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166 Cards in this Set

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What is the definition of pain?
Whatever the experiencing person says it is, existing whenever he or she says it does.
The definition rests on the belief that the only real authority is the pt.
Is pain subjective or objective?
Subjective
Name the three kinds of pain.
Acute, Chronic, Intractable
What is acute pain?
Pain that is rapid on onset, mild to severe and lasts from a few minutes to any period less than 6 months. Protective in nature.
What is chronic pain?
Pain that may be intermittent or persistent, but last for 6 months or longer. Interferes with normal functioning.
What is intractable pain?
Pain that persists even with interventions. e.g. bone cancer
True or False:
Pain is the body's defense mechanism and occurs when tissue damage activates nerve endings.
True
What is referred pain?
Pain that is perceived in an area distant from it's point of origin.
What is Phantom Limb pain?
Pain that occurs in a patient who has had a body part amputated.
What is diabetic neuropathy?
Damage to peripheral nerve endings from long term diabetes, numbness and tingling of the extremities.
List some descriptive terms of pain.
Sharp, dull, diffuse (covers a large area, pt. is unable to pinpoint a specific area), shifting, continuous
True or False:
Pain is one of the body's defense mechanisms?
True
What is the 5th vital sign?
Pain
What are the common responses to pain?
Behavioral, Physiological, Affective
What are behavioral responses to pain?
Grimacing, moaning, crying, restlessness, guarding, refusing to move.
What are the physiological responses to pain?
increased pulse, respiration, B/P, muscle tension and rigidity.
What are the affective responses to pain?
anxiety, depression, anger, anorexia, fatigue, helplessness and stoicism
Describe the pain scale
Scale is from 0-10
Slight or mild: 0-3
Moderate: 4-6
Severe: 7-10
How do you assess pain in a cognitively impaired patient?
Use family and caregivers in questioning, they have intuitions about their family member/patient.
Use DX, is it associated w/pain?
Watch facial expressions, change in behavior, are they restless?
How do you assess pain in infants and small children?
Watch body language, are they pulling at a body part such as an ear (for earaches) Are they pulling their legs to their chest (for abd. pain) what is their level of irritability? Are they eating, taking a bottle? If not this could indicate a sore throat. In older children, use the face pain scale to assist in assessing pain.
How do you assess pain in the elderly?
This is the most challenging as they will not always admit to pain. They attribute chronic pain to old age. Very stoic, seen as beginning of serious illness or death.
How do you assess pain in a cognitive patient?
Pt. should describe pain using pain scale, indicate location, duration, intensity, history, aggravating factors, alleviating factors and how it has complicated their lifestyle.
What are some of the factors that may affect how pain is perceived?
Culture, religious beliefs, family, gender, age, environment.
What are the three general classes of drugs used for pain control?
1. Non-opioids
2. Opioids
3. Adjuvant drugs
What are non-opioid drugs?
Drugs used to treat mild to moderate pain.
Used for musculoskeletal disorders.
Anti pyretics and anti inflammatory drugs...they share the ability to do both.
What are opioid drugs?
Narcotic analgesics, controlled substances:
Used to relieve moderate to severe pain, cause CNS depression, respiratory depression, nausea, vomiting, constipation
What are adjuvant drugs?
Corticosteroids, anti-convulsants, and anti-depressants
Give some examples of non-opioid drugs.
Aspirin, NSAIDS, and acetaminophen
Give some examples of opioid drugs.
Morphine, Demerol, and Codeine
What are the NANDA Nursing DX for pain?
Pain
Pain, chronic
R/T:
Injury agents: Biological, Chemical, Physical, Psychosocial
What are the nursing goals for pain?
Client will require no more than one pain medication per 12 hours by (date).
What are the nursing interventions for pain?
Monitor for pain at least q2 hours
Have pt. rain pain using 0-10 at each incidence of pain.
Teach the pt. to report pain as soon as it starts.
Administer pain meds as ordered, monitor and record pain relief within 30 minutes and have the pt. rank the pain again.
Provide a calm, quiet environment.
Monitor VS q4 hours
Monitor side effects
Promote activity & exercise as tolerated.
Monitor BM every shift.
ESSENTIAL NEED For NUTRITION
Define nutrition
The study of nutrients in foods, how they are used in the body & sometimes the study of human behaviors related to foods.
It is an essential human need.
Profoundly influences long-term health.
Define acid-base balance.
The body's pH:
7.34-7.45
What are the types of acid-base imbalance?
Metabolic Acidosis or Alkalosis
Respiratory Acidosis or Alkalosis
Name the different types of electrolyte imbalance.
Hyponatremia: Too little salt
Hypernatremia: Excess salt intake
Hypokalemia: Too little potassium
Hyperkalemia: Excess potassium
Hypocalcemia: Too little calcium
Hypercalcemia: Excess calcium
Hypomagnesemia: Too little magnesium
Hypermagnesemia: Too much magnesium
What is the normal range for sodium?
135-145 mEq/ml
What is the normal range for potassium?
3.5-5.0 mEq/ml
What is the normal range for calcium?
4.5-5.5 mg/dl
What is the normal range for bicarbonates?
22-26 (arterial) mEq/L
24-30 (venous) mEq/L
Name the six classes of nutrients.
Carbs, fats, water, minerals, vitamins, protein.
Which nutrients give you energy?
Carbs, lipids and proteins.
Which nutrient regulates and controls processes?
Water
What are the physiological values of nutrients?
Used for:
Growth, repair, development activity, reproduction, health maintenance, recovery from illness or injury.
Calories per gram of carbs?
4
Calories per gram of fats?
9
Calories per gram of protein?
4
What % of your daily intake should be carbohydrates?
45-60%
How many grams a day of protein should women get?
56 gm/day
How many grams a day of protein should men get?
63 gm/day
What % of your daily intake should be lipids? (fats)
30%
What vitamins are fat soluble?
Vitamins A, D, E & K
Why are vitamins needed?
They're needed for metabolizing energy nutrients and they are classified as either water or fat soluble.
Which patients will have issues with water soluble vitamins?
Gastric-bypass patients
Which vitamin is needed for iron absorption?
Vitamin C
Vitamin C deficiency causes what?
Anemia
Where are fat soluble vitamins stored?
In the liver
What are the religious dietary restrictions for Islam?
pork, alcohol, caffeine, Ramadan fasting sunrise to sunset for a month, Ritualized methods of animal slaughter required for meat ingestion
What are the religious dietary restrictions for Christianity?
Minimal or no alcohol, holy day observances may restrict meat
What are the religious dietary restrictions for Hinduism?
All meats, Alcohol
What are the religious dietary restrictions for Judaism?
Pork, predatory fowl, Shellfish (eats only fish w/scales) rare meats, blood, mixing milk or dairy products with meats, kosher food preparation, 24 hr fasting on Yom Kippur, a day of atonement, No leavened bread on passover, no cooking on the Sabbath (saturday)
What are the religious dietary restrictions for Mormons?
Alcohol, Tobacco, Caffeine and limit meat.
What are the religious dietary restrictions for Seventh Day Adventists?
Pork, Shellfish, Alcohol, Coffee, Tea
Vegetarian or ovolactovegetarian diets are encouraged.
What are the 4 levels of dysphagia?
dysphagia puree, dysphagia mechanically altered, dysphagia advanced and regular.
tender
to extend, to offer, to stretch, to hang out
What does Vitamin E do?
acts as an antioxidant
What does Vitamin K do?
necessary for blood clotting
What are the main functions of electrolytes and minerals?
help regulate body processes and are important in acid-base balance
What are the bodies trace minerals?
Iron, Zinc and Copper
What are the bodies major minerals?
Sodium, Calcium and Potassium
Water makes up what % of body weight?
60%
What is Basal Metabolism Rate?
The amount of energy required to carry on the involuntary activities during rest.
What is BMR for men?
1 cal/kg of body weight/hour.
What is BMR for women?
0.9 cal/kg of body weight per hour.
What is the rule of 5 for women?
100# for 5ft of height, 5 #s for each inch over 5'
+/- 10% for body frame size
What is the rule of 6 for men?
106# for 5' of height
6# for each inch over 5'
+/- 10% for body-frame size
How do you calculate BMI?
Weight in Kg
-----------------------
(1.7m x height in meters)
List some common diet orders
NPO
Clear liquids
Full liquid diet
Pureed diet
BRAT diet (Bananas, Rice, Applesauce and Toast)
Soft diet
Vegetarian diet
ADA diet
Heart Healthy diet
Low Carbs-good for diabetics
No concentracted sweets-good for diabetics
True or False:
BP and HR will change based on the fluid in the body?
True
What does Calcium do for the body?
Makes up bone and tooth structure
Plays a role in muscle contraction
The heart is dependent upon calcium/potassium
Need 1200 mg daily
What are the signs and symptoms of too much calcium?
Weakness, lethargy, depressed reflexes, bone pain, constipation
What are the signs and symptoms of too little calcium?
Numbness, tingling in the extremities, muscle tremors, cramps and cardiac issues such as arrythmias
What is the role of potassium in the body?
Essential for acid base balance.
What are the signs and symptoms of too much potassium?
Cardiac arrythmias
What are the signs and symptoms fo too little potassium?
muscle cramps, irregular heartbeat
What is the role of sodium in the body?
Essential in acid base balance
What are the signs and symptoms of too much sodium?
causes retention of fluid, high bp
What are the signs and symptoms of too little sodium?
severe muscle cramps
pH < 7.35 is...
Acidic
pH >7.45 is...
Alkalotic
What is the substance that prevents the body fluids from becoming too acidic or alkalotic?
A buffer
What is the most important buffer system in the body?
The carbonic acid-sodium bicarbonate system.
How does carbonic acid enter the system?
Through breathing
How is sodium-bicarbonate regulated?
It's regulated by the kidneys.
What is Respiratory Acidosis?
Decreased pH
Increased HCO3 (bicarbonate)
Increased pCO2 (carbon dioxide concentration)
What is Respiratory Alkalosis?
Increased pH
Decreased HCO3
Decreased pCO2
What is metabolic acidosis?
Decreased pH
Decreased HCO3
Decreased pCO2
What is metabolic alkalosis?
Increased pH
Increased HCO3
Increased pCO2
Causes of Respiratory Acidosis
Respirations decrease and enlongate
Overdose of sedative
Cardiac arrest
Chronic respiratory disease
inadequate mechanical ventilation
What are the symptoms of Respiratory Acidosis?
Confusion
Vertigo
LOC change/Loss of LOC
How do you treat Respiratory Acidosis?
Improved ventilation
-lungs are the problem so kidneys compensate and retain more bicarbonate.
What are the causes of metabolic acidosis?
Diarrhea
renal failure
excessive intake of salicylates (aspirin)
What are the signs and symptoms of Metabolic Acidosis?
Headache
Confusion
Increased R rate and depth (because you're trying to blow off CO2 and get rid of acid.)
How do you treat Metabolic Acidosis?
Identify the cause and give Sodium Bicarbonate
Kidneys compensate by retaining Bicarbonate
Lungs compensate by blowing off CO2
What are the causes of Respiratory Alkalosis?
Anxiety
Hyperventilation
Fever
Excessive mechanical ventilation
What are the symptoms of Respiratory Alkalosis?
Light-headed
Inability to concentrate
How do you treat Respiratory Alkalosis?
Sedate
Correct breathing pattern
Lungs are the problem so kidneys will compensate by excreting more bicarbonate
What are the causes of Metabolic Alkalosis?
Vomiting
Gastric Suction because it causes the patient to lose all acid and potassium
Hypokalemia
What are the symptoms of Metabolic Alkalosis?
dizziness
tingling in toes and fingers
slow respirations to compensate for loss of CO2
Treatment for metabolic alkalosis?
Identify problem
-if vomiting give IV fluids
-If low potassium, give potassium
Kidnes compensate by excreting excessive Sodium Bicarbonate
Lung retain CO2
The amount of urine a bladder can hold
600 ml
The sympathetic nervous system is responsible for what?
Retaining urine in the bladder
The parasympathetic nervous system is responsible for what?
Emptying the bladder
How long is the male urethra?
6-8 inches long
How long is the female urethrea
1.5-2.5 inches long
Hesitency
Delay or difficulty initiating voiding
Frequency
Increased incidence of voiding
Urgency
Strong desire to void
Retention
Retaining urine in the bladder
PVR
Post Void Residual
Dysuria
Painful or difficult urination
Incontinence
Involuntary loss of urine
Nocturia
Awakening at night to urinate
Hematuria
Blood in the urine - typically indicative of a UTI or kidney issue
What is the first principle of growth and development?
That growth and development are:
Orderly & Sequential
Continuous & Complex
have Milestones
What is the second principle of growth and development?
That growth and development follow:
Regular and predictable trends
What is the third principle of growth and development?
That growth and development are differentiated and integrated
What is the fourth principle of growth and development?
That there are different aspect, different states, different rates and the factors that modify are:
Nutrition
love & affection from caregivers
Illness
What is the 5th principle of growth and development?
Pace varies for each person
What are the factors that facilitate or delay development?
Genetics, Prenatal care, Individual, caregiver, environment, & nutrition
What type of theorist was Erik Erikson?
Psychosocial
According to Erikson, there were 8 stages of development. What are they?
1. Trust vs. Mistrust (birth-12mos)
2. Autonomy vs. shame/doubt (1-3)
3. Initiative vs. guilt (4-6)
4. Industry vs. inferiority (6-11)
5. Identity vs Role confusion (teens)
6. Intimacy vs. Isolation (young adult)
7. Generativity vs. Stagnation (middle adulthood)
8. Ego vs. despair (later adulthood)
What type of theorist was Jean Piaget?
Cognitive
What are the four stages of development that Piaget identified?
1. Sensorimotor (birth - 24 mos)
2. Pre-operational (2-7)
3. Concrete Operational (7-11)
4. Formal Operational (11+)
What type of theorist was Robert J. Havinghurst?
Developmental
What were Havinghursts' stages?
1. Infancy/Early Childhood
2. Middle Childhood 6-12)
3. Adolescence (13-19)
4.Young Adulthood (20+)
5. Middle Adulthood (40+)
6. Later maturity
What are the characteristics of Staphylococcus?
Spherical
GP in clusters
Catalase positive
Opaque
Smooth
Convex
Where does Staph normally live?
Normal flora on skin, GI tract and anterior nares
Is Staph pyogenic? (Meaning causing pus forming diseases)
Yes
Is Staph suppurative (meaning forming or discharging pus)
Yes
Is the pus purulent?
Yes
What is the hallmark of a Staph infection?
Abscess
Name some disease associations to Staph.
Skin & wound infections
Colitis
Osteomyelitis
Pneumonia
Food poisoning
Name the most common and most significant form of Staph.
Staphylococcus aureus
Describe S. aureus
It is a primary pathogen
Coagulase positive
often B hemolytic on blood agar
Responsible for hospital and community MRSA strains
What bacteria causes UTI?
Staphylococcus saprophyticus
What bacilli is the primary normal flora on skin and often the contaminant in lab tests?
Staphylococcus epidermidis
What is a catalase?
An enzyme that catalyzes.
What is coagulase?
An enzyme that clots plasma.
What are the two forms of staphylococcal coagulase and how are they detected?
Free: detected by slide tests
Bound: detected by tube tests
What is MSA?
Mannitol Salt Agar
Presumptive test for S. aureus. High salt concentration (hypertonic solution). Staph is just about the only bacteria that can tolerate this salt level.
What are the characteristics of Streptococcus/Enterococcus?
GP
Spherical to ovoid
pairs of chains
Fastidious and capnophilic
Catalase negative
Colonies are minute, translucent and convex
What group does Streptococcus pyogenes belong to?
Group A
Name the Streptococcus pyogenes characteristics and disease associations.
Beta hemolytic
Associated with soft tissue infectons, pharyngitis and nephritis
What group does Streptococcus agalactiae belong to?
Group B
Name the Streptococcus agalactiae characteristics and disease associations.
B hemolytic
Neonatal infections
What group does Streptococcus & Enterococcus fall into?
Group D
What are some characteristics and disease associations with Streptococcus & Enterococcus?
non-hemolytic
Causes UTI
Which group is the only bacterial toxin to cause pharyngitis?
Group A Strep: the only bacterial toxin that causes pharyngitis, even though most are viral infections.
Name some characteristics of the Haemophilus species.
GNB
Fastidious
Will only grow on a chocolate agar
accounts for about 10% of normal flora
Name some species of the Haemophilus.
H. influenza
H. aegyptius
H. ducreyi
What are some diseases affiliated with H. influenzae?
Meningitis
Pneumonia
Epiglottis
Arthritis
Cellulitis
What are some diseases affiliated with H. aegyptius?
Pink eye (pediatric conjunctivitis)
What are some diseases associated wtih H. ducreyi?
Chancroid (on of 5 classical STIs)
How do you grow H. influenzae?
Requires a chocolate agar and a capneic atmosphere for growth.
Haemophilus is pleomorphic. Define pleomorphic.
Demonstrating a variety of shapes and forms. In relation to Haemophilus on a gram stain, they show a variety of shapes from coccobacilli to bacilli to filaments.