💉- Sleep & Palliative Care Test Flashcards
Leptin
Is decreased during sleep deprivation
Tells you to stop eating
Gherlin
Is increased during sleep deprivation
Tells you when you’re hungry
RAS
Reticular activating system
Regulates sleep and wakefulness
NREM stage I
- polysomnography (sleep readings)
- can be awakened without difficulty
- if aroused, may feel as if hasn’t slept
- dreams usually not remembered
- lasts 5-10 mins
NREM stage II
- Light sleep ; polysomnographic readings show intermittent peaks and valleys
- ❤️rate slows, decrease body temp
NREM stage III
- deep sleep ; aka slow wave or delta sleep
- if aroused during this stage, may feel disoriented for a few minutes
- snoring and sleep walking may occur
- important for restorative processes such as healing, growth and tissue renewal
REM sleep
- usually occurs 90 mins after sleep onset
- final R.E.M. Stage may last up to an hour ; first one lasts typically 10mins
- increased ❤️rate, temp, BP, metal and gi secretions
- spontaneous awakenings
- essential for mental and emotional restoration
- intense dreaming occurs
Rebound R.E.M.
A person deprived of R.E.M. Sleep for several nights will usually spend greater amount of time in the R.E.M. Sleep on successive nights
Dyssomnia
Characterized by insomnia or excessive sleepiness
Ex: insomnia , circadian disorders, sleep apnea, RLS, hypersomnia, narcolepsy
Parasomnia
Patterns of waking that appear during sleep
Ex: sleep walking/talking, bruxism, night terrors, R.E.M. Sleep behavior disorder, nocturnal enuresis
Bruxism
Grinding and clenching of the teeth, usually occurs during stage II NREM sleep
Circadian disorders
Abnormality in sleep/wake times
Ex: jet lag, working night shift, rotating shifts
What is an associated cause of RLS
Low iron levels
Night terrors vs Nightmares
Night terrors occur during NREM (deep sleep)
Nightmares occur during R.E.M. (Dream)
Secondary sleep disorders
Occur when disease process alters sleep stages or quantity/quality of sleep
Ex: depression, hyper/hypothyroidism, pain, airway passage obstruction and CNS dysfunction
Sleep provoked disorders
Because of the disease presences , person gets worse as they sleep
Ex: CAD, asthma, COPD, diabetes, gastric ulcers, epilepsy
What is an appropriate bedtime snack
Complex carb (bread, cereal) + protein (milk, cheese)
Tryptophan
An amino acid found in turkey , promotes sleep
Perioperative nursing
Involves patient care before, during and after surgery
AORN and TJC established patient safety goals
Prevent infection
Improve accuracy of patient identification
Increase patients involvement of care
Perform a time out before starting procedures
NEVER events
Medicare will no longer reimburse institutions for care related to these complications
Ex: surgery on wrong body part, wrong person, wrong surgery, VTE after knee or hip replacement, foreign body left in patient after surgery, surgical site infections after certain elective procedures
What are the 4 ways to classify surgeries
By body system
Purpose
Level of urgency
Acuity
Ablative surgery
Removal of a diseased body part
Ex: a cholecystectomy removes a diseased gallbladder
Diagnostic (exploratory) surgery
Confirm or rule out a diagnosis
Ex: biopsy, fine-needle aspiration, invasive testing such as a cardiac catherization
Palliative surgery
Alleviate discomfort or other disease symptoms without producing a cure
Ex: nerve root destruction for chronic pain
Reconstructive surgery
Restore function
Ex: rotator cuff repair
Transplant surgery
Replaces a malfunctioning body part, tissue or organ
Ex: also includes joint replacements
Emergency surgery
Requires transport to OR as quickly as possible to preserve the patients life or function
Causes: internal hemorrhage, rupture of an organ and trauma
Urgent surgery
Is scheduled within 24-48 hours to alleviate symptoms, repair a body part or restore function
Ex: removal of a cancerous breast and internal fixation of a fracture
Elective surgery
Performed when surgery is the recommended course of action, but the condition is not time sensitive
Ex: repair of a torn ligament, removal of rectal polyps or rhinoplasty (repair of the nose)
Who is responsible for obtaining informed consent for the surgical procedure
The surgeon is responsible for 1. Giving the patient the necessary info and 2. Determining the patients competence to make an informed decision about the surgery
What is the nurses responsibility in reference to informed consent
Verifying that the surgical consent form is signed and witnessed
What is included in the pre-operative checklist
Vitals, assessment, chart components, MAR, valuables, family
Sterile team
Includes the surgeon, RNFA, surgical tech, scrub nurse
What are the duties of the scrub nurse or surgical tech
Sets up sterile field, prepares surgical instruments, assists with sterile draping, responds to needs of surgeons and maintains sterile field
What does the sterile field encompass
The client and area immediately surrounding the client, waist or table up
Clean team
Abide by clean technique (medical asepsis) include the anesthesiologist or nurse anesthetist, circulating RN, biomedical tech, radiology tech
*should never enter the sterile field
Circulating nurse
Is a RN who applies the nursing process to coordinate all activities in the operating room
General anesthesia
Produces rapid unconsciousness and loss of sensation
Conscious sedation
Is an alternative form of anesthesia that provides IV sedation and analgesia without producing unconsciousness
Ex: bronchoscopy And cosmetic surgery
Regional anesthesia
Prevents pain by interrupting nerve impulses to and from the area of the procedure - the patient remains alert but is numb in the involved area
Ex: minor ambulatory procedures
Spinal anesthesia
Is the injection of an anesthetic into the cerebrospinal fluid in the subarachnoid space - this injection blocks sensation and movement below the level of the injection
Ex: surgical procedures in lower abdomen, pelvis and lower extremities
Epidural anesthesia
Requires insertion of a thin catheter into the epidural space - anesthetic agents are infused through the catheter to produce loss of sensation
Local anesthesia
Produces loss of pain sensation at the desired site
Ex: a wound to be sutured or skin growth removal
Can be applied topically or injected
Who positions the client for surgery
The circulating nurse. Being mindful of - high risk for pressure ulcers, shearing of tissue and padding bony prominences
What are the 5 variables to consider while positioning a patient for surgery
Access to surgical site
Access to patients airway
Need to monitor vital signs
Comfort
Safety
What things are included in the TIME OUT (final check)
Right patient
Right procedure
Right site
What are the 5 responsibilities of the circulating nurse
Time out
Monitor Sterile field
Monitor I&O
Sponge, sharps and instruments count
Documentation
Responsibilities of postoperative nurse
Initial QUICK focused assessment of patient in presence of anesthesia
Vital signs every 5-15 minutes
Airway management
Dressing assessment/drainage
Fluid therapy
Aldrete Recovery Scale
Actual vs perceived loss
Actual - can be identified by others; not just the person experiencing it (ex: death, theft, destruction)
Perceived - is internal; only identified by the person experiencing it
Physical vs psychological loss
Physical - includes injury (amputated limb), removal of an organ, loss of function (immobility)
Psychological - commonly seen in the areas of sexuality, control, fairness, meaning and trust
External bs internal loss
External - actual losses of objects that are important to the person b/c of sentimental value (ex: jewelry, a home)
Internal - is another name for perceived or psychological loss
Loss of aspects of self
Include physical losses such as body organs or limbs , developmental change (aging process), loss of hopes and dreams and faith
Environmental loss
Involves a change in the familiar; even if the change is positive
Ex: new home, new job
What is grief , mourning and bereavement
Grief - physical, psychological and spiritual responses to a loss
Mourning - action associated with grief (ex: crying)
Bereavement - mourning and adjustment time following a loss
Uncomplicated grief
(Normal grief)
Is the natural response to a loss
Complicated grief
Aka prolonged acute grief
Is characterized by its length of time and intensity of emotion - responses last longer than 6 months and maladaptive
Ex: bereaved may become depressed, violent or suicidal etc
Chronic grief
A type of complicated grief - begins as normal grief but continues long term, with little resolution of feelings and inability to rejoin normal life
Masked grief
Occurs when the person is grieving, but expressing the grief through other types of behavior
Ex: a man whose wife died may begin drinking heavily
Delayed grief
Is grief that is put off until a later time
Disenfranchised grief
Is experienced in connection with a loss that is not socially supported or acknowledged by the usual rites or ceremonies
Ex: miscarriage, termination of foster placement, mistress whose lover dies
Anticipatory grief
Is experienced before a loss occurs
Uniform determination of death act
Provides a highly reliable means of declaring death for respirator-maintained bodies; loss of brain stem function
What are the 5 stages of dying
Denial Anger Bargaining Depression Acceptance
Palliative care vs hospice care
Palliative - holistic comfort care
Hospice - holistic care of patients who are dying or debilitated and not expected to improve
List 4 nursing interventions involving loss , grief and dying
Therapeutic communication
Facilitating grief work
Helping families
Specific activities involved in care of the dying person
What are the 3 components of facilitating grief
Expressing feelings
Recalling memories
Finding meaning
Gravely disabled client
The gravely disabled or threat to yourself or others can be held involuntary
Conditional release
Requires outpatient treatment for specified period
Unconditional release
Discharge or termination of client-institution relationship
What are the 5 clients rights related to mental health
Right to treatment
Right to refuse treatment
Right to informed consent: based on right to self-determination
Freedom from restraint
Confidentiality
