Fundamentals of Nursing Final Exam

general adaption syndrome stages

alarm, resistance, exhaustion

alarm stage

- the central nervous system is aroused, and body defenses are mobilized
- fight or flight
- increased HR, BP, BV, ^ oxygen intake, hyperglycemia, increased mental awareness, pupils dilate

resistance stage

- the body stabilizes and responds in an attempt to compensate for the changes induced by the alarm stage
- everything/vitals goes back to normal
- If you stay here then you have good coping mechanisms

exhaustion stage

- continuous stress causes progressive breakdown of compensatory mechanisms
- the body is no longer able to resist the effects of the stressor
- energy depletion
- depression, HTN, anxiety

developmental crisis

- Loss that is expected to happen as you age
- Ex. Empty nest syndrome, toddles being separated from their parents

adventitious crisis

- a man made or a violent act
- ex. natural disaster, man-made disaster, or crime of violence

situational stress

- stress related to a situation
- ex. job change, motor vehicle crash, severe illness, divorce

second traumatic stress

the trauma a person experiences from witnessing other people's suffering
- a component of compassion fatigue
- common in health care workers and first responders
- results in intrusive symptoms such as nightmares and anxiety
- begin to avoid interactions and have difficulties in sleeping and relating to friends or family.

PTSD

- a person experiences or witnesses a traumatic event and responds with intense fear or helplessness
- sometimes manifested by nightmares and emotional detachment
- s/s: daytime flashbacks, bad nightmares, high incidence of suicide, headaches, irritability, hyperarousal

situational factors (influencing stress and coping)

- for nurses: high-acuity patient load, job environment, constant distractions, responsibility, conflicting priorities, and intensity of care
- Adjusting to chronic illness

maturational factors

- vary with life stages
- adolescents: •go through identity v role confusion (questioning sexuality, friends family)
- stress for adults centers around beginning a family and a career, losing parents, seeing children leave home, and accepting physical aging

sociocultural factors

- living with chronic poverty or physical disability
- Living under conditions of continuing violence, disintegrated neighborhoods, or homelessness
- person's values differ from the dominant culture in aspects of gender roles, family relationships, and religious beliefs

compassion fatigue

- a state of burnout and secondary traumatic stress
- Being numb to what you are doing everyday
- Nurses: being overworked, understaffed, seeing sad everyday

second victim syndrome

- Result of a medical error
- The nurse also feels the guilt for the error that they performed
- Can lead to long-term stress and suicide
- Proposed rights for second victims include respect, just treatment, understanding and compassion, supportive care, transparency, and the opportunity to contribute

trust vs. mistrust

- infancy
- 0-18 months
- Develops trust following consistency in caregiving and nurturing interactions
- Distinguishes self from environment

autonomy vs. shame and doubt

- 18 months to three years
- Begins to communicate likes and dislikes
- Increasingly independent in thoughts and actions
- Appreciates body appearance and function (e.g., dressing, feeding, talking, and walking)

initiative vs. guilt

- age 3 to 5, preschooler
- Identifies with a gender
- Enhances self-awareness
- Increases language skills, including identification of feelings

industry vs. inferiority

- age 6 to 11 (elementary school)
- Incorporates feedback from peers and teachers
- Increases self-esteem with new skill mastery (e.g., reading, mathematics, sports, music)
- Aware of strengths and limitations

identity v role confusion

- 12-18 years
- Accepts body changes/maturation
- Examines aitudes, values, and beliefs; establishes goals for the future
- Feels positive about expanded sense of self

intimacy vs isolation

- young adult (18-40)
- Has stable, positive feelings about self
- Experiences successful role transitions and increased responsibilities

generativity vs stagnation

- middle adulthood (40's to 60's)
- Able to accept changes in appearance and physical endurance - Reassesses life goals
- Shows contentment with aging

integrity vs despair

- late adulthood
- Feels positive about life and its meaning
- Interested in providing a legacy for the next generation

good coping mechanisms for stress

- Journaling
- Exercise
- Sleeping
- Meditation
- Music
- Time management

bad coping mechanisms of stress

- Drugs
- Overeating
- Drinking
- Watching TV

self-esteem

- an individual's overall feeling of self-worth or the emotional appraisal of self-concept
- represents the overall judgment of personal worth or value

self-concept

- how one views self
- A positive ... gives a sense of meaning, wholeness, and consistency to a person.
- A healthy ... provides a high degree of stability, which generates positive feelings toward self
- components include identity, body image, and role performance

poor self concept symptoms

- Slumped posture
- Poor hygiene
- Self harm behaviors
- No eye contact
- Hesitancy in speech
- Unkept appearance

role conflict

- when a person has to simultaneously assume two or more roles that are inconsistent, contradictory, or mutually exclusive
- reversal of a normal role
- mom of two young kids has to also take care of parents

role ambiguity

- unclear role expectations, which makes people unsure about what to do or how to do it, creating stress and confusion.
- starting a new job and not being sure what to do

role strain

- a feeling of frustration when a person feels inadequate or unsuited to a role
- role is a lot of work
- providing care for a disabled child or a family member with dementia or terminal cancer

role overload

- having too many roles; too much going on
- having more roles or responsibilities within a role than are manageable
- Working full time and taking care of chronically ill partner

gender identity

one's sense of being male or female

gender role

feminine and masculine behavior exhibited

sexual orientation

as a person's sexual identity in relation to the gender to which they are attracted,

PLISSIT

- model used to communicate with a patient about sexuality
- sexual health history
- Permission
- Limited Information
- Specific Suggestions
- Intensive Therapy

contraception

- Promote condoms
- 100% pregnancy avoidance: ABSTINENCE
- Smoking increases the risk of stroke or clot with a person on birth control

non-prescription contraceptives

- abstinence
- barrier methods (condoms, spermicidal products)
- timing of intercourse with regard to a woman's ovulation cycle

prescription contraceptives

- hormonal contraception
- IUDs
- the diaphragm
- the cervical cap
- sterilization

HPV

- Sexually transmitted disease that can lead to cervical cancer
- spread through direct contact with warts, semen, and other body fluids from others who have the disease
- Vaccine for it starting at 8-12 years (Gardasil)

chlamydia

- Can lead to infertility of left untreated
- Symptoms don't show up until later
- can be transmitted during the birthing process and cause conjunctivitis and pneumonia in newborns
- can cause PID

PID

Symptoms don't show up until later

sexual dysfunction

- Illness
- Medications
\--- Antidepressants and antihypertensive can lead to this
- Aging changes

sexual education health promotion

- teach BSE and testicular self exam
- should be done monthly
- instruct patient on s/s of STI
- HPV vaccine

infertility

- the inability to conceive after 1 year of unprotected intercourse
- Choices for the infertile couple include pursuit of adoption, medical assistance with fertilization, or adapting to the probability of remaining childless

personal and emotional problems affecting sex

patients who have problems with one or more of the stages of sexual activity, including the feeling of wanting sex, the physiological processes and emotions of having sex, and the feelings experienced after sex

risk factors for surgery

- Hx of clotting disorders/bleeding disorders
- Age
- Smoking (\#1 risk factor)
- Sleep apnea
- Immunosuppressed pts
- Pts with electrolyte imbalances

surgical assessment questions

- Thorough medication history
- Physical history and diseases
- Surgical history (surgery in the past, reactions to the surgery/anesthesia, complications)

preoperative assessments

- Do baseline vital signs and physical assessment
- medical and surgical history
- medications/allergies
- Make sure informed consent in signed
- Check for pregnancy
- Ask what their occupation is

preoperative interventions

- education
\--- NPO
\--- remove anything that can be removed
\--- pain
- communication:
\--- time out from pre op to intra op and from intra op to post op
- prevention of skin infections, maintain normal fluid and electrolyte balance
- prevention of bowel incontinence and contamination:
\--- Want a bowel prep if surgery is the stomach and below
\--- When doing a bowel prep monitor K+ to prevent a cardiac dysrhythmia

circulating nurse

- performs OR activities outside the sterile area (position pt, get equipment such as blood, take count of medical equipment)

scrub nurse

- assists the surgeon in the sterile area
- must have a thorough knowledge of each step of a surgical procedure and the ability to anticipate each instrument and supply needed by the surgeons

intraoperative interventions: physical preparation

- Explain to the patient all the activities that will be performed before implementing the activities
- position patient correctly
- attach all machines and devices to the patient

intraoperative interventions: intraoperative warming

- prewarm for a minimum of 30 minutes may reduce the occurrence
of perioperative hypothermia
- The nurse in the OR applies warm coon blankets, forced-air warmers, or circulating-water mattresses to patients

postoperative interventions

- airway, breathing, and circulation,
- assess for gag reflex before giving food
- pt should know what complications can occur
- need a ride home after surgery (cannot leave on their own)

postoperative care phase 1: immediate postoperative recovery

-Patient transported to the PACU following surgery
-Hand-off from surgical team: vitals, type of anesthesia, complications, I&Os, blood loss, new wounds or lines
-Frequent assessments until stable

postoperative care phase 2: recovery in ambulatory surgery

-Less frequent monitoring
-Promotion of comfort and well being until discharge
-Initiate postoperative teaching with patient and family

postoperative care phase 3: recovery and convalescence

-PACU until stable then return to inpatient unit; may remain on unit for 1 or more days
-Discharge home to continue recovery
-Goal is to return to a relatively functional level of wellness as soon as possible

general anesthesia

- Complete relaxation and paralysis of all muscles (deep sleep)
- patient loses all sensation, consciousness, and reflexes, including gag and blink reflexes
- given via IV infusion or inhalation
- Have to be intubated
- More risk for complications

complications of general anesthesia

- vomit aspiration
- cardiac irregularities
- hypotension, hypothermia, hypoxemia
- nephrotoxicity
- respiratory depression

moderate sedation

- Conscious sedation
- used routinely for short- term surgical, diagnostic, and therapeutic procedures that do not require complete anesthesia but rather a depressed level of consciousness
- In the IV decreased level of consciousness but not completely asleep
- Much less of a risk factor

complications of moderate sedation

- aspiration
- decreased LOC
- hypoxemia
- respiratory depression

epidural/spinal block

- loss of sensation in an area of the body by anesthetizing sensory pathways
- Need to do a test dose to make sure it is in the right space
- Biggest risk: severe headache
- patient requires careful monitoring during and immediately after regional anesthesia for return of sensation and movement distal to the point of anesthetic injection

epidural/spinal block complications

- hypotension
- hypothermia
- injury to spinal cord
- respiratory paralysis
- spinal headache

local anesthesia

- loss of sensation at the desired site
- commonly used in ambulatory surgery
- an also be used in addition to general or regional anesthesia
- injected locally or applied topically
- risk for having drug interactions and allergic effects an infection

local anesthesia complications

hives, rash, anaphylaxis

postoperative complications

- POUR (Post operative urinary retention)
- malignant hyperthermia
- fluid and electrolyte balance
- PONV (post operative nausea and vomiting)
- comfort

malignant hyperthermia s/s

- cyanosis
- muscle rigidity
- skin modeling (red splotches with pure white blanches around), - tachy
- cardiac arrythmia

POUR (post op urinary retention)

- 4-6 hours after surgery if the patient doesn't urinate they need a bladder scan and might need a foley catheter back in

fluid and electrolyte balance

- Fluid volume deficit/hypovolemia is common after surgery
- Tachycardia and hypotension

comfort after surgery

If the patient had surgery use a hug me pillow for splinting

PONV (post op Nausea/vomiting)

- can lead to serious complications, including pulmonary aspiration, dehydration, and arrhythmias resulting from fluid and electrolyte imbalance
- just medicate the client to fix this

informed consent

- It is the surgeon's responsibility to explain the procedure, associated risks, benefits, alternatives, and possible complications before obtaining the patient's oral and documented informed consent
- In some instances, the patient's medical power of attorney may give consent if the patient is unable to do so
- fifth-grade or lower reading level
- nurse's job is to witness

actual loss

- Not being able to see, touch, hear or know a person or object
- loss of a body part, death of a family member, or loss of a job

perceived loss

- Something one person can view as a loss that someone else may not view as a loss
- rejection by a friend to be a loss, breakups
- easy to overlook by others because they are experienced so internally and individually

necessary losses

- losses that happen overtime that everyone experiences
- children growing up and graduating or moving out; not always negative, can be positive
- death of a loved one, divorce, or loss of independence changes life forever and often significantly disrupts a person's physical, psychological, and spiritual health

maturational loss

- all normally expected life changes across the life span
- toddler experiences separation anxiety from a parent when starting preschool
- A grade school child may not want to lose a favorite teacher and classroom
- A college student may not want to leave the campus community

situational loss

- Sudden, unpredictable external events/ Loss based on a certain situation
- a person in an automobile accident sustains an injury with permanent physical changes that make it impossible to return to work or school

grief

normal but bewildering cluster of ordinary human emotions arising in response to a significant loss, intensified and complicated by the relationship to the person or the object lost

Normal (uncomplicated) grief

- handling the grief in a good way that does not pose long term effects
- Ex. parents die and you cope regularly and get back to life as it was after going through the grief stages

anticipatory grief

- Knowing that the grief is coming
- occurs before the actual loss or death occurs, especially in situations of prolonged or predicted loss
- ex. There is a cancer diagnosis, and a person is going to die soon

disenfranchised grief

- Not socially sanctioned
- ex. An ex-husband died and they are sad; not something they want to be open about

ambiguous grief

- a type of disenfranchised grief, can occur when the person who is lost is physically present but not psychologically available
- don't actually know what happened; child is kidnapped, and they are grieving whether they are alive or not

complicated grief

not coping properly (risk: hx of depression, hx of multiple losses, how the person passes away, no social support)

chronic grief

- grieving longer than they should
- can include years to decades of intense grieving.

exaggerated grief

- maladaptive behaviors
- only go to sleep if I drink due to grief; or do drugs
- suicide is a risk for these individuals.

delayed grief

- a person's grief response is unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss
- frequently triggered by a second loss, sometimes seemingly not as significant as the first loss
- ex. a college student whose parent has died, but the full realization of the loss comes after the family pet dies or the student fails a course.

masked grief

- not going through the grieving process; not acknowledging the grief; manifests in headaches, heartburn etc. because they are internalizing the grief

Kubler-Ross stages of dying

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

denial

- denying that the pain is happening
- get a diagnosis and don't believe it or fail to realize that a family/friend is going to die

anger

The person expresses resistance or intense anger at God, other people, or the situation.

bargaining

The person cushions and postpones awareness of the loss by trying to prevent it from happening.

depression

The person realizes the full impact of the loss.

acceptance

The person incorporates the loss into life.

palliative care

- focuses on the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness
- primary goal of palliative care is to help patients and families achieve the best possible quality of life
- appropriate both for patients still receiving aggressive treatment with hope of achieving a cure and for patients who have forgone any life-extending treatment

hospice care

- philosophy and model for the care of redundant patients and their families at the end of life
- usually have less than 6 months to live

s/s of a dying person

- SOB
- death rattle
- loss of consciousness
- sudden energy
- pale skin
- anorexia
- nausea
- decreased urine output; dark-colored urine
- confusion or disorientation
- decreased muscle tone

families in EOL

- Educate family members in all settings about the symptoms that the patient is likely to experience and the implications for care
- instruct families to not force patients to eat anything

helping families adjust to death

- Help the survivor accept that the loss is real
- Support efforts to adjust to the loss
- Encourage establishment of new relationships.
- Interpret "normal" behavior and assure them it will eventually return to normal
- Provide continuing support.
- Be alert for signs of ineffective, potentially harmful coping mechanisms

autopsy

- Keep everything in the body
- Dentures, lines, catheters, etc.
- If there is no autopsy and the doctor tells you to take it out then you can take it out

postmortem care

- Note the time of death, reason for death, identify the tags for the body (on the big toe, around each wrist and on the zipper)