Fundies bible FINAL
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Dec 6, 2023
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Chapter 38
1. Benefits of physical activity
o
Elevates mood and attitude.
o
Enables physical fitness.
o
Helps one to quit smoking and stay tobacco-free.
o
Boosts energy levels.
o
Helps in the management of stress.
o
Promotes a better quality of sleep.
o
Improves self-image and self-confidence.
2. Benefits of correct body alignment
»
Correct alignment reduces strain on musculoskeletal structures, aids in
maintaining adequate muscle tone, promotes comfort, and contributes to
balance and conservation of energy
3. Factors that influence patient’s activity tolerance
o
Physiological
o
Emotional
o
Developmental factors
4. Diseases/problems associated with obesity
»
Obesity: major international public health problem affecting children and
adults
Associated with:
o
Osteoarthritis
o
Low back pain
o
Osteoporosis
o
Gait disturbances
o
Soft tissue problems
5. Effects of older adult’s changing gait on fall risk
»
Take smaller steps and keep feet closer together, which decreases base of
support and alters body balance and increases risks for falls
Ex. The nurse is caring for an older adult in a long-term care setting. The nurse
reviews the medical record to find that the patient has progressive loss of total
bone mass. The patient’s history and tendency to take smaller steps with feet kept
closer together will most likely result in which of the following?
A) Increase the parent’s risk for falls and injuries
B)
Result in less stress on the patient’s joints
C)
Decrease the amount of work required for patient movement
D) Allow for mobility in spite of aging effects on the patients joint
6.
Factors that influence activity and exercise (cultural background)
Bible:
Fundies
Final!
Cultural background: there are cultural differences regarding the extent to which
people exercise
Individuals with lower level of education and minority racial/ethnic groups
tend to have higher levels of physical activity at work but lower levels of non-
work physical activity
Difference may limit positive effects of physical activity on an
individual’s health because nonwork physical activity has a stronger
positive association with health relative to work physical activity
Consider education regarding value of exercise and learn what motivates
individuals to exercise and what activities are appropriate and enjoyable
7.
P
ossible causes of loss of bone mass in the older adult
o
Physical inactivity
o
Hormonal changes
o
Increased osteoclastic activity (i.e., activity by cells responsible for
bone tissue absorption)
8. Effect of bone loss in the older adult
o
Weaker bones
o
Causing vertebrae to be softer and long shaft bones to be less
resistant to bending
o
Making an individual prone to fractures and muscle injuries
9.
Aerobic activity effects on diabetes
o
Diabetes mellitus: moderate to high volumes of aerobic activity have been found to
be associated with lower cardiovascular and overall mortality risks in type 1 and
type 2 diabetes
o
Aerobic training increases cardiorespiratory fitness, decreases insulin resistance,
and improves lipid levels and endothelial function
10.
Orthostatic hypotension (S/S)
§
Dizziness
§
Light-headedness
§
Nausea
§
Tachycardia
§
Pallor
§
Fainting
11.
Socioeconomic factors to consider in the assessment
o
Assess resources and access to facilities or public areas/parks
o
Assess hours of work
o
Assess social support
o
Educational level
o
Income
o
Ability to pay for fees/equipment
Chapter 48
12.
Pressure injury stages
o
Stage 1: Non-blanchable erythema of intact skin
o
Stage 2: Partial-thickness skin loss with exposed dermis
o
Stage 3: Full-thickness skin loss
o
Stage 4: Full-thickness skin and tissue loss (Pressure Injury)
13.
Primary
, secondary, and tertiary intention
o
Primary intention – wound that is closed.
o
Secondary intention – wound edges not approximated.
o
Tertiary intention – wound that is left open for several days, then wound
edges are approximated
14.Wound repair
Homeostasis – injured blood vessels constrict, and platelets gather to stop bleeding. Clots
form to provide cellular repair.
Inflammatory phase – cells secrete histamine, resulting in vasodilation of surrounding
capillaries and migrate serum and white blood cells into the damaged tissue.
Proliferative phase – this phase can last 3 to 24 days while new vessels are being
reconstructed. The wound fills with granulation tissue, wound contraction, and wound
resurfacing by epithelialization.
Maturation – it is the final stage of healing. I could sometimes take more than a year,
depending on the depth and extent of the wound.
15.
Complications of wound healing
»
Hemorrhage – extensive bleeding from a wound site
»
Infection – second most common health care associated infection.
Microorganisms invade the wound tissue.
»
Dehiscence – when an incision fails to heal properly, the layer of the skin
and tissue separate. I.e., c-section and other abdominal surgeries. This
can happen after a certain strain such as coughing, vomiting, or siting up
in bed.
»
Evisceration – total separation of wound layers occurs, and protrusion of
visceral organs are exposed through a wound opening.
16.
Factors influencing pressure injury formation and wound healing
§
Nutrition
§
Tissue perfusion
§
Infection
§
Age
§
Psychosocial impact of wounds
17.
Bony prominences most frequently affected
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18.
Nursing diagnoses for pressure injuries
o
Impaired Skin Integrity
o
Risk for Impaired Skin Integrity
o
Risk for Infection
o
Acute or Chronic Pain
o
Impaired Mobility
o
Impaired Peripheral Tissue Perfusion
19.
Benefits of Vitamin C for wounds
»
Nutritional status – nutritional support is very important for wound healing
and tissue repair. They need calories and protein to help replace
subcutaneous tissue. Vit C promotes collagen synthesis, capillary wall
integrity, and improve immunological function.
20.
Patients that need more frequent skin assessment
o
Neurological impaired
o
Chronically ill
o
Long-term care
o
ICU
Chapter 50
21.
Surgical risk factors
»
Smoking
: higher risk for developing pneumonia, atelectasis, and delayed
wound healing
o
Increases risk of aspiration
»
Obesity
: increased risk for atelectasis, pneumonia, and death
o
Risk for impaired mobility = increased risk for VTE
o
Increased risk for wound infection, blood loss, pressure injuries,
dehiscence, and evisceration
22.
Effects of glucose control
»
Poor glucose control increases risk for wound infection and mortality
Bony prominences most frequently
underlying pressure injury
23.
Responsibilities of the PCU nurse
o
Inserts IV catheter (if not already present)
o
Administers preoperative medications
o
Monitors vital signs
o
Inserts catheter
24.
Intrinsic vs. extrinsic factors
25.
Acute care postoperative recovery and convalescence implementation
»
Maintaining
respiratory function
: positioning; I/S; early ambulation allows
chest wall expansion and stimulates increased RR (also increases
peristalsis)
»
Maintaining
neurological function
: deep breathing and coughing for
retained anesthetic gases; monitor LOC
»
Promoting normal
gastrointestinal function
and adequate nutrition
o
Progressive diet after surgery
o
Promote ambulation and exercise = increased peristalsis and
promotes return of bowel function
o
Maintain adequate fluid intake
26.
Nursing goals in the pre-op area
»
Quality improvement and evidence-based practices
»
Patient safety through high quality care
»
Teamwork and collaboration
»
Effective communication and interactions
»
The nursing process to deliver timely assessment and interventions in all
phases of surgery
»
Advocacy for a patient and the patient’s family
»
Cost containment
27.
Early and late signs of malignant hyperthermia
»
Early signs
: tachypnea, tachycardia, heart arrhythmias, hyperkalemia,
hypercarbia (high co2), and muscular rigidity
»
Late signs
: elevated temperature, myoglobinuria, and multiple organ failure
»
First S/S occur in OR
»
May occur in early pos—op period
Intrinsic risks
: (inside
body)
o
Altered nutrition
o
Decreased mobility
o
Older age
o
Decreased mental
status
o
Infection
o
Incontinence
o
Impaired sensory
perception
o
Co-morbidities such
as
diabetes,
OR risk factors:
o
Length of surgery
o
Position on OR table
o
Positioning devices
used
o
Warming devices
o
Anesthetic agents
o
Intraoperative
hemodynamics
o
Length of time on OR
Extrinsic risks:
(outside)
o
Temperature
o
Friction
o
Shearing forces
o
Moisture
28.
Interventions to promote bowel function post-op
»
Early ambulation
29.
Review of emotional health
»
Review of emotional health: surgery is psychologically stressful and can
create anxiety
o
Self-concept
o
Body image
o
Coping resources
30.
Minimizing risk for surgical wound infection
»
Minimizing risk for surgical wound infection
o
Antibiotics
o
Skin antisepsis
o
Clipping instead of shaving hair
Chapter 14
31.
Ageism
»
Undermines the self-confidence of older adults, limits their access to care,
and distorts caregivers’ understanding of the uniqueness of each older adult.
»
Nurses should promote positive perception regarding the aging process when
establishing therapeutic relationships and value the experiences of older
adults.
32.
Change and loss in the older adult
o
Alterations in health status
o
Loss of significant others
o
Decreased sense of being useful
o
Decreased socialization
o
Decreases in income
o
Decrease in independent living
33.
Health care settings where older adults are encountered
o
Private homes
o
Apartments
o
Retirement communities
o
Adult day care centers
o
Assisted-living facilities
o
Nursing centers
34.
Assessing an older adult with hearing impairment
»
Move to quiet area for those with a hearing impairment; face patient and
speak directly in clear, low-pitched tones
»
Memory deficits affect accuracy and completeness of assessment
35.
Physiological changes of the thorax and lungs
o
Respiratory muscle strength decreases
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o
Anteroposterior diameter of thorax increases
36.
ADLs vs. IADLs
»
ADLs: Direct care measures usually performed during a normal day
o
Includes: ambulation, toileting, eating, dressing, bathing, personal
device care, functional mobility (getting into/out of a bed or bathtub),
and grooming
»
IADLs: Activities that support daily life and are oriented toward interacting
with the environment
o
Includes: shopping, caring for pets, home maintenance, preparing
meals, housecleaning, writing checks, and taking medications
37.
Symptoms of cognitive impairment
»
Disorientation, loss of language skills, loss of the ability to calculate, and
poor judgment are not normal aging changes and require further assessment
for underlying causes.
»
Delirium, Dementia, and Depression
38.
Risks in the acute care setting
o
Delirium
o
Dehydration
o
Malnutrition
o
Health care–associated infections
o
Urinary incontinence
o
Falls
39.
Barriers for older adults
»
Previous health care experiences, personal motivation, health beliefs,
culture, health literacy, and non-health-related factors such as transportation
and finances
40.
Psychosocial changes of the older adult
o
Retirement
o
Social isolation
o
Sexuality
o
Housing and environment
o
Death
Chapter 35
41.
Spirituality positive effects
»
Research shows that spirituality positively affects and enhances physical and
psychological health, quality of life, health promotion behaviors, and disease
prevention activities.
»
Ability to cope with anxiety, stress, and depression.
42.
Factors influencing spirituality
43.
Assessment tools for spirituality
o
Listening
o
Ask direct questions
o
FICA (Faith, Importance, Community, Address)
o
Spiritual well-being (SWB) scale
44.
Nursing diagnoses regarding spirituality
o
Risk for Spiritual Distress
o
Defective Spiritual Distress
o
Hopelessness
o
Spiritual Distress
o
Decreased Spiritual Distress
45.
To assess, evaluate, and support a patient’s spirituality, the best action a
nurse can take is to:
A) assist the patient to use faith to get well.
B) refer the patient to the health care facility chaplain.
C) provide the patient with a variety of religious literature.
D) determine the patient’s perceptions and belief system.
46.
Spirituality defined
»
An awareness of one's inner self and a sense of connection to a higher
being, nature, or some purpose greater than oneself
»
Includes personal beliefs that help a person maintain hope and get
through difficult situations.
»
The human spirit is powerful, and spirituality has different meanings for
different people.
47.
Nurses need to be self-aware
»
Nurses need to be aware of their own spirituality to provide appropriate
and relevant spiritual care to others.
»
As a nurse, you need to care for the whole person and accept a patient’s
beliefs and experiences. It is important to conduct a self-assessment of
your own biases as it relates to religion and spirituality.
48.
Constructs of spirituality
»
Self-transcendence – authentically connecting to one’s inner self.
»
Connectedness – being intrapersonally connected with oneself,
interpersonally connected with others and environment, and
transpersonally connected with God or an unseen higher power.
»
Faith – allows people to have firm believes despite lack of physical
evidence.
»
Hope – several meanings that vary based on what’s being experienced.
o
Terminal illness
o
Near-death
experience
o
Acute illness
o
Chronic illness
»
Inner strength and peace – spirituality gives people the ability to find a
dynamic and creative sense of inner strength to use when making difficult
decisions.
»
Meaning and purpose – spirituality help people find meaning in positive
and negative events.
49.
Spiritual distress
»
A disruption in the life principle that pervades a person’s entire being and
transcends the person’s biologic and psychosocial nature
50.
Establishing presence for health promotion
»
Establishing presence: involves
giving attention, answering questions, having
an encouraging attitude, and expressing a sense of trust; “being with” rather
than “doing for”
Chapter 36
51.
Influences on response to death
»
Each person responds to loss differently
o
Culture, spirituality, personal beliefs, previous experience and degree of
social support influences the way a person responds to death
52.
Actual loss, necessary loss/maturational loss, situational loss, perceived loss
»
Actual loss – occurs when a person can no longer feel, hear, see, or know a
person or object. Example: the loss of a body part, death of a family member or
loss of a job.
»
Necessary loss – in the lifespan of an individual change will involve a necessary
loss such as death, divorce, or loss of independence.
»
Situational loss – sudden, unpredictable external events. Example: accident
leading to loss of function.
»
Perceived loss – it is defined by the person experiencing the loss and it is less
obvious to other people.
53.
Types of grief
»
Normal (uncomplicated)
»
Anticipatory – before the actual loss or death occurs
»
Disenfranchised (ambiguous) – less significant, no direct relationship
»
Complicated (chronic, exaggerated, delayed, masked)
54.
Factors influencing loss and grief
o
Human development
o
Personal relationships
o
Nature of the loss
o
Coping Strategies
o
Socioeconomic loss
o
Culture
o
Spiritual and religious beliefs
55.
Nursing diagnoses related to loss and grief
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»
relevant for patients experiencing grief, loss, or death
Includes:
o
Impaired family coping
o
Death anxiety
o
Pain (Acute or Chronic)
56.
Goal of palliative care vs. hospice care
»
Palliative care
o
Focuses on the prevention, relief, and reduction of symptoms
o
Goal is to help achieve the best possible quality of life
»
Hospice care
o
Focuses on the care of terminally ill patients
o
Goal is to manage pain, provide comfort, ensure quality of life
o
Prioritize care according to patient wishes
57.
What’s essential to the assessment process?
»
A trusting, helping relationship with grieving patients and family member
58. Postmortem care
Care of the body after death deserves the same respect and dignity as that of a living person.
o
Dysfunctional Grief
o
Anticipatory Grief