NURS-100 Final Exam 2020

What is CAUTI?

catheter associated urinary tract infection

What is a CAUTI?

catheter associated urinary tract infection

What is CLABSI?

central line associated blood stream infection

Principles of surgical asepsis / sterile field

♦ A sterile object remains sterile only when touched by another sterile object. ♦ Only sterile objects may be placed on a sterile field. ♦ If sterile package is torn, it is NOT sterile. ♦ A sterile object or field out of the range of vision is NOT sterile. ♦ An object held below a person's waist or behind their back is contaminated. ♦ Sterile fields that become wet are NOT sterile, even if the liquid was sterile (IE: spill sterile water on sterile field, it is contaminated because the table below the field is not sterile) ♦ The edges of a sterile field or container are considered to be contaminated. (1 inch border) ♦ Sterile object exposed to the air for a long period is NOT sterile. ♦ When surgically scrubbing hands, keep hands above elbows so washing water runs towards elbow and not towards hands. ♦ Wash hands before starting. ♦ Check expiration date and package integrity. ♦ Open packages away from you on a flat surface. ♦ When adding to sterile field, do not let wrapper fall to field.

Enhancing therapeutic communication factors

♦ Active listening ♦ Establishing trust >> Use pt first name >> Be honest! If you don't know, tell them and find out! ♦ Restating, clarifying and validating messages >> Use pt's own words to restate or clarify >> Provide education rather than false sense of hope ♦ Interpreting body language and sharing observations ♦ Open-ended questions ♦ Use silence! >> Sometimes the best thing to say is nothing >> Demonstrates acceptance >> Shows them that it's okay to be upset and cry ♦ Summarizing the conversation

Risk factors for fluid/electrolyte and acid/base issues

♦ Age ♦ Environment ♦ GI output ♦ Chronic diseases (diabetes a big one!) ♦ Trauma ♦ Therapies (like diuretics)

Tuberculosis main points

♦ Airborne droplet transmission ♦ Can affect other parts of body beyond lungs ♦ Fatigue, night sweats, bloody sputum (hemoptysis) ♦ Typically confirm with a chest xray or sputum culture ♦ Positive cases = antibiotics 6-9 months ♦ Many times nurses perform DOT

Respiratory causes of alkalosis and symptoms

♦ Anxiety ♦ Pain ♦ Fever ♦ Hyperventilation ♦ ASA OD ♦ Liver failure ♦ Pregnancy (Think about things that make you breathe quickly, like anxiety) Symptoms Confusion, light headed, parethesias, extremity spasms, dry mouth, sweating, palpations, dysrythmias

Examples of hygeine related questions to ask patients

♦ Any changes? How long have you noticed ____? ♦ Hindrances to ADLs? ♦ Any SOB during ADLs? ♦ What can I (or someone of the same gender) help with?

Components of safety check before leaving patient's room

♦ Are the side rails up? ♦ Is the bed in the low position? ♦ Are the bed wheels locked? ♦ Is the patient's call device in reach? ♦ Is the overbed table clean and uncluttered? ♦ Is there uncluttered walking space? ♦ "What else can I do for you?"

Considerations for history questions related to smoking

♦ Ask about vaping and smokeless tobacco ♦ Document "number of cartridges per week"

Barriers to therapeutic communication

♦ Asking too many questions ♦ Asking why ♦ Firehosing information ♦ Changing the subject inappropriately ♦ Failing to probe ♦ Expressing approval or disapproval ♦ Offering advice ♦ Providing false reassurance ♦ Stereotyping ♦ Using patronizing language

What to document regarding ETT

♦ Assessment ♦ ETT size ♦ ETT position ♦ Location ♦ Vent settings ♦ Patient response ♦ Cuff pressure ♦ Communication ♦ Education ♦ When suctioned and what got out from suctioning

Developmental factors that affect oxygenation in older adults:

♦ Atherosclerosis (plaque/cholesterol buildup) ♦ Decreased muscle mass ♦ Decreased chest wall compliance ♦ Calcification of valves ♦ Decrease in cilia ♦ Decreased immune response ♦ Cough (GERD can cause upper resp. infections)

List safety hazards for healthcare workers

♦ Back injury ♦ Needlestick injury ♦ Radiation injury ♦ Violence ♦ Prevention

List the different categories of infectious agents

♦ Bacteria ♦ Viruses ♦ Fungi ♦ Protozoa ♦ Helminths ♦ Prions

Important bathing highlights

♦ Bathe head to toe (clean → dirty) ♦ Wash and dry well under folds of skin/breasts ♦ Assess back/heels! ♦ Change water as needed ♦ Perineal area last ♦ Lines! IVs, feeding tubes and their method of attachment to skin ♦ Never clip nails!

Considerations for patients with dementia

♦ Be flexible ♦ Use distraction/negotiation ♦ Reward ♦ Individualize (Ask family what works for them at home if applicable) ♦ Stop if needed

List 5 moments for hand hygeine

♦ Before patient contact ♦ Before aseptic task ♦ After body fluid exposure risk ♦ After patient contact ♦ After contact with patient surroundings

Where is the upper/lower airway sterility dividing line?

♦ Between epiglottis and larynx ♦ Upper airway insterile, lower airway sterile

What is HCO3- and what are the ranges for ABGs?

♦ Bicarbonate ♦ Regulated by the kidneys ♦ HCO3 normal = 22-26 mEq/L ♦ Below 22 = Acidosis ♦ Above 26 = Alkalosis

Diagnostic test examples

♦ Blood specimens (CBC, Electrolytes) ♦ Xrays ♦ TB testing ♦ Thoracentesis (Pleural fluid)

List medications that can promote lung function

♦ Bronchodilators ♦ Resp anti-inflammatory (corticosteroids used in asthma) ♦ Nasal decongestants (side effects - BP) ♦ Antihistamines ♦ Cough meds (antitussives, expectorates)

Hair and facial care

♦ Brush daily ♦ Shampoo/dry shampoo ♦ Use electric shaver if on anticoagulation meds! ♦ If wet shave, soften beard with warm compress ♦ Consider culture!

Regulatory mechanisms trying to keep homeostasis

♦ Buffers are your first line of defense >>> fast acting ♦ Respiratory system is your second line of defense >>> occurs within minutes of a pH change >>> hyperventilate = exhaling CO2 - goes more alkaline >>> hypoventilate = holding in CO2 - goes more acidic ♦ Kidneys third line of defense >>> slowest, takes a few days to kick in

What is CO2 and what are the ranges for ABGs?

♦ Byproduct of cellular metabolism ♦ Regulated by lungs primarily ♦ PaCO2 normal = 35-45 mmHg ♦ Below 35 = Alkalosis ♦ Above 45 = Acidosis

Respiratory causes of acidosis and symptoms

♦ CNS depression ♦ Pneumo ♦ Hypoventilation ♦ Atelectasis ♦ Pulmonary infection ♦ Heart failure ♦ PE (pulmonary embolism) ♦ NM disease Symptoms Dyspnea, shortness of breath, reslessness, heart attack, tachycardia, confusion, dysrythmia, drowsy, decreased LOC

"For every day you spend in bed..."

"... it takes you two days to recover."

What developmental factors affect safety for infants and toddlers?

♦ Cannot recognize danger ♦ Tactile exploration of environment ♦ Totally dependent ♦ Motor vehicle accidents - car seats not set properly ♦ Choking ♦ Falling from windows ♦ Accidental drowning ♦ Poisoning (medication!) ♦ Asphyxiation - infants BACK and BARE is best, no pillows, blankets stuffed toys

What are some indirect indicators of poor tissue oxygenation?

♦ Capillary refill over 3 seconds ♦ Skin color ♦ Mucosa color ♦ Level of consciousness (LOC)

List common and serious noscomial (HAI) infections

♦ Central line-associated bloodstream infections (CLABSI) ♦ Surgical site infections (SSI) ♦ Catheter-associated urinary tract infections (CAUTI) ♦ Ventilator-associated pneumonia (VAP) ♦ Multidrug-resistant organisms (MDROs) ♦ Clostridium difficile infections

How does breathing happen?

♦ Chemoreceptors detect high CO2 levels and low blood O2 ♦ Lung receptors in chest wall/lung are sensitive to compliance/expansion/resistance

Respiratory focused assessment - what history questions should you ask?

♦ Chest pain? >>> Men - severe chest pain typical >>> Women - chest pain, jaw pain, neck pain, shoulder pain - if they say "uncomfortable", dig in further ♦ Smoking >>> Documented as "pack year history" packs per day x years smoking. 2 packs/day for 10 years = "20 pack year history" >>> Ask about smokeless tobacco, vaping (cartridges per week?) ♦ Dyspnea ♦ Cough - dry? productive? smell? ♦ Wheezing ♦ Exposure ♦ Respiratory infections ♦ Allergies ♦ Medications (some might affect oxygenation) ♦ Family history

Cleaning vs Disinfection vs Sterilization

♦ Cleaning—removal of soil from objects ♦ Disinfection—process to eliminate most/all microbes ♦ Sterilization—complete destruction of all microbes including spores

Domains of learning

♦ Cognitive >>general recall of information ♦ Affective >>changing beliefs and attitudes ♦ Psychomotor >>hands-on skills requiring mental and physical activity >>learners retain 10% of what they read but 90% of what they speak and do

What to assess for in skin:

♦ Color: pallor, erythema, jaundice, cyanosis ♦ Texture, thickness, turgor, temperature, hydration > ideal would be smooth, warm, supple ♦ Assess lesions ♦ Skin folds

Types of upper respiratory infections

♦ Common cold - viral ♦ Rhinosinusitis - viral or bacterial ♦ Pharyngitis - viral or bacterial ♦ Influenza ♦ Can lead to further complications such as respiratory compromise, secondary infection (IE bronchitis), exacerbation of underlying condition

List types of bathing

♦ Complete bed bath ♦ Partial bed bath ♦ Tub bath ♦ Shower ♦ Bag bath ♦ Sponge bath ♦ Therapeutic bath

What can affect ventilation?

♦ Compliance of the lungs ♦ Neuromuscular diseases that affect compliance (muscular dystrophy, Guillain Barre) ♦ Skeletal issues (IE: kyphosis - hunching of back) ♦ Airway resistance (IE: Asthma)

Influenza main points

♦ Contagious - can be contagious 1 day before show symptoms. direct contact & droplets ♦ Fatalities - especially in older adults and children under 2 ♦ Symptoms - cold symptoms + fatigue, muscle pain, fever, vomiting, diarrhea, headaches ♦ Can lead to pneumonia, dehydration, exacerbate underlying conditions ♦ Prevention! Get a vaccine and wash your hands

Adventitious lung sounds

♦ Crackles - fluid in lower airways, will NOT clear with coughing (sounds like rubbing hair by ear) ♦ Rhonchi - fluid in upper airways, OFTEN cleared with cough (sounds "junky") ♦ Wheezes - can hear on inspire and expire, high-pitched, will hear with asthma and obstruction ♦ Pleural friction rub - "grating" sound, painful condition

Respiratory assessment considerations for older adults

♦ Decreased cardiac output = decreased perfusion = decreased oxygenation ♦ Murmurs = decreased oxygenation ♦ Hypertension ♦ Decreased cilia activity ♦ Decreased chest wall compliance

Lifestyle factors that can affect oxygenation

♦ Diet >>> Obesity - difficulty taking a deep breath in >>> Malnourishment - decreased muscle strength, anemia >>> Diet high in carbs - carbs break down into CO2 (bad for COPD patients) ♦ Hydration ♦ Pregnancy (baby pushing on diaphragm preventing mother's deep breath) ♦ Exercise - positive increase can help be more effective at delivering oxygen ♦ Smoking - nicotine is vasoconstrictive ♦ Alcohol and drugs impair tissue oxygenation ♦ Stress - can increase metabolic rate and oxygen demand

Developmental factors that affect oxygenation in young/middle age adults:

♦ Diet ♦ Exercise ♦ Stress ♦ OTC Drugs ♦ Smoking

Sign of worsening ventilation and oxygenation

♦ Diminished or no breath sounds "This is a sign the patient is going down the tubes"

Principles for pouring sterile liquids

♦ Discard about 1-2ml. Prior to pouring solution into sterile container or onto sterile field. ♦ Palm the label of a sterile bottle when pouring to prevent it from becoming saturated and unreadable. ♦ Check expiration date. ♦ Don't lean over field to pour.

List general precautions to prevent contamination between nurse and patient

♦ Don't share personal items (IE cell phone) ♦ Dispose of soiled materials properly ♦ Cough etiquette ♦ Work restrictions for sick nurse ♦ Don't hold soiled linens, etc next to your uniform ♦ Maintain skin integrity/wound care ♦ Perineal hygiene ♦ Keep drainage bags closed

Bed making considerations

♦ Don't sling around dirty sheets or lay them on the floor ♦ Take linen hamper to room (leave outside door) ♦ Change once per shift unless incontinent or febrile (fever) ♦ Miter the corners if no fitted sheets ♦ Wrinkles can cause pressure sores! ♦ Position patient (comfortable, optimize breathing pattern) ♦ Take opportunities to change sheets - when they are in the shower, at PT, etc ♦ Special considerations for bony prominences on immobile patients

What is incentive spirometry for?

♦ Encourages deep breathing ♦ Reduces respiratory complications after surgery

Other factors affecting communication (aside from verbal/nonverbal)

♦ Environment >> TV on loud and distracting? >> Family/friends in room >> Is this location private enough for the conversation? >> Report, is patient being included? >> Nurses on break, be aware of HIPAA ♦ Personal space >> Intimate distance (less than 18 inch away) >> Personal distance (18 inch - 4 feet) >> Social distance (4 - 12 feet) >> Public distance (over 12 feet) ♦ Sociocultural factors >> Be aware of patient and own cultural beliefs >> Know what types of cultures are in your community ♦ Roles and relationships >> White coat syndrome (might be intimidated by provider and not ask questions) >> Anyone in scrubs might look like a nurse (introduce yourself, clarify your role or others' roles)

Nursing considerations for those with ETT

♦ Explain procedure (won't be able to talk, scary) ♦ Bag with 100% prior to intubation ♦ Make sure all equipment is ready to go ♦ Make sure suction is available ♦ Monitor patient during procedure >>>Sats, VS, EKG, aspiration ♦ Verify placement of tube >>>ETCO2, bilateral breath sounds, x-ray ♦ Oral care every 4 hours or more (prevent VAP) ♦ Inflated balloon with 20-25mmHG >>>too low, aspiration possible, ineffective ventilation >>>too high, necrosis of trachea possible ♦ Document post procedure!!

Things to consider before a bath

♦ Explain what you are doing, even if the person is unconscious ♦ Bed is raised to your waist ♦ Side rails down on the side you are working ♦ Assure privacy/adequate light ♦ Area is free of obstacles ♦ Generational issues ♦ Any premedication needed for pain or nausea ♦ Tub bath can be a source of infection! ♦Is my patient stable enough for this form of bath?

What developmental factors affect safety for adolescents?

♦ False confidence; feel indestructible ♦ Risk-taking behaviors ♦ Most lack adult judgement ♦ "Challenges" IE: Eating tide pods, cinnamon challenge

Vent settings we need to know

♦ FiO2 - amount of oxygen ♦ Rate - number of breaths per minute (including machine breaths) ♦ VT - tidal volume, amount of oxygen each breath is giving, typically 8-10mL/kg - too much can cause barotrauma ♦ PEEP - Positive End Expiratory Pressure - extra pressure applied at end of exhalation in order to pop alveoli open to allow for better gas exchange (equivalent of a sigh)

Recommendations for foot care of diabetic patients

♦ Foot exam every year ♦ Inspect feet daily ♦ Wash feet in lukewarm water (not hot!) ♦ Good closed toed shoes ♦ Clean, dry socks ♦ If dry, use lanolin ♦ File nails straight across ♦ No OTC products for fungal infections ♦ No lotion between toes ♦ Don't cross legs ♦ Exercise regularly ♦ Don't smoke ♦ Wash and dry minor cuts immediately

List "never events":

♦ Foreign object left in patient ♦ Air embolism ♦ Administering wrong type of blood ♦ Severe pressure injuries ♦ Falls and trauma ♦ Infections associated with urinary catheters ♦ Infections associated with IV catheters ♦ Symptoms resulting from poorly controlled blood sugar levels ♦ Surgical site infections following certain elective procedures (e.g., certain orthopedic surgeries, bariatric surgery for obesity) ♦ Deep vein thrombosis or pulmonary embolism following total knee and total hip replacement procedures.

Why is pH so important?

♦ Function and shape of hormones and enzymes ♦ Change in electrolyte distribution ♦ Changing membrane excitability ♦ Decrease drug effectiveness

List medications that can negatively affect respiration

♦ General anesthetics ♦ Opioids ♦ Mag sulfate (too much can paralyze diaphragm) ♦ Antianxiety ♦ Sedatives ♦ NM blocking agents (neuromuscular paralyzers) ♦ Beta blockers (for those with asthma)

List PPE

♦ Gown ♦ Eyewear/goggles (not just glasses alone) ♦ Mask/respirator ♦ Gloves

What are the two types of pneumonia?

♦ HCap - Healthcare acquired pneumonia >>> Non-hospitalized person that had contact with healthcare system (IE: left rehab center, were in dialysis recently) ♦ VAP - Ventilator associated pneumonia >>> High mortality rate >>> Diagnosed 48+ hours after someone placed on a ventilator (trach or ET tube)

Things to remember with all isolations:

♦ Hand hygiene is essential ♦ Dispose of supplies appropriately ♦ Use recommended PPE ♦ Specimen collection considerations (close lid tightly!) ♦ Bagging trash/changing linen (double bag needed?) ♦ Items brought from visitors appropriate? ♦ Transporting a patient considerations ♦ Our uniforms and shoes!

Developmental factors that affect oxygenation in infants/toddlers:

♦ Hyaline membrane disease causing lack of surfactant (especially in premature babies) ♦ Teething can cause nasal congestion and bacterial growth can cause infection ♦ Secondhand smoke

Considerations for perineal care

♦ If providing self-care, make sure hygeine is adequate ♦ Clean female patients perineum front → back ♦ Menstruating concerns met? ♦ Daily catheter care ♦ Uncircumcised males must have foreskin retracted before cleansing and then replaced

List some factors that increase risk for infection:

♦ Immunocompromised ♦ Stress ♦ Invasive lines/procedures ♦ Multiple people in/out ♦ Antibiotics

Communication related nursing diagnosis examples

♦ Impaired Oral Communication >>appropriate for dyspnea, stuttering, medical condition that impairs ability to speak, aphasia that affects either expression or ability to receive messages ♦ Impaired Communication >> appropriate if client is unfamiliar with dominant language or has some other difficulty sending/receiving messages

Where do you typically hear crackles?

♦ In the lower lobes, such as with pneumonia. ♦ Does not clear with cough.

Eye care considerations

♦ Incorporated into bath ♦ Glasses and contact care ♦ Prosthetic eye care ♦ New wipes for eye infections ♦ Matted eyes - use warm compress for 3-5 min ♦ Unconscious patients with eyes open need eye care every 2-4 hours with saline or artificial tears and to use eye shields

Additional oral care considerations for unconscious patients

♦ Increased risk for infection > Oxygen dries out the mouth further > Ventilator associated pneumonia ♦ Frequent oral care (no more than 2 hours) ♦ Do not place fingers in mouth ♦ PPE considerations ♦ Pooling of secretions (suction saliva) ♦ Turn onto side while performing oral care to prevent aspiration

TB test result determinations

♦ Induration 5mm+ = positive IF patient has been in close contact with a TB case or has HIV ♦ Induration 10mm+ = positive if has diabetes, steroid use, chronic renal failure or foreign born ♦ Induration 15mm+ = positive for a person with no underlying health conditions ♦ Can have a false positive if they have had the TB vaccination

Oral care developmental considerations

♦ Infants - teething, foods that may irritate gums ♦ Teens to middle adult - no issue if good hygeine ♦ Older adults - medications, chronic diseases, physical disabilities, decreased vascularity of gums, edentulous (no teeth)

Bronchitis main points

♦ Infection of bronchi - viral or bacterial ♦ Cough, chills, malaise, chest wall pain >>>Productive cough usually means bacterial

List the links in the chain of infection

♦ Infectious agent ♦ Reservoirs ♦ Portal of exit ♦ Means of transmission ♦ Portal of entry ♦ Susceptible host

Respiratory focused assessment - what components for inspection?

♦ Inspection comes first! What do you see? >>> Overall color, LOC, chest wall movements, symmetry? ♦ Breathing patterns, pursed lip breathing? ♦ Respiratory rate ♦ Apnea? ♦ Chest form deformity ♦ Sputum color, odor, quantity?

Components of a learning assessment

♦ Intended audience ♦ Learning needs ♦ Knowledge level ♦ Health beliefs and practices ♦ Physical readiness ♦ Emotional readiness ♦ Ability to learn ♦ Health literacy level ♦ Neurosensory factors ♦ Learning styles

Metabolic causes of alkalosis and symptoms

♦ Lactate admin via dialysis ♦ Antacids ♦ Vomiting ♦ NG suctioning ♦ Diuretics ♦ Excess bicarb use (Think about things that make you lose acids, like vomiting) Symptoms Muscle twitch, tetany, dizziness, weakness, disorientation, N/V, depressed respirations, dysrythmias

List considerations for restraint safety in the hospital

♦ Least invasive to Invasive ♦ Last resort ♦ For the immediate physical safety of the patient and others ♦ Chemical vs. physical ♦ Medical order and consent ♦ Quick tie release ♦ Be aware of where you connect it to on the bed ♦ How often do you check on patient who has physical restraints? >>Every 30 minutes and check skin integrity ♦ Release restraints how often? >>Every 2 hours or per hospital policy, check skin integrity and allow joint movement ♦ Restraint use must be reviewed every 24 hours to see if use is still needed

List individual factors affecting safety

♦ Lifestyle ♦ Cognition ♦ Sensoriperceptual status ♦ Ability to communicate ♦ Mobility status ♦ Physical and emotional health ♦ Safety and awareness

Respiratory assessment - auscultation

♦ Listen anterior, posterior, laterally ♦ Use diaphragm of stethoscope in organized fashion bilaterally ♦ Hope for clear sounds

What developmental factors affect safety for older adults?

♦ Loss of muscle strength and joint mobility ♦ Slowing reflexes ♦ Sensory losses ♦ Falls!!

Considerations for mobilizing secretions

♦ Maintain clear airway ♦ Humidification (bubbling oxygen through water, O2 hood/tent, liquefies secretions) ♦ Nebulizer adds moisture or medication (bronchodilators/mucolytic agents) to inspired air

Steps for making an occupied bed

♦ Maintain patient safety during the procedure. ♦ Assess the patient's ability to move and need for assistive equipment and patient-handling devices. ♦ Position the patient laterally near the far siderail, and roll soiled linens under him. ♦ Place clean linens on the side nearest you, and then tuck under the soiled linens. ♦ Roll the patient over the "hump," and position him on his other side, near you. Raise the near siderail. ♦ Move to the other side of the bed; pull soiled and clean linens through, and complete the linen change as in Procedure 25-15: Making an Unoccupied Bed. ♦ Place the bed in a low position, raise the siderails, and fasten the call light to the pillow

Considerations for patient environment comfort

♦ Make sure patient's room is comfortable ♦ Assure bed, table, TV, remotes are working ♦ Personal belongings within reach ♦ Put on TV shows they like or let them know available

Oxygen safety considerations

♦ Make sure pt knows to keep lighters, cigarettes, fireplaces away ♦ O2 tanks can rupture and become a missile ♦ Document education!!

Describe "droplet precautions"

♦ Mask ♦ Private room or physically seperated by at least 3 feet ♦ Supplies kept outside the room ♦ (or refer to hospital policy) ♦ Infection examples: flu, strep throat, whooping cough, bacterial meningitis

What kinds of precautions do we use for COVID-19?

♦ Masks (N95?) ♦ Faceshields ♦ Gowns ♦ Gloves ♦ Shoe Coverings ♦ Hair Coverings ♦ Figuring it out as we see it unfold

What developmental factors affect safety for adults?

♦ May be exposed to injury in the workplace ♦ Lifestyle choices impact health ♦ Some decline in strength and stamina; others maintain fitness

What is capnography?

♦ Measures levels of CO2 in exhaled and inhaled air ♦ More reliable than a pulse ox

Factors that might affect pt's ability to communicate and understand what you are communicating to them

♦ Medications (will this impact speech or LOC? Is it the best time to talk to them if they have just taken medication?) ♦ Language barriers (speak/translate into native lang.) ♦ Cognitive function/impairment (yes/no questions) ♦ Hearing (hearing aids? sign language? read lips?) ♦ Vision (are they wearing their glasses/lenses?) ♦ Aphasia (brain damage involving communication) ♦ Psychological barriers (intubated? oral problems?)

Chest Physical Therapy purpose and considerations

♦ Mobilizes pulmonary secretions ♦ Postural drainage - positioning and turning patient to help with drainage, not always necessary in all lung segments ♦ Chest percussion - pat chest wall rythmically with cupped hands over a single layer of clothing ♦ Vibration - shaking over certain areas ♦ Do not do percussion for patients on blood thinners or bleeding issues ♦ Do not do percussions for patients with osteoperosis or bone breakage

Oral care considerations

♦ Mouth care every shift, including tongue ♦ Denture care and gum care included ♦ Water-soluable lip moisturizer (no petroleum!) ♦ Encourage self-care if possible ♦ Is patient on anticoagulants? (gum bleeding, stomatisis) ♦ Conscious - place in semi-high or high Fowler's

Feet and nail care considerations

♦ Nails clean and filed (do not clip!) ♦ Be alert to diabetic patient's feet ♦ Clean between toes and dry well ♦ Podiatry may need to be consulted ♦ Check peripheral pulses to determine adequate blood flow >Peripheral neuropathy will require special hygeine considerations

Things to look for and terminology to use when documenting focused respiratory assessment

♦ Nasal Flaring ♦ Retractions ♦ Accessory muscle use ♦ Grunting ♦ Orthopnea (difficulty breathing while lying down) ♦ Paroxysmal nocturnal dyspnea (PND - sudden waking up with shortness of breath) ♦ Conversational dyspnea ♦ Stridor ♦ Wheezing ♦ Diminished or absent breath sounds

Oxygen delivery methods

♦ Nasal cannula (NC) >>>simple, up to 6L/min >>>typically use NC for COPD patients with ≤ 2L ♦ Masks >>>over nose and mouth >>>simple, short term, 30-60% >>>NOT for CO2 retainers (like COPD) ♦ Venturi masks >>>higher concentrations - 24-60% >>>can be used for COPD since precise ♦ Non-rebreathers (step before have to intubate) >>>60-95% >>>make sure bag IS inflated

Describe "airborne precautions"

♦ Negative pressure room that is private ♦ N95 or Respirator PAPR ♦ Supplies kept outside the room ♦ (or refer to hospital policy) ♦ Infection examples: TB, chickenpox, measles

Developmental changes in skin

♦ Neonates >>skin super thin, high risk for skin breakdown, change diapers frequently >>micropreemies, skin is like tissue paper ♦ Toddler >>developing greater risk to infection, important to teach good hygeine ♦ School Age >>often rely on parents to tell them when to bathe ♦ Teens >>more self-conscious, overactive sebacious gland, may bathe more frequentlywithout skin drying out as readily ♦ Older Adults >>skin dries out easier, may want only to wash face every day and bathe less often

Ear and nose care considerations

♦ No Q-tips in ears ♦ Take care of hearing aids ♦ Crusted nares can be softened with saline ♦ Suction nares as needed

What can you delegate to a UAP? (picmonic sourced)

♦ Noninvasive interventions >>Skincare >>Hygeine >>ROM exercises >>Mobility >>Grooming

What are the defenses against infection?

♦ Normal flora ♦ Body system defenses ♦ Inflammation (vascular and cellular responses)

Three parts of a water seal chest tube

♦ One chamber for suction ♦ One chamber for drainage of what comes out ♦ One chamber connected to water seal

Types of artificial airways

♦ Oral >>>Displaces tongue preventing obstruction of trachea ♦ ETT >>>Through nose possible, but usually orally >>>Short term (around 14 days) >>>Relieve obstruction, prevent aspiration, clear secretions ♦ Tracheal >>>Long term use (but can be short also) >>>Surgically placed

Complications of O2

♦ Oxygen toxicity >>>can set in after 1-2 days of being on 50% O2 or more >>>can damage alveolar-capillary membrane ♦ Absorption atelectasis >>>really high oxygen wipes out nitrogen required to keep lungs open >>>causes lung collapse (atelectasis) ♦ Dry mucous membranes ♦ Infection >>>empty any water in any tubing WHY WE WANT DESIRED RESULT USING LOWEST AMOUNT OF O2 POSSIBLE!

When to give oxygen?

♦ PaO2 <60mmHG >>> Keep around 80mmHG ♦ SaO2 <90% room air >>>Keep around 95% ♦ Change in patient baseline >>>Especially with COPD patients ♦ May be needed with fever, infection, anxiety, anemia

Chest tube care considerations

♦ Pain management - they are extremely painful! ♦ Positioning ♦ Assess for tension pneumothorax - no clamping!! ♦ All connections are taped ♦ Use occlusive dressing ♦ Keep vaseline gauze, sterile water and clamps at bedside

Why do nurses need teaching skills?

♦ Part of independent nursing practice >> should incorporate in everything you do ♦ Patients participate in healthcare decisions ♦ Hospital stays can be brief ♦ Healthcare is expensive >> teaching when to contact doctor vs followup vs ER >> don't want them racking up unnecessary bills

List safety hazards found in the community

♦ Pathogens (mosquitos, ticks, rodents) ♦ Pollution (outdoor and indoor, smoking = indoor pollution) ♦ Motor vehicle accidents (distracted driving, improper safety) ♦ Weather incidents (heat is most common) ♦ If a carseat has been in a car accident, must replace the carseat

Collaborative Professional Communication examples

♦ Patient rounding - patient's entire healthcare team gathers around the bedside to discuss patient's care ♦ Huddles - all nurses gather to get assignments, updates, best practices, etc

Considerations for bathing delegation

♦ Patient's limitations and restrictions ♦ The amount of assistance necessary for patient ♦ Use of assistive devices (canes, walker, gait belt) ♦ Specific safety precautions to follow (present by door, shower chair) ♦ Presence of obstacles and how to maintain them (tubes, catheters, bandages) ♦ Observations to make during the procedure and why they are important (skin condition, specimen collection, documenting presence or appearance of urine/stool) ♦ Is this an appropriate patient to delegate bathing for? ♦ Follow up afterwards! ♦ You are ultimately responsible!

When to be cautious giving oxygen?

♦ Patients with COPD >>> Primary drive to breathe is hypoxia, so if too much oxygen, they will stop breathing ♦ Need to frequently assess these patients >>>LOC, Sats, RR, ABGs

Who has an increased risk for aspiration?

♦ Patients with decreased level of consciousness ♦ Patients with decreased gag reflex ♦ Patients with decreased cough reflex ♦ Patients with difficulty swallowing Aspiration can cause pneumonia

Benefits of bathing and skin care

♦ Perfect time for an assessment >Notice dry skin, rashes, acne, abrasions, pressure points, dandruff, hair loss, lice ♦ Therapeutic for both patient and RN >Deepens respirations and improves circulation ♦ Partial bed bath can promote independence >Patient can help clean ♦ Psychological considerations

What are nursing diagnosis?

"Actual or potential health problems which nurses, by virtue of their education and experience, are capable and licensed to treat"

Rank the following nursing diagnosis as low, medium or high priority? "Ineffective Airway Clearance" "Risk for Falls" "Altered Role Performance"

"Ineffective Airway Clearance" - HIGH "Risk for Falls" - MEDIUM "Altered Role Performance" - LOW *Risk for falls has potential for future injury, but ineffective airway clearance is something they already have occurring.

What affects nonverbal communication?

♦ Personal appearance (professional attire) ♦ Posture and gait (get on their level) ♦ Facial expressions (avoid looking annoyed/shocked) ♦ Eye contact (culture can perceive as rude, trauma) ♦ Gestures (thumbs-up can be good or rude) ♦ Sounds (mm-hmm can show active listening) ♦ Touch (shoulder or holding hands, ask permission)

What is homeopathy's "law of similars"?

"Like cures like" • A substance that causes an illness in a healthy person can, when given in an extremely small dose, be used to effectively cure a person who is sick with that very same illness >>>Example: Cinchona (Peruvian tree bark) is used to treat malaria. When a healthy person ingests it, they get similar symptoms to malaria.

What is a "risk" in the hospital setting in regards to law?

"Risk" refers to legal risks that open up the possibility that legal action can be brought against the hospital for that unanticipated event.

What does TKO mean?

"To keep open" A very slow drip of solution to keep the vein open. Usally 20-30 cc/hour depending on hospital policy.

What does it mean when someone is technically aryan?

"of Europe's ancient Germanic tribes" Some groups are considered a separate race even though they are not "ex: Jews, Slavs, Irish"

What are the categories on the bristol stool chart?

#1 = constipation #4 = normal #7 = diarrhea

What is 'risk for activity intolerance'

'Risk for activity intolerance' is a nursing diagnosis. Example: Patient that has been on bedrest for a week and is now going to start getting out of bed

What developmental factors affect safety for preschool age children?

♦ Play extends to outdoors ♦ More adventurous ♦ Try new activities without practice ♦ More time outside the home ♦ Stranger danger ♦ Motor vehicle accidents - car seats not set properly ♦ Choking ♦ Falling from windows ♦ Accidental drowning ♦ Poisoning (medication!)

What could slow down diffusion?

♦ Pleural effusion ♦ Pneumothorax ♦ Asthma ♦ Anemia

List safety hazards found in the home

♦ Poisoning (carbon monoxide, household chemicals, lead, medicines, slime) ♦ Scalds/burns (hot water, grease, sunburn, cigarettes) ♦ Fire ♦ Firearms ♦ Electrocution (holiday lights) ♦ Falls! (slips, rug tripping, stairs, bathtub, low toilet seat, high bed)

Describe "contact precautions"

♦ Private room if possible, or in room with patient who has same infectious organism ♦ Gowns & Gloves (or refer to hospital policy) ♦ Remove PPE before leaving room ♦ Infection examples: VRE, MRSA, C. diff, open wounds

Eyes/Vision assessment components

-Inspect eyebrows/eyelashes -Cornea -Pupils -Reaction (direct / consensual) -Visual fields -EOM (extra ocular movements) up down, side to side starting at center with each movement check. Center up, center down, center right, center left -Visual acuity with Snellen Vision Chart (20 feet) or Rosenbaum Vision Chart 14 in. from chart -Light reflex (dim lights, come at eye from side with pen light) - Nystagmus = watch for 'bouncing' of eyeball at end of tracking (drunk driving test)

What is a "protective environment"?

♦ Private room with positive pressure for protecting patients at high risk of infection. ♦ Mask ♦ Gloves ♦ Gown ♦ (or refer to hospital policy) ♦ Patient examples: transplant patients, neutropenic patients secondary to chemotherapy

When to use surgical asepsis

♦ Procedures that perforate the skin > IV starts > Injections ♦ Compromised skin integrity > Fresh surgical incision > Performing a dressing change ♦ Insertion of catheters into sterile body cavities > Urinary catheter > PICC line > Central line placements > Accessing a port

What numbers does the pain scale run from and to?

0-10

What is a normal creatinine lab value?

0.6-1.2

NCLEX Question The ambulatory care nurse is discussing preoperative procedures with a Japanese American client who is scheduled for surgery the following week. During the discussion, the client continually smiles and nods the head. How should the nurse interpret this nonverbal behavior? 1. Reflecting cultural value 2. An acceptance of treatment 3. Client agreement to the required procedures 4. Client understanding of the procedures

1 Nodding or smiling by a Japanese American client may reflect only the cultural value of interpersonal harmony. This nonverbal behavior may not be an indication of acceptance of the treatment, agreement with the speaker or understanding of the procesudre.

What are our goals related to hygiene and ADLs?

♦ Promote normal structure and function of body tissues ♦ Assess ADLs ♦ Provide assistance ♦ Promote independence as much as possible ♦ Provide education ♦ Never assume

NCLEX Question How would you, as the nurse, support a culture of safety? Select all that apply. 1. Completing incident reports when appropriate 2. Completing incident reports for a near miss 3. Communicating product concerns to an immediate supervisor 4. Identifying the person responsible for an incident

1, 2, 3, 4

NCLEX Question The nurse educator is providing in-service education to the nursing staff regarding transcultural nusing care. A staff member asks the nurse educator to describe the concept of acculturation. The nurse educatory should make which most appropriate response? 1. It is a process of learning a different culture to adapt to a new or changing environment 2. It is a subjective perspective of the person's heritage and a sense of belonging to a group 3. It is a group of individuals in a society who are culturally distinct and have a unique identity 4. It is a group that shares some of the characteristics of the larger population group of which it is a part.

1. Acculturation is the process of learning a different culture to adapt to a new or changing environment. Option 2 describes ethnic identity. Option 3 describes ethnic group. Option 4 describes a subculture.

What is a normal isotonic range? 1. 250-375 mOsm 2. 375-410 mOsm 3. 220-620 mOsm 4. 110-200 mOsm

1. 250-375 mOsm 250-375 isotonic. over 375 hypertonic, under 250 hypotonic

The written goal statement in a client's care plan is: Client will have clear lung sounds bilaterally within 3 days. One of the interventions to meet this goal is that the nurse will teach the client to cough and deep breathe and have the clinet do this several times every 2 hours. At the end of the third day, the client's lungs are indeed clear. In order to relate the intervention to the outcome, the nurse should: 1. Ask how many times per day the client practiced the coughing and deep breathing exercises 2. Tell the client that the lungs are clear 3. Document the assessment findings to show the effectiveness of the intervention 4. Write thie evaluation statement: goal met, lung sounds clear by third day

1. Ask how many times per day the client practiced the coughing and deep breathing exercises Wees said that this is because this is an intervention that we teach the patient to do, but we do not have them do it with us there every time, so we need to know if it was performed in order to know if it led to the outcome.

What are the 4 predominant reasons prompting patients to file a lawsuit?

1. Desire to prevent a similar (bad) incident from happening again 2. A need for an explanation as to how and why an injury happened 3. A desire for financial compensation to make up for actual losses, pain and suffering or to provide future care for the injured patient 4. A desire to hold doctors accountable for their actions

Types of Distress

1. Developmental (Associated with life Stages; bodily changes, role changes) 2. Situational (Unpredictable; disasters, hurricane, covid-19) 3. Physiological (Affects body structure/function; Chemical/Physical, smoking, lack of sleep, etc) 4. Psychosocial (Arise from life; events, work, relationships, etc)

What is the order of assessment for the abdomen?

1. Inspection 2. Auscultation 3. Palpation 4. Percussion

What is the most appropriate response to describe the concept of acculturation? 1. It's a process of learning a different culture to adapt to a new environment 2. It's a group of individuals in a society who are culturally distinct 3. It's a subjective perspective of the person's heritage 4. It's a group that shares some of the characteristics of the larger group

1. It's a process of learning a different culture to adapt to a new environment

Which patient condition requires airborne precautions? 1. Meningitis 2. Influenza 3. Measles 4. C diff What will you always wear for airborne precautions? What other illnesses requires airborne precautions?

1. Meningitis N95 mask or respirator TB, chickenpox/varicella/shingles

A nursing diagnosis is NOT

1. Statement of equipment used in medical regimen (e.g. "Large blood pressure cuff needed for...") 2. Statement of medical regimen (e.g. "Give antibiotic as ordered by doctor") 3. Statement of a diagnostic procedure 4. A statement of a nursing activity. 5. A statement that includes the care required by the patient/client 6. Astatement of an interpersonal problem the nurse has with the patient/client (e.g "Pt uses call light too much") 7. A statement of a nursing need (e.g. "Give meds after break") 8. The same as a medical diagnosis ("Pneumonia related to respiratory congestion") 9. A statement that no problems exist that require nursing intervention. 10. A statement of a nursing problem ("Difficult to transfer to wheel chair...")

What is the normal range for urine specific gravity and what do we use it for?

1.002 - 1.030 1.00 is water, so if the specific gravity is low it can give indication of increased fluid. If high, can give indication they are dry.

How to clean patient with IV if no needle-free connector on tubing

1.Remove the gown first from the arm without the IV line. 2.Lower the IV container, and pass the gown over the tubing and the container, taking care to keep the container above the level of the patient's arm.

How many people on average will someone with COVID-19 infect?

10

What score on the geriatric depression scale indicates depression?

10 or greater

How many people per year are killed by medication errors on average?

100,000 people per year

What is a normal sodium (Na) lab value?

135-145

How much excercise is recommended?

150-250 minutes per week / 2.5-4 hours per week

Normal age range for potty training?

18-36 months If significantly older, can consider illness, stress, neglect, insufficient ADH

NCLEX Question When communicating with a client who speaks a different language, which best practice should the nurse implement? 1. Speak loudly and slowly 2. Arrange for an interpreter to translate 3. Speak to the client and family together 4. Stand close to the client and speak loudly

2 Arranging an interpreter would be the best practice when communicating with a client who speaks a different language. Options 1 and 4 are inappropriate and ineffective. Option 3 is inappropriate because it violates privacy and does not ensure correct translation.

Common skin issues

♦ Pruritus (itch) ♦ Dry skin ♦ Maceration (contact with moisture for too long) ♦ Excoriation (lesion created from picking at skin, not related to cosmetic reasons like acne or existing lesion) ♦ Abrasion ♦ Pressure injuries ♦ Acne ♦ Burns

IV solutions can only be hung for _____. Once they "expire" you have to change the bag for a new one. 1. 12 hours 2. 24 hours 3. 36 hours 4. 1 week

2. 24 hours

Which patient is appropriate to delegate morning cares to a UAP? 1. A patient complaining of new onset chest pain 2. A patient with a 4 day old stoma 3. A patient with activity intolerance 4. A patient with persistent vomiting following a head injury

2. A patient with a 4 day old stoma Remember that "activity intolerance" is someone that could go into respiratory distress and require assessment/intervention. 4 day old stoma is 4 days post-op and relatively stable. ***Palm said question like this is highly likely on the final***

What is albumin? 1. Viscous solution with crystallized sugar molecules used as an expander 2. A protein found in the plasma of the blood 3. A small country in Europe 4. The name of my mom's cat

2. A protein found in the plasma of the blood Albuming can be used as an expander (answer 1) but #1 is wrong because it is a protein and it does not contain crystallized sugar molecules

Which intervention is appropriate for a patient with a nursing diagnosis of Disturbed Sensory Perception: Gustatory? 1. Limit oral hygeine to 1x per day 2. Assess for open sores or open areas in the mouth 3. Teach the patient to combine foods in each bite 4. Instruct the patient to avoid salt substitutes

2. Assess for open sores or open areas in the mouth

Which situation would the nurse's use of critical thinking be a priority when providing care to a group of clients? 1. Administering IV push meds to critically ill patients 2. Educating a home health client about treatment options 3. Teaching new parents car seat safety 4. Assisting an orthopedic patient with the proper use of crutches

2. Educating a home health client about treatment options (she did not say why during the lecture, but likely because 'educating' is more complex than 'skills', so critical thinking is the key word in the question. The car seat option is also teaching/educating, but it's not complex and requiring critical thinking)

Which is an example of primary health prevention? 1. Scheduling a mammogram 2. Getting the flu vaccine 3. Attending rehab after a stroke

2. Getting the flu vaccine Vaccinations all fall under primary. Mammogram would be secondary, rehab would be tertiary trying to get them back to how they were

What is the most important thing an RN can do if they were concerned about risk for impaired skin integrity? 1. Place a barrier cream on patients 2. Identify those at risk 3. Turn patients frequently 4. Encourage ambulation

2. Identify those at risk All of these would likely be done, but the most important thing is the first thing you would do using your critical thinking skills, which is to identify

Which finding is contrary to what could be explained by a normal response to anxiety? 1. Increased HR 2. Low-normal hematocrit 3. Increased RR 4. Urinalysis indicating dehydration

2. Low-normal hematocrit All the other answers could be indicative of anxiety.

A patient is admitted for the diagnosis of dehydration. Which sign or symptom is the most common of a sodium imbalance? 1. Hyperreflexia 2. Mental confusion 3. Irregular heartbeat 4. Muscle weakness

2. Mental confusion

How long after surgery is it normal to have decreased bowel sounds?

24 hours

What is a "normal" patient serum osmolality?

275-295 mOsm/kg This is an isotonic state.

Risk factors for skin concerns

♦ Reduced sensation (hypoethesia) ♦ Vascular insufficiency ♦ Immobility ♦ Nutritional status ♦ Secretions/excretions on skin (IE: incontinence) ♦ Skin diseases ♦ Jaundice ♦ Casts, friction, retraints, etc

What do we use oxygen therapy for?

♦ Relieve or prevent hypoxia ♦ Remember oxygen is a medication and has side effects >>> Verify MD orders >>>7 rights for med administration

Metabolic causes of acidosis and symptoms

♦ Renal failure ♦ DKA (diabetic keto acidosis) ♦ Starvation ♦ Salicylate poisoning ♦ Diarrhea ♦ Fistulas (abnormal connection btw two body parts) ♦ Aspirin poisoning Symptoms Headache, confusion, restlessness, weakness, increased HR, rapid shallow breathing, drowsy, dysrythmia, coma, seizures

What level of pain is typically the goal in a hospital setting?

3 or less

An older patient who lives in an ALF mentions they are experiencing hearing and vision changes. Which type of sensory deprivation is this person experiencing? 1. Stable affect 2. Improved task completion 3. Altered perception 4. Increased need for social interaction

3. Altered perception

Which does NOT belong in regards to diabetic foot care? 1. Receives a foot exam every year 2. Inspects feet daily 3. Applies lotion to feet and in between toes 4. Does not cross legs

3. Applies lotion to feet and in between toes Lotion contains a lot of water and the moisture between toes can be a risk factor for a fungal infection, yeast thrives off of sugar so diabetic already has increased risk Yes they should inspect daily and have regular exams, no they shouldn't be crossing legs due to compromised vasculature

Which CAM therapy focuses on the relationship between the structure and function of the human body? 1. Massage 2. Acupuncture 3. Chiropractic

3. Chiropractic

Your patient's lab results show the patient is hypotonic with a serum osmol of 200. Which IV solution would work best to slowly bring this to isotonic? 1. 3% NS (1025 osmol) 2. LR (1775 osmol) 3. D 1/2 NS (406 osmol) 4. NS (150 osmol)

3. D 1/2 NS (406 osmol) Wees said something like this will be on the test. Key word when you see this on the test ***SLOWLY*** so you don't want something drastically higher/lower than where they currently are

Which of the following is considered a biology-based method in CAM? 1. Yoga 2. Acupuncture 3. Dietary supplements 4. Pet therapy

3. Dietary supplements Yoga = Mind-Body Acupuncture = Alternative medicine Pet therapy = Mind-Body

What is the first step in an abdominal assessment? 1. Percuss 2. Palpate 3. Inspect 4. Auscultate

3. Inspect We want to auscultate before we touch the abdomen, but we want to inspect before anything else. "Look, listen, feel"

What PPE do you apply second in the donning process? 1. Gloves 2. Gown 3. Mask 4. Hair covering

3. Mask Donning order: Gown, Mask, Hair Covering, Gloves *If face shield is to be worn, don after mask *If shoe covers to be worn, don after hair covering

Which meal tray should the RN deliver to a patient of Orthodox Judaism faith who follows a kosher diet? 1. Noodles and cream sauce with shrimp, veggies, mixed fruit, iced tea 2. Crab salad on a croissant, veggies, potato salad, milk 3. Sweet and sour chicken with rice, veggies, mixed fruit, juice 4. Pork roast, rice, veggies, mixed fruit, milk

3. Sweet and sour chicken with rice, veggies, mixed fruit, juice Orthodox Judaism does not eat shellfish, pork or meat with dairy in the same meal

Libby comes to the urgent care clinic after throwing up for the past 36 hours. Which ABG is most likely observed? 1. pH 7.30; PaCO2 50; HCO3 27 2. pH 7.43; PaCO2 50; HCO3 28 3. pH 7.49; PaCO2 43; HCO3 29 4. pH 7.47; PaCO2 30; HCO3 23

3. pH 7.49; PaCO2 43; HCO3 29

What is the acceptible lab range for potassium? Why is too high/low not as flexible for this particular lab value?

3.5-4.5 (or 3.5-5) The heart is very sensitive to potassium levels and a low or high value is a concern for cardiac rythm, heart attack, etc. If you see outside of 3.5 to 5, be concerned! 2.5 or less & 6.0 or more can be life-threatening (Mayo Clinic)

What is a normal potassium (K) lab value?

3.5-5 Memory trick: how many bananas do you usually buy in a bunch? 3.5-5

Proper way to use crutches?

30 degrees elbow flexion Do not rest on axillae (1-2in from armpit) Crutch moves with the inured leg

Symptoms of low oxygen / pulmonary embolism

♦ Restlessness ♦ Feeling of impending doom ♦ Anxiety ♦ Confusion

Which client DOES NOT have a high risk for obesity and diabetes mellitus? 1. 40 year old Latino American man 2. 45 year old Native American woman 3. 40 year old African American man 4. 23 year old Asian American woman

4. 23 year old Asian American woman

Which instruction should the nurse include when providing discharge teaching to a patient who has a visual deficit? 1. Install blinking lights for phone ringing 2. Wear properly fitting shoes and socks 3. Have gas appliances checked regularly for leaks 4. Avoid using throw rugs in the home

4. Avoid using throw rugs in the home Blinking lights would be for audio deficit, shoes and socks for diabetes, gas appliances for olfaction

What PPE do you remove last in the doffing process? 1. Gown 2. Gloves 3. Mask 4. Hair Covering

4. Hair Covering Doffing order: Gloves, Gown, Mask, Hair Covering *If face shield is to be worn, remove before mask *If shoe covers to be worn, remove last, touching only the inside ***If your mask is an N95/Respirator, only remove after leaving the patient's room!

What is a normal change related to aging? 1. Urinary incontinence 2. Long-term memory loss 3. Macular degeneration 4. Increased information processing time

4. Increased information processing time The other options are not normal changes due to aging

The nurse is conducting a thorough psychosocial assessment of a client who presents with complaints of fatigue, tearfulness and relationship difficulties. What action by the nurse would support accurate assessment? 1. Take detailed notes to record client responses 2. Ask as many questions as possible to explore all areas of concern 3. Start the interview by asking a series of yes/no questions 4. Investigate the client's culture prior to the interview

4. Investigate the client's culture prior to the interview Wees said this is because you would do this first and because it would help you to ask/act in a way that is suitable to the patient's culture. You would know their culture off their intake paperwork.

What is the most common type of anemia? 1. Normocytic 2. Alcoholism related 3. Liver deperfusion 4. Iron deficiency

4. Iron deficiency

After determining a nursing diagnosis of acute pain, the nurse develops the following appropriate client-centered goal: 1. Encourage the client to implement guided imagery when pain begins 2. Administer analgesic 30 minutes before treatment 3. Determine the effect of pain intensity on client function 4. Pain intensity reported as a 3 or less 30 minutes after physical therapy

4. Pain intensity reported as a 3 or less 30 minutes after physical therapy This one is specific, measureable, attainable and has a time component

What is important to educate patients about when they choose to use herbal and dietary supplements? 1. Nothing, we don't have to educate 2. Informing them they are making a big mistake 3. Telling them your favorite supplements 4. Purchasing from a credible source

4. Purchasing from a credible source

When arriving to a client's room to provide care, the client is praying with the family. What action shold be taken by the nurse? 1. Stand quietly just inside the room door until the prayer is completed 2. Come to the bedside and join in with the prayer 3. Politely ask the client to allow care to proceed 4. Quietly shut the door and wait in the hall until asked to enter

4. Quietly shut the door and wait in the hall until asked to enter This is because standing or otherwise being in the room could make the patient/family feel rushed.

Which of the following is not an HAI? 1. CLABSI 2. VAP 3. CAUTI 4. RSV What do all these acronyms stand for?

4. RSV - Respiratory syncytial virus (common virus) HAI = healthcare associated infection CLABSI = central line associated blood stream infection VAP = ventilator associated pneumonia CAUTI = catheter associated urinary tract infection

An elderly woman arrives in the ED after refusing to eat or drink for almost 4 weeks. The RN would expect which finding? 1. Increased BP 2. Jugular vein distention 3. Moist mucous membranes 4. Weak, rapid pulse

4. Weak, rapid pulse

What is ADPIE (definition and the acronym)

5 stages of the nursing process, the process for basic nursing care. Assessment (subjective and objective) Diagnosis Planning (make goals SMART) Implementation (direct or indirect care) Evaluation (did it work?)

What should the pH of urine be?

5.0-9.0

What is a normal glucose lab value?

70-100 Memory trick: how many M&Ms (glucose/sugar) do you usually eat at once? 70-100

What is a normal blood urea nitrogen (BUN) lab value?

8-21 Memory trick: how much would you spend on a cheeseburger in a bun? $8-21

Where do you hear rhonchi and what does it indicate?

♦ Rhonchi heard over larger airways ♦ Mixed issue - airway constriction and secretions ♦ "gurgling" sound that clears with cough

5 rights of delegation (picmonic sourced)

♦ Right Task >>Little supervision >>Repetitive >>Non-invasive >>Predictable results with minimal risk involved ♦ Right Circumstance >>Patient must be stable >>Consider available resources ♦ Right Person >>Qualified ♦ Right Direction/Communication >>Clear, consise, complete, correct information ♦ Right Supervision >>Provide appropriate monitoring, evaluation, interventions when needed and feedback

List example nursing diagnoses R/T safety

♦ Risk of Aspiration ♦ Risk for Contaminations ♦ Risk for Falls ♦ Risk for Injury ♦ Risk for Poisoning ♦ Risk for Suffocation ♦ Risk for Physical Trauma

Developmental factors that affect oxygenation in school age/teenagers:

♦ Secondhand smoke ♦ Smoking

Considerations for bed position for lung drainage

♦ Semi-Fowler reduces stasis of secretions ♦ For pneumo, pneumonia atelectasis you want to position patient "good lung down" to help promote perfusion ♦ For lung infection with pus drainage, put patient "good lung up" so pus doesn't drain into good lung ♦ Prone position currently being used for COVID-19 or head injuries

Considerations for using an interpretor/translator

♦ Speak to patient, not translator ♦ Still use your tone, gestures, facial expressions ♦ Say exactly what you intend to say to the patient ♦ Use family members as a last resort and gain permission (they might not know the medical terms, or might not translate everything you say)

What can you delegate to a LPN? (picmonic sourced)

♦ Stable patients with predictable outcomes ♦ Some invasive tasks >>Dressing changes >>Catheterization ♦ Some med admin >>Cannot give IV push meds, IV medications through central venous line, central venous access device, midline catheters ♦ Can gather patient data but RN must interpret it

What is special about chest tube dressing?

♦ The dressing is air tight ♦ Always have clamps, fresh sterile water and new airtight dressing at bedside for chest tube patients for emergencies!

What factors determine the rate of diffusion?

♦ The thickness of the membrane ♦ The total amount of lung tissue available

Why is effective communication important?

♦ Therapeutic communication promotes personal growth and is key to nurse-patient relationships ♦ Patient safety requires effective communication ♦ Improves patient outcomes and increases patient satisfaction ♦ Joint Commission National Patient Safety Goal

Majority of older Americans have below average health literacy. What is a result of this?

♦ They tend to use the ER more often (expensive) ♦ More often back in less than 2 weeks ♦ More likely to be hospitalized Can be prevented if we communicate and educate patients at a better level

A postoperative patient is using PCA. You will evaluate the effectiveness of the medication when: A. you compare assessed pain w/baseline pain. B. body language is incongruent with reports of pain relief. C. family members report that pain has subsided. D. vital signs have returned to baseline.

A Patient is the best judge of whether they are getting pain relief or not

Respiratory assessment - palpation

♦ Thoracic excursion (hands posteriorly around 10th rib and looking for symmetrical movement with inspiration) ♦ Tenderness or masses ♦ Skin temperature ♦ Capillary refill ♦ Edema

Pneumonia main points

♦ Typically get after URI or flu ♦ Full-scale inflammatory response from alveoli ♦ Alveoli fill up with exudate (pus and fluid) ♦ Causitive agents: fungi, virus, parasite (rare) ♦ Cough, malaise, chest pain with breathing, discolored sputum, fever, chills, high WBC count, dyspnea ♦ Can be transmitted in air, through contact, dirty respiratory equipment (IE sleep apnea machine, vent tubes)

What it means when it says high-flow regarding enemas

A "low" enema is given by standard procedure. A "high" enema attempts to clear as much of the large intestine as possible. With a "high" enema, the client receives initial instillation of the fluid in the left lateral position. The client then moves to the dorsal recumbent position and then the right lateral position for the remainder of the instillation. This turning process allows the fluid to follow the shape of the large intestine.

Those at higher risk of infection due to inadequate perineal care

♦ Uncircumsised males ♦ Urinary catheters ♦ Rectal/genital surgery ♦ Childbirth ♦ Incontinent ♦ Morbidly obese

Other factors affecting pulmonary system

♦ Underlying pulmonary disease >>> Pulmonary hypertension, pulmonary embolism ♦ Neurological disease >>>Stroke >>>Spinal cord injury >>>Apnea >>>Neuromuscular diseases (ALS, Guillain Barre)

Complications related to ETT

♦ Unplanned extubation - IE confused patient pulls out tube ♦ Aspiration ♦ Infection ♦ Laryngeal/upper airway damage ♦ Hypotension ♦ Barotrauma ♦ VAP (ventilator associated pneumonia) **Oral care every 4 hours or less is very important**

Who or what can an RN not delegate? (picmonic sourced)

♦ Unstable patients ♦ Any element of nursing process: ADPIE ♦ Starting or monitoring parenteral therapy ♦ Discharge planning ♦ Health education ♦ Transfusions of blood or blood products

Environmental factors that can affect oxygenation

♦ Urban living (pollution, smoke, allergies) ♦ Occupational pollutants (allergens in workplace, coal miners example)

Considerations for health promotion

♦ Vaccinations >>> annual flu vaccine >>> especially for those in long term care, those that are immunocompromised, adults over 50 ♦ Lifestyle >>> Nutrition, body weight, smoking cessation, exercise ♦ Environment >>> Avoid secondhand smoke, wear masks

Ventilation vs Respiration

♦ Ventilation is the movement of a volume of air into and out of the lungs. ♦ Respiration is the exchange of oxygen and carbon dioxide across a membrane >> External respiration = the exchange of gases with the external environment. Occurs in the alveoli of the lungs. >> Internal respiration = the exchange of gases with the internal environment, and occurs in the tissues.

Focused assessment for F/E and A/B

♦ Vital signs ♦ Weights ♦ Input/Output

What affects verbal communication?

♦ Vocabulary (don't use medical jargon with pts, developmental age tailoring) ♦ Denotative (literal meaning) ♦ Connotative (interpretation of meaning) ♦ Pacing - appropriate speed of speech ♦ Tone ("your test results are in" happy or monotone) ♦ Clarity and brevity ♦ Timing and relevance (are they in pain? hungry?) ♦ Credibility ♦ Humor (be cautious)

What is an antibody?

A blood protein produced in response to an antigen

How is a pneumothorax or hemothorax relieved?

A chest tube is inserted to drain the air or blood from the chest cavity

Rather than a respiratory disease, what have we begun referring to COVID-19 as? Why?

A circulatory system disease. This is because we are seeing long term repercussions such as kidney failure, strokes, glaucoma, heart conditions, blood clots

What is pneumothorax?

A collapsed lung

What is critical thinking?

A combination of: Reasoned thinking Openness to alternatives Ability to reflect A desire to seek truth Reflect on your assumptions Linked to evidence based practice Helps you know what is important and how to figure out what interventions to use and why NURSES ARE CRITICAL THINKERS - characteristic that distinguishes a professional nurse is cognitive not a psychomotor skill

What is a communicable disease?

A disease that spreads from one person or animal to another.

What is a reservoir?

A habitat in which that microbe lives, grows, and multiplies. Reservoirs can include humans, animals, and the environment.

What is inference?

A logical assumption - cannot prove it is true, but have signs that suggest it might be the right answer Kind of like a hunch, an idea what something might be based off of observations. Nursing diagnosis are inferences - only your reasoned judgement, more or less accurate Example - patient trembling and crying, inference they may be anxious

What does a wheeze sound like and what does it indicate?

♦ Wheezes are "musical" or "high-pitched" >>> Indicate narrowing of the airways (can be obstruction)

What is albumin? Where produced? What does it do and what texture is it? What does high and low albumin indicate?

A protein found in the plasma in the blood • Produced by the liver • Prevents fluids from escaping the blood vessels, can be used clinically to increase low blood pressure • Viscous (like honey) • High albumin = dehydration/dry • Low albumin may indicate malnutrition, liver disease, kidney disease, stress response

What is a virus?

A protein molecule looking for a host

What is a bowel diversion? What is the output from a bowel diversion called?

A surgical procedure where the pt no longer eliminates from the anus, but from elsewhere in the body. Output is called "effluent"

What does "frail/fragile elderly" mean?

A syndrome or set of characteristics that describes a heightened state of vulnerability for developing adverse health outcomes. It is a multi-system reduction in a person's physiological capacity. The point at which the human organism is believed to have its least capacity for survival and will frail in response to minor internal/external insult. IE: much more likely to die from something like the common cold

What is the Braden Scale and how often is it used? Does a lower score mean a higher or lower risk?

A tool used for predicting pressure sore risks. Typically done every shift, may even be built into charting program. 12 or below = high risk 13-14 = moderate risk 15-16 = low risk

What is "tort"?

A wrong that causes harm. Tort requires the following to be valid: • Accused wrongdoer had to have a duty • There had to be a breach of duty • There had to be harm (some claim emotional distress as harm) • The harm has to be a result of the breach of duty

In order to provide safe, effective care, when assessing a client's use of alternative therapies, the nurse should ask: A. What herbal supplements have you taken? B. Have you ever used relaxation therapy? C. What types of activities or remedies do you use when you do not feel well? D. Do you use holistic treatments?

A. Phrasing in a non-judgemental way, assessing that they aren't taking anything that will be contraindicated and so we can be transparent with the provider.

The nurse is administering a sustained release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's best course of action? A. Ask the prescriber to change the order. B. Crush the pill with a mortar and pestle. C. Hide the capsule in a piece of solid food. D. Open the capsule and sprinkle over pudding.

A. We cannot crush, chew or open a sustained release capsule.

NCLEX Question The client has a draining abdominal wound that has become infected. In caring for the client, the nurse will implement A.Contact precautions B.Droplet precautions C.No precautions D.Airborne precautions

A. Contact precautions

ABG test example: What do Jack Black's lab results indicate? Jack Black's labs are: pH of 7.31 PaO2 = 77 PaCO2 = 51 mmHg HCO3 = 25 mEq/L A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. metabolic alkalosis

A. Respiratory Acidosis

"Risk for" diagnosis never have what?

AEB / AMB

What is adjunctive therapy?

drugs that do not contain acetaminophen and those not classified as nonsteroidal antiinflammatory or opioid agents

When would we see white blood cells in the urine?

during an infection

Eustress vs. Distress

eustress: positive stress, protective distress: negative stress, can threaten health

What is alopecia?

hair loss

What does half-life mean?

half-life is the time it takes for the body to lower the amount of medication by half. Short half-life meds needs to be given more frequently than longer half-life meds.

If you see redness in skin assessment and press on it with your finger, you typically expect to see blanching. If there is no blanching, what does that indicate?

indicator of pressure ulcer starting

What is pyelonephritis?

inflammation of the kidneys or ureters

When would we see bilirubin in the urine?

kidney damage, gallstones

Nurses are _____________________ when they suspect abuse.

mandatory reporters Nurses are legally required to report suspected child abuse, suspected elder abuse or neglect to The Department of Health & Welfare and/or The Commission on Aging who contacts law enforcement.

Normal ABG values for ABG

pH = 7.35-7.45 PaCO2 = 35-45 HCO3 = 22-26 PaO2 = 80-100

Which position seems to help COVID patients oxygenate?

prone

More Abbreviations q (lowercase Q) VSS s/p Abx s/s ac pc hs WA NOC ad lib EOS

q (lowercase Q) - every (as in q day) VSS - vital signs stable s/p - status post Abx - antibiotics s/s - signs & symptoms ac - before meals pc - after meals hs - hour of sleep, bedtime WA - while awake NOC - night shift ad lib - as desired EOS - end of shift

What is SSI?

surgical site infection

What is an etiology?

the cause or reason for the nursing diagnosis Better to use "unknown etiology" than "unknown factors" or "psychosomatic conditions"

What is VAP?

ventilator associated pneumonia

How many ml/day should fluid intake be?

~ 2300 ml/day

What is the volume of urine a normal bladder can hold?

~500mls • 300+ mls can be painful. • Possible to hold 1000mls in some cases. ***If you feel patient is retaining urine, you can palpate the suprapubic region

What colors are the different needle gauges? (memory tricks in parenthensis, I hope they help!)

• 14 = orange (a sonnet poem has 14 lines... and orange does not rhyme?) • 16 = grey (grey like asphalt, new drivers are 16?) • 18 = green (green rhymes w/ 18) • 20 = pink (pink rhymes w/ wink - one eye/2020 vision) • 22 = blue (blue rhymes w/ 22) • 24 = yellow (24 carat gold looks yellow)

Volume ranges for IM injections?

• 2-5 ml for adults • 1 ml for children • 0.5 ml for infants

Chronic illness statistics

• 70% of all deaths in the US • 80% of older adults have at least one • 50% of older adults have at least two • 36% of adults and 17% of children were obese (2011-2014) • 1 in 3 adults have arthritis • Hypertension, hyperlipidemia, diabetes, arthritis • Depression can be brought on by chronic conditions

What is a breach of duty?

• Action outside the standard of care. • Would a "reasonable and prudent" person have done the same thing or not? • Example using latex catheter for someone with latex allergy AKA negligence

List nursing diagnosis related to pain

• Activity intolerance • Anxiety • Fatigue • Insomnia • Impaired social interaction • Ineffective coping • Impaired physical mobility

What are the five different types of pain?

• Acute (AKA transient) ---protective, identifiable, short duration, limited emotional response • Chronic (AKA persistent) ---not protective, has no purpose, may or may not have identifiable cause • Chronic episodic ---occurs sporadically over an extended duration • Cancer ---can be acute or chronic • Idiopathic ---chronic pain without identifiable physical or psychological cause

What are the types of side effects?

• Adverse (undesired/unintended....mild to severe, IE coma after a med) • Toxic (symptoms that risk permanent damage. IE drug that if given at too high dose or over a period of time cause nerve damage in the ear is called ototoxic. Some drugs may be nephrotoxic (kidney), heptatoxic (liver)) • Idiosyncratic (Unexpected side effect, but not necessarily a bad thing) • Allergic reaction (involves the immune system, drug is thought to be foreign substance and makes antibodies against it. The allergic reaction may worsen the next time the patient comes in contact with the drug.)

What are the physiological factors that influence pain?

• Age • Genes • Neurological function • Fatigue ---Fatigue increases the perception of pain and can cause problems with sleep and rest.

Fluid/Electrolyte considerations for assessment

• Age: very young and old at risk for F/E imbalance • Environment (example: excessively hot outside) • Dietary intake: fluids, salt, foods rich in potassium, calcium, and magnesium • Lifestyle: alcohol intake history • Medications: include over-the-counter (OTC) and herbal, in addition to prescription medications • Medical history (recent surgery, GI output, acute illness or trauma, chronic illness) • Daily weight • Fluid I&O (food, drink, IV... urine, diarrhea, vomit, suction, wound drainage, etc) • Lab studies

What is Ayurveda?

• Alternative medical system from ancient India • Health is a balance between 3 forces called Dosha (creation, preservation, destruction) • Imbalances may be related to age, lifestyle, diet, seasons • Practitioner obtains lifestyle history and physical assessment to determine person's Dosha • Interventions used aim to reduce symptoms through prescribing exercise, breathing, meditation, herbs

List organizations that have clinical guidelines available to manage pain:

• American Pain Society • Sigma Theta Tau • National Guidelines Clearinghouse

What are the two kinds of pet therapy and benefits?

• Animal assisted therapy - animal is part of treatment >>helps with anxiety of pt and visitors, encourage pts to take medication • Pet visitation - increase socialization and keeps pt in touch with reality, feelings of "at home" ****Also therapy for the staff. ***Contraindicated with allergies

Which medications impact elimination and how?

• Antacids slow peristalsis • Aspirin and NSAIDs irritate stomach • Antibiotics wipe out the gut flora causing discomfort/diarrhea • Opioids slow down peristalsis and cause constipation

List things that can increase risk for diarrhea

• Antibiotics • Enteral nutrition • Food intolerances • Diagnostic testing • C. diff • Food borne illness

What are the psychological factors that influence pain?

• Anxiety • Coping style • Pain tolerance - the level of pain someone is willing to accept

When there is an issue that presents the need for a disclosure, what are the two things that patients usually ask?

• Are there gonna be problems down the road from this? • What are you going to do to prevent this from happening again?

Considerations for sleeping disorders:

• Assess for pain, pain med before bed could help • Keep active during the day • Keep light dim and noises low • Consider "do not disturb" signs • Collaborate between day and night shift to do as many procedures as possible during the day • Confusion may be related to sleep disorder

When assessing for pain, what do we need to remember?

• Assess through the patient's eyes - pain is individualistic >>> Ask about their pain level >>>Use ABCs of pain management >>> Pain is not a number • Be aware of possible errors in pain assessment • If using a tool, be aware of clinical usefulness, reliability and validity of the tool in that specific patient population

Safety considerations regarding supplements/herbs

• Assess what they are taking - possible contraindications or side effects could be causing the issue • Lack of standardization • Lack of formulary • Drug-drug interactions • Toxicity

Assisted living vs nursing care facility vs memory care

• Assisted living - provides services for someone who needs some but not full assistance. Semi-autonomous, able to manage some ADLs but may need help. 24 hour supervision, so not considered "aging in place". (IE some memory or mobility problems) • Nursing care/home - require around-the-clock care and monitoring. More complex requirements needing assistance. Skilled (IE physical therapy, respiratory therapy) and unskilled care (IE bathing, hygiene, feeding) • Memory care - Like nursing care but with additional staff specialized to assist with memory impairment

What are the social factors that influence pain?

• Attention • Previous experience • Family and social support • Spirituality ---Spirituality includes active searching for meaning in situations, such as "why am I suffering?" • Cultural ---interpretation of meaning of pain and expression of pain can vary with culture and ethnicity

List types of alternative medical systems

• Ayurveda (from ancient India, health is balance between 3 forces) • Chinese medicine • Acupuncture • Homeopathy • Naturopathy

Food intake factors influencing elimination

• Bacteria in yogurt promotes peristalsis and healing in GI tract • Pasta and simple carbs can slow down peristalsis • Beans, spicy foods cause gas and frequent defacation • Allergies can cause diarrhea, discomfort, bloating, gas, intestinal bleeding

What is naturopathy?

• Based on the healing power of nature • Health is the outcome of understanding that nature allows the body to heal itself • Disease and aging result from ignoring the laws of nature • Supports body healing itself through nutrition, lifestyle counseling, dietary supplements, medicinal plants, exercise, massage, joint manipulation

In regards to medication, the patient has the right to:

• Be informed of med name, purpose, ADE (adverse events) • Refuse • Have healthcare provider assess med history • Advised if experimental • Labeled meds • No unnecessary meds • Informed if part of a study

What effects do pain have on the patient?

• Behavioral effects • Influence on ADLs

What to assess for abuse

• Bruising around head, neck, face or in an area you would not expect bruises, or bruising patterns • Burns • Fractures (especially multiple fractures) • Depression, withdrawn, not engaging in favorite activities • Dehydration, malnutrition • Excoriation from urine/feces • Delerium • Infection

What are the different types of laxatives and examples?

• Bulk forming agents: Nonfoods, Metamucil >>> high in fiber, needs increased water intake to be effective • Softener: Colace >>> enables moisture and fat to penetrate stool • Osmotic: Miralax >>> draws water into the stool from surrounding tissue • Lubricant: Mineral oil >>> coats stool and GI tract with waterproof layer • Stimulant: Dulcolax, castor oil, senna >>> irritates bowel wall to stimulate intense peristalsis

Which vitamins impact elimination and how?

• Calcium can cause constipation • Magnesium can loosen stools • Vitamin C can soften stools

How can we help reduce errors related to self-medication with older patients?

• Calendar or chart on when to take meds • Pill box that has all the days of the week • Placing drugs in larger sized cartons • Printing in larger print, color-coding • Easy to open caps

Why encourage exercise in older adults?

• Can improve continence • Prevent further loss in mobility • Impoves strength, balance, endurance • Helps with fall prevention • Maintain independence longer • Maintain health • Reduce morbidity Some activity is better than none, and more is better than some!

Jean Watson's theory

• Caring is the primary focus of nursing • Authentic presencing

What are the three different types of drug names? (nomenclature)

• Chemical name >>>N-acetyl-para-aminophenol • Generic name >>>acetaminophen • Brand or Trade name >>>Tylenol

What are manipulative and body-based healing modalities?

• Chiropractic • Massage • Osteopathy

What is magnet therapy?

• Claimed to improve movement and musculoskeletal pain, especially in injury or arthritis • Idea is that iron in hemoglobin is attracted to the magnet, which increases bloodflow to the area and helps with healing

Things to be mindful of when caring for patients with an indwelling catheter

• Clean perineal area daily • Clean well after each bowel movement • Encourage fluids (helps flush bacteria) • Prevent trauma (watch for pulling on tubing) • Monitor urine output • Be sensitive • Allow for independence if possible (cleaning) • Always be assessing!

Special considerations for older adults with med admin

• Clear instructions • Memory aids • Assess for dysphagia (difficulty swallowing) • Review medications (including OTC) • Educate • Physiological changes (may affect absorption) >>> liver shrinks >>> decrease gastric emptying >>> decrease renal blood flow >>> decrease lean body mass >>> decrease total body water

What are some behavioral responses to pain that you may see? May use these terms for charting.

• Clenching teeth • Facial grimacing • Holding or guarding the painful part • Bent posture • Chronic pain will affect a patient's activity level

What do we assess for in a urinalysis?

• Color • Clarity • Odor • pH • SG • Protein • Glucose • Ketones • Bilirubin • WBCs • Nitrate • RBCs

What are the two types of holistic modalities?

• Complimentary - treatment used together with traditional medical care • Alternative - used instead of traditional medical care Holistic is AKA as "CAM" (complimentary and alternative medicine)

Difference between concentration meditation and mindfulness meditation?

• Concentration focuses on breath, sound (like a mantra) or object • Mindfulness directs thoughts, feelings, attention at one thing to open your mind to relaxation

What are the reasons for using an NG tube?

• Decompression • Enteral feeding • Compression • Lavage

Nursing diagnosis examples related to fluid imbalances

• Decreased cardiac output • Acute confusion • Impaired gas exchange • Excess fluid volume • Risk for electrolyte imbalance • Deficient knowledge regarding disease management • Risk for injury • Deficient fluid volume

Driving safety considerations for older adults

• Decreased reaction time normal with aging • Medication reactions (such as hypotension) • Falling asleep at the wheel • Neuro or muscular defecits • Wear glasses/hearing aids • Encourage a refresher course! • Avoid high traffic/icy areas

What are the three D's of cognitive problems?

• Depression • Dementia • Delirium ***These are not normal in the process of aging, but are common

What is yoga and what is it beneficial for?

• Designed to integrate body, mind and spirit • Improves breathing and posture through stretching and positioning • Known to decrease BP, increase heart and respiratory function, improves physical fitness, decreases anxiety

What is homeopathy?

• Developed by Hippocrates in 5th century • All symptoms represent the body's attempt to restore itself • Based on 3 principles: law of similars, law of minimum dose, single remedy

Side effect of probiotics? Patient contraindication for probiotics?

• Diarrhea side effect • Immunocompromised pt contraindicated

Caregiver role strain causes

• Difficulty in performing caregiver role • Unpredictable or unstable illness course • Caregiver has health problems • Multiple competing roles • Caregiver has no respite from caregiving demands ***Thinking about holistic care includes thinking about the caregiver too because the caregiver impacts the patient

Margaret Newman's theory

• Disease as disequilibrium • Sometimes imbalance stimulates person towards growth and is sometimes necessary and beneficial for adaptation

Things to remember regarding safety with medication administration

• Don't let yourself be interrupted • One patient at a time • Involve patient (they may know something you don't, like someone else just gave that medication) • Document only AFTER you have given the medication • Only document what you gave • Don't leave pills at the bedside • Do not delegate! • Question orders - make sure dose is correct, patient is not allergic • Have another RN check your math • Assure wrappers are intact • Waste narcotics with a witness • Report and document any abnormal side effects • If a dose was missed, have to notify physician, notify charge nurse, reschedule and document (includes patient refused, errors, held for some reason) • If patient is questioning the medication, always check again • Record if medication is held or refused

What is Traditional Chinese Medicine (TCM)?

• Each person has their own balance of yin & yang energies and if balances are disturbed, ill health will result • Yin and Yang each associated with characteristics like temperature, color, scent, etc • Treatment often includes lifestyle modifications and herbs often given in tea form *** Prof Palm mentioned this is important: Illness traditionally thought to be imbalance of hot/cold - if thought to be cold illness, will consume hot foods and liquids, bundle up in blankets

In addition to physical sensation, what are the other components of pain?

• Emotional • Cognitive

Martha Rogers' theory

• Energy fields affect health

Which medications can you not crush?

• Enteric coated (EC) • Timed released capsules • Sustained released (SR) • Long Acting (LA, XL, CD) • Buccal tablets • Sublingual tablets

What are eucalyptus, peppermint, lavender and tea tree each used for as related to aromatherapy?

• Eucalyptus - protect against respiratory problems, cough/cold • Peppermint - relieve nausea and heartburn, headaches, muscle aches • Lavender - relaxation, decrease stress • Tea tree - fungal infections, lice, help clear skin

How often do IVs need to be changed?

• Every 3-5 days (depending on hospital policy) EXCEPTION: 24 hours maximum to change an IV started in the field (example: hiking accident)

5 reasons for legal actions against nurses

• Failure to follow the standards of care mandated by the hospital relating to giving medications or using medical equipment and devices • Failure to communicate to physicians changes and observations of a patient's condition • Failure to properly document the patient's treatment • Failure to access and monitor the condition of the patient • Failure to act as the patient's advocate

Cultural considerations for Catholics

• Fasting during lent • No meat on Fridays (fish okay) • Have "last rights" by a priest if death is eminent • Receive blessings from their priest • May want a rosary near them or on them when critically ill

What are the s/sx of depression? What are some treatment options?

• Fatigue • Anorexia • Constipation • Subjective feelings aren't necessarily only "sadness", can say they are feeling "irritable" or something similar • Antidepressants, but side effects may not be worth the benefit for older adults and can take weeks to see benefit - monitor at all times • Reminiscing - positivity, significant life experiences

Fluid balance relies on which factors?

• Fluid intake >>> Thirst is important regulator • Fluid distribution • Fluid output • Things that regulate fluid volume >>> Brain - Antidiuretic hormone (ADH) >>> Kidney - Renin-angiotensin-aldosterone system (RAAS) >>> Heart - Atrial natriuretic peptide (ANP)

What are some complications that can occur due to IV therapy?

• Fluid overload • Infiltration - fluid left vein and went into tissue • Extravasation - infiltration that contained medication which sloughed off tissue • Phlebitis - inflammation around the insertion site • Local infection • Bleeding at the infusion site

Cultural considerations for Orthodox Judaism

• Foods must be prepared in kosher kitchens • No meals containing both meat and dairy • No pork/pork products • No shellfish

Influences on drug actions

• Genetics • Age • Body weight • Comorbidities • Stress (we metabolize at different rates with stress) • Diet

Considerations for the following nationalities: • German • Hispanic • Japanese • Chinese • Philipino • American Indians

• German - often stoic, don't complain or cry, don't say they are in pain • Hispanic - often animated, can have large family visits, very expressive • Japanese - often agreeable or smiling even when in pain • Chinese - often friendly, may have literacy differences • Philipino - often have huge family connections and primary focus on their families • American Indians - Wees only said "what are their belief systems and what are they gonna go for or not go for"

What is imagery?

• Guide imagination to create desired event or scenario • Focus attention on creating desired outcome

Top 8 leading causes of death in the elderly:

• Heart disease • Cancer • Chronic lower respiratory diseases • Stroke • Alzheimer's disease • Diabetes mellitus • Accidents • Influenza and pneumonia

What are the most expensive health conditions?

• Heart disease • Cancer • Stroke • Diabetes Because they are long-term and rarely cured. ***can be modified or prevented with healthy behavioral interventions

Risk factors for falls

• History of falls • >80 years old • Multiple illnesses • Weakness • Confusion • Incontinence (wet floor, hurrying) • Communication impairments • Vision impairment • Substance abuse • Environment

Types of medication allergy reactions

• Hives • Rash • Itching • Rhinitis • Wheezing • Angioedema Consideration: narcotics can have an itching side effect that is not related to an allergic reaction

IV site selection tips

• Hot pack both arms • Select the straightest vein • Avoid valves • Take advantage of bifurcations • Ask the patient if they are a hard stick • Sit down • Raise the bed up • Use lots of alcohol swabs • Make the pt laugh • Bevel up!!

At what angle do you give an IM injection? Angle for a subcutaneous injection? Angle for an intradermal injection?

• IM - 90 degree angle • Subcutaneous - 45 degree angle • ID - 10-15 degree angle

What is homeopathy's law of minimum dose?

• If a large dose can stimulate disease, then a small dose can stimulate the body's defense against the disease >>>Similar to idea of antibodies

What are some changes that should be made to a home where an elderly person is "aging in place"?

• If bedroom was on a second floor, consider moving to the first floor • Additional lighting, especially in stairways • Remove rugs due to tripping hazard • Possible home healthcare nurse

What types of health conditions would be contraindicated for acupuncture?

• Immunocompromised due to breaching the skin with a needle, can introduce pathogens • Bleeding disorders

Benefits of laughter?

• Increase pulse • Increase respiration • Increase oxygenation • Increase relaxation • Decrease stress

Nursing diagnosis related to COVID-19

• Ineffective airway clearance • Impaired gas exchange • Altered thermoregulation (IE fever) • Anxiety related to lack of knowledge and powerlessness

Reasons for performing a bladder irrigation

• Instill medications into bladder • Restore or maintain patency (keeping bladder open) • Continuous bladder irrigation (CBI) can be used to flush blood clots, loose tissue, mucous etc especially after surgery

Which drugs are measured in units?

• Insulin • Penicillin • Heparin • Some electrolytes

What is therapeutic touch?

• Involves laying on of hands • Provides comfort, pain relief and healing • Premise is that humans consist of energy fields that penetrate the body and exist outside the body • In pain and illness, the freeflow of energy is disrupted, the practitioner rebalances the energy

What is reiki?

• Involves laying on of hands or hands a few inches from body • Patient draws energy from the practitioner

What are the three types of IV solutions?

• Isotonic: 250-375 mOsm ("I so" perfect) • Hypotonic: <250 mOsm • Hypertonic: >375 mOsm ("high is dry")

How does critical thinking help you manage a patient's pain?

• Knowledge of pain physiology and the factors that influence pain help you manage a patient's pain • Critical thinking attitudes and intellectual standards ensure the aggressive assessment, creative planning and thorough evaluation needed to obtain an acceptable level of patient pain relief, while balancing treatment benefits with associated risks

What are the signs that you need self care?

• Lack of sleep • Feelings of busyness and being overwhelmed • Over-commitment • Disorganized • Neglect of health • Disconnection of mind and body • Discouragement and apathy

What are probiotics, their benefits and two main species?

• Live microorganisms similar to those found normally in our GI tract • Taken orally, enhance immune response, stabilize GI mucosal barrier. • Useful for antibiotic-associated diarrhea, IBS, bladder and intestinal infections, yeast infections, lactose intolerance • Lactobacillus and bifidobacterium ***Key is keeping all different species in balance. Imbalance can lead to compromised health

Why do we give a patient an IV?

• Maintains patient's daily fluid requirements • Replaces fluids lost from procedures • Access to the veins to give fast acting medication • Can pull off excess fluids (like a dry sponge)

What is massage?

• Manipulation of muscles and other soft tissues • One of oldest forms of healing • Control stress, improve mobility, relieve pain, promotes muscle relaxation, increases lymphatic circulation by decreasing inflammation, breaks up scar tissue and improves blood flow throughout muscles

What is chiropractic medicine?

• Manipulation of the body focusing on the relationship between the structure of the spine and the function of the human body • Believes disease is caused by irritation of the nervous system • 31 pairs of spinal nerve branches off the spinal cord that innervates all organs in the body • Manipulation of body structures can relieve pressure on nerves to allow proper flow of nerve impulses

What do we assess in regards to medication administration?

• Medical history • Medication history • Allergies • Diet • Physical assessment is a must prior to med administration

Nontherapeutic medication use examples

• Medication abuse (IE selling their meds) • Medication dependence • Nonadherence (antidepressant is good example, feel better and stop taking it on their own)

Adventitious breath sounds

Abnormal breath sounds Crackles -Air passing through fluid or mucous -Most common in lower lobes Gurgles -Air passing through narrowed air passages as a result of secretions/swelling/tumors -Predominately over trachea and bronchi Wheezes -Air passing through constricted bronchus -High pitched; on expiration Friction rub -Rubbing together of inflamed pleural surfaces -Superficial grating heard during inspiration and expiration

What is enuresis?

Accidental passage of urine. >>> Nocturnal enuresis = nighttime bed wetting

What does "ADL" stand for?

Activities of Daily Living

What is ADL and what are some examples?

Activities of Daily Living Personal Hygiene (bathing, grooming, oral or nail care) Continence Management (mental/physical) Dressing (ability to select and wear proper clothes) Feeding (can feed themselves or not) Ambulating (person's ability to move independently) Toileting (6 looked at by insurance companies, will pay for homecare if patient needs assistance witih two or more)

Examples of nursing diagnosis related to mobility and exercise

Activity Intolerance Impaired Physical Mobility Risk for Disuse Syndrome Sedentary Lifestyle Etiologies for the above Acute pain r/t musculoskeletal injury Ineffective health maintenance r/t bedrest Risk for injury r/t unsteady gait

What are the three types of nursing diagnosis?

Actual Risk Possible

What are the four types of NANDA diagnosis?

Actual (Problem-Focused) Risk Health promotion Syndrome

Actual diagnosis vs potential diagnosis

Actual diagnosis Constipation r/t decreased fluid intake and decreased activity AEB No BM in 4 days Potential diagnosis Risk for Falls r/t RLE weakness (Risk for dx: NEVER have an AEB)

Acute vs chronic nature of illnesses

Acute • Short period of time • Range from limited to major • Expected to recover Chronic • More than 6 months • Life changes • Remission • Exacerbation • Cannot be cured, only controlled

What is the difference between acute and chronic infection?

Acute infection: Rapid onset but duration is short Chronic infection: Develop slowly and last for extended periods of time

What is delirium?

Acute state of confusion, typically reversible within 3 weeks. **Keep the patient safe! 50% of older adults in hospitals may experience delirium. **estimated 40% of cases could be prevented by medication administration, evaluation of complications, assessment of nutrition, sleep, UTI

Two types of coping mechanisms

Adaptive - healthy, reduce negative effects (diet, walking, etc) Maladaptive - unhealthy, temporary fix, possible harmful effects (smoking, alcohol, etc)

What is an ADE?

Adverse drug event - any injury resulting from a medication a patient has taken. Includes allergic reactions and overdose.

Aerobic vs anerobic exercise

Aerobic - uses oxygen, rapid workout - walking, jogging, swimming, etc Anaerobic - without oxygen (things that can cause muscle pain due to lactic acid buildup, intense bursts) - weight lifting, sprints, etc

When does "older adulthood" begin and how long does it last?

Age 65 through the rest of the lifespan

When is the risk of suicide the highest? (both men and women)

Age 85+

Examples of assessment data

Age, sex, race Appearance General status of patient Anything that stands out (tubes, drains, IVs, dressings) Mental status/emotional state (alert, oriented to time, person, place) Vision Hearing Physical findings in any body system (You can see much of it) Consider cultural and economic status

What is one of the first signs of hypoxia?

Agitation

What do you always assess for before inserting a catheter?

Allergies to iodine and latex

Approaches to coping

Alter the Stressor (change jobs) Adapt to the Stressor (changing thoughts about clinicals) Avoiding the Stressor (mentally blocking)

When mixing insulin in one syringe, do you draw long acting or short acting first?

Always draw short acting first and then long acting. It is safer if we accidentally got a scant amount of short acting into the long acting vial than the other way around. Never stick a syringe filled with long acting into a short acting vial.

What assessment do you always do before administering digoxin?

Always take an apical pulse for a full minute. If heart rate is 60 or below, hold the dose and contact physician.

Consideration for changing medicated patches

Always take the previous patch off! If you forget to remove the old one and clean the skin in that area, patient could overdose. Narcotic patches need to be wasted with a witness.

Two most common types of dementia

Alzheimer's - the most prevalent. Age is the main risk factor. After age 65, odds doubles every 5 years. Half of adults 85+ will have Alzheimer's. Multi-infarct - most common form of vascular dimentia. Loss of cognitive function due to damaged blood vessels in the brain. Multiple areas of the brain have been injured due to a series of small strokes after changes in vascularity of the brain

What is the most dangerous thing we do with an IV?

An IV bolus (AKA push) This is a medication that is given all at once.

How can an apology be an ethical dilemma?

An apology may be used as evidence of admission of guilt in a legal sense, except in states where there are specific laws making apologies inadmissible.

What is stridor?

An emergency lung sound that is seen in airway constriction that can lead to complete closure

What could pale skin be an indication of, especially in older adults?

Anemia, nutritional deficiency

Psychological defense mechanisms

Anger (first protective response, can be healthy if explained) Hostility (destructive behaviors, physical or verbal abuse) Depression (can occur from unresolved anger/anxiety) Abuse from a patient is never okay but does happen. Work to deescalate (communication, open-ended questions help)

How to prevent sensory overload?

• Minimize unnecessary light in patient's room • Plan care to provide patient with uninterrupted periods of sleep • Speak calmly with moderate voice volume • Provide a private room if possible and limit visitors

Fall prevention considerations

• Monitor every 30-60 minutes • Frequent reminder to use call light • Assist out of bed ASAP • Remind to use cane, walker, etc • Remind to use glasses, hearing aids • Night lights • Decrease clutter! • Toilet every 1-2 hours • Observe for med side effects • Orient frequently • Call light within reach • Bed in low position HIGH RISK: Move close to nurse's station, bed alarms, family or "sitter" at bedside

When would a 20 gauge needle be used?

• Most common size used for IV transfusions • Suitable for non-emergency blood transfusions

What do we need to remember when retrieving a urine specimen from a catheter?

• Never take a sample from the bag - could have microorganisms, be old, etc. • Always clean the port before removing a sample

Cultural considerations for Islamic Muslims

• No alcohol • No pork • Fasting during Ramadhan • No male nurses for female patients • Coverings important • Pray 5 times per day

Cultural considerations for Jehovah's Witnesses

• No blood transfusions • Do not celebrate holidays

What are T'ai Chi and Qigong?

• Non-aggressive types of martial art; series of movements, breathing and meditation • Improves body strength, flexibility, balance, increases stamina, decreases pain and stiffness **Great way to keep elderly population active. Studies show residents in long-term care show improvement in physical and mental way of life when participating in T'ai Chi

In order to promote good defacation, what must a patient have?

• Normal GI tract function • Sensory awareness • Voluntary sphincter control • Rectal capacity

What is the placebo response?

• Occurs as a result of the patient's expectation that a treatment will be effective. The stronger a person's belief in a treatment efficacy, the stronger the effect • Basic, underlying principle of holistic healthcare • Traditional therapy discourages use for pain control • Attempted to factor out this effect when conducting research trials

Calcium and albumin relationship

• One of the important functions of albumin in the bloodstream is to bind calcium molecules as a reserve. • Approx. 60% calcium in the blood is unbound and free-floating. This ionized calcium is crucial for muscle activity • 40% of calcium in the blood is bound to proteins, with most of it bound to albumin.

What do we mean by onset, peak, trough, duration and plateau?

• Onset....time it takes for med to produce an action after it's taken • Peak...time it takes for a med to reach its highest effective concentration • Trough...min blood serum concentration of med reached just before next dose is due • Duration ....time during which the med is present in concentration great enough to produce a response • Plateau...blood serum concentration of a med reached and maintained after repeated fixed doses (better and more effective to give pain meds around the clock and maintain levels)

What is the difference between oral fluids, enteral fluids and parenteral fluids?

• Oral = taken by mouth • Enteral = going through GI tract, but through an NG tube rather than orally • Parenteral = IV

Name the ways a nurse monitors fluid excess/loss and fluid maintenance?

• PO • IV • drains • urine output • blood pressure • LOC • Labs • Lung sounds (crackles and rhonchi indicate fluid) • Weight (best way to track fluid)

Which health conditions prompt CAM use?

• Pain (most common) • Cancer • Anxiety • Colds, headache, insomnia • Learning disorders • Stress

Pain management needs to be _______________. Pain management needs to consider ______________.

• Pain management needs to be systematic. • Pain management needs to consider the patient's quality of life.

List example goals for the following nursing diagnosis: Deficient fluid volume related to excessive diarrhea, vomiting, and use of potassium-wasting diuretic

• Patient's fluid volume will return to normal by time of discharge. • Patient will achieve normal electrolyte balance by discharge.

List all required parts of medication order

• Patient's name • Date/time order written • Name of drug to be administered • Dosage of drug • Route of drug to be used • Frequency to be given • Signature of the practitioner writing order • If a controlled drug, DEA number

When we give a paralytic agent, what do we also give?

Antianxiety medication and pain medication

What are effector antibodies?

Antibodies that kill the current antigen infection (like an army: attacks but then dissipates after the war)

Psychological Responses to stressors

Anxiety Emotion depicted by feelings of uneasy feelings, dread, vague complaints and physiological changes like: Increased BP, elevated HR, nausea, trembling, perspiring Mild-moderate Severe Fear Feeling of worry from an identified danger, threat or pain Fear is cognitive, present, identifiable, physical/psychological event

What is an antigen?

Any protein deemed "worthy" of action by the immune system

What does the risk manager in a hospital do?

Anytime there is an unexpected event in a hospital where there is a patient injury, the hospital is exposed to a legal risk. The risk manager is involved as a liason between the attorneys and the hospital.

Order of heart auscultation

Aortic Pulmonic Tricuspid Mitral "All Patients Take Medicine"

Demographics and risk factors of COVID

Apparent risk factors: age, comorbidities, demographics. Has the ability to affect people of all ages and health statuses and ranges from no symptoms to severe or deadly disease. Poor people and ethnic minorities are higher risk, likely due to socioeconomic risk factors. These communities are likelier to have preexisting conditions such as diabetes, obesity, asthma, cardiovascular disease.

What is an ethics committee?

Appointed by the CEO of the hospital. Typically includes a hospital spiritual professional, nurse, physician. A provider can present a case where they have an ethical dilemma and the committee works together to make a decision.

What are the key components of a nursing care plan?

Appropriate diagnosis (proper terminology/layout) SMART goals

AEB vs AMB

As Evidenced By As Manifested By

Ways to prevent burnout

Ask for help Say "no" Delegate Self Care!! Join professional organizations Offer support Change shifts/floors Apps

When patients say they are in pain but don't appear to be in pain, what should we do first?

Ask the patient what they would like us do to help them. • Might not want a pill. They might want ice, or to lay on their side, etc.

If a patient asks your religion, what is the best way to respond?

Ask them a question such as "are you feeling anxious?" You do not need to answer. It does not matter what YOU believe. Remain impartial at all times.

What is an important step in the pouching procedure?

Assess skin and stoma site! If you think it looks abnomal, ask the patient since they are more familiar with their own bodies. Can refer to ostomy specialist, provider or wound care nurse.

Assist vs Complete vs Partial bath

Assist Bath - nurse helps patient with areas that may be difficult to reach (back, feet, legs, etc) Complete bath - nurse washes patient's entire body without assistance from the patient Partial bath - nurse cleanses only the areas that may cause odor or discomfort (axillae, perineum). If complete bath may be stressful to patient, may choose partial bath.

Where does diffusion happen?

At the alveoli-capillary membrane level. This is where the gases move between the membrane and the blood.

Lung assessment components

Auscultate: Vesicular sounds (fancy word for wind sounds when breathing in and out) (heard over most lung fields) Bronchial (Over trachea, Abnormal over lung tissue) Bronchovesicular sounds (Between scapulae and lateral to sternum)

When a smiling and cooperative patient complains of discomfort, nurses caring for this patient often harbor misconceptions about the patient's pain. Which of the following is true? A. Chronic pain is psychological in nature. B. Patients are the best judges of their pain. C. Regular use of narcotic analgesics leads to drug addiction. D. Amount of pain is reflective of actual tissue damage.

B

When would a 24 gauge needle be used?

• Pediatrics • Elderly adults

What is acupuncture?

• Penetration of the skin by thin needles to stimulate anatomical structures of the body • Energy believed to travel through channels in the body called "meridians" • Acupuncturist selects acupoints based on patient's pulses, appearance, color of tongue, odors, general complaints on the body • Stimulation of points restores "flow of the Qi (AKA Chi)" along meridians • Studies show that acupuncture can help with back pain, knee pain, headaches, osteoarthritis

What are the tenets of holistic healthcare?

• People (are unique, connect to and interact w/the environment) • Health (includes spiritual component, self-healing, balance, integration) • Illness (constitutes an imbalance, allows for growth)

Types of elder neglect/abuse

• Physical abuse - bodily harm from hitting/kicking/slapping, restraints, locking in a room • Emotional/psychological abuse - hurtful words, yelling, threatening, repeatedly ignoring, preventing from seeing friends/relatives • Financial abuse - money or belongings stolen, forging checks, stealing social security, changing name on bank • Neglect - caregiver doesn't respond to patient's needs • Abandonment - leaving older adult who needs help alone without setting up care

What factors disrupt health?

• Physical disease • Injury • Mental illness • Pain • Loss • Impending death • Competing demands • The unknown • Imbalance • Isolation

What is relocation stress syndrome?

• Physiological or psychological disturbances following the transfer from one environment to another >>>Example: moving from own home to longterm care >>>Symptoms: anxiety, confusion, hopelessness, loneliness • Ways to help >>>Incorporating as much of "them" as possible can help - how they would like the room arranged, where they would like their pictures. >>>Reminiscing

Vaccinations for older adults

• Pneumonia - 65+ years, two-step process, only needed once in a lifetime • Shingles/Herpes-Zoster - two-step immunization for herpes-zoster, restricted to those who have had chicken pox in the past • Varicella - older adults who have never had chicken pox should have the varicella vaccine to protect against chicken pox and shingles • High dose flu vaccine - older adults have lower immune response and highest risk of death from flu, so adults 65+ can get 4x antigen to increase immune response.

NCLEX Question A client living with AIDS develops oral hairy leukoplakia, an infection caused by the Epstein-Barr virus. The leukoplakia is considered a A.Nosocomial infection B.Secondary infection C.Systemic infection D.Primary infection

B. Secondary infection (AIDS being primary infection)

What is the difference between bacteriostatic and bacteriocidal?

Bacteriocidal involves the treatment of a bacterium such that the organism is killed. A bacteriocidal treatment is always lethal and is also referred to as sterilization. Bacteriostasis (bacteriostatic) refers to a treatment that restricts the ability of the bacterium to grow but does not kill the organism.

What do you do if patient extubates themselves?

Bag and call for help!

Why should family members never push the med admin button on a patient's PCA pump?

Because if the patient is too drowsy to push the button themselves, it could be easy for a family to accidentally overdose the patient. Only the patient themselves should ever push the PCA pump button.

Why do we get reinfected with viruses?

Because they mutate and look different to our antibodies

What is faith? **Likely test question related to this

Believing in something you can't see (could be a god, could be that you believe breakfast will be delivered)

Third tier of needs in hierarchy

Belongingness and Love Needs (Psychological needs) Intimate relationships Friends

Which side of a needle should be facing up while inserting? Why?

Bevel up Easier insertion and quicker closure on removal

What can our own assumptions about patients in pain cause?

Biases we have based on culture, education or experiences can cause us to think of them as "malingerers" or "complainers" and limit our ability to help the patient.

What is a cystocele?

Bladder prolapse into vagina (Rectocele if prolapse into rectum)

What is hematuria?

Blood in the urine

Define "body alignment"

Body alignment refers to the relationship of one body part aligning to another body part along a horizontal or vertical line

Normal or abnormal in older adults? Bone density loss Osteoporosis Joint stiffness Joint pain Loss in joint mobility Increased abdominal fat deposit

Bone density loss - Normal Osteoporosis - Abnormal Joint stiffness - Normal Joint pain - Abnormal Loss in joint mobility - Normal Increased abdominal fat deposit - Normal

Objective vs Subjective data

Both are parts of the assessment. • Objective = labs, auscultation, anything you can see/hear • Subjective = anything the patient/someone else tells you

How does hypoventilation affect risk for hypoxemia and hypoxia?

Breathing fewer times per minute = bringing in less oxygen = less oxygen in the blood

Ethnicity has the power to do what?

Bring people together or divide them

What is pleural effusion?

Build-up of excess fluid between the layers of the pleura outside the lungs

What is bruit?

Buzzing sound heard when auscultating the heart (and feel a thrill)

Medication controls pain how?

By blocking impulses from coming through the control gate.

NCLEX Question When implementing the use of restraints on a hospitalized client, the nurse should A.Restrain all confused clients so that they do not sustain a fall injury. B.Tie the restraint to the bottom of the siderail so the client cannot reach it. C.Ensure that the primary care provider renews the order for restraints once every 24 hr. D.Release the restraints and provide skin care at least once every shift.

C

What is homeopathy's "single remedy"?

• Practitioner tries to find a single remedy that will focus on all of a patient's symptoms

List mind-body interventions

• Prayer • Meditation • Imagery • Humor • Music therapy • Yoga • Hypnosis • Biofeedback • Pet Therapy

What are the three levels of health protection?

• Primary - prevent/slow onset of disease >>> eating healthy, exercising, sunscreen, seatbelt, immunizations • Secondary - detect and treat illnesses in early stages >>> breast self-exam, testicular exam, diabetes screenings, mammogram, colonoscopy • Tertiary - stopping disease progression, return to pre-illness state >>> rehab

Benefits of music therapy?

• Promote wellness • Release emotions • Manage pain • Manage stress • Improve communication/language skills • Keep Alzheimers pt calm and improve memory

What is the Z track method and what do we use it for?

• Pull the skin taut before injection, remove needle and release the skin • Prevent seepage of medication into the needle track and reduce discomfort

Florence Nightengale's theory

• Putting patients in the best condition for nature to act upon them • Emphasized touch, kindness, fresh air, warmth, quiet, cleanliness

Normal cognitive ability changes in older adults

• Reaction time slows, so may take longer to process new information. • Normal to have clear memories of the past, but slower or some trouble recalling what they did earlier in the day. • No loss of intelligence! ***Any decline in mental acuity should be evaluated. Can be common, but doensn't mean it is "normal"

What are the three types of sensory deprivation?

• Reduced sensory input (lost hearing aids) • Elimination of patterns or meaning from input (beeping machine makes them thing their cell phone is going off) • Restrictive environment (strapped to a stryker bed and can only look at ceiling)

Reasons for urinary catheterization

• Relieving urinary retention • Obtaining sterile urine specimen • Measuring post-void residual • Protecting excoriated skin • Emptying bladder before, during, and after a surgery or procedure • Monitoring of critically ill patients • Physiological conditions • Monitoring of critically ill patients

When do we use CUS and what does it stand for?

C- State your CONCERN U- Say why you are UNCOMFORTABLE S- State "This is a SAFETY" issue, explain how and why Used when speaking up for safety.

NCLEX Question Which action by the nurse is a nonverbal behavior that enhances communication? A. Keeping a neutral expression on the face B. Maintaining a distance of 6-12 inches C. Sitting down to speak with patient D. Asking mostly open-ended questions

C.

Options to help support caregivers

• Respite skilled care • Support groups • Hiring home healthcare • Hospital/Clinic case management or social worker

What are the six rights of medication administration?

• Right patient • Right drug • Right dose • Right route • Right time • Right documentation

What is osteopathy?

• Same priveleges as a an MD (prescribe meds, perform surgery, etc) but training includes osteopathic manipulation • Normalize joint function, eliminate strains, facilitate functions

Education for older adults regarding sexual function

• Sexual feelings do not necessarily disappear with age • Sexual expression does not necessarily stop or get lost with age

What are the sensory systems?

• Sight (vision) • Hearing (auditory) • Taste (gustatory) • Touch (tactile) • Smell (olfactory)

What do we monitor a patient for in relation to medication?

• Signs and symptoms of oversedation • Signs and symptoms of respiratory depression • Potential side effects of opioids (IE constipation)

Older adult physiological changes related to urinary elimination

• Size and function of kidneys begin to decrease by age 50. By age 80 only have 2/3 functioning nephrons so lose some ability to concentrate urine • Acid-base/electrolyte concerns with vomiting/diarrhea • Loss of abdominal and perineal tone • Leakage of urine/Incomplete bladder emptying • Prostate gland enlargement

What are the 6 markers in SPICES?

• Sleep disorders • Problems with eating/feeding • Incontinence • Confusion • Evidence of falls • Skin breakdown

When would a 22 gauge needle be used?

• Slow speed transfusions • Older adults

NCLEX Question The nurse is caring for a patient who has Hepatits B and accidentally sticks herself with a contaminated needle after administering an injection. Which action should the nurse take first? A. Immediately notify the supervisor B. Complete an incident report using objective data C. Thoroughly flush the area with water D. Obtain baseline lab work as quickly as possible

C. Thoroughly flush the area with water

When your ventilator alarm goes off, what is the first thing you do?

CHECK YOUR PATIENT! Don't check the machine first, make sure your patient is okay and then check your ventilator.

What do we mean by "stopping the line"?

Calling for a procedure "time-out" when there is a concern for safety.

Aspirin/NSAID issue relating to ostomies?

Can make the ostomy site bleed.

Fentanyl patches are typically only used on patients with which health condition?

Cancer

Mechanical aids for walking

Canes Walkers Braces Crutches

Initial irrigation of a newly created ostomy can or cannot be delegated?

Cannot delegate for initial irrigation, but once the ostomy is established, can be delegated.

What is a suprapubic catheter?

Catheter surgically inserted through the abdomen when the urethra cannot be used

What are memory cells?

Cells that remember a specific antigen so that if it returns, the body can quickly respond Wees said "they hold a grudge" The response of memory cells depends on how big the infection was. If an infection comes and goes quickly, there may not be much of a memory cell response.

Patients with sensory deficits often _____________.

Change behavior in either adaptive or maladaptive ways.

What is presbyopia?

Change in vision associated with aging, lens becomes less elastic and less able to see near objects

Charting physical appearance

Chart what you see - important cues to overall wellness Nourishment Skin color Expression Body shape/build Relative age

If you must do a digital removal of impacted stool, what is an important consideration?

Check vital signs first and monitor throughout. Digital removal can stimulate the vagus nerve and cause heart rate and blood pressure to drop.

Why is pain the most common symptom prompting the use of CAM?

Chronic pain is difficult to treat with traditional medical care, so a lot of people turn to CAM.

Most health problems in older adults are ___________ and they can affect ___________________.

Chronic, independent living

Why close "interview" after meeting client before starting assessment?

Closing the 'interview' with a patient is important for maintaining the rapport and trust between the client and nurse as well as to facilitate future interactions. The closing should contain an offer for questions, conclusions, plans for the next meeting, and a summary to verify accuracy.

What are cataracts?

Clouding of the lens resulting in blurred vision, sensitivity to glare, image distortion. Can occur in one or both eyes.

What is an ileal-anal anastomosis?

Colon is surgically removed and ileum is connected to the rectum. This procedure should result in a continent bowel elimination, but feces will be very liquidy due to bypassing large intestine.

What are lymphocytes?

Common white blood cell, trillions circulate in the body looking for antigens

Urinary incontinence can be __________ but is never considered _________.

Common, normal

How do we escalate a safety concern?

Communicate through appropriate chain of command when needed.

Steps to lower stress response in a patient

Communication! Always communicate and educate about what we are doing or going to do - can helpt alleviate 7anxieties about procedures, new medications, treatments If communication not helping, move on to other techniques like relaxation If all else fails, doctor's order Always least invasive to most invasive

Bathing

Complete bed bath - like it sounds, full bath while bedridden Partial bed bath - only areas that may cause odor or discomfort Always follow principle of "clean to dirty" in direction of cleansing. Never begin with buttocks or perineum

Pressure ulcers are directly caused by _____________.

Compromised blood flow

What does the movement of fluid (osmosis) depend on as it relates to IVs?

Concentration of the IV solution and the cell's need for water or need to get rid of water.

Difference between concentric and eccentric tension?

Concentric - increased muscle contraction that causes muscle shortening (example when a patient pulls up using overhead trapeze) Eccentric - used to control the speed and direction of movement (example when patient uses overhead trapeze to slowly lower into bed) Can remember "eccentric" like "descend slowly" and "concentric" like "sudden onset"

If someone following TCM believes their illness is a "cold" illness, what will they traditionally want to include in their treatment?

Consume hot foods/liquids, bundle up in blankets

What is allopathy?

Conventional western medicine >>>treats pathologies/symptoms

What is integrative healthcare?

Coordinated care that encompasses all treatment modalities

What is a CVAT assessment?

Costovertebral angle tenderness • Formed by the junction of the 12th rib and the spine • Tap closed fist onto open hand flat on patient's back in this region, if inflamed kidneys will be tender for the patient

What should you do if a patient is cramping during an enema? What about if the abdomen becomes rigid, patient complains of pain or there is bleeding?

Cramping is normal. Clamp the enema for 30 seconds, allow patient to relax and then slowly restart. If abdomen becomes rigid, patient complains of pain or there is bleeding, we would stop, notify the MD, obtain baseline vital signs in an assessment.

What is the difference between criminal and civil law?

Criminal has intent, punishment is typically your freedom being taken away. Civil penalty is typically financial.

What is reflection?

Critical thinking skill seen in those with experience

Considerations for giving medication tablets through an NG tube

Crush and administer one tube, flush it, then crush another, flush it, etc. This is important to prevent clogging the tube and not being able to identify how much medication the patient received.

A patient has just undergone an appendectomy. When discussing with the patient several pain-relief interventions, the most appropriate recommendation would be: A. adjunctive therapy. B. nonopioids. C. NSAIDs. D. PCA pain management.

D A, B and C are usually used a day or more after surgery rather than immediately after surgery.

The RN is caring for a patient who has a continent ileostomy. Which intervention will the nurse add to the plan of care? A. change the ostomy appliance PRN B. Place a bedside commode by the patient's bed C. Keep the collection device below the bladder D. Insert a tube into the stoma to drain the pouch

D Since it is continent, it does not have a pouch attached at all times.

Normal lab values for • Sodium • Potassium • Calcium • Magnesium • Chloride • Phosphate • Bicarbonate • Blood urea nitrogen • Creatinine

• Sodium: 135-145 • Potassium: 3.5-5 • Calcium: 8.5-10.5 • Magnesium: 1.6-2.6 • Chloride: 95-105 • Phosphate: 2.5-4.5 • Bicarbonate: 22-26 • BUN: 8-21 • Creatinine: 0.5-1.2

What is biofeedback and who is it beneficial for?

• Someone can learn voluntary control over involuntary activity, such as heart rate. • Beneficial for those with anxiety • Uses electronic instruments to measure the body's functions such as brain activity, BP, muscle tension, heart rate, skin temperature

Cultural considerations for Latter-Day Saints (AKA The Church, LDS, Mormons, The church of Jesus Christ of Latter-Day Saints)

• Special "underwear" they always wear, work around it if you can • Specific male/female roles, women can be less vocal • No alcohol • No caffeine • Can have large support group visits • Blessings or prayer from elders/bishops

What do the following types of orders mean? • Standing • Routine • PRN • STAT • On Call • Verbal

• Standing = each doctor has their own list, all orders available can be used at your discretion • Routine = scheduled orders to be done at a routine time • PRN = as needed • STAT = immediately • On Call = give when called to give (IE before surgery) • Verbal = over the phone told by provider and charted by the nurse on behalf of the provider (always read back!)

What are big factors that lead to a decline in mental health in older adults?

• Stress >>IE physiological changes, parenting grandchildren, learning new things about electronics • Loss >>IE death of loved ones, losing their home

The RN is working on a medical-surgical floor. Which behavior by a licensed practical nurse (LPN) would cause the nurse to intervene immediately? A. Applies a clean ostomy appliance B. Irrigates a newly created colostomy C. Applies an external fecal collection system D. Irrigates an ileostomy

D. Irrigates an ileostomy B is also needing intervention, but D is the most important because we should NEVER irrigate an ileostomy.

Which action violates a principle that is key to proper hand washing at the bedside? A. Washing your hands for 1 min B. Using warm, not very hot water C. Using the soap provided by the agency D. Shaking your hands dry over the sink

D. Shaking your hands dry over the sink Will not completely remove excess moisture and can cause reacquisition of microbes

What are some interventions for electrolyte imbalances?

• Support prescribed medical therapies • Aim to reverse the existing acid-base imbalance Interventions for acid-base imbalances requires frequent arterial blood gases (ABGs)

What is retinopathy?

Damage to the retina that causes vision impairment.

What elements make up the assessment part of the nursing process?

Data collection methods: Observation Interview Examination Documenting history and physical during assessment

Which steroid has been used recently and is showing promise in reducing mortality from COVID?

Decadron (dexamethasone)

History of COVID-19 When did it appear in China? When was it declared a pandemic by the WHO?

December 2019 - large cluster of viral pneumonia cases reported in Wuhan, China March 11, 2020 - WHO declared pandemic

What is the most important age-related functional defecit of the kidneys?

Decline in the glomerular filtration rate. Affects the ability to dilute and concentrate the urine. Makes it difficult for the kidneys to help maintain acid/base balance. Caused by decreased blood flow related to aging.

What makes memory storage increase and decrease?

Decrease • Lack of sleep • High cortisol levels • High adrenaline levels Increase • Hand-written notes • Music • Repetition

Older patients ability to perceive pain is ____________.

Decreased

Older patient abdominal assessment considerations

Decreased abdomen muscle tone GI pain must be differentiated from cardiac Constipation more common Higher incidence of colon cancer Decreased absorption of medications by liver

Older patient musculoskeletal assessment considerations

Decreased muscle mass Osteoarthritic changes Decrease nerve conduction and muscle tone

What is hypoxia?

Decreased tissue oxygenation ♦ Can be due to airway obstruction, altitude, not bringing in enough air, poor perfusion

What is Kussmauls breathing?

Deep and labored breathing ♦ Often associated with severe metabolic acidosis

Everyone has their own ___________ of health and illness.

Definition

What is urinary hesitancy?

Delay or difficulty in initiating a stream of urine

What do we delegate and not delegate?

Delegate tasks Do not delegate assessments, education, complex interventions

What is the most common behavioral health problem among older adults? What are the risk factors specifit to older adults?

Depression. Risk factors: • Disability • Medical problems (directly caused by or psychological reaction to the fact they have the disease) • New illness • Prior depression • Sleep disturbances • Bereavement

How do the body's senses help the body maintain homeostasis?

Detect changes in the environment and initiate responses. Example from Wees: If you see something scary, your blood pressure goes up

What is the Fulmer SPICES Framework?

Developed in 1983 as part of geriatric resource nurse model of care on how to best assess common geriatric conditions in the hospital setting. • Important for the acute care setting • Focuses on 6 marker conditions in older adults • The presence of these conditions can lead to increased death rates and higher costs in longer hospitalizations ***Positive response should lead to more detailed assessment

What are hemorrhoids and what increases risk?

Dilated veins in rectum • Straining • Pregnancy • Heart failure • Liver disease

What is oliguria?

Diminished urination - less than 400ml in 24 hours

List modes of transmission for infectious agents

Direct contact ♦ Direct contact with infected person or item ♦ Droplet (5+ microns in size) Indirect contact ♦ Airborne (less than 5 microns in size) ♦ Vehicles (nonliving object transferring, such as water or soil) ♦ Vector (living object transferring, such as mosquitos or ticks)

What is DOT?

Direct observation therapy - nurse actually goes to patient's home to watch them take the medicine

What are drug classifications?

Drug classification refers to the name of the group of drugs that have a similar effect. Examples are antihypertensives, diuretics, analgesics etc.

What to remember when choosing a naturopathic or homeopathic provider?

Education and training varies, so make sure you have done your research on that person

Older patient vascular assessment considerations

Efficiency of blood vessels decreased overall More likely to have sign of arterial/venous insufficiency in lower extremities Peripheral edema is common in those with venous insufficiency Higher BP Varicosities more frequent

What is hospice?

End of life care - committed to making the end of life as free from pain, anxiety, and depression as possible

What is hospice?

End of life care for patients expected to die within 6 months. Focuses on pain management, psychosocial care. Can be done in patient's home or in a facility.

What is the difference between exogenous and endogenous infections?

Endogenous infections involve becoming infected with a person's own resident bacteria/microflora. Exogenous infections involve a pathogen entering a patient's body from his/her environment.

What is your responsibility if abuse or neglect is suspected?

Ensure the safety of the victim first. Call police/911 if in immediate danger. Nurses are mandatory reporters - must report abuse or suspected abuse to adult protective services. It is our duty to protect lives.

What are coronaviruses?

Enveloped RNA viruses known to infect birds and mammals. There are 4 other known human coronaviruses, but all cause mild symptoms. All human coronaviruses may have originated in bats with other mammal intermediaries such as civets, camels and cows.

What are the two main layers of skin?

Epidermis and Dermis

Alarm Stage Hormones & Functions

Epinephrine-adrenaline! Blood flow is being shunted to vital organs. Norepinephrine is secreted too In response to the epinephrine release, the endocrine system releases: •Corticotropin-releasing hormone (sends messages to ACTH & ADH) •Aldosterone •Antidiuretic Hormone (raises blood pressure by lowering urine output) •Cortisol—glucose sparing

What is aromatherapy?

Essential oils from plants (roots/leaves/blossoms) used to enhance psychological and physical well-being. • Can be used in compresses, baths, applied topically (monitor for contact dermatitis) • Stimulates brain to decrease pain • Improves/enhances cognitive function

Fourth tier of needs in hierarchy

Esteem Needs (Psychological needs) Prestige Feelings of accomplishment

What is the difference between ethics and law?

Ethics • Decisions are shaped by their values, principles and purpose • What's good, right and meaningful • Action can be unethical but legal Law • Basic enforceable standards of behavior • Aim is to regulate behavior in order to maintain social order • Action can be legal but conflict with your ethics

How often should you schedule toileting for an incontinent older adult patient?

Every 1-2 hours.

Oral care how often for ETT or vent patient?

Every 4 hours or less

What is hirsutism?

Excessive growth of dark or coarse hair in a male-like pattern (face, chest, back)

What is respiration?

Exchange of gases

Protein in urine - expected vs variation

Expect less than 20 mg/dL • Higher level most common indicator of renal disease • Increase can be caused by stress or exercise

What are the two types of respiration?

External: at the alveoli level Internal: at the tissue and organ level

What is the most common legal risk event in the hospital?

Falls

Dementia, Delerium and Depression are all easy to distinguish in the older adult patient T/F?

False All three have similar symptoms in older adults, such as confusion, distraction and memory loss so they are hard to distinguish

The following nursing diagnosis is written correctly: Congestive heart failure r/t decreased cardiac output AEB dyspnea T/F?

False Medical diagnosis "congestive heart failure" should not be included.

If your patient has a one-way IV port, it is okay to disconnect the tubing for certain cares. T/F?

False The only way it would be okay to disconnect the tubing is if it was a two-way port because it has a stopcock in the middle to help with infection control.

Polypharmacy is not a risk factor for delerium T/F?

False This is a common risk factor for delerium

Stress incontinence is the loss of urine after feeling a sudden need to urinate T/F?

False This is urge incontinence. Stress incontinence is caused by increased intra-abdominal pressure

You should always place your unconscious patient in a semi-fowler's position when providing oral care T/F?

False Unconscious patient should be placed side-lying to prevent aspiration

After handling a sharp, you should ALWAYS recap your needle. T/F?

False You will almost always deploy safety mechanism and take it immediately to the sharps bin without recapping. There may be rare instances where you need to recap, but you will never "ALWAYS" recap a needle

If you had a patient with a nursing diagnosis of activity intolerance, it would be best to allow them a tub bath. T/F?

False. Activity intolerance can indicate the patient may have shortness of breath with getting out of bed, so we would rather give them a bed bath than have them get out of bed.

What is hyperopia?

Farsightedness - sees distant objects well, but not near objects

What is HIPAA? What are covered entities under HIPAA?

Federal law protecting patient confidentiality. Covered entities are the organizations that HIPAA rules apply to. Covered entities include anyone that transmits health information electronically.

Genitalia and anus assessment components

Female Inspect Palpate - NO! Unless c/o abnormality Male Inspect hair, skin, scrotum, inguinal area Palpate - scrotum if c/o abnormal Anus - you could ask about hemorrhoids or bleeding

De-escalation techniques

First, keep your own safety in mind! Realize how or why they are upset AVOID "I'm sorry" (if you didn't do anything wrong, can make patient feel as if they need to comfort the nurse) AVOID "Don't be angry" or "everything will be okay" Don't negate their anger Calm words Non-confrontational verbiage or body language Setting clear limits/boundaries Therapeutic communication Acknowledge the anger and ask what is going on "You seem like" "Let's discuss how you're feeling about" "What can we do to help you?" Use their own words - if they said "angry", say "angry" Avoid commands, insults, anger towards patient Avoid closed-ended (one word response) questions *Non-invasive to invasive*

Most popular natural product used by adults?

Fish oil and omega 3's

What can happen if you infuse any IV fluid too rapidly or excessively?

Fluid toxicity • Especially in older patients or young children

Nursing assessments for mobility

Focused nursing history Focused physical assessment (grips, foot push/pulls, strength activities) Gait Activity Tolerance Functional independence measures (such as test to see if strong enough to stand)

When do you typically use logrolling for a patient?

For a patient with bone or spinal issues that requires we need to keep the patient "in-line"

When giving ear drops, what is the difference in administration for kids vs adults?

For children, pull auricle down and back. For adults, pull auricle up.

What is the definition of safety?

Freedom from physical and psychological injury

Components of auscultation

Frequency Loudness Quality (gurgling, blowing) Duration

What is nocturia?

Frequent urination during the night • May be r/t excessive fluid intake or a variety of urinary tract and cardiovascular problems

What is friction?

Friction is a force that occurs, in the opposite direction, that opposes movement

Components of integumentary assessment

Gathering data about skin, hair and nails Inspect and palpate: Hygiene and cleanliness Skin color Lesions and vascular changes/markings Petechiae (tiny round brown-purple spots due to bleeding under the skin) Edema and hydration Integrity Hair (color, distribution, alopecia (patchy hair loss)) Nails (color, nail bed angle, clubbing, blanching test) Turgor Describe what you see

What is GAS?

General Adaptation Syndrome - physical response to stressors 1. Alarm Stage (fight or flight, has shock & countershock phases) 2. Resistance (form of adaptation, parasympathetic) 3. Recovery or Exhaustion (person adapts or doesn't)

Consideration when palpating the carotid artery

Gently if at all One side at a time Caution to occlude blood flow to the brain

If patient doesn't speak the same language as you do, what should you do?

Get a translator > google, "getting by" are not okay

Why are diabetic patients more prone to UTIs?

Glucose in the urine is a breeding ground for bacteria.

Types and use for mechanical ventilation

Goal to support the patient until underlying issue is corrected ♦ Negative pressure >>> Like a turtle shell or iron lung >>> Used with neuromuscular disease, not enough chest wall strength to get good ventilation ♦ Positive pressure >>> ET tubes, trach >>> Pushes air into the lungs

What is tachypnea?

Greater rate of breathing (over 20)

What is solar lentigo?

Harmless patches of dark skin that appear on older adults in areas exposed more often to the sun. AKA liver spots

How do you prevent aspiration for patient on vent or ETT?

Head of bed up 30 degrees

Head/Neck Assessment components

Head size and shape Facial features (symmetry) Eyes (edema, sunken) Symmetry of facial movements When palpating, approach from head of bed, one hand on each side to feel for symmetry

Physiological responses to stress

Headaches Diaphoresi (sweating, such as palms) Dry mouth Increased blood glucose Increased heart rate Chest pain

What is a nosocomial infection?

Healthcare-Associated Infection (aka HAI)

What is palliative care?

Help patient learn how to live life fully with an incurable condition that will never be pain free.

Benefits of exercise

Helps older adults with balance Improves cardiovascular health Enhances immune system Promotes weight loss Decreases stress, increases overall feeling of wellbeing

When would a 14 or 16 gauge needle be used?

High risk surgical procedures. (Think - might have unexpected hemorrhage and need to infuse blood quickly) **Requires a large vein

Why should we take it slow when we move an older patient from lying to sitting to standing?

Higher likelyhood for orthostatic hypotension

What do you do if a provider's medication order is missing something?

Hold the drug and clarify with the provider

What is the Valsalva maneuver? When can it be dangerous?

Holding breath and straining to defacate. Pts with heart disease, glaucoma, or any sort of intercranial pressure will have increased risk of heart arrhythmias

What is a community care facility?

Home health assistance round-the-clock for those "aging in place" is considered a CCF. Also includes clinics and adult community centers that have health initiatives (exercise, immunization initiatives, etc)

Benefits of honey?

Honey has been shown to be more effective than cough medication in relieving frequency and severity

What is the difference between assessment and evaluation?

How the information is used! Assessment used to create a plan Evaluation used to edit or write new plan

What are carriers?

Human reservoirs that are infected without having any symptoms of the disease

What are the terms for low/high calcium?

Hypocalcemia and hypercalcemia Memory trick: calcium is practically in the terms :)

What are the terms for low/high potassium?

Hypokalemia and hyperkalemia Memory trick: potassium = K = Kalemia

What are the terms for low/high sodium?

Hyponatremia and hypernatremia Memory trick: sodium = Na = NAtremia

Why are older adults at a greater risk for hypothermia? Why are older adults at a greater risk for hyperthermia?

Hypothermia risk due to loss of subcutaneous fat. (less insulation) Hyperthermia risk due to insufficient sweat glands.

What do we need to remember as a nurse when we have a patient that has low oxygenation?

IT IS SCARY FOR THEM ♦ Stay with your patient ♦ Nurse stay calm! ♦ Inform patient about what is going on ♦ Hold their hand

What are crystalloids?

IV electrolytes

What is the nursing process good for?

Identifying client needs and delivering care to meet those needs

Legal action is much more likely to occur by a patient or their family if what happens/doesn't happen?

If a patient feels that there has been a "coverup" or the hospital was dishonest or didn't disclose information, they are much more likely to sue.

What is a peer review as it relates to actions taken in the hospital and ethics/law?

If a situation was not handled in a way that a nurse or someone else thinks it should have been, that person can request a peer review to determine what the best "reasonable and prudent" policy or procedure could be created for the future.

If a nurse is acting within their Scope of Practice but outside their Scope of Employment, what could happen?

If there is a lawsuit that names that specific nurse, the hospital can say "they were practicing outside their scope of employment and the hospital will not cover them". The nurse would be personally responsible to pay any financial award.

What is the difference between an ileostomy and a colostomy?

Ileostomy = stool exits the body from somewhere along the small intestine Colostomy = stool exits the body from somewhere along the large intestine

Which type of ostomy do we NEVER irrigate?

Ileostomy can never be irrigated

What is spiritual distress?

Impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, such as art, music, literature, nature, and/or a power greater than oneself • Acute illness • Chronic illness • Terminal illness • Near-death experiences

Example of what part of nursing process? Elevate left ankle on 2 pillows Apply ice pack for 20 minutes every hour Use patient preferred distraction techniques (TV, music, video games, visitors if desired) Reassess pain after 1 hour

Implementation

Catheter size vs lumen size

In catheters, a small number = a narrow lumen, big number = big lumen (opposite of needle gauge scale) IE might use a 5, 8 or 10 for a child and a 14, 16, 18 for adults

Where are the thirst control mechanisms located?

In the hypothalamus in the brain. • biggest one to remember is ADH

Name and describe each type of vaccine.

Inactivated: "Dead" virus. Safer but less effective. Need a booster. Booster stimulates bigger immune response after seeing the virus a second time. Attenuated: "Weakened" virus grown in an environment that weakens it. Creates long term immunity. May cause disease if not altered enough, so risky but most effective. One shot. Needs cold, dark storage. (MMR is attenuated) Subunit: Part of antigen. Often has an "adjuvant" attached to attract lymphocytes (to cause inflammation/edema) to enhance antibody response • MRNA Vaccine for COVID-19? Possible new type? (This was discussion and she added to slide but not originally part of lecture)

What is ethnicity?

Includes a person's race, language and religion. • Like race - derived from a person's origins • Unlike race - can denote a person's language, culture and/or religion

Older patient ear assessment considerations

Increase in coarse hair growth Pinna increases in width and length (visible part of ear) Drier earwax Tympanic Membrane is less flexible Presbycusis (age related hearing loss)

What is glaucoma?

Increased pressure in the anterior cavity of the eyeball that distorts the shape of the cornea and shifts the position of the lens. Results in loss of peripheral vision or blindness. The most common type is "open angle glaucoma"

Most older adults live where?

Independently (rather than in long term care) • called "aging in place".

What is inductive vs deductive reasoning?

Inductive gathers evidence to form a theory (specific to general) Deductive starts with a theory and finds evidence for it (general to specific) Can remember like: inductive = into a theory deductive = determine it's true

Nursing diagnosis example r/t pneumonia

Ineffective airway clearace r/t increased secretions **Respiratory alkalosis/acidosis is NOT a nursing diagnosis**

What could red skin be an indication of, especially in older adults?

Infection, inflammation, beginning of a pressure injury

Musculoskeletal assessment components

Inspect Mobility Muscle Size Any contractures Muscle strength Skeletal structure Joints Palpate Tenderness Joints for ROM

Breast/Axillae Assessment components

Inspect Palpate Ask questions Men and women

Nose assessment components

Inspect and palpate nose Palpate facial sinuses Tip chin back and observe nasal passages for symmetry Ask about history of allergies (olfactory lobe damage causes poor sense of direction) Older adults: Diminished sense of smell discrimination Nosebleeds from HTN (hypertension)

Ear/Hearing assessment components

Inspect auricles Palpate auricles Inspect ear canal Visualize tympanic membrane ™ with otoscope Whisper test Rinne - tuning fork behind ear on bone Weber - test is tuning fork to center of head

Mouth/Oropharynx assessment components

Inspect lips, buccal mucosa for color, moisture, and symmetry Inspect teeth and gums Inspect tongue for position, color, ability to protrude, movement Inspect the hard/soft palate for texture, color Inspect the oropharynx for color and texture Inspect for presence of tonsils

Neck assessment components

Inspect neck muscles for masses/ swelling Inspect head movement Assess muscle strength Palpate the neck enlarged lymph nodes Palpate trachea Inspect/ Palpate thyroid

Abdomen assessment components

Inspect skin color, symmetry, abdominal movements, vascular pattern Auscultate bowel sounds, bruits Palpation light, do so after auscultation, not before Percussion we will not do

Peripheral Vascular Assessment Components

Inspect skin on hands and feet (color, temperature, edema, skin changes) Peripheral pulses (Assess bilaterally, Equal and full, Thready is abnormal) Capillary Refill Time ((CRT) normal is < 3 seconds If delayed, may be arterial insufficiency)

Components of a physical examination

Inspection Auscultation Palpation Percussion Unofficial component: Olfaction

Which medication laws are more strict? State and Federal or Institutional?

Institutional - the rules determined by the facility itself are typically more strict than the actual regulations.

What is "normal" intake and output daily?

Intake: ~2500ml/day • Fluids, food, oxidation Output: ~2500 ml/day • Skin/lungs - 900ml • Feces - 100ml • Urine - 1500 ml

What is a saline lock for?

Intermittent venous access. Can have an open IV line without the need to have the patient hooked up to an IV bag all the time. Saline clamped off in the tube keeps clots from forming and can use the access when needed.

What type of injection takes the longest to absorb and why?

Intradermal because not a lot of blood vessels

What is an infection?

Invasion of a host organism's bodily tissues by disease-causing organisms.

What is clinical reasoning/judgement?

Involves observing, comparing, contrasting and evaluating client's condition to determine whether change has occurred. Involves careful consideration of client's health status in light of what is expected based on condition, medications and treatment. Collectively referred to as the nursing process. Common standards: Clarity, Accuracy, Precision, Relevance, Depth, Breadth, Logical Reasoning, Significance, Fairness.

What is astigmatism?

Irregular curvature of the cornea or lens that scatters light rays and blurs or distorts the image on the retina

What is dementia?

Irreversible progressive decline in mental abilities. Involves both memory impairments and disturbance in at least one other area of cognition (such as aphasia/communication, apraxia/movements, agnosia/recognition) • Affects 1 in 5 adults over 70 years. • Not a normal result of aging, but very common. • Global impairment - meaning that it affects every process, IE language, math, memory, decisionmaking, reaction time • We aren't sure what causes dementia yet

Difference between isotonic and isometric?

Isotonic - Movement of joint during muscle contraction (think squats) Isometric - Muscle contraction without joint movement (think planks... can remember plank = like a ruler = metric system = isometric)

How does RAAS help regulate fluid levels?

It affects the amount of water filtered out through the kidneys. *Kidney-related process

How can pH affect the heart?

It effects cell membrane excitability

Why do we use D5 1/2 NS (hypertonic) IV solution in recovery after surgery?

It is common for OR patients to become fluid overloaded during surgery because IV fluids are used to regulate BP during blood loss. Once in the recovery room hypertonic solutions are hung to pull excess fluid off to obtain normal isotonic.

Consideration for carrying suppository medication

It is often designed to dissolve with heat, so if you carry the pouch in your hand, by the time you get to the patient and open it, the suppository could have melted. Carry by corner or in a cup.

What indicates that you are allowed to cut a tablet in half?

It is scored. If it is not scored, DO NOT cut, chew or crush. If it is enteric or sustained release (SR) coated, DO NOT cut, chew or crush.

Which part of your brain determines how you feel about a painful sensation, and which part determines where it is coming from and what to do about it?

• The limbic system determines how a person feels about pain. (fight or flight center of the brain) • The prefrontal cortex decides where the pain is coming from and what to do about it. • There is no single pain center.

What can you do to prevent culturally important things (such as charms) from arcing with machines in order to allow the patient to keep them?

Keep on their gown but put tape over it > Instinct is to not allow them to have it for safety, but remember can be very important to them to the point of possibly helping with healing

What does surfectant do?

Keeps alveoli open so gas exchange can occur

What do coagulation issues have to do with kidney failure? (Both related to critical COVID cases)

Kidneys have micro blood vessels, so even tiny blood clots can cause cell death and eventually kidney failure

Older patient lung assessment considerations

Kyphosis may be present related to osteoporosis (hunching back) AP diameter widens Inspiratory muscles less powerful Less elasticity of alveoli Cilia decreased in numbers and function Less elastic recoil

Why do we NOT use LR when hanging blood?

LR has calcium in it. The extra calcium could bind with the preservatives added to blood by blood banks for storage. This potentially increases the risk of blood clots if used for blood transfusions. ***We only use NS when hanging blood!

Know trach suction, trach care and respiratory assessment from lab for lecure exam!

Lab and lecture work together and these parts may be on lecture exam per Prof Baker!

Epidural infusions need to have the tubing ______?

Labeled to differentiate from other tubing.

William has a right pneumothorax. Which of the two factors affecting the rate of gas diffusion is causing William to be hypoxemic?

Lack of available lung tissue

How can anemia affect diffusion?

Lack of blood cells = lack of hemoglobin to diffuse

What is the primary organ of elimination?

Large intestine (or kidney if referring to urinary elimination)

What are colloids?

Larger IV particles such as blood or blood particles

Needle/catheter sizes - smaller gauge number means...

Larger lumen. Small number = wide needle Big number = narrow needle

Why does laughter help with IV insertion?

Laughter is a vasodilator

Describing lesions

Lesions...Don't attach a diagnosis to the description. Just describe the lesion (see image) or say 'lesion'

Fatal limits for pH?

Less than 6.9 or greater than 7.8 are fatal

What do you look for in a new patient (first glance assessment)

Level of alertness? Food in front of them? Facial expression/emotional state (pain obvious?) Connected to IV, oxygen, suction, dressings, etc?

What is the difference between a Levin and a Salem NG tube?

Levin = single lumen Salem = double lumen

What is pediculosis and what are the three types?

Lice infestation ♦ Capitis - on the head ♦ Corporis - on the body ♦ Pubis - on the pubic area

Cultural considerations for use of hand gestures

Limit use of hand gestures because different cultures have different meanings for gestures

What does percussion help identify?

Location Size Density of structures Considered advanced practice in nursing, but can try if would like

What do we need to take into consideration for a patient on steroids?

Long term use of steroids can cause atrophy of the skin. Especially important to consider with older adults due to skin already naturally thinning.

How do you determine if nursing diagnosis is "impaired gas exchange" or "risk for impaired gas exchange"?

Look at the labs to see the ABG results. IE: They have pneumonia, but their labs are currently normal, diagnosis would be "risk for" and not "actual"

How can decreases in sensory perception impact nutritional status?

Loss in taste makes foods less appealing. Making foods appear more visually appealing can help.

What is macular degeneration?

Loss of central vision due to damage to the macula lutea, the central portion of the retina. Leading cause of visual impairment in older adults - slow progressive loss of central and near vision usually present in both eyes. ***Risk factors = excessive sunlight and smoking

What is presbyopia?

Loss of lens flexibility normal with aging leading to a decrease in vision (farsightedness) Starts around age 40

Why are older adults at a higher risk for pressure injuries and more likely to bruise?

Loss of subcutaneous fat (padding) and thinner skin

Why would you hold dialysis?

Low blood pressure

What does hypotonic mean? What is the range of the osmolality for a hypotonic IV solution?

Low level of particles in the solution. • Less than 250 mOsm

What is hypoxemia?

Low oxygen in the blood

What is bradypnea?

Lower rate of breathing (less than 12)

What are the three checks of medication administration?

MUST check at least three times between the medication and the medication record/order (MAR).

What are energy based healing modalities?

• Therapeutic touch • Reiki • Magnet therapy • T'ai Chi; Qigong

What is medication reconciliation?

Making sure medication ordered now is medication patient has used before (such as with new patient or transferring patient) • Verify list of meds they were taking • Clarify meds that are now ordered (med, dose, frequency) • Reconcile if new medications or have been given in the past • Transmit data to communicate with new provider

Aside from oral medications, what are some more options of pain therapies?

• Topical analgesics (creams, ointments, patches) • Local anesthesia • Regional anesthesia (like a nerve block) • Perineural local anesthetic infusion (like a PCA pump) • Epidural analgesia (catheter into epidural space in the spine - tube MUST be labeled so not mixed up with IV)

What is a retention enema?

Meant to be retained in the colon for a long period of time, volume is much lower than in a cleansing enema Oil retention - lubricate Medicated - administer antibiotics Nutritive - dehydrated or frail, introduce nutrition Soapsuds - use pure castile soap

Why do we use lactated ringers (LR) as the IV bag during surgery?

Mechanical ventilation during surgery (OR) can create an acidotic environment. LR osmolality is 275 (isotonic). Anaestheiologists typically use LR instead of NS (normal saline) because it has the additive sodium lactate which metabolizes into bicarb (HCO3).

What is the basis for non-pharmacological pain relief interventions?

Meditation, distraction, breathing, etc help to keep the "gate" closed and therefore help decrease the sensation of pain

Who created the gate-control theory of pain?

Melzack and Wall in 1965

What is the length of the urethra in both men and women?

Men: ~20cm Women: ~3-4cm

What is a modality? What are the two main types?

Method of treating a disorder • Traditional and holistic

What are resident flora?

Microbes normally found in the body that can be pathogens, but are not pathogenic

What are transient flora?

Microorganisms that temporarily colonise the skin. This includes bacteria, fungi and viruses, which reach the hands, for example, by direct skin-to-skin contact or indirectly via objects.

Stages of dementia

Mild - difficulty learning new tasks Severe - dependent upon others, restless, loss of recognition Terminal - all tasks affected. Can't sit up, can't hold head up, risk of aspiration/bed sores/pneumonia/UTI

What is an MMSE?

Mini Mental State Exam Screens for cognitive reasoning, done often in long term care facilities. Testing and retesting helps map changes in mental status.

Difference between morbidity and mortality

Mortality is likelihood of dying Morbidity is likelihood of remaining sick from something

What is absorption?

Movement of drug from site of administration into the blood stream. Many factors that influence this (ROUTE, ABILITY OF MED TO DISSOLVE (ie form), BLOOD FLOW TO AREA, BSA, LIPID SOLUBILITY OF MED Blood Brain Barrier must be lipophilic to work ie inderal),PRESENCE OF FOOD ON THE STOMACH)

Older patient mouth assessment considerations

Mucosa dry Receding gums Tastes diminishes Teeth may show staining Tooth loss Sluggish gag Pain

What is an MDRO?

Multidrug resistant organism

Effects of immobility

Muscle atrophy/joint dysfunction Renal calculi (kidney stones) Decreased gas exchange/atelectasis/pnemonia Venous stasis/increased coaguability > DVT Orthostatis hypotension Glucose intolerance Decreased dopamine production Hormone imbalances Pressure ulcers Constipation > Paralytic ileus UTI Depression Sleep disturbances Disorientation

Should you recap a dirty needle if you don't have a sharps container available?

NO. Never recap a dirty needle. ever.

What is myopia?

Nearsightedness - sees close objects well, but not distant objects

A 24-year-old nursing student has no previous hospitalizations or known chronic health problems, takes no medications, and has no current respiratory symptoms. On routine purified protein derivative, or PPD, testing (tuberculin skin testing), the student has an area of induration measuring 5 mm. How would you interpret these results?

Negative

What is age-based descrimination?

Negative and stereotypical views and expectations related to older adults

Hemoglobin in urine - expected vs variation

Negative on dipstick, microscopic exam should be >5 RBC in high power field • detected with UTI, bladder or kidney disease, cancer, gallstones or helpatitis

WBC/leukocytes in urine - expected vs variation

Negative on dipstick, microscopic exam should be >5 WBC in high power field • increased in bacterial infection, calculus formation, fungal or parasitic infection, glomerulonephritis, interstital nephritis or tumor

Do you call an elderly person living in a long term care facility a "patient"?

No - they are a resident.

Is holistic healthcare the same as alternative healthcare?

No - you can have the holistic approach while using traditional healthcare. • Alternative and complimentary medicines use it more often, but it is not excluded from traditional healthcare.

What is apnea?

No breathing

What is race?

No consistent definition - but currently defined by a group of people with certain physical characteristics (skin color, facial features)

What is a latent infection?

No s/sx for long periods of time, even decades

Does lack of pain expression indicate that a patient is not experiencing pain?

No!

Should you ignore intuition?

No! Investigating intuition is important, you're probably feeling that "spidey sense" because you have seen these data clusters or situation before

A patient has adequate blood oxygen levels based on a pulse oximeter reading of 98%. Can you conclude that the organ and tissue oxygenations are adequate?

No. Just because the blood cells we can see are being fully oxygenated doesn't mean that the tissues and organs are being oxygenated efficiently. ♦ Example: Anemia

Is respiratory acidosis or alkalosis an appropriate nursing diagnosis?

No. Nursing diagnosis will focus on the cause, such as "impaired gas exchange"

Is a parent to a developmentally delayed adult intrinsically a legal guardian?

No. They can be surrogate decisionmakers, but they are not legal guardians. They can help make decisions until it comes to a life or death decision. > Parents cannot make a "do not resuscitate" decision unless they have gone to court and become legal guardians. > Exception if multiple providers agree with the decision, can move forward with it (new law in Idaho)

When would an 18 gauge needle be used?

• Trauma • Surgery • Blood transfusions • CT scan with dye **Requires a large vein

What is eupnea?

Normal breathing (12-20) No physical retractions

What is presbycussis?

Normal loss of hearing related to aging. Starts around age 65. Can cause sense of balance changes.

What does isotonic mean? What is the range of the osmolality for an isotonic IV solution?

Normal range of particles in solution. • 250-375 mOsm "I so perfect"

What solution do you use to flush an IV?

Normal saline. Typically 10ml

What is the difference between pneumonia and walking pneumonia?

Nothing >>> May be different causitive factor, but pneumonia is pneumonia

What is the Nurse Practice Act?

Nurse Practice Act- approved by state legislature, defines your functions as a nurse; generally nurse cannot administer meds without a prescriber order. Even with an order it is still the nurses responsibility to give the medication appropriately. Nurse should know what the med is, does, and the adverse affects. If the nurse is unclear or believes the drug is harmful or not in the best interest of the patient, he/she is to clarify the order.

How can pain medication cause an ethical dilemma?

Nurse cannot decide to withold pain medication even if they feel that the patient is an addict and they do not feel ethically correct administering it.

Can you delegate an enema?

Nurse has to complete pre-procedure assessment, educate the UAP and then yes, it can be delegated. Exceptions: Do not delegate if patient is unstable Do not delegate if the enema has medication in it

Difference between medical diagnosis and nursing diagnosis (examples)

Nursing diagnosis is directed towards the patient and his physiological and psychological response. Medical diagnosis is particular with the disease or medical condition. Its center is on the illness.

Considerations for drug side effects with older adults

Older adults are prone to experiencing side effects more due to decreased liver size, blood flow changes **Especially neurological or mood related ones

Likely targets for neglect/abuse

Older adults who have no family or friends nearby

Which age group is the fastest growing?

Older adults. Estimated to reach 25% of population will be over 65 by the year 2060.

What is strabismus?

One eye deviates from a fixed image

What are the three ways to make a diagnosis statement?

One part: example "disuse syndrome" Two part: example "stress r/t studying" Three part: example "stress r/t exam cramming AEB sweating, loss of appetite, diarrhea

Difference between one piece and two piece ostomy pouches

One piece is attached to the skin barrier as a unit. Two piece has a pouch that can detach from the skin barrier.

When a PCA pump is used, who is allowed to push the button to administer pain medication?

Only the patient!

Open ended question vs closed ended question

Open - cannot give short answer Closed - can answer with 1-2 words

Neurological assessment components

Orientation (Time, place, person) Memory and attention span -Examples: start with 100 and subtract 7 -What is you have for dinner last night? -Breakfast this morning? LOC (level of consciousness) Glasgow Coma Scale aka "GCS" Cranial nerves Pain (safety pin or packet corner sharp or dull?) Motor -Assess gait - Romberg's test (stand with eyes closed without falling to the side, used for DUI checks) -Coordination test (walk a straight line heel to toe) - Palmer's (or pronator's) drift (eyes closed, hold arms out, do they stay level or drift?) Reflexes (rate 0-4, check Babinski foot stroke) Palpation - touch lightly bilaterally using finger tips or cotton, same areas at same time

Charting mental status

Orientation to self, place, date, time Note mood, anxiety, speech Questions can allow patient to share where they are emotionally. Example: Nurse: How has your mood been lately? Patient: "Oh, fine I guess". ("I guess" is an indicator) Nurse: "Okay. Got it. So, have you had any problems with depression in the past? Ever taken an antidepressant? Any thoughts of suicide?" Patient: "Well, I took Prozac for awhile but I am not on it now." Nurse: Okay, so depression in the past, right? Depression is a lack of feel good chemicals, like Serotonin or Dopamine. So, on a zero to ten scale, zero being severe depression, ten being top of the world...how would you rate your mood?

Even if you are not religious or spiritual, what is important to remember as a nurse?

Others may get great comfort from their belief systems. Their connection to their faith may be the most important factor in helping them to heal. Beliefs and convictions are powerful resources for healing. Physical and psychological well-being results from beliefs and expectations. Mind, body and spirit are interrelated.

A PCA pump has a lockout interval to prevent the patient from being able to _________.

Overdose

What is the number one cause of constipation?

Overuse of laxatives

Abbreviations (some) PO STAT Tx Dx Thx Sx Rx d/t s/t r/t r/o c/o +/-

PO - Per Os (orally) STAT - Statum (immediate) Tx - treatment Dx - diagnosis Thx - therapy Sx - surgery Rx - pharmacy or prescription d/t - due to s/t - secondary to r/t - related to r/o - rule out c/o - complains of +/- - with or without / maybe or maybe not / possible

What are the characteristics of pain? What is an acronym to remember them?

PQRST • Provoking/Pallative - what makes it worse/better? • Quality - what does it feel like? • Region/Radiation - where does it hurt? does it move? • Severity - how severe is the pain at its worst/best? • Time - When did it start, how long does it last?

What is dysuria?

Painful or difficult urination

What is a clean catch?

Patient cleans genitalia before catching urine sample. They will initiate the stream of urine into the toilet and then catch specimen mid-stream.

What is PCA or PCA pump?

Patient controlled analgesia • Allows patient to self-administer with minimal risk of overdose • Maintains a constant plasma level of analgesic

What is the best indicator for fluid status?

Patient's weight. Daily weight variances.

What is informed consent?

Patients have to be told in plain English what is going to happen, what the risks are, what options they have and all the consequences each option may have. Patient cannot be incapacitated for any reason and still give informed consent. >Example: once patient is given a sedative, they cannot give informed consent

When do COVID-19 antibody levels peak and when are they no longer detectable?

Peak at 4 weeks No longer detectable at 3 months

What is Cheyne-Stokes breathing?

Periods of deep breathing that alternate with periods of apnea ♦ Associated with heart failure, drug use, brain damage

What is neurogenic bladder?

Person cannot perceive bladder fullness or have inability to control urinary sphincters causing frequent involuntary loss of urine. May need to frequently self-catheterize. May be due to nerve damage.

4 components of assessment

Physical appearance Mental Status Mobility Behavior

What is the difference between physical dependence and drug tolerance?

Physical dependence: A state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist Drug tolerance: A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time

First tier of needs in hierarchy

Physiological Needs (Basic Needs) Food Water Warmth Rest

Nursing measures to promote activity and exercise

Plan and vary exercise routine Use buddy system and rewards Integrate exercise into routine activity (squat putting away dishes) Recognize and appreciate success Proper positioning with pillows, sandbags, trapezes, etc Get creative! (drawing circles instead of physical therapy, dancing with grandkids to build balance) Getting creative can increase compliance

What elements make up the planning part of the Nursing Process?

Planning is aimed at preventing, reducing, eliminating, the client's health problems.

What problems is a patient at high risk of developing if they have a lack of surfactant?

Pneumonia Atelectasis (partial or complete collapse of lung)

What is the difference between pneumothorax and a tension pneumothorax?

Pneumothorax can be caused by too high levels of positive pressure - can pop a lung Tension pneumothorax is when air builds up in the pleural space, pushes against mediastinum and great vessels, can cause heart to stop

Considerations for patient for assessment

Positioning Draping Infection Control Lighting Temperature Privacy

Older patient breast/axillae assessment considerations

Postmenopausal females show breast change in shape and are more pendulous Lesions detected more easily due to less dense breast tissue

What is a collaborative problem?

Potential problems that nurses manage using both independent and physican-prescribed interventions. These are problems or conditions that require both medical and nursing interventions with the nursing aspect focused on monitoring the client's condition and preventing development of the potential complication.

What is a major problem of older adults in hospitals and nursing facilities that can lead to infection and death?

Pressure injuries

What is the difference between a primary and secondary illness?

Primary: First infection that occurs in a patient Secondary: Subsequent infections in a patient

What is evaluation?

Process of reviewing interventions to determine their effectiveness Was outcome met?? -Yes? Then goal was met and problem resolved. -No? Not met or partially met? Why? Plan will need to be modified

How does ANP help regulate fluid levels?

Produces sodium and fluid loss by decreasing sodium reabsorption, decreases thirst. Stimulated by cardiac output - stretch receptors in the heart wall cause stimulate release of Atrial natriuretic peptide (ANP). * Heart-related process

Science says physical differences (ie race) between people are what?

Products of evolution and adaptation of groups of human beings to the environments in which they lived. > Race does not imply intelligence or health nor does it divide people ethnically

What would you use a barrier cream for?

Protecting skin from moisture to prevent skin breakdown

What is proteinuria?

Protein in the urine

We as nurses need to remember that pain can have different meanings for different patients. IE: Hysterectomy pain from cancer vs from complicated childbirth What is the underlying factor that determines how they will perceive the pain as it relates to this information?

Psychological differences

What is Pyuria?

Pus in the urine, looks very cloudy or white in color

What is QSEN?

Quality and Safety Education for Nurses

What is the difference between active and passive ROM?

ROM = Range of motion Active ROM = patient performs movement Passive ROM = nurse assists patient in moving

What are cleansing enemas used for and what are the different types?

• Treat severe constipation or impaction • Clear the colon • Empty the colon when starting a bowel-training program Examples: Return flow (AKA Harris flush) - raising bag of water or saline up and down to flush colon Hypotonic - contains large volume of fluid that distends colon and stimulates peristalsis Hypertonic - attracts water into the colon, which distends the colon and stimulates peristalsis Isotonic - normal saline in a very large volume that distends the colon

Charting Edema

Record indention recovery time in seconds Scoring system •No clinical edema = 0 •≤ 2 mm indentation = 1+ edema •Slight pitting •No visual distortion •Disappears rapidly •2-4 mm indentation = 2+ edema •Somewhat deeper pitting •No readably detectable distortion •Disappears in 10-15 seconds •4-6 mm indentation = 3+ edema •Pit is noticeably deep •May last > 1 minutes •Dependent extremity looks fuller & swollen •6-8 mm indentation = 4+ edema •Pit is very deep •Last as long as 2-5 minutes •Dependent extremity is grossly distorted

How does ADH help regulate fluid levels?

Reduces urine output to retain fluids and increases thirst. Stimulated by stress (IE exercise or narcotics) *Brain-related process

What is distribution?

Refers to the manner in which the drug is transported by the bloodstream to the various area of the body. This is r/t the chemical make up of the drug and of the individual. Affected by: circulation, membrane permeability (blood brain / placental barrier), protein binding (Drugs can be bound to protein. It is the free drug that is active. So if malnutrition/liver disease...less circulating albumin so more free thus active form)

What is holism?

• Treats the whole person • Preventative strategies; lifestyle changes • Optimal wellness

What is Biot's breathing?

Regular deep inspirations followed by regular or irregular periods of apnea ♦ Associated with herniations of the brain, stroke, trauma

If a patient mentions they are using herbs for a medical condition, what should you do?

Reinforce importance of credible sourcing of herbs to prevent contamination with lead, mercury and arsenic.

How to plan goals?

Related to diagnosis Include time frame (May by short term or long term) Example Nursing Dx: Impaired physical mobility, inability to bear weight on left leg r/t total knee replacement AEB inflammation of knee joint -Long term Goal: improved mobility, ability to bear weight on left leg -Short term Goal: ambulate with crutches by end of week, be able to stand without assistance by end of the month

Difference between religion and spirituality

Religion usually refers to an organized set of beliefs by a group of people who see themselves as different from others. (What practices, rites and rituals should I follow? What is right and wrong? What is true and false?) Spirituality deals with individual beliefs and attempts to relate to a god, the universe, others or one's self. (Where do I find meaning? How do I feel connected? How should I live?) Both provide: belief, comfort, reflection, ethics, awe

What does "enema until clear" mean?

Repeat enema until you see clear fluid only

What form of transmission is COVID believed to be? What type of precautions are recommended? How long are studies showing it lives on surfaces for?

Respiratory droplets - via direct and indirect transmission Contact and droplet precautions. Airborne precautions recommended during aerosol-generating procedures because there is evidence that the virus can be aerosolized. (nebulizers, incentive spirometers, flutter valves, suctioning without closed system). Negative pressure room. Infectivity still detected at 6 days but not at 9 days on surfaces. Suspended aerosols viable for 3 hours

In the absence of a legal document filed with the court stating "do not resuscitate", what is the expectation for the healthcare team in the event the patient codes?

Resuscitate. Err on the side of life.

What is the difference between LR (lactated ringers) and Ringer's solution?

Ringer's solution usually has sodium bicarbonate instead of sodium lactate in it. Sometimes Ringer's solution also has more glucose (sugar) in it than lactated Ringer's.

Even though herbs are popular, they are not ______________.

Risk free Manufacturing standards are not as strict as medications are.

What is barotrauma?

Rupture of alveoli and pneumothorax caused by too high of tidal volume from ventilator

Why are the first COVID symptoms respiratory? How is this related to the coagulation symptoms?

SARS-COV-2 binds to ACE2 receptors and some are found in the lungs. Vascular endothelium also expressess ACE2 and direct viral damage to these cells could account for the hypercoaguable profile of COVID

ADPIE Goals need to be:

SMART Specific Measureable Achievable Realistic Timed ...and patient oriented! Example: The patient will report pain 4/10 by 1900 8/25/2020.

What are you looking for when choosing the best plan of care exam answer?

SMART interventions (specific, measurable, attainable, realistic, timed) and patient-centered!

Second tier of needs in hierarchy

Safety Needs (Basic Needs) Security Safety

Age considerations for assessment

Safety considerations Social/Emotional needs Educational Approach Physical assessment differences (foot problems versus cranial malformation...)

What is the difference between Scope of Practice and Scope of Employment?

Scope of Practice = what the board of nursing says you are legally qualified to do Scope of Employment = what your employer says you are allowed to do

What are concomitant symptoms?

Secondary symptoms that may increase pain sensitivity

Why do we encourage older adults to try and continue exercising and maintaining an active lifestyle?

Sedentary lifestyle increases the risk of age-related diseases and premature death.

What are the principles of body mechanics and what is the biggest body mechanic mistake that nurses make?

See image for mechanics Biggest mistake is not raising the bed!

Fifth tier of needs in hierarchy

Self-actualization (Self-fulfillment needs) Achieving one's full potential including creative activity

Difference between sensible and insensible loss

Sensible loss can be perceived by the senses and measured. >>> urine, sweat, diarrhea, blood, vomit, gastric suction Insensible loss cannot be perceived or measured directly. >>> exhaled air with moisture in it, tissue edema, internal bleeding

What is a detached retina?

Separation of the retina from the layer underneath. Occurs from trauma or failed recent cataract surgery. **This is an opthalmologic emergency and presents as a curtain coming down across vision

What is a "never event"?

Serious reportable events that cause serious injury or death to a patient. These should never happen in a hospital.

How to prevent sensory deprivation?

• Turn on lights and open blinds during day time • Sit down with patients, speak, touch and listen to feelings and perceptions • Provide/teach about activities like puzzles

Urobiligen in urine - expected vs variation

• Up to 1 mg/dL • Increased in cirrhosis, heart failure, liver disease, infectious mononucleosis, malaria and pernicious anemia

Patient confidentiality and right to dignified care

Should be obvious

What does asymptomatic mean?

Showing no signs or symptoms

What does symptomatic mean?

Showing signs of a disease or injury

What does the "S" stand for in SBAR? What do the other letters stand for?

Situation Background, Assessment, Recommendation

Components of inspection

Size Shape Color Symmetry (Bilateral comparison) Position Abnormalities

What is an SNF?

Skilled Nursing Facility - a medical treatment center that provides things like respiratory therapy, physical therapy, speech therapy, nutritional services. Round-the-clock. Often used for those with stroke or post-surgery. Also called "rehab". Goal is discharge to home or a facility.

What is the primary organ of absorption?

Small intestine

Nursing diagnosis related to urination

• Urinary Elimination Alteration • Functional/stress/overflow/reflex/urge • Urinary Incontinence • Urinary Retention • Acute Pain

When to use soap and water versus alcohol-based wash?

Soap and water (Properly 15 seconds with friction) ♦ Visibly soiled ♦ After using restroom ♦ Surgical/ICU Scrub ♦ Infections caused by spores Alcohol-based wash ♦ Before eating ♦ After touching intact skin ♦ Before performing invasive procedures ♦ After removing gloves ♦ After contact with inanimate objects

Patient says they are taking XYZ supplement. What should your response be?

Something along the lines of "does your provider know?" or "let's check with the doctor"

Phosphorus: sources, effects of deficiency, symptoms of excess

Sources: dairy, beef, pork, beans, sardines, eggs, chicken, wheat bran, chocolate Deficiency effects: bone loss, poor growth Excess symptoms: tetany, convulsions

Calcium: sources, effects of deficiency, symptoms of excess

Sources: dairy, sardines, green leafy veggies, broccoli, whole grains, egg yolks, legumes, nus, fortified products Deficiency effects: bone loss, tetany, rickets, osteoporosis Excess symptoms: kidney stones, constipation, intestinal gas

Sodium: sources, effects of deficiency, symptoms of excess

Sources: table salt, milk, meat, eggs, baking soda, baking powder, celery, spinach, carrots, beets Deficiency effects: dizziness, abdominal cramping, nausea, vomiting, diarrhea, tachycardia, convulsions, coma Excess symptoms: thirst, fever, dry and sticky tongue and mucious membranes, restlessness, irritability, convulsion

Potassium: sources, effects of deficiency, symptoms of excess

Sources: unprocessed foods especially fruits, any vegetables, meats, potatoes, avocados, legumes, milk, molasses, shellfish, dates, figs Deficiency effects: muscle weakness (including heart & respiratory), weak pulse, fatigue, abdominal distention Excess symptoms: cardiac dysrhythmias, cardiac arrest, weakness, abdominal cramps, diarrhea, anxiety, paresthesia *Typically caused by prolonged vomiting, diarrhea.

Magnesium: sources, effects of deficiency, symptoms of excess

Sources: whole grains, nuts, legumes, green leafy veggies, lima beans, broccoli, squash, potates Deficiency effects: tremor, spasm, convulsions, weakness, muscle pain, poor cardiac function Excess symptoms: weakness, nausea, malaise *Commonly caused by alcoholism.

What are SMART goals?

Specific, Measurable, Attainable, Realistic, Timed

Who do you consult if you are worried your older adult patient is at risk for aspiration due to trouble swallowing?

Speech pathologist

What are the two main categories of infection precautions?

Standard and Isolation

Standardized vs individualized care plan

Standardized is overall vague/general - can be useful for the etiology Individualized tailors general interventions to the patient. Example: constipation Standard: increase fluids Individualized: prune juice and privacy

What do you do if the patient breaks sterile field or touches an area you just cleaned for a sterile procedure?

Start over

Factors affecting mobility and activity

Stress Nutrition Externam environment Lifestyle Diseases and abnormalities Lifespan (older adults)

What is the primary risk factor for IBS?

Stress!

What is the Babinski reflex?

Stroke bottom of foot from heel towards great toe Normal response - curling/flexion of toes Positive Babinski response - fanning of toes up and out (Positive Babinski is normal for babies and abnormal for children, teens, adults)

Subjective vs objective

Subjective - the patient or their family/friends tell you Objective -factual data (Inspection, Auscultation, Palpation, Percussion, diagnostic/lab results, nurse observed grimace) Can remember like "subjective" told by the subject and "objective" from observation

Difference between objective and subjective data?

Subjective: What the patient says (or what someone else says, like a previous nurse, family, etc) Objective: What you personally see/hear

What are biology-based healing modalities?

Substances found in nature such as: • Dietary therapies >> traditional medicine example: low sodium diet >> alternative medicine example: "fiery nature" illness (pittadosha), would eat cold foods • Herbs >> promote performance, energy, treat/prevent illnesses, alleviate depression >> Examples: echinacea, garlic, cranberries, ginseng, ginko • Nonherbal dietary supplements >> Not plant based: hormones, probiotics, melatonin, vitamins, minerals, honey • Aromatherapy

What is the difference between surgical asepsis and medical asepsis?

Surgical asepsis is sterile technique Medical asepsis is clean technique

Examples of olfaction information

Sweet, fruity breath (possible diabetic keto acidosis?) Musty odor from cast (possible infection?) Body odor (poor hygene, stress?)

What is debriefing?

Talking about a traumatic experience in a peaceful setting. Pulling out those memories in a setting where you don't have those trauma-related hormones can help your brain to reprocess that experience and store it in a "better" way.

If a physician orders a dose of medication that you feel would be harmful to the patient, what do you do?

Tell the physician your concerns. If you do not feel comfortable telling the physician, you can turn it over to the charge nurse to discuss it with them. You have the right to not give a dose you feel is harmful. On a test question, the answer is DO NOT give the medication if you feel it will be harmful to the patient.

Components of palpation

Temperature Moisture Texture Turgor Tenderness Thickness

What is tracheal shift a sign of?

Tension pneumothorax pushing trachea to the side

Heart assessment components

Terms for heart sounds: Whoosh Gallop High pitched sounds Cracking Scratching Click Louder upon inpiration/expiration or no change Terms for pulses: Bounding, strong, weak, thready, or absent Regular, irregular Skips, missed beats (palpated during CMS assessment) Blue and/or clubbing nail beds Lips dusky/pale/pink Capillary refill charted by seconds: 1 second, 2, 3, 4, >4 Clubbing/no clubbing of the nails noted Inspect jugular vein for distention (frequently from heart failure)

Glucose in urine - expected vs variation

Test should be negative for glucose • Positive indicates elevated blood sugar • Indicates impaired carbohydrate metabolism • May be detected with diabetes, fever, fasting, high-protein or low-carb diet, vomiting, and during post-anaesthesia period

Ketones in urine - expected vs variation

Test should be negative for ketones • Indicates impaired carbohydrate metabolism • May be detected with diabetes, fever, fasting, high-protein or low-carb diet, vomiting, and during post-anaesthesia period

What is a GUIAC / Fecal Occult Blood Test (FOBT)?

Test to look for presence of blood in stool. Useful in diagnosis of colon cancer. Can get false readings if patient is eating something containing iron or taking aspirin/NSAIDs.

Who decides what gauge needle to use, where to put it and when to change it?

The RN.

What is the definition of "health"?

The WHO defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. **Health is personalized and everyone may have a different definition

What does activity tolerance mean?

The amount of activity or exercise that a patient is able to perform

What is ethnocentrism?

The belief that one's own culture is superior to all other cultures

Why is a tracheostomy better than an endotracheal tube?

The breath has to travel a shorter distance. Trying to breathe through the longer tube can cause fatigue and lower oxygenation.

What is a nursing care plan?

The care plan identifies: 1. The care needed 2. Priority of care to be given 3. It is a method of communication between nurses and the healthcare team 4. It individualizes care for each patient 5. It is a method to ensure continuity of care

What is sensory overload?

• When a person receives multiple sensory stimuli and cannot perceptually disregard or selectively ignore some stimuli • Prevents meaningful response by the brain. Thoughts are racing, attention is scattered, anxiety and restlessness occur

What can depression lead to?

• Worsening of medical condition • Delayed recovering • Risk of illness • Alcoholism • Increased pain and disability • Suicide

What is the difference between a doctor and a nurse?

The doctor recognizes, diagnosis and treats the disease The nurse recognizes, diagnosis and treats the patient's reaction to the disease

What is implementation?

The doing and documentation (charting) of nursing care ***If it's not charted, it wasn't done*** Constant reassessment of reactions to the plan, physically, mentally, socially, etc Prioritize care Delegate (when appropriate) Supervise Interventions must match the problem and the goal - ie: if the diagnosis is about pain and the goal is pain reduction, the interventions cannot be about urinary output.

If you have a "piggyback" IV, why is one bag hung higher up than the other?

The higher bag will infuse first and the lower bag will take over when the higher bag is empty. Use to infuse medications in 50-100ml volumes without the need for additional lines.

What color stools require visiting a doctor?

• Yellow - can be due to metabolic conditions or liver problems • White/clay - sign of an obstruction • Black and tarry - can indicate upper GI bleed (except newborn's first stool) Above and other colors can be caused by food, but the above can indicate bigger problems.

What is therapeutic effect?

The intended or desired effect...sometimes one drug can have multiple effects so it's impt to know what your patient is using it for (Right 7)

What is the Nurse Practice Act?

The law that lists the legal duty that nurses have.

What is respiratory physiology?

The lungs bringing in oxygen and exchanging gases at the alveoli level to get the tissues the oxygen they need and remove the waste

What does "compliance" mean in terms of the lungs?

The measure of the lungs' ability to stretch

Who is responsible for protecting the patient from injury until full sensory and motor function return after anesthesia?

The nurse!

Who is responsible for providing emotional support to patients receiving local or regional anesthesia?

The nurse!

Reminder: don't add anything to an NCLEX question, just use the information they give you only!

The nursing world is perfect in these scenarios, so if the best answer includes a CNA helping you, then you have a CNA

Why do we tend to want to minimize a patient's pain? (not meaning make it better, minimize meaning make it seem less of a problem than it is)

The pain can make us feel powerless about how to help that patient.

What is the significance of a portal of exit in the chain of infection?

The pathogen must exit the reservoir in order to spread infection

What is a patient "missing" when they have a trach in?

The patient loses the protective filtration and humidification that air receives traveling from the nose to the throat. This is bypassed with a trach.

Hyponosis key things to remember

• You do not surrender your free will or lose your personality. • Most don't lose consciousness or have amnesia. • You cannot be put under hypnosis against your will • Success depends on your willingness to experience it

What are the four categories of the "older adult" population?

• Young-old: 65-74 years • Middle-old: 75-84 years • Oldest-old: 85+ years • Centenarians (subgroup) 100+ years

What does colonization mean?

The presence of bacteria on a body surface (like on the skin, mouth, intestines or airway) without causing disease in the person.

What is drug metabolism and where does it take place?

The process of breaking down the drug. Occurs in GI tract, liver, kidney, skin; If liver disease or in elderly, the liver detoxifies less and the drug can build up to toxic levels.

What is acculturation?

The process of learning a different culture to adapt to a new or changing environment. AKA assimilation

What is drug excretion and where does it occur?

The process of removing a drug or metabolites from the body. The most common route is the urine. Some others are biliary system, lungs, breast milk, sweat glands, saliva

What is micturation?

The process of urination

Minerals to build immunity for COVID-19

• Zinc • Selenium • Iron • Magnesium • Vitamin D

List things that can increase risk for constipation

• bed rest • opioids • decreased fluid or fiber intake • CNS disease • depression (due to not eating well)

Why is "reasonable and prudent" more often considered for rural hospitals?

The resources available in a rural hospital are different than in a larger hospital, so the standards of care are different and we look to what other "reasonable and prudent" people would have done with those same resources available.

What factors contribute to reaching a centenarian age? What are some statistics relating to centenarians?

• genetic composition • environment lived in • lifestyle • 12% live independently • 90% are cognitively intact well into their 90s.

What is epidemiology?

The study and analysis of the distribution (who when and where), patterns and determinants of health and disease conditions in defined populations

What is excoriation?

The superficial layers of skin are absent due to skin breakdown

What is the difference between osmolarity and osmolality?

The term "osmolarity" is used for something outside the body and "osmolality" when it is inside the body. Memory trick: • osmol"AIR"ity = "in the air" like an IV bag hung up

What is gate control theory of pain modulation?

The theory that some sensations (massage, touch, pressure) travel faster along nerve impulses than pain sensations do, so when the pain signals arrive to the brain, the pain is diminished because the signals are "blocked at the gate"

What is polypharmacy?

The usage of many drugs at one time.

What is the theory about how narcotic medications work to manage pain?

Theorized that they block the "gate", preventing pain sensations from being transmitted

What does hypertonic mean? What is the range of the osmolality for a hypertonic IV solution?

There is a high level of particles in the solution. • More than 375 mOsm "High is dry"

Aside from speed, why do we use parenteral forms of medication administration?

They are more accurate and predictable since not having to be processed and absorbed in the GI tract.

Why is skin turgor not necessarily the best assessment for dehydration in older adults?

They are more prone to "tenting" due to decreased skin elasticity and not necessarily dehydration. Look for other dehydration markers as well.

Important thing to remember when using a prepackaged enema

They have caps! Remove the cap before insertion so it does not come off inside the body

What is important to know regarding salt substitutes?

They often contain potassium which can affect the heart, especially if the patient is taking medication.

What is the basis for safe, effective nursing care?

Thinking, Doing, Caring

Why are older adults more susceptible to skin breakdown and delayed healing related to integument?

Thinning skin, possible nutrition deficiency

Assessment guidelines

Third person in room if opposite sex Observe nonverbal cues Age appropriate (use play, treat teens as individuals, confidentiality, rest periods for older adults (use aids such as glasses, canes, hearing aids, etc)) Head to toe Organized Focused versus general/complete Document ASAP with appropriate abbreviations (allows accuracy)

Tips for exam when you see "data clusters"

This means each answer is a patient or family scenario. Be sure to read the nursing diagnosis statement very carefully and then read each scenario (data cluster) to choose the best fit for the diagnosis. Look for clues like "actual", "potential", "enhanced readiness"...these will help you pick your best answer

What do you do in the evaluation portion of nursing diagnosis?

Tie in your goals with what you see the patient doing now

Why do we put someone in a medicated coma?

To decrease oxygen demand (sleeping cells have lower metabolism)

Why do we take vaccines?

To stimulate memory cells to recognize an infection if we encounter it in the future.

What is hypocarbia?

Too low CO2 in blood

What is hypercarbia?

Too much CO2 ♦ Can be caused by chest wall deformity (can't exhale completely, hypoventilation (common in COPD)

What does TPN mean?

Total parenteral nutrition - IV solution high in electrolytes and sugar AKA "banana bag"

Options for moving patients out of bed

Transfer board Mechanical lift Transfer belt

How to treat anemia? Difference between types of anemia: • Microcytic • Normocytic • Macrocytic

Treatment depends on the type, severity, result of lab tests, and overall condition of the patient. The most common type is iron-deficiency anemia, and iron supplementation is the most effective strategy to treat iron deficiency anemia. •Microcytic anemia: In this type, the red blood cells have a smaller size than usual. The leading causes of microcytic anemia are deficiency of iron and thalassemia. •Normocytic anemia: In this type, the RBCs have average size but are low in number than usual. Kidney diseases and chronic disorders are some of the causes of normocytic anemia. •Macrocytic anemia: The red blood cells have a large size than usual and are deficient in the blood. Lack of vitamin B12 and excessive intake of alcohol are the causes of macrocytic anemia.

What is it called when the nurse tries to fix something for the patient using a variety of approaches?

Trial and error (versus scientific method)

A nurse will always wear an N95 (or respirator) for airborne precautions T/F?

True

Dehydration can cause mental confusion in the elderly T/F?

True

People with anemia tend to have higher rates of insomnia. T/F?

True

True or false? The American Nurses Association (ANA) supports aggressive treatment of pain and suffering, even if it hastens a patient's death.

True

The following nursing diagnosis is written correctly: Risk for falls r/t decreased sensation and mobility in legs" T/F?

True "Risk for" may have a r/t factor if it logically makes sense such as in this example, but they will not have an AEB component

Chronic use of laxatives can lead to dependency T/F?

True Can decrease colon's ability to contract, worsening constipation

An example of an exogenous healthcare associated infection is a patient contracting an illness from a healthcare worker T/F?

True Exogenous comes from outside the patient's own body. (Exo like exit) Endogenous comes from within the patient's own body. (Endo like inside)

The following nursing diagnosis is written correctly: Impaired walking r/t stiffness and pain s/t rheumatoid arthritis T/F?

True Medical diagnosis is included here, but only as a "s/t secondary to"

Diarrhea could cause a person to go into metabolic acidosis T/F?

True Think of it like vomit would be losing acid = alkalosis. Diarrhea would be losing alkalinity = acidosis.

How long can you use an IV bag for?

Typically bag must be changed every 24 hours, even if it is not empty. (may vary depending on hospital policy)

What is an idiosyncratic drug side effect?

Unexpected side effect, but not necessarily a bad thing. IE: Wellbutrin for depression, but we find out it also helps quit smoking and ADHD

Why do we use nursing diagnosis?

Unifies our language (North American Nursing Diagnosis Association (NANDA)) Helps set nursing priorities/ interventions Helps identify how client responds, and identifies resources to prevent or resolve problems. Provides a system to evaluate nursing care for effectiveness Nursing diagnoses are an effective teaching tool to help sharpen their problem-solving and critical thinking skills.

What do URI and LRI stand for?

Upper respiratory infection / Lower respiratory infection

Difference between urge incontinence, stress incontinence and overflow incontinence?

Urge = urge to urinate, bladder very full, involuntarily loses urine Stress = bladder may not be full, but increased intra-abdominal pressure causes involuntary urine loss (IE laugh, sneeze, cough) Overflow = physical pressure on the bladder causes involuntary urine loss (IE fecal impaction, enlarged prostate)

What is a UA and what is it used for?

Urinary Analysis • used to check the appearance, concentration and content of urine ***Test within 2 hours of collection ***First morning void preferable ***Dipstick, quick result

What is polyuria?

Urinating large and excessive amounts (symptom of diabetes)

What is a UC and what is it used for?

Urine Culture • looking for bacteria in the urine, figure out which microbe is causing the infection ***Sterile culture sent to lab ***24-48 hours for result

What is anuria?

Urine output less than 100ml in 24 hours

What drug interaction can ginko have?

Used for dementia or cognitive impairments, but can inhibit platelet aggregation, so it can increase bleeding when someone is using anti-coagulant drugs.

What drug interactions can St. John's Wort have?

Used to treat depression but can inhibit or potentiate many different drugs. Examples: • decrease effect of digoxin • decrease effect of Xanax • decrease effect of coumadin • taking with antidepressants can cause buildup of too much seratonin in the body (example sources from Mayo clinic)

What is SBARQ?

Used when escalating concerns. ♦ S - Situation >> Name, unit, patient's name/room, problem ♦ B - Background >> Pertinent information to situation, circumstances leading up to situation (don't need long history) ♦ A - Assessment >> State problem and what you think is causing it >> Be detailed - exact numbers, not "low BP" R - Recommendation >> State what you think will correct the problem or what you need from the provider Q - Questions >> Allow patient opportunity to ask or answer questions ***ALWAYS read and repeat back to your provider when they provide orders***

What is isokinetic exercise?

Variable resistance maintaining speed (think stationary bike)

Additional concerns for "oldest-old" adults and centenarians?

• increase in sensory impairments • oral health concerns • inadequate dietary intake • functional limitations

Where in the body are fluids found?

• intracellular (in the cells) • vascular (in the blood vessels) • interstitial (AKA "third space", extracellular)

Which IV solution medications do not mix well with LR?

• methylprednisone • nitroglycerin • nitroprusside • norepinephrine • propanolol

What is a special consideration for injecting insulin?

Verify the dose with another RN before administering!

Older patient eye assessment considerations

Visual acuity decrease with age Peripheral vision decreases Color vision declines Presbyopia common in older clients (gradual, age-related loss of the eyes' ability to focus actively on nearby objects)

Why do older adults have a decreased ability for greater lung expansion?

Weakening muscles and decreased elasticity of chest walls. Breathing can become more shallow and gas exchange impacted. Breath sounds may not be heard as far down the torso due to decreased expansion. ***increases risk of death from respiratory illnesses

What does it mean to delegate?

What does it mean to delegate? Transferring authority to another person to perform a job in a certain situation. You are responsible to know what can be delegated! Assessment cannot be delegated Teaching cannot be delegated Can giving meds? Maybe to an LPN depending on training (ie not chemo drugs) Turning a patient? ...yes

What is the most important thing to assess for when considering "aging in place" vs a residential facility/long term care facility?

What is the current level of the patient's independence?

What is medication interaction?

When one medication modifies the action of another

What is a disclosure as it relates to ethics and law in a hospital?

When something happened that was outside the standard of care, explaining to the patient what happened even if they would have never been harmed or found out about it. Example: latex catheter used for patient with allergy

What is synergistic effect?

When the combination of more than one drug that causes a drug's effect to be boosted

Which CAM methods are often used with cancer?

• prayer • relaxation • meditation • massage • aromatherapy More than 60% of cancer patients use some form of CAM

When would you choose a needle with a smaller gauge?

When you may need to do rapid infusion or the solution is thick, such as blood.

What do you have a patient do to see if they are strong enough to stand?

While lying down, place feet flat on bed and try to lift hips off of the bed

What does WNL stand for?

Within normal levels

Does the patient have the right to refuse a medication ordered by the doctor? What do you do if they refuse?

YES they can refuse any medication they want to refuse. We would want to tell them that they have the right to refuse it, tell them what it can do, what could happen if they don't take it and let them decide what they want to do.

Can people with disease be healthy?

Yes, someone that has disease can be healthy because health includes their mental and social wellbeing as well and we are looking at the total person.

What does it mean that bathing is an independent RN action?

You should never have to be told to bathe your patient, provide oral care, etc. These are independent actions.

Can you put a medical diagnosis inside a nursing diagnosis? Example: Excessive fluid volume r/t congestive heart failure

You want to avoid including a medical diagnosis if there is another answer that is suitable. ***If including a medical diagnosis in your nursing diagnosis, it should only be "secondary to" and not used for r/t or AEB. >>"Excessive fluid volume r/t decreased cardiac output" is a better choice than "Excessive fluid volume r/t congestive heart failure"

What is the format of a nursing diagnosis?

_______________r/t_____________AEB________________ Inconsistent attendance related to (r/t) crummy car as evidenced by (AEB) missing lectures

What can cause burnout in nursing?

•Difficulty personalities •Working long shifts or long stretches •Rotating shifts (swinging from day to night) •Low staffing ratio •O.T. Shift •Patient population •Inability to delegate •Poor eating and exercising habits •Relying on unhealthy forms of coping at home There will be stressors at work. What can you do now to decrase your stress? Health promotion activities will make you a more empathetic nurse!

Anemia symptoms

•Fatigue •Unusually pale skin •Shortness of breath (increased RR) •Increased infection rate •Insomnia •Pica (craving non-food items like dirt, chalk, paper, and ice during pregnancy) •Lower body temperature •Brown or red urine (a result of rapid destruction of RBCs) •Dementia (Vitamin B12 plays a significant role in the absorption of iron and folate. Anemia that occurs due to a lack of deficiency of vitamin B12 can show signs of dementia. ) •Headaches •Irregular heart beat •Damaged skin and hair •Mouth and tongue swelling •Leg cramps (AKA RLS) •Brittle nails

Vitamin B1 Benefits Deficiency issue Sources

•Helps fight fatigue •Deficiency leads to 'beri-beri •Sources: Yeast, cereals, rice, liver, legumes •Is destroyed by severe washing of rice and veggies

Ideas to help patients with stress

•Identifying a support person •Spiritual support •Crisis interventions •Referrals •CAM (Complementary and Alternative Medicine, examples aromatherapy, massage, acupuncture...) •Music •Art therapy •Apps •Humor—need to be cautious

What are the characteristics of a nurse who is practicing critical thinking?

•Listening •Exhibiting •Practicing (in a competent way) •Questioning

Nitrite in urine - expected vs variation

•Negative •Increase in bacteruria, presence of nitrite-forming bacteria, such as e-coli

Critical thinking: •What can you do if the CNA reports to you a blood pressure of 210/118?

•Retake the vital signs •On a different arm •On the same arm •Try a different blood pressure cuff •Try a different sized blood pressure cuff. •Validate all other vital signs for yourself •Check if on blood pressure medications that have/have not been given •Check on patients status...pain? Anxiety? Detoxing from ETOH? •Call the doctor if no obvious solution (e.g. medicate for pain) •If PRN medication is available, medicate the patient and retake BP after the appropriate time has past. (e.g. IV meds wait 5 to 10 minutes, PO meds 30 min-45 minutes...)

Why is it important for a nurse to be aware of their body balance, alignment and posture?

•To reduce the risk of injury •To facilitate body movements •To allow for physical mobility without muscle strain •To avoid excessive use of muscle energy (muscle fatigue/strain)

Water soluble and fat soluble vitamins

•Water soluble B and C (we can't overdose on these) •Fat soluble A, D, E, and K (easily stored so can become toxic)

What is cystitis?

bladder inflammation