NURS 425 Exam 1 Blueprint
Disclaimer: This document is designed to help guide your study and help you focus on topics
that we find to be some of the most important information that was covered in the material for
the exam. This is not all of the information that will be on the exam, so please be sure to study
information that was covered in class but is not on this study guide.
Topics for exam 1:
Holistic Care for the High-Acuity Client Module
High acuity - acute or chronic complex patients with unpredictable outcomes, commonly in
critical care or ICU
Nurse therapeutic communication at the end of life
1. Normalize processes and feelings and emotions
2. Resources like pastoral care (religious care from a pastor)
Differences between palliative care, hospice, end of life care and withdrawal of care.
1. Palliative Care
a. Comfort care
b. Improving quality of life
c. Accepting new norms
d. Lasts until the end of life period
e. Curative treatments
2. Hospice Care
a. 6 months or less to live
b. This is a type of palliative care
c. Inpatient or in-home
3. End of Life Care
a. Final phase of care
b. Death is imminent
c. Can use hospice and palliative care
d. Shift of care to physiological and emotional
4. Withdrawal of Care
a. Withdrawing life supporting measures
b. Commonly with sedation meds, pain meds, dry secretion meds to ease comfort
c. Family and client must be prepared
d. Pastoral care
Manifestations of sleep deprivation
, 1. Delirium
2. Stress
Manifestations and nursing interventions for delirium
1. Aggression, suspicion, acute confusion, altered mental status, altered consciousness
2. Those with delirium are 5 times more at risk for death
3. Can be caused by
a. Infection
b. Adverse drug reactions
c. Lack of sleep
d. Metabolic conditions
4. Prevention is key
a. Avoid meds that cause delirium like Benzos
b. Last resort: antipsychotics if patient is a danger to self or others
5. Sedation can be used to treat delirium in patients deemed dangerous to self/others
Nurse teaching and communication related to pain treatment/medication in the high acuity
environment
1. Opioids in addition to nonopioids to manage pain
2. Nonopioids can augment (increase effectiveness) the effects of opioids
3. Advocate for patient control
Nursing interventions and considerations for sedation in the high-acuity environment
1. Sedation is associated with use of a ventilator (physically breathes for the patient)
2. Sedation can be used to treat delirium
a. Only if you have to and use as little as possible
3. Use as little as possible and only if completely necessary
a. USED TO use benzos but they cause PTSD
i. Can increase delirium and lead to respiratory distress
ii. Med interactions
4. Monitor to make sure patient is not over-sedated
Physiologic changes in the older adult
1. Neurological
a. Decrease in the production of neurotransmitters
b. BBB is more permeable
c. Ventricles dilate (hydrocephalus causing pressure on brain tissues)
2. Cardiovascular
a. Decreased elasticity of arterial walls
b. Loss of conductive tissue (tranmit electrical signals to facilitate cardiac
contraction)
c. Calcification of valves (restricts blood flow out of heart making heart work
harder)
3. Respiratory
a. Calcification of costal cartilage (reduces flexibility of ribcage limiting inspiration)
b. Decrease chest wall compliance (chest wall is resistant to expansion so body has
to work harder to breathe)
c. Lower capacity for RBC to carry O2
d. Loss of lung elasticity and recoil
, 4. Gastrointestinal
a. Wearing down of teeth
b. Decreased saliva
c. Decreased thirst response
d. Decreased functionality of LES
e. Decreased digestive function
f. Malabsorption in GI tract
g. Reduced perfusion to liver
5. Genitourinary
a. Decreased GFR (the rate at which toxins are filtered out of the blood and
eliminated)
b. Decreased creatinine clearance (accumulation of toxin in blood)
c. Incontinence
d. Higher risk of UTI
6. Integumentary
a. Loss of elasticity of connective tissues (skin, bone, cartilage, fat, blood, lymph)
b. Decreased SQ tissue
c. Thinning of dermal and subdermal layers
d. Fragile blood vessels
e. Reduced lean mass
7. Musculoskeletal
a. Decreased muscle mass
b. Stiff joints
c. Decreased mobility
d. Loss of bone mass
Factors influencing older adults in the high-acuity environment
1. Rapid onset of symptoms
2. Quicker deterioration of condition
3. Early warning signs masked by comorbidities
Factors that contribute to high-acuity admissions
1. Age
2. Acute issues
a. Stroke, trauma, aneurysm
3. Exacerbation of chronic illness
4. Economic factors
Complications from the high-acuity environment
1. Pain management
a. Resp depression
b. Altered LOC
c. Expected vs problematic alterations
d. Polypharmacy
Expected physiologic changes at the end of life
1. Cardiovascular and VS changes
a. Leaky vessels, inefficient perfusion, loss of conductive tissue, calcification of
valves
2. Decreased efficacy of drugs
3. Incontinence
Disclaimer: This document is designed to help guide your study and help you focus on topics
that we find to be some of the most important information that was covered in the material for
the exam. This is not all of the information that will be on the exam, so please be sure to study
information that was covered in class but is not on this study guide.
Topics for exam 1:
Holistic Care for the High-Acuity Client Module
High acuity - acute or chronic complex patients with unpredictable outcomes, commonly in
critical care or ICU
Nurse therapeutic communication at the end of life
1. Normalize processes and feelings and emotions
2. Resources like pastoral care (religious care from a pastor)
Differences between palliative care, hospice, end of life care and withdrawal of care.
1. Palliative Care
a. Comfort care
b. Improving quality of life
c. Accepting new norms
d. Lasts until the end of life period
e. Curative treatments
2. Hospice Care
a. 6 months or less to live
b. This is a type of palliative care
c. Inpatient or in-home
3. End of Life Care
a. Final phase of care
b. Death is imminent
c. Can use hospice and palliative care
d. Shift of care to physiological and emotional
4. Withdrawal of Care
a. Withdrawing life supporting measures
b. Commonly with sedation meds, pain meds, dry secretion meds to ease comfort
c. Family and client must be prepared
d. Pastoral care
Manifestations of sleep deprivation
, 1. Delirium
2. Stress
Manifestations and nursing interventions for delirium
1. Aggression, suspicion, acute confusion, altered mental status, altered consciousness
2. Those with delirium are 5 times more at risk for death
3. Can be caused by
a. Infection
b. Adverse drug reactions
c. Lack of sleep
d. Metabolic conditions
4. Prevention is key
a. Avoid meds that cause delirium like Benzos
b. Last resort: antipsychotics if patient is a danger to self or others
5. Sedation can be used to treat delirium in patients deemed dangerous to self/others
Nurse teaching and communication related to pain treatment/medication in the high acuity
environment
1. Opioids in addition to nonopioids to manage pain
2. Nonopioids can augment (increase effectiveness) the effects of opioids
3. Advocate for patient control
Nursing interventions and considerations for sedation in the high-acuity environment
1. Sedation is associated with use of a ventilator (physically breathes for the patient)
2. Sedation can be used to treat delirium
a. Only if you have to and use as little as possible
3. Use as little as possible and only if completely necessary
a. USED TO use benzos but they cause PTSD
i. Can increase delirium and lead to respiratory distress
ii. Med interactions
4. Monitor to make sure patient is not over-sedated
Physiologic changes in the older adult
1. Neurological
a. Decrease in the production of neurotransmitters
b. BBB is more permeable
c. Ventricles dilate (hydrocephalus causing pressure on brain tissues)
2. Cardiovascular
a. Decreased elasticity of arterial walls
b. Loss of conductive tissue (tranmit electrical signals to facilitate cardiac
contraction)
c. Calcification of valves (restricts blood flow out of heart making heart work
harder)
3. Respiratory
a. Calcification of costal cartilage (reduces flexibility of ribcage limiting inspiration)
b. Decrease chest wall compliance (chest wall is resistant to expansion so body has
to work harder to breathe)
c. Lower capacity for RBC to carry O2
d. Loss of lung elasticity and recoil
, 4. Gastrointestinal
a. Wearing down of teeth
b. Decreased saliva
c. Decreased thirst response
d. Decreased functionality of LES
e. Decreased digestive function
f. Malabsorption in GI tract
g. Reduced perfusion to liver
5. Genitourinary
a. Decreased GFR (the rate at which toxins are filtered out of the blood and
eliminated)
b. Decreased creatinine clearance (accumulation of toxin in blood)
c. Incontinence
d. Higher risk of UTI
6. Integumentary
a. Loss of elasticity of connective tissues (skin, bone, cartilage, fat, blood, lymph)
b. Decreased SQ tissue
c. Thinning of dermal and subdermal layers
d. Fragile blood vessels
e. Reduced lean mass
7. Musculoskeletal
a. Decreased muscle mass
b. Stiff joints
c. Decreased mobility
d. Loss of bone mass
Factors influencing older adults in the high-acuity environment
1. Rapid onset of symptoms
2. Quicker deterioration of condition
3. Early warning signs masked by comorbidities
Factors that contribute to high-acuity admissions
1. Age
2. Acute issues
a. Stroke, trauma, aneurysm
3. Exacerbation of chronic illness
4. Economic factors
Complications from the high-acuity environment
1. Pain management
a. Resp depression
b. Altered LOC
c. Expected vs problematic alterations
d. Polypharmacy
Expected physiologic changes at the end of life
1. Cardiovascular and VS changes
a. Leaky vessels, inefficient perfusion, loss of conductive tissue, calcification of
valves
2. Decreased efficacy of drugs
3. Incontinence
