exam1 Flashcards

1
Q

4 aspects of clinical judgement

A

noticing
interpreting
responding
reflections

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2
Q

what is critical thinking

A

a combination of reasoned thinking, openness to alternatives, ability to reflect, and desire to seek truth

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3
Q

EBP

A

most efficient. based around scientific evidence, clinical experience, and patient values

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4
Q

florence nightingale

A

founder of modern nursing. started the first nursing school

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5
Q

patricia benner

A

noves to expert nurse

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6
Q

noves

A

task oriented nurse. don’t see whole picture

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7
Q

advanced beginner

A

thinks more about what makes the most sense

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8
Q

competent nurse

A

recognize patterns

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9
Q

proficient nurse

A

looking more holistically

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10
Q

expert nurse

A

sees and fixes a problem before it becomes one

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11
Q

Marlowe hierarchy of needs from most to least

A

physiological
safety
love and belonging
esteem
self actualization

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12
Q

CRAAP acronym

A

currency
relevance
authority
accuracy
purpose

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13
Q

health

A

state of complete physical, mental, and social well being

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14
Q

5 stages of illness behavior

A

experience symptoms
sick role behaivor
seeking professional care
dependance on others
recovery

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15
Q

spirituality

A

a journey, subjective experiences.

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16
Q

religion

A

has beliefs and practices

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17
Q

best to measure intake

A

graduated cup

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18
Q

best to measure outtake

A

gradient cylinder

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19
Q

positive in fluid balance

A

input greater than output

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20
Q

negative in fluid balance

A

output greater than input

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21
Q

NPO

A

nothing per oral

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22
Q

I/o q hour

A

input and out take every hour

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23
Q

strict I/o

A

measure everything

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24
Q

enteral

A

directly to GI

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25
CC
another word for milligrams
26
void
urine
27
EHR
electronic health record
28
measuring food
percentage as whole
29
how does infection spread
pathogen must exit reservoir
30
indirect contact
contact with fomite- contaminated object
31
common infection portal of entry
wounds, surgical sites, insertion sites of tubes and needles
32
systemic infection
pathogens invade blood or lymph
33
bacteremia
bacteria in blood
34
exogenous infection
pathogen acquired from healthcare enviroment
35
endogenous infection
pathogen arises from patients normal flora, with some treatment cause the microbe to multiply
36
stages of infection
incubation prodrome illness decline convalesence
37
primary defense
Normal flora of the body skin Respiratory tree eyes mouth GI tract Anus and urethra
38
secondary defense
Phagocytosis Complement cascade Inflammation Fever
39
active immunity
body makes its own antibodies or T lymphocytes
40
passive immunity
when a person receives antibodies from someone else. like vaccine
41
bronchodilators
Relax the smooth muscles lining the airways.
42
can assessment be delegated
no
43
activities that dont need assessment
mobility, transfer, bathing, dressing, feeding, toileting, continence
44
diagnosing involves
critical thinking and logical reasoning
45
risk diagnosing
no signs or symptoms but pieces come together that patient could have it
46
prioritizing problems top-bottom
transcendence (least), self actualization, aesthetic, cognitive, self-esteem, love and belonging, safety and security, physiological
47
when writing quality statement
avoid using medical diagnosis and treatments for etiology be sure the etiology doesn't restate the problem be descriptive
48
outcome
specific observable measure, must include target time
49
goal
broad, nonspecific statement about desired result
50
direct care
counseling observing interactions physical care ADLs teaching
51
indirect care
advocacy delegating evaluating
52
empathy
You understand peoples pain
53
sympathy
you feel bad for people, but you dont understand their pain
54
concrete
clear and confident
55
aphasia
unable to speak
56
are you able to tell the patients everything will be okay?
no
57
safety
basic human need for patients, us and other workers
58
how many patients die a year due to mistakes in care
161K
59
Factors affecting patient safety
lifestyle, cognition, developmental stage, balance, gait, mobility, ability to communicate, visual acuity, emotional health, safety awareness
60
never events
things that should never happen in the hospital due to protocols
61
whats the most common safety concern in healthcare
falls
62
Sentinel event
events that can lead to death or a lot of harm. Ex- medication error, delay in treatment
63
safety hazards for workers
workplace violence, disease, back injury, radiation, needlestick injury
64
improving safety in workplace
follow protocols, speak up, communicate, taking care of yourself, continuing caring, don’t assume
65
restraints
device or method use for restricting to help keep patient from hurting themselves. You must have an order for this. If they have one, monitor them every 2 hours.
66
why hourly rounding?
meet patients need instead of waiting for them to need. Also reduce call button times
67
scale for fall risk
morse
68
what to do if someone falls on your shift
document findings and look for injuries. Identify actions to prevent recurrence
69
moral distress
you know what the right thing to do is but you are unable to do it
70
ethical principles
autonomy, nonmalefinence, beneficence, fidelity, veracity, justice
71
autonomy
respecting the patients right to choose. Patient needs all the info to choose
72
nonmaleficence
do no harm. benefits need to outweigh
73
beneficence
doing the right thing
74
fidelity
keeping promises
75
veracity
telling the truth
76
justice
treat everyone equally, everyone gets equitable care for their case
77
nurse practice act is determined by
state board of nursing
78
patient bill of rights
States they will get care, they have the right to know there problems
79
PSDA (patient self determination act)
advanced directives. General term to indicate what a person wants or don’t want.. Ex- DNR, ADA (Allow natural death), living will, organ donation, health power of attorney
80
HIPPA
privacy and portability act
81
EMTALA ( emergency medical treatment and active labor act)
Patient that comes to ER must be triaged
82
ADA
American disability act. Specialized needs
83
Mandatory reporting
must report if we see experience or think could be present. Ex- abuse, infectious diseases
84
Patient confidentiality
only the people who need to know can know Informed consent- got to have all the info
85
FALSE IMPRISONMENT
lead patient to believe they couldn’t do something
86
Assault and battery
assault- threat battery- actually did something
87
Slander and libel
slender is spoken against the patient libel is written against
88
AIDET
Acknowledge Introduce- name role Duration- brief idea of how long you'll be in there Explanation- briefly explain what your going to do and warn about pain Thank you- thank for time and cooperation
89
SBAR
Situation- general overview. Ex- code, race, allergies, etc Background- past history. Explain what has been done so far and how patient is responding Assessment- quick head to toe summary Recommendation- summarize plan of care, recommendations that will help, test results
90
subjective data
what patient says
91
objective data
what can be seen, only facts
92
initial assessment
when patient first comes in, gives a baseline
93
ongoing assessment
every other encounter with patient after first
94
comprehensive assessment
head to toe, look at everything
95
focused assessment
aimed at one specific area in general. What problem specifically is.
96
what must we check for in every single assessment
safety
97
what should we do after hearing info from a patient
validate it with them
98
clinical reasoning through use of
critical thinking
99
actual nursing diagnosis
has evidence for support
100
risk nursing diagnosis
a tendency for it to happen but hasn’t happened yet. No evidence yet
101
prioritizing patient needs
use ABC 1- airway, breathing 2. circulation 3. pain
102
why is shelter a physiological need
protects from elements like heat, and is important for body temp
103
critical thinking you need
education reflection experience
104
SMART
Specific Measurable Attainable- can they do this in this amount of time? Relatable- does it relate to what's going on with patient timely - what's the time goal?
105
STANDARDIZED nursing care plan
everyone has it
106
individualized care plan
fits need of specific patient
107
interventions
things we do to help
108
independent intervention
nurse can do it on there own. Need no order
109
dependent intervention
doctors order for intervention
110
interdependent intervention
working with other departments
111
implementation
putting intervention into affect
112
direct implementation
things I do
113
indirect implementation
things I was told to do
114
delegation
Right task Right circumstance Right person Right direction/ communication Right supervision
115
evaluation
Did intervention work? Determines what comes next -discontinue interventions -continue interventions -revise interventions most forgotten phase
116
physiological needs
food, air, water, shelter, sleep, clothing, reproduction
117
safety needs
personal security, employment, resources, health, property
118
love and belonging
friendship, intimacy, family, sense of connection
119
esteem
respect, self esteem, status, recognition, strength, freedom
120
self actualization
desire to become the most one can be
121
Who can i use SCD on
bed bound patients who do not have blood clots or compartment syndrome
122
who to use a TED on
patients that are more mobile
123
biggest disadvantage to oxygen
fire hazzard
124
protective precautions
protecting the patient
125
Analytical reasoning
Interventions are based on likelihood of desired outcome. Rely heavy on textbook info
126
Intuitive reasoning
Used by experienced nurses based on their in depth knowledge to intuitively grasp the info and know how to respond
127
Narrative reasoning
Helps the nurse to use info based on clients illness experience, coping ability and vision of future to develop client center plan of care