Terms you should know (adding)

Nocturia

To urinate in the middle of sleep at night

Euphoria

To experience intense happiness

Paresthesia

Pins and needles

Sleep apnea

Breathing stops and starts during the night

Exaberating

Making a situation or condition worse

Apnea

Temporary stop in breathing during sleep - lowering O2 level

OSA - Obstructive Sleep Apnea

Throat muscles relax and blocks airway during sleep

If there is low SpO2,

the nurse should wake the patient up

Normal range of WBC

5,000-10,000uL

>10,000uL of WBC can result in what?

Infection, inflammation, tissue injury, death, and cancer

<5,000uL of WBC can result in what?

Leukopenia - bone marrow depression

If >10,000uL of WBC,

the nurse should take the patient’s temperature

Tremors

Arithmic movements of tremble

Lethargy

Severe tiredness, sluggishness, and low level of mental alertness or consciousness

Obtunded

Diminished response to environmental stimuli

Flat affect

Total or near-absence of outward emotional expression

Parkinson’s disease

CNS disorder that results in slowness of movement, tremors, and muscle stiffness

Labile

Rapid shift in expressions

Dysarthria

Slur of words

Dysphonia

Abnormal pitch and tone

Asphasia

Confusion of knowledge

Delirium

Rapid mental confusion, disorientation, and inability to focus

MMSE — Mini-Mental State Examination

• 30 point questionnaire

• 5-10 minutes

• Screens for cognitive impairment

MOCA — Montreal Cognitive Assessment

• 30 total points

• 10 minutes

• Higher of 26 is normal

• Memory tested

MINI-Cog

• 3 minute

• Screens for cognitive impairment and dementia in older adults

• 3 word recall

• Clock drawing

Supine

Laying on back

Prone

Lying on belly

Lateral

Lying on side

Sim’s

The comfy sleeping position

Dorsal recumbent

Women perineal care position

Fowler’s

Sitting down at a 60o degree angle with back against HOB

Orthopneic

Hunched over while sitting down - for ease of SOB

Tachycardia

HR is rapid

Tachypnea

Breathing is rapid and shallow

Hypoxia

Tissues do not get enough O2 to function

Stage 1 Hypertension

When BP is 130-139/80-89 mmHg

Stage 2 Hypertension

When BP is ≥140/≥90 mmHgE

Elevated BP

When BP is 120-120/<80 mmHg

If BP cuff is too tight,

inaccurate HIGH BP reading

If BP is too loose,

inaccucrate LOW BP reading

Orthostatic hypotension

Drop is ≥20/≥10 mmHg from expected

Hypothermia

When body temp. drops below 95F (35C)

Vesicular sounds

• Softest

• Lowest pitch of all

Decreased breath sounds

Decreased in intensity or even absent in sound

• Occur in airway disease or obstructure, diaphragm paralysis, or impairment of sound transmission

Fine crackles

• High-pitched sounds

• Occur when inhaled air meets deflated alveoli

• @base of lower lobes

Coarse crackles

• Low pitched bubbling sounds — VELCRO

• Caused when air meets secretions in large airways

• @Trachea and large bronchi

Rhonchi

• Low-pitched sounds — SNORING / WATER NOISES

• Caused by airway obstruction from thick secretions, muscular constriction, or masses

• @bronchi

Wheezes

• Continuous and high-pitched muscial sounds — FART / MOANING

• Caused by narrow airways of swelling, secretions, and masses

• @lung fields

Stridor

• Loud and high-pitched

• Crowing sounds — SIG CRYING

• Caused by upper airway obstruction

• @trachea

Somnolent

Drowsy and causing sleep

Stupor

Less awareness

Semicoma

Mild coma

Delirium

Sudden and severly impaired

Dementia

Slow and normal until late ages

Depression

**

Characteristics of a profession

• Specialized knowledege

• Credentials/licensure

• Ethical standards

• Service to society

• Autonomy in practice

• Ongoing professional development

ANA Code of Ethics for Nurses

The nursing profession’s expression of its ethical values and duties to the public

Florence Nighingale

• Collected morbidity and mortality data

• Joined the Kaiserwerth program

• Crimean War — helped British soldiers

• Founded St. Thomas’ Hospital in London

Mary Seacole

• Jamaican nurse and business woman during Crimean War

• Rejected from Nightingale’s team

• Served at British hospital that was ran by Nightingale

• Served for soldiers at “hotel“

Phases of nurse-patient interaction

1. Preorientation — nurse gathers data before meeting patient

2. Orientation — nurse introduces themselves, develops trust, and identify patient’s concerns

   1. Approximate length of stay is established

3. Working — nurse and patient meet the tasks, periods of intense effort, and even resistance to change (regression)

4. Termination/evaluation — marks the end of the relationship when patient’s needs are met

Nurse-patient communication aspects

• Context — mood of the interaction, relationship between sender & receiver

• Feedback — when a receiver relays to a sender the effect of the sender’s message

  • Correction from the patient during feedback

• Sender — the one sending the message

  • Either nurse or patient can be sender

• Channel — the method/medium through which the message is transmitted

Communication criteria

• Feedback

• Appropriateness

• Efficiency

• Flexibility

The nursing process!

1. Assessment — assessing the patient’s pain level using a numeric scale

2. Diagnosis — identifying that the patient has acute pain related to surgery

3. Planning

4. Implementation — administering prescribed analgesics as ordered

5. Evaluation — determing whether pain relief goals were achieved

In evaluation phase, when outcomes are not met,

You must review the process and obtain more assessment

Therapeutic communication on SURGERY

Reflect the concerns and questions back to the patients because it shows that you acknowledge and care

During an interview, a patient reports difficult rising from a chair. Which nursing action best demonstrates appropriate use of therapeutic communication and clinical judgment?

Later, observe the patient rising froma chair and begin ambulation

• Why? SUBJECTIVE reports should be validated with objective information

  • Observing the patient’s movement provides objective data related to the reported difficulty

Under-involvement vs over-involvement

Under-involvement occurs when a nurse fails to give adequate attention with patient.

Over-involvement occurs when a nurse gives too much special attention to the point of crossing boundaries

Incongruence vs congruence

Incongruence is when the patient’s nonverbal expressions and verbal expression DO NOT align with one another.

Congruence is when the two concepts DO align with one another

Swanson’s theory of caring

Swanson defines “caring” as a nurturing way of relating to an individual when one feels a personal sense of commitment and responsibility

• Its for like person-centered care – individuality

5 caring processes of Swanson

1. Maintaining belief = sustaining faith in patient’s capacity to get through hardship

2. Knowing = striving to understand an event as it has meaning in the life of the patient and avoiding assumptions

3. Being with = being emotionally present with the patient and sharing feelings without burdening the patient

4. Doing for = doing for the patient what they would do for themselves IF POSSIBLE

   1. Enabling = facilitating the patient’s passage through life transitions and unfamiliar events

SBAR

Framework for communicating critical patient information clearly/efficiently

• Situation — describe immediate concern

• Background — provide RELEVANT clinical context (diagnosis, medications, recent procedures)

• Assessment — share your clinical interpretation

• Recommendation — suggest specific intervention

I-SBAR-R

Framework for patient handoffs with other HCP and reduce medical errors

• Introduction (I) — identify yourself, your location, and your role when the other provider does not know you

• Readback (R) — confirm information and instructions to improve communications accuracy

Tanner’s model of clinical judgment

• Noticing – perceiving or recognizing RELEVANT patient information and changes in clinical situations

• Interpreting – making sense about patient’s signs, symptoms, and assessment findings

• Responding – determining and implementing the nursing interventions necessary based on your interpretation

• Reflecting – reflecting to patient’s responses and evaluating the effectiveness

Thoracic ratio

Anteroposterior diameter of chest should be less than lateral diameter

Barrel chest

• Rounded

• Bulging chest

• Caused by air trapping in the lungs or stiffening of rib cage

Pigeon chest

• Breastbone and ribs grow outward

• Protruding

Funnel chest

• Breastbone and ribs grow inward

• Sunken

Cyanosis

Bluish-purplish discoloration of skin, lips, nails, or mucous membranes caused by lack of oxygen in blood

DKA — Diabetic ketoacidosis

Caused by your body not having enough INSULIN to turn blood sugar into energy

Tail of spence

Armpit hunnie bunchiez

Cerebr—

Cerebrum/brain

Cortex—

Outer layer

Encephal—

Brain

Neuro—

Nerve

Hemi—

Half

—phasia

Speech

—plegia

Paralysis

—ischemia

Restricted blood supply

UTI can make you delirious (delerium) or any infections because,

Any acute infections need meds give side effects (especially at night)