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Types of Assessment comprehensive, episodic or problem-focused,
emergency
comprehensive assessment (initial) results in baseline data for problem
identification and care planning, time consuming,
complete, all aspects of preventive health/physical
disease
episodic/problem-focused assessment based on the patient's health issues, involves one or
two body systems. smaller scope, but more in depth
What is the nursing process? systematic problem-solving approach to identifying
and treating human responses to actual or potential
health difficulties. patient centered and focuses on
problem solving and inhaling strengths. uses ADPIE
convalescent period recovery period from the infection. signs and
symptoms disappear and the person returns to a
healthy state, may be a temporary of permanent
change in the
patient's previous health state
body's defense against infection body's normal flora, inflammatory response and immune
response
inflammatory response and 5 cardinal protective mechanism that eliminates the invading
signs of it pathogen and allows for tissue repair to occur.
redness, heat, swelling, pain, and loss of function
immune response involves specific body responses to an invading
foreign protein, like producing an antibody to and
antigen or a cell-mediated defense, or cellular
immunity (increase in WBCs)
factors affecting host susceptibility intact skin and mucous membranes, normal pH levels,
body's white blood cells, age, sex, race, hereditary
factors, immunization (natural or acquired), fatigue,
climate, nutritional and general health status, stress, and
use of invasive or indwelling medical devices
, medical asepsis reduce the number and transfer of pathogens, clean
technique
surgical asepsis keep objects and areas free from microorganisms.
sterile technique
number of organisms more organisms present the longer it takes to destroy
them
factors that reduce the asepsis/aseptic technique, nature and number or
incidence of healthcare- organisms present, equipment being used,
associated infection sterilization and disinfection
sterilization process by which all microorganisms are destroyed,
including spores
disinfection process by which all microorganisms are destroyed,
except spores
standard precautions used in care of all hospitalized patients, applies to
blood, body fluids, secretions, excretions, broken skin,
mucous membranes
transmission based precautions used in addition to standard precautions for patients
with suspected infection, includes airborne or
droplet or contact precautions
isolation protective aseptic techniques. protective procedure
designed to prevent the transmission of specific
organisms
cdc guidelines standard and transmission-based precautions
PPE gloves, gown, masks, protective eye gear
factors that affect safety in an developmental considerations, lifestyle, mobility,
individual's environment sensory perceptions,
knowledge, ability to communicate, physical health
state, and psychosocial health state
developmental considerations for never leave infant unattended, use crib rails, monitor
neonate and infants choking hazards and car seats
developmental considerations for childproof home, prevent poisoning, child abuse
toddler and preschool children warnings, car seats
developmental considerations for avoid activities that are potentially dangerous, safety
school aged child at home, school and community. Teach bicycle
safety, child abduction, wear seatbelt
developmental considerations for teach safe driving, tobacco and alcohol avoidance, and