💉- Sleep & Palliative Care Test Flashcards by Carolyn Cuartero

Leptin

Is decreased during sleep deprivation

Tells you to stop eating

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RAS

Reticular activating system

Regulates sleep and wakefulness

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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

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NREM stage II

Light sleep ; polysomnographic readings show intermittent peaks and valleys
❤️rate slows, decrease body temp

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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

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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

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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

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Dyssomnia

Characterized by insomnia or excessive sleepiness

Ex: insomnia , circadian disorders, sleep apnea, RLS, hypersomnia, narcolepsy

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Parasomnia

Patterns of waking that appear during sleep

Ex: sleep walking/talking, bruxism, night terrors, R.E.M. Sleep behavior disorder, nocturnal enuresis

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Bruxism

Grinding and clenching of the teeth, usually occurs during stage II NREM sleep

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Circadian disorders

Abnormality in sleep/wake times

Ex: jet lag, working night shift, rotating shifts

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What is an associated cause of RLS

Low iron levels

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Night terrors vs Nightmares

Night terrors occur during NREM (deep sleep)

Nightmares occur during R.E.M. (Dream)

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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

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Sleep provoked disorders

Because of the disease presences , person gets worse as they sleep

Ex: CAD, asthma, COPD, diabetes, gastric ulcers, epilepsy

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What is an appropriate bedtime snack

Complex carb (bread, cereal) + protein (milk, cheese)

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Tryptophan

An amino acid found in turkey , promotes sleep

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Perioperative nursing

Involves patient care before, during and after surgery

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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

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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

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What are the 4 ways to classify surgeries

By body system

Purpose

Level of urgency

Acuity

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Ablative surgery

Removal of a diseased body part

Ex: a cholecystectomy removes a diseased gallbladder

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Diagnostic (exploratory) surgery

Confirm or rule out a diagnosis

Ex: biopsy, fine-needle aspiration, invasive testing such as a cardiac catherization

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Palliative surgery

Alleviate discomfort or other disease symptoms without producing a cure

Ex: nerve root destruction for chronic pain

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Reconstructive surgery

Restore function

Ex: rotator cuff repair

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Transplant surgery

Replaces a malfunctioning body part, tissue or organ

Ex: also includes joint replacements

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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

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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

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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

Gherlin

Is increased during sleep deprivation

Tells you when you’re hungry

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💉- Sleep & Palliative Care Test Flashcards

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