Older Adults Study Guide PDF

CHAPTER 10 - OLDER ADULTS ○ Introductory Paragraph & Racial Disparities - pg 190-191 Life expectancy at birth 1900s: 49.2 years 2015: 78.8 years Racial disparities: in the 1900s race defined US life...

CHAPTER 10 - OLDER ADULTS ○ Introductory Paragraph & Racial Disparities - pg 190-191 Life expectancy at birth 1900s: 49.2 years 2015: 78.8 years Racial disparities: in the 1900s race defined US life expectancy Hispanic female → non-hispanic black females→ hispanic males → non hispanic black males. In 2015 white people had a higher life expectancy than african americans ○ Theory of aging - pg 194 Wear-and-Tear Theory proposes that repeated insults and the accumulation of metabolic wastes eventually cause cells to wear out and cease functioning Genetic Theories of aging propose that cells have a preprogrammed, finite number of cell divisions. Time of death is determined at birth. The genetic messages within the various body cells specify how many times the cell can reproduce, thus defining the life of that cell Cellular Malfunction hypothesizes that a malfunction in the cell causes changes in cellular DNA, leading to problems with cell replication. The cellular malfunction can be the result of: chemical reaction with the DNA (cross-linking theory) abundance of free radicals that damage cells and impair their ability to function normally (free-radical theory) buildup of toxins over time that causes cell death (toxin theory) Autoimmune Reaction hypothesizes that cells change with age. Over time the changes result in the immune system’s perceiving some cells as foreign substances and triggering an immune response to destroy the cells ○ Stages of older adulthood - pg 194-195 Key Point: The fastest growing segment of older adults is the oldest-old Young-Old: Age 65 - 74 Physical and psychological adaptations to retirement are paramount in this age-group One key indicator of well-being is use of leisure time (4% exercising) By age 65, young-old people experience effects of chronic illnesses that began in middle adulthood and lack of self-care d/t the demands and stressors during middle adulthood Young-old person face barriers to health: ○ Lack of supplemental insurance not covered under Medicare ○ Perceptions of self as “getting old” ○ Changes in physical activity Middle-Old: Age 75 - 84 Developmental challenge of middle-old persons is an increasingly solitary, sedentary lifestyle Spends one-fourth of their leisure time in solitary activities of reading, relaxing, and thinking—more than their younger cohort (2% of time spent exercising) - Lack of physical activity increases risk associated with chronic conditions Adapted Physical Activity (APA) programs are group exercise programs designed for persons with chronic conditions ○ Goal: correcting sedentary lifestyle and prevent disability secondary to the chronic condition  ○ The focus of APA programs is on functional ability rather than treating existing disability, and they are beneficial throughout the older adult years Oldest-Old: Age 85 and older Developmental challenges of the oldest-old are sensory impairments, oral health, inadequate nutritional intake, and functional limitations Hearing, vision, edentulism (having no natural teeth which is usually income related), nutrition (soft foods may be higher in fats, carbs and calories which should typically be avoided to combat obesity and decreased activity levels), functional limitations (ability to kneel, reach overhead, walk a few blocks) Centenarians: people aged 100 years and older ○ - Favorable interactions between genetic composition, environment, and lifestyle (behaviors) ○ Table 10-2* ○ Cognitive development - pg 195 No loss of intellectual capacity Older adults learn new material more slowly bc: Reaction time slows Short-term memory declines Takes longer to respond to a stimulus Takes more time to process incoming information Memory Loss of short-term memory is more common than loss of long-term memory Physical health problems or medications may affect memory Active social life with complete engagement and participation in the community delays memory loss with aging Regular mental exercises appear to stimulate the brain and enhance memory Adequate sleep and rest, a nourishing diet, avoidance of drugs and alcohol slow memory loss ○ Common health problems - pg 197-199 Chronic diseases = higher morbidity (die sooner) 6 of the 7 leading causes of death among older adults are chronic diseases  ○ 1. Heart disease ○ 2. Cancer ○ 3. Chronic lower respiratory diseases ○ 4. Stroke ○ 5. Alzheimer’s disease ○ 6. Diabetes mellitus ○ 7. Accidents ○ 8. Influenza and pneumonia Prevalence of chronic conditions differs by race and ethnicity Heart disease, cancer, stroke, and diabetes are among the most common and costly chronic health conditions Ex. CHF patient needs to take his medications religiously and eat food with less than 2 g sodium daily. Check his weight every morning right after using the bathroom to predict disease exacerbation. Every time there is exacerbation and then remission the disease has progressed even further. The patient’s functional status is diminished. The more frequent the exacerbation and remission the faster progression of the chronic disease and the shorter the life. Osteoporosis Loss in bone mineral density that increases the risk of fracture Increased risk: age, women (normal bone density is less than men and hormonal changes at menopause along with inadequate calcium intake), cigarette smoking, excess alcohol consumption, lack of weight bearing exercises Dementia Irreversible progressive decline in mental abilities; affects about one in five adults older than 70 years Not a normal result of aging Polypharmacy The simultaneous use of multiple medications to treat the same condition. It is a risk factor for acute confusion, delirium, and depression in older adults Avg meds elderly receives is 11, need to organize the meds for them and make sure they are not being over treated with more than 1 med in the same group Look for herbal meds (not controlled dose) and OTC med interactions and prescribed meds If there is a med that is not useful call physician and discontinue Pharmacogenomics: the discipline that blends pharmacology with genomic capabilities Future of drug therapy for older adults will take into consideration DNA variants and individual responses to medical treatments Technology is expected to increase the efficiency of the drug industry and result in cheaper, more effective drug therapies for older adults Depression Medical problems can cause depression in older adults either directly or as a psychological reaction to the illness Not only affects mood but also affects energy, sleep, appetite, and physical health Memory problems, sluggish speech and movements, and low motivation (similar symptoms to dementia) Side effects of multiple medications can cause depression Elder abuse Be alert for patterns of injury in older adults If you suspect abuse, your first priority is to ensure the client is safe and cared for - Next we must report abuse Ageism Age-based discrimination Negative expectations for older adults can cloud nursing assessments, planning, and interventions ○ Table 10-1 (focus on normal aging change) Just review from the book (I wrote it out for us - Trist) Musculoskeletal Normal aging change: decreased muscle strength, body mass, bone mass, joint mobility; increased fat deposit Areas for assessment: activity/exercise tolerance; joint pain and ROM; gait, balance, posture, change in height; susceptibility to falls, ability to perform ADLs Cardiovascular Normal aging change: Decreased cardiac output; increased peripheral resistance, systolic blood pressure Areas for assessment: activity tolerance, blood pressure, orthostatic hypotension, arrhythmia Respiratory NAC: decreased elasticity of chest wall, intercostal muscle strength, cough reflex; increased anteroposterior diameter of chest, rigidity of lung tissue AFA: cough reflex, use of accessory muscles for gas exchange, mouth breathing Gastrointestinal NAC: decreased saliva production, GI motility, gastric acid production AFA: ability to chew, dentition, pattern of elimination, frequency/size of meals Integument NAC: decreased skin elasticity, nail growth; increased dryness of skin, thinning of skin layers, nail thickening, hair thinning AFA: susceptibility to hypo/hyperthermia; intact skin, bruising; dry skin; bathing pattern Genitourinary NAC: decreased: GFR, blood flow to the kidneys, bladder capacity, vaginal lubrication, hardness of erection AFA: continence; urgency, frequency, nocturia,; hydration status; drug levels; sexual pattern Nervous system NAC: decreased: nerve cells, neurotransmitters, REM sleep, blood flow to CNS AFA: diminished reflexes, sleep pattern, depression Endocrine NAC: decreased nerve cells; neurotransmitters; REM sleep; blood flow to CNS AFA: diminished reflexes; sleep pattern; depression Sensory NAC: decreased visual status generally; decreased sensations AFA: adequate lighting, cerumen buildup, home safety, pain sensation, driving ability, environmental stimulation Cognition NAC: Decreased short-term memory; increased reaction time, information-processing time AFA: memory changes, learning barriers, adaptive coping Personality NAC: increased cautiousness, widowhood, grandparenthood AFA: sources for social support, social network ○ Example problem: Dementia - pg 200-201 Point: not a normal result of aging, but is common Problem: dementia involves problems with aphasia, apraxia, and agnosia Assessment: risk factors (ATOH, FMH, head injury), use “the sweet 16” (16 oral questions to test mental state) Analysis/Dx: impaired verbal communication, and fear Outcomes: will not be fearful, carry out 2 and 3 word commands, and will be free from harm Interventions: safe environment, provide cognitive function/activites, orient to reality, supervision, assist ADLs Evaluation: monitor physical, behavioral, emotional, and symptoms of fear ○ Communicating with persons with cognitive deficit: include iCare 10-1 - pg 207-208 Use simple, short sentences, with one idea at a time. Ask, “Where does it hurt?” rather than, “Please describe the quality and location of your pain.” Avoid vague comments (e.g., “I see,” “Um-hmm,” “Yes, yes, okay”). The patient will not be able to interpret these responses. Instead, echo the patient’s comment and state your response directly and simply: “You are hungry. I will bring your lunch.” Repeat your words exactly, if the patient doesn’t understand what you say. Under other circumstances, you usually rephrase your sentences when someone doesn’t understand,  but for patients with dementia, giving new information just adds to their confusion Try to understand that the patient’s reality is distorted and he is behaving in the only way he is able. When the patient is conversing superficially and seems comfortable, it may seem he is competent iCare 10-1 Never call a person “sweetie” or “honey” or “dear.” This sends a message that you think the person is not your equal. Ask, “What is your name?” and “How would you like to be addressed?” Encourage storytelling and reminiscing. Pull up a chair and sit down to speak with the person at eye level. Try to respond to the person’s feelings instead of the content of his words. This helps to reassure them. For example, if a woman is constantly searching for her husband, don’t say, “Your husband is not here.” Instead, say, “You must miss your husband,” or “Tell me about your husband.” Approach unhurriedly, do not rush an older adult and do not speak too rapidly. Allow the patient time to speak and express his or her concerns. If the person has difficulty finding the right word, supply it unless doing so upsets the person. This helps control frustration levels. If you do not understand what the patient is trying to say, ask him or her to point to it or describe it (e.g., “What does X look like?”). Gently hold or pat the person’s hand, offering comfort and reassurance CHAPTER 12 - STRESS & ADAPTATION (naccashian didn't add stress) ○ How do coping & adaptation relate to stress? - pg 230 Coping strategies are the thinking processes and behaviors a person uses to manage stressors Adaptive (effective) coping consists of making healthy choices that reduce the negative effects of stress (e.g., exercising to relieve tension, engaging in a favorite hobby, consulting others for support or advice) Maladaptive (ineffective) coping does not promote adaptation. Unhealthful coping choices include overeating, working too much, excessive sleeping, and substance abuse Three approaches to coping are commonly used 1. Altering the Stressor. In some situations, a person takes actions to remove or change the stressor 2. Adapting to the Stressor. It is not always possible to remove or change a stressor. Adapting involves changing one’s thoughts or behaviors related to the stressor 3. Avoiding the Stressor. Sometimes it is healthy to avoid a stressor. In other situations, avoidance may be maladaptive The Outcome of Stress: Adaptation or Disease E+R=O E is the event (stressor) R is the person’s response (which is determined in part by past experiences, perception of the stressor, and coping methods used), and O is the outcome. Personal Factors Influence Adaptation Perception of the Stressor A person’s perception may be realistic or exaggerated (negative or positive) Overall Health Status Stressors may actually cause a healthy person to engage in constructive adaptive behaviors that improve health (EX: modifying diet and exercising to control bp and prevent complications)  Support System Friends, family, counseling and church groups, or people who share common interests often support each other in times of difficulty. A good support system can help a person adapt to stress and solve problems Hardiness People who thrive despite overwhelming stressors tend to have a quality that has been termed hardiness. They maintain three key attitudes that help them weather adversity: commitment, control, and challenge. Other Personal Factors Age, developmental level, and life experiences all affect a person’s response to stress ○ The General Adaptation Syndrome & Local Adaptation Syndrome - pg 232-235 The General Adaptation Syndrome (GAS) (SELYE) Includes Nonspecific, Systemic Responses GAS has three stages: (1) the initial alarm stage (2) resistance (adaptation) (3) recovery or exhaustion Alarm Stage—Fight or Flight (2 phases) Shock phase begins when the cerebral cortex first perceives a stressor and sends out messages to activate the endocrine and sympathetic nervous systems - Epinephrine (adrenaline) prepare the body for fight or flight Countershock phase, all the changes produced in the shock phase are reversed, and the person becomes less able to deal with the immediate threat - Endocrine system responses  Sympathetic Nervous System Responses SNS stimulates the adrenal glands to secrete adrenaline and norepinephrine, which increase mental alertness Adrenaline also increases the ability of the muscles to contract and causes the pupils to dilate, producing greater visual fields Other Body System Responses in the Alarm Stage Cardiovascular system: HR, contraction, BP, blood volume ↑, Peripheral/visceral vasoconstriction ↑ BF to vital organs like brain, lungs, muscles, blood clots easily Respiratory system: Bronchioles dilate leading to ↑ depth of respiration and tidal volume. O2 becomes more available Metabolism: Metabolic rate ↑, liver converts more glycogen to glucose (glycogenolysis), making it available for energy, use of fat for energy ↑ Urinary system: Blood flow to kidneys ↓, retain more Na+ and water, renin is secreted → angiotensin → constricts arterioles → ↑ BP  Gastrointestinal system: Peristalsis and secretions of digestive enzymes ↓ Musculoskeletal system: blood vessels dilate, increasing flow of blood/O2 to skeletal muscles ○ Resistance Stage—Coping With the Stressor Body tries to cope, protect itself against the stressor, and maintain homeostasis through physiological and psychological coping mechanisms Physical adaptations help the heart rate, blood pressure, cardiac output, respiratory function, and hormone levels return to normal If the person adapts successfully or if the stress can be confined to a small area (as in the inflammatory response), the body regains homeostasis If the stress is too great (as in serious illness or severe blood loss), defense mechanisms fail, and the person enters the third phase of the GAS. ○ Exhaustion or Recovery Stage—Final Effort to Adapt - Exhaustion: If stress continues and adaptive mechanisms become ineffective or are used up - Vasodilation, decreased blood pressure, and increased pulse and respirations - Physical adaptive resources and energy are depleted and body is unable to defend itself and cannot maintain resistance against the continuing stressors - Exhaustion usually ends in injury, illness, or death - Recovery: if adaptation is successful ○ The Local Adaptation Syndrome Involves a Specific Local Response Localized body response, it involves only a specific body part, tissue, or organ. It is a short-term attempt to restore homeostasis. Reflex Pain Response ○ Protective reflex, an involuntary, predictable response. Pain receptors send sensory impulses to the spinal cord, where they synapse with the spinal motor neurons. The motor impulses travel back to the site of stimulation, causing the flexor muscles in the limb to contract. Local, rather than a whole-body, response Inflammatory Response ○ Local reaction to cell injury, either by pathogens or by physical, chemical, or other agents ○ Classic symptoms of inflammation: pain, heat, swelling, redness, and loss of function ○ Adaptive in that it protects the body from infection and promotes healing ○ Inflammatory process includes a vascular response, a cellular response, formation of exudate, and healing ○ Vascular Response: Immediately after injury, blood vessels at the site constrict (narrow) to control bleeding Injured cells release histamine → vessels dilate → ↑ blood flow Dying cells release kinin → capillaries more permeable leading to edema WBC move into area to fight off infection ○ Cellular Response: Specialized white blood cells (phagocytes) migrate to the site of injury and engulf bacteria, other foreign material, and damaged cells and destroy them ○ Exudate Formation: The fluid and white blood cells that move from the circulation to the site of injury are called exudate ○ Healing: the replacement of tissue by regeneration or repair Regeneration: is replacement of the damaged cells with identical or similar cells Repair: occurs when scar tissue replaces the original tissue ○ Analysis/Nursing Diagnosis - pg 245 Stress is nonspecific, so there is almost no limit to the number of nursing diagnoses that could be stress induced  It is important to correctly identify the etiology of the diagnosis so that you can choose interventions to remove or modify the stressor ○ Health Promotion Activities - pg 246-247 Nutrition Important for maintaining physical homeostasis and resisting stress Adequate nutrition is essential to maintain the integrity of the immune system; proteins are needed for tissue building and healing Overweight and malnutrition are stressors that may lead to illness - Maintain normal weight, limit fat intake no more than 30% of daily calories, limit sugar/salt, eat more fish/poultry and less red meat, eat smaller more frequent meals, consume 25 grams of fiber, no more than 2 alcoholic drinks per day Exercise Regular exercise promotes physical and emotional homeostasis - Exercise of moderate to vigorous intensity for at least 150 minutes per week - During exercise the brain releases endogenous opioids (endorphins), which create a feeling of well-being Benefits: improves muscle tone, controls weight, improves heart/lung function, reduce risk of CVD, promotes relaxation and reduces tension Sleep and Rest Sleep and rest recharge the brain, and boost mood, restore energy, allow the body to repair itself, and promote mental relaxation cool, dark, and quiet room is more conducive to quality sleep Leisure Activities Involves physical or sedentary activities Leisure activities are a form of rest and, as such, are restorative Getting outside can boost a mood, lower blood pressure, muscle tension, and stress hormones Sleep and rest recharge the brain, and boost mood, restore energy, allow the body to repair itself, and promote mental relaxation cool, dark, and quiet room is more conducive to quality sleep Time Management People who manage their time efficiently and organize their life routines feel more in control and therefore less stressed Teach clients how to delegate responsibilities and set boundaries on the use of time and learn to say no Avoiding Maladaptive Behavior Advise clients to avoid unhealthful behaviors, such as overuse of caffeine, alcohol, tobacco, recreational or prescription drugs, and even food - Counseling may be beneficial ○ Stress Management Techniques - pg 249 Exercise Reduces stress because it releases tension held in muscles, improves muscle tone and posture, expresses emotions, and stimulates the secretion of endorphins, thus creating a feeling of well-being and relaxation Relaxation techniques Progressive relaxation in a quiet meditative state or lying in bed, relaxing and contracting muscle groups is much less traumatic and damaging to fragile joints and  muscles than active exercise Passive relaxation occurs when the person relaxes the muscle groups without first contracting them. It is even less traumatic and requires even less energy than progressive relaxation Meditation Manage stress through rhythmic breathing, heightening a person’s focus or awareness while freeing the mind of unpleasant thoughts Increases harmony among mind, body, and spirit, thereby reducing anxiety and giving the person control Mindfulness is a type of mediation involving focus on the present and living each moment to the fullest Yoga involves strengthening and stretching muscles, improving balance, and releasing stress Visualization or Imagery techniques Often used to complement the effects of relaxation technique Aromatherapy Concentrated oils, such as lavender or chamomile, to help reduce stress - Calming oils send messages to the parts of the brain that affect mood and emotion Biofeedback Electronic instruments to measure neuromuscular and autonomic nervous system activity and provide information about those responses to the person - Feedback helps person learn how to voluntarily control certain responses Acupuncture Insertion of fine needles into “meridian points” to regulate the flow of energy or life force throughout the body Can modify pain perception and restore normal physiological functions Chiropractic Adjustment Misalignment of the vertebrae leads to pain, loss of function, and illness. Realignment is performed to free energy, release muscle tension, and improve body function and health Touch Therapies Healing energy is channeled through a practitioner’s hands to improve well-being, reduce pain, and accelerate healing Massage Manipulation of the soft tissues, massage relaxes muscles, releases body tension, improves circulation, and allows energy and blood to flow through muscles and soft tissues more readily Reflexology Application of pressure to specific points on the feet, hands, or ears, which are thought to correspond with certain organs of the body Other activities - Humor, listening to music, engaging in art activities, dance and sports, journal writing CHAPTER 15 - Culture ○ Why learn about culture? Population is diverse Health Disparities Exist Among Racial and Ethnic Groups Health status: minorities other than asians experience higher rates of illness and death ○ Infant mortality rates are higher for blacks, american indians and alaska natives ○ Blacks, american indians, alaska natives have higher prevalence of asthma, diabetes and cardiovascular ○ Blacks are 8-10 times more likely to have higher rates of HIV/AIDS  ○ Quality of care: depending on socioeconomic status Access to care: lack of access to preventative healthcare and language barriers Nursing care that is appropriate for the dominant cultural group may be ineffective and inappropriate for people who have a different cultural heritage ○ What is meant by culture? And characteristics of culture? - pg 299-300 What is meant by culture? Culture is what people in a group have in common Totality of socially transmitted behavior patterns, arts, beliefs, values, customs, lifeways and all other products of human work and thought characteristics of a population of people that guides their worldview and decision making Subculture: groups within a larger culture or social system that have some characteristics that are diff than the dominant culture Characteristics of culture Cultural beliefs provide identity and a sense of belonging if they continue to satisfy its members and do not conflict with the dominant culture Cultures consist of common beliefs and practices. Most members of a culture share the same beliefs, traditions, customs, and practices as long as they continue to be adaptive and satisfy the members’ needs. Culture can influence everything its members think and do Culture is both universal (everyone has it) and dynamic (active). Cultural customs, beliefs, and practices are not static. They change over time and at different rates as members adapt and respond to their environment Culture exists at many levels. Culture exists in both the material (art, writings, dress, or artifacts) and the nonmaterial (customs, traditions, language, beliefs, and practices) Cultural values, beliefs, and traditions are passed down from generation to generation. Learning occurs through life experiences shared with other members of the culture, either formally (schools) or informally (families) Ethnicity + Race Ethnicity: similar to culture, refers to groups whose members share a common social and cultural heritage. Race: strict to biology, refers to the grouping of people based on skin color, blood type, bone structure. (white, black, asian, islander) ○ How does culture affect health? - pg 303 Communication Exchange of information, ideas, and feelings. (verbal and nonverbal language) - Culture influences how feelings and thoughts are expressed and which verbal and nonverbal expressions are appropriate to use Space Refers to a person’s personal space, or the boundary lines that determine how close another person can be to another person Time orientation Individuals tend to be past-, present- or future-oriented Social organization Includes the family unit and the wider organizations with which the individual or family identifies Environmental Control Refers to a person’s perception of his ability to plan activities to control nature or direct environmental factors ex. If person feels like they don't have control they won't seek medical care Biological variations Include ways in which people are different genetically and physiologically - Body build and structure, skin color, vital signs, enzymatic and genetic variations, and drug metabolism Other culture specifics  Religion and Philosophy: religion may determine what healthcare treatments a person will permit Education: influences the perception of wellness and illness and the knowledge of options that are available for healthcare Technology: availability of supplies and equipment in the healthcare setting becomes culturally expected Politics and the Law: government policies affect healthcare by determining eligibility, allocation of funds, reimbursement for providers, and acceptable standards Economy: condition of the economy directly affects the availability of funds for publicly funded services & individual’s ability to pay for healthcare ○ What is culturally competent care? - pg 309 Cultural awareness refers to an appreciation of the external signs of diversity Cultural sensitivity has more to do with personal attitudes and being careful not to say or do something that might be offensive to someone from a different culture Cultural competence is both knowledge and behavior that enable practitioners to provide quality care to diverse peoples in a way that is sensitive to differences ○ Purnell model and barriers to culturally competent care - pg 310-311 Is for cultural competence stresses teamwork in providing culturally sensitive and competent care to improve outcomes for individuals, families, communities Cultural competence: adapting care to be congruent with the patient’s culture Levels of cultural competence: Unconsciously incompetent—not being aware that you lack knowledge about another culture Consciously incompetent—being aware that you lack knowledge about another culture Consciously competent—learning about the client’s culture, verifying generalizations about the culture and providing culture specific interventions Unconsciously competent—automatically providing culturally congruent care to clients of diverse cultures Barriers to culturally competent care Bias ○ Lack of impartially, one sided Ethnocentrism: tendency to think that your own group is superior Cultural stereotyping: belief that all people of a certain racial group are alike Transcultural nurse theorist: madaline linager Prejudice: when someone doesn't like a certain culture Discrimination: ex of not employing someone based off of culture/race/ethnicity Racism ○ - Form of prejudice and discrimination based on the belief that (1) race is the principal determining factor of human traits and capabilities and that (2) racial differences produce an inherent superiority (or inferiority) Sexism ○ - Assumption that members of one sex are superior to those of the other sex - Male chauvinism (assumption of male superiority) Language barriers ○ - Foreign languages, dialects, regionalism, street talk, and jargon will obviously affect your ability to communicate with clients ○ - If a consent issue is involved, the hospital must ensure adequate resources to comply with informed consent requirements ○ - Healthcare jargon Other barriers ○ - Lack of knowledge about the cultural and ethnic values, beliefs, and behaviors of people within their community  ○ - Emotional responses, such as fear and distrust can arise when members of different cultural groups meet ○ - Self-knowledge is essential in removing barriers and helps you to effectively communicate with your clients. ○ Analysis/Nursing Diagnosis and planning outcomes/evaluation - pg 313-314 Analysis/nursing diagnosis Nutrition Alteration: Body Nutrition Deficit might apply to a patient who is hospitalized and cannot obtain foods prepared in the traditional way of his ethnic group Parenting Alteration could occur if the patient’s traditional methods of discipline are not acceptable or appropriate in the dominant culture Powerlessness might occur when the patient is unable to make healthcare personnel understand the importance of his cultural rituals or healthcare practices Verbal Impairment is sometimes used for patients who do not speak or understand the nurse’s language Health Maintenance Alteration might be used for clients and/or caregivers who do not follow a health-promoting or therapeutic plan Planning outcomes/evaluation Agrees to take prescribed analgesic (pain medication) before bedtime and after family leaves for the evening Talks to her spiritual adviser about conflicts between the treatment plan and her religious beliefs Freely shares information about folk practices and OTC medications with the provider CHAPTER 16 - Spirituality ○ Everything on pg. 319 & What Are Religion and Spirituality? - pg 319 - 321 Spirituality of the Nurse. Each nurse’s spirituality serves as part of the guiding framework for her practice Spirituality of the Patient and Family. Spirituality will be understood in different ways by your patients and their families Effects of Nursing Education. The emphasis placed on spiritual care differs; however, many teach students to avoid imposing their spiritual beliefs on patients Demands of Nursing Practice. Time constraints imposed by the day-to-day patient care can have a negative impact on your ability to meet patients’ spiritual needs History of Spirituality in nursing Pre-Christian era, caring for the sick was an expression of the values of hospitality and charity. People prayed to the god(s) for healing and as an adjunct for primitive medical procedures Early Christian era, nursing the sick was honored and respected because it was one of Jesus Christ’s primary teachings Post-Reformation period in Europe, nursing orders continued to flourish. Spirituality was at the heart of human nature and thus was fundamental to healing Mid-20th century, with advances in the sciences and as more nurses studied in university settings, the spiritual underpinnings of nursing were replaced by what could be seen and tested by the scientific method Key point: Today, spiritual care cannot be the “overlooked” area of nursing practice. Professional standards of care make clear that meeting patients’ spiritual needs is essential to provide holistic nursing care ○ What Are Religion and Spirituality? What is religion Religion serves as a “map” tells you what to believe and what values are essential Provides codes of conduct that integrate beliefs and values into a way of living Rituals, symbols, sacraments, and holy writings serve as bases of authority and provide diverse ways to go beyond the physical and access the divine Eschatology, or doctrines about the human soul and its relation to death, judgment,  and eternal life What is spirituality? Day-to-day, moment-by-moment journey in life and living Involves personal subjective experiences that take place over time Insight, value, purpose, and meaning of life derived from accumulated life experiences Most people are comfortable with their beliefs (or lack thereof); your primary goal is to support their healing, not convert them to a different view Religion (map) Spirituality (journey) Roadmap that defines: beliefs, values, and code of conduct/ethics Journey through life. A personal quest to define meaning, and satisfaction in life. A will to live, a belief in self. Explore who you are A tradition of worship that provides: rituals, answers, norms, and A dynamic relationship that transcends the capacity to know and connection to God be known. Connected to yourself, nature, and higher power. Roadmap about what to belief, how beliefs affect life, and self Lifelong process of growth and constant process of taking truth ad image/identity adding individual insight Issues: faith, belief, trust, the nature of good and evil, meaning of Issues: faith, hope, love suffering, judgment, ot enlightenment ○ ○ Core issues of Spirituality - 321-322 Faith Global framework of our beliefs, the strength of which guides and grounds us - Allows us to trust and to maintain an optimistic perspective on life events and to find purpose in life Represents a set of beliefs developed over time, through events that cause us to suffer and those that enable us to rejoice Faith struggles are common among people who experience illness and significant loss Hope Expectation of positive outcomes that is consistent with a desired future goal - Basic human need to achieve, create, and to shape something of our life that will endure Love Core of one’s strength, the basis for caring relationships Some view love as a trade (extend love in hopes of getting something in return) - Even when our love is shared, we must inevitably face separation at our death or the death of our loved ones Love and health are interconnected; thus, illness and sudden injury commonly prompt “struggles with love” Unconditional love is demonstrated through kindness, patience, endurance, and truthfulness ○ Barriers to Spiritual care - pg 328-329 Lack of General Awareness of Spirituality Lack of Awareness of your own spiritual belief system 1. Understand the differences among religion, spirituality, and spiritual care. 2. Develop an awareness of your own spirituality and how it is applied (or not) in meeting the patient’s spiritual needs. 3. Open yourself by being totally present with the patient, including being an active listener. Remove biases and personal perspectives 4. Develop your critical and reflective thinking abilities.  5. Reflect on your thoughts and feelings about end-of-life issues 6. Reflect on your personal experience with grief and loss Differences in spirituality between nurse and patient Be careful not to impose your beliefs on the patient or discount the importance of the patient’s beliefs and rituals Fear that your knowledge base is insufficient Nurses sometimes avoid giving spiritual care because they believe they lack knowledge of spirituality or of the patient’s religion Your ability to incorporate spiritual care into practice will increase with experience Fear of where spiritual discussions may lead Fear that inquiring into the spiritual domain might cause harm to the patient - Realize that providing spiritual intervention doesn’t mean you need to be a chaplain instead you can collaborate with them ○ Spiritual Assessment Tools - pg 330 HOPE (most known in palliative care) H—sources of Hope O—Organized religion P—Personal spirituality/Practices E—Effects on medical care and end-of-life issues SPIRIT (spiritual assessment) SP—Spiritual/religious belief system I—Integration within a spiritual community R—Ritualized practices and restrictions I—Implications for medical care T—Terminal events planning ○ Nursing Diagnosis Moral distress Impaired religiosity: (altered ability to exercise reliance on beliefs or practice rituals associated with religious faith.) Risk for impaired religiosity (the potential for altered ability to or interference with the ability to exercise reliance on beliefs or practices associated with religious faith.) Risk for spiritual distress Spiritual distress: overwhelming anxiety associated with the need to have a surgical procedure that is not accepted by her religion. Spiritual pain (awareness of death, loss of relationship/self, etc) ○ Standard Spirituality interventions (NIC Nursing Interventions Classification) ○ Active Listening (NIC) Establish a trusting relationship and to hear, understand, and interpret what the client is saying Presence (NIC): be with the patient and family in meaningful ways Touch (NIC): caring touch like hand holding or touching an arm/shoulder facilitates communication and conveys concern/comfort Exploring meaning (non-NIC): clear understanding of the illness or loss, facilitate the patient’s search for meaning by asking probing questions, providing explanations Reminiscence Therapy (NIC): recalling and sharing of past life events with another person, promotes meaning-making through rethinking and clarifying previous experiences ○ Spiritual support (NIC) Assisting the patient to feel balance and connection with a greater power - Forgiveness Facilitation (NIC): act of pardoning or being pardoned for an offense, debt, or obligation. Letting go of the resentment felt for another promotes constructive changes in a person’s life Hope inspiration (NIC): subjective state of confidence in the possibility of a better future. It includes a positive orientation, faith, and will to live Prayer (non-NIC): If the patient asks you to pray with him, determine whether he simply wants you to be present while he or another person leads the prayer. If a patient asks you to pray for him, assess what it is that he wants you to pray for. Often the patient is merely asking you to pray for him on your own time Do not use family members as interpreters  ○ Pt could not want family to know what is going on ○ Could hold fundamental information, or exclude certain info they dont think is important but could be for the doctors. CHAPTER 17 - Death, Loss & Grief ○ What is Loss? & What is Grief? - pg 338-339 ○ Categories of Loss Actual loss Death of a loved one, theft, deterioration, destruction, and natural disaster. The loss can be identified by others, not just by the person experiencing it Perceived loss ○ Internal, it is identified only by the person experiencing it Physical loss (1) injuries (amputated leg), (2) removal of an organ (hysterectomy), and (3) loss of function Psychological losses Perceived losses, commonly seen in sexuality, control, fairness, meaning, and trust External losses Actual losses of objects that are important to the person because of their cost or sentimental value Internal loss Another term for perceived or psychological loss Loss of Aspects of Self Physical losses such as body organs, limbs, body functions, and/or body disfigurement Psychological include aspects of one’s personality, developmental change, loss of hopes and dreams, and loss of faith Environmental Loss Involves a change in the familiar, even if the change is perceived as positive Loss of Significant Relationships Actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation ○ What is grief? Grief is the physical, psychological, and spiritual responses to a loss Mourning consists of actions associated with grief (wailing, wearing black clothing). This is normal and a natural responses to a loss Bereavement is the period of mourning and adjustment after a loss The intensity of the grief depends on the meaning the person attaches to the loss Types: ○ Uncomplicated grief (natural process, insense then starts to diminish) ○ Dysfunctional grief – aka – complicated (workaholic, distracts) ○ Disenfranchised grief – Grief is not sanctioned by society (mistresses lover dies) ○ Anticipatory (before loss occurs) Stages of grief (Elisabeth Ross) Denial Anger Bargaining Depression Acceptance ○ Factors Affecting Grief- pg 339 Significance of the Loss The meaning the person has attached to the person or object lost will be different for each person  Support System People with strong emotional and psychosocial support typically have less complicated grief Unresolved Conflict Prolonged or dysfunctional (complicated) grief can occur with unresolved conflict Circumstances of the Loss ○ Manner and circumstances of the death can leave the bereaved feeling guilty, responsible, or unprepared Previous or Multiple Losses Several losses in a short period of time may experience dysfunctional (or complicated) grief Spiritual/Cultural Beliefs and Practices Spirituality and religious beliefs can help or hinder the grieving process Timeliness of the Death Death of a child or a young person is more difficult to accept than the death of an older person ○ Legal & Ethical Considerations at End of Life - pg 347-349 Advance Directives Advanced directive: group of instructions (written or oral) stating a person’s wishes regarding his healthcare if he were incapacitated or unable to make that decision Living will: document that provides specific instructions about the kinds of healthcare the person would wish or would wish not to have in particular situations Durable power of attorney (DPOA): identifies another person to make decisions for the individual regarding healthcare choices when he is unable to do so based on circumstances Prescriptions for DNR/DNAR (must be written by a doctor) DNR prescription is written by a provider and means do not resuscitate the patient in the event of cardiac or respiratory failure AND–comfort measures Assisted suicide Means making available that which is needed for the patient to end his own life Patient is physically capable of ending his own life, has expressed the intention to do so, and has turned to the healthcare provider merely to supply the means ANA opposes assisted suicide Nurses are prohibited from participating in assisted suicide or euthanasia (direct violation of the code of ethics) Palliative sedation: controlled and monitored use of sedatives and nonopioid medications to induce unconsciousness to relieve suffering Euthanasia Active euthanasia occurs as a result of a direct action (giving overdose of meds) - Voluntary (patient consents), involuntary (patient refuses), or nonvoluntary (patient is unable to consent) ○ Assistant serves as the direct agent of death Passive euthanasia occurs as a result of a lack of action (withholding meds or food) ○ Honoring the refusal of treatments is not considered passive euthanasia and can be ethically and legally permissible Autopsy medical examination of the body to determine the cause of death provide relevant data about disease processes and causes requires signed permission from the next of kin, except in cases in which autopsy is required by law (if death was suspicious) Organ Donation 18 years of age or emancipated minor, next of kin can donate organs when a person dies, unless an objection is known, relatives cannot revoke a person’s donation, even after death, person making the gift can amend or revoke it at any time  A conflict between a potential organ donor’s advance directives and measures to ensure the viability of his organs (life support) must be resolved as soon as possible, by one of the following, in this order: (1) the donor (if able), (2) the surrogate decision-maker, or (3) another person as authorized under state law. Until resolution, maintaining the suitability of the organs has the highest priority ○ Therapeutic Communication - pg 351 ( nurses role) Critical to building a trusting relationship with dying or grieving patients and their significant others Most important to listen to the dying patient and to be alert for and respond to nonverbal cues Encourage patients and family members to express their feelings and reassure them that their feelings are normal and not “wrong.” Find out why the patient is seeking certain end of life options: Does she wish to avoid suffering, or does she fear being a burden to loved ones? ○ Facilitating Grief Work - pg 351-356 Expressing Feelings You may need to facilitate the process, using your therapeutic communication skills to help them feel comfortable Recalling Memories Grieving patients and family members may need to recall memories, both good and difficult Go through photos with them and ask questions Look for objects of sentiment such as a heirloom and ask questions Finding Meaning Help the patient or family find meaning in their lives or in their past - Facilitating life review to recognize the unique contributions this person has made to family, friends, and society Bibliotherapy Uses guided reading of self-help literature or fiction to increase client awareness and understanding and promote healing Poems, novels, and essays can help produce new insights Chapter 19 - Patient teaching ○ Domains of learning - 390-391 Cognitive learning Cognitive skills are the mental activities for processing incoming information - Learning is not about how many facts you can recall but rather how meaningful the information is and how effectively you can use it when needed Goal is then to expand their learning beyond simple remembering and understanding Promote their thinking to a higher level that involves applying, evaluating, and creating ways to meet their own healthcare needs Lectures, reading materials, panel discussions, audiovisual materials, programmed on instruction, Web-based or mobile application information, and problem-based learning  Psychomotor learning Involves learning skills that require both mental and physical activity Requires the learner value learning the skill (affective domain) as well as understand and implement the skill (cognitive domain) To gain proficiency, learners have to practice and receive feedback to correct any errors Demonstration and return demonstration, simulation models, audiovisual materials, journaling and self-reflection, and printed materials, especially with photographs and illustrations Affective learning “feeling domain” Involves changes in feelings, beliefs, attitudes, and values Includes receiving and responding to new ideas, demonstrating commitment to or preference for new ideas, and integrating new ideas into a value system Role modeling, group work, panel discussion, digital storytelling, role-playing, mentoring, one-to-one counseling and discussion, blogs, interactive applications, and digital and printed materials ○ 5 Rights of teaching Right time: are they ready, free of pain, built a trusting relationship, enough time? Right context: quiet/private environment? Right goal: are they actively involved? Caregivers included? Are the objectives realistic? Right content: content appropriate to pt needs? Presented at pts level? Relevant to pt? Right method: learning style? Learning ability? ○ Need to review Factors that affect client learning - pg 391-395 Motivation, readiness, timing, feedback, repetition, learning environment, scheduling the session, amount and complexity, communication, developmental change, cultural factors. Health literacy The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. ○ Table 19-2 - pg 396-697  ○ Barriers to teaching & learning - pg 399 Barriers for the teacher Competing demands on the nurse’s time (e.g., to prepare for teaching) Conflicting schedules between the nurse’s available time for teaching and the patient’s available time to learn Ineffective coordination of class lecture with clinical experience Lack of space and privacy Teaching not seen as a priority (by the nurse or the organization) No third-party reimbursement for teaching Frustration with the amount of documentation needed Barriers to technology-based learning Lack of social interaction Poor learner motivation Diverse learning styles Time issues Technical problems (software or devices) Access to the Internet, for some learners ○ Creating teaching plans - pg 402-409 Too long to copy and paste into the study guide. Just review from book Chapter 27 - Nutrition ○ Box 27-1 - pg 659 ○ ○ What are the energy nutrients - pg 661-664 Macronutrients supply the body with energy (kilocalories), protein, carbs, fat Micronutrients help manufacture, repair, and maintain cells (ADEK is fat soluble) Anabolism involves the formation of larger molecules from smaller ones Catabolism involves the breakdown of larger molecules into smaller components ○ Carbohydrates (primary energy source for body) 4 kcal/g Types of CHOs Simple carbohydrates aka sugars ○ Monosaccharides (simple sugars) consist of a single unit ○ Disaccharides are molecules made up of two saccharides Complex carbohydrates consist of long chains of saccharides (polysaccharides) Function of CHO: ○ Supply energy for muscle and organ function since carbs are more easily and quickly digested ○ Provides nearly all energy for brain and nervous system ○ Glucose stored in liver and skeletal muscle tissue as glycogen ○ Glycogenolysis: glycogen converted back to glucose ○ Spare protein: glycogen stores low→breakdown of body stores of protein (gluconeogenesis) and lipids (fats) to use for energy. Proteins are used for energy, they are not available for their primary functions of tissue growth, maintenance, and repair ○ Play a role in nutrition and metabolism by enhancing insulin secretion, increase satiety, improve absorption of Na+ and excretion of Ca+ ○ Proteins 4 kcal/g Overview Complex molecules made up of amino acid Essential amino acids must be supplied in the daily diet because they cannot be manufactured by the human body Nonessential amino acids can be synthesized in the body Complete protein foods contain all of the essential amino acids necessary for protein synthesis Incomplete protein foods (e.g., nuts, grains) do not provide all of the essential amino acids  Protein Metabolism and storage Continually breaks down and resynthesizes protein into tissues - Maintains a balance between tissue protein and plasma protein - Nitrogen balance: intake and output equal Positive nitrogen balance intake > output leading to supply of amino acids available for growth, pregnancy, and tissue maintenance and repair. ○ Want a positive nitrogen balance when you're healing, creating an anabolic environment to heal Negative nitrogen balance intake < output d/t illness, injury, burns, malnutrition Functions of proteins: Tissue building: essential for growth, maintenance, and repair of body cells and tissues Metabolism: essential for building body tissue, facilitate cellular reactions throughout the body Immune system function: Lymphocytes and antibodies are proteins Fluid balance: attract water, proteins in cells/bloodstream help regulate fluid balance Acid–base balance: blood proteins function as buffers Secondary energy source: proteins can be broken down to provide energy when stores of the other energy nutrients are inadequate ○ Fats 9 kcal/g ○ Types of lipids: Glycerides (true fats) consist of one molecule of glycerol attached to 1,2,3 fatty acid chains Glycerol is an alcohol composed of three carbon atoms Fatty acids are long chains of carbon and hydrogen atoms ending in an acid Triglycerides are the main glycerides found in foods, glycerol attached to 3 fatty acid Sterols consist of rings of carbon and hydrogen. Cholesterol needed for the formation of cell membranes, vitamin D, estrogen, and testosterone. Synthesized in liver and found in animal foods Phospholipids consist of phospholipids and a protein, major transport vehicles for lipids in the bloodstream Low-density lipoproteins (LDLs) transport cholesterol to body cells. High LDL = fatty deposits on vessel walls High-density lipoproteins (HDLs) remove cholesterol from the bloodstream, returning it to the liver, where it is used to produce bile Saturated and Unsaturated Fatty Acids classified as: saturated, unsaturated, or trans fats Unsaturated fatty acid is not completely filled with all the hydrogen it can hold so it is lighter and less dense ○ 1. Monounsaturated fat molecules have one unfilled spot where hydrogen is not attached ○ 2. Polyunsaturated fatty acids contain two or more unfilled spots for hydrogen (good dietary fat to reduce risk of heart disease) liquid at room temp 3. Saturated fatty acids are those in which every carbon atom is fully bound to hydrogen, solid at room temp 4. Trans-fatty acids are saturated man made fats, process solidifies the fat and extends the shelf life of the food Unsaturated is good, saturated is bad Essential and Nonessential Fatty Acids A fatty acid is considered essential if (1) the body cannot manufacture it and (2) its absence creates a deficiency disease Functions of Lipids Supply essential nutrients: food fats supply the essential fatty acids and aid in the absorption of fat-soluble vitamins Energy source: body burns fat for energy when engaging in sustained light activity, when glycogen stores are exhausted, and when at rest Flavor and satiety: promote satiety since digested slowly leaving stomach full for longer Cholesterol functions  Provides insulation, protects vital organs, aids in thermoregulation, and enables accurate nerve-impulse transmission ○ What must I know about energy balance? - pg 671-672 Carbohydrates = 4 kcal/g Protein = 4 kcal/g Fat = 9 kcal/g In determining total energy (kilocalorie) needs, consider the client’s basal metabolic rate and the duration and intensity of daily physical activity What is the basal metabolic rate? Measure of the energy used while at rest in a neutral temperature environment—the energy required for vital organs such as the heart, liver, and brain to function Direct calculation requires calorimeter Indirect calculation involves: ○ Measuring oxygen uptake per unit of time ○ Serum thyroxine levels ○ BMR calculation → Sedentary women/older adults: 1,600 kcal/day Children, teenage girls, active women and most men: 2,200 kcal/day - Teenage boys, active men, very active women: 2,800 kcal/day What Factors affect Basal Metabolic Rate Body composition Growth periods: BMR increases during periods of growth (first 5 years of life) Body temp: BMR increases 7% for every 1 degree Environmental temp: cold weather causes increased BMR Disease process: BMR increases with disease and injury Prolonged physical exertion What are some body weight standards? Men: 106 lb (47.7 kg) for the first 5 ft (150 cm), then add 6 lb/in. (2.7 kg/2.5 cm) Women: 100 lb (45 kg) for the first 5 ft (150 cm), then add 5 lb/in. (2.25 kg/2.5 cm) Add 10% for large body frame; subtract 10% for small body frame ○ Body Mass Index (BMI) Classifications of BMI Severe Underweight Calculating: BMI= weight (kg) / Height (m)^2 ○ Providing Parenteral Nutrition Parenteral (through IV)  Patients who are NPO for prolonged periods must receive glucose and electrolytes through IV or Total Parenteral Nutrition (TPN) and IV lipid infusion to meet body needs Nurses need to monitor nutrition status through lab values. TPN is all nutrition, PTPN is only partial, has to be going through a PICC line or a port Affects the kidneys ○ Providing Enteral Nutrition - pg 693-696 Enteral nutrition (tube feeding) refers to the delivery of liquid nutrition into the upper intestinal tract via tube Preferred method of feeding for a patient who has a functioning intestinal tract but needs nutritional support Risks: Aspiration: If enteral formula is aspirated into the lungs, it can lead to infection, pneumonia, abscess formation, adult respiratory distress syndrome Bacterial growth: The high glucose content of enteral formulas provides a medium for bacterial growth Other complications: Diarrhea, nausea and vomiting, nasopharyngeal trauma, alterations in drug absorption and metabolism Using enteric tubes To lavage (wash out body cavity) the stomach To collect a specimen of stomach contents for laboratory tests To prevent nausea, vomiting, and gastric distention postoperatively Selecting a feeding tube Short-term (less than 6 weeks) delivered through a nasogastric or nasoenteric tube Small-bore NG tubes: small, flexible tubes are preferred for feeding. Passed through one naris, passed through the nasopharynx into the esophagus, and finally into the stomach NE tube is longer than an NG tube, extending through the nose down into the duodenum or jejunum. May be used for patients at risk for aspiration Large-bore (larger than 12 Fr) NG tubes made of polyvinyl chloride (PVC) are used when a nasogastric or orogastric tube is placed so the stomach can be emptied (lavaged) they are short term ○ Salem sump tubes: lumen for drainage and another lumen to allow air to enter the stomach ○ Levin tube: used for drainage and has a single lumen with holes in tip and along sides ○ Gastrostomy tube (G-tube), percutaneous endoscopic gastrostomy tube (PEG), jejunostomy tube (J-tube, PEJ), or gastrostomy button (G-button) is preferred for long-term feeding and are placed surgically or laparoscopically through the skin and abdominal wall into the stomach or jejunum ○ ○ Procedure 27-2 NG tube insertion - pg 697  ○ ○ Checking feeding tube placement - pg 700 ○ Checking feeding tube placement Radiographic verificationis the most reliable method for confirming tube placement and must be performed before the first feeding is administered No single bedside method reliably verifies tube placement, so you must use the aspirate in combination with other methods for bedside verification Respiratory distress: cyanosis or difficulty breathing, coughing, and choking are indicators that the tube is in the respiratory tract Inability or compromised ability to speak ○ Methods for checking NG feeding Tube Insertion 27-6 - pg 701-702 Chest X-Ray is recommended for infusing feedings or meds pH testing of gastric juice Capnometry (CO2 detection) Highly accurate Do not use: Auscultation of air through NG Air bubbling method CHAPTER 32 - EXERCISE & IMMOBILITY ○ Types of exercise - pg 831 Isometric exercise Involve muscle contraction without motion Usually performed against an immovable surface or object (ex. Pressing hand against wall, plank or wall sit) Each position held for 6-8 seconds and repeated 5-10 times Effective for developing total strength of muscle or group of muscles Benefits: used for rehabilitation since exact area of muscle weakness can be isolated and strengthened, no special equipment, little chance of injury, can be used by patient’s who are bed-bound Isotonic exercise involves movement of the joint during the muscle contraction Weight training with free weights Weight is moved throughout the ROM, the muscle shortens and lengthens Body weight resistance (calisthenics) Isokinetic exercise Speed of the movement remains constant, but the resistance varies - Performed with specialized apparatuses that provide variable resistance to movement  Combines the best features of both isometrics and weight training by providing resistance at a constant, preset speed while the muscle moves through the full ROM Specialized machines(ex. Stationary bike) Aerobic exercise Acquires energy from metabolic pathways that use oxygen—the amount of oxygen taken into the body meets or exceeds the amount of oxygen required to perform the activity Uses large muscle groups can be maintained continuously, and is rhythmic in nature Increases heart and respiratory rate (providing exercise for the cardiovascular system while also exercising skeletal muscles) Jogging, brisk, walking, cycling Anaerobic exercise Occurs when the amount of oxygen taken into the body does not meet the amount of oxygen required to perform the activity Rapid, intense exercises such as lifting heavy objects and sprinting ○ Example Problem: Prolonged Mobility - pg 842-843 Key Point: prolonged immobilization causes physiological changes in nearly every body system, as well as psychologically. For purposes of example problem, consider prolonged immobility to be due to bed rest, extensive time in traction, quadriplegia. Not the same as limited mobility. - Musculoskeletal - One of first systems affected by immobility - Atrophy- 10% loss of muscle strength per week - Wasting of the gastrocnemius, soleus, leg muscles that control flexion and extension of the hip, knee, and ankle - Joints become stiff - Contractures: the strongest muscles (flexors) pull the joints, leading to contractures, or joint ankylosis - Cardiovascular - Venous stasis: leads to increased cardiac and venous stasis - Decreased cardiac reserve: heart rate and stroke volume increase to maintain blood pressure. But with immobility, cardiac reserves decrease, which means the heart is less able to respond to the body’s demands - Edema: without muscle activity, gravity causes blood to pool, which leads to edema. Fluid in the tissue is more prone to pressure injury. - Risk for thrombosis: leads to compression and injury of the small vessels in the legs and decreased clearance of coagulation factors, causing blood to clot faster. Stasis, activation of clotting, and vessel injury (Virchow’s triad) are associated with an increased risk for DVT formation - Orthostatic hypotension: inactivates the baroreceptors involved with vasoconstriction and dilation; less able to regulate blood pressure. Dizziness and lightheadedness occur - Lungs - Decreased ventilation: decreased strength of all muscles and decreased chest wall expansion, which impairs ventilation - Pooling in lungs: shallow respirations; secretions pool in lungs - Risk for atelectasis or pneumonia: pooled secretions block air passages or alveoli, decreased air-gas exchange, and often lead to atelectasis (collapse of air sacs) or pneumonia - Integumentary system - Pressure injury: pressure over bony prominences compresses capillaries resulting in decreased circulation. Tissue hypoxia then damages local tissues. - Metabolism - Energy: increases serum lactic acid, decreases adenosine triphosphate (energy) - Metabolic rate drops - protein and glycogen synthesis decrease; fat stores increase - Glucose intolerance - Decrease muscle mass - Stress response: triggers release of thyroid hormones, epinephrine, norepinephrine, adrenocorticotropic hormone from the pituitary gland, and aldosterone from the kidneys- same as stress response - Increased excretion of calcium: immobility alters parathyroid function, calcium metabolism, and bone formation. Result is osteoporosis, calcium depletion in joints, and renal calculi - Risk for fractures with minimal trauma - Gastrointestinal - Slows peristalsis, leading to constipation, gas, difficulty evacuating stool from the rectum. Paralytic ileus (cessation of peristalsis) can occur - Appetite diminishes and digestion slows, often leading to decreased caloric intake - Muscle is broken down as a fuel source - Urinary - Supine position inhibits drainage of urine from the kidney and bladder. Urine becomes stagnant- ideal environment for infection. - Increased calcium levels and stone formation - Urinary retention- decreased muscle tone leads to decreased bladder tone, which leads to urinary retention - bedpan/urinal- many patients have difficulty voiding in a bedpan or urinal - Psychological effects - Affect- moodiness, depression, anxiety, hostility, disturbed sleep, apathy, poor body concept - Cognition- decreased concentration, recall, and problem-solving - Self-care: reduced ability to perform self-care