Test 3 Objectives.docx

Objectives Chapter 42: Self-Concept Dimensions of Self-Concept- There is a couple of definitions that you do have to know and those concepts are: *-Self-knowledge: “who am I?” this is the patient or person asking themselves if they can do this. For Example , a patient is asking themselves “can they...

Objectives Chapter 42: Self-Concept Dimensions of Self-Concept- There is a couple of definitions that you do have to know and those concepts are: *-Self-knowledge: “who am I?” this is the patient or person asking themselves if they can do this. For Example , a patient is asking themselves “can they really handle going through chemotherapy?” or “can I be a new mom?” “I don’t know if I can do this” its really asking about what can I really do? -Self-expectation: “who or what do I want to be?”- *-Self-Evaluation: “How well do I like myself?” Another way you can assess self-evaluation on another person is by talking about life experiences. For example, you don’t just go up to someone and say “hey Samantha, do you like yourself” instead you can talking about life experiences like “hey Samantha, tell me a little bit about your life” This would aid in an open ended question and then Samantha would tell me all these things about herself and I can then determine if those things are positive or more negative and that would tell me about the self evaluation that Samantha has for herself. Maslow’s Subsets of Esteem Needs Self-esteem- Strength, achievement, mastery and competence, confidence in the face of the world, independence, freedom. Respect needs- Status, dominance, recognition, attention, importance, appreciation Three Major Self-Evaluation Feelings- We focus on these specific three as nurses because we think about safety first. If a person is feeling guilty; what if they are going to start having thoughts about suicide? What if they feel shame? This would bring on bad/negative thoughts as well. It is our responsibility as nurses to ask if we feel a patient feels guilt or shame that we ask. “Do you have plans? Do you plan on harming yourself? Do you have the resources to follow through with this plan? “All of these are mandatory questions. Even if you suspect something, it is our responsibility to report it. Same thing with abuse, it doesn’t matter if the child seems happy overall but if you saw multiple bruises at different healing phases. if you saw an x-ray with broken bones that weren’t healed correctly. If you see a spiral fracture, these are all things that NEED to be reported. Pride: based on positive self-evaluation Guilt: based on behaviors incongruent with the ideal self Shame: associated with low global self-worth Formation of Self-Concept- Babies in the beginning think they are mom or they are dad or whoever they see as the stronger/primary parent. The child/baby thinks they and the parent are one. They think they are one person and as they become older, they become self-aware and understand that they are their own human being. Infant learns physical self-different from environment. - he/she becomes self aware and If basic needs are met, child has positive feelings of self.- if you always tell a child positive things, they will grow up having self-confidence, they will have positive feelings about themselves. if you tell them negative things, they will grow up needing therapy. Child internalizes other people’s attitudes toward self. Child or adult internalizes standards of society. Like when someone is little and they see in the media/magazines all these skinny people and grow up thinking this standard is beautiful. When in reality that person is more than likely anorexic. Stages in Development of Self Self-awareness (infancy)- when the child becomes self-aware; they are not part of mom/dad as one; they realize they are their own human being. Self-recognition (18 months) – this is the age where a child starts developing their own personality. You start to see their colors fly. You start knowing what they like/dislike. Self-definition (3 years)- this is the age where they can walk, talk, tell you about themselves. Tell you what their name is at this point. Self-concept (6–7 years)- This is when the children understand the changes they are going to go through. This is the stage where they understand that they are a boy or girl. That understand they are different than the other gender. They start to say things like “you can’t play with us because you’re a girl.” Attachment- which means to bond. children must be able to attach to somebody. A child must be able to bond to develop. Factors Affecting Self-Concept Developmental considerations-children with special needs might have a difficult time going through all of these stages. Culture- culture affects self concept. Culture Dissonance- this means that the child has different beliefs than the parents. For example, if the parent migrated from another country to the United States and brought their beliefs over here, then decided to have children here, The child would grow up with the beliefs and cultural traits here in the United States. Internal and external resources History of success and failure Crisis or life stressors- can interfere with self-concept. If you grew up in a stressful environment, that might cause difficulty in attachment or cause difficulties being self-aware. Aging, illness, disability, or trauma- all of these have an effect on self-concept and what we think about ourselves, how we think about others and how we see the world. Assessing Self-Concept- how the nurse can assess self concepts of a patient. Personal identity- if a patient wants to be called Philip when their name is Jane, then you call them Philip. We assess and respect the patient’s personal identity and call them how they would like to be called. Personal strengths- We want to know the patients’ personal strengths. For example: a patient can be really good at communication. Body image- its important to assess somebody’s body image because of trauma. For example: a burn victim, is the patient going to have issues with body image when they go home? Yes. This doesn’t necessarily have to be trauma, this could be a part of natural growth. Self-esteem- self-esteem can lead to self-care deficits. If you are a patient and your self-esteem is in the toilet. Will the patient be able to take care of themselves, If they don’t take care of themselves then that affects their health long term. Role performance- this falls into like if a man is used to be the bread winner and now he is in the hospital and now there is no money coming in to take care of the family. Self worth- Global self- an example of this would be a husband passing away and the wife is unable to detach herself from the husband. Like the patient saying “I don’t know what to do without him” This happens a lot in couples who have been married for 50-60 years and one dies and then the other passes shortly after. This is global self. They are unable to detach themselves. Self destructive behaviors- an example of this would be like if a nurse worked in psych; taking care of the addict and the addict blaming somebody else. They lost their job, their house, their car, they lost custody of their kids but blame the mom when really its their fault. They blame their falling on somebody else. Assessing Self-Esteem Socialization and communication- we want our patients to socialize and communicate, even if its just walking the dog and talking to their neighbor. Significance- “what does this mean to you” Competence- how competent the patient is Virtue- a question you can ask the patient about virtue “tell me about your beliefs” “tell me something ethical” “tell me about the principals you follow” “tell me about any moral beliefs you have” Power- we as nurses have the power to make change. What if Samantha is John’s nurse and John was a drug addict. Samantha helps with Johns rehab for about 3 months. Then when John is discharged, he realizes he was influenced by Samantha to make this big change and turned his life around. Samantha had the influence to change John’s life in a positive way. Power is able to create change. Powerless: When someone feels powerless, we can encourage the patient. Be their cheer leader! “You can do it!” “just one week left John!” ^^^^^^^^^ a patient can go back and forth on the spectrum. They can get better, then worse. Like hitting a roadblock or maybe having a relapse due to current events that pushed them back into having low self-esteem. Without self-esteem, would you be able to reach self-actualization? No. Nursing Strategies to Identify Personal Strengths Encourage patients to identify their strengths- if John says he’s a really good communicator; I am going to focus on that. Replace self-negation with positive thinking- instead of saying “OMG I’m not going to pass this class” say “OMG, I’ve been here before and I made it all the way here. I am going to pass this class.” Notice and reinforce patient strengths- again, what is john good at? Reading? Communicating? We are going to encourage that. Encourage patients to will for themselves –“come Jiovonne, you can do this, we can help you in walking again but we gotta start here okay” Help patients cope with necessary dependency- our goal is always to restore somebody’s health but unfortunately, we can’t always restore health then it’s our job to help the patients with coping with these changes. Chapter 43- Stress and Adaptation What is stress? Is a response to change in a normal balanced state. (a little stress is okay, a lot of stress is not okay. When someone gets so stressed out to the point where they can no longer eat or do things to function is NOT okay. That’s when it becomes NOT NORMAL) Examples of Physiologic Stressors Chemical agents- a person taking drugs, not just illegal drugs, prescribed drugs too because if somebody can’t afford them then that’s stressful, or if a prescribed medication makes you feel worse with the side effects than the actual illness (chief complaint). Physical agents-heat, cold, trauma Infectious agents-viruses, bacteria Nutritional imbalances- a person not eating. Hypoxia- The absence of enough oxygen in the tissues to sustain bodily functions. Genetic or immune disorders Age- When we age, we start to get more stressed. Think about when you were 6-7. Do we really have stress when we are 6 or 7? No. As we get older, we get jobs, bills, kids, things happen around us and we become elder, and we start going through the process of losing our loved ones and losing our independence by not being able to change our briefs. Having to rely on somebody else to assist you with your ADL’s is very stressful. Physiologic Homeostasis Local adaptation syndrome (LAS)—involves only ONE specific body part. An example of this would be appendicitis. That is only affecting ONE specific body part. A person is having pain in the stomach resulting from inflammation of the appendix. Reflex pain response Inflammatory response General adaptation syndrome—biochemical model of stress (Selye, 1976) Alarm reaction- your gonna see increased heart rate, high bp, vasoconstriction, metabolism, water retention, increased glucose. Stage of resistance Stage of exhaustion Local Adaptation Syndrome- ONE SPECIFIC THING Localized response of the body to stress Involves only a specific body part (such as a tissue or organ) instead of the whole body Stress precipitating the LAS may be traumatic or pathologic Primarily homeostatic short-term adaptive response Two types: reflex pain response and inflammatory response Look at the picture on slide 19 and know possible signs and symptoms for general adaptation syndrome, including the alarm reaction, stage of resistance, and stage of exhaustion. Reaction Alarm- Think about a patient who is going to undergo a very scary procedure. For example, if a patient is going to get their foot chopped off and the physician orders labs and the patients’ labs come back with increased glucose. Are they diabetic? No, they are in a fight or flight response or in the first stages of the alarm reaction. You are initially shocked during this whole process. Person perceives stressor, defense mechanisms activated Fight-or-flight response Hormone levels rise, body prepares to react Shock and counter-shock phases Stage of Resistance Body attempts to adapt to stressor Vital signs, hormone levels, and energy production return to normal Body regains homeostasis or adaptive mechanisms fail Stage of Exhaustion Results when adaptive mechanisms are exhausted Body either rests and mobilizes its defenses to return to normal or dies Psychological Homeostasis (also know your ineffective coping) Mind–body interaction Anxiety Coping mechanisms Ineffective coping mechanisms Defense mechanisms Coping Mechanisms- crying, laughing, sleeping, cursing. Physical activity exercise. Taking a deep breath, practicing mindfulness exercises. Ineffective Coping Mechanisms- avoiding, excessive drinking, blaming others. Lack of eye contact, limiting relationships to those with similar values and interests. Defense Mechanisms (+ adaptation) – Compensation- when you compensate. A person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area. For example, A student who has difficulty with academics may excel in sports. Denial-A person refuses to acknowledge the presence of a condition that is disturbing. For example, the patient saying “this is not true” “this cant be true” “my husband cannot have this” Displacement-putting the stressor on somebody else. Example: you need 1 million by next week and you just put it on your husband. A person transfers (displaces) an emotional reaction from one object or person to another object or person. Adaptation-This happens in response to the stressor, you adapt to it. Regression- seen more in children when they have a very stressful environment or a large stressful situation, so they regress to another time in their childhood. Effects of Stress- Stress and basic human needs.- stress is a good thing in small amounts. Stress in health and illness.- nausea, vomiting, diarrhea, headache. Stress is a big factor in autoimmune diseases like lupus. Lupus can be brought on by a large stressful event in someone’s life. Long term stress can affect the way your brain functions and can even change the structure of it. Family stress-stress happening due to family. Changes in family structure and roles. This can lead people to feelings of anger, helplessness, and guilt. This can also include loss of control over someone’s normal routines. This also includes concern for future stability. All of these are family stresses. Crisis -if a crisis occurs, it will lead to more stress. This leads to effects of the body where the body begins to have issues and shut down. Sources of Stress- Developmental stress: occurs when person progresses through stages of growth and development – as we grow we gain more stress due to responsibilities. You start to have bills, a job, kids, providing for the new family. Situational stress: does not occur in predictable patterns E.g. illness or traumatic injury, marriage or divorce, loss, new job, role change. Like Jiovonne’s patient who was fine one day and the next day he woke up experiencing paralysis. This was an unpredictable event and is situational stress. Teaching Healthy Activities of Daily Living- Exercise- 30-45 minutes per day 4 days a week (most of the week) Rest and sleep - 8 hours per day Nutrition- atleast 3 meals per day Use of support systems- use your friends, family members, whoever is your support system. Use of stress management techniques Stress Management Techniques- Relaxation- deep breaths is something that is universal and something that leads to relaxation. Mindfulness- self awareness Anticipatory guidance- Guided imagery- using mental images to relax like thinking of the beach. Crisis intervention- may plan, if your having a baby and you see that diapers are expensive, you can intervene and start buying diapers right now so it wont be so stressful later. Crisis Intervention (what not to do)- you do NOT want to give false promises, you do NOT want to give information and patient teaching when a patient is having a crisis. The patient will NOT remember as they are stressed. Evaluating the Care Plan- The patient verbalizes the causes and effects of stress and anxiety. The patient identifies and uses sources of support. The patient uses problem solving to find a solution to stressors. The patient practices healthy lifestyle habits and anxiety-reducing techniques. The patient verbalizes a decrease in anxiety and increase in comfort. Chapter 44: Loss, Grief and Dying Types of Loss Actual loss: can be recognized by others; meaning someone else can see the actual loss. If a patient went into surgery and came back and they lost their leg, you can see that actual loss. Perceived loss: is felt by person but intangible to others; Jiovonne got robbed and lost her peace of mind. Physical loss versus psychological loss Maturational loss: Maturational loss is experienced as a result of natural developmental processes. As examples, a first child may experience a loss of status when a sibling is born, and the parent of a single child may experience a sense of loss when the child begins school. Situational loss: Situational loss is experienced as a result of an unpredictable event, including traumatic injury, disease, death, or national disaster. Anticipatory loss: Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Anticipatory loss is often seen in the families of patients with serious and life-threatening illnesses and may lessen the effect of the actual loss of the family member. Loss occurs when a valued person, object, or situation is changed or becomes inaccessible such that its value is diminished or removed. Engel’s Six Stages of Grief: this is very individualized and people can hop back and fourth between these stages. Shock and disbelief—if my husband died and I said “no, hes not dead. He is coming back” shock happens in the beginning but can happen at other stages as well. Developing awareness- if my husband died and I said “okay, maybe he is gone.” I am aware of it. Restitution- kind of like coping; finding peace with it. Resolving the loss-would be like “everything is gonna be okay” Idealization Outcome Definition of Death Uniform Definition of Death Act: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. Medical criteria used to certify a death: cessation of breathing, no response to deep painful stimuli, and lack of reflexes (such as the gag or corneal reflex) and spontaneous movement, flat encephalogram. Multiple physicians do these multiple tests and sign off to declare you dead and put their license on the line to do so. You have to be declared brain dead in order to be considered dead. With organ donation, there is still a pulse, but you are brain dead. You must be declared brain dead because when you are brain dead there is no coming back. Providing Care to Facilitate a Good Death Guided by the values and preferences of the individual patient Independence and dignity are central issues- you still talk to the patient, even if they are not awake. There have been people that have reported hearing everything when they came back or woke back up. Continue to provide patient privacy. Be respectful. You still knock, you still wash your hands. Even if they are not awake. Don’t say anything negative Providing control - The care of the dying patient should be guided by the values and preferences of the individual patient. Independence and dignity are central issues for many dying patients, particularly in older adults. Maintaining control and not being a burden can also be relevant concerns. Palliative care- Palliative care of dying patients is an interdisciplinary undertaking that attends to the needs of both patient and family. Focus on the relief of symptoms- if the patient has stage 4 cancer all over their body, provide pain relief of their symptoms. Explain to them what it is you are giving and why. Some people correlate morphine with addiction. Provide the education. DNR-do no resuscitate Full Code-help them with everything you can to save them. Chemical Code- where the patient only wants the medications but is still DNR. Kübler-Ross’s Five Stages of Grief Denial: The patient denies the reality of death and may repress what is discussed. The patient may think, “They made a mistake in the diagnosis. Maybe they mixed up my records with someone else’s.” Anger: The patient expresses rage and hostility and adopts a “why me?” attitude: “Why me? I quit smoking and I watched what I ate. Why did this happen to me?” Bargaining: The patient tries to barter for more time: “If I can just make it to my son’s graduation, I’ll be satisfied. Just let me live until then.” Many patients put their personal affairs in order, make wills, and fulfill last wishes, such as trips, visiting relatives, and so forth. It is important to meet these wishes, if possible, because bargaining helps patients move into later stages of dying. Depression: The patient goes through a period of grief before death. The grief is often characterized by crying and not speaking much: “I waited all these years to see my daughter get married. And now I may not be here to see her walk down the aisle. I can’t bear the thought of not being there for the wedding—and of not seeing my grandchildren.” Acceptance: When the stage of acceptance is reached, the patient feels tranquil. The patient has accepted the reality of death and is prepared to die. The patient may think, “I’ve tied up all the loose ends: made the will, made arrangements for my daughter to live with her grandparents. Now I can go in peace knowing everyone will be fine.”Remember that these phases can overlap and someone can also go backwards in the spectrum. Meaning they can go from depression back to denial. Terminal Illness- An illness in which death is expected within a limited period of time. The provider is the only person who can tell a patient they have a terminal illness. Effect on the patient- terminal illness effects the patient and the family The Dying Person’s Bill of Rights- patients have the right to make all their decisions until they pass, this falls under autonomy. Palliative Care and Hospice care fall under Terminal illness as well. Advance Care Planning Advance Directives include living wills and durable power of attorney; these are specific instructions for the healthcare provider. these indicate: who will make decisions for the patient in case the patient is unable. -Power of attorney the kind of medical treatment the patient wants or doesn’t want. how comfortable the patient wants to be. how the patient wants to be treated by others. what the patient wants loved ones to know. – even though a patient has a power of attorney, the patient can have certain things remain private. Durable power of attorney means that if I am unable to make my own decisions then the durable power of attorney can make those decisions. Special Orders Physician order for life-sustaining treatment form (POLST) Allow natural death, do-not-resuscitate, or no-code orders MOST COMMON Comfort measures only Terminal weaning-. Gradual removal of interventions. Voluntary stopping of eating and drinking (VSED)/ refusing TPN Active and passive euthanasia – we don’t do this here. Palliative sedation Developing a Trusting Nurse–Patient Relationship Explain the patient’s condition and treatment. Teach self-care and promoting self-esteem. Teach family members to assist in care. Meet the needs of the dying patient. Meet family needs. Postmortem Care of the Body Prepare the body for discharge. Place the body in anatomic position, replace dressings, and remove tubes (unless there is an autopsy scheduled). Place identification tags on the body. Follow local law if patient died of communicable disease.- communicable disease like covid that had to be reported when it first started. Communicable means it has to be reported. If the patient died traumatically for example, if they were in an accident and they stomach was popped out, cover that up before so the family will not see it.. if its like on the face, cover that up and explain to the family beforehand. If you ran a code and the patient is covered in blood, clean the patient up before the family comes in the room. Do not show a bloody patient to their family. RANDOM THINGS I THOUGHT WOULD BE HELPFUL. DNR- Do not resuscitate. Full Code- We do everything we can to help the patient. Psychosomatic Disorder- The body starts to show stress. The person starts vomiting, the eye starts twitching. That’s when it starts turning into bad stress when the body starts reacting. Grief: internal emotional reaction to loss Bereavement: state of grieving from loss of a loved one Mourning: actions and expressions of grief, including the symbols and ceremonies that make up outward expression of grief Dysfunctional grief: abnormal or distorted; may be either unresolved or inhibited Allostasis -this process of achieving stability or homeostasis through physiologic or behavioral change. RELAXATION ACTIVITIES Deep Breathing Sit comfortably and place your hands on your stomach. Inhale slowly and deeply, letting your abdomen expand as much as possible. Hold your breath for a few seconds. Exhale slowly through your mouth, blowing through puckered lips. When your abdomen feels empty, begin again with a deep inhalation. Progressive Muscle Relaxation Tighten your hand into a fist and notice how it feels. Hold the tension for a few seconds. Loosen your grip, relax the muscles in your hand, and let the tension slip away. Continue to tighten–hold–relax each muscle group, moving head to toe: face, shoulders, arms, chest, back, abdomen, legs, and feet.