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Krystan: Semester One Nursing School > Nursing 2700 Fundamentals: Exam Three > Flashcards

Nursing 2700 Fundamentals: Exam Three Flashcards

1
Q

Define diabetes mellitus

A

A chronic multi system disease related to abnormal insulin production, impaired insulin utilization, or both

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2
Q

What are some primary prevention measures that can be taken as pertains to alterations in cellular regulation?

A

Not smoking
Healthy diet
Using sunscreen
Removing at risk tissues like moles or polyps

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3
Q

What are some secondary prevention strategies to prevent alterations in cellular regulation?

A

Mammograms
Prostate exams
Colonoscopies
PSA tests

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4
Q

The processes of biochemical reactions occurring in the body’s cells that are necessary to produce energy, repair, and facilitate growth of cells and maintain life is known as…

A

Metabolism

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5
Q

What is glucose regulation?

A

The process of maintaining optimal blood glucose levels

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6
Q

What is normal blood glucose for a random sampling?

A

Between 70 and 140 mg/dL

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7
Q

What would be considered hyperglycemia in a fasting state?

A

Greater than 100 mg/dL

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8
Q

What would be considered hyperglycemia in a normal, non-fasting state?

A

Greater than 140 mg/dL

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9
Q

What is hypoglycemia?

A

Insufficient/low blood glucose, usually defined as less than 70 mg/dL

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10
Q

What are the parameters for severe hypoglycemia?

A

Less than 50 mg/dL

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11
Q

What are the parameters for severe hyperglycemia?

A

Greater than 180 mg/dL

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12
Q

What are the signs and symptoms of hypoglycemia?

A 
Reduced cognition
Tremors
Diaphoresis
Weakness
Hunger
Headache
Irritability 
Seizures
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13
Q

What are the signs and symptoms of hyperglycemia?

A 
Polyuria
Polydipsia (excessive thirst)
Polyphagia (excessive hunger)
Dehydration
Fatigue
Fruity breath odor
Kussmaul breathing
Weight loss
Poor wound healing
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14
Q

Where is glucagon released from and what does it do?

A

Released from the pancreas, and targets the liver to release stored glucose into the blood to raise blood glucose levels

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15
Q

Where is insulin secreted from and what does it do?

A

Released from the pancreas, and targets body cells to take up glucose, reducing blood glucose levels

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16
Q

What are some genetic risk factors for the development of diabetes?

A

Family history of diabetes
Obesity
Low level of HDL cholesterol

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17
Q

Which populations are most at risk for developing T2DM?

A

African American
Hispanic/latinos
Native Americans

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18
Q

Which specific community has the highest incidence of T2DM in the world?

A

The Pima Indians of the Gala River community

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19
Q

What are some lifestyle risk factors for the development of diabetes?

A 
Poor diets with high fat intake
Excess calorie intake leading to obesity
Low fiber intake
Too many carbohydrates 
Lack of exercise
Being very old
Gestational diabetes
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20
Q

Why does being very old increase diabetes risk?

A

Reduction in lean muscle mass and insulin production, reducing the body’s capacity to regulate and metabolize glucose

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21
Q

What medical conditions are associated with impaired glucose regulation?

A 
GI problems
Vitamin D deficiency 
Infection, injury, cancer, surgery (all increase need for insulin)
Hypothyroidism 
Cardiovascular disease 
Cushing syndrome 
Pancreatitis
Cystic fibrosis
Corticosteroid use
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22
Q

What is metabolic syndrome?

A

A clustering of at least three of these conditions: central obesity, hypertension, high blood sugar, high serum triglycerides, and low serum HDL cholesterol

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23
Q

What does metabolic syndrome increase the risk of?

A

Cardiovascular disease and T2DM

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24
Q

What random blood sugar level is considered pre-diabetes?

A

Over 140 mg/dL

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25
Q

What is type one diabetes?

A

The pancreas produces no insulin due to viral or autoimmune destruction of parts of the pancreas

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26
Q

What is the treatment for type one diabetes mellitus?

A

Insulin injections are necessary, and balanced food intake and healthy lifestyle choices to reduce complications

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27
Q

What are the other health risks of type one diabetes?

A

Heart disease
Kidney disorders
Retinal damage

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28
Q

What are the three main signs and symptoms of type one diabetes?

A

Polyuria
Polydipsia
Polyphagia

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29
Q

What is the defining characteristic of T2DM?

A

Pancreas producing insufficient or defective insulin for the body’s needs

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30
Q

What are the top signs and symptoms of T2DM?

A

Fatigue
Recurrent infections
Prolonged wound healing
Visual changes

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31
Q

When is gestational diabetes most likely to begin manifesting?

A

After the 20th week of gestation

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32
Q

What are the negative effects of GDM (during pregnancy and later in life)?

A 
Hypertension during pregnancy
Premature birth
Large for gestational age baby
Congenital abnormalities
Future obesity
Mother developing diabetes later in life
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33
Q

What are some risk factors for a newborn developing hypoglycemia?

A 
Gestational diabetes mellitus
Large for gestational age by weight
Small for gestational age by weight
Born earlier than 37 weeks
APGAR score less than 5
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34
Q

Why are babies born to mothers with diabetes/GDM at risk for hypoglycemia right after birth?

A

Because maternal glucose crosses the placenta but insulin doesnt, so when the baby is born, they suddenly dont have the glucose levels they are used to and can become hypoglycemic

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35
Q

What are some signs and symptoms of hypoglycemia in infants?

A 
Jitters
Irritability
Cyanosis
Tachypnea
Apnea
Temperature instability
Lethargy
Seizures
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36
Q

How soon should blood sugar be screened in infants born to diabetic mothers?

A

By one hour of age

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37
Q

How soon should infants at risk for hypoglycemia (but not born to diabetic mothers) be screened?

A

Between one to two hours of age, or when signs of hypoglycemia are observed

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38
Q

What are nursing actions if blood glucose is less than 40 mg/dL in a newborn?

A

Feed immediately
Confirm blood glucose
Check blood glucose one hour after feeding

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39
Q

What should the nurse do if the infants blood glucose is greater than or equal to 40 mg/dL?

A

Feed at least every three hours

Assess risk factors to determine screening intervals

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40
Q

All blood glucose screening intervals are every three hours for infants at risk after initial assessment!

A

However, depending on risk factors, the amount of time this continues for can vary!

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41
Q

Another name for A1C is

A

Glycated hemoglobin

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42
Q

What does an A1C test tell you?

A

Average blood sugar level for the past two to three months

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43
Q

What is considered a normal A1C level?

A

Below 5.7

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44
Q

What A1C score is considered prediabetes?

A

Between 5.7 and 6.4

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45
Q

How is diabetes confirmed through A1C testing?

A

An A1C level of 6.5 percent or higher on two separate tests

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46
Q

What random blood sugar level suggests diabetes?

A

Higher than 200 mg/dL

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47
Q

What fasting blood sugar level is considered prediabetes?

A

Between 100-125 mg/dL

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48
Q

How is diabetes confirmed though fasting blood sugar levels?

A

Blood sugar of 126 mg/dL or higher on two separate tests

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49
Q

When an oral glucose tolerance test is done, a score of what after what time period indicates diabetes?

A

A reading of over 200 mg/dL after two hours

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50
Q

What are the five components of diabetes management?

A 
Nutrition
Exercise to maintain proper body fat
Self-monitoring of blood glucose
Medication
Education
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51
Q

What are primary strategies to prevent diabetes?

A

Avoid excess calorie intake
Exercise for 30-60 minutes at least 3 or 4 times a week
Eat whole grains, fruits, vegetables, lean meats
Low sodium diet
Education about cultural influences

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52
Q

What are secondary prevention strategies for those with diabetes?

A

Blood pressure and cholesterol management
Keep A1C below 7%
Annual dental, foot, and eye exams

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53
Q

What are the four main factors influencing labor?

A

Passenger
Passageway
Primary and secondary powers
Position of the mother

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54
Q

What are some determining factors for how the passenger moves through the birth canal?

A

Fetal head size
Fetal presentation
Fetal lie
Fetal position

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55
Q

How does the fetal head adapt during labor?

A

The skull bones squish together and come to more of a point to fit through the birth canal

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56
Q

What are the three different types of fetal presentation?

A

Cephalic
Breech
Shoulder

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57
Q

What is fetal lie?

A

Relationship of maternal longitudinal axis (spine) and fetal longitudinal axis (spine)

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58
Q

What is the difference in appearance between caput and cephalhematoma? Why?

A

Caput will cross suture lines, causing more uniform swelling of the head. The blood in a cephalhematoma will not cross suture lines, resulting in more localized swelling

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59
Q

What is the most common pelvis shape in women?

A

Gynecoid (round)

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60
Q

What is the second most common pelvis shape in women? How does it affect labor?

A

Anthropoid. It will lead to a longer and harder labor, but it is still possible to have a vaginal birth with this pelvis shape

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61
Q

What is the common term used to describe primary powers?

A

Contractions

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62
Q

What does the nurse note when assessing primary powers?

A

Frequency
Duration
Intensity

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63
Q

Where do contractions start in the uterus?

A

At the top of the fundus, and then they radiate down and in

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64
Q

Which marker determines the fetal station?

A

Ischial spine

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65
Q

When does effacement happen?

A

During the first stage of labor

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66
Q

What is effacement?

A

Shortening, opening up, and thinning of the cervix

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67
Q

What is meant by dilation?

A

The enlargement/widening of the cervical canal once labor has begun

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68
Q

What is measured with Bishops score?

A 
Dilation: in cm
Effacement: percentage score
Station: -3 to +3 in relation to ischial spine
Position: posterior or anterior
Consistency: firm or soft
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69
Q

What bishops score indicates favorability for birth?

A

Above 5

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70
Q

How is a bishops score given?

A

Each item can be given a score of 0, 1, or 2 for a maximum of 10

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71
Q

Do dilation and effacement happen simultaneously?

A

If a woman has had a child before, yes.

If not, effacement happens before dilation

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72
Q

What is meant by secondary powers?

A

Voluntary bearing down/pushing efforts

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73
Q

What is encompassed in the first stage of labor?

A

Onset of regular contractions to complete dilation

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74
Q

What are the three phases of the first stage of labor?

A

Latent phase
Active phase
Transition phase

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75
Q

What characterizes the latent phase of the first stage?

A

Dilated 0-4 cm

Contractions irregular, mild/moderate, occurring every 5-30 minutes for 30-45 seconds

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76
Q

What characterizes the active phase of stage one of labor?

A

4-7 cm dilated

Contractions are more regular, moderate to strong, occurring every 3-5 minutes and lasting for 40-70 seconds

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77
Q

What characterizes the transition phase of the first stage of labor?

A

Dilated 7-10 cm

Strong contractions every 2-3 minutes for 45-90 seconds

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78
Q

When do women need to go to the hospital in the labor process?

A

It depends for each woman, but if the membranes are broken, she should go (infection risk). Women should go when in true labor, but potentially sooner if a multipara

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79
Q

When does amniotic fluid rupture?

A

Can occur anytime, but usually happens during the transition phase

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80
Q

How do you test for amniotic fluid?

A

Nitrazine paper

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81
Q

What is a normal nitrazine paper reading?

A

Blue from an alkaline pH

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82
Q

What is concerning in a nitrazine paper reading?

A

Yellow coloring from acid in urine

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83
Q

What is show?

A

Vaginal discharge

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84
Q

What is encompassed in the second stage of labor?

A

Full dilation to the delivery of the baby

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85
Q

What happens in the second stage of labor before the baby is born?

A

Full dilation and intense contractions every 1-2 minutes

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86
Q

What can impact the length of the second stage of labor?

A 
Use of epidural
Mother’s age
BMI
Emotional state
Support system
Fetal size/position/presentation
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87
Q

What happens in the third stage of labor?

A

Delivery of the placenta

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88
Q

How long should the third stage of labor last?

A

Between 15 and 30 minutes

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89
Q

What do nurses worry about as the third stage of labor gets longer?

A

Postpartum hemorrhage and anemia

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90
Q

How long is the fourth stage of labor?

A

The first two hours after the delivery of the placenta

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91
Q

What complications are most likely in the fourth stage of labor?

A

Hemorrhage and sub-involution of the uterus

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92
Q

What are some non-pharmacological methods for pain management during labor?

A 
Lamaze/Bradley techniques
Hypno-birthing relation technique
Breathing and visualization
Water therapy
Position changes
Massage
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93
Q

What are some pharmacological methods for pain control during labor?

A 
Systemic analgesia
Opioids 
Opioid agonist-antagonist
Inhaled analgesia 
Epidural and intrathecal anesthetic
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94
Q

What is the biggest concern with systemic analgesia?

A

Neonate respiratory depression

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95
Q

What is the most common inhaled analgesia?

A

Nitrous oxide

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96
Q

What assessments need to be done on a woman in labor?

A

Vital signs
Complete assessment upon admission
Focused assessments: vaginal exams

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97
Q

When monitoring the fetus during labor, what is the biggest concern being monitored for?

A

Perfusion through the placenta to the fetus

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98
Q

What four elements are monitored for the fetus during labor?

A

Baseline heart rate
Variability
Accelerations
Decelerations

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99
Q

What are the two ways to monitor the fetus externally?

A

Contractions and ultrasound

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100
Q

How is baseline heart rate for the fetus determined during labor?

A

The average rate over a 10 minute segment of monitoring is the baseline

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101
Q

When looking at a fetal heart rate strip, what is something you want?

A

Variability

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102
Q

What could lack of variability indicate?

A

Lack of oxygen to the fetus

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103
Q

What are some good shapes versus bad shapes on a fetal HR strip?

A

A V shape, indicating a HR dip, is okay. A shape of a U or W is bad, and might indicate lack of oxygen or problems with the placenta

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104
Q

What are some things that can be determined using Leopold maneuvers?

A

Number of fetuses
Presenting part of the fetus
Fetal station
Expected location for fetal heart rate

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105
Q

What are hypercontractions?

A

Contractions that are less than one minute apart

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106
Q

What will help calm down hypercontractions?

A

Giving fluid (helps the uterus calm/relax)

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107
Q

How many RNs will be present during and immediately after delivery?

A

Two

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108
Q

What will the primary/mom nurse do during the birth process?

A 
Record times
Assist doctor/midwife
Monitor for complications 
Assist with episiotomy/laceration repair
Clean up the patient
Monitor vitals, fundus, and bleeding
Encourage bonding and breastfeeding
Give pitocin
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109
Q

What will the baby RN do in the L/D process?

A

Observe baby for complications
Assess APGAR at one and five minutes
May do baby cares (vaccines, weight, length)
Vital signs every 30 minutes or per policy
Suction mouth and nares
Call NICU if necessary

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110
Q

What will the circulating nurse do during a cesarean birth?

A

Record times
Observe for breaks in sterility
Helps with patient recovery

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111
Q

What will the baby nurse do during a cesarean birth?

A

Follow policies
Assess APGAR
Vitals every 30 minutes or as ordered

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112
Q

What must be occurring for labor to be considered true labor?

A

Cervical dilation bishops score

Regular contractions that are increasing in intensity and frequency

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113
Q

treat all pain, even if the patient is barely dilated

A

It still hurts

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114
Q

What are some sources of pain during the labor process?

A 
Dilation
Effacement
Fetal descent and pressure
Lacerations
Expulsion of placenta
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115
Q

What can the nurse do to support a woman emotionally during labor?

A

Be present
Get loved ones involved if possible
Listen when the patient verbalizes pain

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116
Q

What are some primary postpartum cares/focuses?

A

Pain relief
Bladder emptying
Preventing hemorrhage
Bonding/breastfeeding support

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117
Q

What are the two types of episiotomy cuts and what is involved in each?

A

Midline: cuts only through tissue
Lateral: cuts through muscle and tissue

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118
Q

What are some cultural considerations for labor and delivery?

A

Culture and involvement of family members/spouse
Beliefs about pain and pain control
Patient autonomy vs cultural expectation and decision making

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119
Q

When should a woman empty her bladder in the labor and delivery process?

A

Before, during, and after delivery

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120
Q

What is being tested for with the infant heel prick test?

A

PKU and 50+ other metabolic conditions

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121
Q

When is blood pressure checked on a newborn?

A

After 24 hours

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122
Q

Define genetics

A

The study of heredity

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123
Q

Define genomics

A

The study of the structure of the genome through the mapping and sequencing of DNA

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124
Q

Define epigenetics

A

The environment’s role in activating and deactivating genes

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125
Q

What is responsible for gene regulation and all cellular activities?

A

An individual’s DNA sequence

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126
Q

What is the important key point to remember when considering things like epigenetic changes, chemical tags, and cellular reproduction?

A

There are many ways and many points where things can go wrong genetically, leading to disease

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127
Q

Why is it virtually impossible for there to be genetically identical individuals?

A

Because such a vast amount of chromosome exchange happens during cell division

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128
Q

What happens when a change in gene DNA nucleotides is caused by incorrect translation in the mRNA?

A

Disease

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129
Q

What are causes that can lead to cell mutations after conception?

A 
Environmental chemicals
Drugs
Diet
Stress
Trauma
Aging
**can be problems in mother during pregnancy or just factors throughout a person’s lifespan that affect**
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130
Q

Germline mutations

A

Mutations from inherited DNA in gametes/sex chromosomes that are duplicated in every cell

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131
Q

Somatic mutations

A

Acquired genetic alterations within cells that may be passed to future progeny of that cell, but are NOT in sperm or egg cells (will not affect future generations)

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132
Q

Define pharmacogenetics

A

The study of how a person metabolizes medications based on genetic makeup

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133
Q

What are some examples of the use of pharmacogenetics in personalized medicine?

A

Psychiatry: drug choice and response
Pain management: addition potential
General: minimizing drug side effects

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134
Q

Why is genetic makeup important to consider when a medication is prescribed?

A

Because genetics plays a role in how the body metabolizes medications

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135
Q

What are some drugs/classes that we currently know have a genetic influence component?

A 
Opioids 
Antidepressants
Statins (cholesterol)
Warfarin
Folate
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136
Q

What does the ANA Genetics and Genomics Nursing Curricular Guidelines and Outcomes challenge nurses to do?

A

Recognize personal attitudes about genetics
Advocate for genetic services and patient autonomy
Incorporate genetics/genomics into practices
Tailor genetic info to the specific patient (culture, literacy, etc)

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137
Q

What must a nurse understand when assessing genetic risk?

A

The relationship of genetics and genomics to health, prevention, screening, treatment, and monitoring

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138
Q

What must the nurse consider when completing physical assessments, collecting personal/family histories, and analyzing information relating to genetics?

A

Genetic, environmental, and genomic influences and risks

Patient’s knowledge and perceptions of genetics

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139
Q

In the clinical setting, where does the identification of hereditary risk begin?

A

With the primary care nurse

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140
Q

What information is collected when doing a family history to identify individual and family genetic risk factors?

A

3 generation family history with names, DOBs, health status of each person, cause of death, medical condition and ages of diagnosis, racial and ethnic backgrounds

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141
Q

What is meant by adult-onset monogenic disorders?

A

Single-gene disorders that usually manifest in adulthood but can begin in childhood. These are totally hereditary conditions

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142
Q

What is an example of an adult-onset monogenic disorder?

A

Huntington’s disease

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143
Q

What are multifactorial disorders?

A

Disorders that stem from a combination of genetic and environmental factors

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144
Q

What are some examples of multifactorial disorders?

A

Cancer

Heart disease

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145
Q

What might a red flag in a patient’s personal or family history indicate?

A

Potential for inherited susceptibility to disease or genetic condition

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146
Q

What has a significant influence on distribution, incidence, and prevalence of many genetic diseases?

A

Ethnicity and race

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147
Q

What are some red flags that can be identified during a family history?

A

Known genetic disorder in the family with multiple generations affected
Early onset disease in first or second degree relatives
Sudden cardiac death of individual believed to be healthy
Ethnic predisposition to genetic disorder

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148
Q

What should be the next step when a red flag is identified?

A

Referral to a genetic specialist

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149
Q

What information should a nurse provide to patients and families so they can make informed decisions regarding going to a genetic specialist?

A

Reasons for testing
Types of tests
Benefits and risks

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150
Q

What are the benefits of genetic testing?

A

Definitive diagnosis
Information about familial risk
Identifying prevention, treatment, and management options

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151
Q

What are the risks of genetic testing?

A

Potential for discrimination based on results
Anxiety
Psychological impacts of findings
Ambiguous findings/variations of unknown significance
Unexpected revelations about family relationships

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152
Q

What are some potential barriers to genetic technology and services?

A 
Culture
Language
Family values
Traditions
Religion
Health beliefs 
Money
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153
Q

Diagnostic testing

A

Confirms or rules out a diagnosis

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154
Q

Carrier testing

A

Determines if someone carries a recessive or x-linked disorder

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155
Q

Predictive or presymptomatic testing

A

Tells whether a person is likely to develop a condition

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156
Q

Prenatal or antenatal testing

A

Looking for genetic or chromosomal disorders like Down syndrome before a baby is born

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157
Q

Susceptibility testing

A

Looking for genetic risk for a complex disorder involving multiple risk factors

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158
Q

Pharmacogenetic testing

A

Looking for genetic variants to determine medication responses

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159
Q

How long might the genetic testing process take?

A

Four weeks or more

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160
Q

What is the nurses role while the patient waits for genetic test results?

A

Emotional support

Discussion of strategies for when results are learned

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161
Q

What is the role of the nurse once testing results are learned?

A

Clarify information
Explore implications
Recommend health promotion and prevention practices
Collaborate with other healthcare providers

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162
Q

Why should a nurse understand what genetic test results mean?

A

To be able to explain them, provide support, and connect patients to resources

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163
Q

What does a positive result mean/indicate in genetic testing?

A

Change in gene/chromosome/protein
Confirm diagnosis
Provide options for prevention and management

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164
Q

What can a positive result in a genetic test not tell you?

A

Course or severity of disease

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165
Q

What does a negative test result for a genetic test mean?

A

No change, disorder is ruled out

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166
Q

What can a negative result in a genetic test not guarantee?

A

That a mutation in another gene wouldn’t cause that same disorder later on

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167
Q

What does a variant of unknown significance mean?

A

Abnormal DNA variation not yet associated with a disorder

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168
Q

Why are variants of unknown significance hard to evaluate?

A

Because everyone has natural variations in their DNA that are not harmful

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169
Q

What is precision medicine?

A

Medical treatment tailored to the individual patient

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170
Q

How many genes have alterations that are linked to breast cancer?

A

17

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171
Q

“Whatever the person says it is, and existing whenever the person says it does,” is one definition of…

A

Pain

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172
Q

Define acute pain

A

Pain with a short duration and rapid onset, may last up to 6 months

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173
Q

Define chronic pain

A

Pain that lasts for 6 months or longer and interferes with ADLs

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174
Q

Define intractable pain

A

Chronic pain that is highly resistant to relief

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175
Q

What are some emotions that can influence pain?

A 
Fear
Anxiety
Sadness/grief
Depression
Anger
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176
Q

What are some signs that an infant is in pain?

A 
Crying
Grimacing
Twitching
Poor feeding
Fluctuation in temperature 
Skin mottling
Decreased o2 sats
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177
Q

What are some signs that an adult with cognitive or communication impairment is in pain?

A

Grimacing
Withdrawal
Labored breathing
Decreased activity or mobility

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178
Q

How can sociocultural factors influence pain expression and pain treatment options?

A

Some cultures may believe pain is to be endured stoically

They might be resistant to pain relief medications for this reason or other cultural beliefs

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179
Q

Cutaneous stimulation for pain relief operates under what theory?

A

The gate-control theory

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180
Q

What is a TENS or PENS unit?

A

Transcutaneous (or percutaneous) electrical nerve stimulator

Interferes with pain perception

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181
Q

How is acupuncture believed to relieve pain?

A

Believed to stimulate the endogenous analgesia system

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182
Q

How does accupressure help relieve pain?

A

It stimulates specific pressure points for the release of endorphins

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183
Q

How does massage help to reduce pain?

A

It involves cutaneous stimulation and muscle relaxation to reduce pain

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184
Q

What are some cognitive non-pharmacologic pain relief tactics?

A 
Distraction
Relaxation
Guided imagery
Hypnosis
Therapeutic touch
Humor
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185
Q

How does sequential muscle relaxation work?

A

Client tenses their muscles for 15 seconds, then relaxes them while exhaling

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186
Q

How does hypnosis work?

A

It is the induction of a deeply relaxed state and then the introduction of therapeutic suggestions

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187
Q

How does therapeutic touch work?

A

Practitioner uses hands to direct energy fields around the body

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188
Q

What is a common side effect for NSAIDs?

A

Gastric irritation and bleeding

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189
Q

What can reduce the side effects of NSAIDs?

A

Taking them with food and using pills with enteric coating

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190
Q

Codene/hydrocodone is also known as..

A

Vicodin

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191
Q

Morphine/hydromorphone is also known as

A

Dilaudid

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192
Q

Pentazocine is also known as..

A

Talwin

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193
Q

Nalbuphine is also known as

A

Nubain

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194
Q

Define tolerance

A

Body becoming adjusted to drug and needing increasing doses for the same effect

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195
Q

Define physical dependence

A

Need for a drug that causes withdrawal because the body gets used to it

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196
Q

Define psychological dependence

A

Addiction

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197
Q

What is psychoneuroimmunology?

A

A branch of medicine that deals with the influence of emotional states and nervous system activities on immune function (especially pertaining to onset and progression of disease)

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198
Q

Define stress

A

Physical, psychological, social, or spiritual effect of life’s pressures and events

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199
Q

Define stressor

A

Psychological, social, environmental, physiological, or spiritual stimulus that disrupts ability to maintain internal stability

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200
Q

Define distress

A

Chronic or excessive stress that prevents the body from achieving and maintaining homeostasis

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201
Q

Define eustress

A

Stress that can be challenging and useful

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202
Q

External stressors

A

An external stressful situation, such as death of a loved one

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203
Q

Internal stressors

A

Stressful presence within someone, such as anxiety or negative self-talk

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204
Q

Developmental stressors

A

Stressors that can be predicted at various life stages (going to college stress, retirement, etc)

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205
Q

Situational stressors

A

Unpredictable stressors, such as sudden illness/catastrophe/accident

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206
Q

Physiological stressors

A

Stressors that affect body structure or function

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207
Q

Psychosocial stressors

A

Stressors that arise from work, family dynamics, living situation, relationships, etc.

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208
Q

What are adaptive coping strategies? Give examples

A

Healthy choices that reduce the effects of stress

Examples: exercise, healthy eating, talking to a friend

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209
Q

Define maladaptive coping strategies and give examples

A

Choices that don’t promote adaptation to the stressful situation
Examples: overeating, working too much, substance abuse, excessive sleeping

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210
Q

What are some common coping approaches?

A

Altering the stressor
Adapting to the stressor
Avoiding the stressor

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211
Q

What are some personal factors that influence adaptation?

A 
Perception
Overall health status
Support system
Hardiness
Age 
Developmental level
Life experiences
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212
Q

How is hardiness defined?

A

Thriving despite overwhelming stressors (takes commitment + control + view of stress as a good challenge)

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213
Q

What are the three stages of general adaptation syndrome?

A

Alarm stage
Resistance stage
Exhaustion or recovery stage

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214
Q

What happens in the alarm stage of the GAS?

A

fight or flight stage
Shock phase: lasting usually less than 24 hours, high levels of epinephrine
Counter shock phase: shock phase reversed

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215
Q

What happens during the resistance stage of the GAS?

A

Body tries to cope, protect against the stressor, and maintain homeostasis

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216
Q

What happens in the exhaustion or recovery stage of GAS?

A

Exhaustion: stress continues, adaptation unsuccessful, body cannot maintain resistance, ends in injury, illness, or death
Recovery: successful adaptation leading to recovery/continuing

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217
Q

What are some physiological responses to stress?

A 
Muscle tension
Headaches
Nausea
Weight changes
Chest pain
Increased heart rate
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218
Q

What are some emotional and behavioral responses to stress?

A 
Anger
Anxiety
Depression
Fear
Lethargy
Illness
Crying
Aggression
Rebellion
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219
Q

What are some cognitive responses to stress?

A

Poor judgement
Forgetfulness
Decreased accuracy
Decreased problem solving

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220
Q

What are some health promotion activities for stress prevention/reduction?

A 
Nutrition
Exercise 
Sleep and rest
Leisure activities
Good time management skills
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221
Q

How does relaxation work to reverse some stress responses?

A

Elongating muscle fibers reduces neural impulses to that area and reverses some stress responses

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222
Q

How does exercise help to reduce stress?

A

Releases muscle tension
Expresses emotions
Releases endorphins

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223
Q

When is the best time to exercise to enhance sleep?

A

At least two hours before going to bed

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224
Q

What types of foods promote sleep? Why do they help?

A

Milk, cheese, and other animal products because of the tryptophan and adenosine

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225
Q

What types of foods may hinder sleep?

A

Saturated fats

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226
Q

How might alcohol contribute to restless/disruptive sleep?

A

While it hastens the onset of sleep, it disrupts REM/slow wave sleep and can cause spontaneous waking

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227
Q

How do hypnotics affect sleep?

A

Increase sleep amount but decrease sleep quality

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228
Q

How does ambien affect sleep?

A

Promotes normal REM

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229
Q

How do amphetamines affect sleep?

A

Reduce REM sleep

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230
Q

What are some environmental factors that promote or hinder sleep?

A

Temperature
Noise
Presence or absence of others
Light

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231
Q

What are dyssomnias?

A

Sleep disorders

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232
Q

Insomnia

A

Inability to fall asleep, remain asleep, or go back to sleep

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233
Q

Sleep-wake schedule disorders

A

Abnormalities in sleep due to things like traveling, shift work, or large changes in total sleep time

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234
Q

Restless leg syndrome

A

CNS disorder characterized by uncontrollable leg movements while resting or before sleeping

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235
Q

Sleep apnea

A

Periodic interruption of breathing while sleeping

236
Q

What are the two types of sleep apnea?

A

Obstructive sleep apnea (OSA)

Central sleep apnea (CSA)

237
Q

Hypersomnia

A

Excessive sleeping, especially during the day

238
Q

Narcolepsy

A

Condition where the brain cannot regulate sleep/wake cycles, leading to spontaneous sleep episodes

239
Q

Parasomnias

A

Patterns of waking behavior that appear during sleep (such as sleepwalking)

240
Q

What are some nursing interventions to create a restful environment for sleep?

A

Dry, clean, irritant free linens
Good body alignment for patient
Dark and quiet room
Temperature controlled room

241
Q

What are some common bedtime rituals and routines?

A

Reading, watching tv, praying/meditating

For children: having a favorite toy, blanket, or bedtime story

242
Q

What are some good recommendations (and things to avoid) when it comes to bedtime stories?

A

Complex carbs and maybe a small amount of protein

Avoid: alcohol and caffeine

243
Q

Beyond gender, what does sexuality encompass?

A

How we perceive ourselves, relate to others, and express ourselves sexually

244
Q

According to the WHO, “a central aspect of being human throughout life that encompasses sex, gender identity and role, orientation, eroticism, pleasure, intimacy, and reproduction” is a definition of..

A

Sexuality

245
Q

How does the WHO define sexual identity?

A

A person’s perception of his or her own gender, gender identity, gender role, and sexual orientation

246
Q

Androgyny

A

A blending of masculine and feminine traits and roles

247
Q

Why is androgyny considered a positive trait?

A

Because it gives individuals greater adaptability in life situations

248
Q

Define gender identity

A

The image we have about ourselves as a man or a woman

249
Q

At its broadest definition, what does it mean to be transgendered?

A

Forming a gender identity that is not the same as one’s biological gender

250
Q

What does it mean to be transsexual or transgendered?

A

Identifying with gender opposite of biological sex

251
Q

What are some early indicators of being transsexual?

A

Dissatisfaction with gender from a young age
Believing one will grow up to be opposite gender
Dressing and playing like opposite gender

252
Q

What has a person undergone when they are a postoperative transsexual patient?

A

Genitalia change and legal gender change

253
Q

What is another name for being Inter sexed?

A

Hermaphrodite

254
Q

What does it mean to be intersexed?

A

To be born with ambiguous sex organs

255
Q

How do issues of sexual differentiation occur in utero?

A

Sex organs differentiate at around seven weeks in utero. Sometimes this happens incorrectly or not fully

256
Q

What are some key components of sexuality that develop in the birth through preschool period?

A

Children frequently touch their genitalia, enjoy nudity, and enjoying holding hands, hugging, snuggling, etc

257
Q

What are some key components of sexuality in school age children through puberty?

A

Most identify with same sex parent and have same sex friends
Gender roles develop
Secondary sex characteristics develop
First attraction and masturbation may take place

258
Q

What are key components of sexuality that develop/occur in adolescence?

A

Heightened sexual interest and activity
Hormone changes
Sexual exploration

259
Q

What are some components of sexuality that develop/occur in young adulthood?

A

Sexual identity and self concept exploration

Development of intimate relationships and long term commitments as part of sexual maturity

260
Q

What are some components to remember about sexuality in middle adulthood?

A

May have more time for sex

May be hindered by menopause and other health concerns

261
Q

What are some components to remember about older adults and sexuality?

A

Most are still sexually active and enjoy sexual activity

Problems may arise due to failing health and medication side effects

262
Q

Why is it important for the nurse to understand cultural influences on sexuality?

A

Because culture influences our views on everything related to sex and gender

263
Q

What does it mean to be ethnocentric as related to sexuality?

A

It means you believe your culture and sexual behaviors and beliefs are the norm

264
Q

What must the nurse be mindful of when it comes to patients and their sexual knowledge?

A

We cannot assume adequate sexual knowledge in our patients

265
Q

How does the WHO define sexual health?

A

A state of physical, emotional, mental, and social well-being related to sexuality, not just the absence of disease, dysfunction, or infirmity

266
Q

What is required for sexual health?

A

Positive and respectful mindset
Openness
Opportunity

267
Q

What is necessary for sexual health attainment and maintenence?

A

Sexual rights of all being respected, protected, and fulfilled

268
Q

What are paraphilias? Give examples

A

Sexual deviations, like exhibitionism, sadism, pedophilia, fetishism)

269
Q

Chlamydia trachomatis

A

Most common and treatable STI
Caused by bacteria and treated with antibiotics
May not have symptoms, may cause pain during sex, vaginal discharge, and eye discharge

270
Q

Gonnorrhea

A

Caused by bacterium and treated with antibiotics

Causes painful urination and abnormal discharge, can lead to infertility if left untreated

271
Q

Syphilis

A

Bacterial infection that is diagnosed with blood test and occurs in stages
Starts with painless sores and a rash, then has a latent phase, then causes damage to brain, eyes, and heart over the course of years
Treated by penicillin

272
Q

HPV

A

Human papillomavirus
Viral infection that causes warts on skin and mucous membranes
Has no cure, but may go away on its own

273
Q

Herpes simplex virus

A

Viral infection transmitted orally or by genital contact

Characterized by blister groups or cold sores

274
Q

Which STIs are often tested for and treated together?

A

Chlamydia and gonorrhea

275
Q

What are the best ways to prevent STIs?

A

Abstinence

Sexual monogamy with someone who has never had an STI

276
Q

What is sexual harassment?

A

A person in power making unwanted sexual advances, which often leverage the success or employment of the other person

277
Q

What are some important statistics regarding rape?

A

One in six women and one in 33 men are victims of attempted or completed rape

278
Q

In what situations should a nurse do a focused sexual assessment?

A

Someone with an STI or illness that affects sexual function
Pregnancy/infertility cases
Abnormal menstruation
Urinary problems

279
Q

What are some interventions for PMS?

A 
Balanced diet
Exercise 
Adequate sleep
Avoid tobacco
Limit alcohol/caffeine
Drink water
280
Q

What are some planned parenthood guidelines for safer sex?

A 
Be honest about sexual practices and history
Avoid exchange of bodily fluids
Avoid contact with genital sores
Get routine checkups
Accept responsibility for your actions
281
Q

What are the steps of PLISSTI that a nurse can use to counsel for sexual problems?

A

Ask permission
Supply limited information
Give specific suggestions
Refer for intensive therapy

282
Q

What are some effective responses to inappropriate sexual behaviors towards a nurse?

A

Tell them it is inappropriate
Tell them to stop
Clearly state expected behavior
Refocus their attention

283
Q

What should you do if you feel you’ve been sexually harassed?

A

Confront the harasser, if possible
Keep a written record
Report concerns

284
Q

What are some guidelines to remember for taking a sexual history?

A 
Privacy and confidentiality
Be relaxed
Use eye contact
Use an inviting opening
Don’t use conversation stoppers
Use good non-verbal cues
Use their terminology
Recognize that they may be embarrassed 
Make them comfortable
Start with less sensitive topics first
285
Q

What are some good guidelines for condom use?

A

Use latex
Handle gently
Use water-based lubricants
Check expiration dates

286
Q

What are some things to avoid when using condoms?

A

Don’t store in wallet
Don’t open with a sharp object
Don’t reuse
Don’t use with lotions or oils

287
Q

What are some factors that affect sexuality?

A 
Culture
Religion
Lifestyle
Knowledge about sex
Health status
Social context
288
Q

What are some factors that sexual problems can be related to?

A 
Fatigue
Impaired mobility
Pain
Fear
Low self esteem
Self care deficits
Disturbed body image
STIs
Sexual harassment or rape
Dysfunctional intimate relationship
289
Q

What increases the risk for STIs?

A

Alcohol and drug use

Having many sexual partners

290
Q

What are some teaching topics pertaining to sexuality?

A

Self-examination of testicles and breasts
STI prevention
Contraception use

291
Q

Which age group accounts for half of all new STI cases?

A

People ages 15-24

292
Q

Who suffers from more serious and frequent STI complications?

A

Women

293
Q

The body’s attempt at self-protection is…

A

Inflammation

294
Q

What are the classic symptoms of inflammation?

A 
Pain
Heat
Swelling
Redness
Loss of function in the area
295
Q

There can be no healing without..

A

The inflammatory response

296
Q

What kind of inflammation can lead to diseases and other conditions?

A

Chronic inflammation

297
Q

What are the four components of the inflammatory response?

A

Vascular response
Cellular response
Exudate response
Healing

298
Q

Inflammatory process: vascular response

A

Immediate vasoconstriction to minimize bleeding (short time period), the vasodilation from histamine release to allow leukocytes and clotting factors into the area

299
Q

Inflammatory process: cellular response

A

Phagocytes (WBCs) go to injury site to engulf bacteria, foreign particles, and cellular debris. Also ward off potential invading pathogens

300
Q

Inflammatory process: exudate response

A

Fluid and white blood cells moving from circulation to injury area. Causes release of pus, which is a protein rich substance, to get the gross stuff out of the wound

301
Q

Inflammatory process: healing

A

Replacement of tissue by regeneration (replacement of damaged cells) or repair (scar tissue replacing original tissue)

302
Q

What tissue type regenerates easiest?

A

Skin

303
Q

What are some common changes in coloration of the skin?

A

Pallor
Jaundice
Ecchymosis
Petechiae

304
Q

Ecchymosis

A

Discoloration of skin from bleeding underneath the skin

305
Q

Petechiae

A

Brown purple spots on the skin, usually from minor trauma and blood clotting disorders

306
Q

Nevus simplex is also known as

A

Stork bites (normal birthmarks)

307
Q

Capillary hemangiomas

A

Flat or raised non-cancerous red or pink tumors on the face. Usually caused by overgrown small blood vessel

308
Q

Cafe-au-lait spots

A

Light brown birthmarks

309
Q

Mottling

A

Blue/pale, blotchy, webbed looking pattern on skin. Normal in babies, also present when someone is dying

310
Q

How does the nurse assess skin temperature by palpación?

A

Using the dorsum of the hands or the fingers

311
Q

What are some words that could be used to document moisture level?

A 
Diaphoretic
Dry
Rough
Oily
Well-hydrated
312
Q

What are some factors that affect skin texture?

A 
Exposure
Age
Impaired circulation
Hyperthyroidism
Endocrine disorders
313
Q

Where should a nurse assess skin turgor in infants?

A

On the abdomen

314
Q

Where should the nurse assess skin turgor in adults?

A

Collarbone area

315
Q

Where should the nurse assess skin turgor in older adults?

A

Back of hand

316
Q

What are some illnesses that contribute to edema?

A 
Kidney disease
CHF
Peripheral vascular disease
Low albumin
Protein energy malnutrition
317
Q

Milia

A

White raised areas that look like whiteheads. Usually on the face, especially on infants. Caused by keratin trapped under the skin

318
Q

Nevi

A

Freckles/moles/birthmarks

Can develop in adulthood even into ones 50s

319
Q

Skin tags

A

Tiny buds of skin around the skin creases

320
Q

Striae

A

Stretch marks caused by pregnancy or other drastic weight changes

321
Q

What are the warning signs of malignant lesions/skin marks?

A 
Asymmetry 
Border irregularity
Color variation (not just one solid color)
Diameter greater than 0.5 cm
Elevated 
Changing over time
322
Q

What are some things to be assessed when looking at hair?

A 
Type
Color
Distribution
Thickness
Texture
323
Q

Alopecia

A

Usually describes hair loss along temples and mid-scalp (male-pattern baldness), but can also describe any random hair loss in patches

324
Q

Hirsutism

A

Excess hair on the face or trunk

325
Q

Describe half and half nails and what usually causes them

A

The reddish pink band at the bottom of the nails covers 20-60% of the nail instead
Often occurs in renal disease or with low albumin levels

326
Q

Describe Mees Lines and what causes them

A

Transverse white lines in nail beds (of all nails). Caused by severe illness, nutritional deficiencies, or heavy metal poisoning

327
Q

What are splinter hemorrhages? What causes them?

A

Small vertical lines in the nail bed caused by hemorrhages under the nail bed.
Can be caused by endocarditis or trauma to the nail

328
Q

What causes black nails?

A

Blood under the nails due to trauma

329
Q

What causes white spots on the nails?

A

Zinc deficiencies

330
Q

What might thickened nails indicate?

A

Poor circulation

331
Q

What might cause thick, yellow nails?

A

Fungal infection (onychomycosis)

332
Q

What might cause brittle nails?

A

Hyperthyroidism, malnutrition, calcium or iron deficiency, harsh nail products

333
Q

What might cause soft, boggy nails?

A

Poor oxygenation

334
Q

What is clubbing? Where is most commonly seen?

A

Enlargement of the ends of the fingers and a downward slope of the nails
Common in COPD patients

335
Q

Why are infants more prone to skin breakdown?

A

Thinner skin and more permeable

Less subcutaneous fat

336
Q

Why are aging adults more prone to skin breakdown?

A

The skin is drier
Subcutaneous tissue layer is thinner
Loss of collagen

337
Q

How does impaired mobility make one prone to skin breakdown?

A

More weight is on certain areas of the body for longer, and that pressure can lead to skin breakdown

338
Q

What are some general factors that affect skin integrity?

A 
Age
Impaired mobility
Nutrition
Diminished sensation or cognition
Impaired circulation
Medications
Moisture 
Fever
Contamination or infection
Lifestyle
339
Q

What nutrients are needed to maintain skin integrity?

A

Adequate protein, calories, and cholesterol

340
Q

What is the role of protein in maintaining healthy skin?

A

Maintains the skin
Repairs minor defects
Preserves/contains intravascular volume

341
Q

What is the role of cholesterol in maintaining healthy skin?

A

Fuel for wound healing and maintaining a waterproof barrier

342
Q

Why can high cholesterol cause issues for skin integrity?

A

It can block blood flow to areas of the body, making that skin more susceptible

343
Q

How can insufficient calories lead to skin breakdown?

A

The body will use protein for energy, and then the skin cannot use it for repair

344
Q

How do vitamin C, zinc, and copper aid in wound healing?

A

They aid in collagen formation, which is crucial to wound healing

345
Q

Why are individuals with decreased sensation at risk for skin injury?

A

They are less able to feel pain and pressure, so sores and wounds may go untreated

346
Q

Why is an individual with impaired cognition at risk for skin breakdown?

A

They are not aware of the need to reposition or unable to communicate pain/pressure

347
Q

What are two forms of impaired circulation?

A

Arterial insufficiency

Venous insufficiency

348
Q

How does venous insufficiency manifest?

A

Normal color and temperature of skin, but lots of edema in the extremities

349
Q

How does arterial insufficiency mainifest?

A

Pale, dusky, cool skin with decreased or absent pulses. No edema present

350
Q

When it comes to skin integrity, both arterial and venous insufficiency cause what problem?

A

Delayed wound healing

351
Q

What are some medications that may impact skin integrity?

A 
BP meds
NSAIDS
Steroids
Anticoagulants
Chemo
Some antibiotics
352
Q

What is maceration?

A

Softening of the skin due to excessive moisture, which puts someone at risk for skin breakdown

353
Q

What are the two most common sources of excessive skin moisture?

A

Incontinence and fever

354
Q

Why does fever predispose someone to skin breakdown?

A

Sweating increases moisture level and increased metabolic rate increases tissue demand for oxygen

355
Q

What are some lifestyle habits that impact skin health?

A 
Tanning
Hygiene habits
Exercise
Diet
Smoking
Body piercings and tattoos
356
Q

What is the universal assessment tool for pressure ulcers?

A

The Braden scale

357
Q

What factors does the Braden scale look at?

A 
Sensory perception
Moisture
Activity
Mobility
Nutrition
Friction and sheer
358
Q

What Braden scale score indicates pressure ulcer risk?

A

18 or lower

359
Q

What does the Norton scale look at?

A 
Physical condition 
Mental state
Activity
Mobility
Incontinence 
(Also for pressure ulcers)
360
Q

What are some ways the nurse can promote optimal skin integrity?

A

Inspection
Managing moisture
Optimizing nutrition and hydration
Minimizing pressure by repositioning regularly

361
Q

What part of the brain controls the balance between heat production and heat loss?

A

The hypothalamus

362
Q

What are the compensatory mechanisms involved in decreasing body temperature?

A

Vasodilation
Sweating
Inhibition of heat production

363
Q

What does the body do to increase temperature?

A

Shivering

Releasing epinephrine to increase metabolic rate

364
Q

What three factors interact to produce body heat?

A

Metabolism
Skeletal muscle movement
Non-shivering thermogenesis (metabolism of brown fat)

365
Q

Radiation

A

Loss of heat through waves emitting from a surface

366
Q

How much body heat is lost through radiation?

A

60%

367
Q

Convection

A

Transfer of heat through air or water currents

368
Q

How much body heat is lost through convection?

A

15%

369
Q

Evaporation

A

Water evaporating from skin or mucous membranes to cool the body

370
Q

How much body heat is lost through evaporation?

A

About 20%

371
Q

Conduction

A

Heat transferring by direct contact with a surface or body

372
Q

How much body temperature is lost through conduction?

A

About 3%

373
Q

Why is maintaining body heat harder for the elderly?

A

Slower metabolism
Decreased vaso motor control
Loss of subcutaneous tissue

374
Q

What are some additional factors that influence body temperature?

A 
Environment 
Gender (menstrual cycle and hot flashes)
Exercise
Emotions/stress
Circadian rhythm
375
Q

Why does hyperthermia happen?

A

The body cannot promote heat loss fast enough to balance heat production or environmental heat

376
Q

What temperature range can indicate heat exhaustion?

A

Between 98.6 and 103

377
Q

What are warning signs of heat exhaustion?

A 
Weakness
Nausea
Vomiting
Syncope
Tachycardia
Tachypnea
Muscle aches
Headaches
Diaphoresis
Flushed skin
378
Q

What temperature range is considered heatstroke?

A

Above 103

379
Q

What are the symptoms of heat stroke?

A 
Rapid and strong pulse
Throbbing headache
Delirium
Confusion
Lethargy
Red/hot/dry skin
Dizziness
Seizures
Coma
380
Q

What is hypothermia?

A

Abnormally low core temperature (less than 95 degrees)

381
Q

What are early signs of hypothermia?

A

Shivering
Cyanosis of lips and fingers
Poor coordination

382
Q

What temperature indicates severe hypothermia?

A

Below 82.4 degrees

383
Q

What are the signs of severe hypothermia?

A

Unconsciousness
Shivering ceases
Pulse and respirations are irregular and hard to detect

384
Q

How soon upon admission must a skin assessment be done?

A

Wishing 24 hours

385
Q

Are pressure ulcers reportable/punishable offenses in hospitals?

A

Yes, as mandated by the joint commission

386
Q

How many stages of pressure ulcers are there?

A

Four

387
Q

What characterizes an unstagable (or stage 5) pressure ulcer?

A

Severity cannot be determined because so many things are going on. No more pain in the area due to nerve death

388
Q

What characterizes a stage four pressure ulcer?

A

Extensive damage extending into the muscle or bone, often no more pain in the area

389
Q

What is crucial to promote healing in pressure ulcers?

A

Follow up care

390
Q

How long does the pre-embryonic stage last?

A

From conception to day 14

391
Q

What does the ectoderm develop into?

A 
Epidermis
Glands
Nails/hair
CNS/PNS
Lenses of eyes
Tooth enamel
392
Q

What does the mesoderm develop into?

A 
Bones 
Teeth 
Muscles
Dermis
CT
Cardiovascular system
Spleen
Urogenital system
393
Q

What does the endoderm develop into?

A

Epithelial lining in respiratory, digestive, and reproductive tracts, roof of the yolk sac

394
Q

How long does the embryonic stage last?

A

From 15 days to 8 weeks after conception

395
Q

What is the major accomplishment during the embryonic stage?

A

All organ systems and external features develop

396
Q

What is the difference between the amnion and the chorion?

A

Chorion covers the fetal side of the placenta and contains the umbilical blood vessels
Amnion forms the amniotic sac (more on the outside)

397
Q

What are the functions of amniotic fluid?

A 
Maintain fetal body temperature
Waste repository
Cushion
Maintain electrolyte homeostasis
Provide infection barrier
Aids in lung development and symmetric growth
398
Q

What is the purpose of the placenta?

A 
Metabolic exchange
Hormone production
Respiration
Nutrition
Storage
Excretion
399
Q

How many arteries and veins does an umbilical cord have?

A

Two arteries and one vein

400
Q

How long does the fetal stage last?

A

From 9 weeks to the end of pregnancy

401
Q

What is the defining feature of the fetal stage?

A

Viability and the fetus being recognizable as human

402
Q

What do urine pregnancy tests look for?

A

Human chorionic gonadotropin

403
Q

How does Nagel’s rule work and what does it calculate?

A

Calculates due date

Take the first day of the last menstrual cycle, subtract three months, and add seven days (plus a year)

404
Q

What causes nausea and vomiting during pregnancy?

A

Hormonal changes
Increased abdominal pressure
Delayed gastric emptying

405
Q

What is some helpful teaching for a pregnant client with nausea and vomiting?

A

Eat crackers or toast before getting out of bed
Avoid spicy/greasy/gas forming foods
Drink fluids between meals, not with meals
Eat small frequent meals
Avoid caffeine
Ginger tea

406
Q

How is nausea and vomiting treated medically?

A

Vitamin C and B6

407
Q

What causes heartburn in pregnancy?

A

Stomach being displaced by uterus
Slower GI motility
Hormones causing relaxation of sphincter

408
Q

What are some helpful teachings for heartburn?

A

Small frequent meals
Don’t get too hungry
Check with doctor before taking antacids

409
Q

What are some helpful teachings for the pregnant client who is constipated?

A

High fiber diet
Lots of fluid
Regular exercise

410
Q

When is urinary frequency most common in pregnancy?

A

First and third trimesters

411
Q

What should the nurse instruct the pregnant patient regarding urinary frequency?

A

Void when the urge is present, or every 2-3 hours
Drink 10-12 glasses of water daily
Monitor for s/s of UTI

412
Q

What causes breast tenderness in pregnancy?

A

Hormone changes and breast enlargement

413
Q

What teaching is appropriate for the patient regarding breast tenderness?

A

Wear a well supportive bra

414
Q

What are hemorrhoids?

A

Swollen veins in the rectal/vaginal/anal area

415
Q

What causes hemorrhoids in pregnancy?

A

Pressure on the veins in the perineum from the weight of the fetus and the stress of pushing during labor

416
Q

What teaching is helpful for the pregnant or postpartum woman with hemorrhoids?

A

Warm sitz baths
Witch hazel baths
Topical ointments

417
Q

Why does uterine cramping happen during pregnancy?

A

Preparation of uterus for labor

418
Q

What kind of uterine cramping should a woman worry about?

A

Cramping increasing in frequency and intensity before 37 weeks gestation

419
Q

When do women need to call their provider regarding vaginal bleeding?

A

If there is any present. The provider will tell her what to do

420
Q

Which lab tests are done during the first OB visit?

A 
UA and C&S
CBC
Hemoglobin
Hematocrit
Blood type and Rh
Rubella
TB
BMP/CMP
Hep B
HIV
Gonorrhea and syphilis
421
Q

What assessment activities are done during the first OB visit?

A 
Health history
Active history
Herpes screening
Complete physical exam 
Breast and pelvis exam
Intimate personal violence screening
Teaching
422
Q

Which fetal tests are sometimes done during the first OB visit or first trimester?

A

Alpha fetalprotein and chorionic villus sampling (both for chromosomal abnormalities)

423
Q

When are fetal heart sounds first heard and seen during an ultrasound?

A

As early as six weeks

424
Q

When can fetal HR be heard via Doppler?

A

10-12 weeks

425
Q

Why does back pain often occur in pregnancy?

A

Exaggerated lumbar and cervical thoracic curves in the spine develop

426
Q

How can the woman minimize/prevent back pain during pregnancy?

A 
Good posture
Good body mechanics 
Relaxation techniques
Firm mattress
Abdominal support 
Back rubs
Ice and heat
427
Q

When is back pain concerning in pregnancy?

A

When accompanied by vaginal bleeding, contractions, or when the pain is cyclical (indicating contractions)

428
Q

Why does bleeding gums happen during pregnancy?

A

Increased vascularity and proliferation of connective tissue

429
Q

How can pregnant women minimize bleeding gums?

A

Eat a balanced diet with protein, fruits, and vegetables

Practice good dental hygiene

430
Q

Why do congestion and nosebleeds often happen during pregnancy?

A

Hyperemia of mucous membranes due to estrogen levels

431
Q

What is quickening?

A

Fetal movement

432
Q

When is quickening first able to be felt?

A

Between weeks 16 and 25 of pregnancy

433
Q

What are some genetic tests available for pregnant women?

A 
Maternal serum alpha fetoprotein 
Amniocentesis
Cordocentesis 
Chorionic villus sampling
Quad marker screening
434
Q

What to fetal genetic tests look for?

A

Down syndrome
Neural tube defects
Chromosomal abnormalities

435
Q

What is the purpose of a screening ultrasound?

A

Measuring the clear space at the back of the baby’s neck (looking for Down syndrome)

436
Q

When is gestational diabetes testing done?

A

Second trimester

437
Q

What assessments and tests are done during the second trimester?

A 
BP
UA
Fundal height
Fetal heart tones
All genetic testing
Gestational diabetes
Rh antibodies 
CBC
438
Q

How often does a woman go to the doctor during the second trimester?

A

Monthly

439
Q

Glucose challenge test

A

One hour glucose test, done first, no fasting needed

440
Q

Glucose tolerance test

A

Three hour GTT, done if glucose challenge abnormal, fasting required

441
Q

What weeks are most crucial for fetal development?

A

Weeks 10-15

442
Q

What should a woman do if she feels Braxton-Hicks contractions?

A

Rest
Change positions
Do deep breathing

443
Q

When does a woman need to call her doctor regarding Braxton-Hicks contractions?

A

If they don’t go away and become more intense and frequent

444
Q

Why does shortness of breath occur during the third trimester of pregnancy?

A

Diaphragm is restricted by the enlarged uterus

445
Q

When is swelling normal in pregnancy?

A

Late in pregnancy
In hot weather
With excessive sitting/standing/poor posture
When wearing constrictive clothing

446
Q

When is swelling abnormal during pregnancy?

A

When it becomes generalized edema and is accompanied by signs and symptoms of preeclampsia

447
Q

What is a mucus plug?

A

A barrier that seals the cervix during pregnancy

448
Q

When doing a fetal kick count, what is considered normal/good?

A

10 movements in two hours

449
Q

When does a fetal kick count need further evaluation?

A

Less than 3 movements in one hour

450
Q

If further evaluation is needed after a fetal kick count, what is the next step?

A

A non-stress test

451
Q

What is being assessed/monitored for with a non stress test?

A

Intact fetal CNS and to rule out fetal death

452
Q

What does a reactive/good non-stress test look like?

A

Before 32 weeks: 2 accelerations in 20 minutes lasting 10 seconds with HR going 10 BPM above baseline
After 32 weeks: 2 accelerations in 20 minutes lasting 15 seconds with HR going 15 BPM above baseline

453
Q

If a non-stress test is non-reactive, what is the next step in evaluating the fetus?

A

Biophysical profile (BPP)

454
Q

What elements are assessed in a BPP?

A 
Fetal heart rate
Fetal breathing
Fetal tone
Fetal movement
Amniotic fluid volume
455
Q

How is a BPP scored?

A

Each element is scored 0, 1, or 2 for a max score of 10

456
Q

What is it called when the amniotic fluid volume is low?

A

Oligohydramnios

457
Q

What might cause Oligohydramnios?

A

Hypertension
PROM
Drugs

458
Q

What is amniotic fluid made from?

A

Mom’s plasma

459
Q

How is a group B streptococcus test done?

A

Vaginal or anal swab at 35-37 weeks gestation

460
Q

When is a pregnancy considered post-dates?

A

After 40 weeks (40-42)

461
Q

What are presumptive pregnancy signs? Give examples

A

Symptoms that could accompany pregnancy or something else, like fatigue, nausea, and vomiting

462
Q

What are some probable pregnancy signs?

A 
Fetal movement
Breast tenderness
Uterine growth
Lack of menses
Positive urine pregnancy test
463
Q

What is the only positive sign of pregnancy?

A

Ultrasound verification

464
Q

When might the provider decide to strip a pregnant woman’s membranes?

A

When they are not going into labor and should be

465
Q

The uterus switches from what cavity to what cavity during pregnancy?

A

Pelvic to abdominal cavity

466
Q

By what point do you want the baby to be in a vertex position?

A

33-34 weeks

467
Q

What changes happen to blood pressure during pregnancy?

A

Systolic will stay the same or decrease

Diastolic will/should decrease

468
Q

Why does BP go down during pregnancy?

A

Because progesterone should have a relaxing effect on the vessels

469
Q

What changes happen in the urinary system during pregnancy?

A

System gets larger and more relaxed
Increased urinary frequency
Lag time between urine formation and when it reaches the bladder

470
Q

What are some common skin changes during pregnancy?

A

Hyperpigmentation
Línea nigra from belly button to symphysis pubis
Cholasma

471
Q

At what point in pregnancy do Braxton hicks contractions usually start?

A

Around 28 weeks

472
Q

The hormone of pregnancy

A

Progesterone

473
Q

What does progesterone do during pregnancy?

A

Endometrial development
Relaxes uterine muscle and pelvic girdle
Breast tissue growth
Increases prolactin and oxytocin

474
Q

How much weight should be gained in the first trimester?

A

2-5 pounds

475
Q

How much weight should be gained in the second trimester?

A

One pound per week

476
Q

How much weight should be gained in the third trimester?

A

One pound per week

477
Q

How much fish should a pregnant woman consume during pregnancy?

A

No more than 12 ounces

478
Q

Which fish should be avoided during pregnancy?

A

Swordfish
Shark
King mackerel
Tilefish

479
Q

Heart rate during exercise should be kept below what during pregnancy?

A

140 BPM

480
Q

How much water is needed per day during pregnancy to prevent UTIs and maintain amniotic fluid?

A

2 liters

481
Q

What are some tips for UTI prevention during pregnancy?

A

2 L water per day
No bubble baths
Cotton underwear
Avoid tight pants (increases heat and infection risk)

482
Q

What are warning signs/signs of preterm labor?

A

Regular contractions before 37 weeks
Vaginal bleeding
Water leaking
Heartburn with headache

483
Q

What are some maternal emotional changes during pregnancy?

A 
Accepting pregnancy
Identifying with mother role
Reordering relationships 
Establishing relationship with baby
Preparing for birth
484
Q

What are some paternal emotional adaptations while the mom is pregnant?

A

Accepting it
Pregnancy like symptoms
Establishing a relationship with the baby
Identifying with father role

485
Q

What are some cultural factors that can influence pregnancy and delivery?

A 
Diet
Religion
Beliefs and folklore
Cultural practices and modesty beliefs 
Pain/expression/management 
Touch and eye contact
Others present during birth (father, doula, etc)
486
Q

Explain the GTPAL terminology

A 
Gestations: total # of pregnancies
T: # of term babies
P: # of preterm babies
A: # number of abortions/miscarriages 
L: # of living children
487
Q

Primagravida

A

First pregnancy

488
Q

Multigravida

A

More than two pregnancies

489
Q

Grandmultigravida

A

Greater than or equal to 5 live births

490
Q

What are some considerations for the pregnant adolescent?

A

Extra prenatal care
Alcohol/smoking/drugs
Weight gain concerns
Need to involve social worker, psychologist, school system

491
Q

Active immunity

A

Immunity developed through exposure to a disease

492
Q

What are the two types of active immunity? Give examples of each

A

Natural (getting sick and developing antibodies that way)

Artificial (getting a vaccine and developing antibodies from that)

493
Q

Passive immunity

A

Immunity given by antibodies being transferred

494
Q

What are the two types of passive immunity? Give examples

A

Natural (passed through placenta or breast milk)

Artificial (anti-serum or immune globulin)

495
Q

What are benefits and drawbacks to passive immunity?

A

Immediate action, no need for antibodies to be created. But usually only provide short term immunity

496
Q

What is an example of a passive immunity injection that can be given?

A

Hepatitis B immune globulin

497
Q

At what age should infants begin receiving an annual influenza vaccine?

A

6 months old

498
Q

What are some reasons why parents might choose to not vaccinate?

A 
Religious beliefs
Conflicting or lack of information
Beliefs that vaccines cause autism or other issues
Limited healthcare access
Cultural values
499
Q

What are two additional vaccines recommended for the 7-18 age group?

A

Meningococcal vaccine and HPV

500
Q

Which vaccine is contraindicated during pregnancy?

A

Rubella

501
Q

Discuss the risks of contracting rubella during pregnancy

A

Can cause birth defects or miscarriage

502
Q

If a pregnant woman has not receive the rubella vaccine, when will she receive it?

A

As soon as the baby is born

503
Q

What vaccine is recommended for all adults at age 65?

A

Pneumonia

504
Q

What additional vaccine does the CDC recommend for those over 60 years old?

A

Shingles vaccine

505
Q

What are some things the nurse should assess prior to vaccine administration

A

Allergies (especially to eggs), any immune contraindications

506
Q

What should be done if a child is behind on their vaccine schedule?

A

Give as many as possible to start catching the child up

507
Q

What should be documented after a vaccine is given?

A

Injection site, lot number, and expiration date of vaccine

508
Q

What information should the nurse provide to patients/caregivers prior to giving a vaccine?

A

Vaccine information sheet for every vaccine to be given

509
Q

What does the nurse evaluate following vaccine administration?

A

Site of administration for an allergic reaction

Development of fever (tell parents that fever is normal but notify them of when it is considered serious)

510
Q

What are some age-related considerations when administering a vaccine?

A 
Muscle tone
Pain tolerance
Skin thickness
Fear of needles
Administration site
511
Q

What are some barriers that may prevent a patient from receiving recommended immunizations?

A 
Language barriers
Cultural beliefs
Lack of education
Lack of insurance or healthcare access 
Lack of transportation 
Immunosuppressed child
Religious or personal beliefs
512
Q

Which barriers to immunization are the hardest to overcome?

A

Religious or personal beliefs against vaccination

513
Q

What can the nurse do to eliminate some other barriers to immunization?

A

Educate about benefits
Get materials in their native languages
Connect them to resources (such as health institutions with reduced cost immunizations or public health nurses that will come to you)

514
Q

TDaP vaccine

A

Tetanus, diphtheria, and pertussis original vaccine given earlier than 7 years to build up immunity

515
Q

Tdap vaccine

A

Booster vaccine given at age 11 to offer continued protection. Contains full dose of tetanus and reduced doses of diphtheria and pertussis

516
Q

What four factors integrate together to contribute to health?

A

Social
Psychological
Spiritual
Biological

517
Q

Self concept

A

One’s overall view of oneself

518
Q

What does it mean to have a healthy self-concept?

A

Having a mostly positive perception when making self evaluations (in things like appearance, sexual performance, intelligence, success, friendship, etc)

519
Q

Self concept influences social functioning

A

Self concept is also influenced by social functioning

520
Q

Describe the idea of the dynamic self

A

Who we are is subject to change through the influence of society and environment

521
Q

How does concept of self develop in infancy?

A

Infant learns that the physical self is different from the environment

522
Q

How does self-concept develop in childhood?

A

Children internalize other’s attitudes about them and use that to shape self-concept

523
Q

How does self-concept develop in childhood and adulthood?

A

Children and adults internalize societal standards and evaluate to see how they compare

524
Q

How does self concept develop throughout adulthood?

A

Adults come to a point of self actualization and continuing self-adjustment (“this is who i am and who I will continue to be”)

525
Q

In childhood, what factors influence the formation of self-concept?

A

Gender and gender role expectations
Friends and media
Family and peer relationships

526
Q

Internal locus of control and self concept

A

Inner voice influences self-concept. Belief that one can control their own life

527
Q

External locus of control and self-concept

A

Attribute control to factors outside of oneself (like people, institutions, or God)

528
Q

What are the four interrelated components of self-concept?

A

Body image
Role performance
Personal identity
Self-esteem

529
Q

What predicts a positive body image?

A

A close match between one’s ideal body image and sensory input about one’s body

530
Q

How do gradual vs sudden body changes impact body image?

A

Gradual changes, like aging, are usually easier to adapt to, while sudden changes, like injury/deforming accident, are much harder to accept

531
Q

What health problems can occur because of negative body image?

A 
Depression
Smoking
Increased unplanned pregnancies
Increased STIs
Increased bullying risk
532
Q

How does positive body image influence health?

A

Leads to much higher overall life happiness

533
Q

Define role performance

A

Actions and behaviors demonstrated in fulfilling a role (the reality of it, not the expectation)

534
Q

What is role strain?

A

Mismatch between role expectation and role performance

535
Q

Interpersonal role conflict

A

When your expectations for a role are different from how others expect you to fill that role

536
Q

Personal identity

A

Your view of yourself as a unique person, separate from all others

537
Q

How is personal identity determined and learned?

A

It develops over time and is influenced by those around us. It is relatively constant and consistent

538
Q

What marks a strong sense of personal identity?

A

Valuing oneself and others, and being less likely to compare or be overly influenced by others

539
Q

What marks a weak sense of personal identity?

A

Difficulty distinguishing boundaries and taking things too personally

540
Q

What could cause an impaired sense of identity?

A

Serious or chronic illness

541
Q

Self esteem

A

How well a person likes himself. The meeting of the ideal self and the real self

542
Q

What are symptoms of anxiety?

A 
Nervousness 
Fearfulness
Uneasiness
Nausea
Trembling
Sweating
543
Q

Differentiate between fear and anxiety

A

Fear: specific, cognitive response to a known threat
Anxiety: vague, emotional response to an unknown threat

544
Q

Is anxiety common?

A

Yes, mild anxiety is normal and necessary for survival

545
Q

Normal anxiety

A

Essential reaction to realistic danger. Allows us to survive and move on

546
Q

Abnormal anxiety

A

Anxiety out of proportion to the threat that lasts long after the threat is over

547
Q

Adaptive coping strategies (list)

A 
Exercise
Talking
Fun/leisurely activities 
Relaxation
Deep breathing
548
Q

Maladaptive coping strategies

A 
Excess sleeping
Excess eating
Smoking
Excessive crying
Drinking
Cursing 
Nail biting
549
Q

Define defense mechanisms

A

Unique patterns of coping with anxiety

550
Q

Give two examples of defense mechanisms

A

Denial

Displacement

551
Q

What can overused defense mechanisms lead to?

A

Becoming maladaptive or development of psychological disorders

552
Q

What are some myths about depression?

A

One can just “get on with life”
Everyone likes to talk about their feelings
Medications cure depression
Once cured, depression won’t return

553
Q

According to the APÁ, what are the characteristics of major depressive disorder?

A 
Depressed mood most of the day every day for two weeks
Insomnia or hypersomnia 
Loss of energy
Feelings of worthlessness
Difficulty concentrating 
Recurrent thoughts of death
554
Q

How is sadness different from depressed mood?

A

Sadness is linked to specific situational elements, while depressed mood is characterized by feelings of emptiness

555
Q

What are two age groups that are more likely to suffer from depression?

A

Older adults

Those in their 40s

556
Q

Physiological depression theory

A

Depression caused by biochemical imbalances

557
Q

Psychodynamic depression theory

A

Depression is related to loss, abandonment, or detachment

558
Q

Cognitive depression theory

A

Depression is caused by negative thinking

559
Q

Social or environmental depression theory

A

Depression is caused by family/social relationships or environmental factors

560
Q

What are some (research supported) depression risk factors?

A 
Family history
Hormone or nutrition imbalance
Inability to externalize anger
Low self esteem
Negative thinking
Traumatic loss
Catastrophe
Chronic disease
Being female
Learned helplessness/hopelessness
561
Q

What is the prevailing depression theory? What treatment is normally associated with it?

A

Physiological theory

Treatment with antidepressants

562
Q

What are some strategies for effective communication when collecting psychosocial information?

A 
Be aware of your biases and discomforts
Use active listening
Proceed from general to specific information
Follow the patient’s cues
Keep it focused on the patient
563
Q

How can a nurse help hospitalized patients maintain a sense of personhood?

A 
Introduce yourself
Listen actively
Speak to the patient, not about the patient, when they are in the room
Use eye contact and touch
Explain
Be gentle
Provide privacy
564
Q

What are some behaviors associated with low self-esteem?

A 
Avoiding eye contact
Slouched posture 
Slow movement
Speaking hesitantly 
Frequent apologizing
565
Q

What are two guidelines to keep in mind when analyzing self-esteem data?

A

Avoid seeking simplistic cause and effect relationships

Avoid confusing low self concept with clinical emotional or behavioral psychiatric diagnoses

566
Q

What are some key nursing actions to promote self-esteem in patients?

A

Encourage independence
Monitor for and discourage negative self talk and self-criticism
Use positive, reaffirming language
Establish a therapeutic nursing relationship
Help the client with realistic goals

567
Q

How can parents promote self-esteem in their children?

A 
One on one time
Frequent touch
Refrain from negative criticism
Establish routines
Treat child with respect 
Set realistic expectations
Be a role model
568
Q

What can a nurse teach a patient about positive body image?

A

Healthy does not mean perfect
Focus on being active and eating healthy
Accept compliments

569
Q

When does anxiety become a problem?

A

When it interferes with ability to meet basic needs

570
Q

What are anxiety assessments that warrant immediate intervention by a mental health professional?

A

Suicidal thoughts and plans
Assaultive or homicidal thoughts/plans
Loss of touch with reality
Significant or prolonged inability to care for oneself or family

571
Q

Why is a physical assessment important for clients with anxiety?

A

To treat underlying disease or disorder

572
Q

What are some specific nursing actions to reduce anxiety in patients?

A 
Calm, safe environment
Establish a trusting relationship
Be present and stay with the patient
Identity client triggers
Encourage non-stressful activities
573
Q

What is the most vital intervention when caring for a depressed patient?

A

A good nurse-patient relationship

574
Q

What are specific depression risk factors for older adults?

A 
Dementia
Cancer
Substance abuse 
MI
Functional disability 
Being widowed
Being a caretaker
Isolation
575
Q

What are some feelings s/s of depression?

A 
Flat affect
Difficulty concentrating 
Loss of interest in activities
Feelings of worthlessness/guilt
Suicidal thoughts
576
Q

What are some cognitive s/s of depression?

A 
Preoccupation with loss
Guilt
Self blame
Confusion
Ambivalence
577
Q

What are some behavioral s/s of depression?

A 
Sleep issues
Eating issues
Fatigue
Restlessness
Agitation 
Withdrawal
Substance abuse
578
Q

What are some lifestyle s/s of depression?

A

Isolation
Self-medicating
Reckless behavior

579
Q

Why might physiological effects manifest with depression?

A

To mask the depression with a more “legitimate” complaint

580
Q

What are some symptoms of depression in older adults?

A 
Difficulty concentrating 
Forgetfulness
Reduced alertness
Saying “I dont know” a lot
Slow to speak and respond to verbal stimuli
Daytime sleeping
581
Q

What are some s/s of dementia (but not depression) in older adults?

A 
Difficulty finding words, especially nouns
Short term memory loss
Difficulty with calculations
“Near miss” answers
Disorientation
Fragmented sleep
582
Q

How does a nurse determine when to refer someone to a mental health specialist for depression symptoms?

A

Personal history of depression or bipolar disorder
Family history
Recurrent depression within one year of stopping effective treatment
Major depression before age 20
Life threatening depressive episode

583
Q

What are risk factors for suicide?

A

Substance abuse
Family history
Family violence
Recent losses

584
Q

What are warning signs of suicide?

A 
Risky behavior
Changes in routine 
Giving away stuff
Personality changes
Talking about death and suicide
585
Q

Discuss medication and depression/suicide risks with older adults!

A

There is one successful suicide for every four attempts among older adults!

586
Q

What is the most important intervention to prevent suicide?

A

Assessment

587
Q

What are some other important interventions to prevent suicide?

A 
Evaluate medications and side effects
Do not avoid talking to the patient out of fear of saying the wrong thing 
Know your own feelings/anxieties/biases 
Ask patient if they are suicidal 
Monitor patient
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Krystan: Semester One Nursing School (6 decks)

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