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Enthusiasm Stagnation Frustration Apathy 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 p.782 * p.787 * p.798 * p.812 * p.788 * p.818 * * p.970 p.805 * p.818 * p.102 7 * p.796 * p.103 1 * p.102 6 * p.950 * p.951 * p.956 * p.970 p.950 * p.820 * 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 p.957 * p.961 * p.104 9 * p.111 1 * p.565 * p.579 * p.582 * p.553 p.578 * p.575 * p.599 * p.598 * p.740 * p.606 * p.602 * p.603 * p.609 * p.591 p.688 * p.688 * 41 42 43 44 45 46 47 48 49 50 p.689 * p.694 * p.695 * p.711 * p.695 * p.739 * p.766 * p.763 * p.750 * p.743 * #7 in class #18, 28, 38 in textbook 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 18 1 11 30 16 2 18 12 15 9 4 15 21 10 9 9 14 11 8 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 4 3 3 6 6 10 0 30 20 20 0 1 2 3 17 2 16 3 26 15 41 42 43 44 45 46 47 48 49 50 6 7 4 25 4 17 15 7 0 6 Problems Critical thinking application Brain storming Critical Thinking Indicators Include three aspects of critical thinking Behaviors demonstrating Knowledge & intellectual skills Affective or emotional behaviors Critical Thinking in Action Chart 3-1 (pp.26) details some questions to help the nurse analyze a patient care situation and determine a course of action Knowledge & Intellectual Skills Nursing process and decision-making skills judges the value of information Evaluation 評鑑 From lower to high level Simple as baseline builds a pattern from diverse elements Synthesis 綜合 Analysis separates information into part for better understandin 分析 applying knowledge to a new situation Application 應用 understanding information 理解 Comprehension recall of data Knowledge 知識 (Bloom,1956) Learn from your mistakes and strengths to improve your own style Build your fundamental knowledge Understand your fundamental knowledge DO2 vs. VO2 18 MI, CV disoders A patient who arrives in the emergency department complaining of squeezing substernal pain that radiates to the left shoulder and jaw also complains of nausea, diphoresis, and shortness of breath. What should the nurse do? A) B) C) D) Complete the patient’s registration information, perform an EKG, gain IV access, and take vital signs Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician Gain IV access, give sublingual nitroglycerin, and alert the cardiac catheterization team Administer oxygen, attach a cardiac monitor, take vial signs, and administer sublingual nitroglycerin Sodium →→ Hypertension Tx Hypertension→→ Sodium, but Potassium 21 The nurse is caring for a patient receiving spironolactone to treat hypertension. Which instruction should the nurse give the patient? Choose foods high in potassium B) Take potassium supplements each day C) Discontinue sodium restrictions D) Avoid salt substitutes A) Medication Treatment Table 32-4, pp. 1026-1029 Diuretic and related drugs Thiazide diuretics Loop diuretics Potassium-sparing diuretics Aldosterone receptor blockers Adrenergic inhibitors-central-acting adrenergic antaginists Calcium channel-blocking agents ACE inhibitors Angiotensin II receptor antagonists Beta-Adrenergic blockers Alpha-adrenergic blockers Vasodilators 26 The nurse is caring for a 28-year-old nonsmoker with a deficiency in the enzyme antitrypsin. To what deficiency does this predispose the young patient? Pulmonary edema B) Development of lobular emphysema C) Cystic fibrosis D) Empyema A) Changes in Alveolar Structure with Emphysema The bronchioles, alveolar ducts, and alveoli are destroyed, and the air spaces within the lobule are enlarged Changes occur in the lobule, preserving the peripheral portions of the acinus Laboratory Assessment Status if arterial blood gas values for abnormal oxygenation, ventilation, and acid-base status Sputum samples Hemoglobin and hematocrit blood tests Serum alpha1-antitrypsin levels drawn Chest x-ray Pulmonary function test Risk Factors for COPD Tobacco smoke causes 80-90% of COPD cases! Passive smoking Occupational exposure Ambient air pollution Genetic abnormalities Alpha1-antitrypsin deficiency 20 A patient diagnosed with multiple sclerosis has decreased vital lung capacity. The nurse is aware that vital capacity measures: A) B) C) D) The volume of air inhaled and exhaled with each breath The volume of air in the lungs after a maximum inspiration The maximum volume of air inhaled after normal expiration The maximum volume of air exhaled from the point of maximum inspiration Lung Capacities Total Lung Capacity (TLC) = RV+IRV+TV+ERV Vital Capacity (VC) =IRV+TV+ERV=TLC-RV Functional Residual Capacity (FRC) = RV+ERV Inspiratory Capacity (IC) = TV+IRV Pulmonary Function Tests The most accurate measures for asthma are pulmonary function tests using spirometry including Forced vital capacity (FVC) Forced expiratory volume in the first second (FEV1) Peak expiratory rate flow (PERF) Chest x-ray to rule out other causes 25 A 10-year-old girl is having an asthma attack on the school grounds at recess. Which the following is the preferred treatment to alleviate her airflow obstruction? A) B) C) D) Corticosteroids Anticholinergics Beta-adrenergics Peak flow monitoring device Medications Used for Asthma Quick-relief medications, see Table 24-2, pp.693 Beta2-adrenergic agonists Anticholinergics Long-acting medications, see Table 244, pp.713 Corticosteroids Long-acting beta2-adrenergic agonists Leukotriene modifiers 20 Auscultation of the lung fields provides the nurse with information on the type of breath sound the patient is exhibiting. While listening over the manubrium, the nurse auscultates loud expiratory sounds that lst longer than inspiratory sounds. The nurse will document her findings as: A) B) C) D) Vesicular breath sounds Bronchovesicular breath sounds Bronchial breath sounds Tracheal breath sounds Assessment of Breath Sounds Normal breath sounds (see Table 21-5, pp.575) Bronchial Bronchovesicular Vesicular Abnormal (adventitious) breath sounds (see Table 21-6, pp. 575) Crackles Wheezes Rhonchus Friction rubs 30 Changes in the cardiac structure and function occur in the heart of an older adult. Which of the following is a normal change expected in the aging heart? A) Increase Deceased B) C) D) left ventricular ejection time Deceased connective tissue in the SA and AV Increase nodes and bundle branches Thickeing rigidity Thinning and flaccidity of cardiac valves Widening of the aorta Enthusiasm Stagnation Frustration Apathy Teaching vs. Learning Assess, Learn, Evaluate We always teach you, not evaluate you Critical Thinking Indicators Include three aspects of critical thinking Behaviors demonstrating Knowledge & intellectual skills Affective or emotional behaviors Ways to Exercise Your Brain Pre-reading Add notes from textbook into handout Review anatomy & pathophysiology from your previous lectures or textbook Power-points Assign reading, especially emphasizing in class Practice questions from CD, NCLEX, or learning resource center Group study review (Sharing) Ask questions immediately after reading After exam ALWAYS clarify the concepts which you have missed