1/14/21 Lecture Flashcards


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1

how much of communication is non-verbal?

70-80%

2

anything the pt or caregiver says to you

subjective

3

anything that you acutally observe

objective data

4

tachycardia

>100

5

bradycardia

<60

6

who should you not get an oral temp on?

anybody <4, mouth breathers, & pt's with facial trauma

7

who should you not get a rectal temp on?

pt's with diarrhea, pt's <3 mo old

8

how does chronic lung dz affect O2?

lowers it

9

where is the most accurate location to check for heart rate?

5th intercostal space

10

normal temp?

96.8-100.4

11

normal heart rate

60-100

12

normal respirations

12-20

13

normal BP?

120/80

14

normal O2

90-100

15

how long do we count VS for?

30s unless abnormal, then count for 1 full min

16

in what order (in regards to invasiveness) do we assess pt's?

least to most invasive

17

in what order do we assess the abd?

  1. inspect
  2. auscultate
  3. percuss
  4. palpate
18

in what order do we assess all other areas (besides abd)?

  1. inspect
  2. palpate
  3. percuss
  4. auscultate
19

in regards to painful areas, which order do you assess?

assess painful areas last

20

in what order do we listen for bowel sounds?

  1. RLQ
  2. RUQ
  3. LUQ
  4. LLQ
21

how long do you have to listen for bowel sounds before you can say they are absent?

1 full minute

22

what are the stages of edema?

1+, 2+. 3+, 4+

23

what does the Romberg test tell us?

balance

24

what are the phases of the nurse-pt relationship?

  • pre-interaction
  • orientation/introductory
  • working
  • termination
25

can halt a therapeutic relationship and can even provoke feelings of anger or aggression with the pt/family

nonverbal communication

26

it is very important to be aware of your __________________ (in regards to nonverbal communication)

  • stance
  • posture
  • where your arms/hands are
27

what are some forms of nonverbal communication?

  • body movements and posture
  • touch
  • facial expressions
  • vocal cues
28

what are some examples of health disparities?

  • race
  • gender and sexuality
  • economics
  • language and literacy
  • geography
  • bias and discrimination
29

2 ways we can help eliminate disparities?

  1. social determinants of health
  2. improving health literacy
30

what are some ways in which we can assess cultural competence?

  • communication
  • space
  • time orientation
  • social orientation
  • environmental control
  • biological variations
31

used to evaluate distance vision

Snellen chart

32

how is the Snellen chart test completed?

chart is mounted on a wall 20ft from the pt; pt covers one eye and identifies the letters

33

what tests are used to assess extraocular muscle function?

corneal light reflex and the 6 cardinal positions of gaze

34

what are the 6 cardinals positions of gaze?

  1. superior rectus (CN III)
  2. inferior oblique (CN III)
  3. medical rectus (CNIII)
  4. superior oblique (CN IV)
  5. inferior rectus (CN III)
  6. lateral rectus (CN VI)
35

what nodes do we palpate?

  • occipital (base of the skull)
  • postauricular (over the mastoid)
  • preauricular (in front of the ear)
  • tonsillar (angle of the mandible)
  • submandibular (along the base of the mandible
  • submental (midline under the chin)
  • anterior cervical (
36

auscultatory sites for the heart

  • aortic
  • pulmonic
  • Erb's
  • tricuspid
  • apical/mitral
37

what order do we palpate the abd?

  1. RLQ
  2. RUQ
  3. LUQ
  4. LLQ
38

what are the stages of edema?

  • 1+ (rapid skin response)
  • 2+ (10-15s skin response)
  • 3+ (prolonged skin response)
  • 4+ (prolonged skin response)
39

describe the Romberg test

client stands w/ feet together, arms at both sides, & eyes closed; the client should be able to stand w/ minimal swaying for at least 5 s

40

implies special feelings on the part of both the patient and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude

rapport

41

ability to see beyond outward behavior and to understand the situation from the patient's point of view

empathy

42

type of touch that is impersonal and businesslike; is used to accomplish a task

functional-professional

ex: a tailor measuring a customer for a suit or a physician examining a pt

43

type of touch that is still rather impersonal, but it conveys an affirmation or acceptance of the other person

social-polite

ex: handshake

44

touch at this level indicates a strong liking for the other person-a feeling that he or she is a friend

friendship-warmth

ex: laying one's hand on the shoulder of another

45

type of touch that conveys an emotional attachment or attraction to another person

love- intimacy

ex: engaging in a strong, mutual embrace

46

touch at this level is an expression of physical attraction only

sexual arousal

ex: caressing or touching another w/ intent to create sexual arousal

47

having the knowledge, abilities, and skills to deliver c are congruent with the patient's cultural beliefs and practices

cultural competence

48

difference, inequity, discrepancy, or gap

disparity

49

health difference that is closely linked with social, economic, or environmental disadvanatages

health disparity

50

consist of a variety of circumstances and conditions "in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks"

social determinants of health (SDOH)

51

the SDOH model has 5 key elements:

  1. economic stability
  2. education
  3. social and community context
  4. health and healthcare
  5. neighborhood and built environment