OSU OKC Final 1314 - Science MedicineNursing Save HOSA nursing assis...

OSU OKC Final 1314 Students also studied Science MedicineNursing Save HOSA nursing assisting test Teacher 98 terms Felix_Mugo2Preview NUR170 Exam 1 103 terms noblekid_KePreview nur 222 exam 1-4 LATEST QUESTION...Teacher 8 terms Stuvia_Testbanks Preview

ATI CBC

Teacher Vic Clinical Judgement interpretation or conclusion of the patient needs by assessment/response of the patient

inductive reasoning: specific to general through assessment

deductive reasoning: general to specific through nursing process

Recognize assumptions Evaluate arguments Draw conclusion professional identity sense of ones self in relation to others that is influenced by characteristics, norms, and rules of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse doing, being, acting ethically, flourishing, changing identities Delegation Right task, circumstances, person, direction, supervision/evaluation

can: bathing, toileting, dressing, feeding

cannot: initial assessments, meds, dressing changes, interventions that require skill Culture can be modified or changed

competence: ability to understand, adapt care to needs

enculturation: learned, socialization

acculturation: acquired by contact with culture

assimilation: gives up original culture identity

biculturalism: dual pattern of identification

ethnicity: modifiable, generational

race: heredity, non modifiable

Safety number one priority

adverse: unintended harm by omission or commission

near miss: could cause harm but did not

sentinel: loss of life or limb

leadership patient centered care, just culture, learning, communication, evidence based practice right patient right drug right dose right route right time right documentation dosage calculation(Dosage/On-Hand) X Quantity Mobility state or quality if being mobile or moveable optimal mobility relies on bones, joints, articular cartilage, tendons, ligaments, muscle, and muscle contraction

primary: reg pays activity

secondary: screening, fall risk assessment

tertiary: treatment

Gas exchange compromised when there is impairment if ventilation, altered transport of oxygenation, or inadequate perfusion supply of oxygen, removal of waste o2 in co2 out cardiovascular, neurologic, hematologic, ventilation, transport, perfusion acid base

metabolic acidosis: low bicarb

respiratory acidosis: high carbonic

metabolic alkalosis: high bicarb

respiratory alkalosis: low carbonic

PH: 7.35-7.45

PAO2: 80-100

PACO2: 35-45

BICARB: 22-26

LOW= ACID

HIGH=ALKALINE

Pain pain is whatever the patient says it is

duration: acute, chronic, combination

non-pharmacologic: massage, positioning, splinting, thermal interventions, mind- body therapy location, intensity quality, onset duration, relieving factors, comfort goal

Normal pregnancy 38-40 weeks aches, pains, morning sickness, nausea, vomiting, constipation, breast changes, food cravings, backache, polyuria GTPAL gravida term parity abortion living # preg, #term, #preterm, # abort, #living

TWINS COUNT AS GRAVIDA 1 BUT LIVING 2

Normal postpartum

• Period after pregnacy & delivery (usually 6 weeks) when the body returns to the

nonpregnat state.

• Care during thise period is focused on wellness & family integrity.
• Teaching must be initiated early to cover the physical self care needs & the

emotional needs of the mother, infant, & family.Complicated postpartum DVT, mastitis, URI, UTI, thrombophlebitis, hematomas, abscess formation, endometriosis, perineal cellulitis, hypovolemic shock, infection, mental disorders

risks: c section, prolonged pain, prolonged labor, hemorrhage

maintain semi fowlers position Normal newborn RR is 30 to 50 breathes per minute

HR: 120-140 bpm

BP: 60-80/40-50 mmHg;

axillary temp less than a 97.6 may be caused by prematurity, infection, or environmental temperature APGAR activity, pulse, grimace, appearance, respiration scores above 7 after birth are good 0-10 Fluids and Electrolytes Process of regulation the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes.vomit/diarrhea, fever, malabsorption, excess fluid, hemorrhage burns, head injury, kidney injury, diabetes mellitus, eating disorders, cancer, meds, diuretics, laxatives, alcoholism, crush injuries can cause: changes in LOC, confusion, respiratory, pulmonary congestion, bounding pulse, tachycardia, edema, nausea IV therapy fluids

NS: expands volume, keep vein open

LR: fluid resussitation

D5W: isotonic-hypotonic once in body

D5 1/2 NS: NA/Vol replacement, go slow, hypertonic

ANY ADVERSE EFFECTS: STOP TRANSFUSION

Perfusion The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.

at risk: Middle Aged, men, older, black

risks: smoking, obesity, diabetes, genetics, stress, African American, older, sedentary lifestyle

Adult health promotion minimize risk factors, teaching, lifestyle changes assessment.screening management nutrition, obesity, cancer, cad, smoking cessation Adult immunizations

(1) Td: Every 10 yrs 0.5 ml IM

(2) Influenza: pts 6 months to 18 yrs and ≥ 65 yrs or if high risk every year, given in autumn 0.5 ml IM (3) Pneumococcal polysaccharide: ≥ 65 yrs, or if high risk every 10 yrs 0.5 ml SC or IM Communication complete, clarity, concise, courtesy, correct, concrete, consideration do not ask patient why do not dismiss feelings do not give advice situation background assessment recommendations Patient educationteach back method to ensure proper learning Maslow's Hierarchy of Needs (level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization Elimination removal, clearance, or separation of matter or the excretion of waste products through the skin, kidneys, lungs, intestines

risk: infants, toddlers, pregnant, older adults

Palliative care Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.does not aim to cure any stage of serious illness advance care planning psychological assessment referral to resources family support medication management pain management End of life care warm blanket, reposition, music, pastor, antiemetic, foley Cath, elevate HOB, oral care quiet room, light massage family education bereavement counselor morphine