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Adult Health part 2
Obesity, Nutrition, Stress, Pain, Sleep, and Ethics
| Question | Answer |
|---|---|
| How do Obesity and Overweight develop? | By an imbalance between energy expenditure and energy intake from a long-term sedentary lifestyle and/or excessive calorie intake. |
| What is Obesity? | Obesity is an abnormal increase in the proportion of fat cells. |
| Obesity primarily occurs in the _____ and _______ tissues of the body. | visceral, subcutaneous |
| Adipocyte hypertrophy | A process by which adipocytes can increase their volume several thousandfold to accommodate large increase in lipid storage. |
| Weight gain in adulthood is characterized predominantly by _____________. | Adipocyte hypertrophy |
| In the United States, obesity is... | the most common nutritional problem. |
| Obesity affects __________ of the population of the United States. | One-third |
| Obesity has reached epidemic proportions in non-developed countries as well as developed countries. | True |
| Obesity is... | the second leading cause of preventable death and the third leading reason for liver transplantation. |
| ________must exceed energy expenditure for obesity to continue. | Caloric consumption |
| What is the cause of Obesity? | Significant genetic/biologic susceptibility factors that are highly influenced by environment and psychosocial factors. |
| What is the current standing on the cause of obesity as primarily genetic? | Strong evidence of genetic predisposition, however, the most common form is considered to be polygenic. ID'ing these genes will lead to a better understanding of the patho. |
| ______is influenced by many factors that are integrated by the brain. | Appetite |
| What part of the brain is the main regulator of appetite? | the hypothalamus. |
| What hormones interact with the hypothalamus to affect obesity? | Leptin, Insulin, Ghrelin, Peptide YY, and Cholecystokinin. |
| What environmental factors affect obesity? | Greater access to food, such as prepackaged food, fast food, soft drinks, and increased portion sizes. Also, obese individuals tend to underestimate food and caloric intake. |
| The _____ component to overeat is powerful. | emotional |
| There is a strong social component to eating. | True |
| Primary Obesity | Majority of obese people Excess caloric intake for the body's metabolic demands |
| Secondary Obesity | Results from various congenital anomalies, chromosomal anomalies, metabolic problems, or CNS lesions and disorders. |
| What is the most common clinical index of obesity or altered body fat distribution? | Body Mass Index |
| Body Mass Index (BMI) | uses weight-to-height ratios degree to which a pt is classified as underweight (<18), healthy weight (18-25), overweight (25-29), or obese (>30). |
| What is the Waist-to-Hip ratio (WHR)? | a method of describing distribution of subcutaneous and visceral adipose tissue |
| What is an optimal WHR? | < 0.80 |
| What WHR indicates greater risk for health complications? | > 0.80 |
| People with more _________ are at an increased risk for cardiovascular disease and metabolic syndrome. | Visceral fat |
| What is the preferred measurement tool to use when a pt is predominantly muscular? | the WHR |
| Android obesity | Fat located primarily in the abdominal area at greater risk for obesity-related complications |
| Gynoid obesity | fat located primarily in the upper legs |
| What are the psychologic health risks of obesity? | Depression, low self-esteem, risk of suicide, discrimination |
| What are the Metabolic health risks of obesity? | Type 2 diabetes mellitus, metabolic syndrome, polycystic ovary disease |
| What are the Respiratory health risks of obesity? | Obesity hypoventilation syndrome, sleep apnea, asthma, pumonary hypertension |
| What are the reproductive (women) health risks of obesity? | Menstrual irregularities, infertility, gestational diabetes, overdue births, induced labors, and longer labors |
| What are the reproductive (men) health risks of obesity? | hypogonadism, gynecomastia |
| What are the Musculoskeletal health risks of obesity? | Osteoarthritis, impaired mobility and flexibility, gout, lumbar disk disease, chronic low back pain |
| What are the cardiovascular health risks of obesity? | hyperlipidemia, sudden cardiac death, right-sided heart failure, LVH, coronary artery disease, deep vein thrombosis, atrial fibrillation, hypertension, cardiomyopathy, venous stasis |
| What are the Liver/Gallbladder health risks of obesity? | nonalcoholic steatohepatitis (NSAH), gallstones |
| What are the genitourinary health risks of obesity? | end-stage renal disease (ESRD) secondary to diabetes and hypertension, stress incontinence |
| What cancers can be caused by obesity? | endometrial, breast, cervical, ovarian, uterine, and gallbladder cancer in women. Colorectal cancer in both genders. Prostate cancer in men. |
| Most conditions associated with obesity improve with weight loss. | True |
| Obese pts have a _________ quality of life | decreased |
| _________ obesity pts are at a greater risk of cardiovascular problems. | Android |
| Obesity is a significant risk factor for predicting what type of disease? | cardiovascular. |
| What are some symptoms of obesity hypoventilation syndrome? | decreased chest wall compliance increased work of breathing decreased total lung capacity and functional residual capacity |
| ___% of pts with type 2 diabetes are obese. | 80 |
| Glucose control is improved by... | weight loss and exercise |
| Hyperuricemia and Gout | disease causing swollen joints: a metabolic disorder mainly affecting men in which excess uric acid is produced and deposited in the joints, causing painful swelling, especially in the toes and feet. |
| NASH can... | eventually lead to cirrhosis. Weight loss can improve this condition. |
| Obesity is one of the most important known... | preventable causes of cancer |
| An obese pt may withhold information out of.... | embarrassment or shyness |
| When talking with an obese pt, the nurse should... | respond to concerns about diagnostic tests |
| When talking with an obese pt, the nurse needs to... | provide acceptable reasons for personally intrusive questions |
| What subjective information about the obese pt should the nurse collect during assessment? | time of obesity onset disease related to metabolism/obesity medications Hx with weight gain/loss Interested in losing weight? contributors to weight gain what impedes weight loss how pt uses food other overwght family mem environ/genetic factors |
| What objective information about the obese pt should the nurse collect during assessment? | Height, weight, BMI, skinfold thickness, waist circumference |
| Planning for the Obese pt | Modify eating patterns |
| Planning for the Obese pt | Participate in a regular physical activity program |
| Planning for the Obese pt | Achieve weight loss to a specified level |
| Planning for the Obese pt | Maintain weight loss at a specified level |
| Planning for the Obese pt | Minimize or prevent health problems related to obesity |
| ________ approach ought to be used with attention to _______ factors | Multipronged, multiple |
| What should the nurse stress in pt education about losing weight? | health eating and exercise |
| What factors should be used in a weight loss program? | dietary intake, physical activity, behavior modification, and/or drug therapy |
| The nurse needs to _____, ______, and _______ when helping a pt lose weight. | supervise, educate, motivate |
| 3 things to be considered when implementing a weight-loss plan | set a realistic and healthy goal 1 to 2 lbs per week slower weight loss offers better cosmetic results |
| Weight loss plateaus can last from ________ to ___________. | several days, several weeks |
| How often should a pt weigh him/herself? | once a week with similar clothing at the same time of day. Daily weighing is not recommended. |
| Low calorie diet | 800 to 1200 calories |
| Very low calorie diet | < 800 calories |
| What is the cornerstone of nutritional therapy? | restricted food intake |
| ______ of the diet should be plant-source, ______ or ____ from animal protein. | 2/3, 1/3, less |
| Serving of fruit and vegetables | size of a woman's fist or a baseball |
| Serving of meat | Human's palm or a deck of cards |
| Serving of cheese | Size of a thumb or six dice |
| Exercise is... | an essential part of a weigh control program should be done daily for 30 mins to an hour |
| What kinds of exercise should be encouraged? | walking, swimming, cycling |
| Self-monitoring | show what and when foods are eaten |
| Stimulus control | separate events that trigger eating from the act of eating |
| rewards | incentives for weight loss |
| 2 categories of drug therapy | - decrease food intake by reducing appetite/increasing satiety - decrease nutrient absorption |
| Which drugs are not approved by the FDA? | Drugs that increase energy expenditure |
| Appetite-suppressing drugs: Serotonergic mechanisms in CNS | -Phentermine -Diethylpropion -Phendimetrazine Recommended for SHORT-TERM use |
| Nutrient absorption-blocking drugs | work by blocking fat breakdown and absorption in intestine inhibits action of intestinal lipases undigested fat excreted in feces - Orlistat (Xenical) |
| Bariatric surgery is used... | to treat morbid obesity |
| A pt must meet all of the following criteria to be considered a candidate for bariatric surgery: | -BMI >40 with one or more obesity-related complications -18 yrs or older -understands risks/benefits -Has been obese for >5 yrs -Has tried and failed to lose weight |
| A pt must meet all of the following criteria to be considered a candidate for bariatric surgery: | -has no serious endocrine problems -has psychiatric and social stability -availability of a team of health care providers -surgery would decrease or eradicate high-risk conditions |
| 3 categories of bariatric surgery: | restrictive, malabsorptive, combination of restrictive and malabsorptive |
| Restrictive surgery | reduces size of stomach to <30 ml causes pt to feel full quicker normal digestion/absorption decreased risk of anemia/vit B12 def. |
| Vertical banded gastroplasty | -type of restrictive surgery -partitions stomach into a small pouch -stoma opening to rest of stomach is banded to delay emptying. |
| Adjustable gastric banding (AGB) | -type of restrictive surgery -LapBand -size limited by inflated band around fundus of stomach -band connected to subQ port -can be inflated/deflated to change stoma size -better choice for pts who are surgical risks -weight loss is slower |
| Malabsorptive surgeries | Nutrients pass without being digested |
| Biliopancreatic diversion (BPD) | -removes 3/4 of stomach to decrease food intake and acid output -remaining 1/4 of stomach connected to lower small intestine -pancreatic enzymes and bile enter final segment of intestine |
| Combination of restrictive and malabsorptive surgery | -Roux-en-Y surgery |
| Roux-en-Y surgery | create a pouch of the stomach, connect the last part of the small intestine to it. Offers the greatest degree of weight loss. Risk of dumping syndrome and nutritional deficits. |
| _______ is one of the most common complications of surgery with obese pts. | Wound infection |
| Obese pts undergoing anesthesia have an increased risk of failing to wean from mechanical ventilation. Why? | Because the chemicals used for anesthesia are stored in the fat cells of the body. |
| How often should the nurse ambulate the obese client after transfer to the PACU? | 3-4 times a day |
| What kind of diet should the post-bariatric surgery client follow? | high protein, low carb, low fat, low roughage, eat 6 small meals a day, fluids should not be ingested with meals. |
| Possible complications from bariatric surgery | anemia, vit deficiencies, diarrhea, psychiatric problems, peptic ulcer formation, dumping syndrome, and small bowel obstruction |
| __________ is the first line of intervention for metabolic syndrome | Lifestyle therapy. |
| What lifestyle changes should be made in the pt with metabolic syndrome? | manage cholesterol stop smoking lower BP reduce glucose levels |
| 5 essential components of nutrition | Carbohydrates, Fats, Proteins, Vitamins, and Minerals |
| Carbohydrates | primary source of energy 4 kcal per gram compose 47% of daily caloric needs chief protein-sparing ingredient simple/complex |
| Fats | Major source of energy 9 kcal per gram source of insulation 20-35% of daily caloric intake carriers of essential fatty acids/fat-soluble vitamins |
| Proteins | 4 kcal per gram essential for tissue growth, repair, maintenance body regulatory functions energy production animal/plant sources 15-20% daily caloric needs essential/nonessential amino acids |
| Essential amino acids | must come from dietary sources |
| Complete source of essential amino acids | contain all essential amino acids: milk, eggs, meats |
| Incomplete source of amino acids | lack one or more essential amino acids: grains, nuts, seeds, legumes |
| Nonessential amino acids | body can synthesize these if protein is unavailable |
| Vitamins | required in small amount for normal metabolism function primarily in enzyme reactions water/fat soluble |
| Minerals | necessary for building tissues regulation of body fluids assist in various body functions toxic in excess amounts |
| Major minerals | Calcium, chloride, magnesium, phosphorus, potassium, sodium, sulfur |
| Lacto-ovo vegetarians | watch for vitamin and mineral deficiencies |
| Vegans | can develop anemia and neurological symptoms of deficiency. Possible deficiencies: calcium, zinc, vitamins A and D, protein, iron |
| Fad diets | Atkins, South Beach, Cabbage soup, Zone, Weight watchers, Jenny Craig, liquid |
| Medical diets | low sodium, ADA, low fat, low carb |
| Primary protein-calorie malnutrition | lack of nutritious food intake |
| Secondary protein-calorie malnutrition | problem with ingestion, digestion, absorption, metabolism |
| Serum albumin | protein, not a good indicator of acute changes in nutritional status |
| Serum prealbumin | a better indicator for under-nutrition. A protein synthesized by the liver |
| Serum Transferrin | another indicator of protein status. synthesized by the liver and used to transport iron. It decreases during states of protein deficiency. |
| Serum electrolyte levels in under-nourished pts | elevated K, RBC count and Hgb count decreases, liver enzymes elevate, vitamins are diminished (steatorrhea - fatty stools) |
| Skinfold thickness test | an indicator of subQ fat stores. Decreased in acute protein malnutrition. |
| Mid-arm muscle circumference test | an indicator of protein stores. Decreased in protein malnutrition. |
| Normal albumin level | 3.8 - 4.5 g/dl |
| Normal prealbumin level | 20 mg/dl |
| What is the first overall goal for the pt with PCM? | The pt will achieve weight gain. |
| What is the second overall goal for the pt with PCM? | The pt will consume a specified number of calories per day (with a diet individualized for the pt) |
| What is the third overall goal for the pt with PCM? | The pt will have no adverse consequences related to malnutrition or nutrition therapy. |
| The nurse should educate the malnourished pt about _________ and _________. | Health promotion, disease prevention |
| When should feeding tubes and parenteral nutrition be implemented? | As a last resort |
| Stress is related to ____% of office visits. | 75 |
| Stress is linked to which leading causes of death? | Heart disease (chronic stress doubles risk of MI), cancer, accidents, and suicide |
| Stress is a _______ and is very __________. | perception, individualized |
| Stress | The perception that one cannot adequately cope with demands being made on person or well-being. |
| What is the key aspect of stressors? | They require an individual to adapt |
| 2 types of stressors | physiologic or emotional/psychologic |
| Type, duration, and intensity of a stressor influence an individual's... | adaptive response |
| Examples of physiologic stressors | skin burn, chronic pain, hypothermia, infectious disease, excessive noise, starvation, running a marathon, birth of a baby. |
| Examples of emotional/psychologic stressors | diagnosis of cancer, marital problems, failing an exam, inadequate financial resources, grieving, caring for a disabled child, winning or losing an athletic event, winning the lottery |
| Stress affects which three interrelated systems? | Immune, endocrine, nervous |
| Acute stress response | a state of physiologic and psychologic arousal characterized by increased sympathetic nervous system activity that leads to increased heart and resp rate, BP, muscle tension, and brain activity, and decreased skin temp. |
| The body responds physiologically to both ________ and ___________ stressors. | actual, perceived |
| The complex process by which an event is perceived as a stressor and by which the body responds is not fully understood. | True |
| The chemicals that the immune system uses to influence the CNS and the endocrine system. | Cytokines |
| The chemicals that the CNS uses to influence the immune system and the endocrine system. | Neuropeptides |
| The chemicals that the Endocrine system uses to influence the CNS and the immune system. | Endocrine hormones |
| What happens if stress is excessive or prolonged? | pysiologic responses can become maladaptive and lead to harm and disease. |
| What effects does stress have on cognitive function? | poor concentration, impaired decision making, memory problems |
| What effects does stress have on behavior? | withdrawing from others, irritability, or substance abuses |
| Stress-induced immunosuppression may ______ or _______ risk of progression of immune-based diseases. Give examples of these diseases. | exacerbate, increase -MS, asthma, RA, cancer |
| Excessive activation of the sympathetic nervous system may cause or worsen: | Migraine headaches, IBS, peptic ulcers, control of metabolic disorders |
| Excessive activation of the SNS... | induces hippocampal damage (memory impairment) and increases risk of cardiovascular disease |
| Examples of internal influences on stress | age, health status, personality characteristics, previous experience with stressors |
| Examples of external influences on stress | cultural and ethnic influences, socioeconomic status, social support, timing of stressors |
| The hardy person has | a clear sense of personal values and goals, a strong tendency toward interaction with the environment, a sense of meaningfulness, and an internal rather than external locus of control |
| Internal locus of control | perceives that life is self-determined, as opposed to being directed by outside or external events. |
| Sense of Coherence (SOC) | believed to be a more powerful mediator of stress and illness than hardiness. Is a key determinant of health. refers to how an individual sees the world and one's life in it. |
| What are the 3 components of SOC? | Comprehensibility, manageability, and meaningfulness |
| Resilience | being resourceful, flexible, and having an available source of problem-solving strategies. |
| Attitude | positive emotional attitudes can prevent disease and prolong life. |
| People with a _________ attitude tend to report poorer health compared with people with ___________attitudes | pessimistic, optimistic |
| Emotion-focused coping | managing emotions that one fells when a stressful event occurs |
| What is the purpose of emotion-focused coping? | to help decrease negative emotions and help create a feeling of well-being |
| Problem-focused coping | find solutions to resolve problems causing stress |
| What is the purpose of problem-focused coping? | allows one to look at a challenge objectively, take action to address the problem, and reduce the stress |
| When will emotion-focused coping predominate? | When a situation is unchangeable or uncontrollable. |
| When will problem-focused coping predominate? | When a problem can be changed or controlled. |
| Coping flexibility | the ability to change and adapt coping strategies over time and across different stressful situations |
| 3 stages of the General Adaptation Syndrome | Alarm, resistance, exhaustion |
| What are 3 benefits of relaxation strategies? | deal better with stressors, increase sense of control, reduce tension |
| Examples of relaxation strategies | relaxation breathing, meditation, imagery, music, muscle relaxation (progressive, passive), massage |
| Regular elicitation of the relaxation response has been proven to be an effective treatment for a wide range of stress-related disorders, including chronic pain, insomnia, and hypertension | true |
| Physical signs and sx of stress response | increased HR and BP, hyperventilation, or headache |
| Behavioral signs and sx of stress response | anxiety, irritability, or impaired speech |
| Cognitive signs and sx of stress response | self-reports of forgetfulness or indecision |
| Coping | A person's cognitive and behavioral efforts to manage specific external or internal stressors that seem to exceed available resources. |
| 2 types of coping | positive and negative |
| Positive coping | activities such as exercise and use of social support |
| Negative coping | may include substance abuse and denial |
| coping resources | characteristics or actions drawn on to manage stress and include factors within the person or the environment |
| What is the opposite of the stress response? | The relaxation response |
| Relaxation response | a state of physiologic and psychologic deep rest characterized by decreased SNS activity. |
| Decreased SNS activity | decreased HR, RR, BP, muscle tension, brain activity. increased skin temp |
| When a person is stressed, muscles ______ and breathing becomes ______ and ______. | tense, shallow, rapid |
| What is the simplest and most effective way to stop the stress response? | Deep and slow breathing. It is difficult to maintain tension when breathing in a slow, deep, and relaxed pattern. |
| The way one breathes affects every aspect of life. | True |
| Relaxation (abdominal) breathing | Performed while sitting, standing, or lying down. Strong use of the diaphragm. Forms the basis for most relaxation strategies. |
| What is the most natural way of breathing for infants and sleeping adults? | Relaxation (abdominal) breathing |
| What is the most efficient way of breathing? | Relaxation breathing |
| 3 basic types of meditation | Concentration, guided, and mindfulness |
| Concentration meditation | directs the mind to a single focus (breath or a mantra) |
| Mindfulness | focus on all sensations, perceptions, cognitions, and emotions as they arise moment to moment in the field of awareness |
| What are the health benefits of meditation? | reversal of coronary artery disease, decreased levels of cortisol, decreased cholesterol levels, increased airflow to lungs, and promotion of wound healing |
| Imagery | generate images that have a calming effect on the body. Involves a focused mind and incorporates all senses to create physiologic and emotional changes. |
| Guided imagery | images are suggested by another person |
| Benefits of imagery | anxiety reduction, decreased muscle tension, improved comfort during medical procedures, immune system improvement, decreased recovery time after surgery, reduction in sleeping problems |
| In the preoperative setting, it has been successful in decreasing anxiety and HR, providing distraction, and increasing the pain threshold. | Music |
| Music decreases _____ and ____ while evoking the _________ response. | anxiety, pain, relaxation |
| Music that contains approx. ____ to ____ beats/min is generally soothing. | 60, 80 |
| Fast-tempo music can be | stimulating and uplifting |
| What kind of music is best for relaxation? | Music with low-pitch tones and without words |
| 2 types of muscle relaxation | progressive and passive |
| Progressive muscle relaxation (PMR) | tensing and relaxing of muscles. Begin at the extremities and gradually move across the whole body. |
| Contraindications for PMR | muscle or connective tissue damage, low back pain, increased intracranial pressure, uncontrolled hypertension, severe CAD |
| Passive muscle relaxation | focus only on relaxation of muscles. muscles are never tightened. frequently used for chronic pain exacerbated by tension |
| Massage | involves systematic manipulation of soft tissue to reduce tension and enhance health and healing |
| Strategies for Clinical practice | Relaxation breathing, imagery, music, passive/progressive muscle relaxation, exercise, massage, meditation, art therapy, journaling |
| The role of the nurse in stress management is to | facilitate and enhance the processes of coping and adaptation. |
| Pain is: | Always subjective - it is what the client says it is Highly individualized (clients have different pain tolerances) |
| Nurses are _____ and ______ responsible for managing pain and relieving suffering. | ethically and legally |
| Providing pain relief is considered | a basic human right |
| Transduction | pain producing stimulus sends an impulse across a peripheral pain nerve fiber initiating an action potential |
| Neuropathic pain | abnormal processing of stimuli by the nervous system |
| Transmission | the movement of pain impulses from the site of transduction to the brain. |
| Perception | awareness and meaning of pain |
| Modulation | inhibition of the pain impulse |
| Protective reflex response | bypasses the brain. sensory impulses to spinal cord, synapse with motor neurons. Impulses sent along efferent fibers back to site of stimulation. Contraction of muscle - withdrawal from source of pain. |
| sensory component of pain | recognition of the sensation as painful |
| affective component of pain | emotional responses to the pain experience |
| behavioral component of pain | observable actions used to express or control the pain |
| cognitive component of pain | beliefs, attitudes, memories, and meaning attributed to the pain |
| sociocultural component of pain | demographics, support systems, social roles, and culture |
| Examples of adjuvant drugs | tricyclic antidepressants, antiseizure drugs, anxiolytics, antihistamines, benzodiazepines, caffiene, dextroamphetamine, corticosteroids |
| Step 1 | Pain - nonopiods for mild pain (aspirin, acetaminophen, NSAIDs), adjuvant drugs as needed. |
| Step 2 | Pain persists or increases - Opioids for mild to moderate pain (codeine, oxycodone), continue Step 1 drugs and adjuvant drugs as needed. |
| Step 3 | Pain persists or increases - Opioids for moderate or severe pain (morphine, hydromorphone, methadone), replace step 2 opioid, continue step 1 drugs and adjuvant drugs as needed |
| Does prolonged opioid use cause addiction? | 20% will abuse the pain medications 4% will become addicted to pain meds |
| Adult pain scale | 0-10; 0 = no pain, 10 = worst pain |
| Wong or Faces pain scale | used for children or those who cannot communicate |
| Pain assessment for cognitively impaired individuals | moans, grunts, cries, sighing, facial expressions, breathing, body movements, body tensions, consolability |
| "PQRSTU" - P | Pain pattern. What provokes, precipitates? |
| "PQRSTU" - Q | Quality. What does it feel like? Sharp, dull, achy... |
| "PQRSTU" - R | Radiates? Referred? Location, deep? |
| "PQRSTU" - S | Severity. Scales: adult, wong faces |
| "PQRSTU" - T | Time. When did it start? Duration? |
| "PQRSTU" - U | How does the pain affect "you"? |
| When it comes to analgesics, what is the basic rule of thumb? | "start low and go slow" |
| NSAIDS | for mild to moderate pain do not depress the CNS Ibuprofen, naproxen |
| Opioids | for severe or chronic pain monitor for constipation, urinary retention, sedation, respiratory depression |
| What is Narcan? | an opioid antagonist. reverses respiratory depression |
| What is Tegretol? | an anti-seizure medication that is used as an adjuvant "co-analgesic" medication |
| What are the benefits of pre-medicating a client before a painful procedure? | allows clients to cooperate more fully and reduces the experience of pain |
| What are the benefits of client administered opioids? | minimal risk of overdose (dosing and limits are set) clients gain control over their pain allows for maintaining constant plasma levels of the analgesic for sustained relief. |
| Basal rate | low-dose of continuous infusion programmed to be administered every hour |
| What are the nurse's responsibilities related to PCA? | EDUCATE CLIENT ON EQUIPMENT assess ability to locate and press button assess for pt IV access assess functioning equipment document amount used/frequency and any waste |
| Fentanyl patch | continuous opioid administration by self-adhesive patch |
| CAM treatments | acupuncture, acupressure, massage therapy, biofeedback, relaxation techniques, chiropractic therapy, prolotherapy, ozone injection therapy, platelet rich plasma injection, guided imagery, art therapy, music therapy |
| What are some professional responsibilities of the nurse regarding care of the client in pain? | assess all client's pain routinely report/document pt's pain collaboratively plan outcomes for relief collaboratively plan interventions follow through with interventions report what has been effective for managing pain |
| Circadian rhythm | the 24-hour, day-night cycle. Influence the pattern of major biological and behavioral functions: body temp, HR, BP, hormone secretion, sensory acuity, mood. |
| What affects circadian rhythms? | light temperature, social activities, and work routines |
| Stage 1: NREM | Lightest level of sleep. lasts a few minutes gradual fall in VS and metabolism easily aroused |
| Stage 2: NREM | Period of sound sleep lasts 10 to 20 mins relaxation progresses/body continues to slow arousal remains easy |
| Stage 3: NREM | initial stages of deep sleep lasts 15 to 30 mins muscles are completely relaxed/VS decline but remain reg difficult to arouse, rarely moves |
| Stage 4: NREM | deepest stage of sleep lasts 15 to 30 mins VS significantly lower than waking hours very difficult to arouse sleeper sleepwalking/enuresis sometimes occur |
| REM sleep | vivid, full-color dreams begins 90 mins after sleep rapidly moving eyes, fluctuating HR/RR, increased/fluctuating BP Loss of muscle tone very difficult to arouse duration increases with each cycle and averages 20 mins |
| When do dreams occur? | in both NREM and REM sleep |
| What kind of dreams occur in REM sleep? | more vivid, elaborate dreams that are important to learning, memory processing, and adaptation to stress |
| What are the functions of sleep? | conserves energy, body tissue and brain tissue restoration, cognitive restoration. |
| How does Illness inhibit sleep? | Illness causes pain, physical discomfort, anxiety, and depression. It may also require a person to sleep in a position they are not accustomed to. |
| Sleep apnea | A disorder characterized by the lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. |
| 3 types of sleep apnea | central, obstructive, and mixed |
| What is the most common form of sleep apnea? | Obstructive sleep apnea (OSA) |
| CPAP machine | Continuous Positive Air Pressure machine. |
| Insomnia | The most common sleep-related complaint. Chronic difficulty falling asleep, frequent awakenings from sleep, and/or a short sleep or nonrestorative sleep. Associated with poor sleep hygiene. |
| Narcolepsy | a dysfunction of mechanisms that regulate the sleep and wake states. EDS is the most common complaint associated with this disorder. |
| What are the most common complaints for the person with OSA? | Excessive daytime sleepiness and fatigue |
| Parasomnias | sleep problems that are more common in children than in adults. |
| Signs and symptoms of sleep deprivation | blurred vision, clumsiness, confusion/disorientation, irritable, apathetic, agitated, excessive sleepiness, decreased: reflexes, response time, reasoning/judgment, alertness, motivation, and increased sensitivity to pain |
| Excessive Daytime Sleepiness contributes to: | poor work/school performance accidents behavior/emotional problems |
| When assessing a pt's sleep health, the nurse should... | determine contributing factors to sleep deprivation |
| Promote good sleep habits | Go to bed - have a routine for sleeping Turn off the TV/Computer to decrease distractions exercise daily (2 hours before bedtime) Avoid caffeine, alcohol, nicotine, heavy meals prior to bedtime |
| Natural sleep aids | stress reduction, back rubs, light snack, comfortable mattress, herbal treatments (aroma therapy, melatonin, valerian, L-trytophan, magnesium) |
| Parmaceuticals to assist with sleep | pain relievers sedatives (give as a LAST RESORT. many side effects, may produce opposite effect) |
| What can a nurse do to decrease noise in the health care setting? | close doors to client's room keep doors to work areas closed when in use reduce volume of phone/paging equipment wear rubber-soled shoes turn volume down on equipment alarms turn off/down TV/radio Keep necessary convos at low levels in private areas |
| For sleep promotion in the health care setting: | plan care to decrease the amount of interruptions promote comfort: blankets, pillows, room temp, backrub |
| Morals | specific beliefs, behaviors, and ways of being derived from doing ethics. Fundamental standards of right and wrong. |
| Values | something of worth or something that is highly regarded. Concepts, ideals, and themes that give meaning to life. |
| Laws | a binding custom or practice of a community: a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority. Have enforced consequences and are not optional. |
| Ethics | A branch of philosophy, the study of ideal human behavior and ideal ways of being. A systematic approach to understanding, analyzing, and distinguishing matters of right and wrong. |
| Ethical code | systematic guidelines for shaping ethical behavior that answer the normative questions of what beliefs and values should be morally accepted. |
| Egoism | the theory that the pursuit of your own welfare is the basis of morality. |
| Utilitarianism | actions are evaluated according to the usefulness of their consequences. Attempt to promote the greatest good and inflict the least amount of harm. |
| Deontological principle | focused on duties and rules. Ethically bound to act only from a sense of duty. Consequences are irrelevant. Duties and laws are absolute and unconditional. |
| The categorical imperative | Act only on the maxim whereby thou canst at the same time will that it would become a universal law |
| Agape | Unconditional love |
| Autonomy | the freedom and ability to act in a self-determined manner. The right to generate personal decisions independent of outside interference. |
| Fidelity | strict observances of promises and duties |
| Beneficence | people take actions to benefit and to promote the welfare of other people |
| Veracity | Truthfulness (an unwillingness to tell lies) |
| Non-malfeasance | "Do no harm". If you cannot do good, you generally are required to at least do no harm. "intentionally refraining from actions that cause harm". |
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