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Flashcards in nur104 test 4 Deck (205):
1

What is Loss

the undesired change or removal of a valued object, person, or situation

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how is loss categorized

actual vs. perceived
physical vs. psychological
external vs. internal
loss of aspects of self
enviromental loss
loss of significant relationship

3

what is actual loss

death of loved one, theft, deterioration, destruction, & natural disaster can be identified by others no just by person experience

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what is perceived loss

internal only by person experiencing it

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what is physical loss

injuries, removal of organ, loss of function

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what is psychological loss

belief system sexuality, control, fairness, meaning & trust

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what is external loss

actual loss of object that importantb/c of cost or sentimental value

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what is internal loss

percieved or psychological loss

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loss of aspects of self

could be physical loss, psych & perceived (personality, developmental change(aging) hopes, dreams, faith)

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what is enviromental loss

change in familiar even positive changes (job, home) (perceived or actual)

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what is loss of significant relationships

actual loss of spouse,family member, divorce, seperation

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what is grief

physical, psychological & spiritual response to loss can interfer with health & delay healing

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what is mourning

actions associated with grief

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what is nereavement

mourning & adjustment time after loss

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what are factors affecting grief

significance of loss, amount of support, conflict, circumstances of loss, previous loss, developmental stage, spiritual & cultural background, timeliness of death

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what are types of grief

uncomplicated and complicated

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what are uncomplicated grief

abbreviated-process faster & anticipatory grief- letting go before loss

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what are complicated grief

chronic, masked,delayed, disenfranchised

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what is chronic grief

complicated begins as normal continues long term

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what is masked grief

complicated when grieving express through behavior

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what is delayed

complicated put off until later time

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what is disenfranchised grief

complicated not supported

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how is death defined

historical, heart-lung, whole-brain, higher-brain, uniform determination of death act

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what is historical

cessation of flow of bodily fluids

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what is heart-lung death

spontaneous respiration & circulation

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what is whole-brain death

all functions of brain including brain stem

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what is higher-brain death

higher brain functions (brain stem & resp could still be working)

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what is uniform determination of death act

loss of brainstem functions

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what is the physiological stage 1-3 mo prior to death

begins withdraw from world & people sleep increase food intake decrease

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what is physiological stage 1-2 wks prior death

host of physical changes begin lose ability maintain self cardio deterioration decrease BP, pulse change & skin color, resp rate increase or decrease apnea

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what is physiological stage days -hrs prior to death

surge of energy desire eat &talk get dehydrated decrease blood vol

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what is physiological stage moments prior to death

doesn't respond to touch sound short series long spaced breath before stops

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what is the end of life care

palliative and hospice care

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what is the end of life palliative care

cure no longer possible or refuse tx (comfort care)

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what is end of life hospice care

die within 6mo

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what are the psychological stages of dying (five stages (kubler-ross)

denial, anger, bargaining, depression, acceptance

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what are legal & ethical considerations

advance directives,DNR, assisted suicide, euthanasia, autopsy

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what is advanced directives

group instructions stating persons wishes (durable power attorney)

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what is DNR

do not resuscitate

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what is assisted suicide

making available needs for pt end his own life

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what is euthanasia

good death deliberate end of life one suffering terminal or incurable illness

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what is autopsy

examination of body determine cause of death

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what is assessment of terminally ill client & family

knowledge, history of loss, coping abilities & support, meaning of loss/illness, depression of grief, physical assessment, cultural & spiritual assessment

44

what is diagnosis for terminally ill pt & family

most norm loss grieving as problem, etiology, anticipatory grieving, dysfunctional grief AEB panic, hostility, regression, signs of deflated self-esteem

45

what are interventions for grief or loss

promote norm grieving , teach loss education through childhood help prepare in life, unse intervention based on stege person is in, encourage participation in support group, altered grief-professional help

46

what is therapeutic communication

perfect listening skills, encourage & accept expression of feelings, reassure not wrong feel anger, relief, or other unacceptable feeelings, respond nonverbal cues with touch, eye contact, increase self awareness, continue communicate even in case of coma

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what is care of the dying patient

meeting physiological needs
meeting psychological needs
addressing spiritual needs
addressing cultural needs

48

what is providing postmortem care

care of body , norm for nurse feel grief when dies must also take care of yourself

49

what are types of stress

eustress, distress, external, internal, developmental, situational, physiological, & psychological

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what is eustress

good stress

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what is distress

can threaten health

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what is external stress

RT family, enviroment

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what is internal stress

anxiety

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what is developmental stress

life stages

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what is situational stress

random, unpredictable

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what is physiological stress

affect body structure/function

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what is psychological stress

arise from life events

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what are maladaptive coping strategies

ineffective coping

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what is adaptive coping strategies

effective coping

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what are general approaches for coping

alter, adapt, & avoid stressors

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what are personal factors influencing adaptation

personal perception of stressor(how handle), overall health status, support system, hardiness, & personal factors

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what is stage 1 of adaptaion alarm fight or flight

endocrine system, sympathe nervouse system, CV, respiratory, metabolic, urinary, gastrointestinal, & musculoskeletal

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how is the sympathe nervouse system affect in stage 1

epinphrine or norepinephrine

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how is the CV system affected in stage 1

vasoconstriction elevated BP

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how is the respiratory system affected

dilated bronchioles

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how is the metabolic affected in stage 1

increased availability of glucose

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how is urinary affected in stage 1

sodium & water retention

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how is gastrointestinal affected in stage 1

decreased peristalis

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how is musculoskeletal affected in stage 1

increased blood flow to muscles

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what is the second stage of adaptation

resistance stage

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what is the second phase resistance stage

use coping mechanisms failure to adapt to stress leads to third stage

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what is the third stage of adaptation

exhaustion

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what is the third stage exhaustion

adaptive mechanism become ineffective/ nonexistent decrease BP, elevated pulse, respiration usually ends in death

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what is the third stage if adaptation is successful

recovery stage

75

what are response to stress

physical response local adaptation response involving specific body part, tissue, or organ

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what is another response to stress

psychological feelings, thoughts, behavior (anxiety & fear, ego, anger, depression)

77

what are consequences of failed adaptation in stress induced organic responses

continual stress, repeated CNS sti,ulation, elevation of certain hormones, results in long term changes in body system

78

what are consequences of failed adaptation of somatoform disorders

hypochondriasis, somatization, somatoform pain disorder, & malingering

79

what are consequences of failed adaptation of stress induced psychological responses

crisis, burnout, post-traumatic stress disorder (PTSD)

80

what is crisis

does not respond to adaptive activities
overwhelming
demands immediate response
produces change
brings unsolved problems
increased affect & decrease communication
require intervention

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what is focused assessment for ineffective coping to stress

lack of goal-directed behavior
inability to problem solve
unexplained fatigue
destructive behavior

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what is focused assessment for ineffective denial to stress

disavows knowledge meaning of event to decrease anxiety
delays in seeking care refuse tx
continues behavior that exacerbates condition

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what is diagnoses to ineffective coping to stress

life even tends produce crisis
observable anxiety
behavior & language disorganized
diificult to understand

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what is diagnoses to ineffective denial to stress

inappropriate use of denial as a coping behavior

85

what are planning expected outcome to stress tolererancce the pt will

be able identify stressors
demonstrate decreased stress
develop effective methods of coping with stress

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what is planning expected outcome for ineffective coping to stress the pt will

demonstrate effective coping behavior
effectively solve a problem
return to previous level of functioning

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what is planning expected outcome for ineffective denial to stress the pt will

demonstrate low to moderate anxiety receice facts of illness in positive manner

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what are stress reduction intervention health promotion activites

promote adequate nutrition, establish exercise routine, teach importance 7-8 hr sleep, specific intervention relieve anxiety, anger management, stress management tech(meditation, biofeedback, reiki, hmor), change perception of self

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what are interventions to improve coping skills

therapeutic relationships, enhancing social support, protecting vulnerable self, practice adaptive thinking (self suggestion, coping thoughts, inner dialogue), gaining control through knowledge

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what are interventions RT to crisis

prevent crisis by communicate clearly & anticipate situation
during crisis calm voice & slowly short phrases, avoid talking about future

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what are intervention help effectively manage stressors

focusing, reconstruction, compensating, stress managment skills (relaxing activities, meditation & prayer, creative activites, guided imagery, keeping a journal

92

what is evaluation of stress

maintaining effectiveness of coping abilities assess outcomes
reassess if outcome not met
adjust the care plan

93

what is gender

it is determined by chromosome structure XX female and XY male

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what are gender role

societal norms for behavior and old stereotypical males are breadwinners and females are nurses, teachers

95

what are concepts related to sexuality

gender identity and sexual orientation

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what is gender identity

internal feeling of maleness or femaleness transgender, transsexual, intersexed, crossdresser

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what is sexual orientation

its based on the gender of the person one is sexually attracted to heterosexual, homosexual, or bisexual

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what is transgender

think of self as female even if have male genitles

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what is transsexual

feels like women even though male appearance

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what is intersexed

ambiguous sexual organs internal ovaries external penis

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what is a cross dresser

also known as transvestite wears clothing of opposite sex

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what is heterosexual

attracted to opposite sex

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what is homosexual

attracted to same sex

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what is bisexual

attracted to both sexes

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what are factors affecting sexuality

culture, religion, lifestyle, knowledge about sex, health status, & social context

106

what other factors could affect sexuality

medication such as alcohol, antianxiety, anticonvulsants, antidepressants, antihistamines, antihypertensives, chemotherapy, opiods, & stimulants also decreased libido & sexual performance dysfunction

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what are concepts RT sexual health

state of physical, emotional, mental, & social well being RT sexuality

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what is required of sexual health

positive & respectful approach to sexual relationship, optimum expression of sexuality, & forms of sexual expression

109

what are sexual health

sexual response cycle and sexual expression

110

what is sexual response cycles

?desire, excitement, plateau, orgasm, resolution

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what is sexual expression

intimate relationships, fantasies & erotic dreams, touching, sexual intercourse, alternate sexual expression, celibacy

112

what are problem affecting sexuality

medical & relationships

113

what problems affecting sexuality does medical cause

STI's sexually transmitted infections, dysmenorrhea, premenstrual syndrome (PMS), sexual response cycle disorder (low libido, arousal disorder, orgasmic disorders)

114

how do relationship problem affect sexuality

negative intimate relationships, sexual harassment, rape, dysfunctional intimate relationship

115

what are concepts of rest

rest-physically/ mentally relaxed; refreshing

116

what are concepts of sleep

physiology of sleep cyclical states, decreased skeletal muscle activities, decreased metabolism, reduced consciousness

117

what are functions of sleep

restores energy, improves ability to cope, strengthens the immune system

118

what are the stages of non-rapid eye movement NREM sleep

stage 1 lightest sleep transition (5-10 min)5%
stage 2 eye movement stops 50%/sleep
stage 3 deep sleep diffulcult to arouse 8%/sleep
stage 4 no eye movement or muscle activity deepest sleep difficult arrouse 11%

119

stage V rapid eye movement REM sleep

dreaming high brain activity 20-30min 25%/sleep last cycle may last up to 60min

120

What is the sleep cycle

norm adult sleep 4-6 cycles nightly each last 100 min average 7-8hr range 5-10hr

121

what is the function of the sleep cycle

energy conservation & restoration

122

what are factors that affect sleep & rest

lifespan, lifestyle, sleep disorder

123

how long should newborns sleep

16-20hrs

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how long should infants sleep

min of 14hr/day

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how much sleep should school age & adolescents

they increase the need with growth spurts

126

how much sleep should elderly get

they need less sleep but more rest

127

what in lifestyle affect sleep & rest

enviroment, nutrition, exercise, sleep patterns

128

what are sleep disorders

insomnia, circadian disorder, restless leg syndrome, sleep deprivation, hypersomnia, sleep apnea, & narcolepsy

129

what is insomnia

inability fall asleep, remain sleep, or go back sleep

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what is circadian disorder

sleep wake schedule, time zone (jet leg), shift work

131

what is restless leg syndrom

disorder of CNS uncontrolled movement of leg low levels of iron & some antidepressants can cause

132

what is sleep deprivation

not actually a sleep disorder its a result of prolonged sleep distrubance result from NREM & REM

133

what is hypersomnia

excessive sleep especially in daytime

134

what is sleep apnea

periodic interruption in breathing during sleep

135

what is narcolepsy

chronic disorder caused by brains inability to regulate sleep-wake cycles normally

136

what is parasomnias

sleepwalking/talking, night terrors, substance-induced, nocturnal enuresis, bruxism, REM sleep behavior disturbance

137

What is pain

unpleasant sensory/emotional experience
can have destructive effects, warn of potential injusry, its a multidimensional experience

138

what are classifications of pain

origin, cause, quality, intensity, & duration

139

what is the classification of pain origin mean

superficial, visceral, radiating,or referred, phantom

140

what is the classification of pain cause mean

nociceptive
neuropathic

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what is the classification of pain quality mean

how the pain feels to the patient

142

what is the classification of pain intensity mean

subjective; use rating scale 0-10

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what is the classification of pain duration mean

acute, chronic, intractable

144

what is physiology of pain

transduction, transmission, pain perception, & pain modulation

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what is physiology of pain transduction mean

a process where nociceptors become activated by perception of potentially damaging mechanical, thermal, & chemical stimuli

146

what is physiology of pain transmission mean

its the peripheral nerves that carry the pain message to the dorsal horn of the spinal cord

147

what is physiology of pain perception mean

its the recognition in the frontal cortex and the brain recognizes and defines a stimulus as pain

148

what is physiology of pain modulation mean

it changes the perception of pain by either facilitating or inhibiting pain signal

149

what are factors the influence pain

past experience w/ pain
emotions, developmental, sociocultural factors, communication skills, cognitive impairments, other illness that contribute to pain

150

what are pain assessments

complete pain history, nonverbal signs of pain, & pain scale

151

what are nonpharmacological measures of pain management

cutaneous stimulation, immobilization & rest, cognitive behavioral interventions

152

what are pharmacological measures of pain management

nonopioid analgesics
Opioid analgesics

153

what are pharmacological measures of pain management that is nonopioid analgesics

NSAIDS & Acetaminophen

154

what are pharmacological measures of pain management that is Opioid analgesics

IV, IM, transdermal, & epidural form
patient controlled analgesia pumps-only pt push PCA button

155

what are special nursing consideration

managing pain in elderly, pts with addictions, & use of placebos

156

what are classifications of surgeries

purpose, degree of urgency, & degree of risk

156

what are increased surgical risk factors

age, personal habits, allergies, type of wound, preexisting conditions, mental status, & medication

157

what are perioperative nursing responsibilities

nursing history, assessment, preop screening tests, surgical consent, preop teaching, discussion, printed materials, prepare pt physically

158

how do you prepare pt physically for preop

assess NPO status, prepare skin: surgical scrub, bowel prep, facilitate empty bladder, administer preop medication, apply antiembolism stockings, & remove prostheses

159

what are intraoperative nursing responsibilites

sterile & clean team, anesthesia, skin prep, positioning, final verification, sterile field, moitor I&O, sponge, sharps, & instrument count, & documentaion

160

what are postanesthesia recovery unit (PACU)

recovery from anesthesia, airway management, vital sign/level consciousness, dressing assessment/drainage, fluid therapy, & pain control

161

what are postop nursing care

intial physical assessment, frequent vitals, dressing management, pain control, DVT prevention-SCDs, incentive spirometry/cough & deep breathing, early ambulation, & pt teaching

162

how are pt response to illness influenced by relationship

physical pathology
psychosocial health
overall wellness

163

what is psychosocial health theory

understanding people as a combination of psychological & social events

164

what is the self concept of psychosocial health mean

overall view of self

165

what are factors affecting self concets

gender, developmental, family & peers, internal/external influence

166

what are the components of self concept

body image, role performance, personal identity, & self-esteem

167

what are psychosocial illness

anxiety & depression

168

what is psychosocial illness anxiety

vague uneasy feeling of discomfort, threat, norm & abnormal, various levels, signs & symptoms

169

what is psychosocial illness depression

feeling of sadness diagnosed if depressed a day of two weeks, causes, S&S, & Tx

170

what is assessment of psychosocial

biological, psychological, & social details
functional abilities
self efficacy
family relationships
relationships with the wider social enviroment
interpersonal communication
social resources & networks
understanding current illness
usual coping mechanisms
health priorities

171

what is diagnosis of psychosocial

interrupted family processes, parental role conflict, risk loneliness, isolation, risk viollence to others, impaired social interaction

172

what is diagnosis of self concept

chronic low self-esteem, situational low self-esteem, disturbed personal identity, ineffective role performance, disturbed body image

173

what is outcomes for low self-esteem

identify stressors, positives, encourage own behavior, action needed to influence outcome, returns baseline or improves

174

what is outcomes for disturbed body image

physically adapt changed image mentally adapt to changed image

175

what are some interventions for preventing depersonalization

introduce self, pt preferred name, listen, eye contact, & touch, dont talk about pt in other rooms, move gently, explain all procedure

176

what are nursing interventions for promoting self esteem and self concept

feeling of acceptance, sense of competence, control, moral worth

177

what are nursing interventions for promoting positive body image

allow grieving process active listening help express anger, frustration, resentment

178

what are nursing interventions for facilitating role enhancement

communication between pt & significant other RT role responsibilities
describe realistic roles & responsibilities RT health changes

179

what are nursing interventions for anxiety

identify coping strategies(defense mech( calm & safe envirometn, identify triggers, use clear factual info

180

what are nursing interventions for depression

therapeutic communication, promote activity, good nutrition & hydration, provide support self care & decision making suicide prevention

181

what are types of sensory systems

vision, hearing, taste, smell, touch, kinesthetic

182

what are the purposes of sensory systems

provide info about internal & external enviroment
enable people experience world
allows response to changes
help maintain homeostasis
necessary for human growth & development

183

what are components of sensory experience

stimulus, reception, perception, arousal mechanisms, & response to sensation

184

what does the stimulus do

stimulate receptors (loud noise, bright light, sour fruit)

185

what is perception

ability interpret sensory impulse give meaning to impulse

186

how is perception affected

location, number of receptors activated, frequency of action & changes

187

what is the arousal mechanism

composed of consciousness & alretness mediated by RAS (reticular activating system)

188

how is the arousal mechanism affected

enviroment & medication

189

what is the response to sensation

it requires people to be alert & receptive to stimulation

190

what are factors that affect the response to sensation

intensity of stimulus. contrasting stimuli, adaptation to stimuli, & previous experience

191

what are factors that affect the sensory function

age/stage of life
culture
illness
medication
stress
personality
lifestyle

192

what are sensory alterations

sensory deprivation & overload
impaired vision, hearing , taste, smell, tactile perception, & kinesthetic sense, & seizures

193

what is a general assessment of sensory system to health history & physical to gather data RT

factors affecting sensory perception (visual, auditory, & dental exam)
mental status
level consciousness
recent changes in sensory stimulation
use of sensory aids
clients enviroment
support network
focused examination of affected sense

194

what is diagnosis for sensory deficits

disturbed sensory perception-actual sense & cause
risk for disturbed sensory perception
acute confusion
chronic confusion
impaired memory

195

what is diagnosis for related sensory diagnosis

risk for injury
imbalanced nutrition less than body requirements
impaired verbal communication
social isolation
self care deficit
disturbed thought processes

196

what are planning outcomes for sensory deficit

pt does not experience injury
outcome specific to deficit

197

what are planning outcomes for sensory deprivation

pt remains oriented to person, place, & time
short term may include using adaptive equipment

198

what are planning outcomes for sensory overload

pt remains oriented to person, place, & time
short term planning may include decreased anxiety, lucid communication, reports excessive stimuli, establish routine sleep-wake cycle, positive coping behavior

199

what are nursing interventions for sensory deprivation

focus prevention, support senses(sensory stimulation(glasses, hearing aids), orientation-calendar; view of enviroment, provide stimuli-reg contact;touch, television/radio, pet therapy, smells

200

what are nursing interventions for sensory overload

minimize stimuli-less light, noise, less tv/radio, calm tone, reduce noxious odors
provide rest & teach stress reduction

201

what are nursing interventions for impaired vision

attend to glasses, sufficient light, protect eyes in sunlight, magnifying lens/lg-print books, evaluate-ability perform ADLS, remain safe in enviroment, & need for assistance(seeing eye dog)

202

what are nursing interventions for impaired hearing

care for hearing aid, closed cation tv, reg inspection of ear canal, techniques to improve communication, promote safety, assess for social isolation

203

what are nursing interventions for the confused patient

reorient frequently(state name,day,time,provide clocks,calenders,visual clues to time, use personal belongings,maintain safe enviroment, communicate clearly slowly(respond to feeling & use gestures), limit choices, promote feelings of security, use alternative therapies

204

what are nursing interventions for the unconscious patient

continue orientation to reality, safety measures(bed low position, side rails up), attend to body systems(eye care, ROM, skin care/mouth care, urinary drainage, bowel management, nutrition