FPCC - Exam 3 Questions and answers FPCC - Exam 3 Questions and answers, Exams of Nursing

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FPCC - Exam 3 Questions and answers transdermal, intradermal, sub, into joints CORRECT ANSWERS✅ 4 routes that local and topical anesthesia’s can be administered through change in heart rate, burning, itching, rash, decreased sensation CORRECT ANSWERS✅ 5 side effects/precautions for local/topical anesthesia massage, TENS, heat and cold, acupuncture CORRECT ANSWERS✅ 4 types of cutaneous stimulation that are non-pharmacological interventions use a pain scale, reassess signs and symptoms of pain, vital signs, evaluate pain impact on physical and social function, evaluate family/friend's observations of patient pain, ASK how much or if pain prevents from ADLs CORRECT ANSWERS✅ 6 ways to evaluate pain management cutaneous CORRECT ANSWERS✅ this is superficial pain, arising from subQ tissue or skin (ex. paper cut, hot to touch) visceral CORRECT ANSWERS✅ this pain is caused by the stimulation of deep, internal pain receptors. Can be described as a tight pressure or cramping (ex. menstrual cramps, bowel disorders, labor pain, organ cancer) FPCC - Exam 3 Questions and answers deep somatic CORRECT ANSWERS✅ this pain originates in ligaments, tendons, nerves, blood vessels, and bones. Localized and described as achy or tender. (ex. fracture, sprain, arthritis, bone cancer) psychogenic CORRECT ANSWERS✅ this pain is believed to originate from the mind; patient perceives pain despite no physical cause that can be identified. visceral, somatic CORRECT ANSWERS✅ two types of nociceptive pain are ___ and ___. neuropathic CORRECT ANSWERS✅ type of pain that is a complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of stimuli. acute CORRECT ANSWERS✅ which type of pain is protective- acute or chronic? whenever you take full set of vitals (routinely) CORRECT ANSWERS✅ when should pain be assessed on patient? patient self report CORRECT ANSWERS✅ what is the most reliable way to assess patient pain? FPCC - Exam 3 Questions and answers tracheal deviation and unilateral chest expansion CORRECT ANSWERS✅ 2 things you may see if patient experiences atelectasis due to a mucous plug or secretion block. (no ventilation) parathyroid CORRECT ANSWERS✅ With immobility, ___ gland issues are common due to hypercalcemia and there's an increased release of Ca from bones. footdrop CORRECT ANSWERS✅ joint contracture of immobility when the foot permanently drops into plantar flexion UTI CORRECT ANSWERS✅ during immobility, urine can pool in the pelvis when laying down and increases the risk for developing ___ kidney stones CORRECT ANSWERS✅ another name for renal calculi is disease (disorders and injuries), environment (workplace, school, community, family support), medical therapies (bed rest, splints/casts, restraints) CORRECT ANSWERS✅ 3 categories to assess when assessing someone's mobility/immobility. sprain CORRECT ANSWERS✅ this is a torn ligament FPCC - Exam 3 Questions and answers low, wide CORRECT ANSWERS✅ you want a patient with a ___ center of gravity and a __ base of support flexibility, aerobic, resistance CORRECT ANSWERS✅ 3 types of exercise to encourage to your patients 1-1.5 CORRECT ANSWERS✅ daily protein intake should be ___-___ g/kg of body weight a day. high protein, high calorie, vitamins B and C CORRECT ANSWERS✅ 3 dietary implementations to encourage in an immobile patient to aid METABOLIC function chest physiotherapy, HOB up, hydrate (2500mL/day) CORRECT ANSWERS✅ 3 respiratory implementations to encourage in an immobile patient monitor color and amount of urine, acidify urine (cranberry juice), maintain positive fluid balance, assist to void on hourly rounds CORRECT ANSWERS✅ 4 GU elimination implementations to encourage in an immobile patient clock in room, open shades during day, TV on, involve patient CORRECT ANSWERS✅ 4 psychosocial implementations to encourage in an immobile patient FPCC - Exam 3 Questions and answers SCDs, 8 CORRECT ANSWERS✅ These are used to PREVENT venothrombic events, but not as a therapy; should change every ___ hours. demineralization CORRECT ANSWERS✅ the goal of musculoskeletal maintenance with immobile patients is reducing ____. hand splint CORRECT ANSWERS✅ these are used if patient gets hand contractures, but should NOT use a washcloth. xerostomia CORRECT ANSWERS✅ excessively dry mouth smoking, b12 and zinc deficiency CORRECT ANSWERS✅ 3 nutritional status indicators that can cause a loss of gustatory function anosmia CORRECT ANSWERS✅ sense of smell is lost yawning, sleepy, preoccupied with somatic complaints, decreased attention span, difficulty concentrating, problem solving, and remembering, hallucinations, tearful, irritable, depressed CORRECT ANSWERS✅ 8 CMs of sensory deprivation FPCC - Exam 3 Questions and answers Patient will advance the right crutch, then advance the left foot. Then advance the left crutch, then advance the right foot. This is not done simultaneously. Logrolling CORRECT ANSWERS✅ special turning technique used when the pt's spine must be kept in straight alignment You will need at least two nurses for this procedure, more if the patient is large. Logrolling moves the patient's body as a unit. One nurse is positioned at the level of the patient's head. The other staff members are distributed along the length of the patient. Everyone must move the patient in unison. Trapeze bar CORRECT ANSWERS✅ Triangular- shaped device that is attached to an overhead bed frame. The patient can use the base of the triangle as a grip bar to move up in bed, turn, and pull up in preparation for getting out of bed or getting on & off the bed pan. Trochanter rolls CORRECT ANSWERS✅ made from tightly rolled towels, bath blankets, or foam pads. They are placed snuggly adjacent to the hips & thighs *to prevent external rotation of the hips* FPCC - Exam 3 Questions and answers Transfer board CORRECT ANSWERS✅ a wood or plastic device designed to assist with moving patients. 1. Place the board under the patient on the side in which he/she will be moved. 2. It is best to use a draw sheet to slide the patient across the board. *Also used by patients with long-standing mobility problems to increase their independence* Mechanical lift CORRECT ANSWERS✅ hydraulic device used to transfer patients. Place a fabric sling under the patient & attach chains or straps from the sling to the lifting device. -Especially useful when providing care for *obese & immobile patients.* -Often seen in home care. -Most position patients in a *seated position, ideal for sitting them in a chair.* -Some have the patient *supine, maybe to transfer patient from bed to stretcher, or have them lifted up while we make their bed.* FPCC - Exam 3 Questions and answers Transfer belt CORRECT ANSWERS✅ a heavy belt several inches wide that is used to *facilitate transfer or provide a secure mechanism to hold the patient when ambulating* -Apply belt *around patient's abdomen*, close to their center of gravity. -The belt may have external grip holds, or you may grip the entire belt with your hand. Active range of motion (AROM) CORRECT ANSWERS✅ actively moving own extremity through ROM like extension, flexion. Want to encourage & teach clients to keep moving. Passive range of motion (PROM) CORRECT ANSWERS✅ movements of the joints through their range of motion *by another person* -support above & below the joint -take joint to point where pt starts to feel resistance -avoid pain. if pt feels pain, stop -slow & gentle movements FPCC - Exam 3 Questions and answers Lateral recumbent position CORRECT ANSWERS✅ side-lying with legs in a *straight* line Oblique position CORRECT ANSWERS✅ patient is on side with the top hip & knee flexed, however the top leg is *behind* the body. Places less pressure on the trochanter than the lateral position. Prone position CORRECT ANSWERS✅ patient lies on the abdomen with his head turned to one side. -Only position that allows full extension of the hips & knees. -Also, allows secretions to drain freely from the mouth. What are the dangers of the prone position? CORRECT ANSWERS✅ -Most difficult to move a frail or unconscious patient to this position, because it requires the greatest amount of manipulation to position the patient appropriately. -Creates lordosis (inward curving of the spine/back) and rotation of the neck, so this is not good for patients with cervical or spine problems. FPCC - Exam 3 Questions and answers -Inhibits chest wall expansion so not good for patients with cardiac or respiratory difficulty. *Only use for short periods of time.* Sim's position CORRECT ANSWERS✅ semi-prone position -Lower arm is positioned behind the patient and the upper arm is flexed. -The upper leg is more flexed than the lower leg. -This facilitates drainage from the mouth and limits pressure on the trochanter and sacrum. Sim's position is ideal for ____ CORRECT ANSWERS✅ enemas or a perineal procedure. Supine position CORRECT ANSWERS✅ dorsal recumbent position. -Patient lies on his/her back with head and shoulders elevated on a small pillow. The spine is aligned and the arms & hands rest comfortably at the side FPCC - Exam 3 Questions and answers Technique for moving patients (3) CORRECT ANSWERS✅ 1. Use a friction reducing device to move the patient if the patient can assist with movement. Use a full body swing if patient cannot assist. 2. Remove the pillow, have patient flex his/her neck, fold her arms across the chest, & place feet flat on the bed. 3. Have a nurse on each side of the bed and on the count of three, have him/her push off with their heels as the nurses shift the weight forward. Technique for turning the patient (3) CORRECT ANSWERS✅ 1. Use a friction- reducing device and draw sheet to move the patient. 2. Position a nurse on each side of the bed, and place the patients arm & leg to the side you are going to roll them towards. 3. One nurse places hands on the patient's shoulders while the other places on the patients hips. Each nurse will roll the patient in the intended direction. FPCC - Exam 3 Questions and answers 9. Two nurses: one nurse stands on each of the patient's sides, grasping hold on the transfer belt. 10. *Slowly guide the patient forward, observe for signs of dizziness or fatigue.* 11. Have a goal or outcome to how far you want the patient to walk. Single ended cane with a half circle handle is used for a patient who CORRECT ANSWERS✅ needs minimal support and is able to negotiate stairs. Single ended cane with a straight handle is used for patients with CORRECT ANSWERS✅ hand weakness with good balance. Multipronged cane/quad cane CORRECT ANSWERS✅ 4 feet to it. Patient will *use cane on strong side.* The cane goes forward with the weaker side to promote a balance. It should fit at the *top of the hip with a 30-degree angle flexion* Walkers CORRECT ANSWERS✅ *should be at hip level, with 30 degrees of flexion.* FPCC - Exam 3 Questions and answers -Make sure patient stands *within the walker, not behind it* so when the walker goes forward they are not leaning far forward & the center of gravity isn't shifting too far forward causing the patient to fall. -the walker should ideally be lifted & not scooted, lifted then stepped into. -Tennis balls/wheels on walkers have the advantage of decreasing friction & work but the disadvantage is an increase in fall risk. Braces support ____ CORRECT ANSWERS✅ joints and muscles that cannot independently support the body's weight. -Most commonly used in lower extremities. nursing responsibilities: assisting the patient into and out of the brace and monitoring the condition of the skin under the brace Crutches CORRECT ANSWERS✅ -The crutch should not hit the axilla, *it should be three finger widths below the axilla* -The hand grip must be at a position that there is enough flexion there that you can push a little bit with it. FPCC - Exam 3 Questions and answers -If you have to teach a client to go up stairs or up a curb, they must go up with the uninjured leg, then they bring the crutch & injured extremity. When you go down, go down with the crutch & injured leg first. *Up with the good & down with the bad.* -When leaning on the crutch, they are at risk for damaging their nerves & cutting off their circulation in their arms. Restraints are a _____ resort CORRECT ANSWERS✅ LAST Use restraints to CORRECT ANSWERS✅ 1. reduce fall risk 2. prevent interruption of therapy 3. maintain life support 4. reduce risk to others DO NOT use restraints just because it's easier for the nurse. 2 types of restraints CORRECT ANSWERS✅ 1. physical 2. chemical FPCC - Exam 3 Questions and answers *remove one at a time* -always want to assess circulation What is the most commonly used restraint? CORRECT ANSWERS✅ rails. Forms of restraints CORRECT ANSWERS✅ 1. limb- goes around wrist or ankle 2. mitten- a patient who is trying to escape from soft wrist restraints; person who is scratching a lot 3. belt- allows patient to turn while being restrained 4. vest Measures to prevent injury & risk of complications in clients who are restrained CORRECT ANSWERS✅ Assess for: 1. pressure ulcers 2. pneumonia 3. constipation 4. emotional harm How many fingers should you be able to get under a restraint? CORRECT ANSWERS✅ 1-2 fingers to keep it from restricting circulation FPCC - Exam 3 Questions and answers Documentation for a restrained client CORRECT ANSWERS✅ 1. all nursing interventions that were done to eliminate the need for restraints 2. reason for placing the restraint 3. the initial restraint placement, location, circulation, & skin integrity 4. the teaching session with the patient & family members 5. circulation checks, & restraint removal per agency protocol. 6. entries on fall risk assessment sheet, restraint flowsheet, and nursing notes according to agency policy Culture & sensory function CORRECT ANSWERS✅ people of different cultural backgrounds tend to prefer differing amounts of eye contact, personal space, & physical touch Illness & sensory function CORRECT ANSWERS✅ 1. neurological disorders such as MS slow the transmission of nerve impulses 2. diseases that affect circulation may impair function of the sensory receptors and the brain, altering perception & response. 3. reduced or lack of oxygen harms & even destroys cells, causing widespread damage to the neurological system FPCC - Exam 3 Questions and answers Medications & sensory function CORRECT ANSWERS✅ medications that cross the blood brain barrier affect neurologic or sensory function by damaging or killing brain cells Stress & sensory function CORRECT ANSWERS✅ stress can cause too much stimulation. stressors may lead to stimulation overload-- more stimuli than the person can handle Personality/lifestyle & sensory function CORRECT ANSWERS✅ clients are at risk for sensory alterations if their previous level of stimuli does not match their current level Kinesthesia CORRECT ANSWERS✅ muscle sense. a complex process involving proprioceptors that detect stretch in muscles to create a mental picture of how the body is positioned Stuporous CORRECT ANSWERS✅ requires vigorous stimulation before responding Obtunded CORRECT ANSWERS✅ dull the sensitivity of FPCC - Exam 3 Questions and answers 6. sports equipment- make sure kids wear protective gear Presbycusis CORRECT ANSWERS✅ progressive sensorineural loss associated with aging. It results from deterioration of the hair cells in the cochlea. leads to diminished ability to hear high-pitched sounds and to distinguish sounds in a noisy environment. Tinnitus CORRECT ANSWERS✅ ringing in the ears Impacted cerumen CORRECT ANSWERS✅ condition in which earwax becomes tightly packed in the ear canal, blocking the canal. Congenital hearing deficit CORRECT ANSWERS✅ patient is born with it Illness/trauma causing hearing deficit CORRECT ANSWERS✅ trauma to ear or tympanic membrane can cause hearing loss. ask the patient about medications (aspirin causes tinnitus, lasix causes hearing loss, aminoglycosides are ototoxic) Auditory assessment CORRECT ANSWERS✅ 1. age- 30 year olds see hearing loss FPCC - Exam 3 Questions and answers 2. medical history- frequent ear infections or any trauma 3. environment- ask client about noise exposure 4. assistive devices- hearing aids 5. ability to perform self care- can they do this safely? 6. patient behaviors that show they do not hear well 7. perform the whisper test 8. perform audiometry (hearing testing) Auditory deficit implementations CORRECT ANSWERS✅ 1. use written tools 2. legally you have to have an interpreter when someone does not speak the same language. for deficits, you will use someone who knows sign language 3. encourage client to use their hearing aid if they have one. Make sure they have a good fit & know how to handle it correctly. Gustatory deficits CORRECT ANSWERS✅ loss of taste -around age 50 you start to have decreased sense of taste -assess nutritional status since they are not eating -perform a taste test. give pt something salty, sour, bitter & see if they can correctly identify the taste FPCC - Exam 3 Questions and answers Impaired taste most commonly results from ____ CORRECT ANSWERS✅ xerostomia (excessively dry mouth) which may be caused by meds, decreased saliva production, inadequate fluid intake, poor nutrition, or poor oral hygiene. Other causes of taste deficits include: CORRECT ANSWERS✅ 1. common cold 2. infections of the nose, sinuses, mouth, or salivary glands 3. smoking 4. vit. b12 or zinc deficiency 5. dental fillings 6. dementia 7. injury to the nose, mouth, head 8. metallic taste can occur during pregnancy due to hormonal fluctuations or from cancer, peptic ulcer & kidney disease Gustatory deficit implementations CORRECT ANSWERS✅ 1. assess nutritional status 2. oral hygiene- can correct dry mouth & enhance sense of taste 3. presentation of food- serve food how its supposed to be served. concentrate on visual appeal of the meal FPCC - Exam 3 Questions and answers Speech deficit/aphasia CORRECT ANSWERS✅ aphasia- patient has difficulty with words medical history- strokes, head injuries Expressive aphasia CORRECT ANSWERS✅ patient can understand, but can't produce words to speak Receptive aphasia CORRECT ANSWERS✅ patient can't understand the language Global aphasia CORRECT ANSWERS✅ patient can't understand language or produce words Speech/aphasia implementations CORRECT ANSWERS✅ 1. speech techniques- introduce yourself & speak clearly/politely. give full info to client. use short sentences 2. ask yes/ no questions. 3. give them time to answer- pause between questions. do not rush client to answer. 4. use tools like a picture chart Sensory deprivation CORRECT ANSWERS✅ lack of meaningful stimuli FPCC - Exam 3 Questions and answers Causes for sensory deprivation CORRECT ANSWERS✅ 1. impaired sensory reception (neuro injury, dementia, depression, meds) 2. inability to transmit or process stimuli 3. restricted mobility 4. sensory deficits 5. nonstimulating monotonous environment 6. being from a different culture & unable to interpret received cues Sensory deprivation CMs CORRECT ANSWERS✅ 1. yawning & sleeping 2. preoccupied with somatic complaints 3. decreased attention span 4. difficulty concentrating, problem solving, remembering 5. disorientation or confusion 6. hallucinations 7. tearful, easily annoyed, depressed Sensory deprivation nursing interventions CORRECT ANSWERS✅ 1. keep client oriented 2. adapt communication- be conversational FPCC - Exam 3 Questions and answers 3. maximize environmental input- turn on music, open shades 4. encourage social interaction 5. encourage use of devices (hearing aids) 6. provide mental stimulation- tv, games, crossword puzzles Sensory overload CORRECT ANSWERS✅ environmental or internal stimuli or combination of both exceed a higher level than the patient's sensory system can effectively process Causes of sensory overload CORRECT ANSWERS✅ 1. hospitalized pts- combination of physical discomfort, anxiety, separation from loved ones, & being in an unfamiliar hospital environment 2. medications that stimulate the CNS 3. mental health conditions are exacerbated by high intensity noise & light in the environment Sensory overload CMs CORRECT ANSWERS✅ 1. fatigue & sleeplessness 2. irritability or anxiety 3. reduced ability to problem-solve 4. scattered attention, racing thoughts FPCC - Exam 3 Questions and answers Cutaneous/superficial pain CORRECT ANSWERS✅ arises in the skin or the subcutaneous tissue. injury is superficial, may cause significant short-term pain Visceral pain CORRECT ANSWERS✅ caused by the stimulation of deep internal pain receptors. it is most often experienced in the abdominal cavity, cranium, or thorax. not well localized & can be described as tight, pressure, or crampy pain Deep somatic pain CORRECT ANSWERS✅ originates in the ligaments, tendons, nerves, blood vessels, and bones. localized & can be described as achy or tender Radiating pain CORRECT ANSWERS✅ starts at the origin but extends to other locations FPCC - Exam 3 Questions and answers Referred pain CORRECT ANSWERS✅ occurs in an area that is distant from the original site Phantom pain CORRECT ANSWERS✅ pain that is perceived to originate from an area that has been surgically removed. Psychogenic pain CORRECT ANSWERS✅ refers to pain that is believed to arise from the mind Nociceptive pain CORRECT ANSWERS✅ most common type of pain experienced. it occurs when pain receptors (nociceptors) respond to stimuli that are potentially damaging. may occur as result of trauma, surgery, or inflammation. 2 types of nociceptive pain CORRECT ANSWERS✅ 1. visceral pain (pain originating from internal organs) 2. somatic pain (pain originating from skin, muscles, bones, connective tissue) FPCC - Exam 3 Questions and answers Neuropathic pain CORRECT ANSWERS✅ complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli. Acute vs. chronic pain CORRECT ANSWERS✅ 1. acute- short duration, generally rapid in onset 2. chronic- pain that has lasted 6 months or longer and often interferes with daily activities. Words patients use to describe pain CORRECT ANSWERS✅ sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling What is the 5th vital sign? CORRECT ANSWERS✅ pain scale. pain is whatever the patient says it is & exists when the patient says it exists. PQRST CORRECT ANSWERS✅ P- provokes the pain, palliates the pain (makes it better), pattern Q- quality R- radiation, referred pain S- severity, pain scale. assess before & after every intervention FPCC - Exam 3 Questions and answers 4. respiratory system- pts in pain tend to breath shallowly. these changes can lead to pneumonia, atelectasis, underventilation, & resp. acidosis 5. GU- hormones lead to decreased urinary output, retention, fluid overload, hypokalemia, HTN, & increased cardiac output 6. GI- intestinal secretions & smooth muscle tone increase, & gastric emptying & motility decrease. Nonpharmacological pain relief measures CORRECT ANSWERS✅ exercise, meditation, visualization, and music therapy can prompt the release of endogenous opioids. *they offer an alternative for people with mild pain* who do not wish to take potent drugs for pain relief. *they should be used as an adjunct to pharmacological therapies for pts with moderate to severe pain* Nonpharmacological cutaneous stimulation: TENS units CORRECT ANSWERS✅ transcutaneous electrical nerve stimulator -worn externally -consist of electrode pads, connecting wire, & stimulator. -pads are applied directly to painful area. once activated, the unit stimulates A- delta sensory fibers FPCC - Exam 3 Questions and answers Nonpharmacological cutaneous stimulation: acupuncture CORRECT ANSWERS✅ application of extremely fine needles to specific sites in the body to relieve pain Nonpharmacological cutaneous stimulation: acupressure CORRECT ANSWERS✅ stimulates specific sites in body. instead of needles, fingertips provide firm, gentle pressure over the various pressure points. provides a calming effect through release of endorphins Other cutaneous stimulation CORRECT ANSWERS✅ 1. massage 2. application of heat & cold 3. contralateral stimulation- stimulating the skin in area opposite to the painful site. Cutaneous stimulation works best on pain that is _____ CORRECT ANSWERS✅ localized and not diffuse Distraction for pain CORRECT ANSWERS✅ 1. visual tactics such as watching TV 2. auditory such as music FPCC - Exam 3 Questions and answers 3. tactile such as massage, holding a pet, hugging a loved one 4. intellectual such as crossword puzzles or a challenging game Progressive relaxation CORRECT ANSWERS✅ the person sits comfortably & tenses a group of muscles for 15 seconds and then relaxes the muscle while breathing out. Guided imagery CORRECT ANSWERS✅ uses auditory and imaginary processes to affect emotions and help calm, divert, and relax Diaphragmatic breathing CORRECT ANSWERS✅ effective measure to invoke relaxation and improve tissue oxygenation for pain management. goal is to train patients to intentionally take slow, even breaths using the diaphragm to inhale & exhale at the same rate for 5 to 8 breaths per minute. Analgesics CORRECT ANSWERS✅ classified into 3 groups: nonopioids, opioids, & adjuvants Choice of treatment is based on _____ of pain the patient is experiencing CORRECT ANSWERS✅ the level FPCC - Exam 3 Questions and answers 3. pruritus- reduce dose by combining. use cool packs, lotion, or topical anesthetics. administer antihistamines. 4. respiratory depression- assess resp. status before administering & frequently afterward. reduce dose by 25% when you observe signs of oversedation. if pt is nonresponsive, stop the opioid and administer an antagonist. 5. drowsiness- teach pt drowsiness will subside. during daytime, offer stimulants such as caffeine. offer a lower dose more frequently Patient controlled analgesia (PCA) CORRECT ANSWERS✅ PCA pumps are an effective & safe way to deliver opioids. they provide excellent pain relief & give pt a sense of control. most PCA pumps can be programmed with 1 or 4 hour maximum lockout interval to prevent overdosing. if the pt reaches the set limit, the pump will trigger a "lockout" even if the pt keeps pressing the button PCA by proxy CORRECT ANSWERS✅ someone other than the patient presses the button to inject a dose of pain medication into the patient When you begin the PCA infusion, you will have another _____ check dosage calculations & confirm the settings on the pump CORRECT ANSWERS✅ nurse FPCC - Exam 3 Questions and answers Chemical pain relief measures: types of regional anesthesia CORRECT ANSWERS✅ nerve blocks & epidural injection anesthetic agent is injected into or around the nerve that supplies sensation to a specific part of the body Nerve blocks may be used for CORRECT ANSWERS✅ short term pain relief after surgical procedures or long term management of chronic pain Local anesthesia CORRECT ANSWERS✅ injection of local anesthetics into body tissues. lidocaine or marcaine may be used. local anesthetics are injected into subcutaneous tissue for minor surgical procedures. they may also be injected into joints & muscles for pain relief Topical anesthesia CORRECT ANSWERS✅ involves applying an agent that contains cocaine, lidocaine, or benzocaine directly to the skin, mucous membranes, wounds or burns. FPCC - Exam 3 Questions and answers it is quickly absorbed & provides pain relief for mild to moderate pain Addiction CORRECT ANSWERS✅ state of psychological dependence in which a person uses a drug compulsively & will engage in self-destructive behavior to obtain the drug Drug tolerance CORRECT ANSWERS✅ tolerance to opioids can occur, but increasing the dose or changing the route of administration can correct the problem Physical dependence CORRECT ANSWERS✅ leads to withdrawal symptoms when the medication is stopped abruptly; it can be prevented by decreasing the dose slowly over time. Behaviors that may indicate addiction CORRECT ANSWERS✅ 1. repeated requests for injections of an opioid or atypical high dosing when pain should normally be diminishing 2. refusal to try oral meds for pain relief 3. "doctor shopping" 4. "pharmacy shopping" FPCC - Exam 3 Questions and answers *pH down, PaCO2 up, HCO3 normal* Respiratory acidosis acute CM CORRECT ANSWERS✅ 1. increased pulse & RR 2. headache, dizziness 3. confusion, decreased LOC 4. muscle twitching Respiratory acidosis chronic CM CORRECT ANSWERS✅ 1. weakness 2. headache Respiratory acidosis interventions CORRECT ANSWERS✅ 1. provide pulmonary hygiene 2. institute measures to improve gas exchange, such as chest physiotherapy, bronchodilators, antibiotics possible. 3. provide supplemental oxygen 4. maintain hydration Respiratory alkalosis CORRECT ANSWERS✅ may be caused by hyperventilation resulting from anxiety, fever, sepsis, thyrotoxicosis, lesion in the respiratory center in the brain, or excessive ventilation with a mechanical ventilator FPCC - Exam 3 Questions and answers *pH up, PaCO2 down, HCO3 normal* Respiratory alkalosis CM CORRECT ANSWERS✅ 1. confusion, difficulty focusing 2. headache 3. tingling 4. palpitations 5. tremors Respiratory alkalosis interventions CORRECT ANSWERS✅ 1. if caused by anxiety, encourage the pt to relax & breathe slowly 2. for other causes: identify & treat the underlying disorder. Metabolic acidosis CORRECT ANSWERS✅ may be caused by retained acids in the blood resulting from renal impairment, poorly controlled diabetes mellitus, or starvation conditions that decrease bicarbonate, such as excessive GI loss, will also trigger metabolic acidosis FPCC - Exam 3 Questions and answers may be caused by excessive intake of acids, which may occur with aspirin poisoning, or by prolonged infusion of chloride containing IV fluids *pH down, PaCO2 normal, HCO3 down* Metabolic acidosis CM CORRECT ANSWERS✅ 1. headache 2. confusion, drowsiness 3. weakness 4. peripheral vasodilation 5. NV 6. kussmaul's breathing (rapid & deep) 7. frequently associated with hyperkalemia Metabolic acidosis interventions CORRECT ANSWERS✅ 1. treatment is directed at correcting the underlying problem 2. bicarbonate may be ordered Metabolic alkalosis CORRECT ANSWERS✅ may be caused by excessive acid loss due to vomiting or gastric suction, use of potassium-wasting diuretics, hypokalemia, excess bicarbonate intake, or hyperaldosteronism FPCC - Exam 3 Questions and answers Obesity & cardiac health CORRECT ANSWERS✅ obesity increases the risk of developing atherosclerosis & HTN. excess fat stores in & around the heart itself reduce its effectiveness as a pump. the workload of the heart is increased by the need to perfuse the excess body tissues Exercise & cardiac health CORRECT ANSWERS✅ exercise improves blood circulation & delivery of oxygen to tissues & cells. it also increases metabolic demands. the body responds by increasing the heart rate & rate & depth of breathing. Tobacco use/substance abuse & cardiac health CORRECT ANSWERS✅ tobacco use is a major risk factor in several chronic CV conditions. Alcohol abuse causes fatty infiltration of the heart muscle, thrombi in the coronary arteries, heart enlargement & dysrhythmias Levels of prevention CORRECT ANSWERS✅ 1. primary prevention- activities are designed to prevent or slow onset of disease. ex: eating healthy, exercising 2. secondary prevention- involves screening activities & education for detecting illnesses in the early stages. ex: breast self exam 3. tertiary prevention- focuses on stopping the disease from progressing & returning the individual to the pre-illness stage. ex: rehab FPCC - Exam 3 Questions and answers Conditions that increase cardiac output by increasing stroke volume include: CORRECT ANSWERS✅ 1. increased blood volume (as occurs during pregnancy) 2. more forceful contraction of the ventricles (as occurs during exercise) Conditions that decrease cardiac output by decreasing stroke volume include: CORRECT ANSWERS✅ 1. dehydration 2. active bleeding 3. damage to the heart (heart attack) Up to a point, an increase in heart rate increases cardiac output. However, a very rapid heart rate limits the time allotted for the ventricles to fill resulting in _____ CORRECT ANSWERS✅ decreased stroke volume & decreased cardiac output Heart failure CORRECT ANSWERS✅ the heart becomes an inefficient pump & is unable to meet the body's demands impaired circulation leads to systemic & pulmonary edema which further impairs gas exchange. FPCC - Exam 3 Questions and answers Cardiomyopathy CORRECT ANSWERS✅ heart muscle disorder that results in heart enlargement & impaired cardiac contractility Dysrhythmias CORRECT ANSWERS✅ alterations in heart rate or rhythm. can lower cardiac output, decrease tissue oxygenation, & increase risk of stroke Heart valve abnormalities CORRECT ANSWERS✅ create turbulent flow, leading to a decrease in cardiac output & compromised tissue oxygenation. P wave CORRECT ANSWERS✅ represents the firing of the SA node & conduction of the impulse through the atria. in the healthy heart, this leads to atrial contraction. QRS complex CORRECT ANSWERS✅ represents ventricular depolarization & leads to ventricular contraction T wave CORRECT ANSWERS✅ represents the return of the ventricles to an electrical resting state so they can be stimulated again (ventricular repolarization). U wave CORRECT ANSWERS✅ not always seen on the ECG, but may be detected with an electrolyte imbalance such as hypokalemia or hypercalcemia. FPCC - Exam 3 Questions and answers 5. echocardiogram- ultrasound. gives info about stroke volume & valves & how its functioning Nursing diagnoses related to circulation & perfusion CORRECT ANSWERS✅ 1. decreased cardiac output 2. activity intolerance 3. impaired gas exchange 4. fatigue 5. ineffective health maintenance 6. risk for imbalanced fluid volume Preload CORRECT ANSWERS✅ the pressure that the blood is placing on the muscle fibers in the ventricles at the end of diastole. increased preload- pregnancy decreased- fluid volume loss Afterload CORRECT ANSWERS✅ Pressure in the wall of the left ventricle during ejection increase afterload- hypertension, anything that causes vasoconstriction decrease- anything that reduces resistance. FPCC - Exam 3 Questions and answers Cardiac interventions CORRECT ANSWERS✅ 1. manage anxiety 2. promote circulation- promote venous return -elevate patients legs above level of the heart -avoid sitting with legs crossed -encourage & support ambulation -provide ROM exercises -apply compression devices -quit using tobacco bc smoking restricts blood flow -take good care of feet & prevent injury to feet. -regular exercise improves circulation & oxygen delivery 3. prevent clot formation -turn pts frequently -promote adequate hydration -promote smoking cessation IV therapy CORRECT ANSWERS✅ administration of fluids, electrolytes, medications, or nutrients by the venous route. FPCC - Exam 3 Questions and answers IV fluids are used to: CORRECT ANSWERS✅ 1. expand intravascular volume 2. correct an underlying imbalance in fluids or electrolytes 3. compensate for an ongoing problem that is affecting either fluid or electrolytes Isotonic fluids remain in the _____ CORRECT ANSWERS✅ intravascular compartment Hypotonic fluids pull body water _____ of the intravascular compartment CORRECT ANSWERS✅ out Hypertonic fluids pull body water ______ the intravascular compartment CORRECT ANSWERS✅ into Isotonic fluids CORRECT ANSWERS✅ normal blood serum osmolality is 275-295 mOsm/kg. Isotonic solutions have similar tonicity (250 to 375 mOsm/L). Therefore when infused, *they remain inside the blood vessels.* Isotonic fluids are useful for clients with _____ CORRECT ANSWERS✅ hypotension or hypovolemia FPCC - Exam 3 Questions and answers 2. D5 0.45 % NaCl 3. D5 Lactated ringers 4. 10% dextrose in water (d10w) Over the needle catheters CORRECT ANSWERS✅ also called angiocaths. a polyurethane or teflon catheter is threaded over a metal needle. you pierce the skin & vein with the needle, advance the catheter into the vein, & remove the metal needle. *this is ideal for brief therapy* Inside the needle catheters CORRECT ANSWERS✅ this type of catheter is similar to the over the needle catheter; however, the polyurethane or teflon catheter lies inside the metal needle. after you advance the catheter into the vein, you withdraw the needle Butterfly needle CORRECT ANSWERS✅ short, beveled metal needle with flexible plastic flaps attached to the shaft. Butterfly needle is commonly used for CORRECT ANSWERS✅ intermittent or short term therapy for children & infants for single dose medications & drawing blood FPCC - Exam 3 Questions and answers Butterfly needle disadvantages CORRECT ANSWERS✅ bc the inflexible metal needle remains in the vein, a butterfly needle is more likely to infiltrate (damage the vein & allow fluid to leak into the interstitial spaces) than a flexible plastic catheter. Midline peripheral catheter CORRECT ANSWERS✅ a peripherally inserted flexible IV catheter typically inserted into the antecubital fossa & then advanced into the larger vessels of the upper arm for greater hemodilution. Midline peripheral catheter is left inserted for how long? CORRECT ANSWERS✅ typically 1-4 weeks. A midline peripheral catheter should be changed only when _____ CORRECT ANSWERS✅ there is a specific indicator (swelling, pain) A midline peripheral catheter is easily confused with CORRECT ANSWERS✅ a peripherally placed central line (PICC) Peripheral intravenous lock CORRECT ANSWERS✅ also called a saline lock, a prn adapter, & sometimes a heparin lock FPCC - Exam 3 Questions and answers establishes a venous route as a precautionary measure for clients whose condition may change rapidly or who may require intermittent infusion therapy. How is the patency of a peripheral intravenous lock maintained? CORRECT ANSWERS✅ by injecting normal saline or a dilute heparin solution Central venous access device (CVAD) CORRECT ANSWERS✅ intravenous line inserted into a major vein. typically, the subclavian or internal jugular vein is used. CVADs are used to: CORRECT ANSWERS✅ administer large volumes of fluid or highly irritating medications, when peripheral sites are unavailable, for monitoring central venous pressure, & for frequent blood draws. Advantages of central lines CORRECT ANSWERS✅ 1. accommodates highly irritating solutions 2. central veins are accessible even if the pt is experiencing fluid depletion 3. can be left in longer than peripheral IVs 4. nutrition can be given parenterally 5. phlebitis, extravasation, & infiltration less likely to occur FPCC - Exam 3 Questions and answers Nontunneled CVC CORRECT ANSWERS✅ inserted by a physician, specially trained nurse practitioner, or physician assistant through the skin into the jugular, subclavian & occasionally femoral veins. they are sutured into place. intended for shorter use than a PICC line (less than 6 weeks) dont routinely replace Tunneled CVC CORRECT ANSWERS✅ intended for long term use. the catheter is inserted by a surgeon through a 3-6 in subcutaneous tunnel in the chest wall & then into the jugular or subclavian vein, risk of infection is less with their use than it is with PICCs or nontunneled central lines. Implanted port CORRECT ANSWERS✅ the catheter enters the internal jugular vein in the neck, & it may be tunneled or untunneled to a completely implanted port in the upper chest. FPCC - Exam 3 Questions and answers placed by surgeons & only specially trained nurses are allowed to access an implanted port bc of risk of infiltration into the tissue if the needle placement is not correct. intended for long term use Intraosseous devices CORRECT ANSWERS✅ designed for immediate access (within seconds) and short term use (less than 24 hrs) used to administer fluids when a peripheral catheter cannot be inserted or when a central line insertion is not advisable, but especially in emergency situations. placed into the matrix of a bone most common access site is the proximal tibia in both children & adults. sternum & head of humerus can also be used in adults osteomyelitis is a rare complication. How does a nurse choose the size of the IV catheter? CORRECT ANSWERS✅ select the smallest diameter and the shortest length catheter that will accommodate the prescribed therapy. FPCC - Exam 3 Questions and answers nurses commonly use a 20-22 gauge catheter for adult peripheral infusions. a 20 gauge will accommodate adult blood transfusions you will need the larger 16-18 gauge for rapid infusions, thick fluids, or surgical/trauma patients. the smaller 24 gauge is used in geriatric & neonates Macrodrip vs microdrip tubing CORRECT ANSWERS✅ 1. macrodrip delivers 10-20 drops per ml of solution; select a macrodrip for most adult infusions 2. microdrip delivers 60 drops per ml; use for very slow infusion rates or for infants & children How many times should you attempt to initiate an IV? CORRECT ANSWERS✅ twice. do not make more than 2 attempts Selecting a peripheral IV site CORRECT ANSWERS✅ 1. age- for adults, you will use veins in hands or arm; for infants veins in the scalp or foot 2. type of solution- for irritating solutions, choose a large vein 3. speed of infusion- the faster the rate, the larger the vein and the larger the IV catheter you will need 4. duration- some recommend changing every 72-96 hours FPCC - Exam 3 Questions and answers IV complications & interventions: phlebitis CORRECT ANSWERS✅ inflammation of the vein causes: may be due to mechanical irritation, infusion of solutions that are irritating to the vessel, or sepsis dextrose solutions, potassium chloride, antibiotics, and vit. c are associated with higher risk trauma to the vessel, compression of the line by client movement, or low flow rate signs & symptoms: redness, pain, warmth at site, swelling, palpable cord along the vein, sluggish infusion rate, elevated temp. slowed or stopped infusion, inability to restart flow of iv -discontinue IV & restart in new location -apply cold compress initially if site is warm & tender. then apply warm compress IV complications & interventions: thrombophlebitis CORRECT ANSWERS✅ thrombosis & inflammation FPCC - Exam 3 Questions and answers causes: use of veins in leg for infusion, use of hypertonic or highly acidic solution, can be a result of untreated phlebitis signs & symptoms: sluggish flow rate, edema, tender & cord-like veins, warmth, & erythema at site -discontinue IV infusion, restart in opposite extremity w/ new equipment -apply warm compress -consult provider IV complications & interventions: local infection CORRECT ANSWERS✅ causes: poor technique when inserting, leaving in place longer than 96 hours, or direct contamination signs & symptoms: redness, swelling, exudate, elevated temp -remove IV line -apply sterile dressing over site -administer antibiotics if necessary FPCC - Exam 3 Questions and answers IV complications & interventions: nerve injury CORRECT ANSWERS✅ causes: using inner surface of wrist & forearm; not anchoring the vein for puncture; using a large needle; advancing the needle across instead of with the vein; inserting too deeply signs & symptoms: direct injury- sharp acute pain at the site or up and down the arm; pins and needles or electric shock sensation compression injury- pain & tingling typically appear 24-96 hours after venipuncture -do not make more than 2 attempts if pt complains of symptoms: -stop procedure & withdraw catheter -apply pressure to prevent hematoma -report to supervisor -do not start a new IV in affected arm -treat infiltration if it occurs IV complications & interventions: septicemia CORRECT ANSWERS✅ presence of microorganisms or their toxic products in the circulatory system FPCC - Exam 3 Questions and answers causes: reinserting a catheter used in an unsuccessful insertion; removing & reinserting a stylet, placing catheter in a joint flexion signs & symptoms: sharp, sudden pain at site, jagged catheter end on removal, dyspnea, chest pain, tachycardia, hypotension -apply a tourniquet above the site -notify physician & radiologist -start a new IV line -prepare pt for radiographic exam IV tubing should be changed every ____ days when fluid is constantly infusing CORRECT ANSWERS✅ 4-7 days. If tubing is being used intermittently, how often should it be changed? CORRECT ANSWERS✅ every 24 hours When should the dressing over a peripheral IV site be changed? CORRECT ANSWERS✅ change peripheral IV dressings routinely when the catheter is replaced, or as clinically indicated (when the dressing becomes damp, soiled, loose) FPCC - Exam 3 Questions and answers What kind of dressing should ideally be used over both central & peripheral IV sites? CORRECT ANSWERS✅ transparent, semipermeable dressings. these allow direct visualization of the site between dressing changes, permit evaporation of moisture, & provide secure anchor for the catheter. When you discontinue a peripheral IV, what should you note & document about the catheter? CORRECT ANSWERS✅ 1. chart date & time therapy was discontinued 2. note the condition of the site, including presence of any complications. if complications are present, document interventions. Surgical "never events" CORRECT ANSWERS✅ 1. surgery on the wrong body part 2. surgery on the wrong patient 3. DVT or pulmonary embolism after total knee or hip replacement. 4. foreign body left in a patient after surgery 5. surgical site infections Ablative surgery CORRECT ANSWERS✅ involves removal of a diseased body part Diagnostic (exploratory) surgery CORRECT ANSWERS✅ done to confirm or rule out a diagnosis FPCC - Exam 3 Questions and answers Palliative surgery CORRECT ANSWERS✅ performed to relieve discomfort or other disease symptoms without producing a cure Reconstructive surgery CORRECT ANSWERS✅ performed to restore function Cosmetic surgery CORRECT ANSWERS✅ done to improve appearance transplant surgery CORRECT ANSWERS✅ replaces a malfunctioning body part, tissue, or organ Procurement surgery CORRECT ANSWERS✅ related to transplant surgery. an organ or tissue is harvested from someone pronounced brain dead for transplantation into another person Emergency surgery CORRECT ANSWERS✅ requires transport to the operating suite as soon as possible to preserve the patient's life or function ex: internal hemorrhage, rupture of an organ, trauma FPCC - Exam 3 Questions and answers -interfere with metabolism of anesthetics -increase potential for excessive bleeding -decrease cerebral blood flow -cause HTN -increase effects of opioids & stimulants Surgical risk: personal habits CORRECT ANSWERS✅ substance abuse can increase surgical risk. smoking affects pulmonary function; long term alcohol use contributes to liver disease habitual substance abusers may have a cross tolerance to anesthetic & analgesic agents causing them to need higher than normal doses Surgical risk: allergies CORRECT ANSWERS✅ patients may be allergic to meds, tape, latex, and solution used in surgery Perioperative patient-focused model (PNDS) CORRECT ANSWERS✅ the patient is at the center of the model & the focus of the care. the perioperative nurse intervenes within the context of the healthcare system to assist the patient throughout the experience. FPCC - Exam 3 Questions and answers Surgical focused nursing history CORRECT ANSWERS✅ collect assessment data from the client, significant others, medical records & other members of the healthcare team include: -health history -physical status -allergies -meds -knowledge & understanding of the surgery & anesthesia -cultural & spiritual factors -access to social resources -coping strategies -use of alcohol & drugs Will a chest xray be ordered on every patient before surgery? CORRECT ANSWERS✅ No. routine chest xray is not recommended for all patients prior to surgery FPCC - Exam 3 Questions and answers An ECG (EKG) will usually be required for which patients? CORRECT ANSWERS✅ patients older than 50 Normal CBC results CORRECT ANSWERS✅ RBC: male- 4.7-6.1 female-4.2-5.4 hemoglobin: male- 14-18 female- 12-16 hematocrit: male- 42-52% female- 37-47% platelet 150,000-400,000 WBC FPCC - Exam 3 Questions and answers helps protect patients from having a surgery they dont understand or want, & the signed document protects the healthcare agency & workers from later claims Teaching pt's how to help prevent surgical site infections CORRECT ANSWERS✅ before surgery: 1. if you smoke, stop 2. discuss health problems with surgeon 3. ask surgeon whether or not you should have antibiotics before surgery 4. dont shave near where you will have surgery after: 1. be sure family & friends wash hands 2. when anyone examines you/checks incision ask them if they have washed their hands 3. wash your hands before caring for your own incision 4. do not allow family & friends to touch your incision or surgical dressing 5. know how to care for incision before going home 6. report signs of infection to physician right away FPCC - Exam 3 Questions and answers Ways to provide preop teaching CORRECT ANSWERS✅ written instructions, video presentations, phone contact or face to face discussion to provide teaching. teach in terms patient will understand. obtain an interpreter for translation if pt speaks a language you dont speak include family in teaching Physical prep for surgery: maintaining normothermia CORRECT ANSWERS✅ maintaining a normal body temp helps produce good surgical outcomes. in addition to monitoring temps, you can provide blankets, socks, and head coverings, and keep room temp at or above 75. Physical prep for surgery: nutritional status CORRECT ANSWERS✅ to decrease the risk for NV, patients usually fast, taking no food or liquids (NPO) for 8 hrs prior to surgery. stress importance of fasting FPCC - Exam 3 Questions and answers Physical prep for surgery: skin prep CORRECT ANSWERS✅ patients may be asked to shower or scrub the surgical site with soap or antibacterial solution the evening before surgery & the morning of. final skin prep should be completed before taking the pt into the surgical suite Physical prep for surgery: bowel prep CORRECT ANSWERS✅ enemas are now used primarily for surgical procedures of the colon, not for all surgeries. to empty the colon of feces, pts are asked to consume a low-residue diet for several days before surgery & are given a regimen of meds. Physical prep for surgery: urinary elimination CORRECT ANSWERS✅ indwelling catheters are not routinely inserted for surgery. catheterization may be prescribed if it is important to keep the bladder empty during surgery, if fluid status is being carefully monitored, or if surgery is expected to last for a prolonged period of time Physical prep for surgery: preop meds CORRECT ANSWERS✅ the anesthesiologist may prescribe preop meds to relax the pt, reduce respiratory secretions, or reduce the risk of vomiting & aspiration