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452 Cards in this Set
- Front
- Back
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Nursing defenition
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according to the American Nurses Assoc. nursing is the diagnosis and treatment of human responses to actual or potential health problems
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Nursing process
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systematic method of assessing, diagnosing, planning, implementing and evaluating the care required by any patient in any setting. nursing process is a clinical framework and themeans by which the majority of the Nurse Practyice Acts in the US define practice of nursing
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assessment
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process by which nurse collects and analyzes data about the client
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Implementation
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may include any of these activities, intervening, delegating, and coordinating
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Evaluation
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the process of determining both the clients progress toward the attaining of expected outcomes and the effectiveness of nursing care
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Standard of clincial nursing practice
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established by American Nurses Assoc. divided into two subsets standars of care adn standards of professional performance
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standards of care
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1. assessment, 2.diagnosis, 3. outcome ID 4. planning, 5. implementation, 6. evaluation
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Standards of professional performance
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1. quality of care, 2. performance appraisal, 3. education 4. collegiality, 5. ethics 6. collaboration 7. research, 8. Resource Utilization
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focused health assesment
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performing selected portions of the history and examination. - primary tool by which nurses nurture and sustain life and contribute to the success of the health care team
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emergency nursing assessment
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referrs to the data collection process that occurs in a life threatening situation
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Time lapsed nursing assessment
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repeated assessment obtained to compare data collected at one or more points in time with baseline data
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primary data
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nurse derives directly from the patient, can be subjective or objective
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secondary data
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data derived from all other sources. the sum of all primary and secondary data is the patients database
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Baseline data
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data taken at the time of the first encounter
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objective data
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data capable of being verified
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secondary data
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sources include the patients family and friends, other nurses and professionals
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Gordon's typology of Functional Health patterns
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method to organize data
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valid data
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only valid data is documented, to be valid data must be accurate, complete, and factual. ie recording slept well is an assumtion that may or may not be factual.
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nursing diagnosis
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are derived from assessment. are also called conclusions. the subject of the dx may be a patient, family or community. may be health or life problem. nursing dx directs the planning of patient goals and the selection of appropriate nursing interventions
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components of a nursing dx
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consists of a dx label, the defenition of the dx and its defining characteristics, related factors and risk factors. the dx label is the name of the diagnosis, each dx has its own defenition.
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defining characteristics
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part of each nursing dx. defining characteristics are like manifestations of the diagnosis or signs or symptoms
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related factors
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part of each nursing dx. show some sort of pattern in relationship to the dx. factors may be causative, antecedent to the dx, are associated with a dx are contributing to the dx or are abetting a dx
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risk factors
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refer to those variables that increase a patients vulnerability to developing an actual nursing dx
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types of nursing dx
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actual, risk and wellness
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actual diagnosis
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refers to a human response to a health condition or life process that is happening now at the present time
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risk diagnosis
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refers to a diagnosis that is likely to occure in a vulnerable person
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wellness diagnoses
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refer to human responses to achieve even greater levels of welleness. the dx name or label includes the words potential for enhanced or readiness for enhanced
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formulating nursing diagnoses
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dx may be documented in one of 3 ways, 1. using the dx name or label alone 2. along with its related factors 3. using the name related factor and defining characteristics
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prioritizing nursing diagnosis
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1. physiological needs 2. safety needs 3. social needs 4. esteem needs 5. self actualization needs
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ANA standard of care on Diagnosis
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Anurse analyzes the assessment data in determining diagnoses
dx are validated with the patient, family etc. dx are documented in a menner that facilitates the determination of expected outcomes and plan of care |
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Nursing dx outcomes
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must be time measurable, and attainable.
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Nursing dx goals
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patient centered future oriented and action / direction oriented. always expressed in terms of patients goals to be achieved. most often use the very will do not refer to a nurses to do list, not statements of what tx are to be performed
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outcomes
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statements of reportable observable, or measurable results expected to occur as a reslt of nursing interventions
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Discharge planning
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begins at the time the patient is admitted. involves active participation from the pt. family etc. is faciliated by an interdisciplinary team approach and requires teaching so taht the patient or family is capable of managing post discharge care
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handwritten care plans
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handwritten onto kardex which includes patients id and background info, listing of patients dx's and listing of problem specific interventions
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Standardized care plans
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Joint Commission for the Accrediation of Healthcare Organizations supports the use of standardized plans. they are specific for dx, allow for addl or deletion to accomodate agency policies, sprovide space to tailor, are included in the patients chart
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policies
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written instructions designed to address a commonly occurring problm in an institutionally approved manner
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protocols
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are institutionally approved `preprinted detailed instructions on how to perform specific clinical tasks
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standing orders
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are institutionally and departmentally approved instructions granting the nurse the authority to act in the bsence of a physician
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independent nursing intervention
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include repositioning a patient in bed who is at risk of impaired skin integrity.
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dependent nursing intervention
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ordered by a Dr. or carried out under a physicians supervision for the treatment of a medical dx.
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Terminal evaluation
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evaluation of outcomes which occurs prior to the discharge of a patient from the hospital or prior to a case being closed in a community setting.
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Quality of nursing care evaluation
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looks at structure, process and outcomes
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structure
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the setting or the environment in which the care is given
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process
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the appropriateness of the care given and wheterh policies and procedures were followed to maximize patient safety, minimize medication error, minimize infections , and insure patients and families feel welcome
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outcome evaluation
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examines such quality indicators as number of patient falls, number of new pressure ulcers formed, number of postoperative wound infections and number of tube fed patients developing aspiration pneumonia
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audit
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a record or chart review
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concurrent audit
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uses interview, obersravtion and a chart reviwe to evaluate ongoing practice.
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peer review
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is an audit perfomred by one's colleagues, using standards of practice or other standardized criteria to evaluate performance
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planning
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first step is to identify expected outcomes for each of the actual diagnoses and frame them in terms of patient goals
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ineffective airway clearance
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any patient with thick sputum production, especially a smoker, has the possiblity of developing ineffective airway clearance
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high fever
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any patient with high fever is likely to become dehydrated unless adequate hydration or rehydration occurs
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nursing assistant tasks
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those that address ADL's
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LPN tasks
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include the performance of a number of procedures
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eduemosnistic model of health and wellness
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focuses on health as well beign, self fulfillment and self actualization
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adaptive model of health and wellness
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views health as adaptation to the physical and social world in which a person lives, and views disease as maladaption
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role performance model of health and wellness
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views health in functional terms, if I can function, I am healthy
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clinical model of health
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views health as the absence of disease. emphasis on disease treatment outweighs emphasis on health promotion and diease pervention. also called a traditional defenition of health.
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florence Nightengale's defenition of health
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being well and using every power the individual possesses to the fullest extent
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world health organizations defenition of health
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state of complete physical mental and social well being and not just the absence of disease
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Roy's adaptation model
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developed by sister callista roy, defines health as adaptation and of illness as maladaptation
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role performance model of health
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the ability to function within one's role
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websters defenition of health
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a condition of being sound in minde, body and spirit, especially freedom from physical disease or pain.
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Health Status
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refers to a person health state or condition at one particual point in time.
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health beliefs
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the aymara of Bolivia believe that loss of blood is associated with loss of the persons spirit. health beliefs reflect the influence of a persons culture
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health behaviors
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refer to actions taken to promote health, protect health or prevent illness and disease
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internally controlled person
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self motivated or self directed in effecting healthy behavior changes
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externally controlled person
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requires external motiators
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self efficacy theory
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developed by Bandura, means that if a person believes they can do it, they do it.
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health belief model
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Rosenstock and Becker
examines motivational influences on health behavior chagne as it relates primarily to compliance with treatment regimn for a disease. |
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Health promotion model
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Pender. emphasis is on health promotion behavior change only. it examines cognitive perceptual factors, modifinying factors and participation in health promoting behavior
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Stages of behavior change
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prochaska and DiClementes, examinies any kind of behavior change. therefore it may be applied to health promotion, protection or disease prevention
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stages of behavior changes 1-5
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1 precontemplation
2 contemplation 3 preparation 4 action 5 maintance |
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piaget infant behaviors
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progression cognitively form a stage where most action is reflexive to a circular phase in which the infant perceives other objects and persons as an extension of the self, that is everything returs to the self
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flouride levels
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if less than 0.7 parts per million, then use a supplement
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Eriksons toddler theory
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autonomy versus shame development .
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Freuds toddler stage
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anal stage
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Piagets toddler stage
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12-18 months olds seek new goals and develop rituals
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Havighurst toddler theory
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children in this age group progress in language development, learn urine and bowel control, begin to learn right from wrong
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Kohlbergs toddler theory
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preconventional stage of moral development, distinguishing right from wrong on the basis of reward and punishment.
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Fowler's toddler theory
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spiritual development remains undifferentiated
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westerhoffs toddler theory
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toddler is guided by parents in a simple prayer and ritual
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toddler Dr. info
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recommends visits at 15 & 18 months
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Early childhood
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3-6 years, time of play play is motor development oriented. play is also group oriented imaginative and creative
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Erikson's early childhood theory
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3-6 yo. initiative versus guilt
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freud's early childhood theory
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end anal stage by 2-3, and begin pallic stage 4-5. Oedips complex. Genitals become focus of attention
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Havinghurst's early childhood theory
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3-6 yo child learns to identify sexual differences becomes sexually modest, relate emotionally to parents
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Piagets early childhood theory
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preconceptual phase 2-4 year olds, manifested by egocentrism and begin the intuitive thought phase 4-7 yo which is manifested by decreased egocentrism and kidea formation.
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kohlbergs early childhood theory
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child learns to share and to be kind, helpful etc. this behavior begining around age four is called presocial an dis performed for adult approval. Child is developing a capacity for moral thinking but would not as yet place the child at the level where moral thought occurs
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fowler's early childhoood theory
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childs imagination and experience combine with the images and beliefs transmitted by others to form an intuitive projective spirituality
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westerhoff's early childhood theory
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the child experiences faith within the context of those with whom the child lives
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adolescence
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12-18 years, pubertal development, self concept change, falue testing, stress and conflict.
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Erikson's adolescence theory
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this stage of identity and repudiation versus identity confusion is know for increasing independence in and responsibility for values, choices, and actions
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Freud's theory of adolescents
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genital stage aimed at attainign mature sexual relationship. pregenital stages may be reactivated and then repressed when moving to the genital stage
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havighurst's adolscense stage
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tasks are to establish new relationships with members of both sexes, develop masculine or feminine social roles, accept one's physique , attain emotional independence from parents and other adults
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Piaget's adolescents stage
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this is the formal operations phase, rational deductive and future thinking
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Kohlberg's adolescents stage
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most continue at the conventional level - golden rule or law and order morality. some may proceed to Kohlbergs postconventional stages, where laws and rules are questioned and right and wrong decisions are reached on the basis of one's internally developed value system
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Fowler's adolescent stage
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spiritual development focuses on fashioning a world and envrinment built on others expectations. reject the other people or grous because of differences
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young adulthood 20-40
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20-40 yo. recommended to have a cmplete health exam every one to three years for emales and every five years for males.
monthly testicular self examins or males and breast exams for females. pap smear for all over 18. clinical breast exam q 3 years by a Dr. |
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Erikson adulthood stage
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does not examine the 25-40 age range per se. limited to 18-25 year olds who face the task of achieving intimacy or facing isolation. those in this tage perceive sexual behavior as a desirable expression of intimacy.
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Freud young adulthood
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believes development concludes with the genital stage, entered into in adolescence
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Harvingston young adulthood stage
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developmental tasks are selecting a mate and learning to live together, starting a family, rearfing children, managing a home, becoming established in a occupation
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Fowlers young adulthood stage
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spiritually people between 18 - 30 develope an individuating and reflexive spriituality, meaning they construct their own highly self conscious approach to spirituality
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Westerhoffs young adulthood stage
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young adult enters a faith searching period after questioning and doubting, the young adult develops a cognitively grounded and effective faith.
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Middle Adulthood 40-65
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mid career and lifestyle changes. should have annual heath exams for females and 2-3 years for males. yearly mammograms, pelvic and prostate screenings. TD booster every ten years
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Eriksons view of middle adulthood 40-65
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generative versus stagnation years continue
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Havighursts view of middle adulthood
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tasks are to assist children in transition to adulthood, relateo to spouse as a person, maintane adult civic and social responsibilities
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Fowlers middle adulthood view
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after 30 years of age the person is aware of spiritual truth from a number of different perspectives
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Westerhoff's view of middle adulthood
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indicates that middle adult years are characterized by an owned faith put into action personally and socially. the middle aged adult acts ont he basis of his or her belief
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Older adulthood - young old
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65-74 task of adapting to retirement and accepting changes in physical ability.
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older adulthood middle old
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74-84, have task of adapting to a decrease in swiftness of movement, reaciton time,
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oldder adulthood old old
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85-up, have the task of adapting to increasing physical problems and phychosocially coping with multiple losses
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Erikson's older adulthood view
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integrity versus despair
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freud's view of older adulthood
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genital stage of development remains operative
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Havighursts view of older adulthood
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defines tasks for the elderly as adjustment to retirement, decrease in income, decline in physical health and strength and death of spouse. tassks also include establishing an affiliation with ones age group
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fowler view of older adulthood
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universalizing stage of spirituality in which a person is permeated by and permeats love and justice. this stage may never occure
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westerhoff's view of older adulthood
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faith that is owned continues inot older adulthood
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Prevention of constipation
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dr45ink at least 6 eight ounces of water daily, exercise and include roughage
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health illness continuum
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health illness status of a person is not an absolute state, but a relative placement along a continuum of health and illness
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Travis' illness wellness continuum
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wellness is differentiated from the term health because according to Travis and Ryan, wellness is a choice a philosophy or way of life, the intergration of body mind spirit and high level self acceptance. in the wellness model the person chooses healthy lifestyles and makes healthy choices
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Dunn's high level wellness grid
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looks at two dimensions. one is environment varying form favorable to unfavorable the other is the wellness death diminsion. dunn does not ephasize distinctions between health and wellness as Travis did. Dunn looks at the person within the context of the family, community and society
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Ecological or Epidmiological model of health and illness
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disease is due to a interaction between the disease causing agent, the person or host and the environment. three rings. looks at the agent, host and environment within an interactive system where each componet is interdependnt on the other. epidemiologic means it looks at the cause of and influences on disease
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Ecological model example
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nurse or health educator (agent) who brings people (hosts) concepts and practices that prevention illness within homes and community (environment)
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disease
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specific pathologic state with defined signs and symptoms
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illness
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a unhealthy state or condition of the mind or body in which physical social emotional intellectual or spiritaul functioning is compromised
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sickness
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is the opposite of wellness, a state of not being well, but it has also entered the vernacular to mean discgust
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Talcott Parsons sick roll
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sickness which begins with the experience of signs and symptoms of illness and the assumption of the sick role carrries with it responsibilities that include a search for the health care needed to recover, dependence on health care providers for recovery and participation in recovery. in other words patient is expected to assume responsibility for getting well quick
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stress
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sometimes it refers to the forces or stimul that impinge upon an individual, - stressors. When streass is deffined as a stimulus the resulting model is called a stimulus based stress model
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response based model
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stress is used to describe a persons response.
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general adaptation syndrome
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bodily organs and systoms involved in GAS are the adrenal lymphatic structures and teh GI tract. if only one organ reacts alone, the the resulting syndrome is called a local adaptation syndrome,
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general adaptation syndrome (GAS) and local adaptation syndrome (LAS) typical pattern
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the stressor yields an alarm response, which is followed by a resistance phase, if resistance fails, exhaustion occurs leading to rest recovery or death.
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physiological response to sterss
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shock phase begins, epinephrine and cortisone are released, body prepares for fight or flight
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Fight or flight
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detrusor muscle of the bladder relax, urethral sphincter contracts allowign for greaater bladder capacity without voiding. sympathetic release also stimulates hypothalamus to release corticotrophins
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corticotrophins
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effect the release of pituitary adrenocorticotropin. which acts on the adrenal cortex and the adrenal medulla adrenal cortex releases glucocorticoids are released causing an anti inflamm response. increased blood sugar for energy.
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adrenocortical stimulation
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also causes a release of mineral corticoids which conserve sodium, retain water, increase blood volume, and increase blood pressure.
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stimulation of adrenal medula
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nor epinephrine is released decreasing renal blood flow and increasing renin release, renin is a potent vasoconstrictor. also secretes epinephrine which starts the cycle again.
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shock phase
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first part of alarm reaction. may endure as long as 24 hours
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2nd part of alarm reaction
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countershock phase physiiologic changes reverse themselves. resistance sets in
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3rd phase of alarm reaction
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resistance phase. body attempts to cope, if coping is unsuccesssful, the body becomes exhausted
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final phase of alarm reaction
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exhaustion phaser, either the body rests or you die.
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Stimulus based model negatives
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the stimulus based model does not fully explan why the same stimul are perceived differently.
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response based model of stress - negatives
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doesn ot explain why some people are more inclined to stress than others
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Transaction based model of stress
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Lazarus - four factors operating in streass and adaptation theory. They include the sensitivity of th eperson to stress, the person's vulnerability at any one point in time,
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Summary of Lazarus stress theory
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needs to consider the presence or absence of these orther transactional factors over and above the interaction between environmental stimulus and the individuals respones. . (interpretation of the stimuli)
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Brief of transaction based model of stress
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cognitive (interpretive) affective (mood) and adaptive mechanisms that influence the relationship between an environmental stimulus and a persons response.
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psychologic indicators of stress
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include anxiety fear, anger depression and unconscious ego defense mechanism.
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anxiety
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is a vague and uneasy discomfort stemming from a source that is not easily identifiable. it is an alerting signal of an ill defined threat or danger. As such it is future related..
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anxiety classification
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mild,moderate,severe or panic
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severe anxiety
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characterized by inability to focus except on the anxiety itself. because severe anxiety interferes with a patients ability to function, it requires intervention.
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Panic
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an overwhelming anxiety in which the patient loses contrl of self and in whih distortions of reality may occure
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physical effects of anxiety
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no increased heart rate with mild anxiety. moderate anxiety may have a increased heart and respiratory rate. severe = impaired communication, wide eyed & apprehensive, tachycardia & hypervent.
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fear
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in anxiety there is no clear cut object causing the anxiety. the object of fear on the other hand is known
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anger
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a negative response associated with a feeling of animosity or strong displeasure
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depression
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is more than a passing blue mood. it may be endogenous (stemming from inside) or exogenous (situational or reactive.
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Characteristics of depression
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diminished interest in usual please outlets, change in appetite, change in sleep habits, restlessness, sense of hopelessness, sense of worthlessness, decreased ability to concentrate
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mild depression
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may accompany grief and resemble grief but should not be confused with normal grief reactions that occure with the loss of a loved one.
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compensation
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defense mechanism - compensates for a weakness by overachieving or overcompensating in another area
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displacement
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transfers emotions from one person animal or object to another
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identification
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defense mechanism - imitating the behvior of a feared or respected individual in order to relieve anxiety
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intellectualization
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defense mechanism. distance one's self from an emotionally painful event by subjecting tyhe incident to intellectual analysis
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introjection
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defense mechanism - assuming and accepting the values or norms of others as ones own.
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reaction formation
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defense mechanism. reacts in the opposite manner
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sublimation
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defense mech. turning of aggressive or sexual drives or energy into socially laudable or praiseworth behavior.
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cognition
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simply means thinking
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problem solving
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ability helps a person think through a stress generating problems and find solutions
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structuring
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helps establish a routine yielding a decreased need for change and decreased sterss. extremem structuring creates rigidity and may represent obsessive compulsive tendencies
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self control
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helps a person to assume a I am in control demeanor.
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suppression
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is consciously willing oneself to think of the stressful events at another time.
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fantasy
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another way of responding to stress . if fantasy focuses on practical solution then it can be useful if a persons fantasy focuses on escape, like living alone on a tropical island then it delays problem solving.
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Four most basic techniques in performing a physical
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percussion, inspection, palpation, and ausculation
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palpation
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use the pads of your fingers best at sensing vibrations or at discriminating changes in texture. to palpate light, use3 dominant hand aprallel to the part examines. Deep = fingers of dominant hand are placed on top of fingers of other hand
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performing a physical exam, order
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inspect, palpate, persuss, auscultate. Except for GI inspect the palpate.
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percussion
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lightly but sharply. tape of the fingers may be direct. middle finger tap the frontal mxillary sinuses. percussion is indirect when the nurse uses the middle finger of the dominant hand to tap the middle finger of the other had in an intercostal space or abd.
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general survey of a patient
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includes age, gender , general appearance, behavior, relevance and organization of thought and vital signs resp. rate and temp.
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idea weight of women
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assign 100 #s for the first 5 ft. of height. Add 5 #'s for each addl inch. add 10% if large body frame, subt. 10% if small.
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Mens idea weight
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100#'s for first 5 feet. add on six pounds for every addl inch. add 10% for lg frame, subt 10% for a small frame
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Body mass index
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takes into consideration both weight and height.
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To calculate BMI
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divide weight in Kilograms by height in meters squared. when measuring wt in kids, remember that infants are weighed without clothing. When measuring kids ht, kids up to 2 must be in a recumbent position with knees fully extended.
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techniques used in the physical assessment of the neurological system
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include assessments of crain nerves, deep tendon reflexes, sensory and motor function and level of consciousness
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cranial nerves
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forehead for alignment of eyebrows and the patients ability to wrinkle the forehead and raise the eyebrows first and then symmetrically - cranial nerve V, trigiminal branch of the forehead and cranial nerve VII , facial
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cranial nerve III
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oculomotor eyelids for ptosis or drooping
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Cranial nerve II
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optic, inspect the eyes for visual acuity using the Snellen chart. peripheral vision in the uncovered eye by testing the visual fields
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Cranial nerve VI
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abducens, ask if there is any double vision
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cranial nerve III
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oculomotor, assess they pupils for symmetry
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cranial nerve IV
|
trochlear, eye movement in all six directions up down out
|
|
|
cranial nerve VII
|
close eyes tightly (fascial nerve)
|
|
|
Nerve I
|
olfactory nerve, assess smell
|
|
|
Cranial nerve VIII
|
vestibulocochlear by teating hearing
|
|
|
cranial nerve IX
|
glossopharyngeal,ask patient to identify foods quality of swallowing with small amounts of water
|
|
|
cranial nerve XII
|
hypoglossal, extend tongue without deviating, talk without slurring words
|
|
|
cranial nerve XI
|
spinal assessory, inspect symmetry of shoulders or the drooping of one more than the other by the patients ability to move head side to side even when opposed with mild pressure.
|
|
|
Deep tendon reflexes
|
five deep tendon reflexes biceps, triceps, brachioradialis, patellar and the achilles
|
|
|
biceps deep tendon reflex.
|
spinal cord level c3 and c6. Rest patients arm & place thumb over the biceps tendon
|
|
|
triceps deep tendon reflex
|
level C7/C8find the tendon 1-2 inches above the elbow
|
|
|
patellar deep tendon reflex
|
spinal cord level L2L3 and L4kneecap. use percussion hammer, , kick up = quadricep muscle contracts
|
|
|
achilles deep tendon reflex
|
spinal cord level S1/S2 support the patients foot in your nondominant hand and dorsiflex it . this mvmt stretches the Achilles tendon slightly, observe plantar flexion (jerking downward)
|
|
|
Plantar deep tendon reflex
|
superficial - not a deep tendon reflex. Moving from heel to the ball of the foot and then moving across the ball to the great toe wihle observing a bending downward of the toes. negative babinski = normal. in a abnormal response, the toes flare and move upward. an infant normally has a positive babinski until 6 months old.
|
|
|
brachioradialis deep tendon reflex
|
spinal cord level C3-C6, two to five cms above the wrist.
|
|
|
sensory function
|
may be performed bu ysing a wisp of rolled cotton. Perform lateral and medial assessments
|
|
|
perform motor function tests
|
pt. sits on table - finger to nose, finger to nurses finger, finger to finger, finger to thumb, alternating supinatyion/pronation of hand on thighs test
|
|
|
motor function tests - lying down
|
heel down thin test, toe to nurses finger test
|
|
|
motor performance tests - standing
|
walking gait test, romber test, stand on one foot with eye closed, heel to toe walking test, toe walking heel walking tests
|
|
|
rombergs test
|
facing the patient so that you may steady or catch the patient, ask patient to close eyes, observe sway or its absence. if sway occures document the direction . observation of sway or moving the legs apart to maintain balance is abnormal.
|
|
|
level of consciousness assessment
|
fully alert and oriented to comatose. a score of 15 is the bet possible, a score of 7 or less indicates coma, the lowest possible score is 3.
|
|
|
respiratory sytem assessment
|
inspection, palpation, percussion, ascultation
|
|
|
resp. system inspection
|
inspect for normal size and shape. in the infant the shape is like a round cylinder, the A-P diameter = the transverse. by six yo the shaqpe is less round because the AP diameter is decreasing. adulty ap = tx's transverse.
|
|
|
respiratory system palpation
|
for chest excursion - equal bilateral mvmt on inspiration and expiration. expansion 3-5 cm or 1.5-2 inches. remitus - bilaterally symmetrical, tactile sensations in palmar surface of fingertips upon patients vocalization of words
|
|
|
normal breath sounds
|
are called bronchial, bronchovesicular and vesicular.
|
|
|
inspiratory ration
|
1-2 (short inspiration, long expiration) at bronchial level, 1-1 at bronchovesicular, 5-2 at at vesicular (long inspiration short expiration
|
|
|
lung sounds
|
high pitched and harsh at the bronchial level, moderately pitched and softening at the bronchovesicular level, low pitched and softtly sighing at the vesicular level
|
|
|
bronchial sounds
|
apex of the lungs
|
|
|
bronchovesicular sounds
|
correspond to the area between the apex and the base of the lungs
|
|
|
vesicular sounds
|
correspond to the base of the lungs
|
|
|
adventitious sounds
|
include wheezing, gurgles (rhonchi) and crackles (rales)
|
|
|
wheezing
|
a high pitched whistling sound heard especially over the anterio posterior bronchial areas. caused by bronchoconstriction due to bronchial edema and secretions or bronchial obstruction . not usually relieved by coughing
|
|
|
gurgles - rhonchi
|
low pitched gurgling sounds heard best on expiration and frequently cleared on coughing. these sounds are usually emitted by secretions in the bronchi and hence are heard best over the bronchial areas
|
|
|
crackles - rales
|
sound like noise emitted when salt is thrown into fire or like th enoise that occurs when you use your finger to rub a lock of hair.harshly and quickly near your ear. heard at the bse of the lungs, rales may or may not be cleared on coughing
|
|
|
pleural friction rub
|
heard best along the lateral or anterior chest, sounds like the noise that occurs when you use your fingers to rub a lock of hair back and forth slowly and gently near your ear. occurs throughout inspiration and expiration and is not cleared by coughing
|
|
|
cardiovascular system assessment
|
move head to toe, neck, jugulars, carotids then heart, then peripheral vascular system
|
|
|
assessment of jugular veins
|
inspect the vein with patient lying at a 45degree semi fowlers position. if no distention lower head of bed to 30 deg. and check again. distention over 3 cm above the sternal angle is abnormal
|
|
|
assessment of the carotid arteries
|
inspect for visible pulsating masses palpate gently only one at a time (brain blood flow). to avoid a carotid sinus response, and injurious bradycardia never massage nor apply pressure to the carotid artery, listen to carotid - bruit (murmer like sound)
|
|
|
assessment of heart inspection
|
aortic area (second intercostal space to the right of the sternal border) the pulmonic area (2nd intercostal space to the left of the intercostal border) tricuspid or right ventricular area (5th IC space left of SB) apex 5-6th IC space along the mid clavicular line
|
|
|
heart assessment - auscultate
|
semiflowers 30-45degree angle. s1 and s2 (lub dub) S1 = systole s2 = diastole
|
|
|
heart sound s3
|
left ventricular failure. if failure is suspected but not heard, put patient in the supine position and ask the pt. to turn ot the left side.
|
|
|
s4 heart sound
|
abnormal in the child or adult although it may be present in a healthy appearing older adult. sound occurs immediately before the first heart sound r/t decreased flexibility of LT vent. - hyerptension.
|
|
|
s3 + s4
|
= gallop rythem
|
|
|
mumurs
|
swooshing noises that occure during systole, diastole or throughout the cardiac cycle they are casued by turbulent blood flow though one or more heart valves.
|
|
|
peripheral vascular system assessment
|
nails - clubbing, capillary return, buergers test, rubor (rubby redness) find pulses bilaterally head to toe
|
|
|
Buerger's test
|
arterial adequacy test
|
|
|
pulses
|
brachial radial, femoral posterior popliteal, posterior tibial and dorsalis pedis
|
|
|
bruit
|
indicates turbulent flow caused by a partial femoral obstruction, requiring prompt notification of the MD>
|
|
|
abdominal assessment inspection
|
inspect for contour symmetry in supine and semi flowers and standing positions
|
|
|
abdominal assessment, auscultate
|
gurgling sounds q 5-20 seconds. before saying they're absent listen 3-5 minutes
|
|
|
abdominal assessment percuss
|
beginning in the right lower quadrant persuss in a straing line up until the sounds of tympany change to dullness. this is the lower rt margin of the liver. beginnin at umbilicus, go up until chagnes - this is lower left margin of liver. begin at rt midclavicular line, persuss down, - upper rt margin of liver. begin at sternal border - percuss down = upper lt margin of the liver
|
|
|
abdominal assessment palpation
|
ileosecal area to right lower quadrant, progressing up over the ascending colon, across over the transverse colon, and down over the descending colon, rt uq = liver or gallbladder
|
|
|
ADL assessments
|
performed upon admission of a clinet to the hospital or health care agency and at those points in time when changes are expected
|
|
|
instrumental activities of daily living (IADL)
|
refers to tasks involving the basic tolls or instruments of daily life needed to live independently. including use of a phone, meal prep, laundry, meds, and handle finances
|
|
|
mental status assessment
|
involves attention span, baility to calculate, memory, and assessment of speech and language and assessment of orientation
|
|
|
Speech and language assessment
|
sensory ability is either visual or auditory. loss of the ability to interpret both writtend and spoken words is sensory aphasial
|
|
|
visual aphasia
|
loss of ability to interpret written words
|
|
|
motor or expressive aphasia
|
loss of ability to use words appropriately
|
|
|
immediate recall test
|
ask person to repeat 3 to 8 digits. the ability to repeat 5-8 is considered normal
|
|
|
recent memory test
|
ask patient to recall todays events
|
|
|
remote memory test
|
ask patient to recall and describe an event from the past, also called long term memory
|
|
|
attention span assessment
|
ask patient to count backwards from 100 or to recite the alphabet
|
|
|
calculation assessment
|
ask patient to subtract seven or three form one hundred then continue sub. 7s these test are called the serial threes or seral sevens .normal - completion in 90 seconds
|
|
|
primary prevention
|
aims at preventing illness and disease before it occurs. techniques include teaching health promotion
|
|
|
secondary prevention
|
intended to detect and treat disease and health problems in the earliest stages . techniques include, screenings, nursing assessments, neruo checks, administration of meds
|
|
|
tertiary prevention
|
designed to restore maintain and maxamize health & optimize functioning in the later stages of illness. ie referring patients to support groups
|
|
|
Breast cancer
|
most common cancer among women in the US and second leading cause of cancer related deaths. only skin cancer is more common than prostate cancer amont men. prostate cancer is 2nd only to lung CA as leading cause of CA deaths in men
|
|
|
Orthodox jews circumcision
|
done on 8th day after birth
|
|
|
four catagories of inteventions
|
stress reducing, alternative/complementary therapies, research derived interventions, research derived interventions and clinical practice guidelines
|
|
|
stress reducing interventions
|
also called mind/body therapies. incl. progressive relaxation techniques, biofeedback, imagery, yoga, mediation, prayer, musical therapy and hypnosis
|
|
|
progressive relaxation
|
in quiet place, progressively tense and relax each muscle group. to complete this exercise it takes at least 10 minutes.
|
|
|
biofeedback
|
process by which the body learns to bring autonomic nervious system responses under its control. these responses incl. heart rate, rhythm, blood pressure, peristalsis and skin temp.
|
|
|
process imagery
|
may be used to prepare a patient for an anxiety provoking prcedure by mentally rehearsing the procedure process with the patient in a calm atmosphere
|
|
|
end state imagery
|
find healed state.
|
|
|
mediation
|
altered state of consciousness in which the mid is focused in passive attention and quiet resulting in an experience of transcendence. focus on object and repeat mantra
|
|
|
yoga
|
system of belief and practices aimed at the union of the individual self with the universal self. takes 8 stages to get to this union
|
|
|
hypnosis
|
method of altering consciousness by focusing attention on one thought thereby distractign consciousness from other thoughts
|
|
|
National institute of health office of alternative
|
studies the use of complementary and alternative medicine (CAM).
|
|
|
complementary and alternative therapy
|
touch therapy, massage, reflexology, accupressure, aromatherapy, chiro,
|
|
|
research derived interventions
|
many interventions address the objective of Healthy people 2000
|
|
|
healthy people 2000
|
the nations disease prevention and ehalth promotion agenda. coordinated by US dept of Health and human services office of disease prevention. now HP 2010.
|
|
|
Fraingham heart study
|
1948 - over 5k residents in Framingham MA. studies relation btw dietary fat and blood cholesterol levels, & tobacco, wt, and HBP and heart disese
|
|
|
Nurses health study
|
1976 Dr. Frank Speizer of Harvard began a large study into risk factors for major chronic disease in women.
|
|
|
Nurses Health study II
|
by Dr. Walter Willet also of Harvard. RN's were chosen for the study because of their ability to respond to brief, technically worded questions and becausei t was assumed they would be willing participants. This is still ongoing
|
|
|
agency of healthcare research and quality AHRQ
|
leading federal agency on quality research. one of its tasks has been to develop and disseminate clnical practice and provide organization
|
|
|
National Guidelines Clearinghouse
|
includes its own clinical practice4 guidelines as well as those developed by health professional organizations foundations and other government agencies
|
|
|
Diagnoses
|
the conclusions drawn form the assessment process, and they are listed in their order of priority
|
|
|
safety
|
freedom from the risk of injury
|
|
|
temp. comfort zone
|
18.3 to 23.9 Celsius (65-75 F)
|
|
|
Avoid inducing vomitting for the following
|
oils b/c r/o aspiration, acid, alkalines -esophageal damage
|
|
|
radiation
|
overexposure to radiation in adults may result immediately in radiaation sickness. if the patient survives the initial then = great risk of CA
|
|
|
Traditional rememdies
|
some contain lead. Greta and azarcon are mexican tx for disgestive issues & have lead in them
|
|
|
azoque
|
Contains mercury!
some Latin Americans use to tx dirrhea |
|
|
coining and cupping
|
practices that require theapplication of aheated coin of the heated mouth of a cup to the back or neck.
|
|
|
Topical garlic
|
traditional remedy for Yemenite Jews placed on wrist to tx infectious disease. may resul in the formatino of blisters or garlic burns
|
|
|
poisonous plants
|
have become one of the nations leading substances causing toxic ingestion
|
|
|
Regional Poison Control Center
|
located at cardinal Glennon Childrens hospital in St. Louis Missouri
|
|
|
bicycle related head injuries
|
cause 67% of bicycle related deaths each year.
|
|
|
rear facing car seat
|
birth to 20 pounds or as close to one year as possible
|
|
|
fire safety
|
R- rescue
A - Alarm C - Confine E. extinguish |
|
|
PASS
|
to operate a extinguisher correctly. P=pull pin, A = aim, s = squeeze handle, s = sweep the fire from side to side.
|
|
|
ultraviolet A waves
|
are longer waves responsible for photosensitivity, photoallergic, or phototoxic reactions. a = allergy
|
|
|
Ultraviolet B rasy
|
shorter and are responsible for burning, tanning, and skin cancer. B = burn. Max exposure = btw 10am and 3pm.
|
|
|
Para Amino Benzoic acid (PABA)
|
frequently found in sunscreens. it increases the efectiveness of the screen.
|
|
|
Parsons 1789
|
only sunscreens with this in it are effective against UVA and UVB radiation . Do NOT apply sunscreen to infants less than six months of age.
|
|
|
Carbon monoxide detectors
|
must be approved by underwriters laboratory
|
|
|
physical restraint alternatives
|
leg bands. Bed/chair exit safety monitor = position sensitive
|
|
|
Rogers and Bocchino
|
outlined restraing avoidance or restrain substitute strategies
|
|
|
IV lines
|
capped IV lines are much preffered to Keep Open IV lines.
|
|
|
Document the following on all restraint interventions
|
your assessment and DX. Alternative interventions attempted, time physician was notified, order given, reason for the restraing. client/guardian permission for restraing. time applied, pts response q 30 min, time given joint exercise and skin care
|
|
|
use of restrains
|
must be per physician approval. within 24 hours if emergency
|
|
|
MD order for restraints
|
must say why and length of time to be used.
|
|
|
mummy restraing
|
blanket wrapped ina special way to enclose a childs body to prevent mvmt during a procedure
|
|
|
1976 Omnibus udget Reconciliation Act (OBRA)
|
states nursing home residents have the righ tto be free from physical or chemical restraints that are not required to treat specific medical conditions
|
|
|
safety research for restraints
|
research has shown the restraints double hospital length of stay. restrained patients are 8 x more likely to die than unrestrained.
|
|
|
assessment
|
refers to the gathering of health data
|
|
|
medical asepsis
|
refers to biological safety techniques used during daily routine care to prevent infection or control its spread
|
|
|
surgical asepsis
|
refers to those techniques a nurse uses to establish and maintain a field free of all organisms, including spores. used for IM injections, starting IVs, chaning surgical dressings,
|
|
|
medical asepsis chain of infection
|
infections agent,2. reservoir, 3 portal of exit, 4. mode of transmission. 5. entry portals 6. susceptible host,
|
|
|
methods used to control or eliminate infectious agents
|
cleaning - , disinfection and sterilizing.
|
|
|
cleaning
|
removal of all foreign material from objects by cleansing, which inhibits the growth of organisms. six steps rinse, hot water, clean grooves, rinse, towel dry, clean sink bursh etc.
|
|
|
disinfecting
|
removes all but spores. May be bactericidal or bacteriostatic
|
|
|
sterilizing
|
destroys all MO's including spores. moist heat (autoclaves), free steam, gas, boiling radiation.
|
|
|
Stage one of a inflammatory response
|
1. vascular and cellular response, histamine release causing vasodilation altered capillary permeability causes leakage of leukocytes which stimulates an increase in leukocyte producti8on resulting in high white blood cells.
|
|
|
Stage II of a inflammatory response
|
exudative stage. fluid that seeped through blood vessels, dead phagocytes & dead tissue cells form exudate.
|
|
|
exudate catagories
|
serous-clear, serum like
purulent-pus, containing drainage sanguinous - dark or bright red bloody drainage serosanguineous-thin, bloody drainage diluted by serous fluid |
|
|
stage III of a inflammatory response
|
reparative phase. regeneration of tissue.fibrous tissue formation = 2 stages, 1st=fragile granulation tissue laid down 2. firm tissue called cicatrix tissue develops.
|
|
|
antibody mediated response (AKA humoral circulating immunity
|
resides in the b lymphocytes and the antibodies produced in B cells mediate the response. B cells acitvated by FB which activates ATB's
|
|
|
another word for antibody
|
immunoglobulin.
|
|
|
IgM
|
when present, indicates the client is currently or actively infected. 1st Immunogobulin produced during a response
|
|
|
IgG
|
when present, indicate the client was infected by this specific pathogen in the past. Crosses placenta to provide protection to baby
|
|
|
IgA
|
located in external secretions and in the resp. tract and plasma
|
|
|
IgD
|
function unknown
|
|
|
IgE
|
produce the typical signs and symptoms of allergy and anaphylaxis
|
|
|
cell mediated defense (aka cellular immunity)
|
resides in T cell system. on exposure lymphoid tissue released large amt of T cells.
|
|
|
stages of a infectious process
|
incubation, prodromal, illness and convalescence
|
|
|
incubation period of a infection
|
time btween the invasion and the first sign or symptom
|
|
|
prodromal stage of infection
|
time between onset of nonspecific signs and symptoms of infection to more disease specific signs and symptoms
|
|
|
illness stage of infection
|
during which the disease specific signs and symptoms are present
|
|
|
convalescence stage of infection
|
the time period between the disappearance of the acute signs and sumpts of the disease and full recovery
|
|
|
wound healing phases
|
inflammatory, destructive, proliferative, maturation
|
|
|
inflammatory phase of wound healing
|
hemostasis occurs- vessels constrict platelets form making a fibrin matrix. injured tissue and cells secrete histamine - vasodilation - increased permeability which allows serum and WBC to pass forming exudate. s&s redness, etc.
|
|
|
destructive phase of wound healing
|
2-5 days. macrophages continue to clean wound and stimualte fibroblast which makes collagen - main ingred. in scars. fibroblasts need vitamin B, and c and amino acids and O2
|
|
|
proliferative phase of wound healing
|
last 3-24 days. characterized by beginning of wound closeure and increasing strength of closure
|
|
|
maturation phase of wound healing
|
final stage. increased strength of closure, - several months to a year.
|
|
|
healing by primary intention
|
when sides of wound are closed with bandage of some kind
|
|
|
secondary intention healing
|
wound is not approximated but allowed to close by filling with scar tissue
|
|
|
abscess
|
sac like accumulation of pus
|
|
|
macule
|
small red spot
|
|
|
nodule
|
node or aggregation of cells. subq nontender
|
|
|
papule
|
red elevated are on the skin that is solid. smaller than 0.5cm
|
|
|
pressure ulcer
|
also called decubitus ulcer. caused by shearing or friction
|
|
|
pustule
|
sac like lesion
|
|
|
tumor
|
spontaneous new unrestrictive growth of tissue
|
|
|
ulcer
|
open sore that may be associated with deep loss of skin
|
|
|
stages of pressure ulcers
|
1-4
|
|
|
stage one of pressure ulcer
|
the skin is intact but a nonblanching erythema is present
|
|
|
stage II of pressure ulcer
|
partial thickness skin loss that involves the epidermins and may extend into the dermis. the lesions presents as an abraision, blister or shallow crater
|
|
|
stage III of pressure ulcer
|
full thickness skin loss, including damage to or necrosis of subq tissue but not the fascia lesion looks like a deep crater.
|
|
|
stage IV of pressure ulcer
|
full thickness skin loss with damage to or necrosis of muscle, bone and surrounding structure
|
|
|
hemorrhage
|
is an abnormal loss of blood
|
|
|
internal hermorrhage
|
characterized by a iformation of a hematoma
|
|
|
dehiscence
|
is the partial or complete rupture of a sutured wound usually abdominal and is most frequently accompanied by at least partial seperation of the underlying tissue
|
|
|
evisceration
|
is the protrusion of viscera through a dehisced wound
|
|
|
deficiencies in Viatimins B & C
|
lead to poor wound healing
|
|
|
shaman
|
one who uses magic to cure the sick
|
|
|
DOT
|
directly observed therapy. used for antiTB therapy
|
|
|
empirical therapy
|
when a Dr. gives a tx prior to C&S being done based on the Dr.s expert knowledge
|
|
|
NSAIDS
|
to minimize gastric irritation, take with food. may cause asthma attack
|
|
|
clean
|
near absence of microorganisms
|
|
|
dirty
|
soiled or contaminated objects capable of causing infection
|
|
|
three principles needed to obtain medical aespsis
|
1. items entering the vascular system must be sterile. 2. all items contacting the mucus membrane that is not intact must be free of MOs 3. all items that contact the skin must be clean
|
|
|
handwashing
|
10-15 seconds
|
|
|
sterile field
|
in surgery requires use of mask gloves gown
|
|
|
area of sterile field considered contaminated
|
2.5 cm edge.
|
|
|
wound healing by proximal intention
|
wound is usually cleansed daily allowed to dry then redressed. dressings are no longer needed after drainage stops
|
|
|
for wounds healing by 2ndary intention,
|
the dressing material itself provides a means of removign exudate and debris
|
|
|
five types of dressings
|
dry gause, wet dressings, nonadherent dressings, self adhesive dressings and hydrocolloid dressings
|
|
|
Hydrocolloid dressings
|
hydrogen gel. occlusive & contain gel forming agents. form a waterproof barrier. they liquefy debris. used for shallow to moderate skin ulcerations
|
|
|
normal white blood cell count
|
4500-11,000
infection = leukocytosis |
|
|
ESR - erythrocyte sedimentation rate
|
nonspecific test that detects the presence of inflammation. rises with autoimmune diseases. 0-15 normal
|
|
|
serum albumin levels
|
albumin is a resevoir for nitrogen which is needed for tissue growth. when blood vol decreases, SA increases. a high SA level may mean dehydration. low - liver or renal disease 3.4-4.8
|
|
|
Harrison narcotic act
|
begain in 1914. classsified narcotics and established reulations. later refined under the controlled substance act
|
|
|
drug addict defention
|
any individual - habitually uses any narcotic drug as to endanger public morals
|
|
|
drug dependent
|
experiences withdraws
|
|
|
Cough syrup with docein
|
is a class V controlled substance
|
|
|
distribution of narcotics
|
only those health professionals registered with the DEA and possessing a registration or DEA number may write a RX for a controlled substance
|
|
|
dispensing narcotics
|
dose is written in med record and on narcotic inventory sheet
|
|
|
Schedule II drugs
|
may not be dispensed in the hospital for a period longer than seven days with any single order
|
|
|
Schedule III and IV
|
limited by the federal government to one hundred dosage units or to 33 days whichever is less
|
|
|
NP and narcotics
|
can not prescribe them.
|
|
|
drug name
|
chemically it contains the same therapeutic or active ingredients, but different binding agents
|
|
|
pharmocokinetics
|
refers to drug absorption distribution biotransormation and excretion
|
|
|
drug absorption
|
occurs by means of diffusion, active transport or pinocytosis
|
|
|
diffusion
|
fat suluble drugs are nonpolar nonionized drugs that passively diffuse back and forth across membranes once they break down
|
|
|
active transport
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is the movement of molecules across a cell membrane it is used to move polar ionized drugs cross cell membranes
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pinocytosis
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is a process by which cells ingest smal sac or vacuole
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PO meds
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bile is needed to facilitate the systemic absorption of fat soluble drugs. food stimulates bile absorption, therefore food helps the absportion of fat soluble drugs, food inhibits the absoprtion of water soluble drugs
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achlorhydria
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the absence of hydrochloric acid in teh stomach inhibits the absoprtion of acid based drugs and inhibits the dissolution of alkaline or basic drugs
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PH of drugs
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acidic drugs are absorbed more rapidly by the acidic gastric mucosa. basic drugs are absorbed more rapidly by the more alkaline intestinal mucosa
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enteric coated drugs
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coating stays until it reaches the intestine. absence of bile and pancreatic enzymes inhibits the dissolution of enteric coated agents
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subcutaneous injections
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subcu tissue damage occurs readily. oils are irritating and are nto give subq maximum subq i one MM.
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intramuscular
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speedier than subq b/c of the rich blood supply in muscle. up to 2ml are tolerated well massage to the site after injection accelerates absorption
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IV meds
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usually only water based solutions. deliver IV push very slowly. fat emulsion during parenteral feeding may be administered by IV but central lines are best
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drug half life
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time needed fo rthe blood level of the drug to decrease by 50%
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vectors
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needed to distribute DNA during gene therapy. 2 = liposome, 2nd = virus
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first pass effect
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refers to absorption of drugs through the intestinal tract and the drugs entry into the portal circulation before entering the systemic circulation. first pass thru liver - detoxifies before going ststemic
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prodrugs
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are drugs that upon biotransformation (metabolis) in the liver, produce active metabolites ie heparin after passing through the liver becomes morphine
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hepatic isoenzyme syste
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performs an important role in biotransformation one major enzyme is P450 system. drugs that inhibit P450 speed it up
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half life abbreviation
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t1/2
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half life basics
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water soluble drugs have short half life(hours) lipid solubles - days. digoxin = 36-48 hours
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drug excretion
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thru lungs, exocrine glands,kidneys liver and intestine.
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glomerular filtration rate
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as fluid volume increases, the rate of filtration increases and the rate of reabsorption decreases
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urine PH
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acidic urine pH traps acidic drugs and an alkaline urine pH traps alkaline drugs
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Undesired drug effects
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may be categorized as iatrogenic effects, side effects adverse effects, toxic effects, allergic and immunological reactions and carcinogenic, chain reaction, cumulative, idiosyncratic and teratogenic reactions
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iatrogenic effects
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a illnes induced in the client by the drug. ie ace inhibitors can cause a cough
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medication side effects
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actions or effects of a drug that are not specifically intended. althought usually adverse they may also be beneficial.
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bone marrow supression signs and symptoms
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anemia, neutropenia, thrombocytopenia,
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neurotoxic reactions from medications
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CNS-confusion,excitation, sedation, thought distrubances, depression
ANS- constipation, diarrhea PNS - paresthesias, perpheral neuritis, cranial nerve deficits |
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Stevens Johnson syndrome
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caused by some PCN, sulfa. hydantoins, allopurinol.. progressive and erosive involvement of mucous membranes of the mouth, esophagus nose nasopharynx, trachea bronchial tree and genitalia.
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toxic epidermal necrosis
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caused by same agent as stevens johnson syndrome. similar reaction, but progresses to 30% loss of epidermis due to necrosis
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anticoagulant induced skin necrosis
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occlusive thrombi of vessels supplying skin and subq tissue of areas with large amounts of adipose tissue
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toxic effect of drugs
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those effects secondary to an elevated plasma concentration of the drug
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allergic / immunologic reaction drug reaction
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account for 10-50% of all adverse drug reactions. 4 types I,II, III, IV
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Type I reaction
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results from IgE. characterized by uticaria, angioedema and anaphylaxis. first sign = may be difficulty swallowing or breathing.
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Type II reaction
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IgG and sometimes IgM. s&s those of hemolysis (break down of RBC). FEever. Acute flank pain - RBC affecting Kidneys. . bad blood - clerical error
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Type III reaction
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antigens interact with antibodies resulting in serum sickness. Fever, arthralgia rash. within a few days of injection. ersolves 7-14 days
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Type IV reaction
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rash, 2dary to topical agents. mediated by T Cells. rare with systemic drugs
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carcinogenic reaction
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drug induce3d changes in DNA
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chain reaction of medication
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ie steroid PT - sodium retention, increased fluid volume, HTN, etc.
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cumulative effects of drugs
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serum plasma level sof a drug rise or when the amount ingested exceeds that excreted. digoxin can have a cumulative effectt with no S&S.
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intradermal agents
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a minute amount of agent is injected. producing a tiny buldge in the skin. - TB
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eyedrops and ointments
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dropped into lower conjunctival sac, never onto the cornea.
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ear drop meds
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kids pull ear lobe down and back. adults, pull up and back. tepid water to prevent vertigo
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metered dose inhaler
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do not put all the way in mouth. can use a spacer. driven by a gas propellent.
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six general principals of using inhalers
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1. allow 1-2 minutes btw puffs 2. after inhaling, hold breath. 3. wash 2qd. 4. rinse mouth 5. have a back up. 6. never use long acting meds for asthma attack.
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nebulizer
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delivers a fine mist or spray. spinhalers and roahaler accept capsules or powder.
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calculating pediatric meds
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need ht, wt, and body surface area. if drug is not exceptionally toxic, can use wt as guideline.
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IV flow rates
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ml x dropss / milileters
--------------------- minutes |
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how many drops per minute to give 1000 ml in 480 minutes using a drop factor of 15
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1000ml x 60 drops/ml
___________________ 480 minutes = 124.8 = 125 |
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titrating a dose or titratino
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refers to adjusting a dowe to achieve a desired effect. oral and iv meds may be titrated.
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IV dosage rations
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if the ratio is 1:6 then the proportion is 1/6 or 0.167
a proportion multipled by 100 yields a percent |
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five rights for patients meds
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drug, dose, client, route, time.
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right drug
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medication administration record,Kardex and the drug label must all agree
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therapeutic index
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a measure of the relative safety of a drug. If 100 animals test the lethal dose / effective dose yields the therapeutic index. Higher T1 = safter
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plateu or steady state principal
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refers to the fact that when a drug is given at fixed intervals, it takes four or five half lives for its plasma concentration to reach a steady staet or plateau level
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trough level
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refers to the plasma concentration of the drug prior to the next dose. rising trough level implies increasing risk of toxicity
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drugs & pregnancy ratins
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A.B.C.D,X. A- least harful to the fetus .
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GsPD
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glucose 6 phosphate dehydrogenase. controls level of methaemoglobin. affects drug metabolism.
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I & O
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under supervision CNA can monitor I & O. Output should be at least 2/3rds of intake. 30-60 ml per hour.
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nitro
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can give up to 3 doses under the tongue
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thought disturbance
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thought to be associated with a increased dopamine level
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akathisia
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motor restlessness, pacing rocking or foot tapping
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dystonia
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acute muscle spasms of neck face jaw tongue or hyperarching of the back
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tardive dyskinesia
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involuntary and abnormal face arm or leg movements. tongue darting, lip smacking
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phenytoin
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used to tx seizures, long term use causes mouth issues.
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medication effects on the automnomic nervious system
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r/t effect on adrenergic and cholinergic systems. (sympa / para).
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Monomine oxidase - A
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A=alpha, means metabolized or degrades nonepinephrine antidepressent
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MAO B
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(b - beta) txs parkinson's disease
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stomatitis
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result from cancer chemotherpay. it is an inflammation of themout and may be accompanied by ulceration and dry mouth
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hematologic effects from medication
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occur as a resultl of administration of agent sthat alter the production of red blood cells, white blood cells, platelets and or hemoglobin that increases or decreases clotting ability.
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folic acid deficiency
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may lead to megablostic anemia recommend all wome of child bearing age take .4 mg
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pernicious anemia
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no intrisnic factor, bitamin B12 cannot be absorbed, which causes abornmal RBC production.
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platelet count
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150000-400000
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thrombocytosis
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overproduction of platelets. polycythemia ver is a disease characterized by an overproduction of platelets
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fibrinolytic agents
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clot busters
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hemostatic agent
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used to control bleeding. Vitamin K -
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common advic
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based on unprofessional opinion
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heiarchy of needs
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most to least. food basic, air water etc. nest, sex, next safety, love, esteem, self actualization
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