Terms and Knowledge Flashcards
(521 cards)
0
Q
The exchange of _____________ ___________ occurs between the environment and the ______.
A
Respiratory gases, blood
1
Q
Which two systems supply the oxygen demands of the body?
A
Cardiac and Respiratory
2
Q
The exchange of oxygen and carbon dioxide during cellular metabolism
A
Respiration
3
Q
Medical problems that affect oxygenation:
A
COPD Asthma Bronchitis Cancer (lung) Pregnancy Exercise MI Allergies Obesity Croup
4
Q
What is an MI?
A
A myocardial infarction is irreversible tissue death because of absence or diminished blood supply.
5
Q
What is COPD?
A
A non-curable combination of emphysema and bronchitis (Chronic Obstructive Pulmonary Disease)
6
Q
Ineffective ______ and Ineffective _____ _______ are two problems with meeting oxygen needs.
A
Heart (pump), Gas exchange
7
Q
Primary function of the lungs:
A
Transfer oxygen from the atmosphere into the alveoli and carbon dioxide out of the body.
8
Q
Airways of lung transfer oxygen from the _________ to the _______ where oxygen is exchanged for ______ _______
A
Atmosphere, Alveoli, Carbon Dioxide
9
Q
Through the _____ ________ membrane, ______ transfers to the _______ and _____ ______ transfers from the ______ to the ______
A
alveolar capillary, oxygen, blood, carbon dioxide, blood, alveoli
10
Q
Causes gases to move into and out of the lungs
A
Pressure change
11
Q
________ pressure is ______, (less than ______ pressure which is ____ mm Hg at sea level).
A
Intrapleural, negative, atmospheric, 760
12
Q
The major inspiratory muscle of respiration
A
Diaphram
13
Q
The diaphragm and external intercostal muscle contract to creat negative pleural pressure and increase size of thorax.
A
Inspiration
14
Q
The process of moving gases into and out of the lungs
A
Ventilation
15
Q
The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.
A
Perfusion
16
Q
Exchange of respiratory gases in the alveoli and capillaries
A
Difussion
17
Q
The effort required to expand and contract the lungs
A
Work of Breathing
18
Q
The amount of energy expended on breathing depends on:
A
Depth of breathing
Rate of breathing
Compliance
Airway Resistance
19
Q
An active process, stimulated by chemical receptors in the aorta
A
Inspiration
20
Q
A passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work
A
Expiration
21
Q
Chemical produced in the lungs to maintain the surface tention of the alveoli and keep them from collapsing
A
Surfactant
22
Q
Collapse of the alveoli that prevents the normal exchange of oxygen and carbon dioxide
A
Atelectasis
23
Q
The ability o the lungs to distend or expand in response to increased intra-alveolar pressure
A
Compliance
24
Compliance decreases in:
Pulmonary Edema
Interstitial Fibrosis
Pleural Fibrosis
Congenital Structural Abnormalities (Kyphosis)
Traumatic Structural Abnormalities (Fractured ribs)
25
The increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli
Airway resistance
26
Diseases that cause airway obstruction:
Asthma
| Tracheal edema
27
The amount of air exhaled after normal inspiration
Tidal Volume
28
The amount of air left in the alveoli after a full expiration
Residual volume
29
The maximum amount of air that can be removed from the lungs during forced expiration
Forced Vital Capacity
30
Measures the volume of air entering or leaving the lungs
Spirometry
31
Primary function is to move blood to and from the alveolar capillary membranes for gas exchange
Pulmonary Circulation
32
Flow of Pulmonary circulation:
Right ventricle--Pulmonary Artery--Pulmonary arterioles--Pulmonary capillaries--Alveolar capillary membranes(Exchange of gases/Diffusion)--Pulmonary venules-- Pulmonary veins--Left atrium
33
Delivery of oxygen depends on:
Ventilation (Amount of oxygen entering the blood)
Perfusion (blood flow tot he lungs and tissues
Rate of Diffusion
Oxygen-carrying cappacity
34
Carrier for oxygen and carbon dioxide, transports 97% of oxygen
Hemoglobin
35
Carbon dioxide diffuses into red blood cells and is hydrated into ________ _____.
Carbonic Acid
36
Carbonic acid dissociates into ______ and ________.
Hydrogen (H)
| Bicarbonate (HCO3-)
37
_________ blood transports majority of carbon dioxide back to the lungs to be exhaled.
Venous
38
_______ and _________ regulators control the process of respiration
Neural and Chemical
39
Neural regulation controls:
```
Respiratory rate
Respiratory Depth
Respiratory rhythm
(CNS)
Voluntary control of respiration (Cerebral cortex)
```
40
Maintains rate and depth of respirations based on changes in the blood concentrations of CO2 and O2 and hydrogen ion concentration (pH)
Chemical regulation
41
Cardiovascular flow:
Deoxygenated blood---- right side of heart----- lungs----- left side of heart (DR.LL)
42
The right ventricle pumps blood through the ________ circulation
Pulmonary
43
The left ventricle pumps blood through the ________ circulation
Systemic
44
As the myocardium stretches, the strength of the subsequent contraction increases.
Starling's law
45
S1 sounds are the closing of:
Mitral and tricuspid valves
46
S2 sounds are the closing of:
Aortic and pulmonic valves
47
Branch of systemic circulation that supplies the myocardium with oxygen and nutrients and removes wastes
Coronary artery circulation
48
Arteries and veins that deliver nutrients and oxygen to the tissues and remove waste products
Systemic circulation
49
Amount of blood ejected from the left ventricle each minute
Cardiac output
50
Amount of blood ejected from the left ventricle with each contraction
Stroke volume
51
Cardiac output=
Stroke volume x Heart rate
52
Normal cardiac output
4-6L/min
53
Amount of blood in the left ventricle at the end of diastole
Preload
54
Resistrance to the left ventricular ejection
Afterload
55
Generates electrical impulses that are needed for a normal heartbeat
Conduction system (of the heart)
56
Normal sinus rhythm originates at the ___ ______ and follow the normal sequence through the conductive system
SA node (pacemaker of the heart)
57
Normal Sinus rhythm
75bpm (NSR)
58
Rate at which impulses are initiated at the SA node
Normal Sinus Rhythm
59
Sinus rhythm of 40-60bpm
AV is transmitting impulses
60
Mediates impulses between the atria and the ventricles
AV node
61
Reflects the electrical activity of the conduction system
Electrocardiogram (ECG)
62
Influences the rate of impulse generation and the speed of conduction pathways; two systems: sympathetic and parasympathetic
Autonomic nervous system
63
Increases the rate of impulse generation and impulse transmission and innervates all parts of the atria and ventricle
Sympathetic nervous system (fight or flight)
64
Decreases the rate and innervates atria, ventricles, and sinoatrial and atrioventricular nodes
Parasympathetic System (Digestion)
65
Flow of conduction system
Sinoatrial node--atrioventricular node--bundle of His--Bundle branches--Purkinje fibers
66
Deoxygenated blood goes to the ______ side of the heart
right
67
Oxygenated blood goes to the _____ side of the heart
left
68
Physiological factors that affect oxygenation:
Decreased oxygen-carrying capacity
Hypovolemia
Decreased inspired oxygen concentration
Conditions affecting chest wall movement (pregnancy, obesity)
Musculoskeletal abnormalities (trauma, neuromuscular disease, CNS alterations)
Influences of chronic disease
69
Factors affecting oxygenation:
Physiological factors
Developmental factors
Lifestyle
Environmental
70
Representation of electrical conduction through both atria.
P wave
71
Representation and average travel time of impulse through the conduction system
PR interval- 0.12-0.2 seconds
72
Increase in PR wave indicates:
a block in the impulse transmission through the AV node (greater than 0.2seconds)
73
Decrease in PR wave indicates:
the initiation of the electrical impulse from a source other than the SA node (less than 0.12 seconds)
74
Indicates that the electrical impulse traveled through the ventricles (and average time)
QRS complex (0.06-0.1 seconds)
75
Atrial contraction follows the ________ and ventricular contraction follows the ________.
P wave, QRS complex
76
Increase in QRS duration indicates:
delay in conduction time trough the ventricles.
77
Representation and average time needed for ventricular depolarization and repolarization
QT interval (0.12-0.42seconds)
78
_______ varies inversely with changes in the heart rate
QT interval
79
increase in QT interval is caused by:
changes in electrolyte values, hypocalcemia, therapy with drugs (disopyramide/Norpace, amiodarone/Cordarone)
80
Decrease in QT interval occurs when:
Digitalis therapy, hyperkalemia, hypercalcemia
81
Alterations is respiratory functioning
Hypoventilation
Hyperventilation
Hypoxia
82
Alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide.
Hypoventilation
83
```
Signs and symptoms:
Mental status change
Dysrhythmias
Potential Cardiac Arrest
Convulsions
Unconsciousness
```
Hypoventilation
84
State of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism
Hyperventilation
85
```
Signs and symptoms:
Rapid respirations
Sighing breaths
Numbness
Tingling of hands/feet
Light-headedness
Loss of consciousness
```
Hyperventilation
86
Inadequate tissue oxygenation at the cellular level
Hypoxia
87
Causes of Hypoxia
Decreased hemoglobin level and lowered oxygen-carrying capacity of the blood
A diminished concentration of inspired oxygen (high-altitudes)
The inability of the tissues to extract oxygen from the blood (cyanide poisoning)
Decreased diffusion of oxygen from the alveoli to the blood (pneumonia)
Poor tissue perfussion with oxygenated blood (shock)
Impaired ventilation (rib fractures/chest trauma)
88
Sites of cyanosis for hypoxemia
Central cyanosis: tongue, soft palate, conjunctiva
89
Peripheral cyanosis
extremities, nail beds, earlobes
90
Alterations in cardiac functioning:
```
Disturbances in conduction (Dysrhythmias)
Tachycardia
Bradycardia
Atrial Fibrillation
Paroxysmal supra ventricular tachycardia
Ventricular Dysrhythmias
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
(REQUIRE IMMEDIATE INTERVENTION-LIFE-THREATENING)
```
91
Rhythm disturbances caused by electrical impulses that do not originate from the SA node.
Dysrhythmias
92
Signs and symptoms of left-sided heart failure
```
Fatigue
Breathlessness
Dizziness
Confusion
Crackles in the base of lungs
Hypoxia
Shortness of breath on exertion
Cough
Paroxysmal nocturnal dyspnea
*Left sided lungs*
```
93
Signs and symptoms of right-sided heart failure:
```
Weight gain
Distended neck veins
Hepatomegaly
Splenomegaly
Dependent peripheral edema
*Right sided=body*
```
94
acquired or congenital disorder of a cardiac valve by stenosis or regurgitation
Impaired valvular function
95
Coronary artery flow to the myocardium insufficient to meet myocardial oxygen demands- results in angina, or MI/ACS(acute coronary syndrome)
Myocardial ischemia
96
Failure of the myocardium to eject sufficient volume to the systemic and pulmonary circulations- results in right or left sided heart failure
Altered cardiac output
97
Transient imbalance between myocardial oxygen supply and demand
Angina
98
Signs and symptoms:
Chest pain: aching, sharp, tingling, burning, or feels like pressure
Left-sided or substernal
Can Radiate to left or both arms, jaw, neck and back
Relieved with rest and coronary vasodilators (nitroglycerin)
Lasts 3 to 5 minutes
Angina
99
Results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion
MI (myocardial infarction)/ ACS (acute coronary syndrome)
100
Signs and symptoms:
Chest pain: crushing, squeezing or stabbing
Left chest and sternal area and maybe back
May radiate down the left arm, neck, jaw, teeth, epigastric area, and back
Lasts more than 20 minutes
Male MI
101
```
Signs and symptoms:
Angina
Fatigue
Indigestion
Shortness of breath
Back or jaw pain
```
Female MI
102
Subjective sensation of difficult or uncomfortable breathing. Sign of hypoxia
Dyspnea
103
An abnormal condition in which a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated
Orthopnea
104
Bloody sputum
Hemoptysis
105
Signs and symptoms of CO poisoning
Malaise
Flulike symptoms
Excessive sleepiness
106
Dyspnea management includes:
```
Airways maintenance
Mobilization of pulmonary secretions
Hydration
Humidification
Nebulization
Coughing and deep-breathing techniques
Chest physiotherapy (postural drainage- SYSTIC FIBROSIS)
Splinting w/ pillow
Percussion sequence
```
107
If oxygen is greater than _______, humidification is needed
4L/minute
108
Cardio protective nutrition
Diets rich in fiber
109
The goal of oxygen therapy is to use the ______ ______ ____ _______ ______ for an acceptable blood oxygen level without causing harmful side effects
Lowest Fraction of Inspired Oxygen (FiO2)
110
Purpose of oxygen therapy:
Prevent or relieve hypoxia
111
Oxygen therapy is for patients with an arterial partial pressure (PaO2) of _____ mm Hg or less OR arterial oxygen saturation (SaO2) of ____% or less on room air at rest, on exertion or with exercise
55, 88
112
Determines ability of the lungs to efficiently exchange oxygen and carbon dioxide
Pulmonary Function tests
113
Patient walks on a treadmill at a specified speed and duration of time. test evaluates the cardiac response to physical stress.
ECG exercise stress test
114
This is a noninvasive measure of heart structure and heart wall motion. It graphically demonstrates overall cardiac performance
Echocardiography
115
Portable ECG worn by patient. The test produces a continuous ECG tracing over a period of time. Evaluation of ECG goes along with diary patient keeps of ADLs.
Holter monitor
116
Used to visualize cardiac chambers, valves, the great vessels, and coronary arteries. Pressures and volumes within the four chambers of the heart are also measured
Cardiac catheterization and Angiography
117
Visual examination of the tracheobronchial tree through a narrow flexible fiberoptic bronchoscope
Bronchoscopy
118
Surgical perforation of chest wall and pleural space with a needle to aspirate fluid for diagnostic or therapeutic purposes or to remove a specimen for biopsy
Thoracentesis
119
Obtained to identify a specific microorganism or organism growing in the sputum
Sputum specimens
120
Provide important information for assessment of patient's respiratory and metabolic acid/base balance and adequacy of oxygenation
Arterial blood gases
121
ECG stress test with the addition of thallium-201 injected intravenously. Determines coronary blood flow changes with increased activity
Thallium stress test
122
A slow heartbeat marked by a pulse rate below 60 beats per minute
Bradycardia
123
Abnormally rapid respirations
tachypnea
124
Abnormally slow breathing
bradypnea
125
absence of oxygen
Anoxia
126
Air hunger resulting in labored or difficult breathing, sometimes accompanied by pain. It is normal when due to vigorous work or athletic activity, but should quickly return to normal when the activity ceases.
Dyspnea
127
An abnormally rapid heart rate, greater than 100 beats per minute
Tachycardia
128
An oxygen deficiency in body tissues. A decreased concentration of oxygen in inspired air
Hypoxia
129
Increased minute volume ventilation, which results in a lowered CO2 level (hypocapnia). Frequent finding in many disease processes such as asthma, metabolic acidosis, pulmonary embolism, and pulmonary edema, and also in anxiety-induced states
Hyperventillation
130
Labored breathing that occurs when lying flat and improves when standing or sitting up.One of the classic symptoms of left ventricular heart failure, although occasionally occurs in other cardiac or respiratory illnesses
Orthopnea
131
Reduced rate and depth of breathing that causes an increase in carbon dioxide
Hypoventilation
132
The expectoration of blood that arises from the larynx, trachea, bronchi, or lungs
Hemotypsis
133
Used when a patient can cough effectively but is not able to clear secretions
Oropharyngeal and nasopharyngeal suctioning
134
Used when the patient is unable to manage secretions
Orotracheal and nasotracheal suctioning
135
A component of pulmonary hygiene, consists of drainage, positioning and turning and is sometimes accompanied by chest percussion and vibration
Postural drainage
136
Group of therapies for mobilizing pulmonary secretions
Chest Physiotherapy (CPT)
137
Adds moisture or medications to inspired air by mixing particles of varying sizes with air
Nebulization
138
Prevents obstruction of the trachea by displacement of the tongue into the oropharynx
Oral airways
139
Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions
Endotracheal and tracheal airways
140
Long-term assistance, surgical incision made into trachea
Trachostomy
141
Maintainence and promotion of lung expansion includes:
Ambulation
Positioning (45degrees semi-fowlers- reduces pulmonary stasis, maintains ventilation and oxygenation)
Incentive spirometry (encourages voluntary deep breathing)
Noninvasive ventilation (maintains positive airway pressure and improves alveolar ventilation)
CPAP
142
Restoration of Cardiopulmonary Functioning: CPR:
C irculation
A irway
B reathing
(Defibrillation/AED)
143
Restorative and Continuing Care:
Rehabilitation
Incentive Spirometer
Pursed Lip Breathing
Diaphragmatic breathing
144
Carbon dioxide transport
diffused into red blood cells--hydrated into carbonic acid (H2CO3)--dissociates into hydrogen (H) and bicarbonate (HCO3-)--Hemoglobin buffers the hydrogen ion (deoxyhemoglobin),bicarbonate diffuses into plasma--deoxyhemoglobin combines with carbon dioxide and venous transports back to lungs--exhaled
145
Access to sufficient, safe and nutritious food to maintain a healthy lifestyle.
Food security
146
Diet therapy
Diets used for disease control (such as Diabetes 1 (DM) or mild hypertension)
147
Energy needed to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature)
BMR- Basal metabolic rate
148
Factors affecting energy requirements
```
Gender
Body mass
Menstruation
Illness
Fever
Starvation
Injury
Infection
Age
Thyroid
Activity
```
149
Amount of energy that an individual needs to consume over a 24-hour period for the body to maintain all of its internal working activities while at rest.
REE- Resting energy expenditure
150
Factors influencing metabolism
illness
pregnancy
lactation
activity level
151
If energy requirements are completely met by kcal intake in food, weight ___________. If exceeded, weight _________. If not met, weight ______.
Remains the same, goes up, goes down
152
The elements necessary for the normal function of numerous body processes. Carbohydrates, proteins, fats, water, vitamins and minerals are all examples.
Nutrients
153
Proportion of essential nutrients to the number of kilocalories
Nutrient density
154
Produces 4kcal/g
main source of fuel
Glucose for the brain
Consists of complex and simple saccharides
Carbohydrate
155
A polysaccharide that is the structural part of plants and is not broken down by human digestive enzymes
Fiber
156
Produces 4kcal/g
Essential for building of body tissue, maintenance, and repair
Collagen, hormones, enzymes, immune cells, DNA and RNA
Amino Acids
Necessary for nitrogen balance
Protein
157
Achieved when the intake and output of nitrogen are equal.
Nitrogen balance
158
Produces 9kcal/g
Consists of triglycerides and fatty acids
Saturated, polyunsaturated and monounsaturated
Linolenic acid
Calorie dense
Fats
159
Makes up 60-70% of body weight
Greater percentage for lean people (because more is in the muscle)
All cell function depends on a fluid environment
Water
160
Organic substances present in small amounts
Chemicals that act as catalysts in biochemical reactions
Essential for metabolism
Water-soluble or fat-soluble
Vitamins
Fat-soluble: A, D, E, K
water-soluble: C, B (8 B vitamins)
161
Inorganic elements essential as Catalysts for enzymatic reactions
Macro-minerals(100mg or more per day) (balance pH)
Trace elements (less than 100mg per day)
Minerals
162
```
Begins in the mouth and ends in the small and large intestines.
Uses enzymes (protein-like substances that act as catalysts to speed up chemical reactions)
```
Digestion
163
Wavelike muscular contractions that move fod
Peristalsis
164
Villi increase surface area for this
Works by means of passive diffusion, osmosis, active transprt, and pinocytosis
Intestine is primary area
Absorption
165
Refers to all of the biochemical reactions within the cells of the body
Metabolism
166
building of more complex biochemical substances by synthesis of nutrients
Anabolism
167
Breaking down of biochemical substances into simpler substances and occurs during physiological states of negative nitrogen balance (starvation) when wasting of body tissues occurs
Catabolism
168
Chyme is moved through peristalsis and is changed into feces
Elminiation
169
Acceptable range of quantities of vitamins and minerals for each gender and age group
DRIs- Dietary Reference Intakes
170
The average needs of 98% of the population (not exact individual needs)
RDA- Recommended Dietary Allowance
171
Amounts of nutrients on a food label
Daily values
172
Keep total fat intake between ____ and ____ % of total calories
20, 35
173
A measurement system of the size and makeup of the body
Anthropometry
174
Provides an estimate of what a person should weight
Ideal body weight
175
Measures weight corrected for height and serves as an alternative to traditional height-weight relationships. Calculated by dividing the patient's weight in kilograms by height in meters squared (kg/m^2)
BMI (body mass index) 25-30=overweight
176
Included in Health Assessment:
```
Health status
Age
Cultural background
Religious food pattern
Socioeconomic status
Personal food preferences
Psychological factors
Use of alcohol/illegal drugs
Use of OTC supplements or drugs
Prescription drugs
General nutrition knowledge
```
177
Difficulty swallowing
Dysphagia
178
Nursing diagnosis for Nutrition
```
Risk for aspiration
Readiness for enhanced nutrition
Imbalanced nutrition (more or less than body requirements)
Feeding self-care deficit
Diarrhea
Deficient knowledge
Impaired swallowing
```
179
Causes of Anorexia
Pain
Fatigue
Medications
180
Preferred method of meeting nutritional needs if a patient is unable to swallow or take in nutrients orally, but has a functioning GI. Provides nutrients right to the GI.
Enteral Nutrition (EN)
181
Form of specialized nutrition support in which nutrients are provided intravenously. Uses peripheral or central line
Parenteral nutrition (PN)
182
Patients for PN
Patients unable to digest or absorb into the GI (EN)
Patients in highly stressed physiological states
Sepsis
Head injuries
Burns
183
Sometimes added to PN to provide supplemental kilocalories, prevent essential fatty acid deficiencies, and help control hyperglycemia during periods of stress
Intravenous fat emulsions
184
Enteral Feeding Complications
```
Pulmonary Aspiration
Diarrhea
Constipation
Tube occlusion
Tube displacement
Abdominal cramping
Nausea/vomiting
Delayed gastric emptying
Serum Electrolyte imbalance
Fluid overload
Hyperosmolar dehydration
```
185
Complications (metabolic) of PN
```
Electrolyte imbalance
Hypercapnia
Hypoglycemia
Hyperglycemia
Hyperglycemic hyperosmolar nonketotic coma (HHNKC)
Hyperglycemic nonketotic syndrome (HHNS)
```
186
The use of specific nutritional therapies to treat an illness, injury, or condition
MNT- medical nutrition therapy
187
MNT is necessary for:
metabolizing certain nutrients
Correcting nutritional deficiencies
Eliminating foods that worsen disease states
188
Malabsorption syndromes
Celiac disease, diverticulitis,
189
Gastrointestinal diseases:
```
Peptic ulcer
Inflammatory Bowel disease
Crohn's
Idiopathic ulcerative colitis
Malabsorption (Celiacs)
Short bowel syndrome (Lifetime EN or PN)
Diverticulitis
```
190
Treatment for diabetes type 1
Insulin and dietary restrictions
191
Treatment for diabetes type 2
```
Exercise
Diet therapy
Carbohydrate consistency and monitoring
Saturated fat less than 7%
Cholesterol less than 200mg/dL
Protein intake 15-20% of diet
```
192
Goals of diabetes mellitus
Normal to near-normal glucose levels
less than 100mg/dL LDLs
Less than 130/85 mm Hg
Avoidance of hypoglycemia
193
AHA dietary guidelines for Cardiovascular disease
balance caloric intake and exercise
Maintain healthy body weight
Eat diet rich in fruits, vegetables, complex carbohydrates
Eat fish twice per week
Limit foods/beverages high in sugar and salt
Limit trans-fat to less than 1%
194
Cancer and nutrition
Malignant cells compete with normal cells for nutrients
Anorexia, vomiting, nausea, and taste distortions are common
Malnutrition associated with cancer increases morbidity and mortality
Radiation causes anorexia, stomatitis, severe diarrhea, intestinal strictures, pain
195
Management of nutrition in cancer patients
Maximize fluid and nutrient intake
Individualize diet choices to patient's needs, symptoms, and situation
Encourage small, frequent meals and snacks easy to digest
196
Nutrition and HIV/AIDS
Body wasting and severe weight loss
Severe diarrhea, GI malabsorption, altered nutrient metabolism
hypermetabolism as a result of cytokine elevation
Maximize calories and nutrients
Encourage small, frequent, nutrient-dense meals with fluid in between
197
Freedom from physiological and physical injury. A basic human need.
Safety
198
Developed to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care systems within which they work
QSEN- Quality and Safety Education for Nurses
199
QSEN minimizes the risk of harm to patients and providers by :
System effectiveness
| Individual performance
200
What are the three basic needs?
Oxygen, Nutrition, Temperature
201
What are the signs and symptoms of carbon dioxide poisoning?
Nausea
Dizziness
Headache
Fatigue
202
Responsible for the enforcement of federal regulations regarding the manufacture, processing, and distribution of foods, drugs, and cosmetics to consumers against the sale of impure or dangerous substances.
FDA- Food and Drug Administration
203
Safety in Health Care Organizations includes;
```
Performance Improvement
Risk management and safety reports
Current reliable technology
Evidence-based practice
Safe work environment
Adequate staff education
```
204
The standards for safety have been developed by
The ANA- American Nurses Association
205
Safety in health care settings helps by:
Reducing the incidence of illness and injury
Prevents extended length of treatment/stay
Improves or maintains functionally status
Increases patient's sense of well-being
206
A safe environment includes meeting patients' _______ and _________ needs, applies to all places where patients receive ______ ,includes patients' and health care providers' __________; reduces risk of _______ and ________ of pathogens; maintains _______ and reduces _______.
physical, psychosocial, care, well-being, injury, transmission, sanitation, pollution
207
Occurs when the core body temperature is 35*C or below (95*F)
Hypothermia
208
Safety of food includes: Proper ______, Proper _____, and a clean _______ area.
Storage, refrigeration, preparation
209
Any substance that impairs health or destroys life when ingested, inhaled, or absorbed by the body.
Poison
210
The leading cause of unintentional death among adults 64 years and older
Falls
211
Any microorganism capable of producing an illness
Pathogen
212
Reduces, and in some cases prevents, the transmission of disease from person to person
Immunization
213
A harmful chemical or waste material discharged into the water, soil, or air.
Pollutant
214
Highest safety risk for Infants, toddlers, and preschoolers
Injuries
215
Highest safety risk for School-Age children
Head injuries, vehicular accidents
216
Highest safety risk for adolescents
Drinking, drugs, smoking, vehicular accidents, STIs
217
Highest safety risk for Adults
Lifestyle habits: smoking, drinking, drugs, stress
218
Highest safety risk for older adults
Falls and accidents
219
The _______ and _____- have placed increased emphasis on error prevention and patient safety
TJC (Joint Commission) and CMS (Centers for Medicare and Medicaid Services)
220
The ______ ______ ____ _______ of the Joint Commission are specifically directed to reduce the risk of medical errors
National Patient Safety Goals
221
Adverse events that should never occur in the health care setting. The CMS names them based on SREs (Serious Reportable Events)
Never Events
222
Presence of a Never Event can cause the CMS to deny _______ to hospitals
Payment
223
Provides detailed information abut chemicals, health hazards imposed, first aid guidelines, and precautions for safe handling and use of chemicals.
MSDS- Material Safety Data Sheet
224
Accidents (other than falls) in which the patient is the primary reason for the accident.
Patient-inherent accident
225
Accidents that are caused by health care providers
Procedure-related accident
226
Accidents resulting from the malfunction, disrepair, or misuse of equipment or from an electrical hazard.
Equipment-related accidents.
227
Nursing Diagnoses for patients with safety risk:
```
Risk for falls
Impaired home Maintainence
Risk for injury
Deficient knowledge
Risk for poisoning
Risk for suffocation
Risk for trauma
```
228
Any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely
Restraing
229
The ____ and _____ enforces standards for the use of restraints
Joint Commission and CMS
230
RACE in fire intervention:
R escue and remove all patients in immediate danger
A ctivate the alarm. Do this BEFORE attempting to extinguish even minor fires
C onfine the fire by closing doors and windows and turning off oxygen and electrical equipment
E xtinguish the fire using an appropriate extinguisher
231
PASS (for correct use with a fire extinguisher)
P ull pin
A im at the base of the fire
S queeze handles
S weep from side to side
232
Hyper-excitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions that is paroxysmal and episodic, causing loss of consciousness, falling, tonicity, and clonicity.
Seizure
233
A bright light, smell or taste
Aura (warning sign to a seizure)
234
Prolonged or repeated seizures indicate....
Status Epilepticus (a medical emergency and requires intensive monitoring and treatment)
235
Acute care safety includes:
```
Seizures
Poisoning
Electrical hazards
Radiation
Disasters
```
236
Hospitals must have an ______ _____ plan
Emergency management
237
The coordinated efforts of the musculoskeletal and nervous systems maintain _____, ______, and body _____ during lifting, bending, moving, and performing ADLs
Balance, Posture, Alignment
238
The relationship of one body part to another along a horizontal or vertical line.
Body Alignment
239
Occurs when a relatively low center of gravity is balanced over a wide, stable base of support and a vertical line falls from the center of gravity through the base of support
Body Balance
240
Raising the height of a bed when performing procedures is an example of
Body balance
241
Result of weight, center of gravity, and balance.
Coordinated Body Movement
242
The force exerted on a body by gravity
weight
243
Centers of gravity are usually ______ at ____ to ____% of standing height
midline, 55-57%
244
A force that occurs in a direction to oppose movement
Friction
245
To reduce friction, you need to.....
decrease surface area
246
Having a patient cross their arms over their chest when helping them move up in bed is an example of....
Reducing friction
247
Physical activity used to condition the body, improve health, and maintain fitness
exercise
248
the type and amount of exercise or activity a patient is able to perform
Activity tolerance
249
Three categories of exercise:
Isotonic
Isometric
Resistive isometric
250
Exercises that cause muscle contraction and change in muscle length. Combats osteoporosis
Isotonic exercise
251
Walking, swimming, dance aerobics, jogging, bicycling, moving arms and legs with light resistance are examples of :
Isotonic exercise
252
Exercises that involve tightening or tensing muscles without moving body parts. Decreases muscles wasting, increases circulation, increases osteoblastic activity.
Isometric Exercises
253
Contraction of gluteal muscles is an example of
Isometric exercise
254
Exercises in which the individual contracts the muscles while pushing against a stationary object. Promote muscle strength, provide sufficient stress against bone to promote osteoblastic activity
Resistive isometric exercises
255
Push-ups and hip lifting are examples of
Resistive isometric exercises
256
Bones perform which five functions in the body
```
Support
Protection
Movement
Mineral storage
Hematopoiesis (blood cell formation)
```
257
An articulation that connects bones
Joint
258
Three classifications of joints
Synovial
Cartilaginous
Fibrous
259
Joints that fit closely together and are fixed, permitting little (if any) movement. Example- Tibia and Fibula
Fibrous joint
260
Joints that have little movement but are elastic and use cartilage to unite separate body surfaces. Example: Ribs to costal cartilage
Cartilaginous joints
261
True joints that are freely movable and the most mobile, numerous, and anatomically complex body joints. Example: elbow, knee
Synovial joints
262
Three things that support the musculoskeletal system
Ligaments
Tendons
Cartilage
263
White, shiny, flexible bands of fibrous tissue that bind joints and connect bones and cartilage
Ligaments
264
White, glistening, fibrous bands of tissue that connect muscle to bone
Tendons
265
Nonvascular, supporting connective tissue with the flexibility of a firm, plastic material
Cartilage
266
Contraction of _____ ______ allows people to walk, talk, run, breathe, and participate in physical activity
Skeletal Muscle
267
Muscles that cause joint movement
Antagonistic muscles
268
Muscles that contract to accomplish the same movement
Synergistic muscles
269
Muscles that stabilize joints
Antigravity muscles
270
The _______ system regulates movement and posture
Nervous
271
The major voluntary motor area of the nervous system that regulates movement and posture is located in the _______ ______ and is called the _____ ____.
Cerebral cortex, Precentral gyrus (OR motor strip)
272
Awareness of the position of the body and its parts
Proprioception
273
Balance is controlled by the nervous system, specifically the _____ and the inner _____.
cerebellum, ear
274
Assessment of sitting patient:
_____ is erect
Neck and vertebral column are _______
body weight is distributed on the _____ and ______
Thighs are _____ and _______
Feet are _____ on the floor
_______ are supported on the armrest, in the lap, or on the table.
Head, straight, buttocks, thighs, parallel, horizontal, supported, forearms
275
```
Assessment of standing:
Head is ______
Body parts are _______
Spine is ________ with normal ________
Abdomen is _____
Knees are in a straight line between _____ and _____, slightly ______
Feet are ____ on the floor and pointed _______
Arms hang comfortably by side
```
erect, symmetrical, straight, curvatures, tucked, hips, ankles, flexed, flat, forward
276
When the patient is placed in lateral position with all supports removed except one pillow.
Recumbent
277
Three components of mobility assessment:
ROM, Gait, Exercise
278
An assessment technique used to determine the degree of damage or injury o a joint. Answers questions about joint stiffness, swelling, pain, and limited and unequal movement.
ROM
279
The manner or style of walking, including rhythm, cadence, and speed
Gait
280
Nursing diagnosis for activity and exercise;
```
Activity intolerance
Ineffective coping
Impaired gas exchange
risk for injury
Impaired physical mobility
Imbalanced nutrition: more than body requirements
acute or chronic pain
```
281
Before starting an exercise program, you must teach a patient to calculate their ____ ____ _____.
maximum heart rate
282
Calculation for maximum heart rate
Subtract current age in years from 220. (Obtain TARGET heart rate by determining 60-90% of maximum)
283
Lasts 5-10 minutes, includes stretching, calisthenics, and/or aerobic activity performed at lower intensities
Warm-up
284
Last 5-10 minutes, allows body to readjust gradually to baseline functioning and provides and opportunity to combine movement such as stretching with relaxation-enhancing mind-body awareness.
cool-down
285
______ released federal ergonomic guidelines to prevent musculoskeletal injuries in the workplace (Good body mechanics)
OSHA
286
A drop in blood pressure that occurs when a patient changes from a horizontal to a vertical position. Relieved by dangling.
Orthostatic Hypotention
287
How long should a cane be?
Equal to distance between the greater trochanter and the floor
288
How far forward should the patient move the cane before stepping?
6-10inches (15-25cm)
289
How do you measure for crutches?
Measure patient's heigh, angle of elbow flexion, and distance between crutch pad and axilla (armpit).
Should be 3-4 finger widths from axilla
30 degree elbow flexion (measured with a goniometer)
290
Four types of crutch gait
Four-point alternating gait (weight on both legs)
Three-point alternating gait (weight on one foot)
Two-point gait (partial weight on both feet)
Swing-through gait (no weight on feet)
291
In what ways does exercise help people with CHD (chronic heart disease)?
```
Reduced mortality and morbidity
Improved quality of life
Improved left ventricular function
Increased functional capacity
Decreased blood lipids and apolipoproteins
Psychological well-being
```
292
How does exercise help patients with hypertension?
Lowers blood pressure (low to moderate intensity aerobic exercise- walking/bicycling--- high-intensity aerobics/weight training have minimal benefits)
293
How does exercise help those with COPD?
Pulmonary rehabilitation helps patients reach an optimal level of functioning
294
How does exercise help patients with diabetes mellitus?
Improved glucose control
Cardiovascular fitness
Psychological well-being
Lowers blood sugar levels (at least 24hours)
(low to moderate intensity exercises, carry carbohydrates(sugar/candy) and wear med. alert bracelet)
295
A cyclical physiological process that alternates with longer periods of wakefulness.
Sleep
296
24-hour day-night cycle.
Circadian rhythm
297
Factors that affect circadian rhythms:
light
temperature
social activities
work
298
_____ _____ synchronize a person's sleep cycles.
Biological clocks
299
Sleep is regulated by the ______
CNS- central nervous system
300
The major sleep center in the body.
Hypothalamus
301
RAS
Reticular Activating System
Located in upper brainstem and maintains alertness and wakefulness by visual, auditory, pain and tactile sensory stiumuli.
302
BSR
Bulbar synchronizing region
| Takes over as stimuli to RAS decline to cause sleep
303
Two phases of normal sleep:
Nonrapid eye movement
Rapid eye movement
NREM and REM
304
A person usually passes through _____ complete sleep cycles each night.
4-5
305
Four stages of sleep:
NREM Stage 1---NREM stage 2--- NREM stage 3---NREM stage 4--- NREM stage 3----NREM stage 2--- REM sleep--- NREM stage 2-->
306
Complete sleep cycles (Stages 2-3-4-3-2-REM) lasts _________ minutes with REM ______ each cycle, with the last REM sleep being _____ during the last sleep cycle.
90-100, lengthening, 60 minutes.
307
Although the purpose of sleep is unclear, it contributes to ______ and ______ restoration. NREM sleep contributes to _____ restoration and maintenance of ________ functions (such as heart rate dropping to 60bpm or less, blood pressure, and muscle tone)
Physiological, psychological, body tissue, biological
308
_______ occur in both REM and NREM sleep are are important to learning, memory processing, and adaption to stress
Dreams
309
________ causes early-morning awakening and fatigue
Hypertension
310
Urination during the night
Nocturia
311
Caused by low levels of iron, pregnancy, renal failure or an itching sensation deep in the muscles.
RLS- Restless leg syndrome
312
Inadequacies in either quality or quantity of sleep on a daily basis. Excessive sleepiness.
Hypersomnolence
313
Involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleeping
Polyosmnogram
314
Symptom patients experience when they have chronic difficulty falling asleep, frequent awakening from sleep, and/or a short sleep or nonrestorative sleep
Insomnia
315
Practices associated with sleep
Sleep hygiene
316
Sudden muscle weakness during intense emotions such as anger, sadness, or laughter. Can occur at any time.
Cataplexy.
317
Feeling of being unable to move or talk just before waking or falling asleep
Sleep paralysis
318
OSA
obstructive sleep apnea
obesity and hypertension as risk factors
Excessive daytime sleepiness
Stopping breathing for up to 30 seconds
319
Dysfunction of mechanisms that regulate sleep and wake states.
Narcolepsy
320
_____ ______ is caused by emotional stress, medications, and environmental disturbances
Sleep deprivation
321
Signs and symptoms of sleep deprivation
Fever
Difficulty breathing
Pain
322
Signs and symptoms of Narcolepsy
REM sleep within 15 minutes of falling asleep
EDS
Cataplexy
Falling asleep uncontrollably at inappropriate times
Sleep paralysis
323
Types of sleep apnea
Primary central
Central
Obstructive
324
Sleep problems that are more common in children than adults. Include sleepwalking, night terrors, SIDS, nightmares, bed-wetting, teeth grinding, body rocking.
Parasomnias
325
Feeling mentally relaxed, free from anxiety, and physically calm.
Rest
326
Sleep needed: Neonates
16 hours/day
327
Sleep needed: toddlers
12 hours/day
328
Sleep needed: School age children
9-10 hours/day
329
Sleep needed: Young adults
6-8.5 hours/day
330
Sleep needed: Infants
8-10 hours/night (15 hours/day)
331
Sleep Needed: Preschoolers
12 hours/night
332
Sleep needed: Adolescents
7.5Hours/night
333
Sleep needed: Middle and older adults
Declines with age (from 6.5-8hours/night)
334
Physical Illnesses affecting sleep:
```
Hypertension
Respiratory
Musculoskeletal
Chronic Illness
GI
Nausea
```
335
Drugs and Substances affecting sleep:
```
Hypnotics
Diuretics
Narcotics
Antidepressants
Alcohol
Caffeine
Beta-blockers
Anticonvulsants
```
336
Nursing Diagnosis for Sleep Pattrn
```
Anxiety
Ineffective breathing pattern
Acute confusion
Compromised family coping
Ineffective coping
Insomnia
Fatigue
Sleep deprivation
Readiness for enhanced sleep
```
337
Two subjective measures of sleep:
Epworth Sleepiness Scale (evaluates severity of EDS)
| Pittsburgh Sleep Quality Index (assess sleep quality and sleep patterns)
338
Things to include in Sleep History
```
Description of problems
Usual Sleep pattern
Physical and Psychological Illness
Current Life Events
Emotional and Mental status
Bedtime routines
Bedtime environment
Behaviors of sleep deprivation
```
339
Pain involves _____, _____, and _____ components
Physical, emotional, cognitive
340
Pain results from ______ and/or ______ stimulus
Physical, Mental
341
Four physiological processes of nociceptive (normal) pain:
Transduction
Transmission
Perception
Modulation
342
Converts energy produced by stimuli into electrical energy.
Transduction
343
A sensory peripheral pain nerve fiber that receives an impulse that is sent from pain-producing stimuli and results in an action potential
Nociceptor
344
Cellular damage caused by stimuli results in the release of excitatory neurotransmitters (prostaglandins) which surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response.
Transmission
345
A symptom, not a disease. Symptoms include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feces
Constipation
346
Results from unrelieved constipation, A collection of hardened feces wedged in the rectum that a person cannot expel
Impaction
347
An increase in the number of stools and the passage of liquid, unformed feces.
Diarrhea
348
Constipation is a greater health risk for these people due to straining. Caused by feces passing through the intestines too quickly to allow for absorption of fluid and nutrients.
Recent abdominal, gynecological, or rectal surgery (effort to pass stool causes sutures to separate)
349
Factors influencing bowel elimination: Age
Infants digest food quickly because of rapid peristalsis.
| Older adults experience changes in the GI system that impair digestion and elimination
350
Factors influencing bowel elimination: Diet
Fiber- provides bulk of fecal material (whole grains, fruit, veg)
Diets high in veg and fruit decrease risk of colorectal cancer
Gas-producing foods (onions, cauliflower, beans) stimulate peristalsis
Food intolerance increases peristalsis (lactose, gluten)
351
Factors influencing elimination: Fluid Intake
Inadequate fluid intake or fluid loss affect the character of feces
Reduced fluid slows passage of food (constipation)
Increased fluid increases peristalsis (diarrhea)
Adults need 1100-1400mL/day
352
Factors influencing elimination: Physical Activity
Exercise/Activity promote peristalsis
| Immobilization depresses peristalsis
353
Factors influencing elimination: Psychological
Stress- peristalsis increases (diarrhea and gaseous distention)
Stress is associated with ulcerative colitis, IBS, gastric/duadenal ulcers, Crohn's disease
Depression slows peristalsis (constipation)
354
Factors influencing elimination: Personal habits
Work schedules
Forgetting to go
Chronic illness affects physical activity
355
Factors influencing elimination: Position
Immobilized in bed- defecation difficult
| Supine position- impossible to contract muscles for defecation
356
Factors influencing elimination: Pain
Hemorrhoids
Rectal surgery
Rectal fistulas
Abdominal surgery
357
Factors influencing elimination: Pregnancy
Size of fetus increases and pressure is exerted on the rectum
Slowing of peristalsis during third trimester (constipation)
Pregnant women frequently strain during defecation or delivery and results in hemorrhoids
358
Factors influencing elimination: Surgery/Anesthesia
General anesthetics- cease peristalsis (paralytic ileus: lasts 24-48hrs)
359
Factors influencing elimination: Medication
Laxatives and cathartics: soften stools and promote peristalsis
---Chronic use causes intestines to become less responsive to stimulation of laxatives. Can cause serious diarrhea leading to dehydration and electrolyte depletion
360
Patients at risk for impaction:
Patients who are:
debilitated
confused
unconscious
361
Signs of impaction
Inability to pass a stool for several days despite repeated urge to defecate. Continuous oozing diarrhea. Anorexia, nausea, vomiting, abdominal distention, cramping, rectal pain.
362
Results of prolonged diarrhea
Excess loss of colonic fluid, serious fluid and electrolyte or acid-base imbalances
Infants and older adults are susceptible
Skin breakdown
363
the inability to control passage of feces and gas from the anus.
Incontinence
364
When the bowel wall stretches and distends. Common cause of abdominal fullness, pain and cramping. Dispelled through mouth or anus.
Flatulence
365
Dilated, engorged veins in the lining of the rectum. Internal or external. People at risk include patients who are pregnant, with heart failure, and chronic liver disease.
Hemorrhoids
366
A temporary or permanent artificial opening in the abdominal wall
Stoma.
367
A temporary or permanent artificial opening in the ileum
Ileostomy
368
A temporary or permanent artificial opening in the colon
Colostomy
369
Fecal Occult Blood Testing: Purpose and Results
To detect blood in the stool and screen for colon cancer
| Bluish color- positive/ No color- negative
370
Examination of the upper GI tract allows more direct visualization through a lighted fiber-optic tube that contains a lens, forceps, and brushes for biopsy. Patient has nothing by mouth, removes all jewelry, Light sedation required.
Endoscopy
371
Uses high-frequency sound waves to echo off body organs creating a picture. Preparation depends on the organ to be visualized and includes NPO or no preparation
Ultrasound
372
X-ray film examination of the body from many angles uses a scanner analyzed by a computer. Preparation is usually NPO. Patient needs to lie very still, if claustrophobia is a problem, use light sedation.
Computerized Tomography Scan
373
A noninvasive examination uses magnet and radio waves to produce a picture of the inside of the body. Preparation includes NPO 4-6hrs before. No metallic objects.
Magnetic Resonance Imaging (MRI)
374
Nursing diagnosis for elimination:
```
Bowel Incontinence
Constipation
Risk for constipation
Perceived constipation
Diarrhea
Toileting self-care deficit
```
375
Types of Enemas
```
Cleansing
Tap water
Normal saline
Hypertonic Solutions
Soapsuds
Oil Retention
Carminative
Medicated
```
376
Oral, tablet, powder, or suppositories that empty the bowel short-term.
Cathartics and Laxatives (Cathartics are more powerful)
377
Instillation of a solution into the rectum and sigmoid colon. Used as temporary relief of constipation and emptying bowel before diagnostic tests or surgery.
Enema
378
Cleansing enemas
- Promote complete evacuation of feces from colon
- Stimulate peristalsis through the infusion of large volume of solution or through local irritation of the mucosa of the colon.
- Includes tap water, normal saline, soapsuds solution, and low-volume hypertonic saline
379
Tap Water Enemas
- Hypotonic and exerts osmotic pressure lower than fluid in interstitial spaces
- Net movement of water is low
- Do not repeat tap-water enemas because of water toxicity or circulatory overload
380
Normal Saline Enema
- Safest solution (Best for Infants/Children because of risk for fluid imbalance)
- Stimulates peristalsis
- Does not create danger of excess fluid absoption
381
Hypertonic Solutions Enema
- Exert osmotic pressure that pulls fluids out of interstitial spaces.
- Best for patients unable to tolerate large volumes of fluid
- Not for dehydrated patients or young infants
- 120-180mL
- Fleet enema is most common
382
Soapsuds enema
- Add soapsuds to tap water or saline (Use pure liquid castile soap)
- Creates intestinal irritation to stimulate peristalsis
- Caution in pregnant women and older adults because of electrolyte imbalance or damage to intestinal mucosa
- Either high or low pressure
383
Oil retention enemas
- Lubricate rectum and colon
- Feces absorb the oil and become softer/easier to pass
- Retained for several hours
384
Carminative enemas
- Provide relief from gaseous distention
- Improve ability to pass flatus
- MGW solution (30mL magnesium, 60mL glycerin, 90mL water)
385
Medicated enema
- Contain drugs
- Used to treat patients with dangerously high serum potassium levels
- Kayexalate (sodium polystyrene sulfonate: contains a resin that exchanges sodium ions for potassium ions in the large intestine)
- Neomycin solution (an antibiotic used to reduce bacteria in the colon before bowel surgery)
386
A pliable hollow tube that is inserted through the patient's nasopharynx into the stomach.
NG tube (nasogastric tube)
387
Position and conditions for enema
Left side, right knee flexed (because intestines curve left)
May elevate head of bed for difficulty breathing
Lukewarm water
Expel air from tubing over sink or trashcan
VERIFY ORDER
Insert correct distance (Infant- 1-1.5in, Child- 2-3in, Adult- 3-4in.)
Ask patient to take slow deep breathes and relax
388
The functional unit of the kidney, forms the urine.
Nephron (composed of the glomerulus, bowman's capsule proximal convoluted tubule, loop of Henle, distal tubule, and collecting duct)
389
Kidneys are responsible for maintaining a normal RBC volume by producing ___________.
Erythropoietin
390
Loss of voluntary control of urination caused by damage to the spinal cord above the sacral region. Urination occurs without the urge to void.
Reflex incontinence
391
Occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine.
Overflow incontinence
392
Causes of overflow incontinence
Head injury, spinal injury, multiple sclerosis, diabetes, trauma to urinary system, post anesthetic sedatives/hypnotics, tricyclics, and analgesia.
393
A life-threatening problem affecting the heart rate and blood pressure, is caused by an overly full bladder.
Hyperflexia
| Paralyzed patients
394
Decreased blood flow to and through the kidney
Prerenal
395
Disease conditions of the renal tissue
renal
396
Obstruction in the lower urinary tract that prevents urine flow from the kidneys
postrenal
397
BPH
Benign prostatic hyperplasia- enlargement of the bladder- Older men suffer this, making them prone to urinary retention and incontinence.
398
An indirect method of cleaning the blood of waste products using osmosis and diffusion, with the peritoneum functioning as a semipermeable membrane. Removes excess fluid and waste products from the bloodstream when a sterile electrolyte solution.
Peritoneal dialysis
399
Factors influencing urination
```
Diseases
Sociocultural factors
Psychological factors
Fluid imbalance
Surgical procedures
Medications
Diagnostic examinations
```
400
Awakening to void one or more times at night- a sign of renal alteration.
Nocturia
401
An excessive output of urine.
Polyuria
402
A urine output that is decreased despite normal intake
Oliguria
| *400mL/24hr
403
No urine produced
Anuria
404
Promoting increased urine formation
Diuresis
405
An accumulation of urine resulting from an inability of the bladder to empty properly. Bladder unable to respond to the micturition reflex.
Urinary retention
406
Urinary retention signs and symptoms
pressure, discomfort, tenderness over the symphysis pubis, restlessness, diaphoresis
407
Occurs if a patient has urinary retention or cannot empty the bladder completely.
Residual urine
| * >= 100mL
408
Bacteria in the urine caused by UTI
Bacteriuria
409
Bacteria in the blood stream caused by bacteriuria to spread to kidneys
Bacteremia (urosepsis)
410
Causes of UTI:
```
Residual urine in the bladder
Urinary retention (caused by obstructed catheters)
Poor perineal hygiene (inadequate handwashing, failure to wipe front to back, frequent sexual intercourse)
*Women more susceptible (shorter urethra, closer to anus)
```
411
Pain or burning during urination (symptom of UTI)
Dysuria
412
Irritated bladder causing frequent and urgent sensation of the need to void (symptom of UTI)
Cystitis
413
Blood-tinged urine caused by irritation to bladder and urethral mucosa
Hematuria
414
UTI that spreads to upper urinary tract and kidneys. Adds symptoms of fever and chills.
Pyelonephritis
415
The involuntary leakage of urine that is sufficient to be a problem. Can be temporary, permanent, continuous, or intermittent
Urinary incontinence
416
when the intra abdominal pressure exceeds urethral resistance. Muscles around urethra become weak and a small amount of urine may be leaked spontaneously
Stress incontinence (occurs more often in older women)
417
Sudden, involuntary contraction of the muscles of the urinary bladder, resulting in an urge to urinate.
OAB- Overactive bladder
| all ages, older adults more likely incontinent
418
Conditions for urinary diversion to drain urine from a diseased or dysfunctional bladder
Cancer, radiation injury to bladder, chronic urinary infection
419
Created from a distal portion of the ileum and proximal portion of the colon. Ureters are embedded, situated under the abdominal wall and has a narrow ileal segment brought through the abdominal wall to form a smal stoma.
Continent Urinary Reservoir
| *Refer to ostomy nurse
420
Uses an ileal pouch to replace the bladder. Anatomically the pouch is in the same position where the bladder was before removal, allowing patients to void normally.
Orthotopic neobladder
| *Refer to ostomy nurse
421
Urine drains continuously because a patient has not sensation or control over urinary output, requiring the application of a collection pouch at all times.
Incontinent urinary diversions
| *Refer to ostomy nurse
422
Urinary drainage directly from one or both kidneys- tube placed directly into the renal pelvis.
Nephrostomy
423
Nighttime voiding without awakening
Nocturnal enuresis
424
Most people void ____ or more times a day.
5
425
Patients who void frequently during the night may have:
Renal disease
Prostate enlargement
Cardiac disease
426
Feeling of need to void immediately
Urgency
427
Painful or difficult urination
Dysuria
428
Voiding at frequent intervals- less than 2 hours
Frequency
429
Difficulty initiating urination
Hesitancy
430
Leakage of urine despite voluntary control of urination
dribbling
431
Physical Assessment of Urinary system
Skin/Mucosal mebranes
Kidneys
Bladder
Urethral Meatus
432
Assessment of Urine
Intake and Output
Color, Clarity and Odor
Urine testing
433
Urine output ranges
1200-1500 mL
| *Hourly output of less than 30mL for more than 2 consecutive hours is cause for concern
434
Normal and Abnormal Urine color
Pale, straw color- amber color
Abnormal: Red (bleeding; Dark- kidneys or ureters, Light- bladder or urethra), Orange (phenazopyridine, uniary analgesic), Red (beets, rhubard, blackberries), Dark Amber (high concentrations of bilirubin caused by liver dysfunction)
435
Normal and abnormal Urine Clarity
Transparent
Abnormal: cloudy (from standing in container), Cloudy/foamy (high protein concentrations), thick and cloudy (bacteria or WBCs)
436
Normal and abnormal odor:
Characteristic odor
| Abnormal: Stagnant/ammonia (incontinent), Sweet/fruity (diabetes mellitus or starvation), Foul odor (infection)
437
Weight or degree of concentration of a substance compared with an equal volume of water.
Specific Gravity
* Uses a urinometer
* part of urinalysis
438
Suggested daily fluid intake
1200-1500mL
439
Involved introducing a latex or plastic tube through the urethra and into the bladder. Provides a continuous flow of urine in the patients unable to control micturition or those with obstructions
Catheterization
| *Requires a health care providers order, ASEPTIC TECHNIQUE
440
Catheter patient fluid intake
2000-2500mL
441
Involves surgical placement of catheter through the abdominal wall above the symphysis pubis into the urinary bladder
Suprapubic catheterization
442
Soft, pliable, latex sheath that slips over the penis. Suitable for incontinent or comatose men who still have complete and spontaneous bladder emptying
Condom catheter
443
Introduce a straight single-use catheter long enough to drain the bladder; when the bladder is empty, immediately withdraw the catheter; repeat as necessary
Intermittent
444
Remains in place for longer period until patient is able to void voluntarily or continuous accurate urine measurements are no longer needed
Indwelling/Foley catheter
445
Initiating an exercise program
1. Assess fitness level
2. Design the fitness program
3. Assemble equipment
4. Get started
5. Monitor progress
446
The point at which a person is aware of the pain.
Perception
| *no single pain center in brain
447
Release of inhibitory neurotransmitters which work to hinder the transmission of pain
Modulation
448
Pain has emotional/cognitive components in addition to physical sensation
Gate-control theory of pain (Melzack and Wall-1965)
449
Point at which a person feels pain
Pain threshold
450
Level of pain a person is willing to accept
Pain toleranc
451
Protective, has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. Eventually resolved, once injured area heals. Treated aggressively
Acute pain
| *unrelieved can progress to chronic pain
452
Not protective, serves no purpose. Lasts longer than 6 months and is constant or recurring with a mild-to-severe intensity
Chronic pain
| *Arthritis, back pain, myofascial pain, headache, peripheral neuropathy
453
When a person with chronic pain who consults with numerous health care providers and is labeled a drug seeker when he/she is actually seeking pain relief
Pseudoaddiction
454
Chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition.
Idiopathic pain
| *complex regional pain syndrome (CRPS)
455
usually caused by tumor progression and related treatments/infections/physical limitations
Cancer pain
456
Pain that occurs sporadically over an extended period of time, may last for hours, day, or weeks.
Chronic episode pain
| *migraine headaches, sickle cell disease
457
Factors influencing pain: psychological
Age (particularly in infants and older adults)
Fatigue (heightens perception of pain and decreases coping)
Genes (increase/decrease sensitivity to pain)
Neurological function (interrupts normal pain reception or perception)
458
Nursing Diagnosis: Pain
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Activity intolerance
Anxiety
Ineffective coping
Fatigue
Fear
Hopelessness
Impaired physical mobility
Imbalanced nutrition: less than body requirements
Insomnia
Powerlessness
Chronic low self-esteem
Impaired social interaction
Spiritual distress
```
459
Nonpharmacological pain-relief interventions
Relaxation and Guided imagery (decreases pulse, bp, respirations)
Distractions (inhibits painful stimuli)
Music (treats stress, pain, anxiety, depression)
Cutaneous Stimulation (massage, warm bath, ice bag, TENS)
Herbals (May interact with analgesics, lack of evidence)
Reducing pain perception (Remove or prevent painful stimuli)
460
Pain Assessment
OLD CARTS (onset, location, duration, characteristics, aggravating, relieving, timing, severity)
461
A variety of medications that enhance analgesics or have analgesic properties
Adjuvants
462
The coordinated efforts of the musculoskeletal and nervous systems
Body mechanics
463
The force exerted against the skin while the skin remains stationary and the boney structures move
Shear
464
Fractures caused by weakened bone tissue
Pathological fractures
465
Increased muscle contraction causes muscle shortening, resulting in movement such as when a patient uses an overhead trapeze to pull up in bed
Concentric tension
466
Helps control the speed and direction of movement
Eccentric tension
467
Combination of concentric tension and eccentric muscle actions
Isotonic contraction
468
Static contraction, causes an increase in muscle tension or muscle work but no shortening or active movement of the muscle (Instructing a patient to tighten and relax a muscle group)
Isometric contraction
469
An inducing or compelling force and occurs when specific bones such as humerus, ulna, and radius and the associated joint (such as the elbow) act together as a lever
LEverage
470
The position of the body in relation to the surrounding space
Posture
471
Normal state of balanced muscle tension
Muscle tone
472
Inclining of head to affected side, in which sternocleidomastoid muscle is contracted
Torticollis
473
Exaggeration of anterior convex curve of lumbar spine
Lordosis
474
Increased convexity in curvature of thoracic spine
Kyphosis
475
Lateral S or C shaped spinal column with vertebral rotation, unequal height of hips and shoulders
Scoliosis
476
Hip instability with limited abduction of hips and occasionally adduction contractures
Congenital hip dysplasia
477
Legs curved inward so knees come together as person walks
Knock-knee (genu valgum)
478
One or both legs bent outward at knee, normal until 2-3yrs
Bowlegs
479
95% medial deviation and plantar flexion of food
| 5% lateral deviation and dorsiflexion
Clubfoot
480
Inability to dorsiflex and invert foot because of peroneal nerve damage
Footdrop
481
Internal rotation of forefoot or entire foot, common in infants
Pigeon toes
482
Loss of muscle tone and joint stiffness
Muscle atrophy
483
An intervention that restricts patients to bed for therapeutic reasons
bed rest
484
When a patient is immobile and his/her body excretes more nitrogen (from amino acid breakdown) than it ingests (in proteins)
Negative nitrogen balance
485
Collapse of lung
Atelectasis
486
Inflammation of the lung from stasis or pooling of secretion
Hypostatic pneumonia
487
Increase in heart rate of more than 15% and a drop of 15mmHg+ in systolic and drop of 10mmHg+ diastolic BP when patient changes from supine to standing position
Orthostatic Hypotention
488
An accumulation of platelets, fibrin, clotting factors, and the cellular elements of the blood attached to the interior wall of a vein or artery, which sometimes occludes the lumen of th evessel.
Thrombus
489
When bone tissue is less dense or atrophied due to immobilization
Disuse osteoporosis
490
An abnormal and possibly permanent condition characterized by fixation of the joint
Joint Contracture
491
Food permanently fixed in plantar flexion
Footdrop
492
Renal pelvis fills before urine enters ureters due to insufficient (to overcome gravity) peristaltic contractions of the ureters
Urinary stasis
493
Calcium stones that lodge in the renal pelvis or pass through the ureters
Renal calculi
494
An impairment of the skin as a result of prolonged ischemia (decreased blood supply) in tissues. Characterized by inflammation and forms over a bony prominence
Pressure Ulcer
495
Maximum amount of movement available at a joint in one of the three planes of the body: Saggital, Transverse, Frontal
ROM- Range of Motion
496
Measures height, weight, and skinfold thickness; used to assess metabolic functioning and to evaluate muscle atrophy
Anthropometric measurements
497
A dislodged venous thrombus that travels through the circulatory system to the lungs and impairs circulation and oxygenation, resulting in tachycardia and shortness of breath
Embolus
498
Nursing Diagnosis for Mobility/Immobility
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Ineffective airway clearance
Ineffective coping
Risk for injury
Risk for impaired skin integrity
Insomnia
Social isolation
```
499
Percussion and positioning used to effectively prevent pneumonia and keep airways clear. Helps patient drain secretions from specific segments of the bronchi and lungs into the trachea so he or she is able to cough and expel them.
CPT- Chest physiotherapy
500
One-sided paralysis
Hemiplegia
501
One-sided weakness
Hemiparesis (less serious than hemiplegia)
502
What is the primary function of the cardiopulmonary system?
To deliver oxygen, nutrients, and other substances to the tissues and facilitate the removal of cellular metabolism waste products by way of blood flow through other body systems (respiratory, digestive, renal)
503
What is the flow of the cardiopulmonay system?
Delivery of deoxygenated blood (blood high in CO2, low in O2) to the right side of the heart, then the lungs, where it is oxygenated. Then travels from lungs to left side of the heart and pumped through the tissues.
504
Process of moving gases into and out of the lungs
1. Perfusion
2. Diffusion
3. Compliance
4. Ventilation
5. Surfactant
6. Atelectasis
4. Ventilation
505
T or F: Neural and chemical regulators control the process of respiration
T
506
Which two body systems are primarily responsible for supplying the oxygen demands of the body?
1. Endocrine and cardiac
2. Cardiac and respiratory
3. Respiratory and peripheral vascular
4. Hepatic and cardiac
2.
507
Primary function of the lungs is:
1. Transfer CO2 from the alveoli and O2 out of the body
2. Exchange CO2 for O2
3. Transfer O2 from the atmosphere into the alveoli and CO2 out of the body as waste
4. Transfer Co2
3
508
Cardiopulmonary physiology involves delivery of deoxygenated blood to the ___ side of the heart and then to the ___ where it is oxygenated
1. left, heart
2. right lungs
3. left lungs
4. right heart
2
509
The left ventricle pumps blood through _____ circulation
1. ventricular
2. pulmonary
3. systemic
4. cyanotic
3.
510
The amount of energy expended on breathing depends on the (Select all that apply)
1. rate of breathing
2. compliance
3. depth of breathing
4. color of their shirt
5. airway resistance
all but .4
511
Measures the volume of air entering or leaving the lungs
1. tidal volume
2. residual volume
3. forced vital capacity
4. Spirometry
4
512
Ability of the lungs to distend or expand in response to increase intra-alveolar pressure
1. surfactant
2. atelectasis
3. compliance
4. airway resistance
3
513
Amount of air exhaled after normal inspiration
1. tidal volume
2. residual volume
3. forced vital capacity
4. compliance
1.
514
Increase in pressure that occurs as the diameter of the airways decreases from the mouth/nose to alveoli
1. atelectasis
2. Airway resistance
3. Compliance
4. Forced vital capacity
2
515
T or F
| Humidification is never administered with oxygen
F (if over 4%)
516
_____ articles which can produce ______
1. secure, open flame
2. remove, oxygen
3. remove, spark/open flame
4. remove, humidification
3
517
Place ___ ____ in view
1. christmas tree adapters
2. Open flames
3. Cigarettes
4. Caution signs
4.
518
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Secures and maintains ____ of ______ used for flow of oxygen
1. integrity, devices
2 .spark, fire
3. integrity, skin
4. Flow, oxygen
```
1.
519
Describe CO2 transport:
CO2 diffuses into RBCs--- hydrated into carbonic acid--- dissociates into hydrogen and bicarbonate--- hemoglobin buffers hydrogen, bicarbonate diffuses into plasma--- deoxyhemoglobin combines with co2 and venous blood transports back to lungs to be exhaled
520
Define stoke volume
The volume of blood ejected from the ventricles during systole
