(Although there are stages individual can go back and forth between but usally go through all to reach acceptance)
1. Denial – act like nothing happened – refusal to accept – no understanding
2. Anger – resistance, anger at God, other people or situations
3. Bargaining – cushions/postpones awareness of loss, make promises to self, God, loved ones
4. Depression – once fully realize full impact of loss, sadness, hopelessness, loneliness, withdraw
5. Acceptance – person incorporates the loss into life and finds ways to move forward
What signs do you observe with imminent death?
- Irregular breathing
- Cool Extrimities
- Decreased LOC
- Fixed dilated pupils
- Muscles become weak and atonic
Palliative care =
Primary focus-
Prevention, relief, reduction, or soothing of symptoms for people who face chronic life threatening illnesses or who are at the end of life. (Not just dying pts*)
-Throughout entire course of illness.
Primary Focus: Help clients/family achieve the best quality of life
Hospice =
The final phase of palliative care
Designed for those who will not benefit from med tx’s, will not live > 6 months, actively dying.
What does the nurse do to provide hospice care?
* meet individual needs
* provide palliative treatment
* avoidance of loneliness
* understanding of scope of activities client can tolerate encourage, and provide rest periods
An emotional response to a loss unique to the individual
- a process of coping based on personal experiences, cultural expectations, spiritual beliefs
Grief
An outward social expression of grief and associated behaviors. Rituals are culturally influenced – a learned behavior.
Mourning
True or False-
Because I have experienced many losses the next will be easier to handle.
False. Just because you have experienced multiple
losses does not mean that any loss is less significant or easier to handle.
Cultural competency as a nurse:
(required in death and dying)
-promote cultural influences
-practices within available needs
-involve physician in cultural practices and preferences. -Understand the culture at hand, decision makers, need the familial support.
- Accommodate needs as much as possible, give privacy,
provide private room, move room mates
A nurse has the responsibility of managing a deceased client's postmortem care. Arrange the steps for postmortem care in the proper order.
1. Bathe the deceased's body.
2. Collect any needed specimens
3. Remove all drains and indwelling tubes
4. Position the body for family visit/viewing
5. Speak to the family members about their possible participation
6. Confirm that request for organ/tissue donation and/or autopsy has been made
7. Notify a support person (eg spiritual provider, bereavement specialist) for the family
8. Accurately tag the body, indicating deceased's identity and safety issues regarding infection control.
6,2,5,3,1,4,7,8
6. Confirm that request for organ/tissue donation and/or autopsy has been made
2. Collect any needed specimens
5. Speak to the family members about their possible participation
3. Remove all drains and indwelling tubes
1. Bathe the deceased's body
4.Position the body for family visit/viewing
7.Notify a support person (eg spiritual provider, bereavement specialist) for the family
8. Accurately tag the body, indicating deceased's identity and safety issues regarding infection control.
Pain management
What are the first 4 stages of sleep?
Nonrapid eye movement (NREM)
What is the fifth stage of sleep?
Rapid Eye Movement sleep (REM)
What stage of sleep is characterized by:
- Light sleep: person wakes easily, “floating” feeling, day dreaming
-Rolling eye movements & relaxed muscles
-Lasts only a few minutes
Stage 1 --Non REM
What stage of sleep is characterized by: - Period of sound sleep, relaxation progresses
- Arousal remains relatively easy
- Lasts 10 to 20 minuets
Stage 2 - NREM
Stage 3 of Non REM sleep is characterized by:
- initial stage of deep sleep
- difficult to arouse sleeper, muscles relaxed
- vitals decline but are normal
- 15 to 30 minutes
What is the deepest stage of sleep and how long does it last? Sleepwalking and ensuresis (bed-wetting) sometimes occur in this stage.
Stage 4- NREM
lasts approximately 15 to 30 minutes
- If sleep loss has occured sleeper will spend considerable portion of night in this stage
Loss of skeletal and muscle tone, increase of gastric secretions, fluctuating heart and respiratory rates, increased or fluctuating blood pressure are all signs of...
REM sleep
Insomniacs rarely reach this stage of sleep
The client reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs during which sleep phase?
When does this stage usually occur and how long does it last?
REM sleep
-Occurs about 90 minutes after sleep has begun.
-Duration increases with each cycle and averages 20 minutes
Most older adults have almost no ____ sleep.
No Deep sleep ( stage 4) .
What contributes to the older adults change in sleep pattern?
- Awakens more at night: explains tendency to nap during day
- Takes longer to fall asleep
- Chronic illness (pain) or medications
- CNS changes: Sensory impairment reduces sensitivity to time cues that maintain circadian rythm
Define rest.
What are ways people gain rest?
Rest is a state where you feel mentally relaxed, free from
anxiety, and physically calm
People gain rest reading a book, practicing exercise, listening to music, taking a long walk, sitting quietly.
Factors affecting sleep are...
and which of these can be modified?
illness, stress, medications, lifestyle, environmental disturbance or changes, altered sleep pattern (e.g. night shift), exercise, food
Who in the hospital is most vulnerable to sleep deprivation and how can we treat it?
Patients in the ICU
Tx= elimination or correction of factors disrupting sleep pattern- nurses play a key role in determining those factors
If a client complains of not being able to sleep and tossing and turning in bed all night, what would you recommend?
Lay in bed only 30 minutes to 1 hour. If you can't sleep then get up and do something until tired.
The nurse incorporates what priority nursing intervention into a plan of care to promote sleep for a hospitalized client?
C. Avoid awakening client for nonessential tasks
Older adults are cautioned about the long-term use of sedative and hypnotics because these medications can:
A. Lead to sleep disruption
Which intervention is appropriate to include on a care plan for improving sleep in the older adult?
D. Decrease fluids 2 to 4 hours before sleep
There are four adult clients who see the nurse for complaints of fatigue. The adult client at greatest risk is the one who gets:
B. 10 hours of sleep
Rationale:
Data from over one million adult Americans revealed that the group that slept more than 8.5 hours each night had the greatest mortality.
What is cognitive learning and what behaviors are included from simplest to complex?
includes all intellectual behaviors and requires thinking
1. Knowledge: learning and being able to recall
2. Comprehension: ability to understand
3. Application: using abstract, newly learned ideas
4. Analysis: breaking down info into organized parts
5. Synthesis: ability to apply knowledge and skills to produce a new whole
6. Evaluation: a judgement of the worth of a body of info
What is affective learning?
Examples
Deals with expression of feelings and acceptance of attitudes
