midterm 2.0 Flashcards
(261 cards)
1
Q
Prejudice
A
A hostile attitude toward others simply because their apart of a certain group with objectionable characteristics
2
Q
Stigma
A
Negative attitude, discrimination, rejecting attitudes and behaviours towards people
3
Q
Stereotype
A
Over-generalized beliefs about a particular category of people
4
Q
Dorthy Dix
A
Advocated for humane treatment, helped make mental health hospitals and humane prisons (social reform)
5
Q
What was the first antimanic drug?
A
Lithium
6
Q
What was the first anti-psychotic drug?
A
Chlorpromazine
7
Q
What was the first anti-depressant?
A
Maoi & Tricyclic
8
Q
discrimination
A
negative differential treatment of others becayse they are members of a certain group or identified as being negatively different
9
Q
discrimination can include and arises from
A
ignoring, derogatory name-calling, denying services, and threatening
lack of understanding and appreciation of differences among people
10
Q
3 levels of stigma
A
self, public, structural
11
Q
What was the first mental health treatments?
A
- Lobotomy
2.Malaria Fever
3.Hydrotherapy
4.Insulin coma therapy
5.Electro shock therapy
12
Q
What is projection?
A
falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object (ex. it’s your fault that I failed)
13
Q
What is transference?
A
When the client unconsciously transfers assets of a past relationship to someone else onto you as a nurse (ex. abandonment issues - get’s mad when you leave the room)
14
Q
What are the 4 main concepts (meta-paradigms)
A
- The Person
- The Environment
- Nursing Role
4.Health
15
Q
what is self-awareness
A
process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognizing how they affect self and others
16
Q
What was Jean Watson’s theory?
A
Theory of Human Caring: transpersonal model: care valued over cure, patients need for dignity comes b4 tasks
17
Q
What was Dorothea Orem’s Theory & descirbe
A
Self-Care Theory: promotes active engagement in care
18
Q
florence nightingale theory and describe
A
environmental theory: made clear difference in roles b/w medicine & nursing, healing rather than disease & disease prevention
19
Q
virginia henderson theory & describe
A
needs theory: promote client’s independence by understanding needs & assisting needs until they can themselves
20
Q
Hildegard Peplau
A
Theory of Interpersonal Relations - to form therapeutic relationships
21
Q
What was Sister Roach’s theory?
A
The human act of caring - The 6 C’s
22
Q
betty neuman theory & explain
A
neuman’s system model - client system - holistic focused on prevention
23
Q
sister callista roy
A
adaptation theory & how ppl cope & respond to stressors, patient adaptive being constantly interacting w/ environment
24
Q
What were the 6 C’s in Sister Roach’s theory?
A
- Compassion
- Confidence
- Commitment
- Conscious
- Comportment
- Competence
25
What is compassion?
caring/spending/gather info/listening time with patients, EMPATHY (understanding situation), trust their nurse
26
What is competence?
having knowledge/skills/energy/experience required to respond adequately to demands/responsibilities
specific knowledge to interact w/ clients
27
What is confidence?
quality which fosters trusting relationships, trusting in own ability to provide care, knowing you can make differences
Physical appearance, the way you walk, talk, behave
28
What is conscience?
State of moral awareness, ethical practice, accountability and responsibility, moralðical decisionmaking
29
What is commitment?
Having good intentions and devoting yourself to your patients
30
What is comportment?
Having the appropriate attitude and dressing appropriately (how you present yourself)
31
philip bakers model of recovery
tidal model: assisting patients w/ reclaiming lives after setback, emphasises own personal story
32
What is the definition of a nursing process?
The nursing process is a problem solving approach to identifying, diagnosing and treating the health issues of the clients.
33
What are the 5 steps to the nursing process and explain
1. Assess: gather info about pt condition
2. Diagnose: identify the pt problems
3. Plan: set goals of care and desired
outcomes and identify nursing actions
4. Implement: perform the nursing actions identified in planning
5. Evaluation: determine if goals and expected outcomes are achieved
34
What is the purpose of STEP 1: ASSESSMENT?
Collection of data to determine the clients health and functional status & coping patterns
To establish a database about the clients health problems
-Identify priorities
-Recognize significant data/patterns
-Identify strength & problems
35
What does the DC conceptual framework consist of?
1. Physiological variable (physical)
2. Psychological variable (mental state)
3. Developmental variable (age & stage)
4. Sociocultural variable (relationships)
5. Spiritual variable (beliefs/purpose in life)
36
What are some sources of assessment data?
1. Client during interview
2. Family/friends
3. Charts
4. Direct observation
5. Measurements/ test results
37
What is the difference between objective data & subjective data?
Objective: observations or measurements of clients health status
Ex: BP of 120/70 or temp of 36.5
Subjective: clients reports ONLY
Ex: i feel dizzy right now
38
What is the purpose of STEP 2: NURSING DIAGNOSIS?
You prioritize what is most important which is done in colab with pt
Purpose: conclusion about the ways in which the illness is most impacting your pt and how you as the nurse will intervene to reduce this impact
holistic & patient centered
39
What are the characteristics of a nursing diagnosis using PNUR taxonomy?
Variance in __________ ( specific behaviour from assessment data) related to stressor
40
What is NANDA?
North American Nursing Diagnosis Association
Professional organization of nurses who standardized nursing terminology for the purpose of nursing diagnosis
41
What is the purpose of STEP 3: PLANNING?
Purpose: to set priorities and goals
42
what is SMART
specific, measurable, achievable, realistic, time frame
43
What is a nursing care plan
Legal document that is individualized and client centered which documents each stage of the nursing process
44
What is the purpose of STEP 4: IMPLEMENTATION?
Purpose: performance of nursing actions and documenting activities/responses
Assess & reassess through out implementation
Prevent, reduce or resolve health problems
45
What are the steps to intervention as prevention?
Primary:
Health promo & disease prevention
Before stress impacts baseline health
Maintain & promote health
Secondary:
Symptoms are present
Stressor has impacted baseline
Regain health
Tertiary:
Rehab & recovery
Prevent reoccurrence
46
What is the purpose of STEP 5: EVALUATION?
Purpose: measure the degree to which goals and desired outcomes have been achieved
Determine whether to continue, modify or terminate the plan of care
47
PHILOSOPHY
Considered as a science
Study of the fundamental nature of knowledge reality and existence
48
Nursing philosophy
Pertains to what we believe in correlation to our job
Who are we? What do we believe in? Nature of nursing? Morality?
49
Theory
System of ideas intended to explain something
Based on expert opinion/experience
50
Conceptual framework
Visual representation/organization of concepts and explains their relations
51
Concepts
abstract ideas or general notions that occur in the mind, in speech, or in thought
52
Metaparadigm concepts of nursing
Person
Health
Environment
Nursing
53
Ethics
The study of good conduct, character & motives.
In nursing, involves accountability
54
College of Registered Psych Nurses of BC
Primary purpose: protect the public
Defines/provides RPNs with practice standards
Defines/provides RPNs with a Code of Ethics
Is governed by the Health Processions Act
55
BCCNM Professional standards
Therapeutic Relationships
Theory/knowledge base
Professional Accountability
Ethical Practice
56
Health care ethical principles
Autonomy
Beneficence
Non-maleficence
Dignity
Justice
Truthfulness, informed consent & confidentiality
57
HC ETHICAL PRINCIPLES: Autonomy
Relates to someones independents & being able to make decisions without others influences
58
HC ETHICAL PRINCIPLES: Beneficence
Promoting good choice for others
59
HC ETHICAL PRINCIPLES: Non-maleficence
Avoidance of harm
60
HC ETHICAL PRINCIPLES: Dignity
Maintaining someones integrity & privacy
Protecting them from experiences where they feel less than.
61
HC ETHICAL PRINCIPLES: Justice
Refers to fairness
62
HC ETHICAL PRINCIPLES: Truthfulness, informed consent & confidentiality
Obligation to be 100% truthful
Respecting confidentiality
63
Mental health care ethical issues
Behaviour control & restraint
Relational engagement & boundaries
Confidentially
Ethical practice environment
Social justice
64
Behaviour control & restraint
Ex:
Physical restraining a patient in a safe position which could look like restraint
Chemical restraint to slow their behaviour down
65
Relational engagement & boundaries
Ex:
Receiving & giving gifts
When patient only wants you to help them
66
Confidentiality
Sharing all what is needed to know
Sharing only what is relevant
67
Critical thinking
The art of analyzing and evaluating thinking with a view to improving it
Encompasses both cognitive processes and attitudes
Consciously examining our own thought process
68
problematic thinking
egocentric & sociocentric
69
Egocentric thinking
Results from out tendency to be self centered and to view situations/info from our own point of view with the assumption it is right
70
Sociocentric thinking
Looking into the lens that the group norms opinion is right without questioning it
71
How do our personal traits impact our thinking
Autonomy
Fair mindedness
Humility
Courage
Integrity
Perseverance
Confidence
Empathy
72
Autonomy CHECK
think for yourself based on rational thinking aware of your biases
73
Fairmindedness CHECK
Open to opposing views, treat all viewpoints fairly
74
Humility CHECK
admitting mistakes
75
Courage CHECK
Courage to look at issues or sides that we have strong feelings against
76
Integrity
Be true to ones thinking
Sticking to it
77
Perseverance
finding solutions
We dont give up
78
Confidence
We trust our decision
79
Empathy
Genuinely trying to understand and put yourself in someone elses shoes
80
Critical thinking standard: Clarity
Can you elaborate on that?
Could you express that in another way?
Making sure we clearly understand what is going on
81
Critical thinking standard: Accuracy
Is the info true
Does it represent the truth?
Is the info accurate
82
Critical thinking standard: Precision
Could you be more specific?
Give me more details
Specific
83
Critical thinking standard: Relevance
How is the info relevant to the question?
84
Critical thinking standard: Depth CHECK
Does the answer to the question address all the complexity of the situation
85
Critical thinking standard: Breadth
Have we taken all points of views?
Have we considered alternate decisions
86
Critical thinking standard: Logic
Does it make sense?
87
elements of critical thinking
purpose of thinking (goal), question at issue (what qts am i raising), information, concepts (what theory guide thinking), assumptions (what biases impact thinking), inferences (reasoning to explain conclusion), points of view (sensitivity to other perspectives), implications (consequences of thinking)
88
Problem solving process
Clarify the nature of a problem & suggest possible solutions
Evaluate solutions & choose the best one to implement
89
What are the 3 types of problem solving questions
1. There is a correct answer- requires knowledge
2. No "right" answer -calls for subjective opinion/preference
3. Multi "right" answers- clinical judgement must be made
90
Open ended questions vs closed ended questions
Open ended questions:
Allows us opportunity to hear the clients perspective and will provide more detailed info
Example: What has it been like for you since your husband left?
Closed ended questions:
Used when only a yes or no answer is required. They give us factual info but limited detail.
Example: Do you have a history of high blood pressure?
91
Summary of Neuro Assessment: Health history
Asking about past seizures, substance use, head injuries, behavioural changes, numbness, dizziness, medications
92
Summary of Neuro Assessment: Glasgow Coma scale
Eye response 1-4
Verbal response 1-5
Motor response 1-6
93
summary of neuro assessment: neurological assessment form/neurovitals
PERRLA, GSC, MOTOR STRENGTHS (bilateral equality) & SENSATION, VITAL SIGNS
94
Summary of Neuro Assessment: LOC vs orientation
Level of consciousness = alert/ drowsy
orientation = Date, place, time, name, situation
95
Summary of Neuro Assessment: eyes
glasses, cataracts, PERRLA
96
Summary of Neuro Assessment: ears
hearing aids, cerumen
97
Summary of Neuro Assessment: swallowing reflex
impaired, delay, pocketing, coughing with food bolus
98
Summary of Neuro Assessment: pain
LOTTAARP, scale out of 10 (0 = none, 10 = worst)
99
Summary of Neuro Assessment: analgesics and alternate pain treatments
hot blankets, ice packs, guided meditation
100
Summary of Neuro Assessment: seizure activity
grand mal
101
What does the INITIAL neuro assessment include? (7)
1. Substance abuse?
2. History of headaches, numbness, change in speech or senses
3. Recent behavioral changes
4. Past trauma to head
5. History of seizures or lost of consciousness
6. Vital signs
7. Allergies & medication history
102
What is PERRLA?
Pupils: presense of pupils in both eyes
Equal: observe size of BOTH pupils
Round: BOTH pupils should be round
Reactive to
Light and pupils constrict immediately to light
Accomodation: look at eye movement and pupil size as eyes accommodate to object moved from far to close
103
balance and coordination can indicate
damage to cerebellum, disease process (parkinsons, huntingtons), deconditioning
104
gait
person's walking pattern
105
ataxia
presence of uncoordinated, abnormal movements
collection of symptoms affecting balance, coordination, speech, fine motor control
106
Reflexes: What is it? Why do we test it? How do we test?
Automatic response of the body to stimulus
Tests to see if sensory and motor pathways are intact which can indicate spinal cord injury
Rated on 0-4+ scale
0: no response
1+: sluggish
2+: expected response
3+: more hyperactive
4+: brisk and hyperactive
COMPARE BOTH SIDES
107
MMSE
(7-8mins) used in hospital to assess progression of dementia (scores outta 30) lower score = severity
108
MoCA
montreal cognitive assessment (10-12 mins) commonly used in hospital. toassess for cognitive impairment
used to see if baseline is getting worse
109
Mental status exam: abstract thinking
"Is the glass half full/empty?"
110
Mental status exam: intellectual function
Listen and focus on their vocab
111
Mental status exam: attention span
Observe their attention span
112
Mental status exam: memory
Ask easy, basic questions they should remember
113
Mental status exam: judgement
Are they making good choices?
114
Mental status exam: knowledge
Do they know general knowledge
115
Pain assessment
5th vital sign
Use LOTTAARP
Rmr that pain can impact all 5 variables so we need to take holistic view: "How has your pain impacted your.."
116
LOTTAARP
L: location
O: onset
T: type
T: timing
A: associated symptoms
A: alleviating factors
R: radiating
P: precipitating
117
What are the different types of pains?
Acute
Chronic
Neuropathic pain
118
Factors impacting pain perception: age
Older adults tend to under report pain or may be less sensitive to pain
119
Factors impacting pain perception: fatigue
Heightens pain perception and intensifies pain
120
Factors impacting pain perception: heredity
may determine pain tolerance
121
Factors impacting pain perception: neurological functioning
MS spinal cord injury
122
Factors impacting pain perception: attention
More you attend or focus on pain the more intense the pain feels
123
Factors impacting pain perception: beliefs
Thoughts, feelings all impact pain perception- thinking errors like "this will never get better"
124
Factors impacting pain perception: spiritual factors
Beliefs about pain and how to treat it, how you attribute meaning to your pain has a influence of pain perception
125
Factors impacting pain perception: culture
They follow their cultural norms which shapes how cope & think about pain & how its reported
126
Factors impacting pain perception: stress
stress can lower a persons pain tolerance, low mood triggers flight or fight which can lead to depression/anxiety
127
Nursing role (9)
Build trust so patients feel comfortable talking about their pain
Believe your patient when they tell you about their pain
Be aware of your own biases around pain & coping
Recognize that a history of chronic pain, depression/anxiety can lead to more severe experience of pain
Be culturally sensitive & aware
Use rating scales that fit for your patients
Administer pain medication as ordered
Be aware of other pain relief measure
Assess pain frequently both pre/post med
128
phaarmacological interventions for pain
NSAIDs & nonopoids (advils), opoids (morphine), co-analgesics (gabapentin)
129
Health history: Respiratory
Pain
Fatigue
Smoking history
Dyspnea
Cough
Shortness of breath
Environmental exposure
Past history of respiratory infection
Health risks
Self care behaviour
130
What does Aphasia mean?
When there is an injury to cerebral cortex which can lead to loss of understanding & speech
131
What does AVPU mean?
Alert
Responds to Verbal
Responds to Pain
Unresponsive
132
summary of resp assessment: airway assessment
patent vs obstructed
133
summary of resp assessment: chest auscultation
posterior & anterior
5 lobes (2 R & 3 L)
assess apex, midlung, base (bilateral comparison)
listen for adventitious sounds (wheezes, crackles)
134
summary of resp assessment: respirations
RR (12-20)
easy or regular
laboured, effortful/irrgular cheyne stokes
accessory msucles
135
summary of resp assessment: O2 delivery system
room air, nasal prongs, simple masks
136
summary of resp assessment: O2 saturation
assesses diffusion and perfusion via pulse oximetry
137
summary of resp assessment: cough
frequent, intermittent, occasional
productive vs nonproductive
sputum characteristics
138
summary of resp assessment: mental alertness
assess LOC in relation to oxygenation
139
summary of resp assessment: activity tolerance
any SOB or SOBOE noted
140
summary of resp assessment: environmental factors
smoker, TB, asbestos
141
Hypoxia
Inadequate tissue oxygenation, present as apprehension, restless, confusion, cyanosis
142
hypoxia can result from
inadequate delivery of O2 to tissues either from low blood supply or from low amount of O2 in the blood (hypoxemia)
143
Tachypnea
Rapid rate but with no blood gas abnormality
144
Bradypnea
Slowed breathing rate
145
Dyspnea
Shortness of breath
146
Apnea
Absence of breathing
147
diffusion
movement of O2 & CO2 b/w alveoli and blood across a membrane
main purpose of breathing is for this gas exchange to occur
148
perfusion
the distribution of oxygen rich red blood cells to tissues
149
ventilation
mechanical process of inspiration and expiration
150
Vital signs: oxygen saturation
Assessing diffusion & perfusion
Pulse oximeter estimates a clients arterial blood oxygen saturation by attaching a sensor to the persons finger
Purpose: to detect hypoxemia
151
conduction system
responsible for contraction of the heart using electrical current
152
conduction system order
SA node, atria, AV node, bundle of his, right & left bundle branches, ventricles
153
What is normal pulse rate?
60-100 bpm
154
What is tachycardia?
Over 100 bpm
155
What is bradycardia?
Under 60 bpm
156
quality of pulse
thready/weak, bounding
157
Apical heart sounds: S1
"LUB"
Close of tricuspid & bicuspid valves
Signals that beginning of systole
158
Apical heart sounds: S2
S2
"DUB"
Closure of pulmonary & aortic valves
Signals the end of systole
159
common alterations in cardiac functioning (conduction issues)
dysrhythmias: deviation from sinus rhythm
atrial fibrillation
ventricular tachycardia
ventricular fibrillation
asystole
160
common alterations in cardiac funcitoning (valve issues)
stenosis, regurgitation
161
common alterations in cardiac functioning (ischemic issues)
angina, MI, ACS
162
Blood pressure: systole
Occurs when the heart is contracting and blood is being squeezed out of the heart and into the body
represents the time between S1 & S2
163
Blood pressure: diastole
Occurs when blood is refilling from the atria into the ventricles
Represents the time between the last "DUB" and the next "LUB"
164
systolic range
100-139
165
diastolic range
60-89
166
What is systemic blood pressure?
Cardiac output(CO) x Peripheral resistance (PR)
167
Cardiac output
Volume pumped bu each ventricle per minute
168
Peripheral resistance
Determined by a change in the diameter of the arterioles
169
What impacts BP? (5)
Volume of blood (CO)
Heart rate (CO)
Diameter of arteries (PR)
Elasticity of arteries (PR)
Viscosity of blood (PR)
170
What is hypotension?Why does it occur?
Abnormally low BP
Systolic blood pressure falls to 90mm Hg or below
Occurs due to dilation of arteries, loss of blood or failure of heart to pump adequately
171
What is hypertension? Why does it occur?
140/90mm Hg or above
Heart must continually pump against greater peripheral vascular resistance
Thickening and loss of elasticity of arterial walls
172
What is orthostatic hypotension?
Systolic pressure suddenly falls greater than 15mm Hg then a fall in diastolic pressure occurs during sitting or standing
assess: dizziness, lightheadedness
Causes:
ANS diseases, dehydration, blood loss, anemia, beta blockers, anti-hypertensives
173
What are risk factors of hypertension?
Family history
Smoking
Obesity
Age
High fat/sodium diet
Stress
Excessive alcohol consumption
Diabetes
Menopause
Use of oral contraceptives
174
What are some subjective health history questions you would ask? (respiration/cardio)
Have you had any of the following....
Chest pain
Dyspnea
Orthopnea
Cough
Fatigue
Cyanosis
Edema
Cardiac history
Family cardiac history
175
What are some objective data that you would collect?
Inspection:
Color, edema
Palpation:
Temperature of skin
Pulses (carotid and peripheral)
Extremities for pitting edema
Auscultate:
Apical pulse
BP
176
Lymphatic system: Veins
Returns blood to heart visa low pressure using:
-skeletal muscles
-breathing pressure gradients
-intraluminal valve & calf pump
177
arteries
carry oxygenated blood from heart
designed to withstand the pressure created with each heartbeat
elastic fibres: stretchy, strong, tough
178
What does adequate blood circulation depend on?
Efficient heart pumping action of the heart
Responsive blood vessels
Adequate blood volume
179
What is a blood vessel?
Any vessel that conveys/carries blood:
Arteries, arterioles, capillaries, venules, veins
180
Vascular system: what are subjective data you would collect?
History of problems w circulation
Leg pain or cramps
Skin changes in arms or legs
Swelling in arms or legs
Lymph nodes enlargement
Skin ulcers
Blood clots
Medication
181
Vascular system: what are some objective data you would collect?
Inspection:
Colour
Size
Swelling
Edema
Ulcer
Varicose vein
Palpation:
Temperature
Moisture
Cap refill
Varicosities
Pulse
Auscultation:
Listen for femoral and abdominal aortic bruits
182
What is Arteriosclerosis?
Peripheral blood vessels loose elasticity- grow rigid
Increase blood pressure
183
What is atherosclerosis?
Deposit of fatty materials in vessels/blockages
184
What are the main functions of the lymphatic system? (3)
1. Maintain fluid balance
2. Immune system function
3. Absorption of fat
185
Lymphatic system: what are subjective data you would collect?
Lymph node enlargement?
Recurrent infection?
History of chronic illness?
Swelling?
Delayed healing?
Family history?
186
Lymphatic system: what are some objective data you would collect?
Inspect & palpate
Assess lymph nodes
Compare each side for size, consistency, tenderness, warmth
Enlarged, hardened tender nodes reveal potential sites of infection or disease
187
Lymphatic system: What should we keep in consideration when working with older adults?
Number & size of nodes decrease w age
Nodes are more fibrotic and fatty than in younger person, resulting in an impaired ability to resist infection
188
assessment is
purposeful, systematic, and dynamic process, involves collection, validation, analysis, synthesis, organization, and documentation, identify health problems, response to stressors and provides foundation for care
189
guiding principles
critical thikning to geather relevant and valid assessment data, be mindful of uncovering hard/sensitive information, guided by theory and a compassionate understanding of client
this is why we do re-interaction phase to fact check to see relability
190
Type of health assessment: Complete health assessment
Detailed health history & physical exam
191
Type of health assessment: Episodic/problem centered assessment
Focused on particular problem
192
Type of health assessment: Follow up assessment
Follow up about change or about specific area
193
Type of health assessment: emergency assessment
Quick focused, based on safety
194
What are the 8 components of a health history?
1. Biographical/demographic data: DOB, name
2. Chief concern/reason for visit
3. History of present illness
4. Past health history
5. Family history
6. Holistic assessment (using 5 variables
7. Perception of health
8. Mental status exam
195
Mental status exam: Appearance/psychomotor
1. Appearance/psychomotor: how they look like & body image
196
Mental status exam: Mood/affect
2. Mood/affect: how they feel & physical observations expressed in comparison
197
Mental status exam: Speech
3. Speech: fast, slow, clear, slurred
198
Mental status exam: Thought form
4. Thought form: how someone is thinking (process)
199
Mental status exam: Thought content
5. Thought content: what someone is thinking
200
Mental status exam: Perception
6. Perception: issues w perception: hallucinations etc 5 senses
201
Mental status exam: Cognition
7. Cognition: ability to use memories, Cant concentrate
202
Mental status exam: Insight/judgement
8. Insight/judgement: Insight describes a person’s understanding of a set of circumstances. It reflects awareness of his or her own thoughts and feelings and an ability to compare them with the thoughts and feelings of others
ability to reach a logical decision about a situation and to choose a reasonable course of action after examining and analyzing various possibilities. Throughout the interview, the nurse evaluates the person’s problem-solving abilities and capacity to learn from past experience.
203
Mental status exam: risk assessment
9. Risk assessment: any safety concerns
204
Physical exam: Vital signs
Blood pressure
Temp
Heart rate
205
Physical exam: Head (5)
Hair
Eyes
Ears
Mouth
Cranial nerves
206
Physical exam: Neck (4)
Lymph nodes
Trachea
Thyroid glands
Carotid glands
207
Physical exam: Upper extremities (6)
Skin, nails
Muscle strength
Range of motion
Brachial/radial pulses
Bicep Tendon reflex
Senstation
208
Physical exam: Chest back (6)
Skin
Breast
Armpit
Lungs
Heart
Spinal column
209
Physical exam: Abdomen
Skin
Abnormal sounds
Specific organs
210
Physical exam: Genitals (3)
Testicles
Vagina
urethra
211
Physical exam: lower extremities
Skin
Toe nails
Range of motion
Femoral, popliteal, dorsalis pedis, posterior tibial pulses
Reflexes
Sensation
212
What are the assessment techniques?
Inspection: Looking
Auscultation: listening to sounds
Palpation: feeling
Percussion: assess vibrations
Olfaction: smell
213
What are conceptual models good for?
Map for problem solving process
Draws different concepts together
Foundational framework
214
Who is Betty Neuman?
Emphasizes holistic nature
Person is seen as a whole
215
CONCEPT: PERSON
Viewed as a client system- not one individual
open system interacting with environment
- physiological variable
- psychological variable
- sociocultural variable
- developmental variable
- spiritual variable
216
CONCEPT: ENVIRONMENT
All internal & external and interpreted influences surrounding a person
Internal: influences within the person
External: influences outside of the person
Interpreted: the sum of total of the persons interpretation of the internal and external environments
217
whats a stresssor
Any stimuli that have the potential to create instability in a person
218
What is an intrapersonal stressor?
Arises from within a person
219
What is an interpersonal stressor?
Occurs between two people
220
What is an extrapersonal stressor?
Arises from our environment
221
What is the person to environment relationship?
Dynamic
Client impacts environment, environment impacts client
Continuous feedback loop: stress & reaction
222
CONCEPT: HEALTH
Viewed on a continuum from wellness to illness
Wellness: harmonious balance between person and environment
Illness: Stressor has disrupted baseline health
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What does recovery mean?
Represents the return and maintenance of system stability following treatment for stressor reactions
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CONCEPT: NURSING
Pysch nurse works towards assisting the client system to attain, retain and maintain optimal wellness
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What does renal failure lead to ?
Electrolyte imbalance, hypertension, pitting edema, low urine production, metabolic acidosis & uremia
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What are kidney stones?
Build up of minerals or waste product inside kidneys that clump together
Small stones: move through urinary tract with no symptoms
Large stones: cause pain during urination, blood in urine, nausea, sharp pain
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What is Pyelonephritis?
A kidney infection which often is a complication of UTI
Patient will experience flank pain, fever, chills, dysuria & foul smelling urine
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What is proteinura?
Presense of protein in the urine, can be a sign of kidney disease
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What is urinary incontinence?
Involuntary loss of urine
Can lead to significant psychological impairment
Can lead to skin breakdown, pressure ulcers, and social isolation
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What is a neurogenic bladder?
A problem in which person lacks bladder control due to brain, or spinal cord damage
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What is urinary retention?
Inability to empty the bladder and becomes more alkaline which leads to UTI
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What is nocturia?
Waking at night to empty bladder (2 or more times)
Related to old age, prostate issues
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What is hematuria?
Blood in urine
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What is obliguria?
Low urine output
Feels like renal failure
minimum hourly output we want to see is 30cc/hr
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What is polyuria?
Large amount of urine output
Seen in diabetes
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What subjective data would be collected? (Urination)
interview = TR skills
Patterns of urination, symptoms, degree of thirst
Diet: diuretics ex: alcohol/caffiene inhibits ADH
Assess impact on self concept, sexuality & beliefs
Assess px primary concerns to ensure goals align
Be culturally sensitive
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What objective data would be collected? (urination)
Skin (hydration status & skin breakdown)
Kidneys (Flank pain or tenderness)
Bladder (tenderness, distended?)
Female perineum (rash)
Male (discharge, inflammation of urethral opening)
Characteristics of urine
Measurement of fluid intake vs output
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Urine testing
Routine urinalysis- collect during normal voiding
Check results ASAP within 2 hrs or refrigerate
Urea is normal waste product in urine
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What are normal urine results?
95% water
Normal pH (4.6-8.0)
No protein
No glucose
No blood
No ketones
No bacteria
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What are some factors affecting normal bowel elimination?
Inadequate water intake
Inadequate fibre
Physical activity
Medication
Hemerroids
Infections
Food intolerance
Age: elasticity gets weaker
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What are common alternations in bowel elimination?
Bowel incontinence: cant control bowel movements
Constipation: have to know that they are at higher risk after surgery bc of sedation
Diarrhea: more than 5x a day unformed feces
Fecal impaction: large volume of poop from chronic constipation
Flatulence: gas in intestinal tract-leads to abdominal distention
Hemorroids: swollen veins in anus
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What subjective data would be collected? (Defecating)
Assess:
patients normal bowel patterns & habits
patients description of stool characteristics
medication history including use of laxatives etc
patients diet history
patients fluid intake
any unplanned weight gain/loss
any recent surgery or GI related illness
any pain or discomfort around elimination
any nausea or vomiting
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What objective data would be collected? (Defecating)
Exam mouth for concerns w chewing
Inspect 4 quadrants of abdomen
List for bowel sounds
Palpate all 4 quadrants
Inspect feces for color, odor, consistency, frequency, shape
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What is sexual orientation?
Who you want to be in bed with
Heterosexual, homosexual, bisexual, etc
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reproductive and sexual health
physical, mental, and social well-being in all matters relating to sexuality
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reproductive and sexual health relates to
healthy and safe sex life
infertility issues
access to contraception and family planning
HIV & STI screening and treatment
safe pregnancy, prenatal care and child birth
postpartum depression, testicular/breast/prostate cancer
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What is gender presentation?
How we present ourselves to others
Feminine, masculine, androgynous
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What is gender dysphoria?
When a person doesnt see or feel themselves to be the same gender they were born into
Not considered a disorder unless this causes them significant distress or social emotional impairment for atleast 6 month duration
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What is infertility?
Inability to conceive a child, can lead to feelings of failure and worthlessness
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What is sexual abuse?
Includes domestic violence, often presents with physical symptoms leads to shame and inadequacy
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What is sexual dysfunction?
Can be related to other health problems or medication side effects, illness or disability
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What is chlamydia?
Most common bacterial STI
Presents with genital discharge and burning on urination
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What is gonorrhea? What happens if left untreated?
Second most common bacterial infection; leads to pain during sex or urination
If left untreated can lead to infertility.
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What is human papilloma virus?
Causes cervical/reproductive cancer & warts
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What is syphilis?
Bacterial infection, easily treated
Diagnosed with blood test often misdiagnosed can cause impaired neurological functioning
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What is hep C?
Viral infection attacks liver
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What is herpes? HSV
High prevalence, high stigma, incurable
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How is sexual health screening done?
Gathering a complete sexual health history
Swab for culture and bacteria
Blood work
Pelvic exam
Inspection of symptomatic area
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What is permissive questioning?
What do you need to ask about?
First you need to establish rapport and ask about less sensitive topics in order to gain trust
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angina
pain caused due to supply and demand oxygen in heart (pain due to lack of oxygen)
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we create therapeutic relationships
- core of psych nursing
- communication skills to develop rapport, trust, and respect
- privacy and confidentiality
- non-judgmental attitude & empathy
- be self aware to avoid projecting feelings, thoughts, beliefs
- establish & negotiate professional boundaries
