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Final Exam Reveiw

Name three consequences for the lack of trans-cultural awareness A. incorrect nursing judgments B. Inappropriate teaching C. Unsafe interventions
How does an individual acquire culture Learn it
Define stereotype A fixed concept of how all members of an ethic group act or think
how do individuals learn values by observing behavior and the response it evokes
define culture social characteristics of a specific group passed from generation to generation
how do you treat the patient's religious beliefs with respect
what do you do if you determine that a cultural health practice is harmful to the patient explain the hazards of continuing the practice
if you don't answer call lights promptly, what can you be accused of negligence
define malpractice an act of negligence by a professional
define libel written defamation of a person
define slander verbal defamation of a person
define accountability being responsible for your own actions
define battery assault that is carried out or commission of bodily injury or contact without consent
Which organization has priority in limiting the LVN's duties and responsibilities Hospital policy and procedure
Duties of the admission nurse include A. Explaining visiting hours and rules B. Explaining the environment and hospital activities C. Explaining communication systems
what are the guidelines used to judge whether a nurse is providing competent care Standards of Care
Who makes the rules and regulations concerning nursing practices BVNPT (Board of Vocational Nurse and Psychiatric Technician Examiners)
What is the nurse's best protection against malpractice Reasonable prudent care
Forgetting to give medication to the patient is an example of what type of negligence Malpractice
The MD has signed the D/C (Discharge) order for you patient. Your patient must: Meet all nursing care plan objectives
List 3 facts about patient charts A. It is a legal document B. It is a permanent record C. It is a property of the hospital
what does a nurse's ethical code do Provide standards of conduct
When a patient is admitted without medical orders or the nurse has problems transcribing the MD orders, what must the nurse do Call the doctor
In terms of privacy, can the nurse or the patient lock the bathroom door No
What does the Good Samaritan Act do protects you from liability if you render prudent (careful) care at the scene of an accident
Define and give examples of objective data Info that's verifiable, measurable, uses senses ie. (V.S. Facial Expressions)
Define NCP and tell me what the NCP is based on a guide for nursing care NCP is Based on assessment data
in what phase of the nursing process is documentation found Implementation
Name one of the primary purposes of the BCP and pt. chart Communication; legal record
When (under what circumstances) do you write a nurse's note (ie DAR, SOAP, narrative note) A. whenever pt's condition changes B. to address problems on NCP C. to address main DX
define planning part of the nursing process that involves setting priorities & realistic goals
Define intervention activity performed by nurse that should promote/achieve desired pt outcome
Differentiate between Dependent&Independent nursing measures A. Dependent: requires MD Rx- Meds, heating pads B. Independent: no MD Rx required- position change, assess, vital signs
Maslow's Hierarchy of Needs Physiological, Safety and Security, Love and Belonging, Self-esteem, Self-actualization
Implementation implementations is part of the nursing care plan in which nsg, actions are carried out
Subjective Data symptoms, facts, perception, or sensation apparent only to the person affected
Three rules of writing patient goals patient centered, measurable/ observable, realistic and time oriented
the components of the nursing process is; assessment, Dx, expected outcome, Planning and implementation, evaluation
which steps in the nursing process are identified with patient problems Expected Outcome
Risk for skin impairment r/t surgical procedure, What does r/t mean? Related to
Define assertibeness Ability to stand up for one's self and one another using open/honest communication; not violating others right
which of the five senses is the last to leave the body of a dying pt Hearing
The most effective thechniques to facilitate communication is Listnening
how do you verify that your message has been accureately rec'd listen for feedback
Establishing a trusting relationship w/your pt is based on Maintaining cofidentiality
what kind of a respose can you expect to get if you ask "closed" questions Yes/No
Define Empathy Identifying with person's feelings/problems
Define sympathy actual feeling of regret or sorrow for pt's plight
success of interdisciplinary approach to health care depends MOST on Effective communication
What are the four parts of the communication process Sender, Msg, Receiver, Feedback
Name the two types of communication verbal and non-verbal
Define nososcomial infection a facility-acquired infection
Chain of infection (definition) a process that begins when an agent leaves its reservoir or host through a portal of exit, and is conveyed by some mode of transmission, then enters through an appropriate portal of entry to infect a susceptible host
Infectious agent micro organism capable of producing an infection
Reservoir where micro organism resides, it can be a food or water source also a human source
Portal of exit in order for agent to establish infection, it must leave reservoir like: nose, mouth, open wounds, etc.
mode of transmission micro organism travels to another host
Chain of infection Reservoir-portal of exit-means of transmission-portal of entry-host
Portal of entry infectious agent enters body of susceptible host (a person who is susceptible to an infection)
Standard of precautions treat each patient as if they were infectious (break the chain of infection)
Surgical Asepsis keeping work area sterile and free of all pathogens including spores
Medical Asepsis keeping work area clean and free of most pathogens
pathogens pathogens are microorganisms causing diseases
Prodromal Period the most infectious stage of infection, the beginning of the appearance of signs and symptoms
Dysuria painful or difficult urination
Bulimia excessive and unstable appetite binging and purging
Gastritis inflammation of lining of stomach
Oliguria scanty urine output
Emesis vomiting
Polyuria Excessive out put of urine
Peristalsis Wave-like contraction of intestinal muscles to move contents of GI tract
Hematuria blood in urine
Cystitis Inflammation of bladder
Retention inability to empty the bladder
Flatulence excessive intestinal gas
Jaundice yellowing of tissue bilirubin in blood
micturation urination
During an enema, your pt c/o abdomen cramping, what do you do? lower solution container, have pt relax and then continue
what are the four segments of the large intestine Ascending, descending, transverse, and sigmoid colons
list two terms of urination voiding and micturation
what changes occur in the digestive system of the aging person decreased thirst mechanism, decreased taste, decreased peristalsis, all leading to constipation
what measure is most frequently ordered for pt's with fecal impaction oil retention, enema
what method is usually used to collect a "clean catch" us Mid-stream sampling
name some normal constituents of feces bacterial, bile
name some abnormal constituents of feces blood, worms
List four activities that cause stress incontinence laughing, coughing, sneezing, lifting
name two important nsg measures for pt's with indwelling cath clean around meatus, keep drainage bag below bladder
what is the purpose of digital disimpaction to break up fecal mass
BRP bathroom privileges
F/C foley cath
UA urinalysis or urine
What's the abbreviation to describe defecation BM
the purpose of maintaining a wide base of support is to provide stability & balance
Define adduction lateral movement of body part toward the midline
define abduction lateral movement of body part away from midline
How high is the HOB elevated for semi-Fowler's 30-45%
Define body mechanics The efficient use of the body
what does a trochanter roll do prevents external rotation of legs
name three positions used for rectal exam A. Sims B. Lithotomy C. Knee-Chest
Which organ is quickly affected by lying in one position for a long time Lungs
Contracture a permanent shortening muscle
When a patient is having dyspnea (shortness of breath) position them _________ sitting up
prone position lying on the abdomen
A mechanical lift & a draw sheet helps you transfer a dependent pt from bed to Guerney
Decubitus Ulcer lack of circulation over bony prominence
why do we bend our knee's when lifting prevent injury to our back
Define atrophy decreased in size and decreased in strength of muscle
Define Erythema redness of skin
Necrosis tissue death due to the lack of oxygen
Dorsiflexion turning sole of foot upward
Plantar Flexion aka foot drop; sole of foot downward
ROM range of motion
Hypoxia (Hypo + Oxygen) decreased levels of oxygen to tissue
Difference between Active and passive ROM Active: pt does exercise Passive: Nurse assists wit exercise
Define edema fluid in the tissues; swelling r/t fluid in the tissues
Define Atelectasis incoplete expansion or collapse of lung
Define ascites accumulation of fluid and protein in the peritoneal cavity
Define cerumen ear wax
Define disoriented unaware of time, place or identity
Define auscultation listening for sounds within the body
Define sputum secretions from the respiratory tract (not saliva)
Define turgor skin elasticity
Define ecchymosis bruise, bleed under skin
Define cynotic blue due to the lack of oxygen
what color should the skin and mucus membranes be pink
what color of skin and mucus membranes is reportable STAT Dusky and bluish
Percussion and the chest/back to asses the lungs is done to check for what Fluid in the lungs
how can you help your pt increase his fluid intake offer fluid between meals
in what position should the pt be in to eat fowlers
most important source of calcium Milk
name all five food groups in the food pyramid Grains, vegetables, fruit, milk, meats&beans
ac before meals
pc after meals
the main source of energy comes from what nutrient carbs
I/O intake and output
be able to compute fluid intake 1 0z= 30 ml
why are clear and full liquid diets inadequate too few calories
who's responsible for making notations q d re; what pt eats nurse
S/Sx of malnutrition irritability, poor muscle tone/skin turgor, malises, weakness
give examples of clear liquids water, jello
cc cubic centimeter
what's monitored when pt is on strict output Ua, emesis, liquid BM, drainage
The key to maintaining a good nutritional diet is eat a variety of foods
BMR basal metabolic rate
what's restricted on a low calorie diet carbs
Define ischemia decreased blood flow in to an area
what nursing activities are appropriate for patients with edema assess skin, weigh daily, and monitor I&O
what is the first priority in the ER assess breathing
you find a patient on the floor (fell) what do you do first quick assessment to determine nursing interventions
Define STAT immediately
Created by: CesarP