Nursing ADN Trivial Pursuit Questions and
Answers
Recognize Cues (Perfusion)
List 3 cues that indicate impaired perfusion
-edema-decreased tactile sensation-SOB
-diminished peripheral pulses-tachycardia/bradycardia
-hypotension/hypertension-low O2Sat-chest pain
-inadequate urine output-confusion-syncope
-activity intolerance-cap refill>3seconds f-abnormal heart/lung sounds
Recognize Cues (Perfusion)
List 3 aspects of a perfusion assessment
-BP, Pusle, O2Sat
-Cap refill
-check pulses
-listen to heart tones
-listen to lungs
-fluid volume status (I&O;turgor,edema)
Recognize Cues Perfusion
List 2 Diagnostic tests for Perfusion
-EKG/ECG-Venous Doppler
-Echo-CXR
-CBC
-BMP(electrolytes)
-BNP
-Troponin
-Heart Cath
Analyze Cues and Prioritize Hypotheses (Perfusion)
List 3 interrelated concepts for perfusion
-gas exchange-clotting
-elimination
-tissue integrity
-fluid and electrolytes balance
-mobility
-intracranial regulation
-reproduction
,Generate Solutions (Perfusion)
What should the goal be for a pt with edema?
-decreased edema
-have adequate I&O
-have adequate fluid volume
-adequate mobility/activity tolerance
-can perform ADL's
Take Action (Perfusion)
List 3 nursing interventions for impaired perfusion?
-educate on diet, exercise, stress reduction, rest, smoking cessation
-monitor VS, EKG, cholesterol, weight, electrolytes, abnormal assessment findings (edema, diminished
pulse, etc)
Evaluate Outcomes (Perfusion)
What are the expected outcomes of giving a beta blocker?
Decrease B/P and HR
Evaluate Outcomes (perfusion)
What is the expected outcome of giving a diuretic?
Increased urinary output, decreased edema
Recognize Cues (Tissue Inegrity)
What are risk factors for impaired Tissue integrity?
-elderly-poor perfusion
-diabetic-functional ability problems-smoking-obesity
-homeless
-quadriplegia/paraplegia
-bedbound
-incontinence
-poor nutrition
Recognize Cues (Tissue Inegrity)
What is the tool used to determine a patient risk for tissue breakdown?
Braden Scale
Analyze Cue/Prioritize Hypothesis (Tissue Integrity)
What are associated nursing problems for a patient with impaired tissue integrity?
, -impaired perfusion-impaired mobility
-impaired thermoregulation-impaired immunity
-impaired sensory perception
-impaired comfort
-impaired coping
-impaired fluid and electrolytes balance
Generate Solutions (Tissue Integrity)
Patient goals for impaired tissue integrity
-no skin breakdown/no further skin breakdown
-no infection
-control pain
-understand wound care/ self-care
Take Action (Tissue Integrity)
Nursing Interventions for impaired tissue integrity
-turn schedule
-keep patient clean and dry, use pure-wick or catheter if necessary
-assess skin frequently
-educate on hygiene, self-care, wound care
-educate on good nutrition
Recognize Cues (fluid and electrolytes)
Which body systems are most affected by imbalance in fluid and electrolytes?
-musculoskeletal
-cardiac
-renal
-Integument
-endocrine
-neurological
Recognize Cues (fluid and electrolytes)
Normal Lab Values
Potassium 3.5-5.0 mEq/L
Sodium 135-145 mEq/L
Calcium 8.6-10.2 mg/dL
Magnesium 1.3-2.3 mg/dL
Phosphorus 2.5-4.5 mg/dL
Urine Output 30 ml/hr
Analyze Cues/Prioritize Hypothesis (Fluid and Electrolyte Balance)
Other than fluid and electrolytes,
Answers
Recognize Cues (Perfusion)
List 3 cues that indicate impaired perfusion
-edema-decreased tactile sensation-SOB
-diminished peripheral pulses-tachycardia/bradycardia
-hypotension/hypertension-low O2Sat-chest pain
-inadequate urine output-confusion-syncope
-activity intolerance-cap refill>3seconds f-abnormal heart/lung sounds
Recognize Cues (Perfusion)
List 3 aspects of a perfusion assessment
-BP, Pusle, O2Sat
-Cap refill
-check pulses
-listen to heart tones
-listen to lungs
-fluid volume status (I&O;turgor,edema)
Recognize Cues Perfusion
List 2 Diagnostic tests for Perfusion
-EKG/ECG-Venous Doppler
-Echo-CXR
-CBC
-BMP(electrolytes)
-BNP
-Troponin
-Heart Cath
Analyze Cues and Prioritize Hypotheses (Perfusion)
List 3 interrelated concepts for perfusion
-gas exchange-clotting
-elimination
-tissue integrity
-fluid and electrolytes balance
-mobility
-intracranial regulation
-reproduction
,Generate Solutions (Perfusion)
What should the goal be for a pt with edema?
-decreased edema
-have adequate I&O
-have adequate fluid volume
-adequate mobility/activity tolerance
-can perform ADL's
Take Action (Perfusion)
List 3 nursing interventions for impaired perfusion?
-educate on diet, exercise, stress reduction, rest, smoking cessation
-monitor VS, EKG, cholesterol, weight, electrolytes, abnormal assessment findings (edema, diminished
pulse, etc)
Evaluate Outcomes (Perfusion)
What are the expected outcomes of giving a beta blocker?
Decrease B/P and HR
Evaluate Outcomes (perfusion)
What is the expected outcome of giving a diuretic?
Increased urinary output, decreased edema
Recognize Cues (Tissue Inegrity)
What are risk factors for impaired Tissue integrity?
-elderly-poor perfusion
-diabetic-functional ability problems-smoking-obesity
-homeless
-quadriplegia/paraplegia
-bedbound
-incontinence
-poor nutrition
Recognize Cues (Tissue Inegrity)
What is the tool used to determine a patient risk for tissue breakdown?
Braden Scale
Analyze Cue/Prioritize Hypothesis (Tissue Integrity)
What are associated nursing problems for a patient with impaired tissue integrity?
, -impaired perfusion-impaired mobility
-impaired thermoregulation-impaired immunity
-impaired sensory perception
-impaired comfort
-impaired coping
-impaired fluid and electrolytes balance
Generate Solutions (Tissue Integrity)
Patient goals for impaired tissue integrity
-no skin breakdown/no further skin breakdown
-no infection
-control pain
-understand wound care/ self-care
Take Action (Tissue Integrity)
Nursing Interventions for impaired tissue integrity
-turn schedule
-keep patient clean and dry, use pure-wick or catheter if necessary
-assess skin frequently
-educate on hygiene, self-care, wound care
-educate on good nutrition
Recognize Cues (fluid and electrolytes)
Which body systems are most affected by imbalance in fluid and electrolytes?
-musculoskeletal
-cardiac
-renal
-Integument
-endocrine
-neurological
Recognize Cues (fluid and electrolytes)
Normal Lab Values
Potassium 3.5-5.0 mEq/L
Sodium 135-145 mEq/L
Calcium 8.6-10.2 mg/dL
Magnesium 1.3-2.3 mg/dL
Phosphorus 2.5-4.5 mg/dL
Urine Output 30 ml/hr
Analyze Cues/Prioritize Hypothesis (Fluid and Electrolyte Balance)
Other than fluid and electrolytes,
