week 10- transitions and autonomy Flashcards
1
Q
trajectories of illness
A
- short period of decline over weeks/months
- long-term functional limitations and gradual deterioration in health and functioning, with intermittent exacerbations
- prolonged dwindling over years
2
Q
chronic illness trajecory
A
- pre-trajectory: before the illness course begins, no signs or symptoms present
- trajectory onset: signs and symptoms are present, includes diagnostic period
- crisis: life-threatening situation
- acute: active illness or complications that require hospitalization
- stable: symptoms controlled by regimen
- unstable: symptoms not controlled by regimen but not requiring hospitalization
- downward: progressive deterioration of physical status, mental status, or both, characterized by increasing disability, symptoms, or both
- dying: immediate weeks, days, and hours preceding death
3
Q
nursing interventions for chronic illness trajectory
A
- pre-trajectory: focus on disease prevention, health promotion, early detection
- trajectory onset: education, provide supports/coping resources
- crisis: immediate care/stabilize patient
- acute: direct care, monitor for complications
- stable: ongoing support, monitor for complications, reinforce self-management skills
- unstable: adjust treatment plans, symptom management
- downward: palliative care, manage care
4
Q
relational nursing recommendations for the care of patients with chronic illness
A
- what gives their life meaning?
- education about the illness and its management
- ongoing assessment, focusing on the prevention of complications
- symptom management
- set realistic goals and expectations
- focus on potential rather than limitations
- teach the skills required for effective self-care
- encourage the verbal expression of feelings.
- facilitate the grieving process.
- provide resources
- help the person die with dignity and comfort
5
Q
developmental transitions
A
retirement, grandchildren
6
Q
situational transitions
A
widowed, retirement home, becoming a caregiver
7
Q
health-illness transition
A
moving between hospital and home, experiencing persistent illness
8
Q
later life transitions
A
process during which people redefine their sense of self and develop self-agency in response to disruptive life events
ie. developmental, situational, health-illness
9
Q
transition characteristics
A
- can be predictable or unanticipated
- speed and intensity of change make the difference between a transitional crisis and a gradual adaptation
- most difficult transitions are those that result in loss of status, independence or opportunity
- ideal outcome occurs when gains in satisfaction/new roles offset losses
10
Q
societal factors affecting family relationships
A
- nuclear/blended families
- economic challenges
- multi-generational households
- caregiver role
- widowed/divorced
11
Q
physical factors that affect coping and loss
A
- number of concurrent medical conditions
- use of sedatives
- nutritional state
- inadequate rest can lead to mental and physical exhaustion
- inadequate exercise limits emotional outlet
12
Q
psychological factors that affect coping and loss
A
- unique nature and meaning of loss
- individual coping behaviour, personality and mental health
- individual level of maturity and intelligence
- previous experience with loss or death
- sex-role conditioning
- immediate circumstance surrounding loss
- perception of preventability
- number/type/quality of secondary losses
- presence of concurrent stresses or crises
- timeliness of loss
13
Q
social factors that affect coping and loss
A
- support systems and acceptance of assistance of its members
- sociocultural, ethnic, religious or philosophic background
- educational, economic and occupational background
14
Q
factors specific to death and dying that affect coping and loss
A
- role that the deceased occupied in family/social system
- amount of unfinished business
- perception of fulfillment in life
- immediate circumstances surrounding death
- length of illness before death
- anticipatory grief
15
Q
coping assessments
A
- goal is to differentiate between those likely to cope effectively and those at risk for ineffective coping
- includes questions about recent significant events, religious values and relationship to that which has been lost/gained
16
Q
nursing interventions for coping
A
- establish rapport
- be ready to listen
- offer support and direction
- encourage griever to talk and tell story of relationship
17
Q
autonomy
A
- ethical principle meaning freedom to make independent choices, self-governing
- implies respect for people, freedom to make choices/act on choices
- requires independence from controlling influences, proper information
- limited by the fact that providers are not required to practice outside of accepted standards of care
18
Q
paternalism
A
- well-intended actions of benevolent decision-making, leadership and decision-making
- making decisions on behalf of patients
- assumption that patient’s values are the same as the provider’s
19
Q
informed consent
A
person must receive all the necessary information about the nature of the treatment, expected risks/benefits, alternative courses of action, consequences of not having the treatment
20
Q
decision-making capacity
A
- depends on the treatment and time of treatment
- if a patient regains capacity after someone has already made a decision on their behalf, the patient’s wishes govern
21
Q
substitute decisions act (1992)
A
- involves formal appointment of a decision-maker through a POA document
- only trained capacity assessors may determine capacity for the purpose of the SDA
- POA for personal care names an SDM, highlights wishes about future treatment, must have two witnesses and must be in writing
- the grantor must be capable at time of signature, capable for any directions/wishes they’ve indicated and be over 16
- the POA for personal care comes into effect when the person is incapable or is unable to see the consequences of their decision
22
Q
A
