317 Final Flashcards
types of grief
normal, prolonged, anticipatory, disenfranchised, complicated, exaggerated, delayed, masked, ambiguous
normal grief
common universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual response to loss and death.
prolonged grief
causes distress and intrusive thoughts
anticipatory greif
when a person experiences an unconscious process of disengaging or letting go before the actual loss of death occurs, especially in a situation of predicted or prolonged loss.
disenfranchised grief
occurs when the relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance (her examples were death of a gay partner or ex-partner).
complicated grief
prolonged significantly difficult time moving forward after the loss. It is a chronic and disruptive yearning for the deceased. It is characterized by trouble accepting death. It might be seen when the loss is from homicide, suicide, or accident
exaggerated grief
self destructive or maladaptive behavior, obsession, or psychiatric disorder
delayed grief
may be caused by loss being so overwhelming that the person must avoid the full realization of the loss
masked grief
interferes with the normal functioning but the person is unaware of the disruptive behavior as a result of the loss or ineffective grief resolution.
ambiguous grief
loss occurs when the lost person is [physically present, but not psychologically available (kidnap, brain injury, dementia).
mourning
time in which the outward social expression of grief takes place
bereavement
encompasses both grief and mourning and includes the emotional responses and outward behaviors of the person experiencing loss
patient symptomology in the last few hours of life
Noisy breathing Urinary incontinence or retention Pain Restlessness Dyspnea nausea/ vomiting Sweating Twitching/ jerking Confusion
4 goals of symptom management at end of life
comfort, dignity, quality of life, and support
admission criteria for hospice
pt desires service and only has 6 months or less to live
palliative care
for a person suffering from a life threatening illness and the care aims to prevent and relieve suffering by early identification, assessment, and pain treatment
goal of palliative care
decrease severities of symptoms and focus on trying to help family cope
hospice
curing measures and further medical care are stopped. focus is to enhance quality of life
kubler ross’s stages of grief
denial, anger, bargaining, depression, acceptance
describe the criteria for coroner’s case
cases in which the patient dies after 12 hours of being admitted into the hospital, in surgery, procedure, or if thought to be caused by malpractice. Also patients that seem to be neglected, malnutrienced, or under 18
what cannot happen if a patient dies and is on a coroner’s case?
nothing can be removed from the body until the body is released
dementia
decline in brain function and difficulties with skills such as memory and attention, orientation, place or person, and regulating emotions
delirium
is a sudden deterioration of mental functioning, due to an acute illness
depression
a low mood and or loss of interest in activities
cognitive impairment vs dementia
dementia has a much worse severity. example cognitive impairment person might forget where they put their keys but a dementia patient may put their keys in the freezer
nursing care for patients with dementia
safety! protect wandering and falling, protect others from inappropriate behaviors, help them use their brain, assist with ADLs, sticky notes
nursing diagnosis of patient with dementia
Ineffective coping related to changes in life situation as evidenced by inattention to personal hygiene, and health seeking behaviors.
A’s of dementia
Anogosnia - ignorance of the presence of disease
Agnesia - inability to recognize objects using the senses
Aphasia - loss of the ability to speak or understand spoken, written, or sign language
Apraxia - inability to make purposeful movements
Altered perception - misinterpretation of information from senses
Amnesia - memory loss
Apathy - lack of interest in activities
sundown phenomenon
Sundowning syndrome is a set of symptoms that can be seen in patients with dementia in which they become confused and agitated late afternoon and in the evenings. The closer to evening the “sundown,” the more confused and agitated the client becomes. Causes can be fatigue, unfamiliar environment, noise, medications, lighting, and disruption of circadian rhythms.
understand the use of diversion with a patient with cognitive changes
You do not want to make the patient get more agitated about the situation with arguing. In order to help, one must divert this by giving them something to do with their hands. Validate, reassure, and distract them with something that promotes comfortability.
relationship between aging and chronic illness
aging does not automatically lead to disability and dependence. most older people remain functionally independent despite the fact that most older adults have at least one chronic disease
identify safety measures that are appropriate to put in place for aging client
prevent falling by wearing nonslip foot wear, encourage them to use cane, walker… keep medication in original container, buy special alarm necklace incase of falls
3 top causes of death
heart disease, neoplasm (tumor/cancer), lower respiratory disease
theories of aging
biological - stochastic and nonstochastic.
psychosocial - disengagement, activity, and continuity/developmental
stochastic
views the effects of biological aging as results from random cellular damage that occurs over time from both the internal and external environment; nurture
non stochastic
views biological aging as the result from complex, genetic, and predetermined processes within the body; nature
disengagement theory
Aging individuals withdraw from customary roles and engage in more introspective, self-focused activities.
activity theory
older people continue to live healthy and satisfying lives when they continue to be actively engaged in social roles and exercise their physical and mental capacities.
continuity/developmental theory
suggests that as people age, personality remains stable and behavior becomes more predictable.
difference between men and women as they age
men are more likely to live with spouse, have health insurance, fewer chronic health problems, and less likely to be involved with caregiving
woman more likely to live alone, have loss of spouse, and more likely to suffer from chronic illness
how is dementia diagnosed
if a pt can not perform two ADLs and possibly on CAT scan or MRI
most types of dementia can only be
found on autopsy
brain death shows as
ventilator dependent and no brain stem reflexes
brain death test and procedures
multimodality evoked potentials (MEP), electroretinography (ERG), and the use of an EEF
2 interventions to decrease chance of developing pneumonia
IS and early ambulation
a pt with DKA or HHNS will be
severely dehydrated
Hemoglobin A1C levels
the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.
microvascular complication of diabetes in eyes
retinopathy
What is the upper limit of PNA vaccines a pt should get in their lifetime
2
NG feeding, what type of PNA is he at risk for
aspiration
Has PNA, needs antibiotics, what do we do first?
sputum culture
Cold and clammy
need some candy - hypoglycemic
Receive report that patient is having nightmares and flashbacks after a car accident what is wrong with them
PTSD
Betty Neuman’s primary prevention promotes patient’s wellness by stress prevention and reduction of _____ _____
risk factors
3 assessments that you would observe during ALARM stage of GAS
Increased HR, BP and respirations, glucose levels, oxygen requirements
patient with Stroke on comfort care, has distended abdomen and pressure on lungs. patient dies. is this a coroner’s case?
no
Deontological
People are worthy of respect
Fidelity
Faithfulness to responsibilities
Values
Personal belief about worth of given idea or behavior
Rules with Title IV ACT of 1964 and related antidiscrimination ACT of 2003
Free translator, verbal and written notification of right to receive services
patient on pain meds, muscle relaxer and sleep aide; becomes confused and combative; what caused it?
medication interaction
Total knee replacement, 2 days post op and still needs oxygen, why is he still requiring oxygen?
Decreased chest expansion
Nociceptive pain that can be superficial or deep
somatic
Nonpharmacological treatment with electrical stimulation
TENS unit
Screening test is useful in determine presence of neurological impairment
clock test
what do patients want from health care and providers
access, safety, outcomes, and respect
never events and examples
serious and preventable events that should never occur in hospital setting. example: pressure ulcer or wrong site surgery
sentinel events and examples
unexpected outcomes or risk involving death or serious physical or psychological injury. example is patient suicide, medication error, or delay in treatment
dependent nursing actions
doing something in guidance of the physician. example: medication administration
independent nursing action
part of the nursing process. you challenge the ways others think and look for rational and logical answers to problems.
domain
It is the knowledge of nursing practice and nursing history, nursing theory, education, and research. Gives nurses a comprehensive perspective that allows you to identify and treat patients’
theory
a set of concepts,definitions,and assumptions in order to explain a particular phenomenon.
paradigm
is a pattern of beliefs used to describe the domain of a discipline
Henderson’s theory
there are 14 basic life activities a patient needs assistance with, help with these needs until patient is able to do them alone.
Leininger’s theory
focusing on culture
Nightingale’s theory
based on bringing patient closer to nature
Orem’s theory
teaching patients to be self sufficient, practice self care, Goal: teaching patient to manage own health problems
Neuman’s theory
role of nurse is to stabilize patient, identify stressors, and assess the whole
Roger’s theory
unitary beings. Nurses role is to be truly present with patient and accept the patient’s view on reality
Watson’s theory
Caring
Roy’s theory
adaptation
Roy’s theory
adaptation
4 Cs
comfort, connection, confirmation, courtesy
maslows hierarchy of basic needs
At the base is physiological needs Then safety Then love/beloging Esteem And at the top (which means it is the least important) is self actualization
dreyfus model
shows how students acquire skills through formal instruction and practicing. students move through 5 stages.
karaoke-yahiro and saylor model
three levels of things as you grow as a nurse from a beginner to expert
respite care
provides short term relief or time off for people providing home care to an individual who is ill, disabled, or frail.
enculturation
experiences, observations, and norms that an individual learns and develops as their primary culture.
acculturation
adoption of a second culture which replaces the primary culture
multiculturalism
being aware of the different cultures, and has an impact due to cultural values, health beliefs and practice
ethnocentrism
a person’s belief that their own culture is superior over others
emic worldview
is an insider’s perspective into their own native culture
etic worldview
An etic worldview is an outsider’s perspective. In other words, an etic perspective is the perspective from an observer
morals vs ethics vs values
morals- standard of right and wrong, ethics- behavior, values - beliefs
altruism
a concern for the welfare and well being of a patient
autonomy
is the right to self determination. A person’s right to choose and ability to act on that choice (based on respect for human dignity), even when it is not in their best interest
justice
being fair to all people
fidelity
the obligation to be loyal to commitments made to oneself and to others
paternalism
occurs when health care providers decide what is “best” for clients. Can be a negative outcome of beneficence
veracity
the duty to tell the truth
nonmaleficence
the obligation of the health care provider to do no harm
AIDET
acknowledge, introduce, duration, explanation, thank you
using LAST in conflict resolution
Listen, advice/apologize, solve, thank you
4 Ps
4 P’s pain, potty, position, and possessions
CUS
I am concerned. I am uncomfortable. Stop there is a safety issue
medicare part A
hospital insurance
medicare part B
covers some preventative and primary care
medicare part C
medicare advantage plan
five rights of delegation
right person, right task, right supervision, right communication, and right circumstance
pneumonic - please take sue cold cuts
Compare and contrast the values associated with blood pressures
Normal SBP <120 and DBP <80
Prehypertension 120-139 or 80-89
Hypertension, stage 1: 140-159 or 90-99
Hypertension, stage 2: ≥160 or ≥100
primary vs secondary hypertension
primary is an unknown cause and secondary is resulting from a cause
first line therapy for stage 1 hypertension includes
diuretics, calcium channel blockers, ace inhibitors, and ARBs
DASH diet
consists of lowering salt intake, increasing potassium, calcium, magnesium, and fiber. The diet should have low concentrated carbohydrates and be low calorie.
how to figure out the MAP
((systolic) + (diastolic x2))/3
6 Ps with peripheral arterial disease
pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
poikilothermia
loss of temperature regulation
Bp highest at what part of the day
10 am - 6 pm
BP lowest at what part of the day
between midnight and 3 am
LDL
bad cholesterol - promote formation of atherosclerosis. want it less than 100
HDL
good cholesterol - associated with coronary artery disease want it higher than 35
total cholesterol
want less than 200
Two risk factors for coronary artery disease
hypertension and smoking
ejection fraction of systolic heart failure
is lower because the ventricle loses the ability to generate enough pressure to eject blood forward. EF usually less than 45% and can go as low at 10%
FACES
fatigue, limitation in activity, chest congestion, chest congestion, cough, edema, SOB
electron beam computed tomography (EBCT
locates and measures coronary calcification
Coronary Computed Tomography Angiography (CCTA)
using IV contrast and radiation, CCTA can detect calcified and noncalcified plaques in the artery
diagnosis of acute myocardial infarction
12-lead ECG, Serum Cardiac Biomarkers, Coronary Angiography
Serum Cardiac Biomarkers
Cardiac specific troponin, creatine kinase MB, and myoglobin are released into blood from necrotic heart muscle after an MI and can be tested fo
Interpersonal communication
exchange of information between two or more people. uses verbal and nonverbal cues to accomplish personal and relational goals.
Transpersonal communication
specific responses that encourage the expression of feelings and ideas and convey acceptance and respect.
feedback in communication
Feedback is a response to the message. Feedback can be positive, negative,verbal, or nonverbal.
intimate zone of space
(0- 18 inches): holding a crying infant, performing physical assessment, bathing, grooming, dressing, feeding, and toileting a patient
personal zone
(18 inches to 4 ft): sitting at a pt’s bedside, taking a pt’s nursing history, teaching an individual pt
socio-consultative zone
(4-12ft): giving directions to visitors in the hallway, asking if families need assistance from the pt doorway, giving verbal report to a group of nurses.
public zone
(12ft. and more): speaking at a community forum, lecturing to a class of students, testifying at a legislative hearing
social zone
(permission not needed): hands, arms, shoulders, back
consent zone
(permission needed): mouth, wrists, feet
vulnerable zone
(special care needed): face,neck, front of body
intimate zone of touch
(permission and great sensitivity needed): genitalia, rectum
SOLER
s- sitting posture o- observe an open posture l- lean toward the patient e- establish and maintain eye contact r- relax
methods of delivery of O2
Nasal cannula (1-6L/min), Simple mask (5-10 L/min), Partial rebreather (8-12 L/min), Non-rebreather (10-15 L/min), and the Venturi mask (4-12 L/min).
Betty Neuman’s Systems Theory
used to describe the concepts of stress and reaction to stress. views a patient, family, or community as constantly changing in response to the environment and stressors.
Intellectual indicator
someone setting unreasonable standards for perfection
maturational crisis
Varies with life stages
In preadolescents: puberty, school, and sex
In adults: major life changes including starting a family, losing their parents, and accepting physical changes
situational crisis
external sources such as job changes, car crash, illness, caregiver stress
General Adaptation System and the responses within the body
alarm stage, resistance stage, exhaustion stage
alarm stage
flight-or-fight reaction, Rising hormone levels result in increased blood volume, blood glucose levels, epi and NE amounts, HR, blood flow to muscles, oxygen intake
resistance stage
body stabilizes by normalizing and repairing damage, Hormone levels, HR, BP, and cardiac output should return to normal
exhaustion stage
body is no longer able to resist effects of stressor and has depleted the energy to maintain adaptation
symptoms of hyperglycemia
dry mouth, extreme thirst, frequent urge to urinate, drowsiness, frequent bed wetting, abdominal pain
symptoms of hypoglycemia
“Cold and clammy, patient needs some candy.”
sweating, trembling, dizziness, mood changes, hunger, headaches, blurred vision, extreme tiredness and paleness
somogyi effect
High blood sugar in early morning- low blood sugar at night causes rebound high blood sugar in the morning
Dawn phenomenon
High blood sugar early in morning. A decrease in insulin with an increase in glucagon and cortisol cause hyperglycemia in morning
Basal
mimics what pancreas does to keep blood sugar in normal range when a person’s not eating - Lantus/Levemir
Bolus
mimics the increase of insulin the pancreases sends out in response to food - Humalog/Novolog
CLABSI
central line associated bloodstream infection. Microorganisms can enter the bloodstream and contaminate CVCs through 2 mechanisms: extraluminally or intraluminally.
HAIs
hospital acquired infection. primary cause of preventable death and disability among hospitalized patients.
CAUTION
C- Close system catheter selection consider alternatives
A- Aseptic management
U- Universal standard precautions
T- Tie secure catheter to patient tubing to bed
I- Indication for use and to discontinue
O- Obstruction free specimen from sampling port
N- No dependent loops
FEV1
FEV1 is the maximal amount of air you can forcefully exhale in one second. low in COPD patients
