NSG 117 Final Exam Review

What is included in medication safety, what are the 7 rights of med admin, what needs to be included in a drug order?

7 rights of drug administration Rght patient, drug, time, dose, route, reason, documentation Rights for a drug order, needed for a drug to be ordered to be given All orders must include: Patient's name, Date Name of the drug, Dose of the drug, Route of the drug, Frequency of administration, Any special instructions (i.e. hold if HR <60) If ordered PRN (as needed) a reason must be give (i.e. give PRN for fever)

If a patient is immobile or has low mobility what other nursing diagnosis do they most likely have?, what are some of the ways you can diagnose?

A patient who is experiencing an alteration in mobility often has one or more nursing diagnoses, 2 diagnosis most directly related to mobility problems are impaired mobility, and risk for disuse syndrome- imobile patient at risk for multisystem problems because of inactivity. The diagnosis of impaired mobility applies to the patient that has some limitation but is not completely immobile. The diagonsis of risk for dissue syndrome applies to the patient who is immoblie and at risk for multisystem problems because of inactivity. Other potential diagnoses are: Imparied airway clearance, Impaired sleep Risk for impaired skin integrity/ imparied skin integrity Risk for constipation Social isolation Ways to diagnoses/tests=Radiographic tests X-ray MRI CT scans Bone scan Bone mineral density Myelogram Arthrography Other diagnostic tests Arthroscopy Electromyography Blood tests Analysis of joint fluids Pathologic analysis of biopsied tissue

What is included in the assessment of wounds?

Always through the patient's eyes Continually assess skin for signs of breakdown and/or ulcer development. monitor bony prominences/pressure points wound appearance character of wound drainage Drains (serous, serosanginous, sanginous, pruluent wound closures palpation of wound would cultures psychosocial factors (embarrassment ect) for pressure ulcers, preform predictive measures, mobility status, nutrition status, body fluids, pain level/location,

Describe BMI limits and what its based on

Based on height and weight 15- severely underweight- anorexia Less than 19- underweight 19-24.9 optimal body weight composition, elderly person should strive for BMI greater than 21 25-29.9- Overweight- may be appropriate depending on health status 30-34.9- class 1 obesity- slow weight loss advised to promote permanent weight loss, not appropriate for older populations to lose weight 35-35.9- class 2 obesity- slow weight loss advised- may be a candidate for bariatric surgery if comorbidities present and not able to achieve long-term weight loss through diet and exercise. Greater than 40- class 3 obesity- extreme obesity- formerly known as morbid obesity, may be a candidate for bariatric surgery based on health status, age and level of obesity and history of not being able to achieve long term weight loss through diet and exercise

What does benefice mean?

Beneficence is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as "actions guided by compassion.

What are the internal and external variables when it comes to health and wellness?

Internal variables Developmental stage Intellectual background Perception of functioning Emotional factors Spiritual factors External variables Health belief Family role and practices Social determinants of health

What are nursing sensitive outcomes?

Outcomes that are directly influenced by nursing practice Care delivery outcomes are the observable or measurable effects of health care interventions Although it is important to research the effects of nursing care on nurse sensitive indicators, some researchers choose outcomes that do not measure a direct effect of nursing care, such as length of stay, mortality, quality of life, and patient satisfaction. Researchers need to select appropriate outcomes when designing their studies. For example if a nurse researcher intends to measure the success of a nurse initiated protocol to manage blood glucose levels, they will not look at mortality, they will obtain the blood glucose level of paties placed on the protocl and compate them to desired range that represents good blood glucose control

What does veracity mean?

Veracity is defined as being honest and telling the truth and is related to the principle of autonomy. It is the basis of the trust relationship established between a patient and a health care provider.

What is fragmented sleep?

Waking up once or twice briefly during the night is normal. interrupted sleep/fragmented sleep is when you wake up for prolonged periods at least four times over the course of about eight hours.

What does autonomy mean?

recognizing each individual patient's right to self-determination and decision-making. As patient advocates, it is imperative that nurses ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions.

What is impaired mobility, what can happen to body as a result of this?

the inability to move about freely, immobility, can impact limb, skin, whole body system, due to broken bones, or bed ridden.- disrupts metabolic processes, constipation, decreases metabolic rate, urinary output and V.S can be impacted (decreases) Paralysis/vegetative state=risk for skin breakdown/pressure ulcer development

What are the three domains of learning?

3 domains include Cognitive, Affective, Psychomotor\ Cognitive- (understanding) education intended to increase a patient's knowledge of a subject, for example, using methods such as written material, lecture, and discussion. Affective- (attitudes) education intended to change attitudes, such as viewing the lifestyle modifications associated with the treatment of coronary artery disease as a positive change rather than a burden. Psychomotor- (requires that the patient have opportunities to touch and manipulate equipment and practice skills. Appropriate teaching methods based on domain learning: Cognitive- discussions (one or group), involve a nurse and one patient or a nurse w/several patients, promotes active participation and focuses on topics of interest to patients, allows peer support, enhances application and analysis of new info. (Lecture- is a more formal method of instruction because it is educator controlled, helps learners acquire new knowledge and gain comprehension.) (Question & answer session- addresses patient's specific concerns, helps patient apply knowledge.) ( Role play/discovery- allows the patient to actively apply knowledge in controlled situations, promotes synthesis of info and problem solving.) (Independent project, computer assisted instruction, field experience- allows patients to assume responsibility for completing learning activities at their own pace, promotes analysis, synthesis, and evaluation of new info and skills.) Affective- role play- allows expression of values, feelings, and attitudes, Discussion (groups)- allows patient to receive support from other in a group, helps patient learn from other's experiences, promotes responding-valuing, and organization, discussion (one/one)- allows discussion of personal, sensitive topics of interest or concern. Psychomotor- DEMONSTRATION- provides presentation of procedures, or skills of the nurse, permits patient to incorporate modeling of nurse's behavior, allows nurse to control questioning during demonstration, Practice- gives patient opportunity to perform skills using equipment in a controlled setting, provides repetition, RETURN DEMONSTRATION- permits patient to perform skills as nurse observes, provides excellent source of feedback and reinforcement, assists in determining patient's ability to correctly perform a skill or technique, Independent projects/games- requires teaching method that promotes adaptation and origination of psychomotor learning, permits learner to use new ski

What is included in the diagnosis portion of the nursing process, what is included and not included in an at risk diagnosis and a real diagnosis, how do you know if the diagnosis is correctly written give example.

A clinical judgment is made by a nurse to describe a patient's response or vulnerability to health conditions or life events that a nurse is licensed and competent to treat. NEVER MEDICAL DIAGNOSIS Use NANDA approved nursing diagnoses 3 part diagnosis- actual problem PES format, problem, etiology (cause, can be known or unknown) (related to) supporting signs/symptoms (defining characteristics in nursing diagnosis textbook) At-risk diagnosis (2 parts)- doesn't have any signs or symptoms, only has problem and etiology/cause/r/t. Correct nursing diagnosis- impaired mobility R/T acute pain, AEB: pain rated a 7 on a pain scale of 0-10, limits movement of the right leg At-risk diagnosis- Risk for impaired skin integrity R/T surgery incision site/open wound.

What does SBAR mean, what does each letter stand for?

A communication tool used between health care workers (nurses during a shift chnge) S- what is happening at the current time, this is where you state your name, title, where you are, and a BRIEF description of what is going on with the patient (code status might help) B- What are the circumstances leadin up to this situation? Who is our patient, why did they come in, what is their dagnosis, labs, v.s, medications list, med allergies A- What does the nurse think the problem is? Give conclusions about the situation. Using "might be" or "could be" are helpful, no diagnosis is necessary, describe changes from past labs, v.s, mentation/physical changes R- What should we do to correct the problem? give a recommendation, when do you want doctor to come up to see patient, change meds, change interventions, change time between v.s being taken ect.

What are the different steps in the nursing process?

ADPIE Assessment Diagnosis Planning Implementation Evaluation

What is ANA code of ethics,

ANA code of ethics promotes ethical decision making by setting standards for collaborative interprofessional communication. Code of ethics-Nursing code of ethics is a statement of philosophical ideals of right and wrong that define the principles that you will use to provide care to your patients. Also incorporate your own values, ethics into your practice Set of guiding principles that all members of a profession accept Collective statement about the groups expectations and the standards of behavior. Created by american Nurses Association-ANA, 1950 Describes the nurses obligation to the patient, the role of the nurse as a member of the health care team, and the duties of the nurse to the profession and to society. Key principles in the code include advocacy, responsibility, accountability, and confidentiality.

What are the seections in a reasearch study?

Abstract- brief summary that quickly tells you if the article is research or clinically based. Sumarrized the purpose of the article. Includes the major themes or findings of the article, also includes the manor themes or findings and the implications for nursing practice Introduction- contains more info about the purpose of the article. Brief supporting evidence as to why the topic is important. Together the abstract and intro help you decide if you want to continue to read , relate article to you PICOT question closely? Literature review/background- detailed background of the level of science or clinical info about the topic. Offers an argument about what led the author to conduct the study or report on a clinical topic. This is very valuable, build your knowledge even if article doesnt fit your PICOT question. Manuscript narrative- the "middle section" or narrative, differs based on the type of EB article it is (included in this is purpose statement, methods/design, analysis, results/conclusions, and clinical implication) Purpose statement- explains the focus of intent of a study. It includes the hypotheses/ relationship between variables Methods or designs- explains how a research study was organized and conducted to answer the research question or test the hypothesis. Explains the type of study that was conducted. (RCT, case control, qualitative) Analysis- explains how the data collected in a study are analyzed. Statistical results from study are explained Results or conclusions- what happened in the study, what was the outcome, explains the data and answers their research question. Clinical Implications- explains whether the findings from the study have clinical implications. Explains the generalizability or how to apply findings in a practice setting for the type of subjects studied. (how to apply this research to real life patients)

Describe the health promotion for specific culture groups, what does a nurse have to do?

Accept a patient's cultural background and belief system and be prepared to offer culturally sensitive approaches in a patient's native language Be careful not to generalize or steretype patients soley on the basis of their culture Collaborate w/pther nurses and educators to develp appropriate teaching approaches and ask people from their cultural group to help by shaing their values and beliefs. Ethic nurses are excellent resources-provide input through their experiences to improve the care provided to members of their own communities. Be aware of cultural differences, conflicts and values

In nursing care, what is advocacy and what does it entail?

Advocacy- refers to the application of one's skills and knowledge for the benefit of another person. As a nurse, you advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment.

What is included in fire safety, what does PASS and RACE stand for, what is included in electrical safety?

Always keep the phone number for reporting fires visible on the telephone Know the fire drill and evacuation plan of the agency. Know the locations of all fire alarms, exits, extinguishers, and oxygen shut offs in your work area. PASS- pull pin, aim at base, squeeze, sweep from side to side (how to use fire extinguisher) RACE- Rescue and remove all patients in immediate danger, Activate the alarm, always do this before attempting to extinguish even a minor fire, Confine the fire by closing doors and windows and turning off oxygen and electrical equipment, Extinguish the fire with an appropriate extinguisher. Make sure oxygen is grounded, teach patient about safety around oxygen (supplemental oxygen poses a serious fire risk) Electrical safety- make sure everything is up to date and isn't shorting out, have maintenance check.

explain anorexia and bulimia

Anorexia nervosa- one of a group of psychiatric conditions associated w/a fear of weight gain and distortion of body image, characterized by an avoidance of food consumption often combined with excess exercise w/the intent to lose weight. Untreated, patients experience extreme weight loss and muscle wasting, representing a condition of insufficient nutrition, most common among adolescents- females, but is seen in both genders and can occur in childhood and adulthood Bulimia Nervosa- Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time), feeling a lack of control over eating behavior during eating binges, recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, use of laxatives or diuretics, strict dieting, or fasting, or vigorous exercise, binge eating and inappropriate compensatory behavior that both occur, on average, at least once a week for 3 months, self-evaluation unduly influenced by body shape and weight.

Describe the nursing process for skin

Assessment- through the patient's eyes, continually assess skin for signs of breakdown and/or ulcer development, monitor bony prominences/pressure points, wound appearance, character of wound drainage, drains, wound closures, palpation of wound, would cultures, psychosocial factors (embarasment ect), for pressure ulcers, preform predictive measures, mobility status, nutrition status, body fluids, pain level/location, Diagnosis- nursing diagnoses associated with impaired skin integrity and wounds: Impaired skin integrity, risk for impaired skin integrity, risk for infection, acute or chronic pain, impaired mobility, impaited peripheral tissue perfusion (especially in diabetics) Planning- Plan interventions according to risk for pressure ulcers, type and severity of the wound, presence of compilation, setting priorities include preventing pressure ulcers from developing and promoting wound healing, must include teamwork and collaboration with wound techs. Implementing- Includes health promotion- preventing of pressure ulcers, topical skin care and incontinence management, protective positioning, support surfaces, as well as in acute care the management of pressure ulcers-wound management (debridement, protection, education, nutritional status), first aid for wounds, cleaning, protecting, dressings (using the correct dressings, changing dressings, packing a wound, securing dressings), heat and cold therapies (choice of moist or dry, warm, moist compresses, warm soaks, sitz baths, commercial hot and cold packs, cold, moist, and dry compresses, cold soaks, ice bags or collars. Evaluating- Through the patient's eyes- include the patient and caregiver in the evaluation process, patient outcomes- individualize nursing interventions for what worked/helped improve wound healing and change those that didn't seem to help this particular patient, includes an ongoing evaluations, and a validated risk-assessment tool.

What is included in caring communication?

Caring touch Provides comfort Creates a connection Non-contact touch- refers to eye contact Contact touch- obvious skin to skin contact and is referred to as "therapeutic touch" Task-oriented touch- used when performing a task or procedure- skillful and gentle performance of a nursing procedure conveys security and a sense of competence.- when doing procedure explain everything before and during-puts the client at ease. •Caring touch- form of non-verbal communication, which successfully influences a patient's comfort and security, enhances self-esteem, increases confidence of caregivers, and improves mental well-being. This is expressed in the way you hold a patient's hand, give a back massage, gently position a patient, or participate in a conversation, you connect with the patient physically and emotionally. •Protective touch- A form of touch that protects a nurse/ and or the patient- Holding/bracing a patient to prevent falling, or a nurse distancing themselves from the patient to avoid suffering. Patients can look at this in both a good and bad way. Because touch conveys many messages, use it with discretion. Be aware of cultural preferences, and situations where touch isn't acceptable. Listening- Necessary for meaningful interactions with patients. True listening leads to knowing and responding to what really matters to a patient and family. To listen effectively you need to silence yourself and listen with an open mind. Through active listening, you begin to truly know your patients and what is important to them. Give patient your full attention while they tell their story-very important A therapeutic skill that includes interpreting, understanding, and respecting what a patient or family caregiver is saying an expressing that understanding and respect.

How do you promote sleep in a hospitalized patient?

Cluster care allow most amount of sleep- ICU patients- hooked up to monitors to closely watch vitals instead of waking up each hour. Close curtains between patients in semi private rooms Dim the lights on the hospital nursing unit at night Reduce noise- conduct conversations and reports in a private area away from patient rooms and to keep necessary conversations to a minimum, especially at night Provide patients with ear plugs or eye masks to decrease noise and light stimulation. Closet doors to patients rooms when possible, keep doors to the work area on units closed when in use. Wear rubber soled shoes, avoid clogs Turn of equipment not in use Turn down alarms and bee[son bedside monitoring equipment Turn off tv. Radio unless patient prefers soft music Avoid abrupt noise- flushing a toilet, moving a bed Give patients a bath/clean themselve, back rub, cold bath for sweating Relieve irritating tape/ replace loose, reposition for comfort, give meds if possible during the waking hours. Perform activities together/cluster care- at least 2-3 hours of uninterrupted sleep. Promote stress reduction, guided imagery, relaxation techniques

What is hypovolemia and what causes it, what happens to the body once it has this, what should the nurse do?

Conditions such as shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume also known as hypovolemia Decreased circulating blood volume (hypovolemia) results in hypoxia to body tissues. With significant fluid loss, the body tries to adapt by peripheral vasoconstriction and by increasing the heart rate to increase the volume of blood returned to the heart, thus increasing the cardiac output. Can be caused by dehydration, put the patient in trendelenburg position, give fluid bolus of normal saline.

What is urinary incontience, what are some complication, and what are some preventions?

Defined as the complaint of any involuntary loss of urine Significant problem for older adults who experience problems w/ mobility or the dexterity to manage their clothing and toileting behavior Physiological, psychological conditions, and diagnostic or treatment-induced factors can all affect normal urinary elimination. Knowing these factors can help you anticipate possible elimination problems and intervene when problems develop. Complications- skin breakdown, UTI/infections, impacts on social life-psychological impact Preventions- Maintain a healthy weight., Practice pelvic floor exercises. Avoid bladder irritants, such as caffeine, alcohol and acidic foods. Eat more fiber, which can prevent constipation, a cause of urinary incontinence. Don't smoke, or seek help to quit if you're a smoker.

What is included in delegation regarding a patient who is immobile?

Delegate turning q2 hrs. The skills of pressure injury risk assessment cannot be delegated to assistive personnel. They can keep the Pt skin dry, provide hygiene after incontinence or exposure of skin to wound drainage. report any changes in the Pt skin such as redness, break in the Pt skin. They can report any redness or abrasions from medical devices. They can pressure redistribution mattress, bed or chair cushions as needed, and position aids.Ccant delegate Evaluation, Assessment and teaching.

What is included in the evaluation phase of the nursing process?

Determines whether a patient's condition or well-being improved after nursing interventions were delivered Critical to knowing a patient's health status Evaluate interventions and outcomes in the areas of health promotion, prevention of illness and injury, and alleviation of suffering. Ongoing process that includes a before-and-after comparison or an after comparison with an established standard Continuously examine results by gathering subjective and objective data from a patient, family, and health care team members. Compare clinical data, patient behavior measures, and patient self-report measures collected before implementation with the evaluation findings gathered after administering nursing care. Evaluate whether the results of care match the expected outcomes and goals set for a patient. Use evaluative measures: (inspect color, condition, measure diameter ect) If goals were not met, figure out how to improve, change intervention, or stop entirely.

Describe the Braden Scale and what it is used for

Developed on the basis of risk factors for pressure ulcers. Has 6 subscales: Sensory perception, moisture, activity, mobility, nutrition, and friction/shear. A total score ranged from 6-23. Lower score indicates a higher risk for pressure ulcers Anything above 18 is considered precautionary level.

What is sleep apnea, explain the different types, what are some s/s and how do you treat?

Disorder in which an individual is unable to breath and sleep at the same time. Lack of airflow through the nose and mouth for periods from 10 seconds to 1-2 minutes in length. 3 types of sleep apnea, obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed Obstructive sleep apnea- cessation or stopping of airflow despite the effort to breath. Occurs when muscle or soft structure of the oral cavity or throat relax during sleep, the upper airway becomes partially or completely blocked, nasal airflow diminished (hypopnea), or stops (apnea).Structural abnormalities such as a deviated septum, nasal polyps, narrow lower jaw, or enlarged tonsils= predisposed to OSA. Obesity, hypertension, smoking, heart failure, alcohol, nasopharyngeal structural abnormalities, large neck circumference, and menopause are increased risks for OSA. May be a link between OSA and occupations where people inhale solvents. The person tries to breathe because chest and abdominal movements continue, which often results in loud snoring sounds. When breathing is partially or completely diminished-must awaken to breathe. Central sleep apnea- involves dysfunction in the respiratory control center of the brain. The impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease. Oxygen saturation of blood fals-common in pt's w/brainstem injury, stroke, obesity, muscular dystrophy, and encephalitis.Tend to wake up during night-complain of insomnia-mild intermittent snoring is present Mixed sleep apnea- Mixed apnea is an apnea that begins as a central apnea and ends as an obstructive apnea Common symptoms of OSA- fatigue, morning headaches, irritability, depression, difficulty concentrating, decrease in sex drive Untreated sleep apnea increases- risk of hypertension, diabetes, heart disease, heart failure, Treat w/lifestyle changes- lose weight, use Bilevel positive airway pressure (BiPAP), and continuous positive airway pressure (CPAP), surgery, and oral repositioning devices for the jaw and tongue.

What is evidence based practice, and what is the highest level of it?

Evidence based practice- is a problem solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinicians' expertise, patient preferences, and values, and available health care resources in making decisions about patient care. Highest level of EBP evidence- systemative review or meta-analysis of randomized controlled trials (RCT). Evidence based clinical practice guidlnes based on systematic review

Explain what fat soluble and water soluble vitamins and what can happen in the body if there is a deficency

Fat soluble A, D, E, K Stored in the fatty compartments of the body- longer period of time-toxicity Acquired through dietary intake, Vit D-sun Hypervitaminosis- when someone has a mediados intentional or not of vitamins- toxicity A- eyes, vision, skeletal muscles/soft tissue development strength, carrots, orange foods, eggs, fish. Deficiencies= visual issues, dry swollen conjunctiva D- bones, absorb calcium + phosphorus, sunshine, milk, fish, eggs. Deficiency= rickets- bone loss, bowed out legs, muscle pain, falls E- antioxidant, protects cells from damage, fat containing food-good fat- nuts, oils, avocados, dark leafy greens. Deficiency= balance issues. K-clotting, antidote for coumadin, dark green veggies, eggs. Deficiency= bleeding/ excessive Water-soluble vitamins- 1103 PP Pee it out C and B complex- 8 vitamins Body doesn't store these, and need them provided in our daily food intake-absorbed into the GI tract. C- needed for tissue building, metabolism, iron absorption (scurvy- vitamin C low) B-metabolism, gives us energy, Low B1- Thyme, Beri Beri-a disease causing inflammation of the nerves and heart failure Low B2- Kyphosis, cracking inside mouth, swollen, smooth tongue Low B12- anemia, pins and needles, yellowing of skin, intrinsic factor absorbs b12, most common in middle eastern pop (pernicious anemia) + vegans.

What is the prioritization with oxygenation?

First thing you do is raise the HOB Then put patient in orthopneic position Sit em up/pull em up Admin oxyen- has to be prescribed by doctor, can neg impact person w/copd-brain stops telling them to breathe Remember the A, B C's- airway, breathing, circulation

What is included in the assessment portion of the nursing process, what are some cultural considerations, what do you need to take into account with elderly people, what are some interview techniques, what is the data collection process/phases of helping relationship?

Gather info about patient condition, collect a comprehensive set of data about a patient, and recognize/identify patterns that begin to reflect the meaning of a patient's response to health problems. Patient-centered view Data sources- patient, family/caregivers, health care team, medical records, scientific literature, nurses experience, Includes health hx, Biographical information, chief concern or reason for seeking care, patient expectations, present illness or health concerns, past health history/past hospitalizations. family history, psychosocial history, spiritual health, review of systems, observation of patient behavior, diagnostic and laboratory data Cultural considerations Involves self-awareness, reflective practice, and knowledge of a patient's core cultural background Adapt each assessment to the uniqueness of each patient Cultural humility requires you to recognize your own knowledge limitations and cultural perspective and thus be open to new perspectives. Show patients respect and understand their individual needs/differences Don't impose your own attitudes, biases, or beliefs Avoid stereotyping and assumptions tied to stereotypes=can lead to collection on inaccurate information Ask questions in a constructive way and probing way to allow you to truly know who a patient is. Elderly considerations Listen patiently, older adults are a rich source of wisdom and experience Allow for pauses and give patients time to tell their story Recognize normal changes associated w/aging, older adults symptoms are often mutated or less obvious, vague, or nonspecific compared to younger adults Some patients may not report symptoms because they attribute them to old age or they think nothing can be done for them Patient w/limited hearing or a visual impairment, use nonverbal communication when conducting your interview. Maintain eye contact w/patient Affirmative head-nodding regulates an interaction, supports spoken language, and allows for comments on the interaction. Smiling-positive sign that indicated good humor, warmth, and immediacy, help when first establishing the nurse-patient relationship Forward leaning- shows awareness, attention, and immediacy, also suggests interest in a person and what they have to say. Interview techniques Observations open-ended questions Directed closed-ended questions Leading questions Back channeling ("all right, go on, or uh-huh") Probing Interpreting Back up any subjective data from the patient with your objective data. Data Collection Process Can be a comprehensive or problem-based focused assessment Interpret data/info, use clinical inferences, and cues to guide you, critically anticipate-continuously think about what the data tells you and decide whether more data is needed. (always have supporting signs and symptoms before you make an inference) Validate the info you have collided to avoid making incorrect inferences, comparison of data with w/another source to determine data accuracy Phases of the helping relationship-preorientation, orientation, working, termination.

What are the nursing goals for culture?

Goal is to give holistic care to clients that meets their needs of the body, mind,and spirit. Not to let a cultural difference negatively influence care/create a barrier to proper care Work with the client to find out what they need spiritually/culturally, respect their wishes.

What are risk factors for poor perfusion, modifiable and nonmodifiable risk factors, populations at risk.

Good perfusion is needed for a lifetime therefore everyone is at risk for poor tissue perfusion There are non-modifiable risk factors (genetics, family hx) and modifiable risk factors (smoking, diet) Modifiable risk factors- smoking (nicotine vasoconstricts), elevated serum lipids (contribute to atherosclerosis), sedentary lifestyle (contributes to obesity), Obesity (increased risk for type 2 diabetes, and atherosclerosis), Diabetes Melitus (increased risk of atherosclerosis), Hypertension (increases work of myocardium) Unmodifiable risk factors- age (risk increases with age), gender (more risk for men then women), genetics (family hx, african america men are at a higher risk for hypertension) Populations at risk: Older adults-stiffening and thickening of the heart tissues decreased the ability to respond to the need for increased circulation and prolongs the time needed for the heart to return to a resting state after stress. Decreased elasticity of arteries limits the consistent forward movement of blood to organs. The valves in veins become less efficient, contributing to peripheral edema, and the sluggishness of blood flow contributes to deep vein thrombrosis. Low income + low education- are contributing factors to adverse cardiovascular disease outcomes. Social and psychological factors such as acess to health care, medical compliance, eating habits, depression, and stress are thought to play a role in this relationship. Individual risk factos: Genetics-predisposition to developing a cardiovascular disease in the future puts you at a higher risk requiring prevention early. Lifestyle- lifestyle choices may exacerbate disease among those who have genetic predisposition, include smoking, inactivity, unhealth diet, and obesity, all increase risk for hypertension, type 2 diabetes, which impair perfusion Immobility- those who are immobile are at risk for impaired tissue perfusion, includes those who are paralyzed, unconscious or have an impaired cognitive state, or on bed rest. Sitting in one position for to long can block blood flow to legs. Impaired perfuson caused by immobility can cause pressure ulcers and thrombi

Describe the risk factors for pressure ulcers

Impaired sensory perception- unable to feel when a part of their body undergoes increased, prolonged pressure or pain, can't feel or sense that there is pain or pressure= risk for development of pressure injuries (diabetics) Imparied mobility- unable to independently change positions are at risk for pressure injuries- (very sick weak patients, patients with a spinal cord injury). Alteration in LOC-unable to protect themselves from pressure injury. Confused or disoriented may be able to feel pain/pressure but are not always able to understand how to relieve themselves or how to communicate their discomfort. A patient in a coma cannot perceive pressure and is unable to move voluntarily to relieve pressure. Shear- sliding movement of skin and subcutaneous tissue while the underlying muscle and bone are stationary. (HOB is elevated and the sliding of the skeleton starts but the sjub us fixed because of friction w/the bed. Also occurs when transferring a patient from bed to stretcher when a patient's skin is pulled across the bed-can be avoided using safe patient handling techniques) When shear is present, the skin and subcutaneous layers adhere to the surface of the bed, and the layers of muscle and bones slide in the direction of body movement. Damage occurs at the deeper fascial level of the tissues over the bony prominence. The underlying tissue capillaries are stretched and angulated by the shear force resulting in necrosis deep within the layers causing undermining of the dermis and is a cause of pressure injury development. Friction- force of two surfaces moving across one another such as the mechanical force exerted when skin is dragged across a coarse surface such as bed linens. Unlike shear injuries, friction injuries affect the epidermis of the skin, appears red and painful and is sometimes referred to as a sheet burn, can lead to formation of pressure ulcers Moisture- presence and duration of moisture on the skin increases the risk of pressure injury. Moisture reduces the resistance of the skin to other physical factors such as pressure, fraction, or shear. Prolonged moisture softens skin, making it more susceptible to damage.(includes prolonged exposure to wound drainage. Urine, stool, perspiration, wound exudate, mucous and or saliva) Medical device-related pressure injuries- from feeding tubes, nasogastric tubes, endotracheal tubes, nasotracheal tubes, tracheostomy tubes, oxygen cannula and tubing, BiPAP machines, drainage tubing, indwelling urinary catheter, orthopedic devices, neck collar, compression stockings, immobilization devices.

What is the chain of infection?

Includes Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host Infectious agent- microorganisms including bacterial, viruses, fungi, and protozoa, the potential for microorganisms or parasites to cause disease depends on their virulence- ability to produce disease. Reservoir- a place where microorganisms survive, multiply, and await transfer to a susceptible host. Common reservoirs= human animals, food, oxygen, water, temperature, pH, light Portal of exit- ways that a microorganism leaves the body of the currently infected patient to find another host to live in. Common portal of exits- skin and mucous membranes, respiratory (sputum), urinary tract (urine from UTI), gastrointestinal tract (fecal matter), reproductive tract (secretions), blood. Modes of transmission- how the microorganism gets from one person to another. Contact/direct- person to person through physical contact, Indirect= personal contact of susceptible host with contaminated inanimate object, sneezing and then touching doorknob, then another person touching the same doorknob. Droplet-infect person coughs or sneezes, creating droplets that carry germs short distances w'in 6 feet. Airborne- organisms are carried in droplet nuclei or residue or evaporateed droplets suspended in air during coughing or sneezing Vehicles- caontaminated items, sharps injuries, when bloodborne patheogens enter a person through skin puncture by a used needle or sharp instrument, water, drugs/solutioins, blood, food (improperly handled, sroted or cooked Vector- flies, parasitic conditions from mosquito, louse, flea, tick Portal of entry- Organisms enter the body in a similar way that they leave, must maintain skin integrity, natural defenses Susceptible Host- refers to the new host that a pathoeogen finds to grow in. The level of susceptibility depends on the

What are the interventions for wounds?

Increase amount of protein intake- promotes wound healing includes health promotion- prevention of pressure ulcers, topical skin care and incontinence management, protective positioning, support surfaces, acute care the management of pressure ulcers-wound management (debridement, protection, education, nutritional status), first aid for wounds, cleaning, protecting, dressings (using the correct dressings, changing dressings, packing a wound, securing dressings), heat and cold therapies (choice of moist or dry, warm, moist compresses, warm soaks, sitz baths, commercial hot and cold packs, cold, moist, and dry compresses, cold soaks, ice bags or collars.)

Explain the difference between cultural individualism and collectivism

Individualism stresses individual goals and the rights of the individual person Collectivism- focuses on group goals, what is best for the collective group, and personal relationships. Collectivistic cultures foster the development of an interdependent self-concept, considering their social worth in relation to others. An individualist is motivated by personal rewards and benefits. The collectivist is motivated by group goals). U.s- individualistic society Latin america+Asian, African society- collectivist society

What are the three phases in wound healing and what is included in each?

Inflammatory phase- lasts 3-5 days, homeostasis develops, macrophages remove debris. Includes swelling, clotting, increased WBC's Granulation phase-lasts 5-21 days, new blood vessels and tissues are formed. Fibroblasts create new collagen. Vessels and tissues. Maturation phase- lasts for months, collagen fiber is remodeled,scar formation and contraction occur. (excessive collagen production= keloid scarring)

What are some interventions related to spirtuality?

Involves recognizing and honoring the religious beliefs and practices of those in our care. Spiritual care often does not include religion Spiritual care interventions include keeping vigil with a family as a loved one struggles to recover, crying with a family member when their loved one dies, or supporting a newly diagnosed chronically ill patient, redefining the patient's value and life's meaning. Care can be provided by giving a gentle back rub, speaking soothing words, or reading a prayer or special religious text Cannot be boxed in and narrowly defined, each patient is unique and believes in different things Communicate honestly with the patient to find out what their needs are individually. (understand the words being spoken as well as non-verbal gestures) Then implement the spiritual care needed. This includes Giving verbal support and encouragement of spiritual beliefs Making a referral to chaplain or pastoral care board-certified professional, using religious literature that is meaningful to the patient and the patient's family Using prayer with the patient's or family's consent (all conveys a powerful message of car compassion, love and concern for our patients) Provide presence

Explain the difference between HDL and LDL, how do you lower LDL

Lipid profile- several tests that assess lipid metabolism, Included are low density lipoprotein (LDL's) and high density lipoprotein (HDL's) Also includes cholesterol and triglycerides. For HDL cholesterol, or "good" cholesterol, higher levels are better. High-density lipoprotein (HDL) cholesterol is known as the "good" cholesterol because it helps remove other forms of cholesterol from your bloodstream. Higher levels of HDL cholesterol are associated with a lower risk of heart disease. LDL (low-density lipoprotein), sometimes called "bad" cholesterol, makes up most of your body's cholesterol. High levels of LDL cholesterol raise your risk for heart disease and stroke To reduce LDL- 1. Eat heart-healthy foods Reduce saturated fats. Saturated fats, found primarily in red meat and full-fat dairy products, raise your total cholesterol. Eliminate trans fats. Eat foods rich in omega-3 fatty acids. Increase soluble fiber. Add whey protein.

Explain the difference between micro and macronutrients, what are macro and microminerals?

Macronutrients Protein- 4 cal per gram, 10-30% of daily diet, builds muscle/growth, important for wound healing, immune function (belly fat),blood clotting, fluid regulation, and acid base balance relies upon proteins complete proteins- sufficient amount of 9 amino acids, Incomplete- don't have all 9 amino acids Fatty acids- 20-35%, limit saturated fats, 9 cals/gram, main source of cholesterol-300 mg/day, stored for energy-main source in diet + insulation, helps in hormone production- helps absorb vitamins (absorb vitamins w/fat) Carbs- women-25 grams/day, men- 38 grams/day, 4 cals/gram, fruit=natural/healthy carb, stored as glycogen-regulates glucose micronutrients (Vitamins and minerals) Vitamins (fat + water soluble) MInerals- trace amounts Minerals- inorganic elements essential to the body as catalysts in biochemical reactions Macrominerals- meet daily requirement of 100 mg Microminerals- less than 100 mg, trace amountsP

What are some urinary incontinent interventions

Maintain adequate hydration, avoid or limit drinking beverages that contain caffeine, coffe, tea, chocolate drinks, soft drinks, don't limit fluid intake, if you experience incontinence, concentrated urine may irritate the bladder and increase bladder symptoms. Keep good voiding habits, women- sit well back on the toilet seat and avoid hovering over the seat, make sure that the feet are flat on the floor, void at regular intervals, 3-4 hours depending on fluid intake, avoid straining when voiding or moving the bowels, take enough time to empty the bladder completely Keep the bowles regular- a rectum full of stool may irritate the bladder, causing urgency ad frequency. Prevent urinary tract infections- women- cleanse the perineum from FRONT TO BACK after each voiding and bowel movement, wear cotton undergarments, drink enough water to pass pale yellow urine, shower or bathe regularly Stop smoking to reduce your risk for bladder cancer and reduce the risk of developing a cough, whcih can contribute to stress urinary incontinence Report to your health care provider any changes in bladder habits (frequency, urgency, pain when voiding, or blood in the urine)

What can you do for a patient that is on fall precautions/fall risk?

Make sure 2 side rails are up, call light is within reach, bedside table w/in reach, bed in lowest position, clean area in hospital Age, fall history, high-risk meds, mobility, cognitiation, assessment needs to be done on admission to identify patients who are a fall risk- yellow wristband (Morse fall assessment--document all findings) Make sure lights are on in the room, call light w/in reach Bed alarm on, set for specific patient ( on leg- notifies nurse when patient is close to vertical, infrared on headboard- when patient tries to leave the bed) Fall risk assessment needs to be done also after a fall, following a change in LOC/condition, and when transferred. Risk for fall nursing diagnostic process: Observe patients posture, ROM, gait, strength, balance, body alignment (Decrease in left lower extremity strength, demonstrates unsteady gait, impaired balance when standing) Assess patient's visual acuity- ability to read, identify distant objects (reports difficulty seeing at night, blurred vision, unable to identify near objects w/out glasses) Complete a home hazard appraisal. (Poorly lit home, excessive amount of furniture in living room, rugs not secure through house, carpet on stairs not secure (tacks), no grab bars in bathtub/ restroom (toilet)).

What do you have to do when communicating with older adults?

Make sure the patient knows that you are talking Face the patient, be sure that your face/nouth are visible to them and do not chew gum, or talk while chewing Speak clearly but do not exaggerbate lip movements or shout Speak a little more slowly but not excessively slow Check whether patient uses hearing aids, glasses, or other adaptive equipment Choose a quite, well-lit environment w/minimal distractions Allow time for the patient to respond. Don't assume that patient is being uncooperative if he or she does not reply or takes a long time to reply. Give the patient a chance to ask questions Keep communication short, and to the point. Ask + answer one thing at a time.

What are some examples of different learning materials, how do you choose which one to use for each patient?

Many tools are available. Selection of the right tool depends on the instructional method, a patient's learning needs, and the ability to learn. Written materials printed and online materials/literature- needs to be easy to read, info needs to be accurate and current, method is ideal for understanding complex concepts and relationships. (cognitive) Programmed instruction- written sequential presentation of learning steps requiring that learners answer questions and educators tell them whether they are righ/wrong- primarily verbal, sometimes uses pictures, diagrams, requires active learning, giving immediate feedback, correcting wrong answers, reinforcing right answers, learners learn at their own pace. Computer instruction- use of programmed instructions format in which computers store response patterns for learners and select further lesions on basis of these patterns (programs can be individualized), method requires reading comprehension, pyschomotor skills, and familiarity w/computers Non print materials Diagrams-illustrations show interrelationships by means of lines and symbols, Method demonstrates key ideas, summarized and clarifies key concepts Graphs (bar, circle, or line)- visual representation of numerical data (graphs help learner grasp info quickly about a single subject) Charts- highly condensed visual summary of ideas and facts that highlights series of ideas, steps, or events. Charts demonstrate relationships of several ideas/concepts. Method helps learners know what to do. Pictures- photographs or drawings used to teach concepts in which the third dimension of shape and space is not important. Photographs are more desirable than diagrams because they more accurately portray the details of the real item Physical objects- use of actual equipment, objects, or models to teach concepts or skills. Models are useful when real objects are too small, large, or complicated or are unavailable. Allows learners to manipulate objects that they will use later in skill Slides, audiotapes, tv, videotapes- used with printed material or discussion. Materials are useful for patients with reading comprehension problems and visual deficits.

Describe obesity and what health risks are associated with this?

Most common form of excessive nutrition Chronically high intake of calories Multifactorial and can include overeating, inactivity, and genetics. Associated with systemic, chronic low-grade inflammation and conditions related to the metabolic syndrome- type 2 diabetes, heart disease, and stroke, medical complications, shortened life span.

Explain the importance of handwashing, how long should you do it for, and when do you use hand sanitizer?

Most effective way to prevent spread of infection Wash with soap and water for at least 20 seconds Can use hand sanitizer but must wash hands after in contact with C.diff patient, before eating, and after they have become visibily soiled.

how do you evaluate learning?

Most effective way to see if patient has learned for psychomotor= teach-back Through a patient's eyes- engage patient to determine if they perceive having learned what they expected, be sure expectations have been fully met Teach back- imperative to assess whether a patient understands info during an education session. Teach back is a closed loop communication technique that assesses patient retention of the info given during a teaching session. Ask the patient to explain material that was discussed, demonstrate a skill or explain whey diet and exercise are important in managing blood glucose levels. The response allows you to determine the degree to which the patient remembers and understands what was taught or demonstrated. Use nonjudgmental language so that patients don't feel tested IF any instructional approach involved measuring weather learning objectives were met.Measure whether the patient has new knowledge, behavior or skills, that education aimed to provide. Consider these questions as you evaluate the patient: Were the goals and outcomes realistic? Is the patient able to perform the skill at home? Does the patient continue to have problems understandingObserve return demonstrations to see whether the patient has learned the necessary psychomotor skills for a task. -Ask the patient to restate instructions in his or her own words -Ask the patient questions to see whether there are areas of instruction that need reinforcing or re-teaching, -Give simple written tests or questionnaires before, during, and after teaching to measure cognitive learning

Describe the difference between non-maleficence, and maleficence

Nonmaleficence- directs us to act in ways that avoid harm to others including even the risk of harm Includes harms such as pain, disability, or death A challenge in health care is that we are often required to inflict some harm and risk in order to benefit the patient and avoid greater harm. These harms are not avoidable if we are to properly treat the patient, so we are required to carry out such treatments in ways that are unlikely to cause undue risk or needles harm. maleficence pg 295 PP Refers to harm or hurt. The opposite of non-maleficence

What is the code of ethics?

Nursing code of ethics is a statement of philosophical ideals of right and wrong that define the principles that you will use to provide care to your patients. Also incorporate your own values, ethics into your practice Set of guiding principles that all members of a profession accept Collective statement about the groups' expectations and the standards of behavior. Created by american Nurses Association-ANA, 1950 Describes the nurses obligation to the patient, the role of the nurse as a member of the health care team, and the duties of the nurse to the pro

Describe orthostatic hypotension and how do you test it?

Orthostatic hypotension- also referred to as postural hypotension, occurs when a drop in systolic by 20 and a diastolic by 10 mmhg. Test it by first laying patient supine, getting bp, then moving to fowlers position and checking again, then waiting 5 more minutes before sitting them at 90, dangling, and then standing. If the bp drops or the patient becomes light headed/dizzy help them lay back down in bed.

What is oxygenation, what are the three steps closely related, what is the difference between perfusion and transport, what are some examples of supplementary oxygen (what levels of oxygen do they provide), what percent of oxygen is in room air, and how does that concentration change when using supplemental oxygen?

Oxygenation of blood occurs through 3 steps, ventilation, perfusion, and transport. Ventilation is the act of breathing in o2 and breathing out co2 from your lungs. Perfusion relates to the ability of the cardiovascular system pump oxygenated blood to the tissues and return deoxygenated blood to the lungs. Transportation refers to the blood's ability to move throughout the body getting from point A to point B. Oxygen delivery systems: (room air=21%, adding 1 L brings oxygenation up by 3% but doing 2 or 3 brings it up by 4 %, on 1L=24%, 2L=28%) Nasal cannula- 2-6 L/min, easily tolerable, effective for low concentration, does not impede eating or talking, can be drying to mucous membranes, may cause skin irritation Simple face mask- 6-12L, useful for short periods (patient in transport), contraindicted for patients who retain co2, patients feel like they are sufficating, therapy interrupted by eating/drinking. Increased risk of aspiration Partial/Nonrebreather- 10-15 L/min, useful for short periods, delivers increased FiO2, easily humidifies, does not dry mucous membranes, hot and confining, irritate skin, tight seal necessary, interferes w/eating/drinking, bag must be partially inflated, bay may twist/kink, should not totally deflate. Venturi mask- high-flow delivery device, provides specific amount of oxygen and humidity added, maksi and added humidity may irritate skin, therapy interrupted by eating/drinking, specific flow rate must be followed.

What is included in caring for a patient that is on restriants, what patients would need to go on restraints, and what do you do once the restraints are on, what kind of different restraints are there?

Patients that are confused or agitated or who repeatedly try to remove medical devices may temporarily need physical restraints to keep themselves safe. Chemical restraints-anxiolytics, sedatives used to manage a patient's condition Not a solution to a pts problem, only temporary to ensure staff and patient safety not standard treatment, use alternatives first and then go to restraints Order from doctor-state-location/reason Renewed every 4 hours from doctor for adult, 2 hours for children (9-17), and 1 hour for children (less than 9 yrs old) 24 hour limit on them, under certain circumstances may be kept on for safety Check every 15 mins for violent patients Non-violent check ever q2 hours Check V.S, skin integrity underneath restraints, nutrition, hydration, circulation to an extremity, ROM, hygiene, elimination needs, cognitive functioning, psychological status, and need for restraint. Assess violent patients continuously via audio, video call Try to get patient off restraints ASAP

What is included in the implementation phase of the nursing process?

Performance of nursing and collaborative interventions necessary to achieve the goals and expected outcomes needed to support or to improve a patient's health status. Strong clinical reasoning and decision making help you accurately identify appropriate nursing interventions for patient's specific nursing diagnoses Delegating-can assign non-invasive, repetitive interventions to RAP like skin care, transfer, mobility skills/ROM, hygiene, V.S for patients that are stable, at the end of the day you are responsible for ensuring that you assign each task appropriately and that the AP completes each task according to the standard of care, mus be done correctly, documented, and evaluated

What is perfusion, how does it work, what is central perfusion, and what impairs it, what is the SA node?

Perfusion- refers to the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells. (provide our body w/nutrients) Perfusion- refers to the ability of blood to transport oxygen-containing hemoglobin to cells and return carbon dioxide containing hemoglobin to the alveoli. Perfusion is a normal physiological process that requires the heart to generate sufficient cardiac output to transport blood through patient blood vessls for distribution in tissue throughout the body. Maintaining cardiovascular health is essential. Heart pumps blood through arteries that bring it to the organs of the body through capillaries and the veins bring that blood back to the heart Central Perfusion- Systemic, heart perfusion, force of blood movement generated by cardiac output, Impariment of Central perfusion occurs when cardiac output is inadequate, reduced cardiac output results in a reduction of oxygenated blood reaching the body tissues, shock, untreated, leads to ischemia, cell injury/death. Starts when the heart is stimulated by an electrical impulse that originates in the sinoatrial (SA) node and travels to the atrioventricular (AV) node. From the AV node the impulse moves through a series of branches (bundle of His) and Purkinje fibers in myocardium, which causes the ventricles to contract.

What is pneumonia, preventions, treatments/collaborations what is aspiration pneumonia, what are the causes, what are aspiration precautions?

Pneumonia- inflammation of terminal bronchioles and alveoli, can be viral or bacterial, (viral= nonproductive cough, white.clear secretions, Bacterial= productive cough, white, yellow or green sputum) Manifestations include: fever, chills, dyspnea, sharp, stabbing chest pain upon inspiration, crackles may be heard, children may have nasal flaring,older adults may experience confusion. Prevention- getting enough air into lungs/alveoli getting expanded, getting patient up and moving, deep breathing excersices. Treatment- coughing/incentive spirotomer (deep breathing exercises, may loosen up sputum/secretions), asses resps, administer antibiotics, increase oral fluid intake, vaccinate 65+, get patient up and moving, sitting, incentive spiromter 10 times every hour they are awake. Collaboration- work with respiratory therapists to get ideas on deep breathing exercises, work with pharm, and provider, dietician if necessary Aspriation pneumonia- goes down the wrong pipe, food, vomit ect, causing a bacterial/viral infection in the luns Causes of aspiration pneumonia- poor oral hygiene, dysphagia/trouble swallowing, neurological condition, elderly+ confused can be a risk factor. Causes- regurgitation of formula (tube feeding), feeding tube displacement, deficient gag reflex, delayed gastric emptying, verify tube placement- palace patient is a high fowlers position or elevate HOB to min 30-45 degres during feedings and for 2 hours afterward, reposition tube and verify tube placement by ordered chest x-ray, reassess for return of normal gag reflex, until then place patient on aspiration precautions and in semi-fowlers position Aspiration precautions- skiill of following precautions can be given to AP for feeding tube patient, position patient upright, High fowlers position, immediately report any onset of coughing, gagging or wet voice or pocketing of food t the nurse, maintain good oral hygiene.

Describe primary, secondary, and teritary intention for wound healing.

Primary Intention- wound margins are well approximated (lined up-stitched together), lacerations and surgical incisions. This process has the most rapid healing. Secondary intention- wound margins are not well approximated, larger wound area requires the formation of granulation tissue to fill in the gap. A longer period of time is needed to heal. Tertiary intention- wound healing is delayed and occurs when the wound that was previously open is now closed. This process is usually associated with large infected and contaminated wounds. ( wound vac may be required) Second and third is where the skin doesn't come together

Describe primary, secondary, and tertiary prevention for health and wellness.

Primary prevention- true prevention that lowers the chances that a disease will develop. (includes immunizations and teaching) Secondary prevention-focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions.(screening, mammogram, cholesterol test ect) Tertiary Prevention- occurs when a defect or disability is permanent or irreversible (they now have this disease but are trying to prevent from making the disease worse.

What are the interventions for immobile patients? (primary + secondary)

Primary prevention-Regular physical activity, protection against injury, optimal nutrition, fall prevention measures Secondary prevention-Osteoporosis screening, fall assessment screening Collaborative interventions-Frequent turning, positioning, alignment Skin assessment and skin care Range of motion Deep breathing Weight bearing (if possible) Measures to optimize elimination Nutrition Exercise therapy Ambulation Joint mobility (ROM) Stretching Balance Pharmacologic agents Anti-inflammatory agents Analgesics Muscle relaxants Nutrition supplementation Surgical interventions Curative versus palliative Immobilization Casts and splints, braces, traction, slings, shoulder immobilizers, pillows, etc. Assistive devices and patient handling technology Crutches, canes, walkers, wheelchairs, prostheses

What are the different interventions for pressure injuries?

Prompt Identification for Pt that are at risk or imparied wound healing. Nutrition- Pt with existing wounds or those at risk need extra protein, calories and nutrients. Prevention of pressure injuries minimizes the impact of the risk factors contributing factors have on pressure injury development. Topical skin care and Incontinence Management when cleaning the skin avoid soap and hot water. Use cleaners with nonionic surfactants that are gentle to the skin. Positioning (turning) patients is a consistent element of evidence-based pressure injury prevention. Positioning reduces or relieves pressure at the bony prominences and support surfaces to limit the amount of time exposed to pressure. Preventing pressure injuries- Elevating the head of the bed 30 degrees or less decreases the channel pressure injury developing from shearing force. (never massage reddened areas). Protect the patient from pressure point from medical devices such as O2 tubing and feeding tubes, casts. (Thirty degree lateral position is at which pressure points are avoided). Keep skin dry and clean, apply moisture barriers to areas at least 3x a day. Following each incontient episode clean the area promptly with no rinse perineal cleaner and protect skin with moisture barrier ointment. Establish a turning schedule for the patient. Provide adequate nutrition, and fluids.

Describe spiritual presence and how does a nurse do this?

Providing presence is a person-to-person encounter conveying a closeness and sense of caring. Presence involves "being there" and "being with." the ability to touch another person both physically and spiritually. Nursing presence is the connectedness between a nurse and a patient. Probably the most important approach to meet patients spiritual needs The nurse must be an active listener who can demonstrate empathy, humility, vulnerability, and commitment. Demonstrates this through the personal relationship that develops with the patient and the patient's family. This allows the nurse and patient to mutually experience the uniqueness of the other, you are able to learn about the patient's spiritual/religious needs,

What is a caring presence?

Providing presence is a person-to-person encounter conveying a closeness and sense of caring. Presence involves "being there" and "being with." Nursing presence is the connectedness between a nurse and a patient. Establishing presence strengthens your ability to provide effective patient-centered care. Doesn't need to be an intervention, no needed outcome is required

What are incontinent goals and what do they have to be?

Realistic and individualized goals along w/relevant outcomes. A general goal is normal urinary elimination but sometimes the individual goal differs, depending on the problem. Long term or short term. Short term goal for a Pt w/dx of Impaired mobility status would be that the Pt will be able to independently use the toilet. Appropriate outcome would be that "Pt is observed to safely transfer to the toilet" interventions- ensure the nurse call light is within reach, providing assistive devices like a raised toilet seat and providing easy access to the urinal when in bed. Long term goal- would be several weeks of pelvic floor exercises to improve urinary control. "Pt will experience normal continence". Outcome for the goal is "decrease the number of incontinence pads by 1 to 2 within 8 weeks. Interventions will include kegel exercises. Make sure goals and outcomes are achievable and relevant to the Pt situation. Must be SMART (specific, measurable, attainable, realistic, and time sensitive)

Describe accountability, what is the TJC?

Refers to answering for your own actions. You make sure your professional actions are explainable to your patients and your employer. Monitor individual and institutional compliance with national standards established by agencies such as the TJC TJC establishes national patient safety guidelines to ensure patient and workplace safety through consistent, effective nursing practices.

what is hope and why is it important?

Refers to beliefs, wishes and actions taken in situations of uncertainty Hope is linked to faith and tends to have an emphasis on the fear of the unknown and the unseen Patients may hope for relief from pain even in the face of relentless pain Nurses must foster hope to promote the health of patients (patient's that are hopeless tend to have a more dire outcome) When hope for a cure is not possible, nurses can direct patients to reconfigure what they are hopeful about. (Help set new attainable goals for the patient) When a person has the attitude of something to live for and look forward to , hope is present Multidimensional concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges. It's energizing and motivates people to achieve their goals, and helps them deal with life stressors

What is dysphagia, what are some s/s, what can happen as a result of this condition?

Refers to difficulty swallowing Complications include aspiration pneumonia, dehydration, decreased nutritional status, and weight loss Leads to disability or decreased functional status, increased length of stay and health care costs, increased likelihood of discharge to institutionalized care, and increased mortality. Warning signs include cough during eating, change in voice tone or quality after swallowing, abnormal movements of the mouth, tongue, or lips, slow weak imprecise or uncoordinated speech, abnormal gag, delayed swallowing, incomplete oral clearance or pocketing, regurgitation, pooling, delayed or absent trigger of swallow, and inability to speak consistently. Common in patients with neurological disorders, stroke Often leads to an inadequate amount of food intake resulting in malnutrition. Have an assessment done by a speech-language pathologist, or registered dietician.

Describe fidelity and how does it apply to nursing?

Refers to faithlessness or the agreement to keep promises. You have a duty to be faithful to the patients you care for, to the institution you work for, and to yourself. Id you assess a patient for pain and offer a plan to manage the pain, the standard of fidelity encourages you to initiate the interventions in the plan asap and to monitor the patient's response to the pain Honored when we strive to provide excellent care to all patients. Including those whose values are different from our own. Duty to apply the same skills and knowledge to the care of patients and families, regardless of their background, lifestyle, or past or present choices. Out dty to the institution us means that we follow the policies and procedures set forth, or if its not correct, we seek to correct it and improve the standard of care provided by the institution Duty to oneself is honored when we attend to our own needs for emotional support, mentoring, or continuing education. This commitment to ourselves is essential to the delivery of safe and effective care to patients.

What is accountability and how does it relate to nursing?

Refers to individuals being answerable for their actions. It involves follow up and a reflective analysis of decisions and an evaluation of their effectiveness. As a nurse you take the responsibility to provide excellent patient care by following standards of practice and institutional policies and procedure. You assume responsibility for the outcomes of the actions, judgements, and omissions in providing that care. You sometimes delegate responsibility but remain accountable for the care you delegates. If you delegate taking v.s you are responsible for knowing what your patients v.s are not in the normal range

What is albumin, what does it look at in the blood and what does it mean if its low, and very low., what is prealbumin?

Serum albumin measures circulating protein in the blood Low albumin can reflect protein-calorie malnutrition However other conditions such as chronic inflammation, blood loss, altered fluid status can all cause low serum albumin, elevated high-sensitive C-reactive protein (hsCRP) is helpful for identifying inflammation in conjunction with low serum albumin Very low albumin levels indicate severity of illness and are also predictors of mortality in adults other than age 60. Prealbumin reflects recent dietary protein intake, Low prealbumin is more closely related to nutritional status than albumin is.

What is included in the planning phase of the nursing process, what must goals be, and how do you prioritze

Setting goals and expected outcomes for patients based on diagnosis, prescribing nursing interventions appropriate for each diagnosis. Goals must be smart- specific, measurable, attainable, realistic, timed goal-a broad statement that describes the desired change in a patient's condition, perceptions, or behavior,short-term or long-term, often based on standards of care or clinical guidelines established for minimal safe practice. Prioritize interventions based on clinical importance, a real problem is more important than a risk, treat what could kill them fastest first and go from there. (Airway, Breathing, Circulation, ABC'S)

What is local inflammation, what are the s/s of local inflammation, what is the difference between subjective and objective data?

Signs- objective data, what you can see, V.S, how patient looks etc Symptoms- subjective data, what the patient tells you " I feel funny". Local manifestations for Inflammation- swelling, pain, heat, redness, exudate (serious, fibrinous, purulent, hemorrhagic. Local inflammatory response (local inflammation) occurs within the area affected by the harmful stimulus. Acute local inflammation develops within minutes or hours following a harmful stimulus, has a short duration, and primarily involves the. innate immune system.

What is the difference between spirituality and religion?

Spirituality- An awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself Includes personal beliefs that help a person maintain hope and get through difficult situations. The human spirit is powerful, and spirituality has different meanings for different people. Nurses need to be aware of their own spirituality to provide appropriate and relevant spiritual care to others Patients can be spiritual and not follow a specific religion. Religion- refers to a specific systematic/system of faith, examples -catholisism, christianity, muslim, jewish, buddism, paganism.

Desribe the 4 stages of pressure injuries

Stage 1 pressure injury-non blanchable erythema of intact skin which may be darkly pigmented (does not include the colors purple pr maroon as those are deep tissue injury). Stage 2 pressure Injury- partial thickness skin loss with exposed dermis. The wound is pink or red and moist and may also present as intact or ruptured serum filled blister. Stage 3 Pressure Injury- Full thickness skin loss in which adipose (fat) is viable in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough or eschar may be visible. The depth of the injury varies by location. Undermining and tunneling may occur. Stage 4 pressure Injury- Full thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage, bone. Can have slough an eschar and undermining and tunneling can occur. Depth varies by location. ****IF SLOUGH OR ESCHAR OBSCURES THE EXTENT OF TISSUE LOSS THIS IS AN UNSTAGEABLE PRESSURE INJURY***

What are some general sleep promotion techniques?

Stick to a routine, same time going to bed, waking up, night time routine Manage symptoms- treat underlying disease/illness preventing good sleep If chronic sleep problems, the initial referral is often to a comprehensive sleep center for assessment of the problem.The nature of the sleep disturbance then determines whether referrals to additional health care providers are necessary.-(mental health care provider for emotional stress or crisis) Exercise at least 2 hours before bed, give time for body to relax Avoid eating in bed, coffee, chocolate late in evening/night Help patients develop behaviors conducive to rest and relaxation, develop good sleep habits at home- pt's need their bed partners to learn techniques that promote sleep and conditions that interfere with it. Parents work with their shift schedule+ environment to create good sleeping habits for their children. Sleep Hygiene Habits- exercise daily, but in the morning/afternoon-at least 2 hours before going to bed. Cation against sleeping long hours during weekends or holidays to prevent disturbances of normal sleep-wake cycle If possible patients should not use the bedroom for studying, snacking, watching TV, or other non-sleep activities Avoid worrisome thinking when going to bed, use relaxation techniques. If you don't fall asleep within 30 minutes of laying down, get up and do a quiet activity until feeling sleepy, then go back to sleep. Limit caffeine to morning coffee and limit alcohol intake to no more than 1-2. More than that can disrupt sleep schedule. Discontinue use of electronic devices about 30 mins before bedtime Earplugs and eye shades may be helpful Avoid heavy meals about 3 hours before bedtime, a light snack may help Establish environmental controls- comfortable room temp, proper ventilation, minimal sources of noise, comfortable bed, and proper lighting Some patients benefit from sleeping with a familiar inside noise-fan, soothing noise- ocean waves/rainfall Promote safety- soft light from bedside table can help orient confused patients Bedtime snacks such as a dairy product-warm milk/cocoa Melatonin is a pharmacological way to induce sleep- improves circadian rhythm and reduces sleep onset time. Valerian is effective in mild insomnia, lavender essential oil may improve sleep quality, passionflower has mild sedative effects and is used as a natural sleep aid., chamomile, herbal tea, mild sedative effect, but be aware of risks with the drugs, talk to HCP.

What are the different incontinent types and what causes each?

Stress incontinence- leakage of small amounts of urine during physical movement (coughing, sneezing, exercising) Urge incontinence- Leakage of large amounts of urine at unexpected times, including during sleep. Overactive bladder-urinary frequency and urgency, with or without urge incontinence.(feel urge to pee but sometimes don't actually pee) Functional incontinence- untimely urination because of physical disability, external obsticals, or cognitive problems that prevent person from reaching toilet Overflow- unexpected leakage of small amounts of urine because of full bladder Mixed incontinence- usually occurance of stress and urge incontinence together Transient incontinence- leakage that occurs temporarily because of a situation that will pass (infections, takng a new medication, colds w/coughing)

How does spirituality influence health?

Studies have shown that prayer and meditation have the ability to bolster your immune system, meaning fewer days laid up in bed with the flu and more days out living your life. Some research shows a connection between your beliefs and your sense of well being. Positive beliefs, comfort, and strength gained from religion, meditation, and prayer can contribute to well being. It may even promote healing. Improving your spiritual health may not cure an illness, but it may help you feel better. An individual's intrinsic spirit seems to be an important factor in healing. Healing often takes place because of believing. Spirituality has a positive impact on ability to cope with anxiety, stress, and depression. A person's inner beliefs and convictions are powerful resources for healing.

What is cultural competence and what does a nurse have to do to show this?

Taking cultural needs into account/ part of the care plan. Also known as transcultural care-emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values, therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue Requires you to address your own biases/ implicit bias, be respectful of and responsive to individual differences/ preferences, needs, values Ensure patients guide all clinical care decisions.

What is included in pneumonia discharge teaching?

Teach patient about the use of an incentive spirometer, or flutter valve (deep breathing excercise) Incentive spirometer- used as a deep breathing exercise to help loosen secretions from respiratory tract, long slow inhalation causes the ball to rise-keep at a certain level designated by respiratory therapist, ues negative pressure A flutter valve is similar- deep breathing exercise, long slow exhalation that uses positive pressure and vibrations to loosen secretions. Rest as needed. Rest often throughout the day. Alternate times of activity with times of rest. Drink liquids as directed. Ask how much liquid to drink each day and which liquids are best for you. Liquids help thin your mucus, which may make it easier for you to cough it up. Do not smoke. Avoid secondhand smoke. Smoking increases your risk for pneumonia. Smoking also makes it harder for you to get better after you have had pneumonia. Ask your healthcare provider for information if you need help to quit smoking. Limit alcohol. Women should limit alcohol to 1 drink a day. Men should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor. Use a cool mist humidifier. A humidifier will help increase air moisture in your home. This may make it easier for you to breathe and help decrease your cough. Keep your head elevated. You may be able to breathe better if you lie down with the head of your bed up.

What are some basic charting rules, what does the nurse have to remember to do?

The nursing record should include assessment, planning, implementation, and evaluation of care. Ensure the record begins with an identification sheet. This contains the patient's personal data: name, age, address, next of kin, carer, and so on. All continuation sheets must show the full name of the patient. Be Accurate-Write down information accurately in real-time. Inaccurate or misleading documentation is unethical and can harm patients. Avoid Late Entries-Late entries can introduce inaccuracies. If you have to document something after the fact, follow your employer's late entry policy and clearly mark late entry notations. Prioritize Legibility-Others must be able to read your documentation without difficulty. In addition, legible writing improves your credibility and authority. Use the Right Tools-Nursing documents can be used in legal proceedings. For that reason, use only blue or black ink and never erase information from a nursing document; make a correction and initial it instead. Follow Policy on Abbreviations-When you use abbreviations, be sure they're standard for your employer. Don't use obscure or colloquial abbreviations, which can be confusing to other people reading your documentation. Document Physician Consultations-Document all parties consulted during patient care, including names, times, responses, and any resulting actions. This is critical in case a need or emergency arises. Chart the Symptom and the Treatment-Make sure you document both the symptom and the treatment you administered to address it.

What is therapeutic communication, what are the different therapeutic communication techniques, what does SURETY and ADIET stand for

Theraputic communication- is a dynamic and interactive process in which words and actions are used by clinicians and patients to collaboratively achieve identified healthcare outcomes, Very important part of the healing process. This type of communication promotes understanding and builds relationships that lead to positive patient outcomes. Theraputic communication techniques include active listening, sharing observation, sharing empathy, sharing hope, sharing humor, sharing feelings, using silence, providing information, clarifying, focusing, paraphrasing, validation, asking relevant questions, summarizing, self-disclosure, and confrontation Active listening: attentive to what a patent is saying both verbally and non-verbally. (Sit at an angle facing the patient, creating a non-confrontational communication, Uncross your legs and arms, your "open" to what the patient says, Relax. Communicate a sense of being relaxed and comfortable with the patient, Eye contact-establish and maintain intermittent eye contact to convey your involvement in and willingness to listen to what the patient is saying, Touch-use touch that is respectful to communicate empathy and understanding to the patient, know the patient's comfort level w/touch, Your intuition, trust your intuition as you grow in confidence to individualize, adapt, and apply communication techniques in your interpersonal encounters w/your patients=SURETY model) Share observations-helps patients share info w/out extensive questioning. Share empathy- the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other person. Key part of communication Sharing hope Sharing humor-when appropriate, know the patient's culture and know if humor is okay to use Sharing feelings/.using touch AIDET-acknowledge, introduce, duration, explain, thank you

How do you evaluate immobility?

Through the patient's eyes- were the patient's goals or expectations met? In their opinnion did they improve- see the change that was planned? As a nurse you take what the patient says, and compare it to what clincially really happened and see if the goals were met, unmet, or partially met Then make changes based on that-new diagnosis, new interventions ect

What is included in a learning assessment?

Through the patients eyes- find what the patient needs speficially, expectations ect Determine the patients learning needs, motivation to learn, readiness and ability to learn, teaching environment, resources for learning and health literacy. Performing a learning needs assessment (LNA) should be considered as an essential step in the planning process, as it can help ascertain that educational activities are designed for the purposes of enhancing learning outcomes, improving patient outcomes, and optimizing cost-effectiveness of organizational resources.

Describe the 5 stages of health behavior change

Transtheoretical model of change 1. Precontemplation- lack awareness that things can be better. "This is the way it is", "It is what it is", don't believe they have a problem. 2.Contemplation- recognize a problem or pattern and are considering what to do about it. "I think I might go on a diet, maybe I should go to rehab" 3.Preparation- take small steps, make a commitment to change, includes education. "I'm looking into different diet plans, I'm looking at different rehab centers" 4. Action- belief that you can change and make a difference. (going on weightwatchers, watching your weight, actually going to rehab.) 5..Maintenance-control over it, avoiding temptation, living in the new status quo, sticking to the diet plan, staying sober. (often the hardest part, addicts relapse about 10 times before they completely recover)

How do you communicate with a cognitively impaired patient?

Use simple sentences and avoid long explanations Ask one question at a time Allow time for patient to respond Be an attentive listener Include family and friends in covo, especially in subjects known to patient Use pictures or gestures that mimic the action required.

What is a bowel/bladder program, what is included in these programs to be sucessful?

Used in patients with chronic constipation, urinary incontinence, secondary to cognitive impairment, also called habit training Involves setting up a daily routine. By attempting to defecate/urinate at the same time each day and using measures that promote defecation, a patient may establish a normal defecation pattern, Program requires time, patience, and ocnsistency Needs to have a caregiver able to devote the time to the training program. A successful program includes- assessing the normal elimination pattern and recording times when a patient is incontient Acknowledge risk for older adults, add fiber to diet, minimum 1500 ml of fluid each day. Choose time based on the patient's pattern to initiate defecation control measures, offer a hot drink (hot tea) or fruit juice (prune juice) or whatever fluid normally stimulate peristalsis before the defecation time Help patient to toilet and provide privacy Instruct the patient to lean forward at the hips while sitting on the toilet, apply manual pressure with the hands over the abdomen ad bear down but do not strain to stimulate colon emptying An unhurried environment and non-judgmental caregiver Maintaining normal exercise w/in the patient's physical ability. Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence. The goals are to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. It also can diminish leakage and the sense of urgency associated with the problem.

what is DVT, which life threatening condition is it associated with, how do you asses to see if patient has a DVT, what are some risk factors for developing a DVT, and what are some nursing interventions?

Venous thromboembolism (VTE) is a blood clot in a vein. It is related to 2 life-threatening conditions, Deep vein thrombosis (DVT) and pulmonary embolism. DVT- a clot in a deep vein, usually the leg. measure calf size daily if at increased irks for DVT, unilateral increase in leg calf size indicates the early sign/presence of a DVT, use a doppler to check pedal pulses, tibial pulses, blood flow to leg/foot. Determine whether the patient is experiencing leg pain by gently palpating under thighs and along the calves, note any tenderness, cramping, look for redness, gently palpate for presence of edema, compare findings in both legs, unilateral redness, tenderness, and edema all indicate possible DVT Risk factors for developing deep vein thrombosis- surgery, trauma, long periods of not moving (bed rest, sitting, long car or airplane trips, cancer and cancer therapy, past history of DVT, increasing age, pregnancy and 4-6 weeks after giving birth, certain illnesses (heart failure, inflammatory bowel disease, some kidney disorders, hypertension, hyperlipidemia, nephrotic syndrome, autoimmune disease, including systemic lupus erythematosus, obesity, smoking, use of birth control pills, varicose veins, haiving a tube in a main vein (needed to give meds over a long period of time, having thrombophilia (one of several diseasees in which the blood does not clot correctly) Nursing interventions- bed rest, keep legs elevated, no compression stocking- can cause the clott to dislodge and travel to lungs causing a pulmonary embolism, start and continue blood thinner medication until the clot dissolves completely.

What is included in assessing adequate ventilation, what is considered the most important to check/assess?

Ventilation is the process of inhaling oxygen into the lungs and exhaling carbon dioxide from the lungs. May be impaired by the unavailability of of oxygen, such as at high altitudes, as well as by any disorder affecting the conducting airways, lungs, or respiratory muscles. Asessment of gas exchange involves recongizing indications of adequate and inadequate ventilation, transport, and perfusion. Adequate ventilation is apparent when the following occurs: Breathing is quiet and effortless at appropriate rate for age, oxygen saturation (SaO2) is between 95-100, skin, nails beds, and lips are appropriate colors for the patient's race (not pale/pallor or cynaotic- late stage of poor oxygenation), thorax is symmetric with equal thoracic expansion bilaterally, spinous process are in alignment, scapulae are bilaterally symmetric, anterroposterior (AP) diameter of the chest is approximately 1:2 ratio of AP to lateral diameter, trachea is midline, breath sounds are clear bilaterally. Most important are respiratory rate/depth, rhythm, use of accessory muscles to breathe Use pulse ox, check capillary refill (determins oxygenation and perfusion)

Who are at risk for health and wellness problems?

Vulnerable populations are more likely to develop health- related problems and experience worse outcomes Most vulnerable populations are persons with low socioeconomic status and persons who are members of ethnic and racial minorities.

What are the general rules with delegation, what are the five rights to delegation?

You can't delegate what you can't EAT- evaluations, assesments, or teaching Five rights to delegation-: Right task- ones that are included in the delegate's job description or are included in the health care agency's policies and procedures. (training if needed) Right circumstance- patient status comes into play, needs to be stable in order to delegate tasks. The delegatee must report changes in patient condition to nurse. Nurse must then reasess and evaluate the situation and appropratness of delegation when conditions change. Right person- does the delegatee have the knowledge and skills required to perform the activity- responsibility lies with the nure, employer, & delegatee. Right directions/communication- give clear, concise description of a task, including its objective, limits, and expectations. Communication needs to be ongoing between the nurse and delegate-responsible to ask questions to clarify info Right supervision/evaluation- provide appropriate monitoring, evaluation, intervention as needed, and feedback.Nurse must follow up with the delegatee at the end of the activity to evaluate patient outcomes, be available and ready to intevene when appropriate, and ensure appropriate documentation. You are responsible at the end of the day for any activity you delegate Don't delegate anything you wouldn't do Never delegate clinical reasoning, nursing judgment (steps of nursing process-assessment, diagnosis, planning, intervention, evaluation, or patient teaching), and critical decison making You delegate tasks NOT patients AP's attend to basic patient needs (hygiene, meal assistance, ambulation)

Which populations are susceptible to infection and why?

age (older patients have a weakened immune system, slow response, nutritional status (deficient food intake), stress, immunocompromised patient. Very young- low immunity, three types of immunity= innate- born with it, skin normal flora, Adaptive immunity-after being exposed or immunized and growing immunity, passive immunity- short-lived/term, immunity from mother, passed from mom to baby during birth, doesn't last long. Poor/Uninsured- hard to get meds/ vaccines Residents of geographic areas where an infection is prevalent- living close together makes it easier to catch an infection + close quarters

What is dehydration, what causes it, what are some s/s, what are some nursing interventions?

occurs when there is an extracellular fluid volume imbalance and hypernatremia. The EVC is too low, and the body fluids are too concentrated Clinical dehydration is common with gastroenteritis or other causes of severe vomiting and diarrhea when people are unable to replace their fluid output with enough intake of dilute sodium-containing fluids. S/S of dehydration are Feeling very thirsty, dry mouth, urinating and sweating less than usual, dark-colored urine, dry skin, feeling tired, dizziness, headache, skin tenting, low bp, fatigue/weakness, pallor, fainting, thickening of respiratory sections making it difficult for a patient to expectorate secretions. Body fluids become concentrated, output is larger than input Nursing interventions- fluid as tolerated, correct the underlying cause/ disease