NUR 111 FINAL EXAM

Autonomy vs. shame and doubt

(1-3 years) ♦Begins to communicate likes and dislikes ♦Increasingly independent in thoughts and actions ♦Appreciates body appearance and function

Cognition of Delirium

Memory and judgment is impaired, attention span will fluctuate ▪ Activity Can be increased or decreased Hypervigilant - watching everything, asking questions, paranoid Sundowning - later in day their confusion begins ▪ Emotional state Rapid swings, very anxious, illusions and hallucinations, angry, agitated, act out ▪ Prognosis Reversible ▪ Assessment Four cardinal features ♦Acute onset and fluctuating course ♦Inattention ♦Disorganized thinking ♦Disturbance of consciousness

When setting up a PCA pump, the nurse should question which opioid order?

Meperidein (Demerol)

Need to drink ______ fluid daily

2000-2500 mL Unless they have heart or kidney disease ▪ 1200-1500 is usually adequate unless the client has a history of UTI's ➢ Avoid fluids 2 hours before bedtime

▪ A client has just undergone an appendectomy. When discussion with the client several pain relief interventions, the most appropriate recommendation would be

PCA pain management

The demand is ordered by the health care provider and is only available within specific intervals

True

THE NUMBER ONE INTERVENTION IS ALWAYS, ALWAYS, ________

ALWAYS TO ASSESS

Second part of physical exam ______

Abdominal ♦Bowel motility ➢ Sounds occur irregularly 5-35 times per min. ➢ Normally takes 5-20 seconds to hear a bowel sound ➢ Takes 5 minutes of listening before determining that bowel sounds are absent

Contemplation

Considering a change within the next 6 months ♦Ambivalence may be present, but clients will more likely accept information as they are developing more belief in the value of change

Social justice

acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability or sexual orientation

family

defined biologically, legally, or as a social network with personally constructed ties and ideologies

Beneficence

doing or actively promoting good

Hypoxia

don't have enough oxygen Cyanosis, restlessness, irritable, confusion, decreased

Synergistic effect

drug interaction in which the bacterial killing effect of two antibiotics given together is greater than the sum of the individual effects of the same drugs given alone

Family nursing

is based on the assumption that all people regardless of age are a member of some type of family form There are different approaches for family nursing practice Family nursing practice has three levels of approaches ♦Family as context ♦Family as client ♦Family as system

Within transcultural nursing, sensitivity to the social organization is the recognition of the client's

status and expected role in the family

Partnership model

▪ Coprimary nursing ▪ Modification of primary nursing ▪ RN is partnered with an LVN, LPN or NAP and the pair work together consistently to care for an assigned group of pt.

Calcium

Normal levels 2.25-2.75 mmol/L or 9.0-10.5 mg/dL

Medicare

for seniors

Unemancipated minors may not consent to abortions without one of the following

➢ Consent of one parent ➢ Self-consent being granted by a court order ➢ Consent specifically given by a court

Industry vs. inferiority

(6-12 years) ♦Incorporates feedback from peers and teachers ♦Increases self-esteem with new skill mastery ♦Aware of strengths and limitations

Trust vs. mistrust

(birth to 1 year) ♦Develops trust following consistency in caregiving and nurturing interactions ♦Distinguishes self from environment

Ego integrity vs. despair

(late 60s to death) ♦Feels positive about life and its meaning ♦Interested in providing a legacy for the next generation

Intimacy vs. isolation

(mid 20s to mid 40s) ♦Has stable, positive feelings about self ♦Experiences successful role transitions and increased responsibilities

Generativity vs. self-absorption

(mid 40s to mid 60s) ♦Able to accept changes in appearance and physical endurance ♦Reassesses life goals ♦Shows contentment with aging

Convalescence

- Interval when acute symptoms of infection disappear - Defenses against infection ➢ Normal flora ➢ Body system defenses ➢ Inflammation

Trauma

- Pathophysiology Trauma and damage may occur to the eardrum and ossicles by infection, by direct damage, or through rapid changes in the middle ear cavity pressure

Primary nursing

- RN assumes 24 hour responsibility for planning, directing and evaluating the pt. care from admission through discharge - High degree of autonomy and feel challenged and rewarded

Kussmaul's respiration

- abnormally deep, regular and increased in rate

Hyponatremia

- serum level below 136 mEq/L ♦Interventions ➢ Priority is monitoring the pt. response to therapy to prevent hypernatremia and fluid overload ➢ Drug therapy ➢ Nutrition therapy ▪ Increasing oral Na intake and restricting oral fluid intake

What is the difference in the scope of practice of RN's and LPN's?

A RN can function independently, LPN can do an assessment, but must report to RN

Nursing health history

Biographical info, reason for seeking health care, client expectations, present illness or health concerns, health history, family history, environmental history, psychosocial history, spiritual health, review of systems ▪ Focus on older adults Nonverbal ♦Client-directed eye gaze ♦Affirmative head nodding ♦Smiling ♦Forward leaning ♦Touch

Launching children and moving on

Accepting multitude of exits from and entries into family system ➢ Adjusting to the reduction in family size ➢ Developing adult to adult relationships between grown children and their parents ➢ Realigning relationships to include in laws and grandchildren ➢ Dealing with disabilities and death of parents

Action

Actively engaged in strategies to change behavior. This stage may last up to 6 months ♦Be aware of previous habits that may prevent action on new behaviors. Identify barriers and facilitators of change

Which patient would benefit most from the use of a patient-controlled PCA pump A. a 75 yr. old woman in the last stages of the dying process who is experiencing occasional episodes of confusion B. a 60 year old man who is mentally alert and experiencing left-sided weakness after a stroke C. a 42 year old man that is mentally alert and recovering from a fractured femur D. a 15 yr old girl who is recovering from a head injury

C

Reinforcement-extinction

Certain behaviors become common or are avoided, depending on whether they are approved and reinforced or discouraged and punished

Drug order should include

➢ Patients name ➢ Date the drug order was written ➢ Name of drug ➢ Drug dosage amount and frequency ➢ Route of administration ➢ Prescribers signature Six rights of medication administration ➢ Right drug ➢ Right dose ➢ Right time ➢ Right route ➢ Right patient ➢ Right documentation

Uniform anatomical gift

➢ Person who is at least 18 yrs. of age has the right to make an organ donation ▪ Make gift in writing with their signature

Evaluation

➢ Planned, ongoing, purposeful activity in which clients and health care professionals determine the client's progress toward goals/outcomes and the effectiveness of the nursing care plan ➢ Everything revolves around outcomes

Assessment (from lecture)

➢ Preparation ▪ Physical - offer bathroom first, provide privacy, know what position is best for your patient ▪ Developmental Children - incorporate play Adolescents - right to privacy Elderly - tire easily, give them a chance to rest ▪ Psychological - tell pt. what you are doing before you do it - don't ask - leaves room for them to say no ▪ Environment Warm room, pen light and all other equipment

Research process

➢ Problem identification ➢ Study design ➢ Conducting the study ➢ Data analysis ➢ Use of the findings

Implementation

➢ Protocol ▪ Plan is sort of standard for everybody ➢ Standing order ▪ ▪ Give the nurse a little bit of autonomy Example (if pt. has chest pain, then I can give them nitro) ♦Common on floors that have the same type of pt. coming in

Continuing care

➢ Provided over a prolonged period ➢ For pt. who are disabled, who never were functionally independent, or who suffer a terminal disease ➢ Nursing homes, group homes, retirement communities, adult day care, assisted living, respite care, hospice

Clinical pathways

➢ Provides a means of standardizing care for pt. with similar diagnoses

Health assessment and physical exam

➢ Purpose ▪ Gather baseline data ▪ Supplement, confirm or refute data obtained in the history ▪ Confirm and identify nursing diagnoses ▪ Make clinical judgments about pt. changing health status and management ▪ Evaluate the outcomes of care ➢ Skills of physical assessment ▪ Inspection ▪ Palpation ▪ Percussion ▪ Auscultation ▪ Olfaction ➢ Assessment of age groups ▪ Children Gather info. from parents or guardians Perform exam in a nonthreatening area; provide time for play to become acquainted Call children by first name, address parents as Mr. Mrs. Etc. Open-ended questions ▪ Adolescents Treat them as adults, they tend to respond better Have right to confidentiality ▪ General survey General appearance and behavior Vital signs

Immobility problems (integumentary system)

➢ Reduced skin turgor ➢ Skin breakdown

Standard precautions

➢ Reflect that all body excretions, secretions and moist membranes excluding perspiration are potentially infectious

Preventive and primary health care

➢ Schools, physical offices, occupational health clinics and nursing centers ➢ Health promotion is key

Pain

➢ Self-report always the most reliable indication of pain ➢ 100% subjective ➢ Acute or chronic ➢ Nocicpetive pain - either visceral or somatic ➢ Neuropathic pain - results from some type of nerve injury ➢ Some terms ➢ Self-report always the most reliable indication of pain ➢ 100% subjective ➢ Acute or chronic ➢ Nocicpetive pain - either visceral or somatic ➢ Neuropathic pain - results from some type of nerve injury ➢ Some terms ➢ Self-report always the most reliable indication of pain ➢ 100% subjective ➢ Acute or chronic ➢ Nocicpetive pain - either visceral or somatic ➢ Neuropathic pain - results from some type of nerve injury ➢ Some terms ▪ Addiction - a primary, chronic neurobiologic disease with genetic, psychosocial and environmental factors influencing its development and manifestations ▪ Pseudoaddction - an iatrogenic syndrome created by the undertreatment of pain ▪ Tolerance - state of adaptation in which exposure to a drug induces changes that result in a decrease in one or more of the drug's effects over time ▪ Physical dependence - adaptation manifested by a drugclass- specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist

Inflammation

➢ Should function for our entire lives ➢ BANDS ▪ Immature neutrophils ▪ Sign of long term infection ▪ Shift to the left is a lot of bands ➢ There is always inflammation with infection ▪ But not always infection with inflammation ➢ Review of cells ▪ Macrophage Initiates the immune response Comes from monocytes ▪ Lymphocyte Primary cell in the immune response B or T cells ▪ T-lymphocytes Cell mediated immunity ▪ B-lymphoctyes Humoral response ➢ Immunoglobulins ▪ IgG = most common ▪ IgM - first to increase in immune response ▪ IgA = found in secretions ▪ IgE = bound to mast cells ▪ IgD = activates B cells

Empathetic listening

➢ Sit at eye level, maintain eye contact (be aware of culture), do not interrupt, wait during a pause, avoid long silences, use repetition after long pause if appropriate, touch when appropriate

Problem-oriented approach

Focus on the client's presenting situation and begin with problematic areas

Charting by exception

Focuses on documenting deviations from the established norm or abnormal findings

Secondary prevention

Focuses on individuals who are experiencing health problems or illness and who are at risk for developing complications or worsening conditions Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the client to return to a normal level of health as early as possible

Acute care (immobility) - Metabolic system

Give client a high-protein, high calorie diet

IF IT IS NOT DOCUMENTED _____

IT DOES NOT COUNT

Role performance

Is the way in which individuals perceive their ability to carry out significant roles Individuals develop and maintain behaviors that society approves through the following processes

Primary prevention

Is true prevention; it precedes disease or dysfunction and is applied to clients considered physically and emotionally health Includes all health promotion efforts, as well as wellness education activities that focus on maintaining or improving the general health of individuals, families and communities

State level

Maintaining a safe meat supply through livestock inspections, ensuring safe food storage etc.

Absorption

The movement of a drug from its site of administration into the bloodstream for distribution to tissues Bioavailability - a measure of the extent of drug absorption for a given drug and route First past effect - the initial metabolism in the liver of a drug absorbed from the GI tract before the drug reaches systemic circulation through the bloodstream

Sequence of inflammatory response

Vascular Constriction Hyperemia and edema ▪ Cellular exudates - nutrophilia, pus ▪ Tissue repair and replacement ➢ Assessment of inflammation ▪ Warmth ▪ Redness ▪ Swelling ▪ Pain ▪ Decreased function

Two dimensions

Vertical - supports the transcendent relationship between a person and God or some higher power Horizontal - describes positive relationships and connections people have with others

Family as client

When the family as client is the approach, family processing and relationships (e.g., parenting or family care giving) are the primary focuses of nursing care

Family as context

When you view the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the client's family) ♦Although the focus is on the individual's health status, assess how much the family provides the individual's basic needs

Sleep

a cyclical physiological process that alternates with longer periods of wakefulness ➢ Circadian rhythm ▪ Influence the pattern of major biological and behavioral functions

External otitis

a painful condition caused when irritating or infective agents come into contact with the skin of the external ear - occurs more often in hot, humid environments, especially in the summer and is commonly referred to as swimmer's ear because of the high incidence in people involved in water sports ♦Necrotizing or malignant otitis is the most virulent form of external otitis ➢ Organisms spread beyond the external ear canal into the ear and skull

Kardex

a portable "flip-over" file or notebook

Consultation

a process in which you seek the expertise of a specialist, to identify ways to handle problems in client management or the planning and implementation of therapies

Biot's respiration

abnormally shallow for two to three breaths followed by irregular period of apnea

Community associated infection

acquired by persons who have not been hospitalized or had a medical procedure recently (within the past year)

Integrity

acting in accordance with an appropriate code of ethics

An older adult is being started on a new antihypertensive medication. In teaching the client about the medication, the nurse

allows the client time to express himself and ask questions

Quality improvement

an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of clients and others

A client has recently been told he has terminal cancer as the nurse enters the room, he yells "my eggs are cold, and I'm tired of having my sleep interrupted by noisy nurses" the nurses may interpret the client's behavior as

an expression of anger stage of dying

When a smiling and cooperative client complains of discomfort, nurses caring for this client often harbor misconceptions about the client's pain. To properly care for clients in pain, nurses need to remember that...

clients are the best judges of their pain

Altruism

concern for the welfare of others

Do not offer a _____ a back rub

heart patients

For a functional illiterate client, the nurse will focus on

incorporating nonmedical terminology

Residents

individuals living in a facility for the rest of their lives

When faced with a scenario where it is believed that a client from another cultural background is using herbal remedies along with the prescribed medication to treat her arthritis. The nurse's first action should be to

inquire of the client as to the reason for using herbal remedies along with the prescribed medication

The nurse recognizes the following as an appropriate strategy for communicating with clients who are not fluent in English

interaction with an interpreter for all communication

Family and friends should not be used as _____ except at the care recipient's request

interpreters

Family resiliency

is the ability of the family to cope with expected and unexpected stressors

Family durability

is the term for the interfamilial system of support and structure that extends beyond the walls of the household ♦For example: the parents may remarry or the children may or may not leave home as adults, but in the end the "family" transcends long periods and inevitable lifestyle changes

Family diversity

is the uniqueness of each family unit ♦For example: some families will experience marriage for the first time and have children in later life, when others are grandparents at the same age

The pt. is receiving his first dose of an opioid analgesic for pain. The nurse expects that another medication will prob. Be ordered concurrently for this pt. will be...

laxative

Which health problem would the nurse expect to see in a client who cannot synthesize T-suppressor lymphocytes?

leukemia

Furuncle

localized external otitis caused by bacterial infection, usually staphylococcus, of a hair follicle The manifestations include intense local pain to light touch. The area is swollen and red, with tight skin covering the area, possibly with a purulent head Treatment consists of local and systemic antibiotics and local heat application ♦May be incised and drained if it does not resolve with the use of antibiotics

Medicaid

low income families, long term care disabilities

From culture to culture time often takes on different meanings, in exploring the relationships of time to nursing interventions, the nurse should

maintain a flexible attitude when the client request procedures to be done at specific times

Traditional western medicine, in contrast to alternative therapy, uses

medication administration

Established pain management guidelines direct nurses to frequently assess the client's pain. The most appropriate action for the nurse to take when assessing the client's reaction to pain is to ..

offer the client a pain scale to objectively identify the pain

Planning

prioritize, come up with objective, measurable goals and outcomes, then define nursing interventions

Which of the following is a primary concern for the nursing care for a dying patient

promote dignity and self-esteem ß was a test question

Managed care organization

provides comprehensive preventive treatment services to a specific group of voluntarily enrolled persons

During postmortem care the nurse should give priority to

providing culturally and religiously sensitive care in body preparation

A client newly diagnosed with diabetes needs to learn how to use a glucometer. Use of a glucometer constitutes

psychomotor learning

Cheyne-stokes respiration

rate and depth are irregular, alternating periods of apnea and hyperventilation

▪ Following a surgical procedure, an older Chinese woman refuses to perform the ROM and breathing exercises requested, in addition is hesitant to complete the hygienic care and grooming. The nurse recognizes that this is most likely related to

reliance upon family members to assist with care

Human dignity

respect for inherent worth and uniqueness of individuals and populations

Confidentiality

respecting privileged info. on pt.

Autonomy

right to self-determination

Autonomy

self determination; acting on one's own

Must have Dr. order to put patient in ______

shower or tub

Teratogens

substances that can interfere with normal prenatal development and cause one or more developmental abnormalities in the fetus

Long term care insurance

supplemental insurance for coverage of long-term care services

The nurse has important information to share with a pt. who brought their child to the ER. The parent is very anxious and just learned his son requires surgery. The most effective teaching method is

telling

Definitive therapy

the administration of antibiotics based on known results of culture and sensitivity testing identifying the pathogen causing infection

Empiric therapy

the administration of antibiotics based on the practitioner's judgment of the pathogens most likely to be causing an apparent infection; it involves the presumptive treatment of an infection to avoid treatment delay before specific culture info. has been obtained

Nonmaleficence

the duty to do no harm to a pt.

Fidelity

the duty to tell the truth

Veracity

the duty to tell the truth

Colonization

the establishment and growth of microorganisms on the skin, open wounds, or mucous membranes, or in secretions without causing adverse clinical signs or symptoms

Cohorting

the practice of grouping pt. who are colonized or infected with the same pathogen

▪ When helping a person through grief work, the nurse knows that

the stages of grief may occur in the standard order, they may be skipped, or they may reoccur

Ototoxicity

toxicity to the ears

Nephrotoxicity

toxicity to the kidneys

Private insurance

traditional fee-for-service plan

Self-esteem

usually highest in childhood, drops during adolescence, rises gradually throughout adulthood, and declines again in old age ▪ Other than childhood, the mid-60s seem to represent the highest level of self-esteem across the life span

One aspect of culture is invisible or less observable to others. A nurse wanting to develop an awareness of the practices of different cultures within that community would have which of the following as an example of this component?

wearing an amulet or charm ♦Because you don't know what the amulet means

The nurse plans to teach a client about the importance of exercise

when the client's pain medications are working

A postoperative client is using a PCA. You will evaluate the effectiveness of the medication when

you compare assessed pain with baseline pain

Acoustic neuroma

▪ A benign tumor of cranial nerve VIII ▪ Depending on the size and exact location of the tumor, damage to hearing, facial movements, and sensation can occur ▪ Manifestations begin with tinnitus and progress to gradual sensorineural hearing loss in most patients ▪ Later, patients have constant mild vertigo ▪ As the tumor enlarges, nearby cranial nerves are damaged ▪ Surgical removal via a craniotomy is performed and the remaining hearing is lost

Diagnosis

▪ A nursing diagnosis focuses on a client's actual or potential response to a health problem rather than on the physiological event, complication or disease ▪ NANDA - four types of nursing diagnoses Actual Risk Wellness Health promotion ▪ Components Diagnostic label - the name of the nursing diagnosis as approved by NANDA-I Related factor - a condition or etiology identified from the client's assessment data Risk factors Support ▪ Documentation

Social roles

▪ A primary group - has intimate, continued face-to-face contact; mutual support of members; and the ability to order or constrain a considerable proportion of individual members behavior ▪ Secondary groups - groups that have limited, intermittent contact and generally less concern for members' behavior

Determine client centered goals and outcomes

▪ A specific and measurable behavior or response representing the client's highest possible level of wellness and independence in function ▪ Long term goals ▪ Short term goals ▪ Expected outcomes

Definition of health

▪ A state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity

Homelessness

▪ Absolute homelessness describes people without physical shelter who sleep outdoors, in vehicles, abandoned buildings or other places not intended for human habitation ▪ Relative homelessness describes those who have a physical shelter but one that does not meet the standards of health and safety ➢ Trauma is a sudden unplanned event ▪ In care for these families answer their questions honestly ▪ When you do not know the answer, find someone who does ▪ Take time to be sure the family is comfortable ▪ Sometimes telling the family that you will stay with their loved one while they are gone is all they need to feel comfortable in leaving

➢ Client-inherent accidents

▪ Accidents where the client is the primary reason for the accident

Therapeutic communication techniques

▪ Active listening SOLER ♦Sit facing the client ♦Observe an open posture ♦Lean toward the client ♦Establish and maintain intermittent eye contact ♦Relax ▪ Sharing observations ▪ Sharing empathy ▪ Sharing hope ▪ Sharing humor ▪ Sharing feelings ▪ Using touch ▪ Using silence ▪ Providing information ▪ Clarifying ▪ Focusing ▪ Paraphrasing ▪ Asking relevant questions ▪ Summarizing ▪ Self-disclosure ▪ Confrontation

➢ Drug interactions

▪ Additive effect - drugs used together so that small doses of each drug can be given ▪ Synergistic effect - combined effects are greater than the effects of each drug alone ▪ Antagonistic effect - combination of two = drug is less effective ➢ Idiosyncratic reaction - occurs unexpectantly in a particular pt., from genetic traits

Health belief model

▪ Addresses the relationship between a person's beliefs and behaviors ▪ It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies ▪ First - individuals perception of susceptibility to an illness ▪ Second - the individual's perception of the seriousness of the illness Is influenced and modified by demographic and sociopsychological variables, perceived threats of the illness, and cues to actions ▪ Third - the likelihood that a person will take preventive action - results from the person's perception of the benefits of and barriers to taking action ▪ A client's perception of susceptibility to disease as well as his or her perception of the seriousness of an illness, helps to determine the likelihood that the client will or will not partake in health behaviors

Common record-keeping forms

▪ Admission nursing history forms ▪ Flow sheets and graphic records ▪ Home care documentation ▪ Long term health care documentation

LOC

▪ Alterations in breathing pattern Bradypnea - rate is regular but abnormally slow Tachypnea - rate or breathing is regular but abnormally rapid Hyperpnea - labored, increased in depth and increased in rate Apnea - cease for several seconds Hyperventilation - rate and depth increase Hypoventilation - rate is abnormally low and depth of

Labyrinthitis

▪ An infection of the labyrinth, which may occur as a complication of acute or chronic otitis media ▪ Infection results from an erosion of the bony capsule, allowing organisms to invade the inner ear ▪ Labyrinthtitis often results from the growth of a cholesteatoma (benign overgrowth of squamous cell epithelium) from the middle ear into the semicircular canal ▪ Manifestations include Hearing loss, tinnitus, nystagmus to the affected side, and vertigo with nausea and gomiting Meningitis (infection of the brain covering) is a common complication of labyrinthitis ▪ Treatment of the disease includes the use of systemic antibiotics ▪ Advice pt. to stay in bed in a darkened room until manifestations are reduced

Selecting nursing interventions

▪ Any treatment or action, based upon clinical judgment and knowledge, that nurses perform to enhance the client's outcomes ▪ Nursing initiated - independent ▪ Physician initiated

Pressure ulcers

▪ Area of tissue necrosis when soft tissue is compressed between bony prominence and external source over a period of time ▪ Contributing factors Intensity ♦After a period of tissue ischemia, if the pressure is relieved and the blood flow returns, the skin turns red ➢ Hyperemia ▪ When you note hyperemia, document location, size, and color and reassess the area after 1 hour ♦If blanching occurs and the erythema returns when you remove your finger the hyperemia is transient and is an attempt to overcome the ischemic episode ♦If area does not blanch, deep tissue damage is probable Duration Tissue tolerance ▪ Risk factors Impaired sensory perception, impaired mobility, altered LOC, shear, friction, moisture ▪ Classification (once ulcer is staged it can be staged up but not back down)

Establish priorities

▪ Assigning priorities ▪ Setting priorities High Intermediate Low

ASKED model of cultural competence

▪ Awareness ▪ Skill ▪ Knowledge ▪ Encounters ▪ Desire

Basic human needs model

▪ Basic human needs are elements that are necessary for human survival and health ▪ Maslow's hierarch of needs Physiological (oxygen, fluids, nutrition, body temp, elimination, shelter, sex) à safety and security (physical safety, psychological safety) à love and belonging needs à self-esteem à self actualization Certain human needs are more basic than others; that is, some needs must be met before other needs Self-actualization is the highest expression of one's individual potential and allows for continual discovery of self It is unrealistic to always expect a client's basic needs to occur in the fixed hierarchial order

Behavior stress management techniques

▪ Benson's relaxation techniques ▪ Meditation ▪ Guided imagery ▪ Breathing exercises ▪ Physical exercise ▪ Progressive muscle relaxation ▪ Biofeedback

Effects of aging of hearing

▪ Big ears ▪ Increased hair ▪ Decreased cerumen ▪ Increased impaction ▪ Decreased elasticity ▪ Degenerative changes ▪ Altered vestibular function

Functions of sleep

▪ Brain restoration - brain filters stored info. about the day's activities

➢ Signs of impeding death

▪ Breathing pattern change Pattern may slow, periods of apnea Disorientation Restlessness Coolness of extremities and mottled Increased sleeping Fluid and food decrease ♦Do not force foods, will cause more discomfort Incontinence Congestion and gurgling ♦"the death rattle" ➢ Place them on their side with a towel under mouth

Eternal nutrition

▪ Candidates - stroke, brain injury, head and neck surgeries ▪ Nutrients via GI tract ➢ Nose ▪ Nasogastric - nose to stomach ▪ Nasointestinal - nose to jejunum ➢ Surgically ▪ Jejunostomy ▪ Gastrostomy ➢ Tube placement must be verified by x-ray before the initial feeding ▪ Also check pH before sending to x-ray ➢ Enteral feeding ▪ Feeding - gavage ▪ Suction - lavage ▪ Bolus vs. continuous Bolus - intermittent ♦Before feeding insert 30 cc of air, then aspirate back 5 cc, us pH strip to test Continuous ♦Check every 4-6 hours ▪ Residuals 200 mL or more don't give the food back and discontinue the feed ▪ Flushes 30 cc of water before and after feeding ▪ Timing Every 24 hours hang a new bag ♦Never hang more than 8 hrs of feed at a time ▪ Overall goal Use the GI tract, if you don't it will atrophy Care of pt. with malnutrition and obesity

Clinical signs of death

▪ Cessation of apical pulse ▪ No respirations ▪ No blood pressure ▪ Irreversible brain damage

➢ Pulse

▪ Character of pulse Tachycardia - faster Bradycardia - slower Rhythm - regular/irregular Strength - strong (3+)/weak/thready/bounding(4+) Equality - never carotids (cut off circulation to brain) ▪ Count for 30 seconds and multiple by 2 If irregular check apical and count for full minute PMI - point of maximal impulse

Human ecology model

▪ Client and immediate family ▪ People and settings that have frequent contact with pt. and family ▪ Local community and its values and policies ▪ Social systems such as government and church

Implementation

▪ Clinical guideline or protocol - a document that guides decisions and interventions for specific health care problems or conditions ▪ Standing order - a preprinted document containing orders for the conduct of routine therapies, monitoring guidelines and/or diagnostic procedures for specific clients with identified clinical problems

Cognitive approaches to stress management

▪ Cognitive reframing Find the positive instead of the negative ▪ Mindfulness ▪ Journaling ▪ Humor

Indirect care

▪ Communicating nursing interventions (change of shift report), delegating, supervising and evaluation

Wound complications

▪ Hemorrhage - uncontrolled bleeding Most apparent within first 24-48 hrs. ▪ Infection Purulent drainage, color, swelling, redness, fever, smell, pain, WBC ▪ Dehiscence - separation of skin and dermal layers before healing takes place First step is to call the MD ▪ Evisceration - when an organ protrudes through a wound Immediately get sterile towels, soaked in normal saline and cover the organ Let OR know Call the MD ▪ Fistula - passageways between 2 organs or from organ to outside

➢ Malnutrition

▪ Hypoproteinemia - decrease in serum proteins - occurs as protein synthesis in the liver decreases ▪ Anorexia nervosa - self induced starvation ▪ Bulimia nervosa - episodes of binge eating and followed by some form of purging behavior

Respirations

▪ Hypoxic drive - low oxygen level stimulates urge to breathe fv. CO2 levels ▪ 12-20 = normal ▪ Count for 30 seconds and multiple by 2 If irregular count for a min. ▪ Observe if using accessory muscles Retraction - using all those muscles

➢ History taking

▪ Identifying information Informant ♦The person who furnishes the information ♦Chief complain ➢ the specific reason for the child's visit to the clinic, office or hospital

Electrical hazards

▪ If pt. receives electrical shock immediately determine if there is a pulse ▪ If no pulse initiate CPR

Teaching methods based on client's developmental capacity

▪ Infant Be consistent, hold firmly while speaking softly, have infant touch textures ▪ Toddler Use play, picture books, simple words ▪ Preschooler Role play, imitation and play, encourage questions, offer explanations, encourage children to learn together ▪ School age child Teach psychomotor skills needed to maintain health, offer opportunities to discuss health problems and answer questions ▪ Adolescent Allow them to make decisions ▪ Young or middle adult Encourage participation and setting mutual goals ▪ Older adult Teach when alert and rested Keep sessions short

Diagnosis Components

▪ P - problem ▪ E - etiology Four categories ♦Pathophysiology ♦Treatment ♦Situation ♦Maturational ▪ S - signs and symptoms (support of the statement)

Types of drainage

▪ Serous - clear, watery plasma ▪ Serosanguineous - pale, red, water: mixture of clear and red fluid ▪ Sanguineous - bright red; indicates active bleeding ▪ Purulent - thick, yellow, green, tan or brown =

➢ Tolerance/dependence

▪ Tolerance - decreasing response to repeated drug doses ▪ Dependence Physiological - need for a drug to avoid physical withdrawal symptoms Psychological - addiction, an obsessive desire for the euphoric effects of the drugs

infection control ➢ Droplet

▪ Transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth - Coughing, sneezing, or talking - Travel short distances, usually 3 feet

Dyspnea management

▪ Treat primary cause, and relieve the psychological distress ▪ Medications Opioids etc. ▪ Cool air ▪ Wet cloths' to pt. face ▪ Positioning ▪ Imagery and deep breathing

Neoplasms

▪ Tumors of the middle ear are rare ▪ The most common type of tumor is the glomus juglare, a highly vascular benign lesion arsing from the jugular vein ▪ The growth of any lesion within the middle ear area disrupts conductive hearing, erods the ossicles and may spread to the inner ear and nearby cranial nerves ▪ The many blood vessles of the glomus jugulare tumor give it a reddish color and a visible pulsation when seen through the eardrum

➢ Variations

▪ Unknown etiology - nurse does not know the cause or contributing factors ▪ Complex factors - too many etiologic factors to list them all out ▪ Secondary to - to divide the etiology into 2 parts

➢ Common types of urinary alterations

▪ Urgency - feeling of need to void immediately ▪ Dysuria - painful or difficult urination ▪ Frequency - voiding at frequent intervals ▪ Hesitancy - difficulty initiating urination ▪ Polyuria - voiding large amounts ▪ Dribbling - leakage of urine despite voluntary control of urination ▪ Incontinence - involuntary loss of urine ▪ Hematuria - blood in urine ▪ Retention - accumulation of urine in the bladder, with inability of bladder to empty fully

Telehealth nursing

▪ Using the nursing process to provide care and access to health care over the telephone

Respiratory nursing care

▪ Ventilation Air in and out Mouth-bronchioles Airway management Breathing mechanism ▪ Respiration O2 in and CO2 out Alveoli Gas management Oxygenation ➢ Number of packs per day x number of years smoking = pack years ➢ Breath sounds ▪ Crackle - very fine bubbles in the bases of your lungs - alveoli level ▪ Wheeze - whistling in lungs during expiration and respiration - airways are constricted - mid-chest ▪ Rhonchi - junk in your bronchi and bronchials - air (bubbles) passing through the junk - mid-chest ▪ Stridor - upper airway - sounds almost like snoring but not coming from nose Pediatric variation - barking dog/barking seal (croup) ▪ Pleural friction rub ➢ In pediatrics - respiratory is the most important thing to asses

Forms of communication

▪ Verbal communication Connotative meaning is the shade or interpretation of a word's meaning influenced by the thoughts, feelings or ideas people have about the word ▪ Non-verbal communication Approx. 7 % of meaning is transmitted by words Personal appearance Posture and gait Facial expression Eye contact Gestures Sounds

Fourth part of physical, Neuro

♦Two types of aphsia ➢ Sensory (or receptive) ▪ Person cannot understand written or verbal speech ➢ Motor (or expressive) ▪ Can understand written and verbal speech but cannot write or speak appropriately Communication and physical assessment of the child ➢ Communicating with families ▪ Communicating with parents Encourage parents to talk Directing the focus Listening and cultural awareness Using silence Being empathic Providing anticipatory guidance Avoiding blocks to communication ♦Blocks to communication

Ethical principles

➢ 3 principles have been proven to be highly relevant in bioethics ▪ Autonomy ▪ Beneficence, nonmalefience ▪ Veracity - was thought that telling the truth could be

Health policy

➢ A set course of action undertaken by governments or health care organizations to obtain a desired outcome

Nursing process (from lecture)

➢ ADPIE ▪ Assessment - the systemic collection of data relating to clients Collect, validate, analyze ▪ Diagnosis - the analysis of collected data to identify the client's needs or problems ▪ Planning - a two part process of Identifying goals and desired outcomes Monitoring the client's response ▪ Implementation - putting the plan of care into action ▪ Evaluation Determining the client's progress Monitoring the client's response

The Joint commission

➢ Address the organizations level of performance in key functional areas, including pt. rights, pt. treatment and infection control ➢ Focuses on the organization's ability to provide safe high quality care but now also requires evidence of actual performance and continue improvement

DRUG reactions

➢ Adverse drug event - any undesirable occurrence related to administering or failing to administer a prescribed medication ➢ Adverse drug reaction - any unexpected, unintended, undesired or excessive response to a medication give at therapeutic dosages ➢ Allergic reaction - an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a pt. to a particular medication; a type of adverse drug event ➢ Idiosyncratic reaction - an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual pt.

Chain of infection

➢ An infectious agent or pathogen ➢ A reservoir or source for pathogen growth ▪ Most common reservoir is the human body ➢ A portal of exit from the reservoir ➢ A mode of transmission ▪ Major route for pathogens in the health care setting is the unwashed hands ➢ A portal of entry to a host ➢ A susceptible host

Immobility problems (metabolic system)

➢ Anorexia ➢ Negative nitrogen balance ➢ Negative calcium balance

Medication error

➢ Any preventable event that may cause or lead to inappropriate medication use or pt. harm while the medication is in the control of the health care professional, patient or consumer

Ambulation

➢ Assess pt. and environment ➢ Explain ➢ Assistive devices ➢ Falls ➢ When you document you document in ft. (count the tiles on the floor) ➢ Cane goes on strong side ➢ Stand on the affected side when using gait belt

Spirituality

➢ BELIEF ▪ Belief systems ▪ Ethics ▪ Lifestyle ▪ Involvement ▪ Education ▪ Future events ➢ Spirituality is unique, subjective and personal

Bowel and bladder - lecture notes

➢ Bladder ▪ Terminology Dysuria - painful Polyuria - excess Oliguria - small, sporadic, under, low volume Nocturia - urinating at night Anuria - no urine output Hematuria - bloody ▪ Factors influencing urination Disease, sociocultural, psychological, muscle tone, fluid balance, surgery, growth and development, medications, diagnostic exams ▪ Stress incontinence - void wile coughing, sneezing, laughing etc. ▪ Urge incontinence - can't control the need to go ▪ Overflow incontinence - bladder can't hold anymore ➢ Bowel ▪ Factors influencing bowel elimination Age, infection, diet, fluid intake, physical activity, diagnostic tests, psychological, personal habits, position, pain, surgery/anesthesia, medications, disease ▪ Elimination problems Constipation Impaction Diarrhea Incontinence Flatulence Hemorrhoids

Activity and exercise

➢ Body alignment - the relationship of one body part to another body part along a horizontal or vertical line ➢ Body balance - occurs when a relatively low center of gravity is balanced over a wide, stable base of support and a vertical line falls from the center of gravity through the base of support ➢ Friction - a force that occurs in a direction to oppose movement ▪ The greater the surface area of the object you are moving, the greater the friction

Altered self-concept/self-esteem

➢ Body image ▪ Stroke, colostomy, anorexia, arthritis, incontinence, obesity, multiple sclerosis, amputation, scarring, aging, pregnancy, mastectomy, rape, assault ➢ Role performance ▪ Inability to balance career and family, physical, emotional, or cognitive deficitis preventing role assumption, loss of satisfying role, transition from school to work setting, promotion or demotion, changing work environment, empty nest, assuming responsibility for aging parent ➢ Identity ▪ Job loss, change in marital status, abuse or neglect, dependency on others, sexuality concerns, repeated failures, societal attitudes, conflict with others ▪ Role performance stressors

Pharmacologic principles

➢ Chemical name - the name that describes the chemical composition and molecular structure of a drug ➢ Generic name - name given to a drug by the US adopted names council ➢ Trade name - the commercial name given to a drug product by its manufacturer ➢ Therapeutic equivalence - the drugs must have been proven to have the same therapeutic effect I the body before one drug can be therapeutically substituted for another ➢ Pharmaceutics - the science of preparing and dispensing drugs, including dosage form design ➢ Pharmacokinetics - the rate of drug distribution among various body compartments after a drug has entered the body. Includes absorption, distribution, metabolism and excretion of drugs

Role strain

➢ Combines role conflict and role ambiguity ➢ Some express role strain as a feeling of frustration when a person feels inadequate or unsuited to a role, such as providing care to a family member with Alzheimer's disease

Assessment

➢ Cues - pieces of information that you gather, can see it, feel it, hear it etc. ▪ Concrete information ➢ Inferences - what you decide ▪ Should never be documented as so, document the data you obtain

Culture

➢ Cultural assessment ▪ Is there anything I need to know about you to make this better for you? ➢ Population diversity ▪ Visible Clothing, jewelry, tattoos ▪ Invisible Beliefs and ideas ➢ Nursing goal ▪ Must understand your own limitations and why you hold those views ➢ Definitions ▪ Culture The totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, life ways, and all other products of human work and thought characteristics of a population of people that guide their worldview and decision making ▪ Ethnicity Shared identity such as ♦Values, geographical area, social and cultural values, language ▪ Acculturation The process of adapting to and adopting a new culture/modification ▪ Assimilation Incorporation of the dominant culture

DAR

➢ Data ➢ Action ➢ Response of the client

Immobility problems (musculoskeletal)

➢ Decrease in muscle strength ▪ 3% loss each day (health teenager) ➢ Disuse osteoporosis ➢ Disuse atrophy ➢ Contractures ▪ Can happen after 8 hours of immobility ▪ Example: foot drop ➢ How to prevent ▪ ROM (passive or active) ▪ Isometric exercises ▪ Physical therapy ▪ Occupational therapy ▪ Brace the foot for foot drop ▪ Calcium supplements

Immobility problems (cardiovascular)

➢ Decreased cardiac output, cardiac reserve, cardiac efficiency, venous return and circulating volume ➢ Edema ➢ Valsalva maneuver ▪ Happens with pain, when they have to use the bathroom and they are straining ➢ Orthostatic hypotension ▪ 20 mm drop in blood pressure ➢ Thrombus

Immobility problems (GI system)

➢ Decreased peristalsis ➢ Constipation

Immobility problems (respiratory system)

➢ Decreased respiratory movement ➢ Poking respiratory secretions ➢ Atelectasis ▪ Secretions block a bronchial and everything below it collapses ➢ Hypostatic pneumonia ▪ Secretions are pooling

Spiritual health

➢ Definition of spirituality - an awareness of one's inner self and a sense of connection to a higher being, nature or to some purpose greater than oneself ➢ Self-transcendence - the belief that there is a force outside of and greater than the person ➢ Faith allows people to have firm beliefs despite lack of physical evidence ➢ Beliefs and values ▪ Values allow people to determine what is important to them and help people appreciate the beauty and worth of thoughts, objects and behaviors ➢ Inner strength is a source o energy that instills hope, provides motivation and promotes a positive outlook on life ➢ Inner peace and harmony fosters calm, positive and peaceful feelings despite life experiences of chaos, fear and uncertainty ➢ Atheist - do not believe in the existence of God ➢ Agnostic - believe that there is no known ultimate reality ➢ Spiritual well being

Documentation and informatics

➢ Documentation is anything written or printed you rely on as record or proof for authorized persons ➢ Consultations - form of discussion whereby one professional caregiver gives formal advice about the care of a client to another caregiver ➢ Referrals - an arrangement for services by another care provider ➢ Purposes of documentation - communication, legal documentation, financial billing, education, research and auditing-monitoring

Mobility and immobility

➢ Effects on systems (not including the ones I touched on already) ▪ Psychosocial effects Often leads to emotional and behavior responses, sensory alterations and changes in coping

Ostomies

➢ Enemas ▪ Limit is 3 ➢ Nutritional considerations for clients with ostomies ▪ Low fiber diet for first weeks ➢ Give yourself time to defecate!

Bed positions

➢ Fowlers - 45 degrees ➢ Semi fowlers - 30 degrees ➢ Trendelenburg - head of bed down ➢ Reverse trendelenburg - foot of bed down ➢ Flat

Client safety

➢ Freedom from psychological and physical injury, is a basic human need that must be met ➢ Individual risk factors ▪ Lifestyle ▪ Impaired mobility ▪ Sensory or communication impairment ▪ Lack of safety awareness ➢ Nine life saving pt. safety solutions ▪ Be aware of look alike, sound alike med names ▪ Use pt. identification ▪ Communication during pt. handover ▪ Perform correct procedure at correct body site "time out" ▪ Control concentrated electrolyte solutions Six rights of medication administration ▪ Ensure med. Accuracy at transitions in care ▪ Avoid catheter and tubing misconnections ▪ Do not reuse single-use injection devices ▪ Improve hand hygiene

Care of pt. with ear and hearing problems

➢ Hearing problems reduce the ability of the pt. to meet the human need for sensation and cognition ➢ They can lead to confusion, mistrust, social isolation and the inability to give and receive accurate information

Restorative care

➢ Help individuals regain max. functional status and to enhance quality of life through promotion of independence and self care ▪ Home health ▪ Rehab ▪ Extended care facilities

Fluid and electrolytes

➢ Homeostasis ▪ No body system works well if 2 liters of blood volume are gained or lost ➢ Fluid balance ▪ Min amount of urine per day needed to excrete toxic waste products is 400-600 mL ▪ In healthy adult, insensible water loss is about 500-1000 mL/day ➢ Hormonal regulation ▪ Aldosterone Prevents Na and H2O loss ▪ Antidiuretic hormone Prevenets H2O loss ▪ Natriuretic peptides More Na secreted, faster filtration = more urine ➢ Fluid imbalances ▪ Dehydration Assessment ♦Gordon's functional health patterns ➢ Patterns that most affect fluid status are the nutritional-metabolic pattern and the elimination pattern ♦Weight change of 1 pound corresponds to fluid volume change of about 500 mL

Secondary and tertiary care

➢ Hospitals, intensive care, psychiatric facilities, rural hospitals

Nurse practice acts

➢ Includes statements that refer to protecting the health and safety of the citizens in the jurisdiction ➢ Protect the title of RN

Delirium

➢ Increased intracranial pressure ▪ Cranial skull is fixed Can't handle anything else ♦If anything is added it can't be accommodated resulting in change in LOC ➢ First place, then time, then self ➢ LOC ▪ Alert - awake, interactive, oriented X 4 ▪ Lethargic - drowsy, easily awakened ▪ Stuporous - arouses with noxious stimuli Sternal rub - most common ▪ Comatose - cannot be aroused ▪ LOC is the first sign that CNS has declined ➢ Localizes to pain - reach up and knock away painful stimuli ➢ Withdraws to pain - cannot identify where the pain is, they are just rying to get away from it

Nature of infection

➢ Infectious - may not pose a risk for transmission ➢ Communicable - can be transmitted from one person to another ➢ Symptomatic - pathogens multiply and cause clinical signs and symptoms ➢ Asymptomatic - clinical signs and symptoms are not present

Legal aspects of pt. rights

➢ Informed consent ▪ Nurse cannot obtain consent ➢ Leaving against medical advice ▪ Explain dangers and risks of leaving ➢ Physical restraints ▪ Last resort ▪ Expires every 24 hr.

Role overload

➢ Involves having more roles or responsibilities within a role than are manageable

Role ambiguity

➢ Involves unclear role expectations, which makes people unsure about what to do or how to do it, creating stress and confusion

End of life care for children

➢ Is now widely understood that terminally ill children develop an awareness of the seriousness of their diagnosis, even when protected from the truth ➢ Give honest and accurate information ➢ Clarify misconceptions and let the child know that he or she did not cause the illness or death ➢ Communicating with dying children ▪ Eye level ▪ Let the child's questions guide ▪ Provide opportunities for the child to express feelings ▪ Encourage feedback ▪ Use other resources ▪ Use the child's natural expressive means to stimulate dialogue ➢ Children's understanding of and reactions to dying ▪ Infants and toddlers Likely they have no concept of death Regression to less independent behavior

Minors may give consent in the following situations

➢ Lawfully married or a parent ➢ Pregnancy (excluding abortions) ➢ Venereal disease ➢ Drug or substance abuse

Communication

➢ Levels of communication ▪ Intrapersonal communication Occurs within the individual ▪ Interpersonal communication One-to-one interaction ▪ Transpersonal communication Occurs within a person's spiritual domain ♦Example: prayer ▪ Small-group communication ▪ Public communication

Advance directives

➢ Living will ▪ Documents a person's wishes will still living ➢ Durable power of attorney ▪ Allows a designee to make decisions if pt. becomes incapacitated

The infectious process

➢ Localized - client usually experience localized symptoms, such as pain and tenderness and redness at the wound site ➢ Systemic - affects the entire body instead of just a single organ ➢ Course of infection by stage

Immobility problems (pyschoneurologic)

➢ Lowered self-esteem ➢ Exaggerated emotional reactions ➢ Apathetic, withdrawn ➢ May be angry and aggressive ➢ Impairs motor and social development of young children

ASEPSIS

➢ Medical = clean technique ➢ Surgical = sterile technique

Pharmacology

➢ Metric ▪ KHDBDCM ß make up your own mnemonic to remember Kilo, Hecto, Deka, Base, Deci, Centi, Milli, Micro Smaller units end in i ▪ 1 kg = 2.2 lb ▪ 1 liter = 32 fl oz. ▪ 2.54 cm = 1 in. ▪ 1 teaspoon = 5 mL ▪ 1 tablespoon = 15 mL

Diagnosis

➢ NIC - deals with interventions ➢ NOC - deals with outcomes

Urinary elimination

➢ Nocturia - awakening to void one or more times at night ➢ Polyuria - excessive output of urine ➢ Oliguira - urine output that is decreased despite normal intake ➢ Anuria - no urine is produced ➢ Dieresis - increased urine formation ➢ Insensible water loss ➢ Fever causes an increase in body metabolism and accumulation of body wastes ▪ Highly concentrated ➢ Urinary retention ▪ Accumulation of urine resulting from an inability of the bladder to empty properly

Pain and children

➢ Nonnutritive sucking - reduces behavior, physiologic and hormonal responses to pain from procedures ➢ Kangaroo care - skin-to-skin holding of infants dressed only in diapers against their mother or father's chest ➢ Distraction ➢ Relaxation ➢ Guided imagery ➢ Positive self-talk ➢ Thought stopping ➢ Behavior contracting

PICO format for evidence based practice

➢ P = patient population of interest ➢ I = intervention of interest ➢ C = comparison of interest ➢ O = outcome Example: ▪ Does the use of therapeutic distraction (I) compared with the standard reorientation to the environment (C) reduce the incidence of wandering (O) in the clients with dementia (P)

Identity vs. role confusion

(12-20 years) ♦Accepts body changes/maturation ♦Examines attitudes, values, and beliefs; establishes goals for the future ♦Feels positive about expanded sense of self

Initiative vs. guilt

(3-6 years) ♦Identifies with a gender ♦Enhances self-awareness ♦Increases language skills, including identification of feelings

How many times per year, is the licensure exam for RN's administered?

2 times a year

Risk factors

A risk factor is any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increase the vulnerability of an individual or group to an illness or accident Risk factors play a major role in how a nurse identifies a client's health status

Value formation and moral development

A value is a personal belief about worth that acts as a standard to guide behavior; a value system is an entire framework on which actions are based and is the backbone to how one thinks, feels and takes action

Direct care

ADL's, instrumental ADL's (teaching pt. essentially how to be productive in society), physical care techniques, counseling, teaching, controlling for adverse reactions, preventive measures

Factors affecting bowel elimination

Age, diet, fluid intake, physical activity, psychological factors, personal habits, position during defecation, pain, pregnancy, surgery and anesthesia, medications, diagnostic tests

Sources of Infection Chain

Agent - organism the spreads disease Reservoir - where organism live Exit - how organisms escape reservoir Transmission - how organism spreads pathogens Entry - how pathogen enter host Host - infected with pathogens form organisms

Identification

An individual internalizes the beliefs, behavior and values of role models into a personal, unique expression of self

Inhibition

An individual learns to refrain from behaviors, even when tempted to engage in them

Substitution

An individual replaces one behavior with another, which provides the same personal gratification

Perichondritis

An infection of the perichondrium, a touch, fibrous tissue layer that surrounds the cartilage and gives shape to the pinna When infection occurs between the perichondrium and the cartilage, blood flow to the cartilage can be reduced to the point that necrosis occurs and the pinna may become deformed The goal treatment is to eliminate the infection and ensure that the perichondrium stays in direct contact with the cartilage

The nurse notes that the client has a "left shift of their WBC count" which lab result supports this conclusion?

BANDS outnumber the segmented neutrophils

Goal Guidelines

Client centered, singular, specific, measurable/observable, attainable/mutual, realistic, time limited

▪ Guidelines for goals and expected outcomes

Client-centered Singular goal or outcome Observable Measurable Time limited Mutual factors Realistic

▪ Pulse deficit

Compare radial for a min. against apical for a min. Greater than 2 beats off, then there is some alteration

Preschool

Egocentric 3-5 years have usually heard the word death and had some sense of its meaning Dead person in coffin still breathes, eats and sleeps Take the literal meaning of words May conceive illness as punishment Separation from parents is biggest fear

Disinfection

Eliminates many or all microorganisms, with the exception of bacterial spores from inanimate objects

Acute care (immobility) - Cardio System

Discourage the client from using the valsalva maneuver

Perfusion

Distribution of oxygenated RBCs to cells throughout the body

Excretion

Elimination of the drug from the body Primary organ is the kidney ➢ Pharmacodynamics - the study of the biochemical and physiologic interactions of drugs at their sites of activity ➢ Pharmocotherapeutics - the treatment of pathologic conditions through the use of drugs

Acute care (immobility) - Respiratory system

Encourage client to deep breathe and cough every 1-2 hours

Defines the principles of drug actions

Drug actions - the cellular processes involved in the interaction between a drug and body cells; also called mechanism of action ➢ Dosage forms ▪ Enteral ▪ Parenteral ▪ Topical ➢ Toxicology - the study of poisons, including toxic drug effects and applicable treatments ➢ Pharmacognosy - the study of drugs that are obtained from natural plant and animal sources ➢ Half-life- time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%

▪ Active listening

Ears open and mouth shut Mind active ▪ Validating feelings/normalizing grief process ▪ Providing accurate information ▪ Suggesting options Not the same as giving advice Do not use the phrase "you should" or "you shouldn't"

Pulse ox

Evaluates diffusion and perfusion ▪ Oxygen is a medication - MUST HAVE ORDER

Continuous or basal infusion of an opioid in addition to demand dosing causes overmedication

False

During the lockout interval, a dose will be delivered if a client presses the button more than twice

False

Meperidine (Demerol) is the drug most commonly used in PCA therapy

False

▪ True or false: a patient experiencing chronic pain is in danger of experiencing respiratory depression when taking opioids as a long-term therapy

False

Concept of family

Families are as diverse as the individuals that compose them, and clients have deeply ingrained values about their families that deserve respect

Personal protective equipment

Gloves, gown, mask, eye protection

Excessive hot or cold

Heat exhaustion (cramps, get dizzy, give fluids, need to replace electrolytes), heat stroke (heat loss mechanisms stop working, will not sweat), hypothermia (blood pressure drops, heart rate drops, vessels constrict, fingers blue, use warm blankets, soup), malignant hyperthermia (genetic, when person gets general anesthesia), frostbite ▪ Heat loss Radiation - transfer of heat from the surface of one object to the surface of another without direct contact Conduction - transfer of heat from one object to another with direct contact Convection - transfer of heat away by air Evaporation - transfer of heat energy when a liquid is changed to a gas

First part of physical exam is _____

Height and weight Skin, hair and nails ♦Skin ➢ Assessment of skin reveals changes in oxygenation, circulation, nutrition, local tissue damage and hydration ➢ Pallor (decrease in color) - reduced amount of oxyhemoglobin ➢ Vitiligo - loss of pigmentation

➢ Implementation ▪ Mild to moderate anxiety

Help pt. to focus and solve problems by asking openended questions, giving broad openings and exploring and seeking clarification Prevent escalation to more distressing levels ♦Provide calm presence, recognize the anxious person's distress and be willing to listen

Illness

Illness is a state in which a person's physical, emotional, intellectual, social, developmental or spiritual functioning is diminished Is not synonymous with disease ▪ Illness behavior People who are ill generally act in a way that medical sociologists call illness behavior

Procedure related accidents

Include med and fluid administration errors, improper application of external devices, and accidents related to improper performance of procedures

Developmental changes

Infants, toddlers, preschoolers ♦Prolonged immobilization delays the child's gross motor skills, intellectual development or musculoskeletal development Adolescents ♦Alters adolescent growth patterns Adults ♦Some lose their jobs which affects their self-concept Older adults ♦Progressive loss of total bone mass ♦Increases physical dependence on others and accelerates functional losses

Catheterization

Intermittent and indwelling retention catherizations Intermittent - introduce a straight single use cath. Long enough to drain bladder Indwelling or foley cath remains in place for a longer period of time ▪ Coude cath - used on male clients who may have enlarged prostates ▪ Sterile technique ▪ Bag hangs on bed frame without touching floor ▪ Do not raise bag higher than pt. bladder ▪ Perineal hygiene at least 3 times a day

Incubation period

Interval between entrance of pathogen into body and appearance of first symptoms

Prodromal stage

Interval from onset of nonspecific signs and symptoms to more specific symptoms

Illness stage

Interval when client manifests signs and symptoms specific to type of infection

Body image

Involves attitudes related to the body, including physical appearance, structure or function

Metabolism

Involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite or a less active metabolite

Identity

Involves the internal sense of individuality, wholeness, and consistency of a person over time an in different situations

Self-esteem

Is an individual's overall feeling of self-worth or the emotional appraisal of self-concept It is the most fundamental self-evaluation because it represents the overall judgment of personal worth or value

Family as system

It is important to understand that although you are able to make theoretical and practical distinctions between the family as context and the family as client, they are not necessarily mutually exclusive ♦Often times you will use both simultaneously When viewing the family as system, use elements from both of the above perspectives

Hypokalemia

K below 3.5 ♦Interventions ➢ Aim to prevent K+ loss, increase in K+ levels, and provide a safe environment ➢ Priorities are ensuring adequate oxygenation, pt. safety for falls prevention and prevention of injury from K+ administration and monitoring the pt. response to thrapy ➢ Drug and nutrition therapy ➢ RESPIRATORY MONITORING is performed at least hourly for severe hypokalemia

________ swabs dry the mucous membrane and erodes enamel

Lemon glycerine

Potassium

Major cation of the ICF Normal = 3.5-5.0 mEq/L

Preparation

Making small changes in preparation for a change in the next month ♦Client believes advantages outweigh disadvantages of behavior change. May need assistance in planning for the change

Equipment related accidents

Malfunction, disrepair, or misuse of equipment or from an electrical hazard

Local level

Many cities or counties offer a variety of health care services to meet the needs of their residents

School-aged

May feel intense guilt and responsibility for the event Respond to logical explanations and comprehend the figurative meanings of words Have a deeper understanding of death in the concrete sense May fear the reason for illness, communicability of the disease to themselves or others

Adolescents

Most have a mature understanding of death Tend to think they will not die as a young person Least likely of all age groups to accept cessation of life, particularly their own was a test question More worried about physical changes than death itself Skin integrity and wound care

Third part of physical exam ______

Musculoskeletal ♦Common postural abnormalities ➢ Kyphosis - hunchback ➢ Lordosis - increased lumbar curvature ➢ Scoliosis - lateral spinal curvature ➢ Osteoporosis

Factors influencing

Newborns (can't shiver, lose body temp through head), everything slows down in elderly, exercise, hormones, circadian rhythm (temp. is lower at night), stress (increases metabolism), environment, temp. alterations

______ rinses for chemo patients

Normal saline

Precontemplation

Not intending to make changes within the next 6 months ♦Client will not be interested in information about the behavior and may be defensive when confronted with the information

Tertiary prevention

Occurs when a defect or disability is permanent and irreversible Involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration Care at this level aims to help clients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairments

Gordon's 11 functional health patterns

Offers a holistic framework for assessment of any health problem

➢ Assess for gag reflex ➢ Sims position ➢ Suction available ➢ Never use your finger to keep mouth open ➢ Need more frequent oral care ➢ Petroleum jelly on lips

Oral hygiene for unconscious patient

Interview

Orientation phase ♦Introduce yourself, position and explain the purpose of the interview ♦Establish trust and confidence with the client ♦Gather demographic data Working phase ♦Gather info. about the client's health status ♦Use variety of communication strategies ➢ Active listening, paraphrasing and summarizing to promote a clear interaction ♦Obtain a nursing health history Termination phase ♦Give pt. a clue that interview is coming to an end ♦Summarize the important points and ask pt. whether the summary was accurage ▪ Open-ended questions Shows that you want to hear the pt. thoughts and feelings ▪ Back channeling - includes active listening prompts such as "all right", "go on", or "uh-huh" ▪ Explanatory model - asking the pt. what might be causing his or her problem ▪ Problem seeking interview technique - takes the info. provided in the pt. story and then more fully describes and identifies specific problem areas ▪ Close-ended questions - limit the pt. answers to one or two words

The experience of loss, death and grief

Other theories (we weren't tested on them, but you might want to look them up in your book) ▪ Bowlyb's attachment theory ▪ Grief tasks model ▪ Dual process model ➢ Factors influencing loss and grief ▪ Human development ▪ Personal relationships ▪ Nature of loss ▪ Coping strategies ▪ Socioeconomic status ▪ Culture and ethnicity ▪ Spiritual and religious beliefs ▪ Hope

Cerumen of foreign bodies

Pathophysiology ♦Cerumen (wax) is the most common cause of an impacted canal ♦Cerumen impaction in the older adult is common, and often removal of the cerumen fromolder adults improves hearing ♦Removal may also improve mental status

Diagnostic related groups

Payment is predetermined based on diagnosis

Acute care (immobility) - Integumentary system

Perform ROM exercises ➢ Positioning techniques ▪ Trochanter roll ▪ Trapeze bar ▪ Supported fowlers position 45-60 degrees Knees slightly elevated without pressure to restrict circulation in lower legs ▪ Supine position Rest on their backs ▪ Prone position Lies face or chest down ▪ Side-lying Rest on the side with the major portion of the body weight on the dependent hip and shoulder ▪ Sims Places the weight on the anterior ileum, humorus and clavicle Review major abbreviations and incorrect abbreviations (not going to type them out here) (kee pages 68-70)

Palliative care

Prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness, including care of the dying and bereavement follow-up for the family ▪ Primary goal is to help clients and families achieve the best possible quality of life ▪ Hospice - final phase designated to clients who no longer benefit from medical treatments, who will likely not live more than 6 months, or who are actively dying

Airborne precautions

Private room with negative airflow

HIPPA

Protects confidentiality and privacy of pt. health information ➢ 4 areas ▪ Portability of healthcare coverage ▪ Privacy regulation ▪ Security regulation ▪ Administrative provisions for transmissions of electronic

What would an RN who has been inactive for more than 5 years need to do to be removed from the inactive list?

Prove they've been active in another state or apply and take an approved refresher course

Public health policy

Refers to local, state and federal legislation, regulations and funding r/t health care service delivery and reimbursement

Cleaning

Removal of all soil from objects and surfaces

Patient self determination act

Requires health care agencies to provide written info. to clients about their right to make decisions about their care

Pt. self-determination act

Requires health care institutions to provide written info. to clients concerning the clients rights under state law to make decisions, including the right to refuse treatment and formulate advance directives

Role conflict

Results when a person has to simultaneously assume two or more roles that are inconsistent, contradictory, or mutually exclusive ➢ The sick role involves the expectations of others and society regarding how an individual behaves when sick

Legal guidelines for recording

Review these if you must, examples: not erasing, black ink, correcting errors promptly etc.

➢ Implementation Severe to panic anxiety

SAFETY!! Firm, short simple statements Grief and loss ➢ A normal dynamic, individualized process which pervades every aspect of persons experiencing the loss of a significant other ➢ Mourning - one's cultural response to grief ➢ Bereavement - period of mourning

Self concept

Sense of competency Perceived reactions of others to one's body Ongoing perceptions and interpretations of the thoughts and feelings of others Personal and professional relationships Academic and employment related identity Personality characteristics that affect self-expectations Perceptions of events that have an impact on the self Mastery of prior and new experiences Ethnic, racial and spiritual identity

Braden scale

Sensory perception Moisture Activity Mobility Nutrition Friction and shear

Never events

Serious and costly errors in health care delivery that should never happen

Hypernatremia

Serum Na level over 145 mEq/L ♦Interventions ➢ Monitoring pt. response to therapy and preventing hyponatremia and dehydration ➢ Drug therapy ➢ Nutrition thrapy

Federal level

Significant funding for health and disease research; supplemental funding for education for health professionals, including nurses and physicians; and paying for individual health care services through medicare, Medicaid, SCHIP and the veterans administration health care system

Family Function

Specific functional aspects include the way a family reproduces, interacts to socialize its younger, cooperates to meet economic needs and relates to the larger society also focuses on the processes used by the family to achieve its goals

Functional nursing

Staff members are assigned to complete certain tasks for a group of pt. rather than care for specific pt. Tasks are completed quickly and little confusion about job responsibilities Care may be fragmented Caregiver may feel unchallenged

Stages of Pressure Ulcer

Stage one ♦Intact skin with change in 1 or more of the following ➢ Temperature, color, consistency, sensation Stage 2 ♦Partial thickeness ♦Superficial (1st layer, maybe a little into dermal layer) Stage 3 ♦Full thickness - dermal involvement ♦Damage and/or necrosis of subcutaneous tissue Stage 4 ♦Full thickness - exposed bone, muscle or tendon ➢ Healing

Skeletal system

Support, aid in movement, protect organs, mineral storage, and RBC production

Maintenance stage

Sustained change over time. This stage beings 6 months after action has started and continues indefinitely ♦Changes need to be integrated into the client's lifestyle

Community based nursing

Takes place in a community setting such as the home or clinic, where the focus is on the needs of the individual or family

Vital signs

Temp, pulse, respirations, blood pressure (always in that order TPR BP), pain

Sterilization

The complete elimination or destruction of all microorganisms, including spores

Complementary and alternative therapies

The therapies are organized into two types ▪ Nursing accessible therapies A nurse can begin to learn and apply in client care ▪ Training specific therapies A nurse cannot perform without additional training and/or certification ➢ Nursing accessible therapies ▪ Relaxation therapy ▪ Meditation and breathing ▪ Imagery ➢ Training specific therapies ▪ Biofeedback ▪ Therapeutic touch ▪ Chiropractic therapy ▪ Traditional Chinese medicine ▪ Acupuncture ▪ Herbal therapies ➢ Nursing role in complementary and alternative therapies ▪ Allopathic physicians and more conventional practitioners need to begin to understand the benefits of therapies that encourage active participation by their clients in preventing or managing illness rather than relying solely on surgery or drugs ▪ Clients who benefit from these groups are those who have chronic health problems that have historically been difficult to treat using traditional allopathic medicine

Otitis media

The three most common forms of otitis media are acute otitis media, chronic otitis media, and serous otitis media Each type affects the middle ear but has slightly different causes, incidences, and pathologic changes If otitis progresses or remains untreated, permanent conductive hearing loss may occur Otitis media is less common in adults than in children Acute otitis media and chronic otitis media are similar ♦An infecting agent introduced into the middle ear causes inflammation of the mucosa, leading to swelling and irritation of the small bones within the middle hear ♦A purulent inflammatory exudates follows The Eustachian tube and mastoid, connected to the middle ear by a sheet of cells, are also affected by the infection

▪ Distribution

The transport of a drug by the bloodstream to its site of action

Self-concept

an individual's conceptualization of himself or herself ▪ It is the subjective sense of self and a complex mixture of unconscious and conscious thoughts, attitudes, and perceptions ➢ In general, young children tend to rate themselves higher than they rate other children, suggesting that their view of themselves is positively inflated ➢ The adolescent experience appears to adversely affect selfesteem, more strongly for girls than for boys ➢ Statements such as "I can get through anything" or "I've never been sick a day in my life" indicate that a person's thoughts about personal health are positive ➢ Negative perceptions regarding health status are reflected in such statements as "It's not worth it anymore" or "I'm a burden to my family" ▪ always changing and is based on the following

Superinfection

an infection occurring during antimicrobial treatment for another infection, resulting from overgrowth of an organism not susceptible to the antibiotic used or a secondary microbial infection that occurs in addition to an earlier primary infection, often due to weakening of the pt. immune system function by the first infection

Health care associated infection

an infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission

Performance improvement

an organization analyzes and evaluates current performance to use results to develop focused improvement actions

Critical pathways

are multidisciplinary treatment plans that outline the treatments or interventions clients need to have while they are in a health care setting for a specific disease or condition

A client recently diagnosed with a terminal illness is asking the nurse about organ and tissue donation at the time of death. The nurse should

assist the client to obtain the necessary information to make the decision

Family Structure

based on the ongoing membership of the family and the pattern of relationships, which are often numerous and complex

Justice

being fair or equal in one's action

Adaptive and maladaptive uses of defense mechanisms

▪ Compensation - used to make up for perceived deficiencies and cover up shortcomings related to these deficiencies to protect the conscious mind from recognizing them ▪ Conversion - the unconscious transformation of anxiety into a physical symptom with no organic cause. Often the symptom functions to gain attention or as an excuse ▪ Denial - involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes or needs by ignoring their existence ▪ Displacement - the transference of emotions associated with a particular person, object or situation to another nonthreatening person, object or situation ▪ Dissociation - disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. It may result in a separation between feeling and though. This can also manifest itself in compartmentalizing uncomfortable or unpleasant aspects of oneself ▪ Identification - attributing to oneself the characteristics of another person or group. This may be done consciously or unconsciously ▪ Intellectualization - a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing ▪ Introjections - process by which the outside world is incorporated or absorbed into a person's view of the self ▪ Projection - refers to the unconscious rejection of emotionally unacceptable features and attributing them to other people, objects or situations ▪ Rationalization - consists of justifying illogical or unreasonable ideas, actions or feelings by developing acceptable explanations that satisfy the teller as well as the listener ▪ Reaction formation - when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion ▪ Regression - reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited ▪ Repression - first-line psychological defense against anxiety. It is the temporary or long-term exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness. This happens at an unconscious level ▪ Splitting - the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of the self and of others tend to alternate between opposite poles ▪ Sublimation - unconscious process of substituting mature, constructive and socially acceptable activity for immature, destructive and unacceptable impulses. Often these impulses are sexual or aggressive ▪ Suppression - the conscious denial of a disturbing situation or feeling ▪ Undoing - is most commonly seen in children. It is when a person makes up for an act or communication ▪ Altruism - deal with emotional conflict or stressors by helping someone else out

Common problems in bowel elimination

▪ Constipation Symptom not a disease ▪ Impaction Obvious sign is the inability to pass stool for several days, despite the repeated urge to defecate Loss of appetite ▪ Diarrhea Increase in number of stools and passage liquid, unformed feces ▪ Incontinence ▪ Flatulence ▪ Hemorrhoids ▪ Bowel diversions

Tinnitus

▪ Continuous ringing or noise perception in the ear ▪ Is a common hearing problem ▪ Diagnostic testing cannot confirm tinnitus, nor can the disorder be observed ▪ Tinnitus can have disturbing emotional consequences for the person afflicted with this disorder ▪ Symptoms range from mild ringing, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with thinking and attention span ▪ Be alert to the many factors that cuase tinnitus Presbycusis, ososclerosis, meniere's disease, certain drugs, exposure to loud noise and other inner-ear problems When no cuase can be found or the disorder is untreatable, therapy focuses on ways to mask the tinnitus with background sound, noisemakers, and music during sleeping hours Ear mold hearing aids can amplify sounds to drown out the tinnitus during the day

Body temp

▪ Controlled by hypothalamus ▪ Heat produced - heat loss = body temp. ▪ Diaphorectic - when you sweat a lot ▪ Anhidrosis - can't sweat ▪ Surface vs. core temperature

➢ Trans-cultural nursing

▪ Cultural awareness - simply aware ▪ Cultural sensitivity - I may not agree but I am sensitive to the pt. needs ▪ Cultural competence - incorporation of cultural values

Drug orders

▪ Date and time order was written ▪ Drug name ▪ Drug dosage ▪ Route of administration ▪ Frequency of administration ▪ Physicians signature

Abnormal flexion

▪ Decortications - back arches up off of bed, hands up, thumbs rotate out and toes point ▪ Decerabration - back arches, hands extend out, thumbs rotate out and toes point ➢ No response = brain dead ➢ Delirum - clinical picture ▪ Onset = short ▪ Cause or contributing factors General medical problem, drug or alcohol withdrawal, lack of oxygen, hypoglycemic, head injury, high fever, hypotension, change in environment

infection control ➢ Contact

▪ Direct- contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person ▪ Indirect contact transmission involves contact of a susceptible host with a contaminated intermediate object in the pt. environment ➢ Effective hand washing includes wetting, soaping, lathering, applying friction under running water for at least 15 seconds, rinsing and adequate drying

Vertigo and dizziness

▪ Dizziness is a disturbed sense of a person's relationship to space ▪ True vertigo is a real sense of whirling or turning in space ▪ Factors affecting the ear that cause vertigo include Meniere's disease, labyrinthitis, acoustic neuromas, motion sickness, and drug or alcohol ingestion Manifestations of vertigo include nausea, vomiting, falling, nystagmus, hearing loss and tinnitus Until the cause of the vertigo can be treated, each manifestation is treated Teach pt. these strategies to reduce manifestations ♦Restrict head motions and move more slowly ♦Maintain adequate hydration, especially after vomiting ♦Take drugs that reduce the vertigo effects Teach pt. to maintain a safe, uncluttered environment to prevent accidents during periods of vertigo and to use a can or walker to maintain balance

Aspiration risk

▪ Dysphagia - difficulty swallowing ▪ 2 people with a big risk Poor gag reflex LOC ➢ Must have bowel sounds before you feed someone ➢ Assisting patients ▪ Assess Gag reflex, LOC, environment of room (smells, urinals, bedpans), pain, fatigue, minimize interruptions, oral hygiene ▪ Position Upright Leave upright for at least 30 min so food can digest ▪ Stroke patients Food on strong side

➢ If medication error occurs

▪ Ensure pt. is safe ▪ Notify provider ▪ Report incident to appropriate person ▪ Fill out an incident report

Non-opiod analgesics

▪ First-line therapy for mild to moderate pain ▪ Ceiling effect

Blood pressure

▪ Force on the arteries by pulsing blood under pressure from the heart ▪ Systolic - peak max pressure when ejection occurs Think of "sisterly love" (hug, contract) ▪ Diastolic - ventricles relax ▪ Hypertension Most common > 140/90 Headache, dizziness, flushed face ▪ Hypotension Systolic < 90 Dizziness, confusion, HR increases

Seizure

▪ Generalized tonic-clonic or grand mal seizure lasts approx. 2 min and is characterized by a cry, loss of consciousness with falling, tonicity (rigidity), clonicity (jerking) and incontinence ▪ Status epilepticus Prolonged or repeated seizures Medical emergency and requires intensive monitoring and treatment

Developmental (r/t safety)

▪ Infant, toddler and preschooler Growing children are curious and completely trusting of their environment and do not perceive themselves to be in danger ▪ School aged children Increasingly explore their environment ▪ Adolescent Involve many factors outside of the home environment, particularly their almost constant involvement with members of their peer group ▪ Adults Lifestyle factors such as child rearing, high stress levels, inadequate nutrition, use of firearms, excessive alcohol intake and substance abuse ▪ Older adults Most injuries involves falls, automobile accidents and those related to burns or fires

Sleep disorders

▪ Insomnia - difficulty falling asleep, frequent awakenings and/or a short sleep or non-restorative sleep Pt. usually gets more sleep than he or she realizes More frequent in women ▪ Sleep apnea Lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep Central - impulse to breathe temporary fails ♦Common in pt. with brain stem injury, muscular dystrophy and encephalitis and people who breathe normally during the day Obstructive ♦Most common ♦Structures of oral cavity or throat relax during sleep ♦Obesity, smoking, alcohol and positive family history greatly increase risk ▪ Narcolepsy Excessive daytime sleepiness is most common complaint REM sleep occurs within 15 min. of falling asleep Cataplexy - sudden muscle weakness during intense emotions occurs at any time during the day Falling asleep uncontrollably at inappropriate times ▪ Sleep deprivation

Collection methods

▪ Interview, nursing health history, physical exam, labs/diagnostic test results ▪ Interview Phases ♦Orientation - introduce yourself and role ♦Working - gathering the info. ♦Termination - end the interview Communication during interview

Urinary incontinence

▪ Involuntary leakage of urine that is sufficient to be a problem ▪ Stress incontinence ▪ Urge incontinence

Exercise and activity

▪ Isotonic - cause muscle contraction and change in muscle length ▪ Isometric - involves tightening or tensing of muscles without moving body parts ▪ Resistive isometric - individual contracts the muscle while pushing against a stationary object or resisting the movements of an object

Restorative care

▪ Kegal excercises ▪ Bladder retraining Suppress urination and increase time by 15 min. every week ▪ Minimize tea, coffee or other caffeine drinks and alcohol ▪ Habit training ▪ Self catheterization ▪ Maintenance of skin integrity Warm water and mild soap - best way to remove urine from skin ▪ Promotion of comfort Sitz bath Bowel elimination

➢ Grief models

▪ Kubler-ross Denial Anger Bargaining Depression Acceptance ➢ Anticipatory grieving ▪ Can be useful, but also can have a downfall when things don't go as schedule ➢ Disenfranchised grief - when it's not a socially accepted loss ➢ It's not how can I make them feel better but how can I better help them

quality improvement

▪ Learning oriented (prevention) ▪ Cross-functional

Level of pain

▪ Level 1 pain (1-3 rating) - use non-opioids ▪ Level 2 pain (4-6 rating) - use weak opioids alone or in combo with adjuvant drug ▪ Level 3 pain (7-10 rating) - use strong opioids ➢ Side effects of opioids ▪ Constipation, nausea, vomiting, urinary retention, itching, sedation, respiratory depression ➢ Sedation scale ▪ 1 = alert and awake ▪ 2 = slightly drowsy, but easy to arouse ▪ 3 = always drowsy, but arousable ▪ 4 = somnolent, little or no response to stimuli ➢ PCA pump ➢ Non-pharmacologic interventions ▪ Massage, imagery etc.

Private health policy

▪ Made by health care organizations, such as hospitals and includes those polices instituted to govern employee practices and health care services provided by the organization

Stimulating micturition reflex

▪ Men stand, women sit ▪ Sound of running water ▪ Stroking inner aspect of the thigh ▪ Pour warm water over client's perineium

UTI

▪ Most common health care associated infection ▪ Residual urine in bladder becomes more alkaline and is an ideal site for microorganism growth ▪ Hematuria - blood tinged urine ▪ Urine appears cloudy because of presence of WBC or bacteria

Methods of recording

▪ Narrative documentation ▪ Problem-oriented medical record Database Problem list Nursing care plan ▪ Progress notes

Management of wounds

▪ Need an order for dressing change ▪ Debridement hurts, medicate your patient

Head-to-toe assessment

▪ Not going to type this out, if you need to review the skill in your book

➢ Total pt. care

▪ Nurses are responsible for planning, organizing and performing all care - Nurse maintains high degree to practice autonomy - RN performs many tasks that could be performed by caregiver with less training at a lower cost

Factors that affect healing

▪ Nutrition ▪ Tissue perfusion ▪ Infection ▪ Age Older people heal slower Newborns heal slower - no immune system Kids heal quickly

Infection control ➢ Airborne

▪ Occurs by dissemination of either airborne droplet nuclei or dust particles containing the infectious agent ▪ Measles, varicella and TB

Onset, peak and duration

▪ Onset of action - time required for a drug to elicit a therapeutic response after dosing ▪ Peak effect - the time required for a drug to reach its max. therapeutic response in the body ▪ Duration of action - the length of time the concentration of a drug in the blood or tissues is sufficient to elicit a response ▪ Peak level - the max. concentration of a drug in the body after administration, usually measured in a blood sample ▪ Trough level - the lowest concentration of drug reached in the body after it falls from its peak level ▪ Toxicity - the condition of producing adverse bodily effects due to poisonous qualities ▪ Therapeutic index - ratio of a drug's toxic level to the level that provides therapeutic benefits

➢ Opioid analgesics

▪ Oral route is preferred ▪ Morphine - gold standard ▪ Hydromorphone (dilaudid) 8 times more potent than morphine ▪ Fentanyl ▪ Be concerned if you see pt. on Demerol Considered to be outdated Accumulation of toxic metabolite can cause central nervous system toxicities

Hearing loss

▪ Pathophysiology Hearing loss is one of the most common handicaps in North America It may be conductive, sensorineural, or a combination of the two Conductive hearing loss occurs when sound waves are blocked from contact with inner ear nerve fibers because of external ear or middle ear disorders If the inner ear sensory nerve fibers that lead to the cerebral cortex are damaged, the hearing loss is termed sensorineural Combined hearing loss is known as mixed conductivesensorineural ▪ Etiology and genetic risks Conductive hearing loss can be caused by an inflammation or obstruction of the external or middle ear by cerumen or foreign objects Otitis media with effusion is the commonest cause of acquired hearing loss in children Sensorineural hearing loss occurs when the inner ear or auditory nerve is damaged Prolonged exposure to loud noise can damage the hair cells of the cochlea Many drugs are toxic to the inner ear structures Older pt. are especially at risk for ototoxicity because of reduced kidney function Presbycusis is a sensorineural hearing loss that occurs as a result of aging ♦This hearing loss is caused by breakdown or atrophy of the nerve cells in the cochlea, loss of elasticity of the basilar membrane or a decreased blood supply to the inner ear

Mastoiditis

▪ Pathophysiology an infection of the mastoid air cells caused by untreated or inadequately treated otitis media

Meniere's disease

▪ Pathophysiology has three features ♦Tinnitus ♦One-sided sensorineural hearing loss ♦Vertigo, occurring in attacks that can last for several days The pathology of Meniere's disease is an excess of endolymphatic fluid that distorts the entire inner canal system At first hearing loss is reversible, but repeated damage to the cochlea from increased fluid pressure leads to permanent hearing loss The exact cause is unknown, but it often occurs with infections, allergic reactions, and fluid imbalances Long term stress may also have a role in the disease

Model for QI and PI

▪ Plan ▪ Do ▪ Study ▪ Act

➢ Lab tests

▪ Plasma proteins - albumin - chronic Pre-albumin - acute ♦Shows sudden changes ▪ Hemoglobin - shows if there is iron deficiency

Management of pressure ulcers

▪ Positioning q2h - 30 degree lateral position should prevent positioning directly over the body prominences If in chair - shift weight every 15 minutes ▪ Skin care-keep dry ▪ Supportive devices ▪ Nutrition - double protein, increase calories ▪ Physical therapy, nutritionists, infectious disease

Nurses role in death

▪ Practice the art of presence ▪ Assess for spiritual issues ▪ Provide palliative symptom management ▪ Promote dignity and self-esteem ▪ Become an effective communicator ▪ Counsel about anticipatory grieving/end of life decision making

Data sources

▪ Primary = client ▪ Secondary = family, health care team, medical records, literature review, nurses experience

Pressure Ulcer Healing

▪ Primary intention Wound is closed Surgical wounds, mild sutures, stitches ▪ Secondary intention Wound edges are not approximated Open, takes longer to heal, increased risk of infection, scarring ➢ Wound repair ▪ Partial thickness Heal by regeneration ♦Inflammatory response ♦Proliferation and migration ➢ Cells travel better over a moist surface ♦Re-establishment of epidermal layers ▪ Full thickness Healed by scar formation ♦Inflammatory phase ♦Proliferation ♦Remodeling ➢ One year ➢ Prediction and prevention

Contact precautions

▪ Private room preferred ▪ Gloves ▪ Wash hands before leaving pt. room ▪ Gown - remove before leaving pt. room

Droplet precautions

▪ Private room preferred ▪ Maintain distance of at least 3 feet ▪ Mask

Pt. centered care

▪ Providing care that is respectful of and responsive to individual pt. preferences, needs and values and ensuring that pt. values guide all clinical decisions ▪ Includes family and significant others in decision making

FIRES

▪ RACE R - rescue and remove all pt. in immediate danger A - activate the alarm C - confine the fire E - extinguish the fire

Team nursing

▪ RN functions as a team leader and coordinates a small group of ancillary personnel to provide care to a small group of pt. - Each member of the team is able to participate in decision making and problem solving - Pt. is confronted with many different caregivers - Team leader may not have leadership skills

Mobility

▪ ROM ▪ Gait ▪ Exercise

Steps of data analysis

▪ Recognize a pattern/trend ▪ Compare with norms ▪ Make a reasonable conclusion

Basic elements of the communication process

▪ Referent Motivates one person to communicate with another ▪ Sender and receiver Sender - person who encodes and delivers the message Receiver - person who receives and decodes the message ▪ Messages The content of the communication ▪ Channels Means of conveying and receiving messages through visual, auditory and tactile senses ▪ Feedback The message the receiver returns Indicates whether the receiver understood the meaning of the sender's message ▪ Interpersonal variables Factors within both the sender and receiver that influence communication Example: perception

Care after death

▪ Requesting organ or tissue donation ▪ Autopsy ▪ Certifying and documenting the occurrence of a death ▪ Providing safe and appropriate postmortem care Ask family if they would like to spend time with the body to come to terms with what has happened and to say their goodbyes (before cleaning and bagging and after cleaning if they choose not to do it themselves) Before preparing the body ask the physician whether an autopsy will be ordered ➢ Sense of hearing is last to go

➢ Six rights of med. Administration

▪ Right pt. Ask name and DOB ▪ Right dose Only break tabs that are scored Crushing meds ♦Don't use favorite food ♦Use small amount of food ▪ Right drug If pt. questions drug, stop and clarify ▪ Right time ▪ Right route IV = fastest absorption ▪ Right documentation Initial on the MAR after med is given Document reason if drug not given

Falls

▪ Risk higher in older clients ▪ One of the more common factors precipitating a fall is pt. attempt to go to bathroom

Neurotransmitter stress responses

▪ Serotonin synthesis more active in stress response ▪ During stress there may not be enough serotonin in the brain

➢ Barriers

▪ Socializing ▪ Giving unrestricted and sometimes unasked for advice ▪ Offering premature or inappropriate reassurance ▪ Giving overready encouragement ▪ Defending a situation or opinion ▪ Using stereotyped comments or cliches ▪ Limiting expression of emotion by asking directed, close-ended questions ▪ Interrupting and finishing a person's sentence ▪ Talking more than the interviewee ▪ Forming prejudged conclusions ▪ Deliberately changing the focus ▪ Communicating with families through an interpreter Communicate directly with family members when asking questions to reinforce interest in them and to observe nonverbal expressions, but do not ignore the interpreter Post questions to elicit only one answer at a time ▪ Communicating with children Active attempts to make friends with children before they have had an opportunity to evaluate an unfamiliar person tends to increase their anxiety Continue to talk to the child and parent but go about activities that do no involve the child Communicating with children ♦Avoid sudden or rapid advances, broad smiles, extended eye contact, or other gestures that may seem threatening ♦Communicate through transition objects such as dolls etc. ♦Assume a position that is at eye level with the child ♦Be honest

Electrolyte balance and imbalances

▪ Sodium Major cation in ECF Hyponatremia - serum level below 136 mEq/L ♦Interventions ➢ Priority is monitoring the pt. response to therapy to prevent hypernatremia and fluid overload ➢ Drug therapy ➢ Nutrition therapy ▪ Increasing oral Na intake and restricting oral fluid intake Hypernatremia ♦Serum Na level over 145 mEq/L

Spiritual problems

▪ Spiritual distress - the impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature and/or a power greater than oneself

Stages of sleep

▪ Stage 1 Non-REM Lightest level of sleep, lasts 10-30 min., easily aroused ▪ Stage 2 Non-REM Sound sleep, relaxation progresses, arousal relatively easy , 10-20 min. ▪ Stage 3 Non-REM Initial stages of deep sleep, difficult to arouse, muscles completely relaxed, 15-30 min ▪ Stage 4 Non-REM deepest stage of sleep, very difficult to arouse, 15-30 min ▪ REM sleep Vivid dreaming, begins about 90 min. after sleep has begun, very difficult to arouse, duration of REM sleep increases with each cycle and averages about 20 minutes ➢ Newborns and children spend more time in deep sleep

Types of drugs orders

▪ Standing order - continous ▪ One-time (single) order ▪ PRN - as needed ▪ STAT - must be given within 30 min. of when order was written ▪ Now - within 90 min.

What is anxiety

▪ Stressor - is external ▪ Anxiety - your perception ▪ Fear - danger, something physiological in the environment causing alarm Anxiety ➢ Mild anxiety ▪ Occurs in normal everyday living ➢ Moderate anxiety ▪ Learning and problem solving can still take place, but not at optimal level ➢ Severe anxiety ▪ Learning and problem solving are not possible at this level ➢ Panic ▪ Unable to process what is going on, even when it is pointed out by another ▪ Learning and problem solving are not possible

Mediators of the stress response

▪ Stressors Physical and psychological ▪ Perception ▪ Personality ▪ Social support High and low social support ▪ Culture ▪ Spirituality and religious beliefs

Effective stress busters

▪ Stressors Physical and psychological ▪ Perception ▪ Personality ▪ Social support High and low social support ▪ Culture ▪ Spirituality and religious beliefs ➢ Effective stress busters ▪ Sleep ▪ Exercise ▪ Reduction or cessation of caffeine intake ▪ Music ▪ Pets ▪ Massage ➢ Cognitive reframing ▪ The goal is to change the individual's perception of stress by reassigning a situation and replacing irrational beliefs ➢ Mindfulness ▪ Includes being in the moment by paying attention to what is going on around you ➢ Journaling ➢ Humor

Communities

▪ Support ▪ Empowerment ▪ Boundaries and expectations ▪ Constructive use of time

Reporting

▪ Telephone reports ▪ Telephone or verbal orders Emergency situations Read back complete order Write TO (telephone order) or VO (verbal order) Physician must sign order within the time frame (usually 24 hours)

Teaching approaches

▪ Telling There is no opportunity for feedback ▪ Participating The nurse and pt. set objectives and become involved in the learning process together ▪ Entrusting Provides the client the opportunity to manage self-care Nurse observes pt. progress and remains available to assist without introducing more new information ▪ Reinforcing Requires using a stimulus that increases the probability for a response Feedback is a common form of reinforcement Are positive or negative ➢ Instructional methods ▪ One-on-one discussion ▪ Group instruction ▪ Preparatory instruction ▪ Demonstrations Return demonstration - have a chance to practice the skill ▪ Analogies ▪ Role play ▪ Simulation

Other drug effects

▪ Teratogentic - effects of drugs or other chemicals result in structural defects in the fetus ▪ Mutagenic - effects are permanent changes in the genetic composition of living organisms and consist of alterations in the chromosome structure, the number of chromosomes, or the genetic code of the DNA molecule

General adaptation syndrome

▪ The alarm stage Initial, brief, adaptive response (fight or flight) ▪ The resistance stage Sustained and optimal resistance to the stressor occurs If stressors are not overcome the organism may experience the exhaustion stage ▪ Exhaustion stage Occurs when attempts to resist the stressor prove futile Resources are depleted, and the stress may become chronic

Attributes of healthy families

▪ The crisis proof, or effective, family is able to combine the need for stability with the need for growth and change This type of family has a flexible structure that allows adaptable performance of tasks and acceptance of help from outside the family system

Holistic health models

▪ The holistic health model of nursing attempts to create conditions that promote optimal health ▪ In this model, nurses using the nursing process consider clients the ultimate experts regarding their own health and respect clients' subjective experience as relevant in maintaining health or assisting in healing

Times

▪ Tid - three times a day ▪ Q8h - every eight hours

Health promotion model

▪ Was designed to be a "complementary counterpart to models of health protection" ▪ Id defines health as a positive, dynamic state, not merely the absence of disease ▪ The health promotion model describes the multidimensional nature of persons as they interact within their environment to purse health ▪ Focuses on the following three areas Individual characteristics and experiences Behavior specific knowledge and affect Behavioral outcomes ▪ Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development

Planning

▪ When considering time as a factor in setting priorities Initial ♦Involves development of preliminary plan of care following admission assessment and initial selection of nursing diagnoses Ongoing ♦Involves continuous updating of the client's plan of care Discharge ♦Involves the critical anticipation and preparation for meeting the clients' needs after discharge ▪ Nursing-sensitive client outcome - an individual, family or community state, behavior, or perception that is measurable along a continuum in response to a nursing intervention

➢ Evaluation

▪ You conduct evaluative measures to determine if you met expected outcomes, not if nursing interventions were completed ▪ Five elements Identifying criteria and standards Collecting evaluative data Interpreting and summarizing findings Documenting findings Care plan revision Quality improvement - the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality management - a term for managing the individual

➢ Territoriality and personal space

▪ Zones of personal space Intimate zone (0-18 in) Personal zone (18 in-4ft) ♦Sitting on bedside Social zone (4-12 ft) ♦Making rounds with physician Public zone (12ft and greater) ▪ Zones of touch Social zone (permission not needed) ♦Hands, arms, shoulders, back Consent zone (permission needed) ♦Mouths, wrists, feet Vulnerable zone (special care needed) ♦Face, neck, front of body Intimate zone (great sensitivity needed)

Quality assurance

▪ inspection oriented (detection) ▪ narrow focus

Family with young children

♦Accepting new generation of members into system ➢ Adjusting marital system to make space for children ➢ Taking on parental roles ➢ Realignment of relationships with extended family to include parenting and grand parenting roles

Unattached young adult

♦Accepting parent-offspring separation ➢ Differentiation of self in relation to family of origin ➢ Development of intimate peer relationships ➢ Establishment of self work

Family later in life

♦Accepting shifting of generational roles ➢ Maintaining own or couple functioning and interests in the face of physiological decline; exploration of new familiar and social role options ➢ Making room in system for wisdom and experience of older adults; supporting older generations without over functioning for them ➢ Dealing with retirement ➢ Dealing with loss of spouse, siblings, and other peers and preparation for own death, a life review, in which one reviews life experiences and decisions

Joining of families through marriage: newly married couple

♦Commitment to new system ➢ Formation of marital system ➢ Realignment of relationships with extended families and friends to include spouse

Cognitive and perceptual disturbances

♦Illusions ➢ Misinterpret their environment ▪ You can explain it to your patient ♦Hallucinations ➢ Visual or tactile Physical needs ♦SAFETY ♦Distract them ♦Self care deficits

Family with adolescents

♦Increasing flexibility of family boundaries to include children's independence ➢ Shifting of parent-child relationships to permit adolescents to move into and out of system ➢ Refocusing on midlife material and career issues ➢ Beginning shift toward concerns for older generation

Hypercalcemia

♦Level above 10.5 mg/dL or 2.75 mmol/L ♦Interventions ➢ Drug therapy ➢ Dialysis ➢ Cardiac monitoring of pt ▪ Phosphorus

Hypocalcemia

♦Levels below 9.0 mg/dL or 2.25 mmol/L ♦Interventions ➢ Drug and nutrition therapy ➢ Keep room quiet, limiting visitors, adjusting the lighting, and using a soft but reassuring voice ➢ Injury prevention

Interventions on fluid and electrolytes balance

♦Management aims to prevent injury, prevent further fluid losses and increase fluid compartment volumes to normal ranges ♦Pt. safety, fluid replacement and drug therapy ▪ Fluid overload Most common is hypervolemia Assessment ♦Pitting edema Interventions ♦Pt safety include preventing fluid overload from becoming worse, leading to pulmonary edema and heart failure ♦Risk for skin breakdown ♦Drug and nutrition therapy

Family forms

♦Nuclear family ➢ The nuclear family consists of husband and wife (and perhaps one or more children) ♦Extended family ➢ Includes relatives (aunts, uncles, grandparents and cousins) in addition to the nuclear family ♦Single parent family ♦Blended family ➢ Is formed when parents bring unrelated children from prior or foster parenting relationships into a new, joint living situation ♦Alternative patterns of relationships ➢ Include multi-adult households, "skipgeneration" families (grandparents caring for grandchildren), and communal groups with children. "non-families" (adults living alone), cohabitating partners, and homosexual couples ▪ More grandparents are raising their grandchildren Due to a number of societal factors: the increase in the divorce rate, dual income families and single parenthood Most often it is a consequence of legal intervention when parents are unfit or renounce their parental obligations

Interview questions

♦Open ended - elicit info. opportunity ♦Close-ended - can be answered shortly

PIE

♦Problem ♦Intervention ♦Evaluation Focus charting ♦Narrative format

Hyperkalemia

♦Serum level higher than 5.0 ♦Interventions ➢ Drug therapy ➢ Monitoring to prevent cardiac complications, pt. safety for falls prevention, monitoring he pt. response to therapy and health teaching

SOAP

♦Subjective ♦Objective ♦Assessment ♦Plan ♦Sometimes I and E are added ➢ Intervention ➢ Evaluation

Med admin - lab overview

➢ Skin applications ▪ Apply med with gloved hand and applicator ▪ Patches - make sure you remove the old patch ➢ Sublingual/Buccal ▪ Sublingual - under tongue, must dissolve completely ▪ Buccal - med goes against the mucous membrane of check until dissolves Switch sides to avoid breakdown of membrane ➢ Nasal ▪ Inspect nose first ▪ Blow nose before procedure ➢ Eye drops and ointments ▪ After administration gently press on the medial nasolacrimal canthus with a tissue to prevent systemic drug absorption ➢ Inhalers ▪ Make sure pt. rinses out mouth after use ➢ Suppositories ▪ Use water soluble lubricant ▪ Do not place suppository in stool, must dissolve against rectal wall

Social, cultural and religious influences on child health

➢ Socialization - the process by which society communicates its competencies, values, and expectations to children ➢ The most important influences on development of a positive self-image are warm, understanding parents who actively foster their children's growth

Data collection

➢ Subjective data - what the client reports, believes or feels ➢ Objective data - what can be observed

Potential for microorganisms or parasites to cause disease depends on ...

➢ Sufficient number of organisms (dose) ➢ Virulence, or ability to survive in the host or outside the body ➢ Ability to enter and survive in the host ➢ Susceptibility of the host

Client education

➢ Teaching - an interactive process that promotes learning ▪ Most effective when it responds to the learner's needs ➢ Learning - the purposeful acquisition of new knowledge, attitudes, behaviors and skills ➢ Functional illiteracy - inability to read above 5th grade level ➢ Domains of learning ▪ Cognitive learning Includes all intellectual behaviors and requires thinking ▪ Affective learning Deals with expression of feelings and acceptance of attitudes , opinions, or values ▪ Psychomotor learning Involves acquiring skills that require the integration of mental and muscular activity, such as the ability to walk or to use an eating utensil ➢ Motivation ▪ Mild level of anxiety motivates learning ▪ Social motive - need for connection, social approval or self-esteem ▪ Task mastery motives - based on needs such as achievement and competence ▪ Physical motive - some pt. are motivated to return to a level of physical normalcy ➢ Self-efficacy - a concept included in social learning theory ▪ Refers to a person's perceived ability to successfully complete a task

Health and wellness

➢ The two overarching goals for Health People 2010 are ▪ To increase quality and years of health life ▪ To eliminate health disparities

Immobility problems (urinary system)

➢ Urinary stasis ➢ Decreased bladder emptying ➢ Urinary retention ➢ Urinary infection ➢ Potential for renal stones

3 stages of Inflammation

➢ Vascular and cellular response ▪ Redness, heat, pain, swelling ➢ Inflammatory exudates (drainage) ➢ Tissue repair

Oxygenation

➢ Ventilation - the process of moving gases into and out of the lungs ➢ Perfusion - relates to the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs ➢ Diffusion - is responsible for moving the respiratory gases from one area to another ➢ Work of breathing - the effort required to expand and contract the lungs ➢ Airway resistance - the pressure difference between the mouth and the alveoli in relation to the rate of flow of inspired gases ➢ Methods of oxygen delivery ▪ Nasal cannula ➢ 1-6 L/min ➢ 24% ▪ Simple face mask 5 L/min 40-60% ▪ Partial rebreather 6-11 L/min 60-75% ▪ Non-rebreather 90% ▪ Venturi mask 4 L/min 25% Care of pt. requiring oxygen therapy or tracheostomy ➢ Hypoxemia - low levels of oxygen in blood ➢ Hypoxia - decreased tissue oxygenation ➢ Oxygen content of the atmospheric air = approx. 21% ➢ When oxygen flow rate is higher than 4 L/min is needed, humidity is added to the delivery system

Nutrition

➢ Water ▪ Muscle contains water so leaner people have a higher concentration of water compared to obese people and infants have most % of water ➢ Metabolism ▪ Anabolism - building ▪ Catabolism - breakdown

Mr. Gaskins (Hint hint's)

➢ You do not need an order to do an otoscopic exam ➢ Conductive hearing loss resulting from any physical obstruction of sound wave transmission ➢ Sensorineural hearing loss resulting from a defect in the chochlea, the eighth creanial nerve, or the brain ➢ Mixed ➢ Tinnitus - both ears equally, if it's in one ear it is NOT tinnitus ➢ The eardrum does regenerate and heal