NURS 2001 Final Exam Outline

Flashcards of key vocabulary terms and definitions from NURS 2001 lecture notes, covering topics such as asepsis, activity, safety, medications, skin and wound care, urinary and bowel elimination, cardiovascular function, oxygenation, sensory function, the nursing process, health disparities, communication, and fluid and electrolyte balance.

Infectious agent

Bacteria, viruses, fungi, parasites

Reservoir

People, animals, soil, food/water, inanimate objects

Portal of exit

Resp, GI/GU, Bld, tissues, wounds

Means of transmission

Direct, indirect, airborne

Susceptible host

Immunocompromised and the extremes

Contact: Isolation

MRSA, C. Diff; PPE: Mask, Gloves, Gowns, Mask and eyewear; Get their own equipment/room to prevent spread; Wash hands with soap and water to kill the bacteria that is resistant to sanitizer

Droplet: Isolation

Rubella, mumps, diphtheria, adenovirus; PPE: Gloves, mask, eyewear; Teach cough etiquette; 3 Feet away from the patient!

Airborne: Isolation

Measles, chicken pox, herpez zoster, TB; PPE: Gloves, gowns, respirators, eyewear; Negative pressure room; Only transport pt when necessary

Fowler’s Position

Head of bed is elevated 45-60 degrees. PROMOTES cardiac and respiratory functioning AND eating, conversation, urinary and intestinal elimination.

Supine (dorsal) recumbent position

Patient is laying flat on their back with heads and shoulders slightly elevated with pillows. Contraindicated in spinal anesthesia or surgery on the spinal vertebrae.

Side-lying or lateral position (Sims’s)

Allows for an alternative for supine and relieves the tension from the sacrum, heel, and scapulae.

Prone

Lies on the abdomen with the head turned to the side. This position helps prevent flexion contractures of the hips and knees. Covid patients go on prone positions. Contraindicated for people with spinal problems.

Walker

Keep all 4 points on the floor! DO NOT lift or twist ⇒ falls! Push up from the chair NOT the walker

Cane

Hold on the strong/unaffected side! Move cane with your weak/affected side. UP with good leg! DOWN with bad leg

Crutches

Hold 1-2 inches under axilla; NEVER right under. Strength should come from the arms/forearms! NEVER swing through

Restraints

Physical or chemical restraints are used to limit a patient’s freedom and movement.

device Ambularm

Sensors that detect when a patient is going to start walking

Rights of medications

Right medication, pt, dose, route, time, reason, assessment data, documentation, response, education, refuse

Intradermal injection

TB/allergies -wheal in forearm

Subcutaneous injection

Insulin/heparin - Slower absorption in arms, abdomen, thighs

Intramuscular injection

Influenza - optimal absorption in. deltoid, vastus lateralis, ventrogluteal NOT DORSOGLUTEAL

Stage I wound

Non blanchable redness; can be warm/cool or firm/soft

Stage II wound

Partial thickness loss of dermis + shallow open ulcer or blister filled with serum that are closed or ruptured

Stage III wound

Full thickness tissue loss + FAT is visible; could have slough may have tunneling

Stage IV wound

Muscle, bone, tendon are exposed!

Unstageable wound

Base of ulcer covered by slough and/or eschar; we don't know the staging until we debris

Deep tissue injury (DTI)

Persistent nonblanchable deep red wound or blood filled blister; pain, edema, temp changes after the color changes

Function of skin

Temperature regulation, fluid balance, protection, sensation, and vitamin D synthesis

Intermittent catheter

Stays in the bladder; only for the time of relief. Sterile technique

Indwelling urethral catheter

Relieves urinary retention, obtaining sterile urine specimen, emptying bladder for surgery, monitoring critically ill patients, increasing comfort for patients. Bag should be less than 2/3

Supreapubic catheter

Surgical procedure. NOT through bone

External catheters

Condom catheter + purewick

Diuretics

Prevent reabsorption of water and certain electrolytes in tubules. turns urine pale yellow

Transient urinary incontinence

Appears suddenly and lasts 6 months or less

Mixed urinary incontinence

Urine loss with features of two or more types of incontinence

Overflow urinary incontinence

Overdistention and overflow of bladder

Functional urinary incontinence

Caused by factors outside the urinary tract

Reflex urinary incontinence

Emptying of the bladder without sensation of voiding

Total urinary incontinence

Continuous + unpredictable loss or urine

Stress urinary incontinence

Involuntary loss of urine related to an increase in intra-abd pressure

Urinary retention

Pt is holding in urine preventing the release of bladder muscle! causes UTIs, discomfort, and abdominal distention.

Clay/white stool

Decreased bile or post-barium

Black/tarry stool

Meds + upper GI bleeding

Red stool

Lower GI bleeding or diet

Pale stool

Fat malabsorption

Hard/dry stool

Dehydration, decreased GI motility/mobility, stress + environment

Narrow/pencil shaped stool

Rectal outlet obstruction

Pungent Aroma stool

Infection + blood

Pus stool

Bacterial infection

Mucus stool

Inflammation

Parasites stool

Parasitic infection

Blood stool

Gi bleeding

Steatorrhea stool

Fat malabsorption

PAD/PVD: Circulatory Disease S&S

Claudication (pain to muscles), Weak/absent pulses distally, sores/wounds poor with poor healing, poor nial growth, ED

Deep Venous Thrombosis causes and S&S

Prolonged sitting, bed rest, dehydration, post partum, estrogen/OC, leg surgery, trauma; S&S: leg pain, swelling, erythema, low grade fever

Hypertension

Intermittent or sustained elevation in diastolic or systolic BP d/t obesity, genetic, renal dz, life-style, salt intake, increased sympathetic activity

Coronary Artery disease

Progressive buildup of atherosclerotic plaque in the coronary arteries

TIA/mini stroke

Temporary blockage of blood flow to the brain (Ischemic stroke is impending)

Ischemic Stroke

Plaque or clot, Afib is a common cause

Hemorrhagic Stroke

Bleeding in the brain (Subarachnoid or intracerebral)

Dysrhythmia/Arrhythmia

Disturbances to the rate of the heart; fatigue, heart palpitations, trouble breathing, dizziness

Myocardial Ischemia

Decreased oxygenation to the heart

Angina

Temporary imbalance b/w oxygen demand/supply causing chest discomfort

Myocardial Infarction

Acute coronary syndrome, death of heart tissue d/t lack of oxygen

Heart Failure

Decreased ability of the heart to pump

Arteriosclerosis

Thickening of the arterial wall

Atherosclerosis

Formation of plaque within the arterial wall

Circulation

The flow of blood throughout the heart and blood vessels

Perfusion

Blood flow to a capillary bed to provide nutrients and oxygen to tissues and organs

Systole cardiac cycle

Ventricle contraction

Diastole cardiac cycle

Ventricles relaxed, blood flow/filling

Sinoatrial (SA) node

Fires at 60-100 bpm; the primary pacemakers

LSHF (Left Sided Heart Failure) and S&S

Ineffective left ventricular contraction leads to pulmonary congestion or edema and decreased cardiac output. fluid backs up into left atrium then lungs; S&S: Bibasilar crackles and pulmonary edema/congestion, oliguria, weakness, breathlessness, cough, tachycardia

RSHF (Right Sided Heart Failure) and S&S

Left ventricular failure, right ventricular MI, or pulmonary HTN, PE. Right ventricle cannot clear completely. Leads to peripheral edema due to increase pressure in venous system; S&S: Edema and weight gain, JVD, hepatomegaly, Ascites, weakness

Eupnea

Normal breathing

Bradypnea

Less <12 breaths per minute

Tachypnea

> 20 breathes per minute

Apnea

Periods of no respirations

Hyperventilation

Increased rate and depth (trying to blow off CO2)

Cheyne-stokes breathing

Periods of inspiration and expiration with apnea

Kussmauls breathing

Deep and rapid breathing pattern

Hypoxia

Inadequate amount of oxygen available to the cells

Pneumonia

Infection of the lungs by bacteria, fungi, viruses; impairs gas exchange. Edema is triggered in small airways when there is debris or a solid in there

COPD: Asthma

episodic airway obstruction and hyper responsiveness of the airway due to multiple stimuli

Status Asthmaticus

Severe life threatening airway obstruction leads to arrest

Chronic Bronchitis

Excessive production of mucus (cough for at least 3 months for 2yrs) linked with pollutants and cigarette use

Emphysema

Altered lung compliance (abnormal permanent dilation of airspaces); genetic and behavioral

Proprioception

recognition of body position

Paraplegia

Paralysis on the lower half of the body. Spinal cord injury below cervical level

Quadriplegia

Paralysis of all 4 limbs (maybe torso); Spinal injury at cervical level. Affects Breathing!

Hemiplegia

Paralysis of one side of the body. Common for stroke or brain injury

Nursing assessment + diagnosis

Gather data and utilize it to find the issue the pt is experiencing. to then later find a solution

Independent Nursing Interventions

Activities nurses are licensed to initiate based on their knowledge/skills

Dependent Nursing Interventions

Activities carried out under physician order

Collaborative Nursing Interventions

Activities Carried out in collaboration with other health team members

Cognitive Nursing Evaluation

Asking patient to repeat information or apply knowledge

Psychomotor Nursing Evaluation

asking patient to demonstrate new skill

Affective Nursing Evaluation

Observing patient behavior and conversation

Physiologic Nursing Evaluation

Using physical assessment skill to collect and compare data

Illness

Unique response of a person to a disease; an abnormal process involving a changed level of functioning