Foundations Exam Four Flashcards
(226 cards)
1
Q
A person who lives as a member of a gender other than expected based on sex or gender assigned at birth;
A
Transgender
2
Q
An identity label sometimes adopted by male-to-female trans people to signify that they are women while still affirming their transgender history
A
Trans Women
3
Q
An identity label sometimes adopted by female-to-male trans people to signify that they are men while still affirming their transgender history
A
Trans Man
4
Q
A political statement, as well as sexual orientation, which advocates breaking binary thinking and seeing both sexual orientation and gender identity as potentially fluid. The term is a simple label to explain a complex set of sexual behaviors and desires
A
Queer
5
Q
An individual who is unsure of and/or exploring their gender identity and/or sexual orientation
A
Questioning
6
Q
A set of medical conditions that feature congenital anomaly of the reproductive and sexual system. Born with sex chromosomes or external genitalia that are not considered standard for either male or female
A
Intersex
7
Q
An attraction to people regardless of their gender; may be attracted to their own gender as well as other genders
A
Pansexual
8
Q
Prejudice against individuals and groups who display non-heterosexual behaviors or identities, combined with the majority power to impose such prejudice; usually used to the advantage of the group in power.
A
Heterosexism
9
Q
Someone who feels comfortable with the gender identity assigned to them based on their sex assigned at birth
A
Cisgender
10
Q
Gender identity not exclusively male or female
A
Nonbinary
11
Q
Examples of hormone therapy as medical intervention
A
Estrogen
Testosterone
Gonadotropin-Releasing hormones (block puberty)
Suprellin implant (block puberty)
12
Q
Normal Cognitive Functions
A
Perception
Consciousness
Thought
Memory
13
Q
3 things required for perception to occur?
A
- A functionary sensory system
- Neurotransmission: receive a stimuli and then a neural impulse is sent to the brain to be interpreted
- Processing
14
Q
Three types of sensory receptors?
A
- Exteroceptors
- Proprioceptors
- Interoceptors
15
Q
The sensory receptor responding to stimuli from external environment (vision, hearing, pain, and somatic receptors)
A
Exteroceptor
16
Q
The sensory receptor related to body’s physical state, position, and sensation of movement (inner ear, muscles, tendons, and joints)
A
Proprioceptor
17
Q
The sensory receptor related to change in internal environment (blood pressure, O2 level, viscera and deep tissues)
A
Interoceptor
18
Q
Consciousness
A
State of awareness and responsiveness
19
Q
Orientation
A
Person, place, time, situation
20
Q
Judgement
A
Insight - process of reasoning (determine the stimuli’s meaning)
21
Q
Memory
A
Ability to store and recall
22
Q
Comprehension
A
One’s ability to understand
23
Q
Life span considerations
Newborn - Infant for
Cognitive Processes
A
Sensorimotor
Language not developed
24
Q
Life span considerations
Toddler - Preschool
Cognitive Processes
A
Object permanence
Verbal language and reasoning develop
Egocentric view
Concrete thinking
25
Life span considerations
School-age to Adolescent
Cognitive Processes
School-age develops abstract thinking
| Adolescents being to perform complex mental processes
26
Life span considerations
| Adult-older adult
Rational thinking
Increased age - higher likelihood of neurological problems
Cognitive impairments are not considered a normal sign of aging
27
Factors affecting cognitive function
```
Oxygenation/circulation
Nutrition
Fluid and electrolyte balance
Medications
Medical
Enviornment
```
28
What percentage of oxygen is required for brain functioning?
20%
29
What is the most vital factor affecting cognitive function?
Oxygen to the brain
30
What step comes first in CPR?
Circulation - so you can have perfusion of oxygen
31
What percent of glucose is used by the brain?
25% of glucose
32
What mineral is needed for hemoglobin?
Iron
33
What electrolyte has the biggest influence on water?
Sodium
34
What do you use to remove excess ammonia?
Lactulose --> poop out extra ammonia
- Binds with the ammonia n the blood leading to loose bowel movements
35
Which medications act directly on the CNS?
Anticonvulsants, opiates, antipsychotics
36
Medical factors affecting cognition
- Head trauma
- Degenerative processes
- Infectious processes
(Cancer)
37
Examples of environmental factors affecting cognition
Hearing problems, vision problems, pain, discomfort, no sleep
38
Acute changes in mentation, consciousness, or the ability to maintain attention
Delirium
39
Where is delirium most common?
ICU (but preventable)
40
Three impacts of delirium
- Increases mortality risk
- Increases hospital length of stay
- Can cause long term cognitive impairment
41
3 Types of Delirium
Hyperactive
Hypoactive
Mixed
42
Hyperactive Delirium
the easiest to assess; patient is disruptive and active
43
Hypoactive Delirium
most common form of delirium; patient is sleepy and has highest mortality risk
44
Risk Factors for delirium
```
Medications
Anesthesia
ICU on ventilator
Stroke
Dementia
Respiratory Failure
Sepsis
Drug/Alcohol abuse
Isolation
```
45
How do you assess a patient's cognitive baseline when experiencing delirium?
Use the family members or past medical charts
46
Nursing Management of Delirium
- Early ambulation
- Promote adequate sleep
(close blinds, prevent noise)
- Frequent reorientation
(remind them of time)
- Enhance sensory stimuli
(glasses and hearing aids)
47
Progressive impairment of intellectual function and memory
Dementia
| - Gradual decline and permanent *
48
Dementia - cerebral atrophy or shrinking of cortex
Alzheimer's Dementia
49
Dementia - inadequate blood flow due to plaques or arterial brain lesions (stroke patients higher risk)
Vascular Dementia
50
Dementia - nerve cell loss and impairment of frontal and anterior temporal lobes
Frontotemporal Dementia
51
Dementia - clumps of protein causing neurodegeneration
Lewy Body Dementia
52
Dementia - if dementia occurs greater than 1 year after Parkinson's
Parkinson's Disease Dementia
53
Causes of Dementia
```
Trauma
Circulation
Genetics
Alteration in neurotransmitteres
Infectious agents
```
54
Some experiences the aging person may experience that could lead to depression
```
Loss
Agism
Chronic Pain
Decreased independence (retirement/unable to work)
Decreased health
```
55
Symptoms of depression in the elderly
Forgetfulness
Fatigue
Changes in behavior or mood
56
Impaired speech related to motor control, weakness, paralysis, or incoordination of the oral musculature
Can write or select words appropriately/ Hearing not impacted
Dysarthria
57
Complete or partial loss of language abilities
Aphasia
58
Unable to say what they want to say
Expressive aphasia
59
Inability of retrieving words
Anomia
60
Speech is articulated well, but hard time understanding what others are saying or what is written in front of them
Receptive Aphasia (Wernicke)
61
Functional skills, reading, writing, language areas impaired
Speech very poor, meaningless recurrent sounds
Global aphasia
62
What can the nurse use to assess alterations in cognitive function?
- Mini-mental status exam
| - Pfeiffer
63
What is the Pfeiffer exam?
10 questions
A correct response gets a 1
Score of 7 or less indicates cognitive impairment
64
First neurological signs of reduced oxygen?
Confusion
65
What assessment to check reduced oxygen?
Pulse Ox & ABGs
66
What electrolyte is linked to cognitive impairment
Sodium
67
What can you use to orient the patient to date and time?
Large calendar and write on white board
| - Point out date/time on their own devices
68
What do we do to help orient patient to day and night?
Keep windows and blinds open, lights on
Stimulation during the day to mimic daytime behavior
69
What sort of recommendation for family support should you give those experiencing progressive cognitive impairment?
Educate family members
Observe for signs of caregiver burnout
Observe for signs of elder abuse
70
Complex process that alters our psychological and physiological systems
Stress
71
Good stress?
Eustress
72
Initial reaction to potential stress; interpretation of situation and determination if it is a stressor
Appraisal
73
Managing stress; can mitigate or reduce the stress of emotion it causes (how stress is handled)
Coping
74
Outcome of coping; when a person successfully adjusts or adapts to stress
Adaptation
75
If a person is unable adapt, what may occur??
Pathological manifestations
76
What does homeostasis balance?
- Blood pressure
- Glucose regulation
- Temperature regulation
- Acid-base balance
- All vital processes
77
Restoration of balance in response to stress, through physiological mediators
Allostasis
78
When allostasis is stained and homeostasis is not achieved
Allostatic load
79
Which division of the ANS secretes norepinephrine and epinephrine
Sympathetic
80
Which division of the ANS secretes acetylcholine
Parasympathetic
81
Examples of excitatory actions
Pupil dilation, increased heart rate, bronchial dilation, increased glucose
82
Examples of inhibitory actions
Decrease digestive function, inhibit insulin secretion, prevent urination
83
Where does cortisol come from
Adrenal glands on top of kidneys
84
Does cortisol come before or after SNS response
After the initial SNS response
85
Two physiological affects of cortisol
Metabolism &
| Immune function
86
Acute cortisol
Protective
87
Chronic cortisol
contributes to problems
88
What does prolonged stress lead to?
Anxiety, depression, and other alterations in health
89
Neuro reaction to stress
pupils dilate
90
Cardiac reaction to stress
tachycardia, hypertension, angina, dysrhythmia
91
Lung reaction to stress
increased RR, hyperventilation
92
GI reaction to stress
loss of appetite, N/V, increased hydrochloric acid production
93
Skin reaction to stress
diaphoresis, contraction of arrestor pili muscles
94
Musculoskeletal reaction to stress
increased muscle tension in large muscles, tremor/shakiness in smaller
95
Problem focused coping
deals with the issue/stress
96
Emotion focused coping
controls emotions during stress
97
Adaptability to adversity
resistance
98
Ability to move forward despite adversity
Resilience
99
increase in resiliency and resistance from experiencing and evolving from the past
vulnerability
100
Coping across the life span
| Newborn and Infant
Dependent on care of others to survive
Stressors are typically quickly resolved
Infants need the stress of a nurturing environment
101
Coping across the life span
| Toddler and preschooler
Still dependent on adults
Social and familial interaction and behavior impacting coping
Stressful issues are perceived more intensely at this age in comparison to adults and may have an impact later in life
102
Coping across the life span
| School-age - adolescent
Social environment begins to expand
influenced by a balance of home support and an internal sense of self-worth
Younger children may have a hard time distinguishing reality from imaginative thinking
Adolescent children capable of rationalization and are able to utilize more coping mechanisms, but also may use negative coping skills
103
Coping across the life span
| Adult-older adult
In adulthood, the ability to cope with stress is partly dependent upon how coping developed through the formative years
Life changes and physiological changes compound and add to stress
104
Where is the line drawn for when a legal substance becomes maladaptive coping pattern?
The line is drawn when cognitive status is altered and the use of the substance is consistent to get that alteration in cognitive function
105
Refusing to believe or accept something
Denial
106
Attributing one's own thoughts onto another
Projection
107
Concealing the motive for behavior by giving a socially acceptable reason for the action
Rationalization
108
Consciously dismissing something from the mind and thoughts
Suppression
109
Immersing something in the subconscious or unconscious level of thought
Repression
110
Nursing Assessment (stress) identification
- Previous experience with coping strategies
- Is it effective?
- Identify RF that may affect coping
- Identify strengths and challenges
- Educational opportunities related to coping
111
Measurement tools for stress
Everyday Hassles scale
| Coping self-efficacy scale
112
Some stress management techniques
```
visualization
imagery
affirmations
meditation
biofeedback
therapeutic touch
massage
yoga
deep breathing
journaling
```
113
Framework that consists of a set of concepts related to individuals, groups, situations, and events
conceptual framework
114
Nursing concepts (4)
person
environment
health
nursing
115
provides the foundation for nursing knowledge and gives direction to nursing practice
nursing theory
116
a process to guide decision making during a person's life / helps to determine what is rights or wrong in a given situation
values
117
disposition towards an object or subject
attitude
118
ideas that one accepts as true
belief
119
values held by a group that determines appropriate conduct for members of the group
professional ethics
120
each person has the right to autonomy and the ability to make their own decision
respect for persons
121
what is a person's ability to make decisions based on
assessment of their mental and physical functioning
122
doing good / actions should promote an optimal outcome
beneficence
123
examples of beneficence
giving pain medication
| dressing changes to promote wound healing
124
avoid doing harm or remove from harm
nonmaleficence
125
examples of nonmalficence
medications to stop seizures
| teaching a pt how to use a cane when walking to avoid falling
126
nurses providing each patient the same resources they would offer any other patient / fairness with resources
justice
127
examples of things offered to provide justice to pts
```
time
service
education
supplies
care
```
128
three things pts are entitled to recieve
privacy and confientiality
veracity
fidelity
129
being honest
veracity
130
patient health information is not shared
privacy and confiendtiality
131
honoring commitments
fidelity
132
group of individuals that are separate from the incident that help make a ruling
ethics committee
133
legally what do nurses have to have
a nursing license
134
types of research -
| measurable numeric data under conditions of considerable control with statistical procedures to analyze data
quantitative
135
types of research -
| focuses more on subjective or lived experience; less control and little statistical analysis involved
qualitative
136
when the person who collects the data directly is the one who writes up the study on the topic
primary research
137
when the initial data is collected by someone else and is analyzed or interpreted by a second person
secondary research
138
Scientific process
```
problem identification
research a solution
develop an implementation plan
implement the plan
evaluate the effectiveness of the solution
```
139
PICOT method
```
P = patient or problem
I = intervention
C = comparison
O = outcome of interest
T = time of interest (not always)
```
140
sources reviewed by a panel of experts related to the field to determine if they study has used reliable methods for conducting the study
peer reviewed resources
141
preventing adverse outcome for patient
safety
142
viewed on a continuum from poor to high / measure of excellence
quality
143
6 components of quality
```
safe
effective
patient-centered
timely
efficient
equitable
```
144
why does safety matter
third leading cause of hospital-related deaths in 2017 was preventable medical errors
145
why is root cause analysis (RCA) used
to determine the underlying cause of an event / helps determine if errors are active or latent
146
error that results in death or serious injury
sentinel event
147
safety issues in healthcare?
medication safety
healthcare worker risks
environmental safety
148
examples of healthcare worker risks
needle sticks
back injuries
exposure to toxic chemicals
poor staffing ratios can increase this
149
who measures for quality and safety outcomes
centers for medicare and medicaid services (CMS)
150
what does the center for medicare and medicaid service do
collects info from every facility and unit to develop benchmarks for hospital to achieve
151
diverse practices that are not considered as part of conventional allopathic medicine
complementary and alternative medicines
152
system in which medical doctors and other healthcare professionals treat symptoms and diseases using drugs, radiation or surgery (western medicine)
allopathic medicine
153
integrative health combines allopathic medicine, CAM, nutrition, exercise and stress reduction
holistic care
154
the mind, body, and spirit are all separate and joining parts that function in the overall environment
holism
155
an impaired ability to perform activities of daily living
self-care deficit
156
what is the nursing goal
interventions focus on reducing risk factors or targeting contributing factors
157
examples of CAM
herbs and natural products
massage, relaxation, yoga, mindfulness, progressive muscle relaxation, meditation and guided imagery
acupuncture and chiropractic care
158
what is the primary focus for mindfulness-based stress reduction
meditation
159
what does mindfulness-based stress reduction do for the body
increases self-awareness
| permits a nonjudgemental attitude
160
how does CAM impact nursing
```
initial assessment (what does the pt use and how will it interact with whats prescribed)
recommendation for non-pharmacological therapy for pts
```
161
what do nurses need
nonjudgemental attitude and to be aware of their own beliefs
162
california poppy (what does it do)
pain relief, sedation, anxiety relief
163
what should you not mix California poppy with
monoamine oxidase inhibitors
164
what is ginkgo biloba used for
alzheimers or memory problems
165
warnings for ginkgo biloba use
do not handle or eat fruit/seed
| caution when using aspirin or other blood-thinning drugs
166
what is ginseng used for
energy increse
167
ginseng warnings
may increase glucose and blood pressure
| increase tumor growth in estrogen dependent cancer
168
butterbur warnings
can contain pyrrolizide alkaloids (PA) that cause liver damage
*look for types labeled PA free*
169
what can st johns wort be used for
depression
170
warnings for st johns wort
may interfere with HIV tx
light sensitivity
dangerous w SSRIs, tricyclics, and MAOIs
can lower effects of meds
171
valerian use
anxiety and insomnia
172
valerian warnings
do not combine with other sedation meds
173
when should you avoid feverfew
pregnancy
174
processes herbal remedies go through (3)
standardization
regulatory
credentialing
175
standardization of herbal remedies
consistent amount per dose
176
practice based on the intentional and compassionate use of energy to promote balance and wellbeing through touch
therapeutic touch
177
unpleasant sensory or emotional experience associated with actual or potential tissue damage
pain
178
how often should pain be checked
as often as vital signs
179
pain that lasts up to 6 months due to actual or threatened damage; considered a protective mechanism
acute pain
180
what is present with acute pain
inflammatory and (sometimes, not always) sympathetic nervous system reaction
181
example of inflammatory component with acute pain
redness, swelling, tenderness
182
example of sympathetic nervous system reaction with acute pain
tachycardia, hypertension, tachypnea
183
how is acute pain treated
common analgesia and opioids
184
pain lasting longer than 6 months; no longer a protective mechanism and considered. a disease or a condition
chronic pain
185
acute pain from surgery, injury, or active disease process
nociceptive pain
186
four phases of nociceptive pain
transduction
transmission
perception
modulation
187
transduction (nociceptive pain)
prostaglandins are released to potentiate an action potential
188
tx of transduction phase
NSAIDS or steroids
189
transmission (nociceptive pain)
substance P is released: a significant pain messenger
190
tx of transmission phase
opioids
191
perception (nociceptive pain)
interpret or process pain
192
modulation (nociceptive pain)
norepinephrine or serotonin sent to areas of distress and receptors down regulate and pain is reduced
193
aching, throbbing pain in bones, joints or skin
somatic pain
194
organ related, poorly localized, cramping, squeezing or heavy
visceral pain
195
caused by damage to the somatosensory nervous system
neuropathic pain
196
what can cause neuropathic pain (3)
nerve damage
chemo
radiation
197
symptoms/ description of neuropathic pain
tingling
electric-like
pins and needles
numb characteristic
198
things that cause pain that normally wouldn't cause pain
allodynia
199
heightened feeling of pain
hyperalgesia
200
treatment of neuropathic pain
antidepressants
SSRIs
anticonvulsants (gabapentin, pregabalin)
201
similar to nociceptive pain that does not have a discernible source
nociplastic or central pain
202
example of nociplastic pain
fibromyalgia
203
tx for nociplastic pain
complex
focused on restoring sleep or activity tolerance
not opioids
204
pain lifespan consideration
| newborn and infant
neonatal pain, agitation, and sedation scale (N-PASS)
or FLACC behavioral pain scale is used
**pain is undertreated**
205
pain lifespan consideration
| toddler and preschooler
Wong-baker FACES scale
| Pain causes distrust
206
pain lifespan consideration
| School-age and adolescent
persistent pain can cause developmental regression
adolescents may hide pain
numeric rating scale (0-10)
207
pain lifespan consideration
| older adult
associated with conditions like arthritis
checklist of nonverbal pain indicators (CNPI)
critical care pain observation tool (CPOT)
208
when is N-pass used
premature infants (1st 100 days of life)
209
FLACC
face, legs, activity, cry, countability
greater than 1 indicates pain but not intensity
210
which tool can measure intensity
Wong-Baker
211
when is CPOT used
18 years or older who are unable to report pain (0-8)
score greater than one indicates potential pain
212
what increases with pain
```
blood pressure
HR
RR (quality diminished - depth/shallow)
blood glucose
oxygen consumption
lactate
ketones
```
213
what decreases with pain
immune response
ability to think, learn, make decisions,
RR quality
214
```
non-pharmacological pain management
Physical ex (4)
```
heat (no longer than 30 mins)
cold
transcutaneous electrical nerve stimulation
massage
215
considerations for non-pharm pain management
ensure no signs of skin irritation
216
when is heat contraindicated as tx
over areas of bleeding, topical ointments, and over burned or irritated skin
217
when is cold contraindicated as tx
areas of poor circulation, Raynaud phenomenon, or irritated skin
218
examples of cognitive and behavioral pain management
distraction
relaxation
imagery
mindfulness
219
examples of relaxation for pain management
meditation and rhythmic breathing
220
safety parameters for PCA
minimum time interval between doses
maximum dose allowed over time period
specific dosing in milligrams or micrograms
221
what monitoring may be added to patients w PCA
end-tidal carbon dioxide
| oxygen sat and respirations
222
what type of drug scheduling used after a procedure a few days ago
PRN - working towards discharge
223
Considerations for Spinal Analgesia
Medications given into epidural or intrathecal space
Lower dosage needed
HTN common side effect
Continuous = monitoring what?
- End tidal carbon dioxide
224
What side effects occur from opioids
sedation
resp depression
constipation
vasodilation and htn
225
who is at risk for SE from opioids
opioid- naive patients
elders
use of other sedation meds
obstructive sleep apnea
226
Pasero Opioid Induced Sedation Scale
```
S = sleep, easy to arouse
1 = awake and alert
2 = slightly drowsy, easily aroused
3 = frequently drowsy, arousable, drifts to sleep during convo
4 = somnolent, minimal or no response tp physical stimulation
```
