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105 Cards in this Set

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Research utilization involves:
a. Communication of research findings
b. observing outcomes from changing practice
c. use of knowledge in practice
d. all of the above
D. all of the above

Research utilization requires that the knowledge generated through research be communicated to nurses, other health care professionals, and consumers for use in practice to achieve the desired outcomesfor patients, nurses, and health care agencies
Which of the following strategies for communication of research findings would reach the largest audience?
A. Presentation at a nursing research conference
B. Presentation to legislators
C. Publication in a nursing journal
D. Television news release
D. Television news release
A TV news release would reach the largest amount of nurses, other health care providers, and consumers. The other options reach only a selected audience, such as nurses or policy makers.
Which strategy of communicating research findings would probably have the most lasting effect?
A. Presentation at an interdisciplinary conference
B. Presentation in a clinical journal
C. Publication in a clinical journal
D. Publication in a research newsletter
C. Publications in clinical journals are accessible by practicing nurses, nurse researchers, and other health care professionals for years. Newsletters and presentations are available for only a limited period of time to select audiences.
Comprehensive scholarly synthesis of scientifically sound research that is evident in integrative reviews or research and meta-analyses is called:
A. cognitive clustering
B. comprehension of research findings
C. research summary
D. synthesis of clinical findings
A. cognitive clustering
Cognitive clustering is a comprehensive scholarly synthesis of scientifically sound research that is evident in integrative review of research and meta-analyses. Expert researchers, who have programs of research in this area, often do these summaries that are published in research and clinical journals or books.
Which of the following has not been identified as a barrier to using research knowledge in nursing practice?
A. Findings are communicated primarily to other researchers
B. Nursing studies have adequate replication
C. Practitioners often do not value research
D. Researcher-oriented studies often do not solve pressing clinical problems
B. Nursing studies have adequate replication. Nursing studies that have adequate replication are strengths for research utilization, not barriers.
A nurse practicing in a SNF heard about a new way to prevent falls in elderly patients from the nurse practitioner providing care to patients in the SNF. The nurse worked with that nurse practitioner to implement a protocol to prevent falls. The nurse's actions are typical of:
A. early adopters
B. innovators
C. laggards
D. late majority
A. early adopters
Eraly adopters learn new ideas repidly, use them, and then serve as role models in their use, but often do not create or initiate the implementation of new ideas. In this example, the new idea was communicated by the N.P. (innovator) to the nurse (early adopted) who assisted with making the change in practice for other nurses and health care professionals.
Approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality care
Evidence-based prcatice
What are the 3 components that the nurse must be aware of when dealing with EBP?
1) Best available research evidence
2) Client population characteristics, state, needs, values & preferences
3) Resources, including practitioner expertise
What is translational research?
translating findings that are discovered in a controlled environment to real-life practice. Also, the outcomes found from human clinical trials need to be adopted and maintained in clinical practice.
-• The testing of the effect of interventions in real life.
• Aimed at promoting the rate and extent of adoption of EBP by healthcare providers.
•Translational research further subdivided to describe both T1, which is moving research findings from "bench to bedside" and T2, the translation of results from clinical studies into everyday clinical practice and health decision-making.
•The work in this competency is directed to T2.
Research
The systematic investigation of clinical phenomenon or the generating of new knowledge.
Research utilization
- Was a term used in the 1980’s and 90’s to describe a 2-step process of dissemination and implementation.
- Spread the word about your findings!
Dissemination
The systematic efforts to make research available. Spreading the word about your findings!
Implementation
Is the systematic use of scientifically sound, research-based innovations.
How does EBP build onto research utilization?
Builds on RU and integrates clinical expertise and patient/family preferences and values.
Clinical Practice Guidelines
Are systematically developed statements to assist practitioners and patients make decisions about appropriate health care for specific clinical circumstances
Compatibility (EBP)
How the EBP is perceived as consistent with the needs of the adopters or with past practice
Complexity (EBP)
How difficult the EBP is to use and understand. (How many steps, one step =good. Too many steps makes it too hard to implement).
What are the steps to EBP?
1. Create an EBP culture (where clinicians are committed to all steps of the EBP process)

2. Ask clinical questions in PICO format

3. Search for the best evidence (use multiple sources to locate information, clearly identify search terms, inclusion and exclusion criteria (wouldn't want evidence about thyroid procedures with dogs)

4. Critically appraise the evidence (Is there siffiecient research? Are the results valid? Was there enough rigor? Hierarchy of evidence?)

5. Integrate the evidence with clinical expertise and patient preferences and values (Adapting the protocol to fit the needs of the stakeholders (clinicians and clients))

6. Evaluate the outcomes of the practice decisions or changes based on the evidence and applicability to your client population. (Did outcomes improve???)

7. Disseminate EBP results

8. Continuous evaluation of outcomes
What does PICO-T stand for? What is it used for?
Population (participants of interest)
Intervention (needed for practice)
Comparison (of interventions to determine which is best for practice)
Outcome (needed for practice)
Time

oExample: P: Among residents of a skilled nursing facility (mostly elders), how would I: playing music in the dinning room from T: 7am to 8am C: compare with the usual practice of not playing music O: affect the number of people having breakfast in the dinning room (communication, social interaction)?

Used to:o The PICOT define a problem and formulate a specific question about it
What are some examples of synthesized knowledge that you can use in EBP?
•National Guidelines Clearing House – Started in 1998 to store EB guidelines, provides free access and updated weekly
•Evidence-Based Nursing
•The Johanna Briggs Institute
•Cochrane Collaborative
•Health Information Resources
Expertise
reflected in numerous ways, but especially in regard to effective and efficient assessments and diagnoses, thoughtful identification of problems, and compassionate use of individual patients' predicaments, rights, and preferences.
What are some barriers to EBP?
•Lack of time to locate and synthesize knowledge (Not enough time to research and get enough approval for your new EBP protocol)
•Negative attitudes towards research and EBP
•Some nurses lack of skill to search the literature and to interpret evidence
•Access to the internet and computerized resources
•These barriers need to be kept in mind even as one moves through the steps in the process.
•It is your obligation to bring these new ideas to practice, to better the practice.
When can you disseminate your EBP results? What step is "dissemination"?
Stage 7: Dissemination
oWhen the practice change has been modified sufficiently in the Pilot Testing Phase, so that it is working as expected, it is ready to be implemented in other areas.
oA detailed dissemination plan is needed to ensure a smooth implementation process throughout the organization. This includes planning for communication and training, and obtaining sufficient resources.
oSend a publication out!
What is the justice perspective of EBP?
fairness of benefits distribution among beneficiaries should guide implementation of EBPs.
What is the utility perspective of EBP
maximization of benefits and minimization of risk should guide implementation of EBPs.
What is a BMI that would be considered "underweight"?
<18.5
What would be considered a normal BMI?
18.5 - 24.9
Which BMI range is considered to be overweight? Obese?
Overweight --> 25.0 -29.9

Obese -->
Class I: 30.0-34.9
Class II: 35 - 39.9
Class III: 40.0 + (Extreme obesity)
What is a BMI that would be considered "underweight"?
<18.5
What are the daily recommendations of vegetables, fruits, grains, meat, & dairy?
The food pyramid indicates that the client should have:

Grains: 6 to 7 oz per day
Vegetables: 3 cups/week dark green veggies
2 cups/week orange veggies
3 cups/week legumes
3 cups/week starchy vegetables
Fruit: 1.5 to 2 cups fruit per day
Meat: 5 to 6 oz meat and beans per day
Dairy: 3 cups milk, yogurt, and cheese per day.
How do you determine which foods a person on a full liquid diet can or can't eat?
A full liquid diet contains only liquids or foods that turn to liquid at body temperature. Pudding, juices, hard candy, Cream of Wheat cereal, and fruit smoothies are permitted on a full liquid diet.
What is the best indication of proper placement of a nasogastric tube in the stomach?
Gastric secretions are acidic as evidenced by a pH of less than 6.
What are some things to remember with gravity feeding tubes?
- Should be at room temperature to avoid cramping
- Should be hung at least 1 foot above the insertion point
- Feedings may be administered if there is less than 90 to 100 mL of residual volume
- To prevent or reduce the risk of aspiration, the client should be placed in Fowler’s position during feeding
What are the 6 classes of nutrients?
Which are needed for energy?
Which are needed to regulate body processess?
6 classes of nutrients:
1) Carbohydrates
2) Proteins
3) Lipids
4) Vitamins
5) Minerals
6) Water

Needed for energy: Carbs, proteins, lipids
Needed to regulate body processes: vitamins, minerals, water
What are some factors that increase the BMR? (Basal metabolic rate)
Growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (epinephrine and thyroid hormones)
What are some factors that decrease BMR?
Aging, prolonged fasting, and sleep all decrease BMR
How many calories equal one pound of body fat?
3,500 calories = 1 lb.
Which nutrient is most vital to life? Why?
Water... Because our body doesn't store it and it is the fluid medium needed for all chemical reactions
Which enzyme breaks down protein?
pepsin
What is the main symptom of urinary retention?
Overflow urination
When a person's bladder is very full, what two ways will allow you to know?
1) Looking at lower abdomen, if it is distended to the left, you can know they have an extremely full bladder
2) You can also palpate it and watch it get distended to the left as well
Give some examples of organic solutes in the urine?
Urea, ammonia, creatinine, uric acid (processed by liver)
Give some examples of inorganic solutes found in the urine.
Sodium, chloride, potassium, sulfate, magnesium, phosphorus
What is the normal amount of urine produced daily?
1200-1500 ml daily
What is the normal pH of the urine?
pH: 4.5-8
What are some choice antibiotics for the treatment of cystitis? (UTI)
Cipro, keflex, septra, bactrim
A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe?
a) Respirations that cease for several seconds
b) Respirations that are regular but abnormally slow
c) Respirations that are labored and increase in depth and rate
d) Respirations that are abnormally deep, regular, and increased in rate
D) Kussmaul's respirations are abnormally deep, regular, and increased in rate.

Apnea: is described as respirations that cease for several seconds
Bradypnea: resp are regular but abnormally slow
Hyperpnea: resp are labored and increased in depth and rate
What is atelectasis?
collapsed lung
Integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care
EBP
The systematic investigation of clinical phenomenon or the generating of new knowledge.
Research
Macule
Freckle, flat <1cm
Papule
Wart, acne or pimples (solid and elevated) <1cm
Plaque
A bunch of papules in a patch.
Patch
Flat greater than >1cm (birthmark)
Vesicle
Circumscribed, filled with thin serous fluid. Herpes, Varicella.
Mole
macule or papule
Cyst
1 cm or > fluid filled, semi solid, elevated, encapsulated.
Wheal
Red, irregular, raised, localized and edematous (HIVE)
Bulla
Circumscribed, filled with thin serous fluid.
Herpes, ck.pox
> .5cm
Nodule
Elevated, solid, hard mass thru the dermis
Tumor
Elevated, solid, hard mass thru the dermis > 2cm, poss. Irregular
Where are the gonads located?
On the ovaries and testes
Where is the hypothalamus and the pituitary gland located?
In the center of the brain
Define: oogenesis & spermatogenesis
Oogenesis or oögenesis is the creation of an ovum (egg cell). It is the female form of gametogenesis. The male equivalent is spermatogenesis . It involves the development of the various stages of the immature ovum.
Where is the GnRH hormone released from? Where does it act?
GnRH is secreted by the hypothalamus and acts on the pituitary gland.
What hormones does the pituitary gland secrete that have to do with reproduction?
- FSH (Follicular stimulating hormone)
- LH (luteinizing hormone)
What is the FSH hormone responsible for?
FSH (Follicular stimulating hormone)

- Women: Stimulates growth and maturation of follicles so ovulation takes
place
- Men: Stimulates production of sperm
What is Luteinizing Hormone responsible for?
stimulates ovulation in females and the synthesis of androgen in males
In women, which hormone is released at puberty and cause ovulation?
FSH, LH
What kind of feedback back system do the gonads have for the most part? In what case is this feedback system different (which is normal)?
Mostly negative feedback (low estrogen and testosterone, trigger increased release GnRH at hypothalamus / High estrogen or testosterone triggers decreased release of GnRH)

Positive feedback with estrogen in women and happens at ovulation ( high estrogen, increased GnRh)
What are the steps following gonadal feedback in women?
1) Maturation of follicles
2) Complete ovulation
3) Develops into corpus lutheum
4) Secretes progesterone
5) Maintains vascularity
How does the hypothalamus know when to release GnRH and when not to?
+/- feedbacks that stimulate the pituitary
What are some factors that effect the menstrual cycle?
- Stress
- Pregnancy
- Strenuous activity
- body fat (low body fat)
- medications
Why does low body fat mess with menstruation?
low body fat = no period because hormones are made with cholesterol
What is perimenopause?
A period of about 4-7 years before menopause occurs where a woman's periods are longer/shorter, heavier/lighter, and they eventually stop all together.
Dyspareunia
Painful intercourse
Cystocele
When the wall between the vagina and the bladder ruptures and bladder comes through to the vaginal side
Uterine prolapse
occurs when the ligaments that hold the uterus in its place in the pelvis weaken -- and the uterus tilts or slips, sometimes protruding into the vagina.
leiomyoma
A leiomyoma (plural is 'leiomyomata') is a benign smooth muscle neoplasm that is not premalignant. They can occur in any organ, but the most common forms occur in the uterus, small bowel and the esophagus.
Female orgasm is a result of what two events?
- uterine and vaginal contractions
- rapid release of muscular tension in the reproductive structures
Erectile dysfunction is commonly seen with which kinds of drugs?
Anti-hypetensives (beta-blockers, Ca2+ blocker, ACE, ARB, Diuretic)
What are some abnormal reproductive assessment findings in male patient's?
- absence of pubic hair
- penile growths or masses
- Vesicles, erosions, ulcers, edema
- Penile discharge
- Erythema at penis or scrotum
- Masses at scrotum or inguinal region
A 58-year-old male patient with a history of transient ischemic attacks (TIAs) is undergoing rehabilitation following an ischemic stroke. The patient’s medical history is likely to be related to which of the following health problems?
A) Inguinal hernia
B) Erectile dysfunction
C) Testosterone deficiency
D) Benign prostatic hyperplasia (BPH)
B) Erectile dysfunction
What are some very normal vaginal changes that happen in women during menopause.
With advancing age, changes occur in the female reproductive system. Many of these changes are related to the altered estrogen production that is associated with menopause. A reduction in circulating estrogen and increase in androgens in postmenopausal women are associated with breast and genital atrophy, reduction in bone mass, and increased rate of atherosclerosis. Vaginal dryness may occur and can lead to urogenital atrophy and changes in the quantity and composition of vaginal secretions.
Define: Prepuce
Foreskin (of either the penis or the clitoris)
What is the recommended method and age prostate screening should occur at/in.
The American Cancer Society recommends that men older than 50 years have a digital rectal examination (DRE) and prostate-specific antigen (PSA) test yearly to screen for prostate cancer.
What percentage of the infant's body weight is water?
70-80%
What percentage of a person's body weight is water? How much of that is extracellular? Intracellular
60 %
Intracellular: 40%
Extracellular: 5%
Interstitial: 15%
With a PT who is on a loop diuretic, what should the nurse be looking for? Which signs/ signs of what?
Loop diuretics may result in renal loss of potassium (i.e., hypokalemia). Clinical manifestations of hypokalemia include fatigue, muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, soft, flabby muscles, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia, and electrocardiographic changes.
With a PT who is on a loop diuretic, what should the nurse be looking for? Which signs/ signs of what?
Loop diuretics may result in renal loss of potassium (i.e., hypokalemia). Clinical manifestations of hypokalemia include fatigue, muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, soft, flabby muscles, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia, and electrocardiographic changes.
Which type of organ failure may lead to hypermagnesmia? Why?
Causes of hypermagnesemia include renal failure (especially if patient is given magnesium products), excessive administration of magnesium for treatment of eclampsia, and adrenal insufficiency.
A positive Chvostek sign indicates which electrolyte imbalance?
low serum calcium levels
With hyperventilation you ________ CO2.
With hypoventilation you _______ CO2.
Hyperventilation = blow off CO2, decreased amount of CO2, reduce respiratory acidity
Hypoventilation = holding on to CO2, increase amount of CO2 in blood, increase plasma acidity.
Functions of water in body?
- Transport of nutrients, electrolytes, and oxygen to cells and carrying waste products away.
- Regulation of body temperature
- Lubrication of joints and membranes
- Medium for food digestion
What is SIADH?
SIADH, excessive ADH secretion causes water retention. Caused by cancers of the blood, and pituitary gland.
What is Diabetes Insipidus?
DI, diminished ADH secretion causes massive water loss, leading to dehydration. Usually caused by traumatic brain injury.
What is Diabetes Insipidus?
DI, diminished ADH secretion causes massive water loss, leading to dehydration. Usually caused by traumatic brain injury.
Where is aldosterone secreted from? What does it do?
Adrenal Glands produce aldosterone, a mineralcorticoid that promotes sodium retention in the kidneys.
Isotonic solutions
when the solutions on both sides of a selectively permeable membrane have established equilibrium or are equal in concentration
Hypotonic solutions
- when a solution contains a lower concentration of salt or solute than other solutions, the solution is hypotonic
Hypertonic solutions
when a solution that has a higher concentration of solutes than another solution
What are the correct levels of Sodium?
Correct levels or potassium?
Sodium --> 135-145
Potassium --> 3.5-4.5
Normal amount of calcium in plasma?
Magnesium?
Calcium --> 8.6-100 mg/dl
Magnesium --> 1.2-2.0 mEq/L
What is the normal amount of fluid intake for your average person?
Daily fluid intake and output is usually 2000 to 3000 ml. This is sufficient to meet the needs of the body and replace both sensible and insensible fluid losses. These would include urine output and fluids lost through the respiratory system, skin, and GI tract.
What are some signs of hypo/hypercalcemia?
Signs of hypercalcemia are lethargy, headache, weakness, muscle flaccidity, heart block, anorexia, nausea, and vomiting. Paresthesia, facial spasms, and muscle tremors are symptoms of hypocalcemia.