Term
| 7 signs of urinary problems |
|
Definition
1. when urine output falls below 30 cc's per hr.
2.cloudy or fould smelling
3.difficulty urinating
4.can start but can't maintain stream.
5.blood in urine
6.increased creatinine levels and/or Blood Urea Nitrogen levels.
7.bladder is distended |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| secreted by the adrenal gland when serum Na is low. Prevents H2O and Na loss. |
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Term
|
Definition
| acts on the kidneys to increase total body water. (normal range is 270-300m/L) |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
| BUN values can increase with? |
|
Definition
| high intake of protein, fluid deficit or presence of gout. |
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Term
|
Definition
Adult male: 0.8-1.4mg/dl
Adult female: 0.6-1.1mg/dl |
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Term
| panic value for creatinine |
|
Definition
| 10mg/dl in nondialysis patients. |
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Term
|
Definition
| to obtain sterile urin specimen or check residual urine. |
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Term
|
Definition
| routine, scheduled basis-client with MS |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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|
Term
| 3 purposes for nasogastric intubation |
|
Definition
| gastric decompression, gastric lavage, gastric feeding |
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Term
|
Definition
| actual, risk for, wellness |
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Term
|
Definition
| explains how we came to the nursing diagnoses |
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Term
|
Definition
*group closely related to the problem tracks the process start-finish, compares it to what was supposed to happen.
*staff who work in the ares doing the same job are very helpful. |
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Term
|
Definition
1.protection
2.thermoregulation
3.sensation
4.metabolism
5.communication |
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Term
| Risk factors to skin in hospital |
|
Definition
1.moisture
2.pressure
3.Irritation
4.Rubbing
5.Friction/Shearing
6.Pruritis
7.Nutrition |
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|
Term
| patient with skin breakdown and immobile should have head of bed at... |
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Definition
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|
Term
| what scale rates a persons risk for skin breakdown and risk for pressure ulcers? |
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Definition
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Term
|
Definition
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Term
|
Definition
| on the skins surface, open sore |
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Term
|
Definition
| pitting down to the dermis |
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Term
|
Definition
| pitting, open wound down to muscle and or bone. |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| containing serum and blood |
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Term
|
Definition
|
|
Term
|
Definition
Primary intention
Secondary intention
Tertiary intention |
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Term
| phases of normal wound healing |
|
Definition
1.Inflammation
2.Proliferation
*Granulation
*Contraction
*Epithelialization
3.Remodeling |
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|
Term
| 3 factors for healing a wound |
|
Definition
1.warm
2.moist
3.free of infection |
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Term
|
Definition
1.Bacteria
2.Fungi
3.Virus
4.Parasites |
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|
Term
| Give a source of infection |
|
Definition
1.Human beings
2.Animals
3.Inanimate objects |
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|
Term
| What is a portal of exit for infection? |
|
Definition
1.Sputum
2.Emesis
3.Stool
4.Blood |
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Term
|
Definition
|
|
Term
| What are modes of transmission of infection? |
|
Definition
1.Contact
2.Vehicle
3.Airborne
4.Vectorborne |
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|
Term
| Name 5 portals of entry for infection |
|
Definition
1.Mucous membranes
2.Nonintact skin
3.GI tract
4.GU tract
5.Respiratory tract |
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|
Term
| Name 4 susceptible hosts for infection |
|
Definition
1.Immunosupressed elderly
2.Chronically ill
3.Trauma
4.Surgery |
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|
Term
| What is the main focus in breaking the chain of infection? |
|
Definition
| Transmission, Contain it then treat it. |
|
|
Term
| describe airborn infection |
|
Definition
| drobplets smaller than 5mm |
|
|
Term
| describe Droplet infection |
|
Definition
|
|
Term
|
Definition
| reduce the spread of microorganisms |
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Term
|
Definition
| using sterile items free of all organisms |
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Term
|
Definition
| redness, swelling, heat, drainage, pain, limited function |
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|
Term
|
Definition
| fever, malaise, anorexia, raised HR and RR, enlarged lymph nodes, possible nausea and vomiting. |
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Term
|
Definition
| a condition of general bodily weakness or discomfort, often marking the onset of a disease. |
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Term
|
Definition
| contains items that you can sqeeze blood out of. |
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Term
|
Definition
| contains anything that is sharp or could cut someone. Do not recap needles before throwing them away. |
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|
Term
| risks factors for nosocomial infections |
|
Definition
1.Immobility-atelectasis/pneumonia
2.Wound-MRSA or other oranisms
3.Foley catheter or incontinence-UTI or urosepsis
4.Central IV-sepsis
5.Incision-local infection or sepsis |
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Term
|
Definition
| local or generalized invasion of the body by pathogenic microorganisms or their toxins: dental sepsis; wound sepsis. |
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Term
|
Definition
1.incomplete expansion of the lungs at birth, as from lack of breathing force.
2.collapse of the lungs, as from bronchial obstruction. |
|
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Term
|
Definition
| unable to restrain natural discharges or evacuations of urine or feces. |
|
|
Term
| what do immunizations do? |
|
Definition
| Make the host less susceptible |
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Term
|
Definition
| a wasting away of the body or of an organ or part, as from defective nutrition or nerve damage. |
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Term
|
Definition
| a shortening or distortion of muscular or connective tissue due to spasm, scar, or paralysis of the antagonist of the contracting muscle. |
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Term
|
Definition
| fall in blood pressure associated with an upright position, usually occurring as a result of standing still for a long time or rising from a prolonged stay in bed and often causing faintness, dizziness, and vision disturbances. |
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Term
|
Definition
| Kidney Stone. an abnormal stone, or concretion, composed primarily of oxalates and phosphates, found in the kidney. |
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| head of bed raised 80-90 degrees |
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Term
|
Definition
| lying supine with legs flexed at the knee and rotated outward. |
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Term
|
Definition
|
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Term
|
Definition
| in semi prone with left arm behind the body, right flexed at knee. |
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Term
|
Definition
| supine with head of bed at 30-40 degrees. |
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Term
|
Definition
| lying supine with legs bent at knees, calves parallel to the floor. Feet in sturups |
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Term
|
Definition
| prone, hands and knees, head down butt in air. |
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Term
|
Definition
| lying supine with head 30-40 degrees lower than feet. |
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|
Term
|
Definition
| Inputs, environment-patient-feedback, ouputs |
|
|
Term
|
Definition
1.Activity and Exercise
2.Nutrition and Metabolism
3.Urinary and Bowel Elimination
4.Sleep and Rest
5.Cognition and Perception
6.Coping
7.Oxygenation
8.Perfusion |
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|
Term
|
Definition
| bio/psycho/social/spiritual |
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|
Term
| Pre-op the nurse needs to ensure what? |
|
Definition
1.labs, exrays are present
2.verify consent forms are signed
3.IV started
4.Pt underessed and in gown
5.Pt values taken care of
6.Surgical site marked
7.Verify NPO status |
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|
Term
|
Definition
1.Local
2.Moderate (conscious)sedation
3.Regional
4.General |
|
|
Term
|
Definition
says when patient can leave the PACU. Based on
1.Respiration
2.O2 sat
3.Consciousness
4.Circulation
5.Activity |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| the characteristic pattern or psychological and physiologic responses a person experiences after the loss of...1.a significan person. 2.object, 3.belief, 4.relationship |
|
|
Term
|
Definition
1.To make the outer reality of the loss into an internally accepted reality.
2.To sever the emotional attachment to the lost person or object.
3.To make it possible for the bereaved person to become attached to other people or objects. |
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|
Term
|
Definition
| State of complete desolation, encluding total response including emotional, physical social and cognitive responses. |
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Term
|
Definition
| formalized process of grieving, varies form culture to culture. |
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Term
|
Definition
| anticipating the impending loss of a loved one |
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|
Term
| birth-2 year old perception of death |
|
Definition
| sense of separation; no concept of death |
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|
Term
| 2-5 year old perception of death |
|
Definition
| death is transient, not a permanent state. |
|
|
Term
| 6-10 year old perception of death |
|
Definition
| Beginning awareness of reality of death |
|
|
Term
| 13-25 year old perception of death |
|
Definition
| Realization of mortality and eventual death; death anxiety more evident; death perceived as a future event. |
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|
Term
| 26-65 year old perception of death |
|
Definition
| More aware and accepting of death |
|
|
Term
|
Definition
1.Dejected physical appearance
2.Slowed motor function.
3.Weeping.
4.Outbursts of anger.
5.Emotional blunting.
6.Unkept appearance.
7.Sleep disturbance.
8.Appetite disturbance. |
|
|
Term
|
Definition
1.Cessation of heart-lung function
2.Cessation of whole-brain function
3.Cessation of higher-brain function |
|
|
Term
|
Definition
1.Denial
2.Anger
3.Bargaining
4.Depression
5.Acceptance |
|
|
Term
|
Definition
| includes everything that is going on besides what is being spoken. It includes thinking about your thinking. |
|
|
Term
| The communication process |
|
Definition
1.Sender
2.Encode
3.Communication channel
4.Reciever
5.Decode
6.Feedback |
|
|
Term
| phases of nurse-client relationship |
|
Definition
1.Orientation
2.Working
3.Termination |
|
|
Term
|
Definition
1.two way process
2.needs to be learner-centered
3.Learner specific
4.Need to have trust in the relationship. |
|
|
Term
|
Definition
1.Cognitive
2.Affective
3.Psychomotor |
|
|
Term
|
Definition
| basic knowledge, learning facts, problem solving. |
|
|
Term
|
Definition
| feeling or beliefs about ones self that something needs to change. Lifestyle change |
|
|
Term
|
Definition
| Performing skills and procedures |
|
|
Term
|
Definition
1.Pain
2.Information overload
3.Emotional stress
4.Denial of problem
5.Language
6.Senses
7.Environment
8.Cultural considerations |
|
|
Term
| Teaching goals should include |
|
Definition
| Who, Does, What, How, When |
|
|
Term
|
Definition
| compares, describes, evaluates, explains, identifies, labels, lists, names, plans, selects, states, writes, |
|
|
Term
|
Definition
| accepts, attends, chooses, discusses, displays, initiates, joins, paricipates, shares, uses, |
|
|
Term
|
Definition
| assembles, calculates, changes, demonstrates, measures, moves, organizes, shows |
|
|
Term
|
Definition
1.Environmental
2.Occupational
3.Intellectual
4.Spiritual
5.Physical
6.Emotional
7Social |
|
|
Term
|
Definition
1.Primary-general healthy living practices
2.Secondary-trying to screen to catch a disease early and then intervene to treat and prevent complications.
3.Tertiary-Working with a patient who has a disease to rehabilitate them to the optimal level of function. |
|
|
Term
|
Definition
| a subjective response to both physical and psychological stressors. |
|
|
Term
|
Definition
| Pain receptors, located at the ends of small afferent neurons, found through entire body except in the brain. |
|
|
Term
| Pain occurs from 5 types of stimuli |
|
Definition
1.Biological
2.Mechanical
3.Thermal
4.Electrical
5.Chemical |
|
|
Term
|
Definition
| a polypeptide element of kinin protein system, appears to be the most abundant and potent pain-producing chemical. |
|
|
Term
| Chemicals that bind with nocioreceptors |
|
Definition
1.Bradykinin
2.Prostoglandins
3.Histamine
4.Hydrogen+potassium ions. |
|
|
Term
| Inhibitory neurotransmitters |
|
Definition
| transmit Endorphins to the opoid receptors on the pre-synaptic site, inhibiting pain. |
|
|
Term
|
Definition
| Has sudden onset, is usually temporary, and is localized. Last less than 6 months and has identifiable cause. |
|
|
Term
|
Definition
| from receptors in the skin or close to the body surface. |
|
|
Term
|
Definition
| arises from body organs. Dull and poorly localized because of low number of nociceptors. |
|
|
Term
|
Definition
| Pain that is percieved in an area distant from the site of stimuli. |
|
|
Term
|
Definition
| usually lasting longer than 6 months. Doesn't always have an identifiable cause. |
|
|
Term
|
Definition
| Pain that exceeds baseline treated or untreated pain. Pain returns before medication has worn off. Or before patient can have another dose. |
|
|
Term
| does pain decrease with aging |
|
Definition
|
|
Term
|
Definition
| Pain originating in the brain, most commonly in the thalamus |
|
|
Term
|
Definition
| Syndrome that follow amputation of body part, but the pain persists. |
|
|
Term
|
Definition
| Pain that is experienced in the absence of any measurable cause. |
|
|
Term
|
Definition
| the amount of pain a person can endure before outwardly responding to it. |
|
|
Term
|
Definition
| Transitional stage between drowsiness & sleep |
|
|
Term
|
Definition
| Light sleep, easily awakened |
|
|
Term
|
Definition
| Deep, slow wave sleep, Muscles relaxed but tone maintained. |
|
|
Term
|
Definition
| Muscles at lowest tone, Irregular respirations, Vivid dreams, Difficult to awaken, Cortisol, ACTH, and catecholamines released, Begins every 50-90 minutes after sleep occurs, Averages 20 minutes, but duration increases with each cycle. |
|
|
Term
|
Definition
*24 hour cycle
*Biological rhythm that synchronizes the sleep cycle.
*Influences major biological & behavioral function. |
|
|
Term
|
Definition
| Characterized by insomnia or excessive sleepiness |
|
|
Term
|
Definition
Activities that are normal while awake but abnormal during sleep
*sleep walking, talking etc.. |
|
|
Term
|
Definition
| Sleepwalking, occurse during stage 3 & 4 of non-REM sleep |
|
|
Term
|
Definition
| upper airway blockage, Snoring |
|
|
Term
|
Definition
| Caused by a defect in the brain's respiratory center. Results in cessation of both nasal airflow and chest movements. |
|
|
Term
| Factors affecting self-care |
|
Definition
| Culure, values, beliefs, Environment, Motivation, Mental Health, Cognitive Abilities, Energy, Acute Illness/Surgery, Pain, Neuromuscular Function, Sensory Deficits |
|
|
Term
| Health promotion vs Health prevention |
|
Definition
Promotion-general health care and activities.
Prevention-Actions to prevent a specific disease from occuring. |
|
|
Term
|
Definition
1.Narrative notes
2.SOAP notes or SOAPE notes
3.PIE notes or ADOPIE notes
4.FOCUS DAR notes |
|
|
Term
| Every time you pick your pen up off the paper to do something else you draw line and initial it. |
|
Definition
|
|
Term
| If your didn't document it... |
|
Definition
|
|
Term
| When should you chart procedures/meds etc.. |
|
Definition
|
|
Term
|
Definition
| Before you actually perform a task. |
|
|
Term
|
Definition
1.What must be documented in order to communicate and provide optimal patient care?
2.What will legally satisfy the accurate and complete requirment for documentation? |
|
|
Term
| Nursing Entries on Client Record |
|
Definition
1.Admission entries
2.Nursing notes
3.Nursing discharge summary
4.Medication administration record
5.Incident report or occurrence report.
6.Doccumentation of care. |
|
|
Term
|
Definition
| Medication Administration Record |
|
|
Term
|
Definition
| Subjective, Objective, Assessment, Procedures, Evaluate |
|
|
Term
|
Definition
| Subjective, Objective, Assessment, Procedures, |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Situation, Background, Assessment, Recommendation, Need to be able to select appropreate examples of info contained in each step |
|
|
Term
|
Definition
| Plan, Implement, Evaluate |
|
|
Term
|
Definition
| Predetermined research based pathway. Easy to follow, predictable. |
|
|
Term
|
Definition
1.Assessment & Evaluation
2.Teaching
3.Titrating medication
4.Patient with questionable stability
5.Care for patient according to Maslow
6.Sometimes only RN's can take phone orders from physicians |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Limit potasium-
limmit protien- With reinal malfunction not able to rid of the protien
If you have to choose between sodium or potasium you'll error on the side of potasium. In heart patient it is opposite |
|
|
Term
|
Definition
|
|
Term
|
Definition
| drug, dose, route, time, signiture, frequency(if it's more than one time dose) |
|
|
Term
|
Definition
1.Inadequate tissue perfussion
2.low urine output less than 30cc per hr
3.>2 second cap refill
4.Cool pale extremities
5.Weak thready pulse
Treatment
1.Trandelenburg position
2.IV fluids
Compensated-Raised RR Raised HR
Decompenstated-hypotension Lowered BP(hypovolemic) |
|
|
Term
|
Definition
1.H&H
Treatment
1.Blood transfussion
2. |
|
|
Term
|
Definition
1.Low PaO2 < 80
2.Low SpO2 <90%
3.Accessory muscle/stridor, drooling, SOB, fatiqued, wide eyed
Treatments
Highfowlers, tripod, O2-nasal cannula
Packed RBC/Iron |
|
|
Term
|
Definition
Raised heart rate
Raised RR
Change in LOC level of consciousness
Low BP |
|
|
Term
|
Definition
|
|
Term
|
Definition
Affective,
Cognitive,
Psychomotor |
|
|
Term
|
Definition
Point of care
Narrative Notes
-SOAP/SOAPE
-PIE/ADOPIE
-FOCUS DAR |
|
|
Term
|
Definition
Flow sheet
Charting by exception
Clinical pathway
Clinical care bundles |
|
|
Term
|
Definition
| Situation, Background, Assessment, Recomendation, (reporting to another nurse should include all these points |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Arterial blood Gas
Actual PaO2 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| IV started, check for signature, belongings, NPO status, x-rays/labs present, right sight |
|
|
Term
|
Definition
60 min before or less
discontinued after 24 hrs |
|
|
Term
|
Definition
| Adrete Score, Airway, Breathing, Temp, BP,RR, LOC, SpO2 sat, |
|
|
Term
|
Definition
Nothing by mouth,
Done pre op so their body spends energy healing rather than digesting.
Post op- if you don't hear bowl sounds. |
|
|
Term
|
Definition
|
|
Term
| the most sensitive noninvasice indicator of kidney failure is... |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
foley cath.
More perminent. |
|
|
Term
|
Definition
| drugs taken to stimulate the rectal area |
|
|
Term
| 4 kinds of wound drainage |
|
Definition
serous
serosanguinous
singninous
pirulent |
|
|
Term
|
Definition
primary-closed and aligned
secondary-bottom up
tertiary-leave it open for a while allow new tissue to grow. |
|
|
Term
|
Definition
|
|
Term
|
Definition
Inflammatory
*Hemostasis
*Inflammation
Proliferative
*Granulation
*Contraction
*Epithelialization
Remodeling
*New collagen scar tissue |
|
|
Term
|
Definition
| Protein/calories/vitimin C |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| neurological damage, stroke, muscle atrophy(elderly) |
|
|
Term
|
Definition
|
|
Term
| Risk factors for enteral feeding |
|
Definition
| aspiration, infection, skin breakdown, nausia, vomiting, hyperglycemia |
|
|
Term
|
Definition
|
|
Term
|
Definition
| a blood disorder consisting of a decrease in the volume of circulating blood |
|
|
