Monday's test

Dissociation

Painful events or situations are separated or dissociated from the conscious mind. Patients will often say, "I had an out-of-body experience" or "it happened to someone else, but it was as though it happened to me." Overuse can lead to: One of the dissociative disorders, such as multiple personality disorder

Required data for a verbal telephone order:

Patient's first and last name Date order received Time order received What needs to be done When it should be done Indication whether order is a: Telephone order (T.O.) Verbal order (V.O.) Provide the following information: Your name and credentials Name of health-care provider giving the order Documentation that the order was read back to the prescriber for verification and validation

Pulmonary edema

Pink and frothy, or bubbly, sputum is indicative of fluid and blood mixed together and is seen in a life-threatening condition

Intimate personal space

Ranging from physical contact to 18 inches

Intellectualization

Separates self from uncomfortable emotions by focusing on facts and logic. When her husband dies, the wife relieves her pain by saying, "It's better this way because he was suffering so much." Overuse can lead to: Allows facts and logic to take the place of feeling emotions over time.Similar to Mr. Spock on Star Trek.

Reaction formation (overcompensation)

Similar to compensation, except the person usually develops the exact opposite trait Overuse can lead to: Failure to resolve internal conflicts

The Pleura

The chest cavity is lined with a thin membrane that also covers each lung, similar to a sac within a sac.

Sublimation

Unacceptable traits or characteristics are diverted into acceptable traits or characteristics. Overuse can lead to: The "socially accepted" behavior might actually reinforce the negative tendencies, and the person may still show signs of the undesirable behavior or trait.

Denial

Unconscious refusal to see reality.Usually the first defense learned and used.Is not consciously lying. Overuse can lead to: Repression, dissociative disorders

Avoidance

Unconsciously staying away from events or situations that might open feelings of aggression or anxiety Overuse can lead to: May become socially isolated

Rationalization

Use of a logical-sounding excuse to cover up true thoughts and feelings The most frequently used defense mechanism Overuse can lead to: Self-deception

Chest x-ray

Used to visualize lung fields; air appears dark so it can be determined if all lobes are filling with air. Fluid, dense tissue, and infiltrate appear white.Used to determine lung filling and size of cardiac silhouette, as well as to identify tumors, pneumonia, infiltrate, and effusions.

"Readiness for enhanced knowledge," with descriptors

Used when the patient has some basic knowledge about the illness and is ready for further teaching.

"Deficient knowledge," with descriptors:

Used when the patient is lacking knowledge about the disease process or management of the disease, including diagnostic testing, medications, and treatment.

hypoxemia

When oxygen levels in the blood drop below normal range

Dyspnea

When the patient is having difficulty moving air in and out of the lungs, it is referred to as dyspnea

dependency phase

a person relies on others for help in diagnosis and treatment

When carbon dioxide increases above normal amounts, it causes the blood to become more

acidic

External respiration occurs between the

alveoli and the capillaries

Internal respiration occurs between the

bloodstream and the body cells

connotative meaning

emotional associations attached to a word

The parietal lobes contain

general sensory areas where sensations such as touch are felt and interpreted

ISBARR

introduction, situation, background, assessment, recommendation, read back

Receptive aphasia (Wernicke's aphasia)

is a deficit in auditory comprehension or in receiving information. The patient can hear but cannot understand what is said, may be slow to respond, or may understand only a portion of what is said.

Global aphasia (expressive and receptive)

is a deficit of planning, production, and comprehension of language. Patients with global aphasia can speak and understand only a few words.

Expressive aphasia (Broca's aphasia)

is a disturbance in speech planning and speech production. Persons with expressive aphasia cannot produce fluent speech. Their speech has been described as "halting.

endotracheal tube

is a firm but flexible plastic tube that may be inserted through the nose or the mouth

stress

is identified as a nonspecific response of the body to any demand made on it.

Adaptation

is the ability to positively adjust to changes that occur in an individual's world.

Aphasia

is the inability to speak or understand language.

Directive interview

is used when time is limited or during an emergency

dennotative meaning

literal meaning

exhalation, also known as expiration.

muscles relax, again in response to nerve stimulus, the size of the chest cavity decreases. The ribs come inward, the diaphragm rises upward, and the lungs are then compressed, forcing the air to go out.

The left temporal and parietal lobes hold

speech areas that are involved in thoughts that precede speech

The respiratory center is in the

the medulla, located in the brainstem.

The normal respiration pathway is through the

the nostrils into the pharynx, into the trachea, and then to either the right or the left bronchus, which branches into the bronchioles that terminate into the alveoli.

Deep within the cerebral hemispheres, gray matter called the basal ganglia regulates

the use of accessory movements, such as gestures, when communicating.

non directive interview

to explore thoughts and feelings

Close ended questions

to obtain specific data, such as a health history

You need to assist the patient to turn, cough, and deep breathe every ______ hours to help prevent hypostatic pneumonia.

two hrs

The occipital lobes contain

visual areas that receive impulses from the eyes that allow us to "see" and interpret what is being seen

recovery phase

when the person is slowly able to resume independence and regain his or her health

public space distance

12 feet if possible

casual personal space

18 inches to 4 feet

HCO3 normal range

22-26

PaCO2 Normal Range

35-45 mm Hg

social consultative space

4 to 12 feet

pH Normal Range

7.35-7.45 Significance of Levels Above Normal Alkalosis Significance of Levels Below Normal Acidosis

PaO2 Normal Range

80-100 mm Hg

SaO2

95%-99%

SaO2 normal range (blood oxygen saturation)

95%-99% Hyperventilation or excess supplemental oxygen Hypoxemia and hypoxia

Identification

A person takes on the ideas or personality traits of someone that he or she fears or respects. Overuse can lead to: Assumes mannerisms, wears clothing, and arranges hair and appearance to match those of the other person.

Early Signs and Symptoms of Hypoxia

Agitation Anxiety Changes in level of consciousness Disorientation Headache Irritability Restlessness Tachypnea

Causes of Hypoxia and Hypoxemia

Airway obstruction due to a tumor, choking on a foreign body, thick mucus, or swollen airways Anemia Atelectasis (collapsed lung) Chronic lung disease Decreased cardiac output High altitude Hypoventilation due to anesthetics, sedatives, or coma Poor peripheral circulation Pulmonary embolus

Repression (stuffing)

An unconscious "burying" or "forgetting" mechanism Excludes or withholds from our consciousness events or situations that are unbearable; a step deeper than "denial" Overuse can lead to: Flashbacks, posttraumatic stress disorder, amnesia

Conversion reaction

Anxiety is channeled into physical symptoms. (Note: Often, the symptoms disappear soon after the threat is over.) Overuse can lead to: Anxiety not dealt with can lead to actual physical disorders, such as gastric ulcers, and possibly some cancers.

symptomatic phase

As observable symptoms develop

prodromal phase

Before a person develops symptoms of a specific illness, he or she may simply "not feel good," with generalized body aches and fatigue

Projection (scapegoating)

Blaming othersA mental or verbal "finger-pointing" at another for the problem Overuse can lead to: Finds faults in everything and everyoneFails to learn to take personal responsibilityMay develop into delusional tendencies

Late signs and symptoms of hypoxia

Bradycardia Cardiac dysrhythmias Cyanosis Decreased respiratory rate (bradypnea) Retractions

The left frontal lobe contains

Broca's motor speech area

Assessing Respiratory Status

Color of skin and mucous membranes Respiratory effort Cough Chest appearance Oxygenation status Oxygen saturation

DESC method

Describe, Explain, State, Consequences

Isolation

Emotion that is separated from the original feeling. Overuse can lead to: Avoids dealing with true feeling Can increase stress

Regression

Emotionally returning to an earlier time in life when there was far less stress Commonly seen in patients while hospitalized (Note: Everyone does not go back to the same developmental age. This is highly individualized.) Overuse can lead to: May interfere with perception of reality May interfere with progression and development of personality

hypoxia

In the event of hypoxemia, the blood cannot take adequate amounts of oxygen to the tissues during internal respiration, causing hypoxia

Venturi mask

Liter Flow 24%-80% Contains a plastic valve between the tubing from the oxygen source and the mask, which allows a precise mix of room air and oxygen to equal a specific percentage of oxygen. The dial on the valve (or interchangeable adapter) indicates the liter flow to use to equal a specific percentage of oxygen. This gives more exact control of inspired oxygen, especially for patients with COPD. The physician orders percentage of oxygen, not liter flow. You must check the dial or adapter to determine the liter flow necessary to equal the oxygen percentage and set the flowmeter accordingly.

Nasal cannula

Liter flow 1-6 L/min A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils. Apply correctly. Nasal prongs curve inward when inserted into the nares, and tubing slips over the ears. The slider fits under the chin

Simple face mask

Liter flow 1-6 L/min Delivers oxygen directly to the nose and mouth; patient may breathe through nose or mouth; flow rate less than 5 L/min will cause carbon dioxide to accumulate in the mask. May cause patient to feel claustrophobic and hot; elastic straps hold mask in place and may irritate skin above the ears, causing pressure. Pad with gauze 4×4s if needed.

T-piece

Liter flow 4-10 L/min Attaches to the flange of the tracheostomy; oxygen flows from one side of the T-piece to the trachea. During exhalation, air exits through the open end of the T-piece. Keep the connection to the tracheostomy intact, being careful not to allow tension on it to pull out the inner cannula.

Tracheostomy collar

Liter flow 4-10 L/min Delivers highly humidified oxygen through large tubing; rests over the tracheostomy with an elastic band that goes around the neck and can be tightened at the sides. Due to high humidity, condensation builds up in the large tubing. Be cautious when turning or moving the patient so that pooled water does not migrate into the tracheostomy and cause choking.

Partial rebreathing mask

Liter flow 6-15 L/min Mask with bag attached that traps carbon dioxide for rebreathing to lower pH levels; ports on the side of the mask allow most exhaled air to discharge. When used correctly, rebreathing bag will not collapse during inhalation; if collapse occurs, increase flow rate according to prescriber's orders.

Nonrebreathing mask

Liter flow 6-15 L/min Prevents the patient from rebreathing any exhaled air; it escapes through a one-way valve that does not allow room air to enter. The bag traps oxygen as a reservoir for inhalation; only delivery device that can provide 100% oxygen when set at 15 L/min. When used correctly, rebreathing bag will not collapse during inhalation; it should remain at least half full. If it does not, increase the oxygen flow rate according to prescriber's orders.

Face tent

Liter flow 8-12 L/min Used for patients who feel claustrophobic with other masks because the top is open; allows for high amounts of humidity to be used due to open top. Oxygen delivery is not as precise, so it is important to assess oxygen saturation and signs and symptoms of hypoxia in your patient using this device.

Restitution (undoing)

Making amends for a behavior one thinks is unacceptable Making an attempt at reducing guilt Overuse can lead to: May send double messages. Relieves the "doer" of the responsibility of being honest in the situation

Compensation

Making up for something we perceive as an inadequacy by developing some other desirable trait Overuse can lead to: Use of drugs or alcohol to feel confident in social situations

Peak flow

Measures the amount of air that can be exhaled with force using a peak flowmeter. Used to determine dosage and frequency of some respiratory medications. Can be used by patient to monitor the effectiveness of medications.

Minimization

Not acknowledging or accepting the significance of one's own behavior, making it seem less important. Overuse can lead to: No motivation to change behavior, so it can become more unhealthy or antisocial with no consequences.

seeking help phase

The phase of illness in which an individual seeks help from a medical professional. In some cultures, an individual may seek help from a healer or other alternative practitioner.

parietal pleura

The portion of the pleura that lines the chest cavity

inhalation, also known as inspiration.

The pressure within the lungs then drops below atmospheric pressure, or becomes negative pressure. This causes a sort of vacuum; air is pulled into the lungs until the pressure in the lungs equals the pressure outside the body.

Poor Health

This occurs when both health and environment are not favorable.

High-Level Wellness

This occurs when both the environment and health are favorable.

Protected Poor Health

This occurs when the environment is favorable but health is not.

Emergent High-Level Wellness

This occurs when the environment is not favorable, but health is favorable.

Pulmonary function tests

To determine lung capacity, volume, and flow rates. Used to diagnose obstructive or restrictive lung diseases such as COPD and asthma.

Tuberculin skin test

To determine reaction to presence of tuberculin bacillus in skin layers.If skin over and around injection site elevates and indurates (gets hard) with or without redness, the result is positive. This indicates past exposure to the disease or current disease. Must be followed up with chest x-ray for confirmation. False positives are caused by the malaria vaccine given in many African countries.

Bronchoscopy

To visualize trachea and bronchii; to obtain biopsies of abnormal tissue; and to obtain samples of lung cells, fluids, and other material inside the air sacs. Used to diagnose lung conditions such as interstitial disease, infection, airway blockage and cancer; also used to dilate narrowed airways.

Displacement (transference)

Transferring anger and hostility to another person or object that is perceived to be less powerful: the "kick-the-dog syndrome" Overuse can lead to: Loss of friends and relationships Confusion in communication