ADPIE Assessment: deliberate systematic collection of data to determine current and past health status, including patient’s ability

to function and cope. Identification actual or potential health problems, needed to formulate a nursing diagnosis. Collection and verification of data Data Collection: Subjective data: Information given directly from the patient ( i.e. pts perception understanding and interpretation of what is happening. Objective Data: concrete observed and collected information Sources of data: client ( primary source) family members, medical records Methods of collection: Health Hx, Interviewing using open ended questioning, Physical exam, vital signs, diagnostic testing Purpose Health Hx Nursing Dx and care plan Mange patient problems Evaluate nursing care Steps: Collection and verification of data from primary source and secondary source the analysis of all data as a basis for developing a nursing diagnosis identifying collaborative problems and developing a plan if pt centered care. Gather health history - Biological data - Chief complaint - Present health concerns - Past history - family history - review of systems - patient profile Cultural considerations: consider health believes, use of alternative therapies, nutritional habits, relationship with family and personal comfort zone, perception and reporting, Physical example: Head to toe, baseline vitals

Diagnosis: a nursing diagnosis is a clinical judgment about individual , family, or community responses to actual and potential health problems or life processes. It focuses on a client’s response to a health problem, rather than a physiological event, complication, or disease. Critical thinking:

Decision making steps - Interpret & analyze data - cluster findings - Group signs - Group behaviors - Look for defining characteristics: clinical criteria or assessment findings that support an actual Dx. Clinical criteria can be either objective or subjective signs and symptoms, clusters of signs and symptoms, or risk factors that lead to a diagnostic conclusion. Approach: Diagnostic reasoning: assessment data Defining Characteristics: assessment findings Clinical criteria: signs and symptoms Components of a nursing Diagnosis: Problem : Diagnostic label : What is the problem from the nursing assessment: NANDA Etiology : Related to factors : what is causing the problem: 4 categories Pathophysiological, treatment relates, situational (environmental or personal), Maturational ( age related), something that can be treated by the nurse, not medical dx Symptoms: Defining characteristics: objective and subjective data Planning: Priorities !!! ABC ⇒ Safety ⇒ Maslow Two step process: Writing measurable outcomes with pt specific goals developing nursing interventions Expected outcomes: measurable criteria to evaluate goal achievement Goal: A broad statement describing a desired change in a client’s condition or behavior Outcomes: S: specific M: measurable A: Attainable R: Realistic T: Timed Two types of goals: - Short term: achieved in one week or less - Long term: achieved in weeks or months Nursing interventions: actions used to achieve the desired outcomes/goals NIC: nursing intervention classification: - 3 types: independent, dependent, collaborative - 2 other classifications: direct, along with pt, or indirect, on pt’s behalf

Review all consequences to nursing Dx .Determine how this will affect the client Focus on the set outcomes and goals. Negotiate a plan 7. Verbalize the problems 5. Evaluate the plan Preventative ethics: Advance directives: decisions made by competent individual about their future health care Living Will: Identifies treatments a person wants or does not want or wants should he or she become unable to make their own decisions – enforceable by law Durable power of attorney for health care: A person legally designated to make health care decisions for an individual who is no longer able to make decisions for themselves Infection control: Chain of infection: Must have at least 3 elements Infective agent Reservoir Portal of exit Means of transmission Portal of entry Susceptible host . Is there an ethical dilemma 2. continuous assessment of outcomes and goals Documentation: DAR D: Data A: Action (intervention) R: Response (pt’s response to interventions) Ethics in Nursing Autonomy: right to self determination. putting their interests above your own Nonmaleficence: Do no harm Justice: fairness Veracity: truthfulness Fidelity: being true to your word Ethical Decision Making: Seven Step process 1. and freedom of decision. Identify possible courses of action 6. Gather all relevant data 3. carrying out plan of care Critical thinking approach: .Determine probability of the consequences . right to refuse care Beneficence: Positive action don’t to benefit others. Clarify Values 4.Review all NIC .Implementation Phase: action phase. independence.

increased pulse. Diff clinical manifestation: Watery diarrhea (10-15*/ day) ABD cramping Fever Blood and pus in stool Nausea Dehydration Loss of appetite Weight loss Risk factors: Antibiotic exposure GI surgery Immunocompromised Potential complications Hypovolemia . diff clostridium difficile: spore-forming gram-positive anaerobic bacillus. loss of infection Clinical Manifestations: Increased WBC. malaise. Radiation. usually seen with antibiotic use. contact with personal items. Allergens. Nausea. Infection Local response: redness. anorexia. invasive procedures. heat. swelling.Inflammation: Vascular and cellular response Inflammatory exudate Tissue repair Inflammatory response: Always present with infection Causes: Heat. c. carrier C. diff releases several toxins which attack cells and can lead to death C. contact with infected surface Risk Factors: immunocompromised. fever HAIs Factors: Rate of contact: # of times a person comes in contact with health care worker Invasive procedures Therapy Length of stay Two types HAIs Exogenous infections: MRSA Endogenous Infection: C. and respiration. Diff MRSA: death caused by sepsis Occurs from: skin-skin. Trauma. pain.

skin intact Stage 2: Partial thickness. or both.Renal failure Peritonitis: bowel perforation. or shallow crater .⇑pressure ⇒ occluded blood vessel ⇒ tissue ischemia ⇒ Tissue death Length of time pressure is exerted Ability of tissue to tolerate externally applied pressure Contributing Factors Shearing force: pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement Friction Excessive Moisture Pressure Ulcer staging Stage 1: persistent redness in lightly pigmented skin . toxic megacolon Death Infection Prevention: Chain of infection Asepsis: Hand hygiene Standard precautions Disinfect & Sterilize Patient education: Hand hygiene Personal care products Cough etiquette Hygiene Peri-care Wound Care: Prevent and manage infection Cleanse wound Removable nonviable tissue Manage exudate Maintain the wound in a moist environment Protect the wound Pressure ulcers : localized area of tissue necrosis caused by unrelieved pressure that occludes blood flow to the tissue Influencing factors Amount of pressure: if pressure is greater on capillary than normal capillary pressure it will collapse . dermis. presents as an abrasion. intact or ruptures blister. loss of epidermis.

muscle Stage 4: Full thickness loss can extend to muscle. escar. pain. consistency. stage. location. may require debridement May allow eschar to act as a physiological cover Possible complication: Recurrence Cellulitis Chronic infection Osteomylitis Assessment: Stage Percentage Color Measurement Exudate: amount. down to but not through underlying fascia. or wound dressing Good nutrition Self care and signs of breakdown Initiate specialty services if needed Musculoskeletal Osteoporosis: Chronic progressive metabolic bone disease characterized by Porous bone Low bone mass Structural deterioration of bone tissue Increased bone fragility More common in women because ….. color. or tunneling may be present Unstageable: wound covered by eschar. Slough. exudate. or supporting structures. Lower calcium intake then men Less bone mass because of smaller frame Bone reabsorption begins earlier and accelerates after menopause Pregnancy and breastfeeding deplete woman’s skeletal reserve of calcium Longevity increases likelihood of osteoporosis. and tissue appearance Keep ulcer bed moist Cleanse with nontoxic solutions Debride Use adhesive membrane. tendon. women live longer than men Etiology and Pathophysiology Peak bone mass is achieved before age 20 Bone loss after midlife is inevitable but rate of loss is variable In osteoporosis bone reabsorption exceeds bone deposition . odor Surrounding skin condition Treatment: Document : size. Does not expose bone. infection. or muscle may be visible or palpable.Stage 3: Full thickness skin loss involving damage or necrosis of subcutaneous tissue. bone. Bone tendon. ointment.

common in older adults who have a short term illness Develops in three days!!!!! Acute. hips. and wrist Many drugs can interfere with bone absorption Walking is best weight baring exercise Risk Factors Female Increased aging Family Hx White or Asian Small structure Early menopause Excess alcohol intake Cigarette smoking Anorexia Oophorectomy Sedentary lifestyle Insufficient calcium intake Low testosterone levels in men Diagnostics Hx and physical Bone mineral density Change in height is # 1 indicator Osteopenia is more than normal bone loss but not yet at the level of osteoporosis Good sources of calcium Sardines Milk Yogurt Turnip Spinach Cottage cheese Ice cream Supplement Vitamin D Delirium vs. Dementia Delirium: State of temporary but acute mental confusion. sudden.Occurs most commonly in spine. unexpected Early manifestations Inability to concentrate Irritability Insomnia Loss of appetite Restlessness .

Cognitive impairment Disorientation Clouded sesnorium Dementia: Syndrome characterized by dysfunction or loss of : Memory Orientation Attention Language Judgment Reasoning Can manifestations …. family Hx. chronic progressive. and require total care Diagnostics Dx of exclusion Comprehensive Pt evaluation . hallucinations Alzheimer’s disease: #1 form of dementia. more common in women Caused by changes in brain structure and function: Development of plaques and tangles Loss of connection between cells and cell death Leads to brain atrophy Pathological changes begin 5-20 years before clinical manifestation . progression is variable ranges 3-20 years Late stages Long-term memory loss Unable to communicate Can’t perform ADLs Pt may become unresponsive. degenerative disease of the brain Age is most important risk factor. incontinent.Confusion Later Manifestations Agitation Misperception Misinterpretation Hallucinations Manifestations are sometimes confused with dementia and depression Key distinction is patient with delirium exhibits sudden…. delusions. Personality changes Behavioral problems: agitation.

accumulation of water .Brain imaging Definitive dx can only be made at autopsy SLEEP Purpose of sleep Remains unclear Physiological and psychological Maintenance of biological function Dreams Occur in NREM and REM Important for learning. and adaptive to stress Rest contributes Mental relaxation Freedom from anxiety State of mental. 3rd leading cause of blindness Etiology and Pathophysiology Age Blunt trauma Congenital factors Radiation and UV light exposure ( Tanning beds) Long-term corticosteroid use Ocular inflammation Senile cataract Most common Altered metabolic processes cause . physical and spiritual activity Sensory Cataract: cloudy or opaque lens interferes with passage of light causing glare or blurred vision.Altered lens fiber structure Clinical Manifestations Decreased vision Abnormal color perception Glaring of vision Diagnostic studies Past medical Hx Physical examination Visual acuity Ophthalmosocy Slit lamp microscopy Glare Testing Glaucoma . memory.

directness.A group of disorders characterized by Increased IOP against optic nerve Optic nerve atrophy Peripheral visual field loss Balance between aqueous production and reabsorption needed for normal level of IOP Communication Verbal Communication Sign language. and sincerity Dress and attire Visual aids Personal space Eye contact Emotional content Setting time place Rhythm and pacing Attitude and confidence Agenda Silence Actions speak loader then words Factors influencing communication Physical and emotional factors Developmental factors Sociocultural factors Gender Therapeutic communication Active listening Sharing observations Sharing empathy Sharing feelings Using touch Using silence . or spoken word Vocabulary Denotative and connotative meaning Pacing Intonation Clarity and brevity Timing and relevance Nonverbal communication Body language Voice quality Manner. written.

inhalation. nose.Providing information Clarifying Focusing Paraphrasing Asking questions Summarizing self-disclosure Confrontation Nontherapeutic communication Asking personal questions Giving personal opinions Changing the subject Automatic responses False reassurances Sympathy Asking for explanations Approval or disapproval Defensive responses Arguing Respiratory Physiology of Respiration Ventilation Compliance Diffusion Oxygen-hemoglobin dissociation Atrial blood gases Mixed venous blood gases Oximetry (finger.Peripheral: respond to decrease O2 levels Pneumonia: Acute inflammation of the lungs caused by microbial organism. and hematogenous spread Types of pneumonia: . leading cause of death in the US from infectious disease Etiology: Likely results when defense mechanisms become incompetent or overwhelmed Mucociliary mechanism impairment Alteration of leukocytes from malnutrition Immunosuppression from other disease processes Three ways organisms can reach the lungs: Aspiration. toes) Oxygen delivery Control of respirations Chemoreceptors .central: respond to co2 increase .

exercise Drug therapy Patient education Stress management Secondary hypertension: Elevated BP with an identifiable cause Congestive heart failure CHF . Usually occurs 48-72 hours after aspiration Opportunistic pneumonia: Immunocompromised patients . usually follows aspiration of material from the mouth or stomach into the trachea and then into the lungs.Diet . chemotherapy. pts with protein-calorie malnutrition.Community-Acquired Pneumonia: is defined as a lower respiratory tract infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization Hospital-Acquired pneumonia: occurs after the first 48 hours of admission and not incubated at the time of hospitalization Aspiration pneumonia: Sequela occurring form abnormal entry of secretions or substances into the lower airway. radiation. current use of antihypertensive medication BP = Cardiac output * systemic vascular resistance Sutohypertention caused by calcification of veins Primary hypertension: No identifiable causes Risk factors Age Alcohol Cigarette smoking DM Elevated serum lipids Excess dietary sodium Gender Family Hx Obesity Ethnicity Sedentary lifestyle Socioeconomic status Stress Treatment and Prevention Lifestyle modifications . patents who are being treated with immunosuppressive drugs. and corticosteroids Cardiovascular system Hypertension: Persistent elevation of systolic BP equal to or greater than 140 or diastolic BP equal to or greater to 90.

nausea. GI suctioning. emphysema). the pressure in the veins of the lung increases causing fluid accumulation in the lungs. fever. and extremities. inability to access fluids. the right ventricle becomes to damaged and is unable to pump blood efficiently to the lungs and left ventricle. the gastrointestinal tract. decreases intake (anorexia. congenital heart disease clots in pulmonary arteries pulmonary hypertension heart valve disease. and third-space fluid shift. Left Sided Heart failure The left side of the heart receives oxygenated blood from the lungs and pumps it into systemic circulation. burns. fistulas. diarrhea. the body does not receive enough oxygen. as in vomiting. As the ability to pump blood out of the left ventricle is decreased. . Causes of left-sided heart failure Alcohol abuse MI Cardiac infection Hypertension Hypothyroidism Leaking/narrowing valves Clinical Manifestations Abnormal heart sounds (murmur) Abnormal lung sounds Edema Distended neck veins Hypotrophy of liver Dysrhythmias Weight gain Fluid and electrolytes Hypovolemia: fluid volume excess: loss of water and electrolytes.Right-sided Heart Failure The right ventricle loses it’s ability to contract. blood loss. Diabetes insipidus and uncontrolled diabetes mellitus also contribute to a depletion of extracellular fluid volume. causing congestion. excessive sweating. Causes of right-sided heart failure left-sided heart failure lung diseases (chronic bronchitis. Resulting in shortness of breath and pulmonary edema. causing fatigue. Blood backs up into the liver. causing blood to back up into the body.

heart failure.Signs and symptoms Acute weight loss Decreased skin turgor Oliguria Concentrated urine Weak rapid pulse Capillary refill time increased Low CVP Decreased BP Dizziness Flattened neck veins Weakness Confusion Thirst Increased pulses Muscle cramps Sunken eyes Hypervolemia: fluid volume excess: compromised regulatory mechanism. prolonged corticosteroid treatment. Signs and Symptoms Acute weight gain Peripheral edema Ascites Distended jugular veins Crackles in the lungs Elevated CVP SOB ⇑ BP Bounding pulse and cough ⇑ respiratory rate Sodium imbalance (neurological) Excess: Hypernatremia Thirst CNS deterioration Increased interstitial fluid Elevated body temp Swollen dry tongue and sticky mucus membrane Hallucinations Lethargy Restlessness Irritability Seizures . sever stress. over consumption of sodium containing fluids. cirrhosis. such as renal failure. and hyperaldosteronism contribute to fluid volume excess. fluid shift (treatment of burns).

Hyperglycemia .Pulmonary edema ⇑ BP ⇑ pulse Deficit: Hyponatremia CNS deterioration Potassium imbalance: ( cardiac) Excess: hyperkalemia V-fib ECG changes CNS changes Deficit: hypokalemia Bradycardia ECG changes CNS changes Diabetes Glucose: energy Two sources: Food: absorbed into bloodstream. Hispanic. insulin assists glucose into tissues and cells Liver: Stores glucose as glycogen and releases it when blood glucose levels are low (gluconeogensis) Type 1 Diabetes Risk factors: Unknown Family Hx Type 2 Diabetes Risk Factors: Weight: high amounts of fatty tissue causes insulin resistance Inactivity: Increased weight. Native American.Hyperosmolar hyperglycemic syndrome .diabetic ketoacidosis . making tissue and cells insulin sensitive Family Hx Race: African American. exercise uses up glucose. Asians Age: >45yo Gestational Diabetes Polycystic ovarian syndrome HTN High LDL/HDL Diabetes PCs Acute complications .

Infection Urinary 24 hour urine specimen collection: Always through away the first urine because you need to start with an empty bladder. 2000-3000mL of urinary retention is considered a medical emergency. unsure that serum creatinine is determined during 24 hour period. Urinary retention: the inability to empty the bladder completely despite micturition or the accumulation of urine in the bladder because of inability to urinate. medical emergency Chronic urinary retention: incomplete bladder emptying despite urination. Acute urinary retention: the complete inability to pass urine via micturition. and 4. Can be associated with urinary leakage or post void dribbling. at the end of 24 hours instruct patient to urinate.Retinopathy: can lead to blindness. 24 hr urine is collected to check clearance of creatinine by the kidneys.3. 12-24 hour urine test may also be done to test for protein in urine. also at risk for cataracts and glaucoma .LE complications related to decreased sensation . chronic alcoholism and drugs. Deficient detrusor contraction strength leads to urinary retention when the muscle strength is no longer able to contract with enough force or for a sufficient period of time to completely empty the bladder. given an estimate of the GFR. dyslipidemia . Common cause enlarged prostate. E. coli most common cause. keep collected specimen on ice or refrigerated. primarily body muscle mass. it is more accurate then dipstick. Normal postvoid residual volume 50-75ml a finding of over 100ml indicates the need to repeat measurement An abnormal PVR in an elderly pt is a measurement of > 200ml on two separate occasions Urinary retention is caused by two different dysfunctions of the urinary system: bladder outlet obstruction and deficient detrusor contraction strength.Hypoglycemia <70 can be fatal because brain needs glucose to function Chronic complications . Creatinine is a waste product of protein breakdown. persistent proteinuria usually indicates Glomeruli renal disease. over distention. called overflow urinary incontinence. long standing DM.Neuropathy .CVD: Atherosclerosis. .Integumentary complications . Pregnant women are at increased risk. PVD.. primarily in women. Common causes of deficient detrusor contraction strength are neurological diseases affecting sacral segment 2. Obstruction leads to urinary retention when the blockage is sufficiently severe so that the bladder can no longer evacuate its contents despite detrusor contraction. HTN. URINARY TRACT INFECTION: Page 1155 Lewis Most common bacterial infection in women. There are also fungal and parasitic infections but they are less common Kidney infections may present as lower back pain. cerebrovascular.

glycogen rich epithelial cells and normal flora keep the vaginal pH acidic (3. including UTI and urinary retention . pregnancy-induced changes. and flank pain Lower urinary tract infection: confined to lower urinary tract and usually has no systematic manifestation Pyelonephritis: inflammation of the renal parenchyma and collecting system Cystitis: inflammation of the bladder wall Urethritis: inflammation of urethra Urosepsis: UTI that has spread into systemic circulation. ureters. and urosepsis UTI’s can also be classified by their natural history.0) high urea concentration. stones. and a increase in vaginal pH. or recurrent Bodies natural defenses against UTIs Normal voiding with complete bladder emptying Ureterovesical junction competence Peristaltic activity that propels urine towards bladder. diabetes.5). In postmenopausal women. Treatment giving women low dose estrogen replacement to acidify the vagina After seven days on antibiotic therapy pcp my order a repeat UA to check for nitrates to make sure UTI has been completely eliminated Urinary Incontinence : an under diagnosed and underreported problem that can significantly impact the quality of life and decrease independence. medication and underlying physical conditions. Causes may include cognitive decline. secondary infection. a decrease and lactobacillus. renal damage. increasing the risks for a UTI. typically causes fever.When an older adult has an UTI it may manifest as confusion!!!!!! Classification: Upper urinary tract infection: involves renal parenchyma. and abundant glycoproteins that interfere with bacterial growth Menopause and UTIs Before menopause . a life threatening condition. Uncomplicated: are infections that occur in otherwise normal urinary tract usually only involves the bladder Complicated: are the infections that coexist with obstruction. and my lead to compromise of the upper urinary tract. chills. lower estrogen levels cause vaginal atrophy. Patients with complicated UTI’s are at risk for Pyelonephritis. for example initial infection. Antibacterial properties of urine (pH<6. pelvis.5-4. catheters. neurological disease. or an infection that is recurrent.

or demanding. threatening. Latrogenic: is an unknown cause Mixed Incontinence: combination of Stress and Urge incontinence Problems with fecal incontinence may signal neurological causes for bladder problems because of shared nerve pathway. when combined with urge incontinence is referred to as mixed incontinence.Types: Stress Incontinence: Most common type. Protein. sneezing. glucose. Stress can facilitate growth and personal development. coughing. causing inadequate bladder emptying. The appraisal or perception of a stressor. overflow incontinence and infection. nitrates. Abnormal UA findings: Ketones. People experience stress as a consequence of daily life and stress can be helpful in stimulating thinking processes and helping people stay alert in their environment. Education on kegal exercises. How people react to . Urge Incontinence: over active bladder is common cause Reflux Incontinence: leakage with out warning may be caused by neuro defect Overflow Incontinence: caused by full bladder. Constipation and impaction can partially obstruct the urethra. distention Functional Incontinence: is caused by loss of cognitive function. blood Fecal incontinence: Occurs with Motor and sensory dysfunction Weakness or disruption of anal sphincters Nerve Damage Trauma Constipation: Causes: Insufficient dietary fiber Inadequate fluid intake Decreased physical activity Ignoring the urge to defecate Medications Neuro dysfunction Emotions Bowel obstruction Watch for laxative abuse!!!!! Stress and coping Stress: is an experience that a person is exposed to through a stimulus or stressor. environment. possible in ability to urinate. Stress can also be a link between environmental demands and a persons perception of those demands as challenging. may be caused by poor pelvic muscle strength leading to possible leakage when laughing.

its effect on their situation and support at the time of the stressor. disequilibrium occurs. and a crisis results. The increased blood volume (from increased extracellular fluid and the shunting of blood . stressors have the potential to lead to alterations in immune system function. of what is happening and what they are able to do about it Suicide: is caused by an inability to cope Body’s response to stress: Interrelationship of Nervous system: Cerebral cortex: evaluates and plans course of action. and their usual coping methods. increased 02 consumption. theses functions are involved in the perception of a stressor Limbic system: mediator of emotions and behavior. Corticosteroids play an important role in turning off the stress response . Immune system: Brain is connected to the immune system by neuroanatomic and neuroendocrine pathways.stress depends on how they view and evaluate the impact of the stressor. behaviors. is central to the connection between the nervous system and endocrine system in response to stress. When stress overwhelms a person’s existing coping mechanisms. Corticosteroids are essential for the stress response. which if left uncontrolled can become self-destructive. stimulated by limbic system. an event or thing that has caused an individual stress. increased cerebral blood flow increases mental alertness. and inhibiting inflammation response. the person has experiences a trauma Stressors: disruptive forces operating with in or on any system . they produce a number of physiological responses including increased blood glucose. Endorphins have an analgesic-like effects and blunt pain perception during stress situations involving painful stimuli. potentiating the actions of catecholamines on blood vessels. Dilation of skeletal muscle blood vessels increase blood supply to the large muscles and provide for quick movement. Reticular formation: contains RAS. When stimulated emotions. which sends impulses contributing to the alertness to the limbic system and cerebral cortex. overstimulation due to stress can lead to sleep disturbances. secretes neuropeptides that regulate the release of hormones by thee anterior pituitary . When stimulated the RAS increases its output of impulses leading to wakefulness. Endocrine System: SNS stimulates the adrenal cortex to release epinephrine and norepinephrine (catecholamines) . and feelings can occur to ensure survival and selfpreservation. Hypothalamus / Pituitary: fight or flight. Chronic stress induces immunosuppression The increase in cardiac output. If symptoms of stress persist beyond the duration of the stressor. increase in blood glucose. Both acute and chronic stress can affect immune function. which prepare the body for fight or flight. including decreased number and function of natural killer cells. and increased metabolic rate make the stress response possible. Appraisal: How people interpret the impact of the stressor on them selves.

parathyroid. blood pressure. In this stage of the General Adaptation Syndrome. During exhaustion there is potential for an individual to experience physical illness as the immune system breaks down. intestinal problems and eating issues may present. and gonadal hormones. the body is using stores of energy. the body is reacting to continued stress and the requirement to constantly prepare for action by being alarmed. case of Flight or Fight response: arousal of the sympathetic nervous system. and increasing blood glucose levels Neurphysiological responses to stress function through a negative feedback Structures that control response to stressors: Medulla oblongata: Controls heart rate. The body can activate the alarm stage many times throughout the day in response to stressful situations. Regulates the secretion of thyroid.Reacting to Ongoing Stress During resistance. the liver releases additional glucose into the blood for energy and your heart rate may rise. which produces cortisol. hormones. and respirations.Be Flight or Fight Ready The hypothalamus. increasing blood pressure. such as ACTH. Breathing may become rapid and shallow. respiratory rate. diverting blood from the intestines to the brain and strained muscles. When stress is excessive or prolonged. Heart rate increases in response to impulses from sympathetic fibers and decreases with impulses from parasympathetic fibers Reticular formation: Small cluster of neurons in the brain stem and spinal cord. Acute stress leads to physiologic changes that are important for adaptation Exhaustion. insomnia.away from the GI system) helps maintain adequate circulation to vital organs I traumatic blood loss. muscle pains. Reaction prepares you for action by increasing heart rate. headaches. the body’s immune system may become weakened or there may be damage or disease to other internal organs. minerals and glucose.Weakening of the Immune System This is the body’s response to continued long term stress. physiologic responses can be maladaptive and lead to harm and disease Pain Transduction: Noxious stimuli causes cell damage with the release of sensitizing chemicals. continuously monitors the physiological status of the body through connections with sensory and motor tracts Pituitary Gland: Produces hormones necessary for adaption to stress. During the exhaustion stage. these substances activate noiciceptors and lead to generation of action potential Transmission: Action potential continues from site of injury to spinal cord ⇒ brainstem and thalamus ⇒ thalamus to cortex for processing . fatigues. General adaptation Syndrome: When the body encounters a physical demand the pituitary initiates GAS Phases of GAS Alarm . Resistance . Symptoms such as stomach problems. adrenal and pituitary glands release additional hormones into the bloodstream in order for the body to be prepared for action.

7. 4. 2.⇑RR. 3. 8. agitation. confusion. enhancing function and quality of life Factors Influencing Pain Physiologic Affective Cognitive Behavioral Sociocultural Spiritual Psychological Cultural Treatment of pain Principals 1. anxiety.Perception: Conscious experience of pain Modulation: neurons originating in the brainstem descend to the spinal cord and release substances that inhibit nociceptive impulses Acute/transient pain Sudden onset Less then 3 months or time for normal healing to occur Mild to sever Generally can ID a precipitating event or illness Course of pain decreases over time and goes away as recovery occurs Can progress to chromic pain Clinical manifestations: ⇑HR.⇑BP. urinary retention Chronic Pain Gradual onset > 3 months Does not go away Treatment goals include: control to the extent possible. diaphoresis. Follow the principals of pain assessment Every client deserves adequate pain management Base the treatment on pt goals Use multidisciplinary approach Evaluate the effectiveness of all therapies Use both drug/non drug therapy Prevent/manage med side effects Incorporate teaching throughout assessment and treatment Distraction: redirection of attention onto something away from the pain Radiating pain: sensation of pain extending from initial site of injury to another part of the body. 5. 6. pain feels as though it travels down or along body part Legal Torts: Three types .

Intentional tort: Willful act that violates a person or property Assault Battery False imprisonment Intentional infliction of emotional distress Conversion of property. three conditions must be met 1.Adequate Disclosure Adequate disclosure of the Dx Nature and purpose of the proposed treatment Risks and consequences Probability of success Availability of alternative treatment 2. Lawyer. Transport DNI/DNR is separate . Voluntary consent: patient must not be persuaded or coerced in any way Death and Dying Loss: occurs throughout life after attachment forms Types of Loss: Grief: is the emotional response to loss Bereavement: Individual’s emotional response to the loss of a loved one Physical Manifestations: Occurs when all vital organs cease to function: irreversible cessation of circulatory and respiratory function or all functions of the brain Brain Death: cerebral cortex stops functioning or is irreversibly damaged Coma or unresponsiveness Absence of brainstem reflexes Apnea Assessment by physician DNR/DNI require physician’s orders and must be renewed. shared decision-making process between a provider and recipient of care.Understanding and Comprehension: of the information being provided before receiving sedating preoperative medication 3.destruction of persons property Quasi-intentional tort: Deformation of character: intentionally harmful slander (spoken) Libel (written) Invasion of privacy Breach of confidentiality: privileged communication DR. priest Unintentional Tort: Negligence: failure to act as a reasonable person would Malpractice: Professional negligence Informed Consent: an active.

two admission criteria ( pt wants service. 6mths or less to live) .Hospice: six months from death.

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