Nursing Comprehensive Study: Perfusion, Oxygenation, End-of-Life, Spirituality, Self-Concept, and Stress

A comprehensive vocabulary review deck covering 50 fundamental nursing concepts across perfusion, oxygenation, end-of-life care, spirituality, self-concept, and stress adaptation.

Perfusion

The flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells.

Cardiac Output (CO)

The volume of blood pumped by the heart each minute, calculated as $\text{Cardiac Output (CO)} = \text{Stroke Volume (SV)} \times \text{Heart Rate (HR)}$. Normal CO is $4\text{ to }8\,\text{L/min}$.

Preload

The volume and end-diastolic pressure within the ventricles prior to contraction.

Afterload

The resistance the left ventricle must overcome to eject blood into systemic circulation.

Starling's Law of the Heart

Physiological principle stating that as the myocardium stretches, the strength of the subsequent contraction increases.

Central Perfusion

Perfusion generated by cardiac output that supplies blood to the systemic circulation.

Local / Tissue Perfusion

The volume of blood flowing to target tissues through patent capillaries.

S1 Heart Sound

The first heart sound, produced by the closure of the mitral and tricuspid (atrioventricular [AV]) valves.

S2 Heart Sound

The second heart sound, produced by the closure of the aortic and pulmonic (semilunar) valves.

Ischemia

Reduced blood flow to tissues causing reversible tissue distress.

Infarction

Cellular and tissue death resulting from prolonged ischemia.

Anoxia

The complete absence of oxygen reaching tissues.

Left-Sided Heart Failure Assessment Findings

Pulmonary symptoms resulting from backup of blood, including basilar crackles, dyspnea, and shortness of breath.

Right-Sided Heart Failure Assessment Findings

Systemic venous congestion signs, including peripheral edema, jugular venous distention (JVD), and ascites.

Cardiac Diagnostic Workup Lab Markers

Key diagnostic blood tests evaluated during cardiac evaluations, including Troponin, Creatine Kinase (CK-MB), Natriuretic Peptides (BNP), Lactic Dehydrogenase, Homocysteine, C-Reactive Protein, Serum Lipids, PT/INR, and PTT.

AHA Health Promotion Perfusion Recommendations

Primary recommendations including a low-sodium diet ($<1500\,\text{mg/day}$), saturated and trans fats $<10\%$ of calories, regular physical activity, smoking cessation, maintaining blood pressure $<120/80\,\text{mm Hg}$, total cholesterol $<200\,\text{mg/dL}$, and fasting glucose $<100\,\text{mg/dL}$.

Three Steps of the Oxygenation Process

1. Ventilation: Movement of air into and out of the lungs. 2. Diffusion: Gas exchange across the alveolar-capillary membrane. 3. Perfusion: Pumping of blood to and from pulmonary capillaries and body tissues.

Surfactant

A chemical compound in the lungs that lowers surface tension in the alveoli, preventing alveolar collapse (atelectasis) during expiration.

Hypoventilation

Inadequate alveolar ventilation leading to carbon dioxide retention (hypercapnia).

Hyperventilation

Excessive ventilation that eliminates carbon dioxide faster than it is produced by the body (hypocapnia).

Hypoxia

Inadequate tissue oxygenation at the cellular level. Early clinical signs include restlessness, anxiety, tachycardia, and tachypnea; late clinical signs include severe dyspnea, bradycardia, extreme confusion, and cyanosis.

Kussmaul Respirations

Deep, rapid, and labored breathing pattern functioning as a compensatory physiological response to metabolic acidosis or diabetic ketoacidosis (DKA).

Cheyne-Stokes Respirations

A rhythmic respiratory cycle of alternating apnea and hyperventilation, characteristically seen in terminal conditions or brain injuries.

Fine Crackles

High-pitched, popping adventitious breath sounds auscultated during inspiration.

Coarse Crackles (Rhonchi)

Low-pitched, rumbling or fluid adventitious breath sounds heard in the airways.

Wheezes

High-pitched, musical adventitious breath sounds secondary to bronchospasm and narrowed airways.

Stridor

A harsh, high-pitched inspiratory adventitious sound indicating acute upper airway obstruction.

Positive Tuberculin Skin Test (TB/PPD) Thresholds

Induration cutoffs: $\ge 5\,\text{mm}$ for high-risk groups, HIV infection, and organ transplant recipients; $\ge 10\,\text{mm}$ for healthcare workers, recent immigrants, and congregate settings; $\ge 15\,\text{mm}$ for low-risk, general population individuals.

Venturi Mask

An oxygen delivery device providing a precise, titratable $\text{FiO}_2$ ranging from $24\%$ to $50\%$, making it ideal for patients with COPD.

Non-Rebreather Mask

An oxygen delivery device delivering high concentrations of oxygen ranging from $60\%$ to $100\%$ for acute emergency hypoxia.

Long-Term Home Oxygen Therapy ABG Criteria

Arterial blood gas laboratory thresholds requiring $\text{PaO}_2 \le 55\,\text{mm Hg}$ or $\text{SaO}_2 \le 88\%$ on room air at rest, on exertion, or during exercise.

Pursed-Lip Breathing

A breathing technique that maintains positive expiratory pressure in the airways, preventing premature airway collapse.

Diaphragmatic Breathing

A breathing technique that enhances lung expansion, strengthens the diaphragm muscle, and decreases the overall work of breathing.

Grief

The internal emotional response to an experienced loss.

Mourning

The outward social expressions, rituals, and behaviors associated with grief.

Bereavement

The comprehensive state of having suffered a loss, encompassing both grief and mourning.

Disenfranchised (Ambiguous) Grief

Grief experienced when a loss cannot be openly acknowledged, socially sanctioned, or publicly mourned (e.g., loss of an ex-spouse, early pregnancy loss, or a stigmatized death).

Complicated Grief Categories

Atypical grief responses categorized into Chronic grief, Exaggerated grief, Delayed grief, and Masked grief.

Kübler-Ross's Five Stages of Dying

The psychological stages experienced during dying: 1. Denial, 2. Anger, 3. Bargaining, 4. Depression, 5. Acceptance.

Dying Person’s Bill of Rights Provisions

Key patient rights including the right to maintain hope, participate in care decisions, receive comfort care over cure, express feelings, avoid dying alone, remain free of unnecessary pain, and have body sanctity respected post-mortem.

Approaching Death Physical Assessment Signs

Observable physiological declines near end-of-life including mottling of extremities, decreased urinary output, Cheyne-Stokes breathing, audible secretions ("death rattle"), decreased responsiveness, and cool, clammy skin.

End-of-Life Standards Nursing Organizations

Professional organizations guiding palliative and terminal care: End-of-Life Nursing Consortium (ELNEC), American Nurses Association (ANA), American Association of Critical-Care Nurses (AACN), and American Society for Pain Management Nursing (ASPMN).

Loss and Dying Nursing Diagnoses

Key NANDA diagnoses including Death Anxiety, Compromised Family Coping, Grieving, Complicated Grieving, Hopelessness, and Spiritual Distress.

Palliative Care

Care focused on symptom management and enhancing quality of life at any stage of an illness alongside curative therapies.

Hospice Care

Comprehensive comfort care provided to terminally ill patients with a medical prognosis of $\le 6\,\text{months}$, prioritizing comfort over curative efforts.

Post-Mortem Care

Nursing care after death focused on maintaining dignity, respecting body sanctity, accommodating cultural and religious preferences, cleansing the body, elevating the head on a pillow, closing the eyes, facilitating family viewing, and documenting per coroner and organ donation guidelines.

Spirituality

The universal human dimension of seeking meaning, purpose, connection, and transcendence.

Religion

An organized framework of beliefs, communal worship practices, and rituals.

Core Constructs of Spirituality

Key internal spiritual dimensions: Self-transcendence, Connectedness, Faith, Hope, Inner Strength and Peace, Meaning and Purpose in life, and Spiritual Well-being.

Spiritual Distress

A state of impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, nature, or a higher power.

FICA Spiritual Assessment Tool

An assessment acronym representing: F (Faith or belief system), I (Importance and Influence on daily life), C (Community: spiritual group or support network), and A (Address or Action in clinical care).

Atchley's Continuity Theory of the Spiritual Self

A conceptual model incorporating deep inner silence, insight, compassion, connection with the ground of being, transcendence of personal self, wonder, and transformation.

Joint Commission Hospital Spiritual Care Requirement

A regulatory standard mandating that accredited healthcare facilities provide access to spiritual and pastoral care services tailored to individual patient needs.

Establishing Presence

A therapeutic nursing strategy centered on "being with" the patient rather than merely "doing for"—providing undivided attention, active listening, and fostering an environment of trust.

Barriers to Spiritual Care in Nursing

Factors causing spiritual care neglect: inability to recognize spiritual needs, personal discomfort, fear of imposing beliefs, lack of education or training, or assuming shared religious beliefs are required.

Spiritual Health Nursing Diagnoses

Standardized diagnoses including Spiritual Distress, Risk for Spiritual Distress, Readiness for Enhanced Spiritual Well-Being, Risk for Impaired Religiosity, and Hopelessness.

Religious Care

Care focused on supporting a patient's adherence to specific religious doctrines, rituals, and practices.

Spiritual Care

Care aimed at helping individuals discover personal meaning, hope, and connection regardless of their religious affiliation.

Self-Concept

The subjective, cognitive appraisal of oneself, encompassing personal attitudes, beliefs, and perceptions.

Self-Esteem

The emotional appraisal of one's self-concept, representing feelings of self-worth or value.

Four Primary Components of Self-Concept

1. Identity, 2. Body Image, 3. Role Performance, 4. Self-Esteem.

Role Strain

Stress resulting from feeling inadequate or unsuited to fulfill a specific role.

Role Conflict

Stress that occurs when facing contradictory expectations across concurrent roles.

Role Ambiguity

Confusion resulting from unclear or vaguely defined role expectations.

Role Overload

The strain caused by accumulating more role responsibilities than are manageable.

Identity vs. Role Confusion

Stage 5 of Erikson's developmental theory, occurring during adolescence, which represents the developmental period most vulnerable to identity confusion.

Nursing Assessment of Self-Concept Alterations

Clinical behaviors observed to detect altered self-concept: nonverbal cues (avoiding eye contact, slumping posture, disheveled grooming), self-deprecating remarks, coping histories, and social interactions.

Therapeutic Nursing Influence on Self-Concept

Nursing behaviors that strengthen patient self-concept: modeling nonjudgmental attitudes, exhibiting positive body language, demonstrating unconditional acceptance, and preserving patient autonomy and control.

General Adaptation Syndrome (GAS)

Selye's three-stage physiological stress response model consisting of: 1. Alarm Stage (immediate fight-or-flight response), 2. Resistance Stage (compensation and adaptation to the stressor), and 3. Exhaustion Stage (breakdown of compensatory reserves leading to disease susceptibility).

Allostatic Load

The cumulative biological wear and tear on the body resulting from chronic, unmanaged stress, which can lead to chronic hypertension, immune dysfunction, clinical depression, and accelerated cardiovascular disease.

Displacement (Defense Mechanism)

An ego defense mechanism in which an emotion is redirected toward a safer, less threatening target.

Projection (Defense Mechanism)

An ego defense mechanism in which undesirable personal feelings, impulses, or traits are attributed to others.

Rationalization (Defense Mechanism)

An ego defense mechanism in which unacceptable behaviors or outcomes are justified through logically plausible excuses.

Regression (Defense Mechanism)

An ego defense mechanism involving reverting to behaviors characteristic of an earlier developmental level.

Sublimation (Defense Mechanism)

An ego defense mechanism characterized by channeling socially unacceptable drives into constructive, acceptable channels.

Compassion Fatigue

A state of progressive physical and emotional exhaustion caused by prolonged exposure to the suffering and trauma of patients.

Second Victim Syndrome

Acute psychological distress (guilt, anxiety, depression) experienced by healthcare professionals following an unanticipated clinical adverse event or medical error.