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Foundations > Test #6 > Flashcards

Test #6 Flashcards

1
Q

Teaching-learning process

A

the acquisition of a skill or knowledge by practice, study, or instruction

  • teach in short sequences, pace yourself
  • learning anatomy: need to memorize facts
  • dealing with patients: intuitive component
  • pharmacology: previous knowledge of patho, chem, A&P, math
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2
Q
  1. Cognitive Domain of learning
A
  • refers to rational thought, what one generally considers thinking
  • may involve learning facts, raching conclusions, solving problems, making decisions, using critical thinking skills
  • exp: teaching a new mother the physiology of the breast and its role in milk production
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3
Q
  1. affective domain of learning
A
  • emotions or feelings
  • changes beliefs, attitudes, values
  • what motivates the patient?
  • exp: helping a new mother explore the benefits of breast feeding for her baby’s health
  • affective learning changes beliefs, attitudes or values
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4
Q
  1. psychomotor domain of learning
A
  • muscular movements learned to perform new skills and procedures
  • dexterity to manipulate the body parts, tools or objects needed to perform the skill or procedure
  • exp: help re-learn or learn new skills after a stroke or colostomy
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5
Q

teaching-learning relationship

A
  • characterized by mutual sharing, advocacy, negotiation
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6
Q

effective learning

A
  • occurs when patients and healthcare professionals are equal participants in the teaching-learning process
  • primary loyalty is to the patient
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7
Q

qualities of a teaching-learning relationship

A
  • patient focus
  • holism
  • negotiation
  • interactive
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8
Q

purposes of patient education

A
  • assist patients and family to cope with alterations in health status
  • health promotion, disease prevention, restoration of health or function, promotion of coping
  • Primary Prevention: to promote health/wellness, wash hands, exercise, diet
  • Secondary Prevention: prevent or diagnose illness early, mammogram
  • Tertiary prevention: restore optimal health and function if illness has occured, Physical therapy
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9
Q

assessing learning needs

A
  • begins with determining what the patient needs to know or do to function more independently
  • establish priorities
  • baseline knowledge, cultural and language needs, priorities
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10
Q

realistic approach to teaching

A
  • pt energy level/comfort level
  • pt age
  • pt emotional state
  • pt cognitive abilities
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11
Q

assessing learning readiness

A
  • try to modify their motivations if necessary (make them more realistic and focus on more important things)
  • motivation/desire to learn
  • compliance
  • sensory and physical state
  • literacy level
  • health literacy level
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12
Q

patient learning nursing diagnoses

A
  • health-seeking behaviors
  • ineffective therapeutic regime management
  • Deficient knowledge
  • readiness for enhanced parenting/health maintenance
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13
Q

documentation of learning

A

very important

  • medicare
  • insurance
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14
Q

Newborn and Infant Teaching

A
  • immunizations
  • normal growth and development (regular check ups)
  • care seat safety
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15
Q

Toddler and preschool teaching

A
  • safety practices
  • well-child visits
  • proper sleep
  • nutrition
  • avoidance of secondhand smoke
  • regular immunization schedules
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16
Q

School age child teaching

A
  • proper nutrition
  • sleep
  • exercise
  • safety
  • learning to deal with stress and frusteration
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17
Q

Adolescent Teaching

A
  • smoking
  • safe driving
  • preventing STDs
  • avoiding drugs and alcohol
  • avoiding gang-related violence
  • maintaining mental health
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18
Q

Adult and older adult teaching

A
  • exercise
  • nutrition
  • self-examinations
  • health screening
  • stress management
  • reduction or cessation of smoking and alcohol consumption
  • prenatal care for women
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19
Q

body fluid

A
  • 70-80% in babies

- 50% in older adults

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20
Q

kidney diease

A

3x more likely in african americans

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21
Q

Distribution of body fluids

A
  • intracellular: inside the cell, 65%
  • extracellular: outside the cell, 35%
    1. intravascular: most, inside the vessels/arteries/veins, plasma and RBCs
    2. interstitial: less, not in the cell, not in the vessels, between the cell, contains lymph, tissue fluid
    3. transcellular: least, CSF, peural fluid, intraoccular, GI, peritoneal, synovial
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22
Q

Normal values: Electrolytes in Body Fluids

A
  • sodium Na+: 135-145
  • Potassium K+: 3.5-5.0
  • Bicarbonate HCO3: 22-26
  • Chloride CL-: 95-105
  • Magnesium Mg++: 1.5-2.5
  • Phosphate PO4-: 2.8-4.5
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23
Q

3 main extracellular electrolytes

A
  1. sodium
  2. chloride
  3. bicarbonate
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24
Q

3 main intracellular electrolytes

A
  1. potassium
  2. fosfate
  3. sulfate
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25
Q

anions

A
  • negative ions
  • cl-
  • HCO3-
  • PO4 3- (phosphate)
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26
Q

cations

A
  • positive ions
  • Na+
  • K+
  • Ca+
  • Mg
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27
Q

solute

A

electrolyte, disolved particles

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28
Q

solvent

A
  • solute goes into

- water

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29
Q

diffusion

A
  • random movement of solute equalizes distribution of solute
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30
Q

filtration

A
  • water and electrolytes move together across membrane under pressure, capillaries
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31
Q

osmosis

A
  • semipermeable

- movement of water across membrane (less to more) to equalize ion concentration

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32
Q

osmotic pressure

A
  • drawing power to water, albumin pulls water into intravascular space
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33
Q

isotonic

A
  • same osmolarity as plasma, normal saline
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34
Q

hypertonic

A
  • higher osmotic pressure
  • pulls fluid from cells
  • cells shirinks
  • 3% sodium chloride, 10% dextrose in water
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35
Q

hypotonic

A
  • low osmotic pressure
  • 45% normal saline move fluid into cells
  • cell blows up
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36
Q

hydrostatic pressure

A
  • determines direction of filtration

- high to low (capillaries)

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37
Q

hemolysis

A

cell blows up and dies

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38
Q

Osmosis

A
  • movement of solvent (water) across a semipermeable membrane
  • moves from an area of lesser solute concentration (electrolytes) to an area of greater solute concentration
  • hyperosmolar: more concentrated
  • hypoosmolar: more dilute
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39
Q

osmotic pressure

A
  • drawing power of water
  • highly concentrated fluid has high osmotic pressure, draws water to it
  • works to attain equilibrium
  • osmolarity: describes the concentration of solutions, the number of molecules per liter of solution
40
Q

IV solutions

A
  1. isotonic solutions: same concentation (osmolarity) as bloos plasma
    - exp: 0.9% NS
    - no change, increase in volume
  2. hypotonic solution: solution of lower osmotic pressure
    - lower concentration of solutes than blood plasma
    - exp: NS 0.45%
    - pulls fluid into cells
    - water loss only, no electrolytes loss
  3. hypertonic solution: higher osmotic pressure (more concentrated than blood plasma)
    - D5NS, 3% sodium chloride, 10% dextrose in water
    - pulls fluid from cells, shrinks them
    - can cause increase in BP, edema, heart failure
41
Q

Diffusion

A
  • move down concentration gradient
  • moves from high concentration to low concentration
  • random movement of a solute (electrolyte, gas) across a semi-permeable membrane
  • cream in coffee
  • oxygen, carbon dioxide between alveoli and blood vessels
  • moves from areas of high concentration to an area of lower concentration across a concetration gradient
42
Q

active transport

A
  • moves from area of lower to higher concentration
  • uses energy
  • requires metabolic activity and uses energy to move substances across cell membranes
  • enables larger substances to move into cells
  • moleculrs can also move to an area of higher concentration (uphill)
  • sodium/potassium pump
  • potassium pumped in (2 k+)
  • sodium pumped out (3 na+)
43
Q

Filtration

A
  • water and substances move together across a membrane becayse of fluid pressure
  • can happen from intracranial pressure
  • occurs in capillary beds
  • movememnt from an area of higher pressure to an area of lower pressure (hydrostatic pressure)
44
Q

albumin

A
  • albumin inside vessel pulls water towards it
45
Q

regulation of body fluids

A

homeostatis is maintained through: fluid intake, hormonal regulation, fluid output

46
Q

Fluid intake

A
  • thirst control center located in the hypothalamus
  • osmoreceptors monitor serum osmolarity (maintain changes in osmo pressure)
  • when osmolarity increases (blood more concentrated) thirst sensation
  • salt increases serum osmolarity, protectve against dehydration
  • high glucose also increases serum osmolarity, symptoms of diabetes
  • osmolarity in blood: high = dehydration, low = overhydration
47
Q

average adult fluid intake

A
  • 2200-2700ml per day
  • oral 1100-1400ml per day
  • solid foods 800-1000 ml per day
  • oxidative metabolism 300ml per day (cell breaking down molecules into energy)
48
Q

ADH - antidiuretic hormone

A
  • helps kidneys maintain h2o in body
  • stored in posterior pituitary and released in presonse to serum osmolarity
  • prevents diuresis, saves water
  • ain, stress, circulating blood volume affect the release of ADH
  • increase in ADH = decrease in urine output
  • increased ADH –> constrict vessels –> increaed BP –> kidney retain h20 –> decreased urine output
  • decreased ADH –> increased urine output –> dehydration –> decreased BP
  • SIADH: syndrome of inappropriate ADH – releases ADH when not needed, low sodium, diluted blood
  • diabetes insipidus: too little ADH or kidneys not working so increased urination
  • increased osmolarity in blood stimulates ADH secretion ( increased h20 reabsorption, concentrated urine, blood plasma decreased concentration)
49
Q

Renin angiotensin aldosterone

A
  • stimulated by decreased BP
  • initiated by a change in renal perfusion
  • renin produced by kidneys is released in response to low perfusion related to a decreased in extracellular colume
  • increased blood flow to kidneys
  • stimulate release of aldosterone which promotes na+ retention in kidneys and increases BP
50
Q

Aldosterone

A
  • stimulated na+ retention
  • increases BP and decreases potassium
  • acts on the distal portion of the renal tubules to icnrease the reabsorption of sodium and the secretion and excretion of potassium and hydrogen
  • sodium and water retained –> restored blood volume
  • HTN, plaque, etc –> edema
51
Q

atrial naturetic peptide (ANP)

A
  • secreted from atrial cells of the heart in response to atrial stretching and an increased in circulating blood volume
  • ANP acts as a diuretic, causes na+ loss, inhibits thirst –> decreased blood volume
  • protective if blood volume is high
  • not protective in cardiac disease (na+ imbalance)
  • helps control na+, h20, k+, and fat –> decreased BP
52
Q

organs of water loss (fluid outtake)

A
  • kidney
  • lungs
  • skin
  • GI tract
53
Q

kidneys, fluid output

A
  • major regulatory organs of fluid balance
  • receive about 180 Ls of plasma to filter each day (1L/hr)
  • around 1500ml of urine produced each day (63ml/hr)
  • urine volume changes related to variation of the amount and type of fluids ingested
  • minimum volume of urine to exrete waste is about 400ml a day (15ml/hr)
54
Q

skin, fluid output

A
  • insensible water loss: (breathing, we can’t measure)
  • occurs through the skin and lungs
  • sensible water loss: sweating, excess perspiration
  • insensible and sensible fluid loss through the skin - 500-600ml a day
55
Q

lungs, fluid output

A
  • expire approximately 500ml of water daily
  • increase in water loss related to administration of oxygen
  • clients on high 02 need extra fluids to compensate
56
Q

GI tract, fluid output

A
  • 3-6 L of isotonic fluid moves into the GI tract and then returns to the extracellular fluid space
  • vomiting increases GI losses and electrolytes
  • 200ml of fluid is lost in the feces each day
  • diarhea can increase this loss
57
Q

major cations in body fluids

A
  • positive ions
  • sodium 135-145
  • potassium 3.5-5.0
  • calcium 9-10.5
  • magnesium 1.5-2.5
58
Q

sodium regulation

A
  • most abundant cation electrolyte in extracellular fluid
  • can cause altered mental status
  • major contributor to maintaining water balance
  • sodium is taken in through fluid and maintained through aldosteone
  • helps maintain BP and blood volume
  • needed for electrical impulses to travel along nerves
59
Q

potassium regulation

A
  • can disrupt the release of calcium and affect HR
  • major electrolyte and principle cation in the intracellular fluid
  • regulates metabolic activity
  • required for transmission of nerve impulses, normal cardiac confuction and normal smooth and skeletal muscle contraction
  • regulated by dietary intake and renal excretion
  • hypokalemia: cramping, irregular HR
  • hyperkalemia: weak muscles, MI, dysrhythmias
60
Q

calcium regulation

A
  • stored in the bone, plasma and body cells
  • 99% of calcium is in the bones and teeth
  • 1% is in extracellular fluid
  • 50% of calcium in the extracellular fluid is boun to protein (albumin)
  • 40% is free ionized calcium
  • hyper: thirst, nausea, vomiting, fatigue
  • hypo: neuro muscular irritability, muscle cramps
61
Q

calcium regulation

A 
- calcium is necessary for:
bone and teeth formation
blood clotting
hormone secretion
cell membrane integrity
cardiac conduction
trasmission of nerve impulses
muscle contraction
- parathyroid hormone regulates calcium in blood
62
Q

chvosek sign

A
  • tap ear and if low ca then twitch
63
Q

trousseau sign

A

BP on forearm and decreased calsium makes wrist hyperextension

64
Q

magnesium regulation

A
  • makes protein
  • helps with blood sugar
  • muscle and nerve function
  • natural blood thinner
  • laxative
  • essential for enzyme activities
  • neurochemical activities
  • cardiac and skeletal muscle excitability
  • regulation of dietary, renal, parathyroid hormone
  • 50-60% of magnesium contained in bones
  • hypo: muscle weakness, seizures
  • hyper: hypotension, heart dysrhythmias, lethargic, sleepy, decreased respiratory rate
65
Q

anions

A
  • chrloride cl- 98-105
  • bicarbonate HCO3- 22-26
  • phosphate PO4- 2.5-4.5
66
Q

chloride regulation

A
  • major anion in ECF
  • chloride follows sodium
  • regulated by dietary and kidneys
  • helps with BP, PH of body fluids
  • skin test: checks for cystic fibrosis
67
Q

Bicarbonate regulation

A
  • kidneys and lungs regulate levels
  • major chemical buffer within the body
  • found in both ECF and ICF
  • essential to acid-base balance
  • increased bicarb = risk for alkalosis
68
Q

phosphate regulation

A
  • buffer anion found mostly in ECF
  • maintains bone and teeth
  • inverse relationship between phosphate and calcium
  • phosphate also promotes normal neuromuscular function
  • neutralizes acids in the blood
  • hemoglobins depend on phosphate for proper functioning
69
Q

Buffer

A
  • a substance that can either absorb or release a hydrogen ion H+
  • arterial PH reflects the concentration of hydrogen ions in the blood
  • the PH scale measures acidity or alkalinity of a fluid. normal range for arterial blood 7.35-7.45
70
Q

biological regulation of PH

A

Buffering systems: hydrogen and potassium switch places

  • hemoglobin-oxyhemoglobin system
  • chrloride shift within - exchange of bicarb and chloride across cell membrane
71
Q

Regulation of acid base balance, lungs

A
  • physiologicalL lungs and kidneys
  • lungs: early response, quickest, seconds to minutes
  • increased hydrogen and co2 (acidosis) stimulates increased resp rate/depth –> exhales CO2
  • decreased co2 and hydrogen (alkalosis) –> retain co2 and decreased Resp rate
  • examples: diabetic ketoacidosis, co2 retaining patients with COPD
72
Q

Regulation of acid base balance, kidneys

A
  • takes longer (hours to days) and lasts longer/stronger
  • increased or decreased production of bicarb, excretion of h+ by amonia formation, phosphoric acid
  • acid excess (acidosis) –> reabsorption of bicarb
73
Q

sodium imbalances

A
  • most frequent electrolyte disorder
  • hyponatremia: seizures, coma. < 135 serum na+
  • GI losses (vomiting, diarrhea)
  • kidney disease
  • skin loss, perspiration
  • psychogenic polydypsia (excessive thirst for no reason)
  • SIADH
  • Hypernatremia: >145
  • excess salt intake
  • infusion of hypertonic saline
  • excess aldosterone
  • diabetes insipitus (low ADH/thirst/dilute urine excreted - Na+ not excreted)
  • dehydration (h20 follows na+ but na+ does not follow h20)
74
Q

Potassium Imbalances

A
  • decreased magnesium can lead to decreased potassium
  • hypokalemia 5.0
  • depress cardiac conduction, altered ekg, arrest
  • renal failure
  • fluid volume defecit
  • cell damage from burns, trauma
  • adrenal insufficiency
  • rapdi infusion of stored blood
  • salt substitutes
75
Q

hypocalcemia

A
  • hypocalcemia: ionized ca < 8.5
  • illness affecting thyroid, parathyroid
  • renal failure (not excreting phosphate) alcoholics, pancreatitis
  • neuromuscular and cardiac sx
  • increased relfexes, cramps, numbness/tingling
76
Q

hypercalcemia

A
  • bone cancer
  • ionized ca > 5.5 or serum ca > 10.5
  • immobility, osteoporosis, neoplasm –> bone loss of ca into blood
  • kidney stones, decrease reflexes
  • increased thirst, urination, constipation, kidney stones
77
Q

magnesium imbalances

A
  1. 5-2.5
    - malnutrition, malabsorption –> decreased mg, hyperacive reflexes
    - excess intae and renal problems –> increased mg, decreased HR
78
Q

chrloride

A
  • follows na, acid/base balance
79
Q

respiratory acidosis

A
  • too much co2 in blood
80
Q

respiratory alkalosis

A

too little co2 in blood

81
Q

metabolic acidosis

A

too little bicarb

82
Q

metabolic alkalosis

A

too much bicarb

83
Q

blood gas and acid/base balance

A
  • opiod drug overdose=acidosis
  • pulmonary edema=acidosis
  • airway obstruction=acidosis
  • pneumonia, obesity=acidosis
  • alkalosis hypera excitabiity of CNS
  • normal arterial blood PH 7.35-7.45
  • acidosis < 7.35
  • alkalosis > 7.45
  • respiratory acidosis/alkalosis is shown in PCO2 35-45
84
Q

metabolic acidosis/alkalosis

A
  • base excess: amount of buffer
  • norm: -2 (HCO3 22-26)
  • alkalosis: bicarb greater than 26
  • acidosis: bicarb less than 22
85
Q

nursing process: assessment

A
  • history: surgery, burns, renal, respiratiry or cardiac disease, GI distress, diet/fluid intake
  • age: infants have more body water, infants/children have low tolerance for change
  • adolescents: sports, recreational drugs
  • older adults: decreased kidney fxn, decreased compensation
  • environmental factors (sweating)
  • diet: intake, change
  • lifestyle: etoh, smoking
  • medications: diuretics, steroids, opiods, ABX, GI meds, NSAIDS, ecstacy
86
Q

nursing process: diagnosis

A
  • risk for deficient fluid volume
  • decreased cardiac output
  • excess fluid volume
  • impaired gas exchange
87
Q

nursing process: goals

A
  • pt will demonstrate serum electrolyte levels WNL within 48 hours
88
Q

nursing process: interventions

A
  • strict I&O daily
  • offer 240ml of fluid 1 hour after meal
  • monitor daily serum electrolytes
89
Q

IV administration

A
  • magnesium can relieve muscle cramping and nerve pain
90
Q

peripheral IV

A

arms, legs

91
Q

saline lock

A

makes it so blood doesnt come out of an iv not attached to tubing

92
Q

patient controlled analgesia (PCA)

A
  • Good: psot op pt, set at base amt, no overdoes, bolus does

- Bad: too sleepy, can’t hit button

93
Q

Central Venous catheters

A
  • do not use less than 10ml syringe
  • goes into large vein and straight to heart
  • scrub hub 15-30 secs to clean
  • neck IJ or EJ
  • chest: subclavian vein
94
Q

infiltration

A
  • IV fluid/med comes out of vein into surrounding tissues vein blows
  • stop IV, take out
95
Q

phlebitis

A

superficial veins

  • redness, swelling
  • inflammation of endothelium of vein
  • potassium and phenergen = burning in veins

Foundations (8 decks)

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