Holistic Care of the Patient and Family Flashcards
What are the 5 stages of loss according to Kübler-Ross and Kessler?
Denial, Anger, Bargaining, Depression, and Acceptance
What is the benefit of the denial stage?
it may protect the patient against the emotional impact of the illness and conserve energy by removing worrying
What are the stages of bargaining, depression, and acceptance characterized by?
an attempt to regain control
Are Kübler-Ross’s stages fixed?
no. It is a dynamic process and patients may regress to earlier stages during periods of heightened anxiety
What is the first priority for many family members of patients that are in the ICU?
communication
A client was involved in a motor vehicle crash and sustained multiple lower-extremity fractures. He will need additional surgery and prolonged physical therapy. The nurse finds the client drawing plans for remodeling his porch to accommodate a wheelchair. This behavior reflects which stage of illness?
Acceptance
When interacting with a client in denial, what is the nurse’s best strategy?
Function as a noncritical listener
What is an appropriate nursing intervention for a client experiencing shock and disbelief about his or her diagnosis?
Providing accurate information
Which changes can induce anxiety in the high-acuity client?
Weaning from mechanical ventilation
Increasing mobility
Changing monitoring
What are some contraindications to massage therapy?
advanced osteoporosis, bone fractures, burns, DVT, eczema, phlebitis, and skin infections
How may complementary and alternative therapies be used?
In lieu of standard medical treatment
As a complement to standard medical treatment
What best describes the use of humor as therapy?
Humor is a CAT that can be used with high-acuity clients.
Guided imagery may be a useful strategy for clients with which conditions?
Anxiety
Depression
Pain
What is the initial goal in treating high acuity patients?
to decrease stress and promote comfort rather than to increase knowledge
Which patients are at the most risk for a low level of health literacy?
those older than 65, members of minority groups, immigrants, those of a lower socioeconomic status, or those suffering from chronic illness
When might patients begin to experience periods of low health literacy?
During times of depression, uncontrolled pain, or complex medical situations
When is the optimal time to transfer a patient out of the ICU?
during the daytime
Why are family members restricted from visiting during invasive procedures and CPR?
the family might lose control, the unpleasantness of what families might see, insufficient room at the bedside, and increased risk of litigation
What are the advantages of families being present during CPR?
the family is better equipped to make decisions regarding resuscitative efforts, the family can say goodbye, witnessing the procedure provides a sense of control, the family gets closure, the family can preserve the patient’s dignity, and they express fewer symptoms of PTSD than those who cannot be present
What are the 4 core components of family-centered care?
Dignity and respect, information sharing, participation, and collaboration
When teaching high-acuity clients, what are the initial goals?
To reduce stress
To promote comfort
Which strategy should the nurse use to reduce transfer anxiety?
Introduce the client and family to the receiving nurse before the transfer occurs.
What is the effect of unrestricted visiting hours on some clients?
Fewer hallucinations
Family presence during CPR contributes to which result?
Ability of family to say goodbye
What is the pneumonic used in order to develop cultural competence?
CRASH
What does CRASH stand for?
Consider Culture, show Respect, Assess and Affirm differences, Show Sensitivity and Self-Awareness, and provide care with Humility
Describe cultural diversity
Cultural diversity plays an important role in the care of the high-acuity client
How can the nurse enhance communication with clients?
Speaking in small units of speech
Which term describes a set of social, cultural, and political beliefs held by a group of individuals?
Ethnicity
Which nursing skills demonstrate cultural competence?
Showing respect
Assessing and affirming differences
Showing sensitivity
Providing care with humility
What may occur if a patient is exposed to noise for continuous periods?
sensory overload
What does the WHO recommend for sound levels in patient rooms?
levels of 35dB or less
What are common features of delirium?
an acute onset of fluctuating awareness, impaired ability to attend to environmental stimuli, and disorganized thinking
What factors can contribute to inability of hospitalized patients to get adequate sleep and rest?
Alterations in the light or dark cycle, pain, environmental noise, caregiver interruptions, and stress
What have sedative hypnotics been linked to?
increase in falls, delirium, and functional decline in patients (particularly in the elderly)
What are the benefits of REM sleep?
facilitates protein anabolism, restores the immune system, and promotes healing
Which noise do high-acuity clients report as being most annoying?
Staff’s loud voices
Which nursing interventions would support the client’s REM sleep?
Dimming lights during normal sleep time
Reducing environmental noise
Providing opioid analgesia at bedtime
What are common characteristics of delirium?
Inability to attend to environmental stimuli
Acute onset
Disorganized thinking
Agitation
