Nursing 2MM3 Exam Review Flashcards
(210 cards)
1
Q
What are modifiable risk factors?
A
Those that can be potentially altered through lifestyle change and medical treatment
- hypertension
- diabetes
- high cholesterol
- smoking
2
Q
What are non-modifiable risk factors?
A
Age, gender, race, low birth rate
3
Q
What is an ischemic stroke?
A
results from inadequate blood flow to the brain from partial or complete blockage of artery
4
Q
What is a transient ischemic stroke?
A
temporary episode of neurological dysfunction, symptoms last less than 1 hour
5
Q
What is a thrombotic stroke?
A
Occurs when a clot forms in a diseased and narrowed BV in the brain
- most common
- sudden onset
- usually remains conscious in first 24 hrs
6
Q
What is an embolic stroke?
A
occurs when an embolus lodges and blocks a cerebral artery resulting in infarction
- remains conscious
- sudden onset
7
Q
What is a hemorrhagic stroke?
A
result from bleeding in the brain tissue or in the subarachnoid space
8
Q
What is a intracerebral stroke?
A
bleeding in the brain caused by a rupture of a vessel
- occurs during activity
- sudden onset
- decreased LOC
9
Q
What is a subarachnoid stroke?
A
intracranial bleeding into the CSF filled space
- silent killer
10
Q
What are side effects of left sided stroke?
A
paralyzed right side, expressive aphasia, receptive aphasia, amnesic aphasia, global aphasia, dysphagia, slow and cautious, memory deficits
11
Q
What is expressive aphasia?
A
AKA: Broca’s aphasia
- cannot produce language, spoken or written
- can understand speech
- singing can be used as a tool
12
Q
What is receptive aphasia?
A
inability to understand written or spoken language
13
Q
What is global aphasia?
A
Both receptive and expressive
14
Q
What are side effects of right sided stroke?
A
Paralyzed left side, spacial-perceptual, impulsive and quick moving, memory deficits
15
Q
What is a MRI used for?
A
used to determine the extent of injury, greater specificity in determining location
16
Q
What is a CT scan used for?
A
fast imaging, indicates size and location of lesion, helps differentiate between the type of stroke
17
Q
What is delirium?
A
state of acute mental confusion
18
Q
What is delirium characterized by?
A
acute onset, fluctuating course, altered LOC
19
Q
What are predisposing factors?
A
present at the time of admission, demographic, cognitive status, functional status, coexisting conditions
20
Q
What are precipitating factors?
A
noxious insults related to hospitalization, surgery, drugs, incurrent illness
21
Q
What is hypoactive delirium?
A
decreased alertness, decreased psychomotor activity
22
Q
What is hyperactive delirium?
A
Agitation, restlessness and hallucinations
23
Q
What is mixed delirium?
A
alternating periods of hyperactive and hypoactive
24
Q
What is dementia?
A
impaired memory, slow gradual decline, chronic, decreased orientation, decreased ability to perform ADL’s
25
What is vascular dementia?
cause by stroke or chronically damaged/narrowed brain blood vessels
26
What are signs and symptoms of vascular dementia?
difficulty concentrating and analyzing situations, unsteady gait, restlessness, agitation, incontinence
27
What are risk factors for vascular dementia?
aging, increased BP, atherosclerosis, diabetes
28
What is Parkinson's dementia?
a progressive neurodegenerative disease of the CNS
29
What are signs and symptoms of Parkinson's dementia?
dysphagia, difficulty concentrating, confusion
30
What is the progression of Parkinson's dementia?
gradual onset, ongoing progression
31
What is Alzheimer's disease?
abnormal protein deposits form plaques and tangles in the brain (connections b/w cells die off)
32
What are signs and symptoms of Alzheimer's disease?
memory loss, disorientation, reduced cognition, decline in social skills
33
What are risk factors for Alzheimer's disease?
older population, genetic, hospitalization, medical conditions
34
What are treatments for Alzheimer's disease?
creating a safe and supportive environment, cholinesterase inhibitors
35
What is lewy body dementia?
protein deposits in nerve cells, accumulation of Lewy bodies results from the loss of neutrons that create ACTH and dopamine
36
What are signs and symptoms of Lewy body dementia?
cognitive fluctuations, hallucinations, motor disturbances
37
What are risk factors for Lewy body dementia?
60+, male, family history
38
What is fronto-temporal dementia?
degeneration of the frontal, temporal, or both sides (tau protein)
39
What are signs and symptoms of fronto-temporal dementia?
behavioural: loss of inhibitions, depression, compulsivity, loss of empathy
language: aphasia, loss of semantics
40
What is the progression of fronto-temporal dementia?
gradual decline, stepwise, rare, more common younger
41
What is Huntington's dementia?
A progressive brain disorder caused by a single defective gene on chromosome 4
42
What are signs and symptoms of Huntington's dementia?
involuntary jerking, slow abnormal eye movement, impaired gait, difficulty with speech and swallowing
43
What are cognitive changes of Huntington's dementia?
disorganized thinking, behavioural/emotional instability, lack of awareness
44
What are behavioural changes of Huntington's dementia?
depression, irritability, social withdrawal, insomnia, fatigue
45
What is prediabetes?
blood sugars that are higher than normal, can turn into type 2
46
What are risk factors for prediabetes?
high BP, high cholesterol, high BMI, sleep apnea, psychiatric disorders
47
What is gestational diabetes?
occurs during the 2nd or 3rd trimester of pregnancy
48
What is metabolic syndrome?
cluster of metabolic disorders, abdominal obesity, increased TG levels, decreased HDL levels, hypertension, increased glucose levels, insulin resistance
49
What is type 2 diabetes?
insulin resistance or dysfunctional secretions
50
What are risk factors for type 2 diabetes?
40+, family history, history of prediabetes, heart disease, hypertension, high cholesterol, overweight, sleep apnea
51
What are signs and symptoms of type 2 diabetes?
non specific manifestations, fatigue, weight gain, tingling/numbness, prolonged wound healing
52
What is type 1 diabetes?
the pancreas does not produce any insulin, rapid onset, acute manifestations
53
What are signs and symptoms of type 1 diabetes?
polyuria, polydipsia, polyphasic, weight loss, weakness, fatigue
54
What is nephropathy?
microvascular complications associated with damage to the SBV's that supply the glomeruli of the kidney
55
What is neuropathy?
nerve damage that occurs because of the metabolic derangements associated with diabetes
56
What is retinopathy?
microvascular damage to the blood vessels of the retina
57
What is hypoglycaemia?
extremely low blood glucose levels
58
What are risk factors for hypoglycaemia?
alcohol intake without food, loss of weight without change in dose, taking too much meds/insulin, pregnancy
59
What are symptoms of hypoglycaemia?
cold/clammy skin, headache, hunger, nervousness, tachycardia, confusion, nausea, numbness/tingling
60
What is hyperglycaemia?
high blood glucose levels
61
what are risk factors for hyperglycaemia?
corticosteroids, emotional/physical stress, illness, infection, lack insulin
62
What are symptoms of hyperglycaemia?
abdominal cramps, blurred vision, elevated BG, headache, increased urination, weakness, fatigue
63
What are symptoms of hyperglycaemia?
abdominal cramps, blurred vision, elevated BG, headache, increased urination, weakness, fatigue
64
What is environmental data?
home characteristics, community characteristics, access to healthcare
65
What is the Friedman family assessment model?
identifying data, developmental stage and history, family structure, family function, family coping
66
What is the Calgary family assessment model?
developmental stages, structural, developmental, functional
67
What is ethnicity?
a family's cultural, historical, linguistic and ethnic origin
68
What is race?
influences individual members and group identification
69
What is social class?
shaped by education, income and occupation
70
What is religion and spirituality?
can influence their ability to cope with or manage an illness or health concern
71
What is environment?
the larger community, neighbourhood and home contexts
72
What is gender?
a set of beliefs or expectations of masculine and feminine behaviours and experiences
73
What is rank order?
order of children by age and gender
74
What are subsystems?
smaller groups of relationships within a family
75
What is a functional assessment?
how family members interact and behave towards each other
- instrumental functioning
- expressive functioning
76
What is instrumental functioning?
the normal activities of daily living
77
What is expressive functioning?
the ways in which people communicate
- emotional communication
- verbal communication
- nonverbal communication
- circular communication
- problem solving
- roles
78
What is developmental assessment?
nteractions between an individuals development and the phase of the family developmental lifestyle
1) family life stages
2) tasks
3) attachments
79
What is the McGill/Developmental Model?
family as a subsystem, health as the focus of worth, learning the process through which the health behaviours are acquired
80
What is a randomized control trial used for?
effectiveness of a prevention or treatment/therapy/intervention
81
What is a randomized control trial?
strongest design, people randomly selected to receive the intervention or not to
82
What are pros of randomized control trial?
random selection and longitudinal
83
What are cons of randomized control trial?
cost, long period follow up, generalizability
84
What are cohort analytic studies used for?
effectiveness of a prevention, treatment, intervention
85
What is a cohort analytic study?
longitudinal, prospective study
- 2 groups people select control or experimental
- NO randomization
- group differences may be due to factors that were there prior to intervention
86
What are cons of cohort analytic study?
increased bias, expensive
87
Cohort analytic study
Eligible participants --> non random allocation
- -> a) school based --> i) outcome ii) no outcome
- -> b) diet exercise --> i) outcome ii) no outcome
88
What is investigator triangulation?
more than 1 data collector
89
What is theory triangulation?
findings are examined in relation to existing theories
90
What is member checking?
come up with an idea and go back to ask the participant
91
What is PICO?
Population, intervention, comparison, outcome
92
What is a case control study used for?
exposure is related to an outcome
93
What is a case-control study?
looks at 2 groups of people, those that were exposed to the intervention and those that weren't (look back in time)
94
What are pros of case-control studies?
allows assessment of unreachable populations, control group included
95
What are the negative of case-control studies?
hard to get control group that matched perfectly
96
What is the mechanism of case-control studies?
Eligible participants
- -> outcome --> i) exposure ii) no exposure
- -> no outcome --> i) exposure ii) no exposure
97
What is a cohort study used for?
What is the likelihood that a person will experience or develop the outcome if they are exposed to a disease
98
What is a cohort study?
participants are followed over time, ensure the disease preceded outcome
99
What is the mechanism of a cohort study?
eligible participants with exposure
- -> outcome
- -> no outcome
100
What is a phenomenological approach?
the lived experience of individuals
101
What is grounded theory?
the process that shapes behaviour and interaction
102
What is ethnographic study?
how cultural knowledge, norms, values influence one's life experience within social context of a culture or subculture
103
What is homogenous sampling?
select participants who have similar narratives of a phenomenon
104
What is heterogenous sampling?
select participants who can provide different narratives of a phenomenon
105
What is snowball sampling?
used when no sampling frame exists
106
What is theoretical sampling?
associated with grounded theory, aim to seek data that challenge emerging ideas
107
What is the effect of smoking on surgery?
smokers are at an increased risk for post op complications
- increased mucous thickness
- greater difficulty clearing airways
108
What is the effect of alcohol/substance abuse on surgery?
predispose the patient to adverse reactions of anesthetic, cross-tolerant, withdrawal
109
What is the effect of obesity on surgery?
reduce respiratory and cardiac function, increased risk of embolus, pneumonia, poor wound healing, dehiscence
110
What is the effect of immunocompetence on surgery?
excess thinning of skin, destruction of collagen, impaired vascularization, infection, poor wound healing
111
What is the effect of malnourishment on surgery?
poor tolerance of anesthesia, delayed blood clotting mechanism, infection, poor wound healing
112
What is the effect of young age in surgery?
less BV, dehydration, over hydration, airway management, temperature management
113
What are respiratory complications of surgery?
airway obstruction, hypoxemia, hypoventilation, atelectasis (collapsed lung)
114
What are cardiovascular complications of surgery?
hypotension, hypertension, dysrhythmia, fluid retention, DVT, syncope
115
What are the neurological complications of surgery?
delirium, delayed awakening
116
What are the GI/GU complications of surgery?
nausea and vomitng, post operative ileus, paralytic ileus, low urine output, urinary retention
117
What are integument complications of surgery?
surgical site infections
118
What are psychological complications of surgery?
anxiety, depression, confusion, delirium, disturbed sleep pattern, body image
119
What is the mechanism of biguanides?
enhance insulin sensitivity in the tissues and improve glucose transport into the cells
- doesn't promote weight gain
120
What is the mechanism a-glucosidase inhibitors?
slow down the absorption of carbs in the small intestine
| - not effective against hyperglycaemia
121
what is the mechanism DPP-4 inhibitors?
enhance incretin pathways, stimulates the release of pancreatic beta cells
122
What is the mechanism of SGLT inhibitors?
block the reabsorption of glucose by kidney, increasing glucose excretion and decreasing blood glucose levels
- enhances urinary glucose excretion
123
What the mechanism of insulin secretagogues?
increases beta cell insulin production from the pancreas
- promotes weight gain
- hypoglycaemia
124
What is the mechanism meglitinides?
stimulate a rapid and short lived release of insulin from the pancreas
- more rapidly absorbed and eliminated
125
What is the mechanism of thiazolidediones?
improve insulin sensitivity transport and utilization
| - increased HDL and BP
126
What causes motor dysfunction in stroke patients?
symptoms are caused by destruction of motor neurons in the pyramidal tract
127
What is the outcome of elimination function in stroke patients?
prognosis of only one hemisphere affected is good because there is partial sensation of bladder filling and voluntary urination, constipation is common
128
What are warning signs of a stroke?
face drooping, arm weakness, speech difficulty
129
What is the most important point in a patients history?
time of onset
130
What is the time frame in which stroke will be assessed, acute health needs adressed, undergo diagnostic studies and receive thrombolytic therapy
4.5 ours from onset of symptoms
131
What does acute care begin with?
airway
breathing
circulation
132
What is the number of patients that worsen in the first 24-48 hours?
25%
133
What always increases after stroke and what meds are given?
bp always increases; give antihypertensive
134
T/F: many acute interventions are continued into rest of care
true
135
Physical therapy focus on
- mobility
- progressive ambulation
- transfer techniques
- equipment needed
136
Occupational therapy focuses on
- retraining skills of daily living
| - cognitive and perceptual training
137
Speech therapy focuses on
- speech
- communication
- verbal and eating abilities
138
T/F: risk of aspiration pneumonia is low due to impaired consciousness and dysphagia
- false; its high
139
T/F: Enteral tube feedings also place the patient at risk for aspiration pneumonia
true
140
T/F: only certain patients should be screened for swallowing ability and kept on NPO until they know
false: all patients
141
What kind of airway is used to prevent the tongue from falling back and obstructing airway
oropharyngeal
142
If a artificial airway is needed what may need to occur?
tracheostomy
143
When should oral care be preformed when patients are on vent to prevent occurrence of vent assisted pneumonia
every 2 hours
144
What scale is used to evaluate and document neurologic status in acute stroke?
NIH stroke scale
145
What does NIHH measure?
- severity
| - predicts short and long term outcomes
146
Goals for cardiovascular system are
- maintaining homeostasis
147
Why is hypertension sometimes seen after a stroke?
to increase cerebral blood flow
148
What is important to monitor for before ambulating patient?
orthostatic hypotension
149
After a stroke a patient is at risk for
venous thrombo embolism: not moving around much
150
Most effect prevention of VTE is
mobility
151
How should u position the joints ?
higher than the joint closer to it to prevent edema
152
T/F: skin is highly susceptible to breakdown after a stroke; compounded by
- true; lack of mobility, circulation and sensation
| - age, poor nutrition, edema, dehydration and incontinence
153
What is the most common bowel problem for patients after a stroke?
constipation
154
What is used to prevent or treat constipation?
- stool softeners (laxatives, suppositories)
155
T/F: remove indwelling catheter as soon as possible to prevent infection
true
156
Bladder retraining:
- adequate fluid intake (7am-7pm)
- observe for restlessness (pee)
- scheduled toileting
- bladder distention assessment
157
Patients with left or right side stroke or at higher risk
right; mobility difficulties
158
In wha time span should the nutritional needs be met by someone who has had a stroke
- 72 hours
159
What position and how long should the patient be in it after feeding
high fowlers; 30 min
160
T/F: pureed foods and thin liquids are the best choice
false; to bland and smooth; can choke
161
T/F: milk products should be avoided as they increase viscosity of mucous and salivation
true
162
How is the effectiveness of dietary programs evaluated?
- maintenance of weight
- adequate hydration
- patient satisfaction
163
4 ways to check for swallowing safety
- sit patient at 90 degree angle
- assist patients head forward
- assist patient to remain sitting for 30 min
- ensure no food pocketing
164
Delirium risk factors
- older than 65 or 70
- alcohol use
- depression
- extensive surgery
- hip fracture
- previous delirium
- severe illness
165
agnosia
inability to recognize object by sight, touch or hearing
166
apraxia
inability to carry out learned sequential movements by command
167
t/f: elimination issues are temporary
true
168
anomic apasia
least severe; difficulty naming things
169
Dysarthia:
issue with muscle movement of speech
170
2/3 strokes occur in people above what age?
65 years
171
T/F: strokes are more common in men
true
172
What is the single most important risk factor for stroke?
hypertension
173
Diabetes increases the chance of getting a stroke by how many times?
4-5x higher
174
What does the severity of function loss depend on?
- location
| - extent of brain involved
175
T/F: stroke is the third most common cause of death in Canada
true
176
Who gets strokes more? men or women
men
177
Who is more likely to die from a stroke?
women
178
t/f: those of colour are more likely to get a stroke
true
179
What arteries supply the brain?
- internal carotid
| - vertebral
180
When does cell death occur?
after 5 min
181
when do thrombotic strokes occur?
- during sleep or after sleep
182
How do signs and symptoms of thrombotic strokes develop?
slowly
183
What is the most common stroke? 60%
thrombotic
184
2/3 of thrombotic strokes are associated with
- diabetes and hypertension
185
what are the two subtypes of hemorrhagic strokes?
- intracerebral: ruptured vessel
| - subarachnoid: intrancranial bleeding into CSF
186
When do intracerebral strokes occur? Sudden or gradual onset of symptoms?
with activity; sudden onset with fast progression
187
Possible causes of subarachnoid strokes are
- drugs
| - trauma
188
t/f: ischemic and hemorrhagic symptoms are the same
true
189
What would a stroke in the middle cerebral artery lead to?
greater weakness in upper extremities
190
Aphasia
total loss of comprehension and use of language
191
dysphagia
inability to communicate
192
t/f: if stroke affects one side of your brain it usually doesnt interfere with bladder problems
true
193
most important tests
- MRI
| - non contrast CT
194
Which kind of infections are stroke patients particularly vulnerable to?
respiratory
195
t/f: patients with left sided stroke are commonly faster in organization and performance
false; slower
196
homonymous hemianopsia
blindness in the same half of each visual field
197
diplopia
double vision
198
ptosis
drooping eyelid
199
Nutrition: patients with severe impairment may require
- enteral: directly into stomach
| - parenteral: into vein
200
How to assess swallowing
- elevate bed and presume with crushed ice or ice water to swallow
201
Wound Dehiscence
separation and disruption of previously joined wound edges; preceded by sudden discharge
202
Wound Evisceration
visceral organs protrude through wound opening
203
t/f: Surgical wound dressings are left dry and untouched for minimum 48 h postop
true
204
first sense to return in unconscious patients is
Hearing
205
emergence delirium
Occasionally patients will wake up agitated; a condition in which patients may be disoriented to place, time, and person.
206
- The goal of PACU care
is to identify actual and potential patient problems that may occur as a result of anaesthetic administration and surgical intervention
207
delirium tremens
post op reaction characterized by restlessness insomnia nightmares, tachycardia, apprehension, confusion, disorientation, irritability, hallucinations due to alcohol withdrawal
208
Three phases of PACU
1. right after surgery; intense monitoring and ECG
2. Ambulatory surgery patients; prepare for transfer home etc
3. prepare patient for self care
208
Three phases of PACU
1. right after surgery; intense monitoring and ECG
2. Ambulatory surgery patients; prepare for transfer home etc
3. prepare patient for self care
209
One side neglect is common in left or right stroke?
- right; forget to shave or dress one side
