Fundamentals Exam 4 Flashcards
condition in which the human being responds to changes in its normal balanced state
stress
any event or stimulus that causes an individual to experience stress
stressor
adjustments made in response to the stressful event
coping response
can be positive or negative
adaptation
Dealing with problems and situations successfully
Coping
an innate or acquired way of responding to a changing environment or specific problem or situations
coping mechanism
Efforts to improve a situation by making changes or taking some action
type of coping mechanism
problem-focused
Includes thoughts and actions that relieve emotional distress
type of coping mechanism
emotion-focused
Smoking, Alcohol Use, Overeating, “Pill-Popping”, Excessive caffeine intake, drugs
type of coping mechanism
maladaptive
a stimulus based model involving the three stressor stages
GAS (general adaptation syndrome)
cortisone and epi released. Fight or flight reaction. Short lived. Mobilizes us to react.
Stage 1: alarm reaction
body adapts. Attempts to limit the stressor to the smallest area of the body that can deal.
Stage 2: resistance
If stress continues, coping exhausted, stress spreads to rest of body, body either returns to normal or death takes place.
Stage 3: exhaustion
The 4 factors that determine if a situation is stressful
Ability to cope with stress
Practices & norms of client’s peer group
Impact of social environment to help adaptation
Resources available
Decreased concentration/ attention to detail
Changes in eating, sleeping, and activity habits
Increased irritability
mistakes (poor judgment)
Lethargy/ decreased productivity
These behavioral signs of stress are…
Subtle
use of chemical substances
absenteeism/illness
Emotional outbursts/crying
These behavioral signs of stress are…
More overt
Name some interventions that can be used to decrease stress
Exercise/nutrition/rest Relaxation techniques (progressive, imagery) Time Management Spirituality Build support systems Enhance self-esteem Supportive care establish a therapeutic relationship Medications
the knowledge that one has about oneself
self knowledge
what one expects of oneself; may be realistic or unrealistic
self expectation
how a person is perceived by others and society
social self
the appraisal of oneself in relationship to others, events or situations
social evaluation
Hospitalization threats due to stress
New roles, different views, threat to self concept, loss of privacy, financial worries.
Related to actual physical gender
Related to gestures, mannerisms, dress, and vocabulary
Gender label
A concern with or an interest in sexual activity
The condition of being characterized by sex of gender
The ways we experience and express ourselves as sexual beings
Influence by life experiences
Sexuality
The activities that involve the body in the expression of erotic or affectionate feelings
This includes but not limited to behavior involved in reproduction
Sexual behavior
Chromosomal make-up, genitalia, secondary sex characteristics, and hormonal states
Biological sex
Belief or awareness or being male or female
Gender identity
Outward expression of a person’s sense of maleness or femaleness
Gender role
the directionality of one’s sexual interest.
Sexual orientation
Focus shifts from procreation to companionship,
Changing physical appearance may lead to concerns about sexual attractiveness. Need for education on normal physical changes and how to adapt. More chronic illnesses and medications. Remember: the capacity for sexuality is lifelong.
In older adults
People experience a day-night, 24 hour cycle known as the…
Circadian rhythm
Stage of sleep: Transition between drowsiness and sleep Only lasts a few minutes Feels as though daydreaming if awakened during this state Heart rate decreases
Stage 1
Stage of sleep: 40-50% of sleep time Can be easily awakened Muscles relax Body functions slow
Stage 2
Stage of sleep: Deep sleep Body functions continue to slow Sleep walking and bed-wetting can occur Dreams occur- often realistic
Stage 3
Stage of sleep: Both eyes move rapidly Low or absent muscle tone BP and HR fluctuate Oxygen consumption increased Dream can occur- vivid, wild, unrealistic
Rapid eye movement (REM)
Usual order of the sleep stages
1, 2, 3, 2, REM
Usually lasting 90 min each
REM lengthens throughout night
Drowsiness/sleepy, minutes, decreased heart rate
Half our sleep time, easily awakened, relaxed muscles, slow body functions.
Deep, sleep walking, realistic dreams
Non rapid eye movement
Inability to obtain amount of sleep one believes is necessary for healthy functioning
Insomnia
Cessation of breathing for a time during sleep
Sleep apnea
Sudden falling asleep during the daytime
Narcolepsy
Decreased quality and consistency of sleep
Sleep deprivation
Most common form. Occurs when muscles of the oral cavity or throat relax during sleep. Upper airway becomes blocked and nasal airflow stops. When awakened, voluntary control of upper airway muscles is restored and obstruction is relieved. More than 10 seconds. Causes a serious decline in arterial O2 level
Obstructive apnea
Involves defects in the brain’s respiratory control center. Impulse to breathe temporarily fails. O2 saturation falls
Central apnea
One of the most common reasons to seek medical attention
Pain
There is a lack of objective evidence in obtaining pain so it is ______ and the pain is what the patient says it is, must believe them
Subjective
Processing of painful stimuli, travel from injury to spinal column to brain where it is perceived and a response takes place.
Nociception
Suggest there are specific pain receptors in the body
Specificity theory
Bodies natural supply of opiate like substances, activated by stress or pain, occupy spots in brain where pain is perceived.
Endorpohins
Proposes that a gate control system modulates sensory input following stimulation of the skin before pain perception and response is evoked. Assumes peripheral pain fibers synapse in the spinal cord – the synapses act as “GATES” to block pain impulses when closed. Large A nerve fibers (heat, cold, and touch convey impulses through the same synapses). Ex. Give pt a backrub. If you bombard with large sensory impulses, you close the gate to the pain impulses (small C fibers are stimulated by pain).
Gate control
Reaction to pain- increased resps, increased heart rate, increased B/P, diaphoresis, pupil dilation.
Low to moderate pain (Sympathetic Nervous System stimulation)
Reaction to pain- pallor, muscle tension, decreased pulse and B/P, rapid irregular resps, May see no change in vital signs, N/V, weakness or exhaustion
Severe pain (Parasympathetic Nervous System stimulation)
Brief duration The end is expected Onset usually immediate may subside with or without treatment Self limiting complete relief is expected to come soon Often frightening for the client Once pain is relieved, full attention can be give towards recovery
Acute pain
Lasts a prolonged period of time May never gain relief Remissions and exacerbations Client can become frustrated and depressed Pain becomes part of client’s life
This is a disability and can lead to job loss divorce ability to perform ADL’s sexual dysfunction social isolation
Chronic pain
Can be acute, chronic or both associated with progressive malignant-type processes.
May be described as intractable.
Often described as all-consuming and interfering with quality of life.
Examples:
Arthritis
Cancer
Malignant pain
Duration of time or the intensity of which a subject accepts a stimulus above the pain threshold before making a verbal or overt pain response
Pain tolerance
Intensity of the noxious stimuli necessary for the person to perceive pain
Pain threshold
Factors that increase tolerance
Alcohol/Drugs, Hypnosis, Warmth, Rubbing, Distraction, Faith, Strong beliefs. Decrease tolerance: Apprehension, Boredom, Fatigue, Anger, Weak, debilitated, Persistent pain, Stress
Loss that can be recognized by others
Actual loss
Loss that is experienced by one person but cant really be verified by others
Perceived loss
Loss experienced before the loss actually occurs
Anticipated loss
Is the total response to the emotional experience related to loss
Grief
Is the subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship
Bereavement
Is the behavioral process through which grief is eventually resolved or altered: it is often influenced by culture, spiritual beliefs, and custom
Mourning
3 types of greif
Normal
Anticipatory
Disenfranchised
When societal norms do not define the loss as a loss and the person does not gain support from others
Disenfranchised grief
4 tasks that promote a healthy adjustment to loss or to grief:
T- to accept the reality of the loss
E- experience the pain of the loss
A-adjust to the environment without that person/object in it
R-reinvest the emotional energy into new relationships–cope
multidimensional, changing life force, characterized by a confident, yet uncertain expectation of achieving a goal
Hope
Developed a framework for understanding the process of dying, which is also applicable for the process of grieving.
The model should be used as a guide and not rigidly adhered to.
5 stages
Not every person exhibits every behavior of every stage and not every person progresses smoothly through the stages.
Stages are not neat and orderly
Kubler-Ross Stages of Dying
5 stages of Kubler-Ross Stages of Dying
- Denial- Initial reaction is one of shock and disbelief. So overwhelming that cannot deal with feelings. Example responses: “This can’t be.” “They must have made a mistake.” How nurses can help in this stage: Support patient, but don’t reinforce denial.
- Anger- As reality slowly works it’s way into consciousness, denial no longer works and is replaced by anger. Anger may be directed at family, friends, health care workers, God… The “why me” stage. How to help: Help patient understand that the anger is a normal response, Do not take anger personally, Allow patient as much control over life as possible, Deal with needs underlying the angry reaction.
- Bargaining- Seeks to bargain for more time in an effort to prolong the inevitable. May express feelings of guilt for past sins. Referred to as the “Yes me, but…” stage. Bargaining usually takes the form of promises. “If I can live until my child graduates, I will…” How to help: Listen and encourage patient to talk to relieve guilt and irrational fear. If appropriate, offer spiritual support
- Depression- The “Yes, me” Stage. Client recognizes that the loss is going to happen. Will experience grief as they mourn what they are losing. May become depressed and withdraw or may talk freely. How to help: Allow to express sadness. May convey caring by touch (if appropriate) Just listen.
- Acceptance- Comes to term with the loss. Usually neither terribly happy or sad. May begin making plans (wills, prosthesis…). Putting closure on unfinished business. How to help: Help loved ones understand the patient’s decreased need to socialize. Encourage to participate as much as possible in the treatment program
Durable power of attorney for health care
DNR Do not resuscitate
Living will
is a notarized statement appointing someone else to manage health care treatment decisions when the client is unable to do so.
Health care proxy
Stiffening of the body that occurs about 2-4 hours after death
Results from lack of ATP, which causes muscles to contract and joints to immobilize, Usually leaves the body after about 96 hours
rigor mortis
Preparation of the body
Viewing by the family/for transport/storage Close eyelids Remove all tubes Wash body, comb hair Dress in clean gown Fresh top sheet Position flat with hand on chest, dentures in, and eyelids closed - SUPINE POSITION Disposition of belongings
the gradual decrease of the body’s temperature
algor mortis
RBC’s break down, releasing hemoglobin, which discolors tissues (usually in lowermost areas of body)
livor mortis
