Finals 1020

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clugger
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272960
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Finals 1020
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2014-05-03 13:47:13
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Finals 1020
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  1. Healthy people 2020
    Purpose and goals
    • Improve health of all Americans
    • 10 year goals
    • High. Quality longer lives free of preventable disease , disability, injury, premature death
    • Health equity, eliminate disparities, improve health of all groups
    • Create social and physical environments that promote good health
    • Promote quality of life, healthy development, healthy behaviors across all life stages
  2. Infection cycle process
    6 elements of infection
    • 1. Infectious agent (bacteria, virus, fungi, protozoa)
    • 2. Reservoir (where germs live and multiply, e.g. humans, food, water, insects, soil, animals, contaminated things)
    • 3.Portal of Exit (how germs leave the body, e.g. respiratory, intestinal, urinary, genitourinary tract, open wounds , blood, body fluids)
    • 4.Transmission ( how germs are spread, e.g. physical contact, droplet, stool, airborne, insects, needle stick, ingestion...)
    • 5.Portal of entry (how germs enter the body, e.g. mucus membrane, respiratory tract, open wounds, intestinal...)
    • 6. Susceptible host (person who gets the infection because unable to fight infection (infants, elderly, ill people, children who are not fully immunized or underdeveloped immune system, people taking drugs that lower immune defense, people under stress...)
  3. endogenous
    "having an internal cause or origin"

    Regarding infection: infectious agent has been in the body already, certain circumstances enable outbreak (e.g. taking antibiotics that weaken good bacteria, weakening of own immune system...)
  4. exogenous
    "growing and originating from outside of an organism"

    E.g. germs that come from outside and enter the body through a portal of entry
  5. Safety
    Standard Precautions
    • Apply to care of all patients
    • 1st tier of protection
    • 1. All blood and body fluids, secretions (except sweat), non-intact skin, mucous membrane may contain pathogens
    • 2.hand hygiene, use gloves, safe injection practices
    • 3.respiratory hygiene, cough etiquette
  6. safety
    Tier 2 precautions
    Used for patients known or suspected to be infected or colonized with infectious agent

    Contact precaution: tier 1 + gloves

    Droplet precaution: tier 1+ gloves+ mask

    Airborne precaution:tier1+ full mask ?+ gown+ linen ventilating system,
  7. VS across the lifespan
    Temperature, pulse, respiration, BP see chart
  8. How to count respirations
    • patient should sit upright
    • Do not tell patient that you are counting the breaths
    • Inhaling + exhaling = 1 count
    • Count for one minute
  9. BP
    normal
    prehypertension
    Stage 1 hypertension
    Stage 2 hypertension
    • Systolic/diastolic
    • Normal: >120/<80
    • Prehypertension: 120-139 / 80-89 (lifestyle changes, meds only with compelling indications e.g. renal disease)

    Stage 1 hypertension: 140-159 / 90-99 (follow up with provider 1-2 month)

    Stage 2 hypertension: >=160 / >=100 (refer for care 1 week or immediately if warranted)
  10. BP
    Cuff sizes
    Width of cuff = 2/3 of upper arm covered (or other extremity

    • alternatively:
    • Cuff width 40% of arm length  encircles 80% of arm circumference

    • Cuff too narrow-> reading too high
    • Cuff too wide -> reading too low

    Error can be as much as 30 mm Hg
  11. What is thermoregulation?
    It is the process of temperature regulation

    • = regulation of heat production and heat loss
    • Balance controlled by hypothalamus (input from sensory receptors in the skin)

    decreasing temperature= peripheral vasodilation -> core warm blood to body surface, sweating, inhibition of heat production


    Increasing temperature= shivering, release of epinephrine-> increase of metabolism, blood vessels constrict-> blood away. From body surface, piloerection (hair stand up)

    + behavioral control e.g. getting a blanket
  12. Ways of taking temperature ?
    • Temporal: most accurate CORE temperature, requires special scanning thermometer, any head covering or side on pillow can produce false high
    • Rectal: represents CORE temperature, for clients who cannot follow directions, or if accuracy is crucial, risk of injury of mucosa especially infants, presence of stool can lead to false reading
    • Oral: simple, convenient, safe if patient can follow instructions, slow, can take up to 8 minutes for accurate reading, mouth closed for several minutes, eating, drinking hot/cold before can cause false reading, do not use if breathing problems, chilling, confused, unconscious, oral injury)
    • Axillary: safe, easy, also uncooperative or unconscious patients, routine measurements, NOT CORE temperature, one of the least accurate sites, Diaphoretic (sweating) can cause false reading, slow -> up to 8 minutes
    • Tympanic membrane: fast (2-5 sec.), also uncooperative and unconscious, special thermometer, prone to caregiver errors, cerulean/earwax can cause false reading, risk of injury, uncomfortable, not so accurate, do not with ear injury or infection
  13. Vital signs
    1.Weight 2.Temperature 3. Pulse
    4.Blood Pressure
    5. Pain  6. Respiration
    • 5. Pain:
    • Ask patient to rate their pain
    • Including patient in pain management
    • Provide prescribed analgesics promptly
    • Assess for response of treatments including level of sedation 30-60 MI Tues after treatment, injectable meds more quickly
    • Reduce anxiety and fear with information and control of pain management


    • 6. Respiration:
    • Respiratory rate: number of times a person breathes
    • Apnea: cessation of breathing, 4-6 minutes-> brain damage or death
    • Respiratory depth/ tidal volume=amount of air taken in, 300-500 ml, special equipment or deep, normal, shallow
    • Respiratory rhythm: regular/ irregular, e.g. Cheyne Stoke (increase + decrease + apnea) and Biota's breathing (irregular respiration and depth, usually shallow,  periods of apnea)
    • Respiratory effort: normal/effortless, dyspnea=labored breathing (often fatigue and fear), orthopnea=difficulty/inability to breath in horizontal position
  14. breath sounds
    wheezes= high pitched, continuous musical sounds, usually on expiration, narrowing of airways, heard without stethoscope (e.g. asthma)

    stridor= piercing, high pitched sound, heard without stethoscope, primarily during inspiration, infants with respiratory distress or someone with obstructed airway

    rhonchi= low pitched, continuous gurgling sounds, secretion in large airways, often cleared through coughing

    crackles=discontinuous sounds usually on inspiration or throughout, fluid in alveoli, high pitched popping, low pitched bubbling, like rubbing strands of hair with fingertips

    stertor=labored breathing with snoring sound
  15. Orthostatic hypotension
    Hypotension that occurs with rapid position change like sitting up after laying in bed
  16. Medication rights
    • 1. Right medication
    • 2. Right patient
    • 3. Right dose
    • 4. Right time
    • 5. Right route
    • 6. Right documentation
    • 7. Right to know
    • 8. Right to refuse
  17. 5. VS= Pain
    Non pharmaceutical interventions
    • massage
    • Application of heat and cold
    • immobilization
    • Cognitive: positive thoughts
    • distraction
    • Relaxation techniques SMR
    • Guided imagery
    • hypnosis
    • Therapeutic touch
    • humor
    • Expressive writing
  18. What is hardiness ?
    • Developing a very strong positive force to live- and enjoy the fight
    • Adapting to change, take initiative in dealing with life situations
    • Some people blossom during times of adversity
    • See themselves as hardy: " I can deal with this."
    • People who thrive despite overwhelming stressors
    • Commitment (involved vs. isolated), control (active vs. passive), challenge (opportunities)
  19. Vulnerable (populations)
    Homeless, poor, ill, disabilities, minorities,

    Developmental stage, other illnesses, risk factors, chronic illness, acute illness,

    "health and illness and illness as a individual experience"
  20. Defense mechanisms
    • Avoidance; "I can't go..."
    • Compensation: "great singer instead of great..."
    • Conversion: "Back pain before exam"
    • Denial: " I can quit any time"
    • Displacement: "kicking the dog"
    • Disassociation:  describes events as if happened to somebody else
    • Identification: taking ideas of somebody feared or respected
    • intellectualization: "I think" rather than "I feel"
    • Minimization: making something less important
    • projection: blaming others
    • rationalization: using of logical sounding excuse
    • Reaction formation: develops opposite trait
    • Regression: behavior of earlier stage of. development
    • Repression: forgetting of painful events
    • Restitution: flowers after beating
    • Sublimation: unacceptable behavior reverted to socially excepted ones
  21. Types of families
    • Traditional : married couple with kid(s)
    • Married adults with no kids
    • Dual earner families
    • Single parent families (28%)
    • Blended and stepfamily: remarried single-> stepfamily, remarried with kids together-> blended family
    • Extended family
    • others
  22. Sensory overload
    Too much input

    Decrease input by darken room, turn off TV, decrease noise,

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