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Exam 2
lectures 7-11
86
Nursing
Graduate
10/12/2012

Additional Nursing Flashcards

 


 

Cards

Term

levels of communication

Definition

intrapersonal

interpersonal

group

public speaking

Term

intrapersonal

Definition
occurs within an individual; that is, persons "talk to themselves" silently or form and idea in their own mind. self talk
Term

interpersonal

Definition
exchange of information between two persons or among persons in a small group
Term

public communication

Definition
interaction of one individual with large groups of people.
Term

forms of communication

Definition

verbal

usually conscious, spoken or written

nonverbal

often less conscious, body language, gestures

Term

therapeutic relationship

Definition
a relationship between a nurse (or other health professional) and a client (patient, family, etc.)
Term

phases of therapeutic relationship

Definition

stage 1: pre-interaction

stage 2: orientation

stage 3: working

stage 4: termination

Term

stage 1: pre-interaction

Definition

gathering information prior to meeting client

examining own feelings/fears/anxiety about working with patient

Term

stage 2: orientation (introductory)

Definition

creating a trusting environment

asking, "how would you like to be addressed?"

establishing expectations

gathering assessment information

identifying problems

setting goals

developing plan of care

Term

stage 3: working

Definition

maintaining trust and rapport

problem-solving through the plan of care

remaining an active participant in the relationship

continuously evaluating progress through plan of care

clarifying feelings and concerns through verbal/nonverbal communication

Term

stage 4: termination

Definition

concluding the relationship when (goals have been achieved, client is being discharged, rotation is over [student])

recognizing feelings about the termination of the relationship

Term

barriers to communication

Definition

physical

perceptual (speakers)

emotional

cultural

language

gender

interpersonal (Hx w/ communicating)

Term

barriers to communication in health care

Definition

patient/family fears

emotional control of healthcare providers

insensitivity by health care provider

sense of guilt

disagreement w/ decisions

cultural difference

personal issues

ethical concerns

Term

components of communication

Definition

content

words, gestures, substances of message

process

sending, receiving & interpreting, reacting

Term

therapeutic communication

Definition

techniques that assist the nurse in interacting more therapeutically w/ the clients

techniques are: client centered, goal directed

Term

therapeutic communication techniques

Definition

using silence

observing

asking open-ended questions

encourage

clarifying

restating

reflecting

focusing

giving information

summarizing

Term

non-therapeutic communication techniques

Definition

excessive questioning (especially yes/no ?s)

advising

agreeing

challenging

change of topic

denying

interpreting

passing judgment

reassuring

disrepectful words/tone/body language

Term

vital signs

Definition

temperature

pulse

respiration

blood pressure (BP)

oxygen saturation

 + an assessment of pain is standard

Term

temperature

Definition

heat produced-heat loss=body temperature

relatively narrow temperature range, 98.6°(normal for young healthy adult)-100.4°F (36°-38° C)

time of day affects temp

6am lowest-4pm highest

pyrexia(fever)- not harmful is stays below 102.2° F (adults) and 104° F (children)

Term

pulse sites

Definition

temporal

carotid

apical

brachial

radial

ulnar

femoral

popliteal

posterial tibial

dorsalis pedis

Term

pulse strength

Definition

+3: increase, bounding, full

+2: normal, easily palpable

+1: tready, weak, barely palpable

0: absent

Term

pulse rates

Definition

infant: 120-160

toddler: 90-140

preschooler: 80-110

school-ager: 75-100

adolescent: 60-90

adult: 60-100

bradycardia <60

tachycardia >100

Term

respiratory rates

Definition

newborn: 35-40

infant: 30-50

toddler: 25-32

child: 20-30

adolescent: 16-20

adult: 12-20

Term

respiratory depth

Definition

full: full expansion of the lungs, obvious movement of rib cage

normal: relaxed, automatic and silent

shallow: small amount of air passes through the lungs

Term

respiratory rhythm

Definition

regular: interval occurs between each respiratory cycle

irregular: periods of apnea w/ shallow and deep breathing

Term

Blood Pressure (BP)

Definition

hypotension: systolic of <90

normal: ≤120/80

hypertension: >140/90

 

Term

documentation

Definition

vital aspect of nursing practice. Anything written or printed within a patient record, may be paper, electronic or both.

provides evidence for credentialing, research, reimbursement and plan of care

necessary to reflect status of patient upon admission, transfer and discharge

Term

confidentiality

Definition

legal and ethical obligations

HIPPA

access to electronic medical record(EMR)

Term

multidisciplinary(all departments) communication within health care team

Definition

patient record (confidential, permanent legal documentation)

reports (oral[change of RN, telephone], written, audiotape)

Term

purpose of records

Definition

communication

legal documentation

reimbursement

education

research

auditing and monitoring

Term

guidelines for quality documentation and reporting

Definition

factual

accurate(exact amts & times)

complete (cover every aspect)

current (as close to time of care)

organized (be logical & have in sequence)

draw single line through errors and inital

Term

methods of documentation

Definition

SOAP (subjective, objective, assessment, plan)

SOAPIE (subjective, objective, assessment, plan, intervention, evaluation)

PIE (problem, intervention, evaluation)

Focus charting (focus on pt concerns)

Term

charting by exception

Definition

reduces time required to chart

uses flow sheet for assessment and interventions

narrative format for abnormal findings

narrative format for variances from interventions

used mainly in ER & critical care

Term

common record keeping forms

Definition

admission nursing history form

flow sheets and graphic records

patient care summary (Kardex)

acuity (scale for amt of care) recording

standerized care plans

most will be obsolete once EMR takes effect

Term

nursing informatics

Definition

informatics (science and art of turning data into information)

information technology(IT) (management and processing of information)

health care information system (HIS) (group of systems used that support and enhance health care)

Term

principles of nutrition

Definition

digestion

absorption

metabolism

storage

nutrition is the sum of processes by which one takes in and utilizes nutrients

Term

digestion

Definition

mouth: mastication(chewing)- amylase in saliva breaks down carbs(starches)

stomach: hydrochloric acid(HCL), lipase, and amylase (digest fats and carbs)

small intestine: digestive enzymes, including trypsin and pepsin, allows most nutrients to be absorbed (fats, carbs and protein)

large intestine: absorbs electrolytes and H2O (helps maintain fluid electrolyte balance)

Term

absorption

Definition

small intestine(simple nutrients)

duodenum (cholesterol, vitamins E & K, folic acid, thiamin and riboflavin)

jejunum (glucose, amino acids, minerals and fats)

ileum (sucrose, maltose, and lactose)


w/diarrhea: nutrients absorption is lost. moces through small intestine too quickly to be absorbed

Term

metabolism

Definition

all biochemical and physiological processes in the body

anabolism: production of complex substances (lipogenesis, gluconeogenesis)

catabolism: breakdown of body tissues into simpler subtances (glycolysis)

Term

storage

Definition

energy stores

adipose tissue(fats), muscle(glycogen & protein), liver(glycogen)

Term

essential nutrients

Definition

carbohydrates: primary source of energy

proteins: essential for body tissue growth, maintenence, and repair; energy source

lipids: carry essential fatty acids and fat soluble vitamins(a,d,e,k); energy source

vitamins: essential for normal metabolism

iron(mineral): helps blood and muscle deliver O2 to every body cell & removes carbon dioxide from cells

Term

factors affecting nutrition

Definition

socioeconomic

physical illness

cultural

food-drug interactions

incomplete diets

Term

nutrition risk factors: older adult

Definition

limited incomes

live alone/ no desire to cook or eat

functional limitations

chronic illness

poor oral health

taste bud atrophy

Term

other factors affecting nutrition

Definition

obesity (66% of americans > age of 20 are overweight or obese)

malnourishment (31-33% of US pts in hospitals are considered malnourished or at nutritional risk)

Term

nutritional screen(RN)

Definition

TJC indicates all patients are to undergo a nutritional screen within 24 hrs of admission

  • diet intake Hx
  • physical findings
  • laboratory findings
  • body mass index (BMI)
Term

nutritional assessment (RD or nutritionist)

Definition

the following would indicate referral for nutritional assessment:

  • Hx of weight loss( 10# during a 6 month period)
  • current "nutritional supplement" or "modified diet" intake
  • nutritional impact symptoms (chewing/swallowing difficulties, N, V, D, constipation, etc.)
  • skin breakdown
Term

signs of dysphagia(difficulty swallowing)

Definition

cough

change in voice tone or quality after swallowing

slow, weak imprecise or uncoordinated speech

abnormal gag reflex

delayed swallowing

pocketing, regurgitation

Term

enternal nutrition

Definition

nasogastric tube(NG): nose into stomach

nasointestinal: nose into jejunum

gastrostomy: into stomach

jejunostomy: into jejunum

Term

therapeutic diets

Definition

clear liquid

full liquid

dysphagia pureed

mechanical soft

soft/low residue

high fiber

low sodium

low cholesterol

diabetic

regular

Term

vegetarian diets

risk for vitamin and protein deficiencies

Definition

vegetarian(red meat excluded from diet)

vegan(no animal products): risk for B12 deficiency

lacto-ovo vegetarian (like vegan but somtimes eats dairy products and eggs)

Term

pain

Definition

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in termss of such damage

always subjective

Term

allodynia

Definition

pain due to a stimulus that does not normally provoke pain

ex: gentle brush of hand or fingers (fibromyalgia & migraines)

Term

analgesia

Definition
absence of pain in response to stimulation which would normally be painful
Term

dyesthesia

Definition

an unpleasant abnormal sensation, whether spontaneous or evoked

ex: foot falls asleep

Term

hyperalgesia

Definition

increased pain from a stimulus that normally provokes pain

 

Term

hypoalgesia

Definition

diminished pain in response to a normally painful stimulus

ex: stub toe while running(don't feel it)

Term

hyperesthesia

Definition

increased sensitivity to stimulation(lower threshold for pain)

ex: person who is very tired may feel severe pain from a small bump into a table

Term

hypoesthesia

Definition

decreased sensitivity to stimulation (higher threshold for pain)

 

Term

nociception

Definition

the process of encoding noxious(harmful) stimuli

ex: sprains, bone fx, sunburn

Term

nociceptors

Definition

receptors(neurons) that are capable to encode noxious (harmful) stimuli

ex: touch receptors

Term

pain threshold

Definition
the minimum intensity of a stimulus that is perceived as painful
Term

pain tolerance level

Definition
the maximum intensity of pain-producing stimulus that a person is willing to accept in a given situation
Term

paresthesia

Definition
an abnormal sensation, whether spontaneous or evoked
Term

sensitization

Definition
increased responsiveness of nociceptors to their normal input
Term

somatic pain

Definition

pain receptors are activated in either the body surface or in the musculoskeletal tissues

ex: surgical sites, fx, arthritis, muscle trauma (strain)

described as dull, achy or throbbing

easy to localize

Term

visceral pain

Definition

pain felt when internal organs are damaged

ex: organ distention, inflammation

described as aching, cramping or squeezing

difficult to localize

Term

neuropathic pain

Definition

caused by injury or malfunction of the spinal cord or peripheral nerves

ex: diabetic neuropathy, shingles

occurs in waves of intensity and frequency

described as burning, tingling, shooting, stinging, stabbing, piercing, cutting, drilling, shocking

Term

acute pain

Definition

comes on quickly, can be severe, but lasts a relatively short time

usually easily described and observed

Term

chronic pain

Definition

ongoing or recurrent

lasting more than 3 months

not easily described

effects well being

can look like s/s of depression

Term

transduction

Definition
afferent nerve endings translate noxious(harmful) stimuli into nociceptive impulses
Term

transmission

Definition
via the afferent neurons, impulses are sent to the dorsal horn of the spinal cord, and then along the sensory tracts to the brain
Term

modulation

Definition

pain-related neural impulses are dampened or amplified

gate-control theory is one explanation

Term

perception

Definition
the subjective experience of pain that results from the interaction of transduction, transmission, modulation and the physiological aspects of the individual
Term

gate control theory

Definition

incoming pain impulses from nociceptors are modulated at a "gate" in the dorsal horn of the spinal cord

the "gate" integrates messages from the central and peripheral nervous systems

can make pain "worse" than it is. can also make pain "less" than it is 

Term

reflex arc

Definition
the neuronal pathway that allows immediate reaction
Term

SNS (sympathetic nervous system) responce to pain

Definition

involves the immediate bodily response to severe acute pain

initial response is typically helpful, but prolonged activation can be detrimental(exhaustion)

reactions are via effect on the neuroendocrine system

Term

neuroendocrine (nerves & hormones) responses to SNS stimulation

Definition

vasoconstriction

elevation of BP

↑ HR

dilation of bronchioles

ihibition of peristalsis

inhibition of digestive enzyme secretion

Term

neuroendocrine response to pain

Definition
hormones are secreted directly from endocrine organs into the blood stream
Term

hormonal response to pain

Definition

hormones ↑ in response to pain

corticotrophin-releasing hormone (CRH): ↑ BP and HR, produces behavioral responses to stress

adenocorticotropic hormone (ACTH): stimulates cortisol production

cortisol: maintains blood glucose levels, suppresses inflammatory response

adrenaline and noradrenaline: produces vasoconstriction, ↑ BP, dilates airways

glucagon: ↑ blood sugar, stimulates liver function

vasopressin: causes sodium and H2O retention by kidneys

renin & angiotensin II: promotes sodium reabsorption by kidneys, ↑ BP

growth hormone: effects metabolism or protein, carbs and fats, ↑ protein breakdown

interleukin I: ↑ coritsol release, activates inflammatory response

Term

physiological responses to pain

Definition

cardiovascular: ↑ BP, HR, peripheral vascular resistance, oxygen consumption and risk of MI

GI: delayed gastric emptying, ↓ bowel motility, paralysis of ileum

Resp:limiting of resp muscle movement to relieve pain

Genitourinary: fluid and electrolyte imbalance

musculoskeletal: muscle spasms at pain site, impaired muscle function (↑ risk for blood clot)

immune system: poor wound healing

 

Term

psychlogical responses to pain

Definition

anxiety

disrupted sleep

cognitive impairment

interference w/ ADLs

depression (w/ chronic pain)

Term

behavioral responses to acute pain

Definition

facial grimace

fist clenching

jaw clenching

guarding of area

altered posture

moaning

withdrawal

Term

behavioral responses to chronic pain

Definition

interferences w/ ADLs

nutrition problems

sleep problems

hygiene problems

emotional distress

social dysfunction

Term

factors influencing pain

Definition

age

gender

culture and family

personal meaning of pain

emotional state

Term

treatment of pain according to type of pain

Definition

somatic: NSAIDs, muscle relaxants, antispasmotics, anxiolytics

visceral: opioids, corticosteriods, anxiolytics

neuropathic: methadone, antidepressants, anti-sz, anxiolytics

Term

non-pharmacological approaches to pain

Definition

comfort measures

heat or cold

distraction(tv, internet, visitors)

massage

guided imagery

music

biofeedback

meditation

hypnosis

prayer

etc.

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