what is the definition of loss?
the removal, change, or reduction in value of something valued or held dear and the feelings which result
the meaning of loss is?
what is the definition of bereavement?
emcompasses grief and mourning and denotes emotions & behavior esp death
what is the definition of grief?
emotional, physical, cognitive, and behavioral responses to breeavement, separation, or loss
what is the definition of mourning?
social, cultural acts, and expressions used by a bereaved person to convey thoughts & feelings of sorrow
what is an advanced directive (code status)?
Written document that provides direction for future health care when the client may no longer be able to make personal choices-usually involves DNR orders and the issue of organ transplants
What is the definition of thanatology?
Discipline that deals with death and death-related topics such as attitudes, rituals, and related practices
what is palliative care?
the control of pain, symptoms and distress for clients whose disease is not reponsive to curative treatments
What are tangible losses?
- apparent and easily recognized.
- physical losses (death,body part, health,relationship,job,income)
what are intangible losses?
- symbolic and psychological losses
- things difficult to define (prestige,power,dreams,plans)
what is the bereavement periord?
the time it takes for grieving
what is the intensity of grief driven by?
- individuals personality
- nature of the relationship with the dying person
- concurrent life crises
- coping resources
- availability of support system
what are the 3 types of grieving?
What is Anticipatroy grieving?
intellectual and emotional responses and behaviors that you work through anticpating the potential loss.
What does the anticipatory grieving stage allow time for?
- time to settle personal and family issues
- confirm love and support
- plan for the burial
- draw families together
What is complicated grief?
- grief that is unresolved over time
- occurs after the death of a significant other
Mourning ____ the dead and helps us manage the ______ after death.
List 5 important things about mourning practices.
- Rituals=funerals, burials, memorial services
- sad and difficult to attend
- help to express their feelings
- take comfort with others who are grieving
- pay tribute to a person's life
what is the definition of hospice?
Is a philosophical concept of providing palliative or supportive care to dying people
List 4 important things about hospice care.
- concept care that provides compassion, concern, and support for the dying
- exists to provide support and care for persons in last phases of incurable disease
- patient must desire the services
- patient must have 6months or less to live
What are the factors affecting the grief response?
- older adults
How do you handle children and death?
- younger than 3=cannot comprehend death
- 3-5 years=view death as a kind of sleep-may believe they caused death
- 6-10 years= begin to fear death, try to give meaning to death
- 10-12 years=understand that death is irreversible, interested in death rituals
- adolecents=have a mature understanding of death, may struggle accepting death
What are the 3 normals areas of grief reactions?
- recognition=shock and denial
- reflection=physical,emotional,and spiritual suffering
- redirection=reorganization and moving forward
What are the 3 responses in the recogntion phase.
- Somatic responses
- psychological responses
- behavioral responses
List the imporant things about somatic responses.
- physical reaction to grief
- n/v, abd cramping, diarrhea, dry mouth, tachycardia, palpitations, chest pain, dyspnea, tremors, dizziness, tachypnea
List the 4 important things about psychological responses in recognition phase.
- compartmentalization=person to appears to understand loss but actions do not correlate to reality
- deception=inaccurate info is given to protect the other person
- true denial=the reality is overwhelming, so the person blocks reality and may have bizarre thinking
- anger=denial and disbelief are replaced by reality
What are the things involved in the behavioral response in the recognition phase?
What is the refelction phase?
- 2nd area.
- physical, emotional, and spiritual suffering
- focus on achieving control after chaos and comfort after pain
- somatic response are similar to recognition phase
What are the responses of psychological in the reflection phase?
- anger resurfaces
- guilt with remorse
- crying spontaneously
- mood swings
What is the redirection phase?
- the 3rd phase in grief
- may take years to complete
- may never be completed
Why is fluid & electrolyte important?
- maintain body temperature
- cellular shape
- a vehicle to transport nutrients, gases & wastes
- joint lubrication
what are the % of body fluids in infants, adults, and geriatrics?
What is the goal of maintaining balance of F&E?
keeping the total input of water and electrolytes relatively equal to the amount of lost
What is the total amount of fluid intake for an adult?
What are the 4 routes of fluid output?
- insensible losses through skin as perspiration and water vapor
- noticeable loss through the skin as sweat
What is the total amount of fluid output in an adult?
What are the major electroclytes?
How much of intracellular fluid contains dissolved solutes essential to F&E balance and metabolism?
How much of extracellular fluid is total body of water?
How much fluid is found in the intravascular space and where is it located?
6%-space between arteries and veins
How much fluid is found in the interstitial space and what does it do?
22%-transporting and removes nutrients
How much fluid is found in the transcellular space and where is it located?
2%-cerebrospinal, synovial joints, eyes
List 3 important things about sodium.
- essential in maintining proper balance of water in and between compartments
- vascular volume which affects blood pressure
- critical to nerve impulse conduction
List 2 important things about potassium.
- maintains the sodium-potassium pump
- critical to all cells especially to cardiac and skeletal muscles
What is Osmosis?
movement of water through a semi-permeable membrane from an area with a lesser conc. to an area of greater conc.
what is osmolality?
- measure of water in volume
- describes body fluid by millomoles/kg
- measures by volume IV fluid by millomoles/liter
what is diffusion?
a passive process where molecules move through a cell membrane from an area of high conc. to an area of lower conc.
what is the Active transport?
- ATP (sodium-potassium pump)
- sodium moves from an area of low conc. to a high conc.
- potassium stays in the cell
what is filtration?
balance between fluids within the capillary depends on hydrostatic pressure and colloid osmotic pressure
what is hydrostatic pressure?
the pressure exerted by the weight of fluid within a compartment or closed system
what is the role of the neuroendocrine system?
regulates fulid intake by producing and secreting hormones that stimulate or inhibit osmotic receptors in the carotid arteries and aortic arch
what are the 3 most important hormones?
- antidiuretic hormone (ADH)
- Thyroid hormone
what is colloid osmotic pressure?
the osmotic pressure exerted by large molecules, such as proteins.
Explain the process of the antidiuretic hormone.
- prevents fluid loss
- if there is fluid overload=ADH hormone will not be secreted and kidneys want to release water and urine output will increase
- if there is fluid deficit=ADH hormone will be secreted and kidneys will hold water and urine output will decrease
Explain the effect of Aldosterone.
- fluid deficit=aldosterone secretion is increased and retention of sodium and excretion of potassium in the distal tubules and collecting ducts of the kidneys
- fulid overload=aldosterone secretion is decreased and retention of potassium and excretion of sodium and water
Explain the process of Thyroid hormone.
- thyroid hormone affects the fluid volume by influencing cardiac output.
- Increase in thyroid hormone causes increase in cardiac output, increases urinary output
How is sodium regulated and what is the normal levels?
- Sodium is regulated by the aldosterone secretion and dietary intake.
- Normal level is 135-145 mEq/L
How is potassium regulated and what is the normal level?
- Potassium regulated by the renal excretion and dietary intake.
- Normal level is 3.5-5 mEq/L
What is the normal pH value of arterial blood?
normal vaule 7.35-7.45
Explain the ph values.
- ph of 7 is neutral
- ph below 7 is acidic/acidosis
- ph above 7 is basic/alkaline/alkalosis
What are factors that affect F&E balances?
- medical treatments
What is the nursing diagnosis of Deficient fluid volume?
- refers to a state of hypovolemia (low blood volume)
- not enough fluid in either the intracellular or extracellular space
What is the nursing diagnosis Excess fluid volume?
- refers to a state of hypervolemia (high blood volume)
- water intoxication
- edema in the interstitial space
- excess fluid in the intracellular space
What is the nursing diagnosis Electrolyte imbalance?
refers to either a defict or excess of one or more electrolytes.
How does a person get a deficit of fluid volume?
- abnormal losses through skin
- decreased intake of fluid
- movement of fluid into a third space
- increase of GI losses (n/v, diarrhea)
- increased urine loss
- hyperventilation (loss of water through expired air)
- trauma, wounds, and drainages
what is third spacing?
a shift of fluid from the intravascular space into a portion of the body from which it is not easily exchanged with the rest of the ECF.
What are some nursing interventions to help with deficent fluid volume?
- assess changes in clinical signs of DFV
- adminster oral fluids
- provide prn medications for nausea
- assess bowel sounds
- implement measures to prevent skin breakdown
what type of people are at risk for dehydration?
- older people
- ill clients who have a decreas response to thirst
- patients who kidneys have a decreased ability to concentrate urine
what type of measurment will give you the best accurate reading if a person has a defict or excess fluid volume.
where would you most likely see an affect of edema on a patient?
- hands and feet
- breath sounds
- wet cough
- short of breath
What causes excess fluid volume?
- rapid administration of sodium-containing infusions
- diseases that alter regulatory mechanisms (CHF, renal failure, cirrhosis of the liver, Cushing's syndrome)
- steroid excess
what are some nursing interventions for a patient with excess fluid volume?
- Assess changes in clinical signs (breath sounds, skin turgor, output, edema)
- encourage intake of low sodium and fluid
- monitor fluid intake and output
- administer diuretics
- employ measures to prevent skin breakdown
When does overhydration occur?
- when there is an excessive intake of water
- excessive ADH secretion
What results in a low sodium level?
Hyponatremia-water retention in the brain cells cause a loss of sodium. Typical signs are pitting edema over bony prominences. Cells swell.
What results in a high sodium level?
Hypernatermia-cells have insufficient fluid and become dehydrated. Cells shrink. Body tries to conserve as much water as possible
What is the most noticeable sign of any deficit or excess in a person?
What results in low potassium level?
Hypokalemia-severe can affect cardiac conduction and function.
What is a common cause of hypokalemia?
use of potassium wasting diuretics, for example thiazide diuretics or loop diuretics.
What are nursing interventions for a patient with hypokalemia?
- monitor digitalis closely, becuase hyopkalemia enhances digitalis toxicity
- administer oral potassium with food or fluid to prevent gastric irritation
- monitor heart rate and rhythm
- monitor IV potassium
- Teach about potassium rich foods
What are nursing interventions for a patient with hyponatremia?
- monitor fluid intake and output
- assess signs of cerebral edema, change in mental status, n/v, abd cramps, diarrhea, fever, muscle twitching
- monitor laboratory data
- assess if hypertonic saline solution
- encourage food and fluid high in sodium
What are nursing interventions for a patient with hypernatremia?
- monitor fluid intake and output
- monitor behavior changes
- monitor laboratory data
- encourage fluids as ordered
- monitor diet as ordered
What results in high potassium level?
Hyperkalemia symptoms irritability in muscles and later muscles weakness, n/v, diarrhea, colic, numbness
What causes hyperkalemia?
Renal failure (any decrease in renal function decreases the amount of potassium the kidney can excrete).
What are nursing interventions for a patient with hyperkalemia?
- monitor receiving diuretics
- teach patients to avoid foods high in potassium
What is the primary purpose of chloride?
- involved in regulating the acid-base balance in the body
- an important buffer in the exchange of oxygen and carbon dioxide in the red blood cells
What is PaCO2?
Reflects the depth of pulmonary ventilation. Normal is 35-45 mm Hg.
When a PaCO2 level is below 35 what does it indicate?
When a PaCO2 level is higher than 45 what does it indicate?
What is PaO2?
Reflects the partial pressure of O@ in arterial blood. Normal is 80-100 mm Hg. Has no role in acid-base balance when it is within normal limits
What is bicarbonate?
Major component of acid base balane and is excreted and reproduced by the kidneys to maintain a normal acid base environment. Normal range 22-26 mEq/L.
What are nursing interventions to correct acid-base imbalances?
- typically need written orders
- usually uses supportive fluid and electrolyte replacement
- support of respiratory function with primary respiratory imbalances
If a patient has a HIGH pH, LOW PaCO2 and NORMAL HCO3 and hyperventilating what acid-base balance is this patient in?
If a patient has a LOW pH, HIGH PaCO2 and NORMAL HCO3 and hypoventilating what acid-base balance is this patient in?
If a patient has a HIGH pH, NORMAL PaCO2 and HIGH HCO3 what acid-base balance is this patient in?
If a patient has a LOW pH, NORMAL PaCO2 and LOW HCO3 what acid-base balance is this patient in?
What is the definition of nutrition?
the science of food and nutrients and of the process by which an organism ingests them and uses them for energy to grow. maintain funtion, and renew itself.
What is the buliding block of a diet?
What is a nutrient?
a biochemical substance used by the body for growth, maintenance, and repair. Body must have a variety of a sufficent amount to optimal health.
What is nutritional status?
The condition of the body resulting from use of available essential nutrients.
What are the 6 things good nutritional status is essential for?
- 1. organ development and function
- 2. reproduction
- 3. growth and maintenance
- 4. optimal activity and working efficiency
- 5. resistance to infection
- 6. repair bodiliy damage or injury (healing)
What are the 4 main functions of the GI tract?
What are the major energy nutrients of food?
- carbohydrates-simple or complex
- proteins-20 amnio acids
- fats-triglycerides, phospholipids, and steroids
- vitamins-organic substances (coenzymes)
- minerals-inorganic elements
What are factors affecting nutritional deficits?
- anorexia=reduced desire for food
- dysphagia=difficulty swallowing
- digestion and absorption=inflammatory bowel disease, diarrhea, cystic fibrosis, lactose intolerance
What is malnutrition?
any nutritional disorder caused by: imbalanced, insufficent, excessive diet, impaired absorption or metabolism of nutrients
what is nutritional deprivation?
a result of inadequate intake that could be caused by: nausea/vomiting, difficulty swallowing, inability to obtain food, problems that increase energy needs
Explain the process of starvation within the first 10 days.
- body attempts to reduce its energy first by lowing voluntary activity and BMR
- Glycogen stored in the liver converts to glucose
- last only a few hours
- "catabolism"=breakdown of muscle and body mass
- protein can supply calories for about 2 weeks
What happens in the process of starvation after 10-14 days?
- breakdown of fat occurs for energy through lipolysis
- liver makes ketone bodies from fatty acids for use as fuel by most tissues
- Ketosis occurs as ketone bodies accumulate, which are end products
- catabolism results in negative nitrogen balance
- Blood urea nitrogen (BUN) and CREAT will rise
- levels decline and fats are used to a greater extent for energy needs
What are the 3 reasons to perform a nutritional screening?
- 1. identify clients who need an in-depth assessment
- 2. establish baseline values to evaluate the efficacy of nutritional regimens
- 3. provide a system for early recognition od increased health risk caused by nutritional factors
What are tools to assess a persons daily intake?
- 24-hour recall
- food frequency questionnaire
- food diary
- household food consumption
What are the different types of diets a patient may be on for nutritional therapy?
- NPO-nothing by mouth
- clear liquids-any liquid you can see thru
- full liquid-liquid soups
- regular diet
How much of the carbohydrates, proteins, and fats should be covered in a normal daily intake?
- Carbohydrates 50-60%
- Proteins 25-50%
- Fats 10-30%