Term
| What are the five ethical principles? |
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Definition
Autonomy-ability of client to make personal decisions, even if they arent in their best interest
Beneficence-care given is in best interest of the client
Fidelity-keeping ones promise about care offered
Justice-fair treatment
Nonmalificence-avoidance of harm or pain as much as possible |
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Term
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Definition
| Professional negligence - nurse administers large dose of med due to calc error and the client dies |
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Term
| The core of nursing practice is regulated: |
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Definition
| state law: Can revoke/issue license; define nursing practice parameters (standards of care) [ANA]; regulate practice; adopt rules and regulations for this; set standards for nursing programs |
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Term
| Five elements to prove negligence |
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Definition
1. duty
2. breach of duty-not meet standard
3. forseeability of harm
4. breach of duty has potential to cause harm
5. harm |
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Term
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Definition
| should be used to verbalize concerns related to assignment in light of current legal scope of practice, job description and area of competence |
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Term
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Definition
-required by PSDA
Living will: clients wished for treatment if incapacitated or facing end of life issues
Durable POA: proxy authorized for decisions when client is unable
Providers Orders: DNR/AND |
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Term
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Definition
abuse suspicion, communicable disease,
-ensures med treatment
-monitors for outbreaks
-plan/evaluate control/prevention plan
-determine health priorities from trends
-identify outbreaks |
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Term
| Included in a chart and why |
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Definition
Assessments; medication administration; treatments given and the client’s responses; client education
For: communication, legal documentation, financial billing, education, research, monitoring |
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Term
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Definition
| significant objective info report is given at the conclusion of each shift by the nurse leave to the nurse assuming responsibility for the client; face-to-face, audio-taped, presents on rounds |
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Term
| Five rights to delegation |
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Definition
| Task, circumstance, person, communication, supervision/evaluation |
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Term
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Definition
| monitor client findings, reinforce teaching, perform tacheostomy care, suctioning, NG patency check, administer enteral feeding, insert urinary catheter, administer meds |
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Term
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Definition
| ADLS, bathing, grooming, dressing, toileting, ambulating, feeding (without precautions), positioning, bed making, specimen collection, I&O, vital signs for the stable |
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Term
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Definition
| hand hygiene, compromised health/defenses against it, poor asepsis, poor hygiene/nutrition, stress, corwded living environment, older adults, poor lifestyle choices, recent exposure (poor sanitiation, mosquito born/parasitic disease, endemic in visited area) |
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Term
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Definition
| Infection in hospital from exogenous (outside pt) or endogenous (altered flora); most commonly UTI; from e.coli or s.aureus or enterococci |
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Term
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Definition
Fever
Increased pulse and RR
Malaise
Anorexia
N/V
Enlarged lymph nodes (waste) |
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Term
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Definition
first stage of 3 in inflammatory response
Redness
warmth
edema
pain/tenderness
loss of use of affected part |
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Term
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Definition
WBC above 10,000/uL and left shift from neutrophil increase
Elevated ESR rate
Positive culture |
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Term
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Definition
| infectious agent (bacteria, virus, fungi, protozoa); reserboir to grow (wound drainage, food, o2 tubing); exit portal; means of transmission; entry portal to a susceptible host |
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Term
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Definition
| cover mouth and nose using a favial tissue to contain secretions, turn head and stay a minimum of 3 ft away from others, mask if continual, hand hygiene |
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Term
| Standard (tier 1) precautions |
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Definition
all body fluids, mucous, intact skin
gloves, masks, eye/ shields if spraying |
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Term
| Transmission Precautions (Tier 2) |
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Definition
Airborne - <5um (TB [special mask], measles, varicella), private room, negative air pressure exchanged every 6 hours, masks
Droplet - > 5um (pneumonia, mumps, rubella, pertussis, SF) private/same disease room, masks
Contact (resp virus, wound, enteric, herpes simplex), private/same disease room, gloves/gowns for all, proper disposal |
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Term
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Definition
fall-risk assessment upon admission; document risks and implement safety measure:
-call light/respond quick
-orient to setting
-place near nursing station
-ensure things are in reach
-low bed, rails up if compromised
-avoid full bedrails for those who attempt to get up
-clutter free; locks; sensors
-educate |
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Term
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Definition
rescue equipment at bed, remove unsafe items in event, assist ambulation,
advise: nothing in mouth, do not restrain, lower to floor with space, protect head and flex fwd, body on side, loosen clothes;
Stay with/call for help
Explain/provide comfort |
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Term
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Definition
face-to-face assessment then prescription in writing
Emergency: obtain order ASAP
Include: Reason, type of restraint, location, how long to be used, and type of behaviors demonstrated that warrant use and rewrite order every 24 hours |
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Term
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Definition
Food, fluid, safety and comfort assessments performed and documented every 15-30 minutes
Quick release knot fitting two fingers, pad bony prominences, regularly assess, never leave unattended w/o
Document: Behaviors, actions causing, when applied/removed, location, type, care, meds, response when removed |
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Term
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Definition
RACE
R-rescue
A-alarm
C-contain
E-extinguish (A-paper/wood/trash fire; B-flammable liquids/gas fire, C-electrical fire) |
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Term
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Definition
nurses often collaborate to promote safety
to initiate a plan of care, the nurse must identify risk factors using a risk assessment tool, and complete a nursing history, a physical examination and a home hazard appraisal |
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Term
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Definition
semi-fowler - 30d; prevent tube regurgitation and aspiration
fowler 45 - NG, suctioning, vent, abdomen surgery drainage
high-fowler 90 - lung expansion; sever dyspnea
prone - abdomen, oral/throat surgery drainage
lateral - side, 3 pillows, sleep
sims - oral drainage between sims/lateral
orthopneic - sit; arms on bed table (copd)
trendelenburg - head below feet; venous return
Reverse T - feet below head; gastric emptying, esophogeal reflux |
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Term
| Mobility assessment sequence |
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Definition
| ROM, Moving from supine to sitting on the side of the bed, Gait, Exercise tolerance |
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Term
| Triage classes/ categories during mass casualty events |
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Definition
I - Emergent - highest priority; life threatening injuring with high possibility of survival when stabilized
II - Urgent - major injurys, not yet life threatening; can wait 45-60 for treatment
III - Nonurgent - minor injuries, do not need immediate attention
IV - Expectant - not expected to live and will be allowed to die naturally; provide comfort not restorative care |
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Term
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Definition
routine starting at age 20
dental - every 6 months
BP - 2 years starting at 20
BMI - each routine
Cholesterol - every 5 starting at 20
Glucose - every 3 starting at 45
Colorectal - FOBT starting at 50, colonoscopy every 10
Pap - every 2y from 20-30 then 1-3years
Breast - every 3y @ age 20; yearly @ 40
Mammogram - @ 40 then yearly
Testicular - 20, yearly
Prostate/digital rectum - males above 50 |
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Term
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Definition
Cardiovascular disease: CAD, hypertension, stroke
Mobility: arthritis, osteoporosis, falls
Mental health: depression, dementia, suicide
DM, Cancers, Incontinence, Abuse/neglect, cataracts, alcoholism, pain |
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Term
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Definition
Alternative medical philosophy (acupuncture, homeopathy, Chinese meds)
Biological and botanical therapies (naturopathic therapy, diets, vitamins, minerals, herbal)
Body manipulation (massage, touch, chiropractic therapy)
Mind-body therapies (biofeedback, art therapy, meditation, yoga, psychotherapy)
Energy therapies (Reiki, therapeutic touch) |
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Term
| Specialized license versus nursing CAM therapy intervention |
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Definition
SL: acupuncture/pressure, homeopathic medicine, naturopathic medicine, chiropractic medicine, massage therapy, biofeedback, therapeutic touch
Nursing: guided imagery/visualization therapy, healing intention, breath work, humor, mediation, simple touch, music therapy, therapeutic communication |
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Term
| Specialized License CAM Interventions |
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Definition
Acupuncture/pressure – alters body function or produces analgesia
Homeopathic medicine – healing remedies
Naturopathic med – diet, exercise, environment and herbal promote natural healing
Chiropractic med – treated by manipulation of the spine
Massage therapy – relaxation/circulation improved stretching/loosening muscles
Biofeedback - increase awareness of body responses to minimize extremes
Therapeutic touch – hands to help bring clients energy fields into balance |
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Term
| Nursing CAM interventions |
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Definition
Guided imagery/visualization therapy – healing/relaxation by focusing on images
Healing intention – healing through caring, compassion and empathy in prayer
Breath work – breathing patterns to reduce stress and increase relaxation
Humor – reduce tension and improve mood – coping mechanism
Meditation – calm mind and body
Simple touch – communicates presence, appreciation and acceptance
Music therapy – relaxation with distraction from pain; concentration
Therapeutic communication – verbalize/become aware of emotions and fairs |
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Term
| Systolic BP versus Diastolic BP |
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Definition
Systole – contraction
Diastole – relaxation
Systolic BP – occurs during ventricular systole of the heart, when ventricles force blood into the aorta and represents the maximum amount of pressure exerted on the arteries
Diastole BP – occurs during ventricular diastole of the heart, when the ventricles relax and exert minimal pressure against arterial walls, and represents the minimum amount of pressure exerted on arteries |
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Term
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Definition
balance between heat lost and heat produced: Results from basal metabolic rate, muscle activity, thyroxine output, sympathetic stimulation, dehydration, injury/illness (fever response)
Oral: 4+ in sublingual pocket 36-38; no trauma to face, do not use if bite
Rectal: .5d less than oral; not with bleeding precautions/stool, second measure if above 37.2
Axillary: clean/dry with arm over/held down; use under 3m
Tympanic: pull ear up and back(a)/down and back(c); outer ear canal
Temporal: wipe lens with alc; scan/hold against flat forehead moving gently over to temporal artery, touching skin behind ear; release and read
Fever not harmful unless past 39 |
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Term
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Definition
abnormally elevated temperature
Obtain specimen for WBC/ESR/electrolytes
Antibiotics from culture
Fluids/rest
Antipyretics (tylenol/motrin/aspirin-not children)
Prevent shivering; head covered
Oral hygiene |
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Term
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Definition
temp below 35
Heated humidified O2
Warming blanket
Warmed fluids
Cardiac monitoring with emergency resuscitation on standby |
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Term
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Definition
rate/rhythm of heart
0-4/absent to bounding scale; 2 is normal
Apical may be faster in pulse deficit then radial and only appear during dysrhythmia - use for irregularities, before cardiac meds, rapid rates and infants(normal is 120-160 bpm) |
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Term
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Definition
| Conduction: heat from body to surface (submerged in cold water); convection: heat by air currents; evaporation: heat through water vapor (sweat/diaphoresis); radiation: one object to another without contact (heat loss to cold room) |
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Term
| Tachycardia/Bradycardia measuring |
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Definition
Tachycardia
Assess/monitor: for other s/s: pain, anxiety, restlessness. Fatigue, low BP, low o2 sats, for potential side/adverse effects of medications
Bradycardia
Assess/monitor: s/s: hypotension, chest pain, syncope, diaphoresis, dyspnea, altered mental status |
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Term
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Definition
Age - decreases with age (infants 30-60; school-aged 20-40; 12-20)
Pain - increases before stabilizing; decreases depth
Brainstem injury - decreases rate and rhythm
impaired 02 (95-100% norm, below 85% abnorm)
Check RR in semi-fowlers |
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Term
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Definition
Determined by CO: BP = CO x SVR (systemic vascular resistance d/c)
Normal 120/80
Prehypertension: S 120-139 D 80-99
Stage 1 hypertension: S 140-159 D 90-99
Stage 2 hypertension: greater than 160/100
based off highest reading; difference = pulse pressure
infants-low; children/fat-higher; adults increase w age; OA-increase systolic due to d.elasticity; higher in AA; lowest in early morn |
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Term
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Definition
Rest 5m before; no caffeine/smoking 30m before
Not on side with IV/mastectomy or shunt
Use arm with higher vascular reading
Sit, feet flat, arm at heart level
Inflate to 30mmHg above palpated systolic and release at 2/3mmHg per sec
Measure standing after initial; 2m apart |
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Term
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Definition
Factors: renal or thyroid disease, meds, constriction of BV, increased fluid
Potassium, Calcium and Magnesium can help lower BP
Restrict sodium, carb, and saturated fat intake |
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Term
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Definition
can lead to stress disorders or depression
Language, communication, culturally inappropriate tests and tools that lead to misdiagnosis, and ethnic variations in drug metabolism related to genetics
Nurses should always accommodate cultural beliefs and values except in direct conflict w essential health practices |
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Term
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Definition
Factors within the culture that may be held differently
based on: age, gender, sexual orientation, marital status, family structure, income, education level, religious views, life experiences |
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Term
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Definition
| Connectedness with a higher power, achieve balance in life, maintain health, to seek health care, and to deal with illness and injury as well as give hope(anticipation/optimism; provides comfort), faith(religion or culture) and transcendence |
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Term
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Definition
examination includes looking at the structure and function of the system; examining each joint and muscle, the surrounding tissues and comparing symmetric parts
Inspection and palpation: height, posture, spine/back, ROM, muscle symmetry and strength |
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Term
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Definition
examination can evaluate the major indicators of neurological function and assist with recognizing dysfunction; integrated with other assessments
Level of consciousness and general state of health (motor function and mental status for cerebral function, cranial nerve assessment, sensory function and reflexes) |
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Term
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Definition
Alert - responsive, fully responds
Lethargy - open eyes and respond but is drowsy and falls asleep repeatedly
Obtundation - needs to be lightly shaken
Stupor - painful stimuli to achieve brief response, sometimes not verbally
Coma - 3 on Glasgow Coma scale, no response, abnormal posturing |
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Term
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Definition
Orientation of time and place
Attention and calculation of counting backwards by 7
Registration and recalling of objects
Language, inculding naming of objects, following of commands and ability to write |
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Term
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Definition
Collect stool specimen for serial fecal occult test (guaiac)
Fiber requirement 25-30
Foods high: whole grains, fruits, veggies |
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Term
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Definition
dilated BV in rectal wall from straining, can be caused by heart failure, liver disease and pregnancy
itchy, painful, bloody
moist wipes to cleanse; moisture creams/ointments may help |
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Term
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Definition
| Full bladder control 4-5 years, prostate enlargement after 40 years, Older: fewer nephrons, loss of blader muscle tone, inefficient emptying, nocturia; childbirth – kegel exercises; pregnancy increases circulatory volumve/renal workload up to 50%, relaxin – relaxation of sphincter, sodium leads to decrease, spinal cord injury, suppression of the urge whith pain, alterations in glomerular filtration rate from anesthesia/opiod analgesics causes decrease, meds |
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Term
| If found with an evisceration: |
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Definition
You will see protrusion of organ from wound caused by seosanguineous fluid.
Call for help
Stay with the client
Position supine
Cover with sterile towels/sterile saline dressings
Observe for shock |
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Term
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Definition
- Inflammatory – 3 days – control bleeding with clot formation; deliver O2, WBC, nutrients
- Proliferative: 3-24 days: replace lost tissue with connective/granulated; contract wound edges; resurface new epithelial cells
- Maturation/Remodeling: strengthening collagen scar/restoration of normal appearance; one year plus depending on extent |
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Term
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Definition
oGR above 100mL: withhold, notify, semi-Fowler, recheck in 1 hour
oDiarrhea 3+ in 1 day: notify, dietitian, skin care
oNausea/vomiting: withhold, turn to side, notify, check patency, aspirate residual; auscultate
oAspiration: withhold; notify; x-ray; o2 as indicated; turn to side; suction; temp; auscultate
oSkin irritation: skin barrier; monitor placement |
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Term
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Definition
- Excoriation of nares and stomach: apply lubricant as needed; asses color of drainage. REPORT DARK/COFFEE-GROUND OR BLOOD STREAKED DRAINAGE immediately
- Discomfort: rinse mouth with water for dryness; throat lozenges; oral hygiene frequently
- Occlusion of NG leading to distention: irrigate per facility protocol to unclog; tap water with enteral feedings; change position in case the tube is against the stomach wall |
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Term
| Documentations when discontinuing an NG tube |
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Definition
| tubing removal/condition of the tube, volume and description of the drainage, abdominal assessment including inspection, auscultation, palpation and percussion; last and next bowel movement and urine output |
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Term
| Accidental Decannulization |
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Definition
Emergency in first three days
Ventilate with manual resusitation bag
call for help
immediately hyperextend the neck with obturator inserted into treacheostomy tube
Quickly and gently replace tube and remove obturator
Secure tape, assess placement with bilateral auscultation
If fail: o2 through stoma. If fail: cover stoma and o2 through mouth/nose |
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Term
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Definition
Trauma client – 16 gauge – rapid fluid volume
Surgical client - 18 gauge – rapid blood
Other – 22-24 gauge – children/adults theater |
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Term
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Definition
Never give in bolus if it can cause serious adverse reactions; IV pump; potassium chloride
Never administer IV meds through tubing that is infusing blood, blood products or nutritional solutions
Fragile veins, anticoagulants, elderly: no tourniquets, use BP cuff, do not slap extremity
Edema: Digital pressure with alcohol pad over selected vein to displace it
Fluids should not hang more than 24 hours |
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Term
| Needle sizes, gauge and degree entering |
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Definition
Intradermal: tuberculin/allerfy/canver immunotherapy: 3/8 to 5/8 inch 26-27, .01 to .1mL; 10-15degrees
Subcutaneous(pinch an inch)[heparin/insulin]: max 1.5mL; 5/8 to 1/2 inch 25-27n, 45-90 d
Insulin – 25,26,27
Intramuscular: 1 to 1 1/2 inch, 18 to 27n, 22-25 gauge; 1-3ml injected
Z-track: Type of IM injection that prevents medication from leaking into subq; stains |
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Term
| Preventing error in the nursing process |
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Definition
A: Obtain necessary preadministration data (HR/BP)
Question prescriptions that seem unclear or inappropriate or not gradual!
P: Set priorities, identify client outcome
I: No distractions during med prep.
Double check labels, measurements, amount, 6 rights
Educate client then omit/delay if client questions size or appearance or as indicated by their condition
Discarding controlled substance must be witnessed
E: Evaluate response, document, and report
Recognize side/adverse effects – document and report
Errors – report (not part of permanent record) |
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Term
| Six Rights to safe administration |
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Definition
1. Right Client verify identification each time, check allergies by bracelet, asking and med administration record – Jco requires two identifiers (person-specific)
2. Right Medication check label 3 times
3. Right Dose calculate and check drug reference to ensure its within usual range
4. Right Time on time to maintain consistent therapeutic blood level
5. Right Route
6. Right Documentation immediately record pertinent info, including response to med |
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Term
| Medication Reconciliation |
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Definition
| JCo requires this. Nurse should compile list of current medications ensureing all are included, with correct dosages and frequency. Compare list with new medication prescriptions and reconcile to resolve any discrepancies. This list becomes current for administration. This should be done: on admission, when transferring between units/facilities and at discharge. |
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Term
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Definition
| Components: client name, date and time, name of med, dosage, route, frequency, signature |
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Term
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Definition
| routine/standard(regular schedule), single/one time(certain time or as soon as possible), stat(once, immediately), PRN(per needed with clinical judgement; prescription says what doage, what frequency and under what conditions), standing(for specific circumstances/units) |
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Term
| Nurses legal responsibility to med administration |
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Definition
- Preparing, administering and evaluating client responses to meds
- Maintaining up to date knowledge including: uses, mechanisms of action, routes of administration, safe dosage range, side effects, adverse responses, precautions and contraindication
- Determining accuracy of med orders |
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Term
| just some parental facts/locations |
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Definition
Parenteral – vastus lateralis site < 2 years of age,
>2 can use ventral gluteal up to 2mL or deltoid up to 1mL
Tuberculin syringe for solution colunes < 0.5 mL |
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Term
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Definition
o Call by name and identify yourself
o Maintain eye contact at eye level
o One question/one direction at a time said briefly and slowly with time for response
o Avoid lengthy conversations
o Adequate sleep and pain management |
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Term
| Aphasia defecit (speech/language) clients |
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Definition
o Greet client and call them by name
o Speak clearly, slowly and short without shouting
o Pause between statements to allow understanding
o Check for comprehension
o Minimize background noise
o Ask questions that requires simple answers and allow for time
o Match verbal with nonverbal
o Picture charts or other speech therapist measures (writing) may improve communication
o Acknowledge and frustration expressed |
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Term
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Definition
o Call by name before approaching and introduce yourself, staying within visual field
o Give specific information on location of items in area of building or food on tray leaving
o Explain interventions before touching
o Inform client of your departure
o Appraise clothing and suggest changes if soiled or torn
o Made a radio, television, compact disc, or digital audio file player available for use |
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Term
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Definition
o Sit and face client without covering mouth while speaking
o Hearing devices
o Speak slowly and clearly without shouting, try lowering pitch
o Brief sentence/simple words, write down if not understood
o Sign language interpreter if necessary |
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Term
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Definition
- Prepare a sterile syringe
- Clamp catheter between injection port/extension tubing
- Cleanse injection port with antiseptic swab/wipe
- Insert needle of syringe with irrigant into injection port
- Inject slowly
- Withdraw and remove clamp; allowing irrigant to drain into drainage bag |
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Term
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Definition
8-10 for children
14-16 for women
16-18 for men |
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Term
| Urinary elimination diagnostic tests |
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Definition
Bedside sonography/bladder scan – ultrasound scanner noninvasively measures bladder volume after voiding
KUB – kidneys/ureters/bladder – xray to determine size, shape, and position of kidneys
IVP – contrast to ciew ducts, renal pelvis, uterters, bladder and urethra, Iodine is used – check for a shellfish allergy
Renal scan – renal blood flow and anatomy of kidneys without contrast
Renal Ultrasound – view of gross renal structures
Cystoscopy – endoscope to visualize bladder/urethra
Urodynamic testing – tests bladder muscle function by filling with Co2 ot .9% sodium chloride and comparing pressure readings with clients reported sensations |
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Term
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Definition
Pyridium – orange
Amitriptyline – green/blue
Levodopa (dopar) – brown/black
Chemotherapy – toxic for kidneys |
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Term
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Definition
Causes: GI loss, diaphoresis, renal loss, third spacing, hemorrhage, altered intake
Vitals: hyperthermia, tachycardiam thready pulse, hypotension, orthostatic hypotension, decreased central venous pressure, tachypnea, hypoxia
dizzy, syncope, confused, weak, tired
decreased production of urine, flattened neck veins |
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Term
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Definition
assess respiratory status
SOB, dyspnea
Check urinalysis, O2 sat, CBC and electrolytes
Measure client weight daily at same time, same scale
Vitals
LOC
heart rhythem
IV
Shock position (back with legs elevated)
Fluid replacement
I&O-alert under 30 hour
assess gait |
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Term
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Definition
assess respiratory status
SOB, dyspnea
Check urinalysis, O2 sat, CBC and electrolytes
Measure client weight daily at same time, same scale
Vitals
LOC
heart rhythem
IV
Shock position (back with legs elevated)
Fluid replacement
I&O-alert under 30 hour
assess gait |
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Term
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Definition
Tylenol max of 4 g/day
Fiber: 25-30
Blood glucose: 70-250
Potassium: 3.5-5
Serum Sodium: 136-145
Calcium 9-10.5
Mg: 1.3-2.1 |
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Term
| Pressure Ulcer Risk Lab Values |
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Definition
Norton below 14
Braden Below 18
Serum below 3.5 |
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Term
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Definition
1 mg = 1000mcg
1g = 1000mg
1kg = 1000g
1oz = 30mL
1L = 1000mL
1tsp = 5mL
1tbsp = 15mL
1tbsp = 3tsp
1kg = 2.2lb
1gr = 60mg |
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Term
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Definition
what you have of the quantity
Have/Quantity = Desire/X
desired*quantity/have = amount to be given
by weight:
Amount prescribed*kgweight (mg*kg) = TDD
TDD/# of doses per day = amount per dose ^use this as desired |
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Term
| Manual and Electronic pump math |
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Definition
Electronic: mL/hr
Volume(mL)/Time(hr) = IV flow rate
Volume(mL)/Time(min) = XmL/60min
Manual:
Volume to be infused/Time(min)*drop factor
drop factor*Volume(mL)/Time(hr)*(1hr/60m) |
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