FNP exam 1 Flashcards by Molly Krue

the difference in NP Scope and Standard of practice

Scope: governed by state; Standard: governed federally

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Shuler’s NP Practice Model

1993 - holistic patient model that includes physical, psychological, social, cultural, environmental, and spiritual dimensions

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Swanson’s “A Spirit-Focused Conceptual Model”

1995 the core of patients and nurses is viewed as the “spirit of caring”. Nursing is viewed as goal-directed interpersonal relationship between pt and nurse, based on traditional nursing process components (assessing, planning, intervening, evaluating)

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Cumbie, Conley, and Burman’s Model of Promoting Process Engagement

2004 client centered theory to help APRN’s manage care of chronically ill clients. interventions chosen are based on each pts specific needs and expectations of their care and are developed in collab with the patient.

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Ryan’s Integrated Theory of Health Behavior Change (ITHBC)

2009 Health promotion activities are an integral part of the long-term health and well-being of both healthy people and those with chronic illness.

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primary prevention

Prevents disease before it can happen

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Secondary Prevention

screen for diseases before they go unknown

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Tertiary Prevention

Rehab and prevents disease from progressing to something worse

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Nonmaleficence

duty to do no harm

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utilitarianism

the right act produces the greatest good for the greatest number

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beneficene

the duty to prevent harm and promote good

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justice

duty to be fair

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fidelity

duty to be faithful

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veracity

duty to be truthful

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Autonomy

the duty to respect an individual’s thoughts and actions

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cultural competence

learning about another person’s culture

cultural sensitivity

respecting one’s cultural beliefs

cultural humility

lifelong process to reflect on your own culture and beliefs and how that impacts interactions with others

Vax at birth

Hap B Birth
-hep B (3 dose) rec.
-rsv antibody (depending on maternal rsv vax status, can be given between birth and 6 mo) (1 dose)

Vax at 2, 4 & 6 months

DIHHPeR
(alot of diapers)
-Diphtheria, tetanus, & acellular pertussis (DTaP) (5 doses)
-Inactivated Poliovirus (PV) (4doses)
-Haemophilus influenzae (HiB) (4doses)
-Hep B (3 doses) (skip at 4 mo) (must weigh greater >2000gm) (if mom hep B+, give hep b immunoglobulin also)
-Pneumococcal Conjugate (PCV13) (4doses)
-Rotavirus (RV) (2-3 dose) rec.

Vax at age 12-15 months

Help! I Don’t Have Very Much Peace
(toddler age)
-Hep A (2 doses, 6mo apart starts 12 mo)
-Inactivated Poliovirus (PV)
-DTaP
-Hib
-Varicella (VAR)
-MMR
-Pneumococcal Conjugate (PCV 15 or 20)

Vax at ages 4-6 years

I Did My Vaccines
(ready for school)
-Inactivated Poliovirus
-DTaP
-MMR
-Varicella (VAR)

Vax at age 11-12 years

Tweens Have Money
-Tdap
-HPV (2-3 doses)
-Meningococcal (2 doses, one now one at 16)

Flu Vax

begins at age 6 months, TWO doses first (between 6 mo and 8 years) and then 1 dose annually

Covid Vax

begins at 6 months-3 years, one dose based on formula

vax at age 19 and up

Congrats! It's Time for more Vaccines, HH-ooRay! -Covid (1 or more doses) -Influenza (annually) -Tdap (or Td booster) (every 10 years, with every pregnancy (27-36 weeks) or for wound management if >5 years) -Varicella (2 doses 4-8 weeks apart) -HPV (rec till 26 but 27-45 can still get) (2-3 dose) -Hep B (2-3-4-dose, for all adults 19-59 and 60+ if risk factors and if never recieved) -RSV (seasonal admin during preg 32-36 weeks, Sept-Jan)

Vax at age 50 and up

ZiiPeR you're done! -Zoster (age 50, 2 doses 6 months apart) -Flu (annually) -Pneumococcal polysaccharide (PCV 15 & PPSV23 a year later OR single dose of PCV20. Age 65) -RSV (age 60 for those at risk)

4 Signs and Maneuvers for Appendicitis

-Rovsing's sign (right lower abd pain upon palpation of the left side of the lower abd) *Rov=right -Psoas sign (pain with lying on Left side and moving Right leg backwards like stretching hip OR while supine, pressing on patients Right thigh while they try to lift it up) -Mcburney's point (midway between umbilicus and RIGHT superior iliac spine) -Obturator Test (have patient bend knee and push knee internally)

Signs and Maneuvers for Cholecystitis

-Murphys sign (have pt exhale while palpating gallbladder, then inhale while pressing into gallbladder, if they abruptly stop inhaling, this is positve)

Signs for Abd bleeding or nec pancreatitis, splenic rupture, liver injury

-Cullen's sign (periumbilical ecchymosis) -grey turner's sign (flank ecchymosis)

5 Areas for listening to the heart

All People Enjoy Time Magazine -Aortic: Right 2nd intercostal space -Pulmonic: Left 2nd intercostal space -Erb's point: Left 3rd intercostal space -Tricuspid: 4th intercostal space, lower left sternal border -Mitral: Left 5th intercostal space, medial to midclavicular line

Best places to auscultate certain heart sounds

S1: Apex (mitral) S2: Aortic and Pulmonic area S3 (ventricular gallop): Apex S4 (atrial gallop): Apex ***always pathologic!! ***remember, apex is bottom of heart, base is top

first line hypertension drugs for nonblack patients

Thiazides, ACEI, ARB, CCB

first line hypertension drugs for black patients (also first line for HTN & diabetes)

Thiazides or CCB

first line hypertension drugs for patients with CKD

ACEI or ARB

Side effects of first line HTN meds

-ACEI: cough, angioedema, hyPERkalemia -ARB: hyPERkalemia -CCB: dihydropyridines (edema) non-dihydropyridines (decreased HR and constipation) -Thiazides: hyPOkalemia

Regurgitation murmur

valves do not close correctly causing backflow and a murmur sound

Stenosis Murmur

valves dont open correctly causing the blood to flow through a smaller opening causing a murmur sound

Difference between sensitivity and specificity in epidemiology

Sensitivity: identifies people who truly have disease (true positives) Specificity: identifies the people without the disease (true negatives)