Test 2 Flashcards
Define teaching
the concept of imparting knowledge through a series of directed activities. (It consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.)
Define learning
the purposeful acquisition of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus.
What are the three major purposes of comprehensive patient education?
- health promotion and illness prevention
- health restoration
- coping
What is the goal of education others about their health?
to help individuals, families, or communities achieve optimal levels of health.
What are the three domains of learning?
- Cognitive (understanding)
- Affective (feelings, attitudes, beliefs)
- psychomotor (motor skills)
What are the six cognitive behaviors that make up cognitive learning?
- Remembering (learning new info)
- Understanding (knowing the meaning of the new info)
- Applying (using the info/idea in a new situation)
- Analyzing (breaking down and organizing the info)
- Evaluation (ability to judge the value of something for a given purpose)
- Creating (ability to apply knowledge and skills to create something new)
What are the five behaviors associated with affective learning?
- Receiving (learner is passive; involves only paying attention to the information being presented)
- Responding (active participation; listing and then reacting verbally and nonverbally)
- Valuing (attaching worth and value to the acquired info as demonstrated by the learner’s behavior)
- Organizing (developing a value system and organizing values according to their worth)
- Characterizing (acting and responding with a consistent value system; requires introspection and self-examination of one’s own values
WHAT IS THE CIRCADIAN RHYTHM?
24 HOUR DAY-NIGHT CYCLE/SLEEP CYCLE (aka diurnal)
What controls the rhythm of the sleep-wake cycle and coordinates it with other circadian rhythms?
the suprachiasmatic nucleus (SCN) nerve cells in the hypothalamus
What major biological and behavioral functions have their patterns influenced by circadian rhythms?
body temperature heart rate blood pressure hormone secretion sensory acuity mood
What factors affect circadian rhythms and daily sleep-wake cycles?
light
temperature
social activities
work routines
What does RAS stand for and what does it do?
Reticular activating system (in the hypothalamus):
it maintains alertness, wakefulness, and consciousness by releasing catecholamines such as norepinephrine in response to visual, auditory, pain, and tactile sensory stimuli, as well as responds to activity from the cerebral cortex such as emotions or thought process.
What does the homeostatic process do?
primarily regulates the length and depth of sleep (aka process S)
What do the circadian rhythms influence?
the internal organization of sleep and the timing and duration of sleep-wake cycles (aka Process C: biological time clocks)
What is time of wake up defined by?
the intersection of process s and process c
What is the major sleep center in the body and what does it secrete? for what purpose?
the hypothalamus secretes hypocretins (orexin) that promote wakefulness and rapid eye movement (REM) sleep.
Prostaglandin D2, L-tryptophan, and growth factors control sleep.
What are the two phases of normal sleep?
non rapid eye movement (NREM)
rapid eye movement (REM)
What does each sleep cycle consist of and how long is it?
Each cycle consists of four stages of NREM sleep and a period of REM sleep and is approx 90-100 minutes long.
How many sleep cycles does a person usually pass through per night?
4-5, depending on the total amount of time a person spends sleeping
When does a person usually reach REM sleep?
about 90 minutes into the sleep cycle
What happens during stage 1 of NREM sleep and how long does it last?
Last a few minutes
Light sleep with decreased physiological activity begins with gradual fall in vital signs and metabolism. (easy arousal)
What happens during stage 2 of NREM sleep and how long does it last?
Lasts 10-20 min
Sound sleep where relaxation progresses and body functions continue to slow. (easy arousal)
What happens during stage 3 of NREM sleep and how long does it last?
Lasts 15-20 min
Initial stages of deep sleep where muscles are completely relaxed, vital signs decline but remain regular. (arousal is difficult and sleeper rarely moves)
WHAT HAPPENS DURING STAGE 4 OF NREM SLEEP AND HOW LONG DOES IT GENERALLY LAST?
Lasts approx 15-30 min
Deepest stage of sleep where vital signs are significantly lower than during waking hours; SLEEP PARALYSIS (AROUSAL IS VERY DIFFICULT)
At what NREM stage of sleep does sleepwalking and bedwetting sometimes occur?
Stage 4
What happens during REM sleep and how long does it last?
Duration increases with each sleep cycle and averages 20 minutes.
Vivid, full-color dreaming occurs. Stage typically is characterized by rapidly moving eyes, fluctuation heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions. (arousal is very difficult)
hypersomnolence
a condition where a person experiences significant episodes of sleepiness, even after having 7 hours or more of quality sleep. Other terms used to describe hypersomnolence include excessive daytime sleepiness, excessive daytime somnolence, and hypersomnia.
what does a polysomnogram monitor?
the stages of sleep and wakefulness during nighttime sleep.
What three sleep problems do sleep disorders usually result in?
- Insomnia
- abnormal movement or sensation during sleep or when waking up at night
- Excessive daytime sleepiness
cataplexy
sudden muscle weakness during intense emotions such as anger, sadness, or laughter.
stereognosis
a sense that allows a person to recognize the size, shape, and texture of an object
What are 6 of our senses?
o Sight/visual o Hearing/auditory o Touch/tactile o Smell/olfactory o Taste/gustatory o Position and motion/kinesthetic
Sensory reception
the stimulation of sensory nerve fibers and the transmission of impulses to higher centers within the brain.
What does normal sensation involve?
o Reception: stimulation of a receptor such as light, touch, or sound
o Perception: integration and interpretation of stimuli
o Reaction: only the most important stimuli will elicit a reaction
What are the three types of sensory alterations?
- Sensory deficits – deficit in the normal function of sensory reception and perception
- Sensory deprivation – inadequate quality or quantity of stimulation
- Sensory overload – reception of multiple sensory stimuli
Identify factors that normally promote and disrupt sleep.
- Drugs and Substances
- Lifestyle
- Usual sleep patterns
- Emotional stress
- Environment
- Exercise and fatigue
- Food and caloric intake
What factors affect sensory function?
o Age - Various changes occur across the life span
o Meaningful stimuli - Reduce the incidence of sensory deprivation
o Amount of stimuli – can cause sensory overload
o Social interaction – increases with lack of socialization with family
o Environmental factors – Occupation, recreation, and sports activities
o Cultural factors – sensory alterations occur in select groups
What should be assessed regarding sensory alterations during the nursing process?
o Through the patient’s eyes o Sensory alteration history o Physical assessment o Health promotion habits o Communication methods o Use of assistive devices o Persons at risk – elderly o Mental status o Ability to perform self-care o Environmental hazards o Social support o Other factors affecting perception o Communication
What are some diagnosis that apply to patients with sensory alterations?
o Risk-prone health behavior o Impaired verbal communication (related to stroke) o Risk for injury o Impaired physical mobility o Bathing self-care deficit o Situational low self-esteem o Risk for falls o Social isolation
Aphasia
loss of ability to understand or express speech, caused by brain damage
What should happen during the planning process regarding sensory alterations?
- Partner with patient and use your knowledge to decide goals and outcomes.
- Set priorities according to type and extend of sensory alterations, safety, and patient preferences.
- Collaborate with colleagues that need to be involved
Acute definition
Of abrupt onset, in reference to a disease. Acute often also connotes an illness that is of short duration, rapidly progressive, and in need of urgent care. “Acute” is a measure of the time scale of a disease and is in contrast to “subacute” and “chronic.”
What are some interventions that promote the care of sensory alterations?
- Screening
- Preventive measures
- Use of assistive devices
- Promoting meaningful stimuli
- Establishing safe environments
- Communication
What are some interventions that relate to sensory alterations for acute care?
- orientation to the environment
- Communication
- controlling sensory stimuli
- safety measures
What are some interventions that relate to sensory alterations for restorative and continuing care?
- maintaining healthy lifestyles
- understanding sensory loss
- socialization
- promoting self-care
**WHEN ASSESSING A PATIENT FOR SENSORY ALTERATIONS, WHAT DO YOU ALWAYS NEED TO REMEMBER TO ASK?
ASK IF THEY WEAR/USE ASSISTIVE DEVICES SUCH AS HEARING AIDES, GLASSES, ETC. AND MAKE SURE THEY HAVE THEM.
HOW DO OUR SENSES CHANGE WITH AGE?
AS ADULTS OUR SENSORY DECLINES - MOST OLDER ADULTS WILL HAVE SOME KIND OF SENSORY IMPAIRMENT.
WHAT HAPPENS TO OUR VISUAL FIELDS AS WE AGE?
THEY START TO DIMINISH (EX. DRIVING AT NIGHT BECOMES AN ISSUE BECAUSE THE STOPLIGHTS ARE HARD TO DETERMINE)
HOW DOES “SOCIAL ISOLATION” RELATE TO SENSORY ALTERATIONS AS A NURSING DIAGNOSIS?
WHEN PEOPLE HAVE A HARD TIME INTERACTING WITH OTHER PEOPLE DUE TO A SENSORY IMPAIRMENT, THEY TEND TO START ISOLATING THEMSELVES SO AS NOT TO HAVE TO DEAL WITH IT.
HOW DO DAILY LIVING PUZZLES AND OTHER ACTIVITIES EFFECT SENSORY ALTERATIONS?
THEY HELP TO STIMULATE AND EXERCISE THE SENSES.
HOW DOES THE DISEASE PROCESS EFFECT SLEEP?
ANY ILLNESS THAT CAUSES PAIN, PHYSICAL DISCOMFORT, OR MOOD PROBLEMS SUCH AS ANXIETY OR DEPRESSION OFTEN RESULT IN SLEEP PROBLEMS DUE TO DISRUPTED SLEEP PATTERNS.
WHAT ARE SOME EXAMPLES OF HEALTH ISSUES THAT DISRUPT SLEEP?
- RESPIRATORY DISEASE OFTEN CAUSES SHORTNESS OF BREATH AND THE NEED TO SLEEP WITH HEAD RAISED (UNFAMILIAR/UNCOMFORTABLE POSITIONS)
- ASTHAM, BRONCHITIS, ALLERGIES ALER THE RHYTHM OF BREATHING
- COMMON COLD CAUSES NASAL CONGESTION
- HYPERTENSION
- PEPTIC ULCERS
- NOCTURIA (URINATION DURING THE NIGHT)
- RESTLESS LEG SYNDROME
WHAT HAPPENS TO SLEEP AS WE AGE?
OLDER ADULTS EXPERIENCE INCREASED SLEEPING DIFFICULTIES; EPISODES OF REM SLEEP TEND TO SHORTEN - ELDERLY SUFFER FROM SLEEP DEPRIVATION DUE TO AGE AND OTHER HEALTH RELATED ISSUES
IF AN ADULT SLEEPS FOR 8 HOURS SHOULD THEY BE RESTED?
NOT NECESSARILY - “RESTED” IS A SUBJECTIVE TERM. A PERSON MUST FEEL RESTED IN ORDER FOR IT TO APPLY.
WHAT ARE SOME HEALTH PROMOTION INTERVENTIONS TO IMPROVE THE QUALITY OF A PERSON’S REST AND SLEEP?
- Environmental controls
- Bedtime routines
- Promoting Safety
- Promoting Comfort
- Establishing periods of rest and sleep
- Stress reduction
- Bedtime snacks
- Pharmacological approaches
WHAT NEEDS TO BE ASSESSED DURING A SLEEP FOCUSED ASSESSMENT?
- DESCRIPTION OF SLEEPING PROBLEMS
- USUAL SLEEP PATTERN
- PHYSICAL AND PSYCHOLOGICAL ILLNESS
- CURRENT LIFE EVENTS
- EMOTIONAL AND MENTAL STATUS
- BEDTIME ROUTINES
- BEDTIME ENVIRONMENT
- BEHAVIORS OF SLEEP DEPRIVATION
HOW CAN YOU EVALUATE THE PATIENT TO SEE IF SLEEP INTERVENTIONS ARE WORKING?
ASK QUESTIONS TO SEE IF THE PATIENT FEELS MORE RESTED AND GOALS HAVE BEEN MET.
What are some examples of sleep diagnoses for patients with sleep problems?
- ineffective breathing pattern
- acute confusion
- ineffective coping
- insomnia
- fatigue
- disturbed sleep pattern
- sleep deprivation
- readiness for enhanced sleep
Why are dreams important?
helps with learning, memory, and adaptation to stress
What are the theories regarding the functions of sleep?
- body tissue restoration
- restoration of biological processes
- energy conservation
- brain tissue restoration
- dreams
How is advocacy defined in the ANA Code of ethics?
the support of a particular cause (a nurse advocates for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment)
How is confidentiality defined in the ANA Code of ethics?
protection of patients’ personal health information
Code of ethics
set of guiding principles that all members of a profession accept
What principles remain constant throughout revision of the ANA code of ethics?
- advocacy
- responsibility
- accountability
- confidentiality
How is responsibility defined in the ANA Code of ethics?
a willingness to respect one’s professional obligations and to follow through (a nurse is responsible for her/his actions and those they delegate tasks to)
How is accountability defined in the ANA Code of ethics?
the ability to answer for one’s actions (a nurses actions are explainable to your patients and your employer)
What is emphasized in the ethics of care?
the importance of understanding relationships, especially as they are revealed in personal narratives.
Autonomy
freedom from external control
What does beneficence refer to?
taking positive actions to help others - the agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest.
What happens as soon as you judge a patient?
you loose your ability to think objectively
nonmaleficence
the avoidance of harm or hurt
just culture
the promotion of open discussion without fear of recrimination whenever mistakes, especially those involving adverse events, occur or nearly occur. (accountability and quality are achieved by improving processes and systems in the work environment)
fidelity
the agreement to keep promises - nurses need to follow through on actions and interventions.
justice
fairness
What do you need to be able to clarify to resolve ethical dilemmas?
value, fact, and opinion
What process is an effective and important part of ethical discourse?
Clarifying the values of those involved (ie. your own, your patients’, your co-workers)
Deontology
a proposed system of ethics that defines actions as right or wrong on the basis of their “right-making characteristics” such as fidelity to promises, truthfulness, and justice. (most familiar in health care practitioners)
Utilitarianism
a system of ethics that proposes that the value of something is determined by its usefulness (aka consequentialism because its main emphasis is on the outcome or consequence of action
Feminist ethics
system of ethics that looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which a point of view has become ignored or invisible. (closely relates to ethics of care)
Casuistry
care-based reasoning that turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an intimate understanding of particular situations.
What elements are essential in the processing of ethical dilemmas in nursing situations?
- the presumption of good will on the part of all participants
- strict adherence to confidentiality
- patient-centered decision making
- welcome participation of families and primary caregivers
How do you determine if an ethical dilemma exists?
if the question is perplexing and the answer has relevance for several areas of human concern, an ethical dilemma exists.
What are the 7 steps in the resolution of an ethical dilemma?
- Ask the question, Is this an ethical dilemma?
- Gather info relevant to the case. (patient, family, institutional and social perspectives are important sources)
- clarify values (fact, opinion, values)
- verbalize the problem the facilitate discussion
- identify possible courses of action
- negotiate a plan (requires confidence in one’s own point of view and a deep respect for the opinions of others)
- evaluate the plan over time
What are some current issues in which ethical concerns arise?
- Quality of Life
- Disabilities
- Care at the End of Life
- Health Care Reform
What is the difference between accountability and responsibility?
accountability refers to being responsible for your actions while responsibility refers to following through on your obligations of work
