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What are the 4 components of self-concept?
- Body Image
- Self Esteem
- Roles
- Self-Identification
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What is role conflict?
Required to assume 2 roles that are incongruent
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What is role ambiguity?
Unclear role expectations
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What is role strain?
Blends role conflict & ambiguity
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What is role overload?
Having more roles than can be managed
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What will you include in your assessment and planning for patients with
delirium?
- Identify normal
- Past and present health status
- Description of onset, duration, range and intensity of symptoms
- Presence of chronic physical illness, dementia, depression, etc
- Lab values
- Medication history/use
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How do we assess dementia?
- Careful Hx from patient or informed source
- How long? Onset? S/Sx? Impairments
- Mental status assessment
- Important to obtain an objective
- assessment because social skills are often maintained despite cognitive decline
- Blessed Scale and
- Clock Drawing tests are commonly referred to
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What is important about ventilation of the lungs?
- Movement
- of air into/out of the lungs
- Respiration
- Exchangeof oxygen/carbon dioxide
- Alveolarcapillary/capillary cell membrane
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What are interventions for OSA (apnea)?
- -respiratory system compressed->happens a lot with obese patients.
- Typically snore.
-can give them CPAP
-have them sleep more sitting up than lying flat
-pulse ox monitor
-always be closer to nursing station
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Signs of dyspnea
- (nasal flaring,
- retractions, accessory muscle use, grunting, orthopnea, stridor, wheezing,
- pursed-lipped breathing)
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What is hypoxemia?
Low arterial blood oxygen levels
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What are s/s of mild hypoxemia?
◦Restlessness
◦Anxiety
- ◦Disorientation,
- confusion, and listlessness
◦Headaches
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What are s/s of severe hypoxemia?
◦Cyanosis
- ◦Cheyne-Stokes
- respiration
◦Apnea
◦Tachycardia
◦Hypotension
◦Asystole
◦Polycythemia
◦Coma
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What is hypoxia?
- }Deficient
- Oxygen availability
- }Inadequate
- pulmonary ventilation
- }Accumulation
- of abnormal hemoglobin in blood
}Ischemia
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S/S general hypoxia
}Headaches
}Fatigue
}Nausea
}Cyanosis
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s/s severe hypoxia
- }Changes
- in level of consciousness
}Coma
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What is a low-flow mask?
24-35%
Regular room is 21%
Assess for patient compliance
If not wearing simple mask, figure out why not wearing it
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What is a Partial/rebreathing masks?
Gives higher O2
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What is a simple face mask?
- open ports for exhaled gas, 5-12 l/min, 40-90% 02,
- variation due to holes
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What is a partial rebreather?
- block inhalation of o2 on one side, 6-15 L/min, deliver 70-90%, used less
- often
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What is a non rebreathing mask?
100% o2 10+L/min
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What is a face tent?
-good for people who are claustrophobic
-humdified o2
-10-15 L/min
40% o2
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What is a venturi mask?
-delivers controlled o2 concentration
100%
-allowing more or less room air to come in
Typically not humidifying so can cause mucosal damage
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What are the 5 Rights of Delegation
- Right task,
- circumstance,
- person,
- direction,
- supervision.
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What are the 6 Fs for Failure?
- •Failure to appropriately assess a
- client
- •Failure to report changes in client
- status
- •Failure to document in the client
- record
•Failure to obtain informed consent
- •Failure to report a coworker’s
- negligence
•Failure to provide adequate education
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What are the four elements of malpractice?
–Duty
–Causation
–Harm/Injury
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