Stimulates muscles to contract which produces purposeful movement
Nervous System
Most people go through four or five cycles of sleep each night. How long do each cycle lasts about?
90-100 minutes
Are caused by an alteration of normal body structure and function, chemical agents, physical agents, infections, and hypoxia
Physiologic stressors
According to ______, there are _____ _____ in the dying process.
Kübler-Ross, five stages
Which nonsteroidal anti-inflammatory drug might be administered to inhibit platelet aggregation in a patient at risk for thrombophlebitis?
1) Ibuprofen (Motrin)
2) Celecoxib (Celebrex)
3) Aspirin (Ecotrin)
4) Indomethacin (Indocin)
3). Aspirin
Rationale:
Aspirin is a unique NSAID that inhibits platelet aggregation. Low-dose aspirin therapy is commonly administered to decrease the risk of thrombophlebitis, myocardial infarction, and stroke. Ibuprofen, celecoxib, and indomethacin are NSAIDs, but they do not inhibit platelet aggregation.
What are the 3 types of muscle that the muscular system is made up of?
Skeletal, cardiac, and smooth or visceral muscles.
Comprises about 75% of total sleep time, consists of four stages.
NREM- non rapid eye movement
Stress can be categorized as what?
Developmental or situational stress
What are the two kinds of written advance directives
A living will and a durable power of attorney for health care
The nurse assesses clients' breath sounds. Which one requires immediate medical attention? A client who has:
1) Crackles
2) Rhonchi
3) Stridor
4) Wheezes
3). Stridor
Rationale:
Stridor is a sign of respiratory distress, possibly airway obstruction. Crackles and rhonchi indicate fluid in the lung; wheezes are caused by narrowing of the airway. Crackles, rhonchi, and wheezes indicate respiratory illness and are potentially serious but do not necessarily indicate respiratory distress that requires immediate medical attention.
Exercise that involves tightening or tensing the muscle without moving
Isometric
Which sleep stage is this?
-The depth of sleep increases, and arousal becomes increasingly difficult.
-This stage composes about 10% of sleep.
Stage 3
Responsible for developing intervention, provide guidance, trusting nurse-patient relationship, asking open-ended question and actively listening
What is the nursing practice for stress?
A nurse should explain what to patients upon admission or upon the request of client or caregiver. This include who to make decision for the client in the event the client cannot make decision for him or herself
Advance care planning
The nurse assesses the client's pedal pulses as having a pulse volume of 1 on a scale of 0 to 3. Based on this assessment finding, it would be important for the nurse to also assess the:
1) Pulse deficit
2) Blood pressure
3) Apical pulse
4) Pulse pressure
2). Blood pressure
Rationale:
If the leg pulses are weak, the nurse should assess the blood pressure in order to further explore the reason for the low pulse volume. If the blood pressure is low, then a low pulse volume would be expected. The pulse deficit is the difference between the apical and radial pulse. The apical pulse would not be helpful to assess peripheral circulation. The pulse pressure is the difference between the systolic and diastolic pressures.
Are used for side-to-side transfers only, these include roller boards, slide boards, transfer boards, or inflatable mattresses
Lateral-assist devices
Is characterized by a disruption and misalignment of the client’s sleep-wake cycle.
Circadian rhythm disorder AKA jet lag
Poorly localized and describes pain from diseased, inflamed, or ischemic organs, such as with pneumonia or bowel obstruction.
Visceral pain
True or False
A DNR, which is written by a healthcare provider at the request of the nurse or designated healthcare surrogate, indicates to the healthcare team how to proceed in the event of a cardiopulmonary code.
False
A client who has experienced prolonged exposure to the cold is admitted to the hospital. Which method of taking a temperature would be most appropriate for this client?
1) Axillary with an electronic thermometer
2) Oral with a glass thermometer
3) Rectal with an electronic thermometer
4) Tympanic with an infrared thermometer
3) Rectal with an electronic thermometer
Rationale:
The rectal route is the most accurate for assessing core temperature, especially when it is critical to get an accurate temperature. Therefore, in this situation it is preferred. Temperature is a particularly relevant data point for this client with hypothermia as it indicates the patient's baseline status and response to treatment. The electronic thermometer is safer than glass and is relatively accurate. Mercury thermometers are no longer used in the hospital setting. The accuracy of tympanic thermometers is debatable.
What is Crepitation?
Is an audible or palpable popping during joint movement
Other situations that can promote better rest and sleep are what?
1)Decreasing carbonated cola beverages
2)Engaging in exercise during the day
3)Controlling the sleeping environment
Cutaneous stimulation is best used with what?
chronic, localized pain
A client who is _____________ will exhibit behaviors of accepting the diagnosis, such as discussing with family and reflecting on one’s life
Coping with end-of-life care
Which change in hygiene practices may be necessary as the patient ages?
1) Brushing teeth twice a day
2) Bathing every other day
3) Decreasing moisturizer use
4) Increasing soap use
2) Bathing every other day
Rationale:
As a person ages, sebaceous glands become less active, causing skin to dry. Older people may find it necessary to bathe every 2 days, increase the use of moisturizers, and decrease soap use to prevent further drying of skin. Older adults should brush their teeth after every meal and at bedtime to prevent tooth decay. It is recommended that people of all ages brush their teeth at least twice a day, so that option does not represent a change in an older adult's hygiene practices.