Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
123 Cards in this Set
- Front
- Back
|
What are characteristics of stage 1 in NREM sleep
|
Stage The person is in a transitional stage between wakefullness and sleep,relaxed but somewhat aware of surroundings, involuntary muscle jerking,person can be arouse easily
|
|
|
What are characteristics of stage 2 sleep
|
person can be aroused with relative ease 50 to 55 percent of sleep is in stage 2
|
|
|
What are characteristics of stage 3 sleep
|
Depth of sleep increases and arousal becomes more difficult.
|
|
|
What are characteristics of stage 4 sleep
|
AKA delta sleep, deepest sleep, hard to arouse,slower brain waves are recorded on an EEG, pulse and respitory decrease, BP decreases, muscles relax metabolism slows and the body temperature is low.
|
|
|
What are characteristics of REM sleep
|
eyes dart back and forth quickly. face twitching,large muscle immobility,respirations irregular, rapid or irregular pulse, BP increases or fluctuates. increase in gastric secretions, metabolism increases; body temp increases,
|
|
|
What is Dyssomnias?
|
are sleep disorders characterized by insomnia or excessive sleepiness
|
|
|
what is insomnia
|
difficulty falling asleep, intermittent sleep, or early awakening from sleep.
|
|
|
what is hypersomnia
|
a condition characterized by excessive sleep. a person may fall asleep while eating or while having a conversation.
|
|
|
what is narcolepsy
|
uncontrollable desire to sleep. can fall asleep while standing, in the middle of a conversation or while swimming.
|
|
|
Define a sleep attack
|
irresistible urege to sleep regardless of the type of activiey in which the person is engaged.
|
|
|
(def) Perioperative nursing
|
Nursing care provided for the patient before, during and after surgery
|
|
|
What are the three phases of the perioperative period
|
The preoperative, intraoperative, postoperative
|
|
|
What happens in the preoperative phase
|
beginning with the decision the surgery is necessary and will take place, and lasting till the patient is tranferred to the OR bed.
|
|
|
(def) Interoperative phase
|
Begins when the patient is transferred to the OR bed,until transfer to the postoperative recovery area
|
|
|
(def) Postoperative phase
|
Lasting from admission to the recovery area to complete recovery from surgery
|
|
|
(def) Elective surgery
|
Procedure that is preplanned and based on the patient's choice and availability of sheduling for the patient, surgeon, and facility.
|
|
|
(def) Emergency surgery
|
Must be done immediately to preserve life
|
|
|
(def) Urgent surgery
|
must be done within a reasonably short time frame to preserve health
|
|
|
(def) Optional surgery
|
Is not critical to survival or function
|
|
|
(def) Minor surgery
|
Performed in physician's office,OP,Same day.procedure is usually brief and carries lower risk
|
|
|
(def) Major surgery
|
Higher degree of risk, involves major body organs or life threatening situations
|
|
|
(def) Anesthesia
|
technique of making potentially uncomfortable interventions tolerable and safe.
|
|
|
(def) General anesthesia
|
involves the administration of drugs by the inhalation, IV, rectal or oral rout to produce CNS depression.
|
|
|
What are the three phases of general anesthesia
|
Induction,Maintenance,Emergence
|
|
|
(def) Regional anesthesia
|
Anesthesia is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to the CNS receptors.
|
|
|
(def) Nerve blocks
|
Injecting a local anesthetic around a nerve trunk supplying the area around the jaw face and extremities.
|
|
|
(def) Spinal anesthesia
|
injecting a local anesthetic into the subarachnoid space through a lumbar puncture causing sensory motor and autonomic blockage
|
|
|
(def) Epidural anesthesia
|
anesthesia injected through the intervertebral spaces, usually the lumbar region
|
|
|
(def) caudal anesthesia
|
is the injection of the local anesthetic into the epidural space through the caudal canal into the sacrum
|
|
|
(def) Topical anesthesia
|
used on mucous membranes, skin, wounds, burns
|
|
|
Moderate Sedation/Analgesia
|
is used for short-term and minimally invasive procedures. the pt. maintains cardiorespitory functions and can respond to verbal commands while the IV administration of sedatives and analgesics raises the pain threshold and produces an altered mood with some degree of amnesia.
|
|
|
(def) Informed consent
|
The patient's voluntary agreement to undergo a particular procedure or treatment.
|
|
|
(def) Advanced directives
|
Legal document that allowes the patient to specify instructions for his or her healthcare treatment should he or she be unable to cummunicate these wishes postoperatively, two types: living will, and durable power of attorney.
|
|
|
Preoperative assesment
|
Review past med hx, identify pt. with continuing care needs.
determmine com support sys. financial, educational, coping strategies and current level of functioning. |
|
|
Who is at greatest risk for surgery?
|
Infants and older adults
|
|
|
Why is it important to know about Pt. Hx of cardiovascular disease?
|
Cardiovascular diseases such as thrombocytopenia, hemophilia, recent MI or cardiac surgery increase the risk for hemorrage and hypovolemic shock, hypotension venous stasis and thrombophlebitis.
|
|
|
Why is it important to know about Pt. Hx of Respiratory disease?
|
Pneumonia bronchitis asthma emphysema and COPD increase the risk for respiratory depression from anesthesia as well as postoperative pneumonia, atelectasis and alterations in acid-base balance.
|
|
|
What is important to know about Pt. Hx of kidney and liver diseases?
|
Kidney and liver diseases influence the patient's response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter metabolism and excretion of drugs, and impaired wound healing.
|
|
|
what is important to know about Pt. Hx of Endocrine disease?
|
Diabetes mellitus increase the risk for hypoglycemia or acidosis and slow wound healing
|
|
|
Why is it important to know about Pt. Hx of medications?
|
> risk of rxn to anesthesia.
anticoagulants cause bleeding Tranquilizers = hypotensive Adrenal steroids abruptive withdrawl may cause cardiovascular collapse. |
|
|
what is important to know about Pt. Hx of previous surgeries
|
how did the Pt. tolerate the anesthesia,hypothermia,thrombophlebitis, or surgical site infection, was the past experience negative,or painful
|
|
|
Why is it important to know about Pt. Hx of Nutrition
|
Malnutrition or obesity increases surgical risk.
|
|
|
What is important to know about Pt. Hx of use of alcohol or nicotine
|
Alcoholics require more anesthetic and analgesics. Pt. who smoke are higher risk for respiratory problems.
|
|
|
Why is it important to know about Pt. Hx of ADL's
|
Exercise,rest,and sleep habits are important for preventing postoperative complications and facilitating recovery.
|
|
|
Why is it important to know about Pt. Hx of coping patterns
|
Assessment of the Pt.'s Psychological, sociocultural and spiritual dimensions is as important as the physical and examination.
|
|
|
what are the evidence based guidlines for the management of acute surgical pain?
|
1 the pain reported by the pt. is the determining factor in pain control
2 pain must be assessed every 2 hrs. after major surery 3 the older patient is at risk for under and over treatment of pain. |
|
|
What are the most common causes of postoperative complications?
|
Cardiovascular and respiratory alterations including; atelactasis, pneumonia, thrombophlebitis, and emboli.
|
|
|
name some strategies to overcome postoperative complications.
|
Deep breating, Coughing, Incentive spirometry, Leg exercises, and Turning in bed.
|
|
|
What are some things a nurse can look for to make sure a patient is prepared for surgery?
|
How is the skin?
Elimination? peristalsis doesn't return 24 to 48 hours after surgery. Check with doctor to see how long to fast. Need good sleep. |
|
|
what is the role of sedatives in surgery
|
Diazepam, midazolam, and lorazepam help to alleviate anxiety and decrease recall of events related to surgery.
|
|
|
What is the intraoperative nurse Assessing?
|
Pt's emotional and physical state, skin prep, start IV's,give preoperative medications. help reduce anxiety in the patient.
|
|
|
What is the intraoperative nurse Diagnosing?
|
making sure the patient is positioned properly for the procedure.watching for effects of the anesthesia, equipment used, potential hazards. disruption of tissues and the incision closure.
|
|
|
What is the intraoperative nurse identification and planning?
|
focuses on identifying actions most effective for preventing complications, resolving patient problems, and ensuring patient safety.
|
|
|
What is the intraoperative nurse implementing?
|
intraoperative nurse will be in charge of positioning, draping, documenting, and transfering the patient to PACU unit.
|
|
|
What is the postoperative nurse's immediate concerns?
|
Respitory status, Cardiovascular status, CNS status, fluid status, wound status, and pain mngmnt.
|
|
|
(def) circadian rhythms
|
the regulating mechanism in the person's individual biologic clock
|
|
|
(def) melatonin
|
A natural chemical produced at night that decreases wakefulness and promotes sleep
|
|
|
(def) dyssomnias
|
sleep disorders characterized by insomnia or excessive sleepiness
|
|
|
Some ways to treat insomnia are.
|
Pharmacologic therapy
stimulus control sleep restriction sleep hygiene cognitive therapy multicomponent therapy relaxation therapy |
|
|
(def) Narcolepsy
|
condition characterized by an uncontrollable desire to sleep
|
|
|
(def) sleep attack
|
irresistible urge to sleep, regardless of the type of activity in which the patient is engaged
|
|
|
(def) cataplexy
|
sudden loss of motor tone that may cause the person to fall asleep; usually brought on by strong emotion
|
|
|
(def) Hypnagogic hallucinations
|
Nightmares or vivid hallucinations
|
|
|
(def) Sleep-onset REM periods
|
during a sleep attack, the person moves directly into REM sleep
|
|
|
(def) Sleep paralysis
|
skeletal paralysis that occurs during the transition from wakefulness to sleep
|
|
|
(def) sleep apnea
|
a condition in which a person experiences the absence of breathing (apnea)
or diminished breathing efforts (hypopnea)during sleep between snoring intervals. |
|
|
Name all the dyssomnias
|
Insomnia, Hypersomnia, Narcolepsy, sleep apnea, Restless leg syndrom, Sleep deprivation
|
|
|
What are the parasomnias
|
Somnambulism and Enuresis
|
|
|
(def) nocturnal myoclonus
|
involves marked muscle contractions that result in jerking of one or both legs during sleep. may last 28 sec
|
|
|
Implementing good sleep
|
Prepare a restful environment
promoting bedtime rituals protein and carbohydrates alleviate pain using medications to promote sleep |
|
|
how much sleep do newborn and infants need?
|
Newborns need Avg.16/24 hrs
Infants need 10 to 12 with several naps during the day. mostly REM |
|
|
how much sleep do Toddlers need?
|
12 hrs at night with 2 naps during the day.
|
|
|
how much sleep do Preschoolers need?
|
9-16 hours at night
REM patterns simillar to adults decreased daytime napping |
|
|
how much sleep do school aged children need?
|
10-12 hrs - younger
8-10 hrs older |
|
|
how much sleep do young adults need
|
Avg 8 hrs
REM is 20% of sleep |
|
|
how much sleep do middle-aged adults need
|
Decreased total sleep time, less stage 4, becomes aware of sleep disturbances
|
|
|
how much sleep do older adults need
|
5-7 hrs. less sound sleep. stage 4 is decreased. difficulty falling asleep. health,psychlogical,drug therapy
|
|
|
How do physical activity and exercise help sleep?
|
Helps to increase fatigue
helps to increase REM and NREM excessive exercise can decrease the quality of sleep |
|
|
What is L-tryptophan
|
It is the active sleep ingredient in turkey meat. helps to promote sleep
|
|
|
How does Protein effect sleep?
|
Increases alertness and concentration
|
|
|
How do carbohydrates affect sleep?
|
Affect brain serotonin levels and promote calmness and relaxation
|
|
|
What affect does alcohol have on REM sleep?
|
Use in moderation can induce sleep.Excessive amnts limit REM sleep and delta sleep. no alcohol 6hrs before sleep
|
|
|
What affect does smoking have on sleep?
|
Stimulating effect, don't sleep as deep, no smoking after the evening meal appears to improve the smoker's ability to fall asleep
|
|
|
What two cardiac pains are more likely during REM?
|
CAD and MI
|
|
|
What is the effect of Liver failure and encephalitis on sleep?
|
cause a day and night reversal in sleep patterns
|
|
|
What happens to the GI during REM?
|
GI secretions increase during sleep
|
|
|
Epilepsy seizures are most likely to happen in what sleep NREM or REM?
|
NREM,
REM will suppress the seizure |
|
|
How does hyperthyroidism affect sleep?
|
difficulty falling asleep
|
|
|
how will end stage renal disease affect sleep?
|
Disrupts nocturnal sleep and leads to excessive daytime sleepiness
|
|
|
(def) Dyssomnias
|
sleep disorders characterized by insomnia or excessive sleepiness
|
|
|
(def) Hospice care
|
concept of care that provides compassion, concern, and support for the dying.
|
|
|
(def) Palliative care
|
an approach that improves the quality of life of patients and their families who face problems associated with life threatening illness
|
|
|
Goals of Palliative care
|
1 Prevent and relieve suffering
and 2 Improve quality of life that is remaining |
|
|
What two criteria are necessary for the hospice program?
|
1 Pt. must desire the services and agree in writing. not a curative service, can withdraw at any time.
2 pt. must be eligible. two physicians certify that pt. has less than 6 months to live |
|
|
Identify some ethical and legal issues regarding End Of Life Care (EOLC) Organ donation.
|
Need to be legally competent
Immediate family makes the decision.Permission must be obtained by family at the time of donation.Physician must be notified immediately to proceed with organ donation. |
|
|
Omnibus Reconciliation Act
|
requires all institutions that participate in medicare to provide written information to patients concerning their right to accept or refuse treatement.
|
|
|
What are advance directives?
|
Written statements of a person's wishes regarding medical care
|
|
|
What is a DNR order and who must order it?
|
Order written by a doctor supporting a patients wish to allow a natural death and comfort code status
|
|
|
What is Full Code status?
|
Complete and total heroic measures, which may include CPR drugs and mechanical ventilation.
|
|
|
What is a chemical code
|
involves the use of drugs for resuscitation without the use of CPR interference of technology
|
|
|
What is a "no code"
|
allowes the person to die with comfort measures only and without the interference of technology
|
|
|
What is an out of the hospital DNR
|
terminally ill patients who wish to have no heroic measures used to prolong life after they leave an acute care facility
|
|
|
What is Euthanasia
|
Deliberate act of hastening death
|
|
|
What is the ANA's stand on Euthanasia?
|
Nurses should not participate in active euthanasia because such an act is in direct violation of the code for nurses,
|
|
|
What are some communication techniques to help the dying client and their family
|
1 Empathy-identification with and understanding of another's situation, feelings
2 Listening-an active process required in the development of empathy toward another's feelings |
|
|
List the clinical s/s of approaching death
Sensory |
Hearing is the last to go.
Touch,decreased sensation especially at the extremities. decreased taste and smell, Blurred vision,glazing of eyes blink reflex absent, eyelids remain half open. |
|
|
List the clinical s/s of approaching death
Cardiovascular |
Increased HR,later slowing and weakening pulse,Irregular rhythm,Decreased BP, Delayed absorption of meds
|
|
|
List the clinical s/s of approaching death
Respitoratory system |
Generally respirations cease first, increased RR, Cheyn-stokes respirations, ineffective cough,irregular breating, Death rattle
|
|
|
List the clinical s/s of approaching death
Urinary system |
Gradual decrease in urinary output, incontinent of urine, unable to urinate.
|
|
|
List the clinical s/s of approaching death
GI system |
Slowing or cessation,accumulation of gas, constipation, distention and nausea, loss of spincter control, BM may occure before death.
|
|
|
List the clinical s/s of approaching death
musculoskeletal system |
Gradual loss of ablility to move
difficulty; speaking, swallowing, maintaining body posture and alignment,loss of gag reflex,jerking seen in pts with large amnts of opioids. |
|
|
List the clinical s/s of approaching death
integumetary |
mottling of hands, feet, arms and legs,clammy skin, cyanosis of nose, nail beds knees waxlike skin when very near death
|
|
|
Define Bereavement
|
The period of time following the death of a loved one during which grief is experienced and mourning occurs
|
|
|
What are the s/s of psychological grief
|
anger, guilt anxiety sadness depression and despair
|
|
|
what are s/s of physiological grief
|
sleeping problems, changes in appetite, physical problems or illness.
|
|
|
What is anticipatory grief
|
the grief experienced for the caregiver of the patient with a chronic illness often begins long before the actual death event
|
|
|
Adaptive grief
|
grief that assists the person in accepting the reality of death.
|
|
|
What are some goals of the grieving process
|
resolving emotions. reflecting on the dying person, expressing feelings of loss and sadness, and valuing what has been shared
|
|
|
What was Kubler-Ross's version of the stages of grief?
|
Denial,Anger,Bargaining,Depression, and Acceptance
|
|
|
What are some s/s of complicated grief?
|
Prolonged and intense mourning loss of a loved one, self neglect, and denial of the loss for longer than six months
|
|
|
What does Martocchio teach about grief?
|
1 Shock and disblelief
2 Yearning and protest 3 Anguish, disorganization and dispair 4 reorganization and restoration |
|
|
What does Rando teach about grief?
|
Avoidance, Confrontation, and accommodation
|
|
|
What are your thoughts on grief
|
Be aware of how grief affects you personally, know what can and can't be controlled
|
