Medsurglecture#1 - questions and answers from test bank PDF

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Chapter 8 Notes Culture- Beliefs, religion Subculture- Share characteristics as distinct entity; Minority: differs from majority; cultural characteristics, physical characteristics, or both Groups -Ethnic minorities: - Sex or religion groups -Powerlessness or lack of control; Gerontologic considerations - Ageism; stereotyping older adults’ behaviors or vulnerability based on prior experiences or anticipation of behaviors Stereotyping: assumption that all people of particular culture share same values Generalizations: acknowledges common trends in a group while recognizing need for more information; broad pattern of beliefs Race: biologic differences in physical features; Ethnicity: kinship for country or ancestral origin; ethnic names, clothing, dance, food, customs Ethnocentrism: belief that one’s own ethnic heritage is superior to others Acculturation- involves the process of adapting to or taking on the behavior’s of another group Cultural Blindness: an inability to recognize the values, beliefs, and practices of others because of strong ethnocentric preferences. Cultural imposition: is an inclination to impose one’s cultural beliefs, values, and patterns of behavior on persons from a different culture Cultural taboos: activities governed by rules of behavior that a particular cultural group avoids, forbids, or prohibits. Culturally Influenced Characteristics • Eye contact: conveys nursing respect and understanding – Asian or Native American: offensive or invasion of privacy • Space and distance: affects interactions between nurses and clients – Latinos are comfortable by sitting close. • Touch: Nurses needs to honor and respect differences related to touch. – Arab culture prohibits male healthcare providers from physically examining women. • Time: Clock time and social time are viewed differently. • Diet: means of survival – Other meanings: social, cultural, religious practices – Nurses must consider cultural or religious preferences on dietary restrictions to specific conditions. Verbal Communication Patterns • Communication patterns differ among subcultures.

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– Communication patterns • Examples: Anglo-Americans are open to providing personal health information; Asian Americans control emotions and not reveal physical discomfort. Distrust for healthcare personnel; nurses must show professionalism via introductions and respecting privacy. • Language – English as second language; unfamiliar with English medical terminology – Translator: caution with use of family members; miscommunication – Cultural sensitivity: nurse’s actions, cultural respect, nonverbal communication When Clients speak no English  Learn a second language, especially one spoken by a large ethnic population serviced by the health agency  Speak words or phrases in the client’s language, even if it is not possible to carry on a conversation  Refer to an English/foreign language dictionary for bilingual vocabulary words  Construct a loose-leaf folder or file cards with words to one or more languages spoken by clients in the community When English is a second language  Determine if the client speaks or reads English, or both  Ask questions that can be answered by a ‘yes’ or ‘no’  Speak slowly, not loudly, using simple words and short sentences.  Avoid using technical terms, slang, or phrases with a double or colloquial meaning  Avoid displaying impatience Health Beliefs and Practices • Health beliefs (ideas) and practices (actions)—strongly influenced by culture – Three views of disease • Biomedical or scientific: cause–effect philosophy of human body function • Naturalistic or holistic: natural balance is essential for health; Native Americans • Magico-religious: supernatural forces dominate; Caribbean culture Cultural Assessments • Biocultural: physical, body structure, mobility, behavior – Biocultural ecology: adaptation and homeostasis – Nursing practice: knowledge of susceptibility to disease due to genetic distinctions • Cultural heritage: affects access to quality healthcare

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– Examples: rituals related to birth or death, hygiene practices, special clothing, or amulets • Nurse assesses behaviors and issues that compromise health restoration, maintenance, and promotion. Transcultural Nursing • Specialty nursing care provided within the context of another’s culture • Culturally sensitive care recommendations: – Learn to speak second language. – Be aware of biocultural aspects of disease. – Integrate cultural practices and facilitate rituals.

Chapter 11 Nociceptive pain types  Somatic pain- Superficial somatic pain/cutaneous pain Deeper somatic pain caused from trauma Dull, aching, diffuse discomfort with long-term disorders

 Visceral pain- arises from internal organs

Referred pain: discomfort in a general area of the body but not in the exact site where an organ is located Neuropathic pain  Pain processed abnormally by the nervous system Acute pain- less than 6 months Chronic pain- more than 6 months Pain Transmission • Four phases – Transduction: Conversion of chemical information in the cellular environment to electrical impulses that move toward the spinal cord * Initiated by cellular disruption – Transmission: Peripheral nerve fibers form synapses with neurons in the spinal cord. – Perception: Brain experiences pain at a conscious level; locates pain, its intensity, and what it means; and gives emotional response. Pain threshold: point at which the pain-transmitting neurochemicals reach the brain, causing conscious awareness *Hyperalgesia Pain tolerance: amount of pain a person endures once the threshold has been reached *Variables: age, gender, fatigue – Modulation: Brain transmits a response down the spinal nerves to the point where the pain transmission originated to alter the pain experience.

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*Endogenous opioids—neurochemical Painful sensation is reduced. Pain Assessment

 Client’s description of its onset, quality, intensity, location, and duration Allodynia- exaggerated pain response • Pain assessment tools: quantify pain intensity • Types – Numeric scale – Word scale – Linear scale – FACES scale Pain Management • Drug and nondrug interventions • Techniques for pain management – Blocking brain perception – Interrupting pain-transmitting chemicals – Combining analgesics – Substituting sensory stimuli – Altering pain transmission Techniques used to prevent, reduce, or relieve pain – Drug therapy • Opioids—narcotic: interfere with pain perception centrally (at the brain); used for mild to moderate pain • Oxycodone, morphine sulfate • Nonopioids—non-narcotic: alter neurotransmission at the peripheral level (sight of injury); for mild pain • Ketorolac tromethamine (Toradol), Tylenol Methods of Pain Medication Administration • Routes – Analgesic drugs: oral, rectal, transdermal, or parenteral • Equianalgesic dose – Patient-controlled analgesia (PCA) – Intraspinal analgesia – Palliative sedation: relieving intractable pain experienced by dying client Addiction • Repetitive pattern of drug seeking and drug use to satisfy a craving for a drug’s mind-altering or mood-altering effects Tolerance • Condition in which a client needs increasingly larger doses of a drug to achieve the same effect as when the drug was first administered

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– Consequence of poor pain control • An ineffective dose should be increased by 25% to 50% – Consult with physician Physical Dependence • Person experiences physical discomfort, known as withdrawal symptoms, when a drug taken routinely for some time is abruptly discontinued. • To avoid withdrawal symptoms, drugs should be discontinued gradually. – Lowered over 1 week or longer

Chapter 12 Infection- invasion of the body with agents that have the potential to cause disease Bacteria- single-celled microorganisms Aerobic-grows with oxygen Anaerobic- grows without oxygen  Streptococci round bacteria that grow in chains  Bacilli are rod-shaped  Staphylococci are round shaped that grow in clusters  Spirochetes are spiral-shaped bacteria Viruses- so small that they can be seen only with a high-powered electron microscope; two types: those whose nucleic acid is composed of DNA and those whose nucleic acid is composed of RNA  Self limiting; dormant in living host Fungi- is divided into two basic groups: yeast and molds  Fungal infections: superficial, intermediate, deep Rickettsia- resembles but is different from bacteria. Like viruses, they invade living cells and cannot survive outside a living organism or host. – Invade living cells and cannot survive outside a living organism or host – Transmitted by arthropods; fleas, lice, ticks, mosquitoes *Examples: Lyme disease, malaria, West Nile virus Protozoans- single-celled organisms classified according to their motility Mycoplasmas- single-celled that lack a cell wall; infect surface linings of respiratory, genitourinary, and GI tract *Examples: autoimmune disorders, Crohn’s disease Helminths- Infectious worms *Groups: roundworms, tapeworms, flukes Prions- Alzheimer’s disease *Protein Non-pathogens: harmless Pathogens: cause infectious disease

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Chain of infection:

Infectious Agent Reservoir- is the environment in which the infectious agent can survive and reproduce Portal of Exit- is the route by which the infectious agent escapes from the reservoir. Means of Transmission- refers to how it is transferred or moved from its reservoir to the susceptible host. Portal of Entry- how the infectious agent gains access to the host Susceptible Host- is the person on or in whom the infectious agent will reside. Defenses against infection: Mechanical: physical barriers  Skin and mucous membranes; normal flora, mucus  Physiologic reflexes; sneezing, coughing, vomiting  Macrophages Chemical: natural biologic substance  Enzymes: tears, saliva, mucus  Antibodies  Secretions: interferon Pathophysiology of Infection: Localized infection  Leukocytosis: activates the inflammatory process  Vascular response: redness and heat  Chemical response: pain  WBCs destroy toxins and remove debris 6

Care of the client with infection: Signs and symptoms  Localized, generalized, sepsis Symptoms of infections: subtle, atypical  Lower normal or baseline temperature  Changes in behavior and mental status Generalized infection  Sepsis: systemic inflammatory response syndrome  Sever sepsis: organ dysfunction, hypotension, and hypoperfusion PCO2 145 mEq/L – Medical Management: water intake, hypotonic IV solution (0.45% NaCl or 5% Dextrose) • Nursing Management: I&O; assess vital signs; dietary restrictions or supplements • Potassium Imbalances • Function: maintaining normal nerve and muscle activity

• Hypokalemia – Causes: potassium-wasting diuretics (Lasix, HydroDIURIL), GI tract fluid loss (suctioning, drains, vomiting), corticosteroids, IV insulin and glucose – Assessment Findings: fatigue, weakness, nausea, cardiac dysrhythmias, paresthesias • Diagnostic Finding: 5.5 mEq/L – Medical management: decreasing K+ intake, administration of insulin and glucose, Kayexalate, peritoneal dialysis or hemodialysis • Nursing Management: medications, diet teaching • Calcium Imbalances • Hypocalcemia • Function: blood clotting, transmission of nerve impulses, regulated by parathyroid gland – Causes: vitamin D deficiency, hypoparathyroidism, burns, pancreatitis, corticosteroids, blood administration, intestinal malabsorption Assessment Findings: tingling, circumoral paresthesia, muscle cramps, positive Chvostek’s sign, Trousseau’s sign, bleeding, tetany Diagnostic Finding: serum calcium 10 mg/dL – Medical Management: cause, IV sodium chloride, Lasix, corticosteroids or plicamycin – Nursing Management: diet teaching, fluids, fall safety • Magnesium Imbalances • Function: transmission of nerve impulses, activation of enzyme systems including functioning of B vitamins • Hypomagnesemia – Causes: alcoholism, diabetic ketoacidosis, renal disease, burns, malnutrition, intestinal malabsorption, diuresis, prolonged gastric suction Assessment Findings: tachycardia, paresthesias, neuromuscular irritability, HTN, mental changes Diagnostic Finding: serum magnesium 2.1 mEq/L – Medical Management: decreasing oral magnesium or parenteral replacement, mechanical ventilation • Nursing Management: BP and respiratory monitoring • Acid–Base Balance • Regulation of normal plasma pH (7.35 to 7.45= normal) • Carbonic acid (H2CO3) and bicarbonate (HCO3) – Chemical: adding or removing hydrogen ions – Organ: lungs regulate carbonic acid levels and kidneys regulate bicarbonate levels; decompensation • Imbalance types – Acidosis: excessive accumulation of acids or excessive loss of bicarbonate in body fluids – Alkalosis: excessive accumulation of bases or loss of acid in body fluids • Acid–Base Imbalances • Metabolic Acidosis (pH 7.45) – Causes: excessive bicarbonate-containing drugs, diuretic therapy, vomiting, gastric suctioning – Assessment Findings: anorexia, nausea, paresthesias, confusion, hypertonic reflexes, decreased respirations – Medical Management: cause, potassium administration, sodium chloride administration • Nursing Management: ABG findings; reports assessment findings

• Acid–Base Imbalances—(cont.) • Respiratory Acidosis (pH...