Nursing Unit 1

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callmelauren122001@yahoo.com
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Nursing Unit 1
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2012-09-18 23:26:17
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Unit 1 Nursing
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  1. Nursing process
    • Assesment
    • Nursing Diagnosis
    • Planning
    • Implementing 
    • Evalutaion
  2. Florance Nightingale
    Manipulation of environment of the patient to assist in recovery
  3. Virginia Henderson
    Nursing is independent of the pratice of medicine
  4. Tertiary care
    Higher lever of care, major hospital, surgery
  5. Maslow
    • Pyrimid of human needs 
    • Hierarchy of basic humand needs
    • self 
    • esteem needs 
    • social needs 
    • safty needs 
    • physological needs 
  6. Circulation affects??
    • All aspects of well being
    • No pumping rest of the body suffers
  7. Vital Signs
    Temp, BP, Pulse, Respiration
  8. Pulse OX
    Amount of oxygen in blood 95%-100%
  9. Vital Sign Regulator
    Central Nervous System
  10. Hypothalamus
    Controls Temp
  11. Blood Pressure Controls
    • Medulla
    • Vasoconstriction
    • Vasodiliation
  12. SA node
    Controls pulse
  13. Labiel
    up and down temp
  14. Vital Signs influences 
    age, hormons, race, diet, weight, medications!!
  15. High BP
    Leads to kidney failure
  16. Temp range
    • Oral 98.6-100.4f
    • Axillary 1 degree lower 
    • Rectal 1 degree higher
  17. Geriatric
    Lower than normal temp
  18. Pyrexia
    Fever
  19. Hyperpyrexia
    Above 104 f 
  20. Signs of fever
    flush, warm, pirspiration, lathargic, shivvering, increase BP
  21. Antpyretics
    Tylonel
  22. Five steps to Nursing Process 
    Assesment, nursing Dx, plan-outcome, intervention, evaluation
  23. Types of thermomiters 
    • glass
    • electronic
    • tympanic
    • tape
    • disposable 
  24. Afebrile 
    No fever 
  25. SA node
    creates electrical impulses causing contraction of atria 
  26. Pulse rate adult
    60-100
  27. Cardiac output amount CO
    • 5000ml
    • amount of blood pumped by heart in a min
  28. Stroke volume  SV
    amount of blood ejected from left ventrical with each contraction
  29. Heart rate HR
    the number od times the heart contracts 
  30. Pulse Site 
    • Temporal 
    • Carotic
    • Apical
    • Brachial
    • Radial
    • Femrol
    • Popliteal
    • Dorsalis Pedis
    • Posterior Tibial
  31. Temprol
    About tempal in hair line 
  32. Carotid
    In neck
  33. Apical
    Below nipple on left
  34. Brachial
    Upside of elbow
  35. Radial 
    Upper part of wrist
  36. Femoral
    Groin
  37. Popliteal
    Behind knee
  38. Dorsalis Pedis
    Top of foot
  39. Posterior Tibial
    Behind ankle bone on inside
  40. Pulse assessment
    • Rate-beats per min
    • Rhythm-pattern of the rate
    • Quality-strength of pulse 
  41. TEDS
    Machanical leggings to increase blood flow
  42. Carbon Dioxide 
    Levels stimulate breathing 
  43. Inspiration
    Breathing in diaphram contracts-pulls down
  44. Expiration
    Breathing out diaphragm relaxes moves up
  45. Diaphoretic 
    Exsessive sweating 
  46. General Survey
    Study the whole individual 
  47. Gait
    coordinated arms swinging freely
  48. Assessment Includes 
    • S-severity
    • L-location
    • I-influencing factors
    • D-duration
    • A-associated symtpoms
  49. O,P,Q,R,S,T,U
    • O-onset
    • P-provocative or pallative-what bring it on
    • Q-quality & quantity
    • R-region or radiating
    • S-seversity scale-pain-1-10
    • T-timing-constant ot comes and goes
    • U-understanding  
  50. Skin layers
    • Epidermis 
    • Dermis
    • Subcutaneous layer
  51. Epidermis 
    • no vascular
    • basal cells
    • keratin & melanin layers
    • horney cells-shed every 4 weeks 
  52. Dermis 
    • Connective tissue 
    • Collagen
    • Elastic tissue
  53. Epidermis layer contains 
    • Horney cell layer
    • Basal cell layer 
    • Melanocytes 
  54. Dermis layer contains 
    • Connective tissue
    • Hair follicle 
    • Sebaceous gland
    • Eccrine gland 
    • Apocrine gland 
    • Nerves
  55. Subcutaneous layer contains 
    • Adipose tissue 
    • Blood vessles 
    • Fat 
  56. Vellos Hair 
    Covers most of body very fine 
  57. Terminal hair 
    Darker thicker hair scalp eyebrow
  58. sebaceous glad 
    produces lipid substance through hair follical 
  59. eccrine gland 
    Coiled tubes that open directly to skin surface 
  60. Apocrine gland 
    produces think milky substance and opens at hair follicle 
  61. Pallor color
    • white skin color-fear, anxiety
    • Black people-gray ashy
  62. Erythema
    • red-fever, inflammation
    • Black people-hardened skin warm
  63. cyanosis
    • blue-decreased oxygen in blood 
    • black people-blue lips
  64. jaundice 
    • yellow-high amount og bilirubin
    • Black people-look in eye for yellowness 
  65. Jaundice
    Increase of bilirubin in tissue
  66. Cyanosis
    Bluish color due to lack of oxygen in reb blood cells 
  67. Hypertension
    High BP
  68. Hypotension
    BP below 90 systolic
  69. Primary/essential hypertension
    We DONT know what causes it
  70. Secondary Hypertenion
    We KNOW what causes it
  71. Normal Systolic and Diastolic
    120/80
  72. Prehypertension systolic and diastolic
    120-139/80-89
  73. Stage 1 Hypertension
    140-159/90-99
  74. Stage 2 Hypertension
    160 and up/100 and up
  75. Gerontology
    Study of all aspects of aging and its consequences
  76. Ageism
    When older people are steryotyped
  77. Erikson 
    • Ego integrity vs despair 
    • Life review or reminiscence
  78. Havighurst 
    Maintence of social contacts and relationships
  79. Abnormal Aging
    • Confusion & disorientation
    • Aizhemers
    • Sundowning 
    • Loss of lang skills
    • Poor judgment 
    • Loss of ability to calculate
  80. The 3 D's
    • Dementia
    • Depression
    • Delirium
  81. Type 1 Diabeties 
    • Insulin Dependent 
    • usualy children
  82. Type 2 Diabeties 
    Oral med to help body untilize insulin produced by body
  83. Communication
    TO get Information
  84. Elements of Communication
    • Source (encoder)
    • Message
    • Channel
    • Receiever (decoder)
    • Feedback 
  85. SBAR
    • S-situation
    • B-backround
    • A-assesment
    • R-recommendation
  86. Chaffee
    an active, organized, cognative porcess used to carefully examine ones thinking ans the thinkgin of others
  87. Setterstan and Lauer
    Recognizing an issue exists, analyzing information, evaluating information, and making conclusion
  88. Fowlers position
    Head up 45 degress
  89. Suspine position
    Flat on back not elevated 
  90. Prone position
    On stomach flat 
  91. Sims position
    Laying on side with upper leg bent out for stability
  92. Alopecia
    Loss of hair
  93. Annular
    circular shape to skin lesion
  94. Bulla
    Elevated cavity containing free fluid larger that 1cm diameter
  95. Confluent
    skin lesion that run together
  96. Crust
    extrude left on skin
  97. Erosion
    Shallow depression in skin 
  98. Erythema
    Intense redness of skin
  99. Excoriation
    self inflicted abrasion on skin due to scratching 
  100. Fissure
    linear crazk in skin extending into dermis
  101. Furuncle
    Boil, suppurative inflammatory skin lesiondue to infected hair follicle
  102. Hemangioma
    skin lesion due to benign proliferation of blood vessels in dermis
  103. Keloid
    hypertrophic scar, elevated behoy site of original injury
  104. Maceration
    softening of tissue by soaking
  105. Macule
    flat skin lesion with only a color change 
  106. Nevus 
    mole, circumscribed skin lesion due to excess melanocytes
  107. Nodule
    elevated skin lesion less 1cm
  108. Papule
    skin lesion bigger than 1cm
  109. plaque
    skin lesion in which papules coalasce or come together 
  110. Purpura 
    read purple skin lesion due to broken blood vessels 
  111. Pustule
    elevated cavity containing thick turbid fluid
  112. S.L.I.D.A.
    • Severity
    • Location
    • Influenceing factor
    • Duration
    • Associated Symptoms
  113. O.P.Q.R.S.T.U.
    • Onset
    • Provacation
    • Quality 
    • Region
    • Severity
    • Timing 
    • Understanding 
  114. I.P.P.A
    • Inspect
    • Palpate
    • Percuss
    • Asultaion

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