Exam 5 (Valencia Nursing I)

body’s potentially harmful reaction to a stimulus
physiologic stress

comprises the emotional and cognitive factors involved in the appraisal of threat
psychological stress

occurs when social systems are challenged by factors such as racism, economic hardship, or political upheaval
sociocultural stress

demand from the internal or external environment that exceeds the persons immediate available resources or ability to respond
Stress, as defined by Kasl

A non specific response of the body to any demand made upon it
Stress, as defined by Seyle

an event or stimulus that disrupts the person sense of equilibrium

process by which the person interprets a stressor as either a threat or challenge
stress appraisal

Example of autoimmune disease triggered by stress
Rheumatoid arthritis

Nursing care of stress is directed at what
altering stimuli that are stressors to the patient

Seyles theory that noted the body responds in the same way to any demand, whether it be physical, emotional, pleasant or unpleasant
GAS (general adaptation syndrome).

Three Stages of General Adaptation Syndrome (GAS)
(1) Alarm Stage
(2) Resistance
(3) Exhaustion

What happens during the alarm stage of GAS
stressor is strong enough to alter homeostasis

What happens during the resistance stage of GAS
body adapts to the stressor. Repairs and restores resources.

What happens during the exhaustion stage of GAS
Resources are complete depleted. Death can occur at cellular level. Chronic stress leads to disease called stress related illness

Tissues effected by stress. manifests as inflammation, reflexive response to pain, hypoxia secondary to catecholamine release.
Local adaptation syndrome

Local adaptation syndrome is mostly a ___ response

means by which homeostasis is established.

Example of allostatic response
flight or fight response

the automatic, often unconscious assessment of a demand or stressor

The first stage of appraisal addresses what
immediacy of the threat and degree of ambiguity of the threat

The second stage of appraisal addresses what
Coping options are evaluated

person with high sense of coherence is likely to do what?
recognize and utilize resources in stressful situations

persons with a low sense of coherence are likely to do what?
become overwhelmed and have difficulty coping

the dynamic and behavioral effort to manage demands that are appraised or exceeding immediately available resource

T/F Coping always guarantees success or healthy behavior

unconscious, protective coping methods that people may apply in response to perceived threat
Defense mechanisms (short term use)

In situations where the problem has no solution, emotion focused coping strategies work to do what?
Ease the emotional distress (ex: person diagnosed with diabetes may be overwhelmed, stressed, focus is to relieve the stress)

Coping usually involves what
problem focused and emotional focused efforts

Nervous system response during the first few minutes of stress
-NS initiates release of hormones (increases cardiac output and elevates blood pressure
-Increase in blood flow to muscles, decrease to digestive tract
-Smooth muscle in bronchi relax and dilate, while respiratory rate increases
-pupillary dilation
All can result in sensations of palpitations, light headedness, nausea, and anxiety. (like before an exam)

Immune system response during stress
-First response is pain
-Vasodilation and swelling
-Phagocytes and macrophages migrate to the area
-Neutralize, or initial general response

Endocrine system response during stress
-Corticosteroids and catecholamines released. Affects inflammatory response, and blood vessels
-Stress induced hyperglycemia (ex: gestational diabetes, myocardial infarction hyperglycemia, postop hyperglycemia)

characterized by unrealistic levels of worry and tension with or without an identifiable cause
Generalized anxiety disorder (GAD)

This level of anxiety can be motivational, foster creativity, and actually increase the ability to think clearly
Mild anxiety

This level of anxiety narrows focus, dulls perception, and may challenge the person to pay attention or use appropriate problem skills
Moderate anxiety

These two types of anxiety are considered normal and are experienced by everyone on a regular basis (and for nursing students, daily)
Mild to moderate

This level of anxiety results in the inability to make decisions, solve problems
severe anxiety

the highest level of anxiety. Associated with dread or terror
panic attack

a person who is diaphoretic, has chest pain, is having difficulty breathing, and heart palpitations might be having what?
panic attack

characterized by flash backs and erratic behaviors as a result of a horrifying experience
post traumatic stress disorder PTSD

Can develop when a persons ability to cope is exceeded by a trauma experienced

this prepares the affected person to attack physically or otherwise

A person who has ________ _____ may express it through violent or abusive behavior
unresolved anger

a person who has ______ ______ _______ suppresses their emotions. This can lead to high blood pressure, depression, and GI tract upset
chronically suppressed anger

A patient has just experienced a loss a loved one, this patient is most likely experiencing what

A patient has just been in a paralytic accident which will no longer allow them to compete in triathlons. This patient will most likely suffer from what

What can happen if initial feelings of depression are not addressed
Clinical depression can develop. Can lead to suicide

For some people, feelings of _______ can serve as a motivator for change. It can lead to a happier and healthier lifestyle.

In stressful situations, parasympathetic, rather than sympathetic, stimulation is the primary event. This can result in what response inside the body?
increase GI motility, bronchial constriction. Which can both result in IBS, or asthma

A patient is in the hospital for a knee replacement and is extremely nervous about the post operative effects of the replacement . The patient also has HIV. The nurse should be concerned about what?
Progression of HIV to AIDS and reduction of the antiretroviral therapy.

High stress loads are known to exacerbate what?
sclerosis and other autoimmune diseases

Measure of ______, found in the blood, urine, and saliva, is the STANDARD for laboratory assessment of physiologic stress

A man who is under physically stressful situations should expect a rise in what?

T/F: Stress can delay ovulation and suppress menstration

Irritability, agitation, anxiety, and poor eye contact may prove more revealing than verbal response. These are examples of what.
Non behavior responses

Caring for own children as well as the parents
sandwich generation

It is necessary for nurses to assess which systems for sign of stress
cardio, resp, neuro, musculoskeletal, GI, urinary, cognitive, and emotional. So basically everything.

A patient has just verbalized that they are going to commit suicide, or have thought about it. What should the nurse do?
Do not leave the patient alone. Ensure patient safety always and contact the necessary services (psychiatric).

people with poor coping skills, or none at all typically respond to challenges with?
Denial and avoidance.

Examples of anger management interventions:
-Expressing feelings
-idnetifying potential solutions
-time out
-diffusing the situation with humor
-owning the feelings
-deep breathing exercises

Nutritional stress reduction consists of consuming what types of foods?
fruits and veggies, legumes, fish, poultry, whole grains
Take multivitamins

short term assistance provided at a time of physical or emotional upheaval with the goal of helping the person in distress to regain equilibrium
crisis intervention

Providing counselors for school students after the death of another student, and encouraging a person to drive as soon as possible after involvement in a fatal accident are examples of what
crisis intervention

Mental or physical exhaustion due to constant stress

burnout increases by the cycle of what
exhaustion, cynicism, and lack of civility

empathetic nurses might experience what after being overwhelmed by the constant needs of patients and families
compassion fatigue

Occurs during deep sleep and is manifested by quick scanning movements of the eyes
REM sleep

A patient is agitated, and impulse. It is possible that they have been deprived of?
REM sleep

Lightest level of sleep. Vital signs and metabolism slow. Resting my eyes.
NREM 1 (lasts a few minutes)

Relaxation increases and sleep becomes deeper. Snoring may occur but you can still be woken easily. Occasionally involves some muscle jerks.
NREM 2 (lasts 10-20 minutes)

Initial stage of sleep sleep. More difficult to be woken and rare movement. Vital signs decrease but rhythm maintained. GH is released
NREM 3 (15-30 minutes)

Deepest stage of sleep. Very strong stimuli needed to be woken. Vital signs significantly decreased. Restoration continues.
NREM 4 (15-30 minutes)

This stage of sleep may be prog longed if the patient is deprived of sleep

This stage of sleeping may involve nocturnal enuresis or somnambulism.

This stage of sleeping involves occurrence of vivid, colorful dreams. Usually starts about 90 minutes after sleep is initiated.

Rapid eye movements occur during this stage of sleep. Heart rate and respirations also fluctuate

The longer the person sleeps and the more sleep cycles they go through, the longer this phase of sleep lasts.
REM (averages 20 mins)

The nerve cells of the hypothalamus control this.
Circadian rhythm

Newborns require the _____ amount of sleep and elderly require the _______

Patient education about normal features of sleep during infancy should include what?
Eye movement, Grimacing, body movement
Are all normal for this age group.

New borns typically sleep how long between feedings?
2 to 4 hour blocks

T/F It is okay for older infants to sleep on their stomachs?
True. Older infants have developed good head control

Toddler and preschoolers typically sleep for how long?
10-12 hours

A patient is showing signs of withdrawal and providing vague physical complaints. They are probably deprived of what stage of sleep?

Characterized by the inability to regulate the sleep wake cycle

A patient is undergoing a polysmonography and it is noted that within a few minutes, the patient has already entered REM sleep. This is most likely a positive indication for what condition?

A woman and her husband are sleeping. He is overweight and also smokes. Suddenly she is awoken by snorting sounds and sees his chest and abdomen moving. After 10 seconds he is awake it stops. Her husband probably has what condition?
Obstructive sleep apnea

Pulmonary hypertension, left sided heart failure can result from prolonged what?
Sleep apnea

Risk factors for OSA
obesity, large neck circumference, smoking, alcohol use and family history of OSA

A patient has low 02 sat, acidosis, and hypercapnia. What condition might they have?

Sleep deprivation can eventually lead to what?

Negative health effects of sleep deprivation
-disorientation and hallucinations
-glucose metabolism
-increased freq of seizures
-obesity and weight gain

The most effective treatment for sleep deprivation
correction of the factors that are interrupting the sleep pattern

patients in which care units are especially at risk for sleep deprivation
acute care units (intensive care, cardiac carE)

Disorders associated with abnormal sleep behaviors, rather than disorders of sleep itself.

T/F You should attempt to wake a person from parasomnia
False. Safety needs are met, but encourage the person to go back to sleep as the event ends.


effective interventions for nocturnal enuresis are currently
bed alarms. also behavioral therapy in conjunction with bed alarms

parasomnia in which the person wakes up in a terrified state. Can be triggered by fever, lack of sleep, alcohol, conflict, emotional stress
sleep terrors. Effects children most often

clenching or grinding of teeth, possibly related to stress.

A disorder that effects sleep (ex: heart failure, COPD, pain, gastric reflux, depression)
secondary sleep disorder

snacks that contain ____ can be used to promote calmness and relaxation
complex carbohydrates

children and adults who sleep less per night are more likely to be _______

T/F Small amounts of alcohol can help some people fall asleep
True, but this increases wakefulness in last half of the night

Alcohol typically inhibits which phase of sleeping?
REM. Called a hangover bro.

These types of drugs suppress REM sleep

A patient should have how much time in-between activities to allow for rest or sleep
90-120 minutes

Pain from coronary artery disease is more likely to occur during which phase of sleep?

People with hypertension often wake up when and experience what?
early mornings. fatigue

Epileptic seizures occur most often during what phase of sleep?

What are some physical signs that may indicate potential sleep problems?
obesity, thick neck, nasal polyps, deviated sputum, shortness of breath

Normal episodes of OSA per hour
5 per hour

Mild OSA episodes per hour
5-15 episodes per hour

Moderate OSA episodes per hour
15-30 episodes per hour

Severe OSA episodes per hour
30 or more apneic or hyopneic episodes per hour

T/F Medications reset the circadian rhythym

Treatments for insomnia include
simulus control
sleep restriction
sleep hygiene
cognitive therapy (relaxing and changing patterns)

Treatments for hypersonmia is aimed at
correcting underlying conditions contributing towards hypersomnia

People with narcolepsy should avoid
heavy metals
long distance driving
long periods of sitting

Treatments for OSA are
lifestyle changes:
sleep practices
decrease alcohol intake
no use of tobacco
weight loss

CPAP is commonly used in patients with which condition?

Infants and older adults often sleep best in
softly lit rooms

A patient who is having trouble going to sleep can be provided (as diet tolerates)
piece of toast, crackers, glass of juice, milk (serotonin helps induce sleep)

Exercise causes fatigue and relaxation. This can increase which phases of sleep?
NREM and REM. It is not recommended to do vigorous exercises within 2 hours of sleep

Sleep rarely occurs until a person is

Interventions to enhance sleep at home?
sleep diary

addresses issues of health, disease and disability found within a defined group of people (or population) or in a specific person as a member of that community
community health

examines the greater community as a whole- the city, state, nation, continent, world—-and designs collaborative and interdisciplinary strategies to keep the population healthy
public health nursing

group of clients within a community
target population, or target of interest

examples of public nurse interventions
-advocating with housing authorities to ensure accessible and safe housing
-planning multilingual, culturally based immunization clinics to increase participation
-investing the inciendce of food born illness

Who requires public health nurses to coordinate services, provide health education, promote healthy lifestyles, consult with govt officials, and participate with regulatory activities?

the conditions in which people are born, grow, live, work, and age, including the health system
social determinants of health

social determinants of health are affected by?
-organization and government policies
-health literacy
-where you live or work
-social exclusion
-family structure and more.

Can cause a population to either be health, or vulnerable to disease and disability. Has both plus and negatives to it
social determinants

public health nursing focuses on
-disease prevention
-health protection
-health promotion within identified populations

Who develops programs to address health concerns globally in response to data collection and analysis conduced worldwide

The provision of skilled nursing care outside traditional care setting is called
community based nursing

critical roles played by the community based nurse
-advocating for patient
-conducting routine check ups
-caring for sick or dying
-providing client education
-managing chronic client conditions
-home care
-Education (key role_

the purpose of ____ ____ ____ ____ is to promote, maintain, or restore health at an optimal level of functioning and reduce the effects of disability and illness for individual clients and their families
home health care nursing

home health care services are reimbursed by:
-private health insurance

includes interventions designed to prevent disease or disability. Examples: wellness programs, fitness classes, nutrition education
primary prevention

focuses on early identification of a illness or phenomenon and limitation of its impact or recurrence through specific interventions. Examples: bp screening, routine blood sugar screening
secondary prevention

addressing childhood obesity might be considered what level of prevention
secondary prevention

involves interventions for those already experiencing symptoms of disease. Focuses on maintenance and restoration, rehab
tertiary prevention

A nurse who is response for monitoring blood glucose levels for a student diagnosed with diabetes would be practicing what level of prevention strategy

host/ intrinsic factors
genetics, age, gender, ethnic group, immunization status, human behavior

environmental factors/extrinsic factors
immediate physical environment. food, vectors of disease, socioeconomic influences

purpose an epidemiologist is to
establish programs to prevent the development of disease and control its spread

consists of studies that are conduced once a disease is evident. Time and place and characteristics of people with the disease are considered
descriptive epidemiology

generates a hypothesis of why the disease might be occurring in the community and tests that hypothesis. Ex: analysis of pollution
analytic epidemiology

variables to consider when identifying a vulnerable population
-marital status
-educational level
-crime level
-use of illegal or regulated substances

useful demographic assessment tools and community health planning resources
-United states census data
-State department of health data websites
-Health people 2020

Assessment of the community begins with what type of collection of data?
broad based (both community and client)

a nurse is driving through a community and observing the community. What would this be called?
windshield survey

After the collection of data, the nursing process consists of four stages:
-diagnose greatest problems or needs
-establish goals
-plan interventions on primary, secondary, tertiary level
-evluate effectiveness of interventions

24 page assessment for adult home care clients used to track outcome based quality improvements

Factors that a nurse would assess that could impact client safety:
-carpet or throw rugs
-safety railings or pull up bars
-height of toilet
-ability to prepare meals
-dress and bathe independently
-safe: clean, smoke alarms?

individuals or groups with an investment or significant interest in a topic

A community based nurse should be familiar with
referral agencies

is often defined as the absence of something to which the affected person has formed an attachment and can involve people, places or things

Just like pain, the meaning of what is determined by who, therefore making it a subjective experience
the person affected by the loss

an emotional response to loss

T/F: as the significance of the loss increases, a deeper level of grief along with more acute feelings of loss can be expected

What are some examples of reminders that can elicit a grief response, even years later
people, places, sighs, sounds, visiting a favorite place.

See page 1113 table 41-1 for common reactions to loss

Defined as the cognitive, affective, cultural and social reactions to an expected death. This type of grief occurs BEFORE an actual death occurs
anticipatory grief

Emotional support with positive presence, active listening, and reassurance while encouraging verbalization of the upcoming loss would be interventions for what type of grief.
anticipatory grief

The outward social expression of loss. Can be demonstrated by cultural norms, customs, rituals, traditions and religious or spiritual beliefs

Worden describes the process of grieving as a series of tasks. Those tasks consist of?
(1) accepting the reality of the loss. Shock–>disbelief–>reality of actual loss
(2) grieving person works through the pain of grief, experiencing emotional, cognitive, behavioral responses
(3)emotional relocate the decreased and move on

includes both fried and mourning and can be described as the inner feelings and outward expression that people experiencing loss demonstrate

can be described a period of time that the pain of loss is felt, the person experiences the grieving process, and begins to adjust to life.

Care of the dying consists of four areas of knowledge and skill
(1)scientific and clinical knowledge
(2)interpersonal skills
(3) sound ethical and professional pricinples
(4) skills or organization

skills that will allow the nurse to rapidly respond to potentially difficult and distressing problems related to end of life care.
Scientific and clinical knowledge

skills that include the ability to listen to patients and families, as well as other members of health care team.
interpersonal skills

When the bereaved person is unable to progress through the stages of grief, this type of grief occurs
complicated grief

complicated grief typically lasts how long after the death of a significant person
6 months or more

if a death is related to trauma, suicide, homicide o any other sudden or unexpected death, this increase the risk for ____ ____
complicated grief

this type of grief typically results in a person being unable to continue normal life processes
complicated grief

Type of complicated grief that is characterized by reactions that do not diminish over time and continue for an indefinite period
chronic grief

type of complicated grief that is characterized by the survivor being overwhelmed with grief and being unable to function in daily life. they may exhibit self destructive behaviors, and potential for suicide is increased
exaggerated grief

this type of complicated grief is characterized by suppression of the grief. the person consciously or unconsciously avoids the pain that has occurred with the loss
delayed grief

this type of complicated grief occurs when the behaviors of the survivor interfere with normal functioning, BUT the person is not aware that its concealing the normal grieving process
masked grief

any loss that is not vlaieded or recognized. occurs when loss can not be openly acknowledged or publicly shared
disenfranchised grief

factors that contribute to the grief and bereavement process
(1)importance that was attributed to the loss
(2)circumstances of the death
(3)nature of the relationship to the deceased

Age group that often feels intense emotions while working towards the resolution of a loss

example of a loss that occurs as a result of growing older
-loss of ability to perform ADL

people who were the primary caregiver of the decreased most often have neglected what?
Their own health care. Undiagnosed and untreated health problems pose a major concern

When a loss is related to a murder, what can be compromised in the survivor?
sense of security, sense of control

occurs with a sudden, violent or traumatic, multiple deaths, loss that is related to social stigma, or death of a young person
complicated loss

sudden death results in a feeling of:
being out of control, wondering about meaning of death or even life

Physical symptoms of death include:
-weakness and fatigue
-increased drowsiness
-sleeping more and responding less
-decrease in oral intake and impaired gag reflex
-surges of energy
-changes in bowel habits
-cold extremities
-vital sign changes
-death rattle: secretions build up

cooling after death
algot mortis

skin becoming pale and bluish
liver mortis

stiffening of the joints of the body
rigor mortis

it is extremely important for the nurse to develop what during experience of lsos
trust and rapport

legal documents that allow people to communicate their wishes about the type of medical care they would like to receive at end of life
advance directives

includes hospice care, but is not of this type of care is hospice care
palliative care

this type of care is provided for patients who are expected to live on 6 months or less

begins at the time of diagnosis and includes curative measures
palliative care

the goal of hospice care is:
symptom control and quality of life measures

hospice occurs in various settings with a focus on
symptom control and understanding that dying is normal

states that this type of care improves quality of life of patients families who face life threatening illness, by providing pain and symptom relief, and spiritiual/psychosocial support from diagnosis to end of life
palliative care

used on conduction with other therapies that are intended to pro-long life, such as chemotherapy or radiation therapy
palliative care

what can be disruptive and distressing to a patient who is actively dying
transferring to a new facility. only done if patient or family requests change

Care of the patient who is imminently dying consists of basic nursing care, which involves:
-gentle bathing
-peri care
-oral care
-decreasing environmental stimuli
-symptom management and comfort
-management of airway issues

a patient is confused and states that she is seeing her deceased mother. she is also reaching out and grabbing onto something in the air. This patient is likely experiencing what
near death awareness

pronouncing death begins with
identifying the patient

documentation of the time of death includes:
-patients name
-time the call was made
-actual findings upon physical examination

T/F you should remove any invasive tubing or lines before an autopsy is performed
false. . If no autospy is performed, medical equipment and tubing can be removed.

Bereavement support begins when after a death?
immediately to begin to say goodbye and let go

After the death of an infant, it is encouraged that the parents do what?
Hold their child. The baby is wrapped snugly in a blanket. Siblings can participate in this process

T/F You should limit the information you provide children who were closed to the decreased to prevent any emotional trauma.
False. You should be open and honest and answer any questions they may have.

People who are grieving need to demonstrate what:
(1) that they can talk about the meaning of their loss
(2) use available support systems
(3}) deal with the loss as they move through the stages of grief

this can occur when a nurse is exposed to frequent loss and death and available time for grief may be inadequate before another patient dies
accumulation of loss

sometimes nurses develop methods called ___ ____ to temporarily cope with loss and grief
defense mechanisms

this will strengthen the nurses ability to continue providing effective care
-proper diet, exercise, sleep, time for relaxation, vacations. (self care)

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