NR 226-exam 3 Questions and Answers

NR 226-exam 3 Questions and Answers nursing knowledge base requires knowledge, brings comfort, makes plans to care for patients loss, grief, and death, guides the grief process, explains patho of related illness, knows cultural perspectives on meaning of loss/death, social support, concepts of caring, concepts of stress and coping experience of loss, grief and death person revolves around grief, loss, knowledge, and death death ultimate loss, last developmental task for individual, considered the ultimate loss, competes the life cycle types of death natural, expected, sudden, unexpected and suicide grief emotional response to loss, manifested in ways unique to an individual based on personal experience, cultural expectations and spiritual belief, subjective response of emotional pain to loss, reacting and responding to the losses in one's life, a natural and needed reaction to loss, may begin before loss or death occurs loss examples losing body parts or function, illness, self-esteem, friendship, childhood friends, identity, confidence, job or income that is grieved throughout the process of life loss an actual or potential situation in which something that is valued is changed or no longer available necessary loss people learn to live through this loss, eventually replaced with something different or better maturational loss ending a life span with normally expected life or adult children leaving the house situational loss sudden unpredictable death, automobile accidents leaving permanent damages in the body leading unable to achieve life goals actual loss occurs when a person can no longer feel, see, hear, or know a person or object like loss of body part, death, losing a job perceived loss easy to overlook because internal, uniquely defined by the person experiencing the loss and is less obvious to other people like rejection from a friend, rejected by a group that affects our confidence anticipated loss having a sense of full extent may not known bereavement common depressed reaction to the death of a loved one, associated with a time of intense personal suffering/sorrow over the loss like emotional and outward behavior mourning reaction activated by a person to assist in overcoming a great personal loss, include socially/culturally prescribed practices, sometimes it is common to feel an increase grief on the death anniversary or birthdays ultimate loss death types of loss maturational loss, situational loss, personal loss, death kubler-ross's stages of dying denial, anger, bargaining, depression, and acceptance grief and grieving the subjective response of emotional pain to loss, reacting and responding to the losses in one's life, a natural and needed reaction to loss, may begin before loss or death occurs types of grief normal, anticipatory, disenfranchised and complicated grief normal grief is a complex response emotional, cognitive, social, behavioral and spiritual components anticipatory grief type of grief is to expect, await, or prepare oneself for the loss disenfranchised grief when the individual cannot openly grieve complicated grief dysfunctional grief, the grieving person has a prolonged or significantly difficult time moving forward after a loss nurses role recognize the influence of grief on behavior with types of grief and factors, access for grieving behaviors like clinical symptoms whether normal or abnormal, provide empathetic support like therapeutic communication or physical presence, and develop goals for grief, loss, and end of life with interdisciplinary team approach normal clinical symptoms of grief verbalization of the loss, crying, sleep disturbance, loss of appetite, and difficulty concentrating complicated grief clinical symptoms greatest risk for the patient, extended time of denial, difficulty moving forward, unable to accept the death, conflicted relationships with the deceased, loss associated with homicide, suicide, sudden accidents or the death of a child has the potential to become complicated factors influencing loss and grief human development, personal relationships, nature of the loss, coping strategies, socioeconomic status, culture ethnicity, spiritual and religious beliefs, cause of death goals for the grief process resolving emotions, reflecting on the dying person, expressing feelings of loss and sadness, valuing what has been shared resolution of grief begins when grieving person can complete the following tasks; have positive interactions, participate in support groups, establish goals and work to achieve them, discuss the meaning of the loss and its effect communicating with the dying patient therapeutic communications, careful attention to what the patient expresses verbally and nonverbally, assisting patient in saying goodbye, provide private, comfortable environment nursing diagnoses relevant to grief, loss or death hopelessness, fear, grieving, spiritual distress, caregiver role strain end of life care goals provide comfort, supportive care during dying process, improve quality of life remaining, assist clients to manage the events preceding death so they can die peacefully, help clients to determine their own physical, psychological and social priorities, support the clients will and hope implementation of death protect against abandonment and isolation; physical care provide adequate nutrition and maintain elimination patterns, keep patient clean, dry, well-groomed, odor-free, and comfortable, provides the patient with feelings of self-esteem and self-worth, adjusting the environment to increase comfort and safety is paramount support the grieving family assist with end of life decision making treatment goals, advanced directive, DNR physical changes hours or days before death increased periods of sleeping/unresponsiveness, coolness, color changes in extremities, nose, fingers, bowel or bladder incontinence, decreased urine output, dark-colored urine, restlessness or discoloration, decreased intake of food or fluids, inability to swallow, congestion/increased pulmonary secretions, noisy respirations (death rattle), altered breathing, decreased muscle tone, relaxed jaw muscles, sagging mouth, weakness and fatigue hospice exists to provide support and care for persons in las phases of incurable diseases, services are available 24 hours a day, 7 day a week-care provided wherever the patient resides hospice admission patient must desire services, physician must certify patient has 6 months or less to live medically supervised multi-disciplinary team nurse as case manager with expertise in pain and symptom management, emphasize palliative rather than curative care difficult decision lack of information about hospice care, physician may view decline as personal failure and patients or family see it as giving up hospice definition bereavement counseling and grief support are incorporated into plan of care for family members and significant others during patients illness and after death care after death organ and tissue donation, autopsy, documentation, postmortem care with culture specific, death certificate, funeral/burial nurses grief come to grips with understanding the grief process, appreciating the experience of the dying patient, using effective listening skills, acknowledging personal limits, knowing when there is a need to get away and take care of the self professional standards of care related to end of life issues nursing code of ethics, dying person's bill of rights, american society of pain management nurses guidelines pre-operative begins with decision to have surgery, lasts until patient is transferred to operating room, medical/surgical hx, consent, allergies, blood type, confirm procedure, location, educate on risk factors intraoperative extends from admission to surgical department to transfer to recovery room postoperative lasts from admission to recovery room to a follow up evaluation in the clinical setting or home urgency surgical procedures elective, urgent or emergency risk surgical procedures major and minor purpose surgical procedures diagnostic, ablative, palliative, reconstructive, transplantation, constructive elective surgery by choice urgent surgery nonthreatening emergency surgery life threatening major emergency extensive reconstruction or alteration in body parts (CABG, colon resecation) minor emergency min alteration, cataract surgery, facial plastic, tooth extraction abaltive removal of diseased body part palliative to reduce intensity of the symptoms, not for a cure reconstructive to restore function or appearance, transplantation constructive restores the function that lost body part or congenital anomalies cosmetic to improve personal appearance risk factors of surgery age, nutrition, obesity, sleep apnea, immunocompromised pt. that has cancer, HIV/AIDS, bone marrow issues, fluid electrolyte imbalance, pregnancy general anesthesia patient unable to recall the surgical procedure, administration of drugs by inhalation, intravenous, rectal or oral route regional anesthesia loss of sensation to area like spinal/epidural/nerve blocks, anesthetic agent injected near a nerve or nerve pathway or around operative site, no sedation topical anesthesia used on mucous membranes, open skin, wounds, burns local anesthesia loss of sensation at site like skin growth, cornea of the eye, lidocaine or xylocaine conscious sedation to have depressed level of consciousness, patient must independently maintain their airway, short acting iv sedation, used for short term procedures like bedside bronchoscopy, colonoscopy induction from administration of anesthesia to ready for incision maintenance from incision to near completion of procedure emergence starts when patient emerges from anesthesia and is ready to leave operating room informed consent information providing consent is a choice-surgeon must explain the procedure to patient, description of procdure and alternative therapies, underlying disease process and its natural course, name and qualifications of person performing procedure, explanation of risks and how often they occur and explanation that patient has the right to refuse treatment or withdraw consent informed consent voluntary agreement, legal document with ethical imperatives, person performing surgery obtains consent (usually MD), nurse witness nurses signature indicates patient signed without coercion or force and patient was alert and aware (competent) advance directives living wills and durable power of attorney living wills written document that direct treatment in accordance with patients wishes in the event of terminal illness, it is something that patient shares with their family, what is the wishes of the patient, do I need CPR/do I need g-tube durable power of attorney legal document that give someone you choose the power to act in your place when mentally incapacitated ambulatory surgery same day surgery, reduces length of hospital stay and buts costs, reduces stress for the patient, may require additional teaching and home care services for certain patients, older patients, chronically ill patients, patients with no support system like cholecstectomy outcomes for the surgical patient be free from injury and adverse effects, be free from infection, maintain fluid and electrolyte balance, skin integrity, demonstrate understanding of physiologic and psychological responses to surgery, participate in rehabilitation process, ambulate same day, decrease DVT developmental considerations for infants mortality rate are high, immature/decreased physiological functions, example of infants will have difficulty maintain body temp/shivering reflex/blood volume/infection developmental considerations for toddlers parents will bring the child two weeks pre-surgical to meet nurses, allowing to handle a bear with bandage in the surgical wound site developmental considerations for school age children adolescents, and adults age appropriate care developmental considerations for older adults same as children assessment nursing and medical history past illnesses, surgeries, and reasons for surgeries assessment risk factors age, nutrition, obesity, sleep apnea, immunocompetence, fluid and electrolyte imbalance, and pregnancy, perceptions and knowledge assessment medication history prescription, over the counter, herbs, street drugs, previous pain med, narocotics, morphine assessment allergies drugs, latex, food, and contract assessment smoking cigarettes or packs per day assessment alcohol ingestion and substance use and abuse use per day or week assessment support sources family, friends and home environment nursing diagnoses for preoperative phase deficient knowledge, anxiety, disturbed sleep pattern, anticipatory greiving and ineffective coping nursing diagnoses for intraoperative phase risk for aspiration, ineffective protection, impaired skin integrity, risk for periperative-positioning injury, risk for impaired body temperature, ineffective tissue perfusion, risk for deficient fluid volume nursing diagnoses for postoperative phase acute pain, risk for infection, risk for injury, risk for deficient fluid volume, ineffective airway clearance, ineffective breathing pattern, self-care deficit with bathing, hygiene, dressing, grooming and toileting, ineffective health maintenance, and disturbed cody image usual presurgical screening tests electrocardiography, complete blood count, electrolyte levels with BMP which is basic metabolic panel, urinalysis and chest x-ray nurse's role in presurgical screening ensure tests are explained to patient, ensure results are recorded in patient records before surgery, ensure that abnormal results are reported nursing interventions to meet psychological needs of surgical patients establish therapeutic relationship and allow patient to verbalize fears and concerns, use active listening skills to identify anxiety and fear, use touch to demonstrate genuine empathy and caring, and be prepared to respond to common patient questions about surgery preparing the patient through teaching surgical events, sensations, and equipment to expect, ID learning needs, coughing and splinting, incentive spirometry, turning and leg/ankle exercies, SCD's and TEDs, pain management, rest and comfort, hygiene and skin prep, dietary, fluid, restrictions, activity restrictions and recommendations preoperative instructions time of arrival, NPO status, belonging and clothing instructions, what to expect and discharge teaching