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Janet-Lecture notes
Janet- Lecture notes- ALL
| Question | Answer |
|---|---|
| Objectives | Discuss values essencialto the professional nurse, list & describe the 5 common modes of value trasmission, Give examples of nursing practice that is consistant practice that is consistant with the code of ethics for nursing, summarize the patients Bill o |
| Values in Nursing | Honesty, compassion, empathy, respect |
| Development of Values | ethics (professional, list of things right or wrong), morals (everyones own opinion of what is right or wrong), modeling (good role model), Moralizing (religious values), Lazifaire (loose values, children explore their own values, often leads to confusion |
| Values Essential to the professional Nurse | Altruism- (concern for ALL others), Autonomy (Right for patient to make their own decisions), Interigty, Human Dignity (respect for all peoples values, beliefs), Social justice |
| Ethical | Right or wrong, nursing code of ethics (organizations) |
| Morals | similar to ethics, personal |
| ANA Code for Nursing | 1. Compassion, Respect and Dignity. 2. Protect health, safty and rights (safety /c procedures and med.s). 3. Commitment to PATIENT 4. accountable/ responsible 5. Competent 6. Improve conditions 7. Advance profession (research and edu.).8.Collabrates (with |
| Advanced Directives | DNR, Living Will, Durable POA |
| Pt. Bill of Rights | High quality care, Clean and safe, Involvement of care, Privacy- HIPPA, Prepared for Discharge, Billing and Insurance |
| Intentional Tort | Assault (verbal) & battery (physical), Defamation of Character (negative statement), HIPPA, False Imprisonment, Fraud |
| Unintentional | Negligence, Malpratice |
| Negligence: Failure to | Observe & Communicate changes, Provide safety, properly assess, Question inappropriate orders, properly perform procedures, properly administer medication, document condition and response |
| 4 elements between Negligence and Malpratice | 1. Duty, 2. Breach of duty, 3. Causation (did breach cause a problem?) 4. Damages |
| Professional and legal Regulation of Nursing pratice | Nurse Pratice- most important law affecting, Standards- set by professional nursing organization, Credentialing- accrediationl licensure, certification (ie: teaching) |
| Legal Aspects of Nursing | -Informed concent, contracts, collective bargaining, competent pratice, client education, documentation, adequate staffing, professional liability ins, risk managment programs, incidence or varience reports, good samaritan laws, student liability (not und |
| ALWAYS GO BY BOOK | a judge will |
| Important points | ANA code of ethics- nurse must care for patient regardless of background or medical hx (AIDs pt. or murderer, must care for same as anyone else), Universal Infection precautions |
| 2 situations a nurse can deny giving care | conflicts /c deeply held religious believes (some ppl and abortion), or great potential for harm to nurse (nurse is immuno compromised) |
| Rehablitation act and ADA | prohibit discrimination |
| Important points to concider | compentent adults have the right to make decisions based on their religious beliefs; also, Jehovias Witnesses believe that if they receive blood products there is enternal concenquences |
| Nutrition Maslow | Malsow is used in business |
| Maslow in Nursing | looking for such things as under nutrition, giving Ensure as a suppliment, height, weight, diet, medicaiton that effect stomach, vit. are things that would go under the basic level. |
| BMR | Male has higher BMR the women, Female has 0.9 cal/kilo |
| Increased BMR | Fever, medication, stress, anxiety and infection |
| Decreased BMR | Age, fasting, sleep |
| Calories | 1 lbs body fat = 3500 calorie |
| To loose or gain 1 lbs per week you must adjust calories by | 500 calories per day |
| Enteral feeding generaly equals | 1 calorie/mL |
| Carbohydrates | Sugars and starchs. It is the most abundent and least expensive source of calorie in the world. |
| Carbohydrates are converted to | gluecose for transport through the blood |
| Sources of Carbohydrates | plants and lactose. (Lactose is the only animal source.) |
| Protein | are required |
| Fats | Most concentrated. Come in saturated (raises cholesterol levels) and unstaurated |
| Vitamins | Determine Calories needs |
| Basal metabolic rate (BMR) | the amount of energy expended while at rest, while the digestive system is inactive, (which requires about twelve hours of fasting in humans). |
| The release of energy in BMR is | sufficient only for the functioning of the vital organs, such as the heart, lungs, brain and the rest of the nervous system, liver, kidneys, sex organs, muscles and skin |
| Approximent estimated energy requrement for males (adult) | 2200-3200 |
| Vitamin A content in cooked spinach | 943 mg per cup |
| Vitamin A content in cooked broccoli | 153 mg per cup |
| US consumes ___?___ whole grains | 13% |
| US consumes ___?___ refined grains | 87% |
| Recommened whole grains, recommened refined grains | 50% of each |
| Whole grain | Whole grains contain the entire grain kernel -- the bran, germ, and endosperm. Examples include: whole-wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal, brown rice |
| Palm of hand = | serving size |
| Components of nutrient assessment Hx taking- | dietary, medical, socioeconomic data |
| Components of nutrient assessment Physical assessment | clinical data, antropometric data |
| antropometric data is | measure the absolute and relative variability in size and shape of the human body. Depending on the objective, anthropometric instrumentation may include weighing scale, anthropometer, skinfold calipers, body volume tanks, and bioelectrical impedance anal |
| Components of nutrient assessment Lab data | protein status, body vitamins, mineral and trace element status |
| Food habits: physical | geographic locations, food, technology, income |
| Food habits: food technology | is good in america |
| Food habits: physiologic | health, hunger, stage of development |
| Food habits: psychologic | culture, religion, tradition, education, politics and social status |
| Developmental Concideration: growth | Infancy, adolescence, pregnancy and lactation. Age related changes in metaboism and body compisition |
| Developmental Concideration: Nutrition needs | level off in adulthood, fewer calories are needed in adulthood because of decrease in BMR |
| Risk factors for poor nutrition status | development factors, state of health, alcohol abuse, medications, mega doses of nutrient supplements |
| Dietary Data | 24 hour recall, food diary, diet history |
| Assessing diet | Usual intake, Allergies and intolerances (lactose intolerance), food preparation and storage (can someone with arthritis open a jar?), disorders (anorexia), dietary pratices |
| Enteral Nutrition: short term | nasogastric or nasointestinal |
| Enternal Nutrition: long term | enterostomal tube (a opening in stomacg -PEG- or jejunium |
| Nursing conciderations with tube feedings | promote patient safety, monitor patient for complications, provide comfort measures, provide instructions to go home with |
| Total Patenteral Nutritional (TPN) | is the practice of feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins. |
| Partial Patenteral Nutritional (PPN) | solution, containing some essentail nutrients, is injected into a vein to supplement other means of nutrition, usually a partially normal diet of food. |
| Complications of parenteral nutrition | Insertion problems, infection, metabolic alterations due to a vascular insertion, fluid, electrolyte and acid base imbalance |
| Nutrition based nursing interventions | Screening pt. at home for nutritional risk, observing intake and appetite, evaluating the patients tolerence, assisting the patient with eating, administering enternal and parenteral feedings, consulting with the dietitian and physician, addressign potent |
| Levels of prevention: primary | diet (teach/prevent) |
| Levels of prevention: Secondary | tests/labs/screening |
| Levels of prevention: tertiary | enteral feeding |
| Nutrition in nursing (nursing dx): As a problem- | Altered Nutrition increased body requirements, decreased body requirements |
| Nutrition in nursing (nursing dx): As an Etiology- | Constipation R/T inadequate Fuber, Self esteem disturbance R/T Obesity |
| Nutrition in nursing (nursing dx): As a sign and symptom- | noncompliance r/t stated desire to change eating habit AEB eating donuts |
| Hospital Diets | NPO (risk for impaired oral mucous membrane)-{give ice chips, hard candy, gum}. Clear liquid diet, full liquid, soft, vegitarian (may need supplements of B12, Vit. A, Iron. |
| Nursing Implications of Albumin- If Albumin is low... | Peripheral edema may exist, skin integrity may be at risk, |
| Albumin may be low as a result of | Cirrhosis of the liver (from medications such as PCN, ASA), or severe malnutrition and burns (loose protein through the skin) |
| Albumin maybe high as a result of | dehydration, rx: Heparin, osmotic pressue |
| Over 1/2 of plasma protein is synthesized by the | liver, which can result in edema |
| If protein is increased edema may | go down |
| BUN adult level | 5-25 mg/dl |
| BUN stands for | Blood Urea Nitrogen |
| BUN is higher in | Elderly |
| BUN is the end product of | protein metabolism and is excreted by kidneys |
| BUN is (or can be) increased by | dehydration, pre-renal failure, GI bleed, if protein level increases |
| If you can't excrete BUN through kidneys it goes in to | blood |
| BUN is decreased by | some medication (antipsyc), and malnutritionq |
| Creatinine in adult male | 0.5-1.5 mg/dl, slightly lower in female r/t decreased muscle mass |
| CREATININE is used to dx | renal function |
| Creatinine is the by-product of | muscle catabolism |
| Creatinine and BUN is | read together |
| Creatinine clearence is a | 24 hr test to determine GFH |
| Decreased Creatinine is found with | reduction in total muscle mass and malnutrition |
| Increased Creatinine is found with | kidney problems, many Rx |
| Blood glucose test | Finder stick, FBS, HGB A1C (if hemoglobin is low it will falsely change the other) |
| Hemoglobin | Protein in RBC's, gives blood red color, carries oxygen, |
| Hemoglobin levels | 12-15 is normal, 8 is bad, decreased in anemia, increased with fever |
| Hematocrit | Volume of RBC's packed in 100 ml of blood, expressed as a percent |
| Hematocrit levels | @ 40% is normal, 20% is low (over hydrated from IV), 60% is dehydrated |
| cytic = | size |
| chromic = | color |
| mean = | avg. |
| normocytic | MCV- normal size |
| normochromic | MCHC- normal color |
| Microcytic | decreased MCV- small |
| Hypochromic | decreases MCHC- light |
| Macrocytic | increased MCV- large |
| Hyperchromic | increaed MCHC- dark (rare) |
| Iron Cells | Microcytic (small), Hypochromic (pale) |
| Iron absorbtion requires | acidic enviroment, best taken on an empty stomach (with juice) |
| Injections of Iron are given | IM (parental) |
| When giving iron IM use | 2 track because iron stains the skin |
| Iron is found in | spinish, liver, red meat |
| Iron can cause | constipation and green and black stool |
| Iron deficienty is cause from | Chronic bleen, blood loss from surgery, dietary issues |
| RBC size | 4-5 (x10 to the 6th power /ml) |
| For RBC values outside of the norm | look at Hemoglobin and Hemacrit values and RBC indices |
| Signs and symptoms of RBC deficiencies are | fatigue and dyspenia |
| hemoglobin A1C | Glycosylated Hemoglobin is 120 days, Glucose to Hgb, 6-8% is normal |
| Level of prevention: Primary | before you know the disease exists |
| LOP: Primary- Nursing intervention | promote good diet |
| Level of Prevention- Secondary | early detection, prompt intervention, health maintence |
| Level of Prevention- Tertiary | decreased disability prevent complications, incrreased functions |
| WBC (# of leukocytes) | Phagocytes |
| WBC increased | infection, leukocytosis |
| WBC decreased | Bone marrow, depression, leukopenia |
| Nursing Measures for WBC | Increase host resistance fluids, nutrition, sleep, assess s&s of infection, Avoid germs, |
| HCT | volume % of packed cell. Inversely amount of water |
| Increased HCT | dehydration, polycythemia |
| Decreased HCT | Anemia |
| HCT Nursing Measures | Assess fluid status: S & S of dehydration and urine output |
| HGB | Oxygen Carrying |
| Increased HGB | Dehydration, Polycythemia |
| Decreased HGB | Anemia |
| Nursing interventions | Fatigue, Activity intolerance, High risk injury, high risk infection, Assess S&S |
| MCV | mean corpuscular volume, cell size |
| Increase MCV | Macrocytic |
| Normal MCV | Normocytic |
| Decreased MCV | Microcytic |
| Nursing Interventions MCV | folic acid or B12 defucuency, iron deficiency anemia |
| MCHC | mean corpuscular hemoglobin concentration |
| MCHC is | Average concentration of Hgb in a red blood cell or color of cell |
| Normal MCHC | Normochromic |
| Increased MCHC | Hyperchromic (rare) |
| Decreased MCHC | Hypochromic |
| Nursing measures of MCHC | Iron deficiency Anemia |
| B12 is needed for | nerve function, |
| B12 can cause | Paresthesias |
| Paresthesias is | sensation of tingling, pricking, or numbness of a person's skin |
| B12 deficiency often occurs because the person | cannot absorb B12 properly |
| Food with B12 include | Animal proteins, eggs, dairy |
| Inability to absorb B12 can cause | Pernicious anemia, Intrinisic factor, Shillings Test |
| B12 deficiency is often seen with | GI surgery, stomach cancer, people with stomach issues |
| If some one has a B12 deficiency they will need | Parental Injections |
| Shilling's test | test to see if there is a B12 problem |
| Intrinsic factor | ability to absorb B12 |
| Folic Acid Cells | Macrocytic (large), Normochromic (normal color), |
| Folic Acid deficency is similar to | B12 but NO paresthesias |
| Folic acid comes from | green leafy veggies and nuts |
| MCV would elevate with | Macrocystic |
| These effect folic acid | Chrones Disease, alcohol problem, some medications |
| In Maslow anemia could go in | physiological |
| Fluids purpose | Transportation, Metabolism, Solvents, Lubricant, Vascualar Volume, Temperature, Digestion, elimination |
| Fluid goes | in and out of cells |
| Fluids assist in | body temp |
| fluids promote | digestion |
| fluid acts as a lubricant for | tissue and joints |
| Hemacrit over 40% is | high |
| Intracellular water percentage is | 70% |
| Extracellular water percentage is | 30% |
| Extracellular water is found in | intravascular and interstitial |
| Water accounts for | 50-60% of body weight |
| 2/3rds of water is found in | ICF |
| 35-40% of body weight is in | cell fluid |
| Plasma accounts for ? body weight | 5% |
| Interstitial fluid accounts for ? body weight | 10- 15% |
| Extral cellular fluid accounts for ? body weight | 15-20% |
| Fluid Sources | Injested liquids, water in food, metabolism |
| Sensible fluid loss | perspriation, waterm fecesm urine, gastric flushing |
| Normal fluid loss through urine per HOUR | 20 ml/ hour |
| Patients often on fluid restrictions | CFH, decreased renal function |
| Hypothalmus tells us | we're hungrey |
| Insensible Fluid loss | perspiration, fever, respiration increased suctioned, drainage from wound, burn pt. |
| When respiration increased | fluid loss increased |
| Measure urine concentration | blue sheet/ More fluid, more particals, higher number specific gravity= more concentrated/ less hydrated |
| kidneys | filter blood |
| Nephrons | job is to filter (GFR) |
| Kidneys excrete | 1-2/L urine production per day |
| An indicator of Renal disease is | urine out put of less then 20/ml/hr |
| Increased ADH from pituitary gland = | increased H2O retention= urine concentration |
| Secrete renin | increased powerful vasoconstrictor |
| renin triggers aldosterone (adrenal cortex) to | retain sodium and H2O |
| dialysis is done because | the kidneys don't filter properly |
| Atrial Natruiretic paptide (ANP) | is a hormone that promotes vasodilation |
| kindeys secrete | renin |
| ANP suppresses | renin levels |
| ANP increases | GFR |
| ANP | promotes vasodilation |
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