Pwrpnts Flashcards
Types of loss (5)
1) Actual loss
2) Perceived loss
3) Anticipatory loss
4) Maturational loss
5) Situational loss
Actual Loss
Loss of a person or an object that can’t be experienced anymore seen or felt anymore. Easily identified with others outside the loss. Spouse, home, object, home,
Maturational loss
Any changes in developmental process that is normally expected in a lifetime. “Child 1 st day of school” “ Retirement”
Situational loss
Sudden unpredictable loss. ex) typhoon-car accident can have multiple losses “limb–>health–>job–>loved one”
Perceived loss
Internal– ex) loss of self-esteem- loss of confidence-loss of position or status
They need same kind of care as other losses
Anticipatory loss
Deal with a loss before it actual happens.
Start processing loss before it happens.
Bereavement
combination of grief and mourning
Grief
total response to the Emotional response to loss.
Thoughts, feeling, behaviors–>crying~anger
Mourning
Outward social expression of a loss. Behavioral process through which grief is eventually resolved.
Often influenced by culture and custom, and can often last a year or more.
Grief process can take an average of 2 years.
Theories of grief (3)
1) Kubler- Ross- stages of dying (most common)
2) Bowlby- phases of mourning
3) Worden- tasks of mourning
Kubler-Ross
5 Stages of Dying
Stage 1- Denial Stage 2- Anger Stage 3- Bargaining Stage 4- Depression Stage 5- Acceptance
Bowlby’s Theory (4)
1) Phase of numbing (like denial)
2) Phase of yearning and searching (sobbing~painful~tightness in the throat)
3) Phase of disorganization and despair~ (leads to acceptance)
4) Phase or reorganization
Worden’s Theory
!) To accept the reality of the loss
2) To work through the pain of grief
3) To adjust to the environment in which the deceased is missing
4) To emotionally relocate the deceased and move on with life
Types of grief (3)
1) Normal grief~ crying-sobbing
2) Anticipatory grief~ before loss actually occurs(Alzheimer’s, terminal cancer)
3) Complicated grief~can become dysfunctional (sudden death- can’t view the remains)
a) chronic grief~ person can’t move on.
b) delayed grief~ suppressed or
postponed.
c) exaggerated grief~ so overwhelmed
can’t function
d) masked grief~ behaves in ways
that interfere with
normal functioning
but is unaware of it.
Factors influencing loss and grief (6)
1) Significance of the loss
2) Culture
3) Spiritual belief
4) Sex role
5) Socioeconomic status
6) Age
Part 2 of influencing loss and grief (7)
1) Human development
2) Personal relationship
3) Nature of loss
4) Coping strategies
5) Socioeconomic status
6) Culture and ethnicity
7) Spiritual & religious beliefs
Page 711
Assessment
1) Type and stage of grief
2) Grief reaction
3) Factors that affect grief
4) End-of-life decisions
5) Nurses experience with grief
6) Client expectations
Concept of Death Based on Developmental Level (7)
Infancy- 5 y/o~ does not understand concept of death
5 yrs~ 9 yrs~ Understands that death is final.
Believes own death can be avoided
9-12 y/o- Understands death as inevitable and unavoidable~ begins to recognize own mortality
12-18 y/o~ Fear of lingering death.
May fantasize that death can be defied
18-45 y/o~ Attitude influenced by religious and cultural beliefs
45-65 y/o~ Experiences death of parents and peers.
Death anxiety.
Fears prolonged illness
65 and over~ Sees death as having multiple meanings.
Death of family members and peers experienced
Signs of impending death
- Loss of muscle tone
- Slowing circulation
- Changes in vital signs
- Sensory impairment
Care of dying patient
1) Assist in peaceful death
2) Meet physiological needs
3) Client bill of rights
4) Hospice and home care
5) Spiritual support
Body changes after death (3)
1) Rigor mortis
2) Algor mortis
3) Livor mortis
Care of the body after death
1) Make environment clean and body appear comfortable
2) Remove all equipment and supplies
3) Remove soiled linens
4) Place the body in the supine position
5) One pillow under head and shoulders
6) Close eyelids
7) Insert dentures, close mouth
8) Clean gown, comb hair
9) Remove jewelry
10) Pull top bedding to shoulders
11) Organize clothing and valuables to take home
Sympathoadrenal Response to pain
- Increased pulses rate
- Increased systolic B/P
- Increase respiratory rate
- Diaphoresis
- Increased muscle tension
- Pallor
- Pupil dilation
- Rapid speech/ elevated pitch
- Increased alertness
Parasympathetic Response to pain
- Decreased pulse rate
- Decreased systolic B/P
- Syncope
- Nausea/ Vomiting
- Warm dry skin
- Prostration
- Pupil constriction
- Slow, monotonous speech
- Withdrawal
Behavioral Responses
- Immobility
- Withdrawal
- Rubbing body part
- Grimacing
- Restlessness
- Writhing
- Unusual postures
- Extreme quietness
- Groaning, crying
Affective (feeling) Response
- Fear/ Flight
- Anxiety
- Depression
- Anger
- Hopelessness
- Powerlessness
- Fatigue/ exhaustion
- Feeling of being punished
Acute pain
- Follows normal nociceptor activation pathway to the brain
- cause is known and treatable.
- Origin is tissue Trauma
- Temporary- rapid onset, short duration
- Pain is specific and localized
- Serves as a warning of tissue damage and subsides with healing
- Behavior and physiologic signs:
~Rubbing
~guarding
~grimacing
~brow wrinkling
~ lip biting
~ change in HR, RR, BP
Chronic Pain
- Most is neuropathic; it follows an abnormal pathway for pain that results from nerve damage from anatomic and physiologic conditions and underlying diseases
- Cause may be unknown; treatment may not be helpful
- Develops slowly; discomfort lasts longer than 6 months
- Pain is nonspecific and generalized
- Behavioral and Physiological signs include unusual sensations such as:
~burning
~Shooting pain
~Abnormal sensations that occur when there
is no painful stimulus present
Pain is the?
5th vital sign
Physiology of pain
- Nociceptors/ pain receptors are stimulated by cell damage and the release of neurotransmitters such as bradykinin, histamine, prostaglandins, or substance P.
- The stimulated nociceptor cells activate
- Afferent nerve pathways (linkage of neurons from periphery of the body to toward the central nervous system)
- Nerve impulses then travel up the spinal cord to the brain
- In the brain, the cortex interprets the impulses as pain and identifies the location and qualities of the of the pain.
- The efferent nerve pathways then carry the pain message down the spinal cord to the affected area of the body
Gate Control theory
- Synapse act as gates that can open or close to pain impulses
- Stimulation of large-diameter fibers via heat, cold, or touch can close the gate and interfere with pain impulse transmission fro the spinal cord to the brain
- Similar gating mechanisms exist in nerve fibers of the cerebral cortex of brain which regulates thoughts and emotions
- Therefore, cognitive- behavioral therapies such as imagery and distraction help relieve pain
Classification of pain
- Nociceptive Pain
* Somatic Pain
* Visceral Pain - Neuropathic Pain
* Centrally generated pain
* Peripheral generated pain
Nociceptive Pain
Normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged; usually responsive to nonopioids and / or opioids
* Somatic~ musculoskeletal pain (bone, joint, muscle~ achy throbbing) * Visceral~ organ area; ex) pancreas, heart. poorly localized. (aching or cramping)
page 966
Neuropathic pain
Arises from abnormal or damage neurons
* Centrally generated pain- injury to the peripheral or central nervous system (ex; Phantom pain–> damaged nerves)Injury to the nerve itself
Injury to the damaged nerves)
* Peripheral generated Pain~Felt in many nerve fibers (ex; diabetic neuropathy~ periphery neuropathic disease--> difficult to treat)
Pain is experienced by:
- Age
- Fatigue
- Genetic sensitivity
- Cognitive function
- Prior experiences
- Anxiety and fear
- Support system
- Culture
Nonpharmacologic Interventions
- Eliminate any factors that could cause the gate to open:
* Alleviate patients fears
* Give patient control over his pain
* Facilitate patient rest
* Alleviate hunger
* Regulate temperature and room ventilation
Will help gate to close:
* Distractions
* Relaxation
* Cutaneous Stimulation- Warm or cold packs,
analgesic ointments, counterirritants,
TENS unit (Iggy pg 60)
* Contralateral Stimulation ( stimulates
opposite side–>charley horse
rub the other side)
* Humor within reason (releases endorphins)
Pharmacological Interventions
- Analgesic (class)
* medications that relieve pain
3 classification of Analgesics
1) Nonopioid
2) Opioid
3) Adjunvants
Nonopiods analgesics
Example; Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, and acetaminophen
*Block pain on the peripheral nervous system
* Generally used to treat mild to moderate pain
* May have one or all of the following properties;
~ Anti pyretic (decreased fever)
~ Analgesic (reduce pain)
~ Anti- inflammatory (decrease inflammation)
Side effects: Distress to GI tract at the level of the gut, can have bleeds. Needs to be taken with food.
CAN be combined with opioid analgesics
Opioid Analgesics
- Controlled substances
- Examples: codeine, hydrocodone (Vicodin), hydromorphone (Dilaudid), morphine, fentanyl, methadone (Dolophine)
- Block pain transmission at central nervous system (CNS) level
- Used for moderate to severe pain
- Routes of administration
- Opioid agonists bind to opioid receptors sites
to produce analgesia - Also bind to other receptor sites which produces side effects
Can be given by various routes — 4-10 pain scale
Opioid Agonist Side effects
- Drowsiness, sedation
- Respiratory depression
- Nausea with or without vomiting
- Decease bowel mobility/constipation
- Urinary retention
- Orthostatic hypotension
- Dizziness
- Rash
Narcotic Antagonist
- Prevents narcotic/ opioid from doing its work
* Narcan
Agonist-Antagonist
*Relieves pain but blocks some of the side effects of pure opioids
Adjuvant Medications
*Drugs not originally developed for analgesic use
But discovered good for pain. Used for neuropathic pain (Phantom limb pain, pain below spinal cord injury)
- Preparations
* Tricyclic Antidepressants
* Anticonvulsants
* Antianxiety
* Corticosteriods
Local Anethestics
- Alcaine
- Xylocaine- with or without Epinephrine
- EMLA
- Epidural
Surgical interventions for pain relief
Often for chronic pain
- Permanent
- Last resort
- Dorsal Rhizotomy~ Cutting of the posterior nerve roots are they enter the spinal cord (full motor function)
- Chordotomy~ Resection of the spinal cord tract and paralysis will result
% of US population belongs to Racial or ethnic groups?
33%
Population stats
European (white) American–66.9%
African America- 12.8%
Hispanic American= 14.4 %
Asian American - 4.3%
Estimated what % of minority groups will make up US population by 2050?
50%
Culture
consists of the totality of socially transmitted knowledge of values, beliefs, norms and lifeway’s of particular group that guides their thoughts, and behaviors and also decision making
Visible & Invisible components
Visible- easily seen or observed–>customs, rituals, language, appearances
Invisible- less observable–>values, morals, beliefs
It is important to understand - the invisible value- belief system of a particular culture is the major driving force behind the visible practices.
Ethnicity
Refers to a shared identity related to a social and cultural heritage such as values, language, geographical space, racial characteristics
Race
is a term that is often contrasted with ethnicity but it is more limited to common biological attributes such as skin color (black~white)
Intercultural Encounters
In any intercultural encounter, there is an insider or native perspective and an outsider’s perspective
Emic worldview– Insider perspective
Etic worldview– Outsider perspective
(Korean lady soup-book)
Enculturation
socialization into one’s primary culture as a child
Acculturation
The process of adapting to and adopting a new culture
Assimilation
When an individual gives up his or her ethnic identity in favor of the dominant culture
Biculturalism
When an individual identifies equally with two or more cultures
Cultural Backlash
Occurs when experiences with a new or different culture is extremely negative and as a result that culture is rejected
Transcultural nursing
An area of study and practice that focuses on the care, health and illness patterns of individuals with similarities and differences in their cultural beliefs, value and practices.
The practice of transcultural nursing is to provide care that considers the cultural aspects of each client.
Goal–> Culturally congruent care
~that fits individual’s valued life patterns
and set of meanings
~ the clients and NOT based on predetermined criteria
3 Levels of cultural competence
1) Practitioners~ ability to bridge the cultural gap~ and give client meaningful care
2) Organizational~ System wide support
3) Societal~ knowledgeable and skilled communities to help with rights and needs
Development od cultural competence (5)
`1) Cultural Awareness
2) Cultural Knowledge
3) Cultural Skills
4) Cultural Encounters
5) Cultural Desires
Cultural Conflict
1) Ethnocentrism~ A tendency to hold ones own way of life as superior to others
* judging of others through the lens of ones own cultural beliefs
* When action is taken based on ones prejudices discrimination occurs
2) Cultural Imposition~ Using ones own values, beliefs as an absolute guide in dealing with clients and interpreting their behaviors
* result from cultural ignorance or cultural blindness
Cultural Healing Modalities (2)
1) Externalizing health care system
2) Internalizing health care system
Externalizing health care system
Connect health and illness to social and cosmological factors
Ex) “AIDS” may be seen as punishment from God for ones evil deeds
Internalizing health care system
Are found in modern societies with highly scientific and technological capacities to examine biological causes of health and illness
Ex) Western biological system
Cross-cultural healers (2)
1) Naturalistic practitioners
2) Personalistic practitioners
Naturalistic practitioners
(western culture)
Attribute illness to natural, impersonal and biological forces that cause alteration in the equilibrium of the human body
* healing emphasizes naturalistic modalities–> cold, heat chemical, massage, surgery
Personalistic practitioners
(nonwestern culture)
Believes that health and illness can be caused by the active influence of an external agent which can be human (sorcerer) or nonhuman (God, devil)
*Emphasizes the importance of humans relationships with others, both living and deceased, and with their duties
* use healing–> combo–> supernatural, magical and religious
* also naturalistic such as herbs, massage aromatherapy
Cultural and Life transitions (5)
transition to different phases of life are generally marked by rituals
1) rights of passage
1) Pregnancy
2) Childbirth
3) Newborn
4) Postpartum period
5) Grief and loss
page 110-113
Cultural assessment (4)
1) Census data
2) Interview-ask questions
3) Establishing relationships
4) Participation
Guide for cultural assessment (10)
1) Ethnic heritage and ethnohistory
2) Biocultural history
3) Social organization
4) Status hierarchy
5) Appropriate or expected roles
6) Religious and spiritual beliefs
7) Communication patterns
8) Time orientation
9) Caring beliefs and practices
10) Experience with professional health care
Recurrent Caring construct in both Western and Nonwestern cultures (11)
1) Respect for an adult
2) Concerns for and about
3) Attention to details
4) Helping/assisting or facilitative acts
5) Active listening
6) Presence (being physically there)
7) Understanding (beliefs, values, lifeway’s, ect..)
8) Connectedness
9) Protection (gender related)
10) touching
11) Comfort measures
