Foundations of Professional Nursing Exam 4

1. Discuss Common Alterations in Sleep and Rest -Stages of a normal sleep cycle (POWERPOINT) -Proper rest and sleep are as important to health as good nutrition and adequate exercise. Physical and emotional health depends on the ability to fulfill these basic human needs. Individuals need different amounts of sleep and rest. Without proper amounts, the ability to concentrate, make judgments, and participate in daily activities decreases; and irritability increases. -Identifying and treating patients' sleep pattern disturbances are important goals. To help patients you need to understand the nature of sleep, the factors influencing it, and patients' sleep habits. -Sleep provides healing and restoration. -Some patients have preexisting sleep disturbances; other patients develop sleep problems as a result of an illness or hospitalization. Physiology of Sleep: (POWERPOINT) -Circadian rhythms --Affected by light, temperature, social activities, and work routines. -The biological rhythm of sleep frequently becomes synchronized with other body functions. --People experience cyclical rhythms as part of their everyday lives. --The most familiar rhythm is the 24-hour, day-night cycle known as the diurnal or circadian rhythm (derived from Latin: circa, "about," and dies, "day"). The suprachiasmatic nucleus (SCN) nerve cells in the hypothalamus control the rhythm of the sleep-wake cycle and coordinate this cycle with other circadian rhythms. --Circadian rhythms influence the pattern of major biological and behavioral functions. The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24-hour circadian cycle. --All persons have biological clocks that synchronize their sleep cycles. This explains why some people fall asleep at 8 p.m., whereas others go to bed at midnight or early in the morning. Different people also function best at different times of the day. --Failure to maintain an individual's usual sleep-wake cycle negatively influences the patient's overall health. Physiology of Sleep: Sleep Regulation (POWERPOINT) -Regulated by a sequence of physiological states integrated by central nervous system (CNS) activity -Hypothalamus -Reticular activating system (RAS) -Homeostatic process (Process) --Sleep is associated with changes in the peripheral nervous, endocrine, cardiovascular, respiratory, and muscular systems. --Specific physiological responses and patterns of brain activity identify each sequence. Instruments such as the electroencephalogram (EEG), which measures electrical activity in the cerebral cortex; the electromyogram (EMG), which measures muscle tone; and the electrooculogram (EOG), which measures eye movements provide information about some structural physiological aspects of sleep. --The major sleep center in the body is the hypothalamus. It secretes hypocreatins (orexins) that promote wakefulness and rapid eye movement sleep. Prostaglandin D2, L-tryptophan, and growth factors control sleep. --Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness. The RAS receives visual, auditory, pain, and tactile sensory stimuli. Activity from the cerebral cortex (e.g., emotions or thought processes) also stimulates the RAS. Arousal, wakefulness, and maintenance of consciousness result from neurons in the RAS releasing catecholamines such as norepinephrine. --The homeostatic process (Process S), which primarily regulates the length and depth of sleep; and the circadian rhythms (Process C: "biological time clocks"), which influence the internal organization of sleep, timing and duration of sleep-wake cycles, operate simultaneously to regulate sleep and wakefulness (Daroff et al, 2012). Time of wake up is defined by the intersection of Process S and Process C. Stages of the Adult Sleep Cycle (POWERPOINT) -Four stages of NREM -Sleep cycle lasts 90 to 100 minutes -Sleep goes through stages 1 to 4, then reversal from 4 to 3 to 2, followed by REM --The normal sleep pattern for an adult begins with a presleep period during which the person is aware only of a gradually developing sleepiness. This period normally lasts 10 to 30 minutes; however, if a person has difficulty falling asleep, it lasts an hour or more. --Once asleep, the person usually passes through four or five complete sleep cycles per night, each consisting of four stages of nonrapid eye movement (NREM) sleep and a period of rapid eye movement (NREM) sleep. --A person usually reaches REM sleep about 90 minutes into the sleep cycle. 75-80% of sleep time is spent in NREM sleep. --With each successive cycle stages 3 and 4 shorten, and the period of REM lengthens. REM sleep lasts up to 60 minutes during the last sleep cycle. Not all people progress consistently through the stages of sleep. --Sleep becomes more fragmented with aging, and a person spends more time in lighter stages. Functions of Sleep: (POWERPOINT) -Purpose of sleep --Remains unclear --Physiological and psychological restoration --Maintenance of biological functions -Dreams --Occur in NREM and REM sleep --Important for learning, memory, and adaptation to stress --NREM sleep contributes to body tissue restoration. --During sleep the heart rate falls to 60 beats/min or less, which benefits cardiac function. Other biological functions decreased during sleep are respirations, blood pressure, and muscle tone. --The body needs sleep to routinely restore biological processes. During deep slow-wave (NREM stage 4) sleep, the body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells. Protein synthesis and cell division for renewal of tissues such as the skin, bone marrow, gastric mucosa, or brain occur during rest and sleep. NREM sleep is especially important in children, who experience more stage 4 sleep. --Another theory about the purpose of sleep is that the body conserves energy during sleep. The skeletal muscles relax progressively, and the absence of muscular contraction preserves chemical energy for cellular processes. Lowering of the basal metabolic rate further conserves body energy supply. --REM sleep is necessary for brain tissue restoration and appears to be important for cognitive restoration and memory. --A loss of REM sleep leads to feelings of confusion and suspicion. --Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate; and some believe that they are functionally important to learning, memory processing, and adaptation to stress. --The ability to describe a dream and interpret its significance sometimes helps resolve personal concerns or fears. --Another theory suggests that dreams erase certain fantasies or nonsensical memories. Physical Illness: (POWERPOINT) -Physical illness can cause pain, physical discomfort, anxiety, depression, and sleep disturbances: -Hypertension -Respiratory disorders -Nocturia -Restless leg syndrome (RLS) -American Academy of Sleep Medicine --Respiratory disease—such as chronic obstructive pulmonary disease (COPD), emphysema, asthma, allergies, or the common cold—often interferes with sleep. --Connections between heart disease, sleep, and sleep disorders exist. Sleep-related breathing disorders are linked to increased incidence of nocturnal angina (chest pain), increased heart rate, electrocardiogram changes, high blood pressure, and risk of heart diseases and stroke. --Nocturia disrupts the sleep cycle. --Restless leg syndrome (RLS) can occur before sleep onset. RLS symptoms include recurrent, rhythmical movements of the feet and legs. Patients feel an itching sensation deep in the muscles. Relief comes only from moving the legs, which prevents relaxation and subsequent sleep. --Sleep disorders are conditions that, if untreated, generally cause disturbed nighttime sleep that results in one of three problems: insomnia, abnormal movements or sensation during sleep or when awakening at night, or excessive daytime sleepiness. --Many adults in the United States have significant sleep problems from inadequacies in either the quantity or quality of their nighttime sleep and experience hypersomnolence on a daily basis. --The American Academy of Sleep Medicine developed the International Classification of Sleep --Disorders version 2 (ICSD-2), which classifies sleep disorders into eight major categories. --Individuals with sleep-related breathing disorders have changes in respirations during sleep. --Hypersomnias are sleep disturbances that result in daytime sleepiness and are not caused by disturbed sleep or alterations in circadian rhythms. --The circadian rhythm sleep disorders are caused by a misalignment between the timing of sleep and individual desires or the societal norm. --The parasomnias are undesirable behaviors that occur usually during sleep. --Sleep and wake disturbances are associated with many medical and psychiatric sleep disorders, including psychiatric, neurological, or other medical disorders. --In sleep-related movement disorders the person experiences simple stereotyped movements that disturb sleep. The category of isolated symptoms, apparently normal variants, and unresolved issues includes sleep-related symptoms that fall between normal and abnormal sleep. --The "other" sleep disorders category contains sleep problems that do not fit into other categories. --A polysomnogram involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep. The Multiple Sleep Latency Test (MSLT) provides objective information about sleepiness and selected aspects of sleep structure by measuring eye movements, muscle-tone changes, and brain electrical activity during at least four napping opportunities spread throughout the day.

normal sleep involves two phases nonrapid eye movement (NREM) and rapid eye movement (REM). - During NREM, a sleeper progresses through 4 stages during a typical 90-minute sleep cycle. The quality of sleep from stage 1 through stage 4 become increasingly deep. Lighter sleep is characteristic of stage 1 and 2, during which a person is more easily aroused. Stage 3 and 4 involve a deeper sleep called slow-wave sleep -REM sleep is the phase at the end of each sleep cycle. DIfferent factors promote and interview with different stages of the sleep cycle

1. Discuss Common Alterations in Sleep and Rest Nursing interventions designed to promote sleep cycles Implementation: (POWERPOINT) Health promotion: --Environmental controls --Promoting bedtime routines --Promoting safety --Promoting comfort --Establishing periods of rest and sleep --Stress reduction --Bedtime snacks --Pharmacological approaches --Environment controls --Nursing interventions designed to improve the quality of a person's rest and sleep are largely focused on health promotion. Patients need adequate sleep and rest to maintain active and productive lifestyles. During times of illness, rest and sleep promotion are important for recovery. --In community health and home settings, help patients develop behaviors conducive to rest and relaxation. --Patients benefit most from instructions based on information about their homes and lifestyles such as which types of activities promote sleep in a nightshift worker, or how to make the home environment more conducive to sleep. They will likely apply information that is useful and valued. --All patients require a sleeping environment with a comfortable room temperature and proper ventilation, minimal sources of noise, a comfortable bed, and proper lighting. Eliminate distracting noise so the bedroom is as quiet as possible. In the home the television, telephone, or the intermittent chiming of a clock often disrupts a patient's sleep. Patients vary in regard to the amount of light that they prefer at night. Acute care -Environmental controls -Promoting comfort -Establishing periods of rest and sleep -Promoting safety -Stress reduction -Restorative or continuing care -Controlling physiological disturbances -Pharmacological approaches --In a hospital, the nurse controls the environment in several ways. --When planning interventions to promote sleep, consider the usual characteristics of the patient's home environment and normal lifestyle. --Patients in acute care settings have their normal rest and sleep routine disrupted, which generally leads to sleep problems. In this setting, nursing interventions focus on controlling factors in the environment that disrupt sleep, relieving physiological or psychological disruptions to sleep, and providing for uninterrupted rest and sleep periods for the patient. --When the patient's condition demands more frequent monitoring, plan activities to allow extended rest periods. --Patients with OSA are at risk for complications while in the hospital. Surgery and anesthesia disrupt normal sleep patterns. After surgery, patients reach deep levels of REM sleep. This deep sleep causes muscle relaxation that leads to OSA. Patients with OSA who are given opioid analgesics after surgery have an increased risk of developing airway obstruction because the medications suppress normal arousal mechanisms. Recommend lifestyle changes to patients with OSA that include sleep hygiene, alcohol moderation, smoking cessation, and a weight-loss program. --One of the most effective therapies is use of a nasal continuous positive airway pressure (CPAP) device at night, which requires a patient to wear a mask over the nose. A mask delivers room air at a high pressure. --Patients who are hospitalized for extensive diagnostic testing often have difficulty resting or sleeping because of uncertainty about the state of their health. Giving patients control over their health care minimizes uncertainty and anxiety. --Providing for personal hygiene improves a patient's sense of comfort. --As a nurse you will learn to control symptoms of physical illness that disrupt sleep. --The liberal use of drugs to manage insomnia is quite common in American culture. --Medications that induce sleep are called hypnotics. Sedatives are medications that produce a calming or soothing effect. Benzodiazepines and benzodiazepine-like drugs are common classifications of drugs used to treat sleep problems. Regular use of any sleep medication often leads to tolerance and withdrawal. --Bedtime routines relax patients in preparation for sleep. It is always important for persons to go to sleep when they feel fatigued or sleepy. --A bedtime routine (e.g., same hour for bedtime, snack, or quiet activity) used consistently helps young children avoid delaying sleep. --Adults need to avoid excessive mental stimulation just before bedtime. --For any patient prone to confusion or falls, safety is critical: Night light, Beds set lower to the floor, Remove clutter --Sleepwalkers are unaware of their surroundings and are slow to react, increasing the risk of falls. Do not startle sleepwalkers but instead gently awaken them and lead them back to bed. --Infants' beds need to be safe. To reduce the chance of suffocation, do not place pillows, stuffed toys, or the ends of loose blankets in cribs. Loose-fitting plastic mattress covers are dangerous because infants pull them over their faces and suffocate. Parents need to place an infant on his or her back to prevent suffocation --People fall asleep only after feeling comfortable and relaxed. --In the home, it helps to encourage patients to stay physically active during the day so they are more likely to sleep at night. Increasing daytime activity lessens problems with falling asleep. --The inability to sleep because of emotional stress also makes a person feel irritable and tense. When patients are emotionally upset, encourage them to try not to force sleep. Otherwise insomnia frequently develops, and soon bedtime is associated with the inability to relax. Preschoolers have bedtime fears (fear of the dark or strange noises), awaken during the night, or have nightmares. --Cultural tradition causes families to approach sleep practices differently. --Some people enjoy bedtime snacks, whereas others cannot sleep after eating. A dairy product such as warm milk or cocoa that contains L-tryptophan is often helpful in promoting sleep. A full meal before bedtime often causes gastrointestinal upset and interferes with the ability to fall asleep. --Warn patients against drinking or eating foods with caffeine before bedtime. --Melatonin is a neurohormone produced in the brain that helps control circadian rhythms and promote sleep. It is a popular nutritional supplement that is found to be helpful in improving sleep efficiency and decreasing nighttime awakenings. The recommended dose is 0.3 to 1 mg taken 2 hours before bedtime. --Several other herbal products assist in sleep. Valerian is effective in mild insomnia and RLS. It effects the release of neurotransmitters and produces very mild sedation. Kava helps promote sleep in patients with anxiety. It should be used cautiously because of its potential toxic effects on the liver. Chamomile, an herbal tea, has a mild sedative effect that may be beneficial in promoting sleep. --The use of nonprescription sleeping medications is not advisable. Patients need to learn the risks of such drugs. Over the long term these drugs lead to further sleep disruption, even when they initially seemed effective.

Environmental controls: - all patients require a sleeping environment with comfortable room temperature and proper ventilation, minimal sources of noise, a comfortable bed, and proper lighting -instruct parents to place the infant on a firm mattress that is covered with a fitted sheet and clothe baby is a sleeper for warmth and to not place anything in infants crib and positon crib away from the window -eliminate distracting noise so the bedroom is as quiet as possible -some patients sleep better with familiar inside noise such as a light fan blowing -a bed or mattress need to provide support and comfortable firmness. Bed boards places under mattress add support. Extra pillows can be important to help the patient position comfortably in bed. The position of the bed in the room also makes a difference in some patients -infants and older adults sleep best in softly lit rooms Promoting Bedtime routines: -bedtime routines help relax patients in preparation for bed -For newborns and infants, holding them snuggly in a blanket, singing/talking, and gentle rocking help them fall asleep -a bedtime routine used consistently helps young children avoid delaying sleep and parents need to reinforce patterns of preparing for bedtime -adults need to avoid excessive mental stimulation before bedtime. Reading a novel, watch Tv, listening to music can help a person relax -relaxation exercises like slow deep breathing for 1-2 mins relieve tension and prepare the body for rest. Guided imagery and praying also promote sleep -discourage patients from trying to finish office work or family problems right before bedtime Promoting safety: - small night lights help patient orient to the room environment before going to the bathroom. -beds set lower to the floor lessen the chance of a person falling when first standing -place bell on the bed if someone needs help going to the bathroom -make sure room is clear of objects before going to bed -do not startle sleepwalkers, gently wake them up and lead them back to bed Promoting comfort: -soft cotton nightclothes keep the infant or small children warm and comfortable -instruct patients to wear loose fittin clothes to bed. an extra blanket is sometimes needed from keeping a person from feeling chilled -patients need to void before going to bed Establishing periods of rest and sleep: - encourage patients to stay physically active during the day so they are more likely to sleep at night. Increasing daytime activity lessens problems with falling asleep Stress reduction: -when patients are emotionally upset, encourage them to try to not force sleep. Otherwise, insomnia frequently develops and soon bedtime is associated with the inability to relax -encourage a patient who has difficulty falling asleep to get up and pursue a relaxing activity instead of staying in bed and thinking about sleep -with nightmares, comfort children and leave them in their own beds so their fears are not used as excuses to delay bedtime. Keeping a light in the room can also help Pharmacological approaches: -Valerin is effective in mind insomnia and RLS -Kava helps promote sleep in patients with anxiety -Chamomile (herbal tea) has a mind sedative effects that may be beneficial in promoting sleep

Stereognosis=allows a person to recognize/sense the objects size/shape/texture. --Kinesthesia=allows person to know/sense body parts position/movement without seeing them. --Speaking is not a sense, but it is similar because some patients lose ability to interact with others if speaking is compromised.

-Sensory reception involves sensory nerve fiber stimulation and impulse transmission to higher centers in the brain. -Normal sensation: 1. Reception: receptor stimulation (light, touch, or sound) 2. Perception: integration and interpretation of stimuli 3. Reaction: only the most important stimuli will elicit a reaction --The nervous system is continually bombarded with thousands of bits of information for the sensory organs. After interpreting the significance of stimuli, the person will react to the most meaningful ones. --The balance between sensory stimuli entering the brain and those actually reaching a person's conscious awareness maintains a person's well-being.

1. Discuss Common Alterations in Sleep and Rest Characteristics of common sleep disorders

Sleep Disorders: (POWERPOINT) 1. Insomnia= Adjustment sleep disorder (acute insomnia), Inadequate sleep hygiene, Behavioral insomnia of childhood, Insomnia caused by medical condition 2. Sleep apnea=Primary central sleep apnea, central sleep apnea caused by medical condition, obstructive sleep apnea syndromes, excessive daytime sleepiness 3. Narcolepsy=Cataplexy, Sleep paralysis -Sleep deprivation=Emotional stress, Medications, Environmental disturbances, Symptoms 4. Parasomnias=Somnambulism (sleepwalking), Night terrors, Nightmares, Nocturnal enuresis (bed-wetting), Body rocking, Bruxism --Insomnia, the most common sleep disorder, is a symptom patients experience when they chronically have difficulty falling asleep. --Insomnia=have chronic difficulty falling asleep, frequent awakenings from sleep, and short sleep or nonrestorative sleep, often associated with poor sleep hygiene or practices a patient associates with sleep. It often signals underlying physical and psychological disorder --People with insomnia experience EDS and insufficient sleep quantity and quality --Transient insomnia=caused by situational stresses --Chronic insomnia s/s= sleepy, fatigued, depressed, and anxious --Insomnia Treatent= improved sleep hygiene measures, biofeedback, cognitive techniques, and relaxation techniques --Sleep apnea is a disorder characterized by lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. Three types of sleep apnea are known: central, obstructive, and mixed. The most common form is obstructive. --Obstructive sleep apnea (OSA) ---The two major risk factors for OSA are obesity and hypertension. ---OSA occurs when muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing nasal airflow (hypopnea) or stopping it (apnea) for as long as 30 seconds. ---Excessive daytime sleepiness is the most common complaint. people with severe OSA often report daytime naps and experience a disruption in their daily activities ---Feelings of sleepiness are usually most intense on awakening, right before going to sleep, and about 12 hours after the midsleep period. ---OSA Causes a serious decline in arterial oxygen saturation level and patients are at risk for cardiac dysrhythmias, right-sided HF, pulmonary hypertension, angina attacks, stroke, and hypertension --Central sleep apnea (CSA) involves dysfunction in the respiratory control center of the brain. The impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease. This is common in patients with brainstem injury, muscular dystrophy, and encephalitis --The oxygen saturation of the blood falls. The condition is common in patients with brainstem injury, muscular dystrophy, and encephalitis. Less than 10% of sleep apnea is predominantly central in origin. --People with CSA tend to awaken during sleep and therefore complain of insomnia and excessive daytime sleepiness (EDS). Mild and intermittent snoring is also present. --Treatment includes therapy for underlying cardiac or respiratory complications and emotional problems that occur as a result of the symptoms of this disorder. --Narcolepsy is a dysfunction of mechanisms that regulate the sleep and waking states. --During the day a person suddenly feels an overwhelming wave of sleepiness and falls asleep; REM sleep occurs within 15 minutes of falling asleep. Cataplexy, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day. --Sleep paralysis is another symptom= -they will fall asleep uncontrollably at inappropriate times and symptoms appear in adolescents and can be mistaken as EDS that commonly occurs in teens --Sleep deprivation is a problem many patients experience as a result of dyssomnia. Causes include fever, difficulty breathing, pain, emotional stress, medications, and disturbances in the health care setting. --Owing to long work schedules and rotations, health care providers are prone to sleep deprivation. Hospitalization makes patients prone to sleep deprivation caused by environmental noises and interruptions for care. --Parasomnias are sleep problems that are more common in children. These include sleepwalking, night terrors, nightmares, bed-wetting, body rocking, and tooth grinding. When adults adults have these problems, it often indicates more serious disorders. Sleep and Rest: (POWERPOINT) -Rest contributes to: Mental relaxation, Freedom from anxiety, State of mental, physical, and spiritual activity -Bed rest does not guarantee that a patient will feel rested. --Rest does not imply inactivity. When rested, people experience feelings of rejuvenation, feeling refreshed, and able to carry out of activities of daily living. --Illness and unfamiliar health care routines affect the usual rest and sleep patterns of hospitalized patients. It will be important to allow patients periods of rest. --Nurses frequently care for patients who are on bed rest to reduce physical and psychological demands on the body in a variety of health care settings. However, these people do not necessarily feel rested. Some still have emotional worries that prevent complete relaxation. --You must always be aware of a patient's need for rest. Lack of rest for long periods causes illness or worsening of existing illness.

1. discuss End-of-Life Care Grieving: -characteristics -influencing variables -nurses role

signs and symptoms of typical grief (POWERPOINT) 1. Emotional expressions=sadness, numbness, helplessness, loneliness, anxiety, depression, fear, guilt, denial, ambivalence, anger, exhaustion 2. Behavioral expressions= crying, insomnia, difficulty with ADLs, disorganization, preoccupation w lost, person/object 3. Physical signs=N&V, anorexia, weight loss/gain, constipation, diarrhea, diminished hearing/sight, chest pain, SOB, tachycardia Complications of Grief: (POWERPOINT) 1. Chronic Grief is when: S&S of grief continue beyond the expected time frame, severity of symptoms is greater, and clinical depression may occur 2. Delayed Grief=no or suppressed expression of grief and is delayed reaction of grief Types of grief= normal, anticipatory, disenfranchised, and complicated grief Grieving: factors influencing grief expression: (powerpoint) 1. Human development= patient age and stage of development affect the grief response 2. Personal relationships= when loss involves another person, the quality and meaning of the lost relationship influence the grief response 3. Nature of the loss= exploring the nature of a loss will help you understand the effect of the loss on the patient behavior, health, and well-being 4. Coping strategies=the losses that patients face from the time they were children formulate the coping skills they will use when faced with larger and more painful losses in adulthood. These coping strategies: talking, journaling, sharing their emotions with others may be healthy and effective 5. Socioeconomic status=infleunces a persons greif in direct and indirect ways. (limited finance, limited resources) 6. culture=during times of loss and grief patients and families draw on the social and spiritual practices of their culture to find comfort, expressions, and meaning in the experience. The nurse needs to understand and appreciate each patient cultural values related to death, loss, and grieving. Culture extends beyond the geographic location of a person. Consider the influence of sexual orientation, socioeconomic status, and family makeup when assessing the cultural influence on grief practices and death rituals 7. spiritual and religious beleifs=like culture influences, spirituality and or religious practices and beliefs provide a framework to navigate, understand, and heal from loss, death, and grief. Patients faith may influence the way they respond to illness, treatment, advanced life support options, autopsy, organ donation, and what happens to the body and spirit after death. They draw on spiritual beliefs to provide comfort and seek understanding at times of loss. You must remain open to the varying views and beliefs that are in contrast to your own to best support and care for your patients. Hope=considered to be a component of spirituality that energizes and provides comfort to individuals experiencing personal challenges.

2. Discuss Common Sensory Alterations Sensory overload & interventions

-excessive sensory stimulation prevents the brain from responding appropriately/ignoring certain stimuli. A person no longer perceives the environment in a way that makes sense. Overload prevents meaningful response by the brain; the patients' thoughts race, attention scatters in many directions, anxiety and restlessness occur. -Overload is individualized compared to sensory deprivation Interventions: -Vision=suggest the use of yellow lenses or shades on windows to minimize glare and to wear sunglasses. To enhance vision, use warm incandescent lighting and colors with sharp contrast and intensity -hearing= amplify the sound of telephone and TV. Instill softening agent like hydrogen peroxide to remove build-up of cerumen -Taste and smell= good oral hygiene keeps the taste buds well hydrated. Well-seasoned, differently textured food eaten separately heightens taste perception. Improve smell by strengthening pleasant olfactory stimulation (cologne, mild room deodorizers, fragrant flowers, and sachets) -Touch= providing touch therapy stimulates existing function. if a person is oversensitive to tactile stimuli then keep the bed linens loose to minimize direct contact with the patient and to protect the skin from the exposure to irritants are helpful measures

2. Discuss Common Sensory Alterations Sensory deprivation & interventions

-sufficient quality and quantity of sensory stimulation is needed to maintain a persons awareness. three types of sensory deprivation 1. reduced sensory input (sensory deficits from visual or hearing loss) 2. the elimination of inputs patterns/meaning (exposure to strange environments) 3. restrictive environments (bed rest) effects of sensory deprivation: 1. Cognitive=reduced capacity to learn, inability to think or problem solve, poor task performance, bizarre thinking, increased need for socialization, altered mechanisms of attention 2. Affective= boredom, restlessness, increased anxiety, emotional lability, panic, increased need for physical stimulation 3. Perceptual= changes in visual/motor coordination, reduced color perception, less tactile accuracy, changes in ability to perceive size and shape, and cahnges in spatial and time judgment

1. identify education needs of clients Domains of learning

1. Cognitive Learning= requires thinking and encompasses the acquisition of knowledge and intellectual skills. 6 cognitive behaviors= applying, analyzing, creating,evaluating, understanding, remembering 2. Affective Learning=deals with an expression of feelings and the development of attitudes, beliefs, and values. It includes: Receiving, responding, valuing (Learning what matters), organizing, characterizing 3. Psychomotor Learning= acquiring motor skills that require coordination and the integration of mental/physical movements. It takes practice and includes: adaption, complex overt response, guided response, set, mechanism, origination, perception

Spirituality quiz (week 13) 1. A devout Christian client is states she is angry with God. This is a sign of which of the following? 2. Even though a client suffered a stroke with left sided paralysis the client is upbeat and and eager to learn how to bathe and dress. This is a sign of which of the following? 3. An atheist client was diagnosed with terminal cancer and is withdrawn and angry. He says he doesn't know why was even born. A nurse can consult with which of the following to support the client? 4. What is included in a FICA assessment? 5. A Muslim client on bed rest wants to pray and asks for the bed to be turned toward the East. What is the best course of action the nurse can take?

1. Spiritual distress 2. Spiritual well being 3. chaplain 4. Faith, Importance, Community, Address 5. Move the client to a room with where the bed typically faces East

3. Identify Complementary and Alternative Therapies

Complementary and Alternative Therapies:(POWERPOINT) --Allopathic or traditional Western medication has successfully been used to treat many common conditions. However, many patients are exploring alternative methods. --Despite the success of allopathic medicine, many conditions (chronic back/neck pain, arthritis, GI problems, allergies, headache, anxiety) are sometimes difficult to treat. --75% of patients seek care from their primary care practitioners for stress, pain, and health conditions for which no causes or cures are known. --Allopathic medicine is less effective in preventing disease, decreasing stress-induced illnesses, managing chronic disease, and addressing the emotional and spiritual needs of individuals, and improving quality of life and general well-being. Complementary/Alternative/Integrative Approaches to Health: (POWERPOINT) -CAM= multiple health care approaches with a history of use/origins outside of mainstream medicine -Complementary= therapies used in addition to conventional treatment (aka integrative therapies) -Alternative= therapies that replace allopathic medical care -Whole medical systems= based on different philosophies and life systems --Complementary therapies complement conventional treatments. Many of them, such as therapeutic touch, contain diagnostic and therapeutic methods that require special training. Others, such as guided imagery and breathwork, are easily learned and applied. Others include relaxation; exercise; massage; reflexology; prayer; biofeedback; hypnotherapy; creative therapies, including art, music, or dance therapy; meditation; chiropractic therapy; and herbs/supplements. --Because of the increased interest in complementary therapies, many health care programs, including medical and nursing schools, have integrated conventional "biomedical" education with programs that incorporate complementary and alternative therapy content. --Alternative therapies may include the same interventions as complementary therapies, but they become the primary treatment, replacing allopathic medical care. --Alternative therapies are based on completely different philosophies and life systems than those used by allopathic medicine. The National Institutes of Health (NIH)/National Center for Complementary and Alternative Medicine (NCCAM) calls them whole medical systems such as traditional Chinese medicine (TCM), Ayurveda, and various forms of traditional or folk medicine. --Integrative health care emphasizes the importance of the relationship between practitioner and patient; focuses on the whole person; is informed by evidence; and makes use of appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health Complementary, Alternative, and Integrative Approaches to Health (Cont.): (POWERPOINT) -Holistic nursing= treats the mind-body-spirit of the patient -Use holistic nursing interventions: relaxation/music/touch therapy and guided imagery -The American Holistic Nurses Association maintains Standards of Holistic Nursing Practice Complementary, Alternative, and Integrative Approaches to Health (Cont.): (POWERPOINT) Integrative nursing: -Advances health and well-being through caring-healing relationships -Uses evidence to inform traditional and emerging interventions that support whole-person/whole-systems healing -Weigh risks/benefits of each intervention when recommending complementary therapies --Grounded in six principles, integrative nursing is defined as "a way of being-knowing-doing that advances the health and well-being of persons, families, and communities through caring-healing relationships. --Although the body of evidence about CAM is growing, limited data make it difficult to establish the specific benefits of complementary therapies. --Weigh the risk and benefits of each intervention and consider the following when recommending complementary therapies: (1) the history of each therapy (many have been used by cultures for thousands of years to support health and reduce suffering); (2) nursing's history and experience with a particular therapy; (3) outcomes and safety data, including case study and qualitative research; and (4) the cultural influences and context for certain patient populations

1. identify education needs of clients Teaching and learning

II. Teaching starts with Assessment A. Client 1. Age a. Vocabulary ability (0 to 11 - limited vocabulary and 12 to 18 - expanding vocabulary b. Cognitive potential (Infant, Toddler , School age=concrete thinkers and many adults are concrete thinkers) 4) Teenager & adults (abstract thinkers) c. Education level=Most have 8th to 12th grade and College (don't assume they know health care just because of they have a college degree, even a PhD) c. Profession=Clue to knowledge base and Clue to skill abilities d. Literacy=Reading level =Most adults assume 4th to 5th grade and Health care literacy=Ability to understand health care literature 2. Physical health a. Neurologically intact? Ability to learn or Learning deficits b. Has energy to learn? c. Fatigues easily? d. Ability to perform skills: Amputations, Paralysis, Paresthesia, Hypoesthesia, Range of Motion, Immobilization=Splints, Casts, Enforced 3. Psychological health a. Open to learning b. Change of affect=Depression, Anxiety, Fear 4. Emotional health a. Open to learning b. Distraught c. Flat 5. Family/household members/care givers B. Client Needs 1. Current knowledge=Preexisting condition (like diabetes)/New condition (like diabetes) 2. Demands of current condition a. Knowledge base needs:Example diabetes=Need to know What diabetes is, Complications of diabetes, What to do if complications set in, Medications b. Skills needs:Example diabetes=Glucometer, Insulin injections,Medication administration c. Affective needs=Potential emotional impact of diabetes/Diabetic support groups 3. Resource needs & availability a. Home 1) Are there steps (in some cases where mobility is an issue)? 2) How many bathrooms? Is a dedicated bathroom available (in cases like C Diff)? 3) Is a kitchen available? b. Pharmacies and medical supply stores nearby home c. Transportation (for appointments) d. Income 4. Referrals & consults=Refer client or obtain consults to help client for discharge 1) Physical needs 2) Psychological needs 3) Emotional needs 4) Resource needs 5. Readiness to learn=Client is open to learning/ Client needs other needs met before education 1) Example diabetes=Client may be overwhelmed by the diagnosis and needs someone to talk about life with diabetes prior to teaching III. Conclusion A. Client is ready to learn 1. Potential diagnoses=Readiness for enhanced knowledge, Readiness for enhance self-care B. Client needs more care prior to learning=Emotional needs, Physical needs, Psychological needs IV. Planning A. Goals & objectives 1. Prioritize the learning needs 2. Develop objectives 3. Determine timeframe to achieve goals B. Pick topics V. Implementation A. Teaching plan 1. Topic outlines 2.Method of teaching=Lecture, Discussion, Demonstration, Video, Pamphlet, Etc. 3.Timeframe for each topic=How many sessions and How much time per topic 4. Place=Hospital room, Conference room, Etc. -Is privacy important? VI. Evaluation A.Type of evaluation 1.Quiz 2. Game (fill-in-the-blank, crossword puzzle, etc. 3. Discussion 4.Return demonstration B.Timing of evaluation= Pick the time for the evaluation(s) C.Evaluator= Who will do the evaluation

2. Discuss Common Sensory Alterations Factors influencing sensory function

Nursing Knowledge Base:Factors Affecting Sensory Function: (POWERPOINT) -Age=Various changes occur across the life span -Amount of stimuli =Can cause sensory overload -Environmental factors=Occupation, recreation, and sports activities -Meaningful stimuli=Reduce the incidence of sensory deprivation -Social interaction=Increases with lack of socialization with family -Culture=Sensory alterations occur more often in select groups cultural groups --Infants and children are at risk for visual and hearing impairment because of a number of genetic, prenatal, and postnatal conditions. --Visual changes occur during adulthood that result in the need for glasses (40 to 50 years old). Glaucoma, reduced visual fields, increased glare sensitivity, impaired night vision, reduced depth perception, and color discrimination can occur. --Aging results in a gradual decline of acuity in all senses. Patients who are older, immobilized, or confined in isolated environments are at risk for sensory alterations. --Hearing loss usually begins around 30 years of age. --Gustatory and olfactory changes begin around age 50 (decrease in the number of taste buds and sensory cells in the nasal lining) --Proprioceptive changes common after age 60 include increased difficulty with balance, spatial orientation, and coordination. --Meaningful stimuli include those activities and people who have a positive influence on the patient, such as pets, music, TV, movies, family, clock, and calendar. --A disruptive roommate or too many visitors or too much light or noise in the room can negatively affect the patient. --Excessive stimuli in an environment causes sensory overload. The frequency of observations and procedures performed in an acute health care setting are often stressful. If a patient is in pain or restricted by a cast or traction, overstimulation frequently is a problem. --The amount and quality of social contact with supportive family members and significant others influence sensory function. The absence of visitors during hospitalization or residency in an extended care facility influences the degree of isolation a patient feels. The ability to discuss concerns with loved ones is an important coping mechanism for most people. Therefore the absence of meaningful conversation results in feelings of isolation, loneliness, anxiety, and depression for a patient. --Occupations and recreational or sports activities can have effects on sight, hearing, and body parts. --A hospitalized patient is sometimes at risk for sensory alterations as a result of exposure to environmental stimuli or a change in sensory input. Patients who are immobilized by bed rest or who have a chronic disability are unable to experience all of the normal sensations of free movement. --Certain sensory alterations occur more commonly in select ethnic groups. --Cultural factors= non-hispanic whites had more prevalence of macular degeneration than non-hispanic African Americans but a lower prevalence of diabetic retinopathy and glaucoma

3. Identify Complementary and Alternative Therapies

Nursing-accessible therapies 1. Relaxation Therapy (POWERPOINT): -Involves arousal reduction -Progressive/passive relaxation -Limitations --Some CAM therapies are general in nature and use natural processes to help patients with acute or chronic conditions. They are easily learned by health care professionals. --The relaxation response is the state of generalized decreased cognitive, physiological, and/or behavioral arousal. --The process of relaxation elongates the muscle fibers, reduces the neural impulses sent to the brain, and decreases the activity of the brain, as well as other body systems. Decreased heart and respiratory rates, blood pressure, and oxygen consumption and increased alpha brain activity and peripheral skin temperature characterize the relaxation response. --Relaxation helps individuals develop cognitive skills to reduce the negative ways in which they respond to situations within their environment. Cognitive skills include the following: --Focusing (the ability to identify, differentiate, maintain attention on, and return attention to simple stimuli for an extended period). --Passivity (the ability to stop unnecessary goal-directed and analytic activity). --Receptivity (the ability to tolerate and accept experiences that are uncertain, unfamiliar, or paradoxical). --Progressive relaxation training teaches an individual how to effectively rest and reduce tension in the body. The person learns to detect subtle localized muscle tension sequentially, one muscle group at a time. --One active progressive relaxation technique involves the use of slow, deep abdominal breathing while tightening and relaxing an ordered succession of muscle groups, focusing on the associated bodily sensations while letting go of extraneous thoughts. --The goal of passive relaxation is to still the mind and body intentionally without the need to tighten and relax any particular body part. --One effective passive relaxation technique incorporates slow, abdominal breathing exercises while imagining warmth and relaxation flowing through specific body parts such as the lungs or hands. Passive relaxation is useful for persons for whom the effort and energy expenditure of active muscle contracting leads to discomfort or exhaustion. --Be aware that on occasion some relaxation techniques result in continued intensification of symptoms or the development of altogether new symptoms. --An important consideration when choosing a relaxation technique is the physiological and psychological status of the individual. Progressive relaxation requires energy and is not recommended for weak patients. 2. Meditation and Breathing (POWERPOINT): -Meditation=Any activity that limits stimulus input by directing attention to a single unchanging or repetitive stimulus, person becomes more aware of self -Clinical application= reduces RR/BP/HR/oxygen consumption and reduces anxiety -Limitations= May become hypertensive and enhance certain drugs effects --Meditation includes a wide range of practices that involve relaxing the body and stilling the mind. --Four components of meditation are (1) a quiet space, (2) a comfortable position, (3) a receptive attitude, and (4) a focus of attention. --Meditation differs from relaxation; the purpose of meditation is to become "mindful," increasing our ability to live freely and escape destructive patterns of negativity. --Most meditation techniques involve slow, relaxed, deep abdominal breathing that evokes a restful state, lowers oxygen consumption, reduces respiratory and heart rates, and reduces anxiety. --Meditation reduces overall systolic and diastolic blood pressures and significantly reduces hypertensive risk. It also successfully reduces relapses in alcohol treatment programs. Patients with cancer who use mindfulness-based cognitive therapies often experience less depression, anxiety, and distress, and report an improved quality of life. --Patients suffering from posttraumatic stress disorder and chronic pain also benefit from mindfulness meditation. Meditation increases productivity, improves mood, increases sense of identity, and lowers irritability. --Considerations for the appropriateness of meditation include the person's degree of self-discipline; meditation requires ongoing practice to achieve lasting results. Most meditation activities are easy to learn and do not require memorization or particular procedures. --Meditation is contraindicated for some people. A person who has a strong fear of losing control will possibly perceive it as a form of mind control and thus will be resistant to learning the technique. Some individuals become hypertensive during meditation and require a much shorter session than the average 15- to 20-minute session. --Meditation may enhance the effects of certain drugs. Therefore, monitor individuals learning meditation closely for physiological changes with respect to their medications. Prolonged practice of meditation techniques sometimes reduces the need for antihypertensive, thyroid-regulating, and psychotropic medications (e.g., antidepressants, antianxiety agents). In these cases, adjustment of the medication is necessary 3. Imagery (POWERPOINT): -A mind-body therapy that uses the conscious mind to create mental images to stimulate physical changes in the body, improve perceived well-being, and/or enhance self-awareness -Clinical applications= Pain control, Limitations, Relatively few side effects --Frequently imagery, combined with some form of relaxation training, facilitates the effect of the relaxation technique. Imagery may be self-directed, in which individuals create their mental images, or guided, during which a practitioner leads an individual through a particular scenario. --Imagery often evokes powerful psychophysiological responses such as alterations in gastric secretions, body chemistry, internal and superficial blood flow, wound healing, and heart rate/heart rate variability. Although most imagery techniques involve visual images, they also include the auditory, proprioceptive, gustatory, and olfactory senses. --Creative visualization is self-directed imagery based on the principle of mind-body connectivity. --Imagery helps control or relieve pain, decrease nightmares, and improve sleep. It also aids in the treatment of chronic conditions such as asthma, cancer, sickle cell anemia, migraines, autoimmune disorders, atrial fibrillation, functional urinary disorders, menstrual and premenstrual syndromes, gastrointestinal disorders such as irritable bowel syndrome and ulcerative colitis, and rheumatoid arthritis. --Imagery has relatively few side effects: Increased anxiety and fear sometimes occur when imagery is used to treat posttraumatic stress disorders and social anxiety disorders/ Some patients with chronic obstructive pulmonary disease (COPD) and asthma experience increased airway constriction when using guided imagery. Thus you need to closely monitor patients when beginning this therapy..

3. Identify Complementary and Alternative Therapies -Training-specific therapies

Training-Specific Therapies: (POWERPOINT) -Biofeedback -Acupuncture -Traditional Chinese medicine -Therapeutic touch -Chiropractic therapy -Natural products and herbal therapies --Training-specific therapies are CAM treatments that nurses (or other health care providers) administer only after completing a specific course of study and training. --These therapies require postgraduate certificates or degrees indicating completion of additional education and training, national certification, or additional licensure beyond the registered nurse (RN) to practice and administer them. --Several training-specific therapies (biofeedback, acupuncture) are very effective and often recommended by Western health care practitioners. -Others training-specific therapies (homeopathy, naturopathy) have not been adequately studied and their effectiveness has been questioned. --Many complementary therapies elicit positive effects, but all therapies carry some risk, particularly when used in conjunction with conventional medical therapies. Therefore you need advanced knowledge to effectively talk about therapies/educate safe use with patients 1. Biofeedback: (POWERPOINT) -A mind-body technique that uses instruments to teach self-regulation and voluntary self-control over specific physiological responses. -Instruments measure, process, and provide information about neuromuscular and autonomic nervous system activity. -Immediate feedback is provided in physical, physiological, auditory, and/or visual signals. --Electronic or electromechanical instruments give information to patients about their muscle tension, cardiac activity, respiratory rates, brain-wave patterns, and autonomic nervous system activity. --Feedback increases a person's awareness of internal processes that are linked to illness and distress. --Biofeedback therapies are used to change thinking, emotions, and behaviors, which in turn support beneficial physiological changes, resulting in improved health and well-being. --Biofeedback is an effective addition to more traditional relaxation programs because it immediately demonstrates to patients their ability to control some physiological responses and the relationships among thoughts, feelings, and physiological responses. --Biofeedback provides immediate feedback about which stress relaxation behaviors work most effectively. --Biofeedback is helpful in stroke recovery, smoking cessation, attention-deficit/hyperactivity disorder (ADHD), epilepsy, headache disorders, and a variety of gastrointestinal (GI) and urinary tract disorders. Patients who are compliant have more positive results. --Several precautions have been put forth, particularly for those with psychological or neurological conditions. --During biofeedback sessions, repressed emotions or feelings for which coping is difficult sometimes surface. --Thus practitioners need to be trained in more traditional psychological methods or have qualified professionals available for referral. --Long-term use of biofeedback sometimes lowers blood pressure, heart rate, and other physiological parameters. As with other biobehavioral interventions, monitor patients closely to determine the need for medication adjustments. 2. Acupuncture: (POWERPOINT) -Regulates or realigns vital energy (qi), which flows through channels in the form of a system of pathways called meridians -Effective for pain -Also used to treat other disorders with varying effectiveness --As a key component of TCM, acupuncture is one of the oldest practices in the world. --When applied outside the whole system practice of TCM, acupuncture is viewed as a mind-body therapy and is called medical acupuncture. In the United States, medical acupuncture is often provided as an individual treatment by conventionally trained health care providers. --Acupuncture regulates or realigns the vital energy (qi), which flows like a river through the body in channels that form a system of 20 pathways called meridians. An obstruction in these channels blocks energy flow in other parts of the body. Acupuncturists insert needles in specific areas along the channels called acupoints, through which the qi can be influenced and flow reestablished. Current evidence shows that acupuncture modifies the body's response to pain and how pain is processed by central neural pathways and cerebral function. --Acupuncture is effective for a variety of health problems, such as low back pain, myofascial pain, hot flashes, simple and migraine headaches, osteoarthritis, plantar heel pain, and chronic shoulder pain. --Acupuncture is a safe therapy when the practitioner has the appropriate training and uses sterilized needles. Although needle complications occur (e.g., infection, fainting), they are rare if the practitioner takes appropriate steps to ensure the safety of the equipment and the patient. In addition, you need to exercise caution when using acupuncture with pregnant patients and those who have a history of seizures, are carriers of hepatitis, or are immune compromised. Treatment is contraindicated in persons who have bleeding disorders and skin infections. 3. Traditional Chinese Medicine (POWERPOINT) -"Life in balance" -Health promotion -Yin and yang are opposing, complementary forces that exist in dynamic equilibrium -Methods for evaluation of patient's condition=Observing, Hearing/smelling, Asking/interviewing, Touching/palpating. -Therapeutic modalities --TCM is a whole system of medicine that began approximately 3600 years ago. Chinese medicine views health as "life in balance," which manifests as lustrous hair, a radiant complexion, engaged interactions, a body that functions without limitations, and emotional balance. --Health promotion encourages healthy diet, moderate regular exercise, regular meditation/introspection, healthy family and social relationships, and avoidance of environmental toxins such as cigarette smoke. --Yin represents shade, cold, and inhibition; whereas yang represents fire, light, and excitement. Yin also represents the inner part of the body, specifically the viscera, liver, heart, spleen, lung, and kidney; whereas yang represents the outer part, specifically the bowels, stomach, and bladder. Harmony and balance in every aspect of life are the keys to health, including yin-yang balance. Imbalance ultimately leads to disruption of vital energy, qi, which then compromises the body-mind-spirit of the person, causing "disease." Disruptions in qi along the meridians can be systematically evaluated and treated by TCM practitioners. --TCM practitioners use four methods to evaluate a patient's condition: observing, hearing/smelling, asking/interviewing, and touching/palpating. --Therapeutic modalities include acupuncture, Chinese herbs, tui na massage, moxibustion (burning moxa, a cone or stick of dried herbs that have healing properties on or near the skin) cupping (placing a heated cup on the skin to create a slight suction), tai chi (originally a martial art that is now viewed as a moving meditation in which patients move their bodies slowly, gently, and with awareness while breathing deeply), qi gong (originally a martial art, now viewed as a series of carefully choreographed movements or gestures that are designed to promote and manipulate the flow of qi within the body), lifestyle modifications, and dietary changes. --Evidence about its effectiveness is limited. Some evidence shows that TCM is helpful in treating fibromyalgia and in addressing symptoms associated with menopause. --There is some concern about the safety of Chinese herbal treatments that are used in teas, remedies, and supplements. Recent reports about these products suggest that many Chinese herbs are contaminated with drugs, toxins, or heavy metals or that many ingredients may not be clearly listed or labeled. Further, these herbs can be very powerful, interacting with drugs and causing serious complications. --When assessing a person using TCM, you need to ask your patient about the therapies he or she receives, including the types of herbs that the patient is using. Some patients consider these as teas or dietary additives, powders, or supplements and not as over-the-counter medications. 4. Therapeutic Touch: (POWERPOINT) -Affects energy fields with conscious intent to help or heal -Five phases: centering, assessing, unruffling, treating, and evaluating --Therapeutic touch (TT) is a natural human potential that consists of placing the practitioner's hands on or close to the body of a person. A nurse developed this therapy. The practitioner attempts to redirect energy to bring the person back into an energy balance similar to that of the practitioner. Phases: -Centering: To begin the practitioner centers physically and psychologically, becoming fully present in the moment and quieting outside distractions. -Assessing: Then the practitioner scans the body of the patient with the palms (roughly 2 to 6 inches [5 to 15 cm] from the body) from head to toe. -Unruffling: While assessing the energetic biofield of the patient, the practitioner focuses on the quality of the qi and areas of energy obstructions, redirecting the energy to harmonize and move. -Treating: Using long downward strokes over the energy fields of the body, the practitioner touches the body or maintains the hands in a position a few inches away from the body. -Evaluating: Ensuring that energy is flowing freely, and determining additional outcomes and responses to the treatment. -Evidence supporting the effectiveness of TT is inconclusive, although it may be effective in treating pain in adults and children, dementia, trauma, and anxiety during acute and chronic illnesses.

Sensory alterations Powerpoint!!!

--People learn about the environment from five experiences (Sight=visual, Hearing=auditory, Touch=tactile, Smell=olfactory, Taste=gustatory, Position and motion=kinesthetic) --Humans rely on a variety of sensory stimuli to give meaning and order to events occurring in their environment. --sensory function alterations change a person's ability to relate to/function within the environment --Nurse=meet needs of patients w/ existing sensory alterations and recognize patients most at risk for developing sensory problems. You also help patients who have partial/complete loss of senses by finding alternate ways to function safely within their environment.

1. identify education needs of clients Basic learning principles

Achievement of desired learning outcomes depend on motivation to learn, the ability to learn, and the contest and environment where learning will take place Motivation to learn: -Attentional set= the mental state that allows the learner to focus on and comprehend a learning activity -Motivation -Use of theory to enhance motivation and learning=learning theories focus on how individuals learn and can facilitate the teaching-learning process by creating the desired climate and guiding the selection of instructional strategies. Social Learning theory considers the personal characteristics f the learner, behavior patterns, and the environment and guides the educator in developing effective teaching interventions that result in improved motivation and enhanced learning -psychosocial adaption to illness= patients need to grieve because they cannot learn when they are unwilling or unable to accept the reality of illness -active participation= learning occurs when a patient is actively involved in education Ability to learn: -Developmental capacity=You need to know a patient's level of knowledge and intellectual skills before beginning a teaching plan. Learning occurs more readily when new information complements existing knowledge. -Learning in childern= intellectual growth moves from the concrete to the abstract as the child matures. Therefore, the information presented to children needs to be understandable, and the expected outcomes must be realistic based on the child's developmental stage -learning in adults= the amount of information you provide and the amount o time you spend with an adult patient varies, depending on the patients personal situation and readiness to learn. An adults readiness to learn is often associated with their developmental stage and other events that are occurring in their lives. -physical capacity= learning depends on patients physical development and overall physical health. To learn psychomotor skills, a patient needs to possess a certain level of strength, coordination, and sensory acuity. The following physical skills are necessary for psychomotor skills: size, strength, coordination, sensory acuity,

2. Discuss Common Sensory Alterations Sensory deficits Sensory Alterations: (POWERPOINT) -Sensory deficits=Deficit in the normal function of sensory reception/perception -Sensory deprivation=Inadequate stimulation quality/quantity -Sensory overload=Reception of multiple sensory stimuli and person cannot selectively ignore some stimuli. --When a patient suffers from more than one sensory alteration, the ability to function and relate effectively within the environment is seriously impaired. --When a person loses visual or hearing acuity, the person withdraws by avoiding communication or socialization with others in an attempt to cope with the sensory loss. It becomes difficult for the person to interact safely with the environment until the person learns new skills. When a deficit develops gradually, or when considerable time has passed since the onset of an acute sensory loss, a person learns to rely on unaffected senses. Some senses may even become more acute to compensate for an alteration.

Common sensory deficits= visual deficits, hearing deficits, balance deficit, taste deficit, and neurological deficit

3. utilize expressions of caring with clients experiencing loss and grief Caring and the nurse-patient relationship Presence and touch Listening to clients Knowing a patient and clinical decision making

Crisis management= an event that disrupts daily routines that sparks emotional and physical human responses (POWERPOINT) 1. establish rapport with the client: be eye to eye, use touch appropriately (culture, religion), sound confident, and use active listening 2. secure the client's safety and well being: make sure the client is eating, sleeping/resting, attending to hygiene and make sure the client is safe 3. provide social support: help client to mobilize social support network (family, friends, professionals) 4. RN= be present, stay or be immediately available, check frequently 5. use therapeutic communication: be eye to eye, use touch appropriately (culture, religion), sound confident and caring, use active listening, encourage expression/client to finish thoughts, give client time to talk, redirect and refocus, reassure client what they are feeling & thinking is normal 6. Help client define the problem: client will know the general problem, but not specifics, feed them bite sized pieces of information, just enough for now, don't overwhelm them with the "big" picture, some crises have no decisions others require decisions 7. Simplify problem solving: answer questions directly and as simply as possible, take lead from client (age, level of function, experience, religion, culture, etc), set realistic goals - give clear choices 8. Support the client's decision: reassure the client and have someone physically present with the client care of the care giver= express feelings with other staff/EAP, seek reassurance, rest, exercise, take time off grieving: health promotion (POWERPOINT) -The RN will be present and use therapeutic communication to support the client and be available for interventions. -The RN will encourage client to discuss the meaning of the loss to instill hope and faith. -The RN will assess for healthy progression of grief symptoms to identify need for further interventions. -The RN will assess for signs of ineffective coping (i.e. inability to carry out ADLs, signs of clinical depression, and lack of grief expression) to identify need for further interventions or referral to mental health services. -The RN will share resource information to help the client cope with the loss. -The RN will share with client typical grief behavior by teaching thoughts, feelings, and behaviors that can be expected to help client identify with what is "normal". -The RN will allow the client time for grieving because the rate and time of grieving varies from person to person. -The RN will provide sensitive and factual information concerning the loss to help the client accept the reality of the loss -The RN will help client mobilize support network (contact family and friends) to recruit help with expression of grief and help with day to day tasks. 1. Providing pressure=a person to person encounter conveying closeness and sense of caring. presence involves "being there" and "being with" -being there= physical presence, communicating, and understanding -being with=being available and at a patient disposal -Both results in improves mental well being on the nurse and patient and improved physical well being of the patient 2. Touch=the use of touch is one comforting approach that reaches out to the patient to communicate concern and support. There is contact touch and noncontact touch=eye contact. Caring touch influences a patients comfort and security, enhance self-esteem, increases confidence in caregivers, and improves mental well being 3. Listening to the meaning of hat a patient says helps create a mutual relationship. True listening leads to knowing and responding to what really matters to the patient and family 4. Knowing the patent=comprises both a nurses understanding of a specific patient and his or her subsequent selection of interventions. It is essential when proving patient-centered care. Knowing emerges from a caring relationship between a nurse and a patient, in which a nurse engages in a continuous assessment, striving. to understand and interpret a patient's needs across all dimensions. Two elements that facilitate knwoing=continuty of care and clinical expertise 5. Spiritual Caring=An individual archives spiritual health after finding a balance between their life values, goals, and beliefs and those of others -In a caring relationship, the patient and nurse come to know one another so both move toward a healing relationship by: 1. Mobilizing hope for the patient and the nurse 2. finding an interpretation of illness, symptoms, or emotions that is acceptable to the patient 3. assisting the patient in using social, emotional, and spiritual resources 4. recognizing that caring relationships connect us human to human, spirit to spirit 6. Relieving symptoms and suffering=The relief of symptoms and suffering encompasses caring nursing actions that give a patient comfort, dignity, respect, and peace, and provide necessary comfort and support measures to the family or significant others. Ensuring that the patient care environment is clean and pleasant makes the physical environment a place that soothes the mind, body, and spirit 7. Family care=as a nurse is is important to know the family almost as thoroughly as you know a patent. The family is a great resource. It is critical that the nurse ensures the patines well being and safety and helps the family members to be active participants. Showing a family that you care for and are concerned about the patient creates an openness that then enables a relationship to form with a family

1. discuss End-of-Life Care Grief theories

Grief theories describe physical, psychological, and social reactions to loss. The variety of theories supports the complexity and individuality of grief response Grieving Theories: (POWERPOINT) 1. Kubler-Ross 5 Stages of Grief= denial, anger, bargaining, depression, acceptance 2. Bowlby Attachment Theory 4 phases= 1. shock/numbing= protects the person from the full impact of the loss 2. yearning & protest/ searching= emotional outbursts, chest/throat tightness, SOB, lethargy, insomnia, and loss of appetite 3. disorganization/ despair= endless examination of how and why the loss occurred or expression of anger at anyone who seems responsible for the loss. 4. recovery/reorganization= acceps the change, assume unfamiliar roles, acquire new skills, builds new relationships, and begins to separate himself from the lost relationship without feeling that they are lessening the importance 3. Worden-Grief Task Model 4 tasks 1. accept the reality of loss 2. work through & experience the pain of grief 3. adjust to environment without the deceased, new roles 4. relocate relationship w deceased, emotional withdrawal Trajectories of bereavement: common grief, chronic grief, chronic depression, depression followed by improvement, and resilience

1. Discuss Common Alterations in Sleep and Rest Factors that influence sleep: drugs, physical illness

Factors Influencing Sleep (POWERPOINT) 1. Drugs and substances=Hypnotics, diuretics, narcotics, antidepressants, alcohol, caffeine, beta-blockers, anticonvulsants --sleepiness, insomnia, and fatigue often result as a direct effect of commonly prescribed medications which alter sleep and weaken daytime alertness 2. Lifestyle=Work schedule, social activities, routines 3. Usual sleep patterns=May be disrupted by social activity or work schedule 4. Emotional stress=personal problem worries, physical health, death, losses --Emotional stress causes a person to be tense and often leads to frustration when sleep does not occur. Stress also causes a person to try too hard to fall asleep, to awaken frequently during the sleep cycle, or to oversleep. Continued stress causes poor sleep habits. --Older patients frequently experience losses that lead to emotional stress such as retirement, physical impairment, or the death of a loved one. Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent or early awakening, feelings of sleeping poorly, and daytime sleepiness. 5. Environment=Noise, routines (Good ventilation is essential for restful sleep. The size, firmness, and position of the bed affect the quality of sleep. If a person usually sleeps with another individual, sleeping alone often causes wakefulness) -Physiological, psychological, and environmental factors inhibit sleep. 6. Exercise and fatigue=Moderate exercise and fatigue cause a restful sleep (2 hours of exercise before bedtime allows the body to cool down and maintain a state of fatigue resulting from exhausting r stressful work makes falling asleep difficult ) 7. Food and calorie intake=Time of day, caffeine/nicotine/ alcohol=produce insomnia (Eating a large/heavy/spicy meal at night often results in indigestion that interferes with sleep. Some food allergies cause insomnia. Weight gain contributes to OSA because of the increased size of the soft tissue structures in the upper airway and weight loss causes insomnia and decreased amounts of sleep.) --Following good eating habits is important for proper sleep.

Assessment: -Communication: Aphasia: (Expressive=motor, Receptive=sensory, or Global) --To interact with patient/promote interaction with others, understand the patient's method of communication. --Vision becomes almost a primary sense for people with hearing impairments. As a result face-to-face communication is essential. --Patients with visual impairments are unable to observe facial expressions/nonverbal behaviors to clarify the content of spoken communication. Instead, they rely on voice tones to detect the communications emotional tone. Some patients with visual deficits learn to read Braille. --Aphasia patients have varying degrees in inability to speak, interpret, or understand language. --Expressive aphasia (type of motor aphasia)= inability to name common objects or express simple ideas in words or writing. (EX= a patient understands a question but is unable to express an answer) --Sensory/receptive aphasia= inability to understand written or spoken language. A patient is able to express words but is unable to understand questions or comments of others. --Global aphasia=inability to understand language or communicate orally. --The temporary or permanent loss of the ability to speak is extremely traumatic to an individual. Assess for alternate communication methods and whether they cause anxiety. Patients who have undergone laryngectomies often write notes, use communication boards or laptop computers, speak with mechanical vibrators, or use esophageal speech. Patients with endotracheal or tracheostomy tubes have a temporary loss of speech. Most use a notepad to write their questions and requests. However, some patients become incapacitated and unable to write messages. Determine whether the patient has developed a sign-language system or symbols to communicate needs.

Nursing diagnoses that apply to patients with sensory alterations include: -Risk-prone health behavior -Impaired verbal communication -Risk for injury -Impaired physical mobility -Bathing self-care deficit -Situational low self-esteem -Risk for falls -Social isolation --After assessment review all available data and look critically for patterns and trends suggestive of sensory alterations health problem. --Validate findings to ensure accuracy of the diagnosis. Determine the factor that likely causes the patient's health problem. The etiology or related factor of a nursing diagnosis is a condition that nursing interventions can affect. The etiology needs to be accurate; otherwise nursing therapies are ineffective. Some patients have health care problems for which sensory alteration is the etiology, such as with the diagnosis of risk for injury. --You select nursing diagnoses by recognizing the way that sensory alterations affect a patient's ability to function. In addition, most patients present themselves to health care professionals with multiple diagnoses. Recognize patterns of data that reveal health problems created by the patient's sensory alteration.

3. utilize expressions of caring with clients experiencing loss and grief Facilitate spiritual health in nursing

Grieving, Loss, Spiritual: NANDA diagnoses (POWERPOINT) -Anticipatory grieving R/T poor prognosis of ____ -Complicated grieving R/T stress of death of ____ -Chronic sorrow R/T death of child/long-time partner/other -Ineffective coping R/T death of _____ -Sleep pattern disturbance R/T death of _____ -Self-care deficit R/T situational crisis of ____critical condition -Spiritual Distress R/T crisis of ____ -Readiness for Spiritual Enhancement R/T reconnection to ______ Grieving, Loss, Spiritual: Outcomes (POWERPOINT) -Expression of peace with life/situation -Expresses desire to connect with family/live -Expresses acceptance of health condition -Develops new life goals -Returns to work -Participates in health care interventions Spirituality is: (POWERPOINT) -searching for meaning of life/beyond one's self -awareness of one's inner self -sense of connectedness to a higher power, being -Transcendence= connectedness to a higher power -Self-transcendence=connectedness to self -Connectedness=being connected to inner self, others, and higher power -Hope= an energizing source oriented toward future goals - something to live for Spiritual wellbeing: (POWERPOINT) 2 dimensions: connectedness to higher power and connectedness to others 1. highly individual and personal 2. encourage the client to talk about what the loss means to them 3. support client in their expression of spirituality= visitation by minister, clergy, & counselor, reading material including Holy & Revered texts, religious expressions and rituals, offer presence as a way to convey caring and human warmth Near Death Experiences=Do not contradict client and family (POWERPOINT) Spiritual Health concepts: spirituality, spiritual well being, religion, faith, and hope Spiritual distress can occur from acute illness, chronic illness, or terminal illness Spiritual care needs to be a central theme in promoting individuals overall well being because of its importance in health promotion - remain aware of a patients spiritual resources and needs. it is always important for patients to be able to express and exercise in their beliefs for spiritual comfort. -Nurses provide spiritual care by supporting patients participation in spiritual rituals and activities. Plan care to allow time for religious readings, spiritual visitations, or attendance at religious services. Allow family members to plan a prayer session. Make arrangements with spirtual care professionals for the patient and family to participate in religious practices. Clergy often visits people who are unable to attend religious services. Taped mediations, classical, or religious music, and televised religious services provide other effective options. Always respect the icons, medals, prayer rugs, or crosses that a patient brings to a health setting and ensure that they are not accidentally lost, damaged, or misplaced. Use prayer, meditation, and support grief work

Implementation: -Patients can learn to adjust to sensory impairments at any age with the proper support and resources. -Health promotion= Screening, Preventive measures, Use assistive devices, Promote meaningful stimuli, Establish safe environments, Communication --The most effective interventions enable a patient with sensory alterations to function safely with existing deficits and continue a normal lifestyle. --Good sensory function begins with prevention. When a patient seeks health care, provide education about interventions that reduce the risk for sensory losses. --Preventable blindness is a worldwide health issue that begins with children and requires appropriate screening. --Most common visual problem=refractive error (nearsightedness). The nurse's role=detection, education, and referral. --Aging causes degenerative ear changes. Patients need to have hearing screenings at least every decade to age 50 and every 3 years after that. --Children/adults are vulnerable to eye injuries. Parents and children require counseling on ways to prevent eye trauma. --Corrective contact lenses, eyeglasses, or hearing aids=need be clean, accessible, and functional. --Older adults are often reluctant to use hearing aids. Acknowledging a need to improve hearing is a person's first step. Give patients useful information on the benefits of hearing aid use. --To promote meaningful stimuli= take in consideration the environment by improving lighting/hearing/ tactile/taste/smell sensations. If a patient is overly sensitive to tactile stimuli (hyperesthesia), minimize irritating stimuli. --In creating a safe environment, adaptations are needed for patients with reduced vision/hearing/olfaction/tactile sensation. --Speaking allows patients to interact with others. Speech sensory alterations/inability to communicate causes loneliness and decreased self-esteem. --Patients with sensory deficits often develop alternate ways of communicating that rely on other senses. (Ex=patients with artificial airways= communicate effectively with boards, laptops, and written messages.)

Implementation: Acute Care (POWERPOINT) -Orientation to the environment -Communication -Sensory stimuli control -Safety measures --Patient with recent sensory impairment needs orientation to the immediate environment= keep all objects in the same position and place. --Most common language disorder following a stroke=aphasia. Initially, you need to establish very basic communication and recognize that it does not indicate intellectual impairment or personality degeneration. Stroke patients need special assistive devices to aid in communication. --Patients need time for rest and freedom from stress caused by frequent monitoring and repeated tests. Reduce sensory overload by organizing the patient's care plan. Combining activities (dressing, bathing, and vital signs) in one visit prevents the patient from becoming overly fatigued. Try to control extraneous noise in and around a patient's room. Often necessary to ask a roommate to lower TV volume or move patient to a quieter room. --It is wise to note on the intercom system at the nurse's station and in the medical record that the patient is deaf/blind. Patients with reduced tactile sensation risk injury when their conditions confine them to bed because they are unable to sense pressure on bony prominences or the need to change position. Restorative and continuing care (POWERPOINT) -Maintaining healthy lifestyles -Understanding sensory loss -Socialization -Promoting self-care --Many of the interventions applicable to health promotion, such as adapting the home environment, are useful after a patient leaves an acute care setting. --Patients who have experienced a recent sensory loss need to understand how to adapt so their living environments are safe and appropriately stimulating. --When sensory alterations hinder interactions, a person feels ineffective and loses self-esteem. --When we promote self-care, the patient's self-esteem will be bolstered. For example, patients with decreased vision can still feed themselves, if the nurse places food on the plate according to the face of a clock. Also, the use of warm incandescent lighting and shades will help to reduce glare. If the sense of touch is diminished, the patient can dress more easily with zippers or Velcro strips, pullover sweaters or blouses, and elasticized waists. For patients with balance and strength issues, safety bars in the bathroom can be helpful, as can placing nonskid surfaces on the floor.

1. Discuss Common Alterations in Sleep and Rest Sleep requirements of different age-groups Normal Sleep Requirements and Patterns: (POWERPOINT) -Neonates=16 hours a day -Infants=8 to 10 hours at night for a total of 15 hours per day -Toddlers=Total 12 hours a day -Preschoolers=12 hours a night -School Age=9 to 10 hours -Adolescents=Get ~7½ hours -Young Adults=Get 6 to 8½ hours -Middle and Older Adults=Total number of hours declines --Sleep duration and quality will differ across the life span.In adolescents, shortened sleep time often results in excessive daytime sleepiness, which frequently leads to reduced performance in school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol.Pregnancy increases the need for sleep and rest. However, a majority of pregnant women describe variations in sleep habits. Estrogen has been shown to decrease REM sleep.In middle age, the amount of stage 4 sleep begins to fall—a decline that continues with advancing age.Older adults experience weakening, desynchronized circadian rhythms that alter the sleep-wake cycle.Episodes of REM sleep tend to shorten. There is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep sleep.

Neonates= up to age 3 months gets 16 hours of sleep a day, the sleep cycle in generally 40-50 mins with wakening occurring one-two sleep cycles. 50% of sleep is in REM, which stimulates higher brain centers Infants=usually develop nighttime patterns of sleep by 3 months of age, normally takes several naps during the day but sleeps an average of 8-10 hours at night with a total of 15 hours slept. 30% of sleep is in REM and awakening is common in the early morning Toddlers=by age of 2, they usually sleep through the night and take daily naps. Total sleep=12 hours a day. After 3 years, children give up on daytime naps and its common for toddlers to awaken during the night Preschoolers=sleep about 12hours a night, by age 5, they rarely take daytime naps, partial awakening followed by the normal return of sleep is frequent. School-age children=6-year-olds get 11-12 hours and 11-year-olds get 9-10 hours. 6-7-year-olds usually go to bed with some encouragement or do quiet activities and the older child usually resists sleeping because they are unaware of fatigue or has a need to be independent Adolescents=majority of teens get about 7 hours or less a night Young adults=average 6-8.5 hours of sleep a night. 20% of sleep time is REM sleep, which remains consistent throughout life. Pregnancy increases the need for sleep and rest Middle adults=during middle adulthood the total time spent sleeping at night declines. The amount of stage 4 sleep begins to fall, a decline that continues with advancing age. Insomnia is particularly common Older adults=experience weakening desynchronized circadian rhythms that alter the sleep-wake cycle. Episodes of REM sleep tend to shorten. Stages 3 and 4 NREM sleep progressively decreases and some adults have almost no stage 4. The tendency to nap seems to increase progressively with age because of the frequent awakenings experienced at night

1. Discuss Common Alterations in Sleep and Rest Nursing diagnoses Assessment (POWERPOINT) -Through the patient's eye -Sleep assessment --Sources for sleep assessment = Patient, family --Tools for sleep assessment -Sleep history --Description of sleeping problems, usual sleep pattern, current life events, physical and psychological illness, emotional and mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation -Description of sleeping problems --Conduct a more detailed history when a patient has a sleep problem. This ensures that you provide appropriate therapeutic care. --Open-ended questions help a patient describe a problem more fully. --Ask specific questions related to the sleep problem. -Usual sleep pattern --Have patients describe their normal sleep patterns. -Physical and psychological illness -Current life events -Emotion and mental status -Bedtime routines -Bedtime environment -Behaviors of sleep deprivation --Determine whether the patient has any preexisting health problems that interfere with sleep. A history of psychiatric problems also makes a difference. If the patient has recently had surgery, expect him or her to experience some sleep disturbance. Patients usually awaken frequently during the first night after surgery and receive little deep or REM sleep. Depending on the type of surgery, it takes several days to months for a normal sleep cycle to return. --In your assessment learn if the patient is experiencing any changes in lifestyle that disrupt sleep. A person's occupation often offers a clue to the nature of the sleep problem. --A patient's emotions and mental status affect the ability to sleep. When a sleep disturbance is related to an emotional problem, the key is to treat the primary problem; its resolution often improves sleep. --Ask patients what they do to prepare for sleep. --Pay special attention to a child's bedtime rituals. Some young children need a special blanket or stuffed animal when going to sleep. --Observe for behaviors such as irritability, disorientation (similar to a drunken state), frequent yawning, and slurred speech. If sleep deprivation has lasted a long time, psychotic behavior such as delusions and paranoia sometimes develop. --A general description of the problem followed by more focused questions usually reveals specific characteristics that are useful in planning therapies. To begin, you need to understand the nature of the sleep problem, its signs and symptoms, its onset and duration, its severity, any predisposing factors or causes, and the overall effect on the patient. --Proper questioning helps to determine the type of sleep disturbance and the nature of the problem. --As an adjunct to the sleep history, have the patient and bed partner keep a sleep-wake log for 1 to 4 weeks. --Ask the following questions to determine a patient's sleep pattern: --What time do you usually get in bed each night? --How much time does it usually take to fall asleep? Do you do anything special to help you fall asleep? --How many times do you awaken during the night? Why? --What time do you typically wake up in the morning? --On average, how many hours do you sleep each night? --Patients with sleep problems frequently show patterns drastically different from their usual one, or sometimes the change is relatively minor. --Assess patients' sleep patterns by using a nursing history to gather information about factors that usually influence sleep. Sleep is a subjective experience. Only the patient is able to report whether or not it is sufficient and restful. If the patient is satisfied with the quantity and quality of sleep received, you consider it normal, and the nursing history is brief. If a patient admits to or suspects a sleep problem, you need a detailed history and assessment. If a patient has an obvious sleep problem, consider asking if his or her sleep partner can be approached for further assessment data. --A poor night's sleep for a patient often starts a vicious cycle of anticipatory anxiety. --Usually patients are the best resource for describing sleep problems and how they represent a change from their usual sleep and waking patterns. --In addition, bed partners are able to provide information about patients' sleep patterns that helps reveal the nature of certain sleep disorders. --When caring for children, seek information about sleep patterns from parents or guardians because they are usually a reliable source of information. --Two effective subjective measures of sleep are the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. --Another brief subjective method to assess sleep is a numeric scale with a 0 to 10 sleep rating. --When suspecting a sleep problem, assess the quality and characteristics of sleep in greater depth by asking the patient to describe the problem. This includes recent changes in sleep pattern, sleep symptoms experienced during waking hours, use of sleep and other prescribed or over-the-counter medications, diet and intake of substances such as caffeine or alcohol that influence sleep, and recent life events that have affected the patient's mental and emotional status. --If a patient's sleep is adequate, assess his or her usual bedtime, normal bedtime ritual, preferred environment for sleeping, and usual preferred rising time. --When a patient has a sleep problem, conduct a complete sleep history. Diagnosing sleep problems depends on identifying factors that impair sleep.

Nursing Diagnosis (POWERPOINT) -Anxiety -Ineffective breathing pattern -Acute confusion -Compromised family coping -Ineffective coping -Insomnia -Fatigue -Sleep deprivation -Readiness for enhanced sleep --Review your assessment data, looking for clusters of data that include defining characteristics for a sleep pattern disturbance or other health problem. --If you identify a sleep problem, specify the condition, such as insomnia or sleep deprivation. By specifying the sleep disturbance diagnosis, you are able to design more effective interventions. --Assessment also identifies the related factor or probable cause of a sleep disturbance such as a noisy environment or a high intake of caffeinated beverages in the evening.

1. discuss End-of-Life Care Hospice & palliative care

Palliative care= symptom/pain control (nausea/vomiting/anorexia, physical stress, mental stress). Patients may be in hospice or may still be in curative tract (POWERPOINT) Hospice= when terminal prognosis < 6 months, it is comfort care, symptom control, and focuses on client and family. Occurs in hospital, nursing home, home, or hospice house (POWERPOINT) What is provided as part of comfort care symptom control= pain medications, antiemetics, appetite boosters, diet/fluid as tolerated and prescribed, daily hygiene, full/abbreviated bath, oral care, information, emotional support/crisis management (POWERPOINT) Palliative care=focuses on the prevention, relief, and reduction of disease/disorders symptoms throughout the entire courses of illness. The primary goal is to help patients and families achieve the best possible quality of life. Palliative care philosophy: -affirms life and regards dying as a normal process -neither hastens or postpones death -integrates psychological and spiritual aspects of patient care -offers a support system to help patients live as actively as possible until death -enhances the quality of life -uses a team approach to meet the needs of patients and families Hospice care=a philosophy and model for the care of terminally ill patients and their families at the end of life. It gives priority to managing a patients pain and their symptoms, comfort, quality of life, and attention to physical, psychological, social, and spiritual needs and resources Hospice programs are built on theses cores and beliefs: -patient and family are the unit of care -coordinated home care with access to inpatient and nursing home beds when needed -physician-directed services -provision of an interdisciplinary care team -medical and nursing services available at all times -bereavement follow up after patients death -use of trained volunteers for visitation and respite support

3. Identify Complementary and Alternative Therapies -Safe and unsafe herbal therapies Natural Products and Herbal Therapies: (POWERPOINT) -A natural product is a chemical compound or substance produced by a living organism. -Herbal medicines are not approved for use as drugs and are not regulated by the FDA. -Although many herbs are safe and effective, "natural" does not equal "safe." -Some interact with prescription and over-the-counter medications. -Look for U.S. Pharmacopeia (USP)-verified dietary supplement mark. --As the oldest form of medicine, archeological evidence suggests that herbal remedies have been used for more than 60,000 years. Herbal medicines are a prominent part of health care among indigenous populations worldwide. --Nonvitamin, nonmineral natural products are used by almost 20% of the U.S. population to prevent disease and illness and to promote health and well-being. Natural products include herbal medicines (also known as botanicals), dietary supplements, vitamins, minerals, mycotherapies (fungi-based products), essential oils (aromatherapy), and probiotics. --The most frequently used products are garlic, ginseng, ginkgo biloba, cranberry, Echinacea, saw palmetto, soy, black cohosh, St. John's wort, glucosamine, peppermint, fish oil/omega 3, soy, and milk thistle. --Many are sold as foods or food supplements. The Dietary Supplement Health and Education Act (1994) allows companies to sell herbs as dietary supplements as long as no health claims are written on their labels. --A number of herbs are safe and effective for a variety of conditions. --Because they are not regulated, concentrations of the active ingredients vary considerably. Contamination with other herbs or chemicals, including pesticides and heavy metals, is also problematic. Not all companies follow strict quality control and manufacturing guidelines that set standards for acceptable levels of pesticides, residual solvents, bacterial levels, and heavy metals. --Teach patients to purchase herbal medicines only from reputable manufacturers. Labels on herbal products need to contain the scientific name of the botanical, the name and address of the actual manufacturer, a batch or lot number, the date of manufacture, and the expiration date. --Using natural products that have been verified by the U.S. Pharmacopeia (USP) is another way to ensure product safety, quality, and purity. --Some herbs also contain toxic products that have been linked to cancer. --As with any other medication, examine herbs for interaction and compatibility with other prescribed or over-the-counter substances that are being used simultaneously. The Integrative Nursing Role: (POWERPOINT) -Need to encourage dialogue about the use of CAM -Responsibility to understand the benefits of therapies that encourage active patient participation -Multiple practitioner approach: integrative -Holistic in nature -Follow Nurse Practice Act scope of practice. -Work closely with patient --Most people using and seeking information about CAM are well educated and have a strong desire to actively participate in decision making about their health care. Allopathic physicians have increasing concerns that current conventional medicine is not meeting the needs of their patients. --Mainstream physicians who have increasing concerns that current conventional medicine is not meeting the needs of their patients. --All providers, including nurses, need to encourage open, honest dialogue about the use of CAM by patients and better understanding of the benefits of therapies that encourage active participation by patients in preventing or managing illness rather than relying solely on surgery or drugs. --Integrative health care involves interprofessional group practices in which a patient seeks care simultaneously from more than one type of practitioner. An interprofessional group practice represents a truly integrated system where all practitioners work side-by-side to improve the well-being of their patients. --This integrative approach is consistent with nursing's patient-centered legacy, focused on whole-person well-being and health. --Nurses should be essential participants in this type of health care delivery system as many already practice the use of touch, relaxation techniques, imagery, and breathwork using the principles of integrative nursing. --Know which patient is most likely to benefit from each therapy, which complications might occur, and which precautions are needed when using these therapies. --Familiarize yourself with the evidence in each modality that you incorporate into your practice. Know which patient is most likely to benefit from each therapy, when to employ the various therapies, which complications might occur, and which precautions are needed when using these therapies. --You need enough knowledge to discuss the full range of possible therapeutic options, both biomedical and complementary, so that you can help patients make informed health care decisions. --Always ask patients directly about their use of complementary therapies, including self-care activities such as yoga, meditation, or dietary supplements. --Be aware of the safety precautions for each complementary therapy and incorporate these in your teaching plans. Understand your state Nurse Practice Act with regard to complementary therapies and practice only within the scope of these laws.

Safe Herbs 1. Aloe-acceleration of wound healing 2. Chamomile=antiinflammatory and calming agent 3. Echinacea=stimulant of immune system 4. Feverfew=antiinflammatory and inhibition of serotonin and prostaglandins 5. Garlic=inhibition of platelet aggregation 6. Ginger=antiemetic 7. Gingko Biloba=memory improvement 8. Ginseng=increaed physical endurance and improved immune function 9. Licorice 10. Saw palmetto=prevention of conversion of testosterone to dihydrotestosterone 11. Valerian=central nervous system depression Unsafe Herbs: 1. Calamus 2. Chaparral 3. Coltsfoot 4. Comfrey 5. Ephedra 6. Life root 7. Pokeweed

1. identify education needs of clients Role of the nurse in patient education

Teach information that patients and families need. you clarify information provided by HCP's and are the primary source of information that patients need to adjust to health problems. It is also important to understand patients preferences for what they wish to learn. Carefully determine what patines need to know and find the time to educate them when they are ready to learn.

1. identify education needs of clients The environment that promotes learning

The ideal environment for learning is well lit, has good ventilation, is quiet, has appropriate furniture, and a comfortable temperature.

1. identify education needs of clients Interventions when providing patient education to older adults

VII. Older adults A.May need to repeat B.May need to divide into smaller bites of information over several sessions

2. discuss discharge planning and instructions Discharge assessment Discharge plans Discharge instructions

VIII. Discharge Planning A. Discharge Planning starts upon admission B. Assessment --Identification of urgent needs that need to be resolved before discharge teaching -- Identification of learning needs for discharge -- Identification of who needs to hear the discharge instructions C. Conclusion -- Readiness to learn discharge instructions D. Planning -- Discharge topics --Teaching plan E. Implementation --Discharge instructions= Delivered in the appropriate manner and Paper copy provided for client and caregivers --Include the following= Discharge instructions for client needs, Medication instructions, Follow up appointment instructions (Primary provider and Consults) --When to call provider/consult for urgent complications --When to go to emergency room for emergent complications

Signs of impending death: -level of consciousness changes -low blood pressure -breathing changes= Cheyne stokes breathing -SOB/dyspnea -pallor to mottling -ice cold extremities -dry skin -reduced UOP -reduced GI function -pain -fatigue -talking to dead relatives

What happens after death - pallor mortis=pallor (minutes onset, visible in 10-20 minutes) -algor mortis=cooling (minutes onset to 36 hrs) -livor mortis=blood settling (minutes onset, visible in 2 hours) -rigor mortis=stiffening (2 -4 hr onset, 13 hr peak, 16 -60 hr duration)

1. discuss End-of-Life Care Types of loss

ambiguous loss=sometime people experience losses that are marked by uncertainty= a type of disenfranchised grief that can occur when the lost person is physically present but not psychologically available as in dementia or brain injury

1. discuss End-of-Life Care Postmortem care Nurse's own grief experience when caring for dying patients

When death occurs: (POWERPOINT) 1. Death assessment: 1 physician 2 RNs -no response, no breathing X 1minute, no apical pulse X 1 minute (5th ICS, midclavicular line), pupils fixed and dilated, time of death is the time of agreement 2. Preparing the body for viewing: head of bed down, eyes closed, leave tubes???, bath?? bed change??, chairs, hands out, cultural considerations 3. Notifying the family= private area, sitting, eye level, if sudden death, may need to summarize events leading up to death, give verbal warning shot, use the word died, answer questions, offer to have someone stay with family, family can stay as long as they want 4. paper work; identify funeral home at specific location, belongings go with family or body?, family signs the form, make sure identification is on the body, to morgue, call to funeral home, pick uP, funeral home will call the family When a patient dies, nurses provide or delegate postmortem care, the care of the body after death. Above all, a deceased person body deserves the same respect and dignity as that of a living person and needs to be prepared in a manner consistent with a patient's cultural and religious beliefs -Need to perform postmortem are ASAP to prevent discoloration, tissue damage, or deformities -Maintaining the integrity of cultural/religious rituals and mourning practices at the time of death gives survivors a sense of fulfilled obligations and promotes acceptance of the patients death -The nurse coordinates patient and family care during and after death

3. utilize expressions of caring with clients experiencing loss and grief Patients' perceptions of caring

When patents sense HCPS as sensitive, sympathetic, compassionate, and interested in them. they usually become more involved in their plan of care They do not perceive cultural bias when they perceived nurses to be caring Frequently patient and nurses differ in their perceptions of caring. For that reason, focus on building a relationship that allows you to learn what is important to your patients.

Teaching Tools for instruction:

Written Materials: Printed material and online materials= materials need to be easy to read, information needs to be accurate, and is ideal for understanding complex concepts and relationships Programmed Instruction: Instruction is primarily verbal, but educator sometimes uses pictures or diagram, the method requires active learning Computer Instruction: method requires reading comprehension, psychomotor skills, and familiarity with computer Nonprint materials: Diagrams= method demonstration key ideas, summarizes and clarifies the key concept Graphs=help learner grasp information quickly about a single concept Charts=demonstrate relationships of several ideas or concepts and helps learners know what to do Pictures=photogrsphs are more desirable than diagrams because they more accurately portray the details of the real item Physical objects= models are useful when real objects are too small, large, or complicated and allow learners to manipulate objects that they will use later in skill Other Audiovisual Materials: slides, television, videotapes= materials are used for patients with reading comprehension problems and visual deficits.

cardiac death: 1. unresponsive 2. absent vital signs 3. fixed & dilated pupils >99% death assessment: 1. unresponsive-noxious stimulus 2. no breathing and no apical pulse X 1 minute 3. fixed & dilated pupils Brain death: 1. absence of brain activity 2. no cerebral blood flow <1%

death causes: 1. heart disease 2. cancer 3. accidents (unintentional ) 4. chronic lung disease 5. stroke Male: heart disease cancer accidents (unintentional) stroke suicide Alzheimer's Female: heart disease cancer stroke accidents (unintentional) atherosclerosis septicemia