Final EXAM Study Guide 1020 c PDF

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Final Study Guide Perfusion/ Gas Exchange  Hypoxia  Ischemia  Necrosis  Perfusion Impairment Examples: · Prolapse Birth (Cord comes down 1st, pushing on the cord) · Heart Attack (Blood blocked by clot) · Diabetes (Poor circulation, EX: Neuropathy)  Perfusion can affect thermoregulation  Tachyp...

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Final Study Guide Perfusion/ Gas Exchange 

Hypoxia  Ischemia  Necrosis

 Perfusion Impairment Examples: · Prolapse Birth (Cord comes down 1st, pushing on the cord) · Heart Attack (Blood blocked by clot) · Diabetes (Poor circulation, EX: Neuropathy)

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Perfusion can affect thermoregulation

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Tachypnea- Fast breathing

 Brachypnea- Slow breathing

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Clubbing- Sof, spongy fingers, 180-degree angle

 Pulse Deficit: Apical rate - Radial rate; The number of heart beats that do not perfuse 

(spread) Pulse Pressure- Numeric difference between your systolic and diastolic blood pressure

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Systolic VS Diastolic Systole · Contraction of the ventricles · Max pressure heart exerts · Lub- The 1st heart sound S1 · Closure of mitral and tricuspid

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Diastole · Relaxation of the ventricles · Amount of pressure in your arteries · Dub- 2nd heart sound S2 · Closure of aortic and pulmonic valves

Normal Respiration Rate: Infant= 30-60 per minute; Adult= 12-20 breaths ; Elderly= 12-18 (living independently) and 16-25 breaths (long-term care) Tachypnea: Rapid heart rate Brachypnea: Slow heart rate Perfusion/ Gas Exchange Risk factors and Inventions over Life Span Infants Risk Factors Perfusion: ·

Congenital heart defect

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Systolic bp afer birth is low due to weaker lef ventricle 1

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Low birth weight / malnutrition

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Thermoregulation (too hot or too cold)- Infants do not have heat-conserving capacity

Nursing Interventions: ·

Collaborative (surgical interventions)

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Nutrition Education/hydration

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Adding/removing clothing to regulate body temperature

Risk factors Gas Exchange: ·

Breathe through nose for first 3 months

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Do not produce surfactant until 30-32 weeks

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Less surface area in alveolar as well as narrow branching of peripheral airways

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Great risk for respiratory and lung infection

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Fetal hemoglobin (shortened survival of erythrocytes causing anemia)

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Lower levels of hemoglobin caused by gradually diminishing maternal iron stores

Nursing Intervention: ·

Aiding airway clearance using an aspirator or saline flush

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Nutrition/Hydration

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Changing position

Elderly 

Risk Factors Perfusion: ·

Males and African Americans are at a greater risk for impaired perfusion

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Alveoli dilate which decreases surface area of pulmonary capillary network Blood perfusion becomes impaired when anatomical changes such as fibrosis and sclerosis effect the sinoatrial node, mitral valve, and aortic valves Risk Factors Gas Exchange · Lack of ability to initiate immune response due to infection impairs gas exchange

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Risk of pneumothorax

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Higher rates of COPD

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Older adults are at risk for impaired gas exchange because their chest becomes stiffer due to loss of elastic recoil, and respiratory muscles become weaker reducing the effectiveness of coughing

Nursing Intervention ·

Administering oxygen

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Changing positioning (semi-fowlers position or horizontal)

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Intubation (airway support)

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Chest tubes

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Nutrition therapy (high protein and high calorie meals given to patient) to maintain immune system support Providing further education -how to breathe deeply -encouraging cough -medication education -education for medical equipment -getting adequately hydrated

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Artificial airways (tracheostomies, postural drainage, pharmacologic therapy)

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Circulation fan

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Smoking cessation

*Accessory muscles (Bad. Lol)- Sternocleidomastoid and the scalene muscles (anterior, middle and posterior scalene) are typically considered accessory muscles of breathing. The right lung is longer than the lef lung. EX: Right side= Lung, Lung, Lung; Left side= Lung, Heart, Lung

Pulses   

Palpation of a radial pulse: Examines rate, rhythm, strength, and equality Auscultation of an apical pulse: Examines rate and rhythm Normal pulse: Infant: 120-160; Adult 60-100

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Tachycardia- Fast heart rate; 100-180 beats/minute; Can be caused by exercise, stress, poor oxygenated blood, elevated temperature, decrease in BP, emotions, medicine, & prolonged periods of application of heat

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Bradycardia- Slow heart rate; below 60 beats/minute; Found in thin people, found in men while they sleep, Hypothermia, older individuals, & medications.

Thermoregulation  

Thermoregulation: Process that balances heat production & heat loss

4 ways to lose heat · Radiation: Heat transfer without contact usually in the forms of infrared rays EX: Sun’s ·

rays Conduction: Transfer of heat from 1 molecule to a molecule of lower temp EX: Body gets cold when submersed in cold water - Accounts for minimal heat loss

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Convection: Dispersion of heat by air EX: Heater that blows warm air Vaporization: Continuous evaporation of moisture

Bodily attempts to regulate chills: · Shivering= Heat production · Sweating= Decrease heat loss · Vasoconstriction= Decreases heat loss Normal core body temperature · 37 degrees C or 98.6 degrees F Thermoregulation · Body process that balances heat production & heat loss · Maintain body's temperature Factors affecting heat production · Basal metabolic rate (BMR) · Muscle activity · Thyroxine output · Epinephrine, norepinephrine and sympathetic stimulation/stress response · Fever

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Your body has a "thermostat" that controls your body's temperature. It is part of your brain called the hypothalamus

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Infants and elderly have less efficient physiological mechanisms for heat production and conservation 4

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Infants · Babies don’t shiver ·

Less weight to surface area ratio

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Fontanels – lose heat very easy

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Immature hypothalamus

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No heat-conserving capacities – linked with oxygen consumption and metabolism

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Malnutrition can cause lack of ability to thermo-regulate

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Older Adults · Slower circulation- decreased vasoconstrictor responses ·

Reduced function of thermoregulatory capacity of the skin

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Reduced heat productionassociated with slower metabolic and physical activity

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Diminished ability to regulate body temperature

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Reduced perception of heat and cold

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Lack of resources to stay warm or cool

Oxygenation 

Inspiration- an active process, stimulated by chemical receptors in the aorta

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Expiration- a passive process that depends on the elastic recoil properties of the lungs and requires little to no muscle work

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Surfactant- a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

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Atelectasis- a collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide.

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Ventilation- the process of moving gases into and out of the lungs.

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Perfusion- relates to the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.

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Diffusion- the process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues.

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Hypoxemia- Refers to a decrease in the amount of arterial oxygen (SpO2)

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Hypoxia- Inadequate tissue oxygenation at the cellular level.

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4 factors that influence oxygenation: ·

Physiological

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Developmental

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Lifestyle

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Environmental

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CPAP: Delivers continuous airway pressure during each cycle of inhalation/exhalation

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BiPAP: Delivers higher pressure during inhalation and lower pressure during exhalation. (Prevents micro atelectasis)

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Respiratory Acidosis: pH decreases, pco2 increases

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Respiratory Alkalosis: pH increased, pco2 decreased

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Metabolic Acidosis: pH decreased, hco3 decreased ·

May have Kussamaul respirations (breathing faster)

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Metabolic Alkalosis: pH increased, hco3 increases

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Positioning:

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Final Study Guide Fowlers: Patient is eating, NG tube insertion, Eases difficulty breathing (promotes lung expansion) Semi-Fowlers: Ventilator assisted patient (lung expansion), gastric feeding tubes (reduce risk of aspiration)

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Trendelenburg: head of bed down, postural drainage, poor peripheral perfusion (venous return) Reverse Trendelenburg: promotes gastric emptying, prevent esophageal reflux Supine: vertebral injuries, cervical traction- neck brace, hypotensive

Heart Structure of the Heart Wall · Epicardium: Outermost layer · Myocardium: Muscular middle layer; Cardiac muscle tissue · Endocardium: Thin, smooth membrane that lines the inside

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NANDA

Ethics 

Autonomy: Independent decisions supported by knowledge and self-confidence EX: A nurse finds an alternative treatment option for blood transfusion for a Jehovah Witness patient that decides that treatment option doesn’t support his values.

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Beneficence: Doing good for others despite your personal beliefs. Ex: If a nurse in a prison had to care for an inmate regardless of how she felt about him due to his criminal background.

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Accountability: Willingness to accept responsibility for one’s actions. EX: Nurse realizes that a medication error has been made. The nurse reports the error and takes responsibility to ensure patient safety despite personal consequences.

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Justice: To act fairly and equitable; it also mandates that people be treated impartially EX: No matter a patient’s color, class, creed, or ability to pay. They should be given the same quality of health care when in need.

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Fidelity: Keeping your promise, doing what is expected of you, performing your duties, being trustworthy, and providing high quality, safe care in a competent manner EX: Patient request pain meds. and RN informs the patient that they cannot receive them for another hour but promises to return promptly in an hour. The nurse keeps her promise. Non-Maleficence: Inflicting the least amount of harm possible to reach a beneficial outcome. (The greater good) EX: If a patient tells a psychiatrist that they plan to hurt someone the psychiatrist can disclose that information to the police, breaking patient provider confidentiality.

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Veracity: Truthfulness EX: Telling the patient the truth not matter the circumstances.

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Deontology: Places the value on intentions rather than the outcomes EX: Is late to class but drives speed limit

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Utilitarianism: The greater good EX: Is late and speeds to class Values: Priority instilled in you from external factors that influence your right and wrongs Principle: Concept used to apply values. EX: Quantity of life (saving life) vs Quality of life (abilities) Ethical Dilemma: 2 ethical principles that come into contact

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Patient Rights: Rights people have as a patient. Patient Responsibility: Giving accurate and complete history, changes in health status, when they want to try something different. Nursing Code of Ethics 9 Provisions: 1) Compassion and respect for inherent dignity 2) Primary commitment is to the patient 3) Promotes, advocates for, and protects the rights, health, and safety of the patient 4) Authority, accountability, and responsibility 5) Same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. 6) Establish, maintain, and improve the ethical environment of the work settings and conditions of employment that are conductive to safe, quality health care.

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7) Advance the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. 8) Collaborate with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 9) Articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. -

These are guiding principles to everyone in the profession, including students, nurses and nurse educators, requiring all to be committed to excellence, compassion, and integrity.

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Ethical Principles: · Respect for persons · Maleficence · Justice · Fidelity

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Ethical Theories: · Ethics of duty - Moral duties are self-evident, needing no further justification. - Based on deontology · Ethics of consequences - Moral actions are defined entirely based on the outcomes · Ethics of character - Character develops over time based on life experiences and our willingness to reflect on our actions and motives. · Ethics of relationships - Focused on the nature and obligations inherent in human relationships and community.

Communication 

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Accepting: Reassurance, conveys an attitude of regard and non-judgement (therapeutic) EX: Body language such as head nodding, eye contact, and verbally reassuring the patient by using phrases such as “yes, I understand”. Rejecting: Refusing to consider or showing contempt for client’s idea and behavior (nontherapeutic) EX: Changing the subject or not actively listening to the patient

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Empathy: Ability to understand and share the feelings of another (therapeutic) EX: Empathetic response: “I understand that there must be a lot of emotions associated with this diagnosis. Would you like to talk about what you are feeling?”

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Sympathy: Feelings of sorrow or pity for someone else’s misfortune (non-therapeutic) EX: Sympathetic response: “Wow, that’s awful! This has to be hard, but at lease you’re alive.” 10

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Clarifying: A form of communication where the listener restates their understanding back to the speaker to check for understanding. Can involve open-ended questions. (therapeutic) EX: Nursing students inquiring and restating the information that was read on the syllabus to the professor. Questioning: Closed ended questions or comments (nontherapeutic) EX: If students asked the professor if they had homework due this week and the answer was simply “yes” rather than going into what is due. - Questioning allows for confusion and limits elaboration or discussion of a topic.

IS THIS RIGHT? 

Voicing doubt: It undermines the patient’s beliefs by not reinforcing the exaggerated or false perceptions (therapeutic) EX: “Isn’t that unusual?”, “Really?”, “That’s hard to believe.”

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Voicing Approval: Implies a need for patients to have the nurse’s support and approval. (Nontherapeutic) It creates a self-focus for the nurse over the patient. EX: “You have no reason to be crying/scared.”

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Giving advice: Giving someone a recommendation or opinion on how to handle a given situation. EX: “If it were me, I would…”, “You should really exercise more.”

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Focusing- Paying attention to the patient verbally and nonverbally. EX: Actively listening, making eye contact Restating: Encourages patients to describe situations more fully demonstrates that the nurse is listening (Therapeutic) EX: Patient: “I couldn't sleep last night.” Nurse: “You had trouble sleeping last night?”

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False Reassurance: Discounts the patient's feelings; Cuts off conversation about legitimate Demonstrates a need by the nurse to “fix” something that the patient just wants to discuss concerns of the patient EX: “Everything will be okay.”, “Surgery is nothing to be concerned about.”

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SOLER (active listening): ·

S- Sit EX: Encourages the listener to sit

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O- Open stance EX: Reminds the nurse to maintain an open stance or posture while listening

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L- Lean EX: Suggests that the listener lean toward the speaker, positioning the body in an open stance

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E- Eye Contact EX: Refers to maintaining eye contact without staring.

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R- Relax EX: Reminds the nurse to relax

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Final Study Guide Types of Hospitals and Insurance Hospitals  

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For-Profile: Gives profit to shareholder; Pays property taxes; Employees get stock EX: OP Med Non-Profile: Does not pay property taxes; Charity level care (give away enough care to compensate for not paying taxes); Can’t have a profit at the end of the year, so when they do they put it somewhere else like a new building EX: Baptist Charity: Bills insurance and what insurance doesn’t pay they cover for patient; Fundraising; No property taxes. Ex: St. Jude’s and Shriner’s Government: Owned and operated by government Ex: VA Hospital (Federal), State mental hospital (State)

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Medicare- Over 65 or unable to work because of disability, No matter income, Must have worked 2 ½, Federal, comes out of Social Security check, Acute Medicaid- State, any age and/or pregnant, Low income requirement, Chronic/Acute, used in Nursing homes PPO- Private payer option, mainly for patient with conditions HMO- Health management organization, must see primary to see specialist ACA- Voluntarily insurance exchange, Federal, has levels that could block you for going to certain hospitals, Low reimbursement

Health care organizations: are a purposefully designed, structured social system developed for the delivery of health care services by specialized workforces to defined communities, populations, or markets. Categories of HCO: •

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Mission Focus · Research · Education · Practice · Community Financial Classification · For profit · Not for profit Ownership · Public · Private

*PEOPLE + PURPOSE = ORGANIZATION*

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Health care organizations: 12

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Are driven by the need to provide a broad spectrum of care to diverse consumers in a variety of s...