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Nur 3010 exams > Healthcare Delivery/foundations + Stress > Flashcards

Healthcare Delivery/foundations + Stress Flashcards

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1
Q

what are the 5 basic needs of Maslow Hierarchy?

A
  1. physiological needs
  2. safety & security
  3. belongingness and affection
  4. esteem and self-respect
  5. self actualization
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2
Q

what are the 3 levels of care?

A

primary care, secondary care, tertiary care

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3
Q

what is primary care?

A

focus is on health promotion and prevention of illness or disease.
interventions include: teaching about healthy lifestyles

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4
Q

what is secondary care?

A

centers on health maintenance and is aimed at early detection.
prompt intervention to prevent/minimize the loss of function and independence
interventions include: health screening (ex: BP for HTN)

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5
Q

what is tertiary care?

A

focuses on minimizing deterioration.
improving quality of life

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6
Q

what is the nursing process?

A

assessment, diagnosis, planning, implementation/intervention, evaluation

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7
Q

describe assessment?

A

health history
physical assessment
“ongoing”
relevant information from family, health care team, MR
recording of data to EHR (electronic health record)

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8
Q

describe diagnoses?

A

based on collection and analysis of assessment data
actual or potential health problems
collaborative problems
NOT MEDICAL DIAGNOSIS

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9
Q

what materials are used for nursing diagnoses?

A

ANA’s scope and standards of practice
NANDA International (NANDA-I)

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10
Q

describe planning

A

prioritization (Maslow’s hierarchy)
established expected outcomes: attainable and quantifiable
establish goals: immediate, intermediate, long term
determine nursing action: planned interventions
standardized intervention: NIC system

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11
Q

describe implementation?

A

carry out plan of care
nurse assumes responsibility
goals are used as a focus
“ongoing” assessment
revisions when necessary
all interventions should be patient focused and outcome directed

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12
Q

describe evaluation?

A

allows nurse to determine patient’s response to interventions
“have outcomes been met?”
DOCUMENTATION

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13
Q

assessment begins with initial patient contact. which nursing activity is included during this component of the nursing process?
a. interviewing and obtaining a nurse hx
b. choosing a nursing dx
c. established expected outcomes
d. determining nursing actions

A

a. interviewing and obtaining a nursing hx.

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14
Q

what are the 7 components of health history?

A

biographical data
chief complaint
present health concern/illness
past health history
family history
review of systems
patient profile

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15
Q

what are components of the physical exam?

A

general observations (posture, bosy movements, speech patterns)
vital signs and pain (bp, pulse, RR, temp., pain)
focused assessment of body systems

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16
Q

what is stress

A

any change in the environment perceived as challenging, threatening, or damaging to the persons balance/equilibrium
- can be internal or external
- usually felt by the person who experiences the insult first

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17
Q

what is homeostasis?

A

steady state within a system, the degree to which we experience equilibrium

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18
Q

what is adaptation?

A

adjustment to the change so that the person is in equilibrium again

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19
Q

what is coping

A

a compensatory process that has physiologic and psychological components

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20
Q

what are the 3 types of stressors?

A

physical: cold, heat, chemical agents
physiologic: pain, fatigue
psychosocial: fear

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21
Q

describe the HPA axis

A

hypothalamic, pituitary, adrenal connection
- fight or flight response
- stimulated by SNS
- releases epinephrine and norepinephrine into bloodstream
- these hormones stimulate the nervous system and produce metabolic effects that increase glucose levels + metabolic rate

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22
Q

what are catecholamines?

A

primary epinephrine and norepinephrine

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23
Q

what is the equation for cardiac output

A

HR x stroke volume

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24
Q

what is the equation for BP

A

CO x PVR (peripheral vascular resistance)

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25
how does stress affect out stomach?
blood goes to critical organs and away from the stomach when stressed, leading to feelings of nausea
26
how does stress affect out skin?
similar to stomach (blood goes away from it), leading to acne/pimples
27
what is negative feedback?
mechanisms throughout the body monitor the internal environment and restore homeostasis (goal)
28
how does negative feedback work?
mechanisms sense deviations and trigger a response to offset it (compensates)
29
what are the compensatory mechanisms of negative feedback?
blood pressure, acid-base balance, blood glucose, fluid and electrolyte balance
30
what major organs are affected from negative feedback
heart, lungs, kidneys, liver, GI tract, skin
31
what is the net result of negative feedback
homeostasis
32
what is the connection between negative feedback and steady state
equilibrium is achieved by continuous, variable action of organs involved in making adjustments and by continuous exchange of chemical substances among cells, interstitial fluid, and blood (adjustment for homeostasis) - ex: increased CO2 in extracellular fluid -> increased pulmonary ventilation -> decreased CO2 levels
33
what is the best indicator of metabolic imbalance?
accurate RR
34
cellular adaptation in response to stress
hypertrophy (increase cell size)/hyperplasia (increase cell #) atrophy (decrease cell size) dysplasia (malignancies or cancer cells) metaplasia (scar tissue)
35
what are the early identification of stressors
vital signs emotional distress problems in movement/sensation problems with affect, behavior, speech, cognitive ability, orientation, or memory obvious impairments or lesions diagnostic studies (labs, CT scans, MRI)
36
describe intracellular fluid
fluid within cells
37
describe extracellular fluid
circulating plasma (within blood vessels) interstitial (between cells) lymphatic system pleural/pericardial/peritoneal cavities, synovial (joint spaces), CSF
38
what do movement of fluid through capillary walls depend on?
hydrostatic pressure: exerted on walls of blood vessels osmotic pressure: exerted by protein (albumin) in plasma
39
describe osmosis
low solute concentration to area of high solute concentration TIP: focuses on solution (liquid)
40
describe diffusion
solutes move from area of high concentration to low concentration TIP: focuses on solutes across membrane
41
describe filtration
movement of water, solutes occurs from area of high hydrostatic pressure to area of low hydrostatic pressure (glomeruli filtration) - occurs in kidneys
42
describe active transport
sodium-potassium pump - maintains higher concentration of extracellular sodium, intracellular potassium
43
examples of fluid gains
eating/drinking IV fluid TPN, parenteral nutrition *fluid retention: HF, kidney failure, cirrhosis, hypernatremia (doesn't cause gain, BUT prevents elimination)
44
examples of fluid losses
kidney: urine output of 1 mL/kg/hr skin loss: sensible -> sweating, insensible -> fever, exercise, burns lungs: 300-500mL everyday, more with increased RR GI tract: large losses -> diarrhea, fistulas third spacing pathologic -> DI, bleeding
45
clinical manifestations of fluid volume deficit?
tachycardia poor skin turgor weakness low/absent urine output sweating anxiety confusion/AMS tachypnea
46
clinical manifestations of fluid volume excess (ex: CHF)
edema jugular vein distention pulmonary crackles (third spacing) SOB high BP *weight gain: important in community care but not some much hospital nausea
47
normal sodium levels
135 - 145
48
normal potassium levels
3.5 - 5.0
49
HYPO-natremia (<135) causes
fluid overload: imbalance of water, losses by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, certain medications, SIADH
50
HYPO-natremia manifestations
largely depends on fluid status nausea, abdominal cramping, neurologic changes (AMS)
51
HYPO-natremia management
follow up w/ nephrology manage underlying condition Na replacement (symptomatic) free water restriction (pee excess water allows for sodium retention)
52
HYPER-natremia (>145) causes
fluid deprivation excess sodium administration DI (diabetes insipidus) heat stroke hypertonic IV solutions
53
HYPER-natremia manifestations
thirst elevated temp low BP tachycardia neurologic changes
54
HYPER-natremia management
gradual lowering of Na level with hypotonic solution *in hyperosmolar patient, 0.9% would be relatively hypotonic -> key to drop Na slowly
55
HYPO-kalemia (<3.5) causes
GI losses medications (lasixs) prolonged intestinal suctioning recent ileostomy tumor of the intestine alterations of acid-base balance poor dietary intake hyperaldosteronism
56
HYPO-kalemia manifestations
ECG changes dysrhythmias dilute urine excessive thirst fatigue anorexia muscle weakness decreased bowel motility paresthesias
57
HYPO-kalemia management
K+ replacement IV (no faster than 10 meq/L) or PO monitor ECG assess medications
58
why is it important to not PUSH IV K+
burns IV can cause cardiac arrest
59
HYPER-kalemia causes
*rarely occurs in patients with normal renal function* main: impaired renal function rapid administration of potassium hypoaldosteronism medications tissue trauma acidosis
60
HYPER-kalemia manifestations
cardiac changes dysrhythmias muscle weakness parethesia's anxiety GI manifestations
61
HYPER-kalemia management
meds: insulin (causes intracellular shift of potassium and glucose), dextrose (supplements glucose), calcium gluconate (stabilize myocardium, makes heart resistance to electrolyte change) monitor ECG emergent dialysis
62
calcium values
<8.6 mg/dL, >10.2 mg/dL (9-11 mg/dL)
63
HYPO-calcemia causes
hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, medications
64
HYPO-calcemia manifestations
Trousseau signs, Chvostek sign, seizures, tetany, numbness, paresthesias, hyperactive DTRs, resp. symptoms of abnormal clotting, anxiety
65
HYPO-calcemia treatment
oral calcium vitamin D IV calcium gluconate
66
HYPER-calcemia causes
rarely occurs in patients with normal renal function - malignancy and hyperparathyroidism, bone loss r/t immobility, diuretics
67
HYPER-calcemia manifestations
polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, diarrhea, peptic ulcer, bone pain, *ECG changes, dysrhythmias*
68
HYPER-calcemia management
treat underlying cause - administer IV fluids, furosemide, phosphates, calcitonin, bisphosphonates
69
magnesium values
1.3-3.0 m/dL
70
HYPO-magnesemia causes (<1.3)
- associated w/ hypokalemia & hypocalcemia - alcoholism, GI losses, internal/parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood
71
HYPO-magnesemia manifestations
- chvostek & trousseau signs - apathy - depressed moods - psychosis - neuromuscular irritability - muscle weakness - tremors - ECG changes & dysrhythmias
72
HYPO-magnesemia treatment
IV or PO magnesium supplements
73
HYPER-magnesemia causes (>3.0)
rarely occurs in patients with normal renal functions - kidney injury, DKA, excessive administration of magnesium, extensive soft tissue injury
74
HYPER-magnesemia manifestations
hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, cardiac arrest
75
HYPER-magnesemia management
- IV calcium gluconate - Administer IV fluids, hemodialysis - observe for decreased respirations, decreased DTRs and changes in LOC
76
phosphate values
2.5-4.5 mg/dL
77
HYPO-phosphatemia (<2.5) causes
alcoholism, referring of patients after starvation, pain, heat stroke, resp. alkalosis, hyperventilation, DKA, hepatic encephalopathy, major burns, hyperparathyroidism, low mag., low pot., diarrhea, vitamin D deficiency, use of diuretics and antacids
78
HYPO-phoaphatemia manifestations
neurological symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection
79
HYPO-phosphatemia management
IV or PO replacement
80
HYPER-phosphatemia causes
rarely occurs in patients with normal renal function - kidney injury, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy
81
HYPER-phosphatemia manifestations
few sx., soft tissue calcifications, sx. occur due to associated hypocalcemia
82
HYPER-phosphatemia mangement
phosphate binding agents dialysis
83
chloride values
97 - 107 mEq/L
84
HYPO-chloremia causes
Addison disease, reduced chloride intake, GI loss, DKA, excessive sweating, fever, burns, medications, metabolic alkalosis
85
HYPO-chloremia manifestations
agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma
86
HYPO-chloremia medical management
replace chloride IV NS oe 0.45% NS
87
HYPO-chloremia nursing management
assessment, avoid free water, encourage high-chloride foods, patient teaching r/t high chloride foods
88
HYPER-chloremia (>107 mEq/L) causes
excess sodium chloride infusions w/ water loss, heatd injury, hypernatremia, dehydration, severe diarrhea, resp. alkalosis, metabolic acidosis, hyperparathyroidism, medications
89
HYPER-chloremia manifestations
tachypnea, lethargy, weakness, rapid deep respirations, hypertension, cognitive changes
90
HYPER-chloremia medical management
restore electrolyte and fluid balance, LR, sodium bicarbonate, diuretics
91
PaO2 value
80 - 100 mmhg - measure of partial pressure oxygen in blood
92
PaCO2 vale
35 - 45 mmhg - ventilation (lungs) in blood
93
pH
7.35 - 7.45
94
HCO3
22 - 26 mEq/L - kidney function

Nur 3010 exams (13 decks)

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