Fundamentals Final EXAM Review PDF

lOMoARcPSD|44914129 Fundamentals Final EXAM Review Fundamentals of Nursing (Keiser University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Ashley Skeffrey ([email protected]) ...

lOMoARcPSD|44914129 Fundamentals Final EXAM Review Fundamentals of Nursing (Keiser University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 FUNDAMENTALS FINAL EXAM REVIEW: CHAPTER 3: PRINCIPLES OF HEALTHCARE ETHICS: PRINCIPLES OF HEALTHCARE ETHICS:  Respect for persons: Individuals are treated as autonomous agents and persons who have limited autonomy are protected.  Beneficence: To do or promote good to help others.  Nonmaleficence: To avoid doing harm, to remove from harm, and to prevent harm.  Justice: Making fair decisions about resource allocations for societies or groups. RIGHTS AND ETHICAL RULES OF PROFESSIONAL-PATIENT RELATIONSHIPS:  Veracity: To tell the truth.  Fidelity: Nurses commitment to patients.  Privacy  Confidential INTENTIONAL AND UNINTENTIONAL TORTS: INTENTIONAL TORTS:  Assault  Battery: (touching pt body without consent) (ex. performed CPR to a patient that did not want to be resuscitated.) If a nurse fail to obtain consent for a procedure she can be sued for battery.  Defamation of character  Fraud  Invasion of privacy  False Imprisonment Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 UNINTENTIONAL TORT:  Negligence  Malpractice: o Four elements needed to prove malpractice:  Duty to the plaintiff  Failure to meet the standard of care, or a breach of duty, which may be an act of omission  Causation (i.e., that the breach of duty produced the injury in a natural and continuous sequence)  Damages, which require a physical, emotional, financial, or other injury to the patient Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 CHAPTER 5: NURSING PROCESS: FOUNDATION FOR CLINICAL JUDGMENT PHASES OF THE NURSING PROCESS: TYPES AND SOURCRCES OF DATA: Types of data:  Subjective data  Objective Data Subjective data, also known as symptoms, include the pts feelings and statements about his or her health problems. Subjective data are obtained through the interview and are best recorded as direct quotations from the pt. Objective data, observed perceptible, and measurable. Sources Of Data: Two major sources of data exist for the collection of information about the patient. The pt is considered the primary source of data because only he or she can give a firsthand description of the health problem and its effects on his or her lifestyle. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 All other sources, including family members, significant others, other members of the healthcare team, lab tests and literature view, are considered secondary sources. NURSING DIAGNOSIS STATEMENT: Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 CHAPTER 11: HEALTH WELLNESS AND INTEGRATIVE CARE ILLNESS PREVENTION (PRIMARY, SECONDARY & TERTIARY): Primary prevention focuses on the health of a person or population, which the goal of preventing a disease or illness. (ex. vaccines, educational programs) Secondary prevention includes screening for those at risk for developing an illness or those who could have disease diagnosed early in the process for prompt treatment. (mammo, ct lung cancer screening, colonoscopy, pap smear) Tertiary prevention occurs when diagnosis of a long-term disease or disability has already been made. The goal is to minimize complications and maximize function in any way possible for these pts. A rehabilitation or long-term care facility provides tertiary prevention care. IHC THERAPIES AND INTEGRATIVE HEALTHCARE:  Acknowledges the connections among the body, mind, spirit, and existing symptoms in caring for individuals as they interact with their environment.  Includes all areas of lifestyle, body, mind, and spirit as well as partnering with the patient and focusing on health promotion and disease prevention. IHC: INTEGRATED HEALTHCARE: Is a comprehensive often interdisciplinary approach to treatment, prevention and health promotion that brings together complementary and conventional therapies. Allopathic medicine: traditional western medicine Traditional medicine: ancient systems of medicine (Chinese or native American medicine) Iatrogenic illness: illness that results from certain treatments and may be traced ro overuse and adverse responses to medication, in addition to abuse of prescription medications. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 CAM (Complementary and Alternative Medication) Medical and healthcare systems and products that are traditionally not a part of the allopathic medicine (nutrition, exercise, stress reduction) DOMAINS OF COMPLEMENTARY AND ALTERNATIVE PRACTICES: Selected Herbs, Minerals, and Vitamins for mental Health Use: Ginko Biloba: Uses:  Reduces senility.  Reduces shorth-term memory loss.  Improves peripheral circulation. Actions/Precautions:  Uses a circulatory aid and antioxidant.  Possible side effects include GI distress, headache, and allergic reaction.  Caution if taking aspirin or other blood thinner meds. Dose:  60mg bid.  Alzheimer 240 mg divided 2-3 times daily. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 Ginseng (Asian and American): Uses:  Reduces stress and fatigue.  Improves physical and mental function.  Assist smoking cessation efforts. Actions/Precautions:  Use the root.  Use may raise blood pressure and serum glucose levels and can. Increase the growth of estrogen-dependent cancer. Dose:  American- 0.03% ginsenoside, 1-2 fresh root  Asian- 1.5% ginseng, 1-2 fresh root.  For both: 200-600mg liquid extract daily. St. John’s wort: Uses:  Treats mild to moderate depression, loss of interest, anorexia, fatigue, chronic fatigue immune dysfunction syndrome and anxiety. Actions/Precautions:  May interfere with HIV meds.  Use may cause light sensitivity.  Hypericin is the active ingredient.  May lower activity of nonsedating antihistamines, oral contraceptives, antiepileptics, calcium channel blockers and some antifungal. Dose:  300-500mg TID with meals for 4-6wk  0.5mg hypericin per capsule Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 Valerian: Uses:  Relieves anxiety and insomnia. Actions/Precautions:  Forms include a tea (2-3 dried root several times a day) or capsules.  Herb is nonaddictive.  Do not take with tranquilizes. Dose:  300-400mg 1-2 times daily Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 CHAPTER 14: COMMUNICATION IN THE NURSE-PATIENT RELATIONSHIP: Therapeutic Communication Techniques:  Offering self  Open-ended questions  Opening remarks  Restatement  Reflection  Focusing  Encouraging elaboration: o (ex pt:“I am going to be fired, I hate my boss” – (ex. nurse: can you tell me a little about your boss?”)  Seeking clarification  Giving information: o (ex. my purpose in being here is to talk about skin integrity”).  Looking at alternatives: o (ex. perhaps we can talk about what triggers your anger”).  Silence  Summarizing: some ex are: o Adult- “Today we have talked about your plans after discharge, they include…. o Adolescent- “Let’s review what we’ve talked about today”. o Child- “We talked about what to do if you feel mad today. Tell me three things that you can choose to do. Nontherapeutic Reponses: Non-therapeutic responses interfere with or block therapeutic communication. Non-therapeutic responses may prevent nurses from functioning as professionals and therapeutic agents in the care of patients. Rescue Feeling Rescue Feeling occurs when a nurse feels essential to the pts welfare. The nurse thinks that he or she has exceptional abilities to help the pt, and the nurses expectations for the pt will be. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 False Reassurance False reassurance means giving reassurance that is not based on the real situation. It is a way of minimizing the pts situation. For ex saying don’t worry everything will be fine, minimizes the pts concerns but is false reassurance. Giving Advice Giving advice is another common nontherapeutic response. Doing so focuses exclusively on the nurse’s experience and opinions. Changing the subject Is a way a nurse avoids listening to what the pt has to say. The pt is left with the feeling that his or her feelings have been discounted. Being Moralistic Being moralistic means seeing a situation as good or bad or right or wrong. It is a judgmental approach. The nurse must become aware of how he or she uses the word should. Nonprofessional Involvement Nonprofessional Involvement occurs at a time when the nurse goes outside the boundaries of the therapeutic relationship and establishes a social economic or personal relationship with the pt Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 CHAPTER 15: PATIENT EDUCATION AND HEALTH PROMOTION: THREE LEVELS OF DISEASE PREVENTION: Primary prevention- seeks to prevent a disease or to stop something from ever happening. Ex. immunizations, contraceptives. Secondary prevention- seeks to identify specific illness or condition at an early stage. Ex. physical assessment, vision screening, mammo, colonoscopy… Tertiary prevention- occurs after disease or disability has occurred and the recovery process has begun. Ex. cardiac rehab, support groups, health education. Health Promotion: Health promotion helps to reduce excess mortality address the leading risk factors and underlying determinations of health. (factors that combined affect the health of individual, families and communities.  Restoration of Optimal Health and Function after Illness (Tertiary Prevention) o Focuses on limiting disability or restoring function.  Coping with Alterations in Health Status o Focuses on enhancing coping of individuals and families who experience new and/or frightening procedures or must adjust to live with chronic illness or disability. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 ASSESING LEARNING NEEDS AND ASSESING LEARNING READINESS: ASSESSMENT FOR LEARNING:  Baseline knowledge: assess what the learner already knows (“Tell me what you know about…..”). Finding out what a patient already knows helps the nurse determine where to start with their teaching.  Cultural and language needs – healthcare providers need to recognize and address the unique culture, language, and health literacy of diverse consumers and communities. Assess the patient’s ability to understand and speak English; an interpreter (no family members) may need to be arranged for any significant teaching session.  Priorities – patients have many learning needs, therefore it might be beneficial to ask the following questions (patient): what is my main problem?; What do I need to know?; and Why is it important for me to do this?” ASSESING LEARNING READINESS:  Motivation: provides the incentive for learning. Starts with the patient’s recognition of the need to know.  Compliance: (following or not following the recommended plan).  Sensory and physical state: Ex: patients who receive pain medication after surgery may have difficulty concentrating; patients with poor vision may be unable to give themselves subcutaneous injections safely.  Literacy level: a major barrier to optimal health outcomes and successful patient education is literacy. Patients and families with poorer reading skills are believed to have greater difficulty navigating the healthcare system and are at risk for experiencing poorer health outcomes. Behaviors and Responses That May Indicate Limited Literacy Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 Timing and Amount of Information: When planning a teaching session, consider factors such as the amount f time available and the amount of material that needs to be covered. The time when pts are very receptive to teaching is often referred to as a teachable moment. Teach back: This technique is one where the pt teaches back to you the information that he or she has learned and closes the communication loop to ensure that the content delivered was heard and understood. Using this technique is a quick way to evaluate the effectiveness of your instruction. Return Demonstration: The return demonstration is a way of testing skill performance. A pts degree of accuracy and independence in performing a skill is almost always a clear indication of learning. Communication through an interpreter:  Speak to the patient rather than the interpreter  Speak slowly  Use simple question  Try to always use the same interpreter CHAPTER 17: SAFETY Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 FALL PREVENTION:  Remove throw rugs  Ensure stairways are well lighted and repaired  Remove clutter from stairways and walkways  Install handrails whenever needed  Avoid use of unstable ladders and step stools  Never attempt to do anything beyond reach or physical ability  Clean damp areas promptly In all healthcare environments, ensure the room needs to be free from clutter, and well lighted during transfer and ambulation. Teach pts with orthostatic hypotension to change positions slowly to allow for blood pressure to stabilize. RECOMMENDATION FOR RESTRAIN?  Use the least restrictive restrain possible.  Correct size  Apply correctly so it maintains body alignment and ensures patient comfort.  Patients with restrains needs to be observe frequently.  Continuous monitoring  Assess circulation.  Removal of restrains are by one at the time.  Allow ADL  Discontinue use as soon as feasible. Documentation:  Document alternative methods attempted.  Check valid order by an appropriate provider, restrains are used for violent, self-destructive patients need to be reorder at least every 24 hours. CHAPTER 18: HEALTH ASSESSMENT OBTAINING SUNJECTIVE DATA: THE INTERVIEW: Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129  Being professional concerned and attentive throughout the interview  Maintaining eye contact, occasionally nodding, or verbally responding to pt remarks  Sitting at pt eye level, appearing unhurried and taking notes  Positioning computers so that the nurse can face the pt  Using closed and open-ended questions appropriately  Maintaining control over the interview OBTAINING OBJECTIVE DATA: THE PHYSICAL ASSESSMENT:  This is data that can be directly observed, through the senses of sight, hearing, touch, and smell.  Also, ultrasounds, and another diagnostics test. Can be obtain by:  Inspection- observation  Palpation- use of hands and fingers (texture, size, consistency, masses, and fluids.)  Percussion- hearing, hands tap an area on the patient that produces a sound.  Auscultation: Stethoscope small- bell/ big one- diaphragm CHAPTER 19: VITAL SIGNS PULSE RESP TEMP SYSTOLIC DIASTOLIC Adult 60-100 12-20 97-99 90-120 60-80 Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 Older Adult 60-100 12-20 95-99 90-120 60-80 TEMPERATURE:  Humans maintain a consistent internal (core) body temperature between 36.5°C and 37.5°C (97.6°F to 99.6°F) by oral measurement.  When body temperature exceeds 37.5°C, this is termed hyperthermia, fever, or pyrexia.  Heat is lost through four processes: Radiation, conduction, convection, and evaporation.  radiation: transfer of heat from one object to another without touching (heat lost from the body to a cold room)  conduction: transfer of heat from the body directly to another surface (when the body is immersed in cold water)  convection: dispersion of heat by air currents (wind blowing across exposed skin)  evaporation: dispersion of heat through water (perspiration)  temperature reflects the balance between heat the body produces and heat lost from the body to the environment Death may occur if a person’s core body temperature drops to 25°C (77°F) or rises to 45°C (113°F). Reliability of a temperature value depends on selecting the most appropriate site, choosing the correct equipment, and using the correct procedure. The most commonly used sites are the mouth, rectum, ear (tympanic), forehead (temporal artery), and axilla. Procedures: Temperature Assessment  Sites: o Oral o Rectal- most accurate Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 o Ear (tympanic) o Temporal artery (forehead) o Axillary Factors Affecting Core Body Temperature  Age – baseline body temp drops with age  Environment – death at 77°F and 113°F  Time of day – temp is lower in the morning  Exercise – increased breakdown of carbs and fats for energy increases temp  Stress – SNS is stimulated and metabolic rate increases, increasing temperature  Hormones – women have greater variations in temperature (progesterone) Factors Affecting Oral Body Temperature Measurement  Recent smoking  Recent chewing gum  Oxygen administered by mask or cannula  Recent intake of hot or cold liquid drinks or food *wait 15 to 30 minutes after drinking hot or cold liquids to allow for temperature to return to the baseline PULSE:  Ventricle contractions eject blood into the arteries.  Blood entering the aorta from the left ventricle causes aortic wall distention.  As the aorta expands and contracts, a pulse wave travels along the blood vessels.  The pulse wave or pulsation can be felt where the arteries lie close to the skin surface. Procedures: Pulse Assessment Characteristics of the pulse include:  Rate (frequency): Number of pulsations per minute Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129  Rhythm: Regularity of the pulsations  Quality: Strength of the pulsations Palpation and auscultation are methods used to assess pulse rate. *rate, rhythm (regularity), and quality (strength) Sites:  Temporal  Carotid  Apical  Brachial  Radial  Femoral  Popliteal  Pedal  Posterior tibial Factors Affecting Pulse:  Age – pulse rate decreases with age  Autonomic nervous system – stimulation of the vagus nerve reduces pulse rate. Stimulation of the SNS (i.e., pain), increases pulse rate  Medications – diuretics and beta-blockers Respiratory:  Respiration: A term that summarizes two different but related processes —external respiration and internal respiration.  Inspiration: Active contraction of inspiratory muscles resulting in increased intrathoracic volume as the lungs expand; airway pressure becomes negative and air flows inward.  Expiration: Airway pressure becomes slightly positive as natural lung recoil occurs and air flows out as muscles relax. External respiration: is the process of taking oxygen into and eliminating carbon dioxide form the body. Internal respiration: refers to the use of oxygen, the production of carbon dioxide, and exchange of these gases between the cells and blood. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 Inspiration: is breathing “in” and expiration is breathing “out” Rate:  Normal respiratory rate for an adult is 12 to 20 breaths per minute.  Respiratory rate should be assessed without patient awareness.  Tachypnea: Abnormally fast respiratory rate (>20 breaths/minute in adult).  Bradypnea: Abnormally slow respiratory rate ( ultimately the hippocampus regulates the emotional information processes and serves as the coordinator of activity in the HPA axis -> although activation of the HPA (hypothalamic-pituitary-adrenal) axis is critical to the stress response, activation of the ANS occurs first -> release of epinephrine and norepinephrine for fight or flight response -> after ANS stimulation, HPA axis is activated -> release of glucocorticoids, namely CORTISOL occurs. Glucocorticoids provide energy to the CNS, muscles, and other systems in the body. These steroids (glucocorticoids) have anti-inflammatory effects, suppress immune activity, increase blood glucose levels, and increase arousal and cognition. Resilience: the ability to recover from an adverse event. Resistance: adaptability to adversity- individuals is able to handle and adapt to stressor. Vulnerability: inability to adapt to adversity; usually follows one or more adverse events, leading to decreased resistance and resilience. Progressive allostatic load: overexpression of stress response mediators (sympathetic activity, glucocorticoids release) leading to cellular damage and pathology *When it comes to coping, coping mechanisms in a current stressful situation are dependent on the individual’s level of resistance, resilience, and vulnerability acquired through prior adverse events. Cognitive and physiologic response to stress: appraisal is the initial reaction to an event to tell if it is stressful. *Appraisal precedes stress. Once a situation is accepted as stress, appraisal continues with how to deal with the stressor (secondary appraisal). Coping Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 mechanisms are imitated during secondary appraisal to cope with the stress. Social buffering (relying on other individuals for help) may occur. DEFENSE MECHANISMS may also be used to deal with the stressor. Coping can also be harmful if an individual chooses to use alcohol or drugs to cope with stress (avoidance coping) -> prolonged avoidance of a situation can lead to allostatic load with possible disease manifestations. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 FACTORS AFFECTING COPING PATTERNS:  Lifestyle: Diet; activity and exercise; sleep; safety and security  Previous experience  Involuntary relocation  Social interaction  Sensory deficits Lifestyle consideration: allostatic load may be higher in individuals with poor nutritional selections, sedentary lifestyle, and self-destructive behaviors. The individual with an unhealthy lifestyle is at risk for many diseases. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 Diet: good nutrition Is essential for optimal functioning of cells throughout every tissue and organ in the body. overnutrition can be as detrimental as being malnourished Activity and exercise: exercise helps maintain a healthy cardiovascular system, improves muscle tone, and can greatly benefit psychological well-being. Additionally, exercise can be used as a coping mechanism in helping decrease feelings of anxiety (emotion-focused coping) and help with processing a situation to take action (problem-focused coping). Sleep: sleep is an important part of health and well- being. It becomes increasingly difficult to function optimally when there is a sleep deficit. With extreme sleep deficit in case of chronic insomnia, the stress response system may not function optimally when there is a sleep deficit. With extreme sleep deficit in cases of chronic insomnia, the stress response system may not function adequately. Subsequently, sleep deprivation can increase allostatic load and lead to pathologic processes. SAFETY: stress caused by a dangerous situation would be quite high with a low sense of security vs. stress playing in a competitive game while being surrounded by friends would evoke a higher sense of security. The degree of safety will, and security will influence the effectiveness of coping mechanism. previous experience: successful outcomes will build confidence and aid in a subsequent similar stressful situation. Repeated stressors that affect coping may stimulate less heightened perceptions of stress with each encounter. Perceptions of stress can also be learned from other’s experiences. involuntary relocation: moving is stressful even if it is fully supported by all who are going. The transition of leaving behind familiarity and support and building a new routine can be stressful. Older adults may face involuntary relocation. Coping mechanisms are needed when moving to a new environment. People at any age who are hospitalized dace stress adjusting to the new environment with many different kinds of stimuli. Patients can sometimes feel stressed when its time to be discharged back home. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 ALTERED COPING PATTERN:  Addictive behaviors  Physical illness  Anxiety and depression  Violent behavior  Areas of assessment include: o Physiologic stress o Psychological stress o Environmental stress o Sociocultural stress PSYCHOSOCIAL AND PHYSIOLOGIC EXPRESSIONS OF STRESS: Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 HEALTH PROMOTIONS: identifying and reducing stressors: assist patient in identifying sources of stress and help develop strategies for coping and adapting addressing perfection: feelings of having to perform without error can be extremely stressful. Help patients realize that a desire for perfection and unrealistic self-expectations is stress inducing. Encourage patients to be realistic about what they are trying to accomplish and to remember that relationships are more important than things or tasks. Supportive internal messages: restructure negative self-messages that can lead to feelings of inferiority and self-doubt. Thought stopping. Patients can learn to replace defeating negative internal messages with supportive messages to help cope with difficulties using assertiveness: another useful technique for changing behavior in response to stressful encounters is assertiveness. enables people to act in their best interest, to stand up for themselves, to express feelings openly and honestly, and the exercising their rights while still respecting the rights of others. Being assertive requires practice. making lifestyle changes: adequate sleep and nutrition, limit or eliminate smoking, reduce caffeine intake, avoid dependence on substances to mask pain or bad feelings (‘pill popping”). All such measures will promote healthier management of stress. exercising: helps counteract the stress response. Physical exertion helps to release tension from the muscles and is a natural outlet when the body is in a fight-or- flight state of arousal. Also triggers the release of natural opioids like endorphins. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 relaxation techniques: deep breathing: breathing is an important element of the relaxation response. As stress and tension mount during the day, breathing becomes shallow and irregular and the heart rate accelerates. Poorly oxygenated blood contributes to lethargy, tension, and depression. When a person is relaxed, breathing slows and deepens and the heart rate returns to normal, a person can use slow, deep breathing to trigger the relaxation response. The act of taking a few deep breaths before a stressful situation can decrease fear and anxiety, allowing for a more relaxed frame of mind. Meditation: Meditation can be used for shifting thoughts from threats to challenges and decreasing stress arousal NURSING INTERVETIONS FOR ALTERED FUNCTION Relaxation training: Having relaxation tapes available for patients to use is becoming a common practice in institutional and community setting, telling the patient to take a few deeps breaths before a procedure can decrease anxiety. Nurses should use relaxation technique during:  Before and after diagnostic test or treatments  During childbirth  After surgery to help manage postoperative pain  During recovery from myocardial infarction  During chemotherapy and radiation treatments for cancer  While calming an anxious or agitated person  Before a painful procedure such as an intramuscular injection or inserting an intravenous line modification of the environment: in the hospital, keep down the conversational noise in the hallways, turn off unnecessary lights, organizing nursing care to minimize patient disturbance crisis intervention: a crisis is a situation where the coping strategies that a person used to use no longer work. Support is needed from family, friends, health care providers (nurses), clergy. A person experiencing a crisis can reach a state of becoming dysfunctional or nonfunctional. Sometimes a crisis can become unsafe. One way to de-escalate such a situation is through L.E.A.P: listen, empathize, affirm, and partner. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 CHAPTER 42: LOSS AND GRIEVING: Characteristic of a normal grief and loss:  to make the outer reality of the loss into a internally accepted reality  to alter the emotional attachment to the lost person or object  to make it possible for the bereaved person to become attached to other people or objects. Grief: is the price we pay for becoming attached to people, objects, and beliefs. Through the grief process, the person is able to change the attachment to the lost person or object and becomes attached to other people and objects bereavement: the person’s total response to a loss which includes emotional, physical, social, and cognitive responses Mourning: behaviors vary from culture to culture. It is the outward, social expression of loss anticipatory grief: facilitates coping with loss when the loss actually occurs. The loss can be anything from losing a significant person, object, or relationship FACTORS AFFECTING GRIEVING:  Meaning of the loss  Circumstances of the loss  Religious or spiritual beliefs and loss  Personal resources and stressors  Sociocultural resources and stressors Meaning of the loss: many will apply their own values to how others should feel about a loss (i.e., divorce may be extremely undesired and cause intense grief in one person, whereas it may be welcomed and a cause of happiness in another) circumstance of the loss: a loss that occurs under violent conditions is much more difficult to cope with than a death that occurred under peaceful circumstances. A death that is a suicide or homicide is usually more stressful than a death due to natural causes Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 religious or spiritual beliefs and loss: some people find strength in dealing with loss through their faith. Some believe that death is the end; others believe that death is the beginning of a new life in heaven or hell; some believe in reincarnation. Some may think their loss is a punishment for past sins. Nurses must hold a nonjudgmental stance with regard to others’ faith or spiritual beliefs, as well as lack of such beliefs personal resources and stressors: these factors influence a response to a loss through the following factors –coping skills, previous experiences with loss, emotional stability, spiritual beliefs, physical health, developmental stage, current stressors, and socioeconomic status. Socioeconomic status is one of the major factors related to the ability to cope with loss. sociocultural resources and stressors: sociocultural resources include sources of support available through family, friends, coworkers, and formal institutions. Sometimes these supports can be helpful, or they can be a source of added stress (specifically if support system lacks empathy toward the loss). WORKING THROUGH GRIEF STAGES: Assisting patients move through different phases of grief: shock (protect the patient from physical harm and on assisting the patient to accept the reality of the loss. Help the patient contact family members), protest ( interventions should be focused on getting the patient to express thoughts and feelings about the loss and maintain normal health status, disorganization (place emphasis on getting the patient to accept the reality of the loss and begin to reorganize their life and continue interventions that started in the shock phase, and reorganization (place emphasis on helping patients continue changing patterns of behavior so that they can find renewed meaning in life). support groups: help prevent or assist with intense emotional distress or lack of social support or prolonged grief. Some will need more help than self-help groups can provide. Some may need more in the means of individual counseling or psychotherapy. Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 RESPONSE TO DYING AND DEATH: Denial Anger Bargaining Depression Acceptance many patients do not follow these steps in order. Many go back and forth from one stage to another; others remain in one stage until their death. Nurses must be aware that there is no one right way for a patient to respond to dying. Nurses must adapt their care based on patients’ current responses and needs and not expect them to always progress through defined stages. PHYSICAL SIGNS OF DYING: When a patient is dying, the lungs become less efficient for gas diffusion and oxygenation. As blood pressure and heart rate decrease, the body becomes increasingly unable to maintain circulation and to perfuse tissues, and the brain ceases to regulate vital centers.  The skin may become extremely pale, cyanotic, jaundiced, mottled, or cool Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129  Heart rate is irregular, and the pulse is weak, rapid, and irregular  Respirations are changed: shallow, labored, faster or slower, or irregular.  Difficulty swallowing and loss of appetite  Urine output is decreased due to worsening renal function and limited fluid intake  Fecal retention or impaction occurs due to reduced gastrointestinal motility  Incontinence occurs due to relaxation of the sphincter tone  Generalized weakness  Increased fatigue or somnolence or restlessness and increased anxiousness and agitation  Decreased responsiveness to external stimuli, disorientation HOSPICE AND PALLIATIVE CARE: Hospice: focus on relieving symptoms and supporting patients with a life expectancy of 6 months or less and their families. Palliative care: focuses on improving the quality of life of patients and their families at any time during a life-threatening illness through prevention and relief of suffering by means of early identification and treatment of pain and other physical, psychosocial, and spiritual problems. May be given at any time during a patient’s illness. May be given during a patient’s illness, from diagnosis to end of life. Palliative care:  Providers relief from pain and other distressing symptoms  Affirms life and regards dying as a normal process  Intends neither to hasten or postpone death  Integrates the psychological and spiritual aspects of patient care  Offers a support system to help patients live as actively as possible until death  Offers a support system to help the family cope during the patient’s illness and in their own bereavement  Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated  Will enhance quality of life and may also positively influence the course of illness.  Is applicable early in the course of illness, in conjunction with other therapies such as chemotherapy or radiation therapy, and includes those Downloaded by Ashley Skeffrey ([email protected])  lOMoARcPSD|44914129 investigations needed to better understand and manage distressing clinical complications Caring for the deceased: nursing care continues after the death of a patient  Concern for dignity in care of the body and sensitivity to the needs of the deceased patient’s family are nurses’ responsibilities  Immediately after a patients’ death is pronounced, family members may wish to sit with the patient  The nurse should remove unneeded items and clean, position, and cover the patient  Under some circumstances (unexpected death), tubes and IV lines should not be removed from the patient  religious/spiritual, and cultural beliefs and customs should be observed as much as possible POSTMORTEM CARE: Nurses are responsible for following the federal and state laws regarding requests for organ or tissue donation, obtaining permission for autopsy, ensuring the certification and appropriate documentation of the death, and providing postmortem(after-death) care. After postmortem care is completed the client family becomes the nurse primary focus. Downloaded by Ashley Skeffrey ([email protected])