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