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Nursing 111 > Exam 5 > Flashcards

Exam 5 Flashcards

Self concept, sleep & rest; fluid and electrolytes; Grief and spirituality;

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1
Q

components of self concept

A
  • body image
  • personal identity
  • role perfomrance
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2
Q

factors that affect self concept

A
  • environment
  • support system/ resources
  • stressors
  • background
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3
Q

stressors affecting self concept

A
  • identity stressor
  • body image stressors
  • self esteem stressors
  • role stressors
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4
Q

how to improve self esteem

A
  • demand respect
  • teach others to treat you well
  • tell others what you like about them
  • acknowledge your worth
  • overcome the fear of failure
  • increase your comfort zone
  • reframe thoughts
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5
Q

sleep: homeostatic drive

A

-maintains internal equilibrium by adjusting its physiological processes influencing many body functions:
-thirst, sleep
this is your mind telling you to sleep when you are tired.

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6
Q

circadian rhythm

A

daily rythmic activity cycle based on 24hour intervals

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7
Q

Stage 1 of sleep

A
  • very light sleep, if not disturbed person will move onto 2nd stage
  • muscle contractions (Hypnic Myoclonia) occur and are preceeded by the feeling of falling
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8
Q

Stage 2 of sleep

A
  • person starts to think of images but no visions are seen with your eyes
  • if undistrubed, drift off into stage 3
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9
Q

Stage 3 of sleep

A
  • deeper sleep, muscled are relaxed, and HR is slowed down, BP is falling, breathing is steady and even
  • hard to be woken up
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10
Q

Stage 4 of sleep

A
  • dreaming stage
  • deepest sleep of all stages
  • person usually only wakes if there is a sudden loud noise.
  • BP, HR, and brain speed up
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11
Q

when does sleep walking, night terrors, and bed wetting occur

A

stages 3 &4 of sleep

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12
Q

stage 5 (REM sleep)

A
  • if awakened now..most dreams will be remembered
  • REM slows as person wakes
  • adults have 3-5 periods of REM a night
  • REM is about 90% of time
  • brain and eyes move fast
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13
Q

percenatge of time in each sleep stage

A
  • 50% in stage 2 sleep
  • 20% in REM
  • 30% in other stages
  • infants spend 50% in REM
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14
Q

sleep cycles

A
  • 90-110 minutes each cycle
  • first cycle of night is short REM periods and long deep sleep periods
  • as night progresses–REM increases and deep sleep decreases
  • by morning–all sleep is either stage 1 or 2 or REM
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15
Q

Sleep disruptions

A

-if REM is disturbed, our bodies don’t follow normal sleep cycles next time around–we slip directly into REM until we catch up

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16
Q

sleep needs/ different ages

A
  • infants 18-20 hrs/day
  • babies-16 hrs/day
  • teens-9hrs/day
  • adults 7-8hrs/day
  • -needs can fluctuate 5-10hrs
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17
Q

sleep deprivation

A
  • increases effects of alcohol
  • negative effects on immune and nervous system
  • causes memory problems and clumsiness.
  • severe deprivation– mood swings hallucinations
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18
Q

benefits of sleep

A
  • body cells regenerate during sleep

- grow and repair damage caused by ultraviolet rays and stress

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19
Q

most common sleep disorders

A
  • insomnia
  • sleep apnea
  • narcolepsy
  • restless legs syndrome (RLS)
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20
Q

heavy smokers and alcohol use sleep issues

A
  • alcohol deprives person on REM sleep

- smokers often decrease REM sleep because wake every 3-4 hrs from nicotin withdrawal

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21
Q

sleep apnea

A

-interruption of breathing during sleep
-often associated with obesity, enlarged tonsils, decreased muscle tone due to aging
-airflow obstructed for 10-60 sec while person struggles to breath due to suction collapsing wind pipe
blood oxygen levels fall= person awakes
-person is always sleepy=possible personality change/ depression

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22
Q

sleep apnea risks

A
  • morning headaches, decline in mental functions, disinterest in sex, increased BP, irregular heart beat, increased risk of stroke or MI
  • increased risk of MVA’s and sudden respiratory arrest during sleep
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23
Q

how to help sleep apnea

A
  • lose weight, sleep on back, or surgery to remove obstruction
  • CPAP (continuous positive airway pressure device) while sleeping
  • never take sedatives or sleeping pills
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24
Q

Restless leg syndrome

A
  • hereditary disorder causing unpleasant crawling, prickling, or tingling of legs and feet
  • causes person to wake often with urge to move feet
  • often associated with anemia, pregnancy, and diabetes
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25
Q

narcolepsy

A
  • sleep attacks at times during the day
  • brain is unable to regulate sleep wake cycles normally
  • can last a few seconds or over 30mins
  • hereditary, brain injury, neurological disease
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26
Q

narcolepsy symptoms

A
  • loss of muscle control
  • hallucinations
  • disruption of night time sleep
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27
Q

what can help narcolepsy

A
  • stimulants and antidepressants can control symptoms

- naps during the day can help reduce daytime excessive sleepiness

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28
Q

sleep hygiene

A
  • sleep schedules of going to bed and getting up all week
  • daily exercise 5-6 hrs before bedtime
  • relax watch tv, pray, read, meditate
  • avoid alcohol caffeine and nicotine
  • comfotable bedroom temperatures
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29
Q

how can we help pts sleep

A

music
back massage
clean wrinkle free bedding????

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30
Q

Transcelullar

A

fluid contained within the specialized cavities of the body

  • CSF, pleural fluid, digestive secretions
  • equals 1 Liter of fluid
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31
Q

Active transport

A
  • substance combines with a carrier on outside of cell surface and move in together but then seperate
  • moves against normal concentration gradient from low to high
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32
Q

fluid intake vs fluid output

A
  • driven by thirst mechanism in hypothalmus
  • urine- increase w diabtetes, decreae w renal disease
  • insensible loss-lungs- increase vs decrease respiration rate-water vapors
  • feces
  • skin-sweat, fever, burns abrasions
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33
Q

kidneys regulating fluids

A

conserves and excretes

  • excretes-1200-1500 cc water daily
  • minimum output-500 cc/day
  • filters 135-180 L of plasma/day
  • conserves w/ dehydration or less intake
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34
Q

how do kidneys know when to excrete or conserve with increased serum osmolality

A
  • regulated by antidiuretic hormone-hypothalmus

- ADH production- ^ in distal tubule permeability- ^ of reabsorption of water into the blood- decreased urine output

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35
Q

how do kindeys know when to excrete or conserve with decreased serum osmolality

A
  • ADH suppression- decreased distal tubule permeability- decreased reabsorption of water into the blood- increased urine output
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36
Q

selective retention and excretion by kidneys: renin angiotensin aldosterone mechanism

A

INCREASES BLOOD VOLUME

  • decreased blood flod or BP to kindeys- the release of renin-conversion of angiotensinogen ro angiotensin I to II- promotion of Na+ and H2Oretension to increase blood volume
  • release of aldosterone is also stimulated which promotes Na+ retention
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37
Q

when does renin system kick in

A
  • when blood vol is low if BP is low the heart gets the blood first- kidneys see this so increase blood vol
  • renin causes retention of Na+, if you retain salt water will follow so this will ^ blood vol
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38
Q

Selective retention and excretion by kidneys: Atrial natriuretic Hormone

A

DECREASES BLOOD VOLUME

  • released from the cell of the heart in response to excess blood vol and stretching of atrial walls
  • secreted w/ ^ BV–CHF, renal failure, increased BP
  • it causes renal excretions of Na+ & water, vasodilation, decreases BV and increases osmolality serum
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39
Q

isotonic imbalance

A

-water & electrolytes are lost or gained in equal proportions so osmolality remains constant

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40
Q

osmolality

A

solute concentration

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41
Q

hypovolemia vs hypervolemia

A
  • fluid volume deficit

- fluid volume excess

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42
Q

hypotonic vs hypertonic

A
  • lower osmolality (less solute)

- higher osmolality (more solute)

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43
Q

oslmolar balance

A

loss or gain of only water so osmolality of serum is altered

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44
Q

hyperosmoolar vs hypoosmolar

A
  • dehydration-increased solute

- overhydration-decreased solute

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45
Q

isotonic solutions

A
  • 0.9% NS
  • Lactated Ringers
  • D5W 5% dextros in water
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46
Q

When are isotonic solutions used

A
  • used to expand the intravascular compartments & restore vascular volume by remaining in compartments
  • used with hypotension and hypovolemia
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47
Q

hypertonic solutions

A
  • Dextrose solution
  • 5% dextrose in NS-(D5NS)
  • 5% dextrose in 1/2 NS-(D5 1/2NS)
  • 5% dextrose in LR-(D5LR)
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48
Q

When would you use Hypertonic solutions

A
  • water moves from cells (intracelular) into interstitial space then to vascular compartments - dilutes blood concentration
  • not used for dehydration!
  • used with edema
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49
Q

D5W

A

isotonic on inital administration but then provides free water when dextrose is metabolized- expands intracelullar and extracelullar volumes
-not used for pt at risk for intracranial pressure

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50
Q

Hypotonic solutions

A
  • 0.45% NaCl (half normal saline)

- 0.33% NaCl (1/3 normal saline)

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51
Q

when would you use hypotonice solutions

A
  • provide free water and treats celullar dehydration
  • water moves from vascular compartments into interstitial space and into cells
  • cells will expand–not for cerebral edema!!
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52
Q

Sodium 135-145 mEq/L

A
  • most abundant cation in ECF and greatest determinant of serum osmolality(solute concentration)
  • reg of water balance when reabsorbed from tubules
  • chloride and water reabsorbed with it to maintain ECF vol
  • transmits nerve impulses
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53
Q

continuous or excess excretions =

A

hyponatremia- water imbalance

GI loss, sweating, diuretics

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54
Q

hyponatremia

A
  • low solute concentration in vascular compartment d/t excretions leaving a higher solute concentration in interstitial space and cells-cells swell bc water is pulled to higher solute
  • water intoxiacation
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55
Q

hypernatremia

A
  • thirst mechanism helps to prevent it-shouldn’t happen

- increase solute in ECF-increase pull of water from cells=cell dehydration

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56
Q

Potassium 3.5-5mEq/L

A
  • main cation in ICF ( sm amount in ECF)
  • regulates ICF osmolality
  • needed for healing and growth
  • helps promote conduction of nerve impulses
  • VITAL for skeletal, cardiac function, & smooth muscle activity
  • kidneys excrete about 80% of all K+
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57
Q

hypokalemia

A
  • t be stored by body must be digested by daily
  • lost with heavy perspiration and poor intake
  • losses- vomiting, gastric suction, K+ wasting diuretics
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58
Q

hypokalemia can cause

A

-causes muscle weakness, leg cramps, fatigues, anorexia, N/V, decreased BS, and decreased motility, cardiac disrhythmias, decreased reflexes, weak and irreg pulse, and numbness

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59
Q

Hyperkalemia

A
  • > 5
  • more dangerious than hypo
  • increased intake and K+ sparing diuretics–disfunctioning kidneys
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60
Q

Hyperkalemia can cause

A
  • Cardiac arrest, GI hyperactitity, diarrhea, irritability, confusion, cardiac dysrhythmias, decreased HR, muscle weakness, absence of reflexes,paresthesias(tingling pricking) & numbness of extremities
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61
Q

K+ usual dose

A
  • must be diluted

- 20-40 mEq/L

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62
Q

Magnesium

A
  • 1.5-2.5 mEq/L
  • abundant cation in ICF
  • needed for intracelullar metabolism-ATP production, protein and DNA synthesis, regulator of neuromuscular, and cardiac function
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63
Q

where is magnesium found

A

-cereal grains, nuts, dried fruit, legumes, green leafy veggies, dairy, meat, fish

64
Q

Hypomagnesemia

A
  • seen concurrently with low serum Ca levels
  • reduced intake- dieting, NG suction
  • impaired GI absorption from disease
  • increased secretions- alcoholism, laxative abuse, diarrhea
65
Q

hypomagnesemia can cause

A

-neuro irritability w/ tremors, increased reflexes, convulsions, tachycardia, ^ BP, dysrhythmias, confusions/disorientation, vertigo, anorexia, resp difficulties, dysphasia, Chyostek’s & Trousseau

66
Q

Chyosteks

Trousseau

A
  • touch cheek and lip and cheek go up

- take BP with cuff on wrist curls in

67
Q

hypermagnesemia

A
  • > 2.5

- oversupplementation or decreased excretions–renal failure

68
Q

hypermagnesemia can cause

A

-decreased BP, bradycardia, decreased reflexes, N/V, muscle weakness, paralysis, lethargy, drowsiness, resp depression, coma, resp and cardiac arrest

69
Q

Chloride

A
  • 95-108 mEq/L
  • functions with Na to reg serum osmolality and bld vol. Cl follows Na
  • reg of acid-base balance
  • buffer in exchange of O2 & Carbon dioxide in RBCs
  • in same foods as Na
70
Q

hypochloremia

A
  • <95

- loss through GI tract, kidneys, sweating

71
Q

Hypochloremia can cause

A

-muscle twitching, tremors, tetany(involuntary contraction of muscles)

72
Q

Hyperchloremia

A
  • > 108
  • excess replacement of NaCl, KCL
  • causes hypernatremia
73
Q

hyperchloremia can cause

A

-weakness lethargy, risk of dysrhythmia or coma

74
Q

Calcium

A
  • 8.5-10.5 mg/dL
  • vital in nueromuscular funtion, cardiac function, essential for bld clotting, bones and teeth
  • w/ increasing age intestines are less effective w/ absorption causing increase in renal excretions= bld levels fall = pull of Ca from bones
  • decreased Mg are found concurrently with low serum Ca levels
75
Q

what helps keep Ca in bones

A
  • weight bearing exercises
  • vit D
  • absorbed in intestines only under activated Vit D
76
Q

where can Ca be found

A
  • found in leafy greens, milk, canned salmon, supplements

- (1,000-1,500 mg/day)

77
Q

hypocalcemia

A

-from removal of parathyroid gland or injury to it

78
Q

hypocalcemia can cause

A
  • tetany, numbness or tingling around the mouth, hands, and feet, and poss, seizures
  • Chvostek’s and trousseau’s
79
Q

hypercalcemia

A
  • excess released from bones

- prolonged immobolization

80
Q

hypercalcemia can cause

A

-lethargy, weakness, bone pain, anorexia, N/V

81
Q

Phosphate (PO4)

A
  • 2.5-4.5 mg/dL
  • major component of ICF, also in ECF in bone and skeletal muscles and nerve tissue
  • essential for function of muscles, nerves, and RBC & involved in metabolism of protein, fat, and carbs
  • increased in children d/t bone growth
82
Q

acidic
basic
normal pH of blood

A

7
7.35-7.45
lungs and kindeys prevent acidosis and alkalosis

83
Q

buffers

A

acids are constantly produced during metabolism

-pH maintained by respiratory and renal systems

84
Q

HCO3 bicarbonate

A

regulated by kidneys

-normal serum level-22-26 mEq/L

85
Q

Fast acid-base regulators

A
  • lungs

- eliminating or retaining carbon dioxide w/ alteration of RR

86
Q

acidosis vs alkalosis affects on lungs

A
  • increase rate and depth of respiration

- decrease in rate and depth on respiration

87
Q

Slow acid-base regulators

A
  • kidneys-ultimate regulator thru excretions or conservations of bicarb
  • takes hrs and days to correct imbalances but more permanent
88
Q

acidosis affects on kidneys

A

-reabsorption of bicarb & excretions of hydrogen ions

89
Q

where is carbon dioxide levels measured

A

arterial PaCO2

venous blood PCO2

90
Q

blood ph
PaCO2
HCO3
PaO2

A
  • 7.35-7.45
  • 35-45
  • 22-26
  • 80-100
91
Q

interpreting ABG pt 1

A

pH up=ALKALOSIS

pH down=ACIDOSIS

92
Q

respiratory function vs metabolic function

A
  • indicated by PCO2

- indicated by HCO3

93
Q

interpreting ABG pt 2

R.O.M.E

A

Respiratory
Opposite (pH up PCO2 down)
Metabolic
Equal (pH up HCO3 up)

94
Q

pitting edema

A

1+=2mm
2+=4mm
3+=6mm
4+=8mm

95
Q

good fluid and electrolyte balance

A
  • drink 6-8 glasses of water/day
  • avoid foods w/ excess salt and caffeine
  • well balanced diet
  • limit alcohol intake
  • increase fluids before during and after strenuous activity
  • replace electrolytes
96
Q

urine Specific gravity

A

1.005-1.030

high=urine concentrated

97
Q

when to notify an MD about urine output

A

30-50 cc/hr

98
Q

Impact of loss: Toddler/Preschool

A

Magical thinking

99
Q

Impact of loss: school age

A

death final

100
Q

Impact of loss: Adolescent

A

reckless behavior “immortality”

101
Q

Impact of loss: young adult

A

religious cultural beliefs start to form

102
Q

Impact of loss: adult

A

accepts own mortality

103
Q

Stages of Grieving:Denial

A
  • need to see facts-documentd, explanations

- allow them to ask questions- be open and patient

104
Q

Stages of Grieving: Anger

A
  • “why me”
  • let them talk while you just listen
  • support system
  • faith foundation
105
Q

Stages of Grieving: Bargaining

A
  • “Please god I will be a better person…”

- support, prayer, positivity

106
Q

Stages of Grieving: Depression

A
  • Physical side effects
  • listening, support, encouragement, reassurance
  • pharmacueticals are sometimes necassary to treat depression
107
Q

Stages of Grieving: Acceptance

A
  • won’t let the issue run your life
  • continued support
  • love, encouragement, prayer
  • acceptance from others
  • start working on the new you–history of disease
108
Q

factors influencing response to loss

A
  • significance of loss
  • culture
  • spiritual beliefs
  • socioeconomic status
  • support system
  • cause of loss
  • gender
109
Q

Cultural beliefs: American

A

family members and friends are support

expect high quality of care

110
Q

Cultural beliefs: Canadian

A
  • socialized medicine
  • trust physicians
  • willing to wait for treatment
111
Q

Cultural beliefs: Chinese

A

-combo of herbal and western medicine

112
Q

Cultural beliefs: Cuban

A
  • extended family must participate

- insult if large amount of family/friend aren’t present at death

113
Q

Cultural beliefs: Filippino

A
  • often noncompliant
  • home remedies
  • beleive in supernatural cause of disease
114
Q

Cultural beliefs: Haitian

A
  • obedient to health care professionals

- rarely ask questions

115
Q

Cultural beliefs: Jamaican

A
  • Home remedies
  • respectful of physician
  • reluctant to admit pain
116
Q

Cultural beliefs: Japanese

A
  • confidentiality important

- illness kept to immediate family only

117
Q

Cultural beliefs: Korean

A
  • need to include family in plan of care

- prefers noncontact

118
Q

Cultural beliefs: northern european

A
  • very modest
  • stoic with pain tolerance
  • express little emotion
119
Q

Cultural beliefs: southern european

A
  • whole family is involved
  • very independent
  • educated by reluctant to get medical attention
120
Q

Cultural beliefs: vietnamese

A
  • negative emotions conveyed in silence
  • avoid touching head-considered sacred
  • back rub-uneasy experience
  • organ donation = suffering in next life
121
Q

signs of impending death

A
  • loss of muscle tone
  • difficulty speaking
  • difficulty swallowing
  • slowing of circulation
  • changes in respiration
  • sensory impairment– last sense to go is hearing
122
Q

signs of death

A
  • total lack of response to external stimuli
  • no muscular movement, especially breathing
  • no reflexes
  • flat encephalogram- no brain waves for 48 hrs, life support
123
Q

cerebral death/ higher brain death

A
  • occurs when the cerebral cortex is irreversibly destroyed
  • presence of cardiac activity
  • absence of responsiveness to external stimuli, apnea, absence of cephalic reflexes
124
Q

Legalities related to death

A
  • advanced healthcare directives: tell someone what you want to happen
  • autopsy: must be done if died alone
  • certification of death
  • euthanasia
  • inquest- unwitnessed death investigation
  • organ donation: next of kin has to allow it even if license says organ donor
125
Q

Nursing Process: Assessment

A

recognize the state of awareness

126
Q

Nursing Process: diagnosis

A

fear, hopelessness

127
Q

Nursing Process: planning

A

dying person’s Bill of Rights

128
Q

Nursing Process: implementation

A
  • focus on individual
  • death with dignity
  • hospice/ palliative care(focuses on pain, stress)
  • meeting spiritual and physical needs
  • family support
129
Q

Nursing Process: evaluation

A
  • personal involvement in selecting and evaluating

- individual’s expressed satisfaction with current life circumstances

130
Q

Hospice

A
  • team of doctors, nurses, social workers, counselors, home health aide, clergy, therapists, trained volunteers
  • pain/symptom control
  • spiritual care
  • homecare and inpatient care
  • respite care
  • family conference
  • bereavement care
131
Q

spirituality

A
  • needs
  • well-being
  • distress
  • development
  • religion
  • agnostic-not enough evidence for GOD
  • atheist- no GOD
132
Q

Spiritual development: infants & toddlers

A
  • no sense of right or wrong
  • copy others
  • parents are omnipotent-all the power
  • God responsible for natural events
133
Q

Spiritual development: school age

A

-spiritual disappointments- wish for something that does not come true

134
Q

Spiritual development: adolescents

A

-question science/religious points of view

135
Q

Spiritual development: adult

A
  • answer questions from children

- religious philosophy

136
Q

Spirituality assessment

A
  • environment
  • behavior
  • verbalization
  • affect and attitude
  • interpersonal relationships
137
Q

what do beliefs affect

A
  • diet and nutrition
  • healing
  • birth
  • death
138
Q

Spiritual beliefs: adventist

A

-dead are asleep until the return of Jesus Christ at which final rewards and punishment will be given

139
Q

Spiritual beliefs: baptists

A

-clergy seeks to minister by counsel and prayer with patient and family

140
Q

Spiritual beliefs:buddhist

A

-last rite chanting at bedside soon after death

141
Q

Spiritual beliefs: mormon

A
  • ground burial
  • cremation is discouraged
  • preaching gospel to the dead
142
Q

Spiritual beliefs: eastern orthodox

A

-last rites obligatory if death is impending

143
Q

Spiritual beliefs: episcopalian

A

-“Litany of dying” is adminstered prior to time of death

144
Q

Spiritual beliefs: quakers

A

-do not belief in life after death

145
Q

Spiritual beliefs: greek orthodox

A
  • last rites are administered of sacrament of holy communion

- priest should be called early enough so patient is still conscious

146
Q

Spiritual beliefs: hindu

A
  • priest may tie thread abound neck or wrist to signify blessing- do not remove
  • immediatley after death priest pours water into mouth
  • family washes body
  • body is cremated
147
Q

Spiritual beliefs: muslim

A
  • patient must confess sins and beg for forgiveness
  • family is present
  • family washes, prepares, and places body facing mecca
  • no autopsy
148
Q

Spiritual beliefs: johovah’s witness

A
  • no last rites

- no blood products

149
Q

Spiritual beliefs: judaism

A
  • body washed by family

- no cremation or autopsy allowed

150
Q

Spiritual beliefs: lutheran

A

“last rites” optional

151
Q

Spiritual beliefs: methodist

A
  • believe in divine judgement after death

- good will reward and evil punished

152
Q

Spiritual beliefs:roman catholics

A
  • “sacrament of the sick”

- “last rites”

153
Q

spiritual health: nursing diagnosis

A
  • spiritual distress
  • spiritual wellbeing-potential for enhanced
  • coping-ineffective
  • anxiety
  • hopelessness
154
Q

spiritual health: planing and implementation

A
  • provide spiritual resources
  • help fulfill religious obligations
  • help identify inner strengths
  • self examination of own beliefs
  • focus on clients beliefs
  • presencing-living in moment
155
Q

spiritual health: evaluation

A
  • client express comfort with spiritual beliefs
  • client continues spiritual practices appropriate to health status
  • client expresses decreased feelings of guilt
  • client displays a positive affect
156
Q

Gordon’s value of belief pattern: subjective data

A
  • “what is important to your life?”
  • “does religion help when difficulties arise?”
  • “does hospitalization interfere with your religious practice?”
157
Q

Gordon’s value of belief pattern: objective data

A
  • evidence of religious articles present (statues, rosary beads)
  • prayer books

Nursing 111 (2 decks)

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