everything
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | What are the techniques in interviewing process.
Problem Seeking & Problem Solving, Direct & Open-Ended Questioning
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| show | What are the three phases of a basic interview.
Orientation, Working, and Termination Phase
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| show | What is the first step in nursing assessment.
Nursing Health History
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| show | Basic components of the nursing health history.
Bio. Info.
Reasons for seeking hxcare
Pt. expectations
Past Hx
Hospitalization
Treatment
Outcomes
Family
Environmental
Psychosocial
Present Hx State & R.O.S.
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| What is the focus of nursing history. | show 🗑
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| A statement of potential or actual patient problems. | show 🗑
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| show | Nursing diagnostic involves four elements.
Analysis & Interpretation of data, Clustering of Data, Identification of Pt. Problems, Formulation of Nsg. Dx.
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| show | It requires validation and clustering of data.
Interpretation of data
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| show | Determining whether data gathered is complete and accurate.
Validation of data
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| Grouping related data, usually sx & sy, indicating a general problem. | show 🗑
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| show | A hx care problem that is currently perceived by the pt. or assessed by the nurse.
Actual Hx Care Problem
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| show | A hx care problem in which the patient is at risk.
Potential Hx Care Problem
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| show | When planning, a nurse should consider the level of potential pt. involvement, time limit and what?
Available Hx care system resources
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| In implementation of the NCP, what actions are taken. | show 🗑
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| Interventions based on instructions or written directives given by another professional. | show 🗑
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| show | Aspects of care encompassed by licensure and law.
Independent Intervention
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| Interventions that the nurses carry out in collaboration with another professional. | show 🗑
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| show | True or False. The NCP is modified as the Pt's state of Hx changes and as needs for care changes.
True
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| show | In evaluation of NCP, outcomes of nursing interventions maybe used for.
Malpractice suits
Staff Evaluations
Reviews
Promotions
Nursing Research
Quality Improvement
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| What are the enrivonmental fire safety precautions? | show 🗑
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| show | What are environmental radiation safety precautions?
Label radioactive materials
Limit time spent
Distance yourself from the source
Use lead apron
Never touch dislodged implants
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| show | What are environmental precautions for disposing infectious wastes?
Needles should not be recapped, bent or broken
Yellow for infectious
Green for biodegradable
Black for nonbiodegradable
Red for blood, sharp items, contaminated
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| show | It is to restrict client movement through the application of a device?
Physical restraints
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| Medications given to inhibit specific behavior? | show 🗑
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| show | Restraints should have?
Reason & method
Date & time of use
Duration & release from it
Assessment of pt's response & further need of use
Half bow or safety knot & secured to the bedframe or chair
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| Restraints should not be? | show 🗑
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| show | Neurovascular, circulatory & skin integrity is assessed in using restraints when?
Then removed at least every?
Every 30 minutes
Removed @ least q 2 hrs. to promote circulation
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| show | Who are those prone to accidental poisoning?
Toddlers
Preschoolers
Young school age
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| show | In older adults, poisoning & overdose of prescribed medz. will yield?
Diminished eyesight
Impaired memory
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| If lye, grease, petroleum or household cleaner is ingested, a nurse should? | show 🗑
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| Nosocomial infections can be transmitted by a healthcare personnel by? | show 🗑
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| Standard precautions apply to? | show 🗑
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| show | Diseases under transmission based precautions are?
Measles
Chickenpox (varicella)
Disseminated varicella zoster
T.B.
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| show | Droplet precautions diseases are?
Adenovirus, Influenza
Sepsis, Scarlet Fever
Epiglottitis, Mumps
Meningitis
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| Barrier protection for transmission based droplet precautions is? | show 🗑
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| Transmission based contact precautions diseases are? | show 🗑
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| Smallpox is a droplet type with S&S of fever, back pain, vomiting, malaise, headache & papules that turn into? | show 🗑
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| show | In case of fire, a nurse should
R-rescue
A-alarm
C-confine
E-extinguish
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| show | Head tilt-chin lift is used in B.L.S. but if pt. has a neck injury, what do you use?
Jaw thrust maneuver
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| A.B.C.D.'s of B.L.S. are: | show 🗑
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| show | Apical & radial pulse will always yield?
Identical result
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| show | In assessing for a pulse to an
infant < 1 yr old?
a child > 1 yr old?
Brachial (<1yr)
Carotid (>1yr)
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| For infants on B.L.S., chest compression is 1/2 - 1 inch deep @ least 100 times/min using? | show 🗑
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| show | When performing a Heimlich Maneuver to an obese or pregnant, what do you do?
Chest thrusts
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| For unconscious adult (B.L.S.), you do a? | show 🗑
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| For unconscious pregnant, a pillow or rolled blanket is placed on the right side to? | show 🗑
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| Unconscious pregnant needing defibrilation should have the paddles placed 1-rib higher than the usual because? | show 🗑
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| show | This is used to convert ventricular fibrilation into a perfusing rhythm?
Automated External Defibrillator
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| Automated External Defibrilator is C/I to? | show 🗑
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| show | A surgeon is responsible for getting consent & a nurse can be a witness provided the pt. understood the procedures explained by the doctor. What is the next step?
Document the witnessing of consent signing
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| In general anesthesia, solid & liquid foods are withheld for? | show 🗑
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| When is enema or laxative performed in clients for surgery? | show 🗑
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| If client has a Foley catheter before surgery, it should be emptied & document the? | show 🗑
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| 3 levels of moral development (premoral or preconventional level, conventional level, postconventional level). | show 🗑
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| show | 4 conservation principles (conservation of energy, structural integrity, personal integrity, and social integrity).
Myra Levine
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| 4 types of personality (sanguine, melancholic, phlegmatic, choleric). | show 🗑
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| 5 hierarchy of needs (physiological, safety & security, love & belonging, self esteem, self actualization). | show 🗑
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| show | Adaptation model. Each person is a unified biopsychosocial system in constant interaction with changing environment.
Sister Calista Roy
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| show | All behavior is learned.
B.F. Skinner
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| show | Believed that nurse helps patients meet a perceived need that the patient cannot meet themselves.
Ida Jean Orlando
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| Birth trauma. | show 🗑
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| show | Care, Core, Cure.
Lydia Hall
🗑
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| Cognitive development (sensorimotor, peri-operational thought, concrete operations, formal operations). | show 🗑
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| show | Conceptualized the behavioral system model. Each person is composed of 7 subsystem (ingestive, eliminative, affiliative, aggressive, dependence, achievement and sexual).
Dorothy Johnson
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| show | Developed self-care and self-care deficit theory.
Dorothea Orem
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| Developmental task. | show 🗑
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| show | Focused on manipulating the environment for the patient's recovery.
Florence Nithingale
🗑
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| show | Founded psychobiology. Believes in totality of man/holistic approach.
Adolf Meyer
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| show | Goal attainment theory. Nursing as a helping profession.
Imogene King
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| show | Health as expanding consciousness. Humans are unitary beings in whom disease is a manifestation of the pattern of health.
Margaret Newman
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| Health care system model. Nursing is concerned with all the variables affecting an individual's response to stress, which are interpersonal, intrapersonal, and extrapersonal in nature. | show 🗑
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| Human becoming. Emphasized free choice of personal meaning in relating value priorities. | show 🗑
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| Human caring model. Nursing is the application of the art and human science through transpersonal caring. | show 🗑
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| Humanistic nursing practice theory. Nursing is an existential experience. | show 🗑
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| show | Identified 14 basic needs. Nurse functions to assist client in performing activities contributing to health, recovery, or peaceful death.
Virginia Henderson
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| show | Identified 21 nursing problems. Defined nursing as service to individuals and families, therefore, society.
Faye Abdellah
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| show | Interpersonal model. Nursing is an interpersonal process of the therapeutic interactions between sick and nurse.
Hildegard Peplau
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| show | Interpersonal theory (anxiety occurs due to poor interpersonal relationship).
Harry Stack Sullivan
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| Introversion and extroversion - persona/anima | show 🗑
|
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| show | Modeling and role-modeling theory.
Helen Erickson, Evelyn Tomlin & Mary Ann Swain
🗑
|
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| show | Nurse's individual philosophy lends credence to nursing care.
Ernestine Weidenbach
🗑
|
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| Presented grand theory of nursing. All persons are caring and nursing is a response to unique social call. | show 🗑
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| show | Psychosexual theory (oral, anal, phallic, latent, genital stage). Psychoanalytical theory (Libido is the psychic reservoir of psychic energy, id, ego, & superego).
Sigmund Freud
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| Psychosocial development (trust vs. mistrust, autonomy vs. shame/doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role confusion, intimacy vs. isolation, generativity vs. stagnation, integrity vs. despair). | show 🗑
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| Superinferiority and inferiority complex / birth order. | show 🗑
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| show | The science of unitary human beings. Human beings are more than and different from the sum of their parts.
Martha Rogers
🗑
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| Theory based on bodily characteristics (endomorphic, mesomorphic, ectomorphic). | show 🗑
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| Transcultural nursing. Nursing is a humanistic and scientific mode of helping a client through specific cultural caring process. | show 🗑
|
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| show | Pulsating abdominal mass
Abdominal Aortic Aneurism
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| show | Painful board-like abdomen
Abruptio Placenta
🗑
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| show | Uremic frost on skin
Acute Renal Failure
🗑
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| show | Bronze pigmentation of skin
Addison's Disease
🗑
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| Outburst laughter or cry fasciculations | show 🗑
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| Pain upon exertion | show 🗑
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| Mc Burney's sign | show 🗑
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| Boutonnier deformity, swan neck deformity, ulnar drift, Bouchard's nodes | show 🗑
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| Murmur heard high on chest | show 🗑
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| show | Rocking, spinning, routines
Autism
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| Grayish white discharge, malodorous | show 🗑
|
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| show | Raccoon's eye
Basilar Fracture
🗑
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| Meconium staining | show 🗑
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| show | Russel's sign, binge eating
Bulimia Nervosa
🗑
|
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| Cherry pink flushed face | show 🗑
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| Jack hammer syndrome | show 🗑
|
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| show | Cloudy vision
Cataract
🗑
|
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| Gluten sensitivity, water, pale, foul smelling stool | show 🗑
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| Maculopapulovesiculo rash | show 🗑
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| Rice water stools | show 🗑
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| Pulling up of arms & legs, red-face crying | show 🗑
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| show | Barrel chest, clubbing of fingers
C.O.P.D.
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| Moon face, buffalo hump | show 🗑
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| Homonymous hemianopsia | show 🗑
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| Feeling of fullness at vagina | show 🗑
|
||||
| show | Recent and past memory defect
Delirium
🗑
|
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| Recall or learning memory impairment | show 🗑
|
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| Flashes of light, vein in line of sight | show 🗑
|
||||
| show | 3 P's: polydipsia, polyphagia, polyuria
Diabetes Mellitus
🗑
|
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| show | Pseudomembrane
Diptheria
🗑
|
||||
| show | Cramping, colicky pain in left lower abdominal quadrant
Diverticular Disease
🗑
|
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| Saddle nose, Brushfield's spot's (Trisonomy 21) | show 🗑
|
||||
| show | Ortolani's sign, Galeazzi's sign, asymmetry of gluteal, popliteal & thigh folds
Dysplasia of Hip
🗑
|
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| Cullen's sign | show 🗑
|
||||
| Premenstrual pain decreasing as menstrual flow decreases | show 🗑
|
||||
| show | Exposed bladder, appears to be turned inside out
Exstrophy of Bladder
🗑
|
||||
| show | Radar gaze
Failure to Thrive (FTT)
🗑
|
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| show | Barret esophagus
G.E.R.D.
🗑
|
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| Halos around light | show 🗑
|
||||
| show | Dysuria, genital discharge
Gonorrhea
🗑
|
||||
| Exopthalmia | show 🗑
|
||||
| show | Hemarthrosis
Hemophilia
🗑
|
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| Asterixis | show 🗑
|
||||
| show | Ribbon-like, foul smelling stool
Hirschprung's Disease (megacolon)
🗑
|
||||
| show | Grapelike growth, large abdomen
H-mole
🗑
|
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| Bossing's sign, setting sun eyes | show 🗑
|
||||
| Trousseau's sign | show 🗑
|
||||
| High pitch cry | show 🗑
|
||||
| show | Doll's eye
Increased Intraoccular Pressure
🗑
|
||||
| show | No passage of meconium
Intestinal Obstruction
🗑
|
||||
| show | Dance sign, currant jelly-like stool, sausage like
Intussesception
🗑
|
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| Activity intolerance | show 🗑
|
||||
| Strawberry tongue | show 🗑
|
||||
| show | Red gelatinous sputum
Kleibsella Pneumonia
🗑
|
||||
| XXY in males | show 🗑
|
||||
| show | Pulmonary manifestations (i.e. orthopnea, crackles, cyanosis, etc.)
Left Ventricular Heart Failure
🗑
|
||||
| show | Less than 2.5 kgs or 5 1/2 lbs
Low Birth Weight
🗑
|
||||
| show | Red-ringed circular rash (erythema chronicum migrans)
Lyme Disease
🗑
|
||||
| show | Blackwater fever
Malaria
🗑
|
||||
| Whirling, vertigo, tinnitus | show 🗑
|
||||
| show | Kernig's sign, Brudzinki's sign
Meningitis
🗑
|
||||
| show | White "cheesy" discharge
Moniliasis
🗑
|
||||
| Gower's sign | show 🗑
|
||||
| show | Charcot's triad: intention tremor, nystagmus, scanning speech (clipped)
Multiple Sclerosis
🗑
|
||||
| show | Nasal smile
Myasthenia Gravis
🗑
|
||||
| show | Nonproductive that progresses to mucoid sputum
Mycoplasmal Pneumonia
🗑
|
||||
| show | Viselike or crushing pain radiating to shoulder, arms, jaw or back
Myocardial Infarction
🗑
|
||||
| Purulent conjunctivitis (N. Gonorrhea) | show 🗑
|
||||
| show | White patches on tongue (Candida Albicans)
Oral Thrush
🗑
|
||||
| Kyphosis | show 🗑
|
||||
| show | Ringing or buzzing
Otosclerosis
🗑
|
||||
| Steatorrhea | show 🗑
|
||||
| show | Machinery-type murmur throughout the heartbeat in the left 2nd or 3rd interspace
Patent Ductus Arteriosus
🗑
|
||||
| Pill rolling | show 🗑
|
||||
| show | Abdominal muscle rigidity with rebound tenderness
Peritonitis
🗑
|
||||
| Beefy red tongue | show 🗑
|
||||
| show | Paroxysmal cough ending with a whoop
Pertussis
🗑
|
||||
| Nikolsky sign | show 🗑
|
||||
| show | Fever, vaginal discharge, lower abdominal cramping
Pelvic Inflammatory Disease (PID)
🗑
|
||||
| show | What is the purpose of IV fluid therapy?
Maintenance, to replace or correct deficits, to restore ongoing loss, for meds, nutrition, phlebotomy, transfusions or blood product therapy.
🗑
|
||||
| What is oncotic pressure? | show 🗑
|
||||
| show | What is hydrostatic pressure?
Blood pressure
🗑
|
||||
| What is normal serum osmo? | show 🗑
|
||||
| show | What can expand the intravascular compartment?
Hypertonic fluids.
🗑
|
||||
| What is the problem with using hypertonic fluids? | show 🗑
|
||||
| What is a S/sx of fluids administered too fast? | show 🗑
|
||||
| What happens if you expand the intra Cellular compartment too fast? | show 🗑
|
||||
| show | What are the two basic types of parenteral fluids?
Crystalloid and Colloid
🗑
|
||||
| show | What is a crystalloid fluid?
An Electrolyte containing solution.
🗑
|
||||
| show | What are the three basic types of crystalloid fluids?
Isotonic, Hypotonic and Hypertonic
🗑
|
||||
| show | Why are crystalloid fluids called true solutions?
Because they can pass through semipermeable membranes.
🗑
|
||||
| show | What is a Colloid fluid?
Contains proteins and starches.
🗑
|
||||
| show | What can't a Colloid fluid do?
Pass between compartments. They draw the fluid to them.
🗑
|
||||
| Name three problems with IV fluid therapy. | show 🗑
|
||||
| What three things can an LVN NOT do? | show 🗑
|
||||
| What can an RN NOT do with a central line. | show 🗑
|
||||
| How do you determine whether it is a central line or a peripheral line? | show 🗑
|
||||
| Name some isotonic fluids | show 🗑
|
||||
| Why do you need to be careful with LR and dehydration? | show 🗑
|
||||
| show | What does the liver do to lactate? (LR)
It metabolizes the lactate to bi-carbonate which buffers acidosis
🗑
|
||||
| show | What are two common uses for Normal Saline (NS)?
To treat hyponatremia and intravascular dehydration.
🗑
|
||||
| show | Name a Hypotonic solution?
0.45 NS ( 1/2 NS)
🗑
|
||||
| What is a problem with Hypotonic solutions? | show 🗑
|
||||
| show | What makes Hyper tonic fluids different than the others?
It has more dissolved particles than body fluid.
🗑
|
||||
| What does a hypertonic fluid do? | show 🗑
|
||||
| What are hypertonic fluids used for? | show 🗑
|
||||
| What is dangerous about hypertonic dextrose saline solutions? | show 🗑
|
||||
| What is a hypertonic dextrose saline fluid solution used for? | show 🗑
|
||||
| show | What type IV line do you use with Hypertonic dextrose saline?
10% solutions can go peripheral but all others 20% and above must use a central line?
🗑
|
||||
| Why must most hypertonic dextrose saline solutions be used with a central line? | show 🗑
|
||||
| show | How do you infuse hypertonic dextrose saline solutions?
You must use an infusion pump.
🗑
|
||||
| show | Plasma expanders are not considered what?
Blood products.
🗑
|
||||
| What do you NOT have to do with plasma expanders? | show 🗑
|
||||
| Which of the two main categories of fluids do plasma expanders fall into? | show 🗑
|
||||
| show | What are Colloids used for?
Maintenance of blood volume, hypovolemic shock, dialysis.
🗑
|
||||
| show | In which patients do you need to use colloid product with cautiously?
renal insufficiency and CHF
🗑
|
||||
| show | PPN is used in what type of line?
Peripheral
🗑
|
||||
| TPN is used in what type of line? | show 🗑
|
||||
| What are the components of TPN? | show 🗑
|
||||
| TPN usually come in a _____hour supply. | show 🗑
|
||||
| Name some indications for TPN. | show 🗑
|
||||
| show | How do you know TPN is working?
By weighing daily.
🗑
|
||||
| What is the consideration with IVs and glucose? | show 🗑
|
||||
| show | What should you monitor with TPN?
I & O, weight, liver and renal function and electrolytes.
🗑
|
||||
| Why do you monitor liver and renal function with TPN? | show 🗑
|
||||
| Why do you use a micron filter with TPN? | show 🗑
|
||||
| Why do you taper TPN? | show 🗑
|
||||
| Can you run other things in the TPN IV tubing? | show 🗑
|
||||
| show | What is an important consideration with albumin?
May cause anaphylaxis
🗑
|
||||
| What are some potential complications with TPN? | show 🗑
|
||||
| Nursing process | show 🗑
|
||||
| show | Decision making process
identify purpose, set criteria, weigh criteria, seek alternatives, examine alternatives, project, implement, evaluate
🗑
|
||||
| Assessing | show 🗑
|
||||
| show | Diagnosing
analyze data, identify risks & strengths, formulate diagnostic statements
🗑
|
||||
| show | Planning
Prioritize,formulate goals and outcomes,select interventions, write orders
🗑
|
||||
| Implementing | show 🗑
|
||||
| show | Evaluating
compare data to outcomes, draw conclusions, modify care plan
🗑
|
||||
| subjective data | show 🗑
|
||||
| show | objective data
signs detectable to observer
🗑
|
||||
| directive interview | show 🗑
|
||||
| Non directive interview | show 🗑
|
||||
| show | Cephalo caudal approach
head to toe approach
🗑
|
||||
| show | Maslow's Theory
hierarchy of needs
🗑
|
||||
| validation | show 🗑
|
||||
| show | cues
what pt. says or nurse sees
🗑
|
||||
| inferences | show 🗑
|
||||
| diagnosis | show 🗑
|
||||
| risk factors diagnosis | show 🗑
|
||||
| show | wellness diagnosis
readiness for enhancement of wellness
🗑
|
||||
| show | possible diagnosis
evidence is incomplete
🗑
|
||||
| show | syndrome diagnosis
associated with a cluster of other diagnoses
🗑
|
||||
| show | diagnostic 3 part statement
PES
🗑
|
||||
| show | Problem
statement of clients response
🗑
|
||||
| Etiology | show 🗑
|
||||
| Signs and Symptoms | show 🗑
|
||||
| show | nursing intervention
any treatment based on clinical judgment that a nurse performs
🗑
|
||||
| show | formal care plan
written or computerized guide
🗑
|
||||
| informal care plan | show 🗑
|
||||
| standardized care plan | show 🗑
|
||||
| show | individualized care plan
tailored for specific pt.
🗑
|
||||
| show | Nursing Care Classification (NOC) standardized nursing language indicator
concrete observable state of behavior
🗑
|
||||
| Using Silence | show 🗑
|
||||
| show | Sitting quietly (or walking with PT) and waiting attentively until client is able to put thoughts and fments or questions that (a) encourage the client to verbalize, (b) choose a topic of conversation, and feelings into words
Using Silence (example)
🗑
|
||||
| show | Providing general leads
Using statements or questions that (a) encourage the client to verbalize, (b) choose a topic of conversation, and facilitate continued verbalization.
🗑
|
||||
| show | "Perhaps you would like to talk about..." ; "would it help to discuss your feelings?"; "and then...."; "I know what you are saying"
Providing General leads (example)
🗑
|
||||
| Using specific and tentative | show 🗑
|
||||
| show | "You scratched my arm" instead of "you are clumsy as an ox" OR "you seem concerned about mary" rather than "you don't care about mary"
Specific & Tentative (examples)
🗑
|
||||
| Open-ended question | show 🗑
|
||||
| show | "I'd like to hear more about that"; "What brought you to the hospital today?"; "you said you were frightened yesterday, how are you feeling today?"
Open-ended question (example)
🗑
|
||||
| show | Using Touch
Providing appropriate forms of touch to reinforce caring feelings.
🗑
|
||||
| show | Putting arm over client's shoulder OR placing hand over client's hand
Using touch (example)
🗑
|
||||
| Restating | show 🗑
|
||||
| Client: "I couldn't manage to eat any dinner last night- not even dessert" Nursing- "you couldn't manage to eat any dinner last night- not even dessert?" | show 🗑
|
||||
| Paraphrasing | show 🗑
|
||||
| Client: " I have trouble talking to strangers" Nurse "You find it difficult talking to people you don't know" | show 🗑
|
||||
| show | Seeking clarification
Making the clients overall meaning of the msg understandable. It is used when paraphrasing is difficult or when communication is rambling or garbled. To clarify, the RN may restate the msg or confess confusion & ask PT to repeat
🗑
|
||||
| Nurse: "I'm puzzled" Nurse: "I'm not sure what you mean by ___ Would you please repeat that again?" | show 🗑
|
||||
| show | Perception Checking/ Consensual Validation
A method similar to clarifying that verifies the meaning of specific words rather than the overall message
🗑
|
||||
| show |
C: "it just won't stop" N: "I'm not sure what you mean - it won't stop" OR C: "my husband never gives me presents" N: "He never gives you gifts for your birthday or christmas?"
Perception Checking/ Consensual Validation (example)
🗑
|
||||
| Offering Self | show 🗑
|
||||
| "I'll stay with you till your daughter arrives"; "we can sit here quietly for awhile, we don't need to talk unless you would like to" | show 🗑
|
||||
| show | Giving Information
Providing, in simple and direct manner, specific factual information the client may or may not request. When information is not known, the nurse states this and indicates how the nurse will obtain the information.
🗑
|
||||
| "Your surgery is scheduled for 11am tomorrow"; I don't know the answer to that, but I'll find out from the unit manager, when she comes in" | show 🗑
|
||||
| Acknowledging | show 🗑
|
||||
| show | "You trimmed your beard and mustache" OR "you walked twice as far today with your walker"
Acknowledging (example)
🗑
|
||||
| show | Clarifying time or sequence
Helping the client clarify and event, situation, or happening in relationship to time
🗑
|
||||
| show | C: "I puked this morning" N: "before or after breakfast?"
Clarifying time or sequence(example)
🗑
|
||||
| show | It is a style or process of persuading a group of people, usually his followers to attain a desired objective.
Leadership
🗑
|
||||
| show | A leader that is chosen by the administration or a group which are given the official capacity to act.
Formal / appointed / elected / designated
🗑
|
||||
| A leader that does not have official appointments or designations but is usually chosen by the group itself. | show 🗑
|
||||
| It states that leaders are born and not developed because some people are born with characteristics to be great. | show 🗑
|
||||
| show | A person can be an effective leader if he has all the intellectual, emotional, physical and other personal traits of an effective leader.
Trait Theory
🗑
|
||||
| He is a leader who makes other people feel better in his/her presence which is an inspirational quality that the leader possessed. | show 🗑
|
||||
| It states that there is no personality, traits to be a good leader, but rather leadership is the relationship that exists among people in a social situation. | show 🗑
|
||||
| show | A leader that can immediately resolve a sudden crisis, emergency or critical situation.
Contingency Theory
🗑
|
||||
| A leader that knows how to determine the maturity of his followers. | show 🗑
|
||||
| show | A leader who uses a support system method.
Path Goal Theory
🗑
|
||||
| A style where the leader makes all the decisions and disallows his members to influence him. Followers dislike this leader and leader has little trust to his members. His aim is to develop Self. Uses trial & error and a critic. | show 🗑
|
||||
| show | A leadership style where it is loose and permissive. His approach is "Do your own thing". His reference is "You" and has the desire to develop only "Friendship".
Laissez-Faire
🗑
|
||||
| show | A leader whose authority is from the group. Gives importance to participation, involvement and development of the group. He is a helper and uses "We" as his reference of leadership.
Democratic
🗑
|
||||
| show | A leadership style that uses repetition and tries to develop the system as his objective. His reference is "they" and acts as a ruler and a regulator type of leader.
Bureaucratic
🗑
|
||||
| show | A power whereby the leader has the official capacity to exercise rights and demand obligations from subordinates.
Legitimate Powers
🗑
|
||||
| show | I - olfactory (sensory)
sense of smell
🗑
|
||||
| II - optic (sensory) | show 🗑
|
||||
| show | III - oculomotor (motor)
extraocular eye movement, pupil
constriction and dilation
🗑
|
||||
| IV - trochlear (motor) | show 🗑
|
||||
| V - trigeminal (sensory/motor) | show 🗑
|
||||
| show | VI - abducens (motor)
lateral movement of eyeballs
🗑
|
||||
| show | VII - facial (sensory/motor)
facial expression, taste
🗑
|
||||
| VIII - auditory (sensory) | show 🗑
|
||||
| IX - glossopharyngeal (sensory/motor) | show 🗑
|
||||
| X - vagus (sensory/motor) | show 🗑
|
||||
| XI - spinal accessory (motor) | show 🗑
|
||||
| XII - hypoglossal (motor) | show 🗑
|
||||
| show | Trust vs. Mistrust
Infancy (0-18 mos)
🗑
|
||||
| Autonomy vs. Shame & Doubt | show 🗑
|
||||
| show | Initiative vs. Guilt
Preschool (3-6yrs)
🗑
|
||||
| show | Industry vs. Inferiority
School-age (6-12yrs)
🗑
|
||||
| show | Identity vs. Role Confusion
Adolescence (12-18yrs)
🗑
|
||||
| Intimacy vs. Isolation | show 🗑
|
||||
| show | Generativity vs. Stagnation
Adulthood (25-45yrs)
🗑
|
||||
| Integrity vs. Despair | show 🗑
|
||||
| show | Teaching that is Dependent on environment Needs security
Infant (0-18mos)
🗑
|
||||
| show | Teaching focused on Separation anxiety Self exploration Environment
Infant (0-18mos)
🗑
|
||||
| Teaching focused on Natural curiosity Separation Intrusive procedure | show 🗑
|
||||
| Teaching focused on Ego Body mutilation (pain) believes illness is self caused & punitive | show 🗑
|
||||
| show | Teaching focused on Limited time Active imagination (animistic thinking, fearful)
Preschool (3-6yrs)
🗑
|
||||
| show | Teaching focused on Reality Objectivity Separation anxiety (tries to appear brave)
School Age (6-12yrs)
🗑
|
||||
| Teaching focused on Cause & effect Concrete Information (passive coping strategy) | show 🗑
|
||||
| Teaching focused on Abstract hypothetical thinking Logic & scientific principles | show 🗑
|
||||
| Teaching focused on Body image Self esteem & identity (feel invincible) | show 🗑
|
||||
| Teaching focused on Autonomy Self direction Critical thinking | show 🗑
|
||||
| Teaching focused on Competency based learner (can make decision personally & socially) | show 🗑
|
||||
| show | Teaching focused on Physical changes Alternative lifestyle Sense of well developed (questions achievements & contributions to family & society, confident)
Middle Adult (25-45yrs)
🗑
|
||||
| Teaching focused on Cognitive & physical changes No formal learning (decreased S.T.M., risk taking, easily fatigue) | show 🗑
|
||||
| For a hospitalized Child, focus on | show 🗑
|
||||
| For a hospitalized Toddler, focus on | show 🗑
|
||||
| For a hospitalized Preschooler, focus on | show 🗑
|
||||
| show | For a hospitalized School-age, focus on
Loss of control
🗑
|
||||
| For a hospitalized Adolescent, focus on | show 🗑
|
||||
| PRE-OPERATIVE CARE, a parent or a legal may sign the consent of a MINOR, while the OLDER client may need whom? | show 🗑
|
||||
| show |
Acknowledges understanding of the procedure
🗑
|
||||
| PRE-OPERATIVE CARE, NPO is 6-8 hrs. before Gen. Anesthesia, while for Local Anesthesia is? | show 🗑
|
||||
| show |
Total Parenteral Nutrition
🗑
|
||||
| PRE-OPERATIVE CARE, if client has a Foley Catheter, drain before the surgery and note the? | show 🗑
|
||||
| PRE-OPERATIVE CARE, what do you use to clean the surgical site? | show 🗑
|
||||
| show |
Narcotic Drugs as pain reliever, note it will not make the client an addict to such
🗑
|
||||
| PRE-OPERATIVE CARE (client teaching), demonstrate what to the client? | show 🗑
|
||||
| PRE-OPERATIVE CARE (client teaching), instruct not to what? 24 hours before the surgery. | show 🗑
|
||||
| show |
Pneumonia & Atelactasis
🗑
|
||||
| PRE-OPERATIVE CARE (client teaching), instruction of let & foot exercises will prevent what? Facilitate what? | show 🗑
|
||||
| PRE-OPERATIVE CARE (client teaching), instruct the client on how to splint an incision by? | show 🗑
|
||||
| show |
Allergies for latex
🗑
|
||||
| PRE-OPERATIVE CARE (checklist), ensure that informed consent forms were signed for the operative procedure and for what other reasons? | show 🗑
|
||||
| PRE-OPERATIVE CARE (checklist), ensure that history, P.E., consultation requests, prescribed laboratory results, EKG, chest radiography are documented & recorded plus? | show 🗑
|
||||
| PRE-OPERATIVE CARE (checklist), after removing everything unnecessary, documented it, kept or given to family members, the nurse must document the? | show 🗑
|
||||
| PRE-OPERATIVE CARE (medications), instruct client about the desired effects and then what? | show 🗑
|
||||
| PRE-OPERATIVE CARE (medications), after administering medications, next to the client, place what? | show 🗑
|
||||
| show | PRE-OPERATIVE CARE (inside O.R.), after verifying identification bracelet & verbal response, the nurse will review chart and then confirm what?
Operative procedure & site
🗑
|
||||
| show | PRE-OPERATIVE CARE (inside O.R.), the clients chart will be reviewed for completeness and taking a note about what?
Allergic reactions information
🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), what is the period of this stage?
1-4 hours after surgery
🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), monitor airway patency & adequate ventilation because prolonged mechanical ventilation during anesthesia may affect what?
Postoperative Lung function, extubated patients may not be able to maintain airway
🗑
|
||||
| POST-OPERATIVE CARE (immediate), the client maybe unable to clear his/her airway, that is why it is important to monitor what? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), encourage Deep Breathing & Coughing exercises, monitor pulse oximetry, O2 administration and then observer for?
Chest movements for symmetry and use of accessory muscles.
🗑
|
||||
| POST-OPERATIVE CARE (immediate), note rate, depth & quality of respirations, RR should be? | show 🗑
|
||||
| POST-OPERATIVE CARE (immediate), a breath sound of stridor, wheezing or crowing indicates what? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), a breath sound of crackles or ronchi may indicate?
Pulmonary Edema, monitor signs of Atelectasis or Pulmonary embolism
🗑
|
||||
| POST-OPERATIVE CARE (immediate), check capillary refill, assess the skin, peripheral pulses & edema and monitor for bleeding. A bounding pulse may indicate what? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), unless contraindicated, client is placed on Fowler's position after surgery to increase?
Size of the thorax for lung expansion
🗑
|
||||
| POST-OPERATIVE CARE (immediate), what type of positioning is avoided if the pharyngeal reflexes have not yet returned? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), if comatose or semicomatose, what type of positioning?
Side lying & keep an oral airway in place.
🗑
|
||||
| POST-OPERATIVE CARE (immediate), assess L.O.C., wake client periodically until awaken and if awaken? | show 🗑
|
||||
| POST-OPERATIVE CARE (immediate), main body temperature and prevent heat loss by? | show 🗑
|
||||
| POST-OPERATIVE CARE (immediate), an exposed skin, cool OR, or maybe from anesthesia may result to? | show 🗑
|
||||
| POST-OPERATIVE CARE (immediate), assess surgical site, drains & wound dressings for? | show 🗑
|
||||
| POST-OPERATIVE CARE (immediate), record I&O, monitor for Fluid & Electrolyte imbalance, N&V, NGT patency, abdominal distention and the return of what? | show 🗑
|
||||
| POST-OPERATIVE CARE (immediate), how many hours is it that the client is expected to void urine after the surgery? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), assess for pain, PRE-OP & POST-OP medz, then inquire about the type & location of pain by asking the client to?
Rate the pain from 1-10, note facial expression, body gestures, increase PR, BP & RR.
🗑
|
||||
| show | POST-OPERATIVE CARE (immediate), inquire effectiveness of last medication, if on a Narcotic drug, assess every 30 minutes for?
RR & pain relief
🗑
|
||||
| show | POST-OPERATIVE CARE (intermediate), how many hours is this stage after surgery?
4-24 hours
🗑
|
||||
| POST-OPERATIVE CARE (intermediate), monitor airway patency, encourage Deep Breathing & Coughing exercises, monitor circulatory status encourage the use of what? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (intermediate), assess for mobility on all extremities & encourage early ambulation by first sitting on the edge of the bed with feet supported. But if client is unable to move, what do you do next?
Turn the client every 1-2 hours.
🗑
|
||||
| POST-OPERATIVE CARE (intermediate), reinforce wound with sterile dressing if necessary and always keep it? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (intermediate), monitor I&O, N&V and if vomiting, have a suctioning equipment available and ready to use. NPO status is observed until?
Gag reflex & peristalsis returns
🗑
|
||||
| show | POST-OPERATIVE CARE (intermediate), when oral fluids are permitted, start with?
Ice chips & water, then advance to Clear Liquids up to Regular Diet as prescribed
🗑
|
||||
| POST-OPERATIVE CARE (intermediate), after NPO order is lifted, what do you assess for? | show 🗑
|
||||
| POST-OPERATIVE CARE (intermediate), how many mL per hour should a client void? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (intermediate), if with Foley Catheter, client is expected to void within 6-8 hours. Ensure that the amount is at least?
200mL
🗑
|
||||
| show | POST-OPERATIVE CARE (extended), what is the period of this stage?
1-4 hours after surgery
🗑
|
||||
| POST-OPERATIVE CARE (extended), on this stage, you monitor for signs of infection such as? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (extended), the client is advised to do R.O.M. exercises every 2 hours and encourage ambulation to promote?
Peristalsis & passage of flatus
🗑
|
||||
| show | POST-OPERATIVE CARE (extended), the client is encouraged to perform A.D.L. & eat foods that will promote wound healing. What are the foods?
Protein & Vitamin C
🗑
|
||||
| Inflammation of the alveoli caused by an infectious process that may develop as a result of infection, aspiration or immobility? | show 🗑
|
||||
| show | Collapse of the alveoli with retained mucous secretions and is the most common postoperative complication?
Atelectasis, usually around 1-2 days postoperatively
🗑
|
||||
| POST-OPERATIVE CARE (Pneumonia & Atelectasis) Assessment / increase risk for dyspnea/ elevated temperature/ productive cough/ and what more? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (Pneumonia & Atelectasis) Nsg Inter. / assess for lung & breath sounds/ reposition client every 1-2 hour/ inc O.F.I. / early ambulation and?
Deep breathing & coughing exercises/ incentive spirometer/ chest physio/ postural drainage
🗑
|
||||
| An inadequate concentration of oxygen in arterial blood? | show 🗑
|
||||
| POST-OPERATIVE CARE (Hypoxia) Assessment / cyanosis/ dyspnea/ hypertension/ tachycardia and what else? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (Hypoxia) Nursing Intervention, monitor signs of hypoxia/ eliminate cause/ monitor lung sounds/ administer oxygen/ D.B. & C. E. and what more?
Monitor pulse oximetry & reposition client
🗑
|
||||
| show | It blocks the pulmonary artery and disrupts blood flow to one or more lobes of the lung?
Pulmonary Embolism
🗑
|
||||
| POST-OPERATIVE CARE (Pulmonary Embolism) Assessment / dyspnea/ cyanosis/ tachycardia and what more else? | show 🗑
|
||||
| POST-OPERATIVE CARE (Pulmonary Embolism) Nursing Intervention / what is the first thing that you should do? | show 🗑
|
||||
| Loss of large amount of blood externally or internally in a short time? | show 🗑
|
||||
| POST-OPERATIVE CARE (Hemorrhage) Assessment / restlessness/ hypotension/ cool, clammy skin and what other else? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (Hemorrhage) Nursing Intervention / provide pressure to the site of bleeding immediately and then what?
Notify the physician, administer O2, IV fluids & blood as prescribed & lastly prepare client for surgery if needed
🗑
|
||||
| Loss of circulatory fluid volume, which usually is caused by hemorrhage? | show 🗑
|
||||
| POST-OPERATIVE CARE (Shock) Assessment / / restlessness/ hypotension/ cool, clammy skin and what other else? | show 🗑
|
||||
| POST-OPERATIVE CARE (Shock) Nursing Intervention / elevate legs only if the client did not have Spinal Anesthesia/ determine & treat cause of shock/ administer O2/ monitor V.S., L.O.C./ monitor I & O. and what if the client had Spinal Anesthesia? | show 🗑
|
||||
| show | Inflammation of a vein, leg veins commonly affected, often accompanied by clot formation?
Thrombophlebitis
🗑
|
||||
| POST-OPERATIVE CARE (Thrombophlebitis) Assessment / vein inflammation/ aching or cramping pain/ elevated temperature and what? | show 🗑
|
||||
| POST-OPERATIVE CARE (Thrombophlebitis) Nursing Intervention / monitor leg/ encourage antiembolism stockings – removed 2x/day for washing & inspection of leg/ give heparin sodium or warfarin (coumadin)/ the leg is elevated by 30 degrees & do not? | show 🗑
|
||||
| show | Involuntary accumulation of urine in the bladder as a result of loss of muscle tone?
Urinary Retention
🗑
|
||||
| POST-OPERATIVE CARE (Urinary Retention) Assessment / inability to void/ restlessness & diaphoresis/ lower abdominal pain/ distended bladder and what else? | show 🗑
|
||||
| show | Pour warm water on the perinium, allow pt to hear running water then CATHETERIZE if all non invasive attempts fail
🗑
|
||||
| Failure of appropriate forward movement of bowel contents and maybe due to anesthetic medications or manipulation of the bowel during the surgical procedure? | show 🗑
|
||||
| show | POST-OPERATIVE CARE (Paralytic Ileus) Assessment / abdominal distention/ absence of bowel sounds, bowel movement or flatus, what is the first indication of this condition?
Nausea & Vomiting immeidately postoperatively
🗑
|
||||
| POST-OPERATIVE CARE (Paralytic Ileus) Nursing Intervention / monitor I & O/ maintain NPO until bowel sounds return/ patency of NGT/ early ambulation/ administer IVF or TPN, medications and what is the noninvasive action? | show 🗑
|
||||
| show | Caused by poor aseptic technique or a contaminated wound before surgical exploration?
Wound Infection
🗑
|
||||
| POST-OPERATIVE CARE (Wound Infection) Assessment / fever & chills/ edematous skin at incision site & tight skin sutures/ increased WBC and what is the order of the inflamed incision site? | show 🗑
|
||||
| show | REEDA- Redness, Erythema, Ecchynosis, Drainage, Approximation for wound edges
🗑
|
||||
| show | Separation of the wound edges at the suture line?
Wound Dehiscence, usually occurs 6-8 days after
🗑
|
||||
| show | Appearance of underlying tissues through the wound
🗑
|
||||
| POST-OPERATIVE CARE (Wound Dehiscence) Nursing Intervention / low Fowler's position to avoid abdominal tension/ cover with NSS dressing and then immediately? | show 🗑
|
||||
| Protrusion of internal organs through an incision. Common on obese, with past abd. surgery or who have poor wound healing. | show 🗑
|
||||
| POST-OPERATIVE CARE (Wound Evisceration) Assessment / serosanguinous discharge from dry wound/ with loops of bowel or other abdominal contents through the wound and the client is reporting? | show 🗑
|
||||
| POST-OPERATIVE CARE (Wound Evisceration) Nursing Intervention / Fowler's position/ cover wound with sterile NSS and ? | show 🗑
|
||||
| show | In ambulatory surgery, the criteria for client discharge are the following, he/she is alert and oriented/ has voided/ not in respiratory distress/ vomiting & in minimal pain and also the client is able to?
Ambulate, swallow & cough
🗑
|
||||
| POST-OPERATIVE CARE (Discharging) assess pt's readiness to learn, educ. level, & desire modify lifestyle/ demo incision care/ written guide to pt & family &? | show 🗑
|
||||
| show | Formula for IV Calculations
CC's per hour X Drop Factor / 60
🗑
|
||||
| Ordered 1000 cc 5% D/ 0.45 NS at 100cc/hr. Drop factor is 60 | show 🗑
|
||||
| show | Ordered: 1500 ML0.9% NS to infuse 90 cc/hr. Drop Factor: 20 gtt/ml
30
🗑
|
||||
| ORDERED: Ampicillin 500 mg in 50 cc 0.9% NS to infuse 1hour. Drop Factor: 10 gtts/ml | show 🗑
|
||||
| Ordered 1250 cc 2.5 % D/W to infuse from 12 noon to 6 pm. The Drop Factor is 15 gtts/ml. | show 🗑
|
||||
| show | ORDERED: 1000 cc RLS adn 1000 cc 5% D/LRS and 1000 cc 0.9% NS to infuse over 24 hours. DROP FACTOR: 12 gtt/ml
25
🗑
|
||||
| show | ORDERED: 1000 cc 5%D/0.45% NS with 40 mEq of KCL to infuse in 8 hours. DROP FACTOR: 12 gtts / ml
25
🗑
|
||||
| ORDERED: An infant weighs 18 # has an IV of 500 cc 10% D/W to infuse over 24 hours. DROP FACTOR: 60 gtts/ml | show 🗑
|
||||
| ___% of the average adult's weight is fluid | show 🗑
|
||||
| Intracellular fluids (ICF) | show 🗑
|
||||
| show | What % of body weight is ICF?
40%
🗑
|
||||
| show | Extracellular fluid (ECF)
fluid outside of a cell; divided into 3 parts, Interstitial fluid, intravascular fluid, and transcellular fluids
🗑
|
||||
| show | What % of ECF makes up body weight?
20%
🗑
|
||||
| show | What is interstitial fluid?
contains lymph, fluid between cells and outside blood vessels
🗑
|
||||
| What is Intravascular fluid? | show 🗑
|
||||
| show | Electrolytes
minerals or salts; when melted or dissolved in water it separates into ions and is able to carry an electrical current
🗑
|
||||
| Cation | show 🗑
|
||||
| Anion | show 🗑
|
||||
| Solute | show 🗑
|
||||
| show | Solvent
dissolvable in plasma
🗑
|
||||
| Osmosis | show 🗑
|
||||
| Osmotic pressure is: | show 🗑
|
||||
| A solution with the same osmolarity as blood plasma is called: | show 🗑
|
||||
| show | Movement of a solute in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration is:
diffusion
🗑
|
||||
| show | Filtration
water and diffusable substances move together in response to fluid pressure, moving from an area of higher pressure to an area of lower pressure
🗑
|
||||
| Hydrostatic pressure | show 🗑
|
||||
| Increased hydrostatic pressure causes what? | show 🗑
|
||||
| Active transport | show 🗑
|
||||
| show | Homeostasis
physiological balance
🗑
|
||||
| show | Osmoreceptors
continually monitor the serum osmotic pressure, when osmolality increases, hypothalamus is stimulated
🗑
|
||||
| ADH | show 🗑
|
||||
| Aldosterone | show 🗑
|
||||
| Insensible water loss | show 🗑
|
||||
| Sensible water loss | show 🗑
|
||||
| show | The lungs expire____ml of water a day
400ml
🗑
|
||||
| What are the major cations? | show 🗑
|
||||
| What are the major anions? | show 🗑
|
||||
| show | __% of sodium is in the ECF? Function of Na+?
90%, maintain water balance
🗑
|
||||
| __% of K+ in ECF. What's it's function? | show 🗑
|
||||
| show | 1% of Ca+ is in blood, 99% in bone; what is the function?
blood clotting, bone/teeth formation
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|
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| Magnesium is essential for: | show 🗑
|
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| show | __% of magnesium in ECF. Na plasma concentration is:
1%; 1.5-2.5 mEq/L
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|
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| Bicarbonate, a chemical base buffer, is regulated by: | show 🗑
|
||||
| Buffer | show 🗑
|
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| What is the largest chemical buffer in ECF? | show 🗑
|
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| Biological regulation | show 🗑
|
||||
| Fluid volume deficit (FVD) | show 🗑
|
||||
| Fluid volume excess (FVE) | show 🗑
|
||||
| Hyperosmolar imbalance | show 🗑
|
||||
| show | Hypoosmolar imbalance
water excess
🗑
|
||||
| TPN or total parenteral nutrition | show 🗑
|
||||
| show | IV fluid and electrolyte therapy
crystalloids
🗑
|
||||
| show | Colloids
blood and blood component
🗑
|
||||
| show | Vascular access devices include:
catheters, cannulas, infusion ports,
🗑
|
||||
| the breakdown of RBC's is called: | show 🗑
|
||||
| Autologous transfusion collection of clients own blood (pre-op) | show 🗑
|
||||
| One of the most common electrolyte imbalances is: | show 🗑
|
||||
| The client most at risk for FVD's is: | show 🗑
|
||||
| show | One reason older adults experience fluid and electrolyte imbalance and acid-base imbalances is they:
have a decreased thirst sensation
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|
||||
| show | Output recorded on an I & O record includes:
urine, diarrhea, vomitus, gastric suction, and drainage from wounds and tubes
🗑
|
||||
| Health promotion activities in the area of fluid and electrolyte imbalances focuses primarily on: | show 🗑
|
||||
| show | TPN is delivered by:
indwelling or central IV catheter
🗑
|
||||
| show | As a safety alert the RN is aware the following med is never given directly through IV:
Potassium chloride, it will burn the vein
🗑
|
||||
| Indications of IV fluid infiltration include: | show 🗑
|
||||
| show | CDC recommends replacing peripheral venous catheters and rotating sites should occur at least every:
72-96 hours
🗑
|
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