Nursing 100 Fundamentals of Theory Final Exam Questions & Answers

Stages of Kubler-Ross's psychosocial responses to grief & loss - ANSWERS1. Denial & Isolation 2. Anger 3. Bargaining 4. Depression 5. Acceptance Maslow's Hierarchy of Needs & Meeting Basic Human Needs and how it's used to treat patients. - ANSWERS-Absence of basic human needs results in illness -Presence of basic human needs helps prevent illness or signals health -Meeting basic human needs restores health -One feels something missing when needs are unmet -One feels satisfaction when needs are met Maslow's Hierachy of Needs -Physiologic Needs - essential to life - ANSWERSoxygen; skin color, V/S, mental responsiveness; Intake & elimination of fluids;I & O, skin turgor, weight, mucous membranes; Food;weight, muscle mass, labs; Temperature;Physical activity;Rest & sleep Maslow's Hierachy of Needs - Safety and Security - ANSWERSo Physical protect from potential or actual harm o Emotional Free of fear, anxiety Allow independence Explanations Maslow's Hierachy of Needs - Love and belonging - ANSWERSo Understanding & Acceptance Involve family / friends in patient care Establish trusting relationship Refer to support groups Maslows Hiearchy of Needs - Self Esteem - ANSWERS-Respect values & beliefs -Role change -Body image change -Encourage to set attainable goals -Facilitate support from family / friends Maslows Hiearchy of Needs - Self-Actualization - ANSWERS-Reach full potential through development of capabilities -Continues throughout life Acceptance of self & others as they are Discriminate between good & evil Happiness & affection for others Incontinence - ANSWERSloss of voluntary control of urination Stress Incontinence - ANSWERSleakage when coughing, sneezing, or increased intra-abdominal pressure Functional Incontinence - ANSWERSinability to get to toilet in time or inability to recognize need to urinate Urge Incontinence - ANSWERSinability to delay need to urinate Overflow Incontinence - ANSWERSretention with leakage that exceeds bladder capacity Total (reflex) Incontinence - ANSWERScomplete lack of control over urination Enuresis - ANSWERSincontinence in child after toilet control expected Frequency - Altered urine pattern - ANSWERSvoiding too often but normal total amounts Dysuria - Altered urine pattern - ANSWERSdifficulty or painful urination Nocturia - Altered urine pattern - ANSWERSfrequency that occurs during sleeping hours Hesitancy - Altered urine pattern - ANSWERSdelay or problem starting urinary stream Retention - Altered urine pattern - ANSWERSinability to empty bladder Urgency - Altered urine pattern - ANSWERSneed to void without ability to hold or delay Neurogenic - Altered urine pattern - ANSWERSbladder-nervous system damage Components of a clear liquid diet - ANSWERS• Liquids can have color but must be able to see through (Coffee is ok) • No milk products • Nutritionally inadequate over time • Used as preparation for surgery, diagnostic studies, post-operative advancement • Hydrates, rests GI tract • Need to offer fluids q 2 hr Surgical asepsis - ANSWERSsterile technique; practices that render & keep objects & areas free from microorganisms Surgical classifications: Urgent - ANSWERSmust be done within a reasonably short time frame to preserve health, but is not an emergency. Surgicale Classification- elective - ANSWERSprocedure that is preplanned & based on the patient's choice & availability of scheduling for the patient, surgeon, & facility; Non-urgent; does not have to be done immediately Surgical Classification -emergent - ANSWERSmust be done immediately to preserve life, a body part, or function Cognitive learning - ANSWERSstoring & recalling of new knowledge (brain) Affective learning - ANSWERSchanges in attitude, values, feelings (emotional) Psychomotor learning - ANSWERSintegration of mental & muscular activity (physical) Cognitive teaching strategy - ANSWERSlecture or discussion, panel discussion, discovery, audiovisual materials, printed materials, programmed instruction, computer-assisted instruction programs Affective teaching strategy - ANSWERSrole modeling, discussion, panel discussion, audiovisual materials, role playing, printed materials Psychomotor teaching strategy - ANSWERSdemonstration, discovery, audiovisual materials, printed materials Catheter Urine Specimen procedure - ANSWERS•Collect from specimen port on drainage tubing •Cleanse with alcohol & use sterile syringe to pull out urine •Collect urine only from upper tubing, never from drainage bag •Urinalysis - collect 30 mL; Culture & Sensitivity (C&S) - collect 10 mL •Label & send specimen to lab within 30 min. or refrigerate until sent Timed specimen collections (24-hour specimen): - ANSWERSTimed specimen collections (24-hour specimen): •obtain correct container & preservative or ice if needed •Instruct patient/family about collection •Begin with empty bladder, end with empty bladder -Have patient void before beginning -Have patient void & add to collection at end of test •Keep all urine for designated time frame Clean Catch Specimen Collection - ANSWERS-collected during midstream -first small amount of urine voided helps to flush away any organisms near the meatus -urine voided at midstream is most characteristic of urine body is producing -patient voids & discards a small amount of urine; continues voiding in a sterile specimen container; stops voiding into container; removes container & continues voiding; then discards the last amount of urine in the bladder What is involved in hospice care? - ANSWERS-Terminal Illness -Death expected within a limited period of time -What patient needs to know -how disease will progress; go through stages of grief; support in decision making; right to consent to or refuse any & all treatment -What family needs to know -how disease will progress; encouraged to participate in care planning; support family while grieving -How to "break" the news -Dying patient's Bill of Rights (Box 43-2, p 1550) •Sense of hopefulness, participation in decisions, expression of feelings & emotions •Not die alone, religious or spiritual needs, honesty Pallative Care - ANSWERS-Taking care of the whole person - body, mind, spirit, heart, soul -Provide best quality of life by symptom management Hospice Care - ANSWERS-provided for people with limited life expectancy, often in the home -focuses on the needs of the dying - comfort & dignity; encompasses biomedical, psychosocial, & spiritual aspects Advance Directives - ANSWERSallow individual to state in advance what their choices would be should certain circumstances develop Living Wills - ANSWERSprovide specific instructions about kinds of healthcare that should be provide or forgone Durable Power of Attorney for Healthcare - ANSWERSappoints an agent that the person trusts to make decisions in the event of subsequent incapacity. Combination Directive - ANSWERScombination of Power of Attorney for Healthcare & Living Will Comfort Measures Only - ANSWERSgoal of treatment is a comfortable dignified death & that further life-sustaining measures are no longer indicated. Slow Code - ANSWERSin the case of cardiopulmonary or respiratory arrest, calling a code & resuscitating the patient are to be delayed until these measures will be ineffectual. Terminal weaning from ventilator - ANSWERSgradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis. Factors affecting grief and dying - ANSWERSDevelopmental considerations -child has limited understanding but needs to grieve -Family -Who has died -Socioeconomics -financial burden or loss; -Cause of Death -Culture,Gender,Religion Nursing role with grief and death - ANSWERS-Personal emotional involvement -Need to explore own beliefs about death -Burn-out from work in areas of frequent death -Critical Care, ER, Hospice, Long Term Care How can a nurse meet the physical needs of a dying patient? - ANSWERSSkin care - clean & dry Oral & nasal care q 2 hr Turn & reposition q 2 hr Pain control Maintain nutrition & hydration Patent airway Vision may diminish - control lighting in the room How does a nurse provide psychological support to a dying patient? - ANSWERSAllow to verbalize feelings, fears Do not leave alone Include family What does a nurse need to do about the spiritual needs of a dying patient? - ANSWERSo Spiritual / Religious needs Know & respect special ceremonies, rituals Contact clergy to visit if patient desires Postmortem Care - ANSWERS•Anatomical position -Removal of soiled dressings & tubes -Who will bathe the body? -Identification tags -Personal items -Order to release body / mortuary notification -Special handling for communicable disease How does a nurse support grieving patient's family? - ANSWERS-Provide information on what is happening -Provide private area to grieve -Allow family time alone with patient before & after death, if so desired -Assist with contacting mortician -May attend funeral services Stoma Care Assessments - ANSWERS-Should be moist & red or pink if circulation is adequate -Pale or bluish indicates problem -bleeds easily (mucosa) but amount is minimal -Very edematous at first, but will shrink down to normal size as healing occurs (6-8 weeks) -Protrude above skin about ½ to 1 inch -may need dilation in early days to prevent strictures Stoma Care Cleansing - ANSWERS-Wash gently with gauze or clean cloth & water -Pat dry Peristomal Skin Care Assessments - ANSWERS-skin should be intact, free of redness -Watch for any irritation, rash, signs of infection -Erosion around stoma can cause stoma to become flat or indented Peristomal Skin Care Cleansing - ANSWERS- no harsh or abrasive cleansers -use mild soap & water -dry gently -use skin protectant products to toughen area & protect from irritating stool Peristomal Bag or Applicance changes - ANSWERS• Disposable one-piece bags may be used at first -will have karaya or stomahesive attached • After stoma is stable, two-piece bag may be used - face plate attaches to skin around stoma - bag attaches to face plate - easy to remove & empty bag without disturbing seal on skin - bag is changed only when it leaks or seal is lost o opening in karaya should be cut 1/8 inch larger than stoma to protect skin & avoid stoma rub - may use charcoal or other deodorizer in bag to control odor - Bismuth subgallate oral also controls odor