1
Q
components of self concept
A
- body image
- personal identity
- role perfomrance
2
Q
factors that affect self concept
A
- environment
- support system/ resources
- stressors
- background
3
Q
stressors affecting self concept
A
- identity stressor
- body image stressors
- self esteem stressors
- role stressors
4
Q
how to improve self esteem
A
- demand respect
- teach others to treat you well
- tell others what you like about them
- acknowledge your worth
- overcome the fear of failure
- increase your comfort zone
- reframe thoughts
5
Q
sleep: homeostatic drive
A
-maintains internal equilibrium by adjusting its physiological processes influencing many body functions:
-thirst, sleep
this is your mind telling you to sleep when you are tired.
6
Q
circadian rhythm
A
daily rythmic activity cycle based on 24hour intervals
7
Q
Stage 1 of sleep
A
- very light sleep, if not disturbed person will move onto 2nd stage
- muscle contractions (Hypnic Myoclonia) occur and are preceeded by the feeling of falling
8
Q
Stage 2 of sleep
A
- person starts to think of images but no visions are seen with your eyes
- if undistrubed, drift off into stage 3
9
Q
Stage 3 of sleep
A
- deeper sleep, muscled are relaxed, and HR is slowed down, BP is falling, breathing is steady and even
- hard to be woken up
10
Q
Stage 4 of sleep
A
- dreaming stage
- deepest sleep of all stages
- person usually only wakes if there is a sudden loud noise.
- BP, HR, and brain speed up
11
Q
when does sleep walking, night terrors, and bed wetting occur
A
stages 3 &4 of sleep
12
Q
stage 5 (REM sleep)
A
- if awakened now..most dreams will be remembered
- REM slows as person wakes
- adults have 3-5 periods of REM a night
- REM is about 90% of time
- brain and eyes move fast
13
Q
percenatge of time in each sleep stage
A
- 50% in stage 2 sleep
- 20% in REM
- 30% in other stages
- infants spend 50% in REM
14
Q
sleep cycles
A
- 90-110 minutes each cycle
- first cycle of night is short REM periods and long deep sleep periods
- as night progresses–REM increases and deep sleep decreases
- by morning–all sleep is either stage 1 or 2 or REM
15
Q
Sleep disruptions
A
-if REM is disturbed, our bodies don’t follow normal sleep cycles next time around–we slip directly into REM until we catch up
16
Q
sleep needs/ different ages
A
- infants 18-20 hrs/day
- babies-16 hrs/day
- teens-9hrs/day
- adults 7-8hrs/day
- -needs can fluctuate 5-10hrs
17
Q
sleep deprivation
A
- increases effects of alcohol
- negative effects on immune and nervous system
- causes memory problems and clumsiness.
- severe deprivation– mood swings hallucinations
18
Q
benefits of sleep
A
- body cells regenerate during sleep
- grow and repair damage caused by ultraviolet rays and stress
19
Q
most common sleep disorders
A
- insomnia
- sleep apnea
- narcolepsy
- restless legs syndrome (RLS)
20
Q
heavy smokers and alcohol use sleep issues
A
- alcohol deprives person on REM sleep
- smokers often decrease REM sleep because wake every 3-4 hrs from nicotin withdrawal
21
Q
sleep apnea
A
-interruption of breathing during sleep
-often associated with obesity, enlarged tonsils, decreased muscle tone due to aging
-airflow obstructed for 10-60 sec while person struggles to breath due to suction collapsing wind pipe
blood oxygen levels fall= person awakes
-person is always sleepy=possible personality change/ depression
22
Q
sleep apnea risks
A
- morning headaches, decline in mental functions, disinterest in sex, increased BP, irregular heart beat, increased risk of stroke or MI
- increased risk of MVA’s and sudden respiratory arrest during sleep
23
Q
how to help sleep apnea
A
- lose weight, sleep on back, or surgery to remove obstruction
- CPAP (continuous positive airway pressure device) while sleeping
- never take sedatives or sleeping pills
24
Q
Restless leg syndrome
A
- hereditary disorder causing unpleasant crawling, prickling, or tingling of legs and feet
- causes person to wake often with urge to move feet
- often associated with anemia, pregnancy, and diabetes
25
narcolepsy
- sleep attacks at times during the day
- brain is unable to regulate sleep wake cycles normally
- can last a few seconds or over 30mins
- hereditary, brain injury, neurological disease
26
narcolepsy symptoms
- loss of muscle control
- hallucinations
- disruption of night time sleep
27
what can help narcolepsy
- stimulants and antidepressants can control symptoms
| - naps during the day can help reduce daytime excessive sleepiness
28
sleep hygiene
- sleep schedules of going to bed and getting up all week
- daily exercise 5-6 hrs before bedtime
- relax watch tv, pray, read, meditate
- avoid alcohol caffeine and nicotine
- comfotable bedroom temperatures
29
how can we help pts sleep
music
back massage
clean wrinkle free bedding????
30
Transcelullar
fluid contained within the specialized cavities of the body
- CSF, pleural fluid, digestive secretions
- equals 1 Liter of fluid
31
Active transport
- substance combines with a carrier on outside of cell surface and move in together but then seperate
- moves against normal concentration gradient from low to high
32
fluid intake vs fluid output
- driven by thirst mechanism in hypothalmus
- urine- increase w diabtetes, decreae w renal disease
- insensible loss-lungs- increase vs decrease respiration rate-water vapors
- feces
- skin-sweat, fever, burns abrasions
33
kidneys regulating fluids
conserves and excretes
- excretes-1200-1500 cc water daily
- minimum output-500 cc/day
- filters 135-180 L of plasma/day
- conserves w/ dehydration or less intake
34
how do kidneys know when to excrete or conserve with increased serum osmolality
- regulated by antidiuretic hormone-hypothalmus
| - ADH production- ^ in distal tubule permeability- ^ of reabsorption of water into the blood- decreased urine output
35
how do kindeys know when to excrete or conserve with decreased serum osmolality
- ADH suppression- decreased distal tubule permeability- decreased reabsorption of water into the blood- increased urine output
36
selective retention and excretion by kidneys: renin angiotensin aldosterone mechanism
INCREASES BLOOD VOLUME
- decreased blood flod or BP to kindeys- the release of renin-conversion of angiotensinogen ro angiotensin I to II- promotion of Na+ and H2Oretension to increase blood volume
- release of aldosterone is also stimulated which promotes Na+ retention
37
when does renin system kick in
- when blood vol is low if BP is low the heart gets the blood first- kidneys see this so increase blood vol
- renin causes retention of Na+, if you retain salt water will follow so this will ^ blood vol
38
Selective retention and excretion by kidneys: Atrial natriuretic Hormone
DECREASES BLOOD VOLUME
- released from the cell of the heart in response to excess blood vol and stretching of atrial walls
- secreted w/ ^ BV--CHF, renal failure, increased BP
- it causes renal excretions of Na+ & water, vasodilation, decreases BV and increases osmolality serum
39
isotonic imbalance
-water & electrolytes are lost or gained in equal proportions so osmolality remains constant
40
osmolality
solute concentration
41
hypovolemia vs hypervolemia
- fluid volume deficit
| - fluid volume excess
42
hypotonic vs hypertonic
- lower osmolality (less solute)
| - higher osmolality (more solute)
43
oslmolar balance
loss or gain of only water so osmolality of serum is altered
44
hyperosmoolar vs hypoosmolar
- dehydration-increased solute
| - overhydration-decreased solute
45
isotonic solutions
- 0.9% NS
- Lactated Ringers
- D5W 5% dextros in water
46
When are isotonic solutions used
- used to expand the intravascular compartments & restore vascular volume by remaining in compartments
- used with hypotension and hypovolemia
47
hypertonic solutions
- Dextrose solution
- 5% dextrose in NS-(D5NS)
- 5% dextrose in 1/2 NS-(D5 1/2NS)
- 5% dextrose in LR-(D5LR)
48
When would you use Hypertonic solutions
- water moves from cells (intracelular) into interstitial space then to vascular compartments - dilutes blood concentration
- not used for dehydration!
- used with edema
49
D5W
isotonic on inital administration but then provides free water when dextrose is metabolized- expands intracelullar and extracelullar volumes
-not used for pt at risk for intracranial pressure
50
Hypotonic solutions
- 0.45% NaCl (half normal saline)
| - 0.33% NaCl (1/3 normal saline)
51
when would you use hypotonice solutions
- provide free water and treats celullar dehydration
- water moves from vascular compartments into interstitial space and into cells
- cells will expand--not for cerebral edema!!
52
Sodium 135-145 mEq/L
- most abundant cation in ECF and greatest determinant of serum osmolality(solute concentration)
- reg of water balance when reabsorbed from tubules
- chloride and water reabsorbed with it to maintain ECF vol
- transmits nerve impulses
53
continuous or excess excretions =
hyponatremia- water imbalance
| GI loss, sweating, diuretics
54
hyponatremia
- low solute concentration in vascular compartment d/t excretions leaving a higher solute concentration in interstitial space and cells-cells swell bc water is pulled to higher solute
- water intoxiacation
55
hypernatremia
- thirst mechanism helps to prevent it-shouldn't happen
| - increase solute in ECF-increase pull of water from cells=cell dehydration
56
Potassium 3.5-5mEq/L
- main cation in ICF ( sm amount in ECF)
- regulates ICF osmolality
- needed for healing and growth
- helps promote conduction of nerve impulses
- VITAL for skeletal, cardiac function, & smooth muscle activity
- kidneys excrete about 80% of all K+
57
hypokalemia
- t be stored by body must be digested by daily
- lost with heavy perspiration and poor intake
- losses- vomiting, gastric suction, K+ wasting diuretics
58
hypokalemia can cause
-causes muscle weakness, leg cramps, fatigues, anorexia, N/V, decreased BS, and decreased motility, cardiac disrhythmias, decreased reflexes, weak and irreg pulse, and numbness
59
Hyperkalemia
- >5
- more dangerious than hypo
- increased intake and K+ sparing diuretics--disfunctioning kidneys
60
Hyperkalemia can cause
- Cardiac arrest, GI hyperactitity, diarrhea, irritability, confusion, cardiac dysrhythmias, decreased HR, muscle weakness, absence of reflexes,paresthesias(tingling pricking) & numbness of extremities
61
K+ usual dose
- must be diluted
| - 20-40 mEq/L
62
Magnesium
- 1.5-2.5 mEq/L
- abundant cation in ICF
- needed for intracelullar metabolism-ATP production, protein and DNA synthesis, regulator of neuromuscular, and cardiac function
63
where is magnesium found
-cereal grains, nuts, dried fruit, legumes, green leafy veggies, dairy, meat, fish
64
Hypomagnesemia
- seen concurrently with low serum Ca levels
- reduced intake- dieting, NG suction
- impaired GI absorption from disease
- increased secretions- alcoholism, laxative abuse, diarrhea
65
hypomagnesemia can cause
-neuro irritability w/ tremors, increased reflexes, convulsions, tachycardia, ^ BP, dysrhythmias, confusions/disorientation, vertigo, anorexia, resp difficulties, dysphasia, Chyostek's & Trousseau
66
Chyosteks
| Trousseau
- touch cheek and lip and cheek go up
| - take BP with cuff on wrist curls in
67
hypermagnesemia
- >2.5
| - oversupplementation or decreased excretions--renal failure
68
hypermagnesemia can cause
-decreased BP, bradycardia, decreased reflexes, N/V, muscle weakness, paralysis, lethargy, drowsiness, resp depression, coma, resp and cardiac arrest
69
Chloride
- 95-108 mEq/L
- functions with Na to reg serum osmolality and bld vol. Cl follows Na
- reg of acid-base balance
- buffer in exchange of O2 & Carbon dioxide in RBCs
- in same foods as Na
70
hypochloremia
- <95
| - loss through GI tract, kidneys, sweating
71
Hypochloremia can cause
-muscle twitching, tremors, tetany(involuntary contraction of muscles)
72
Hyperchloremia
- >108
- excess replacement of NaCl, KCL
- causes hypernatremia
73
hyperchloremia can cause
-weakness lethargy, risk of dysrhythmia or coma
74
Calcium
- 8.5-10.5 mg/dL
- vital in nueromuscular funtion, cardiac function, essential for bld clotting, bones and teeth
- w/ increasing age intestines are less effective w/ absorption causing increase in renal excretions= bld levels fall = pull of Ca from bones
- decreased Mg are found concurrently with low serum Ca levels
75
what helps keep Ca in bones
- weight bearing exercises
- vit D
- absorbed in intestines only under activated Vit D
76
where can Ca be found
- found in leafy greens, milk, canned salmon, supplements
| - (1,000-1,500 mg/day)
77
hypocalcemia
-from removal of parathyroid gland or injury to it
78
hypocalcemia can cause
- tetany, numbness or tingling around the mouth, hands, and feet, and poss, seizures
- Chvostek's and trousseau's
79
hypercalcemia
- excess released from bones
| - prolonged immobolization
80
hypercalcemia can cause
-lethargy, weakness, bone pain, anorexia, N/V
81
Phosphate (PO4)
- 2.5-4.5 mg/dL
- major component of ICF, also in ECF in bone and skeletal muscles and nerve tissue
- essential for function of muscles, nerves, and RBC & involved in metabolism of protein, fat, and carbs
- increased in children d/t bone growth
82
acidic
basic
normal pH of blood
7
7.35-7.45
lungs and kindeys prevent acidosis and alkalosis
83
buffers
acids are constantly produced during metabolism
| -pH maintained by respiratory and renal systems
84
HCO3 bicarbonate
regulated by kidneys
| -normal serum level-22-26 mEq/L
85
Fast acid-base regulators
- lungs
| - eliminating or retaining carbon dioxide w/ alteration of RR
86
acidosis vs alkalosis affects on lungs
- increase rate and depth of respiration
| - decrease in rate and depth on respiration
87
Slow acid-base regulators
- kidneys-ultimate regulator thru excretions or conservations of bicarb
- takes hrs and days to correct imbalances but more permanent
88
acidosis affects on kidneys
-reabsorption of bicarb & excretions of hydrogen ions
89
where is carbon dioxide levels measured
arterial PaCO2
| venous blood PCO2
90
blood ph
PaCO2
HCO3
PaO2
- 7.35-7.45
- 35-45
- 22-26
- 80-100
91
interpreting ABG pt 1
pH up=ALKALOSIS
| pH down=ACIDOSIS
92
respiratory function vs metabolic function
- indicated by PCO2
| - indicated by HCO3
93
interpreting ABG pt 2
| R.O.M.E
Respiratory
Opposite (pH up PCO2 down)
Metabolic
Equal (pH up HCO3 up)
94
pitting edema
1+=2mm
2+=4mm
3+=6mm
4+=8mm
95
good fluid and electrolyte balance
- drink 6-8 glasses of water/day
- avoid foods w/ excess salt and caffeine
- well balanced diet
- limit alcohol intake
- increase fluids before during and after strenuous activity
- replace electrolytes
96
urine Specific gravity
1.005-1.030
| high=urine concentrated
97
when to notify an MD about urine output
30-50 cc/hr
98
Impact of loss: Toddler/Preschool
Magical thinking
99
Impact of loss: school age
death final
100
Impact of loss: Adolescent
reckless behavior "immortality"
101
Impact of loss: young adult
religious cultural beliefs start to form
102
Impact of loss: adult
accepts own mortality
103
Stages of Grieving:Denial
- need to see facts-documentd, explanations
| - allow them to ask questions- be open and patient
104
Stages of Grieving: Anger
- "why me"
- let them talk while you just listen
- support system
- faith foundation
105
Stages of Grieving: Bargaining
- "Please god I will be a better person..."
| - support, prayer, positivity
106
Stages of Grieving: Depression
- Physical side effects
- listening, support, encouragement, reassurance
- pharmacueticals are sometimes necassary to treat depression
107
Stages of Grieving: Acceptance
- won't let the issue run your life
- continued support
- love, encouragement, prayer
- acceptance from others
- start working on the new you--history of disease
108
factors influencing response to loss
- significance of loss
- culture
- spiritual beliefs
- socioeconomic status
- support system
- cause of loss
- gender
109
Cultural beliefs: American
family members and friends are support
| expect high quality of care
110
Cultural beliefs: Canadian
- socialized medicine
- trust physicians
- willing to wait for treatment
111
Cultural beliefs: Chinese
-combo of herbal and western medicine
112
Cultural beliefs: Cuban
- extended family must participate
| - insult if large amount of family/friend aren't present at death
113
Cultural beliefs: Filippino
- often noncompliant
- home remedies
- beleive in supernatural cause of disease
114
Cultural beliefs: Haitian
- obedient to health care professionals
| - rarely ask questions
115
Cultural beliefs: Jamaican
- Home remedies
- respectful of physician
- reluctant to admit pain
116
Cultural beliefs: Japanese
- confidentiality important
| - illness kept to immediate family only
117
Cultural beliefs: Korean
- need to include family in plan of care
| - prefers noncontact
118
Cultural beliefs: northern european
- very modest
- stoic with pain tolerance
- express little emotion
119
Cultural beliefs: southern european
- whole family is involved
- very independent
- educated by reluctant to get medical attention
120
Cultural beliefs: vietnamese
- negative emotions conveyed in silence
- avoid touching head-considered sacred
- back rub-uneasy experience
- organ donation = suffering in next life
121
signs of impending death
- loss of muscle tone
- difficulty speaking
- difficulty swallowing
- slowing of circulation
- changes in respiration
- sensory impairment-- last sense to go is hearing
122
signs of death
- total lack of response to external stimuli
- no muscular movement, especially breathing
- no reflexes
- flat encephalogram- no brain waves for 48 hrs, life support
123
cerebral death/ higher brain death
- occurs when the cerebral cortex is irreversibly destroyed
- presence of cardiac activity
- absence of responsiveness to external stimuli, apnea, absence of cephalic reflexes
124
Legalities related to death
- advanced healthcare directives: tell someone what you want to happen
- autopsy: must be done if died alone
- certification of death
- euthanasia
- inquest- unwitnessed death investigation
- organ donation: next of kin has to allow it even if license says organ donor
125
Nursing Process: Assessment
recognize the state of awareness
126
Nursing Process: diagnosis
fear, hopelessness
127
Nursing Process: planning
dying person's Bill of Rights
128
Nursing Process: implementation
- focus on individual
- death with dignity
- hospice/ palliative care(focuses on pain, stress)
- meeting spiritual and physical needs
- family support
129
Nursing Process: evaluation
- personal involvement in selecting and evaluating
| - individual's expressed satisfaction with current life circumstances
130
Hospice
- team of doctors, nurses, social workers, counselors, home health aide, clergy, therapists, trained volunteers
- pain/symptom control
- spiritual care
- homecare and inpatient care
- respite care
- family conference
- bereavement care
131
spirituality
- needs
- well-being
- distress
- development
- religion
- agnostic-not enough evidence for GOD
- atheist- no GOD
132
Spiritual development: infants & toddlers
- no sense of right or wrong
- copy others
- parents are omnipotent-all the power
- God responsible for natural events
133
Spiritual development: school age
-spiritual disappointments- wish for something that does not come true
134
Spiritual development: adolescents
-question science/religious points of view
135
Spiritual development: adult
- answer questions from children
| - religious philosophy
136
Spirituality assessment
- environment
- behavior
- verbalization
- affect and attitude
- interpersonal relationships
137
what do beliefs affect
- diet and nutrition
- healing
- birth
- death
138
Spiritual beliefs: adventist
-dead are asleep until the return of Jesus Christ at which final rewards and punishment will be given
139
Spiritual beliefs: baptists
-clergy seeks to minister by counsel and prayer with patient and family
140
Spiritual beliefs:buddhist
-last rite chanting at bedside soon after death
141
Spiritual beliefs: mormon
- ground burial
- cremation is discouraged
- preaching gospel to the dead
142
Spiritual beliefs: eastern orthodox
-last rites obligatory if death is impending
143
Spiritual beliefs: episcopalian
-"Litany of dying" is adminstered prior to time of death
144
Spiritual beliefs: quakers
-do not belief in life after death
145
Spiritual beliefs: greek orthodox
- last rites are administered of sacrament of holy communion
| - priest should be called early enough so patient is still conscious
146
Spiritual beliefs: hindu
- priest may tie thread abound neck or wrist to signify blessing- do not remove
- immediatley after death priest pours water into mouth
- family washes body
- body is cremated
147
Spiritual beliefs: muslim
- patient must confess sins and beg for forgiveness
- family is present
- family washes, prepares, and places body facing mecca
- no autopsy
148
Spiritual beliefs: johovah's witness
- no last rites
| - no blood products
149
Spiritual beliefs: judaism
- body washed by family
| - no cremation or autopsy allowed
150
Spiritual beliefs: lutheran
"last rites" optional
151
Spiritual beliefs: methodist
- believe in divine judgement after death
| - good will reward and evil punished
152
Spiritual beliefs:roman catholics
- "sacrament of the sick"
| - "last rites"
153
spiritual health: nursing diagnosis
- spiritual distress
- spiritual wellbeing-potential for enhanced
- coping-ineffective
- anxiety
- hopelessness
154
spiritual health: planing and implementation
- provide spiritual resources
- help fulfill religious obligations
- help identify inner strengths
- self examination of own beliefs
- focus on clients beliefs
- presencing-living in moment
155
spiritual health: evaluation
- client express comfort with spiritual beliefs
- client continues spiritual practices appropriate to health status
- client expresses decreased feelings of guilt
- client displays a positive affect
156
Gordon's value of belief pattern: subjective data
- "what is important to your life?"
- "does religion help when difficulties arise?"
- "does hospitalization interfere with your religious practice?"
157
Gordon's value of belief pattern: objective data
- evidence of religious articles present (statues, rosary beads)
- prayer books
Nursing 111
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