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TheoryExam4
GWCC Block 1 nursing
| Question | Answer |
|---|---|
| A person suffers a loss when . . . | any aspect of self is no longer available to that person. |
| Goals of end of life care include (3) | -provide comfort and supportive care during dying process - improve quality of remaining life - ensure a dignified death |
| What is not a goal of end of life care? | prolonging life |
| Death occurs when . . . | ALL vital organs and systems cease to function. Irreversible cessation of circulatory and respiratory function. - EEG flat - EKG flat |
| What are three physical manifestations of dying? | - cellular metabolism decreases - body slows down until all function ends - generally respiration ceases first, then heart stops within a few minutes |
| What are some signs of dying with the integumentary system? | -mottling of hands/feet, arms and legs - cyanosis of nose, nail beds, knees - waxlike skin when very near death |
| What are the progressive respiratory signs of death? | - increased respiration rate - cheyne-stokes respiration - inability to cough/clear secretions "death rattle" - irregular breathing |
| What are some urinary system signs near death? | - a gradual decrease in urinary output - incontinent of urine - unable to urinate |
| What is a normal amount of urine to excrete per hour? | 30 mL or more |
| What are some GI system signs of death? | - slowing of GI tract and possible cessation of function - accumulation of gas - distension and nausea - loss of sphincter control |
| What are some signs of musculoskeletal system process of dying? | -gradual loss of ability to move - sagging of jaw, loss of facial muscle tone - difficultly speaking - swallowing is difficult -difficultly maintaining body posture - loss of gag reflex - joints become stiff - jerking in pt with opiod meds |
| The musculoskeletal system declines in which order? | periphery to core of body |
| What are some cardiovascular signs of dying? | -increased heart rate - later slowing and weaking of pulse - irregular rhythm |
| Near the end of life it is common to have . . . | visual and auditory hallucinations. |
| Brain death is defined as | - cerebral cortex stops functioning or is irreversibly destroyed -coma or unresponsiveness - absence of brain stem reflexes - apnea |
| Cerebral cortex is responsible for | -voluntary movements - cognitive functioning |
| Kubler-Ross 4 stages of grieving | Denial Anger/bargaining Depression Acceptance |
| Four tasks of healthy grieving | -accept the reality of the loss - experience the pain of grief - adjust to environment without the deceased - reinvest emotional energy in a new relationship |
| People can hurt physically from grief. This is called . . . | visceral pain |
| Grief and grieving take at least | one year |
| Durable power of attorney | can make many decisions (money, care, etc) |
| Medical power of attorney | can only make medical decisions |
| actual loss | can be recognized by others |
| perceived loss | is experienced by one person but cannot be verified by others. Includes psychological losses (loss of dreams, independence, etc). |
| anticipatory loss | experienced before the loss actually occurs. Example, a dying spouse. |
| situational loss | loss because of a situation: injury, job, death of a child |
| developmental loss | losses that occur as part of normal development and life process: retirement, death of aged parents or pets |
| loss of aspect of self | limb or scar, change in mental or emotional capacity |
| loss of external objects | loss of inanimate objects that have importance (money, house), or loss of animate objects such as a pet |
| grief | the total response to the emotional experience of loss. Manifested in thoughts, feelings, and behaviors, overwhelming distress or sorrow. Grief can manifest physically as well. |
| mourning | the behavioral process through which grief is eventually resolved. It's essential for health. |
| abbreviated grief | brief but genuinely felt |
| disenfranchised grief | occurs when a person is unable to acknowledge the loss to other persons, often because of socially unacceptable relationships (suicide, abortion, extramarital relationship) |
| complicated grief | strategies to cope with grief are maladaptive and unhealthy. Includes suicidal thoughts, barriers to expressing grief (culture, family), strained relationships with the person who has passed. Includes unresolved or chronic grief. |
| inhibited grief | many normal symptoms of grief are inhibited, and other effects are expressed instead including somatic symptoms. |
| delayed grief | grief is delayed until much later |
| exaggerated grief | a survivor appears to be using dangerous activities as a method lessen the pain of grieving |
| Kubler Ross 5 stages of grief | Denial Anger Bargaining Depression Acceptance |
| What are some symptoms of the anger stage of grief | client or family may direct anger at nurse or staff about matters that normally would not bother them. |
| What are some symptoms of the bargaining stage of grief? | seeks to bargain to avoid loss. May express feelings of guilt or fear of punishment for past sins, real or imagined. |
| Normal manifestations of grief that are considered normal | verbalizing loss, crying, sleep disturbances, loss of appetite, difficulty concentrating. |
| Inspiration is a _____ process. | Active! Expiration is passive. |
| Persons with breathing difficulties have to actively perform . . . | inpiration, and expiration (which should be passive) so they work 2x as hard |
| Influenza is transmitted . . . | by droplets and touching nose and eyes |
| clear mucous | healthy, or virus |
| white/opaque mucous | viral |
| gray mucous | viral (?) |
| yellow mucous | bacterial |
| green mucous | bacterial |
| brown mucous | old blood |
| red mucous | new blood |
| rust colored mucous | respiratory disease |
| lower airway disorders examples | pneumonia, TB, valley fever (coccidoidmycosis) |
| upper airway disorders examples | influenza, viral colds |
| pathophysiology of respiratory disorders | -altered ventilation -altered perfusion - altered gas exchange - ineffective airway clearance - infections |
| two types of influenza | influenza types A and B |
| the most common complication of influenza is | pneumonia-- this is the main reason people die of the flu |
| treatments for the flu | analgesics, antipyretics rest, fluids antiviral drugs prevention (vaccine) |
| two examples of antiviral drugs, and when to give them | Tamiflu, Relenza, give within 48 hours of first symptoms |
| The common cold is caused by which virus? | Adenovirus (aka acute viral rhinitis) |
| symptoms of the common cold appear within | 5-7 days after initial exposure: sneezing, itchy and watery eyes, fatigue, dry nose and mouth. 2-3 days after symptoms being, runny nose with thick secretions, fever (sometimes), tired. Resolves within 5 days. |
| complications of the common cold | sinitus, tonsilitis, pharnyngitis, lung infections |
| pathophysisiological course of pneumococcal pneumonia | 1- aspiration of virus 2- release of bacterial endotoxin 3- inflammatory response 4- red hepatization 5- grey hepatization 6- resolution |
| red hepatization is when . . . | the tissues are inflamed and red, similar to granulation tissue. |
| grey hepatization is when . . . . | fibrin is deposited on the pleural surface, and phagocytosis occurs in the alveoli. |
| A normal chest xray looks like | mostly black. |
| An xray with pneumonia looks like . . . | a grey cloud. |
| three ways organisms reach the lungs | aspiration inhalation hematongenous spread |
| types of pneumonia | -community acquired -hospital acquired |
| community acquired pneumonia is defined as | - lower respiratory infection of lung - onset in the community occurs during the first 2 days of patient hospitalization |
| hospital-acquired pneumonia is defined as | - occurs 48 hours or longer after admission, and not incubating at time of hospitalization |
| risk factors for hospital-acquired pneumonia include | - immunosuppressive therapy - general debility - endotracheal intubation |
| What is the second most common nosocomial infection? | hospital acquired pneumonia, and insurance won't pay for this type of pneumonia! Assessment upon admission is very important! |
| What is the pneumonia that often occurs with HIV/AIDS and immunocompromised patients? | Pneumocytis jiroveci (PCP) |
| What patients are at risk for opportunistic pneumonia? | -severe malnutrition - immune deficiencies - chemo/radiation - transplant recipients |
| clinical manifestations of PCP | - fever, tachypnea, tachycardia, dypsnea, non-productive cough, hypoxemia |
| clinical manifestations of community acquired pneumonia | -sudden onset of fever, chills, productive cough with purulent sputum, pleuritic chest pain, confusion and stupor in older adults |
| What are some complications of community acquired pneumonia? | pleurisy, pleural effusion, atelectasis, bacteremia |
| define pleural effusion | fluid collecting in pleural space, usually reabsorbed in 1-2 weeks or requires thoracentesis |
| define atelectasis | collapsed alveoli, usually clears with cough and deep breathing |
| define bacteremia | bacterial infection in blood |
| define empyema | pus-involved infection, usually requires antibiotics and drainage of exudate |
| define pericarditis | spread of microorganism to heart sac |
| What is the significance of seeing banded neutrophils in the blood? | banded neutrophils are immature. Segmented are mature. If you see banded, the body has used up all the mature ones. Signals severe or long-term infection. |
| Patient with pneumonia needs at least ___ L of fluid a day and at least ___ calories per day. | 3 L, 1500 calories |
| Nursing dx related to pneumonia | Ineffective breathing pattern Ineffective airway clearance Acute pain Imbalanced nutrition: less than body requires Activity intolerance |
| Pulmonary TB is a disease caused by the ___ organism. | mycobacterium tuberculosis |
| Pathophysiology of TB | areas of necrosis, degeneration, and fibrosis (granulomas present), can spread to new areas of lung, may enter blood stream and disseminate to brain, liver, kidneys, bone marrow. |
| The sputum test for TB looks for | acid fast bacteria (AFB) |
| The skin test for TB looks for | induration (hardness) around area of injection, as well as redness and vesicles (blister). Need to palpate and measure boundaries of hardness. |
| Clinical manifestations of TB | insidious onset(no symptoms), fatigue, nausea, weight loss, anorexia, constant low-grade fever, night sweats, cough with mucopurulent sputum streaked with blood, chest tightness, dull chest pain. |
| A positive sputum test for TB is determined by __ | acid fast bacteria that is collected three mornings in a row |
| The most reliable test for TB is the | Mantoux test |
| The blood test used to detect TB is | QuantiFERON- TB Gold |
| Treatment drugs for TB include | -Isoniazid + Rifampin (turns urine orange!) - Phyrazinamide (PZA) and Ethambutol - Streptomycin + a quinolone drug may be added - course of therapy lasts 6 months - sputum samples every 2-4 weeks until negative for 3-6 months. |
| Precautions for TB patient in hospital include | - negative pressure room - N95 mask - HEPA respirator |
| Treatment of Coccidoidomycosis (Valley Fever) includes (and risks/side effects of treatment are) | Amphotericin B IV this can be very toxic including hypokalemia, nephrotoxicity, and anemia |
| What are the four ways of knowing? | Empirical Ethical Personal Aesthetic |
| What is empirical knowing? | factual, observable phenomena and theoretical analysis |
| What is aesthetic knowing? | The art of nursing, expressed by each nurse through his or her creativity and style in meeting the needs of clients. Empathy, compassion, holism, sensitivity. |
| What is personal knowing? | knowing, encountering, and actualizing the concrete, individual self. The way nurses view their own selves and the clients is of primary concern in any therapeutic relationship. |
| What is ethical knowing? | focuses on matters of obligation or what ought to be done, and goes beyond simply following ethical codes. |
| What are the four stages of NREM sleep? | Stage I: very light sleep Stage II: body continues to slow down with heart, respiration, body temperature fall. Stages III and IV: deepest stages, differ in % of delta waves. Difficult to arouse. |
| Describe REM sleep | Brain activity and metabolism increase, recurs every 90 minutes and lasts 5-30 minutes. |
| A healthy adult experiences ___ sleep cycles per night. | 4 to 8 |
| narcolepsy | daytime sleepiness caused by a lack of the chemical hypocretin in the CNS. Their sleep at night has early REM, hallucinations, night paralysis. |
| hypersomia | person gets adequate sleep at night but is still sleepy during the day. |
| parasomnia | behavior that interferes in sleep and may even occur during sleep: sleepwalking, night terrors, bruxism. |
| Pain may be described in terms of (4) | location duration intensity etiology |
| chronic pain persists for | 6 months or longer |
| mild, moderate, and severe pain on a pain scale | 1-3 mild 4-6 moderate 6+ severe |
| define physiological pain | when an intact, properly functioning nervous system sends signals that tissue is damaged |
| define somatic pain | originates in skin, muscles, bone or connective tissue |
| define visceral pain | originates in organs and/or hollow viscera. Poorly located, cramping, aching, throbbing, or pressing sensations. |
| neuropathic pain | damaged or malfunctioning nerves due to illness, injury, or other reasons. -peripheral - central |
| pain threshold | least amount of stimuli needed for a person to label a sensation as pain |
| pain tolerance | the maximum amount of painful stimuli that a person is willing to withstand without seeking pain relief. |
| Hyperalgesia, allogynia, hyperpathia, and dysethesia | conditions of abnormal pain processing that may signal the development of neuropathic processes. |
| Hyperalgia/hyperpathia | a heightened response to painful stimuli (eg paper cut = severe pain) |
| allodynia | non-painful stimuli produces pain (contact with linen, water, wind) |
| dysesthesia | unpleasant abnormal sensation |
| sensitization | increased sensitivity of a receptor after repeated activation by noxious stimuli |
| windup | progressive increase in excitability and sensitivity of spinal cord neurons leading to persistent, increased pain |
| nociception | physiolocial processes related to pain perception |
| Mnemonic for pain assessment | COLDERR character onset location duration exacerbation relief radiation |
| Non-opiods: advantages | do not produce tolerance or addiction many are OTC |
| non-opioids: disadvantages | analgesic ceiling, increasing dose above upper limit produces no greater pain relief |
| examples of non-opiods | acetaminophin asprin NSAIDs |
| opioids work by | binding to pain receptors in the CNS and causing inhibition of transmission of nociceptive input. |
| advantages of opiods for pain | no analgesic ceiling, several routs of administration, and often combined with non opiod analgesics for relief of moderate pain. |
| What is given as an antidote for opiod caused respiratory depression? | Narcan |
| The WHO pain management ladder | mild pain (1-3): NSAIDS, acetominophen, adjuvants moderate pain (4-6): opiods severe paint (7-10): long-acting titrate |
| Adjuvant therapy | used in conjunction with opiods and non opiods. Generally developed for other purposes but also effective for pain. Examples, antidepressants, antiseizure, steriods, B-antagonists |
| define drug tolerance | need for increased dose to have adequate pain control. Rotate drugs if tolerance develops. |
| define physical drug dependence | expected response to ongoing exposure to drug, withdrawal syndrome when blood levels drop abruptly. |
| define drug addiction | neurobiologic condition with drive to obtain and take drugs for reasons other than they were prescribed for. Tolerance and physical dependence are not indicators of addition |
| Describe breakthrough pain | transient, moderate to severe pain that occurs beyond the pain treated by current analgesics. Rapid in onset, brief in duration. |
| Subjective vs. Objective evaluation of pain | Subjective: what the patient says is pain. Objective: what the nurse observes with body language. A nurse should always first rely on subjective reports of pain. |
| What are five dimensions of pain? | Physiologic Affective (emotional) Behavioral Cognitive (personal beliefs and attitudes) Sociocultural |
| the physiological process by which information about tissue damage is communicated to the CNS | nociception |
| Four processes of nociception | Transduction Transmission Perception Modulation |
| Transduction and drugs affecting this process | the conversion of a stimulus (pain, tissue damage) into neuronal action potential. NSAIDs and acitominophen |
| Transmission and drugs affecting this process | Movement of pain impulses from site of transmission to the brain. (1) along peripheral nerve fibers (2) through dorsal horn of spine (3) to thalamus and cerebral cortex Opioids |
| Perception (stage of pain transmission) and drugs affecting this process | When pain is recognized, defined, and responded to. Opiods |
| Modulation (stage of pain transmission) and drugs affecting this process | Signals move from central back down to peripheral. Body's attempt to treat pain with endorphins or change behavior to reduce pain. Antidepressants. |
| What other chemicals besides drugs act like opiods on the body? | Body's natural endorphins, foods (chocolate), exercise, laughter, massage (trascutaneous nerve stimulation) |
| Two main *types* of pain | 1) Nociceptive- damage to somatic or visceral tissue. 2) Neuropathic- abnormal processing of stimuli by the nervous system. |
| What is somatic pain like? | aching, throbbing, sharp, localized, "show me where it hurts". Arises from bone, joint, skin, or connective tissue damage. |
| What is visceral pain like? | arises from internal organs, or tumor or obstruction. Often referred pain. |
| What is neuropathic pain like? | damage to peripheral nerves or CNS. Burning, shooting, stabbing, or electrical in nature. |
| Deafferentation | damage or injury to either the peripheral or central nervous system |
| Polyneuropathies vs. mononeuropathies | describes neuropathic pain: felt along many peripheral nerves, or only along one damaged nerve. |
| What is the goal of acute pain? | pain control with eventual elimination |
| What is the goal of chronic pain? | control to the extent possible, focus on enhancing function and quality of life. |
| Pain is assessed on a ___ point scale | 11 point scale, with 0 being no pain and 10 being severe pain. |
| What is adjuvant drug therapy? | To treat pain. Drugs such as antidepressants, antiseizure drugs, B-adrenogenic agonists, corticosteriods, and local anesthetics are used in conjunction with opiods or non-opiods. |
| Acute viral rhinitis is caused by | an adenovirus |
| The onset symptoms of influenza are . . | typically abrupt with systemic symptoms of cough, fever, and myalgia, headache and sore throat. |
| In adults a normal tidal volume is . . . | 500ml |
| mechanical receptors are stimulated by . . . | a variety of physiologic factors including irritants, muscle stretching, and alveolar wall distortion. |
| the respiratory defense mechanisms include . . . | filtration of air, mucociliary clearance system, cough reflex, reflex bronchoconstriction, and alveolar macrophages. |
| During assessment of respiratory system, the respiratory (3) should be assessed. | Rate, depth, rhythm. |
| Three ways to acquire pneumonia | aspiration, inhalation, hematogenous spread |
| Examples of hospital acquired pneumonias | Pseudomonas aeruginosa, Enterobacter, Escherichia coli, Proteus, Klebsiella, Staphylococcus aureus, Streptococcus pneumoniae, Oral anaerobes, |
| Examples of community acquired pneumonias | Organisms that are commonly implicated in CAP include S. pneumoniae (35%), H. influenza (10%), and atypical organisms (e.g., Legionella, Mycoplasma, Chlamydia, viruses) |
| The most common cause of pneumonia | Pneumococcal pneumonia is the most common cause of bacterial pneumonia and is caused by the Streptococcus pneumoniae organism. |
| Maslow's Hierarchy of needs | Self-actualization Self-esteem Love/Belonging Safety Physiological Needs |
| Stress is . . | a nonspecific response to a change, demand/stressor |
| Examples of *subjective* findings related to stress (symptoms) | fatigue, discouragement, emotional detachment, feelings of personal inadequacy, projected anger, tension in relationships, substance abuse |
| Name acute and long-term effects of stress | anxiety disorder, depression, substance abuse, eating disorders, diabetes and hypertension, heart disease, stroke |
| Grading anxiety (4 levels) | 1) mild: promotes problem-solving 2) moderate: limited responses, headache, GI 3) severe: impending doom 4) panic: "paralyzed" |
| Define coping | A person's cognitive and behavioral effort to manage specific external or internal stressors that seem to exceed available resources |
| MDD (major depressive disorder) | May be an acute or gradual change in behavior, unable to function socially, difficulty concentrating, no change in level of consciousness |
| Minor depression | depressed mood that may be chronic, pessimistic about everything, feel sorry for self, increase or decrease in sleep pattern, flat affect, slow level of consciousness responses |
| Psychotic vs. Neurotic | a) Psychotic feels worse in AM, improves by end of day. b) neurotic feels better in AM, but worse as day goes on: "sundowning" |
| reactive depression happens after . . . | a significant loss |
| depression can be the side effect of drugs (name them) or as a side effect of chronic medical disorders | antihypertensives, steroids, contraceptives |
| Delirium vs. Dementia | a) delirium: not permanant, sudden change in consciousness, downdowning syndrome, need bright envinronment. b) dementia: permanant, secondary to cerebral disease such as Alzheimer's. |
| Hallucinations | sensory impressions without exernal stimuli |
| Illusions | real stimuli that has been misinterpreted |
| Delusions | false fixed belief (I"m Cleopatra!" |
| The phases of a crisis are . . | the same as the phases of grief: DABDA |
| anger vs. aggression | a) anger is an *emotional* response to the perception of frustration, desires, a threat to one's needs physical or emotional. b) aggression: harsh *verbal or physical action* that reflects rage, hostility, potential for physical or verbal destructiveness |
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