exam week9 part 3

  1. what are the appropriate interventions for client with dysphagia?
    • recommend further evaluation
    • implement specialized feeding techniques and diet
    • work with client and family to develop a plan to assist with difficulties
    • Review pt history, interview family, assess mouth, throat and observe client swallowing
  2. Clear liquids
    • short term, after surgeries
    • no nutritional value
    • water, tea, coffee, broth, gingerale, clear juice
  3. Ful Liquid Diet
    • GI disturbances/Short Term
    • liquid at body temp
    • Jello, Ice Cream
  4. Pureed Diet
    • modified soft diet
    • liquid may be added to food
    • blended to semi solid consistency
  5. Soft Diet
    • easily chewed and digested
    • oatmeal
    • chopped/shredded meat with gravy
  6. what is enteral nutrition
    • tube feeding
    • through gastrointestinal system
  7. parenteral nutrition
    • IV feeding
    • irritates vein
    • very high in electrolytes and sugar
  8. Total Parenteral Nutrition
    • TPN
    • feeding through central line
    • must be weaned off
  9. what are the different types of enteral nutrition devices
    • Nasogastric Tube
    • Nasointestinal/Nasoenteric Tube
    • G-Tube
    • Gastrostomy(PEG)
    • PEJ
  10. gastrostomy tube
    • goes into the stomach thru small surgical opening
    • post op it is sterile
    • after fistula forms nurse can reinsert if comes out
  11. G-Tube
    • small low profile
    • goes into the stomach through small surgical opening in side
  12. nasointestinal/nasoenteric tube
    • longer than NG tube it goes into the small bowel
    • used if pt has risk for aspiration
    • decreased gag reflex
  13. NG tube
    • single or double
    • goes in to the stomach
  14. PEJ
    goes into the small bowel through a surgical opening used for long term feeding
  15. to check placement of NG tube
    • aspirate
    • auscultate
    • check residual  pH greater than 7 =respiratory
  16. types of loss
    • Actual loss
    • Perceived loss
    • Anticipatory loss
    • Situational loss
    • Developmental Loss
    • loss of aspect of self
    • Loss of External Objects
    • Loss of Familiar Environment
    • Loss of Loved One
  17. Actual Loss
    Experienced by one but can be recognized by others
  18. Perceived Loss
    Experienced by one but cannot be verified by others
  19. Anticipatory Loss
    experienced before the actual loss occurs
  20. Situational Loss
    • occurs with:
    • the loss of one's job
    • death of a child
    • loss of functional ability
  21. Developmental Loss
    Child moving away to college
  22. Loss of an aspect of self
    • change in person's body image
    • even if not noticed by others
  23. loss of external objects
    loss of inanimate object
  24. loss of familiar environment
    • having to move
    • losing family home
  25. loss of loved one
    spouse or close family member dies or moves away
  26. what are the types of grief
    • Abbreviated Grief
    • Anticipatory Grief
    • Disenfranchised Grief
    • Complicated Grief
  27. what is Abbreviated grief?
    brief but genuinely felt
  28. what is anticipatory grief
    experienced in advance of the event
  29. what is disenfranchised grief
    • occurs when a person in unable to acknowledge the los to other persons
    • (AIDS, abortion or suicide, other stigmatized health states)
  30. What is Complicated Grief?
    coping mechanisms that are unhealthy, maladaptive

    Grief that may be unresolved(extended in length & severity) or inhibited (suppressed)
  31. What are Kubler-Ross' Stages of Grieving?
    • DABDA
    • Denial
    • Anger
    • Bargaining
    • Depression
    • Acceptance
  32. Kubler-Ross'
    • client refuses to believe that loss is happening
    • usually short
    • Nursing Action
    • Verbally Support Client (do not reinforce denial)
  33. Kubler Ross'
    client directs anger at others

    • Nursing Action:
    • Help client understand anger is normal
    • avoid retaliation
  34. Kubler-Ross'
    • Client seeks to bargain to avoid loss (usually with God)
    • Nursing Implication:
    • Listen, encourage client to talk to relieve Guilt or Fear
  35. Kubler-Ross'
    • Grieves over what happened and what cannot be
    • Nursing Implication:
    • Allow client to express sadness
    • Sit quietly
    • convey caring touch
  36. Kubler-Ross'
    • Client comes to terms with loss
    • Have decreased interest in surroundings
    • Nursing Implication
    • Help family understand client's need for decreased need to socialize
    • Encourage client to participate as much as possible
  37. Factor affecting Loss and Grief Response
    • Age
    • Significance of Loss
    • Culture
    • Spiritual Belief
    • Cause of loss or death
  38. what are the different types of awareness the nurse must assess for with a dying client
    • closed awareness
    • mutual awareness
    • open awareness
  39. what is closed awareness
    • client is unaware of impending death
    • family may not completely understand why the client is ill
  40. what is open awareness
    client and people know about the impending death and feel comfortable discussing it
  41. what is Mutual Awareness
    Client, family, and health personnel know that the prognosis is terminal, but do not talk about it. Client may use this state to protect the family
  42. what does the nurse need to assess on terminally ill pt
    • Muscle Tone
    • Circulation
    • respirations
    • sensory changes
  43. clinical manifestations
    impending death
    muscle tone
    • relaxation of facial muscles
    • difficulty speaking
    • difficulty swallowing
    • decreased GI activity
    • urinary or rectal incontinence (decreased sphincter control)
  44. impending death
    • cold skin
    • circulation slows
    • cyanosis of extremities
  45. impending death
    changes in respirations
    • rapid shallow irregular or abnormally slow resp
    • Noisy breathing
    • mouth breathing
  46. what are advanced directives
    legal documents that allow a person to specify aspects of the care they wish to receive should they become unable to communicate their preferences
  47. what are the physiological needs of the dying patient?
    • related to the slowing of body processes.
    • personal hygiene
    • controlling pain
    • relieving respiratory difficulties
    • assist with movement, nutrition, hydration, elimination
  48. Implementing
    what is the major nursing responsibility for clients who are dying
    • minimize loneliness, fear, depression
    • maintain clients sense of security, self-confidence, dignity, self worth
    • help client accept losses
    • provide physical comfort
  49. in what ways can control be given to the  dying patient?
    • give them options/choices
    • location of care
    • times of appointments
    • activity schedule
  50. how can the nurse help the client maintain dignity and self worth
    • maintaining the humanity
    • maintain their beliefs, values and cultures
  51. what responsibility do nurses have for themselves "ability to provide spiritual care"
    • the nurse has to be comfortable with their own beliefs
    • they have ethic and moral responsibility to not impose their own beliefs onto the client
Card Set
exam week9 part 3
nutrition lab Grief, death and dying lecture