Final Objectives.docx

Final Objectives 45,46,47 Chapter 45- Sensory Functioning Senses Involved in Sensory Reception Visual (vision) Auditory (hearing) Olfactory (smell) Gustatory (taste) Tactile (touch)- example of this would be like a child holding onto a specific stuffed animal or a person holding onto a specific blan...

Final Objectives 45,46,47 Chapter 45- Sensory Functioning Senses Involved in Sensory Reception Visual (vision) Auditory (hearing) Olfactory (smell) Gustatory (taste) Tactile (touch)- example of this would be like a child holding onto a specific stuffed animal or a person holding onto a specific blanket. Stereognosis (perception of solidity of objects)- Kinesthetic and visceral (basic internal orienting systems) Proprioception is the perception or awareness of the position and movement of the body. States of Awareness include when someone is conscious or unconscious. Conscious Delirium, dementia (Alzheimers), confusion, normal consciousness, somnolence (sleepy or drowsy), minimally conscious states, locked-in syndrome. Locked in syndrome also known as pseudo coma is when the patient is conscious and able to think but unable to move or communicate verbally. This means that the patient cannot voluntarily chew, swallow, breathe or speak but they can move their eyes up and down and blink to communicate, as a result, these patient rely completely on a caregiver and follow normal sleep cycles. This happens when there is damage to the Pons. (The Pons is the middle part of the brainstem which includes 2 corticospinal tracts that connect the cerebral cortex to the spinal cord, leaving the patient paralyzed.) Unconscious- Always give respect to patients, even when they are unconscious because hearing is the last thing to go so they can hear you. Be RESPECTFUL. Treat them as if they are still conscious. Asleep, stupor, coma Vegetative state Factors Contributing to Sensory Alteration Sensory overload- Areas that would experience sensory overload would be like a patient in the critical ICU, the patient is really sic so there’s a lot of things going on, your going to have people to come check on every hour or quicker, your going to have someone come and check drips, fluids, vitals, etc. so this would lead to sensory overload with how busy it is. Sensory deprivation- The opposite of sensory overload. Sensory deficits Sensory poverty Sensory Deprivation Occurs when a person experiences decreased sensory input; Patients at high risk include: Environment with decreased or monotonous stimuli Impaired ability to receive environmental stimuli Inability to process environmental stimuli Sensory Overload- things that you can do to prevent a patient from reaching sensory overload are dimming lights, CLUSTER CARE. You can provide cluster care, give the patient all of their medications at one time so you can avoid going in the room several times, if the patient would like a bath, help them shower at the same time and ask if there’s anything else so you can give a nice gap instead of coming in and out several times. The patient experiences so much sensory stimuli that the brain is unable to respond meaningfully or ignore stimuli The patient feels out of control and exhibits manifestations observed in sensory deprivation Nursing care focuses on reducing distressing stimuli and helping the patient gain control over the environment Additional Sensory Alterations: The biggest thing with patients who have sensory alterations or deficits is SAFETY. If someone is blind, they are a fall risk. If a patient can’t hear and you need to give patient education, you are concerned about understanding/communication. Sensory deficits: Impaired sight or hearing Altered taste Numbness or paralysis Sensory processing disorders Sensory poverty Factors Affecting Sensory Stimulation Developmental considerations- younger to older changes how we respond to stimulus. Culture Personality and lifestyle- some people say they thrive in chaos, some not so much. Stress and illness- if your stressed or ill, you probably would respond well to someone who is coming in to touch you or move u, or turning them and bothering them every 15 minutes. Medications affect how we are affected in our sensory stimulation depending on the type of medication and its effects/reactions. Physical Assessment Assessment of the ability to perform self-care Vision and hearing assessments- if there is a patient who you know normally uses glasses and the patient isn’t wearing them, but PT wants to come take them, stop and ask where the patients glasses are. If they normally wear dentures and without them, they wont be able to eat properly or chew, make sure the patient has these on. If the patient uses hearing aids and you need to provide patient education or the doctor or someone is coming in to speak with them, make sure they have their hearing aids. Caring for Visually Impaired Patients #1 Acknowledge your presence in the patient’s room Speak in a normal tone of voice Explain the reason for touching the patient before doing so Keep the call light within reach Orient the patient to sounds in the environment and the arrangement of furnishings. (patients that are visually impaired usually have a counting system.. if they take 5 steps and grab the chair then count another 3 steps and grab the door handle to the restroom. That’s how they keep track of where they are so you don’t want to move any furniture around. ) Clear pathways (to ensure patient safety and reduce fall risk) Assist with ambulation Indicate when leaving the room (explain to them everything you are doing as you are leaving the room to ensure the patient understands when you left the room. Explain you are on the way out, explain the noise of the door closing and that you will be back later to check on them) (outside the hospital you can still help with patient safety like providing a cane and sunglasses. Even though they are visually impaired, we want to protect what they do have left, even if its shadows they see. We want to protect their eyes from the sun) Caring for Hearing-Impaired Patients Orient the patient to your presence before speaking (KNOCK, make noise, explain everything you are doing so you don’t come off as sneaky or startle the patient and EXPLAIN everything that you are doing and why) Decrease background noises before speaking (make sure the TV is not on, theres no music in the background) Check the patient’s hearing aids Position yourself so that light is on your face (so the patient will be able to read your lips) Talk directly to the patient while facing him or her (for the patient to be able to read your lips) Use pantomime or sign language as appropriate Write any ideas you cannot convey in another manner Do not chew gum, cover your mouth, or turn away when speaking Communicating With a Patient Who is Confused (the main thing that changes is the patients mental status. For example, when you talk to a patient in the morning and she says she loves her son and her favorite color is pink but then later on you see the same patient and they said they don’t have a son and their favorite color is yellow. These are queues that the patient is confused) Use frequent face-to-face contact to communicate the social process Speak calmly, simply, and directly to the patient Orient and reorient the patient to the environment (make sure the patient knows why they are there) Orient the patient to time, place, and person Communicate that the patient is expected to perform self-care activities Offer explanations for care (for example if a patient thinks there is a needle in their arm, get the catheter and show them the plastic portion to show what is in their arm and give them peace of mind) Reinforce reality if the patient is delusional Emphasize patient’s strengths rather than weaknesses (if john is really good at puzzles, emphasize that, instead of their weaknesses) Communicating With an Unconscious Patient Be careful what is said in the patient’s presence; hearing is the last sense that is lost. Assume that the patient can hear you and talk in a normal tone of voice. Speak to the patient before touching. Keep environmental noises at a low level. Chapter 46- Sexuality Sexual Identity Self identity Biologic sex—chromosomal development Gender identity – what you as a human bring identify as. Gender role behavior or expression Sexual orientation Sexual Expression Ranges from adaptive to maladaptive Masturbation (the main thing is to educate that this is a normal part of life.. especially w like school nurses.) Sexual intercourse—vaginal or anal Oral–genital stimulation Abstinence Alternative: voyeurism, sadism, masochism, sadomasochism, pedophilia Factors Affecting Sexuality Developmental considerations (how you’ve been raised in your house as a child) Culture Religion Ethics Lifestyle (notice that there is no ages affecting sexuality. Because they still have sex, in some nursing homes they have caught residents and as long as they are consenting adults then its okay) Menstruation Menstruation: normal vaginal bleeding that prepares for the presence of a fertilized ovum. Four Phases: Follicular: one follicle produces a mature ovum Proliferation: the endometrium becomes thick and velvety Luteal: the corpus luteum develops Secretory: the endometrial lining disintegrates Note: so your ovaries make an egg, it begins to travel, during this phase the uterus or the endometrium becomes nice and thick to be able to carry a fetus if you get pregnant/ to carry the fertilized ovum. The ovum begins to travel down the fallopian tube and the ovum waits to see if it makes a friend (waits for a sperm) if the sperm and ovum meet, they join together to make a baby. In order for the fertilized ovum to thrive, the endometrium has to be nice, thick and vascular because at this phase, the fertilized ovum gets its oxygen and circulation from. Then you have the corpus luteum which is what sustains the pregnancy for the first 12 weeks. This is what produces progesterone and makes you feel sick and sleepy. However if you never got pregnant, then the secretory stage would happen and the lining would disintegrate and your menstrual cycle would start. A normal cycle is between 28-32 days. YOU HAVE TO KNOW THE 4 PHASES. Menopause: cessation of menstrual activity ( a full 12 months w no cycle) Patient education: lets say you are a school nurse and there is a 13 yr old who started her cycle. You can educate on the ability to get pregnant, educate on ability to get pregnant even when on period, educate on proper hygiene, educate on no douching, no deodorant, sprays because it messes with your normal bacteria and ph balance, just use regular soap and water. Causes of Menstrual Cycle Irregularities Pregnancy or breast-feeding (if you’re pregnant, you won’t have a period up to 40 weeks. When breastfeeding, it is said that you wont have a period but breast feeding is not a contraceptive and the patient can still possibly get pregnant) Eating disorders, extreme weight loss, extreme exercise (you have to have a certain amount of body fat to even menstruate. If your body is having a hard time maintaining just you, how is it going to support growing a baby so you have to be a certain weight to be able to create life.) so very thin people, or anybody w really low body fat like long distance runners have trouble with menstruation. Polycystic ovary syndrome (PCOS) – this is an abnormality in hormones. You need hormones to go up and down during the menstruation cycle. You need estrogen to go up and come down and you need progesterone to go up and stay up if you get pregnant. Premature ovarian failure. Your ovaries don’t function as they should like a normal woman every month. You have an ovary of a 40 year old so there is still a chance you could become pregnant but it’s just very minimal. This happens either because your ovaries don’t ovulate or possibly the quality of the egg that wont stick. Pelvic inflammatory disease (PID) this is an inflammation in the reproductive organ. Uterine fibroids-this is a solid mass that could potentially turn cancerous **Say you have a patient: we want to know if that patient is sexually active to determine pregnancy or STI’s/ diseases. STI’s that are left untreated can cause long term effects and possibly infertility. Sexually Transmitted Infections HIV Bacterial vaginosis (BV) Chlamydia Cytomegalovirus Genital herpes Gonorrhea Hyman papillomavirus (HPV) Syphilis Trichomoniasis Prevention of STIs Delay having sexual relations as long as possible Have regular checkups for STIs Learn the common symptoms of STIs Avoid having sex during menstruation (more bacteria, increases likelihood of infections) Avoid anal intercourse (more bacteria) Avoid douching (strips natural bacteria) Male Sexual Dysfunction- give education on what’s causing it and if it can be fixed and if it cant be fixed then what medications they can use to kind of slow the process or help. Erectile dysfunction Premature ejaculation Delayed ejaculation Female Sexual Dysfunction- provide patient education, let them feel heard, don’t be judgemental, the last thing these patients want to see is a nurse that is embarrassed to talk about it. Make them feel like there can be a resolution. Inhibited sexual desire. Dyspareunia- painful intercourse Vaginismus-The vaginal muscles involuntarily or persistently contracting when they attempt vaginal penetration. This does not interfere with arousal but can prevent penetration. Vulvodynia- this is ongoing pain around the opening of the vagina also known as the vulva. This pain can be so bad that some people can’t even sit for long periods of time and cant even think about having sex. **Anticholinergics & Antihistamines dry you out- in order for intercourse, there has to be some sort of lubrications and these dry you out so this can be a question that you can ask if they are taking any of these that could be the cause. **Hypertensive medications vasodilate, in order for an erection, it needs to have vasoconstriction and that’s why hypertensives cause erectile dysfunction. Effects of Illness, Injury, and Medications Diabetes mellitus Cardiovascular disease Diseases of the joints and mobility Surgery and body image (if someone has a colostomy bag, it could be too embarrassing or not able to if its in the way) Spinal cord injuries (depending on where the spinal cord injury is, some individuals will not be able to perform) Chronic pain (if your in pain all the time, the last thing on ur mind is sexual activity) Mental illness Medications (anticholinergics, antihistamines, hypertensives) Nursing History Reproductive history History of STIs History of sexual dysfunction Sexual self-care behaviors Sexual self-concept Sexual functioning Physical Assessment Physical examination Annual gynecologic exam with pap smear Suspected STI Suspected pregnancy Workup for infertility Unusual lump, discharge, or appearance of genital organs Request for birth control (responsible to educate on but we don’t prescribe) Change in urinary function Methods of Contraception Behavioral Barrier -condoms, etc. Hormonal- birth control Intrauterine devices -IUD can be placed for 5-10 years and removed whenever. Emergency contraception -plan B Sterilization- tie tubes or vasectomy Barrier Methods of Contraception Condom Diaphragm - Cervical cap -is a lot smaller than diaphragm and can be left in longer Spermicides-any sperm that comes into contact is killed. Put on diaphragm or cervical cap. Vaginal sponge Chapter 47- Spirituality Meeting Spiritual Needs Offering a compassionate presence (a hug if they need a hug. If they don’t like hugs you can just sit there and be present to try to be there for the patient) you still ask if its okay to hug. Assisting in the struggle to find meaning in the face of suffering, illness, and death Fostering relationships that nurture the spirit Facilitating patient’s expression of religious or spiritual beliefs and practices (if they ask you to pray with them then pray w them. We obtain accurate info and do what we can to accommodate the patients asking/ beliefs. For example, if the patient only wants hot or cold drinks after delivering a baby for the next 24-48 hours then you make sure that happens) Beliefs Related to Faith (regardless of what you believe, if you don’t believe in what they do, you still have to provide these patients with the same respect as everybody else) Agnostic: one who holds that nothing can be known about the existence of a higher power Atheist: person who denies the existence of a higher power Factors Affecting Spirituality Developmental considerations Family Ethnic background Formal religion Life events **Jehovah Witness don’t accept blood. Catholic doesn’t allow birth control. Focused Assessment Spiritual beliefs Spiritual practices Relation between spiritual beliefs and everyday living Spiritual deficit or distress Spiritual needs Need for meaning and purpose Need for love and relatedness Need for forgiveness Significant behavioral observations. Patient Goals/Outcomes: Spiritual Distress Explore the origin of spiritual beliefs and practices Identify factors in life that challenge spiritual beliefs Explore alternatives to these challenges Identify spiritual supports Report or demonstrate decreased spiritual distress after intervention Implementing Spiritual Care Ethical and professional boundaries Offering supportive or healing presence Facilitating patient’s practice of religion Meeting spiritual needs of millennials Praying with or for patients Counseling patients spiritually Contacting a spiritual counselor Resolving conflicts between spiritual beliefs and treatments Facilitating the Practice of Religion Familiarize the patient with pastoral and religious services within the institution Respect the patient’s need for privacy during prayer Assist the patient to obtain devotional objects and protect them from loss or damage Arrange for the patient to receive sacraments if desired Attempt to meet religious dietary restrictions Arrange for a priest, minister, or rabbi to visit if the patient wishes Evaluating Expected Outcomes Identify some spiritual belief that gives meaning and purpose to life Move toward healthy acceptance of the current situation Develop mutually caring relationships Reconcile interpersonal differences causing anguish Verbalize satisfaction with relationship with God Express peaceful acceptance of limitations and failings Express ability to forgive others and live in the present Demonstrate interior state of joy, freedom from anxiety, and guilt