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Nurs 3351: Exam 1 Study Guide
QSEN 6 core comptencies: - correct answer 1. patient-centered care
- teamwork and collaboration
- safety
- quality improvement
- informatics
- evidence-based practice nursing-sensitive patient outcome - correct answer defined as an individual, family, or community state, behavior, or perception that is measured along a continuum in response to a nursing intervention(s). case management - correct answer is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes." Clinical pathways - correct answer (critical paths, patient care protocols, care maps) are interprofesionald care plans that specify care and desired outcomes during a specific time period for patients with a particular diagnosis or health condition. delegation - correct answer is transferring authority to a competent individual for completing selected nursing tasks in a selected situation
Five rights of delegation: - correct answer 1. right task
- right circumstances
- right person
- right directions and communication
- right supervision and evaluation serious reportable event (SRE) - correct answer also called a "never" event, to describe adverse events that are serious, largely preventable, and of concern to the public and health care providers National Patient Safety Goals: - correct answer Goal 1: identify patients correctly Goal 2: improve communication among the health care team Goal 3: use medications safely Goal 6: use clinical alarm systems safely Goal 7: prevent health care-associated infections Goal 15: identify the safety risks inherent in the agency's patient population Determinants of health - correct answer are factors that influence the health of individuals and groups and help explain why some people experience poorer health than others health disparities - correct answer are difference in the incidence, prevalence, mortality rate, and burden of diseases that exist among
Ethnocentrism - correct answer refers to the belief that one's own culture and worldview are superior to those of others from different cultural, ethnic, or racial backgrounds culture-bound syndromes - correct answer are illnesses or afflictions that are recognized only within a cultural group Teaching plan - correct answer 1. Assessment of the patients ability and readiness to learn
- Identification of teaching needs
- Development of learning goals with the patient
- Implementation of the teaching
- Evaluation of the patients learning health literacy - correct answer is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Medicare - correct answer is a federally funded health insurance program for people ages 65 years or older, as well as for people under the age of 65 with certain disabilities and people of any age with end- stage renal disease requiring dialysis or a kidney transplant Medicaid - correct answer is a state-administered, needs-based program to assist eligible low-income people, including medicare beneficiaries, with certain medical expenses
The effects of aging on drug metabolism: - correct answer 1. drug- receptor interaction: brain receptors become more sensitive, making psychoactive drugs very potent
- metabolism: liver mass shrinks, hepatic blood flow and enzyme activity decline, metabolism drops to 2/3 the rate of young adult, enzymes lose ability to process some drugs, thus prolonging drug half- life
- absorption: gastric emptying rate and motility slow, absorption capacity of cells and active transport mechanism decline
- circulation: vascular nerve control is less stable causing a more potent reaction to drug (anti-hypertensive drop BP too low)
- excretion: renal blood flow, GFR, renal tubular secretion and reabsorption and number of functional nephrons decline; half-life of renally excreted drugs increases
- distribution: lean body mass falls, adipose stores increase, total body water declines raising the concentration of water-soluble drugs, plasma protein levels decrease reducing sites available for protein-bound drugs Cardiac Index (CI) - correct answer a measure of the cardiac output of a patient per square meter of body surface area; reference range: 2.8-4. L/min/m^ preload - correct answer the volume of blood in the ventricles at the end of diastole, before the next contraction afterload - correct answer peripheral resistance against which the left ventricle must pump
C-reactive protein (CRP) - correct answer is a protein produced by the liver during periods of acute inflammation; high level is linked w/ presence of atherosclerosis Homocysteine - correct answer an amino acid that is produced during protein catabolism that has been identified as a risk factor for CVD; may cause damage to the endothelium or have role in formation of thrombi Cardiac Natriuretic Peptide Markers - correct answer There are 3: atrial natriuretic peptide (ANP) from the atrium, b-type natriuretic peptide (BNP) from the ventricles, and c-type natriuretic peptide from endothelial and renal epithelial cells B-type natriuretic peptide (BNP) - correct answer Peptide that causes natriuresis. Elevation helps to distinguish cardiac vs. respiratory cause of dyspnea. Lipoprotein-associated phospholipase A2 - correct answer an inflammatory enzyme expressed in atherosclerotic plaques; elevated levels associated with increased risk of CAD 12 - Lead ECG - correct answer Electrodes are placed on the chest and extremities, allowing the ECG to record cardiac electrical activity from 12 different views. Identifies conduction problems, dysrhythmias, position of the heart, cardiac hypertrophy, pericarditis, myocardial ischemia or infarction, pacemaker activity, and effectiveness of drug therapy at one point in time
Holter monitoring - correct answer Ambulatory ECG monitoring; usually performed over 24-48 hours and then correlating rhythm changes with symptoms and activities recorded in diary. Normal patient activity is encouraged to stimulate conditions that produce symptoms. Event monitor - correct answer Ambulatory ECG monitoring; records rhythm disturbances that are not frequent enough to be recorded in one 24 hour period. Allows more freedom than Holter Monitor. 6 - minute walk test - correct answer Distance patient is able to walk on a flat surface in 6 min. Used to measure response to treatments and determine functional capacity for activities of daily living. Useful in people who are unable to perform treadmill or exercise bike testing. May be a better measure of fitness for older adults than exercise testing. Echocardiogram - correct answer transducer that emits and receives ultrasound waves is placed in four positions on the chest above the heart. Transducer records sound waves that are bounced off the heart. Also records direction and flow of blood through the heart and transforms it to audio and graphic data that measure valve abnormalities, congenital heart defects, wall motion, EF, and heart function. stress echocardiogram - correct answer Combination of echocardiogram and exercise test. Resting images of the heart are taken with ultrasound, and then the patient exercises. Post-exercise images are taken within 1 minute of stopping exercise. Differences in left
single photon emission computed tomography (SPECT) - correct answer Used to determine size or risk of infarction and to determine infarction size. Small amounts of radioactive isotope are injected IV and recordings are made of the radioactivity emitted over a specific area of the body. Circulation of the isotope can be used to detect coronary artery blood flow, intracardiac shunts, motion of ventricles, EF, and size of the heart chambers Exercise (stress) nuclear imaging - correct answer Nuclear imaging images are taken at rest and after exercise. Injection is given at maximum HR (usually 85% of age-predicted maximum) on bicycle or treadmill. Patient is then required to continue exercise for 1 min to circulate the radioactive isotope. Scanning is done 15-60 min after exercise. A resting scan is performed 60-90 min after initial infusion or 24 hr later. Pharmacologic nuclear imaging - correct answer - Regadenoson, dipyridamole, or adenosine is used to produce vasodilation when patients are unable to tolerate exercise. Vasodilation increases blood flow to well-perfused coronary arteries. Scanning procedure is same. Positron Emission Tomography (PET) - correct answer Highly sensitive in distinguishing viable and nonviable heart tissue. Uses two radionuclides. Nitrogen- 13 - ammonia is injected IV first and scanned to evaluate myocardial perfusion. A second radioactive isotope, fluoro- 18 - deoxyglucose, is then injected and scanned to show myocardial metabolic function. The scans will differ in a injured or ischemic heart. Cardiovascular magnetic resonance imaging (CMRI) - correct answer Noninvasive imaging technique obtains information about heart tissue,
EF, aneurysms, cardiac output, and patency of proximal coronary arteries. It does not involve ionizing radiation and is an extremely safe procedure. Provides images in multiple planes with uniformly good resolution. magnetic resonance angiography (MRA) - correct answer Used for imaging vascular occlusive disease and abdominal aortic aneurysms. Same as MRI but with use of gadolinium as IV contrast medium. cardiac computed tomography (CT) - correct answer heart-specific CT imaging technology with or without IV contrast medium used to visualize heart anatomy, coronary circulation, and blood vessels Coronary CT angiography (CTA) - correct answer use of CT with injected IV contrast medium to obtain images of blood vessels and diagnose CAD Calcium-scoring CT scan - correct answer also known as ultrafast CT, uses a scanning electron beam to quantify calcification in coronary arteries and heart valves. Primarily used for risk assessment in asymptomatic patients and to assess for heart disease in patients with atypical symptoms potentially related to cardiac causes cardiac catheterization - correct answer involves insertion of catheter into heart to obtain information about O2 levels and pressure readings within heart chambers. Contrast medium is injected ti assist in seeing structures and motion of heart. Insertion into vein for right side of heart and insertion into artery for left side of heart.
hemodynamic monitoring - correct answer Invasive and minimally invasive bedside hemodynamic monitoring is done using intraarterial, pulmonary artery, and central vein catheters to monitor arterial BP, stroke volume variation, pulmonary artery pressure, pulmonary artery wedge pressure, cardiac output, and central venous pressure. Used to evaluate cardiovascular status and response to treatment. artery dissection - correct answer perforation of an artery; caused by the catheter during angiography can cause cardiac tamponade or require emergency coronary artery bypass surgery. Findings include: severe hypotension, tachycardia cardiac tamponade - correct answer acute compression of the heart caused by fluid accumulation in the pericardial cavity. Manifestations include hypotension, JVD, muffled heart sounds, and paradoxical pulse cardioversion and defibrillation - correct answer cardioversion is the delivery of a direct countershock to the heart synchronized to the QRS complex. Defibrillation is the delivery of an unsynchronized, direct countershock to the heart. Defibrillation stops all electrical activity of the heart, allowing the SA node to take over and reestablish a perfusing rhythm. compartment syndrome - correct answer Pressure from tissue swelling or bleeding within a compartment or a restricted space causes reduced blood flow to the area. Untreated, the affected area will become necrotic and die
intermittent claudication - correct answer numbness or burning pain in the extremity that ceases with rest Stable (exertional) angina - correct answer occurs with exercise or emotional stress and is relieved by rest or nitroglycerin Unstable (preinfarction) angina - correct answer occurs with exercise or at rest, but increases in occurrence, severity, and duration over time Variant (Prinzmetal's) Angina - correct answer Is due to a coronary artery spasm, often occurring during periods of rest thallium scan - correct answer Thallium 201 is injected intravenously to allow for myocardial perfusion and assess damage to heart muscle from heart attacks. Radioisotopes cannot reach areas of decreased or absent perfusion, and the areas appear as "cold spots"
