KT Final

What are the four elements of a full-spectrum nurse?

clinical judgement, critical thinking, problem solving.

Benefits to EHR how does it reduce errors?

computer physician order entry, allows providers to enter orders electronically instead of being handwritten it reduces number of errors resulting from illegible handwriting and/or incomplete orders

What percent of magnesium is found in the blood, what percent of magnesium is found in ICF/Bone?

1% blood 99% ICF and bones

Embryonic stage: When does this stage occur?

15 days until 8 weeks after conception

Normal blood pH levels

7.35-7.45

What does serum osmolality measure

A measure of the solute concentration of the blood. It is expressed as Miliosmoles per kilogram.

list the 4 components of informatics

data information knowledge wisdom

what is quantitative research?

data consisting of numbers has a hypothesis uses objective data needs to be in a controlled environment

describe how the diaphragm, accessory muscles, and pressure changes in the lungs creates exhalation

diaphragm and accessory muscles- when the muscles relax the chest and lungs return to normal size pressure change- reduction in size causes pressure to rise above atmospheric pressure and air flows out of lungs

describe how the diaphragm, accessory muscles, and pressure changes in the lungs creates inhalation

diaphragm- during contraction the chest cavity is pulled downward, pulling the base of the lungs with it accessory muscles- intercostal muscles contract pulling the ribs outward to slightly expand the chest cavity and lungs pressure change- expansion of the lungs creates negative pressure and pulls air in through the nose/mouth and into the trachea

how is gestational diabetes managed?

dietary modifications physical approaches psychosocial approaches educational requirements.

What is the small intestine responsible for?

digestion of food and absorption of nutrients into the bloodstream

Right method:

do the teaching strategies fit the learning style of the learner? Do the strategies fit the client's learning ability. are the teaching strategies varied?

why is skin care around a stoma so important.

essential to prevent skin breakdown, which may lead to infection, discomfort, and leakage of ostomy output from around the appliance.

What is included in the Full Outline of Responsiveness (FOUR) assessment?

eye response, motor response, brainstem reflex, and respiration assessment

What cranial nerves are involved with taste? What area of the brain is closely associated with taste?

facial and glossopharyngeal nerves (cranial nerves VII and IX, respectively)

What is sub-involution?

failure of uterus to return to non-pregnant state; when the uterus remains enlarged with continued lochial discharge and can result in postpartum hemorrhage

What is lanugo on a newborn?

fine downy hair usually found on forehead, ears and shoulders.

What is a stork bite?

flat pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead

portal of exit

for an infection to spread , a pathogen must exit the reservoir. in the case of human and animal reservoirs the most frequent portal of exit is through body fluids.

Nagel's Rule: memorize this

for calculating delivery date, take the first day of the woman's last menstrual cycle, subtract 3 months, then add 7 days and 1 year ( as appropriate).

what are the risk factors of type 2 diabetes mellitus?

genetic environmental lifestyle factors

what is information?

groupings of data processed into a meaningful, structured form

List some examples of medical asepsis measures used in a healthcare setting:

hand washing cleaning visible soil from objects and surfaces disinfecting all tools and equipment. isolation for patients who are highly contagious.

how do reduced or lack of oxygen in the blood alter sensory functions?

harms and even destroys cells, causing widespread damage to the neurologic system. Some conditions affect specific sensory organs. For example, diabetic retinopathy is the leading cause of blindness among adults ages 20 to 74. Hypertension, too, can damage the retina of the eyes.

Nosocomial infection:

healthcare acquired infection

what are the health risks associated with type 1 diabetes?

heart disease, kidney disorders, and retinal damage

How can the nurse improve visual stimulation?

help the patient with glasses to apply them whenever she is not sleeping. Make sure eyeglasses are clean and in good repair. Put artwork on the walls, furnish colorful pajamas and robes, and place pictures or flowers where the patient can see them. Unless the patient objects, open curtains during the daytime to allow sunlight to enter the room. Avoid keeping the patient in a dark room, except to promote sleep.

what can be a response to hypoxemia?

hyperventilation

how are hyper and hypoventilation related to carbon dioxide levels?

hyperventilation-removal of carbon dioxide is increased thus lowering the amount of CO2 in the blood hypoventilation- CO2 levels in the blood are increased

What might result when someone loses the sense of smell?

lose their appetite, and nutritional deficits may result

the gastrointestinal tract-

many pathogens that reach the stomach are destroyed in it's acid environment those that successfully enter the small intestine face the antimicrobial action of the bile. simple peristalsis and vomiting/diarrhea are first line defense mechanisms for pathogens that invade the gastrointestinal tract.

risk factors for nosocomial infections:

medically inserted devices dirty equipment immunosuppressants antibiotics sick staff

what is hypoxia?

oxygen deficiency in the tissues of the body

What is vernix caseosa?

protective, thick, cheesy covering that is more present in creases and folds.

what is data?

raw, unprocessed numbers, symbols, or words that have no meaning "discrete entities that are described objectively without interpretation"

Do not ____________a smoke - filled room or a room with blaze.

re-enter

Benefits to EHR how does it benefit research?

records are placed in data storage areas so information can be sorted and analyzed to create information and knowledge necessary to aid research to support decision making

rest and sleep-

rest and sleep renew the body and mind and conserve strength. sleep needs vary and there is really no " correct" amount or pattern of sleep. however, 6-9 hours per night is considered fully restorative.

what is respiration?

the exchange of the gases oxygen and carbon dioxide in the lungs

prodromal stage-

the first appearance of vague symptoms. not all infections have this stage

Why might it be normal to hear a murmur?

the foramen ovale (hole in heart that allows blood to bypass pulmonary trunk) is still closing until 1 year of age

What is informatics?

the managing and processing of information necessary to make decisions

the mouth-

the mouth normally has a large number of pathogenic microorganisms, but saliva, like tears, contains lysozyme and helps continually wash microbes from the teeth and gums.the rich blood supply of the mouth swiftly transports defensive blood cells that keep microorganisms in check.

When the serum pH falls below 7.35, the patient is _____

Acidotic

At what age should parents begin teaching their children basic information about approaching body changes, menstruation, sexual intercourse, and reproduction.

Ages 10-12

What are four sources of power?

Coercion Authority Reward Expert

What are the basic functions of the neurological system (6)?

Cognition Emotion Memory Sensation Perception Regulation of homeostasis

Domains of learning

Cognitive learning Psychomotor learning Affective learning Motivation and its influence on learning

What stress related factors can increase pain in labor?

Fear Anxiety Tension

Name 4 holistic nursing theorists

Florence Nightingale Martha Rogers Margaret Newman Jean Watson

What is hyperglycemia?

Is the term used to describe a state of elevated blood glucose, generally defined a state as greater than 100mg/dl in fasting state or greater than 140mg/dl .

What psychological factors can impair the progress of labor (3)

Maternal stress Anxiety Tension

Malpractice

Negligence in a professional setting

Gravidity

Number of pregnancies

What does tactile stimulation center on?

Physical touch

Holistic care contends that all healing is what?

Self healing

What are some examples of nursing values (7)

Silent suffering as a response of pain Objective reporting and description of pain Use of nursing process Nursing autonomy Caring Knowledge Critical thinking

What are the major electrolytes in the ECF?

Sodium, Chloride, and Bicarbonate. Also albumin in small quantities

What is masteration, what can it cause

Softening of skin due to moisture Skin breakdown

What is a solute?

Solid substances that dissolve in body fluids

Impact of surgery on sexuality

Some people may avoid sex because of sexual esteem issues (e.g., feeling unattractive, concern about partner's reaction). Examples: Hysterectomy, Mastectomy, orchiectomy, prostatectomy, or colectomy

Discuss personality and lifestyle differences related to stimulation. How does this connect with potential for sensory alteration?

Some people, by nature, like excitement, change, and stimulation; others prefer a more predictable and quiet life. Clients are at risk for sensory alterations if their previous level of stimuli does not match their current level. Health problems, a change of environment, or loss of a partner can each create changes in stimuli.

What is a belief?

Something that an individual accepts to be truth

Ideal teaching environment (2) Benefit of ideal environment What are the challenges regarding teaching environments (2)

Somewhere quiet Free of distraction So the focus can be 100% on the information provided to the patient. Not always quiet places in the hospital or healthcare setting Time is also crucial when working as a nurse.

Describe the following components of the inflammatory response: Cellular response

Specialized WBC (phagocytes) migrate to the site of the injury and kill bacteria and damaged cells. Sometimes form a wall around invading pathogen. Pus refers to the accumulation of dead cells, digested bacteria and other cell debris in the presence of infection

Where is transcellular fluid found?

Specialized fluids that are contained in body spaces and digestive juices.

How parents can build self-esteem in their children? (4)

Spending some one-on-one time with the child as often as possible: read, play, or just be together. Free with touches: a hug, a pat on the back. Refraining from frequent negative criticism. Providing nearly total acceptance of the child.

What are some ways a parent can help to promote self-esteem in their children? (4)

Spending some one-on-one time with the child as often as possible: read, play, or just be together. Free with touches: a hug, a pat on the back. Refraining from frequent negative criticism. Providing nearly total acceptance of the child.

Do Deep Tendon Reflexes occur at the brain or the spinal cord?

Spinal cord

How can you test for a ruptured amniotic membrane? (3)

Sterile speculum examination Nitrazine (pH) Fern tests

Factors impacting a negative intimate relationship (8)

Stress Physical illness Mental illness Hormones Fatigue Distractions Low self-esteem Financial pressure.

What does the Purnell and Paulanka model for cultural competence stress?

Stresses teamwork in providing culturally sensitive and competent care to improve outcomes for individuals, families, and communities

What is the difference between superficial and deep tendon reflexes?

Superficial involves the connection brain to spinal cord, deep tendon is just the spinal cord

Amnisure test

Taking fluid to put on a test strip, will show up as positive or negative.

Task vs Relationship leadership Explain each What do effective leaders do?

Task- Focusing on getting things done Relationship- Building interpersonal relationships among staff Balance the two for high level productivity and job satisfaction

taste sensory function changes associated with aging

Taste buds atrophy and decrease in number, so there is less ability to perceive tastes, especially sweetness. Dry mouth may alter the sense of taste.

What is the primary intervention for a wellness diagnosis label? What phrase begins these statements (20 NANDA-1 labels)

Teaching Readiness for enhanced

Transactional leadership

Telling style. People are motivated by reward and punishment and work best with a clear chain of command.

Ethnocentrism

Tendency for people to think their culture is superior to others

Complementary medicine

Tested therapies that are outside of the mainstream medical or nursing care to complement those of conventional medicine. Ex: Chiropractic care

What is the source of funding for all health care?

The American people

Embryonic stage: What is the difference between the amnion and the chorion?

The chorion develops from the trophoblast and contains the chorionic villi on its surface. The billi burrow into the decidua baslis and increase in size and complexity as the vascular processes develop into the placenta. Becomes the covering of the fetal side of the placenta. The amnion develops from the interior cells of the blastocyst, is the inner layer of the amniotic cavity, amnion is the innermost covering of the amniotic sac. Covers the umbilical cord, covers the chorion on the fetal surface of the placenta.

What predicts a positive body image?

The closer the match between a person's ideal body image and sensory input about his or her body ( perceived by the image), the more positive the person's body image is likely to be.

These four qualities of defamation must be present (quasi-intentional tort)

The communication about the person was false Was made to another person or persons, Caused the defamed person to experience shame and ridicule and had a negative impact on the person's reputation Was made as a statement of fact rather than as an opinion.

Where is the costovertebral angle?

The costovertebral (CV) angle is formed by the junction of the 12th rib and the spine on both sides of the back.

Nonmaleficence

The duty to do no harm

Beneficence

The duty to promote good

What does dilation describe?

The enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun

Role-modeling/playing teaching strategy

The instructor teaches by example, demonstrating the behaviors and attitudes that learners should adopt. More effective when the teaching point corresponds with the role models actions. Students or patients learn by seeing, hearing, and doing. Must connect the learning to the objectives. More successful when the teaching point is made apparent to learners during the learning experience.

Which parents does the school aged child strongly identify, what type of friends do they mostly have? How do school aged children gain awareness of gender roles and emerging gender identity?

The school-age child strongly identifies with the same-sex parent and has mostly same-sex friends. Through interaction at home, school, and other activities.

Nursing process vs. Teaching process What will you need to do as the nurse in these processes (5)

The teaching process parallels the nursing process Learning needs and readiness Make educational diagnosis Write learning objectives Plan and implement teaching strategies Evaluate client learning.

What happens during the third stage of labor?

The third stage of labor lasts from the birth of the baby until the placenta is delivered.

Convection: What % of body heat loss

The transfer of heat through currents of water and air. Ex; a hypothermic patient being immersed in hot bath. Or a patient with a fever sitting under a cool fan. (15%-20% of body heat loss to the environment).

Holistic nursing practice is what 3 things

Theory-based Relationship-centered Potent solution to a number of problems facing contemporary nursing and healthcare.

Why is heat loss in a newborn so critical to monitor and prevent?

Thermoregulation provides a neutral thermal environment that helps a newborn maintain a normal core temperature with minimal O2 use and caloric expenditure. Newborns keep warm by burning brown fat, specific to only newborns, but only within a specific temperature range. Becoming chilled can use all brown fat reserves, increase O2 requirements, and ultimately cause acidosis.

Hypernatremia signs and symptoms

Thirst Elevated temperature Dry mouth and sticky mucous membranes If severe: Hallucinations Irritability Lethargy Seizures

Personal values

Those that are apart of your own value system that you have chosen Ex: Money, scholarship, friendship, fairness

Professional values

Those you acquire through socialization into nursing. Ex: From teachers, peers, learning, experiences

Define coercion power What are three types

Threat of pain or harm Economic Physical Psychological

How are values transmitted?

Through social interaction

Mees lines What kind of client does it occur in (2)

Transverse white lines in the nailbed . Occurs in clients who have experienced severe illnesses or nutritional deficiencies.

What situations might impact a patient's orientation, particularly in the acute care setting?

Trauma

What might cause abnormal findings in LOA (Level of Arousal)? (4)

Trauma Neurological disorder, Hypoxia Chemical substances.

Complementary modality

Treatment that is used together with traditional medical care

How is arousal classified when measuring LOC?

Type of stimuli required to produce a response from the client

What are 4 newborn screenings the nurse should encourage?

Universal Newborn screening Hearing screening Bilirubin screening Congenital heart defect screening (BP and pulse ox)

3 causes of dyspareunia in men

Urinary tract infection Phimosis (condition in which the foreskin of the penis is too tight) Balanitis (inflammation of the penis)

Fluid volume deficit increases what?

Urine osmolality

Ranges for urine pH

Urine pH normally ranges from 5.0 to 9.0, with an average of 6.0. .

Confirming pregnancy What teaching needs to be done with women taking home pregnancy tests?

Urine samples should be done with the first void in the morning and instructions followed on packaging.

Major function of magnesium

Used in over 300 biochemical reactions in the body

Alternative modality

Used instead of traditional medical care

36 week visit GBS How is this test done?

Vaginal / rectal swab.

What factors differentiate subcultures (5)

Values Behavior Ancestry Lifestyle How they dress

Cultural specifics

Values, beliefs, and practices that are special or unique to a culture

Why are serum electrolytes measured

Venous blood samples are taken commonly to measure sodium, potassium, chloride, and bicarbonate levels.

Two types of communication

Verbal and nonverbal

What does a Biomedical healthcare system combine

Western biomedical beliefs with allopathic medicine

What does it mean to fill in the "sensory gap?" What is the result of filling in the sensory gap?

When environmental stimuli are deficient, the remaining stimuli, such as distant noises, minor pain, and cold extremities, can become overly noticeable or distorted, filling in the "sensory gap" and causing the patient a level of distress that is out of proportion to the intensity of the stimulus. Clinical manifestations include problems with perception, cognition, and emotion

What is meant by secondary powers?

When the woman feels a voluntary need to push, also known as bearing down, in order to expel the fetus.

What is interrole conflict?

When your ideas but how to perform Your Role may be different from others ideas, particularly those that are in roles of authority such as instructors.

Describe milia When are they present, when do they fade?

White, raised areas on the nose, chin and forehead of newborns Present at birth, fade in infancy

Alternative medicine: Chinese medicine

Yin and yang energies, complementary but opposing life forces

How are superficial reflexes tested?

You can elicit superficial reflexes by swiftly and lightly stroking a body part (with a reflex hammer)

What did Garon's 2012 study reveal about nurses' open communication in the workplace?

a study exploring nurses perception of their ability to speak up and be heard in the workplace environment found open communication leads to better patient care, improve safety, and better staff satisfaction.

hypoglycemia is what?

a symptom of the underlying disorder, not a disease

Substance abuse:

alcohol curbs hunger because it contains many calories. as a result, many chronic alcohol users do not consume an adequate diet. alcohol is also toxic to the liver and the cells lining the digestive mucosa.

How does the Full Outline of Responsiveness score work?

all on a scale of 0-4, with 0 being the most poor responses, and 4 being normal or regular responses. Score out of 16

Define medical asepsis:

also called "clean technique" refers to procedures that decrease the potential for the spread of infections.

When possible, nurses should use ______________________ instead of restraints.

alternative interventions (distractions, medications)

Where is the preferred place to take a newborns temp?

axillary

What are some simple ways to minimize anxiety and confusion in the healthcare setting?

■ Explain all procedures and care. This will decrease anxiety and help orient confused clients. ■ Hang a calendar in the room, along with a schedule of activities. ■ A large clock on the wall is also helpful. ■ Encourage family members to bring in familiar objects from home. ■ If the patient is disoriented, provide information at each visit.

Why is screening for postpartum depression so critical?

because many women feel guilty about having these feelings when they believe it should be a happy time in their lives.

What is pseudomenses?

bleeding from the infant vagina - resulted from mother's burst of hormones.

13) The nurse is developing a teaching plan for adolescents about acne. The nurse incorporates which characteristic as commonly responsible for the failure of treatment of acne in teenagers? a. Topical treatment b. Systematic treatment c. A dominant parent who wants treatment and a passive teenager who doesn't d. A dominant teenager who wants treatment and a passive parent who doesn't

c. A dominant parent who wants treatment and a passive teenager who doesn't Rationale: The active participation of a teenager is needed for the successful treatment of acne. Systemic and topical therapies are needed in most acne treatments.

List some myths about depression. (4)

"getting on with life" will cure depression Everyone likes to talk about how they feel. Medication is the answer to depression Once depression has been cured, it does not return.

Why should nurses be patient advocates (4)

(1) Their professional role requires it. (2) They have special knowledge that the patient does not have. (3) They have a special relationship with patients. (4) One aspect of the nursing role is to defend patient's autonomous decisions.

how do diseases that affect circulation alter sensory functions?

(e.g., atherosclerosis) may impair function of the sensory receptors and the brain, thereby altering perception and response.

Digoxin (Cardiac glycoside) Action Complications (6) Route (2) What should the nurse monitor prior to administration (2) When should the nurse hold?

*Increases force and efficiency of myocardial contractions and decreases HR which gives the ventricles more time to fill* Bradycardia Cardiotoxicity Anorexia N/V Fatigue Weakness Orally, IV HR, rhythm HR < 60

What are the disadvantages of audio-recorded report?

- A major disadvantage of an audio recorded report is that oncoming nurse has limited opportunity to ask questions about the client. Occasionally audio quality is poor and the report is not clear.

what are some secondary prevention techniques for preventing diabetes?

- Blood pressure and cholesterol management - Healthy people 2020 reinforces these goals of A1C < 7% as wells as control blood pressure and lipid levels. - Have annual dental, foot, and eye exam.

What are key elements needed in all handoff reports, regardless of format used? Why do you think discharge planning progress is important for all patients in handoff reports?

- Client progress made during your shift - therapies and treatments administered - teaching done - consultations done or planned with other disciplines - status of identified desired outcomes - any changes in client status - progress made on discharge planning

Identify 4 mucus membrane assessment components that can be used to monitor fluid, electrolyte, and acid-base balance

- Color - moisture - continuity of mucous membranes - tongue turgor

Identify 5 skin assessment components that can be used to monitor fluid, electrolyte, and acid-base balance

- Color - temperature - moisture content - continuity - turgor - edema

In what ways can a nurse facilitate role enhancement? (7)

- Help the client distinguish between ideal and actual role performance - Help the person I get to identify her past, present, and future roles. For older adults, encourage reminiscence. - Discuss boundaries, expectations, and management defined by lifestyle and family Networks. - Facilitates communication between client and significant other regarding the sharing of role responsibilities to accommodate rule changes of the ill person. - Compare realistic roles with previous and functional roles. - Help the client examine the difference between previous rules and current Roll by providing education and learning environment that focuses on positive supportive change. - Help the client identify roleplay behaviors needed in new rules

what are the risk factors for hypoglycemia for infants?

- IDM or gestational DM - Large for Gestation Age by weight - Small for Gestation Age by weight - <37 weeks - 5" APGAR <5

what are the basic firearm safety measures should be taught to all young kids? what measure can gun owners take?

- If the see a firearm Instruct them to stop and then call an adult - Teaching kids to stop will help them think through. - Teach family to lock up all the firearms

What are eight strategies for the nurse to employ for assertive communication in the healthcare setting?

- Question care decisions openly and honestly. - Use I statements - focus on the issue, not the participants. - Use effective nonverbal language. - Don't invite negative responses. - Use fogging to help you accept criticism without becoming anxious or defensive. - use negative inquiry. - Strive for a workable compromise

What are warning signs of suicide? (10)

- Withdrawal from social contact - Desire to be left alone - Preoccupation with death and dying, or violence - Risky or self-destructive Behavior, such as using drugs or driving unsafely - Changes in routine, sleeping patterns - Changes in eating habits - Giving away belongings or getting Affairs in order - Personality changes, such as becoming very outgoing after being shy - Saying goodbye to people as if they won't be seen again - Talking about suicide

what populations are at risk for impaired glucose utilization (diabetes)?

- african americans - native americans - hispanic/latino Pima Indians of Gila River community in Arizona have the highest documented incidence rates of type 2 diabetes in the world

What are some of the barriers that may prevent patients from receiving recommended immunizations? (5)

- concerns about side effects - moral religious beliefs - cost - lack of information - language barriers

To prevent falls, nurse must provide:

- constant surveillance for infants and young children - assess elderly safety needs carefully

An RN must do everything to prevent medication error that might cause harm or death to their patient. To prevent error RN must:

- create a culture of trust - report near missed incidents - communicate effectively

Safety hazards in the healthcare agency include:

- falls - equipment-related accidents - fires - electrical hazards - restraints - mercury exposure - biological hazards.

What are ways a nurse can promote a positive body image in patients through teaching? (7)

- healthy does not mean perfect - focus on activity and healthy eating - don't make negative comments about your body - keep a list of things you like about your body - accept compliments - challenge critical comments - surround yourself with positive people

what are the four pathophysiological conditions that affect pulmonary function?

- hypoxemia -hypoxia -hypercarbia -hypocarbia

A person's safety is influenced by developmental factors as well as individual factors, such as: .

- lifestyle - cognitive awareness - sensory perceptual status - ability to communicate - mobility status - sensory losses - particularly hearing and vision losses

What are some of the changes to the 2018 AAP Recommended Vaccine schedule?

- maximum ages for the first and last doses of the rotavirus series have been added to the catch-up schedule -The polio vaccine rows clarify the catch-up schedule for people ages 4 and older.

Community hazards include

- motor vehicle accidents - pathogens - improper sanitation - pollution (air, water, noise, and soil) - electrical storms.

Major causes of unintentional deaths in the United States are (3):

- motor vehicle accidents - poisoning - falls.

what are the possible causes of hypoglycemia?

- overproduction of insulin by the pancreas - glucose mal-absorption - insufficient glucose storage (glycogen) in the liver - poor dietary habits

When planning to meet safety needs of clients, nurses need to consider:

- physical factors in the environment - the psychological and physiological state of the individual.

The main safety hazards in the home are:

- poisoning - carbon monoxide poisoning - scalds and burns - fires - falls - firearm injuries - suffocation - strangulation from cord near the crib - drowning - take-home toxins.

what are the negative affects of gestational diabetes?

- pregnancy-induced hypertension - premature birth large fetus size - congenital abnormalities - future obesity - diabetes in infants - A mother tends to develop type 2 DM later in life

What can nurses do to eliminate the barriers with vaccinations?

- provide evidence based information on the benefits and importance of immunizations -provide visual aides for those who may not be able to read -get a translator if there is a language barrier

what are the Common side effects of diuretics?

- weakness - muscle cramps - skin rash - increased sensitivity to sunlight (with thiazide diuretics) - dizziness - lightheadedness - joint pain.

Workplace hazards to nurses include:

-*back injuries* - needle stick injuries - radiation injury - violence.

what are some primary prevention techniques for diabetes?

-Avoid excessive calorie - Exercise at least 30 to 60 minutes at least 3 to 4 times a week. - Eat high whole grains, fruits, and vegetables that are deep orange in color, leafy green vegetables, and legumes/beans, lean meat and low fat milk. - Eat low sodium diet food to lower blood pressure and reduce the risk for cardiovascular disease. - Understand cultural influence and educate accordingly.

List the benefits of breastfeeding to the mother

-Decreased postpartum bleeding and more rapid involution -Reduced risk for ovarian cancer, breast cancer, type 2 diabetes, hypertension, cardiovascular disease, & rheumatoid arthritis -More rapid postpartum weight loss -Delayed return to menses -Increased bonding, attachment, and maternal role attainment

How would the nurse promote bonding?

-Delaying nursing cares for the first hour after birth and through the first breastfeeding attempt to allow for immediate parent-infant contact. -Placing infant skin-to-skin -Promote rooming in (staying w/ baby) -Promote early initiation of breastfeeding & teach how to recognize feeding cues -Encourage bonding by cuddling, bathing, feeding, diapering, etc. -Provide frequent praise, support and reassurance to new mothers as they move towards independence

What two additional vaccines are recommended for preteens and teens?

-HPV -Meningococcal

What are some "feeding-cues" for mom to watch for?

-Hand to mouth or hand to hand movements -sucking motions -Rooting reflex: infant moves toward whatever touches the area around the mouth and attempts to suck -Mouthing

What should you discuss with your client when performing a nursing history focused on bowel elimination?

-Normal bowel pattern -Appearance of stool -Changes in bowel habits or stool appearance -History of elimination problems -Use of bowel elimination aids, including diet, exercise, medications, and remedies

List the benefits of breastfeeding to the baby

-Reduced infant & child mortality -Reduced risk for GI infections, celiac disease, asthma, IBD/IBS, respiratory infections, SIDS, otitis media, necrotizing enterocolitis (in pretermers), type 2 diabetes, acute lymphocytic & myeloid leukemia, and more. -Enhanced neurodevelopment, including higher intelligence

The Braden scale components (6) What score represents a high risk

-Sensory Perception I. Completely limited ii. Very Limited Iii. Slightly limited Iv. No impairment -Moisture i. Constantly moist ii. Often moist iii. Occasionally moist iv. Rarely moist - Activity i. Bedfast ii. Chairfast iii. Walks occasionally iv. Walks frequently -Mobility i. Completely immobile ii. Very limited iii. Slightly limited iv. No limitations - Nutrition i. Very poor ii. Probably inadequate iii. Adequate iv. Excellent -Friction and shear (when skin and bone move in the opposite direction of the support surface) i. Problem ii. Potential problem iii. No potential problem → Total score of 12 or less represents High Risk

Benefits to EHR what ways does it help in planning care?

-allows for better communication that promotes continuity of care with realtime updates of documentation -healthcare professionals can evaluate treatment, monitor health status, and make changes to plan of care as needed that can be seen by others in seconds

what is pneumococcal disease? what can it cause? (3)

-an infection caused by a type of bacteria called Streptococcus pneumoniae 1. pneumonia 2. bloodstream infection (sepsis) 3. meningitis

Disadvantages of EHR (4)

-expensive -frequent downtime -lack of integration -difficulties with change

list 3 nursing interventions to promote optimal respiratory function in patient with chronic lung disease

-frequent position changes to keep areas of lungs well ventilated -incentive spirometry -positioning patients upright for meals

when is a cough significant? (3) when should a cough be evaluated?

-persistance -recurring -productive -lasts more than 3 weeks -cannot be explained

what are the two most common pulmonary circulation abnormalities that affect ventilation and oxygenation?

-pulmonary embolus -pulmonary hypertension

what are the major risk to oxygenation in older adults ? (3)

-reduced lung expansion -difficulty expelling mucus/foreign material -declining immune system

According to the ANA Professional Standards of Care, nurses document what? (9)

-relevant data in retrievable format -diagnoses/issues that facilitate determination of expected outcomes and plan -expected outcomes as measurable goals -the plan of care that uses standardized terminology -implementations and modifications of identified plan -coordination of care -results of evaluation -effective communication in written form -cooperation in creating a documented plan

Disadvantages to paper (6)

-retrieving information may be slow -limited access to chart and must be in the same location -documentation is time consuming -high risk for patient care error -storage of paper records is expensive -confidentiality is difficult to protect

what is wisdom? how does it develop?

-the appropriate use of knowledge in managing or solving human problems -it develops as an outcome of your clinical experience, theoretical knowledge, critical thinking, and intuition

Three causes of dehydration

1) Insufficient intake of fluids 2) Excessive fluid loss 3) Fluid shifts

name the medications that are associated with urinary retention?

1. Anticholinergics 2. Antidepressants (e.g., duloxetine or imipramine) 3.Antispasmodics(Muscarinic receptor antagonists (e.g., tolterodine tartrate) 4.Estrogen 5.Botulinum toxin injections

lifestyle considerations elders:

1. By age 75, the total number of nephrons ↓ by 30-50% 2. ↓ Peripheral blood flow, impaired renal function (longer excretion rates so the risk for medication toxicity) 3. Post-op and/or post-infection: takes longer for normal renal function to return 4. Decreased elasticity and muscle tone in bladder wall; ↓ capacity from 500 ml to 250 ml. (urinary retention so ↑ risk UTI) 5. Urinary incontinence 6. Nocturnal frequency (fall risk issues!)

List five actions you would use as a nurse to promote self-esteem in your patients.

1. Establish therapeutic nursing relationship emphasizing trust, consistency, honest communication, and unconditional positive regard. 2. Encourage the client to be as independent as possible. 3. Monitor 4 + discourage self-criticism and negative self-talk 4. teach the client to substitute positive self-talk for negative self-talk. 5. Use positive and affirming language.

What are the 5 steps for Assertive Communication?

1. Get the person's attention. 2. Express your concern. 3. State the problem. 4. Propose an action. 5. Reach a decision.

what are 3 ways to identify whether hydration is adequate and urine output is within normal limits?

1. Output MLs- The kidneys produce urine at a rate of about 50 to 60 mL per hour, or 1,500 mL per day. output may fluctuate by 1,000 mL to 2,000 mL 2. Output normal frequency- Most people void about five or six times per day, even eight times is normal— typically after awakening, after each meal, and just before bedtime. 3. output abnormal Frequency- Sometimes frequent urination is a sign of other medical problems, such as diabetes or urinary tract infection.

what are the 6 lifestyle risk factors for impaired glucose regulation?

1. Poor diets with high intake of saturated fat 2. Excess calorie intake leading to obesity 3.Low fiber intake 4. Inappropriate intake of carbohydrates 5. Very old - due to a reduction in lean muscle mass & reduction in insulin production and capacity to regulate and metabolize glucose regulation 6. Very young - gestational diabetes and elevated glucose levels in utero

how do you Explain how to collect a clean-catch urine specimen to a client?

1. The client must cleanse the genitalia before voiding 2.collect the sample in midstream because the initial flow of urine may contain organisms from the urethral meatus, distal urethra, and perineum. A mid- stream sample is free of these contaminants.

what are some Medications that have significant interactions with diuretics?

1. digoxin 2. antihypertensives 3. lithium 4. certain antidepressants (especially when taking thiazide or loop-acting diuretics) 5. immunosuppressant cyclosporine, especially when the patient is taking a potassium-sparing diuretic.

what are the primary functions of the kidneys?

1. filter metabolic wastes,toxins, excess ions, and water from the bloodstream and excrete them as urine. 2.The kidneys also help to regulate blood volume, blood pressure 3. regulate electrolyte levels, and acid-base balance by selectively reabsorbing water and other substances

What actions should you take before inserting a catheter?

1. gather appropriate supplies 2. prepare the patient 3.explain the reason for insertion to the patient,the expected length of time the catheter will be needed, and the sensations he is likely to have. 4. Explain that when the catheter is inserted it may feel as though he is voiding, but the urine is going into the tube, not onto the bed If there is swelling or bleeding in the urinary tract, insertion may be painful.

To ensure safety, focus on:

1. observing or predicting situations that are potentially harmful 2. educating clients to safeguard themselves and their family

Nurses must be familiar with fire procedures. In the event of a fire, nurses must:

1. protect clients from injury 2. report 3. contain 4. put out fire.

Identify the 5 activities that promote normal urination patterns

1. provide privacy 2. position appropriately 3.schedule elimination 4. Providing and monitoring fluid and nutrition 5.Assisting with hygiene

What are the 3 most common medications increase the amount of urine voided?

1. thiazide 2. potassium-sparing 3. loop-acting diuretics

Magnesium normal values, and where is it found

1.5-2.5 mEq/L Skeletal system 50-60%

What percent of our body weight does extracellular fluid account for?

20%

what is a random blood sugar test?

A blood sample will be taken at a random time. a random blood sugar level of 200 milligrams per deciliter or higher suggests diabetes.

Between an episiotomy or a laceration during childbirth, which is preferred?

A tear is actually preferred because the jagged edge healing process is advanced, and when an episiotomy is performed, the patient is more likely to tear further than they would with a lac.

Discuss important things to remember regarding audiovisual media.

A television or radio in the room may provide meaningful stimulation. Teach NAPs to choose appropriate music and programs for the patient. Inappropriate choices (e.g., cartoons with laugh tracks) offer meaningless stimulation and may lead to sensory deprivation.

Lecture teaching strategy: What is it? How can it be enhanced? Types of attention getters should be supported by(6)

A traditional method in which one or more presenter orally share info while learners listen. it can be enhanced by including discussion and question and answer periods for clarifying content and by use of computer projected slide presentations. Stories Quotes Images Analogies Metaphors Humor.

Describe normal findings of mental status and cognitive function.

Ability to express and explain realistic thoughts with clear speech, speak with smooth, natural pattern; follow multi step directions; listen; answer questions; and recall significant past events

How do diuretics work?

Act by increasing volume of urine production in treatment of hypertension, heart failure, and kidney disorders.

How can we change the preload without meds?

Add volume

Which stage marks a time of heightened sexual interest and activity?

Adolescence

What factors affect total body water content

Age, gender, and the number of fat cells.

Exemplar potassium channel blocker Exemplar calcium channel blocker

Amiodarone Verapmil

Name 2 examples of traditional modality

Antibiotics Surgery

What should the nurse look for when observing the nostrils of a newborn?

Are there two of them and are they open and patent? *Look for flaring

Does passive transport require energy?

Aww hell nah

The nurse is completing an admission assessment. Which interview question best reflects a belief related to holistic healthcare? A ."Can you tell me the names of the medications you are taking?" B."Can you tell me how you normally handle stress?" C."Can you tell me how long you have had your symptoms?" D."Can you tell me your age and where you live?"

B."Can you tell me how you normally handle stress?"

Diltiazem (Calcium channel blocker) What should the nurse monitor before giving med (2) What else should the nurse monitor (2) Route (2) Contraindication

BP HR Daily weight Edema Orally, IV Grapefruit juice

Alternative medicine: Homeopathy

Based on an understanding of how the body heals itself and an acceptance that all symptoms represent the body's attempt to restore itself to health

What is race based on?

Based on biological similarities

Where does the right of privacy come from?

Bill of rights

How can a new nursing student begin to assume leadership skills?

By helping to influence your coworkers to work towards the same goals. Enabling you all to move in the same direction.

How do most tissues heal? explain process

By repair, scar tissue replaces original tissue

Benefits of music therapy (5)

Calm agitation Decrease BP Decrease pulse Relaxation Stress reduction

What is the grading scale of DTR?

Each DTR corresponds to a certain level of the cord and is graded on a 0 to 4+ scale

Describe the elements of professional collaborative communication

Each member of the care team plays a role in achieving the goal of providing optimal patient care. Nurses, physicians, and other health professionals work must communicate effectively with one another to make this happen. Being assertive without being aggressive

What belief is holistic healthcare founded on? There is no separation between what 3 things

Each person is a whole in constant interaction with the environment. Body Mind Spirit

Printed materials teaching strategy: What is provided? To be sure the client understands the info, you must

Fact sheets and discharge instructions, printed pamphlets. Provide and opportunity for them to ask questions after they read the materials. Provide take home summary of the main points you want them to most remember.

Printed materials

Fact sheets and discharge instructions, printed pamphlets. When teaching children, you might use age appropriate printed books, coloring books. to be sure the client understands the info, you must provide and opportunity for them to ask questions after they read the materials. Provide take home summary of the main points you want them to most remember.

Justice

Fairness and equal treatment

Unintentional injuries are the _________ leading cause of death in the United States.

Fifth

What is the best position for a laboring woman is best during early labor?

Forward leaning

How does general anesthesia effect bowel movements?

General anesthesia block of parasympathetic stimulation to smooth muscle of colon→ slowing or ceasing of peristalsis

what are the risk factors for impaired glucose utilization?

Genetics - family history of diabetes, obesity, or low level of high-density lipoprotein (HnDL)

bleeding gums How can women minimize this?

Gently brush teeth & observe good dental hygiene.

Subcultures

Group within a larger group

Bicultural

Identify self with two cultures

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

If they become painful, frequent, and regular.

What can imbalance in the 3 forces of ayurveda lead to?

Illness

What can expert power be derived from (2) ?

Knowledge and skills

Name an example of compensatory justice?

Malpractice lawsuits

Give an example of how politics can affect health

Medicare for those over the age of 65

What is a medical error?

Medication or treatment errors done by healthcare professionals

What findings are normal for nails (3) What findings are normal for surrounding cuticles (3)

Nail- Smooth, Transparent, Convex Cuticles- Smooth, Intact, No inflammation

Differences between PMS and PMDD (3) Can both happen at same time

PMS is shorter, usually milder, and involves more physical symptoms. A women can suffer from both PMS and PMDD at the same time, or may have one and not the other.

Alternative medicine: Acupuncture

Penetration of the skin with thin needles to stimulate anatomical structures of the body

What are the levels of function related in terms of performance and expectations? (3)

Physical Mental Social

What need can communication help meet?

Physical Psychosocial Emotional Spiritual

What are the key elements of a physical assessment for a client with urination problems?

Physical assessment for urinary elimination includes examination of the kidneys, bladder, urethra, and skin surrounding the genitals, as appropriate.

Demonstration and return demonstration teaching strategy Pro Con

Pros Allows for targeted questions and answers and practical matters rather than theory Cons Requires demonstrator to have specialized expertise if highly technical tasks are involved.

ANA definition of nursing (4)

Protection/promotion/optimization of health and abilities Prevention of illness and injury Alleviation of suffering through diagnosis and treatment of human response Advocacy

What is something a nurse should always do when performing a sexual health assessment?

Provide privacy

Consequentialism

Rightness or wrongness of an action depending on the consequences of the act rather than on the act itself

What is urinalysis?

Routine screening test that includes a measure of urine pH at specific gravity.

When determining level of orientation, what measure remains intact the longest?

Self-identity

What 3 values does a biomedical healthcare system emphasize?

Self-reliance Individualism Aggressive action

What are some ways to stimulate the sense of smell?

Stimulate the sense of smell with fruits and flowers, or even aromatherapy. Pleasant smells may also stimulate appetite

Epinephrine (Adrenergic agonists) Action Therapeutic effects (3) Complications (3) Nurse should continuously monitor what? Routes (2)

Stimulates heart Increased HR Increased rate of conduction Activates receptors in kidneys to release renin Vasoconstriction Hypertensive crisis Dysrhythmias *Cardiac monitoring* IV or IM

Reflect on a Wellness Diagnosis label.

Teaching is the primary intervention for wellness diagnoses, such as readiness for enhanced breastfeeding, readiness for enhanced communication, and the almost 20 other NANDA-I labels beginning with the phrase "readiness for enhanced".

Who won the 2007 Super Bowl?

The Indianapolis Colts

Major function of bicarbonate

The kidneys regulate extracellular bicarbonate to maintain acid-base balance.

What is intravascular fluid?

The plasma within the blood

What is the main function of intravascular fluid?

Transporting blood cells

Lifespan teach/learn factors: Children 4 nursing strategies Example:

Use strategies to gain trust Reduce their anxiety Promote cooperation Enhance their emotional readiness to learn. EX: give the child a tour of the hospital a week before scheduled surgery and introduce the nurses and physicians who will be doing their surgery.

Guided imagery

Using the imagination to create a desired event or scenario.

What are the major concerns associated with sodium intake?

We are consuming too much of it, with chronic diseases ( EG hypertension, diabetes, chronic kidney disease), African Americans, and people older than age 51 are especially sensitive to the blood pressure raising effects of salt.

List the warning signs of heat exhaustion (10)

Weakness Nausea, Vomiting Syncope Tachycardia Tachypnea Muscle aches Headaches Diaphoresis Flushed skin.

What are some reversible causes of anosmia?

Zinc deficiency, heavy smoking, cocaine use, rhinitis, and sinusitis

What is congenital rubella syndrome?

a condition that occurs in a developing baby in the womb whose mother is infected with the rubella virus

11) A mother reports that her teenager is losing hair in small round areas on the scalp. The nurse interprets this as suggesting which condition? a. Alopecia b. Seborrhea dermatitis c. Hirsutism d. Paronychia

a. Alopecia Rationale: Alopecia is the correct term for thinning hair loss.

5) The nurse is assessing the dorsalis pedis pulses on an 88-year-old client. She notes the feet to be cool and assesses weak, thready pulses. The nurse's next action would be to: a. Assess the popliteal and femoral pulses b. Assess a 1-minute apical pulse c. Notify the physician STAT d. Apply a warm pack and reassess in 20 minutes

a. Assess the popliteal and femoral pulses Rationale: Completing an assessment of other peripheral pulses will provide further data about the adequacy of circulation to the legs.

in which structures of the lungs does gas exchange take place?

alveoli and capillaries

what does ABG stand for?

arterial blood gas

List some causes of tactile sensitivity loss.

can be caused by a cerebrovascular accident (stroke), brain or spinal tumor or injury, or peripheral nerve damage caused by diabetes, Guillain-Barré syndrome, or chronic alcoholism.

convalescence-

characterized by tissue repair and return to health as the remaining number of microorganism approaches zero.

sensory and perceptual abilities in adolescents

children are developmentally driven toward peers, and the increased social interaction provides a wealth of sensory stimulation.

what is knowledge?

data that has been grouped together creating meaningful information and relationships which are then added to other structured information

How often should the urine collection bag be emptied?

every 8 hours

what can lead to hypoxemia?

hypoventilation

What are the potassium sparing diuretics?

reduce the amount of water in the body. Unlike other diuretic medicines, these medicines do not cause potassium loss.

Define "healthcare-related" infection:

refers to infections associated with healthcare given in any setting (hospitals, nursing homes, ambulatory care etc.)

Invasive procedures:

several procedures are associated with increase risk of infection. for example, urinary catheterization IV line insertion

what is a nephron?

structural and functional units that form urine there are about 1 million per kidney

When looking at the eyes and ears of a newborn, what is important?

symmetry

What is peristalsis?

the involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wavelike movements that push the contents of the canal forward.

Why do hemorrhoids occur especially during pregnancy and postpartum?

they are common during pregnancy and childbirth due to the pushing.

what is the treatment for hypoglycemia?

treatment depends on the cause

How does fatigue affect oxygenation?

when we are fatigued, the lungs and blood lack adequate oxygen levels making us feel tired

how do narcotics effect bowel movements.

↓ GI activity through action on the CNS → constipation

what questions should you ask when doing a urinary assessment?

➤ Have you experienced any problems with urinary tract infections or kidney and bladder problems? ➤ Have you ever lost control of your urination? ➤ Have you ever had urinary tract surgery or diagnostic procedures?

Describe some important safety interventions for patients with tactile deficits

➤ Use a bath thermometer to monitor water temperature and prevent burns. ➤ Change position frequently to relieve pressure on bony prominences. ➤ Use properly fitting shoes and socks. ➤ Immediately report any signs of circulatory impairment (e.g., declining motor function, cool temperature, gray-blue coloration). ➤ Inspect

Advantages of paper (4)

-Care providers are comfortable with it because it is familiar -paper records do not require large databases and secure networks to function -no downtime for system changes -inexpensive

how is documentation used for reimbursement and utilization review?

-Insurance companies, government and 3rd party payers, budget managers, and organization billing staff use client health records to determine cost of care -they also use the health record for utilization review to determine whether medical treatments and interventions were necessary and appropriate

Norton scale (5)

-Physical Condition Good Fair Poor Very bad -Mental condition Alert Apathetic Confused Stuporous -Activity Ambulant Walks with help Chairbound Bedfast -Mobility Full Slightly impaired Very limited Immobile -Incontinence None Occasional Usually urinary Urinary and fecal

why might some adults need vaccines? (4)

-Some adults were never vaccinated as children -Newer vaccines were not available when some adults were children -Immunity can begin to fade over time -As we age, we become more susceptible to serious disease caused by common infections (such as flu and pneumococcus)

What information must the nurse provide to patients/caregivers prior to the administration of a vaccine?

-a copy of the current vaccine information -in the case of an incompetent adult, VISs shall be provided to the individual's legal representative. If the incompetent adult is living in a long-term care facility, VISs may be provided at the time of admission, or at the time of consent rather than prior to each vaccination

what are the major risk to oxygenation in young and middle-age adults? (2)

-continued bad habits such as smoking which leads to more serious problems like emphysema -natural decline in number of cells and efficiency of organs

in a comprehensive assessment, what should be included in a nursing history for a patient with with oxygenation concerns? (6)

-demographic data -health history -respiratory history -cardiovascular history -environmental history -lifestyle

Advantages of EHR (5)

-enhanced communication and collaboration -improves access to information -saves time -improves quality of care -information is private and safe

what effect does ventilation have on arterial PCO2?

-hyperventilation: large amounts of carbon dioxide diffuse into the alveoli and are exhaled into the air, causing arterial PCO2 values to fall. -hypoventilation: less carbon dioxide diffuses into the alveoli for exhalation, leaving more carbon dioxide in the arterial blood, which causes PCO2 values to rise.

what are the major risk to oxygenation in infants and toddlers? (6)

-immature surfactant system -high risk for respiratory distress syndrome -immature pulmonary circulation -small/narrow airways -large adenoids and tonsils -immature immune system

Benefits of EHR how is it efficient?

-improved access can increase efficiency, productivity, and continuity of care -it conveniently stores all patient information in one place

what types of injuries are most likely to cause oxygenation problems? (3)

-injuries to the chest wall -injuries to the CNS that may affect regulation of breathing -injuries that may be associated with embolus formation

What does the nurse evaluate following the administration of a vaccine?

-monitor for any adverse reactions and report findings to the Vaccine Adverse Event Reporting System (VAERS), even if the cause is unknown

list six signs a nurse would observe in a patient experiencing dyspnea

-nasal flaring -head bobbing -retractions -use of accessory muscles during inspirations -grunting -inability to speak sentences without stopping to breath (conversational dyspnea)

What should the nurse assess prior to administration of a vaccine? (4)

-review immunization history -assess need for immunizations using the Advisory Committee on Immunization Practices (ACIP) immunization schedule -screen for contradictions and precautions -educate the patient using the Vaccine Information Statement (VIS)

What are some reasons parents may choose not to have their children immunized? (6)

-severe allergic reactions to previous vaccines -compromised immune system -fear of possible outcomes -not wanting to inflict pain -Religious beliefs , social beliefs -lack of education

what environmental and lifestyle factors that influence ventilation can be avoided or minimized? (9)

-stress -allergic reactions -poor nutrition -smoking -substance abuse -exposure to hazardous material -temperature and humidity -poor air quality -altitude changes

what pulmonary system abnormalities affect ventilation and oxygenation? (4)

-structural abnormalities - airway inflammation and obstruction -alveolar-capillary membrane disorders - atelectasis

what are the major risk to oxygenation in school-age children and adolescents? (5)

-tonsillitis -upper respiratory infections -viral infections (pneumonia) -exercise induced asthma -bad social habits (smoking)

Three stages of development that affect moral decisions?

1) Childhood- Base their morals on avoiding punishment and personal interest 2) Adolescence- Principles focus on pleasing others and following rules 3) Adulthood- Base moral principles on universal and impartial principles of justice

Briefly describe the steps of Informal Negotiation.

1) Clarify the situation in your own mind - what are you trying to achieve? What problems am I likely to encounter? 2) Set the stage - make direct statements between the two parties to open communication. 3) Conduct the negotiation - clarify the problem, make the opening move. 4) Continue with offers and counteroffers - back and forth ideas about compromise. 5) Agree on the resolution of the conflict.

Common causes of malpractice litigation (6)?

1) Failure to respond 2)Failure to educate 3)Failure to follow standards of care and institutional policies/procedures 4)Failure to communicate 5)Failure to document 6)Failure to act as an advocate

List the 5 steps in avoiding medication error

1) Follow the rights of med administration 2) Investigate any concerns the patient has with the medication before administering 3)Questions prescriptions that are incomplete or that seem inappropriate 4) Make sure equipment used to administer drugs is working properly 5) Use the correct technique to provide the patient treatment

What are the 10 steps to Baby-Friendly hospital status?

1) Have a written breastfeeding policy that is routinely communicated to all healthcare staff. 2) Train all health care staff in skills necessary to implement this policy. 3) Inform all pregnant women about the benefits and management of breastfeeding. 4) Help mothers initiate breastfeeding within 30 minutes of birth. 5) Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants. 6) Give newborn infants no food or drink other than breast milk unless medically indicated. 7) Practice rooming-in (allow mothers and infants to remain together 24 hrs a day) 8) Encourage breastfeeding on demand 9) Give no pacifiers or artificial nipples to breastfeeding infants. 10) Foster the establishment of breastfeeding support groups, and refer mothers to them on discharge from the hospital or clinic.

Professional guidelines (5)

1) Healthcare professionals have an obligation to society to be competent in their field 2)Allow only competent members into the field 3)Discipline members of profession who do not practice at a professional level 4)Do no harm 5) Use high moral and ethical standards to resolve dilemmas

Why is evaluative feedback important? Evaluative feedback is important because:

1) It reinforces constructive behavior 2) It discourages unproductive behavior. 3) It provides recognition. (1067)

7 Right of Nurses in the healthcare workplace

1) Practice in a manner that fulfills their obligations to society and to those who receive nursing care 2) Practice in environments that act in accordance with professional standards and legally authorized scopes of practice 3) To work in an environment that supports and facilitates ethical practice as defined by the code of ethics for nurses 4) Freely and openly advocate for their patients and themselves without fear or retribution 5) Fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities 6) A work environment that is safe for their patients and themselves 7) Negotiate the conditions of their employment (either as individuals or collectively) and all practice settings

JCO specific guidelines for use of restraints (3)?

1) Should only be used to ensure the physical safety of the resident or another resident 2) Should only be used when less restrictive interventions are not successful 3)Should only be used on the written order of a physician, which includes a specific episode with start and end times

Sunscreen (5 things)

1) UVA and UVB labeled "broad-spectrum" 2) No lotion can block sun completely, can't be labeled as sun block anymore 3) Can't claim to be waterproof/sweatproof 4) Water resistant sunscreen must reveal the amount of protection time (60 minutes) 5) Cannot be labeled over SPF 50

Identify strategies to minimize liability in nursing practice (3)

1)Perform timely patient assessments and document your findings for every patient interaction 2)Communicate all changes in patients status to the primary health care provider and document changes 3)Use proper change of command to ensure appropriate and timely care when primary health care provider is not available

What are Nurse Practice Act designed to do? (3)

1)Regulate nursing practice to promote health safety for general public 2)Define the scope of nursing practice 3)Approve programs providing pre-licensure nursing education to students

what are the 4 risk factors of metabolic syndrome?

1. Central obesity 2. Hypertension 3. Gout 4. Pre-diabetes

name 4 additional medical risk factors for impaired glucose regulation:

1. Crushing syndrome 2. Recurrent pancreatitis 3. Cystic fibrosis 4.Use of corticosteroids

name 4 additional medical risk factors for impaired glucose regulation:

1. Cushing syndrome 2. Recurrent pancreatitis 3. Cystic fibrosis 4.Use of corticosteroids

What are some common birth defects associated with congenital rubella syndrome? (7)

1. Deafness 2. cataracts 3. heart defects 4. intellectual disabilities 5. liver and spleen damage 6. low birth weight 7. skin rash at birth

lifestyle considerations adolescents:

1. Education important: nocturnal enuresis is not the same as nocturnal emission! 2. Females from ages 15-24 experience the most frequent UTI's 3. Patient education focuses on good hygiene practices 4. Urination after intercourse

lifestyle considerations for school aged kids?

1. Elimination system reaches maturity (kidneys double in size between ages 5-10) 2. Enuresis: the involuntary passing of urine (10% all six-year-olds) 3. Nocturnal enuresis: not considered problem until > 6 years of age

List five additional factors that influence body temperature

1. Environment - extremely high external temp can cause heat stroke, very low external temp can cause hypothermia 2. Gender - woman's body temp varies with her menstrual cycle and pregnancy by as much as 1° F, or 0.6° C. Body temp = low when progesterone levels are low and vice versa. Hormone fluctuations during menopause cause temp fluctuations known as hot flashes 3.Exercise 4.Emotions and stress - emotional stress, excitement, anxiety and nervousness stimulate the sympathetic nervous system, causing production of epinephrine and norepinephrine. These then increase metabolic rate, which increases body temp. 5.Circadian rhythm - cyclical repetition of certain physiological processes (ex; changes in temp and blood pressure). Temp is usually lowest in the early morning hours and highest in the late afternoon or early evening.

what are the 4 major symptoms of type 2 diabetes mellitus?

1. Fatigue 2. Recurrent infections 3. Prolonged wound healing 4. Visual changes

what actions should be taken by the nurse if an infants blood sugar is ≥ 40 mg/dl?

1. Feed at least every 3 hours (see ground rules) 2. Assess infant risk factor category to determine the recommended screening intervals below

what actions should be taken by the nurse if an infants blood glucose is If glucose is < 40 mg/dl?

1. Feed immediately (see ground rules) 2. Send confirmatory serum glucose 3. Consider possible causes 4. Check with glucometer 1 hours after feeding

what are the 5 components of diabetes management?

1. Nutrition 2. Exercise to maintain proper body fat 3. Glucose monitoring 4. Medication 5. Education 6. Self-monitoring blood glucose

lifestyle considerations adults:

1. Pregnancy: ↑ urinary frequency and ↑ risk of UTIs; decreased perineal muscle tone 2.Ages 40-70, filtering ability of kidneys ↓ due to nephron loss 3.Males: enlarged prostate gland increases in males >50 years of age 4.Females: ↓ estrogen levels cause ↓mucous membranes

Identify at least five independent nursing actions that you can take to encourage regular elimination in a good client:

1. Provide privacy when using the bathroom (are the seated upright?) 2. Allow for uninterrupted time to defecate, especially after meals (often after meals, some may need assistance) 3.Assume a seated or squatting position when attempting to have a BM (seated upright) 4.Drink at least 1,500 mL (preferably 8 to 10 glasses, or 2,000 to 2,400 mL) of fluid per day 5.Exercise 3 to 5 times per week (range of motion for pts that cannot do much)

what does a urinary nursing history consist of (subjective data)?

1. the pattern of urination (frequency, times of day, normal volume and any recent changes) 2. Symptoms of urinary alterations (urgency, lose urine w/ cough or sneeze, leakage at other times) 3. Factors affecting urination (age, environmental factors, medication history, psychological factors, muscle tone, fluid balance, current surgical or diagnostic procedures, disease conditions)

what are the secondary functions of the kidneys?

1. to produce erythropoietin 2.secrete the enzyme renin 3.activate vitamin D3 (calcitriol).

list the two Causes of Type 1 Diabetes Mellitus:

1. viral or autoimmune destruction of parts of the pancreas 2. genetic factors

what are the clinical skills for nurses regarding diabetes management?

1.Assessment 2.Blood glucose monitoring 3.Dietary teaching 4.Medication Administration

steps to giving insulin:

1.Clean the vial, insert the air 2.Clean the site 3.inform the patient about the procedure 4.when injecting insulin, the skin is gently pinched and the needle inserted @ 45 or 90-degree angle 5.An injection that is too deep or too shallow might affect absorption rate. 6.No aspiration is necessary, do not massage the injection site massaging interferes with absorption

What actions can you take to make the patient more comfortable when he receives an enema?

1.Explain the purpose of the enema and what the patient can expect. 2.Always provide privacy when administering an enema. 3.Reassure the patient that you will be immediately available to help the patient to the restroom or onto the bedpan. 4.Lubricate the tip of the enema and administer the solution slowly. 5.Have the patient breathe slowly through the mouth.

what are the infant feeding groundrules?

1.Feed within 1 hour of birth, no matter when you check the first glucose 2. At any time, if unable to feed well within 15 minutes, then feed a minimum of 5 ml/kg of formula or EBM via gavage, bottle, or SNS.

list the 6 steps in evidence-based practice and research

1.Formulate an answerable question about prevention, diagnosis, prognosis, and interventions 2.Conduct a systematic review of published evidence to find studies that shed light on desired topic 3.evaluate or grade the quality of the evidence obtained. Involves validity, application, and impact 4.compiling and analyzing data to prepare a structured report of the review 5.translating the evidence into guidelines for practice 6.integrating guideline and evidence with clinical expertise, patient preferences and characteristics

what does a physical urinary assessment consist of? (objective data)

1.Inspection/observation 2.Skin: color, texture, turgor, edema - Mucous membranes - Urethral meatus (presence of discharge) - Perineal area 3. Palpation (urinary bladder) 4. Percussion (of kidneys to detect areas of tenderness) 5. Intake and output 6. Characteristics of Urine (Color and odor) 7. Urine testing - Specimen collection (random, clean-voided or midstream, sterile and timed) - Urinalysis/specific gravity/urine culture 8. Diagnostic exams (invasive and noninvasive)

what is the RN's role when a patient has diarrhea?

1.Monitor stools to quantify diarrhea 2.assess and monitor for fluid imbalance 3.monitor skin integrity Proper dietary teaching: clear liquid, banana, rice, applesauce, toast (BRAT), what foods to avoid

what are the special considerations for infants?

1.Newborn voids within 24 hours of birth 2.70-75% total body weight is fluid 3.Cannot effectively concentrate urine (appears light yellow or clear) 4.2-5 years' age can associate sensations of bladder filling and urination 5.Urinary Tract Infections (UTIs) second most common infections (2 nds to upper respiratory infections) - More common in newborn and young infant boys (obstructions/malformations of urinary system) - Older infants and children- girls more UTI's due to urethral contamination stool

what are the elements of a bowel training program

1.Planning the program with the patient and caregiver 2.Gradually increasing fluid (8 glasses of water a day) 3.fiber 4.activity to promote regular bowel movements 5.Initiating a designated uninterrupted time, in private, to defecate 6.Developing a staged treatment plan when constipation develops to prevent recurrence 7.Regularly modifying the plan based on the patient's response

what are the 2 responsibilities of the institutional review boards?

1.Protect research participant from harm 2.ensure that research is of value

What types of conditions or surgeries are associated with a high incidence of altered urination? (3)

1.Reproductive and Urinary Tract Surgeries 2.Surgery in the Pubic Area, Vagina, or Rectum 3.Anesthetic Agents

what are the 4 rights of informed consent?

1.Right to not be harmed 2.Right to full disclosure 3.Right to self-determination 4.Rights of privacy and confidentiality

What are the normal heart rate ranges for a newborn?

110-160 bpm

Sodium normal values

135-145 mEq/L

1st and 2nd line of treatment for BP

1st- Lisinopril 2nd- Losartan

Embryonic stage: How many arteries and veins does an umbilical cord have?

2 arteries & 1 vein.

What should the vascularature structure of the umbilical cord on a newborn look like?

2 arteries / 1 vein

General recommendations for total fluid intake

2,700 mL per day for women 3,700 mL per day for men.

How long should the fourth stage of pregnancy last?

2-4 hours

What is a normal voiding pattern of a newborn?

2-6 times in first 24 hours, then 6-8 times afterwards.

Medical prescriptions for restraints must be renewed at least every_______________.

24 hours

Potassium (K) normal values and where is it found?

3.5-5.0 mEq/L Intercullular

What are the normal respiration ranges for a newborn?

30-60 breaths per minute

What percent of our body weight does intracellular fluid account for?

40%

How much potassium should adults consume daily?

4700 mg/day

How much blood does the average adult have?

5 liters

How long should the third stage of labor take?

5-30 minutes

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

6 months

What is a normal range for the blood pressure of a newborn?

60-80/40-50 Often not done or done once prior to discharge from the hospital

More than half of all falls occur in the home; about 80% involve people older than age _____.

65

what is a normal blood glucose?

70-140mg/dl

A newborn is delivered vaginally at term 1 minute ago. The newborn cried loudly at delivery Has a heart rate of 140/minute Has well flexed arms and legs Grimaces when nurse rubs soles of feet Pink with mild acrocyanosis What is the newborns Apgar score?

8 For heart rate, 0 means absent, 1 is slow (below 100/min), and 2 means above 100/min. This newborn scores 2 for a heart rate of 140/min. For respiratory effort, 0 means absent, 1 means slow or weak, and 2 reflects a good cry. This newborn scores 2 for crying loudly at delivery. For muscle tone, 0 is flaccid, 1 indicates some flexion of the extremities, and 2 is well flexed. This newborn scores 2 for well-flexed extremities. For reflex irritability, 0 means no response, 1 is a grimace, and 2 is a cry. This newborn scores 1 for grimacing when the nurse rubs the soles of his feet. For color, 0 is pale or blue, 1 reflects a pink body with blue extremities, and 2 means completely pink. This newborn scores 1 for being pink with mild acrocyanosis.

Calcium (Ca) normal values and where is it found?

8.4-10.5 mg/dls 99% skeletal

Fetal stage How long does this stage last?

9 weeks gestation until delivery - roughly 32 weeks for a term baby, but technically ends at the time of delivery for any gestational age past 9 weeks.

What is the normal range for the temp of a newborn?

97.7 - 99.5 F

Hyponatremia lab values and causes:

<135 mEq/L Causes: loss of sodium and gain of water,

Hypokalemia lab value

<3.5 mEq/L

Hyperkalemia lab values and causes and symptoms:

>5.0 mEq/L Causes: decreased K+ excretion (renal failure), high K+ intake Signs/symptoms: cardiac arrest or dysrhythmias, hyperactivity of smooth muscle (diarrhea, abdominal cramping), muscle weakness.

What does the principle of utility state?

A "good" act is one that produces the greatest good for the greatest amount of people

Healing modalities, energy therapies: Therapeutic touch What does it provide (3)

A bio-field therapy, uses the hands on or near body Comfort Healing Pain relief

what is a fasting blood sugar test? what are the normal and abnormal values?

A blood sample will be taken after an overnight fast. A fasting blood sugar level of less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If it's 126 mg/dL or higher on two separate tests, indicates diabetes.

What are bowel diversions and why are they performed?

A bowel diversion is a surgically created opening for elimination of digestive waste products from the bowel. This procedure is performed for clients with a variety of conditions, including: cancer ulcerations trauma inadequate blood supply Temporary diversions are performed to allow healing of the distal portion of the bowel permanent diversions are performed in instances of severe disease or trauma when the bowel is necrotic or cannot be salvaged.

What are some of the earliest indicators of increased intracranial pressure?

A changing LOA, along with forgetfulness, restlessness, or sudden quietness,

How is cultural competence obtained?

A continuum ranging from cultural destructiveness (most negative) to cultural proficiency ( most positive).

Impact of depression on sexuality

A depressed person experiences significant loss of interest in activities that previously brought pleasure. Thus it is common for people with depression to avoid engaging in interpersonal activities, including sex.

Half and half nails What kind of client does it occur in (2)

A distal band of reddish-pink covers 20%-60% of the nail. Occurs in clients with low albumin levels or renal disease.

what do you look for when you percuss a bladder?

A distended bladder produces a dull sound as opposed to the normal tympanic sound of intestinal air.

Patient Self-Determination Act

A federal law that mandates that every individual has the right to make decisions regarding medical care, including the right to refuse treatment and the right-to-die, durable power of attorney

Explain the importance of knowing the patient's health literacy for effective teaching. Give an example of utilizing one of the strategies. .

A gap in health literacy occurs when a health care provider uses medical terminology that is unfamiliar or misunderstood by the patient, thus resulting in an unintended message or lack of meaningful information. Ask questions that involve "what" and "how" not just "yes" and "no"

Healing modalities, energy therapies: Reiki

A healing technique based on the principle that the therapist can channel energy into the patient by means of touch, to activate the natural healing processes of the patient's body and restore physical and emotional well-being.

Statutory Law

A law passed by congress or state legislative body States use their police powers to pass laws to ensure the general health, welfare, and safety of their citizens Ex: Definition of nursing

How is a manager different from being a leader?

A manager is an employee of an organization who has the power, authority, and responsibility for enforcing decisions and for planning, organizing, coordinating, and directing the work of other. A leader is someone who is inspiring to others and should be something every manager strives to be.

What is a complete blood count test

A measure red blood cells, white blood cells, and platelets- Also included is hematocrit, a measure of the percentage of RBC's in whole blood.

What is Trichotillomania? How can you treat it?

A mental health disorder characterized by the repeated pulling out of one's own hair Cognitive behavioral therapy

What is the power of mentorship and preceptorship in the development of leadership and management skills? How do mentors and preceptors differ?

A mentor is someone more experienced who provides career development assistance, such as coaching, sponsoring advancement, providing challenging assignments, protecting proteges from adversity, and promoting positive visibility. They also provide guidance to a new student or recent graduate as they continue in the profession. A preceptor is someone with more experience who provides practical teaching and guidance for a student or new employee. The first component of leadership and management development is of the self, and the second is of others - which is mentorship and preceptorship.

What is a misdemeanor?

A minor charge, which involves less than a year in jail. Includes crimes such as assault, battery, and petty theft. May also lose your nursing license if the crime is against a person or that can cause harm.

What is role strain?

A mismatch between role expectation and role performance.

What is the Denver Developmental Screening Test and what does is examine?

A neurological screening for young children that examines motor, language, and coordination skills

Stage 2: Advanced beginner Who functions at this level? Characteristics of this stage (5)

A new graduate usually functions at this level. Focus on more aspects of a clinical situation. Use more facts More sophisticated use of the rules Recognize similarities in situation Distinguish abnormal findings but cannot readily understand their significance

What does Perry say about the latest research regarding phases of labor?

A noted transition phase is not always included due to use of anesthetics.

Why do you think it important for the nurse to be mindful of the five "rights?"

A nurse should be mindful of these five rights because it helps for the most effective outcomes of teaching a patient and helping to make sure the patient can fully understand the self care.

If a patient responds to painful stimuli, what action occurs?

A patient will withdraw from the pressure

Bisexuality

A person who is sexually and emotionally attracted to both males and females.

Transvestite (Cross-Dresser):

A person who occasionally or frequently wears clothing characteristic of the opposite sex, particularly the undergarments, as a form of sexual expression. The person often carries out this behavior in secret.

What is a durable power of attorney?

A person who will make healthcare decisions in the event a patient is unable to do so

Impact of mania on sexuality

A person with hypomania or mania may be preoccupied with pleasurable activities and increased sexual activity, as well as verbalization and acting out. Both extremes are disruptive to a relationship

Paternalism

A policy of treating subject people as if they were children, coercing the client to act as you wish, rather than as they wish.

What is a nurse practice act?

A provision that creates and empowers a state board of nursing to regulate the practice of nursing in that state (varies from state to state).

What does a good non-stress test look like?

A reactive (good) non-stress test is a normal baseline rate with moderate variability, accelerates at least twice in 20 minutes for at least 15 seconds.

What is the pathway from stimuli to the CNS?

A receptor converts a stimulus to a nerve impulse and transmits the impulse along sensory neurons to the central nervous system (CNS).

Define critical thinking What does it involve (3)?

A reflective thinking process Collecting information Analyzing the adequacy/accuracy of the info Considering options for action.

Ethical dilemma

A situation in which a choice must be made between two equally undesirable actions. There is no clear right or wrong option.

Define sensory deprivation.

A state of RAS (reticular activating system) depression caused by a lack of meaningful stimuli.

What is sensoristasis? When do sensory alterations occur?

A state of optimal arousal. When the body experiences meaningless or limited stimulation (sensory deprivation), excessive stimulation (sensory overload), or sensory deficits.

Describe the relationship between a stimulus, a nerve receptor and the brain.

A stimulus may be a sight, sound, taste, touch, pain, or anything that stimulates a nerve receptor. The brain must receive and process it to make it meaningful.

what is a Straight catheter and why is it used?

A straight catheter is a single- lumen tube that is inserted for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure post void residual volume (PVR), or to relieve temporary bladder distention). After the bladder is empty or the sample obtained, the catheter is removed and the patient resumes voiding independently.

What would reflect transformational leadership within the hospital?

A supportive climate where followers are listened to and feel as though they are being coached or mentored by their leaders.

Lecture

A traditional method in which one or more presenter orally share info while learners listen. it can be enhanced by including discussion and question and answer periods for clarifying content and by use of computer projected slide presentations. Teachers can engage learners with an attention getting opening and by supporting teaching points with stories, quotes images analogies or metaphors and humor.

What is anxiety?

A vague, emotional response to a known or unknown threat.Related to the anticipation of a future event and is the result of psychological conflict rather than physical threat.

Always ask for _____ before touching anyone

A warm glass of milk, just kidding the answer is permission

Define socialization

A way of learning to be a member of a society

What would you teach a postpartum woman about proper nutrition?

A well balanced diet helps promote healing and health in the postpartum period. Proper nutrition postpartum will help combat constipation and anemia, provide quality nutrients for women who choose to breastfeed, promote weight-loss and promote healing and well-being.

Multigravida (Multip)

A woman who has had 2+ pregnancies

Primigravida (Primip)

A woman who is pregnant for the first time

Nulliparous

A women who has never given birth

Which of the following healing modalities would be inappropriate for the patient receiving chemotherapy to use? A) Acupuncture B) Meditation C) Biofeedback D) Yoga

A) Acupuncture Chemo can cause an increase in bleeding, even with the small needles

A nurse is caring for a newborn who just had a circumcision using the Gomco clamp technique. Which of the following instructions should the nurse include when teaching the parents to care for this site? *Select all that apply* A) Apply petroleum jelly to the penis for the first 24 hr B) Cleanse the penis with warm water and mild soap C) Apply gentle pressure from a sterile gauze pad to control slight bleeding D) ​Gently wipe away any yellow exudate on the penis E) Apply the diaper loosely over the penis

A) Apply petroleum jelly to the penis for the first 24 hr C) Apply gentle pressure from a sterile gauze pad to control slight bleeding E) Apply the diaper loosely over the penis

The concept of "knowing" the patient comprises both the nurse's understanding of a specific patient and the nurse's subsequent selection of interventions. To know a patient means that the nurse (Select all that apply.) A) Avoids assumptions. B) Focuses on the patient. C) Engages in a caring relationship. D) Forms the relationship quickly.

A) Avoids assumptions. B) Focuses on the patient. C) Engages in a caring relationship.

Define hypothermia:

Abnormally low core temp, less than 95° (35°). As body temp drops, metabolic processes slow. Prolonged exposure to the cold is no longer correctable by shivering and may prove fatal. (Remember older adults usually have normal temp of less than 95°F).

Shared touching: May be an alternative to sexual intercourse for those who want? (3) Why is shared touching referred to as a safer form of sex?

Abstinence Decreased STI risk Intimacy but have mobility and physical complications that makes sexual intercourse difficult Bodily fluids are not exchanged (no babies or STI)

In which 2 processes do molecules move

Active and Passive transport

Techniques to enhance communication (12)

Active listening Establishing trust Being assertive Restating Clarifying Validating messages Interpreting body language Sharing observations Exploring issues Using silence Summarizing the conversation Process recordings

Which phase of labor is the most uncomfortable and where an epidural is usually given

Active phase

Healthcare promotion and personal responsibility

Active strategies depend on the individual becoming personally involved in adopting a proposed program of health promotion. Examples of lifestyle change are performing daily exercise as part of a physical fitness plan and adopting a stress management program as part of daily living.

What is the content of communication (4)

Actual subject matter Words Gestures Substance of the message

Which of the alternative systems of medical practice involves stimulation of points along meridians to restore qi flow?

Acupuncture

Situational leadership

Adaptability is the key to the situational approach. Instead of assuming that one particular approach works in all situations, situational theories recognize the complexity of work situations and encourage the leader to consider a number of factors when deciding what action to take. Every situation is different. This theory emphasizes that you understand all of the factors that affect a particular group of people in a particular environment, and vary the type of leadership to meet the needs of the situation.

What do adolescents need to make informed choices about sex as they move towards adulthood? (4)

Adolescents need information about body changes Interpersonal relationships Contraception (birth control) Preventing Sexually Transmitted Infections

Sexuality development: Middle Adults

Adults in the middle years experience life changes that may enhance physical and emotional intimacy. For many parents, their children are now young adults who no longer rely on parental support, and they have more privacy and time to spend together. However, new stressors may arise. In times of economic downturn, for example, middle-aged adults are also one of the groups most seriously affected. In addition, this may also be a time when physical changes and chronic diseases emerge that could affect sexual patterns.

What should adults limit their sodium intake to

Adults should limit their intake of salt to 2300 mg/day.

Pre-operative transsexual/transgender

Adults who alter their physical appearance through dress, makeup, and or the use of hormones so that their external appearance corresponds with their gender identity.

Neurological deficits in older adults are usually the result of what factors? (9)

Adverse effects of medications or medication interactions Nutritional deficits Dehydration Cardiovascular changes, Diabetes Degenerative neurological condition Alcohol or drug use Depression Abuse.

Role of the nurse: Change agent What skills may the nurse use to accomplish this change? Example

Advocating for change on an individual, family, group, community of societal level that enhances health. Counseling Communication Education Ex: Working to improve the nutritional quality at a school lunch program

What is the nurses most important obligation in ethical decisions?

Advocating for your client

What are some reasons adolescents become sexually active? (6)

Affection Peer pressure Symbol of maturity Spontaneous experimentation To feel close, Feels good/right

When is feedback particularly important to the learner? What is the impact of judgmental feedback?

After completing a task, positive feedback encourages learners and boosts morale when it comes to tackling difficult content or devoting the time and effort needed to get the most out of the educational process. This is especially critical when significant behavioral changes are required to be a successful learner. Be careful not to sound judgemental when clients are learning a new skill or giving home care. fear of failure, or judgement can be a serious barrier to learning at what could be the patients most teachable moment.

Post-operative transsexual/transgender

After extensive counseling and successfully living through the opposite gender role for period of time, they may decide to undergo surgery to reconstruct their external genitalia and remove the reproductive organs of the biological birth gender

What is the fourth stage of pregnancy?

After the delivery of the placenta, the recovery stage

Level of knowledge:

Again, like stated before, *asking them simple questions and working your way up to more difficult ones is a way to assess their general level of knowledge.* "I see you have diabetes, can you tell me what you know about diabetes?" Energy level: Do they appear winded or exhausted from doing any of these tasks or things you have asked them to do? EX: falling asleep, asking them if they are feeling tired. Or are they talking to fast and are eyes darting?

List factors impacting skin integrity (10)

Age Impaired mobility Nutrition Diminished sensation/cognition Impaired circulation Medications Moisture Fever Contamination/Infection Lifestyle

Identify the factors that affect bowel elimination:

Age Stress Dietary intake Fluid intake Activity Medications (pain meds) Surgery Anesthesia Pregnancy Pathological conditions

What modifications are necessary when performing a comprehensive assessment on toddler/older child?

Age appropriate modifications that the child would understand Ex: For smell, using a banana or apple

Why does the nurse need to assess the impact of the healthcare environment on sensory deficits?

Age-related hearing changes: the noise of the healthcare environment may make it difficult to decipher voices. Visual deficits or impaired balance: will often modify his home environment to improve function in the home; however, when the patient is hospitalized or moved to a long-term care facility, these aids may no longer be feasible. To assist the patient, you must determine which environmental conditions worsen sensory deficits and which help to compensate.

What are risk factors for suicide? (11)

Alcohol abuse History/family history of mental disorders or substance abuse Family history of suicide Firearm in home Family violence physical or sexual Compulsive gambling, Significant medical illness Recent losses Recent discharge from psych. unit Age, gender, and race

What four terms can define a patients LOC?

Alert Lethargic Stuporous Comatose

What is the range of arousal when assessing LOC?

Alert to deeply comatose

When the serum pH is above 7.45 the patient is ______

Alkalotic

What does a successful visualization relating to guided imagery incorporate?

All of your senses

What should you check for before administering aromatherapy to a patient

Allergies

Patient Protection and Affordable Care Act and its influence on health promotion

Allow older people and others to receive free wellness services from their primary health care provider

Congestion and nosebleeds Why does this happen?

Also due to increased estrogen levels, can be reduced with using nasal sprays and humidifiers.

Constipation Why does this happen?

Also may occur because of increased progesterone (relaxes smooth muscle in GI tract) & organ displacement as fetus grows.

Identify the five categories of Complementary Alternative Medicine (CAM) identified by NCCAM

Alternative systems of medical practice Biologically based theories Energy therapies Manipulative/body based methods Mind/Body based interventions

Is the use of touch as a caring and healing intervention supported by research?

Although traditionally we have thought of touch as a caring and healing intervention, there is actually not a lot of empirical evidence that supports its use as a nursing intervention. Furthermore, there are wide differences in how touch is perceived among both patients and nurses. Use touch carefully, considering personal and cultural preferences, observing the patient's reaction, until research evidence provides clear guidelines for practice

Genetic testing What genetic tests are available for pregnant women?

Amniocentesis, Percutaneous umbilical blood sampling, chorionic villus sampling, maternal serum alpha-fetoprotein (MSAFP), quad marker screening.

what do the values of hemaglobin A1C mean?

An A1C level of 6.5 percent or higher on two separate tests indicates the presence of diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.

what do you look for when you inspect the bladder?

An empty bladder, or one with limited urine, is small and sits below the symphysis pubis. a distended bladder rises above the symphysis pubis. If it is very distended, you may be able to see a rounded swelling above the symphysis pubis.

What are health concerns associated with olfactory deficits and gustatory deficits? How might a nurse improve a patient's sense of different tastes?

An impaired sense of smell diminishes taste and denies the client the pleasure of enjoying food. This often leads to weight loss. Home safety issues are also a concern for the client who cannot smell. If the client has lost weight, be sure to check the fit of any dentures or dental appliances. Weight changes may affect their fit and make it even harder to eat. provide frequent oral hygiene. Assess for sores or open areas in the mouth. These require prompt treatment because they may become infected and further damage the sense of taste. Teach clients to eat foods separately or drink water between bites to distinguish the taste of the food more readily. Seasonings, salt substitutes, spices, or lemon may improve the taste of foods and encourage the client's appetite

What is teaching?

An interactive process with activities that meet intended outcomes

Categorical Imperative

An unconditional moral obligation that is binding in all circumstances and is not dependent on a person's inclination or purpose.

What can depress the RAS?

Anesthesia, sedatives, opioids, and some other drugs depress the RAS, as does a darkened, quiet environment.

Anal stimulation/intercourse Term for it: Protection (2)

Anilingus Lubrication essential to lessen tears to rectal mucosa, prevent harm to anal sphincter Condom can be used to prevent escherichia Coli from rectum to vagina

What are signs and symptoms of hyponatremia?

Anorexia, Nausea and vomiting Weakness Lethargy Confusion Muscle cramps or twitching seizures

Many school-age children are curious and may ask explicit questions about sexual activity, reproduction, and sex roles, how should parents/nurses answer these questions?

Answer with facts and follow up with age-appropriate printed material.

Barriers for the learner in the healthcare setting (8)

Anxiety Fatigue Illness Lack of time Low literacy Negative environmental influence Personal stress Physical condition

How common is anxiety?

Anxiety is so common that mild anxiety is considered normal and even necessary for our survival.

What is a port wine stain on a newborn?

Apillary angioma below the surface of the skin that is purple or red, varies in size and shape, and does not blanch or disappear. Common on the face.

What are characteristics a lethargic patient would display?

Appears drowsy, easily drifts off to sleep.

Role of the nurse: Research consumer

Applying evidence-based practice to provide the most appropriate care to identify clinical problems that warrant research, and to protect the rights of research. Seeking future education.

How long does it take from onset of regular contractions to complete dilation (First stage)

Approximately 12 hours

In what way might a nurse make therapeutic use of a patient's sense of smell?

Aromatherapy

Examples of holistic nursing interventions (9)

Aromatherapy Collecting information Guided imagery (reminiscence) Humor/Laughter/Play Meditation Music therapy Therapeutic communication Spirituality Touch/Massage

What are the 4 primary determinants of BP?

Arterial baroreceptors ANS RAAS Kidneys

What 2 areas to nurses apply knowledge to provide patient-centered care.

Arts and sciences

Sexuality changes in aging adults (women) (4)

As a result of age-related changes, postmenopausal women report less sexual stimulation and reduced desire, so they tend to need more foreplay and direct clitoral stimulation for sexual enjoyment. They may have fewer orgasms or orgasms that are weaker in intensity. Nevertheless, some women "rediscover" sexual desire after menopause. Loss of vaginal lubrication and experience pain during intercourse, caused by vaginal thinning and dryness. Suggesting water-soluble lubricants to counteract vaginal dryness and enhance pleasurable sensations during sexual activity.

Middle Adults (Men) sexual development

As a result of the aging process or health conditions (e.g., type 2 diabetes or hypertension), men may experience erectile difficulty. They may perceive this problem as a threat to their masculinity and sexual attractiveness, and their self-image may suffer. Men also experience a decrease in the sex hormone testosterone. Many men remain fertile into old age, although sexual desire and the ability to achieve and maintain erection decrease gradually with aging.

What role does a student nurse play with regard to oral report generally and end of shift report or leaving the patient care unit specifically?

As a student nurse, you will receive report from either the nurse completing the shift or from the nurse assigned to the client during the shift you will be working. Report any changes to the nurse assigned to the client during your shift, and always give report before leaving the unit.

Role of Protein in Edema (albumin) What happens when serum albumin levels are low?

As blood circulates in the body, it exerts pressure in the blood vessels that can force fluid out into the tissues. Albumin, a protein in blood, generally prevents the fluid from leaking out and accumulating in the tissues. If serum albumin levels are low, it cannot carry out its function of maintaining fluid balance, so fluid escapes into the surrounding tissue.

Shortness of breath Why does this occur now?

As the infant grows, organs shift and pressure is increased into the thoracic cavity.

What two cultures tend to be the most sexually conservative?

Asian Americans Muslim Americans

A patient calls at 4 weeks postpartum complaining her discharge has a foul odor. What do you do?

Ask for other symptoms that are presenting in the patient - signs of infection should be identified and reported to the patient's provider. A postpartum infection typically requires 24 hours of IV broad spectrum antibiotics. Endometritis is the most common PP infection.

Describe the method of assessing immediate memory

Ask patient to repeat a series of 3 numbers you say slowly, gradually increase the amount of numbers until they cannot repeat the series

Barriers to communication (10)

Asking too many questions Asking why Fire-hosing information Changing the subject inappropriately Failing to probe Expressing approval/disapproval Offering advice Providing false reassurance Stereotyping Using patronizing language

What is assertive communication?

Assertive communication is the expression of a wide range of positive and negative thoughts and feelings in a style that is direct, open, honest, spontaneous, reasonable, and non-judgemental.

Utilitarianism

Asserts that the value of an action is determined by its usefulness, states that an act must results in the greatest good for the greatest number of people

6 characteristics of delegation (ADPPIE)

Assess Diagnose Plan interventions Plan outcomes Implement Evaluate

What should the nurse do with CAM regarding nursing care (2)

Assess patients' use of CAM Integrate CAM into your nursing care as appropriate.

What does the Romberg test in the body?

Assesses the equilibrium in the ear, controlled by vestibular cells

Role of the nurse: Client/Family educator Once the diagnosis is made, nurses do what 3 things?

Assessing and diagnosing the teaching needs of the client, group, family, or community. Plan how to meet these needs Implement the teaching plan Evaluate its effectiveness

What is the most important nursing intervention with suicide?

Assessment Be alert for risk factors and warning signs that may indicate the possibility of suicide

What does effective teaching begin with?

Assessment of learning needs

What is the goal of Madeline Leiningers theory? Through what 3 things

Assist nurses to provide culturally congruent care Accommodation, re-patterning and and negotiation

Acculturation

Assuming the characteristics of a culture Ex: Moving to Mexico and eating Mexican food

Describe the warning signs of malignant lesions:

Asymmetrical Border irregularity Color variation Diameter greater than 0.5 cm Elevated above skin surface

Vaginal discharge When do women need to call their provider?

At anytime during the pregnancy when there is fluid leakage or bleeding - in the first trimester, this can indicate miscarriage, while in the second & third trimesters can indicate preterm labor, labor, placenta previa, placental abruption, etc.

Describe why an individual with impaired cognition is at risk for skin breakdown:

At higher risk to have skin breakdown because they're not aware of the need to reposition.

Describe why infants are at increased risk for decreased body temperature:

At risk for decreased body temp because they lose 30% of their body heat through their head, which is proportionally larger than the rest of the body compared to adults

In what environments is it essential to use effective collaborative communication?

At the bedside, at The nurses station, in care conferences and via the patient record, quiet rooms away from distraction.

smell sensory function changes associated with aging

Atrophy and loss of olfactory neurons decreases the ability to perceive smell (which may also alter the sense of taste).

Healthy People 2020 4 goals

Attain high quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all stages of life.

In what ways can a nurse attend to the importance of communication in the teach-learn process?

Attend carefully to verbal and nonverbal feedback that the client gives; it can tell you whether or not the learner is attentive and focusing on the learning activities.

What experiences make up sexuality (9)

Attitudes Beliefs Behaviors Desires Fantasies Practices Rules Relationships Values

What type of stimulation would an alert patient require?

Auditory stimuli, will respond in a timely manner

Nurse practice acts all include the following? (5)

Authority of board of nursing, its composition and powers. Definition of nursing and boundaries of nursing practice. Standards for the approval of nursing education programs Requirements for licensure of nursing. Grounds for disciplinary actions against nurses license.

Alopecia areata

Autoimmune disorder that causes the affected hair follicles to be mistakenly attacked by a person's own immune system; usually begins with one or more small, round, smooth bald patches on the scalp.

Describe deep tendon reflexes (DTR).

Automatic responses that do not require conscious thought from the brain.

Major ethical principles (6)

Autonomy Nonmaleficence Beneficence Fidelity Veracity Justice

What are three ethics committee models?

Autonomy model Patient benefit model Social justice model

Describe passive communication.

Avoid conflict and allows others to take the lead. It tends to be submissive, helpless, indecisive, apologetic, or whining. " Whatever you want, I don't want you to change anything for me."

Which of the alternative systems of medical practice is based on the philosophy of restoring balance?

Ayurveda

A nurse is assessing a patient who is 1 day post-partum and is not breastfeeding. The nurse notes the patients breasts are engorged. Which of the following actions is appropriate for the patient to take? A) Wear a loose fitting bra B) Apply ice packs C) Taking a warm shower D) Pumping her breasts

B) Apply ice packs Rationale: Nurse should suggest that the patient apply ice packs to her breasts in a pattern of 15 minutes on and 45 minutes off to relieve engorgement by reducing swelling

A nurse is performing a gestational age assessment using the New Ballard Score for newborn maturity rating. Which of the following findings indicates the newborn is pre-term? A) Creases over the entire plantar surface B) Flat areola C) Leathery skin D) Flexion of the extremities at rest

B) Flat areola Rationale: Preterm newborns lack developed breast tissue, so the areola appears flat with minimal or no breast buds. Term newborns have a raised to a full areola with breast buds.

The nurse notes that a patients grandmother is looked to for input whenever questions arise about the patients care choice. Which cultural specific will guide the nurses plan of care: A) Communication B) Social organization C) Environmental control D) Biological variations

B) Social organization

What are some barriers to effective teaching and learning in the healthcare environment for the teacher? How might those barriers be overcome? (See BOX 19-5 and text narrative.)

Barriers for teacher: Competing demands on the nurses time, limited opportunity to prepare for teaching, conflicting schedules between the nurses available time for teaching and patients available time to learn, lack of space and privacy Barriers for learner: Illness, fatigue, and personal stress, physical condition, anxiety, low literacy, negative environmental influence, lack of time to learn.

Deontology

Based on rules and principles and uses language of rights and duties. Considers an action to be right or wrong regardless of consequences

Four components of fetal cardiac monitoring Describe each

Baseline heart rate: 110-160 bpm is normal Variability = absent, minimal, moderate Accelerations =Present or absent accelerations are good Decelerations = Early, late, variable, severe or prolonged

What does the BALI acronym stand for?

Be aware of your own cultural heritage Appreciate that the client is unique: influenced, but not defined by his culture. Learn about the client's cultural group Incorporate the client's cultural values/ behaviors into the care plan

Planned Parenthood Safe Sex Suggestions (6)

Be honest about current sexual practices and sexual history, as well as sexual health and concerns Avoid the exchange of body fluids by using latex barriers Avoid contact with genital sores or growths Have routine checkups for infection Consult a healthcare provider for diagnosis and treatment of symptoms Accept responsibility for your actions

determining depression in older adults

Because depression is so common, many patients who see will have at least some degree of depression. It will be important for you to differentiate among temporary, situational sadness, low energy, and a psychiatric diagnosis like dementia.

Why is intermittent catheterization preferred for patients who must be catheterized over lengthy periods of time?

Because it reduces the risk of infection and allows the patient to completely empty their bladder.

Suicide risk with older adults.

Because metabolism changes with aging, the risk of adverse medication effect is high for older adults. Closely supervised patients being treated with antidepressants because of severe side effects are possible. When a patient is admitted to a hospital there is risk that self administered medications may be overlooked. If one of those medications is an antidepressant too, Miss doses combined with physical illness may cause depression symptoms to worsen

Why are Deep Tendon Reflexes instantaneous?

Because the brain is not involved

Describe the cause of motion sickness.

Because the vestibular cell nuclei also receive input from neurons involved in vision, a mismatch between the position or acceleration of the head and the visual field can result in motion sickness.

What do postpartum women need to know about birth control?

Because there is such uncertainty about when ovulation will occur, discussing contraceptive options early in the postpartum period is critical to avoiding unintended pregnancy.

Campinha-Bacote Model

Becoming culturally competent you need the skills, awareness, knowledge, and desire

What are the benefits of bedside report (walking rounds)?

Bedside report, sometimes known as walking rounds, allows you to observe important aspect of care, such as patient appearance, IV pumps, and wounds. With a bedside report, the outgoing nurses can introduce you to the patient and you can begin your assessment.

Describe the pre-interaction phase

Before you meet the patient, you gather information about them from their chart/report.

Explain disciplinary actions for unacceptable nursing decisions or actions.

Begins with a complaint Complaint assigned to an investigator If valid, case is heard by board of nursing members Have the right to an attorney throughout whole process

When determining mental status and cognitive function, what is assessed? (7)

Behavior Appearance Response to stimuli Speech Memory Communication Judgement

What is learning a change in (4) What does it occur as a result of (3)

Behavior Attitudes Skills Knowledge Situations Events Exposures.

Mongolian spots, where (2), what kind of patients (4) Resulting from what? When do they fade?

Benign, blue-black birthmarks that occur on the lower back and buttocks of Black, Hispanic, Native American and Asian babies. Result of pigmented cells in the deeper areas of skin. Most fade by age 2, but some persist until adolescence.

Metroprolol (Beta adrenergic blockers) Action Therapeutic effects (4) When should the nurse hold medications (2) Complications (5) Route

Beta 1 adrenergic blockade in electrical conduction system of heart Decreased contractility, Decreased HR Vasodilation Excretion of water and sodium *HR < 60* *SBP less than 100* Bradycardia Decreased cardiac output AV block (dysrhythmias) Orthostatic hypotension Rebound MI excitation Oral

Quickening/fetal movement When do women usually feel movement?

Between 16 & 20 weeks.

The kidneys affect pH by regulating the amount of ______ that is kept in the body.

Bicarbonate

Healing modalities: Mind-Body interventions (8)

Biofeedback Humor Hypnosis Imagery Meditation Music therapy Prayer Yoga

What information do young adults need regarding sexuality (3)

Birth control Prevention of STIs Relationship and communication issues.

What happens if the bladder doesn't empty properly?

Bladder distention can occur. If the bladder is distended, excessive bleeding can occur, increasing the risk of postpartum hemorrhage.

Identify the limitations of acupuncture. (7)

Bleeding Broken needles Fainting Inadequately sterilized needles Post treatment drowsiness Puncture of internal organ Seizures

Vaginal discharge Is bleeding okay in pregnancy?

Bleeding is never normal during pregnancy and should always be investigated by the provider.

Diltiazem (Calcium channel blocker) Action What patients is it used for? (3) Complications (6)

Blocking of calcium channels in blood vessels leading to vasodilation of peripheral arterioles of the heart, decrease force of contraction and slower rate *Hypertension*, angina, cardiac dysrhythmias Orthostatic HTN Peripheral edema *Constipation* Bradycardia Dysrhythmias Toxicity

Spironolactone (Potassium sparing diuretics) Action Used in patients with (2) Route Side effect

Blocks action of aldosterone which results in potassium retention and excretion of sodium and water HTN and CHF Oral Hyperkalemia

CO=HR x SV What is cardiac output? What is heart rate? What is stroke volume?

Blood pumped by the heart per minute Beats per minute Amount pumped per beat

Explain cyanosis What is it associated with Best place to assess (3)

Blue-gray discoloration of the skin Extreme cold In the extremities (hands, feet), lips

Acrocyanosis (newborns)

Bluish discoloration of palms and soles in the first few hours to days of life, is normal in newborn

Mottling What kind of patient does it occur in, what does it mean (2)?

Bluish marbling Light-skin clients (cold) Newborns (overstimulation of the autonomic nervous system)

What are the four interrelated components of self-concept?

Body Image Personal Identity Role performance Self-esteem

Compare and contrast manipulative and body-based methods with energy therapies.

Body based methods focus on manipulating and moving the body to improve health Energy therapies. Biofield therapies affect energy that surrounds and penetrates the body. The existence of biofields has not been scientifically proven.

Masturbation: Why do young children touch themselves? Why do sex therapist recommend masturbation for men/women?

Body exploration, should learn its private Men: Erectile Dysfunction Women: Resolve orgasm difficulty

What is proprioception?

Body positioning.

Major functions of calcium (4)

Bone health, neuromuscular functioning, cardiac functioning

Ovum stage: What does the mesoderm develop into? *Middle layer*

Bones and teeth, muscles (skeletal, smooth, and cardiac), dermis & connective tissue, cardiovascular system & spleen, and urogenital system.

Similarity between disease and illness

Both are social constructs in which people are in an imbalanced, unsustainable relationship with their environment and are failing in their ability to survive and create a higher quality of life.

In holistic care, treatment outcomes are enhanced if what?

Both the practitioner and the patient believe that the treatment will be effective.

Braxton-Hicks contractions How are these contractions different than labor contractions?

Braxton Hicks contracts may be felt through the uterine wall as soon as the fourth month. They are irregular and painless, and occur throughout the pregnancy. After the 28th week they will increase in frequency.

Uterine cramping Why does this happen?

Braxton Hicks contracts may be felt through the uterine wall as soon as the fourth month. They are irregular and painless, and occur throughout the pregnancy. After the 28th week they will increase in frequency.

How does breast milk stool differ from formula stool?

Breast milk stools are yellow/golden, pasty, mustard & cottage cheese mixture (BARF) Formula stools are pale yellow to light brown, firm consistency, more offensive odor.

Non-pharmacologic pain management for labor (5)

Breathing/ Visualization Water therapy Position changes Massage Transcutaneous Electrical Nerve Stimulation--TENS

Thoughts on teaching populations with special needs (5)

Brief/frequent sessions Minimizing distracting stimuli in the environment. Present information slowly Use repetition Be satisfied with slower progress.

What is rubra lochia?

Bright red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1-3 days after delivery.

What is Ecchymosis Where is it seen? The color varies based on what? What can it indicate (4) ?

Bruised area (blue/green/yellow) May be seen anywhere on the body. The color will vary based on the age of the injury. Physical abuse, internal bleeding, side effect to medication, or bleeding disorder

sensory and perceptual abilities in early adulthood and older adults

By early adulthood, senses are at their peak, unless they are affected by illness or injury. As the adult ages, all of the senses are affected. Older adults experience a generalized decrease in the number of nerve conduction fibers, resulting in slower reflexes and delayed response to stimuli. Structural changes also occur in the aging eye and ear. Sensory decline with aging may cause withdrawal, depression, social isolation, and hallucinations. Keep in mind that aging is not the only cause of sensory deficits in older adults.

How does culture provide an identity for an individual?

By providing a sense of belonging for its individuals. they do so as long as they do not conflicted with the dominant culture and continue to satisfy its members.

A nurse is caring for a patient who is in labor and has pain in her lower back because the fetal head is in a posterior position. Which of the following non-pharmacological pain management techniques is likely to be most effective in relieving this type of pain? A) Breathing techniques B) Effleurage C) Counterpressure D) Therapeutic touch

C) Counterpressure

The charge nurse of a unit tries, as a rule, to admit Hispanic clients to a room at the end of the hall so that "the noise from the family will not disturb others." This nurse is exhibiting A) Racism B) Prejudice C) Discrimination D) Sexism

C) Discrimination

A nurse is teaching the parents of a term newborn how to bathe him. Which of the following instructions should the nurse include? A) Give him a bath after feeding B) Clean his ears and nose with cotton swabs C) Give him a sponge bath until the stump falls off D) Bathe him everyday

C) Give him a sponge bath until the stump falls off Rationale: Immersing the umbilical cord stump in water might delay the process of drying, separation, and healing. Sponge baths are appropriate until the stump falls off

The nurse is caring for a patient who has been sullen and quiet for the past three days. Suddenly, he says, "I'm really nervous about surgery tomorrow, but I'm more worried about how it will affect my family." What should the nurse do? A) Assure the patient that everything will be all right and continue what she/he is doing. B) Tell the patient that whatever happens is out of his control, so he shouldn't worry. C) Stop what he/she is doing (if possible) and ask the patient to expand on his statement. D) Contact hospital clergy to come and talk with the patient.

C) Stop what he/she is doing (if possible) and ask the patient to expand on his statement.

Why is it essential to remember CUBAN when giving any type of report?

C- Confidential U- uninterrupted B- brief A- accurate N- named nurse This is used for ultimate effectiveness for end of shift or transfer reports. You cannot be very effective if one of these are missing.

What is included in hand off report?

CRITICAL elements to include in an end of shift report: Name, age, room number. Admitting diagnoses and surgeon Surgical procedure and when arrived on unit pertinent orders such as IV solution and rate of infusion, doet, activity, nasogastric tube placement, incentive spirometry Plan of care such as pain management, dressings, and significant intervention for co-morbidities. Current status assessment: pain level, VS, nausea, lung sounds, ability to move, dressings, concerning trends, pertinent lab values, NG output, Urinary output.

Mindfulness of sexual knowledge for the nurse What 3 factors should you not let lead you to make assumptions regarding a patients knowledge of sexuality

Cannot assume that young adults have adequate sexual knowledge. Clients' age Level of education Life experiences

Sexuality development: Beginning at birth (3)

Caregivers respond to the infant with preconceived thoughts about what their gender role entails. The first two years of life can be highly sensual; as infants are nursed, stroked, bathed, and massaged, they develop their first attachment experience through bonding with a parent or caregiver. It is not unusual for children this age group to touch their genitals and enjoy being nude. This behavior is part of the exploration of their bodies and just normal part of childhood development.

Jean Watson aspect of holistic nursing, what is the primary focus of nursing?

Caring

Who proposed that moral development and reasoning are different among men and women.

Carol Gilligan

Function of extracellular fluid

Carries water, nutrients and oxygen to the cells

What are some causes of postpartum depression?

Causes can be biologic, psychologic, situational and multi-factored. Extreme changes in hormones is one of the most important etiologies in PPD

Function of intracellular fluid

Cell functioning and metabolism

Major function of potassium

Cellular metabolism

Hearing sensory function changes associated with aging

Cerumen is drier and more solid, creating hearing loss. Scarring occurs (e.g., from previous inflammation over the life span). Hearing changes commonly include presbycusis (hearing loss of high-frequency tones) and decreased speech discrimination.

Health teaching

Chance remark by the nurse Based on a perception of desirable individual behavior Structurally planned teaching according to patient needs

Medications and BP what changes (2)

Change HR Change SV (pre/after loads)

Nausea and vomiting What causes it?

Changes in hormones or increased pressure in the abdominal cavity as organs are displaced.

3 things to check for in regards to a male newborns genitalia

Check placement of meatus Foreskin Scrotum: palpate for testes

Sexuality development: Ages 8-12

Child is in transition between childhood and puberty. Secondary sex characteristics become apparent. In females, breast buds form, and pubic hair appears. For a significant number of girls, menarche (beginning of menstruation) occurs. Boys become more muscular, the voice deepens, hair in facial and axillae develop, and the genitals begin to increase in size. The first attraction, either heterosexual or homo- sexual, may occur during this stage, and the child may begin to masturbate more frequently, but privately.

Sexuality development: Age 5

Children mimic adults by holding hands or hugging. Adults, who find these actions amusing or endearing, frequently reinforce such behaviors. Young children also may practice getting married, playing house, or playing doctor. It is not unusual for preschool children to masturbate and ask questions about "where babies come from."

What is the oldest continuously practiced medicine in the world?

Chinese medicine

Healing modalities: Manipulative/Body-based methods (3)

Chiropractic Massage Osteopathy

4 types of STI's

Chlamydia Trachomatis (Most common, 1/15 people have it in US, may not show symptoms) Gonorrhea (Caused by bacteria, common among young adults, 820,000 new cases per year) Syphilis (STI caused by bacterium that is transmitted from person to person by direct contact with the syphilis sore, which can occur on the external genitalia, vagina, lips, mouth, anus, and in the rectum. If left untreated, long term neurological complications and even death may occur) Genital Human Papillomalvirus (STI can affect the genital areas, mouth, and throat of males and females. It can also cause genital warts and certain types of cancers (cervical, genital, oropharyngeal). Most people with HPV dont know they are infected, and in many instances the STI will go away without intervention. There are more than 40 types of HPV and it is possible for a person to get more than one type. The HPV vaccine is recommended to minimize the chance of contracting HPV. )

List several measures to employ to reduce sensory overload in radio/tv

Choose programs to meet the client's interests. Do not leave the TV or radio on 24 hours a day.

Genetic testing What do these tests look for?

Chromosomal anomalies

Characteristics of verbal communication (9)

Clarity Credibility Connotation (implied meaning) Denotation (literal meaning) Humor Intonation (tone) Pacing Timing/Relevance Vocabulary

Identify the 3 types of enemas available for use:

Cleansing Retention (oil retention to soften) Return-flow (Harris flush)

Who are the nurses learners? (3)

Clients Families Others who care for the clients.

3 aspects of full spectrum nursing

Clinical judgment Critical thinking Problem solving

Leaders and managers interpersonal skills (5)

Coaching Conflict negotiation/solution Employee development Networking Reward and punishment

Mentorship: Someone more experiences provides career development in these areas (6)

Coaching Sponsoring advancement Guidance to new students Providing challenging assignments Protecting proteges from adversity Promoting positive visibility

Communication challenges (6)

Cognitive delays Speech delays Deaf Language barriers Education level Environmental factors.

How can cognitive understanding influence the impact of appearance and function on body image?

Cognitive understanding indicates that a person can be attractive without conforming to Media portrayal of ideal body image.

How can the nurse include the interdisciplinary team in the sensory deprivation reduction?

Collaborate with other healthcare team members in caring for clients with sensory deprivation. Music therapy, activities, physical therapy, speech therapy, nutritional therapy, and occupational therapy may all be valuable in the care of the client. Carefully monitor the use of sedating medications that may contribute to sensory deprivation.

What is the correlation of collegiality and effective communication?

Collegiality requires that you share your knowledge. We can give knowledge formally, (conferences, speaking at conferences, teaching) and Informally. You have to provide positive reinforcement for things that you see nurses doing. Also note when you see less than best practices. Even if the nurse has more experience. Why is this important? It impacts patient outcomes.

Venous Insufficiency characteristics: Color(2) Temperature Pulse Edema Skin changes

Color- Normal or cyanotic Temperature- Normal Pulse- Normal Edema- Often marked Skin changes- Brown pigment around ankles

Arterial Insufficiency characteristics: Color (2), why? Temperature, why? Pulse Edema Skin/nail changes (4)

Color- Pale (worsened by elevation), Dusky red (when extremity is lowered) Temperature- Cool (blood flow to extremity blocked) Pulse- Decreased or absent Edema- Absent or mild Skin changes- Thin, shiny, decreased hair growth, thickened nails

What is colostrum?

Colostrum is the "early milk" that is clearish yellow in color and will transition to "true milk" within the first 72-96 hours after birth.

What is the most successful environment for communication? (4)

Comfortable temperature Free of unpleasant smells Private Quiet

4 factors lowering resistance to change

Commanding change Sharing information Refuting currently held beliefs Providing psychological safety

Describe a situation where the nurse must communicate assertively.

Communicating assertively can be used to advocate for clients. you must question care decisions that don't seem right to you, and assertively discuss errors or poor clinical judgment with coworkers.

The Essence of the ANA Standards of Professional Performance (9)

Communication Collaboration Ethics Education Environmental Health Evidence-Based Practice and Research Leadership Professional Practice Evaluation Quality of Practice Resource Utilization

Cultural specifics that affect health (10)

Communication Personal space Time orientation Social organization Environmental control Biological variations Religion and philosophy Politics, law Economy Education

Describe some alternative measures for facilitating communication.

Communication boards, a magic slate, pictures, or writing may be helpful. You might also hang a message board in the room and ask family members to post photos, cards, or notes. Computers are useful if the patient has one; and texting might also be used.

What does QSEN say about collaborative professional communication abilities for the new nursing graduate?

Communication is essential for teamwork and collaboration. On graduation from nursing school, you should be able to analyze differences and others communication style preferences and Describe the impact of your own communication Style on others.

Roles of the nurse (9)

Communicator Client/family educator Client advocate Counselor Change agent Direct care provider Leader Manager Research consumer

Barriers for the teacher in the healthcare setting (4)

Competing demands with nurses time Limited opportunity to prepare Conflicting schedules of patient/nurse Lack of space/privacy

Common Law

Compilation of laws made by judges or courts based on common customs and traditions.

Common law

Compilation of laws made by judges or courts, also referred to as case law, based on common customs and traditions.

Define illness

Composed of the subjective experience of the individual and the physical manifestation of disease.

Two types of meditation: Concentration meditation (3) Mindfulness meditation (4)

Concentration: Focus on the breath, a sound (mantra), or an object Mindfulness: Thoughts, Feelings, Sensations, Stimuli

What does CUBAN stand for?

Confidential Uninterrupted Brief Accurate Named Nurse

Cultural conflict

Conflict between the guests of different cultures and nationality

Reasons for inappropriate sexual patient behavior (8)

Confusion Neurological disorders (Frontal Lobe_ Mental illnesses Poor impulse control Misinterpretation of Nursing Care Need to have power/control over others Worries about sexual functioning Unrealistic view of nursing based on sexual stereotypes.

List the types of illnesses that contribute to edema (4)

Congestive Heart Failure Kidney disease Peripheral Vascular Disease Low albumin levels

Discuss conscious and unconscious muscle sense.

Conscious muscle sense is perceived in the parietal lobes Unconscious muscle sense occurs in the cerebellum, which coordinates movement

Recommended Blood Glucose Screening Intervals for persistant hypoglycemia in infants?

Consider IV glucose for persistent hypoglycemia not improving with enteral feeds

What 2 things make up an Indigenous healthcare system

Consists of folk medicine and traditional healing methods Example: May include over-the-counter (OTC) and self-treatment remedies.

Laws are primarily derived from what four sources?

Constitution Statutes Administrative bodies Courts

RAAS system What does angiotensin ll do? What does aldosterone do?

Constriction of arterioles and veins Retention of water by kidneys

Contamination of wound. Colonized Critically colonized

Contamination of a wound refers to the presence of microorganisms in the wound. All chronic wounds are considered contaminated. As bacteria begin to increase in number, a wound is said to be colonized. A wound becomes critically colonized when the bacteria begin to overwhelm the body's defenses. Critical colonization may be detected by subtle signs, such as an increase in drainage, or by more pronounced signs, such as a new foul odor, a change in color of the wound bed, new tunneling of the wound, or absent or friable granulation tissue.

Identify limitations of herbal therapy.(3)

Contamination with other chemicals/herbs Toxic agents Variety of standards used from one company to another

What are the two types of civil law?

Contract law and tort law

Role of the nurse: Manager

Coordinating the activities of all members of the team

Uterine cramping: How do women differentiate between normal cramping and cramping they should worry about?

Cramping that is painful and/or accompanied by vaginal bleeding or discharge should be concerning and require medical evaluation.

Servant leadership style

Creates an environment where people under them flourish, makes the team stronger.

How can a nurse promote motivation in learners?

Creating a warm, friendly environment can enhance social needs motivation, as can your enthusiasm.

Alternative medicine: Ayurveda is creation-balance between what 3 forces

Creation (Kapha) Preservation (Pitta) Destruction (Vata)

Intentional tort

Crime with intent to harm another person Ex: Assault, battery, false imprisonment, invasion of privacy

What is a felony?

Crimes punishable by imprisonment in a state or federal penitentiary for more than 1 year, person also may lose professional license

Cultural shock

Cultural misunderstanding and interpersonal conflict

RN Education pathways: Baccalaureate What percent of RN's get this training? How long is it usually? What does it prepare students for (5)?

Currently, 34% of RNs report getting their training at this type of institution. This number is expected to increase. 8+ semesters Address complex clinical situations Direct patient care Work in community care Use research Go on to graduate degree

Explain Central cyanosis What is it associated with?

Cyanosis in the tongue, mucous membranes and facial features Hypoxia

The nursing instructor is teaching a class on nursing theory. One of the students asks, "Why do we need to know this stuff? It doesn't really affect patients." The instructor's best response would be: A) "You are correct, but we have to learn it anyway." B) "Exposure to theories will help you later in graduate school." C) "Theories help keep the focus of nursing narrow." D) "Theories help explain why nurses do what they do."

D) "Theories help explain why nurses do what they do."

A patient who is 1 day postpartum that she is concerned about her newborn receiving enough nourishment from breastfeeding. The nurse should explain that she should look for which of the following as a sign of adequate nutrition? A) Milk supply is plentiful by the newborns 2nd day B) Newborn has returned to birth weight 6 to 8 days following delivery C) Newborn feeds at least 6 times in 24 hours D) Newborn has 6 wet diapers and 3 stools per day after day 4

D) Newborn has 6 wet diapers and 3 stools per day after day 4

The most important concept about vulnerable subcultures guiding nursing care is that person belonging to these groups: A) Receive different healthcare B) Have difficulty complying with their therapy C) Never have insurance D) Often have limited access to healthcare

D) Often have limited access to healthcare

A nurse is assessing a patient who is at 20 weeks of gestation. She instructs the patient to be sure to report headaches, blurred vision, and swelling of her hands because there are indications of which of the following complications of pregnancy? A) Hyperemesis gravidarum B) Gestational diabetes C) Abruptio placenae D) Preeclampsia

D) Preeclampsia Rationale: At this time, it is important to instruct the patient to report any indications that her blood pressure has risen. Classic manifestations of preeclampsia include headache, vision changes, epigastric or abdominal pain, and edema, especially of the face and hands.

A nurse is performing umbilical cord care for a term newborn. Which of the following findings requires further assessment and intervention? A) Clear gel at the tip B) Blackening of stump C) Hardening of stump D) Redness at the base

D) Redness at the base Rationale:​ Redness at the base, swelling, purulent drainage, or a foul odor are indications of infection. The nurse should notify the provider immediately about these findings.

A nurse is assessing a patient at a routine antepartum visit. For a rough estimate of the number of gestational weeks a patient is at, the nurse should measure the number of cm between which 2 anatomical landmarks? A) Mons pubis and xiphoid process B) Mons pubic and the umbilicus C) Top of the fundus and umbilicus D) Symphasis pubis and top of fundus

D) Symphasis pubis an top of fundus Rationale: ​Between gestational weeks 18 and 32, the nurse should measure fundal height using a disposable metric tape measure, noting the distance from the symphysis pubis to the top of the fundus. The result in cm is a rough estimate of gestational age.

What does meconium look like?

Dark green/black & tarry/viscous

Pus refers to the accumulation of what, in the presence of infection (3)

Dead cells Digested bacteria Other cell debris

Criminal Law

Deals with the wrongs or offenses against society

Criminal law deals with

Deals with wrongs or offenses against society.

Civil law deals with

Deals with wrongs to individuals

Losartan (Angiotensin 2 receptor blockers) Action What does it cause (2) What does it not increase levels of? What patients is it used for? (2) Side effects (think lisinopril, what2 side effects are lowered) Route

Decrease angiotensin 2, block actions instead of blocking production Dilation of arterioles/veins Decreases release of aldosterone Bradykinin HTN, HF (DM) Lisinopril minus cough, lower risk of hyperkalemia Oral

What is the purpose of primary prevention strategies?

Decrease the vulnerability of the individual or population to disease or dysfunction

Fenofibrate (Antilipemic agents) Effect on triglyceride/HDL levels Complications (4) When should the nurse administer it/What route

Decrease triglycerides, increases HDL levels GI distress Gallstones Myopathy Hepatotoxicity Oral, 30 minutes before meals

Lovastatin(Anti-lipemic agents) Effect on HDL/LDL Decreases what 3 things? Complications (2) Monitor what 3 things? Route/Time

Decreases LDL, Increases HDL Plaque site inflammation Thromboembolism Atrial fibrilation Hepatotoxicity Myopathy Liver function tests Report new aches Report new tenderness Oral, *bedtime*

Dyspareunia (Women) What causes vaginal dryness (4) What can resolve vaginal dryness? Other causes of dyspareunia (4)

Decreases sexual desire. Vaginal dryness resulting from hormonal changes, the aging process, tampons, and antihistamines. A water-based lubricant or saliva helps to resolve vaginal dryness. Vaginal or urinary tract infections, pelvic inflammatory disease, and endometriosis.

What is role performance?

Defined as the actions of person takes and the behaviors he demonstrated for filling overall. Instead of expectations, role performance is the reality.

What is the Role Performance Model of Health? Examples (3)

Defines health in terms of individuals ability to perform social roles Occupational health evaluations School physical examinations Physician excused absences.

Diuretics: Main side effect Consideration for nurse Nurse will monitor what 4 things

Dehydration Timing when given BID or more Electrolytes Daily weights I&O Postural hypotension (teach)

Furosemide (Loop diuretics) Side effects (7) Nursing considerations (6)

Dehydration Hyponatremia Hypochloremia Hypotension Ototoxicity Hypokalemia Hyperglycemia Monitor BP Daily weights S/S of dehydration (turgor>chest) Monitor for tinnitus Monitor electrolytes (hypokalemia < 3.5) Consume foods w/ potassium

What can a slow turgor response indicate (2)?

Dehydration Malnutrition

What can therapeutic touch treat? (3)

Dementia Anxiety Trauma

What might abnormal findings in the evaluation of abstract thinking indicate? (4)

Dementia Delirium Mental retardation Psychosis

What might abnormal findings in the evaluation of judgment indicate? (3)

Dementia, Psychosis Substance abuse

What aspects should be evaluated in a nursing history focused on fluid, electrolyte, and acid-base balance?

Demographic data past Medical history Current health concerns Food and fluid intake Fluid elimination Medications Lifestyle

What is the best tool to use to assess neurological and motor function in children under five?

Denver Developmental Screening 2

What are characteristics of depression? (6)

Depressed mood most of the day nearly every day for at least 2 weeks, typically accompanied by markedly diminished interest or pleasure in activities the person previously enjoyed Insomnia/Hypersomnia Loss of energy Feelings of worthlessness Diminished ability to concentrate Recurrent thoughts of death

How do positive and negative body images influence health? (4)

Depression Initiation of smoking among adolescents Increase risk for unintended pregnancy and sexually transmitted infections, including hiv Increased incidence of being bullied

What is the demographic for depression?

Depression occurs in all age groups, and affects 9.1% of the population in the US and is one of the top three risks for functional decline. Incidence of depression is higher in women than men.

List some truths about depression. (4)

Depressive disorders are more common among women than men. Spiritual distress is associated with depression. Depression can be defined as a maladaptive emotional response. Low socioeconomic circumstances and social isolation correlate with depression.

Define dehydration

Describes a state of negative fluid balance which there is a loss of water from intracellular, extracellular cellular or intravascular spaces

AHA:

Describes in simple language the right of patients to receive high quality care. Telling patients the complete and current information about their disease or condition, diagnosis, treatment, and prognosis. information is communicated in a language they understand and the right to be informed of hospital policies and practices that relate to them.

ANA Code of Ethics

Describes the standards of professional responsibility for nurses and provides insight into ethical and acceptable behavior

How does a nurse document LOC?

Describing the client's response Using the Glascow Coma Scale to grade eye, motor, and verbal responses

How can a nurse role model optimal health (2)?

Develop a healthy lifestyle Obtain support from like-minded colleagues

PLISSIT model, what is it? What does PLISSIT stand for? Which parts can the nurse address?

Developed as a guideline for counseling for sexual problems. *Permission *Limited Information Specific Suggestions Intensive Therapy *=nurse can address

Embryonic stage: What is the major accomplishment during this stage?

Development of organ systems & main external features.

What is the purpose of the ethics committee?

Develops guidelines and policies, provides education and counseling, and in the case of ethical dilemmas, reviews the case and provides a forum for the expression of the diverse perspective for those involved.

What are some types of alternative health care (3)

Diet therapy Mind/body control Aromatherapy

What is the differences in transfer and end of shift reports?

Differences in transfer and end of shift: Transfer is much more detailed. Give medical history, review the meds, you talk about family, send chart, the ups and downs of the patient. End of shift: What is happening now, and not the history (for the most part) of the patient.

Complications nurse observes for: Hemorrhage: what are some possible causes of this? (13)

Difficulty expulsing fetus Lacerations of the birth canal Placenta accreta, increta, percreta Ruptured uterus Inversion of the uterus Coagulation disorders Placental abruption Placenta previa Manual removal of a retained placenta Magnesium sulfate administration during labor or postpartum period Chorioamnionitis - infection of amniotic sac/fluids Uterine subinvolution

Nitroglycerin (NTG) (Angina: Organic Nitrates) Action What patients is it given to? Complications (4) Routes (6)

Dilates veins and decreases venous return which reduces cardiac oxygen demand *Chronic stable exertional angina* *Headache* Orthostatic hypotension Reflex tachycardia Tolerance *Sublingual tablet* Translingual spray SR capsules Transdermal patches Topically IV

Why do women experience pain in labor? (8)

Dilation Effacement Cervical stretching Distention of lower segment of the uterus Uterine ischemia due to uterine contractions Pressure & distention of the vagina that is referred to burning, splitting, etc. Pressure & pulling on pelvic structures Soft tissue lacerations

what are different roles of the RN?

Direct care provider communicator client/family educator client advocate counselor change agent leader research consumer manager

Absence of spirituality creates a sense of what 3 things?

Disconnection from one's true source State of disease. Loss of meaning to one's life

Margaret Newman aspect of holistic nursing

Disease is inevitable, as an equilibrium, promotes a patient to adapt and grow and mature.

What do disorders of the cerebellum cause?

Disorders of motor and cerebellar function result in pain or problems with movement, gait, or posture.

Describe the connection between the musculoskeletal system and the neurological system

Disorders of motor and cerebellar function result in pain or problems with movement, gait, or posture. So when you assess the musculoskeletal system, you also assess the motor functions of the neurological system.

Heartburn What causes it?

Displacement of abdominal organs during second and third trimesters due to growing fetus, and decreased GI motility due to increased progesterone levels.

What is the final question to always ask when you have completed a change-of shift report and when you have completed a transfer report?

Do you have any questions?

What is the importance of documentation of teaching and the patient's learning? Describe effective documentation.

Documentation provides legal evidence that teaching was done and communicates the information to other health professionals. Write objective statements about what was taught and the client skills and behaviors that demonstrate learning.

What is the only effective way to do measure the maternal pelvis? Is this recommended? Why?

Doing a CT scan NOT recommended due to the high amounts of radiation exposure.

Give at least five strategies to prevent fluid and electrolyte imbalance.

Drink at least 8 8 to 10 ounce glasses of water per day Limit consumption of fluids high in salt, sugar, caffeine, or alcohol. Weigh yourself daily if fluid balance is critical or if you are experiencing excessive loss or gain. Eat a well-balanced diet, including dairy products are rich in calcium. Drink water before, during, and after strenuous exercise.

Constipation What teaching is helpful?

Drink plenty of fluids, eat a diet high in fiber, & exercise regularly.

Baby RN role (vaginal birth) (7)

Dry baby Suction mouth/nares Vitals APGAR score Length/weight Give meds Follow NRP guidelines

Veracity

Duty to tell the truth

Define communication

Dynamic, two-way process of sending, receiving, interpreting and responding to messages by sharing or transmitting thoughts or feelings

Define defensive mechanisms

Each person develops unique patterns of coping with anxiety which are consciously or unconsciously to relieve anxiety. Denial Refusing to acknowledge the existence of a real life situation or associated feelings Displacement Transferring feelings from one target to another that seems less threatening Ex: Kicking the dog when you are angry at your boss

What 5 elements are used in Chinese medicine? What happens if the balance is disturbed?

Earth Water Wood Fire Air/Metal Illness

Complementary and Alternative Modalities for PMS (9)

Eat balanced diet, low in fat and high in calcium Use supplemental vitamins if necessary Get enough sleep Exercise Avoid tobacco, caffeine and alcohol Drink plenty of water to counteract the drying effect of low estrogen levels Use soy products which are rich in phytoestrogens Try the herbal remedies (red clover and black cohosh) Use natural progesterone cream which is made from yam root applied 12 days out of each month

Nausea and vomiting What teaching is helpful?

Eat dry crackers or dry toast 30mins to an hour before getting out of bed. Avoid having an empty stomach and ingesting spicy, greasy, or gas forming foods. Drink fluids between meals.

Heartburn What teaching is helpful?

Eat small, frequent meals, don't allow the stomach to be too empty or too full, remain upright for at least 30 minutes after meals, check with provider before using any OTC antacids.

Why are marriage rates lower among African Americans (3)

Economics Unequal gender ratio (84 males per 100 females), Cultural acceptance of single parenting.

What does excess fluid in the interstitial space cause?

Edema

__________ is major health protection strategy in preventing injuries

Education

Genetic testing What are the possible outcomes of these tests?

Education on results of testing, further genetic counseling, etc.

As a nurse, in which of the following cultural health practices would you support your client: efficacious, neutral, dysfunctional, uncertain?

Efficacious is the most helpful, neutral may be helpful or harmful

What is skin turgor assessing in the skin?

Elasticity

Anion

Electrolyes that carry a negative charge

Cation

Electrolytes that carry a positive charge

Leaders and managers decisional activities (5)

Employee evaluation Job analysis/redesign Personnel allocation Resource allocation Unit based decisions

how does documentation help educational research?

Enables research of unfamiliar diagnoses, cause and progression of disease, treatment methods, and outcomes across varied populations and diseases

Explain Complementary and Alternative Modality (CAM)

Encompasses a range of philosophies, approaches, and therapies that the conventional healthcare system does not commonly use, accept, understand, study, or make available.

Integrative modalities

Encompasses all treatment modalities

A primary function of the medical malpractice system

Encourage healthcare providers to adhere to standards of practice and perform their responsibilities in a competent manner.

What kind of practices should the nurse encourage? What kind of practices should the nurse allow? What kind of practices should the nurse discourage

Encourage practices that are effective but not harmful. Allow practices that are safe, but not known to be effective. Discourage practices that are unsafe

Effect of positive feedback (2) When is positive feedback especially critical

Encourages learners Boosts morale when it comes to tackling difficult content or devoting the time and effort needed to get the most out of the educational process. When significant behavioral changes are required to be a successful learner.

Martha Rogers aspect of holistic nursing

Energy fields affect health

What is engorgement?

Engorgement occurs when breast milk is not expressed, and is usually due to vein and lymphatic congestion rather than milk "fullness", and resolves spontaneously within 24-36 hours.

What is critical to ensure when using bedside reports?

Ensure that the patient's privacy rights are protected when using bedside reports.

Nursing as a profession (5)

Entry level nursing education require coursework in basic and social sciences as well as humanities, arts, and general education. Nursing education and practice are increasingly based on research from nursing and related fields State or provincial regulatory bodies have defined the criteria that nurses must meet to practice , and they monitor members for adherence to standards. Nursing is clearly focused on providing service to others Major professional organizations have developed ethical guidelines to guide the practice of nursing.

Ovum stage: What does the ectoderm develop into? *Upper/outer layer*

Epidermis, glands (anterior pituitary, cutaneous, and mammary), nails and hair, central and peripheral nervous system, lens of the eyes, tooth enamel, and floor of the amniotic cavity.

List several measures to employ to reduce sensory overload in sleep and rest

Establish a schedule for care that allows for uninterrupted periods of sleep and rest. Instruct NAPs and family members on the importance of allowing the client adequate rest and the need to avoid interruptions.

What happens to estrogen and progesterone postpartum?

Estrogen is decreased and progesterone also decreases, reaching their lowest levels 1 week after birth

Nursing Ethics

Ethical questions that arise out of nursing practice

What clinical model correlates to High-Level Wellness?

Eudaimonistic model

What group of people has a future time orientation?

Europeans

Archetypes

Example of a person or thing, something that is recurrent and has its basis in facts Ex: Mexican americans have brown eyes

Hirsutism What can cause it(2)?

Excessive facial or trunk hair endocrine disorders or steroid use.

List some maladaptive coping mechanisms for anxiety. (11)

Excessive sleeping eating smoking crying pacing fidgeting drinking laughing cursing nail-biting finger tapping

What are the symptoms of anxiety? (11)

Excessive worry Feeling Agitated Restlessness Fatigue Difficulty concentrating Irritability Tense muscles Insomnia Panic attacks Avoiding social situations Irrational fears

Define verbal communication

Exchange of messages using spoken or written words

Define nonverbal communication

Exchange of messages without words

List some adaptive coping mechanisms for anxiety. (5)

Exercising Talking with others Engaging in pleasurable activities Deep breathing Using relaxation programs.

State the four elements of litigation process in a nursing malpractice case

Existence of a duty Breach of duty Causation Damage

Skin is normally smooth and soft List the factors that affect skin texture (4)

Exposure (exposed skin is drier, elbows and knees) Age (Infant skin is very smooth) Hyperthyroidism and other endocrine disorders (course skin) Impaired circulation (smooth, thin, shiny skin with little hair)

What does the Glasgow Coma Scale (GCS) evaluate? (3)

Eye opening Motor responses Verbal responses

What are factors that contribute to poor quality hand off reports?

Factors contributing to poor quality handoffs include lack of standardized protocol or form, relying on memory, varying levels of experience, and lack of dedicated time for reporting.

Define disease What does it literally mean?

Failure of a person's adaptive mechanisms to counteract stimuli and stresses adequately, resulting in functional or structural disturbances. Without ease.

Negligence

Failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent manner

Explain why an individual with decreased sensation may be at risk for injury (2)

Falls risk Less sensation of a hot surface

Fraud

False representation of significant facts by words or by conduct. Intentionally misleading or deceiving another person to act or not to act for the personal gain of the one committing the fraud. Ex: Making false statements, falsifying documents, or concealing information that should be disclosed.

What are some research supported depression risk factors? (11)

Family history of depression Hormonal or nutritional imbalance Inability to externalize anger Low self-esteem Negative thinking Learned helplessness and hopelessness Prior success or failure in coping mechanisms Traumatic loss Catastrophic stressors (unemployment) Chronic disease Female gender

Heart failure results from inadequate pumping causing decreased tissue perfusion, what are 4 physical manifestations of this?

Fatigue SOB Weakness Activity intolerance

Hypokalemia signs and symptoms

Fatigue Anorexia/Bulimia Nausea, and vomiting Muscle weakness Decreased GI motility Dysrhythmias Paresthesia Flat T wave on ECG Increased sensitivity to digitalis

Judgment and learning

Fear of failure, or judgement can be a serious barrier to learning at what could be the patients most teachable moment.

What are some reasons for celibacy (abstinence) (5)

Fear of or lack of desire for intimate relationships Childhood sexual trauma A developmental or physical disability that limits opportunities for meeting prospective partners, limits privacy, or interferes with the ability to communicate or act on desires The desire to focus energies elsewhere because of a low libido. The need to regain balance after the loss of a relationship, whether through separation, divorce, or death.

How do females communicate(2)? How do males communicate (3)?

Females- Form connections and establish relationships Males- Focus on goals, tasks, and maintaining independence

What determines how the fetus advances through the birth canal (passageway) (5)

Fetal head size Presentation Fetal lie Fetal attitude Fetal position

What is preload? Higher preload results in what?

Filling pressure of the heart at the end of diastole Greater volume of blood in the heart at end of diastole

Should nails be firm or soft on palpation?

Firm

Differentiate between the first and second period of reactivity in newborns

First period: the newborn is alert, exhibits exploring activity, makes sucking sounds, has a rapid heart & respiratory rate. BPM as high as 160-180, but stabilizes to 100-120 after roughly 30 minutes post birth. Second period: the newborn reawakens, becomes responsive again after rest, often gags and chokes on mucus that has accumulated in the mouth. Usually occurs 2-8 hours after birth.

A nursing unit in the hospital has begun a "Silent Night" program to promote a quiet, restful nighttime environment for patients. This program is most likely based on the theory of who?

Florence Nightingale

Nausea and vomiting How is this treated medically?

Fluid replacement, electrolyte management, nausea management.

Hypermagnesemia signs and symptoms

Flushing and warmth of skin Hypotension Drowsiness, Lethargy Hypoactive reflexes Depressed respirations Bradycardia

What type of neurological exam does a nurse usually perform? Why?

Focused assessment A comprehensive assessment takes hours to complete

Social justice model

Focuses more on broad social issues involving the entire institution, rather than on a single patient issue.

Compensatory justice

Focuses on making amends for wrongs that have been done to individuals or groups

Autonomy model

Focuses on patients needs and desires

What is the goal of tertiary prevention?

Focuses on rehabilitation and to retain an optimal level of functioning regardless of their disabling condition.

What is the holistic belief system

Focuses on the need for harmony and balance of the body with nature

How can a nurse minimize malpractice risk?

Follow the ANA standards of care and practice to your facilities policy

Cesarean birth: Baby nurse role (3)

Follows NRP guidelines Assesses APGAR score Vital Signs q30" x4 or more frequently if issues

What are the factors that produce the number of tastes a human can perceive?

Foods stimulate different combinations of taste buds. That stimulation, together with the sense of smell, produces the vast number of tastes we can perceive.

How does the nurse help a mother position her baby to nurse?

Football or clutch hold (under the arm) Modified cradle (across the lap) Cradle (most common, holding the baby) Side-lying (mother is lying down on side) Provide support from pillows or firmly rolled blankets.

Recommended Blood Glucose Screening Intervals for all other at risk infants?

For all other at risk infants initially screened that do not fall in the above criteria, screen glucometer AC or q3 hours x2

Non-stress test When are non-stress tests performed during pregnancy?

For antepartum evaluation of fetal well being during the third trimester.

When does ovulation occur in lactating women?

For lactating women, serum prolactin levels remain above non-pregnant levels, prolonging the first ovulation. **First ovulation is heavily influenced by breastfeeding patterns, such as length, amount, and if supplementation is also being used.

Ethical Agency

For nurses, is the ability to base their practice on professional standards of ethical conduct and to participate in ethical decision making (nurses have choices and are responsible for their actions)

what is an oral tolerance test? what are the normal and abnormal values?

For this test, pt. Fast overnight and the fasting blood sugar level are measured. Then pt. is asked to drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours A blood sugar level of less than 140 mg/dL is normal. A reading of more than 200 mg/dL after two hours indicates diabetes. A reading between 140 and 199 mg/dL indicates prediabetes.

Identify the limitations of chiropractic therapy (5)

Fractures Acute myelopathy Dislocations Osteoporosis Rhuematoid arthritis

Two types of breech presentation, define each

Frank- Feet above butt Footling- Feet below butt

Examples of nevi (3)?

Freckles Moles Birthmarks

Give 4 examples of ethnic groups

French Canadians Roman Catholics Hmongs Latinos.

What 3 factors describe primary powers? Explain each

Frequency (Time from beginning of one contraction to the next) Duration (Length) Intensity (Strength at peak)

Ovum stage: How long does it last?

From conception until 14 days.

High potassium foods

Fruits and vegetables

Describe functional health

Functional health can be characterized as being present or absent, having high level or low level wellness, and being influenced by neighborhood and society

What would the nurse note during a postpartum assessment? (3)

Fundal height Uterine placement Uterine consistency

What can cause patchy hair loss? (4)

Fungal infections of the scalp Hair pulling Constant hat wearing Alopecia areata

Characteristics of nonverbal communication (6)

Gait Gestures Facial expression Personal appearance Posture Touch

What are some cultural influences regarding sexuality (5)

Gender role Gender identity Marriage Sexual expression Social responsibilities.

Difference between boys and girls moral development

Girls develop morally by paying attention to community and to relationships, whereas boys tend to process dilemmas through more abstract ideals or principles.

Authoritarian leadership style

Gives orders, makes decisions for the group as a whole, and bears most of the responsibility for the outcomes. May be either punitive or kind and compassionate. Can be an efficient way to run things when a group needs lots of direction in achieving high-quality and high-quantity outputs. When used long term, it tends to inhibit creativity and motivation.

What are two assessments associated with Level of Consciousness (LOC)?

Glasgow Coma Scale (GCS) Full Outline of UnResponsiveness (FOUR).

what hormone is released by the pancreas in response to low blood sugar (hypoglycemia)?

Glucagon- released by alpha cells of the pancreas

Goal vs Learning objective

Goals: Broad in scope and set down what is expected as the final outcome of the teaching and learning process Should address all three domains of learning Objectives: Single, specific, on-dimensional behaviors that must be completed to accomplish the goal. Short term and ideally accomplished in one or two sessions. Should include an action verb, an activity that can be measured or observed, the circumstances of the learners performance, and how the learning will be measured

Describe gradual body changes and impact on body image.

Gradual changes and physical appearance occur naturally throughout the life as body matures and grows old. Most people adapt to such changes relatively easily, especially because their friends and colleagues are aging, too.

Norton scale values: Low risk Medium risk High risk Very high risk

Greater than 18 = Low risk Between 18 and 14 = Medium risk Between 14 and 10 = High risk Lesser than 10 = Very high risk

Dominant culture

Group that has the most authority or power to control values and reward or punish behaviors. It is usually, but not always, the largest group.

Define vulnerable populations

Groups that are more likely to develop health problems and experience poorer outcomes because of limited access to care

What is a common vaccine recommended for women that men should also get but are not typically offered?

HPV vaccine

Alopecia

Hair loss. Along the temples and center of scalp is considered normal balding in men, largely genetically based.

5 kinds of nail abnormalities

Half and half nails Mees lines Splinter hemorrhages Black nails White spots

Where might handoff or change of shift report take place?

Hand off report may be given at the bedside or in a conference room, using paper notes or a mobile desktop EHR device.

Explain osteopathy

Hands-on, whole-body approach to medical care that emphasizes the role of the musculo-skeletal system in health and disease

Vaginal discharge Why does this happen?

Happens for a variety of reasons, during first trimester is often indicative of miscarriage or ectopic pregnancy.

Complications nurse observes for: Fetal hypoxia: what nursing actions should be taken?

Have NRP team present at delivery, initiate respiratory support, delay cord clamping, etc.

What are Mandatory Reporting Laws?

Have a duty to report physical, sexual or emotional abuse or neglect of vulnerable adults, whether you suspect it or have actual evidence of it. These laws also protect you when reporting abuse.

Ethnic group

Have some characteristics in common that are not shared or understood by outsiders

Cultural Influences: Latinos Males: Females:

Have strong ties to the Roman Catholic Church and a tradition of rigidly defined gender roles. Males: The norm in Hispanic culture is for the male to be given more freedom as a child, but he is expected to be a virile, responsible provider for his family as an adult. Females: is typically raised to be more passive and obedient throughout her life.

Breast tenderness What teaching is appropriate?

Have the patient wear a bra with adequate support.

What are some questions to ask the patient regarding suicide?

Have you thought about harming yourself? If so, do you have a plan?

Multiparous

Having given birth to more than one child

How does Purnell's model define cultural competence?

Having the knowledge, abilities, and skills to deliver care congruent with the client's cultural beliefs and practices

_____________ to safety occur at all ages and vary according to age and development of the individual. Younger children are curious they exceed their judgment which pose them to injury

Hazards

What kind of symptoms can acupuncture help heal? (7)

Headache Migraine Dental pain Neck pain Nausea Lower back pain Knee osteoarthitis

Describe the clinical application of acupuncture. (9)

Headaches Lower back pain Musculoskeletal sprains Myofascial pain Osteoarthritis Sciatica Shoulder pain Tennis elbow Whiplash

Alternative medicine: Naturopathy

Healing based on the healing power of nature. Health is the outcome of understanding nature and allowing the body to heal itself.

What is HITECH? what does it do?

Health Information Technology for Economic and Clinical Health improves quality and efficiency of EHR

What is HIPAA? what does it do? what 2 things does it require?

Health Insurance Portability and Accountability Act protects and maintains privacy of individually identifiable health information -must obtain consent before disclosure of health information -must limit disclosure of information to what is necessary for intended purpose

What is the Clinical Model of Health? When do people seek medical care? What kind of model is this? Also referred to as ______ healthcare

Health is defined by the absence and illness by the conspicuous signs and symptoms of disease. When they are very ill Conventional Episodic healthcare.

what is primary prevention?

Health promotion and illness prevention- happens BEFORE disease develops examples: eating healthy diet, sunscreen use, HPV vaccines, quitting smoking, having moles/polyps removed, not handling dangerous chemicals

Exposure to excess noise can produce _______________. The ill or injured are especially sensitive to noise.

Hearing loss

HF causes reduction in cardiac output, what 4 other factors does this impact?

Heart rate Stroke volume Preload Afterload

Radiation What % of body heat loss

Heat leaves the body through electromagnetic waves when the body is hotter than the surrounding area. By contrast the body can absorb heat from a lamp, or heater through the same mechanism of radiation. Accounts for 50% of body heat loss.

The Heimlich maneuver differs from the American Red Cross choking rescue maneuver in that:

Heimlich does not include back blows.

are antidiarrheal medications recommended for acute diarrhea?

Hellz nah. (no)

How can the nurse improve auditory stimulation?

Help the patient with a hearing aid to apply it whenever she is not sleeping. Check that the hearing aid has working batteries and the sound is set at the appropriate level. When possible, move the patient to a quiet area to avoid background noise when communicating

Lifespan teach/learn factors: Adults/Older adults 5 nursing strategies

Help them identify their own learning needs. Explain why the information/skill is important. Include materials with practical tips and realistic goals for learning. Honor cultural background local customs/practices, and personal preferences. Use take home materials (posters, table tents, and tip sheets)

What is the work of the cerebellum?

Helps coordinate muscle movement, regulate muscle tone, body positioning and maintain posture and equilibrium.

Which tests are done during a first visit?

Hemoglobin, hematocrit, WBC, blood type & Rh factor, rubella titer, urinalysis, renal function test, pap test, cervical cultures, HIV antibody, hep b surface antigen, toxoplasmosis, RPR/VDRL (syphilis).

What complications might you see during the fourth stage of labor? (3)

Hemorrhage Anesthesia complications Unstable vitals due to blood loss

Why are newborns given the Hep B vaccine?

Hep B vaccine is given to all infants, and is especially helpful for those who are born to mothers with an unknown HepB status, or a positive HepB status.

Healing modalities: Biology based methods (4)

Herbs Aromatherapy Non-herbal dietary supplements Dietary therapies

Inter-sexed person

Hermaphrodites are born with ambiguous sexual organs. Ex: the person may have female internal organs (ovaries and uterus) but enlarged clitoral tissue resembling a penis.

What types of people are most likely to use CAM? (3)

High income levels Hospitalized in past year Women

How does blood flow in terms of pressure?

High to low

The placebo effect relating to... Holistic healthcare: Traditional therapy:

Holistic healthcare relies on the placebo effect Traditional therapy discourages the use of placebos to manage pain (ethicists hold that placebos are deceptive and do not respect patient autonomy)

Vulnerable populations as subcultures (7)

Homeless Poor Mentally ill People with physical disabilities Young Elderly Some ethnic and racial minority groups

Which of the alternative systems of medical practice involves giving medications in very small doses?

Homeopathy

What are the 2 reasons for heightened sexual interest and activity in adolescence?

Hormonal changes accompanying puberty Culture's emphasis on sex.

The Joint Commission:

Hospital accreditation standards require educators in health care organizations to consider the literacy, developmental and physical limitations, financial limitations, language barriers, culture, and religious practices of every patient. Teaching must include any person who will be responsible for the patients care.

Fetal station, how is it scored?

How far baby's head is out in relation to mother's pelvis Scored from -3 (deep in pelvis) to +3 (delivering)

What is self-esteem?

How well a person likes himself. The difference between the "ideal self", and "actual self" "what I think I ought/want to be" vs "what I really am"

Confirming pregnancy What do urine pregnancy tests look for?

Human chorionic gonadotropin (hCG)

Hyperthyroidism effect on BMR, effect on temp Hypothyroidism effect on BMR, effect on temp

Hyper =increased BMR = more heat even in cool temps. Hypo = decreased BMR = feeling cold more often

What kind of hair can indicate hyperthyroidism/hypothyroidism?

Hyper-Fine and silky hair Hypo- Dry and coarse hair

What is nitroprusside used for? How should it be administered?

Hypertensive crisis *IV*

how does hypoventilation affect risk for hypoxemia and hypoxia?

Hypoventilation is a decrease in the amount of air into and out of the lungs. This increases the risk of hypoxemia because less air reaches the alveoli. Hypoxemia can progress to hypoxia which is an oxygen deficiency in the body tissue

how is PCO2 related to oxygen?

Hypoventilation severe enough to cause hypercarbia is usually associated with hypoxemia because inadequate amounts of oxygen are inhaled. Hyperventilation may or may not be associated with adequate oxygen levels

What does ISBARR stand for?

I=Identify, Say NAME, TITLE, and UNIT S= Situation. I am calling about (Patient Name & Room Number) The PROBLEM I am calling about is: B=Background State Admission Diagnosis & Date State pertinent Medical History Brief synopsis of Treatment if pertinent A=Assessment Most recent Vital Signs, Changes in VS or Assessment from Prior assessment R= Recommendation. Say what you think would be helpful or needs to be done (meds, treatments, tests, x-rays, EKG, CT, transfer to another unit, physician evaluation) Ask about any Changes in Orders R= Response with Repeat Back, Restate orders you have been given, Clarify how often to do vital signs, Under what circumstances to call back

Durable Power of Attorney (POA)

Identifies a person who will make healthcare decisions in the event the patient is unable to do so.

Nurses Bill of Rights

Identifies the rights nurses should expect from their workplace

Wha is the goal of secondary prevention?

Identify individuals in an early state of a disease process and prevent it from getting worse

6 steps of conflict resolution

Identify the problem Generate possible solutions Evaluate possible solutions Choose the best solution Implement the chosen solution Evaluate results

list the 6 steps of conflict resolution.

Identify the problem or issue: Generate possible solutions: Evaluate suggested solutions: Choose the best solution: Implement the solution chosen Evaluate—Is the problem resolved:

Describe two ways to utilize Deficient Knowledge in the nursing diagnosis.

Identify the specific knowledge defcit as the problem, and follow with the etiology and the related signs and symptoms.

How is personal identity developed?

Identity develops over time, beginning in childhood when you identified with your parents, and then later with teachers, peers, and others. Personal identity is relatively constant and consistent. This culturally determined and learned through socialization.

Rh antibodies and Rhogam:

If a mother is Rh negative, she will need to receive a dose of Rhogam between 26 and 28 weeks, and if her infant is Rh positive she will receive another dose of Rhogam within 72 hours after delivery.

Explain how insufficient calories predispose an individual to skin breakdown: When undernutrition is prolonged, what can the person experience (3) What does this result in

If calorie intake is inadequate, the body uses proteins for energy (catabolism); they are then unavailable for building and maintenance functions (anabolism) When undernutrition is prolonged, the person experiences weight loss, loss of subcutaneous tissue, and muscle atrophy. As a result, padding between the skin and the bones decreases, predisposing the skin to pressure ulcers.

What happens if there is Rh incompatibility during pregnancy?

If the blood of an Rh-positive fetus gets into the bloodstream of an Rh-negative woman, her body will understand it is not her blood and will fight it by making anti-Rh antibodies. These antibodies can cross the placenta and try to destroy the fetus's blood. This reaction can lead to serious health problems and even death in a fetus or newborn

What does The Joint Commission strongly suggest when a care setting uses an audio-recorded report?

If you are going to use an audio report or written report, there must always be time for face to face interaction before the end of shift nurse leaves for the day to involve time for questions.

If you believe an order is inappropriate or unsafe, what is your legal and ethical responsibility?

If you believe an order is inappropriate or unsafe, you are legally and ethically required to question the order.

What can a loss of function result in (2)? What can it indicate?

Illness or disease Need for nursing intervention.

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

Illness, especially hospitalization, can have depersonalization effect that alters the self-concept. The ill person may feel that she has become an object to be examined, poked, prodded, and discussed. You can help patients maintain a sense of personhood by using a caring approach: -Introduce yourself if the patient does not know you. -Address the patient by her preferred name each time you enter the room, and always speak respectfully. -Listen actively when the patient speaks.

Why do women urinate so much immediately postpartum?

Immediately postpartum, the body is removing extra fluid from the pregnancy, so urine output in the first 2-3 days is usually high. **Fluid loss through perspiration and increased output account for 5-7 pounds of weight loss

Effective responses by nurse to inappropriate sexual patient behavior (9)

Immediately tell the client that their behavior is inappropriate. Do not express anger Use Clear I statements Let the client know what behavior you expect. Be direct with your comments. If a client is exposing himself, let him know what you expect him to wear. If the client is attempting to touch you, tell him "don't touch me". Refocus the client attention on the carry or delivering. If you are extremely uncomfortable or the client continues, leave the room and report the incident to your instructor or nurse assigned to the client.

Describe why an individual with impaired circulation is at risk for skin breakdown: Impaired arterial circulation (3) what does it lead to Impaired venous circulation, what does it make the tissues susceptible to (3)

Impaired arterial circulation restricts activity, produces pain, and leads to muscle atrophy and thin tissue that can lead to ischemia and necrosis. Impaired venous circulation results in engorged tissues containing high levels of metabolic waste products that make the tissue susceptible to edema, ulceration, and breakdown.

What is one of the main causes of chronic wounds?

Impaired circulation

Describe a variety of situations that increase the risk for sensory deprivation.

Impaired sensory reception (e.g., neurological injury, dementia, depression, sleep deprivation, sensory losses, and CNS depressant medications) Inability to transmit or process stimuli (e.g., nerve or brain injury) Restricted mobility Sensory deficits (e.g., vision, hearing) A non stimulating, monotonous environment. Being from a different culture and unable to interpret received cues

Infection

Implies the microorganisms are causing harm by releasing toxins, invading body tissues, and increasing the metabolic demand of the tissue.

Explain pallor What can it indicate (2)? Best places to assess (5)?

In African-Americans, a paleness to the skin Poor circulation or low hemoglobin (anemia) Oral mucous membranes, conjuctiva, nailbeds, palms, sole of feet

in the case of risk factors for hypoglycemia or suspected hypoglycemia the nurses action is to _________________?

In both cases whether the infant is at risk or has signs of hypoglycemia Nurse's action is to check glucose level (glucometer):

What is external locus of control?

In contrast, people who have an external locus of control attribute control of their situation to factors outside themselves., including other people, institution, and God. they may feel they lack the ability to change what happens to them.

When does ovulation occur in non-lactating women?

In non-lactating women, ovulation occurs as early as 27 days postpartum, with an average time of 7-9 weeks

How has the nation's definition of health changed since the 1940's?

In the 1940's many children and young adults lost their lives to various infectious diseases, and for this reason, health was viewed as an absence of disease because the standards for health were much lower in this time.

Breast tenderness What causes this?

In the early weeks, is a response to increased levels of estrogen & progesterone. Later in the pregnancy, growth of the mammary glands and high levels of placental and lactation hormones can continue to create tenderness.

Where are the likely areas of infection in the postpartum population?

In the uterine lining (Endometritis) Wound infections in episiotomies, lacerations, or cesarean birth incisions Urinary Tract Infections (UTI)

Moral distress

Inability to carry out a moral decision

What aspects should be evaluated in a nursing history focused on fluid, electrolyte, and acid-base balance?

Includes questions about demographic data, Past medical history, Current health concerns, Food and fluid intake, Fluid elimination, Medications, and Lifestyle.

Affective learning

Includes receiving and responding to new ideas, demonstrating commitment to or preference for new ideas, and integrating new ideas into a value system. EX: an adolescent makes eye contact with the nurse as she explains the admission process.

Psychomotor learning

Includes sensory awareness of cues involved in learning, as well as imitation and performance of skills and creation of new skills. EX: A client identifies that he needs to read instructions before starting a project.

What are the two most common sources of excess moisture on the skin?

Incontinence Fever

How does impaired mobility increase skin breakdown

Increase in pressure from being in same position

What can humor, laughter, and play do for a patient? (2)

Increase trust Decrease stress

Explain the cascade of changes that are associated with stress response. 3 physiological 4 psychological

Increased heart rate/Metabolic heart rate Increased respiratory rates Tightened muscles Fear Nervousness Negative mood Irritability

Medical risk factors: why is glucose regulation impaired by hormonal changes ?

Increased need for insulin happens with infection and other stress conditions such as traumatic injury, cancer, and surgery.

Financing of health care

Increasing costs due to new and advanced technology use in the diagnosis and care of patients. Increasing growth of prescription drug use Aging of US citizens Ways to decrease costs; non professional caregivers (pros and cons), shorter hospital stays, outpatient services.

Is teaching a medically delegated activity or an independent nursing function?

Independent nursing function.

A nursing care plan provides direction on the type of nursing to who?

Individual Family Community

3 levels of conflict

Individual Group Organizational

Biofeedback

Individuals can learn voluntary control over involuntary activities Ex: Heart rate

Autonomy

Individuals right to choose, and act on that choice Ex: Informed consent, Privacy & Confidentiality

How is self-concept developed in different age levels? (4)

Infant- Learning that physical self is different from the environment: "me, not me" Child- Internalizing other' attitudes about the self primarily parents and peers: " who do they say that I am?" Child and adult- "Internalizing standards of society: "how do I compare with others?" Adult- Self-actualization and self - adjustment : "this is who i am and who i will continue to be"

Explain why infants are more prone to skin breakdown (2) Explain why older adults are more prone to skin breakdown (6)

Infants- Their skin is thinner and more permeable than adult skin. Older adults- The activity of the sebaceous and sweat glands diminishes, resulting in drier skin. Xerosis (itchy, red, dry, scaly, cracked, or fissured skin) is a problem for up to 85% of older adults and can be a threat to the integrity of their skin. Loss of lean body mass Subcutaneous tissue layer thins, giving the individual a sharp, angular appearance. The strong bond between the epidermal and dermal layer decreases as the dermal layer loses elasticity as a result of changes in its collagen fibers. Regeneration of healthy skin takes at least twice as long in an 80-year-old as in a 30-year-old. In addition, many older adults have chronic diseases that interfere with healing. Diabetes, for instance, predisposes to infection, and liver dysfunction interferes with synthesis of blood-clotting factors.

Where to assess turgor: Infants Older adults

Infants: Abdomen Older adults: Sternum (not over 65)

How can inflammation be stimulated (2)

Infection Trauma

What is endometritis?

Inflammation of inner lining of uterus

How can education affect health status?

Influences perception of health and wellness

What are the nurses three roles as an advocate?

Inform clients of rights Support the decisions the client makes Communicate

The ANA has specified that RNs may not delegate the following tasks:

Initial nursing assessment; follow-up assessments if nursing judgment is indicated Nursing diagnosis Decisions and judgments about outcomes Formulation and approval of a patient plan of care Interventions that require professional nursing knowledge, decisions, or skills Decisions and judgments necessary for the evaluation of patient care

what are the 3 ways insulin is delivered?

Injection Pen Pump

how do you assess a urethra?

Inspect the urethral orifice. Look for erythema, discharge, swelling, or odor. These are all signs of infection, trauma, or inflammation.

how would the nurse assess the bladder durning an assessment?

Inspect, palpate, and percuss the lower abdomen. Correlate your findings with data about the client's fluid intake and voiding.

Describe methods in which the nurse can promote optimal skin integrity and reduce the risk of skin integrity alterations by (4)

Inspection Managing moisture Optimizing nutrition and hydration Minimizing pressure

List several measures to employ to reduce sensory overload in auditory

Instruct NAPs to be aware of appropriate noise and light levels, especially at night. Speak in a moderate tone of voice, using a calm and confident manner. Do not speak about the client to others in his presence, even when he seems unresponsive. Consider the use of earplugs for the client.

what hormone is released by the pancreas in response to high blood sugar (hyperglycemia)

Insulin - released by beta cells of pancreas

Describe the last step of change: Integration.

Integration is making sure that everyone has moved into a new comfort zone following the change.

What does a good compromise preserve?

Integrity of all parties when there is disagreement among them in an ethical situation.

What changes do NOT occur in normal aging? (3)

Intelligence Memory Discrimination

Impact of psychosis on sexuality

Interpersonal relationships and sexual patterns are disrupted by lack of contact with reality or frank delusions.

Three types of extracellular fluid

Interstitial Intravascular Transcellular

What do labor and delivery nurses do? (6)

Interview (History and birth plan) Physical Assessments (Vitals, Focused assessment, SVE, Monitor FHR and UC, ROM, Leopolds) Comfort measures Teaching Interventions (IV, Labs, Hygiene, Elimination) Relay information to MD/CNM

The nurse puts a restraint jacket on a client without the client's permission and without a physician's order. The nurse may be guilty of.

Invasion of privacy

Phosphate and Calcium have a ____ relationship

Inverse

What do primary powers describe? What does this indicate?

Involuntary uterine contractions Start of labor

Civil Law

Involves a dispute between individuals or entities often results in the guilty party paying monetary damages.

For each evaluation of patient orientation, what must a nurse take into consideration as part of the assessment: Place

Involves awareness of surroundings. The patient should know that he is, for example, in the hospital and not in church. Patients who have been moved may not recall their room number but are easily reoriented.

Excessive fluid volume

Involves excessive retention of sodium and water in the ECF. Fluid volume excess can result from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart.

For each evaluation of patient orientation, what must a nurse take into consideration as part of the assessment: Person

Involves recognition of familiar persons and self-identity. The client should be able to state their name or identify people in photographs at the bedside. Because a client may meet many health professionals during a hospitalization, she may not be able to recall your name unless you have had repeated encounters with her

Healing modalities, energy therapies: Magnet therapy

Iron on in hemoglobin is attracted to a magnet placed on the skin. Application of a magnet to an injured or fatigued area increases blood flow, which is supposed to aid in healing

What are signs of sensory deprivation?

Irritability Confusion Reduced attention span Decreased problem-solving ability Drowsiness Depression Preoccupation with somatic complaints Delusions Hallucinations

what are signs of sensory overload?

Irritability Confusion Reduced attention span Decreased problem-solving ability Drowsiness (due to insomnia) Muscle tension Anxiety Inability to concentrate Decreased ability to perform tasks Restlessness Disorientation

What is hypoglycemia?

Is a state of insufficient or low blood glucose levels, defined as less than 70mg/dl.

Right time:

Is learner ready, free of pain and anxiety, motivated? do you and learner have trusting relationship? Is this sufficient time for teaching?

What is self-concept?

Is one's overall view of oneself. It is your complete and unique answer to the question , "who you think you are?"

Right content:

Is the content appropriate for the clients needs? is it new information or reinforced information that was already provided? is it presented at the nurses level? is it relevant to the learner?

Right goal:

Is the learner actively involved in planning the learning objectives? are you and your client both committed to reach mutually set goals of learning that achieve the desired behavioral changes? Are friends and family included in planning so they can help follow through on behavioral changes?

What is body image?

Is your mental image of your physical self, including both physical appearance and physical functioning. Both cognitive understanding and sensory input influence body image.

What happens to blood volume during pregnancy?

It doubles

What is a drawback to bedside report format?

It has been previously criticized for being time-consuming although, using electronic template and process at the bedside has decreased the time spent in change of shift report.

Describe two ways to utilize deficient knowledge in the nursing diagnosis.

It identifies knowledge deficits, allowing you to address them. You can use knowledge deficits to identify risk factors for illness.

What is the benefit of audio-recorded report?

It is a convenient, but sometimes time-consuming, way to transmit information. - An advantage of this method is that the outgoing nurse continues to provide patient care while the incoming nurse receives report.

What is common for transgendered people at an early age? (2)

It is common for transexuals to express dissatisfaction with their gender They may insist that they will grow up to be the opposite gender.

What is motivation? How does it impact learning?

It is created by an idea, a physical need, an emotion, or some other kind of force. Motivation is greatest when clients recognize the need for learning, believe it is possible to improve their health, and are interested in the information they are being given.

When planning a teaching session, the nurse needs to consider the teaching environment, scheduling for uninterrupted time and the amount and complexity of the content. Why is it important for the nurse to consider each? What are the challenges of each aspect of the teaching event?

It is important to consider the teaching environment because you will want to go somewhere quiet and free of distraction so the focus can be 100% on the information provided to the patient. The challenges are, there are not always quiet places in the hospital or healthcare setting; time is also crucial when working as a nurse.

What is the essence of leadership?

It is the ability to influence other people

Describe in one sentence task vs. relationship leadership theory.

It is the idea that some leaders hone in on the tasks being done, while other leaders focus more on the interpersonal aspects and ignore the quality of job performance.

What is the essence of the situational leadership?

It is the realization that one particular approach does not work in every situation. Therefore, situational leadership encourages the leader to consider a number of factors when deciding what action to take. Every situation is different.

What is the impact of emotional intelligence on leadership effectiveness?

It usually inspires the same feelings of enthusiasm, caring, and support throughout the team

Give 2 examples of how religion can affect health

Jehovas witnesses may not accept blood transfusions Many religions forbid abortions

signs and symptom of hypoglycemia in infants:

Jitteriness irritability cyanosis tachypnea apnea temperature instability hypotonic lethargy poor feeding tremors high pitched cry seizures

How can a nurse help a new mother prevent further loss of blood volume?

Keeping hydrated during first days of postpartum period and initiation of breastfeeding.

When does urinary function return to normal postpartum?

Kidney function returns to normal by roughly 8 weeks postpartum

Describe Kinesthesia

Kinesthesia or muscle sense, is a complex process involving proprioceptors that detect stretch in muscles to create a mental picture of how the body is positioned.

Barriers to culturally competent care

Lack of knowledge Emotional responses Ethnocentrism Cultural stereotypes Prejudice Discrimination Racism Sexism Language barrier Street talk, slang, jargon

Describe the importance of comfort and rest to a postpartum patient

Lack of sleep & fatigue are common complaints for new parents - disrupted sleep and fatigue in the postpartum woman can contribute to the development of postpartum depression (PPD)

Laissez-Faire Leadership (permissive or nondirective)

Laissez-faire means "let it alone". Has a relatively inactive style and intervenes only when goals have not been met or a problem arises. Gives followers the majority of control in the decision-making process. Leader offers little feedback and support to the followers, postpones decision making, or never makes it all, which leads to poor quality and inefficient work output.

Non-pharmocalogic pain management interventions (childbirth preparation) (3) Explain each

Lamaze: Relaxation and breathing techniques Bradley: working in harmony with the body, utilizing breath control, abdominal breathing, and general body relaxation Hypno-birthing: relaxation technique that teaches the woman to control her response to the discomfort in labor

Developmental variations that can impact the communication process (5)

Language skills Level of education Maturity Cognitive development Physical development

Discuss depression in middle aged adults.

Large international study found that people in their late 40's are approximately twice as likely to be taking antidepressants as those under 25 and over 65, and that happiness and well-being reach their lowest in the 40's

what do you need to know regarding History & physical assessment during an appointment?

Last menstrual date, social supports, & full review of systems to determine risk factors for ongoing pregnancy, physical to determine baseline vital signs, weight, & pelvic exam.

What happens during the second stage of labor?

Lasts from the time the cervix is fully dilated to the birth of the fetus - This is the stage where the infant is born.

How does the nurse assess LATCH?

Latch Audible swallowing Type of nipple Comfort level of the mother Hold (positioning)

Compare and contrast the timing (frequency), intensity and duration, and dilation size in cm of the three phases of labor.

Latent- Frequency 5-30 minutes Mild and irregular contractions Duration: 30-45 seconds contractions, Up to 4 or 5cm. Active phase: Frequency- 3-5 minutes Regular, Moderate/Strong contractions Duration: 40-70 seconds Starts at 5cm Transitional phase: Frequency 2-3 minutes Contractions are measured as mild, moderate & strong. Duration: 45-90 seconds Traditionally starts at 8 cm

American Disabilities Act

Law that prohibits employers from discriminating against people with physical disabilities

What are Good Samaritan Laws?

Laws designed to protect from liability those who provide emergency care to someone who is in need of emergency medical services.

Impact of diabetes on sexuality Males: Females:

Leads to neurological changes Male: Erectile dysfunction Female: Vaginal dryness, loss of orgasmic ability, vaginal yeast infections common with diabetes causing itching and painful sex.

What are the characteristics of culture (10)

Learned Taught Shared by its members Dynamic and adaptive Complex Diverse Exist at many levels Have common beliefs and practices All-encompassing Provide identity

Digital Sources of Information

Learners can obtain extensive info and support geared toward the lay public as well as healthcare professionals via the internet through electronic mailing lists. Learners can connect with others in similar situations though electronic mailing lists and other threaded discussions.

Digital sources of information teaching strategy

Learners can obtain extensive info and support geared toward the lay public as well as healthcare professionals via the internet through electronic mailing lists. Learners can connect with others in similar situations though electronic mailing lists and other threaded discussions.

Discuss the benefits of active learning?

Learning is more meaningful when the client is actively engaged in the planning and the learning activities. LEarners retain 10% of what they read, but they retain 90% of what the speak or do.

What is the expected outcome of relaxation therapy during the first few months, (2)

Learning to focus on body sensations/tensions Increased sensitivity in detecting muscle tension

CAM use by age Who uses it the Least Who uses it the Most: When does use progessively decline:

Least by those younger than age 18 Most by middle adults. Use progressively declines after age 69

What are three characteristics of bisexual individuals?

Least understood and least accepted by hetero/homosexual communities. Less likely to be found in long term monogamous relationships Often experience feelings of isolation.

Documentation of teaching: What does it provide? What kind of statements should be made

Legal evidence that teaching was done and communicates the information to other health professionals. Objective statements

Standards of care

Legal guidelines for nursing practice and provide the minimum acceptable nursing care

Why would a nurse wear clean gloves during a hair and scalp assessment (2)

Lesions Lice

What skin abnormalities require assessment (3)

Lesions Variation in pigment Break in continuous tissue requires assessment.

Cerebral function evaluations are doing by using what four assessments?

Level of consciousness Orientation Mental status and cognitive function Communication.

Cerebral function evaluations are done by using what four assessments?

Level of consciousness Orientation Mental status and cognitive function Communication.

Café-au-lait Spots, where? What can they indicate?

Light brown birthmarks, Can occur anywhere on the body. Most likely not associated with medical problems, but can indicate a genetic disorder

What about bilirubin stool?

Light yellow/pale in color

how do you palpate the bladder?

Lightly palpate the lower abdomen to define the bladder margin. Observe the patient's response to palpation, noting signs of tenderness or discomfort. An empty bladder, or one with limited urine, will not be palpable.

LIVE and LEARN model of cultural competence

Like Inquire Visit Experience Listen Evaluate Acknowledge Recommend Negotiate

What is Erythema What is associated with it(4)?

Localized redness of the skin Rashes Skin infections Prolonged pressure on the skin Application of heat/cold.

perception requires the functioning of what four things?

Location of the receptors and pathway activated, Number of receptors activated Frequency of action potentials generated (which varies according to the intensity of the stimulus) Changes in location, number, and frequency

4 types of diuretics

Loop Thiazide Potassium-sparing Osmotic

tough sensory function changes associated with aging

Loss of sensory nerve fibers and changes in the cerebral cortex decrease the ability to perceive light touch, pain, and temperature variations

Describe anticipated normal memory in an older adult (short and long term)

Loss of short term memory, long-term memory often not impacted

What are depression risk factors for older adults?

Losses of friends and family or multiple physical illnesses.

Define hypovolemia, when would it occur?

Low blood volume, may occur with surgery, or trauma, or uterine rupture.

Explain the role of cholesterol in maintaining healthy skin (2)

Low cholesterol levels predispose patients to skin breakdown and inhibit wound healing. Fats provide fuel for wound healing, and maintain waterproof barrier in the stratum corneum

What are the major electrolytes in the ICF and what are there charges?

Magnesium (+) Potassium (+) Phosphorus (-)

Healing Modalities: Energy Therapies (5)

Magnet therapy Reiki Therapeutic touch T'ai Chi Qigong

4 factors impacting implementing change

Magnitude of the change Complexity of the change Pace of the change Stress level of those involved

What are some other factors that can influence (and thus, must be considered) the actual implementation of change.

Magnitude of the change Complexity of the change Pace of the change Stress level of those involved Integration

Function of body fluids (6)

Maintain blood volume. Regulate body temperature. Transport material to and from cells. Serve as a medium for cellular metabolism. Assist with digestion of food. Serve as a medium for excreting waste

Explain the role of protein in maintaining healthy skin (4)

Maintain the skin Repair minor defects Preserve intravascular volume, Edema decreases skin elasticity and interferes with the diffusion of oxygen to the cells.

List some social interaction measures that reduce sensory deprivation.

Make regular contact with the patient. ■ Provide continuity of care by assigning the same personnel whenever possible. ■ Encourage patients to have some form of social interaction.Children may play video games with others online. ■ Avoid isolating the patient when at all possible. Ensure that any patient in isolation receives adequate stimulation

How can the nurse enhance vision when there is a deficit?

Make sure eyeglasses are clean, in good repair, and of the proper prescription. Place them within easy reach or help the client put them on if necessary. Offer a magnifying lens or large-print books and magazines for clients with presbyopia. Provide enough light, but avoid glare: Use soft, diffuse lighting; provide sunglasses, visors, or hats with brims when the client is outdoors.

A confused client who fell out of bed because side rails were not used is an example of which type of liability?

Malpractice

What STATE laws affect nursing practice? (4)

Mandatory reporting laws Good Samaritan laws Safe harbor laws Nurse practice acts

why is documentation important for quality improvement?

Manual audits are done to formulate strategies to improve care, decrease length of stay, control costs, identify knowledge and practice gaps

Discussion with aging adults and sexuality (5)

Many healthcare providers have hesitated to offer sexual counseling out of fear that such intimate discussion might offend their patients. Older adults may also hesitate to discuss their sexual problem with healthcare providers unless encouraged to do so. You should address the topic as you would any other area (e.g., "We have discussed your medical needs and your dietary needs; let's now discuss your sexual needs"). Once you introduce the subject and people feel comfortable, they are usually eager for advice and solutions. You can help aging clients to understand that sexual feelings do not necessarily disappear with age, and sexual expression need not stop

What does the MORAL model stand for?

Massage the dilemma Outline the options Resolve the dilemma Act by applying the chose option Look back and evaluate

Impact of cancer on sexuality

May be accompanied by body image changes, fatigue, nausea, and fear of death, all of which may lead to feeling unattractive and lower desire for sex

What do memory problems indicate?

May be benign or may signal underlying neurological problems - temporary memory loss may also occur after trauma.

Impact of cardiac and respiratory disease on sexuality

May cause people to restrict sexual activity due to fatigue, dyspnea, or fear of over-stressing the heart

Impact of spinal cord injury on sexuality (3)

May make it impossible for a person to feel physical stimulation. May or may not experience psychogenic or reflexogenic genital arousal. Some men may not be able to get erect and are fertile, others may have no genital response.

Urinary frequency Why does this happen?

May occur during first and third trimesters - in third trimester, is common because of increased pressure on the bladder.

What is value neutrality?

Means that we attempt to understand our own values regarding an issue, and to know when to put them aside.

How do medications alter sensory function?

Medications that cross the blood brain barrier affect neurologic or sensory function by damaging or killing brain cells. For example, aspirin and furosemide (Lasix) become ototoxic if taken for a long period of time and impair function of the auditory nerve. CNS depressants, such as opioid analgesics and sedatives, blunt reception, and perception of stimuli.

Describe the orientation phase When does it begin? What is the goal of this phase?

Meeting the patient, introducing yourself and your role, inform client pertinent info will be shared with care team Begins when you meet the client and introduce yourself Establish rapport and trust with patient

Define ethnicity

Members share same social and cultural heritage passed on from generation to generation

When does the amniotic fluid rupture?

Membranes can rupture spontaneously at any time during labor, but most commonly in the transition phase

Cognitive domain of learning includes (7) Example

Memorization Recall Comprehension Analyze Synthesize Apply Evaluate ideas. EX: A client is able to report the names and doses of the three medications he is taking.

Aging adults (men) (3)

Men report erectile difficulty and need more time and more direct genital stimulation to achieve erection. It may take longer to ejaculate, and the orgasmic contractions may be less intense. When penetration is not possible (e.g., because of male erectile dysfunction), many couples find satisfaction with alternate forms of sexual stimulation and expression.

What are attitudes?

Mental dispositions or feelings toward a person, object, or idea

Is the mentorship or preceptorship role more encompassing?

Mentorship

List the three factors that interact to produce body heat:

Metabolism Movement of skeletal muscle Non-shivering thermogenesis

Define modality

Method of treating a disorder

Identify the clinical applications of herbal therapy (5)

Mild gastrointestinal disturbances Urinary tract infections Relaxation Premenstrual symptoms Sleep

Types of skin lesions (4)

Milia Nevi Skin Tags (Archrodon) Striae

Compare and contrast mind-body and biologically based therapies

Mind body therapies: Completely mental and don't involve you taking any medicines Biologically based therapies: Based in substances found in nature such as food, herbs, vitamin, and aromatherapy

What are some ways values can be transmitted (3)?

Modeling values from others Making responsible choices Results of reward and punishment

Explain the process of diffusion

Molecules of a solute move through a cell membrane from an area of higher concentration to an area of lower concentration. High to low

In civil cases what is the remedy for the harm the patient suffered?

Money

What promises can be used to obtain reward power (4)

Money Services Goods Recognition

Arterial Blood Gases are used to measure ____

Monitor acid-base balances

What do you do for a patient with sub-involution?

Monitor fundal position and consistency Monitor lochia for color, amount, consistency, and odor. Monitor vital signs. Encourage the client to use activities that can enhance uterine involution, such as breastfeeding, early and frequent ambulation, & frequent voiding. D&C (dilation & curettage) can be necessary to remove retained placental fragments.

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

Monitor their length and frequency, and intensity.

PMDD (Pre-Menstrual Dysphoric Disorder)

More severe forms of menstrual cycle dysfunction become seriously depressed for a week or more before their periods

Patient has a new prescription for furosemide, when should they take it?

Morning

Sexuality development: Age 3 (2)

Most children recognize the gender differences and know their names of their body parts. Toddlers are interested in their bodies and curious to see the genitals of others.

Hormonal Replacement Therapy (HRT)

Most effective treatment to relieve the symptoms of menopause, such as itching, dryness, discomfort with intercourse, hot flashes, sleep disturbances, and other symptoms. Hormone replacement therapy can either increase or decrease the risk of heart disease, depending on when hormone therapy is started; how long will it remain on it; and individual differences Prevent loss of bone density Decreased risk of colorectal cancer Increased risk of blood clots, breast and ovarian cancer, and dementia

Aging adults sexual development (5)

Most older adults are sexually active and regard sexuality as an important part of life. Little evidence exists to support the premise that age-related changes result in decreased sexual relationships A substantial number of men and women engage in vaginal intercourse, oral sex, and masturbation even in their 80s and 90s You should recognize that older adults have sexual needs (e.g., reassurance from a sexual partner or sexual stimulation) and sexual problems (e.g., lack of closeness). Sexual problems are more likely to result from failing physical health and medication side effects than from age alone. Other obstacles for sexual expression are lack of a partner (especially for women) and lack of privacy (hospital/long term care settings).

When do women need to go to the hospital? Why does this differ for primiparas and multiparas?

Most primiparas women seek admission in the latent phase because they have not experienced and are not sure of the, "right" time to come in. Multiparous women usually do not come to the hospital until they are in the active phase. Women who have given birth before are less anxious about the process, have a better idea of when is the right time to go to hospital

Explain the process of filtration

Movement of both water and smaller particles from an area of high pressure to one of low pressure High to low

Explain active transport

Movement of fluid and solutes requires energy. Occurs when molecules move across a cell membrane against a concentration gradient (low to high). Requires energy.

Explain the process of osmosis

Movement of water across a membrane from an area of less concentrated solution to an area of more concentrated solution. Water moves across the membrane to dilute the higher concentration of solutes Low to high

Hyperkalemia signs and symptoms

Muscle weakness Dysrhythmias Flaccid paralysis Intestinal colic Tall T waves on ECG

What is magnet therapy primarily used for

Musculoskeletal pain for patients with injury or arthritis.

What elements must be present to use the good samaritan defense? (4)

Must be emergency situation You cant be the cause of injury Care was provided in reasonably competent manner Person receiving care did not object to care

Assessing remote memory, adaptation for children

Names of toys, people in their family, or names of familiar cartoon characters.

Describe the method of assessing recent memory

Naming 3 items, then ask the patient to recall them later in the exam.

Inherent (definition)

Naturally ocurring consequence; latent imminent; intrinsic.

What are the two most common types of unintentional tort?

Negligence and malpractice

What might abnormal findings in mathematical and calculation skills indicate? (assuming adequate education level and age appropriate)

Neurological impairment or developmental delay.

When assessing behavior, what may abnormal behaviors indicate?

Neurological or psychological problems, as well as from a variety of medications, alcohol, and street drugs.

What system of the body controls and effects all systems of the body and allows interaction with the outside world?

Neurological system

Hypomagnesemia signs and symptoms

Neuromuscular irritability Disorientation Mood changes Dysrhythmias Increased sensitivity to digitalis

What are some concerns about delegating to other qualified health care personnel? How might those concerns be soothed?

New graduate nurses may feel uncomfortable delegating to other staff, or experienced nurses may not be used to having other staff to delegate to. Observing how other nurses delegate will help the RN understand ways to do so. Knowing what the nurse is NOT allowed to delegate may also ease concerns - see page 1068.

Medical Risk Factors: why is vitamin d deficiency a risk factor for impaired glucose regulation?

New research also indicated vitamin D deficiency -insulin resistance and development of autoimmune diseases required for the cellular metabolism of glucose.

What can newborns see at birth?

Newborns can detect large objects and faces 8-12in away. Their eyes are sensitive to bright light and they often respond better in low light.

Why do we need to monitor a newborn's temperature closely?

Newborns have ineffective thermoregulation after delivery - a baby getting too cold could have an increase in O2 demands and develop acidosis.

Do secondary powers have any effect on cervical dilation?

No

vaginal discharge Does all bleeding mean a woman will have a miscarriage?

No - bleeding can also indicate gestational disease, placenta previa, placental abruption, vasa previa (vessels implanted into membranes rather than the placenta), premature labor or cervical dilation, or hydatidiform mole.

Do nurses still need to support patients spirituality even if their own spirituality conflicts?

No, just kidding the answer is yes.

CAM use by race

Non-Hispanic whites use CAM more often than do Hispanics and non-Hispanic blacks, and are more likely to report CAM use to their healthcare provider

How should a nurse communicate with a patient with impaired speech? (4)

Nonverbals are key Ask the client to use hand gestures Use a picture board Be positive and patient

Normal nail angle in degrees Clubbing nail in degrees, what can this indicate

Normal 160° Clubbing nail angle is 180°+ , can indicate long term hypoxic states such as chronic lung disease

What is normal and what is concerning for amniotic fluid testing

Normal: clear, odorless, straw colored, slightly pink OK. Concerning: meconium, color (yellow/port wine), & foul odor.

Moisture: What is skin normally (2) What can cause excessive moisture? What is expected from oily skin? What can dry skin result from (5)?

Normally skin is warm and dry. Excessive moisture may result from hyperhidrosis (excessive sweating). Oily skin expected with acne Dehydration, chronic renal failure, hypothyroidism, excessive exposure, or overzealous hygiene.

Cultural competence when teaching, nurse should be aware of what factors (6) If english is not clients primary language, what can the nurse use?

Norms Values Communication Social structure Time orientation Cultural identification An interpreter.

What is NANDA?

North American Nursing Diagnosis Association communication method to emphasize independent practice of nurses and individual client plans made up of diagnostic labels

A patient who is described as comatose would

Not respond to verbal or painful stimuli.

A patient is experiencing rubra 2 weeks postpartum. What interventions should you take?

Notify provider and perform prescribed interventions based on abnormality cause.

What factors regarding social organization can affect health?

Nuclear, single parent, or extended family

How long is the second stage of labor for nulliparous and multiparous women?

Nulliparous- 50-60 minutes Multiparous- 20-30 minutes

Stage 3: Competence How many years to achieve this level? Characteristics of this stage (4)

Nurses achieve competence after 2-3 years of nursing practice in the same area. Gained additional experience Wrestle with more complex concerns Able to handle their patient load and prioritize More emotionally involved in their caregiving role

Stage 3 Competence:

Nurses achieve competence after 2-3 years of nursing practice in the same area. competent performers have gained additional experience and wrestle with more complex concerns. they are able to handle their patient load and prioritize situation. they are also more involved in their caregiving role and may be more emotionally involved in the clinical choices made.

Define nursing

Nurses are a widely varied group of people with varying skills. they perform activities designed to provide care ranging from basic to complex in a growing number of settings, making it hard to describe the boundaries of the profession and difficult to set a definite definition.

Stage 5: Expert (4) Do all nurses reach this stage?

Nurses are able to see what needs to be achieved and how to do it. They trust in and use their intuition while operating with a deep understanding of a situation Often recognizing a problem in the absence of the classic signs and symptoms. They have expert skills and are often consulted when others need advice or assistance. No

Nursing values and behaviors (6)

Nurses primary concern is the good of the patient Nurse ought to be competent Nurse demonstrates a strong commitment to service Nurse believes in the dignity and worth of each patient Nurse constantly strives to improve their profession Nurse works collaboratively within the profession

What is the largest subculture in the healthcare field?

Nursing

What is NIC?

Nursing Intervention Classification standardized nursing terminologies, used across settings and specialities, includes interventions nurses do on behalf of clients

What is NOC

Nursing Outcomes Classification standardized classification of client outcomes, evaluates the effect of nursing interventions

Why should nurses know more about the culture and ethnicity of clients?

Nursing care that is appropriate for the dominant cultural group may be ineffective and inappropriate for people who have a different cultural heritage.

INC definition of nursing What are some key nursing roles (9)

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, communities in all settings. Promotion of health Prevention of illness Care of ill/disabled/dying. Advocacy Promotion of safe environment Research Participation in shaping health policy Systems management Education

What 3 thing can a patients nails reflect?

Nutritional state Occupation General state of health

Fidelity

Obligation to keep promises made

What should the nurse look for when assessing the head of a newborn?

Observe for changes in shape and color

List several measures to employ to reduce sensory overload in stress

Observe for the client's reaction to environmental stimuli. Remove annoying or bothersome stimuli if possible. Provide a calm presence; If possible, provide a private room and limit visitors. Reduce unessential tasks by other health team members. Control pain and nausea with ordered medications. Teach clients about stress reduction techniques. Provide relaxing music that promotes visualization and deep-breathing techniques.

What area of the brain is closely associated with vision?

Occipital region

Decelerations = Early, late, variable, severe or prolonged

Occur when there isn't enough oxygen for a baby to make it through a contraction. Early: Can be normal if baby is also having accelerations between contractions, often indicates that delivery will occur soon - infant pressure causes decrease. Late: Decelerations that occur after a contraction - blood flow & O2 through placenta is not sufficient. Variable decelerations: jagged decels, usually in relation to cord - can be ok, or bad.

Bleeding gums Why does this happen?

Occurs as a result of elevated estrogen levels that increases vascularity and proliferation in connective tissue.

Why does hyperthermia occur?

Occurs because the body cannot promote heat loss fast enough to balance heat production or high environmental temperatures.

Describe the following components of the inflammatory response: Vascular response (5 steps)

Occurs immediately after injury, the blood vessels constrict (narrow) to control bleeding. After injured cells release histamine, the vessels dilate and increase blood flow to the area (hyperemia). The dying cells release kinins, causing the capillaries to become more permeable, allowing movement from capillaries to tissues The tissue becomes edematous (swollen). Leukocytes (WBC) then move into the area, local blood flow decreases allow infection to be fought.

Assault

Occurs when a nurse intentionally places a patient in immediate fear of personal violence or offensive contact. Must include words expressing intention to cause harm in some type of action.

Whistle-blowing

Occurs when a person identifies in the workplace an incompetent, unethical or illegal situation or action of others and appeals to someone who may have the power to stop it

When does deficient fluid volume occur?

Occurs when there is a proportional loss of fluid and electrolytes from the ECF

Overcoming impediments to making and sustaining behavioral change for higher level wellness:

Often have to have many opportunities before achieving success (baby steps) Reverting back to old behavior is common, to be expected (find patients motivation) Community has to be a part of the change; needs to support behavioral change; needs to support behavioral change Work towards a health care delivery system that emphasizes health promotion

RN Education pathways: Diploma What is it modeled after? How many years is it usually? What does it focus on (2) ?

Oldest type of nursing education, modeled after the Nightingale schools of nursing apprenticeship style of learning. Usually three years Focuses on clinical experience and direct patient care

All infants of diabetic mothers including gestational diabetes are screened by ___________ ________ (no matter when infant fed)

One hour of age

One-to-One Instruction and Mentoring

One teacher presents info to an individual learner. They mutually formulate objectives at the beginning of the session. Often the learner receives printed or audiovisual materials to reinforce the info. Role modeling and problem solving are being presented by the teaching nurse. Directly observe and offer feedback on the learners performance.

What are the benefits to the patient?

Open communication leads to better patient care, improve safety, and better staff satisfaction.

Developing intimate relationships. What does intimacy involve (7) Is intimacy always sexual? Can sexual relationships occur without intimacy?

Openness Mutual respect Caring Commitment Protection Honesty Devotion. No Yes, many sexual relationships occur without intimacy

Florence Nightingale 4 aspects of holistic nursing

Optimal health Touch Kindness Quiet environment

What is the connection between optimal sensory function and health screening?

Optimal sensory function requires periodic health screening along with early identification and treatment of health problems. Comprehensive healthcare is the ideal approach, because sensory problems are often related to other health disorders. For example, to protect his vision, a client with hypertension needs to have periodic eye examinations and to control his blood pressure.

4 evaluation methods of teaching

Oral questions, interviews ,questionnaires checklists Direct observation of client performance Reports and client records Tests, checklists, and written exercises

Define religion

Ordered system of beliefs, cause of nature and the universe

In which 2 processes does water move

Osmosis and Filtration

What should be used in combination with the Glascow Coma Scale to achieve best practice?

Other evaluations of brainstem reflexes, eye examination, vital signs, and respiratory assessment

What does the status of acid-base reflect in the human body?

Overall body functioning

First Trimester consists of:

Ovum Embryonic stage Fetal stage

What does PACE stand for? What do you think is the value of using a standardized approach to change-of-shift (hand off) report?

P- Patient/ problem A- assessment/ actions C- continuing/ changes E- evaluation This may be of value to the end of shift nurse because it will help them remember everything to tell the oncoming nurse and leave more time for answering any additional questions.

what PICOT? what is it used for? you may not always need what 2 things?

P-patient, population, or problem I-intervention, treatment, cause, contributing factor C-comparison intervention, control O-outcome T-time used to formulate research questions comparison intervention and time

identify normal PO2, SaO2, and PCO2 levels

PO2: 80-100 mm Hg SaO2: 95%-100% PCO2: 35-45 mm Hg

What can prolonged, untreated, or poorly controlled HTN cause? What does it effect? (4)

PVD Heart Brain Eyes Kidneys

What are the 5 classic symptoms of inflammation

Pain Heat Swelling Redness Loss of function

What is the number one complaint in regards to episiotomies and lacs?

Pain (No shit)

What is dysmenorrhea? What are symptoms (7) What are treatments (3)

Painful menstruation caused by strong uterine contractions that cause ischemia of the uterus. Cramping Lower abdominal pain Back pain Upper thigh pain Headache Vomiting Diarrhea. Bedrest Application of heat Analgesics such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)

What is dyspareunia?

Painful sexual intercourse

What types of disapproval might an adolescent receive regarding masturbation? (3)

Parental Cultural Religious

Identify an ethical dilemma related to immunization

Parents not getting recommended vaccines for their children

What should parents do in regards to questions children may ask regarding sexuality?

Parents should give factual answers without offering explanations beyond what the child asks.

Many young adults practice serial monogamy, what is this?

Partners are mutually faithful but make no lifelong commitment

5 P's affecting labor

Passenger (fetus and placenta) Passageway (birth canal) Powers (contractions) Position of mother Psychological response

What type of transport is diffusion?

Passive transport

What type of transport is filtration?

Passive transport

What type of transport is osmosis?

Passive transport

What also influences perception?

Past experiences, knowledge, and attitude also influence perception.

How does time orientation affect health?

Past or future orientation.

Biomedical (allopathic) perspective treats what two things?

Pathologies Symptoms

Who can guided imagery be used for? (2)

Patient outcomes Personal outcomes

Describe patient rounds approach. What are the benefits of this collaborative approach?

Patient rounding is a collaborative approach in which Physicians and nurses gather at the patient's bedside to discuss goals for care and/or changes in the plan of care and answer the questions of the patient, family, and Healthcare staff. Benefits: Meeting for Rounds allows the nurse to provide input, which results in improved nurse and physician working relationships and professional satisfaction.

Who should the nurse facilitate communication between about CAM

Patients and their healthcare providers.

What are some reasons that teaching has become a progressively more important role of the nurse?

Patients are taking responsibility into their own healthcare. patients and families need information so that they can make informed decisions. Who are the nurse's learners? When patients are being sent home they often times still need assistance with dressing changes, medications, and skilled procedures, such as urinary catheterization. nurses have the responsibility to teach the families how to provide care and to teach patients to care for themselves as they are able. Patient education can overall decrease the cost of healthcare by teaching preventative measures and performing self care for shorter hospital visits.

Why is it important to compare the environment with the patients non-healthcare life style and environment?

Patients can develop either sensory overload or sensory deficit depending on what they are used to

What situations might impact a patient's orientation, particularly in the acute care setting?

Patients often lose track of day and time, but should know the year

Tenets of Holistic Healthcare (3)

People (are unique, connect to and interact with environment) Health Illness (constitutes an imbalance, promotes growth)

What is the Adaptive Model of health? When does illness occur? Example

People ability to adjust positively to social, mental and physiological change is the measure of their health. Failure to adapt to change Example: spirituality can be useful in adapting to a decreased level of functioning in older adults.

How can health promotion lower healthcare costs?

People can stay out of hospitals more often because people will value health and thus be healthier and thus lowering hospital costs.

Characteristics of young adults sexual development (3)

People define their sexual identity and resolve issues related to their sexual orientation and self-concept. As a part of sexual maturity, they develop an intimate relationship in which there is both communication and respect. Many people find a life partner during this period and make long-term plans, which often include parenting. However, some adults continue to struggle with their sexual identity, sexual orientation, or ability to form or commit to intimate relationships.

How does timing influence learning?

People retain information better when they have an opportunity to use it soon after it is presented.

What is Internal locus of control?

People who allow their inner "voice" to influence their self concept have what is called an internal locus of control. such people feel they can exert control over their lives. they take appropriate responsibility for their life experience and for their responses to them. this enables them to interpret unexpected adverse events in a more positive light.

Transsexual/Transgender

People who identify with the opposite gender from their biology Ex: a person with the physical appearance and reproductive organs of a woman who feels and perceives herself to be a man.

What is a strong personality?

People with a strong sense of personal identity are less likely to compare themselves to others or be unduly influenced by them. They tend to appreciate the unique perspective and contributions of others, yet value their own perspectives and contributions.

What is a weak personality?

People with weak sense of personal identity have difficulty. They may interpret events in the environment personally, or they may interpret the personal experiences as belonging to everyone.

Procedural justice

Perceived fairness of the process used to determine the distribution of rewards Ex: Working on holidays

How can environmental control affect health?

Perception in the ability to control nature of ones environment

Biggest concern through placenta to fetus (fetal monitoring)

Perfusion

List the compensatory mechanisms involved in decreasing body temperature: (4)

Peripheral vasodilation Inhibition of heat production. Vasodilation diverts core-warmed blood to the body surface, where heat can be transferred to the surrounding environment Sweating

What did the "sexual revolution" of the 1960's result in? What happens when these values conflict with traditional religious values?

Permissive sexual values in the broader Western culture Anxiety and Sexual dysfunction

What four components make up a person sexual identity? What else do these components make up?

Person's perception of his or her gender Gender identity Gender role Sexual orientation. All of these are also part of a person's overall self concept.

Personal space impacting communication: Personal distance: Social distance: Public distance:

Personal distance- 18 inches-4 feet Social distance- 4-12 feet Public distance- 12 feet or more

2 concerns of delegation

Personal risk to licensure Concerns regarding quality of care.

What is the role of pet therapy in reducing sensory deprivation?

Pet therapy can increase socialization, lower blood pressure, and decrease loneliness and pain

List entities of health (5) What are some reasons for the confusion regarding the use of the term "health?"

Philosophy of care (health promotion/maintenance) Healthcare delivery system Personal health behaviors Costs Insurance. All of these entities are continually changing and the definition of health is different in each entity making it confusing to have a universal definition.

Role of the nurse: Direct care provider What patient needs does the nurse address (4) Examples (3)

Physical Emotional Social Spiritual Examples: Listening to lung sounds, giving meds, patient education.

What are two factors that influence readiness? How would you describe readiness?

Physical condition and emotions. Readiness is the demonstration of behaviors that indicate the learner is both motivated and able to learn as a specific time.

What might abnormal findings in the evaluation of thought processes indicate? (3)

Physical disorders (dementia) Psychiatric disorders (psychosis) Alcohol/drugs.

Motivation and its influence on learning: What can it be created by? (4) When is motivation greatest (3)

Physical need Idea Emotion Some other kind of force. Clients recognize the need for learning Believe it is possible to improve their health Interested in the information they are being given.

Describe the relaxation response, what types of arousal are decreased (3)

Physiological Cognitive Behavioral

What is serosa lochia?

Pinkish brown color and serosanguineous (composed of serum and blood) consistency. Lasts from approximately day 4 to day 10 after delivery.

What is asset planning? What levels can positive actions can asset planning approaches be made at? (4)

Planning approach that, given the realities of the present, helps focus the family and their providers on the building blocks for their future. Personal Employment Community Societal

Signs and symptoms of type 1 diabetes mellitus?

Polyuria Polydipsia Polyphagia

What are the signs and symptoms of hyperglycemia?

Polyuria-excessive urination. Polydipsia- excessive thirst Dehydration Fatigue Fruity odor to breath Kussmaul breathing Weight loss Polyphagia-Hunger Poor wound healing

Fetal position: How might the naming change with a sacral or a mentum presentation?

Position is denoted by a 3 letter abbreviation. Right or Left side of pelvis (R or L), Part of the fetus presenting FIRST (O for occiput, S for sacrum, M for mentum (chin), and Sc for scapula) Last letter is the location of the presenting part in relation to Anterior (A), posterior (P), or transverse (T) portions of the pelvis. (A,P, and T are in relation to where the back of the baby's head is).

What does a positive Romberg test indicate?

Positive Romberg is indicated by swaying and moving. May indicate a vestibular or cerebellar disorder.

Role of the nurse: Leader What examples can the nurse use to inspire others? (3) Examples (2 people)

Positive health Assertive communication Willingness to improve. Florence Nightingale Walt Whitman.

How are superficial reflexes graded?

Positive or negative

41 and 42 week visits When is a pregnancy considered "post dates"?

Postdates is after 42 weeks gestation have been completed.

What happens to maternal glucose levels postpartum?

Postpartum glucose levels DECREASE due to changes in hormones - in diabetic mothers, they typically require less insulin for several days following birth.

What are the differences between power and authority?

Power - the ability to influence other people despite differences resistance from them. One person or group is able to impose their will on another person or group. Authority - A source of power that is granted to an individual or a group by virtue of position.

How is power different from empowerment?

Power is the ability to influence others (the action), while empowerment is a psychological state - (the feeling) of competence, control and entitlement that an individual experiences.

How to prevent STI's

Practice abstinence or to participate only in a committed, mutually monogamous sexual relationship with someone who has never had an STI or is at low risk for one.

Four phases of the therapeutic relationship

Pre-interaction phase Orientation phase Working phase Termination phase

TTM stages of making and sustaining a behavioral change

Precontemplative: Not considering change Contemplative: Aware of but not considering change soon Preparation: Planning to act soon Action: Has begun to make behavioral change (recent) Maintenance: Continued commitment to behavior( Long-term) Relapse: Reverted to old behavior

Health promotion relating to population change

Predicted that by 2050, the majority of people in the US will not be of White European descent. These predictions indicate that current knowledge about and approaches to health promotion may not meet the needs of the future US population.

Religious practice restrictions regarding sexuality (8)

Premarital sex Birth control Homosexuality Abortion Extramarital relationships Masturbation are common Opposite gender healthcare providers and have rules about body coverings and modesty Education about the structure and function of the human body is governed by some religions.

How can a nurse therapeutically use themselves?

Presence and intention on healing process

What is being tested for at the 36 week visit?

Presence of group B strep.

Stages of pressure ulcers (5)

Pressure Ulcer 1- Skin is red, not broken Pressure Ulcer 2- Skin is broken open, most painful Pressure Ulcer 3- Broken dermal layer, into tissues below Pressure Ulcer 4- Broken through all layers of skin Unstagable pressure ulcer- Full thickness tissue loss in which the base of the ulcer is covered by slough

What is afterload?

Pressure against which the heart must work to eject blood during systole. End load against which the heart contracts to eject blood

Impediments to moving from acute and chronic disease focused health care delivery

Prevention takes time to implement and requires personal action and responsibility. Also, it takes a long time to see the effects of it.

Morals

Private, personal or group standards that consider in a broad general matter, what is good or bad, right or wrong

Define problem solving

Process by which nurses consider an issue and attempt to find a satisfactory solution to achieve the best outcomes.

What are 3 places nurses can obtain ethical guidance from?

Professional codes of ethics. Standards of practice. American Hospital Association's Patient Care Partnership

Complications nurse observes for: Dystocia: what does this term refer to?

Prolonged, difficult labor due to inadequate contractions

Amiodarone (Potassium channel blockers) Action Complications (5) Routes (2)

Prolongs the action potential and refractory period of cardiac cycle to prevent and treat dysrhythmias *Toxicity* Sinus bradycardia Visual disturbances Liver/thyroid dysfunction Photosensitivity Oral, IV

What are some health promotion activities for newborns?

Promote breastfeeding Newborn screenings Administer medications

What kind of education will you provide to patients who've just had an episiotomy or lac?

Promote measures to help soften client stools. Educate client about proper cleansing to prevent infection HAND WASHING Squeeze bottles with antiseptic solution/warm water for comfort and cleansing after voiding. Cleaning from front to back Blot dry, not wipe Sparingly use antiseptic cream/spray Changing perineal pads from front to back after voiding/stooling Promote comfort measures such as ice packs, sitz baths, nonopioid analgesics (unless birth was c-section), and topical anesthetics for pain.

What are some strategies when caring for a patient with severely limited vision?

Provide an uncluttered environment, and do not rearrange furniture. Place the call bell, phone, and self-care items within easy reach. Consider books on tape or Braille for the client. Keep the bed in a low position. When helping the client walk, ask which side she prefers to have you on. Offer her your arm and allow her to grasp it. If a visually impaired client uses a guide dog, do not distract the dog. A guide dog in a harness is working and should be approached only with the owner's permission.

Describe the QSEN model for patient centered care competency (3)

Provide patient-centered care with sensitivity and respect for the diversity of human experience. Seek learning opportunities with patients who represent all aspects of human diversity. Recognize personally held attitudes about working with patients from different ethnic, cultural, and social backgrounds

Oral-genital stimulation: Positive Negative What is Cunninlingus What is Fellatio Forms of protection

Provides intimacy without risk of conception Can lead to STI's Cunninlingus-women oral sex Fellatio- male oral sex Protection, dental dams, condoms?

Define preceptorship:

Provides practical teaching and guidance for a student or new employee

Why is it important to determine if a psychosocial issue is a problem, a symptom of a problem or the etiology of a problem?

Psychological issues involved nearly all areas of patients functioning, so there's overlap between what we are calling, " psychosocial" diagnosis and Those used in the rest of the chapter to describe more specific problems of self-concept, anxiety, and depression.

Leaders and managers informational responsibilities (3)

Public relations Monitoring Spokesperson

Identify cardiovascular assessment components that can be used to monitor fluid, electrolyte, and acid-base balance

Pulse - blood pressure - orthostatic hypotension - capillary refill - jugular venous distention - peripheral edema

Three types of torts

Quasi intentional tort Intentional Unintentional

What is GTPAL What does each letter mean/how many weeks

Quick method to overview a womans obstetric history G- Number of pregnancies T- Number of full term births (after 37 weeks) P- Number of pre-term births (After 20-before 37 weeks) A- Number of abortions spontaneous or elective (Before 20 weeks) L- Number of living children

Stage 4: Proficient (3)

Quickly take in all aspects of a situation and immediately give meaning to the cluster of assessment data Serves as a resource to less experienced nurses. Proficient nurses see the "big picture"

Characteristics ethnic groups may share

Race, ancestry, physical characteristics, geographic region, lifestyle, religion)

4 Components of heat radiation

Radiation Evaporation Convection Conduction

When the serum pH is too acidic (pH is low), the lungs remove carbon dioxide through ____

Rapid, deep breathing

Identify respiratory assessment components that can be used to monitor fluid, electrolyte, and acid-base balance

Rate Depth Pattern Breath sounds

What 4 pieces data are being gathered with the assessment of communication ability?

Rate Flow Choice of vocabulary Enunciation

Describe the physical assessment you would perform for a client with constipation:

Recall that in abdominal assessment, the order of the exam is: 1.inspection 2.auscultation 3.percussion 4.palpation. Observe the size, shape, and contour of the abdomen, and listen to bowel sounds. Percuss and palpate the abdomen for tenderness, presence of air or solid, and presence of masses. Inspect the anus for signs of hemorrhoids. Depending on the policies of your institution as well as your skill with assessment, you might also palpate the anus and rectum for the presence of stool or masses.

Describe the method of assessing recent memory

Recalling the date of a major historical event or a birthday

Describe the method of assessing remote memory

Recalling the date of a major historical event or a birthday

What does the affective learning domain include (4) Example

Receiving/responding to new ideas Demonstrating commitment of ideas Preference for new ideas Integrating new ideas into a value system. EX: an adolescent makes eye contact with the nurse as she explains the admission process.

What do recent demographic trends in North America indicate?

Recent demographic trends indicate that by the year 2043, the United States will be primarily a minority country, meaning that no group will make up a majority of the population by that year.

List the four components of the sensory experience.

Reception Perception Arousal Mechanism Responding to Sensations

Do all receptors respond to all types of stimuli?

Receptors usually respond to only one type of stimulus.

Primary RN role (vaginal birth) (8)

Record times Assist with pushing Assist MD/CNM Observe for complications Assist with repair Monitor vitals, lochia, fundus Assist with feeding infant Give Pitocin as ordered

Primary RN role in fetal monitoring (during and immediately after delivery) (8)

Records times Assists MD/CNM Observes for complications and intervenes as necessary. Hemorrhage Assists MD/CNM as needed for laceration/episiotomy repair Cleans up patient and room Vital signs, fundus, and bleeding assessments Encourages bonding/breastfeeding

List several measures to employ to reduce sensory overload olfactory

Reduce noxious odors by promptly emptying commodes and bedpans, removing meal trays, using deodorant sprays, and keeping wounds covered.

What are the signs and symptoms of hypoglycemia?

Reduced cognition Tremors Diaphoresis Weakness Hunger Headache Irritable Seizure

Lisinopril (ACE inhibitors) Action (2) Side effects (5) Route Used in patients with (4) Increase of bradykinin leads to (3) Should it be used in pregnancy?

Reduces BP by reducing production of angiotensin 2 by blocking conversion of angiotensin 1 to 2 and increasing the levels of bradykinin. Reduces vessel constriction and promotes kidney excretion of na/h2o Vasodilation Excretion of na/h2O of potassium by action in kidneys Reduction in pathological changes in blood vessels and the heart that results from angiotensin 1 and 2 Oral HTN, HF, MI, DM, *angioedema* *dry cough* *first dose hypotension* No

Administrative Law

Refers to the laws that govern the activities of administrative agencies, are created at the federal level by congress, and at the state level by legislative bodies Ex: Delegation and supervision

Fetal stage: What is the feature of this stage?

Refinement of structure and function, & the fetus is less vulnerable to teratogens except for those that affect central nervous system functioning. Viability is also achieved between 22 & 25 weeks of age.

List 5 factors that can help a nurse be more culturally competent

Reflect and know yourself Keep learning Accommodate and negotiate Collaborate Respect

Regulatory law

Reflect decision made by administrative bodies

In what two ways can tissue heal?

Regeneration (replacement of damaged cells with identical or similar cells) Repair.

Major function of sodium

Regulation of fluid volume

What is the physiological depression theory?

Relate depression to biochemical imbalances from hormonal, neurological, or genetic factors.

What is the psychodynamic depression theory?

Relate depression to loss, abandonment, and emotional detachment and to diurnal and seasonal mood variations

What is the cognitive depression theory?

Relate depression to negative thinking.

What is the social/environmental depression theory?

Relate depression to poor family relationships, difficult interpersonal relationships, and socioeconomic and political factors

Define fetal lie What are the options of fetal lie (2) Which is preferred?

Relationship of the maternal and fetus longitudinal axis (spine) Longitudinal (preferred) (parallel to mother) Transverse (right angle to mother)

What do patients use reiki for?(4)

Relaxation Improving health and well-being Stress reduction Symptom relief

What are limitations of the Glasgow Coma Scale?

Relies heavily on vision and verbal interaction, and does not evaluate brainstem reflexes.

Keys to memorability of retention of teaching (3) Will all teaching be retained?

Repetition Reinforcement Practice No

What is the value of repetition?

Repetition helps drive the learning in the brain to master the skill.

How should a nurse communicate with a patient when there is a language barrier present? (3)

Request a translator Use good non-verbal communication Pictures/art if necessary for patient understanding.

What type of stimulation would a stuporous patient require?

Require vigorous stimulation before responding

What does The Joint Commission demand when caring for patients with sensory deficits?

Requires that you address the communication needs of patients with vision, speech, hearing, language, and cognitive impairments. Regardless of the primary medical diagnosis, you may need to modify your approach to the client or alter the environment. Describe the sensory deficits on the nursing care plan, along with strategies to deal with them. For example, if the patient recovering from an abdominal surgery has no vision in his left eye, nursing orders should specify to approach the patient from the right.

Why do we usually get vital signs in the order of respirations, heartrate, and temp?

Respiratory rate is taken first before the infant becomes active or agitated by further examination.

False Imprisonment

Restraining of a person without proper legal authorization

Black nails What is it associated with?

Resulting from blood under the nail Associated with local trauma

Describe the termination phase

Reviewing and summarizing help to bring the relationship to a comfortable conclusion

Why are there so many blood tests

Rh factor & blood type: detects maternal/fetal blood incompatibilities or neonatal hyperbilirubinemia. CBC w/ diff, hemoglobin & hematocrit: detects infection & anemia Hemoglobin electrophoresis: identifies hemoglobinopathies such as sickle cell & thalassemia. Rubella titer: detects rubella immunity Hep B screening: identifies carriers of Hep B HIV antibodies: Detects HIV carriers Toxoplasmosis, herpes, other infections: test for infections that can cross the placenta to the fetus VDRL - required by law.

What is RhoGAM and when is it given?

Rh immune globulin is given within 72 hours after birth to prevent sensitization in the Rh-negative woman who had an Rh+ baby (fetomaternal transfusion of Rh-positive RBC's). RhoGAM promotes lysis of the fetal Rh-positive blood cells before the mother's body develops antibodies to combat them -- this administration is intended to prevent issues in future pregnancies, should the Rh-negative woman have another Rh-positive fetus

If you had a patient with impaired kinesthetic sense, what might you suggest?

Rhythmic movement (e.g., t'ai chi, dance, yoga) Aerobic activities, such as walking, running, or bicycling Strength training, such as weight-bearing exercise or use of light weights Flexibility activities, such as stretching Balance conditioning with eyes open and closed (e.g., standing on one foot) Putting joints through full range of motion, especially rotation

Nitroglycerin (Angina: Organic Nitrates) When should they take the first tab? When should they take 2nd tab? When should they take 3rd tab? If not resolved, what should the patient do? Are headaches common? Where should vial be kept/what color is it? How should patient be positioned?

Right away when CP occurs In unresolved after 5 minutes After 5 more minutes Seek medical attention Yes Original container, dark colored amber Laying down

What are the 5 Rights of Teaching Explain each

Right time: Is learner ready, free of pain and anxiety, motivated? do you and learner have trusting relationship? Is this sufficient time for teaching? Right context: is the environment quiet, free of distractions, and private? is the environment soothing or stimulating, depending on the desired effect? Right goal: Is the learner actively involved in planning the learning objectives? are you and your client both committed to reach mutually set goals of learning that achieve the desired behavioral changes? Are friends and family included in planning so they can help follow through on behavioral changes? Right content: Is the content appropriate for the clients needs? is it new information or reinforced information that was already provided? is it presented at the nurses level? is it relevant to the learner? Right method: do the teaching strategies fit the learning style of the learner? Do the strategies fit the client's learning ability. are the teaching strategies varied?

What do nurses worry about as the third stage gets longer? What can providers do to help remove the placenta?

Risk for difficult removal of the placenta Increasing the risk of postpartum hemorrhage. Providers may provide gentle continuous pressure on the umbilical cord

What reflexes are present at birth but disappear during infancy? (5) When might these reflexes reappear?

Rooting Sucking Palmar grasp Tonic neck reflex Moro reflex May return after stroke or traumatic brain injury

What 3 reflexes should the nurse look for in newborns and why are they significant?

Rooting: Rooting reflex is when the baby has an object touched near the mouth and the baby attempts to follow the object and suck. Sucking: allows the baby to suck and swallow milk Extrusion: when the baby pushes out any food placed on its tongue

Embryonic stage: What is the purpose of amniotic fluid?

Roughly 700-1000 mL's are in the sac (at birth) to maintain a constant body temperature, serve as a source of oral fluid & as a repository for waste and assists in maintenance of fluid and electrolyte homeostasis. Also cushions the fetus from trauma by blunting and dispersing outside forces. Allows freedom of movement for musculoskeletal development, acts as a barrier to infection.

What vaccine preventable disease is of concern when acquired by a pregnant woman?

Rubella

Which vaccines may be given postpartum and why?

Rubella - for women who haven't received the vaccine or are not serologically immune (titer). To prevent contracting rubella in future pregnancies, typically given as the MMR (measles mumps rubella). Varicella - to be given to postpartum women who have no immunity to varicella, the first dose before hospital discharge & a 2nd dose in 4-8 weeks during follow-up. Tdap - recommended for women who have not previously received the vaccination. Given to decrease risk of pertussis in mother, and prevent exposure of pertussis to newborn.

Name the 3 stages of lochia and how long they last

Rubra : Lasts 1-3 days after delivery Serosa : Last from about day 4 to day 10 after delivery Alba : Lasts from approximately day 11 up to 4-8 weeks postpartum.

Professional healthcare system

Run by a set of professional healthcare providers who have been formally educated and trained for their appropriate roles and responsibilities.

Patients need routine teaching focused on what sexuality topics? (2)

STI prevention Birth control

________ is a basic human need.

Safety

When caring for a client with an indwelling catheter, you notice sandy particles around the urethral meatus. What should you do?

Sandy particles means encrustation. Provide perineal care and obtain an order for replacement of the catheter from the doctor

Cradle cap How can it be removed?

Scaly white patches over the scalp due to secretion of sebum—is common. It can be removed with washing and gentle scrubbing.

Nursing as a discipline: What is it driven by (2) ? What 2 boundaries of knowledge must a profession have to be considered a discipline?

Scientifically based and self-governed profession that focuses on the ethical care of others. Aspects of theory and practice it demands mastery of both theoretical knowledge and clinical skill. Theoretical and practical boundaries.

Transformational leadership

Selling style. The ability to motivate and inspire followers, creates a supportive climate.

Identify limitations of therapeutic touch (2)

Sensitive to human interaction/touch Sensitivity to energy re-patterning.

What does the psychomotor learning domain of learning include (4) Example

Sensory awareness of cues involved in learning Imitation of skills Performance of skills Creation of new skills. EX: A client identifies that he needs to read instructions before starting a project.

What do the authors Wilkinson and Treas view as the three primary tasks of a leader in healthcare?

Set direction (i.e., help other people develop vision, a mission, goals, and purpose Build commitment (i.e., help other people develop motivation, team spirit, and teamwork) Confront challenges that arise from innovation, change, and turbulence

Teaching children about predators (3)

Set the stage for open discussion Know what's going on Just say no

Group discussion teaching strategy: What is it? Effective group discussion requires what (3)

Several participants discuss topics, exchanging info and presenting their points of view. An atmosphere of trust that encourages everyone to participate. Openness to new ideas Confidentiality of the content expressed

Nausea and vomiting At what point should women seek medical attention?

Severe vomiting (hyperemesis gravidarum), or nausea and vomiting accompanied with diarrhea.

What determines the nature and quantity of the exudate response (2)

Severity of the injury Tissues involved in injury

Heterosexuality

Sexually and emotionally attracted to members of the opposite sex

Homosexuality

Sexually and emotionally attracted to members of the same sex

Democratic (participative) leadership style

Shares the planning, decision making, and responsibility for outcomes with members of the group. This type of leader tends to provide guidance rather than control. Less efficient way to run things, but it is more flexible and more likely to foster motivation and creativity. Group output tends to be of high quality.

What vaccine is recommended for all adults at age 65 unless contraindicated?

Shingles

What are the early signs of hypothermia(3)? Progressive signs of hypothermia (5)

Shivering Cyanosis of the lips and fingers and poor coordination. First cold then pain in the extremities. As it progresses Mental impairment Confusion Disorientation Slowing of the heart rate and respirations Inability to take precautions from the cold.

How does the body respond in order to increase body temperature? (3)

Shivering and the release of epinephrine, which increases metabolism. Blood vessels constrict (To reduce heat loss) which shunts blood away from the periphery to the core of the body where the blood is warmed. Piloerection (hair standing on end) also occurs, but is insignificant to heat conservation.

Why is fentanyl good for labor?

Short half-life

Identify the clinical applications for chiropractic therapy Pain (3) May enhance the effects of conventional treatment in (6)

Short term pain/disability Lower back pain Joint pain caused by osteoarthritis Pediatric asthma Headaches, Dysmenorrhea, Vertigo, Tinnitus Visual disorders

If the serum pH is too alkaline (pH is high), the lungs try to conserve carbon dioxide through ____

Short, shallow respirations

What happens during effacement?

Shortening and thinning of the cervix during the first stage of labor, expressed in percentages.

Which type of fetal presentation can lead to a cesarean birth?

Shoulder

What are striae? What kind of patient do we see this in (3)?

Silver-pink stretch marks Pregnant women Women who have had children, Anyone with significant weight fluctuations.

Resistance of blood flow is determined by what 3 things?

Size (diameter) of vessel Length to travel Thickness of blood

Identify 10 physical assessment components that can be used to monitor fluid, electrolyte and acid-base balance

Skin Mucous membranes Cardiovascular system Respiratory system Neurological system Temperature Pulse Respirations Blood Pressure O2 levels

Why aren't the skull bones fused?

Skull bones aren't fused because it allows for flexibility in the birthing canal.

List three contributing factors to difficulty maintaining body heat in the elderly:

Slower metabolism Decreased vasomotor control Loss of subcutaneous tissue

When evaluating the neurological system in older adults, what are commonly observed changes? (3) Why?

Slower reaction time Decreased ability for rapid problem-solving Slower voluntary movement The number of functioning neurons decreases

Splinter hemorrhages What is it associated with (2)

Small hemorrhages under the nail bed. Associated with bacterial endocarditis or trauma.

What are milia on a newborn?

Small raised white spots on the nose, chin and forehead

Capillary Hemangiomas, where? When do they fade?

Small, irregular pink-red areas often seen around the face and neck of newborns. Typically disappear in infancy, can last till age 5.

What factors can enhance or limit healthy behaviors according to health ecology? Example:

Social and environmental factors Example: Most people can benefit from physical activity such as walking, and people are more likely to walk in areas where there are sidewalks or walking paths and where the feel safe.

What is the greatest determinant of serum osmolality?

Sodium

4 main classifications of antidysrhythmitics Major concern of these meds?

Sodium channel blockers Beta adrenergic blockers Potassium channel blockers Calcium channel blockers Toxicity

What kind of cells cannot regenerate (2)

Some CNS and cardiac cells

Do receptors remain activated for as long as a stimulus is applied?

Some do, however most receptors adapt to stimuli; that is, their response declines with time. Adaptation explains why, over time, you become unaware of an unpleasant smell or the persistent hum of an air conditioner.

List several measures to employ to reduce sensory overload in Tactile

Some patients are overly sensitive to touch, though. In those instances, you must minimize irritating stimuli.

4 aspects of holistic healthcare: health

Spiritual component Self-healing Balance Integration

Slander

Spoken or verbal form of defamation of character

SROM AROM

Spontaneous Rupture of Membranes Artificial Rupture of Membranes

Sexually Transmitted Infections: How are they spread (3) What % of STI's occur under age 25? How are they diagnosed (Males/Females) How are they treated? If untreated can they cause further issues?

Spread through direct sexual contact or open wound or body fluid transmission 66% Male- Urethra swab Female- Swab from secretions near cervix Antibiotics Yes

Give an example of how a nurse would assess LOC using painful stimuli?

Squeezing the trapezius muscle

Patricia Benner's 5 Stages of Nursing development

Stage 1 Novice Stage 2 Advanced beginner Stage 3 Competence Stage 4 Proficient Stage 5: Expert

How does a patient position themselves for the Romberg test, what is the goal?

Stand with feet together and eyes closed, and maintain balance with minimal swaying.

What is the main focus of a nursing care plan? (3)

Standardized Holistic care Evidence-based

What is the purpose of using the SBAR model in inter-disciplinary communication? Why do you think the SBAR model is so effective in improving communication between nurses and physicians?

Standardized communication tools are quite effective in overcoming differences in nurse physician communication Styles, and conveying key information clearly and concisely. This is so effective for the physician and nurse because it leaves more time for each of them to ask questions when you follow the order of SBAR. Also, usually covers everything the physician needs to know for the call.

How should a mother be positioned in the first phase of labor, why?

Standing up To put the baby in an occiput position

Condom instructions (Donts) (4)

Store condoms in your wallet or other places where condom can break Use fingernails or teeth to open the condom wrapper Reuse a condom Use lotions or oils with condoms

SWOT Analysis

Strengths Weakness Opportunities Threats Can help identify skills you possess and what skills you need to develop

Define race

Stricly related to biology Ex: White, African American, American Indian

Minority groups

Subgroups of the population that consist of fewer than 50% of the population

What are electrolytes?

Substances that develop an electrical charge when dissolved in water

What is angina? Angina results from what?

Sudden pain beneath sternum radiating to left shoulder arm and jaw Insufficient blood supply to heart due to a blockage of blood flow in coronary arteries

In what ways can the support network of a patient with sensory deficits be a help?

Support persons may help the client to adapt to deficits by assuming chores that the client can no longer perform or by providing comfort to the client so he is less distressed by the sensory losses

Role of the nurse: Client advocate

Supporting clients right to make healthcare decision when they are able to voice their opinions and protecting clients from harm when they are unable to make decisions. Helping a client explain to his family that he does not want further treatment.

How does the fetal head adapt during labor? What can this result in, how long does this last?

Sutures & fontanels make the head flexible during labor. May result in molding (shaping of the head to the birth canal) for up to 3 days.

Describe why fever predisposes an individual to skin breakdown (2)

Sweating which can cause maceration of the skin. Increases the metabolic rate, thereby increasing the tissue demand for oxygen.

Swelling Where is swelling normal?

Swelling is normal in the lower extremities

Constitutional Law

System of fundamental laws and principles that describes the nature, functions and limits of a government Ex: Free speech

Pharmacologic methods for pain management

Systemic analgesia Inhaled analgesia Epidural and intrathecal anesthetic and opioids

There is a small amount of blood in the heart and lungs, but most blood is where?

Systemic circulation

What is the biggest concern with using systemic analgesia?

Systemic narcotics too close to delivery can impact baby

Moral framework

Systems of thought that are the basis for the different perspectives people have in ethical situations.

Healing modalities, energy therapies: Tai-chi Qijong (3)

Tai-chi: Non-aggressive martial art Qijong: Series of movements, breathing, and meditation

What does the nurse always do when teaching about sexual health? (2)

Take time to get to know your client and find out what they already know about sexuality. Open-ended questions

What is an example for your own learning when repetition was important to meeting outcomes?

Taking blood pressures in lab was repeated to make sure we get the correct answers every time. Repetition helps drive the learning in the brain to master the skill.

Cultural assimilation

Taking the essential values and beliefs of a dominant culture

How should a nurse communicate with a patient with impaired cognition? (8)

Talk first, touch second. Stimulate memory Use short sentences Do not argue or insist the patient agree with you. Provide reminders Orient the client Avoid using slang or jargon Don't assume, ANYTHING

How should a nurse communicate with a patient with impaired hearing? (3)

Talk loud. Good use of nonverbal communication Read patients nonverbals to see if confusion arises.

List the lifestyle habits that impact healthy skin (8)

Tanning (exposes skin to ultraviolet radiation) Hygiene habits (excessive or insufficient skin hygiene) Regular exercise (Improves circulation which is necessary for skin integrity) Nutritious diet (provide necessary nutrients to maintain skin integrity) Smoking (compromises the oxygen supply to the tissues, making skin more prone to breakdown and delaying wound healing) Body piercings and tattoos (present a risk for infection and scarring) Necrosis (premature death of cells) Impaired venous circulation results in engorged tissues containing high

What can occur with taste deficits?

Taste deficits may decrease the pleasure associated with eating; weight loss and malnutrition may result.

Douching:

Teach women that douching is unnecessary and is associated with significant risks. It can wash away the lactobacilli that clean the vagina and protect it from infection. Women who douche are at increased risk for some StIs and for PID. Furthermore, douching is essentially useless as a method of contraception. Some women douche because they notice an odor. Reassure them that this is normal during certain times of their menstrual cycle. If the odor doesn't disappear after washing, they should see their healthcare provider.

Factors contributing to the frequency of nurses moral problems? (5)

Technological advances The needs of a multicultural population. Cost containment efforts in healthcare. The nature of nursing work The nature of the nursing profession.

What are the three main characteristics of skin?

Temperature Moisture Texture

Give an example of how The Joint Commission is involved in collaborative professional communication.

The 2013 National patient safety goals added goal 2.03.01, which calls for getting important test results of the right staff person on time. The broad go to calls for improving the effectiveness of communication among caregivers.

What is Baby-Friendly hospital status?

The Baby-Friendly Hospital initiative was founded to encourage institutions to offer optimal levels of care for lactating mothers.

What is the Rh factor?

The Rh factor is a protein that can be found on the surface of red blood cells. If your blood cells have this protein, you are Rh positive. If your blood cells do not have this protein, you are Rh negative

What is perception?

The ability to interpret the impulses transmitted from the receptors and give meaning to the stimuli.

Bioethics

The application of ethical principles to every area of healthcare

What are Magico-religious beliefs?

The belief that supernatural forces dominate.

Feminist Ethics

The belief that traditional ethical models provide a mostly masculine perspective that de-values the moral experience of women

Signs and symptoms of excessive fluid volume

The blood pressure is elevated, pulse is bounding, and respirations are increased and shallow.

why is urine osmolality higher than serum levels

The body excrete nitrogenous waste as well as electrolytes.

Describe the working phase What is the goal of this phase?

The bulk of therapeutic communication occurs in this stage, mutual respect between patient and nurse is created, relationship is courteous, competent, trustworthy, and confidential. Goal is to establish rapport and trust through the use of verbal and nonverbal communication

Ovum stage: What does the endoderm develop into? *Lower/deep layer*

The epithelium lining of the respiratory tract & digestive tract, including the oropharynx, liver and pancreas, urethra, bladder & vagina.

Why is it difficult to assess the size and shape of the pelvis? (2)

The examiner does not have direct access to the bony structure The structures are covered in tissues.

Describe the following components of the inflammatory response: Exudate response

The fluid and white blood cells that move from circulation to the site of the injury. Ex: Surgical incision may ooze serosanguineous (clear/pinkish) exudate for several days

medical risk factors: explain why a gastrointestinal problem can lead to impaired glucose regulation?

The gastrointestinal problem can lead to malabsorption and resulting nutrient deficiency.

why is documentation important regarding legal matters?

The healthcare record is legal evidence of care given to patient and used to judge whether interventions were timely and appropriate

Identify five ways to regulate the flow rate of IV fluid.

The height of the solution container Client position. Blood pressure. Internal diameter of the IV catheter. Condition of the catheter and tubing.

Discuss depression in older aged adults.

The incidence of depression is slightly higher in older adults than rest of the population. 10% of adults ages 65-74 that they had feelings associated with depression all or most of the time. Adults over 75 reported at 12%

Role-Modeling/Playing

The instructor teaches by example, demonstrating the behaviors and attitudes that learners should adopt. More effective when the teaching point corresponds with the role models actions. Students or patients learn by seeing, hearing, and doing. Must connect the learning to the objectives. More successful when the teaching point is made apparent to learners during the learning experience.

Pressure is highest when blood leaves where?

The left ventricle

Causes of Erectile Dysfunction (4) Which is the most common cause of ED?

The most common cause of ED is diseases of the blood vessels (e.g., hypertension, high cholesterol, or diabetes) Underlying neurological (e.g., spinal cord injury, Parkinson's disease, stroke) Endocrine problems (diabetes). Common psychological problems that contribute to ED include performance anxiety, childhood sexual abuse, relationship

RN Education pathways: Doctorate

The most unusual pathway to nursing, the nursing doctorate parallels the physician pathway to healthcare. Very limited enrollment. Can be (DNP/DNS) doctors of nursing practice/science, researchers.

Explain Stage 1: Novice When does it begin? 2 characteristics of this stage

The novice nurse has little nursing experience and is the first stage of acquiring clinical knowledge. Begins with the onset of your education. Task oriented and following rules

What determines the sensitivity of an area and the amount of sensory cortex area?

The number of cutaneous receptors determines the sensitivity of an area and the amount of space devoted to that region in the sensory cortex area. The hands and face have the most receptors and therefore the largest area in the sensory cortex.

What defines the scope of nurse practice?

The nurse practice act

To what should oral report be restricted?

The oral report provides an opportunity for professional communication that assists in organizing your work and also for learning, building team relationships, and collaborating to improve patient care.

Define fetal presentation What are the options for a fetus presentation, % of each (3)

The part of the fetus that is entering the pelvis first Cephalic/Vertex (Head) 96% Breech (Butt or feet) 3% Shoulder 1%

What is a physician or midwife saying when they state a patient is 3/80/-2?

The patient is 3 cm dilated 80% effaced Baby's head is 2 inches above the ischial spine

What must the nurse remember when assessing LOC if the patient does not speak the nurse's language?

The patient may not respond to questions or commands

Informed consent

The permission for all types of care given by the patient with full knowledge of the risks, benefits, costs and alternatives

What is the prevailing theory of depression and how does it influence treatment?

The physiological theory of depression predominates in the medical community, and current evidence shows that biochemical processes determine moods, thought, cognition, and perception. Therefore, treatment of serious depression relies more heavily on antidepressant medication than on psychotherapy.

Embryonic stage: What is the purpose of the placenta?

The placenta functions as an endocrine system in early stages, producing 4 hormones to maintain pregnancy - hCG, hCS/hPL, progesterone & estrogen. Metabolic functions of the placenta are respiration, nutrition, excretion, and storage for the fetus. Oxygen diffuses from the maternal blood across the placental membrane into fetal blood, and carbon dioxide diffuses opposite - serves as the fetal lungs. Provides active transport of glucose to the fetus. Removes wastes from fetus.

Define authority power

The power granted to an individual by position

What is values clarifacation?

The process of becoming conscious of and naming ones values

what is glucose regulation?

The process of maintaining optimal blood glucose levels

What is the general purpose of oral report?

The purpose of giving an oral report is to maintain continuity of care.

why does quality matter when giving oral report?

The quality of report you give and receive, influences how you and others plan the days or nights work. Bad report is not helpful.

Health Teaching and Health Promotion

The registered nurse uses strategies to promote health and a safe environment.

What is the Wellness-illness continuum: When does wellness occur? What clinical model correlates to it?

The relationship between health and illness. Wellness occurs when incremental increases in health are beyond the midpoint. Clinical model of health

What are ureters?

The remaining organs of the urinary system transport or store the urine once it is formed.

What might be the result of high task low relationship leadership? How about low task, high relationship leadership?

The result of a high task low relationship leadership style may greatly impact the morale and productivity of the team. The low task high relationship leadership style, on the other hand, may not be very productive either. Their quality of job performance may also suffer.

Describe what the reticular activating system (RAS) does.

The reticular activating system (RAS), located in the brainstem, controls consciousness and alertness. The neurons of the RAS make connections between the spinal cord, cerebellum, thalamus, and cerebral cortex, relaying visual, auditory, and other stimuli that help keep us awake, attentive, and observant.

What test can be used to identify or confirm clubbing?

The schamroth window test. When putting nails together, should be able to see a gap in between (did this in class)

Define health promotion

The science and art of enabling people to increase control over their lifestyle to move toward a state of wellness

Ethics

The study of a system of moral principles or standards, or the process of using them to decide your conduct and actions

Demonstration/Return Demonstration

The teacher explains and demonstrates a skill or task. The learner then demonstrates comprehension by returning the demonstration. Return demonstration should be scheduled close to the initial teaching of the skill. This format allows for targeted questions and answers and practical matters, rather than theory. Mannequins are being used more and more in clinical teaching.

vision sensory function changes associated with aging

The vitreous humor becomes thinner, and "floaters" appear in the visual field. The lens becomes discolored and opaque; the pupil becomes smaller. Therefore, less light reaches the retina, limiting vision. The lens becomes less flexible and less able to focus on near objects. The ciliary body contracts and the lens thickens, bringing loss of visual acuity, decreased ability to accommodate to distance and sudden changes in illumination, and decreased night vision. Peripheral vision decreases. Tear production decreases.

In what ways can the support network be influential when patients are experiencing sensory overload or deprivation?

They can help to calm the patient. Family members can also help clients who are confused from sensory alterations by reorienting and calming the client.

1:1 Instruction and Mentoring teaching strategy 3 aspects

They mutually formulate objectives at the beginning of the session. Role modeling and problem solving are being presented by the teaching nurse. Directly observe and offer feedback on the learners performance.

What is important for the nurse to consider if a patient is using herbal therapies to treat depression?

They work sometimes and all options should be considered.

Explain what the following findings may indicate: Thickened nails: Thick, yellow nails: Brittle nails (5): Soft, boggy nails:

Thickened nails: May result from poor circulation Thick, yellow nails: An indication of fungal infection (onychomycosis) Brittle nails: Seen with hyperthyroidism, malnutrition, calcium, and iron deficiency, and repeated use of harsh nail products. Soft, boggy nails: Seen with poor oxygenation.

Signs and symptoms of deficient fluid volume

Thirst Rapid weak pulse, or orthostatic hypotension

What is hemoglobin A1C?

This blood test indicates your average blood sugar level for the past two to three months.

Gestational diabetes testing Glucose challenge test

This screening is performed first for patients at risk of developing gestational diabetes, usually between 26 & 28 weeks and detects hyperglycemia. This is the one hour test that doesn't require fasting.

Gestational diabetes testing Glucose tolerance test:

This test is done for people who have elevated 1 hour glucose challenge tests, which includes glucose fasting and hourly venous glucose levels to diagnose gestational diabetes. Requires 2 elevated hourly glucose levels.

RN Education pathways: Associates Who conceptualized it, when did it emerge? What percent of RN's get this training? How many years it is usually? What does it focus on (2)

This type of program conceptualized by Mildred Montag, emerged during the nursing shortage following WWII. 45% of RN's report getting their training at these types of institutions. Typically two years Focuses on liberal arts and sciences

Assessment of orientation includes evaluation of awareness of what three things?

Time Place Person

Skin tags (acrochordons) Where do they occur, what kind of patient, color

Tiny tags or buds of skin usually around skin creases in middle and older adults where friction occurs. Can be brown, black.

What does Petechiae look like? What makes it visible in the skin?

Tiny, pinpoint red or reddish-purple spots Extravasation (leakage from vessels) of blood into the skin.

What does holistic nursing care require regarding middle adults sexuality?

To assess and formulate strategies to address their sexual concerns.

What is the purpose of sensation?

To grow, develop, and function, we must be able to sense and respond to sensory input.

What is the goal of an incident report?

To prevent the incident from occurring again and for quality improvement in the agency. Should not be used to discipline staff members or placed in employee files.

What is the purpose of change of shift (hand off) report?

To promote continuity of care.

What is the common goal among all healthcare providers?

To provide the patient optimal care

What is the role of the nurse as client advocate in the delivery of ethical nursing care?

To safeguards client against abuse and violations of their rights Ex: Calling the provider for the 3rd time on a shift

Diffuse alopecia What can cause it (3)

Total hair loss Chemotherapy Nutritional deficiencies Endocrine disorders.

How would you describe transactional leadership?

Transactional leadership is the idea that people are more motivated by reward or punishment. It establishes a clear chain of command.

Middle aged Adults (Women) sexual development

Transition through menopause (cessation of menstruation), a process that varies widely. Some are relieved that the prospect of childbearing has ended, while others may mourn the loss of the ability to give birth. Normal physiological changes include decreased vaginal secretions and vaginal wall thinning that result from decreased levels of estrogen and progesterone. These changes may result in painful intercourse and decrease a woman's desire for sexual activity. Some women also experience hot flashes, sleep disturbances, and mood changes.

Four characteristics of Holistic healthcare (4)

Treats the whole person Lifestyle changes Optimal wellness Preventative strategies

How is true sadness different from depression?

True sadness may come from a divorce, a death, or other loss, while a depressed mood is typically marked by a sense of emptiness. This emptiness contributes to a depressed person's tendency to withdraw from social contacts and also explains the characteristic flat affect of depression.

Hair and scalp assessment (8)

Type of hair (long, coarse, thick, brittle) Color Distribution Quantity Thickness Texture Lubrication Separate hair to determine scalp

RN Education pathways: Masters How long is it?

Typically students have Baccalaureate in other fields Complete 3 years of schooling then can complete licensing exam for a masters in nursing.

Urinary frequency How do women differentiate between normal frequency vs. UTI?

UTI usually has increased frequency with urine that is foul-smelling, contains blood or is cloudy.

Purnells levels of cultural competence?

Unconsciously incompetent Consciously incompetent Unconsciously competent Consciously competent

Where is an axillary temp taken?

Under the armpit

How does environment affect the level of wellness?

Unfavorable environment (low level wellness) Favorable environment (high level wellness)

Basic stages of Lewins change process and corresponding comfort zones (3)

Unfreezing (Comfort zone) Change (Discomfort zone) Refreezing (New comfort zone)

Negative aspects of sexual intercourse (3)

Unprotected sex can lead to conception Risk of STI's Partners do not reach orgasm at same time

What is CUS language?

Use :critical language: such as: C- Concerned U- uncomfortable S- safety Language was designed to help nurses express themselves to physicians in an effective way I feel concerned.... I am uncomfortable...... This is a safety issue...

Condom instructions (Do's) (4)

Use condoms Treat condoms gently and keep them out of the sun Use only water based lubricants Check the expiration date

What are some key strategies in teaching children? .

Use strategies to gain trust, reduce their anxiety, promote cooperation, and enhance their emotional readiness to learn. EX: give the child a tour of the hospital a week before scheduled surgery and introduce the nurses and physicians who will be doing their surgery

It is hard for a patient to admit they lack knowledge, as a result what three things should the nurse do when providing care for patients (3)

Use street terminology for the patient to understand Assess patient's knowledge Assess patient's understanding of sexual terms.

How does the nurse assess skin temperature by palpation? What does the nurse compare? What should the nurse check for areas of, what can this indicate?

Use the dorsum of the hand or fingers to assess skin temperature. Compare temperature of hands and feet, left and right side of the body. Be sure to check areas of erythema, can indicate infection or inflammatory changes.

When is the patient benefit model used?

Used when a patient is not competent to make own decisions

Therapeutic touch: How is it done? How far do energy fields extend from the physical structure of the body? How does energy flow in illness/pain?

Uses the hands on or near the body to provide comfort, pain relief, and healing. Humans consist of energy fields that penetrate the body and extend 5 to 15 cm (2 to 6 in.) In health, energy flows freely through the system in a balanced manner. But in illness or pain, the free flow of energy is disrupted.

Role of the nurse: Communicator (6)

Using interpersonal/therapeutic communication skills to address the needs of the client Facilitate communication in the healthcare team Advise the community about health promotion/disease prevention Counseling a client Discussing staffing needs at a meeting Providing HIV education at a local school.

Role of the nurse: Counselor

Using therapeutic communication skills to advise clients about health related issues (weight loss)

Culture universals

Values, beliefs, and practices that people from all cultures share

What are the 4 phases of the inflammatory process?

Vascular response Cellular response Exudate response Healing

What creates the nails underlying color?

Vascularity of the nailbed

What are the signs of postpartum depression?

Very similar to those of adult depression, except the mother's guilt is strongly centered in worries about being an incompetent or inadequate parent. Feelings of detachment or lack of love towards the newborn, and irritability are also common.

Explain the role of vitamin c, zinc, and copper in wound healing:

Vit-C, Zinc and copper are involved in the formation and maintenance of collagen, so a deficiency can delay wound healing.

Nursing Care During Labor & Delivery: Assessments (3)

Vital signs Complete assessment on admission (all systems) Focused assessments (Sterile vaginal exams--SVE)

Vital sign frequency for baby RN

Vital signs q30" x4 or per hospital protocol

C-Section RN role postoperative (7)

Vitals EKG monitoring Lochia Fundus Incision Pain relief Assist with feeding/bonding

Why do newborns need to be given Vitamin K?

Vitamin K helps infants prevent vitamin K deficiency bleeding (hemorrhagic disease). Newborns don't produce their own vitamin K until 7 days of age

Explain what factors impact relationships and roles in communication (4)

Vocabulary Tone of voice Use of gestures Distance

What can newborns hear at birth?

Voices and other sounds

Hemorrhoids What teaching is appropriate? .

Warm sitz bath, witch hazel pads, & applying topical ointments to help relieve discomfort

What is the largest single constituent in the human body?

Water

Evaporation:

Water converted to vapor and lost from the skin as perspiration or the mucous membranes through breath. Water loss by evaporation is called insensible loss Affected by humidity, if air is really humid then less moisture evaporates from the skin, thus less cooling occurs.

What are major concerns associated with potassium intake?

We are not consuming enough of it, moderate potassium deficiency is associated with increases in blood pressure, Salt sensitivity, risk of kidney stones, and risk of bone turnover. Because of its effect on blood pressure, low intake of dietary potassium is associated with increased risk of stroke.

What is the Eudaimonistic Model? What aspects of life does it emphasize? What creates life meaning? Example

Well-being indicates optimal health Social Mental Physiological Spiritual aspects of life Attaining life goals Ex: Even a patient who is dying from cancer can still be considered healthy if they find meaning in life.

When can a gap in health literacy occur? What kind of questions should the nurse ask?

When a health care provider uses medical terminology that is unfamiliar or misunderstood by the patient, thus resulting in an unintended message or lack of meaningful information. Ask questions that involve "what" and "how" not just "yes" and "no"

Battery

When an offense or harmful physical contact is made to the patients without his consent or there is an unauthorized touching of a persons body

Describe sudden body changes and impact on body image.

When changes in appearance or function occur abruptly such as with illness or injury, they are more difficult to accept.

What are the benefits of face-to-face report? What is a drawback to this report format?

When given in a conference room, an oral report does not let you directly observe the patient, but it is time efficient and still allows interaction between nurses.

Conduction:

When heat is transferred from a warm to a cool surface by direct contact. Ex:Using an icepack on your forehead when running a fever.

Temperature value for heat stroke 2 key indicators List the symptoms of heat stroke (11)

When hyperthermia progresses to a temp above 103°F Change in mental status Decrease in level of consciousness. Symptoms include Rapid strong pulse Throbbing headache Delirium Confusion Impaired judgment Lethargy Red, hot, dry skin Dizziness Seizures Coma. The body is unable to sweat.

Ballotable

When pushing on baby's head during cervical check, baby bounces back up.

What is show?

When the cervix is dilating, more bright red bloody mucus is discharging from the vagina during labor.

What decision must the parents of an inter-sexed (hermaphrodites) infants make?

Whether to have the child undergrowth surgery to make the assigned sex consistent with a physical appearance or to delay assignment and allow the child to choose at a later time.

Stereotypes

Widely held, but oversimplified beliefs that have no basis in facts Ex: All asians are intelligent

What is flushing What can cause it (6)?

Widespread, diffuse area of redness Fever Excessive room temperature Sunburn Polycythemia (an abnormal increase in red blood cells) Vigorous exercise Certain skin conditions (rosacea)

Define followership

Willingness to work with others toward accomplishing the group mission. Also refers to those who show a high degree of teamwork and build cohesion among the group.

Why is it best to take the "win-win" approach to conflict resolution?

Win-win approach is best because in healthcare, our aim should be to work together more effectively, not defeat the other party. The people who lose are likely to feel bad about losing. As a result, they may spend their time and energy preparing to win the next round rather than on their work. A tie (neither side wins or loses) may just be a stalemate. No one has won or lost, but the problem is also still there, and no gain is achieved. These reasons make the win-win approach the best for healthcare.

When should a newborn's first bowel movement be?

Within 12-24 hours of birth

What factors might impact the length of the second stage of labor? (10)

Woman's age, BMI Emotional state Support Fatigue level Fetal size Position Presentation Parity Epidural use.

Furosemide (loop diuretic) Action Used in patients with (2) Routes (3)

Works in kidney to block re-absorption of na/cl and prevent reabsorption of water HF and edema Orally, IV, IM

Hydrocholorothiazide (Thiazide diuretics) Action Used in patients with (2) Route Side effects (7)

Works in kidney to block re-absorption of na/cl and prevent reabsorption of water HF, Edema Oral Dehydration Hyponatremia Hypochloremia Hypotension Ototoxicity Hypokalemia *Hyperglycemia* (difference from furosemide)

Clonidine (Centrally acting alpha2 agonists) Action Therapeutic effects (3) What disease is it used for? Complications (3) Routes (3)

Works with CNS to decrease sympathetic outflow which results in decreased stimulation of the adrenergic receptors Bradycardia Decreased cardiac output Peripheral vasodilation Primary Hypertension Drowsiness Dry mouth Rebound HTN Orally, epidural, transdermal

Major function of chloride

Works with sodium to regulate osmotic pressure, and with the bicarbonate buffer system to regulate acid-base balance.

Libel

Written or published form of defamation of character

For each evaluation of patient orientation, what must a nurse take into consideration as part of the assessment: Time

Year, date, and time of day. Older adults who become disoriented to time usually think it is an earlier date. If the client offers a bizarre time or futuristic date, consider psychiatric concerns as the cause of disorientation.

Jaundice, color? What is it associated with? Best place to assess (5) How long is normal for newborns

Yellow-orange cast to skin Liver disorder Sclera, mucous membranes, hard palate of the mouth, palms, and soles. First few weeks of life

What is alba lochia?

Yellowish white creamy color, fleshy odor. Lasts from approximately day 11 up to 4-8 weeks postpartum.

Can increased intracranial pressure be life-threatening?

Yes

Is biomedical (allopathic) conventional?

Yes

Nursing as an occupation: Is it an autonomous occupation? What are nurses not in control of?

Yes Practice environment Working conditions Schedule

Fantasies and Erotic Dreams: Do most people have sexual fantasies? What 2 things do sexual fantasies serve to increase? Are erotic dreams common among men and women?

Yes Self esteem and sexual arousal Yes

Does milk "come in" if a woman decides not to breastfeed? What interventions might you employ?

Yes - colostrum within the first 24 hours, and true milk comes in within 72 hours. This milk should not be expressed if a woman chooses not to breastfeed, and comfort measures should be taken to ease discomfort and engorgement.

how would the nurse assess kidneys during an assessment?

You cannot usually palpate the kidneys. Instead, examine them by assessing for costovertebral angle tenderness (CVAT). Place one palm flat on the CV angle and lightly strike it with the closed fist of the other hand If kidney inflammation is present, percussion of this angle produces pain.

What developmental modifications may have to be made if doing a neurological exam on an older adult?

You may need to perform the sensory neurological exam over several sessions. The full exam is lengthy, and older adults fatigue easily. If the client seems to be getting tired, stop the test and finish at a later time.

How might a nurse increase effectiveness in teaching populations with special needs?

You may need to use brief, frequent learning sessions or pay special attention to minimizing distracting stimuli in the environment. You may need to present information slowly, use repetition, and be satisfied with slower progress.

What are some tips for tactile stimulation?

You may want to hold a patient's hand Provide a back rub with morning and bedtime care. Gentle hand massage is sometimes effective in calming agitated patients. Healing touch: using the patient's energy fields has the potential to aid in pain control and facilitate self-healing. However, people do respond differently to being touched, so adjust the amount of touch you provide according to the patient's reaction.

What do many young adults have questions about

Young adults often wonder whether their sexual behaviors and responses are normal

How can a nurse enhance hearing when there is a deficit?

Your interventions should focus on supporting auditory function, improving communication, and creating a safer environment.

What should a nurse include in a transfer report?

Your name, facility, and phone number patient's name, age, gender, and admitting and current diagnosis patient's physician, if still following patient procedures or surgeries performed current medications and last date/ time each was taken/ next doses due patient status at present as well as progression since last admission last set of vital signs, Plus any pertinent Trends since admission

What is personal identity?

Your view of yourself as a unique human being, different and separate from all others.

What can White spots indicate?

Zinc deficiency

what is cyanosis?

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood

What factors might cause a hospitalized patient to experience sensory overload?

a combination of physical discomfort, anxiety, separation from loved ones, and the experience of being in the unfamiliar hospital environment. Medications that stimulate the CNS Substances, such as caffeine. Physical conditions that activate the CNS (e.g., hyperthyroidism, acute brain injury) Some mental health conditions (e.g., psychosis, sensory integration disorder, attention deficit hyperactivity disorder) are exacerbated by high intensity noise and light in the environment

how does a cough affect oxygenation?

a cough indicates an obstruction (mucus, debris) that is interfering with oxygen getting to the lungs.

Kinesthesia sensory function changes associated with aging

a decrease in muscle fibers and diminished conduction speed of nerve fibers, resulting in slowed reaction time, decreased speed and power of muscle contractions, and impaired balance.These place older adults at increased risk for falling

what is telehealth?

a form of communication that sends healthcare information between patients and professionals at different locations

Why does a nurse need to assess a patient's healthcare environment?

a health- care environment can have too many or too few stimuli. As part of your assessment, observe how the client is responding to the conditions of the environment.

What is chyme?

a mixture of partially digested food, water, and gastric juices

stage 2 advanced beginner

a new graduate usually functions at this level. An advanced beginner begins to focus on more aspects of a clinical situation. use more facts, make more sophisticated use of the rules and recognize similarities in situation. the nurse can distinguish abnormal findings but cannot readily understand their significance

susceptible-

a person who is at risk for infection because of inadequate defenses against the invading pathogen. the very young, or the very old are in this category as are the immunosuppressed.

What are ethical decisions affected by ?

a person's developmental stage, values, ethical frameworks and principles, and professional guidelines

Describe what type of medications make a patient at risk for skin breakdown: (6)

a. Blood pressure medications decrease the amount of pressure required to occlude blood flow to an area, creating a risk for ischemia b. Anti-inflammatory medications,such as OTC nonsteroidal anti-inflammatory drugs (NSAIDs, ibuprofen) and steroids (prednisone), inhibit wound healing c. Anticoagulants can lead to extravasation (leakage of fluid) of blood into subcutaneous tissue; as a result, even minimal pressure can cause a hematoma d. Chemotherapeutic agents delay wound healing because of their cellular toxicity e. Certain antibiotics, psychotherapeutic drugs, and chemotherapy agents for cancer increase sensitivity to sunlight, increasing the risk for sunburn f. Herbal product (lavender and tea tree oil) cleanse the skin but also have a drying effect

6) The nurse understands the primary reason a healthy geriatric patient is more likely to develop a pressure ulcer on the elbow as compared to a healthy middle-age adult is: a. The older patient has less subcutaneous padding on the elbows. b. The attachment between the epidermis and dermis is weaker. c. Older adults have a poor diet that increases risk for pressure ulcers. d. Reduced skin elasticity is common in the older adult.

a. The older patient has less subcutaneous padding on the elbows. Rationale: Although all options are related to causes of skin injury in older adults, the layer of tissue below the dermis decreases in size with age, and so the older client has little subcutaneous padding over bony prominences, thus they are more prone to skin breakdown than a healthy, younger adult.

14) A client is diagnosed with a fungal infection of the scalp. The nurse would document this as: a. Tinea capitis b. Tinea corporis c. Tinea cruris d. Tinea pedis

a. Tinea capitis Rationale: Tinea capitis is a fungal infection of the scalp. Tinea corporis describes fungal infections of the body. Tinea cruris describes fungal infections of the inner thigh and inguinal creases, and tinea pedis is the term for fungal infections of the foot.

Define artificially acquired active and passive immunity

active: antigenes are introduced in vaccines: body produces antibodies and specialized lymphocytes passive: preformed antibodies in immune serum are introduced by injection (short lived lasting only 4-6 months)

Define naturally acquired active and passive immunity

active: antigens enter the body naturally; body induces antibodies and specialized lymphocytes passive: antibodies pass from mother to fetus via the placenta or to infant via the mothers milk (short lived lasting only 4-6 months)

What are some common causes of visual deficits?

age-related changes, refractive errors, orbital trauma, cataracts, glaucoma, diabetic or hypertensive retinopathy, macular degeneration, or loss of visual fields after a stroke

How does a nurse improve the quality of instruction? What does it mean to evaluate the entire nursing process?

allow clients to evaluate their own progress and determine future learning needs. direct observations of client performance are anecdotal, descriptive notes that make of the learners performance. clients can keep records of performance and results.

what is the large intestine?

also known as the colon, is larger in diameter than the small intestine but shorter in length. It extends from the ileum of the small intestine to the anus. The colon secretes mucus, which facilitates smooth passage of stool, and absorbs water, some vitamins, and minerals. Approximately 80% of the fluid that enters the colon is reabsorbed along its passage. Normal flora in the colon aid in the digestive process. These bacteria are responsible for producing vitamin K and several of the B vitamins.

nutrition-

an acute infection depletes the body's nutritional stores, therefore, it is important to monitor and support client nutrition, including protein, vitamins minerals, and water.

Describe aggressive communication

an aggressive approach is for the other to lose. The goal is to win and to be in control. "My way is the correct way. You don't know what you're talking about."

What is an episiotomy?

an intentional incision made by a provider of the skin between the vagina and anus during child birth

Why is it important for the nurse to consider stages of cognitive development in learners?

an understanding of intellectual development will help you to gear your teaching strategies and content to the level of the learner. EX: a young child may not have adequate fine motor skills to complete a skill such as tying shoes without assistance.

What is a laceration when it comes to child birth?

an unintentional break or tear in the skin between the vagina and anus

SWOT:

analysis plan to demonstrate your: Strengths, weaknesses, opportunities, and threats to becoming an effective leader and manager.

When does gestational diabetes occur?

around 20 weeks gestation

what is the relationship between arterial PO2 and SaO2 levels?

arterial PO2 is the partial pressure of oxygen in the arteries, together they indicate the degree to which the tissues are receiving oxygen

Most fatal home fires occur while people are _________, and most deaths result from __________ inhalation

asleep, Smoke inhalation

What are the benefits to the inter-professional team members when everyone speaks with assertive communication?

assertiveness recognizes your rights while respecting the rights of others. It allows you to take responsibility for your own thoughts and actions without blaming others, encourages feedback, and enables you to find mutually satisfying solutions to Conflict by confronting people constructively.

Nursing interventions for promoting safety in the healthcare facility focus on :

assessing for risk and creating a safe environment.

What awareness must the nurse have for effective culturally competent teaching?

awareness of norms, values, communication, social structure, time orientation, and cultural identification are important in planning teaching. If english is not the clients primary language, you may need to use an interpreter.

17) A client is admitted with suspected malignant melanoma on his left shoulder. During the physical assessment, the nurse would anticipate observing: a. A brown mole that has equal, symmetrical borders b. A brown or black mole with red, white, or blue areas c. Petechiae d. A flat, black mole that is less than 0.5cm in diameter

b. A brown or black mole with red, white, or blue areas Rationale: Melanomas have an irregular shape and lack uniformity in color. They may appear brown or black with red, white, or blue areas.

8) A nurse is administering a cold therapy application to a client. Which of the following manifestations should the nurse identify as an indication for discontinuing the application due to a systemic response? a. Reduced blood viscosity b. Shivering c. Numbness d. Hypotension

b. Shivering Rationale: Shivering is a systemic response to cold therapy as the body attempts to promote heat production. The other answers are incorrect. Cold application increases the blood's viscosity. Heat application reduces the blood's viscosity. Numbness is a localized response that results as a local anesthetic effect from cold therapy. Numbness is a localized response that results as a local anesthetic effect from cold therapy.

stage 1 Novice:

begins with the onset of your education. the novice nurse has little nursing experience and is the first stage of acquiring clinical knowledge. at this stage you are talk oriented and focus narrowly on "learning the rules."

how do Muscarinic receptor antagonists cause urinary retention?

block nerve receptors in the smooth muscle of the bladder. These medications control bladder contraction and reduce urinary frequency for people suffering from overactive bladder and urge incontinence.

What are Mongolian spots on a newborn?

bluish purple spots of pigmentation found on the shoulders, back and buttocks - common on dark skinned infants

What are some comfort measures you may try for engorgement?

breast binders ice packs fresh cabbage leaves mild analgesics

how do newborns defend themselves from sensory overload?

by exhibiting avoidance behaviors, such as crying, mottling, poor feeding and sleeping, and even yawning.

18) An 85-year-old female client who has spent a great deal of time outdoors tells the home health nurse that her skin is dry and itchy. What is the most important information for the nurse to give the client? a. "Soak in a bubble bath once a day." b. "Bathe with antimicrobial soap once per day." c. "Bathe with mild soap and water or with water only." d. "Scrub the skin vigorously to remove dead skin cells."

c. "Bathe with mild soap and water or with water only." Rationale: Bathing with mild soap and water or with water only can relieve skin itching and dryness. Bubble baths and antimicrobial soap can be very drying to an elderly person's sensitive skin. Scrubbing vigorously may worsen skin dryness.

The nurse is performing a head-to-toe physical assessment on a 65-year-old man with a 25-year history ofChronic Obstructive Pulmonary Disease (COPD). He states, "I smoke a pack of cigarettes a day andalways seem so short-of-breath!" What assessment data observed by the nurse would indicate he has had a long history of low oxygen levels (hypoxia)? a. Pitting edema in lower legs b. Multiple lesions distributed evenly across the skin of his abdomen c. Clubbing of the distal ends of his fingers on both hands d. Jaundice observed in his sclera and conjunctiva

c. Clubbing of the distal ends of his fingers on both hands Rationale: With a 25-year history of COPD and smoking one pack of cigarettes per day, this patient has a history of decreased oxygenation (chronic hypoxia) as evidenced, in part, by his current shortness of breath. In response to oxygen deprivation, the capillary beds in the fingertips become larger. Pitting edema, skin lesions and jaundice are not caused by chronic hypoxia.

3) When the nurse performs an integumentary assessment of an elderly patient, the nurse would expect to find: a Thin, transparent fingernails b. Thick, oily hair c. Decreased elasticity d. Warm, moist skin

c. Decreased elasticity Rationale: Elderly skin loses elasticity, the other changes vary between individuals.

4) Of the following factors, which would put a client at greatest risk for impaired skin integrity? a. The medication digoxin b. Moisture c. Decreased sensation d. Dehydration

c. Decreased sensation Rationale: Decreased sensation would greatly increase the risk for injury with a tear or break in the skin. This could lead to a delay in seeking treatment due to lack of awareness.

A nurse on the labor and delivery unit is caring for a newborn immediately following birth. Which of the following actions by the nurse reduces evaporative heat loss by the newborn? a. Placing the newborn on a warm surface b. Preventing air drafts c. Drying the newborn's skin thoroughly d. Maintaining ambient room temperature at 24 C (75 F)

c. Drying the newborn's skin thoroughly Rationale: Heat loss through evaporation occurs when moisture on the skin is converted to a vapor. This process is the most significant cause of heat loss in the first few days of life but is minimized by quickly and thoroughly drying the infant. Placing a newborn on a warm surface is heat conduction. Air drafts is an example of radiation. Room temperature is an example of convection.

15) A client is examined and found to have pinpoint, pink-to-purple, non-blanching lesions that are 1-3 mm in diameter. The nurse documents this assessment as: a. Ecchymosis b. Hematoma c. Petechiae d. Café-au-lait spots

c. Petechiae Rationale: Petechiae are small macular lesions 1-3 mm in diameter. Ecchymosis is a purple-to-brown bruise, macular or popular, and varied in size. A hematoma is a collection of blood from ruptured blood vessels more than 1 cm in diameter. Café-au-lait spots are light brown areas, usually benign, but can indicate neurofibromatosis.

10) During an examination of a 5-month-old infant, a flat, dull pink, macular lesion is noted on the infant's forehead. The nurse suspects which condition? a. Milia b. Mongolian spots c. Salmon Patch d. Capillary (strawberry) Hemangioma

c. Salmon Patch Rationale: Salmon patches are common vascular lesions in infants. They appear as flat, dull pink, macular lesion sin various regions of the face and head. When they appear on the nape of the neck, they're commonly called "stork bites." These lesions fade by the first year of life.

How does the nurse gather initial information about mental status and cognitive function?

can be gathered while doing other body system assessments

how does an antidepressant cause urinary retention?

can reduce stress incontinence by causing bladder muscles to relax. Some drugs work by stimulating the nerve that controls the urethral sphincter.

what are Loop-acting diuretics?

cause the kidneys to excrete more urine by reabsorbing less water. This reduces the amount of water in the body and lowers blood pressure.

How about teaching strategies for a patient who has hearing impairment?

check to make sure that it is working, the batteries are functional, and the sound is adjusted to a comfortable level. Encourage your client to wear her hearing aid as much as possible. A significant number of people with hearing impairment do not wear hearing aids. provide written instructions to ensure that she understands the teaching and instructions.

What are examples of a non stimulating, monotonous environment?

children in orphanages; people in prison; homebound disabled and older people; patients in nursing homes and other institutions; and hospitalized patients in isolation, seclusion, or private rooms.

Who are the nurse's learners?

clients, families, and others who care for the client. Also, NAP can become nurse's learners as well. EX: If you notice there is an error in the way they are doing blood pressure, you can correct them and show them the right way.

All inpatients should be assessed for their risk for falls. Pts. with prior fall risk are at high risk of falling will need _____________ ________________.

close monitoring

What is the communication continuum?

communication continuum' describes the array of possible channels we have at our disposal for communicating and collaborating with colleagues. i.e. Assertive and aggressive

mode of transmission

contact, either direct or indirect is the most frequent mode of transmission of infection. direct contact between two people usually involves touching, kissing, or sexual intercourse. animals commonly transmit infection via scratching and biting as well. Indirect contact involves contact with fomite- a contaminated object that transfers a pathogen. some types of fomite transmission include droplet transmission: infection travels in water droplets expelled from the patient- coughing, sneezing, talking etc. airborne transmission- microorganism that float considerable distances on air currents can pass infection.

How does botulism toxin cause urinary retention?

control spasms of overactive bladder by relaxing the muscles. It has FDA approval for use in overactive bladder related to nerve damage, such as with spinal cord injury or multiple sclerosis.

What cranial nerve is employed in hearing?

cranial nerve VIII

Breaks in the skin:

creates a portal of entry for infection

16) What is the most appropriate nursing diagnosis for a client with a reddened sacrum unrelieved by position change? a. Sedentary lifestyle b. Risk for impaired skin integrity c. Noncompliance d. Impaired skin integrity

d. Impaired skin integrity Rationale: This client has an actual- not potential- skin impairment. There isn't enough information to indicate a sedentary lifestyle or noncompliance.

7) A nurse is caring for a client who has meningitis, a temperature of 39.7° C (103.5° F), and is prescribed a hypothermia blanket. While using this therapy, the nurse should know that the client must carefully be observed for which of the following complications? a. Dehydration b. Seizures c. Burns d. Shivering

d. Shivering Rationale: The hypothermia blanket, if used improperly (at inappropriately low temperatures, or without skin protection), can cause the client to cool too fast, leading to shivering. To prevent heat loss from the skin, the body becomes peripherally vasoconstricted in an attempt to reduce heat loss. The body will also try to increase heat production by shivering, which can increase the metabolic rate by two to five times and in doing so greatly raise oxygen consumption.

12) A mother of a 4-month-old infant asks about the strawberry hemangioma on his cheek. What information should the nurse provide to the mother? a. The lesion will continue to grow for 3 years and then need surgical removal. b. If the lesion continues to enlarge, referral to a pediatric oncologist is warranted. c. Surgery is indicated before age 12 months if the diameter of the lesion is greater than 3 cm. d. The lesion will continue to grow until age 1 year and then begin to resolve by age 2-3 years.

d. The lesion will continue to grow until age 1 year and then begin to resolve by age 2-3 years. Rationale: These rapidly growing vascular lesions reach maximum growth by age 1 year. The growth period is then followed by an involution period of 6-12 months. Lesions show complete involution by age 2-3 years. These benign lesions don't need surgical or oncological referrals.

The nurse would monitor the body temperature most closely/frequently in the care of: a. The patient with an infection b. The patient who is an infant c. The patient who has experienced heat stroked. d. The patient with a head injury

d. The patient with a head injury Rationale: All of the patients depicted would need to have their temperatures monitored closely. However, a patient with a head injury may have damage to the hypothalamus and therefore loss of global thermoregulation. The temperature of this patient would need to be monitored more frequently than the other patients

what is qualitative research?

data consisting of words, documents, interviews, photos has limited number of participants no hypothesis done in natural setting uses subjective data

what is constipation? what causes it?

decrease in frequency of BMs. As the length of time between BMs increases, more water is reabsorbed from the feces. As a result, constipation is also associated with passage of dry, hard stool that requires more effort to pass.

When does sensory overload occur?

develops when either environmental or internal stimuli—or a combination of both— exceed a higher level than the patient's sensory system can effectively process

A mom is discouraged about the breastfeeding process. How would you promote breastfeeding to her?

education early and ongoing support and assistance with latch and supply offer group support and ways to connect with other breastfeeding mothers refer to outpatient lactation consultants, etc

groups at high risk for fluid imbalances? (10)

elderly infants - depression - burn patient - confused - fever - hyperventilation - diarrhea - disease process - medical treatments - pneumonia

how does documentation effect planning and evaluation?

enables physicians, nurses, and others to plan and evaluate treatment and monitor health status over time

How does nursing fit into the defining characteristics of a profession?

entry level nursing education require coursework in basic and social sciences as well as humanities, arts, and general education. nursing education and practice are increasingly based on research from nursing and related fields state or provincial regulatory bodies have defined the criteria that nurses must meet to practice , and they monitor members for adherence to standards. nursing is clearly focused on providing service to others the major professional organizations have developed ethical guidelines to guide the practice of nursing.

List nursing interventions to prevent suicide. (6)

evaluate the patient's medications it's risk factors are present, put them prominently on the care plan and report them to other caregivers. Do not avoid the patient because of fear of saying the wrong thing. Talking about suicide does not increase the risk. Be aware of your personal feelings and anxieties regarding suicide. If the patient mentioned suicide specifically, be direct. Ask whether he is having thoughts of harming himself. If he answers yes, do not leave him. Have someone contact his primary care provider So that a psychiatric consult can be ordered, and possibly transfer to a psychiatric unit if the patient is physically stable.

How does nursing fit into the defining characteristics of an occupation?

even though nurses are hourly wage earners, they function more autonomously than most occupations. however, nurses are still not in control of their practice environment, working conditions, and schedule.

what is hyperventilation?

fast, deep breaths that move large amounts of air through the lungs causing too much carbon dioxide removal from the lungs

What is tachypnea?

fast, shallow breathing, more than 24 breaths/min

What is secondary prevention?

focuses on identifying the disease early, when it is mild and implementing measures that can halt of slow disease progression- SCREENING! examples: mammograms, prostate exams, breast self exams

An authoritarian leader

gives the orders and makes decisions for the group as a whole. It can be effective because the outcome is usually high quality and high quantity. However, in this type of leadership style, there is not a lot of room for creativity.

How does a goal differ from a learning objective?

goals are broad in scope and set down what is expected as the final outcome of the teaching and learning process. Objectives are single, specific, on-dimensional behaviors that must be completed to accomplish the goal.

What are some key strategies in teaching adults and older adults? (See Table 19-2)

help them identify their own learning needs. explain why the information or new skill is important. be sure to include materials with practical tips and realistic goals for learning. Honor cultural backgrounds, local customs and practices, and personal preferences. Use take home materials (posters, table tents, and tip sheets)

how do Antispasmodics cause urinary retention?

help to relax the bladder and prevent urge incontinence. For example, propantheline bromide (Pro-Banthine) is prescribed to stop bladder muscle contractions (overactive bladder).

What are the effects of carbon dioxide levels on the nervous system?

high CO2 levels have an anesthetic effect on the nervous system and can lead to somnolence, come, and death (known as carbon dioxide narcosis) low CO2 levels have a stimulating effect on the nervous system and lead to muscle twitching or spams and numbness and tingling in the face and lips

what is hypercarbia?

high level of CO2 in the blood

The balance between heat production and heat loss is controlled by what? What does it recognize, sent by what?

hypothalamus. It recognizes small changes in body temperature that are sent to it by sensory receptors in the skin

immunizations-

immunizations via vaccination can protect against several infectious diseases.

From what do sensory deficits stem?

impaired reception, perception, or both.

Which of the six sensory deficits are nurses most likely to confront in practice?

impaired vision and hearing are the ones you are most likely to encounter in nursing practice.

What are some other causes of taste deficits?

include the common cold infections of the nose sinuses, mouth, or salivary glands; smoking; vitamin B12 or zinc deficiency; dental fillings and inlays; dementia; injury to the mouth, nose, or head.

Cognitive learning

includes memorization, recall, comprehension, and ability to analyze, synthesize, apply, and evaluate ideas. EX: A client is able to report the names and doses of the three medications he is taking.

what can you recommend to assist a client with constipation?

increase high fiber foods, fluid intake increase activity provide privacy offer laxatives whens lifestyle changes are ineffective

What is diarrhea?

increase in the frequency of BMs. As transit time through the colon decreases, less water is reabsorbed and stools are often watery.

Environmental factors:

increased exposure to pathogens in one's work situation (teachers, health care workers) living situation ( nursing, parents of children in preschool etc,)

Risk factors for STI's (4)

increases if a person has unprotected sex or sex with more than one partner. Alcohol and drug use Sharing needles Noncompliance with the STI treatment regimen

What is Community (herd) immunity?

indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not

List the six links in the chain of infection

infectious agent reservoir portal of exit mode of transmission portal of entry susceptible

what is nursing informatics?

informatics applied to nursing practice, education, and research

what happened to inhaled air in the airways? how does it occur?

inhaled air is moistened, warmed, and filtered. moistened by mucous membrane warmed by blood flowing through the vascular airway filtered by cells secreting sticky mucus and cilia sweeping trapped debris out of the airway

__________________ are major cause of death among individuals of all ages in the united states and Canada

injuries

how do you assess perineal area?

inspect skin color, condition, texture, turgor, and presence of urine or stool. Clients who have urine leakage or a urinary catheter are at risk for perineal skin problems. Ammonia in the urine may result in skin excoriation, skin breakdown, and subsequent infection. If both urine and stool are present on the skin, the likelihood of skin breakdown.

what is the treatment for type 1 diabetes?

insulin injections to control blood glucose levels balanced with food intake and lifestyle behaviors to reduce complications

how does documentation effect communication?

interdisciplinary teams use the health record to communicate about patients status and care and allows them to plan and evaluate treatment and monitor health status over time.

Define clinical judgment What 4 factors can the nurse use to determine whether change has occurred in the client?

involves careful consideration of the client's health status in light of what is expected based on the client's condition, medications, and treatment. Observing Comparing Contrasting Evaluating

Teaching is an interactive process with activities that meet intended outcomes. What is learning?

is a change in behavior, knowledge, skills, or attitudes. It occurs as a result of planned or spontaneous occurring situations, events, or exposures.

What is Cephalhematoma?

is a collection of blood between the periosteum and the skull bone that it covers, but does not cross the suture line. Typically results from pressure of fetal head against maternal pelvis, or forceps delivery.

problem solving:

is a process by which nurses consider an issue and attempt to find a satisfactory solution to achieve the best outcomes.

critical thinking:

is a reflective thinking process that involves collecting information, analyzing the adequacy and accuracy of the information. nd carefully considering options for action.

reservoir

is a source of infection: a place where pathogens survive and multiply. the human body is the most common reservoir for pathogens, but surfaces, contaminated water, dirt etc can also be reservoirs. . some individuals can also be reservoirs even if they have no symptoms. these individuals are called carriers. some factors that affect the quality of the reservoir: nutrient availability moisture availability temperature oxygen pH and electrolytes- lights- microbes grow best in the dark

hygiene -

is crucial for maintaining intact skin, a primary defense. encourage frequent handwashing as well as regular showering or bathing, to decrease the bacterial count on the skin.

A laissez-faire leadership style

is more of a "sit back and watch" approach. They will not intervene unless goals have not been met or a problem arises. Most people in this group get frustrated and confused with the lack of guidance or direction from this kind of leader. There are a few in this group who may be mature and actually thrive with this leadership style.

Right context:

is the environment quiet, free of distractions, and private? is the environment soothing or stimulating, depending on the desired effect?

what is the duodenum?

is the first section of the small intestine. It is a C-shaped tube that branches off from the stomach, about 30 to 60 cm (1 to 2 ft) long. The duodenum processes chyme by mixing it and adding enzymes. The bile duct and main pancreatic duct both enter the small intestine at the level of the duodenum.

what is an ongoing catheter, and why is it used?

is used for continuous bladder drainage (e.g., when the bladder must be kept empty or when continuous urine measurement is needed). It is usually a double-lumen tube: one lumen is used for urine drainage, and the second lumen is used to inflate a balloon near the tip of the catheter. A triple- lumen indwelling catheter is used when the patient requires intermittent or continuous bladder irrigation.

how does estrogen cause urinary retention?

is used to improve the blood flow to the urethral tissues and increase thickness of mucosal and urethral tissues. Estrogen is not FDA-approved for treatment of stress incontinence, although may be prescribed for other reasons.

how does wheezing affect oxygenation?

it is a sign of airway obstruction that is caused by things like

how does dyspnea affect oxygenation?

it is an increased effort to breath, when this occurs there is not enough oxygen in the lungs

how does orthopnena affect oxygenation?

it is shortness of breath when laying down, this is because of an increase of pressure in the blood vessels of your lungs requiring more oxygen intake

What level of stimuli is needed to maintain arousal?

it varies: Some people feel optimally alert in bright, noisy, fast-paced environments, whereas others prefer much lower levels of stimulation. The brain adapts to constant stimuli, such as a ticking clock. Thus, to maintain arousal, some variation in stimuli is required, such as different pieces of music or an ever changing view.

What is the ileum?

joins the small and large intestine. It is responsible for absorption of fats; bile salts; and some vitamins, minerals, and water. However, nutrients are absorbed mainly in the duodenum and jejunum.

Where interstitial fluid is found

lies in the spaces between the body cells

the genitourinary tract-

like the respiratory tree, the genitourinary tract is protected with mucous membranes. the epithelial cells lining the urethra and anus secrete mucus, which adheres to pathogens to promother there excretion through urine and stool. urine itself is highly acidic and contains lysozyme. mucous membranes lining the vagina also help keep pathogens from from establishing colonies there in addition to the vagina's normally high acidty.

What is caput succedaneum?

localized swelling of the soft tissues of the scalp caused by pressure on the head during birth, or by vacuum extraction during birth. Bruising is often seen on these areas

what is hypoxemia?

low level of oxygen in the blood

what is hypocarbia?

low levels of CO2 in the blood

Chronic disease:

many chronic diseases diminish the body's ability to fight infection. diseases that impair peripheral circulation, such as uncontrolled hypertension (high blood pressure) and diabetes mellitus. poor circulation prevents antibodies and t cells from reaching the pathogens and damaged tissue, making it easier for pathogens and damages from

What are some causes of hearing deficits? What area of the brain is closely associated with hearing?

may result from injury or disease in structures of the ear, the nerves, or the brain. The auditory area in the brain is located in the temporal lobes

What are some reasons a nurse might adopt a non-assertive communication style?

men and women tend to communicate differently. The same is true when communicating with persons of higher or lower status. When speaking to Physicians, some nurses still communicate their needs in the style that assures the physicians that they are not telling them what to do. this has been referred to as the "doctor-nurse game".

ranges for: metabolic acidosis metabolic alkalosis respiratory acidosis respiratory alkalosis

metabolic acidosis: ↓pH, normal PCO2, ↓HCo3 metabolic alkalosis:↑ pH, normal PCO2,↑ HCo3 respiratory acidosis:↓pH, ↑PCO2, normal HCo3 respiratory alkalosis:↑pH,↓PCO2, normal HCo3

What is the jejunum?

middle section of the small intestine

What is one of the most common causes of impaired taste? What causes this?

most commonly results from xerostomia (excessively dry mouth) which may be caused by medications, decreased saliva production, in-adequate fluid intake, poor nutrition, or poor oral hygiene.

Benefits to EHR What makes it more accessible?

multiple people from different locations can access a patients chart at the same time

Major function of phosphate

nerves muscle acid base balance

portal of entry

normal body openings such as the conjunctiva, vagina, or mouth are potential portals of entry, as are cuts or wounds.

Will all of a nurse's teaching be remembered? What is necessary for information to be memorable?

not all teaching will be remembered, and that is normal. repetition, reinforcement, and practice are necessary for retention; and so is information made memorable

ANA:

nurses are responsible for promoting and protecting health, safety, and rights of patients. Patient teaching is essential in fulfilling that responsibility.

clinical judgement:

observing, comparing, contrasting, and evaluating the client's condition to determine whether change has occurred. It also involves careful consideration of the client's health status in light of what is expected based on the client's condition, medications, and treatment.

What cranial nerve is associated with the sense of smell?

olfactory nerve (cranial nerve I)

A democratic leadership,

on the other hand, is where the leader and the group make decisions as a whole. It may not be as effective, but it does tend to foster more creativity and motivation. Group output tends to be of high quality.

All other at risk infants are screened by _________ ___________ , or when signs/symptoms of hypoglycemia observed.

one to TWO hours of age

What is the onset, peak, and duration of rapid acting insulin?

onset within 10-30 minutes peak 30-90 mins duration 1.5-5 hours

what is the onset, peak, and duration of intermediate acting insulin?

onset- 1-2 hours peak- 4-12 hours duration- 18-24 hours

What is the onset, peak, and duration of short acting insulin?

onset- 30-60 minutes peak- 2-5 hours duration- 5-8 hours

what is the onset, peak, and duration of Long-acting insulin?

onset-1-1.5 hours peak-none duration- 20-24hours

List four risk factors for healthcare-related infections. Use your best judgment here. Think about what brings individuals into a healthcare setting, what they may have done to them, and who/what they come into contact with.

open wound/surgical site medically implanted devices contact with infected individuals indwelling catheter poor hand hygiene

what does a pulse oximetry reading tell you?

oxygen saturation levels

what are normal pH, HCo3, and PCO2 levels?

pH: 7.35-7.45 HCo3: 21-28 PCO2: 35-45

What is type 2 diabetes mellitus?

pancreas produces defective insulin unable to serve needs of the body

infectious agent

pathogens are microorganisms that are capable of causing disease the largest groups of pathogenic microorganisms are: bacteria viruses fungi Less common: helminths protozoa prions

What are the major patient care concerns associated with bowel incontinence?

patient embarrassment anxiety social isolation lowered self-concept In addition, clients with bowel incontinence are at risk for skin breakdown.

The environment includes the _________ and ____________factors that contribute to the life and well-being of each person. It may be identified as any setting where the nurse and client interact.

physical and psychosocial

What is erytema toxicum

pink rash that appears suddenly anywhere on the body of a term infant during the first 3 weeks; commonly known as newborn rash.

Discuss two broad ways to prevent sensory deprivation:

providing stimulation supporting the patient's ability to perceive and interpret stimuli

Usual protocol for vital signs, fundus, bleeding assessments for RN

q15" x4 > q30" x2 > q1' x2

Illness or injury:

recuperation from infection or injury limits the physical resources available to combat a new pathogen.

back pain How can women prevent this?

regular exercise, pelvic tilt exercises, proper body mechanics & side lying position.

sensory perceptual abilities of infants

require sensory stimulation to grow and develop normally. Tactile stimulation through cuddling, feeding, and soothing creates a bond between infant and caregivers, provides comfort and pleasure, and teaches the infant about the external environment. Exposure to voices, music, and ambient noise develops the auditory nervous system. By 1 year of age, the child can discriminate between different sounds and often recognizes the source. Lights, colors, and contrast allow the infant to observe the world in which she lives.

what does the RACE stand for? (fire safety)

rescue, alarm, contain, extinguish

exercise and activity-

research tells us that exercise is just as important as rest and sleep. too little activity causes circulation to slow and the lungs to supply less oxygen.

What is Omaha?

researched based, comprehensive, standardized taxonomy across the care continuum for all patients

what are other forms of telehealth? (4)

rural healthcare home health monitoring compensating for shortage of healthcare providers emergency care triage

What are clinical practice guidelines?

satements developed by systematic review of evidence and an assessment of the benefits and harms of care options

Recommended Blood Glucose Screening Intervals for infant diabetes mellitus (IDM) or large for gestational (LGA) age ≥ 37 weeks

screen glucometer AC or q3 hours for 12 hours from birth

Recommended Blood Glucose Screening Intervals for infant w/diabetic mother (IDM) or large for gestational (LGA) age ≥ 37 weeks

screen glucometer AC or q3 hours for 12 hours from birth

Recommended Blood Glucose Screening Intervals:Late Pre-term infants 34-36 6/7 weeks and term SGA?

screen glucometer AC or q3 hours for 24 hours from birth

Group Discussion

several participants discuss topics, exchanging info and presenting their points of view. Effective group discussion requires an atmosphere of trust that encourages everyone to participate. Openness to new ideas and confidentiality of the content expressed are essential for participation.

How long does involution take?

should occur within two weeks. Occurs with contractions of the uterine smooth muscle, whereby the uterus returns to its pre-pregnant state

List the six primary defenses against infection

skin the respiratory tree eyes the mouth the gastrointestinal tract the genitourinary tract

how do neurological disorders alter sensory functions (multiple sclerosis)?

slow the transmission of nerve impulses.

what is hypoventilation?

slow, shallow breaths that move only a small amount of air into and out of the lungs

Tobacco use:

smoking is a major risk factor for pulmonary infections. smoking interferes with normal respiratory functioning, including the ability to move the chest, cough, sneeze or have full air exchange. chemicals in tobacco paralyze cilia;thus secretions pooling in the lower airways creating a favorable environment for bacterial growth.

Medications:

some medications are given for the purpose if suppressing the immune response, for example to patients receiving organ or tissue transplants. for most patients, however, decrease immunity is an unwanted side effect of treatment. even common medications such as NSAIDS decrease immune response. even antibiotics can cause infections by killing the normal harmless flora and allowing harmful microbes to survive(yeast infection) these types of infections are known as superinfections

Describe how stress can impact a patient's need for more stimulation or reduced stimulation.

stress provides sensory stimulation at a time when the person may have been experiencing deprivation. However, stress can cause too much stimulation. Physical illness, pain, hospitalization, tests, and surgery are all stressors that can lead to sensory overload— more stimuli than the person can handle.

what does surfactant do for alveoli?

surfactant is a lipoprotein that lowers the surface tension within the alveoli to allow them to inflate during breathing

What tastes can be detected by the taste buds? Where are these tastes located on the tongue?

sweet, sour, salty, and bitter. A proposed fifth taste bud, glutamate, can detect savory flavors. buds for sweet and salty tastes are primarily on the tip of the tongue for sour taste, on the two lateral sides of the tongue for bitter taste, primarily on the posterior tongue and the soft palate

Ferning testing

taking amniotic fluid on a microscope slide with the appearance of ferns.

List measures to employ to reduce sensory overload in vision

teach patients to provide their own stimulation by counting, singing, reading, playing video games, social networking, or reciting poetry.

What might a nurse suggest to a patient to try to reduce sensory deprivation?

teach patients to provide their own stimulation by counting, singing, reading, playing video games, social networking, or reciting poetry.

Nursing interventions for promoting safety in the home focus on client ___________.

teaching

What happens without sufficient stimuli?

the CNS becomes lethargic, and the person may lose consciousness.

What is two-point discrimination?

the ability to perceive as distinct two close but separate points pressed against the skin.

eyes-

the lacrimal glands produce tears that contain lysozyme, an antimicrobial enzyme. this means that tears help the body wash infective organisms from the eyes.

what is ventilation?

the movement of air into and out of the lungs through the act of breathing

what is Glomerular filtration?

the movement of substances from the blood within the glomerulus into the capsular space

What is tubular reabsorption?

the movement of substances from the tubular fluid back into the blood

the respiratory tree-

the nares, trachea, and bronchi are covered with mucous membranes that trap pathogens, which are then expelled. the nose contains hairs that filter the upper airway; and the nasal passages, sinuses, trachea, and larger bronchi are lined with cilia, tiny hairlike cells that sweep tiny microorganisms upward from the lower airways.

How does culture impact sensory-perceptual status?

the nature, type, and amount of interaction and stimulation that people feel comfortable with

Multiple sexual partners:

the number of sexual partners is directly related to the risk of sexually transmitted infections and cancer

What is Latch?

the placement of the infant's mouth over the nipple, areola, and breast, making a seal between the mouth and breast to create adequate suction for milk extraction

stage 4 Proficient:

the proficient nurse is able to quickly take in all aspects of a situation and immediately give meaning to the cluster of assessment data, and serves as a resource to less experienced nurses. Proficient nurses see the "big picture"

What is involution?

the return of the uterus to a non pregnant state after birth

incubation-

the stage between successful invasion of the pathogen into the body and the first appearance of symptoms. in this stage the person is not aware of infection but is capable of infecting others.

decline-

the stage during which the patient's immune defense along with any medical therapies successfully reduce the number of pathogenic microbes

illness-

the stage marked by the appearance of the signs and symptoms characteristic of the disease.

What are retractions and why are they of concern?

the sucking in of the skin around the bones, and in the chest indicate respiratory distress

skin-

the surface of intact, healthy skin is tough and resilient and prevents entry of many pathogens. the normal flora of the skin inhibit multiplication of other organisms, including pathogens that land on the skin

Explain how the teaching process mimics the nursing process.

the teaching process is very similar to the nursing process because nurses are constantly teaching patients about why they are doing things and how. This helps ease clients anxiety and be at a better understanding of what and why things are happening to them.

Followership -

the willingness to work with others toward accomplishing the group mission. Also refers to those who show a high degree of teamwork and build cohesion among the group.

How do central nervous system abnormalities affect ventilation and oxygenation?

they interfere with the regulation of breathing or by limiting gas exchange

Who is at the greatest risk for postpartum depression(PPD)?

those who have a history of anxiety or depressive mood disorders, including episodes of PPD. Young age, unintended pregnancy, family history, etc.

what is the purpose of mechanical ventilation?

to assist a patient in breathing

How does nursing fit into the defining characteristics of a discipline?

to be considered a discipline a profession must have a domain of knowledge that has both theoretical and practical boundaries. it is a scientifically based and self-governed profession that focuses on the ethical care of others it is a discipline, driven by aspects of theory and practice it demands mastery of both theoretical knowledge and clinical skill

why is oxygen humidified?

to prevent drying of the airway mucosa and to keep secretions thin

Why are newborns given erythromycin?

to prevent infection of the eyes in the newborn, specifically against neisseria gonorrhoeae (gonorrhea)

why would a patient need a chest tube?

to release built up fluid around the lungs

Why do you think it is important for a nurse to know about the components of the sensory experience?

to understand that patients may have a negative experience with something so they will turn away at the sign of something that caused them harm before (injections)

sensory perceptual abilities of newborns

track objects and respond to light, but their vision is far less acute than that of older children and adults. Their hearing is especially acute at low frequencies. can discriminate between different tastes, and they prefer sweet over sour. They react to odors and seem to be able to discriminate between the smell of their own mother's breast milk and that of another woman. The face, hands, and soles of the feet are the most sensitive. newborns are easily overstimulated by the loud noises, bright light, high contrast objects, and sensitive areas (back and bottom of feet), particularly when more than one sense is involved.

What is the impact of playing the doctor-nurse game?

unclear and indirect communication contributes to errors and to poor patient outcomes. "This is what I think is the problem is but if you do not agree then we can go with your thoughts if that is what you want"

________ is irritating to the skin. Therefore, perineal cleansing is an integral part of toileting hygiene.

urine

what are Thiazide diuretics used for?

used to treat high blood pressure by reducing the amount of sodium and water in the body. They also dilate blood vessels, thereby lowering blood pressure.

What is standardized nursing language?

using the same term to describe a clinical condition in all EHRs

sensory perceptual abilities in childhood

visual acuity improves; full depth perception is achieved during the preschool period. Hearing is usually fully developed in young children; however, they may experience reversible hearing loss as a result of frequent ear infections and cerumen impaction. In contrast to toddlers, who often lose their balance when walking, older children are sure and steady on their feet.

What is the glomerular filtration rate?

volume of filtrate formed per minute by both kidneys

Body temp values for severe hypothermia Describe the signs of severe hypothermia (3) When does death result

when body temp drops below 82.4°F (28°C) Person becomes unconscious Stops shivering. Pulse and respirations are irregular and difficult to detect. Death usually results when the body temp falls below 70°F - 75°F (21°C - 24°C)

A human's response to a stimulus is based on what factors?

when they are alert and receptive to stimulation. For example, a fatigued new mother may wake up to the soft cry of her infant yet sleep through the persistent ringing of the doorbell.

stress reduction-

whether physical or mental, stress decreases the body's immune defenses. numerous studies demonstrate a correlation between increased stress and increased disease.

Benefits of EHR how does it maintain privacy?

with the use of HIPAA and HITECH

Can a defense mechanism be overused?

yes Overused defense mechanisms can be maladaptive and lead to psychological disorders such as phobias, Obsessive Compulsive Disorders or dissociative disorders.

Developmental stage:

young children are vulnerable because their immune systems are immature and have had limited exposure to pathogens. children frequently begin to have more infection when they start interacting with people outside their family (eg. daycare or school) . older adults are also susceptible hosts because their immune response declines with aging. skin, a primary defense becomes less elastic and more prone to breakdown with aging