NSG 212 - Exam 6 KW

what is loss?

•When someone or something of value experiences change or is no longer accessible resulting in diminishing or removing of its value

types of loss

Actual
Perceived
Anticipatory
necessary
developmental
situational

actual loss

•Recognizable to the person experiencing the loss, as well as, other people
-Example= losing a loved one

perceived loss

•Recognizable to the person experiencing the loss but not to others
example=losing the ability to be independent

anticipatory loss

•When a person experiences a reaction to loss that has not occurred yet
example=terminally ill loved one

necessary loss

•Related to changes in the life cycle that can be anticipated. The loss may be replaced by something different or better.
example=leaving home to go to college

developmental or maturational loss

•Normal and expected, results from the normal life transitions in the developmental process of life, and results in the development of coping skills
example= empty nest feeling of a house

situational loss

unanticipated loss caused by an external event
example= losing home to natural disaster

what is grief?

•"Grief is an internal emotional reaction to loss."
•Mourning is the act of grieving and expressing grief.
•"Bereavement is a state of grieving due to loss of a loved one."

types of grief

•Normal/Uncomplicated
•Dysfunctional/Complicated
•Anticipatory
•Disenfranchised

normal/uncomplicated grief

•May show negative emotions, such as hopelessness, withdrawal, anger, resentment, and guilt
•Over time, negative emotions will change to acceptance with some acceptance being evident by 6 months following the loss.
•May demonstrate physical complaints, such as fatigue, change in sleeping patterns, chest pain, palpitations, nausea, and headaches
example=mourning the death of a grandparent

dysfunctional/complicated grief

•Also called unresolved grief
•Types include chronic, delayed, masked, and exaggerated grief
•Difficult progression through the usual grief stages
•Usually prolonged grieving
•May result in depression, decreased self-esteem, intense guilt, and suicidal ideation
•Physical complaints may continue for an extended time.
example=pt being avoidant of reminders or unable to return to normal activities

anticipatory grief

•The process of starting to "let go" of someone or something before the loss actually occurs.
example=grieving the anticipated loss of a child from terminal; illness

disenfranchised grief

Grief for a loss that may not be considered socially acceptable or cannot be shared publicly.
examples=relationship kept secret where grief cannot be openly expressed.

stages of grief as defined by Elisabeth Kubler Ross

•Denial – Difficulty accepting the reality of a diagnosis, death, or loss

•Anger – Expression of rage and hostility

•Bargaining – An attempt to negotiate for a cure or more time

•Depression – A period of grief

•Acceptance – The reality of the diagnosis, death, or loss is accepted, and the person feels tranquil and prepared and moves forward to prepare for the future.

denial

•Difficulty accepting the reality of a diagnosis, death, or loss
"that cannot be right"

anger

•Expression of rage and hostility
ex=trying to place blame on the nurse

bargaining

An attempt to negotiate for a cure or more time
ex=praying if you do this ill do this

depression

•A period of grief
ex=sadness

acceptance

•The reality of the diagnosis, death, or loss is accepted, and the person feels tranquil and prepared and moves forward to prepare for the future.

palliative care

is appropriate for anyone with a chronic disease or illness regardless of disease stage

hospice care

indicated when a pts life expectancy is 6 months or less, focus of treatment is shifted from a cure to quality of life and support for the pt as they approach death

s/s management at end of life

pain, dyspnea, excess oral secretions, N/V, restlessness, anxiety, urinary inc, urinary retention, diarrhea or bowel inc, constipation, dehydration

clinical signs of approaching death

•Labored breathing
•Collection of mucus in large airways
•Decreased level of consciousness
•Relaxation of facial muscles
•Inability to swallow
•Slow and weak pulse
•Decreased blood pressure
•Bowel and/or bladder incontinence
•Decreased urine output
•Cool, mottled (cyanotic) extremities
•Perspiration
•Diminished sensation of touch
•Difficulty speaking
•Nausea, abdominal distention, and/or flatus
•Agitation or restlessness
•Loss of movement and reflexes

postmortem care

•Ask if the family wishes to spend time with the body.
•Determine whether the patient's personal belongings should be sent with a family member or the body.
•Perform care with compassion and respect while attending to client and family wishes per their religious, cultural, and social practices.

postmortem care-preparing the body

•Provide privacy.

•Removes all lines and tubes – unless this is a coroner’s (medical examiner’s) case or organs or tissues are to be donated.

•Elevate the client’s head as soon as possible to prevent discoloration of the face.

•Cleanse the body as indicated.

•Align the body in the supine position with the head on a pillow, eyes closed, dentures in place, and arms with palms down on top of the sheet and blanket.

•Change linens and gown.

•Comb the patient’s hair and replace hairpieces if present.

•Tidy the room, removing unnecessary equipment, supplies, and soiled linens.

•Provide a calm environment by reducing lighting and minimizing noise.

postmortem care-after family viewing

•Complete required documentation.
•Apply identification tags according to facility policy.
•Transport patient remaining sensitive to visitors and staff or request transport for the patient as indicated by facility policy.

general adaptation syndrome (GAS)

•Also called "stress syndrome"
•Theory of adaptation to stress developed by Hans Selye
•Has three stages:
-Alarm reaction
-Resistance stage
-Exhaustion stage

GAS- Alarm Reaction

fight or flight

•Functions of the body are increased to respond to stress.

•There are increases in mental alertness, heart rate, blood pressure, and blood flow to muscles due to the release of hormones, including epinephrine, norepinephrine, and cortisone.

GAS - Resistance Stage

stress continues, body tries to cope

•Normalization of body functions while responding to the stress

•Body attempts to return to homeostasis while coping with the stressor

•Heart rate, blood pressure, and hormones stabilize

GAS - Exhaustion Stage

homeostasis or dies

•Functions of the body are no longer able to respond to the stressor and the individual is unable to adapt.

•This stage results in either death or recovery.

local adaptation syndrome (LAS)

localized response-hot stove
ex=inflammatory response and reflex pain response

defense mechanisms

-compensation
-denial
-displacement
-dissociation
-introjection
-projection
-rationalization
-reaction formation
-regression
-repression
-sublimation
-undoing

compensation (defense mechanism)

•Emphasizing a more desirable trait/over achieving in an attempt to overcome a perceived weakness
- Example: Someone emphasizing that they are good at English when they are struggling in math.

Denial (defense mechanism)

•Refusing to acknowledge a disturbing condition
- Example: Someone refusing to go to the dentist although they are having significant tooth pain.

displacement (defense mechanism)

•Moving emotion from one object/person to another
- Example: A person angry with their spouse punches a pillow.

dissociation (defense mechanism)

•Subconsciously allowing the mind to forget a terrible event to protect oneself
- Example: A person forgets the events of an ER visit and stay in the ICU.

introjection (defense mechanism)

•Incorporating qualities/values of another into their ego
- Example: Older sibling teaching younger sibling to wash their hands as their parents have taught them.

projection (defense mechanism)

•Attributing own thoughts/impulses to another
- Example: A person who dislikes a person accuses that person of disliking them.

rationalization (defense mechanism)

•Giving logical/socially acceptable reasoning for questionable behaviors
-Example: A patient who forgot to take his medication says, "If you didn't prescribe me so much medication, it would be easier for me to remember to take it."

reaction formation (defense mechanism)

•Exhibiting behaviors and attitudes that are the opposite of what he/she would normally do
-Example: A person who despises their ex-spouse is especially nice to them

regression (defense mechanism)

•Returning to earlier behaviors; seen in children
-Example: A child may experience nocturnal enuresis when previously toilet-trained when a new sibling comes home from the hospital.

repression (defense mechanism)

•Choosing to remove an event that produces anxiety from conscious awareness
-Example: A person forgets an exam, because exams make them anxious.

sublimation (defense mechanism)

•Substituting good/positive behavior or goal for one whose usual method of expression is not socially acceptable or is blocked
-Example: A person who likes to paint graffiti is hired to paint a mural for their town.

undoing (defense mechanism)

•Making up for previous bad acts
-Example: A child who has misbehaved picks flowers in the yard for their grandmother.

complementary health approaches

•Interventions that are not usually part of conventional medicine but can be used with conventional therapies.

integrative health (IH)

•The combination of conventional medicine and complementary health approaches in a coordinated way.

complementary therapies

treatment used with or to enhance allopathic medicine

alternative therapies

treatments that replace allopathic medicine and become the primary treatment

CAM

complementary alternative medicine

CAM terminology

-allopathic medicine
-holism
-holistic nursing
-integrative health care

allopathic medicine(biomed)

•Using medications, surgery, and radiation to treat diseases and symptoms.

holism

•Philosophy and theory focusing on interactions and connections between the parts of the whole.

holistic nursing

•Care built on a philosophy of holism with the goal of healing the whole person.
•Focus on the patient alone; listen carefully and non-judgmentally

integrative health care

•Using allopathic and complementary and alternative medicine together.
•Focused on the whole person's optimal health.

3 categories of Complementary Health Approaches

-Mind-body practices
-Natural products
-Other CHAs

categories of CAM

•Energy therapies
•Mind-body therapies
•Body-based and manipulative methods
•Movement therapies
•Whole medical systems
•Biological and botanical therapies

energy therapies

•Energy Healing: Based on belief of vital life force within and around body. Illness is a result of an imbalance in the energy field.

oChakras: Energy centers (crown, brow, throat, heart, solar plexus, sacrum, coccygeal)

oEtheric body (aura): Surrounds body—7 layers

other ex=•Therapeutic touch, Reiki, magnet therapy

mind-body therapies

placebo effect, is known as the power of the mind-body connection
ex=•Acupuncture, art therapy, biofeedback, breath therapy, meditation, yoga, tai chi, guided imagery, psychotherapy

body based and manipulative methods

Acupressure, chiropractic therapy, massage, and touch

acupuncture/acupressure

•The body has 12 meridians through which qi vertically flows.
ex=fingers (acupressure) or needles (acupuncture)

biological and botanical therapies

•Impacting health through the use of natural products.
•Vitamins, minerals, probiotics, herbal preparations, diets

natural products and herbal remedies

-natural products
-non-vitamin and non-mineral products
-herbal remedies
•Many of these products are not regulated by the FDA.

natural products

•Herbal medicines, vitamins, minerals, dietary supplements, and essential oils

non-vitamin and non-mineral products

•May be used to promote health and prevent illness and disease

herbal remedies

•The oldest form of medicine; derived from plant sources

aloe

heals wounds

chamomile

calm, reduce inflammation

echinacea

improve immune function

garlic

reduce aggregation of platelets

ginger

antiemetic

ginkgo biloba

increase memory

ginseng

improve physical endurance

valerian

decrease anxiety, improve sleep

homeopathic medicine

•Bringing about healing in by administering substances to ill patients that would cause the same illness in someone who is well.

•"Like cures like”: The belief that an illness can be cured by a substance that produces symptoms similar to those of the illness in healthy people.

"Law of minimum dose”:The belief that medication has a greater effectiveness the lower the dose; many homeopathic treatments are diluted until none of the original

ayurveda

•One of the oldest medical systems in the world
•Originated in India in the Vedic civilization
•Ayurvedic medicine has the goal of integrating and balancing the mind, body, and spirit.
•Key concepts include life forces, the body's constitution, and universal interconnectedness among the universe, people and their health
•Individualized treatments prescribed by Ayurvedic practitioners may include minerals, herbs, metals, and other materials; activity; nutrition; and recommendations for lifestyle.

traditional Chinese medicine (TCM)

ying and yang
•Categorizes symptoms and conditions using 8 principles:
oHeat/cold
oExterior/interior
oDeficiency/excess
oYin/yang
•Theory of five elements:
oFire, earth, metal, water, wood
•Qi is energy flowing through 12 meridians (energy circuits) in the body. It is composed of yin & yang—when out of balance, leads to poor health.
•According to TCM, meridians are the energy pathways in the body. Free movement through these energy pathways is the goal of TCM.
•Uses acupuncture, diet, herbs, massage, exercise, and breathing to restore health

shamansim

•The medical system that is practiced most widely
•The spirit world is where illness is believed to originate.
•Information about the correct treatment is obtained from the spirit world by the shaman.
•Treatment may include retrieval of lost soul energy, restoration of a right relationship between the individual and the spirit world, and treatment of symptoms
•Techniques for healing include native herbs, animals, techniques of purification, ceremonies, and rituals

naturopathic medicine

•Promoting natural healing using environment, exercise, diet, and herbal remedies
•Holds the belief that health is a state of being that is dynamic and gives abundant energy for patients to live in complex societies
•Naturopathic practitioners use a variety of treatment methods, including changes to lifestyle and diet, reduction of stress, dietary and herbal supplements, detoxification guided by a practitioner, and manipulative therapies.

functions of rest and sleep

•Rest refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed.
•Sleep is a state of rest accompanied by altered consciousness and relative inactivity.
•Sleep is part of what is called the sleep-wake cycle. Wakefulness is a time of mental activity and energy expenditure.
•Sleep is a period of inactivity and restoration of mental and physical function.
•During sleep, the brain and neurons communicate with each other to remove toxins that build up during the awake hours.

reticular activating system (RAS)

•Reticular Activating System (RAS)
◦Facilitates reflex and voluntary movements
◦Controls cortical activities related to state of alertness
•Bulbar synchronizing region
•Hypothalamus—control center for sleeping and waking
•Work together to control the cyclic nature of sleep

factors affecting sleep

◦Older Adults: Early bed/early wake/naps during the day…may not feel rested

•Motivation: Time to sleep

•Culture: Bedtimes, where to sleep, who to sleep with

•Lifestyle and habits: Traveling, change in work hours (JOB) , changing shifts, watching TV or playing video games before bed

•Environmental factors: Privacy, room temperature, too noisy, too much/too little light, pets, loud noises, snoring

◦Smoking: More difficult time falling asleep due to nicotine…Withdrawal

•Psychological stress: Anxiety, fear, worry…decrease REM sleep

•Illness: May require MORE sleep; may affect REM/NREM cycle

•Medications: May induce sleep but interfere with sleep cycle; may not be able to reach or stay in stages; barbiturates, amphetamines, and antidepressants decrease REM sleep

•Diet: Caffeine, heavy meals before bed

•Exercise: If done within 2 hours of sleep, can disrupt sleep; can promote sleep if done at other times during the day

sleep requirements

Normal Developmental Sleep Patterns

•Age: Sleep Averages per 24 hr

oBirth to 3 months: 16 hr a day

oInfants (3 months to 1 year): 8 to 10 hr plus with two to three naps

oToddlers: 11-14 hr with some sleep during a daytime nap

oPreschoolers: 11-13 hr with less napping during the day

oSchool-age: 10 to 12 hr for younger children with 9 to 10 hr for older ones

oAdolescents: 8-10 hr

oYoung Adults: 7-9 hr

oMiddle Adults: 6 to 8.5 hr

oOlder Adults: 7 to 8 hr with daytime naps possibly accounting for some of the hr

ICSD Classification of Sleep Disorders

-Insomnia
-Sleep-related breathing disorders
-Central disorders of hypersomnolence
Circadian rhythm sleep-wake disorders
-Parasomnias
-Sleep-related movement disorders
-Other sleep disorders

insomnia

recurring problems in falling or staying asleep

obstructive sleep apnea (OSA)

•Sleep apnea can be a single disorder or a mixture of the following.

◦Central: Central nervous system dysfunction in the respiratory control center of the brain that fails to trigger breathing during sleep.

◦Obstructive: Structures in the mouth and throat relax during sleep and occlude the upper airway.

•CPAP is the treatment.

◦Continuous Positive Air Pressure

◦Forces air into the lungs…Keeps airway patent.

◦Remember this from Oxygenation and Circulation lecture.

Idiopathic Hypersomnia

excessive sleep, particularly during the day

narcolepsy

uncontrollable sleep attacks

Chronic or recurrent pattern of sleep–wake rhythm disruption

•Primary causes:
◦An alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule whether desired or required
◦A sleep-wake disturbance (e.g., insomnia or excessive sleepiness)
◦Associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder)
•Treatments:
◦Behavioral therapy
◦Light therapy
◦Avoiding naps
◦Keeping a regular sleep schedule

somnambulism

sleep walking

RBD

acting out dreams

States of Awareness conscious

•Conscious

◦Delirium: Disorientation, confusion, hallucination

◦Dementia: Difficulty with orientation, memory

◦Confusion

◦Normal consciousness

◦Somnolence: Extreme drowsiness, will respond to stimuli

◦Minimally conscious states: Follows commands

◦Locked-in syndrome

states of awareness - unconscious

•Unconscious

◦Asleep

◦Stupor: Need repeat or extreme stimuli to arouse

◦Coma: Cannot be aroused

◦Vegetative state: Postures/withdrawals from stimuli, cannot be aroused, non-purposeful movements

Sensory deficits

•Absence of one or more senses

Sensory poverty:

Not experiencing world up close

Sensory deprivation:

•Decreased sensory input, may hallucinate to maintain level of arousal
oEnvironment with decreased or monotonous stimuli
oImpaired ability to receive environmental stimuli
oInability to process environmental stimuli

stereognosis -sensory

perception of solidity of objects

kinesthetic and visceral-sensory

basic internal orienting systems

proprioception-sensory

movements and body positions

effects on sensory deprivation

•Cognitive disturbances
◦Inability to control thoughts
◦Short attention span
◦Difficulty concentrating
•Emotional disturbances
◦Anxiety
◦Fear
◦Anger
◦Panic
◦Depression