Exam 1: NR 509/ NR509 (New 2026/ 2027 Update) Advanced Physical Assessment Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Chamberlain

Exam 1: NR 509/ NR509 (New 2026/ 2027 Update) Advanced Physical Assessment Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Chamberlain Q. Dependent intervention ANSWERS prescribed by the provider, but implemented by the nurse (prescriptions for tests, medications, IV therapy, diet etc) Independent intervention: Q. ANSWERS RNs are accountable for & are licensed to prescribe, perform, or delegate based on their knowledge and skills (usually in response to nursing diagnosis) Q. Collaborative intervention ANSWERS implemented in collaboration with other healthcare team members (physical therapist, nutritionists etc) Q. Describe the components of the nursing process ADPIE: ANSWERS Assessment: Inspect, Auscultate, Palpate, Percuss (we're not doing this one) Diagnosis: nursing not a medical diagnosis Plan: goals & SMART outcome Implementation: interventions Evaluation: did interventions work, how to improve Q. Apply the components of the nursing process in formulating patient-specific care plans using NANDA format. ANSWERS Problem focused: (Problem focused diagnosis) r/t (related factors) AEB (defining characteristics) Q. Risk: ANSWERS Risk for ____. Risk factors: ____. Q. Health Promotion: ANSWERS Defining characteristics are evidence of desire. Example: Readiness for enhanced self-care AEB expressed desire to enhance self-care. Q. Discuss the importance of implementing and evaluating evidence-based interventions in nursing care ANSWERS Ideally, a nurse should choose an intervention because of firm evidence that it is the best possible approach for the patient. You would expect such interventions to be those that come from a sound body of scientific research. Q. Identify the six links of the chain of infection ANSWERS Agent: germs (virus, bacteria, parasite etc) 2. Reservoir: where germs live (human, animal, food, soil water etc) 3. Portal of Exit: how germs get out (mouth (saliva/vomit), cut in skin (blood)) 4. Mode of Transmission: How germs get around (contact, droplets, aerosol) 5. Portal of Entry: how germs get in (mouth, cuts in skin, eyes) 6. Susceptible Host: next sick person (elderly, young, unimmunized etc) Q. Understand the processes involved in the body's primary, secondary, tertiary defenses. ANSWERS Primary: First line defense (Normal flora of the body, skin, respiratory tree, eyes, mouth, GI tract, genitourinary tract and anus) Secondary: Phagocytosis, complement cascade, inflammation, fever Tertiary: Active immunity, passive immunity, humoral immunity, cellular immunity Q. Discuss standard precautions, medical asepsis and appropriate use of sterile technique ANSWERS Use with all patients, regardless of suspected or confirmed presence of infection Principle: All blood, body fluids, secretions, excretions except sweat, non intact skin, and mucus membranes Perform hand hygiene; use gloves, gown, masks, eye protection, or face shield (depending on expected exposure) and safe injection practice Do not completely protect against microorganisms spread by contact, droplets, or through the air. Q. Discuss the factors that increase the risk of infection. ANSWERS Developmental stage: young children Breaks in first line of defense: skin integrity break Illness of injury: recuperation from infection or injury limits physical resources to combat new pathogen Tobacco use: please take care of your cilia Substance use, including alcohol: think of the cilia Multiple sex partners: higher STD risk Environmental factors: irritants to respiratory airways, breaks in the skin, work situations, and living situations Medications: immunosuppressants Nursing and Medical procedures: several procedures are associated with an increased risk for infection Q. Describe isolation precautions that must be taken when there is concern about contact, droplet, or airborne disease transmission. ANSWERS Contact: possible private room, clean gown and gloves upon entry, proper disposal of contaminated items in the room, double-bag and mark linens Airborne: same as contact precautions and special room for patient, special mask for nurse, mask for patient when transported Droplet: same as contact precautions and mask, eye protection, stay 3 feet from patient Q. Primary prevention ANSWERS prevent slow onset of disease, such as eating healthy, exercising, wearing sunscreen, obeying seatbelt laws, and keeping up with immunizations. (PPT) Reduce new cases. Q. Secondary Prevention ANSWERS screenings and education for detecting illnesses at early stages; Breast-self examination, testicular examination, regular physical exams, BP and diabetes screenings, and tuberculosis skin tests. (PPT) Reduce new cases in those who have been exposed or have early symptoms Q. teriary prevention ANSWERS Focus on stopping disease from progressing and returning individuals to pre-illness state. Rehab is an intervention used during this level. (PPT) Reduce complications and deaths in those with disease. Q. identify health promotion issues and ways to promote the health of individuals, families, and communities. ANSWERS Role modeling Healthy People 2020: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all the group Create social and physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life changes Q. Distinguish between levels of prevention and the role prevention takes in the nursing process ANSWERS The nurses role in health promotion primarily os to motivate clients and facilitate change. Clients are independently responsible for most of their health promotion activities. Nurses may need to help identify goals , but it is essential that the goals be the client's and not yours. Q. Infant/toddler safety risk ANSWERS Choking (highest incidence 6 months - 3 years old) Falling Drowning Sudden infant death Accidental injury Ingesting poisons Q. Preschool safety risk ANSWERS Less prone to falls Choking (highest incidence 6 months - 3 years old) Drowning Sudden infant death Accidental injury Ingesting poisonsAccidental deaths Nonfatal injuries Q. School aged children safety risk ANSWERS Outside injuries Sport injuries Broken bones Higher risk of abduction Q. Adolescent safety risk ANSWERS Accidental death--motor vehicle accidents, risk increases from drugs, alcohol Accidental injuries--sports and recreational injuries, including diving, drowning (risk also increases with drugs and alcohol) Q. Adult safety risk ANSWERS Workplace injury Accidental death--unintentional poisoning (causes more deaths than motor vehicle accidents) Accidental injuries--musculoskeletal injuries (weekend athlete) Q. Older adult safety risk ANSWERS falls Car accidents Q. Individual risk factors ANSWERS Lifestyle, cognitive awareness, sensory and perceptual status, impaired communication, impaired mobility, physical and emotional wellbeing, safety awareness Q. Home safety hazards ANSWERS Poisoning Carbon monoxide exposure Scalds and Burns Fires Firearm injuries Falls Suffocating/Asphyxiation Take-home Toxins (workplace to home) Q. Community safety hazards ANSWERS Motor vehicle accidents Food-borne pathogens Vector-borne pathogens Mosquitos Other insects Animals Water-borne pathogens Pollution Water contamination Noise Soil (improper waste disposal and excessive pesticide contaminated soil) Weather Hazards Healthcare agency safety hazard Healthcare culture: disrespectful behavior that discourages staff to speak up about risk and errors, and blatant disregard of expressed concern Quality nursing care: Higher patient death rates associated with fewer nurses to provide care; also less nursing time provided to patients is associated with higher rates of infection, GI bleeding, pneumonia, cardiac arrest and death from these and other causes) Back injuries Needle stick injuries Violence Radiation Falls Alarm Fatigue Equipment Fires/electrical hazards Restraints How to prevent falls in HC agency Slip-resistant slippers, warning sticker on chart or door, bed alarm, 1:1, education (teach pt to get up slowly and fall prevention strategies to pt and family), LOS, review medications, avoid excessive alcohol, review environment for safety, provide gait training, place call light within reach, provide nightlight, keep disoriented patients room near nursing station, Benefits of exercise Produces long term health benefits, including lowering risk for early death, heart disease, type 2 diabetes, hypertension hyperlipidemia, metabolic syndrome, colon and breast cancers, and depression. Risks of Exercise Cardiac injury Musculoskeletal injury Dehydration Temperature regulation problems (Hyperthermia, heat exhaustion, Hypothermia) body alignment Spine in neutral (resting) position. Good posture contributes to normal functioning of the nervous system (sit up, I see you slouching!) and improves feelings of well-being. Balance The broader base of support, the lower the center of gravity and the easier to maintain balance Coordination Smooth movements require coordination between nervous system and musculoskeletal system. Cerebral cortex: involuntary movement Cerebellum: Coordinates movements, proprioception, the awareness of posture (sit uuuup), movement, and position sense. Basal Ganglia: located deep in the cerebrum, assist with coordination of movement Joint mobility allows you to sit, stand, bend, walk, perform other activities ROM Active ROM Passive ROM identify assessments and interventions appropriate for the patient with mobility concerns Passive range of motion (PROM) movement of joints by another person Active Range of Motion (AROM) patient independently moves joints Continuous passive motion (CPM) employs device to gently flex and extend knee joint Discuss the factors that affect skin integrity Age Mobility status Impaired circulation medications lifestyle nutrition/dehydration infection, sensation level moisture fever Use the Braden scale to assess risk for pressure ulcers Will complete every shift Protocols based on Braden score scale This scale once you get a number then evaluate if pt. at risk or not, and if they are need to perform intervention Braden Scale - green to red- less is best (score them less which means they are at higher risk, err on side of caution) Sensory perception Moisture Activity Mobility Nutrition Friction/Shear This is the place where nurses gets sued, if pt. has a score of 10 and is considered high to severe, need to document what you have done and follow up Describe measures taken to mobilize secretions and promote optimal respiratory function and oxygenation Deep Breathing and coughing Hydration Chest physiotherapy Oxygen therapy: Nasal Cannula Mask Transtracheal catheter Distinguish between different family structures traditional nuclear -blended & stepfamilies -grandparent -extended families -dual-earner -sandwich families -single-parent Discuss ways in which economic factors and acute or chronic illness affect nursing care of families healthcare is expensive -instruct families on importance of vaccines -chronic illness/disability is a big strain financially & emotionally List the four essential concepts of nursing theory Person/client- individual preferences to care Health- nurses care deeply about the health status of their patients Nursing (caring)- maintain lvls of caring/compassion in relation to other concepts Environment- create a caring environment Describe types of nursing theories and contributions of non-nursing theories Grand: broad & abstract Mid-range: more narrow & specific Clinical Practice Theories: guide daily tasks & are limited in scope Non-nursing theories: Maslow's Hierarchy of Needs, Erikson's Psychosocial Development Florence Nightingale focus on environment, cleanliness, & nutrition that allow nurse to give higher Jean Watson Human Caring Theory (grand) Hildegard Peplau Theory of Interpersonal Relations Madeleine Leininger theory of caring to help nurses provide cultural competent care Katharine Kolcaba Theory of Comfort, more holistic view of patient & nursing care than earlier biomedical theories about pain Patricia Benner From Novice to Expert Describe nursing considerations for care of belongings and aspects of personal hygiene including skin, hair, nails, and oral care. Belongings: document and store where it is not a trip hazard Skin: bathing, massage, moisturize Hair: Brush hair to remove tangles, massage scalp, stimulate circulation, and distribute oil down the hair shaft. Shampoo hair and groom according to their preferences. Wash beards daily, comb and trim as needed. Nails: inspect for shape, contour, and cleanliness Primary wound wound involves minimal or no tissue loss & has well-approximated edges, little expected scarring Secondary wound wound involves extensive tissue loss which prevents edges from approximating (coming together), or should not be closed (infection) -heals from inner to surface w/ granulation tissue -heal more slowly -prone to infection -develop more scar tissue Review the order of steps taken in the completion of a bed bath. Eyes, face, arms, chest, abdomen, legs, feet, back, buttocks, perineum Complications associated with poor oral hygiene are: Periodontal disease (pyorrhea) Gingivitis Halitosis Stomatitis (inflammation of oral mucosa) Glossitis (Inflammation of tongue) Cheilosis (cracking/ulceration of lips) Oral Malignancies Hospital acquired pneumonia (HAP) Normal ranges for PO2, SaO2, PCO2 PO2: 80-100 mm Hg SaO2: 95%-100% PCO2: 35-45 mm Hg Evaluate adequacy of oxygenation, breathing, and gas exchange, and modify nursing activities appropriately based on outcomes Medications to improve respiratory function Mechanical ventilator: Acute or chronic respiratory failure Chest tube drainage: to make room for lungs to fully expand (Pneumothorax, hemothorax) Incentive Spirometry: usually reserved for pt at risk for developing atelectasis or pneumonia Mobilizing secretions: respiratory conditions, UTI influenza, pneumonia Deep breathing and cough: promotes gas exchange Oropharyngeal airway: C shaped hard plastic, open airway by holding tongue away from back of pharynx Nasopharyngeal airway: flexible rubber tube, semiconscious patients can tolerate; open airway by holding tongue away from back of pharynx Describe measures taken to mobilize secretions and promote optimal respiratory function and oxygenation Deep Breathing and coughing Hydration Chest physiotherapy Oxygen therapy: Nasal Cannula Mask Transtracheal catheter Adverse Reaction Undesirable drug effects, severe and life threatening. Side Effects Undesirable drug effect, is a mild reaction. First Pass Ingest the drug orally, metabolized (usually by the liver or gut), the effect of the medication is reduced, and only part of the drug reaches the systemic circulation. The drugs will end up becoming less powerful. first pass routes Hepatic arterial Oral/entral Portal venous Half-Life Time required for the body to eliminate 50% of a drug Approximately how many half lives does it take to remove a drug from the body? About 5 half-lives Off Label Drugs Drug is FDA approved for one use, but is being prescribed for a different purpose. FDA Approved Drugs approved for a specific purpose Sublingual Route of Administration absorbed more rapidly than enteric-coated tablets. Sublingual medications are placed under the tongue and dissolve, allowing for quick absorption through the mucous membranes and entry into the bloodstream. Bypass first-pass effect Enteral Route of Administration enteric-coated tablets have a coating that prevents them from being broken down in the acidic environment of the stomach. They are not absorbed until they reach the higher pH of the intestines, resulting in slower absorption. Intravenous Route of Administration Medication administered via the veins, produces the most rapid drug response , can produce an almost immediate onset of action (bypasses the first past effect) Intramuscular Route of Administration Requires a needle for administration, medication is administered in the muscle, allows drug to diffuse slowly into the many blood vessels within muscle tissue (bypasses the first pass effect). Subcutaneous Route of Administration Medication administered under the skin into the SUBCUTANEOUS tissue (bypasses the first pass effect) Intradermal Route of Administration Medication is administered into the DERMIS of the skin (bypasses the first pass effect). Buccal Route of Administration Medication is administered in the oral mucosa between the cheek and gum (bypasses first pass effect) Rectal Route of Administration The delivery of medication via the rectum, good alternative when oral is not available (does NOT bypass first pass effect) Topical Route of Administration Medication is applied directly on the skin via ointment, gels, or creams (bypasses the first pass effect) Transdermal Route of Administration Medication is administered via adhesive patches, provide constant rate of absorption (bypasses first pass effect) Inhalation Route of Administration Medication is directly delivered to the lungs for rapid absorption (bypasses first pass effect) potential for abuse or addiction Schedule I Drug schedule 2 schedule 3 schedule 4 schedule 5 1: very high risk (not considered legitimate medical use): heroin, LSD, Marijuana 2: high risk (have a strong potential for abuse or addiction but also have legitimate medical use): opium, morphine, cocaine 3: moderate risk (have less potential for abuse or addiction than schedule I or II drugs and have a useful medication purpose): Short-acting barbiturates and amphetamines 4: low risk: (a medically useful category of drugs that have less potential for abuse or addiction than those of Schedules I, II, and III): diazepam and chloral hydrate 5: very low risk: (medically useful category of drugs that have less potential for abuse or addiction than those of Schedules I through IV): antidiarrheals and antitussives with opioid derivatives. Drug Distribution The movement of the drug from the circulation to body tissues. Quick Distribution Sites The heart, liver, and kidneys. Slow Distribution Sites Bone, skin, muscle, fat, and brain (blood brain barrier). Drugs bound to protein (albumin) make the drug __________________________. Pharmacologically inactive and not available. Free Drug An active drug or other compound that is not bound to a carrier protein. How do albumin levels potentially effect drug levels? If levels are low, there is a higher amount of free drug (increased drug activity). If levels are high, there there is more bound drug than there is free drug (decreased drug activity). What can affect albumin levels? Low = Kidney/liver disease, inflammation, or infections. High = Dehydration, stress, ore use of steroids/insulin/birth control medications. Cytochrome P450 enzymes Family of enzymes most predominant in liver but also found in the intestines, lungs, and other organs, are essential for the metabolism of many medications. CP450 Enzyme's Influence on Drug Interactions -inhibitor -inducer -inhibitor: slows its activity leading to a reduction of metabolism resulting in a higher concentration of the drug in the bloodstream -inducer: increases its activity which increases metabolism and lowers concentration of the drug Agonist Attach and response is elicited Mimics body's own regulatory molecules Antagonist Attach and no response is elicited (blocks the mechanism) Blocks receptor activation and prevents receptor from behaving its normal manner Partial Antagonist Ability to activate receptor upon bonding Patient Rights of Drug Administration Right drug, dose, time, route/form, patient, documentation, reason for indication, response, refuse Ways to Prevent Medication Errors Right drug, dose, patient, time, route, documentation; check 3x before administering QSEN Medication Error Prevention Patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics. Most common med error children/elderly children: dosing errors elderly: not adhering to the medication schedule/ forgetting to take medications, dosing mistakes Disease States that Increase Metabolic Needs COPD, fever, burns, cancer, diabetes, and hyperthyroidism. BMI scale Underweight 18.5 Normal 18.5-24.9 Obese greater than equal to 30 Class 1 30-34.9 Class2 35-39.9 Class 3 40 Characteristics of Metabolic Syndrome Excess abdominal fat, insulin resistance, hypertension, hyperglycemia, and dyslipidemia. Glycogenolysis Breakdown of glycogen to glucose, provides immediate glucose during fasting Glycogen Stored glucose in the liver and skeletal muscles. Starvation The brain starts glycogenesis to make glucose, resulting in the conservation of protein and the production of ketones. marasmus kwashiorkor Marasmus: total calorie insufficiency Kwashiorkor: protein deficiency (calories but no proteins) After 5-7 days of acute physiological stress the body will adapt similar to starvation. Ketones and fatty acids from the lipolysis of fat stores are used for energy, and body proteins are conserved Osteoporosis A condition in which the body's bones become weak and break easily. Hyperlipidemia High cholesterol Neonate Tetralogy A combination of problems caused by a birth defect that changes the way blood flows through the heart. Pregnancy Categories A- Safe, B- Problems in Animals, not humans, C- Caution, if benefits outweigh the risks you can use it, D- Studies show fetal risk, only use if benefits outweigh the risk, X- NEVER. Elemental Formulations for Enteral Nutrition Contain peptides and amino acids, have lots of GI side-effects (EX: Vivonex Plus) Polymeric Formulations for Enteral Nutrition Contains proteins, carbohydrates, and fats. Is the most common formula, has less side effects (EX: Ensure) Modular Formations for Enteral Nutrition Contain only carbohydrates or only fat or only protein. Used when needing added calories along with other enteral nutrition. Nasogastric Enteral Feeding and dangers of Nasogastric Enteral Feeding Tube is inserted through the nose into the stomach. The tube can accidentally be placed in the patient's lung, and if patient is lying flat it can cause leakage. Peripheral Parenteral Nutrition (PPN) and Indications for Parenteral Nutrition (PPN) Prescribed for patients who require nutrient supplementation through a peripheral vein (hands, arms, veins in extremities) because they have an inadequate intake of oral feedings. Procedure restricted oral intake, anorexia related to cancer treatments, GI Disorders prevent oral intake, NPO greater than 5 days. Central Total Parenteral Nutrition (TPN) and indications for Total Parenteral Nutrition (TPN) A large central vein (subclavian or internal jugular) is used to deliver nutrients directly into the patient's circulation; generally indicated for nutritional therapy lasting longer than 7-10 days. Metabolic stress (need large amount of nutrients), nutritional support if NPO more than 10 days, and gastric dumping. Osmolarity Measurement of total concentration of solute particles in a solution Causes of Fluid Loss and signs and symptoms of fluid loss GI loss, renal excretion, hemorrhaging, burns, and sweat. Low weight, low bp, tachycardia, weak respirations, poor turgor, and low level of consciousness. Causes of Excess Fluid and signs and symptoms of Excess fluid Abnormal absorption, excessive IV fluid, and renal retention. High, weight, high bp, bradycardia, lungs leaking fluid, mushy turgor. What is Acid Base Homeostasis ad what is it regulated by? Refers to the processes that maintain the proper pH of body fluids. Regulated by the lungs and kidneys. Isotonic Solution Hypotonic Solution Hypertonic Solution Iso: Solution that has the same osmotic pressure as in the cell (0.9% saline solution) Hypo: Solution outside the blood cell has lower osmotic pressure than inside the cell (0.45-0.25% saline solution) Hyper:Solution outside the blood cell has higher osmotic pressure than inside the cell (3-5% saline solution) Electrolytes in the body Sodium, potassium, calcium "Acid" in the Acid-Base Balance and "Base" in the Acid-Base Balance "Acid" = Hydrogen ions & CO2 "Base"= Bicarbonate Crystalloid Salt that dissolves readily into true solutions, such as in intravenous solutions. Colloids Substances such as large protein molecules that do not readily dissolve into true solutions (albumin, globulin, and fibrinogen) Electrolyte that is highest inside the CELL is _______________. Potassium Electrolyte that is highest inside the VASCULAR system is ________________. Sodium Fresh Frozen Plasma Liquid portion of whole blood is separated from cells and frozen, used for clotting factors Packed Red Blood Cells A blood product with an extremely high proportion of red blood cells, used for oxygenation Whole Blood Refers to the mixture of both plasma and formed elements, used for hypovolemia (low blood volume) Blood Products Risks Must be same blood type and protein matched What is GERD (gastroesophageal reflux disease) what are the symptoms how do you manage it what medication do you take for it? Digestive disease in which solids and fluids return to the mouth from the stomach. Symptoms: dyspepsia after eating (heartburn/indigestion), regurgitation, coughing & wheezing at night, hoarseness, dysphagia/odynophagia (difficulty/painful swallowing), epigastric pain, belching, flatulence, nausea, pyrosis (retrosternal burning), pharyngitis, severe dental caries. Manage it: Weight loss, stop smoking, alcohol reduction, low fat diet, and better sleep habits. Meds: Antacids (first line therapy), then H2 blockers & proton pump inhibitors. what is PUD (peptic ulcer disease) what are the symptoms how do you manage it What medication do you take for it? Stomach ulcer caused by high acidity; H. pylori associated with the disease Symptoms: Dyspepsia, gastric pain in middle/upper stomach Manage it: Avoid coffee, alcohol caffeine, NSAIDS, cigarettes, black pepper, and spicy foods Meds: Proton pump inhibitors, antibiotics Hyperacidity Excessive amount of acid in the stomach Dyspepsia Difficult digestion; indigestion Antacids Mechanism of Action: Neutralize the acids in the stomach and stimulates mucosa secretion (OTC: Aluminum, magnesium, calcium, and simethicone/anti-gas) Suffix: "carbonate" or "hydroxide" Adverse effects of Antacids Diarrhea, constipation, renal stones, acid base imbalance (alkalosis), rebound of hyperacidity, and masking the bleeding of an ulcer. Contraindications fo Antacids Allergy to meds, chronic renal failure, electrolyte imbalance, and GI obstruction. Major Risk of Drug-Drug Interactions with Antacids are: Decreases the absorption of drugs, chemical deactivation of some drugs, increases urine acidity, and hypercalcemia (too much calcium). Antacids need to be taken ___________ before or after other medications. 1-2 hours H2 Antagonist Mechanism of Action Binds to receptor site and blocks histamine; parietal cells receptor site is blocked and decreases the ability to secrete HCL and vagal and gastrin stimulation is inhibited and blocks histamines. Suffix: -"-tidine" Ex: cimetidine Indications for H2 Antagonist GERD and PUD Vitamin B __________ the absorption of H2 Antagonist Inhibits How do H2 Antagonists work? They block the H2 receptors on parietal cells in the stomach to decrease acid production (suppresses day time & nocturnal basal gastric acids). Proton Pump Inhibitors Mechanism of Action They prevent the H+ ion from being pumped out so it is not available to create HCl. Suffix: "-prazole" Ex: omeprazole PPIs are _________ percent effective. 90 Indications for PPIs GERD, PUD, NSAID induced ulcers, and Zollinger-Ellison Syndrome Side Effects of Proton Pump Inhibitors Headaches, constipation, dizziness Drug-Drug Interactions with PPIs Diazepam, Phenytoin, and Warfarin Zollinger-Ellison Syndrome Hypersecretion of gastric acid that produces peptic ulcer Side Effects of H2 Antagonists Hypotension, lethargy, increased liver function. Adverse Drug Reactions of Proton Pump Inhibitors Osteoporosis, B12 Deficiency, C Doff, hypomagnesia, gastric cancer, and cardiovascular events. Bristol Stool Chart Medical aid to classify stool. Types 1 and 2 indicate constipation, Types 3 and 4 indicate ideal stools, Types 5, 6 and 7 indicate diarrhea. Always look at your own stool. It is important to know what your normal is and what should be normal. Type 1 Stool Separate hard lumps like nuts (difficult to pass) Type 2 Stool Sausage shaped but lumpy Type 3 Stool Like a sausage but with cracks on surface Type 4 Stool Like a sausage or snake, smooth and soft Type 5 Stool Soft blobs with clear-cut edges (passed easily) Type 6 Stool Fluffy pieces with ragged edges, a mushy stool Type 7 Stool Watery, no solid pieces (entirely liquid) Antidiarrheal Categories Probiotics, Adsorbents, Opioids, and Antimotility (anticholinergic) Adsorbents Mechanism of Action Coat the wall of the GI tract, has a chemical binding to toxins and bacteria. Examples of Adsorbents Bismuth subsalicylate (Pepto-Bismol), activated charcoal, aluminum hydroxide Adsorbents can be given as a/n ______________. Enema Anticholinergic Drugs (AntiDiarrheal) Mechanism of Action Blocks cholinergic receptor sites, slows peristalsis or intestinal contractions of smooth muscle & decreases gastric secretions. Side Effects of Anticholinergic Drugs Dry mouth, dry eyes, blurry vision, urine retention, drowsiness/dizziness, and upset stomach. Antidiarrheal Opioids Mechanism of Action Slow peristalsis, bind to opioid receptor sites in gut wall. Indications for Antidiarrheal Opioids Chronic diarrhea Side Effects of Antidiarrheal Opioids Constipation Probiotics Mechanism of Action Live microbial cultures administered to exert a beneficial effect Laxative Classes Bulk forming, emollient, hyper osmotic, saline, and stimulant. Bulk Forming Laxative Mechanism of Action Water retaining, patient needs to drink lots of water. (Ex: Citrucel, Metamucil) Emollient Drugs Mechanism of Action Lubricates/softens the stool. (Ex: Docusate sodium/Colace, and mineral oil). Hyperosmotic Drugs Mechanism of Action Increases water content inside the stool. (Ex: Glycerin, lactulose, and polyethylene glycol 3350) Saline Drugs Mechanism of Action Increases osmotic pressure for stool (Ex: Magnesium salts/Milk of Magnesia) Stimulant Drugs Mechanism of Action Induces peristalsis. (Ex: Bisacodyl and Sennosides) Irritable Bowel Syndrome (IBS) A common condition of unknown cause with symptoms that can include intermittent cramping, abdominal pain, bloating, constipation, and/or diarrhea. Management of IBS Avoid food allergens, stress, antidiarrheals or anticonstipation. What bacteria causes GERD? H. pylori Antiemetic Drug Classes Anticholinergics, antihistamine blockers, antidopaminergic, neurokinin, prokinetic, serotonin blockers, and TCH. Anticholinergic Drugs (Antiemetic) Mechanism of Action Act at vomiting center to block nausea and vestibular (inner ear disturbances) Indications for Anticholinergic Drugs (Antiemetic) Motion Sickness or pre-op Antihistamines (Antiemetic Use) Mechanism of Action Block H1 receptor sites for inner ear disturbances. Indications for Antihistamines (Antiemetic) Vertigo, motion sickness, nausea Antidopaminergic Drugs Mechanism of Action Block dopamine receptors at vomiting center. Indications for Antidopaminergic Drugs Used for psychotic disorders, intractable hiccups, nausea Serotonin Blockers Mechanism of Action Block serotonin receptors at vomiting center. Indication for Serotonin Blockers Used for nausea and vomiting in patients receiving chemotherapy and for postoperative nausea and vomiting. H2 (Histamine 2) Receptors control the acceleration of heart rate and gastric secretions. H1 (Histamine 1) Mediate smooth muscle contraction and dilation of capillaries Administration of Head/Ear/Eyes/Nose (HEEN) Drugs Nasal, optic, and ophthalmic Classes of HEEN Drugs Antihistamines, decongestants, antitussives, and expectorants Antihistamines Mechanism of Action H1 Antagonist, competes for the receptor site for histamines to block the antihistamine response (common receptor sites: Nose, eyes, bronchi, GI, and skin). H1 effect in the Lungs Bronchoconstriction, resulting in coughing/wheezing Antihistamine effect in the Lungs Bronchial dilation/relaxation, relief of coughing and wheezing Antihistamine Pregnancy Category Category B Indications for Antihistamines Allergic responses, motion sickness, Parkinson's, and insomnia Contraindications for Antihistamines Narrow angle glaucoma, seizure disorders, cardiac disease/HTN, liver disease, and renal disease. Sedating Antihistamines Diphenhydramine (Benadryl) for ALLERGY and Phenothiazine (Promethazine) & Dimenhydrinate (Dramamine) for NAUSEA Non- Sedating Antihistamines Loratidine (Claritin), Cetirizine (Zyrtec), and Fexofenadine (Allegra) Sedating Antihistamines are given for _____________________. Upper respiratory tract infections Patient Teachings for Sedating Antihistamines May make you drowsy, can affect gastric motility & urine retention, elderly are more likely to fall. Patient Teachings for Non-Sedating Antihistamines Do not take Zyrtec at night because it can keep you up, can have more drug-drug interactions. Decongestants Mechanism of Action Constrict the small vessels that supply the upper respiratory tract by the nasal sinuses. Once the vessels shrink, nasal secretions in the swollen mucous membranes are able to drain. Routes of Delivery of Decongestants Oral and inhaled The Two Classes of Inhaled Decongestants Alpha-Adrenergic Vasoconstrictor and Intranasal Steroids Indications for Decongestants Viral or bacterial infection, allergies, or inflammatory response. Decongestants Pregnancy Category Category C Why should someone with HTN not take decongestants? Because the decongestants cause vasoconstriction throughout the body. Because of this, bloop pressure will increase. Major Side Effects of Decongestant: Alpha-Dadrenergic Vasoconstrictor: Oxymetolazine (Afrin) Rebound congestion, limit to 3 days MAXIMUM USE, and over use/dependency. Adverse Effects of Nasal Decongestants (Adrenergic Drugs) Nervousness, insomnia, heart palpitations, and tremors Drug-Drug Interactions with Nasal Decongestants (Adrenergic Drugs) Synergist with MAO Inhibitors (anti-psychotic drugs) Steroid Nasal Decongestants Mechanism of Action Turn of the inflammatory response Adverse Effects of Steroid Nasal Decongestant Drugs Nasal dryness and bloody nose Opioid Antitussives Mechanism of Action Suppress the cough reflex by direct action on the cough center in the medulla. Nonopioid Antitussives Mechanism of Action Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated. Indications for Opioid Antitussive Drugs Helps with strong, dry, non-productive cough Indications for Nonopioid Antitussive Drugs Helps with nagging unproductive cough that won't go away (hacking). Side Effects of Opioid Antitussives Drowsiness, constipation, can be addicting (Schedule V drug) Expectorants Mechanism of Action Thins and increases mucus flow allowing secretions to be more easily expectorated. Any drug with a "D" or "DM" in the name contain ______________________. Decongestants ___________ in the only allergy/coughing medication safe for children aged 5 and younger. Benadryl Glaucoma What terms are part of the clinical judgement model? Recognizing cues, analyze cues, prioritize the hypotheses, generate solutions (planning), take action and evaluate outcomes In the clinical judgement model what is it to recognize cues? Identifying relevant and important information from different sources (medical history, vital signs) In the clinical judgement model what is it to analyze cues? Organizing and linking the recognized cues to the patients clinical presentation (fever and elevated HR, maybe infection) In the clinical judgement model what is it to prioritize hypotheses? Evaluating and ranking hypotheses according to priority (urgency, likelihood, risk, difficulty, timing) In the clinical judgement model what is it to generate solutions? Identifying expected outcomes and using hypotheses to define a set of interventions to get to the expected outcome, focus on SMART goals and the possibility of multiple interventions What are SMART goals? Goals you create that are specific, measurable, achievable, relevant and time bound In the clinical judgement model what is it to take action? Implementing the solution(s) that address the highest priorities for your patient, it is patient centered and includes action verbs In the clinical judgement model what is it to evaluate outcomes? Comparing observed outcomes against expected outcomes What are the terms for the nursing process? Assessment, diagnosis, planning, implementation and evaluation What is the most important thing you can do as a nurse to obtain information from a patient? Assess them What is the use of nursing diagnoses in plan of care documentations? To modify the care plan as needed for the patient and determine if new interventions are needed. The nursing diagnosis reflects the patients responses to actual or potential health problems (it is different from a medical diagnosis) How is a nursing diagnosis different then a medical diagnosis? The nursing diagnosis is a statement of health that the nurses can identify, prevent or treat independently Is the nursing process linear? Why or why not? No, the nursing process is not intended to be linear. It is a model that follows logical progression What is the role of clinical judgement in providing care? Clinical judgement is using your knowledge and skills as a nurse to make clinical judgements about the patients condition and situation at hand in order to help them What are some developmental factors that create safety risks for infants/toddlers? Learning how to move and walk What are some developmental factors that create safety risks for school age children? Becoming more physically active (playground, sports etc) What are some developmental factors that create safety risks for adolescents? Engaging in risky behaviors What are some developmental factors that create safety risks for adults? Workplace and lifestyle choices What are some developmental factors that create safety risks for older adults? Impaired mobility and falls What are the two discussed types of individual risk factors for safety? Lifestyle and cognitive awareness Give some examples of how an individuals lifestyle choices can affect safety Smoking, drinking, engaging in risky behaviors Give some examples of how an individuals cognitive awareness can affect safety Stress, sensory & perceptual status, impaired communication, impaired mobility, physical & emotional wellbeing and safety awareness (ability to determine safety) What are some safety concerns in the home? Poisoning (toxic cleaning agents), falls, fires, burns etc What are some safety concerns in the community? Car accidents, pathogens, pollution, extreme weather What are some safety concerns in the clinical setting for patients? Malfunctioning equipment, medication errors, alarm fatigue from providers, miscommunication (from persons on the team to the patient and to each other), patients risks (falls, suicide), and clutter in the patient room What are some safety concerns in the clinical setting for workers? Back injuries, needle sticks, exposure to radiation, violence and improper storage of equipment How can we prevent falls in the clinical setting? Assess our patients to ensure optimal safety, identify cues from your patient that may indicate potential safety hazards, communication to make sure that the patient is safe, keep at least 2 bedrails up, lower patient bed when not performing tasks and keep walkways clear What are three tool used to assess fall risk? Morse Fall Scale, Johns Hopkins Assessment and Get Up and Go Test What are the levels of the Morse Fall Scale? Score of 0-24 is no risk, score of 25-50 is low risk and score of 51 and above is high risk What is assessment criteria is used in the Morse Fall Scale? History of falling, IV/heparin lock (do they have an IV line or a saline block), mental status, whether they have an ambulatory aid, their gait (normal or impaired) and if they have any secondary diagnoses What assessment criteria is used in the Johns Hopkins Assessment? Age, fall history, elimination for urine and bowel, medications, patient care equipment, mobility and cognition What movements make up the Get Up and Go Test? Move from sitting to standing without using the arms to help the patient rise, walk several paces, turn. and return to the chair, sit back down in the chair without using arms for support What are four factors that affect mobility and activity? Developmental stage, nutrition, lifestyle and environmental factors What are some benefits of exercise? Improved cardiovascular health (lower risk of MI and stroke), lower risk of diabetes, hypertension, colon/breast cancer, increased muscle tone and flexibility, enhances immune system, promotes weight loss, decreases stress and depression and increases overall wellbeing What are some risks of exercise? Cardiac injury, musculoskeletal injury, dehydration, and temperature regulation What are the principles of body mechanics for patients and nurses? Use proper body alignment, have a wide base for support, avoid bending and twisting, squat to lift, keep objects close when lifting, raise beds, push versus lift and get help when needed What are standard nursing interventions for a patient with mobility concerns? Assess the patient, ADL limitations, wristbands, remove clutter, provide walker/cane, plan varying exercise routines to keep it fun and integrate exercise in routine activities What are the six links of the chain of infection? Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host What is included in the bodies primary defense system? The skin, mouth, respiratory tree and GI tract What is included in the bodies secondary defense system and how does it work? Phagocytosis, inflammation, fever etc. It is where specialized WBCs destroy the pathogen What is included in the bodies tertiary defense system and how does it work? Immune cells, the pathogen is detroyed through active, passive or specific immunity What are some ways to promote immune function? Nutrition, hygiene, rest, exercise, stress reduction and immunization What are some symptoms a patient might show if they have an infection? Fever, flushed complexion, tachycardia, sweating, cough etc What are the transmission based precautions? Airborne, contact and droplet and standard precautions What are standard precautions? Hand hygiene, gloves, gown and eyewear What are airborne precautions and when are they used? They are used when the pathogen is transmitted through air currents. You need gloves, gown, goggles, and a respirator. They patient should be in a single room with reverse airflow What are some diagnoses that would warrant the use of airborne precautions? Pulmonary tuberculosis, chickenpox and measles Can a patient with airborne precautions share a room with someone else? They have to be in a single room What are contact precautions and when are they used? They are used when the organisms are spread through direct contact with the patient or environment, it is the most common form of transmission. You need gloves and gown if you plan to have any contact with the patient or their environment What are droplet precautions and when are they used? They are used when the pathogen is spread through close respiratory or mucous membrane contact via sneezing or coughing. You need gloves, gown, face mask and goggles if you are dealing closely with secretions Can a patient on contact precautions share a room with someone else? Not unless they have the same diagnosis and are also on contact precautions What are some diagnoses that would warrant the use of contact precautions? MRSA, VRE and C. Diff What are some diagnoses that would warrant the use of droplet precautions? Influenza, pertussis and rubella Can a patient on droplet precautions share a room with someone else? Not unless they have the same diagnosis and are also on droplet precautions What are some factors that increase the risk of infection? Developmental stage, illness or injury, tobacco use, substance abuse, environmental factors, chronic disease, medications and procedures Why are multidrug-resistant organisms (MDROs) of special concern in healthcare? The symptoms stay/last longer, there is a higher rate of recurrent infection and there is increased mortality What is a nurses role in recognizing, preventing and helping to contain a biological epidemic Nurses should be able to recognize when individuals need to be placed into certain precautions in order to decrease spread. By placing patients into precautions before they start to spread you are preventing any one else from getting sick. When the patient is contained, the spread will slowly disipate and become contained when no one else can be infected. What factors affect skin integrity? Age, impaired mobility, nutrition, hydration, diminished sensation, impaired circulation, medications, moisture, fever, infection and lifestyle What are contributing factors in the development of pressure wounds? Pressure, shear (moving down in bed), friction (moving up in bed) and moisture Describe serous wound drainage Normal healing fluid, thin and watery Describe sanguineous wound drainage leakage of fresh blood, thin Describe serosanguineous wound drainage Thin and watery fluid that is pink due to the presence of small amounts of RBCs Describe purulent wound drainage It is a sign of infection, it has a thick texture, unpleasant odor, can be white yellow or brown fluid Describe purosanguineous wound drainage It consists of blood and pus, it is often seen in a new wound that is infected What is the Braden scale used for? It predicts the amount of risk a patient has of obtaining a pressure sore How do you assess risk for a pressure sore using the Braden scale? You assess sensory perception, moisture, activity, mobility, nutrition and friction/shear on a scale of 1 to 4 (1 being the worst and 4 being no issues) the lower the score the more chance for a pressure sore to occur How to prevent a pressure sore from occuring? Monitoring, manage moisture, dressings, collaboration, minimize pressure, optimize nutrition and patient teaching What are characteristics of primary intention wound healing? The wound has minimal tissue loss, it can be left open to heal or sutured at an early stage to help close and heal What are characteristics of secondary intention wound healing? The wound has extensive tissue loss and is left open to heal, it heals from the inside out and can leave a scar How does personal hygiene relate to health and wellbeing? Keeping good personal hygiene makes sure that there is less of a chance of spreading infection and making sure your body stays healthy What hygiene activities can be delegated to unlicensed personnel? Face washing and oral care What are activities that cannot be delegated to unlicensed personnel? Activities that have to do with evaluation, assessment and teaching (EAT) What are some safety concerns associated with a tub or shower? Risk of falling, loss of consciousness, limited mobility to clean self and use of water that is too hot and can cause burns What are nursing considerations for aspect of personal hygiene including skin, hair, nails and oral care? Bathing, shaving, trimming nails and brushing teeth What are some social, historical, economic and political changes that have influenced nursing practices? Safety education, genomics, public perceptions, healthcare reform and public health policy What is included in the development of professional nursing roles? Autonomy/accountability, caregiver, advocate, educator, communicator and manager What educational programs are available for professional registered nurse education? 3 year hospital based programs, 2 year community college programs, 4 year bachelors degree What is nursing research? It is the systematic inquiry designed to generate evidence about issues of importance to the nursing profession, including nursing practice, education, administration and informatics What are the four essential concepts of nursing theory (the nursing metaparadigm)? Person (patient), environment (internal and external factors), health (defined by patient) and nursing (nursing actions) How are nursing theories influenced by non-nursing theories? Theories from psychology and education in regards to development and learning were applied to nursing theories to make them more detailed What was Florence Nightingales nursing theory? Environment theory which means the nurse manipulates the patients environment What was Hildegard Peplaus nursing theory? Interpersonal theory which means the interpersonal relationship between the nurse and patient is important What was Virginia Hendersons nursing theory? Need theory which means nurses help patients perform Hendersons's 14 basic needs What was Dorothy Oems nursing theory? Self-care theory which means nurses care for and help the patient attain total self care What is the significance of evidence-based nursing practice and how might one integrate research into practice? The significance is that with evidence-based nursing practice, the nurse can integrate the best available research evidence with their individual expertise to make sure the patient is getting the best care possible What is the process of urine formation and elimination? Liquid goes through the kidneys and becomes urine, ureters take it to the bladder and is excreted from the bladder then urethra What are factors that affect urinary elimination? Developmental stage, personal/sociocultural/environmental, nutrition/hydration/activity level, medications, and surgery/anesthesia What are some pathological conditions that affect urinary elimination? UTI, calculi, cardiovascular/metabolic diseases, neurogenic bladder and impairments What are the 7 types of urinary incontinence? function, reflex, stress, total, mixed, urge and overflow incontinence What causes functional urinary incontinence? Urine loss due to the inability to reach the toilet due to environmental barriers What causes reflex urinary incontinence? Emptying the bladder without the need or sensation of having to go What causes stress urinary incontinence? Involuntary loss of urine due to a rise in intra-abdominal pressure caused by things such as coughing, sneezing, childbirth etc What causes total urinary incontinence? Continuous and unpredictable loss of urine due to surgery, trauma or a physical malformation What causes mixed urinary incontinence? Urine loss with two or more different types of incontinence What causes urge urinary incontinence? Involuntary loss of urine that occurs soon after feeling the sensation of needing to void, not making it to the toilet in time after the urge What causes overflow urinary incontinence? Involuntary loss of urine after over distension or overflow of the bladder, the signal to void may be absent or diminished here What kind of diagnostic tests used in identifying urinary elimination problems? Routine urinalysis which tests for pH, specific gravity, glucose, proteins, ketones, and blood What are some common urinary elimination issues? UTI, urinary retention, urinary incontinence, and urinary diversions What are interventions/ things that promote normal urination? Providing privacy, positioning patients properly, establishing toileting routines, providing adequate fluids/nutrition and assistance with the timing of voiding What are ways to care for patients with urinary elimination issues? Foley catheters, medications, hydration/nutrition, education and surgery What are the components of a complete medication order? Patients full name, date and time order was written, name of the medication, dosage of the medication, medication frequency and duration, route of administration, the indication (reason for medication) and signature of prescriber What are the 6 patient rights to medication administration? Right person, right drug, right dose, right route, right time and right documentation What are the lesser important rights but still acknowledged rights with medication administration? Right to refuse, right to know and right reason When are the three checks for med administration? You check the med as you pull it from supply to check drug name and dosage, you check it again as you prepare it to place it on the tray to take into the patient room and you check it again in the patient room before administering What are the three most common causes of medication errors? Lack of knowledge, faulty communication and equipment errors How can a nurse work to prevent medication errors? Going through the 6 rights and 3 checks, checking medication spelling, questioning irregular orders, eliminating distractions, making sure you have the right patient and doing a double check of the patient allergies What is the nurses responsibility if there is a medication error? Check vital signs immediately, report the error to the provider and notify the charge nurse then complete report How do you safely administer drugs that are delivered orally? Make sure the drug is swallowed and check for aspiration What kind of patients are at risk for aspiration? Patients who have had a stroke, who have dysphasia, neurological disorder and who have a difficult time swallowing etc How do you safely administer drugs that are delivered enterally? Administering the drug directly into the stomach or intestine through the proper tubing placed How do you safely administer drugs that are delivered topically? Make sure the drug is not an allergy beforehand and then make sure it is completely absorbed into the skin after applying with gloves on How do you safely administer drugs that are delivered through the respiratory system? Make sure that the patient has no airway obstructions and breathes deeply to make sure the medication reaches the intended area How do you safely administer drugs that are delivered parenterally? Make sure the right needles are used, make sure IVs go directly into the vein, make sure the IM goes directly into the muscle, make sure subcutaneous injections go into the subcutaneous tissues and make sure intradermal injections are directly under the skin and do not penetrate the dermis What are some individual factors that influence oxygenation? The patients age and development level What are some environmental factors that influence oxygenation? Stress, allergic reactions, altitude, occupational exposures etc What are some pathological factors that influence oxygenation? Pain medications, asthma etc What are adequate oxygenation saturation levels? 95% SpO2 and above What are adequate breathing respirations? Between 12-20 respirations a minute What is the process of adequate gas exchange? When air enters the respiratory system and from within the lungs it binds to hemoglobin in the bloodstream and is used within tissues and CO2 takes its place in the blood to then be taken back to the lungs and expelled out of the body What actions can you take if your patient is having trouble breathing? Position them for optimal breathing (sitting up as high as they can tolerate), provide supplemental O2 and promote deep breathing and hydration What measures are taken to mobilize secretions and promote optimal respiratory function and oxygenation? Giving the patient an incentive spirometer, using a nebulizer, encouraging the patient to turn, cough and take a deep breath and suctioning out secretions after they have been mobilized What is an appropriate amount of oxygen flow when using a nasal cannula? Between 1-6 L What is an appropriate amount of oxygen flow when using a simple face mask? Between 6-10 L What is an appropriate amount of oxygen flow when using a non-rebreather or peak flow mask? Between 15-20 L What body structures are involved in the GI system? The mouth, esophagus, stomach, pancreas, liver, SI and LI What are some factors of a normal bowel elimination? It is solid/formed and easy to pass, it is brown in color and can happen a few times a day to a few times a week depending on the person What are some factors that can influence the state of a patients bowel elimination? Developmental stage, personal and sociocultural factors, nutrition/hydration, activity, medications and surgery/procedures What are the two most common problems with bowel elimination? Constipation and diarrhea What are characteristics of constipation? It is a fecal impaction or bowel obstruction, it decreases the number of bowel movements the patient will have and the stool is dry and hard to pass What are characteristics of diarrhea? Loose watery stool What are some questions you can ask to assess bowel elimination problems? What time of day do you usually have a bowel movement? What problems have occurred or are occurring with your bowel movements such as diarrhea or constipation? Ask about elimination aids. Ask about ostomy or ileostomy routines. What are some nursing interventions that promote normal bowel eliminations? Privacy, correct positioning, timing, fluid intake, proper diet and exercise What are the functions of fluid balance within the body? Maintain blood volume, regulate body temp, transport material to and from cells, serve as a medium for cellular metabolism, assist with digestion of food and serves as a medium for excreting waste What are the three fluid compartments? Vascular, interstitial and transcellular What is third spacing? When fluid is in the wrong compartment and cannot perform its allocated task How many mL of water should you take in per day? Between 1,500 and 2,000 mL per day What organ is the most important for creating fluid output? The kidneys The same two body systems regulate fluids and acid base balance within the body, what are those two systems? The respiratory and urinary (lungs and kidneys) In what kind of fluid can you find sodium? The extracellular fluid What are symptoms of hypernatremia? Thirst, increased temp and lethargy seizures What are symptoms of hyponatremia? Confusion, weakness and lethargy seizures In what kind of fluid can you find potassium? The intracellular fluid (IN circle K) What caused hyper/hypokalemia? Diarrhea or vomiting What can happen from hyper/hypokalemia? It can cause heart arryhthmias What essential vitamin must be present for calcium to be absorbed? Vitamin D What are some symptoms of too much calcium? Kidney stones, flaccidity and muscle cell contraction issues (including cardiac) What are some symptoms of not enough calcium? Tetany cramps and muscle cell contraction issues (including cardiac) In what fluid can you find magnesium? The intracellular fluid What can too much and not enough magnesium cause within the body? Dysrhythmias and muscle cramping What electrolyte works closely with sodium and potassium? Chloride What electrolyte works inversely with calcium? Phosphorus is inverse of calcium What is caused by low calcium and high phosphorus levels? Tetany cramps What is cased by high calcium levels? Bradycardia What is caused by low phophorus? Low HR and oxygenation What electrolyte can be affected if the renal system is not functioning properly? Bicarbonate What is the main idea of aseptic technique? You touch things that are clean to clean meaning once it is removed from the patient it should not be directly reapplied What are the order of steps for administering a bed bath? Wash the eyes, wash the face, wash one arm from fingers to armpit, wash armpit, repeat with other arm and armpit, wash the chest, wash hands, wash abdomen, wash leg from ankle to knee then knee to thigh, wash foot, wash the other leg and foot, then wash the perineal area What are the characteristics of fowlers position? Legs flat with head of the bed inclined as close to 90 degrees (sitting up straight) as the patient can handle What are the characteristics of semi-fowlers position? Legs flat with the head of the bed inclined between 45-60 degrees What are the characteristics of supine position? Laying flat on their back What are the characteristics of prone position? Laying flat on their stomach with their head turned to one side What are the characteristics of lithotomy position? On their back with their feet up in stirrups What are the characteristics of side-lying positions? Patient is turned on their side with the opposite leg extended over to that side How do you measure a patient for a cane? Patient stands, the handgrip of the cane should reside around their hip/waist area How do you teach a patient to use a cane? Tell them to place the cane on the strong side of their body, they should move the cane between 6-10 inches forward and then lead with the weak leg as the strong leg will then land bast the cane and the movements can be repeated How do you measure a patient for a walker? Patient stands, the walker should be as high as the hip joint and when in use the patients elbows should be bent to around 30 degrees How do you teach a patient to use a walker? Tell them to stand inside the frame of the walker and hold onto bath handgrips, they should move the walker a few inches and then reposition themselves within the frame, continuing this pattern to move How do you measure a patient for crutches? Crutches should be set at the patient height How do you teach a patient to use crutches? With non-weight bearing on one leg, the crutches will move simultaneously forward a few inches and the uninjured foot will swing through and land in between the crutches, the movement will be repeated for movement. With both legs bearing weight, the patient will move the leg opposite of the crutch that is moving to mimic an actual walking motion How do you remove sutures? Cut as close to the skin on one side of the suture with scissors because you want to try to drag a little of the exposed suture through the skin, then pull the uncut side out taking the internal portion with it What is the correct order to don PPE? Wash hands, put on gown, mask, goggles then gloves What is the correct order to doff PPE? Take off the gloves, eyewear, gown then mask Increa