Shared Flashcard Set

Details

OCTC Nursing
Unit test 3
177
Nursing
Professional
09/13/2012

Additional Nursing Flashcards

 


 

Cards

Term
 Regulatory Law [administrative]  
Definition

-Regulatory Law [administrative] – Laws created by administrative bodies such as State Board of Nursing. Ex: duty to report incompetent nursing care.

Term
Common Law 
Definition

Common Law – results from judicial decisions made in courts when individual legal cases are decided. Ex: informed consent and client’s right to refuse treatment - usually involve negligence and malpractice. 

Term
Statutory Law
Definition

Statutory Law [legislation] – Laws created by elected legislative bodies.  [civil or criminal]

Ex: Nurse Practice Act: describes and defines the legal boundaries of nursing practice within each state.

-

Term
Criminal laws 
Definition

Criminal laws – public laws – prevent harm to society and provide punishment for crimes; address issues that affect society and its order [includes felony misdemeanor]

Term
Felony
Definition

*felony – crime of more serious nature (imprisonment of > 1 year or even death)

Term
Misdemeanor
Definition

*misdemeanor – crime of less serious nature (penalty or fine – imprisonment < 1 yr)

Term
Civil laws
Definition

Civil laws – private laws – protect rights of individuals; society as a whole is not harmed.

 

*Harm to: individuals, property – penalty: monetary payment.

Term
Tort
Definition

Torts- Civil or private wrong committed against      person or property

 

*unintentional tort – must prove harm was done.

Term
Negligence
Definition

Negligence: conduct that falls below the standard of care.

Term
Malpractice
Definition

Malpractice: negligence done by nurse/physician that results in harm to the patient.


*intentional tort: willful acts that violate another’s rights

Term
Assault
Definition

Assault – any willful attempt or threat to harm another

Term
Battery
Definition
Battery – any intentional touching of another’s body w/out consent
Term
Invasion of privacy
Definition

Invasion of privacy – patients are entitled to confidential health care.

Term
Libel
Definition

Libel – defamation of character in written words

Term
Slander
Definition

Slander – defamation of character in spoken words

Term
Used to establish malpractice
Definition

Used to establish malpractice:

1.     The nurse (defendant) owed a duty to the patient (plaintiff)

2.     The nurse did not carry out that duty

3.     The patient was injured

4.     The nurse’s failure to carry out that duty caused the injury

Term
Good Samaritan Laws
Definition

Good Samaritan laws: protect health care professional from being liable when helping in an emergency situation. Keep giving help until someone of higher experience comes. You are not covered if accept gross payment.

Term
Standards of care
Definition

Standards of Care: legal guidelines for nursing practice and provide minimum nursing care. Reflect values and priorities of profession. ANA- develop standards for nursing practice and policy statements. Standards outline scope, function, and role of nurse’s in practice. NPA-set out every states standards of care.

Term
Consent form
Definition

Consent form: nurse is witness to pt signing form. MD- explains procedure & makes sure pt understands, not nurse. In emergency- assume consent is given

Term
Informed consent
Definition

Informed consent: process of abtaining permission from a client to perform a specific test/procedure after describing all risks, side effects, benefits, alternatives, and risks of refusal. Provides a legal duty for HCP to disclose material facts in terms the client is able to understand to make an informed consent.

Term
Short Staffing
Definition

Short staffing- legally accept assignment b/c if not you are not being a good nurse (Insubordinate). Call manager/supervisor abt getting more help. When facility is continuing to be understaffed & not doing anything- can be penalized.

Term
Common Negligence Acts
Definition

Common Negligence Acts

Failure to assess and/or monitor, including making a nursing diagnosis: failure to monitor in timely manner, use proper equipment to monitor the client, document the monitoring

Failure to notify health care provider of problems

Failure to follow orders

Failure to follow 6 rights of medication administration

Failure to convey discharge instructions

Failure to ensure client safety, esp those with hx of falling, heavily sedated, disequilibrium problems, frail, mentally impaired, get up at night, uncooperative

Failure to follow policies and procedures

Failure to properly delegate and supervise

Failure to follow proper aseptic technique

Failure to give adequate report to the next shift/department

Term
Incident report
Definition

Incident report- written when something did cause or could have caused injury. Never document in pt’s medical chart record that an occurrence report was completed. Keep copy for yourself.

Term
physicians orders
Definition

-physician’s orders – nurses are obligated to carry out.

Term

-verbal orders 

Definition

-verbal orders – per JCAHO – must be recorded then tell them back.

Term

-DNR orders 

Definition

-DNR orders – must be written and specific

Term
Living wills
Definition

-Living wills – documents instructing physicians to withhold or withdraw life-sustaining procedures.

Term
-if a nursing student’s actions cause harm to a patient, who’s liable?
Definition


                  Student, instructor, hospital, educational institution

Term

The nursing process is:

 

Definition

An organized SYSTEMATIC [step-by-step process] method/framework for providing individualized care to:

                  Patients – Families – Communities.

Term
standardized care is beneficial because
Definition

*standardized care is beneficial to the patient because: they are getting universal care!

Term
Assessment
Definition

*assessment = building your database.

Term
The nursing process is;
Definition

The nursing process is used to:

                  -Identify, diagnose & treat human responses to health and illness.


                  **IT IS NOT A MEDICAL DIAGNOSIS!!!**

 

Term
Full definition of the nursing process
Definition

Nursing process: an organized, standardized, step-by-step, systematic method/framework for providing individualized care to patients, families, and communities. It is problem solving, decision making method, and ongoing. It is a cyclic, dynamic process used to identify, diagnosis, and treat human responses to health and illness. The process promotes organization, to assist a pt to achieve desired outcomes, steps to build upon each other & overlap, used with pt throughout the life span in any setting. 

Term

5 Steps of the nursing process.

 

(ADPIE)

Definition

Assessment- creating a database, organizing data, subjective/objective data, ongoing

Diagnosis- analyze and interpret data, identify nursing diagnosis & collaborative problems

Planning- establish outcomes, identify nursing interventions, writing care plan

Implementation- deliver care, putting care plan into action, assist pt to achieve goals

Evaluation- diagnosis, related factors, goals, actual outcomes, did nursing interventions work, did pt achieve outcomes/goals you made for them.

Term
Ultimate goal
Definition

Ultimate goal- promote and restore pt wellness, to maintain the pt’s present state of health or sense of wellness

Term
Evidence based practice
Definition

Evidence-based-practice- based on evidence using problem solving, research, experience, intuition in making decisions about client care.

Term
Priority setting
Definition

Priority setting:

·       High priority: bleeding/breathing. Immediate threat to client’s survival

·       Intermediate priority: nonemergency. Anticipating teaching needs for post-op, new meds

·       Low priority: often related to client’s developmental needs and long term care needs

Term
Ethics
Definition

Ethics- study of conduct and character and motives. It is concerned with determining what is good or valuable for individuals, for groups of individuals, and for society. Acts that are ethical reflect a commitment to standards beyond personal preference. Conflict occurs when ethics, values, and decisions about health care collide

Term
Autonomy
Definition

Autonomy- commitment to include client in decisions about all aspects of care. Ex- signed consent form

Term
Beneficence
Definition

Beneficence- taking positive actions to help others. Good Samaritan.

Term
Nonmaleficence
Definition

Nonmaleficence- avoidance of harm or hurt. Commitment to do no harm. Health care professional tries to balance the risks, and benefits of a plan of care while striving to do the least harm possible.

Term
Justice
Definition

Justice- fairness. Nonjudgmental.

Term
Fidelity
Definition

Fidelity- agreement to keep promises. Support the reluctance to abandon clients even during disagreements. Follow through with care offered to client. 

Term
Code of ethics
Definition

Code of ethics- set of guiding principles that all members of a profession accept. It is a collective statement about the group’s expectations and standards of behavior. Codes serve as guidelines to assist professional groups when questions arise about correct practice or behavior. BOX 22-1 pg 315

Term
Advocacy
Definition

Advocacy- support of a cause, as a nurse you are an advocate for health, safety, and rights of the client

Term
Responsibility
Definition

Responsibility- duty, willingness to respect obligations and to follow through on promises. You are responsible for your actions

Term
Accountability
Definition

Accountability- ability to answer for one’s own action. The joint commission and ANA provide standards for monitoring and protecting nursing practice:

§  national guidelines to ensure client safety and workplace safety through consistent, effective nursing practice

§  monitoring provision of client education about smoking cessation for all client populations

§  establish national standards for continuing education and curriculum development for nursing schools

§  protection of ethical decision making, by requiring health care institutions to create an accessible multidisciplinary forum for discussion about ethical issues

Term
Confidentiality
Definition

confidentiality-HIPPA mandates the confidential protection of client’s personal health information.

 

Term

Values

 

Change and develop over time.

Definition

Values- nursing is a work of intimacy. Nursing practice requires you to be in contact with clients not only physically but also emotionally, psychologically, and spiritually. You agree to provide care to your clients solely on the basis of their need for your service. You will work with clients whose values differ from yours. It is important to have clarity about your own values: what you value, why, and how you respect your own values even as you try to respect those of others whose values differ from yours. A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. The values that an individual holds reflect cultural and social influences, and these values vary among people and develop and change over time. Discussion about ethical issues require that you maintain respect for differing values. This is nonjudgmental. Maintain respect for different values. Development begins at childhood.

Term
Value formation
Definition

Value formation- begins in childhood. Schools, governments, religious traditions, and other social institutions play a role in formation of values. Over time, an individual acquires values by choosing come that the community holds strongly and perhaps discharging or transforming others. 

Term
Values Clarification
Definition

Values clarification- ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas one needs to distinguish between value, fact, and opinion. You need to tolerate differences, which can become the key in the search for resolution of ethical dilemmas. Clarifying values- your own, your client’s, your co-workers. People can be so passionate about their values that they provoke judgmental attitudes during conflict. Some consider these values as facts, not opinion. 

Term
Three steps of the process of values?
Definition

1.     choice- choose freely, choosing from alternatives, choosing after consideration of the consequences

2.     prizing- with pride and happiness, with public affirmation. Cherish choice with pride

3.     acts- with incorporation of the choice into one’s behavior, with consistency and regularity on the value

 

Term
Process of ethical dilemma
Definition

Process of Ethical dilemma: each step resembles steps in critical thinking. Process begins with gathering of all pertinent information, then the group proceeds through assessment, planning, implementation, and evaluation. To distinguish an ethical problem from other kinds of problems, if it is ethical it will entail at least one of the following: 1.) you are able to resolve it solely through a review of scientific data, 2.) it is perplexing, you cannot easily think logically or make a decision about the problem, 3.) answer to the problem will have a profound relevance for areas of human concern. Steps:

·       step 1- gathering information and facts

o   ask the question, it this an ethical dilemma- answer will have relevance for areas of human concern

o   gather info relevant to case

·       step 2- state the problem

o   clarify values- distinguish between fact, opinion, and values

o   verbalize problem

·       step 3- identify course of action

o   negotiate plan

o   evaluate plan over time

Ethical decision making tree: 

Term

Specific gravity

 

Definition

-Specific Gravity – [1.0053 – 1.030] weight or degree of concentration

Term

Urinalysis

U/A

Definition

-Urinalysis [U/A] – lab analysis of urine.

Term
Specimen collection
Definition

-Specimen collection – collected random, clean-voided or midstream, sterile and timed specimens.

Term
Routine urinalysis
Definition

routine urinalysis – collect during normal voiding from and indwelling catheter or urinary diversion collection bag

Term

clean-voided midstream

(culture and sensitivity)

Definition

-clean-voided/ midstream: (culture and sensitivity) – use a sterile specimen cup

Term

Sterile specimen

(culture and sensitivity)

Definition

-sterile specimen (culture and sensitivity) – if patient has an indwelling catheter, collect a sterile specimen by using aseptic technique through the special sampling port – allows fresh, uncontaminated urine to be sampled.

Term
24 hr. Urinalysis 
Definition

-24 hour urinalysis – discard 1st void and record time of the 2nd void – collect over 24 hours in sterile cup and keep on ice or refrigerated in brown jug.

Term
Normal Urine appearance
Definition

Normal Urine Appearance:

·       Pale yellow, straw to amber depending on concentration

·       No casts/ crystals

·       No pus, no blood

Term
Infected Urine Characteristics.
Definition

-Infected Urine Characteristics:

·       Cloudy, thick: white blood cells

·       Red/ pink: red blood cells

·       Strong ammonia odor

·       s/s: dysuria, frequency, urgency, hesitancy, fever, flank pain, abdominal pain, vomiting

Term
Urinary output
Definition

Output- should be at least 75 cc of urine an hour

Output of 30cc or less for more than two hours should be reported; intake should equal output

The best measure of cardiac output is urinary output.

Term

Urinary Tract Infections

(UTI)

Definition

-UTI – 40 % of health care related infections often due to poor hand washing/ catheter care/ urinary retention/ residual urine – Medicare will not reimburse hospitals for readmission due to UTI acquired during previous stay.

 

Term

Bed pan and specimen Collection:

approximate what is normal

Definition

Bed pan and specimen Collection: approximate what is normal- try to allow pt positions that are as close to normal method of voiding as possible- men standing, women sitting down.

Term

Intravenous Pyelogram

(IVP)

Definition

IVP (Intravenous Pyelogram)- views collecting ducts & renal pelvis, ureters, bladder, and urethra. Converts dye into urine.

 

ASSESS CLIENT FOR SHELLFISH (IODINE) ALLERGY BEFORE TEST B/C DYE CONTAINS SHELLFISH!!

Term
Urine Culture
Definition

Urine Culture- must be done on sterile, or clean catch/clean voided specimen.

Checking for microorganisms

Term
Anuria
Definition

*anuria – no urine output

Term
Diuresis
Definition

*diuresis – increased urination

Term
Oliguria
Definition

*oliguria – small amount of urine output

Term
Residual urine
Definition

*residual urine – amount left in bladder after voiding

Term
Dysuria
Definition

*dysuria – painful or difficult urination – cause by bladder infection, trauma, or inflammation of urethral sphincter.

Term
Frequency
Definition

*frequency – voiding at frequent intervals (< 2 hours) caused by fluid intake, bladder inflammation, pressure on 

Term
Urgency
Definition

*urgency – feeling of need to void immediately – caused by full bladder, bladder irritation or infection, overactive bladder, psychological stress.

Term
Use of fiber in the diet
Definition

-the use of fiber in the diet:

·       Low Fiber: low residue for when you have diarrhea

·       High Fiber: for constipation

Term
→Know how incontinence affects the aging:
Definition

→Know how incontinence affects the aging:

-Disturbed body image due to wet clothes, odor, need for absorbent undergarments

-Embarrassed/ashamed

-Skin integrity:

·       You don’t want skin breakdown!

·       Respect privacy

·       Change absorbent undergarments often when soiled

·       Good hygiene/ peri-care / skin protectants

High risk for infection

Term
Incontinence on age 
Definition

Incontinence on age- 50% affected are nursing home residents. Embarrassed, body image, psychological problems, wear depends, nocturia, leaking urine, check for skin integrity (breakdown & turgor), disturbed body image due to wet clothes,odor.


Older people are very concerned about their bowels.

Term
Small intestines
Definition

Small intestines absorb most of the nutrients and electrolytes

Term
Fecal impaction: unrelieved constipation
Definition

Fecal impaction: unrelieved constipation; collection of hardened feces wedged in rectum that can’t expel

·       Obvious sign is inability to pass stool for several days

·       When continuous oozing of diarrhea stool occurs, suspect impaction

·       Liquid portions of feces located higher in colon seeps around impaction mass

·       Loss of appetite, nausea, vomiting, abdominal cramping

If you suspect impaction then perform a digital examination of rectum and palpate for impacted mass

Term
Colors of stool
Definition

Iron supplements make stool black.

 

High GI bleeding= black stool,

Low GI bleeding= red stool

 

Colon cancer- grey to white stool color

 

 

 

 

 

Term
Fecal Occult blood test
Definition

Fecal Occult blood test – a common lab test that clients can perform at home or nurses perform at client’s bedside. Measures microscopic amounts of blood in feces. Useful screening tool for colon cancer.


**NSAID’s decrease clotting factors – can cause bleeding (aspirin) stop taking them 3-5 days before test

 

Term
Normal stool
Definition

Normal stool:

·       Soft, brown

·       Odor: pungent (affected by food type)

·       Frequency 2-3 times per week or more

·       Amount: 150 g/day

·       Shape: resembles diameter of rectum

Term
Ethics
Definition

*Ethics – the study of conduct and character – concerning what is good/valuable for people, groups of people and society at large.

Term
Autonomy
Definition

*Autonomy – the ability or tendency to function independently – include the client in all aspects of care ex. The consent that clients read and sign before surgery.

Term
Beneficence
Definition

*Beneficence – doing good

Term
Nonmaleficence
Definition

*Nonmaleficence – the avoidance of harm or hurt

Term
Justice
Definition

*Justice – fairness

Term
Fidelity
Definition

*Fidelity – the agreement to keep promises

Term
Code of Ethics
Definition

Code of Ethics:

A set of guiding principles that all members of a profession accept.

A collective statement about the group’s expectations and standards of behavior.

Serves as guidelines to assist professional groups when questions arise about correct practice/behavior.

*The ANA reviews and revises the code of ethics regularly*

 

*ADMINISTER CARE IN A NON-JUDGEMENTAL MANOR!!!*

Term
Steps in the valuing process
Definition

-Steps in the valuing process:

Step 1 Chooses:

1.     Choosing freely

2.     Choosing from alternatives

3.     Choosing after consideration of the consequences

Step 2 Prizes: (cherish the decision you made)

4.     With pride and happiness

5.     With public affirmation

Step 3 Acts: (on your belief)

6.     With incorporation of the choice into one’s behavior

7.     With consistency and regularity on the value

Term
Values
Definition

VALUES:

Personal beliefs about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior.


-development of values begins in childhood, shaped by the family school age, schools, governments, religious tradition reinforce or challenge family values → finally, individual experiences influence value formations

Term
Values Clarification
Definition

VALUES CLARIFICATION:

You need to tolerate differences which sometimes become the key in the search for resolution of ethical dilemmas.


To resolve ethical dilemmas one needs to distinguish between value, fact and opinion.

Term
Quality of life
Definition

-quality of life – deeply personal – depends on the patient’s culture and who is making decisions for the patient.

Term
How to process and ethical dilemma:
Definition

How to process and ethical dilemma:

Step 1. (assess) ask the question, is this an ethical dilemma? If a review of scientific data doesn’t resolve the question, the question is perplexing, and the answer will have relevance for areas of human concern then – Yes!

Step 2. Gather info relevant to the case. Client, family, institutional and social perspectives are good sources for this step.

Step 3. Clarifying values. Distinguishing between fact, opinion and values.

Step 4. Verbalize the problem. Clear, simple statement about the dilemma.

Step 5. Identify possible courses of action.

Step 6. Negotiate a plan – requires confidence in one’s own point of view and a deep respect for the opinions of others.

Step 7. Evaluate the plan over time.

Term
Stress
Definition

Stress: the body’s reaction to any environmental demand. It is and experience a person is exposed to, through a stimulus or stressor.

Term
Stressor
Definition

Stressor: any situation, demands, or event that threatens a person’s security. They are disruptive forces operating within or on any system. Can be neutral-neither good nor bad. How does someone perceive stress? Some are eustressful- positive and stimulating. 

Term
Appraisal
Definition

Appraisal: how people interpret the impact of the stressor on themselves. Quality of the stressor-intensity, scope, duration, number and nature of other stressors, predictability are all determined by the person experiencing these stressors. Characteristics of individual that influence stress response: level of personal control, availability of social supports, feelings of competence, cognitive appraisal

Term
organs that maintain homeostasis:
Definition

organs that maintain homeostasis:

1.     Medulla oblongata – controls HR, BP, RR

2.     Reticular formation – sleep/wake cycles; levels of consciousness – causes alertness during stress

3.     Pituitary gland – makes hormones that modulate vital functions

Term
The Sympathetic Nervous System [Fight-or-Flight]
Definition

The Sympathetic Nervous System [Fight-or-Flight]

HR 

BP (vasoconstriction)

RR (shallow breathing)

GI tract movement

blood flow to skeletal muscles

epinephrine/norepinephrine release (adrenaline hormones)

production of glucose in the liver for energy!

 

[parasympathetic ns = the relaxation response/ opposite of the sns]

 

 

Term
General Adaption Syndrome
Definition

General Adaptation Syndrome – describes how the body responds to stressors through the alarm reaction, resistance stage and exhaustion stage – did most of his research on animals.

Stage 1 – ALARM!!! The body actives fight or flight when stressors are threatening

Stage 2 – RESISTANCE – adaptation occurs – long term stressors deplete adaptive energy resulting in:

Stage 3 – EXHAUSTION – body’s adaptive energy is depleted resulting in disease, collapse, or death.

 

Term
*Resilience/Hardiness
Definition

*resilience/hardiness helps the body deal with stress. Individuals are resourceful, flexible and have good problem solving skills.

Term
Quality of stressor
Definition

Quality of stressor: intensity, scope, duration, number and nature of other stressors, predictability

Term
Coping
Definition

Coping:

A person’s cognitive and behavioral efforts to manage specific external and internal stressors that seem to exceed available resources

-methods of coping

Problem focused: dealing with problem and its obstacles. Ex. Learning how to manage your diabetes.

Emotion focused: regulating emotional response to event. Ex. Venting feelings, attending support group

Successful coping = the ability to change and adapt coping strategies.

Term
Defense mechanisms
Definition

Defense mechanisms:  not done consciously – protection from anxiety and stress.

Term
Compensation
Definition

-compensation – making up for deficiency in one area of self-image by strongly emphasizing an asset.

Term
Conversion
Definition

-conversion – turn anxiety into a physical complaint ex: can’t go to school because my stomach hurts.

Term
Denial
Definition

-denial – refusing to acknowledge anything that causes intolerable emotional pain.

Term
displacement
Definition

-displacement – transferring emotions to something else.

Term
Identification
Definition

-identification – patterning behavior after another person’s – qualities, characteristics, actions.

Term
Dissociation
Definition

-dissociation – experienced a sense of numbing and a reduced awareness of one’ surroundings.

Term
Regression
Definition

-regression – reverting back to an earlier life phase.

Term
Relaxation techniques
Definition

Relaxation Techniques:

-belly breathing

-meditation

-music

-massage

-positive imagery

-tensing and relaxing muscles

Term
Nurses are at high risk for?
Definition

*Nurses are at high risk for maladaptive coping: substance abuse and dependence

Term
Loss
Definition

Loss – any situation, actual, potential or perceived, wherein a valued object or person is changed or is no longer accessible to the individual and that requires adaptation through the grieving process. Loss involves Grief.

Term

Types of losses

 

(SNAP M)

Definition

Situational

Necessary

Actual

Perceived

 

Maturational

 

Term
Situational loss
Definition

·       Situational- sudden, unpredictable external event. External loss due to circumstances usually beyond ability to control. Ex- loss of loved one, giving up child for adoption

Term
Necessary loss
Definition

·       Necessary- normal part of living, results from change. Ex- switching schools, changes in life

Term
Actual loss
Definition

·       Actual- person can no longer feel, hear, or know a person or object. Ex-loss of limb, loss of job.

Term
Perceived
Definition

·       Perceived- loss of self-esteem due to being fired from job. Ex- loss of beauty, youth, status, money

Term
Maturational
Definition

Maturational- developmental changes, loss of freedom of lack of responsibility as one enters adolesnece. Ex- child going to school, retirement.

Term
Grief
Definition

Grief – the emotional and behavioral response to a loss. A normal, natural and adaptive response to loss.

Term
Uncomplicated grief
Definition

·       Uncomplicated - (normal)

Term
Complicated grief
Definition

Complicated – people don’t go through the entire grieving process. Numbness, bitterness, not willing to move forward, can develop psychiatric problems.

 

Term
Disenfranchised grief
Definition

Disenfranchised – marginal/unsupported.

Ex: mistress loses her lover – lost someone to murder/suicide.

Term
Anticipatory grief
Definition

Anticipatory – beginning to “let go” before the actual death – especially with someone who has long term illness.

Term

Tasks of Grief work

 

(TEAR)

Definition

Tasks of Grief work:

T - to accept the reality of the loss

E - experiencing the pain of the loss

A - adjustment to life that no longer includes the loss

R - reinvesting emotional energy into new relationships

Term
Five stages of Dying (Kubler-Ross)
Definition

Five stages of Dying (Kubler-Ross)


§  Denial

§  Anger

§  Bargaining

§  Depression

§  Acceptance

Term
Attachment Theory (Bowlby)
Definition

Attachment Theory (Bowlby)

 Numbing

Yearning and searching- emotional outbursts of tearful sobbing and acute distress

Disorganization and despair

      Reorganization

Term
Tasks of Mourning (Worden)
Definition

Tasks of Mourning (Worden)

Accepting the reality of loss

Working through the pain of grief

Adjusting to the environment without deceased

      Emotionally relocating the deceases and moving on with life


Term
The Grieving nurse
Definition

The Grieving Nurse


The nurse will grieve and this should be permitted. Attending funerals.

Develop a support system; know when to ask co-workers for help.

Take time to cry with and for patients.

Incorporate stress management techniques into life: exercise, listen to music, laugh, pray.

 

Term
Acid Base balance
Definition

Acid-Base balance refers to the homeostasis of the hydrogen (H) ion concentrations in body fluids.

 

Balance is regulated by: LUNGS – KIDNEYS - BUFFER SYSTEMS

Term

Arterial Blood Gas

(ABG) values

Definition

-the best way to evaluate acid-base balance:

Arterial Blood Gas (ABG) Analysis

 

Normal ranges:

pH                              7.35 - 7.45

PaCO2                              35 – 45 mm/Hg

HCO3                          22 – 26 mEq/L

Term
Reflects pulmonary ventilatation
Definition

PaCO2 reflects depth of pulmonary ventilation

 

                  < 35 = hyperventilation

                  > 45 = hypoventilation

Term
Reflects renal component
Definition

HCO3 (bicarbonate) Major renal component

 

                  <22 = metabolic acidosis

                  >26 = metabolic alkalosis

Term
Acid / Base
Definition

 

[image]                                                                                                           

 

above the waist we’re acid


 

below the waist we’re base

 

Term
Respiratory Acidosis
Definition

Respiratory Acidosis

Hypoventilation


Chronic COPD patients LIVE in this status

pH       PaCO2


Term
Repsiratory Alkalosis
Definition

Respiratory Alkalosis

Hyperventilation – anxiety is most common cause – ‘blowing off CO2

pH       PaCo2 



Term
Metabolic acidosis
Definition

Metabolic Acidosis

AID’s patient’s severe diarrhea

pH       HCO3 

Term
Metabolic Alkalosis
Definition

Metabolic Alkalosis

Most common causes: vomiting and gastric suction

pH       HCO3

Term

Sodium 

 

(Electrolyte alterations)

Definition

Sodium:

                  Hyponatremia (low sodium in blood)

              s/s: hypotension, tachycardia, coma, death

 

              Hypernatremia (high sodium in blood)

              s/s: thirst, dry sticky mucous membranes, confusion

Term

Potassium 

 

(Electrolyte Imbalances)

Definition

Potassium:
                 
Hypokalemia (low potassium in blood)

               s/s: muscle weakness, cardiac arrhythmias, paresthesias

 

              Hyperkalemia (high potassium in blood)

              s/s: muscular weakness, cardiac irregularities; nausea & vomiting


[*can cause cardiac dysrhythmias (irregular heartbeats)]

Term

Calcium

 

(Electrolyte Imbalances)

Definition

Calcium:

                      Hypocalcemia (low calcium in blood)

                  s/s: muscle tetany, muscle cramps, cardiac arrhythmias

 

                  Hypercalcemia (high calcium in blood)

                  s/s: bone and joint pain, muscle weakness


[*can cause cardiac dysrhythmias (irregular heartbeats)]

Term

Magnesium

 

(Electrolyte Imbalances)

Definition

Magnesium:

                  Hypomagnesemia (low magnesium in blood)

               s/s: cardiac arrhythmias

 

[*can cause cardiac dysrhythmias (irregular heartbeats)]

Term
Values for Electrolyte lab values
Definition

Serum Potassium (K+)                          3.5 – 5.3

Serum Sodium (Na+)                           135 - 145

Serum Chloride (Cl-)                           100 – 106

Serum Bicarbonate (HCO3)                     22 - 26   (arterial)

Blood pH                                            7.35 – 7.45

Term

Fluid Intake/Output

 

(values)

Definition

Daily total fluid intake: 2500 ml/day

·       From liquids                         1500 ml

·       From food                             800 ml

·       From metabolism             200-300 ml


[they should equal each other]

 

 

Daily total fluid output: 2500 ml/day

·       Skin                         400 – 600 ml

·       Lungs                       300 – 400 ml

·       Kidneys                        1500 ml

·       Intestines                       200 ml

Term
Vulnerable to dehydration
Definition

Vulnerable to dehydration:


-very young / very old

-massive burn victims (susceptible to shock / dehydration)

-people on diuretics

Term

Intravenous Fluids

 

Study the handout on fluid deficit vs. fluid excess (if you know one, the other is opposite)

Fluid deficit: ex. AID’s patient with excessive diarrhea

Fluid excess: ex. Congestive Heart Failure

**the best assessment of fluid volume = taking daily weight, at the same time, in the same clothes**

 - remember that in Fluid Deficit/ dehydration, HCT & Na+ levels will be higher!

Definition

Intravenous Fluids


-osmolality – number of osmols per Kg of solution.

3 Types of Fluid Given Intravenously:

1.     Isotonic: expands intracellular and extracellular space equally – stays in the vascular space

2.     Hypotonic: swells the cells

3.     Hypertonic: shrinks the cells

Term

Isotonic Solutions

 

Study the handout on fluid deficit vs. fluid excess (if you know one, the other is opposite)

Fluid deficit: ex. AID’s patient with excessive diarrhea

Fluid excess: ex. Congestive Heart Failure

**the best assessment of fluid volume = taking daily weight, at the same time, in the same clothes**

 - remember that in Fluid Deficit/ dehydration, HCT & Na+ levels will be higher!

Definition

ISOTONIC SOLUTIONS

-used most often

-stays in the intravascular space

-the doctor orders the rate of fluid flow

-monitor patient for: appropriate rate/flow and s/s of fluid overload

Most Used:

·       Lactated Ringers (LR) – volume expander, the fluid of choice in massive burn victims

·       0.9% Normal Saline (NS)

·       D5W

**D5W isotonic ONLY IN BAG – acts like a hypotonic solution in body as it metabolizes, leaving only water. 

Term

Hypotonic Solutions

 

Study the handout on fluid deficit vs. fluid excess (if you know one, the other is opposite)

Fluid deficit: ex. AID’s patient with excessive diarrhea

Fluid excess: ex. Congestive Heart Failure

**the best assessment of fluid volume = taking daily weight, at the same time, in the same clothes**

 - remember that in Fluid Deficit/ dehydration, HCT & Na+ levels will be higher!

Definition

HYPOTONIC SOLUTIONS


-swells the cells

-mostly used when people need hydration

-DO NOT GIVE in patient with increased intracranial pressure – CVA, head trauma

→Most Used: 0.45% saline (1/2 Normal Saline)

Term

Hypertonic Solutions

 

Study the handout on fluid deficit vs. fluid excess (if you know one, the other is opposite)

Fluid deficit: ex. AID’s patient with excessive diarrhea

Fluid excess: ex. Congestive Heart Failure

**the best assessment of fluid volume = taking daily weight, at the same time, in the same clothes**

 - remember that in Fluid Deficit/ dehydration, HCT & Na+ levels will be higher!

Definition

HYPERTONIC SOLUTIONS


-higher osmolality than plasma, > 375 mEq/L

-shrinks the cells – pulls fluid from the cells to the vascular space

-closely monitor for circulatory overload due to intravascular expansion

-NOT GIVEN in congestive heart failure

-NOT GIVEN in cellular dehydration

→Most Used:

·       D5 1/2 NS

·       D5 NS

·       D5 LR

Term

Primary organ of bowel elimination

Definition
Large Intestine
Term
Expels feces and flatulance from the rectum
Definition
Anus
Term
Propels food through the length of the GI tract. 
Definition
Peristalisis
Term
Peristaltic movement in the small intesting facilitate both digestion and absorption.
Definition
Segmaentation
Term

Factors affecting bowel elimination?

 

(P SPAM)

Definition

Pregnancy

 

Surgery and anesthesia

Position during defecation

Age/Physical activity

Medication and laxatives

Term

Common bowel elimination problems

 

(I FICH)

Definition

Incontinence 

 

Flatulance 

Impaction

Constipation

Hemorrhoids

Term
Cathartics
Definition

Accelerates BM

 

(stronger than a laxative)

Term
Laxatives
Definition
Ease defecation
Term
Opiates
Definition
Anti-diarrheal agent
Term
Diarrhea
Definition
Recipe for skin breakdown.
Term
NG tube
Definition
"NOT"a sterile technique
Term
Acid Base Lab Values
Definition

pH  -    7.35 - 7.45

PCO2 - 135 - 145

HCO3 - 22 - 26

Term

(Cannot urinate)

inability of the bladder to empty resulting in an accumulation of urine in the bladder.

Definition
Retention
Term
Occurs as a result of delivery of a baby, hemorrhoid surgery or other surgeries, medications/anasthesia, etc.
Definition
 Urinary retention
Term

(urinating small amounts frequently)

bladder is so full that the external urethral sphincter is unable to hold back urine; sphincter temporarily opens allowing a small amount of urine to escape, then closes again-small amounts of urine voided 2 or 3 times an hour with no reilief of discomfort, or may continually dribble urine .

 

Definition
Retention with overflow
Term
Bladder distention with absence of urine output over several hours. 
Definition
Acute Retention
Term
Inability to hold/control urination until reaching the toilet caused by being to far away from toilet facilities, waiting too long to go to the toilet, clothing that is difficult to unbutton or unfasten.
Definition
Functional incontinence
Term
Involuntary leakage of urine during increased abdominal pressure resulting from activities such as exercise/lifting weight, or coughing, laughing, sneezing, etc.
Definition
Stress incontinence
Term
Involuntary passage of urine after a strong urge to void.
Definition
Urge incontinence
Term
Combination of stress and urge incontinence.
Definition
Mixed incontinence
Term
Involuntary loss of urine at intervals with sensation to void.
Definition
Reflex
Term
Specific gravity
Definition

Non-invasive way to check hydration

Normal - 1.0053 - 1.030 urine will appear yellow to light amber.

 

Under - 1.010 - over hydrated, urine will look clear like water.

 

Over 1.025 - patient is dehydrated; urine will appear concentrated and dark.

Term
How to process an ethical dilemma
Definition

Gather information

Verbalize the problem

Consider Actions

Term

Confidentiality

 

(HIPAA)

 

Definition

HIPAA

Health 

Insurance 

Portability and 

Accountability 

Act

Term
Deontology
Definition

Defines actions as right and wrong depending on their "right making characteristics such as fidelity to promises, truthfulness, and justice.

 

(Examines a situation for rightness and wrongness.)

Term
Consequentialism
Definition
Main emphasis is on the outcome or consequences of action. 
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