FUNDS EXAM #2 (Mod 6 sleep/stress/ communication/Documentation

Compare and contrast techniques that enhance communication with those that hinder communication

(Enhancers) Dispositional traits: Warmth and friendliness, Openness and respect, Empathy, Honesty, authenticity, trust, Caring, Competence (Enhancers) Rapport builders: Specific objectives, Comfortable environment, Privacy, Confidentiality,Patient vs. task focus, Utilization of nursing observations, Optimal pacing (Hinders) Communication blockers: Failure to perceive the patient as a human being, Failure to listen, Nontherapeutic comments and questions, Using clichés, Using closed questions, Using questions containing the words "why" and "how", Using questions that probe for information

Define stressors?

Physiologic Stressors: chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders. Psychosocial Stressors: car accidents, interpesonal relationships, trauma, rapid changes, horrible history

Discuss rest and sleep changes related to older adults

-An average of 7 to 8 hours of sleep -Sleep is less sound, and stage IV sleep is absent/decreased. -Periods of REM sleep shorten. - Have more difficulty sleeping -Decline in physical health, psychological factors, effects of drug therapy (e.g., nocturia), or environmental factors may be implicated as causes of inability to sleep.

Identify critical aspects of documentation

-Documentation should be factual and objective, not judgmental -Documentation must be accurate -Documentation should demonstrate what you did and why you made the decisions you did - Care plans need to be pertinent and updated -Correct errors according to institutional policy- no whiteout, scribbling over, writing over, cutting off - Never document in anticipation of doing something -Date and time all entries -Documentation should enable the reader to know what occurred- who called whom, what information was conveyed, and what the response was. -Abbreviations should comply with institutional policies

Describe how to teach an adult learner and an older adult learner.

-Identify learning barriers -Allow extra time. -Plan short teaching sessions. -Accommodate for sensory deficits -Reduce environmental distractions. -Relate new information to familiar activities or information.

Describe the sources of stress among older adults.

-Invasive or health-related tests -diagnosis of chronic illness -declining capabilities -retirement -loss of spouse -alcohol abuse - loss of independence

Discuss physical/ psychological effects of insufficient sleep

-Irritability, moodiness - increased risk for diabetes, insulin resistance, obesity, BP - decreased growth hormone -impaired immunity - pain

Describe the teaching and learning process.

-Summary of the learning need -The plan -The implementation of the plan -Evaluation results

Discuss interventions focused on rest and sleep.

-Teach sleep hygiene techniques -Avoid caffeine, alcohol, nicotine, mental & physical activities later in the day, avoid napping, eating light snacks (complex carbohydrates and protein), avoid excessive fluid intake during the night, sleep in quiet, cool and dark room free from unfamiliar noises, eliminate alarm clock, warm bath before bedtime, light therapy -Use of medications and herbal remedies Nonbenzodiazepine, nonbarbiturate CNS depressant - less residual sleepiness and dependance or tolerance; OTC antihistamine (short-term basis); analgesic if with pain Others, backrub (massage), teach how not to worry, clustering nursing care

Describe the general adaptation syndrome (GAS) steps.

1st stage: Alarm reactions - FIGHT OR FLIGHT MODE overload of epinephrine, corticosteroids (glucose), aldosterone (sodium), cortisol 2nd stage: Resistance: BODY STABILIZES and resisted stressor effects. Body responds the opposite of alarm reaction (leads to recovery!!) 3rd stage: Exhaustion - ALLOSTATIC LOAD when body is unable to resist the stressor effects. (leads to recovery or death!!) (chronic diseases happen here!)

Describe assessment techniques/ interventions focused on stress.

Assessment: -Include nursing history and physical assessment! -Identify risk factors, indicators, stressors and coping skills Assess for any cardiac dysrhythmias, chest pain, headache, hyperventilation, diarrhea, tense muscle, skin lesions Intervention: -Teach healthy activities of daily living -Regular exercise, rest and sleep and proper nutrition -Encourage use of support system -Encourage use of stress management techniques -Relaxation, meditation, anticipatory guidance, guided imagery, biofeedback -Provide crisis intervention

Define types of coping mechanisms.

Behaviors used to decrease stress and anxiety. -Crying, laughing, sleeping, cursing -Physical activity, exercise -Smoking, drinking -Lack of eye contact, withdrawal -Limiting relationships

What are the characteristics of a REM sleep?

Brain waves resemble wakefulness

Discuss the 3 domains of learning and teaching strategies for each.

Cognitive: storing and recalling new knowledge in the brain Affective: changing attitudes, values, and feelings Psychomotor: learning a physical skill Teaching strategies Cognitive domain: lecture, panel, discovery, written materials Affective domain: role modeling, discussion, audio visual materials Psychomotor domain: demonstration, discovery, printed materials

Discuss assessment techniques focused on rest and sleep.

Identify patient's sleep-wakefulness pattern, factors affecting the patient's sleep If admitted to the facility, assess the patient's usual times for retiring and waking, bedtime rituals, sleep environment Assess energy level (weakness, fatigue), facial characteristics (swelling of eyelids) or behavioral characteristics (yawning, rubbing eyes), obesity, deviated septum, type of snoring pattern (OSA)

Describe sympathetic adrenal medullary responses to stress.

In response to stress, SNS stimulates adrenal medulla to release epinephrine and norepinephrine to prepare the body for Fight or flight response.

Describe hypothalamic pituitary responses to stress.

In response to stress, hypothalamus releases corticotropin which stimulates anterior pituitary gland to release (ACTH) which then releases glucocorticoid (sugar) and aldosterone (sodium).

Discuss common sleep disorders.

Insomnia: difficulty falling asleep, intermittent sleep, or difficulty maintaining sleep Circadian rhythm sleep-wake disorders: recurrent pattern of sleep-wake rhythm disruption caused by a misalignment between the internal circadian rhythm and the sleep-wake schedule Parasomnias: patterns of waking behavior that appear during REM or NREM stages of sleep. They are more commonly seen in children. Obstructive sleep apnea: serious sleep disorder in which the throat muscles intermittently relax and block the airway during sleep, causing breathing to repeatedly stop and start

Describe the communication process and levels of communication.

Intrapersonal: Self-talk; communication within a person Interpersonal: Occurs between two or more people with a goal to exchange messages Group: Small-group

Define homeostasis?

Maintaining a balanced internal environment

Discuss levels of anxiety.

Mild Anxiety: It increases alertness and perceptual fields. -Causes restlessness and increased questioning. Moderate anxiety: narrows a person's perceptual fields to focus on immediate concerns, with inattention to other communications and details. - Causes quavering voice, tremors, muscle tension, butterflies in the stomach, slight increases in respirations/pulse. Severe Anxiety: very narrow focus on specific details, causing all behavior to be geared toward getting relief. -Causes difficulty communicating verbally, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation. Panic: causes the person to lose control and experience dread and terror. -Causes agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, chest pain or pressure

The nurse recognizes the stages of sleep when the client sleeps over 50% of the time during the course of the night?

NREM Stage II

Discuss the physiology of sleep.

Non-rapid eye movement (NREM): 75% to 80% of total sleep time. (Easier to arouse) Rapid eye movement (REM): 20 to 25% of total sleep time. (More difficult to arouse) Light-sleep states: Stage 1 - 5% and Stage 2 - 50 to 55% Deep-sleep states: Stage 3 - 10% and Stage 4 - 10%

Describe the expected outcome in each phase of the helping relationship

Orientation phase: -The patient will call the nurse by name. - The patient will accurately describe the roles of the participants in the relationship. -The patient and nurse will establish an agreement about: Goals of the relationship, location, frequency, length of the contacts, and duration of the relationship. Working phase: -The patient will actively participate in the relationship. -The patient will cooperate in activities that work toward achieving mutually acceptable goals. -The patient will express feelings and concerns to the nurse. Termination phase: -The patient will participate in identifying the goals accomplished or the progress made toward goals. - The patient will verbalize feelings about the termination of the relationship.

What factors affect stress?

Surgical procedures Retirement Illness or traumatic injury Marriage or divorce The school-aged child socializing with peers The adolescent striving for independence The middle-aged adult accepting physical signs of aging

What does TEACH stand for?

T - Tune into the patient. E - Edit patient information. A - Act on every teaching moment. C - Clarify often. H - Honor the patient as a partner in the education process.

Define adaptation?

The change that takes place as a result of the response to a stressor

Define stress?

condition in which the human system responds to changes in its normal balanced state.

Define the mind-body interaction.

humans react to threats of danger as if they were physiologic threats. A person perceives the threat on an emotional level, and the body prepares itself either to resist the danger or to run away from it. This causes you to feel the physiologic indicators like neck pain, constipation, headache, increased urination, nausea, weight gain/loss, sleep distubances.