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Fundamentals (Nurs 113) > Mental Health, stress, coping, loss, dying, death and grief > Flashcards

Mental Health, stress, coping, loss, dying, death and grief Flashcards

1
Q

What is resilience?

A

the strength to cope with change, stress, problems, challenges, hardship and loss

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2
Q

What will nurses assess for?

A

Self concept
coping skills
stressor
history of past and present loss
compassionate care of dying patient
dignified post morterm care

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3
Q

What is the comparison between stress and self concept?

A

self esteem determines how a person may react to stressors and cope with it
individuals with low self esteem react to stressors in a more intense manner

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4
Q

which lab result will be high when we are stressed?

A

Cortisol levels will be extremely high. There will be high levels

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5
Q

What is stress?

A

the body response to change in its normal perceived balanced state perceived threat

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6
Q

What are the 2 types of stressors

A

Physiological and psychosocial

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7
Q

Physiologic stress

A

an altercation in the normal body structure and function. affects the body

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8
Q

Psychosocial stress

A

Affects the mind

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9
Q

Give some example of psychosocial stress

A

-traumatic experiences
-horrors of history
-fear of aggression or mutilation: muggings

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10
Q

Physical s/s short term stress

A

-Muscle tension
-Headache
-Increased bp
-Sweating
-Dry mouth
-Heart palpitation or irregular heartbeat
-Increased incidents of infection
-Skin rashes
-Stomachache, constipation, or diarrhea

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11
Q

Emotional/Cognitive
s/s short term stress

A

-nervousness or anxiety
-anger or irritability
-inability to concentrate or forgetfulness
-depression, fatigue, withdrawl
-being overwhelmed
-sleep pattern disturbance
-eating habits change
-alcohol or drug use increase

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12
Q

Cognitive s/s of long term stress

A

-Problems with concentrating, learning, thinking and memory
-Decrease self-confidence and increased negativity
-Inhibited decision making and constant worrying

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13
Q

Emotional s/s long term stress

A

-Low morale, guilt and unhappiness
-feeling hopeless/helpless and depressed
-feeling apprehensive, anxious, or nervous
-irritability, agitation, moodiness, inability to relax, unhappiness

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14
Q

Physical s/s long term stress

A

-head, muscle, and stomach pain
-GI: nausea, diarrhea, vomiting
-change in vitals signs and weigh, stiff neck or jaw
-fatigue and loss of sex drive
-sexual problems
-forgetfulness and lack of energy/focus

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15
Q

Behavioral s/s long term stress

A

-insomnia or sleeping too much
-stress eating or bingeing
-loss of sex drive
-social withdrawal and increase in nervous habits
-abnormal use of caffeine, cigs, alcohol etc
-decline in work performance
-family responsibilities are neglected

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16
Q

How might chronic stress affect mental health

A

-anxiety, depression, obesity
-substance abuse and sleep problems

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17
Q

How might chronic stress affect physical diseases or conditions

A

-Respiratory problems asthma
-neuro problems
-CVA

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18
Q

what’s important to remember with chronic stress

A
  • Certain illnesses are exacerbated
    -asthma, peptic ulcer, arthritis, CHD, diabetes, HTN, CAD, migraines
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19
Q

What are examples of maladaptive coping mechanisms

A

-Bullying or aggressive behavior
-compartmentalization
-denial, dependency and displacement
-emotional outburst: crying
-lack of eye contact, cursing, smoking
-limit relations with those similar in values and interest
-overreacting
-regression or rationalism
-self-harm and substance abuse
-sensationalizing
-sleeping too much or too little
-violence

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20
Q

Positive coping mechanism

A

-self care
-problem solving: to-do list
-expressing distress and distancing self from stress or the stressor
-ignoring self harm impulses
-limiting caffeine and alcohol
-music, art and, massage therapy
-praying and counseling
-education and medication
-recreational technique and activity

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21
Q

As a nurse self care exercises can you recommend for your patient?

A

-exercise
-healthy diet: avoid caffeine
-sleeping 6-8 hours a night
-deep breathing exercise
-managing triggers
-asking for help
engaging in support systems

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22
Q

What is anxiety

A

a vague, uneasy feeling of discomfort or dread, the source of which is often unknown or nonspecific

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23
Q

What are the 4 categories of stress?

A

-mild
-moderate
-severe
-panic

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24
Q

Mild anxiety

A

Facilitates with problem solving
Presented in day to day activities
manifested by restlessness and increased questioning

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25
Moderate anxiety
Perceptual fields narrowed so that focus on immediate concerns, with inattention to other communication and details. Voice tremors, butterflies in stomach etc
26
Severe anxiety
Perceived fear of danger with emotional stress. Manifested with fear of danger that is not real. Difficulty communicating verbally, increased motor activity, a fearful facial expression, headache. nausea, vomiting etc Anxiety is no longer functioning as a signal for danger but a need for change
27
Panic
-Disorganized state -Increased physical activity, loss of rational thought
28
what are the 5 step techniques used to promote adaptive outcomes, reestablish equilibrium, and improve the patients ability to cope with future crisis?
1. identify the problem 2. list alternatives 3. choose one of the alternatives 4. implement the plan 5. evaluate the outcome
29
What is the nurse priority intervention ?
To maintain physical and psychological safety
30
What are the other considerations for a crisis intervention plan
- Must be individualized -Source of stress must be identified -Must assist with managing higher levels of stress
31
When does stress become a crisis?
when there is no positive mechanisms or stress management strategies
32
If stress is not managed what can occur?
anxiety
33
What is loss?
a negatively perceived event that has long term effects on the person way of life, social situation, relationships and of seeing the world and themselves basically losing something that is of great value to you
34
Actual loss
Can be recognized by the person and others Others can ACTUALLY see it losing a limb, a child, a valued object etc
35
Perceived loss
Felt by the individual but incapable for others loss of joy, youth, independence etc
36
Anticipatory loss
Loss that has not occurred as yet Often seen in families with patients who have serious and life threatening illnesses Patients on hospice
37
Situational loss
occurs from an unpredictable event Family losing home from tornado
38
Maturational loss
occurs with natural developmental process A only child may experience this feeling when another child is born
39
What is important to know with terminal illness?
Death is expected
40
What are some rights that a patient have?
-Right to be treated as a living human bein until they die -Right to maintain a sense of hopelessness -Right to express their feelings -Right to participate in decisions
41
Palliative vs Hospice care
-Palliative care is for patients with a life threatening diagnosis. It focuses on symptom of a life-limiting illness. -Hospice care for end of life care
42
Hospice care
-This is care given 6 months or less to live -The goal is to have a pain free and "good" death
43
What is bereavement support
-available for 13 months following the loss of a loved one
44
what is the provider responsible for with a patient who has a terminal illness?
They are responsible for what, when and how the patient should be told
45
What are the physiologic needs of a dying patient?
Hygiene Pain control Nutritional needs
46
What are the psychological needs of a dying patient?
Pain Separation Patient control over fear of the unknown Leaving loved ones Loss of dignity Loss of control Unfinished business Isolation
47
Dying patient needs for intimacy
The patients needs ways to be physically intimate that meets needs of both partners
48
Dying patient spiritual needs
Patient needs for meaning and purpose, love and relatedness, forgiveness, and hope
49
When might a psychology consulted be needed?
-after diagnosis of terminal illness -beginning of treatment -during advancement of illness -end of life and during the dying process
50
Signs and symptoms of a patient that is actively dying
Loss of appetite Decreasing blood pressure Weak, slow or irregular pulse Difficulty swallowing or talking Nausea, and abdominal distention Restlessness, confusion or agitation Increased sleep or periods of drowsiness Loss of movement, sensation and reflexes Gurgling or crackling sounds with breaths Cheyne-strokes respirations Urinary and bowel incontinence Decreasing temperature Cold and clammy skin Cyanosis of the extremities Cooling Mottling
51
Can nurses pronounce death?
No
52
The 5 types of death
-Suicide -Homicide -Unknown -Accident -Natural
53
Postmortem care
-reviewing organ donation arrangements -caring for the body -care for the family -preparing the body for discharge -follow the local law if the patient died at of a communicative disease -ensure the death certificate issued and signed
54
Caring for the body after death
-Elevate the clients head to prevent facial discoloration by raising the head of the bed and placing a pillow behind their head and shoulders -Provide care with respect and compassion while attending to the desires of the clients and family wit their culture and make attempts to comply
55
Preparing the body for viewing
-Make sure to ask the family member what they would like to be on the patients body -Maintain privacy -Remove all tubes -Remove all personal belongings to be given to family -Dim the lights and minimize noise -Remove excess supplies, equipment, soiled linens -Brush and comb the clients hair -Replace any hairpieces -Apply fresh linens wit absorbent pads on beds and gown -Cleanse and align the body supine with a pillow under the head, arms with palm of hand down outside the sheet and blanket, denture in place, and eyes closed
56
Do nurses sign the death certificate
No We make sure that it is signed by the provider
57
Where do we put the the tags on the body
the shroud and the body
58
What is the nurses legal responsibilities for discharge?
-Document who was at the bedside -Who the personal effects was given to -The condition of the body -To whom the body was discharged -Making sure the physician signs the death certificate
59
How do we care for the family after their family member have died?
-Listen to family expression of grief, loss and helplessness -Offer solace and support -Be an active listener -Arrange and make time for the family member to view the body -If there is a sudden death provide a place for the family to grieve
60
Is it appropriate for the nurse to attend the funeral of a patient who died?
-yes and make follow up visits for the family
61
What are the categories of grief?
Physical Emotional Social Spiritual
62
Mourning
The actions and expressions of grief An example is a funeral ceremony
63
Bereavement
This is a state of grief that is felt due to the loss of loved ones
64
Dysfunctional grief
Abnormal and distorted This may be unresolved or inhibited
65
Anticipatory Grief
This grief is "letting" go of a loved one or something before it is gone The grieving process is started before the loss
66
Delayed Grief
Associated with normal grief and occurs after future unrelated loss occurs. Delay in emotional response
67
Complicated/Dysfunctional grief
Abnormal because of how long it takes Person is unable to function normally
68
Chronic Grief
Can lead to mental health illness
69
What are the stages of grief
1. Denial and isolation 2. Anger 3. Bargaining 4. Depression 5. Acceptance
70
Denial
There is denial of the reality that the person has died Might say "there is a wrong diagnosis, there is a mistake"
71
Anger
Directs anger towards, self, others, a deity, objects etc
72
Bargaining
The client negotiates for more time
73
Depression
Overwhelmingly saddened Crying Not speaking much
74
Acceptance
The client acknowledges what is going on
75
Factors that affect loss and death
Culture Sex Ritual practices Spirituality, Faith, and religion
76
Advanced directive
Living will Durable power of attorney
77
Living will
Provide specific instructions about the kinds of health care that should be provided in particular situations
78
Durable power of attorney
Appoints an agent the person trust to make decision in the vent of subsequent incapacity
79
Remember that patients have the legal and ethical right to refuse treatment
Remember that patients have the legal and ethical right to refuse treatment
80
MOLST/POLST form
Order that indicate the patient wishes about treatment used in medical crisis -Must be completed and signed by a healthcare profession not by the patinet
81
DNR
-Allows a natural death -Do not attempt to resuscitate whose heart is being stopped -Slow code is not allowed and can lead to legal action against the license nurse
82
CPR
-This is mandatory for respiratory or cardiac arrest unless the patient has DNR OR PCP order
83
Advanced directive
-For patients over 18 -Instructions for future treatment -appoints a health care representative -does not guide emergency medical; personnel
84
MOLST/POLST FORM
-For persons with serious illness at any age -Provides medial order for current treatment -Guides action by emergency medical personnel when made available -Guides inpatient treatment decision when made available
85
End of Life Treatment
-Do not resuscitate: no code -Only comfort measures -Active or passive euthanasia: lethal injection death -Terminal weaning
86
Terminal illness
-palliative sedation -lowering consciousness -Organ donation

Fundamentals (Nurs 113) (11 decks)

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