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1400 BP Final
| Question | Answer |
|---|---|
| Critical thinking is | intentional, contemplative, and outcome-directed thinking. |
| Critical thinking is required to use | the nursing process successfully |
| Critical Thinking means | careful judgement |
| Critical thinking involves | problem solving and decision making |
| First step in critical thinking | define the problem clearly |
| second step in critical thinking | consider all possible alternatives as solutions |
| third step in critical thinking | consider outcomes for each alternative |
| fourth step in critical thinking | predict likelihood of each outcome occuring |
| Last step in critical thinking | choose alternative with best chance of success and fewest undesirable outcomes |
| Skills for critical thinking | effective: reading, writing, communicating; attentive listening |
| Critical Thinking in Nursing Requires | skills and experience as well as knowledge and is influenced by professional standards and codes of ethics |
| Critical THinking assessment | organized and systematic, includes gathering and recording data |
| Critical thinking diagnosis | requires analysis of data gathered, clustering related information, identifying problem areas, and choosing appropriate nursing diagnoses |
| Critical Thinking Planning | involves determining specific desired outcomes for each nursing diagnosis |
| Critical Thinking Implementation | involves preparing for and performing the interventions |
| Critical Thinking Evaluation | involves gathering data to determine if expected outcomes have been achieved |
| Definition of the Nursing process | An organized sequence of problem-solving steps used to identify and to manage the health problems of clients. It is accepted for clinical practice established by the ANA. |
| Steps in the nursing process | assessment, diagnosis, planning, implementation, evaluation (ADPIE) |
| Assessment | the nurse collects pt health data |
| diagnosis | the nurse analyzes the assessment data in determining diagnoses |
| planning | the nurse identifies expected outcomes individualized to the pt |
| implementation | the nurse implements the interventions identified in the plan of care |
| evaluation | the nurse evaluates the pts progress toward attainment of outcomes |
| JCAHO requires that every client's medical record provide evidence of the | planned nursing interventions for meeting the clients needs. |
| The plan of care should be reviewed and updated once every | 24 hours |
| Documentation is part of which step of the nursing process? | Implementation |
| Evaluation includes clinical impressions and inferences regarding the pts progress toward expected | outcomes and the effectiveness of your interventions to bring these outcomes about. |
| If goals/outcomes are not being reached, the plan must be | revised (a continual process) |
| If goals are reached and the problem is resolved it is evaluated, signed off in the nurses notes as met and | removed from the plan of care. |
| Selecting nursing interventions | planning the measures that the client and nurse will use to accomplish identified goals involves critical thinking. |
| Nursing interventions are directed at | eliminating the etiologies |
| The nurse selects strategies based on the knowledge that certain nursing actions produce desired effects. Nursing interventions must be | safe, within the legal scope of nursing practice, and compatible with medical orders. |
| Priority setting (prioritizing) | placing nursing diagnoses/interventions in order of importance |
| high priority | life-threatening problems |
| medium priority | problems that threaten health or coping ability |
| low priority | problems that do not have a major effect on the person if not attended to that day or week |
| Prioritization of problems | problem ranked according to their importance |
| Physiologic needs for basic survival take | precedence. |
| After physiologic needs rare met, | safety problems take priority |
| Every nurse must attempt to look at each pt | holistically, keeping psychosocial needs in mind while working on physical probleems. |
| First stage of grief, Denial: | person refuses to acknowledge loss and pretends everything is okay, serves as a buffer to client to develop coping mechanisms. "No, not me" "there must be a mistake", will acquire more than one opinion. |
| Second stage of grief, Anger | Becomes angry with family, situations, staff, or God. May refuse treatment. "Why me" "leave me alone" |
| Third stage of grife, bargaining | pt wishes for more time to avoid loss, often bargains with god. trying to buy more time. if i promise to ___, them maybe i can life___, promises seldom kept |
| fourth stage of grief, depression | most common emotion, less talkative, feelings of sadness and grief-internal struggles about life and death. May attempt suicide. "nothing i can do", "whats the use?", begin to accept death. |
| fifth stage of grief, acceptance | loss is inevitable and may want to plan, peaceful acknowledgement of loss, struggle is over, hope continues in some, sometimes unrealistically, business is taken care of. |
| In America, death is viewed as | negative and unacceptable. |
| Americans tend to be more | youth and beauty oriented. |
| In other societies, death is viewed as | natural, normal event. |
| Death is | a real part of life, just as birth and aging. Inevitable. Final stage of growth and development. |
| Glargine (Lantus) ONSET | 2-4 Hours |
| Glargine (Lantus) PEAKS | NO PEAK |
| Glarging (Lantus) DURATION | 24 Hours |
| Type 1 diabetics are more prone to | hypoglycemia and ketoacidosis |
| Type 1 diabetes accounts for | 10% of all diabetics. Formally called Juvenile onset. Usually during the childhood years: 5-11y/o |
| Type 1 diabetes is where the pancrease produces | no insulin |
| Type 1 Diabetes Treatment: | Insulin injections, diet and exercise. MOre difficult to control. May be "Brittle" Develops more complications |
| Type 2 Diabetes (NIDDM) The pancreas produces some insulin but not in sufficient quantities. OR the cells of the body are not | receptive to insulin |
| Age of onset of NIDDM | 40, but may be as young as early teens. Now being detected in obese children |
| NIDDM is treated with | diet and exercise. 80% are obese and weight loss often corrects the imbalance. |
| Hypoglycemia is | low blood glucose level. Most times an adverse reaction to treatment of HYPERglycemia |
| Hypoglycemia happens when | too much insulin is in the bloodstream. Lvls fall below 60 mg/dL. Tumor of the beta cells of the pancreas or tumors of the liver, adrenal glands or intestines rapidly dumping carbs into upper intestine. |
| Hypoglycemia S/S | Confusion, difficulty processing info, anxious, irritable, HA, Hunger, |
| Hypoglycemia could lead to... | seizures, brain damage, death |
| Hypoglycemia occors when a person doesn't | eat but continues to take insulin or diabetic meds. Not eating enough cals to compensate for meds. Extensive Exercise. Alcohol consumption. |
| Normal blood sugar levels | 70-110 |
| Venous blood draw to detect Diabetes | lab draw, may be routine, may be to confirm low or high bs, may be random or fasting |
| Glycoslated hemoglobin (Hemoglobin A1C) | average of the glucose lvl for past 2-4 months. <7% good control >8% poor control |
| Oral glucose tolerance test | NPO for 8 hours prior. Fasting blood and urine. Glucose bolus is consumed (75-100g). Blood is taken at 30m., 1h,2h,up to 5h! Blood Glucose <140 is norm. >140 is impaired tolerance. >200 DIABETES! |
| Postprandial glucose test | pt will eat a meal of about 100g of carbs after overnight fast. two hours after meal, blood is drawn. l |
| Nursing conderations of postprandial glucose test | make sure pt eats at least 75% of meal. make sure the lab is on time drawing the blood. a blood sugar of >160 is positive for diabetes! |
| Capillary Blood | Finger sticks, allows for self-monitoring. Must be used by all diabetics. Testing times vary. Should be done more frequently with illness, surgery, stress, increased or decreased activity. |
| URINE TESTS | tests for SADs or sugar acetone determination. Not very accurate. Glycosuria and Ketonuria may not become evident until glucose exceeds renal threshold. Used to be the only way diabetics could monitor blood sugars. Will be very high in Hyperglycemia |
| Humalog, Novolog ONSET | 5-15mins |
| Humalog, Novolog PEAK | 1-2hrs |
| Humalog, Novolog DURATION | 3-4hrs |
| Diabetes is the sixth leading | cause of death by disease |
| Diabetic eye disease is the leading cause of | blindess. |
| Diabetics are 2-4 times more likely to die from | heart disease. |
| Theory of aging: Autophagocytosis | Portions of cells are consumed to reduce their size. During this process a brown colored reside called lipofuscin forms. This substance accumulates as ppl age. Cell shrinkage caused by autophagocytosis contributes to decreased weight height |
| GANGRENE | diabetes is the leading cause of foot and leg amputations |
| Oral hypoglycemic agents may increase the tissue response to | insulin |
| Complications of Diabetes | atherosclerosis, peripheral vascular disease, decreased wound healing, neuropathy, Kidney disease, stroke, |
| Theory of Aging: Stress response | Selye proposed that physical, psychological, and social changes produce biological stress. The defense mechanisms associated with the stress response eventually weaken, leading to death. |
| Sulfonylureas | promote insulin secretion by the pancreas. |
| NPH (Humulin N, Novolin N)ONSET | 1-1.5hrs |
| NPH (Humulin N, Novolin N)PEAK | 4-12hrs |
| NPH (Humulin N, Novolin N)DURATION | 24hrs |
| NPH (Humulin N, Novolin N) | intermediate acting |
| Usual insulin administration sites | upper outer portion of the arm, anterior surface of the thigh, or the abdomen |
| SubQ administration injects a small amout of medication (.5-1mL) into tissue below the | dermal layer into subq fat. |
| Size of SubQ needle | 25 or 27 gauge needle, 3/8 to 1/2 inch long |
| Angle of SubQ administration | a 45 or 90 degree angle is usd, depending on the amount of subQ tissue on the pt. |
| Insulin Pumps | deliver basal (all the time) and bolus when necessary. Consists of an extermal pump and tubing with asmall needle. Costly. |
| An insulin pump must be changed every | 2-3 days |
| Injection pens | preloaded cartridges with the prescribed dosse. |
| Exenatide (Byetta) is an injection pen and should be given | 1 hour before breakfast or dinner. one hour after oral hypoglycemic agents. |
| Aging theory: Faulty DNA Rep: DNA is suceptible to damaging agent such as free radicals which has the potential to scramble to code. The dmged DNA cannot program the continued, orderly synthesis of proteins. | When this happens repeatedly, fewer cells are capable of reproduction. Because billions of cells are damaged in the aging process, tissue disorganization occurs and leads to organ failure. |
| What is a FREE RADICAL you say? | Unstable atoms with excessive energy capable of damaging DNA molecules. it is possible that fre eradicals are responsible for changes in aging. Healthy cells resist the dmging effects of free radicals using chemicals. |
| Myth or fact? Old People are SICK | Myth |
| Myth or fact? Old people can't learn new things | Myth! |
| Myth or fact? Among older americans, the poverty rate is the highest at older ages. Nine percent of those 65-74y/o live in poverty, 12% of persons 74-85 live in poverty and 14% of those over 85 live in poverty. | Sad Fact :( |
| Myth or fact? Genetics are the main factor in longevity | Mythhhh |
| myth or fact? the pop of people over 85 is currently the fastest growing segment of the older population. | Fact! |
| Myth or fact? Most old people live in nursing homes and are isolated from their families | MYTH |
| Myth or fact? The HIspanic older population is expected to grow the fastest. | Fact |
| Myth or fact? old people aren't sexual! | MYTH! ew. |
| Myth or fact? Life expectancy has been extended for both sexes. Males can expect to 73 and females to 79 | FACCT |
| Myth or fact? It is too late for lifestyle changes to improve health | MYTH! |
| Myth or FACT? By 2030 one in five people will be over 65 | FACT. |
| Myth or fact? Old people are poor and unhappy and senile. | Myth. |
| Clusters of melanocytes form senile | lentigo (lentingines) most often referred to as "age spots" and are most often seen on areas of the body exposed to sunlight. |
| Older people have decreased bladder | capacity and tone. Loss of nephrons, decreased spinchter control. |
| Elder abuse is most often inflicted by | a spouse or adult children in the home and is often undetected. |
| Elder abuse is most often related to | caregiver stress, unresolved family conflicts, or families with a history of abuse. |
| Nursing responsibilities (elder abuse) | identify those at risk, assess signs and symptoms of suspected elder abuse, avoid a condescending tone of voice or judgemental expression, report to appropriate agency. |
| Self neglect is defined as | failure to provide for the self because of a lack of ability or lack of awareness |
| self neglect indicators | inability to obtain adequate food and liquid. Inability to maintain ADLS. POor hygiene. Changes in mental function. Inability to manage money. Failure to keep appointments. Suicidal acts |
| Even unintentional abuse is devastating to the older adult. it is most likely to occur when the caregiver lacks | the knowledge, stamina or resources needed to care for an older loved one. Stress builds, leaving the caregiver feeling trapped, frustrated or angry. |
| Physical Abuse | Any action that causes physical pain or injury |
| Neglect | a passive form of abuse in which caregivers fail to provide for the needs of the older person under their care (accounts for almost half of the verified cases of elder abuse) |
| Emotional abuse | verbal or non verbal. includes behaviors such as isolating, ignoring or depersonalizing older adults, or ignoring. |
| financial abuse | when the resources of an older person are stolen or misused |
| abandonment | occurs when dependent older persons are deserted by the person or persons responsible |
| Abusive behaviors in health care settings | use of sedatives, hypnotics, restraints, derogatory language, when not medically necessary, witholding privleges, excessive roughness, delays in bathroom break, eating their food, theft, striking, no privacy, |
| Changes in musculoskeletal include | Thinned intervertebral disks, decreased bone calcium, smaller muscle mass, less elastic ligaments and tendons |
| Changes in the Respiratory include | thickened alveolar walls, weakened respiratory muscles, decreased vital capacity. |
| Specific interventions for confusion and disorientation: | Validation Therapy (encourage activities), Reorientation, Reminiscence, REmotiviation, |
| Constipation is an effect of aging caused by | decreased bowel motility. bed rest. pain meds. poor diet. |
| S/S of constipation include | abdominal cramping or rectal pain, abdominal distention, the passing of small amounts of liquid stoole and loss of appetite. |
| Diet Remedies for Constipation | Hot water and lemon, prunes, bran, roughage fruits and veggies, encourage @least 2500mL of fluid/day, exercise, poo when you need to! impacted stool may require removal. |
| Preventing falls | assess meds. change positions slowly. use gait belt. educate to keep active. ensure proper arthritis and osteoporosis treatment. limit bed confinement. use assistive devices. low beds. call bell avail.brakes locked on w/c. clear paths. lights bright. c |
| Apical Pulse | located in the 5th left intercostal space, just outside the mid-clavicular line |
| Modifiable factors affecting CAD | Hyperlipidemia, Hypertension, Smoking, Diabetes Mellitus, Obesity, Sedentary lifestyle, alcohol intake, elevated homocysteine levels |
| nON-MODIFiable factors affecting CAD | Age, gender, genetics, race |
| Coronary Artery Disease occurs when major | coronary arteries supplying the myocardium are partially or completely blocked |
| CAD is usually caused by | arteriosclerosis or atherosclorsis which can affect blod vessels in ANY organ or tissue. |
| Arteriosclerosis | An abnormal thickening, hardening and loss of elasticity of arterial walls. Lipis, cholesterol, calcium and thrombi adhere to damaged arterial walls decreasing blood flow and decreasing the oxygen carrying capability of blood... PLAQUE. |
| Atherosclerosis | Form of arteriosclerosis in which thickening and hardening of the vessel wall are caused by soft deposits of fat and fibrin that harden over time. |
| Affects of nervous system on the heart | The autonomic nervous system affects heart rate through sympathetic and parasympathetic nervous system innervation. |
| Sympathetic Nerve Fibers | Adrenergic neurotransmitters (norepinephrine and epinephrine) excite SA and AV nodes increasing heart rate. ALSO the Beta-adrenergic receptors in the atria and ventricles which increase contraction force. |
| Parasympathetic Nerve Fibers | Release Cholinergic neurotransmitter acetylcholine and slow down the heart rate. |
| aFTERLOAD | amount of pressure ventricles most overcome to eject the blood volume it holds |
| Cardiac Output | Amount of blood pumped out of the left ventricle in one minute normally 4-8 L/min. Heart rate x Stroke Volume = Cardiac Output |
| LUB is the first heart sound and is referred to as | S1 and it is the closing of the mitral and tricuspid valves |
| DUB is the second heart sound and is referred to as S2 it is the closing of the | aortic and pulmonic valves |
| ventricular gallop or S3 | abnormal sound that follows s1 and s2 |
| atrial gallop or s4 | abnormal sound that comes before s1 |
| Electrical conduction of the heart | Polarization then depolarization and then repolarization. |
| polarization | negative state inside myocardial cells |
| depolarization | Positive state inside myocardial cells |
| repolarization | Cells return to normal until the next stimulus is sent. |
| prehypertension | systolic 120-139 and diastolic 80-89 |
| Documenting the pulse | Rhythm: pattern of pulsations and the pauses between them. Quality: Palpated Volume. Full, Weak, or Thready. and Rate |
| Oral Hypoglycemic: Second GEn Sulfonylureas (glimepiride, glipizide, glyburide) | stimulates insulin release, are more potent than first gen sulfonylureas |
| Oral Hypoglycemic: Alpha-Glucosidase (acarmose, miglitol) | Delays digestion of carbs, effects are additive to sulfonylureas in type 2s |
| Oral Hypoglycemic: Biguanide Compound (Metformin) | Improves use of insulin in type 2s |
| Oral Hypoglycemic: Thiazolidinediones (Avandia, actos) | increases effects of circulating insulin |
| Oral Hypoglycemic: Meglitinides (Prandin) | Stimulates insulin release |
| Oral Hypoglycemic: Januvia | Increases effects of incretin; prolongs the release of insulin and reduces production of glucose by the liver. |
| Oral Hypoglycemic: Byetta | mimics incretin |
| Oral Hypoglycemic: Symlin | Mimics amylin; lowers blood sugar especially after meals' slows move-of food from stomach |
| Oral Hypoglycemic: metformin and sitagliptin | combo product for use as adjunct to diet and exercise to improve glycemic control in adults with type 2 when mono-therapy is not controlling levels. |
| Pancreas Transplant is for who? | Type 1 Diabetics Only. Requires lifeong immunosuppressive drug therapy. |
| Mixing Insulin | Clear to cloudy. Administered within 15 minutes! |
| Diabetic Ketoacidoses | a type of metabolic acidosis occurs when there is an acute insulin deficiency or an inability to use whatever insulin the pancreas secretes. |
| Cancer warning signs: 1. a change in bowel habits or bladder function. 2. Sores that do not heal. 3. Unusual bleeding or discharge. | 4. Thickening or lump in the breast or other body parts. 5. Persistent indigestion or difficulty swallowing. 6. A change in a wart or mole. 7. A persistent nagging cough or hoarseness. |
Created by:
christinego
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