Intro to NP Exam 4

What is Peripheral Neuropathy

Decreased sensation, especially of feet, in patients with Diabetes, and other

neurological and peripheral vascular disorder.

Safety Teaching for Patients with Peripheral Neuropathy

• Teach to wear firm sole shoes, check shoes to make sure do not fit too tight

• Check water temperature before putting feet in water.

• Check feet daily for cuts and sores

• Never go barefoot.

Dementia

• Dementia is a decline in cognitive

abilities that interferes with daily

life

• Encompasses a range of

symptoms affecting memory loss,

difficulties with language, and

changes in mood and behavior

• Often results from various

underlying diseases, with

Alzheimer’s being the most

common

Management of Patients with Dementia + Interventions

is cognitive decline slower and degenerative- cause by Alzheimer’s and other dementias. Do

not argue with patient, live in their reality, redirect instead of trying to correct them and their perceptions. Sun downing syndrome occurs in evening when light changes, keep room lights adjusted.

Do not schedule important activities or treatments in evening. Keep a consistent schedule for patient; they will become stressed with many changes.

Delirium

• Delirium is an acute mental

disturbance often characterized by

confusion, disrupted attention, and

disordered thinking

• Can be caused by infections (UTI),

change in medication, change in

surroundings, hypoxia

Interventions for those with Hearing loss

if hearing impaired patient provide written handouts for directions in addition to your teaching.

If hearing aides are worn, make sure family bring into patient and that they are able to put them on during hospital stay.

Interventions for those with Vision Loss

Make sure good lighting, patient has clean glasses on, no scatter rugs,

clutter/ cords should be at walls and behind furniture not across walkways.

Maturational/Developmental Crisis - what is it

changes related to maturation and growth and development (ex: marriage, having a baby, retirement, midlife career changes)

Situational Crisis

loss of loved one, unexpected change in life, accidents, job loss

Adventitious Crisis

natural disaster/violence

Verbal vs. Nonverbal Signs of Pain

Nonverbal signs of pain, grimacing, clenching teeth, restlessness.

Verbal signs- crying, moaning, self-pain rating

Vital Signs related to pain

vitals will change in response to pain, heart

rate, and blood pressure will increase with pain and respirations.

Compassion Fatigue and ways to decrease its presence

hits nursing profession during stressful shifts and crisis- offering yoga classes and other meditation are good coping mechanisms to help balance one’s fatigue.

Sensory Overload

ICU due to may loud sounding noises and activities nonstop- can lead to confusion

Decrease stimulation.

Encourage family to visit or be present to reorient patient

Decrease number of providers entering room

Silence alarms and dim lights

Effective coping demonstrates

positive outlook on life, involving family and friends to help in care.

Maladaptive coping demonstrates

will be demonstrated in inappropriate behaviors and substance abuse such as

alcohol, smoking and other dangerous or self-harm behaviors. Anger, depression.

Objective Pain Assessment

• Vital signs initially showing an elevation in blood pressure, heart rate, and

respiration

• Muscle tension or rigidity

• Pallor

• When pain becomes more severe, there is a decrease in blood pressure and

heart rate

• Nausea and vomiting

• Fainting

• Withdrawal to pain

• Grimacing

• Restlessness

• Guarding the area of pain

• Diaphoresis

Subjective Pain Assessment

• The nurse uses subjective indicators to assess the client’s pain by asking questions about the characteristics of the pain.

• Location

• Duration

• Quantity

• Quality

• Chronology

• Aggravating Factors

• Relieving Factors

• Associated Phenomenon

Nonpharmacological Pain Management

• Positioning and padding bony prominences

• Cutaneous Stimulation – therapy applied to the skin

• Heat/Cold Therapy – do not apply to direct skin

• Heat: muscular pain

• Cold: swelling, 20-30 minutes at a time, not on direct skin, Q2-3 hours

• Touch

• Massage – sit up slowly to decrease orthostatic BP

• Acupuncture

• Acupressure

• Electronic Stimulating Unit

• Hypnosis

Nonpharmacy Pain Management - Distraction

• Distraction techniques can be used for mild pain or as an adjunct to other modalities to relieve pain.

• Music

• Watching TV

• VR googles

8 Stages of Erikson’s Theory of Development

• Trust vs. Mistrust (Birth to 1 year)

• Autonomy vs. Shame and Doubt (1 to 3 years)

• Initiative vs. Guilt (3 to 6 years)

• Industry vs. Inferiority (6 to 12 years)

• Identity vs. Role Confusion (12 to 19 years)

• Intimacy vs. Isolation (20 to mid-40s)

• Generativity vs. Stagnation (mid-40s to mid-60s)

• Integrity vs. Despair (mid-60s to death)

difference between palliative and hospice care

• Palliative care is different from hospice care, as palliative care is provided

while the client is still engaging in curative treatment methods.

• No time constraints with palliative care

• Doesn’t offer respite care for the family members

What is Palliative Care

• Holistic care provided throughout the lifespan for clients experiencing

severe medical illness and particularly for clients approaching end of life.

• Goal is to improve quality of life for the client as well as the family and

caregivers.

• Initially concentrated on lessening client suffering at end of life, but current

best practice dictates it be implemented earlier in the course of life-

threatening health events.

• Advanced stages of cancer, refractory cardiac disease (heart failure), renal

or respiratory failure, and neurodegenerative conditions such as

Alzheimer’s disease and Parkinson’s disease

What is Hospice Care

• The administration of medical care to support the client who has a terminal illness, so they can live the last days of their life as best as they can, as long as they can.

• Provided when treatment will no longer cure or control the illness.

• Interprofessional, holistic care that treats the whole person, including caregivers and family members.

• Care is provided at home or in a facility

Hospice Criteria

• Admission into hospice care is dependent upon the client meeting specific

criteria in addition to having a health care provider make a diagnosis of a

life expectancy of fewer than six months.

• (1) a hospice provider and the primary care provider must officially state the client is terminally ill

• (2) the client must agree to palliative care as opposed to curing their

illness (relief of symptoms)

• (3) the client is required to sign a statement that they are choosing hospice care in place of other benefits to treat their illness

• May opt out of hospice care at any time

• Will provide support up to 13 months for grieving family members

What is Self-Concept

• The way a person thinks about themselves or the overarching perception

of who they are.

• A unique, dynamic, subjective, and evolving process that occurs

throughout the lifespan and is most flexible in the early stages of human

development.

• Shapes not only one’s identity but influences the relationships individuals

form over the course of their lifetime.

What is Self-Esteem

• Although the terms self-concept and self-esteem are frequently used interchangeably

• self-concept relates to how a person perceives or thinks about him- or herself vs self-esteem relates to how a person feels about him- or herself.

Emotional Intelligence

when an individual can perceive, understand, control, manage, and evaluate emotions – very important to develop this!

Identity Stressors Include

• Body image stressors

• Self-esteem stressors

• Role performance stressors

Postmortem care

• Physical care performed after death to prepare a body for viewing, autopsy,

or release to funeral home.

• Includes washing the body, accounting for the client’s possessions, removing invasive devices such as intravenous catheters and indwelling catheters, and placing identification tags in at least two areas

• Also includes documenting the date and time of death, the name of anyone notified, location of belongings, and where the client's body is moved (funeral home name).

General Adaptation Syndrome

• A three-stage response to stress that includes alarm, resistance, and

exhaustion.

• When activated, several body systems respond immediately to the stressor(s).

• These physiological changes occur whether the perceived stressor is considered positive (eustress) or negative (distress).

• The goal of GAS is for the body to return to a steady state of internal, physical, and chemical balance (homeostasis) to maintain optimal functioning.

Fight or Flight

• When a situation is determined to be stressful, the hypothalamus

secretes corticotropin releasing factor (CRF) which activates the

sympathetic nervous system (SNS) to release norepinephrine, epinephrine, and dopamine also known as the “fight or flight” response which causes an increase in heart rate, blood pressure, cardiac output, dilation of bronchial airways, pupil dilation, and an increase in blood glucose

Sources of Stress

Physiological (physical)

• Generally associated with injury or illness; the body’s reaction is immediate and necessary for survival.

Psychological (emotional)

• Associated with an event, situation, comment, condition, or interaction

that is interpreted as negative or threatening.

• S/S: poor eye contact, irritability,

agitation, poor sleep, lack of eating or

overeating, depression

Acute Stress

• The most common and frequent type of stress.

• Usually brief and can be positive or negative.

• Causes an immediate reaction and triggers the fight-or-flight response.

• EX: motor vehicle accident, experiencing the loss of a loved one

Episodic Acute Stress

• Episodic acute stress

• Occurs when someone experiences frequent bouts of acute stress.

• Over time, can negatively impact relationships, work, and overall health.

• EX: ndividuals taking on more responsibility than they can reasonably handle and

frequently feeling disorganized and rushed

Chronic Stress

A disabling condition that occurs when stress levels are heightened, constant, and

prolonged.

• EX: poverty, illness, disease, dysfunctional family system

Promoting Restful Sleep Habits

• Avoid stimulants, such as caffeine,

alcohol, and nicotine at least four to six

hours before bedtime.

• Remove unnecessary light and noise.

• Exercise during the day

• Establish a bedtime routine, such as

taking a warm shower or bath.

• Keep room dark, quiet, and at a

comfortable, cold temperature.

• Go to bed only when tired.

• Nap for less than 30 minutes

• Routine of same bedtime every night

• Avoid cell phones before bed

• If no sleep in 20 minutes, go to another

room and read or listen to music.

• Turn the clock away from view.

Types of Greif

Normal: Also known as uncomplicated grief, is caused by the loss of someone very close, through death or the ending of a relationship

• Time varies

• Response varies from person to person

• Sadness, guilt, yearning, anger, and regret.

Anticipatory: Grief that is experienced before the expected loss of someone or something

Prolonged grief disorder (PGD): Previously known as complicated grief; lasts >6 months and can be so significant, it affects the client's ability to function

• self-blame, anger, and difficulty participating in new and different activities

Disenfranchised: Grief related to a relationship that does not coincide with what is considered by society to be a recognized or justified loss

• Left to grieve alone and often have feelings of isolation, depression, low self esteem

• Loss of a pet

Kubler Ross Stages of Grieving

• Denial: Client refuses to believe the truth and this helps to lessen the pain

of the loss

• Anger: Client is trying to adjust to the loss and is feeling severe emotional

distress, often asking "why me?" and suggesting "it’s not fair”

• Bargaining: Usually involves bargaining with a higher power by making a

promise to do something in exchange for a different, better outcome

• Depression: Reality sets in, and the loss of the loved one or thing is deeply

felt

• Acceptance: Client still feels the pain of the loss but realizes they will be all

right

• Not sequential and may not experience all of these

Physiological Alterations at End of Life

• Breathing and Respirations: often predictable

• Dyspnea: shortness of breath —> Tx with opioids, antianxiety meds

• Retention of secretions in the respiratory tract, also known as “death

rattle” —> Anticipated death of days to hours, Turn head to side, suction

• Cheyne-Stokes respirations: an irregular respiratory rate fluctuating

between several quick breaths and periods of apnea —> Within three days of death

• Pain —> Experienced by nearly 60% of older adult hospice clients who have cancer. Occurs as a result of nerve injury, organs being stretched and

compressed, and/or bone pain. Schedule of medications is necessary. Nonopioids to opioids

• Temperature —> Ability of the nervous system to regulate body temperature

diminishes, causing clients to experience both increased and decreased temperature. Also caused by infection, cancer, and cancer therapy. Mottling occurs hours or days before death, with the upper and lower extremities becoming cool to the touch. Mottling occurs as result of the heart's inability to pump blood effectively, leading to decreased blood perfusion throughout the body.

• Vision and Hearing —> Clients may experience hallucinations

or report hearing and seeing those who have already died. Provide reassurance to patient and family

Nonverbal signs of stress

• avoiding eye contact

• fidgeting

• reduced facial expressions or micro expressions

• tense or inward posture

recommendations for patients with presbyopia

Presbyopia: decrease in the ability to focus up close or with small print,

aging process

• Starts in 40s and worsens until age 65

• Ensure good lightening for reading

• Glasses are being used

• Clutter free area for walking