Week 4- Fundamentals

Levinson

•Evolution of individual life structure • •Self (Motives, Values) •Social/Culture (Family, Career, Religion, Ethnicity) •Personal role (Husband, Father, Friend, Student) When 1 changes the entire life structure must reorganize

Erikson

•Expanded to include cultural & social influences in addition to biological processes - development is a continuous process

Fowler

•Faith •Spiritual identity of humans (not necessarily religious) •7 stages total - developed throughout life

Havinghurst

•Living and growing is based on learning - you must continuously learn to adjust to changing conditions

Freud

•Pleasure-seeking instincts drive behavior •Unconscious mind •Id •Ego •Superego

Regardless of the type of ambulatory care facility, what need is common to all clients who are given care?

•Referrals •Education •Stress reduction •Surgery

Genomics

•Study of interactions of all genes in the human body - with each other and environment

Kübler-Ross defines five stages of psychosocial responses to dying and death. Which statement is characteristic of the Denial stage?

"The doctors must have made a mistake."

The client has been on a ventilator for several days following a stroke. It is determined the client will not regain consciousness. The family has stated the client would not want to be maintained on a ventilator and has agreed to terminal weaning. The family has asked what will happen. What would the nurse state to the family? Select all that apply.

"Your relative may breathe on her own for hours to days." "No one can tell you if and when your loved one will die." "We will keep your relative comfortable throughout the dying process."

Steps of EBP (evidence based practice)

1. Collect the most relevant and best evidence 2. Critically appraise the evidence you gather 3. Integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change 4. Evaluate the practice decision or change 5. Share the outcomes of EBP with others

Lawrence Kohlberg

A childs beginnings of moral development result from caregiver-child communications during early childhood years, as the young child tries to please his or her parents and caregivers

Home health services

A covered expense under Part A of Medicare in which a licensed home health agency provides home health care to an insured.

Study infants -> older adults

ATI book

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience?

Actual loss

Phenotype

An organism's physical appearance, or visible traits.

A nurse is caring for a client who has stage IV lung cancer and is 3 days postoperative following a wedge resections. The client states, "I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my daughter's wedding." Based on Kubler-Ross' model, which stage of grief is the client experiencing?

Bargaining

According to the Harvard University Medical School committee, what function must be irreversibly lost to define death?

Brain function

A nurse is caring for a client who has a terminal illness. Death is expected within 24 hours. The client's family is at the bedside and asks the nurse about anticipated findings at this time. Which of the following findings should the nurse include in the discussion?

Decreased muscle tone.

The client is actively dying and has a prescription for Do Not Resuscitate. The nonresponsive client is mouth breathing and has noisy respirations. The client is incontinent of urine and feces. Family is at the bedside. What interventions would be appropriate for the nurse to perform to meet the needs of the client and the family? Select all that apply.

Elevate the head of the bed to a semi-Fowler's position. Encourage the family to reminisce about positive, enjoyable events that the client and family shared together. Cleanse the client's mouth every shift and prn.

When evaluating EBP nursing Research

Focus on 1.Validity - The legitimacy accuracy and soundness of all aspects of study 2.Reliability - The extend to which measurements result is consistent 3.Relevance - The logical connection between two ideas, tasks or events 4.Outcome - The conclusions reached through the process of research * Failure to utilize EBP to guide nursing care increases the risk of poor outcomes

A nurse is caring for a young client who is dying of renal failure. What should the nurse do when caring for the dying client's family members?

Inform the family members that it is time to bid farewell to the client

A client asks a nurse to explain a living will. What is the nurse's best answer?

It lists specific instructions for health care provisions.

Carl Joung

Jung did not believe that libido alone was responsible for the formation of the core personality. Ancestral memories/survival memories - Fear of spiders, snakes, the dark

A nurse is developing a plan of care for a dying client. Which physiologic basic human need should be addressed?

Personal hygiene

A client is diagnosed with a terminal illness. Who is usually responsible for deciding what, when, and how the client should be told?

Physician

A dying client is crying. She states, "Why me, Lord?" and "I can't pray." What would be an appropriate nursing diagnosis based on this data?

Psycho-spiritual distress

Which statement accurately describes the process known as grief reaction?

Reactions to grief may differ from client to family.

According to established standards, which health care provider should conduct a holistic assessment for all clients admitted to the hospital?

Registered nurse

A young client died following a cardiac arrest. The nurse caring for the client and the family notes that some members of the family refuse to accept that the client has died. What stage of grief is the family experiencing?

Shock and disbelief

A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge?

Stages of grief reactions may overlap and are individualized.

The client is terminal and has unrelieved and intractable pain. The nurse is administering hydromorphone intravenously. The client states, "I want you to give me additional medication so I will die. I can't go on any longer." What action would the nurse take?

State, "This is not something I or any of the nurses can do."

A client is being transferred from the hospital to a long-term care facility. What will happen to the client's medical record?

The chart remains in the hospital records.

A client has suddenly become very ill and needs to be transferred in the intensive care unit (ICU). What action by the nurse would ensure continuity of care?

The nurse provides an SBAR report to the nurse in the ICU

A dying client is undergoing terminal weaning. What is the purpose of this intervention?

To gradually withdraw mechanical ventilation

At what point during hospital-based care does planning for discharge begin?

Upon admission to the hospital

Illness-Wellness Continuum

a model that illustrates the full range of health between the extremes of illness and wellness

evidence-based practice

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences

Carol Gilligan

conception of mortality from the female viewpoint that was not represented in Kohlbergs work.

Genotype

genetic makeup of an organism

Enterostomal care-Enterostomal therapy

nurses specialize in the management of patients with urinary and fecal diversions, draining wounds and fistulas, fecal and urinary incontinence, and chronic wounds such as pressure ulcers and vascular ulcers.

Medicare pays for the first

pays for the first 100 visits following a hospital stay

Epigenetics

study of changes that occur in organisms due to modification of gene expression and hereditability (not change in DNA sequence)

The nurse has performed an assessment of a client scheduled for discharge to be cared for by the family. Which situation would the nurse question regarding discharge of this client to be cared for by the family?

the client and family lack knowledge of the treatment regimen

A nurse assesses a terminally ill client with a DNR order, with findings of decreased blood pressure, urinary and bowel incontinence, loss of reflexes, and Cheyne-Stokes respirations. Based on these findings, the nurse recognizes that:

these are signs of impending death.

A nurse providing palliative care for a dying man and his family knows that the goal of palliative care is what?

to aggressively treat the symptoms of the disease

Which of the following is the major goal of ambulatory care facilities?

to provide care to clients capable of self-care at home

Gould

•Ages 16-60 - viewed as transformational leading to developmental stages 18-22yrs, 22-28yrs, 29-34yrs, 35-43yrs, 43-50yrs, 50 and over.

Piaget

•Cognitive development - assimilation & accommodation •As you grow and learn you build upon what you already know as well as alter some information to make more sense of new information.