NR226 FINAL REVIEW

SLEEP

Sleep Hygiene

Key strategies for good sleep habits include:

• Shutting off electronics before bed.

• Practicing meditation.

• Working out early in the day, avoiding late-day workouts.

• Reducing caffeine intake.

Narcolepsy

• Definition: a condition that makes people very sleepy during the day and can cause them to fall asleep suddenly. It can also cause muscle weakness, sleep paralysis, hallucinations and changes in REM sleep

• Job and Independence: Individuals with narcolepsy typically cannot maintain a job or live alone due to safety concerns.

• Fall Risk: Narcolepsy poses a fall risk, necessitating supervision.

• Living Situation: People with narcolepsy should live with someone to ensure their safety.

Restless Leg Syndrome

• Symptom: Legs move involuntarily at night, disrupting sleep.

• Intervention: Ask patients if they require a sleeping aid.

Common Issues in Children/Preschoolers

• Night Terrors

• Sleepwalking

Promoting Sleep

• For patients with difficulty sleeping, cluster care to minimize disturbances.

Insomnia

• Assessment: Determine if a patient with insomnia is improving by asking if they feel more rested.

PAIN

Pain Assessment

• Patient Reports: Always believe a patient's pain report, even if they rate it as 10/10.

• Scaling: Use a pain scale to quantify the pain.

• Appropriate Relief: Tylenol is not suitable for high pain levels.

Post-Colon Removal Assessment

• Use OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity) to assess the wound and pain.

PCA Pumps (Patient-Controlled Analgesia)

• Function: Allows patients to self-administer medication within set limits.

• Control: PCA pumps regulate the amount of medication a patient can receive.

• Monitoring: PCA pumps monitor the patient's respiratory rate (RR).

Chronic Pain

• Attitude: Avoid accusing patients with chronic pain of drug-seeking behavior.

• Intervention: For patients in constant pain affecting sleep, offer pain relief medication.

Acute Pain

• Treating acute pain is a nursing priority.

Pain Medication Administration

• Education: Inform patients that pain medication takes time to be effective.

• Non-Pharmacological Relief: Use distraction techniques such as talking or meditation.

SURGICAL

Post-Operative Complications

• Gastrointestinal (GI): Hypoactive bowel sounds are normal immediately post-surgery due to anesthesia.

• Abnormal: Hypoactive or absent bowel sounds 3 days post-op are not normal.

Pre-Operative Procedures

• Consent Form: Obtaining the consent form is the priority.

• Assessment Order: Conduct the general survey (talking) before hands-on assessments like IPPA (Inspection, Palpation, Percussion, Auscultation).

Preventing Skin Breakdown

• Reposition patients every 2 hours.

Pre-op/Intra/Post-op

• Review the EDAPTS (Early Detection and Prevention Tool Sets) for comprehensive coverage.

Post-Op Complications and Treatments

• Atelectasis: Use a spirometer and ambulate patients early.

• Blood Clots: Administer Heparin/Warfarin and use sequential compression devices.

• Pressure Injuries: Reposition every 2 hours and increase protein intake.

Post-Surgery Priority Systems

• Respiratory System: Assess lung sounds first.

• Circulation: Hypovolemia (low fluid) indicates a circulation issue.

• GI: Watch for paralytic ileus/dehiscence.

OLDER Adults

Social Isolation

• Risk: Be aware of isolation risks in older adults, especially after retirement.

• Red Flag: Lack of socialization is a significant concern.

• Prevention: Encourage group activities or visits to the community room in nursing homes.

Hearing Aids

• Communication: Speak face to face to allow lip-reading.

• Speech: Speak slowly and clearly without shouting.

• Response Time: Allow ample time for the client to respond.

Signs of Aging

• Refer to Unit 5, slide 3 for common signs, especially related to skin and urinary systems.

• UTI: Elderly individuals may experience frequent urination.

• BPH: Causes nocturia (nighttime urination) and a weak stream.

Safety Risks

• Fall Risks: Assess for clutter, wires, rugs, and lack of handrails.

• Handrails: Ensure handrails are present in bathrooms and on stairs.

Alzheimer’s

• Family Needs: Families of newly diagnosed Alzheimer’s patients need counseling and support groups.

Examining Older Adults

• Approach: Avoid rushing; incorporate rest and limit position changes.

STOMA

Stoma Assessment

• Normal Appearance: Beefy red and moist.

• New Stoma: Slight bleeding and swelling are normal.

• Abnormal Appearance: Pale or purple stoma is not normal.

• Visibility: Ensure the stoma is visible; change the colostomy bag if it is full.

• Definition: Ostomy is another term for stoma.

• Location: Ostomies can be located in different parts of the GI tract.

Ostomy Diet

• Diet: Familiarize yourself with appropriate and inappropriate foods.

• Avoid: No broccoli, beans, or raw vegetables.

• Introduction: Introduce new foods one at a time.

15-Year-Old Female with New Stoma

• Priority: Proper skin and stoma care education.

Ileostomy Considerations

• Fluid Intake: Increase fluid intake.

• Skin Cleaning: Perform more frequent skin cleanings.

RANDOM

Maladaptive Grieving

• Consequences: Can lead to bad habits like smoking, drinking, and not sleeping.

• Progression: Can develop into complicated grief.

Therapeutic Communication

• Empathy: Show empathy by offering your presence (e.g., sitting with the patient).

Ethics

• Understand ethical principles; they are frequently tested.

Sympathetic Response Post-Accident

• Vitals: Respiratory rate (RR) and heart rate (HR) increase.

• Physical: Sweating and muscle tension increase.

• GI: GI motility decreases.

End of Life Priority

• Comfort Care: Prioritize pain management and symptom relief.

• Pain: Administer pain medication.

• Nausea: Administer anti-emetics.

Colorectal Cancer Risks

• Crohn’s disease

• Tobacco use

• Polyps

Airway Priority

• Intervention: Improve airway with quick repositioning, unless the patient is displaying Cheyne-Stokes respirations. Cheyne-Stokes respiration a abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease in rate and depth of breathing, and then a period of apnea.

• Advocacy: Advocate for patients who can voice their needs.

• Grief: Do not yell; offer support to grieving patients.

Crohn’s Disease and Ulcerative Colitis (UC)

• Cure: Both have no cure; they are managed symptomatically.

• Nature: Both are inflammatory conditions.

• Crohn's: Characterized by flare-ups.

• Diet: No high fiber, as it increases peristalsis.

• Management: Reduce stress and use medications like steroids.