Module 1 and 2 patient centered care.

Atrophy

(n.) the wasting away of a body organ or tissue; any progressive decline or failure; (v.) to waste away

Hypertension symptoms

-Typically asymptomatic -Headache- uncommon but occurs in the back of the head and person wakes up with it. -Other symptoms relate to target organ damage: -Brain- CVA -Kidneys- loss of ability to concentrate urine -Heart- Heart failure, CAD, sudden death -Circulatory- peripheral vascular disease

Pain

-algia, -dynia

What is patch testing?

-allergy testing -small amount of substance placed on skin in shallow cups ("Finn chambers")--> papular vesicular reaction within 48-72 hours

High blood pressure Stage 1 hypertension

140/80-89

Stage 2 hypertension

140/90 or higher

Hypertensive crisis measurements

180/120 or higher

Why might a 2 year old develop lead poisoning?

2 years explore by putting things in their mouth which could contain lead dust particles.

How high should a mechanical lift be raised during transfer?

3-4 inches to clear the mattress.

Serum albumin

3.5-5.5 g/dL. It's a protein made by the liver.

What muscle strength would the nurse record for a patient with full ROM with resistance?

4 is with slight resistance. 5 is full strength. 0 no contraction 1 visible contraction but no movement. 2 limb movement but not against gravity. 3 movement against gravity not resistance.

Friction

A force that opposes motion between two surfaces that are in contact

Third degree burn

A full-thickness burns that involve the epidermis, dermis, and varying levels of the subcutaneous and underlying structures. Fatty white or brown color, dry leathery texture. Little to no pain.

Second degree burn

A partial-thickness burn involving the epidermis and the dermis. Red, moist with blisters.

What kind of wound involves the epidermis and dermis but not the subcutaneous layer?

A partial-thickness wound.

Hypertensive crisis

A severe elevation in blood pressure (greater than 180/120 mm Hg) that can cause damage to organs such as the kidneys or heart.

What is a chronic wound?

A wound that fails to progress to healing in a timely manner, often remaining open for an extended period of time

What is a closed wound? Open wound?

A wound that has no breaks in the skin surface, while an open wound would.

What is an acute wound

A wound that progresses through the phases of wound healing in a rapid, uncomplicated manner

What is the pneumonic for early malginant melanoma screening.

ABCDE Or Assymetry Border that is irregular. Color that is uneven Diameter that is usually as large as a pea Evolving or changing over time.

What is a partially movable joint called?

Amphiarthrosis joint

Suspected deep tissue pressure injury

An area of intact skin that is purple or maroon or a blood-filled blister

What effect can low potassium have on the heart?

Cardiac dysrhythmia

Wound cultures

Cultures identify the organisms causing infection. Because some bacteria are present on healthy skin, normal skin flora may be identified in wound cultures along with any pathogenic bacteria.

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

DASH diet acronym

Dietary Approaches to Stop Hypertension.

Lipids

Energy-rich organic compounds, such as fats, oils, and waxes that can be measured in the blood.

Whats the term for a total seperation of tissue layers allowing visceral organs to protrude through the incision.

Evisceration

Friction vs shear

Friction: when one object moves against another Shear: when one object moves but a part of them doesn't

stage 4 pressure ulcer

Full-thickness tissue loss with exposed bone, muscle, or tendon

FIM scale

Functional independent measurement scale. For example 1 is total dependence. 2 is Max 25% 3. Is mod 50% 4. Min /CHA 75% 5. Sup/SBA No contact. 6. Mod independent. 7. Independent

African Americans are at higher risk for what?

Increased risk of strokes, heart disease and kidney disease.

What is the initial phase of healing in which bleeding is reduced as the blood vessels constrict in the area?

Inflammatory stage.

The nurse recognizes that which advisory bodies aim to improve the quality, safety, efficiency, and effectiveness of health care? Select all that apply. One, some, or all responses may be correct.

Institute of medicine. National quality forumn. National center for nursing quality. Association for healthcare research/quality. Organizations that do not are the joint comission and centers for medicare.

Ischemia

Lack of blood supply

Adjuvant medications

Medications that are not primarily indicated for treatment of pain, but are used to augment pain relief medications

primary osteoarthritis

Most common form of arthritis, aging phenomenon, oligoarticular, 80-95% of people over 65 years -> more often in females, obesity, hereditary, secondary (trauma, neuromuscular dysfunction, metabolic disorders) -> hips in men, knees in women -> knees, hips, first metatarsal of foot and hands, lumbar and cervical vertebrae -> DIPs (Heberden's) and PIPs (Bouchard's) -> when it happens in fingers most often in women it is genetic

What change in an older patient would warrant teaching isometric exercises?

Muscular atrophy.

What is an approximated wound?

One that is closed with the wounds edges touching each other.

OLD CARTS

Onset Location Duration Characteristics Aggravating and Alleviating Factors Related Symptoms Treatment Severity

Breakthrough pain

Pain that occurs between doses of pain medication

Somatic pain

Pain that originates from skeletal muscles, ligaments, or joints.

Malignant hypertension treatment

Place patient in fowler position. Administer O2. Administer IV Beta blocker. Monitor BP Q15 minutes. until diastolic >90.

What is one safety measure that you might implement for a toddler?

Placing window guards on all windows. You would want to insure safety in the home environment first.

FDA pregnancy safety categories

Pregnancy Male reproductive potential Female reproductive potential Lactation.

What is granulation

Process of wound healing where new red tissue develops made up of blood vessels.

malignant hypertension

Rapidly progressive hypertension Diastolic pressure is usually >140 mm Hg Life-threatening organ damage

What is transmission?

Second phase of nociception where pain impulse moves from the spinal cord to the brain

Wound healing where edges can't be easily approximated and wound fills with granulation

Secondary intention

What are the primary labs to look for with tissue integrity?

Serum albumin, prealbumin levels.

first degree burn

Superficial burns through only the epidermis. Redness, dry mild blister.

What kind of wound involes just the epidermis?

Superficial wounds.

Opioid analgesics

Synthetic pain-relieving substances that were originally derived from the opium poppy, Naturally occurring opium derivatives are called opiates.

Systolic/diastolic bp

Systolic is the highest pressure on walls while diastolic is lowest.

What does a full thickness wound entail?

The dermis, epidermis and subcutaneous layer are all penetrated with bone and muscle possibly being involved.

Footdrop

The foot falls down at the ankle; permanent plantar flexion

What factor in neonates might contribute to drug toxicity?

The liver having not fully developed. The liver is responsible for ridding the body of toxic substances and filtering the blood.

What is the third phase of wound healing?

The maturation phase in which scar tissue forms.

What is the proliferative phase?

The phase in which the defect is repaired and new tissue begins filling in the skin begins to resurface.

Range of motion

The range through which a joint can be moved

Procedure in which a physician removes a sample of living tissue from the wound to identify infection

Tissue biopsy

Peripheral vascular disease

Vascular disease affecting blood vessels outside of the heart and especially those vessels supplying the extremities.

What interventin might a nurse use for a patient with decreased bone density

Weight bearing exercises.

Uses black light to identify presence of infectious organisms and proteins.

Wood lamps

Is it possible for laxatives to have an impact on drug therapy?

Yes it is, they can decrease the absorption of other drugs in the body.

secondary osteoarthritis

a degenerative condition superimposed on or preexisting joint problem like a congenital hip dislocations or trauma

Patient-controlled analgesia (PCA)

a drug delivery system that uses a computerized pump with a button the patient can press to deliver a dose of an analgesic through an intravenous catheter

Titration

a measured amount of a solution of unknown concentration is added to a known volume of a second solution until the reaction between them is just complete

Tunnel (sinus tract)

a narrower passageway extending outward from the edge of the wound

Physical dependence

a physiological need for a drug, marked by unpleasant withdrawal symptoms when the drug is discontinued

Visceral pain

a poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera

Prealbumin

a thyroxin-binding protein measured to evaluate the nutrition status of critically ill patients who are at high risk for malnutrition. 15-36 m/gl.

What's a fistula?

abnormal connection between two organs or between an organ and the body surface.

arteriosclerosis

abnormal hardening of the walls of an artery or arteries

Isotonic exercise

activity that combines muscle contraction with repeated movement

ABC's of nursing

airway, breathing, circulation

What is a synarthrosis joint?

an immovable joint

Nonopioid analgesics

analgesics that are not classified as opioids like NSAIDS and acetaminophen.

sanguineous drainage

bloody drainage

Bruit

blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

Rheumatoid arthritis (RA)

chronic joint condition with inflammation and pain; caused by an autoimmune reaction against joint tissue, particularly the synovial membrane

Serous drainage

clear, watery plasma

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

Subcutaneous layer

connective and adipose tissue layer just under the dermis. Delivers blood to dermis.

What is transduction

conversion of one form of energy into another. In sensation, the transforming of stimulus energies, such as sights, sounds, and smells, into neural impulses our brain can interpret

Fourth degree burns

destroy all layers of skin and involve tendons, muscles, and sometimes bones. Dry charred, painless, brown color.

What is a freely movable joint?

diarthrosis joint.

Cellulitis

diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling

Analgesic

drug that relieves pain

Essential hypertension

elevated blood pressure of unknown cause that develops for no apparent reason; sometimes called primary hypertension

Chronic pain

episode of pain that lasts for 3 months or longer; may be intermittent or continuous

Undermining

erosion of tissue from underneath intact skin at wound edge

hyperlipdemia

excessive amounts of lipids in the blood

Isometric exercise

exercise in which muscle tension occurs without a significant change in muscle length

Contracture

fibrosis of connective tissue in the skin, fascia, muscle, or joint capsule that prevents normal mobility of the related tissue or joint

stage 3 pressure ulcer

full thickness tissue loss with visible fat

Secondary hypertension

high blood pressure caused by the effects of another disease

First aid for burns

immediate attention,cool water, clean dressing, elevate burn site above the heart to keep from swelling, treat for shock. Do not attempt to remove clothing where skin has been burned away. With third and fourth go to emergency room.

Spinal cord stimulation

implantation of a device into the epidural space to treat chronic neurologic pain by producing a tingling sensation that alters pain perception

Dash diet directives.

increase fruit, vegetables, and low fat dairy; k, mg, ca

Osteoarthritis

inflammation of the bone and joint

Pressure injuries

injuries or wounds that result from skin deterioration and shearing

Stage 1 pressure ulcer

intact skin with nonblanchable redness

Anaerobic exercise

intense short bursts of activity in which the muscles work so hard that they produce energy without using oxygen

Normal blood pressure

less than 120/80

Pain tolerance

level of pain a person is willing to accept

Disuse osteoporosis

loss of bone mass due to lack of activity

Flaccidity

loss of muscle tone, limp

Gait

manner of walking

Patient-controlled analgesia

medications administered intravenously by means of a special infusion pump controlled by the patient within order ranges written by the physician

Logrolling

method of moving a person as a unit, without disturbing the alignment of the body.

Serosanguineous drainage

mixture of serum and red blood cells

Multi-modal

more than two modes

Nocioceptive pain

normal process, sensing a noxious stimuli, perceiving as pain

Radiating pain

pain felt at the site of tissue damage and in nearby areas

Psychogenic pain

pain for which no physical cause can be identified

Neuropathic pain

pain from damage to neurons of either the peripheral or central nervous system

What is modulation

pain message is inhibited during this last phase of nociception

Phantom pain

pain or discomfort felt in an amputated limb

Nociceptors

pain receptors

Referred pain

pain that is felt in a location other than where the pain originates

Acute pain

pain that is felt suddenly from injury, disease, trauma, or surgery. Will be short term, less than 3 months.

Hemiplegia

paralysis of one side of the body

Dehiscence

partial or total separation of wound layers

stage 2 pressure ulcer

partial thickness skin loss involving epidermis, dermis, or both

Nociception

perception of pain

Albumin

protein in blood; maintains the proper amount of water in the blood

Serum Electrolytes

reported as mEq by Liter; most of the K in the body is inside the cells and its concentration is 3.5-5.0; the heart muscle is paticularly sensitive to high or low levels of potassium; abnormal levels can produce cardiac arrest; Sodium is 135-145

Maceration

softening of tissue by soaking

Placebo

something which has a positive mental effect, but no physical effect

Aerobic exercise

sustained exercise that increases heart and lung fitness; may also alleviate depression and anxiety

Elevated blood pressure

systolic: 120-129 diastolic: less than 80

Pain threshold

the point at which a person feels pain

What is perception?

the process of organizing and interpreting sensory information, enabling us to recognize meaningful objects and events

Active range of motion

the process whereby a patient puts a joint through its full extent of movement

Drug tolerance

the tendency for larger doses of a drug to be required over time to achieve the same effect

Passive range of motion

therapist putting a patient's joints through available range of motion without assistance from the patient

Necrosis

tissue death

What are the four physiologic processes?

transduction, perception, transmission, and modulation of pain.

Pott disease

tuberculosis of the spine

Transcutaneous electrical nerve stimulation (tens unit)

uses a device that delivers electrical impulses through the skin, which cause changes in muscles

Hemiparesis

weakness on one side of the body

What is tertiary intention

when a delay occurs between injury and closure

What is pertussis?

whooping cough caused by Bordetella pertussis. Contact precautions are droplet based.

WHat is primary intention

wounds that heal under conditions of minimal tissue loss