Lecture 2 Exam Review Week 5 Flashcards
State of complete mental, and social well being, not merely the absence of disease or infirmity
Health
Active state of being healthy by living a lifestyle promoting good physical, mental, and emotional health
Wellness
Medical term, referring to pathologic changes in the structure or function
Disease
Number of
Mortality
Attainment of the highest level of health
Health Equity
Particular type of health difference that is closely linked with social, economic, and environmental disadvantage
Health Disparity
Disparities are Influenced by:
Race and Ethnicity
Poverty
Sex
Age
Mental Health
Educational Level
Disabilities
Sexual Orientation
Health Insurance
Access to Healthcare
Conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect wide range of health functioning, and quality of life outcomes and risks.
Social Determinants
Institutional or Structural Racism
Systemic Distribution of resources, power, and opportunity to benefit peoplewho are white and to the exclusion of people of color.
Inclusion
Giving everyone a sense of purpose and belonging
Equity
Ensuring that everyone has access to the conditions they need to thrive.
Unconscious or Implicit Bias
Prejudice in favor or against one thing, person, or group as compared to another, in a way that is considered unfair
Vulnerable Populations
Access to care, quality of care, health insurance status, specific sources of ongoing care, and quality and access to care for people with limited English proficiency. Recognize disparities do exist. Plan specific and individualized interventions for patients who are at most at risk
Things a person can change
Risk Factors that are modifiable
Nonmodifiable
Things that can not be changed
Human Dimensions
Interrelated factors influencing health- illness status
Physical
Emotional
Intellectual
Environmental
Sociocultural
Spiritual
How one feels about themselves
Self- Esteem
Perception of their Physical self
Body Image
Maslow’s of Hierarchy of Needs
Basic Human Needs
Physiologic
Safety and Security
Love and Belonging
Self- Esteem
Self- Actualization
People’s behaviors, feelings about self and others, values, and priorities all relate to what?
Physiologic and psychosocial needs
Basic human needs are common to all people. True or False
True.
Meeting these needs is essential for health and survival of all people.
A person can meet some needs independently, but……
Most needs require relationships and interactions with others for partial or complete fulfillment
Characteristics of Basic Needs
Their lack of fulfillment results in illness
Their fulfillment helps prevent illness or signals health
Meeting basic needs to restore health
Fulfillment of basic needs restores health
A person feels something is missing when a need is unmet
A person feels satisfaction when a need is met
Six Major Areas of Risk Factors
Age
Genetics
Physiologic Factors
Health Habits
Lifestyle
Environment
Physiologic
Must be met to maintain life
Safety and Security
Encouraging spiritual practices and independent decision making
Love and Belonging
Including family and friends and establishing caring relationships with Patients
Self Esteem
Respecting Patients values and beliefs and setting attainable goals
Self- Actualization
Provide a sense of direction and hope, maximize patient potential
Satisfying one’s needs often depends on the ?
Physical and social environment, especially one’s family and community.
Must be met minimally to maintain life
Oxygen water food
Balance between intake and elimination of fluids
Elimination
Temperature
Sexuality
Physical Activity
Rest
Physiological Needs
Safety and Security Needs
Second in priority
Have both physical and emotional components
Being protected from potential or actual harm
Examples:
Using proper Hand Hygiene
Using electrical equipment
Administering Medications knowledgeably
Skillfully moving and ambulating patients
Third in Priority and called Higher Level needs
Understanding and acceptance of others in both receiving and giving love
Feeling of belonging to groups such as family, peers, friends, and a neighborhood.
Unmet may lead to loneliness and isolation
Love and Belonging
Examples of Interventions
Including family in patient care and friends as well
Establishing a trusting nurse- patient relationship
Self- Esteem Needs
Need for a person to feel good about one’s self.
Sense of accomplishment and to believe that others also respect and appreciate those accomplishments.
Positive self esteem facilitates the person’s confidence and independence.
Factors affecting Self Esteem
Role Changes
Body Changes
Self- Actualization
Highest Level of Needs
Acceptance of self and others
Ability to be objective
Feelings of happiness
Using creativity as guideline for solving
differentiate between good and evil
Family
Group of people who live together and depend on another for support.
Nuclear Family
Traditional Familyb
Extended Family
Includes Aunts and Uncles
Blended Family
Two parents and their unrelated children from previous
Single- Parent Family
May be separated, divorced, widowed, or never married
Cohabitating Adults
Unmarried Adults, communal or group marriages
Functions and Factors Affecting Family and Community
Family Functions
Community Factors Affecting Health
Risk Factors for Altered Family Health
Environmental Health
Family Functions
Physical
Economic
Reproductive
Affective and coping
Socialization
Risk Factors for Altered Family Health
Lifestyle
Psychosocial
Environmental
Developmental
Biologic risks
Community Factors Affecting Health
Social Supports Systems
Community Health Care Structure
Economic Resources
Effect on individuals and families
Environmental Health
Physical, chemical, and biologic, psychosocial factors in the environment
Quality of Air
Climate change/ actions
Reducing waste in clinical setting
Nurse and Environmental Health
Nurses are :
provide healing and safety
trusted sources
largest health care population
work with variety of cultures
Translate Information
Primary
Directed toward promoting health and preventing the development of disease and processes of injury
Secondary
Tertiary
Begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate PTs to max level of functioning.
Stages of Change Model
Prochaska and DiClemente
Used by counselors addressing behaviors including injury prevention, addiction and weight loss.
Health Belief Model
Rosenstock
Concerned with what people perceive to be true about themselves in relation to their health.
Health Promotion Model
Murdaugh
Developed to illustrate how people interact with their environment as they pursue health
Health- Illness Continuum
Views health as a constantly changing state with high- level wellness and death on opposite sides of a continuum
Coexistence of different ethnic, racial, and socioeconomic groups within on social unit
Cultural Diversity
Varying by:
Religion
Language
Physical Size
Sexual Orientation
Disability
Occupational Status
Geographical Location
Cultures
Shared system of beliefs, values, and behavioral expectations.
Cultures and Subcultures
Combination of body of belief and knowledge and behavior
Social structure for daily living
Influences roles and interactions with others and in families and communities
Apparent in the attitudes and institutions unique to particular groups
Dominant Group
Largest group
Most authority of control and values
Minority Group
Smaller group
Physical or cultural characteristic identifies the people as different from dominant group
Cultural Assimilation
Acculturation
Minorities living within a dominant group lose the characteristics that made different
Values replaced by those dominant culture
Culture Shock
Feelings a person experiences when placed in a different culture
Ethnicity and Race
Sense of Identification with a collective cultural group
Based on heritage
One can belong to an ethnic group through birth or adaptation
Share unique cultural and social beliefs and behavior patterns
Largely develops through day to day life with family and community
Race is based on
Specific characteristics
Skin pigmentation, body stature, facial features, hair texture
Physical Characteristics are
No longer considered a reliable way to determine a person’s race
stereotyping
Assigning characteristics to a group of people without considering specific individuality
Cultural Blindness
Ignoring difference in people and proceeding as though the differences do not exist
Culture Conflict
People become aware of the differences, feel threatened, respond by ridiculing the beliefs of others to increase their own security
Implicit Bias
Prejudice in favor or against one thing, in a way that is considered unfair. Unconscious bias occurs automatically in the brain.
Cultural Imposition
Imposing one’s beliefs. Believe them to better their values.
Dominant group
(usually largest group)
* Group has the most authority to control values and sanctions
of society
Minority group (smaller group)
A physical or cultural characteristic identifies the people as
different from dominant group
Cultural Assimilation
Minorities living within a dominant group lose the
characteristics that made them different
* Values replaced by those of dominant culture
Cultural Shock
The feelings a person experiences when placed in a different
culture
* May result in psychological discomfort or disturbances
Ethnicity
Sense of identification with a collective cultural group
Based on group’s common heritage
One can belong to ethnic group through birth or adoption of characteristics of that group
Largely develops on group’s common heritage
Race
Typically based on specific characteristics
Physical characteristics are no longer considered reliable way to determine a person’s race
Factors Inhibiting Sensitivity to Diversity
Stereotyping- Assigning characteristics to a group of people without considering specific individuality.
Implicit Bias- Prejudice in favor or against one thing, in a way that is considered unfair; unconscious bias occurs automatically as the brain makes quick judgements based on past experiences and backgrounds
Cultural Imposition-Tendency of some to impose their beliefs, practices and values on another culture because they believe them superior.
Cultural blindness
the ignoring of differences in people and proceeding as though the differences do not
exist
Culture conflict
*People become aware of differences, feel threatened, respond by
ridiculing the beliefs of others to increase their own security
Cultural Influences on Health Care, Health, and Illness
Physiologic Variations
Reactions to pain
Mental Health
Assigned Sex roles
Language Communication
Orientation to space and time
Food and Nutrition
Family Support
Socioeconomic Factors
Values and beliefs about health, illness, and health care are influenced by cultural groups, ethical, and religious.
Elements of Cultural Competence
Developing Self Awareness
Demonstrating knowledge and patients culture
Accepting and respecting cultural differences
Resist judgements
Being open to and comfortable with cultural encounters
Accepting responsibility for ones own cultural competency
Ethnocentrism
Belief that one’s ideas, beliefs, and practice are the best or superior or are most preferred to those of the others.
Cultural Humility
Recognition of diversity and power imbalances among individuals or communities, with the action of being open, self- aware, egoless, flexible, excluding respect and supportive interactions, focusing on both self and other to formulate a tailored response.
Guidelines for Nursing Care
Cultural Assessment
Transcultural Nursing
Develop cultural self- awareness
Develop cultural Knowledge
Accommodate cultural practices in health care
Respect cultural care
Cultural Assessment and Areas Nurses Need to Understand
Beliefs, values, traditions, and practices of a culture
Culturally defined, health related needs of individuals, families, and communities .
Attitude toward seeking help from health care.
Sexuality encompasses
Biologic Sex or sex at assigned at birth
sexual activity
gender identities vs roles
sexual orientation
Sexual Health represents the integration of the somatic, emotional, intellectual, and social aspects of sexual being in ways that are positive.
Sexual Identity
Self Identity
Biological Sex
Gender Identity
Gender Role
Sexual Orientation
Pedophilia is not
Adaptive must report abuse
State mandated
Sexual Expression
Ranges from adaptive to maladaptive
Between two consenting adults
mutually satisfying
not harmful
Conducted in private
Gender Identity
Gender Expression
Gender Diverse
Gender Dysphoria
Cisgender
Transgender
Gender Binary
Sexual Orientation
Heterosexual
Gay or lesbian
Bisexual
Asexual
Questioning
Sexual Expression
Ranges from adaptive to maladaptive
Between two adults consent
Not harmful
Lacking in force or coercion
Masturbation
Sexual Intercourse - Vaginal or anal
Oral- Genital stimulation
Factors Affecting Sexuality
Developmental Considerations
Culture
religion
Ethics
Lifestyle
Menstruations
Normal vaginal bleeding that prepares for the presence of fertilized Ovum
Four Phases of Mens.
Follicular
Proliferation
Luteal
Secretory
Menarche
First Period
Menopause
Cessation of menstrual activity
Causes of menstrual irregularities
Pregnancy
Breast feeding
Eating Disorders
Extreme weight loss
PCOS
Premature ovarian failure
Name STI
HIV
Chlamydia
Genital Herpes
Gonorrhea
HPV
Trichomoniasis
Syphilis
STI Information
Delaying sexual relationships
Have regular checkups for STIs
Learn the common symptoms of STIs
Avoid sex during menstruation
Avoid anal intercourse
Avoid douching
Sexual Dysfunction
Males
Erectile Dysfunction
Premature Ejaculation
Delayed Ejaculation
Females
Inhibited Sexual Desire
Dyspareunia
Vaginismus
Vulvodynia
Quid pro Quo
Withheld in exchange for something else
Sexual Harassment
Unwelcome behavior that is based on a person’s sex or gender
Hostile Environment
Unwelcome sexually oriented and gender based behaviors
Sexual joking
Sexual bantering
Offensive pictures and languages
Sexual Behavior
Responding to Harassment in the Nursing Environment
Be Self Aware
Confront and Provide Feedback
Set limits
Enforce Limits Report and document the incident. Submit to Supervisor
Nursing History and Physical Assessment
Reproductive History
History of STIs and Sexual Dysfunction
Sexual behaviors , self concept, and functioning
Interventions for Physical Sexual Assessment
Physical Exam
Annual Exam
Suspected STI or Pregnancy
Work up for infertility
Unusual lump or discharge
BETTER acronym
B ring up topic
E xplain
Tell
T timing
E ducate
R record
Patient Outcomes Regarding Sexuality
Define sexuality
Establish open patterns of communication
Develop self awareness and body awareness
Practice responsible sexual expression
Implementation
Establish trust relationship
Teach about sexuality
Promote responsible sexual expression
Contraception
Advocating for patients sexual needs
Healthcare needs for all people
Meeting Spiritual Needs
Offering compassionate
Facilitating patient’s expression of religious or spiritual beliefs and practices
Spirituality
Anything that pertains to the person’s relationships with a nonmaterial life force or higher power
Faith
Confident belief in something for which there is no proof or evidence
Religion
Organized system of beliefs about a higher power
Hope
Ingredient in life responsible for positive outlook
Love
Connectedness with others
Suffering
Specific state of distress that occurs when the intactness or integrity of the person is threatened
Elements of Spirituality
Experienced as a unifying force, life principle, and essence of being
experienced in and through connectedness with nature, earth, environment, and cosmos
Shapes the self becoming and is reflected in ones being, knowing, and doing
Provides purpose, meaning, strength, and guidance
Factors Affecting Spirituality
Developmental considerations
Family
Ethnic Background
Formal Religion
Life Events
Nursing History and Observation
H Sources of hope
O organized religion
P personal practice
E effects on medical care and end of life
Observe for significant or sudden changes in spiritual practices, mood changes, sudden interest in matters, and disturbed sleep
Focused Spirituality Assessment
Spiritual beliefs and practices
Relation between spiritual beliefs and everyday living
Spiritual Needs
Need for meaning and purpose
Need for love and relatedness
Need for forgiveness
PT Goals and Outcomes Spiritual Distress
Explore the origin of spiritual beliefs and practices
Identify factors in life that challenge beliefs
Identify spiritual supports
Report or demonstrate decreased spiritual distress after intervention
Implementing Spiritual Care
Ethical and professional boundaries
Offering supportive or healing presence
Facilitating PTs practice of religion
Praying
Conseling patients
Facilitating the Practice of Religion
Familiarize the PT with pastoral and religious services within the institution
Respect privacy during prayer
Assist to obtain devotional objects
Arrange for sacraments if needed
Meet religious dietary restrictions if needed
Counseling Patients Spiritually
Have the Patient articulate beliefs
Explore the origin of the PT spiritual beliefs and practices
Identify life factors that challenge PTs beliefs
Develop spiritual beliefs that meet the need for meaning purpose, care, and relatedness, and forgiveness
Room Preparation for Counselor Visit
Make sure the room is orderly and free of unnecessary equipment
Provide a seat for the counselor near the patient’s bed
Clear the top of the bedside table and cover with a clean white cloth for sacraments
Draw the bed curtains if the patient can’t be moved to a private setting
Evaluating Expected Outcomes
Identify some spiritual belief that gives meaning and purpose of life
Move toward healthy acceptance of the current situation
…..
Growth
Increase in body size or changes in body cell structure, function, and complexity
Development
Orderly patter and changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences and learning.
Growth and Development
Orderly and Sequential
Genetics
Determines the person’s cellular differentiation, growth, and function
Heredity
Refers to transmission of genetics
what is passed down and inherited from one generation to another
Genomics
Study of the structure and interactions of all genes in the human body.
HGP
Human Genome Project
Determine the order of sequence of all bases in human DNA
Making maps that show the locations of genes on chromosomes
Different Theories
Freud: theory of psychoanalytic development
* id, ego, superego; oral, anal, phallic, latency, genital a/w age
* Piaget: theory of cognitive development
* Sensorimotor, preoperational, concrete, formal operational stages
* Erickson: theory of psychosocial development
* Expanded on Freud to include cultural & social influences (__ vs. __)
* Havighurst: theory based on developmental tasks
* Gould: theory based on specific beliefs and developmental phases
* 16 – 60 years old; transformation-focused
* Levinson: based on the organizing concepts of individual life structure
* Novice, settling down, midlife transition, entering middle adulthood
* Kohlberg: theory of moral development
* Build on Piaget’s theory, preconventional, conventional, postconventional level
* Gilligan: conception of morality from the female viewpoint
* Kohlberg + female perspective
* Fowler: theory of faith developme
Freud
theory of psychoanalytic development
* id, ego, superego; oral, anal, phallic, latency, genital a/w age
Piaget
theory of cognitive development
* Sensorimotor, preoperational, concrete, formal operational stages
Erikson
theory of psychosocial development
* Expanded on Freud to include cultural & social influences (__ vs. __)
Havighurst
theory based on developmental tasks
Gould
theory based on specific beliefs and developmental phases
* 16 – 60 years old; transformation-focused
Levinson
based on the organizing concepts of individual life structure
* Novice, settling down, midlife transition, entering middle adulthood
Kohlberg
theory of moral development
* Build on Piaget’s theory, preconventional, conventional, postconventional level
Gilligan
conception of morality from the female viewpoint
* Kohlberg + female perspective
Fowler
Theory of faith development
Incorporating Principles of Growth and Development
Know the various stages of cognitive, psychosocial, moral, and spiritual development.
Remember that patients are members of families and that the family unit can have both positive and negative influences on the development of individual members
Maintain flexibility in assessing PTs and respect their uniqueness
Anticipate possible regression during crisis
Understand the environment and cultural influences have strong effect on development
Common Health Problems in Middle Adulthood
Malignant Neoplasms
CV Diseases
Injury
Depression
DM
Chronic Lower Respiratory Disease
Liver and kidney disease
Alcoholism
Role of the nurse to health of middle adult
Health related screenings, examinations, and immunizations
Teach dangers of substance use, smoking, alcohol consumption
Teach adults to eat a diet low in fat and cholesterol
Teach importance of regular exercise
Variation in Life Expectancy Older Adulthood
Socioeconomic and race ethnicity factors
Behavioral and metabolic risk factors
Health Care factors
Common Myths of Older Adults
Ageism
Older Adults
Old Age begins at 65
Most older adults are in LTC
Do not care how they look
Bladder problems
Can’t learn new things
Not interested in sex.
Physiologic Changes of Older Adults
General Status
Every Single system is affected
Senses are the ones that are hit hard the most
Cognitive Development in Older Adults
Intelligence increases into the 60s and cognition does not change appreciably with aging
Response and reaction times increase
Mild short term memory loss
Dementia, Alzheimer’s disease, depression and delirium may occur and cause what?
Cognitive Impairment
Psychosocial Development of Older Adult
Self concept is relatively stable
Disengagement theory: An older adult may substitute activities but does not disengage from society
Erikson- Ego integrity vs Despair and disgust
Havighurst
Major tasks are maintenance of social contacts and relationships
Adjusting Changes of Older Adulthood
Physical Strength and Health
Retirement and income
Spouse or Partner Health
Relating to one’s age group
Social roles
Living arrangements
Family and role reversal
Moral and Spiritual Development of Older Adults
Kohlberg
Completed their moral development and most at conventional level
Spiritually- may be at earlier level often at the individualize - reflective level
Self- Transcendence is characteristic of life
Gerotranscedence
Describes the transformation of a person’s view of reality from a rational, social, individually focused, materialistic perspective to a more transcendent vision
Health of the Older Adult
Most older people are not impaired
More vulnerable to physical, emotional, or socioeconomic problems
Probability of becoming ill
Chronic health problems or disability may develop
Polypharmacy
Accidentally Injuries
Elder Abuse
Delirium
Temporary state of confusion that can last from hours to weeks and resolves with treatment.
Hypoactive
Hyperactive
Causes of Accidental Injuries in Older Adults
Changes in vision and hearing
Loss of mass and strength of muscles
Slower reflexes
Decreases sensory ability
Economic factors
Elder Abuse
Experienced in 1 in 10 communities
Social, financial, environmental, educational inequities increase the risk
SPICES assessment tools
S Sleep Disorders
P Problems with eating or feeding
I Incontinence
C Confusion
E Evidence of falls
S Skin Breakdown
Nursing Actions to Promote Health in Older Adults
Physiologic function
Cognitive function
Psychosocial needs
Nutrition
Sleep and Rest
Elimination
Activity and Exercise
Sexuality
Meeting Developmentally Tasks
Senses Involved in Sensory Reception
Visual
Auditory
Olfactory
Gustatory
Tactile
Stereognosis- perception of solidity of objects
Kinesthetic and Visceral - Basic internal orienting systems
Proprioception
RAS
Reticular Activating System
Monitors and regulates incoming stimuli, maintaining, enhancing,
Conscious
Delirium, dementia, confusion, normal consciousness, somnolence, minimally conscious states, locked in syndrome
Unconscious
Asleep, stupor, coma
Vegetative state
Sensory Overload
Pt experiences so much sensory stimuli that the brain is unable to stimuli meaningful or ignores it
PT feels out of control
Nursing care focuses on reducing stimuli and help patient regain control of the environment
Sensory Deprivation
Occurs when a person experiences decreased sensory input
PTs at high risk
Environment with decreased or monotonous stimuli
* Impaired ability to receive environmental stimuli
* Inability to process environmental stimuli
* Effects of sensory deprivation: Perceptual, cognitive, & emotional
disturbances
Sensory Deficits
Impaired sight or hearing
Altered Taste
Numbness or paralysis
Sensory Poverty
Becoming Poorer as we lose the ability to be sensually present in the moment
Factors Affecting Sensory Stimulation
Developmental Considerations
Culture
Personality and Lifestyle
Stress and Illness
Medications
Assessment of the Sensory Experience
Stimulation
Reception
Transmission - perception- reaction
Signs and symptoms of sensory deprivation and overload
Physical Assessment
Assessment of the ability to perform self care
Vision and hearing assessments
Interventions to improve Sensory Functioning
Prevent disturbed sensory perception and stimulate the senses
Patient Outcomes for Sensory Alterations
Live in a developmentally stimulating and safe environment
Exhibit a level of arousal that allows for meaningful stimuli organization
Schedule health screenings
Maintain orientation of time place and person
Respond appropriately to sensory stimuli while executing self care activities
Nursing Care for Visually Impaired Patients
Acknowledge your presence in the PT room
Speak in normal voice
Explain the reason of touching before doing it
Keep the call light in reach
Clear Pathways
Assist with ambulation Indicate when leaving
Nursing Care for Hearing Impaired
Orient the Patient to your presence …
Nursing care for a Patient who is confused
Frequent face to face contact
Speak calmly, simply, and directly to PT ….
Nursing Care for Unconscious Patient
Be careful what is said in PTs presence, haring is last sense lost.
Assume that the PT can hear you and talk in a normal tone
Speak to patient before touching
Keep noises low in the environment
Actual Loss
Can be recognized by others
Perceived Loss
Felt by person, but is intangible to others
Maturational Loss
Experienced as a result of an unpredictable event
Anticipatory Loss
Loss has not yet taken place
Grief
Internal emotional reaction to loss
Bereavement
State of grieving from loss of a loved one
Mourning
Actions and expressions of grief, including symbols and ceremonies that make up outward expression of grief.
Dysfunctional Grief
Abnormal or distorted. May be either unresolved or inhibited.
Stages of Grief for Engels
Shock and Disbelief
Developing Awareness
Restitution
Resolving the Loss
Idealization Outcome
Kubler Ross 5 Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance
Uniform Definition of Death Act
Individual who has sustained
1. Irreversible cessation of circulatory and respiratory functions
- Irreversible cessation of all functions of the entire brain, including the brainstem, is dead.
Medical Criteria used to Certify Death
Cessation of breathing
No response to deep painful stimuli
Lack of reflexes
Flat encephalogram
Clinical Signs of Impending Death
Difficulty talking or swallowing
Nausea, flatus, and abdominal distention
Urinary or BM incontinence or constipation
Loss of movement, sensation, and reflexes
Decreasing body temperature with cold and clammy skin
Weak slow and irregular pulse
Decreasing blood pressure
Noisy, irregular, or Cheyne Stokes respirations
Restlessness and agitation
Cooling, mottling, cyanosis of areas and extremities
Providing Care to Facilitate a Good Death
Guided by values and preferences of the individual patient
Independence and dignity are central issues
Providing control
Focus on relief symptoms
Palliative vs Hospice
Meant to enhance a person’s current care by focusing on quality of life for them and family
Palliative Care
Give Patients with life threatening illnesses best qualify of life they can have by aggressive managements of symptoms
Hospice Care
Limited Life expectancy, in home or hospice house, inpatient
Poor performance status, declining status, advanced…
Advance Directives
Include living wills and durable power of attorney indicate:
who will make decisions for PT when unable to
Kind of medical treatment the PT wants
How the PT wants to be treated
What the PT wants loved ones to know
Mourning
Actions and expression of grief, including the symbols and ceremonies that make up outward expression of grief
Dysfunctional Grief
Abnormal or distorted, may be either unsolved or resolved
Terminal Illness
Illness in which death is expected within a limited period of time
effect on the PT
effect on the Family
The Dying Person’s Bill of Rights
POLST
Medical order indicating a patient’s wishes regarding treatments commonly used in a medical crisis
Must be completed and signed by a healthcare professional, not the PT
Inpatient: Need inpatient order
Special Orders
Allow natural death DNR or no code
Comfort Measures
Terminal Weaning
VSED
Voluntarily stopping of eating and drinking
Active and Passive Euthanasia
Not in California ….
Palliative Sedation
Not in California ….
Factors Affecting Grief and Dying
Developmental Considerations
Family
Socioeconomic factors
Cultural, sex, assigned at birth, and religious influences
Cause of Death
Needs of Dying Patients
Physiologic Needs
Pain control and nutrition and hygiene
Psychological Needs
Fear of unknown, pain, separation, leaving loved one s
Needs for Intimacy
Physical needs ways to be physically intimate that meets needs of both partners
Spiritual Needs
Patient needs meaning and purpose, love and relatedness, forgiveness and hope
Developing a trusting Nurse Patient Relationship
Explain the PT condition and treatment
Teach self care and promoting self esteem
Teach family members to assist in care
Meet the needs of the dying patient
Meet the family needs
Interventions Providing Postmortem Care
Care of the body
Care of the family
Care of other patients
Caring for oneself
Prepare body for discharge
Place ID tags
Follow local law of communicable disease
Place in anatomical position, replace dressings and remove tubes unless autopsy scheduled
Interventions Postmortem Care of Family
Listen to family’s expressions of grief, loss, and helplessness
Offer solace and support by being an attentive listener
Arrange for family to view the body
Provide private place for family to begin grieving
It is appropriate for the nurse to attend the funeral and make a follow up visit to the family
Dimensions of Self Concept
Self Knowledge: Who am I?
Self Expectation: Who I want to be?
Self Evaluation: How well do I like myself?
Three Major Self evaluations
Pride Positive self examination
Guilt Based on behaviors incongruent with the ideal safe
Shame Low global self worth
Formation of Self Concept
Infant learns physical self different from environment
Basic needs met, infant has positive feelings of self
Child internalizes other peoples attitude toward self
Factors Affecting Self
Factors Affecting Self-Concept
* Developmental considerations
* Culture
* Internal and external resources
* History of success and failure
* Crisis or life stressors
* Aging, illness, disability, or trauma
Nursing Strategies to Identify Personal Strengths
Encourage PT to identify strengths
Replace self- negation with positive thinking
Notice and reinforce patient strengths
Encourage patients to will for themselves
Help patients cope with necessary dependency
Helping Patients Maintain Sense of Self
Communicate worth with looks, speech, and judicious touch
Acknowledge patient status, role, and individuality
Speak to PT respectfully
Converse with the patient about their life experiences
Offer simple explanations for procedures
Respect privacy
Acknowledge and allow of expression of negative feelings
Examples of Physiologic Stressors
Chemical Agents
Physical Agents
Infectious Agents
Nutritional Imbalances
Hypoxia
Genetic or immune disorders
Local Adaptation Syndrome
Involves one specific body part
Reflex pain response
Inflammatory response
General Adaptation Syndrome
Biomedical model of stress
Alarm Reaction
Stage of resistance
Stage of Exhaustion
Local Adaptation Syndrome
Localized response of the body to stress
Involves only a specific body part such as tissue or organ
Stress precipitating LAS may be traumatic or pathologic
Primarily Homeostatic
Short term adaptive response
Alarm Reaction
Person perceives stressor
Defense mechanisms activated
Fight or Flight
Hormone levels rise
Shock and counter shock phases
Stage Resistance
Body attempts to adapt to stressor
Vital signs, hormone levels, and energy production return to normal
Body regains homeostasis or adaptive mechanisms fail
Stage of Exhaustion
Results when adaptive mechanisms are exhausted
Body either rests and mobilizes its defenses to return to normal or dies
Examples pf Psychosocial Stressors
Accidents
Stressful or traumatic experiences of family members
Horrors of history
Fear of aggression
Rapid changes in the world
Inherent stressors
Psychological Homeostasis
Mind body interaction
Anxiety
Coping Mechanisms
Defense Mechanisms
Coping Mechanisms
Crying, Laughing, sleeping, and cursing
Physical activity, exercise
Taking a deep breath mindfulness
Smoking, drinking
Lack of eye contact and withdrawal
Limiting relationships to those with similar values and interests
Task Oriented Reactions to Stress
Attack Behavior
Attempts to overcome obstacles to satisfy need
Constructive: Assertive
Destructive: Aggression, hostility
Withdrawal Behavior
Physical Withdrawal from threat
Admitting Defeat, feeling guilty, isolated
Compromise Behavior
Substitution of goals or negotiation to partially fulfill needs
Effects of Stress
Stress and basic human needs
Stress in health and illness
Long term stress
Family stress
Crisis
Developmental Stress
Occurs when person progresses through stages of growth and development
Situational Stress
Does not occur in predicable patterns
illness, divorce, marriage
Stressful Activities in Nursing
Assuming responsibilities for one is not prepared for
Working with unqualified personnel
Working in unsupportive environment
Caring for dying patient
Conflict with peers
Being unable to take right action
Teaching Activities of Healthy Daily Living
Exercise
Rest and Sleep
Nutrition
Support Systems
Use of stress management
Stress Management Techniques
Relaxation
Mindfulness
Guided Imagery
Crisis Intervention
Crisis Intervention
Disturbance caused by a precipitating event, coping ineffective
Stabilization
Acknowledgement
Facilitation of understanding
Encourage effective coping
Recovery
Referral
Evaluating the Care Plan
PT verbalizes the causes and effects of stress and anxiety
Uses support systems
Uses problem solving to find a solution to stressors
Practices healthy habits and anxiety reducing techniques
PT verbalizes decrease in anxiety and increase in comfort
