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PNUR 2101 CONCEPTS > FINAL (SHAWNA) > Flashcards

FINAL (SHAWNA) Flashcards

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1
Q

4 basic elements of mobility

A

Body alignment
Joint mobility (ROM)
Balance
Coordination

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2
Q

What does ROM refer to? What is it varied by?

A

Maximum movement possible for joint

Active or Passive

Age, activity level, genetic can impact

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3
Q

What is Active ROM

A

done first as it’s less intrusive​

Uses patients own strength to create the movements through the joints​

Ask the patient to slowly move each joint through it’s full ROM (flexion, extension, etc.)​

Tell patient to stop the movement and tell you if they experience any pain​

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4
Q

What is Passive ROM

A

more intrusive as you manipulate the person’s joints for them​

Tell the patient to relax and then support the joint and move it through its range of motion.​

Observe and compare each side of the body for symmetry, pain, inflammation or stiffness​

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5
Q

Factors that impair mobility? (8)

A

Congenital or acquired postural abnormalities eg. scoliosis​

Damage to the CNS as it regulates voluntary movement​

Impaired muscle development eg. MS ​

Direct trauma to the musculoskeletal system eg. fracture​

Inflammatory diseases eg. Rheumatoid Arthritis​

Bed rest or reduced activity tolerance​

Pain​

Medications​

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6
Q

Rheumatoid Arthritis overview

A

Chronic, inflammatory disease

Primarily impacts synovial membrane but can impact organs ex. lung

Cause is unknown

Symptoms are related to inflammation
- Objective: heat
- Subjective: pain

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7
Q

Osteoarthritis overview

A

Chronic degenerative joint disease

Risk factors: older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.

Symptoms: pain that worsens with activity, joint stiffness and loss of function, decreased ROM

Signs: limited joint motion

encourage weight bearing exercises, increase vitamin C & D

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8
Q

Osteoporosis Overview

A

“Brittle bones” Decreased density of bones and deterioration of bone tissue, leading to bone fragility and increased risk for fractures ​​

Commonly seen in hip, wrist and spine​

Risk Factors: ​
Gender- female​
Age (65+)​
Post-menopausal (early menopause) ​
Ethnicity- Caucasian, Asian​
History of fractures (from minor falls/injuries)​
Family history​
Bone structure/body weight- thin, “small boned”​
Smoking​
Alcohol abuse​
​
Health Promotion/Prevention​
Diet, exercise​
Fall prevention​

​

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9
Q

What can immobility cause?

A

Stiffness and pain in the joints ​

Cardiovascular changes e.g. orthostatic hypotension​

Metabolic changes e.g. loss of calcium, constipation​

Respiratory complications e.g. atelectasis, pneumonia​

Urinary changes eg. increased risk for urinary stasis or renal calculi​

Poor hygiene r/t immobility can lead to skin breakdown, and sustained pressure on joints can lead to pressure ulcers​

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10
Q

Components of Hair Assessment

A

Uniformity/thickness​

Color​

Amount of hair (alopecia)​

Body hair (lanugo)​

Texture (oily/dry)​

Scalp is free of lesions ​

Parasites (lice etc.)​

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11
Q

Components of Nail Assessment

A

Texture- smooth, thick/thin​

Color- capillary refill, cyanosis​

Cleanliness​

Length eg. nail biting​

Shape & curvature

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12
Q

Wound assessment and documentation

A

Size, shape and texture​

Colour​

Location/Distribution​

Surrounding skin​

Elevation ​

Exudate/discharge​

Odour​

Measure height, width and depth​

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13
Q

Skin Assessment Methods (2) - Objective

A

Inspection
- Colour
- Edema
- Bruising
- Markings
- Irritation

Palpation
- Temperature
- Moisture
- Turgor
- Edema
- Texture

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14
Q

What does S.M.A.R.T goals stand for?

A

Specific, Measurable, Attainable, Realistic, Timely

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15
Q

Overview of medication administration?

A

preparing, giving, and evaluating the effectiveness of prescription and non-prescription drugs

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16
Q

What are the 7 rights of medication administration?

A
  1. right med
  2. right pt
  3. right dose
  4. right time
  5. right route
  6. right reason
  7. right documentation
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17
Q

Some practice setting have 10 rights. What are the additional 3?

A
  1. right to refuse
  2. right pt education
  3. right evaluation
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18
Q

What is pharmacology and why does the RPN have to be familiar with it?

A
  • pharmacology: the study or science of drugs
  • the RPN needs to know this so they can understand how each drug will affect the pt
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19
Q

What are the 3 names a medication might be known as?

A
  1. generic name: name given by the developer of the medication/official name (ex; ibuprofen)
  2. trade name: brand name, given by the manufacturer and can vary in diff countries (ex; advil)
  3. chemical name: describes the med’s molecular structure
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20
Q

What is drug classification? (2)

A

the desired effect on the body system

the type of drug it is

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21
Q

What do medication forms tell you?

A

indicates route

must ensure correct form is used as this affects absorption and metabolization

ex; tablet, ointment, suppository

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22
Q

What are pharmacodynamics?

A

the study of what the drug does to the body

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23
Q

What is the therapeutic effect? (pharmacodynamics)

A
  • intended or expected effect on the body
  • ex; tylenol will relieve a headache
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24
Q

What is a side effect? (pharmacodynamics)

A
  • unintended secondary effects
  • ex; morphine may cause a rash
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25
What are toxic effects? (pharmacodynamics)
- an accumulation of meds in the body to the point where it is poisonous
26
What is a contraindication? (pharmacodynamics)
- any characteristic of the pt that makes the use of the med dangerous - ex; pregnancy, other meds
27
What is pharmaceutics?
- how various med forms/routes influence the way the body metabolizes a drug and the way the drug effects the body - ex; oral, sublingual, inhalation etc
28
What is pharmacokinetics?
- how the medication moves into, through, and out of the body
29
What is absorption? (pharmacokinetics)
the movement of a drug from its site of administration into the blood
30
What is distribution? (pharmacokinetics)
transport of a drug in the body by bloodstream to its site of action
31
What is metabolism? (pharmacokinetics)
the biological transformation or metabolic breakdown of a drug in the body (most commonly done in the liver)
32
What is excretion? (pharmacokinetics)
- the elimination of drugs from the body - kidneys are the primary way - bowel and liver are responsible to a lesser extent
33
What is parenteral admin? (pharmacokinetics)
- IV - IM - subcutaneous (SC)
34
What is inhalation admin? (pharmacokinetics)
- nebulizers - nasal sprays
35
What is transmucosal admin? (pharmacokinetics)
sublingual
36
What is gastroenteral admin? (pharmacokinetics)
- PO - suppositories
37
Transdermal/topical admin (pharmacokinetics)
- patches - creams - ointments
38
What is onset of action? (pharmacokinetics)
- time is takes for the drug to elicit a therapeutic response
39
What is peak effect? (pharmacokinetics)
- time needed for a drug to reach it's maximum therapeutic response
40
What is duration of action? (pharmacokinetics)
- length of time that the concentration is sufficient to elicit a therapeutic response - time it lasts before it wears off
41
What is a half life? (pharmacokinetics)
- the time it takes for one half of the drug to be eliminated from the body
42
What is a drug schedule?
- determined by Health Canada - whether or not a drug requires a prescription; regulates access - based on its medicinal ingredients and puts the drug on the Prescription Drug List - schedule I, IA, II, III, IV must be sold from pharmacies
43
What is a schedule I drug?
- need a prescription - ex; amoxicillin, sertraline
44
What is a schedule IA drug?
- abuse potential, requires triplicate/duplicate prescription in order to sell for tracking and forgery purposes - ex; Tylenol #3, (30 mg codeine) fentanyl
45
What is a schedule II drug?
- no prescription req but pharmacist supervises sale - ex; Tylenol #1 (8 mg codeine)
46
What is a schedule III drug?
- drugs that can be sold without a prescription (locked after closure, if no pharmacist on duty, cannot sell) - hydrocortisone topical cream
47
What is a schedule IV drug?
prescription by pharmacist
48
What is a unscheduled drug?
- no restriction, can be sold anywhere - ex; Tylenol, Tums
49
Natural health product advantages:
adjunct therapy to support conventional pharmaceutical therapies
50
Natural health product disadvantages:
- drug-drug interactions - allergic reactions - adverse side effects - people believe they are safe
51
Common OTC meds:
- NSAIDS: ASA, ibuprofen - Non-opioid analgesics: acetaminophen - Anti-emetics: dimenhydrate - Antihistamines: diphenhydramine - natural health products (NHPs)
52
Nursing process: assessment (med admin)
- gather comprehensive medication profile including: - all meds pt takes on regular basis - hx of allergies - use of OTC and NHPs - intake of alcohol, tobacco, caffeine - illicit drug use
53
Nursing process: dx (med admin)
- developed from assessment data through critical thought - nursing dx r/t medication therapy: - variance in knowledge base - variance in protection - variance in health beliefs
54
Nursing process: planning (med admin)
- goals are pt focused - they include a time frame
55
Nursing process: interventions (med admin)
- interventions are based on evidence-based practice - interventions are done as independent nursing functions or collaborative interdisciplinary care - nurse to discuss with pt the risks of not taking meds as prescribed - have pharmacist discuss side effect profile - provide education on long term consequences stopping
56
Nursing process: evaluation (med admin)
- include monitoring whether or not the pt goal has been met or not - includes observing for therapeutic effect, adverse effects, toxicity of a medication - if the goal is not met then nursing care plan will need to be revised
57
Administering medication overview:
- read the DRs orders and check it against the MAR - DRs order are transcribed onto the MAR by either the nurse or a unit clerk - contact the doctor the pharmacy to clarify any unclear or questionable orders prior to adminstering - never leave poured medications unattended - plan your time wisely so that the medication is giving within 30 mins of the ordered time - don't let yourself multi task or be distracted while pouring or admin meds - provide adjuctive interventions as indicated - ensure 3 med checks - dientify client by name and check write band against MAR - inform the client about what medication you're giving listen to them if they express a concern - don't forget to ask about allergies - admin drug - record drug admin on MAR - evaluate and document the client's response to drug
58
when and how many safety checks are there?
Before taking out med During pouring out med After med is poured 3 checks
59
Patient medication adherance:
- have you ever stopped taking a prescribed medication? why did you stop? - when pts stop their medication we need to be curious open to their reasons
60
What do regulatory bodies do?
- protect the public - grant your license
61
Regulation: (5)
1. registration 2. educational programs 3. enforce/regulate/monitor standards of practice 4. inquiry + discipline 5. try to promote interprofessional collaboration
62
Who protects the nurses?
- BCCNM - BC nurses union
63
What is involve in the duty to report:
- if you have knowledge of a nurse who is incompetent or impaired, you have a duty to report - ex; drug use, sexual relations, untx MH conditions
64
What are the 4 main documents of the BCCNM?
1. code of ethics 2. scope of practice 3. professional standards: broad; how you shld behave as a professional 4. standards of practice: narrower; baseline req. for specific actions; documentation, duty to report, indigenous safety, etc.
65
Scope of practice triangle:
- bottom: Health Practitioner's Act (HPA) - bottom middle: standards, limits, conditions - top middle: employer, health authority - top: RPN; individual competence
66
What is considered documentation?
- any written or electronically generated information about a client that describes the care or service provided to that client - a nursing action that produces a written account of pertinent pt data, nursing clinical decisions and interventions, and pt responses in a health record
67
Key purposes of documentation: 3
1. communication 2. safe and appropriate nursing care 3. professional and legal standards
68
BCCNM professional standards: documentation Standard 2, #7, #8
- Standard 2: competent, evidence- informed practice - #7: documents the application of the clinical decision-making process in a responsible, accountable, and ethical manner - #8: applies documentation principles to ensure effective written/electronic communication
69
Legal issues of documentation:
- client's record is a permanent, legal document - may be req. to provide evidence in court and/or coroner's inquests - must clearly document all nursing care given, that care decisions were based on assessment, and that the nurse cont. to monitor, document, and report pt responses - in court: care not documented = care not given - FOIPPA
70
Ethical issues of documentation:
- RPN code of ethics: - #8: protects the confidentiality of all info gathered in the context of the professional relationship - #9: practices within relevant legislation that governs privacy, access, use
71
Ways to Keeping records confidential:
- use computer passwords, log out when finished - be mindful of screens and papers and that they are not viewable - be aware of agency policies re: documenting sensitive info - ensure all written documentation is secured - it is up to the RPN to safeguard the privacy, security, and confidentiality of health records
72
Common principles of documentation
- Only use agency-approved abbreviations - Never use pencil, only dark blue or black ink - Document ASAP in chronological order, not prior to giving care - Follow proper protocol for errors, no erasing or white out is permitted - Documentation must be clear, concise, factual, objective, timely and legible - RPN's must add their signature and designation in a clear, legible manner (F. Nightingale DCSPsycN)
73
What do we chart?
- status and health concerns of the client (assessment data) - changes in status - nursing care, interventions - advocacy by nurse on behalf of thee client - client responses and effectiveness of the care provided - effectiveness of meds and PRN meds
74
Problem-oriented/charting by exception:
- DARP, SOAP(IE) - focusing on documenting only deviations from the norm, narrative format

PNUR 2101 CONCEPTS (4 decks)

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