Test 4 Study Guide (Grief, End of Life Care, Stress and Coping) Flashcards
Physical (Physiological) Response to Stress
- headache
chest tightness
SOB
Hypertension
negative/pessimistic
anxiety/depression
Fight or Flight Response to Stress
*Physical responses
- Increase HR, BP, RR, oxygen, cardiac output
- Increase in blood glucose from our liver
- Increase mental alertness and more focused
- Increased clotting ability in blood
- Bronchial airways dilate
- Pupil dilatation (get bigger to take everything in)
- Decreased pain perception: cannot feel pain
- Decreased hearing
- Decrease salivation and digestion
- Muscles tense and trembling
- Sweaty palms
General Adaptive Syndrome
- Process your body goes through when exposed to positive or negative stress triggered by physical or psychological stress
-Body’s attempt to maintain homeostasis = body will attempt to return to steady state of internal, physical, and chemical balance and maintain optimal functioning
*Stages
1- Alarm: Fight or flight, initial recognition of stress, CNS stimulation,
2- Resistance: severe stress that has lasted long, parasympathetic nervous system, body resists, counter stress, body alert, hormone and body functions return to normal, body repairs damage caused by threat
3- Exhaustion: if our body cannot fight stressors anymore, cannot stand it anymore, ran out of resources, may result in illness/disease: chronic hypertension, depression, diabetes, autoimmune disorders, infections, inflammation, CV disease, arthritis, psoriasis, IBS, cancer
Types of Stress
*Acute: most common, brief, trigger flight or flight, chest tightness, headache, GI, irritability, sweaty palms, SOB
*Episodic: Multiple episodes of acute stress piled on. Work problems, too much responsibility, disorganized and rushed, tension headache/migraines, hypertension, pessimistic outlook, negative worldview and impact
*Chronic: Consistent, prolonged, heightened state of stress, think they have little to no control, continuous activation of nervous system, leads to chronic health problems: anxiety, depression, suicide, cancer, cardiovascular, disease >Stressors: poverty, life problems, racism, illness, disease, dysfunction family system
Post Traumatic Stress Disorder
- In response to a prolonged heightened stress
- Symptoms lass longer than a month
- Not everyone who exp
- Manifestations: flashback, intrusive reoccurring thoughts or memories, nightmares, sweating,
Crisis: Crisis Intervention
Coping Strategies
*Healthy: meditate, yoga, journals, dieting,
*Not Healthy: drinking, smoking, drugs, over eating
Defense Mechanism
A.K.A. Ego Defense Mechanism
- Denial
- Rationalization
- Projection
- Repression
- Regression: I just want to be taken care of
- Compartmentalization
- Conversion
- Compensation
- Displacement
- Identification
Hospice Care
*Criteria for admission
- Have to have a terminal illness
- Dr. has stated you have less than 6 months and is terminally ill
- Accept to stop treatment to cure or control illness
- Medications can be given
- Can get out of or get kicked out of hospice
- Allow them to live the last days of their life as best as they can and for as long as they can
- Primary caregiver, close friend or family
- Usually in their home or, hospital, extended care facility, inpatient hospice
Respite Care
- Associated / apart of hospice
- Caregivers to provide support for the family / gives family a break
*running errands, housekeeping, transportation, childcare assistance, visitations
Palliative Care
- Chronic or terminal illness
- Can continue treatment for illness but still aware they will probably still die, maintaining highest quality of life
- No time rules
- Provided before identification of terminal illness
- Does not matter on the life expectancy
- Advanced stages of cancer, renal failure, respiratory failure, neurodegenerative conditions (Alzheimer’s and Parkinson’s)
Pain Control
- Critical to ensure relief and do not suffer unnecessarily, nurse promote pain management, ethical responsibility to alleviate pain/suffering
-Pain can be from nerve injury, organ stretched and compromised, bone pain - Nonopioids and opioids (educate on constipation, nausea, vomiting, sedation, respiratory depression, myoclonus, addiction but irrelevant)
- Three-step ladder approach: Strong opioid plus non-opioid and adjuvant analgesics
- Non-steroidal and anti-inflammatory drugs (NSAIDS)
- Codeine or tramadol
- Morphine
- Diversion
- Relaxation exercises
- Imagery
-Massage therpy - Breathing exercises
- Music
- Spiritual
-Lighting/noise changes - Repositioning
- Heat or cold
Planning Care
*Patient advocacy
- Social Isolation
- Dignity and sense of control
- Spirituality
- “Good death”
- closure
Physical Changes During Dying Process
(pattern referred to “actively dying” or “imminent death”
*Nursing care/ interventions
-Dyspnea (shortness of breath or labored breathing):
*Morphine to widen blood vessels to increase blood flow, reduces sense of difficulty breathing, decrease anxiety
*Oxygen therapy to relief labored breathing and psychological comfort to family
*Fan for comfort and moves air around which reduces exertion
*Anxiolytics (Benzos) to relieve anxiety
-Death rattle (secretions trapped/rattling around in upper airway) hrs. to days before death
*Repositioning/ turn head to side and rolling to the side
*Oral atropine drops, scopolamine patches
*Oral suctioning to eliminate secretions from mouth, deep suctioning is not effective
-Cheyne - Strokes (period of breathing that increases then slows down repetitively=apnea, not responsive or alert) within days of death
*Fan to blow lightly of client, family education that breathing is typical and expected
-TEMPERATURE: cannot regulate body temperature
*infection, cancer, cancer therapy, opioids, blood transfusion reactions, pain, hypoxia, fear, anxiety, environment **hot/cold compress, warm sponge bath, hypothermia blankets, adjust heat, ac, fan, antipyretic meds: acetaminophen, ibuprofen, naproxen, aspirin
*Mottling is the hearts inability to pump blood effectively that leads to decreased blood perfusion, begins in feet and moves up, indication of impending death, no discomfort, cold to touch **Interventions: comfortable and warm blankets
-HEARING/VISION: Hallucinations *Just roll with it, support them, make sure they are safe
> G.I. / G.U.: stop eating, become incontinent, stop producing urine, do not need fluids, *We can treat it, but not expected to have normal BM/UO, their organs will shut down, provide education
>Vascular changes: mottling in the skin due to lack of blood, cold to the touch
Post-Mortem Care
*How to care for patient/body: washing the body, keeping their eyes and mouth closed, accounting for client’s possession’s, removing invasive devices such as IV’s, catheters, change dressings, at least two ID tags (toe, arm, outside of body bag), provider states time of death and cause, documentation, names of anyone notified, location and belongings, where the body has been transported (funeral home name), leave in dentures, do not shave
*How to care for patients family: allow the family to stay with patient for as long as they want, but provide good education on what to expect: bruising or changes in their skin color
