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206 Cards in this Set

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What are Florence Nightengale's contributions to nursing?

1. Established hospital management standards


2. Nursing education


3. Nutrition important to health


4. Records maintenance



What was nursing like in the 19th - 21st Centuries?

1. Schools w/hospitals ("apprenticeships")


2. WWII - more nurses in field; emphasis on education

What is ANA and what does it do?

American Nurses' Association;


Standards of Practice, lobbying, education

What is NLN and what does it do?


National League for Nursing;


primary source of research data re: nursing education

What is AACN and what does it do?

American Association of Colleges of Nursing;


Voice for higher nursing ed, quality education standards

NCLEX

National Council Licensure Examination

APRN

Advanced Practice RN

ICN

International Council of Nurses

NSNA

National Student Nurses Association

QSEN

Quality & Safety Education for Nursing

What are the Nurse Practice Acts?

State regulations on nursing

What are the six steps of the Nursing Process?

1. Assess


2. Diagnose


3. Outcome Identification


4. Planning


5. Implementation


6. Evaluation

What are the eight nursing roles?

1. Caregiver (primary role)


2. Communicator


3. Teacher/educator


4. Counselor


5. Leader


6. Researcher


7. Advocate


8. Collaborator

General Systems Theory

Breaks whole into parts to learn how the parts work together

Adaptation Theory

Adjustment of living things to other living things and environmental conditions

Developmental Theory

Process of growth and development; definite stages, but progress and behaviors unique to each individual

What is Erik Erikson's Psychosocial Developmental Theory based on?

How individuals learn to interact with the world (based on age)

What is Maslow's Theory of Human Needs based on?

Physical and psychosocial needs (not age)

What are the types of quantitative research?

1. Descriptive (explore, describe, no prior research)


2. Correlational (type & degree of relationship)


3. Quasi-experimental (cause & effect; clinical setting)


4. Experimental (highly controlled, lab setting)

What are the types of qualitative research?

1. Phenomenology (experiences lived by the subject)


2. Grounded Theory (how people describe own reality and how beliefs related to their actions)


3. Ethnography (issues of a certain culture)


4. Historical (review past to increase understanding today)

What is PICO?

Format in which to ask clinical questions:



P = Patient, population, problem


I = Intervention


C = Comparison


O = Outcome

What is Morbidity?

How frequently a disease occurs

What is Mortality

Number of deaths resulting from a certain disease

What is illness?

Response of a person to a disease

What are the six human dimensions?

1. Physical


2. Emotional


3. Intellectual


4. Spiritual


5. Environmental


6. Sociocultural

Primary Health Promotion

Focus on people/groups; *teaching*

Secondary Health Promotion

Screening for early detection; *screening*

Tertiary Health Promotion

Begins after diagnosis & treatment; goal is to decrease disability and increase rehabilitation

What are the three components of the Health Belief Model?

1. Perceived susceptibility to disease


2. Perceived seriousness of disease


3. Perceived benefit of action

Health Promotion Model

Incorporates individual experiences & characteristics, behavior-specific knowledge & beliefs

Health-Illness continuum

Health is constantly changing; person adapts

Agent-Host Environment

Interaction between external agent & susceptible host; environment is cause of disease (useful with infectious disease)

What are levels in Maslow's Hierarchy of Needs?

(From the bottom):


1. Physiological


2. Safety & Security


3. Love & Belonging


4. Self-Esteem


5. Self-Actualization

Community Health Nursing

Focuses on whole population within a community

Community Based Nursing

Focuses on healthcare needs of individuals and families

Cultural Assimilation

Minority takes on values of dominant group (also called acculturation)

Ethnicity

Sense of identification with a collective cultural group; based largely on common heritage

Race

Based on physical characteristics

Cultural Imposition

Belief that all should conform to your own system

Culture Conflict

Aware of cultural differences, feel threatened, respond by ridiculing other beliefs

Ethnocentrism

Belief that own culture, beliefs, etc. are superior to others

Common health problems: Native Americans/Alaska Natives

Heart disease; cirrhosis of the liver, FAS, DM

Common health problems: African Americans

Hypertension, stroke, sickle cell anemia, lactose intolerance, keloids

Common health problems: Asians

Hypertension, lactose intolerance, cancer of the liver, Thalassemia

Common health problems: Hispanics

DM, lactose intolerance

Common health problems: Whites

Heart disease, DM, obesity, breast cancer

What are the five Professional Values stated by AACN?

1. Altruism (self-less)


2. Autonomy


3. Human dignity (respect)


4. Integrity


5. Social Justice

Utilitarian Theory of Ethics

Rightness/wrongness depends on its consequences

Deontologic Theory of Ethics

Rightness/wrongness is based on a rule, regardless of consequences

What are the five principles of Bioethics?

1. Autonomy (self-determination)


2. Nonmaleficence (avoid causing harm)


3. Benficence (benefit the pt)


4. Justice


5. Fidelity (keep promises)

Ethical Distress

Knowing the right thing to do, but unable to execute

Civil Law

Regulates relationship among people

Criminal Law

State & federal criminal statutes

Crime

Punishable by the state

Tort

Subject to civil court; damages settled with $

Sentinel Event

Unexpected occurrence involving death, serious injury, or the risk of

Never Event

Serious reportable event

Pay-for-Performance

Financial incentives for certain achievements

DRGs

Diagnosis-Related-Groups: fixed reimbursement for certain things (adjustments for severity)

Capitation

Fixed amount per enrollee of health plan

Primary Healthcare

Family practice physicians


Goal: prevention

Secondary Healthcare

Specialty physicians


Goal: specialized expertise

Tertiary Healthcare

Subspecialty physicians


Goal: care, complex disorders

Fee-for-service

Fee paid for each thing provider does; rewards more care, not better care

Community Health Centers

Regionalized services for vulnerable populations; emphasize primary care and education

What are the two types of Prepaid Group Practice?

1. HMO (Health Maintenance Org):


Group of affiliated providers; little or no choice of providers


2. PPO (Preferred Provider Org):


Third-party payer contracts w/group of healthcare providers

Accountable Care Organizations

Incentives to provide well-coordinated care to patients; one bill for all services

Medicare

Government-financed, age 65+; DRGs; some things not paid for (hospital errors)

Medicaid

Government-financed; low income, blind, disabled; DRGs

Respite Care

Gives caregivers time away

Palliative Care

Relief of distress; goal to prevent and relieve suffering

QSEN

Quality & Safety Education for Nurses

What are the six QSEN competencies?

1. Patient-Centered Care


2. Teamwork & Collaboration


3. EBP


4. Quality Improvement


5. Safety


6. Informatics

What is Concept Mapping?

Identifying, Displaying, and linking key concepts

What are the five steps to Concept Mapping?

1. Skeleton diagram


2. Analyze & categorize data


3. Analyze nursing diagnosis relationships


4. Identify goals, outcomes, interventions


5. Evaluate

What are the four space zones?

1. Intimate (0-18 inches)


2. Personal (19 - 4 ft)


3. Social (4 ft - 12 ft)


4. Public (12 ft. +)

What does SBAR stand for?

S = Situation


B = Background


A = Assessment


R = Recommendation

What are the three phases of helping relationships?

1. Orientation (development of trusting relationship important)


2. Working (interaction essential)


3. Termination (examine goals)

What are the six interviewing techniques?

1. Open-ended


2. Closed


3. Validity (validate what nurse believes she heard/observed)


4. Clarifying (to gain understanding of pt's comment)


5. Reflective (repeating what patient said)


6. Directing

What factors affect patient learning?

1. Age & developmental level


2. Family support networks & financial resources


3. Cultural influences


4. Health literacy

Piaget's Theory for children & adolescents

1. Infants: teaching directed @parents


2. Toddlers/preschoolers: teaching directed @parents


3. School-aged: simple & logical statements


4. Adolescents: formal vs. concrete operations

What are Formal Operations?

Using logical reasoning to solve hypothetical problems

What are Concrete Operations?

Using logical reasoning to solve concrete problems

What barrier is there to adult learners?

They must believe that they need to learn before they are ready to

What must be identified in aged adults before teaching?

Learning barriers

What are the three learning domains?

1. Cognitive


2. Physical (physical activity)


3. Affective (changes in attitude, value, feeling)

What is the Outcome/Identification phase of the Nursing Process for Teaching based on?

Learning domain (cognitive, physical, affective)

What are the 11 teaching strategies?

1. Role modeling


2. Lecture


3. Discussion


4. Panel Discussion


5. Demonstration


6. Discovery (patient guided to discover solution)


7. Role Playing


8. Audiovisual Materials


9. Printed Material


10. Programmed Instruction


11. Web-Based Introduction & technology

How does a nurse act as a counselor?

Helping patients make decisions that promote their well-being

What are the three types of counseling?

1. Short-term (situational crisis)


2. Long-term (developmental crisis)


3. Motivational Interviewing (discussing feelings & incentives with pt)



What are the four teaching tools?

1. Teach-back (assesses literacy & confirms learner understanding)


2. Ask me 3 (promotes understanding)


3. Newest Vital Sign (assesses low health literacy)


4. TEACH acronym

What does TEACH stand for?

T = Tune into pt


E = Edit pt info


A = Act on every teaching moment


C = Clarify often


H = Honor of pt as partner

What are the six styles of leadership?

1. Autocratic


2. Democratic


3. Laissez-faire


4. Quantum


5. Transactional


6. Transformational

Autocratic leadership

Leader has control; others have little say

Democratic leadership

Equality

Laissez-faire leadership

Leader relinquishes power; encourages independent activity

Quantum leadership

Organization & members viewed as interconnected & collaborative

Transactional leadership

Good behavior rewarded, bad is punished

Transformational leadership

Leaders inspire change

What are the six conflict resolution strategies?

1. Avoiding


2. Collaborating (win-win)


3. Competing (win-lose)


4. Compromising (both relinquish something)


5. Cooperating/Accommodating (one party lets other win)


6. Smoothing (compliment, focus on agreement, decrease emotions)

What are the three components of heritage?

1. Culture


2. Ethnicity


3. Religion

Acculturation

Process of adopting to and acquiring another culture

Assimilation

Process by which a person develops a new cultural identity; becomes like dominant culture

Biculturalism

Dual pattern of identification and often of divided loyalty

What are the traditional causes of illness?

1. Biomedical (scientific) - germ theory


2. Naturalistic (holistic) - forces of nature; origins in Greek humoral theory; hot/cold theory


3. Magicoreligioius - domination of supernatural forces

What is normal adult BMI range?

19 - 25




(lbs/inches)*703

What is stroke volume?

Amount of blood pumped into aorta each cycle (normal is 70 ml in adults)

What three factors are assessed with pulse?

Rate, rhythm, force

What is pulse pressure?

Difference between systolic and diastolic

What are the five determining factors of BP?

1. Cardiac output


2. Peripheral vascular resistance


3. Volume of circulating blood


4. Viscosity


5. Elasticity of vessel walls

Ausculatory Gap

Period when Korotkoff sounds disappear during auscultation

When are orthostatic vital signs taken?

When decrease in volume suspected; hypertension; fainting/syncope

What are the steps for Orthostatic (Postural) VS?

1. Baseline at supine; wait 2-3 minutes


2. Sitting; wait 2-3 minutes


3. Standing; wait 2-3 minutes

Hypopituitary Dwarfism

Deficiency in GH in childhood

Gigantism

Increased secretion of GH before puberty

Acromegaly

Increased secretion of GH in adulthood

Marfan's Syndrome

Connective tissue disorder; arachnodactyly, hyperextensible joints, tall, thin

Achondroplastic Dwarfism

Genetic; converting cartilage to bone

Endogenous Obesity (Cushing's)

Uneven distribution of fat; increased production of ACTH, which stimulates cortisol secretion

What is a PHR?

Personalized Health Record; updated by patient

What is a HIE?

Health Information Exchange; done by hospital, accessible by patients

What are Source-Oriented Records?

Paper records kept by each health care group

What are POMR's?

Problem-Oriented Medical Records

What is SOAP?

Format for documentation:




S = Subjective Data


O = Objective Data


A = Assessment


P = Plan

What is PIE?

Format for documentation:




P = Problem


I = Intervention


E = Evaluation




Done at beginning of each shift

What is CBE?

Charting by Exception; only significant findings charted

What are the benefits of CBE?

1. Saves time


2. Increases emphasis on significant data


3. Easy retrieval

What are Collaborative (Critical) Pathways?

Care maps

What is Occurrence Charting?

Charts unexpected outcomes, outcomes not met, interventions not implemented

What is a Patient Care Summary

Overview of valuable patient info (documentation, lab & test results, orders, meds)

What are flow sheets?

Used to quickly record routine care

What are graphic records?

Used to record specific patient variables (pulse, RR, BP, etc.)

What is charted on a medication record?

Meds, administering nurse, reason

What is an acuity record?

Ranks patient condition and need for nursing assistance from high to low

What is an RAI?

Resident Assessment Instrument (RAI) - form of long term care documentation

What does an RAI contain?

1. Minimum data set (core set of screening, clinical, functional status elements)


2. Triggers - resident responses indicating risks



What do nursing informatics integrate?

Nursing science, computer science, information science

Infection

Disease state resulting from presence of pathogens

Pathogens

Disease-producing microorganism

Bacteria

Most common cause of infection

Gram positive

Thick cell wall, resist colorization

Gram negative

Complex cell wall; decolorized by alcohol

What two types of antibiotics are there?

1. Gram positive efficient


2. Broad spectrum

Virus

Smallest microorganism; viewable by electron microscope; antibiotics don't affect; (some antiviral meds for prodromal stage)

Fungi

Plant-like organism; treated with anti-fungals (many infections resistant)

Parasites

Live on or in host

What factors affect infection?

1. Number of organisms


2. Virulence


3. Immune system function


4. Length & contact with person

Endemic

Occurring in one region/population

Reservoirs

Natural habitat of organism


People: carriers exhibit no signs/symptoms


Animals (e.g. Rabies)


Soil (e.g. Tetanus)


Water (e.g. Giardia)


Milk (e.g. Listeria)

Portal of Exit

Point of escape from reservoir

Direct Transmission

Touching, kissing, etc.

Indirect Transmission

Contact with contaminated fomite (inanimate object)

Vector

Non-human carriers that transmit through injection of saliva

Vehicle

Transmission without injection

Droplet transmission

Airborne; >5 mcm sized particles

Portal of Entry

Entry to new host


(most common: urinary, respiratory, skin, GI)

What are the stages of incubation?

1. Incubation (between invasion and appearance of symptoms)


2. Prodromal (most infections, vague signs/symptoms)


3. Full Stage (specific signs & systems; localized vs. systemic)


4. Convalescent (recovery


Some infections cycle through

What are the two types of defense against infection?

1. Inflammatory response (eliminates pathogen; tissue repair)


2. Immune response (body responses to invader)

Antigen

Foreign body/material

Antibody

Body's response to antigen

Antigen-antibody reaction

Humoral immunity

Cellular immunity

Increase in WBC to destroy harmful cells

What is susceptibility affected by?

1. Skin integrity


2. pH of GI & GU


3. # of WBC


4. Age, sex, race, heredity


5. Immunizations


6. Fatigue, health/nutrition, preexisting illness, previous/current treatments, certain meds


7. Stress

Asepsis

All activities to prevent or break chain of infection

Medical Asepsis

"Clean technique"; decrease in number and transfer of pathogens

Surgical Asepsis

"Sterile technique"; render and keep objects and areas free from microorganisms

When do you use hand hygiene?

1. Before & after touching patient


2. Before a clean or aseptic procedure


3. After body fluid exposure


4. After touching patient surrondings

HAI

Healthcare Associated Infections; nosocomial infections

Exogenous HAI

Causative organism acquired from other people

Endogenous HAI

Causative organism acquired from microbial life in the person

Iatrogenic

Results from treatment or diagnostic procedure

Bundles

Evidence-based practices with proven positive outcomes

Disinfection

Destroys pathogens (except spores)

Sterilization

Destroys pathogens (including spores)

PPE

Personal Protective Equipment

Standard Precautions

Used in All hospital care

Transmission-based precautions

Used when pathogens suspected

Airborne Precautions

When infections spread through air (TB, Varicella, Rubeola, SARS)




Private room w/negative air pressure; door closed

Droplet Precautions

When infections spread by large droplet (Rubella, Mumps, Diptheria)




Private room, door open, visitors 3 ft away from patient

Contact Precautions

When infections are multi-drug resistant (MDRO)

When should you use soap and water to wash hands?

When hands visibly soiled

When should you use alcohol-based handrubs?

Hands not visibly soiled; before/after patient contact; after body fluid contact; after removing gloves; before donning gloves; before inserting catheters; if moving from contaminated site to clean after contact with objects

What factors affect safety?

1. Developmental


2. Lifestyle (occupation, social behavior)


3. Environment


4. Mobility


5. Sensory Perception


6. Knowledge


7. Ability to communicate


8. Physical health state


9. Psychosocial health state

What increases likelihood of falls?

1. History of falls


2. Age 65+

Types of restraints

Side rails; geriatric chairs with attached trays; tie appliances; chemical restraints

What does RACE mean?

R = Rescue


A = Activate alarm


C = Confine fire


E = Evacuate

What does PASS mean?

P = Pull pin


A = Aim


S = Squeeze


S = Sweep

Disaster

Tragic event of great magnitude; requires response of people outside involved community

Bioterrorism

Deliberate spread of pathogens in a community

Chemical terrorism

Deliberate release of chemical compound that has potential for harming health

Nuclear terrorism

Intentional introduction of radioactive materials to cause harm

Cyber terror

Use of high technology to disable/delete critical infrastructure data

Erythema

Dilation of superficial blood vessels; inflammation

Cyanosis

Inadequate oxygenation

Janudice

Elevated bilirubin

Pallor

Decreased amount of circulating blood causing inadequate oxygenation

Ecchymosis

Collection of blood in subcutaneous tissues; purple

Petechiae

Hemorrhagic spots caused by capillary bleeding

Primary lesions

Arise from previously normal skin

Secondary lesions

Arise from changes in primary lesion

Turgor

Elasticity of skin; measured at sternum or clavicle

Edema

Excess fluid in tissues; skin folds sometimes difficult to lift; taut/shiny; indentations remain

What could Edema be caused by?

Heart failure, overhydration, kidney failure; trauma; peripheral vascular disease

Senile keratosis

Raised, dark areas

Senile lentigines

Flat, brown age spots

Cherry angiomas

small, round red spots