Nursing 106 Final Exam Flashcards
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1
Q
State of emotional, psychological, and social wellness
A
Mental health
2
Q
Able to deal with normal emotions Has satisfying interpersonal experiences Productive Can adapt to change Can cope with adversity Demonstrates a positive self-concept
A
Characteristics of a mentally healthy person
3
Q
Self determination
A
Autonomy
4
Q
Responsibility for one’s self
A
Independence
5
Q
Maximization of ones potential Tolerance of life's uncertainties Self-esteem Mastery of the environment Reality orientation Stress management
A
Components of mental health
6
Q
The relationship between the nurse and the client is..
A
The essence of nursing
7
Q
Also referred to as the helping relationship
A
Therapeutic nurse-client relationship
8
Q
The context for the professional role of the nurse as a communicator
A
Therapeutic nurse client relationship
9
Q
Purposeful connections guided by the nurse Professional boundaries clearly defined Specific purpose Goal directed Definite beginning and ending
A
Characteristics of a therapeutic relationship
10
Q
Mutual satisfaction of needs Emotional commitment to each other General purpose No specific goal Ending undefined, ongoing
A
Characteristics of a social relationship
11
Q
The total environment in which the communication occurs
A
Context
12
Q
Set of pre-established guidelines and expectations that direct the course of nurse-client interactions
Protect the public through state nursing practice standards
Legally regulated in each state
Established by professional nursing organizations to reflect values and priorities of nursing profession
Define nurses accountability to the public
A
Standards of nursing practice
13
Q
First step of nursing process
The collection of information about the client and family
Identifies the clients needs and concerns
A
Assessment
14
Q
Second phase of the nursing process
Critical analysis and interpretation of data collected
A
Diagnosis
15
Q
Third phase of nursing process
Criteria used to evaluate effectiveness of nursing care
Established collaboratively by nurse and client
Define desired outcomes
A
Outcome identification
16
Q
Fourth step of the nursing process
Consists of establishing priorities from problems identified in nursing diagnosis
Process of nurse selecting interventions to achieve the outcomes
A
Planning
17
Q
Fifth step of nursing process
Involves the implementation of the interventions identified in the plan of care
Nurse carries out the interventions
A
Implementation
18
Q
Sixth step of nursing process
Determines progress toward desired outcomes
Did the interventions work?
A
Evaluation
19
Q
Value of nursing
Caring, compassion
A
Altruism
20
Q
Value of nursing
Equal opportunity and access to health care facilities for all individuals
A
Equality
21
Q
Value of nursing
Right to make choices regarding health care decisions, right to self determination
A
Freedom
22
Q
Fourth and fifth values of nursing
A
Human dignity and respect
23
Q
Value of nursing
Just distribution of resources and honesty
A
Justice and truth
24
Q
Quality of nurse client relationship Should reflect genuine feelings Expression is mainly nonverbal Must be accompanied by other communication techniques By itself it isn't sufficient
A
Warmth
25
Quality of nurse client relationship
Communicates that the client is valued
In conjunction with warmth = unconditional positive regard
Involves acceptance of others for who they are
Client is regarded as a person of worth
Nurses attitude must be nonjudgmental
Discuss ways to demonstrate respect
Respect
26
Quality of nurse client relationship
Authenticity
Openness, honesty, sincerity
Conveyed by congruent and clear communication
Genuineness
27
Quality of nurse client relationship
Communicates to others that we understand how they are feeling
Involves unconditional acceptance of client
"your pain in my heart"
Temporariy living in clients life without judgment
Also involves maintaining separateness from client so boundaries are not violated
Empathy
28
Quality of nurse client relationship
Therapeutic technique to convey understanding to client
Reveals thoughts, feelings, personal experiences in an appropriate way
First determine if self disclosure will benefit the client
Use professional judgment to determine the use of self disclosure
Nurse also has to be comfortable revealing the information
Self disclosure
29
Exception to clients right to confidentiality
Based on California supreme court decision in Tarasoff vs. regents of university of California
Must warn police and third parties if client threatens their safety
Duty of warn
30
Exception to clients right to confidentiality
| Parents have right to information about their children unless emancipated or over age 18
Minor children
31
Decision should result in greatest good or produce least harm to the client
Beneficence
32
Equality, fairness, just distribution of resources
Justice
33
```
Detailed
Clear
Concise
Concrete
Focused
```
Specificity
34
Provides temporary relief from fear and anxiety
Decreases tension
Encourages positive interaction
Promotes trust and healing
Consider timing, content, context, clients receptivity
Avoid negative humor that is racist, sexist, ageist, or degrading
Humor
35
Elusive concept
Broader than formal religion
Involves finding meaning in pain and suffering
Helps clients find meaning in pain and suffering
Avoid imposing ones own spiritual beliefs and values onto clients
Discuss ways of meeting spiritual needs appropriately
Spirituality
36
Most clients are admitted to an inpatient setting voluntarily
Voluntary hospitalizations
37
Clients who do not wish to be hospitalized and treated
Involuntary hospitalizations
38
Clients have right to treatment in what kind of environment to meet their needs
Least restrictive environment
39
Boundary violation
| Ex. Using client for business purposes, developing friendships for clients, becoming sexually involved with clients
Over involvement
40
Boundary violation
Ex. Failing to attend to client treatment needs, maintaining superficial relationship, following nurses agenda, not addressing problems in sufficient detail, avoiding clients
Under involvement
41
First theorist to describe nurse client relationship as foundation of nursing practice
Dr. Hildegard Peplau
42
Phase I of nurse client relationship
| Only phase in which client is not active participant
Pre-Interaction Phase
43
Task of pre-interaction phase
Prepare for interview, develop goals and arrange for private setting
44
Phase II of nurse client relationship
Formal relationship begins
Begins when nurse and client meet
Ends when client begins to identify problems
Convey that relationship will be a partnership
Provide basic information, introduce self
Help client identify goals and problems
Develop trust
Orientation phase
45
What is the important responsibility of orientation phase?
Develop therapeutic contract
46
Not a legal contract
Usually verbal
Provides structure and guidelines for the relationship
Establishes role expectations
Determines mutually agreed upon goals
Identifies parameters of confidentiality
Sets frequency, time, and place of meetings
Therapeutic contract
47
Third phase of nurse client relationship
Nurse and client focus on meeting goals established in orientation phase
Active involvement in problem solving
Implement plans of action
Working phase
48
Fourth phase of nurse client relationship
Therapeutic relationships have predetermined ending
Occurs when outcome criteria are achieved, client is discharged or insurance runs out
Phase bound by time restrictions established during orientation phase
Termination phase
49
Prepare client for termination phase when?
First interview
50
Indicate how many interviews will take place
Begin to space interviews further apart
Begin to decrease amount of time of each contact
Periodically remind client of number of meetings remaining
Summarize major achievements
Encourage client to express feelings
Make referrals as necessary
Termination phase
51
Discourage discussion of new issues
Maintain boundaries of relationship
Stay within time frame of original contract
Termination phase
52
```
Communication conflicts with other health professionals
Value conflicts
Cost containment measures
Violation of professional boundaries
Violation of confidentiality
Client dependency
```
Barriers to relationship
53
Demonstrating sympathy rath than empathy
Client dependency
54
Attributing characteristics to a group of people assuming that all persons in the group possess them
Stereotyping
55
Universal tendency of people to think that their own ways of thinking and behaving are the only right ways
Ethnocentrism
56
Confusion regarding meaning of words
| Confusion regarding tone and volume of voice
Language difficulties
57
Most of the meaning of a communication transaction is transmitted how?
Nonverbally
58
Demonstrate that the nurse is paying attention to what a client is saying.
Attending behaviors.
59
In therapeutic communication, you must avoid:
```
Making assumptions
"You" statements which suggest blaming
Advice giving
Double questions
"Why" or "How come" questions
Ambiguous, vague, unclear comments
Generalized statements
Incongruent messages
```
60
Provides time for the client and nurse to think. Must be used strategically. Should be brief. Avoid long _____, especially with adolescents.
Silence
61
Also referred to as door-openers. Indicate encouragement to continue talking. Verbal responses such as "hmmm hmmm", "go on", "yes", or "uh-huh". Use sparingly. Convey that the nurse is listening.
Noncommittal encouragers
62
Repeats the words of the client. Restate exactly, change only the pronoun, communicates that the nurse is listening, encourages the client to continue talking, use in moderation and only as a point in emphasis.
Restatement
63
Restates the part of the client's statement that is most significant. Ex: Client says, "I was going to a movie but my friend told me not to go and that I should study for the chemistry test." The nurse says, "Your friend told you that you should study for chemistry."
Selective restatement.
64
State the client's original message into the nurse's own words. Keep the original meaning. Change as many words as possible. Ex: Client says, "I want to drop chemistry, but I won't be able to get into the nursing program in the fall." Nurse says, "You don't want to continue in the course, but you won't have the required prerequisites for the nursing major."
Paraphrasing
65
Select the main idea. Use the nurse's own words. Make the statement more concise and to the point. Change as many of the client's own words as possible. Ex: Client says, "I am fighting with my husband and he starts sulking and leaves the house, so we never get anything worked out between us." Nurse says, "You are having arguments with your husband, but nothing has been resolved."
Selective paraphrasing
66
Focuses on the emotional aspects of the message. Puts into the words the feelings the client's comments. Helps the client clarify and bring feelings to the surface that are not being expressed. Ex: Client says, "I was fired yesterday. My boss has no respect for all that I have done the past 30 years. The company treats me like I never existed." Nurse says, "You feel unappreciated."
Reflection
67
Pulls together several main ideas. Reduces long interaction to few concise sentences. Can be used at end of interview. Can provide continuity from one interview to the next.
Summarization
68
Helps the nurse understand clients messages by asking for more information. Helps clients understand their own messages. Makes vague messages clearer. Often stated tentatively or phrased as a question. Ex: "Could you go over that again?" "Tell me more about that." "I'm not sure what you mean."
Clarification
69
Focus is on the underlying meaning of the message. Goal is to fully understand what the client is communicating. Requires an active interpretation of the message. Conveys acceptance, warmth, empathy, and respect. State the client's feelings that may not have been expressed verbally in your own words. Combine Reflection and Paraphrase. Ex: Client says, "No one pays any attention to me. I should just stop going to the meetings. It's a waste of my time." Nurse says, "You are angry that you are being ignored when you attend the meetings."
Active listening
70
What are direct questions punctuated with?
A question mark
71
What are indirect questions punctuated with?
A period.
72
Used to obtain facts, clarify information, compare information, verify observations, and interpret meaning of facts.
Direct questions
73
Type of direct question that is broad, solicits the client's views and opinions, thoughts, and feelings, is similar to an essay question on a test, and often begins with "what" "How" and "in what way".
Open direct question
74
Type of direct question that is narrow, limits the client to a specific answer, demands facts only, limits expression of feelings, and resembles multiple choice or true-false questions with forced responses.
Closed direct question
75
What type of question is more effective in the therapeutic interview?
Open
76
Why are open questions more effective in the therapeutic interview?
Closed questions block spontaneous communication and free flow of information and may require more and more questions to obtain the information.
77
What are some situations in which closed direct questions are appropriate?
Emergencies (suicide or crisis), Information is needed quickly, only specific or factual information is needed.
78
Type of indirect question that inquires without seeming to do so and leaves the field wide open for the client to respond. Often begin with "tell me" "I wonder" or "I would like to hear about"
Open indirect question
79
Type of indirect question that is more focused and asks for specific information
Closed indirect question
80
Encourages the client to select a specific topic to discuss, helps the client expand or be more specific.
Focusing
81
Communicates how another person's behavior affects us
Feedback
82
Assist client in gaining insight and self awareness and in developing more effective communication skills
Purposes of feedback
83
Determine motivation for giving feedback. Give only if relationship is solid and trust has been established. Give only if it is in the best interest of the client and only with a desire to be helpful. Gain permission from the client before giving feedback. Remember that feedback must be solicited!
Principles of feedback
84
With feedback, what kind of behavior should you focus on?
Observable behavior
85
What kind of comments should you provide with feedback?
Specific comments
86
In what manner should you never give feedback?
A judgmental manner
87
When should you give feedback?
Close to the event, timed well. Also when the client is ready to receive it.
88
How should you describe the behavior when giving feedback?
In respectful factual terms, do not evaluate the behavior
89
Where should you give feedback?
In a private location to maintain confidentiality
90
In what way should you direct the feedback for the behavior?
Direct it towards behaviors the client cnan control and change.
91
What is the formula for feedback?
Describe the client's behavior without judging it and be specific. Describe concretely how the behavior affects you. Describe what response or change you would like. Check the receiver's reactions to determine how he or she is feeling about your comments. Ex: "When you yell at me, I get scared. I wish you would just tell me what you think without yelling. How do you feel about that?"
92
Saving what one thinks, feels, or wants in a direct, respectful way. Setting goals, acting on these goals in a clear and consistent manner. Taking responsibility for the consequences of those actions.
Assertive behavior
93
Can assertiveness be learned?
Yes
94
A response that disregards the rights of others. Often loud, forceful, and confrontational. Places undue responsibility on others. May lead to physical or verbal violence.
Aggressive behavior.
95
A response that disregards one's own needs and rights to avoid conflict. May involved remaining silent or accepting unfair comments.
Nonassertive or Passive behavior
96
What is the formula for assertive responses?
```
D.E.S.C. script:
D: Describe the situation
E: Express what you think and feel
S: Specify your request.
C: Express the consequences of responding (or not responding) to the request.
```
97
What are the advantages of Electronic Communication in health care?
Convenient easy and efficient
Fastest way to transmit knowledge and info
Distance is not a factor
Cost effective
Can communicate with many people at once
Can attach documentation
Recipient can think before responding and return messages when convenient
98
What are the disadvantages of electronic communication in health care?
Information on Internet may not be reliable or valid
Not everyone has access to electronic communication
Problems with software compatibility
Doesn't provide opportunity to observe nonverbal interpretation of messages.
Privacy may be compromised
99
New standards passed by the federal government to protect patients' privacy and safeguard medical records that is required in all healthcare settings
Health Insurance Portability and Accountability Act (HIPAA)
100
What are some advantages of client teaching?
Clients make informed decisions about their health. It's cost effective. Educated clients have fewer complications, fewer hospitalizations, and visits to the physician.
101
Can RNs delegate client teaching?
No. It is a legal responsibility of the RN.
102
Requires that all clients receive teaching
| Must be documented that learning occurred
Joint Commission on accreditation of Healthcare Organizations (JCAHO)
103
```
Multidisciplinary
Includes client and family
Ongoing
Interactive
Consistent with plan of care
Establish priorities
Instructions are understandable
Begin with what client wants to know
Provide specific content
Engage client as active and equal partner
Start when client is ready
Assess client’s previous knowledge and experience
Select appropriate time for teaching
Schedule short sessions
Incorporate cultural beliefs
Use clear precise language
Repeat key concepts
Choose appropriate teaching methods
Use visual aids
Document client teaching
Evaluate effectiveness
```
Principles of client teaching
104
The client teaching plan should include:
Health care problem
Risk factors
Treatment
Self-care skills
105
What are the seven steps for problem solving?
1. Recognize there is a problem
2. Identify the parameters of the problem.
3. Generate possible solutions and consequences
4. Select the best solution
5. Develop the plan
6. Implement the plan
7. Evaluate the effectiveness
106
A technique used in cognitive therapy.
Internal dialogue
Has powerful influence on our behavior
Influences how we interpret what is happening to us and what we do.
Positive self-talk
107
To change irrational beliefs and negative self-talk, to alter feelings about a situation or experience, to eliminate maladaptive behaviors by changing our thoughts and beliefs
Goals of cognitive therapy
108
Cognitive distortion in which the person exaggerates impact of events and everyday events are seen as tragic and intolerable
Catastrophizing
109
Cognitive distortion in which a person sees a single negative event as proof that all future events will be negative
Over-generalizing
110
Type of cognitive distortion in which the person predicts negative consequences as though they are already established facts
Fortune telling
111
Type of cognitive distortion in which the person sees everything in extremes, it is all black or white
All or nothing thinking
112
Type of cognitive distortion in which the person dwells on only the negative details of events and ignore the positive
Mental filtering
113
Type of cognitive distortion in which the person feels that they were the cause of unfortunate events or other people's behavior
Over personalizing
114
Helps the client learn to change behavior by identifying alternative ways of thinking that are more logical and rational
Cognitive therapy
115
Form of cognitive therapy based on the premise that behavior is controlled by our values and beliefs. Founded by Albert Ellis
Rational Emotive Therapy
116
ABC technique that is part of RET to help people identify distorted thinking and irrational beliefs that lead to unhappiness
A: Activating Stimulus (Event)
B: Belief
C: Consequence or feeling associated with event and belief
117
What is the premise for relaxation exercises?
Muscle tension is related to anxiety, if tense muscles can relax that leads to reduced anxiety
118
Process of rhythmic breathing and tensing and releasing muscles. Done in an orderly sequence. Usually starts with facial muscles and progresses to the feet. Tense each muscle, hold for 10 seconds, then relax. Do not over control breathing because it can lead to lightheadedness
Progressive muscle relaxation
119
Used to diminish reaction to stressors, minimize the effects of stress, reduce breathing rate, and decrease blood pressure
Meditation
120
Purposeful use of imagination or sensory images to achieve relaxation. Process of mentally picturing an event. Useful for clients undergoing medical procedures. Promotes relaxation, changes physiological responses, alleviates pain, promotes comfort, influences heart rate, blood flow, immune responses. May promote healing.
Visual imagery
121
Who is visual imagery contraindicated for?
Persons who are psychotic or have a history of schizophrenia
122
Neurotransmitter that has an important role in emotions, thought processes, sensory perceptions, sleep, and appetite
Serotonin
123
Adequate levels of Serotonin promote
```
Relaxation
Contentment
Peace
Optimism
Well-being
Security
Confidence
Concentration
```
124
Low levels of serotonin may lead to
```
Insecurity
Depression
Anger
Fear
Confusion
Inability to concentrate
Anxiety
Suicidal thoughts
```
125
What are some foods that boost serotonin levels?
Whole grains: brown rice, wild rice, whole wheat cereals, whole corn
Whole grain flour products: multiple grain breads, pastas, tortillas
Pumpkin and squash: acorn squash, butternut squash, yellow squash, zucchini
Root vegetables: potatoes, yams, carrots, onions, celery, radishes
126
Neurotransmitter that has an important role in controlling involuntary movements, judgment, reasoning, and insight
Dopamine
127
Adequate levels of dopamine promote
```
Energy
Positive mood
Enthusiasm
Strength
Vitality
Alertness
Problem solving ability
```
128
Excessive levels of dopamine could lead to
```
Disturbed perception
Paranoia
Violence
Sleep disturbances
Insomnia
Delusions and hallucinations
Increased sex drive
Elevated vital signs
```
129
Low levels of dopamine could lead to
```
Low energy
Excessive sleeping
Suicidal thoughts
Depression
Weight gain
Decreased sex drive
Muscular disturbances
```
130
Foods that boost dopamine are:
Fish and seafood
Chicken
Turkey
Beans and legumes
131
What should you eat before a test?
Tuna fish sandwich, bean salad, baked chicken breast, green beans, broiled salmon, and lentils
132
What are some guidelines for requesting support?
```
Identify need for support
Identify best person to ask
Get to the point
Be specific
Communicate clearly, directly, honestly, and assertively
```
133
Normal human emotion that is a strong, uncomfortable, emotional response. Results when person is frustrated, hurt, or afraid. Can be positive: problem solving, energizes body for self defense, conflict resolution. More often perceived as negative.
Anger
134
What are some physical problems in denying or suppressing anger?
Migraine headaches
Ulcers
Coronary artery disease
135
Emotional problems in denying or suppressing anger?
Depression
Low self esteem
Problems in interpersonal relationships
136
How can anger be managed?
Expressing feelings, yelling or hitting a punching bag. Aggressive physical activities can increase anger, so walking and talking may be more effective.
137
What are some assessments that can identify an angry client?
```
Clenched fists or jaw
Turning away
Refusing to maintain eye contact
Forgetting about appointments
Late for appointments
Angry tone of voice
Talking more loudly
```
138
What are some therapeutic nursing interventions for anger?
Help client identify and recognize anger
Give permission for anger
Normalize client's feelings
Help client accept responsibility for anger
Use mutual problem solving: help client in developing a plan to cope with situation
Explore alternative coping responses
139
What is the first phase of the aggression cycle?
Triggering Phase - results when an event in the environment initiates the client's hostility
140
What is the second phase of the five phase aggression cycle?
Escalation phase - client progresses toward loss of control. May begin yelling, swearing, threatening, demanding, or using threatening gestures
141
What is the third phase of the five phase aggression cycle?
Crisis phase - client loses the ability to perceive events accurately. Cannot solve problems. Unable to express feelings appropriately, cannot control behavior, may result in physically aggressive behavior
142
What is the fourth phase in the five phase aggression cycle?
Recovery phase - client regains physical and emotional control, voice lowers, regains ability to communicate clearly and rationally, muscle tension decreases, physical relaxation increases
143
What is the fifth phase of the five phase aggression cycle?
Post-crisis phase - client returns to level of functioning before the aggressive incident, may appear remorseful, may attempt to reconcile with others, may cry or quietly withdraw
144
When will intervention work to prevent physically aggressive behavior?
Triggering or Escalation phase
145
What are some early warning signs of impending aggression that occur during the triggering and escalation phase?
```
Speaking more quickly
Louder, slightly angry tone of voice
Sarcastic statements
Pacing, restlessness
Rapid and jerky gestures
Clenching fists and pointing
Breathing rapidly
Losing the ability to think clearly
```
146
What are some late warning signs of impending aggression that occur during the crisis phase?
```
Consist of small gestures that suggest impending movement
Leaning forward in chair
Grasping arms of chair
Clenching fists
Whitening knuckles
Raising closed fist over head
Shaking fists
Pounding fist into opposite palm
Throwing objects and screaming
Cannot communicate clearly
Verbal comments may indicate they are about to strike out
```
147
What are some nursing interventions for during the triggering phase?
Approach client in calm and non-threatening manner
Convey empathy for anger
Encourage client to express feelings verbally
Convey confidence in client to maintain control
Take client to quiet area
Decrease environmental stimulation
Suggest physical activity such as walking
Offer medications as ordered
Assist client with relaxation and problem solving techniques
148
What are some nursing interventions for during the escalation phase?
Provide directions to client in calm, firm, unhurried voice
Direct client to take a time-out in a quiet area
Set limits on client's behavior: aggressive behavior is not acceptable, communicate expected behavior, give alternatives
Offer medications if not given previously
Obtain assistance from other staff members if necessary for a show of force
149
What are some nursing interventions for during the escalation phase?
Avoid demonstrating any of the warning signs of aggression: do not raise voice or speak loudly, avoid aggressive movements
Decrease eye contact
Give client more room and personal space
150
What are some nursing interventions for the crisis phase?
Staff with training in managing behavioral emergencies must take charge of the situation when the client becomes physically aggressive.
Use physical intervention strategies if necessary.
Use with caution.
Used only by staff members who are adequately trained.
May use seclusion, restraints
151
Involuntary confinement of a person in a specially constructed locked room. Equipped with security window or camera for monitoring. All dangerous objects are removed.Purpose is to decrease stimulation, protects others from harm, prevents property destruction, provides privacy for client
Seclusion
152
Direct application of physical force to client without permission. Purpose is to restrict freedom of movement and provide protection for client and others. Physical force may be human, mechanical, or both.
Restraint
153
Staff members physically control client and move him or her to seclusion
Human restraint
154
Angle and wrist restraints fastened to the bed frame
Mechanical restraint
155
What are some important protocols for seclusion and restraint?
Must follow health care facility's protocols and standards
Short term use is permitted only when clients are dangerous to themselves or others
Must be used for minimal time necessary
Must use least number of restraint points necessary to provide maximum freedom of movement
Obtain a physician's order as soon as possible
Inject client with IM medication if not given earlier
Closely assess client and document accurately
Must assess every 2-4 hours
Must obtain physician's order for continued restraints every 12 hours
156
What are some interventions to be used during the recovery phase?
Encourage client to talk about situation or triggers that resulted in aggressive behavior
Help client relax and sleep
Explore alternatives to aggressive behavior to avoid future episodes
Conduct debriefing session with staff members
Remove client from restraint or seclusion as soon as he or she meets behavioral criteria
Discuss the behavior in calm, rational manner
157
What are some general safety guidelines for interventions?
Position yourself just outside client's arm
Stand on client's non-dominant side
Keep client in visual range
Be sure door is readily accessible
Don't let client come between you and door
Request assistance if the client's aggression has escalated
158
For clients who are dangerous to themselves or others. May be held for 48-72 hours on inpatient unit
Legal responsibilities
159
Protection of potential victims of client's aggression
Duty to Warn
160
Act that result in person's fear that he or she will be touched without consent
Assault
161
Involves touching another person without permission
Battery
162
Daily wear and tear on the body that cannot be avoided. Each person perceives it differently.
Stress
163
Stress is linked to the 6 leading causes of death:
```
Heart disease
Cancer
Lung ailments
Accidents
Cirrhosis of the liver
Suicide
```
164
What can double a person's risk of having a heart attack?
Chronic stress
165
Developed by Hans Selye, he defined stress as a nonspecific response to any demand or stressor. Believed diseases were the result of excessive reactions to stress. Intense and prolonged exposure to stress leads to permanent pathological changes in body and possibly death. The body's attempt to compensate for stress through a series of physiological changes, commonly called fight-or-flight response. Premise is that although factors that cause stress vary, the biological stress response is still the same.
General Adaptation Syndrome
166
First stage of General Adaptation Syndrome
Alarm reaction
167
Hypervigilant state, mobilization of body's physical defense, body's resistance is diminished, death may occur if stressor is very strong
Alarm reaction
168
What is the second stage of General Adaptation Syndrome
Stage of Resistance
169
Body tries to regain equilibrium, hormonal and chemical changes occur, body tries to restore function, resistance is increased
Stage of Resistance
170
What is the third phase of the General Adaptation Syndrome?
Stage of Exhaustion
171
Body can no longer adapt to stressor, negative response to stress occurs, serious symptoms result: physical collapse, mental disorganization, possibly death
Stage of Exhaustion
172
What is the premise for the Recent Life Changes Questionnaire?
People become ill after experiencing multiple life changes. Not all events have the same effects.
173
A diffuse apprehension that is vague in nature and associated with feelings of uncertainty. Psychological distress that results from normal life experiences. It is a normal response to threatening events and unavoidable in life.
Anxiety
174
When no real threat exists. When the threat has been eliminated but continues to impair functioning. When person uses maladaptive coping responses. When anxiety escalates to a high level.
Problematic anxiety
175
When there is a vague feeling of dread or apprehension that is unwarranted by the situation. When there is a sense of impending doom without knowing the reason.
Pathological anxiety
176
Anxiety is rated on a
Continuum
177
Anxiety that occurs with tension in response to events of day to day life. Prepares individual for action by sharpening the senses, increasing perceptual field, and increasing alertness and confidence. Pt can multi-task, has mild muscle tension, and appropriate speech rate and volume. Optimal learning occurs at this level.
Mild anxiety +1
178
Feeling that something is wrong. Increased nervousness and agitation. Perceptual field decreases. Decreased attention span. Learning still occurs but requires focusing and assistance from others. Acceleration in rate of speech. Increase in volume of speech. Moderate muscle tension. Frequent changes in body position. Excessive hand gestures.
Moderate anxiety +2
179
Anxiety in which pt has significant decrease in cognitive skills, extremely diminished perceptual field. Difficulty with thinking and reasoning. Very poor problem solving. Extremely limited attention span. Inability to distinguish relationships among concepts. Difficulty completing even simple tasks.Severe muscle tension. Rapid speech, shouting, pacing, wringing hands, confusion. Sense of impending doom. Physical symptoms. Severe behavioral disorganization/discomfort
Severe anxiety +3
180
Most intense level of anxiety. Perceptual field reduced to a detail. Thinking completely distorted and illogical. Loss of contact with reality. Incapable of differentiating between real and unreal stimuli. May have hallucinations and delusions. Feels of dread and terror. Extreme muscle tension. Concentration, learning, problem solving are impossible. Feelings of being overwhelmed, helpless, and complete loss of control. Physical and emotional exhaustion. Protective measures must be initiated promptly. State is incompatible with life.
Panic anxiety +4
181
What are some therapeutic nursing techniques for lower level anxieties?
Help client identify the presence of anxiety and explore possible reasons. Encourage client to express feelings and explore healthy coping responses that worked in the past, initiate physical exercise, music, crafts, reading. Normalize their feelings.
182
Therapeutic nursing interventions for clients with severe or panic levels?
Stay calm, speak in low voice. Use clear simple statements. ALWAYS remain with the client. Minimize environmental stimuli. Take care of physical needs. Provide opportunities for discharging excess energy. Offer high-calorie fluids and finger foods.Assess needs for time-out, medication, seclusion, or restraints.
183
What are Kubler-Ross's five stages of grief?
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Denial
Anger
Bargaining
Depression
Acceptance
```
184
What are Parkes' four phases of grief?
Shock and disbelief: numbness protects bereaved from overwhelming pain
Yearning and Searching: Bereaved longs for the lost one to return, wants to be reunited with dead person
Disorganization and Despair: Emptiness, depression
Recovery and Reorganization: recovery is gradual, loss is never gone but readjustment to life is made
185
Complicated grieving occurs when there is:
Absence of emotion
Excessive emotion
Prolonged grief
186
Definition of death in which there is a cessation of apical pulse, respirations, and blood pressure
Heart-lung death
187
Definition of death in which the client is able to breathe but is irreversibly unconscious
Cerebral death or Higher brain death
188
The world Medical assembly's definition of death is
Total lack of response, no muscular movement (especially breathing), no reflexes, flat encephalogram
189
What are some signs of impending death?
Loss of muscle tone
Jaw may sag
Difficult to speak
Loss of gag reflex
Urinary and rectal incontinence due to decreased sphincter control
Slowing of circulation: mottling, cyanosis of extremeties. Decreased blood pressure. Slower pulse.
Change in respiration: Cheyne-Stokes respirations
Sensory impairment
Blurred vision
Random hand movements
Impaired sense of taste and smell
190
What is important in caring for the body after death?
Provide dignity and sensitivity to family
Clean the body and position with hands on chest, dentures in, and eyelids closed.
Give family the option to view or not to view the body and go with them.
Clarify personal belongings that are to stay with the body or who has taken the personal items and document it.
