds can help with permanent heating loss - Most elderly do no but hearing aids because medicare dosen't cover it
81
Sensory Perception/ Hearing impairment | -Surgery
Stapedectomy - Tympanoplasty - myringotomy - cochlear implant
82
Sensory Perception/ Hearing impairment | -Meds
* decongestants - hearing can be loss due to upper respiratory infection * Steriods - Sudden sersorineural hearing loss * Antibiotics - Ear infections

Nursing 101 (4 decks)

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