Exam 5

Experience of Pain

"Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does" (Margo McCaffery 1968) The International Association of the Study of Pain (IASP) defined pain as an unpleasant sensory and emotional experience associated with or resembling that associated with, actual or potential tissue damage -Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors. -Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons. -Through their life experiences, individuals learn the concept of pain. -A person's report of an experience as pain should be respected. -Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being. -Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

Do-not-resuscitate (DNR) order

(no code) on the medical record of a pt if the pt or surrogate has expressed a wish that there be no attempts to resuscitate the pt -DNR order means that no attempts are to be made to resuscitate a pt whose breathing or heart stops Allow natural death (AND) order instead of DNR bc it is easier for families to authorize doing something positive rather than preventing something (a resuscitative effort) that is usually perceived to be helpful -Do-not-intubate (DNI) order Comfort Measures Only & other special orders -indicates that the goal of treatment is a comfortable, dignified death & that further life-sustaining measures are no longer indicated -Do-not-Hospitalize order is for pt in long term care who elected not to be hospitalize for further aggressive treatments Terminal weaning is the gradual withdrawal of mechanical ventilation from a pt w/ a terminal illness or an irreversible condition w/ a poor prognosis Voluntary stopping of eating and drinking (VSED) Euthanasia- good dying Active euthanasia- taking specific steps to cause a pts death (doing something to end a pts life) Passaic euthanasia- is withdrawing medical treatment w/ the intention of causing the pts death (not doing something to preserve a pts life) Palliative sedation is the lowering of pt consciousness using meds for the express purpose of limiting pt awareness of suffering that is intractable and intolerable

Applying General Principles for Analgesic Administration

-Choose a pain scale or instrument that most accurately assists with assessment of pain. -Try various pain control measures. -Use pain control measures before pain increases in severity. -Ask the patient what has been effective for pain relief in the past. -Select and modify pain control measures based on the patient's response. -Encourage the patient to try the pain treatment several times before labeling it ineffective. -Be open minded about alternative, nonpharmacologic pain relief strategies. -Be persistent. -Be a safe practitioner Breakthrough pain, or breakthrough cancer pain, is a temporary flare-up of moderate to severe pain that occurs even when the patient is taking around-the-clock (ATC) medication for persistent pain and has had well-controlled background pain

Factors Affecting Spirituality

-Developmental Considerations -Family -Ethnic Background -Formal Religion -Life Events Religion and Law, Ethics, and Medicine -Christian Scientists, Jehovah's Witnesses, and members of certain faith-healing groups are among those challenging the intricate web of rights and responsibilities that links people, society, church, and state. -These religious bodies are asking for protection, under the umbrella of religious freedom, of the believer's right to exercise individual decisions in accordance with scriptural interpretations, even though those decisions may result in a person's own death or that of a family member, including a child Parish Nursing -seek to reclaim the church's role in the ministry of healing and focus again on the impact that spirituality, caring relationships, and a responsibly balanced life can have on health and wellness -the key roles of the parish nurse are health educator, personal health counselor, referral agent, trainer of volunteers, developer of support groups, integrator of faith and health, and health advocate

Nursing Process for Grieving or Dying Pt and Families Continue

-Meeting the needs of the dying pt -addressing physiologic needs-like personal hygiene, pain control, nutritional and fluid needs, movement, elimination, and respiratory care -addressing psychological needs-like fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, and unfinished business -addressing needs for intimacy- like partners may wish to be physically intimate with the dying person but are afraid of "hurting" them and may also be afraid that an open expression of sexuality is somehow "inappropriate" when someone is dying -addressing spiritual needs-like comfort in the support they receive from their religious faith -meeting the needs of the family- like listening to their concerns -providing postmortem care-like caring for the patient's body, caring for the family, and discharging specific legal responsibilities also ensuring that a death certificate is issued and signed, labeling the body, and reviewing organ donation arrangements -caring for the body like placed in normal anatomic position to avoid pooling of blood, soiled dressings are replaced, and tubes are removed-nurse is legally responsible for placing identification tags on either the shroud or garment the body is clothed in and on the ankle to ensure that the body can be identified even if it is separated from its shroud (identification tag on the patient's dentures or other prostheses to ensure that the mortician receives these) -caring for the family like listening to the family's expressions of grief, loss, and helplessness -caring for other pts -caring for oneself Evaluating

Pain in Older Adults

-adults older than 65 experience more pain than younger adults -impacts the emotional well. being, functional ability, sleep, coping, and recourses -physiologic changes affect their sensation of pain & the pharmacokinetics and pharmacodynamics consideration of pain meds -polypharmacy influence decisions regarding multimodal pain management regimens -pain is not part of again, it is the most common health conditions and is associated with disability and related to changes in mobility -older adults may be reluctant to report pain bc of feeling of illness or death -boredom, loneliness, and depression may affect perception and report of pain -using a standardized tool will determine the impact of chronic pain on functional status (mood, mobility, ADLs, sleep, weight changes, and cognitive status), etc

Vital Signs

-blood pressure (systolic 120/ diastolic 80) hypotension low blood pressure hypertension high blood pressure -heart rate (60-100 bpm) bradycardia less than 60 bpm tachycardia more than 100 bpm -respiratory rate (12-20 breaths/min) bradypnea less than 12 breaths/min tachypnea more than 20 breaths/min -temperature (97.8 - 99 degrees F) hypothermia less than 95 degrees F hyperthermia more than 104 degrees F -Oxygen saturation (95%-100%) hypoxemia low oxygen levels -Pain 0-10

Managing Pharmacologic Relief Measures

-is a complex process that requires adequate assessment, consideration of guidelines and regulations, knowledge of medications, sufficient tracking and follow-up, patient teaching, and an interprofessional, multimodal approach Analgesic drug is a pharmaceutical agent that relieves pain Opioid analgesics (all controlled substances, e.g., morphine, codeine, oxycodone, meperidine, hydromorphone, methadone) Nonopioid analgesics (acetaminophen and NSAIDs) Adjuvant analgesics (anticonvulsants, antidepressants, multipurpose drugs) -nurse administering analgesics needs to combine a healthy respect for the drug being administered with a thorough knowledge of its mechanism of action, side effects, and administration guidelines -Opioids relieve pain that is peripheral/nociceptive in nature, such as acute pain due to injury, pain associated with rheumatoid arthritis, or cancer pain -Nonopioid analgesics, such as acetaminophen and NSAIDs, are usually the drugs of choice for both acute and persistent moderate chronic pain

Psychological Homeostasis Continue

-panic causes the person to lose control and experience dread and terror-increased physical activity, distorted perception of events, and loss of rational thought-difficulty communicating verbally, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure -anxiety disorders are persistent and affects responses from a cognitive, behavioral, emotional, and physiologic perspective -anxiety disorders include panic disorder, generalized anxiety disorder (GAD), phobias (agoraphobia, social phobia, specific phobia), separation anxiety disorder, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder Coping Mechanisms -are behaviors used to decrease stress and anxiety -typical coping behaviors include the following Crying, laughing, sleeping, cursing, Physical activity, exercise. Taking a deep breath, using practiced mindfulness/centering exercises, Verbally debriefing with another person, journaling, Engage in an enjoyable activity as a distraction, Smoking, drinking Lack of eye contact, ignoring the stressor, withdrawal, Limiting relationships to those with similar values and interests -Task-oriented reactions involve consciously thinking about the stress situation and then acting to solve problems, resolve conflicts, or satisfy needs-these reactions include attack behavior, withdrawal behavior, and compromise behavior Defense Mechanisms -protect a person's self-esteem and are useful in mild to moderate anxiety-when extreme, however, they distort reality and create problems with relationships

Conversions

1 tsp (teaspoon)= 5 ml 1 Tbs (tablespoon)= 3 tsp=15 ml 1 oz= 30 ml 1 cup= 8 oz =240ml 6 oz= 180 ml 4 oz = 120ml 1 gr (grain)= 60 mg 1 kg= 2.2 lbs 1 lb= 16 oz 0.5 oz = 15 ml 1000 mcg = 1 mg 1000 mg = 1 g 1000 g = 1 kg 1000 ml = 1 L

Formation of Self-Concept

1. an infant learns that the physical self is different from the environment. If basic needs are met, warmth and affection are experienced, and the caregivers' anxiety is minimized, then the child begins life with positive feelings about self. 2. the child next internalizes (incorporates into self) other people's attitudes toward self, including attitudes directed toward the child's innate tendencies, such as temperament and aggression. This internalization forms the foundation of self-concept. Parents or other direct caregivers play the most influential role; peers play the second most influential role. Later, the child continues to behave in ways that confirm this early self-concept. How loved you felt as a child is a great predictor of how you manage all sorts of difficult situations later in life 3. the child or adult internalizes the standards of society. Stages in the development of the self include self-awareness (infancy), self-recognition (18 months), self-definition (3 years), and self-concept (6 to 7 years)

Socialization & Communication

Adaptive responses: Maintains usual social patterns, communicates needs and accepts offers of help, serves as support for others. Maladaptive responses: Isolates self, exhibits superficial self-confidence, is unable to express needs (becomes hostile, ashamed, frustrated, depressed) Significance "Are there people in your life with whom you share a close relationship?" Competence "What are the things you need to do to feel important?" Virtue "Tell me something about the moral-ethical principles that govern your life." Power "How important is it to you to 'be in control' of your life (health)?"

Ethical and Legal Dimensions

Advance care planning (ACP) is a process of planning for future care in the event a person becomes unable to make their own decisions Advance directives (written)—a living will and a durable power of attorney for health care—can minimize difficulties by allowing people to state in advance what their choices would be for health care should certain circumstances develop -Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations -A durable power of attorney for health care appoints an agent the person trusts to make decisions in the event of subsequent incapacity A Physician Order for Life-Sustaining Treatment form POLST form, is a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis -because it is a medical order, a POLST form must be completed and signed by a health care professional and cannot be filled out by a patient Death Certificate -for each person who dies Organ Donation Autopsy -consent for this is legally required -the HCP responsibiliy to obtain permission for an autopsy

Nursing Process for Grieving or Dying Pt and Families

Assessing -Patient and family's understanding of medical condition, prognosis, and dying process -Patient and family's attitude toward death and dying and knowledge of the dying process -Patient's preferences for end-of-life treatment and care, such as desire to be at home or in a hospital, and decisions concerning treatment, resuscitation, advanced life support, organ donation, and so forth -Documented evidence of advance care planning -Existence of an advance directive -Religious beliefs -Cultural influences -Stage of grief and death reaction -Adequacy of coping behaviors -Adequacy of resources -Physiologic needs of the patient- personal hygiene, pain control, nutritional and fluid needs -Psychological needs of the patient and family-fear of the unknown, pain, separation -Spiritual needs of the patient and family: need for meaning and purpose, for love and relatedness, for forgiveness, for hope Diagnosing Planning Implementing -developing trusting nurse-pt and nurse-family relationships -HOPE -explaining the pts condition and treatment -teaching self-care & promoting self-esteem -teaching family members to assist in care

Nursing Process for Comfort and Pain Management

Assessing -Routine pain assessment -common misconceptions: the doctor has prescribed pain-relieving medication for me, which I will be given routinely, if I ask for something for my pain, I will immediately become addicted to the medication, sometimes it is better to put up with the pain than to deal with the side effects of the pain medication, I should somehow be able to control my pain. It is immature to talk about pain, It is better to wait until the pain gets really bad before asking for help. If I take the medication now for moderate pain, it won't relieve severe pain later on,I don't want to bother anyone—I know how busy everyone is, It's natural for me to have excruciating pain after surgery. After a few days, I should notice it lessening -components of a pain assessment: Patient's initial verbalization and description of the pain, Onset of the pain: etiology or mechanism of injury (if known), Duration of the pain, Location of the pain: localized, generalized, radiation, Quality and character of the pain- Intensity: severity of the pain, Aggravating or causal factors: what triggers or makes it worse, Alleviating/relieving factors: what makes it better, Other contributing or related factors: anxiety, fear, depression, insomnia Effect on function: activities of daily living, recreation, work, quality of life, Pain management goal -The primary purposes of using a guide to assess pain are to: (1) eliminate guesswork and biases when dealing with the patient's pain; (2) appreciate what the person is experiencing; (3) analyze findings that will help prepare an appropriate nursing response to the patient's pain; and (4) facilitate improved outcomes, such as fewer complications, shorter hospital stays, and improved quality of life

Nursing Process for the Pt with Stress and Anxiety

Assessing -nursing history -physical assessment Diagnosing -stress as the problem -stress as the etiology Outcome Identification and Planning Implementing -teaching health activities of daily living -exercise, rest & sleep, nutrition -encouraging use of support systems -encouraging use of stress management techniques -relaxation, mindfulness, anticipatory guidance, guided imagery -providing crisis intervention -crisis standards of care Evaluating

Nursing Process for Fluid, Electrolyte Balance

Assessing -nursing history related to the pt's fluid and electrolyte status -physical assessment of the skin and mucous membranes, vital signs, & neurologic assessment-identifying relative symptoms like excessive thirst, nausea, vomiting, diarrhea, draining wounds, or other fluid losses -fluid intake & output -daily weight -lab studies like urine pH & specific gravity, arterial blood gasses serum electrolytes, blood urea nitrogen and creatinine levels (^BUN: found with impaired renal function like shock, heart failure, & salt and water depletion, diabetic ketoacidosis, burns ^creatinine: found with impaired renal function, heart failure, shock, fluid volume deficit), complete blood count (^hematocrit found in severe fluid volume deficit & shock, decreases hematocrit found in acute, massive blood loss or fluid overload, ^hemoglobin found in hemoconcentration of the blood, decreased hemoglobin found with anemia or severe hemorrhage) Diagnosing Planning Implementing -preventing fluid & electrolyte imbalances -developing a dietary plan -modifying fluid intake: for fluid volume deficit, increase foods with high water content (citrus fruit, melons, celery); for hypokalemia, increase foods with high potassium content (bananas, citrus fruits, apricots, melons, broccoli, potatoes, raisins, lima beans) hypernatremia, avoid foods high in sodium (processed cheese, lunch meats, canned soups and vegetables, salted snack foods) and eliminate the use of table salt Evaluating

Nursing Process for Spiritual Health

Assessing -nursing history-an assessment of the patient's spirituality—including beliefs and practices, the effect of these beliefs on everyday living, spiritual distress, and spiritual needs—should be included in each comprehensive nursing history -H—Sources of Hope, meaning, comfort, strength, peace, love, and connection O—Organized religion P—Personal spirituality and practice E—Effects on medical care and end-of-life issue -nursing observation-include sudden changes in spiritual practices (rejection, neglect, fanatical devotion), mood changes (frequent crying, depression, apathy, anger), sudden interest in spiritual matters (reading religious books or watching religious programs on television, visits to clergy), and disturbed sleep Diagnosing Planning -enhancing spiritual health -addressing spiritual distress Implementing Spiritual Care -ethical and professional boundaries -offering supportive or healing presence -facilitating the practice of religion -nurturing spirituality -praying w/ pts -praying for pts -counseling pts spiritually -contacting a spiritual counselor Promoting meaning and purpose Promoting love and relatedness Promoting forgiveness Evaluating

Nursing Process for Pt w/ Alterations in Self-Concept

Assessing -personal identity describes a persons conscious sense of who they are-"How would you describe yourself to others?" Pay special attention to the labels used by the patient and the order in which they appear -personal strengths -body image is the persona subjective view of their physical appearance-body image disturbances can be expected with any alteration in bodily appearance, structure, or function RESPONSE TO MALFORMATION OR LIMITATION Adaptive responses: Patient exhibits signs of grief and mourning (shock, disbelief, denial, anger, guilt, acceptance). Maladaptive responses: Patient continues to deny and to avoid dealing with the deformity or limitation, engages in self-destructive behavior, talks about feelings of worthlessness or insecurity, equates deformity or limitation with whole person, shows a change in ability to estimate relationship of body to environment. INDEPENDENCE-DEPENDENCE PATTERNS Adaptive responses: Patient assumes responsibility for care (makes decisions), develops new self-care behaviors, uses available resources, interacts in a mutually supportive way with family Maladaptive responses: Patient assigns responsibility for their care to others, becomes increasingly dependent, or stubbornly refuses necessary help -self esteem use the opportunity to ask questions about whether patients like themselves, and whether they are pleased with their expectations and the progress they are making to realize these expectations -role performance occupation or profession-role ambiguity (failure to completely and accurately understand what a role demands), role stress (disparity between what one believes the role demands and what one is able to offer), and role overload (limited time because of other commitments makes it impossible to meet realistic role expectations)

Nursing Process for the Pt with a Sexual Health Needs

Assessing -sexual history-any inpatient or outpatient receiving care for pregnancy, STI, infertility, or contraception-any patient experiencing sexual dysfunction-any patient whose illness will affect sexual functioning and behavior in any way -privacy is essential for the sexual history; doors should be closed, and no interruptions allowed-sit close to the patient and speak in a quiet, relaxed, objective tone of voice-use eye contact and open body posture-explain to the patient that only providers directly involved with the care of the patient will have access to this information -obtain reproductive health information first, followed by the sexual health history -better model: Bring up the topic of sexuality so that patients know they can discuss sexuality openly. Explain that you are concerned with all aspects of patients' lives affected by disease. Tell patients sexual dysfunction can happen and that you will find appropriate resources to address their concerns. Timing is important to address sexuality with each visit to let patients know they can ask for information at any time. Educate patients about the side effects of their treatments and that side effects may be temporary. Record your assessment and interventions in patients' medical records -physical assessment Diagnosing Planning Implementing -teaching about sexuality and sexual health -nurse-pt relationship -promoting responsible sexual expression Contraception is a process or technique for preventing pregnancy by means of a medication, device, or method that blocks or alters one or more of the processes of reproduction in such a way that sexual intercourse can occur without impregnation Evaluating

Nursing Process for Rest and Sleep pg 1327

Assessment Rest and Sleep Nursing History -sleep history-assess sleep-wakefulness patterns, effects on everyday functioning, use of sleep aids, sleep disturbances, contributing factors, nature/cause of problem, accompanying signs & symptoms, dates of occurrences, severity of the problem, treatment of problem, coping with problem? --adequacy of rest and sleep equals pt's statements (subjective) -sleep diary-record for 2wks- time pt retires, time pt tries to fall asleep, time pt falls asleep, time pt wakes up at night & resumes to sleep, time pt wakes up in the am, any stressors affecting sleep, food, drinks or medications affecting sleep, physical & mental activities, activities performed 2-3hrs before sleep, worries or anxieties affecting sleep -past medical history -physical exam --sleep characteristics: restlessness, sleep postures, sleep activities, snoring, leg-jerking --decrease energy levels, decreased facial characteristics, behaviors -diagnostic & lab studies --hormone levels Diagnosing Planning Implementing --preparing a restful environment, promoting bedtime rituals, offering appropriate bedtime snacks or drink (light protein or carb snack), promoting relaxation and comfort, respecting normal sleep-wake patterns, minimizing sleep and rest disturbances in healthcare settings, using medications to promote sleep, teaching about rest and sleep, Evaluating

Assessing IV site

Assessment IV insertion -determine most desirable vein -assess non dominate arm -to make vein more visible use gravity, warmth, flick or tap vein, fist clenching, clean vigorously, place tourniquet -obtaining venous access by positions pt in low-fowler, protective towel or pad arm, hold arm below heart, open & close fist, if vein cant be felt stoke the vein downward or remove tourniquet and place warm, dry compresses over intended vein for 10-15mins, cleanse site, avoid touching site and let site dry for 30secs -iv insertion by stabilizing vein, insert iv catheter directly atop vein, bevel up, 15-30 degree angle over skin, watch for blood flashback, and release tourniquet -monitoring infusion rate & iv sites during the patient assessment, beginning of shift, every 2hrs, very time iv meds are given, check site for complications, assess desired effects, assess potential adverse effects, change iv every 48-72hrs, inspect/palpate site every 2hrs -special considerations: less then 2 attempts by 1 nurse (then another nurse can try), interfering factors with iv placement could include older age, obesity, hypovolemia, injection drug use, presence of multiple iv access

Times of Medications

BID > two times per day PRN > as needed NPO > nothing by mouth QID > four times per day HS > hour of sleep STAT > immediately p.c. > after meals TID > three times per day PO > by mouth a.c. > before meals Qh > every hour OS > left eye a.d > right ear OD > right eye a.s > left ear OU > both eyes a.u > both ears

Common Responses to Pain

Behavioral (Voluntary) Responses Moving away from painful stimuli Grimacing, moaning, and crying Restlessness Protecting the painful area and refusing to move Physiologic (Involuntary) Responses Typical Sympathetic Responses When Pain Is Moderate and Superficial Increased blood pressure * Increased pulse and respiratory rates * Pupil dilation Muscle tension and rigidity Pallor (peripheral vasoconstriction) Increased adrenaline output Increased blood glucose Typical Parasympathetic Responses When Pain Is Severe and Deep Nausea and vomiting Fainting or unconsciousness Decreased blood pressure Decreased pulse rate Prostration Rapid and irregular breathing Affective (Psychological) Responses Exaggerated weeping and restlessness Withdrawal Stoicism Anxiety Depression Fear Anger Anorexia Fatigue Hopelessness Insomnia and other sleep disturbances Powerlessness (* an increase in vital signs may occur briefly in acute pain but may not occur when chronic pain is present)

Body Fluids

Body Fluid Compartments -Intracellular fluid (ICF) is the fluid within cells, constituting about 70% of total body water or 40% of adult's body weight -extracellular fluid (ECF) is all the fluid outside the cells-30% of total body water or 20% adults body weight -ECF includes two major areas, the vascular (intravascular) and interstitial compartments. (a third transcellular fluid compartment) -Intravascular fluid, or plasma, is the liquid component of the blood (i.e., fluid found within the vascular system). -Interstitial fluid is the fluid that surrounds tissue cells and includes lymph -Transcellular fluids include cerebrospinal, pericardial, synovial, intraocular, and pleural fluids, as well as sweat and digestive secretions. -The capillary walls and cell membranes separate the intracellular and extracellular compartments Variations in fluid content -Fat cells contain little water, whereas lean tissue is rich in water (the more obese a person is, the smaller the person's percentage of total body water is when compared with body weight) -Because women tend to have proportionally more body fat than men do, they also have less body fluid than men -the decreasing percentage of body fluid in older people is related to an increase in fat cells In addition, older adults lose muscle mass as a part of aging. -The combined increase of fat and loss of muscle results in reduced total body water; after the age 60 years, total body water is about 45% of a person's body weight -This decrease in water increases the risk for fluid imbalance in older adults.

Major Electrolytes Continue

Calcium (Ca2+):8.6-10.2 mg/dL normal ionized serum calcium level: 4.5-5.1 mg/dL Function -role in blood coagulation and in transmission of nerve impulses -helps regulate muscle contraction and relaxation -major component of bones and teeth Sources/Losses -absorbed from foods in the presence of normal gastric acidity and vitamin D -lost via feces and urine -milk and milk products; dried beans; green, leafy vegetables; small fish with bones; and dried peas and beans Regulation -primarily excreted by GI tract; lesser extent by kidneys -regulated by parathyroid hormone and calcitonin -high serum phosphate results in decreased serum calcium; low serum phosphate leads to increased serum calcium Magnesium (Mg2+):1.3-2.3 mEq/L Function -metabolism of carbohydrates and proteins -role in neuromuscular function -acts on cardiovascular system, producing vasodilation Sources/Losses -enters the body via GI tract -green, leafy vegetables; nuts; seafood; whole grains; dried peas and beans; cocoa -lost via urine with use of loop diuretics Regulation -eliminated by kidneys -regulated by parathyroid hormone Chloride (Cl-):97-107 mEq/L Functions -major component of interstitial and lymph fluid; gastric and pancreatic juices, sweat, bile, and saliva -acts with sodium to maintain the osmotic pressure -combines with hydrogen ions to produce hydrochloric acid Sources/Losses -enters body via GI tract -almost all chloride in diet comes from salt -found in foods high in sodium, processed foods Regulation -normally paired with sodium; excreted and conserved with sodium by the kidneys -regulated by aldosterone -low potassium level leads to low chloride level

Commonly Occurring Defense Mechanisms

Compensation A student who has difficulty with academics may excel in sports. Denial Despite finding a lump in her breast, a woman does not seek medical treatment. Displacement An employee who is angry with a coworker kicks a chair. Dissociation An adult cannot recall childhood memories surrounding the traumatic death of a sibling. Introjection An older sibling tells his preschool sister not to talk to strangers, expressing his parents' values to his younger sister. Projection A person who denies any sexual feelings for a coworker accuses them of sexual harassment. Rationalization A patient who forgot to keep a health care appointment says, "If patients didn't have to wait 3 months to get an appointment, they wouldn't forget them." Reaction formation A married woman is attracted to her husband's best friend but is constantly rude to him. Regression Children may regress to soiling diapers or demanding a bottle when they are ill. Repression A father may not remember shaking his crying baby. Sublimation A person who is aggressive toward others may become a star football player. Undoing A husband who was physically abusive to his wife may bring her an expensive present the next day.

Common pain syndromes producing Neuropathic Pain

Complex regional pain syndrome (causalgia) occurs in the area of a partially injured peripheral nerve (the most common lesions are of the brachial plexus or median or sciatic nerve). The pain is described as burning, severe, diffuse, and persistent and is elicited by minimal movement or touch of the affected area. It increases with repeated stimulation and continues even after stimulation ceases. Postherpetic neuralgia an acute central nervous system infection, such as herpes zoster (shingles). The severity of the pain may be mild to severe. Intractable pain may persist for months to years. Phantom limb pain occur in any person who has had a body part amputated either surgically or traumatically. Pain varies and may be a severe, burning, fiery sensation; crushing; cramping; a sense that the limb is edematous; or a sensation that the limb is being twisted and distorted. It may be triggered by the sensation of touching the residual limb, the occurrence of another illness, fatigue, atmospheric changes, and emotional stress. Trigeminal neuralgia This manifests as sudden, violent, lightning-like stabs of intense pain in one or more divisions of the trigeminal nerve, the fifth cranial nerve. Pain is usually experienced in the mouth, gums, lips, nose, cheek, chin, and surface of the head and may be triggered by everyday activities such as talking, eating, shaving, or brushing one's teeth. Diabetic neuropathy This is a common complication of long-term diabetes. Metabolic and vascular changes result in damage to peripheral and autonomic nerves. Sensory loss can result when peripheral nerves are involved and eventually lead to injury progressing to infection and gangrene. Symptoms include sensations of numbness, prickling, or tingling (paresthesias).

Electrolytes

are substances that are capable of breaking into particles called ions -ion is an atom or molecule carrying an electrical charge -cations are ions with a positive charge-major cations are sodium, potassium, calcium, hydrogen and magnesium -anions are negative charge-major anions are chloride, bicarbonate, phosphate -urea and glucose are examples of non-electrolytes -major electrolytes in the ECF are sodium, chloride, calcium, and bicarbonate -major electrolytes in ICF are potassium, phosphorus and magnesium Solvents are liquids that hold a substance in solution Solutes are substances that are dissolved in a solution -water is the primary solvent in the body-electrolytes and non-electrolytes are solutes

Factors Affecting the Pain Experience

Cultural and Ethnicity Variables -Family, Biological Sex, Gender and Age Variables -Religious Beliefs and Spirituality Environment and Support People Anxiety and Other Stressors Past Pain Experience -Some patients have never known severe pain and have no fear of pain, not realizing how intense the sensation can be. -Some patients have experienced severe acute or chronic pain in the past but received immediate and adequate pain relief. These patients are generally unafraid of pain and initiate appropriate requests for assistance. -Some patients have known severe pain in the past and were unable to secure relief. Even the suggestion of new pain can lead to acute feelings of fear, despair, and hopelessness. -A person whose past pain experience led to correction of unhealthy behavior and produced a greater sense of health and well-being, may respect and value pain and consider the meaning and significance of new pain carefully. -In general, people who have experienced more pain than usual in their lifetimes tend to anticipate more pain and exhibit increased sensitivity to pain. -Some pain memories are virtually unforgettable. New contact with conditions similar to those that caused the earlier pain can provoke a violent response.

Dying and Death

Death (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem -a determination of death must be made in accordance with accepted medical standards The medical criteria used to certify a death are as follows: breathing cessation, no response to deep painful stimuli, lack of reflexes (such as the gag or corneal reflex) and spontaneous movement flat encephalogram (brain waves) Signs of Impending Death -Difficulty talking or swallowing -Nausea, flatus, and abdominal distention -Urinary or bowel incontinence or constipation -Loss of movement, sensation, and reflexes -Decreasing body temperature with cold or clammy skin -Weak, slow, or irregular pulse -Decreasing blood pressure -Noisy, irregular, or Cheyne-Stokes respirations -Restlessness or agitation -Cooling, mottling, and cyanosis of the extremities and dependent areas A Good Death -is one that allows a person to die on their own terms, relatively free of pain, and with dignity

Responses to Dying and Death

Denial: The patient denies the reality of death and may repress what is discussed Anger: The patient expresses rage and hostility and adopts a "why me?" Bargaining: The patient tries to barter for more time: "If I can just make it to my son's graduation, I'll be satisfied. Just let me live until then." Depression: The patient goes through a period of grief before death Acceptance: When the stage of acceptance is reached, the patient feels tranquil. The patient has accepted the reality of death and is prepared to die Terminal Illness -an illness in which death is expected within a limited period of time, the health care provider is usually responsible for deciding what, when, and how the patient should be told Palliative care involves taking care of the whole person—body, mind, and spirit; heart and soul -give patients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms Hospice care is care provided for people with limited life expectancy, often in the home -Indicators for hospice referral include: poor performance status, declining cognitive status, advanced age, poor nutritional intake, pressure injuries, comorbidities, previous hospital admissions for acute decompensation

Factors Affecting Sexuality

Developmental Considerations Culture -every culture has its own norms regarding sexual identity and behavior -culture dictates the choice of sexual partner, duration of sexual intercourse, methods of sexual stimulation, and sexual positions -Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris) -Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora -Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. -Other: all other harmful procedures to the female genitalia for nonmedical purposes—for example, pricking, piercing, incising, scraping, and cauterizing the genital area Religion Ethics -healthy sexuality depends on freedom from guilt and anxiety Lifestyle Menstruation -menarche is the first period for age 12 but can happen to 8-17yrs old -menopause- is the cessation of menstrual activity, occurs between the ages 48 and 55 years-there may be irregular menses over time before menstruation ends Childbearing considerations Sexually Transmitted Infections

Factors Affecting Rest and Sleep

Developmental considerations -65 yrs and older report difficulty falling asleep, early awakening or waking frequently during the night, napping or not feeling rested after a night's sleep -older adults often need more time to fall asleep & are less able to cope with changes in their usual sleep patterns -many take naps during the day, which often results in sleeping fewer hrs at night -chronic illness may also affect their sleep pattern Motivation Culture Lifestyle and habits -physical activity and exercise -dietary habits -smoking Environmental factors Psychological Stress -illness -life situations -the person experiencing stress may find it difficult to obtain the amount of sleep needed-REM sleep decreases in amount, which adds to anxiety and stress

Factors Affecting Self-Concept

Developmental considerations Culture Internal and external resources History of success and failure Crisis or life stressors -cyber bullying, marriage, divorce, acute or chronic illness, an exam, a new job or job loss, a gray hair, a fire Aging,Illness, Disability or Trauma

Factors Affecting Grief and Dying

Developmental considerations Family Socioeconomic factors Cultural, gender, and religious influences Cause of death Mental Health First Aid Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self-help and other support strategies

Nursing Process for Pt w/ Alterations in Self-Concept Continue

Diagnosing -assessment data point to an alteration in self-image, the first task is to determine whether the altered self-concept is the problem, the cause of the problem (etiology), or merely a sign that a problem exists Planning Implementing -helping pt identify and use personal strengths -helping at-risk pt maintain a sense of self -teach self-compassion -modifying a negative self-concept -developing a positive body image -enhance self-esteem in older adults Evaluating

Nursing Process for Comfort and Pain Management Continue

Diagnosing Actual or Potential Health Problems and Needs -types of pain, etiologic factors, to the extent that they are known and understood, pt behavioral, physiologic, and affective responses, other factors affecting pain stimulus, transmission, perception and response -pain or chronic pain as the problem -pain or chronic pain as the etiology Outcome Identification and Planning Implementing -establishing a trusting nurse-pt relationship -manipulating factors affecting the pain experience -removing or altering the cause of pain -altering factors affecting pain tolerance -initiating complementary health approaches and integrative health care -using distraction -visual distractions: counting objects, reading, or watching TV, auditory distractions: listening to music, tactile kinesthetic distractions: holding or stroking a loved person, pet, or toy; rocking; slow rhythmic breathing, interactive video games, project distractions: playing a challenging game, performing meaningful play or work -employing humor, listening to music, using imagery, mindfulness practice (relaxation, meditation and breath work) -using cutaneous stimulation (massage, heat or cold application, acupressure, electrical stimulation), using acupuncture & dry needling -using hypnosis, employing biofeedback, providing healing/therapeutic touch, animal-assisted intervention

Types of Pain

Duration of Pain -Acute pain is generally rapid in onset and varies in intensity from mild to severe (protective in nature) -acute pain warns the person of tissue damage or organic disease and triggers autonomic responses such as increased heart rate, the fight or flight response, and increased BP -after its underlying cause it resolved, acute pain disappears (it should end once healing occurs) -causes of acute pain include a pricked finger, sore throat or surgery -Chronic pain is maladaptive pain that persists or is recurrent for more than 3 months -chronic primary pain, the chronic pain itself is considered the disease (fibromyalgia or back pain) -chronic secondary when the chronic pain results from cancer, surgery or trauma, an issue in the nervous system (neuropathic), headache or orofacial issues, visceral (organ) disease, or musculoskeletal diseases Remission-disease is present, but the person does not experience pain and Exacerbation- the symptoms reappear or pain that is recurring and contains elements of both chronic and acute pain Chronic pain takes a toll on the person experiencing pain and may result in depression, anger, frustration, sleep and appetite disturbances, and dependency. Chronic secondary pain that is associated with a disease process, such as cancer, is more likely to be viewed as valid, while chronic primary pain that is not well defined may be misinterpreted or dismissed by health care providers

Basic Concepts of Stress and Adaptation

Eustress is the term used for short-term stress that promotes positive emotional, intellectual, and physiologic adaptation and development Stress is a condition in which the human system responds to changes in its normal balanced state -results from a change in a person's internal or external environment that is perceived as a challenged, a threat or a danger -it affects the whole person in physical, emotional, intellectual, social and spiritual & it can be positive or negative Stressors is anything that is perceived as challenging, threatening, or demanding that triggers a stress reaction. -internal like an illness, a hormonal change, or fear or external like loud noise or cold temperature Physiologic Stressors -the specific effect is an alteration of normal body structure and function-the general effect is the stress response -primary physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders Psychosocial Stressors -the environment, interpersonal relationships, or a life event can lead to the stress response if a person does not have the resources to adequately respond to the perceived or actual stressor

Fluid Imbalances

Fluid Volume Deficit -occurs when loss of ECF volume exceeds the intake of fluid -involves a loss of both water & solutes in the same proportion from the ECF space Hypovolemia isotonic fluid loss -both osmotic and hydrostatic pressure changes force the interstitial fluid into the intravascular space in an effort to compensate for the loss of volume in the blood vessels -third-space fluid shift refers to a distributional shift of body fluids into the transcellular compartment, such as the pleural, peritoneal (ascites), or pericardial areas; joint cavities; the bowel; or an excess accumulation of fluid in the interstitial space Fluid Volume Excess -excessive retention of water & sodium in ECF in near-equal proportions results in fluid volume excess -may be a result of fluid overload (excess water & sodium intake) or due to impairment of the mechanisms that maintain homeostasis -common causes include malfunction of the kidneys, causing an inability to excrete the excesses, and failure of the heart to function as a pump, resulting in accumulation of fluid in the lungs and dependent parts of the body Hypervolemia is the excessive ECF accumulated in either the intravacular compartment or interstitial spaces (edema) -edema can be observed around the eyes, fingers, sacral spaces, in or around body organs Interstitial-to-plasma shift is the movement of fluid from the space surrounding the cells to the blood -the body attempts to maintain normal balance in all fluid spaces, the intravascular fluid is usually protected at the expense of interstitial fluid and ICF

IV Therapy

Infiltration (fluid leaks out onto the tissue) -swelling, coolness, pallor, leaking at the site, difficulty flushing Phlebitis (inflammation of vein) -induration (hardening), pain or discomfort, redness (erythema), swelling, heat, vein might be indurated, might observe a red streak that follows the superficial vein Infection (bacteria invades iv line, port, skin) -localized redness, purulent (discharge) drainage, pain, warmth, edema, induration, fever, chills, malaise, elevated WBC Extravasation (type of infiltration, a vesicant agent in the iv leaks into surrounding tissues and causes serious tissue damage) -pain, edema, burning, redness (erythema), formation of blisters, necrotic tissue, slough or eschar Hematoma (occurs when the iv angiocatheter passes through more than one wall of a vein or if pressure is not applied to the iv site when the catheter is removed) -swelling, pain, ecchymosis (discoloration or bruising) Air Embolism (occurs when air enters the venous system from the iv catheter and circulates-can be fatal) -hypotension, tachycardia, difficulty breathing, cyanosis (skin, lips nails during blue due to lack or oxygen) Speed Shock (giving iv meds too quickly) -flushed face, systemic reaction such as tightness or pressure in the chest, irregular pulse, flushed skin/face, headaches, changes in LOC or loss of consciousness, feeling of impending doom, cardiac arrest

Self-knowledge "Who am I?"

Global self is used to describe the composite of all the basic facts, qualities, traits, images, and feelings people hold about themselves -Basic facts (sex, age, race, occupation, cultural background, sexual orientation) -Person's position within social groups -Qualities or traits that describe typical behaviors, feelings, moods and other characteristics (generous, hot headed, ambitious, intelligent) Self-Expectations: "Who or What Do I Want to Be?" Ideal self constitutes the self one wants to be False self may develop in people who have an emotional need to respond to the needs and ambitions significant people (parents) have for them Self-Evaluation: "How Well Do I Like Myself?" -(1) self-esteem needs, such as strength, achievement, mastery and competence, confidence in the face of the world, independence, and freedom -(2) respect needs or the need for esteem from others, such as status, dominance, recognition, attention, importance, and appreciation Coopersmith (1967) identified the four bases of self-esteem (1) significance, or the way people feel they are loved and approved of by the people important to them; (2) competence, or the way tasks that are considered important are performed; (3) virtue, or the attainment of moral-ethical standards; and (4) power, the extent to which people influence their own and others' lives Three major self-evaluation feelings or affects found in people are (1) pride, based on a positive self-evaluation, (2) guilt, based on behaviors incongruent with ideal self, and (3) shame, associated with low global self-worth Sullivan (1953) proposed the self-representations of "good-me" and "bad-me" based on reflected appraisals of the self, learned in the context of a child's early relationship with significant others, especially parents

Physical and Psychological Effects of Insufficient Sleep Continue

Healthy People 2030 included increasing the proportion of adults who get sufficient sleep; increasing the proportion of high school students who get sufficient sleep; increasing the proportion of people with sleep apnea symptoms who get evaluated by a HCP; reducing the rate of motor vehicle crashes due to drowsy driving; increasing the proportion of children who get sufficient sleep; and increasing the proportion of infants who are put to sleep on their backs Joint Commission acknowledges the impact of fatigue on healthcare workers and urges greater attention to the issue, suggesting actions for healthcare facilities to reduce fatigue-related risks

Electrolyte Imbalances

Hyponatremia & Hypernatremia Hypokalemia & Hyperkalemia Hypocalcemia & Hypercalcemia Hypomagnesemia & Hypermagnesemia Hypophosphatemia & Hyperphosphatemia Hypochloremia & Hyperchloremia

Factors Affecting Rest and Sleep Continue

Illness -Gastric secretions increase during REM sleep-many people with GERD awaken at night with heartburn or pain -They find that using antacids to neutralize stomach acidity often relieves discomfort and promotes sleep. -Certain epilepsy seizures are associated with certain stages of sleep; sleep deprivation is also associated with activation of seizures in some patients with epilepsy -Liver failure is associated with insomnia, excessive daytime sleepiness, and a reversal in day-night sleeping habits (disturbance of circadian rhythmicity) -Hypothyroidism is associated with sleep disturbances as a result of trouble tolerating cold at night and joint or muscle pain that disrupts sleep -Hyperthyroidism may result in difficulty sleeping due to arousals from nervousness or irritability, night sweats, or frequent urges to urinate -Thyroid disease may also be associated with restless legs syndrome (RLS) which may lead to significant sleep disruption -End-stage renal disease (ESRD) disrupts nocturnal sleep and leads to excessive daytime sleepiness. Patients with ESRD who receive dialysis also have a higher incidence of RLS Medications -Drugs that can affect sleep include benzodiazepines, amphetamines, and antidepressants -Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems. -Paying attention to biologic rhythms may influence drug tolerance and medication effectiveness, and reduce adverse effects, including those related to rest and sleep.

Rest and Sleep Requirements and Patterns

Infants require 12 to 16 hrs each day (including naps) Toddlers 11 to 14 hrs (including naps) Preschoolers 10 to 13 hrs (including naps) School-aged children (6 to12yrs) 9 to 12 hrs of sleep Teenagers 8 to 10 hrs a day The recommended amount of sleep for adults is 7 or more hrs ---those who are able to relax and rest easily, even while awake, often find that less sleep is needed ---others may find that more sleep is required to overcome fatigue Fatigue can be considered normal, protective body mechanism and natures warning that sleep is necessary (chronic fatigue is abnormal and is often symptom of illness) Sleep patterns of older adults vary, but the optimal recommendation for this age group is 7 to 8 or 9 hrs ---they may sleep less, however, because of insomnia and medical conditions that interrupt their sleep and the quality of their sleep changes

Female Primary Sexual Dysfunctions

Inhibited sexual desire consists of an inhibition in sexual arousal so that congestion and vaginal lubrication are absent or minimal Dyspareunia is painful intercourse Orgasmic dysfunction is defined as the inability of a female to reach orgasm Vaginismus is a rare condition in which the vaginal opening closes tightly and prevents penile penetration-due to involuntary spastic contractions of the muscles at and around the vaginal opening and the levator ani muscles Vulvodynia, a chronic vulvar discomfort or pain characterized by burning, stinging, irritation, or rawness of the female genitalia that interferes with sexual activity Effects of Illness, Injury, and Medications -Diabetes Mellitus -Cardiovascular Disease-hypertension, myocardial infarction -disease of the joints and mobility -surgery & body image -spinal cord injuries -chronic pain -mental illness -medications- some may have side effects that may affect sexual functioning Quid pro quo means something given or withheld in exchange for something else-occurs when a person's employment or well-being is dependent on agreeing to unsolicited and unwelcome sexual demands Hostile work environment occurs when sex- or gender-based behaviors create a hostile, intimidating environment that hurts a person's work performance, classroom performance, or general sense of well-being

Gate Control Theory of Pain Melzack & Wall 1965

It describes the transmission of painful stimuli and recognizes a connection between pain and the projection of pain information to the brain The theory states that: -small nerve fibers conduct excitatory pain stimuli toward the brain, exaggerating the effect of the arriving impulses through a positive feedback mechanism -large nerve fibers appear to inhibit the transmission of pain impulses from the spinal cord to the brain through a negative feedback system -example is when a person rubs the site of an injury that has just occurred-this stimulation of the large fibers, which are largely inactive when the small-fiber activity is increased, can decrease the level of pain experienced by the person Other factors thought to have an impact on the opening and closing of this gate are -past experiences, the cultural and social environment, personal expectations, beliefs about pain, the emphasis placed on pain, and emotions -an example, a positive mood, distraction or relaxation can work to close the gate; fear and anxiety have been shown to open the gate, thus increasing the pain experienced Theoretical models that explore pain also consider pain receptors, patterns of activity, the brain's role in managing inputs, and neurohormonal control of pain

Concepts of Loss and Grief

Loss occurs when a valued person, object or situation is changed or becomes inaccessible such that its value is diminished or removed Actual loss can be recognized by others as well as by the person sustaining the loss—for example, loss of a limb, a child, a valued object such as money, and a job Perceived loss such as loss of youth, financial independence, or a valued environment, is experienced by the person but is intangible to others Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place-often seen in the families of patients with serious and life-threatening illnesses and may lessen the effect of the actual loss of the family member Grief is an internal emotional reaction to loss. It occurs with loss caused by separation or by death Mourning is the actions and expressions of that grief, including the symbols and ceremonies (a funeral or final celebration of life) that make up the outward expressions of grief Bereavement is a state of grieving due to loss of a loved one Grief Reactions (1) shock and disbelief, (2) developing awareness, (3) restitution, (4) resolving the loss, (5) idealization, and (6) outcome -(1) denial and isolation, (2) anger, (3) bargaining, (4) depression, and (5) acceptance Dysfunctional grief is abnormal or distorted; it may be either unresolved or inhibited

Sexual Expression

Masturbation- is a technique of sexual expression in which a person practices self-stimulation Intercourse- is the insertion of the penis into the partners vagina, anus or mouth Vaginal intercourse- the act of placing the penis into the vagina, penile-vaginal intercourse, can be accomplished in various positions Anal intercourse- the act of inserting the penis into the anus and rectum of a partner Cunnilingus- is stimulation of the female genitals by licking and sucking the clitoris and surrounding structures Fellatio- is stimulation of the male genitals by licking and sucking the penis and surrounding structures Abstinence- is not having sex (most effective form of birth control when practiced consistently) Some STIs spread through oral-genital sex, anal sex, or even intimate skin-to-skin contact without actual penetration (genital warts and herpes can be spread this way)

Psychological Homeostasis

Mind-body Interaction -Tomorrow, you are scheduled to take a final examination, and you must earn a passing score to pass the course and remain in the nursing program. After being awake most of the night, you cannot swallow any food at breakfast, you have a rapid heartbeat, you are filled with feelings of apprehension, and you have diarrhea Anxiety -is a vague, uneasy feeling of discomfort or dread, the source of which is often unknown or nonspecific -it is also a feeling of apprehension caused by anticipating a perceived danger -mild anxiety is present in day-to-day living-it increases alertness and perceptual fields (vision and hearing) and motivates learning and growth -moderate anxiety narrows a person's perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details-is manifested by a quavering voice, tremors, increased muscle tension, a report of "butterflies in the stomach," and slight increases in respirations and pulse -severe anxiety creates a very narrow focus on specific details, causing all behavior to be geared toward getting relief-person has impaired learning ability and is easily distracted-extreme fear of a danger that is not real, emotional distress that interferes with everyday life, and avoidance of situations that cause anxiety-difficulty communicating verbally, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation

Pain Process Continue

Modulation of Pain -the process by which the sensation of pain is inhibited or modified -the sensation of pain appears to be regulated or modified by substances called neuromodulators -neuromodulator are endogenous opioid compounds, meaning they are naturally present, morphine-like chemical regulators in the spinal cord and brain -endorphins and enkephalins are opioid neuromodulators -endorphins are produced at neutral synapses at various points along the CNS pathway The endorphin, dynorphin, has the most potent analgesic effect Enkephalins are considered less potent than endorphins -Enkephalins reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons

Characteristics of NREM and REM sleep

NREM Sleep Stage I -person is in a transitional stage btw wakefulness & sleep -person is in a relaxed state but still somewhat aware of surrounding -involuntary muscle jerking may occur & wake person -stage normally lasts only minutes -person can be aroused easily -stage constituents only about 5% of total sleep Stage II -person falls into a stage of sleep -person can be aroused with relative ease -stage constitutes 50 % to 55% of sleep Stage III -depth of sleep increases and arousal becomes increasingly difficult -stage composes about 10% of sleep Stage IV -person reaches the greatest depth of sleep (delta sleep) -arousal from sleep is difficult -physiological changes in the body include: slow brain waves are recorded on an EEG, pulse, RR & BP decrease, muscles are relaxed, metabolism slows and body temp is low -this constitutes about 10% of sleep REM Sleep -eyes dart back and forth quickly -small muscle twitching (on the face) -large muscle immobility, resembling paralysis -respirations irregular; sometimes interspersed with apnea -rapid or irregular pulse, BP increases or fluctuates, increased gastric secretions -metabolism & body temp increases -Encephalogram tracing active -REM sleep enters from stage II of NREM and re-enters NREM sleep at stage II: arousal from sleep difficult -constituents about 20% to 25% of sleep

Parenteral Medications

Outside the intestines or alimentary canal Types of Injections Intradermal (10-15 degrees), Intravenous (25), Subcutaneous (90-45), Intramuscular (90) Anatomy of a Needle Needle cap, Hub, Shaft, Lumen (opening), Bevel (penetrates the epidermis) Needle Gauge -refers to the diameter of the needle (the smaller (18) the gauge, the larger (30) the diameter) -ID injections 26-28, IM injections 26-30, SQ 19-27 (all three overlap 26 & 27) Needle Length -ID injections 3/8" to 3/4", IM injections 7/8" to 1 1/2", SQ injections 1/2" to 5/8" (ID & SQ overlap 1/2" to 5/8") Injection Site -Subcutaneous: abdomen, front/side of thigh, upper/outer arm, buttocks -Intramuscular: ventrogluteal, deltoid, vastus lateralis

Major Electrolytes Continue 2

Phosphate (PO4-):2.5-4.5 mg/dL Function -role in acid-base balance as a hydrogen buffer -promotes energy storage; carbohydrate, protein, and fat metabolism -bone and teeth formation -role in muscle and red blood cell function Sources/Losses -enters body via GI tract -all animal products (meat, poultry, eggs, milk, bread, ready-to-eat cereal) -absorption is diminished by concurrent ingestion of calcium, magnesium, and aluminum Regulation -eliminated by kidneys -regulation by parathyroid hormone and by activated vitamin D -phosphate and calcium are inversely proportional; an increase in one results in a decrease in the other Bicarbonate (HCO3-):25-29 mEq/L Function -regulates acid-base balance Sources/Losses -losses possible via diarrhea, diuretics, and early renal insufficiency -excess possible via over-ingestion of acid neutralizers, such as sodium bicarbonate Regulation -bicarbonate levels regulated primarily by the kidneys -bicarbonate readily available as a result of carbon dioxide formation during metabolism

Pain

Physiologic effects of pain include: hyperglycemia, increased cardiac workload, immune system dysfunction, altered coagulation, gastrointestinal (GI) ileus, urinary retention, decreased lung volume, and fatigue The Joint Commission require hospitals to: -identify pain assessment and pain management, including safe opioid prescribing, as an organizational priority -actively involve the organized medical staff in leadership roles in organization performance improvement activities to improve quality care, treatment, and service and patient safety -assess and manage the pt's pain and minimize the risks associated with treatment -collect data to monitor its performance -compile and analyze data No two people experience pain exactly the same way -differences in individual pain perception and response to pain, as well as the multiple & diverse causes of pain, require the nurse to use highly specialized knowledge and abilities to promote comfort & to relieve pain Although pain is often all-comsuming for pts, it can be missed or misjudged easily bc it is intangible -you must do more than assess to impact change, especially with pain

Sexual Response Cycle

Premenstrual syndrome (PMS) is characterized by the appearance of one or more of the following symptoms several days before the onset of menstruation: (1) emotional symptoms such as depression, irritability, anxiety, changes in sleep habits, changes in sexual desire, poor concentration, crying, anger, and social withdrawal; and (2) physical symptoms such as appetite changes, breast tenderness, bloating and weight gain, aches and pains, swelling, acne, gastrointestinal issues, and fatigue Premenstrual dysphoric disorder (PMDD) differs from PMS primarily in that it is a DSM-5-classified diagnosis by the American Psychiatric Association, and its symptoms are primarily psychiatric in nature-some studies have shown that PMDD is related to serotonin levels, and the symptoms reported are more disabling than symptoms reported with PMS Erogenous zones- areas that when stimulated cause sexual arousal and desire -skin is the largest erogenous zone -most important body organ for sexual arousal & stimulation is the brain Excitement- is initiated by erotic stimulation and arousal Plateau- desire and arousal continue to build and intensify (15-20mins) Orgasm- climax and sexual explosion of the tension that has been building over the preceding phases resolution- return to the normal body functioning present before the excitement phase Sexual dysfunction is a problem that prevents a person or couple from engaging in or enjoying sexual intercourse and orgasm Erectile dysfunction (ED) (Impotence)- is the inability of a male to attain or maintain an erection to such an extent that they cannot have satisfactory intercourse Premature ejaculation is a condition in which a male consistently reaches ejaculation or orgasm before, or soon after entering the vagina or other orifice

Rest and Sleep

Rest is a basic need in health and illness Rest - a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed Sleep - is a state of rest accompanied by altered consciousness and relative inactivity (sleep is part of the sleep-wake cycle) Wakefulness - is a time of mental activity and energy expenditure Sleep - is a period of inactivity and restoration of mental and physical function ---it's a complex rhythmic state involving a progression of repeated cycles, each representing different phases of body and brain activity (and it is crucial for physical, mental, and emotional well-being) ---sensitivity to external stimuli is diminished during sleep as a result of diminished consciousness, this sensitivity can be reversed, as a person can be aroused by sensory or other stimuli Sleep health (proposed to express as a positive, measurable attribute) - refers to a multidimensional pattern of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction, that promotes physical and mental well-being

Circadian Rhythms

Rhythmic biologic clocks are known to exist in plants, animals, and humans-influenced by both internal and external factors, they regulate certain biologic and behavioral functions in humans Circadian rhythms - are predictable fluctuations in processes that occur in repeated cycles of time, completing a full cycle every 24hrs ---fluctuations in a person's heart rate, blood pressure, body temp, hormone secretions, metabolism, performance and mood display circadian rhythms Sleep is one of the body's most complex biologic rhythms ---circadian synchronization exists when a person's sleep-wake patterns follow the inner biologic clock located in the hypothalamus ---when physiologic and psychological rhythms are high or most active, the person is awake-when these rhythms are low, the person is asleep ---light and dark are powerful regulators of sleep-wake circadian rhythm; when there is interference with the normal cycle, circadian disruption (chrono disruption) occurs

Common Sleep Disorders

See notes

Sleep Cycle

Sleep cycle - a person passes consecutively through the four stages of NREM sleep ---this pattern is then reversed and the person returns from stage IV to stage III to stage II ---instead of re-entering stage I and awakening, the person enters into the REM stage of sleep, after the person re-enters NREM sleep at stage II and returns to stages III & IV ---person awakens from sleep at any time will return to sleep by starting at stage I of NREM sleep Most people go through four or five cycles of sleep each night ---each cycle lasts about 90 to 110 minutes ---cycle tends to become longer as morning approaches ---more deep sleep occurs in the delta stage (NREM stages III & IV) in the first half of the night (especially is someone is tired or lost sleep)

Major Electrolytes

Sodium (Na+):135-145 mEq/L Functions -regulates extracellular fluid volume; Na+ loss or gain accompanied by a loss or gain of water -affects serum osmolality -role in muscle contraction and transmission of nerve impulses -regulation of acid-base balance as sodium bicarbonate Sources/Losses -normally enters the body through the gastrointestinal tract from dietary sources, such as salt added to processed foods, sodium preservatives added to processed foods -lost from GI tract, kidneys, and skin Regulation -transported out of the cell by the sodium-potassium pump -regulated by renin-angiotensin-aldosterone system -elimination and reabsorption regulated by the kidneys -sodium concentrations affected by salt and water intake Potassium (K+):3.5-5.0 mEq/L Function -controls intracellular osmolality -regulator of cellular enzyme activity -role in the transmission of electrical impulses in nerve, heart, skeletal, intestinal, and lung tissue; Regulation of acid-base balance by cellular exchange with H+ Sources/Losses -adequate quantities via a well-balanced diet -fruits and vegetables, dried peas and beans, whole grains, milk, meats -lost via kidneys, stool, sweat, emesis Regulation -regulated by aldosterone -eliminated by the kidneys

Factors Affecting Stress and Adaptation

Sources of Stress -Developmental Stress occurs as a person progresses through the normal stages of growth and development from birth to old age -Situational Stress occur at any time, although the person's ability to adapt may be strongly influenced by their developmental level Personal Factors Stress and Adaption In Nursing -Assuming responsibilities for which you are not prepared -Working with unqualified or an insufficient number of personnel -Working in an environment in which supervisors and administrators are not supportive -Experiencing conflict with a peer or other member of the interprofessional team -Caring for a patient who is suffering while also supporting the patient's family -Caring for a patient during a cardiac arrest or for a patient who is dying -Providing care to a patient who is disengaged, nonadherent, or lacks the resources to participate in their care -Knowing the correct, right, or ethical course of action in a situation, but being unable to take that action (moral distress)

Spiritual Health and Healing

Spiritual health (spiritual well-being) is the condition that exists when the person's universal spiritual needs for meaning and purpose, love and belonging, and forgiveness are met Spiritual healing is the movement toward integration, from brokenness to wholeness Steps for Being a Healing Presence 1. Open yourself 2. Intend to be a healing presence 3. Prepare a space for healing presence to take place 4. Honor the one in your care 5. Offer what you have to give 6. Receive the gifts that come 7. Live a life of wholeness and balance Spiritual beliefs and practices are associated with all aspects of a person's life, including health and illness Spirituality, Health, & Illness -guide to daily living habits -source of support -source of strength and healing -source of conflict

Spiritual Dimension

Spiritual needs underlie all religious traditions and are common to all people regardless of whether or not they belong to a particular religious tradition: 1. Need for meaning and purpose 2. Need for love and relatedness 3. Need for forgiveness Spirituality is anything that pertains to a person's relationship with a nonmaterial life force or higher power Aspects of spirituality include the following: -Spirituality is experienced as a unifying force, life principle, essence of being. -Spirituality is expressed and experienced in and through connectedness with nature, the earth, the environment, and the cosmos. -People express and experience spirituality in and through connectedness with other people. -Spirituality shapes self-becoming and is reflected in a person's being, knowing, and doing. -Spirituality permeates life, providing purpose, meaning, strength, and guidance, and shaping the journey Presencing (standing in the presence of another consciously believing in—and affirming—their capacity for wholeness), empathy/compassion, giving hope, love, religion/transcendence, and touch and healing Faith generally refers to a confident belief in something for which there is no proof or material evidence-involves a person, idea, or thing, and is usually followed by action related to the ideals or values of that belief Atheist is a person who denies the existence of a higher power Agnostic is one who holds that nothing can be known about the existence of a higher power Religion can be defined as an organized system of beliefs about a higher power that often includes set forms of worship, spiritual practices, and codes of conduct Hope is the ingredient in life responsible for a positive outlook, even in life's bleakest moments-it enables a person both to consider a future and to work to actively bring that future in

Effects of Stress

Stress and Basic Human Needs -Physiologic Needs: change in appetite, activity, or sleep change in elimination patterns increased pulse, respirations, blood pressure -Safety and Security: feels threatened or nervous, uses ineffective coping mechanisms, is inattentive -Love and Belonging: is withdrawn and isolated, blames others for own faults, demonstrates aggressive behaviors, becomes overly dependent on others -Self-Esteem: becomes a workaholic, exhibits attention-seeking behaviors -Self-Actualization: refuses to accept reality, centers on own problems, demonstrates lack of control Stress in Health & Illness Long-Term Stress Family Stress -caregiver stress, includes chronic fatigue, sleep problems, and an increased incidence of stress-related illnesses, such as high blood pressure and heart disease Crisis -is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is interpreted as a threat to self-In a crisis, the person's usual methods of coping are ineffective-this failure produces high levels of anxiety, disorganized behavior, and an inability to function adequately

Physical and Psychological Effects of Insufficient Sleep

The NSF has identified a link btw insufficient sleep and obesity in adults and children; adults and children who slept less than the recommended hrs per night were more likely to be overweight -this sleep-weight link is related to two hormones: leptin and ghrelin ---leptin signals the brain to stop eating-where ghrelin promotes continued eating ---research suggests that sleep deprivation lowers leptin levels and elevates ghrelin levels, thus increasing one's appetite ---the brain may interpret a drop in leptin as a sign of starvation- the brain then signals the body to eat more while it simultaneously lowers the body's metabolic rate ---when this happens people are more likely to gain weight, even if food intake is decreased People who suffer sleep difficulties caused by working nights or constantly changing work shifts may experience adverse effects like anxiety, personal conflicts, loneliness, depression, GI symptoms, increase in type 2 diabetes, hypertension, & higher rates of cardiovascular disease including stroke and substance abuse ---person who experiences shortened sleep by just a few hrs can have a similar reaction time similar to someone intoxicated with alcohol ---sleep loss that results in fatigue and decreased competence increases the risk of a sleep-related motor vehicle accident Fatigue & sleepiness can compromise pt safety and increase the risk for adverse events such as medication errors ---sleep deprivation and the resulting consequences of decreased alertness and ability to perform tasks competently are well-documented

The Menstrual Cycle

The menstrual cycle is controlled by a series of reactions that rely on a complex interaction between the hypothalamic-pituitary axis, the ovaries, and the uterus Follicular phase- is in the ovaries day 4-14- a number of follicles mature, but only one produces a mature ovum Proliferation phase- the uterus, the endometrium is becoming thick and velvety in preparation for receiving a fertilized egg Ovulation generally occurs on day 14 when the mature ovum ruptures from the follicle and the surface of the ovary and is swept into the fallopian tube mittelschmerz, or middle pain-individuals can detect ovulation by the presence of a sharp, cramping pain over the ovulating ovary Luteal phase- day 15-28- leftover empty follicle fills up with a yellow pigment and is then called the corpus luteum, or yellow body-purpose of the corpus luteum is to produce hormones that encourage a fertilized egg to grow Also during the luteal phase he uterus also undergoes changes; this phase is called the secretory phase-the endometrial lining thickens- in the absence of a fertilized egg, the corpus luteum dies and the endometrial lining disintegrates The menstrual discharge is a bloody fluid that also contains endometrial debris, mucus, and enzymes-normal blood loss averages 30 to 80 mL Menstrual discharge is odorless until exposed to the air, when a person may notice a light, fleshy, pungent odor Some females who experience abdominal cramping during menses, called dysmenorrhea, find that sexual activity and orgasm relieve their discomfort In May 2007, the U.S. Food and Drug Administration (FDA) approved the first oral contraceptive designed to be taken 365 days a year by those who want to avoid menstruating altogether

Physiology of Sleep

The reticular activating system (RAS) and the Bulbar synchronizing region, are believed to work together to control the cyclic nature of sleep RAS extends upward through the medulla, the pons, the midbrain, and into the hypothalamus; the bulbar synchronizing region is also located in the pons and medulla ---it facilitates reflex and voluntary movements as well as cortical activities related to a state of alertness ---RAS comprises many nerve cells and fibers During sleep, RAS experiences few stimuli from the cerebral cortex and the periphery of the body ---wakefulness occurs when this system is activated with stimuli from the cerebral cortex and from periphery sensory organs and cells (sensations such as pain, pressure, and noise produce wakefulness by means of peripheral organs & cells) Hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleep and waking (injury to the hypothalamus can cause a person to sleep for unhealthy amounts of periods) Norepinephrine and acetylcholine (dopamine, serotonin, and histamine) are involved with excitation Gamma-aminobutyric acid (GABA) appears to be necessary for inhibition Melatonin - a hormone is thought to regulate sleep-wake cycle and possibly circadian rhythms

Pain Process

Transduction -the activation of pain receptors -it involves conversion of painful stimuli into electrical impulses that travel from the periphery to the spinal cord at the dorsal horn -the nociceptors (peripheral receptors) respond selectively to mechanical, thermal, and chemical stimuli that are noxious Other substances are also released that stimulate nociceptors or pain receptors -Bradykinin, a powerful vasodilator that increases capillary permeability and constricts smooth muscle, plays an important role in the chemistry of pain at the site of an injury even before the pain message gets to the brain. -Prostaglandins are important hormone-like substances that send additional pain stimuli to the CNS. -Substance P, a neuropeptide, sensitizes receptors on nerves to feel pain and also increases the rate at which nerves fire. Prostaglandins, substance P, and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction) are Neurotransmitters, substances that either excite or inhibit target nerve cells Friction from bed linens and pressure from a cast are mechanical stimulants. Sunburn and cold water on a tooth with caries are thermal stimulants. An acid burn is the result of a chemical stimulant. The jolt of a static charge is an electrical stimulant Transmission of Pain Stimuli -pain sensations from the site of an injury or inflammation are conducted along pathways to the spinal cord and then on to higher centers -these pathways are clearly defined in certain areas but are still somewhat unclear in other areas Perception of Pain -involves the sensory process that occurs when a stimulus for pain is present -it includes the person's interpretation of the pain -the pain threshold is the "minimum intensity of a stimulus that is perceived as painful"

Stages of Sleep

Two major stages of sleep: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep ---these stages have been studied and analyzed with the help of the electroencephalograph (EEG) receives and records electrical currents from the brain ---the electrooculogram (EOG) records eye movements ---the electromyograph (EMG) records muscle tone -these combinations of diagnostic recordings are referred to as a sleep study or polysomnogram Non-Rapid Eye Movement Sleep ---comprises about 75% to 80% of total sleep time-consists of four stages Stage I & II - consuming 5% and 50% of a person's sleep time-light sleep states ---during these stages, a person can be aroused with relative ease Stages III & IV - each represent about 10% of total sleep time-deep sleep states termed delta sleep or slow-wave sleep ---the arousal threshold (intensity of stimulus required to awaken) is usually greatest in stage IV NREM Throughout the states of NREM sleep, the parasympathetic nervous system (PNS) dominates, and decreases in pulse, respiratory rate, blood pressure, metabolic rate, and body temp are observed Rapid Eye Movement Sleep it is more difficult to arouse a person during REM sleep than during NREM sleep ---normal adults, REM state consumes 20% to 25& of a person's nightly sleep time ---people who are awakened during REM state almost always report that they were dreaming (they can vividly recall their dreams even if they were absurd or have no meaning- everyone dreams) During REM sleep, the pulse, respiratory rate, blood pressure, metabolic rate, and body temp increase, whereas general skeletal muscle tone and deep tendon reflexes are depressed ---REM is believed to be essential to mental and emotional equilibrium and to play a role in learning, memory, and adaptation

Pain Scale

assessment tool used to rate the severity of pain Numerical Pain Scale -0-10 Adult nonverbal pain scale -a 10 point scale with 5 categories (face, activity (movement), guarding, physiology (vital signs), respiratory that are scored on a 0,1,2 point system Behavior pain scale -used with critically ill patients who are intubated Checklist of nonverbal indicators -0 if the behavior was not observed and a 1 if the behavior occurred briefly during activity or rest Comfort behavior scale - a tool for assessing pain & sedation in infants CRIES instrument -assessment tool of pain in neonates Critical-Care Pain Observation Tool -facial expression, body movement, compliance w/ the ventilator (intubated pt) or vocalization (extubated pt), muscle tension Face Pain scale -self report measure of pain intensity developed for children -faces 0-10 FLACC behavior scale -used with infants & young children and children with cognitive impairment Iowa pain thermometer -thermometer w/ number or no numbers from no pain to the most intense pain imaginable Oucher pain scale -children scale with realistic faces Pain assessment in advanced dementia scale -pt whose dementia is so advanced that they cannot verbally communicate Wong-Baker FACES pain rating scale -adults and children in all pt care settings

Transgender

describes a wide range of experiences or identities where gender identification and expression differ from societal expectations that are based on a person's biological sex -transgender is an inclusive term used to describe those who feel that the sex that was assigned to them at birth incompletely describes or fails to describe them at all gender fluid-describes a person whose gender identification and behaviors shift from time to time, whether within or outside of societal, gender-based expectations Heterosexual or straight refers to a person who is attracted to a person of the opposite gender. Gay or Lesbian (females) refers to a person attracted to members of the same gender Bisexual refers to a person who is attracted to both males and females. A bisexual relationship or encounter does not necessarily mean a person is gay. Asexual refers to a person who lacks romantic or sexual attraction to others. Questioning refers to a person who is unsure of their sexual orientation On a continuum, sexual behavior ranges from adaptive to maladaptive. Adaptive responses meet the following criteria: -Between two consenting adults -Mutually satisfying to both -Not psychologically or physically harmful to either -Lacking in force or coercion -Conducted in private Maladaptive sexual responses are behaviors that do not meet one or more of the criteria for adaptive responses

Sexuality

encompasses biological sex or sex assigned at birth, sexual activity (pleasure, intimacy, reproduction), gender identities and roles & sexual orientation sexual health- represents the integration of the somatic, emotional, intellectual, and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication, and love The WHO (2021) identifies the following critical elements of positive, holistic sexual health: -Sexual health is about well-being, not merely the absence of disease. -Sexual health involves respect, safety, and freedom from discrimination and violence. -Sexual health depends on the fulfillment of certain human rights. -Sexual health is relevant throughout the individual's lifespan, not only to those in the reproductive years, but also to both the young and the elderly. -Sexual health is expressed through diverse sexualities and forms of sexual expression. -Sexual health is critically influenced by gender norms, roles, expectations, and power dynamics. -Sexual health needs to be understood within specific social, economic, and political contexts gender identity- is the inner sense a person has of being male, female or nonbinary (could be same or different from birth) gender expression- is how a person presents themselves to the world-may or may not same as gender identity gender diverse- represents a wide range of gender identities that many vary from expected developmental norms (nonbinary, genderqueer, gender fluid) gender dysphoria- people who experience clinically significant distress or impairment because their biological sex or sex assigned at birth is contrary to their gender identity are diagnosed cisgender- refers to a gender identity or role performance that matches society's expectations based on biological sex

Local Adaptation Syndrome

is a localized response of the body to stress -it involves only a specific body part like a tissue or organ instead of the whole body -the stress precipitating the LAS may be traumatic or pathologic -LAS is a primarily homeostatic, short-term adaptive response Reflex pain response is a response of the central nervous system to pain -it is rapid and automatic, serving as a protective mechanism to prevent injury -the reflex depends on an intact, functioning neurologic reflex arc and involves both sensory and motor neurons Inflammatory response is a local response to injury or infection -it serves to localize and prevent the spread of infection and promote wound healing General adaptation syndrome (GAS) is a biochemical model of stress developed -the GAS describes the body's general response to stress, a concept that impacts all facets of nursing care. -the GAS is a physiologic response to stress, but it is important to remember that the response results from either physical or emotional stressors, and the stages occur with either physical or psychological damage to the person Alarm Reaction -the sympathetic nervous system initiates the Fight-or-flight response, preparing the body to either fight off the stressor or to run away from it -this phase of the alarm reaction, called the shock phase, is characterized by an increase in energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness Stage of Resistance -having perceived the threat and mobilized its resources, the body now attempts to adapt to the stressor -vital signs, hormone levels, and energy production return to normal -if the stress can be managed or confined to a small area (LAS), the body regains homeostasis Stage of Exhaustion -results when the adaptive mechanisms can no longer provide defense

Active Transport

is a process that requires energy for the movement of substances through a cell membrane, against the concentration gradient, from an area of less solute concentration to an area of higher solute concentration -ATP (adenosine triphosphate) is stored in all cells, supplies energy for solute movement in & out of the cell Fluids move from an area of high pressure to one of lower pressure Capillary filtration results from the force of blood pushing against the walls of the capillaries -at the arterial end of the capillaries, filtration is dependent primarily on arterial blood pressure; at the venular side of the capillaries, filtration is dependent on venous blood pressure Hydrostatic pressure is the pushing force -when hydrostatic pressure inside the capillary exceeds the surrounding interstitial space, fluids and solutes are forced out of the capillary walls into the interstitial space Reabsorption is the process that acts to prevent too much fluid from leaving the capillaries no matter how high the hydrostatic pressure-plasma proteins, particularly albumin, concentrated in the intravascular space or plasma facilitate this reabsorption process by "pulling" the fluid back into the capillaries Colloid osmotic pressure is the pulling force

Adaptation

is the change that takes place as a result of the response to a stressor Physiologic Homeostasis -the autonomic nervous system and the endocrine system primarily control homeostatic mechanisms -the respiratory, cardiovascular, gastrointestinal, and renal systems are involved to a lesser degree-these mechanisms are self-regulating, organized, and coordinated; they occur without conscious thought, and defend against change to the body's internal environment Allostasis to describe this process of achieving stability or homeostasis through physiologic or behavioral changes Examples of Physical Illness Associated with Stress Autoimmune Disorders -Graves disease (hyperthyroidism) -Myasthenia gravis -Psoriasis -Rheumatoid arthritis -Systemic lupus erythematosus (SLE) -Ulcerative colitis Cardiovascular and Hematologic Disorders -Coronary artery disease -Hypertension -Sickle cell disease Gastrointestinal Disorders -Constipation -Diarrhea -Esophageal reflux Respiratory Disorders -Asthma

Self-Concept

is the mental image or picture of self Self-esteem is the need that people have to feel good about themselves and to believe that others hold them in high regard Self-actualization is the need for people to reach their full potential through development of their unique capabilities Identity diffusion is the failure to integrate various childhood identifications into a harmonious adult psychosocial identity, which can lead to disruptions in relationships & problems of intimacy Depersonalization is a persons subjective experience of the partial or total disruption of the ego and the disintegration & disorganization of self-concept Specific components of self-concept include personal identity, body image, self-esteem, and role performance -crucial to each component are the dimensions of self-concept, which include self-knowledge, self-expectations and self-evaluation

Fluid Balance

located within the hypothalamus, the thirst control center is stimulated by intracellular dehydration (the loss of or deprivation of water from the cells) and decreased blood volume -water is an end product of the oxidation that occurs during metabolism of food substances (carbs, fats and protein) -sensible losses can be measured and include fluid lost during urination, defecation, and wounds -insensible losses cannot be measured or seen and include fluid lost from evaporation through the skin and as water vapor from the lungs during respiration -fluid output averages 2,600 mL per day, with approximately 1,500 mL as urine from the kidneys, 600 mL fluid loss from the skin, 400 mL from the lungs, and 100 mL in feces via the gastrointestinal (GI) tract

Osmosis

process of osmosis, water (solvent) passes from an area of lesser solute concentration and more water to an area of greater solute concentration and less water until equilibrium is established -as a result the volume of the more concentrated solution increases and the volume of the weaker solution decreases -the process of osmosis stops when the concentration of solutes has been equalized on both sides of the cell membrane -major method of transporting body fluids Osmolarity is the concentrated number of particles dissolved in a solution-which influences the movement of fluid between compartments Isotonic fluid remains in the intravascular compartment w/o any net flor across the semipermeable membrane-causing cells to stay the same Hypertonic solution has a greater osmolality-water moves out of the cells and is drawn into the intravascular compartment, causing the cells to shrink Hypotonic solution has less osmolarity than plasma-moves out of the intravascular space & into ICF, causing cells to swell and possibly burst Diffusion is the tendency of solutes to move freely throughout a solvent. -the solute moves from an area of higher concentration to an area of lower concentration until equilibrium is established -gases also move by diffusion. -oxygen and carbon dioxide exchange in the lung's alveoli and capillaries occurs by diffusion.

Homeostasis

the balance of fluid, electrolytes and acid-base is interrelated and maintained through the functions of almost every organ of the body -with a healthy person, fluid intake and fluid loss is equal Water in the body functions primarily to: transport nutrients to cells and wastes from cells, transport hormones, enzymes, blood platelets, and red and white blood cells, facilitate cellular metabolism and proper cellular chemical functioning, act as a solvent for electrolytes and nonelectrolytes, help maintain normal body temperature, facilitate digestion and promote elimination, act as a tissue lubricant total body water or fluid refers to the total amount of water, which is approximately 50% to 60% of body weight in a healthy person