Test 8

Question 1

loss and grief

Answer 1

• experienced throughout the lifespan
• grief behavior is shaped by values, culture but grief itself is universal
• grief is a normal response to loss

Question 2

situational loss

Answer 2

• sudden, unexpected, external
• exp: car accident
• loss of person, object, limb, functuion, role

Question 3

maturational loss

Answer 3

• part of life transition, know it is coming, expected

- nurses can help develop coping skills and prep patients for transition- exp: menopause and old age

Question 4

anticipatory grieving

Answer 4

• before an expected event

- exp: terminal illness

Question 5

palliate care

Answer 5

• control of symptoms throughout an illness including bereavement care for family
• not curative

Question 6

hospice care

Answer 6

• 6 months or less to live per Dr. order
• final stage of palliative care
• patient and family with terminal diagnosis
• client and family centered

Question 7

normal, uncomplicated grief

Answer 7

• anger, disbelief, yearning, depression, acceptance

- time to recovery varies, 6 months

Question 8

complicated, dysfunctional grief

Answer 8

• persists greater than 6 months
• interrupts life
• may follow sudden death, death of a child

Question 9

disenfranchised, unsupported grief

Answer 9

• cannot grieve loss openly
• cannot acknowldege loss
• exp: abortion, miscarriage, loss of partner (not liked, not ok to love)
• same as any grief with less/no support

Question 10

factors influencing grief and loss

Answer 10

• age/development:
• children - understanding and behaviors depends on developmental stage
• young adults - experience maturational loss
• midlife - more maturational losses
• older - prior experiences may help coping
• meaning of loss or person: affects the grief response and support
• elderly are at greated risk for lonliness, decrease people in your lives
• coping mechanisms/strategies: people use what has worked before, may need new strategies, suggest expressing feelings
• culture: influences acceptable expression of grief, rituals around death, who is included as family (spudse then parents then children then siblings)
• spiritual belief: influences end of life care, rituals around death, belieg about afterlife
• hope: ability to see life as having meaning, important for nurses

Question 11

nursing process for grief

Answer 11

• know yourself and beliefs, do not push them on others
• take care of yourself
• listen
• respect others beliefs
• dont take negative behaviors personally
• involve patient and family in planning

Question 12

Grief assessment

Answer 12

• establish a relationship first
• assess factors like coping style, meaning of loss, belifes about death, suport
• use open-ended questions
• observe verbal and nonverbal responses
• summarize and validate
• may need to talk to patient and family separately
• assess understanding of treatment options, encourage family involvement, asses other possible causes of symptoms (loss of appetite related to grief?)

Question 13

grief nursing diagnoses

Answer 13

• may address the loss directly or effects
• “hopelessness r/t loss of child AEB social isolation and inability to maintain employment”
• ## “nutirtion less than body requirements r/t decreased appetite and motivation 2nd to grief over loss of child”

Question 14

grief nursing implementation

Answer 14

• facilitate health coping, growth
• enhance quality of life: alleviate symptoms, promote dignity, prevent complications
• therapeutic communication: active listening,

Question 15

insomnia

Answer 15

1) difficulty falling asleep
2) intermittent sleep, waking up and looking at the clock a lot
3) early awaking no matter bed time

Question 16

NREM

Answer 16

• parasympathetic nervous system dominates: rest and digest, decreased pulse/RR/BP/metabolic rate and body temp
• 75%
• 4 stages
  1) makes up 5% of sleep time. light, easily arouse
  2) makes up 50% of sleep.
  3) makes up 10% of sleep time
  4) makes up 10% of sleep time, greatest arousal threshold
• 1&2 = 50% of sleep time, easily aroused
• 3&4 = 20% of sleep time, slow wave and delta sleep

Question 17

REM

Answer 17

• 20-25%
• more difficult to arouse someone
• if awakened durnig REM the person usually remembers dreams
• during rem: increased pulse/BP/RR/metabolic rate/temp
• muscle tone and deep tendon reflexes are depressed
• needed for mental and emotional equilibrium
• plays a role in learning, memory and adaptation
• cycles are longer as morning approaches
• more of the deep sleep is in the first half of the night, the delta stage
• sleep architecture: alternating between the REM and NREM sleep cycles

Question 18

somnambulism

Answer 18

sleep walking

Question 19

sleep hygeine

Answer 19

• decrease smoking
• decrease exercise with 2 hours before bed
• read a book, warm bath before bed

Question 20

hypothalamus

Answer 20

• center for sleeping and waking

Question 21

neutotransmitters

Answer 21

• norepinephrine, acetylcholine, dopamine, serotonin, histamine
• gamma-amimobutyric acid (GABA) is needed for inhibition

Question 22

sleep cycles

Answer 22

• usual pattern: 1,2,3,4,3,2,REM,2,3,4,3,2,REM
• if you wake up at all you always start back at 1
• most people go through 4-5 cycles a night
• each cycle is 90-100 minutes
• everyone is different with their sleep requirements
• 12 hour shifts have been identified as a factor in an increase in the number of errors at work

Question 23

factors influencing sleep

Answer 23

• frequent hospitalization
• anything that causes pain, anxiety, discomfort (full bladder)
• resp issues
• nocturia, disrupts sleep
• environment: noise, smells, light levels, interruptions, sleeping alone (without significant other)
• medications: may interfere with REM, sleep cycle, flushing, vivid dreams
• lifestyle: changes in sleep/work/play pattern, shift work, social activities, stay on schedule
• emotional stress
• exercise and fatigue - 2 hours before sleep
• food intake: caffein, alcohol, stimulents
• alcohol causes early sleep then waking
• give small carb snack before bed
• better sleep if you quit smoking

Question 24

illness and sleep

Answer 24

• gastric secretions increase during REM sleep: GERD, gastric reflux, peptic ulcers
• seizures more likely to happen during NREM sleep
• hypothyroidism decreases NREM sleep
• hyperthyroidism increases the difficulty in falling asleep
• liver failure and ecephalitis tend to reverse day night sleep habits
• End stage renal failure disrupts sleep and leads to daytime sleepiness
• chronotherapeutics: giving meds in regards to biologic rhythms to indluecne drug tolerance and effectiveness

Question 25

Insomnia

Answer 25

• acute: less than 4 weeks
• chronic: 5-6 months
• persistent: more than 6 months
• associated health conditions: obesity, type 2 DM, psych disorders, heart failure, stroke, hypertension, MI
• most MIs happen at night
• hypertension makes it harder for the body to get into REM sleep

Question 26

sleep patterns

Answer 26

• infants: 12-16 hours
• toddlers: sleep time decreases with age, 10-12 hours
• adolescents: may need much more sleep than they get (7 hours) leading to poor concentration
• young adult: need 6-9 hours to function at peak
• middle age: deep sleep declines, emotional and physical issues may cause insomnia
• older adults: 50% have sleep problems retated to physical illness/pain/nocturia. may increase confusion during daytime and at night

Question 27

sleep apnea

Answer 27

• obstructive is most common
• client may not be aware of waking
• usually sig others complain of snoring
• causes increased risks: cardiac problems, HTN, stroke,sexual dysfunction, >10 secs of no breathing
• anesthesia causes temp obstrucitve sleep apean, monitor and position. hyperpharynx can collapse
• sleep deprivation: chronic lack of sleep (nurses, students, patients)
  person stops brathing or diminshed breathing during sleep between snoring intervals
• 10-20 secs without breath, even up to two minutes
• 02 levels in the blood drops, pulse becomes irregular and BP increases
• many people have excessive daytime sleepiness

Question 28

narcolepsy

Answer 28

• uncontrollable desire to sleep
• neurologic disorder
• can fall asleep driving, standing, swimming
• presence of two of these confirms diagnosis:
  1) sleep attacks: irresistable urge to sleep
  2) cataplexy: sudden loss of motor tone that cuases the person to fall asleep
  3) hypnagogic hallucinations: nightmares of vivid hallucinations. sleep-onset REM. during sleep attack the person goes directly into REM
  4) sleep paralysis: skeletal paralysis during the transition from awake to sleep

Question 29

obstructive sleep apnea

Answer 29

• airway occludes becayse hypopharynx collapses
• more than 2x cardiac deaths during sleeping
• treatment: remove tonsils, CPAP

Question 30

restless leg syndrome

Answer 30

• irresistable urge to mvoe the legs
• usually the calves
• diagnosis: urge to move legs, rest-induced, gets better with activity, evening symptoms more severe
• 10% of population has it
• can also happen in a chair

Question 31

parasomnias

Answer 31

• behaviors that happen when awake that appear during REM and NREM
• somnambulism, sleep talking, night terrors, bruxism (teeth grindign, enuresis (bet wetting), eating

Question 32

nonpharmacological approaches to improving sleep

Answer 32

• cognitive behavioral therapy
• sleep hygeine: how to change lifestyle to accomodate beter sleep patterns
• stimulus control: use the bedroom for sleep and sex only
• sleep restriction: only be in bed when asleep, if you can’t sleep get up and do something
• sleep diary: helps determine sleep patterns

Question 33

sleep assessment

Answer 33

• usual sleep patterns
• recent changes
• describe typical night
• impact on function, ADLs
• contributing factors
• bedtime routine

Question 34

sleep nursing diagnoses

Answer 34

• stem -> etiology/RT -> AEB/proof
• ineffective breathing pattern R/T obstruction of airway 2nd to sleep aprea AEB snoring,daytime drowsiness
• risk for injury R?T daytime drowsiness