Final Flashcards
(225 cards)
1
Q
pandemic
A
new strain or virus effects greater number people on larger geographic scale
can cause- social disruption, economic loss and general hardship
2
Q
epidemic
A
rapid spike # infected indivi in a localized area
3
Q
outbreak
A
sudden rise # cases of an identified dis
4
Q
R0 value
A
basic reproductive number
rate dis spreads through susceptible population
5
Q
covid 19 incubation period
A
2-14 days
6
Q
covid 19 symptoms
A
dry cough, SOB, loss taste or smell, myalgia, fatigue and fever
7
Q
swiss cheese model of pandemic defense
A
each slice = guideline
if enough guidelines are in place most of all the holes will be covered
=reduce overall risk
8
Q
covid 19 quarantine v isolation
A
quarantine- slows spread if you came into contact with an infected person
isolation= if you have the virus
9
Q
hypothermia/hyperthermia
A
<95 and >104
10
Q
bradycardia v tachycardia
A
< 60 bpm
> 100 bpm
11
Q
hypo v hypertension
A
< 90/60
> 130/80
12
Q
oxygenation measure of
A
arterial blood
13
Q
hypoxemia
A
< 90%
14
Q
when take vitals
A
admission change in pat condition LOC after fall b/d/a invasive procedures and opiods orthostatic hypotension ~ every 4 hours
15
Q
vitals
A
blood pressure, o2 sat, pulse, respir rate, temp, pain
16
Q
orthostatic hypotension
A
laying-5 min
sitting- 1 min
standing- 3 min
take it first time in morning when get up
have = if S dec. 20 points and D dec. 10 points w/in 3 min position change
17
Q
norm o2 levels
A
> 90 ok > 95 ideal
18
Q
nasal cannula
A
low flow
1-2 L = 24-28%
3-5 L= 32/40%
6L= 44%
19
Q
simple mask
A
5-8 L= 40-60%
5L lowest setting
20
Q
partial rebreather mask
A
8-11L= 50-75%
21
Q
nonrebreather mask
A
10-15L= 80-95%
22
Q
venturi mask
A
4-6L= 24-40%
23
Q
PPE steps
A
personal protective equipment
hand hygiene
gown, mask/ face shield, goggles, gloves
24
Q
hand hygiene times
A
b/a touching pat.
after touching pat surface
fluid exposure
before clean procedure
25
hand hygiene with soap
if hands visibly soiled
bodily exposure
a bathroom
before eating
26
airborne precautions
```
keep door closed
neg room pressure
wash hands b/a
n-95 mask
ex. covid, chickenpox, TB
```
27
droplet precautions
gown, mask, eyewear, gloves
| ex. influenza
28
contact precautions
ex mrsa
pat has specific equip
gown and gloves
29
enteric/special precautions
ex c-diff
pat. specific equip
gown and gloves
30
med v sterile tech
```
med= clean (regular)
sterile= cath, nicu, invasive procedures
```
31
HAI
ssi- surgical site infection
clabsi- central line ass. bloodstream infection
vap- ventilator ass pneumonia
32
only fluid gloves are not needed for
sweat
33
aseptic tech
all act. that prevent or break chain of infection
34
factors affecting personal hygiene
cult, socioeconomic class, spiritual practices, dev lvl, health state, personal pref
35
methods of hygiene
feeding, bathing, dressing/ grooming, toileting
36
oral care concerns
observe for dental caries, periodontal dis
37
oral care steps
toothbrush 45 degree angle, brush from gum line to crown, brush biting surfaces
floss- 18 in, 1-1.5 btw fingers
38
dysphagia
swallowing disorder incl oral cavity, pharynx, esophagus,or gastroesophageal junction
39
cause of dysphagia
always secondary to another dis
neuro event (stroke, injury spinal cord/ brain, ALS, parkinsons, multiple sclerosis
cancer, chemorad, meds, GERD, elderly
40
dysphagia symptoms
drooling, poor secretion management, fluid leaking from oral or nasal cavity, complaints food is "sticking", pain when swallowing, gurgly sounding voice after eating, difficulty coordinating breathing and swallowing, extra time need to chew, weight loss/ dehydration, recurrent aspiration pneumonia
41
chin tuck or oral care
chin tuck not always work!
| oral care important bc bac enters into lungs
42
dysphagia- common tip-offs
coughing, trouble swallowing, choking, drooling, frequent lung infections
43
oral care considerations- specific
chemo agents cause lesions, poor nutrit, diet, self care abilities, comatose, paralyzed, oral surgery
44
oral care- comatose
patient on side, head tilted forward, open mouth w/ pressure on bottom jaw
45
nutrition- considerations
swallowing ability, dev lvl, age, pregnancy, mental health, trauma, chronic dis, meds, religion/preference, economic factors, culture
46
nutrition- measuring intake types
24 hour recall, food diaries, food frequency, diet history
47
incentive spir-purpose
```
before surgery
inc lung vol and venous return
visual reinfor for deep b
sustain max inspiration
prevent/reduce atelectasis
clear secretions, inc gas exchange
```
48
incentive spir- how
sit patient up, assess for pain, admin meds if needed, hold mouth piece and container w/ diff hands, inhale completely with mouth on hose, exhale normally without lips connected
49
sterile def
all path and microo destoyed
50
sterile fields
1inch around not sterile, pinch from center, fold over hands if moving, do not bend/ reach over
51
examples sterile procedures
cath, preparation inject meds, dressing changes
52
sterile gloving steps
cuffed end closest to self, unfold top crease then bottom crease, pinch under middle creases and pull out to expose gloves, use nondominant hand to grab cuff of dominant hand glove, pull on, use gloved hand to slide under folded cuff and put on non-dominant hand
53
measuring urine output- continent
have pat. pee in specimen hat, urinal or bed pan
54
measuring urine output- incontinent
drain urine into measuring device, do not touch spout to bag, wipe spout w/ alcohol before replacing
55
urinary catheters- types
```
intermittent urethral cath- (straight cath, used for short time to drain), indwelling urethral cath (continuous bladder drainage)
suprapubic cath (long-term contin drainage) (surgically inserted, diverts urine from urethra)
```
56
foly cath- care
wash hands, clean area, encourage fluid intake, chart input and output every 8 hours, look for signs of infection (cloudy urine, chills), keep bag lower than bladder, educate self care and hygiene, change leg bags every 5-7 days
57
urinary diversion
```
creation of stoma, (sm intestine to skin)
ileal conduit
cutaneous ureterostomy (ureters attached to skin)
continent urinary divers. (CUD)(pouch created in sm intestine)
```
58
posterior hip replacement precautions
no bending beyond 90 hip flexion, no crossing legs, turning toes in
59
anterior hip replacement precautions
no crossing legs, no turning toes out when leg is behind
60
total knee replacement precautions
no pillow directly under knees, bed locked flat, weight bearing as tolerat.
61
sternal precautions
no pushing/pulling w/ both arms, no arms above shoulders, no lifting
62
back precautions
no bending, lifting or twisting
63
WBAT
NWB
TTWB
weight bearing as tolerated
non weight bearing
toe touch of touch down weight bearing
64
five steps in nursing process
```
ADPIE
asessing
diagnosing
planning
implementing
evaluating
```
65
characteristics of nursing process (SDIOU)
```
systematic
dynamic
interpersonal
outcome oriented
universally applicable
```
66
systematic
ordered sequence of act
67
dynamic
interaction and overlap of five steps
68
interpersonal
comm/ interaction with pat
69
outcome-oriented
nurse and pat work together to id outcomes
70
characteristics of assessment
ppcsfrr
| purposeful, priorit, complete, systematic, factual, relevant, recorded standard manner
71
purpose of assessment
create database
id health problems, health status
makes diagn and planning easier
72
implementing
carrying out plan
73
evaluating
measuring extend outcomes achieved
74
diagnosing process explanation
analyzing pat data to id strengths, problems
| *diff. than usual med diagnosis
75
assessing in relation to data
collecting, validating, and comm w/ pat
76
planning
id pat outcomes and plan interventions
77
nursing diag. format
problem, "related to", etiology/cause, "as evidenced by", defining characteristics
78
wound characteristics- open or closed
is the dermis visible?
| ex. closed= hematoma (bleeding underneath skin)
79
wound characteristics- acute v chronic
chronic wounds take longer to heal
80
wound definition
integrity of skin or mucous mem. is broken/ no longer intact
81
asepsis used for wound care
clean/ medical and surgical (sterile)
82
nutrients needed for wound healing
protein and adeq. blood supply
83
wound healing- first phase I
```
hemostasis
constriction followed by dilation
immediately after tissue/skin injury
platelets attract o/ cells
exudate is formed= pain and swelling
```
84
wound healing- second phase II
inflammatory
lasts 4-6 days
macrophages present, ingest debris and attract fibroblasts
acute inflammatory response = pain, heat, erythema and edema
fatigue is common*
85
wound healing- third phase III
```
proliferation
starts w/in 2-3 days of injury
capillaries grow across wound
thing layer epith cells forms
new tissue growth (granulation) and scar formation
```
86
wound healing- fourth phase IV
maturation
begins 3-6 weeks after injury
collegen tissue dev.
wound remodeling
87
wound site factors that affect healing
pressure (interferes w/ blood supply)
desiccation (too dry)
Maceration (too moist)- inc bac. growth
edema (disrupts normal o2 and blood flow to wound)
infection (energy is diverted to immune response, not wound healing)
necrosis (tissue slough and eschar)
* dictate the difference btw a chronic and acute wound
88
general factors that affect healing
circulation and oxygenation
nutritional status- presence of protein, hydration
addit. chronic illnesses- alter immunes response
wound chara- baseline condition
immunosuppression- ex. aids, or autoimmune reaction
89
wound assessment- inspection
inspection
| edges, location, size, depth, surr. tissue, drainage, type of closure
90
wound assessment- exudate types
type
serous- watery
sanguineous- bloody
serosanguineous- watery and bloody
91
wound assessment- signs of complications
odor, pus (purulent), excessive heat, pain w/ palpation
92
wound complications- infection
```
edema, surr. color hot and painful
erythema
drainage inc (maybe purulent)
wound edges could be seperated w/ dehiscence
inc WBC count
febrile temperature 100.5> 101
```
93
wound complications- hemorrhage, dehiscence, evisceration, fistula
excessive bleeding at wound site
skin pulls apart at suture line
tissue layer seperation
opening created by infection
94
pressure ulcer factors
```
immobility
chronic illnesses
aging skin
malnutrition
fecal, urinary incontin
altered lvl consciousness
```
95
pressure ulcer - stage 1
red and non-blanchable
96
pressure ulcer - stage 2
missing top layer of skin
97
pressure ulcer - stage 3
subcutaneous tissue visible
98
pressure ulcer - stage 4
bone and tendon visible
99
pressure ulcer - "unstageable"
ulcer w/ slough or eschar
100
pressure ulcer - "deep"
closed w/ skin intact
| dark purple color
101
braden scale categories
```
23 points possible
less than 16 = at risk
sensory perception
moisture
activity
mobility
nutrition
friction and shearing
```
102
wound dressings- purpose
```
remove necrotic tissue and exudate
prevent and control infection
maintain moist environment
protect surrounding skin + wound from further injury
provide physical comfort
```
103
penrose drain
passive, no reservoir
104
JP, hemovac or wound vac drain
active
| used neg pressure to pull out exudate
105
cold application effects
15 min at time
vasoconstriction
reduces spasms
106
heat application effects
vasodilation
inc cap perm
red. muscle tension
relieves pain
107
nursing v medical diagnosis
nursing- analyzes pat. response "risk for"
| medical- actual pathophysiology
108
diagnosis purpose-
```
rule out similar problems
determine risk factors
list suspected problems/ symptom patterns
identify resources for health promotion
used to select nursing interventions
```
109
data interpretation- 4 steps
rec. sig. data- compare to standards
rec. patterns (ex. pain, swelling, redness, exudate could indicate an infection)
id strengths and potential problems
reach conclusions (point where make final decision)
110
4 diagnosis components
label
definition
defining charac
related factor
111
types of nursing diagnosis
problem-focused or actual (3 parts)
risk- (2 parts)
health promotion or "readiness for education"
112
validation of diagnosis
have pattern, accurate data, objective data and based on scientific knowledge
need have >50% confidence o/ get same result
113
nursing diag. errors
making legally inadvisable statements
identifying a patient's etiology when it cannot be changed
identifying environmental problems and not patient problems
revere clause
"imbal. nutr. related to insuf. funds in meal budget"
versus
"deficient knowledge related to alteration in diet"
inc. value judgements ("pat. is lazy")
inc. medical diagnosis in nurse diag. statement
diag. with no evidence or data
faulty data analysis
non-specific or individualized diagnosis
114
outcome id and planning- purpose
design PoC w/ pat.
| to prevent, reduce or resolve problems
115
plan of care- allows nurse to
```
indivi care maximizes outcome achievement
set priorities
comm w/ colleagues/ healthcare providers
promote continuity high-quality + cost effective care
coordinate care
evaluate response to care
create record for reimbursement
promote own professional dev
```
116
outcome id and planning- clinical reasoning
know standards for care plan, interventions, and pat outcomes
keep big picture in mind (discharge goals) (how effects interventions and choices)
respect intuition
recg. personal bias
make sure research supports plan before id outcomes
117
comprehensive planning- parts
initial
ongoing
discharge
118
comprehensive planning- initial
dev. by nurse who records history
id e/ problem in prioritized nursing diag
id pat goals
119
comprehensive planning- ongoing
```
done by nurse who has contact w pat
manages risk factors and keeps plan up to date
states diag more clearly
dev new diag
makes outcomes more realistic
id nursing inteventions
```
120
comprehensive planning- discharge
done by nurse w/ closest relationship
begins upon admission
uses teaching skills make sure pat is successful at home
(can incl family educ)
121
nursing diag- problem statement- purpose
suggests pat goals/ outcomes
122
nursing diag- etiology- purpose
suggests nursing interventions
123
high priority interventions
impaired gas exchange
risk for powerlessness
act. intolerance (if not related to condition)
124
low priority interventions
not related to specific health problem
125
maslows hierarchy of human needs
physiologic needs-
| safety, love + belonging, self esteem, self actualization
126
categories of outcomes- cognitive
inc pat knowledge/ intellec beh
| "why infection prevention is important"
127
categories of outcomes- affective
changes values, beliefs and attitudes of pat
128
categories of outcomes- clinical- general
desc expected status of health issues after treatment complete
129
errors writing outcomes
includ more than 1 manifestation in short-term outcomes
vagueness
use verbs that are non-measurable
130
outcome parts- measureable
```
subject- patient
verb
conditions
performance criteria
target time
smart goals (specific, measurable, achiev, relevant, timely)
```
131
implementing-purpose
4th step of process
| help pat achieve goals, prevent dis, and restore health
132
types nursing interventions
direct v indirect
indivi v family v community
nurse initiated v provider initiated
133
nurse initiated interventions
```
not need provider order
monitor health status
redu. risks
resolve and manage problem
assist w/ ADL
promote emotional and physical well-being
```
134
implementation- components
carry out plan
cont. data collection (modify as needed)
document care
135
patient var. influence pat goals
dev. stage
| psychosocial backgrnd
136
nurse var. influence pat goals
resources
curr standards of care
research findings
ethical and legal guides to practice
137
reasons for noncompl w/ interventions
```
lack family supp
low value for outcomes
lack understanding abt beliefs
emotion/phys effects of trtmnt
inabil afford trtmnt
limited access trtmnt
```
138
evaluating- allows nurse to
measure pat achievem outcome
directs nurse intervent
id factors for achiev
modify plan if necess
139
eval- criteria
measurable qualit. that specify skills, or health status
| ex. performance accept. lvl for state
140
statement eval- met v partially v not met
term PoC, continue w/ modification (make more realistic), start over
141
improving performance (4)
step 1- id problem
plan strategy
implement change
if outcomes not met, assess achievement
142
evidence-based p- purpose
support interventions and clinical decision making
| and is the science of nursing
143
evidence-based practice- what
back/ scientific justification for actions
144
national institute goals research w/ evidence-based
prevent dis, build scientific foundation, manage symptoms
145
evidence-based goals- people v nursing process
education, policy dev, ethics, nursing history
146
health
state complete physical, mental, and social wellbeing in addition to absence of disease or infirmity (weakness)
147
illness
response to dis, abnorm process involving changed lvl of funct
148
wellness
state being healthy by living lifestyle promoting good physical, mental and emotional health
149
health dimensions-physical, environ, intellectual
physic- genetics, age, dev lvl
environ- housing, sanitation, climate, nutritional access
intellect- cog abilities, education
150
dimensions of health- sociocul, emotional, spiritual
socio- economic lvl, lifestyle, family cul
emotional- body responce to changing conditions
spiritual- beliefs/values
151
acute illness
rapid onset
brief length
ex. flu, gi bleed, pancreatitis, food poisoning, pneumonia
152
chronic illness
permanent, irreversible changes
2-3 months, long time
ex. heart dis, lung dis, diabetes, kidney dis, arthritis
153
remission
pat have dis but sympt not present
154
illness beh- stage 1
symptoms appear- do not affect ADLs
155
illness beh- stage 2
sick role
decide if need to take action
go to doctor
impede norm activity func.
156
illness beh- stage 3
dependent role
| take prescrip or hospitalized
157
illness beh- stage 4
IV recovery and rehab
158
purpose health illness continuum
measure lvl of health
stages range frm death to high lvl wellness
illustrates dynamic state of health
159
primary health promotion
weight loss
diet, exercise, smoking cessation
(modifiable, used to prevent dis)
most important
160
secondary health promotion
screenings, exam, family counseling
(ID illness early on)
performing stage
161
tertiary health promotion
intervention based
| ex. meds, surgery, OT/PT
162
nursing care goals for older
```
promote indep. func
support indiv. strengths
prevent complications of illness
secure safe/comfort environ
promot return health
```
163
five prts communication (berlo)
stimulus of referent (why need comm in first place)
sender/ source message (encoder)
message itself (content)
medium or channel of comm (verbal v visual)
receiver (decoder)
164
four lvls comm
intrapersonal (self talk)
interpersonal (btw 2+ ppl w/ goal exchange info)
group- e.i. family
small group, organizational communication, group dynamics
165
factors influc comm
dev lvl, gender, sociocul differences, roles/ responsibilities (charge nurse v cna), space and territory, physical, mental and emotional state, values, environ
166
phases helping relationship
orientation
working
termination (end shift or goal met)
167
orientation phase goals- comm
pat descr participants in relationship (name, role and purpose)
pat and nurse agree goals relationship, location, freq, duration of contact, and duration of relationship
168
goals working phase- comm
pat actively particip in relationship
pat coop in act to achieve goals
pat express feelings and concerns to nurse
169
goals termination phase- comm
pat particip in id goals accomplished or progress made
pat express feelings abt termination of relationship
*bed side report important
as if pat has anything to add
170
rapport builders
privac and confiden, optimal pacing, comfortable environ, patient v task focus (asure care abt well being and remember purpose of task
171
SBAR purpose
```
hand off comm
used if calling provider
situation (why calling)
background
assessment (what think issue is)
recommendation
```
172
communication blocks
not listen, use closed questions, nontherapeutic comments, judgemental, false assurance, disruptive interpersonal beh, gossip, changing subject
173
factors affecting patient learning
```
age, dev lvl
family support
financial resources
cul influences
lang deficiet (don't use family as translator)
health literacy lvl (don't assume know)
```
174
critical dev areas
```
physical maturation/abilities
psychosocial
cog capacity
emotional maturity
moral/spiritual dev
```
175
four assumptions abt adult learners (knowles)
inc independence w age
previous experiences alter perceptions
readiness to learn depends on dev lvl
most only want to learn material that is useful
176
teaching plans for older adults
```
id learning barriers (hearing and vision)
allow extra time
plan short teaching sessions
reduce environ distractions
relate new info to familiar activities
```
177
teaching strategies
audiovisual, written mat, discussion, lecture, demonstration, discovery, role-playing
178
types counseling
short term- situational (pain)
| long term- developmental crisis (ambulation)
179
culture
group w shared beh patterns learned through socialization
| inc- location, sexual orientation, religion, race
180
cultural humility
subjective- ongoing
181
cultural competence
objective view, you are the expert
182
cultural assimilation
minorities lose characteristics to dominant group
183
culture shock
discomfort when placed in alt culture
184
cultural imposition
belief everyone should conform to majority belief
185
cultural conflict
ppl aware of cul differences and feel threatened
186
ethnicity
based on heritage
share beh, and beliefs
dev through day to day life
187
ethnocentrism
belief that ideas are superior to all o/
188
cul influences on healthcare
reactions to pain, mental health, gender roles, language, family supp, nutrition, socioeconomic
189
care considerations for pain
not assume
respect right to response of pain
respect beliefs about pain
sensitive to nonverbal cues
190
purpose of documentation
legal, reimbursement, education, research, performance improvement, diag, comm, care planning
191
documentation components-ctfac
content, timing, format, accountability, confidentiality
192
policy for verbal orders
record in chart, read back to verify accuracy, date/ time, record physicians name
193
methods of documenting
chart (focus, exception, pie), source/problem oriented, case management, electronic health record
194
flow sheet types
24 input/output
MAR
acuity record
24hr pt care record
195
ISBARR
hand off communication
| intro, situation, bckgrnd, assessment, recommendation, read back orders
196
what is apa
format for sciences
| clear, concise, organized manner
197
general apa paper format
title page
abstract
intro, lit review, methods, results/findings, discussion
references
198
intext citations
1-2- jones & kim, 2019
| 3+- jones et al., 2019
199
SOAP
subjective, objective, assessment, plan
200
PIE
problem, intervention, evaluation
201
IPASS
patient handoff
illness severity
patient summary
action list (orders need to be completed)
situation awareness
synthesis by receiver (what you interpret from o nurse)
202
nursing incivility
one or more rude, discourteous, or disrespectful actions
may or may not have neg. intent
step below bullying
203
nursing diag format
actual- problem r/t etiology aeb defining characteristics
| risk- problem r/t etiology
204
nurse practice acts
state standards- board of nursing
205
licensure v certification
certification is add. lvl knowledge
206
reasons revoking license
deceptive practice, criminal acts, drug abuse, fraud, physical/mental impairments including age
207
considerations for legal applications
practice within scope- incl practice acts and standards of care
timely charting
208
roles in legal proceedings
defendant, fact witness and expert witness
209
components informed consent- DCCV
disclosure, comprehension, competence, voluntariness
210
purpose incident report
review situation
| not intended as form punishment
211
nursing process purpose
create database
id health problems, health status
makes diagn and planning easier
212
collaborative diag v med diagnosis
med is only physician
| collab is physician and nurse
213
reason for critical thinking
determ credibility
analyze norm from abnorm
distinguish relevant data from irrel
id bias, assumptions or inconsis
214
traditional, scientific and authoritative care
traditional- way always done it
scientific- if backed by objective data/ research
authoritative- told to do by expert
215
definition health-illness continuum
cannot be divided, continuous process
216
steps in infection cycle
organism, reservoir, portal of exit, transm., portal of entry, vulnerable hosts
217
incubation stage
time from infection till appearance of sympt
218
prodromal stage
non-specific sympt.
| * most infectious
219
full stage
recogniz and specific sympt
220
convalenscence
final recovery stage of infection
221
bed bath procedures
wipe inside eye to out w/out soap
| change water at the end
222
standards of nursing practice
dev by ANA guidelines for nursing performance
| definition of what means to provide competent care
223
outcome - goals
```
est. priorities
id and write expected pat. outcomes
use evidence-based interventions
communicate the PoC
keep pat and pat interests / preferences in mind
(not going to do something they hate)
```
224
outcome format categories
cognitive- intellectual beh
psychomotor
affective- attitude
225
alfaro's rule
assess, reassess, revise and record
