Final(plus All Other Decks) Flashcards
Full liquid purpose
transition from clear to soft, short term low nutrients
Clear liquid purpose
Minimal digestion, short term not a lot of nutrients
Soft bland low fiber diet purpose
Decrease fiber for GI stress, can be long term unless calcium is limited
Criteria for diet progression
No N/V, eat 3/4 of current diet, no choking diarrhea or cramping
Barriers and risk factors for lifestyle change involving nutrition
Money, aspiration (secretions weakness diminished sensory), deficient knowledge
Nurse role as caregiver
Promote health, prevent illness, restore health, facilitate coping
Health is
More than just absence of disease
Illness is the ____ to a disease
Response of a person
Health belief model (3)
Individuals perception of susceptibility of an illness, individuals perception of the seriousness of the illness, and the individual’s perception of the benefits of an barriers to taking action
Health promotion should result in
Improving health, enhanced functional ability, better quality of life in all stages of development
Primary prevention
Precedes disease or dysfunction, health education programs, immunization
Secondary prevention
Focus on individuals who are expecting health problems, those at risk for developing complications, ex screenings
Tertiary prevention
Occurs when defect is permanent, minimize effects of long term disease, ex rehab pt surgical treatment
components of urinary system
kidneys, ureters, bladder, urethra
kidneys function
regulate fluids electrolytes and acid base balance, produces hormones that control RBC formation BP and vitamin D activation
glomerular filtration
when SBP t compensate and filtration stops
tubular reabsorption
tubules reabsorb >99% of all filtered water back into the body
Aldosterone
promotes Na reabsorption= water reabsorption
renin production
regulates BP
Erythropoietin
stimulates RBC production in bone marrow
Vitamin D activation
important for absorption of calcium in GI
function of ureters
peristaltic contractions of smooth muscle moves urine along
Rest
Condition where the body is in a decreased state of activity….leads to feeling refreshed
sleep
altered state of consciousness where the persons perception of and reaction to the environment are decreased. Complex rhythmic state involving a progression of repeated cycles……illness and hospitalization can interfere with ability to sleep
how does sleep restore body systems?
Preserves cardiac function, releases growth hormones, conserves energy-decreases metabolic rate, protein and synthesis and cell division
Purpose of sleep
restores body function, releases growth hormone, helps immune function, psychological restoration (memory, learning and cognitive)
RAS (reticular activating system)
located in brain steam. contains special cell that maintain alertness &wakefulness. wakefulness occurs when RSA receives visual, auditory, pain and tactile sensory stimuli
neurotransmitters involved in wake behavior
norepinephrine, dopamine, histamine and serotonin
sleep promoting neurotransmitters
melatonin, adenosine and growth hormone
circadian rhythms- biological clock
influenced by internal and external factors, regulate certain biologic and behavioral functions. one full cycle every 24 hrs
circadian synchronization
when persons sleep-wake cycle follows inner biologic clock….this does not happen when you work night shift
Stages of sleep
four stages of NREM( non rapid eye movement) which comprises 75% of sleep. and one stage of REM( rapid eye movement)
NREM stage 1
drowsiness
last 5-10 min, eyes move slowly under the eyelids, muscle activity slows down, involuntary muscle jerking can occur, easily awakened
NREM stage 2
light sleep
eye movement stop, HR slows, body temp decreases, relaxation progresses, can be awaken with touch or shaking
NREM stage 3
depth of sleep increases, arousal becomes difficult, composes 10% of sleep
NREM stage 4
arousal is difficult, blood flow decreases to the brain and redirects itself to the muscles, restoring physical energy. parasympathetic nervous system dominates( HR, BP, RR drop.) composes 10% of sleep.
REM sleep
dream sleep
constitutes 20-25% of nightly sleep. associated with processing emotions, retaining memories and relieving stress. essential for mental and emotional equilibrium. Breathing is rapid, irregular and shallow. HR, BP, RR, metabolic rate and temp increase!
sleep cycle
NREM 1-2-3-4-3-2-REM-2-3-4-3-2-REM. Usually repeated 4-5 times a night. each cycle lasts 90-100 mins. if awaken at anytime the person returns to stage 1 on NREM
Factors affecting sleep
developmental considerations, motivation, culture( rituals, co-bedding) lifestyle and habits( shift work, stressors) Physical activity( increases REM and NREM sleep) Dietary habits( alcohol, caffeine, and smoking are stimuli’s) environment, psychological stress, illness, medications.
developmental considerations….how much sleep does everyone need?!?!?
infant- 20hrs toddler( 1-4 yr) -12hr, two naps school age (5-12 yr) -10-11 adolescent (teenager) 9-10 hr young adult and older adult- 7-8 hr
dyssomnias
sleep disorders characterized by insomnia or excessive sleepiness
parasomnias
patterns of waking behaviors that appear during sleep
Insomnia- dyssomnias
difficulty falling asleep, intermittent sleep or early awakening. Most common of all sleep disorders. common in people > 60, women after menopause, and people with a history of depression.
transient insomnia
occur due to situational stress…. like before a wedding
sleep hygiene, treatment for chronic insomnia
restrict caffeine, nicotine, alcohol. Avoid stimulating activities after 5 pm. Avoid naps, eat light before bed, sleep in cool dark room and take a warm bath.
stimulus control, treatment for chronic insomnia
use bedroom for sex and sleep only, get out of bed if unable to fall asleep after 15-30 mins, get up at the same time every day no matter what time you fall asleep at night.
relaxation, treatment for chronic insomnia
progressive muscle relaxation, imagery, medication
Narcolepsy-Dyssomnia
uncontrollable desire to sleep, caused from lack of hypocretin, REM sleep occurs in 15 mins, sudden onset “sleep attack”.
Tx- stimulant drugs, brief daytime naps
Obstructive sleep apnea- Dyssomnia
condition in which a person experiences apnea or diminished breathing efforts during sleep. apnea may last 10-20 seconds, up to 2 mins. Oxygen levels drop, pulse becomes irregular, BP increases.
Obstructive sleep apnea-risk factors, cause, treatment
Risk factors-obesity, males and old age. Airway is occluded from the collapsing of the hypopharynx or other structural abnormalities. OSA can lead to cardiovascular problems, death occurs in 38,000 Americans. Treatment-remove tonsils, wearing and oral appliance, CPAP(continuous positive airway pressure)
Restless leg syndrome-dyssomina
feeling of creeping, crawling or tingling sensations in the legs. Treatment- leg massage, heat/cold and medications. U-urge to move legs R-rest induces G-gets better with activity E-evening symptoms are more severe
sleep deprivation- dyssomina
decrease in amount, consistency and quality of sleep. decreased REM & NREM. can cause irritability, loos of concentration to total disintegration of personality. Effect apparent after 30 hrs of wakefulness
Parasomnias
waking behaviors that appear during sleep. somnambulism- sleep walking, sleep talking, night terrors, bruxism- grinding of teeth. MAJOR CONCERN-safety. common in children but they usually outgrow it by adulthood.
role
specific task, action or function specific to one’s position
social role
set of rights, duties, expectations, norms and behaviors Examples- wife mother daughter, student teacher, nurse patient
role norms
when people approve of a social role, they will conform to role norms. anticipation of rewards/ punishments and satisfaction of behaving in a pro-social way makes people conform to a role
nurse aide role
functions under supervision of licensed nurses. care given is related to hygiene, comfort, exercise, safety and elimination needs
LPN role
provide nursing care and health promotion under direction of the RN, physician or dentist. technical college of at least one year of full time study. take the NCLEX-PN
Associate degree nursing
through university, college and community colleges. requires 2 years of full study time
bachelors of science degree in nursing
through colleges and universities, requires four years of study, half year of general education.
Masters of science degree in nursing
concentrated study such as administration, education, nurse practitioners ( peds, family, gerontology, midwife, ect…)
Melatonin
Natural chemical released from the brain at night, decreases wakefulness, promotes sleep
Function of the bladder
Temporary storage of urine, adults can hold 200-300 cc (children 100-200cc) before feeling the urge to void, can expand to 4 L of fluid
Urethra
Tubelike structure that carries urine from the bladder to exit the body, men:6-8 inches long, women: 1.5-2.5 inches long, function is for elimination and reproduction
The ____ void of the day is the most concentrated
First
Incontinence
Involuntary release of urine, causes are damage to spinal cord stress on renal system or poor muscle control
Urinary Retention
When urine is not excreted properly but is produced normally, bladder not responding to micturition reflex
Nocturia
Night urination
Polyuria
Large amounts of urine
Anuria
No urine
Oliguria
Little amount of urine
Diuresis
Excessive urine from Meds
How much urine output for an hour should equal
weight in Kg
Older age affecting urination
Decreased ability to concentrate urine (leads to Nocturia) decrease muscle tone(leads to decrease capacity to hold urin) decreased contractility (leads to urine retention, UTIs)
Alcohol and caffeine have
Diuretic effect, increase urine production
High sodium food and drink
Decrease urine production
Urinary tract infections
Common cause of HAIs in the US, women are more susceptible
Lower urinary tract infections
Cystitis- inflammation of the bladder, urethritis-inflammation of the urethra, 90% from E. Coli
Lower urinary tract infections signs and symptoms
Normal: Fever, chills, not feeling relieved after urination, burning
In elderly: confused, increased falls, sudden incontinence, trachycardia, trachypnea, hypotension
Diagnosis of UTI
Bacteria WBC RBC, identified organism and effective antibiotic
Treatment of a UTI
Increase fluids to 2-3L, (cranberry juice 300cc a day for 3-4 weeks), pain: analgesics
Continence
Control over the time and place of urination, usually between ages 2-5
Stress incontinence
Involuntary loss of urine with abdominal pressure (cough sneeze exercise) usually only small amounts of urine are lost
Urge incontinence
Strong desire to urinate, can’t suppress signal from the bladder to the brain, may have loss of large amount of urine
Overflow incontinence
Loss of urine associated with an over distended bladder, side effect of med enlarged prostate or urinary retention, causes constant dribbling of urine
Functional incontinence
Loss of urine caused by something other than disease (loss of cognitive function, Meds, restraints)
Treatments for incontinence
Medicines (anticholinergics, antispasmodics: ditropan), kegel exercises, post void residuals (PVRs), surgical (elevates urethral position or supports the bladder neck)
ILeal conduit/ urinary diversion
Ureters transplanted to an isolated section of the small intestine (small portion of small intestine brought through surface of abdomen resulting in a stoma)
Continent urostomy– kock ileal reservoir
Pronounced “coke”, uses section of the intestine to create a pouch which will hold the urine, client will need to catheterize the stoma to drain urine
Serum creatinine
Main indicator of kidney problem, blood test with normal range of 0.5- 1.2 mg/dl, measures end product of muscle and protein metabolism, 50% renal function can be lost before it shows in level
Blood urea nitrogen (BUN)
Normal range from 10-20 mg/dl, measures renal excretion of urea nitrogen, increase may be from liver or kidney disease dehydration infection, decrease may be from malnutrition fluid volume excess severe liver damage
Normal range for serum creatinine, BUN, and specific gravity
0.5-1.2 mg/dl, 10-20 mg/dl, 1.005- 1.035
Specific gravity
Normal range is 1.005- 1.035, measures concentration of urine, increase may be from dehydration decreased kidney perfusion, decrease may be from over hydration diuretic Meds or diabetes
There should be no _____ (5) in urine
Blood (except with uti trauma disease) glucose (except with diabetes) ketones (except with diabetes) protein or sediment
Ph of urine normal range
4.6-8
Length of catheter insertion
Male 8 inches female 2 inches
Indwelling urethral catheter
Foley catheter
Intermittent urethral catheters
Straight catheter
Suprapubic catheter
For long term management of urinary incontinence
How to prevent infection in catheter clients
Hang bag on bed frame, keep bag lower than bladder, assess tube for kinks, strict aseptic technique per protocol, and proper catheter care
ages for young- old, middle-old, and old-old
60-74, 75-84, 85 and up
current life expectancy
78.7
genetic theory of aging
“genetic clocks” determine the occurrence and rate of metabolic processes
wear and tear theory of aging
organisms wear out from increased metabolic functioning, cells become exhausted from continual energy depletion
immunity theory of aging
decline in the function of the immune system, thymus loses size and function, leads to increased infections immune disorders and cancer
cross linkage theory of aging
chemical reaction that produces damage to the DNA and cell death, accumulates with age which interferes with cell function
Free radical theory of aging
free radicals (molecules with separated high energy electrons) have adverse effects on adjacent molecules , over time irreversible damage results from the accumulated effects of this damage
Ageism
prejudice of the elderly, view that older people are ‘different’ and don’t have the same needs or desires, also view they have ‘outlived their usefulness’ and ‘are childlike, unable to learn new things, or too old for sex’
chronic illness ___ have at least one ____ have at least two
80% and 60%
physical changes to integumentary system with age
diminished subcutaneous tissue, loss of collagen, wounds heal slow, sweat and sebaceous glands decrease in number and function, dermis thins and flattens, fewer melanocytes= pale
senile lentigo
common skin lesion, smooth brown irregular shape
cherry angiomas
common skin lesion, small round red or brown spots on truck
keratoses
common skin lesion, raised thickened pigmentation scaly and crusty
hair with aging
men: balding is common, women: thinning occurs more facial hair, both: lose pigmentation (graying) ear and nose hair thicken
nails with aging
grow more slowly, become more brittle and yellow
changes to the musculoskeletal system with aging
mobility slows, muscle mass and strength decrease, bone demineralization, joints stiffen, narrowed vertebral spaces (loss of height), kyphosis (curving of spine)
falls in the elderly
1 out of 3 fall each year, primary cause for accidental death, results in injuries, leads to increased hospital costs, loss of independence
common causes for falls
accident (fall from bed), gait disturbance (arthritis), vertigo, polypharmacy, acute illness, confusion and cognitive impairment, orthostatic hypotension, visual disorders
Physical changes to the nervous system with aging
CNS responds more slowly to multiple stimuli, slower responses (especially in unfamiliar settings), decreased reflex response
Short term memory _____ with age
Decreases
Long term memory with aging
Remains intact, temperature regulation and pain/ pressure perception become less efficient
Sleeping patterns with aging
Sleep at night shortens, increase night awakenings, more naps, decrease sleep in stages 3 & 4
Cardiac changes with age
Loss of elasticity in blood vessels (increased BP), fatty plaque deposits continue to occur in blood vessels, venous return less efficient, cardiac output decreases (HR increases with stress exercise an illness and takes longer to return to baseline)
Pulmonary changes with age
Lungs become smaller, decreased effectiveness of cilia, lack of basilar inflation (decreased lung sounds in bases), ribs less mobile, decreased exchange of o2 and co2
GI changes with aging
Teeth poor condition, many wear dentures, decreased saliva, dry mucus membranes, decreased esophageal mobility, decreased gastric secretions and nutrient absorption, decreased gastric mobility and peristalsis
Changes to genitourinary with aging
Decrease blood flow to kidneys, functioning nephrons and bladder capacity decrease by 50%, waste is filtered and excreted more slowly, voiding is more frequent, decreased bladder and sphincter control
Male specific changes in genitourinary with aging
Enlarged prostate (benign prostatic hypertrophy BPH), bladder contractions dribbling retention hesitancy and Nocturia
Presbyopia
Inability to focus or accommodate properly due to decreased elasticity of lens, often need corrective lenses to see close up or detailed work
Prebycusis
Gradual sensorineural loss caused by nerve degeneration in the inner ear, loss of high frequency sounds, difficulty hearing s sh and ch
Eriksons theory
Begins around age 60, ego integrity vs despair, begin to reflect on life and search for meaning, search for acceptance of the past and present w/o the fear of death
Ego integrity
Use life review or reminiscence (tell stories of the past) looks back on life with pride and without regret, looks forward with optimism and enthusiasm
Despair
Has regrets about the past, sees current problems as insurmountable, view life as a series of unresolved problems and missed opportunities, may feel worthless or helpless
What is loss
A situation in which something of value is changed or no longer present
Actual loss
Others can see/ feel this loss
Perceived loss
Felt by the individual
Maturational loss
Results from the developmental process (puberty or aging)
Situational loss
Loss from a life changing (illness death job loss)
Anticipatory loss
Occurs before actual loss happens (may ease actual loss)
Grief
Response to the experience related to loss
Bereavement
Subjective, experienced by surviving loved ones
Mourning
behavior associated with grief, aides in altering or resolving grief
Normal/ uncomplicated grief response
Not prolonged may be abbreviated, less than 6 months
Complicated grief response
Considered unhealthy last longer than 6 months may never accept the loss
Elisabeth Kubler Ross
Studied grief process and stages of grief, said no 2 people grieve the same, stages may overlap or not happen, may never reach acceptance
Stages of grief
Denial, anger, bargaining (with higher power), depression, acceptance (not everyone gets here)
Definitions of death
1) Exhibiting irreversible cessation or RR Apical pulse and BP also called heart lung death
2) exhibited irreversible loss of brain function called cerebral or higher brain death
Palliative care
Approach that improves quality of life of clients and their families facing the problem associated with life threatening illness, provides holistic care, focus is quality of life and management of symptoms
Hospice care
Aiding patient and family when death appears imminent, may be final stage of palliative care, less than 6 months to live, focus on symptom management and bereavement services
Advanced directives (definition and two types)
Allows patient to state in advance of illness their specific wishes, types: living will (gives healthcare providers direction regarding care) durable power of attorney (allows an appointed person to make healthcare decisions in the event the patient is unable to do so)
DNR/ no code
must be an order in pt record, no resuscitation will be attempted once order is in, comfort measures only, can be a DNR with exceptions
signs of impending death
inability to swallow, pitting edema, decrease GI and urinary function, incontinence, loss of mobility/sensation, elevated temp, decreased BP and HR, noisy irregular RR, may loss consciousness
postmortem care for the patient
physician must pronounce death, must follow facility policy, know any cultural or religious factors, prepare body for the release from the facility (supine position, remove tubes, clean body, cover appropriately, place proper ID tags),know if organ donor, autopsy may be preformed(decided by coroner physician or family)
postmortem care for the family
listen to them, honor their grief, determine if they would like to see loved one, offer spiritual care, nurse may also need to comfort other patients that realize a death has happened, need to make sure death certificate is signed by appropriate staff
Stages of competence
Novice(student), Advance beginner (1st year of practice), competent (2-3 years of practice), proficient (4 years), the expert (5 +years)
role as a care provider
traditional most essential role, provides direct care and client comfort, shows sensitivity and concerns for the client
role as a teacher
provides information and helps client to have knowledge and skills, promotes healthy lifestyle, need to know physiological processes pharmacology and nutrition, also need the ability to communicate effectively with pt
role as a counselor
provide emotional intellectual and psychological support, helps client to cope, encourage alternative behaviors recognize choices and develop sense of control, need to be aware of own beliefs and how to conceal them and how to appropriately interact with each level
role as change agent
assist client to make changes to improve health, need the ability to motivate guide and teach
role as client advocate
acts on behalf of the client to bring about change, promotes what is best for the client, protects clients rights wishes and supports their decisions, needs professional communication skills
role as research consumer
engages in evidence-based practice, identifies significant researchable problems and participates in research activities
role as a manager
plans and directs care, coordinates activities, needs the skill of delegation and ability to assess health systems implement changes and evaluate outcomes
classic leadership theory
autocratic (my way is the only way), democratic (lets vote), laissez- faire (do whatever), Bureaucratic (control, focus on procedure), situational
contemporary leadership theory
charismatic, transactional (focus on supervision and group performance), transformational (teaching and mentoring), shared, delegation
delegation regulations
nurse is still responsible to make sure the task is complete, must know who can do the tasks, cannot delegate tasks of the nursing process (assessment and evaluation)
five rights of delegation
task (caregiver is trained and competent), circumstance (appropriate setting resources and supplies), person (best person for client), direction/communication (clear concise), supervision (appropriate monitoring evaluations intervention and feedback)
RN only duties
tasks involving nursing judgment, assessing pt’s response to care, interventions that require independent nursing knowledge or skill
do NOT delegate to LPN
hang IV meds (certain states), IVBP or IVP (certain states), plan of care (may be checked by RN), unstable pt, transcribe orders, take verbal orders from MD, assessments, develop or preform initial teaching, 1st of anything, check advanced directives, complete discharge teaching
do NOT delegate to Nurse Aide
Charting, treatments (except soap suds), Medications (except OTC topical), Assessments (except VS and Blood sugar), interpretation of data, nursing care plan, care of invasive lines, client education, MAY do ADLs
