Exam 2 Review - Nursing Concepts and Assessment

Flashcards covering essential vocabulary, laboratory parameters, physical assessment concepts, and mobility intervention topics for Exam 2 based on the provided review outline.

Exam 2 Format

A 60-minute exam comprising 50 questions in total: 40 multiple choice, 5 select all that apply, and 5 dosage calculations, covering Module 2 and Module 3.

Surgical Incision Assessment

The clinical evaluation of a surgical cut, including inspecting wound edges, closure materials (sutures, staples), surrounding skin integrity, and presence of drainage.

Primary Intention Healing

A type of wound healing where skin edges are neatly approximated with clean surgical margins, resulting in minimal tissue loss and low scar formation.

Secondary Intention Healing

A wound healing process where edges cannot be approximated, requiring the wound to fill in with granulation tissue and heal from the inside out, often seen in pressure injuries.

Tertiary Intention Healing

A delayed primary closure process where a wound is purposely left open for several days to allow infection or edema to resolve before surgical closure.

Pressure Injuries

Localized skin and underlying soft tissue damage evaluated by clinical assessment, staging, identification of risk factors, and implementation of preventive interventions.

Braden Scale

An assessment instrument used to quantify a patient's risk of developing pressure injuries by scoring parameters such as sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

Albumin and Total Protein Labs

Laboratory assessments specified in Pagana-Pagana-Pagana used to evaluate protein intake, visceral protein stores, hepatic synthetic function, and tissue healing capacity.

H&H and RBC Labs

Laboratory evaluations of Hemoglobin, Hematocrit, and Red Blood Cells used to determine oxygen-carrying capacity, blood volume, and clinical signs of anemia or blood loss.

Calcium (Ca) and Phosphorus (P) Labs

Laboratory blood tests assessed alongside total protein and blood counts to monitor mineral homeostasis, bone health, and metabolic balance.

Glasgow Coma Scale

A standardized neurological scoring tool used to evaluate level of consciousness based on motor, verbal, and eye-opening responses.

Visual Acuity

The clinical measurement of the clarity and sharpness of a patient's vision during visual assessment.

Accommodation

The adaptive process by which the optical lens changes focus between distant and near objects during visual examination.

PERRLA

A mnemonic used in visual/neurological assessment meaning Pupils Equal, Round, Reactive to Light, and Accommodating.

Drains

Surgical devices placed within or around a wound site to promote wound healing by evacuating accumulated fluids, blood, or exudate; requiring ongoing assessment of output volume and characteristics.

Dressings

Protective coverings applied to surgical or chronic wounds to absorb exudate, prevent contamination, and support tissue healing.

Aging Skin Assessment

The clinical examination of age-related integumentary changes, such as reduced elasticity and thinning skin, to plan appropriate skin-protective interventions.

Ear Assessment

Physical inspection and testing of the internal and external ear structures and auditory functional status as described in Jarvis.

Dehiscence

The unintended separation or splitting open of previously closed surgical incision layers.

Evisceration

A surgical emergency involving the complete separation of wound layers accompanied by the protrusion of internal visceral organs.

Debridement

The medical or surgical removal of devitalized, non-viable, or infected tissue to promote healthy tissue repair.

Wound Infection

Invasion of wound tissue by pathogenic organisms, identified by localized warmth, redness, swelling, purulent drainage, pain, or systemic signs.

Balance, Stability, and Alignment

The assessment of body posture, center of gravity, and musculoskeletal alignment necessary to preserve equilibrium during movement and positioning.

Osteoporosis

A metabolic bone disorder marked by loss of bone density and mass, leading to structural fragility and higher fracture risk.

Muscle Strength Assessment

The evaluation of active muscle contraction and power applied against physical resistance or gravity.

Active vs. Passive Range of Motion (ROM)

Active ROM refers to joint movement performed entirely by the patient; Passive ROM occurs when an examiner moves the joint without patient muscular exertion.

Contracture

A permanent anatomical shortening and stiffness of a muscle or joint tissue that restricts normal range of movement.

Deep Vein Thrombosis (DVT)

The formation of a blood clot within a deep vein, requiring assessment and preventive interventions such as mechanical compression, prophylactic medication, and early mobility.

ADLs

Activities of Daily Living, representing basic functional self-care tasks including feeding, bathing, dressing, grooming, and mobility.

Positioning Patients

The nursing practice of placing patients in correct body alignments to reduce pressure, improve respiratory function, and prevent joint contractures.

Neurovascular Assessment

Evaluation of distal nerve function and peripheral circulation, assessing color, temperature, capillary refill, peripheral pulses, sensation, and motor response.

Erythropoiesis

The biological process responsible for the formation and production of red blood cells.

Assistive Walking (Crutch, Cane, Walker)

Mobility techniques using devices such as crutches, canes, or walkers to assist patient balance, gait stability, and weight-bearing management.

Potter and Perry Textbook Chapters

Assigned readings covering Chapters 30, 38, 39, and 48 for Module 2 and 3 foundational concepts.

Jarvis Physical Assessment Scope

Physical examination reference material covering Neuro, Head, Eyes, Ears, Nose, Mouth, Throat, Musculoskeletal, and Skin, Hair and Nails.