3106: FINAL EXAM OLD CONTENT

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Definition of health

A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity A state of being that people define in relation to their own values, personality, and lifestyle

Nursing Process

-Assessment -Nursing Diagnosis -Planning -Implementation -Evaluation

Primary intention wound healing

Edges are approximate

Observer of Witness

The nonjudgmental aspect of your self is called the Observer or Witness. Some perceive this aspect as our higher Self.

Allergic reaction

Unpredictable response to a medication

Chain of Infection

infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host

clubbed nails

often occur when patients with chronic oxygen deficiency such as cystic fibrosis and congenital heart defects

Evidence-based knowledge

or knowledge based on research or clinical expertise, makes nurses better informed critical thinkers. Thinking critically and learning about the scientific concepts of deconditioning, comfort, and mobility prepare Tonya to better anticipate Mr. Lawson's needs, identify problems more quickly, and provide appropriate care.

Chemical Medication Name

provides the exact description of medication's composition e.g. N-acetyl-para-aminophenolol which is commonly known as Tylenol. Nurses rarely use chemical names in clinical practice.

Internal Variables influencing illness and illness behavior are:

Perception of illness and nature of illness

Communication and the Nursing Process: Assessment

Through the patient's eyes, physical and emotional factors, developmental factors, sociocultural factors, gender, situation, environmental context.

Discuss the normal process of wound healing.

o Wound healing involves integrated physiological processes. The tissue layers involved and their capacity for regenerating determine the mechanism for repair for any wound. 2 types of wounds those with tissue loss and those without. o hemostasis, inflammation, proliferation and remodeling

Explain nursing considerations related to interpretation of medication orders.

o correctly interpret medication prescriptions, verifying completeness and clarity o accuracy

Nasal cannula

A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils.

Three Levels of Prevention

primary, secondary, and tertiary prevention

Assess a patient's spirituality and spiritual health.

B—Belief system E—Ethics or values L—Lifestyle I—Involvement in a spiritual community E—Education F—Future events

Serous

Clear, watery plasma

Rhinitis

Inflammation of mucous membranes lining nose; causes swelling and clear, watery discharge (mild allergic reaction)

Direct, collaborative intervention:

Medication administration per order set

Serosanguineous

Pale, pink, watery of clear and red fluid

QSEN

Quality and Safety Education for Nurses

Symptoms

Subjective characteristics of disease felt only by the patient ex: aches

Therapeutic range

desired level

Why does our body need oxygen?

to metabolize food our food, turn our food into atp to drive other cell functions

Displacement:

Transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute (e.g., a person transfers anger over an interpersonal conflict to a malfunctioning computer)

Collaborative Management of Hypercalemia

-Fluids: 3000-4000 ml/day - to dilute calcium and promote excretion -Diuretics -Calcitonin - reduces bone resorption -Mobilization-get the pt. moving!

Intracardiac

injection into cardiac tissues (usually limited to physicians)

Three things influence the capacity of the blood to carry oxygen:

the amount of dissolved oxygen in the plasma, the amount of hemoglobin, and the ability of hemoglobin to bind with oxygen.

Standard Precautions

which are designed to be used for the care of all patients, in all settings, regardless of risk or presumed infection status. -Gloves -Sterile vs non-sterile -Gown -Goggles -Face Shields/Masks -Shoe Coverings

Metabolic acidosis signs and symptoms

-CNS depression - headache, confusion, drowsiness -Kussmaul respirations -Dysrhythmias

Methods to obtain data

-Observing -Listening -Translating -Reasoning -Using intuition -Validating

Artificial airways

-Oral airway -Endotracheal and tracheal airways -Invasive mechanical ventilation -Noninvasive ventilation -Chest tubes

physical examination

(conducted during a nursing history and at any time a patient presents a symptom)

Major sites for HAI infection

-Surgical or traumatic wounds -Urinary and respiratory tracts -Bloodstream

Parenteral K+

-Takes 40-60 mEq to inc. K+ by 1 mEQ -Parenteral = IV only-NEVER give IM or IV push -Adults: Do not exceed 10 mEq/hr IV, must be diluted in 100 mL of fluid, run over an hour. Preferred in a central line. -As continuous infusion- normal = 20-40mEq/L -Always on pump Irritating to veins

Comfort Theory

-comfort is a holistic phenomenon -comfort reflects holistic well-being -people experience comfort as feelings of relief, ease, and/or transcendence

Pt. is in state of H20 deficit or solutes too high. What would be the plasma osmolality?

>295mOs/kg

Osmosis

Fluids move from an area of lower solute/more fluid to an area of higher solute/less fluid until the solute concentrations are equal. -movement of H20 from area of dilute solute to more conc solute (passive)

Health promotion

Helps individuals maintain or enhance their present health.

Illness Behavior

Involves how people monitor their bodies and define and interpret their symptoms

Narrative Interaction

Sharing stories

Acute Illness:

Short duration and severe

Factors influencing spirituality

There are many factors that can impact one's spirituality including: -Acute illness -Chronic illness -Terminal illness -Near-death experience -for good or bad

Duration

Time during which medication is present in concentration great enough to produce a response

5 modes of thinking

Total Recall Habits Inquiry New Ideas and Creativity Knowing how you think

External Variables influencing illness and illness behavior are:

Visibility of symptoms, social group, cultural background, economics, and accessibility to health care

QID, qid

four times a day

Trough

lowest level

Outcomes must be

measurable and specific

Perfusion:

the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs

What happens when we breathe out

the thoracic diaphragm relaxes and expels air with co2

Pulmonary veins

Deliver oxygen rich blood from the lungs to the left atrium

Maturation stage

Maturation, the final stage of healing, sometimes takes place for more than a year, depending on the depth and extent of the wound. -The collagen scar continues to reorganize and gain strength for several months. However, a healed wound usually does not have the tensile strength of the tissue it replaces. -Collagen fibers undergo remodeling or reorganization before assuming their normal appearance. Usually, scar tissue forms and it contains fewer pigmented cells (melanocytes) and has a lighter color than normal skin. In dark-skinned individuals, the scar tissue may be more highly pigmented than surrounding skin.

Models of Health and Illness

Models help explain complex concepts or ideas, such as health and illness

Pros and cons of vaginal and rectal administration

PROS •Rapid absorption •Local effects are directly applied •Therapeutic effects provided by local application to the involved sites •Aqueous solutions are readily absorbed and capable of causing systemic effects •Potential route of administration when oral medications are contraindicated CONS •More invasive •Mucous membranes are highly sensitive to some medication concentrations

Patient Teaching - Hypomagnesia

-Caution clients about taking supplements without consulting HCP -Know your foods high in magnesium

Management of Metabolic acidosis

-Treat the cause- will correct the acidosis -Hyperkalemia may accompany metabolic acidosis as a result of a shift of K+ out of the cells. As the acidosis is corrected, potassium moves back into the cells, and hypokalemia may occur. -Hyperventilation to decrease CO2 levels is a compensatory action.

Initiative vs. Guilt

3-6 years -Feels guilty when not acting responsibly -Influenced by spiritual and religious stories, examples, moods, and actions -Models moral behaviors of parents -Begins to ask about God or supreme beings

What is the internal surface area of your alveoli (total surface area where o2 absorbed or co2 absorbed out of blood)?

75 square meters

Healing system:

A true healthcare system in which people can receive adequate, nontoxic, and noninvasive assistance in maintaining wellness and healing for body, mind, emotion, and spirit, together with the most sophisticated, aggressive curing technologies available.

Valvular heart disease

Acquired or congenital disorder of heart valves; valve either does not open or close completely -causes hardening (stenosis) or impaired closure of the valves -when stenosis occurs the flow of blood through the valves is obstructed causing the ventricle to hypertrophy or enlarge. if condition is left untreated left or right sided heart failure occurs

Honor:

An act or intention indicating the holding of self or another in high respect, esteem, and dignity, including valuing and accepting the humanity of people with regard for the decisions and wishes of another.

Identify risk factors and disease processes that influence fluid and electrolyte imbalances.

An illness that causes severe vomiting, diarrhea, and a high fever increases the risk of a fluid and electrolyte disturbance, as does taking medication that causes excessive urination. Profuse sweating from physical exertion can also increase the risk of dehydration.

Cultural transformational agent:

An individual who holds the vision for and works to actualize a plan to transform the culture of an organization to become a caring, healing environment.

Quick stroke assessment

Balance (loss of balance, headaches or dizziness) Eyes (blurred vision) Face (one side of face is drooping) Arms (arm or leg weakness) Speech (speech difficulty) Time (time to call for ambulance immediately)

Plateau

Blood serum concentration is reached and maintained after repeated fixed doses.

Cardiopulmonary resuscitation

CPR -Restoration of cardiopulmonary functioning:

Vehicles

Contaminated items. For example, sharps injuries can lead to infections (e.g., HIV, HBV, HCV) when bloodborne pathogens enter a person through a skin puncture by a used needle or sharp instrument. • Water • Drugs, solutions • Blood • Food (improperly handled, stored, or cooked; fresh or thawed meats)

Regression:

Coping with a stressor through actions and behaviors associated with an earlier developmental period

Secondary Prevention

DETECT -Focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions. -The goal is to prevent the spread of the disease, illness or infection once it occurs, limit disability and prevent death. -Activities are directed at diagnosing and prompt interventions.

Skin

Epidermis •Top layer of skin Dermis •Inner layer of skin •Collagen Dermal-epidermal junction •Separates dermis and epidermis

Nonblanchable erythema

If the erythematous area does not blanch when you apply pressure, deep tissue damage is probable.

Identify patient safety risks (2021 Hospital Patient Safety Goal)

Reduce the risk for suicide

Indirect, independent intervention:

Shift report

CV 3: Holistic communication, therapeutic healing environment, and cultural diversity

Through holistic communication, therapeutic healing environments, and diversity, holistic nurses transform their beliefs into practice, highlighting the how of holistic nursing.16,p.15 Holistic nurses provide culturally competent care. Recognizing culture may also provide an understanding of a person's concept of the illnesses or disease and appropriate treatment.

Modifiable risk factors

e.g. poor nutrition, overeating, overweight, smoking, insufficient rest and sleep etc. This risk factors can be changed.

What is safety?

freedom from psychological and physical injury NO ASSUMPTIONS!

Acidosis

pH below 7.35 increased acid or decreased base

Buccal administration

placing the medication in the mouth against the solid mucous membranes of the cheek. -placed in side of mouth against inner cheek -Standard precautions used by nurse administering medications by sublingual or buccal route as the nurse's hand may come in contact with oral secretions -Warn patients not to chew or swallow the medication or to take any liquids with it (oral route)

Sender

the person who encodes and delivers a message. The sender puts the message into verbal and nonverbal symbols that the receiver can understand. The sender's message acts as a referent for the receiver.

Environmental risk factors

the physical environment in which a person lives can determine their health.

Absent Compensation:

Non-matching is normal & pH is still abnormal nThere is NO compensation, so problem is acute!

Nursing Diagnosis

FOCUS is human/patient response to a health condition. GOAL - help the patient reach maximum level of function and wellness. Ex: Ineffective Airway Clearance R/T Increased Secretions

STAT, stat

immediately

Describe the diagnostic reasoning process.

o data cluster: set of signs and symptoms gathered during an assesment that help you group them together in a logical way o defining characteristics: clinical criteria that are observable and verifiable o data interpretation: analyzing clusters of defining characteristics or risk factors

Active Transport

Active transport is a process that requires energy to move molecules against a concentration gradient. This energy source is ATP adenosine triphosphate. An example is the Sodium-Potassium pump allows sodium and potassium to move in and out of cells to maintain certain concentrations. Na+ moves out of the cell and K+ moves into the cell. ATP

Wellness:

An active process through which people become aware of, and make choices toward, a more successful existence. It is a conscious, self-directed, and evolving process of achieving full potential. Wellness is multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the environment. It is positive and affirming

Direct, independent intervention:

Assessment due to change in status

Objective data

Can observe directly. -The client's blood pressure is 150/88. -There is a stage II pressure injury, 2cm x 2cm on the Rt heel. SIGNS

Intracellular fluid

Fluid found "within" or inside the cells. (2/3 of total). 40% of body weight

Health education

Helps people develop a greater understanding of their health and how to better manage their health risks.

Absorption of Medication

Is the passage of medication molecules into the blood from the site of administration.

Stress impact to the body

KNOW THIS

Severe hypomagnesia

Neuromuscular signs -Tetany, convulsions, Chvostek's and Trousseau's signs -Vasospasms can lead to stroke

BID, bid

twice a day

Cold and distant symptoms

This symptom builds walls or barriers to ensure that others do not permeate or invade your emotional or physical space. This, too, can be a defense due to previous pain from being violated, hurt, ignored, or rejected.

Hypomagnesemia

(<1.3mEq/l) -Rare if adequate diet -Often occurs with other imbalances -If Mg++ low, can't correct K+and Ca++ imbalances -Often seen in critically ill -Alcoholism

Self efficacy

(a person's perceived ability to successfully complete a task) influences social learning theory.

4 factors that influence oxygenation

-physiological -developmental -lifestyle -environmental

Phosphorus:

3.0-4.5 mg/dL -Critical component of all body tissues. -It is essential to the function of muscle and red blood cells -Essential in the formation of adenosine triphosphate (ATP) -Maintenance of acid/base balance -85% is located in bones and teeth -Primary anion of ICF -Metabolism of carbohydrates, proteins and fats.

Describe how to assess for the physical manifestations that occur with alterations in oxygenation.

PAIN: -Chest pain requires immediate evaluation (location, duration, radiation, frequency) -In Men: most often on left side of chest and radiates to the left arm -In Women: much less definitive and is often a sensation of breathlessness, jaw or back pain, nausea, and fatigue -Pericardial pain results from inflammation of the pericardial sac, occurs on inspiration, and does not usually radiate -Pleuritic chest pain is peripheral and radiates to the scapular regions. Coughing, yawning, and sighing worsen pleuritic chest pain. Usually caused by inflammation or infection in the pleural space -Musculoskeletal pain is often present following exercise, rib trauma, and prolonged coughing episodes. FATIGUE: -Subjective sensation in which patient reports loss of endurance -Ask patient to rate on a scale of 0-10 so you can objectify Dyspnea: -Clinical sign of hypoxia -Subjective sensation of difficult or uncomfortable breathing -Shortness of breath usually associated with exercise or excitement, but sometimes present without any relation to activity or exercise -Associated with pulmonary diseases, cardiovascular diseases, neuromuscular conditions, and anemia -May be associated with exaggerated respiratory effort, use of accessory muscles of respiration, nasal flaring, and marked increases in the rate and depth of respirations -When assessing, ask the patient when it occurs; does it affect ability to lie down? (orthopnea is an abnormal condition in which a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated) COUGH: -Sudden, audible expulsion of air from the lungs; the person breathes in, the glottis is partially closed, and the accessory muscles of expiration contract to expel the air forcibly-Protective reflex to clear the trachea, bronchi, and lungs of irritants and secretions -Patients with a chronic cough tend to deny, underestimate, or minimize their coughing because they are so accustomed to it -Sinusitis: person usually coughs in the early morning or immediately after rising from sleep to clear the airway of mucus resulting from sinus drainage -Chronic Bronchitis: cough and produce sputum all day, although greater amounts are produced after rising from a semi recumbent or flat position -Assessment: determine how frequent cough occurs, whether it is productive or nonproductive (sputum produced) -Sputum contains mucus, cellular debris, microorganisms, and sometimes pus or blood: inspect the sputum for color, consistency, odor, amount -Hemoptysis: blood sputum resulting from coughing and bleeding of upper respiratory tract, sinus drainage, or gastrointestinal tract (hematemesis) WHEEZING: -High pitched, musical sound caused by high velocity movement of air through a narrowed airway -Associated with asthma, acute bronchitis, or pneumonia -Occurs during inspiration, expiration, or both

Two Types of Medication dependence/addiction

Physical - is a physiological adaptation to a medication that manifests by intense physical disturbance when the medication is withdrawn. Psychological - a patient desires the medication for benefit other than the intended effect

Single (one-time orders)

Sometimes a doctor orders a medication to be given at a specified time e.g. Ativan 1mg IV on call to MRI.

Presence:

The essential state or core of healing; approaching an individual in a way that respects and honors her or his essence; relating in a way that reflects a quality of being with and in collaboration with rather than doing to; entering into a shared experience (or field of consciousness) that promotes healing potential and an experience of well-being.

Susceptible Host

a person likely to get an infection or disease, usually because body defenses are weak ex: elderly and immunocompromised (covid)

ad lib

as desired

Aldosterone

causes the kidneys to retain sodium and water

every hour

Attentional set

is a mental state that allows the learner to focus on and comprehend a learning activity.

Receiver

is the person who receives and decodes the message

Three of the most essential concepts for healthy relationships are

trust, forgiveness, and appropriate boundary setting.

Pt. in state of H20 excess, amount of solute is decreased or H20 is increased. What would be the plasma osmolality?

< 275 mOs/kg

Social determinants of health (SDOH)

health is determined by a person's circumstances and environment. External factors such as where a person lives, the quality of the environment, income, educational level, and relationships with others have a considerable impact on a patient's health. -SDOH are conditions in which people are born, grow, live, work, and age.

Nursing Assessment Questions: Life and Self-Responsibility

• How do you feel about the changes this illness has caused? • How do these changes affect what you now need to do?

Nursing Assessment Questions: Life Satisfaction

• How happy or satisfied are you with your life? • Which accomplishments help you feel satisfied with your life? • What is it that makes you feel dissatisfied?

Nursing Assessment Questions: Faith, Belief, Fellowship, and Community

• To what or whom do you look as a source of strength, hope, or faith in times of difficulty? • How does your faith help you cope? • What can I do to support your religious beliefs or faith commitment? Would you like me to pray with you or perhaps read from the Koran or Bible? • What gives your life meaning?

Mixed acid base

-Concurrent respiratory and metabolic Imbalance -pH normal; pC02 & HC03 both abnormal -Eg. cardiac arrest

When an error occurs

-First assess the patient's condition, then notify the health care provider -When patient is stable, report the incident -Complete an incident report -Report near misses and incidents that cause no harm

Distribution of medication

after the medication is absorbed it is distributed to the tissues, organs and to its specific site of action.

Transdermal Administration

application of a drug in patch form, which is then absorbed into the blood through the skin -Meds designed to be absorbed through the skin for systemic effect -Patches are disposed of according to facility policy, especially if contains controlled substance -Placement sites rotated to avoid skin irritation -Placement of new patch and removal of old patch are both recorded on MAR -Cleansing the skin site is needed as skin oils may interfere with the adhesive on these products

Pulmonary arteries

carry deoxygenated blood out of the right ventricle and into the lungs

integrality

continuous mutual human field and environmental field process

Interstitial fluid

fluid that surrounds the cells (75% of extracellular fluid)

Communicable Disease

If an infectious disease can be transmitted directly from one person to another, it is termed a communicable disease

Climate Change: Reducing Global Warming

In 2019, the EPA released its annual report on air quality, tracking our nation's progress in improving air quality since the passage of the Clean Air Act.26 At the same time, carbon dioxide and other air pollution is collecting in the atmosphere like a thickening blanket, trapping the sun's heat and causing the planet to warm up. Coal-burning power plants are the largest U.S. source of carbon dioxide pollution, producing 2.5 billion tons each year. Automobiles, the second largest source, create nearly 1.5 billion tons of carbon dioxide annually.

Hypoxia

Inadequate tissue oxygenation at the cellular level -life-threatening CAUSES: -decreased hemoglobin level -diminished concentration of inspired oxygen -inability of tissues to extract oxygen from blood -decreased defusion of oxygen from the alveoli to the blood -poor tissue perfusion with oxygenated blood -impaired ventilation s&s: apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness and behavioral changes. cyanosis, blue discoloration, is a late sign.

Situations for use of isotonic solutions.

Isotonic solutions are used: to increase the EXTRACELLULAR fluid volume due to blood loss, surgery, dehydration, fluid loss that has been loss extracellularly.

Semicritical Items

Items that come in contact with mucous membranes or nonintact skin also present a risk. These objects must be free of all microorganisms (except bacterial spores). Semicritical items must be high-level disinfected (HLD) or sterilized. These items include: • Respiratory and anesthesia equipment • Endoscopes • Endotracheal tubes • GI endoscopes • Diaphragm fitting rings After rinsing, dry items and store in a manner to protect from damage and contamination.

Hyperkalemia

K+>5.OmEq/L -Massive intake of K+ -*Most common cause = impaired renal excretion -Massive trauma (burns, crushing injuries, severe infections) -Potassium sparing diuretics, ACE Inhibitors

Output measurement

Airborne Precautions

Methods of infection control that must be used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei. -travels up to 6 feet -private room -negative-pressure airflow -mask or respiratory protection -n95 -measles, chicken pox, TB

Compensation

Non-matching component is abnormal, but pH is normal -pH 7.32 -PaCO2-60 mm Hg -HCO3-30 mEq/L -Check pH -Look at the value matching pH; does respiratory or metabolic component match pH -Determine extent of compensation

Nonverbal communication

Nonverbal communication includes the five senses and everything that does not involve the spoken or written word. Nonverbal aspects of communication such as voice tone, eye contact, and body positioning are often as important as verbal messages ( Lorié, 2017 ). Thus nonverbal communication is unconsciously motivated and more accurately indicates a person's intended meaning than spoken words ( Varcarolis, 2017 ). When there is incongruity between verbal and nonverbal communication, the receiver usually "hears" the nonverbal message as the true message.

Nutrition and wounds

Normal wound healing requires proper nutrition. Deficiencies in any of the nutrients result in impaired or delayed healing . Physiological processes of wound healing depend on the availability of protein, vitamins (especially A and C), and the trace minerals zinc and copper. Collagen is a protein formed from amino acids acquired by fibroblasts from protein ingested in food. Vitamin C is necessary for synthesis of collagen. Vitamin A reduces the negative effects of steroids on wound healing. Trace elements are also necessary (i.e., zinc for epithelialization and collagen synthesis and copper for collagen fiber linking).

Standards of practice

Nurses use the ANA Standards of Professional Nursing Practice as evidence of the standard of care provided to patients.

Objective data can validate subjective data.

Patient complains of "burning, throbbing pain after twisting rt ankle. Instruct them to rate their pain on a scale of 0-10.

Basic Human Needs

Physiological needs, including the need for sufficient oxygen, nutrition, and optimum temperature, influence a person's safety. According to Maslow's hierarchy of needs, these basic needs must be met before physical and psychological safety and security can be addressed

Breaking the chain of infection

Practicing appropriate hand hygiene, using PPE and Standard Precaution practices and also Isolation -handwashing is MOST important way to break chain of infection -use standard precautions EXAMPLES: reservoir: covering mouth po exit: cover mouth po entry: cover mouth mode of trans: cover mouth susc host: many things, losing weight, get chol down

Total Recall (5 modes of thinking)

Remembering facts or where to look for them.

Rash

Small, raised vesicles that are usually reddened; often distributed over entire body (mild allergic reaction)

Burnout

Stressors such as rapid changes in health care technology, diversity in the workforce, organizational restructuring, and changing work systems place stress on employees. Burnout occurs as a result of chronic stress. In nursing, burnout results when nurses perceive the demands of their work exceed perceived resources. It is manifested as emotional exhaustion, poor decision making, loss of a sense of personal identity, and feelings of failure.

The SURETY Model is one model you can use to facilitate attentive listening and therapeutic communication with your patients

S—Sit at an angle facing the patient. U—Uncross legs and arms R—Relax E—Eye contact T—Touch Y—Your intuition

Spiritual Well-Being

The concept of spiritual well-being has multiple dimensions. The common dimensions of spiritual well-being include meaning and purpose, a sense of peace or fulfillment, and connectedness with others and God or a higher power. Those who experience spiritual well-being feel connected to others and are able to find meaning or purpose in their lives. Those who are spiritually healthy experience joy, are able to forgive themselves and others, accept hardship and mortality, and report an enhanced quality of life.

circular transactional communication process model

The model shows the situational contextual inputs, channels of communication, interpersonal contextual concepts, and factors affecting the sender and receiver. includes several elements: the referent, sender and receiver, message, channels, context or environment in which the communication process occurs, feedback, and interpersonal variables Potential for miscommunication at every step

Healing relationships:

The quality and characteristics of interactions between one who facilitates healing and the person in the process of healing. Characteristics of such interactions involve empathy, caring, love, warmth, trust, confidence, credibility, competence, honesty, courtesy, respect, shared expectations, and good communication.

Referent

The referent motivates one person to communicate with another. In a health care setting sights, sounds, sensations, perceptions, and ideas are examples of cues that initiate the communication process. Knowing a stimulus or referent that initiates communication allows you to develop and organize messages more efficiently. For example, a patient request for help prompted by his difficulty in breathing causes a different response than a patient request resulting from hunger.

Caring, Healing, Transcendent Presence

These perspectives each speak to different facets of the quality and characteristics of the attention that one person gives to another in a relationship.

There are five risk factors associated with metabolic syndrome

They include a large waistline, an increased triglyceride level, a low high-density lipoprotein cholesterol level, hypertension, and hyperglycemia.

Purulent

Thick, yellow, green, tan, or brown

Goal of patient education

To help individuals, families, or communities achieve optimal levels of health

transdermal administration

PRN orders

as needed e.g. Morphine sulfate 2mg IV q2h prn for incisional pain.

AC, ac

before meals

Explain the relationship between clinical experience and critical thinking.

clinical expertise, makes nurses better informed critical thinkers.

SBAR Communication

consistent, clear, structured, and easy-to-use method of communication between healthcare personnel; it organizes communication by the categories of: Situation, Background, Assessment, and Recommendations. S= Situation B= Background A= Assessment R= Recommendation

Affective Domain of Learning

deals with the expression of feelings and emotions, and the development of values, attitudes and beliefs. --Affective learning is accomplished through: role play, and discussions. Includes: -Receiving - simplest behavior in affective learning -Responding -Valuing -Organizing -Characterizing - most complex. Requires highest level of internalization, and self-examination of one's own values.

Nonmodifiable risk factors

e.g. age, gender, genetics, and family history. This risk factors cannot be changed.

q4h

every 4 hours

q am

every morning

The cardiopulmonary system consists of

heart, lungs, airways, and blood vessels. They function to provide and deliver oxygen to the tissues and to remove carbon dioxide from the body.

Intraarticular

injection into a joint (usually limited to physicians)

Simple Diffusion

movement of a solute from an area of high concentration to an area of low concentration Simple diffusion requires no energy. An example is oxygen and carbon dioxide can permeate through cell membranes and are distributed throughout the body. So...... Breathing is an example of diffusion!

Explain the factors that impede or promote wound healing.

o Nutrition o Tissue perfusion o Infection o Age o Psychosocial impact of wounds

Developmental stage

physical & emotional development will influence health. A person's developmental stage may sometimes differ from their chronological age. Assess and adapt your nursing care based on your patient's developmental stage and ability to participate in self-care.

Phases of the Helping Relationship

preinteraction phase, orientation phase, working phase, termination phase

Myocardial ischemia

results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands -two common outcomes of this ischemia are angina and myocardial infarction

s/s

signs and symptoms

Compliance

the ability of the lungs to distend or expand in response to increased intra-alveolar pressure. Compliance decreases in diseases such as pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs.

Incubation Period

the period between exposure to a pathogen and when symptoms and/or signs are first apparent

Direct Care

•Activities of daily living (ADLs) Direct care measures usually performed during a normal day •Instrumental ADLs (IADLs) Activities that support daily life and are oriented toward interacting with the environment •Physical care techniques The safe and competent administration of nursing procedures •Lifesaving measures Ex: Counseling, Teaching, Controlling for adverse reactions, Preventive interventions

Standards for Patient Education

-All state Nurse Practice Acts recognize that patient teaching falls within the scope of nursing practice. -The Joint Commission sets standards for patient and family education. -Successful accomplishment of standards requires collaboration among health care professionals and enhances patient safety.

Motivation to learn

-An internal state that helps arouse, direct, and sustain human behavior -Influenced by the belief of the need to know something

Normal Fluid Delivery

-Arterial pressure drives fluid from the vascular space -Venous pressure is lower and allows fluid and wastes to return to the vascular space -Albumen prevents overdelivery of fluids and supplements venous return by drawing fluid out

Impact of Illness on the Patient and Family

-Behavioral and emotional changes -Impact on body image -Impact on self-concept -Impact on family roles -Impact on family dynamics

Criteria for Nursing Diagnoses

-Can be resolved by Nursing Interventions -Client Problem NOT Nursing Problem

Interstitial Oncotic Pressure increased

-Capillary walls damaged, plasma proteins accumulate in interstitium; draws fluid into interstitium -Causes: trauma, burns, inflammation, major surgery

Hypomagnesemia: what do you see

-Cardiac irritability-arrhythmias (can be lethal if previously had an MI) -GI symptoms-dec contractility causes anorexia, abdominal distention -Psychological-depression, confusion, psychoses

Cultural Health Beliefs

-Cultural beliefs shape a patient's view of health, how they treat and prevent illness, and preferences for care. -Health beliefs often vary within a cultural group, therefore it's very important to assess your patient health beliefs and NOT stereotype.

Assessment findings: Hypernatremia

-Direct effect on excitability and conduction of neurons, therefore more easily activated -Neuro: decreased level of consciousness, (confusion, lethargy, coma) -Seizures if it develops rapidly or is severe. -Laboratory Findings: -Na+ > 145 mE/L -Serum osmolality > 295 mOsm/kg(295 mmol/kg) **All about fluid and neuro!!

Surgical Asepsis Process

-Donning and removing caps, masks, and eyewear -Opening sterile packages -Opening a sterile item on a flat surface -Opening a sterile item while holding it -Preparing a sterile field -Pouring sterile solutions -Surgical scrub -Applying sterile gloves -Donning a sterile gown

Respiratory acidosis signs and symptoms

-Dyspnea at rest -Disorientation -Tachycardia -Lab values - hyperkalemia may result as H+ moves into cells, causing a shift of potassium out of the cell.

How can we take care of ourselves?

-Eat a nutritious diet -Get adequate sleep -Engage in exercise and relaxation activities -Establish a good work-family balance -Develop coping skills -Allowing personal time for grieving -Focus on spiritual health -Find a mentor

Nursing diagnoses that may apply during medication administration

-Impaired Health Maintenance -Lack of Knowledge (Medication) -Nonadherence (Medication Regimen) -Adverse Medication Interaction -Complex Medication Regimen (Polypharmacy)

Causes of Extracellular Fluid Volume Excess (FVE)

-Increased fluid intake/fluid overload IV fluids- too much or too fast -Excessive administration of Na+ containing isotonic IV fluids or oral intake of salty foods and water -Abnormal Fluid retention - Heart Failure -Interstitial to plasma fluid shifts (2nd spacing) -Liver cirrhosis - serum protein, albumin decreases

Factors Influencing Patient Safety

-Knowledge -Environmental safety -Developmental level of patient -Mobility -Sensory -Cognitive status -Lifestyle choices

Prevent mistakes in surgery (2021 Hospital Patient Safety Goal)

-Make sure that the correct surgery is done on the correct patient and at the correct place on the patient's body. -Mark the correct place on the patient's body where the surgery is to be done. -Pause before the surgery to make sure that a mistake is not being made.

Risk factors for developing HAIs

-Number of health care employees with direct contact with the patient -Types and numbers of invasive procedures -Therapy received -Length of hospitalization -Susceptibility of host -Virulence of the infectious agent

Causes of Respiratory alkalosis

-Pain -Anxiety attacks which cause hyperventilation -Early salicylate poisoning -Fever, especially infants

The process of any of these factors will cause wound deterioration:

-Predictive measures - a low score on the Braden scale predicts higher chances or pressure ulcer development. -Decreased mobility -Poor nutritional status -Moisture/incontinence -Pain

Site of exchange

-Pressure is higher on the arteriole end of the capillary than the venous end -Hydrostatic pressure pushes fluid and solutes out on the arteriole end of the capillary -Oncotic pressure prevents overdelivery (maintains vascular volume) -Lower pressure on the venous side of the capillary allows for fluid, solutes, and waste to return to the venous system

Common goals of care applicable to patients with infection often include the following:

-Preventing exposure to infectious organisms -Controlling or reducing the extent of infection -Maintaining resistance to infection -Verbalizing understanding of infection prevention and control techniques (e.g., hand hygiene)

Albumen (safety net)

-Protein molecule present in the blood -Cannot pass through a capillary membrane due to size -Draws water to the albumin molecule "water magnet" and supplements the return rate on the venous side -Prevents overdelivery of water due to pressure

Institute of Medicine (IOM) Competencies for Health Professionals

-Provide Patient Centered Care -Work in interdisciplinary Teams -Employ Evidenced Based Practice (EBP) -Apply Quality Improvement -Utilize informatics

Respiratory physiology

-Structure and function -Work of breathing -Pulmonary circulation -Respiratory gas exchange -Oxygen transport -Carbon dioxide transport

Management of Respiratory Alkalosis

-Talk them down -Inhale own C02(no longer recommended to breath into a bag) -Treat underlying cause -Emotional support -Rx FVD

Assessing Hydration in Infants and Children:

-Tears: absent -Mental Status: lethargic èflaccid è unresponsive. -Skin Turgor: notable delay in return -Capillary refill: > 3 sec, mottled, gray, cyanotic -Estimated % dehydration: Severe Deficit is >10% loss in a Child:>10% deficit (100 mL/kg) or Infant: 15% deficit (150 mL/kg)

Homeostasis

-The body uses several mechanisms to keep fluids and electrolytes in balance. -Osmosis (passive) - Fluids move from an area of lower solute/more fluid to an area of higher solute/less fluid until the solute concentrations are equal. -Example: Boiling a hot dog. -the body likes balance

Water in the body

-The primary fluid of the body is W A T E R ..... -Approximately 60% of the average healthy adult's weight is water. -In good health this volume remains relatively constant and the person's weight varies by < 0.2 kg (0.5 lb) in 24 hours regardless of the amount of fluid ingested. -Water is vital to health and normal cellular function, serving as a medium for metabolic reactions within cells, a transporter for nutrients, waste products and other substances a lubricant, an insulator and shock absorber, one means of regulating and maintaining body temperature.

Why is the nursing process important?

-The steps of the nursing process are the essential core of nursing practice developed by the American Nurses Association (ANA) so that all nurses regardless of role, population or specialty are expected to competently perform. (ANA, n.d.) -We speak of consistent language.

Children are the most vulnerable to environmental exposures for the following reasons:

-Their bodily systems are still developing. -They eat more, drink more, and breathe more in proportion to their body size. -Their behaviors can expose them more to chemicals and organisms.

Why are nursing theories important?

-Theories help nurses to identify the focus, means and goals of practice -Nursing theories enhance communication and accountability for patient care

Spiritual Health: Evaluation

-Through the patient's eyes -Include the patient in your evaluation of care to determine if their expectations were met -Patient outcomes: do you feel more connected to your spiritual source or family? Are you starting to feel more at peace with your diagnosis?

Constructs of spirituality

-Transcendence -Connectedness -Faith and hope -Inner strength and peace -Purpose in life

Define the patient centered interview and interview techniques used in nursing assessment.

-a patient-centered interview is an approach for obtaining the data from patients that are needed to foster a caring nurse-patient relationship, adherence to interventions, and treatment effectiveness. -Orientation, identify problem, assessment, terminate

Defensive mechanisms commonly used in anger include

-a penchant to withdraw and isolate oneself -the impulse to express anger openly in out-of-control rage, verbal abuse, and insults.

Risk Factors for Fluid, Electrolyte, and Acid-Base Imbalances

-age -environment -gi output -chronic diseases -trauma -therapies

Environmental factors influencing oxygenation

-being exposed to occupational pollutants

Medical History regarding Fluid, Electrolyte, and Acid-Base Imbalances

-recent surgery -gi output -acute illness/trauma -chronic illness

Three factors are evident when a healing relationship develops between nurse and patient:

1. Realistically mobilizing hope for the nurse and patient 2. Finding an interpretation or understanding of the illness, pain, anxiety, or other stressful emotion that is acceptable to the patient 3. Helping the patient use social, emotional, and spiritual resources

FVE Interventions

1. VS q4h- report inc HR, BP, RR 2. Check breath sounds q4h, report crackles 3.Weigh daily 4.Monitor peripheral edema q shift 5. Strict I/O

Hypermagnesemia

>2.1 mEq/L -Level of 5-7: drowsiness -7-10 no deep tendon reflexes (dtrs) -10-12 respiratory depression -12-15 coma -15-20 cardiac arrest

Noise and the Stress Response

A growing body of data suggests a link between noise pollution and adverse mental and physical health. Elevated workplace or other noise can cause hearing impairment and contribute to hypertension, ischemic heart disease, and sleep disturbance. Studies show that noise provokes changes in blood pressure, sleep patterns, and digestion, all signs of stress on the body. Studies have examined the relationship of noise pollution in public health for many decades. Stress and noise pollution appear to be worse than originally thought, and noise can now be measured in raising stress levels to the point of causing heart and immune system problems and can alter brain chemistry in deleterious ways. As part of creating healing environments, noise levels from machines and the impact on staff and patients are being reevaluated in today's hospitals.

Paradigm

A paradigm is a pattern of beliefs used to describe the domain of a discipline. It links the concepts, theories, beliefs, values, and assumptions accepted and applied by the discipline

Nursing Process

Assessment Diagnosis Planning Implementation Evaluation

Benefits of Safety & Health Programs

Benefits may include: •Improvements in product, process, and service quality •Better morale •Improved recruiting and retention •More favorable image and reputation

Bactericidal

Capable of destroying bacteria

Connection

Connection is the third principle of influential leadership and is regarded as a core strategy to build and strengthen a compassionate culture that promotes effective relationships and "raises everyone's level of energy, engagement, motivation, and performance." Sharing meaningful experiences through authentic connection fosters organizational commitment and drives performance excellence.

Secondary intention wound healing

Edges are not approximated

Dissociation:

Experiencing a subjective sense of numbing and a reduced awareness of one's surroundings

Plasma Oncotic Pressure decrease

-Fluid stays in interstitium -Causes: excessive protein loss (nephrotic syndrome), liver disease (decreased protein synthesis), malnutrition (decreased protein intake) -Sooooo......Low serum protein levels cause a decrease in plasma oncotic pressure and allow fluid to remain in interstitial tissues causing edema. when plasma protein is low due to protein loss (renal disorders), deficient protein synthesis (liver disease), or deficient intake (malnutrition)

Stages of Infection in Infectious Process

-Incubation Period -Prodromal Stage -Acute Stage -Convalescence Stage

Fluid movement

-Normally ECF & ICF are isotonic -Cell surrounded by hypotonic fluid = fluid moves into cell -Cell surrounded by hypertonic fluid = H20 leaves cell to dilute ECF

Standing orders

-Preprinted document containing medical orders. -Directs patient care in a specific clinical setting.

Causes of Extracellular Fluid Volume Deficit (FVD)

-Severely decreased intake of water and salt -Increased output (diarrhea, vomiting) -Increased renal output (diuretics) -Loss of blood or plasma (hemorrhage, burns) -Massive sweating without water and salt intake

Types of Illnesses

Acute Illness: Short duration and severe Chronic Illness: Persists longer than 6 months

Burns and fluids

Burns place patients at high risk for ECV deficit from numerous mechanisms, including plasma-to-interstitial fluid shift and increased evaporative and exudate output. Fluid loss increases with the percentage of body surface burned. Patients with burns have cellular damage that releases potassium into the blood, and they may become hyperkalemic. In addition, these patients often develop metabolic acidosis because of greatly increased cellular metabolism, which produces more metabolic acids than their kidneys are able to excrete.

Unstageable pressure ulcer

Full-thickness Skin or Tissue Loss—Depth Unknown. Full-thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar are removed to expose the base of the wound, the true depth cannot be determined.

Improve staff communication (2021 Hospital Patient Safety Goal)

Get important test results to the right staff person on time.

Care bundle

Group of interventions related to a disease process or condition.

Droplet Precautions

Methods of infection control that must be used for patients known or suspected to be infected with pathogens transmitted by large particle droplets expelled during coughing, sneezing, talking, or laughing. -travels up to 3 feet -private room -mask or respirator -flu, pneumonia

Evaluate patient outcomes related to spiritual health.

Patient outcomes: do you feel more connected to your spiritual source or family? Are you starting to feel more at peace with your diagnosis?

Construct three part nursing diagnosis statements

Problem, related to (cause) as evidenced by (characteristics)

Hypernatremia:

Na+ > 145 mEq/L 1.Loss of relatively more water than salt -Insensible losses (excessive perspiration and respiratory output without increased water intake) -Diabetes insipidus (ADH deficiency) 2.Loss of relatively more salt than water -Administration of tube feeding, hypertonic parenteral fluids or salt tablets. -Water deprivation, loss of thirst drive

Human health experience:

That totality of human experience including each person's subjective experience about health, health beliefs, values, sexual orientation, and personal preferences that encompasses health- wellness-disease-illness-death.

Destiny Phase of 4-D Cycle

The destiny phase is when the nurse helps the patient focus on the new future that is being created. The emphasis is on empowerment of the patient and sustaining the learning that has occurred.

Environment

The environment is the setting for sender-receiver interaction. An effective communication setting provides participants with physical and emotional comfort and safety. Noise, temperature extremes, distractions, and lack of privacy or space create confusion, tension, and discomfort. Environmental distractions are common in health care settings and interfere with messages sent between people. You control the environment as much as possible to create favorable conditions for effective communication.

Maslow's Hierarchy of Needs

Used to understand the interrelationships of basic human needs *must meet bottom before can meet top

Thoracic Diaphragm

a huge layer of flat muscles right below the lungs (thoracic diaphragm). when it is relaxed is arched & the lungs don't have a lot of volumes. -when contracts, creates more space for lungs to fill with air -when relaxes, expels air

Emotional factors

a patient's degree of stress, depression or fear influences their health beliefs and practices. How people handle stress throughout each phase of their reaction to illnesses.

Broad-spectrum antibiotics

affect a broad range of gram-positive or gram-negative bacteria 426

Prescriptions

are ordered to be taken out of the hospital.

Psychoneuroimmunology

branch of research that seeks to understand the relationship between the mind and body

Seizure precautions

encompass nursing interventions to protect a patient from traumatic injury, to position for adequate ventilation and drainage of oral secretions, and to provide privacy and support following a seizure

Cardiovascular Physiology

four cardiac chambers: two atria and two ventricles -right ventricle pumps deoxygenated blood through the pulmonary circulation and the left ventricle pumps oxygenated blood through the systemic circulation

ego defense mechanisms

regulate emotional destress and give us protection from anxiety and stress -ex: compensation, conversion, denial, displacement, identification, dissociation, regression

Prescriptive theories

says how people or things should function, as opposed to how they actually do address nursing interventions for a phenomenon, guide practice change, and predict the consequences. Nurses use prescriptive theories to anticipate the outcomes of nursing interventions. Prescriptive theories direct nursing actions toward an explicit goal. Wiedenbach's prescriptive theory of the helping art of nursing conveys the purpose of nursing through three components: to motivate the patient, to facilitate efforts to overcome obstacles, and to develop nursing action based on the immediate situation.

General adaptation syndrome (GAS)

three-stage reaction to stress, describes how the body responds physiologically to stressors. The GAS is triggered either directly by a physical event or indirectly by a psychological event. It involves several body systems, especially the neuroendocrine mechanism, which responds immediately to stress. When the body encounters a physical demand such as an injury, the pituitary gland initiates the GAS. A fundamental concept underlying this reaction is that the body will attempt to return to a state of balance, a process referred to as allostasis -Alarm stage (fight or flight) -Resistance stage -Exhaustion stage

Dehiscence

When an incision fails to heal properly, the layers of skin and tissue separate. This most commonly occurs before collagen formation (3 to 11 days after injury). Dehiscence is the partial or total separation of wound layers. A patient who is at risk for poor wound healing is at risk for dehiscence. partial or total separation of wound layers

Factors Influencing Infection Prevention and Control

-Age: infants and older adults have immature defenses against infection -Sex: women and men differ in their immune responses to infections because of sex steroid hormones -Nutritional Status -Stress -Disease Process: other comorbidities weaken the immune system -Travel: multiple diseases have come from food habits other places

Spiritual Health: Assessment

-Ask about their faith/belief system, religious source, life's satisfaction, connectedness with community/culture, understanding of their illness' limitations or threat to their wellbeing -use open-ended questions -Assessment expresses a level of caring and support -Taking a faith history reveals patient's beliefs about life, health, and a Supreme Being -Through the patient's eyes -Assessment tools: -Listening -Ask direct questions -FICA (Faith, Importance, Community, Address) -Spiritual well-being (SWB) scale -BE COMPASSIONATE AND REMOVE PERSONAL BIASES

Management of respiratory acidosis

-Cough, deep breathe**** -Bronchodilation -Humidity -Suction

Elements of Professional Communication

-Courtesy -Use of Names -Caring -Genuineness -Trustworthiness -Autonomy -Responsibility

Collaborative Management of Hypermagnesemia

-Decrease use of MgS04 -If severe resp. depression-ventilator -If due to renal failure-dialysis -Saline infusions with diuretics -Caution: side effect may be loss of Ca++ which makes Mag effect worse -May have to give IV calcium -Focus on prevention! -Assessment -Vital signs, resp. function, ECG changes, urine output, LOC -May need to assess every hour if necessary -Safety issues and seizure precautions -Report any changes in DTRs

Outcomes to look for FVE

1.VS within pt's. baseline range(specify) 2.Breath sounds clear on auscultation 3.Wt decrease from (specify) to baseline of (specify range) 4.Peripheral edema will dec. from 3+ to O in 3 days Evaluation: peripheral edema -3+ to 0; outcome met

Water balance

-Balance of H20 intake and excretion -Controlled by thirst and the kidneys (action of ADH) released in hypothalamus

Cultural Health Beliefs: Implications for patient-centered care

-Be aware of the effect of culture on a patient's view and understanding of illness. -Understand a patient's traditions, values, and beliefs and how they affect their perceptions to illness prevention and treatment. -DO NOT stereotype patients based on their culture -Recognize your patient's unique cultural perceptions regarding the cause of illnesses and disease prevention and treatment. -Be aware of your own cultural background and recognize prejudices that may lead to stereotyping.

Outcomes to look for FVD

1.skin warm, dry 2.Cap refill <3 sec. 3.BP > 100 (at patients baseline range) 4.UO = 30-50cc/hr Evaluation: BP 108/60 outcome met

Anger

Anger is a transient but forceful emotion arising out of a threat. It may be expressed openly, or it may be suppressed quietly and persist as chronic resentment. Resentment is the long-term persistence of the pain of anger, long after the initial situation that sparked the anger has subsided. People may suppress their anger because it makes them feel ashamed or is inconsistent with their image of themselves as good people. -anger in -anger out

Healthy People

Provides evidence-based, 10-year national objectives for promoting health and preventing disease

Extracellular Fluid Volume Deficit (FVD)

too little isotonic fluid in the extracellular compartment CLINICAL DEHYDRATION

Nursing diagnosis

A clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community (NANDA International Knowledgebase, n.d.).

Sociocultural Factors in Communication

Culture influences thinking, feeling, behaving, and communicating. Be aware of the typical patterns of interaction that characterize various ethnic groups, but do not allow this information to bias your response. Know each patient individually (e.g., does he or she feel comfortable with eye contact or in sharing information with others?). You will approach a patient very differently if he or she is open and willing to discuss private family matters versus others who are reluctant to reveal personal or family information to strangers.

Determine standards for evaluation.

Determines whether a patient's condition or well-being improved after nursing interventions were delivered. The outcomes of nursing practice are the measurable conditions of patient, family, or community status; behavior; or perception. These outcomes are the criteria for judging the success in delivering nursing care.

Medical Diagnosis

FOCUS is identification and treatment of a disease. GOAL - to confirm a medical diagnosis, then treat and manage the medical condition. Ex: Chronic Obstructive Pulmonary Disease with Pneumonia

Integrative Health and Wellness Assessment Wheel: Health Responsibility

Health responsibility occurs when an individual takes an active role in making lifestyle choices to protect and improve his or her health. Many of the actions and behaviors that enhance health and well-being are explored in the IHWA. It is suggested that each person comply with all the recommended physicals, dental exams, and age-related screenings, as well as address risk factors for individual lifestyle-related illnesses. Taking responsibility for your personal health record includes compiling all baseline personal physiologic parameters, personal history, family history, and any current symptoms

Noncritical items`

Items that come in contact with intact skin, but not mucous membranes must be clean. Noncritical items must be disinfected. These items include: • Bedpans • Blood pressure cuffs • Bedrails • Linens • Stethoscopes • Bedside trays and patient furniture • Food utensils

Hydrostatic pressure

Major force that moves H20 out of vascular system at the capillary level -In the blood vessels HP is the B/P generated by the contraction of the heart. -Decreases from the arterial to the venous end of the capillary.

Compensation:

Making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset (e.g., a person who is a poor communicator relies on organizational skills)

Respiratory Disorders and fluids

Many acute respiratory disorders predispose patients to respiratory acidosis. For example, bacterial pneumonia causes alveoli to fill with exudate that impairs gas exchange, causing the patient to retain carbon dioxide, which leads to increased PaCO 2 and respiratory acidosis.

NANDA

N - North A - American N - Nursing D - Diagnosis A - Association -Common clinical language -Universal communication -Continuity of care -Identifies a patient's response or vulnerability to health conditions of life events.

Idiosyncratic reaction of medication

Overreaction or underreaction or different reaction from normal. For example, a child who receives diphenhydramine, an antihistamine, may become extremely agitated, or excited instead of drowsy.

Post-traumatic stress disorder (PTSD):

an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience Begins when a person witnesses a traumatic event

Denial

is a defense mechanism that involves refusal to accept reality, often to avoid dealing with painful issues. This mechanism can be harmful, as in addiction where the addict denies his or her addiction.

Regression

is reverting to an earlier stage of development because of overwhelming fear or stress. An older child can regress to an earlier stage of development, or an adult can refuse to leave his or her bed and function normally.

Inhalation route

medications absorbed throught the nasal passages, oral passage, or endotracheal or tracheostomy tubes

Surgical Asepsis

techniques used to destroy all pathogenic organisms also called sterile technique -5 minutes washing hands and to elbow

Factors influencing patient safety

-Patient's developmental level -Mobility, sensory, and cognitive status -Lifestyle choices -Knowledge of common safety precautions

3 broad categories of medication names

-chemical -generic -trade

Option for the Poor and Vulnerable

A basic moral test is how our most vulnerable members are faring. In a society marred by deepening division between rich and poor, our tradition recalls the story of the Last Judgment (Mt 25:31-46) and instructs us to put the needs of the poor and vulnerable first.

A surgical wound requires a Hydrogel dressing. The primary advantage of this type of dressing is that it provides: A. an absorbent surface to collect wound drainage. B. decreased incidence of skin maceration. C. protection from the external environment. D. moisture needed for wound healing.

D. moisture needed for wound healing.

Discovery Phase of 4-D Cycle

Discovery involves the identification of opportunities for improvement that build on previous accomplishments. The focus is on appreciating the best that the current situation has to offer.

Summarize critical thinking skills used in nursing practice.

E.I.E.I.S.A: Evaluation, Inference, Explanation, Interpretation, Self-Regulation & Analysis

National Safety Organizations

Health care provided in a safe manner and in a safe community environment is essential for a patient's survival and well-being. -Nurses are responsible for incorporating critical thinking skills to promote patient safety. -Much of the force behind the focus on safety in hospitals and nursing homes comes from regulatory and accrediting agencies, such as TJC and CMS (also regulations for clinics that take Medicare/Medicaid). -ICSI and MDH Quality Health Scores -National Quality Forum -AHRQ culture of safety

Nutrition Needs

Meeting nutritional needs of patients requires knowledge about healthy food and food safety. Chapter 45 details the principles of balanced nutrition. When you care for patients returning home or if you work in home health, educate them about food safety principles. Also, patients require an adequate, clean water supply for drinking and to wash fresh produce and dishes.

Chronic Illness:

Persists longer than 6 months

Status epilepticus

Prolonged or repeated seizures indicate status epilepticus , a medical emergency that requires intensive monitoring and treatment. It is important that you observe the patient carefully before, during, and after the seizure so that you can document the episode accurately.

Illness prevention

Protects people from actual or potential threats to health.

Effects of Cold Application

The application of cold initially diminishes swelling and pain. Prolonged exposure of the skin to cold results in a reflex vasodilation. The inability of the cells to receive adequate blood flow and nutrients results in tissue ischemia. The skin initially takes on a reddened appearance, followed by a bluish-purple mottling, with numbness and a burning type of pain. Skin tissues freeze from exposure to extreme cold.

Disassociation Symptoms

This symptom involves blanking out during a stressful emotional event. This blanking out results in your being out of touch with your feelings about what happened. It also may result in your inability to remember what happened.

Tertiary intention wound healing

Wound is left open for several days, then wound edges are approximated.

blanchable hyperemia

You assess an area of hyperemia by pressing a finger over the affected area. If it blanches (turns lighter in color) and the erythema returns when you remove your finger, the hyperemia is transient and is an attempt to overcome the ischemic episode, thus called blanchable hyperemia .

Trade Medication name

also known as brand or proprietary name. This is the name under which a manufacturer markets the medication e.g. Tylenol.

Healthcare-associated infection (HAI)

an infection acquired within a healthcare setting during the delivery of medical care

Sanguineous

bright red, indicates active bleeding

Appraisel

how a person interprets the impact of a stressor

Intramuscular

injection into the muscle

Wounds can be classified by the extent of tissue loss:

partial-thickness wounds that involve only a partial loss of skin layers (the epidermis and superficial dermal layers) and full-thickness wounds that involve total loss of the skin layers (epidermis and dermis).

How do I prioritize the Nursing Diagnosis:

-ABC's - Airway, Breathing, Circulation -Basic Needs - Maslows Hierarchy of Needs -Safety

Complications of wound healing are caused by:

-Hemorrhage -Infection -Dehiscence -Evisceration

Environments of Safety

-Individual Risk Factors -Physical environment -Nurse environment

Benner Model of Novice to Expert

-Novice -Advanced Beginner -Competent -Proficient -Expert

Direct Mode of Tranmsission

-Person-to-person (fecal, oral) physical contact between source and susceptible host. -A health care provider's hands become contaminated by touching germs present on a patient, medical equipment, or high-touch surfaces, and the health care worker then carries the germs on his or her hands and spreads to a susceptible person.

Critical Thinking

-The ability to think in a systematic and logical manner. -A continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant. -Recognizing that an issue exists, analyzing information, evaluating information, and drawing conclusions. -Evidence-based knowledge in critical thinking. -Essential in the nursing process. -Involves knowing as much as possible about each patient. -Need to sort out the information into patterns to clarify problems, recognize changes, and make appropriate care decisions under pressure. -Essential process for safe, efficient, and skillful nursing intervention. -Improves patients' outcomes.

Nutritional Status and wounds

An assessment of a patient's nutritional status is an integral part of the initial assessment data for any patient, especially one at risk for impaired skin integrity. The Joint Commission recommends nutritional assessment within 24 hours of admission. Weigh the patient and perform this measure more often for at-risk patients. A loss of 5% of usual weight, weight less than 90% of ideal body weight, and a decrease of 10 lb in a brief period are all signs of actual or potential nutritional problems. Assess the patient's mouth and teeth for oral sores and ill-fitting dentures that impact nutritional intake.

Nursing Process: Planning (Teaching)

Develop a teaching plan -Involve patient in selecting learning experiences -Learning objectives guide the choice of teaching strategies and approaches with a patient. Goals and outcomes Setting priorities -Timing -Organizing teaching material Teamwork and collaboration

Gastrointestinal Output and fluids

Increased output of fluid through the GI tract is a common and important cause of fluid, electrolyte, and acid-base imbalances that requires careful assessment. Vomiting and diarrhea, either acute or chronic, can cause ECV deficit, hypernatremia, clinical dehydration, and hypokalemia by increasing the output of fluid, Na + , and K + . In addition, chronic diarrhea can cause hypocalcemia and hypomagnesemia by decreasing electrolyte absorption. Removal of gastric acid from the body

Identify the purpose of using standardized nursing diagnoses

Provided precise definition of a patient's problem that gives nurses & other members of the health care team a common language for understanding the patient's needs.

The Theory of Unitary Caring

Smith, a scholar of unitary science, caring science, theory-guided practice, and holistic practice, developed the theory of unitary caring. She describes the theory as grounded in the following concepts: manifesting intention, appreciating pattern, attuning to dynamic flow, experiencing the infinite, and inviting creative emergence. The concepts come alive in the intentional caring healing hands therapies such as massage, therapeutic touch, hand massage, and the simple yet complex touch of compassionate nurses. This theory has been advanced in palliative care, care of older adults, caring at a community-based primary care center, and as the curriculum model at least one school of nursing.

Radiation Exposures: Living in the Modern World

We live in a radioactive world—and we always have. Radiation is part of our natural environment. We are exposed to radiation from materials in the earth itself and from the sun. Living in today's world, we are all exposed to far more radiation than ever before, and we are only beginning to calculate the effects on our health.

Disinfection

a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects -Disinfection of surfaces -High-level disinfection, which is required for some items such as endoscopes

Motivational interviewing (MI)

a well-known, research-based method of interacting with patients that was developed in the 1980s to improve outcomes associated with substance abuse.9 MI is a skillful interaction for eliciting motivation for change. The fundamental premise of MI is that patients are often ambivalent to change, and ambivalence affects a patient's motivation and readiness to alter behavior.

topical administration

administration of a substance directly onto the skin or mucous membrane -placed on skin surface, on mucous membranes, or in body cavities -usually require new applications every 24hrs -eyes, ears, nose, rectum, vagina, and lungs, skin -Cleanse skin prior to applying topical meds -Gloves and applicators are used to avoid absorption through nurse's skin during placement -Document body site where applied

Symmetrical relationships

are more equal. A group of patients discussing their plans after discharge is an example of a symmetrical role relationship

Therapeutic communication techniques

are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. -Active Listening -Open Ended Questions -Providing Information -Empathy -Sharing Observations -Using Touch -Using Silence -Paraphrasing -Clarifying -Focusing -Self-disclosure -Confrontation -Summarizing

prn

as needed

Traditional models of therapeutic communication do the following:

define and prescribe various stages or phases, delineate various roles for the nurse or therapist, identify verbal and nonverbal communication skills, and identify therapist characteristics that are essential to creating a therapeutic milieu.

Disinfection

describes a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects. There are two types of disinfection: (1) the disinfection of surfaces, and (2) high-level disinfection, which is required for some patient care items such as endoscopes and bronchoscopes.

Sodium imbalances

hyponatremia/hypernatremia EXCESS SODIUM OR EXCESS WATER LOSS 1.Caused by change in intake or excretion of sodium 2.Caused by change in intake or excretion of water 3.Caused by shift in Na+ or H20

Projection

is a defense mechanism used when one does not want to take responsibility for one's own thoughts and feelings. With this mechanism, one ascribes one's feelings or thoughts to another person and does not take ownership of those thoughts or feelings. An example is when a person strongly dislikes another person but uses projection to assume that person does not like him instead.

Discuss the safe use of abbreviations for prevention of medication errors.

o DONT o using abbreviations or unnecessary zeros in an order contribute to ERRORS o do not accept orders with the abbreviation "u", "U", or "IU" for units o clarify abbreviated drug names or dosing frequencies

Discuss the difference between a goal and an outcome.

o Goal: Broad statement that describes client change, client specific, the opposite of the diagnostic stem o Outcome: Desired result of nursing care. Usually has a time frame. SMART.

Summarize the Seven Rights of Medication Administration.

o Right medication: the medication that is given is the right medication o Right dose: the patient is given the dose that was ordered and the dose is appropriate for the patient o Right patient: Giving the medication to the the patient for whom it was intended. To avoid errors use two identifiers, ask the patient to state their name and check the name band with the medication administration record (MAR) o Right route: The medication is given only the route that was ordered and that the route is safe and appropriate for the patient. o Right time: This means that the drug was given at the correct time as ordered or according to agency policy. Most institutions consider a medication to be given on time if given 30 minutes before or after the prescribed time. o Right documentation: Nurses need to document the delivery of the medication soon after it is given so medications are not given again. Be sure and follow agency policy on documentation. (include required assessments) o Right indication: important to make sure the right medication was ordered.

Descriptive theories

seek to understand rationality by describing and capturing in statistical terms the decisions that people make are the first level of theory development. They describe phenomena and identify circumstances in which the phenomena occur. For example, theories of growth and development describe the maturation processes of an individual at various ages. Descriptive theories do not direct specific nursing activities or attempt to produce change but rather help to explain patient assessments.

Biological half life

the time it takes for excretion process to lower the serum of the medication concentration by half.

Examples of patients who are at risk for the development of pressure injuries include the following:

• Older adults, those who have experienced trauma • Those with spinal-cord injuries (SCI) • Those who have sustained a fractured hip • Those in long-term homes or community care, the acutely ill, or those in a hospice setting • Individuals with diabetes • Patients in critical care settings

Metabolic acidosis

(nonrespiratory cause) -Excess of fixed acids -pH decreases (< 7.35), HCO3 (< 21mEq/L) A cardinal sign! -Compensation: buffer, lungs á resp.& depth to blow off CO2, kidneys excrete H+ and retain HC03 -Noncarbonic acids increase (renal insufficiency) or bicarb decreases -Lungs compensate by getting rid of CO2

Be SMART in setting outcomes.

-Specific -Measurable -Attainable -Realistic -Timed/Timely

Hypercalcemia

> 10.5 mg/dL -Metastatic malignancy, bone tumors -Hyperparathyroidism -Prolonged immobilization -Excessive Ca++ intake -Oliguric phase of renal failure

NANDA International, Inc. (NANDA-I), the Nursing Interventions Classification, and the Nursing Outcomes Classification:

Comprehensive, research-based, standardized classifications to describe nursing judgments, treatments, and nursing-sensitive patient outcomes (NANDA International Knowledgebase, n.d.).

Spiritual Health: Implementation

Health promotion: Establishing presence—involves giving attention, answering questions, having an encouraging attitude, and expressing a sense of trust; "being with" rather than "doing for" -Supportive healing relationship: Mobilize hope, Provide interpretation of suffering that is acceptable to patient, Help patient use resources.

Importance of water

Individuals cannot live without body fluid When an individual loses fluids, by vomiting for example, some of the normal fluid content of the body is lost. If the vomiting continues and the person does not drink fluids, the loss may become serious. The individual will experience dry mucous membranes, an increase in body temperature, and may become lethargic. If the fluid loss goes untreated over time the body's compensatory mechanisms will no longer maintain an adequate fluid balance, and the individual's health may become compromised. Depending on the severity, fluid loss can lead to irreversible heath problems or death. A loss of 20% of the body's fluid content is fatal.

Hypokalemia :

K+<3.5mEq/L -Most common cause = losses through kidneys (example potassium wasting duretics) or GI tract, prolonged NPO without replacement -Transcellular shifts

Religion

Religion is associated with the "state of doing," or a specific system of practices associated with a particular denomination, sect, or form of worship. It is a system of organized beliefs and worship that a person practices to outwardly express spirituality. Many people practice a faith or belief in the doctrines and expressions of a specific religion or sect, such as the Lutheran church or Judaism. People from different religions view spirituality differently.

Oxygen needs

Supplemental oxygen is sometimes needed to meet a person's oxygenation needs. Patients who require supplemental oxygen in health care settings are at risk because oxygen is highly flammable. Fire can occur when a patient on oxygen therapy chooses to smoke or is exposed to a heat source. Be sure to administer oxygen safely and provide patients and family caregivers the information needed to manage oxygen correctly in the home.

Tissue Tolerance

The ability of tissue to endure pressure depends on the integrity of the tissue and the supporting structures. The extrinsic factors of shear, friction, and moisture affect the ability of the skin to tolerate pressure: the greater the degree to which the factors of shear, friction, and moisture are present, the more susceptible the skin will be to damage from pressure. The second factor related to tissue tolerance is the ability of the underlying skin structures (blood vessels, collagen) to help redistribute pressure. Systemic factors such as poor nutrition, aging, hydration status, and low blood pressure affect the tolerance of the tissue to externally applied pressure.

Osmotic Movement of Fluids.

The osmolality or tonicity of the fluid surrounding the cells affects them. Fluids with the same osmolality as the cell interior are termed isotonic. Normally, ECF and ICF are isotonic to one another, so no net movement of water occurs. Changes in the osmolality of ECF alter the volume of cells. Solutions in which the solutes are less concentrated than in the cells are termed hypotonic (hypoosmolar). If a cell is surrounded by hypotonic fluid, water moves into the cell, causing it to swell and possibly to burst. Fluids with solutes more concentrated than in cells, or an increased osmolality, are termed hypertonic (hyperosmolar). If hypertonic fluid surrounds a cell, water leaves the cell to dilute ECF; the cell shrinks and may eventually die (Fig. 17-7).

Evisceration

With total separation of wound layers, evisceration or protrusion of visceral organs through a wound opening occurs. The condition is an emergency. Immediately place damp sterile gauze over site, contact the surgical team, do not allow the patient anything by mouth (NPO), observe for signs and symptoms of shock, and prepare the patient for emergency surgery. The displacement of organs outside of the body.

Assessment Phase

The term assessment implies appraising, evaluating, and judging. An essential characteristic of holistic communication is the mutuality inherent in the experience—this means that both the nurse and the patient/client partner participate equally in the process. Utilizing language that supports the concept of partnership reinforces a commitment to mutuality.

ACCESS model

helps you focus on cultural factors that influence patient educational outcomes. Assessment Communication Cultural Establishment Sensitivity Safety

Cognitive Domain of Learning

occurs when an individual gains information to further develop their intellectual abilities, mental capacities, understanding and thinking process. --Cognitive learning is accomplished through: discussions, lectures, question and answer sessions, role play, discovery and independent projects.

Critical thinking model for safety: evaluation

-evaluate if patient's expectations of care are met -reassess the patient for the presence of physical, social, environmental or developmental risks -determine if changes in the patient's care resulted in increased threats to safety

Interpersonal Relations Theory

-focuses on the importance of the nurse-patient relationship -nurses can provide better care to their patients if they build a strong relationship based on mutual respect -evolves around three phases: orientation, working and termination

Explain stress-management techniques that help individuals cope with stress.

1. Exercise 2. Relax Your Muscles 3. Deep Breathing 4. Eat Well 5. Slow Down 6. Take a Break 7. Make Time for Hobbies 8. Talk About Your Problems 9. Go Easy On Yourself 10. Eliminate Your Triggers

Potassium (K+)

3.5-5.0 mEq/L •Primary cation in intracellular fluid. •Serum levels can spike if there is major cell damage (Where does K+ 'live'?). •Critical electrolyte in the transmission of nerve impulses (***Cardiac***). •80% excreted by the kidneys. •Adult: 3.5-5.0 mEq/L (Serum!!) **Too high or too low results in cardiac arrhythmias. -Normally 98% in ICF -Critically important

Industry vs. Inferiority

6-12 years -Wants to learn about spirituality -Has a clear picture of God or supreme being, morality, and the difference between right and wrong -Sorts fantasy from fact -Demands proof of reality and believes literal meanings of spiritual stories

SBAR Example

A nurse caring for patients on an orthopedic surgery unit administered 1 tablet of oxycodone HCL 5 mg/ ibuprofen 400 mg PO to a patient 30 minutes ago for postsurgical pain. The nurse returns to the patients room to evaluate the effectiveness of the medication. The patient rates his pain as 8 on a scale of 0-10 The nurse uses SBAR to contact the patients health care provider. S= The patient is rating his pain as an 8 on a scale of 0-10. He had his pain medication 30 minutes ago. B= The patient had a knee replacement and returned from the post anesthesia care unit 8 hours ago. He has 1 tablet of oxycodone HCL 5 mg/ibuprofen 400 mg PO ordered every 6 hours. This is the first pain medication he has taken since being admitted to the unit. A= His current medication order is not sufficiently managing the patient' s pain. He does not want to sit-up or move because of the pain he is experiencing. R= I am requesting a change of the pain medication order for the patient.

Self-adhesive, transparent film

Another type of dressing is a self-adhesive, transparent film that traps moisture over a wound, providing a moist environment to encourage epithelial cell growth. A transparent dressing adheres to undamaged skin, does not need a secondary dressing, and permits viewing of the wound. It is ideal for small superficial wounds such as a stage 1 pressure injury or a partial-thickness wound. Use a film dressing as a secondary dressing and for autolytic debridement of small wounds. It serves as a barrier to external fluids and bacteria but still allows the wound surface to "breathe" because oxygen passes through the transparent dressing. This dressing promotes a moist environment to encourage epithelial cell growth. It adheres to undamaged skin, does not need a secondary dressing, and permits viewing of the wound.

Nursing Process: Evaluation (Teaching)

Ask yourself this important question? -Have the patient's learning needs been met? -If not, revise the plan of care and offer additional instruction or reinforcement Patient outcomes -Evaluation - use teach to evaluate -Documentation

Spiritual Care-Giving Scale

Attributes for spiritual care Spiritual perspectives Defining spiritual care Spiritual care attitudes Spiritual care values

Risk for medical errors

Be alert to factors within your own work environment that create conditions in which medical errors are more likely to occur. Distractions during medication preparation or nursing procedures in the form of phone calls, alarms, or staff needing assistance are common. Studies show that overwork and fatigue, particularly when working consecutive 12 hour-shifts, cause a significant decrease in alertness and concentration, leading to errors. It is important for you to be aware of risk factors in the workplace and to include checks and balances when working under stress. For example, to reduce the chance for a medical error, it is essential that a patient's identification be checked by using two identifiers (e.g., name and birthday or name and medical record number) according to agency policy before beginning any procedure or administering a medication

Trust vs. Mistrust

Birth to 18 months -Spiritual well-being provided by parents -Trust provides basis for hope -Love, affection, security, and a stimulating environment promote spirituality

Holistic Communication: Be Clear

C= Center yourself L = Listen Wholeheartedly E: Empathize A: Attention- Be Fully Present R= Respect

Trauma and fluids

Hemorrhage from any type of trauma causes ECV deficit from blood loss. Some types of trauma create additional risks. For example, crush injuries destroy cellular structure, causing hyperkalemia by massive release of intracellular K + into the blood. Head injury typically alters ADH secretion. It may cause diabetes insipidus (deficit of ADH), in which patients excrete large volumes of very dilute urine and develop hypernatremia. In contrast, head injury may cause the syndrome of inappropriate antidiuretic hormone (SIADH), in which excess secretion of ADH causes hyponatremia by retaining too much water and concentrating the urine.

Stressors

any physical, psychological or social stimuli that are capable of producing stress and endangering homeostasis

Intraperitoneal

injection into the peritoneal cavity

Intimacy vs. Isolation and Loneliness

Young adulthood -Establishes self-identity and world view -Forms independent beliefs, attitudes, and lifestyles -Uses principles to solve problems when individual's and society's rules conflict

STAT orders

a single dose to be given immediately e.g. Apresoline 10mg IV STAT

Aura

Before a convulsive episode a few patients report an aura, which serves as a warning or sense that a seizure is about to occur. An aura is often a bright light or a smell or taste.

Engaging Your Observer

Engaging your observer is a process that is useful when confronting a situation or communication that is particularly difficult and emotionally charged. It also helps the nurse be present to a person or situation with clarity and without bias. This practice has its roots in Buddhist psychology. -involves centering, being aware of internal reactions, gratefully acknowledging these reactions, and responding from the higher Self.\

FVD Interventions

Interventions 1.Monitor VS q4h 2.Daily wt: 3.Assist with ambulation 4.Accurate I&O 5.Administer blood, fluids as ordered.

Portal of Entry

Organisms enter the body through the same routes they use for exiting. For example, during venipuncture when a needle pierces a patient's skin, organisms enter the body if proper skin preparation is not performed first. Factors such as a depressed immune system that reduce body defenses enhance the chances of pathogens entering the body.

Mode of Transmission

a way that the causative agent can be transmitted to another reservoir or host where it can live ex: spray from cough (covid)

Nursing Assessment Questions: Connectedness

• What feelings do you have after you pray or meditate? • Who do you feel is the most important person in your life?

Identify patients correctly (2021 Hospital Patient Safety Goal)

Use at least two ways to identify patients. For example, use the patient's name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment.

Implementation: Health Promotion Pulmonary Health

Vaccinations -Influenza, pneumococcal Healthy lifestyle -Eliminating risk factors, eating right, regular exercise (150 mins/wk moderate activity & 2 days of muscle-strengthening) Environmental pollutants -Secondhand smoke, work chemicals, and pollutants

PC, pc

after meals

Describe characteristics of post-traumatic stress disorder.

Defense Mechanisms

are thought processes that allow people to distance themselves from unpleasant feelings, behaviors, and thoughts. Nurses frequently encounter common defense mechanisms. -denial -regression -acting out -projection -displacement -rationalization -repression

Pulmonary Circulation

deoxygenated blood leaves the right ventricle, goes through a valve, and through the pulmonary trunk into the L & R pulmonary arteries towards the lungs. oxygenated blood then leaves the lungs through the few L & R pulmonary veins and into the left atrium

Incentive spirometry

encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume. It is a commonly used intervention that promotes deep breathing and is thought to prevent or treat atelectasis in the postoperative patient. Recent evidence suggests that the use of the incentive spirometer is not as effective at preventing postoperative pulmonary complications as it once was thought to be. The AARC recommends that its use be reserved for patients with existing atelectasis or those with risk factors for developing atelectasis, such as those who have undergone thoracic or abdominal surgery, patients with prolonged bed rest, or patients with neuromuscular disease or spinal cord injuries (

Respiration

exchange of oxygen and carbon dioxide during cellular metabolism

Healthy People 2020

identifies leading health indicators (LHIs), which are high-priority health issues.

Nursing

includes "care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people" . The scope of nursing is broad. For example, a nurse does not medically diagnose a patient's health condition as heart failure. However, he or she assesses a patient's response to the decrease in activity tolerance as a result of the disease and develops nursing diagnoses of fatigue, activity intolerance, and difficulty coping . From these nursing diagnoses the nurse creates a patient-centered plan of care for each of the patient's health problems . Use critical thinking skills to integrate knowledge, experience, attitudes, and standards into the individualized plan of care for each of your patients.

Systemic Inflammation

increase in white cells, fever, or nausea and vomiting ex: radiation exposure

Intravenous

injection into a vein

Public communication

interaction with an audience. Conferences, classroom discussion, speaking with groups of consumers about health-related topics. is interaction with an audience. Nurses often speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. Public communication requires special adaptations in eye contact, gestures, voice inflection, and the use of media materials to communicate messages effectively. Effective public communication increases audience knowledge about health-related topics, health issues, and other issues important to the nursing profession.

Chest physiotherapy (CPT)

is external chest wall manipulation using percussion, vibration, or high-frequency chest wall compression (HFCWC). It is often used in conjunction with postural drainage and can help mobilize pulmonary secretions in a select group of patients. Box 41.7 describes the guidelines to determine whether CPT is indicated. The American Association for Respiratory Care (AARC) does not support the routine use of CPT with all patients. There is no evidence to support its routine use in all patient populations, instead reserving its use for patients with retained secretions who cannot expectorate those secretions, such as patients with cystic fibrosis (CF)

Pacing Conversation

is more successful at an appropriate speed or pace. Speak moderately slowly and enunciate clearly. Talking rapidly, using awkward pauses, or speaking excessively slowly and deliberately conveys an unintended message. Long pauses and rapid shifts to another subject give the impression that you are hiding the truth. Think before speaking and develop an awareness of the rhythm of your speech to improve pacing.

Regulation of ventilation

is necessary to ensure sufficient oxygen intake and carbon dioxide elimination to meet the demands of the body (e.g., during exercise, infection, or pregnancy). Neural and chemical regulators control the process of ventilation. Neural regulation includes the CNS control of respiratory rate, depth, and rhythm. The cerebral cortex regulates the voluntary control of respiration by delivering impulses to the respiratory motor neurons by way of the spinal cord. Chemical regulation maintains the appropriate rate and depth of respirations based on changes in the carbon dioxide (CO 2 ), oxygen (O 2 ), and hydrogen ion (H + ) concentration (pH) in the blood. Changes in levels of O 2 , CO 2 , and H + (pH) stimulate the chemoreceptors located in the medulla, aortic body, and carotid body, which in turn stimulate neural regulators to adjust the rate and depth of ventilation to maintain normal arterial blood gas levels

TID, tid

three times a day

Intimate Distance (0-18 inches)

• Holding a crying infant • Performing physical assessment • Bathing, grooming, dressing, feeding, and toileting a patient • Changing a patient's surgical dressing

Nursing Assessment Questions: Vocation

• How has your illness affected the way you live your life spiritually at home or where you work? • In what way has your illness affected your ability to express what is important in life to you?

Public Distance (12 feet and more)

• Speaking at a community forum • Lecturing to a class of students

Wound classification

•A wound is a disruption of the integrity and function of tissues in the body. Understanding the etiology of a wound is important because the treatment for it varies, depending on the underlying disease process. •There are many ways to classify wounds. Wound classification systems describe the status of skin integrity, cause of the wound, severity or extent of tissue injury or damage, cleanliness of the wound, and descriptive qualities of the wound tissue such as color. •Wound classification enables a nurse to understand the risks associated with a wound and implications for healing •Wounds can be classified by the extent of tissue loss: partial-thickness wounds that involve only a partial loss of skin layers (the epidermis and superficial dermal layers) and full-thickness wounds that involve total loss of the skin layers (epidermis and dermis). •Partial-thickness wounds are shallow in depth, moist, and painful, and the wound base generally appears red. •A full-thickness wound extends into the subcutaneous layer and the depth and tissue type will vary depending on body location.

After Medication Administration

•Clinical observation to evaluate effectiveness of medications •Subjective and objective data show evaluation of medication responses •Assess for adverse effects •Laboratory tests indicate the patient response to some medications •Significant patient deviations from normal response must be reported to the health care provider

Medications exit the body through the: (excretion)

•Kidney - main organ for excretion •Liver •Bowel •Lungs •Exocrine glands •Mammary glands •GI tract -The chemical makeup of medication determines the organ of excretion.

Dermis

•The dermis provides tensile strength, mechanical support, and protection to underlying muscles, bones, and organs. The dermis is made of collagen, blood vessels, and nerves. •Inner layer of skin •Collagen

Three pressure-related factors contribute to pressure ulcer development:

(1) pressure intensity, (2) pressure duration, and (3) tissue tolerance.

Patient-centered interview

(conducted during a nursing history)

Periodic assessments

(conducted during ongoing contact with patients)

Sodium (Na+)

-Accounts for 90% of extracellular fluid cations -Necessary for proper fluid balance -Imbalances in sodium impact ECF/ICF fluid balance. -Critical electrolyte for nerve conduction -Kidneys are primary regulator of sodium balance -Adults: 136-145 mEq/L

Aggressive

-Acts superior -Belittles others -Reactive -Dominates & controls

Standard Nursing Interventions

-Allow nurses to act more quickly and appropriately -Help capture patient care information that can be shared across disciplines and care settings

Nursing Process: Assessment (Teaching)

-Always provide patient-centered teaching. -Assess the patient's learning needs. -Motivation to learn -Readiness and ability to learn -Teaching environment -Resources for learning -Health literacy

Follow these guidelines to ensure safe medication administration:

-Be vigilant during med admin & avoid distractions -Ensure patients receive the appropriate meds -Know why your patient is receiving each medication; what you need to do before, during, and after med admin; and evaluate the effectiveness of meds and any adverse effects. -Verify that medications have not expired -Use 2+ identifiers before administering medications, and check against the MAR -Before administering med, ensure all info is correct -Clarify unclear medication orders and ask for help whenever you are uncertain about an order or calculation. -Use strict aseptic technique during parenteral medication prep and admin -Educate patients about each medication they take while administering meds. -Most of the time cant delegate med admin -Follow safety guidelines to prevent needlestick injuries.

Safety Guidelines For Nursing Skills (med admin)

-Be vigilant during medication administration. -Verify that medications have not expired by checking labels. -Use at least two identifiers before administering meds, and check against the MAR -Before administering medication, check for accuracy three times. -Clarify unclear medication orders and ask for help if needed. -Use the technology available in your agency when preparing and giving medications. -Use strict aseptic technique during parenteral medication preparation and admin -Educate patients about each medication. -Most of the time you cant delegate med admin -Follow safety guidelines to prevent needlestick injuries.

Use medicines safely (2021 Hospital Patient Safety Goal)

-Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. -Take extra care with patients who take medicines to thin their blood. -Record and pass along correct information about a patient's medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.

Supplemental Potassium

-Check renal function. 1st -check output!!! Know GFR (glomerular filtration rate). Orders may be written based on GFR. -PO K+ -Don't dissolve effervescent tabs in mouth -Give with meals -Teach client to report weakness, pulse changes, black tarry stools

Distribution of meds is influenced by:

-Circulation -Membrane permeability - ability of the medication to pass through tissues and membranes to enter a target cell. -Protein binding - the degree to which the medication binds to the serum protein.

Isolation and Isolation Precautions

-Contact Precautions -Droplet Precautions -Airborne Precautions -Protective environment

Core Values of Holistic Nursing

-Core Value #1: Holistic Philosophy, Theory and Ethics -Core Value #2: Holistic Nurse Self-Reflection, Self-Development and Self-Care -Core Value #3: Holistic Caring Process -Core Value #4: Holistic Communication, Therapeutic Relationship, Healing Environment, and Cultural Care -Core Value #5: Holistic Education and Research

Nurses must be alert for increased fluid requirements when a child has which of the following? A.Fever B.Mechanical ventilation C.Heart Failure D.Increased intracranial pressure

-Correct answer is A=fever. Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. -B=Incorrect. Mechanical ventilation. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child, but not as significant as the fluid losses that occur with fever. -C=Incorrect. Heart failure is a case of fluid overload in children. -D=Incorrect. Increased intracranial (ICP) does not lead to increased fluid requirements.

Vaginal or Rectal Administration

-Creams, foams, tablets, liquids, suppositories, and gels can be administered vaginally. -Proper placement often requires special applicator •Clean gloves used to admin rectal suppositories -Vaginal and rectal suppositories often refrigerated because they melt at body temp -Offer an absorbent pad and a comfortable undergarment to collect any medication drainage -Rectal meds are placed above the internal anal sphincter and against mucous membrane -Liquid meds are instilled in rectum using an enema solution -For laxatives, document how long patient was able to retain medication

Vaginal or Rectal administration

The assessment process

-Data collection: Use information about a patient's needs to adapt your data collection. -Interpretation: Critically interpret assessment data to determine whether abnormal findings are present. (Cues and inferences) -Validation: Comparison of data with another source to determine data accuracy

Nursing Process: Diagnosis (Teaching)

-Decisional Conflict -Lack of Knowledge (Affective, Cognitive, Psychomotor) -Impaired Health Maintenance -Impaired Ability to Manage Dietary/Exercise Regime -Self-Care Deficit

Causes of Respiratory acidosis

-Decrease lung surface area -Emphysema -Severe Pneumonia -Atelectasis -Status asthmaticus -CNS depression -barbiturate or sedative overdose -Pulmonary edema -Obstruction -Sleep Apnea, Obesity -Diseases that impair respiratory muscles such as muscular dystrophy, Guillain-Barre syndrome.

Assessment findings: Hyponatremia

-Decreased level of consciousness (Confusion, lethargy, coma) -Seizures if develops rapidly or is very severe -Laboratory findings: Na+< 136 mEq/L, Serum osmolality < 285 mOsm/kg (285 mmol/kg) **All about fluid and neuro!!

Physiological Factors Affecting Oxygenation

-Decreased oxygen-carrying capacity: when the body doesn't have enough RBCs to carry oxygen -Hypovolemia: occurs when shock or dehydration causes extracellular fluid loss and reduced circulating blood volume; resulting in hypoxia to body tissues -Decreased inspired oxygen concentration: oxygen-carrying capacity of the blood decreases -Increased metabolic rate: level of oxygenation declines when body systems are unable to meet this demand; normal in pregnancy, wound healing and exercise

Factors to consider in selection of interventions

-Desired patient outcomes -Characteristics of the nursing diagnosis -Research base knowledge for the intervention -Feasibility for doing the intervention -Acceptability to the patient -Your own competency

Outcomes

-Desired result of nursing care -Usually has a time frame -NOC (Nursing Outcome Classification)- a valuable resource in selecting goals and outcomes linked to NANDA nursing diagnosis

Nurse's Role in Medicaiton Administration

-Determines medications ordered are correct -Assesses patient's ability to self-administer -Determines medication timing -Administers medications correctly -Closely monitors effects -Provides patient teaching -Doesnt delegate medication administration to AP

Internal Variables Influencing Health and Health Beliefs and Practices

-Developmental stage -Intellectual background -Perception of functioning -Emotional factors -Spiritual factors

Your Role in Safety and Quality

-Educate your patients! -Embrace the electronic health record. -Practice Safety for you and your patients, at all times and be observant for potential hazards and report. -Know where your organization maintains Material Safety Data Sheets. Cheerfully complete the mandatory compliance safety program at work

Medication classification indicates the:

-Effect of medication on body system -Symptoms the medication relieves -Medication's desired effect Usually each class contains more than one medication that is used for the same type of health problem. For example, patient's who have asthma may take a variety of medications including the beta2-adrenergic agonists to control their illnesses. The beta2-adrenergic agonists contain more than 15 different medications.

Vector

-External mechanical transfer (flies) -Internal transmission such as parasitic conditions between vector and host such as: • Mosquito • Louse • Flea

Safety Risks in the Health Care Environment

-Falls -Patient-inherent accidents -Procedure-related accidents -Equipment-related accidents -Other medical errors

Nontherapeutic Communication Techniques

-False reassurance -Minimizing or discounting feelings. Expressing approval or disapproval, sparing -Defensive responses -Passive or aggressive responses -Sympathy -Giving advice or personal opinions -Automatic responses -Changing the subject or deflecting -Asking "why" questions/asking for explanations -Arguing

Evaluation

-Fifth step in nursing process -Determines whether a patient's condition or well-being improved after nursing interventions were delivered -The outcomes of nursing practice are the measurable conditions of patient, family, or community status; behavior; or perception. -These outcomes are the criteria for judging the success in delivering nursing care.

History of Nursing Process

-First introduced in 1955 as a 3 step process. -In 1982 NCLEX state board exams started to include NP in test questions. -From this day on NP will become a part of you........... -Each clinical in every course you will complete a clinical paper that uses Nursing Process.

Environmental Theory

-Florence Nightingale -the nurse's role is to manipulate tha patients environment to maximize healing, care for nutritional needs and provide comfort -the nurse promotes healing by "the proper use of fresh air, light, warmth and cleanliness"

Fluid Balance by Age

-Fluid balance in an infant is extremely important because percentage of total body weight is highest in an infant - 70-80%. -By age 2 the percentage of body weight that is fluid is approximately the same as that of a young to middle-aged adult - 50-60%. -Because the elderly have a much lower percentage of body weight that is fluid - 45-55%, they are also highly likely to develop fluid imbalance. -Men: % of H20 > than women -Older adults/very young = less fluid reserve

Why are fluid and electrolytes important?

-Fluid, electrolyte, and acid-base balances within the body maintain the health and function of all body systems. -Fluid is inside the cells and surrounds all the cells. Cellular fluids contain electrolytes such as sodium and potassium and also have a degree of acidity. -Characteristics of body fluids include the fluid amount (volume), concentration (osmolality), composition (electrolyte concentration), and degree of acidity (pH).

Nursing Process: Planning

-Goals & Outcomes -Setting priorities -Teamwork and collaboration -Set common goals of care applicable to patients with infection -Setting priorities: Establish priorities for each diagnosis and for related goals of care. -Teamwork and collaboration: Remember to plan care and include other disciplines as necessary.

Reduce Reservoirs of Infection

-Handwashing, handwashing, handwashing! -Cough -Standard precautions -Proper handling and disposal of body fluids and equipment

Nursing Process: Implementation Skin

-Health promotion -Prevention of pressure ulcers -Topical skin care and incontinence management -Positioning -Support surfaces -Acute Care -Management of pressure ulcers -Wound management -Debridement -Education -Nutritional status -Protein status -Hemoglobin -First aid for wounds -Hemostasis -Cleaning -Protection -Dressings -Suture/staple care -Drainage evacuation -Bandages and dressings

Implementation: med admin

-Health promotion: patient and family caregiver teaching -Acute care: receiving, transcribing, and communicating medication orders; accurate dose calculation and measurement -Avoidance of distractions: correct admin; document med admin -Special considerations: infants and children; older adults; Polypharmacy

Respiratory Alkalosis

-Hyperventilation gets rid of more CO2 -Excessive C02 elimination -Reduces carbonic acid -Raises pH -Compensation: buffer, kidneys excrete more HCO3, retain H+ -kidneys excrete more HCO3, retain H+

Caution with administering hypotonic solutions.....

-Hypotonic solutions are contraindicated in patients who have intracranial pressure as this type of solution will increase the fluid shift into the brain cells and increase cerebral edema. -Also contraindicated in patients that have abnormal fluid shifts such as occurs in patients with burns.

Types of HAI's

-Iatrogenic—from a procedure -Exogenous—from microorganisms outside the individual -Endogenous—when patient's flora becomes altered and an overgrowth results

Steps of the teaching process

-Identify a need for information -Establish learning objectives -The nurse (the sender) conveys information -The patient (the receiver) learns the information -Provide feedback -Evaluate the success of the teaching plan

2021 Hospital Patient Safety Goals

-Identify patients correctly -Improve staff communication -Use medicines safely -Use alarms safely -Prevent infection -Identify patient safety risks -Prevent mistakes in surgery

Health promotion (Wellness) Nursing Diagnostic Statements

-Identify the desire or motivation to improve health status through a positive behavioral change. -Readiness for Enhanced knowledge or -Readiness for Enhanced Health Management

Choose appropriate clinical assessments indicative of fluid and electrolyte imbalances.

-Identifying patients at high risk for fluid, electrolyte, and acid-base imbalances-Determining specific imbalances by identifying the nature of the imbalances to include their severity, etiology, and defining characteristics or assessment findings-Determining the care plan, including the appropriate nursing diagnoses or collaborative problems, followed by the identification of specific outcomes and associated interventions -Evaluating the effectiveness of the care plan TABLE 40-3 are the actual assessments to be done.i.e. (skin turgor, tongue turgor, moisture and oral cavity, tearing and salivation, the appearance of skin and skin temp., facial appearance, edema, body temp., pulse, respirations, blood pressure)

Buffer systems work together

-If a metabolic disturbance causes a pH shift, the lungs compensate by adjusting depth and rate of breathing. -If a respiratory disturbance causes a pH shift, the kidneys compensate by adjusting acid and bicarbonate levels. -If one system fails, others try to compensate

Nursing Diagnosis: Pulmonary Health

-Impaired Cardiac Output -Acute Pain -Activity Intolerance -Risk for Activity Intolerance -Impaired Airway Clearance

Risk factors for pressure ulcer development

-Impaired sensory perception -Impaired mobility -Alteration in LOC -Shear -Friction -Moisture

Communication and the Nursing Process: Planning

-In collaboration with the patient, determine goals and outcomes, set priorities. -Teamwork and Collaboration - Working with other team members to ensure an optimum plan of care.

Attitudes that promote clinical thinking

-Independence -Open-mindedness -Intellectual humility -Challenging the status quo -Questioning -Seeking and Looking for answers -Confidence -Curiosity -Integrity -Perseverance

Document Outcomes

-It is crucial to share information about a patient's progress and current status. -Accurate information needs to be present in a patient's medical record -Nurses and other health care team members know whether a patient is progressing -When documenting a patient's response to your interventions, describe the interventions, the evaluative measures used, the outcomes achieved, and the continued plan of care.

Dressing Changes

-Know type of dressing, and supplies needed. -Prepare the patient for a dressing change. -Review previous wound assessment notes. -Evaluate pain and, if indicated, administer analgesics so peak effects occur during dressing change. -Describe procedure steps to lessen patient anxiety. -Gather all supplies. -Recognize normal signs of healing. -Answer questions about the procedure or wound. -Comfort measures -Administer analgesic medications 30 to 60 minutes before dressing changes -Carefully remove tape -Gently clean wound edges -Carefully manipulate dressings and drains to minimize stress on sensitive tissues -Turn and position patient carefully

Developing Helping Relationships

-Listen actively -Put yourself in the patient's shoes. -Be honest. -Be aware of cultural differences. -Be credible. -Maintain confidentiality -Know role and limitations.

Describe nursing care interventions used to promote oxygenation in the primary care, acute care, and restorative and continuing care settings.

-Long term care settings:positioning, coughing, health education for disease prevention, o2 therapy. -Primary care: vaccinations, flu shot, prevent infections -Restorative and long term: lung expansion exercises -ambulation, positioning, incentive spirometry, noninvasive ventilation -Acute care: dyspnea management • airway maintenance • mobilization of pulmonary secretions• hydration • humidification • nebulization • coughing and deep breathing • chest physiotherapy • artificial airway • suctioning techniques • maintenance and promotion of lung expansion

Osmolality

-Measures concentration of particles in solution. -Another way to think about osmolality is as the specific gravity of body fluids. -Osmotic pressure=drawing power of water -High conc. of solutes>rate to pull water -Measured by milliosmoles -Osmolality=normal osmotic pressure-state of water balance-pulling power of solution for H2O -Serum or plasma osmolality=275-295 mOs/kg -As plasma osmolality increases, thirst occurs. Sensed in hypothalamus, more ADH is released, more H20 is reabsorbed from the kidneys-more water retained -Opposite occurs with H20 excess

Metabolic Alkalosis signs and symptoms

-Most symptoms relate to calcium ionization(hypocalcemia): tingling fingers/toes, dizziness, hypertonic muscles. -CNS stimulation- irritability, nervousness. -Respiratory rate decreases as a compensatory mechanisms. -Arrhythmia's due to hypokalemia.

Assessment findings/Signs and symptoms of Hypocalemia

-Muscle cramps in extremities -Trousseau's sign; Chvostek's sign -Dysrhythmias -Fractures -Bleeding tendencies -Tetany-sustained muscle contractions /seizures -**Low calcium allows sodium to pass into cells, which increases depolarization. - ***Results in 'excitable' cells

When Body Functioning is Intact........

-Must have functioning respiratory & renal system -Carbonate system -resp -co2 + h2o -goal is to maintain 20:1 ratio (base: carbonic acid)

Inhaled or nebulized

-Nasal medications are administered by drop or nebulizer formulations into the nose -Inhalation medications are taken into the body through the respiratory tract (through nasal passages, oral passages, endotracheal tubes, or tracheostomy tubes) -Nebulizers are used to aerosolize medication into a fine-droplet or gas form that is then inhaled for delivery to the lungs -Use medical asepsis when administering nasal preparations (nose connected to sinus) -Decongestant sprays relieve symptoms of sinus congestion -When these meds used in excess, may have systemic effects such as increased heart rate and a rebound effect that increases congestion -Document if instilled into one or both nares and patient's response -Spacers are used to trap the med and allow inhalation over several breaths -Common uses for inhaled meds are to induce anesthesia during surgery & treat resp disorders -Assessment should be done before and after inhaled meds -Important patient education includes determining when inhaler is empty and needs replacement

Role of the Nurse in Teaching and Learning

-Nurses are legally responsible for providing education to all patients -The Joint Commission's Speak Up program: Helps patients understand their rights when receiving medical care -Carefully determine what patients need to know, their preferences and existing knowledge and then find the time to educate them when they are ready to learn.

Indirect Care

-Nursing treatments or procedures performed away from a patient(s) but on behalf of a patient -Communicating nursing interventions -Written or oral -Delegating, supervising, and evaluating the work of other staff members

Lillian Wald

-Often referred to as the founder of public health nursing. -She worked tirelessly providing care via home visits to residents of impoverished neighborhoods of the Lower East Side of New York City. -Her legacy as a social reformer continues to this day because of her efforts aimed at achieving social justice.

Collaborative Management of Hypomagnesemia

-Oral magnesium tablets -Inc dietary intake: Leafy green vegs, choc, peanut butter, bananas -Parenteral magnesium IV (give slowly using an IV pump): Stop if loss of patellar reflex, flushing of face, dec BP -Vital signs q4h -Telemetry -Safety issues, seizure precautions -Monitor labs- (Mg++, K+, Ca++) -Notify HCP if pt. NPO >3days, especially if having other losses, malnourished, or if continues to have low K+ or low Ca++ even after treatment

Priority Setting

-Ordering of nursing diagnoses or patient problems to establish a preferential order for nursing interventions. -Problem-focused diagnoses and problems take priority over wellness, possible risk, and health promotion problems. -Helps you anticipate and sequence nursing interventions when a patient has multiple nursing diagnoses and collaborative problems. -Establish priorities in relation to their ongoing clinical importance

Planning: med admin

-Organize care activities to ensure the safe administration of medications -Goals and outcomes: Setting goals and related outcomes contributes to patient safety and allows for effective use of time during medication administration. -Setting priorities: Provide the most important information about the medications first.

Obstacles to critical thinking

-Overuse of the Habit Mode -Anxiety and Stress -Willingness to go with the status quo.... "We do it that way because that is the way it has always been done." -Lack of Confidence in One's Thinking

Components of a Theory

-Phenomenon: a term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events or a group of situations . Examples: caring, self-care, patient responses to stress. -Concepts: a thought or idea of reality that is put into words or phrases to help describe or explain a specific phenomenon. Examples: coping, adapting, or physical environments. -Definitions: a definition to explain the general meaning of the concepts of a theory. -Assumptions: the "taken-for-granted" statements that explain the nature of the concepts, definitions, purpose, relationships and structure of a theory. Truths, based on values and beliefs. Example: a conscious intention to care promotes healing and wholeness

Restraints

-Physical -Chemical -Ongoing assessment -Restraints require an order -Try other things first -Frequent checks!!

Planning

-Planning involves setting priorities based on patient diagnoses and collaborative problems, identifying patient centered goals and expected outcomes and prescribing nursing interventions appropriate for each diagnosis. -Must be individualized to the unique needs of the patient. -3rd step in the Nursing Process

Protect the susceptible host

-Protect natural defense mechanisms -Maintain healing processes -Keep patients skin lubricated -Sterile technique with appropriate procedures such as cathing

Art of listening

-Provide privacy -Give full attention -Receive and process the message -Clarify if needed -Active listening promotes a sense of connection and caring -As a holistic nurse - presence. -Patient focused - requires energy and concentration. -Looks at both content and feelings the person is conveying. -Uses all the senses. -The nurse should be careful not to react too quickly.

Infection control: Role of the infection control professional

-Provide staff and patient education on infection prevention and control. -Develop and review infection prevention and control policies and procedures. -Recommend appropriate isolation procedures. -Screen patient records for community-acquired infections that are reportable to the public health department. -Consult with employee health departments concerning recommendations to prevent and control the spread of infection among personnel, such as tuberculosis (TB) testing. -Gather statistics regarding the epidemiology (cause and effect) of health care-associated infections. -Notify the public health department of incidences of communicable diseases within the facility. -Consult with all hospital departments to investigate unusual events or clusters of infection. -Monitor antibiotic-resistant organisms in the institution.

Critical Thinking Promotes REFLECTION......

-Purposefully reviewing a situation to discover its purpose or meaning. Reflection is not intuitive. -It is purposefully visualizing a past situation and taking the time to honestly review everything you remember about it. -Allows you to gain new knowledge and raise questions about your practice -Improves ability to problem solve

Data documentation

-Record the results of the nursing health history and physical examination in a clear, concise manner using appropriate terminology. -Baseline to identify a patient's health problems, to plan and implement care, and to evaluate a patient's response to interventions -Record all observations succinctly -Record any subjective information by using quotation marks.

Objectives of Restraints

-Reduce the risk of patient injury from falls -Prevent interruption of therapy such as traction, IV infusions, nasogastric (NG) tube feeding, or Foley catheterization -Prevent patients who are confused or combative from removing life-support equipment -Reduce the risk of injury to others by the patient

Causes of Hypermagnesemia

-Renal insufficiency -Excessive use of Mg++ containing antacids/laxatives or administration of K+ sparing diuretics (conserves Mg++) -Severe dehydration and H20 losses-eg diabetic ketoacidosis

Nursing diagnoses associated with impaired skin integrity and wounds:

-Risk for infection -Imbalanced nutrition: less than body requirements -Acute or chronic pain -Impaired physical mobility -Impaired skin integrity -Risk for impaired skin integrity -Ineffective peripheral tissue perfusion -Impaired tissue integrity

Nursing Diagnoses regarding infection

-Risk for infection -Imbalanced nutrition: less than body requirements -Impaired oral mucous membrane -Impaired tissue integrity -Risk for impaired skin integrity -Social isolation

Oxygen therapy:

-Safety precautions: oxygen is highly combustible; can easily cause fire if there is a spark or open flame -Supply of oxygen -Methods of oxygen delivery -Nasal cannula -High flow nasal cannula -Oxygen masks

Oncotic Pressure

-Same as colloid osmotic pressure -Defined as osmotic pressure exerted by colloids in solution -Pulls H2O into vascular space

Respiratory System

-Second line of defense -Respiratory centers in the brain, (medulla) sense pH changes. -Changes rate and depth of breathing to compensate. -Deeper and more frequent breaths eliminates more carbon dioxide from the lungs. ↑ RR and ↑ depth = ↓ CO2 (blow off acid) -Shallower or less frequent breaths eliminate less carbon dioxide from the lungs. ↓ RR and ↓ depth = ↑ CO2 (increased CO2 retention, increased acid. -The more carbon dioxide present, the more carbonic acid, and a more acidic pH.

Florence Nightingale

-She was an early advocate for the idea that health care is a human right. 4 -"She had a nonjudgemental, nonmoralistic view of the poor, which was radical at the time." -Elizabeth Gaskel, novelist and family friend. 4 -Identified a link between hospital filth and disease. Gathered statistical data that showed many more soldiers died in hospitals from infections than on the battlefield. -Understood that an individual's environment was critical to restoring health. -She was a political activist who changed laws and social conditions that contributed to health problems.

Pressure injuries are classified as:

-Stage 1: Non-blanchable erythema of intact skin -Stage 2: Partial-thickness skin loss with exposed dermis -Stage 3: Full-thickness skin loss with visible adipose fat. -Stage 4: Pressure Injury: Full-thickness skin and tissue loss -Deep tissue injury -Unstageable pressure ulcer

Concepts related to F & E Balance

-The body will attempt to compensate for shifts and will adapt to changes in supply and demand. -If the body is unable to compensate for shifts, nursing interventions will replace, supplement, or stimulate. -As nurses it is important to anticipate interventions based on disease states,and changes in patient conditions.

How does the Holistic Caring Process differ from The Nursing Process?

-The holistic caring nursing process, the third of AHNA's five core values, describes the practice of holistic nursing in language derived from the nursing process while also highlighting the value of caring. -The holistic caring process involves six steps, instead of five, building on the first six ANA standards of care expected of all nurses. -Where the standard nursing process emphasizes the identification and treatment of patient conditions or problems, the holistic nursing process is centered around human health and wholeness and grounded in the worldview and philosophical principles of holistic nursing. -Holistic nursing focuses on protecting promoting and optimizing health and wellness, assisting healing; preventing illness and injury; alleviating suffering; supporting people to find peace, comfort, harmony and balance through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, populations and the planet.

Mixed Acid-Base Disorders

-The simultaneous occurrence of metabolic acidosis and respiratory acidosis, during respiratory and cardiac arrest. -The only mixed disorder that cannot occur is a mixed respiratory acidosis and alkalosis because it is impossible to have alveolar hypoventilation and hyperventilation at the same time. -Because the lungs respond to acid-base disorders with minutes, compensation for metabolic imbalances occurs faster than compensation for respiratory imbalances

Medication Distribution Systems

-Unit dose systems - medication is dispensed in single-unit package. -Automatic medication dispensing system [AMDS])

Teach-Back Quick Guide

-Use teach-back for ALL patients. -Start with most important message. -Limit to 2-4 key points. -Use plain language. -Rephrase message until patient demonstrates clear understanding. Examples: -"Just to be safe, I want to make sure we are on the same page. Can you tell me..." -"I want to make sure that I explained things clearly. Can you explain to me..." -"Can you show me how you would use your inhaler at home?"

Eye drops

-Used to treat eye irritation, infections, or disorders such as glaucoma -Eyedrops can be used for diagnostic procedures or to anesthetize the eye for procedures -Document the eye in which med was instilled and patient's response to med

Eye drops

Management of Metabolic Alkalosis

-VS -I&O - (Volume depletion from GI losses may require administration of fluids. -Monitor electrolytes, treat hypokalemia. -Administer H2 receptor blockers, (Cimetidine to decrease gastric acid secretion) -Protect from falls

Causes of fluid shifts

-Venous H.P increase - fluid overload, heart failure, tourniquets, restrictive clothing, thrombosis, varicose veins. -Plasma O.P. decrease - when plasma protein is low due to protein loss (renal disorders), deficient protein synthesis (liver disease), or deficient intake (malnutrition) -Interstitial O.P. increase - trauma, burns, and inflammation can damage capillary walls and allow plasma protein to accumulate in the interstitium and holds it there -Obstruction of lymph. outflow

Venous Hydrostatic Pressure increase

-Venous end of capillary inhibits fluid movement back into capillary -Causes: fluid overload, CHF, tourniquet, restrictive clothing, varicose veins -fluid overload, heart failure, tourniquets, restrictive clothing, thrombosis, varicose veins.

Causes of Metabolic alkalosis

-Vomiting, gastric suction *most common - loss of highly acidic gastric fluids, diarrhea -Antacid overdose -Excessive diuresis - loss of potassium, hypokalemia predisposes alkalosis.

movement of air through respiratory system

-air comes in through nasal or oral cavity -goes through pharynx -pharynx splits to the esophagus in the back and in front is the larynx -air goes through the larynx (voice box) -from larynx to trachea (cartilage) -trachea splits into two bronchi -bronchi split into smaller and smaller tubes -eventually split to be bronchioles (no cartilage) -air sacs on ends of bronchioles: alveoli

What does oxygen have to go through to get to the hemoglobin?

-alveolis (gas) -layer of fluid lining alveolis (liquid) -epithelial cells (liquid) -basement membrane (liquid) -connective tissue (liquid) -basement membrane (liquid) -endothelial cells (liquid) -plasmsa (liquid) -RBC (liquid) -almost all liquid (predominantly water) -going from gas all the way through many layers of liquid

Implementation

-begins after you develop a patient's plan of care. It involves the performance of nursing and collaborative interventions necessary to achieve the goals and expected outcome needed to support or improve a patient's health. -Direct care interventions -Treatments nurses provide through interactions with patients or a group of patients -Indirect care interventions -Treatments performed away from a patient but on behalf of the patient or group of patients. -Documentation -Interprofessional collaboration the 4th step of the nursing process

Theory of Self-Transcendence

-focuses on self-transcendence as a human capacity to expand personal boundaries intrapersonally, interpersonally and transpersonally -other key concepts include vulnerability and well-being

Critical thinking model for safety: assessment

-identify patient's perception of safety needs and risks -identify actual and potential threats to the patient's safety -determine impact and potential threats to the patient's safety -identify the presence of risks for the patient's developmental stage and patient's environment -determine effect of environmental influence on the patient's safety

Critical thinking model for safety: planning

-involve patient as a partner in planning care -select nursing interventions to promote safety and according to the patients developmental and health care needs -consult with occupational and physical therapists for assistive devices -select intervention that will improve the safety of the patient's home environmnent

Science of Unitary Beings

-major concepts include unitary human beings, human energy field, and environmental energy field. -argues for evolution of people in irreversible and unidirectional ways

What impacts pH?

-pH can shift due to either carbonic acid or bicarbonate. -Hydrogen ions are the root product which impact pH -If hydrogen goes up or bicarbonate goes down, pH decreases. (The acidity increases because of the level of hydrogen goes up (acid) OR the acidity goes up because there is less bicarbonate (base)) -Acidosis occurs at < 7.35. -If hydrogen decreases or bicarbonate increases, pH will increase. (pH becomes more basic due to less acid (hydrogen) or more base (bicarbonate)) -Alkalosis occurs at > 7.45

Theory of integral nursing

-the core concept is healing -nursing is a healing process of knowing, doing and being -the theory has three intentions: embrace the unitary whole person; explore fully the integral process; expand the nurse's capacities to heal

There are 2 main types of medication actions:

-therapeutic effect -adverse effect

Key Points EBT Article

1) Hydration matters in all persons especially older adults and adequate fluid consumption has been associated with fewer falls, lower rates of constipation, lower rates of laxative use as well as better rehabilitation outcomes in orthopedic patients and reduced risk of bladder cancer in men. 2) Potential consequences of dehydration include medication toxicity, urinary and respiratory infections, delirium, electrolyte imbalance, hyperthermia and longer time to wound healing especially pressure ulcers. Even higher mortality rates among hospitalized older adults.3) Indicators of hydration status include urine color charts, serum sodium and osmolality, BUN. Clinical assessments include dry oral mucosa, furrowed tongue, sunken eyes, a rapid pulse. Skin turgor on the sternum is not a reliable indicator in older adults. 4) Nursing implications include prevention of dehydration by calculating a fluid goal, consider fluid preferences, and evaluation "hydration habits". How often are patient's at risk because nurses fail to assess their ability to pour from a bedside pitcher???

Critical Thinking Model of Nursing Judgement

1. Basic Critical Thinking: Beginning nurses are task-oriented. Rely on the experts. Thinking is concrete. 2. Complex Critical Thinking: Rely less on experts and trust their own decisions more. Able to creatively adapt a procedure to the specific needs of the patient. 3. Commitment: Make choices without assistance from others. Accepts accountability for decisions. You choose an action or belief based on available alternatives. Sometimes an action is not to act or delay your action for a later time.

The following three principles are important when cleaning an incision or the area surrounding a drain:

1. Clean in a direction from the least contaminated area, such as from a wound or incision to the surrounding skin or from an isolated drain site to the surrounding skin 2. Use gentle friction when applying solutions locally to the skin. 3. When irrigating, allow the solution to flow from the least to most contaminated area

Steps of evaluating an ABG

1. Evaluate the pH. -Is it normal? (7.35-7.45) -Is it acidic? (< 7.35) -Is it alkaline? (> 7.45) 2. Evaluate the PaCO2 (respiratory component) -Is it normal? (35-45 mm Hg) -Is it high? (> 45) -Is it low? (< 35) -Does the value make sense with the pH? (too much or too little acid) 3. Evaluate the HCO3 (bicarbonate-metabolic component) -Is it normal? (21-28 mEq/L) -Is it high? (> 28) -Is it low? (< 21) -Does the bicarbonate value make sense with the pH? (too much or too little bicarb) 4. Identify the abnormalities -Is the pH abnormal? (if no, great...) -If not, identify acidosis or alkalosis -Identify if PaCO2 and/or HCO3 are out of range (Identify if high or low) -Determine which value makes sense with the pH to determine point of origin 5. Evaluate oxygen status -Evaluate PaO2- (80-100 mm/Hg) -Evaluate SaO2- (95-100%)

Transtheoretical Model of Change (5 Stages of health behavioral change)

1. Precontemplation - No intent to make changes within the next 6 months. The patient is unaware of, not interested in, or underestimates the problem. 2. Contemplation - Considering a change within the next 6 months. The patient may state, "I have a problem that I think I need to work on." 3. Preparation - making small changes in preparation for a major change in the next month. May have tried once in the past but was unsuccessful. Patient believes that advantages outweigh disadvantages of behavior change. 4. Action - Actively engaged in strategies to change behavior, lasts up to 6 months. Patient is committed to change. Patient may state, "I am working really hard to stop smoking." 5. Maintenance - Sustained change over time. Begins 6 months after action has started and continues indefinitely. Patient my state, " I need to avoid people who smoke so I won't be tempted to start smoking again."

The four domains of emotional intelligence

1. self-awareness: recognizing emotions of yourself and others 2. self-management: controlling impulsive feelings and manage your emotions in healthy ways 3. social awareness: observing and understanding the emotions, needs, and concerns of other people 4. relationship management: developing and maintaining good relationships Examining these four domains enhances one's emotional wellness.

Fluid Spacing

1st space = normal distribution of fluid in ICF & ECF compartments 2nd spacing = abnormal accumulation of interstitial fluid (edema) 3rd spacing = fluid accumulates where normally there is none or minimal amount (ascites, burns) Fluid is trapped and essentially unavailable for functional use.

Autonomy vs. Shame and Doubt

20-36 months -Fascination with magic and mystery -Often believes that illness is related to bad behavior -Begins to learn the difference between right and wrong -Imitates parents' spiritual or religious actions; recites prayers and sings simple religious songs, but does not understand their meanings -Interprets meanings literally

Hypophosphatemia:

< 3.0 mg/dL -May occur during the administration of calories to patients with severe protein-caloric malnutrition. Most likely from overzealous intake or administration of simple carbohydrates. -Respiratory alkalosis, phosphorus binding by antacids -Low magnesium levels, low potassium levels and hyperparathyroidism can contribute to low phosphorus levels. -Clinical Manifestations: Most signs and symptoms related to ATP deficiency such as fatigue, impaired oxygen delivery to tissues - increased respiratory rate, muscle weakness, impaired wound healing. -Management: Be alert for early signs of hypophosphatemia, protect from infection, administer parenteral nutrition to malnourished patients slowly to avoid rapid shifts of phosphorus into the cells. Supplements such as Neutra-Phos capsules and dietary sources of phosphorus.

Hypocalcemia

< 9.0 mg/dL -Hypoparathyroidism, thyroid or neck surgery -Impaired GI absorption -Chronic diarrhea, laxative misuse -End-stage renal disease -Acute pancreatitis (decreased absorption and increased output) -decreased dietary intake -Vitamin D deficiency -Multiple blood transfusions (citrate-used to anticoagulate the blood combines with calcium)

Complementary/integrative health approaches (CIHA):

A broad set of healthcare practices, therapies, and modalities that address the whole person—body, mind, emotion, spirit, and environment, not just signs and symptoms—and that may replace or be used as complements to or in conjunction with conventional Western medical, surgical, and pharmacologic treatments.

Pressure Intensity

A classic research study identified capillary closing pressure as the minimal amount of pressure required to collapse a capillary. Therefore, when the pressure applied over a capillary exceeds the normal capillary pressure and the vessel is occluded for a prolonged period of time, tissue ischemia can occur. If the patient has reduced sensation and cannot respond to the discomfort of the ischemia, tissue ischemia, and tissue death result. The clinical presentation of obstructed blood flow occurs when evaluating areas of pressure. After a period of tissue ischemia, if the pressure is relieved and the blood flow returns, the skin turns red. The effect of this redness is vasodilation (blood vessel expansion), called hyperemia (redness).

Healing process:

A continual journey of change and the evolving of one's self through life that is characterized by the awareness of patterns that support or that are challenges or barriers to health and healing and that may be done alone or in a healing community.

Holistic healing:

A form of healing based on attention to all aspects of an individual—physical, mental, emotional, sexual, cultural, social, spiritual, and energetic. The manifestation of right relationship at one or more levels of the body-mind-spirit-environment-energy system.

Changing Dressings

A health care provider's order for wound care indicates the dressing type, the frequency of changing, and any solutions or ointments to be applied to the wound. An order to "reinforce dressing prn" (add dressings without removing the original one) is common right after surgery, when the health care provider does not want accidental disruption of the suture line or bleeding. The medical or operating room record usually indicates whether drains are present and from which body cavity they drain. Always know the type of wound and dressing, the presence of underlying drains or tubing, and the type of supplies needed for wound care. Poor preparation causes a break in aseptic technique or accidental pulling of wound tissue or dislodgement of a drain. Your judgment in modifying a dressing-change procedure is important during wound care, particularly if the character of a wound changes. Notifying the health care provider of any change is essential.

Metatheory

A metatheory is an area of study that looks at the relationships of various components that make up the knowledge of a discipline. These include philosophical, theoretical, and empirical components and provide a broad overview of discipline. Metatheory is used to derive theories and theoretical concepts

Nursing Theory

A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. Theories offer a perspective for assessing your patients' situations. They also help you organize, analyze, and interpret data. For example, if you use Orem's theory in practice, you assess and interpret data to determine patients' self-care needs, deficits, and abilities in the management of their disease. Orem's theory then guides your development of patient-centered nursing interventions.

Sitz Baths

A patient who has had rectal surgery, an episiotomy during childbirth, painful hemorrhoids, or vaginal inflammation benefits from a sitz bath, a bath in which only the pelvic area is immersed in warm or, in some situations, cool fluid. The patient sits in a special tub or chair or a basin that fits on the toilet seat so the legs and feet remain out of the water. Immersing the entire body causes widespread vasodilation and nullifies the effect of local heat application to the pelvic area. The desired temperature for a sitz bath depends on whether the purpose is to promote relaxation or to clean a wound. It is often necessary to add warm or cool water during the procedure, which normally lasts 20 minutes, to maintain a constant temperature. Agency procedure manuals recommend safe water temperatures. A disposable sitz basin contains an attachment resembling an enema bag that allows gradual introduction of additional water. Prevent overexposure of patients by draping bath blankets around their shoulders and thighs and controlling drafts. A patient should be able to sit in the basin or tub with feet flat on the floor and without pressure on the sacrum or thighs. Because exposure of a large part of the body to heat causes extensive vasodilation, assess the pulse and facial color and ask whether the patient feels light-headed or nauseated.

transpersonal

A personal understanding that is based on one's experiences of temporarily transcending or moving beyond one's usual identification with the limited biological, historical, cultural, and personal self at the deepest and most profound levels of experience possible. From this perspective, the ordinary biological, historical, cultural, and personal self is seen as an important but only a partial manifestation or expression of this much greater wholeness that is one's deeper origin and destination. That which transcends the limits and boundaries of individual ego identities and possibilities to include acknowledgment and appreciation of something greater (ANA & AHNA, 2019, p. 121).

Pressure injury

A pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical device or other device. The injury can present as intact skin, a blister, or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities, and condition of the soft tissue.

Pressure Ulcer

A pressure ulcer is a localized injury to the skin and underlying tissue, usually over a bony prominence. It results from pressure in combination with shear and/or friction. •Pressure is the major element in the cause of pressure ulcers. Three pressure-related factors contribute to pressure ulcer development: (1) pressure intensity, (2) pressure duration, and (3) tissue tolerance. •If pressure applied over a capillary exceeds normal capillary pressure and the vessel is occluded for a prolonged time, tissue ischemia occurs. If left untreated, tissue death results.

Filtration

A process whereby fluid and solutes move together across a membrane from one compartment to another in response to fluid pressure to create an equilibrium. The movement is from an area of higher pressure to one of lower pressure -An example of filtration is tissue perfusion whereby water, nutrients and waste products are exchanged at the capillary bed. This exchange occurs as a result of a difference in hydrostatic pressure between the capillaries and the tissue space.

Reservoir

A reservoir is a place where microorganisms survive, multiply, and await transfer to a susceptible host. Common reservoirs are humans and animals (hosts), insects, food, water, and organic matter on inanimate surfaces (fomites). ex: lungs of infected person (covid)

Illness:

A subjective experience of symptoms and suffering to which the individual ascribes meaning and significance; not synonymous with disease; a shift in the homeodynamic balance of the person to disharmony and imbalance.

Suprainfection

A suprainfection develops when broad-spectrum antibiotics eliminate a wide range of normal flora organisms, not just those causing infection. When normal bacterial floras are eliminated, body defenses are reduced, which allows disease-producing microorganisms to multiply, causing illness -the use of broad-spectrum antibiotics for the treatment of infection can lead to suprainfection .

Clinical practice guidelines and protocols

A systematically developed set of statements about appropriate health care for specific health care problems or clinical situations.

Theory

A theory helps explain an event by defining ideas or concepts, explaining relationships among the concepts, and predicting outcomes. In the case of nursing, theories are designed to explain a phenomenon such as self-care or caring.

The nursing assistant asks you the difference between a wound that heals by primary or secondary intention. You will reply that a wound heals by primary intention when the skin edges: A. are approximated. B. migrate across the incision. C. appear slightly pink. D. slightly overlap each other.

A. are approximated.

AIDET:

A=Acknowledge the person with a positive attitude I=Introduce yourself D=Duration, explain how long with the interaction, procedure will take. E=Explain what the patient will experience, treatment, safety precautions T=Thank the patient.

Describe the effect of a patient's level of health, age, lifestyle, and environment on oxygenation.

AGE: -Young'ns prone to upper respiratory infections. School-age risk because around lots of kids. Adolescents because smoking. Older people have calcified heart valves, costal cartilages solidify, and atherosclerosis. Osteoporosis causes trachea to become enlarged bc of calcification. Alveoli enlarge, decreasing usable Surface area. HEALTH Obesity decreases lung expansion. Malnourished have weaker muscles, can't cough as well or expand as well. Hypertension. Exercise increases metabolic activity and oxygen demands, decreasing their average BP and pulse and cholesterol. Increases Cardiac output. Smoking = PVD COPD CAD. Substance abuse = Alcohol decreases respiratory rate and depth, kind of like opposite of exercise. Stress increases metabolic rate and needs, some people can't cope with the increased needs

Five steps of the nursing process

-Assessment -Nursing Diagnosis -Planning and Outcome Identification -Implementation -Evaluation

Assessment regarding infection

-Immunizations & vaccinations -Risk factors for infection -Chronic health problems -Travel history -Stress -Clinical appearance—S/S of infection -Laboratory data—WBCs, Culture/sensitivity, ESR

Patients at greater risk for health care associated infections (HAIs)

-Multiple illnesses -Older adults -Poorly nourished -Compromised immune system

Renal System

-Third level of defense -Slowest but most powerful -Kidneys excrete acids (urine pH is 6 and can vary from 4-8) -Can reabsorb or excrete acids or bases to compensate. -If system fails, large component of pH balance is lost

Collaborative Management of FVD

-Treat the cause -Parenteral replacement: isotonic fluids- LR, 0.9%NaCl -Blood-(if due to blood loss) -Electrolyte replacement as needed -Monitor VS, I & O, Daily weight -Asses and monitor lab values

Levels of critical thinking

-basic critical thinking -complex critical thinking -commitment

Courtesy

Common courtesy is part of professional communication. To practice courtesy, say hello and goodbye to patients and knock on doors before entering. State your purpose, address people by name, and say "please" and "thank you" to team members. Introduce yourself and state your title. When a nurse is discourteous, others perceive him or her as rude or insensitive. It sets up barriers to forming helping relationships between nurse and patient and causes friction among team members.

Chest physiotherapy

External chest wall manipulation using percussion, vibration, or high-frequency chest wall compression (HFCWC) -postural drainage: used to assist in secretion clearance -table 41.6 shows different position for postural drainage

Transcellular fluid

Eyes, brain, spinal canal, lymph, synovial tissue and eyes (small amount of extracellular fluid)

Allopathic/conventional therapies

Medical, surgical, pharmacologic, and invasive and noninvasive diagnostic procedures; those interventions most commonly used in allopathic Western medicine

Material Safety Data Sheet

SDSs inform you of the following things: •the material's chemical make-up; •the material's properties and/or fast-acting health effects that could make it potentially dangerous to handle; •the types of protective gear you will need to wear to work safely with the material; •the first aid treatment information required when someone is exposed to the material; and •how you should respond to accidents.

Toxic effect of medication

Accumulation of medication in the bloodstream. For example toxic levels of morphine will cause severe respiratory depression.

Health promotion:

Activities and preventive measures to promote health, increase well-being, and actualize the human potential of people, families, communities, society, and ecology; such activities and measures include immunizations, fitness and exercise programs, breast self-exams, appropriate nutrition, relaxation, stress management, social support, prayer, meditation, healing rituals, cultural practices, and promoting environmental health and safety.

Acute Illness/Trauma and fluids

Acute conditions that place patients at high risk for fluid, electrolyte, and acid-base alterations include respiratory diseases, burns, trauma, GI alterations, and acute oliguric renal disease. -respiratory disorders -burns -trauma

Portal of Exit

After microorganisms find a site to grow and multiply, they need to find a portal of exit if they are to enter another host and cause disease. Portals of exit include sites such as blood, skin and mucous membranes, respiratory tract, genitourinary (GU) tract, gastrointestinal (GI) tract, and transplacental (mother to fetus). Ex: mouth with cough (covid)

The Air We Breathe

Air pollution is a major environmental risk to health globally. By decreasing air pollution, countries can reduce the burden of disease, including chronic and acute respiratory disease and asthma, strokes, and cancer. The WHO's International Agency for Research on Cancer concluded that outdoor air pollution is carcinogenic to humans, with the particulate matter component of air pollution most closely associated with increased cancer incidence.

Cleaning Skin and Drain Sites

Although a moderate amount of wound exudate promotes epithelial cell growth, some health care providers order cleaning a wound or drain site if a dressing does not absorb drainage properly or if an open drain deposits drainage onto the skin. Wound cleaning requires good hand hygiene and aseptic techniques. You can use irrigation to remove debris from a wound.

Spirituality Assessment

Although spirituality assessment and interventions are discussed separately here, a holistic approach to spiritual caregiving recognizes that they are often same process. Appropriate assessment is basic to integrating spirituality into holistic care. Many scales for assessing spirituality and spiritual caregiving have been developed for use in clinical and educational settings and in research.

Root Cause Analysis

An analytical technique used to determine the basic underlying reason that causes a variance or a defect or a risk. A root cause may underlie more than one variance or defect or risk.

Health

An individually defined state or process in which the individual (nurse, patient, family, group, or community) experiences a sense of well-being, harmony, and unity such that subjective experiences about health, health beliefs, and values are honored; a process of becoming an expanding consciousness.

Droplet mode of transmission

An infected person coughs or sneezes, creating droplets that carry germs short distances (within approximately 6 feet). These germs can land on a susceptible person's eyes, nose, or mouth and can cause infection (e.g., pertussis or meningitis).

Well-being:

An inner attitude of feelings of comfort and harmony and acceptance of the wholeness of one's being. Integrated congruent functioning to achieve one's higher potential

Hemoglobin

An iron-containing protein in red blood cells that reversibly binds oxygen. -four oxygen can bind to one hemoglobin Hemoglobin, which is a carrier for oxygen and carbon dioxide, transports most oxygen (approximately 97%). The hemoglobin molecule combines with oxygen to form oxyhemoglobin.

Developmental Stages and Risks: Adolescent

As children enter adolescence, they develop greater independence and a sense of identity. Adolescents begin to separate emotionally from their families, and peer groups begin to have a stronger influence. Adolescents typically have wide variations that swing from childlike to mature behavior. They test their boundaries by trying risky behaviors. -use of alcohol, tobacco and other substances -suicide

Assertiveness

Assertiveness allows you to express feelings and ideas without judging or hurting others. Assertive behavior includes intermittent eye contact; nonverbal communication that reflects interest, honesty, and active listening; spontaneous verbal responses with a confident voice; and culturally sensitive use of touch and space. An assertive nurse communicates self-assurance; communicates feelings; takes responsibility for choices; and is respectful of others' feelings, ideas, and choices. Assertive behavior increases self-esteem and self-confidence, increases the ability to develop satisfying interpersonal relationships, and increases goal attainment. Assertive individuals make decisions and control their lives more effectively than nonassertive individuals. They deal with criticism and manipulation by others and learn to say no, set limits, and resist intentionally imposed guilt.

Dietary Intake and fluids

Assess dietary intake of fluids; salt; and foods rich in potassium, calcium, and magnesium. Ask patients if they follow weight-loss diets. Starvation diets or those with high fat and no carbohydrate content often lead to metabolic acidosis. In addition, assess a patient's ability to chew and swallow, which, if altered, interferes with adequate intake of electrolyte-rich foods and fluids.

Lifestyle and fluids

Assess your patient's alcohol intake. How many days does a person have an alcoholic drink each week, and how many drinks does he or she have at any one time? Chronic alcohol abuse commonly causes hypomagnesemia, in part because it increases renal magnesium excretion.

Risk for falls

Assessing a patient's risk factors for falling is essential to determine specific needs and develop targeted interventions to prevent falls. Many fall risk-assessment instruments are available; use the tool chosen by your health care agency. Most tools include risk categories on age, fall history, elimination habits, high-risk medications, mobility, and cognition. At a minimum the assessment needs to be completed on admission, following a change in a patient's condition, after a fall, and when transferred. If it is determined that a patient is at risk for falling, ongoing assessments are required. When a patient has a previous history of falling, ask about the nature of the fall and what the patient thinks precipitated it. Focus the assessment on that information to determine whether a condition or risk persists. In many cases family members are important resources in assessing a patient's fall risk. Families often can report on the patient's level of confusion and ability to ambulate or safely toilet. Based on the results of a fall risk assessment, you will implement multiple evidence-based interventions for fall prevention. It is very important that you inform the patient and family members about the fall risks that you identify from the assessment. Often younger patients are not aware of how medications and treatments cause dizziness, orthostatic hypotension, or changes in balance. When patients are unaware of their risks, they are less likely to ask for assistance. If family members are informed, they will often call for help (when they are visiting patients) to be sure that patients have appropriate assistance.

Integrative Health and Wellness Assessment Wheel: Emotional

Assessing our emotional potential assists us in our willingness to acknowledge the presence of feelings, value them as important information, and express them. Emotional health implies that we have the choice and freedom to process and/or express the full spectrum of emotions, including love, joy, guilt, forgiveness, fear, and anger. The expression of these emotions provides immediate feedback about our inner state, which may be crying out for a new way of being. -are responses to and are affected by the events in our lives as we constantly interact with our environment -no such thing as a good or bad emotion; each is part of the human condition

Integrative Health and Wellness Assessment Wheel: Mental

Assessing our mental capacity helps us to examine our belief systems. In our early lives, we had role models who influenced our beliefs, thoughts, behaviors, and values. With maturity and as a result of life experiences, we begin to recognize shifts that occur regarding these same beliefs, thoughts, behaviors, and values, as well as the conflicts that may arise from those shifts. As we strive to perceive the world with greater clarity, we may recognize the variety of perspectives in the world

Ritual and Practice

Assessing the use of rituals and practices helps you understand a patient's spirituality. Rituals include participation in worship, prayer, sacraments (e.g., baptism, Holy Eucharist), fasting, singing, meditating, scripture reading, and making offerings or sacrifices. Different religions have different rituals for life events. For example, Buddhists practice baptism later in life and find burial or cremation acceptable at death. Followers of Islam practice Salah, the second of the Five Pillars of Islam, requiring all Muslims who have reached puberty to worship five times daily, facing the holy city of Mecca. Orthodox and conservative Jews circumcise their newborn sons 8 days after birth. Determine whether illness or hospitalization has interrupted a patient's ability to follow usual rituals or practices. A ritual often provides the patient with structure and support during difficult times. If rituals are important to a patient, use them as part of nursing intervention.

Mobility and wounds

Assessment includes documenting the baseline level of mobility and the potential effects of impaired mobility on skin integrity. Documenting assessment of mobility includes obtaining data regarding the quality of muscle tone and strength. For example, determine whether the patient is able to lift his or her weight off the sacral area and roll the body to a side-lying position. Some patients have inadequate range of motion to move independently into a more protective position. Finally, assess a patient's activity tolerance to determine whether the patient can be transferred to a chair or ambulated more often to relieve pressure from lying down.

Assumptions

Assumptions are the "taken-for-granted" statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory. Assumptions are accepted as truths and are based on values and beliefs. For example, Watson's transpersonal caring theory has the assumption that a conscious intention to care promotes healing and wholeness.

Increasing Self-Knowledge

Awareness and understanding of one's self and one's values, beliefs, motivations, goals, feelings, and actions are imperative to relating in a caring, healing manner. When we are aware of ourselves and understand who we are and the basis for our own attitudes, preconceptions, and reactions, we are in a much better position to empathize, appreciate other people's differences and uniqueness, and encourage their self-revelations. To nurture caring, healing communication and relationships, we need to conduct assessments of ourselves as individuals, as well as our communications, spirituality, and cultural beliefs and traditions. All these factors influence behavior and, without a thoughtful reflection and understanding of them, we deny the very people we care for the opportunity to understand themselves.

What occurs faster: compensation for metabolic imbalances or for respiratory imbalances

Because the lungs respond to acid-base disorders within minutes, compensation for metabolic imbalances occurs faster than compensation for respiratory imbalances.

Assessment for Temperature Tolerance

Before applying heat or cold therapies, assess a patient's physical condition for signs of potential intolerance to heat and cold. First observe the area to be treated. Assess the skin, looking for any open areas such as alterations in skin integrity (e.g., abrasions, open wounds, edema, bruising, bleeding, or localized areas of inflammation) that increase a patient's risk for injury. Because a health care provider commonly orders heat and cold applications for traumatized areas, the baseline skin assessment provides a guide for evaluating skin changes that can occur during therapy. Assess neurological function, testing for sensation to light touch, pinprick, and mild temperature variations. Sensory status reveals the ability of a patient to recognize when heat or cold becomes excessive. Assess a patient's mental status to be sure that he or she can correctly communicate any issues with the hot or cold therapy. Level of consciousness influences the ability to perceive heat, cold, and pain. If a patient is confused or unresponsive, the nurse needs to make frequent observations of skin integrity after therapy begins.

Role of Selected Nutrients in Wound Healing

Calories Fuel for cell energy "Protein protection" 35-40 kcal/kg/day or enough to maintain positive nitrogen balance Protein Fibroplasia, angiogenesis, collagen formation and wound remodeling, immune function 1-1.5 g/kg/day or enough to maintain positive nitrogen balance Poultry, fish, eggs, beef Vitamin C (ascorbic acid) Collagen synthesis, capillary wall integrity, fibroblast function, immunological function, antioxidant 100-1000 mg/day Need long time to develop clinical scurvy from vitamin C deficiency Low toxicity Citrus fruits, tomatoes, potatoes, fortified fruit juices Vitamin A Epithelialization, wound closure, inflammatory response, angiogenesis, collagen formation 1600-2000 retinol equivalents per day Supplement if deficient 20,000 units × 10 days Green leafy vegetables (spinach), broccoli, carrots, sweet potatoes, liver Can reverse steroid effects on skin and delayed healing Vitamin E No known role in wound healing, antioxidant None Fish, oysters, liver, dark meat, eggs, legumes Zinc Collagen formation, protein synthesis, cell membrane and host defenses 15-30 mg Correct deficiencies No improvement in wound healing with supplementation unless zinc deficient Use with caution—large doses can be toxic May inhibit copper metabolism and impair immune function Vegetables, meats, legumes Fluid Essential fluid environment for all cell function 30-35 mL/kg/day Increase by another 10-15 mL/kg if patient is on an air-fluidized bed Use noncaffeine, nonalcoholic fluids without sugar Water is best—6-8 glasses/day

Subjective data

Cannot observe directly. Patients' verbal descriptions of their health problems include patient feelings, perceptions, and self-reported symptoms -"I've got a tingling pain in my foot." -"I feel so sick to my stomach." SYMPTOMS

Subjective data

Cannot observe directly. Patients' verbal descriptions of their health problems includes patient feelings, perceptions, and self-reported symptoms -"I've got a tingling pain in my foot." -"I feel so sick to my stomach." SYMPTOMS

Catholic social teaching

Catholic doctrine on matters of human dignity and common good in society. It is a rich treasure of wisdom about building a just society and living lives of holiness amidst the challenges of modern society. Its roots can be traced to concepts in the Bible and the writings of Catholic thinkers and Hebrew prophets who announced God's special love for the poor and called God's people to a convenant of love and justice.

Chronic illnesses and fluids

Chronic Illness Many chronic diseases create ongoing risk of fluid, electrolyte, and acid-base imbalances. For example, type B chronic obstructive pulmonary disease (COPD) often causes chronic respiratory acidosis. In addition, the treatment regimens for chronic disease often cause imbalances. Assess patients for the presence of these conditions -cancer -heart failure

Colonization

Colonization is the presence and growth of microorganisms within a host but without tissue invasion or damage

Communication

Communication is a lifelong learning process. Nurses make intimate journeys with patients and their families from the miracle of birth to the mystery of death. As a nurse you communicate with patients and families to develop meaningful relationships. Within those relationships you collect relevant assessment data, provide education and counseling and interact during nursing interventions. The use of therapeutic communication promotes personal growth and helps patients reach their health-related goals.

Compassion fatigue:

Compassion fatigue is a condition that can overwhelm health care providers and cause physical, mental, and emotional health issues. The feelings of hopelessness and anxiety from compassion fatigue usually result in feelings of inadequacy and lower self-esteem. These factors can lead to the health care provider lashing out in an attempt to cope with these feelings and stress. This often manifests itself as lateral violence, which refers to a deliberate and harmful behavior demonstrated in the workplace by one employee to another. This includes health care providers engaging in bullying and potentially assaultive behaviors toward co-workers -A state of burnout and secondary traumatic stress -Caring for others who are suffering -Emotional exhaustion -Can overwhelm health care providers and cause physical, mental, and emotional health issues -Can result in a negative work environment

Interdisciplinary/interprofessional:

Conversation or collaboration across disciplines where knowledge is shared that informs learning, practice, education, and research; it includes individuals, families, community members, and various disciplines.

IV Equipment

Correct selection and preparation of IV equipment helps in safe and rapid placement of an IV line. Because fluids infuse directly into the bloodstream, sterile technique is necessary. Organize all equipment at the bedside for an efficient insertion. IV equipment includes VADs; tourniquet; clean gloves; dressings; IV fluid containers; various types of tubing; and electronic infusion devices (EIDs), also called infusion pumps . VADs that are short peripheral IV catheters are available in a variety of gauges, such as the commonly used 20 and 22 gauges. A larger gauge indicates a smaller-diameter catheter. A peripheral VAD is called an over-the-needle catheter; it consists of a small plastic tube or catheter threaded over a sharp stylet (needle). Once you insert a stylet and advance the catheter into the vein, you withdraw the stylet, leaving the catheter in place. These devices have a safety mechanism that covers the sharp stylet when withdrawing it to reduce the risk of needlestick injury. Needleless systems allow you to make connections without using needles, which reduces needlestick injuries.

Subjective Findings

Create a nonthreatening environment when assessing a patient's level of stress and coping resources. Sit at the same height as the patient, arranging the interview environment with the chairs at a 90-degree angle or side by side so that you can maintain or avoid eye contact comfortably. Begin to develop a trusting relationship with your patient while you gather information about the patient's health status from his or her perspective. Use the interview to determine the patient's view of the stress, coping resources, any possible maladaptive coping, and adherence to prescribed medical recommendations such as medication or diet. If the patient is using denial as a coping mechanism, assess if he or she is overlooking necessary information. As in all interactions with the patient, respect the confidentiality and sensitivity of the information shared.

Creating Intention

Creating an intention ideally precedes interaction with a person and is part of the preaccess phase of the holistic nurse caring process. Intention can be defined as "the direction of one's inner awareness and focus for healing." -Creating an intention is a process that affects not only the mental and emotional realms but also the physical world. -creating an intention is a powerful way for the nurse to establish an optimal environment for a caring, healing interaction.

Core Value 4: Holistic Communication, Therapeutic Relationship, Healing Environment, and Cultural Care

Creation of a therapeutic relationship through holistic communication, and the context for its expression—an optimal healing environment—is an enduring tradition in holistic nursing use of self in interacting with another". Incorporating the processes and constructs of therapeutic communication, it acknowledges the infinite, spiritual, and energetic nature of being, the centrality of heart centeredness, and the incorporation of intention, self-knowledge, transcendent presence, and intuition in our interactions. The holistic nurse's communication ensures that each individual experiences the presence of the nurse as authentic, caring, compassionate and sincere. This is deep listening or as some say, "Listening with the heart and not just the ears." We are making a plan of care WITH the patient not FOR the patient

Skills of Critical Thinking

Critical analysis -What if... Socratic questioning -What do I know? Does it apply here? Deductive reasoning -Big concepts to specific examples Inductive reasoning -Specific examples to big concepts

A postoperative patient arrives at an ambulatory care center and states, "I am not feeling good." Upon assessment, you note an elevated temperature. An indication that the wound is infected would be: A. it has no odor. B. a culture is negative. C. the edges reveal the presence of fluid. D. it shows purulent drainage coming from the incision site.

D. it shows purulent drainage coming from the incision site.

Daily weights

Daily weights are an important indicator of fluid status. Each kilogram (2.2 lb) of weight gained or lost overnight is equal to 1 L of fluid retained or lost. These fluid gains or losses indicate changes in the amount of total body fluid, usually ECF, but do not indicate shift between body compartments. Weigh patients with heart failure and those who are at high risk for or actually have ECV excess daily. Daily weights are also useful for patients with clinical dehydration or other causes or risks for ECV deficit. Weigh the patient at the same time each day with the same scale after a patient voids. Calibrate the scale each day or routinely. The patient needs to wear the same clothes or clothes that weigh the same; if using a bed scale, use the same number of sheets on the scale with each weighing. Compare the weight of each day with that of the previous day to determine fluid gains or losses. Look at the weights over several days to recognize trends. Interpretation of daily weights guides medical therapy and nursing care.

Deep tissue injury

Depth Unknown. Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue. Deep tissue injury may be difficult to detect in individuals with dark skin tones.

Discuss nursing roles and responsibilities in medication Administration.

Determines the correct med, assesses the patient's ability to self-administer med, determines whether a patient should receive a med at a given time, administers medications correctly, and closely monitors their effects.

Edema

Disease processes alter these forces and fluid accumulates in the interstitial spaces Known as edema. People with heart failure often develop edema. Venous congestion from a weakened heart that no longer pumps effectively increases capillary hydrostatic pressure, causing edema by moving excessive fluid into the interstitial space. Inflammation is another cause of edema. It increases capillary blood flow and allows capillaries to leak colloids into the interstitial space. The resulting increased capillary hydrostatic pressure and increased interstitial colloid osmotic pressure produce localized edema in the inflamed tissues.

Power and Control Issues

Dominant personality patterns can cause relationship conflicts. Controlling people tend to assert themselves over others and exert power over them. Although there are people who are willing to be subservient to controlling personalities, others reject this, and power battles ensue.

Hemostasis stage

During hemostasis injured blood vessels constrict, and platelets gather to stop bleeding. Clots form a fibrin matrix that later provides a framework for cellular repair.

Alarm Stage

During the alarm stage the central nervous system is aroused, and body defenses are mobilized; this is the fight-or-flight response . During this stage rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. If the stressor poses an extreme threat to life or remains for a long time, the person progresses to the second stage, resistance.

Termination Phase

During the ending of the relationship: • Remind the patient that termination is near. • Evaluate goal achievement with the patient. • Reminisce about the relationship with the patient. • Separate from the patient by relinquishing responsibility for his or her care. • Achieve a smooth transition for the patient to other caregivers as needed.

Ear drops

Eardrops used to treat ear infections and associated pain, soften earwax to ease removal, apply a local anesthetic, and destroy insects trapped in the ear canal -The internal ear is very sensitive to temp changes: warm med to room temp before -If tympanic membrane has been damaged, all procedures are performed with sterile technique to prevent infection -Document the ear in which med was instilled and patient's response to med

Relate fluid and electrolyte balance to various disease processes.

Electrolytes, particularly sodium, help the body maintain normal fluid levels in the fluid compartments because the amount of fluid a compartment contains depends on the amount (concentration) of electrolytes in it. If the electrolyte concentration is high, fluid moves into that compartment (a process called osmosis). Conditions that increase your risk for an electrolyte disorder include: alcohol use disorder. cirrhosis. congestive heart failure. kidney disease. eating disorders, such as anorexia and bulimia. trauma, such as severe burns or broken bones. thyroid disorders. adrenal gland disorders.

Empathy

Empathy is the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other. This is a therapeutic communication technique that enables you to understand a patient's situation, feelings, and concerns. To express empathy, you reflect that you understand and feel the importance of the other person's communication. Empathetic understanding requires you to be sensitive and imaginative, especially if you have not had similar experiences. Strive to be empathetic in every situation because it is a key to unlocking concern and communicating support for others.

vital and essential attributes for therapeutic communication.

Empathy, unconditional regard, genuineness, respect, concern, caring, and compassion

Sociocultural Factors

Environmental and social stressors often lead to developmental problems. Potential stressors that affect any age-group but that are especially stressful for young people include prolonged poverty and physical disability. Children become vulnerable when they lose parents and caregivers through divorce, imprisonment, or death or when parents have mental illness or substance-abuse disorders. Living under conditions of continuing violence, disintegrated neighborhoods, or homelessness affects people of any age, especially young people. A person's culture also influences stress and coping. Cultural variations produce stress, particularly if a person's values differ from the dominant culture in aspects of gender roles, family relationships, and religious beliefs. Other aspects of cultural variations begin with language difference, geographical location, family relationships, time orientation, access to health care programs, and disparities in health care.

primary appraisal

Evaluating an event in terms of personal meaning is primary appraisal . Appraisal of an event or circumstance is an ongoing perceptual process. Stress results when a person identifies an event or circumstance as a harm, loss, threat, or challenge.

Moving a patient

Face direction that you are moving patient DO NOT lift from under the arms Wide stance Low center of gravity

Fellowship and Community

Fellowship is one kind of relationship that an individual has with other people, including immediate family, close friends, associates at work or school, fellow members of a place of worship, and neighbors. More specifically, this includes the extent of the community of shared faith between people and their support networks. Many times social support from faith-based groups helps patients cope with illness and participate in health promotion behaviors. To assess a patient's supportive community, ask questions such as "Who do you find to be the greatest source of support in times of difficulty?" or "When you've faced difficult times in the past, who has been your greatest resource?" Explore the extent and nature of a person's support networks and their relationship with the patient.

Parenteral Replacement of Fluids and Electrolytes

Fluid and electrolytes may be replaced through infusion of fluids directly into veins (intravenously) rather than via the digestive system. Parenteral replacement includes parenteral nutrition (PN), IV fluid and electrolyte therapy ( crystalloids ), and blood and blood component (colloids) administration. IV devices are called peripheral IVs when the catheter tip lies in a vein in one of the extremities; they are called central venous catheters (CVCs) or IVs when the catheter tip lies in the central circulatory system (e.g., in the vena cava close to the right atrium of the heart)

Fluid intake

Fluid intake includes all liquids that a person eats (e.g., gelatin, ice cream, soup), drinks (e.g., water, coffee, juice), or receives through nasogastric or jejunostomy feeding tube. IV fluids (continuous infusions and intermittent IV piggybacks) and blood components also are sources of intake. Water swallowed while taking pills and liquid medications counts as intake. A patient receiving tube feedings often receives numerous liquid medications, and water is used to flush the tube before and/or after medications. Over a 24-hour period these liquids amount to significant intake and always are recorded on the I&O record. Ask patients who are alert and oriented to help with measuring their oral intake and explain to families why they should not drink or eat from the patient's meal trays or water pitcher.

Fluid output

Fluid output includes urine, diarrhea, vomitus, gastric suction, and drainage from postsurgical wounds or other tubes. Record a patient's urinary output after each voiding. Instruct patients who are alert, oriented, and ambulatory to save their urine in a urinal or a calibrated insert, which attaches to the rim of the toilet bowl. Teach patients and families the purpose of I&O measurements. Also teach them to notify the nurse or assistive personnel (AP) to empty any container with voided fluid or how to measure and empty the container themselves and report the result appropriately. Patients need to have good vision and motor skills to perform these measurements. Active involvement of patient and family is an aspect of patient-centered care that is essential to maintaining accurate I&O measurements. When a patient has an indwelling urinary catheter, drainage tube, or suction, record output (e.g., at the end of each nursing shift or every hour) as the patient's condition requires.

Protective environment

Focuses on a very limited patient population. This form of isolation requires a specialized room with positive airflow. The airflow rate is set at greater than 12 air exchanges per hour, and all air is filtered through a HEPA filter. Patients are not allowed to have dried or fresh flowers or potted plants in these rooms -types of room

Forgiveness

Forgiveness A highly significant hallmark of a healing relationship is forgiveness. To be empowered to forgive, it is necessary to release the anger associated with resentment. There are all levels of forgiveness: of self, of spouse or significant other, of children, of parents, of coworkers, of friends, of family, and of God. Forgiveness has been linked to improved mental health, lowered anxiety, reduced anger, and lessened depression. Physiologically, forgiveness has demonstrated positive benefits.

Stage 3 Pressure Ulcer

Full-thickness skin loss with visible adipose fat. •Full-thickness Skin Loss. Full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a Category/Stage III pressure ulcer varies by anatomical location.

Gender and communication

Gender influences how we think, act, feel, and communicate. Men tend to use less verbal communication but are more likely to initiate communication and address issues more directly. They are also more likely to talk about issues. Women tend to disclose more personal information and use more active listening, answering with responses that encourage the other person to continue the conversation. It is important for you to recognize a patient's gender communication pattern. Being insensitive blocks therapeutic nurse-patient relationships. Assess communication patterns of each individual and do not make assumptions based simply on gender, race, sexuality, or cultural differences.

Effects of Heat Application

Generally heat is quite therapeutic, improving blood flow to an injured part. However, if it is applied for 1 hour or more, the body reduces blood flow by a reflex vasoconstriction to control heat loss from the area. Periodic removal and reapplication of local heat restores vasodilation. Continuous exposure to heat damages epithelial cells, causing redness, localized tenderness, and even blistering.

Gestures

Gestures emphasize, punctuate, and clarify the spoken word. Gestures alone carry specific meanings, or they create messages with other communication cues. A finger pointed toward a person communicates several meanings, but when accompanied by a frown and stern voice, the gesture becomes an accusation or a threat. Pointing to an area of pain is sometimes more accurate than describing its location.

Nursing Process: Planning Skin

Goals and outcomes -Plan interventions according to •Risk for pressure ulcers •Type and severity of the wound •Presence of complications Setting priorities -Preventing pressure ulcers -Promoting wound healing Teamwork and collaboration is the key to wound healing.

Assessment: Patient History and Pulmonary Health

Health Risk: family hx of lung cancer and CVD Environmental Exposures Pain Smoking Fatigue Respiratory Infections Dyspnea Allergies Cough Medications

Heart-Centering, Heart Coherence, and the Intuitive Heart

Heart-centering is one of the first processes the nurse engages in prior to any interaction. This process involves the nurse focusing her or his attention on the heart, setting aside concerns and thoughts, and connecting with feelings of love and compassion. -Maintaining this heart-centeredness throughout interactions has many positive effects for the nurse. -In addition to the positive mental, psychological, and physiologic effects, coherence may help to connect people with their intuitive inner guidance. -Research also shows that the positive mental and physiologic effects experienced by the nurse can be transmitted to the person.

High flow nasal cannula

High-flow nasal cannula may be beneficial in patients with ARDS. An alternative to intubation & mechanical ventilation Associated with nosocomial pneumonia and barrow trauma Heated humidification and large-bore nasal prongs to deliver oxygen at flows of up to 50 L/min. Usually well tolerated; allows the patient to talk, eat, and move around.

Prioritizing by importance

High: Nursing diagnoses that, if untreated, result in harm to a patient or other. -Maslow's hierarchy of needs. Intermediate: Nonemergent and not life-threatening. Low: Not always directly related to a specific illness or prognosis but affect a patient's future well-being.

Acknowledgment of the Infinite and Sacred Nature of Being

Holistic nursing acknowledges that people are infinite, sacred, and spiritual beings. Florence Nightingale spoke of human beings as a reflection of the Divine with physical, metaphysical, and intellectual attributes. Jean Watson teaches that we are sacred beings, and Martha Rogers speaks of unitary human beings as energy fields that are infinite in nature. The Model of Whole Person Caring combines these concepts to define person as "an energy field that is open, infinite, and spiritual in essence and in continual mutual process with the environment. Each person manifests unique physical, mental, emotional, and social or relational patterns that are interrelated, inseparable, and continually evolving." Thus, from the perspective of holistic nursing theorists and models, people are infinite and sacred in nature. This orientation makes a difference in how we approach one another. It shifts how we speak, listen, relate, and interact. When we perceive human beings as sacred, our words, actions, and behaviors are significantly affected.

What is holistic nursing?

Holistic nursing focuses on protecting, promoting, and optimizing health and wellness; assisting healing; preventing illness and injury; alleviating suffering, and supporting people to find peace, comfort, harmony, and balance through the diagnosis and treatment of human response.

CV 4: Holistic education and research

Holistic nursing is further realized through education and research.16,p.18 Holistic nurses value all the ways of knowing and learning. Educators need to be familiar with the American Association of Colleges of Nursing (AACN), which includes language for baccalaureate generalist graduates to practice from a holistic, caring framework.19 Holistic nurses look at alternative philosophies of science and research methods that are compatible with investigations of humanistic and holistic occurrences.

Fluid balance regulation

Hormones communicate the regulation of fluid levels: -Antidiuretic hormone (ADH) - Restores blood volume by reducing urine output -Decreased blood volume and increased solute concentration are sensed by the brain -ADH is produced by the hypothalamus -Kidneys retain water, which increases intravascular volume and decreases solute concentration -Renin-Angiotensin-Aldosterone cascade -Special cells in the kidney sense a decrease in blood flow or sodium levels. The net effect is to restore blood volume and renal perfusion through sodium and water retention. -Renin is released into the bloodstream -Renin is converted (several steps) to angiotensin II (vasoconstrictor, sodium and water retention, stimulator of aldosterone production) -Aldosterone causes the kidneys to retain sodium and water

Hydrocolloid dressing

Hydrocolloid dressings are dressings with complex formulations of colloids and adhesive components. They are adhesive and occlusive. The wound contact layer of this dressing forms a gel as wound exudate is absorbed and maintains a moist healing environment. Hydrocolloids support healing in clean granulating wounds and autolytically debride necrotic wounds; they are available in a variety of sizes and shapes. This type of dressing absorbs drainage through the use of exudate absorbers in the dressing; maintains wound moisture; slowly liquefies necrotic debris; and can be left in place for 3 to 5 days. In addition, hydrocolloid dressings are impermeable to bacteria and other contaminants, act as a preventive dressing for high-risk friction areas, and are self-adhesive and mold to the wound. The hydrocolloid dressing is useful on shallow-to-moderately deep dermal injuries. Hydrocolloid dressings cannot absorb drainage from heavily draining wounds, and some are contraindicated for use in full-thickness and infected wounds. Most hydrocolloids leave a residue in the wound bed that is easy to confuse with purulent drainage.

Hydrogel dressing

Hydrogel dressings are gauze or sheet dressings impregnated with water or glycerin-based amorphous gel. This type of dressing hydrates wounds and absorbs small amounts of exudate. Hydrogel dressings are indicated for use in partial-thickness and full-thickness wounds, deep wounds with some exudate, necrotic wounds, burns, and radiation-damaged skin. They debride necrotic tissue by softening the necrotic area. They can be very useful in painful wounds because they are very soothing to a patient and do not adhere to the wound bed and thus cause little pain during removal. A disadvantage is that some hydrogels require a secondary dressing and you must take care to prevent periwound maceration. Hydrogels also come in a tube; thus you are able to squirt the gel directly into the wound base.

Identify the potential clinical outcomes occurring as a result of hyperventilation, hypoventilation, and/or hypoxemia.

Hypoventilation:- decreased rate and depth of breathing.-Small amount of air is moved in & out of lungs.-Retain CO2.S/S- decreased rate and depth of breathing, Small amount of air is moved in & out of lungs, Retain CO2 Hyperventilation:-Increased rate and depth of breathing-Large amount of air is moved in & out of lungs.-"Blow off" CO2.; ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism-S/S- increased RR, sighing breaths, numbness & tingling of hands/feet, light-headedness, loss of consciousness.-Causes of Severe Hyperventilation: Medications, (ASA poisoning, amphetamines), CNS abnormalities, DKA, high altitude, exercise, heat (fever), panic, fear, or anxiety Hypoxemia:-decreased Arterial blood O2 levels, Decreased Hgb levels; diminished concentration of inspired oxygen. Inability of the tissues to extract o2 from the blood.-S/S- Changes in the color of your skin, ranging from blue to cherry red, Confusion,Cough, Fast heart rate, Rapid breathing, Shortness of breath, Sweating, Wheezing.

Warm Soaks

Immersion of a body part in a warmed solution promotes circulation, lessens edema, increases muscle relaxation, and provides a means to apply medicated solution. Sometimes a soak is also accompanied by wrapping the body part in dressings and saturating them with the warmed solution. Position the patient comfortably, place waterproof pads under the area to be treated, and heat the solution to about 40.5° to 43°C (105° to 110°F). Pour solution into a clean or sterile basin or container, then immerse the body part. Cover the container and extremity with a towel to reduce heat loss. It is usually necessary to remove the cooled solution and add heated solution after about 10 minutes. The challenge is to keep the solution at a constant temperature. Never add a hotter solution while the body part remains immersed. After any soak dry the body part thoroughly to prevent maceration.

AHNA

In 1980, founder Charlotte McGuire and 75 founding members began the national organization in Houston, Texas. The national office is now located in Topeka, Kansas. The AHNA's mission is to advance the philosophy and practices of holistic nursing and unite nurses in healing with a focus on holistic principles of health, preventive education, and the integration of allopathic and complementary caring and healing modalities to facilitate care of the whole person and significant others. From its inception in 1980, the AHNA has been the leader in developing and advancing holistic principles, practices, and guidelines. The association predicted that holistic principles, caring and healing, and the integration of complementary and integrative therapies and approaches would emerge into mainstream health care.

Faith

In addition to being a component of spirituality, the concept of faith has other definitions. It is a cultural or institutional religion such as Judaism, Buddhism, Islam, or Christianity. It is also a relationship with a divinity, higher power, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action). Reasoning faith provides confidence in something for which there is no proof. It is an acceptance of what reasoning cannot explain. Sometimes faith involves a belief in a higher power, spirit guide, God, or Allah. It is also the way a person chooses to live. It gives purpose and meaning to an individual's life, allowing for action.

Exhaustion Stage

In the exhaustion stage continuous stress causes progressive breakdown of compensatory mechanisms. This occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation. The physiological response has intensified, but the person's ability to adapt to the stressor diminishes. Even in the face of chronic demands, an ongoing state of chronic activation can occur. This chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs and is called allostatic load . A persistent allostatic load can cause long-term physiological problems such as chronic hypertension, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders.

Inflammation stage

In the inflammation stage, damaged tissue and mast cells secrete histamine, resulting in vasodilation of surrounding capillaries and causes movement/migration of serum and white blood cells into the damaged tissues

Spiritual Health: Planning

-Goals and outcomes: based on diagnoses you have created for the patient; focus on helping patients integrate their own spiritual beliefs -Setting priorities -Collaboration *TERMINALLY ILL - SPIRITUAL CARE IS OFTEN MOST IMPORTANT NURSING INTERVENTION*

Acid/Base Balance

-Just as with fluid status, the body is constantly balancing for acid/base balance. -Infection, disease, and medications can impact the balance. -pH is how acid/base balance is measured. -Normal pH has a very narrow window.

Nursing Process: Implementation (Teaching)

-Maintaining learning attention and participation -Building on existing knowledge -Teaching approaches -Telling (when limited time for teaching & no opportunity for feedback) -Participating -Entrusting -Reinforcing

Patient education includes:

-Maintenance and promotion of health and illness prevention -Restoration of health -Coping with impaired functioning

Factors influencing pressure injury formation and wound healing are:

-Nutrition -Tissue perfusion -Infection -Age -Psychosocial impact of wounds

Electrolyte Concentrations

-oncentration of electrolytes vary by location Extracellular -Sodium, chloride, bicarbonate -Others in lower concentrations Intracellular -Potassium, magnesium, phosphate, sulfate -Others in lower concentrations

Collaborative management of Hypernatremia

1.Replace fluids being lost if cause Hypotonic solution (D5W)-why? 2. Na+ restriction -Treat underlying cause -Diuretics (to remove Na) -Dialysis

Calculating fluid loss/gain

2.2 lbs. = 1 kg = 1 liter*** Shows importance of accurate body weight

Roughly how many alveoli are in each lung?

300 million

Hope

A spiritual person's faith brings hope. When a person has the attitude of something to live for and look forward to, hope is present. It is a multidimensional concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges. Hope is closely associated with faith; it is energizing and motivates people to achieve goals, such as adopting healthy behaviors. People express hope in all aspects of their lives to help them deal with life stressors. It is a valuable personal resource whenever someone is facing a loss or a difficult challenge.

Hyperventilation

A state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism

Causes of Hypomagnesemia

-Alcoholism-causes decrease in Mg absorption in intestines due to decrease in liver enzymes -Severe or chronic malnutrition -Malabsorption syndromes- (Crohn's) -GI losses -Renal losses -Prolonged IV or TPN without Mg++ replacement -Drugs: antacids inhibit uptake of mag from intestines -Excessive calcium intake inhibits Mg++ absorption -Drugs: antacids inhibit uptake of Mg++ from intestines -Excessive calcium intake inhibits Mg++ absorption

Maintenance and promotion of lung expansion

-Ambulation: therapeutic benefits of activity include increase in general strength and lung expansion -Positioning: frequent changes of position reduce stasis of pulmonary secretions and decreased chest wall expansion -Incentive spirometry: pic

Infection Control Nursing Process: Implementation

-Aseptic technique: Medical Asepsis and Surgical Asepsis -Infection control: Handwashing, Standard precautions and Isolation and isolation precautions -Patient and family teaching

Assessing Spirituality

-Assess the patients faith and beliefs -Review the patient's view of life, self-responsibility, and life satisfaction -Assess the extent of the patient's fellowship and community -Review if the patient practices religion and rituals

Patient Teaching - Hypermagnesemia

-Avoid constant use of antacids and laxatives that contain Mg, especially if urine output is decreased -Increase fiber -Drink adequate fluids to promote fecal elimination (if not contraindicated)

Collaborative Management of Hypocalcemia

-Ca++ supplements -Po or IV -IV= do not give IV push except in extreme emergencies; (can cause burning necrosis and tissue sloughing) -Vitamin D -Dietary Consult -Monitor lab values -Neuro: safety -Foods/ fluids rich in calcium -Educate!!

What is our body fluid made of?

-Contains oxygen, nutrients, excretory products -Electrolytes are substances that separate into electrically charged particles when dissolved in water -Cations are positively charged: Sodium (Na+), potassium (K+), calcium (Ca2+), magnesium (Mg2+) -Anions are negatively charged: Chloride (Cl-), bicarbonate (HCO3-), phosphate (PO43-), sulfate (SO42-) -Nonelectrolytes are substances that do not carry an electric charge (glucose/albumin)

Ability to learn is influenced by:

-Developmental capability -Learning in children -Developmental stage -Adult learning -Health literacy and learning disabilities -Physical capability -Learning environment

Risk diagnosis Nursing Diagnostic Statements

-Diagnoses that apply when there is an increased potential or vulnerability for a patient to develop a problem or complication. -Risk for Impaired Skin Integrity -Cannot use 'Risk for' on every diagnosis.

External Variables Influencing Health and Health Beliefs and Practices

-Family role and practices -Social determinants of health (SDOH)

Chemical Buffers

-First line of defense -Chemical buffers act immediately to protect cells -Bicarbonate buffers -Phosphate buffers -Protein buffers -Neutralize acid or make it weaker -Body is more effective with excess acid than excess base -Quick action to minimize damage until other systems take over

Nonassertive

-Focuses on self -Low self concept -Not honest with self or others

Problem-focused Nursing Diagnostic Statements

-Identify an undesirable human response to existing problems or concerns of a patient. -Impaired Skin Integrity

Lifestyle factors influencing oxygenation

-Nutrition -Hydration -Exercise -Smoking -Substance abuse -Stress

Concept Mapping

-Organizes assessment data -Places all of the cues together into clusters that form patterns which leads you to the next step of the nursing process, nursing diagnosis

Evaluation: med admin

-Patient outcomes -Use knowledge of the desired effect and common side effects of each medication to compare expected outcomes with actual findings.

Implementing spiritual care into restorative and continuing care settings

-Prayer -Meditation -Supporting grief work

Conditions Affecting Chest Wall Movement

-Pregnancy -Obesity -Trauma -Neuromuscular diseases -Central nervous system alterations -Influences of chronic lung disease

Evaluating an ABG - Look for compensation

-Respiratory and metabolic systems are linked and try to balance the equation. -Compensating values may be out of range, but do not make sense with the pH. -Compensation may be absent, partial or complete.

Restorative & Continuing Care

-Respiratory muscle training -Breathing exercises -Pursed-lip breathing -Diaphragmatic breathing -Home oxygen therapy (for those below 88% on room air)

Collaborative Management of Hyperkalemia

-Restrict K+ intake -Severe cases: dialysis; insulin & glucose; ion exchange resin: Kayexalate, sorbitol -NPO

Evaluation: Involves Two Parts

-State if the outcome was: Met, Partially Met or Not met -What behaviors/criteria were used to evaluate the outcome.

Theory of health as expanding consciousness

-nursing is caring: a moral imperative -health is expanding consciousness that includes an individual's total pattern -health-illness is a unitary process -people are open systems -research is praxis

Developmental factors influencing oxygenation

-older patients might not have as strong of a cough -could have osteoporosis that impacts the size and shape of the thorax -chronic heart disease -weakened immune system

Respiratory Alkalosis signs and symptoms

-↑ neuromuscular irritability -Tingling around mouth, spasms of fingers -Sx of hyperventilation - lightheadedness, sometimes loss of consciousness. -Lab values

3 mechanisms to eliminate acid excess from the Kidneys

1. Secretion small amts. free H+ in renal tubule 2. Combines H+ with NH3 to form ammonium (NH4) 3. Excretion of weak acids -Urine pH can be 4-8

What is a Nursing Theory?

A foundation of nursing care that conceptualizes an aspect of nursing to describe, explain, predict or prescribe nursing care -Florence Nightingale's Environmental Theory to promote healing and comfort.

Holistic communication:

A free flow of verbal and nonverbal interchange between and among people and significant beings such as pets, nature, and God/Life Force/Absolute Being/Transcendent Being that explores meaning and ideas leading to mutual understanding and growth.

Relationship-centered care:

A process model of caregiving that is based on a vision of community where three types of relationships are identified: (1) patient-practitioner relationship, (2) community-practitioner relationship, and (3) practitioner-practitioner relationship. Each of these relationships is essential within a reformed integrative healthcare delivery system in a hospital, clinic, or community or in the home. Each component involves a unique set of responsibilities and tasks that addresses the three areas of knowledge, values, and skills (Tresolini and Pew-Fetzer Task Force, 1994).

Transformational leadership:

A style of leadership in which the individual identifies the needed change and creates a clearly articulated vision to guide the change through inspiration, integrity, and mutual respect. The change is accomplished with the commitment of the group members and by maximizing human potential and mentorship.

Urination

Adequate blood flow and pressure is critical for kidney function -Average standard (especially postop) is 30 mL/hr or 0.5 mL/kg/hr Urine output reflects status of other systems Kidneys filter the blood and excrete compounds: -Waste products -Electrolytes -Excess fluid -Selectively retain or excrete fluid and electrolytes Kidney failure and malfunction will manifest itself in other systems***

Identity vs. Identity Confusion

Adolescence -Reflects on inconsistencies in stories -Begins to question spiritual practices, forms own opinions, and occasionally discards parents' beliefs -Abstract reasoning leads to exploration of moral issues -Spirituality comes from connectedness with family, nature, and God or a supreme being

Critical thinking

An active, purposeful, organized cognitive process involving creativity, reflection, problem solving, rational judgment, intuitive judgment, an attitude of inquiry, and a philosophical orientation toward thinking about thinking.

Appreciative inquiry:

An asset-based approach built on the assumption that every organization has positive elements and processes and that these strengths can be the starting point for positive change.

Person:

An individual, patient, patient, family member, support person, or community member who has the opportunity to engage in interaction with a holistic nurse.

Infection

An infection results when a pathogen invades tissues and begins growing within a host.

Chip on the shoulder symptoms

Because of your anger over past violation of your emotional and/or physical space and the real or perceived ignoring of your rights by others, you have a chip on your shoulder that declares, "I dare you to come too close!"

Spirituality and Relationship to a Higher Power

Cardiologist and mind-body researcher Dr. Herbert Benson (1996) emphasized that human beings are wired for God in his classic work, and others have agreed. The implication is that every human being needs a relationship with a Higher Power, also variably referred to as the Source, the Divine, God, Christ, Buddha, Yahweh, Spirit, Universal Energy, and others. Maslow's hierarchy of needs suggests that those moving closer to self-actualization also move closer in their search for the Source. Nurses need to acknowledge that people of different religions may view relationship with a Higher Power in myriad ways.

Clarity and Brevity

Effective communication is simple, brief, and direct. For certain populations such as the elderly, fewer words result in less confusion. Speak slowly, enunciate clearly, and use brief examples to make explanations easier to understand. Repeating important parts of a message also clarifies communication. Phrases such as "you know" or "OK?" at the end of every sentence detract from clarity. Use sentences and words that express an idea simply and directly. "Where is your pain?" is much better than "I would like you to describe for me the location of your discomfort."

Martha Rogers

Emphasis on the science and art of nursing, with the unitary human being central to the discipline of nursing

Environment and fluids

Hot environments increase fluid output through sweating. Sweat is a hypotonic sodium-containing fluid. Excessive sweating without adequate replacement of salt and water can lead to ECV deficit, hypernatremia, or clinical dehydration. Ask patients about their normal level of physical work and whether they engage in vigorous exercise in hot environments. Do the patients have fluid replacements containing salt available during exercise and activity?

Design Phase of 4-D Cycle

In the design phase, the focus is on determining the structure for the envisioned future. Typically, choices must be made.

Victimhood or martyrdom symptoms

In this symptom, you identify yourself as a violated victim and become overly defensive to ward off further violation. Or it can be that once you accept your victimization you continue to be knowingly victimized and then let others know of your martyrdom.

Costs of Accidents

Indirect costs: •Schedule delays •Lower morale •Increased Absenteeism •Poor Customer Relations •Re-training

Stage 2 Pressure Ulcer

Partial-thickness skin loss with exposed dermis •Partial-thickness. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or serosanguineous filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising. Bruising indicates deep tissue injury.

Contact Precautions

Methods of infection control that must be used for patients known or suspected to be infected with epidemiological microorganisms that can be transmitted by either direct or indirect contact. -private room -gloves -gowns -C. diff, MRSA, scabies

Medication tolerance

More medication is required to achieve the same therapeutic effect. Occurs over time. Patients hospitalized for acute illnesses do not develop medication tolerance.

facilitated diffusion

Movement of specific molecules across cell membranes through protein channels -Facilitated diffusion is passive and requires no energy other than that of a concentration gradient. -Glucose transport into the cell is an example of facilitated diffusion. There is a carrier molecule on most cells that increases or facilitate the rate of diffusion of glucose into these cells.

Braden Scale

The Braden scale was developed based on risk factors in nursing home patient populations. It is used to predict the patients are risk for developing pressure ulcers. It is composed of six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. The total score ranges from 6 to 23; a lower total score indicates a higher risk for pressure ulcer development.

Relationship to Other Living Beings

Often, relationships with animals can be as important as relationships with other people. Pets and therapeutic animals may provide unconditional love, affection, companionship, and fidelity. Animal-assisted therapy has become very popular, and studies have shown remarkable health benefits. Animals, particularly dogs, have been used to provide an incredible number of services for those with hearing and vision impairment, palliative care patients, elders and Alzheimer disease patients, and children with special needs.

Ego identity vs. Despair and Disgust

Older adulthood -Values love and interactions with others -Focuses on overcoming oppression and violence -Beliefs vary based on many factors such as gender, past experiences, religion, economic status, and ethnic background

Primary Prevention

PREVENT -True prevention that lowers the chances that a disease will develop. The goal is to reduce the incidence of disease. -Primary prevention include health education programs, nutrition programs and physical fitness activities. -Examples include immunizations, early screening etc.

Heart Failure and fluids

Patients who have chronic heart failure have diminished cardiac output, which reduces kidney perfusion and activates the RAAS. The action of aldosterone on the kidneys causes ECV excess and risk of hypokalemia. Most diuretics used to treat heart failure increase the risk of hypokalemia while reducing the ECV excess. Dietary sodium restriction is important with heart failure because Na + holds water in the ECF, making the ECV excess worse. In severe heart failure a restriction of both fluid and sodium may be prescribed to decrease the workload of the heart by reducing excess circulating fluid volume.

Identification:

Patterning behavior after that of another person and assuming that person's qualities, characteristics, and actions

Discuss the influence of spiritual practices on the health status of patients.

People gain spiritual health by finding a balance between their values, goals, and beliefs and their relationships within themselves and others. Throughout life a person often grows more spiritual, becoming increasingly aware of the meaning, purpose, and values of life. In times of stress, illness, loss, or recovery, a person often uses previous ways of responding or adjusting to a situation. Often these coping styles lie within the person's spiritual beliefs.

Person

Person is the recipient of nursing care, including individual patients, groups, families, and communities. The person is central to the nursing care you provide. Because each person's needs are often complex, it is important to provide individualized patient-centered care.

Describe how to assess for the risk factors affecting a patient's oxygenation.

Physiological factors: • decreased O2 carrying capacity • hypovolemia •Decreased inspired O2 concentration • increased metabolic rate Conditions affecting chest wall movements: • pregnancy • obesity • musculoskeletal abnormalities •trauma • neuromuscular diseases • Central nervous system alterations • influences of chronic disease

Holistic ethics

The basic underlying concept of the unity and integral wholeness of all people and of all nature, identified and pursued by finding unity and wholeness within the self and within humanity. In this framework, acts are not performed for the sake of law, precedent, or social norms but rather from a desire to do good freely to witness, identify, and contribute to unity.

Spiritual Health: Diagnosis

Potential diagnoses include: -Risk for Spiritual Distress -Defective Spiritual Distress -Hopelessness -Spiritual Distress -Decreased Spiritual Distress

Describe the differences in wound healing by primary and secondary intention.

Primary: Skin edges are approximated, or closed, and the risk of infection is low. Healing occurs quickly with minimal scar formation, as long as infection and secondary breakdown are prevented. (surgical wound - no tissue loss) Secondary: The wound is left open until it becomes filled by scar tissue. it takes longer for a wound to heal by SI; thus the chance of infection is greater.Secure scaring = potential loss of tissue function (burn, pressure ulcer)

The domain of nursing

The domain is the perspective or territory of a profession or discipline. It provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline. The domain of nursing provides both a practical and theoretical aspect of the discipline. It is the knowledge of nursing practice and nursing history, nursing theory, education, and research. The domain of nursing gives nurses a comprehensive perspective that allows you to identify and treat patients' health care

Ensuring Opportunities for Rest and Leisure

Rest, leisure, and Sabbath time are integral aspects of holistic living and care of the spirit that enhance growth, creativity, and renewal (Mueller, 2000). Leisure is an attitude of the heart that facilitates connection with the inner self and the Sacred Source and opens one to reflect on and envision a life of doing to allow for more Being. Authentic leisure implies an approach to living that allows one to relax into a level of being that deepens self-awareness, nourishes one's wholeness, and enriches connections with the Sacred Source and other people. Assisting persons to consider the place of rest and leisure in their lives is part of holistic nursing. Taking stock of how they integrate rest and leisure into their own lives is a necessary part of self-care for nurses as well. In an increasingly busy society—where filling each moment is viewed in terms of productivity, where even leisure time is scheduled—the notion of rest and leisure deserves thoughtful consideration.

Developmental Stages and Risks: School Age Children

School-age children enter a period of less intense emotions, secure in their dependency on parents and family and with self-confidence tempered by a more realistic perspective. They have energy to explore the environment beyond the home and to gradually increase the scope of interpersonal interaction. -importance of protective gear in sports -school violence (bullying, fighting, abuse)

Pain and wounds

Significant research has been conducted in the study of pain in surgical patients with wounds. The routine assessment of pain in surgical patients is critical to selecting appropriate pain management therapies and to determine a patient's ability to progress toward recovery. The WOCN has recommended that assessment and management of pain also be included in the care of patients with pressure injuries. Use standard pain assessment tools to measure pain acuity, and be thorough in assessing the character of a patient's pain. Maintaining adequate pain control and patient comfort increases the patient's willingness and ability to increase mobility, which in turn reduces pressure injury risk.

Meaning:

That which is signified, indicated, referred to, or understood. Personal/individual meaning denotes symbolic value, significance, and purpose-an individual's perception of an experience. Philosophical meaning is meaning that depends on the symbolic connections that are grasped by reason. Psychological meaning is meaning that depends on connections that are experienced through intuition or insight.

4-D Cycle

The 4-D process enables individuals to discover their foundation of strengths—their positive core. By doing this before envisioning the future (dream), articulating designs for change (design), and establishing a path forward (destiny), they create confidence and hope for the future.

Blood Flow Regulation

The amount of blood ejected from the left ventricle each minute is the cardiac output . The normal cardiac output is 4 to 8 L/min in the healthy adult at rest. The circulating volume of blood changes according to the oxygen and metabolic needs of the body. For example, cardiac output increases during exercise, pregnancy, and fever but decreases during sleep. The following formula represents cardiac output: CO (cardiac output) = SV (stroke volume) x HR (heart rate)

Coronary Artery Circulation

The coronary circulation is the branch of the systemic circulation that supplies the myocardium with oxygen and nutrients and removes waste. The coronary arteries fill during ventricular diastole. The left coronary artery has the most abundant blood supply and feeds the more muscular left ventricular myocardium, which does most of the work of the heart

Developmental Stages and Risks: Older Adult

The physiological changes associated with aging, the effects of multiple medications, psychological and cognitive factors, and the effects of acute or chronic disease increase an older adult's risk for falls and other types of accidents (e.g., burn injuries, vehicular crashes).

Managing stress

The work of professional nursing is difficult as you see patients endure suffering from disease and painful therapies and as you try to manage care responsibilities in busy, fast-paced work settings. -Stress over a prolonged period or when extreme can lead to poor work productivity, impaired decision making and communication, and reduced ability to cope with clinical situations.

Diet Therapies

The intake of food satisfies and promotes a sense of comfort. Food and nutrition are important aspects of patient care and often an important component of some religious observances. Food and the rituals surrounding the preparation and serving of food are sometimes important to a person's spirituality. Consult with a dietitian to integrate patients' dietary preferences into daily care. In the event that a hospital or other health care agency cannot prepare food in the preferred way, ask the family to bring meals that fit into dietary restrictions posed by the patient's condition.

Vocabulary

Vocabulary Communication is unsuccessful if senders and receivers cannot translate one another's words and phrases. When you care for a patient who speaks another language, a professional interpreter is necessary. Even those who speak the same language use subcultural variations of certain words. Medical jargon sounds like a foreign language to patients unfamiliar with the health care setting. Limiting use of medical jargon to conversations with other health care team members improves communication. Children have a more limited vocabulary than adults and often use special words to describe bodily functions or a favorite blanket or toy. Teenagers often use words in unique ways that are unfamiliar to adults.

Nursing Process: Evaluation (Infection Prevention)

Were the interventions successful? -Have the patient's expectations been met? Patient outcomes -Was infection prevented or managed? -Compare the patient's actual response with expected outcomes. -If goals are not achieved, determine what steps must be taken. Was it the right plan?

Infection and wounds

Wound infection prolongs the inflammatory phase; delays collagen synthesis; prevents epithelialization; and increases the production of proinflammatory cytokines, which leads to additional tissue destruction. Indications that a wound infection is present include the presence of purulent drainage; change in odor, volume, or character of wound drainage; redness in the surrounding tissue; fever; or pain.

Inclusive excellence

a comprehensive approach to institutional transformation, focusing on students' ability to recognize, assess, and critically analyze systems of inequity so they may work toward eliminating some of the most urgent injustices of society.

Infectious Agent

a pathogen, such as a bacterium or virus that can cause a disease ex: coronavirus

Holistic Nursing

all nursing practice that has healing the whole person as its goal

Human caring:

The moral ideal of nursing in which the nurse brings one's whole self into a relationship with the whole self of the person being cared for to protect that person's vulnerability, preserve her or his humanity and dignity, and reinforce the meaning and experience of oneness and unity.

In order to use the nursing process...

critical thinking must be in place

Age and wounds

The physiological changes associated with aging affect all phases of wound healing. A decrease in the functioning of macrophages leads to a delayed inflammatory response, delayed collagen synthesis, and slower epithelialization.

Intravascular fluid

fluid within blood vessels (20% of extracellular fluid)- Within the arteries, veins and capillaries (Plasma)

oxyhemoglobin

hemoglobin bound to oxygen. -the formation of oxyhemoglobin is easily reversible, allowing hemoglobin and oxygen to dissociate (deoxyhemoglobin), which frees oxygen to enter tissues.

The four phases involved in the healing process of a full-thickness wound are:

hemostasis, inflammation, proliferation, and maturation.

Peak

highest level

Convalescence Stage

host recovers gradually and returns to baseline. The pathogen load starts to decline, but may not be completely eliminated immediately, hence the host may continue to be a source of infection even if feeling better

Repression

is the unconscious blocking of painful thoughts or feelings. However, this unconscious, repressed material may affect a person's behaviors, moods, and health in undesirable ways. An example of repression is when a victim of childhood abuse has trouble forming normal adult relationships. Defense mechanisms can interfere with healthy relationships and create distance from the truth.

Red Blood Cells and Oxygen

made for the purpose of carrying around oxygen to the body. don't need oxygen, simply carry it around. -has no mitochondria so does not use oxygen

Systemic Circulation

oxygenated blood leaves the left ventricle through the aorta (branches and splits) towards the body (brain, bones, liver, etc) and deoxygenated blood goes back to the heart through the inferior and superior vena cava and into the right atrium

Alkalosis

pH above 7.45 decreased acid or increased base

Diffusion

passive movement of electrolytes or other particles down a concentration gradient from areas of higher concentration to areas of lower concentration. -Occurs within fluid compartment and from one compartment to another. -Example: When you pour a small amount of cream into a cup of black coffee, the cream mixes or spreads through the whole cup of coffee and diffuses throughout. (passive)

Pulmonary arteries and veins

supply blood and return blood to and from all segments of the lungs

The following nursing actions reflect caring:

• Becoming sensitive and supportive to self and others • Being present and encouraging the expression of positive and negative feelings • Developing healing relationships • Instilling faith and hope • Promoting interpersonal teaching and learning • Providing for nursing care needs in a supportive way • Respecting and allowing for spiritual expression

Nursing Assessment Questions: Spirituality and Spiritual Health

• Which experiences in the past have been most difficult for you? • What gives you hope during those difficult times? • Which aspects of your spirituality have been most helpful to you? • Which aspects of your spirituality would you like to discuss?

Invisibility symptoms

This symptom involves your pulling in or overcontrolling so that others, even yourself, never know how you are really feeling or what you are really thinking. Your goal is not to be seen or heard so that your boundaries are not violated.

Vocation

Individuals express their spirituality on a daily basis in life routines, work, play, and relationships. It is often a part of a person's identity and vocation. Determine whether illness, injury, or hospitalization alters the ability to express some aspect of spirituality as it relates to the person's work or daily activities. Expression of spirituality includes showing an appreciation for life in the variety of things people do, living in the moment and not worrying about tomorrow, appreciating nature, expressing love toward others, and being productive. When illness or loss prevents patients from expressing their spirituality, understand the psychological, social, and spiritual implications and provide appropriate guidance and support. Questions to ask include, "How has your illness affected the way you live your life spiritually at home or where you work?" or "How has your illness affected your ability to express what's important in life for you?"

Developmental Stages and Risks: Infants, toddlers and preschoolers

Injuries are the leading cause of death in children over age 1. The nature of the injury sustained is closely related to normal growth and development. Infants and toddlers explore the environment and, because of their increased level of oral activity, put objects in their mouths increasing their risk for poisoning or aspiration and choking on foreign material such as small toys. -infants should sleep on back in crib free of toys, blankets, etc -falls (especially in preschool-age) from lack of coordination

Trauma

Intrusive flashbacks or even intentional thinking back trigger a wave of the same emotions and chemicals experienced during trauma. Early trauma is recognized as having a significant effect on health. Autoimmune diseases develop; the particular disease is dependent upon genetics, environment, and lifestyle. Children who experienced trauma have higher levels of cortisol in their hair, and in a 2015 study, this translated directly to significantly more childhood disease compared to those who were not traumatized. Long-term and unremitting stress can reduce immune function and increase the inflammatory response, and the body enters an illness state. The continuous presence of high levels of cortisol and other stress chemicals triggers inflammatory processes; increases the risk of such disorders as osteoporosis, ulcers, and Alzheimer's disease; and leads to immune system imbalance. Autoimmune diseases are triggered.

Trust

It has been traditionally felt that an ideal nurse-patient relationship requires the development of trust before patients can openly communicate. Trust is an essential element of the therapeutic and healing relationship. -vital step in building trust includes the ability to risk being vulnerable -Firm reliance on the integrity, ability, or character of a person or thing -Trust must be built, earned, and maintained -Maintain confidentiality, connect with the patient, follow through on obligations -Be honest

Body Fluids and wounds

It is important to prevent and reduce the patient's exposure to body fluids; when exposure occurs, provide meticulous hygiene and skin care. Continual exposure of the skin to body fluids increases a patient's risk for skin breakdown and pressure injury formation. Some body fluids such as saliva and serosanguineous drainage are not as caustic, and the risk of skin breakdown from exposure to these fluids is low. However, exposure to urine, bile, stool, ascitic fluid, and purulent wound exudate carries a moderate risk for skin breakdown, especially in patients who have other risk factors such as chronic illness or poor nutrition. Frequent exposure to urine and fecal contents increases patients' risk for incontinence-associated dermatitis (IAD). Additionally, exposure to gastric and pancreatic drainage has the highest risk for skin breakdown. These fluids have digestive qualities that can irritate and break down the skin quickly.

Pruritus

Itching of skin; accompanies most rashes (mild allergic reaction)

Critical Items

Items that enter sterile tissue or the vascular system present a high risk of infection if they are contaminated with microorganisms, especially bacterial spores. Critical items must be sterile. These items include: • Surgical instruments • Cardiac or intravascular catheters • Urinary catheters • Implants

Jean Watson

Jean Watson defines person as "an embodied spirit; a transpersonal, transcendent, evolving consciousness; unity of mind-body-spirit; person-nature-universe as oneness, connected." -first nursing theorist to address the concept of soul -full use of the self -phenomenal field

Describe how to measure and record intake and output

Measuring and recording all liquid intake and output (I&O) during a 24-hour period is an important aspect of fluid balance assessment. Compare a patient's 24-hour intake with his or her 24-hour output. The two measures should be approximately equal if the person has normal fluid balance. -Fluid intake includes all liquids that a person eats (e.g., gelatin, ice cream, soup), drinks (e.g., water, coffee, juice), or receives through nasogastric or jejunostomy feeding tube. IV fluids (continuous infusions and intermittent IV piggybacks) and blood components also are sources of intake. Ask patients who are alert and oriented to help with measuring their oral intake and explain to families why they should not drink or eat from the patient's meal trays or water pitcher. -Fluid output includes urine, diarrhea, vomitus, gastric suction, and drainage from postsurgical wounds or other tubes. Record a patient's urinary output after each voiding. Instruct patients who are alert, oriented, and ambulatory to save their urine in a urinal or a calibrated insert, which attaches to the rim of the toilet bowl. Teach patients and families the purpose of I&O measurements. Also teach them to notify the nurse or assistive personnel (AP) to empty any container with voided fluid or how to measure and empty the container themselves and report the result appropriately.

Meditation

Meditation is a quiet turning inward—the practice of focusing one's attention internally to achieve clearer consciousness and inner stillness. Meditation is both a state of mind and a method. The state is one in which the mind is quiet, open, and receptive. The meditator is relaxed but alert. The method involves the focusing of attention on something such as the breath, an image, a word, or an action such as TaiChi. There is a sustained concentration, but it should be effortless. Meditation allows a better understanding of the self and increased receptivity to insights arising from one's deeper being. -perhaps the single most useful reflective practice to help gain self-awareness and self-knowledge, increase intuition, and enhance one's spiritual development. -takes discipline and practice

Metabolism of Medications

Metabolism -Medications are metabolized into a less-potent or an inactive form that is easier to excrete. -Biotransformation (process by which a substance changes from one chemical to another) occurs under the influence of enzymes that detoxify, break down, and remove active chemicals. -Most biotransformation occurs in the liver, although the lungs, kidneys, blood and intestines also metabolize the medications.

Generativity vs. Stagnation

Middle-age adulthood -Develops appreciation of past spiritual experiences -Embraces people from different faiths and religions -Reviews value system during crisis -Values others

heat therapy

Moist heat applications are therapeutically beneficial in increasing muscle and ligament flexibility; promoting relaxation and healing; and relieving spasm, joint stiffness, and pain. Moist heat has many indications; however, it is most commonly used following the acute phase of a musculoskeletal injury and during and after childbirth, surgery, and superficial thrombophlebitis. Moist heat applications include warm compresses and commercial moist heat packs, warm baths, soaks, and sitz baths. Dry heat is also used to reduce pain and increase healing by increasing blood flow in tissues and can be used at a low level for a longer period with little chance of tissue injury

Hyponatremia:

Na+ < 136 mEq/L Gain of relatively more water than salt. -Due to water excess: (Na+ dilution) -(cardiac, renal, hepatic failure) -Psych Disorders (results in excessive water intake Loss of relatively more salt than water -GI causes, kidney, skin

Partial Compensation

Non matching component is abnormal, and pH is still abnormal. -pH-7.35-7.45, PaCO2-(35-45 mm Hg), HCO3-(21-28 mEq/L) -pH 7.32 -PaCO2-60 mm Hg -HCO3-30 mEq/L -Respiratory acidosis with partial compensation because... -pH is still acidotic -The high PaCO2 makes sense with the pH -The high HCO3 does NOT make sense with the acidotic pH BUT shows the body is trying to balance the increase in acid

Stage 1 Pressure Ulcer

Non-blanchable erythema of intact skin •Nonblanchable Redness. Intact skin presents with nonblanchable redness of a localized area usually over a bony prominence. Discoloration of the skin, warmth, edema, hardness, or pain may also be present. Darkly pigmented skin may not have visible blanching but its coloring may differ from the surrounding area. The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue.

Define the terms nursing process and holistic caring process

Nursing process: A critical thinking five step process that professional nurses use to apply the best available evidence to deliver nursing care. Holistic Caring Process: six steps; focuses on protecting promoting and optimizing health and wellness, assisting healing; preventing illness and injury; alleviating suffering; supporting people to find peace, comfort, harmony and balance through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, populations and the planet.

Phenomenon

Nursing theories focus on the phenomena of nursing and nursing care. A phenomenon is the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent. Examples of phenomena of nursing include caring, self-care, and patient responses to stress.

Medications and fluids

Obtain a complete list of your patient's current medications, including over-the-counter (OTC) and herbal preparations, to assess the risk for fluid, electrolyte, and acid-base imbalances. Use a drug reference book or reputable online database to check the potential effects of other medications. Ask specifically about the use of baking soda as an antacid, which can cause ECV excess because of its high sodium content that holds water in the extracellular compartments. For an individual who uses laxatives, ask about the type of laxative, the frequency of use, and the consistency and frequency of stools. Multiple loose stools remove fluid and electrolytes from the body, thus causing numerous imbalances.

Objective Findings

Obtain objective findings related to stress and coping through observation of the appearance and nonverbal behavior of a patient. Observe grooming and hygiene, gait, characteristics of the handshake, actions while sitting, quality of speech, eye contact, and the attitude of the patient during the interview. Before the interview begins or at the end of the interview, depending on the anxiety level of the patient, obtain basic vital signs to assess for physiological signs of stress such as elevated blood pressure, heart rate, or respiratory rate. Make certain to incorporate cultural components of interpreting the patient's nonverbal communication behaviors.

Oliguric Renal Disease

Oliguria occurs when the kidneys have a reduced capacity to make urine. Some conditions such as acute nephritis cause sudden onset of oliguria, whereas other problems such as chronic kidney disease lead to chronic oliguria. Oliguric renal disease prevents normal excretion of fluid, electrolytes, and metabolic acids, resulting in ECV excess, hyperkalemia, hypermagnesemia, hyperphosphatemia, and metabolic acidosis. The severity of these imbalances is proportional to the degree of renal failure. Although chronic kidney disease is progressive, successful management of imbalances is possible with dietary restriction of sodium and other electrolytes, fluid restriction in severe cases, and eventually dialysis or renal transplant

Airborne mode of transmission

Organisms are carried in droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing. Germs are aerosolized by medical equipment or by dust from a construction zone (e.g., nontuberculous mycobacteria or Aspergillus).

Osmolality

Osmolality is approximately the same in the various body fluid spaces. Determining osmolality is important because it indicates the body's water balance. To assess the state of the body's water balance, one can measure or estimate plasma osmolality. Normal plasma osmolality is between 275 and 295 mOsm/kg. A value greater than 295 mOsm/kg indicates that the concentration of particles is too great or that the water content is too little. This condition is termed water deficit. A value less than 275 mOsm/kg indicates too little solute for the amount of water or too much water for the amount of solute. This condition is termed water excess. Both conditions are clinically significant. Because the major determinants of plasma osmolality are sodium and glucose, one can calculate the effective plasma osmolality based on the concentrations of those substances.

Individual Risk Factors

Other risk factors posing threats to safety include lifestyle, impaired mobility, sensory or communication impairment, limited economic resources, and the lack of safety awareness. Know patients' risks when you plan nursing care. LIFESTLYE: dangerous jobs, use of substances, risk takers, prescribed meds IMPAIRED MOBILITY: Muscle weakness, paralysis, abnormal gait, and poor coordination or balance SENSORY OR COMMUNICATION IMPAIRMENT: Cognitive impairments associated with delirium, dementia, and depression alter concentration and attention span ECONOMIC RESOURCES: People with lower incomes are more likely to have behavioral health issues LACK OF SAFETY AWARENESS

Risk for decreased cardiac output related to weak myocardial contraction outcomes and interventions

Outcomes 1.K+ will increase from (specify) to more normal range of... 2.VS w/i pt's baseline range 3.EKG = NSR- no vent dysrhythmias Interventions 1.Administer K+ supplements 2.Monitor serum K+ levels 3.Orthostatic VS q shift 4.Cardiac monitor- report changes

tissue perfusion

Oxygen fuels the cellular functions essential to the healing process; therefore the ability to perfuse the tissues with adequate amounts of oxygenated blood is critical to wound healing. Patients with diabetes and peripheral vascular disease are at risk for poor tissue perfusion because of poor circulation. Oxygen requirements depend on the phase of wound healing (e.g., chronic tissue hypoxia is associated with impaired collagen synthesis and reduced tissue resistance to infection).

Pros and cons of oral administration

PROS •Convenient •Most Economical •Safest Method •Easiest Method CONS •Slower onset •Can irritate lining of GI tract, discolor teeth, or have unpleasant taste. •Gastric secretions destroy some medications •Can't give to patients who are unconscious, confused, or unable to swallow

Pros and cons of inhaled or nebulized

PROS •Nasal: Provides local effect •Inhaled: Rapid absorption •Provides rapid relief for local respiratory problems •Used for introduction of general anesthetic gases CONS •Can be irritating to nose/nasal passages •Inhaled: Some local agents cause serious systemic effects

Pros and cons of topical or transdermal administration

PROS •Topical: Provides local effect •Painless •Limited Side Effects •Transdermal: prolonged systemic effects with limited side effects CONS •Topical: Patients with skin abrasions are at risk for rapid medication absorption and systemic effects •Medications are absorbed through the skin slowly. •Absorption is affected by the vascularity of the application site •Transdermal: Medication leaves oily or pasty substance on skin and sometimes soils clothing

Pros and cons of eye and ear drops

PROS •Usually treating the area directly CONS Cross-contamination is a potential problem with eye

Parenteral Nutrition

Parenteral nutrition (PN), also called total PN (TPN), is IV administration of a complex, highly concentrated solution containing nutrients and electrolytes that is formulated to meet a patient's needs. Depending on their osmolality, PN solutions are administered through a CVC in cases of high osmolality or through a peripheral intravenous (IV) line for lower osmolality solutions. Safe administration depends on appropriate assessment of nutrition needs, meticulous management of the CVC or IV to prevent infection, and careful monitoring to prevent metabolic complications.

Restriction of Fluids

Patients who have hyponatremia usually require restricted water intake. Patients who have very severe ECV excess sometimes have both sodium and fluid restrictions. Fluid restriction often is difficult for patients, particularly if they take medications that dry the oral mucous membranes or if they are mouth breathers. Explain the reason that fluids are restricted. Make sure that the patient, family, and visitors know the amount of fluid permitted orally and understand that ice chips, gelatin, and ice cream are fluids. Help the patient decide the amount of fluid to drink with each meal, between meals, before bed, and with medications. It is important to allow patients to choose preferred fluids unless contraindicated. Frequently patients on fluid restriction can swallow a number of pills with as little as 1 oz (30 mL) of liquid.

Eye Contact

People signal readiness to communicate through eye contact. Maintaining eye contact during conversation shows respect and willingness to listen. Eye contact also allows people to closely observe one another. Lack of eye contact sometimes indicates anxiety, defensiveness, discomfort, or lack of confidence in communicating. However, people from some cultures consider eye contact intrusive, threatening, or harmful and minimize or avoid its use (see Chapter 9 ). Always consider a person's culture when interpreting the meaning of eye contact. Eye movements communicate feelings and emotions. Looking down on a person establishes authority, whereas interacting at the same eye level indicates equality in the relationship. Rising to the same eye level as an angry person helps establish autonomy.

Connectedness

People who are connected to themselves, others, nature, and God or another Supreme Being usually report higher levels of physical and emotional health. One way patients remain connected is by praying. Prayer is personal communication with one's higher power that provides a sense of hope, strength, security, and well-being; it is a part of faith. Patients often use prayer when other treatments are ineffective, when they are experiencing fear or anxiety, or when they feel that they have no control over what is happening to them. Help patients become or remain connected by respecting each patient's unique sense of spirituality. Assess a patient's connectedness by asking open-ended questions: "Whom do you believe is the most important person in your life?" "In what way do you stay connected spiritually?" "Is prayer something helpful to you?" or "What feeling do you have after you pray?"

CV 1: Holistic philosophy, theories, and ethics

Philosophical, theoretical, and ethical foundations define the who and why of holistic nursing. Holistic nurses embrace a professional ethic of caring and healing that seeks to preserve the wholeness and dignity of self and others. Holistic practice uses presence, intentionality, compassion, and authenticity throughout the holistic nursing process

FVE: Assessment findings

Physical Assessment -Weight gain -Edema -Tachycardia -HTN (however, large volumes can be retained without a change in BP) -Distended neck veins -Crackles in lungs -If severe - confusion, pulmonary edema Laboratory Findings -Decreased hematocrit -Decreased BUN (hemodilution)

FVD: Assessment findings

Physical Assessment: -Weight loss -Orthostatic hypotension -Tachycardia (an increase in pulse by > 20/min is a more sensitive indicator than a decrease in BP) -Dry mucous membranes -Poor skin turgor -Dark yellow urine -If severe - thirst, restlessness, confusion, hypotension, urine output < 30 mL/hr, hypovolemic shock. Laboratory Findings: -Increased hematocrit -Increased BUN > 20 mg/dL (hemoconcentration) -Increased urine specific gravity > 1.030.

Touching

Physical contact through touch in its myriad forms may foster connection. Sensitivity to the meaning of touch for each person is essential in using touch therapeutically. When appropriate, a hand on the shoulder can provide support, a handclasp can convey understanding and presence, an arm around the waist can literally and figuratively give a lift. One patient described a nurse's support in saying, "When the doctor came in to give me the news, she was standing beside me and I could feel her hand on my arm the whole time the doctor was talking. I was so glad that she was just there with me." At times when words cannot be found, or in circumstances where persons are more comfortable with physical expression than with words, touch is a powerful expression of spirit and an instrument of healing.

Assessment and Pulmonary Health: Exam

Physical examination -Inspection: should include observation of the nails for clubbing, neck veins, chest, skin and peripheral edema -Palpation: legs and feet for pitting edema and pulses -Percussion: of chest -Auscultation: of lungs and heart; look for diminished lung sounds, crackles, etc Diagnostic tests

Physical Hazards

Physical hazards in the home and work environment threaten a person's safety and often result in physical or psychological injury or death. In 2016 unintentional injuries became the third leading cause of death ( Kochanek et al., 2017 ). Motor vehicle accidents, poisonings, and falls were the leading causes of unintentional injuries. Additional environmental hazards include fire and disasters. In the work setting, repetitive motion injuries, vehicle accidents, falling objects and falls are common causes of injuries. A nurse's role is to educate patients about the common safety hazards in the home and at work, teaching them how to prevent injury and emphasizing the hazards to which patients are the most vulnerable. -motor vehicle accidents -poison -falls -fire -natural disasters -transmission of pathogens -immunizations

Positioning

Positioning Repositioning (turning) patients is a consistent element of evidence-based pressure injury prevention. The twofold aim of repositioning should be to reduce or relieve pressure at the interface between bony prominence and support surface (bed or chair) and to limit the amount of time the tissue is exposed to pressure. Elevating the head of the bed to 30 degrees or less decreases the chance of pressure injury development from shearing forces. Change the immobilized patient's position according to tissue tolerance, level of activity and mobility, general medical condition, overall treatment objectives, skin condition, and comfort. A standard turning interval of 1.5 to 2 hours does not always prevent pressure injury development; repositioning intervals are based on patient assessment. Some patients may need more frequent position changes, while other patients can tolerate every-2-hour position changes without tissue injury. When repositioning, use positioning devices to protect bony prominences. The WOCN guidelines recommend a 30-degree lateral position, which should prevent positioning directly over the bony prominence. To prevent shear and friction injuries, use a transfer device to lift rather than drag the patient when changing positions.

Posture and Gait

Posture and gait (manner or pattern of walking) can be forms of self-expression. The way people sit, stand, and move reflects attitudes, emotions, self-concept, and health status. For example, an erect posture and a quick, purposeful gait communicate a sense of well-being and confidence. Leaning forward conveys attention. A slumped posture and slow, shuffling gait indicate depression, illness, or fatigue. Facial Expression The face is the most expressive part of the body.

Praying and Meditating

Prayer and meditation are spiritual disciplines practiced in many traditions, both cultural and religious. Appreciating the personal nature of these disciplines, the nurse, with respect and sensitivity, can help patients remember or explore ways in which they reach out to and listen for God or the Sacred Source. Recalling the place and meaning of prayer and the ways in which they experience the presence of and communion with God or the Sacred Source provides patients with a rich resource. In the clinical setting, both the nurse's and the patient's understanding of prayer will determine the role of prayer.

Stage 4 Pressure Ulcer

Pressure Injury: Full-thickness skin and tissue loss •Full-thickness Tissue Loss. Full-thickness tissue loss with exposed bone, tendon, or muscle. Subcutaneous fat may be visible and slough or eschar may be present. Often includes undermining and tunneling. The depth of a Category/Stage IV pressure ulcer varies by anatomical location.

Economic Consequences of Pressure Injuries

Pressure injuries are a continual problem in acute and restorative care settings, especially in patients 65 years and older . Paralysis and spinal cord injury are common preexisting conditions among younger adults with primary diagnosis of pressure injuries. Older adults admitted to acute and long-term facilities are a vulnerable population. Although the cost to provide pressure injury prevention to patients at risk can impact health care services' budgets, the costs to treat a severe pressure injury are substantially higher. When a pressure injury occurs, the length of stay in a hospital and the overall cost of health care increase. These injuries are also costly to patients in terms of disability, pain, and suffering. About 1.6 million patients each year in acute care settings develop pressure injuries, representing a cost of $11 billion to $17.2 billion to the US health care system. The Centers for Medicare and Medicaid Services (CMS) implemented a policy effective October 1, 2008, whereby hospitals no longer receive reimbursement for care related to stage 3 and 4 pressure injuries that occur during a hospitalization. Guidelines such as the WOCN Guidelines help reduce or eliminate the occurrence of pressure injuries and prevent the expenses that will not be reimbursed.

ANA Code of Ethics

Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Provision 2: The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Provision 4: The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Urticaria (hives)

Raised, irregularly shaped skin eruptions with varying sizes and shapes; eruptions have reddened margins and pale centers (mild allergic reaction)

Integrative Health and Wellness Assessment Wheel: Life Balance and Satisfaction

Reflecting on life balance and satisfaction includes identification of joys and possibilities and increased awareness and choices that may enhance our capacities, human potential, and the healing process. -attunes us to our healing awareness -the healing process includes self-assessment and self-reflection to recognize our feelings, attitudes, emotions, and other dimensions of wellness that are literally translated into our total being.

Fostering Connectedness

Relationships are a major aspect of spirituality. Awareness and an appreciation of important relationships in the patient's life enable the nurse to help strengthen meaningful and supportive bonds. Some family members may need encouragement and guidance to visit or call. Patients may need assistance in sharing some aspects of their situation with others—even when they very much want to explain what is happening to them and express their feelings about it. Nurses can remind patients of their network of care and support by recognizing and affirming the support of significant others. Statements such as "you seem especially close to Marta" may provide an opportunity for sharing about a special relationship. Photographs, artwork, and memorabilia of loved ones provide reminders of connections beyond the confines of illness or injury. Visits from pets may be as spiritually uplifting for some people as those from humans. Imagery, pictures, and stories can foster connection with important places, people, and experiences.

Sleep and overall health

Relevant to the connection between thoughts, behaviors, and health is sleep. Restricting sleep to 4 hours a night results in higher blood pressures and reduced function of the entire cardiovascular system. Inflammatory markers increase in the blood, amplifying any chronic pain or inflammatory diseases. Cells begin showing insulin-resistant behaviors that are known to lead to diabetes. Appetite increases and activity decreases, predisposing the individual to obesity. Those who are sleep deprived develop less immunity from vaccines, implying impaired immune function. Sleep apnea, teeth grinding, and other sleep disorders have been directly linked to increased perceived stress and subsequent health issues. Sleep apnea significantly increases inflammation in the body and has been shown to lead to cardiovascular disease. Sleep deprivation increases symptoms of mental health disorders and decreases perceived coping ability. Inadequate sleep is strongly linked to an increased risk of dying.

MI is based on four guiding principles

Resist the righting reflex: The righting reflex is the natural tendency of the nurse to fix a patient's problems by imposing solutions. The nurse must set aside any desire to correct the course and direction of the patient. If the nurse is pushing for change and the patient is resisting, the nurse is in the wrong role; it is the patient who should be voicing the arguments for change. The nurse must suppress what may seem like the right thing to do and instead allow the patient to determine what to do. Understand and explore the patient's motivation: It is the patient's reasons for change, not the nurse's, that are likely to trigger change. The nurse explores the patient's concerns, perceptions, and motivations. Allowing patients to tell their story and encouraging them to discuss not only their reasons for change but also how they might see themselves make those changes form the core of the partnership. Listen with empathy: Answers lie within the patient, and finding them requires listening. Good listening is a complex skill; it is more than asking questions and keeping quiet long enough to hear the reply. Empathy has been defined as a complex, multidimensional phenomenon17 but is typically understood as the ability to identify with the patient's difficulties or feelings. The ability to express empathy enhances the ability to engage patients in making necessary health changes and is a key component of MI. Empower and encourage hope and optimism: The nurse helps the patient discover how change can happen. The nurse views the patient as the expert consultant as ideas and resources for change are explored. Providing ongoing encouragement to foster the belief that the goals are achievable can help the patient carry out a plan to change behavior. Harnessing intrinsic motivation (the drive to do something because it is interesting, challenging, and absorbing) is a (RULE)

Describe the structure and function of the cardiopulmonary system.

RespiratoryFunctions- 1) Ventilation:Movement of air in & out of lung cycle of inhalation and exhalation. 2) Respiration:Process of gas exchange in lungs (O2 oxygenation of blood & elimination of CO2) External respiration (alveolar-capillary membrane) Internal respiration (capillary- cellular membrane)Structure- 1) Upper Airway: Nasal passages, sinuses, mouth, pharynx (throat) 2) Lower Airway: Larynx (vocal cords), Trachea (wind pipe)- in front of esophagus, bronchi, bronchioles, lungs, alveoli Cardiovascularfunction- 1)Transportation: of O2 to cells via heart & vascular system (perfusion- circulation of blood to all body regions.) (circulation of blood to & from the surface of the alveoli. 2)Regulation: thru cardiac cycle by a series of mechanical (contractions) & electrical activities (SA nodes & Av nodes. Thru neural= phrenic Nerve- Supplies movement to diaphragm,Central Nervous System: Controls rate, depth & rhythmCerebral cortex: voluntary controlMedulla oblongata: involuntary controlStructure- Heart, blood vessels, coronary arteries

Collaborative management of Hyponatremia

Rx cause of imbalance** -Mental status-safety -Restrict water if due to dilution -Increase sodium intake (oral or IV) -0.9% Normal Saline -If symptoms are severe, Hypertonic saline may be used (3%soln) CAUTION -Must be on pump -Only for short periods -300-400 mL to inc. 10 mEq (do not want to increase serum sodium by more than 12 mEq/L in 24 hours)

CV 5: Holistic nurse self-reflection and self-care

Self-reflection and self-care, as well as personal awareness of and continuous focus on being an instrument of healing, are significant requirements for holistic nurses16,p.20 Self-reflection is both self-care strategy and a professional practice integrating critical thinking of the mind and compassion of the heart. Caring for self is integral to holistic nursing.

Skin Nursing Assessment Questions

Sensation • Do you have tingling, decreased feeling, or absent feeling in your extremities? • Can you feel pressure when sitting or lying down? • When preparing a bath is your skin sensitive to heat or cold? Mobility • Do you have any physical limitations, injury, or paralysis that limits your ability to move on your own? • Can you change your position easily? • Tell me about any pain you have when you walk, sit down, or move about your home. Continence • Do you have any problems or accidents leaking urine or stool? • What help do you need when using the toilet? In what way? • How often do you need to use the toilet? During the day? At night? Presence of Wound • What do you believe caused your wound? • When did the wound occur? Where is it located? • When did you receive a tetanus shot? • What has happened to this wound since it occurred? What were the changes and what caused them? • What have you done to treat the wound? Which treatments, activities, or care have slowed or helped the wound to heal? • Do you have any pain, itching, or other symptoms with the wound? How are you managing the itching, and what works best for you? • Who helps you care for your wound?

Social Support

Social Support Another area of interest in PNI is how the environment influences health and wellness. The social environment is integral to wellness. Loneliness is a risk factor for coronary heart disease. Women with close female friends have better breast cancer outcomes, developmental stages are positively met for those who live in supportive families, and the symptoms of irritable bowel syndrome are less for those with meaningful social support. Assessing and finding ways to enhance the social environment for our patients become parts of the nurse's role. Nurses can refer patients to support groups and other family services with an understanding that this will improve immune function and healing.

Special Zones of Touch

Social Zone (Permission Not Needed): Hands, arms, shoulders, back Consent Zone (Permission Needed): Mouth, wrists, feet Vulnerable Zone (Special Care Needed): Face, neck, front of body Intimate Zone (Permission and Great Sensitivity Needed): Genitalia, rectum

Denotative and Connotative Meaning

Some words have several meanings. Individuals who use a common language share the denotative meaning: baseball has the same meaning for everyone who speaks English, but code denotes cardiac arrest primarily to health care providers. The connotative meaning is the shade or interpretation of the meaning of a word influenced by the thoughts, feelings, or ideas that people have about the word. For example, health care providers tell a family that a loved one is in serious condition and they believe that death is near; but to nurses serious simply describes the nature of the illness. You need to select words carefully, avoiding easily misinterpreted words, especially when explaining a patient's medical condition or therapy. Even a much-used phrase such as "I'm going to take your vital signs" may be unfamiliar to an adult or frightening to a child. "I'm going to check your blood pressure, heart rate, and temperature" may be more appropriate.

Sounds

Sounds such as sighs, moans, groans, or sobs also communicate feelings and thoughts. Combined with other nonverbal communication, sounds help to send clear messages. They have several interpretations. For example, moaning can convey pleasure or suffering, and crying can communicate happiness, sadness, or anger. Validate nonverbal messages with patients to interpret them accurately. For example, "I notice you frowning as you move, are you having pain?"

Life and Self-Responsibility

Spiritual well-being includes life and self-responsibility. Individuals who accept change in life, make decisions about their lives, and are able to forgive others in times of difficulty have a higher level of spiritual well-being. During illness patients often are unable to accept limitations or do not know how to regain a functional and meaningful life. Their feelings and struggles often reflect spiritual distress. However, they often use their spiritual well-being as a resource for adapting to changes and dealing with limitations. Assess the extent to which a patient understands the limitations or threats posed by an illness (e.g., activity restriction, sexual intimacy with a partner, risk of medical complications) and the manner in which he or she chooses to adjust to them. Ask, "Tell me how you feel about the changes caused by your illness" and "How do these changes affect what you now need to do?"

Life Satisfaction

Spiritual well-being is tied to a person's satisfaction with life and what he or she has accomplished, even in the case of children. When people are satisfied with life and how they are using their abilities, more energy is available to deal with new difficulties and resolve problems. You assess a patient's satisfaction with life by asking questions such as "How happy or satisfied are you with your life?" or "Tell me how satisfied you feel about what you have accomplished in life" or "Describe what makes you feel dissatisfied with your life."

Culture

Spirituality is a personal experience within a cultural context. It is important to know a patient's cultural background and assess his or her values about the health care problem and impending treatment. It is common in many cultures for individuals to believe that they have led a worthwhile and purposeful life. Remaining connected with their cultural heritage often helps patients define their place in the world and express their spirituality. Asking them about their faith and belief systems is a good beginning for understanding the relationship between culture and spirituality.

Quality and safety education for nurses (QSEN)

Standard competencies in knowledge, skills, and attitudes for the preparation of future nurses .

Personal Environment

Strategies to heal the environment abound on both a personal and a professional level. Personally, we can begin to modify our own internal environment. The ability to regulate our state of consciousness, thought patterns, and reactive behaviors gives us the power to move smoothly through external crises both at work and at leisure. Approaching a hectic external environment with internal composure and tranquility makes it possible to transform crises into manageable situations.

Stress

Stress is described as a feeling of being overwhelmed, worried, or run down. Stress can affect everyone regardless of age, socioeconomic status, gender, or profession. An overabundance of stress reduces the function of the immune, cardiovascular, neuroendocrine, and central nervous systems. Stressors are the triggers of stress and are a normal part of life. We are required to adapt, and when stress is perceived, the organism is physiologically prepared to attack or flee from the threat. When one experiences stress, one's biology, emotions, social support, motivation, environment, attitude, immune function, and wellness are all relevant to the experience of stress and have a clear influence on the human being. -An actual or alleged hazard to the balance of homeostasis -Can impact the physical and mental well-being of patients -Nurses need to consider their own stress

Maturational Factors

Stressors vary with life stage. According to Erikson's developmental theory, individuals experience predictable stages of development as particular tasks are accomplished and mastered for each stage. Children who are in the stage of initiative versus guilt identify stressors related to physical appearance, families, friends, and school. During this stage, teaching impulse control and cooperative behaviors is imperative. Preadolescents experience stress related to self-esteem issues, changing family structure as a result of divorce or death of a parent, or hospitalizations. Erikson asserts that during this stage, they can develop a sense of inferiority without proper support for learning new skills. As adolescents search for identity with peer groups and separate from their families, they also experience stress.

Recent Surgery and fluids

Surgery causes a physiological stress response, which increases with extensive surgery and blood loss. In the first 24 to 48 hours after surgery, increased secretion of aldosterone, glucocorticoids, and ADH cause increased ECV, decreased osmolality, and increased potassium excretion. In otherwise healthy patients these imbalances resolve without difficulty, but patients who have preexisting illnesses or additional risk factors often need treatment during this period. through vomiting or nasogastric suction can cause metabolic alkalosis. In contrast, removal of the bicarbonate-rich intestinal or pancreatic fluids through diarrhea, intestinal suction, or fistula can cause metabolic acidosis

susceptibility

Susceptibility to an infectious agent depends on an individual's degree of resistance to pathogens. Although everyone is constantly in contact with large numbers of microorganisms, an infection does not develop until an individual becomes susceptible to the strength and numbers of the microorganisms. A person's natural defenses against infection and certain risk factors (e.g., age, nutritional status, presence of chronic disease, trauma, and smoking) affect susceptibility (resistance)

Tertiary Prevention

TREAT -Occurs when a defect or disability is permanent or irreversible. -The goal is to minimize the effects of long-term disease or disability, by applying interventions that are directed towards preventing complications. -Activities are directed towards rehabilitation and restoration rather than diagnosis and treatment. -The goal is to provide retraining and education to return to the highest level of functioning and help people with disabilities find work and accommodate them to the workplace.

Temperature Needs

Temperature extremes that frequently occur during the winter and summer pose safety risks for vulnerable populations. Exposure to severe cold for prolonged periods causes frostbite and accidental hypothermia. Older adults, the young, patients with cardiovascular conditions, patients who have ingested drugs or alcohol in excess, and people who are homeless are at high risk for hypothermia. In contrast, exposure to extreme heat changes the electrolyte balance of the body and raises the core body temperature, potentially resulting in heatstroke or heat exhaustion. Chronically ill patients, older adults, and infants are at greatest risk for injury from extreme heat.

Territoriality and Personal Space

Territoriality is the need to gain, maintain, and defend one's right to space. Territory is important because it provides people with a sense of privacy, identity, security, and control. It is sometimes separated and made visible to others, as with a fence around a yard or a curtain around a bed in a hospital room. Personal space is invisible and individual and travels with a person. During interpersonal interaction people maintain varying distances between one another, depending on their culture, the nature of their relationship, and the situation. When personal space becomes threatened, people respond defensively and communicate less effectively. Situations dictate whether the interpersonal distance between nurse and patient is appropriate.

Rights and Responsibilities

The Catholic tradition teaches that human dignity can be protected and a healthy community can be achieved only if human rights are protected and responsibilities are met. Therefore, every person has a fundamental right to life and a right to those things required for human decency. Corresponding to these rights are duties and responsibilities - to one another, to our families, and to the larger society.

Systemic Circulation

The arteries of the systemic circulation deliver nutrients and oxygen to tissues, and the veins remove waste from tissues. Oxygenated blood flows from the left ventricle through the aorta and into large systemic arteries. These arteries branch into smaller arteries; then arterioles; and finally, the smallest vessels, the capillaries. The exchange of respiratory gases occurs at the capillary level, where the tissues are oxygenated. The waste products exit the capillary network through venules that join to form veins. These veins become larger and form the vena cava, which carry deoxygenated blood back to the right side of the heart, where it then returns to the pulmonary circulation

Arts and spirituality

The arts have a role in the life of the spirit. Many people find that various forms of artistic endeavor are doors to and expressions of the spirit. The term artist can include anyone who creates—the homemaker who cooks and sews and the carpenter who designs and builds, as well as the more easily recognized persons whose works are heard in symphonies or seen in galleries.

Situations for use of hypertonic solutions.

The cell has an excessive amount of solute extracellularly and osmosis is causing water to rush out of the cell intracellularly to the extracellular area which will cause the CELL TO SHRINK. When hypertonic solutions are used (very cautiously....most likely to be given in the ICU due to quickly arising side effects of pulmonary edema/fluid over load). In addition, it is prefered to give hypertonic solutions via a central line due to the hypertonic solution being vesicant on the veins and the risk of infiltration.

The Community Nursing Practice Model

The community nursing practice model42 (CNPM) emerged from a theoretical perspective of caring and analysis of years of community caring practice exemplars, called nursing situations. The CNPM is grounded in the values of respect for the wholeness and dignity of each person, family, and community. Additionally, nursing practice is intentionally actualized in the values of the World Health Organization's approach to primary health care: empowerment, multi-intersectoral collaboration, access, essentiality, and community participation. Furthermore, the CNPM advances the mission of a college of nursing in the southeastern United States, described nursing as "nurturing the wholeness of persons and environment in caring." The CNPM is depicted as a watercolor of three concentric circles of community, expertise, and support surrounding the core: a nursing situation. The fluidity of the watercolor illustrates the interconnectedness of persons and families with communities. The model has been advanced using participatory action approaches and qualitative methods of study.

Dream Phase of 4-D Cycle

The dream phase involves creatively imagining the future. In this phase, the focus is on merging the best of what is with a vision of what could be. In this phase, the patient's story, insights, and viewpoint are put to constructive use to come up with a vision of how things could be better.

Quantum Physics

The field of quantum physics in health examines the very tiny atomic level of interaction between the self and the environment. Molecules of emotions give off chemical, electrical, and subatomic waves that influence other bonds within the molecules. Thoughts induce emotions, and chains of protein twirl and change to something else and the cell changes. A better understanding of quantum physics in health will help us demonstrate the importance of intention, kindness, self-talk, and true presence in healing.

Packing a Wound

The first step in packing a wound is to assess its size, depth, and shape. These characteristics are important in determining the size and type of dressing used to pack a wound. The dressing needs to be flexible and in contact with the entire wound surface. Make sure that the type of material used to pack the wound is appropriate. If gauze is the appropriate dressing material, saturate with the ordered solution, wring out, unfold, and lightly pack into the wound. The entire wound surface needs to be in contact with part of the moist gauze dressing. It is important to remember not to pack a wound too tightly. Overpacking causes pressure on the wound bed tissue. Pack the wound only until the packing material reaches the surface of the wound; there should never be so much packing material that it extends higher than the wound surface. Packing that overlaps onto the wound edges causes maceration of the skin surrounding the wound.

Friction

The force of two surfaces moving across one another such as the mechanical force exerted when skin is dragged across a coarse surface such as bed linens is called friction. Unlike shear injuries, friction injuries affect the epidermis or top layer of the skin (superficial skin loss). The denuded skin appears red and painful and is sometimes referred to as a sheet burn. A friction injury occurs in patients who are restless, in those who have uncontrollable movements such as spastic conditions, and in those whose skin is dragged rather than lifted from the bed surface during position changes or transfer to a stretcher. This type of injury should not be classified as a pressure injury. Friction leads to pressure injury formation only when it causes harmful shear stress and strain.

Intravenous Therapy (Crystalloids)

The goal of IV fluid administration is to correct or prevent fluid and electrolyte disturbances. It allows for direct access to the vascular system, permitting the continuous infusion of fluids over a period of time. IV therapy requires a health care provider's order for type, amount, and speed of administration of a solution. You regulate IV fluid therapy continuously because of ongoing changes in a patient's fluid and electrolyte balance. To provide safe and appropriate therapy to patients who require IV fluids, you need knowledge of the correct ordered solution, the reason the solution was ordered, the equipment needed, the procedures required to initiate an infusion, how to regulate the infusion rate and maintain the system, how to identify and correct problems, and how to discontinue the infusion.

Increasing Awareness for Change

The hazards that were identified 50 years ago have grown exponentially. They continue to live among us despite vast concern, attempted legislation, and grassroots actions by many people and organizations. A way of life—a conscious choice—is possible only if we are willing to really work to change from an industrial growth society to a life-sustaining society. It is possible to meet our needs and protect our natural resources, including the air we breathe and the water we drink, without destroying our life support system.

CV 2: Holistic caring process

The holistic caring process identifies what holistic nurses do—that is, the practice of holistic nursing. Holistic nurses provide care that recognizes the totality of the human being (the interconnectedness of body, mind, emotion, spirit, social/cultural relationships, context, environment, and energy). Holistic health is a multidimensional state of well-being as perceived by the individual. Holistic health integrates current trends, research, and evidence-based interventions specific to the patient's needs, problem, or situation. Holistic health elicits the patient's story to reveal the context and complexity of the human health experience.

Pre-Access Phase

The holistic communication process acknowledges the importance of being centered and creating an intention before engaging in a caring, healing interaction with another. These two processes, being centered and creating intention, constitute the pre-access phase involved in holistic interactions. This phase lays the foundation for caring, healing communication and occurs before any person-to-person interaction takes place. As the nurse stays present to the moment, to self, and to the person, a healing environment is maintained. Consciously creating a healing environment, no matter where one is working, nurtures both the patient/client and the self at a deep level.

Call to Family, Community, and Participation

The human person is not only sacred, but also social. How we organize our society — in economics and politics, in law and policy — directly affects human dignity and the capacity of individuals to grow in community. Marriage and family are the central social institutions that must be supported and strengthened, not undermined. We believe people have a right and a duty to participate in society, seeking together the common good and well-being of all, especially the poor and vulnerable.

Excretion of Metabolic Acids

The kidneys excrete all acids except carbonic acid. They secrete H + into the renal tubular fluid, putting HCO 3 - back into the blood at the same time. If there are too many H + ions in the blood, renal cells move more H + ions into the renal tubules for excretion, retaining more HCO 3 - in the process. If there are too few H + ions in the blood, renal cells secrete fewer H + ions.

Primary line

The main IV fluid used in a continuous infusion flows through tubing called the primary line . The primary line connects to the IV catheter. Injectable medications such as antibiotics are usually added to a small IV solution bag and "piggybacked" as a secondary set into the primary line or as a primary intermittent infusion to be administered over a 30-to 60-minute period

The Water We Drink

The majority of the planet is composed of water; of that, 97 percent is salt water. The fresh water used to sustain life is only 3 percent of the total amount of water on Earth. Earth has a limited supply of fresh water, stored in aquifers, surface waters, and the atmosphere. Population growth, coupled with industrialization and urbanization, will result in an increasing demand for water and will have serious consequences for human health and the environment. Projections are that by 2025, two-thirds of the world's population could be living in severe water stress conditions.

Message

The message is the content of the communication. It contains verbal and nonverbal expressions of thoughts and feelings. Effective messages are clear, direct, and in understandable language. Individuals with communication barriers may need assistance via clarification devices such as hearing aids, interpreters, or pictures to ensure that messages sent and received are understandable. Personal perceptions may also distort the receiver's interpretation of a message.

Nursing Metaparadigm

The nursing metaparadigm allows nurses to understand and explain what nursing is , what nursing does , and why nurses do what they do. The nursing metaparadigm includes the four concepts of person (or human beings), health, environment/situation, and nursing.

Virulence

The potential for microorganisms or parasites to cause disease depends on the number of microorganisms present; their virulence , or ability to produce disease; their ability to enter and survive in a host; and the susceptibility of the host. degree of pathogenicity

Moisture

The presence and duration of moisture on the skin increases the risk of pressure injury. Moisture reduces the resistance of the skin to other physical factors such as pressure, friction, or shear. Prolonged moisture softens skin, making it more susceptible to damage. The term moisture-associated skin damage (MASD) is defined as inflammation and erosion to the skin caused by prolonged exposure to various sources of moisture, including wound drainage, urine or stool, perspiration, wound exudate, mucus or saliva

Risks in Health Care Agencies

The prevention of medical errors continues to be one of the most pressing health care challenges in the nation. Medical errors occur when planned actions are not completed as intended or wrong plans of care are used. They occur in all health care settings. Be aware of the organizational and regulatory patient safety measures that have been established in the health care setting where you work. -chemical exposure -falls -patient-inherent accidents -procedure-related accidents -equipment-related accidents -workplace safety

Psychosocial Impact of Wounds

The psychosocial impact of wounds on the physiological process of healing is unknown. Body image changes often impose a great stress on a patient's adaptive mechanisms. They also influence self-concept and sexuality. Factors that affect a patient's perception of a wound include: location, the presence of scars, stitches, drains (often needed for weeks or months), odor from drainage, and temporary or permanent prosthetic devices.

Myocardial Pump

The pumping action of the heart is essential to oxygen delivery. There are four cardiac chambers: two atria and two ventricles. The ventricles fill with blood during diastole and empty during systole. The volume of blood ejected from the ventricles during systole is the stroke volume . Hemorrhage and dehydration cause a decrease in circulating blood volume and a decrease in stroke volume. Myocardial fibers have contractile properties that allow them to stretch during cardiac filling. In a healthy heart this stretch is proportionally related to the strength of contraction. As the myocardium stretches, the strength of the subsequent contraction increases; this is known as the Frank-Starling (Starling's) law of the heart . In the diseased heart (cardiomyopathy), Starling's law does not apply because the increased stretch of the myocardium is beyond the physiological limits of the heart. The subsequent contractile response results in insufficient stroke volume, and blood begins to "back up" in the pulmonary (left heart failure) or systemic (right heart failure) circulation

Outline the steps of the holistic caring process.

The six steps of the holistic caring process occur simultaneously, including assessment, diagnosis, outcomes, therapeutic plan of care, implementation, and evaluation

Cancer and fluids

The specific fluid and electrolyte imbalances that occur with cancer depend on the type and progression of the cancer and the treatment regimen. Many patients with cancer develop hypercalcemia when their cancer cells secrete chemicals that circulate to bones and cause calcium to enter the blood. Other fluid and electrolyte imbalances occur in cancer because some types of tumors cause metabolic and endocrine abnormalities. In addition, patients with cancer are at risk for fluid and electrolyte imbalances as a result of the side effects (e.g., anorexia, diarrhea) of chemotherapy, biological response modifiers, or radiation.

Margaret Newman

The task of nursing intervention, according to Newman, "is not to try to change another person's patterns but to recognize it as information that depicts the whole and relate to it as it unfolds." -role of nurse is to assist people to recognize the power within them

The Theory of Compassion Energy

The theory of compassion energy47 provides a theoretical approach to the everydayness of nursing practice. Dunn, founder of the theory and a scholar of unitary and caring science, is a Reiki healer and is certified in holistic nursing. This theory emerged from years of reflective practice and the study of what kept nurses in nursing. Dunn described compassion energy as an intersubjective gift that awakens caring consciousness and inspires the nurse to know the patient as a whole. It is composed of compassionate presence, patterned nurturance, and intentionally knowing the one nursed and self as whole beings, and it aligns with holism as recognized by the holistic nurse. Intentional compassion energy is thus defined as the regeneration of the nurse's capacity to foster interconnectedness when the nurse activates the intent to nurse. Compassion energy provides an opening that uncovers what keeps nurses in nursing.

Shared Vulnerability

The theory of shared vulnerability emerged from a grounded theory study of caring for children with persistent head lice and many years of providing home visits to families with head lice infestations. Holistic values guiding the theory included a focus on the whole person and honoring relationship-centered care, as well as protecting and promoting the well-being of caregivers, children, and families. Parents caring for children were experiencing a stigmatized, chronic condition of shared vulnerability.

The Transactive Relationship Theory of Nursing

The transactive relationship theory of nursing (TRETON) is a middle-range theory that advances not only the usefulness of artificial intelligence in nursing practice but inspires engagement in the process of developing the capacity of humanoid healthcare robots as adjunctive to nursing practice. TRETON is grounded in the values of technological caring and mutual engagement in nursing encounters. Nursing encounters are described as the intentional transactional relationship between healthcare robots and human persons in the healthcare environment. There are three components of the nursing encounter: human engagement between the nurse and patient, technological engagement between the robot and the nurse, and engagement between the robot and the patient. Artificial intelligence in health care is here now and advancing in nursing practice. King and Barry bring artificial intelligence to life in the description of the usefulness of a healthcare robot called Robin in assisting with deep breathing and relaxation techniques. Holistic nursing practice has always been on the leading edge of innovative healing practices: energy work, meditative practices, visualization processes, music, and movement therapies. Now is the time!

Stress Response

There is a cascade of hormones and chemicals that begins when the brain decides there is a threat. This is the fight-or-flight response, enacted when the body moves into a sympathetic state, preparing to expend energy, and shutting down nonessential systems. One of those nonessential systems that shuts down could be the production of natural killer cells that attack mutating cancer cells. The stress response is modified by the number of other concurrent stressors, social support, personality, and previously learned coping skills. Psychological stressors stimulate a physiologic response and are referred to as a reactive response. Perceived stressors begin in the areas of the brain that control cognition and emotions—the cerebral cortex and the limbic system.

Affective Immunology

There is increasing interest in the benefits of positive emotions on the immune system, and this has been called affective immunology, a specialty within the field of PNI. Laughter is a universal language that reduces the stress response, improves learning, increases heart rate and variability, enhances cardiac output, and may be protective against metabolic syndrome. The relationship between the immune system is bidirectional, and an unstable immune function will influence emotional response. As a result, the patient may experience an increase in pain, anxiety, unhealthy coping behaviors (such as drinking alcohol), or disturbances in interactions with others when they are ill. Studies are showing that generating happiness, hope, and other positive emotions improves immune function. This means that the healthy function of the immune system can be moderated by the conscious mind. Happiness and hope can be generated. Laughter therapy has positive immune benefits, and programs to enhance happiness are becoming part of the realm of patient care.

Overenmeshment Symptoms

This symptom requires everyone to follow the rule that everyone must do everything together and that everyone is to think, feel, and act in the same way. Uniqueness, autonomy, and idiosyncratic behaviors are viewed as deviations from the norm.

Evaluation: Pulmonary Health

Through the patient's eyes -Focus on evaluating how the disease is affecting day-to-day activities and how the patient believes he or she is responding to treatment Patient outcomes -Compare the patient's actual progress to the goals and expected outcomes of the nursing care plan to determine his or her health status

Integrative Health and Wellness Assessment Wheel: Spirituality

Throughout history, there has been a quest to understand the purpose of the human life experience. Assessing aspects of our spiritual nature can be a profound learning opportunity Spirit comes from our roots—it is a universal need to understand the human experience. It is a vital element and driving force in how we live our lives, affecting every aspect of our life balance and satisfaction, as well as the degree to which we develop our human potentials. -involves a sense of connection with an absolute, imminent, or transcendent spiritual force, however named, and includes the conviction that ethical values, direction, meaning, and purpose are valid aspects of the individual and universe. It is the essence of being and relatedness that permeates all of life and is manifested in one's knowing, doing, and being. -this interconnectedness with self, others, nature, and God/life force/absolute/transcendent is not necessarily synonymous with religion.

Timing and Relevance

Timing is critical in communication. Even though a message is clear, poor timing prevents it from being effective. For example, you do not begin routine teaching when a patient is in severe pain or emotional distress. Often the best time for interaction is when a patient expresses an interest in communicating. If messages are relevant or important to the situation at hand, they are more effective. When a patient is facing emergency surgery, discussing the risks of smoking is less relevant than explaining presurgical procedures. Face-to-face time while performing assessments, administering medications, or performing procedures offers an excellent opportunity to talk with patients and provide support or education. Patients report improved satisfaction, understanding, and perception of safety with registered nurses (RNs) who provide a bedside hand-off and communicate information about the plan of care

Myocardial Blood Flow

To maintain adequate blood flow to the pulmonary and systemic circulation, myocardial blood flow must supply sufficient oxygen and nutrients to the myocardium itself. Blood flow through the heart is unidirectional. The four heart valves ensure this forward blood flow. During ventricular diastole the atrioventricular (mitral and tricuspid) valves open, and blood flows from the higher-pressure atria into the relaxed ventricles. As systole begins, ventricular pressure rises and the mitral and tricuspid valves close. Valve closure causes the first heart sound (S 1 ). During the systolic phase the semilunar (aortic and pulmonic) valves open, and blood flows from the ventricles into the aorta and pulmonary artery. The mitral and tricuspid valves stay closed during systole, so all of the blood is moved forward into the pulmonary artery and aorta. As the ventricles empty, the ventricular pressures decrease, allowing closure of the aortic and pulmonic valves. Valve closure causes the second heart sound (S 2 ). Some patients with valvular disease have backflow or regurgitation of blood through the incompetent valve, causing a murmur that you can hear on auscultation

Explain indications for use of parenteral intravenous solutions.

To maintain or restore fluid balance or electrolytes when oral replacement is inadequate or impossible. To administer water soluble vitamins. To administer drugs. To provide a source of calories & nutrients. To replace blood and blood products.

Why should we assess the type of tissue in the wound base?

To provide information to help plan appropriate interventions. The assessment of tissue type includes the amount (percentage) and appearance (color) of viable and nonviable tissue. Granulation tissue is red, moist tissue composed of new blood vessels, the presence of which indicates progression toward healing. Soft yellow or white tissue is characteristic of slough (stringy substance attached to wound bed), and it must be removed by a skilled clinician or with the use of an appropriate wound dressing before the wound is able to heal. Black, brown, tan, or necrotic tissue is eschar, which needs to be removed before healing can proceed.

Intonation

Tone of voice dramatically affects the meaning of a message. Depending on intonation, even a simple question or statement expresses enthusiasm, anger, concern, or indifference. Be aware of voice tone to avoid sending unintended messages. If a patient interprets your patronizing tone of voice as condescending, this will inhibit further communication. A patient's tone of voice provides information about his or her emotional state or energy level.

Adverse effect of medication

Unintended, undesirable, often unpredictable (side effect, toxic effect, Idiosyncratic reaction, allergic reaction, medication interactions, medication tolerance, medication dependence)

Caution with administering hypertonic solutions.....

Use cautiously with patients who cannot tolerate additional extracellular fluids, such as those with renal or cardiac dysfunctions.

Electronic communication

Use of technology. MyChart, Electronic Medical Record, Virtual Visits. is the use of technology to create ongoing relationships with patients and their health care team. Secure messaging provides an opportunity for frequent and timely communication with a patient's physician or nurse via a patient portal. An electronic portal enables patients to stay engaged and informed, though the empathetic nature of the therapeutic relationship with the health care team may be more challenging

Securing Dressings

Use tape, ties, or a secondary dressing to secure a dressing over a wound site. The choice of anchoring depends on the wound size and location, the presence of drainage, the frequency of dressing changes, and the patient's level of activity. You will most often use strips of tape to secure dressings. Nonallergenic paper and silicone tapes minimize skin reactions. Common adhesive tape adheres well to the surface of the skin, whereas elastic adhesive tape compresses closely around pressure bandages and permits more movement of a body part. Skin sensitive to adhesive tape becomes severely inflamed and denuded and, in some cases, even sloughs when the tape is removed. It is important to assess the condition of the skin under tape at each dressing change.

Prevent infection (2021 Hospital Patient Safety Goal)

Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.

Nursing Roles

Utilizing warmth, compassion, caring, authenticity, respect, trust, and relationship as instruments of healing in and of themselves and as part of the healing environment Utilizing conventional nursing interventions as well as CIHA that enhance body-mind-emotion-spirit-environment connectedness to foster the healing, health, wholeness, and well-being of people Collaborating and partnering with all constituencies in the health process, including the person receiving care, family, significant others, community, peers, and other disciplines using principles and skills of cooperation, alliance, consensus, and respecting and honoring the contributions of all Participating in the change process to develop more caring cultures in which to practice, learn, and live Assisting everyone to nurture and heal themselves Participating in activities that contribute to the improvement of local and global communities, as well as the betterment of public health, the environment, and the planet Acting as an advocate for the rights of, equitable distribution of, and access to health care for all persons, especially vulnerable populations Participating in and providing leadership in the positive transformation of systems Participating in research of the human experience and improvement of the nursing process Conducting independent and collaborative research and quality demonstration projects to contribute to the rapidly changing knowledge base for education and practices Honoring the ecosystem and our relationship with and need to preserve it, as we are all connected

Health promotion strategies to utilize when working with patients and their families.

Vaccinations, smoking-cessation programs, exercise programs, and nutritional support

Risk Factors

Variables that increase the vulnerability of an individual or a group to an illness or accident Risk factors include: -Nonmodifiable risk factors e.g. age, gender, genetics, and family history. This risk factors cannot be changed. -Modifiable risk factors e.g. poor nutrition, overeating, overweight, smoking, insufficient rest and sleep etc. This risk factors can be changed. -Environment - the physical environment in which a person lives can determine their health.

Vascular Access Devices

Vascular access devices (VADs) are catheters or infusion ports designed for repeated access to the vascular system. Peripheral catheters are for short-term use (e.g., fluid restoration after surgery and short-term antibiotic administration). Devices for long-term use include central catheters and implanted ports, which empty into a central vein. Remember that the term central applies to the location of the catheter tip, not to the insertion site. Peripherally inserted central catheters (PICC lines) enter a peripheral arm vein and extend through the venous system to the superior vena cava, where they terminate. Other central lines enter a central vein such as the subclavian or jugular vein or are tunneled through subcutaneous tissue before entering a central vein. Central lines are more effective than peripheral catheters for administering large volumes of fluid, PN, and medications or fluids that irritate veins. Proper care of central line insertion sites is critical for the prevention of central line-associated bloodstream infection. Nurses and health care providers must have specialized education regarding care of CVCs and implanted infusion ports. Nursing responsibilities for central lines include careful monitoring, flushing to keep the line patent, and site care and dressing changes to prevent CLABSIs.

What four things are processes for providing adequate oxygenation from the alveoli to the blood.

Ventilation, diffusion, respiration, and perfusion

Describe the physiological processes of ventilation, perfusion, and exchange of respiratory gases.

Ventilation- the amount of oxygen entering the lungsdependent upon: 1. Rate & depth of respiration- how fast you breathe, and how much your lungs expand to take in air = affect oxygen and carbon dioxide levels in blood. Hyperventilation & hypoventilation 2. Compliance- lungs inflate easily. Because of their elastin fibers, low water content and low alveolar surface tension. 3. Elastic recoil- tendency of elastin fibers to return to their original position after being stretched 4. Airway resistance- normally low, takes little effort to move air in & out of lungs. 5. Accessory muscles- diaphragm and intercostal muscles Perfusion- blood flow to the lungs & body tissues & organs. Circulation of blood to and from the surface of the alveoli for gas exchange.Dependent on right ventricle for pulmonary circulation and systemic blood pressure for venous return Gas exchange- Exchange occurs at alveoli and capillaries of body tissue.Method of transport is simple diffusion

Decreased lung compliance, increased airway resistance, and the increased use of accessory muscles increase the

WOB, resulting in increased energy expenditure. Therefore, the body increases its metabolic rate and the need for more oxygen. The need for elimination of carbon dioxide also increases. This sequence is a vicious cycle for a patient with impaired ventilation, causing further deterioration of respiratory status and the ability to oxygenate adequately

Warm, Moist Compresses

Warm, moist compresses improve circulation, relieve edema, and promote consolidation of purulent drainage. A compress is a piece of gauze dressing moistened in a prescribed warmed solution. Heat from warm compresses dissipates quickly. To maintain a constant temperature, you need to change the compress often. You can use a layer of plastic wrap or a dry towel to insulate the compress and retain heat. Moist heat promotes vasodilation and evaporation of heat from the surface of the skin. For this reason a patient can feel chilly. Always try to control drafts within the room, and keep the patient covered with a blanket or robe.

Solidarity

We are one human family whatever our national, racial, ethnic, economic, and ideological differences. We are our brothers' and sisters' keepers, wherever they may be. Loving our neighbor has global dimensions in a shrinking world. At the core of the virtue of solidarity is the pursuit of justice and peace. Pope Paul VI taught that if you want peace, work for justice. The Gospel calls us to be peacemakers. Our love for all of our sisters and brothers demand that we promote peace in a world surrounded by violence and conflict.

Care for God's Creation

We show our respect for the Creator by our stewardship of creation. Care for the earth is a requirement of our faith. We are called to protect people and the planet, living our faith in relationship with all of God's creation. This environmental challenge has fundamental moral and ethical dimensions that cannot be ignored.

Integrative Health and Wellness Assessment Wheel: Physical

When a person's basic biological needs for food, shelter, and clothing have been met, there are many ways to seek wholeness of physical potential. Assessing our physical potential includes many elements, with three major areas being nutrition, exercise, and weight. Other vital areas such as alcohol and drug use and sleep that are included in the long form of the IHWA are discussed in conversations as a result of the short form. Typically, people focus on the elements of the physical component but fail to recognize that they are not separate from—or more important than—the other components.

Assessing a patient's faith/beliefs

When assessing a patient's faith, first determine his or her beliefs, especially those that influence hope. For example, ask how a patient believes a chemotherapy drug will affect a newly diagnosed form of cancer. Ask the patient whether he or she believes in the skill or competence of his or her physician. Determine which of your patient's beliefs guide him or her to find meaning in life events and to thus make decisions. Ask your patient whether he or she is able to live according to his or her beliefs. Finally, assess to what extent your patient interrelates with self, others, and/or a source of authority. Faith in an authority (such as a health care provider or senior family member) provides a sense of confidence that guides a person in exercising beliefs and experiencing growth. Assess a person's faith in an authority by asking "To whom do you look to for guidance in life?" The patient's response to an open-ended question such as this is likely to open the door for a meaningful discussion. Listen carefully and explore what is meaningful to the patient.

Drainage Evacuation

When drainage interferes with healing, evacuation of the drainage is achieved by using either a drain alone or a drainage tube with continuous suction. You may apply special skin barriers, including hydrocolloid dressings similar to those used with ostomies, around drain sites with significant drainage for skin protection. The skin barriers are soft material applied to the skin with adhesive. Drainage flows on the barrier but not directly on the skin. Drainage evacuators are convenient portable units that connect to tubular drains lying within a wound bed and exert a safe, constant low-pressure vacuum to remove and collect drainage. Ensure that suction is exerted and that connection points between the evacuator and tubing are intact. The evacuator collects drainage. Assess for volume and character every shift and as needed. When the evacuator fills, measure output by emptying the contents into a graduated cylinder, immediately reset the evacuator to apply suction, and record the output.

Compare and contrast the concepts of religion and spirituality.

When providing spiritual care to a patient, it is important to understand the differences between religion and spirituality. Many people tend to use the terms spirituality and religion interchangeably. Although closely associated, these terms are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice. Religious care helps patients maintain their faithfulness to their belief systems and worship practices. Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships and a relationship with a higher being or life force.

Orientation Phase

When you and a and patient meet and get to know one another: • Set the tone for the relationship by adopting a warm, empathetic, caring manner. • Recognize that the initial relationship is often superficial, uncertain, and tentative. • Expect the patient to test your competence and commitment. • Closely observe the patient and expect to be closely observed by the patient. • Begin to make inferences and form judgments about patient messages and behaviors. • Assess the patient's health status. • Prioritize the patient's problems and identify his or her goals. • Clarify the patient's and your roles. • Form contracts with the patient that specify who will do what. • Let the patient know when to expect the relationship to be terminated.

Working Phase

When you and a patient work together to solve problems and accomplish goals: • Encourage and help the patient express feelings about his or her health. • Encourage and help the patient with self-exploration. • Provide information needed to understand and change behavior. • Encourage and help the patient set goals. • Take action to meet the goals set with the patient. • Use therapeutic communication skills to facilitate successful interactions. • Use appropriate self-disclosure and confrontation.

Excretion of Carbonic Acid

When you exhale, you excrete carbonic acid in the form of CO 2 and water. If the PaCO 2 (i.e., level of CO 2 in the blood) rises, the chemoreceptors trigger faster and deeper respirations to excrete the excess. If the PaCO 2 falls, the chemoreceptors trigger slower and shallower respirations so that more of the CO 2 produced by cells remains in the blood and makes up the deficit. These alterations in respiratory rate and depth maintain the carbonic acid part of acid-base balance. People who have respiratory disease may be unable to excrete enough carbonic acid, which causes the blood to become more acidic and blood CO 2 to increase. If an increased respiratory rate is unable to correct the problem, the kidneys begin some compensatory excretion of metabolic acid.

Postural drainage

a component of pulmonary hygiene; it consists of drainage, positioning, and turning and is sometimes accompanied by chest percussion and vibration. It aids in improving secretion clearance and oxygenation. Positioning involves draining affected lung segments and helps to drain secretions from those segments of the lungs and bronchi into the trachea. Some patients do not require postural drainage of all lung segments, and clinical assessment is crucial in identifying specific lung segments requiring it. For example, patients with left lower lobe atelectasis require postural drainage of only the affected region, whereas a child with CF often requires postural drainage of all lung segments

Autoimmune diseases

a group of inflammatory (often chronic) diseases in which the immune system is attacking the self. Stress has a causative role in autoimmune disease genesis. In rheumatoid arthritis, the immune system believes the cells of the tissue around joints are foreign invaders and attacks them. Inflammation, pain, and eventually disability result. Cancer is another example of an autoimmune disease. Stress management, self-care, meditation, guided imagery, yoga, music, and exercise are found to release endorphins as the sympathetic system is calmed. The immune system steps out of the emergency mode and back into maintenance of function.

Metabolic syndrome

a group of risk factors that increase the likelihood of significant chronic health problems, such as diabetes, stroke, and heart disease. There are five risk factors associated with metabolic syndrome and for an individual to be diagnosed with metabolic syndrome, he or she must have at least three of these risk factors. This syndrome is quite complex, but an underlying factor is low-grade inflammation. Prevention of metabolic syndrome will protect the individual from these major life-threatening diseases. Lifestyle changes, weight and stress management, lowering cholesterol with medication and diet, increasing activity, and self-care are all recommended for those at risk.

Coping

a person's cognitive and behavioral efforts to manage a stressor ( Can et al., 2017 ). It is important to physical and psychological health because stress is associated with a range of psychological and health outcomes ( Can et al., 2017 ). The effectiveness of coping strategies is influenced by a variety of factors, such as a person's age, cultural background, individual circumstances, and past use of coping strategies. Thus no single coping strategy works for everyone or for every stressor.

Discuss the process of crisis intervention.

a specific type of brief psychotherapy and has two specific goals. First is patient safety. Use external controls to protect the patient and others if the person is suicidal or homicidal. Second is anxiety reduction using techniques that put a patient's inner resources into effect. It is more directive than traditional psychotherapy or counseling, and any member of the health care team who has been trained in its techniques can use it. The basic approach is problem solving, and it focuses only on the problem presented by the crisis -Crisis intervention aims to return the person to a precrisis level of functioning and promote growth.

Venipuncture

a technique in which a vein is punctured through the skin by a sharp rigid stylet (e.g., metal needle). The stylet is partially covered either with a plastic catheter or a needle attached to a syringe. General purposes of venipuncture are to collect a blood specimen, start an IV infusion, provide vascular access for later use, instill a medication, or inject a radiopaque or other tracer for special diagnostic examinations. It takes practice to become proficient in venipuncture. Only experienced practitioners should perform it for patients whose veins are fragile or collapse easily such as older adults.

Holistic nurses have a particular obligation to create what type of environment?

a therapeutic healing environment that values holism, caring, social support, and integration of conventional and complementary/integrative approaches to healing. They seek to create caring cultures and environments where individuals, both clients/patients and staff, feel connected, supported, and respected. A particular perspective of holistic nursing is the nurse as the healing environment and an instrument of healing. Holistic nurses shape the physical environment (e.g., light, fresh air, pleasant sounds or quiet, neatness and order, healing smells, earth elements), and they provide a relationship-focused environment by creating sacred space through presence and intention where another can feel safe, unfold, and explore the dimensions of self in healing. The focus on healing environments is extended to the creation of caring cultures and communities where families, populations, and nations can feel connected, supported, and respected. Holistic nurses have an integral role in revisioning and transforming organizational cultures into authentic healing healthcare systems and in trying to remove the political and financial barriers to the inclusion of holistic care in the healthcare system.

Nebulization

adds moisture to inspired air by mixing particles of varying sizes with the air. Aerosolization suspends the maximum number of water drops or particles of the desired size in inspired air. When the thin layer of fluid supporting the mucous layer over the cilia dries, the cilia are damaged and unable to adequately clear the airway. Humidification through nebulization enhances mucociliary clearance, the natural mechanism of the body for removing mucus and cellular debris from the respiratory tract. This, in turn, improves the clearance of pulmonary secretions. Nebulization is also a method of administration for certain medications, such as bronchodilators and mucolytic agents

Topical Administration

Shared theory

also known as a borrowed or interdisciplinary theory, explains a phenomenon specific to the discipline that developed the theory. For example, Piaget's theory of cognitive development helps to explain how children think, reason, and perceive the world. Knowledge and use of this theory help pediatric nurses design appropriate therapeutic play interventions for ill toddlers or school-age children. Knowles' adult learning theory helps a nurse plan and provide appropriate discharge teaching for a patient who is recovering from surgery.

Practice theories

also known as situation-specific theories, bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time. An example of a practice theory is a pain-management protocol for patients recovering from cardiac surgery. Practice theories are less abstract and are often easier to understand and apply than the grand and middle-range theories. -Pic demonstrates the level of abstraction for each of the grand, middle-range, and practice theory categories.

Systemic Infection

an infection throughout the body. can lead to sepsis. ex: infected cut can get into bloodstream if not treated with antibiotics, common cold

Grand theories

are abstract, broad in scope, and complex; therefore they require further clarification through research so that they can be applied to nursing practice. A grand theory does not provide guidance for specific nursing interventions. Instead it provides the structural framework for general, global ideas about nursing. Grand theories intend to answer the question "What is nursing?" and focus on the whole of nursing rather than on a specific type of nursing. The grand theorists developed their works based on their own experiences and the time in which they were living, which helps to explain why there is so much variation among the theories. Grand theories address the nursing metaparadigm components of person, nursing, health, and environment. For example, in Imogene King's theory of goal attainment, the focus of nursing is the interaction of human beings and the environment with an end goal of health.

Interpersonal variables

are factors within both the sender and receiver that influence communication. Perception provides a uniquely personal view of reality formed by an individual's culture, expectations, and experiences. Each person senses, interprets, and understands events differently. A nurse says, "You haven't been talking very much since your family left. Is there something on your mind?" One patient may perceive the nurse's question as caring and concerned; another perceives the nurse as invading privacy and is less willing to talk. Cultural sensitivity enables you to explore the interpersonal variables such as educational and developmental level, sociocultural background, values and beliefs, emotions, gender, physical health status, and roles and relationships that affect how a patient communicates. Interpersonal variables associated with illness such as pain, anxiety, and medication effects also affect nurse-patient communication.

Middle-range theories

are more limited in scope and less abstract. They address a specific phenomenon and reflect practice (administration, clinical, or teaching). While grand theories take a wide-angled lens perspective to nursing, middle-range theories expand on specific concepts or phenomena in a specific field of nursing such as uncertainty, incontinence, social support, quality of life, and caring. For example, Kolcaba's theory of comfort encourages nurses to meet patients' needs for comfort in physical, psychospiritual, environmental, and sociocultural realms. Like many middle-range theories, Kolcaba's theory was based on the works of a grand theorist—in this case, Nightingale. Middle-range theories are also sometimes developed from research, nursing practice, or the theories of other disciplines.

Explain the nurse's role in the implementation process.

begins after you develop a patient's plan of care. It involves the performance of nursing and collaborative interventions necessary to achieve the goals and expected outcome needed to support or improve a patient's health.

Hemorrhage

bleeding from a wound site, is normal during and immediately after initial trauma. Hemorrhage occurs externally or internally. -You detect internal bleeding by looking for distention or swelling of the affected body part, a change in the type and amount of drainage from a surgical drain, or signs of hypovolemic shock. -A hematoma is a localized collection of blood underneath the tissues. It appears as a swelling, change in color, sensation, or warmth that often takes on a bluish discoloration. -External hemorrhaging is obvious. Observe all wounds closely, particularly surgical wounds, in which the risk of hemorrhage is great during the first 24 to 48 hours after surgery or injury.

Intellectual background

cognitive abilities relate to a person's developmental stage. Consider your patient's intellectual background while providing patient education.

Group Dynamics

communication that takes place between members of any group. -We're all part of groups- family, etc. -Effectiveness of group: -unity/cohesion, -develop/modify structure to improve effect -must accomplish goals. -Much of a nurses professional life is spent in groups.

Social Learning theory

considers personal characteristics of the learner, behavioral patterns, and the environment and guides the educator in developing effective teaching interventions that motivate and enhance learning. -According to social learning theory, a person's state of mind, and intrinsic and motivational factors reinforce behaviors and influence learning.

Facial expressions

convey emotions such as surprise, fear, anger, happiness, and sadness. Some people have an expressionless face, or flat affect, which reveals little about what they are thinking or feeling. An inappropriate affect is a facial expression that does not match the content of a verbal message (e.g., smiling when describing a sad situation). People are sometimes unaware of the messages their expressions convey. For example, a nurse frowns in concentration while doing a procedure, and the patient interprets this as anger or disapproval. Patients closely observe nurses. Consider the impact your facial expression could have on a person who asks, "Am I going to die?" The slightest change in the eyes, lips, or facial muscles reveals your feelings. Although it is hard to control all facial expressions, try to avoid showing shock, disgust, dismay, or other distressing reactions in a patient's presence.

The holistic nurse's communication ensures that

each individual experiences the presence of the nurse as authentic, caring, compassionate, and sincere. This is deep listening, or as some say, "Listening with the heart and not just the ears." It is done with conscious intention and without preconceptions, busyness, distractions, or analysis. It takes place in the now within an atmosphere of shared humanness—human being to human being. Through presence or being with in the moment, holistic nurses provide each person with an interpersonal encounter that the individual can experience as a connection with one who is giving undivided attention to his or her needs and concerns. Holistic nurses actively engage in the therapeutic use of self. Communication techniques used by holistic nurses to build therapeutic relationships include but are not limited to unconditional regard, respect, deep and active listening, active observing, demonstrating empathy and concern, instilling hope, mindfulness, relaxation, stress management, goal management, crisis intervention, negotiation, and problem solving.

Sterilization

eliminates or destroys all forms of microbial life, including spores. Sterilization methods include processing items using steam, dry heat, hydrogen peroxide plasma, or ethylene oxide (ETO). The decision to clean, clean and disinfect, or sterilize depends on the intended use of a contaminated item

FICA assessment tool

evaluates spirituality and is closely correlated to quality of life F—F aith or belief I—I mportance and Influence C—C ommunity A—A ddress (interventions to address)

the building of trust can be impaired if individuals have

experienced emotional and/or physical abuse and/or neglect; been chronically put down, belittled, or misunderstood; been emotionally injured in the past and are now fearful of getting hurt again; experienced loss of loved ones through death so that they fear trusting again will lead to abandonment or death; experienced the end of a relationship or a bitter separation or divorce; lived in an emotionally or physically unstable and unpredictable environment; experienced pain from another; experienced victimization; or have low self-esteem and do not believe they deserve anyone's care, having difficulty even trusting sincere, helpful people and developing healthy relationships.

the nurse is not the ____________ regarding another's health and illness experience but is actually a ___________.

expert; learner

Full-thickness wound

extends into the subcutaneous layer and the depth and tissue type will vary depending on body location. -heal by hemostasis, inflammatory, proliferative, and maturation

Therapeutic/Professional Communication

focused on the client, personal, aimed at mutually determined goals. Helping relationship. Some sharing if beneficial to the relationship. -Goals/specific purpose -Focus - Patient Focused -Length -Boundaries -Disclosure

Complementary role relationships

function with one person holding an elevated position over the other person. A complementary role occurs when a nurse provides education to a patient about a new medication.

Presence

has been defined as a way of being, a way of relating, a way of being with, and a way of being there.

Health

has different meanings for each patient, the clinical setting, and the health care profession. It is a state of being that people define in relation to their own values, personality, and lifestyle. It is dynamic and continuously changing. Your challenge as a nurse is to provide the best possible care based on a patient's level of health and health care needs at the time of care delivery.

Right-sided heart failure

impairment of the right ventricle. blood begins to back up into the systemic circulation as evidenced by weight gain, distended neck veins and peripheral edema.

Environment/situation

includes all possible conditions affecting patients and the settings where they go for their health care. There is a continuous interaction between a patient and the environment. This interaction has positive and negative effects on a person's level of health and health care needs. Factors in the home, school, workplace, or community all influence the level of these needs. For example, an adolescent girl with type 1 diabetes needs to adapt her treatment plan to adjust for physical activities of school, the demands of a part-time job, and the timing of social events such as her prom.

theory of integral nursing

includes multiple dimensions of interrelationships. The theory describes four quadrants demonstrating how human beings experience their world through relationships: -The I quadrant represents the individual -the we quadrant demonstrates relationship to others within the context of culture, values, and vision -the it quadrant represents the physical body; and the its quadrant represents relationships to environment and social systems.

Intraarterial

injection into the arteries

Intraosseous

injection into the bone marrow

Intradermal

injection into the dermis just under the epidermis

Epidural

injection into the epidural space

Intrapleural

injection into the pleural space

Intrathecal

injection into the subarachnoid space or one of the ventricles of the brain

Subcutaneous

injection into the tissues just below the dermis of the skin.

Small-group communication

interaction that occurs when a small number of persons meet. Usually goal directed requires an understanding of group dynamics. Examples include nurses working on committees, patient care conferences, patient-teaching classes. is the interaction that occurs when a small number of people meet. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees with nurses or other disciplines and participate in patient care conferences, they use a small-group communication process. Communication in these situations should be organized, concise, and complete. All participating disciplines are encouraged to contribute and provide feedback. Good communication skills help each participant better meet a patient's needs and promote a safer care environment.

Parenteral routes

involves injection of the medication into the tissues: Four major sites of injection: •Intradermal - injection into the dermis just under the epidermis •Subcutaneous - injection into the tissues just below the dermis of the skin. •Intramuscular - injection into the muscle •Intravenous - injection into a vein (there are others too)

Psychomotor Domain of Learning

involves the development of manual or physical skills, such as; learning how to walk, how to type on a computer, use of a glucometer etc. --Psychomotor learning is accomplished through: demonstration, practice, return demonstration, and independent projects/games. -Psychomotor learning includes: fundamental, perception, guided response, mechanism, complex overt response, adaptation, and origination.

Displacement

involves transferring unpleasant emotional pain from the direct source of the pain to another, less threatening person or thing. For example, someone who is angry with his or her boss but who does not feel comfortable confronting the boss instead may become angry with his or her significant other at home.

Now orders

is a one time order to be given ASAP but not right away like a STAT order. A nurse has 90 minutes after receiving a now order to administer it.

Acting out

is a primitive defense mechanism where individuals may injure themselves, punch walls, or have tantrums because of being incapable of verbally expressing their feelings. Angrily throwing an object at the person who is the focus of the individual's anger, rather than verbally discussing the situation, is an example of acting out.

Rationalization

is a process of filtering or reframing reality to make that reality more acceptable. For example, a student might blame her poor exam grade on the professor, rationalizing that his teaching was ineffective, rather than taking responsibility for her lack of studying.

Motivational interviewing (MI)

is a technique that encourages patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior. MI provides a way of working with patients who may not seem ready to make behavioral changes that are considered necessary by their health practitioners. You can use it to evoke change talk, which links to improved patient outcomes A way of working with patients who may not seem ready to make behavioral changes that are considered necessary by their health practitioners. -Goal: to help the patient resolve his or her ambivalence about adopting new self-care behaviors, develop some momentum, and believe that behavioral change is possible

Inspiration

is an active process, stimulated by chemical receptors in the aorta. Expiration is a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work. Surfactant is a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing. Patients with advanced COPD lose the elastic recoil of the lungs and thorax. As a result, the patient's work of breathing increases. In addition, patients with certain pulmonary diseases have decreased surfactant production and sometimes develop atelectasis. Atelectasis is a collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide.

anger out

is directed at other people or things.

anger in

is directing anger at oneself, manifested with either suppressed hostility or depression

Wound infection

is present when the microorganisms invade the wound tissues. -The local clinical signs of wound infection can include erythema, increased amount of wound drainage, change in appearance of the wound drainage, warmth, pain, or edema. The patient has a fever, tenderness, and pain at the wound site, and an elevated white blood cell count. The edges of the wound appear inflamed. If drainage is present, it is purulent, which causes a yellow, green, or brown color, depending on the causative organism.

Airway resistance

is the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli. Any further decrease in airway diameter by bronchoconstriction or the presences of excess mucus can increase airway resistance. Diseases causing airway obstruction, such as asthma, tracheal edema, or COPD, increase airway resistance. When airway resistance increases, the amount of oxygen delivered to the alveoli decreases.

Diaphragmatic breathing

is useful for patients with pulmonary disease and dyspnea secondary to heart failure. This type of breathing increases tidal volume and decreases respiratory rate, which leads to an overall improved breathing pattern and quality of life. Diaphragmatic breathing is more difficult than other breathing methods because it requires a patient to relax intercostal and accessory respiratory muscles while taking deep inspirations, which takes practice. The patient places one hand flat below the breastbone (upper hand) and the other hand (lower hand) flat on the abdomen. Ask him or her to inhale slowly, making the abdomen push out (as the diaphragm flattens, the abdomen should extend out) and moving the lower hand outward. When the patient exhales, the abdomen goes in (the diaphragm ascends and pushes on lungs to help expel trapped air). The patient practices these exercises initially in the supine position and then while sitting and standing. The exercise is often used with the pursed-lip breathing technique.

self-awareness

is viewed as the basic competency for influential leaders, recognizing that when learning about themselves, leaders are then able to serve as inspiring role models and supportive mentors for others. By learning about the self, leaders become comfortable with their internal thought processes, values, beliefs, preferences, and emotions. They become self-managers, careful about how they present themselves and respond to the outside world. A self-aware leader, then, is in a better position to collaborate and connect with others.

Active listening

means being attentive to what a patient is saying both verbally and nonverbally. It facilitates patient communication. Inexperienced nurses sometimes feel the need to talk to prove that they know what they are doing or to decrease anxiety. It is often difficult at first to be quiet and really listen. Active listening enhances trust because you communicate acceptance and respect for a patient. The SURETY Model is one model you can use to facilitate attentive listening and therapeutic communication with your patients

Localized Infection

microbes enter the body and remains confined to a specific tissue -ex: scratch

Ventilation:

moving gases into and out of the lungs with air flowing into the lungs during inhalation and out of the lungs during exhalation

Diffusion:

moving the respiratory gases from one area to another by concentration gradients

Methods of Professional Communication

nDocumentation/Charting/Report/E mail nPagers/Cell-phones nInterdisciplinary communication nPatient nFamilies

Holistic nurses realize that suffering, illness, and disease are

natural components of the human condition and have the potential to teach us about ourselves, our relationships, and our universe. Every experience is valued for its meaning and lesson.

Interpersonal communication

none to one, the nurse and another person, nurse-patient, face-to-face. is one-on-one interaction between a nurse and another person that most often occurs face-to-face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice. It takes place within a social context and includes all the symbols and cues used to give and receive meaning. Because meaning resides in people and not in words, messages received are sometimes different from intended messages. Nurses work with people who have different opinions, experiences, values, and belief systems; thus it is important to validate meaning or mutually negotiate it between participants. For example, use interaction to assess understanding and clarify misinterpretations when teaching a patient about a health concern. Meaningful interpersonal communication results in an exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishment, team building, and personal growth.

Describe the differences between nursing care of acute and chronic wounds.

o Acute: wound is expected to progress through the phases of normal healing, resulting in the closure of the wound. Easily cleaned and repaired. o Chronic wound- is a wound that fails to progress healing or respond to treatment over the normal expected healing time frame (4 weeks) and becomes "stuck" in the inflammatory phase. Assessed less frequently

Describe the components of a critical thinking model for clinical decision making.

o Basic Critical Thinking: Beginning nurses are task-oriented. Rely on the experts. Thinking is concrete. o Complex Critical Thinking: Rely less on experts and trust their own decisions more. Able to creatively adapt a procedure to the specific needs of the patient. o Commitment: Make choices without assistance from others. Accepts accountability for decisions. You choose an action or belief based on available alternatives. Sometimes an action is not to act or delay your action for a later time.

Discuss factors that influence medication errors.

o Distractions o poor staffing o culture of perfection o fear of questioning physicians o punitive response to error ("shame and blame")

Describe complications of wound healing.

o Hemorrhage: bleeding from a wound site (internal or external) o Infection: is present when the microorganisms invade the wound tissues. o Dehiscence: When an incision fails to heal properly, the layers of skin and tissue separate. o Evisceration: With total separation of wound layers, evisceration or protrusion of visceral organs through a wound opening occurs

Explain the relationship of planning to nursing diagnosis

o Planning involves setting priorities based on patient diagnoses and collaborative problems, identifying patient centered goals and expected outcomes and prescribing nursing interventions appropriate for each diagnosis. Must be individualized to the unique needs of the patient.

Describe the pressure ulcer staging system.

o Pressure ulcer staging describes the pressure ulcer depth at the point of assessment. Pressure ulcers do not progress from a Stage III to a Stage I. A Stage III ulcer demonstrating signs of healing is described as a healing Stage III pressure ulcer. o Stage 1: Non-blanchable erythema of intact skin o Stage 2: Partial-thickness skin loss with exposed dermis o Stage 3: Full-thickness skin loss with visible adipose fat. o Stage 4: Pressure Injury: Full-thickness skin and tissue loss

List nursing diagnoses associated with impaired skin integrity.

o Risk for infection o imbalanced nutrition o Acute pain o ineffective tissue perfusion o Impaired physical mobility o Impaired skin integrity o Impaired Tissue integrity

Use the SMART model for writing an outcome statement.

o Specific o Measurable o Attainable o Realistic o Timed/Timely

State evaluation criteria for a patient with impaired skin integrity.

o measure the effectiveness of interventions o important to include the patient and caregiver in the evaluation process o determine what they know about the formation of impaired skin integrity, determine how the patient and caregiver feel about the presence of the wound and the need for wound care, and develop a plan of care to provide education and support

Define the types of nursing diagnoses

o problem-focused (actual) diagnosis: Identify an undesirable human response to existing problems or concerns of a patient. o risk diagnosis: Diagnoses that apply when there is an increased potential or vulnerability for a patient to develop a problem or complication (risk for) o health promotion (wellness) diagnosis: Identify the desire or motivation to improve health status through a positive behavioral change.

Signs

objectively observed indicators of a disorder -objective, measurable, and evidence ex: fever

Feedback

occurs continuously between a sender and receiver. A sender seeks verbal and nonverbal feedback to evaluate the receiver's response and effectiveness of a communicated message. The type of feedback a sender or receiver gives depends on factors such as their background, prior experiences, attitudes, cultural beliefs, and self-esteem. A sender and receiver need to be sensitive and open to one another's messages, to clarify the messages, and to modify behavior accordingly for successful communication.

Blanching

occurs when the normal red tones of the light-skinned patient are absent. When checking for pressure injuries in patients with dark pigmented skin, be aware that dark skin may not show the blanch response. Therefore inspect the pressure area with an adjacent or opposite area of the body for comparison. . Extended pressure occludes blood flow and nutrients and contributes to cell death. •The ability of tissue to endure pressure depends on the integrity of the tissue and supporting structures.

Lateral Violence

or workplace bullying between colleagues sometimes occurs and includes behaviors such as withholding information, backbiting, making snide remarks or put-downs, and nonverbal expressions of disapproval such as raising eyebrows or making faces. Lateral violence adversely affects the work environment, leading to job dissatisfaction, a decreased sense of value, poor teamwork, poor retention of qualified nurses, and nurses leaving the profession. New nurses are especially prone to bullying behavior. Lateral violence can be a precursor to compassion fatigue, when health care workers perceive a threat during interactions with colleagues and react emotionally rather than communicating intentionally in a professional manner.

Perception of functioning

perception of physical functioning affect health beliefs and practices. Assess your patient's level of health by assessing subjective and objective data. This will help in implementing individualized to care.

Acute Stage

phase of rapid multiplication of the pathogen with exponential growth and peak in its' population. Symptoms are very pronounced, both specific to the organ affected as well as in general due to the strong response of the immune system.

Sublingual administration

placing the medication under the tongue e.g. nitroglycerin. -placed under tongue and allowed to dissolve -Standard precautions used by nurse administering medications by sublingual or buccal route as the nurse's hand may come in contact with oral secretions -Warn patients not to chew or swallow the medication or to take any liquids with it (oral route)

Medical Asepsis

practices designed to reduce the number and transfer of pathogens; synonym for clean technique -doing things that would be done at home, washing hands for 15 sec -Hand hygiene/Alcohol-based hand rub -Standard precautions/Isolation Precautions -Cleaning/Disinfection/Sterilization

Goal of oxygen therapy

prevent or relieve hypoxemia by delivering the lowest amount of oxygen possible and achieving adequate tissue oxygenation

Debridement

removal of foreign material and dead or damaged tissue from a wound Removal of necrotic tissue is necessary to rid the wound of a source of infection, enable visualization of the wound bed, and provide a clean base necessary for healing. The method of debridement depends on which is most appropriate for a patient's condition and goals of care. It is important to remember that during the debridement process some normal wound observations include an increase in wound exudate, odor, and size. You need to assess and prevent or effectively manage pain that occurs with debridement. Plan to administer an ordered analgesic 30 minutes before debridement.

Feedback

serves to inform a system about how it functions. For example, in the nursing process the outcomes reflect the patient's responses to nursing interventions. The outcomes are part of the feedback system to refine the plan of care. Other forms of feedback in the nursing process include responses from family members and consultation from other healthcare professionals

Partial-thickness wounds

shallow in depth, moist, and painful, and the wound base generally appears red. -heal by the inflammatory response, epithelial proliferation and migration, and reestablishment of the epidermal layers

Isotonic Solutions

solutions separated by a membrane and containing an equal concentration of non-permeating solutes -Fluids with same osmolality as cell interior -0.9%NS; LR -Fluid shift? None -Expands only ECF, stays where it's administered, no net gain or loss from ICF

Alveoli: movement of o2 and co2

super small and have very thin walls. our circulatory system passes right next to them (arteries - come from the heart to the lungs) with deoxygenated blood. the air is flowing through the bronchioles and fill alveoli and the molecules of oxygen are allowed to cross the membrane of the alveoli and be absorbed into the blood. arteries from the heart release co2 into the alveoli to be exhaled. -o2 coming in and absorbed into alveoli -when we breathe out, we breathe out co2 that was in our blood that gets absorbed into alveoli and squeezed out about 1/5 mm in diameter

Conceptual Framework

term often used synonymously with paradigm. A conceptual framework provides a way to organize major concepts and visualize the relationship among phenomena. Different frameworks provide alternative ways to view the subject matter of a discipline and represent the perspective of the author. For example, the grand theorists all address similar concepts in their respective theories, but each theorist defines and describes the concepts in a different way based on the theorist's own ideas and experiences

Intrapersonal communication

the communication that you have with yourself - self talk. (Centering, Setting your intention). is a powerful form of communication that you use as a professional nurse. This level of communication is also called self-talk. People's thoughts and inner communications strongly influence perceptions, feelings, behavior, and self-esteem. Always be aware of the nature and content of your own thinking. Positive self-talk provides a mental rehearsal for difficult tasks or situations so that you can deal with them more effectively and with increased confidence. You use intrapersonal communication to develop self-awareness and a positive self-esteem to enhance appropriate self-expression. Positive self-talk can diminish cognitive distortions that lead to a decrease in self-esteem and impact your ability to work with patients. Transforming statements from "I'm scared to work with this type of patient" into "This is my opportunity to learn about this patient, and I can ask for help when it's needed" is an example of positive self-talk.

Work of breathing (WOB)

the effort required to expand and contract the lungs. In the healthy individual breathing is quiet and accomplished with minimal effort. The amount of energy expended on breathing depends on the rate and depth of breathing, the ease in which the lungs can be expanded (compliance), and airway resistance.

energy field

the fundamental unit of the living and non-living. Field is a unifying concept. Energy signifies the dynamic nature of the field; a field is in continuous motion and is infinite.

Bacteriostasis

the inhibition of further bacterial growth not killing

Left-sided heart failure

the left ventricle is weakened and the amount of blood ejected drops significantly. resulting in decreased cardiac output. pulmonary congestion can occur as evidenced by crackles in the bases of the lungs, shortness of breath with exertion, hypoxia and cough.

Generic Medication Name

the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. drug book. Acetaminophen is an example of a generic name for Tylenol.

Prodromal Stage

the period between end of incubation period and the point at which the characteristic symptoms of the illness appear. A person in the prodromal stage of an infectious illness often displays nonspecific symptoms, such as fatigue or malaise. -appearance of symptoms

Learning environment

the physical environment where teaching takes place may make learning a either a pleasant or difficult experience. --The ideal environment for learning should be a well lit room, good ventilation, appropriate furniture, and a comfortable temperature.

Humidification

the process of adding water to gas to keep airways moist. It is necessary for patients receiving oxygen therapy at high flow rates, typically greater than 4 L/minute (see agency protocols). Oxygen humidification via nasal cannula or face mask is achieved by bubbling oxygen through sterile water. Sterile water should be used to decrease the risk of hospital-acquired infection; agency protocols must be followed for changing the solution

Chest physiotherapy is reserved for use in patients with

thick secretions to help them mobilize those secretions.

Hypertonic Solutions

those with higher solute concentrations and lower water concentrations; cells placed in these solutions undergo CRENATION -Fluid shift? From ICF to ECF - 3%NS; 50%Dextrose (inc. o.p. of ECF initially) H20 will rush out of cells, cells shrink, ECF volume increases. Too much, cell will die. -Hypertonic solutions pull fluid from the cells causing them to shrink and causing ECF to expand. -Solutions in which solutes more concentrated than cells

Hypotonic Solutions

those with lower solute concentrations and higher water concentrations; cells placed in these solutions gain water; and if they lack a cell wall, may burst -Where will fluid move? -Into cell-too much, cell will swell and burst -A hypotonic solution has < salt or more water than an isotonic solution. -Solutions in which solutes are less concentrated than the cells -0.45%NS; 0.33%NS -D5W -Fluid shift? Fluid will move from dilute ECF to ICF

Explain the three stages of the general adaptation syndrome.

three predictable stages the body uses to respond to stressors, called general adaptation syndrome (GAS). The first stage is the alarm stage, which provides a burst of energy. In the second stage, known as the resistance stage, the body attempts to resist or adapt to the stressor. The last stage is known as the exhaustion stage because energy is depleted.

The primary function of pulmonary circulation

to move blood to and from the alveolar capillary membrane for gas exchange. Pulmonary circulation begins at the pulmonary artery, which receives poorly oxygenated mixed venous blood from the right ventricle. Blood flow through this system depends on the pumping ability of the right ventricle. The flow continues from the pulmonary artery through the pulmonary arterioles to the pulmonary capillaries, where blood comes in contact with the alveolar capillary membrane and the exchange of respiratory gases occurs. The oxygen-rich blood then circulates through the pulmonary venules and pulmonary veins, returning to the left atrium

Epidermis

top layer of skin •The epidermis has several layers within it. The stratum corneum is the thin, outermost layer that is flattened with dead keratinized cells. Cells in the basal layer divide, proliferate, and migrate toward the epidermal surface.

Secondary traumatic stress:

trauma that health care providers experience when witnessing and caring for others suffering trauma Witnessing other people's suffering -common in healthcare workers and first responders

Verbal communication

uses spoken or written words. Verbal language is a code that conveys specific meaning through a combination of words.

Lung Volumes

when we breathe, the air in our lungs is in constant flux -lung volumes are determined by age, gender and height -tidal volume is the amount of air exhaled following a normal inspiration -residual volume is the amount of air left in the aveoli after a full expiration -forced vital capacity is the max amount of air that can be removed from the lungs during forced expiration

Healthy People 2030

will promote a holistic approach to health promotion and disease prevention.

Implementing spiritual care into acute care settings

within acute care settings patient experience multiple stressors that threaten their sense of control. ongoing assessment of spiritual needs is essential because patients needs are often rapidly changing -Support systems -Diet therapies: offer food congruent to their religious observances -Supporting rituals: provide opportunities

Dressing Considerations

• Clean the wound and periwound area at each dressing change, minimizing trauma to the wound • Use a dressing that continuously provides a moist environment. • Perform wound care using topical dressings as determined by a thorough assessment. • No specific studies have proven an optimal dressing type for pressure injuries • Choose a dressing that keeps the periwound skin dry while keeping the injury bed moist. • Choose a dressing that controls exudate but does not desiccate the injury bed. • The type of dressing may change over time as the pressure injury heals or deteriorates. The wound should be monitored at every dressing change and regularly assessed to determine whether modifications in the dressing type are needed • Consider caregiver time, ease of use, availability, and cost when selecting a dressing.

Cultural Diversity and Communication

• Differences in language comprehension may impede understanding and negatively impact the quality and safety of nursing care. • Even among native speakers, variability in word usage, vocabulary, and literacy may skew patient and nurse understanding • Differences in nonverbal communication styles may create misunderstanding or discomfort, including practices regarding personal space, privacy, eye contact, and touch. • Among people of different cultures decision-making authority for patient care decisions may vary. • Variability in religious and spiritual beliefs affects how individuals perceive the health care experience. • Incorporating the patient's beliefs and practices into the health care situation contributes to a patient-centered care experience.

Possible nursing diagnoses for patients with fluid, electrolyte, and acid-base alterations include the following:

• Fluid Imbalance • Dehydration • Electrolyte Imbalance • Acid Base Imbalance • Lack of Knowledge of Fluid Regimen

Goals of Theoretical Nursing Models

• Identify domain and goals of nursing. • Provide knowledge to improve nursing administration, practice, education, and research. • Guide research to expand the knowledge base of nursing. • Identify research techniques and tools used to validate nursing interventions. • Develop curriculum plans for nursing education. • Establish criteria for measuring quality of nursing care, education, and research. • Guide development of a nursing care delivery system. • Provide systematic structure and rationale for nursing activities.

Focus on Older Adults Understanding Differences in Stress and Coping Among Older Adults

• Ordinary hassles of day-to-day living create a source of stress; older adults have more hassles with home maintenance and health than do younger people. • Older adults often use more passive, intrapersonal, emotion-focused forms of coping such as distancing, humor, accepting responsibility, and reappraising the stressor in a positive way. • Life experiences and perspectives of older adults make most problems seem insignificant, especially when older adults have acquired appropriate stress-management techniques • Older adults' coping improves based on earlier experience with coping with traumatic situations • Impaired coping affects overall health in older adults more than in younger adults • Because of the high incidence of depression in older adults, you need to assess for suicidal thoughts and intent. • When marital or partnership dyads are present, the perceived stress of one member has a greater effect on the other member than occurs with middle or young adults

Nursing Diagnostic Process Risk for Fall

• Risk for Injury • Impaired Cognition: Confusion • Lack of Knowledge • Risk for Poisoning • Risk for Trauma Potter, Patricia A.,Perry, Anne Griffin,Stockert, Patricia,Hall, Amy. Fundamentals of Nursing - E-Book (p. 396). Elsevier Health Sciences. Kindle Edition.

Nursing Considerations for Oral Administration

•Assess patient's ability to take medications by the oral route to prevent aspiration •Nurse should verify that the medication was swallowed •Special techniques are used for the patient who has difficulty swallowing large tablets. •Enteric-coated or sustained-release tablets should never be crushed •Antifungal liquid medications may need longer contact with mucous membranes and be prescribed as "swish and swallow." •May be administered through gastrointestinal tube. Liquid medication is preferred, although some tablets may be finely crushed and dissolved in water

Assessing Pressure Ulcers

•Assess pressure ulcers at regular intervals using systematic parameters to evaluate wound healing, plan appropriate interventions, and evaluate progress. Assessment includes wound location, depth of tissue involvement (staging), type and approximate percentage of tissue in wound bed, wound dimensions, exudate description, and condition of surrounding skin. •Pressure ulcer staging describes the pressure ulcer depth at the point of assessment. Pressure ulcers do not progress from a Stage III to a Stage I. A Stage III ulcer demonstrating signs of healing is described as a healing Stage III pressure ulcer. •Use a disposable wound-measuring devices to obtain the measurement of width and length. Measure depth by using a cotton-tipped applicator in the wound bed. •Wound exudate should describe the amount, color, consistency, and odor of wound drainage. Excessive exudate indicates the presence of infection. Examine the periwound area for redness, warmth, and signs of maceration and palpate the area for signs of pain or induration. The presence of any of these factors on the periwound skin indicates wound deterioration.

Risk factors for pressure ulcers

•Patients who are confused or disoriented or who have alterations in level of consciousness are unable to protect themselves. •Shear is the force exerted parallel to skin, resulting from both gravity pushing down on the body and resistance (friction) between the patient and a surface. •Friction is the force of two surfaces moving across one another, such as the mechanical force exerted when the body is dragged across another surface. •The presence and duration of moisture on the skin reduce the skin's resistance and may cause pressure ulcers •Any patient who is experiencing decreased mobility, decreased sensory perception, fecal or urinary incontinence, and/or poor nutrition is at risk for pressure ulcer development. •Patients with altered sensory perception for pain and pressure are at risk because they cannot feel their body sensations. •Patients who are unable to independently change position are at risk because they cannot change or shift off bony prominence areas.

Purposes of dressings

•Protects from microorganisms •Aids in hemostasis •Promotes healing by absorbing drainage or debriding a wound •Supports wound site •Promotes thermal insulation •Provides a moist environment

Factors that influence absorption of meds

•Route of administration •Ability of a medication to dissolve •Blood flow to the site of administration •Body surface area •Lipid solubility

Discuss nursing interventions designed to promote a patient's spiritual health.

•Use assessment data about the spirituality and spiritual behaviors or practices from caregivers of family members with chronic illnesses to identify areas of strength and support. •When appropriate, encourage family caregivers to participate in spiritual behaviors or practices and encourage members from the caregivers' congregations to visit to enhance social support and reduce caregiver burden. •Consider cultural differences and explore personal preferences when determining nursing interventions to enhance spiritual well-being. •Inform caregivers of spiritual resources available in the community (e.g., parish nurses, community- or faith-based support groups, clergy, social services). •Arrange for respite care to allow caregivers to attend religious services if desired to enhance social support and reduce caregiver burden.

"I" Statements

-Makes the statement focus from the sender. -Own your communication. -Makes the communication feel less threatening. -Takes practice.

7 rights of medication administration

-Right medication -Right dose -Right patient -Right route -Right time -Right documentation -Right indication

Renin-Angiotensin-Aldosterone cascade

-Special cells in the kidney sense a decrease in blood flow or sodium levels. The net effect is to restore blood volume and renal perfusion through sodium and water retention. -Renin is released into the bloodstream -Renin is converted (several steps) to angiotensin II (vasoconstrictor, sodium and water retention, stimulator of aldosterone production)

Instructional methods

-Verbal one-on-one discussion -Group instruction -Preparatory instruction - may involve providing information about a procedure to reduce anxiety in your patient. -Demonstrations - very effective when the learner first observes the nurse and during the return demonstration has a chance to practice the skill. -Analogies - supplement verbal instructions with familiar images that make complex information more real and easy to understand. For example, when explaining arterial blood pressure, use an analogy of the flow of water through a hose. -Role-playing -Simulation

Communication and the Nursing Process: Nursing Diagnosis

-Clarifying with client -Many patients have difficulty with some aspect of communication -ND: Impaired Verbal Communication R/T hearing loss, -Impaired Socialization

Healing

A lifelong journey into wholeness, seeking harmony and balance in one's own life and in family, community, and global relations. Healing involves those physical, mental, social, and spiritual processes of recovery, repair, renewal, and transformation that increase wholeness and often (though not invariably) order and coherence. Healing is an emergent process of the whole system bringing together aspects of one's self and the body, mind, emotion, spirit, and environment at deeper levels of inner knowing, leading toward integration and balance, with each aspect having equal importance and value. Healing can lead to more complex levels of personal understanding and meaning and may be synchronous but not synonymous with curing.

Medical errors

A medical error is any preventable event that may cause inappropriate medication use or jeopardize patient safety. -More people die from medical errors than from chronic lower respiratory diseases, accidents, stroke, Alzheimer's disease, and diabetes mellitus.

Use of Names

Always introduce yourself. Failure to give your name and status (e.g., nursing student, RN, or licensed practical nurse) or to acknowledge a patient creates uncertainty about an interaction and conveys an impersonal lack of commitment or caring. Making eye contact and smiling are ways to recognize others. Addressing people by name conveys respect for human dignity and uniqueness. Ask how your patients and co-workers prefer to be addressed and honor their personal preferences. Using first names is appropriate for infants, young children, patients who are confused or unconscious, and close team members. Avoid terms of endearment such as "honey". Even the closest nurse-patient relationships rarely progress to identities beyond first names. Avoid referring to patients by diagnosis, room number, or another attribute, which is demeaning and sends the message that you do not care enough to know the person as an individual.

Gauze sponges

Gauze sponges are the oldest and most common dressing. They are absorbent and are especially useful in wounds to wick away wound exudate. Gauze is available in different textures and various lengths and sizes; the 4 × 4 is the most common size. Gauze can be saturated with solutions and used to clean and pack a wound. When used to pack a wound, the gauze is saturated with the solution (usually normal saline), wrung out (leaving the gauze only moist), unfolded, and lightly packed into the wound. Unfolding the dressing allows easy wicking action. The purpose of this type of dressing is to provide moisture to the wound yet to allow wound drainage to be wicked into the dry cover gauze pad.

obsessive-compulsive personality disorder

People with obsessive-compulsive personality disorder tend to be highly controlling, rigid, and perfectionistic. They have a preoccupation with details, rules, and orderliness. Being stubborn, inflexible, and miserly are other facets of this personality disorder. Another characteristic is failure to allow others to participate in projects or discussions, feeling that their way is the only right way. These people are capable of being highly devoted to their work, which can be seen in a positive or negative light.

Side effect of medication

Predictable, and unavoidable secondary effect. Common side effects are nausea, vomiting, diarrhea, constipation and drowsiness.

Life and Dignity of the Human Person

The Catholic Church proclaims that human life is sacred and that the dignity of the human person is the foundation of a moral vision for society. This belief is the foundation of all the principles of our social teaching. We believe that every person is precious, that people are more important than things, and that the measure of every institution is whether it threatens or enhances the life and dignity of the human person.

cultural competence

The ability to deliver health care with knowledge of and sensitivity to cultural factors that influence the health behavior and the curing, healing, dying, and grieving processes of the person.

Resistance Stage

The resistance stage also contributes to the fight-or-flight response, and the body stabilizes and responds in an attempt to compensate for the changes induced by the alarm stage. Hormone levels, heart rate, blood pressure, and cardiac output should return to normal, and the body tries to repair any damage that occurred. However, these compensation attempts consume energy and other bodily resources.

Administering Eye (Ophthalmic) Medications Delegation and Collaboration

The skill of administering eye medications cannot be delegated to assistive personnel (AP). The nurse instructs the AP about: • The specific potential side effects of medications and to report their occurrence. • The potential for temporary burning or blurring of vision after administration of eye medications.

Trustworthiness

Trust is relying on someone without doubt or question. Being trustworthy means helping others without hesitation. To foster trust, communicate warmth and demonstrate consistency, reliability, honesty, competence, and respect. Sometimes it isn't easy for a patient to ask for help. Trusting another person involves risk and vulnerability, but it also fosters open, therapeutic communication and enhances the expression of feelings, thoughts, and needs. Without trust a nurse-patient relationship rarely progresses beyond social interaction and superficial care. Avoid dishonesty at all costs. Withholding key information, lying, or distorting the truth violates both legal and ethical standards of practice. Sharing personal information or gossiping about others sends the message that you cannot be trusted and damages interpersonal relationships

Intraocular route

inserting a medication similar to a contact lens into the eye. The medication remains in the eye for 1 week

Pursed-lip breathing

involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse. While sitting up, instruct the patient to take a deep breath and exhale slowly through pursed lips as if blowing out a candle. Patients need to gain control of the exhalation phase so that it is longer than inhalation. The patient is usually able to perfect this technique by counting the inhalation time and gradually increasing the count during exhalation. In studies using pursed-lip breathing as a method to improve exercise tolerance in patients with COPD, patients were able to demonstrate increases in their exercise tolerance, breathing pattern, and arterial oxygen saturation

Positive expiratory pressure (PEP)

is an airway clearance technique that can be used with and without oscillation. Its use is typically reserved for patients with CF or other lung diseases in which sputum is retained. The Acapella and Flutter devices are commonly used PEP devices. PEP allows air to be inhaled easily but forces the patient to exhale against resistance. This action helps air get behind the mucus, which then makes it easier to expectorate the mucus. The patient must be physically capable of maintaining a seal with their mouth around the device.

Collaboration

is viewed as the duty and a performance improvement strategy for influential leaders, with the understanding that creating a common goal through partnering with others allows for greater trust, accountability, and harmony. Collaborative action provides a climate for dynamic transformation from a competitive, power-over environment to a cooperative, power-with organizational culture. Sustainable collaboration draws on the expertise, knowledge, and strengths of each team member, allowing for collective decision making, cultivation of strong relationships, and acknowledgment that every person provides a unique talent and contribution to the creation of a high-performing organization.

Discuss the differences between independent and dependent nursing interventions.

o Independent nursing interventions are those sanctioned by professional nurse practice acts. They do not require direction or an order from another health care professional. o Dependent nursing interventions are those that require an order from other health care professionals.

Explain the nursing health history and its components.

o Key component of a comprehensive assessment o Gather Subjective Data o Holistic assessment that covers all health dimensions (Emotional, Social, Cultural, Spiritual, Intellectual).

Personal Distance (18 inches-40 inches)

• Sitting at a patient's bedside • Taking a patient's nursing history • Teaching an individual patient

Principles of Surgical Asepsis

-A sterile object remains sterile only when touched by another sterile object -Only sterile objects may be placed on a sterile field -A sterile object or field out of the range of vision or an object held below a person's waist is contaminated -A sterile object or field becomes contaminated by prolonged exposure to air -When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated through capillary action -Fluid flows in the direction of gravity -The edges of a sterile field or container are considered to be contaminate

What is nursing?

-An art: nurses deliver care -A science: nursing practice is based on a body of knowledge, evidence-based practices and is continually changing By integrating the art and science of nursing the quality of care is at the highest standards and benefits patients and their families.

What is spirituality?

-An awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself. -Includes personal beliefs that help a person maintain hope and get through difficult situations. -The human spirit is powerful, and spirituality has different meanings for different people. -Nurses need to be aware of their own spirituality to provide appropriate spiritual care to others.

Scientific Knowledge Base

-An individual's intrinsic spirit seems to be an important factor in healing. -Healing often takes place because of believing. -Spirituality has a positive impact on the ability to cope with anxiety, stress, and depression. -A person's inner beliefs and convictions are powerful resources for healing.

Critical Thinking Prompts the Nurse to.....

-Answers the question "what if..." -Guides actions and interventions -Allows the thinker to anticipate needs -Bring together many sources of data, discard what is not important, and determine a course of action

Arterial Blood Gases (ABG)

-Arterial Blood Gases (ABG) -Three parts of the ABG give you information about acid/base status. -pH - measure of hydrogen ion concentration -PaCO2 - partial pressure of carbon dioxide (respiratory component) -HCO3 - bicarbonate (metabolic component) -PaO2 - oxygen status

Goals

-Broad statement that describes client change -Client specific -The opposite of the diagnostic stem -Short-term: (Usually < a week, acute care may be hours) -Long-term: (days, weeks or months) -Often based on standards of care or clinical guidelines established for minimal safe practice.

Assessment findings/Signs and symptoms of Hyperkalemia

-CV = most severe; tachycardia to brady, ECG changes, dysrhythmias, cardiac arrest -Neuromuscular: vague muscle weakness, anxiety, irritability -GI: N/V. diarrhea, cramps -GU: oliguria -Lab = á serum osmolality; ácreatinine & BUN

Assessment findings/Signs and symptoms Hypokalemia

-CV: arrhythmias; hypotension, slow, weak pulse, ECG changes -GI: impaired motility, â bs -Neuro: fatigue, confusion -Muscle weakness (can be life-threatening if respiratory muscles are effected) -GU: polyuria

Thirst

-Changes in plasma concentration are monitored in the hypothalamus -Thirst mechanism and ADH excretion are triggered -Conscious ingestion of fluids in response to health habits or social situations -Sensitivity of thirst mechanism decreases in older adults

Pulmonary Health Implementation: Acute Care

-Dyspnea management -Airway maintenance -Mobilization of pulmonary secretions -Hydration -Humidification -Nebulization -Coughing and deep-breathing

Assessment findings/Signs and symptoms of Hypercalcemia

-GI: decreased peristalsis, constipation -Lethargy -Cardiac abnormalities - cardiac arrest if severe -CNS: decreased memory, confusion, psychosis; weak muscles; hypoactive dtrs (deep tendon reflexes) -Renal: kidney stones -Bone pain -Muscle fatigue

HIPAA

-Health Insurance Portability& Accountability Act (1996) -Patient data protected & available only to those needing access -Patient gets notice of privacy practices from HC providers r/t how/when records will be shared -Violations = fines or termination

Assessment: med admin

-History: review the patient's medical history (allergies, meds, diet history, perceptual or coordination problems) -Patient's current condition -Patient's attitude about medication use -Factors affecting adherence to med therapy -Patient's learning needs

Assertive

-Honest -Speaks their mind using "I" statements -Accepts compliments gracefully -Accepts criticism thoughtfully -Sees failure as an opportunity to learn -Promotes patient safety by minimizing miscommunication with colleagues.

Zones of Personal Space

-Intimate Distance (0-18 inches) -Personal Distance (18 inches-40 inches) -Social Distance (4-12 feet) -Public Distance (12 feet and more)

Where is the fluid located?

-Intracellular Fluid (ICF) ~ (2/3 of total). 40% of body weight -Fluid found "within" or inside the cells. -Extracellular (1/3 of total). 20% of weight -Fluid found outside the cells -Interstitial fluid- (75%)Surrounds the cells -Intravascular (20%)- Within the arteries, veins and capillaries (Plasma) -Transcellular- Eyes, brain, spinal canal, lymph, synovial tissue and eyes

anger can serve the following functions, which may turn negatives into positives:

-It is a survival mechanism to protect ourselves and keep us safe. -The discharge of anger releases tension, eventually calming the person. -Anger can both be energizing and provide a sense of control. -Anger can be triggered by injustice and denial of rights. -Anger may improve negotiating skills and induce cooperation. -Anger can motivate change.

Collaborative Management of Hypokalemia

-K+ supplements: po, IV -Stop diuretics -Monitor vital signs-apical pulse, note any irregularities -Full GI assessment -Monitor I&O -Educate re: foods high in K+

Nursing Health History

-Key component of a comprehensive assessment -Gather Subjective Data -Holistic assessment that covers all health dimensions (Emotional, Social, Cultural, Spiritual, Intellectual).

Causes of Metabolic acidosis

-Lactic acid = anaerobic metabolism -Starvation -Shock, cardiac arrest -Severe diarrhea -Renal disease -Ingestions of acids

Impairments to Communication

-Language deficits -Sensory deficits -Cognitive impairments -Structural deficits

Seven Themes of Catholic Social Teaching

-Life and Dignity of the Human Person -Call to Family, Community, and Participation -Rights and Responsibilities -Option for the Poor and Vulnerable -The Dignity of Work and the Rights of Workers -Solidarity -Care for God's Creation

Calcium

-Total Ca++ = 9.0-10.5 mg/dl, app -(Approximate), text states abnormalities <9 and >10.5 -Ionized/ free Ca++ = 4.5-5.6 mg/dl -Cation found in both intra and extracellular fluid -Necessary for healthy bones and teeth, muscle contraction, cardiac function -Blood coagulation -Nerve impulses -Adult: 9.0-10.5 mg/dL -The most abundant cation in the body however the vast majority, 99% in the body is in the skeleton. -Calcium is regulated by a complex interaction of parathyroid hormone, calcitonin and calcitrol, a metabolite of Vitamin D. -Calcium and Phosphate levels have an inverse relationship in the body. -Transmit nerve impulses -Maintain cellular permeability -Form bones and teeth -Blood coagulation -Relaxes smooth muscle

Collaborative Management of FVE

-Treat the cause -Diuretic therapy -Fluid restriction -Para or thoracentesis -Low Na+ diet -Protein may be increased, if malnourished - to increase capillary oncotic pressure. -Early detection -Daily weights -Accurate, strict I&O -Monitor labs -Assess lung sounds, O2 sats -Assess edema

Planning: Pulmonary Health

-Use critical thinking skills to synthesize information from multiple sources -Goals and outcomes -Realistic expectations, goals, and measurable outcomes -Setting priorities -Teamwork and collaboration

Holistic nurse:

A nurse who recognizes and integrates body-mind-emotion-spirit-environment principles and modalities into daily life and clinical practice, creates a caring, healing space within herself or himself that allows the nurse to be an instrument of healing, shares authenticity of unconditional presence that helps to remove the barriers to the healing process, facilitates another person's growth (body-mind-emotion-spirit-environment-energetic connections), and assists with recovery from illness or transition to peaceful death.

When does a nurse initiate a Nursing Diagnosis?

A nursing diagnosis is made when a nurse identifies a health-related problem or the potential to develop a problem based on patient data.

Concepts

A theory also consists of interrelated concepts that help describe or label phenomena. A concept is a thought or idea of reality that is put into words or phrases to help describe or explain a specific phenomenon ( Smith and Liehr, 2018 ). Concepts can be abstract such as emotions or concrete such as physical objects. For example, in Meleis and colleagues' theory of transitions, abstract concepts include coping and adapting, while Nightingale described concrete concepts such as physical conditions and health care environments. Theories use concepts to communicate meaning.

Comfort Measures

A wound is often painful, depending on the extent of tissue injury, and wound care often requires the use of well-timed analgesia before any wound procedure. Administer analgesic medications 30 to 60 minutes before dressing changes, depending on the time of peak action of a drug. In addition, several techniques are useful in minimizing discomfort during wound care. Carefully removing tape, gently cleaning wound edges, and carefully manipulating dressings and drains minimize stress on sensitive tissues. Careful turning and positioning also reduce strain on a wound.

Holistic nursing practice process:

An iterative and integrative process that involves six steps that can occur simultaneously: (1) assessing; (2) diagnosing or identifying patterns, challenges, needs, and health issues; (3) identifying outcomes; (4) planning care; (5) implementing the care plan; and (6) evaluating.

Oxygen masks

An oxygen mask is a plastic device that fits snugly over the mouth and nose and is secured in place with a strap. It delivers oxygen as the patient breathes through either the mouth or nose by way of a plastic tubing at the base of the mask that is attached to an oxygen source.

Identify approaches for establishing presence with patients.

Behaviors that establish the nurse's presence include paying attention, answering questions, listening, and having a positive and encouraging (but realistic) attitude. Establishing presence is part of the art of nursing. It is not simply being in the same room with a patient while performing procedures or sharing technical information with him or her. Presence involves "being with" a patient versus "doing for" a patient. It involves offering closeness with the patient physically, psychologically, and spiritually

Colloid Osmotic Pressure

Blood contains albumin and other proteins known as colloids. These proteins are much larger than electrolytes, glucose and other molecules that dissolve easily. Blood colloid osmotic pressure also known as oncotic pressure, is an inward -pulling force that helps move fluid from the interstitial area back into capillaries.

Bodily Responses to Heat and Cold

Exposure to heat and cold causes systemic and local responses. Systemic responses occur through heat-loss mechanisms (sweating and vasodilation) or mechanisms promoting heat conservation (vasoconstriction and piloerection) and heat production (shivering). Local responses to heat and cold occur through stimulation of temperature-sensitive nerve endings within the skin. This stimulation sends impulses from the periphery to the hypothalamus, which becomes aware of local temperature sensations and triggers adaptive responses for maintenance of normal body temperature. If alterations occur along temperature sensation pathways, the reception and eventual perception of stimuli are altered.

Intuition

Intuition is a useful and foundational element in the holistic communication process. It is defined as "the perceived knowing of things and events without the conscious use of rational processes; using all of the senses to receive information." The usefulness of intuition in the nursing process is well researched and documented. Although intuitive knowing is something that occurs more readily with the experienced nurse, it can be consciously cultivated through various practices. -When the nurse utilizes intuition, she or he engages the full use of self, which is essential in accessing and communicating with the whole person.

Metacommunication

Metacommunication is a broad term that refers to all factors that influence communication. Awareness of influencing factors helps people better understand what is communicated. For example, a nurse observes a young patient holding his body rigidly, and his voice is sharp as he says, "Going to surgery is no big deal." The nurse replies, "You say having surgery doesn't bother you, but you look and sound tense. I'd like to hear more about how you're feeling." Awareness of the tone of the verbal response and the nonverbal behavior results in further exploration of the patient's feelings and concerns.

Microbiome

Microbiome There is also increasing evidence that we can use probiotics to help persons suffering from a variety of illnesses. These include not only bowel disease like irritable bowel syndrome but also psychiatric illness or diabetes. Researchers can now discern which strains of gut bacteria affect the nervous system and even map the exact pathways through which specific gut bacteria influence the brain. For example, people suffering from major depression frequently have elevated levels of the hormone cortisol and the messenger proteins called cytokines, which are released in response to stress.

Risk for injury related to altered thought processes & muscle weakness: Outcomes and Interventions

Outcomes 1)Pt complies with safety precautions (list) 2)Pt remains injury free Interventions 1)Side rails up 2)Assist with walking 3)Call light w/i reach 4)Decreased stimuli 5)Reorient to time and place PRN 6)Monitor Na level

Indirect Mode of Transmission

Personal contact of susceptible host with contaminated inanimate object (e.g., needles or sharp objects, soiled linen, dressings, environment)

Secondary Appraisel

Secondary appraisal, the process by which a person considers possible available coping strategies or resources, occurs at the same time. Stress occurs if the demands placed on the person by the event exceed the ability to cope. Balancing factors contribute to restoring equilibrium. According to crisis theory, because feedback cues lead to reappraisals of the original perception, coping behaviors constantly change as individuals perceive new information. When coping behaviors are ineffective and repeated over and over, a state of stress can result. Stress emerges either when a person views an event as posing a significant risk of harm or when the person is not able to cope with the event's demands.

Situational Factors

Situational stressors in the workplace that affect nurses and other health care professionals include high-acuity patient load, job environment, constant distractions, responsibility, conflicting priorities, and intensity of care (e.g., trauma, emergency, or critical care areas). In addition, changing shifts increases fatigue and work-related stress. Some nurses often ease coping with shift work by knowing their own circadian rhythms. People who function best in the morning have the greatest difficulty with night work and changing shifts. As people age, they tend to become more morning oriented. Morning people need to be counseled about the potentially negative effects of night work for them. In general, people doing shift work need to maintain as consistent a sleep and mealtime schedule as possible.

Spirituality:

The feelings, thoughts, experiences, and behaviors that arise from a search for meaning; that which is generally considered sacred or holy; usually, though not universally, considered to involve a sense of connection with an absolute, imminent, or transcendent spiritual force, however named, as well as the conviction that meaning, value, direction, and purpose are valid aspects of the individual and universe; the essence of being and relatedness that permeates all of life and is manifested in one's knowing, doing, and being; the interconnectedness with self, others, nature, and God/Life Force/Absolute/Transcendent; not necessarily synonymous with religion.

Personality and Wellness

The field of PNI began in cardiovascular rehabilitation, and back in the late 1980s, it was noticed that people with cardiovascular disease tend to have controlling personalities and are quick to anger. Stress and anger management training became part of the treatment regimen in response. Personality traits are thought to be well established and difficult to change by adolescence and are both genetic and environmental. Researchers have since been finding links to personality traits and specific disease. Can people who develop Parkinson disease be identified as high risk before the disease begins by screening their personality characteristics and level of needed locus of control? Would assessing personality type help earlier diagnosis in fibromyalgia patients? Perhaps we will one day predict bipolar disorder by examining extraversion/introversion characteristics of personality. Personality is part of the whole human being along with genetic and environmental roots, so we cannot be surprised that wellness and disease are linked to temperament and how we present ourselves to others.

Using Metered-Dose or Dry Powder Inhalers Delegation and Collaboration

The skill of administering inhaled medications cannot be delegated to assistive personnel (AP). The nurse instructs the AP about: • Potential side effects of medications and to report their occurrence to the nurse. • Reporting breathing difficulty (e.g., paroxysmal or sustained coughing, audible wheezing) to the nurse.

Administering Injections Delegation and Collaboration

The skill of administering injections cannot be delegated to assistive personnel (AP). The nurse instructs the AP about: • Potential medication side effects and allergic responses and the need to report their occurrence along with any changes in patient's vital signs or level of consciousness (e.g., sedation).

Definitions

Theorists use definitions to communicate the general meaning of the concepts of a theory. Definitions may be theoretical/conceptual or operational . Theoretical or conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on the theorist's perspective. Operational definitions state how concepts are measured. For example, a nursing concept conceptually defines pain as physical discomfort and operationally as a patient reporting a score of three or above on a pain scale of zero to ten.

Therapeutic Presence

Therapeutic presence is a relatively new concept being described in psychiatry. Its roots come from holistic nursing, however. Healthcare provider training in mindfulness improves providers' abilities to be present to patients, and this has demonstrated an increase in compassionate attitudes toward patients. A side benefit that has been noted is that physicians trained in mindfulness in preparation for providing psychotherapy have lower burnout levels and display more helpful traits in the patient-centered relationship. Mindfulness and therapeutic presence share a common quality of the ability to be very attentive to an internal experience while simultaneously being receptive to experiences in the environment.

Smothering symptoms

This symptom results when another is overly solicitous of your needs and interests. It can be so overwhelming that you feel like you are being strangled, held too tightly, and lack freedom to breathe on your own.

Crisis Intervention

Magnesium

(1.3-2.1 mEq/L) Role -Activator in many key enzyme reactions -Exerts similar effect as Ca++ on neuromuscular function -Used to prevent convulsions for preeclampsia

Use alarms safely (2021 Hospital Patient Safety Goal)

Make improvements to ensure that alarms on medical equipment are heard and responded to on time.

Wound Care

-Cleaning skin and drain sites -Clean per Dr. orders -Clean from least contaminated to the surrounding skin -When irrigating, allow the solution to flow from the least to most contaminated area

Respiratory acidosis

-*Hypoventilation and retention of CO2 -Retain C02 leads to carbonic acid build up -Decrease pH <7.35 -Compensation: buffer system, kidneys excrete more H+, conserve HCO3 -Kidneys conserve bicarb and secrete acids

Assessment data sources

-*Patient (Best, primary source of data) -Family caregivers and significant others -Health care team -Medical records -Other records and the scientific literature -Nurse's experience

Body Composition of a 70 kg Male

-70 kg Man: -42 L of water: -30 L ICF -11 L ECF (of this 8L interstitial, 3L plasma) 5-6 L of fluid is secreted into and reabsorbed from the GI tract every day, loss of this fluid from vomiting or diarrhea can produce serious fluid and electrolyte imbalances.

Nursing diagnosis

-A clinical judgment made by a nurse to describe a patient's response or vulnerability to health conditions or life events that a nurse is licensed and competent to treat (NANDA-I, 2018b). -The 2nd step in the nursing process.

Nurse- and health care provider-initiated standard interventions include

-Clinical practice guidelines and protocols -Care bundles -Standing orders -Nursing Interventions Classification (NIC) interventions -Standards of practice

3rd spacing of fluids

-Common after trauma, surgery -Fluid where normally is none -Degree R/T severity -Fluid is useless to cells

What position most effectively promotes lung expansion

45 degree semi-fowlers

Normal WBC Count

5-10,000

Compare Achieved Effect with Goals and Outcomes

-Compare clinical data, patient behavior measures, and patient self-report measures collected before implementation with the evaluation findings gathered after administering nursing care. -Evaluate whether the results of care match the expected outcomes and goals set for a patient.

Modeling and role modeling

-describes adaptation [striving for equilibrium] and assessment of adaptive potential -five aims of intervention: build trust; promote positive orientation; promote perceived control; promote strengths; and set mutual health-directed goals -nurse models the patient's world [building a model of the world from the patient's perspective] -role modeling healthy behaviors from within the patient's worldview

Nursing Process

-A critical thinking five step process that professional nurses use to apply the best available evidence to deliver nursing care. -Enables nurses to deliver holistic, patient-centered care (ANA, n.d.) -A problem Solving Process to plan care. -Is in orderly, systematic, cyclical. -Involves the patient with the goal being to nurture the patient to maintain health. -It is dynamic and changing, constantly moving back and forth between the steps. -Begins with first contact with the patient.

5 categories of Social determinants of health (SDOH)

-economic stability -education -health and health care -social and community context -neighborhood environment.

Theory of Transpersonal Caring and Caring Science

-emphasizes caring relationships between nurse and patient. -describes multiple truths, physical and nonphysical realities, relativity of time and space -caring ethic is foundational to all health care

Collaborative Problem

-A problem that requires both medicine and nursing interventions to treat. -All physiological complications are not collaborative problems. -If a nurse can prevent the onset of a complication or provide the primary treatment for it, then the diagnosis is a nursing diagnosis. -Collaboration will better manage the multiple factors that influence the health of individuals, families, and communities.

Defenses agaginst infection

-normal flora: we have tons of bacteria that live in our intestines and throughout the body that helps prevent pathogens from spreading, vitamin synthesis and can kill certain bacteria, assist with production of antibodies -body system defenses: skin -inflammation: the cellular response to injury or infection. inflammation does not always mean infection

The body compensates using three mechanisms.

-Chemical Buffers (Work right now) -Respiratory system (Maximum effectiveness in hours but cannot sustain) -Renal system (Takes days but can maintain balance over time)

What happens when we breathe in

-our brain is telling our diaphragm to contract -diaphragm contracts, gets shorter and opens up space for lungs -lungs expand to fill the space (pressure inside goes down as volume rises) -less pressure inside than outside (negative pressure) -air wants to go from high pressure to low pressure -air flows into lungs -oxygen will go into alveoli and into arteries and then back into veins as oxygen attached to hemoglobin

Classifying pH

-pH is the measurement of the concentration of hydrogen ions. -Lower the pH, the higher the H+ conc. -Lower numbers (<7.35) correspond to acidic states. Higher numbers (>7.45) correspond to alkaline states. -Normal pH is 7.35-7.45. Blood is slightly alkaline. -pH of less than 6.8 or greater than 7.8 is usually fatal.

When would a nurse use critical thinking?

-while performing a nursing assessment -when making a nursing diagnosis -when planning a nursing intervention -when carrying out nursing specialties, like case management and infection control -when they encounter a problem that appears to have no straight forward answer

Two stages of assessment

1) Collection of information from a primary source (the patient) and secondary sources. 2)The interpretation and validation of data to determine whether more data are needed or the database is complete.

Skills Needed to Implement Nursing Interventions:

1. Cognitive - nursing knowledge. 2. Interpersonal Skills - therapeutic communication. 3. Psychomotor Skills - skill, procedures, "doing".

Implementation - Preparing for Action

1. Reassess the client. - Continuous process, each time you talk to the patient. In clinical you will talk to the nurses, maybe listen to report. 2. Review and Revise careplan. 3. Organize resources and delivery. - time management, equipment, personnel, environment, client. 4. Anticipate and prevent complications.

Phases of 3rd spacing

1st phase: vascular to interstitial: 24-48 hours; looks like Fluid volume deficit & shock 2nd phase: tissue to vascular space: 3-5 days after injury; looks like fluid overload

Disease

A disorder or state of unbalance that may produce signs or symptoms.

Asepsis

Absence of pathogens

Indirect, dependent intervention:

Call an ordered referral to a specialist

Patient-centered care:

Care that is respectful of and responsive to individual patient preferences, needs, and values and that ensures that patient values guide all clinical decisions. Patient-centered care encompasses identifying, respecting, and caring about patients' differences, values, preferences, and expressed needs; relieving pain and suffering; coordinating continuous care/listening to, clearly informing, communicating with, and educating patients; sharing decision making and management; and continuously advocating disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health

Communication and the Nursing Process: Implementation

Carry out the plan of care using all the communication techniques appropriate for the individual patient and family

Why is catholic social teaching important?

Catholic social teaching is important because it is based on the belief that human beings are fulfilled in community and family and have the responsibility to participate in society and to promote the common good, especially for the poor and vulnerable.

Holistic Communication: Be CLEAR

Center Yourself: -Pause for a moment. -Breathe deeply. -Connect with a feeling of love and compassion. -Create a silent intention that your thoughts, words, and actions will be for the greater good. Listen Wholeheartedly -Set aside your own thoughts, emotions, and feelings. -Focus on the person's agenda. -Do not judge or analyze. -Open your heart to what is being communicated. Empathize -Come from a place of genuine concern. -Ask yourself: How does this person perceive the situation? What does the world look like through this person's eyes? What is he or she feeling? -Empathy involves an understanding that comes from sensing into the being of another. Attention: Be Fully Present -Be aware of what you are feeling and sensing. Stay present to yourself. -Bring the fullness of yourself to every moment: emotionally, mentally, physically, and spiritually. Respect -Respect all that is. -Respect yourself. Set boundaries if needed. -Respect person. Honor cultural, social, ontological, and ideological differences. -Welcome diversity.

nursing interventions classification interventions

Common interventions recommended for various nursing diagnoses.

Complete an assessment for a patient with impaired skin integrity.

Look for impaired sensory perception, impaired mobility, alteration in LOC, shear, friction, moisture

Inquiry (5 modes of thinking)

Examining issues in depth and questioning that which may seem immediately obvious, "critical thinking".

Antidiuretic hormone (ADH)

Restores blood volume by reducing urine output -Decreased blood volume and increased solute concentration are sensed by the brain -ADH is produced by the hypothalamus -Kidneys retain water, which increases intravascular volume and decreases solute concentration

Assessment

The 1st step of the nursing process - Assessment is essential to learn as much as you can about each patient's health condition and health problem by partnering with the patient and family caregivers in a therapeutic relationship. -collection of information -interpretation and validation of data

Knowing how you think (5 modes of thinking)

Thinking about one's thinking.

New Ideas and Creativity (5 modes of thinking)

Thinking modes special to you, opposite habits.

Proliferative Stage

The proliferative phase begins with the appearance of new blood vessels as reconstruction progresses and lasts from 3 to 24 days. The main activities during this phase are the filling of the wound with granulation tissue, contraction of the wound, and the resurfacing of the wound by epithelialization. -Fibroblasts are present in this phase. Fibroblasts are the cells that synthesize collagen, providing the matrix for granulation. -Collagen provides strength and structural integrity to a wound. During this period the wound contracts to reduce the area that requires healing.

Person-centered care:

The human caring process in which the holistic nurse gives full attention and intention to the whole self of a person, not merely the current presenting symptoms, illness, crisis, or tasks to be accomplished, and that also includes reinforcing the person's meaning and experience of oneness and unity; the condition of trust that is created in which holistic care can be given and received.

Excessive detachment symptoms

This symptom occurs when neither you nor anyone else in the group or family is able to establish any fusion of emotions or affiliation of feelings. You and they seem to lack a common purpose, goal, identity, or rationale for existing together.

Preparing Injections From Vials and Ampules Delegation and Collaboration

The skill of preparing injections from ampules and vials cannot be delegated to assistive personnel (AP).

onset

Time it takes after a medication is administered for it to produce a response

Conversion:

Unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty in sleeping, loss of appetite)

Second victim syndrome:

When a medical error occurs that inflicts significant harm on a patient and the patient's family

Angina pectoris

a transient imbalance between myocardial oxygen supply and demand. The condition results in chest pain that is aching, sharp, tingling, or burning or that feels like pressure. Typically, chest pain is left sided or substernal and often radiates to the left or both arms, the jaw, neck, and back. In some patients, angina pain does not radiate. It usually lasts from 3 to 5 minutes. Patients report that it is often precipitated by activities that increase myocardial oxygen demand (e.g., eating heavy meals, exercise, or stress). It is usually relieved with rest and coronary vasodilators, the most common being a nitroglycerin preparation

Standing orders or routine orders

are carried out until discontinued by the doctor e.g. Acetaminophen 500mg q6h

Domains of learning

cognitive, affective, psychomotor

Social Distance (4-12 feet)

• Giving directions to visitors in the hallway • Asking whether families need assistance from the patient doorway • Giving verbal report to a group of nurses

Nursing Process: Assessment Skin

•Continually assess skin for signs of breakdown and/or ulcer development •Focusing on specific elements, such as a patient's level of sensation, movement, and continence status, helps guide the skin assessment. •Continually assesses the skin for signs of skin breakdown and/or ulcer development. Assessment for tissue pressure damage includes visual and tactile inspection of the skin. •Pay particular attention to areas located over bony prominences; next to medical devices; under casts, traction, splints, braces, collars, or other orthopedic devices. The frequency of pressure checks depends on the schedule of appliance application and the response of the skin to the external pressure.

Critical Thinking in Everyday Nursing Practice

•Nurses must make accurate and appropriate clinical decisions or judgments. •Clinical judgment -Yields a well reasoned answer. -Influenced by a nurse's experience and knowledge. -Partly relies on knowing the patient. -Influenced by the context of clinical situations and the culture of patient care settings. -Nurses use a variety of reasoning approaches in combination. -Conclusion about a patient's needs or health problems.

Nursing diagnoses for patients with safety risk:

•Risk for falls •Impaired home maintenance •Risk for injury •Deficient knowledge •Risk for poisoning •Risk for suffocation •Risk for trauma

Metabolic Alkalosis

-Excess of bases or deficits in acids -Increase in pH : pH >7.45, HCO3>28 -Compensate: lungs â respirations to retain CO2, kidneys retain H+, excrete HC03 -Noncarbonic acids decrease (vomiting or diarrhea) or bicarb increases -Lungs compensate by slowing depth/rate

If you face a violent situation, use the following tips for reducing violence:

1. Be nonjudgmental and empathic of the patient's feelings. 2. Respect personal space. 3. Use nonthreatening nonverbal communication. 4. Do not overreact. 5. Focus on feelings. 6. Redirect or refocus any challenging questions, such as "Why does it always take so long for the doctor to see me?" or "Who's going to make me go to that test?" 7. Set limits. 8. Choose wisely what you insist on. 9. Allow silence for reflection. 10. Allow time for the patient to make a decision.

Hyperphosphatemia:

>4.5 mg/dL -Most commonly seen renal failure -The primary complication of increased phosphorus is metastatic calcification, soft tissue, joints and arteries, which occurs when the calcium-magnesium product (calcium x magnesium exceeds 70 mg/dL) -Clinical manifestations: few, tetany -Management: Measure to decrease the serum phosphate level and bind phosphorus in the GI tract. Restrict food high in phosphorus such as hard cheeses, cream, nuts, meats, whole-grain cereals, dried fruits, fried vegetables, food made with milk.

Illness

A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

Crisis:

A sudden, unpredictable, and potentially dangerous event requiring the president to play the role of crisis manager. Developmental (marriage, childbirth), situational (car crash, severe illness), adventitious (natural disaster)

Habits (5 modes of thinking)

Accepted ways of doing things that work, save time, are necessary.

Nursing interventions

Activities that the nurse plans and implements to help the patient achieve identified outcomes -RN must determine appropriate level of care for delegation of interventions. -Know scope of practice of all personnel involved with the client. -Delegate tasks based on job description, competency, scope of practice. -The RN is ultimately responsible!!

Inserting the Intravenous Line

After you collect the equipment at the patient's bedside, prepare to insert the IV line by assessing the patient for a venipuncture site. The most common IV sites are on the inner arm. Do not use hand veins on older adults or patients who are ambulatory. IV insertion in a foot vein is common with children but avoid these sites in adults because of the increased risk of thrombophlebitis. As you assess a patient for potential venipuncture sites, consider conditions that exclude certain sites. Venipuncture is contraindicated in a site that has signs of infection, infiltration, or thrombosis. An infected site is red, tender, swollen, and possibly warm to the touch. Exudate may be present. Do not use an infected site because of the danger of introducing bacteria from the skin surface into the bloodstream. Avoid using an extremity with a vascular (dialysis) graft/fistula or on the same side as a mastectomy. Avoid areas of flexion if possible and choose the most distal appropriate site. Using a distal site first allows for the use of proximal sites later if the patient needs a venipuncture site change.

Discuss how stress in the workplace affects nurses

An important step in preventing burnout is acknowledging ones own limitations, as well as what ones scope of work is while on the job. By doing this, the person will help to prevent emotional exhaustion and will limit the effects of chronic stress. Journaling and muscle relaxation are good stress-relieving techniques but are not directed at the cause of the workplace stress. Delegating if not applicable is an inappropriate coping mechanism.

Integrative Health and Wellness Assessment Wheel: Environmental

Assessing our environment increases our awareness of its effect on our health and well-being. The environment is the context or habitat within which all living systems participate and interact. This includes the physical body and its physical habitat; cultural, psychological, social, and historical influences; and both the external physical space and a person's internal space (physical, mental, emotional, social, and spiritual experiences). A healing environment includes everything that surrounds the person, as well as patterns not yet understood.

Autonomy and Responsibility

Autonomy is being self-directed and independent in accomplishing goals and advocating for others. Professional nurses make choices and accept responsibility for the outcomes of their actions. They take initiative in problem solving and communicate in a way that reflects the importance and purpose of a therapeutic conversation. Professional nurses also recognize their patients' autonomy.

Denial:

Avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain (e.g., a person refuses to discuss or acknowledge a personal loss)

Preinteraction Phase

Before meeting a patient: • Review available data, including the medical and nursing history. • Talk to other caregivers who have information about the patient. • Anticipate health concerns or issues that arise. • Identify a location and setting that fosters comfortable, private interaction. • Plan enough time for the initial interaction.

Boundary Setting

Boundaries are artificial separations between people that can be either healthy or unhealthy. They define the perimeter of a relationship. In psychotherapeutic work and the therapeutic nurse-patient relationship, the nurse or therapist should have therapeutic neutrality, implying he or she should not give directives about major life decisions to the patient. Nurses and others in therapeutic roles are frequently held in high esteem, and patients should not assume the child role. The patient-provider relationship assumes the provider has power because the patient is seeking help from the provider. This is an asymmetrical relationship. The nurse or therapist is not intended to remain totally neutral, and emotion can be expressed, but neither should the nurse or the therapist reveal significant personal information to the patient. This is a healthy boundary, with attempts to keep the relationship objective and helpful. -Professional working relationships require ground rules and structure -Boundaries must be present for the relationship to be successful -Degrees of self disclosure can be beneficial, but use with caution -Always act in the best interest of patient

cold therapy

Cold therapy refers to the superficial application of cold to the surface of the skin, with or without compression and with or without a mechanical recirculating device to maintain cold temperatures. Cold therapy is designed to treat the localized inflammatory response of an injured body part that presents as edema, hemorrhage, muscle spasm, or pain. Improvement to joint mobility following cold therapy is related to reducing pain and swelling, inhibiting muscle spasm, and reducing muscle tension. Cold therapy most commonly is used immediately after soft tissue and musculoskeletal injuries such as sprains or strains; however, it has been used in the postoperative setting with patients who have undergone orthopedic surgeries, spinal fusion, and lumbar discectomy. Research trials of cold therapy have been inconsistent and frequently found no differences compared with no cold therapy in postoperative pain or analgesic use

Identify the effects that compassion fatigue can have in the health care workplace.

What does decreased hemoglobin cause?

Decreased hemoglobin levels, seen in patients with anemia or blood loss, alter a patient's ability to transport oxygen, causing disturbances in oxygenation.

Cultural Aspects of Care Impact of Skin Color

Detecting cyanosis and other changes in skin color in patients is an important clinical skill. However, this detection becomes a challenge in patients with darkly pigmented skin. Color differentiation of cyanosis varies according to skin pigmentation. In patients with darkly pigmented skin, you need to know the individual's baseline skin tone. • Patients with darkly pigmented skin cannot be assessed for pressure injury risk by examining only skin color • Use natural lighting • Assess for changes in sensation, temperature, or tissue consistency, which may precede visual skin changes • Examine body sites with the least melanin such as under the arm for underlying color identification • Palpate surrounding tissues to identify any changes in temperature, edema, or tissue consistency between area of injury or suspected injury and normal tissue • Circumscribed area of intact skin may be warm to touch. • Localized heat (inflammation) is detected by making comparisons to surrounding skin. • Edema may occur with induration of more than 15 mm in diameter, and skin may appear taut and shiny

Communication and the Nursing Process: Evaluation

Evaluation your own communication with the patient and family. What techniques worked well? What could be improved?

Therapeutic effect of medication

Expected or predicted physiological response

Extracellular fluid

Fluid found outside the cells (1/3 of total). 20% of body weight

Grounding

Grounding is the process of connecting to the earth and the earth's energy field to calm the mind and focus one's inner flow of energy as a means to enhance healing endeavors.15 Centering and grounding may be considered a single, continuous process because one flows into the other. As such, grounding can also be viewed as part of the preaccess phase of the holistic communication process. -Grounding provides the nurse with a steady physical, psychological, and energetic platform on which to anchor the communication process.

Integrative Health and Wellness Assessment Wheel: Relationships

Healthy people live in intricate networks of relationships and are always in search of unifying new concepts of the universe and social order. Meaningful relationships develop from understanding and nurturing those relationships, whether at work, at home, in the community and in organizations, through the ever-expanding web of electronic connection or through others around the world. -Relationships have different levels of meaning, from the superficial to the deeply connected, and the challenges facing these relations can be multifaceted. In assessing our relationships, we begin with ourselves and explore what we hope for, what we can bring to life, and how we engage.

Hypermagnesemia: what do you see

High Mg blocks release of acetylcholine from myoneural junction decrease in muscle cell activity -hypotension-peripheral vessel dilation -Bradycardia -ECG changes- (Heart block, PVCs) -Sedative effects-muscle weakness, lethargy, drowsiness. Loss of DTRs, resp. paralysis, loss of consciousness -Acute elevation in Mg2+ can cause flushing and feeling of warmth

Discuss the risk factors that contribute to pressure ulcer formation.

Impaired sensory perception, impaired mobility, alteration in LOC, shear, friction, moisture

Channels

Individuals use communication channels to send and receive messages through visual, auditory, and tactile senses. Facial expressions send visual messages; spoken words travel through auditory channels. Touch uses tactile channels. Individuals usually understand a message more clearly when the sender uses more channels to send it. Feedback Feedback is the message a sender receives from the receiver. It indicates whether the receiver understood the meaning of the sender's message.

Irrigation

Irrigation Irrigation is a way of cleaning wounds. Use an irrigation syringe to flush the wound with a constant low-pressure flow of solution. The gentle washing action of the irrigation cleanses a wound of exudate and debris. Irrigation is particularly useful for open, deep wounds; wounds involving an inaccessible body part such as the ear canal; or when cleaning sensitive body parts such as the conjunctival lining of the eye. Irrigation of an open wound requires sterile technique. Use a 35-mL syringe with a 19-gauge soft angiocatheter to deliver the solution. This irrigation system has a safe pressure and does not damage healing wound tissue. It is important to never occlude a wound opening with a syringe because this results in the introduction of irrigating fluid into a closed space. The pressure of the fluid causes tissue damage and discomfort and possibly forces infection or debris into the wound bed. Always irrigate a wound with the syringe tip over but not in the drainage site. Make sure that fluid flows directly into the wound and not over a contaminated area before entering the wound.

Pressure Duration

Low pressure over a prolonged period and high-intensity pressure over a short period are two concerns related to duration of pressure. Both types of pressure cause tissue damage. Extended pressure occludes blood flow and nutrients and contributes to cell death. Clinical implications of pressure duration include evaluating the amount of pressure (checking skin for nonblanching hyperemia) and determining the amount of time that a patient tolerates pressure (checking to be sure after relieving pressure that the affected area blanches).

Types of Solutions

Many prepared IV solutions are available for use. An IV solution is isotonic, hypotonic, or hypertonic. Isotonic solutions have the same effective osmolality as body fluids. Sodium-containing isotonic solutions such as normal saline are indicated for ECV replacement to prevent or treat ECV deficit. Hypotonic solutions have an effective osmolality less than body fluids, thus decreasing osmolality by diluting body fluids and moving water into cells. Hypertonic solutions have an effective osmolality greater than body fluids. If they are hypertonic sodium-containing solutions, they increase osmolality rapidly and pull water out of cells, causing them to shrivel. The decision to use a hypotonic or hypertonic solution is made on the basis of a patient's specific fluid and electrolyte imbalance. -Additives such as potassium chloride (KCl) are common in IV solutions (e.g., 1000 mL D 5 ½ NS with 20 mEq KCl at 125 mL/hr). Administer KCl carefully because hyperkalemia can cause fatal cardiac dysrhythmias. Under no circumstances should KCl be administered by IV push (directly through a port in IV tubing ). Verify that a patient has adequate kidney function and urine output before administering an IV solution containing potassium. Patients with normal renal function who are receiving nothing by mouth should have potassium added to IV solutions. The body cannot conserve potassium, and the kidneys continue to excrete it even when the plasma level falls. Without potassium intake, hypokalemia develops quickly.

Mindfulness-Based Stress Reduction

Mindfulness is a moment-to-moment present awareness with an attitude on nonjudgment, acceptance, and openness. This technique entails focusing on attentiveness on regular activities and truly enjoying pleasant experiences. Mindfulness-based stress reduction (MBSR) meditative practices are effective in reducing psychological and physical symptoms or perceptions. They are effective in stress management and symptom control with certain chronic conditions. Through mindfulness exercises people learn to self-regulate awareness and attention to feeling and implement effective changes. Patients use cognitive exercises and subjective experiences to process images or feelings. Patients evaluate these feelings as pleasant or unpleasant and learn strategies to enhance the pleasant experiences and replace the unpleasant experiences. Through MBSR patients can control their stress response to illnesses and treatments, employees can manage job-related stress, and students can learn to manage stress anxiety.

Hypoventilation

Occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide s&s: mental status changes, dysrhythmias, potential cardiac arrest

Medication interactions

One medication modifies the action of another

negative-pressure wound therapy (NPWT)

One treatment modality for wounds is negative-pressure wound therapy (NPWT) or vacuum-assisted closure (one brand name is V.A.C.). NPWT is the application of subatmospheric (negative) pressure to a wound through suction to facilitate healing and collect wound fluid . The vacuum-assisted closure (V.A.C.) is a device that helps in wound closure by applying localized negative pressure to draw the edges of a wound together. NPWT supports wound healing by reduction of edema and fluid removal, macro deformation and wound contraction, and micro deformation and mechanical stretch perfusion. Secondary effects include angiogenesis, granulation tissue formation, and reduction in bacterial bioburden. The V.A.C. Instill system allows intermittent instillation of fluids into a wound and liquefies infectious material and wound debris, especially in wounds not responding to traditional NPWT

Enteral Replacement of Fluids

Oral replacement of fluids and electrolytes is appropriate as long as the patient is not so physiologically unstable that they cannot be replaced rapidly enough. Oral replacement of fluids is contraindicated when a patient has a mechanical obstruction of the GI tract, severe nausea, is at high risk for aspiration, or has impaired swallowing. Some patients unable to tolerate solid foods are still able to ingest fluids. Strategies to encourage fluid intake include offering frequent small sips of fluid, popsicles, and ice chips. Record one-half the volume of the ice chips in I&O measurement. For example, if a patient ingests 240 mL of ice chips, you record 120 mL of intake. Encourage patients to keep their own record of intake to involve them actively. Family members who are properly instructed can also help. Pay attention to each patient's preferred temperature of oral fluids. Cultural beliefs regarding appropriate fluids and fluid temperature may become a barrier to achieving adequate fluid intake unless the fluid with the preferred temperature is available -When replacing fluids by mouth in a patient with ECV deficit, choose fluids that contain sodium (e.g., Pedialyte and Gastrolyte). Liquids that contain lactose or have low-sodium content are inappropriate when a patient has diarrhea. -A feeding tube is appropriate when a patient's GI tract is healthy, but he or she cannot ingest fluids (e.g., after oral surgery or with impaired swallowing). Options for administering fluids include gastrostomy or jejunostomy instillations or infusions through small-bore nasogastric feeding tubes

Risk for decreased cardiac output related to dysrhythmia secondary to hyperkalemia outcomes and interventions

Outcomes 1)VS remain in pt's normal range 2)EKG = NSR K+ lowers from (specify) to more normal range Interventions 1)Vitals signs q4h and prn 2)Continuous EKG- watch for tachy, brady, dysrhythmias 3)Labs: monitor K: report changes to MD 4)Cap refill, CMS q shift

Personal Appearance

Personal Appearance Personal appearance includes physical characteristics, facial expression, and manner of dress and grooming. These factors are a powerful means of nonverbal communications to patients and the health care team. In the health care setting research shows patients prefer that nurses employed in an agency all wear a single uniform and that the "RN" or "LPN" tag be displayed prominently. Many health care agencies restrict how much jewelry you can wear and whether certain types of tattoos need to be covered. For hygienic reasons nurses should have long hair pulled back and off the shoulders and short clean fingernails. Remember, first impressions are largely based on appearance. Nurses learn to develop a general impression of patient health and emotional status through appearance, and patients develop a general impression of the nurse's professionalism and caring in the same way.

passive aggressive

Psychologically, some people are passive-aggressive. This implies that they remain passive and quiet externally, but they are repressing anger internally. The anger seeps out in small ways, such as going behind another's back to gossip about him or her in a spiteful way while remaining superficially pleasant to the other.

Describe the relationship among faith, hope, and spiritual well-being.

Spirituality and faith bring hope. When a person has the attitude of something to live for and look forward to, hope is present. It is a multidimensional concept that provides comfort while people endure life-threatening situations, hardships, and other personal challenges. It is closely associated with faith and is energizing, giving individuals a motivation to achieve and the resources to use toward that achievement. People express hope in all aspects of their lives to help them deal with life stressors.

Situations for use of hypotonic solutions.

The cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis. This will cause CELL SWELLING which can cause the cell to burst or lyses. Hypotonic solutions are used when the cell is dehydrated and fluids need to be put back intracellularly. This happens when patients develop diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia. Important: Watch out for depleting the circulatory system of fluid since you are trying to push extracellular fluid into the cell to re-hydrate it. Never give hypotonic solutions to patient who are at risk for increased cranial pressure (can cause fluid to shift to brain tissue), extensive burns, trauma (already hypovolemic) etc. because you can deplete their fluid volume.

Intention:

The conscious awareness of being in the present moment to help facilitate the healing process; a volitional act of love; conscious alignment of essence and purpose allowing the highest good to flow through a healing intervention.

The Dignity of Work and the Rights of Workers

The economy must serve people, not the other way around. Work is more than a way to make a living; it is a form of continuing participation in God's creation. If the dignity of work is to be protected, then the basic rights of workers must be respected — the right to productive work, to decent and fair wages, to the organization and joining of unions, to private property, and to economic initiative.

Influential Leadership

The influential leadership framework, introduced by Michael Frisina in 2011, identifies three fundamental principles that facilitate effective performance for making a sustainable difference within organizations. -self-awareness -collaboration -connection

Administering Oral Medications Delegation and Collaboration

The skill of administering oral medications cannot be delegated to assistive personnel (AP). The nurse instructs the AP about: • Potential side effects of medications and to report their occurrence. • Informing nurse if patient condition changes or worsens (e.g., pain, itching, or rash) after medication administration.

Developmental Stages and Risks: Adult

The threats to an adult's safety are frequently related to lifestyle habits. For example, a person who uses alcohol excessively is at greater risk for motor vehicle accidents or sustaining an injury at home. People who smoke long-term have a greater risk of cardiovascular or pulmonary disease because of the inhalation of smoke and the effect of nicotine on the circulatory system. Likewise, the adult experiencing a high level of stress is more likely to have an accident or illness such as headaches, gastrointestinal (GI) disorders, and infections.

Aloofness or shyness symptoms

This symptom is a result of your insecurity from real or perceived experiences of being ignored or rejected in the past. Once rejected, you take the defensive posture to reject others before they reject you. This keeps you inward and unwilling or fearful of opening up your space to others.

Support Systems

Use of support systems is important for patients who are in any health care setting. They provide patients with the greatest sense of well-being during hospitalization and serve as a human link connecting the patient, the nurse, and the patient's lifestyle before an illness. Part of a patient's caregiving environment is the regular presence of supportive family and friends. Provide privacy during visits and plan care with the patient and the patient's support network to promote the interpersonal bonding that is needed for recovery. The support system is a source of faith and hope and an important resource in conducting meaningful religious rituals.

hostility

angry feelings motivate aggressive behavior.

Medication forms

medications are available in a variety of forms: -Solid, liquid, other oral forms; topical, parenteral and forms for instillation into body cavities e.g. suppositories.

Spiritual factors

spirituality is reflected on how a person lives his/her life. Religious practices are one way that people exercise spiritualty. For example, a patient of the Jehovah witness faith will not accept a blood transfusion. We need to understand our patient's spiritual beliefs and incorporate them into our nursing care.

Transcendence

the belief that a force outside of and greater than the person exists beyond the material world

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