Patho and Interv FINAL EXAM

S (SBAR)

- Give your name and the unit you are on. I am calling about: (patient name and location) - The problem I am calling about is: (state what the problem is, when it happened, when it started, how severe it is) - The most recent vital signs are: (BP, pulse, respirations, temp and O2 sat). - I have just assessed the patient and I am concerned about

Outcomes of sensory perception

- Good - quality of life, senses intact - Poor - decreased QOL, sensory disruption (hearing, vision, smell, taste, touch), depression, anxiety, suicide, lack of self care, unsuccessful relationships, immunosuppression, cardio gastrointestinal disorders

Hypernatremia Nursing Management

- Gradual lowering of serum sodium level via infusion of hypotonic electrolyte solution - Diuretics - Assessment for abnormal loss of water and low water intake - Assess for over-the-counter sources of sodium - Monitor for CNS changes

hormonal hyperplasia

- Growth (in the # of cells) stimulated by hormonal mechanisms Example: (Pregnancy) - Estrogen stimulation -> mitotic division of glandular cells in the breast tissue

compensatory hyperplasia

- Growth (in the # of cells) stimulated by maladaptive compensatory mechanisms - Overcompensation; exceeds the cell mass necessary Example: (Keloid) - Accumulation of epithelial cells and connective tissue that occurs in wound healing -> an elevated, disfiguring scar

what do endocrine hormones do?

- Growth and development - Homeostasis (the internal balance of body systems) - Metabolism (body energy levels) - Reproduction - Response to stimuli (stress and/or injury)

documentation

- Handwritten or electronic - Common for all disciplines to record on one progress note; problem focused - Patients have access to their records - Nursing documentation based on nursing standards - Required nursing documentation -- Observations of subjective and objective physical, psychological, and social responses -- Interventions implemented and patient's response -- Observations of medications' therapeutic and side effects -- Evaluation of outcomes of interventions - Patient record: primary documentation of patient's problems; verifies behavior and describes care provided - Handwritten documentation always in pen; no erasures - Corrected entries initialed by person making correction - Entry written clearly and without jargon - Meaningful, accurate, objective descriptions; no general or stereotypic statements - Electronic records held to same standards as non-electronic records

Hypothyroidism

- Hashimoto's disease (most common cause •Affects women 5X more frequently than men •Early symptoms may be nonspecific •Assessment: (palpation (size, warm), tenderness) refer to Table 52-2 •Clinical manifestation: extreme fatigue, hair loss, brittle nails, dry skin, numbness and tingling of fingers, hyponatremic, low BP, decreases HR and respiratory rate (slower symptoms = hypo) •Complications: myxedema (coma), may progress to coma and death

CAGE questionnaire (drinking)

- Have you ever felt you should Cut down on your drinking? - Have people Annoyed you by criticizing your drinking? - Have you ever felt bad or Guilty about your drinking? - Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)? (having 1-2 positive answers to identify substance abuse disorders)

Energy therapies (Healing modalities)

- Healing touch - T'ai Chi - Qigong - Reiki - Magnet therapy

ethical issues

- Health care access: vulnerability, SDOH, health disparities - Enforced compliance - Confidentiality, privacy, and discrimination

Primary prevention (diabetes in children)

- Health protection: advocate for policies that limit access to surgery beverages and snacks at school, and programs that raise awareness and family involvement in better nutrition and promote physical activity for families Health promotions and education: - educate to promote good nutrition and a physically active lifestyle - provide classroom contact in the early primary grades to encourage children to make good food choices - limit passive activities and increase sports and physical activity - teach older children how to make better food choices at fast-food restaurants

Depression nursing interventions

- Health teaching about depression (patient and family) - Health teaching about warning signs of suicidal thoughts/behaviors - Sleep, Nutrition, Exercise, Self-care deficits - Behavioral Therapy - Goal Setting - Interprofessional collaboration - Cognitive Behavioral Therapy (CBT) Sleep, nutrition, self-care deficits, behavioral therapy, and interprofessional collaboration

Intake (gains)

- Healthy people gain fluids by drinking and eating - Daily I&O of water are equal - anything that is liquid at room temperature (Jell-o ice cream)

Impaired hearing (definition)

- Hearing deficits may result from injury or disease in structures of the ear, the nerves, or the brain (Box 30-3). Inability to hear decreases the ability to communicate and thus hampers social interaction. - It may interfere with a patient's ability to understand instructions from healthcare professionals and create a safety hazard due to inability to hear warnings.

complications of wound healing

- Hemorrhage (bleeding internal or external) - Infection (bacteria in wound) - Dehiscence (separation of layer(s) of skin from one another) - Evisceration (apply wet sterile dressing and call provider for surgery) - Fistula formation (passage from one cavity to another)

Common fractures

- Hip Fractures - Vertebral Compression Fractures - Femur Shaft Fracture - Clavicle Fracture - Distal Radius Fracture - Tibia-fibula Fractures - Foot Fracture

Primary phase (antibody mediated response)

- Host cell exposed to antigen - Lag time from recognition to creation of Igs to attack invader may be 5-7 days - Primary responder is IgM

Intensity of pain

- How bad does it hurt? - Numeric scale or standardized tool

Nursing assessment of pain (Family)

- How does the pain affect your family? - Validate the family's pain experience -- Have you noticed changes in your loved one? -- "It must be hard to watch your loved one suffer." -- "You're doing a great job caring for your loved one."

pH levels

- Hydrogen is a very strong acid and must be kept within a very precise range in the bloodstream: 7.35-7.45 -- Deviations outside this range can impact cellular function and be potentially life-threatening . - Hydrogen concentration is expressed in terms of pH -- pH is inversely related to the hydrogen ion concentration --- Low pH (acidic) = high concentration of hydrogen ions --- High pH (alkaline)= low concentration of hydrogen ions

potassium imbalances

- Hypokalemia and Hyperkalemia - This is the major cation of the ICF; only 2% of body potassium is found in the extracellular fluid. Potassium is a key electrolyte in cellular metabolism. According to the Dietary Guidelines for Americans, 2010, at least 4700 mg/day of potassium is recommended. However, most American women ages 31 to 50 years consume less than half of the recommended amount of potassium, and intake is only moderately higher for men.

aggregate (definitio)

- broader than population ●Mass or grouping of individuals considered as a whole ●Loosely associated with one another ●Communities and populations are both types of aggregates (ex. pregnant teens, gay men with HIV.SIDA, Elderly adults with diabetes. Term commonly used in epidemiology.)

anxiety disorders

- chronic and persistent - women experience them more often than men (common in adolescents) - associated with other mental or physical comorbidities (depression, heart disease, and respiratory disease) - prevalence decreases with age Types: - panic disorder - generalized anxiety disorder (GAD) - phobias

interrelated concepts of sensory perception

- cognition, nutrition, mobility, tissue integrity, intracranial regulation, perfusion, oxygenation, metabolism, immunity, infection, cognition, mood and affect, safety, functional ability, interpersonal relationships

restraint orders

- complete doctor/providers order is needed to initiate use of restrains (except under emergency situations) - in emergency situations the RN can initiate restraint use until doctors order is obtained - restraints without doctors order are considered false imprisonment

involuntary commitment

- court ordered; without the person's consent Three common elements: - Mentally disordered - Dangerous to self or others - Unable to provide for basic needs Right to receive treatment; possible right to refuse treatment(garvis order, and emergency cannot refuse) - Provisions for emergency short-term hospitalization of 48 to 92 hours

Spinothalamic tract (sensory perception)

- directs sensory neuronal impulses from the spinal cord up through the brainstem to the hypothalamus and upper regions of the brain cortex; The axons of the spinothalamic tract cross over to the other side of the spinal cord before their arrival in the brain.

Examination (Pain and sensory perception)

- done to check sensory, motor, and coordination abnormalities - gives clues to condition -- S/S - dependent on illness or injury - classified to underlying pathologic classification (nociceptive (normal pain process), neuropathic pain (abnormal pain process)

isotonic solution

- equal concentration as blood - Does not cause fluid shifts or alter cell size - Used as a bloodstream volume expander - Ex: 0.9% NaCl (normal saline)

Confidentiality

- ethical duty of nondisclosure (provider has information about patient and should not disclose it) - is especially important in the care of people with psychiatric disorders. Any breach of confidentiality of data about patients, their diagnoses, symptoms, behaviors, and the outcomes of treatment could possibly impact a patient's employment, personal relationships, and insurance benefits.

Epidemic (definition)

- event in which a disease is actively spreading - often used to describe problem that has growth out of control past events: - cholera - bubonic plague - smallpox - ebola

Epidemiology (sensory perception)

Pain - An unpleasant sensation that can range from mild, localized discomfort to agony -- leading cause for work absenteeism - Epidemiology - difficult to define - Populations at risk: -- Age - ↑ with age - Etiology - Acute: tissue injury -- Chronic: ongoing tissue injury (musculoskeletal, neuro, psychological, local or generalized)

grave's disease

Pathophysiology: - Autoantibodies Antithyroperoxidase and Antithyroglobulin bind to and activate thyrotropin receptors within the thyroid gland - This causes the gland to enlarge and secrete high levels of T3 and T4

providing preoperative care (hyperthyroidism)

•Informs the patient about the purpose of preoperative tests, •Explains what to expect with preoperative preparations --- This will help decrease anxiety •Education on how to support the neck with the hands after surgery to prevent stress on the incision,

safety in health care facilities

•Safe Communication -SBAR technique •Safety with medication administration -Prevent med errors with 3 checks of 6 rights -Check allergies •Safety related to oxygenation -Monitor O2 sats and client symptoms -No sparks from smoking or poor electrical equipment •Infection Precautions -Handwashing -Proper isolation precautions.

Hypertonic IV fluids

3% NaCl

What IV fluid would be administered slowly and monitor for fluid overload?

3% NaCl - (Listen to lungs frequently for fluid excess) - (tonicity or the concentration of solutes in solution)

Erik Erikson's stages of psychosocial development

(1) Trust vs. Mistrust; (2) Autonomy vs. Shame; (3) Initiative vs. Guilt; (4) Industry vs. Inferiority; (5) Identity vs. Confusion; (6) Intimacy vs. Isolation; (7) Generativity vs. Self-absorption; (8) Integrity vs. Despair.

components of a medication order

(1) client's full name (2) date & time order was written (3) name of medication (4) dosage size, frequency, and # of doses (5) route of administration (6) printed name and signature of the person writing the order

spinothalamic tract

- Contains sensory (pathway) fibers that transmit the sensations of pain, temperature, and crude or light touch.

Anoxic encephalopathy (intracranial regulation)

- Ischemic Penumbra -> Cerebral Edema = hypoperfusion -> damage to brain cells - decreased circulation = decreased O2 to brain tissue = anoxic encephalopathy = decreased LOC - Cerebral edema = pressure on brainstem = LOC and VS change (Cushing's triad)

Intra-articular fracture

- Extends into the joint surface of a bone

sensory perception and stress

- General principle of stress - "A general adaptive response in order to cope with the altered homeostasis"

History (Pain and sensory perception)

- Pain is subjective and can be objective

purpose of postop dressings

- Provide healing environment - Absorb drainage - Splint or immobilize - Protect - Promote homeostasis - Promote patient's physical and mental comfort

Quality of pain

- What does it feel like? - Sharp, stabbing, achy, dull, burning

Infectious disease diagnosis

❖Risk for infection transmission ❖Deficient knowledge ❖Risk for ineffective thermoregulation

Osmitrol (mannitol) (IICP)

is administered to decrease IICP, decrease cerebral edema. Mannitol increases the osmolarity of the blood so as to draw water from the edema into the blood.

hypotonic solution

- lower concentration than blood (Less solutes than blood) - More water than solutes -> causes a fluid shift from ECF to ICF - Used to treat dehydration (more fluid into cells) - ex. 0.45% NaCl (half normal saline)

Inhalation anesthesia

- route for administering general anesthesia by breathing it in

Hypermagnesemia nursing management

- IV calcium gluconate - Hemodialysis - Administration of loop diuretics, sodium chloride, and LR - Avoid medications containing magnesium - Patient teaching regarding magnesium-containing over-the-counter medications - Observe for DTRs and changes in LOC

Partial thickness wounds

wounds extend through the epidermis but not through the dermis.

Hypocalcemia nursing management

- IV of calcium gluconate for emergent situations - Seizure precautions - Oral calcium and vitamin D supplements - Exercises to decrease bone calcium loss - Patient teaching related to diet and medications

Does intracranial regulation involve the processes that affect equilibrium within the brain and therefore, neurological function? yes or no

yes

IV medications

- IV push (meds injected directly into systemic circulation- usually 1-10 mins) - IV piggyback (smaller bag connected to primary bags infusion line) - medicated drips

duration of pain

- Is the pain constant or does it come and go? - Intermittent, constant

Never events in surgery

- "time out" final verification of correct client, procedure, site •Surgery on wrong body part •Surgery on wrong person •Wrong surgery •DVT or PE after total knee or total hip replacement •Something left in the patient after surgery •Surgical site infections after certain surgeries

Host considerations

•Considerations include: •- Genetics •- Age •- Gender •- Immune status •- Lifestyle factors

Addiction (sensory perception)

- It is characterized by behavior that includes one or more of the following; Impaired control over drug use; Compulsive use of drug; Continued use despite harm from using the drug; Craving of the drug

Infiltration (IV lines)

- (vein broke and IV fluid went into the 3rd space)- (site swelling- remove needle and apply heat to help the body to absorb the fluid faster and get a new peripheral line)

thyroid

- A 2-inch butterfly-shaped gland located on the neck - The thyroid gland secretes T3 and T4 (Thyroxine) -- Thyroxine regulates body metabolism --- Metabolism influences almost every body system The thyroid gland uses iodine, found in many foods, and converts it into T4 and T3

diabetes

- A disorder of carbohydrate metabolism •- Characterized by high levels of blood glucose resulting from the body's inability to produce or utilize insulin. •Effects 9.4% of the population •Key related concepts: •Insulin resistance •Down-regulation •Autoimmunity

Location of pain

- Where do you hurt? - Right, left, bilateral, medial, lateral, anterior, posterior

health disparities

●Differences in access to quality health care and in health outcomes ●Usually characterized as avoidable and unfair ●Many disparities occur along income/class or racial/ethnic lines

Hyperkalemia Nursing Management

- ABCs: Monitor ECG, assess labs, monitor I&O, obtain apical pulse - Limitation of dietary potassium and dietary teaching - Administration of cation exchange resins (Kayexalate) - Emergent care: IV calcium gluconate, IV sodium bicarbonate, IV regular insulin and hypertonic dextrose IV, beta-2 agonists, dialysis - Administer IV slowly and with an infusion pump

surveillance

"an ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice"

Causes/manifestations hypocalcemia

- Causes: hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, medications - Manifestations: tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau sign, Chvostek sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety

necrosis

- Cells dies because of stressors or insults (die from prolonged stress) Example: Infarction, ischemic necrosis - Death of tissue due to prolonged ischemia or lack of oxygen - Heart attacks

B cells

- Don't mature until they encounter antigens - Then stimulated to further mature into plasma cells - Plasma cells produce specific proteins called Immunoglobulins (Igs), also known as antibodies, which attack the antigen - *This maturation process and antibody production makes up 'humoral immunity', which is slower than cell-mediated immunity but confers long-term immunity

transmission-based droplet precautions

- Droplet precautions Pathogen is spread via moist droplets droplets by coughing, sneezing, or touching contaminated objects. •Coughing, sneezing, touching contaminated objects •Precautions include -Same as those for contact -Addition of mask and eye protection within 3 ft of client - Used for organisms transmitted by close contact with respiratory or pharyngeal secretions: influenza, meningococcus - Wear a face mask but door may remain open; transmission is limited to close contact

ischemic stroke

- Etiology: cerebral arteriosclerosis causing cerebral insufficiency, carotid stenosis (carotid artery arteriosclerosis) and atrial fibrillation - is caused by a thrombus or embolus that lodges in a cerebral artery and blocks blood flow to the brain tissue. Ischemia of brain tissue leads to cerebral infarction, which is the death of brain cells. -•Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of brain tissue

Mr. Jones is a 72-year old man who had a left total knee arthroplasty 1 day ago. You are the nurse caring for him on the orthopedics unit in the hospital. - What nursing interventions will you utilize to optimize his pain management?

- Frequent pain assessment, reposition, apply ice to the surgical incision, scheduled acetaminophen (Tylenol), prescribed opioid (oxycodone) before physical therapy and as needed for increased pain, monitor for side effects of opioids, soothing environment, nursing presence to support patient and family

R (SBAR)

- If you have a specific request related to the problem state your request. (Read back all verbal and telephone orders. Request a read-back for all critical test results).

Hyperkalemia prevention

- K+ administration safety •- Do not give KCl IV unless there is urine output of at least 0.5 mL/kg of body weight per hour •- Maximum rate of KCl IV is 10 mEq/hr and MUST be on an IV pump. •- NEVER "push" with a syringe

T lymphocyte immunity

- One type of adaptive immunity - it is cell-mediated immunity Both types utilize the lymphocyte as the primary cell

stress (sensory function)

- Physical illness, pain, hospitalization, tests, and surgery are all stressors that can lead to sensory overload—more stimuli than the person can handle.

Mode of transmission

- The METHOD by which the AGENT leaves the RESERVOIR and enters the HOST - Transmission can be via : 1. vector, vehicle (food, water) 2. direct contact (blood and bodily fluid), 3. droplet and airborne (smaller particles such as TB, measles, chickenpox).

Hyponatremia nursing management

- Treat underlying condition - Sodium replacement - Water restriction - Medication - Assessment: I&O, daily weight, lab values, CNS changes - Encourage dietary sodium - Monitor fluid intake - Effects of medications (diuretics, lithium) - Learn about endocrine diseases that cause hyponatremia

Stress and treatment (sensory perception)

- Treatment - Lifestyle changes: reduce caffeine intake, engage in yoga, increase exercise, ensure sufficient sleep, achieve proper nutrition - Stress management programs - Psychotherapy - Alternative medicine - Pharmacology

cerebrovascular circulation (intracranial regulation)

- Two major routes of cerebrovascular circulation: - Internal carotid-middle cerebral artery circulation (most important) - Vertebral-basilar arterial circulation

Brainstem reflexes (IICP)

- Vital centers of the brainstem control heart rate, respiratory rate, blood pressure, and level of consciousness (LOC)

Fractures

- any disruption, complete or incomplete, in the continuity of a bone causes: - Bones are subjected to a variety of loading forces: tension, compression, bending, torsion, and shear. - When forces exceed physiologic parameters or when a bone abnormality exists, it leads to a fracture. - Helpful to know mechanism of injury: - Often helps identify the type of fracture sustained - Guides initial treatment

Efferent neurons (sensory perception)

- are motor nerves; these neurons exit the spinal cord through the ventral horn and travel to the muscles of the body.

craniectomy vs craniotomy

- crainiectomy: a piece of skull is removed to relieve pressure in brain and is returned back on later. - crainiotomy: is a procedure in which a surgeon removes a section of the skull and replaces the piece of bone, or bone flap, immediately afterward

decussation (Intracranial regulation)

- crossing over at the medulla (lesions on one side of the brain can effect the opposite side of the body) - 80% cross over and 20% on same side so can have crossover and same-side effects

Assessment (restraints)

- determine need for restraints or seclusion - type of restraint/safety device for behaviors and condition of patient (least restrictive alternative for shortest amount of time) - assess and frequently reassess patient is safe and their needs have been met when the use of restraints of seclusion cannot be avoided

biology interventions (Healing modalities)

- dietary therapies - herbs - nonherbal dietary supplements - aromatherapy

sodium imbalances

- hyponatremia, hypernatremia This is a major cation in the ECF. Its primary function is to regulate fluid volume. When sodium is reabsorbed in the kidney, water and potassium are also reabsorbed, thereby maintaining ECF volume. According to the Dietary Guidelines for Americans 2010, adult should limit intake of salt to 2300 mg/day. For older adults, African-Americans, and persons with chronic diseases (e.g., hypertension, kidney disease), the amount should be limited to 1,500 mg/day.

Hashimoto's disease

- hypothyroidism - autoimmune disease in which the body's own antibodies attack and destroy the cells of the thyroid gland

Medications (infection risk)

- medication can inhibit/decrease immune response ▪Even common medications, such as nonsteroidal anti-inflammatory agents (NSAIDs) (e.g., ibuprofen), decrease the immune response. As a side effect, some medications, such as chemotherapeutic agents, decrease the production of white blood cells or cause the cells produced to be abnormal. Even antibiotics can increase the risk for infection.

alternative therapies

- method of treatment used in place of biomedical therapies (Instead of...)

corticospinal tract

- motor pathway - connections between brain and spine

hemiparesis

- slight paralysis or weakness affecting one side of the body Manifestations: - weakness of the face, arm, and leg on the same side (due to lesion in the opposite hemisphere) Nursing Inter: - place objects within pts reach on non-affected side - encourage pt to exercise and increase strength on unaffected side and use this side to exercise affected side.

Contusion

- soft tissue injury produced by blunt force - Pain, swelling, and discoloration: ecchymosis

why is atrial fibrillation a risk factor for strokes?

- someone who have a. fib is at increased risk for strokes because when the heart beats fast (as it does in A. fib) it can cause clots to form - more than 5X more likely to get a stroke

Centrally generated (origin of pain)

- spinal cord injury, amputation EX: phantom pain

nursing management (during hospitalization)

- stress of illness and surgery will increase blood glucose level - continuous regular meal plan - increase intake of noncaloric fluids - continuous taking oral agents and insulin - frequent monitoring of BG levels - pts requiring IV contrast medium should hold their metformin 1-2 days before and 48 hours after contrast

Epidemiology

- the study of disease distributions in human populations

Evisceration (wound complication)

- total separation of the layers of a wound in which internal viscera protrude through the incision - a rare complication and is a surgical emergency - Immediately cover the wound with sterile towels or dressings soaked in sterile saline solution to prevent the organs from drying out and becoming contaminated with environmental bacteria. Have the patient stay in bed with knees bent to minimize strain on the incision. Notify the surgeon Treatment/interventions: - Obesity (lifestyle changes) Surgery (limit activity (lifting) and strain on suture, stool softeners)

Panic anxiety

- visual field narrowed to one detail - scattering brain with lots of thought and they usually increase - feel an enormous threat to survival (fear) - massive dissociation - learning is impossible - repeating details - panic can turn into rage and violence to themselves or others - may pace, run or fight Nursing Interventions: - STAY WITH PT - allow pacing and walk with them -no content inputs to pts thinking by nurse - be direct with fewest words "drink this" "sit down" (try and get them talking "say what you notice/feel/think") - no teaching they wont be able to use it accurately

moderate anxiety

- visual field narrows; selective attention (doesn't notice whats happening in peripheries) - sees, hears, grasps a narrow amount - can talk and communicate if focus is drawn to it - usually can state "I am anxious now" Nursing Interventions: - encourage pt to talk and focus on experience and describe it fully -"tell me what is bothering you, talk to me, what caused you to feel this way?" - no teaching they wont be able to use it accurately

Pharmacokinetics

- what the body does to the drug - Pharmacokinetics refers to the absorption, distribution, metabolism, and excretion of a drug. These four processes determine the intensity and duration of a drug's actions. Each drug has unique pharmacokinetic characteristics.

Planning and Implementation

- working phase - Put the plan of nursing care into action. - Coordinate the activities of the patient, family or significant others, nursing team members, and other health care team members. - Record the patient's responses to the nursing actions.

Gluconeogenesis

- •Breakdown of amino acids and fats to convert into glucose •- Fats are converted into fatty acids and glycerol •Glycerol is used for energy •Fatty acids are a by-product and accumulate in the blood stream •Formation of ketones

Exogenous Healthcare-Related Infection

- ▪Healthcare providers need to determine the source of pathogens in a patient infected while he or she is in the facility. In exogenous healthcare-related infections, the pathogen is acquired from the healthcare environment.

Hypotonic IV fluids

-1/2 NS (0.45% NaCl) -1/3 NS (0.33% NaCl) -1/4 NS (0.225% NaCl) -Free Water

Older adult depression symptoms

-Frequently misinterpreted as a normal part of aging, especially when symptoms overlap with dementia or other physical illnesses -Forgetfulness -Agitation and combativeness -Constant complaining -Irritability -Chronic aches and pains (non-responsive to treatment) (depression is a very high risk for people with chronic illnesses) -Fatigue -Rumination -Paranoia and suspiciousness -Apprehension and anxiety without any cause - common in men 75 years and older

Pt with grave's disease - will T3 and T4 be low or high?

-High - too much being made

Pt with Hashimoto's hypothyroidism - will TSH be low or high

-High - wants the thyroid to make more hormones but unable to bind

Wound Assessment

-Location -Size -Appearance -Drainage -Redness -Swelling Documenting: •Left and Right (refers to the PATIENT's sides) •Distal or Proximal (not top & bottom, not up/down) •Lateral or Medial •Use cm

Pt with grave's disease - will TSH be low or high?

-Low - bc we have so much of T3 and T4 the pituitary gland will not secrete this

Pt with Hashimoto's hypothyroidism - will T3 and T4 be low of high?

-Low - unable to synthesize bc TSH is unable to bind properly

neuromatrix theory

-Matrix of neurons in the brain is capable of generating pain (& other sensations) in the absence of signals from sensory nerves -Accounts for phantom pain

types of Surgical drains

-drain sponge, JP, wound vac (Penrose Jackson-Pratt Hemovac)

intravenous anesthesia

-injected through IV line into the blood -promote rapid induction of anesthesia -used in short surgical procedures -supplement inhalation anesthetics -provide hypnosis, sedation, amnesia, and/or analgesia

What IV fluid is used for hypertonic dehydration?

0.45% NaCl (half NS)

What IV fluid is used for blood transfusion?

0.9% NaCl (Normal saline or NS)

Postop collaborative problems

1) Pulmonary infection/hypoxia (Incentive Spirometer (inhale and monitors lung capacity) main preventions of pneumonia) 2) Deep vein thrombosis/PE (Compression stockings (TEDs, SCD), walking and activity, blood thinners) 3) Hematoma/hemorrhage (Use surveillance technique (BP dropping and HR increasing) (hematoma= see blood pooling, swelling, discolored, bruising/bulge)) 4) Infection (antibiotics, fever, check WBC count (high if infection) 5) Wound dehiscence or evisceration (splinting and limited lifting limit)

pitting edema

Condition in which interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation - Visible indentations when pressure is applied and fluid is displaced - Severity: +1, +2, +3

Outpatient surgery (direct discharge)

1) - Discharge planning, discharge assessment - Provide written, verbal instructions regarding follow-up care, complications, wound care, activity, medications, diet - Give prescriptions, phone numbers o- Discuss actions to take if complications occur 2) - Give instructions to patient, responsible adult who will accompany patient - Patients are not to drive home or be discharged to home alone o- Sedation, anesthesia may cloud memory, judgment, affect ability

Acute phase goals (schizophrenia)

1. Safety - harm to self or others 2. Medication stabilization - if needed (Not eating or drinking r/t to delusions, hallucinations) 3. Medication adherence (Long-term issues are managed and not cured.)

symptoms of anaphylaxis

1) itching, urticaria, erythema 2) bronchoconstriction 3) laryngeal edema, tongue swelling and angioedema 4) widespread vasodilation, BP drops, inducing vascular shock 5) anaphylactic shock MEDICAL EMERGENCY

Doffing PPE

1). Gloves 2). Gown 3). Goggles 4). Mask or face shield 5). Hair cover 6). Shoe cover 7). Wash hands

Donning PPE

1). Gown 2). Mask 3). Face shield or goggles 4). Hair cover 5). Shoe cover 6). Gloves (over gown)

Phillip starts Olanzepine (Zyprexa). What potential side effects and target effects will the nurse monitor for? Select all that apply: 1.Increased hunger and rapid weight gain 2.Tardive dyskinesia 3.Acute dystonia 4.Sedation 5.A decrease in hallucinations 6.Constipation

1,3,4,5,6

Agent

1. Biological: bacteria, virus, fungi, insects 2. Chemical: liquids, solids, gases, dust or fumes 3. Nutrient: dietary components that produce illness if taken in access or if they are deficient. (niacin, vit A, vit D) 4. Physical: mechanical, material, atmospheric, geological, or genetically transmitted. 5. Psychosocial: events that produce stress leading to health problems (war, trauma) (thing that causes the issue or disease)

Six Rights of Medication Administration

1. Right medication 2. Right dose 3. Right patient 4. Right route 5. Right time 6. Right documentation Others: - right reason - right to know - right to refuse

Hypersensitivity types

1. Type I immediate hypersensitivity 2. Type II cytotoxic hypersensitivity 3. Type III immune complex disorders 4. Type IV delayed hypersensitivity

Chlamydia screening

1. Yearly screening of all women who are sexually active and 24 years old or younger. 2. Women older than 24 years old who have a new sexual partner or multiple partners or whose partner has been diagnosed with an STD. 3. Screen all pregnant women at their first obstetrical visit. 4. Routine screening of men is not generally recommended; however, screening should be considered among men who have sex with men in settings with high rates of CT infection

Outcomes of acute inflammation

1. complete resolution - Short-lived reaction that eliminates the injurious agent - Elimination of cellular debris and edema - Ends with the regeneration of normal tissue 2. healing by connective tissue: - Severe tissue injury and larger inflammatory reaction prevent regeneration of normal cells - Inflammatory exudates and cellular debris cannot be cleared - Fibrous scar tissue replaces damaged cells 3. chronic, persistent inflammation that does not recede: - Persistence of the injurious agent or other interference with healing - Inflammation becomes chronic - Extensive tissue damage

TB skin test reaction

2-8 weeks after infection •Reading 48-72 hours after •Induration is raised, hard area , NOT REDNESS. •Diagnosis confirmed with sputum collection and test for acid-fast bacilli and chest x-ray

Hyponatremia

= Serum sodium less than 135 mEq/L - Acute o-- Result of fluid overload of a surgical patient - Chronic o-- Seen outside of hospital setting, longer duration, less serious neurologic sequelae - Exercise associated o-- More common in women of small stature, extreme temperatures, excessive fluid intake, prolonged exercise

Aging and perception of pain

Aging and Perception of Pain: - Pain threshold increases and Pain tolerance decreases - Alteration in the metabolism of drugs and metabolites occurs Pediatrics and Perception of Pain: - Nociceptor system is functional by 20 to 24 weeks' gestation - Children, ages 5 to 18, have a lower pain threshold than adults.

Barin death

Cardinal Findings of Brain Death Are: (1) Coma (2) Absence of brainstem reflexes (3) Apnea

If the patient was alkalotic how would the lungs respond?

Decrease respirations to retain more CO2

If the patient was acidic how would the kidneys respond?

Increase reabsorption of HCO3 in the bloodstream

Referred (source of pain)

Pain in an area is removed or distant from its point of origin; Can be acute or chronic.

Perception of pain

Pain or fear of pain - Serves as a common link among people who require health care. - No equipment can accurately measure pain STRESSORS: - PHYSIOLOGICAL: cell damage - PSYCHOLOGICAL: anxiety, depression, past pain experience, environmental condition, hospitalization - DEVELOPMENTAL: age, coping mechanism - SPIRITUAL: degree of faith

transmission-based airborne precautions

Pathogen is spread via air currents such as via ventilation systems, shaking sheets, sweeping. •Transmission via ventilation systems, shaking sheets, sweeping •Precautions include -Same as those for contact, with addition of special room, special mask, and mask for patient when transported - TB, varicella, other airborne pathogens - Hospitalized patient should be in a negative pressure room with the door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room

Severe anxiety

Perception field greatly reduce, focuses on one detail or many scattered details, has difficulty noticing environmental details - learning & problem solving is hard at this level - try small sentences or 'commands' to get them talking (sit down, tell em how you feel) - usually unable to state/name anxiety - sense of impending doom or dead. Nursing interventions: - allow relief behaviors to be used - encourage pt to talk (venting even if random ideas helps reduce anxiety) - no teaching they wont be able to use it accurately

policy development and enforcement (definition)

Policy development places health issues on decision-makers' agendas, establishes a plan of resolution, determines needed resources, and results in laws, rules and regulations, ordinances, and policies. Policy enforcement compels others to comply with the laws, rules, regulations, ordinances, and policies created in conjunction with policy development. Social Policy = Health Policy! Decisions that governments and corporations make everyday benefit some and burden others.

overal reaction to stress

Psychological: Defense mechanisms and coping strategies Spirit: when overwhelmed by the stress one can feel hopelessness, loss of meaning or purpose, and moral distress

Tertiary prevention

Reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function (ex. management and treatment; rehab for stroke)

Public health nurse role advocate

Role: Pleading a cause or acting on behalf of the client. Goals: 1.Help client obtain great indepence or self-determination (empowerment) 2.To make the System more responsive and relevant to the needs of the client. Actions: 1.Being assertive 2.Take risks 3.Communicate and negotiate 4.Identify and obtain resources Access to Care: Improved health outcomes ●Home visits ●School Nursing and School based clinics ●Hospice ●Places of worship ●Prisons ●Shelters ●Emergency response Health Policy Development and Enforcement ●Healthy foods at school ●Mandatory activity time at school ●Safe green spaces ●Housing ●Water quality

SDOH (examples)

Social factors that affect families and communities such as: ●education ●housing conditions ●options for safe and active transportation ●access to health care services ●access to healthy food ●employment and income ●neighborhood environment and safety ●quality of the built environment such as parks, buildings, and green spaces

systemic anaphylaxis

Still a type I immediate hypersensitivity reaction, but SEVERE and LIFE-THREATENING Small does of an allergen can trigger this response within minutes of exposure Can occur without previous known allergen, at any stage of life Treat with epinephrine, antihistamines and glucocorticoids

Adverse Childhood Experiences (ACEs)

Stressful or traumatic experiences, including abuse, neglect, and a range of household dysfunction, such as witnessing domestic violence or growing up with substance abuse, mental disorders, parental discord, or crime in the home.

protective isolation (definition)

This is used for clients with low WBC counts, clients undergoing chemotherapy, or clients with large open wounds or weak immune systems. Protective isolation usually includes following standard precautions, placing the patient in a private room; restricting visitors; wearing a mask, gown, and gloves for patient care; and special cleaning or disposal of the patient's equipment and supplies. Some units, such as neonatal intensive care units, burn units, and labor and delivery suites, may follow some aspects of protective isolation all the time.

thrombus vs embolus

Thrombus = clot in arteries embolus = dislodged traveling clot in arteries

T or F 1.Informed consent is mandated by state law.

True

true or false? The most important nursing intervention when vomiting occurs postoperatively is to turn the patient's head to prevent aspiration of vomitus into the lungs

True Rationale: The most important nursing intervention when vomiting occurs postoperatively is to turn the patient's head to prevent aspiration of vomitus into the lungs

true or false? The primary goal in withholding food before surgery is to prevent aspiration.

True Rationale: The primary goal in withholding food before surgery is to prevent aspiration.

Is the following statement true or false? - Involuntary commitment requires a court order.

True. - Involuntary commitment is the confined hospitalization of a person without the person's consent but with a court order.

Types of central lines

Tunneled, non-tunneled, implanted port, peripherally inserted central catheters *(PICC)*

True or False: Hyperglycemia, hypertension, and increased cortisol secretion are considered harmful effects of unrelieved pain.

Ture

treatment (Pain and sensory perception)

WHO Step analgesic ladder: - Nonopioid - NSAIDS, acetaminophen (Tylenol) - Opioid (e.g. morphine) - MOA - act on receptors on neuronal cell membranes - inhibit neurotransmitter release

Edema prevention

Walking/ambulating TED socks Diuretics Restrict fluid Elevate legs

A (SBAR)

What is your assessment of the situation? (State what you think the problem is. State if the patient is unstable or appears to be getting worse).

Injurious immunological reactions

When the immune system overreacts and attacks the body's own cells, causing cell injury and creating disease. Allergies are adverse immune reactions in response to contact with an environmental substance. In allergy, the immune system is triggered to synthesize antibodies that cause inflammatory changes in the body.

Macrophages (innate immune response)

arise from WBC monocytes, leave peripheral circulation and migrate to tissues such as lymph nodes, lungs, spleen and CNS. They ingest bacteria or viruses, then go through apoptosis

Chronic wounds

Wounds that exceed the expected length of recovery

Mania

a mood disorder marked by a hyperactive, wildly optimistic state - hypomania (Mild impairment) - mania (severe impairment)

Chronic stress

a physiologic reaction to events resulting in "wear and tear" on the body and negatively impacts health and wellbeing Ex. PSTD

What is important for the ER nurse to assess with an substance use/abuse pt?

a. Drug name/last use b. Pattern of Use: Amount, route, first use, frequency, length of use c. Tolerance (increasing use of drug or alcohol with the same level of intoxication) d. Withdrawal symptoms: a. Shakes? _______b. Tremors? _______c. Cramps, diarrhea, or rapid pulse? _______d. Feeling paranoid, fearful? _______e. Difficulty sleeping? _______ e. Consequences of use (e.g., presenting problems, persistent or recurrent emotional, social, legal, or other problems): _______ f. Loss of control of amount, frequency, or duration of use: _______ g. Desire or efforts to decrease use or control use: _______ h. Preoccupation (increasing focus or time spent on use and obtaining substances): _______ i. Social, vocational, recreational activities affected by use: _______ j. Previous alcohol or drug abuse treatment: _______

Acute wounds

are expected to be of short duration. (heal spontaneously without complications through the three phases of wound healing (inflammation, proliferation, and maturation)).

Clean wounds

are uninfected wounds with minimal inflammation.

incisional pain following an appendectomy is what type of pain?

acute

inflammatory reaction (innate immune response)

begins seconds after innate defense compromised

immunoglobulins

bind with specific antigens in the antigen-antibody response

closed (simple) fracture

bone is broken but no external wound exists (no break in the skin) Management: - Uses manipulation and manual traction - Traction may be used (skin or skeletal)

Fill in the blank: 1.Discussing a patient's problems with one of his or her relatives without the patient's consent is a breach of ________________.

confidentiality

codependence (substance abuse/use)

codependent behaviors focus on others at expense of their own keep addiction secret suffer abuse from addict not allow addict to suffer consequences of actions makes excuse for addict habit this behavior is counterproductive to both

T or F 1.The federal law requiring hospitals to inform patients about their right to be a central part of any health care decision made about them is called the Americans with Disabilities Act.

false

moderate anaphylaxis

flushing, warmth, anxiety, and itching in addition to any of the milder symptoms. more serious reactions include bronchospasm and edema of the airways or larynx with dyspnea, a cough and wheezing. onset same

coping

is deliberate, planned, and psychological effort to manage stressful demands Two types: - problem-focused: the person attacks the source of the stress and solves the problem (eliminating or changing it) - emotion-focused: the person reduces the stress by reinterpreting the situation to change its meaning

Fill in the blank: 1.Being empowered or having the free will to make moral judgments is self-________________.

determinism

full thickness wounds

extend into the subcutaneous tissue and beyond

T or F 1.Involuntary commitment is rarely used to force someone into the hospital for treatment.

false

Skin assessment

focused assessment: - assess wound healing ability - risk for skin breakdown, you will need to gather data on factors that affect skin integrity - The psychosocial issues related to coping with chronic wounds also need to be considered. - braden scale used (sensory perception, moisture, activity, mobility, nutrition, and friction or shear) -Numeric value for six risk factors related to impaired skin integrity -Total score <18 = risk -Required to chart daily if score >18 and twice a day if < 18

Negligence

generally consists of five elements, including the following: (1) DUTY: a duty of care owed by the defendant to the plaintiff (2) BREACH OF DUTY: a breach of that duty (failing to provide reasonable care) (3) CAUSATION: an actual causal connection between the defendant's conduct and the resulting harm (4) PROXIMATE CAUSE:, which relates to whether the harm was foreseeable (5) DAMAGES- laws require a legal harm to be proven (claim must show a harm was suffered in the form of personal injury or property damage)

If you destroy or remove the thyroid what could be the problem?

give them meds to make thyroid hormones, Synthroid medication bc it cant make T3 and T4

Wellness (definition)

health plus the capacity to develop a person's potential leading to a fulfilling and productive life

Health (definition)

holistic state of well-being including soundness of mind, body, and spirit

Inflammation (definition)

is the body's protective response to injury, allergens, or infection. - With infection, this response eliminates pathogens, and with injury, allows for tissue repair - Nurses must identify clients at risk for inflammation, as well as provide treatment for clients experiencing inflammatory responses to infection or injury

Cognition (definition)

is the brain's ability to process, retain, and use information. Cognitive abilities include reasoning, judgment and insight, perception, attention, comprehension, and memory. These cognitive abilities are essential for many important tasks, including making decisions, solving problems, interpreting the environment, and learning new information.

medicare

is the federal health insurance program for: ●People who are 65 or older ●Certain younger people with disabilities ●****People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Battery

is the intentional act of causing physical harm to someone - Most states allow a patient to bring a claim for battery (unconsented to touching) when their consent is not obtained prior to medical treatment being given. Consent is an absolute defense against battery, which is one of the reasons why informed consent is so important in healthcare situations

patient zero

is very common and it is associated with every epidemic we face. We wonder where this new, harmful disease came from and who was the person spreading it to everyone else. It is often very hard to find the origin of diseases. A typical case most have heard about is Mary Mallon. She was cooking for families and was the first to be infected with Typhoid. Now a common epidemic is Ebola or Swin Flu. We look for these causing agents so we can try to pinpoint where the disease, virus, bacteria came from and try to stop it from spreading. By finding where it comes from we then can see what might be able to fight against it and make antibiotics.

Lucunar infarct

ischemia from tiny blood vessel occlusion

Fill in the blank: 1.omitted or refused in the event that a person is unable to make those decisions.

living will

Level of Consciousness (LOC) (intracranial regulation)

measure of arousability and reaction to environment - Alertness: highest level of consciousness, awake and fully interactive with environment - Lethargy: state of sleepy but aroused easily - Obtunded or stuporous: difficult-to-arouse, little or no interaction with environment - Coma: lowest level of consciousness, sleeplike state, no interaction with environment

Ankle sprain is what type of pain?

nociceptor

types of restraints

physical, chemical, seclusion

Monitor patient in restraints

observe and monitor: - patients physical condition: -- vital signs, any injuries, nutrition, hydration, circulation, range of motion, hygiene, elimination and physical comfort - mental state - Psychological and emotional status: -- including psychological comfort and the maintaining of dignity, safety and patient rights - responses to the restraint/seclusion •restraint need, discontinuation readiness and how the patient or resident acts and reacts when the restraint is temporarily removed for ongoing care. •The correct and safe application, removal and reapplication of the restraint

Direct transmission

occurs by immediate transfer of infectious agents from a reservoir to a new host (person to person) - Close proximity of <1 m (3 feet) is required, like sharing the space in a car or small room, to transmit an organism from one person to another

airborne transmission

occurs through droplet nuclei—the small residues that result from evaporation of fluid from droplets emitted by an infected host - Sneezing and coughing are common examples of airborne transmission. Because of the small size and weight of droplet nuclei, they can remain suspended in the air for long periods before they are inhaled into the respiratory system of a host. ❖ pathogen is spread via air currents such as via ventilation systems, shaking sheets, sweeping oTB, varicella(chickenpox), other airborne pathogens oHospitalized patient should be in a negative pressure room with the door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room oIn the community: Masks, hand washing, 6feet part, avoiding crowded spaces

substance use disorder

occurs when an individual continues using substances despite cognitive, behavioral, and physiologic symptoms. - - continued substance craving and use despite significant life disruption and/or physical risk

Receptive aphasia (Wernicke's)

organic loss of the individual's ability to comprehend what has been said to him/her

tertiary prevention (diabetes in children)

primary prevention: - health promotion and education: continue to promote a healthy lifestyle that includes appropriate food choices and daily physical activity within the limitations of T2DM -health protection: educate the teachers on safety precautions for children in their classroom diagnosed with T2DM Rehabilitation: - monitor the child's health - work closely with the child, family, physician, and teacher to ensure proper follow-up

thyroid gland

produces hormones that regulate metabolism, body heat, and bone growth - endocrine gland that surrounds the trachea in the neck - Largest endocrine gland, butterfly shaped organ, located in the lower neck, anterior to the trachea.

Stigma

refers to negative, unfavorable attitudes and behavior they produce. A form of prejudice that spreads fear and misinformation, labels individuals and perpetuates stereotypes. - negative images in media Creates: - self-stigma - avoidance for needed mental health

breach of confidentiality

release of patient information without the patient's consent in the absence of legal compulsion or authorization - outcomes of treatment could possibly impact a patient's employment, personal relationships, and insurance benefits.

Chain of Causation

reservoir -> portal of exit -> mode of transmission -> agent -> portal of entry -> Host The box surrounding the chain of causation in represents the environment, which can have a profound influence at almost any point along the chain. Consider the impact of environmental factors

Analgesic agents (pain management) adverse effects

respiratory depression: - opioids Sedation: - opioids - anticonvulsants Nausea and vomiting: - opioids constipation: - opioids - nonopioids

Illness (definition)

state of being relatively unhealthy

Pharmacodynamics

what the drug does to the body

Countertransference (substance abuse/use)

·in relation to assessment: patient behaviors:

Concept of Causality

•A stimulus or action results in an effect or outcome •Determines if a relationship exists between the risk factor and health effect •Determines if there is a statistical relationship between risk and health issue - Refers to the relationship between a cause and its effect. A purpose of epidemiologic study has been to discover causal relationships, in order to understand why conditions develop, and to offer effective prevention and protection

Diabeteic Ketoacidosis (DKA)

•Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat •Clinical features •Hyperglycemia •Dehydration •Acidosis •Refer to Figure 51-7 "Sick day rules":

fall prevention

•Accurate client assessment for the risk of falls •The immediate initiation of special falls risk interventions when a client is assessed as "at risk" for falls •More frequent monitoring •Providing frequent reminders to the client to call for help before arising from the bed or chair •Using bed and chair alarms •Using a companion, sitter, etc. •Reorienting the person •Placing the client near an activity hub such as the nursing station so that the falls risk client gets more monitoring and observation timed up and go test (TUG)

Unconscious patient (nursing interventions)

•Assessment with Glasgow Coma Scale •Continue orientation to reality. •Safety measures -Bed in low position -Side rails up •Attend to body systems. -Eye care -Range of motion -Skin care/mouth care -Urinary drainage -Bowel management -Nutrition

Impaired vision (nursing considerations)

•Attend to glasses. •Provide sufficient light. •Protect eyes in sunlight. •Provide magnifying lens/large-print books. •Verbalize descriptions others might look at. •Evaluate -Ability to perform ADLs -Ability to remain safe in the environment -Need for assistance à seeing eye dog -Notes about leading a person who has impaired vision

Safety hazards for healthcare workers

•Back injury •Needlestick injury •Radiation injury •Workplace violence •Prevention -Body mechanics -Sharps awareness, proper disposal -Radiation precautions -Environmental awareness of personal safety

Seizures precautions (nursing interventions)

•Bed with padded full-length side rails. •Oral suctioning equipment available. •Room near nurses •Educate client and support people.

Maintaining a Clean Environment

•Clean spills and dirty surfaces promptly. •Remove pathogens through chemical means (disinfect). •Remove clutter. •Consider supplies brought to the client room as contaminated. •Consider items from the client's home as contaminated.

Excessive adrenocortical activity (cushings syndrome)

•Cushing Syndrome •Excessive adrenocortical activity or corticosteroid medications •Clinical manifestations: Hyperglycemia; central-type obesity with "buffalo hump;" heavy trunk and thin extremities; fragile, thin skin; ecchymosis; striae; weakness; lassitude; sleep disturbances; osteoporosis; muscle wasting; hypertension; "moon-face"; acne; infection; slow healing; virilization in women; loss of libido; mood changes; increased serum sodium; decreased serum potassium •Dexamethasone suppression test 3 diagnostic tests and if they have 2/3 they are diagnosed with Cushing's syndrome

Cushings syndrome (carification)

•Cushing Syndrome may be caused by giving corticosteroid medications (side effects discussed later in this lesson) OR by too much adrenocortical hormone release in the body (perhaps by a tumor) •Similar signs & symptoms, similar interventions to address symptoms, different cause & different cure. •Could be from corticosteroid meds or from excess adrenocortical hormone (usually from a tumor)

stroke complications

•Decreased cerebral blood flow •Inadequate oxygen delivery to brain •Pneumonia (immobility, bedrest, dyspnea, unable to get full deep breath) •Vasospasm •Seizures •Hydrocephalus •Rebleeding •Hyponatremia

Patient education

•Deep breathing, coughing, incentive spirometry •Mobility, active body movement •Pain management •Cognitive coping strategies •Instruction for patients undergoing ambulatory surgery

Cognitive Defects (Schizophrenia)

•Deficits in speed of processing complex information •Deficits in maintaining a steady focus of attention over time •Inability to distinguish between relevant and irrelevant stimuli •Difficulty forming consistent abstractions •Impaired working memory •Impairments in ability to learn through verbal instruction

Fluid and electrolyte imbalances (alcoholism)

•Hypomagnesaemia is the most common electrolyte abnormality observed. •Hypocalcaemia is also a frequent electrolyte disturbance and is commonly associated with hypomagnesaemia. •Hypokalemia is occasionally encountered, while multifactorial origin hypophosphatemia is the second common electrolyte abnormality found. •Hyponatremia is also a common electrolyte imbalance.

emergency measures (diabetes)

•If the patient cannot swallow or is unconscious: •Subcutaneous or intramuscular glucagon (1 mg) •25 to 50 mL of 50% dextrose solution IV •Buccal glucose tablets

Mania maintenance phase interventions

•Medication adherence •Psychotherapy -Medication adherence -Psychotherapy (people in psychotherapy are more likely to stay on medication than those not in therapy) -Stress and life style management (via CBT) -Support groups -Acceptance of illness (CBT) -Family-focused therapy

Nursing interventions (alcohol intoxication)

•Monitor VS •Allow client to sleep it off •Protect airway from aspiration •Assess need for IV glucose •Assess for injuries •Assess for signs of withdrawal and chronic alcohol dependence •Counsel about alcohol use •Potential problems of alcohol poisoning and CNS depression

safety hazards in the community

•Motor-vehicle accidents •Community-acquired pathogens •Pollution •Electrical storms

Tx of HHS

•Rehydration •Insulin administration •Monitor fluid volume and electrolyte status •Prevention •BGSM •Diagnosis and management of diabetes •Assess and promote self-care management skills

milieu therapy

•Structure and clear expectations •Promotes safety •Consistent staff person •Gradual involvement in activities •Provides opportunities for learning new skills Unit activities/groups Role modeling behavior by nurses, staff, and providers Conflict resolution, social skills, education

role of nurse (exercise)

- Educate about the relationship between exercise, insulin and blood glucose - Potential post-exercise hypoglycemia - Need to monitor blood glucose levels - avoid trauma to lower extremities if numb (inspect feet daily after exercise) - avoid exercising in extreme hot and cold and during times if poor metabolic control -exercise same time every day

Nursing management diabetes (collaborative care)

- Alcohol (can decrease bodies reaction to glucose if drinking before eating and long-term can increase their BG levels after hours of drinking or sugary/juice/beer mixed drinks) - Nutritive (has calories) and nonnutritive sweeteners (do not have calories) - Misleading food labels ("sugar free" but actually has a sugar-like artificial substance that acts like sugar in the body still) - Follow-up education (reading labels, eating out, buying foods, understanding nutrition values)

goiter

- An abnormally large thyroid gland Can be caused by: - Iodine deficiency- A goiter may be caused by not getting enough iodine through the foods you eat. However, it is rare in the United States, because table salt is supplemented with iodine. - Graves' disease - Hashimoto's disease - Thyroid nodules — Nodules are overgrowths of tissue that may overproduce thyroid hormone or many not cause any symptoms. Rarely, nodules may contain cancer cells. - Thyroiditis — This condition is an inflammation of the cells in the thyroid that may cause the thyroid to produce too much or too little thyroid hormone. - Thyroid cancer — Cancerous cells may grow in nodules on the thyroid.

Grave's disease (diagnosis)

- Blood tests - TSH, T3, T4 - Antibody tests- ELISA test and TSI levels - Ultrasounds of the thyroid - Radioactive iodine scanning - Measurements of iodine uptake differentiates the cause - In Graves, radioactive iodine uptake is high and diffusely distributed over the entire gland TSH levels help us identify where the issue is - pituitary if levels are low, or thyroid if levels are normal or high? - thyroid gland (primary problem) hormone excess

Glycogenolysis

- Breakdown of stored glycogen to get glucose (when blood glucose is low)

diagnosis- blood levels (Hashimoto's hypothyroidism)

- TSH, T3 and T4 -- A high TSH level with low T3 and T4 indicates there is primary hypothyroid disease. -- A high TSH level with normal T3 and T4 indicates mild or subclinical hypothyroidism (really common in women) -- Low TSH and low T4 indicate secondary hypothyroid disease (pituitary gland) -- Based on these lab values, how do we know that this is a secondary disorder? (issue with pituitary gland bc of low TSH presense) Thyroid antibodies - Antithyroglobin (anti-Tg) - Antithyroperoxidase (anti-TPO)

insulin therapy complications

- insulin waning: Progressive rise in blood glucose from bedtime to morning. Tx: increase evening (predinner or HS) dose of intermediate or long-acting insulin or institute before the evening meal if one is not already part of the Tx regimen - Dawn phenomenon: Relatively normal BG until about 3am when the level begins to rise. Tx: change time of injection of evening intermediate-acting insulin from dinnertime to bedtime - somogyi effect: normal or elevated BG at bedtime, a decrease at 2-3 am to hypoglycemia levels, and a subsequent increase caused by the production of counter-regulatory hormones. Tx: decrease evening (predinner or bedtime) dose of intermediate-acting insulin, or increase bedtime snack

diagnostic findings (diabetes)

•Fasting blood glucose 126 mg/dL or more •Casual glucose exceeding 200 mg/dL

Age and stage of life (sensory function)

- Affect sensory function. - People have differing sensory perceptual abilities at different stages of life.

tuberculosis (TB)

Latent Active - Most common infectious disease in the world! Highest mortality rate of all infectious diseases - Kills a million people/year

Controlling nausea and vomiting

- Intervene at first indication of nausea - Medications - Assessment of postoperative nausea, vomiting risk, prophylactic treatment o- Ondansetron (Zofran)

challenges to immunization of children

- Oppose government mandates - Sheer number of vaccines - Veer from the recommended spacing schedule - Religious objections - Philosophy or medical opposition

Hypocalcemia

- Serum level less than 8.6 mg/dL, must be considered in conjunction with serum albumin level - Serum calcium level controlled by parathyroid hormone and calcitonin

Hyperkalemia

- Serum potassium greater than 5.0 mEq/L - Seldom occurs in patients with normal renal function - Increased risk in older adults - Cardiac arrest is frequently associated

Hypernatremia

- Serum sodium greater than 145 mEq/L - Occurs in patients with normal fluid volume, FVD, FVE - Most affected are very old, very young, and cognitively impaired

Musculoskeletal trauma

- Soft Tissue Injury - Skeletal Muscle Injury - Neurovascular Damage - Bone Fracture

Prevention and control TB

- Standardized public health practices for investigating, case and contact finding, as well as care and treatment. - Case management of care and treatment of the individual with TB to ensure medication compliance and barriers to treatment completion are dealt with so treatment completion will occur. - Close monitoring for sputum conversion in people with active disease, in order to adjust medication as necessary. - A high completion-of-therapy rate within 1 year after diagnosis. - Assurance of adequate funding and a dedicated TB control infrastructure. According to the CDC a well-functioning TB control program must focus resources on those at risk for TB exposure and treating latent TB and active TB

Panic disorder emergency care

- Stay with the patient - Reassure him or her that you will not leave - Give clear, concise directions - Assist the patient to an environment with minimal stimulation - Walk or pace with the patient - Administer PRN anxiolytic medications - Afterward, allow the patient to vent his or her feelings

nutritional imbalances

- Undernutrition, over nutrition, malnutrition -> cell injury - Inadequate supply of nutrients necessary for proper cell function - Excessive fat stores place stress on the heart -> heart disease - Extra body weight places increased stress on joints -> arthritis

patient education (insulin therapy)

- Use and action of insulin - Symptoms of hypoglycemia and hyperglycemia -- Required actions in each setting - Blood glucose monitoring - Self-injection of insulin - Insulin pump use

The client taking a MAOI needs to restrict dietary intake of which foods? (select all that apply) 1.Avocados 2.Plums 3.Pepperoni 4.Fava beans 5.Fresh walleye 6.Aged cheeses 7.Asparagus 8.Chinese food

Answers: 1, 3, 4, 6, 8

Rule 25

·everyone who wants tx for substance use can get it (If you don't have good insurance MN state wil pay for substance tx) - rather than giving a pt access to drink and drive and hurt someone Minnesota pays for their treatment

Denial (substance abuse/use)

·in relation to assessment: patient behaviors:

motivation for change (substance abuse/use)

·in relation to assessment: patient behaviors:

sensory overload (nursing interventions)

• Minimize stimuli. -Less light, noise -Less television/radio -Calm tone -Reduce noxious odors. •Provide rest. •Teach stress reduction. •Soft music if patient displays agitation.

Isotonic IV fluids

• Normal Saline (0.9% NaCl) • Lactated Ringer (LR) • 5% dextrose in water (D5W) (IV fluids are used to replace or maintain fluid)

Oral Antidiabetic Agents

- Used for patients with type 2 diabetes who require more than diet and exercise alone - Combinations of oral drugs may be used - Major side effect: hypoglycemia - Nursing interventions: monitor for hypoglycemia -- Glipizide -- Metformin

WBC differential

- Used in the diagnosis of infection and inflammation - Helps indicate the etiology of inflammation - Measures total WBCs and calculates the percentages of specific types of WBCs - Shows the predominant type of WBC responding

Stroke Assessment

•Family Hx •Change in mobility •FAST (face, arms, speech, time) (physical assessment) •Hyper tension, diabetes, atrial fibrillation, hyperlipidemia, high blood pressure (risk factors) •Gender •LOC

physical dependence (sensory perception)

- is a state of adaptation manifested by a drug withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.

Nursing priorities diabetes (disease management)

•Five nursing priorities: •- Nutritional therapy •- Exercise •- Monitoring •- Pharmacologic therapy •- Education

Homeostasis (sensory perception)

- is the state of steady internal, physical, and chemical conditions maintained by living systems. This is the condition of optimal functioning for the organism

Pandemic (definition)

- relates to geographic spread - describes disease that affects a whole country of the entire world Past/current events: - HIV/AIDs - H1N1 (swine flu) - COVID 19 (SARS-CoV-2)

Complications of IV therapy

•Fluid overload •Air embolism •Septicemia, other infections •Infiltration, extravasation •Phlebitis •Thrombophlebitis •Hematoma •Clotting, obstruction

Phosphate Imbalances

Most phosphorus in the body is combined with oxygen, forming phosphate—mostly bound with calcium in teeth and bones as calcium phosphate. Phosphate is the most abundant intracellular anion. Phosphate and calcium exist in an inverse relationship.

hormone excess

Over-production of hormone by endocrine gland - Genetic Mutations - Tumor growth - Autoimmune disorders Example: Graves disease is an autoimmune disease that causes overproduction of thyroid hormone.

False Imprisonment

when a patient is held involuntarily in a hospital, nursing home, other health facility or institution, or even in an ambulance. A critical element of the claim is consciousness of confinement. In other words, the person held had to reasonably believe they could not leave.

infected wounds

when bacteria counts in the wound tissues are above 100,000 organisms per gram of tissue. However, the presence of beta-hemolytic streptococci, in any number, is considered an infection.

Assessment (cushing's syndrome)

•Activity level and ability to carry out self-care •Skin assessment •Changes in physical appearance and patient responses to these changes •Mental function •Emotional status •Medications: adrenal enzyme inhibitors (Metopirone, Cytadren, Lysodren,

Potential nursing diagnoses (alcohol intoxication)

•Acute confusion •Risk for injury •Risk for ineffective breathing pattern •Risk for aspiration

Sensory deprivation (nursing interventions)

•Focus is prevention. •Support senses (e.g., glasses, hearing aids). •Orientation -- Calendar; view of environment •Provide stimuli. -Regular contact; touch -Television/radio -Pet therapy -Smells

delusions nursing interventions (schizophrenia)

•Obtain a good description of the delusions •Do not agree nor disagree with delusions •Orient to reality and distract •Focus on the client's feelings •Address underlying needs

Hallucinations nursing interventions (schizophrenia)

•Obtain a good description of the hallucinations •Use a nonjudgmental manner •Attempt to understand the client's experience and responses •Orient to reality and distract

coping skill deficits (schizophrenia)

•Overassessment of threat •Underassessment of personal resources •Overuse of denial

diabetes support

•Personal support •Friends, family •Community, church •Medical support •Primary care provider, endocrinology, home health nurse •Internet •American Diabetes Association

sensory perception stress and adaptation

- Stress (eustress and distress), coping and adaptation - Stressor: sensory stimuli that elicits a stress response. A challenging demand on the body that arouses a response from multiple organ systems. - Adaptive ability depends on conditioning factors (e.g. age, health status)

immunization education for guardians

"ASK" (Acknowledging, Steering, and Knowing). - The first step is to acknowledge the parents' concerns and then steer the conversation to provide answers and knowing the facts. Another strategy is called "CASE" (Corroborate, About, Science, Explain). - Acknowledge the concerns and have a respectful conversation with the parent. Then, be sure the parent is aware of how the health care provider is knowledgeable on the topic (tell them about yourself and your level of expertise). - Third is to refer to the scientific evidence, and the final step is to explain and advise, following the ACIP guidelines. -These may be time-consuming but the effort may pay off if a parent is able to accept the vaccine for their child.

protective isolation

"Protective environment" •Protects the client from organisms •Used in special situations with immune-compromised client population •Precautions include •-- Room with special ventilation and air filters; no carpeting; daily wet-dusting •-- Avoiding standing water in the room (e.g., humidifier) •-- Nurse not assigned to other clients with active infection •-- Standard and transmission-based precautions, plus mask and other personal protective equipment (PPE) (to protect patient)

Nursing Surveillance

"Purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision-making."

Public health (definition)

"activities that society undertakes to assure the conditions in which people can be healthy" Public health nursing: - nursing that is community based and, most importantly, it is population focused (working with ppl who live, work and play there)

Cushing's triad (intracranial regulation)

(Late sign of increasing ICP) - If the ICP continues to rise and causes significant pressure on the brainstem, a triad of symptoms called Cushing's triad occurs: - Hypertension with a widened pulse pressure (difference between systolic and diastolic pressures) - Bradycardia (Slowed heart rate) - Bradypnea or Abnormal respiratory patterns (triad late signs when pressure gets too high: bradycardia, abnormal respiratory pattern, hypertension)

Public health intervention wheel

(RED PART) - Surveillance: is "an ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice" - Disease and health event investigation: systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures. - Outreach: locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how to obtain services. - Screening: identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations. - Case-finding: locates individuals and families with identified risk factors and connects them to resources.

Types of pain

- Acute: sudden - BP, P, RR increase, range mild to severe, < 3 months, decreases over time, anxiety, confusion, agitation - Chronic: Pain does not go away, > 3 months, withdrawal, decreased physical movement, fatigue - Neuropathic: Abnormal pain processing - phantom limb, diabetic neuropathies, damage to nerve cells or changes in spinal cord, burning, shooting, stabbing, can be referred

Callular adaptation (3)

- Adaptation: compensatory changes in an attempt to maintain homeostasis - Maladaptation: changes which negatively impact the cells structure or function - Death

Mania symptoms

(hypomania, mania, delirium mania) on your pre-class worksheet and they are listed in your book. Individuals diagnosed with mania have severe impairment that affects their functioning within daily life (psychological, social, occupational). Euphoria - person feels like they are on top of the world and nothing will bring them down. Treat everyone as their best friend, lots of joking and laughing This mood can be incongruent with the environment or circumstances at that time. Can quickly change to irritability, especially when the person cannot do what they desire. Changing back and forth quickly is what we call "labile" The irritability can be just for a short time or it can be a prominent symptom of that specific person's mania.

Clean-Contaminated wounds

(risk for infection): wounds are surgical incisions that enter the gastrointestinal, respiratory, or genitourinary tracts. There is an increased risk of infection for these wounds, but there is no obvious infection.

In the Mania video with Christine, what would be a nursing diagnosis for Christine given her symptoms?

**Disturbed Thought Processes** -Disturbed sleep pattern -Imbalanced nutrition -Deficient fluid volume -Impaired verbal communication -Risk for suicide -Risk for other-directed violence -Impaired social interaction -Noncompliance -Self-care deficit -? Risk for injury

Humoral immunity lag time

*Because humoral immunity takes time to develop, what happens during the lag time? *T-cell-cell mediated immune response is activated more quickly, so CD4 cells attack the antigens to blunt the pathogen effect until antibodies are developed

Intracranial Regulation (signs and SX of stroke)

- "Common" Sudden (a) numbness or weakness of face, arm or leg, especially on one side of the body; (b) confusion, trouble speaking, or understanding; (c) trouble seeing in one or both eyes; (d) trouble walking, dizziness, loss of balance or coordination; (e) severe headache with no known cause - "Unique" symptoms of stroke in women; usually Sudden or Severe - do not need to memorize - but know some men and women can present with "unique" s/s - Helpful way to remember: song "Head, shoulders, knees and toes, knees and toes" -Brain, face, arms and legs, arms and legs - And eyes and ears and speech are all sudden - Brain (HA, confusion), face, arms and legs, arms and legs (droop, numbness or weakness) - And eyes (seeing) and ears(balance) and speech are all sudden

Community health (definition)

- "identification of needs and the protection and improvement of collective health within a geographically defined area" - *Collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging Examples of some communities: ●Citizens of a town/neighborhood ●Group of migrant farmers (work, providing for families) ●St. Kate's Students ●Examples of others????

mild anxiety

- "normal" anxiety everyone gets (does not interfere with daily life) - perceptual field widens to observe more - learning is possible - sees, hears, grasps a good amount - usually able to recognize and identify anxiety easily Nursing interventions: - assist pt to use anxiety to encourage learning (centering, relaxation, deep breathing, imagery)

normal vs abnormal sensory perception

- (adequate vs inadequate) - alterations in integumentary system or factors affecting senses such as medication effects, nerve damage. Alterations in individual perceptions, life experiences which lead to cognitively and emotionally manage internal and external situations, availability of resources and support

What IV fluid could be used to treat fluid loss?

- 0.9% NaCl (normal saline or NS) - Lactated ringer's solution (LR) - 5% dextrose in water (D5W)

Assessment (Pain and sensory perception)

- 5th VS - OLDCART

Endocrine system

- A group of organs that produce, store, and secrete chemical messengers called hormones 3 Main Components to the Endocrine System 1.Hypothalamus 2.Pituitary Gland 3.Targets Organs or Tissues

Mandates to inform

- A legal obligation to breach confidentiality "Duty to warn" - Judgment that the patient has harmed someone or is about to injure someone - Based on Tarasoff v. Regents of the University of California

Cause of FVD

- Abnormal fluid losses o-- Vomiting, diarrhea, sweating, GI suctioning - Decreased intake o-- Nausea, lack of access to fluids - Third-space fluid shifts o-- Due to burns, ascites - Additional causes o-- Diabetes insipidus, adrenal insufficiency, hemorrhage - Due to burns, ascites is an example of pt looks overloaded but really dehydrated

Substance abuse effects on family

- Abuse of substances by one or more members has devastating effects on families, their functioning, and the community. Fetal alcohol syndrome (FAS) results from drinking alcohol during pregnancy. Addictions lead to loss of jobs and family relationships. Use of illegal substances can lead to arrest and prison. - Many families try to help their family member learn to abstain or reduce the use of substances. Support groups provide education and help in understanding the addiction. Conversely, some persons who recover from substance abuse find that they must distance themselves from families that are actively using and abusing alcohol and drugs.

Restraint requirements

- According to the Joint Commission on the Accreditation of Health care Organizations and the Centers for Medicare and Medicaid Services, there are many regulations and requirements that address restraints and restraint use including: - The initiation and evaluation of preventive measures that can prevent the use of restraints - The use of the least restrictive restraint when a restraint is necessary - Monitoring the client during the time that a restraint has been applied - Every 15" for behavioral restraints, every 30" for medical restraints

social determinants of health

- According to the WHO, social determinants of health (SDOH)are defined as "the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels - The upstream approach to healthcare asks us to look at the Why and to understand the why we need to understand to SDOH.

Manifestations of fracture

- Acute pain - Loss of function - Deformity - Shortening of the extremity - Crepitus - Local swelling and discoloration - Diagnosis by symptoms and radiography - Patient usually reports an injury to the area

Factors affecting skin integrity

- Age—older adult skin: less elastic, drier, reduced collagen, areas of hyperpigmentation, more prone to injury - Mobility status—increased pressure, shearing, and friction can lead to breakdown - Nutrition/hydration -- Protein—Maintain the skin, repair minor defects, and preserve intravascular volume -- Vitamin C, zinc, copper—formation of collagen -- Dehydration = poor turgor - Sensation level Diminished sensation leads to increased risk for pressure and breakdown - Impaired circulation—negatively affects tissue metabolism - Medications—side effects: itching, rashes - Moisture -- Leads to maceration - Fever -- Depletes moisture Increases metabolic rate - Infection -- Impedes healing - Lifestyle -- Tanning, bathing, piercings, tattoos

Selye's General Adaptation Syndrome (GAS)

- Alarm - SNS and adrenal gland stimulation - "fight or flight" - Resistance - body selects most effective channels of defense - homeostasis - adaptation - HPA axis (cortisol) - Exhaustion stages - resources are depleted - stress overwhelms body

Community and public health promotion

- All efforts that seek to bring move people closer to optimal health. - Community health efforts accomplish this goal through a three-pronged effort to: 1.Increase the span of healthy life for all citizens 2.Reduce health disparities among population groups 3.Achieve access to preventive services for everyone Community health promotion: encompasses the development and management of preventive health care services that are responsive to community health needs.

Health promotion (Components of Community Health Practice)

- All efforts that seek to move people closer to optimal well-being or higher levels of wellness 1.Increase the span of healthy life for all citizens 2.Reduce health disparities among population groups 3.Achieve access to preventive services for everyone Leading Health Indicators: ●Physical activity ●Overweight and obesity ●Tobacco use ●Substance use ●Responsible sexual behavior ●Mental health ●Injury and violence ●Environmental quality ●Immunization ●Access to health care

Maintaining surgical asepsis

- All materials in contact with the surgical wound or used within the sterile field must be sterile - Gowns considered sterile in front from chest to level of sterile field, sleeves from 2 inches above elbow to cuff - Sterile drapes are used to create a sterile field. Only top of draped tables are considered sterile - Items dispensed by methods to preserve sterility - Movements of surgical team are from sterile to sterile, from unsterile to unsterile only - Movement at least 1-foot distance from sterile field must be maintained - When sterile barrier is breached, area is considered contaminated - Every sterile field is constantly maintained, monitored oItems of doubtful sterility considered unsterile - Sterile fields prepared as close to time of use - The routine administration of hyperoxia (high levels of oxygen) is not recommended to reduce surgical site infections

Adverse efects of surgery and anesthesia

- Allergic reactions, drug toxicity or reactions - Cardiac dysrhythmias - CNS changes, oversedation, undersedation - Trauma: laryngeal, oral, nerve, skin, including burns - Hypotension - Thrombosis

Evaluating immunity

- Allergy Panel: Test of immunocompetence by injecting common antigens intradermally. An immunocompetent individual should have at least one or more positive skin reactions - Antibody Titers: Lab tests that measure IgM and IgG levels and confirm adequate immune protection against particular antigens. Example? - Allergy Testing: Skin tests measure IgE reaction at surface, serology tests also measure IgE, associated with allergic or hypersensitivity reactions. ELISA, RAST, and ImmunoCAP IgE testing

McEwen's Longterm stress theory

- Allostasis = a dynamic state of balance that changes according to exposure to stressors - Allostatic load = the wear and tear on body systems caused by stress reactions - Allostatic overload - stress exceeds body's ability to adapt = pathophysiological disorder

Simple reflex arc (sensory perception)

- An afferent neuron carries sensory impulses into the dorsal horn of the spinal cord; The afferent neuron connects with an interneuron in the substantia gelatinosa of the spinal cord; The interneuron connects to an efferent neuron that exits via the ventral horn and enacts motor activity.

chronic inflammation and autoimmune diseases

- An unknown offending agent causes an inflammatory reaction that initiates production of antibodies that attack the body's own tissues - Antibodies produce a persistent inflammatory reaction that cause chronic tissue damage (Offending agent -> inflammatory reaction -> production of antibodies -> persistent inflammatory reaction -> chronic tissue damage)

intraoperative complications

- Anesthesia awareness - Nausea, vomiting - Anaphylaxis - Hypoxia, respiratory complications - Hypothermia - Malignant hyperthermia - Infection

infection antimicrobial agents

- Antimicrobial agents = antibacterial, antiviral, antifungal, antiprotozoan, and antihelminthic medications - Antibacterial agents/medication - classified by activity (bactericidal or bacteriostatic, narrow or broad spectrum) and by mechanism (e.g. interference with protein or cell wall synthesis) - MRSA, VRSA, VRE and DRSP = antibiotic resistant bacteria

fluid

- Approximately 60% of typical adult is fluid -- Varies with age, body size, gender - Intracellular fluid -- 2/3 of body fluid, skeletal muscle mass - Extracellular fluid -- Intravascular: plasma, erythrocytes, leukocytes, thrombocytes -- Interstitial: lymph -- Transcellular: cerebrospinal, pericardial, synovial

Clinical presentation (early signs of IICP)

- As ICP increases within the skull, cranial nerves and brain tissue are compressed. Early signs of increasing ICP include: - Headache (direct compression of brain tissue) - Vomiting (compression of the vomiting center in the medulla) - Decreasing LOC - earliest and most often missed (compression of the reticular activating system RAS) - Altered response of the pupil to light and size of the pupil (Pressure on the third cranial nerve (oculomotor)

Medication (sensory function)

- Aspirin and furosemide (Lasix) become ototoxic if taken for a long period of time and impair function of the auditory nerve. - CNS depressants, such as opioid analgesics and sedatives, blunt reception and perception of stimuli.

relieving pain and anxiety

- Assess patient comfort - Control of environment: quiet, low lights, noise level - Administer analgesics as indicated; usually short-acting opioids IV - Family visit, dealing with family anxiety

Clinical management (IICP) (ICR)

- Assessment and History - LOC, breathing pattern, pupillary changes, eye movement and reflex responses, and motor responses, VS Examination - - S/S - Altered LOC (confusion, delirium, obtundation, stupor, coma), Cushings triad - Diagnostic studies - ICP monitoring, CT scan Treatment: - r/o and treat potential causes: cerebral ischemia or hemorrhage (stroke infarct), hypoxia, infection (meningitis) tumor - Goal: decrease the volume of any one of the three compartments—brain tissue, CSF, or circulation -- Externally draining CSF via a catheter placed in the ventricles -- Blood volume can be reduced by lowering blood pressure. -- Removing brain tissue, such as in a lobectomy, will decrease volume thus ICP - Surgery - craniectomy or craniotomy - Cerebral edema - Mannitol (Osmitrol)

Nursing process communicable disease control

- Assessment: case identification, case finding; comprehensive; no assumptions; community's need for surveillance or new or improved control programs - Planning: assisting with immunizations, symptom relief, controlling disease if present, limiting exposure, collaboration - Implementation: service delivery; supervision of staff; agency functions; primary prevention education for future infections; record keeping and reporting - Evaluation: Continuous process. Based on research and data, feedback from community and interprofessional team.

Infection microorganisms

- Bacteria - Viruses - Fungi - Parasites - Prions - Opportunistic - Nosocomial

C diff pathophysiology

- Bacteria emits toxins that disrupt the intestinal mucosa - Eroding the intestinal epithelial cells - Forming pseudomembranes that contain necrotic tissue, WBCs and mucus

Role of nurse diabetes (nursing management)

- Be knowledgeable about dietary management - Communicate important information to the dietician or other management specialists - Reinforce patient understanding - Support dietary and lifestyle changes - Consider food preferences, lifestyle, usual eating times, and cultural and ethnic background - Review diet history and need for weight loss, gain, or maintenance - Caloric requirements and calorie distribution throughout the day; exchange lists -- Carbohydrates: 50% to 60% carbohydrates; emphasize whole grains -- Fat: 30%, limiting saturated fats to 10% and <300 mg cholesterol -- Nonanimal sources of protein (e.g., legumes, whole grains) and increase fiber - Combining starchy foods with protein and fat slows absorption and glycemic response - Raw or whole foods tend to have lower responses than cooked, chopped, or pureed foods - Eat whole fruits rather than juices; this decreases glycemic response because of fiber (slowing absorption) (juices have a lot of sugar) - Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed

Hypokalemia

- Below-normal serum potassium <3.5 mEq/L - May occur with normal potassium levels: when alkalosis is present a temporary shift of serum potassium into cells occurs

Bipolar Diagnosis

- Bipolar I: Major depression to mania continuum - Bipolar II: major depression to hypomania continuum - Cyclothymic: Minor depression to hypomania continuum Rapid cycling: 4 or more mood episodes in a 12-month period (higher recurrence risk), either in Bipolar I or II (These episodes must be demarcated either by a partial or full remission of at least 2 months' duration or by a switch to an episode of opposite polarity. Duration criteria for episodes are not waived, which means that each major depressive episode must last at least 2 weeks, each manic or mixed episode must last at least 1 week, and each hypomanic episode must last at least 4 days.) Mixed features specifier: displays depressive symptoms at the same time as being in a full manic or hypomanic episode (People in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.)

Blood alcohol level (behaviors)

- Blood Alcohol Levels and Behavior Number of Drinks Blood Alcohol Levels (mg%) Behavior 1-2 - 0.05 Impaired judgment, giddiness, mood changes - 0.10 Difficulty driving and coordinating movements - 0.20 Motor functions severely impaired, resulting in ataxia; emotional lability - 0.30 Stupor, disorientation, and confusion - 0.40 Coma - 0.50 Respiratory failure, death NCLEXNOTE Alcohol abuse continues to require nursing assessment and interventions in all settings. Patients who abuse alcohol for long periods of time are at high risk for alcohol withdrawal syndrome. Observing for signs of seizure activity is a priority nursing intervention.

Neural and endocrine pathways (Sensory perception)

- Brain sensory regions = Amygdala, cerebral cortex and hypothalamus - SAM = Sympathetic Nervous System (Alarm stage) - HPA axis = CRF = anterior pituitary gland to secrete ACTH and posterior pituitary gland to secrete ADH (Resistance stage)

Influenza

- Can be fatal, Oct-May (Peaks in January), The cause of multiple pandemics - Historic: 1918 Spanish flu killed 50-100 million people - Respiratory illness - Agent: Influenza Virus, infects nose, throat and lungs - Can be fatal, The cause of multiple pandemics - Oct-May (Peaks in January) - Influenza: Transmission -- Droplet infection, type A most common - Influenza: Populations at Risk: Everyone! - Serious Risk: -- Elderly, young children, pregnant women, immunocompromised/chronically ill

Clinical manifestations of FVD

- Can develop rapidly - Severity depends on degree of loss - Mild: has the flu ad is dehydrated wont have a drop in BP - Severe: has a drop in BP and a increased pulse Symptoms: Acute weight loss, ↓ skin turgor, oliguria, concentrated urine, capillary filling time prolonged, low CVP, ↓ BP, flattened neck veins, dizziness, weakness, thirst and confusion, ↑ pulse, muscle cramps, sunken eyes, nausea, increased temperature; cool, clammy, pale skin Labs indicate: ↑ hemoglobin and hematocrit, ↑ serum and urine osmolality and specific gravity, ↓ urine sodium, ↑ BUN and creatinine, ↑ urine specific gravity and osmolality

Permanent cells

- Cannot regenerate - Ex: myocardial cells (after heart attack dead cell cannot be replaced)

chemical injury

- Caused by endogenous or exogenous substances that influence the cell - Injure the plasma membrane and gain access to the cell's interior to cause dysfunction of organelles - Endogenous (inside body) example: electrolyte imbalances -- High sodium levels in the blood -> intracellular dehydration -> lethargy, weakness, irritability, confusion -- Uncontrolled diabetes -> high glucose in the blood -> chemical injury of the cells that line the arteries - Exogenous (outside body) example: drugs, environmental pollutants, poisons -- Nephrotoxic medications -> damaging effects on kidney cells -- Alcohol -> damaging effects on liver cells

Causes/manifestations of Hypokalemia

- Causes: GI losses, medications, prolonged intestinal suctioning, recent ileostomy, tumor of the intestine, alterations of acid-base balance, poor dietary intake, hyperaldosteronism - Manifestations: ECG changes, dysrhythmias, dilute urine, excessive thirst, fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesias

Causes/manifestations of hyponatremia

- Causes: Imbalance of water, losses by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, certain medications, SIADH - Manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abdominal cramping, neurologic changes

Causes/manifestations of hyperkalemia

- Causes: Impaired renal function, rapid administration of potassium, hypoaldosteronism, medications, tissue trauma, acidosis - Manifestations: Cardiac changes and dysrhythmias, muscle weakness, paresthesias, anxiety, GI manifestations

Causes/manifestations of hypernatremia

- Causes: fluid deprivation, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions - Manifestations: thirst; elevated temperature

cushing's syndrome/disease clinical manifestations

- Changes in physical characteristics of the body -- Moon Face -- Added fat on back of neck (so-called "buffalo hump") -- Easy bruising of the skin -- Purple stretch marks on the abdomen (abdominal striae) -- Excessive weight gain, most marked in the abdominal region, while the legs and arms remain thin -- Red cheeks ("plethora") -- Generalized weakness and fatigue; wasting of muscles, most noticeably in the upper thighs. You may have difficulty getting up from a chair. - Menstrual disorders - Women may develop male pattern hair growth - High blood pressure that is often difficult to treat - Hyperglycemia (high cortisol)

cognitive behavioral therapy

- Changes negative thinking into more realistic thinking, which in turn changes behaviors - Automatic negative thoughts/cognitive distortions Precipitating event/situation, automatic negative thought, feelings and behaviors, more rational thought

Controlled communicable disease

- Childhood immunizations >78% - Smallpox eradicated - Yaws virtually disappeared (Yaws: a contagious disease of tropical countries, caused by a bacterium that enters skin abrasions and gives rise to small crusted lesions which may develop into deep ulcers.) - Relapsing fever, plague reduced - Leprosy close to elimination

child and adolescent depression symptoms

- Children: anxiety, separation fear, stomach ache, head ache, avoid activities, eating and sleeping habits change, talk about running away -Increased irritability, extreme sensitivity -Frequent complaints of physical illness -Difficulty with relationships -Frequent school absences or poor performance, poor concentration -Persistent boredom -Social isolation -Major changes in eating and/or sleeping habits -Talk of or effort to run away from home -Alcohol or drug use -Reckless risk taking -DON'T ALWAYS SEEM SAD, THOSE WHO CAUSE TROUBLE AT HOME AND SCHOOL (BEHAVIORAL ISSUES) MAY BE DEPRESSED AND NOT KNOW IT

body-baed methods (Healing modalities)

- Chiropractic - Massage - Osteopathy

left ventricular hypertrophy (LVH)

- Chronic hypertension = this - High blood pressure in the systemic circulation places an excessive workload on the left ventricle of the heart - Cardiac muscle cells undergo pathological _______ - Cardiac muscle cells increase in size and oxygen demands, but there is inadequate blood vessel growth to supply these muscle cells - Coronary blood flow is inadequate - The enlarged tissue is now more susceptible to ischemia, infarction, and heart failure Treatment: eliminate stressor and treat hypertension to reverse the hypertrophy

circle of willis (intracranial regulation)

- Circle of Willis - aneurysm - hemorrhagic stroke - ACA - leg weakness, sensory loss - PCA - vision - Cerebellar - balance, N/V, HA - Brain stem - rare - LOC, abnormal respirations, impaired swallowing

Nursing intervention related to wound care

- Cleansing/irrigating - Caring for a drainage device: (Jackson-Pratt; Hemovac) - Debriding a wound: -- Sharp (instrument) -- Mechanical (hydrotherapy) -- Chemical -- Enzymatic (enzyme used) -- Autolysis (body's own way to break down ex. own T cells) - Dressing a wound -- Gauze/transparent film --Hydrocolloids/ hydrogels - Supporting/ immobilizing a wound -- Binders/bandages - Applying heat and cold

Gerontological consideration (fluid and electrolytes)

- Clinical manifestations of imbalance may be subtle - Fluid deficit may cause delirium - Decreased cardiac reserve - Reduced renal function - Dehydration is common - Age-related thinning of the skin and loss of strength and elasticity

Types of fractures

- Closed (Complete) - Incomplete - Open (Compound) - Compression - Transverse - Stress Fracture - Comminuted - Avulsion - Greenstick - Impacted

Ischemic stroke treatment

- Code stroke - Early recognition and emergency management of the acute stroke patient = improved chances of recovering - Clot buster (Thrombolytic): Recombinant tissue-type plasminogen activator (rt-PA) •- Rt-PA dissolves the clot by selectively binds to fibrin and converts plasminogen -> plasmin -> degradation of fibrin matrix (Must be given within 3-4 hours of 1st stroke symptom onset) - Aspirin or another antiplatelet aggregation drug - Surgical thrombectomy for eligible patients

Evaluation

- Collect data. - Compare the patient's actual outcomes with the expected outcomes. Determine the extent to which the expected outcomes were achieved. - Include the patient, family or significant others, nursing team members, and other health care team members in the evaluation. - Identify alterations that need to be made in the nursing diagnoses, collaborative problems, goals, nursing interventions, and expected outcomes. - Continue all steps of the nursing process: assessment, diagnosis, planning, implementation, and evaluation.

factors affecting wound healing

- Complex process - Many body systems are involved in supporting the process - Requires sufficient nutrients and oxygen and efficient removal of tissue debris and microorganisms Factors: - Nutrition - Oxygenation - Circulation - Immune Strength - Contamination - Obesity - Age

Assessment

- Conduct the health history. - Perform the physical assessment. - Interview the patient's family or significant others. - Study the health record. - Organize, analyze, synthesize, and summarize the collected data.

transmission-based contact precautions

- Contact precautions. Pathogen is spread by direct contact •Sources of infection: draining wounds, secretions, supplies •Precautions include -Possible private room -Clean gown and glove use -Disposal of contaminated items in room -Double-bag linen and mark - Use for organisms spread by skin-to-skin contact, such as antibiotic-resistant organisms or Clostridium difficile, VRE, MRSA - Use of barriers to prevent transmission - Emphasize cautious technique because organisms are easily transmitted by contact between the health care worker and the patient - Masks not needed

Labile cells

- Continually dividing and replicating, replacing cells that are eliminated - Ex: skin, GI lining, mucous membranes

nutritional management (diabetes)

- Control of total caloric intake to attain or maintain a reasonable body weight - Control of blood glucose levels - Normalization of lipids and blood pressure to prevent heart disease

Monitoring Blood Glucose

- Cornerstone of diabetes management - Self-monitoring of blood glucose levels has dramatically altered diabetes care - For most patients who require insulin, monitoring blood glucose is recommended two to four times daily (usually before meals and at bedtime)

Adrenal gland simulation (Sensory perception)

- Cortisol - enhances muscle strength, diminishes immunity - Epinephrine - increases HR, BP, vasoconstriction, bronchodilation - Aldosterone - Na+ water reabsorption, K+ excretion

culture (sensory function)

- Culture affects the nature, type, and amount of interaction and stimulation that people feel comfortable with. People of different cultural backgrounds tend to prefer differing amounts of eye contact, personal space, and physical touch.

SIADH vs DI

- DI = High and dry (hypernatremia, dehydration) (•Deficiency of production or secretion (LOW) Anti-Diuretic Hormone) - SIADH = Low and wet (hyponatremia, water retention) (•Abnormally HIGH production or sustained secretion of Anti-Diuretic Hormone)

Atrophy

- Decrease in the SIZE of the cells Causes: - Diminished workload - Lack of nerve stimulation - Loss of hormonal stimulation - Inadequate nutrition - Decreased blood flow - Aging (opposite of Hypertrophy)

adrenal insufficiency

- Decreased ACTH secretion or destruction of the adrenal glands leads to decreased cortisol and aldosterone secretion - decreased testosterone as well - Epidemiology: Rare, 39-60 cases per million people Etiology: - Addison's disease - Autoimmune destruction of the adrenal gland - Tuberculosis of the adrenal gland - Radiation - Tumors of the Pituitary Gland

Gerontologic Considerations (postop)

- Decreased physiologic reserve - Monitor carefully, frequently - Increased confusion - Dosage - Hydration - Increased likelihood of postoperative confusion, delirium - Hypoxia, hypotension, hypoglycemia - Reorient as needed - Pain

Visceral (source of pain)

- Deep, acute pain arising from an internal organs that are diseased/injured - Not well localized; May be referred to another area - internal organs EX. pancreatitis

Pain (definition)

- Defined as "unpleasant sensory, emotional experience with actual or potential tissue damage" - Most common reason for seeking health care

competency

- Degree to which patient can understand and appreciate the information given during the consent process - Cognitive ability to process information at a specific time - Different from rationality - Not clearly defined across the states

Dysplasia

- Deranged cellular growth within a specific tissue - Cells vary in size, shape, uniformity, arrangement, and structure when compared to healthy cells - Often as a result of chronic inflammation or a precancerous condition

sensory overload (definition)

- Develops when either environment or internal stimuli or a combination of both, exceed a level that the patient's sensory system can effectively process. - It can occur in patient's with neurological or psychiatric disorders who are unable to adapt to continuing, non-meaningful stimuli. - Hospitalized patients often experience sensory overload due to a combination of physical discomfort, anxiety, separation from loved ones, and the experience of being in the unfamiliar hospital environment. Medications that stimulate the CNS may also contribute to overload, as will substances, such as caffeine. In addition, physical conditions that activate the CNS (e.g, hyperthyroidism, acute brain injury) contribute to sensory overload.

Influenza (diagnosis and Tx)

- Diagnosis - based on symptoms, presence of influenza in geographic region, and various flu tests with most common are called "rapid influenza diagnostic tests (RIDTs) - Tx - Supportive care -- Fluid replacement -- Self-care -- Bed rest and Throat lozenge - Medications -- Decongestant, Cough medicine, Nonsteroidal anti-Inflammatory drug (NSAIDS), Analgesic, and Antiviral drug

Infection diagnosis

- Diagnosis - history, clinical, symptoms, physical examination, and labs - Laboratory studies - Culture and stain - Biopsy - Serological testing - Direct antigen identification - Polymerase chain reaction (PCR)

Neoplasia

- Disorganized, uncoordinated, uncontrolled proliferative cell growth - Neoplasm & tumor: words used interchangeably - New cells growing within a specific tissue or organ - Benign or malignant, depending on differentiation - Differentiation: when newly growing cells acquire the specialized structure and function of the cells they replace - Benign: well-differentiated; cells that resemble the healthy cells of the tissue of origin(somewhat resemble the tissue it surrounds) - Malignant: poorly differentiated; cells that do not resemble the healthy cells of the tissue of origin (doesn't look like the surrounding tissue)

Bill of Rights for mental health patients

- During admission pts receive and read this to understand their rights - Individuals have the right to receive benefits for mental health and substance abuse treatment on the same basis as they do for any other illnesses, with the same provisions, co-payments, lifetime benefits, and catastrophic coverage in both insurance and self-funded/self-insured health plans.

cellular injury

- Structural and functional changes - Occurs when cells are exposed to a severe stress - No longer able to maintain homeostasis - If the damaging stimulus is removed, cellular injury may be reversible - If the stress is prolonged, the cells may reach a point when recovery is not possible

T cells

- During maturation process develop surface antigens that differentiate them from one another (CD) antigens - Most common T-cells working in cell-mediated immunity are CD4 cells (T helper cells) and CD8 cells (cytotoxic T cells) - CD4 cells influence all other cells of the immune system (very important role!) - CD8 cells directly attack antigens - *T cells cannot be activated by antigen alone - need to be stimulated by APCs (antigen presenting cells), which release cytokines that call for the adaptive immune system to respond

extracellular fluid

- ECF - outside the cells - within the bloodstream (vessels) - 1/3 of the body's water (Constant fluid and electrolyte exchange between the ICF and ECF)

History of infection

- Early 20th century leading causes of death -- Respiratory diseases (e.g., tuberculosis [TB]) and diarrheal diseases were major killers - Infectious disease still a leading cause of death in children worldwide - 90% of Global ID deaths are from six causes: ARI, Diarrheal Diseases, Malaria, Measles (children), TB (adults), HIV (adults)

clinical manifestations of FVE

- Edema - Distended neck veins - Crackles from fluid in the lungs Symptoms: Acute weight gain, peripheral edema and ascites, distended jugular veins, crackles, elevated CVP, shortness of breath, ↑ BP, bounding pulse and cough, ↑ respiratory rate, ↑ urine output Labs indicate: ↓ hemoglobin and hematocrit, ↓ serum and urine osmolality, ↓ urine sodium and specific gravity

Role of public health nurse

- Effective caring: assisting clients to develop capabilities to take charge of life and make own choices -- (●"Opening the door" difficult because clients often the most disenfranchised and fearful of others ●Engagement and rapport essential) - Empowerment: client-centered approach, trust, advocacy, teaching and role modeling, capacity building - Making a difference: protective factors; resilience

types of endocrine dysfunction

- Either hypo or hyperfunction - Dysfunction can occur anywhere along the hypothalamic-pituitary-hormone axis - Endocrine disorders can be referred to as: -- Primary disorder: Dysfunction of the endocrine gland itself (issue at target organ) -- Secondary disorder: Dysfunction caused by abnormal pituitary activity -- Tertiary Disorder: Dysfunction caused by the hypothalamus

Self determinism

- Empowerment or having free will to make moral judgments - Internal motivation to make choices based on personal goals Key values: - Personal autonomy (right to except, refuse treatment) - Avoidance of dependence on others A basic and fundamental psychological need Healthcare/Mental health: - Right to choose one's own health-related behaviors - Possibly different from those recommended by health professionals

pathologic hypertrophy

- Enlarged cells do NOT have adequate nutrition and oxygen; limited angiogenesis - Increase in cellular size w/o increase in supportive structures needed to meet the cell's increased metabolic needs Example: (hypertension) - Increased resistance in systemic circulation leads to increased workload for the left ventricle - left ventricle undergoes this but there is not adequate blood vessel growth to supply these cells - results in increased size of left ventricle w/o enough blood flow to meet the increased metabolic demands

physiologic hypertrophy

- Enlarged cells have adequate nutrition and oxygen because of angiogenesis Example: - A weight lifter wants stronger bicep muscles lifts weights to increase workload - leads to increased size of skeletal muscle cells and overall enlarged muscle - Exercise also stimulates angiogenesis, growth of new blood vessel branches - enlarged muscle is adequately perfused and supplied with blood flow, oxygen, and nutrients because of angiogenesis

Clostridium difficile (C. diff)

- Epidemiology - C - Diff = 223,900 cases and 12,800 deaths in US in 2017 (CDC, 2019) - Diarrheal disease - Transmission - fecal oral - Contact Enteric isolation - Agent: Spore forming bacteria - Opportunistic - Populations at Risk: Recent antibiotic use (Alteration of the normal flora in the gut), PPI use, Lengthy hospital stays, Compromised immune system, Over age 65

outbreak investigation

- Essential to gather preliminary background information - Gather essential supplies needed (PPE, specimen collection) - Inform local animal health and public health authorities Must have a multidisciplinary team •Essential to gather preliminary background information •Gather essential supplies needed (PPE, specimen collection) •Inform local animal health and public health authorities

Nursing process framework (pain management)

- Establish nurse-patient relationship - Identify goals for pain management - Provide physical care - Manage anxiety related to pain - Evaluate pain management strategies

hemorrhagic stroke

- Etiology: hypertension, aneurysm rupture, and oral anticoagulation - is caused by rupture and hemorrhage of a cerebral artery, leading to compression of brain cells and loss of cerebral blood flow. Blood is toxic to brain cells. •Caused by bleeding into brain tissue, the ventricles, or subarachnoid space •May be caused by spontaneous rupture of small vessels primarily related to hypertension; subarachnoid hemorrhage caused by a ruptured aneurysm; or intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations (AVMs), intracranial aneurysms, or medications such as anticoagulants •Brain metabolism is disrupted by exposure to blood. •ICP increases caused by blood in the subarachnoid space. •Compression or secondary ischemia from reduced perfusion and vasoconstriction causes injury to brain tissue - takes longer to heal because of blood vessels are broken

pain management principles

- Every patient deserves adequate pain management - partner with patient and family to design individualized, holistic treatment plan that includes goals, interventions, and evaluations - responsibility of all members of the healthcare team - perform thorough assessment (with any new pain, before and after interventions) - use a multimodal approach (multiple interventions to achieve a goal) - effective and safe analgesia (balance pain relief with patient safety)

lack of resources for vulnerable population

- Everyone has the potential to become vulnerable Members of vulnerable populations often lack resources: ●Education ●Decreased physical capabilities ●Poor communication skills ●Inadequate finances ●Social Support Goal of HP 2020 to "achieve health equity, eliminate disparities, and improve the health of all groups"

Complications (Pain and sensory perception)

- Substance abuse - dysfunctional use of substance in amount and/or methods - Tolerance- state of adaptation - choric exposure = decreased results

Edema

- Excess fluid in the ISF and ICF compartments Occurs for three main reasons: - Elevated hydrostatic pressure created by excess water in the bloodstream --- (Ex. left-sided heart failure which leads to pulmonary edema) - Diminished osmotic pressure created by a low amount of solutes in the bloodstream --- (Ex. hypoalbuminemia = protein starvation) - Inflammation which causes increased capillary permeability (leaking)

benign prostatic hyperplasia (BPH)

- Excessive cell growth of the prostate gland - Physiologic change of aging Etiology (Cause): - Testosterone-sensitive cellular proliferation - Lack of cellular apoptosis in prostate gland Symptoms: - Urinary frequency - Sudden urges - Small volume with each voiding - Incomplete emptying - Obstruction of urine flow - At risk for UTIs due to urine retention Treatment: - Medical: -- Alpha-blockers (relax smooth muscle and help with urine flow) -- 5-alpha-reductase inhibitors (blocks testosterone which stimulates prostate and may reduce its size) - Surgical: -- Transurethral needle ablation (TUNA) -- Transurethral resection of the free flow of urine (TURP)

Neurotransmitters (sensory perception)

- Excitatory or inhibitory chemical mediators that are released from one neuron to stimulate another; Example: dopamine, serotonin, norepinephrine, Gamma amino-butyric acid (GABA); Excitatory NTs: acetylcholine and norepinephrine; Inhibitory NTs: serotonin, dopamine, GABA

Starling's Law of Capillary Forces

- Explains the movement of fluid that occurs at every capillary bed in the body - Hydrostatic pressure and osmotic pressure oppose each other - These forces opposing each other help maintain fluid exchange, fluid balance and homeostasis.

FAST (stroke)

- Facial: droop, ask to smile - Arm: weakness, one dipped down, unable to raise, grasp stronger in one than other - Speech: difficulty, slurred - Time: to call 911, stroke team, timing for Tx - Nursing should know extended common s/s of stroke and that some individuals can have "unique": Refer to s/s of stroke slide - Nurses should also recognize and connect s/s to patho changes: Hemiparesis, visual field deficits, aphasia, dysphasia, confusion, personality changes - Know and recognize stroke to activate Code Stroke FAST - Time is Brain (optimal intracranial regulation)

intracranial regulation (risk factors for stroke)

- Family history - Age 55+ - Gender; male risk is greater than female - Ethnicity; African American risk is greater than Caucasian - Sickle cell disease - Transient ischemic attack (TIA) - Hypertension (HTN) - Hyperlipidemia = Atherosclerosis - Diabetes - Smoking - Obesity - Lack of exercise - Atrial fibrillation - Oral contraceptives - Excess alcohol

Changing post op dressing

- First dressing changed by surgeon - Types of dressing materials - Sterile technique - Assess wound - Applying dressing, taping methods - Patient response - Patient teaching - Documentation

Wound healing

- First-intention wound healing - Second-intention wound healing - Third-intention wound healing - Factors that affect wound healing

Fluid Volume Imbalances

- Fluid volume deficit (FVD): hypovolemia - Fluid volume excess (FVE): hypervolemia

Medication Administration (pain)

- Focus on prevention & control - Do not wait for severe pain - Constant pain requires around-the-clock administration - Use fast-acting drugs for breakthrough pain

dependent edema

- Forms in the lower extremities - Weakened venous valve system, lack of muscle contractions, gravitational forces - Ex: standing or sitting in one position for too long (Lack of muscle contractions forms this sitting fluid (from standing or sitting after a long work day or plane ride))

Fracture stages of healing

- Fracture and Inflammatory Phase: At the site of the fracture, bleeding occurs and a hematoma develops; inflammation causes vascular permeability and the attraction of WBCs (lasts hours to days). - Granulation Tissue Formation: Fibroblasts are attracted to the area and there is growth of vascular tissue (lasts 2 weeks). - Callus Formation: Osteoblasts and chondroblasts are attracted to the granulation tissue and a callus develops. A callus leads to the formation of new mesh-like bone within 4 to 16 weeks. - Lamellar Bone Deposition: Ossification is beginning and the mesh-like bone is replaced by sheets of mineralized bone; strengthening phase. - Remodeling: Remodeling of the bone at the site of healing; the bone is sculpted and refined. Adequate strength returns in 3 to 6 months.

Pressure ulcer stage 3

- Full-thickness pressure ulcer extending into the subcutaneous tissue and resembling a crater. - May see subcutaneous fat and maybe muscle but no bone, or tendon. Interventions: - can apply a wet-damp dressing to promote healing

Pressure ulcer stage 4

- Full-thickness pressure ulcer involves all skin layers and extends into supporting tissue. - Exposes muscle, tendon, or bone, and may show slough (stringy matter attached to wound bed) or eschar (black or brown necrotic tissue). Interventions: - can apply a wet-damp dressing to promote healing

Gate control theory (Pain)

- Gate Control Theory: PAIN may be thought of as being CONTROLLED by a "GATE" in the CENTRAL NERVOUS SYSTEM - WHEN GATE is OPEN , PAIN SENSATION is ALLOWED THROUGH - Activity in the pain fibers (nociceptive nerve impulses) - opens the gate -- Transduction process - uses neurochemicals to stimulate specialized pain receptors in peripheral nerve endings called nociceptors - Activity in other sensory nerves (endorphins released) - closes the gate

Mental status exam (MSE)

- General observations (appearance, psychomotor activity, attitude) - Orientation (Person, time, place, situation) - Mood, affect - Speech (verbal ability, rate, volume, ability to use words correctly) - Thinking processes and content Cognition: -- Attention and concentration -- Abstract or concrete reasoning -- Memory (recall, short and long term) - Judgement and insight - Risk (suicide, homicide, self harm, falls, etc.)

Types of communities

- Geographic—city, town, neighborhood (citizens of St. Paul) - Common interest—church, professional organization (Minnesota nurses association, student nurses association (SNA)) - Community of solution—group of people who come together to solve a problem that affects all of them (Mothers against drunk driving (MADD), alcoholic anonymous members (AA))

magnesium imbalances

- Hypomagnesemia and Hypermagnesemia - Magnesium is a mineral used in more than 300 biochemical reactions in the body. Like calcium, only about 1% of magnesium is found in the blood. The remaining 99% is divided between the ICF and bone (in combination with calcium and phosphorus). Although magnesium deficiency is rare, you may find low levels in individuals who have a high alcohol intake. Some malabsorption disorders may also cause magnesium depletion.

What might decrease renal perfusion?

- Hypotension, hypovolemia, dehydration, low cardiac output

FVE nursing management

- I&O and daily weights; assess lung sounds, edema, other symptoms - Monitor responses to medications—diuretics and parenteral fluids - Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions - Monitor, avoid sources of excessive sodium, including medications - Promote rest - Meds (diuretics?)

FVD nursing management

- I&O at least every 8 hours, sometimes hourly - Daily weight - Vital signs closely monitored - Skin and tongue turgor, mucosa, urine output, mental status - Measures to minimize fluid loss - Administration of oral fluids - Administration of parenteral fluids

intracellular fluid

- ICF - fluid inside the cells - 2/3 of the body's water. (Constant fluid and electrolyte exchange between the ICF and ECF)

interstitial fluid

- ISF - between the intracellular and extracellular spaces (minimal fluid in this space)

hemorrhagic stroke treatment

- IV Mannitol or corticosteroids to decrease cerebral edema Surgery: •- Endovascular coil embolization or microsurgical clipping of a cerebral aneurysm

Diagnosis

- Identify the patient's nursing problems or potential problems. - Identify the defining characteristics of the nursing problems. - Identify the etiology of the nursing problems. - State nursing diagnoses concisely and precisely. - Collaborative Problems - Identify potential problems or complications that require collaborative interventions. - Identify health care members with whom collaboration is essential.

Emergency management

- Immobilize the body part - Splinting: joints distal and proximal to the suspected fracture site must be supported and immobilized - Assess neurovascular status before and after splinting - Open fracture: cover with sterile dressing to prevent contamination - Do not attempt to reduce the fracture

Immune system (sensory perception)

- Immune - immunosuppression (Exhaustion stage or Allostatic overload)

infection clinical manifestations

- Immune - week 6 - Inflammation - week 3 - local sign of infection - Fever, headache, fatigue, anorexia, malaise - systemic signs - Symptom can indicate system affected (jaundice = liver)

Substance use criteria

- Impaired control over substance use •- Taking substance in larger amounts or over a longer period than was intended •- Persistent desire to cut down or regulate substance use (may have unsuccessful attempts) •- A great deal of time spent obtaining, using, or recovering from its effects •- Craving occurs (an intense desire or urge) •- Social impairment Recurrent use results in failure of work, school, or home obligations Continues to use despite persistent or recurrent social or interpersonal problems caused by substance •- Give up or reduce important social, occupational, or recreational activities because of substance use •- May withdraw from family activities Risky use of substance and failure to abstain despite difficulty •- Recurrent use in situations that are physically hazardous •- Continue to use substance despite knowledge of having physical or psychological problems that are likely caused by the use of the substance •- Pharmacologic effects Tolerance develops—needing more of the substance to achieve desired effect •- Withdrawal syndrome occurs when blood or tissue concentration of a substance declines (may not occur for all substances)

infection genetics

- In TB, as with other infectious diseases, both the genetic makeup of the microbe and the genetic make up of the human work together to create pathways and to regulate the success or failure of the microbe - Pathways to develop and produce vaccines -- Live, inactivated, or genetically engineered -- Reverse vaccinology - promising technique to design vaccines for viral and bacterial pathogens for which no vaccine exists now

Stable cells

- In a resting state until stimulated to divide and replicate - Ex: bone cells after a fracture (grow and divide)

in hospital stroke code and women

- In-hospital stroke code (alert) was activated in 46 (30.9%) of the 149 women - Only 15 (10.1%) of the 149 women received thrombolytic therapy Recommendations based on results - - Special attention and awareness to: - Young women < 60 years and non-Caucasian ethnic groups (Colsch, 2019)

hypertrophy

- Increase in the SIZE of the cells - leads to greater metabolic demand and energy needs Causes: - physiologic - pathologic (opposite of atrophy)

Increased Intracranial Pressure (IICP)

- Increased ICP (IICP) Occurs if Compensatory Mechanisms Fail - Brain insult - slight increase in ICP - attempt normal regulation of ICP - slight increase in CPP - ICP remains high (loss of autoregulatory mechanism) - passive dilation - increased cerebral blood flow - further increase in ICP - cellular hypoxia - uncal herniation or further increase in ICP = Brain death

rural community considerations

- Increased rates of obesity. Barriers include: ●Fewer opportunities for walking or other exercise ●Increased time in cars (commuting, driving to essential services) ●Access to care (preventative, diagnosis, treatment and follow-up care) ●Availability to diabetes educator and/or endocrinologists ●Lack of insurance ●Poverty ●Lower Health Literacy

infectious agents of injury

- Injury caused by microorganisms: bacteria, fungi, viruses, parasites - Each type of microorganism carries out injurious cell processes in a distinctive manner -- H. pylori: bacteria that erodes the gastrointestinal mucosal lining and allows gastric acids to penetrate and damage underlying cells -> peptic ulcers -- Human papilloma virus: virus that causes cancerous cell changes within the cervix

Neuropathic pain (causes of pain)

- Injury to nerves that results in repeated transmission of pain signals even in the absence of stimuli

Administration of potassium

- K+ •- KCl supplements orally or IV •- Check renal function before administering K+ IV -- If urine output less than 20 mL/hr for 2 hours = STOP IV K+ infusion. •KCL IV Should not exceed 10 mEq/hr -- To prevent hyperkalemia and cardiac arrest -- In some cases, health care provider might order a little faster (20 mEq/hr), but balancing cardiac risk

Output (loss)

- Kidney: urine output of 1mL/kg/hr - Skin loss: sensible due to sweating and insensible due to fever, exercise, and burns - Lungs: 300 mL everyday, greater with increased RR - GI tract: large losses due to diarrhea and fistulas - Urine 1500 mL/day Notify provider if its less than 30mls/hour

Least restrictive environment

- Larger concept underlying patient's right to refuse treatment - Def: A person cannot be restricted to an institution when he or she can be successfully treated in the community - Medication cannot be given unnecessarily - Use of restraints or locked room only if all other "less restrictive" interventions have been tried first

Chronic pain

- Lasts months to lifetime - Cancer - Non-cancer

informed consent

- Legal procedure to ensure patient knows the benefits and costs of treatment - Mandate of state laws - Complicated in mental health treatment -- Competency necessary to give consent -- Decision-making ability often compromised in mental illness

Acute pain

- Limited duration - Result of tissue damage, surgery, trauma

Advance care directives in mental health

- Living will, durable power of attorney - Psychiatric advance directives - are written instructions for health care when individuals are incapacitated and unable to make these decisions.

infection (wound complication)

- Localized swelling, redness, heat, pain, fever (temperatures higher than 38°C [100.4°F]), foul-smelling or purulent drainage, or a change in the color of the drainage may also indicate infection. Treatment/interventions: •Clean wound well andn frequently - antibiotics if needed

Impaired tactile senstation (definition)

- Loss of tactile sensitivity can be caused by a cerebrovascular accident (stroke), brain or spinal tumor or injury, or peripheral nerve damage caused by diabetes, Guillain-Barré syndrome, or chronic alcoholism.

Exercise

- Lowers blood sugar - Aids in weight loss, easing stress, and maintaining a feeling of well-being - Lowers cardiovascular risk

Infections covered in class

- MRSA: community acquired- body starts to resist the antibiotics and spread through contact between people - C diff: in fecal matter- coming into contact with fecal matter and ingesting it (contact with people, unsanitary condition, unclean water, and resistant to antibiotics) - Influenza: spread through droplets that people breath, talk, cough or sneeze that travel through the air and enter in your nose or mouth - TB: coming into contact with people that has TB - Covid: coming into contact with people that has covid

Hypomagnesemia nursing management

- Magnesium sulfate IV is administered with an infusion pump, monitor vital signs and urine output - Oral magnesium - Monitor for dysphagia - Seizure precautions - Dietary teaching

feedback system (endocrine)

- Maintains Homeostasis - Keeps hormone levels within a narrow range - Pituitary releases either more tropic hormone or stops depending on the needed hormone level - Goal is to keep everything under control - Essential to maintaining homeostasis - Hypothalamus and pituitary monitor hormone levels in the blood - Depending on the levels, the pituitary responds by rereleasing tropic hormone or stopping the release - This helps to maintain the hormone levels within a needed range

physical agents of injury

- Mechanical trauma from an external force: laceration, fall - Temperature extremes: burns, frostbite - Radiation, electrical shock, extreme changes in atmospheric pressure

delirium causes

- Metabolic disorders: hypoxia; hypoglycemia; electrolyte derangements; alcohol or sedative withdrawal; endocrine disorders; paraneoplastic syndromes; hyperthermia; hypothermia; and/or post-operative, anesthetic, or post-cardiac pump states - Toxins—alcohol, drugs (medicinal or illicit), anticholinergic toxicity, herbs/herbal medicines, some over-the-counter agents, poisons - Infections—intracranial or extracranial - Anatomic disorders—various space occupying or structural brain lesions, tumors, neoplasms, trauma - Environmental disorders—sensory and/or sleep deprivation - Other—fever, postictal states, urinary retention, fecal impaction

complementary therapies

- Method of treatment used in conjunction with biomedical therapies (in addition to... Along with... As well as...)

Maintaining cardiovascular stability

- Monitor all indicators of cardiovascular status (BP and HR) - Assess all IV lines - Potential for hypotension, shock - Potential for hemorrhage (decrease BP and increased HR) - Potential for hypertension, dysrhythmias

Nociceptor pain (Causes of pain)

- Most common - Pain receptors (nociceptors) respond to stimuli - Injury to tissue as a result of trauma, surgery, inflammation

hypoxic cell injury

- Most common cause of cellular injury - Oxygen deprivation - Results when the blood can't deliver enough oxygen to the cells - Ischemia: Diminished circulation -- Occurs due to obstruction to arterial blood flow -- Ex: Atherosclerotic plaque, blood clots - Anemia: Insufficient hemoglobin -- Low hemoglobin -> insufficient oxygen carried by the blood -> cells not receiving fully oxygenated blood -- Other examples: high altitude, pneumonia, airway obstruction. suffocation - Causes the cell to enter anaerobic metabolism: - Decreased production of ATP -> slows down all functions of the cell - Production of lactic acid -> alters cellular activity - Anaerobic metabolism can NOT sustain cell life for a prolonged period

Chlamydia

- Most commonly reported STD in the U.S. - Majority of new cases ages 15-24 - Transmitted through sexual contact and from mom to baby - "silent disease" may be asymptomatic Serious complications for women: - Ectopic pregnancy Infertility - Chronic pelvic pain - Preterm labor - Newborn conjunctivitis or pneumonia

Peripheral IV lines

- Superficial lines - For short term use - Need to assess site for signs of infection and infiltration

safety factors (preschoolers)

- Motor vehicle injuries continue to be a major cause of accidental death, along with drowning, fires, and poisoning. - However, falls are the primary cause of nonfatal injuries. - After age 3, children are a little less prone to falls because their gross and fine motor skills, coordination, and balance have improved. - However, the extension of play to the outside environment (playgrounds, pools, front yards, and so on) creates additional safety concerns. - They have the ability to walk and manipulate objects before they have the judgment to recognize dangers such as falling. - In addition, infants and toddlers are curious and tend to explore the environment by putting objects in their mouth. This is why the incidence of choking is highest between 6 mo and 3 yr of age. - As mobility continues to improve, toddlers gain more freedom, and their curiosity leads them to explore cupboards, stairs, open windows, swimming pools, and other hazards

Elimination of TB

- Multidrug-resistant tuberculosis - Clients with HIV and tuberculosis TB case management: - Isoniazid (INH): Treatment more effective with latent disease then active TB treatment - Directly observed treatment (DOT)

Endogenous opioids (sensory perception)

- Natural analgesic neurochemicals that inhibit pain sensation; Endogenous opioids include endorphins, enkephalins, and dynorphins; Endogenous opioids bind to and inhibit receptors in the axons of incoming C and A-delta fibers, which carry pain signals of nociceptors from the periphery.

To be communicable or contagious:

- Need a Portal of Exit from an infected individual (or animal) - Means of Transmission - Portal of Entry into a susceptible host Infectious diseases may or may not be communicable (spread person to person). *Important to consider the pathogenicity of the infectious organism (definition: the genetic ability or capacity of an infectious agent to cause disease in a susceptible host).*

Nociceptors (sensory perception)

- Nerve fibers that respond to noxious stimuli; Found in the skin, muscle, connective tissue, bone, circulatory system, and abdominal, pelvic, and thoracic viscera; Afferent neurons, which are nociceptors, carry the sensations of touch, temperature, vibration, proprioception, and pain into the dorsal horn of the spinal cord.

dementia causes

- Neurodegeneration: Alzheimer's disease, frontotemporal damage, abnormal tau protein formation, Lewy body proteins, Parkinson's disease - Vascular defects: infarcts, arteriopathies, vasculitis - Toxins: alcohol, lead, manganese, drugs (medicinal or illicit) - Infections: prion disease, human immunodeficiency virus, herpes, neurosyphilis, Whipple's disease, progressive multifocal leukoencephalopathy - Inflammatory or autoimmune disorders: multiple sclerosis, paraneoplastic or autoimmune limbic encephalitis, systemic lupus erythematosis, Sjogren's syndrome, Behcet's disease - Neurometabolic disorders: leukodystrophies, adult neuronal ceroid lipofuscinosis - Other: endocrine disorders, space occupying lesions, trauma, neoplasia, paraneoplastic syndromes, normal pressure hydrocephalus, Wilson's disease, Huntington disease, overwhelming changes of environment

Illness (sensory function)

- Neurological disorders, such as multiple sclerosis, slow the transmission of nerve impulses. - Diseases that affect circulation (e.g., atherosclerosis) may impair function of the sensory receptors and the brain, thereby altering perception and response. - Some diseases affect specific sensory organs. - For example, diabetic retinopathy is the leading case of blindness among adults ages 20 to 74. Hypertension, too, can damage the retina of the eyes.

Intracranial Pressure (ICP)

- Normal ICP is based on brain tissue (80%), cerebrospinal fluid (CSF) (10%), and blood volume (10%). - The pressure of these three elements must remain balanced to maintain normal ICP pressure (7 to 15 mm Hg) - To maintain normal ICP, an increase in the volume of any one of the components must be compensated for by a decrease in the volume of another - pressure inside skull, brain tissue and CSF - Normal ICP= 5-7 (all the way up to 15) - Increased ICP - elevated level of ICP - profound influence on outcome Populations at risk: - Increased ICP - Cerebral edema - trauma (TBI), hemorrhage (TBI or stroke), brain tumor, cerebral inflammation, and ischemia

Mental Health Nursing (definition)

- Nursing practice specialty committed to promoting mental health through the assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions (two or more conditions at the same time) across the life span. - ALL nurses need basic mental health nursing competencies to give safe and effective, holistic care.

actue inflammation

- Occurs rapidly in reaction to cell injury - Rids the body of the offending agent - Enhances healing - Terminates after a short period (hours or days) Causes: - Infections - Microbial Toxins - Physical Injury - Surgery - Cancer - Chemical Agents - Tissue Necrosis - Foreign Bodies - Immune Reactions Stages: 1.Vascular permeability 2.Cellular chemotaxis 3.Systemic responses

chronic inflammation

- Occurs when the inflammatory reaction persists (weeks to months w/o resolution or healing) - Inhibits healing and causes continual cellular damage and organ dysfunction: -- Too much of a good thing -- Chemicals and cells that eliminate the cause of inflammation can damage surrounding cells -- If inflammation persists without resolution, healthy cells become damaged (products of WBCs that allow healing in AC inflam are damaging in CH inflam)

Impaired taste (definition)

- Often occurs with aging, decreased desire to eat, nutritional deficit, possible weight loss.

Gerontological considerations (Intraop)

- Older adult patients are at higher risk for complications from anesthesia and surgery compared to younger adult patients due to several factors: o- Age-related cardiovascular and pulmonary changes o- Decreased tissue elasticity (lung and cardiovascular systems) and reduced lean tissue mass o- Decreases the rate at which the liver can inactivate many anesthetic agents o- Decreased kidney function slows the elimination of waste products and anesthetic agents o- Impaired ability to increase metabolic rate and impaired thermoregulatory mechanisms

B lymphocyte immunity

- One type of adaptive immunity - it is humoral immunity Both types utilize the lymphocyte as the primary cell

Classification of wounds

- Open - Closed - Acute - Chronic - Clean - contaminated(risk for infection) - infected - Superficial - partial or full thickness - Penetrating

Routes of Administration

- Oral: (tablets, liquids, buccal (cheek), sublingual (under tongue), enteral meds (tube feeding) - Topical: (creams, transdermal patches, eye/ear, nasal, vaginal, rectal) - Respiratory inhalants: (nebulizer- atomizers, aerosols, metered dose inhaler) - Parenteral: (intradermal (into dermis), transdermal, subcutaneous (subq tissue), intramuscular, intravenous (catheter or IV))- vials, ampules, reconstituting from powder, 2 meds 1 syringe

Normal flora (infection)

- Organisms that perform advantageous functions for the host. Don't cause infection when they stay put -- Candida, Staphylococcus epidermidis and Lactobacillus bulgaricus

Apoptosis

- Organized process that eliminates unnecessary, unwanted, or damaged cells Example: menopause - Ovaries become dysfunctional and degenerate according to a genetically determined lifespan

The senses

- Our senses give us information about the internal and external environments of our bodies. - Enable people to experience the world. - The purpose of sensation is to allow the body to respond to changing situations and maintain homeostasis. - Necessary for human growth and development. - A sensory experience involves four components in the nervous system: stimulus, reception, perception, and an arousal mechanism. - Stimulus: may be light, touch, sound, etc. - Reception: Process of receiving stimuli from sensory nerve fibers (nerve endings) in the skin and body. - Perception: The ability to interpret the impulses transmitted from the receptors and give meaning to the stimuli (integration and interpretation of the stimuli). - Arousal mechanism or reaction: only the most important stimuli will elicit a reaction.

Pain (sensory perception)

- Pain has both physiological and psychological aspects which makes its severity extremely unpredictable - Transduction: Afferent neurons: Nociceptors - Neurochemicals (Prostaglandins- enhance pain effect) -Action potentials (go to spinal cord and send signals) - Transmission: A-delta (Glutamate - amplify) and C-fiber (unmyelated) - Modulation: Pain theories - GCT and Neuromatrix -- Enkephalins, endorphins, and GABA (inhibit) - Perception: interpretation of pain

Diagnostic studies (Pain and sensory perception)

- Pain scale - Visual analog scale, Wong-Baker FACES scale, imaging based on clinical findings

Signs of hypovolemic shock/hemorrhage

- Pallor - Cool, moist skin - Rapid respirations - Cyanosis - Rapid, weak, thread pulse - Decreasing pulse pressure - Low blood pressure - Concentrated urine

Pressure ulcer stage 2

- Partial-thickness skin erosion with loss of epidermis or also the dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red-pink wound bed. - high risk for stage 3/4

Members of the surgical team

- Patient - Anesthesiologist (physician) or certified registered nurse anesthetist (CRNA) - Surgeon - Nurses - Surgical technicians - Registered nurse first assistants (RNFAs) or certified surgical technologists (assistants) Roles: - Circulating nurse - Scrub role - Surgeon - Registered nurse first assistant - Anesthesiologist, anesthetist - Note: role of nurse as patient advocate

Factors affecting bone healing

- Patient age - Medication use - Nicotine use - Nutrition - Type of fracture - Degree of trauma - Systemic and local disease - Infection

Health Insurance Portability and Accountability Act (HIPAA)

- Patient authorization necessary for the release of information with the exception of that required for treatment, payment, and health care administrative operations American Recovery and Reinvestment Act (2009) - Provisions for managing health information - Focus on maintaining privacy of electronic transfer and storage of health information and communication

Protecting patient from injury (surgery)

- Patient identification - Correct informed consent - Verification of records of health history, exam - Results of diagnostic tests - Allergies (include latex allergy) - Monitoring, modifying physical environment - Safety measures (grounding of equipment, restraints, not leaving a sedated patient) - Verification, accessibility of blood

Nonverbal indicators of pain

- Patient is withdrawn, poor eye contact, poor hygiene - Pain behaviors: rubbing injured area, rocking

Positioning factors for surgery

- Patient should be as comfortable as possible - Operative field must be adequately exposed - Position must not obstruct/compress respirations, vascular supply, or nerves - Extra safety precautions for older adults, patients who are thin or obese, and anyone with a physical deformity - Light restraint before induction in case of excitement

Personality (sensory function)

- People vary in their personalities and lifestyles. Some people, by nature, like excitement, change, and stimulation; others prefer a more predictable and quiet life. - Clients are at risk for sensory alterations if their previous level of stimuli does not match their current level. Health problems, a change of environment, or loss of a partner can each create changes in stimuli.

Voluntary admission

- Person retains full civil rights - Free to leave at any time, even against medical advice. - can leave when they are discharged but if they want to leave before the provider discharges them they need to sign the 12 hour intent to discharge. - Then the provider has to see them within 12 hours and decide to let them go or put them on a 72 hold. Or the provider could say I won't put you on a 72 hour hold but I recommend you stay so if you decide to leave it would be AMA (against medical advice).

Epidemiology base elements

- Person: which groups of individuals are affected? - demographics - Place: where is the health issue occurring? - variables of where - Time: over what specific time period is the health issue occurring? - when did they come i contact? What time were they at a certain place? How long, age...?

Key concepts of pain

- Personal and subjective experience Influenced by multiple factors: - Emotions - Developmental stage - Sociocultural factors - Communication & cognitive impairments - Nurse beliefs --- Knowledge and Attitudes Survey Regarding Pain - Right to pain management - pain affect many body systems

Middle cerebral artery

- Supplies a large area of brain tissue (80%); when occluded, it causes a deficit of a major region of the brain. - Most strokes involve a branch of the middle cerebral artery. - Hallmarks: FAST (face, arm, speech)

Postanesthesia acare

- Phase I PACU: area designated for care of surgical patients immediately after surgery and for patients whose condition warrants close monitoring - Phase II PACU: area designated for care of surgical patients who have been transferred from a phase I PACU because their condition no longer requires the close monitoring provided in a phase I PACU - Phase III PACU: setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility

Regulation of endocrine gland receptors

- Pituitary tropic hormones act on endocrine gland receptors on the target organs/tissues - These receptors react depending on how much stimulation they are getting from the tropic hormones - Downregulation (When the hormone is high) -- A result of prolonged, excessive hormone receptor stimulation. -- Cells decrease in the number and/or sensitivity of cell receptors to a hormone. - Upregulation (When the hormone is low) -- A result of decreased hormone receptor stimulation. -- Increased number of cell hormone receptors and an increase in cell receptor sensitivity.

Safety factors (adults)

- Poisoning is now the major cause of death and injury in this age group, followed by motor vehicle accidents. - Workplace injury may also be a significant concern. - Other injuries to adults are related to lifestyle (e.g., excessive alcohol use), stress, carelessness, abuse, and decline in strength and stamina. - For many, work and family responsibilities often leave little time for regular physical activity, increasing the risk of musculoskeletal injury in the "weekend athlete." •May be exposed to injury in the workplace •Lifestyle choices impact health •Some decline in strength and stamina; others maintain fitness

Deep somatic (source of pain)

- Poorly localized; injuries/disorders affecting bones, joints, muscles, skin, or structures composed of connective tissues EX: surgical, burn, or labor pain

Stroke risk factors

- Populations at risk - 2x > African Americans than Caucasians, African American > death rate. - Hispanics increase has increased since 2013 - Any age but > risk with age - HTN, HF, hyperlipidemia, diabetes, smoking, chronic AFIB, obesity, physical inactivity, high BP, heart disease, smoking, high red blood cell count, atherosclerosis - 5th leading cause fo death in US - top leading cause of disability

Mechanisms of infection

- Portals of entry - the means by which an infectious pathogen enters the host (direct entry, ingestion, inhalation and parenteral - Skin - most vulnerable - Respiratory tract - droplet or airborne - Gastrointestinal tract - fecal oral - Blood-blood - needle stick - Maternal - fetal - congenital infection

Hypokalemia nursing management

- Potassium replacement: Increased dietary potassium or IV for severe deficit - Monitor ECG for changes - Monitor ABGs - Monitor patients receiving digitalis for toxicity - Monitor for early signs and symptoms - Administer IV potassium only after adequate urine output has been established

body-mind interventions (Healing modalities)

- Prayer - Meditation - Imagery - Humor - Music therapy - Yoga - Biofeedback - Hypnosis

Nursing interventions for pain

- Presence - Listening - Communication - Compassion

Nursing interventions pressure ulcers

- Prevention - Meticulous skin care and moisture control - Adequate nutrition - Frequent repositioning - Therapeutic mattresses - Client/family teaching Management: - Conduct a pressure ulcer admission assessment for all patients - Reassess risk for all patients daily - Inspect skin daily - Manage moisture - Optimize nutrition and hydration - Minimize pressure

Community and public health prevention

- Prevention means anticipating and averting problems or discovering them as early as possible in order to minimize potential disability and impairment. - It is practiced on three levels in community health: primary prevention, secondary prevention, and tertiary prevention.

Maintaining patient airway

- Primary consideration: necessary to maintain ventilation, oxygenation - Provide supplemental oxygen as indicated - Assess breathing by placing hand near face to feel movement of air - Keep head of bed elevated 15 to 30 degrees unless contraindicated - May require suctioning - If vomiting occurs, turn patient to side

adrenal insufficiency caused by corticosteroids

- Prolonged corticosteroid use beyond 4-5 week can lead to adrenal insufficiency -- Pituitary gland senses high corticosteroid blood levels (because the sterioid levels are high so we don't make our own corticosteroids) -- Negative feedback suppression of CRH and ACTH from the Pituitary -- Adrenal gland down regulates its receptors - Adrenal gland will atrophy - This leads to the inability to secrete natural cortisol

Inflammation goals

- Protective, coordinated, multi staged response to an injury or infection - Reaction is proportional to the extent of tissue injury (stubbed toe diff response than broken leg) - Can be acute or chronic Goals of inflammation: - Wall-off the area of injury - Prevent spread of the injurious agent - Bring the body's defenses to the region under attack

Nurse management PACU

- Provide care for patient until patient has recovered from effects of anesthesia -- Resumption of motor and sensory function o- Oriented o- Stable VS o- Shows no evidence of hemorrhage or other complications of surgery - Vital to perform frequent skilled assessment of patient Assessment: o- Respiratory (airway, breathing, circulation) o- Pain (level of pain) o- Mental status/LOC o- General discomfort

In the Mania video with Christine, what would be some expected outcomes for Christine given her nursing diagnosis?

- Pt will be oriented to person, place, time, situation. - Pt will demonstrate self-control AMB non-intrusive behaviors around other patients.

The depression video of a women Louise, what would be some expected outcomes for Louise given her nursing diagnosis?

- Pt will talk about her feelings - Pt will spend at least 2 hours out of her room

Strain

- Pulled muscle injury to the musculotendinous unit - Pain, edema, muscle spasm, ecchymosis, and loss of function are on a continuum graded first, second, and third degree

hypercalcemia nursing management

- Treat underlying cause - Administer IV fluids, furosemide, phosphates, calcitonin, bisphosphonates - Increase mobility - Encourage fluids - Dietary teaching, fiber for constipation - Ensure safety

Healthy people 2020 goals for HIV and AIDS

- Reduce the number of people who become infected with HIV - Increase access to care and improve health outcomes for people living with HIV - Reduce HIV-related health disparities •Reduce Stigma! •Improve access to care, culturally competent care •1 in 8 do not know they are HIV status and asymptomatic •Routine Screening for ages 13-64 •Retroviral therapy for all living with HIV •Access to Early treatment = better outcomes •Prevention medication (PrEP and Truvada)- educate that they are not 100%

Intraoperative interventions

- Reducing anxiety - Reducing latex exposure - Preventing perioperative positioning injury - Protecting patient from injury - Serving as patient advocate - Monitoring, managing potential complications

Preventing STDs

- Reducing stigma around seeking care, access to affordable care, completion of treatment - Changes in behavior require diverse and multidisciplinary interventions. - Integration of efforts of parents, families, schools, religious organizations, health departments, community agencies, and the media - Educational programs that provide adolescents with the knowledge and skills to -- Refrain the early onset of sexual intercourse -- Make informed decisions related to sexual behavior and health -- Increase the use of contraceptive/protective measures

associative looseness nursing interventions (schizophrenia)

- Refers to haphazard and confused thinking that is manifested in jumbled and illogical speech and reasoning. Thinking that is not bound to reality but reflects the private perceptual world of the individual. •Do not pretend you can understand what the client is saying •Tell client that you are not able to understand what he/she is saying •Look for reoccurring themes •Orient to reality

renin-angiotensin-aldosterone system (RAAS)

- Renin is an enzyme released from the kidneys in response to decreased renal perfusion - Renin converts angiotensinogen from the liver into angiotensin I - In the lungs, the angiotensin converting enzyme (ACE) changes angiotensin I to angiotensin II, a powerful vasoconstrictor - Angiotensin II stimulates the release of aldosterone to increase sodium and water reabsorption into the bloodstream

RICE method

- Rest (helps the body to use nutrients and oxygen for the healing process.) - Ice - Compression (serves to counter the vasodilation effects and development of edema.) - Elevation (injured extremity above the level of the heart will reduce the edema at the inflammatory site by increasing venous and lymphatic return and helps reduce pain associated with blood engorgement at the injury site.) - Immobilize - Anti-inflammatory medications (is used within the first 24-48 hours of injury and then alternate with heat can be used after that normally for chronic issues which promotes circulation)

PACU nurse responsibilities

- Review pertinent information, baseline assessment upon admission to unit - Assess airway, respiratory function, cardiovascular function, skin color, level of consciousness, and ability to respond to commands - Reassess VS, patient status every 15 minutes or more frequently as needed - Administration of postoperative analgesia - Transfer report, to another unit or discharge patient to home

Dehiscence (wound complication)

- Rupture (separation) of one or more layers of a wound - most likely to occur in the inflammatory phase of healing, before large amounts of collagen have been deposited in the wound to strengthen it. - common causes: poor nutritional status, inadequate closure of the muscles, or wound infection. Treatment/interventions: - Obesity (lifestyle changes) Surgery (limit activity (lifting) and strain on suture, stool softeners)

Unconscious patient (safety measures)

- Safety measures are a priority for unconscious patients. Keep the bed in low position when you are not at the bedside, and keep the siderails up. If the patient's blink reflex is absent or his or her eyes do not close totally, you may need to give frequent eye care to keep secretions from collecting along the lid margins. The eyes may be patched to prevent corneal drying, and lubricating eye drops may be necessary. Oral care is also important because the unconscious patient does not take fluids by mouth.

GI tract defense

- Saliva - contains enzymes and antibacterial substances - Gastric Mucus -traps pathogens and destroys with hydrochloric acid - Intestinal flora -'normal' flora or 'good' bacteria that live in the intestinal system.

Immunization knowledge

- Schedule of vaccinations - Community's immunization status - Herd immunity - Barriers to immunization coverage - Planning and implementing immunizations campaigns - Adult immunizations - Immunizations needs of international travelers, immigrants, and refugees

Secondary phase (antibody mediated response)

- Second exposure to same antigen initiates 'amnestic response' - Stimulates increased levels of IgG (predominant Ig made after re-exposure to antigen) - makes up 75-85% of total Igs

Types of wound drainage

- Serous exudate: straw colored and watery in consistency (clean wounds usually drain) - Sanguineous: bloody drainage and indicates damage to capillaries (Usually with deep wounds or highly vascular areas) - Serosanguineous: mix of bloody and straw-colored fluid - Purulent: yellow, contains pus and seen in infected wounds. (pyrogenic bacteria)

hypercalcemia (causes and manifestations)

- Serum level greater than 10.2 mg/dL - Hypercalcemia crisis has high mortality - Causes: malignancy and hyperparathyroidism, bone loss related to immobility, diuretics - Clinical manifestations: polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias

Hypermagnesemia ((causes and manifestations)

- Serum level greater than 3.0 mg/dL - Rare electrolyte abnormality, because the kidneys efficiently excrete magnesium - Causes: kidney injury, diabetic ketoacidosis, excessive administration of magnesium, extensive soft tissue injury - Manifestations: hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, and cardiac arrest

hypomagnesemia (causes and manifestations)

- Serum level less than 1.3 mg/dL - Associated with hypokalemia and hypocalcemia - Causes: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood - Manifestations: Chvostek and Trousseau signs, apathy, depressed mood, psychosis, neuromuscular irritability, muscle weakness, tremors, ECG changes and dysrhythmias

Prevention of infection

- Surgical environment o- Unrestricted zone: street clothes allowed o- Semirestricted zone: scrub clothes and caps o- Restricted zone: scrub clothes, shoe covers, caps, and masks - Surgical asepsis - Environmental controls To help decrease microbes, the surgical area is divided into three zones: the unrestricted zone, where street clothes are allowed; the semirestricted zone, where attire consists of scrub clothes and caps; and the restricted zone, where scrub clothes, shoe covers, caps, and masks are worn. The surgeons and other surgical team members wear additional sterile clothing and protective devices during surgery.

Third spacing complications

- Surrounds organs and interferes with function - Pleural effusion prevents full lung expansion and ventilation - Pericardial effusion constricts the heart and prevents maximum filling

adrenal gland

- The adrenal gland sits on top of the kidney - Made up over the outer cortex and inner medulla - Cortex- Secretes glucocorticoids/corticosteroids, androgens, and mineralocorticoids -- Cortisol- Helps the body deal with stress in the short-term -- Aldosterone- assists in managing the fluid and electrolyte balance - Medulla-Secretes epinephrine and norepinephrine

cerebrovascular circulation and metabolism (intracranial regulation)

- The brain is the most energy-consuming organ in the body, using 20% of the body's oxygen. Also, brain cells solely use glucose to function. - Brain cell metabolism requires a continuous supply of oxygen and glucose. - Lack of cerebral blood flow causes cerebral hypoxia, which causes brain dysfunction. A lack of oxygen for as little as 10 seconds causes a loss of consciousness. A lack of oxygen for 5 minutes causes brain cells to die. - Hypoxia and hypoglycemia have a profound effect on the brain, often causing loss of consciousness and, in some cases, brain death.

Monro-Kellie Doctrine (Intracranial regulation)

- The concept of maintaining normal pressure within the cranium by the compensatory mechanism of one component decreasing to compensate for an increase in another component is known as the Monro-Kellie doctrine. - "fixed box" - compensatory mechanism by compliance to maintain equilibrium

corticospinal tract and decussation (intracranial regaulation)

- The corticospinal neurons in the brain run downward and cross at the medulla to the opposite side of the spinal cord. - The crossing point = decussation - The hemisphere of the brain controls the contralateral side of the body. - R hemisphere lesion = dysfunction in L side body - L hemisphere lesion = dysfunction in R side body

healthy endocrine function

- The endocrine glands must release the correct amount of hormones -- If they release too much or too little, it is known as hormone imbalance - Your body also needs a strong blood supply to transport the hormones throughout the body. - There must be enough receptors (which are where the hormones attach and do their work) at the target tissue. - Those targets must be able to respond appropriately to the hormonal signal.

Safety factors (adolescents)

- The leading cause of death in this age group is motor vehicle accidents, followed by homicide. - Both of these are frequently associated with alcohol and drug use. - Sports and recreational injuries, including diving and drowning incidents, are also common, especially when drinking and drug use are involved. - Peak physical, sensory, and psychomotor abilities give teenagers a feeling of strength and confidence, yet they lack the wisdom and judgment of adults. - This combination, along with feelings of being indestructible, makes them more likely to participate in risk-taking behavior, and, in turn, more prone to injury.

ischemic penumbra and glutamate

- The perimeter around the core ischemic area is called the ischemic penumbra - Stroke - cerebral blood flow disrupted = core ischemia (irreversible infarction) = ischemic penumbra (viable cerebral tissue) - Neuronal injury -> failure of cellular ion pumps -> increased calcium ion influx -> increased release of glutamate into the synaptic space. - Sustained elevations of extracellular glutamate extends the stroke region.

Metaplasia

- The replacement of one cell type by another cell type - Commonly occurs in response to changed environmental conditions or consistent stressors - The substitution of cells enables the tissue's survival - When the stressor is removed or the environment returns to normal, the cells often revert back to their original state Ex. GERD

Boundaries

- Therapeutic relationship: is one that allows nurses to apply their professional knowledge, skills, abilities and experiences towards meeting the health needs of the patient. - Overinvolvement: includes boundary crossings, boundary violations and professional sexual misconduct. - Under involvement includes patient abandonment, disinterest and neglect, and can be detrimental to the patient and the nurse. - Professional boundaries are the spaces between the nurse's power and the patient's vulnerability. - Boundary crossings are brief excursions across professional lines of behavior that may be inadvertent, thoughtless or even purposeful, while attempting to meet a special therapeutic need of the patient. - Boundary violations can result when there is confusion between the needs of the nurse and those of the patient.

Third spacing

- Third space accumulation of fluids: When fluids become "hidden" in body cavities that are normally free of fluids -- Pericardial sac around heart -- Peritoneal cavity -- Pleural space around lungs

Sensory deprivation (definition)

- This is a state of RAS depression caused by a lack of meaningful stimuli. - When environmental stimuli are deficient, the remaining stimuli, such as distant noises, minor pain, and cold extremities, can become overly noticeable or distorted, filling in the "sensory gap" and causing the patient a level of distress that is out of proportion to the intensity of the stimulus. - Think of a patient in isolation or even a prisoner in solitary confinement.

treatment of hypothyroidism

- Thyroid hormone pill (Levothyroxine) once a day. - This medication is a pure synthetic form of T4 which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. - The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established.

What is the goal of the RAAS

- To achieve adequate renal perfusion - How? = By increasing blood pressure and blood volume

It's 7 days later and you are the nurse working in the orthopedics clinic and assess Mr. Jones' pain at his first post-op appointment. He tells you his pain rates 3/10 on average, and increases to 7/10 during physical therapy exercises. He has been cutting his PT sessions short due to pain. - How do you recommend he improve his pain management?

- Utilize acetaminophen (Tylenol) on a scheduled basis; take oxycodone 30-60 minutes before physical therapy sessions; apply ice after physical therapy.

longterm complications (diabetes, peripheral neuropathy)

- Very common - Issues with sensation or pain (tingling, may not feel anything = risk for injury) •Sensory motor nerves in lower extremities •Damage to small arterioles that supply the nerves. •No blood supply= demyelination and axonal injury to nerves •Loss of sensation in the feet •60% to 70% of patients with diabetes have some degree of neuropathy •Nerve damage due to metabolic derangements of diabetes •Sensory versus autonomic neuropathy

impaired vision (definition)

- Visual deficits may result from trauma or disease of the eye, microvascular problems, or CNS disorders. - Common causes of visual deficits include age-related changes, refractive errors, orbital trauma, cataracts, glaucoma, diabetic or hypertensive retinopathy, macular degeneration, or loss of visual fields after a stroke. - Changes in vision affect all aspects of daily living and may severely limit mobility and interaction. - When interacting with a person with blindness in one eye place items on the side of the healthy eye to aid the person in seeing the items.

vulnerable populations definition

- Vulnerability is susceptibility to poor health. Often, vulnerable populations are subpopulations: ●Ethnic or racial minorities ●The uninsured ●Those with HIV/AIDS ●Children ●The elderly ●The poor ●Those who are homeless ●Those with a mental illness The public health nurse (PHN) caseload often consists largely of vulnerable populations

endocrine dysfunction

- What happens when there are problems along hypothalamus-pituitary-hormone axis? 1.Hormone Deficiency 2.Hormone Excess 3.Hormone Resistance As we discuss our clinical models, think about which of these is taking place

washing your hands

- What is your number one way to prevent infection? Not only the provider but also the patient. •When you arrive in the unit •When you leave the unit •Before and after restroom use •Before and after client contact •Before and after contact with client belongings When?: •Before gloving •After glove removal •Before and after touching your face •Before and after eating •After touching a contaminated article •When you see visible dirt on your hands

Aggravating and relieving factors of pain

- What makes your pain better? What makes your pain worse? - Ice, heat, pressure, rest, medications, eating, positioning

Onset of pain

- When did the pain start? - Hours, days, weeks, months

Impaires smell (definition)

- When the sense of smell is lost (anosmia), food does not taste the same. Patients who are unable to smell food lose their appetite, and nutritional deficits may result. Permanent anosmia may develop after cranial nerve damage, a tumor, or atherosclerosis.

HIV/AIDS/TB coinfection

- Without treatment, as with other opportunistic infections, HIV and TB can work together to shorten lifespan. - Someone with untreated latent TB infection and HIV infection is much more likely to develop TB disease during his or her lifetime than someone without HIV infection. (weakened immune system) - Among people with latent TB infection, HIV infection is the strongest known risk factor for progressing to TB disease. - A person who has both HIV infection and TB disease has an AIDS-defining condition.

Dysfunctional wound healing

- Wound Rupture -- Dehiscence: when previously closed wound edges open and rupture -- Evisceration: when internal tissues and organs extrude from the open wound - Keloid Formation: increased collagen formation à hypertrophic scar - Contractures: inflexible shrinkage of wound tissue that pulls the edges towards the center of the wound - Fistula: abnormal connection between two different tissues or organs - Adhesions: abnormal bands of internal scar tissue that can form following invasive surgical procedures - Most serious: -- dehiscence and evisceration require immediate wound protection with sterile, saline-moistened dressings - Evisceration is the worst, as the internal organs are exposed.

open (compund) fracture

- Wound extends to the bone - Grade I: 1 cm long clean wound - Grade II: larger wound without extensive damage - Grade III: highly contaminated, extensive soft tissue injury, may have amputation - internal fixation devices hold bone fragment in position (metallic pins, wires, screws, plates)

Schizophrenia assessment

- You need to do a mental status exam - the areas of behavior, appearance, thought content and processes, cognition, perceptual disturbances and suicide or homicide ideation will be essential.

Pathogen (infection)

- a bacterium, virus, or other microorganism that can cause disease -- Main categories Bacteria, Viruses, Fungi , Parasites, Prions

sympathetic adrenal-medullary (SAM) system

- a circuit that responds to perceived stressors by initiating the release of epinephrine and norepinephrine into the bloodstream - SAM: activates hypothalamus which activates the sympathetic nervous system with a flow of glucose and O2 to muscles and brain. SNS Stimulates the adrenal medulla to release epinephrine which initiates the "fight or flight" response.

Base

- a compound that accepts hydrogen ions in a solution - When bases dominate, a solution is alkaline

acid

- a compound that donates hydrogen ions in a solution - When acids dominate, a solution is acidic

hypothalamic-pituitary-adrenal (HPA) axis

- a major neuroendocrine pathway relevant to the stress response involving the hypothalamus, pituitary gland, and the adrenal cortex - HPA: causes hypothalamus to release the corticotropin-releasing factor which stimulate the pituitary gland to release the ACTH which stimulates the adrenal cortex to produce corticosteroids which stimulate the liver to release energy and suppress the immune system

Buffer

- a neutralizer that attempts to balance the pH - Carbonic acid buffer system absorbs or releases hydrogen ions in response to pH changes in the body

Psychosis (definition)

- a state in which a person experiences hallucinations, delusions, or disorganized thoughts, speech, or behavior. This is the key diagnostic factor in schizophrenia spectrum disorders. - a term used to describe a state in which an individual experiences positive symptoms of schizophrenia, also known as psychotic symptoms (e.g., hallucinations; delusions; disorganized thoughts, speech, or behavior).

negative symptoms (schizophrenia)

- absence of - Impaired ability to hold a job, have meaningful relationships, maintain adequate health and grooming - Poor social functioning - Difficult to assess when overshadowed by positive symptoms - Apathy - absence of emotion - Avolition - lack of motivation to pursue meaningful goals - Alogia - inability to speak because of mental deficiency - Anhedonia-inability to feel pleasure - Affect - what the nurse observes as pt's emotional state - Flat: blank facial expression - Blunted/constricted: reduced or minimal emotion - Inappropriate: emotion incongruent with circumstances of situation - Bizarre: odd, illogical, emotional state that is profoundly inappropriate - social withdrawal - changes in emotions

positive symptoms (schizophrenia)

- added on - Alterations in thinking: delusions, concrete thinking - Alterations in perception: hallucinations Depersonalization (lost their identity or self is different; may be body parts that don't belong to them) Derealization (false perception that environment has changed; like everything seems bigger or smaller) - Disordered thinking tends to be apparent through speech - Associative looseness (ideas illogically tied to each other; thinking is difficult to follow and is illogical) - Neologisms (made up words) - Echolalia (repeating another's words) Clang association (words chosen based on sound, not meaning) - Word salad (jumble of words - meaningless) Behavior/Motor changes: - (Bizarre and agitated behaviors), (eccentric dress, grooming or rituals) - Catatonia: pronounced decrease in rate and amount of movement (or pronounced increase) - Motor retardation: pronounced slowing of movements - Motor agitation: excited behaviors (running or pacing rapidly) often in response to internal or external stimuli

Fistula formation (wound complication)

- an abnormal passage connecting two body cavities or a cavity and the skin. - often result from infection - An abscess forms, which breaks down surrounding tissue and creates the abnormal passageway. Chronic drainage from the fistula may lead to skin breakdown and delayed wound healing. The most common sites where fistulas form are the gastrointestinal and genitourinary tracts.

hyperthyroidism/grave's disease

- anxious, hyperactive to help remember symptoms

free radical injury

- are a by-product of energy production that occurs in the mitochondria of the cells - are unstable cells that react with other cells, disrupting internal organelles and damaging the nucleus and DNA - Cells have mechanisms to remove these cells and minimize injury from them - can cause cellular injury to healthy cells

delusions (definition)

- are erroneous, fixed, false beliefs that cannot be changed by reasonable argument. They usually involve a misinterpretation of experience. For example, the patient believes someone is reading his or her thoughts or plotting against him or her. Various types of delusions include the following: Grandiose: the belief that one has exceptional powers, wealth, skill, influence, or destiny Nihilistic: the belief that one is dead or a calamity is impending Persecutory: the belief that one is being watched, ridiculed, harmed, or plotted against Somatic: beliefs about abnormalities in bodily functions or structures Control delusion False belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior.

Afferent neurons (sensory perception)

- are sensory nerves that carry pain, temperature, touch, proprioception, vibration, and pressure sensations into the spinal cord. - Afferent neurons can be categorized as A-delta and C fibers - A-delta fibers are small in diameter and myelinated. These fibers conduct impulses rapidly and cause the first, short-lived acute experience of pain, , such as occurs when a finger senses a burn and pulls away from the heat source. - C fibers are smaller (than A-delta) in diameter and unmyelinated. These fibers conduct impulses slowly and cause longer-lasting, persistent, dull pain, such as the pain that occurs after a burn has taken place.

C fibers (sensory perception)

- are smaller in diameter and unmyelinated. These fibers conduct impulses slowly and cause longer lasting, persistent dull pain.

Dislocation

- articular surfaces of the joint are not in contact - A traumatic dislocation is an emergency with pain change in contour, axis, and length of the limb and loss of mobility

Causes of hypothyroidism

- autoimmune disease (hashimoto's) atrophy of thyroid glad with aging, treatment for hyperthyroidism (radioactive iodine, thyroidectomy), medications (lithium, iodine compounds anti-thyroid medications), radiation to head and neck in treatment for head and neck cancers, lymphoma, infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma), iodine deficiency and iodine excess. Complications: Myxedema Coma: initially signs of depression, diminished cognitive status, lethargy, somnolence. Progressing to stupor, coma and death. Can exhibit hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia, hypothermia.

acute inflammation Systemic responses (stage 3)

- begins to become systemic and not localized Symptoms: - Fever - Pain - Lymphadenopathy - Anorexia - Sleepiness - Lethargy - Anemia - Weight loss Why do patients develop a fever as part of the inflammatory response?: - Common manifestation of inflammation and infection - Microbial organisms, bacterial products, and cytokines all act as substances that cause fever. - Pyrogens activate prostaglandins to reset the temperature-regulating center in the brain to a higher level. How does this help achieve the goals of the inflammatory process? - A higher body temperature increases the efficiency of WBCs and inhibits the growth of microorganisms.

hemianopsia

- blindness in one half of the visual field of one or both eyes Manifestation: - unaware of persons or objects on side of visual loss - neglect of one side of the body - difficulty judging distances (depth perception) Nursing Inter: - place objects within intact visual field, approach pt from this side as well. - remind/instruct pt to turn head more to compensate for visual loss - encourage eye glasses

panic disorder

- experiences unexpected panic attacks, is worried about having more panic attacks, individual changes behavior - can lead to social isolation and various avoidance's/ phobias/ disorders (ex. agoraphobia, fear of buses, fear of social gatherings..) Diagnostic: recurrent and unexpected panic attacks with other symptoms (ex. sweating, feeling of choking, dizziness, numbness or tingling sensation, chest pain or discomfort, nausea, shaking, pounding heart) Interdisciplinary treatment: - safe and therapeutic environment - medication and monitoring of effects - individual psychotherapy - psychological testing - priority care issues (safety became of high risk for suicide)

Pandemic

- global spread of a specific disease

hypertonic solution

- higher concentration than blood (more solutes than blood) - More solutes than water -> causes a fluid shift from ICF to ECF - Used to diminish cell swelling (cerebral edema) (more fluid into blood stream/vessels from cells) - Ex: Mannitol or 3% NaCl

calcium imbalances

- hypercalcemia and hypocalcemia - Calcium is responsible for bone health and neuromuscular and cardiac function. It is also an essential factor in blood clotting. About 99% of body calcium is located in the bones and teeth. The remaining 1% circulates in the blood and affects system functions. As serum levels drop, calcium leaches from the bones into the blood to compensate. If dietary intake is not sufficient to replace it, bone loss occurs; prolonged deficiencies lead to osteoporosis.

chloride imbalances

- hyperchloremia and hypochloremia - This is the most abundant anion in the extracellular fluid. It is usually bound with other ions, especially sodium or potassium (e.g., as sodium chloride, or salt). A healthy adult between the ages of 19 and 50 should consume 2.3 grams of chloride each day along with 1.5 grams of sodium to replace daily losses and maintain serum blood levels (IOM, 2004).

cardiovascular system (pain effects)

- hypercoagulation - increased heart rate - increased blood pressure - increases oxygen demand

Endocrine system (pain effects)

- hyperglycemia - inflammation

Fluid volume excess (hypervolemia)

- hypervolemia - Isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF - Secondary to an increase in the total body sodium content

fluid volume deficit (hypovolemia)

- hypovolemia - May occur alone or in combination with other imbalances - Loss of extracellular fluid exceeds intake ratio of water -- Electrolytes lost in same proportion as they exist in normal body fluids - Dehydration -- Not the same as FVD -- Loss of water alone, with increased serum sodium levels

conservative measure for pain

- ice - heat - reposition

musculoskeletal system (pain effects)

- impaired muscle function - fatigue - immobility

Osmoreceptors and ADH

- in the hypothalamus respond to changes in blood osmolarity and blood fluid volume - (concentration of solutes in the blood and blood fluid volume) - When blood osmolarity is high (concentrated - lots of solutes)... -- The thirst center is stimulated, to get more fluid in the body to dilute out high osmolarity -- ADH is also released, to prevent fluid from leaving the body (to decrease urine output from leaving the body) drinking more water and keeping the water they have in their body to decrease osmolarity back to where it should be - osmoreceptors, ADH and thirst work together to increase fluid in the body.

Will osmotic pressure increase or decrease after admin of a hypertonic solution?

- increase - pulling more solutes of fluid from cells to the bloodstream)

Hyperplasia

- increase in number of cells - Only occurs in tissues with cells that are capable of mitotic division: - Epithelium - Glandular tissue Causes/Types: - Compensatory - Hormonal

how often do you monitor a patient in restraints?

- initial monitoring is done whenever necessary but at least every 15 minutes of first hour by LIP or RN. - when patient is stable and without significant changes can be monitored at least every 4 hours for adults, every 2 hours for children from 9 to 17 years of age, and at least every hour for those less than 9 years of age.

Sprain

- injury to ligaments and supporting muscle fiber around a joint - Joint is tender, and movement is painful, edema; disability and pain increases during the first 2 to 3 hours

Peripherally generated (origin of pain)

- injury to peripheral nerve EX: diabetic peripheral neuropathy

Sensory perception

- involves receiving and interpreting environmental stimuli, and depends on normal sensory receptors, an intact reticular activating system (RAS), and functional nervous pathways to the brain. - The nurse is responsible for the assessment of sensory perception functioning, as well as implementing treatment or altering the client's plan of care when dysfunction is present.

Intracranial Regulation

- involves the processes that affect equilibrium within the brain and therefore, neurological function - Nurses must understand the impact of alterations in intracranial regulation to provide effective client care. - process of neural and sensory systems - Normal vs abnormal processes (adequate vs inadequate) - alterations in blood brain barrier, cranial nerve function, cerebrospinal fluid, autoregulation, LOC - Interrelated concepts: perfusion, gas exchange, metabolism, cognition, sensory perception, mobility - Outcomes: Good - age appropriate ADLs, cognitive function; Poor - LOC/cognitive function, brain tumors/lesions, cerebral edema, IICP - Assessment: age appropriate responses to stimuli, CN, ICP, CPP, MAP

general anesthesia

- involves the total loss of body sensation and consciousness induced by anesthetic agents administered primarily by inhalation or intravenous injection

tolerance (sensory perception)

- is a state of adaptation in which chronic exposure to a drug causes gradual decreasing results over time.

Recombinant tissue-type plasminogen activator (rt-PA) (ischemic stroke)

- ischemic stroke Tx •rt-PA dissolves the clot •MOA - binds to fibrin rich clot - activates plasminogen = forms cleaved plasmin - plasmin then degrades fibrin matrix = dissolves clot rt-PA exclusion criteria: - Current intracranial hemorrhage or active internal bleeding - Current severe uncontrolled HTN - Taking anticoagulant, regardless INR

accreditation of mental health care delivery systems

- joint commission (JCO) The Joint Commission is the nation's leading accrediting body for health care organizations. -behavioral healthcare organizations providing mental health care, addictions treatment services, opioid treatment programs, child welfare services, foster care, and services to persons with intellectual/developmental disabilities. The Joint Commission's role in the behavioral health care environment and human services is well established and nationally renowned.

Depression symptoms

- low interest/pleasure - worthless feelings - weight loss - low thinking - insomnia/hypersomnia - thoughts of death - fatigue/loss of energy & significant distress SIGECAPS: - Sleep - Interest - Guilt - Energy - Concentration - Appetite - Psychomotor slowing - Suicidal Ideation

Transient Ischemic Attack (TIA) (intracranial regulation)

- mini stroke - Disruption of cerebral circulation with neurological deficits < 24 hours -- Stoke = permanent neuro injury -- TIA = 0 permanent neuro injury •Temporary neurologic deficit resulting from a temporary impairment of blood flow •"Warning of an impending stroke" •Diagnostic workup is required to treat and prevent irreversible deficits - RINDS - reversible ischemic neurological deficits - TIA lasting > 24 hours without interruption

prevalence

- number of active ongoing cases of infection at any given time

Incidence

- number of new cases of infection within a population

substance induced disorders

- occur when medications used for other health problems or medical/mental health disorders causes intoxication, withdrawal, or other health-related problems.

Infection (def)

- or infectious disease, is a state of tissue destruction resulting from invasion of microorganisms into the body - Nurses play an important role in the prevention, detection, and treatment of infection for clients receiving care. - found among people of all ages, races and geographic locations. SDOH, diseases/comorbidities can increase risk - process of integumentary and immune systems -- Normal vs abnormal processes (adequate vs inadequate) - disease caused by microorganisms that invade tissue -- Interrelated concepts: tissue integrity, nutrition, fluid and electrolyte balance, perfusion, inflammation, mobility, oxygenation, immunity -- Outcomes: Good - tissue repair (wound healing) Poor - immune suppression, tissue skin breakdown, altered fluid/electrolyte balance, improper thermoregulation -- Assessment: labs, pain, swelling Etiology - microorganisms (bacteria, viruses, fungi, parasites, prions)

Osmolality

- osmoles of solute per kilogram of solvent - the concentration of a solution expressed as the total number of solute particles per kilogram. (Osm/Kg) - MASS of solvent - ex. Concentration of NesQuick in one kg of milk moles/1 kg of solvent

Osmolarity

- osmoles of solute per liter of solution - the concentration of a solution expressed as the total number of solute particles per liter. (Osm/L) - VOLUME of total solution - ex. Concentration of NesQuick in 1 liter of hot chocolate (solution) Moles of something (particle)/1 L of solution

hemiplegia

- paralysis of one side of the body Manifestations: - paralysis of the face, arm, and leg on the same side (due to lesion in the opposite hemisphere) Nursing Inter: - encourage ROM exercises on affected side - provide immobilization as needed to affected side - exercise unaffected limbs to increase mobility, strength and use

oncotic pressure

- pressure exerted by ALBUMIN (IN THE BLOOD) - Pulls water into the bloodstream from the ISF and ICF - (Just like osmotic pressure but specific to Albumin)

Mean Arterial Pressure (MAP and ICP)

- pressure that propels blood to tissues - cerebral perfusion pressure -(CPP) and increased cranial pressure (ICP) - CPP - net pressure = cerebral blood flow for brain perfusion (normal 60 and 80 mm Hg) decreased CPP = ischemia and increased CPP = IICP - MAP - average pressure in a patient's arteries during one cardiac cycle increased MAP = increased Cerebral blood flow and IICP = decreased MAP - Crucial to maintain normal ICP, MAP and CPP for adequate brain perfusion and oxygenation thus adequate intracranial regulation

MN Nurse practice act

- provides definitions of practical nursing, professional nursing, and advanced practice registered nursing, and provides legal parameters to the scope of practice for nurses.

epidural anesthesia

- regional anesthesia produced by injecting medication into the epidural space of the lumbar or sacral region of the spine

kidneys in acid/base balance

- regulate bicarbonate (HCO3) BASE - Alkalotic: Increase secretion in the urine -> lower pH (more acidic normal range) - Acidic: Increase reabsorption in the bloodstream -> raise pH (more basic normal range)

Lungs in acid/base balance

- regulate carbon dioxide (CO2) ACID - Acidic: Increase ventilation -> eliminate CO2 -> raise pH (more basic normal range) - Alkalotic: Decrease ventilation -> retain CO2 -> lower pH (more acidic normal range)

hypothalmic-pituitary-adrenal axis

- regulatory system of the brain made of the hypothalamus control center and the pituitary and adrenal glands; it influences a person's response to stress and his or her ability regulate emotions -Hypothalamus: connect endocrine to the nervous system and decides what hormones need to be made to create balance and stimulates pituitary gland -Pituitary: involved in every process (master gland), secretes tropic hormone and target organ makes hormone we need

Hemorrhage (wound complication)

- risk of hemorrhage is greatest in the first 24 to 48 hr following surgery or injury. - Swelling of the affected body part, pain, and changes in vital signs (i.e., decreased blood pressure, elevated pulse) may indicate internal bleeding. - External hemorrhage is easier to recognize. You will see bloody drainage on the dressings and in the wound drainage devices. When there is a brisk hemorrhage, blood often pools underneath the client as the dressings become saturated. Treatment: •Pressure on wound if possible •Vitals (low BP) •For internal bleeding the site would be swollen/distended

Uncal herniation (intracranial regulation)

- subtype of transtentorial herniation - Uncal herniation (Part of the temporal lobe, the uncus) #1 is forced through the tentorial notch # 6 —the opening in the sheet of tissue between the temporal lobe and cerebellum - Uncus of temporal lobe slips through notch of tentorium and compresses the ipsilateral CN 3, brainstem, & vital centers - Life threatening

Stroke

- sudden impairment of cerebral circulation •"Brain attack" •Sudden loss of function resulting from a disruption of the blood supply to a part of the brain •Transient Ischemic Attack (TIA) •Types of stroke: refer to Table 67-1 -Ischemic (80%-85%) -Hemorrhagic (15%-20%)

Tonicity

- the amount of solutes in a solution compared to the bloodstream - (concentration compared to solutes in the bloodstream)

Health literacy (definition)

- the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health-related decisions. The ability to read and understand health information is key to managing health problems.

glucose

- the form of sugar that circulates in the blood and provides the major source of energy for body tissues. When its level is low, we feel hunger. •- A major energy source for cell function - Glucose needs help to cross the plasma membrane •- Insulin supports this process - Cell uses glucose for energy - Glucose can be used for energy, stored as glycogen, or converted into fat

Dysarthria

- the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system Manifestations: - difficulty in forming words Nursing Inter: - provide pt w/ alternative methods of communicating - allow pt sufficient time to respond

osmotic pressure

- the pressure exerted by SOLUTES (ANY TYPE) - Pulls water into the bloodstream (ECF) from the ISF and ICF - Determined by the concentration of particles within a solution (the more particles in a solution the higher the osmotic pressure and pulls water into bloodstream) - Higher concentration = higher oncotic pressure - (Opposite of hydrostatic pressure)

hydrostatic pressure

- the pressure exerted by WATER - the pressure within a blood vessel that tends to push water out of the vessel - (Pushes water from the bloodstream into the ISF and ICF) - Created by the pumping action of the heart (each time it pumps is a push of hydrostatic pressure to the ISF and ICF) _ (opposite of osmotic pressure)

recovery

- the single most important goal for a mental health patient - process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential Components: hope, self-direction, individualized or person-centered, empowerment, holistic, non-linear, strengths-based, peer support, respect, and responsibility

genetic defects

- these disorders can damage and mutate DNA -> the initiation of events that can cause cell injury

Americans with Disabilities Act (ADA) and job discrimination

- this act banned discrimination against the disabled in employment and mandated easy access to all public and commercial buildings. (Accommodations for people with mental health)

Assault

-is the intentional act of making someone fear that you will cause them harm. You do not have to actually harm them to commit assault. Threatening them verbally or pretending to hit them are both examples of assault.

What IV fluid has the same tonicity as plasma in the blood?

0.9% NaCl (normal saline or NS)

CAGE questionnaire (drug use)

1. Have you ever felt you ought to cut down on your drinking or drug use? 2. Have people annoyed you by criticizing your drinking or drug use? 3. Have you felt bad or guilty about your drinking or drug use? 4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)? (having 1-2 positive answers to identify substance abuse disorders)

Epidemiology Triangle

1. Host: system affected by condition - considerations include genetics, age, gender, immune status, lifestyle factors. 2. Agent: cause of condition - virus, bacteria, chemical (liquids, solids, gases, dust or fumes), physical 3. Environment: contributes to condition - physical, social, economic (can also be applied to non-communicable diseases

Immune system dysfunctions

1. Hypersensitivity - immune system becomes overreactive to foreign invaders 2. Autoimmunity - immune system can no longer distinguish between self and non-self 3. Immunodeficiency - immune system weakens, cannot destroy foreign invaders and antigens overwhelm the body

Antigen-presenting cells (APCs)

1. Macrophages 2. Dendritic cells -- a. Numerous fine dendritic cytoplasmic projections, attach to a broad range of antigens -- b. Located within the epidermis and mucous membranes, where antigens enter the body -- c. Release cytokines that stimulate cells of both innate and adaptive immune system

Wound healing phases

1. hemostasis: 1.occurs shortly after injury - Platelets aggregate - Vasoconstriction occurs to limit bleeding 2. Inflammation: - Immediately after injury 3. Proliferation: 1.24-48 hours after injury - Granulation tissue forms to serve as the foundation for scar tissue - Granulation tissue secretes growth factors - Epithelial cells proliferate to form a new surface and fill in the gap between wound edges 4. Remodeling: 3 weeks after injury - Scar tissue is structurally refined and reshaped

Three Core PH Functions basic to CH nursing

1.Assessment - Regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community 2.Policy development - Use of assessment data to develop policy and direct resources toward those policies 3.Assurance - Availability of necessary services throughout the community

Stages of infection

1.Incubation period - Microorganism begins active replication - no symptoms in host 2.Prodromal stage - Symptoms are present in the host, usually highly contagious 3.Acute stage - rapid proliferation of pathogen, still contagious = Inflammation 4.Convalescent stage - Body's attempt to contain the infection and eliminate it. Resolution of symptoms starts. 5.Resolution phase - Total elimination of pathogen from the body

Hypoglycemia (causes)

1.Low Blood Sugar (Less than 70mg/dL) 2.Compensatory Mechanisms -- 1.Epinephrine released by adrenal gland -- 2.Glucagon released by the pancreas 3.Liver undergoes glycogenolysis -- 1.Glycogen stores are used until depleted 4.Gluconeogenesis occurs -- 1.Breakdown of the fat and muscle for additional energy -causes: fasting, too much insulin or antidiabetic meds, exercise (excessive) - -Fatty acid build up makes ketones in blood stream

Policy Recommendations

1.Promote understanding of the Social Determinants of Health 2.Improve and Reduce Wealth Inequalities 3.Improve Physical and Built Environments 4.Promote Racial Justice 5.Promote Better Working Conditions 6.Improve Conditions for Children 7.Improve Social Inclusion 8.Improve Education 9.Improve Food Security and Quality 10.Improve Public and Sustainable Transportation 11.Utilize Health Impacts Assessments

school-age children and adolescents (nursing considerations; diabetes)

1.Reluctant to comply with medical regimen 2.Self-concept a.Do not want to be differant (type 1 have higher rate of depression) b.Stigma around weight ●Coordinate a Diabetes Medical Management Plan ○Training of school personnel to identify signs and symptoms of hypo and hyper ●Prevention measures (T2DM) ○Health teaching ○Counseling ●Early Identification ○Referral and follow-up Hypoglycemia- can affect memory tasks and over time impact learning and progress in school Interventions: should be at the individual level as well as community and systems level.

A Home Health Nurse visits a person who is paralyzed and uses a wheelchair. Which client statement(s) indicate that the nurse needs to do further patient education to prevent skin breakdown? 1. "I try to drink plenty of water and eat a balanced diet with vitamins and protein." 2. "The home health aide puts me in the wheelchair at 9 a.m. and I stay in the chair until my partner gets home at 6 p.m." 3. "I have a caregiver who helps change my incontinence brief every 2 hours." 4. "My partner checks my coccyx and heels every day because I cannot feel anything below my waist."

2

A community health nurse is developing a community-wide drug campaign targeting middle school children. The nurse is incorporating information about the dangers of addiction. Which level of prevention would the nurse classify this activity? A.Primary B.Secondary C.Tertiary D.Secondary and Tertiary

A

Ramsay is diagnosed with schizophrenia paranoid type and is admitted in the psychiatric unit of Whitney Medical Center. Which of the following nursing interventions would be most appropriate? •A. Establishing a non demanding relationship. •B. Encouraging involvement in group activities. •C. Spending more time with Ramsay. •D. Waiting until Ramsay initiates interaction.

A A nonthreatening, non demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Encouraging involvement in group activities and spending more time with the client would be threatening for a client who is suspicious of other people's motives. This client is unlikely to initiate interaction; the nurse is responsible for initiating a relationship with the client.

Which activity would reflect a community health nurse working at the primary prevention level? A. Teaching safe sex practices to teenagers B. Performing adult hypertension screening C. Encouraging women to do breast self-examination D. Helping with a postmastectomy exercise program

A An educational program that teaches safe sex practices is an example of primary prevention. Performing hypertension screening (they have not yet been diagnosed) and encouraging breast self-exam are examples of secondary prevention level activities. A postmastectomy exercise program would be an example of a tertiary prevention level activity.

The nurse is evaluating care of a client with schizophrenia, the nurse should keep which point in mind? •A. Frequent reassessment is needed and is based on the client's response to treatment. •B. The family does not need to be included in the care because the client is an adult. •C. The client is too ill to learn about his illness. •D. Relapse is not an issue for a client with schizophrenia.

A Because client respond to treatment in different ways, the nurse must constantly evaluate the client and his potential. Premorbid adjustment must also be considered. Most clients with such condition go home, so the family should be involved. The client can learn about the illness if information is provided gradually. Relapse is common in schizophrenia.

An ER nurse cares for a client who fell at soccer practice and has a swollen ankle. The client was found to have a sprain. What should the nurse teach this client before discharge to home? (SELECT ALL THAT APPLY) •A. Keep the ankle elevated as much as possible. •B. Apply a heating pad for 20 minutes QID. •C. Use an ACE wrap to apply pressure to the ankle to reduce swelling. •D. You should run as much as possible in the next few days to prevent the ankle from becoming stiff. •E. The ACE wrap should be as tight as possible to reduce swelling.

A and C

Patient Self-Determination Act (PSDA)

A federal law that mandates that every individual has the right to make decisions regarding medical care, including the right to refuse treatment and the right-to-die - Information about advance care documents - Question on admission and document about having an advance care document - Information about rights to complete advance care documents and to refuse treatment

Endocrine (review questions)

A group of organs that produce, store, and secrete chemical messengers called hormones. What are hormones? What do they do? Examples? - - Maintain homeostasis, they cause some type of physiological change in the body What are the 3 main components of the endocrine system? - 1) hypothalamus 2) target organ 3) pituitary gland = work together in the process of secreting hormones for endocrine system to work What is the goal of the endocrine system? - maintain homeostasis and hormone level

social marketing

A process "that uses marketing principles and techniques to change target audience behaviors to benefit society as well as the individual"

Depression

A prolonged feeling of helplessness, hopelessness, and sadness - major depression (severe impairment) - minor depression (mild impairment) Affect: "blunted"- reduced from normal, "flat"- absence of expression, "inappropriate"- discourted from the situation and mood and expression don't match

Addison's disease

A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones.

The incidence of measles in the local elementary school has doubled since February. The school nurse knows the critical dimension of the epidemiological investigation is a.Time b.Classroom c.Age d.Ethnicity

A time The three foundational constants of the epidemiological investigation are person, place and time. Time is the critical consideration.

Public health wheel

Addresses prevention and intervention at the individual, community, and system levels.

•The nurse on the pediatric unit is preparing a teaching plan related to children and drowning. Which of the following sources of drowning will the nurse include in her plan? Select all that apply. •A. Bathtub •B. Child wading pool •C. Toilet •D. Mop bucket filled with water

A, B, C, D Drowning is a leading cause of accidental death in children aged 1 to 18 years. Children up to age 4 are especially at risk for drowning and should never be left unattended in or near a bathtub, hot tub, swimming pool, or other source of water. Even wading pools, toilets, and mop buckets hold enough water to drown a small child. All of the answers are correct as sources of drowning.

A nurse cares for a patient who had abdominal surgery yesterday following a gunshot wound. Which of the following interventions are important to promote healing for this patient? (SELECT ALL THAT APPLY). A. Administer oxygen to keep O2 sats >92%. B. Administer pain medications prn. C. Administer IV fluids as ordered. D. Administer IV antibiotics as ordered. E. Look at the surgical incision q2h. F. Feed the patient a high fat diet to promote healing. G. Ask the patient who shot the gun

A, B, C, D, E F: need high protein

•What are some positive effects of pet therapy for residents in a long-term care facility? Select all that apply •A. Increases socialization •B. Increases blood pressure •C. Decreases pain •D. Decreases loneliness •E. Decreases insomnia

A, C, D Many facilities have resident pets or can arrange to have pets visit. Pet therapy can increase socialization, lower blood pressure, and decrease loneliness and perception of pain.

Which person is at risk for impaired skin integrity (Select all that apply)? A.12 year old girl with paraplegia who uses a wheelchair and gets tube feedings at home. B.20 year old student sitting in college classes all day. C.59 year old man who had a stroke with right side paralysis, and difficulty swallowing. D.67 year old woman who has developed diarrhea from C-diff infection. E.84 year old woman with dementia and a history of diabetes mellitus

A, C, D, E

•Which of the following populations are considered high risk for sensory deprivation? Select all that apply, •A. The homebound •B. Those in prison •C. Those who are depressed •D. Those experiencing high anxiety •E. Those feeling pain

A,B, C A nonstimulating, monotonous environment increases the risk for sensory deprivation, such as people who are in prison or who are homebound. Patients with depression are at risk for sensory deprivation, as they might be withdrawn from others and activities or less apt to interact within the usual context of their lives. Patients with anxiety often experience sensory overload. Pain lowers the threshold for processing sensory input, which increases the risk for sensory overload.

•The pediatric nurse educator is preparing a teaching plan for seizure prevention for parents of children with seizures. Which of the following can trigger seizures? •Select all that apply. •A. Fever •B. Video games •C. Sleep deprivation •D. Food allergens •E. Mind-altering substances

A,B, C, E. The most common reason for seizures in a person with epilepsy is failure to take prescribed antiseizure medication. Other common triggers of seizures are illness and fever, sleep deprivation, stress, and ingestion of mood-altering substances. Additionally, high-contrast patterns and flashing or flickering lights (video games, strobe lights) can provoke seizure activity. Ingesting a food allergen invokes an immunological response with reactions related to anaphylaxis.

The nurse is teaching a patient deep-breathing exercises to prevent respiratory complications postoperatively. Which of the following should be included in the education plan? Select all that apply. A.Splint or support the incision to promote maximal comfort B.Inhale slowly through the nostrils, exhale through pursed lips C.Hold breath for about 5 seconds to expand the alveoli D.Repeat this exercise 5 to 10 times hourly E.Close one nostril while inhaling

A,B,C,D Splint or support the incision to promote maximal comfort Inhale slowly through the nostrils, exhale through pursed lips Hold breath for about 5 seconds to expand the alveoli Repeat this exercise 5 to 10 times hourly Rationale: Closing one nostril while inhaling would not be effective in deep breathing exercises.

Medications for TB treatment

A. Isoniazid B. Rifampin C. Rifapentine D. Pyrazinamide E. Ethambutol F. INH + rifampin combination drug

Suicide interventions after crisis

After the crisis period: - Remove objects that could be used to harm self at home - Activate social supports - Increase coping skills - Observe for red flags - Therapy (individual and family) & psychiatry - Education for client and family - Creating a safety plan for the future

The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem? vA. Diminished deep tendon reflexes vB. Tachycardia vC. Cool, clammy skin vD. Acute flank pain

A. To gauge a client's magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.

A client, receiving lithium, indicates to the nurse that medication teaching was effective by stating that lithium should not be taken with: (select all that apply) 1.Diuretics 2.MAOIs 3.TCAs 4.Antibiotics

ANSWER: 1 Lithium is a salt Regular salt and fluid intake Li and Na in same column of periodic table Losing lots of fluid (dehydration) can cause lithium toxicity Low sodium can cause lithium toxicity (lithium decreases sodium reabsorption in kidneys leading to deficiency in sodium creating increase in lithium retention)

A patient with bipolar, manic phase, is taking lithium. The nurse should interpret a lithium level of 0.7 mEq/L as: 1.Below the therapeutic range. 2.Within the therapeutic range. 3.Above the therapeutic range. 4.Within the toxic range.

ANSWER: 2 Therapeutic range: 0.4-1.0

A client taking lithium is experiencing confusion, blurred vision, ataxia and now just had a seizure. The PRIORITY intervention by the nurse would be: 1.Give a dose of lithium. 2.Notify the physician. 3.Administer IM Cogentin. 4.Ask if vomited recently.

ANSWER: 2 Withhold lithium and notify physician Monitor vital signs and level of consciousness Monitor cardiac status Obtain lab samples

A client taking lithium is experiencing nausea & vomiting, course hand tremors, confusion and incoordination when walking. The nurse would most likely see a lithium level of: 1.0.2 mEq/L 2.0.8 mEq/L 3.1.1 mEq/L 4.1.7 mEq/L

ANSWER: 4 <1.5 early signs of toxicity 1.5-2.0 advanced signs of toxicity 2.0-2.5 severe toxicity

On the unit, Christine is prescribed lithium carbonate. What should the nurse include in the client teaching? (select all that apply) 1.You will need to have routine blood draws to examine the serum blood level of lithium. 2.It takes about 1-3 weeks for an optimal therapeutic response to lithium to occur. 3.If you miss a dose, you can double your dose the next time you are supposed to take it. 4.There is no need to taper off lithium, so you can stop it when you feel better. 5.You will need to monitor your weight, thyroid and renal functions while on this medication. 6.Therapeutic serum lithium level is 0.4-1.0 mEq/L.

ANSWERS: 1, 2, 5, 6 1.Routine blood draws: every 2-3 days when starting, then weekly to biweekly, then maintenance at every 1-3 months. 2.Yes: 5-7 days for any effect, then up to 3 weeks for optimal. 3.DO NOT double the dose, take within 2 hours of scheduled time or wait till next day 4.You do not need to taper - but do not discontinue without talking to provider first. 5.Weight: verify not hanging onto extra fluid & from medication itself; Thyroid: can cause goiter (Hypothyroidism); Renal: can cause renal damage 6.Yes; toxic at 1.5, severe toxicity at 2-2.5

The nurse is teaching christine about lithium toxicity. What should the nurse include in the client teaching? (select all that apply) 1.Let your healthcare provider know if you are taking diuretics or nonsteroidal anti-inflammatory medications. 2.Do not eat oranges when taking this medication. 3.There is no need to limit the amount of caffeine intake. 4.You will need to monitor your salt intake while taking this medication. 5.You should drink about 6-8 glasses of water per day. 6.Excessive sweating and diarrhea are expected side effects of lithium.

ANSWERS: 1, 4, 5 1.These increase lithium reabsorption by the kidneys or inhibit lithium excretion (causing too much lithium - toxicity) 2.No restriction on oranges. 3.Do not excessively drink coffee, cola, tea r/t caffeine because it has a diuretic effect. 4.Keep salt intake consistent (do not increase or decrease) 5.Yes; keep water intake consistent 6.These, along with dehydration and illness, cause fluid and electrolyte loss, which increases risk of lithium toxicity Related it back to monitoring weight (holding onto water because it's a salt) and renal function

psychopharmacology

ANTIPSYCHOTIC MEDICATIONS •Help the client be more involved in therapy and completing ADLs •Conventional/traditional/first-generation •Atypical/second-generation •Depot Preparations (IM injections) Not a cure Help client to be more involved in therapy and able to do ADL's Many, many side effects nurse is responsible for monitoring Effective in 2 - 6 weeks DEPOT: Long-lasting IM injections that are given every 2-4, can be up to q three months, in order to increase medications adherence and decrease potential relapse

Mental Health

Able to recognize own potential, Cope with normal stress, Work productively, Make contribution to community. Ability to Think rationally, communicate appropriately, Learn, Grow emotionally, Be resilient Have a healthy self-esteem

IgE

Abundant in ski, mucous membranes, and respiratory tracts. Responds to antigens that commonly cause allergic reactions (ex. pollen, animal dander and dust)

grave's disease manifestations

Accelerated metabolism - Fatigue or muscle weakness - Exophthalmos (bulging eye) - Thyroid dermopathy - Hand tremors - Mood swings - Nervousness or anxiety - Atrial fibrillation - Heart palpitations or irregular heartbeat - Insomnia - Weight loss - Increased frequency of bowel movements - Altered menstruation

Acid base balance

Acid-base refers to the balance of hydrogen and bicarbonate ions within the body (the acidity and alkalinity of body fluids). An arterial blood gas (ABG) analysis is used to determine blood pH and homeostatic mechanisms regulate acid-base levels to keep the pH within a normal range. Acid-base imbalances occur when the pH of the blood falls outside of 7.35 to 7.45. These imbalances can be respiratory or metabolic in origin. Managing acid-base balance is an important role of the nurse, especially in high acuity settings

Ways to reduce risk factors:

Age and mobility status: - Repositioning - Toileting - Providing pillows under bony prominences - Making sure skin has a good balance between dry/moist skin - Educating patients on risk factors (lotion, careful with shear and friction, mobility) Nutrition: - Providing Zinc (promotes healing), calcium, vitamin C, adequate proteins (helps Skin repair). Sensation: - testing senstations - repositioning - reduced shear and friction on skin Circulation and meds: - educate the pt if they develop itching/rash or photosensitivity to the med. Wear hats/long sleeves and other symptoms tell nurse/provider right away - moving around if possible to keep blood flow, massages (hand an feet) Moisture and fever: - Good balance between dry and too moist skin

Vaccines

Allow the body to recognize exposure and develop a response and memory of the antigen without direct diseases contraction (p.212). Either viral or bacterial components Most viral vaccines are inactivated or attenuated, will exhibit antigenic properties, but not transfer disease to an immunocompetent individual Some immunity wears off - need 'booster', or series to provide full effect Toxoids are vaccines produced by killed bacterial derivatives (without disease producing effects. Ex) Tetanus toxoid, repeat q 10 yrs.

Hyperadrenalism (Cushing's syndrome)

An endocrine disorder caused by high levels of cortisol in the blood - Cushing's Syndrome vs. Cushing's Disease Epidemiology: - 10 to 15 people per million per year - More Women than Men- 8:1 Ratio - Most commonly in ages 20-50 Etiology: - Pituitary adenomas are the most common cause - Adrenal Neoplasms - Carney complex - Genetic disorder of adrenal gland hyperplasia - Tumors, especially in the lung, have the potential to secrete ACTH - Exogenous Corticosteroids

Healthcare related infection

An infection acquired as a result of healthcare •Cost to the healthcare system = $4.5 billion/year •Leading cause of death •Preventable with use of aseptic principles/techniques Exogenous healthcare-related infection: Pathogen acquired from healthcare environment Endogenous healthcare-related infection: Normal flora multiply and cause infection as a result of treatment

A client admitted to the psychiatric unit for MDD with a suicide attempt is prescribed a tricyclic antidepressant (TCA). Which interventions should the nurse implement? (Select all that apply) 1.Assess the client's apical pulse and blood pressure. 2.Check the client's serum antidepressant level. 3.Provide for and ensure the client's safety. 4.Evaluate the effectiveness of the medication.

Answer 1, 3 - TCAs have a risk of orthostatic hypotension; you wouldn't want to administer the medication if the BP is less than 90/60

Which client statement indicate that a client may be a safety risk to self or others? 1.I really hate being here. 2.When do staff check client rooms? 3.All the rules are ridiculous here. 4.Which staff are scheduled for tomorrow?

Answer 2

Which statement is correct regarding care of the suicidal client? 1.The more specific the plan, the more likely the client will attempt suicide. 2.Adolescents and older adults rarely have suicidal ideation. 3.Clients who survive suicide attempts rarely attempt suicide again. 4.Discussion of suicidal thoughts enhances aggressive thinking.

Answer: 1

Which statement from a client experiencing depression might precede a suicide attempt? 1.I want to be the best I can be. 2.I have decided to solve all my problems 3.I have the worst family ever. 4.I will try and work with staff.

Answer: 2

Which patient is most likely a candidate for involuntary commitment? 1.A patient who refuses to take medication or 2. One who is singing in the street in the middle of the night disturbing the neighbors?

Answer: 2) The patient who is singing in the night disturbing the neighbors. Rationale: Patients have a right to refuse medication in many states and provinces. Refusing medication does not pose an immediate danger to self or others. The patient who is singing in the street is more likely to be judged as a danger to self or to others.

A client, 80-years-old, complains of stomach pain and is now mute and staring out the window and refusing food. Which of the following interventions are appropriate by the nurse? (Select all that apply) 1.Give the client privacy and close the door. 2.Speak with the client although the client may not answer. 3.Continue to offer the client food and fluids. 4.Regularly assess the client's vital signs and skin turgor.

Answer: 2, 3, 4

A client diagnosed with major depressive disorder appears tired and lethargic, but is willing to try a group activity. What nursing intervention best assists this client to integrate into the milieu? 1.Have the client sit outside of groups until he is ready to fully participate. 2.Encourage the client to choose which of several groups he might like to attend. 3.Arrange for the client to participate in a structured group activity. 4.Do nothing and allow the client to take the initiative in joining a group.

Answer: 3

A client in the ED for a suicide attempt reports taking an overdose of aspirin. The nurse should ask which priority assessment question? 1."How long have you been depressed?" 2."Who is in your support system?" 3."When did you take the pills and how many?" 4."Are you willing to be hospitalized?"

Answer: 3

The nurse is caring for a female patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? a. The patient complains of increased thirst. b. The patient reports a sore throat when swallowing. c. The patient supports her head when moving in bed. d. The patient makes harsh, vibratory sounds when breathing.

Answer: d Rationale: After thyroid surgery, the patient may experience an airway obstruction related to excess swelling, hemorrhage, hematoma formation, or laryngeal stridor (harsh, vibratory sound). Emergency equipment should be at the bedside, including oxygen, suction equipment, and a tracheostomy tray.

What data is notable for decision-making?: •The client is unshaven and unkempt. •The client has diabetes, hypothyroidism, and hypertension. •His gait is ataxic and speech is slurred. What are 2 priority assessment questions to ask next? a.Are you homeless? b.Have you checked your blood sugar recently? c.Are you drinking alcohol? d.Do you have pain? e.Did you eat breakfast?

Answers: B and C Why? What could be the cause of the ataxia and slurred speech. Hypoglycemia - but he is drinking something - pop would raise blood sugar. While moderate amounts of alcohol may cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level -- sometimes causing it to drop into dangerous levels, especially for people with type 1 diabetes. Beer and sweet wine contain carbohydrates and may raise blood sugar. Alcohol can interfere with the positive effects of oral diabetes medicines or insulin. Alcohol may increase triglyceride levels. Alcohol may increase blood pressure. Alcohol can cause flushing, nausea, increased heart rate, and slurred speech. These may be confused with or mask the symptoms of low blood sugar.

Prevention of health problems (Components of Community Health Practice)

Anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment Three Levels: ●Primary: Keep illness or injury from occurring ●Secondary: Efforts to detect and treat existing disease ●Tertiary: Reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function

Type III immune complex disorders

Antigen combines with Igs in the circulation and develop complexes that are deposited in tissues (immune complexes) The deposition within tissue membranes causes organ dysfunction Can be system wide, as in Systemic Lupus Erythematosus (SLE) or localized to specific tissues such as joints in RA Antigen that triggers is unidentifiable

treatment of grave's diseas

Antithyroid Medications: - These drugs help prevent the thyroid from producing hormones. Methimazole and propylthiouracil (PTU) are medications that interfere with the thyroid gland's ability to produce hormones. While effective in relieving symptoms within a few weeks, hyperthyroidism may return after the drug is stopped. Radioactive Iodine (RAI): - Your thyroid gland absorbs nearly all of the iodine in your body. When radioactive iodine (RAI), also known as I-131, is taken into the body in liquid or capsule form, it concentrates in thyroid cells. - Radioactive iodine works by destroying thyroid tissue cells, thereby reducing your thyroid hormone levels. Surgical Removal

Factors affecting web of causation

As health care professionals began to understand the complexity of many of the infectious and noninfectious disease threats, they came to realize that causation was never completely straightforward. Factors such as : •availability of clean water •the number of trained nurses and doctors •the overall nutrition of the population •even political upheaval ...could influence the spread of disease and the number who ultimately died. This refinement in causal thinking also provided opportunities for health care interventions at a variety of levels. Another common term used for this approach is causal matrix.

Mental Health Assessment

Assesses dysfunction & how it affects self-care in everyday life. Assesses emotional & cognitive functioning Indirect, observations inferred through one's behaviors of health/illness - build rapport - current problems - psychosocial assessment - mental status exam (MSE) - physical assessment/VS/labs

determination of competency

Assessment areas. Look at patient ability to: (four things must be met): - Communicate choices - Understand relevant information - Appreciate situation and consequences (insight). - Use a logical thought process to compare risks and benefits of treatment options (judgment).

Nurse management social domain

Assessment: - family factors - culture factors Nursing diagnosis: - social isolation - powerlessness - impaired social interaction - risk for loneliness - interrupted family processes Interventions: - lifestyle reevaluation - time management - prioritizing or lists

Nurse management psychological domain

Assessment: - self- report scales - mental status exam - cognitive thought patterns (catastrophic misinterpretations) Nursing diagnosis: - anxiety - risk for self-harm - social isolation - powerlessness - ineffective family Interventions: - trigger identifications - distraction techniques - positive self talk - panic control treatment - exposure therapy (systematic desensitization; implosion therapy) - CBT - psychoeducation

Rheumatic disease nursing process

Assessment: •- Health history: include onset of and evolution of symptoms, family history, past health history, and contributing factors •- Functional assessment •- Arthrocentesis •- Radiography, bone scans, CT, and MRI •- Tissue biopsy - Blood studies Diagnosis: •Acute and chronic pain •Fatigue •Disturbed sleep pattern •Impaired physical mobility •Self-care deficits •Disturbed body image •Ineffective coping Planning: •Major goals may include -Relief of pain and discomfort -Relief of fatigue -Promotion of restorative sleep -Increased mobility -Maintenance of self-care -Improved body image -Effective coping -Absence of complications Interventions: •Anti-inflammatory medications •Heat to joints for pain management •Splints, but maintain mobility •Provide rest

Nurse management biologic domain

Assessment: - rule out life-threatening medical causes; symptom evaluation - substance use - sleep patterns - physical activity Nursing diagnosis: - anxiety - risk for self-harm - social isolation - powerlessness - ineffective family coping Interventions: - breathing control - nutritional planning - relaxation techniques - increases physical activity Pharmacology interventions: (SSRIs, TCAs, MAOIs, Benzos, Vistaril or Benadryl for people with addiction.

A community health nurse is preparing a presentation for a group of nursing students about community health nursing. Which description about community health nursing would the nurse most likely include in the presentation? A.Focusing on addressing continuous needs B.Working with the client as an equal partner C.Engaging in tertiary prevention as the priority D.Encouraging clients to reach out to the nurse

B

A nurse is caring for a client with Type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? a)Ask the client to describe the process in detail. b)Observe the client drawing up and administering the insulin. c)Provide a health education session reviewing the main points of insulin delivery. d)Review the client's first hemoglobin A1c result after discharge.

B

A patient on the mental health unit is banging their head against the wall and will not stop. The patient strikes out at staff when they approach. Other interventions have been tried, with no effect. What should the nurse do first? a.Call the provider to get an order for seclusion and restraints. b.Organize a team of people to place the patient in a humane wrap to bring to the seclusion room. c.Give the patient a sedating medication by injection. d.Appoint a 1:1 safety assistant to monitor the patient at arms' length.

B

What best defines stroke? A. Fluid accumulation causing pressure on brain B. A sudden impairment of cerebral circulation

B

The school nurse is concerned about the lack of fresh fruit and vegetables in meals provided by the school district. What is the nurse's best action? A.Propose removal of all vending machines from the school district buildings. B.Meet with school administrators to request funding for healthier foods in meals provided by the district. C.Send letters to all parents in the school district informing them students should bring healthy snacks to school. D.Develop nutrition education programs to be taught by all teachers in the school district.

B Increasing funding for the school food program will increase the district's ability to pay for healthier food and additional staff to properly prepare it. Before enlisting community support for funding, the school nurse should begin by talking with school administrators. The nurse should be prepared to discuss health data to support the concerns.

The nurse educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would the nurse state is helpful? •A. Call the provider to request a medication change •B. Encourage the use of learned relaxation techniques. •C. Request that the client be hospitalized until the crisis is over. •D. Wait before the anxiety worsens before intervening.

B The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive and helpful by encouraging the client to use these techniques. Anxiety is a common experience for everyone, and is no reason to change medication. Handling anxiety is a learned skill that is important to reinforce. There is no indication that the client is in crisis. It is much easier to intervene early in anxiety rather than waiting until escalation occurs.

Wayne told his nurse that the FBI is monitoring and recording his every movement and that microphones have been plated in the unit walls. Which action would be the most therapeutic response? •A. Confront the delusional material directly by telling Wayne that this simply is not so. •B. Tell Wayne that this must seem frightening to him but that you believe he is safe here. •C. Tell Wayne to wait and talk about these beliefs in his one-on-one counselling sessions. •D. Isolate Wayne when he begins to talk about these beliefs.

B The nurse must realize that these perceptions are very real to the client. Acknowledging the client's feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation. Confronting the delusional material directly will not work with this client and may diminish trust. Telling the client to wait and talk about these beliefs in his one-on-one counselling session will reinforce the delusion. Isolation will increase anxiety. Distraction with a radio or activities would be a better approach.

A nurse coordinates care for a family of an infant born with a chronic health condition. The nurse focuses on empowering the family to maximize self-care through health promotion, disease prevention, and increased continuity of care. Which role is the nurse demonstrating? A.Consultation B.Case Management C.Screening D.Discharge planning

B is a systematic process by which a nurse assesses clients' needs, plans for and coordinates services, refers to other appropriate providers, and monitors and evaluates progress to ensure that clients' multiple service needs are met in a cost-effective manner. Discharge planning is a component of discharge planning

•A nurse is preparing education for the adult daughter of an 85 year old woman with dementia who has developed occasional incontinence of urine. In order to prevent skin breakdown, the nurse teaches the caregiver to (Select all that apply): A.Apply incontinency briefs in the morning and change them every 6 hours. B.Take her to the bathroom q 2 hours. C.Decrease the amount of fluids offered to her mother. D.Cleanse the perineal area BID. E.Assist her mother to reposition at least q2h.

B and E

•The nurse understands that which of the following organizational factors have been shown to contribute to errors and safety problems in healthcare? Select all that apply. •A. Inadequate financial resources •B. Inadequate training of personnel •C. Inadequate staffing in the organization •D. Staff reluctance to speak up about risk and errors

B, C, D Organizational factors that have been shown to contribute to errors and to safety problems in healthcare include poor design, maintenance failures, unworkable procedures, shortfalls in training, less than adequate tools and equipment, and inadequate staffing. Disruptive behaviors, intimidation in the workplace, and a culture of disrespect among healthcare professionals have also been reported as significant barriers to patient safety. It is clear that such cultures need to be repaired, and many healthcare organizations are working to address disrespectful behavior, staff reluctance to speak up about risks and errors, and blatant disregard of expressed concerns. Inadequate financial resources are not cited as a reason for healthcare agency safety problems and errors.

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply. •A. Analyzing family issues and past problems •B. Developing social skills and supports •C. Learning how to live independently in a community •D. Learning job skills for employment •E. Treating family members affected by the illness •F. Participating in in-depth psychoanalytical counselling

B, C, D, The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client's development of skills in the here and now; consequently, psychoanalytic counselling is not part of the approach.

The nurse assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply. •A. Anhedonia •B. Delusions •C. Flat affect •D. Hallucinations •E. Loose associations •F. Social withdrawal

B, D, E These are considered positive symptoms of schizophrenia. Options A, C, and F are considered negative symptoms.

•The nurse in the intensive care unit enters her patient's room and observes the patient is experiencing a seizure. What are the most appropriate interventions by the nurse? Select all that apply. •A. Insert a padded tongue depressor in the patient's mouth. •B. Turn the patient to his side. •C. Restrain the patient to control his jerking movements •D. Loosen any restrictive clothing •E. Pad the siderails of the patients bed

B, D, E When a seizure is occurring, the nurse would turn the patient to his side to prevent aspiration and loosen any restrictive clothing; also pad the head, foot, and siderails of the bed and place oral suction at the bedside. Do not try to open the mouth and insert a tongue depressor. This action could result in injury to the patient or injury to the nurse (biting). Also do not attempt to restrain the patient, as this may result in muscle and joint injury.

A part of a patient's life that is not governed by society's laws and government intrusion is referred to as: A.Confidentiality B.Privacy C.Informed consent D.Competency

B. - Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Confidentiality is an ethical duty of nondisclosure. Informed consent is a legal procedure to ensure that a patient knows the benefits and costs of treatment. Competency refers to the patient's cognitive ability to process information at a specific time.

Phillip is diagnosed with Schizophrenia. His parent are with him and are upset. They ask how this could have been prevented. What is the nurses' best response? a.Schizophrenia is associated with poor parenting: family therapy will be helpful. b.Schizophrenia is a brain-based illness caused by a genetic predisposition and environmental stressors. You are not to blame for this illness. c.Schizophrenia is caused by excess serotonin- medication will cure this illness. d.Don't worry, schizophrenia is an acute illness and should resolve in 6 months.

B. Initially, families usually experience disbelief, shock, and fear along with concern for the family member. Families may attribute the episode to taking illicit drugs or to extraordinary stress or fatigue and hope that this is an isolated or transient event. They may be fearful of the behaviors and respond to patient anger and hostility with fear, confusion, and anxiety. They may deny the severity and chronicity of the illness and only partially engage in treatment. As families begin to acknowledge the disorder and the long-term care nature of recovery, they themselves may feel overwhelmed, angry, and depressed.

What is a major indicator of extracellular fluid volume deficit (FVD) or hypovolemia ? A.Full and bounding pulse B.Drop in postural blood pressure C.Elevated temperature D.Pitting edema of lower extremities

B. Drop in postural blood pressure Rationale: FVD signs and symptoms include acute weight loss; decreased skin turgor; oliguria; concentrated urine; orthostatic hypotension due to volume depletion; a weak, rapid heart rate; flattened neck veins; increased temperature; thirst; decreased or delayed capillary refill; decreased central venous pressure; cool, clammy, pale skin related to peripheral vasoconstriction; anorexia; nausea; lassitude; muscle weakness; and cramps. Clinical manifestations of FVE result from expansion of the ECF and include edema, distended neck veins, and crackles (abnormal lung sounds).

The community health nurse is performing a home visit to an older client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? vA. "I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup." vB "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids." vC "It is normal to be a little confused following surgery, and it is safe not to urinate at night." vD. "If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress. "

B. In elderly clients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person. There is no mention of medications in the stem of the question or any specific evidence given for the need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly. Urinary retention does normally cause confusion.

The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? vHypophosphatemia vHypocalcemia vHypermagnesemia vHyperkalemia

B. Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include paresthesias and anxiety.

Public health nurse role communication

Barriers to effective communication: 1.Selective perception - a.Interpret through own perception 2.Language barriers - a.Interpret meaning of words differently 3.Filtering information - a.Manipulation of information by the sender to influence the receiver's response 4.Emotional influence - a.How a person feels at the time a message is sent or received influences its meaning. 5.Language of nursing - a.Nurses with a unique vocabulary that may not be understood by clients, family, and community members. - b.The use of scientific terminology or jargon by some health professionals can be confusing.

IgD

Binds to basophils and mast cells in hypersensitivity reactions. Found in skin and digestive and respiratory tracts

diabetes (monitoring and Tx)

Blood Glucose should be maintained between 70-140mg/dL regardless of food intake or physical exercise •- Monitor BG with glucometer •- Preprandial BG- before eating- Ideally 80-130mg/dL •- Postprandial BG- 2 hours after eating and bedtime- Ideally _<180mg/dL •- A1C < 7% Treatment •Lifestyle Modifications •Antidiabetic Agents •Insulin

What are appropriate safety precautions when caring for a patient in the home? A.Do not carry a phone into the patient's home because it may be distracting B.Park the car in a lighted area even if it is a good distance from the home C.Try to schedule visits in the daylight hours when possible D.Drive an expensive car so that neighbors will know you are on official business

C Less crime and better visibility are factors to scheduling visits during the daylight hours. Nurses should carry phones for emergencies, should park close to the patient's home, and should not drive expensive cars when making home visits

A nurse who speaks Spanish is conducting a postpartum home follow-up visit with a Latina woman. The woman delivered a healthy male infant by cesarean section 6 days ago. The client tells the nurse breastfeeding is going well. When the client shows the nurse her incision, the nurse notes there is erythema and a small amount of yellow drainage at one end of the incision. The client tells the nurse she noticed it but did not know what to do. What nursing intervention might have prevented this situation? A.Arranging for a home health nurse to do daily dressing changes B.Instructing the client's husband to call the discharge nurse every day C.Providing the client with written discharge instructions translated into Spanish D.Having the client demonstrate how to change the dressing before discharge

C The client may have know what action to take if she had written discharge instructions in Spanish. Written discharge instructions should be provided for all clients, translated into their language. The discharge nurse should also assess whether the client's literacy level is adequate to understand the instructions.

The nurse is preparing to administer a premedication. Which of the following actions should the nurse take first? A.Have the family present B.Ensure that the preoperative shave is completed C.Have the patient void D.Make sure the patient is covered with a warm blanket

C Have the patient void Rationale: Having the patient void prior to administering a premedication is necessary for patient safety to prevent falls and injury. Shaving is no longer recommended; clipping the hair is evidence-based practice. The family can be present, and a warm blanket can provided any time patient appears cold or asks for it, but the patient fall risk is greatly increased after receiving preoperative medications that are sedative or amnesic.

•The mother of 6-year-old twins says to the pediatric nurse, "My husband and I keep a gun in our home. Do you have any safety tips for us?" The most appropriate response by the nurse is which of the following? Select all that apply. •A. "I do not recommend owning a firearm when children are living in the home." •B. "Be careful not to allow your children into the homes of others who own a firearm." •C. "Be sure to keep your gun unloaded and in a secure and locked cabinet. •D. "Ammunition for your gun should be stored in a different location from the gun.

C, D Education is an essential intervention because of the frequency and severity of unintentional firearm injuries involving children. The American Academy of Pediatrics and other groups have mounted efforts to educate parents so that they will be able to make smart choices related to gun safety. Some key safety rules include the following: Always keep the gun pointed in a safe direction, always keep the gun unloaded until ready to use, store firearms unloaded in a secure and locked container, and store ammunition in a different location from the firearm. Even if parents do not have guns in their own home, it is possible that children will encounter them in other places. Urge parents to teach children safe behavior around firearms, and be sure children know what to do if they see a gun in a friend's home or in school.

Which statements reflect the nursing management of a client with receptive aphasia? A. Encourage the client to repeat sounds of the alphabet. B. Speak clearly to the client in simple sentences; use gestures or pictures. C. Speak slowly and clearly to assist the client in forming the sounds. D. Frequently reorient the client to time, place, and situation.

C. Nursing management of the client with receptive aphasia includes speaking slowing and clearly to assist the client in forming the sounds. Nursing management of the client with expressive aphasia includes encouraging the client to repeat sounds of the alphabet. Nursing management of the client with global aphasia includes speaking clearly to the client in simple sentences and using gestures or pictures when able. Nursing management of the client with cognitive deficits, such as memory loss, includes frequently reorienting the client to time, place, and situation.

While assessing a client's peripheral IV site, the nurse observes edema around the insertion site. How should the nurse document this complication related to IV therapy? vA. Air emboli vB. Phlebitis vC. Infiltration vD. Fluid overload

C. Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid overload are not indications of infiltration.

Causes of FVE

CHF renal failure Cirrhosis excessive NaCI excessive sodium-containing IV (hypertonic) burns - Due to fluid overload or diminished homeostatic mechanisms - Heart failure, kidney injury, cirrhosis of liver - Contributing factors: Consumption of excessive amounts of table salt or other sodium salts - Excessive administration of sodium-containing fluids

adaptive immunity

Called to activate if innate immunity is insufficient Specific protection, only developed after exposure to antigens Develops memory for every individual antigen encountered * Specific: has ability to recognize and remember antigens * Can target non-self antigens and develop memory to them for future reference (after second exposure to antigen) * Can distinguish between antigens belonging to self/host (MHCs or HLAs) from non-self/invader.

What would you do if a voluntary patient asks to leave the hospital?

Cannot leave within a 12 hr. Discuss 12 Hour Notice. If health care providers have evidence that a voluntary client asking to leave mental health inpatient treatment is a danger to themselves or others, they will file for commitment. If not, the client will be discharged, most likely AMA (against Medical Advice).

Public health nurse role manager

Case Management: a systematic process by which a nurse assesses clients' needs, plans for and coordinates services, refers to other appropriate providers, and monitors and evaluates progress to ensure that clients' multiple service needs are met in a cost-effective manner. ●Discharge planning begins on admission as part of continuity of care

Tuberculosis (TB)

Caused by Myobacterium tuberculosis (MTB) Currently: •- TB seen in immune-suppressed patients •- Seen in community through MDR-TB •- Shows the importance of following trends of communicable diseases Surveillance of disease should include: - Geographic area. - Age. - Race. - Location. - Birth place (foreign or U.S. citizen).

Hormone deficiency

Caused by a destruction of the endocrine gland - Autoimmunity - Infection - Inflammation - Infarction - Tumor infiltration Example: autoimmune destruction of islet cells in Type I Diabetes Mellitus

Hyperosmolar Hyperglycemic Syndrome (HHS) (manifestations and Tx)

Clinical Manifestations: •Polyurea, Polydipsia •Signs of Dehydration (can be severe) •- Dry mucous membranes •- Hypotension, tachycardia •Changes in Mental Status •- Lethargy, confusion, coma •Potential for Seizures Diagnostic Criteria: •BG greater than 600mg/dL •Arterial pH: mild acidosis •Blood Osmolarity: Greater than 320mOsm/L •Urine Ketone: Small to none •Blood Ketone: Small to none Treatment: •Fluid and electrolyte replacement •IV Insulin •Treat infection/cause

Diabetic Ketoacidosis (DKA) (manifestations and Tx)

Clinical Manifestations: •Polyuria, Polydipsia, Polyphagia •Nausea and vomiting •Altered Mental Status •- Lethargy, confusion, comatose •Signs of Dehydration •- Dry mucous membranes •- Hypotension, tachycardia •Kussmaul's Respirations •- Sweet breath smell Diagnostic Criteria •BG 250mg/dL or greater •Arterial pH lower than 7.3 •Serum bicarbonate lower than 18mEq/L •Ketonuria (ketones in urine) •Ketonemia (ketones in blood) Treatment •Frequent BG checks •Fluid and Electrolyte replacement •IV insulin

electroconvulsive therapy (ECT)

Common uses: depression with psychotic symptoms, treatment resistant depression - Pre-procedure - During procedure - Post-procedure Pretreatment: •Informed consent, given written information, watch video •Physical exam •Labs •EKG •NPO at least 6 hours before the treatment •Medications: Atropine (smooth muscle relaxant) & Succinlycholine (muscle relaxant), and a short-acting anesthetic During treatment: GRAND MAL SEIZURE IN INDUCED WHILE CLIENT IS ANESTATIZED •EEG to monitor the seizure (30-60 seconds) •EKG •Pulse Oximeter (client is ventilated during procedure) Post-Treatment: •Monitor vital signs •Re-orient (SHORT TERM, TEMPORARY MEMORY LOSS) •Many times need analgesic for pain (HEADACHE, MUSCLE SORENESS)

Fill in the blank: 1._________________ is the degree to which a patient can understand and appreciate the information given during the consent process.

Competence

communication skills

Core Communication skills: - Sending skills - Nonverbal: dress, body language, facial expression, and physical distance - Verbal: speaking and writing - Keep messages honest and uncomplicated - Use few words - Ask for feedback Receiving skills: - Active or reflective listening: work to discover what the client means - Sitting forward - Sustaining eye contact - Nodding the head - Asking occasional questions for clarification - Paraphrasing to reflect back what you have heard - Avoid daydreaming or formulating responses - Observing behaviors - Interpersonal skills - Showing respect - Empathizing - Developing trust and rapport

On assessment of a patient with Acute Renal Failure, the nurse finds the following: distended neck veins, cool and pale skin, and crackles in the lungs. The nurse should suspect the patient is experiencing: a.Hypocalcemia b.Hypovolemia c.Hypervolemia d.Hypercalcemia

Correct answer: C This patient is showing signs of fluid overload. Other findings include elevated blood pressure, bounding pulse, and increased respirations due to increased intravascular volume.

Mr. Arbor complains to the nurse that he is feeling anxious. He states, "I'm just so tired of all these tests they are doing, and it's so noisy here at night." Mr. Arbor's pulse is 110 beats/min, and his blood pressure is 140/70 mm Hg. Nursing actions should include which of the following? a.Turn on the television to provide distraction. b.Ask the client if he would like to discuss his anxiety further. c.Close the blinds, dim the lights, and ask the patient what other measures would help him rest. d.Call the physician and obtain an order for an anti-anxiety medication for prn use.

Correct answer: C. These measures would most directly decrease the client's sensory overload.

cushing syndrome vs cushing's disease (pathophysiology)

Cushing's syndrome: - Adrenal gland tumor, hyperplasia of the adrenal gland or ACTH secretion from a lung tumor - Stimulate the adrenal gland to produce excess cortisol Cushings disease: - Hyperplasia of the anterior pituitary - Either caused by excess CRF in the hypothalamus or adenoma of the pituitary - Pituitary will secrete constant ACTH - Excess ACTH causes hyperplasia of adrenal glands - ACTH secretion is random - Feedback system doesn't respond

cushing's syndrome vs cushing's disease

Cushing's syndrome: - More common - Adrenal neoplasms - Carney Complex - Tumors that secrete ACTH - Ectopic ACTH -more common and if problem is at the adrenal gland itself Cushing's disease: - Cushing's disease is used exclusively to describe the condition of excessive cortisol arising from hyperplasia of the pituitary gland -- Can be due to pituitary tumor or excess CRF from the hypothalamus - problem at the pituitary gland

A client has received a diagnosis of Type 2 diabetes. You are the nurse making first contact with the patient after the diagnosis. What is your priority action? a)Make sure the client understands the basic pathophysiology of diabetes. b)Identify the client's body mass index. c)Teach the client "survival skills" for diabetes. d)Assess the client's readiness to learn.

D

A confused patient has delirium due to an infection and tries to pull out her IV line. What intervention should the nurse do LAST? a.Assess the patient's pain level. b.Evaluate the patient's sensory status. c.Adjust the environment to make sure it is comfortable. d.Apply wrist restraints.

D

The term health can be described in many different ways. How does the community health nurse interpret health? A.The absence of disease B.The potential to lead a productive life C.An environment free of toxins D.A holistic state of well-being

D

Dennis who has had auditory hallucinations for many years tells the nurse that the voices prevents his participation in a social skills training program at the community health center. Which intervention is most appropriate? •A. Let Dennis analyze the content of the voices. •B. Advise Dennis to participate in the program when the voices cease. •C. Advise Dennis to take his medications as prescribed. •D. Teach Dennis to use thought stopping techniques.

D Clients with long-lasting auditory hallucinations can learn to use thought stopping measures to accomplish tasks. Analyzing the content of the voices may be indicated when hallucinations first occur to establish whether the voices are threatening to the client or instructing him to harm others. However, focusing on their content at this point would reinforce this symptom. The voices have lasted many years; the client should participate despite the voices. There is no indication that the client is not taking medication as prescribed.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, the nurse would anticipate a problem with: •A. auditory hallucinations. •B. bizarre behaviors •C. ideas of reference •D. motivation for activities

D In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. All of the other symptoms listed are the positive symptoms of schizophrenia.

Which factor is associated with increased risk for schizophrenia? •A. Alcoholism •B. Adolescent pregnancy •C. Overcrowded schools •D. Poverty

D Low socioeconomic status or poverty is an identified environmental factor associated with increased incidence of schizophrenia. Although alcoholism, adolescent pregnancy, and overcrowded schools may be stressful, research does not show they increase the risk of schizophrenia.

addiction behaviors

Impaired control over drug use Compulsive use Craving Continued use despite harm

What nursing intervention best illustrates the protection of patient confidentiality in the home care setting? A. Only providing positive information to the patient's family B. Leaving the patient's chart in the trunk of the car before entering the home C. Allowing the neighbors into the home during the visit so that the patient can discuss the situation D. Placing the medical record in a secure place within the home

D The home care patient has a right to confidentiality and information should only be shared with patient permission. The nurse may need the chart; therefore, leaving it in the trunk may not be the best intervention. Allowing the neighbors into the home does not respect the patient's privacy

•A patient becomes restless and agitated in the postanesthesia care unit (PACU) as he begins to regain consciousness. The first action the nurse should take is to •a. Turn the patient to a lateral position. •b. Orient the patient and tell him that the surgery is over. •c. Administer the ordered postoperative pain medication. •d. Check the patient's oxygen saturation with pulse oximetry.

D Why? Wanna check airway, breathing and circulation first because the symptoms could be from hypoxia or could just be anxious but rather check to be safe then orient patient

Which of the following is a key value associated with self-determination? A.Dependency B.Advocacy C.Consent D.Personal autonomy

D. - Personal autonomy and the avoidance of dependence on others are two key values of self-determination. Advocacy and consent are not values involved with self-determinism.

What intervention would not be included in aspiration precautions for a patient in the acute phase of a stroke? A.Referral to speech therapy B.Have patient tuck their chin toward the chest when swallowing C.Thickened fluids or pureed diet D.Raise HOB to 30 degrees when feeding

D. Interventions to prevent aspiration include a referral to speech therapy for swallowing evaluation; having the patient tuck the chin toward the chest when swallowing to close off the trachea, preventing aspiration into the lungs; providing thickened fluids or a pureed diet; and sitting the patient at a full upright position (90 degrees) when feeding or providing fluids. The patient's HOB should be elevated to 30 degrees at all times to prevent aspiration of secretions but would not prevent aspiration of food or fluids when feeding.

The nurse is working on a burns unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of what imbalance? a. hypervolemia b. Hypermagnesemia c. Hypercalcemia d. Hypovolemia

D. Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.

Which is an early sign of IICP? (hypertension, decreased LOC, bradycardia?)

Decreased LOC

hormone resistance

Defective hormone action at the cell receptor site. - Genetically inherited defects that produce dysfunctional receptors. Example: Cell receptors throughout the body are insensitive to insulin in Type 2 Diabetes Mellitus

Dementia vs Delirium

Dementia -Onset is slow, over months to years. -Impaired memory, judgment, calculations, attention span, abstract thinking; agnosia -LOC not altered -Activity level not altered; behaviors may worsen in evening (sundown syndrome) -Emotional state is flat; delusions present -Speech and language incoherent, slow (sometimes due to effort to find the right word), inappropriate, rambling, repetitious -Non reversible & progressive Delirium -Onset is sudden, over hours to days -Impaired memory, judgment, calculations, attention span; can fluctuate throughout the day -LOC altered -Activity level can be increased or reduced, restlessness; behaviors may worsen in evening (sundown syndrome); sleep-wake cycle may be reversed -Emotional state consists of rapid swings; can be fearful, anxious, suspicious, aggressive, have hallucinations and/or delusions -Speech and language rapid, inappropriate, incoherent, rambling -Reversible with proper and timely treatment

Addison's disease (diagnosis and Tx)

Diagnosis: - Hyponatremia and hyperkalemia - Rapid ACTH Test- assesses the adrenal cortex ability to produce cortisol -- Pt is administered ACTH (IV) -- Blood Cortisol levels should rise 2-5 times within 15 to 30 minutes bc adrenal gland was stimulated with ACTH IV) -- Rise= normal -- No rise= Adrenal insufficiency -- Why? (we sent the hormone that should stimulate the gland and release cortisol) - Abdominal CT may show enlargement of adrenal glands in cases of TB, fungal infections, adrenal hemorrhage or infiltrating diseases Treatment: - Replacement glucocorticoid and mineralocorticoid daily -- This is achieved with hydrocortisone and 9-alpha-fludrocortisone - May need to increase salt intake in hot weather -- Why do you think? (hot = dehydrated to maintain fluid when its hot out) - Surgery if there is a mass

cushing's syndrome/disease (diagnosis and Tx)

Diagnosis: - Lab values - High WBCs - Hyperglycemia - Hypokalemia (keep sodium but get rid of potassium) - Salivary Cortisol - 24 hour Urine Collection - Dexamethasone Suppression Test - Low dose vs. High dose - Imaging- CT, MRI, X-Ray Treatment: - Treat the Cause -- Surgery to remove tumor -- If surgery doesn't work, agents can be used to inhibit the steroidogenesis (Cortisol secretion) --- Ketoconazole

Diabetes lifestyle modifications

Diet: •- Obesity can lead to insulin resistance •- Carb counting •- Low glycemic index •- Low fat and low sodium Exercise: •- Contractile muscle activity helps the cellular uptake of glucose without insulin for entry •- Exercise also helps with angiogenesis to the heart and large muscles •- Raises HDL cholesterol, reduce obesity, lower blood pressure •- Need to be careful about going into hypoglycemia (for both types (1 and 2), but 1 have to take insulin and 2 you could change lifestyle and not need anything else)

Suicide interventions during crisis

During the crisis period: - Safe environment - Frequent checks (every 15 minutes) - Suicide precautions or suicide observation (one-to-one staff, if more severe) - Make a verbal or written no-suicide contract - Encourage client to talk about feelings and alternatives (CBT, instill hope) - Communicate that crisis is temporary and help is available, client is not alone

Type I immediate hypersensitivity example

EXAMPLE: Allergic Rhinitis ◦Most common example of mild hypersensitivity ◦Approx. 50% of people in US have a positive skin test to one of causative allergens leading to AR (Capriotti & Frizzell, 2016, p.206) ◦Treatment include antihistamines, decongestants and corticosteroids to treat inflammation ◦Common allergens: mold, animal dander or pollen - can be seasonal with different causative agents ◦The 'allergic salut'

Public health nurse role improving health literacy

Effective communication skills strongly influenced by factors: ●Previous experience ●Culture ●Relationships Tens of millions adults are unable to read health related materials. One in 5 have dyslexia, 80% of learning disability Patients with low health literacy are less likely to: ●Engage in prevention strategies ●Have chronic disease under control Patients with low health literacy are more likely to: ●Be hospitalized ●Report poor health ●Die Build Resilience so patients can: ●Understand and complete self-care instructions, including complex daily medical regimens ●Plan and attain necessary lifestyle adjustments to improve their health ●Make positive, informed health-related decisions ●Know when and how to access necessary health care ●Address health issues in their community and society by sharing health-promoting activities with others

Secondary prevention

Efforts to detect and treat existing disease (ex. screening (at risk for it))

Hyperosmolar Hyperglycemic Syndrome (HHS)

Emergency Short-Term Complication of Hyperglycemia: •Diabetes Type 2 •Severe hyperglycemia causes hyperosmolarity of the blood •Severe cellular dehydration occurs •Most often is precipitated by infection or severe stress on the body Pathophysiology: Hyperglycemia •Cellular resistance to insulin prevents glucose from entering the cells •-Compensatory mechanisms ensue •-- Glycogenolysis and Gluconeogenesis •--- Presence of some insulin prevents formation of ketones (or ketones formation may be mild)

measles

Essentially eradicated in 2000, but resurging cases due to lack of immunization in other countries and the US Globally one of the leading causes of death in children - CDC says approximately 197,000 deaths by measles per year worldwide Highly contagious disease, complications include: bacterial pneumonia, eye damage and blindness Possibility of "measles associated immune memory loss" in reference section Supportive treatment (rest, hydration, antipyretics, oatmeal baths) and Vitamin A supplements have been shown to decrease complications by 50% Autism connection proved false!

hyperthyroidism

Excessive secretion of the thyroid hormones T3 and T4 Epidemiology: - 15% of cases with a familial link - Male to Female ratio 1.5 to 10 - Higher rates in Caucasians Etiology - Autoantibodies attack the thyroid gland (Graves' Disease) - Subacute thyroiditis - Toxic multinodular goiter Risk Factors: Being female, being pregnant, being Caucasian, familial link, having specific genes tissue types HLA-DRw3, HLA-B8,9 or HLA-Bw35

Stroke unique signs and Sx

FAST is most common for all but everyone can have unique Signs and Sx of a stroke: Women: - FAST - vision problems - trouble walking or lack of coordination - severe headache w/o a known cause - general weakness - disorientation, confusion or memory problems - fatigue - nausea and vomiting Men: - FAST - vision problems - trouble walking or lack of coordination - severe headache w/o a known cause

diagnostic screening (diabetes)

FPG Test- Fasting Plasma Glucose: •Nothing to eat or drink for 8 hours •Blood Glucose checked usually first thing in the morning •Fasting glucose of 126mg/dL on 2 separate days confirms OGTT- Oral Glucose Tolerance Test: •Person ingests a specific amount of a carb (drink) •BG level checked 2 hours later •140-199 mg/dL indicates prediabetes •Greater than 200mg/dL indicates diabetes A1C- Glycated Hemoglobin: •Can be used to diagnose diabetes and is used to assess blood glucose control over a 3 month period (can tell you their average blood sugar over a 3-month span of time) •A1C of greater than 6.5% diagnoses diabetes •5.7%-6.4% is considered prediabetes

T or F 1.An advanced directive or living will must be signed by an attorney.

False

true or false? The most frequent early sign for a patient at risk for malignant hyperthermia subsequent to general anesthesia is bradycardia.

False Rationale: The most frequent early sign for a patient at risk for malignant hyperthermia subsequent to general anesthesia is tachycardia.

true or false? Intraoperative phase: the period of time from the decision for surgery until the patient is transferred into the operating room.

False Rationale: The preoperative phase is the period of time from the decision for surgery until the patient is transferred into the operating room. The intraoperative phase is the period of time from when the patient is transferred to the operating room to the admission to postanesthesia care unit (PACU).

Is the following statement true or false? Populations and communities are terms that can be used interchangeably.

False Rationale: Populations and communities are two different terms. A population differs from a community in that the individuals of the population do not necessarily interact with one another and do not necessarily share a sense of belonging to that group. Communities involve people who chose to interact with one another because of common interests, characteristics, or goals.

Is the following statement true or false? - The Patient Self-Determination Act ensures that a person with a mental illness is not discriminated against in the workplace.

False. - The Patient Self-Determination Act requires agencies receiving Medicare and Medicaid reimbursement to inform patients at the time of admission of their right to be a central part of any and all health care decisions made about them or for them.

fluid and electrolyte balance

Fluid and electrolyte balance requires the regulation of fluid and electrolytes in a dynamic process that is crucial for homeostasis and life. Nurses encounter potential and actual alterations in fluid and electrolyte balance in all types of clients and health care settings, and nurses play an important role in assuring that the intake of fluid and electrolytes is balanced by the output of both from the body - Necessary for life, homeostasis - Nursing role: anticipate, identify, and respond to possible imbalances

policy development and enforcement

Follow Three General Themes: 1.Tackling inequality and improving living standards 2.Protecting those at the bottom of the pyramid 3.Reforming decision-making 1.These policies aim to close the gap between the rich and the rest of us, and between white people and people of color. 2.These policies protect under-resourced households and communities from health threats posed by the chaos and uncertainty of free markets. They promote not only additional programs and services, but more equitable allocation of public resources for social investments (such as quality schools, housing, and infrastructure) so that the means for achievement are more available to those with fewer individual resources. 3.These policies aim to open and democratize decision-making processes that are too often dominated by concentrated economic and political power.

unstageable pressure ulcer

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Stroke evidence-based nursing interventions

Implement evidence-based nursing interventions to (1) identify people at risk for altered cerebral tissue perfusion (stroke), and (2) prevent and/or activate early emergency management for compromised cerebral tissue perfusion secondary to stroke. (Note: emergency interventions for stroke will be included in NURS 4010)

anesthetic agents

General Inhalation Intravenous Regional Epidural Spinal Moderate sedation can be given by an anesthesiologist, CRNA, or other specially trained and credentialed physician or nurse. The patient receiving moderate sedation is never left alone and is closely monitored by a physician or nurse who is knowledgeable and skilled in detecting dysrhythmias, administering oxygen, and performing resuscitation. The continual assessment of the patient's vital signs, level of consciousness, and cardiac and respiratory function is an essential component of moderate sedation. Pulse oximetry, a continuous ECG monitor, and frequent measurement of vital signs are used to monitor the patient.

classification of diabetes (gestational)

Gestational Diabetes: •Occurs during pregnancy •Resolves after pregnancy •Related to the effects of hormonal changes during pregnancy

Healthy People 2020 health promotion

Goals: ●Attain high quality, longer lives free of preventable disease, disability, injury, and premature death ●Achieve health equity, eliminate disparities, and improve the health of all groups ●Create social and physical environments that promote good health for all ●Promote quality of life, healthy development, and healthy behaviors across all life stages

Which of the following interventions are important to promote healing for this patient? (SELECT ALL THAT APPLY). H. Assist the patient to splint the abdomen when doing coughing & deep breathing exercises. I. Give acetaminophen (Tylenol) for a temperature of 99.2 degrees F. J. Call the surgeon if the patient reports feeling a "popping" sensation at the incision after coughing. K. Call the surgeon if the patient refuses to ambulate. L. Restrict visitors

H and J

assessment of sensory perception

HR, BP, electrodermal, hormone levels, cortisol level, CN, senses - hearing level, visual acuity, integumentary system intact, taste (sweet, salt, sour, bitter), olfactory (odor sensed), affect, communication, ADLs

vulnerable and inequality in healthcare

Health Disparities: ●Poor access to care; quality of care ●Overt discrimination ●Levels and types of care and care settings (Goal of HP 2020 to "achieve health equity, eliminate disparities, and improve the health of all groups")

hypothyroidism

Hypothyroidism occurs when there is insufficient T3 and T4 (Thyroxine) hormone secretion - Epidemiology -- 4% of the US Population per year -- Frequency increases with age -- Occurs more often in women -- Occurs more frequently in caucasians Etiology: - Deficiency of thyroid hormone - Usually a primary process (problem at target organ) - What does this mean? (problem at thyroid gland) Risk factors: being older the 50, being female, being pregnant, autoimmune disorders, radiation to the neck, family history, certain drugs (such as iodine, lithium), iodine deficiency

Evaluating pain

Identify Goals: Verbalize numeric goal - Decreased pain intensity rating Demonstrate functional goal - Accomplish daily tasks, therapeutic activities

When should a vaccine NOT be given?

If currently ill, has fever Any question of immunocompetence Allergies to vaccine components (patient assessed before giving)

clinical examples

If mother is Rh negative and baby is Rh positive, antibodies are developed by mom against the fetal blood cells. IgM cannot cross placental barrier With second pregnancy, the amnestic response occurs and IgGs are present, smaller and can cross the placenta - danger! Treatment: Check mom with antibody screen at 28 weeks Injection of Rh immune globulin if no antibodies produced yet, again at delivery. Baby to be monitored and may require blood transfusion (at risk for anemia)

Preoperative Nursing Interventions

Immediate: •Administering preanesthetic medication •Maintaining preoperative record •Transporting patient to presurgical area •Attending to family needs •Tip: many facilities have a "Pre-op Checklist" Other interventions: •Providing psychosocial interventions -Reducing anxiety, decreasing fear -Respecting cultural, spiritual, religious beliefs •Maintaining patient safety •Managing nutrition (NPO), fluids •Preparing bowel •Preparing skin

Immune dysfunction (hypersensitivity)

Immune response that becomes injurious to tissues. Ranges from mild allergic rash to life threatening conditions Involve either cell-mediated or antibody-mediated mechanisms

older adults (type 2 diabetes)

Impacts 5.9% of the population 65 and older ●Impacts Health: ○Blindness ○Kidney disease ○Foot or leg amputation ●Limits ability to perform activities ●Depression ●Anger

Incidence vs. Prevalence

Incidence = new cases - all of the new cases of a disease or health condition that appear during a given time. (HIV/AIDs have high incidence in the 80s, today it's a low incidence and high prevalence because it has come more of a common chronic illness because we know how to manage it now) Prevalence = all current cases - all of the people with a health condition existing in a given population at a given point in time. Measures disease burden. (HIV/AIDS incidence was high but prevalence was low)

If the patient was acidic how would the lungs respond?

Increase respirations to blow off more CO2

If the patient was alkalotic how would the kidneys respond?

Increase secretion of HCO3 in the urine

In the depression video of a woman Louise, what would be a nursing diagnosis for Louise given her symptoms?

Ineffective coping -Disturbed sleep pattern -Imbalanced nutrition -Risk for suicide -? situational low self-esteem -? Disturbed thought processes

Type IV delayed hypersensitivity

Initiated by T lymphocytes with previous exposure to an antigen The T cells do not attack the antigen until days after initial exposure, and then cause an inflammatory reaction known as contact dermatitis Because of delay, oftentimes difficult to recall exposure Classic example Poison ivy Another more serious example is transplant rejection - Donor tissue cells are antigenic to recipient, so T cells target donor tissue. Does not occur immediately, need to watch for after transplantation

insulin therapy

Insulin therapy: Categories: - Rapid Acting Humalog; Novolog Short-acting insulin (Regular) - Humulin R, Novolin R (Regular Insulin) - Intermediate Humulin N; Novolin NPH - Combinations: NPH/Regular Long Acting Glargine (Lantus) - Varies from 1 to 4 injections per day - May combine a short-acting insulin and a longer-acting insulin - Methods of insulin delivery include: -- Traditional subcutaneous injections -- Insulin pens -- Jet injectors -- Insulin pumps

Pressure ulcer stage 1

Intact skin with non-blanchable redness of a localized area, usually over a bony prominence; skin is not broken but is red or discolored; partial thickness skin loss; skin can be warm or cool. No opening

Pressure ulcer risk factors

Intrinsic factors: -Immobility -Impaired sensation -Malnourishment -Aging -Fever Extrinsic factors: -Friction -Pressure -Shearing -Exposure to moisture

Other lab tests (diabetes)

Islet Cell Antibodies: •Presence of this autoantibody can help diagnose Type 1 diabetes and differentiate it from Type 2 •Presence of ICAs can indicate risk for Type 1 Diabetes development if there is not diabetes already •(islet cells on pancreas and antibodies are in the blood) C-peptide test: •C-Peptides are released when the pancreas produces insulin •Presence of C-Peptides can differentiate Type 1 vs. Type 2 •Type 1: no insulin •Type 2: insulin Can help differentiate between type 1 and 2 diabetes Urine Tests: •Urine Dipstick and Urinalysis •- Glucosuria: •This extra glucose will be excreted in the urine •Glucose in the urine can be indicative of uncontrolled diabetes •- Ketonuria: •Urine that contains ketones can reveal uncontrolled diabetes or prolonged fasting

Bipolar disorder

It may begin with a manic episode or even several manic episodes, but eventually depressive episodes occur Chronic, recurrent illness 25-60% of people with bipolar disorder will make a suicide attempt at least once in their life

History of epidemiologists

John Snow: - spot plotting Cholera Florence Nightingale: - detailed records on morbidity - one of the first systematic descriptive studies of distribution patterns of disease in populations - use statistics as evidence to gain the attention of policy makers and those in power 2020: - Michael Osterholm (U of M) - Kris Ehresmann (disease epidemiology, prevention and control division)

primary prevention

Keep illness or injury from occurring (ex. Immunizations- flu shot, dietary guidance)

education (role of nurse)

Learning assessment is crucial to successful self-management: •Is the client ready to learn? •What is their preferred language? •What is their health literacy? •How does the client prefer to learn? (listen, watch, read, do) •Who is the client's support system, and how can the nurse include in education? •Does the client have any cultural or religious beliefs that may influence their self-management? •Blood glucose monitoring •Relationship between physical activity and blood glucose •Signs and symptoms of hypoglycemia and hyperglycemia •Appropriate action steps for hypoglycemia and hyperglycemia •Medication management

Accountability

Legal liability in psychiatric nursing practice - Assault - Battery - Medical battery - False imprisonment - Negligence Common areas for lawsuits: patients who are suicidal or violent

Stress, disease and lifespan (sensory perception)

Lifespan: - Elderly - decreased immune response = increased infection risk and poor wound healing; increased risk for anxiety and depression - Child - exposure to stressful situations = neurologic and cognitive development implications (increased anxiety and impaired decision making) - Pregnancy - high stress = low fetal birth wt and preterm birth and post partum anxiety and depression

Cardinal signs of inflammation

Localized: - Redness - Swelling - Heat - Pain - Loss of Function

The nurse educating a client taking a tricyclic antidepressant (TCA) should include: (select all that apply) 1.Full effects are not experienced for about 4-8 weeks. 2.There is a high likelihood of anticholinergic effects (some can potentially be severe) 3.Certain foods interact with this medication, so you need to be careful. 4.Serious cardiac side effects can occur. 5.Sedation is a common side effect during initial treatment. 6.There is an increased risk of falling.

MAOIs: block the enzyme (MAO) that metabolizes monoamines such as norepinephrine, dopamine and serotonin But MAOIs also block the breakdown of tyramine in the liver (leading to high blood pressure, hypertensive crisis, cerebrovascular accident {CVA}, death) Answers: 2, 4, 5 Block the breakdown of tyramine in the liver which ca cause = Hypotension is the most critical side effect and could cause falls Tyramine (next slide) Hypertensive crisis: servere headache, stuff and sore neck, flushing, cold and clammy skin, tachycardia, severe nosebleeds, dilated pupils, chest pain, stroke, coma, death, nausea and vomiting

Uncontrolled communicable disease

Malaria (through mosquitos) Cholera Tuberculosis (reemerging since 1980s) Yellow fever COVID-19

C diff (manifestation, diagnostics and tx)

Manifestations: - Pain areas: in the abdomen - Gastrointestinal: diarrhea, bloating, or blood in stool - Also common: fever Diagnostics: - Stool culture - Polymerases chain reaction (PCR) - Sigmoidoscopy or colonscopy - computerized tomography (CT) scan Tx: - Stop the antibiotic - Ironically give another antibiotic - metronidazole (Flagyl), vancomycin (Vancocin) - Surgery - Contact Enteric Precautions -- Isolation - Wash hands

Type II cytotoxic hypersensitivity

Mediated by Igs directed toward antigens present on cell surfaces Igs target cells coated with antigen Antibody-mediated cell destruction and phagocytosis occur Example: Blood transfusion with wrong blood type, resulting in massive hemolytic reaction (cells destroyed)

stress and disease (sensory perception)

Mental health - acute stress disorder; PTSD Physical health - SNS - COPD, asthma exacerbations; MI - Immune - inflammatory response aggravates lupus, MS; immunosuppression = infection risk - GI - worsens inflammatory bowel disorders, peptic ulcers, reflux

hypoglycemia (symptoms)

Mild: - shaky or jittery - sweaty - hungry - blurred vision sleepy or tired - dizzy or lightheaded - confused and disoriented - pale Moderate: - uncoordinated - irritable or nervous - argumentative or combative - trouble concentrating - weak - fast or irregular heart beat Severe: - unable to eat or drink - seizures - unconsciousness

mood vs affect

Mood= persistent emotional state Affect= external display of feelings

IgG

Most abundant immunoglobulin in the bloodstream. Most important anti-pathogenic immunoglobulin in infections and commonly involved in autoimmune disease

IgA

Most abundant in mucosal secretions; sweat, saliva, tears, breast milk, nasal, bronchial and digestive tract secretions.

extrapyramidal side effects (EPSE)

NEED to know EPSE side effects anywhere because it's common for patients to be given Haldol in the ED if they are having trouble controlling their behavior - they could have had a dose and now come up to your floor and you are now seeing the symptoms ANTIEPSE med: diphenhrydramine, benztropine Early: - Dystonia: muscle cramps of the head and neck, oculogyric crisis - Pseudoparkinsonism: stiffening of muscular activity in the face, body, arms, and legs, pill-rolling, shuffling gait - Akathesia: internal restlessness and external restless pacing or fidgeting, incessant foot tapping, rocking back and forth in a chair Late: - Tardive Dyskenesia: after prolonged treatment, more serious, not always reversible Involuntary tonic muscular spasms that typically involve the tongue, fingers, toes, neck, truck or pelvis Lip smacking, uncontrollable biting, chewing or sucking motions, an open mouth, lateral movements of the jaw

natural enzymes (innate immune response)

Natural enzymes, bactericidal, antiviral substances and acidic secretions: - makes skin and mucous membranes inhospitable to pathogens

Types of white blood cells

Neutrophils: first responders! - At the site within first 24-48 hours - Short life-span: hours to days Lymphocytes Eosinophils Basophils Monocytes - Activated after 24-48 hours - Long life-span: weeks to months

Stroke prevention

Nonmodifiable risk factors: -Age (older than 55 years), male gender, African Americans Modifiable risk factors: -Hypertension is the primary risk factor -Cardiovascular disease -Elevated cholesterol or elevated hematocrit -Obesity -Diabetes -Oral contraceptive use -Smoking and drug and alcohol abuse

Assessing pain intensity

Numeric Rating Scale: rate on a scale of 0-10 •- Patient verbalizes numeric rating Wong-Baker FACES Pain Rating Scale: cartoon faces with descriptors •- Patient points to face •- **Not a judgment based on nurse observation of patient's expression

Type I immediate hypersensitivity

Occurs in individuals previously exposed to an allergen IgE binds to mast cells and combines with antigen which in turn releases histamine. Mast cells are widely distributed in tissues, especially respiratory Histamine is potent vasodilator Can be local (extent depends on site of reaction) or systemic Common symptoms are skin rash, nasal or conjunctival discharge, bronchial asthma or allergic gastroenteritis

antagonistic drug interaction

One drug interferes with the actions of another and decreases the resultant drug effect—that is, the combined effect is less than that of one drug given alone.

external advocacy system

Organizations that operate independently of mental health agencies and serve as advocates for the treatment and rights of mental health patients. - no legal authority but influences policies

healthcare system nurse advocate

Our current health care system is often characterized by fragmented and depersonalized services, and many clients—especially the poor, the disadvantaged, those without health insurance, and people with language barriers—frequently are denied their rights. They become frustrated, confused, degraded, and unable to cope with the system on their own. The community health nurse often acts as an advocate for clients.

outbreak investigation

Outbreak Investigations - Communicable disease - Non communicable disease - Exposure to toxins - Investigate - Analyze data - Interpret data - Implement health promotion and risk reduction - Evaluate short-/long-term effects Communicable disease outbreaks - Infectivity of the agent - Numbers infected - Route by which they were infected - Point source - Secondary spread Noncommunicable disease outbreaks - Longevity has led to non-communicable diseases Exposure to toxins - Risk factors adversely affecting the health of the public

Hashimoto's Hypothyroidism

Pathophysiology: - Autoimmune destruction of the thyroid gland - Autoantibodies bind to the TSH receptor sites -- Inflammation and destruction of the thyroid gland -- Destruction of the gland prevents TSH from binding, therefore the gland cannot synthesize T3 and T4 - problem is occurring at the thyroid gland (primary) and deficiency of thyroid hormones Clinical Presentation Decreased metabolic activity! - Elevate cholesterol - Elevated Triglycerides - Anemia due to decreased hematopoiesis - Susceptibility to drug toxicity - Cold intolerance - Weight gain - Fatigue - Constipation - Puffy face

Addison's disease (Patho and symptoms)

Pathophysiology: - Gradual autoimmune destruction of the adrenal gland - Adrenal cortex antibodies - Antibodies to the steroid enzymes -- These prevent the conversion of precursor hormones to adrenal hormones - Decreased secretion of cortisol and aldosterone -- Decreased Stress Response -- Can lead to adrenal crisis Clinical manifestations: - Weakness, fatigue, lethargy, nausea, vomiting, hypotension, hypoglycemia, electrolyte imbalances - Why the hypotension, hypoglycemia? -- Hypotension why? - aldosterone helps us keep fluids and retain sodium and get rid of potassium problems can lead to altered secretion and regulation of these --Hypoglycemia why? - cortisol makes blood sugar high - no cortisol can lead to low blood sugar

Influenza (pathophysiology and maifestations)

Pathophysiology: - Virus enters upper respiratory tract - Invades the lower respiratory tract mucous gland cells, alveolar cells and macrophages - Virus causes respiratory epithelial cells to die Manifestations: - Pain areas: in the muscles - Cough: can be dry or with phlegm - Whole body: chills, dehydration, fatigue (malaise), fever, flushing, loss of appetite, body ache, or sweating - Nasal: congestion, runny nose, or sneezing - Also common: chest pressure, head congestion, headache, nausea, shortness of breath, sore throat, or swollen lymph nodes

internal rights protection system

Patient protective mechanisms developed by the U.S. mental health care system's organizations to help combat any violation of mental health patients' rights, including investigating any incidents of abuse or neglect. - advocates for patients - investigates

Phantom (source of pain)

Perceptions that an individual experiences relating to a limb or an organ that is not physically part of the body.

older adults prevention (diabetes)

Primary Prevention: ●Health Teaching ○Culturally sensitive ○Consider health literacy Secondary: Screening for DM and screening the effects such as diabetic retinopathy, peripheral neuropathy, depression, caregiver strain, etc. (take advantage of opportunities) Tertiary: ●Encourage Self-care (glucose monitoring, medication management, foot care) ●Ongoing education ○Emphasis on the clients needs (i.e. food preparation, activities, sexual function, cost of medication) ●Support groups ●Support navigating Medicare and Medicaid

Prevention of communicable diseases

Primary prevention: - Mass media education campaigns - One-on-one education - Immunization Secondary prevention: - Screening and disease investigation Tertiary prevention: - Ensure additional people not infected - Ill receive care and treatment - Service for high-risk population - Safe handling and control of infectious wastes

(Nursing Process) Characteristics and Community

Problem-solving process; management process; process for implementing change Characteristics: ●Deliberative; adaptable; cyclic ●Client (community) focused; need oriented ●Culturally Sensitive ●Interaction with community (communication, reciprocal interaction, paving way for helping relationship, aggregate application) ●Forming of partnerships and building of coalitions

secondary prevention (diabetes in children)

Prompt treatment: initiate referrals for health care provider follow-up in collaboration with parents of students at risk for T2DM Early diagnosis: - teach older children to calculate their BMI - monitor BMI scores - yearly screenings for height and weight (callpers are useful) - complete health histories on at-risk children

causative factors

Root causes: ●Socioeconomic status/poverty ●Insurance coverage: uninsured and underinsured ●Race and ethnicity (Racism) (Difficulty in measuring due to overlapping of populations)

Louise is taking fluoxetine (Prozac), what important information should the nurse teach about SSRIs? (Select all that apply) 1. They have a Black Box Warning. 2. They increase cardio-toxicity. 3. They increase potential for serotonin syndrome. 4. They are monitored via frequent blood draws. 5. Optimal therapeutic effects take 6-8 weeks.

SSRIs selectively block the neuronal reuptake of serotonin leaning more serotonin available in the synaptic site Answers: 1, 3, 5 Black Box Warning: potential link between taking an SSRI and increased suicidal tendencies (increasing energy while still working on stopping depression, increases risk of suicidal actions) Serotonin syndrome is a rare and life-threatening event Serotonin syndrome symptoms: abdominal pain, diarrhea, sweating, fever, tachycardia, elevated BP, altered mental state, muscle spasms, increased motor activity, irritability, hostility, mood changes Severe: hyperpyrexia (excessive high fever), cardiovascular shock or death Therapeutic effects start in a couple weeks, but optimal therapeutic effects take 6-8 weeks.

Stroke Diagnosis

STROKE- can affect all body systems •Impaired physical mobility •Acute pain •Self-care deficits •Disturbed sensory perception •Impaired swallowing •Urinary incontinence •Disturbed thought processes •Impaired verbal communication •Risk for impaired skin integrity (decreased mobility and sensation) •Interrupted family processes •Sexual dysfunction •Ineffective tissue perfusion (cerebral) •Disturbed sensory perception •Anxiety

Smoking and substance use (infection risk)

Smoking interferes with normal respiratory functioning, including the ability to move the chest, cough, sneeze, or have full air exchange. Chemicals in tobacco paralyze cilia; thus, secretions pool in the lower airways, creating a hospitable environment for bacterial growth. Although tobacco users are most profoundly affected by these changes, people exposed chronically to secondhand smoke (e.g., bartenders, children of smokers) are also affected by these changes and are at increased risk for infection.

Social Determinants of Health

Social factors that affect families and communities such as: ●education ●housing conditions ●options for safe and active transportation ●access to health care services ●access to healthy food ●employment and income ●neighborhood environment and safety ●quality of the built environment such as parks, buildings, and green spaces ●systemic racism

acute inflammation Vascular permeability (stage 1)

Stage 1 - The release of inflammatory mediators à blood vessels dilation and increased capillary permeability - Increased blood flow to site of injury and allows WBCs and fluids to reach the site of injury - Increased fluid -> dilutes the toxins - WBCs -> surround and consume foreign materials, a process called phagocytosis Cardinal signs at this stage: - Redness: vasodilation, increased blood flow - Heat: vasodilation, increased blood flow - Swelling: increased vascular permeability, fluid accumulation - Pain: increased vascular permeability and accumulation of fluid leads to compression of tissues; inflammatory mediators elicit a pain response - Loss of function: related to tissue damage from injury, pain, swelling

acute inflammation Cellular chemotaxis (stage 2)

Stage 2: - Chemotaxis: a chemical signal that attracts platelets and WBCs to the site of injury -- Chemo[taxis] - think taxis, getting people (or cells) to where they need to be! - WBCs arrive at the site of inflammation and release different inflammatory mediators -- Some amplify the inflammatory response -- Some attract more WBCs to the area -- Some attempt to stop the inflammatory response An increased or decreased WBC count? - Increased. During inflammation, more WBCs are being released from the bone marrow into the bloodstream. An increased or decreased CRP? - Increased. An elevated CRP in the bloodstream indicates active inflammation. CRP is a protein released by the liver in response to cytokines, which are inflammatory mediators

Where do lymphocytes come from?

Start in bone marrow, but cannot initiate immunity until mature and pass through lymphoid tissue (thymus, spleen, lymph nodes) T- lymphocytes mature in the thymus gland (T/T), then end up in bloodstream and lymph nodes B- lymphocytes mature within bone marrow (B/B), spleen and lymph nodes

B (SBAR)

State pertinent background information related to the situation. (It may include diagnosis, medications, allergies, labs, code status, interventions, and other pertinent clinical information). Think about the circumstances leading up to the situation.

epidemiology and etiology stress

Stress - Non-specific response of the body to any demand made upon it - normal part of life Epidemiology - acute vs chronic and can lead to various stress related disorders (e.g. PTSD) - Populations at risk: -- Everyone - > work related or serious live events Etiology - Acute stress: good = short term protection from infections - Chronic stress: immunosuppression = at risk for infections

Epidemiology (definition)

Study of disease distribution in populations Study of factors that influence or determine disease distribution - derived from the Greek words epi (upon), demos (the people), and logos (knowledge); the knowledge or study of what happens to people. - Guides the questions the PHNs asks and the steps that they take to find answers and solutions. At its core, Epidemiology is about solving mysteries and then acting on what you learn

What should all people experiencing mania be assessed for?

Suicide

cutaneous (source of pain)

Superficial somatic pain.

Wernicke's syndrome (alcoholism)

Symptoms: - Confusion, diplopia, nystagmus, ataxia - Disorientation, apathy Interventions: - Balanced diet, - Abstinence form alcohol - IV or IM thiamine, - Abstinence form alcohol

Alcoholic Chronic Brain Syndrome (Dementia)

Symptoms: - Fatigue, anxiety, - Personality changes, - Depression, - Confusion - Loss of memory of recent events - Can progress to bedridden, dependent state Interventions: - Balanced diet, - Abstinence form alcohol

Korsakoff's psychosis (alcoholism)

Symptoms: - Memory disturbance with confabulation, - Loss of memory of recent events, learning problem - Possible problem with taste and smell, loss of reality testing Interventions: - Balanced diet, thiamine, abstinence from alcohol

Prevention of pneumonia with patients with influenza

Symptoms: ❖Fever ❖Cough ❖Sore throat ❖Runny or stuffy nose ❖Body aches ❖Headache ❖Chills ❖Fatigue ❖(CDC.gov) Interventions that help: ❖Rest ❖Increase fluid intake ❖Elevate head of bed ❖Acetaminophen p.o. ❖Over the counter cold or flu medications (caution: may contain acetaminophen)

Natural killer cells (innate immune response)

T-lymphocytes that contain cytoplasmic granules, can destroy tumor and virus-infected cells without previous exposure

regional anesthesia

Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked. - anesthesia applied to a limb or an entire section of the body

CIWA scale

The CIWA-Ar scale is the most sensitive tool for assessment of the patient experiencing alcohol withdrawal. Nursing assessment is vitally important. Early intervention for CIWA-Ar score of 8 or greater provides the best means to prevent the progression of withdrawal.

Expressive aphasia (Broca's)

The inability to produce language (despite being able to understand language) - trouble communicating thoughts through speech or writing

passive acquired adaptive immunity

The individual is given premade, fully formed antibodies against an antigen (no action required on the part of the host) Provides immediate immunity, but does not last - only short-term Example: Breast milk contains fully formed maternal antibodies that are passed on to the infant. Serves to protect until the baby's own immune system is more fully developed.

Wound healing intention

The nature of the wound determines the process the body uses to heal - Primary Intention: -- Least complicated -- Clean wound edges, no missing tissue -- Ex: Surgical incision , paper cut- no gap in the tissue) - Secondary Intention: -- Significant loss of tissue within the wound (gap) -- Ex: Severe burns - Tertiary Intention: -- Significant loss of DEEP tissue within the wound -- Contaminated -- Ex: Pressure ulcer

Endogenous healthcare related infection

The pathogen arises from the patient's normal flora, when some form of treatment (e.g., chemotherapy or antibiotics) causes the normally harmless microbe to multiply and cause infection. For example, a yeast infection may develop in a client receiving antibiotics after surgery.

Levels of prevention

The public health nurse can apply all three levels of prevention when working with TB clients: - primary: education, considering health literacy and other barriers - secondary: screening those at risk - tertiary: treating/managing latent and active TB.

herd immunity

The resistance of a group to an attack by a disease to which a large proportion of the members of the group are immune

hygeine hypothesis

Theory that if we clean too much we and our kids are protected too much from common bacteria. in result we and out kids are effected and harmed by small and common bacteria and dont have enough innate or learned bacteria defenses

Synergistic drug interaction

There is an additive effect; that is, the effect of both drugs together is greater than the individual effects.

Incompatibilities drug interaction

These occur when multiple drugs are mixed together, causing a chemical deterioration of one or both drugs. The result is an incompatible solution that should not be administered. You can usually recognize an incompatibility when the mixed solution takes on a changed appearance. However, you should always consult medication resources and compatibility charts before mixing medications. Then, after mixing, double-check the medication for changes in appearance.

transmission-based precautions (definition)

This is the second tier of protection and outlines precautions to be taken based on the mode of transmission of the infection. Recall from the discussion on the chain of infection that pathogens may be transmitted by contact, droplet, or air. Each mode of transmission requires a different approach to prevent infection.

Natriuretic peptides

Three categories: - Atrial natriuretic peptide (ANP) - Brain natriuretic peptide (BNP) - C-type natriuretic peptide (CNP) - Peptides are secreted in response to fluid volume overload -- Stretching of heart chambers and arteries (leads to release of peptides) - Peptides promote increased glomerular filtration rate and increases the excretion of water and sodium (and decrease overall fluid volume)

Medication Admin safety

Three checks: Before you pour: -Check the medication label against the medication pyxis and MAR. (Be sure that the name, route, dose, and time match the MAR entry.) After you pour: -Verify the label against the MAR again At the bedside: -Check the medication again with patient nameband and MAR

Major hormone secreting glands

Thyroid: T3,T4: increase metabolic rate, increase, protein and bone turnover, increase responsiveness to catecholamine's, necessary for fetal growth and development Parathyroid: PTH, REGULATES CALCIUM Adrenal Glands: Mineralocorticosteriods, mainly aldosterone and glucocorticoids, mainly cortisol, increase Na absorption, potassium loss by kidney, affet metablolism of all nutrients, regulates blood glucose levels, affects growth and has anti-inflammatory action and decreases effects of stress Posterior pituitary gland: ADH, oxytocin: increases water reabsorption by kidney, stimulated contraction of pregnant uterus, milk ejection from breasts after childbirth (oxytocin)

Concept of natural history of disease

Timeline shows state of susceptibility, exposure, subclinical disease in which pathologic changes takes place, onset of symptoms, followed by usual time of diagnosis, clinical disease, followed by recovery, disability, or death. 1.Susceptibility Stage 2.Subclinical disease stage a.Incubation period b.Induction period 3.Clinical disease stage 4.Resolution stage

Prevention of communicable diseases education

To adapt health messages to specific population subgroups, include the following: •Develop educational materials from the community perspective, reflecting respect for community values and traditions, relevance to community needs and interests, and participation of the community in the preparation and use of the materials. •Materials must be related to the delivery of health services that are available, accessible, and acceptable to the target population. •All materials must be pretested and have demonstrated attractiveness, comprehension, acceptability, ownership, and persuasiveness. •Materials must have a readability level for the intended audience.

If osmotic pressure is higher than hydrostatic pressure which way will the fluid move?

To the extracellular fluid (ECF) - (out of the cell, to the bloodstream)

If hydrostatic pressure is higher than osmotic pressure which way will the fluid move?

To the intracellular fluid (ICF) - (out of the bloodstream, to the cells)

T or F 1.A mental health professional has the "duty to warn" when a client in his or her care has threatened to injure someone.

True

True or False: The patient's report of pain intensity is considered the most reliable indicator of pain and the most essential component of pain assessment.

True

true or false? The circulating nurse is responsible for monitoring the surgical team.

True Rationale: The circulating nurse is responsible for monitoring the surgical team.

active acquired adaptive immunity

Two ways to develop active acquired adaptive immunity: ◦1. Exposure to antigen ◦- By contracting the disease or illness ◦2. Immunization ◦- Provides exposure to the antigen without contracting the disease

Classification of diabetes (type 1)

Type 1 Diabetes: •Insulin-producing beta cells in the pancreas are destroyed by a combination of genetic, immunologic, and environmental factors •Results in decreased insulin production, unchecked glucose production by the liver and fasting hyperglycemia •Affects 5% of adults with diabetes

classification of diabetes (type 2)

Type 2 Diabetes: •Insulin resistance and impaired insulin secretion •Affects 95% of adults with diabetes, onset over age 30 years, increasing in children r/t obesity •Slow, progressive glucose intolerance and may go undetected for years

type 2 risk factors

Type 2: obesity, age, previous identified impaired fasting glucose or impaired glucose tolerance, hypertension ≥140/90 mm Hg, HDL ≤35 mg/dL or triglycerides ≥250 mg/dL, history of gestational diabetes or babies over 9 pounds

school-age children and adolescents (diabetes)

Type I: ●Leading cause of diabetes in all children ●50% Diagnosed before age 10 Type 2: ●Most diagnosed after age 10 ●Average age of diagnosis 13.5 ●Increase in cases since 1999 (public health crisis) ○Increases in weight of children ○Sedentary lifestyle ○Genetic predisposition People with pigmentation: Possible connection with secreted protein Pigment epithelium-derived factor (PEDF) + obesity = higher risk

Infectious diseases with vaccine

Varicella (chickenpox) Diphtheria Rubella (German measles) Measles (rubeola) Mumps Pertussis (whooping cough) Influenza

longterm complications (diabetes, vascular)

Vascular Damage: - Micro: •Retina •Neurons •Nephrons (kidney) - Macro: •Coronary artery disease •Cerebrovascular disease •Peripheral vascular disease

vulnerable population at risk for

Vulnerability increases one's susceptibility to poor health. Relative risk is the exposure to risk factors involving one's: ●Lifestyle ●Behavior and choices ●Health care services ●Stress ●Heightened risk of adverse health outcomes ●Higher mortality rates ●Less access to health care; disparities in quality of care ●Uninsured or underinsured ●Lower life expectancy ●Overall diminished quality of life

vulnerable populations

Vulnerability is susceptibility to poor health. Often, vulnerable populations are subpopulations: ●Ethnic or racial minorities ●The uninsured ●Those with HIV/AIDS ●Children ●The elderly ●The poor ●Those who are homeless ●Those with a mental illness The LGBTQ Ccommunity

severe anaphylaxis

abrupt onset with the same signs and symptoms described preciously, these symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. dysphagia, abdominal cramps, vomiting, diarrhea, and seizures can also occur. cardiac arrest and coma may follow. severe reactions are also referred to as anaphylactic shock

spinal anesthesia

achieved when a local anesthetic agent is introduced into the subarachnoid space of the spinal cord

Cellular Adaptation

allows the stressed tissue to survive or maintain function - Atrophy - hypertrophy - hyperplasia - metaplasia - dysplasia - neoplasia

IgM

also called macroglobulin due to large size. Earliest immunoglobulin to respond t infection

Acute stress

an intense biopsychosocial reaction to a threatening event, is time limited (usually less than a month) but can occur repeatedly. It can lead to physiologic overload and can result in chronic and negative health impacts

gastroesophageal reflux disease (GERD)

backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus - 20% of the US population experiences GERD - Most common in infants and people >40 years old Causes: - Increased pressure in the stomach against the lower esophageal sphincter (ex: obesity, pregnancy) Symptoms: - Dysphagia, heartburn, epigastric pain, and regurgitation Diagnosis: - Endoscopy Treatment: - lifestyle changes: (small meals, losing weight, no smoking, no laying after meal) - pharmacy: (decrease stomach acidity, improve lower esophageal sphincter, PPIs, histamine-2 receptor antagonists, antacids)

What is a late sign of IICP? (hypertension, disorientation, vomiting?)

hypertension

Closed wounds

if there is a break in the skin or mucous membranes. (Contusions (bruises) or tissue swelling from fractures)

Open wounds

if there is a break in the skin or mucous membranes. (include abrasions, lacerations, puncture wounds, and surgical incisions.)

aphasia

impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).

will hydrostatic pressure increase of decrease after admin of a hypotonic solution?

increase - pushing more fluid out of the bloodstream to the cells

Cytokines (innate immune response)

inflammatory mediators produced by WBC's, promote acute inflammatory reactions, activate macrophages and stimulate growth and production of new cells

tissue integrity (definition)

intact skin and mucous membranes in place to protect and support secretion, excretion, and healing - Nurses play a key role in assessing and maintaining tissue integrity for clients receiving care

Superficial wounds

involve only the epidermal layer of the skin. The injury is usually the result of friction, shearing, or burning.

cellular regulation

is a broad term that encompasses the growth and replication process of cells. This regulation is aimed at maintaining homeostasis, which is a steady state within the body. The nurse must understand how alterations in cellular regulation can impact health and disease in the clients receiving care

Addiction

is a condition of continued use of substances (or reward-seeking behaviors) despite adverse consequences. - it is a physical and psychological dependence to the substance - is a problem that occurs in every profession, in every educational, socioeconomic, ethnic and age group. All nurses must recognize signs and symptoms that people may be using substances.

When assessing pain intensity and duration, the nurse is aware that ________________ pain is due to damage to the peripheral or CNS.

neuropathic

vector transmission

occurs when the infectious agent is carried by a vector (nonhuman carrier such as an animal or insect) - a nonhuman carrier such as an animal or insect. Of all the infectious diseases, vector-borne illnesses are the most complex to prevent and control - Control strategies directed toward vector-borne diseases typically involve community education and environmental measures to hinder the vector from reaching the host.

Indirect transmission

occurs when the infectious agent is transported within contaminated inanimate materials such as air, water, or food (vehicle-borne transmission)

Contaminated wounds

open, traumatic wounds or surgical incisions in which a major break in asepsis occurred. The risk of infection is high for these wounds

Privacy

part of person's life not governed by society's laws and government intrusion

Preoperative phase

period of time from decision for surgery until patient is transferred into operating room. Check: - patient preop education - informed consent - NPO (bowel prep) - Skin prep - documentation (checklist of valuables) - voided prior to transfer - preop meds (given and charted) - side rails up, bed lowest position - hospital gown - allergy band - ID band - eyeglasses, dentures, hearing aids, contacts, jewelry, makeup, and nail polish removed -VS before transfer - preop lab work (surgeon notified abnormalities) - medication (Hx, MAR, high alert meds noted)

Postoperative phase

period of time from when patient is admitted to PACU to follow-up evaluation in clinical setting or at home

Intraoperative phase

period of time from when patient is transferred into operating room to admission to postanesthesia care unit (PACU)

droplet mode of transmission (covid)

respiratory droplets produced when the infected person coughs or sneezes. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity. The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely

Fill in the blank: 1.The right to refuse treatment is related to the larger concept of the right to be treated in the least ____________________ environment.

restrictive

penetrating wounds

sometimes added to indicate that the wound involves internal organs.

What should all people who have depressive symptoms need to be assessed for?

suicide

mild anaphylaxis

systemic reaction consist of peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth and throat. nasal congestion, periorbital swelling, pruitis, sneezing, and tearing of the eyes, begins in first 2 hours after exposure

Solution (definition)

the combination of the solute and the solvent - ex. saltwater

allostatic load

the cumulative changes of the biologic system of your body can be seen in abnormal lab results and this is the result of chronic stress, can cause physical and emotional issues

cervical dysplasia

the presence of precancerous changes in the cells that make up the inner lining of the cervix - Cells vary compared to healthy cells -- Shape -- Size -- Organization - Often detected on a Pap Test - Precursor to cervical cancer - Frequent examinations to monitor cells

Solvent (definition)

the substance doing the dissolving - ex. water

Solute (definition)

the substance to be dissolved - ex. salt

true or false? The CDC is a federal agency responsible for monitoring endemic and epidemic disease, recommending strategies to decrease disease incidence, and developing guidelines to reduce risk to patients and health care workers

true

Anxiety (definition and Symptoms)

uncomfortable feeling of apprehension or dread in response to internal or external stimuli. Factors to see if anxiety is a symptom of mental disorder: (intensity of anxiety relative to situation, trigger for anxiety, symptom clusters manifested) Symptoms: - Physical: heart racing, dilated pupils - Affective: impatient, edgy, fearful - Behavioral: avoidance, restlessness - Cognitive: confused, distracted, tunnel vision, fear of losing control, fear of death

Medical asepsis

•"A state of cleanliness that decreases the potential for the spread of infections" •Promoted through •- Maintaining a clean environment •- Maintaining clean hands •- Following guidelines from the Centers for Disease Control and Prevention (CDC) ▪This refers to procedures that decrease the potential for the spread of infections. You probably already practice medical asepsis in other settings without realizing it. For example, at home you wash your hands before and after handling foods. Before chopping food, you make sure the cutting board and utensils you use are clean. After using it, you wash the board with hot, soapy water. In the healthcare setting, medical asepsis includes hand hygiene, environmental cleanliness, standard precautions, and protective isolation.

Leaking (IV lines)

•(leaking around site onto bed/sheets. Stop IV fluids and get another site)

Phlebitis (IV lines)

•(vein is inflamed) (may have pain and reddened color/swelling- mainly caused by med going through vein like potassium. May get another IV site for some pts, wrap warm blanket around arm to help with pain)

Rheumatic disease

•- "Arthritis" •- NOTE: Rheumatoid Arthritis vs. Osteoarthritis •- Affect primary the joints but also the muscles, bone, ligament, tendons, and cartilage •- Remission and exacerbation •- Marked by inflammation, autoimmunity, and degeneration

Schizophrenia

•- A disorder of thoughts, perceptions, and behavior. •- Characterized by psychosis with prodomal periods, acute, stabilization, maintenance, recovery, and relapse possible. - is a disorder of thoughts, perceptions, and behavior, it is sometimes not recognized as an illness by the person experiencing the symptoms. This is referred to as anasognosia. Many people with thought disorders do not believe that they have a mental illness. Their denial of mental illness and the need for treatment poses problems for the family and clinicians. Some may need commitment to comply with treatment.

Tests for hypocalcemia

•- A, Chvostek's sign is contraction of facial muscles in response to a light tap over the facial nerve in front of the ear. •- B, Trousseau's sign is a carpal spasm induced by •- C, inflating a blood pressure cuff above the systolic pressure for a few minutes.

Environment

•- All external factors surrounding the host that might influence vulnerability or resistance •Geography •Climate •Weather •Safety •Water and Food Supply •Insects, animals •Storage sites of disease causing agents •Social, Cultural, Economic and Psychological influences (Access to care, poverty)

Pediatric considerations (pain)

•- Assessment based on developmental stage •- Opioid dose much smaller and weight based •- High risk for respiratory depression •- Nonpharmacological methods •-- Distraction, play, art, music

Mild depression communication

•- Cognitive behavioral therapy (negative thoughts è rational thoughts) •- Encourage activities r/t problem-solving, coping & assertiveness

Mania Communication interventions

•- Firm and calm approach •- Remain neutral and nonthreatening, avoid power struggles •- Be consistent in approach and expectations •- Listen to and act on legitimate complaints •- Short and concise statements

cerebrovascular disorders

•- Functional abnormality of the CNS that occurs when the blood supply is disrupted •- Stroke is the primary cerebrovascular disorder and the third leading cause of death in the United States. •- Stroke is the leading cause of serious long-term disability in the United States. •- Stroke also called CVA (Cerebro-Vascular Accident)

Nutritional imbalances (alcoholism)

•- Imbalanced nutrition less than body requires •- Malnutrition is common in alcoholism, because people often fail to eat a healthy diet due to the high caloric content of alcohol. Alcohol interferes with the absorption of vitamins and minerals, especially B vitamins. - Working with a holistic nurse to develop a healthy eating plan way be an important first step to recovery

Other depression/mania meds

•- May add antipsychotic agents or benzodiazepines as adjuvants for treatment while mood stabilizers are taking full effect - Adjuvants can help with other symptoms (insomnia, anxiety, agitation) while mood stabilizes are taking full effect

HIV and AIDS

•- May live 15 years after exposure before developing AIDS •- 20% are unaware they are infected •- 25-44 year olds of African/Hispanic descent are most prevalent (why?) •- Numbers on the rise in older adults (Because they are living longer and they are finding other partners after theirs pass away and need education on condom use with multiple partners)

opioid safety (home care and private home)

•- Patient & family education •- Securely store controlled substances •- Dispose of properly •- Monitor for side effects •- File police report if suspect stolen

pancreas

•- Produces insulin •- Insulin facilitates the cellular uptake of glucose

Mania continuation phase interventions

•- Psychoeducation •- Support system •- Living situation -Community resources -Medication compliance -Education about bipolar and relapse prevention, management of a chronic illness -Sleep hygiene, importance of sleep (can be a risk factor for relapse)

risk factors (definition)

•- Risk = Probability that a disease or unfavorable health condition will develop •- Risk factors: negative influences •- Epidemiologists study populations at risk: collection of people among whom a health problem has the possibility of developing because certain influencing factors are present or absent or because there are modifiable risk factors •- Measurement of relative risk ratio= can be: •Behavioral (lifestyle) •Environmental (social Conditions •Genetic (biology) •Health Care system incidence rate in exposed group *divided by* incidence rate in unexposed group Modifiable: meaning you can take measures to change them (behaviors, environment, systems) Non-modifiable: which means they cannot be changed (genetics)

impaired hearing (nursing interventions)

•Care of a hearing aid •Closed-caption television •Regular inspection of ear canals •Teach techniques to improve communication. -Face the person -Speak in a lower pitch -Confirm understanding -Provide written material •Promote safety. •Assess for social isolation. •If a client is deaf: may need sign language interpreter.

medication ofr inflammation

•- Salycilates: i.e. Aspirin •- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): i.e. ibuprofen -- (Ibuprofen hard on gut and hard on liver (not for liver dysfunction or GI issues)) •- Corticosteroids (autoimmune): i.e. prednisone, methyprednisolone. (suppress immune system- more at risk for infections and educate on how to minimize infections. More prone to endocrine problems.) •- Note: Acetaminophen is antipyretic, and analgesic but not anti-inflammatory -- (not normally used for inflammation (but can be alternated with ibuprofen for pain and inflammation management) no more than 4 g per day! Can be damaging to the liver and less than 3g for ppl with liver dysfunction.)

Gerontologic considerations (pain)

•- Sensitive to agents that produce sedation and CNS effects •- Initiate with low dose and titrate slowly •- Increased risk for NSAID-induced GI toxicity •- Acetaminophen preferred for mild pain

Sensory alterations

•- Sensory deprivation •- Sensory overload •- Impaired vision •- Impaired hearing •- Impaired taste •- Impaired smell •- Impaired tactile perception •- Impaired kinesthetic sense

Nursing interventions acute mania phase

•- Sleep •- Nutrition •- Hygiene •- Safety (related to suicide & other)) •- Milieu Therapy •- Physical Activity •- Communication EXHAUSTION!!! - dehydration, lack of sleep, constant physical activity Decrease environmental stimuli. Psychotherapy is NOT effective in this acute phase. Avoid groups at first. Simple, quiet, clear directions. Reinforce reality and refocus. Directions = help with disturbed thought processes (may need to be very precise with directions), give feelings of structure and control Maintain dignity (inappropriate dress, bizarre dress, undressing) Boundary issues Hypersexual behaviors - no regard for consequences Redirect energy into more appropriate channels Seclusion?

Mania symptoms affecting communication

•- Talkativeness, pressured speech •- Loud speech •- Decreased attention span/poor concentration •- Highly distractible •- Racing thoughts •- Possible delusions

web of causation

•- The implication that intervention (or breaking of the web at any point nearest to the disease) could profoundly impact the development of that disease •Complexity of how illness, disease, or injury are determined by multiple causes •-- Affected by interactions of biological and sociobehavioral determinants of health •-- Example: Marshall Islands= TB

Severe depression communication

•- Use simple, concrete words •- Allow time for pt to respond •- "make observations" instead of directly questioning pt

sources of epidemiologic information

•- Vital statistics •- Census data •- Reportable diseases •- Disease registries •- Environmental monitoring •- National Center for Health Statistics Health surveys •- Informal observational studies •- Scientific studies •- Geographic Information System (GIS) PHN must know to find and use data. PHN uses the data to identify key problem areas or concerns and determine priorities. PHN must be able to read tables, charts, figures, graphs (cases per 100,000). Often comparing county to county, local vs state, state vs national, national vs global

Agency protocols (IV site care)

•- dressing/tape type (check at least once a shift) - length of use of a site - Flushing saline locks

anticonvulsants (Analgesic agents pain management)

•- gabapentin (Neurontin), pregabalin (Lyrica) - Routes of administration •-- Oral, topical

Active immunity

•- long-term, sometimes lifelong; acquired naturally or artificially •- Natural active= host infection (illness) •- Artificial active= Vaccine inoculation

Opioid agents (Analgesic; pain management)

•- morphine, hydromorphone (Dilaudid), fentanyl, oxycodone •- Immediate release (IR), extended release (ER, SR), continuous release (patch, infusion) •Routes of administration (Oral, IV, rectal, sublingual, transdermal)

opioid safety (Health agency setting)

•- patient & family education •- Counting controlled substances •- Witness wasting •- Strict monitoring before and after administration

Passive immunity

•- short-term; acquired naturally or artificially •- Natural passive=Maternal antibody transfer •- Artificial passive =Inoculation of antibody products (temporary resistance)

dementia and delirium (diagnosis)

•A diagnosis of either delirium or dementia should be considered if patient exhibits some or all of the following symptoms: •Forgetfulness, with impaired memory and/or judgment Confusion and disorientation Variable degrees of paranoia.

What should a nurse do differently

•A nurse uses a stethoscope to assess a client on contact precautions for MRSA and puts the stethoscope around her neck. - Every pt in precautions has their own stethoscope- shouldn't put around neck. •A nurse carries a folder into a room of a client with isolation precautions and sets it on the over-bed stand, it falls on the floor, she carries it into the break room and sets it on the table at lunch time. - . Don't bring anything in the room - contaminated now •A nurse enters the room of a client on contact precautions for C. diff and empties the commode. Her phone rings and she answers it still wearing the gloves. - Shouldn't be answering phone - contaminated now •A nurse assesses the vital signs of a client on contact precautions for MRSA using a portable machine. The nurse digs in her pocket for a pen, writes down the vitals, and sticks the pen back in her pocket. - Pen contaminated now

hypoglycemia (definition)

•Abnormally low blood glucose level (below 50 to 60 mg/dL); too much insulin or oral hypoglycemic agents, excessive physical activity, and not enough food •Adrenergic symptoms: sweating, tremors, tachycardia, palpitations, nervousness, hunger •Central nervous system symptoms: inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness •Severe hypoglycemia: disorientation, seizures, loss of consciousness, death

safety concerns (diabetes)

•Access to blood glucose monitoring supplies •Access to medications •Access to foods that support good nutrition •Physical ability to administer insulin appropriately •Living independently and dealing with hypoglycemia and hyperglycemia

Adrenocortical insufficiency

•Addison's disease; adrenal suppression by exogenous steroid use •Clinical manefistations: Muscle weakness, anorexia, GI symptoms, fatigue, dark pigmentation of skin and mucosa, hypotension, low blood glucose, low serum sodium, high serum potassium, apathy, emotional lability, confusion •Addisonian crisis: disease progression, hypotension, cyanosis, fever, nausea, vomiting, classic signs of shock, pallor, headache, abdominal pain, diarrhea, confusion restless •Diagnostic tests: adrenocortical hormone levels, ACTH levels, ACTH stimulation test

Nursing interventions for alcohol withdrawal

•Administer benzodiazepines •Monitor VS, especially BP, P, Temp •Seizure precautions •Provide quiet, well-lit environment •Orient client •Don't leave hallucinating, confused clients alone •Administer anti-convulsants as needed •Administer thiamine, po, IM, or IV, as ordered •Administer IV glucose as needed • 10% mortality rate •Holistic: Auricular acupuncture has been used to detoxify people from alcohol, heroin and other drugs •Nutrition •Once stable, energy work, acupuncture, drumming to relieve agitation and create a sense of connectedness with others.

adrenal glands

•Adrenal medulla: -Functions as part of the autonomic nervous system -Catecholamines; epinephrine and norepinephrine •Adrenal cortex: -Glucocorticoids -Mineralocorticoids -Androgens

diabetes mellitus (community health)

•Affects nearly 25.8 million people in the United States •Minority populations and older adults are disproportionately affected •- Latinos are 70% more likely to have diagnosed diabetes compared to non-Latino Caucasians. •- African-Americans are 70% more likely to have diagnosed diabetes compared to non-Hispanic Caucasians. •- Asian Americans are around 20% more likely to have type 2 diabetes than their non-Hispanic white counterparts. •- Additionally, these groups are more likely to experience diabetes-related complications.

Rehabilitation after stroke

•After stroke has stabilized for 12 to 24 hours, collaborative care shifts from preserving life to lessening disability and attaining optimal functioning. •Focus on patient function; self-care ability, coping, and education regarding needs to facilitate rehabilitation •Patient may be transferred to a rehabilitation unit, outpatient therapy, or home care-based rehabilitation.

medications of influenza

•Annual Influenza vaccine helps prevent -Allergy to eggs contraindicates the most commonly available influenza vaccine - influenza vaccine administered IM in deltoid for adults •Anti-viral medications such as oseltamivir (Tamiflu) -Shortens recovery time 1-2 days -Decreases severity of symptoms •When is an anti-viral medication effective? - Best results if started within 48 hours of onset of symptoms.

Other medications (schizophrenia)

•Antianxiety Medications •- benzodiazepines •Antihistamine Medications •- diphenhydramine

chronic complications diabetes (microvascular)

•Areas most noticeably affected •Eyes (retinopathy) •Kidneys (nephropathy) •Skin (dermopathy) •Clinical manifestations usually appear after 10 to 20 years of diabetes. Microvascular changes are present in some patients with type 2 diabetes at the time of diagnosis. However, clinical manifestations usually do not appear until 10 to 20 years later.

longterm complications (diabetes, peripheral vascular disease)

•Arterial plague build up •Narrowing of arteries •Obstruction of blood flow to the lower extremities (especially lower extremities) Result: decreased circulation, poor wound healing

nursing process (restraints)

•Assess •Diagnosis •Intervene •Monitor/Evaluate •Document

Hallucinations

•Auditory (70%) •Visual •Tactile •Olfactory •Gustatory •Command - perceiving a sensory experience without any external stimuli What are you hearing? How often do you hear them? Do they interfere with your thinking? - COMMAND hallucinations: told to do something Important question: "What are the voices telling you to do?" - Outward indications = turning, tilting head as if listening to someone, moving lips silently, stopping suddenly as if interrupted - Hallucinations vs illusion (misinterpretation of a real experience - a coat rack is a bear about to attack)

assessment of DKA

•Blood glucose levels >300 to 1000 •Severity of DKA not only due to blood glucose level •Ketoacidosis is reflected in low serum bicarbonate, low pH; low PCO2 reflects respiratory compensation (Kussmaul respirations) •Ketone bodies in blood and urine •Electrolytes vary according to degree of dehydration; increase in creatinine, Hct, BUN

Hypothalamus

•Called the coordinator because it receives signals from our thoughts, feelings, autonomic function, environmental cues and peripheral endocrine function and... •- DECIDES WHICH HORMONES NEED ADJUSTING TO MAINTAIN BALANCE. •It stimulates or inhibits hormones in the body. •It is the link between the endocrine system and the nervous system.

pituitary gland

•Called the master gland because it is involved in all hormone secretion sequences and has a wide spread effect on the body. •The pituitary gland has two parts—the anterior lobe and posterior lobe—that have two separate functions. •The hypothalamus sends signals to the pituitary to release or inhibit pituitary hormone production.

Safety factors (infants/togglers)

•Cannot recognize danger •Tactile exploration of environment •Totally dependent Preschoolers •Play extends to outdoors •More adventurous - Motor vehicle accidents are the leading cause of death for children ages 1 to 3, followed by drowning. - Falls, choking, sudden infant death syndrome (SIDS), and ingesting poisons are other critical safety concerns. - Infants and toddlers are completely dependent on others for their care.

Gerontological preop considerations

•Cardiac and circulatory compromise •Respiratory compromise •Renal function •Confusion •Fluid and electrolyte imbalances •Skin •Comorbidities •Altered sensory •Mobility restrictions Other special considerations: •Patients who are obese •Patients with disabilities •Patients undergoing ambulatory surgery •Patients undergoing emergency surgery •Age •Type of wound •Preexisting conditions •Mental Status •Medications

Safety hazards in a healthcare facility

•Falls -Prevention: fall risk assessment, environmental safety, clean dry floors, client education •Equipment-related accidents •Fires/electrical hazards •Restraints •Side rails •Mercury poisoning -Prevention: yearly facility training, following facility policy

Longterm complications (hyperglycemia)

•Chronic Hyperglycemia is the most common cause •- Leads to multiple serious complications •- Risk increases over time depending on the duration of chronic hyperglycemia •Hyperglycemia causes damage to the endothelial cells lining the arterioles and arteries •- Damage to small arterial blood vessels occurs first •- Injury to larger vessels can occur next (scarring becoming narrow and vasoconstriction) •- Smaller vessels first than larger vessels •Hyperglycemia causes immunosuppression by causing WBCs to function less efficiently •Higher risk of getting sick, infection

longterm complications (diabetes, cardio vascular disease)

•Chronic hyperglycemia causes damage to the endothelial lining of the artery walls •Plaque build up in coronary arteries •- Narrowing of arteries •- Plaque disruption and emboli Result: reduced blood supply to heart, myocardial infarction, angina

TB risk factors

•Close contact to someone with active TB •Immonocompromised person (HIV, or on immunosuppressive meds) •Substance abuse (IV drugs) •Homelessness •Malnourishment •Immigration from countries with high prevalence of TB •Institutional living •Crowded, substandard housing •Health-care worker

delirium (diagnosis)

•Confused, disturbed, bizarre mental status which is often variable and fluctuating. •Clouded sensorium and inattentiveness which varies widely between normal, agitated and somnolent •Very prominent confusion and disorientation •Overtly impaired short term memory •Fair but impaired long term memory •Frequent visual or tactile hallucinations and occasional olfactory hallucinations •Overtly impaired judgement and social skills •Variable degrees of paranoia •Disturbed behavior Delirium is usually acute in onset (though not always). Its duration is highly variable and often fluctuating in course. It typically affects older people (though not always) with a wide variety of ailments (e.g., infections, depression, diabetes) or substance abuses or those exposed to certain medications and/or poisons. General physical and neurological examinations, vital signs, autonomic signs, and pupil examinations are cause dependent.

medications affecting surgery

•Corticosteroids (immunocompromised) •Diuretics •Phenothiazines •Tranquilizers •Insulin •Antibiotics •Anticoagulants •Antiseizure medications •Thyroid hormone •Opioids •OTC and herbals

social skill deficits (schizophrenia)

•Deficits in the ability to infer another person's mental state or intention •Deficits in facial affect recognition, with particular impairment in assessing negative emotions and fear •Impairments in processing interpersonal stimuli, such as eye contact or assertiveness •Negative symptoms of alogia, avolition, and anhedonia

Clinical Manifestations (diabetes)

•Depends on the level of hyperglycemia •"Three Ps": •- Polyuria •- Polydipsia •- Polyphagia •Fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, recurrent infections •Type 1 may have sudden weight loss

pressure ulcer Assessment

•Determine stage •Stages I to IV: classified by tissue involvement •Stages III and IV: involve tissue necrosis •Suspected deep tissue injury •Use PUSH tool

longterm complications (diabetes, retinopathy)

•Diabetes is the leading cause of blindness in adults •Hyperglycemia damages endothelium of retinal artery •By products of inflammation occlude arteries, leading to ischemia •After initial signs of retinopathy are detected, progression will advance within 5 years

longterm complications (diabetes, nephropathy)

•Diabetes is the leading cause of end-stage renal disease •Hyperglycemia damages the glomerular capillaries, in the kidney, causing the glomerulus to become permeable •Albumin will be excreted in the urine, leading to proteinuria •Overtime, the renal vasculature will thicken due to athlerosclerosis •If enough glomeruli are damaged, constant renin secretion will occur, leading to hypertension, furthering the problem

Preop complication prevention

•Diaphragmatic breathing (deep breathing) •Coughing •Incentive Spirometry •Leg exercises •Sometimes compression devices/pumps or compression stockings on legs. •Turning to side •Getting out of bed

Influenza patient seeking medical attention

•Difficulty breathing or worsening cough -- Influenza could progress to pneumonia •Dehydration (infants/children and elders at high risk during illnesses with fever) -- Assess for symptoms (decreased urine output, hypotension)

diagnosis (adrenal insufficiency)

•Disturbed body image •Self-care deficit related to weakness, fatigue, muscle wasting, altered sleep patterns •Risk for injury related to weakness •Risk for fluid volume deficit •Activity intolerance and fatigue •Risk for infection •Knowledge deficit

Assessment (alcohol intoxication)

•Drowsiness •Slurred Speech •Tremors •Impaired thinking/memory loss •Nystagmus •Diminished reflexes •Nausea/vomiting •Possible hypoglycemia •Increased respiration •Belligerence/grandiosity •Loss of inhibitions •Depression

Diabetic Ketoacidosis (DKA)

•Emergency Complication of Hyperglycemia •Type 1 Diabetes •- NO insulin production •- Hyperglycemia from carbohydrate intake •-- Polyphagia- Why? •- Gluconeogenesis- Why? (breakdown of fat in the body to glucose (feed cells) but makes ketones in blood stream. (breakdown of fatty acids) •-- Ketone formation •-- Ketones are strong acids •--- Blood pH becomes acidic •--- Lungs- hyperventilation to release CO2 (to make pH less acidic,) •--- Kussmaul's respirations (fast deep breaths) •Severe dehydration •- Nausea, vomiting •- Hyperosmolarity of blood •-- Why does this cause dehydration? •--- Severe intracellular dehydration will lead to coma

Enhancing self-care (stroke interventions)

•Enhancing self-care -Set realistic goals with the patient -Encourage personal hygiene -Ensure that patient does not neglect the affected side -Use of assistive devices and modification of clothing •Support and encouragement •Strategies to enhance communication (especially if speech is dramatically impaired ex. Have white board, pen and paper or other ways to communicate) - Encourage patient to turn head, look to side with visual field loss

Teaching patients self-care

•Explain the disease and principles of disease management •Medication teaching •Monitoring •Sources of information •Pain management •Joint protection •Self-care with assistive devices •Exercise and relaxation

Stroke interventions

•Focus on the whole person (and family) •Provide interventions to prevent complications and promote rehabilitation •Provide support and encouragement •Listen to the patient •Relieving sensory deprivation and anxiety •Keep sensory stimulation to a minimum for aneurysm precautions •Realty orientation •Patient and family education •Support and reassurance •Seizure precautions •Strategies to regain and promote self-care and rehabilitation

Health history allergies

•Food allergies or sensitivities. (i.e. shellfish, nuts) •Substance allergies (i.e. Latex) •Medication allergies (i.e. penicillin, anesthesia) - Shellfish/iodine. Should be concern about CT contrast - avocado, banana, chestnut, kiwifruit: latex - Sulfa: Bactrim also found in diabetic drugs Always ask when type of reaction they have: •Allergic reactions: •"My throat felt like it was swelling up & I couldn't breathe." •"My lymph glands were swollen." •Vs. Side Effects: •"I felt sick to my stomach." •"I got constipated."

dementia (diagnosis)

•Forgetfulness, with impaired memory and/or judgment •Variable alertness, until diminished in advance stages of the illness •Confusion and disorientation •Impaired short-term memory (but not always) •Fair, but impaired long-term memory in severe cases •Rare visual, tactile, or olfactory hallucinations •Poor judgment and social skills (this varies according to the area of the brain involved—for example, poor judgment, rather than impaired cognition, occurs in frontotemporal dementia) • Variable degrees of paranoia • Normal behavior until in advanced stages. Dementia often has insidious onset (but can be sudden). Its duration is chronic and progressive, step-wise, or static. It is seen predominantly (but not exclusively) in elderly people with various somatic or traumatic ailments (e.g., stroke, hypertension, or Parkinson's disease) and predisposition to delirium. General physical and neurological examinations, vital signs, autonomic signs, and pupil examinations are cause dependent.

management of hyperclycemia

•Give 15 g of fast-acting, concentrated carbohydrate •- Three or four glucose tablets •- 4 to 6 oz of juice or regular soda (not diet soda) •Retest blood glucose in 15 minutes; retreat if <70 mg/dL or if symptoms persist more than 10 to 15 minutes and testing is not possible •Provide a snack with protein and carbohydrate unless the patient plans to eat a meal within 30 to 60 minutes

Seizures when occurring (nursing interventions)

•Goal is safety •Prevent physical injury: Move hard objects away •Do NOT put things in the client's mouth or try to restrain the client •Turn client on side •Monitor airway/breathing •Observe/document

insulin

•Goal is to "tightly" control •Individualized to patient- •- Age, lifestyle, symptoms, hx of control •- Basal-Bolus- long acting (basal), short acting (postprandial) •-- Used together to mimic pancreatic insulin secretion •Conventional Insulins •- Regular- Rapid acting •- NPH- Intermediate acting •Insulin Analogues- Synthetic insulins that can mimic physiologic insulin secrection •- Lispro, Novolog (rapid acting), Lantus (long-acting)

planning and interventions (cushing's syndrome)

•Goals may include decreased risk of injury, decreased risk of infection, increased ability to carry out self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications

Stroke diagnosis (intracranial regulation)

•Head CT (Computed tomography) w/out contrast •The importance of a CT scan is to identify or exclude hemorrhage as the etiology of the stroke. •Treatment is based on whether the stroke is ischemic or hemorrhagic.

TIA treatment (secondary prevention)

•Health maintenance measures including a healthy diet, exercise, and the prevention and treatment of periodontal disease •Anticoagulant therapy •Antiplatelet therapy: aspirin, dipyridamole plus aspirin (Aggrenox), clopidogrel (Plavix) - Anti-coagulant and anti-platelet = bleeding risk (blood thinner) off of these before surgery, and more bleeding risks •"Statins" (anti-cholesterol): simvastatin (Zocor) •Antihypertensive medications

Nursing Process: Assessment (diabetes)

•History •Physical Examination •Laboratory Examination •Need for referrals Physical activity, diet, family Hx, log to track BG levels, carb counting

hypoglycemia (question)

•How does the nurse know the treatment has been effective? •- When level is corrected •What if the patient is unconscious? •- IV medication to maintain BG levels, glucose tabs in cheek, or IM of glucagon

longterm complications (diabetes, immunosuppression)

•Hyperglycemia causes white blood cells to act inefficiently •- Poor wound healing •- Increased susceptibility to infection •T-cell and phagocytic functions are affected by hyperglycemia •Poor glycemic control can lead to increased colonization of Staph Aureaus and Candida •- Pneumonia (staf infection) •- UTI (staf infection) •-Skin/Soft-tissue infections •- Yeast infections of the skin folds and/or vagina

Hyperglycemia Hyperosmolar syndrome (HHS)

•Hyperosmolar hyperglycemia is caused by a lack of sufficient insulin; ketosis is minimal or absent •Hyperglycemia causes osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased osmolality •Manifestations include hypotension, profound dehydration, tachycardia, and variable neurologic signs caused by cerebral dehydration •High mortality rate

acute complications of diabetes

•Hypoglycemia •DKA •Hyperglycemic hyperosmolar syndrome (HHS) •Comparison of DKA (ketones) and HHS (normally no ketones)

Neuroleptic Malignant Syndrome (NMS)

•Idiosyncratic hypersensitivity to antipsychotic medications •Leads to problems in thermoregulation •Treatment: discontinue medication, fluids, reduce temperature, contact provider immediately decreased LOC Greatly increased muscle tone Increased autonomic dysfunction (hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, drooling) Give fluids to hydrate Correct electrolyte imbalances

incompetent patient

•Individual who is not autonomous •Cannot give or withhold consent -Cognitively impaired - Mentally ill -Neurologically incapacitated

Based on the criteria from a substance use disorder what psychosocial nursing diagnoses have priority?

•Ineffective role performance •Disrupted or dysfunctional family processes •Moral or spiritual distress

Pre operation assessment

•Initiates initial preoperative assessment •Initiates teaching appropriate to patient's needs •Involves family in interview •Verifies completion of preoperative diagnostic testing •Verifies understanding of surgeon-specific preoperative orders •Discusses, reviews advanced-directive document •Begins discharge planning by assessing patient's need for postoperative transportation, care - Preop assessment is a complete head-to-toe of the patient •Nutritional, fluid status •Dentition •Drug or alcohol use •Respiratory status •Cardiovascular status •Hepatic, renal function •Endocrine function •Immune function •Previous medication use •Psychosocial factors •Spiritual, cultural beliefs

Hypothyroidism collaborative care

•Levothyroxine (Synthroid) •- Start with low dose •- Monitor for cardiovascular side effects (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia •- Check lab tests to adjust dose •Increase dose in 4- to 6-week intervals as needed •- Lifelong therapy

Levothyroxine (Synthroid) (hypothyroidism)

•Levothyroxine (Synthroid) is the drug of choice to treat hypothyroidism. •When thyroid hormone therapy is initiated, it is important that the initial dosages are low to avoid increases in resting heart rate and blood pressure. •In a young and otherwise healthy patient, the maintenance replacement dose is adjusted according to the patient's response and laboratory findings. •In a patient with compromised cardiac status, careful monitoring is needed when the dosage is started and adjusted because the usual dose may increase myocardial oxygen demand. The increased oxygen demand may cause angina and cardiac dysrhythmias. •Carefully monitor patients with cardiovascular disease who take this drug. •Monitor heart rate, and report pulse faster than 100 beats/min or an irregular heartbeat. •Promptly report chest pain, weight loss, nervousness, tremors, and insomnia. •In a patient without side effects, the dose is increased at 4- to 6-week intervals. •It may take up to 8 weeks before the full effect of hormone therapy is experienced. •It is important that the patient regularly take replacement medication. •Lifelong thyroid therapy is usually required.

individual factors effecting safety

•Lifestyle •Cognition •Balance, gait, and mobility •Ability to communicate •Visual acuity •Emotional health •Safety awareness

Pain assessment

•Location •Intensity •Quality •Onset •Duration •Aggravating & relieving factors •Nonverbal cues •Family input •Emotions •Developmental stage •Communication •Sociocultural •Nurse beliefs

safety factors (older adults)

•Loss of muscle strength, joint mobility; slowing reflexes; sensory losses - Although many older adults have intact senses that enable them to continue to enjoy life as they age, physiological changes do occur. - These changes may include reduced muscle strength and joint mobility; slowing of reflexes; decreased ability to respond to multiple stimuli; and sensory losses, particularly hearing and vision. These changes increase the older adult's risk for falls, burns, car accidents, and other injury. Falls are the most common cause of accidental death for adults age 50 and older

longtern diabetes complications

•Macrovascular: accelerated atherosclerotic changes, coronary artery disease, cerebrovascular disease, and peripheral vascular disease •Microvascular: diabetic retinopathy (refer to Figure 51-8), and nephropathy •Neuropathic: peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction

disease management goals (diabetes)

•Main goal is to normalize insulin activity and blood glucose levels to reduce the development of complications. •The ADA now recommends HgbA1c less than 6.5% Hemoglobin A1c, also called A1c or glycated hemoglobin, is hemoglobin with glucose attached. The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months by measuring the percentage of glycated hemoglobin in the blood

Stroke planning

•Major goals may include -Improved mobility -Avoidance of shoulder pain -Achievement of self-care -Relief of sensory and perceptual deprivation -Prevention of aspiration -Continence of bowel and bladder -Improved thought processes -Achieving a form of communication -Maintaining skin integrity -Restored family functioning -Improved sexual function -Absence of complications -Improved cerebral tissue perfusion -Relief of sensory and perceptual deprivation -Relief of anxiety -The absence of complications

anti-diabetic non-insulin agents

•Metformin is the most common, first-choice oral medication used when lifestyle changes are not adequate to controlling in BG •- Class- Biguanide •- Biguanides are insulin sensitizers that work to make body tissues less resistant to endogenous insulin •- Inhibits hepatic synthesis of glucose

providing postoperative care (hyperthyroidism)

•Monitor respirations; potential airway impairment •Monitor for potential bleeding and hematoma formation; check posterior dressing •Assess pain and provide pain relief measures •Semi-Fowler's position, support head and neck •Assess voice, discourage talking •Potential hypocalcaemia related to injury or removal of parathyroid glands; Remember back to postoperative care: those concepts apply there as well Monitor calcium level

Hypothyroidism nursing diagnosis

•NURSING DIAGNOSIS: Activity intolerance related to insufficient physiologic or psychological energy •NURSING DIAGNOSIS: Risk for imbalanced body temperature •NURSING DIAGNOSIS: Constipation related to diminished gastrointestinal peristalsis •NURSING DIAGNOSIS: Deficient knowledge about the therapeutic regimen for lifelong thyroid replacement therapy •NURSING DIAGNOSIS: Ineffective breathing pattern related to depressed ventilation •NURSING DIAGNOSIS: Acute confusion related to depressed metabolism and altered cardiovascular and respiratory status •COLLABORATIVE PROBLEM: Myxedema and myxedema coma

assessment (adrenal insufficiency)

•Note any illness or stressors that may precipitate problems •Fluid and electrolyte status •VS and orthostatic blood pressures •Note signs and symptoms related to adrenocortical insufficiency: weight changes, muscle weakness, fatigue •Medications: replacement of steroids (corticosteriods and mineralocorticoids •Monitor for signs and symptoms of Addisonian crisis

Nutrition and bowel (stroke interventions)

•Nutrition: -Consult with speech therapy or nutritional services -Have patient sit upright, preferably out of bed, to eat -Chin tuck or swallowing method -Use of thickened liquids or pureed diet •Bowel and bladder control: -Assessment of voiding and scheduled voiding -Measures to prevent constipation: fiber, fluid, toileting schedule -Bowel and bladder retraining

Alterations in body (schizophrenia)

•Physically awkward •Poor coordination or mirroring •Motor abnormalities •Cigarette-related pathologies, such as emphysema and other pulmonary and cardiac problems •Associated Laboratory Findings •Enlarged ventricular system and prominent sulci in the brain cortex •Decreased temporal and hippocampal size •Increased size of basal ganglia •Decreased cerebral size •Slowed reaction times •Abnormalities in eye tracking

safety hazards in the home

•Poisoning •Carbon monoxide poisoning •Scalds & Burns •Fires •Falls •Firearms injury •Suffocation/asphyxiation •Take-home Toxins from work (asbestos, germs, etc. on clothing)

Hyperglycemia (symptoms)

•Polydipsia •- What is this and what is going on here? •- Excessive thirst bc thirst center is stimulated and fluid shift from cells to bloodstream so cells are dehydrated •Polyurea •- What is this and what is going on here? •- Urinating frequently r/t intake of a lot of water and •Polyphagia •- What is this and what is going on here? •- Body isn't getting glucose so cells are starving

Home care and education (recovering from stroke)

•Prevention of subsequent strokes, health promotion, and follow-up care; refer to Chart •Prevention of and signs and symptoms of complications •Medication education •Safety measures •Adaptive strategies and use of assistive devices for ADLs •Nutrition: diet, swallowing techniques, tube feeding administration •Elimination: bowel and bladder programs, catheter use •Exercise and activities, recreation and diversion •Socialization, support groups, and community resources

nursing management (diabetes insipidus)

•Priority on ABCs: Need adequate hydration, watch VS, symptoms of hypernatremia from pure water loss. •Desmopressin acetate (DDAVP) medication replacing ADH for neuro caused DI. •If nephro caused DI, limit sodium in diet and use thiazide diuretics; or indomethacin (antiinflammatory).

Nursing management of TB

•Promote airway clearance -- Push fluid intake -- Positioning for airway drainage •Educate and promote adherence to treatment regimen •Promote activity (plan slow increase in activity, plan rest) •Promote adequate nutrition (small frequent meals, food resources) •Prevent transmission of TB infection to other people •Monitor for miliary TB (spread beyond the lungs)

Treatments for Schizophrenia

•Psychotherapy •Group therapy •Family therapy •Psychoeducation •Substance abuse treatment if needed •Holistic treatments - music

HIV and AIDS interventions

•Public health nurse interventions may include education about risk reduction behaviors for those who are at risk but not yet infected. •For those who are infected, public health nurses can provide education about treatment, noting that with early initiation of appropriate treatment, a person with HIV can expect to live almost as long as an uninfected person. Nurses can also play a role in promoting good health for those who are infected, helping them access care, and advising them on how to prevent transmitting the virus to others

medical management of hyperthyroidism

•Radioactive I therapy •Medications: -- Hydrocortisone -- Beta-blockers •Surgery; subtotal thyroidectomy •Disease or treatment may result in hypothyroidism Radioactive Therapy: Patients who receive radioactive iodine should be informed that they can contaminate their household and other persons through saliva, urine, or radiation emitting from their body. They should avoid sexual contact, sleeping in the same bed with other persons, having close contact with children and pregnant women, and sharing utensils and cups. Medications: Hydrocortisone is prescribed to treat shock or adrenal insufficiency. Beta Blocker: propranolol [Inderal] Monitor cardiac status. Hold for bradycardia or decreased cardiac output. Use with caution in patients with heart failure. Avoid sedatives and narcotics because these patients are very sensitive to them and they increase the chances of myxedema coma

Tx of DKA

•Rehydration with IV fluid •IV continuous infusion of regular insulin •Reverse acidosis and restore electrolyte balance •Note: rehydration leads to increased plasma volume and decreased K; insulin enhances the movement of K+ from extracellular fluid into the cells •Monitor blood glucose, renal function and urinary output, ECG, electrolyte levels, VS, lung assessments for signs of fluid overload Start IV fluids and regular insulin and monitor BG levels after you start bc you don't want them to become hypotensive

Confused patient (nursing interventions)

•Reorient frequently. -State your name; day, date, time. -Provide clocks, calendars. -Provide visual clues to time. -Use personal belongings. •Maintain safe environment. •Communicate clearly and slowly. -Respond to feelings. -Use gestures. •Limit choices. •Promote feelings of security. •Use alternative therapies. - To promote patient orientation, use simple communication, decrease anxiety, keep the patient safe, and provide continuity of care. - Offer step by step instructions to guide the patient through ADL's.

interventions (adrenal insufficiency)

•Risk for fluid deficit: monitor for signs and symptoms of fluid volume deficit; encourage fluids and foods; select foods high in sodium; administer hormone replacement as prescribed •Activity intolerance; avoid stress and activity until stable, perform all activities for patient when in crisis; maintain a quiet, nonstressful environment; measures to reduce anxiety Immediate treatment is directed toward combating circulatory shock: restoring blood circulation, administering fluids and corticosteroids, monitoring vital signs, and placing the patient in a recumbent position with the legs elevated. Hydrocortisone (Solu-Cortef) is administered by IV, followed by 5% dextrose in normal saline. Vasopressors may be required if hypotension persists. (increase BP)

Diagnosis (cushing's syndrome)

•Risk for injury (muscle wasting) •Risk for infection •Self-care deficit •Impaired skin integrity •Disturbed body image •Disturbed thought processes The three tests used to diagnose Cushing syndrome are serum cortisol, urinary cortisol, and low-dose dexamethasone (Decadron) suppression tests

SBAR

•S = Situation (a concise statement of the problem) • B = Background (pertinent and brief information related to the situation) • A = Assessment (analysis and considerations of options — what you found/think) • R = Recommendation (action requested/recommended — what you want)

Promoting safety

•Safety: -The condition of being safe from undergoing or causing hurt, injury, or loss (Webster's) -Basic human need •Nurses attend to the safety needs of -Clients in all healthcare settings -Healthcare workers, including themselves - Safety is a basic human need, second only to survival needs such as oxygen, nutrition, and fluids. - As a nurse, you will be fundamentally concerned with the safety of your clients. - You must also be concerned with your own safety and the safety of other care providers. - Many accidental injuries can be prevented by being aware of hazards and taking reasonable precautions.

Hyperthyroidism

•Second most prevalent endocrine disorder •Graves' disease (most common cause); •thyrotoxicosis: excessive output of thyroid hormone (thyroid storm) •Affects women eight times more than men •Assessment: thyroid enlarged, soft, may pulsate, thrill is often felt when palpated. •Clinical manifestations: Nervousness; rapid pulse; heat intolerance; tremors; skin flushed, warm, soft, and moist; exophthalmos; increased appetite; weight loss; elevated systolic BP; cardiac dysrhythmias Thyroid storm: high fever, extreme tachycardia, exaggerated symptomsof hyperthyroidism (weight loss, diarrhea, abdominal pain, edema, chest pain, dyspnea, palpations), altered neurological or mental state, delirium psychosis, somnolence or coma,

informed consent (preop)

•Should be in writing •Should contain the following: -Explanation of procedure, risks -Description of benefits, alternatives -Offer to answer questions about procedure -Instructions that patient may withdraw consent -Statement informing patient if protocol differs from customary procedure

Alternative measures to restraints

•Some of the preventive, alternative measures that can decrease the need for restraints in order to prevent the dislodgment of medical tubes, lines and catheters include: •Discontinuing or changing the treatment as soon as medically possible •More frequent monitoring •Using a companion, sitter, etc. •Distraction •Providing constant reminders about the importance of not touching the tube, line or catheter •Keeping the tube, line or catheter out of view •Reorienting the person •Some of the preventive, alternative measures that can decrease the need for restraints in order to prevent violent behaviors that place self and/or others at risk for imminent harm include: •Behavior management techniques •Behavior modification techniques •Keeping the client away from triggers •Stress management and relaxation techniques •Positive and negative reinforcements

corticosteriod therapy

•Suppress inflammation and autoimmune response, control allergic reactions, and reduce transplant rejection •Medications: - (treat underlying cause) tumor or long term steroid use - Dexamethasone: Dexamethasone Intensol, DexPak - Hydrocortisone: Cortisol, Cortef, Hydrocortone, Solu-Cortef - Methylprednisolone: Medrol, Solu-Medrol, Meprolone Prednisone: Meticorten, Deltasone, Orasone, Panasol, Novo-prednisone •Patient education: -Timing of doses -Need to take as prescribed, tapering required to discontinue or reduce therapy -Potential side effects and measures to reduce side effects

Clinical Manifestations ischemic stroke

•Symptoms depend on the location and size of the affected area •Numbness or weakness of face, arm, or leg, especially on one side •Confusion or change in mental status •Trouble speaking or understanding speech •Difficulty in walking, dizziness, or loss of balance or coordination •Sudden, severe headache •Perceptual disturbances Recovery: usually plateaus at 6 months

medical management of hypothyroidism

•Synthetic levothyroxine replacement therapy •Medication interactions (aspirin, Lasix, valium) •Effects of hypnotic and sedative agents; reduce dosage (opioids) •Support of cardiac function and respiratory function (more prone to plaque build up in arteries) •Prevention of complications Diagnositc tests: serum Thyroid-stimulating hormone, serum free T4, Serum T3 and T4, T3 resin uptake, Thyroid Antibodies, Radioactive iodine uptake, fine-needle aspiration biopsy, thyroid scan, serum thyroglobulin Nursing implication: determine if the patient is allergic to iodine (shellfish) and whether the patient has taken medications that contain iodine, as these can alter the tests.

Acute phase nursing interventions (schizophrenia)

•TRUST - establish a rapport with clients •Spend time with the client •Call by name, approach from the front, use touch cautiously if at all •Convey empathy of client's feelings •Reinforce reality •Promote distraction •Safe environment - assess for sensory overload or deprivation •Check for cheeking when giving medications. •Start medication teaching and have patient sign neuroleptic consent. Spend time in frequent, shorter interactions Help client label how they are feeling while conveying empathy of underlying feelings - hard for them to put how they are feeling into words Anxiety and stress can increase positive symptoms With empathy, it helps the client feel more secure during interactions

Thyroid Diagnostic Tests

•TSH •Serum-free T4 •T3 and T4 •T3 resin uptake •Thyroid antibodies (autoimmune: hashimoto and grave's) •Radioactive iodine uptake (rate of iodine absorbed by thyroid gland) •Fine-needle biopsy (thyroid cancer) •Thyroid scan, radioscan, or scintiscan •Serum thyroglobulin •medications that can alter test results (chemo drugs, steroids or antibiotics)

client-centered safety education

•Teach an 88-year-old client who uses a walker and is hard of hearing about preventing falls. The client lives in an apartment has a pet cat. •Teach a 69-year-old visually-impaired client who has rheumatoid arthritis and who is taking a corticosteroid medication about avoiding community-acquired respiratory infections. •Teach a 65-year-old who does daycare for a grandchild at home about preventing poisoning. The safety concerns with prescriptions for warfarin and oxycodone.

developmentally appropriate safety teaching

•Teach the parent of a 2 year old about ways to prevent scalding/burns. •Teach a class of first grade students about Fire Safety. •Teach the parent of a 16-year-old teen diagnosed with depression about firearm (gun) safety in the home. •Teach 13-year-old students in a babysitting safety class about choking hazards for infants.

innate immunity

•The body's first line of defense •Natural anatomic barriers (skin, mucous membranes) •Normal flora •WBCs •Protective enzymes and chemicals

nursing management (SIADH)

•Which fluid imbalance? -Fluid volume excess •Which electrolyte imbalance? -Dilutional hyponatremia •Fluid restrictions (oral care & distraction) •Daily weights •Vital signs •Check LOC •Seizure precautions •Severe hyponatremia: 3% NaCl, diuretic Treatment: Lasix fluid restriction 3% because it has a higher sodium level than 0.9%

provisions of care to restrained patient

•The components of this care are based on the client's needs and it typically includes: •Range of motion exercises to the restrained body part unless the person is sleeping •Turning and repositioning the individual •Skin care if the skin assessment indicates a need to do so •Checking the circulatory status of the affected body part •Providing for all other physical needs such as toileting, hydration, nutrition, etc. •Providing for the patient's psychological needs, such as their need for as much independence as possible, the need for dignity and respect and freedom from anxiety

least restrictive restraint

•The least restrictive restraint to correct the problem such as falls and the dislodgment of tubes, lines and catheters is used when restraints are necessary. Restraints, from the least restrictive to the most restrictive, are: •Mitten restraints that are used to prevent the dislodgment of tubes, lines and catheters •Wrist restraints that are used to prevent the dislodgment of tubes, lines and catheters •A vest restraint that is used to prevent falls as well as disturbed violent behavior •Arm and leg restraints that are used to prevent violent behavior •Restraints should NEVER be used for staff convenience or client punishment.

Thyroid

•Thyroid hormones: T3, T4, calcitonin •Iodine is contained in thyroid hormone •TSH from the anterior pituitary controls the release of thyroid hormone •Controls cellular metabolic activity •T3 is more potent and rapid-acting than T4 •Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone

chronic complications diabetes (macrovascular)

•Tight glucose control may delay atherosclerotic process. •Risk factors •Obesity •Smoking •Hypertension •High fat intake •Sedentary lifestyle

Purpose of immune system

•To protect against invaders, such as microbes and foreign substances that are ingested, inhaled or absorbed. •To distinguish between 'self' and 'non-self'

thyroidectomy

•Treatment of choice for thyroid cancer •Modified or radical neck dissection, possible radioactive iodine to minimize metastasis •Preoperative goals: reduction of stress and anxiety to avoid precipitation of thyroid storm •Preoperative education: dietary guidance to meet patient metabolic needs, avoidance of caffeinated beverages and other stimulants, explanation of tests and procedures, and head and neck support used after surgery Surgery to remove all or partial thyroid, can be used to treat hyperthyroidism or thyroid cancer

delirium tremens (alcohol)

•Tremors •Anxiety •Panic •Disorientation/confusion •Hallucination •Vomiting •Diarrhea •Paranoia •Delusions •Ideas of reference •Suicide attempts •Seizures •Potential coma/death

withdrawal symptoms (alcohol)

•Tremors •Easily startled •Insomnia •Anxiety •Anorexia •Hallucinations

Evaluating patient in restraints

•Trial releases from restraints and attempts to control the behavior with appropriate alternatives to restraint provides the registered nurse and/or licensed independent practitioner (LIP) with reassessment data that guides the decision-making process in terms of the: •Continuing the use of restraints because the clinical justification and the patient/resident behavior remains the same, or •Moving to a less restrictive method, or •Using a preventive alternative strategy rather than the restraint, or •The discontinuation of the restraint

safety factors (school-aged kids)

•Try new activities without practice •More time outside the home •Stranger danger - have developed more refined muscle coordination and control, and their decision-making skills have improved. - However, because they become more involved in activities outside the home, bone and muscle injuries are common. §Injuries are often related to sports, skateboarding, or bicycle riding. - Playground injuries are also common. - Most school-age children are ready to try any new skill with or without practice or training. - They are less fearful than are toddlers. - Exposure to the wider school and neighborhood environment also increases the risk for injury inflicted by people outside the home (e.g., abduction).

improving mobility and preventing deformities

•Turn and position in correct alignment every 2 hours •Use of splints •Passive or active ROM four or five times day •Positioning of hands and fingers •Prevention of flexion contractures (not able to move or extend joints) •Prevention of shoulder abduction •Do not lift by flaccid shoulder •Measures to prevent and treat shoulder problems •Encourage patient to exercise unaffected side •Establish regular exercise routine •Quadriceps setting and gluteal exercises •Assist patient out of bed as soon as possible; assess and help patient achieve balance; move slowly •Ambulation training

Seizures aftermath (nursing interventions)

•Turn client to side •Suction prn •Talk to the client •Assess for injury •NPO until alert •Monitor VS •Document

type 1 risk factors

•Type 1: early-onset, familial, genetic predisposition, possible immunologic or environmental (viral or toxins) factors

paranoia nursing interventions (schizophrenia)

•Use a nonjudgmental manner •Honesty and consistency r/t expectations and enforcing rules •Do not react to criticisms •Look at motivations, not behaviors •Don't whisper or laugh

restraints ethical considerations

•Use of restraints is always a LAST intervention used to keep a patient safe. •Use of restraints has a high risk for injury to the patient. Improper restraint use can lead to serious sanctions by the state health department, The Joint Commission (TJC), or both.

Voluntary consent

•Valid consent must be freely given, without coercion •Patient must be at least 18 years of age (unless emancipated minor) •Consent must be discussed with the client by physician •Patient's signature may be witnessed by professional staff member

Hand washing guidelines

•Wash for at least 15 sec in nonsurgical setting; 2 to 6 min in surgical setting. •Remove jewelry and clean beneath fingernails. •Use a bactericidal solution or use water if hands are visibly soiled. -- Use warm water, not hot. -- Apply soap to wet hands. -- Use friction. -- Rinse soap. -- Towel or hand dry.

Role of PHN home visits (rural community)

●Check on diet and exercise ●BS monitoring, ●Foot care ●Vision Screening ●Diabetes continued education

anticipate risk for diabetes insipidus

•Which patients should I watch closely for DI? -Neuro patients: brain cancer, head injury, brain surgery, CNS infection -Nephro: people with kidney damage, people on lithium -Excessive water intake •What symptoms will make me suspect DI? - Polydypsia & polyuria: Look for s/s of dehydration and hypernatremia Progresses to hypotension, tachycardia, shock

anticipate Risk for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

•Which patients should I watch closely for SIADH? •head injury, brain surgery or tumor, and infection on certain medication: vincristine [Oncovin], phenothiazines, tricyclic antidepressants, thiazide diuretics) and nicotine •What symptoms should I watch for? -Thirst, dyspnea on exertion, fatigue. -Low urine output, increased weight -Hyponatremia worsens: n/v, abd cramps, muscle twitch, progressing to confusion & seizures & coma.

Infectious prevention (questions)

•Why is it important patients are put on precautions? •- Prevent spread •What surveillance interventions do you know about that prevent infection? •- Fever, WBC, asking questions/tested them for common diseases at the time period, who they have been with contact with •What is nosocomial infection? •- Hospital acquired infection •What is community acquired infection? - To protect other patients from catching the disease. Think nurse travels everywhere.

Nonopioid agents (Analgesic; pain management)

•acetaminophen (Tylenol) •NSAIDS •-- ibuprofen (Motrin, Advil), naproxen (Aleve), aspirin •Routes of administration •-- Oral, IV, rectal

Anticonvulsant Medications

•carbamazepine (Tegretol) •- Agranulocytosis and aplastic anemia (via CBC) •valproate (Depakote or Depakene) •- Liver function and platelet count (via CBC) •lamotrigine (Lamictal) •- Stevens-Johnson syndrome (potentially life-threatening rash) •- Aseptic meningitis •Beneficial for both mania and depression (bipolar) •Beneficial for rapid-cycling •Can draw serum blood level to see if it's in the therapeutic range - When lithium is not tolerated, valproate can be used for long-term maintenance therapy

first generation antipsychotics

•haloperidol (Haldol) •chlorpromazine (Thorazine) Mostly affect positive symptoms: Traditional dopamine antagonists Extrapyramidal side-effects (EPSE) are common

herd immunity

•immunity level present in a population group

cross immunity

•immunity to one agent providing immunity to another related agent (coxpox - smallpox)

physical restraint (definition)

•is defined as "any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body", according to the Centers for Medicare and Medicaid Services.

restraint (definition)

•is defined as any physical or chemical means or device that restricts client's freedom to and ability to move about and cannot be easily removed or eliminated by the client.

Local anesthetics (Analgesic agents pain management)

•lidocaine, bupivacaine •Routes of administration •-- Topical, injection

second generation antipsychotics

•risperidone (Risperdal), olanzapine (Zyprexa), aripiprazole (Abilify), clozapine (Clozaril) Affect both positive and negative symptoms Serotonin-dopamine antagonists Cause fewer EPSE, including Tardive Dyskinesia Weight gain, metabolic syndrome Agranulocytosis - clozapine (Clozaril) Generally the first line treatment for Schizophrenia Suicidal behaviors, cognitive symptoms Metabolic syndrome: Glucose dysregulation creating predisposition to diabetes, elevated cholesterol, hypertension Agranulocytosis: decreased in WBC which can lead to serious infections and even death

Clinical Manifestations hemorrhagic stroke

•similar to ischemic stroke (FAST) •Severe headache ("exploding headache") •Early and sudden changes in LOC (may be okay one moment and dramatically changed in seconds) •Vomiting (pts very prone to) Recovery: slower than ischemic usually plateaus at about 18 months

Break down of skin (infection risk)

▪A break in the skin, whether caused by a surgical procedure, skin breakdown, an insect bite, or insertion of an IV device, creates a portal of entry for infectious microorganisms.

illness, injury and chronic disease (infection risk)

▪Recuperation from infection or injury limits the physical resources available to combat a new pathogen.

Multiple sex partners (infection risk)

▪The number of sexual partners is directly related to the risk of sexually transmitted infections and cervical cancer.

Developmental stage (infection risk)

▪Young children are vulnerable because their immune systems are immature and have had limited exposure to pathogens. Children frequently begin to have more infections when they start interacting with people outside their family (e.g., when they begin day care or start school). With exposure, the body's natural defense systems turn on to protect from infection. This is a natural process known as acquiring active immunity.

Native american and alaskan native communites

●562 Federally recognized tribes, Speak 250 languages ●Poverty rate is twice the national average (⅓ live in poverty) ●Unemployment to three times the national rate ●Many live in rural areas or on reservations, ½ live in urban areas ●Many prefer traditional healing and folk practices ●Decades of racism and government oppression and dehumanization Alaska Natives: Eskimos, Aleuts (people of an island chain in Alaska) and Native Americans living in Alaska Native Americans: Eskimos, Aleuts and Native Americans living in other states Indian Health Service: Federal program providing comprehensive health care to Native Americans

Population (definition)

●All people occupying an area or all of those who share one or more characteristics ●People not necessarily interacting with one another; not necessarily sharing a sense of belonging to that group (dif from community) (ex. Elderly population, homeless population, teen population)

Public Health Nursing

●Care encompass a much wider vista ●Primary charge to Prevent health problems ●Promote higher levels of health

Acute Care Nursing

●Care of solitary patients ●Primarily illness end of health continuum

Improve the Physical Environment (Policy Recommendations)

●Create more quality low-cost housing ●tighten zoning to restrict noise and pollution ●create more safe and inviting parks and green spaces ●provide appropriate clean-up and removal of toxic material, "brownfields" and other environmental hazards (Superfund Sites) ●promote farmers' markets and produce sales in local stores; improve traffic safety ●ensure safe sidewalks and streets for pedestrians and bicyclists ●provide reliable and low-cost public transit ●encourage "green" development and pedestrian-oriented planning ●discourage sprawl through incentives and restrictions ●limit promotion and availability of harmful products ●eliminate harmful targeted marketing, and minimize liquor, fast food and cigarette outlets

Promote Better Working Conditions (Policy Recommendations)

●Decrease job strain by increasing job autonomy, control over the pace of work, employee involvement and participatory management ●Provide flexible work hours and job security; reduce disruptive shift changes and extended hours; provide in-service training and jobs with career ladders ●Strengthen and enforce occupational health & safety laws; ●Legislate paid sick leave (including parental and family leave) and vacations ●Remove unfair barriers to unionization and strengthen collective bargaining ●Ensure that jobs are occupationally safe and ergonomically sound ●Increase protections for undocumented workers; expand benefits and increase protections for workers in non-standard arrangements.

Promote Understanding of the Social Determinants of Health (SDOH) (Policy Recommendations)

●Educate decision-makers and the general public about how patterns of inequity in the larger environment—where we live, work and play—influence inequities in health. ●Identify strategies that address key economic, political and community factors that affect health.

Characteristics of Community Health

●Field of nursing with a shift from individual to aggregate ●Combines nursing science with public health science - Community based and population focused - Public health sciences and nursing theory ●Focus on population-level outcomes ●Emphasis on prevention Eight characteristics: 1.Population is client or unit of care. 2.Primary obligation to achieve greatest good for greatest number of people or population as a whole. 3.Processes used include working with the client as an equal partner. 4.Primary prevention is the priority. 5.Strategies are selected to create healthy environmental, social, and economic conditions in which populations may thrive. (SDOH) 6. There is an obligation to actively reach out to all who might benefit from a specific activity. 7. Optimal use of available resources to assure best overall improvement in health of population is a key element. 8. Collaboration with a variety of other professions, populations, organizations, and entities is the most effective way to promote and protect the health of people.

Improve Public & Sustainable Transportation (Policy Recommendations)

●Give precedence to cycling and walking on roads ●discourage out-of-town malls and residential sprawl through land-use and zoning restrictions ● improve public transit, especially for underdeveloped and isolated urban and inner-ring suburban communities as well as to rural areas ●develop light rail, electric buses and other "green" modes of mass transit ●reduce emissions and fuel consumption ●establish dedicated bus lanes; promote neighborhood planning that favors walking.

empowerment

●Having a client-centered approach, denoted by flexibility in dealing with clients. ●Developing a trusting relationship based on mutual respect and dignity. ●Employing advocacy, both at an individual level as well as political advocacy. ●Being a teacher and role model, using a variety of strategies and providing opportunities for clients to safely practice new skills. ●Capacity building through encouraging and supporting of clients' work toward attaining health goals

Secondary screening (for at risk and referrals for kids)

●Height and Weight , BMI https://www.cdc.gov/healthyweight/bmi/calculator.html ●Living in poverty ●Lack of access to healthy food ●Sedentary lifestyle ●Family history Body mass index (BMI) is a person's weight in kilograms divided by the square of height in meters. Underweight = <18.5Normal weight = 18.5-24.9Overweight = 25-29.9Obesity = BMI of 30 or greater children and teens: BMI is age- and sex-specific and is often referred to as BMI-for-age. In children, a high amount of body fat can lead to weight-related diseases and other health issues. Being underweight can also put one at risk for health issues.

poverty (vulnerable populations)

●Impacts health ●High infant mortality ●Complex health issues ●Complications ●Communicable diseases (patho?)

Differential vulnerability

●Negative or stressful events (such as unemployment, divorce, or death of a loved one) hurt some people more than others." ●Early chronic stressors can induce physiological changes that lead to later negative health outcomes.

Conducting a home visit

●Personal safety ●Initial visit - Establish plan of care ●Determine need for future visits ●End visit - Main points, positive attributes identified, teaching/treatment plan, when to call someone, and return visit information ●Documentation

Improve Food Security and Quality (Policy Recommendations)

●Provide affordable and nutritious food for all, especially the most vulnerable. ●Enforce rigorous regulation and monitoring of food safety standards ●Reform the subsidy program that rewards producers of processed foods ●Limit fast-food and alcohol outlets; improve and increase the federal food stamp program ●Support sustainable agriculture and local food production, especially organics ●Encourage community and school gardens ●Promote work and commuting patterns that give families the time and energy to prepare meals and eat together; post accurate nutrition labeling in restaurants ●Reduce chronic stressors that trigger binge eating and junk food as a form of coping ●Include cooking classes and food education in schools ●Regulate advertising and targeted marketing, especially to children ●Ban sales of soft drinks and junk food in schools.

Improve Income and Reduce Wealth Inequalities (Policy Recommendations)

●Raise the minimum wage to a livable level ●Increase income supports, including unemployment insurance and the earned income tax credit ●Improve protections against layoffs; strengthen on-the-job learning opportunities, training for the unemployed and job placement assistance ●Support local ownership (homes and businesses) and community re-investment

Improve Education (Policy Recommendations)

●Require small class sizes ●Reform school financing to equalize school spending and access to quality K-12 education ●Improve teacher compensation, training and support; increase resources for special needs children ●Reform educational policies based on high-stakes testing; promote partnerships with families ●Provide quality universal preschool; increase after-school programs and open facilities for community use ●Reduce financial barriers to college ●Improve nutrition standards in school meals ●Ensure opportunities for quality physical activity, art and music.

Preparing for a home visit

●Review referral ●Call patient to obtain permission ●Assure bag is stocked with supplies and equipment ●Discuss supplies you might need as a nurse for: - Routine visit - Wound care - Central line dressing change

Promote Racial Justice (Policy Recommendations)

●Strengthen and rigorously enforce existing anti-discrimination, voting rights and equal opportunity laws ●promote affirmative action; desegregate schools and neighborhoods ●support housing mobility strategies; provide resources for jobs and educational access and retention ●monitor and eliminate environmental health threats, including lead paint ●address arrest and sentencing discrimination and promote rehabilitation in corrections facilities ●increase access, quality and cultural competence of medical care and social services; protect the civil rights of undocumented workers

Improve Social Inclusion (Policy Recommendations)

●Strengthen democratic decision-making, community organizations and opportunities for civic engagement strengthen labor, education, community development and family welfare policies that reduce inequality and social stratification ●Strengthen laws against discrimination and segregation ●Invest in jobs and public infrastructure in resource-poor communities, promote local hiring and benefit agreements and reduce geographic barriers to opportunity ●Guarantee minimum incomes; remove barriers to health care, social services and affordable housing

Improve Conditions for Children (Policy Recommendations)

●Support and invest in families by providing living wage jobs, family allowances, paid parental family and sick leave, and increasing the earned income tax credit ●guarantee universal quality pre-school and daycare ●provide quality public schooling (including art, music and physical education) and safe places to play ●ensure good nutrition and preventive care (including oral care) ●provide nutrition, resources and support to women before, during and after pregnancy, including prenatal care and post-delivery home visitation ●support stimulating parent-child relations from birth ●promote reading; eliminate advertising aimed at children, including junk food in schools ●provide in-school clinics and after-school programs ●equalize school spending; increase supports for single parents ●Provide education on family planning.

Health Impacts Assessments (Policy Recommendations)

●Utilize Health Impact Assessments (HIAs) to evaluate the consequence of proposed developments and policy initiatives on population health. ●Ask your public health department to conduct a Health Impact Assessment (HIA) on proposed development projects and government initiatives and ordinances. (Ford Plant Project)

Common HAI infections

❖C. difficile o- Most common cause of HAIs ❖Methicillin-resistant S. aureus (MRSA) o- Healthcare-associated MRSA o- Community-associated MRSA ❖Vancomycin-resistant enterococcus (VRE) ❖Multidrug-resistant organisms (MDROs)

prevention of community infections

❖Community-acquired infections oCollaborate effort of CDC, state, and local public health departments oMethods: sanitation techniques, regulated health practices, food preparation, immunization program

Infectious diarrhea diagnosis

❖Deficient fluid volume related to fluid lost through diarrhea ❖Deficient knowledge about the infection and the risk of transmission to others ❖Collaborative problems and potential complications: o- Bacteremia o- Hypovolemic shock

isolation precautions

❖Guidelines to prevent the transmission of microorganisms in hospitals ❖Two tiers: ❖Standard precautions used for all patients oThe primary strategy for preventing HAIs ❖Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes ❖Standard Precautions ❖Contact Precautions ❖Airborne Precautions ❖Droplet Precautions ❖Protective Environment (neutropenic Precautions)

Prevention of HAI infections

❖HAI bloodstream infections; CLABSI oBundle approach: (1) Hand hygiene; (2) maximal barrier precaution; (3) chlorhexidine skin antisepsis; (4) optimal catheter site selection; (5) daily review of line necessity with prompt removal of unnecessary lines

Elements of Standard Precautions

❖Hand hygiene ❖Use of gloves and other barriers ❖Proper handling of patient care equipment and linen ❖Environmental control ❖Prevention of injury from sharp devices and needles ❖Patient placement

home based care reduce risk of infection

❖Health care workers should follow standard precautions in the home setting ❖Patient and family education o- Establish an environment that facilitates hand hygiene and aseptic technique o- Family caregivers should receive annual influenza vaccine o- Equipment care o- "Common-sense cleanliness" o- Food preparation and personal hygiene o- Establishment of reasonable barriers to protect family members

Infectious disease assessment

❖Health history: investigate the likelihood and probable source of infection, associated pathology and symptoms ❖Physical exam

Infectious diarrhea assessment

❖History: recent travel, use of antibiotics, food intake, ❖Hydration status: oThirst oDry mucous membranes oWeak pulse oLoss of skin turgor oSunken eyes oI&O

Infectious diarrhea planning

❖Maintenance of fluid and electrolyte balance ❖Increase knowledge about disease and risk for transmission ❖Absence of complications

Infectious disease planning

❖Major goals may include: oPrevention of spread of infection oIncreased knowledge about the infection and its treatment oControl of fever and related discomforts oAbsence of complications

Correction of dehydration

❖Oral rehydration oORS solution ❖Mild: oDry oral mucous membranes of the mouth and increased thirst oRehydration goal 50 mL/kg per 1 kg ORS over 4 hours ❖Moderate: oSunken eyes, loss of skin turgor, increased thirst, and dry oral mucous membranes oRehydration goal 100 mL/kg of ORS over 4 hours ❖Severe: oSigns of shock (i.e., rapid thready pulse, cyanosis, cold extremities, rapid breathing, lethargy, or coma) oIV replacement until hemodynamic and mental status return to normal then treat with ORS

diarrheal disease

❖Port of entry is oral ingestion ❖Causes o- Bacterial; Campylobacter, Salmonella, Shigella, and E. coli o- Viral; Rotavirus and Calicivirus (often called Norovirus), a virus associated with outbreaks in long-term care facilities and cruise ships o- Parasitic; Giardia and Cryptosporidium species and Entamoeba histolytica

Infectious disease interventions

❖Preventing spread of infection o- Handwashing o- Standard precautions o- Recognition of mode of transmission and establishment of transmission-based precautions as indicated ❖Education about infectious process and the prevention of the spread of infections ❖Assessment and treatment of fever

home based care of infectious disease

❖Reduction of risk to patients o- Care of equipment o- Patient education ❖Reduction of risk to household members o- Prevention of transmission o- Education o- Fever and comfort

collaborative and potential problems

❖Septicemia, bacteremia, or sepsis ❖Septic shock ❖Dehydration ❖Abscess formation ❖Endocarditis ❖Infectious disease-related cancers ❖Infertility ❖Congenital abnormalities

controls for emerging infectious diseases

❖Vaccination programs o-- More than 50 vaccines licensed in the United States o-- MMR, varicella, influenza, HPV ❖Planning for a pandemic o-- Global outbreak of disease o-- H1N1, Asian avian influenza (HPAI)

infection control and prevention

❖World Health Organization (WHO) ❖Centers for Disease Control and Prevention (CDC) oCDC publications, guidelines, and website ❖Occupational safety and health administration (OSHA) oMandatory regulations and guidelines ❖Local agencies ❖Hospital and facility infection control specialists and facility policies