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NUR 111 Stud guide 6
NUR 111 Study guide for test 6
| Define: Extracellular (ECF) | -Intravascular. -Interstitial: around cells, lymph -Transcellular: CSF, pericardial, synovial, intraocular, pleural, sweat, and digestive secretions -ECF=30% body water, 20% adult; more in infants -Major lytes: SODIUM, Cl, Ca, and bicarb |
| Define: Intracellular (ICF) | -The fluid within all cells; accounts for 70% of total body water or 40% of total body weight -Major electrolytes: POTASSIUM, phosphorous, and magnesium |
| Define water's role in body | -Primary body fluid -Imbalances: Deficit/Excess -Functions: •Transport medium for nutrients, hormones, NZ, blood - •Facilitates: cellular metab & function; digestion •Body's solvent •Helps maintain temperature •Promotes elimination •Lubricant |
| Define: fluid Volume Deficit (FVD) | -Loss of both water and solutes in same proportions from ECF space; also known as dehydration, hypovolemia, and isotonic fluid loss |
| Fluid Volume Deficit (FVD) - Causes | •GI: N/V/D, suction, fistulas, hemorrhage •XS sweating •Skin: burns (third-space fluid shifts), draining wounds •XS laxative or diuretics •Polyuria from renal disease • Hyperglycemia • AMS (unable to gain access to fluids, depression, confusion) |
| Fluid Volume Deficit (FVD) - Assessment | Thirst, acute weight loss, weakness, fatigue, anorexia, dry MM, poor skin and tongue turgor, sunken eyes (very severe), flat neck veins, UOP <30mL/hr., postural HoTN, weak rapid pulse, incr: urine S.G., hematocrit, BUN, serum sodium; altered sensorium |
| Fluid Volume Deficit (FVD) - NI | •Assess for presence or worsening of FVD •PO fluids, if indicated •If unable to take PO anticipate TPN or tube feeding order •Monitor response to fluid intake •Be alert for signs of fluid overload •Provide appropriate skin care |
| Define: Fluid Volume Excess (FVE) | Excessive retention of water and sodium in the ECF in near equal proportions; AKA: hypervolemia and excess of isotonic |
| Fluid Volume Excess (FVE): Causes | •Compromised regulatory mechanisms: renal failure, CHF, cirrhosis, Cushing’s •GI irrigation with hypotonic fluid •XS IVF w/ sodium •Corticosteroids •Excessive ingestion of sodium-containing substances in the diet or sodium-containing medications |
| Fluid Volume Excess (FVE): Assessment | Acute weight gain. Peripheral edema, increased BP, SOB, crackles and wheezes, full bounding pulse, JVD, polyuria if renal function is normal, ascites, pleural effusion, pulmonary edema, decreased: BUN, hematocrit, serum sodium, and urine specific gravity |
| Fluid Volume Excess (FVE): Nursing intervention | •Assess presence/worsening of FVE •Low Na & fluid-restricted diet, if ordered •Avoid OTC drugs or check w/ HCP/pharm about Na content •Encourage rest period •Mon resp to diuretics •Teach monitoring of weight and I&O •Skin care •Mon resp status |
| Define: osmosis | Water passes from an area of lesser solute concentration and more water, to an area of greater solute concentration and less water until equilibrium is established |
| Fluid and electrolyte considerations: age | Infants-more body water ECF; ECF is more easily lost than ICF, they dehydrate easily. -Older adults higher risk for FVD: blunted thirst, decreased renal function -After 60, total body water is about 45% due to increased fat and less muscle |
| Fluid and electrolyte considerations: gender | - Women tend to have proportionally more body fat than men, which means less fluid space |
| Fluid and electrolyte considerations: Body fat | More fat=less fluid; more muscle=more fluid |
| Fluid and electrolyte considerations: Fluid intake | Average amount for 24 hour period: 2500-2600mL. Desirable amount for 24 hours: 1500-3500mL Sources: - Ingested water - Ingested food - Metabolic oxidation |
| Fluid and electrolyte considerations: Outs | Output should = intake Sources: - Kidneys - Skin - Lungs - GI tract |
| Define: Sensible fluid losses | Fluid loss that can be measured, such as urine |
| Define: Insensible fluid losses | Fluid loss that cannot be measured, such as sweat |
| Define: Diffusion | The tendency of a solute to move freely throughout a solvent from an area of greater concentration to lesser concentration until equilibrium is established |
| Define: Osmotic pressure | Reabsorption of capillary fluids by a “pulling force” created by the plasma proteins, particularly albumin. |
| Sodium's role | Normal: 135-145mEq/L -Regul ECF volume -Affects serum osmolality -Muscle contr nerve transm -Acid-base balance - Na bicarb -Maint water balance (water follows Na) Sources: PMS foods: Processed foods w/ hi sodium, dairy, IVF Losses: GI, renal, skin |
| Potassium's role | Lab: 3.5-5 -ICF osmol -Regul cell NZ act. -Impulses nerve heart skel intest & lung; prot/carb metab; cell bldg. -Assist acid-base by exchange w/ H+ Source-fruit/veg/pea/bean, whole grain, dairy/meat Loss-GI renal skin XS K= vfib Lo K= heart stop |
| Calium's role | Lab: 8.6-10.2 -Nerve impulses neuromuscular junction: contr/relax muscle -coagulation -Activ essential NZ -Bone & tooth strength Source dairy, pea/bean, OJ, greens, small fish w/ bones Losses: surgery Not enough Ca = jerky movements (tetany) |
| CATIONS | Positively charged ions Examples: sodium, potassium, calcium, magnesium |
| ANIONS | Negatively charged ions Examples: chloride, bicarbonate, phosphate, sulfate |
| NI: increasing fluid intake | Encourage fluids - Set specific amount of fluid intake per 24 hr. period - Explain rationale to pt. - Offer a variety of fluids - Always have fluids readily available |
| NI: restricting fluid intake | Explain rationale - Provide fluid in small cups - Offer fluids q1-2h - Offer ice chips - Avoid offering dry, salty, or sweet foods because they increase thirst - Provide regular oral hygiene - Set specific amount per 24 hr. period or shift |
| NI: Measuring I/O | - Instruct pt. and family about need to measure I&O - Use pt. plan of care to communicate need to measure I&O with other care team members - Measure I&O whenever possible - Record I&O totals each shift |
| IV access: peripheral | For brief access only; must be changed every 72-96 hours -Length: 0.75-1.25in. -Gauge: - 14-18 for blood administration; trauma and surgery pt. - 20-22 for most PIVs, larger for caustic or viscous solutions - 22-24 for elderly |
| Midline Peripheral Catheters | For therapy lasting 2-6 weeks Threads into basilica or cephalic vein and |
| Central venous access: general info | Devices that allow for TPN, vesicant or irritating solutions/meds, antibiotics, and CVP to be administered directly into the superior vena cava. - For long-term therapy - X-rays used to confirm placement before infusion |
| Central venous access:PICC | Peripherally inserted central catheters: thread from arm to SVCIVC -US-guided placement, XR verification. -Easy to care for; pt. are often sent home w/ these -line is >20cm long and only ever replaced if site becomes infected or line is occluded |
| Central venous access: non-tunneled Central Venous catheters | Used in emergent situations and threaded through the jugular, subclavian, or femoral veins - Sutured into place and can remain 3-10 days - Very high risk for infection with these - may have 3 or 4 lumens |
| Central venous access: Tunneled Central Venous Catheters | Surgically inserted (OR) catheter that’s tunneled under the skin to the superior vena cava - Can last indefinitely - May have multiple lumens |
| Central venous access: Implanted ports (Portacath) | Surgically implanted ports in the subcutaneous tissue with a line that ends directly above the right atrium - Has the lowest risk for infection - Can remain in place indefinitely |
| Types of IVF: isotonic | Osmolality = ECF; adds volume - D5W - NS (normal saline): not used for pt. w/ HF, Pulmonary edema, kidney impairment, or sodium retention; contains sodium - LR (lactated ringer’s): replaces sodium and potassium depleted by vomiting |
| Types of IVF: Hypotonic | Total osmolality is less than that of the ECF Solutions: 0.33% NS, 0.45% NS Uses: treatment of hypernatremia Too much can cause fluid depletion, hypotension, and cell damage |
| Types of IVF: Hypertonic | Total osmolality is greater than that of the ECF; any solution with more than 5% dextrose Solutions: D10W, 5%Dextrose in 0.45% NS (D5½NS), 5%Dextrose in NS (D5NS) Uses: treatment of hypovolemia Too much can cause FVE |
| Types of IVF: Plasma expanders | To expand intravascular volume with little fluid |
| Types of IVF: blood products | PRBCs, Platelets, Clotting Factors (for pt. w/ a clotting disorder), Plasma (e.g. FFP [fresh frozen plasma] admin. to a pt. prone to bleeding before an invasive procedure |
| Types of IVF: nutritional | TPN: total parenteral nutrition; physician prescribed diet that must be administered through a central line PPN: partial parenteral nutrition; physician prescribed nutrition that is administer according to facility policy |
| Normal osmolality of blood | 280-300 |
| IV complications: infiltration | Infusion of NON-VESICANT into tissues S/S: (local) pallor, edema, coolness, leaking fluid, discomfort, and a decrease in IV flow rate Treatment: stop IVF, warm compresses, elevate Prevention: inspect IV site often and use appropriate needle gauge |
| IV complications: Define: extravasation | Unintentional administration of a VESICANT into surrounding tissue |
| IV complications: extravasation grading scale | 0. No sym 1. blanch edema <1" cool +/- pain. 2. blanch ed 1-6" cool +/- pain. 3. blanch transl ed >6" cool mild-mod pain ?numb. 4. blanch transl tight leaking bruised; ed >6" pitting, circ impair, mod-sev pain. Blood prod/irrit/vesicant -> necros/blister |
| IV complications: embolism | Bubble in IV (air embolism) or a foreign body S/S: SOB, chest pain, cardiac arrest, LOC Trt: if cath tip has dislodged in vein, place tourniquet above& call HCP immed Prevention: Prime IV lines/attachment, use proper technique inserting catheter |
| IV complications: clotting/ obstruction | Clot at tip of the catheter S/S: Backflow of fluid into IV tubing Treatment: Discontinue IV and restart at new site Prevention: don’t allow IV bag to fully empty, prevent kinking and maintain patency of the tubing, check for adequate flow rate |
| IV complications: hematoma | Blood leak tissue (bruising) Causes: perf vein wall, slipping IV in vein, insuf pres to site after IV removal S/S: bruising, swelling, leak blood Treatment: remove IV, ice 24h, pres, elevate, assess circ, neurol& muscular restart new IV Prev: tech |
| IV complications: define phlebitis | Vein inflam; chemical, mechanical, or bacterial |
| IV complications: phlebitis causes | Chemical: vesicant, rapid rate, incomp meds Mechanical: IV too long, IV flexion area, gauge>vein size, insecure IV Bacterial: infection 2nd to prolonged ur untreated phlebitis, poor aseptic tech, poor hand hygiene |
| IV complications: phlebitis treatment & prevention | S/S: PRISH at insertion site and along vein, cordlike vein Treatment: apply a warm, moist compress and restar IV in another vein Prevention: hand hygiene, aseptic technique, observation of site hourly, dilution of irritating medications/solutions |
| IV complications: thrombophlebitis | Thrombus + vein inflammation S/S: PRISH, fever, low flow rate, leukocytosis Trt: stop IVF, apply cold then warm, elevate, DONT FLUSH Cx catheter, clean site w alcohol, new IV Prev: ck med compatibility, avoid vein trauma starting IV, observe site q1h |
| Define: Managed care | Goal: to provide cost effective, quality care that focuses on costs and improving outcomes, cost control, customer satisfaction, and health promotion and prevention |
| Define: Case Mgt | Multidisciplinary teams that collaborate to manage care w/ an emphasis on collaboration |
| Define: Client-Focused Care | All services and care providers come to the pt.; requires cross-training. (e.g. a nurse draws their own labs) |
| Define: Differentiated Practice | Focuses on best use of nursing staff based on skill sets and education; e.g. CNA, LPN, and RN all have different skill sets and education, therefore they perform different duties |
| Define: Shared Governance | Encourages the participation of nurses in all levels of communication; e.g. the nurse helps set budget and resources available |
| Define: Case Method | One nurse is responsible for providing total care for a group of clients for an 8-12 hour shift |
| Define: Functional Nursing | When the RN performs the more complex tasks and less complex tasks are assigned to the CNA and the LPN; can cause fragmentation |
| Define: Team Nursing | A team of providers led by the RN |
| Define: Primary Nursing | One RN is responsible for a group of pt. 24/7 until they are discharged w/ the RN performing total care for the pts. |
| Skills needed for managing care | - Problem solving skills - Creativity - “rigid flexibility” - Communication skills - Collaboration skills - Delegation skills - Conflict resolution skills - Time management skills |
| Define: Stress | The body’s reaction to any stimulus in the environment that demands change or disrupts homeostasis |
| Define: Stressors | Anything perceived as challenging, threatening, or demanding |
| Define: Stressors - internal/external | Internal: illness, emotional, etc. External: environment, noise, etc. |
| Define: Stressors - developmental | -Infant: learning to trust others -Toddler: learning potty train -School-aged: peer interactions -Adolescent: striving for independence -Middle aged adult: accepting signs of aging -Older adult: reflecting on past life experiences w/ satisfaction |
| Define: Eustress | “Good” stress; manageable stress that keeps us alert and motivated and leads to growth; also known as mild anxiety |
| Define: Distress | When stress becomes uncontrolled, overwhelming, or destructible |
| Define: Homeostasis | A state of dynamic balance that is always adjusting to change Physiologic Mechanisms: (mainly) Autonomic NS and endocrine system |
| Define: Local adaptation syndrome (LAS) | Local Adaptation Syndrome: a short-term localized response of the body to stress; Includes: reflex pain response and the inflammatory response |
| Define: General adaptation syndrome (GAS) | General Adaptation Syndrome: the body’s general response to stress |
| Define: General adaptation syndrome (GAS) | -Stage 1: alarm reaction: stressor perceived activate mechanisms -Stage 2: stage of resistance: body adapts to regain homeostasis; maybe confining it to small area (LAS) -Stage 3: stage of exhaustion: burnout adaptive mech, either rest/recover or die |
| Define: Burnout | A complex syndrome of behaviors characterized by physical and emotional depletion |
| Indicators of stress: Physiologic | backache, constipation, diarrhea, dilated pupils, dry mouth, headache, increased urination, increase in VS, nausea, sleep disturbances, stiff neck, increased perspiration, chest pain, weight gain or loss, decreased sex drive |
| Indicators of stress: psychoemotional | anxiety, fear, anger, and depression |
| Indicators of stress: cognitive | - Inability to solve problems or think through situations - Structuring: depends on the person - Lack of self-control - Suppression: refusal to deal with the situation - Fantasy: pretending the problem doesn’t exist; living outside reality |
| Indicators of stress: spiritual | - Disconnectedness from spiritual foundation - Questioning the purpose/meaning of life - Depends on person: some rely on it, some run away from it |
| Effect of stress on human needs | -Physiol: change appetite, activity, sleep, elimination; incr VS -Safety/Security: threatened, nervous, inattentive -Love/Belonging: withdrawn isolated, aggress -Self-Esteem: workaholic seek attn -Self Actualization: refuse reality, lack of control |
| Stress Reduction techniques | - Daily relaxation program - Regular exercise program - Learn to accept failures - Accept what cannot be changed - Develop collegial support groups - Participate in professional organizations - Humor - Seek counseling, if indicated |
| Define: Anxiety | A vague, uneasy feeling of discomfort or dread from an unknown source |
| Define: Mild Anxiety | An increase in mental alertness and perceptual fields Characterized by: restlessness and increased curiosity/questioning things |
| Define: Moderate Anxiety | Narrows perceptual fields to focus on immediate concerns Characterized bu: quivering of voice, muscle tension, tremors, nausea, and a slight increase in VS |
| Define: Severe Anxiety | Creates a narrow focus on specific details, all behaviors geared towards getting relief Characterized by: inability to communicate, erratic motor activity, headache, nausea, an increase in VS, tachypnea, hyperventilation, and facial expression |
| Define: Panic | Causes a person to lose control and experience dread and terror; can lead to exhaustion and death Characterized by: inability to communicate, lack of control, dread, and terror |
| Define: Coping mechanisms | Stress mgt technique: may be + or -. Learned based on experiences -Crying, laughing, sleeping, cursing -Physical activity, exercise -Smoking, drinking -Lack of eye contact, withdrawal -Limiting relationships to those w/ similar values & interests |
| Pathologic coping syndromes | Anxiety disorders: most common Generalized anxiety disorder Phobias Panic disorder Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder (OCD) |
| Anxiety Reduction techniques | - Exercise - Rest and Sleep - Use of support systems: family, friends, etc. - Relaxation - Meditation - Anticipatory guidance - Biofeedback |
| Define: defense mechanism | Unconscious reactions to stress that typically occur with mild to moderate anxiety to protect self-esteem |
| Defense mechanism: Compensation | Attempting to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area |
| Defense mechanism: Denial | Refusal to acknowledge the presence of a condition that is disturbing |
| Defense mechanism: Displacement | Transferring an emotional reaction from object/person to another object/person |
| Defense mechanism: Introjection | Incorporating qualities and/or values of another person into their own ego structure; important in the formation of conscience in childhood |
| Defense mechanism: Projection | Attributing thoughts and impulses to someone else (e.g. a person who denies sexual feelings for a coworker accuses him of sexual harassment) |
| Defense mechanism: Rationalization | “behavioral justification”; trying to give a logical or socially acceptable explanation for questionable behavior |
| Defense mechanism: Reaction Formation | When a person develops conscious attitudes and behavior patterns that are opposite of what they would like to do |
| Defense mechanism: Regression | Returning to an earlier method of behavior |
| Defense mechanism: Repression | Voluntarily excluding an anxiety-producing event from conscious awareness |
| Defense mechanism: Sublimation | When a person substitutes a socially acceptable goal for one whose normal channel is blocked (e.g. an individual who is aggressive toward others may become a star football player) |
| Defense mechanism: Undoing | An act or communication used to negate a previous act or communication |
| Define: loss | Occurs when a valued Person, Object, or Situation is changed or inaccessible so that its value is diminished or removed - Actual - Perceived - Physical - Psychological - Situational - Anticipatory |
| Define: grief | The total repose to the experience related to loss; a natural response that should occur. It can look like helplessness, loneliness, anger, or depression and it should be shared |
| Define: Mourning | The behavioral process through which grief is eventually resolved or altered |
| Define: Bereavement | The subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship |
| Engel’s Stages of Grief | 1) Shock and Disbelief 2) Developing Awareness 3) Restitution 4) Resolving the Loss 5) Idealization 6) Outcome |
| Kubler-Ross Stages of Grief | 1) Denial and Isolation 2) Anger 3) Bargaining 4) Depression 5) Acceptance |
| Define: Death | An individual who has sustained either (1) irreversible cessation of all circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem |
| Signs of impending death | -Decr tone: jaw sags, eyes roll, decr GI func, prb swallowing, incontinence, loss of extremity mvmt. Decr HR/BP, mottling -Resp irreg, +/- in rate, “death rattle”, cheyne stokes -Decr senses, blurred vision, restlessness, agitation, nausea |
| Body changes after death | -Rigor mortis: stiff 2-4 hr. after death -Algor mortis: gradual decr temp to room temp -Liver mortis: discoloration of tissues on dependent areas -Loss of elasticity: skin tears easily -Liquefaction of body tissues due to bacterial fermentation |
| Post Death Issues | - Death certificate: required by law and must be signed by a physician - Organ donation - Autopsy: performed only to discover cause of death and may be done with blood work or actually opening chest and/or brain cavity |
| Cultural/Faith-based Considerations | - Vigils: sitting with person, waiting for impending death - Rites and Rituals: cultural and spiritual preferences - Inward Grieving vs. Outward Displays |
| Children at End of Life issues | -Provide UTD info -Enc supporters to share in death vigil -Enc parents to provide comfort: singing, massaging, blankets.. -Continuously reassess dying child and supporters for understanding & needs -Avoid euphemisms & use correct terms w/ children |
| Define: Open Awareness | Pt. and family know of impending death |
| Define: Mutual Pretense | Terminal prognosis known by pt. and family but is not discussed |
| Define: Closed Awareness | Pt. is unaware of impending death |
| Abdominal assessment: Inspection | - Skin color - Umbilicus: shape, location - Contour: flat, convex, concave, distended (measure, if distended) - Visible peristalsis |
| Abdominal assessment: Auscultation | 4 quad w/ diaphragm -Normal 5-30/min -Hyper >30/min -Hypo <5/min -Absent: 4 quad 5 min. ea. -Borborygmi: hi-pitched rustling, gurgling <3s. -Peritoneal friction rub: rub of peritoneal memb. Subxyphoid w/ bell for abdominal aorta (bruit) |
| Abdominal assessment: Percussion | Not typically performed, however: tympany over hollow organs (intestines, etc.) and dullness over solid organs (liver, spleen, etc.) |
| Abdominal assessment: Palpation | Light palpation only: 1cm deep in a circular motion in all 4 quadrants; RLQ->RUQ->LUQ->LLQ Palpate tender areas last |
| Urinary elimination: Anatomy 1/3 | - Kidneys: located retroperitoneal and are the primary regulators of fluid and acid-base balances; contain nephrons, which are the functional unit/filtering portion of the kindeys |
| Urinary elimination: Anatomy 2/3 | - Ureters: tubes leading from kidneys to the bladder that use peristalsis to move urine - Bladder: smooth muscle sack that acts as a reservoir for urine |
| Urinary elimination: Anatomy 3/3 | - Urethra: short tube that transports urine from the bladder to the exterior of the body; an act known as: voiding, micturition, or urination - Pelvic floor: the voluntary internal and external sphincters that help to control elimination |
| Urinary elimination: Urinalysis values | - Color clear, straw, dk yellow - Odor sl aromatic - S.G. 1.005-1.035 - RBC 0-2 - WBC 0-5 - Casts 1-2 hyaline casts - Crystals present -Organics urea, uric acid, creatinine, hippuric acid, indican, pigments. -Inorganics ammonia,Na Cl Fe P S K Ca |
| Urinary elimination: blood labs | - BUN: 8-20 mg/dL - Creatinine: female 0.6-0.9mg/dL; male 0.8-1.2 |
| Urinary elimination: Pregnancy and Birth | - Women need to urinate immediately after birth because inflammation may prohibit later on - Newborn GFR is <60 and their urine should be odorless, and possibly cloudy or pink |
| Urinary elimination: Assessment | - Urinary meatus for: redness, discharge, irritation, yeast infection(esp. women) - Kidneys: auscultate renal arteries (1cm above belly button to left and right) and back pain - Bladder: distension |
| Define: Anuria | 24-hour urine output <50mL; kidney shutdown or renal failure |
| Define:Dysuria | Painful or difficult urination |
| Define:Frequency | Increased incidence of voiding |
| Define:Glycosuria | Presence of glucose in urine |
| Define:Nocturia | Awakening at night to urinate |
| Define:Oliguria | Greatly diminished amount of urine in a given time; <400mL in 24 hours |
| Define:Polyuria | Excessive output of urine |
| Define:Proteinuria | Protein in the urine; indicator of kidney disease |
| Define:Pyuria | Pus in the urine; urine appears cloudy |
| Define:Suppression | Stoppage of urine production; normally adult kidneys produce 60-120mL/hr |
| Define: Urgency | Strong desire to void |
| Define: Incontinence | Urinary; involuntary loss of urine |
| Define: Transient incontinence | Appears suddenly and lasts for up to 6 mo.; Can be a result of medication, illness, or a diagnostic procedure |
| Define: Stress incontinence | When movement causes involuntary bladder leakage caused by an increase in intraabdominal pressure that results in pressure on the bladder |
| Define: Urge incontinence | Involuntary urine loss after feeling the urge to void; they can’t make it to the bathroom in time |
| Define: Mixed incontinence | Diagnosis of more than one type of incontinence |
| Define: Overflow incontinence | Incontinence caused by over-distension of the bladder |
| Define:Functional incontinence | Incontinence related to function; e.g. an older adult who cannot ambulate to get to the bathroom in time |
| Define: Reflex incontinence | |
| Define: Total incontinence | |
| Define: Urinary retention | |
| Treatment options for incontinence | |
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