Fundamentals Exam 3 Comprehensive Study Guide

Flashcards covering the nursing process, stress and coping, fluid and electrolyte balance, spiritual health, loss and grief, ethics, and documentation found in the Fundamentals Exam 3 study guide.

Critical Thinking

The systematic, logical, evidence-based process nurses use to recognize a problem, analyze information, evaluate its meaning, and make safe conclusions.

Reflection

The act of intentionally reviewing a past situation to identify its meaning, learn from it, and improve future problem solving.

ADPIE

The five-step nursing process consisting of Assessment, Diagnosis, Planning, Implementation, and Evaluation.

Clinical Judgment Model (CJM)

A six-stage thinking process including recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

Subjective Data

Information reported by the patient that cannot be directly measured by the nurse, such as "My pain is 8/10" or feelings of nausea.

Objective Data

Observable or measurable findings obtained through physical examination, equipment, or records, such as a blood pressure of $88/54$ or a temperature of $38.5^{\circ}C$.

Focused Assessment

A problem-oriented assessment used for a specific symptom or identified problem, involving a detailed look at the affected system and related systems.

SMART Outcomes

Patient-centered goals that are Specific, Measurable, Attainable, Realistic/Relevant, and Time-limited.

Direct Care

Nursing actions performed with the patient, such as ADLs, medication administration, teaching, or lifesaving measures.

Indirect Care

Nursing actions performed on the patient’s behalf, including documentation, consultation, and care coordination.

Stress

A physical, chemical, psychological, or emotional factor that produces tension and threatens homeostasis.

Appraisal

A person’s interpretation of a stressor and their evaluation of available resources to manage it.

Eustress

Positive, motivating stress that can promote growth or performance.

Distress

Stress experienced as harmful, overwhelming, or beyond available coping resources.

Secondary Traumatic Stress

A stress response resulting from witnessing or repeatedly hearing about another person’s suffering.

Situational Crisis

An unexpected event that causes stress, such as a car accident, job loss, or relationship breakup.

General Adaptation Syndrome (GAS)

The body's three-stage physiological response to stress: Alarm, Resistance, and Exhaustion.

Alarm Stage

The immediate fight-or-flight response involving sympathetic activation, dilated pupils, and increased heart rate, blood pressure, and glucose.

Burnout

A state resulting from long-term work demands exceeding resources, characterized by emotional exhaustion, cynicism, and reduced accomplishment.

Compassion Fatigue

A combination of burnout and secondary traumatic stress resulting from repeated exposure to suffering.

Second-Victim Syndrome

A phenomenon where a health care worker is traumatized after involvement in a serious medical error or adverse patient event.

Intracellular Fluid (ICF)

Fluid located inside the cells, accounting for approximately two-thirds of total body water.

Extracellular Fluid (ECF)

Fluid outside the cells, including intravascular plasma, interstitial fluid, and transcellular fluids.

Diffusion

The passive movement of particles from an area of higher concentration to an area of lower concentration.

Isotonic

Same effective concentration as normal blood; little net water shift.

Hypotonic

Lower concentration than blood; water tends to move into cells.

Hypertonic

Higher concentration than blood; water tends to move out of cells.

Osmosis

The movement of water across a semipermeable membrane toward an area with a greater solute concentration.

Hypovolemia

An ECF volume deficit characterized by weight loss, dry mucosa, poor skin turgor, tachycardia, and oliguria.

Hypervolemia

An ECF volume excess characterized by rapid weight gain, edema, crackles, hypertension, and jugular venous distention.

Clinical dehydration

Combination of ECF volume deficit and hypernatremia;
Replace water carefully, monitor sodium and neurologic status, identify source of water loss.

Sodium ($Na^+$)

normal range of $135-145\,mEq/L$.

Major ECF cation; regulates water balance, osmolality, nerve impulses, and muscle function.

Sources: salt/processed foods. Losses: urine, sweat, GI fluids. Regulated mainly by kidneys, aldosterone, ADH, thirst, and natriuretic peptides.

Potassium ($K^+$)

normal range of $3.5-5.0\,mEq/L$.

Major ICF cation; vital for cardiac rhythm, nerve conduction, and skeletal/smooth muscle contraction.

Sources: bananas, oranges, potatoes, tomatoes, beans. Losses: urine, vomiting, diarrhea, drainage. Regulated mainly by kidneys, aldosterone, insulin, and acid–base balance.

Ca

9 - 10.5

Bone/teeth structure, muscle contraction, nerve transmission, blood clotting.

Sources: dairy, fortified foods, leafy greens. Regulated by parathyroid hormone, calcitonin, vitamin D, kidneys, and bone.

Mg

1.3 - 2.1

Neuromuscular stability, enzyme reactions, cardiac function, and blood-pressure regulation.

Sources: nuts, whole grains, legumes, leafy greens. Losses: GI tract and urine. Regulated by kidneys; affected by alcohol, diarrhea, laxatives, diuretics.

Cl-

98-106

Major ECF anion; follows sodium, maintains osmolality/electrical neutrality, helps form gastric acid.

Sources: table salt. Losses: vomiting, gastric suction, diarrhea, diuretics. Regulated with sodium and kidneys.

HCO 3-

21 - 28

Major metabolic buffer; helps maintain acid–base balance.

Kidneys conserve or excrete bicarbonate and hydrogen ions; GI losses and metabolic conditions alter levels.

PO 3- 4

2.5 - 4.5

Bone/teeth, ATP energy, cell membranes, acid–base buffering.

Sources: dairy, meat, beans, nuts. Regulated by kidneys, parathyroid hormone, vitamin D; often moves opposite calcium.

Hypokalemia

A serum potassium level below $3.5\,mEq/L$ that may cause weakness, dysrhythmias, and flat or inverted T waves on an ECG.

Hyperkalemia

A serum potassium level above $5.0\,mEq/L$ that can cause life-threatening dysrhythmias and peaked T waves.

Hypocalcemia

A calcium level below $9.0\,mg/dL$ often characterized by numbness, tingling, and positive Chvostek or Trousseau signs.

Hypermagnesemia

A magnesium level above $2.1\,mEq/L$ often caused by renal failure combined with magnesium antacids, resulting in decreased DTRs and bradycardia.

Respiratory Acidosis

An acid-base imbalance where $pH < 7.35$ and $PaCO_2 > 45\,mm\,Hg$, typically caused by hypoventilation.

Metabolic Alkalosis

An acid-base imbalance where $pH > 7.45$ and $HCO_3^- > 28\,mEq/L$, often caused by vomiting or gastric suction.

ROME

A mnemonic for ABG interpretation: Respiratory Opposite ($pH$ and $CO_2$ move opposite) and Metabolic Equal ($pH$ and $HCO_3^-$ move in the same direction).

Spirituality

An awareness of one’s inner self and a sense of connection to a higher being, nature, or a purpose greater than oneself.

FICA

An assessment tool used to explore spiritual health: Faith, Importance, Community, and Address in care.

Spiritual Distress

A disruption in the life principle that affects the whole person and may manifest as hopelessness, anger, or conflict with beliefs.

Actual Loss

A loss recognized by both the person and others, such as the death of a family member or the loss of a job.

Anticipatory Grief

Grief that begins before an expected loss, such as in the case of a terminal illness.

Disenfranchised Grief

Grief for a loss that is not openly acknowledged or socially supported, such as a miscarriage or the death of an ex-partner.

Complicated Grief

Persistent, chronic, or masked grief that impairs functioning and may require professional treatment.

Palliative Care

Care focused on the prevention and relief of symptoms and suffering to improve quality of life at any stage of serious illness.

Hospice Care

Comfort-focused care for terminally ill patients who are no longer pursuing curative treatment.

Autonomy

The ethical principle of respecting a competent patient’s right to make informed choices, including the right to refuse treatment.

Beneficence

The ethical principle of doing good and promoting the patient's welfare.

Nonmaleficence

The ethical principle of avoiding or minimizing harm; "do no harm."

Fidelity

The ethical principle of keeping promises and professional commitments.

Ethical Dilemma

A situation where two competing courses of action can each be justified by ethical principles, leaving no clearly perfect choice.

Moral Distress

The feeling of being unable to act according to what one believes is ethically right due to external constraints.

Deontology

An ethical approach that focuses on duties, rules, and principles to decide what is right.

Utilitarianism

An ethical approach that chooses the action expected to produce the greatest overall good for the greatest number of people.

Charting by Exception (CBE)

A documentation method that only records abnormal findings or deviations from defined standards.

SBAR

A communication format used for handoffs and provider communication: Situation, Background, Assessment, and Recommendation.

Nursing Informatics

The integration of nursing, computer, and information science to manage and communicate data, knowledge, and wisdom.