NUR 220 Unit 1

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NUR 220 Unit 1
2012-08-23 12:41:50
NUR 220

Unit 1
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  1. Contemporary childbirth is characterized by what 3 things ?
    • 1. family - centered childbirth ( including
    • 2. increased choices including place, caregiver and experiences (analgesia, position)
    • 3. High -tech birthing
  2. In the US , the majority of those over 65 are insured by ________, while the under 65 and in poverty, they are covered by _________.
    • Medicare
    • Medicaid
  3. The two  primary functions of HIPAA are :
    • 1. protect the health insurance coverage of employees and their families if they lose or change jobs
    • 2. addresses the privacy and security of health information
  4. What are the requirements for a professional nurse and their scope of maternity practice?
    • 1. graduate of accredited program
    • 2. successful completion of NCLEX
    • 3. current license as an RN
    • 4. general care of maternal/newborn patients
  5. what are the requirements and scope of practice for a Certified Registered Nurse ( RNC) ?
    • 1. RN with specialty expertise in a particular field of nursing
    • 2. succesful completion of a national certification examination in that field
  6. What are the requirements and scope of practice for a Nurse Practioner?
    • 1. RN with specialized education in either a Doctor of Nursing ( DNP) or masters degree program that functions in an expanded role.
    • 2. can provide : 
    •    * ambulatory care ( woments health center)
    •    * Acute care settings
    • 3. Focus on physical and psychosocial assessment including:
    •    * health history
    •    * physical examination
    •    * diagnostic tests /procedures
  7. What are the requirements and scope of practice for a Clinical Nurse Specialist ( CNS) ?
    • 1. RN with a masters degree and specialized knowledge ina  specific clinical area
    • 2. leadership role to improve patient care both directly and indirectly
  8. What are the requirements and scope of practice for a Certified Nurse-Midwife ?
    • 1. Educated in both Nursing and Midwifery
    • 2. Certified by ACNM ( american college of Nurse-midwives)
    • 3. independently manages the care of women at low risk for complications during pregancy and birth and the care of normal newborns
  9. Name 4 types of Advanced practices nurses  ( APN's)
    • NP
    • CNS
    • CRNA ( certified nurse anesthetists
    • CNM
    • Nurse researcher ( has a PhD )
  10. Which person is most qualified to provide prenatal, intrapartal, postpartal and newborn care for the low-risk childbearing woman?
    a. Acute care clinical specialist
    b. CNM
    c. lay midwife
    d. obstetric NP
    The CNM is most qualified as the overall care of this client
  11. What are the 3 areas of focus of Primary care in community setting ??
    • 1. Health promotion
    • 2. Illness prevention
    • 3. Individual responsibility
  12. What are 2 purposes for Home care ?
    • 1.  Provides additional support and teaching after discharge from acute care settings
    • 2. Allows people to remain at home with conditions that previously would have required hospitalization
  13. As the main providers of home care services , Nurses play a major role in what  4 areas of care?
    • 1. Assessment and therapeutics
    • 2. Communication and teaching
    • 3. problem solving and organization
    • 4. coordination of care with other providers such as:
    •   * lactation consultants
    •   * physical therapists
    •   * social workers
  14. What is the definition of and 4 elements of Negligence in Nursing practice?
    • D: omitting or committing an act that a reasonably prudent person would not omit or commit under the same or similar circumstances.
    • 1. there was a duty to provide care
    • 2. the duty was breached
    • 3. Injury occurred
    • 4. the breach of duty caused the injury
  15. What is the difference between breach of duty by ommission vs commission?
    • breach by ommission: 
    • 1. failure to give a medication
    • 2. failure to assess properly
    • 3. failure to notify physician of change in laboring womans condition

    • Breach by commission:
    • 1. giving the wrong medication
    • 2. placing an infant in the wrong crib
  16. Negligence is determined by comparing the care given to the standard of care.  If the standards were not met, then negligence occured.
  17. Name 5 organizations responsible for standards of care in maternal nursing.
    • ANA ( American nurses assoc)
    • Council of perinatal nurses
    • AWHONN ( Assoc of womens health, obstetrics,and neonatal nurses )
    • AORN ( assoc of operating room nurses )
    • NANN ( national assoc of neonatal nurses )
  18. Name the 3 major areas of informed consent
    • 1. information is clearly and concisely presented in a manner that is understandable to the patient and must include :
    •     * risks and benefits
    •     * probability of success
    •     * significant treatment alternatives
    • 2. Patient must be told the consequences of receiving No treatment /procedure
    • 3. patient must be told they have the right to refuse a treatment or procedure
  19. Name 4 areas of Maternal-fetal conflict that may arise and pose ethical dilemmas for the nursing staff.
    • 1. termination of pregnancy
    • 2. Embryonic and fetal research
    • 3. reproductive assistance
    • 4. Cord blood banking
  20. Abortion is defined as a pregnancy that is terminated before ______ weeks gestation  or if unattainable, a fetus that weighs less than _______ g.
    20 weeks or 500 grams
  21. Name 3 types of reproductive assistance.
    • 1. Therapeuitic insemination  ( TI )
    • 2. Assisted Reproductive technology ( ART)
    • 3. Surrogate childbearing
  22. How is Therapeutic insemination accomplished?
    sperm from a husband, donor , partner is deposited into the woman
  23. Define ART
    • any fertility treatment where BOTH the egg and sperm are handled
    • 1. invitro fertilization and embryo transfer  ( IVF -ET)
  24. What are  common complications of ART ?
    • 1. Multifetal pregnancy which increases chances of :
    •  * miscarriage
    •  * preterm birth
    •  * neonatal morbidity
    •  * neonatal mortality
    •  * C -section birth
  25. Birth rate  is :
    number of live births per 1000 people
  26. Infant mortality rate is :
    number of deaths of infants under 1 year of age per 1000 live births in a given population.
  27. Neonoatal mortality rate is:
    number of deaths of infants less than 28 days of age per 1000 live births
  28. post neonatal mortality is figured :
    number of deaths of infants between the ages of 28 days and 1 year
  29. perinatal mortality is
    includes BOTH  fetal (death in-utero 20 or more weeks gestation )  and neonatal deaths per 1000 live birhts
  30. Maternal mortality rate is:
    the number of deaths from any cause related to , or aggravated by pregnancy or its management during the pregnancy cycle
  31. Statistical data can be used by Nurses to:
    • 1. determine at-risk populations
    • 2. assess the relationship between specific factors
    • 3. establish databases for specific patient populations
    • 4. determine levels of care needed by particular patient populations
    • 5. evaluate the success of specific nursing interventions
    • 6.estimate staffing and equipment needs of units
  32. Evidence based practice is :
    Nursing care in which all interventions are supported by current, valid research or other forms of evident such as committee opinions or task force recommendation
  33. What are the 3 basic competencies in evidence based practice for nurses ??
    1. recognize which clinical practices are supported by sound evidence, which have conflicting findings  and which have no evidence to support their use

    2. to use data in their clinical work to evaluate outcomes of care

    3. to appraise and integrate scientific bases into practice
  34. Acupuncture is :
    technique that uses fine needles to stimulate pressure points
  35. Ayurveda is :
    Classic system of Hinu medicine aimed at helping people lead healthy lives
  36. Biofeedback is:
    Technique designed to help individuals learn to control their physiologic responses
  37. Chiropractic therapy is:
    System that uses concepts of manipulation to address certain health problems
  38. Homeopathy is :
    Healing system that uses the concept of like to cure like
  39. Traditional chinese medicine
    system of medicine based on the balance of energy or chi
  40. Naturopathy is:
    system that uses a variety of natural approaches to preventing and treating problems.
  41. Name 7 types of alternative and complementary therapies
    • Acupuncture
    • Ayurveda
    • Biofeedback
    • Chiropractic
    • Homeopathy
    • Naturopathy
    • Traditional Chinese medicine
  42. Amenorrhea
    Absence of menses
  43. Hypomenorrhea
    abnormally short menstrual cycle
  44. Menorrhagia
    Excessive menstrual flow
  45. Dysmenorrhea
    painful menses
  46. Hypermenorrhea
    abnormally long menstrual cycle
  47. Metrorrahagia
    Bleeding between periods
  48. Define Family power and how it affects health care decisions
    • Family power: individual or group who possesses the potential or actual ability to change teh behavior of other family members .
    • This person/groups attitude may affect how a patient responds to a healcare provider, a diagnosis, treatments , or health teaching.
  49. Culture
    beliefs,values, attitudes and practices that are accepted by the population , a community or an individual . It is learned, not genetic
  50. Ethnicity
    social identity that is associated with shared behaviors and patterns . They include: family structure, religious affiliation, language, dress ,eating habits , health behaviors
  51. Acculturation
    the process by which people adapt to a new cultural norm
  52. Assimilation
    when a group completely changes their cultural identity to become part of the majority culture
  53. Complimentary therapy
    any procedure or product that is used together with conventional medical treatment
  54. Alternative therapy
    used in place of conventional medicine
  55.  4 Benefits of alternative therapy:
    • Emphasis on prevention/wellness
    • Emphasis on healing vs cure
    • Noninvasive approaches
    • cost and access
  56. 4 risks of alternative therapy
    • Lack of regulation and standardization
    • lack of research
    • inadequate training and certification
    • financial and health risks of unproven methods
  57. External genital structures of a fetus are the same for male/female until the end of week _______?
    Nine (9)
  58. Differentiation of external genitals is complete by week ______ ?
  59. Name 4 signs of female puberty
    • Broadening of hips
    • budding of breasts
    • appearance of pubic and axillary hair
    • onset of menstruation ( menarche)
  60. name 4 characteristics of male puberty
    • linear growth spurts
    • increase in size of genitals
    • appearance of pubic , axillary and facial hair
    • deepening of voice
  61. T or F
    All oocytes are formed during fetal development and present in full at birth.
  62. Puberty is initiated by the maturation of the ________-_______ - ________ complex in addition to the input from the CNS.
  63. Puberty is initiated when the CNS stimulates the ________ to synthesize and release _________ ?
    • Hypothalamus
    • GnRH ( gonadotropin-releasing hormone)
  64. What is the sequence of events in the onset of puberty ?
    • CNS  stimulates hypothalamus to release GnRH
    • GnRH is transmitted to the Anterior pituitary where it causes synthesis of LH and FSH
  65. Name 8  hormones that are responsible for puberty and/or development of secondary sex characteristics
    • GnRH
    • LH
    • FSH
    • ACTH
    • GH
    • Thyroid
    • Estrogen
    • testosterone
  66. Name 3 hormones that can disrupt the onset of puberty in too high/low levels.
    • ACTH
    • TH
    • GH
  67. Internal and external female reproductive organs develop and mature in response to estrogen and progesterone
  68. Female external genitals are called the _______ ?
  69. Vulva:
    Mons pubis
    labia ( majora and minora)
    urethral meatus
    vaginal vestibule
    perineal body
  70. This part of the vulva generally gets cut or tears during  vaginal delivery.
    Perineal body
  71. the mons pubis is responsible for protection of the pelvic bones, especially during sex
  72. The labia majora :
    protection of internal structures
    stratified squamous epithelium
    contain hair follicles and sebacious glands
    merge to form the posterior junction of the perineal skin
  73. The dartos muscle sheath is responsible for the wrinkled appearance of the labia majora as well as sensitivity to heat/cold
  74. the labia minora converge near the anus, forming the fourchette
  75. The labia minora:
    * shiny
    * no hair follicles
    * rich in sebacious glands
    * composed of erectile/involuntary muscle tissue
  76. The labia minora secretions serve to:
    • lubricate and waterproof the vulvar skin
    • provide bacteriacidal properties
  77. the size of labia minora increase after puberty and decrease after menopause in response to what hormone ?
  78. Clitoris is made of __________ tissue and is partly covered by the fold of skin called the _________
    • erectile
    • prepuce ( clitoral hood)
  79. The clitoris is very rich in blood and nerve supplies and is the primary erogenous zone for women.
  80. The clitoris secretes ____________. ( pheremone )
  81. Urethral meatus is located ___ to _____ cm beneath the clitoris in the midline of the vestibule
    1 to 2.5 cm
  82. The paraurethral glands are also called __________ and serve to lubricate the vaginal vestibule to facilitate sexual intercourse
    skene's glands
  83. The vaginal opening can also be called the _________ and is the border between the exterior and interior genitals
  84. Hymen: thin, elastic collar or semicollar of tissue that surrounds the vaginal opening.
  85. Bartholin's glands ( vulvovaginal glands) are located external to the hymen at the base of the vestibule and secrete a clear, thick, alkaline mucous that facilitates sperm motility
  86. Perineal body is
    wedge shaped mass of fibromuscular tissue ( appx 4 x 4 x 4 cm) between the lower part of the vagina and the anus
  87. The superficial part of the perineal body between the vagina and the anus is called the ________
  88. This tissue is most likely the site of injury, tearing or episiotomy during vaginal delivery
  89. The anterior wall of the vagina is appx 2.5 cm shorter than the posterior wall , due to the projection of the cervix into the anterior wall.
  90. Vaginal msrmts:
    Posterior wall _________
    Anterior wall _________
    • Post: 7-10 cm
    • Ant: 6-8 cm
  91. the upper part of the vagina is called the _________  ______
    vaginal vault
  92. The recess or hollow area around the cervix is called the
    vaginal fornix
  93. what 7 structures can be palpated through the thin walls of the vaginal vault?
    • Uterus
    • distended bladder
    • ovaries
    • appendix
    • cecum
    • colon
    • ureters
  94. The upper fourth of the vagina is separated from the rectum by the _______ __ _________, and is posterior to the cervix
    Pouch of douglas
  95. The purpose of the vaginal fornix is ________
    allow pooling of semen when woman lies on her back after sex ( increases chances of pregnancy)
  96. the rugae of the vagina have the purpose of _______________
    stretching to accomodate birth of baby and during coitis
  97. the principle muscle responsible for closing the vagina is the ________ _____
    Levator Ani
  98. The thin band of striated muscle at the lowest extremity of the vagina is the _____ ______
    sphincter vaginae
  99. a rich blood supply to the vagina is necessary to maintain a high glycogen content in the epithelial cells and to nourish the underlying musculofascial layer ( where the vaginal vault attaches to cervix )
  100. The normal pH for the vagina ( during reproductive years) is ______ to ______
    4 - 5
  101. The acidic environment of the vagina is maintained by a symbiotic relationship between:
    Lactic acid producing Bacilli ( Doderlein's bacillus or lactobacillus) and the vaginal epithelial cells that contain glycogen ( which the bacilli break down into lactic acid)
  102. The amount of glycogen available in the vaginal epithelial cells is regulated by the _________ _______
    ovarian hormones