fundamentals exam 4

growth and development begins with

conception; this marks the beginning of prenatal development

stages of life

prenatal, newborn, infancy, childhood, adolescence, adulthood, late adulthood

how is each life stage characterized

by unique physical, cognitive, and emotional changes

cephalocaudal principle

development is head to toe progression

proximodistal principle

development is from the center of the body outward

simple to complex principle

development is in an orderly fashion from simple to complex

continuous principle

development is a continuous process characterized by periods of growth and then periods of slow/steady growth

general to specific principle

development occurs from large to small muscle movement

Large: move arm Small: writing

individualized rates principle

development varied from individual to individual (own growth timetable, own rate of development)

Toddlerhood

12-36 months (time of great physical, cognitive, and psychosocial development)

Adolescents

dramatic physical, cognitive, and psychological growth (a transition period between the onset of sexual maturity and ending growth with movement toward emotional maturity)

young adults

complete physical growth by 20yrs old, all organs are fully developed (brain continues until 25)

Age 65+

fastest growing age demographic in the US

Freudian Theory

adult personality is the result of moving successfully from one psychosexual stage to another and that failure to resolve conflicts or being fixed in any of the stages results in personality changes

Erikson Theory

8 staged of psychosocial development, each stage has a unique crisis that builds on the tasks of previous stage/successful resolution of the crisis at each leads to psychosocial growth and development

Piaget's Theory

theory on cognitive development is based on how an individual acquires knowledge/intellect and cognition over time

Kohlberg Theory

believed that children progressively develop moral reasoning as they gain the ability to think logically and contended that moral development continued throughout the lifespan

Hospice care

administration of medical care to support the client who has a terminal illness, so they can live the last days of their life as best they can for as long as they can

When is hospice care provided

when treatment will no longer cure or control the illness

hospice care was originally offered to

clients with terminal cancer but it has now grown to include any client with a terminal illness

what is admission to hospice dependent on

the client meeting specific criteria and the provider making a diagnosis of life expectancy of fewer than 6 months

what is palliative care

holistic care provided throughout the lifespan for clients experiencing severe medical illness particularly for clients approaching end of life

what is palliative care concentrated on

lessening client suffering at the end of life, current best practices dictates it be implemented earlier in the course of life threatening health events

how is palliative care different from hospice

palliative care is provided while the client is still engaging in curative treatments

what is the terminal phase of a clients life called

actively dying/imminent death

what happens to breathing at the end of life

dyspnea occurs, retention of secretions (death rattle), Cheyen Stokes

what is Cheyen Stokes

irregular respirations that fluctuate between several quick breaths followed by periods of apnea

what pain at the end of life caused by

nerve injury, organs being stretched and compressed and or bone pain

what happens to body temperature do at the end of life

the nervous systems ability to regulate body temp diminishes; causing clients to experience both increased and decreased temps

what is Mottling

happens hours or days before death, with the upper and lower extremities becoming cool to the touch (hearts inability to pump blood effectively)

what happens to vision/hearing at the end of life

clients may experience hallucinations or report hearing and seeing people who have already died

what is dignity

an everyday necessity that is essential to the well-being of all clients (most complaints are associated with a lack of caring)

what is the health care team responsible for when a patient is actively dying

for providing a "good death" for the client

what does a "good death" involve

pain management, planning for death, closure at the end of life

what is postmortem care

physical care performed after death to prepare a body for viewing, autopsy, or release to the funeral home

name somethings that are included in postmortem care

washing the body, accounting for possessions, removing invasive devices (catheter/IV), placing 2 ID tage

organ tissue donation is

voluntary; the donor must give authorization before death or a surrogate can give permission

who is allowed talk about organ donation

professionals who have completed a course

A NURSE IS NOT ALLOWED TO TALK ABOUT IT

what is the nurses role during organ donation

assist family who are dealing with this challenging decision

what is grief

the feelings or reactions an individual has to a loss in one's life

normal grief

uncomplicated; caused by the loss of someone very close, through death or the ending of a relationship

anticipatory grief

grief that is experienced before the expected loss of someone

prolonged grief

complicated; longer than 6 months; significant it can affect the clients ability to function

disenfranchised greif

related to a relationship that does not coincide with what is considered by society to be a recognized or justified loss

Kubler-Ross 5 stages of grief

denial, anger, bargaining, depression, acceptance

Denial

client refuses to believe the truth (helps lessen the pain of loss)

Anger

client trying to adjust to the loss and is feeling severe emotional distress "why me"

Bargaining

involves barging with a higher power by making a promise to do something in exchange for a different outcome

Depression

reality sets in and the loss of the loved one or thing is deeply felt

Acceptance

client still feels the pain of the loss but realizes they will be all right

name some common grief reactions

shock, anger, denial, anxiety, sadness, guilt, relief

what can help a person who is grieving

religious-spiritual rituals

6 rights of med admin

right dose, time, client, route, medication, and documentation

What are additional rights to medication admin

right to refuse, right assessment (med is right for client condition), right education, right response (observe the clients right to the drug)

List the routes of medication administration...

Intramuscular, Sublingual, Intradermal, Subcutaneous, Topical, Enteral

what should you check the medication against to make sure it is correct

the medication administration report upon removal from the dispensing device

what also should be checked for additional medication safety

check drug upon preparation, and check the drug just prior to administration

when does reconciliation occur

anytime the client is transferred from one health care professional to another

what does reconciliation include

reviewing the clients current medication then addressing omissions and dupilcates

what is pharmacodynamics

the study of how a drug works in its relationship to drug concentrations and how the body response

Peak Plasma Levels

when a drug is at its highest concentration not necessarily at its most therapeutic level

Trough Serum Levels

the lowest level if concentration of a medication correlates to the rate of elimination

what is pharmacokinetics

the study of the absorption, metabolism, distribution, and excretion of drugs in the human body

what is the dissolution of medication dependent on

its initial state and route of administration

Oral and enteral routes provide what

much slower rate of absorption than IV

what is distribution of med

the process of drug delivery to the target organ or tissues that occur before metabolism and excretion

what is metabolism and biotransformation

the process of converting a medication to a form that is easily excreted from the body

most drugs are metabolized in the

liver

what also has a small responsibility for drug metabolism

the kidneys and small intestines

the flow or oral meds to the liver

stomach to the small intestine and pass through the small intestine to the hepatic circulation via the mesenteric vein and portal vein flowing into the liver

The first pass effect

results in a lower concentration of the medication in the systemic circulation

what is excretion

the process of removing drugs from the body

Primary organ responsible for excretion

kidneys

what organs perform excretion to a lesser extent

skin, lungs, endocrine glands, intestines

drug toxicity

develops when the body is unable to metabolize and excrete a drug

what should a complete medication order contain

client name, date/time order written, drug name (generic) dosage, route of admin, frequency, indication for use, provider signature

enteral route

administered directly into the gastrointestinal tract (feeding tube)

Topical route

applied to the skin/mucous membranes, eyes, nose, respiratory tract, vagina, rectum

parental route

by injection using a needle and syringe

what is an ADR

an adverse drug reaction and they are unintended and nontherapeutic/ they range from tolerable to irreversible damage

How does the nurse asses the client after/during a ADR

by reviewing any contraindication to reviewing the medication/lab values/vital signs/allergies/potential medication interaction

what is an ADE

adverse drug effect; a life threatening reaction that requires medical intervention to prevent death or permanent damage

what has to be reported to the FDA

ADE; adverse drug effects

what does the FDA do with the report

improve safety outcomes, revise drug labels, when needed withdraw drugs from the market

what is a black box warning

issued on medications that may produce lethal and iatrogenic results

when does a hypersensitivity reaction start

when the body perceives a foreign substance (med) as an allergen, this produces antibodies to counteract the allergen

what are the 4 types of hypersensitivity rxn

Allergic, Cytotoxic, Immune complex, Delay (ACID)

anaphylaxis

severe life-threatening rxn resulting from histamine release producing dyspnea, hypotension and tachycardia

Stevens-Johnson Syndrome (SJS)

develops 1-4 days after the admin of drug: respiratory distress, fever, chills, a diffuse fine rash that may turn into blisters

tolerance (drug)

a diminished response to a drug when the drug is repeatedly used the body adapts

resistance (drug)

the ability of microorganisms or cells to withstand the effects of a drug usually effective against them

what are high alert medications

drugs that are associated with an increased risk for causing considerable client harm when they are administered in error

list high alert medications

insulin, opiates, narcotics, intravenous heparin, injectable potassium chloride

one strategy to reduce the risk of harm

manual independent double checks with 2 nurses verifying identical information before giving the drug

what are time critical medications

when administered either 30 mins before/after the scheduled administered time can cause harm to client (IV antibiotics)

what are non-time critical medications

medications that can be administered between one and two hours early or late without harming the client

LOOK-ALIKE DRUGS

medications that either look or sound similar to one another either by generic or trade name

where are electrolytes found

blood, urine, etc. (body fluids)