Unit 4 Flashcards
(117 cards)
0
Q
Environment, basic needs, physical hazards, age/development
A
Safety factors
1
Q
A basic human need ; Freedom from psychological and physical injury
A
Definition of safety
2
Q
Home, community, school, hospital
A
Environments
3
Q
Oxygen, nutrition, temp/humidity, cognitive awareness, emotional state
A
Basic needs
4
Q
Enforce no smoking ; be aware of a decrease in oxygen availability
A
Basic need - oxygen
5
Q
Lighting, obstacles, bathroom hazards, security, pathogens
A
Physical hazards
6
Q
injuries are the leading causes of death in ages_____
A
1-25 years old
7
Q
_______ _______ changes as the patients age
A
teaching purposes
8
Q
in the event of a fire you will be expected to perform _____
A
R-A-C-E
9
Q
Risk for physical violence and work related accidents
A
safety hazard for working in healthcare setting
10
Q
rescue those who are in immediate danger
A
R in RACE
11
Q
Pull the fire ALARM and call it in
A
A In race
12
Q
contain or confine the fire ( close doors)
A
C in Race
13
Q
Extinguish if its a small fire
A
E in Race
14
Q
Pull Pin, Aim at base of fire, Squeeze and Sweep
A
PASS
15
Q
harm to your patient, fellow worker or yourself; liability suit ; loss of licensure
A
violations in safety could result in…
16
Q
lifestyle, neuro function, mobility function, cardiopulmonary function
A
health history data the nurse should gather
17
Q
ask about the home environment and daily activities; meds they take
A
lifestyle
18
Q
ask about balance and coordination
A
neuro function
19
Q
ask about ambulatory aids, ex walkers canes, etc…
A
mobility function
20
Q
ask about SOB or fatigue
A
cardiopulmonary function
21
Q
unexplained bruises or cuts, LOC, how well they make decisions, Musculoskeletal assessment , changes in vitals signs with activity
A
important subjective and objective data that the nurse should gather
22
Q
risk for injury, risk for poisoning, risk for aspiration, risk for impaired home maintenance
A
nursing diagnosis related to safety
23
Q
variance and fall reports do not go into the chart because of _____ ______
A
legal reasons
24
free from injury, free from poisoning, etc..
Goals for safety
25
individualized for each pt ; focus on prevention, holistic in nature
Guidelines for nursing interventions relating to safety
26
wiping up spills, pick up packaging, putting equipment away
Ways to reduce physical hazards
27
physical hazards are reduced, basic needs are met, psychological status is not jeopardized, and transmission of infections are reduced
safe environment for patients
28
offer toileting and fluids frequently
Make sure basic needs are met
29
step in when any type of abuse is witnessed
psychological status is not jeopardized
30
hand washing and wearing gloves
Refusing transmission of infection
31
quality safety of education nursing
QSEN
32
demonstrate effective use of technology and standardized practices that support safety and quality
QSEN safety standards
33
demonstrate affective use of strategies to reduce risk of harm to others and self
QSEN safety Standards
34
use appropriate strategies to reduce reliance on memory
QSEN Safety standards
35
use of biological agents to create fear and threat; most likely form of terrorist attack
Bioterrorism
36
recognizing changes in trends in emergency rooms and urgent care, know policy and procedures, be familiar with syndromes associated with bio-terrorist acts
roles and responsibilities of a nurse in emergency management
37
restriction of freedom of movement or normal access to a person body that is not an usual part of treatment
restraints
38
meds such as anxiolytics and sedatives use to manage a patients behavior that is not a standard treatment
chemical restraints
39
manual, physical or mechanical device that reduce ability of a patient to move freely
physical restraints
40
Know agency policies, ongoing assessments are needed, must be clinically justified
legal implications for restraints use
41
reduce the risk of patient injury, prevent interruption of therapy such as IV, NG, Foleys, prevents patients from removing life supporting equipment , reduce risk of injury to others by the patient
objectives for use of restraints
42
weight sensitive mats, posey beds, side rails, alarms, and one on one
alternative to restraints
43
be aware of who is present, be cautious when leaving at night, do not share personal info, reports suspicious behaviors
Guidelines for keeping yourself safe
44
environmental factors, developmental needs, alternative food patterns, lifestyle, religious practice, economics
factors that affect nutrition
45
lifestyle, work schedule, poor meal choices, lack of access to full service grocery store
environmental factors that affect nutrition
46
food budget, infection, surgery,alcohol/ drug abuse, loss of energy , changes in bowel habits, inadequate diet for more than three days
cues for poor nutrition
47
past nutritional problems, eating habits, sociocultural patterns, perceived nutritional problems, medicine and supplementary intakes
health history data that is necessary for the nurse to gather
48
alert/ responsive, normal weight, well developed muscle tone, good attention span, bright clear eyes, normal heart rate and rhythm
signs of good nutrition
49
obesity, anorexia, rapid heart rate, easily fatigued, no energy , flaccid muscle tone
signs of poor nutrition
50
percent of the total blood volume made up of RBC
Hematocrit blood test
51
Measures the total amount of hemoglobin in the peripheral blood
hemoglobin blood test
52
hemoglobin and hematocrit
H and H
53
measures plasma protein in the blood
albumin blood test
54
to identify patients who are at risk for ASHD
Cholesterol blood test
55
risk for aspiration, deficient knowledge , imbalanced nutrition, risk for imbalanced nutrition, readiness for enhance nutrition, impaired swallowing, feeding self care deficit
nursing diagnosis related to nutrition
56
often done in collaboration with the physician/ dietician, should include patient teaching, provides assistance to create an atmosphere that encourages eating, explain special diets
nursing interventions relating to nutrition
57
NPO, clear liquid/ full liquid , soft mechanical and puree, low residue, low fiber, low fat, low sodium,
types of diets
58
daily activities , activity tolerance, health status, physical problems, mental status, age/ developmental influences,
Data gathered by nurse during assessment
59
body alignment, muscle mass and strength , ROM, ability to accomplish ADLs
parts of a physical exam relating to activity
60
impaired physical mobility, risk for disuse syndrome, ineffective airway clearance, risk for injury, insomnia
nursing diagnosis related to activity
61
if pt is experiencing any mobility problems goals and inspected outcomes are directed towards the _____ ______ ______ ______
promotion of physical activity
62
if a patient has problems related to decrease mobility the goals and expected outcomes are directed towards...
maintaining present function, preventing further muscle weakness, promoting optimal mobility prom
63
assess/ monitor health promotion activities, promote restorative care, promote fitness
nursing intervention related to activity
64
limited bed rest, good body alignment, ROM
assess/monitor pt health promotion activity
65
ambulation assistance, physical therapy
promote restorative care
66
aerobic, isometric, isokinetic, isotonic,
types of fitness
67
sustaines muscle movement, promotes cardiovascular functions and regulates weight control ex.. running, swimming, zumba
aerobic exercise
68
dynamic, active muscle movement, maintains tone and strength, promotes joint and bone health ex... ROM, swimming
Isotonic exercise
69
conditioning :used in rehab
isokinetic exercise
70
static movement , increases heart rate and cardiac output, muscle contractions with joint movement, used with hospital pts
isometric exercise
71
cyclical physiological process that alternates with longer periods of wakefulness, prevents fatigue for mind and body
sleep
72
state of being mentally relaxed, free from anxiety, and physically calm
Rest
73
to reduce stress, to restore biological process for the next period of wakefulness, to conserve and restore energy, to restore cognitive function, to dream
functions of sleep
74
NREM, REM
stages of sleep
75
non Rapid Eye Movement
NREM
76
Rapid Eye Movement
REM
77
day dreaming, 70-80 % of NREM sleep
Stage 1 NREM sleep
78
50% of total sleep ; 10-15 min
stage 2 of NREM sleep
79
more easily aroused in these stages
Stage 1 and 2 of NREM of sleep
80
deep sleep; there is rarely movement
stage 3 Of NREM
81
greatest depth of sleep where all functions slow down
Stage 4 Of NREM
82
deeper sleep; slow wave
Stages 3 and 4 of NREM
83
end of each sleep cycle; lasts 5-30 min ; dream state; distinct eye movement
REM Sleep
84
8-10 hrs at night, 15 hrs total, 30% of sleep time is in REM, 40-50 min sleep cycles
infants
85
12 hrs total, still need daytime naps up until the age 3
toddlers
86
12 hrs 20% REM sleep, night mares ; might need night light
Preschoolers
87
11-12 hrs
school age
88
7 1/2 hrs of sleep
adolescents
89
6-8 1/2 hrs , insomnia starts to occur because of stress
young adult
90
number of hrs decline, insomnia is common
middle adult
91
50% report sleeping problems, takes more time to fall asleep, less REM sleep, Difficult to restore themselves cognitively
elderly adult
92
drugs/ substances, lifestyle, sleep patterns, emotional stress, environment, exercise/fatigue,food intake
factors affecting sleep
93
meds and antidepressants, caffeine, alcohol
drug/substances that affect sleep
94
daily routines, patterns, traveling in different time zones, shift work, night or day, late night life
lifestyle
95
chronic insomnia, falling asleep driving
usual sleep patterns
96
ventilation, mattress, snoring , tv
environment
97
if you exercise it does help with sleep
exercise and fatigue
98
poor sleep, nocturnal syndrome
emotional stress
99
develop good eating habits, do not eat large meals, or spicy meals before sleep, alcohol
food/ calorie intake that affects sleep
100
chronic difficulty falling asleep, most common sleep disorder, nonrestorative sleep
insomnia
101
cessation of breathing or stopping of breathing for a time during sleep
sleep apnea
102
Headaches, constipation can be caused by
Circadian rhythm
103
genetic, excess of daytime sleeping
hypersomnia
104
falling asleep whenever
narcolepsy
105
somabulism, sleep talking, sleep walking, enuresis, nightmares, night terrors, errections
parasomnias
106
most common in children as trying to get into REM sleep
somabulism
107
occurs during non REM and the beginning of REM cycle
Sleep walking
108
bed wetting
enuresis
109
form of seizure , involuntary response
night terrors
110
Restless Leg Syndrome
RLS
111
Periodic Limb Movement
PLM
112
Teeth Grinding, possible seizure
Bruxism
113
genetics, sleep pattern, narcolepsy, some insomnia & somabulism, lifespan , consideration, age, developmental factors
other factors affecting sleep
114
actual intolerance, sleep pattern disturbance, fatigue , anxiety
nursing diagnosis applicable to sleep
115
support rituals, create a restful environment, decrease distractions, try alternative supplements
Nursing interventions relating to sleep
116
if possible avoid sleeping pills
should be non pharm
