Exam 5 : chps 6,7, 8, 21,36,38,14
internal respiration
occurs at the cellular level by means of hemoglobin and body cells
supine position
one in which the client is lying flat with the face up. The arms and legs are extended. The client may wear a paper or cloth examination gown and be further covered with a drape
prone position
opposite of the supine position The client lies on his or her abdomen with the head turned to one side
home care
own surroundings can travel nursing role: coordinator major burden of care Respite care is VITAL!!!
hygiene
personal appearance: part of person's dignity: 1.) order free, 2) odor free mouth care suctioning As indicated: i.e. skin breakdown
postural drainage
positioning technique that facilitates drainage of secretions from the lungs and various lobes or segments of the lungs with the use of gravity
clinical autopsy
postmortem examination to determine cause of death
Cystoscopy (endoscopic examinations)
inspection of the urinary bladder
scope
Examination instrument A tube with a light and lens for looking within the lower intestine
Hydration (provicle fluids)
What can be utilized to thin secretions?
loss of gag reflex
What can happen using a tracheostomy?
residential care
intermediate/sub-acute care costly provide 24/7 care (nursing home or hospital at times)
oxygen tent
a clear plastic enclosure that provides cooled, humidified oxygen. It is most often used in the care of active toddlers
When can hospice care services be terminated?
a client's health improves the client's illness goes into remission the client withdraws for any reason
bronchoscopy (endoscopic examinations)
What is considered the most invasive procedure compared to a chest x ray and ultrasound auscultate before and after the procedure
clients with 6 months or less to live as certified by a physician are accepted for hospice care
What is the eligibility criteria for hospice care?
improve the quality of life for client
What is the goal of palliative care?
repeat or simplify, clarify and expand
What is the nurses role when obtaining a consent form?
preventing the tongue from obstructing the upper airway
What is the purpose of an oral airway?
in respiratory dress, use breather techniques, clients with COPD
What patient would this position be used for?
withdrawal of fluid from the abdominal cavity
What's the purpose of paracentesis?
depression
a deeply sad mood) indicates the realization that death will come sooner rather than later. The sad mood is a result of confronting potential losse
oxygen analyzer
a device that measures the percentage of delivered oxygen to determine whether the client is receiving the amount prescribed by the physician
humidifier
a device that produces small water droplets and may be used during oxygen administration because oxygen is drying to the mucous membranes
pursed-lip breathing
a form of controlled ventilation in which the client consciously prolongs the expiration phase of breathing
flowmeter
a gauge used to regulate the amount of oxygen delivered to the client and is attached to the oxygen source
anger
the emotional response to feeling victimized occurs because there is no way to retaliate against fate
ventilation
the movement of air in and out of the lungs movement of air in the environment
preferred learning style
When a nurse asks a client what she wants to accomplish at the end of the health training, what aspect of learning is being assessed by the nurse? a. preferred learning style b. capacity to learn c. learning readiness d. learning needs
ineffective/weak cough
Which factor can affect airway patency?
third stage bargaining typical emotional response
"God, I'll go to Church every week" "Okay God. but first !" "Ill do anything for just a few more years" Psychological Response attempt to Delay the inevitable Negotiate for significant event: child's graduation/wedding 50th anniversary birth of grandkids/ great grandchild wait for a new cure
typical emotional response for acceptance
"I'm Ready"! "It's going to be okay", "I can't fight it I may as well prepare for it." Coming to Terms with Situation prepared to die hopelessness resolving resume social interactions deal with unfinished business legal & financial saying goodbye making peace clear chest; Family, friends, & God
second stage: anger: typical emotional response
"WHY ME" ?? "This isn't Fair"!! "I've always taken Good Care of Myself!!" Emotional Response feeling of being a victimized Displacement of Anger M.D./Staff Family Members God
typical emotional response for depression
"Yes, this is happening to me" "I'm so sad, why bother with anything?" "I'm going to die soon so what's the point..." Realization & Significance of Death occurs sadness feeling overwhelmed loneliness withdraw from family & friends End of Stage allows for time work through potential losses begin problem solving
first stage denial: typical emotional response
"no, not me" "This can't be happening to me"!! "you're wrong, I want a second opinion!!" "Those Tests got Mixed with Someone Else, You have to Run them Again!!" Initial Coping Mechanism Refuse to believe What they're Being told
nasal cannula (NC)
2-6L/min Flo2; 24%-40% is easy to apply promotes comfort does not interfere with eating or talking is less likely to create feeling of suffocation
trach collar
4-10L/min Flo2 24%-100% facilitates humidifying and warming oxygen
non breather
4-8L/min Fio2 24%-40% delivers Fl0z precisely through adjustable ports build up of carbon dioxide is minimal
simple mask
5-8 L/min provides higher concentration than possible
cognitive domain
A nurse is caring for a client who has to undergo hip surgery in a week. The nurse observes that the client likes to watch videos and demonstrations, and is an avid reader. Which learning style is best suited for the client? a. cognitive domain b. affective domain c. psychomotor domain d. interpersonal domain
assess previous learning and literacy abilities of the client
A 25 year old client has been admitted to a health care facility for hernioplasty. Which teaching method is best suited for the client? a. limit the teaching session to 15 to 20 minutes b. offer praise and encouragement for accomplishments c. provide the client total attention d. assess previous learning and literacy abilities of the client
implement the teaching session when the client is most alert and comfortable
A 73 year old client has been admitted to a health care facility with abdominal pain. Which teaching method is best suited for the client? a. involve the client during the teaching session to impart learning b. implement the teaching session when the client is most alert and comfortable c. use diagrams to aid teaching during the teaching session d. motivate the client to understand the importance and benefits of the session
clean secretions from the skin
A client at the health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. What is one intervention should the nurse perform? a. clean secretions from the skin b. remove dentures from the mouth c. keep all hairpins an clips d. place a rolled towel under the head
You feel angry that your family hopes for your cure?
A client confides to the nurse that he knows he is going to die and really wishes his family would stop hoping for a cure. He feels angry and frustrated when he sees his family trying to be helpful. Which statement is the best therapeutic response? a. "We should take more about your anger toward you family." b. "You feel angry that your family hopes for your cure?" c."It sounds as if you are being very pessimistic" d. "Have you shared your feelings with your family?"
I am certain that the physician would not lie to you
A client expresses to the nurse that the physician purposely provided wrong information about his physical condition. Which statement by the nurse would prevent effective communication? a. " I am not sure what information you are referring to." b. " I am certain that the physician would not lie to you" c. "Do you want to talk to the physician again to clarify issues?" d. "Describe the information to which you are referring."
"Don't worry, everything will be fine."
A client expresses worry about upcoming surgery. Which response by the nurse is a cliché? a."Tell me what you are worried about." b."Do you want to cancel your surgery?" c."Don't worry, everything will be fine." d."Have you spoken to your family about your concerns?"
Are you wondering if this surgery will work for you?
A client is admitted to a health-care facility with bowel obstruction secondary to Crohn disease and is scheduled for surgery. He is concerned whether surgery would cure his condition permanently. What is the most appropriate therapeutic statement? a."Let us give this surgery a chance. You may improve." b. "You have every right to refuse surgery. Shall I call the physician? c. "Are you wondering if this surgery will work for you?" d. "I have seen similar case that was cured by surgery."
You sound discouraged today
A client who has been diagnosed with renal failure asks the nurse if the diagnosis means that he will die soon. What should be the nurse's immediate response? a. "You will do just fine" b. "What are you thinking about?" c. "You sound discouraged today." d. "Death is a beautiful experience."
care is provided by a multidisciplinary team of professionals
A client with carcinoma of the lung is receiving hospice care at her home. What service is offered by hospice care? a. the client receives subacute or intermediate care b. the client is provided with labor intensive treatment c. round the clock nursing care is provided to the client d. care is provided by a multidisciplinary teak of professionals
implementation
A nurse involves an adult client actively in health teaching by encouraging feedback and handling of equipment. In which phase should this activity take place? a. assessment b. planning c. implementation d. evaluation
obtain pamphlets in large print
A nurse is caring for a 65 year old client with symptoms of an eye infection. Which teaching strategy will best promote health teaching fo this client? a. obtain pamphlets in large print b. speak in a louder tone c. use false cards d. select red print on white paper
use supportive statements to correct the client's behavior
A nurse is caring for a client who is recovering from a cerebrovascular accident. The nurse discovers that the client became irritable and angry because his activities are limited. What is the best nursing approach to keep the client motivated? a. ignore the behavior, knowing that the client is grieving b. use supportive statements to correct the client's behavior c. allow frequent and longer visits by family members d. tell the client that he/she knows how the client feels
need for lubrication of the lips
A nurse is caring for a client who is terminally ill and prescribed oxygen therapy. Which intervention is important for the client on oxygen therapy? a. need for intravenous fluids b. need for total parenteral nutrition c. need for lubrication of the lips d. need for frequent mouth care
coordinate community services arrange for home nursing visits secure home equipment
A nurse is caring for a client with a terminal illness in her home. What interventions can the nurse offer to this client? Select all that apply. a. coordinate community services b. arrange for home nursing visits c. secure home equipment d. provide round the clock nursing care e. suggest transferring the client to residential care
nausea
A nurse is caring for a client with bone cancer. The nurse identifies the rise of inadequate consumption of food. What is a possible cause for this diagnosis? a. pressure sores b. nausea c. weakness d. infection
the nurse gives the client a pamphlet on how to clear nasal debris
A nurse is caring for a client with influenza and is impairing health teaching to the client. Which action will help the client retain the key points of the teaching? a. the nurse helps the client in self administration of medications b. the nurse gives the client a pamphlet on how to clear nasal debris c. the nurse shows the client how to measure body temperature d. the nurse explains how to use a nebulizer mask
You are worried that this will extend into your marriage?
A nurse is caring for a client with urticaria and pruritus. The client expresses her concern because she will be getting married within a week. She is worried about having rashes and itching. What would be the nurse's most appropriate response? a. The medications will help a lot to reduce the rashes." b."You are worried that this will extend into your marriage?" c."It is probably just the result of preceding tension." d. "I hope that your husband to the is aware of it."
absence of brain stem reflexes complete absence of central and deep tendon reflexes no spontaneous respiration after being disconnected from a ventilator
A nurse is caring for a dying client who is in a coma. Which conditions indicate brain death in the client? Select all that apply. a. absence of brain stem reflexes b. unreceptiveness or unresponsiveness to moderately painful stimuli c. Paco2 less than 60mm Hg after preoxygenation with 100% oxygen d. no spontaneous respiration after being disconnected from a ventilator
clients with less than 6 months to live
A nurse is caring for a terminally ill client who has been referred for hospice care. Which client is eligible for hospice care? a. clients with less than 6 months to lei b. clients with difficult behavior c. clients requiring high tech palliative care d. clients who cannot live independently
Tell me more about what frightens you about seizures
A nurse is caring for a toddler who has recovered from a seizure. The mother is worried that the seizure may recur. What is the most therapeutic statement? a." Most children will never experience a second seizure" b. "Medicines can prevent the occurrence of seizures" c. "Why worry about something that you cannot control." d. "Tell me more about what frightens you about seizures"
"Yes, I'm dying...."
A nurse is caring for a young client who has been severely injured in a motor vehicle accident. The client has multiple organ failure and is dying. Which statement by the client indicates that the client is in the depression stage of dying? a. "How can it be? No, I'm not dying." b. "What have I done wrong?Why me?" c. "I have just finished college..." d. "Yes, I'm dying...."
use colorful materials
A nurse is caring for an 8 year old client who has been admitted to a health care facility with tonsillitis. When teaching method should the nurse use for this client? a. show enthusiasm b. use colorful materials c. vary tone and pitch d. use the client's name frequently
informing the client about preparing an advance directive
A nurse is caring for an elderly client with a terminal illness. Which intervention by the nurse indicates respect for the rights of the dying client? a. asking the client to avoid talking about death b. informing the client about preparing an advance directive c. avoiding any reference to spirituality when talking to the client d. telling the client that the results of the diagnostic test look good
offer to secure spiritual counseling, if requested, for the client and family members
A nurse is caring for an elderly client with acute renal failure who is dying. How might the nurse cater to the basic needs of the client and his family members? a. offer to secure spiritual counseling, if requested, for the client and family members b. provide nursing care to the client without regard to the nurse's own feelings c. discourage the client from talking to family members about his death d. try to convince the client and family members to agree to organ or tissue donation
provide wrapped ice cubes to be sucked
A nurse is caring for an elderly client with impaired swallowing. What care should the nurse take to maintain adequate fluid volume in the client? a. offer frequent small sips of water b. offer small amounts of beverages c. provide wrapped ice cubes to be sucked d. inform the physician of the need for intravenous fluids
identify him or herself by name, title, and location ask for the family member by name and speak calmly explain that the client's condition is deteriorating
A nurse is caring for an older client who has slipped into a coma. The client is showing signs of multiple organ failure. What care should the nurse take when summoning the family of the dying client. Select all that apply. a. identify him or herself by name, title, and location b. ask the family to rush to the facility without explaining c. ask for the family member by name and speak calmly d. explain that the client's condition is deteriorating e. tell the family all answers to queries will be given at the facility
psychomotor domain
A nurse is teaching a diabetic client the self-administration of insulin. The nurse shows the client how to hold the syringe and read the calibration. This learning style is a part of the a. cognitive domain b. affective domain c. psychomotor domain d. interpersonal domain
child
A nurse motivates a client and promises a reward when the client can name the number of recommended servings in each category within the food pyramid. To which age category does the client likely belong? a. child b. adult c. older adult d. net generation
affective domain
A nurse observes that a client's behavior consists of the following features: supporting, accepting, refusing, and defending. In which learning domain does the client's learning style fall? a. cognitive domain b. affective domain c. psychomotor domain d. interpersonal domain
using judgemental and belitting language
A nurse tells a client, "Are you going to get out of bed, or are you just going to sleep all day and night?" This is an example of which barrier to communication? a.Using leading questions b.Using judgmental or belittling language c.Using comments that give advice d.Using probing questions
in depth information
A nurse understands the need for effective communication with clients during assessments. The nurse is completing the admission history for a client admitted to the health care facility. Which can result from the nurse using open-ended questions during the client admission history assessment? a.predictatble outcomes b.in depth information c. brief interview d. simple reasons
Reviewing health changes
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out during this phase of the relationship? a.Establishing trust and rapport b.Reviewing health changes c. Developing solutions that will be enacted d. Attending to physical health care needs
affective domain
A nurse, caring for a 45 year client, observes that the client has very low motivation and feels that he cannot be cured. Which learning style is best suited for the client? a. cognitive domain b. affective domain c. psychomotor domain d. interpersonal domain
are you feeling tired and frustrated with your recovery from surgery?
A postoperative client has been vomiting. The physician diagnoses him as having paralytic ileus and advises the insertion of a nasogastric tube. The nurse explains the purpose and the procedure to the client. The client expresses that he is fed up with the treatment and cannot take it any longer. What would be the most appropriate nursing response? a. "If you don't have this tube inserted, you will keep vomiting." b. "You have every right to refuse the treatment. Shall I call the physician?" c. "Get this nasogastric tube inserted and you will feel a lot better." d. "Are you feeling tired and frustrated with your recovery from surgery?"
silence
Allows time for considering how to proceed or arouses the client's anxiety to the point that it stimulates more verbalization
changing the subject
Alters the direction of the discussion to a safer or more comfortable topic i.e. Client: "I'm so scared that a mammogram will show I have cancer." Nurse: "Tell me more about your family." improvement: Client: "I'm so scared that a mammogram will show I have cancer." Nurse: "It is a serious disease. What concerns you the most?"
Amish
Clients may be reluctant to spend money on health care unnecessarily. Assess home remedies and folk healing being used. Home deliveries are preferred; expect brief overnight stays following hospital births. A central belief is that illness must be endured with faith and patience. Offer comfort measures and analgesic medications rather than waiting for clients to request them. Clients are formally educated up to eighth grade. Select written health educational materials at the client's level of understanding. photographs are not permitted avoid photographing newborns
Helpful Suggestions for Denial
Answer questions honestly Encourage open communication with MD Do not argue with client
begin with basic concepts
While teaching an adult client how to self administer insulin, which strategy is the best choice to implement health teaching? a. collaborate with the client on content b. determine the client's learning style c. begin with basic concepts d. divide information into manageable amounts
physician they confirm breathing & respiration have ceased
Whose responsibility is it to confirm death in a client?
What are the provisions for Terminal Care?
Basic Needs Still Appropriate : Hydration Nourishment Elimination Hygiene Positioning Comfort
helpful suggestions for depression
Be there active listening offer counseling or social service assistance allow client to rest
Jehovah's Witnesses
Blood transfusions are refused even in life-threatening situations because they believe that blood is the source of the soul. Refer to physicians who practice blood conservation strategies such as autotransfusions and intravenous volume ex
prevent depletion of oxygen
Why do we pre oxygenate clients prior to suctioning?
Church of Jesus Christ of Latter-Day Saints (Mormonism)
Coffee, tea, alcohol, tobacco, illegal drugs, and overuse of prescription drugs are prohibited. Notify the dietary department to provide noncaffeinated beverages. Male members may anoint the sick with consecrated olive oil. Facilitate anointing rituals before surgery or at the client's request
reflecting
Confirms that the nurse is following the conversation i.e. Client: "I haven't been sleeping well." Nurse: "You haven't been sleeping well."
confronting
Calls attention to manipulation, inconsistencies, or lack of responsibility i.e. "You're concerned about your weight loss, but you didn't eat any breakfast."
a false reading and does not allow oxygen to attach to hemoglobin
Carbon dioxide gives?
Hemoglobin saturation with other substances
Cause: Carbon monoxide poisoning Remedy: Discontinue use temporarily
Extraneous light
Cause: Direct sunlight Treatment lights Remedy: Cover sensor with a towel
Barrier to light
Cause: Nail polish Thick toenails Acrylic nails Remedy: Discontinue use temporarily Remove polish Relocate sensor Remove acrylic nails
Movement of the sensor
Cause: Tremor Restlessness Loss of adhesion Remedy: Relocate sensor to another site Replace sensor or tape in place
Orthodox Judaism and some non-orthodox Jews; ie, Conservative, Reform, and Reconstructionist
Circumcision is a sacred ritual performed on the eighth day of life. Provide information on care following circumcision before discharge. Kosher dietary laws allow consumption of animals that chew their cud and have cloven hoofs (eg, cattle, sheep, goats, deer, and bison). Animals are slaughtered according to defined procedures; dairy products and meat are not eaten together. Seafood with fins and scales are permitted (ie, no shellfish, eg, crabs and shrimp). Notify dietary department of the client's food preferences. Packaged food labeled kosher indicates it was "properly preserved." Pareve means "made without meat or milk." Sabbath begins on Friday at sundown and ends on Saturday at sundown. Avoid scheduling nonemergency tests or procedures during this time. Autopsies are not allowed unless required by law. All organs that are removed and examined during an autopsy must be returned to the body so that the body may remain intact for burial. Burial is preferred within 24 hours of death; Judaic law requires that the body not be left alone. Contact the family to stay with the dying client. Orthodox family members may ask a son or relative to close the mouth and eyes of the deceased.
Hinduism
Clients highly value modesty and hygiene. Provide a daily bath but not following a meal; add hot water to cold but not the reverse. The application of a pundra, a distinctive mark on the forehead, is religiously symbolic. Avoid removing or replace it as soon as possible. Hindus value self-control. Offer comfort measures and analgesic medications rather than waiting for Hindu clients to request them. Men do not participate during labor and delivery. Keep men informed of the birthing progress Cleansing of the body after death symbolizes cleansing of the soul. Inquire if the family wishes to wash a deceased client's body. Most clients are vegetarians: beef is forbidden, and some do not consume eggs. Request a consult with the dietitian. Clients may refuse medication in gelatin capsules because gelatin is made from animal by-products.
because it gives the caregiver an opportunity to enjoy brief periods away from home
Why is respite care so important?
structuring
Defines a purpose and sets limits i.e. "I have 15 minutes. If your pain is relieved, we could discuss how your test will be done."
performing post mortum care
Determine that the client is dead by assessing breathing and circulation. Determine if the physician and family have been notified. Ensure that a person of authority has pronounced the death. Notify the nursing supervisor and switchboard of the client's death. Check the medical record for the name of the mortuary where the body will be taken
giving advice
Discourages independent problem-solving and decision-making; provides a biased view that may prejudice the client's choice i.e. "If I were you, I'd try drug therapy before having surgery." improvement: "Share with me the advantages and disadvantages of your options as you see them."
belittling
Disregards how the client is responding as an individual i.e. "Lots of people learn to give themselves insulin." improvement: "You're finding it especially difficult to inject yourself with a needle."
agreeing
Does not allow the client flexibility to change his or her mind i.e. "You're right about needing surgery immediately." improvement: "Having surgery immediately is one possibility. What others have you considered?"
Open-ended questioning
Encourages the client to elaborate i.e. How are you feeling?
Esophagogastroduodenoscopy (endoscopic examinations)
Esophagogastroduodenoscopy—inspection of the esophagus, stomach, and duodenum
Giving Approval or Disapproval
Holds the client to a rigid standard; implies that future deviation may lead to subsequent rejection or disfavor i.e. "I'm glad you're exercising so regularly." "You should be testing your blood glucose each morning." improvement: "Are you having any difficulty fitting regular exercise into your schedule?" "Let's explore some ways that will help you remember to test your blood glucose each morning."
client is instructed on deep breathing and coughing technique withdraw your suction listen to breath sounds
How can you evaluate the outcome of a client after suctioning has occurred?
auscultate the lungs every shift before and after coughing
How do you perform suctioning with a catheter?
dairy products
If a client is lactose intolerant what food should they avoid?
dorsal recumbent
If the nurse places the client on their back with knees bent, hips rotated outward, and feet flat on the exam table. What position would this describe? a. Lithotomy b.Sim's c.Modified standing d.Dorsal recumbent
explain the purpose first before asking questions and gathering data
In opening an interview?
elimination
Incontinence: bowel & bladder urinary retention constipation
defending
Indicates such a strong allegiance that any disagreement is unacceptable i.e. "Ms. Johnson is my best nursing assistant. She would not have let your light go unanswered that long." improvement: "I'm sorry you had to wait so long."
glucometer
Instrument for obtaining measurements Instrument for measuring glucose
disagreeing
Intimidates the client; makes him or her feel foolish or inadequate i.e. "That's not true! Where did you get that idea?" improvement: "Maybe I can help clarify that for you."
epiglottis
It acts as a lid that closes during swallowing, helping to direct fluid and food toward the esophagus rather than the respiratory tract
identifying with the client's feelings
It is important for the nurse to empathize with the client to develop a positive, therapeutic relationship. What is a characteristic of empathy? a.Caring for the client without negative judgment b.Experiencing feelings similar to those of the client c.Identifying with the client's feelings d. Conveying genuine care to the client
nourishment
Lose interest in Eating (nausea & vomiting) poor nutrition alternate sources exhaustion smells
hydration
Maintain Adequate Fluid intake: at least 1 ounce Monitor: intact swallowing reflex Presence of Dysphasia Loss of Sucking Reflex: can no longer use a straw to drink
delegator role
Nurse assigns tasks to others understands legal guidelines for each level of caregiver prior to delegation of tasks follows up on completion of tasks and the outcome accepts responsibility and accountability for tasks assigned and reports need for further patient care as needed
What are the procedures following death?
Physician notification: intern or resident to pronounce: After 1800 call M.D. for further instructions family notification unexpected code family room if available chaplain on call 24/7
procedures for postmortum care
Place the body supine with the arms extended at the sides or folded over the abdomen Remove all medical equipment such as intravenous catheters, urinary catheters, and dressings unless this is a case for the medical examiner or coroner Replace or keep dentures in the mouth. Place a small rolled towel beneath the chin to close the mouth Cleanse secretions and drainage from the skin unless a forensic autopsy will be performed Apply one or more disposable pads between the legs and under the buttocks Attach an identification tag to the ankle or wrist; pad the wrist first if it is used Wrap the body in a paper shroud (a covering for the body); cover the body with a sheet
Christian Scientist
Prayer is the antidote for any illness. Expect that these clients will contact lay practitioners to assist with healing. Legal procedures may be used as an option when the well-being of minor children are threatened by parental refusal for medical care.
centesis (thoracentesis)
Procedure in which a needle is used to puncture the thorax and withdraw fluid
pelvimetry
Procedure in which the pelvis is to measure measured
Using Clichés
Provides worthless advice and curtails exploring alternatives i.e. "Keep a stiff upper lip." improvement: "It must be difficult for you right now."
Demanding an Explanation
Puts the client on the defensive; he or she may be tempted to make up an excuse rather than risk disapproval for an honest answer i.e. "Why didn't you keep your appointment last week?" improvement: "I see you could not keep your appointment last week."
broad opening (therapeutic verbal communication techniques)
Relieves tension before getting to the real purpose of the interaction i.e. Wonderful weather we're having
Paraphrasing
Restates what the client has said to demonstrate listening i.e. Client: "After every meal, I feel like I will throw up." Nurse: "Eating makes you nauseous, but you don't actually vomit."
summarizing
Reviews information that has been discussed i.e. "You've asked me to check on increasing your pain medication and getting your diet changed."
Verbalizing what has been implied
Shares how the nurse has interpreted a statement i.e. Client: "All the nurses are so busy." Nurse: "You're feeling that you shouldn't ask for help."
Sharing perceptions
Shows empathy for the client's feelings i.e. "You seem depressed."
Catholicism
Statues and medals of religious figures provide spiritual comfort. Leave such items on or near the client; keep items safe and return promptly if removed. Artificial birth control and abortion are forbidden. Explain how to avoid pregnancy through methods such as checking basal body temperature and characteristics of cervical mucus. Baptism is necessary for salvation. In an emergency, any baptized Christian should perform baptism by pouring water over the head three times and saying, "I baptize you in the name of the Father, and of the Son, and of the Holy Spirit."
Seventh Day Adventist
Strict dietary laws are followed based on the Old Testament. Request a consult with the dietitian to facilitate a vegetarian diet without caffeine. Saturday is the Sabbath. Avoid scheduling medical appointments or procedures at this time
sigmoidoscopy
Test in which the lower intestine is inspected
denial anger bargaining depression acceptance
The 5 stages of Dying/grief
Have you been feeling like a failure for some time now?
The nurse is caring for a client who is in depression and expresses that he wishes to die because he feels like a failure. What would be the best therapeutic response? a. "Have you been feeling like a failure for some time now?" b. "I see a lot of positive things in you" c. "It is the result of your illness that you feel this way." d. "You have so many purposes in life to live for."
patronizing
Treats the client condescendingly (less than capable of making an independent decision) i.e. "Are we ready for our bath yet?" improvement: "Would you like your bath now or should I check with you later?"
Giving False Reassurance(non therapeutic verbal communication technique)
Trivializes the client's unique feelings and discourages further discussion i.e. "You've got nothing to worry about. Everything will work out just fine." improvement: "Tell me your specific concerns."
helpful suggestions for bargaining
Try and assist with client's wishes encourage family support offer spiritual assistance from clergy or support groups
positioning a client in terminal care
Turn every 2 hours lateral position walk a fine line tolerence increased pain, esp with meds
hospice professionals and volunteers supports care given by the family rganizations also provide support programs for family members and significant other
What Multi-Disciplined services are offered for hospice care?
ineffective or weak cough
What are factors that affect the ability to mobilize secretions?
to provide a place of refuge in a facility for the care of terminally ill clients and the concept of such care itself
What are the goals of hospice care?
lithotomy position
a reclining position with the feet in metal supports called "stirrups." It is used to facilitate gynecologic (female reproductive), urologic, and sometimes rectal examinations
incentive spirometry
a technique for deep breathing using a calibrated device, encourages clients to reach a goal-directed volume of inspired air
Magnetic resonance imaging (MRI)
a technique for producing an image by using atoms subjected to a strong electromagnetic field. prior to procedure make sure all medal objects are removed
direct questioning (therapeutic verbal communication techniques)
acquires specific information i.e. do you have any allergies?
Helpful suggestions for anger
active listening Don't take client's anger personally Do not get angry yourself support
grief work
activities involved in grieving) includes participating in the burial rituals common to a culture
psychological side of dying
acute/chronic pain: any physical problems develop fear spiritual distress: what happens after death ineffective coping hopelessness caregiver role strain
affective
advocating supporting accepting promoting refusing defending
acceptance
an attitude of complacency) occurs after clients have dealt with their losses and completed unfinished business.
G-6-PD deficiency
an enzyme that helps red blood cells metabolize glucose makes red blood cells vulnerable during stress, which increases metabolic needs
EEG
an examination of the energy (activity) emitted by the brain
agiogram
an image The actual image recorded during angiography
fowler's position
an upright seated position
psychomotor
assembling changing empty filling adding removing
examples of verbal communication
attention and concentration language compatibility verbal skills hearing and visual acuity motor functions involving the throat, tongue, and teeth sensory distractions interpersonal attitudes literacy cultural similarities
educator role
avoid giving advice respect patient choices as related to their care teach about procedures, medications, discharge plans, wound care, etc. provide resources and community referral sources
clarifying
avoids misinterpretation i.e. "I don't quite understand what you're askin
race
biologic variations term used to categorize people with genetically shared physical characteristics. Some examples include skin color, eye shape, and hair texture
kinesics
body language, facial expressions, posture, gestures and body movements clothing styles can affect body language
inspiration
breathing in
expiration
breathing out
Diaphragmatic breathing
breathing that promotes the use of the diaphragm rather than the upper chest muscles
acute care
care in hospital setting most costly unstable condition exists with the client
Poor circulation at the sensor site
cause: Peripheral vascular disease Edema Tourniquet effect from taped sensor Vasoconstrictive drug effects Remedy: Change the sensor location or type of sensor. Loosen or change sensor location.
lactase deficiency
causes intolerance to dairy products Without lactase, people have cramps, intestinal gas, and diarrhea approximately 30 minutes after ingesting milk or foods that contain it.
collaborator role
communications with others such as physicians, therapists, nutritionist, staff, etc. works with others to achieve a common goal
brain death
condition in which there is an irreversible loss of function of the whole brain, including the brainstem
Signs and symptoms of inadequate late
decreased respiration, sinueses, thick finger nails, coma, stupor
andragogic learners
divergent thinkers (process multiple applications for new information)
giving general leads
encourages the client to continue i.e. "Uh, huh," or "Go on."
tracheal rings
ensure that the trachea, the portion of the airway beneath the larynx, remains open
Laparoscopy (endoscopic examinations)
inspection of the abdominal cavity
fluoroscopy
form of radiography that displays an image in real time
death
generally determined on the basis that breathing and circulation have ceased
knee chest position
genupectoral position," the client rests on the knees and chest. He or she turns the head, which is supported on a small pillow, to one side
terminal illness
illness with no potential for cure
verbal communication
includes speaking, reading, and writing (oral and written) also includes silence used to gather facts, instruct, clarity, and exchange ideas promote positive and limit negative influences
Nursing implications for tracheostomy
ineffective airway clearance impaired gas exchange risk for infection impaired spontaneous ventilation anxiety deficient knowledge
palliative care
involves providing relief from distressing symptoms, easing pain, and enhancing quality of life Over time, if the doctor or the health care team believes ongoing treatment is no longer helping, there are two possibilities (residential care or acute care)
CPAP mask
is attached to a portable ventilator maintains continuous positive airway pressure keeping the alveoli partially inflated even during periods of expiration
tracheostomy
it's located below the level of the larynx as a result clients cannot speak Clients who are less stable, have an upper airway obstruction, or who require prolonged mechanical ventilation and oxygenation are more likely to be candidates
Signs and symptoms of inadequate oxygenation early
lethargy, restlessness, due to the tissue within the cells rapid shallow breathing, tachycardia, hypertension, confusion
cognitive
listing identifying locating labeling summarizing selecting
grieving
means the process of feeling acute sorrow over a loss
comfort
most challenging issue because of: increased pain, esp. with meds tolerance fear Dulling consciousness suppression of respirations inhibiting ability to communicate
gerogogic learners
need structure and encouragement motivated by a personal need or goal learning is self structured attention affected by low energy level, fatigue, and anxiety practical thinkers (process new information as it applies to a unique personal problems)
Islam (muslim)
prayer and washing are required Pork and alcohol are forbidden Clients prefer to die at home. Only relatives may touch or wash the body of a deceased Muslim. Plan care around prayer and washing rituals, which occur at sunrise, midmorning, noon, afternoon, and sunset. Help clients face Mecca for prayer Clients may refuse medication in capsules and pork insulin. Request that the pharmacist omit alcohol in liquid medications, which usually contain this ingredient. Expect that life support will be unacceptable if there is no hope for a reasonable recovery. Consult the family before performing postmortem care
introductory phase (phases of nurse client relationship)
preconceived ideal, may only last a couple of seconds appropriate dress well groomed smiling eye contact handshake confidence personal odors (cigarettes, strong perfume)
Andragogy
principles of teaching adult learners
gastroscope
procedure where you would examine the stomach
X-ray
produce electromagnetic energy that passes through body structures, leaving an image of dense tissue on special film
terminal care
promoting acceptance providing emotional support care options
helpful suggestions for acceptance
provide physical care be there keep room lighted if client accepting support family members
giving information (therapeutic verbal communication techniques)
provides fact i.e. Your surgery is scheduled at noon
care giver role
provides health related activities the client cannot perform on their own physical and emotional needs
promoting acceptance
providing emotional support support choices regarding terminal care preserving dignity using good listening skills
bargaining
psychological mechanism for delaying the inevitable, involves a process of negotiation, usually with God or some other higher power
dorsal recumbent position
reclining position with the knees bent, hips rotated outward, and feet flat
proxemics
relationship of space to communication misunderstandings of closeness intimate within 6 inches to 4 feet (sharing secrets) personal-6 inches to 4 feet (interview, PA, teaching) social-4 feet to 12 feet (lecturing, group interactions) public space- 12 or more feet (speeches)
respite care
relief for the caregiver by a surrogate
oral suctioning
removal of secretions from the mouth
oropharyngeal
removal of secretions from the throat through a catheter inserted through the mouth
nasopharyngeal
removal of secretions from the throat through a nasally inserted catheter
nasotracheal
removal of secretions from the trachea through a nasally inserted catheter
sigmoidoscope
requires the use of the sims position procedure where the lower intestine is inspected
Computed tomography (CT)
scanning is a form of roentgenography that shows planes of tissue
pedagogy
science of teaching children or those with cognitive ability comparable to children
terminal phase
self limiting nurse and client agree caring attitude, compassion assist with transition
visual impairment
speak in a normal tone use 75-100 watt light source avoid being in front of a window where bright sunlight is shining provide a magnifying glass for reading obtain pamphlets in large (12-16 font) avoid using glossy paper select black print on white paper
percussion
striking or tapping a part of the body type of chest physiotherapy performed by rhythmically striking the chest wall
touch
tactile stimulation by making contact with person or object 2 types: task oriented touch affective touch
external respiration
takes place at the most distal point in the airway between the alveolar and capillary membranes
working phase
tasks are performed mutually plan care and implement plan both nurse and client participate maintain client's independence participation- helps self-esteem and dignity
chest physiotherapy
techniques for mobilizing pulmonary secretions
tripod position
the client is in a seated position with the arms supported on pillows or the arm rests of a chair
orthopedicneic positon
the client leans forward over the bedside table or a chair back
sims position
the client lies on the left side with the chest leaning forward, the right knee bent toward the head, the right arm forward, and the left arm extended behind the body
modified standing position
the client stands with the upper half of the body leaning forward. It is used primarily for examining the prostate gland in men
denial
the psychological defense mechanism by which a person refuses to believe certain information helps people to cope initially with the reality of death
culture
the values, beliefs, and practices of a particular group incorporates the attitudes and customs learned through socialization with others. It includes, but is not limited to, language, communication style, traditions, religion, art, music, dress, health beliefs, and health practices passed from one generation to the next
nurse-client relationship
therapeutic relationship-almost always working towards a goal of better health client centered and goal oriented treat each client as unique, respectful attitude includes client's support system (friends, family, other caregivers)
angiography
to record Test that records an image of blood vessels
vibration
type of chest physiotherapy used to loosen retained secretions
Gerogogy
unique techniques that enhance learning among older adults
hearing impairment
use magic slate, chalkboard, flash cards, writing pads lower pitch voice try and select words that do not begin with "f", "s", "k", and "sh" rephrase rather than repeat when the client does not understand may use stethoscope and place over client's ear, speak into bell with low tone
How do you measure a blood sugar? and when?
usually is measured about 30 minutes before eating and before bedtime to determine what are likely to be the lowest levels of glucose
communication
verbal and nonverbal an exchange of information involves both sending and receiving messages between two or more people followed by feedback indicating that the information was understood or requires further clarification
paralanguage
vocal sounds, not words Ex: making noises, moaning laughing, whistling, and crying uses volume, rate of speech and pitch