NSG Exam 4- ALL

Chiropractice Medicine

- concentrates on relationship between spinal structure and body function - spinal adjustments restore balance in CNS and body - formal accreditation of training programs and licensure- several years of training

regression

- defense mechanism that exhibits returning to earlier behaviors; seen in children

active euthanasia

taking measures or doing something to cause a client's death

mourning

the act of grieving and expressing grief

anticipatory grief

the process of starting to "let go" of someone or something before the loss actually occurs

situational loss

unanticipated and caused by an external event. Ex. car wreck

manipulative/body based practices

various types of massage and body therapy treatments

anticipatory loss

when a person experiences a reaction to a loss that has not occurred yet. Ex. terminal news (grieve a loss that hasnt happened yet)

Kübler-Ross' Theory of Grief

- denial: difficult accepting the reality of a diagnosis, death or loss. "I'm fine", "I cant believe they are gone" - anger: expression of rage and hostility. Ex. blaming god - bargaining: an attempt to negotiate for a cure or more time. Ex trying to bargain with god - depression: a period of grief - acceptance: the reality of the diagnosis, death, or loss is accepted, and the person feels tranquil and prepared and moves forward to prepare for the future

homeopathy

- developed by Samual Hahnemamn 200 yrs ago - rather than using an opposing medicine to tx illness, treat with a minuscule amount of something that causes same sx in a well person (like immunization concept) - not well researched - formal training, no formal licensure

Concept of Chakras

- energy centers - originated in India - pts may wish to follow special diets or take herbal supplements during hospitalizations; need to coordinate with meds and plan of care

healing touch

- energy therapy - Mentgen - similar to therapeutic touch, more specific techniques based on condition/ailment

therapeutic touch

- energy therapy - Kriger - use of hands on or near body to promote healing/wellbeing

POLST

- physician's orders for life sustaining treatment - document with medical orders indicating patient wishes regarding commonly used treatments in medical crises

postmortem care: after family viewing

- complete required documentation - apply identification tags according to facility policy - transport or request transport for the patient as indicated by facility policy

energy medicine

Therapeutic and healing touch, sound, Reiki

projection

a defense mechanism that attributes own thoughts/impulses to another

necessary loss

related to changes in the life cycle that can be anticipated.

reaction formation

defense mechanism that exhibits behaviors and attitudes that are the opposite of what he/she would normally do

living will

gives the client's wishes for medical treatment

energy healing

- based on belief of vital life force within and around body and illness is a result from an imbalance in the energy field - Chakras: energy centers (crown, brow, throat, heart, solar plexus, sacrum, coccygeal) - etheric body (aura): surrounds body in 7 layers

assisted suicide

- can be considered a type of active euthanasia - legal in certain situations in the District of Colombia, California, Colorado, Oregon, Vermont, Washington, Montana and New Mexico

urinary retention management at end of life

- catheterization

Postmortem Care

- ask if the family wishes to spend time with the body - determine whether the pt's personal belongings should be sent with a family member or the body - perform care with compassion and respect while attending to client and family wishes per their religious, cultural, and social practices - depending on facility policy, the nurse may be responsible for asking the family which funeral home they wish to use

end of life care orders

- DNR, DNI, Comfort Measures Only, terminal weaning - orders not to use certain other life-sustaining treatments may also be present based on healthcare provider discussion with the client regarding their wishes, such as ventilator support, dialysis, artificial hydration and nutrition, blood transfusions, medications- such as antibiotics and/or surgery

introjection

- a defense mechanism that incorporates qualities/values of another into their ego - ex. older sibling teaching younger sibling

Meridians

- according to TCM, these are the energy pathways in the body - free movement through these energy pathways is the goal of TCM

nausea/vomiting management at end of life

- administer anti-emetics

support for the family

- allow expression of feelings - encourage the family to plan visits so that the patient has time to rest - provide appropriate information when there are changes in the treatment plan - assess family members' desire to perform patient care and provide education as needed - monitor caregiver fatigue - provide privacy for the family to communicate and share feelings outside of the patient's presence - provide education about physical changes that occur as the patient approaches death if desired

General Adaptation Syndrome (GAS)

- also called "stress syndrome" - theory of adaptation to stress developed by Hans Selye - has three states: alarm reaction, resistance stage, and exhaustion stage

dysfunctional/complicated grief

- also called unresolved grief - difficult progression through the usual grief stages - usually prolonged grieving - may result in decreased self esteem, intense guilt, and suicidal ideation - physical complaints may continue for an extended time

grief

- an internal emotional reaction to loss - types: normal/uncomplicated, dysfunctional/complicated, anticipatory, and disenfranchised

palliative care

- appropriate for anyone with a chronic disease or illness regardless of disease stage - interventions focus on the relief of physical, emotional, spiritual, and psychosocial aspects of the disease - provided by an interdisciplinary team - goal is to aggressively manage symptoms in clients with life-threatening illnesses to provide the best quality of life possible

family stressors

- changes in family roles and structure - feelings of anger, guilt and helplessness - loss of control over usual routines - concern for future financial stability - family structure determines ability of family to cope - rigid family structure is strict and dictatorial - open family structure has few or no boundaries, consequences, or consistent behaviors - both structures can result in outcomes that are positive or negative - function is the course of action that the family uses to attain its goals, including family members problem solving abilities, communication skills, and available resources.

hospice

- comprehensive care provided in various settings, often the home - indicated when a client's life expectancy is 6 months or less - focus of treatment is shifted from a cure to quality of life and support for the client as they approach death - indications for referral may include: comorbidities, poor performance status, poor nutrition, declining cognition, previous hospital admissions, pressure injuries, and advanced age

repression

- defense mechanism that chooses to remove an event that produces anxiety from conscious awareness

compensation

- defense mechanism that emphasizes a more desirable trait/over achieving in an attempt to overcome a perceived weakness

rationalization

- defense mechanism that gives logical/socially acceptable reasoning for questionable behaviors - Ex. "I'm okay; you're okay"

undoing

- defense mechanism that makes up for previous bad acts

sublimation

- defense mechanism that substitutes good/positive behavior or goal for one whose usual method of expression is not socially acceptable or is blocked

autopsy

- examination of tissues and organs following death - findings may help to advance medical science and pinpoint the cause of death - consent is a legal requirement, and it is usually the responsibility of the health care provider to obtain this consent - if death occurs due to suicide, homicide, accident, illegal therapeutic practice, and in some cases within 24 hours of hospital admission, the coroner must be notified according to law. The coroner can then determine if autopsy is necessary and can order one even if they patient/family have refused to consent - most facility policies require that all tubes and lines remain in the patient - forms must be completed per state and federal law

Alarm Reaction stage of GAS

- functions of the body are increased to respond to stress - there are increases in mental alertness, heart rate, blood pressure, and blood flow to muscles due to the release of hormones, including epinephrine, norepinephrine, and cortisone

Exhaustion stage of GAS

- functions of the body are no longer able to respond to the stressor and the individual is unable to adapt - this stage results in either death or recovery

Comfort Measures Only

- goal of treatment is allowing the patient to die in a comfortable and dignified way as there is no longer an indication for further life-sustaining treatment - these DO NOT mean "do nothing" and should not be presented to patients and families as such. It is a transition from aggressive curative treatment to aggressive sx management

what might impact people's openness to and use of CAM therapies

- knowledge about therapies - religious beliefs - prior experience - media coverage - success or lack of success with traditional therapies

clinical signs of approaching death

- labored breathing - collection of mucus in large airways - decreased level of consciousness - relaxation of facial muscles - inability to swallow - slow and weak pulse - decreased blood pressure - bowel and/or bladder incontinence - decreased urine output -cool, mottled (cyanotic) extremities - perspiration - diminished sensation of touch - difficulty speaking - nausea, abdominal distention, and/or flatus - agitation or restlessness - loss of movement and reflexes

constipation management at end of life

- laxatives - enemas

death certificate

- legally required for each client who dies - nurse's responsibility to ensure death certificate is signed by a clinician who is able to sign depending on specific state lawas - advance practice nurses but not registered nurses may sign death certificates after completion of special training in the state of WV

do not resuscitate (DNR)

- may be called No Code, No CPR, or Allow Natural Death (AND)

normal/uncomplicated grief

- may show negative emotions, such as hopelessness, withdrawal, anger, resentment, and guilt - over time, negative emotions will change to acceptance with some acceptance being evident by 6 months following the loss - may demonstrate physical complaints, such as fatigue, change in sleeping patterns, chest pain, palpitations, nausea and headaches

health care surrogate

- medical decision maker not chosen by the patient (MPOA or durable power of attorney for healthcare are chosen by the pt has decision making capacity) - designated by hospital social worker when a patient is unable to make his/her own decisions and a previously completed medical power of attorney document is not available - signed by a healthcare provider - form follows the law and attempts to name the person who is closest to the pt and knows the pt's wishes the best as their medical decision maker - forms vary by facility

Psychoneuroimmunology (PNI)

- mind body modality - neuropeptides are the messenger molecules that connect mind and body, and they travel throughout the body. - Explain connection of emotions with GI distress and other sx - many alternative therapies are based on this connection between mind/spirit and body

Placebo effect

- mind body modality - patients think that they are getting a beneficial tx or medicine, but really aren't, and report improvement in condition or sx - is now known as the power of the mind-body connection

aromatherapy

- mind body therapy - use of essential oils to promote well being - olfactory sense is very powerful - use caution- oils potent - workshop type training

naturopathy

- whole medical systems - more like modern medicine but with focus on pt empowerment and disease prevention, health promotion, and following natural laws - may use complementary therapies in conjunct with care - focus on treating cause of condition rather than sx - no standardized training or licensure

relaxation therapies

- mind body therapy - decreases SNS dominance, allowing inc peripheral circulation, relaxation of muscles, decreased pulse, decreased BP, perceived well being. - includes meditation/hypnosis, progressive relaxation/imagery (visualization), and biofeedback/autogenic training - humor: laughter/play improve immune function - training varies by type of tx

prayer

- mind body therapy - when included in CAT, is the most widely used domain - intercessory prayer by others, prayer use by pt

beliefs underlying CAT

- mind, body and spirit together influence health - health is a balance of systems and illness is manifestation of imbalance - systems reflect instability. Restoring balance will reduce sx. Healing may take time - healing is done by the pt and facilitated by the caregiver

How can nurses incorporate mind body therapies

- mindfullness: help the pt be in the current moment, and not totally consumed by past or future - promotion of relaxation via a number of means (breathing, relaxing muscles, smell the flowers, blow out candle)

diarrhea/bowel incontinence management at end of life

- nearby bedpan - absorbant pads - hygiene care

Resistance stage of GAS

- normalization of body functions while responding to stress - body attempts to return to homeostasis while coping with the stressor - heart rate, BP and hormones stabilize

dyspnea management at end of life

- opioid pain meds such as morphine - positioning the pt in semi-fowlers - relaxation techniques - supplemental oxygen therapy

restlessness management at end of life

- pain medications - anxiolytics - relaxation techniques - therapeutic touch - promotion of decision-making

pain management at the end of life

- pain meds often opioids such as morphine - repositioning - hygiene care - relaxation techniques - therapeutic touch - comfortable clothing - comforting possessions

end of life care

- prioritize management of sx causing the most discomfort. Administer meds as ordered to manage sx - perform ongoing assessments of sx to determine the effectiveness of tx and need for changes in tx plan - manage medication adverse effects - reposition frequently to maintain comfort, airway patency, and skin and mucus membrane integrity - maintain an environment that promotes the patient's self esteem and dignity - promote patient control by encouraging patient decision making in healthcare, foods, and activities - encourage and assist the patient to perform activities of daily living as they are able and wish to do so - encourage relaxation techniques if indicated - use therapeutic touch as appropriate - provide care and support to patient and family - utilize therapeutic communication to develop and maintain communication among the patient, family and healthcare team - assist with the understanding of information about progression of disease and options for tx - assist the patient in clarifying personal goals to assist in effective decision-making - support the use of coping mechanisms the patient has had success with in the past as appropriate - support the pt in participation in religious practices that provide strength and comfort as appropriate - be aware of comments in the presence of unconscious clients as hearing is the last sensation lost

postmortem care: preparing the body

- provide privacy - remove all lines and tubes, unless this is a coroner's (medical examiner's) case or organs or tissues are to be donated - cleanse the body as indicated - align the body in the supine position with the head on a pillow, eyes closed, dentures in place, and arms with palms down on top of the sheet and blanket - change linens and gown - comb the patient's hair and replace hairpieces if present - tidy the room, removing unnecessary equipment, supplies and soiled linens - provide a calm environment by reducing lighting and minimizing noise

Traditional Chinese Medicine

- requires formal training- doctor of traditional Chinese medicine training takes several years - QI (chee) is energy flowing through 12 meridians (energy circuits) in body - composed of Yin and Yang: when out of balance lead to poor health - use acupuncture, diet, herbs, massage, exercise, and breathing to restore health - balance between yin (female, damp, dark properties) and yang (male, dry, bright, airy properties) is essential for health - TCM treatments seek to balance QI and yin/yang health components - also focus on 5 elements: fire, earth, metal, water and wood - pts may ask for TCM tx in hospital: need to assure are compatible with plan of care

caregiver burden

- results from the accumulation of stress experienced by a patient's family members after providing care for the patient for a period of time - may include difficulty sleeping, fatigue, and illnesses such as elevated blood pressure and psychiatric illnesses

excess oral secretion management at end of life

- semi-fowlers or semi prone positioning - anticholinergic medications - suctioning

therapeutic communication techniques for end of life

- silence - offering self - active listening - asking questions - asking open ended questions - clarifying: may accomplish this through restating, reflecting, paraphrasing, or exploring - offering broad opening statements or general leads - demonstrating recognition and acceptance - focusing - giving information - summarizing - touch

dehydration management at end of life

- sips of water and/or ice chips

death

- the 1981 Uniform Determination of Death Act gives a legal definition of death as either (1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem - most protocols for the pronouncing of death require 2 distinct clinical examinations - medical criteria for the certification of death include: cessation of breathing, flat encephalogram (EEG), no response to stimuli that is deep and painful, and lack of spontaneous movement and reflexes

loss

- when someone or something of value experiences change or is no longer accessible resulting in diminishing or removing of its value - Actual, perceived, anticipatory, necessary, developmental/maturational, and situational

Shamanism

- whole medical system - belief that illness/distress originates in spirit world; practiced by indigenous people in many areas - Shaman is spirit leader and healer- goal is to return the person's right relationship with the spirit world - incorporate herbal tx, rituals, and purification ceremonies

Ayurveda

- whole medical systems - Ancient Indian medicine - focus on balance for the person's "type" (dosha). Includes diet, exercise, herbs, meditation, purification. - Requires formal training but no licensure in US - Yoga is one practice used in Ayurveda: postures used with breathing and centering to promote health and reduce sx

passive euthanasia

- withdrawal of medical treatment (not doing something) with the intention of allowing a client's death - most societies have held the belief that this is legally and morally justified while active euthanasia has been considered illegal and immoral, although this distinction is being questioned today

urinary incontinence management at end of life

-nearby bedpan - absorbant pads - hygiene care

Code of Ethics on End of Life Care

ANA Code of Ethics statement says that the nurse "should provide interventions to relive pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life"

adapting to acute and chronic illness

Adaptation involves 2 types of tasks - General tasks such as maintaining self esteem and personal relationships and preparing for the future. - Illness-related tasks, such as handling disability and pain, performing the medical regimen as prescribed, and losing control and independence

whole medical systems (CAM)

Ayurveda, Traditional Chinese Medicine, Shamanism, Homeopathy, Naturopathy

displacement

a defense mechanism that moves emotions from one object/person to another

bereavement

a state of grieving due to loss of a loved one

use of CAT

about 38% of adults and 12% of children use CAT yearly - more women and higher educated pts and a large percentage of seniors - many do not inform HCP of use of therapies - typical uses are to promote well being or treat chronic illnesses or sx

health care proxy

also called a durable power of attorney for healthcare; appoints a medical decision maker for times when the client is unable to make his/her own decisions

holism

belief that all living organisms are continually connecting/interacting with the environment and each other. Belief that a person is more than the sum of his parts, but is dynamic, unified whole (mind/body/spirit). A change in any part of the whole impacts all the other parts

denial

defense mechanism that refuses to acknowledge a disturbing condition

disenfranchised grief

grief for a loss that may not be considered socially acceptable or cannot be shared publicly (Ex. someone dying from overdose, do not want to share due to societal views on this)

alternative therapies

health therapies not generally practiced/accepted by allopathic medicine (biomedicine). Used in place of medical tx

biologically based

herbals, nutritional supplements

Child-Life Services

if desired by the family of children experiencing loss, these services may be able to speak with family and/or children about coping with loss and grief, provide information about resources, and assist in memory-making activities

advance directives

legal documents giving direction for situations at end of life

complementary therapies

may be same as alternative therapies, but used in conjunction with medical management

euthanasia

means "good dying"

terminal weaning

mechanical ventilation is gradually withdrawn from a client with a terminal illness or condition that is not reversible and a poor prognosis

Mind-Body Modalities

meditation, relaxation/imagery, prayer, humor, aromatherapy

developmental/maturational

normal and expected, results from the normal life transitions in the developmental process of life, and results in the development of coping skills

holistic nursing

nursing practice with the goal of healing (not necessarily curing) the whole person. May incorporate CAT

advance care planning

planning for care in the future at times when the client is unable to make his/her own decisions

perceived loss

recognizable to the person experiencing the loss but not to others. Ex. older person with loss of independence

actual loss

recognizable to the person experiencing the loss, as well as, other people. Ex. Death