1110 Final Flashcards Part 1

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name volume amounts of intravascular plasma, intertitial fluid, intracellular

3L, 11L, 28Liters

orthopnea

difficulty breathing while laying flat

noticing

most often the impetus for clinical reasoning and critical to making an effective judgment; "often what is behind the nurse's eyes is more important than what is in front"; influenced greatly by the nurse's expectations for what is happening currently, and what may happen in the hours or days following

(A-delta fibers) are myelin or not myelin

myelinated (A-delta fibers) or unmyelinated (C fibers).

interpretivist perspective

originate from the belief that life experiences are culturally bound, that individuals interpret these experiences on the basis of their encounters within a given culture, and that one circumscribed approach is often not appropriate for a large number of patients; incorporates the nurses intuitions, beliefs, and emotions, as well as the relationship between the nurse and patient

our cells produce two types of acid, there are two different types of acidosis: WHAT acidosis and WHAT acidosis.

our cells produce two types of acid, there are two different types of acidosis: respiratory acidosis and metabolic acidosis.

pH scale goes from WHATto WHAT. WHATvalue is normal

pH scale goes from 1.0 (very acid) to98814.0 (very alkaline; basic). A pH of 7.0 is considered neutral.

Pain can

reduce mobility, impair sleep, contribute to loss of appetite; narcotics used for pain can affect bowel movement

responding

the nurses actions in response to interpretations of data and observations

urine, sweat) is a hypotonic salt solution

• X-linked recessive disorders are caused by ...

a mutation on the X chromosome.

Stridor

a shrill or harsh sound that can be heard during inspiration, expiration, or both. Produced by the flow of air through a narrowed segment of the respiratory tract.

caring

a universal phenomenon that influences the way we think, feel, and behave

color blindness

a variety of disorders marked by inability to distinguish some or all colors

When planning to evaluate a patient's satisfaction with a teaching activity, what is the most appropriate strategy? a. Include a survey instrument b. Observe for level of skill mastery c. Present information more than one time D. Provide for a return demonstration

a. Include a survey instrument

If a person tests positive for a genetic mutation, it means (select all that apply) a. the laboratory found an alteration in a gene. b. the person is predisposed to develop a genetic disease. c. there is the chance other family members may be at risk d. that the person will develop the disease at some point in time. e. that the person should not have any children or any more children.

a. the laboratory found an alteration in a gene. c. there is the chance other family members may be at risk Rationale: A positive test result means that the laboratory found a change in a particular gene, chromosome, or protein that was being tested. A positive result cannot establish the absolute risk of developing a disorder. A positive result indicates the chance that other family members may be at risk for the disorder.

process orientation

accepts that clinical judgment is circular and reciprocal between the nurse and patient; that each brings individual experiences and values; the nurse brings to bear a deep understanding of the patient and notices salient details in order to bring them into treatment; constantly evolving and changing process

where is aldosterone ffrom

adrenal gland to tell kidney

• Genomics is the study of...

all a person's genes (the genome), including interactions of these genes with each other and with the person's environment.

• People making decisions about genetic testing should be aware of ...

all the safeguards that have been developed to maintain confidentiality and actions they need to take to assure information remains confidential.

clinical judgement

an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use of modify standard approaches, or improvise new ones as deemed appropriate by the patient's response

Brief resolved unexplained events (BRUE)

are sudden episodes characterized by apnea, a color change, a change in muscle tone, and altered state of responsiveness in an infant who otherwise appears healthy and who returns to normal behavior and status after the event. More often in infants older than 2 months but younger than 1 year who might have been born prematurely.

• Genetic disorders can be categorized into....(3)

autosomal dominant, autosomal recessive, or sex-linked (X-linked) recessive disorders.

A nurse has prepared a discharge teaching plan for an adult patient who is not being compliant. Which strategy should the nurse include to help increase compliance with following discharge instructions? a. Individualized handout b. Instructional videos c. Internet resources d. Self-help books

b. Instructional videos

Ethics of duty

based on deontology, in which moral duties are seen as self-evident, needing no further justification. Moral action is based on acting according to a specific duty simply because it is the right thing to do.

cyanosis

bluish discoloration of the skin

body has two acid-excretion systems: WHAT 2 organs

body has two acid-excretion systems: lungs and kidneys. The lungs excrete carbonic acid; the kidneys excrete metabolic acids

Pain may be categorized

but not all pain is possible to identify

capillary hydrostatic pressure is WHATthat helps move fluid from capillaries into the interstitial area.

capillary hydrostatic pressure is a relatively strong outward-pushing force that helps move fluid from capillaries into the interstitial area.

Nurse should ensure care equipment is

cleaned or reprocessed appropriately when it is contaminated w/blood or bodily fluids

reflection-on-action

consideration of the situation after the patient care has occurred; often involves verbal narrative (storytelling) and written narrative (journalling)

hemoptysis

coughing up blood or bloody secretions

Active transport is the sodium-potassium pump, which does WHATto Na+ and K+, keeping ICF lower in Na+and higher in K+than the ECF.

ctive transport is the sodium-potassium pump, which moves Na+out of a cell and K+into it, keeping ICF lower in Na+and higher in K+than the ECF.

Hypernatremia (Water Deficit; Hyperosmolar Imbalance)—Body Fluids Too Concentrated

large-diameter fibers have what effects

large-diameter fibers have inhibitory effects to shut the gate

reasoning

leads to clinical judgment; at least 3 types are used: analytic, intuitive, and narrative, depending upon the caregiving situation and the nurses experience;

Essential elements of conducting physical assessment

maintain infection control principles, hand hygiene most important

whay % of the body weight of an adult man is water.

60% of the body weight of an adult man is water.

Important characteristics of the skin

-Color -Moisture -Temperature -Texture -Turgar -Vascularity -Edema -Lesions

Abnormal lung sounds

-Crackles -Rhonchi -Wheezes -Pleural friction rub

major buffer in the ECF is the WHATbuffer system, which buffers metabolic acids

major buffer in the ECF is the bicarbonate (HCO3-) buffer system, which buffers metabolic acids

Consequences of Chronic Stress

- Chronic stress -----> heightened responses. - Exhaustion of resources leads to a loss of homeostasis. - Negative physical, psychological, and/or social manifestations

B. Gaining an understanding of what a woman's health exam means to the patient

A Muslim woman enters the clinic to have a woman's health examination for the first time. Which nursing behavior applies Swanson's caring processes of "knowing the patient?" A. Sharing feelings about the importance of having regular woman's health examinations. B. Gaining an understanding of what a woman's health examination means to the patient. C. Recognizing that the patient is modest; and obtaining gender-congruent caregiver D. Explaining the risk factors for cervical cancer

A hospice nurse sits at the bedside of a male patient in the final stages of cancer. He and his parents made the decision that he would move home and they would help him. The family participates in his care, but lately the nurse has increased the amount of time she spends with the family. Whenever she enters the room or approaches the patient to give care, she touches his shoulder and tells him that she is present. This is an example of what type of touch? A. Caring touch B. Protective touch C. Task-oriented touch D. Interpersonal touch

ADH regulates the osmolality of the body fluids how -by influencing how much water

ADH regulates the osmolality of the body fluids by influencing how much water is excreted in urine. It is synthesized by neurons in the hypothalamus that release it from the posterior pituitary gland.

ANP also regulates ECV by influencing how much sodium and water are excreted where

ANP also regulates ECV by influencing how much sodium and water are excreted in urine.

A patient is fearful of upcoming surgery and a possible cancer diagnosis. He discusses his love for the Bible with his nurse, who recommends a favorite Bible verse. Another nurse tells the patient's nurse that there is no place in nursing for spiritual caring. The patient's nurse replies: A. "You're correct; spiritual care should be left to a pastoral care professional." B. "You're correct; religion is a personal decision." C. "Nurses should explain their own religious beliefs to patients." D. "Spiritual, mind, and body connections can affect health."

capilllary osmotic presssure pulls which way

pulls from interstital fluid into the capillary

The nurse is assessing spiritual needs for a patient who has been newly diagnosed with a chronic illness. Which are appropriate nursing interventions for the spiritual care of this patient? Select all that apply. A. Shared laughter B. Shared tears C. Listening to the patient D. Administering medication E. Praying with the patient F. Ambulating the patient

A, B, C, E

Co-dominance

A condition in which both alleles for a gene are fully expressed

Prayer

A conversation with God or a Higher Power, however that Higher Power is conceived.

C. a sense of presence

A female patient has just found a large lump in her breast. The physician needs to perform a breast biopsy. The nurse helps the patient into the proper position and offers support during the biopsy. The nurse is demonstrating... A. enabling B. comforting C. a sense of presence D. maintaining belief

Addition of H+released by a metabolic acid to a bicarbonate ion makes more WHAT

Addition of H+released by a metabolic acid to a bicarbonate ion makes more carbonic acid.

In which situation would formal patient education courses or classes be the most appropriate strategy?

Address needs common to a group.

Which interrelated concept regarding patient attributes and preferences should the nurse take into consideration when providing patient education?

Adherence

recessive allele

An allele that is masked when a dominant allele is present

An electrolyte is a

An electrolyte is a compound that separates into ions (charged particles) when it dissolves in water.

Beneficence

An obligation to do good by acting in ways that promote the welfare and best interests of others.

Angiotensinhas several functions, one of which is WHAT

Angiotensin II984has several functions, one of which is vasoconstriction

Ethics of relationship

Are focused on the nature and obligations inherent in human relationships and community.

what 2 compartment make ECF

Because ECF is both vascular and interstitial, signs and symptoms arise from lack of volume in both of these compartments.

COLLOIDS EXERT WHAT PRESSURE

Because they are particles, colloids exert osmotic pressure.

Acute Stress

By far, the most common type of stress and typically occurs for a short period of time. It usually occurs in reaction to a real or perceivied deman, threat, or pressure. Resolution of the stressor leads to elimination of the stress response.

Which technique would the nurse use to assess the elasticity of the patient's skin? By using a light palpation method anywhere on the body By inspecting edematous areas on the skin By observing reddened, pink, or pale areas on the skin By grasping the skin of the forearm with the fingertips and releasing it

By grasping the skin of the forearm with the fingertips and releasing it

Body temperature

Can be measured in C or F; rectal is most accurate, axillary is least accurate

Clinical dehydration is common with WHATcauses

Clinical dehydration is common with gastroenteritis or other causes of severe vomiting and diarrhea

The figure given below shows female external genitalia. Which structure does point A indicate? Vagina Clitoris Perineum Urethral orifice

Clitoris

Psychological and emotional stress - Ex of intervention

Cognitive behavioral skills training, meditation, stress inoculation, time management

Moral courage

Enables us to act on our decisions even under the most challenging circumstances.

Ethical reflection and analysis

Enables us to think critically to rank our ethical obligations and priorities.

name 2 clinical conditions that increase ADH levels include severely decreased blood volume

Factors that increase ADH levels include severely decreased blood volume (e.g., dehydration, hemorrhage)

Behavioral - Examples of intervention

Health education Smoking cessation Counseling

Hypomagnesemiais abnormally low or high magnesium concentration in the blood

Hypomagnesemiais abnormally low magnesium concentration in the blood

Hypercalcemia decreases neuromuscular WHAT

Hypercalcemia decreases neuromuscular excitability, the basis for its other signs and symptoms, the most common of which is lethargy

Hypercalcemiais abnormally HIGH OR LOW calcium concentration in the blood

Hypercalcemiais abnormally high calcium concentration in the blood

Respiratory Alkalosis—Deficient Carbonic Acid Caused by Alveolar Hyperventilation clinical examples

Hypoxemia from any cause (e.g., initial part of asthma episode, pneumonia) Acute pain Anxiety, psychological distress, sobbing Inappropriate mechanical ventilator settings Stimulation of brainstem respiratory control (e.g., meningitis, gram-negative sepsis, head injury, aspirin overdose)

Respiratory Acidosis—Excessive Carbonic Acid Caused by Alveolar Hypoventilation examples

Impaired Gas Exchange: Type B COPD (chronic bronchitis) or end-stage type A COPD (emphysema) Bacterial pneumonia Airway obstruction Extensive atelectasis (collapsed alveoli) Severe acute asthma episode Impaired Neuromuscular Function: Respiratory muscle weakness or paralysis from hypokalemia or neurological dysfunction Respiratory muscle fatigue, respiratory failure Chest wall injury or surgery causing pain with respiration Dysfunction of Brainstem Respiratory Control: Drug overdose with a respiratory depressant Some types of head injury

Hyperkalemia—High Serum Potassium (K+) Concentration

Increased K + Intake:Iatrogenic administration of large amounts of IV K+; rapid infusion of stored blood; excess ingestion of K+salt substitutes Shift of K + out of Cells:Massive cellular damage (e.g., crushing trauma, cytotoxic chemotherapy); insufficient insulin (e.g., diabetic ketoacidosis); some types of acidosis Decreased K + Output:Acute or chronic oliguria (e.g., severe ECV deficit, end-stage renal disease); use of potassium-sparing diuretics; adrenal insufficiency (deficit of cortisol and aldosterone)

clincal codittions Hypermagnesemia—High Serum Magnesium (Mg2+) Concentration

Increased Mg 2+ Intake and Absorption:Excessive use of Mg2+-containing laxatives and antacids; parenteral overload of magnesium Decreased Mg 2+ Output:Oliguric end-stage renal disease; adrenal insufficiency

Inflammation is another cause of edema. It increases capillary blood flow and allows capillaries to leak WHATinto the interstitial space

Inflammation is another cause of edema. It increases capillary blood flow and allows capillaries to leak colloids into the interstitial space

Bronchiolitis

Inflammation of the bronchioles. Respiratory syncytial virus (RSV) is the causative agent in more than half of cases.

Magnesium (Mg2+) does WHATin body

Influences function of neuromuscular junctions; is a cofactor for numerous enzymes

Ethical dilemma

Involves a problem for which in order to do something right you have to do something wrong.

Transduction

Involves the conversion of a noxious Mechanical, thermal, or chemical stimulus into an electrical signal called an action potential

Isotonic Imbalances—Water and Sodium Lost or Gained in Equal or Isotonic Proportions

Potassium (K+) amounts in ECF and ICF

Low in ECF, high in ICF. Insulin, epinephrine, and alkalosis shift K+into cells. Some types of acidosis shift K+out of cells.

If the nurse suspects mucus accumulation in the lungs, which part of the lung should be given attention when performing a physical examination? Trachea Clavicles Lower lobes Lung periphery

Lower lobes

Metabolic Alkalosis—Deficient Metabolic Acids Physical examination:

Physical examination:Light-headedness, numbness and tingling of fingers, toes, and circumoral region; muscle cramps; possible excitement and confusion followed by decreased level of consciousness, dysrhythmias (may be caused by concurrent hypokalemia)

Physical examination: Hypomagnesemia—Low Serum Magnesium (Mg2+) Concentration

Physical examination:Positive Chvostek's sign, hyperactive deep tendon reflexes, muscle cramps and twitching, grimacing, dysphagia, tetany, seizures, insomnia, tachycardia, hypertension, dysrhythmias

Heart Rate

Most commonly assessed through palpation of pulse; should also document rate and rhythm

Projection neurons activate endogenous descending inhibitory mediators (see Box 44.1), such as what that aid in producing an analgesic effect.

Projection neurons activate endogenous descending inhibitory mediators (see Box 44.1), such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), that aid in producing an analgesic effect.

Psychological and emotional stress - Outcome

Reduced anxiety and anger Reduced depression Reduced strain

Oxygen saturation and Pain

Routinely assessed with vital signs and considered part of vital signs

What are the symptoms of CF?

Salty skin, poor growth, poor wt gain, steatorrhea (fatty stools), malnutrition Typically diagnosed around 2yo

Which body part is the best site for the nurse to inspect for jaundice? Lips Sclera Mouth Tongue

Sclera

Hypomagnesemiais WHAT signs

Signs and symptoms are similar to those of hypocalcemia because hypomagnesemia also increases neuromuscular excitability

Mantoux test

Skin test for TB.

Development

Spirituality is in part dependent to the stage of the individual.

Substance P cause body to do what •

Substance P • Found in pain • Causes vasodilation and edema

The PaCO2 rises, creating an excess of carbonic acid in the blood, which DECREASE OR INCREASE the pH?

The PaCO2rises, creating an excess of carbonic acid in the blood, which decreases pH

The kidneys excrete all acids except WHAT

The kidneys excrete all acids except carbonic acid.

where is ANP from

heart and tells kidney info

pulmonary disease: respiratory failure

inadequate gas exchange; PaCO2 < 60mmHg

General appearance

includes observations about age, skin, and hygiene

Status Asthmaticus

increasingly severe asthma that is unresponsive to vigorous treatment measures. It is a medical emergency

Pain experience

influenced by tolerance or threshold

Additional factors to assess

body movement, emotional and mental status, and behavior

perception of the pain is

brain interprets the quality of the pain and processes information from past experience, knowledge, and cultural associations in the perception of the pain

A nurse is preparing to implement a teaching plan. Which factor might be considered to be a barrier to patient education? a. Family resources b. High school education c. Hunger and pain D. Need perceived by patient

c. Hunger and pain

What is the most appropriate resource to include when planning to provide patient education related to a goal in the psychomotor domain? a. Diagnosis-related support groups b. Internet resources c. Manikin practice sessions d. Self-directed learning modules

c. Manikin practice sessions

cancers such as lung and breast cancers often develop hypercalcemia because some cancer cells secrete chemicals into the blood that are related to WHAThormone.

cancers such as lung and breast cancers often develop hypercalcemia because some cancer cells secrete chemicals into the blood that are related to parathyroid hormone.

cancers such as lung and breast cancers often develop hypercalcemia because some cancer cells do WHAT

cancers such as lung and breast cancers often develop hypercalcemia because some cancer cells secrete chemicals into the blood that are related to parathyroid hormone. When these chemicals reach the bones, they cause shift of calcium from bones into the ECF.

where is filtration in the body and . Filtration is

capillaries . Filtration is the net effect of four forces, two that tend to move fluid out of capillaries and small venules and two that tend to move fluid back into them

causes of hypokalemia from increased potassium output include WHATexampless

causes of hypokalemia from increased potassium output include diarrhea, repeated vomiting, and use of potassium-wasting diuretics

lungs blow off WHAT. cells produce carbon dioxide (CO2), which combine with water to produce carbonic acid (H2CO3).

cells produce carbon dioxide (CO2), which combine with water to produce carbonic acid (H2CO3).

clinical dehydration. The ECV is too WHAT, and the body fluids are too concentrated

clinical dehydration. The ECV is too low, and the body fluids are too concentrated

Response and Influence of pain is influenced by

cognitive factors(attention given to pain), cultural influences, person's previous experience with pain; distraction is a relieving factor

polygenic inheritance

combined effect of two or more genes on a single character

Tanner's model of clinical judgement

comprised of noticing, interpreting, responding, and reflecting

expectations

comprised of nurse's knowledge, experience, ethical perspective, and knowing the patient; what is brought to bare on the process of noticing

what is osmolality

concentration (osmolality

When describing patient education approaches, the nurse educator would explain that informal teaching is an approach that involves which quality? a. Addresses group needs b. Follow formalized plans c. Has standardized content d. Often occurs one-to-one

d. Often occurs one-to-one

The nurse educator would identify a need for additional teaching when the student lists which example as a type of learning? a. Affective b. Cognitive C. Psychomotor d. Self-directed

d. Self-directed

A nurse manager is reviewing interrelated concepts to the professional nursing role. Which factor should the nurse manager consider when addressing concerns about the quality of patient education? a. Adherence b. Developmental level c. Motivation d. Technology

d. Technology

deep pain typically involving the visceral organs (e.g., with a myocardial infarction or colic from gallbladder or renal stones) activates the what nervous system.

deep pain typically involving the visceral organs (e.g., with a myocardial infarction or colic from gallbladder or renal stones) activates the parasympathetic nervous system.

Swanson's Theory of Caring

defines caring as a nurturing way of relating to an individual; states that caring is a central nursing phenomenon but is not necessarily unique to nursing practice

Leininger's Transcultural Caring

describes the concept of care as the essence and central, unifying, and dominant domain that distinguishes nursing from other health disciplines; caring is an essential human need and helps and individual or group improve a human condition

dyspnea

difficulty breathing

• Autosomal dominant disorders are caused by

dominant allele ; a mutation of a single gene pair (heterozygous) on a chromosome.

physiologically active form of calcium in the blood is WHATcalcium

e physiologically active form of calcium in the blood is ionized calcium

• Stem cells are cells in the body that can differentiate into other cells. Stem cells can be divided into 2 types:

embryonic and adult.

phenocopies

environmentally produced phenotypes that mimic mutations

enzyme renin, which acts on WHAT, an inactive protein secreted by the liver

enzyme renin, which acts on angiotensinogen, an inactive protein secreted by the liver

• Genetic testing may lead to both

ethical and social issues.

alcohol DECREASES OR INCRREASES ADH release, which causes people to urinate frequently when they drink alcoholic

ethyl alcohol decreases ADH release, which causes people to urinate frequently when they drink alcoholic

crossover

exchange of genetic material between non-sister chromatids resulting in chromosomes that incorporate genes from both parents of the organism

extracellular fluid (ECF)outside the cells andintracellular fluid (ICF) In adults ICF is approximately how much of total body water.

extracellular fluid (ECF)outside the cells andintracellular fluid (ICF)iIn adults ICF is approximately two-thirds of total body water.

• DNA fingerprinting begins by

extracting DNA from the cells in a sample of blood, saliva, semen, or other appropriate fluid or tissue.

fast-transmitting myelinated A-delta fibers transmit what kind of info whereas the smaller-diameter unmyelinated C fibers relay impulses that are dull, achy, and poorly localized.

fast-transmitting myelinated A-delta fibers transmit sharp, localized nociceptive information, whereas the smaller-diameter unmyelinated C fibers relay impulses that are dull, achy, and poorly localized.

smaller-diameter unmyelinated C fibers relay impulses that are what

Fluid distribution between the vascular and interstitial parts of the ECF occurs by WHAT.

fluid distributionmeans the movement of fluid among its various compartments. Fluid distribution between the extracellular and intracellular compartments occurs by osmosis. Fluid distribution between the vascular and interstitial parts of the ECF occurs by filtration.

fluid distribution how does Fluid distribution between the extracellular and intracellular compartments occurs by WHAT . Fluid distribution between the vascular capillary and interstitial parts of the ECF occurs by WHAT.

fluid distribution means

Diffusion is passive movement of electrolytes or other particles down a concentration gradient (from areas of WHATconcentration to areas of WHATconcentration).

from areas of higher concentration to areas of lower concentration).

• Genomics includes the study of complex diseases (e.g., heart disease, diabetes mellitus, cancer), because these diseases are typically caused by a combination of ...

genetic and environmental factors rather than by a single gene.

genotype

genetic makeup of an organism

• Pharmacogenomics is the study of

genetic variability of drug responses due to variation in multiple genes.

• GWAS is particularly useful in finding ...

genetic variations that contribute to multifactorial inherited disorders, such as cancer, diabetes, and heart disease.

Genetics vs Genomics

genetics: study of inheritance of individual genes genomics: study of ALL genes in a person/organism (includes major environmental role)

the term fluid means

he termfluidmeans water that contains dissolved or suspended substances such as glucose, mineral salts, and proteins.

hypermagnesemia does WHATto deep tendon reflexes being most common

hypermagnesemia unless the person decreases magnesium intake to match the decreased output. Signs and symptoms are caused by decreased neuromuscular excitability, with lethargy and decreased deep tendon reflexes being most common

hypertonic solution is more WHATthan normal blood

hypertonicsolution is more concentrated than normal blood

hypovolemia means

hypovolemiameans decreased vascular volume and often is used when discussing ECV deficit

if hemorrhage or vomiting decreases the extracellular fluid volume (ECV), blood flow decreases through the renal arteries, and more WHATis released.

if hemorrhage or vomiting decreases the extracellular fluid volume (ECV), blood flow decreases through the renal arteries, and more renin is released.

if hemorrhage or vomiting decreases the extracellular fluid volume (ECV), blood flow decreases through the renal arteries, and more renin is released. This increased RAAS activity causes more WHATand WHATretention, helping to restore ECV.

important fluid homeostasis functions of angiotensin II include stimulation of aldosterone release from the WHAT

important fluid homeostasis functions of angiotensin II include stimulation of aldosterone release from the adrenal cortex.

WHATis osmoreceptor-mediated thirst what is (baroreceptor-mediated thirst and angiotensin II- and III-mediated thirst)

important regulator of fluid intake when plasma osmolality increases (osmoreceptor-mediated thirst) or the blood volume decreases (baroreceptor-mediated thirst and angiotensin II- and III-mediated thirst)

as the blood volume decreases what mechanism happens (baroreceptor-WHAT

infusion of a hypertonic intravenous (IV) solution (more concentrated than normal body fluids) causes water to LEAVE OR ENTER cells by osmosis?? to equalize the osmolality between interstitial and intracellular compartments.

infusion of a hypertonic intravenous (IV) solution (more concentrated than normal body fluids) causes water to leave cells by osmosis to equalize the osmolality between interstitial and intracellular compartments.

autosomal dominant

inheritance pattern of a dominant allele on an autosome

autosomal recessive

inheritance pattern of a recessive allele on an autosome

• Genetic disorders can be (2)

inherited (person born with altered genetic code) or acquired (e.g., replication errors, damage to DNA from toxins).

Chronic(persistent) pain

intermittent or continuous, lasts longer than 6 months

kidneys excrete all acids except carbonic acid. They secrete H+into the renal tubular fluid, putting WHAT back into the blood at the same time.

kidneys excrete all acids except carbonic acid. They secrete H+into the renal tubular fluid, putting bicarbonate HCO3-back into the blood at the same time.

where is the enzyme renin released from

kidneys release the enzyme renin,

Pain threshold

level at which pain is perceived

• By understanding the profound influence that genetics has on health and illness, you can help the patient and family in .....

making critical decisions related to genetic issues, such as genetic testing.

linkage maps

maps of the relative locations, or loci, of genes on a chromosome

Genetic testing may uncover information that ...

may affect a family member who was not tested.

Pain perception

may be slower in older adults, but not different; accurate assessments may be hard to obtain in person with visual or hearing impairments, Pain perception happens in thalamus

• Maintain the patient's confidentiality and respect the patient's values and beliefs because genetic information ....

may have major health and social implications.

Blood Pressure

measured to determine relationship between cardiac output and peripheral resistance; correct technique is imperative

mediators hinder the transmission of nociceptive impulses in the dorsal horn neurons. This inhibition of the pain impulse is the fourth and last phase of the normal pain process known as what

mediators hinder the transmission of nociceptive impulses in the dorsal horn neurons. This inhibition of the pain impulse is the fourth and last phase of the normal pain process known as modulation

(C fibers). are myelin or no myelin

myelinated (A-delta fibers) or unmyelinated (C fibers).

negatively charged are called

negatively charged are called anions.

nociceptive mediators such as whatt examples

nociceptive mediators such as prostaglandins, bradykinin, substance P, and histamine

eupnea breathing

normal breathing

normal pH range of adult arterial blood is WHAT

normal pH range of adult arterial blood is 7.4

Respiratory Rate

# of times a patient inhales and exhales in a minute; rhythm, depth, and effort of breathing should be noted; conducted when patient isn't aware

The patient with which diagnosis should have the highest priority for teaching regarding foods that are high in magnesium? a. Severe hemorrhage b. Diabetes insipidus c. Oliguric renal disease d. Adrenal insufficiency

(C) When renal excretion is decreased, magnesium intake must be decreased also, to prevent hypermagnesemia. The other conditions are not likely to require adjustment of magnesium intake.

Types of Stress

- Acute - Episodic - Chronic

acute respiratory distress syndrome (ARDS)

...

What are other concerns for CF patients?

1. Many require high-fat/calorie diets to maintain growth 2. Vitamin supplementation w/ ADEK and Ca/VitD for bone health 3. CF patients may need insulin therapy for CF related DM

what are the conditions caused by pulmonary disease?

1. hypercapnia 2. hypoxemia 3. hypoxia 4. ventilation/ perfusion abnormalities 5. respiratory failure

what are some pleural abnormalities?

1. pneumothorax 2. pleural effusion

When completing the FICA tool for spiritual assessment, which questions should the nurse ask the patient? (Select all that apply.) A. What things do you believe in that give meaning to life? B. Are you connected with a faith center in your community? C. How has your illness affected your personal beliefs? D. When was the last time you have been to church? E. What can I do for you?

A, B, C, E

A 90-year-old patient is admitted to the hospital. Shortly after admission, the family notices that the patient is exhibiting disorientation and agitation. When questioned about the behavior by the family, the nurse states that the patient is at risk for developing which common complication of hospitalization in older adults? A. Delirium B. Dementia C. Alzheimer's disease D. Sundowner syndrome

A. Delirium

A patient uses rosary beads and attends mass once a week. This expression of spirituality is best described with which term? A. Religiosity B. Faith C. Belief D. Authenticity

A. Religiosity

7. As a nurse in the emergency department, you are caring for a patient who is exhibiting signs of depression. What is a priority nursing intervention you should perform for this patient? a. Assess for depression and ask directly about suicide thoughts. b. Ask the care provider to prescribe blood lab work to assess for depression. c. Focus on the presenting problems and refer the patient for a mental health evaluation. d. Interview the patient's family to identify their concerns about the patient's behaviors.

ANS: A Assessing directly for thoughts of harm to self or others is a priority intervention for any patient exhibiting signs of a mental health disorder. It is estimated that 50% of individuals who succeed in suicide had visited a health care provider within the previous 24 hours. Currently there is no serum lab that identifies depression. The risk of self-harm is a priority safety issue that is monitored in all health care within the scope of the nurse. It is important to obtain information directly from the patient when possible, and then validate the information from family or other secondary sources.

1. The nurse knows that which of the following medical conditions are most commonly associated with anxiety? (Select all that apply.) a. Cancer b. Chronic obstructive pulmonary disease c. Hypothyroidism d. Dysrhythmias e. Encephalitis f. Hyperthyroidism

ANS: A, B, D, E, F Cancer, COPD, dysrhythmias, encephalitis, and hyperthyroidism are all associated with anxiety. Hypothyroidism is not associated with anxiety.

A patient states that everything has been going great; however, the nurse observe the patient biting his nails and fidgeting. What assessment can the nurse make? The patients communication type is a. linguistic. b. paralinguistic. c. explicit. d. inadequate.

ANS: B

4. The nurse is assessing the social support of a patient who is recently divorced and has moved from their hometown to the city due to change in jobs. Which response related to social support would be most therapeutic? a. Encourage the patient to begin dating again, perhaps with members of her church. b. Discuss how divorce support groups could increase coping and social support. c. Note that being so particular about potential friends reduces social contact. d. Discuss using the Internet as a way to find supportive others with similar values.

ANS: B High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships are known to affect a person's coping effectiveness negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping them cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose the patient to predators misrepresenting themselves to take advantage of vulnerable persons.

Critical Thinking: The nurse is seeking clarification of a statement that was made by a patient. What is the best way for the nurse to seek clarification? a. What are the common elements here? b. Tell me again about your experiences. c. Am I correct in understanding that d. Tell me everything from the beginning.

ANS: C

6. The nurse is sitting with the family of a patient who has just received the diagnosis of dementia. The family asks for information on what treatment will be needed to cure the condition. What is the nurse's best response? a. "Hormone therapy will reverse the condition." b. "Vitamin C and zinc will reverse the condition." c. "There is no treatment that reverses dementia." d. "Dementia can be reversed with diet, exercise, and medications."

ANS: C Currently there is no proven treatment that has been shown to reverse dementia, although some treatments can slow the progression of the illness. Hormone therapy, vitamin therapy, diet, and exercise are all important for overall health but do not reverse the progression of dementia.

Anions and cations combine to make

Anions and cations combine to make salts.

When taking care of patients, a nurse routinely asks whether they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? 1. Holistic 2. Health belief 3. Transtheoretical 4. Health promotion

Answer: 1. The nurse is using a holistic model of care that takes a more holistic view of health by considering emotional and spiritual well-being and other dimensions of an individual to be important aspects of physical wellness. The holistic health model of nursing attempts to create conditions that promote optimal health. Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery because they are effective, economical, noninvasive, nonpharmacological complements to traditional medical care.

A nurse is conducting a home visit with a new mom and her three children. While in the home the nurse weighs each family member and reviews their 3-day food diary. She checks the mom's blood pressure and encourages the mom to take the children for a 15- to 30-minute walk every day. The nurse is addressing which level of need, according to Maslow? 1. Physiological 2. Safety and security 3. Love and belonging 4. Self-actualization

Answer: 1. The nurse's actions address the basic physiological needs of nutrition, physical activity, and oxygen. According to Maslow, basic needs must be met before meeting higher level needs.

Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity. 1. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. 2. Eight months after beginning walking, the individual participates with his wife in a local 5K race. 3. The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 lb. 4. The individual walks 2 to 3 miles, 5 nights a week, with his wife. 5. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan.

Answer: 3, 1, 5, 4, 2. This sequence follows the order of the steps of transtheoretical model of change: precontemplation, contemplation, preparation, action, and maintenance.

autosome

Any chromosome that is not a sex chromosome

Which physical examination technique is the nurse performing when listening to heart sounds? Palpation Inspection Percussion Auscultation

Auscultation

A nursing instructor evaluates that a nursing student understands the concept of spirituality in nursing practice when the student makes which statement? A. A lack of spirituality theories has contributed to the omission of this aspect of care. B. A lack of spirituality assessment can have a negative impact on patient care. C. Spirituality assessment is not part of professional nursing care but should be included in holistic care. D. There are currently no nursing diagnoses addressing spirituality to include in the plan of care.

B. A lack of spirituality assessment can have a negative impact on patient care.

What role does pharmacogenomics have in health care? A. It can assess individual variability to many drugs B. It can be used to assess the effectiveness of a drug C. It provides important assessment data for gene therapy D. It can assess the variability of drug responses to single genes.

D. It can assess the variability of drug responses to single genes. Rationale: Pharmacogenomics is the study of genetic variability of drug responses resulting from variation in multiple genes. At this time, such tests are routine for only a few diseases and disorders.

The nurse is reviewing the needs of a patient with cognitive impairment. What is the priority concern that the nurse should address for this patient? A. Promoting at least 6 hours of sleep a night B. Encouraging an oral intake of 1200 calories per day C. Managing the patient's pain from arthritis D. Supervising medication administration

D. Supervising medication administration

If a person is heterozygous for a given gene, it means that the person: A. is a carrier for a genetic disorder B. is affected by the genetic disorder C. has two identical allels for the gene D. has two different allels for the gene

D. has two different allels for the gene Rationale: Heterozygous means the person has 2 different alleles for one given gene.

Cognition

Deep-seated beliefs and values the individual's status impacts thoughts.

Diffusion is

Diffusion is passive movement of electrolytes or other particles down a concentration gradient

Anti-inflammatory drugs (NSAID's), such as ibuprofen (Advil)

Exert their analgesic effects by blocking the action of COX (pg. 104)

Extracellular Fluid Volume Deficit means —Body Fluids Have WHAT Volume BUT WHATOsmolality

Extracellular Fluid Volume Deficit—Body Fluids Have Decreased Volume but Normal Osmolality

Extracellular Fluid Volume Excess—Body Fluids Have Increased Volume but WHATOsmolality

Extracellular Fluid Volume Excess—Body Fluids Have Increased Volume but Normal Osmolality

Pain

Generally assessed with vital signs; often called the "fifth vital sign"

Hypocalcemiais abnormally LOW OR HIGH calcium concentration in the blood

Hypocalcemiais abnormally low calcium concentration in the blood

Hypokalemia causes muscle WHAT, which becomes life threatening if it includes respiratory muscles. It can also cause potentially life-threatening cardiac dysrhythmias.

Hypokalemia causes muscle weakness, which becomes life threatening if it includes respiratory muscles. It can also cause potentially life-threatening cardiac dysrhythmias.

Standard precautions

Include use of PPE when appropriate; gloves, masks, eye protection, face shields, gowns

Insensible means WHAT and is continuous.

Insensible (not visible) water loss through the skin and lungs is continuous. It increases when a person has a fever or a recent burn to the skin (

Its name—antidiuretic hormone—tells you WHAT

Its name—antidiuretic hormone—tells you what it does.

Neuromodulators (Inhibitory) do what •

Neuromodulators (Inhibitory) • Are the natural supply of morphinelike substances in the body • Activated by stress and pain

Nurse should also inspect

Nutritional status of patient and body symmetry

Activity in the dorsal horn integrates and modulates...

Pain inputs from the periphery

Fidelity

Requires to act in ways that are loyal

Which sound is considered an adventitious breath sound? Select all that apply. One, some, or all responses may be correct. Rhonchi Crackles Vesicular Wheezes Bronchial

Rhonchi Crackles Wheezes

Somatic pain: Comes from where and is usually aching or throbbing in quality and well localized

Somatic pain: Comes from bone, joint, muscle, skin, or connective tissue; is usually aching or throbbing in quality and well localized

Substance P found where in body

Substance P • Found in pain neurons of dorsal horn (excitatory peptide)

When a nurse helps a patient find the meaning of cancer by supporting beliefs about life, this is an example of: A. Instilling hope and faith B. Forming a human-altruistic value system C. Cultural caring D. Being with

Neuropathic pain

associated with central or peripheral nervous system

Ethics of consequences

based on a teleological view that moral actions are defined entirely on the basis of the outcomes or consequences of an action.

Nociceptive pain

caused by stimulation of somatic structures

Phantom pain

felt by a person with an amputated extremity

four physiological processes of nociception: what 4

four physiological processes of nociception: transduction, transmission, perception, and modulation

interstitial fluid hydrosttatic pressure pushes which way

from interstital fluid intto tthe capillary

hypotonic solution is more WHATthan the blood

hypotonicsolution is more dilute than the blood

Scope of Stress

no stress --> challenging --> threatening

positively charged are called

positively charged are called cations

interstitial fluid osmottic pressure pulls which way

pullls out of capillary into the interstitial spacee

Which question would the nurse ask as part of the CAGE questionnaire? "Have you ever argued with your partner after drinking alcohol?" "Have you ever been hurt or wounded as a result of your drinking?" "Have you ever felt bad or guilty about your drinking or drug use?" "Have you ever used or had a drink to get rid of stress and worries?"

"Have you ever felt bad or guilty about your drinking or drug use?"

Two adult children of a parent who has Huntington's disease cannot agree on whether or not to be tested for Huntington's disease because of the cost. What assistance should the nurse give when discussing presymptomatic genetic testing? "If one child has the disease, the other will as well." "A positive genetic mutation increases your risk of the disease." "If there is a positive result, the patient will develop the disease." "You can use a direct-to-consumer genetic test to make future life decisions."

"If there is a positive result, the patient will develop the disease." Rationale: With the autosomal dominant Huntington's disease, if the result is positive, the patient will develop the disease manifestations and can plan accordingly for their future. There is a 50% chance for each child to be affected. Direct-to-consumer genetic testing should not be recommended because results may be misleading, are expensive, and may not be associated with genetic counseling, which would be beneficial for these children. There is also currently no regulation of the use of the genetic information that these companies obtain.

• DNA microarray (DNA chip) allows the study of genes that are active and that are inactive in different cell types. This helps to understand (2)...

(1) how cells function normally ; (2) how they are affected when various genes do not perform properly.

The nurse is admitting an older adult with decompensated congestive heart failure. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. The nurse should question which doctor's order? a.Intravenous (IV) 500 mL of 0.9% NaCl at 125 mL/hr b.Furosemide (Lasix) 20 mg PO now c.Oxygen via face mask at 8 L/min d.KCl 20 mEq PO two times per day

(A) A patient with decompensated heart failure has extracellular fluid volume (ECV) excess. The IV of 0.9% NaCl is normal saline, which should be questioned because it would expand ECV and place an additional load on the failing heart. Diuretics such as furosemide are appropriate to decrease the ECV during heart failure. Increasing the potassium intake with KCl is appropriate, because furosemide increases potassium excretion. Oxygen administration is appropriate in this situation of near pulmonary edema from ECV excess.

The patient has recent bilateral, above-the-knee amputations and has developed C. difficile diarrhea. What assessments should the nurse use to detect ECV deficit in this patient? (Select all that apply.) a. Test for skin tenting. b. Measure rate and character of pulse. c. Measure postural blood pressure and heart rate. d. Check Trousseau's sign. e. Observe for flatness of neck veins when upright. f. Observe for flatness of neck veins when supine.

(A, B, F) ECV deficit is characterized by skin tenting; rapid, thready pulse; and flat neck veins when supine, which can be assessed in this patient. Although ECV deficit also causes postural blood pressure drop with tachycardia, this assessment is not appropriate for a patient with recent bilateral, above-the-knee amputations. Trousseau's sign is a test for increased neuromuscular excitability, which is not characteristic of ECV deficit. Flat neck veins when upright is a normal finding.

At change-of-shift report, the nurse learns the medical diagnoses for four patients. Which patient should the nurse assess most carefully for development of hyponatremia? a. Vomiting all day and not replacing any fluid b. Tumor that secretes excessive antidiuretic hormone (ADH) c. Tumor that secretes excessive aldosterone d. Tumor that destroyed the posterior pituitary gland

(B) ADH causes renal reabsorption of water, which dilutes the body fluids. Excessive ADH thus causes hyponatremia. Excessive aldosterone causes ECV excess rather than hyponatremia. The posterior pituitary gland releases ADH; lack of ADH causes hypernatremia. Vomiting without fluid replacement causes ECV deficit and hypernatremia.

The nurse assessed four patients at the beginning of the shift. Which finding should the nurse report most urgently to the physician? a.Swollen ankles in patient with compensated heart failure b.Positive Chvostek's sign in patient with acute pancreatitis c.Dry mucous membranes in patient taking a new diuretic d.Constipation in patient who has advanced breast cancer

(B) Positive Chvostek's sign indicates increased neuromuscular excitability, which can progress to dangerous laryngospasm or seizures and thus needs to be reported first. The other assessment findings are less urgent and need further assessment. Bilateral ankle edema is a sign of ECV excess, and follow-up is needed, but the situation is not immediately life-threatening. Dry mucous membranes in a patient taking a diuretic may be associated with ECV deficit; however, additional assessments of ECV deficit are required before reporting to the physician. Constipation has many causes, including hypercalcemia and opioid analgesics, and it needs action, but not as urgently as a positive Chvostek's sign.

The home health nurse has an acute immunodeficiency syndrome (AIDS) patient who has chronic diarrhea. Which assessments should the nurse use to detect the fluid and electrolyte imbalances for which the patient has high risk? (Select all that apply.) a. Bilateral ankle edema b. Weaker leg muscles than usual c. Postural blood pressure and heart rate d. Positive Trousseau's sign e. Flat neck veins when upright f. Decreased patellar reflexes

(B, C, D) Chronic diarrhea has high risk of causing ECV deficit, hypokalemia, hypocalcemia, and hypomagnesemia because it increases fecal excretion of sodium-containing fluid, potassium, calcium, and magnesium. Appropriate assessments include postural blood pressure and heart rate for ECV deficit; weaker leg muscles than usual for hypokalemia; and positive Trousseau's sign for hypocalcemia and hypomagnesemia. Bilateral ankle edema is a sign of ECV excess, which is not likely with chronic diarrhea. Flat neck veins when upright is a normal finding. Decreased patellar reflexes is associated with hypermagnesemia, which is not likely with chronic diarrhea.

The nurse is assessing a patient before hanging an IV solution of 0.9% NaCl with KCl in it. Which assessment finding should cause the nurse to hold the IV solution and contact the physician? a. Weight gain of 2 pounds since last week b. Dry mucous membranes and skin tenting c. Urine output 8 mL/hr d. Blood pressure 98/58

(C) Administering IV potassium to a patient who has oliguria is not safe, because potassium intake faster than potassium output can cause hyperkalemia with dangerous cardiac dysrhythmias. Dry mucous membranes, skin tenting, and blood pressure 98/58 are consistent with the need for IV 0.9% NaCl. Weight gain of 2 pounds in a week does not necessarily indicate fluid overload, because it can be from increased nutritional intake. Only an overnight weight gain indicates a fluid gain.

The patient's laboratory report today indicates severe hypokalemia, and the nurse has notified the physician. Nursing assessment indicates that heart rhythm is regular. What is the most important nursing intervention for this patient now? a. Raise bed side rails due to potential decreased level of consciousness and confusion. b. Examine sacral area and patient's heels for skin breakdown due to potential edema. c. Establish seizure precautions due to potential muscle twitching, cramps, and seizures. d. Institute fall precautions due to potential postural hypotension and weak leg muscles.

(D) Hypokalemia can cause postural hypotension and bilateral muscle weakness, especially in the lower extremities. Both of these increase the risk of falls. Hypokalemia does not cause edema, decreased level of consciousness, or seizures.

The patient is receiving tube feedings due to a jaw surgery. What change in assessment findings should prompt the nurse to request an order for serum sodium concentration? a. Development of ankle or sacral edema b. Increased skin tenting and dry mouth c. Postural hypotension and tachycardia d. Decreased level of consciousness

(D) Tube feedings pose a risk for hypernatremia unless adequate water is administered between tube feedings. Hypernatremia causes the level of consciousness to decrease. The serum sodium concentration is a laboratory measure for osmolality imbalances, not ECV imbalances. Edema is a sign of ECV excess, not hypernatremia. Skin tenting, dry mouth, postural hypotension, and tachycardia all can be signs of ECV deficit.

Pilocarpine iontophoresis

(sweat test) Measures sweat electrolyte concentration for diagnosis of CF. Normal Chloride <40mEq/L Suggestive of CF 40-60mEq/L. Positive for CF >60mEq/L

, when a hypotonic solution (more dilute than normal body fluids) is administered intravenously, it dilutes the interstitial fluid,increasingg or decreasing its osmotic pressure below intracellular osmotic pressure?. Water moves rapidly into cells until the two osmotic pressures are equal again.

, when a hypotonic solution (more dilute than normal body fluids) is administered intravenously, it dilutes the interstitial fluid, decreasing its osmotic pressure below intracellular osmotic pressure. Water moves rapidly into cells until the two osmotic pressures are equal again.

Risk Factors of stress

- 3.1% of adults older than age 18 years experienced serious psychological distress in the previous 30 days - Highest among middle-aged adults in the 45-65 year-old age group. - Hispanics and women - greates level of general stress are lower income americans, young adults (particulary those with children, and women. - Financial strain - stressful relationships - occupational stress - strained family relationships

Complimentary Therapies - stress

- Acupuncture - Herbals and botanicals - Aromatherapy - Massage - Relaxation techniques - Guided Imagery - Biofeedback - Deep breathing

Psychological and emotional stress - signs and symptoms

- Anxiety, anger, depression, irritability, frustration, overreaction, memory loss, lack of concentration

Pharmacological Therapy - Stress

- Anxiolytics (anti-anxiety agents) - Antidepressants - Psychotherapeutics (mood stabilizers & anti-psychotics) - Muscle relaxants - Anti-migraine agents - Pain medications

Physiological Stress - Examples of intervention

- Biofeedback - Muscle Relaxation - Therapeutic touch/massage - Exercise

Normal Physiological Process: Stress

- Central Nervous System - Limbic System - Symathetic Nervous system Sympathetic nervous system activation: - Norepinephrine & epinephrine (increased heart rate, BP, cardiac output, blood perfusion skeletal muscles, bronchial dilation, pupil dilation, increased blood glucose) Anterior Pituitary---->ACTH----->Adrenal Cortex - Aldosterone (increased sodium and water retention) - Cortisol (increased, protein synthesis, blood glucose, blood pressure, cardiac output, antiinflammatory response, immunosuppression) Posterior Pituitary ------> ADH ( increased water retention) - Endocrine System

Counseling - stress

- Consists of individual or group therapy and includes multiple techniques including: - Cognitive behavioral therapy - Meditation - Relaxation techniques and massage - Time management - Health Education

Collaborative Care - Stress

- Education - Developing an action plan - Accessing resources - Cognitive restructuring

Interrelated Concepts: Stress

- Functional ability - Family Dynamics - Coping - Anxiety - Cognition - Sexuality - Immunity - Sleep - Mood & Affect - Perfusion

Elements of Assessment - Stress

- Goal: Determine individual's stress level and coping strategies - History - Perception of threat - Past coping patterns - Medical History - Social History - Examination - Observatoin of behavior - Mental Health assessment

Physiological Stress - Signs and Symptoms

- Muscle tension, headache, stomachache, acid reflux, tachycardia, hyperventilation, elevated BP

Secondary Prevention - Stress

- No national screening recommendations - Numerous screening tools - Holmes Life Events Scale - Ways of Coping Checklist

Psychological/Emotional Stressors

- Occupational pressures - Academic Pressures - Major Life events - Financial stress - Bereavement - Difficult relationships

Sources of Stress

- Physiological - Psychological/Emotional

Physiological Stress - Outcome

- Reduced somatization - Reduced forehead muscle tension (EMG) - Reduced BP - Reduced level 0-10 scale - Reduction in number and severity of stress warning signals - Reduction in number and severity of stress signs and symptoms

Primary Prevention - Stress

- Stress management and reduction techniques - Counseling - Maintenance of positive relationships - Family, friends, social networks, and others - Maintenance of optimal health - Wellness programs - Health education

Clinical Exemplars of Stress

- Tension Headache - Hypertension - Insomnia

Physiological Stressors

- Trauma - Acute Myocardial Infarction - Acute Renal Failure

Sound characteristics for auscultation

-Frequency -Loudness -Quality -Duration

Purpose of a physical examination

-Gather baseline data about a patient's health status -Supplement, confirm, or refute subjective data obtained. -Identify and confirm nursing diagnoses -Make clinical decisions about a patient's changing health status and management. -Evaluate the outcomes of care

Genetics vs Epigenetics

-Genetics are inherited from parents through DNA. -Epigenetic alterations can occur based on life experience and are also heritable.

Techniques used for a physical assessment

-Inspection-Palpation -Percussion -Auscultation

Nola Pender's Health Promotion Model

-Several factors motivate individuals to adopt behaviors that maintain and improve health - How important is it to be healthy? - What it means to be healthy? - What the benefit and barriers are to health improvement? - How much control they have over the healthcare system & their health. -several key factors that provide primary motivation for individuals to adopt behaviors that maintain and improve their health - the goal is for the individual to move toward a balanced state of positive health and well-being

restrictive lung disease

-characterized by decreased compliance (stiffness) of the lung tissue -it takes more effort to expand the lungs during inspiration, which increases the work of breathing 1. aspiration 2. atelectasis 3. pulmonary edema 4. acute respiratory distress syndrome (ARDS)

obstructive lung disease

-characterized by narrowing of the airways, resulting in airway obstruction that is worse with expiration -more force is required to expire a given volume of air, thus individuals must use their accessory muscles of expiration and have an increased work of breathing 1. asthma 2. COPD -chronic bronchitis -emphysema

pulmonary disease: hypercapnia

-increased CO2 concentration in the arterial blood (increased PaCO2) -caused by: hypoventilation of the alveoli

pneumothorax

-presence of air or gas in the pleural space -open pneumothorax: air that is drawn into the pleural space during inspiration (through the damaged chest wall and parietal pleura or through the lungs and damaged visceral pleura) is forced back out during expiration and only partial lung collapse results -tension pneumothorax: the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing it's escape by closing during expiration -caused by a rupture in the visceral pleura (surrounds the lungs) or the parietal pleura and chest wall -CM: -diagnosis: -treatment:

pleural effusion

-presence of fluid in the pleural space -CM: -diagnosis: -treatment:

pulmonary disease: hypoxemia

-reduced oxygenation of arterial blood (reduced PaCO2) -caused by: respiratory alterations

flail chest

-results from the fracture of several consecutive ribs in more than one place OR fracture of the sternum and several consecutive ribs -causes: -diagnosis: -treatment: A= normal inspiration B= normal expiration C= paradoxical inspiration -the area of the lung underlying the unstable chest wall flattens on inspiration D= paradoxical expiration -the unstable area inflates

respiratory infections

-the most common cause of short-term disability -most of these infections (cold, pharyngitis; sore throat) involve only upper airway -lower respiratory infections most often occur in very young, very old, or who have impaired immunity 1. acute bronchitis 2. pneumonia 3. TB

what are the different types of pleural effusions?

-transudative PE: watery -exudative PE: high concentrations of WBC and plasma proteins -empyema PE: presence of pus -hemothorax PE: presence of blood -cyclothorax PE: presence of chyle

. A fluid with the same tonicity as normal blood is called

. A fluid with the same tonicity as normal blood is calledisotonic.

aspiration

...

atelectasis

...

pulmonary edema

...

diffusion of electrolytes across cell membranes requires proteins that serve as WHAT

... requires proteins that serve as ion channels

• Genetic testing may raise many psychologic and emotional issues. Knowledge of carrier status of a genetic disorder may influence ....

...a person's career plans and decisions for marriage and childbearing.

.Hydrostatic pressure is

.Hydrostatic pressureis the force of the fluid pressing outward against a surface.

What drugs stabilize the Neuronal membrane and act on peripheral sodium channels to inhibit movement of nerve impulses?

.Local anesthetics -injectable or topical * lidocaine *bupivacaine (sensorcaine) . Anti-seizure drugs *gabapentin (neurontin)

Dr. Harold Koenig's 5 Question Spiritual Assessment

1. Do religious/spiritual beliefs provide comfort to you or cause you stress? 2. How might your religious/spiritual beliefs influence your health care decisions? 3. Are there any religious/spiritual beliefs that might interfere with or conflict with your medical treatment? 4. Are you a member of a religious/spiritual community and, if so, is it supportive? 5. Are there any other spiritual needs that someone should address?

What are the key points for the airway clearance agents used in CF?

1. Given multiple times per day (except dornase given daily) 2. Do not mix any other agent w/ Pulmozyme 3. Must keep pulmozyme amps in refrigerator (max 24h at room temp) and protect from light

What are the key points for the CFTR modulator agents?

1. Includes Ivacaftor (Kalydeco), Lumacaftor/ivacaftor (Orkambi) and tezacaftor/ivacaftor (Symdeko) 2. Symdeko and Orkambi are approved for homozygous F508del mutation; Kalydeco not approved for homozygous (but responsive to single mutation) 3. Must take w/ high fat for absorption 4. Kalydeco >12mo; Orkambi > 2yo; Symdeko > 12yo

What are the key points for pancreatic enzyme products (PERT)?

1. Includes Pancrealipase (Creon, Viokace, Zenpep) 2. Max dose 10,000 u/kg/day to minimize colonic stricture 3. Key SE: abdominal pain, flatulence, nausea 4. Dosing based on lipase component, and dose trated every 3-4d until stools are normalized

What is the correct order for inhaled medications in CF?

1. Inhaled bronchodilators = opening airways 2. Hypertonic saline = mobilizing mucus to improve airway clearance 3. Dornase Alfa (Pulmozyme) = thins mucus to promote airway clearance 4. Chest physiotherapy = mobilize mucus to improve clearance 5. Inhaled antibiotics = controls airway infections

What are the most common issues w/ pancreatic enzyme products?

1. PEP formulations not interchangeable 2. Viokace is only tablet form and must be given w/ PPI to ensure appropriate release 3. Do not crush/chew capsule contents 4. DR capsules contain EC microspheres and may be sprinkled on soft, acidic foods and swallowed immediately to avoid mucosal irritation 5. Take PEP before or w/ all meals and snacks, high fat meals need higher doses (50% of mealtime dose w/ snacks) 6. Dispense in original container and do not refrigerate

What are the key points for the inhaled antibiotics in CF?

1. Target P. aeruginosa (either AG or monobactam) 2. All inhaled abx are 28d cycled (28 on/28 off) 3. Do not mix any other nebs w/ abx 4. Indicated for 6+yo w/ P. aeruginosa colonization (Azactam 7+yo) 5. Must separate doses by 6h (TOBI) or 4h (Azactam) 6. Key SE: (AG) Ototox, voice changes, mouth/throat pain; (MB) allergic reactions, bronchospasm, fever, wheezing, cough, chest pain 7. Refrigerate nebs, may keep at RT for up to 28d; May keep TOBI podhaler at RT 8. Counsel on Podhaler technique and not to swallow tabs

Attributes of Spirituality

1. Universal 2. Impacted by Illness 3. Pt and/or family must be willing to share and act on spiritual beliefs 4. Spiritual beliefs/practices are impacted by family and culture 5. RN must be willing to assess and integrate pt beliefs into care 6. RN must be willing to consult with/refer to appropriate spiritual expert 7. Community-based religious organizations can provide support/resources

what are some pulmonary disorders?

1. restrictive lung disease 2. obstructive lung disease 3. respiratory infections

Which score is awarded to a patient whose best motor response is abnormal extension, according to the Glasgow Coma Scale? 5 4 3 2

how much Liters of fluid moves into the GI tract daily and returns to the ECF.

3 to 6 L of fluid moves into the GI tract daily and returns to the ECF.

what % of an older man's weight is water.

50% of an older man's weight is water.

Ethical principle

A general guide, basic truth, or assumption that can be used with judgment to help determine a course of action

Ethical decision making

A method for ensuring that the action we take is well reasoned and can be justified.

A, D, E

A nurse demonstrated caring by helping family members to: (All that apply) A. Become active participants in care. B. Remove themselves from personal care. C. Make health care decisions for the patient. D. Have uninterrupted time for family and patient to be together. E. Have opportunities for the family to discuss their concerns

A nurse enters a patient's room, arranges the supplies for a Foley catheter insertion, and explains the procedure to the patient. She tells the patient what to expect; just before inserting the catheter, she tells the patient to relax and that, once the catheter is in place, she will not feel the bladder pressure. The nurse then proceeds to skillfully insert the catheter. This is an example of what type of touch? A. Caring touch B. Protective touch C. Task-oriented touch D. Interpersonal touch

D. Touch forms a connection between nurse and patient

A nurse hears a colleague tell a nursing student that she never touches a patient unless she is performing a procedure or doing an assessment. The nurse tells the student that from a caring perspective: A. She does not touch the patients either. B. Touch is a type of verbal communication. C. Touch is only used when a patient is in pain. D. Touch forms a connection between nurse and patient.

A nurse is caring for an older adult who needs to enter an assisted-living facility following discharge from the hospital. Which of the following is an example of listening that displays caring? A. The nurse encourages the patient to talk about his concerns while reviewing the computer screen in the room. B. The nurse sits at the patient's bedside, listens as he relays his fear of never seeing his home again, and then asks if he wants anything to eat. C. The nurse listens to the patient's story while sitting on the side of the bed and then summarizes the story. D. The nurse listens to the patient talk about his fears of not returning home and then tells him to think positively.

For which person is genetic carrier screening indicated? A patient with a history of type 1 diabetes A patient with a family history of sickle cell disease A patient whose mother and sister died of breast cancer A patient who has a long-standing history of iron-deficiency anemia

A patient with a family history of sickle cell disease Rationale: Genetic carrier screening should be done in families with a history of sickle cell disease. Iron deficiency is not related to genetic status. Although there is a multifactorial genetic basis for diabetes, there are no genetic markers for testing for the presence of or risk of diabetes. A significant family history of breast cancer may suggest that presymptomatic testing for BRCA 1 and 2 may be indicated.

Ethical problem

A problem with an ethical dimension.

A protective reflex response is what

A protective reflex response also occurs with pain (Fig. 44.3). A-delta fibers send sensory impulses to the spinal cord, where they synapse with spinal motor neurons. The motor impulses travel via a reflex arc along efferent (motor) nerve fibers back to a peripheral muscle near the site of stimulation, thus bypassing the brain. SO THEY DONT GO TO BRAIN

Which behavioral change would the nurse observe in an intimate partner violence (IPV) victim? A sense of helplessness Dependence on a caregiver Underuse of health services Preoccupation with others' or own genitals

A sense of helplessness

Organizational ethics

A set of formal and informal principles and values that guide the behavior, decisions, and actions taken by members of an organization as well as the organizational structures, systems, practices, policies, and procedures developed to ensure ethical operation.

The nurse recognizes that which life events can be spiritually life changing? (Select all that apply.) a. Births b. Weddings c. Medical diagnoses d. Career (day to day job duties) e. Loss of independence

A, B, C, E

Which are true statements about the definition of spirituality in nursing? (Select all that apply.) a. Patient's quality of life, health, and sense of wholeness are affected by spirituality b. An exact definition was developed and adopted in the late 1980s c. Encompasses principle, an experience, attitudes, and belief regarding God d. Head knowledge affects spirituality more than heart knowledge e. Mind, body, spirit, love, and caring are interconnected

A, C, E

The nurse identifies which attributes and criteria of the concept of spirituality? Select all that apply. A. Spirituality is universal. B. Physical illness does not impact the spirit. C. Spirituality manifests whether a person acts on personal beliefs or not. D. Family and culture impact spiritual beliefs. E. Nurses should be aware of local community-based religious organizations.

A, D, E. Illness impacts spirituality in many ways. Some patients and families will draw closer to God to seek support, healing, and comfort. Others may blame and feel anger. Some r neutral in their spiritual reactions. There has to be willingness on the part of patient and/or family to share and/or act on spiritual beliefs and practices. need to be aware of community-based religious organiztions.

A-delta fibers transmit nociceptive impulses from the dorsal horn to the interior deeper laminae (III-IV) of the spinal cord and higher centers of the brain by way of the what tracts

A-delta fibers transmit nociceptive impulses from the dorsal horn to the interior deeper laminae (III-IV) of the spinal cord and higher centers of the brain by way of the "spinothalamic "tracts

Common causes of genetic mutations include (select all that apply) A. DNA damage from toxins B. DNA damage from UV radiation C. inheritance of altered genes from father D. inheritance of altered genes from mother E. inheritance of somatic mutations from either parent

A. DNA damage from toxins B. DNA damage from UV radiation C. inheritance of altered genes from father D. inheritance of altered genes from mother Rationale: Gene mutations occur primarily in 2 ways: They are inherited from a parent (germline mutation) or acquired (somatic mutation) during a person's lifetime. Acquired mutations are caused by environmental factors (e.g., ultraviolet radiation, toxins) and cannot be passed on to the next generation.

A patient recently admitted to the hospital has been diagnosed with delirium. The family of the patient asks the nurse to explain what delirium is. How should the nurse respond? A. Delirium is reversible with treatment of the underlying cause. B. Delirium is progressive and has no known cure. C. Delirium affects a specific area of cognitive functioning. D. Delirium indicates the onset of a cerebrovascular accident.

A. Delirium is reversible with treatment of the underlying cause

A community health nurse is preparing a course on protecting cognitive function. Which population group should the nurse target for teaching? A. Older male adults with diabetes B. Older female adults who are overweight C. Young adults living in school dormitories D. Adolescents attending summer camps

A. Older male adults with diabetes

ADH levels decrease if body fluids become too dilute or concentrated and This allows more water to be excreted in urine, creating a larger volume of dilute urine

ADH levels decrease if body fluids become too dilute. This allows more water to be excreted in urine, creating a larger volume of dilute urine

ADH is synthesized by neurons in the WHATand release from the WHAT

ANP is a weak hormone that increases the loss of WHAT

ANP is a weak hormone that increases the loss of sodium and water in the urine

A nurse is conducting a therapeutic session with a patient in the inpatient psychiatric facility. Which remark by the nurse would be an appropriate way to begin an interview session? a. How shall we start today? b. Shall we talk about losing your privileges yesterday? c. Lets get started discussing your marital relationship. d. What happened when your family visited yesterday?

ANS: A

A patient does not make eye contact with the nurse and is folding his arms at his chest. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills

ANS: A

Critical Thinking: The nurse and the patient are conversing face to face. What communication technique is this? a. linguistic b. paralinguistic c. explicit d. metacommunication

ANS: A

7. A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations? a. Teaching the patient to recognize, reconsider, and reframe irrational thoughts b. Encouraging the patient to imagine being in calming circumstances c. Teaching the patient to use instruments that give feedback about bodily functions d. Provide the patient with a blank journal and guidance about journaling

ANS: A Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking.

2. A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understands that the goal of cognitive therapy will be met when what is reported by the patient? a. "I will tell myself that I am a good person when things don't go well at work." b. "My medications will make my problems go away." c. "My family will help take care of my children while I am in the hospital." d. "This therapy will improve my response to neurotransmitter impulses."

ANS: A Cognitive therapy helps patients restructure their patterns of thinking to various events or thoughts in a more healthy way. Medication alters neurotransmitters but does not make problems go away. Family support is important but is not the goal of cognitive therapy. Neurotransmitters are affected by medication and brain stimulation therapy, not by cognitive therapy.

7. A cognitively impaired patient newly admitted to the hospital is experiencing signs of sundown syndrome. Which intervention is best for the nurse to implement? a. Leave a night light on in the room at all times. b. Leave the television on at night with the volume up. c. Restrain the patient to maintain safety during the confusion. d. Administer a sleeping medication to help the patient sleep.

ANS: A Having a night light on for the patient can help orient them to their surroundings. Having the flickering light and sound from a television will not help a confused patient remain calm or oriented. Restraining a patient will increase their agitation and actually increase their risk of injury if they try to get out of bed. Sleeping medications often increase confusion in cognitively impaired patients.

8. An 82-year-old patient who is in the hospital awakens from sleep and is disoriented to where she is at the present time. The nurse reorients the patient to her surroundings and helps the patient return to sleep. What data does the nurse consider as a probable cause of the patient's confusion? a. Pain medication received earlier in the night b. The death of the patient's spouse 2 years ago c. The patient's history of diabetes d. The age of the patient

ANS: A Medications such as narcotics, hypertensives, sleeping meds, and others can cause disorientation and symptoms of delirium. The death of a spouse is more likely to cause depression than disorientation. A history of diabetes alone does not cause disorientation. Normal aging alone does not cause disorientation, although it is a risk factor.

1. A patient complains of insomnia during his stay in the hospital. Which nursing diagnosis would be a top priority for this patient? a. Anxiety related to hospitalization b. Ineffective Coping related to hospitalization c. Denial related to hospitalization d. High Risk for Insomnia related to hospitalization

ANS: A The information about the patient indicates that anxiety is an appropriate nursing diagnosis. The patient's data do not support Defensive Coping, Ineffective Denial, or Risk-Prone Health Behavior as problems for this patient.

5. A patient reports that he is overwhelmed with anxiety. Which question would be most important to use in assessing the patient during your first meeting? a. "What kinds of things do you do to reduce or cope with your stress?" b. "Tell me about your family history—do any relatives have problems with stress?" c. "Tell me about exercise—how far do you typically run when you go jogging?" d. "Stress can interfere with sleep. How much did you sleep last night?"

ANS: A The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses such as drinking) and would help you understand how he copes and how well his coping strategies and resources are serving him. Therefore, of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended or broad-opening inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general).

5. The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function? a. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. b. Alter the internal state by modifying electronic signals related to physiologic processes. c. Replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities. d. Reduce catecholamine production and promote the production of additional beta-endorphins.

ANS: A When the sympathetic nervous system is operative, the individual experiences muscular tension and an elevated pulse, blood pressure, and respiratory rate. Relaxation is achieved when the sympathetic nervous system is quieted and the parasympathetic nervous system is operative. Modifying electronic signals is the basis for biofeedback, a behavioral approach to stress reduction. Altering thinking and activities from more-stressful to less-stressful reflects the cognitive approach to stress management. Reducing catecholamine production is the basis for guided imagery's effectiveness.

1. The nurse is teaching primary prevention of cognitive impairment at a community health fair. Which topics would be included in the presentation? (Select all that apply.) a. Do not use substances such as cannabis and alcohol. b. Wear helmets when riding bicycles and motorcycles. c. Complete a Mini Mental Status Exam (MMSE) yearly. d. Correct acid-base imbalances related to underlying disease processes. e. Wear a seat belt whenever riding in a motorized vehicle. f. Complete a Confusion Assessment Method (CAM) scale yearly.

ANS: A, B, E Primary prevention attempts to prevent injury. Not using chemical substances, wearing a helmet, and wearing a seat belt are all measures to prevent injury to the brain, which protects cognitive function. An MMSE and CAM are secondary prevention, or screening tools performed once symptoms are present. Correcting acid-base imbalances from underlying disease processes is a tertiary prevention level, aimed at minimizing complications for disease already present.

8. An older adult has experienced severe depression for many years and is unable to tolerate most antidepressant medications due to adverse effects of the medications. He is scheduled for electroconvulsive therapy (ECT) as a treatment for his depression. What teaching should the nurse give the patient regarding this treatment? a. There are no special preparations needed before this treatment. b. Common side effects include headache and short-term memory loss. c. One treatment will be needed to cure the depression. d. This treatment will leave you unconscious for several hours.

ANS: B Common side effects of ECT include headache, sleepiness, short-term memory loss, nausea, and muscle aches. Preparations before and after the procedure are the same as any operative procedure involving the patient receiving anesthesia. Treatment is typically three sessions a week for 4 weeks, not once. Patients are not unconscious after the procedure due to the use of precisely placed electrodes and the use of anesthesia.

6. A patient is newly diagnosed with anxiety and placed on a selective serotonin reuptake inhibitors (SSRIs). The nurse is developing the plan of care for this patient. How long will it take for this medication to become effective? a. The medication will become effective immediately. b. The medication may take up to 12 weeks to become effective. c. The medication may take up to 6 weeks to become effective. d. The medication may take up to 4 weeks to become effective.

ANS: B Efficacy may take at least 8 to 12 weeks. The other options are not realistic.

3. The nurse is teaching a hospitalized patient to use mindfulness to reduce anxiety. Which statement by the nurse is appropriate? a. "How do you feel about what happened to you as a child?" b. "How do you feel about what is going on right now?" c. "Remember a time when you were calm." d. "Tap your hands until the feeling goes away."

ANS: B Mindfulness trains the mind to think in the here and now, and emphasizes attentiveness to all sensations and feelings related to these experiences. Recalling and remembering being calm or previous experiences is not included in mindfulness training. Eye movement desensitization and reprocessing (EMDR) includes expression of feelings and memories while focusing on other stimuli such as sounds, hand taps, and/or eye movements.

1. A nurse working in a pediatric clinic recognizes that which child is most at risk for cognitive impairment? a. An infant who is being fed reconstituted powdered formula b. A toddler living in an older home that is being remodeled c. A preschooler who attends a play group 3 days a week d. A school-age child who rides a school bus 5 days a week

ANS: B Older homes frequently have lead-based paint; paint chips generated by remodeling put toddlers, who often put foreign objects in their mouths, at risk for exposure to lead which is a known toxic substance that can affect cognitive function. Powdered formulas, attendance at play groups, or riding on a school bus are not known to impair cognitive development.

3. A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate? a. "It is probably just coincidental that your blood sugar is high when you are ill." b. "Stressors such as illness cause the release of hormones that increase blood sugar." c. "Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times." d. "Your diet is different here in the hospital than at home, and that is the most likely cause of the increased glucose level."

ANS: B The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. The increase in blood sugar is not coincidental. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

1. Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? (Select all that apply.) a. Assess for bradycardia. b. Ask about epigastric pain. c. Observe for increased appetite. d. Check for elevated blood glucose levels. e. Monitor for a decrease in respiratory rate.

ANS: B, C, D The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and elevation of blood glucose levels. Stress causes an increase in the respiratory and heart rates.

2. The nurse is working with a patient who recently lost her spouse after a lengthy illness. The patient shares that she would like to sell her home and move to another state now that her spouse has passed away. Which of the following interventions would be considered a priority for this patient? (Select all that apply.) a. Notify the provider to evaluate for antidepressant therapy. b. Suggest that the patient consider a support group for widows. c. Suggest that the patient learn stress reduction breathing exercises. d. Suggest that the patient take prescribed antianxiety medications. e. Assist the patient in identifying support systems. f. Notify the provider to evaluate the need for antianxiety medications.

ANS: B, C, E Stress prevention management involves counseling, education, and implementation of techniques to manage problem-oriented and emotion-oriented stress. To prevent physical symptoms, relaxation and deep breathing are effective and individuals can learn to prevent the stress response through cognitive behavioral strategies. Medications are not indicated for patients with known stressors unless the stress is prolonged or the patient has ineffective coping mechanisms.

2. The nurse wishes to use guided imagery to help an anxious patient relax. Which comment would be appropriate to include in the guided imagery script? (Select all that apply.) a. "Imagine others treating you the way they should, the way you want to be treated..." b. "With each breath, you are feeling calmer, more relaxed, almost as if you are floating..." c. "You are alone on a beach; the sun is warm; and you hear only the sound of the surf..." d. "You have taken control; nothing can hurt you now; everything is going your way..." e. "You have grown calm; your mind is still; there is nothing to disturb your well-being..." f. "You will feel better as work calms down, as your boss becomes more understanding..."

ANS: B, C, E The intent of guided imagery for managing stress is to lead the patient to envision images that are calming and health enhancing. Statements that involve the patient calming progressively with breathing, feeling increasingly relaxed, being in a calm and pleasant location, being away from stressors, and having a peaceful and calm mind are therapeutic and should be included in the script. However, words that raise stressful images or memories or that involve unrealistic expectations or elements beyond the patient's control (e.g., that others will treat the patient as he desires, that everything is going the patient's way, that bosses are understanding) interfere with relaxation and/or do not promote effective coping. These attempts are not health promoting and should not be included in the script.

2. The nurse is reviewing new medication orders for several patients in a long-term care facility. Which patient does the nurse recognize as being at the highest risk for having cognitive impairment related to prescribed medications? a. The patient prescribed an antibiotic for a urinary tract infection. b. The patient prescribed a cholinesterase inhibitor for early Alzheimer's disease. c. The patient prescribed a beta-blocker for hypertension. d. The patient prescribed a bisphosphonate for osteoporosis.

ANS: C Anti-hypertensives such as the beta-blockers can cause adverse changes in cognition. While an infection can affect cognition, antibiotics do not generally cause cognitive changes. The cholinesterase inhibitors are prescribed to slow the progression in cognitive decline for patients diagnosed with Alzheimer's disease. Bisphosphonates are used for osteoporosis and are not generally a risk for altered cognition.

5. An older adult who is cognitively impaired is admitted to the hospital with pneumonia. Which sign or symptom would the nurse expect to be exhibited by the patient? a. Severe headache b. Flank pain c. Increased confusion d. Decreased blood glucose

ANS: C Increased confusion is a symptom that occurs in cognitively impaired patients who experience an infection. Severe headache occurs with migraines, meningitis, and other conditions. Flank pain occurs with pyelonephritis. Blood glucose typically increases with an infection.

3. A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient? a. Serum blood levels must be regularly monitored to assess for toxicity. b. To prevent side effects, the medication should be administered as an intramuscular injection. c. Eating foods such as blue cheese or red wine will cause side effects. d. This medication class may only be used safely for a few days at a time.

ANS: C MAOIs have serious food interactions when ingested with tyramine-containing foods such as aged or processed foods. Serum levels are routinely monitored when mood stabilizers such as lithium carbonate are prescribed. It is not necessary to administer this class intramuscularly. This medication takes several weeks to show effectiveness and should not be stopped abruptly; short-term use will not be effective.

8. A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress? a. The patient's wife reports that he spends more time sitting quietly at home. b. He reports that his appetite, mood, and energy levels are all good. c. His systolic blood pressure has gone from the 140s to the 120s (mm Hg). d. He reports that he feels better and that things are not bothering him as much.

ANS: C Objective measures tend to be the most reliable means of gauging progress. In this case, the patient's elevated blood pressure, an indication of the body's physiologic response to stress, has diminished. The wife's observations regarding his activity level are subjective, and his sitting quietly could reflect his having given up rather than improved. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiologic changes from stress and may not reflect improved coping with stress. The patient's report that he feels better and is not bothered as much by his circumstances could also reflect resignation rather than improvement.

1. A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, "This medication isn't working. I don't feel any different." What is the best response by the nurse? a. "I will call your care provider. Perhaps you need a different medication." b. "Don't worry. You can try taking it at a different time of day to help it work better." c. "It usually takes a few weeks for you to notice improvement from this medication." d. "Your life is much better now. You will feel better soon."

ANS: C Seeing a response to antidepressants takes 3 to 6 weeks. No change in medications is indicated at this point of treatment because there is no report of adverse effects from the medication. If nausea is present, taking the medication with food may help, but this is not reported by the patient, so a change in administration time is not needed. Telling a depressed patient that their life is better does not acknowledge their feelings.

4. A patient who is dehydrated has been experiencing confusion. The daughter is concerned about taking the patient home in a confused state. What statement by the nurse is correct? a. "Don't worry; the patient should be fine once they are in a familiar environment." b. "I can make a referral for a home health aide to assist with the patient." c. "Once the dehydration is corrected, the patient's confusion should improve." d. "I can show you how to care for the patient once you return home."

ANS: C The confusion caused by an underlying medical condition is a temporary condition that can be corrected once the underlying condition is treated, in this case once the patient is rehydrated. It is not necessary to teach home care or make a referral to home health because it is not expected that the patient will be confused at discharge. Telling the daughter that there is nothing to worry about diminishes her concern and may decrease her trust in the nurse.

4. A patient has not been sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patient's vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first? a. Go to sleep 30 to 60 minutes earlier each night to increase rest. b. Relax by spending more time playing with his pet dog. c. Slow and deepen breathing via use of a positive, repeated word. d. Consider that a new job might be better than his present one.

ANS: C The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident in his elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system (i.e., Benson's relaxation response) will counter the sympathetic nervous system's arousal, normalizing these vital-sign changes and reducing the physiologic demands stress is placing on his body. Other options do not address his physiologic response pattern as directly or immediately.

1. A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? (Select all that apply.) a. Risk for caregiver strain b. Impaired verbal communication c. Risk for injury d. Imbalanced nutrition, less than body requirements e. Ineffective coping f. Sleep deprivation

ANS: C, D, F Risk for injury, poor nutrition, and impaired sleep are priority needs of the patient experiencing mania related to their impulsivity, inability to attend to activities of daily living such as diet and hygiene, and disruption of sleep. Caregiver strain is important to be addressed but is not a priority need on admission for the patient. Verbal communication improves when the mania is managed, and racing thoughts return to normal patterns. Ineffective coping will require stabilization of the acute phase along with cognitive therapy over time.

Critical Thinking: A patient states, I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which response by the nurse would be an example of interpersonal therapeutic communication? a. It sounds as though you were uncomfortable with the content of your dream. b. I understand what youre saying. Bad dreams leave me feeling tired, too. c. So, all in all, you feel as though you had a rather poor nights sleep? d. Can you give me an example of what you mean by a bad nightmare?

ANS: D

The nurse is admitting a patient to the medical/surgical unit. Which communication technique would be considered appropriate for this interaction? a. Ive also had traumatic life experiences. Maybe it would help if I told you about them. b. Why do you think you had so much difficulty adjusting to this change in your life? c. You will feel better after getting accustomed to how this unit operates. d. Id like to sit with you for a while to help you get comfortable talking to me.

ANS: D

2. A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. Which action should the nurse take? a. Ask the health care provider for a psychiatric referral. b. Administer the PRN sedative medication every 4 hours. c. Suggest the use of a home caregiver to the patient's family. d. Plan to reinforce and repeat teaching about diabetes management.

ANS: D Because behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be needed for these expected short-term cognitive changes. Sedation will decrease the patient's ability to learn the necessary information for self-management.

5. A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient? a. 0 to 0.5 mEq/L b. 0.6 to 0.9 mEq/L c. 1.0 to 1.4 mEq/L d. 1.5 or higher mEq/L

ANS: D Diarrhea, blurred vision, ataxia, and polyuria are all signs of lithium toxicity, which generally occurs at serum levels above 1.5 mEq/L. Serum levels within the normal range of 0.8 to 1.4 mEq/L are not likely to cause signs of toxicity.

4. A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient? a. The medication dose needs to be decreased. b. Treatment is successful, and medication can be stopped. c. The patient is ready to return to work. d. Specific assessment for suicide plan must be evaluated.

ANS: D Energy levels increase as depression lifts; this may increase the risk of completing a suicide plan. An increase in mood would not indicate a decrease or discontinuation of prescribed medication. The patient may be ready to return to work, but assessment for suicide risk in a patient who has had suicidal ideation is the priority assessment.

6. A patient tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response? a. "Why not start by learning to meditate? That technique will cover everything." b. "In cases like yours, physical exercise works to elevate mood and reduce anxiety." c. "Reading about stress and how to manage it might be a good place to start." d. "Let's talk about what is going on in your life and then look at possible options."

ANS: D In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. As a result, further assessment is indicated before potential solutions can be explored. Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

3. The nurse is developing a care plan for a patient newly admitted to a unit that cares for patients with cognitive impairment. What is an important component of care for the patients on this unit? a. Allow food selections from a menu with several choices. b. Schedule frequent field trips off the unit for cognitive stimulation. c. Plan for attendance at activities with several other patients on the unit. d. Plan for a structured daily routine of events and caregivers.

ANS: D Patients with a cognitive impairment benefit from a predictable routine and consistent caregivers. Trips off of the unit may confuse the patient and disrupt their normal routine. Offering too many selections causes confusion and can lead to agitation. Being in large groups for activities can overstimulate the patient and lead to agitation and fear.

2. A female patient is anxious after receiving the news that she needs a breast biopsy to rule out breast cancer. The nurse is assisting with a breast biopsy. Which relaxation technique will be best to use at this time? a. Massage b. Meditation c. Guided imagery d. Relaxation breathing

ANS: D Relaxation breathing is the easiest of the relaxation techniques to use. It will be difficult for the nurse to provide massage while assisting with the biopsy. Meditation and guided imagery require more time to practice and learn.

6. A patient newly diagnosed with depression states, "I have had other people in my family say that they have depression. Is this an inherited problem?" What is the nurse's best response? a. "There are a lot of mood disorders that are caused by many different causes. Inheriting these disorders is not likely." b. "Current research is focusing on fluid and electrolyte disorders as a cause for mood disorders." c. "All of your family members raised in the same area have probably learned to respond to problems in the same way." d. "Members of the same family may have the same biological predisposition to experiencing mood disorders."

ANS: D Research is showing a genetic or hereditary role in the predisposition of experiencing mood disorders. These tendencies can be inherited by family members. Fluid and electrolyte imbalances cause many problems, but neurotransmitters in the brain are more directly linked to mood disorders. Mood disorders are not a learned behavior, but are linked to neurotransmitters in the brain.

1. An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient's chief complaint? a. The patient is responsible for caring for two school-age grandchildren. b. The patient's daughter works to support the family. c. The patient is being treated for hypertension and is overweight. d. The patient has recently lost her spouse and needed to move in with her daughter.

ANS: D The stress of losing a loved one and having to move are important contributing factors for stress-related symptoms in older people. Caring for children will increase the patient's sense of worth. Being overweight and being treated for hypertension are not the most likely causes of insomnia or headache. The patient's daughter may have added stress due to working, but this should not directly affect the patient.

Bacterial Pharyngitis

Abrupt onset (may be gradual in children under 2). sore throat. erythema and inflammation of the pharynx and tonsils. fever (usually high, but may be moderate), begins early in illness and usually lasts 1-4 days. Abdominal pain, vomiting, headache. Cervical lymph nodes may be enlarged and tender. Usually lasts 3-5 days.

term

Acidosis, p. 989 Alkalosis, p. 989 Anion gap, p. 989 Arterial blood gases (ABGs), p. 988 Autologous transfusion, p. 1008 Buffers, p. 988 Colloid osmotic pressure, p. 981 Colloids, p. 981 Crystalloids, p. 999 Extracellular fluid (ECF), p. 980 Extracellular volume deficit (ECV deficit), p. 984 Extracellular volume excess (ECV excess), p. 984 Extravasation, p. 1005 Filtration, p. 981 Fluid, p. 980 Hydrostatic pressure, p. 981 Hypercalcemia, p. 986 Hyperkalemia, p. 986 Hypermagnesemia, p. 986 Hypernatremia, p. 984 Hypertonic, p. 980 Hypocalcemia, p. 986 Hypokalemia, p. 985 Hypomagnesemia, p. 986 Hyponatremia, p. 984 Hypotonic, p. 980 Hypovolemia, p. 984 Infiltration, p. 1005 Interstitial fluid, p. 980 Intracellular fluid (ICF), p. 980 Intravascular fluid, p. 980 Isotonic, p. 980 Metabolic acidosis, p. 989 Metabolic alkalosis, p. 989 Oncotic pressure, p. 981 Osmolality, p. 980 Osmosis, p. 981 Osmotic pressure, p. 981 Phlebitis, p. 1005 Respiratory acidosis, p. 989 Respiratory alkalosis, p. 989 Transfusion reaction, p. 1007

Active transport, diffusion, osmosis, and filtration are WHAT

Active transport, diffusion, osmosis, and filtration are processes that move water and electrolytes between body compartments. These processes maintain equal SAME osmolality in all compartments while allowing for different electrolyte concentrations.

how move water in cells

Active transport, diffusion, osmosis, and filtration are processes that move water and electrolytes between body compartments. These processes maintain equal osmolality in all compartments while allowing for different electrolyte concentrations.

terms

Addiction, p. 1091 Adjuvants, p. 1082 Analgesics, p. 1082 Biofeedback, p. 1079 Breakthrough cancer pain, p. 1089 Chronic pain, p. 1064 Cutaneous stimulation, p. 1080 Drug tolerance, p. 1091 Epidural analgesia, p. 1087 Guided imagery, p. 1079 Idiopathic pain, p. 1064 Local anesthesia, p. 1087 Modulation, p. 1062 Multimodal analgesia, p. 1084 Nociception, p. 1061 Opioids, p. 1082 Pain threshold, p. 1066 Pain tolerance, p. 1063 Patient-controlled analgesia (PCA), p. 1086 Perineural infusions, p. 1087 Physical dependence, p. 1091 Placebos, p. 1091 Pseudoaddiction, p. 1091 Regional anesthesia, p. 1087 Relaxation, p. 1079 Transcutaneous electrical nerve stimulation (TENS), p. 1080 Transduction, p. 1061 Transmission, p. 1061

Factors that affect BP

Age, gender, race, time if day, emotions, pain, personal habits, weight

Aldosterone also contributes to electrolyte and acid-base balance by increasing urinary excretion of WHATions.

Aldosterone also contributes to electrolyte and acid-base balance by increasing urinary excretion of potassium and hydrogen ions.

Aldosterone circulates to the kidneys, where it causes resorption of WHAT

Aldosterone circulates to the kidneys, where it causes resorption of sodium and water

Potassium (K+) what sources

Aldosterone, black licorice, hypomagnesemia, and polyuria increase renal excretion; oliguria decreases renal excretion. Acute or chronic diarrhea increases fecal excretion.

Which action would the nurse take when preparing to assess a patient's abdomen, genitalia, and rectum? Place the patient in the prone position. Change latex gloves to vinyl or nitrile gloves. Ask the patient to assume the lateral recumbent position. Allow the patient to use the restroom

Allow the patient to use the restroom

tidal volume

Amount of air that moves in and out of the lungs during a normal breath

dominant allele

An allele whose trait always shows up in the organism when the allele is present

An example of a nurse caring behavior that families of acutely ill patients perceive as important to patients' well-being is: A. Making health care decisions for patients B. Having family members provide a patient's total personal hygiene C. Injecting the nurse's perceptions about the level of care provided D. Asking permission before performing a procedure on a patient

Religiosity

An external expression (public or private) in the form of practicing a belief or faith, whereas spirituality is an internalized spirited identity. The adherence to religious dogma or creed, the expression of moral beliefs, and/or the participation in organized or individual worship, or sacred practices.

Autonomy

An important extension of respect for persons that suggests that patients must be treated in a way that respects their self-determination by expressing their wishes and making informed choices about their treatment.

Heterozygous

An organism that has two different alleles for a trait

Homozygous

An organism that has two identical alleles for a trait

Phenotype

An organism's physical appearance, or visible traits.

Anions in body fluids are

Anions in body fluids are chloride (Cl − ) and bicarbonate (HCO3-).

A patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been praying daily to help him through this difficult time. He does not have a primary health care provider because he has never really been sick, and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) 1. Difficulty paying his bills 2. Praying daily 3. Age of patient (46 years) 4. Stress from the divorce and the loss of a job 5. Family practice of not routinely seeing a health care provider

Answer: 1, 5. External factors impacting health practices include family beliefs and economic impact. The way that patients' families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors (or lack of them) influence how patients think about health. Economic variables may affect a patient's level of health by increasing the risk for disease and influencing how or at what point the patient enters the health care system.

Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? (Select all that apply.) 1. Regular participation in a book club 2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

Answer: 2, 3, 4, 5. Nurses are particularly susceptible to the development of secondary traumatic stress and burnout—the components of compassion fatigue. Symptoms include decline in health, emotional exhaustion, irritability, restlessness, impaired ability to focus and engage with patients, feelings of hopelessness, inability to take pleasure from activities, and anxiety.

The nurse assesses the risk factors for coronary artery disease (CAD) in a female patient. Which of these factors are classified as genetic and physiological? (Select all that apply.) 1. Sedentary lifestyle 2. Mother died from CAD at age 48 3. History of hypertension 4. Eats diet high in sodium 5. Elevated cholesterol level

Answer: 2, 3, 5. Genetic and physiological risk factors include those related to heredity, genetic predisposition to an illness, or those that involve the physical functioning of the body. This patient's genetic and physiological risk factors include her family history of CAD as well as her history of hypertension and elevated serum cholesterol level. A sedentary lifestyle and dietary choices are behavioral factors that increase the risk for developing CAD.

A nurse working on a medical patient care unit states, "I am having trouble sleeping, and I eat nonstop when I get home. All I can think of when I get to work is how I can't wait for my shift to be over. I wish I felt happy again." What are the best responses from the nurse manager? (Select all that apply.) 1. "I'm sure this is just a phase you are going through. Hang in there. You'll feel better soon." 2. "I know several nurses who feel this way every now and then. Tell me about the patients you have cared for recently. Did you find it difficult to care for them?" 3. "You can take diphenhydramine over the counter to help you sleep at night." 4. "Describe for me what you do with your time when you are not working." 5. "The hospital just started a group where nurses get together to talk about their feelings. Would you like for me to e-mail the schedule to you?"

Answer: 2, 4, 5. This nurse is experiencing symptoms of compassion fatigue. The nurse manager needs to establish a therapeutic relationship with the nurse. Acknowledging personal thoughts and feelings and talking with other nurses to identify coping strategies can help this nurse work through the feelings associated with compassion fatigue. Engaging in healthy behaviors and establishing a good work-life balance may also help.

As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast selfexamination for the women's group. Which statement made by one of the participants is related to the individual's accurate perception of susceptibility to an illness? 1. "I have a door hanging tag in my bathroom to remind me to do my breast self-examination monthly." 2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer." 3. "Since I am only 25 years of age, the risk of breast cancer for me is very low." 4. "I participate every year in our local walk/run to raise money for breast cancer research."

Answer: 2. On the basis of health belief model, this statement indicates that the patient is concerned about developing breast cancer and feels that there is a risk or susceptibility based on recognition of a familial link for the disease. Once this link is recognized, the patient may perceive the personal risk.

A patient discharged a week ago following a stroke is currently participating in rehabilitation sessions provided by nurses, physical therapists, and registered dietitians in an outpatient setting. In what level of prevention is the patient participating? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Transtheoretical prevention

Answer: 3. Tertiary prevention involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration following surgery. Tertiary prevention activities are directed at rehabilitation rather than diagnosis and treatment. Care at this level aims to help patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. This level of care is called preventive care because it involves preventing further disability or reduced functioning.

Based on the Transtheoretical Model of Change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!" 1. "That's fine. Some people who smoke live a long life." 2. "OK. I want you to decrease the number of cigarettes you smoke by one each day, and I'll see you in 1 month." 3. "What do you think is the greatest reason why stopping smoking would be challenging for you?" 4. "I'd like you to attend a smoking-cessation class this week and use nicotine replacement patches as directed."

Answer: 3. The patient's response indicates that he is in the precontemplation stage and not intending to make a change in behavior in the next 6 months. In this stage the patient is not interested in information about the behavior and may be defensive when confronted with the information. Asking an open-ended question about smoking may stimulate the patient to identify a reason to begin a behavioral change. Nurses are challenged to motivate and facilitate health behavior change in working with individuals.

Dermatomes

Areas on the skin that are innervated primarily by a single spinal cord segment

The nurse has provided patient education on diabetes. What opportunity should be provided for the patient in order for the nurse to evaluate the goal of awareness of long-term effects of diabetes?

Ask Questions

At the venous end capillary hydrostatic pressure is WHAT, and the colloid osmotic pressure of the blood is WHAT

At the venous end capillary hydrostatic pressure is weaker, and the colloid osmotic pressure of the blood is stronger

Persussion and auscultation

Auditory skills and concentration

Which physical examination technique is the nurse performing when using the bell of a stethoscope to hear a patient's heart sounds? Palpation Inspection Percussion Auscultation

Auscultation

Average fluid intake from these routes for healthy adults is about WHATmL,

Average fluid intake from these routes for healthy adults is about 2300 mL,

When conducting a spiritual assessment of a hospitalized patient, the nurse should remain aware of which potential barrier to effective communication? A. Clarifying the meaning of a patient's statement B. Multi-tasking while talking to the patient C. Listening to patients' complete statements D. Discussing patient's feelings while hospitalized

B. Multi-tasking while talking to the patient

Because crosses the blood-brain barrier with difficulty, neurological signs and symptoms are less severe or even absent with metabolic ALKALOSIS OR ACIDOSIS

Because crosses the blood-brain barrier with difficulty, neurological signs and symptoms are less severe or even absent with metabolic alkalosis

Bioethics and clinical ethics

Bioethics deals broadly with ethical questions surrounding biological sciences, emerging health care technologies, and health policy; clinical ethics is involved primarily with decision making at the bedside and other patient-specific issues.

Blood contains albumin and other proteins known as WHAT.

Blood contains albumin and other proteins known ascolloids.

Blood colloid osmotic pressure, also called oncotic pressure, is

Bloodcolloid osmotic pressure, also calledoncotic pressure, is an inward-pulling force caused by blood proteins that helps move fluid from the interstitial area back into capillaries.

Bradykinin come from where

Bradykinin • Released from plasma that leaks from surrounding blood vessels at the site of tissue injury

Which type of breath sound is created by the air moving through the larger airways in a healthy individual? Vesicular Bronchovesicular Medium crackles Pleural friction rub

Bronchovesicular

The nurse is assessing a patient's spirituality and observes the patient meditating before any treatments. What is the nurse's best action? A. Document that the patient is not religious B. Offer the patient a copy of the bible to read C. Arrange for quiet time for the patient as needed D. Limit the time patient can meditate before procedures

C. Arrange for quiet time for the patient as needed

A father who has an X-linked recessive disorder and a wife with a normal genotype will A. pass the carrier state to all his children B. pass the carrier state to his male children C. pass the carrier state to his female children D. not pass on the genetic mutation to any of his children

C. pass the carrier state to his female children Rationale: X-linked recessive disorders are caused by a mutation on the X chromosome. If a normal female (XHXH) mates with an affected male (XhY), the carrier state will be passed on to their female children (XHXh) only. Male children will be normal (XHY).

Calcium (Ca2+) amount in ECF? where is mostt calcium in body

Ca2+is low in ECF, mostly in bones and intracellular. Some Ca2+in blood is bound and inactive; only ionized Ca2+is active. Parathyroid hormone shifts Ca2+out of bone; calcitonin shifts Ca2+into bone. Ca2+decreases in blood if phosphate rises and vice versa.

Capillary hydrostatic pressure is strongest at the arterial or venous end of a normal capillary.

Capillary hydrostatic pressure is strongest at the arterial end of a normal capillary.

Cations in body fluids are

Cations in body fluids are sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium ions (Mg2+).

Cells in the atria of the heart release WHAT

Cells in the atria of the heart release ANP

Cells maintain their what intracellular electrolyte concentration by active transport. Active transport requires energy in the form of adenosine triphosphate (ATP) to move electrolytes across cell membranes

Cells maintain their high intracellular electrolyte concentration by active transport. Active transport requires energy in the form of adenosine triphosphate (ATP) to move electrolytes across cell membranes

Exemplar: Hypertension

Chronic elevation of blood pressure. This is one of the most common manifestations of stress related catecholamine effect on the sympathetic nervous system. Catecholamines cause peripheral vasoconstriction and an increased rate and force of cardiac contraction, leading to the elevation of blood pressure. Most commonly diagnosed among adults, although hypertension among young adults and children is on the rise

Combined Volume and Osmolality ImbalanceClinical Dehydration (ECV Deficit plus Hypernatremia)—Body Fluids Have Decreased Volume and Are Too Concentrated

The provision of spiritual care can be thought about in 3 distinct approaches:

Communication - Active listening, learned skill that involves hearing, not only words spoken but those not being spoken. Action - Involves how the nurse carries out nursing activities; giving support and encouragement of spiritual beliefs, making referral to a chaplain, praying with the patient, etc are all examples. Presence - to be an active listener and be able to demonstrate empathy, humility, vulnerability, and commitment.; requires more than just showing up when a person is sick or standing by the bedside, involves the ability to touch a person physically and spiritually.

what is the primary pathophysiology of cystic fibrosis?

Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein mutation resulting in abnormal Cl,HCO3 and Na ions transport across epithelium. Results in thick viscous secretions and organ dysfunction The thick mucus affects the lungs, pancreas, liver and intestines, which causes difficulty breathing, lung infections and digestive complications

What characterizes multifactorial genetic disorder? A. Often caused by single gene alterations B. Genetic testing available for most disorders C. Many family members report having the disorder D. Caused by complex interactions of genetic and environmental factors

D. Caused by complex interactions of genetic and environmental factors Rationale: Multifactorial genetic disorders are diseases that result from complex interactions between genetic alterations and environmental factors. Less often, they are caused by rare singlegene mutations. Sometimes it is difficult to find the disease in a second family member.

PaCO2is partial pressure of carbon dioxide (CO2), a measure of how well the lungs are excreting CO2produced by cells. Increased PaCO2indicates CO2accumulation in blood (more carbonic acid) caused by hypoventilation; decreased PaCO2indicates excessive CO2excretion (less carbonic acid) through hyperventilation .HCO3- is concentration of the base (alkaline substance) bicarbonate, a measure of how well the kidneys are excreting metabolic acids. Increased HCO3- indicates that the blood has too few metabolic acids; decreased HCO3- indicates that the blood has too many metabolic acids .PaO2 is partial pressure of oxygen (O2), a measure of how well gas exchange is occurring in the alveoli of the lungs. Values below normal indicate poor oxygenation It drops rapidly when PaO2falls below 60 mm Hg (8 kPa). Base excess is observed buffering capacity minus the normal buffering capacity, a measure of how well the blood buffers are managing metabolic acids. Values below −2 (negative base excess) indicate excessive metabolic acids; values above +2 indicate excessive amounts of bicarbonate.

pH7.35-7.45pH is a negative logarithm of the free H+concentration, a measure of the blood's acidity or alkalinity. Values below 7.35 indicate abnormally acid; above 7.45 they indicate abnormally alkaline. Small changes in pH denote large changes in H+concentration and are clinically important.PaCO235-45 mm Hg (4.7-6 kPa)PaCO2is partial pressure of carbon dioxide (CO2), a measure of how well the lungs are excreting CO2produced by cells. Increased PaCO2indicates CO2accumulation in blood (more carbonic acid) caused by hypoventilation; decreased PaCO2indicates excessive CO2excretion (less carbonic acid) through hyperventilation.HCO3-21-28 mEq/L (21-28 mmol/L)HCO3- is concentration of the base (alkaline substance) bicarbonate, a measure of how well the kidneys are excreting metabolic acids. Increased HCO3- indicates that the blood has too few metabolic acids; decreased HCO3- indicates that the blood has too many metabolic acids.PaO280-100 mm Hg (10.7-13.3 kPa)PaO2is partial pressure of oxygen (O2), a measure of how well gas exchange is occurring in the alveoli of the lungs. Values below normal indicate poor oxygenation of the blood.SaO295%-100%SaO2is oxygen saturation, the percentage of hemoglobin that is carrying as much O2as possible. It is influenced by pH, PaCO2, and body temperature. It drops rapidly when PaO2falls below 60 mm Hg (8 kPa).Base excess−2 to +2 mEq/L (mmol/L)Base excess is observed buffering capacity minus the normal buffering capacity, a measure of how well the blood buffers are managing metabolic acids. Values below −2 (negative base excess) indicate excessive metabolic acids; values above +2 indicate excessive amounts of bicarbonate.

The nurse is establishing a therapeutic environment for a patient admitted with dementia and influenza. Which intervention would be important for the nurse to implement? A. Keep a radio on all the time to provide sound for the patient. B. Decrease patient confusion by limiting verbal interactions. C. Limit family visits to one person for 30 minutes per day. D. Provide a quiet environment in a private room.

D. Provide a quiet environment in a private room.

When developing a plan of care, the nurse should consider which attribute of the concept of spirituality? A. Spirituality is not a well-known universal concept B. Chronic versus acute illnesses affect spirituality C. Convincing patients to pray is a priority intervention D. Referrals may be needed to spiritual counselors

D. Referrals may be needed to spiritual counselors

As the profession of nursing evolved to incorporate evidence-based practice, which statement is true about spirituality? A. Evidence-based care focuses solely on the physical effects of health and illness. B. An emphasis was placed on spirituality as nursing education moved into colleges and universities. C. Spirituality was incorporated back into care when a concrete definition had been established. D. Spirituality commonly encompasses a concept or belief about God and the inner person.

D. Spirituality commonly encompasses a concept or belief about God and the inner person.

A patient tells the nurse, "I am not a religious person. I believe things happen in life out of pure coincidence." Which evaluation of this patient's spirituality is true? A. This patient is not a spiritual person. B. This patient is more likely to suffer from depression. C. This patient will experience difficulty coping with life changes. D. This patient experiences emotion and should be asked about effects of health changes.

D. This patient experiences emotion and should be asked about effects of health changes.

A couple who recently had a son with hemophilia A is consulting with a nurse. They want to know if their next child will have hemophilia A. The nurse can tell the parents that if their child is a A. boy, he will have hemophilia A B. boy, he will be a carrier of hemophilia A C. girl, she will be a carrier of hemophilia A D. girl, there is a 50% chance she will be a carrier of hemophilia A

D. girl, there is a 50% chance she will be a carrier of hemophilia A Rationale: The mother is a carrier of the allele for hemophilia A. The father is healthy. Each daughter has a 50% chance of being a carrier and a 50% chance of having normal alleles. Each son has a 50% chance of having hemophilia A and a 50% chance of having normal alleles.

Deafferentation pain: Injury to either the peripheral or central nervous system. what is example

Deafferentation pain: Injury to either the peripheral or central nervous system. Examples: cut off leg - Phantom pain indicates injury to the peripheral nervous system; burning pain below the level of a spinal cord lesion reflects injury to the central nervous system.

Normative ethics

Deals with very specific judgments about right and wrong in everyday actions.

Hypocalcemia—Low Serum Calcium (Ca2+) Concentration

Decreased Ca 2+ Intake and Absorption: Calcium-deficient diet; vitamin D deficiency (includes end-stage renal disease); chronic diarrhea; laxative misuse; steatorrhea Shift of Ca 2+ into Bone or Inactive Form:Hypoparathyroidism; rapid administration of citrated blood; hypoalbuminemia; alkalosis; pancreatitis; hyperphosphatemia (includes end-stage renal disease) Increased Ca 2+ Output:Chronic diarrhea; steatorrhea

Hypokalemia—Low Serum Potassium (K+) Concentration

Decreased K + Intake:Excessive use of K+-free IV solutions Shift of K + into Cells:Alkalosis; treatment of diabetic ketoacidosis with insulin Increased K + Output:Acute or chronic diarrhea; vomiting; other GI losses (e.g., nasogastric or fistula drainage); use of potassium-wasting diuretics; aldosterone excess; polyuria; glucocorticoid therapy

clinical condittions Hypomagnesemia—Low Serum Magnesium (Mg2+) Concentration

Decreased Mg 2+ Intake and Absorption:Malnutrition; chronic alcoholism; chronic diarrhea; laxative misuse; steatorrhea Shift of Mg 2+ Into Inactive Form:Rapid administration of citrated blood Increased Mg 2+ Output:Chronic diarrhea; steatorrhea; other GI losses (e.g., vomiting, nasogastric or fistula drainage); use of thiazide or loop diuretics; aldosterone excess

Equipment used

Dependent on problem and knowledge of use

Sacraments

Derived from Latin, means "a sign of the sacred" Recognized by Christian faiths.

Describe processes that regulate fluid distribution, extracellular fluid volume, and body fluid osmolality. • Describe processes that regulate electrolyte balance. • Describe processes that regulate acid-base balance. • Describe common fluid, electrolyte, and acid-base imbalances. • Identify risk factors for fluid, electrolyte, and acid-base imbalances. • Apply the nursing process when caring for patients with fluid, electrolyte, and acid-base imbalances. • Choose appropriate clinical assessments for specific fluid, electrolyte, and acid-base imbalances. • Describe purpose and procedures for measuring and recording daily weights and fluid intake and output. • Explain rationale and procedures for initiating an intravenous line; maintaining the system; changing intravenous solution containers, tubing, and dressings; and discontinuing peripheral venous access. • Describe potential complications of intravenous therapy and what to do if they occur. • Discuss the procedure for initiating and monitoring a blood transfusion and the appropriate nursing actions to take if transfusion reactions occur. • Identify how to evaluate the outcomes of care of patients with fluid, electrolyte, and acid-base imbalances.

Describe the physiology of nociceptive pain. • List the characteristics used to differentiate categories of pain. • Identify the various factors that influence pain. • Explain how cultural factors influence the pain experience. • Demonstrate how to assess a patient experiencing pain. • Contrast the characteristics of acute pain with those of chronic pain • Explain the nursing guidelines for administering analgesics safely • Explain various nonpharmacological and pharmacological approaches to treating pain. • Identify barriers to effective pain management. • Evaluate a patient's response to pain interventions.

Personal ethics

Describes an individual's own ethical foundations and practice.

Sister Callista Roy's Adaptation Model

Describes the patient as a holistic adaptive system influenced by both internal and external stimuli. states that the person is an open adaptive system with input (stimuli), who adapts by processes or control mechanisms (throughput).

Position of patient during exam

Determined by condition and comfort of patient; modesty is important

Nonmaleficence

Directs us to act in ways that avoid harm to others, including even the risk of harm.

Mitochondrial inheritance

Disease occurs in both males and females, inherited through females only

Primary afferent fibers end in the...

Dorsal horn of the spinal cord (pg. 104)

Epiglottitis Cardinal Signs and Symptoms

Drooling, Dysphagia, Dysphonia, Distressed inspiratory efforts. Nasal flaring, suprasternal, substernal, and interostal retractions, pale skin color, and tachcardia. It is a dangerous bacterial infection with rapid onset. Most often in children 3-7.

ECF has what two major divisions.

ECF has two major divisions(intravascular fluidandinterstitial fluid)and a minor division (transcellular fluids)

ECF is approximately how much of total body water.

ECF is approximately one-third of total body water.

Each nociceptor has an axon composed of peripheral afferent nerve fibers that are either what 2 types

Each nociceptor has an axon composed of peripheral afferent nerve fibers that are either myelinated (A-delta fibers) or unmyelinated (C fibers).

Professional ethics

Ethical standards and expectations of a particular profession.

Metabolic Acidosis with Normal anion gap examples clinical

Excess output of bicarbonate:Diarrhea, pancreatic fistula, intestinal decompression, renal tubular acidosis Increase of chloride-containing acid: Parenteral HCl therapy

No Stress

Experience is perceived as easily manageable, and equilibirum is not disrupted.

Challenging

Experience is perceived as manageable but requires mobilization of resources; is not harmful, and equilibrium is maintained

Threatening

Experience is perceived as taxing; exceeds existing resources; causes disruption to equilibrium; can impact health.

Extracellular volume deficitis present when there is insufficient WHATfluid in the extracellular compartment.

Extracellular volume deficitis present when there is insufficient isotonic fluid in the extracellular compartment.

Extracellular volume excess occurs when there is too much isotonic fluid in the extracellular compartment. Intake of sodium-containing isotonic fluid has exceeded fluid output

Extracellular volume excessoccurs when there is too much isotonic fluid in the extracellular compartment. Intake of sodium-containing isotonic fluid has exceeded fluid output

Factors that cause too much ionized calcium to shift to the bound forms cause symptomaticionized hypocalcemia(Kyle et al., 2018). People who have acute WHATfrequently develop hypocalcemia

Factors that cause too much ionized calcium to shift to the bound forms cause symptomaticionized hypocalcemia(Kyle et al., 2018). People who have acute pancreatitis frequently develop hypocalcemia

FICA Spiritual Assessment Tool

Faith or beliefs: What are your spiritual beliefs? Do you consider yourself spiritual? What things do you believe in that give meaning to life? Importance: Is faith/spirituality important to you? How has your illness/hospitalization affected that? Community: Are you connected with a faith center in the community? Is there a person/group that supports you in your beliefs? Address: What can i do for you? What support/guidance can health care provide to support your spiritual beliefs?

Inspection

First step, visual assessment

Laryngomalacia

Flaccidity of the epiglottis and supraglottic aperture and weakness of the airway walls contribute to laryngomalacia, the most common cause of inspiratory stridor in the neonatal period. It may be caused by immature neuromuscular development in the airway.

Fluid Intake Fluids Ingested Oral1100-1400 mL280-1100 mL/hr Foods800-1000 mL Highly variableMetabolism300 mL16-50 mL/hr TOTAL WHAT IS TTOTAL mL/hr Fluid Output Skin (insensible and sweat)500-600 mL300-2100 mL/hr Insensible lungs400 mL20 mL/hr Gastrointestinal100-200 mLNegligible, unless diarrhea during exerciseUrine1200-1500 mL20-1000 mL/hr, depending on hydration status TOTAL WHAT AMOUNT mL

Fluid IntakeFluids Ingested Oral1100-1400 mL280-1100 mL/hr Foods800-1000 mL Highly variableMetabolism300 mL16-50 mL/hr TOTAL2200-2700 mL300-1150 mL/hr Fluid OutputSkin (insensible and sweat)500-600 mL300-2100 mL/hr Insensible lungs400 mL20 mL/hr Gastrointestinal100-200 mLNegligible, unless diarrhea during exercise Urine1200-1500 mL20-1000 mL/hr, depending on hydration status TOTAL2200-2700 mL

Fluid homeostasis is the dynamic interplay of three processes: fluid intake and absorption, fluid distribution, and fluid output

Fluid moves into and out of capillaries (between the vascular and interstitial compartments) by the process of WHAT

Fluid moves into and out of capillaries (between the vascular and interstitial compartments) by the process of filtration

Fluid output normally occurs through four organs: WHAT4

Fluid output normally occurs through four organs: the skin, lungs, gastrointestinal (GI) tract, and kidneys.

Fluid that contains a large number of dissolved particles is more WHATthan the same amount of fluid that contains only a few particles.

Fluid that contains a large number of dissolved particles is more concentrated than the same amount of fluid that contains only a few particles.

Fluids in different body compartments have different concentrations of WHAT

Fluids in different body compartments have different concentrations of electrolytes

For example, concentrations of Na+, Cl − , and HCO3- are WHATin the ECF, whereas the concentrations of K+, Mg2+, and phosphate are what in the ICF.

For example, concentrations of Na+, Cl − , and HCO3- are higher981in the ECF, whereas the concentrations of K+, Mg2+, and phosphate are higher in the ICF.

A patient with a parent that has polycystic kidney disease does not want to have genetic testing done for polycystic kidney disease because they are worried that health insurance will be discontinued if genetic abnormalities are found. Based on the nurse's knowledge of the Genetic Information Nondiscrimination Act (GINA), what should the nurse teach the patient? GINA should protect her from this happening. GINA does not extend to cover preexisting conditions. GINA will only protect her after she is diagnosed with polycystic kidney disease. GINA health coverage nondiscrimination protection also extends to life insurance.

GINA should protect her from this happening. Rationale: GINA prohibits discrimination in health care coverage and employment based on genetic information but does not extend to life insurance, disability insurance, or long-term care insurance.

Hyponatremia (Water Excess; Water Intoxication; Hypoosmolar Imbalance)—Body Fluids Too Dilute clinical examples

Gain of Relatively More Water Than Salt: Excessive ADH (SIADH) Psychogenic polydipsia or forced excessive water intake Excessive IV administration of D5W Use of hypotonic irrigating solutions Tap-water enemas Loss of Relatively More Salt Than Water: Replacement of large body fluid output (e.g., diarrhea, vomiting) with water but no salt

law of independent assortment

Genes located on different chromosomes will be inherited independently of each other

Which area is the nurse preparing to assess when instructing a patient to assume the lithotomy position? Heart Rectum and vagina Musculoskeletal system Genitalia and genital tract

Genitalia and genital tract

Viral Pharygitis

Gradual onset. Sore throat (reaches peak on the second or third day). Erythema and inflammation of the pharynx and tonsils, vesicles or ulcers on tonsils. Fever (usually low grade but may be high). Hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia (early). Cervical lymph nodes may be enlarged and tender. Usually lasts 3-4 days.

Latex

Health professionals can develop latex allergies; should ask patients if they have latex allergy

Behavioral - Outcome

Healthier lifestyle Improved health status

Ethical sensitivity

Helps us recognize when there is an ethical problem or dilemma

Histamine made by what cell and do what

Histamine • Produced by mast cells, causing capillary dilation

While assessing a victim of intimate partner violence, which common physical indicator would the nurse anticipate? Overmedicated Undermedicated Human bite marks Pain when urinating

Human bite marks

Hyperkalemia can cause muscle WHAT

Hyperkalemia can cause muscle weakness, potentially life-threatening cardiac dysrhythmias, and cardiac arrest

Hypernatremia (Water Deficit; Hyperosmolar Imbalance)—Body Fluids Too ConcentratedLoss of Relatively More Water Than Salt: clinical examples

Hypernatremia (Water Deficit; Hyperosmolar Imbalance)—Body Fluids Too ConcentratedLoss of Relatively More Water Than Salt: Diabetes insipidus (ADH deficiency) Osmotic diuresis Large insensible perspiration and respiratory water output without increased water intake Gain of Relatively More Salt Than Water: Administration of tube feedings, hypertonic parenteral fluids, or salt tablets Lack of access to water, deliberate water deprivation, inability to respond to thirst (e.g., immobility, aphasia) Dysfunction of osmoreceptor-driven thirst drive

Hypernatremia may occur in combination with ECV deficit; this combined disorder is called WHAT

Hypernatremia may occur in combination with ECV deficit; this combined disorder is called clinical dehydration.

Hypernatremia, also called WHAT ,is a hypertonic or hypotonic condition.

Hypernatremia, also calledwater deficit,is a hypertonic condition.

Hypernatremia, also called water deficit,is a WHATcondition. Two general causes make body fluids too concentrated: loss of relatively more water than salt or gain of relatively more salt than water

Hypernatremia, also calledwater deficit,is a hypertonic condition. Two general causes make body fluids too concentrated: loss of relatively more water than salt or gain of relatively more salt than water

Hypernatremia, also called water deficit,is a hypertonic condition. Two general causes make body fluids too concentrated: loss of relatively more what than WHATor gain of relatively more salt than water

Hypokalemia is abnormally HIGH OR LOW potassium concentration in the blood

Hypokalemiais abnormally low potassium concentration in the blood

Hypokalemiais abnormally low potassium concentration in the blood. It results from decreased potassium intake and absorption, a shift of potassium from the ECF into WHAT, and an increased potassium outpuT

Hypokalemiais abnormally low potassium concentration in the blood. It results from decreased potassium intake and absorption, a shift of potassium from the ECF into cells, and an986increased potassium outpu

Hyponatremia (Water Excess; Water Intoxication; Hypoosmolar Imbalance)—Body Fluids Too Dilute or too concentrated?

Hyponatremia (Water Excess; Water Intoxication; Hypoosmolar Imbalance)—Body Fluids Too Dilute

Hyponatremia,also called water excess or water intoxication,is a hypertonic hypotonic condition.

Hyponatremia,also calledwater excessorwater intoxication,is a hypotonic condition.

Hyponatremia,also called water excessor water intoxication,is a hypotonic condition. It arises from gain of relatively more WHATthan WHATor loss of relatively more salt than water

Hyponatremia,also calledwater excessorwater intoxication,is a hypotonic condition. It arises from gain of relatively more water than salt or loss of relatively more salt than water

Idiopathic pain is

Idiopathic pain is chronic pain in the absence of an identifiable physical or psychological cause

If the PaCO2 falls, the chemoreceptors trigger SLOWER OR FASTER respirations

If the PaCO2falls, the chemoreceptors trigger slower and shallower respirations

If the kidneys need to excrete a lot of H+, renal tubular cells secrete WHAT

If the kidneys need to excrete a lot of H+, renal tubular cells secrete ammonia

A young mother is worried that her female baby will have hemophilia because the baby's father has it. How should the nurse explain this genetic disorder to the young mother? Nearly all affected people are male. Daughters of affected males will have a 50% chance of being carriers. The daughter has a 25% chance of being affected if the mother is not a carrier. If the mother is a carrier, the child will have a 25% chance of having hemophilia.

If the mother is a carrier, the child will have a 25% chance of having hemophilia. Rationale: Because hemophilia is an X-linked recessive genetic disorder, hemophilia results from a mutated gene on an X chromosome. Whereas mothers always contribute an X chromosome to their offspring, fathers contribute X to their female children and Y to their male children. If the mother is a carrier, there is a 25% chance that the daughter could have hemophilia and a 25% chance that she will be a carrier. If the mother is not a carrier, the daughter will have a 100% chance of being a carrier from her father's affected X chromosome

. If the problem is a metabolic acid-base imbalance, only the kidneys can correct the problem, but the WHAT organ can compensate by changing the amount of carbonic acid in the blood.

If the problem is a respiratory acid-base imbalance, only the lungs can correct the problem, but the kidneys can compensate by changing the amount of metabolic acid in the blood. If the problem is a metabolic acid-base imbalance, only the kidneys can correct the problem, but the lungs can compensate by changing the amount of carbonic acid in the blood.

If the problem is a respiratory acid-base imbalance, only the lungs can correct the problem, but the WHAT organ can compensate by changing the amount of metabolic acid in the blood.

If there are too few H+ions, the WHATacid part of the buffer pair releases some, increasing the bicarbonate, again returning pH to normal.

If there are too few H+ions, the carbonic acid part of the buffer pair releases some, increasing the bicarbonate, again returning pH to normal.

In contrast to pain being a first-person, subjective perception, nociception is definedwhat

In contrast to pain being a first-person, subjective perception, nociception is defined as an observable activity in the nervous system in response to an adequate stimulus (third-person perspective)

Metabolic Alkalosis—Deficient Metabolic Acids clinical examples

Increase of Bicarbonate: Excessive administration of sodium bicarbonateMassive blood transfusion (liver converts citrate to HCO3- Mild or moderate ECV deficit (contraction alkalosis) Loss of Metabolic Acid: Excessive vomiting or gastric suctioning Hypokalemia Excess aldosterone

Metabolic Acidosis—Excessive Metabolic Acids clincal examples

Increase of Metabolic Acids (High Anion Gap): Ketoacidosis (diabetes, starvation, alcoholism) Hypermetabolic state (severe hyperthyroidism, burns, severe infection) Oliguric renal disease (acute kidney injury, end-stage renal disease) Circulatory shock (lactic acidosis) Ingestion of acid or acid precursors (e.g., methanol, ethylene glycol, boric acid) Loss of Bicarbonate (Normal Anion Gap): Diarrhea Pancreatic fistula or intestinal decompression Renal tubular acidosis

Metabolic Acidosis with High anion gap Greater than 5 mEq/L clincal examples

Increase of any acid except HCl:Ketoacids (DKA, starvation, alcoholism), lactic acid (circulatory shock, extreme exercise), excessive normal metabolic acids (oliguric acute kidney injury, end-stage renal disease, severe hyperthyroidism, burns, severe infection), unusual organic acids (salicylate overdose, acids metabolized from methanol, ethylene glycol, paraldehyde)

clincal condition Hypercalcemia—High Serum Calcium (Ca2+) Concentration

Increased Ca 2+ Intake and Absorption:Milk-alkali syndrome Shift of Ca 2+ out of Bone:Prolonged immobilization; hyperparathyroidism; bone tumors; nonosseous cancers that secrete bone-resorbing factors Decreased Ca 2+ Output:Use of thiazide diuretics

How are chronic lung infections managed in CF?

Inhaled antibiotics are recommended for chronic P. aeruginosa lung infections as a 28d cycle (28 on/28 off) May consider 6 mo trial of oral Zithromax that have progressed on conventional treatment (does not have pseudomonal coverage, but interferes w/ biofilm formation)

Fundamental theory of Heredity

Inheritance involves the passing of genes from parents to offspring

sex-linked inheritance

Inheritance of a genetic trait located on the sex chromosomes

A-delta fibers

Initial, sharp pain that accompanies tissue injury

Which assessment is performed first while the nurse initiates the general survey? Inspecting appearance and behavior Taking measurement of vital signs Observing specific body systems Conducting a detailed health history

Inspecting appearance and behavior

4 Basic techniques of physical assessment

Inspection, palpation, percussion, ausculation

Interstitial fluid colloid osmotic pressure normally is a very small or big opposing force.

Interstitial fluid colloid osmotic pressure normally is a very small opposing force.

Interstitial fluid hydrostatic pressure is a weak or strong opposing force that tends to push fluid back into capillaries

Interstitial fluid hydrostatic pressure is a weaker opposing force that tends to push fluid back into capillaries

Interstitial fluid is located between

Interstitial fluid is located between the cells and outside the blood vessels.

Intravascular fluid is

Intravascular fluid is the liquid part of the blood (i.e., the plasma).

Transmission

Is the process by which pain signals are relayed from the periphery to the spinal cord and then to the brain.

Which statement about the lithotomy position is accurate? Select all that apply. One, some, or all responses may be correct. It helps detect murmurs. It facilitates insertion of a vaginal speculum. It is adopted for examination of female genitalia. The patient is lateral with flexion of the hip and knee. The patient is supine, while the legs are raised and knees flexed.

It facilitates insertion of a vaginal speculum. It is adopted for examination of female genitalia. The patient is supine, while the legs are raised and knees flexed.

A preschool child was diagnosed with type 1 diabetes. The parent says that no one else in the family has had diabetes and asks why the child would get it. How should the nurse explain this complex disease? It is a congenital disorder that the child was born with. It is a single gene disorder, meaning only one gene mutation caused the disease. It is a multifactorial genetic disorder caused by one or more genes and environmental factors. It was an acquired genetic mutation, meaning that the child's offspring will not develop diabetes.

It is a multifactorial genetic disorder caused by one or more genes and environmental factors. Rationale: Type 1 diabetes is a multifactorial genetic disorder related to one or more gene mutations and potentially various environmental factors that alter the way the gene(s) work. Type 1 diabetes is not a single gene disorder nor an acquired genetic mutation.

The parents of a child diagnosed with cystic fibrosis ask the nurse what happened to cause this disease. What is the best response by the nurse? It is X-linked, so it was passed to the child from the mother. It is a chromosome disorder that usually skips a generation. It is autosomal recessive, so both copies of the gene are abnormal. It is autosomal dominant, so the abnormal gene allele is expressed instead of the normal allele.

It is autosomal recessive, so both copies of the gene are abnormal. Rationale: Cystic fibrosis is an autosomal recessive disorder, which means both the genes in the pair on the chromosome are abnormal. Cystic fibrosis is not X-linked, from a chromosome disorder, or autosomal dominant.

Respiratory Alkalosis—Deficient Carbonic Acid Caused by Alveolar Hyperventilation Laboratory findings

Laboratory findings:Arterial blood gas alterations: pH above 7.45, PaCO2 below 35 mm Hg (4.7 kPa), HCO3- level normal if short lived or uncompensated or below 21 mEq/L (21 mmol/L) if compensated

Respiratory Acidosis—Excessive Carbonic Acid Caused by Alveolar Hypoventilation Laboratory findings:

Laboratory findings:Arterial blood gas alterations: pH below 7.35, PaCO2 above 45 mm Hg (6 kPa), HCO3- level normal if uncompensated or above 28 mEq/L (28 mmol/L) if compensated

Laboratory findings Hyperkalemia—High Serum Potassium (K+) Concentration

Laboratory findings:Serum K+level above 5 mEq/L (5 mmol/L); ECG abnormalities: peaked T waves; widened QRS complex; PR prolongation; terminal sine-wave pattern

Laboratory findings: Hypokalemia—Low Serum Potassium (K+) Concentration

Laboratory findings:Serum K+level below 3.5 mEq/L (3.5 mmol/L); ECG abnormalities: U waves, flattened or inverted T waves; ST segment depression

Laboratory findings: Hypermagnesemia—High Serum Magnesium (Mg2+) Concentration

Laboratory findings:Serum Mg2+level above 2.1 mEq/L ECG abnormalities: prolonged PR interval

Laboratory findings: Hypomagnesemia—Low Serum Magnesium (Mg2+) Concentration

Laboratory findings:Serum Mg2+level below 1.3 mEq/L ECG abnormalities: prolonged QT interval

Laboratory findings Hypercalcemia—High Serum Calcium (Ca2+) Concentration

Laboratory findings:Total serum Ca2+level above 10. or serum ionized Ca2+level above 5 ECG abnormalities: heart block, shortened ST segments

Laboratory findings: Hypocalcemia—Low Serum Calcium (Ca2+) Concentration

Laboratory findings:Total serum Ca2+level below 9.0 mg/dL or serum ionized Ca2+level below 4 ECG abnormalities: prolonged ST segments

Listening is not only taking in what a patient says, but it also includes: A. Incorporating the views of the physician B. Correcting any errors in the patient's understanding C. Injecting the nurse's personal views and statements. D. Interpreting and understanding what the patient means.

Law of Segregation

Mendel's law that states that the pairs of homologous chromosomes separate in meiosis so that only one chromosome from each pair is present in each gamete

Metabolic acidosis occurs from an increase of metabolic acid or a decrease of WHAT

Metabolic acidosisoccurs from an increase of metabolic acid or a decrease of base (bicarbonate).

Metabolic acidosis occurs from an increase of WHAT or a decrease of WHAT

Metabolic acidosis occurs from an increase of metabolic acid or a decrease of base (bicarbonate). The kidneys are unable to excrete enough metabolic acids, which accumulate in the blood, or bicarbonate is removed from the body directly as with diarrhea (seeTable 42.7). In either case does the blood HCO3- DECREASESS OR INCREASES and the pH INCREASES OR DECREASES

Metabolic acidosisoccurs from an increase of metabolic acid or a decrease of base (bicarbonate). The kidneys are unable to excrete enough metabolic acids, which accumulate in the blood, or bicarbonate is removed from the body directly as with diarrhea (seeTable 42.7). In either case the blood HCO3- decreases, and the pH falls

Metabolic alkalosis occurs from a direct increase of base HCO3- or a decrease of metabolic acid, which increases blood HCO3- by releasing it from its buffering function. Common causes include WHAT

Metabolic alkalosis occurs from a direct increase of base HCO3- or a decrease of metabolic acid, which increases blood HCO3- by releasing it from its buffering function. Common causes include vomiting and gastric suction

Metabolic alkalosis occurs from a direct increase of base HCO3- or a decrease of metabolic acid, which INCREASES OR DECRREASES blood HCO3- by releasing it from its buffering function?

Metabolic alkalosisoccurs from a direct increase of base HCO3- or a decrease of metabolic acid, which increases blood HCO3- by releasing it from its buffering function

Magnesium (Mg2+) WHERE in body

Mg2+is low in ECF, mostly in bones and intracellular. Some Mg2+in blood is bound and inactive; only free Mg2+is active.

Milliequivalents per liter are

Milliequivalents per liter are the millimoles per liter multiplied by the electrolyte charge (e.g., 1 for Na+, 2 for Ca2+). One milliequivalent of one electrolyte can combine with one milliequivalent of another electrolyte, which is why this measurement unit is used.

concentration definition

Millimoles per liter represent the number of milligrams of the electrolyte divided by its molecular weight that are contained in a liter of the fluid being measured (usually blood plasma or serum).

Clinical Exemplar: Tension headache

Most common type of headache among adults and are assoicated with moderate to severe stress causing prolonged muscle tension. Described as a bilateral, dull, bandlike, or pressing pain that builds up gradually and has a prolonged duration. Can occur periodically or for several days in a row, lasting from 30 minutes to days. Is worsened by noise and light. Severity of symptoms tends to be positively correlated with the frequency of occurrence

Carotid bruit

Narrowed blood vessel creates turbulence, causes blowing/swishing sound

Neuropathic pain: Pain caused by a what

Neuropathic pain: Pain caused by a lesion or disease of the somatosensory nervous system; treatment usually includes adjuvant analgesics.

Normal Laboratory Values for Adults BloodOsmolality2 Sodium (Na+) Potassium (K+) Chloride (Cl − ) Total CO2 Bicarbonate Total calcium (Ca2+) Ionized calcium (Ca2+) Magnesium (Mg2+) Phosphate Anion gap Arterial Blood GasespH )O2saturation Base excess−

Normal Laboratory Values for Adults Item Measured Normal Value in Serum or Blood Osmolality285-295 mOsm/kg H2O Sodium (Na+)140 mEq/L Potassium (K+) 4 mEq/L Chloride (Cl − )100 mEq/L Total CO2(CO2total content)30 mEq/L Bicarbonate (HCO3-)Arterial 25 mEq/L Total calcium (Ca2+)10 mg/dL Ionized calcium (Ca2+)5 mg/dL Magnesium (Mg2+)2 mEq/L Phosphate 4 mg/dL Anion gap 6 Arterial Blood Gases pH7.4 PaCO2 40 mm Hg O2saturation 95%-100% (0.95-1.00) Base excess−2 to +2 mm Eq/L (mmol/L)

Moral distress

Occurs when you are unable to act upon what you believe is the morally appropriate action to take or when you otherwise act in a manner contrary to your personal and professional values.

C. Establishing an understanding of a specific patient

Of the five caring processes described by Swanson, which describes "knowing the patient?" A. Anticipating the patient's cultural references B. Determining the patient's physician preference C. Establishing an understanding of a specific patient D. Gathering task-oriented information during assessment

Episodic Acute Stress

Often described as "self-inflicted" stress or in regular chaos and is common among type A personalities. This often occurs by taking on unrealistic assignments beyond what is typically or reasonably expected. These individuals may always be in a hurry and irritable. Constant worry is another form of episodic stress.

Phosphate, what affects

Oliguria and elevated fibroblast growth factor 23 (FGF-23) decrease renal excretion.

Once transduction is complete, twhat comes nextt

Once transduction is complete, transmission of the nociceptive impulse begins.

Osmolality imbalances are disturbances of the WHATof body fluids.

Osmolality imbalances are disturbances of theconcentration of body fluids.

Osmolalityof a fluid is

Osmolalityof a fluid is a measure of the number of particles per kilogram of water.

Osmoreceptors continually monitor plasma WHAT;

Osmoreceptors continually monitor plasma osmolality;

Painful mononeuropathies: Usually associated with a known peripheral nerve injury; pain is felt at least partly along the distribution of the damaged nerve. what arre Examples:

Painful mononeuropathies: Usually associated with a known peripheral nerve injury; pain is felt at least partly along the distribution of the damaged nerve. Examples: Nerve root compression, nerve entrapment, trigeminal neuralgia.

Painful mononeuropathies: Usually associated with a known peripheral nerve injury; pain is felt at least partly along how many damaged nerves

Painful mononeuropathies: Usually associated with a known peripheral nerve injury; pain is felt at least partly along the distribution of the one damaged nerve.

Painful polyneuropathies: Pain felt along the distribution of many peripheral nerves. what are Examples:

Painful polyneuropathies: Pain felt along the distribution of many peripheral nerves. Examples: Diabetic neuropathy, alcohol-nutritional neuropathy, and Guillain-Barré syndrome.

Which portion of the hand is used to assess the thickness of skin? Finger pads Palmar surface Dorsum Fingertips

Palmar surface

Which condition requires a bimanual technique during breast examination? Palpation of lymph nodes Palpation of cancerous lesions Palpation of nipple and areola Palpation of large, pendulous breasts

Palpation of large, pendulous breasts

Parasympathetic Stimulation does what

Parasympathetic Stimulation bPallorCauses blood supply to shift away from peripheryNausea and vomitingVagus nerve sends impulses to chemoreceptor trigger zone in the brainDecreased heart rate and blood pressureResults from vagal stimulationRapid, irregular breathingCauses body defenses to fail under prolonged stress of pain

Calcium (Ca2+), WHATdoes parathyroid hormone do

Parathyroid hormone shifts Ca2+out of bone; calcitonin shifts Ca2+into bone. Ca2+decreases in blood if phosphate rises and vice versa.

Heredity

Passing of traits from parents to offspring

Culture

Pattern of shared attitudes, beliefs, and values.

People who are obese have how much water in their bodies than people who are lean because fat contains less water than muscle

People who are obese have less water in their bodies than people who are lean because fat contains less water than muscle

People who have oliguria (decreased urine output) are at high risk of HIGH OR LOW potassium from the resultant decreased urine output

People who have oliguria (decreased urine output) are at high risk of hyperkalemia from the resultant decreased potassium output

Which physical assessment technique is the nurse using when tapping a patient's skin with the fingertips to vibrate underlying tissues and organs? Palpation Inspection Percussion Auscultation

Percussion

Peripheral sensitization, does what to the threshold for causing an action potential within the peripheral afferent neurons,

Peripheral sensitization, which lowers the threshold for causing an action potential within the peripheral afferent neurons,

Family Dynamics

Person's belief system is strongly influenced w/ in the family.

Betty Neuman's Systems Model

Person- physiological, psychological, sociocultural variables Environment- internal and external factors Health- continuum of wellness to illness Nursing- prevention as intervention Idea: changes in the environment all interact w/ eachother, and negative events in a person's life can negatively affect them in other ways

A couple is delivering their first child. What newborn genetic screening should the nurse teach them about? (Select all that apply.) Phenylketonuria Dienoyl-CoA reductase Polycystic kidney disease Congenital hypothyroidism Hereditary nonpolyposis colorectal cancer syndrome

Phenylketonuria Congenital hypothyroidism Rationale: Newborn genetic screening for phenylketonuria and congenital hypothyroidism are universally required by law in the United States. Genetic screening for dienoyl-CoA reductase, a fatty acid disorder, is required in some states. Hereditary nonpolyposis colorectal cancer syndrome and polycystic kidney disease would only be tested for if there was family history and the family requested it.

WHAT buffers in the renal tubular fluid keep the urine from becoming too acidic when the kidneys excrete H+ions.

Phosphate buffers in the renal tubular fluid keep the urine from becoming too acidic when the kidneys excrete H+ions.

Phosphate is located WHERE

Phosphate is low in ECF; it is higher in ICF and in bones. Insulin and epinephrine shift phosphate into cells. Decreases in blood if calcium rises and vice versa.

Physical examinationCombined Volume and Osmolality ImbalanceClinical Dehydration (ECV Deficit plus Hypernatremia)—Body Fluids Have Decreased Volume and Are Too Concentrated

Physical examination and laboratory findings:Combination of those for ECV deficit plus those for hypernatremia (see previous signs)

Physical examination Hypercalcemia—High Serum Calcium (Ca2+) Concentration

Physical examination:Anorexia, nausea and vomiting, constipation, fatigue, diminished reflexes, lethargy, decreased level of consciousness, confusion, personality change, cardiac arrest if severe

Metabolic Alkalosis—Deficient Metabolic Acids Physical examination:

Physical examination:Arterial blood gas alterations: pH above 7.45, PaCO2normal if uncompensated or above 45 mm Hg (6.0 kPa) if compensated, HCO3- above 28 mEq/L (28 mmol/L)

Metabolic Acidosis—Excessive Metabolic Acids Physical examination:

Physical examination:Arterial blood gas alterations: pH below 7.35, PaCO2normal if uncompensated or below 35 mm Hg (4.7 kPa) if compensated, HCO3- level below 21 mEq/L (21 mmol/L)

Physical examination: Hyperkalemia—High Serum Potassium (K+) Concentration

Physical examination:Bilateral muscle weakness in quadriceps, transient abdominal cramps, diarrhea, dysrhythmias, cardiac arrest if severe

Physical examination Hypokalemia—Low Serum Potassium (K+) Concentration

Physical examination:Bilateral muscle weakness that begins in quadriceps and may ascend to respiratory muscles, abdominal distention, decreased bowel sounds, constipation, dysrhythmias

Physical examinationHypernatremia (Water Deficit; Hyperosmolar Imbalance)—Body Fluids Too Concentrated

Physical examination:Decreased level of consciousness (confusion, lethargy, coma), perhaps thirst, seizures if develops rapidly or is very severe Laboratory findings:Serum Na+level above 145 mEq/L (145 mmol/L), serum osmolality above 295 mOsm/kg (295 mmol/kg)

Physical examinationHyponatremia (Water Excess; Water Intoxication; Hypoosmolar Imbalance)—Body Fluids Too Dilute what are Laboratory findings:

Physical examination:Decreased level of consciousness (confusion, lethargy, coma), seizures if develops rapidly or is very severe Laboratory findings:Serum Na+level below 136 mEq/L (136 mmol/L), serum osmolality below 285 mOsm/kg (285 mmol/kg)

Metabolic Acidosis—Excessive Metabolic Acids Physical examination:

Physical examination:Decreased level of consciousness (lethargy, confusion, coma), abdominal pain, dysrhythmias, increased rate and depth of respirations (compensatory hyperventilation)

Respiratory Acidosis—Excessive Carbonic Acid Caused by Alveolar Hypoventilation Physical examination

Physical examination:Headache, light-headedness, decreased level of consciousness (confusion, lethargy, coma), dysrhythmias

Physical examinationHypermagnesemia—High Serum Magnesium (Mg2+) Concentration

Physical examination:Lethargy, hypoactive deep tendon reflexes, bradycardia, hypotension Acute elevation in Mg2+levels: Flushing, sensation of warmth Severe acute hypermagnesemia: Decreased rate and depth of respirations, dysrhythmias, cardiac arrest

Respiratory Alkalosis—Deficient Carbonic Acid Caused by Alveolar Hyperventilation Physical examination

Physical examination:Light-headedness, numbness and tingling of fingers, toes, and circumoral region, increased rate and depth of respirations, excitement and confusion possibly followed by decreased level of consciousness, dysrhythmias

Physical examination Hypocalcemia—Low Serum Calcium (Ca2+) Concentration

Physical examination:Numbness and tingling of fingers, toes, and circumoral (around mouth) region, positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), hyperactive reflexes, muscle twitching and cramping; carpal and pedal spasms, tetany, seizures, laryngospasm, dysrhythmias

Physical examinationExtracellular Fluid Volume Excess—Body Fluids Have Increased Volume but Normal Osmolality

Physical examination:Sudden weight gain (overnight), edema (especially in dependent areas), full neck veins when upright or semi-upright, crackles in lungs If severe: confusion, pulmonary edema Laboratory findings:Decreased hematocrit, decreased BUN below 10 mg/dL (3.6 mmol/L) (hemodilution)

Physical examinationExtracellular Fluid Volume Deficit—Body Fluids Have WHATVolume but WHATOsmolality

Physical examination:Sudden weight loss (overnight), postural hypotension, tachycardia, thready pulse, dry mucous membranes, poor skin turgor, slow vein filling, flat neck veins when supine, dark yellow urine If severe: thirst, restlessness, confusion, hypotension; oliguria (urine output below 30 mL/hr); cold, clammy skin; hypovolemic shock Laboratory findings:Increased hematocrit; increased BUN above 20 mg/dL (7.1 mmol/L) (hemoconcentration); urine specific gravity usually above 1.030, unless renal cause

Plasma concentrations of K+, Ca2+, Mg2+, and phosphate are very low compared with their concentrations in WHERE

Plasma concentrations of K+, Ca2+, Mg2+, and phosphate are very low compared with their concentrations in cells and bone

Which scale is used to weigh infants? Bed Chair Platform Standing

Platform

A woman with ovarian cancer would like to know which kind of genetic testing could help prevent her daughters from getting ovarian cancer. What should the nurse tell this patient? Forensic testing Carrier screening Predictive testing Prenatal diagnostic testing

Predictive testing Rationale: Predictive genetic testing can be done to find mutated BRCA1 or BRCA2 genes. People who have these genetic mutations can elect to have a prophylactic oophorectomy to prevent the development of the cancer. Diagnostic testing can also identify genetic conditions. Forensic testing is done to identify an individual for legal purposes. Carrier screening identifies an unaffected individual who carries one copy of a specific gene and could pass it to next generations. Prenatal diagnostic genetic testing is done to detect changes in genes or chromosomes of a fetus before birth.

Presence involves a person-to-person encounter that: A. Enables patients to care for self B. Provides personal care to a patient C. Conveys a closeness and a sense of caring D. Describes being in close contact with a patient

Nerves that carry pain impulses from the periphery to the spinal cord

Primary afferent fibers ( A-delta and C-fibers)

Prostaglandins made from where and do what

Prostaglandins • Generated from the breakdown of phospholipids in cell membranes • Thought to increase sensitivity to pain

Acute pain

Recent onset less than 6 months and caused by tissue damage, usually ends when tissue heals

Faith

Refer to a specific religious tradition or belief in something that cannot be touched or seen.

Initial observations

Referred to as general inspection; begins the moment the nurse meets the patient

Morality

Refers broadly to an accepted set of social standards or morals that guide behavior.

Stress

Refers to an individual experience in response to a deman (internal or external) which occurs on a physical, psychological and/or behavioral level.

Hope

Refers to belief, wishes, or actions taken in situation of uncertainty.

Applied ethics (practical ethics)

Refers to the process of applying ethical theory and reasoning to daily life.

Ethics of character

Relies on the character of the individual as the primary source of moral action.

Remember that there is a lot of sodium in normal ECF or ICF.

Remember that there is a lot of sodium in normal ECF.

Removing sodium and water from the renal tubules and returning it to the blood increases the volume of the WHAT

Removing sodium and water from the renal tubules and returning it to the blood increases the volume of the ECF

Renin converts angiotensinogen to angiotensin I, which is converted to angiotensin II by other enzymes in the WHAT

Renin converts angiotensinogen to angiotensin I, which is converted to angiotensin II by other enzymes in the lung

Clinical Exemplar: Insomnia

Represents a group of disorders associated with a disruption of sleep. Acute and chronic stress is one of the leading causes of insomnia. Is described as the inability to fall asleep or stay asleep. The effects inlcude daytime sleepiness, generalized fatigue, irriatibility, and cognitive problems. Chronic insomnia is associated with multiple health-related conditions. Can affect individuals of all ages, but it is more commonly associated with adults and older adults.

Major principles of ethics

Respect for persons, nonmaleficence, beneficence, justice, and fidelity

Respiratory acidosis arises from alveolar HYPOVENTTILATION OR HYPERVENTILATION ; the lungs are unable to excrete enough CO2.

Respiratory acidosisarises from alveolar hypoventilation; the lungs are unable to excrete enough CO2.

Respiratory acidosis arises from alveolar hypoventilation; the lungs are unable to excrete enough CO2. The PaCO2rises, creating an excess of carbonic acid in the blood, which decreases pH The kidneys compensate by increasing excretion of metabolic acids in the urine, which increases blood bicarbonate. This compensatory process is SLOW OR FAST?

Respiratory acidosisarises from alveolar hypoventilation; the lungs are unable to excrete enough CO2. The PaCO2rises, creating an excess of carbonic acid in the blood, which decreases pH (Table 42.7). The kidneys compensate by increasing excretion of metabolic acids in the urine, which increases blood bicarbonate. This compensatory process is slow, often taking 24 hours

Respiratory alkalosis arises from alveolar hyperventilation; do the lungs excrete TOO MUCH OR TOO LITTLE carbonic acid (CO2and water)?

Respiratory alkalosis arises from alveolar hyperventilation; the lungs excrete too much carbonic acid (CO2and water)

Respiratory alkalosisarises from alveolar hyperventilation; does The PaCO2 DECREASE OR INCREASE , creating a deficit of carbonic acid in the blood, which increases pH?

Respiratory alkalosisarises from alveolar hyperventilation; the lungs excrete too much carbonic acid (CO2and water). The PaCO2falls, creating a deficit of carbonic acid in the blood, which increases pH

Magnesium (Mg2+), clinical conditons

Rising blood ethanol increases renal excretion; oliguria decreases renal excretion. Chronic diarrhea and undigested fat increase fecal excretion.

What are the most common organisms for intermittent CF infections?

S. aureus and H. influenzae (esp early in disease), P. aeruginosa (adolescents and adults) When managing P. aeruginosa infections, 2 IV agents preferred esp AGs; Use doses larger than normal to obtain therapeutic drug concentrations in lung tissue and resistant pathogens

Serotonin come from where and do whatt

Serotonin • Released from the brainstem and dorsal horn to inhibit pain transmission

Signs and symptoms of hypernatremia are

Signs and symptoms of hypernatremia are those of cerebral dysfunction, which arise when brain cells shrivel.

Respect for persons

Simply maintains that human beings have an unconditional moral worth that requires us to treat each individual person with great value, dignity, and respect.

incomplete dominance

Situation in which one allele is not completely dominant over another allele

Behavioral - Signs and symptoms

Smoking, overeating, substance abuse

Scope of ethics involves:

Societal ethics, organizational ethics, professional ethics, bioethics & clinical ethics, and personal ethics.

Societal ethics

Society provides a strong normative basis for ethical behavior through the legal and regulatory systems.

Extracellular Fluid Volume Excess—Body Fluids Have Increased Volume but Normal Osmolality

Sodium and Water Intake Greater Than Output, Causing Isotonic Gain: Excessive administration of Na+-containing isotonic IV fluids or oral intake of salty foods and water Renal retention of Na+and water: heart failure, cirrhosis, aldosterone or glucocorticoid excess, acute or chronic oliguric renal disease

Sodium and Water Intake Less Than Output, Causing Isotonic Loss: tell examples

Sodium and Water Intake Less Than Output, Causing Isotonic Loss: Severely decreased oral intake of water and salt Increased GI output: vomiting, diarrhea, laxative overuse, drainage from fistulas or tubes Increased renal output: use of diuretics, adrenal insufficiency (deficit of cortisol and aldosterone) Loss of blood or plasma: hemorrhage, burns Massive sweating without water and salt intake

Combined Volume and Osmolality ImbalanceClinical Dehydration (ECV Deficit plus Hypernatremia)—Body Fluids Have Decreased Volume and Are Too Concentrated

Sodium and Water Intake Less Than Output, With Loss of Relatively More Water Than Salt: All of the causes of ECV deficit (see previous causes) plus poor or no water intake, often with fever causing increased insensible water output

Signs of Respiratory Distress

Stridor, nasal flaring, tachypnea, tachycardia, retractions, drooling, changes in level of consciousness, cyanosis

A facility's administration has concerns about the effectiveness of staff nurses related to patient education. What should be the nurse manager's first action in addressing this concern?

Survey nurses about patient teaching

enabling

Swanson's caring process of _______ is demonstrated by a nurse helping a new mother through the birthing experience.

What is the diagnostic test of choice for CF?

Sweat test that evaluates Cl in sweat, which is high in CF

Sympathetic Stimulation does what

Sympathetic Stimulation aDilation of bronchial tubes and increased respiratory rateProvides increased oxygen intakeIncreased heart rateProvides increased oxygen transportPeripheral vasoconstriction (pallor, elevation in blood pressure)Elevates blood pressure with shift of blood supply from periphery and viscera to skeletal muscles and brainIncreased blood glucose levelProvides additional energyIncreased cortisol level (short term)Heightened memory functions, a burst of increased immunity, and lower sensitivity to painDiaphoresisControls body temperature during stressIncreased muscle tensionPrepares muscles for actionDilation of pupilsAffords better visionDecreased gastrointestinal motility

Sympathetically maintained pain: Associated with impaired regulation of the autonomic nervous system. what are Examples:

Sympathetically maintained pain: Associated with impaired regulation of the autonomic nervous system. Examples: Pain is associated with complex regional pain syndrome, type I, type II.

What are the key counseling points for CF agents?

TOBI podhaler: Do not swallow capsules, do not use w/ nebulizer, take as close to 12h but no less than 6h apart; keep capsules at RT in a dry place PEP: may cause stomach pain, bloating, gas nausea; take at beginning of meal/snack (1/2 dose for snacks); swallow whole if possible, but may sprinkle capsules on apple sauce and taken immediately; do not mix w/ dairy products and drink lots of non-caffeine liquids

A patient tells the nurse about plans to do research about the patient's diagnosis and potential treatment on the Internet. What is the nurse's most appropriate initial response?

Teach about evaluation of Internet resources.

The patient has late stage non-small cell lung cancer. The health care provider is considering using crizotinib for this patient. What should the nurse prepare the patient for before the medication is prescribed? Give chemotherapy first. Test for hypersensitivity to this drug. Test for the abnormal anaplastic lymphoma kinase (ALK) gene. Test for gene abnormalities that will affect the appropriate dose.

Test for the abnormal anaplastic lymphoma kinase (ALK) gene. Rationale: Pharmacogenetics shows that an abnormal ALK gene in the patient with late-stage non-small cell lung cancers causes the cancer to develop and grow. Crizotinib (Xalkori) works by blocking certain proteins called kinases, including the protein produced by the abnormal ALK gene. This drug interacts with many other drugs, so the patient's medications should be reviewed as well.

The abnormally low pH in metabolic acidosis stimulates the chemoreceptors, so the respiratory system compensates for the acidosis by doing WHAAT

The abnormally low pH in metabolic acidosis stimulates the chemoreceptors, so the respiratory system compensates for the acidosis by hyperventilation. Compensatory hyperventilation

DNA methylation

The addition of methyl groups to bases of DNA after DNA synthesis; may serve as a long-term control of gene expression.

The average adult normally excretes only how much mL of fluid each day through feces.

The average adult normally excretes only 100 mL of fluid each day through feces.

Metaethics

The branch of philosophy that considers fundamental questions about the nature, source, and meaning of concepts such as good and bad or right and wrong.

Spirituality

The definitions of spirituality encompass the following: a principle, an experience, attitudes and beliefs regarding God, a sense of God, and the inner person. "Heart" not "head" knowledge. "Spirituality as a personal concept is generally understood in terms of an individual's attitudes and belief related to transcendence (God) or to the nonmaterial forces of life and of nature. Not only transcendence but also the connection of the mind, body, and spirit, in addition to love, caring, and compassion, and a relationship with the Devine." - Mary Elizabeth O'Brien "Spirituality represents a search for the sacred or transcendent (God, Jesus, Muhammad, the Buddha, Brahman, Ultimate Truth of Reality)". - Dr. Harold Koenig

Hyponatremia

The excessively dilute condition of interstitial fluid causes water to enter cells by osmosis, causing the cells to swell. Signs and symptoms of cerebral dysfunction occur when brain cells swell

The couple is adopting a baby. What health information related to the baby's biologic parents will be most useful to the parents and the baby as she grows up? The grandmother had breast cancer. The family has a person with Down syndrome. There is a family history of Alzheimer's disease. The family has familial adenomatous polyposis (FAP).

The family has familial adenomatous polyposis (FAP). Rationale: Because FAP occurs in those with the gene, being able to screen, monitor, and treat this baby will save her life in the long run. Breast cancer may or may not occur if the BRCA 1 or 2 are mutated. Many people who are positive for Apo E-4 do not develop Alzheimer's disease. Down syndrome results from a chromosomal alteration and not a mutated gene.

Transmission to spinal cord

The first order neuron extends the entire distance from the periphery to the dorsal horn of the spinal cord with no synapses. Once generated an action potential travels all the way to the spinal cord unless it is blocked by a sodium channel inhibitor or disrupted by a lesion at the central terminal of the fiber or a dorsal root entry zone lesion

The more H+ions that are present, the more acidic or alkaline is a solution.

The more H+ions that are present, the more acidic is a solution.

The nociceptive impulses are transmitted from the periphery to the spinal cord via the peripheral afferent fibers to where

The nociceptive impulses are transmitted from the periphery to the spinal cord by afferent fibers to the dorsal root ganglia and the superficial lamina I/II of the dorsal horn of the spinal cord.

The particles in the interstitial fluid exert interstitial fluid WHAT pressure, which tends to pull water out of the cell.

The particles in the interstitial fluid exert interstitial fluid osmotic pressure, which tends to pull water out of the cell.

The particles that cannot cross cell membranes easily determine the WHAT(effective concentration) of a fluid.

The particles that cannot cross cell membranes easily determine the tonicity (effective concentration) of a fluid.

Veracity

The principle of telling the truth

The respiratory compensation for metabolic alkalosis is WHAT

The respiratory compensation for metabolic alkalosis is hypoventilation.

The respiratory compensation for metabolic alkalosis is hypoventilation. The DECREASED OR INCREASED rate and depth of respiration allow carbonic acid to increase in the blood, as seen by an increased PaCO2.?

The respiratory compensation for metabolic alkalosis is hypoventilation. The decreased rate and depth of respiration allow carbonic acid to increase in the blood, as seen by an increased PaCO2.

The resulting increased capillary hydrostatic pressure and increased interstitial colloid osmotic pressure produce WHATin the inflamed tissues.

The resulting increased capillary hydrostatic pressure and increased interstitial colloid osmotic pressure produce localized edema in the inflamed tissues.

Ethics

The study of examination of morality through a variety of different approaches

Calcium (Ca2+) . WHATclinical conditions afffect

Thiazide diuretics decrease renal excretion. Chronic diarrhea and undigested fat increase fecal excretion.

adh

This action decreases urine volume, concentrating the urine while diluting the blood by adding water to it

Chronic Stress

This type of stress represents a perpetual or sustained demand, threat, or pressure that is harmful to health because i wears on individuals continuously. It can stem from long-term stressors such as chronic occupational stress, relationship stress, and financial stress. Chronic stress is ofen associated with a loss of hope that the situation can improve.

Thus ANP opposes the effect of WHAT

Thus ANP opposes the effect of aldosterone

Thus fluid moves into the capillary at the venous end, removing WHATproducts

Thus fluid moves into the capillary at the venous end, removing waste products

Transcellular fluids are such as

Transcellular fluids such as cerebrospinal, pleural, peritoneal, and synovial fluids are secreted by epithelial cells

Transduction is the process whereby what

Transduction is the process whereby an activated nociceptor converts energy produced by these stimuli (e.g., exposure to pressure or a hot surface) into an action potential.

C-fibers

Transmit painful stimuli more slowly and produce pain that is typically aching or throbbing.

Justice

Treating people equitably, fairly, and appropriately

Visceral pain: Arises from visceral organs such as the gastrointestinal tract and pancreas; is sometimes subdivided: 1. Tumor involvement of organ capsule that causes aching and it is localized or diffuse pain. 2. Obstruction of hollow viscus, which causes intermittent cramping and is it localized or diffuse poorly localized pain.

Visceral pain: Arises from visceral organs such as the gastrointestinal tract and pancreas; is sometimes subdivided: 1. Tumor involvement of organ capsule that causes aching and fairly well-localized pain. 2. Obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain.

Volume imbalances are disturbances of the amount of fluid in the extracellular or intracellular compartment.

Volume imbalances are disturbances of theamount of fluid in the extracellular compartment.

Water moves across cell membranes by what ,a process by which water moves through a membrane that separates fluids with different particle concentrations

Water moves across cell membranes by osmosis, a process by which water moves through a membrane that separates fluids with different particle concentrations

Water moves into the compartment that has a what osmotic pressure (inward-pulling force) until the particle concentration is equal in the two compartments.

Water moves into the compartment that has a higher osmotic pressure (inward-pulling force) until the particle concentration is equal in the two compartments.

Pain is

Whatever the person experiencing the pain says it is perception of pain cannot be judged by anyone other than person experiencing the pain

D. assess the patient's emotional needs

When a nurse enters a patient's room and says "good morning" before starting care, the nurse combines nursing tasks and conversation. An important aspect of care for the nurse to remember is the need to... A. establish a relationship B. gather assessment data C. treat discomforts quickly D. assess the patient's emotional eneds

When the interstitial fluid becomes hypertonic, water does WHATin cells by osmosis, and they shrivel.

When the interstitial fluid becomes hypertonic, water leaves cells by osmosis, and they shrivel.

When you exhale, you excrete what in the form of CO2and water.

When you exhale, you excrete carbonic acid in the form of CO2and water.

C and E

Which of the following is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors? (All that apply) A. Decreasing the number of consecutive shifts of the nursing staff B. Increasing salary and vacation benefits of the nursing staff C. Increasing the number of nurses who work each shift to decrease the nurse-patient ratio D. Encouraging increased input concerning nursing functions E. Providing nursing staff an opportunity to discuss practice changes they can implement to enhance opportunities for patient caring

With ECV deficit, output of isotonic fluid exceeds intake of WHAT

With ECV deficit, output of isotonic fluid exceeds intake of sodium-containing fluid

With an increase of metabolic acids, does blood HCO3- decreases or increase because it is used to buffer metabolic acids

With an increase of metabolic acids, blood HCO3- decreases because it is used to buffer metabolic acids

Women typically have how much water content than men.

Women typically have less water content than men.

• Autosomal recessive disorders are caused by ...

a mutation in 2 gene pairs (homozygous) on a chromosome.

• Polymerase chain reaction (PCR) is...

a quick method that provides unlimited copies of a DNA or RNA sequence using only a small amount of sample.

problem-focused coping

a type of coping in which people take direct steps to confront or minimize a stressor Attempting to alleviate stress directly by changing the stressor or the way we interact with that stressor. help the pt solve the stressor for themselves

holistic view of the patient situation

accepts that clinical judgment is inherently complex and influenced by many factors related to the particular patient and caregiving situation; includes a willingness to consider all factors involved in a patient's care, including characteristics of the nurse; more than a combination of individual aspects

accumulation of excess fluid in the interstitial space, known as WHAT.

accumulation of excess fluid in the interstitial space, known as edema.

cheyne-stokes breathing

alternating periods of deep and shallow breathing

Pain tolerance

amount of pain that can be handled before responding

clinical reasoning

an iterativee process of noticing, interpreting, and responding- reasoning in transition with a fine attunement to the patent and how the patient responds to the nurse's actions

anion gap,a reflection of unmeasured anions in plasma. You calculate anion gap by subtracting the sum of plasma concentrations of the anions WHAT to items from the plasma concentration of the cation Na

anion gap,a reflection of unmeasured anions in plasma. You calculate anion gap by subtracting the sum of plasma concentrations of the anions Cl − and HCO3- from the plasma concentration of the cation Na

• A mutation is ...

any change in the usual DNA sequence. A genetic mutation is like a spelling error in a gene's sequence.

pH7.35-7.45pH is a NEGATIVE OR POSITIVE logarithm of the free H+concentration,

Referred pain

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

• Germline mutations are passed from...

parent to child.

particles already inside the cell exert ICF WHATpressure, which tends to pull water into the cell.

particles already inside the cell exert ICF osmotic pressure, which tends to pull water into the cell.

what ANP tell kidney

pee out sodium, cloride, and water

Peplau - severe anxiety

perceptual field is so greatly diminished that concentration centers on one particular detail only or on many extraneous details Attention span is extremely limited, and the individual has difficulty completing even the simplest task. Physical symptoms (e.g., headaches, palpitations, insomnia) and emotional symptoms (e.g., confusion, dread, horror) may be evident. Discomfort is experienced to the degree that virtually all overt behavior is aimed at relieving the anxiety

what part of pituitary makes ADH

postterior

Watson's Transpersonal Caring

promotes healing and wholeness; rejects the disease orientation to health care; places care before cure and emphasizes the nurse-patient relationship

proteins are much larger than electrolytes, glucose, and other molecules that dissolve easily. Most colloids are too large do WHAThappens in capillaries in the fluid that is filtered

proteins are much larger than electrolytes, glucose, and other molecules that dissolve easily. Most colloids are too large to leave capillaries in the fluid that is filtered

standards based approach

protocols, decision making tools, decision trees, algorithms, and guidelines; places individualized patient care outside the consideration; useful for beginning nurses and clinicians; rarely used solely by expert nurses

capillary hydrosttatic pressure pushes which way

pushes out of capillary and intto the intersttial fluid

The Joint Comission

puts standards for pain assessment into place

tachypnea breathing

rapid breathing

• Genome-wide association study (GWAS) is an approach that involves ...

rapidly scanning complete sets of DNA, or genomes, of many people to find genetic variations associated with the development or progression of a particular disease.

hypoxia

reduced oxygen of cells in tissues

hypoxemia

reduced oxygenation of arterial blood

pulmonary disease: hypoxia

reduced oxygenation of cells in tissues

Croup

refers to a group of conditions characterized by inspiratory stridor, a harsh cough, hoarseness, and varying degrees of respiratory distress. Major types are acute spasmodic laryngitis (spasmodic croup), acute laryngotracheobronchitis, Acute Epiglottitis, Acute Tracheitis.

reflection-in-action

refers to the nurse's understanding of patient responses to nursing actions while care is occurring; utilizes careful noticing and frequent adjustments; happens real time

• Although gene therapy is a promising treatment option for a number of diseases (e.g., inherited disorders, some types of cancer), the technique ....

remains risky and is still being studied.

Tonsillectomy

removal of tonsils. Reserved for cases of upper airway obstruction, peritonsillar abscess, obstructive sleep apnea, or other serious problems.

renin-angiotensin-aldosterone system (RAAS) regulates ECF or ICF volume by influencing how much WHATand WHATare excreted in urine.

renin-angiotensin-aldosterone system (RAAS) regulates ECF volume by influencing how much sodium and water are excreted in urine.

sample of arterial blood called WHATgases (ABGs)are used to monitor a patient's acid-base balance

sample of arterial blood calledarterial blood gases (ABGs)are used to monitor a patient's acid-base balance

semipermeable cell membranes separate interstitial fluid from ICF. The fluid in each of these compartments exerts WHATpressure, an inward-pulling force caused by particles in the fluid.

semipermeable cell membranes separate interstitial fluid from ICF. The fluid in each of these compartments exertsosmotic pressure, an inward-pulling force caused by particles in the fluid.

kussmaul breathing

slightly increased ventilatory rate and large tidal volume *deep, rapid, labored breathing

bradypnea breathing

slow breathing

what is peripheral sensitization

substances directly affect the nerve fibers, lowering the threshold required to activate nociceptors and generating action potentials across the synaptic cleft, a process known as peripheral sensitization

what does aldosterone do

tell kidney suck up sodium and water and pee out potassium and hydrogen

ADH does what

tells kidney tto suck up watter

term acidosis describes a condition that tends to make the blood relatively WHAT

termacidosisdescribes a condition that tends to make the blood relatively too acidic

term alkalosis describes a condition that tends to make the blood relatively too WHAT

termalkalosisdescribes a condition that tends to make the blood relatively too basic (alkaline). There are two types of alkalosis: respiratory alkalosis and metabolic alkalosis.

term alkalosis describes a condition that tends to make the blood relatively too basic (alkaline). There are two types of alkalosis: WHAT alkalosis and WHAT alkalosis.

termalkalosisdescribes a condition that tends to make the blood relatively too basic (alkaline). There are two types of alkalosis: respiratory alkalosis and metabolic alkalosis.

• A negative test result means that the laboratory did not find an altered form of the gene, chromosome, or protein under consideration. This result can indicate...

that a person is not affected by a particular disorder, is not a carrier of a specific genetic mutation, or does not have an increased risk of developing a certain disease.

• Acquired (somatic) mutations occur in ...

the DNA of a cell at some time during a person's life. An acquired mutation is passed on to all cells that develop from that single cell.

• A positive result of a predictive or presymptomatic genetic test usually cannot establish...

the absolute risk of developing a disorder or predict the course or severity of a condition.

Allele

the different forms of a gene; could be dominant or recessive

meaning-focused coping

the person concentrates on deriving meaning from the stressful experience Stress-reducing technique that refers to anything you might think, feel, and do to give a positive meaning to a stressful situation pt talks to a spiritual leader to better understand the meaning of the stress they are experiencing

interpretation

the process of coming to an understanding of a particular situation; utilizes reasoning, collecting clinical data, and conferring with colleagues

• Stem cells are the subject of much discussion because they may allow for....

the regeneration of lost tissue and restoration of function in a variety of chronic diseases, such as diabetes, heart disease, Alzheimer's disease, rheumatoid arthritis, stroke, spinal cord injury, and burns.

Common pieces of equipment

thermometer, stethoscope, BP device/cuff, pulse oximeter, scale, various charts for visual activity/eyes

thirst-control mechanism is located where within the brain

thirst-control mechanism is located within the hypothalamus in the brain

Palpation

through use of touch when performing assessment

• Gene therapy is an experimental technique that uses genes to ...

treat or prevent disease.

name two major types of fluid imbalances:

two major types of fluid imbalances: volume imbalances and osmolality imbalances

reflecting

two types: reflection-in-action; reflection-on-action; the ability to learn from one's actions

urine volume decreases to maintain fluid balance. These adjustments primarily are caused by the actions of WHATthree hormones

urine volume decreases to maintain fluid balance. These adjustments primarily are caused by the actions of antidiuretic hormone (ADH), the renin-angiotensin-aldosterone system (RAAS), and atrial natriuretic peptides (ANPs)

interpreting

using the particular patient data as well as germane theoretical and experiential knowledge, the nurse begins to make sense of it; expert nurses may utilize a developed sense of intuition

Baseline indicators

vital signs, pain assessment, height, and weight

when you eat more salty foods than usual and drink water, you may notice that your ankles swell or rings on your fingers feel tight and you gain 2 lb (1 kg) or more overnight. These are manifestations of WHAT

Pain begins

with stimuli that causes damage-> sensory peripheral nerves in spinal cord-> thalamus where pain perception happens-> parietal lobes where pain is felt

Genetic disorders can be caused by

• a mutation in a single gene. • mutations in multiple genes (multifactorial inheritance disorder), which are often related to environmental factors. • damage to chromosomes (changes in the number or structure of entire chromosomes).

A positive test result means that the laboratory found a change in a particular gene, chromosome, or protein that was being tested. This result may:

• confirm a diagnosis (e.g., Huntington's disease) • indicate that a person is a carrier of a particular genetic mutation (e.g., cystic fibrosis) • identify an increased risk of developing a disease (e.g., breast cancer) • suggest a need for further testing

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