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Foundations Of Nursing
Test 3
124
Medical
Undergraduate 4
09/22/2008

Additional Medical Flashcards

 


 

Cards

Term
Is anxiety a healthy or an unhealthy warning sign?
Definition
healthy. It is a vague, uneasy feeling of discomfort or dread. ANxiety is actually a healthy warning sign, though most texts treat it as a negative pathology.
Term
_______ is apprehension cued by a threat to some value which the individual holds essential to his personality.
Definition
Anxiety
Term
A threat varies from person to person. For ex/ asking one person to sing in front of a group is very different in individuals. What is the difference between fear & anxiety?
Definition
Fear is usually a specific threat. Anxiety can be less specific or a combination.
Term
What are the 4 levels for anxiety?
Definition
1+ Mild, 2+ Moderate, 3+ Severe, 4+ Panic
Term
What level do you have an enlarged perceptual field, sharpened senses, increased energy and are able to problem solve & learn effectively. It is part of day-to-day living...
Definition
Level 1+ Mild anxiety
Term
What stage is your perceptual field diminished? You are only able to attend to details of task and have no problem solving abilities. There is no new learning at this level & is typical of people with test anxiety.
Definition
Level 3, Severe anxiety
Term
What stage is your perceptual field decreasing... you are limited to the tasks at hand and have less ability to think broadly. You tensions are still tolerable at this stage too. YOu are still able to complete a task.
Definition
Level 2, Moderate anxiety
Term
Intense and pervasive anxiety where you are no longer able to process stimuli from the environment. You have total focus on self and perceptions may be enlarged to distorted with primitive behavior. This is a physiological phenomenon, equivalent to shock but psychological. This stage requires immediate intervention.
Definition
Stage 4, Panic anxiety. (Paranoia is a level 4)
Term
Where does the origin of anxiety come from?
Definition
This depends on biology and physiology.
Term
Is anxiety contagious? How is the nurse important?
Definition
Yes, very... Nurses goals is to reduce anxiety. So, when they are carrying anxiety themselves they need to be aware & sure to not pass it on to others.
Term
Do the anxiety levels change in us daily? Are the stages/levels the same for everyone?
Definition
The levels are a continuum in our day, we slide between them & they differ between people. Meaning that my 2 might be different then your 2 b/c you might be in the beginning while I'm almost at a 3.
Term
Is our environment anxiety ridden?
Definition
Yes, it is thought that we live in an age of anxiety with continued threats all the time.
Term
The nurses #1 goal with anxiety is to reduce it. The patient needs the sense from you that this is ____________. We want to sloooowly easy a person down. How do we do so?
Definition
Manageable. One way is to change your tone & your pace. Answer softly & slowly. Often it requires an exaggerated calm from the nurse.
Term
What is another useful way to deal with anxiety?
Definition
Often it is useful to acknowledge the anxiety and accept it. Patient is distractable, cranky... we want to acknowledge this and accept it. Say, "you seem worried, what's going on here, what's going on now?"
Term
We want to identify the approximate level of anxiety in our patient and respond to the _______ level of anxiety. ______ requires IMMEDIATE intervention and a firm, direct approach.
Definition
highest, panic. For ex/ "Sit down, sit down now... give me the glass." be careful with touch.
Term
Need to be able to differentiate between moderate & severe anxiety. Explain where we are at with each?
Definition
Moderate = tensions are still tolerable, perceptual field is decreasing to where we are limited only to our task at hand and have less ability to think broadly. We are still able to complete our tasks at moderate anxiety. At SEVERE = we have a diminished perceptual field and are only able to attend to the details of our task. We have no problem solving abilities with severe anxiety. There is no new learning at severe anxiety.
Term
Seyle, a biologist in the 60's, explained that stress is a _______________ response of the body to any demand.
Definition
nonspecific. It is nonspecific b/c it doesn't matter what the stressor is. He said stress is nonspecific and can be physical, emotional, tangible or even imagined stress... it does not matter, but they all affect us physiologically. He says stress is NOT a bad thing, it is natural and protective.
Term
A __________ is a factor (real or imagined) that elicits a state of stress.
Definition
stressor
Term
_______ is what is negative and diminishes the quality of life.
Definition
Distress
Term
_____________ is positive and enhances the quality of life.
Definition
Eustress, this is positive stress like an upcoming wedding. Eustress is controlled stress that can give us a competitive edge for giving a speech or performing athletically.
Term
What is LAS?
Definition
Local activation system. When our bodies respond to stress and we get LAS - this is a reaction that happens locally. You've got some cells and blood changes in this one little spot. For ex/ getting bit by a mosquito.
Term
What is GAS? what are its 3 stages?
Definition
General adaptation System. GAS has 3 phases: alarm, resistance and exhaustion. In GAS almost every system is involved, it is full body.
Term
Explain what happens in the 3 stages of GAS (alarm, resistance and exhaustion)...
Definition
ALARM: when you're driving and you hear police sirens right behind you & you feel alarm. Alarm mobilizes the defense system and gets adrenaline going. RESISTANCE: when our body is trying to fight the stressor.. it resolves and heals our body. EXHAUSTION/RECOVERY: our body is attempting to repair the damage. If we can't resist you will get exhaustion in the physiological sense. Multi-system failure. End stage is exhaustion & death of multi-system failure.
Term
How does the endocrine get involved in our response to stress?
Definition
The pituitary gland produces hormones necessary for adaptation to stress such as ACTH (Adrenocorticotropic hormone) which produces cortisol. Pituitary also regulates the secretion of thyroid, gonadal and parathyroid hormones.
Term
How does stress make people ill?
Definition
Stress leads to SO much. 1. increased levels of powerful hormones that change our bodily processes 2) coping choices that are unhealthy 3) neglect of warning signs of illness or failure to adhere to prescribed meds or treatments. Just know, stress is a premediator to disease!
Term
What are some variables from person to person for stress?
Definition
A persons age, their cultural background and many other things that make people different will influence their coping needs and strategies. Different strategies work for different people. Not only does the type of stress make a difference but the persons goals, their beliefs about themselves and the world, their personal resources determine how they cope with stress.
Term
3 big ways to reduce frequency of stress are to:
Definition
1. reduce the frequence of stress inducing situations 2. reducing our bodies physiological response to stress and 3. improving our behavioral/emotional response to stress.
Term
How can we reduce frequency of stress inducing situations?
Definition
Give a person what they ask for :) Also work to have Structure, Time Management, Environmental Manipulation and be Assertive.
Term
How can one reduce their physiological response to stress?
Definition
Breathing, exercise, laughter/humor/play/tears, rest & sleep, relaxation techniques, spirituality, massage, meditation, music, imagery
Term
We can improve our behavioral/emotional responses to stress through:
Definition
support systems, thought stopping, refuting irrational ideas and reframing.
Term
What hormone is related to stress response? WHere is it made?
Definition
Cortisol, the adrenal cortex. IT has all sorts of bad effects in the body when heightened for a long time.
Term
___ is made in the hypothalamus. If we can control this then we can control the whole stress response going to the body if done with medication.
Definition
CRH - Corticotropin-releasing hormone
Term
Differentiate between anxiety & fear...
Definition
anxiety is what causes fear in some cases. You fear the outcomes. A lot of times anxiety can be helpful and used to overcome tests, but fear is normally when you could really be in danger (ie a bear is after you). Fear is usually more specific then anxiety.
Term
What are the components to a stress response?
Definition
There are physiological and psychological components to stress.
Term
What are the components of a stress response?
Definition
To manage stress we must reduce the frequency of stress, reduce the physiological response to the stress, and improve your behavioral and emotional responses to stress.
Term
What levels of anxiety can be healthy & helpful?
Definition
Levels 1 & 2 (Mild and moderate anxiety)
Term
Level __ anxiety makes it difficult to concentrate.
Definition
3
Term
Level__ anxiety is so high it requires immediate intervention.
Definition
4
Term
What is an advance directive???
Definition
This is a general term that describes 2 legal documents: the living will and a medical power of attorney.
Term
A ______ ____ is a document in which you place your wishes about medical treatment when you are unable to speak for yourself.
Definition
Living Will
Term
The person you appoint that you trust to make HC decisions about yourself is called your:
Definition
medical power or attorney (aka health care proxy)
Term
In different states the names "Directive to physicians," "health care declaration" and "medical directive" are all names for one thing... what is it?
Definition
a living will
Term
"health care proxy" "appointment of a HC agent" and "durable power of attorney" are all names given for a.... ?
Definition
medical power of attorney
Term
A HC agent, a HC surrogate, an attorney in fact and a HC proxy are ALL names given for the person who ....
Definition
makes decisions about a persons HC when they are unable to do so themselves.
Term
On what basis should an agent make decisions regarding a person/client's medical treatment?
Definition
The Living Will
Term
How can an agent make decisions if they have not discussed medical treatment options with the person/client?
Definition
They'll make decisions as much as possible. Make decisions made on general statements s/he have made, along with religious and moral beliefs, and values in general.
Term
How does the power given to a 'medical power of atorney' differ from one identified in a 'living will'?
Definition
The medical power of attorney can make HC decisions in all medical conditions. An agent identified in a living will can only make end of life decisions in situations specified in the living will.
Term
Do clients have the right to refuse medical treatment? Even if their doctor and family think the med treatment is in their best interest?
Definition
Yes
Term
What are the 3 reasons advance directives are initially important when making life-sustaining decisions?
Definition
1. the person to make these decisions can be named specifically 2. The persons wishes are all outlined in the document 3. conflict between family members can be minimized or eliminated.
Term
What is the advantage of having a medical power of attorney that identifies a HC agent in addition to having a living will? Conversely, what does a living will provide a person/client's health care agent?
Definition
It allows that person to participate in HC decisions that may be unanticipated and changing. Factors taken into consideration can be broader and based on that person's knowledge of you as a person and your family. The Living Will does provide more specificity in relation to that person's wishes in regard to heroic measures and end of life treatment.
Term
What are emergency personnel required to do if called to an accident of medical crisis? Can a living will’s directives be executed in the situation? What options do individuals have if they do not want to be resuscitated in such a situation but may be unable to speak for themselves?
Definition
Emergency personnel are required to provide life support measures until they have transported the patient to the hospital. A Living Will does not provide a guideline they will follow. They may be allowed to follow a DNR (may withhold CPR) if the patient has a medical bracelet stating so or a signed doctor’s order specifying their DNR status.
Term
Do healthcare providers run a legal risk of malpractice if they withhold treatment consistent with a living will? Do healthcare providers have the option to refuse to honor advance directives? If they feel they cannot ethically follow the directives in a living will, what options are available to them?
Definition
Most statutes state that health care personnel who honor the patients wishes stated in an advanced directive run no legal risk for withholding care that has been specified. Health care providers can refuse to honor advance directives if they are inconsistent with their moral or religious beliefs. It would, however, be in the best interest of the patient and health care provider to remove themselves from that case to avoid health care disputes. Ethics committees may be asked to intervene in extremely complex cases.
Term
How are decisions made regarding care of a client who is unable to verbalize their wishes?
Definition
Physicians should consult with the family but if the decision is one that will result in the termination of a life, the physician may retain the right to make the final decision.
Term
What is the primary purpose of the Patient Self Determination Act (PSDA)?
Definition
This Act requires that patients upon admission to a health care institution be informed of their rights to complete an Advanced Directive.
Term
When choosing your medical power of attorney, who can not be your agent?
Definition
Not your physician and not your lawyer. It is usually a family member. Can always appoint a 2nd person too.
Term
Can your Living Will and/or Medical Power of Attorney be a document you printed off the computer? What else needs to be done in to it? Can you revoke this document once it is done?
Definition
KS requires doc to be notorized or signed in front of 2 witnesses. MO requires it to be signed with a notary present. It is not recommended to add specific instructions to these documents, just discuss what you consider "quality of life" with your agent or attorney. Yes, you can revoke it at any time by executing a new document.
Term
Where should you keep your Living Will and appointed Medical Power of Attorney doc's?
Definition
keep the original signed in a safe place, (not in a safety deposit or other locked storage), make multiple copies & give to physician, take with you to hospital for any procedure. Neither state will honor the document if you call an ambulance or go to the ER w/o a copy of the document. You will need a "non-hospital DNR order" for these situations.
Term
DNR has replaced "__ ____ ____." Legally, are there slow or partial codes?
Definition
no code blue. No, legally there is no slow or partial codes. A DNR order has to be checked & signed by 2 RN's before putting band on their arm.
Term
_____ loss is when a person or object is no longer felt, heard, known or experienced.
Definition
Actual
Term
____________ loss is defined by the grieving client. Could be loss of confidence or prestige. Others do not see this loss as much.
Definition
Perceived
Term
______________ loss is coping with normal life transitions or loss of child or youth. Ex/ child going to college or child going to kindergarten.
Definition
Maturational
Term
___________ loss is a sudden, unexpected, unpredictable external event. ex/ motor vehicle accident
Definition
Situational
Term
_________ loss is death.
Definition
Ultimate
Term
Need to be able to differentiate between the definitions of grief & bereavement.

_______ is the emotional response to a loss. It manifests itself in many ways and is unique to each individual.

_____________ is inward feelings and outward reactions of the survivor. This includes grief and mourning.

Remember, no one really gets over a loss - they can heal and learn to live with it.
Definition
Grief, Bereavement.
Term
What are the 5 stages of grief identified by Elizabeth Kubler-Ross?
Definition
1. DENIAL 2. ANGER 3. BARGAINING 4. DEPRESSION 5. ACCEPTANCE
Term
what happens during the denial stage?
Definition
this is refusal to believe or understand that a loss has occured.
Term
what happens during the anger 2nd stage of grief?
Definition
People resist the loss and may strike out. Person is angry at everything, the situation & even God.
Term
What happens during the bargaining 3rd stage of grief?
Definition
THe person is postponing awareness of reality of loss and may deal in various ways that loss can be prevented. The person wants to make promises with God to try not to have the dreaded outcome.
Term
What happens during the DEPRESSION 4th stage of grief?
Definition
The full impact or loss is realized. Overwhelming feelings of loneliness, sadness and loss may overwhelm the individual.
Term
What happens during the ACCEPTANCE 5th stage of grief?
Definition
The loss is accepted and the individual begins to look at the future again. The person is beginning to incorporate the loss into their life & find ways to move on & forward from the loss they've experienced.
Term
Generally, what are the 4 types of Grief?
Definition
Normal Grief, Anticipatory Grief, Complicated Grief, Disenfranchised Grief
Term
Explain a normal reaction of grief...
Definition
normal feelings, behaviors and reactions to a loss (sorrow, anger, crying)
Term
Explain what a person does in anticipatory grief?
Definition
Disengaging or letting go before the actual loss or death occurs. Grief begins with the diagnosis of cancer and less is experienced when death occurs.
Term
Explain what a person does during Complicated Grief...
Definition
Person has difficulty progressing through the typical stages of grief. The loss is never resolved and the individual may not be able to "go on" leading a normal life.
Term
Explain what Disenfranchised grief is...
Definition
A grief experience that cannot be openly experienced b/c it is not culturally/socially acceptable. Ex/HIV partner
Term
What factors influence loss and grief?
Definition
Human Development, Psychosocial Perspective of Loss & Grief, Socioeconomic Status, Personal Relationships, Culture and Ethnicity, Spiritual Belief
Term
what is the relationship between coping and grief/loss?
Definition
How the individual normally copes with loss influences their experience of grief. Reinforcing successful coping mechanisms should be done and an introduction of new coping mechanisms will be necessary.
Term
Why/how is HOPE so important?
Definition
Hope is the anticipation of a continued good, an improvement or lessening of something unpleasant. Hope provides purpose and direction and gives a reason for being to many clients.
Term
How might a nurse instill hope to an AIDS patient?
Definition
Plan an instructional session to talk about the typical course of AIDS, emphasizing the typical pattern of remissions with drug therapy and review therapies available for treatment. We do this b/c knowledge about the disease will help the client think of themselves as a person living with AIDS, rather than dying of AIDS. Reality of the disease course will help instill hope.
Term
Normal Symptoms of Grief are:
Definition
FEELINGS: sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock/numbness, yearning and even relief. COGNITIONS: disbelief, confusion, sense of presence of deceased, hallucinations, hopelessness. PHYSICAL SENSATIONS: hollw stomach, tight chest and throat, oversensitive nose, feel depersonalized (nothing seems real), feel SOB, muscle weakness, lack energy, dry mouth. BEHAVIORS: sleep and appetite disturbance, absentminded, dreaming of deceased, signing, crying and carrying around objects that belonged to the deceased.
Term
Palliative Care means to _____________.
Definition
Alleviate (reduce or soothing comfort of illness throughout disease without effecting a cure).
Term
Palliative care affirms life and regards death as a ________ process.
Definition
normal
Term
What is the goal of palliative care?
Definition
to increase quality of life and support individual and their family during and after treatments.
Term
What is hospice care?
Definition
An alternative care delivery model for terminally ill and can be considered a phase of palliative care. Generally the client has 6 months or less to live. It is a client & family centered approach to their care... want to figure out how/where to have comfort until death.
Term
Hospice care can be given _________, whereas palliative care provides the greatest degree of comfort and is related to pain issues.
Definition
anywhere
Term
What is the goal of Palliative Care?
Definition
Goal is to assist client in being comfortable and maintain a satisfactory lifestyle until death.
Term
What is the goal of Hospice care?
Definition
Services of both Palliative and Hospice care are available in the home, hospital and nursing home settings. Procided by interdisciplinary team consisting of primary care providers, nurses, spiritual advisors, social workers, and counselors.
Term
Is it alright for nurses to grieve for their clients?
Definition
Of course it is normal for the nurse to grieve for patients they have cared for, especially when it is long term. We need to be a support for each other during these times in our nursing careers.
Term
Can we delegate bathing to AP? WHy might the RN want to do bed bathes?
Definition
Yes, you can delegate, but be sure they know not to massage reddened areas. Tell them early signs of impaired skin integrity and have them tell you if they see any. The RN will want to do the bath themselves to be sure the client is assessed correctly. Can get a lot of info, include tests, during bath time.
Term
Patients often say they cannot bathe with their IV. What should the nurse respond?
Definition
Actually, we can adjust the flow rate to keep the vein open (KVO) flow and remove the tubing. Just cover the IV up (some type of occlusive dressing to cover IV site) and can reattach after bath.
Term
When washing the arm, which way do we go when rubbing & cleaning?
Definition
Start at fingers and go towards the armpit. Also assists in venous circulation going back toward the trunk.
Term
When bathing: do we always go "cleanest to dirtiest" OR "dirtiest to cleanest"?
Definition
Cleanest to Dirtiest
Term
What factors effect a person/patients hygiene?
Definition
Their social practices, personal preferences, body image, socioeconomic status, their health beliefs and motivations (depressed people likely bathe less), cultural variables (we bathe everyday, but others once a week is normal), and their physical condition is a big factor (as you lose mobility things get harder & you're unable to shower daily).
Term
What areas will you review when assessing a patient for their hygiene, cleanliness and needs?
Definition
In physical exam look at skin closely for breakdown, feet & nails (if yellow, curly.. need to go further why they can't take adequate care of themselves), oral cavity (white spots are yeast=thrush), hair and scalp (cleanliness, matting, lice), sensory aids (look for breakdown in nose & ears from oxygen). Always wash GENTLY... and assess ALL areas for cleanliness and the patients particular needs.
Term
What equipment is needed to bathe a client?
Definition
2 washclothes, 2 bath towels, a bath blanket, soap + soap dish, toiletry items, clean change of clothes, laundry bag (NEVER throw linens on the floor or chair close by) and we DO WANT GLOVES for perineal care.
Term
How full is the bath basin? what temp is water?
Definition
1/2 - 2/3 full. Never full or will make a big mess. Water temp is WARM. too hot can burn them & it is very drying.
Term
Why do we use bath blankets?
Definition
To keep the patient warm. Even if you think it is warm water & it will be nice, they will think it is cold. Keep covered except where you're directly working.
Term
Do we remove gown on the affected or unaffected side first?
Definition
unaffected side first.
Term
WHen bathing do we start at the head or feet?
Definition
Head and work towards feet
Term
Clients who are most in need of perineal care are at the ___________ risk of infection. What are the biggest risk factors in perineal care for infection?
Definition
greatest. Uncircumcised male, indwelling urinary catheters, rectal or genital surgery or childbirth.
Term
We know that diabetes & peripheral vascular disease patients have increased risk of foot and nail problems and we should inspect their feet daily. What will you do differently in bathes for these patients?
Definition
Do not soak their feet! We want to wash their feet daily using lukewarm water though, pat feet dry and be sure to dry well between their toes.
Term
If you see a callus or corn on your patients foot during a bath, can you soak it and then cut it off afterwards?
Definition
NO, RN's do not cut corns or calluses or use any type of removers.
Term
Is it okay for an RN to clip or file the patients nails? How?
Definition
RN's can FILE the nails, straight across.
Term
Oral Hygiene is performed every ___ hours (how many times a day?) for a conscious patient and every ___ hours for an unconscious patient.
Definition
conscious patients=every 4 hours while awake or 4 times a day (after meals and before bed).

Unconscious patients=every 2 hours.
Term
Instruct patients to buy a new toothbrush every ___ months and use fluoride toothpaste. How often should they floss?
Definition
every 3 months, floss daily.
Term
Bathe extremities with soap & water, using long, firm strokes from _________ to __________.
Definition
distal to proximal.
Term
What kind of mouthwash should not be used if their mouth is really dry?
Definition
alcohol based, it will make their oral cavity drier & worsen their hygiene in that area.
Term
What can you do so you don't have to change the beds so frequently?
Definition
use an extra pad
Term
The pad can be used as a _____ draw sheet and if they're incontinent.
Definition
draw. can help move the client within the bed with the pad.
Term
How many times should you go around the bed when changing old to new linens? It can be done with unoccupied and when it is occupied.
Definition
Just once, do 1/2 and then the other 1/2. fold sheets into themselves & close to clients back, then make that half of the bed... go around to the other side, have the patient roll onto clean side. Put old linens into a laundry bag & make the other half. Easy peaze.
Term
With pillows, the key is that:
Definition
you do not want them to touch you. End of the pillowcase is folded in like a pocket which helps to keep it on the pillow.
Term
Why should you always do a back rub for your client, even if it is just for 30 seconds after lotion?
Definition
Back rubs promote relaxation, relieve tension & are very good for our clients. They help promote healing. Even if it is very short, they will leave the hospital remembering they were given a back rub. If you meet the needs of your client up front then they'll complain less & hit the call light less. Start at toes & work up their leg to help venous circulation improve.
Term
How often should oral care be performed on an unconscious or NPO patient?
Definition
every 2 hours
Term
How is the unconscious patient positioned for oral care?
Definition
position client on their side (Sim's position) with head turned well toward dependent side. Move client close to the side of the bed & then raise the rail again.
Term
How do you separate an unconscious clients teeth?
Definition
use a padded tongue blade, between back molars, when client is relaxed. Never use fingers to separate client's teeth.
Term
Mustache & beard care should be performed how often?
Definition
they require daily grooming. Imp to keep food particles and mucus out which can easily collect. A shaggy or unkept beard can be trimmed. Clients prone to bleeding (receiving anticoagulants, high doses of aspiring or with low platelet counts) require an electric razor.
Term
Frequency of shampooing?
Definition
depends on a person's daily routines and the condition of the hair. The nurse should remind that suprisingly staying in bed does require even more shampooing. Also excess perspiration and treatments that leave blood or solutions in hair require shampooing.
Term
If a patients oral mucosa is dry & inflamed... do we increase or decrease frequency of oral care?
Definition
You will actually INCREASE the frequency of oral care. Also increase the clients hydration and apply protectant to their lips.
Term
If the gums margins are retracted from the patients teeth with localized inflammation...?
Definition
Determin if client has underlying bleeding tendency (ie anticoagulant therpy), report findings to physician, use soft-bristled toothbrush and INCREASE frequency of oral hygiene.
Term
Why is it so important to have a wrinkle free bed?
Definition
Do not want wrinkles b/c they promote skin breakdown. The lines on skin you see when you get out of bed. These little lines in an elderly frail patient who does not move much will lead to breakdown fast. Be careful when you make their bed & try to straighten their sheets whenever they are not in it.
Term
Do you need to wear gloves when making an occupied bed?
Definition
Wear whenever you're removing dirty linen. Bed might look okay and you won't know there is urine. Need gloves when taking off linens.
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