Fundamentals of Nursing Chapters 27, 33, and 45

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Fundamentals of Nursing Chapters 27, 33, and 45
2012-10-12 19:34:21
Teaching Hygiene Sleep

Week 6 and 7 Flashcards
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  1. List the four major areas for patient education.
    • Promotion of Health
    • prevention of Illness/Injury
    • Resotration of Health
    • Adapting to Altered Health & Function
  2. Define andragogy.
    The art and science of teaching adults.
  3. Define pedagogy.
    The discipline concerned with helping children learn.
  4. Define Geragogy.
    The term used to describe the the process involved in helping older adults learn.
  5. What are the three domains identified by Bloom in 1956?
    • Cognitive domain
    • Affective domain
    • Psychomotor domain
  6. Explain what the Cognitive Domain is.
    • The "thinking" domain: Involves six (6) intellectual abilities and thinking processes.
    • Beginning with:
    • 1. Knowing
    • 2. Comprehending
    • 3. Applying to analysis
    • 4. Synthesis
    • 5. Evaluation.
  7. Explain what the Affective Domain is.
    • The "feeling" domain: Devided into categories that specify the degree of a "person's depth of emotional responses to tasks".
    • It includes emotional and social goals such as:
    • 1. Feelings
    • 2. Interests
    • 3. Attitudes
    • 4. Appreciations
  8. Explain what the Psychomotor Domain is.
    • The "skill" domain: Includes fine and gross motor abilities
    • Such as:
    • 1. Giving an injection
  9. Name three main theoretical constructs (learning theories).
    • Behaviorism
    • Congnitivism
    • Humanism
  10. What are the 15 factors that affect learning?
    • 1. Age and developmental stage
    • 2. Motivation
    • 3. Readiness 
    • 4. Active involvement
    • 5. Relevance
    • 6. Feedback
    • 7. Nonjudgmental support
    • 8. Simple to complex learning
    • 9. Repetition
    • 10. Timing
    • 11. Environment
    • 12. Emotions
    • 13. Physiological events
    • 14. Cultural aspects
    • 15. Psychomotorability
  11. What physical abilities are important for learning psychomotor skills?
    • Muscle strength
    • Motor coordination
    • Energy
    • Sensory acuity
  12. Define Narcolepsy.
    A disorder of excessive daytime sleepiness caused by a lack of the chemical hypocretin in the area of the CNS that regulates sleep.
  13. What is REM Sleep?
    The period of Rapid-Eye Movement
  14. What is NREM sleep?
    Non-Rapid-Eye Movement
  15. Define sleep hygiene.
    • Refers to interventions used to promote sleep. Largely involves nonpharmacologic measures.
    • These involve teaching about: Sleep habits, support of bedtime rituals, the provision of a restful environment, specific measures to promote comfort and relaxation, and appropriate use of hyponotic medications
  16. Define the term circadian rhythm.
    It is sort of a 24 hour internal biological clock. It is from the latin "Circa Dies", which means "about a day".  Although sleep and waking cycles re the best known of the circadian rhythms, body temperature, blood pressure, and many other physiological functions follow a circadian pattern
  17. Describe Stage I of NREM sleep.
    Very light sleep that only lasts a few minutes. The person feels drowsy and relaxed, eyes roll back and forth (side to side), heart rate and respirations drop, and  the person is easily awakened and may deny sleeping.
  18. Describe Stage II of NREM sleep.
    Light sleep where body processes continue to slow down. Eyes usually still, heart rate and respirations continue to slow down, body temperature falls. This stage lasts about 10-15 minutes, but makes up 44-55% of total sleep. To awaken the individual in this stage of sleep requires more effort, than Stage I.
  19. Describe Stages III and IV of NREM sleep.
    This is the deepest sleep and stages III and IV only differ in the percentage of delta waves recorded during a 30 second period. During delta/deep sleep the heart rate and respirations drop to 20-30% below what they are during waking hours. It is very hard to awaken the individual. They are extremely relaxed and snoring may occur. 
  20. What physical changes happen during NREM sleep?
    • 1. Arterial b/p falls
    • 2. Pulse rate decreases
    • 3. Peripheral blood vessels dilate
    • 4. Cardiac output decreases
    • 5. Skeletal muscles relax
    • 6. Basal metabolic rate decreases by 10-30%
    • 7. Growth hormone levels peak
    • 8. Intracranial pressure decreases
  21. What are the sleeping requirements for Newborns?
    16-18 hours of sleep (usually awake 1-3 hours at a time)
  22. What are the sleeping requirements for Infants?
    At first they awaken every 3-4 hours and they eventually even out to approximately 14-15 hours of sleep
  23. What are the sleeping requirements for Toddlers?
    12-14 hours of sleep
  24. What are the sleeping requirements for Preschoolers?
    11-13 hours of sleep, which can fluctuate depending on the physical activity and growth spirts
  25. What are the sleeping requirements for school-age children?
    10-11 hours of sleep
  26. What are the sleeping requirements for Adults?
    Most healthy adults need 7-9 hours of sleep (give or take a few)
  27. What are the sleeping requirements for Older Adults?
    7-9 hours of sleep (although they usually go to bed one hour earlier and get up an hour and half earlier than young adults)
  28. What factors can affect sleep?
    • Illness
    • Environment
    • Lifestyle
    • Emotional stress
    • Stimulants/Alcohol
    • Diet
    • Smoking
    • Motivation
    • Medications
  29. Define Behaviorism.
    Learning should be based ont he learners behavior and what is directly observable. "An act is called a RESPONSE when it can be traced to the effect of a stimulus."
  30. Define Cognitivism.
    Learning is largely a mental, intellectual, or thinking process. The learner structures and processes information, perceptions are selectively chosen by the individual, and personal characteristics have an impact on how a cue is perceived. Importance is put on social, emotional, and physical contexts in which learning occurs, such as the teacher-learner relationship and the environment. 
  31. Define Humanism.
    Learning is believed to be self motivated, self initiated, and self evaluated. Each individual is viewed as a unique composite of biological, phychological, social, cultureal, and spiritual factors. Learning focuses on self development and achieving full potential; it is best when it is relevant to the learner. Autonomy and self determination are important; the learner identifies the learning needs and takes the initiative to meet these needs. Teh learner is an active participnt and takes responsibility for meeting individual learning needs.
  32. How does illness affect sleep?
    It causes pain or physical distress and requires more sleep than normal.
  33. How does the environment affect sleep?
    The absence of usual stimuli or the presence of unfamiliear stimuli can prevent sleep.
  34. How does lifestyle affect sleep?
    Exercise or desk work, late in the day, can delay sleep. This type of activity should be done earlier in the day.
  35. How does emotional stress affect sleep?
    The number one cause of sleep difficulties due to inability to relax
  36. How do stimulants and alcohol affect sleep?
    • Stimulants such as caffeine should be used early in the day, otherwise it can be difficult to fall asleep. 
    • Alcohol, while it can induce sleep, disrupts REM sleep
  37. How does a diet affect sleep?
    • Weight gain can cause broken sleep and early awakening
    • Weight loss can increase sleep and it is less broken up
  38. How does smoking affect sleep?
    • It has a stimulating effect on the body
    • It causes poor sleep (many claim they are light sleepers)
  39. How does motivation affect sleep?
    • It can increase alertness in some situations
    • EXAMPLE: An individual is tired, but they want to see a concert
    • It can also have no effect on other situations
    • EXAMPLE: An individual is tired and wants to drive longer, but may not be able to stay awake
  40. How do medications affect sleep?
    • Hypnotics: Interfere with deep sleep and suppress REM sleep
    • Beta-blockers: Can cause insomnia and nightmares
    • Narcotics: Like morphine, are known to suppress REM sleep and to cause frequent awakening and drowsiness
    • Traquilizers: Interfere with REM sleep
    • Antidepressants: Suppress REM sleep, which is considered to be therapeutic (in some cases, depriving a depressed client of REM sleep will result in an immediate but transient imporvement in mood)
    • NOTE: Clients accustomed to taking hypnotic medications and antidepressants may experience a REM rebound (increased REM sleep) when these medications are discontinued.
  41. How important is teaching to nursing?
    It is a major aspect of the practice
  42. Is teaching an independent or dependent nursing function?
    • Independent
    • You do not need a doctor's orders
  43. What does the State Nurse Practice Act state about teaching?
    • Leagal and professional responsibility
    • The Joint Commission expanded its standards - Provider must consider client literacy level, educational background, language skills, and culture
  44. What is teaching?
    • System of activities intended to produce learning
    • Process designed to produce specific learning
    • Teaching-learning process dynamic
    • Involves variety of learners and settings
    • 1. Clients and families
    • 2. Community
    • 3. Health Personnel
  45. What is the purpose of teaching, in the nursing practice?
    • Reducing health risks
    • Increasing wellness
    • Taking protective health measures
  46. Is teaching stagnet or dynamic?
  47. "To know and not do, is _____ _____ _____."
    Not to know
  48. What is learning?
    • Change in juman disposition or capability that persists and is not simply due to growth
    • Represented by change in behavior
  49. What are the attributes of learning?
    • Experience that occurs inside the learner
    • Discovery of the personal meaning and relevance of ideas = Aha moments
    • Consequence of experience
    • Collaborative and cooperative process
    • Evolutionary process
    • Process that is both intellectual and emotional
  50. What are the factors that affect learning?
    • Learning need
    • Compliance
    • Adherance
  51. There are three factors that affect learning. What does "learning need" mean?
    The desire to know
  52. There are three factors that affect learning. What does "compliance" mean?
    The desire to act on learning
  53. There are three factors that affect learning. What does "adherence" mean?
    The commitment to regimen - If we do not commit to the entire regimen of this class, we will not succeed.
  54. What is the Androgogy Concept?
    • Move from dependence to independence
    • Previous experiences can be used as a resource
    • Related to an immediate need, problem, or deficit
    • More oriented when material is useful immediately
    • Reinforced by application and prompt feedback
    • EXAMPLE: Lecture and reading alone, does not work, we need our labs!
  55. List Bloom's domains of learning.
    • Smile when you put on your thinking CAP!
    • Cognitive: Thinking level
    • Affective: Feeling level
    • Psychomotor: Physical skill level
    • ****All domains must be included in teaching plans****
  56. Which theorists believed in Behaviorism?
    • Pavlov
    • Skinner
    • Thorndike
    • Bandura
  57. What is the Behaviorist Theory?
    • Learning is based on the learner's behavior
    • Act is a response when it is traced to the effects of a stimulus
    • Conditioning used to change behaviors
    • Positive reinforcement (Skinner and Pavlov)
    • Observational learning and instruction, learn through imitation and modeling (Bandura)
    • EXAMPLE: The door closes at 9AM, people learn to be early!
  58. Nurses who use the behaviorism theory will ensure they . . .
    1. Provide sufficient practice time 2. Provide immediate and repeat testing and return demonstration 3. Provide opportunity to solve problems by trial and error 4. Select teaching strategies that avoid distracting information and evoke desired response 5. Praise correct behavior and give positive feedback 6. Provide role models of desired behavior
  59. Which theorists believed in Cognitivism?
    • Piaget
    • Bloom
    • Lewin
  60. What is the Cognitivism Theory?
    • Learning is a complex cognitive activity
    • Learner structures and processes information
    • Perception chosen by individual
    • Personal characteristics affect perceptions
    • Social, emotional, and physical contexts are important
  61. Nurses who use the cognitivism theory will ensure they . . .
    1. Provide social, emotional, physical environments conducive to learning 2. Encourage positive teacher-learner relationships 3. Select multisensory teaching strategies 4. Recognize personal characteristics have an impact on how cues are perceived 5. Develop appropriate approaches for different learning styles 6. Assess developmental and individual readiness to learn 7. Adapt teaching to developmental level 8. Select behavioral objectives and teaching strategies that encompass cognitive, affective and psychomotor domains
  62. Which theorists believed in Humanism?
    • Maslow
    • Rogers
  63. What is the Humanism Theory?
    • Learning is self-motivated, self-initiated, and self-evaluated
    • An individual is a unique composite of biological, psychological, social, cultural, and spiritual factors
    • Learning focuses on self-development and achieving full potential
    • Learning best when relevant to the learner
    • Autonomy and self-determination are important
    • Learner is an active participant and takes responsibility for meetinglearning needs
  64. Nurses who use the humanism theory will ensure they . . .
    1. Convey empathy 2. Encourage learner to establish goals 3. Promote self-learning 4. Serve as facilitator, mentor, or resource for learners 5. Use active learning strategies 6. Expose the learner to new, relevant information 7. Ask appropriate questions 8. Encourage the learner to seek answers
  65. What are the factors that affect learning?
    • Age and developmental stage
    • Motivation
    • Readiness
    • Active involvement
    • Relevance
    • Feedback
    • Nonjudgmental support
    • Simple to complex learning
    • Repetition
    • Timing
    • Environment
    • Emotions
    • Physiological events
    • Culture aspects
    • Psychomotor ability
  66. How does age and the developmental stage affect learning?
    • Age and development influence the client’s ability to learn.
    • Three major developmental stage factors must be considered at each developmental period throughout the life cycle, they are: physical, cognitive, and psychosocial maturation.
  67. How does motivation affect learning?
    The desire to learn. It greatly influences how quickly and how much a person learns. Motivation is generally greatest when a person recognizes a need and believes the need will be met through learning. Often the nurse’s task is to help the client personally work through the problem and identify the need. EXAMPLE: Person with heart disease may need to know the effects of smoking before they recognize the need to stop smoking.
  68. How does readiness affect learning?
    The demonstration of behaviors or cues that reflect the learner’s motivation to learn at a specific time. Readiness reflects not only the desire or willingness to learn, but also the ability to learn at a specific time.
  69. How does active involvement affect learning?
    • When the learner is actively involved in the process of learning, learning becomes more meaningful.
    • If the learner actively participates in planning and discussion, learning is faster and retention is better.
    • Clients who are actively involved in learning about their health care may be more able to apply the learning to their own situation.
  70. How does relevance affect learning?
    • The knowledge or skill to be learned must be personally relevant to the learner. Clients learn more easily if they can connect the new knowledge to that which they already know or have experienced.
    • EXAMPLE: If a client is diagnosed with hypertension, is overweight, and has symptoms of headaches and fatigue, he is more likely to understand the need to lose weight if he remembers having more energy when he weighed less.
  71. How does feedback affect learning?
    • Support of desired behavior through praise, positively worded corrections, and suggestions of alternative methods are ways of providing positive feedback.
    • Negative feedback such as ridicule, anger, or sarcasm can lead people to withdraw from learning, since it is viewed as a type of punishment and it may cause the client to avoid the teacher and their punishment.
  72. How does nonjudgmental support affect learning?
    • People learn best when they believe they are accepted and will not be judged. The person who expects to be judged as a “poor” or “good” client will not learn as well as the person who feels no such a threat.
    • Once learners have succeeded, it builds their confidence and reduces their anxiety, which in turn motivates greater learning.
  73. How does simple to complex learning affect learning?
    This concept allows the nurse to determine the learner’s level of knowledge and to facilitate learning from that point, building with more complex ideas.
  74. How does repetition affect learning?
    • Repetition of key concepts and facts facilitates retention of newly learned material.
    • Practice of psychomotor skills, particularly with feedback from the nurse, improves performance of those skills and facilitates their transfer to another setting.
  75. How does timing affect learning?
    • People retain information and psychomotor skills when the time between learning and active use is short.
    • EXAMPLE: Teaching a client how to use their insulin and then having them do it, solidifies the teaching.
  76. How does the environment affect learning?
    • An optimal learning environment facilitates learning by reducing distractions and providing physical and psychological comfort.
    • Adequate lighting, comfortable temperature, good ventilation, choose a time when there are no visitors and interruptions are unlikely.
    • Privacy is imperative and a support person may give them the confidence they need.
  77. How do emotions affect learning?
    • Fear, anger, anxiety, agitation, and depression can impede learning. Families who are experiencing extreme emotional states may not hear spoken words or may retain only part of the communication.
    • Medications may be prescribed for extremely distraught clients or families to reduce their anxiety and put them in a state where learning can occur.
  78. How do physiological events affect learning?
    • Critical illness, pain, or sensory deficits inhibit learning. The client cannot concentrate and thus learning is impaired. 
    • The nurse needs to try to reduce the physiological barriers to learning, as much as possible before teaching.
  79. How do cultural aspects affect learning?
    • Barriers include language and values.
    • Western medicine may conflict with a client’s cultural healing beliefs and practices. 
    • To be effective the nurse must be culturally sensitive and competent.
  80. How does psychomotor ability affect learning?
    • The nurse must be aware of the client’s psychomotor (physical) skills, as they can be affected by the client’s health.
    • The following physical abilities are important for learning psychomotor skills: 1. Muscle strength 2. Motor coordination 3. Energy 4. Sensory acuity
  81. What is e-health?
    Health information, services, and products provided on the internet
  82. What percentage of adults look online for health information?
  83. An individual who looks online for health information is called an _______?
  84. What is the age group that usually looks online for health information?
    Those who are 55 and older
  85. True or False
    All health information on the internet is true.
  86. What is the best way to handle the following situation:
    A patient wants to tell you what they found on the internet, regarding their illness.
    • Listen to the information they have found
    • Ask questions 
    • Kindly validate or dispute (with information) what they have learned
    • NOTE: Integrate the internet into your teaching plan (apply other strategies for those who do not have access)
  87. ASSESSMENT: What should be included in the Nursing History?
    • Age
    • Client's understanding of the health problem
    • health beliefs and practices
    • Cultural factors
    • Economic factors
    • Learning style
    • Client's support system
  88. ASSESSMENT: What should be included in the Physical Examination?
    • General survey provides useful clues, such as:
    • 1. Mental status
    • 2. Energy level
    • 3. Nutritionaal status
    • Other parts of physical exam reveal additional information, such as:
    • 1. Visual ability
    • 2. Hearing ability
    • 3. Muscle coordination
  89. The NURSING ASSESSMENT for learning should include the following . . .
    • Nursing History
    • Physical Assessment
    • Readiness to Learn
    • Motivation
    • Newest Vital Sign: Health Literacy Test 
    • Joint Commission Suggestions
  90. ASSESSMENT: What should be included in the Health Literacy Test?
    Six questions for the client to answer, while referring to a food label.
  91. ASSESSMENT: What does a nurse need to remember, when the Health Literacy Test has a low outcome?
    • Associated with poor health oucomes and higher health care costs
    • Clients hide low literacy and so lack critical information
    • Have less information about health promotion or management of a disease process
    • Nurses must look for this silent epidemic
  92. What is the point of the Health Literacy Test?
    • To determine the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions.
    • NOTE: Clear communication and plain language is imperative when communicating with all.
  93. NURSING ASSESSMENT for learning: What are the suggestions made by the Joint Commission?
    • Use plain language
    • Use "teach back" and "show back"
    • Limit information to two or three important points
    • Use drawings or models
  94. What are a few Nursing Diagnosis that can be used, when learning has been determined to be the main problem?
    • 1. Deficient Knowledge (specify)
    • 2. Readiness for Enhanced Knowledge (specify)
    • 3. Noncompliance (use with caution because other factors may be the cause - can come off as judgemental)
  95. What are a few Nursing Diagnosis that can be used, when learning is used as the etiology?
    • 1. Risk for Impaired Parenting r/t deficient knowledge
    • 2. Risk for Injury r/t ineffective Health Maintenance
  96. The NURSING PLAN for learning should include the following . . .
    • Teaching plan
    • Involve the client
    • Determining priorities
    • Learning outcomes
  97. The NURSING PLAN: What should be considered when involving the client?
    The plan should stimulate the client's motivation
  98. The NURSING PLAN: What should be considered when determining the priorities?
    • Client's learning needs must be ranked
    • Maslow's hierarchy of needs used to establish priorities
  99. The NURSING PLAN: What should be considered when determining the learning outcomes?
    • State the client behavior
    • Reflect an observable or measurable activity
    • May add conditions or modifiers
    • Use criteria that specify the time that learning occurs
  100. The NURSING PLAN: What should be considered when choosing the content?
    It should be: 1. Accurate 2. Current 3. Based on learning outcomes 4. Adjusted for the learner's age, culture, and ability 5. Consistent with information the nurse is teaching 6. Reflects time and resources available
  101. The NURSING PLAN: What should be considered when determining the teaching strategies?
    They should be suited to the individual: 1. Explanation or description 2. One-to-one discussion 3. Answering questions 4. Demonstration 5. Discovery 6. Group discussion 7. Practice 8. Printed and audiovisual materials 9. Role-playing 10. Modeling 11. Computer learning resources
  102. The NURSING PLAN: How can the learning experience be organized?
    • 1. Start with something the learner is concerned about
    • 2. Discover what the learner knows
    • 3. Address areas that cause anxiety early
    • 4. Teach simple to complex
    • 5. Schedule time for review of content
  103. When IMPLEMENTING the teaching plan, what does the nurse need to remember to do?
    • Be flexible
    • Use techniques that enhance learning
    • Reduce or eliminate barriers to learning
    • EXAMPLE: When the client is watching "Days of our Lives" or busy some other way, it may not be the best time to try and teach. Pick a time when you will have their full attention.
  104. When IMPLEMENTING the teaching plan, what are the guidelines?
    1. Maintain a respectful relationship (do not be condescending) 2. Use the client's previous learning in the present situation 3. Determine optimal time for each session depending on the learner 4. Communicate clearly and concisely 5. Use a layperson's vocabulary 6. Be sensitive to teaching pace (too fast or too slow) 7. Choose the best environment for learning 8. Use teaching aids to foster learning and focus attention 9. Involve the senses 10. Allow learners to discover content for themselves 11. Repetition reinforces learning 12. Employ "organizers" to introduce material 13. Make sure anticipated behavioral changes that show learning has taken place are possible within the context of client's lifestyle and resources
  105. When IMPLEMENTING the teaching plan, what are some special strategies that can be utilized?
    • Client contracting
    • Group teaching
    • Computer learning resources
    • Discovery/problem solving
    • Behavior modification
    • Transcultural teaching
  106. What are some key components of Transcultural Teaching?
    1. Obtain teaching materials, pamphlets, and instructions in languages used by client 2. Use visual aids, such as pictures, charts, or diagrams to communicate meaning 3. Use concrete rather than abstract words 4. Allow time for questions 5. Avoid medical terminology or health care language 6. If understanding another's pronunciation is a problem, validate information in writing 7. Use humor cautiously 8. Do not use slang or colloquialisms (word or phrase that is not formal or lierary, typically used in familiar conversations) 9. Do not assume that a client who nods, uses eye contact, or smiles is understanding what is being taught 10. Invite and encourage questions during teaching 11. When explaining procedures or functioning related to personal areas of the body, consider having a nurse of the same gender do the teaching 12. Include family in planning and teaching 13. Consider the client's time orientation 14. Identify cultural health practices and beliefs
  107. How should the EVALUATION of the learning process be conducted?
    • Ongoing and final process
    • Nurse, client, and support people determine what has been learned
    • Cognitive learning
    • Psychomotor learning
    • Affective learning
  108. EVALUATION: What should be involved in the cognitive learning process?
    • 1. Direct observation 
    • 2. Written measurements 
    • 3. Oral questioning 
    • 4. Self-reports or self-monitoring
  109. EVALUATION: What should be involved in the psychomotor learning process?
    Observing how well the client carries out the skill
  110. EVALUATION: What should be involved in the affective learning process?
    • More difficult to evaluate
    • Inferred by the following: 1. Listening to client's responses to questions 2. Noting how the client speaks about relevant subjects 3. Observing client's behavior that expresses feelings and values
  111. DOCUMENTATION: Why is it important to document the learning process?
    • Provides a legal record that the teaching took place
    • Communicates teaching to other health professionals
    • Documents responses of the client and support people to teaching activities
  112. Parts of the teaching process that should be documented, include the following:
    • Diagnosed learning needs
    • Learning outcomes
    • Topics taught
    • Client outcomes
    • Need for additional teaching
    • Resources provided
  113. EVALUATION: What should be involved in the evaluation of the teaching process?
    • Self-evaluation is important and the nurse must consider all factors: 1. Timing 2. Strategies 3. Content 4. Apparent helpfulness of teaching, etc.
    • Include client evaluations about teaching
  114. What is alopecia?
    Hair loss: May be caused by Chemo and Radiation
  115. What is hirsutism?
    The growth of excessive body hair.
  116. What is pediculosis?
    • Infestation of head lice - Three kinds infect humans:
    • 1. Pediculus Capitis
    • 2. Pediculus Corporus
    • 3. Pediculus Pubis
  117. What is scabies?
    A contagious skin infestation by the itchmite
  118. List the five commonly used bed positions.
    • 1. Flat
    • 2. Fowler's position
    • 3. Semi-Fowlers position
    • 4. Trendellenburg's position
    • 5. Reverse Trendellenburg's position
  119. List the descriptors for each functional level:
    (0)   _____?
    (+1) _____?
    (+2) _____?
    (+3) _____?
    (+4) _____?
    •   0 = Completely independent
    • +1 = Requires use of equipment or device
    • +2 = Semi-dependent - Requires help from another person for assistance, supervision, or teaching
    • +3 = Moderately dependent - Requires help from another and equipment or a device
    • +4 = Totally dependent - Does not participate in activity.
  120. What is hygiene?
    The science of health and its maintenance
  121. What does hygeine involves the care of . . .
    • Skin
    • Feet
    • Nails
    • Oral and nasal cavities
    • Teeth
    • Hair
    • Eyes
    • Ears
    • Perineal-genital area
  122. What is involved with early morning care?
    • Urinal or bedpan
    • Washing face and hands
    • Oral care
  123. What should you never do when you have a client on a bedpan?
    Leave them on too long!!
  124. What is involved with morning care, which is usually after breakfast?
    • Elimination
    • Bath or shower
    • perineal care
    • Back massage
    • Oral, nail, and hair care
  125. What is involved with the hour of sleep (HS) or PM care?
    • Elimination
    • Washing face and hands
    • Oral care
    • Back massage
    • As needed (prn) care includes: more frequent bathing and changes of clothing
  126. What are some of the factors that influence personal hygiene?
    • Culture
    • Religion
    • Environment
    • Developmental level 
    • Health and energy
    • Personal preferences
  127. Give an example of a religious factor for muslims . . . 
    The left hand is used for cleaning, thus they will always eat and take pills with the "clean" right hand. When feeding this individual, you must also feed them with your "clean" right hand.
  128. What is the function of the skin, in relation to hygiene?
    • Protects underlying tissue
    • Reulates body temperature
    • Secretes sebum
    • Transmits sensation
    • Maintains moisture
    • Bactericidal action
    • Produces and absorbs vitamin D
  129. What are some of the glands that are found in the skin?
    • Sudoriferous (sweat) glands
    • Apocrine glands
    • Eccrine glands
  130. What are the sudoriferous glands?
    • Any of the glands in the skin that secrete perspiration
    • Sweat glands
  131. What are the apocrine glands?
    • A type of sweat gland
    • Apocrine glands develop in areas abundant in hair follicles, such as on your scalp, armpits and groin and open into the hair follicle just before it opens onto the skin surface.
  132. What are the eccrine glands?
    • A type of sweat gland
    • Eccrine glands occur over most of your body and open directly onto the surface of the skin
  133. ASSESSMENT: What will the nursing history be used to determine, in relation to the skin?
    • Client's skin care practices
    • Self-care abilities
    • past or current skin problems
  134. What is involved with the NURSING ASSESSMENT of the skin?
    • Taking a Nursing History
    • Physical assessment of the skin
  135. What are some common skin problems?
    • Abrasion - superficial damage to the epidermis
    • Excessive dryness
    • Ammonia dermatitis - diaper or undergarment rash
    • Acne
    • Erythema - Redness
    • Hirsutism - Excessive hair growth
  136. What are some NURSING DIAGNOSIS that can be use for skin issues?
    • Bathing Self-Care Deficit
    • Dressing Self-Care Deficit
    • Toileting Self-Care Deficit
  137. What would be involved with the NURSES PLANNING for skin care?
    • Nurse and, if appropriate, client and/or family set outcomes for each nursing diagnosis
    • Nurse performs nursing interventions and activites to achieve the client outcomes
  138. What is involved with IMPLEMENTING the Nursing Plan for skin care?
    • Assisting dependent clients with bathing, skin care, and perineal care
    • Providing back massages to promote circulation
    • Instructing clients/families about appropriate hygienic practices and alternative methods to dressing
    • Demonstrating use of assistive equipment and adaptive activities
  139. List a few of the general guidelines for sin care, that a nurse needs to remember.
    • An intact, healthy skin is the body's first line of defense
    • The degree to which the skin protects the underlying tissues from injury depends on the general health of the cells, the amount of subutaneous tissue, and the dryness of the skin
    • Moisture in contact with the skin for more than a short time can result in increased bacterial growth and irritation
    • Body odors are caused by resident skin bacteria acting on body secretions
    • Skin sensitivity to irritation and injury varies among individuals and in acccordance with their health
    • Agents for skin care have selective actions and purposes
  140. What is the purpose of bathing a client?
    • Removes accumulated oil, perspiration, dead skin cells, and some bacteria
    • Stimulates circulation
    • Produces a sense of well-being
    • Offers opportunity for assessment
  141. What are the different types of bathing that can be done?
    • Complete bed bath
    • Self-help bed bath
    • partial bath
    • Bag bath (microwave washcloth)
    • Towel bath
    • Tub bath
    • Shower
    • Therapeutic baths
  142. When would a therapeutic bath be given?
    • Give for physical effecs
    • Soothe irritated skin
    • Treat a certain area (perineum - when a woman gives birth)
    • Medication may be placed in the water
  143. How should the eyes of a client be washed?
    Using a corner of the washcloth, move from the inner canthus to the outer canthus.
  144. How should the limbs be washed?
    • With long firm strokes from the wrist (ankle) to the shoulder (hips).
    • This will help with circulation
    • You always go from cleanest to dirtiest, thus hands and feet, armpits and groin are last, when cleaning limbs.
  145. How does soaking the hands or feet help, when cleaning a client?
    • Soaking the hands can loosen soil (feces) from under the nails and in the nail beds
    • Soaking the feet, can help moisturize and soften 
  146. Can a bath be delegated to the UAP?
    • Yes, but they can only report their findings
    • Assessment is an RN task
  147. What is the person-centered approach to bathing a client?
    • Less about tasks than about people and relationships between people
    • Bathing needs to focus on the experience for the client rather than the oucomes (i.e. getting a bath or shower)
  148. Bathing should be seen an a _____ and _____ task.
    necessary and routine
  149. What does bathing without a battle mean?
    Doing things that make the experience soothing: Playing music, singing, and talking can be nice distractions
  150. When doing peri-care how do you specifically clean a female?
    From the top, down, outer to inner
  151. When doing peri-care, how do you specifically clean a male?
    • Gently pull the skin back on the penis, especially if uncircumcised. 
    • NOTE: Remember to slide it back in place!!
  152. In general, how do you perform perineal care?
    • Genital care, peri care
    • Many clients can clean own perineum with assistance
    • To avoid embarrassment, provide care in matter-of-fact way
    • Wear gloves
  153. Define Biological rhythms
    • These exist in plants, animals, and humans. 
    • In humans: these are controlled from within the body and synchronized with environmental factors, such as light and darkness. The most familiar biological rhythm is the circadian rhythm (24-hour internal biological clock).
  154. Define electroencephalogram (EEG)
    A way of measuring sleep objectively, in a sleep disorder laboratory. Electrodes are placed on the scalp to record brain waves. The electrodestransmit electric energy frm the cerebral cortex and muscels of the face to pens that record teh brain waves and muscle activity on graph paper. 
  155. Define Electromyogram (EMG)
    A way of measuring sleep objectively, in a sleep disorder laboratory. Electrodes are placed on the chin muscles. The electrodestransmit electric energy frm the cerebral cortex and muscels of the face to pens that record teh brain waves and muscle activity on graph paper. 
  156. Define Electro-oculogram (EOG)
    A way of measuring sleep objectively, in a sleep disorder laboratory. Electrodes are placed on the outer canthus of each eye to record eye movement. The electrodestransmit electric energy frm the cerebral cortex and muscels of the face to pens that record teh brain waves and muscle activity on graph paper. 
  157. Define hypersomnia
    • Conditions wehre the affected individual obtains sufficient sleep at night but still cannot stay awake during the day. Can be caused by medical conditions. 
    • EXAMPLE: CNS damage and certain kidney, liver, or metabolic disorders, such as diabetic acidosis and hypothyroidism. Rarely does it have a psychological orgin.
  158. Define nocturnal emmissions
    • Wet dreams - experienced by boys, during adolescence
    • orgasm and emission of semen during sleep, several times each month
  159. Define NREM sleep
    Sleep that occurs when activity in the RAS is inhibited. About 75% to 80% of sleep during a night is spent in the four stages of this sleep cycle.
  160. Define parasomnia
    • Behaviors that may interfere with sleep and may even occur during sleep. 
    • The International Classification of Sleep Disorders has put these into different categories: 1) Arousal Disorders - Sleepwalking, sleep terrors 2) Sleep/Wake Transition Disorders - Sleep talking 3) Parasomnias Associated with REM Sleep - Nightmares and 4) Others - Bruxisms
  161. Define Polysomnography
    • Sleep is measured objectively in a sleep disorder laboratory
    • The following tests are recorded: 1) Electroencephalogram (EEG) 2) Electromyogram (EMG) and 3) Electro-oculogram (EOG)
  162. Define REM sleep
    Rapid-eye-movement sleep
  163. Define sleep
    • An altered state of consciousness in which the individual's perception of and reaction to the environment are decreased. 
    • Characterized by minimal physical activity, variable levels of consciousness, changes in the body's physiological processes, and decreased responsiveness to external stimuli. 
    • It appears that individauls respond to meaningful stimuli (smoke detector), while selectively disregarding nonmeaningful stimuli (coo-coo-clock)
  164. Define sleep apnea
    • Characterized by frequent short breathing pauses during sleep. 
    • More than five episodes or five breathing pauses longer than 10 seconds/hour
  165. Define sleep architecture
    Refers to the basic organization of normal sleep
  166. Define sleep hygiene
    • Refers to interventions used to promote sleep.
    • Nursing interventions to enhance the quantity and quality of clients' sleep involve largely nonpharmacologic measures. 
    • These involve health teaching about sleep habits, support of bedtime rituals, the provision of a restful environment, specific measures to promote comfort and relaxation, and appropriate use of hypnotic medications.
  167. Define bactericidal
    Bacteria killing
  168. Define callus
    • A thickened portion of epidermis, a mass of keratotoc material.
    • Most are painless and flat and are found on the bottom or side of the foot over a bony prominence.
  169. Define cerumen
  170. Define cleansing baths
    • Given chiefly for hygiene purposes (rather than therapeutic).
    • Involves all of the following: 1) Complete bed bath 2) Self-help bed bath 3) Partial bath 4) Bag bath (microwave bag) 5) Towel bath 6) Tub bath 7) Shower
  171. Define corn
    • A keratosis caused by friction and pressure from a shoe.
    • Commonly occurs on the fourth or fifth toe, usually on a bony prominence such as a joint.
    • Ususally conical (circular and raised)
  172. Define cross contamination
    The movement of microorganisms from one client to another
  173. Define dandruff
    Appears as a diffuse scaling of the scalp. In severe cases it involves the auditory canals and the eyebrows. 
  174. Define dental caries
  175. Define fissures
    • Deep grooves, frequently occur between the toes as a result of dryness and cracking of the skin.
    • The treatment of choice is good foot hygiene and application of an antiseptic to prevent infection.
    • Often a small piece of guaze is inserted between the toes in applying the antiseptic and left in place to assist healing by allowing air to reach the area
  176. Define gingiva
    The gums
  177. Define gingivitis
    Red, swollen gingiva (gums)
  178. Define hirsutism
    The growth of excessive body hair
  179. Define hygiene
    The self-care by which people attend to such functions as bathing, toileting, general body hygiene, and grooming.
  180. Define ingrown toenail
    Teh growing inward of the nail into the soft tissues around it, most often results from imporper nail trimming.
  181. Define Lanugo
    The fine hair on the body of the fetus, also referred to as down or woolly hair.
  182. Define pediculosis
    • An infestation with lice 
    • Three common types are: 1) Pediculus capitis - Head louse 2) Pediculus corporis - Body louse and 3) Peduculus pubis - the crab louse
  183. Define periodontal disease
    Gum disease
  184. Define plantar warts
    • Warts that appear on the sole of the foot. 
    • Caused by the virus papovavirus hominis and they are moderately contagious.
    • Frequently painful and make walking difficult
  185. Define plaque
    An invisible solt film that adheres to the enamel surface of teeth. It consists of bacteria, molecules of saliva, and remnants of epithelieal cells and leukocytes.
  186. Define pyorrhea
    • Advanced pariodontal disease.
    • The teeth are loose and pus is evident when the gums are pressed
  187. Define sebum
    • An oily substance that 1) softens and lubricates the hair and skin 2) prevents the hair from becoming brittle 3) decreases water loss from the skin when the external humidity is low.
    • Because fat is a poor conductor of heat, sebum 1) Lessens the amount of heat lost from teh skin and 2) has a bactericidal (bacteria-killing) action
  188. Define scabies
    • A contagious skin infestation by the itch mite.
    • Characteristic lesion is the burrow produced by the female mite as it penetrates into the upper layers of the skin. Burrows are short, wavy, brown or black, threadlike lesions most commonly observed between the fingers, creases of the wrists and elbows, beneath breast tissue and in the groin area. 
    • More intense in the evening because teh increased warmth of hte skin has a stimulating effect on the parasites.
  189. Define sudoriferous glands
    • On all body surfaces except the lips and parts of the genitals
    • The body has from 2 - 5 million, which are all present at birth
    • Most numerous on the palms of the hands and the soles of the feet
  190. Define tartar
    A visible, hard deposit of plaque and dead bacteria that forms at the gum lines
  191. Define therapeutic baths
    • Given for physical effects, such as to sooth irritated skin or to treat an area. 
    • Medications may be placed in the water
  192. Define ticks
    Small gray-brown parasites that bite into tissue and suck blood
  193. Define tinea pedis
    Ringworm of the foot, caused by a fungus
  194. Define xerostomia
    • Dry mouth that occurs when the supply of saliva is reduced.
    • This condition can be caused by side effects of certain medications (antihistamines, antidepressants, and antihypertensives)
  195. Define adherence
    Commitment or attachment to a regimen
  196. Define affective domain
    • The feeling domain
    • Divided into categories that specify the degree of the "person's depth of emotional responses to tasks"
  197. Define compliance
    An individual's desire to learn and to act on the learning
  198. Define health literacy
    • The capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions.
    • This would include such tasks as comprehending prescription labels, interpretingappointment slips, completing health insurance forms, and following instructions for diagnostic tests. 
  199. Define humanistic learning theory
    The nurse focuses on the feelings and attitudes of learners, on the importance, on the importance of the individual in identifying learning needs and in taking responsibilty for them, and on the self-motication of the learners to work toward self-reliance and independence.
  200. Define imitation
    The process by which individuals copy or reproduce what they have observed
  201. Define learning
    • A change in human disposition or capability that persists and that cannot be soley accounted for by growth. 
    • Represented by a change in behavior
  202. Define learning need
    A desire or a requirement to know somethingthat is presently unknown to the learner
  203. Define modeling
    The process by which a person learns by observing the behavior of others
  204. Define motivation
    The desire to learn
  205. Define positive reinforcement
    A pleasant experience such as praise and encouragement, in fostering repetition of an action
  206. Define readiness
    • To learn is the demonstation of behaviors or cues that reflect the learner's motivation to learn at a specific time
    • Readiness reflects not only the desire or willingness to learn but also the ability to learn at a specific time.
  207. Define teaching
    • A system of activities intended to produce learning.
    • The teaching process is intentionally designed to produce precific learning
  208. A nurse applying humanistic theory will . . .
    • 1. Convey empathy in the nurse-client relationship
    • 2. Encourage the learner to establish goals and promote self-directed learning
    • 3. Encourage active learning by serving as a facilitator, mentor, or resource for the learner
    • 4. use active learning strategies to assist the client's adoption of new behavior
    • 5. Expose the learner to new relevant information and ask appropriate questions to encourage the learner to seek answers
  209. What is involved with the NURSING EVALUATION of the client, in regards to peri-care?
    • Funtional ability for self care
    • Efficacy of instructions and assistive devices
    • Client status
    • Need for analgesics
    • Tissue integrity
    • Nutrition adequate to support skin integrity
  210. Why is foot hygiene important?
    • Essential for ambulation - 2 to 3 times body weight on the foot with each step
    • Feet develop and are affected by restrictive or supportive shoes
    • Feet fully grown by about 20 years
    • Changes with aging; aging may affect self-care
  211. What is involved with the NURSING ASSESSMENT of the feet?
    • Nursing history 
    • Physical assessment
  212. What will the nursing history determine, in regard to the feet.
    • Normal nail and foot care practices
    • Type of footwar worn
    • Self-care abilites
    • Presence of risk factors for foot problems
    • Any foot discomfort
    • Any perceived foot problems with foot mobility
  213. What will the physical assessment of the feet reveal (common foot issues)?
    • Calluses
    • Corns
    • Unpleasant odors
    • Plantar warts
    • Fissures between the toes
    • Fungal infections (tinea pedis)
    • Ingrown toenails
  214. What would be a few NURSING DIAGNOSIS for the feet?
    • 1. Bathing Self-Care Deficit (foot care)
    • 2. Risk for Impaired Skin Integrity
    • 3. Risk for Infection
    • 4. Deficient nowledge (diabetic foot care)
  215. What are some interventions the nurse can include in the NURSING PLAN, in regard to the feet?
    • Identify nursing interventions that will help the client maintain or restore healthy foot care proactices
    • Establishing desire outcomes for each client
  216. When IMPLEMENTING the nursing plan, what can be done to help the client care for their feet?
    • Teach the client about correct nail and footcare
    • Proper footwear
    • Wearing the correct size
    • Ways to prevent potential foot problems
    • Physical assessment of the feet
  217. In the NURSING EVALUATION of the feet, what will the nurse want to look for?
    • Self-care ability and participation
    • Hygiene
    • Skin integrity and correct practices
  218. What is some general information about our nails?
    • Normally present at birth
    • continue to grow throughout life
    • Tend to be tougher, more brittle, and in some cases thicker with age
    • Older person's nails may grow more slowly and be ridged and grooved
  219. What is involved with the NURSING ASSESSMENT of the nails?
    • Nursing history 
    • Physical assessment
  220. What will the physical assessment of the nails reveal?
    • Normal care practices
    • Self-care abilities
    • Any problems associated with them
  221. What would be a few NURSING DIAGNOSIS for the nails?
    • Bathing Self-Care Deficit
    • Risk for Infection
  222. What are some interventions the nurse can include in the NURSING PLAN, in regard to the nails?
    • Identify measures that will assist the client to develop or maintain health nail care practices
    • Establish a shecdule of nail care
  223. When IMPLEMENTING the nursing plan, what can be done to help the client care for their nails?
    • Check agency's policy regarding nail care
    • One hand or foot is soaked, if needed, and dried
    • Nail is cut or filed straight across beyond the end of the finger or toe
    • Avoid trimming or digging at the lateral corners
  224. What is important to remember, in regard to nail care for diabetics?
    • Nails should be filed rather than cut
    • Infections around the cuticle or inflammation of the tissues must be recorded and reported
  225. In the NURSING EVALUATION of the nails, what will the nurse want to look for?
    • Demonstrate healthy nail care practices
    • Describe causes of nail problems
    • Blanch test (capillary refill)
  226. What is some general information about the mouth?
    • Each tooth: crown, root, pulp cavity
    • Gingiva (gum)
    • Periodontal disease
    • Dental caries (cavities)
  227. What is involved with the NURSING ASSESSMENT of the teeth?
    • Nursing history
    • Physical assessment of the mouth
  228. What will the nursing history of the mouth and teeth reveal?
    • Oral hygiene practices
    • Dental visits
    • Self-care abilities
    • Past or current mouth problems
  229. What are some common problems of the mouth?
    • Halitosis (bad breath)
    • Glossitis
    • Gingivitis
    • Periodontal disease
    • Pyorrhea
    • Reddened or excoriated mucosa
    • Excessive dryness of the bucal mucosa
    • Cheilosis
    • Plaque
    • Tartar
    • Dental caries (cavities)
    • Sordes
    • Stomatitis
    • Parotitis
  230. What clients are AT RISK for oral problems?
    • Serious illness
    • Confusion
    • Coma
    • Depression
    • Dehydration
    • Deficient knowledge, inadequate nutrition, lack of money or insurance, radiation treatment
  231. What would be a few NURSING DIAGNOSIS for the teeth?
    • Impaired Oral Mucous Membrane
    • Deficient Knowledge
  232. Who should be included in setting the NURSING PLAN, in regard to the teeth?
    • The nurse and, if appropriate, the client and/or family set outcomes for each nursing diagnosis
    • The nurse performs nursing interventions and activities to achieve the client outcomes
  233. When IMPLEMENTING the nursing plan, what can be done to help the client care for their teeth?
    • Promote oral health throughout the life span
    • Infants and toddlers: after tooth eruption start dental hygiene, dental visit starting 2 or 3 times a year
    • Preschool and school-aged children: Care essential in deciduous-to-permanent tooth transistion, brush teeth after eathing, regular checkups
    • Adolescents and adults: Maintenance
    • Older adults: Number of eduntulous (denture wearing) adults declining, so cavities a factor
  234. What should the daily routine of oral care consist of?
    • Mechanical brushing and flossing of the teeth: Stimulation of the gums and flushing of the mouth
    • Caring for dentures: Brushing or soaking and flushing of the mouth
    • Assisting clients with oral care: Special needs: xerostomia (dried/cracked lips)
  235. In the NURSING EVALUATION of the mouth, what will the nurse want to look for?
    • Use data collected
    • Judge whether desired outcomes have been achieved: if not, explore why
    • Modify care plan if needed
  236. What can hair tell you about a person?
    It reflects a person's feeling or self-concept, well-being, state of health
  237. What is involved with the NURSING ASSESSMENT of the hair?
    • Nursing history
    • Physical assessment
  238. What will the nursing history of the hair reveal?
    • Usual hair care
    • Self-care abilites
    • History of hair or scalp problems
    • Conditions known to affect the hair (e.g. Alopecia)
  239. What problems will the phycial assessment of the hair/scalp reveal?
    • Dandruff
    • Hair loss
    • Ticks
    • Pediculosis
    • Scabies
    • Hirsutism
  240. What would be a few NURSING DIAGNOSIS for the hair?
    • Dressing Self-Care Deficit
    • Impaired Skin Integrity
    • Risk for Infection
    • Disturbed Body Image
  241. Who should be included in setting the NURSING PLAN, in regard to the hair?
    • The nurse and, if appropriate, the client and/or family set outcomes for each nursing diagnosis
    • The nurse performs nursing interventions and activities to achieve the client outcomes
  242. When IMPLEMENTING the nursing plan, what can be done to help the client care for their hair?
    • Brush or comb daily
    • Washed as needed to keep it clean
    • Beard or moustache care daily
  243. In the NURSING EVALUATION of the hair, what will the nurse want to look for?
    • Use data collected
    • Judge whether desired outcomes have been achieved: if not, explore whyModify care plan if needed
  244. What is some general information about the eyes?
    • Require no special hygiene
    • Lacrimal fluid washes the eye
    • Eyelids and eyelashes prevent entrace of foreign particles
  245. What is involved with the NURSING ASSESSMENT of the eyes?
    • Nursing history
    • Physical assessment
  246. What will the nursing history of the eyes reveal?
    • Client's eyeglasses or contact lenses
    • Recent examinations by ophthalmologist
    • Any history of eye problems and related treatments
  247. What would be a few NURSING DIAGNOSIS for the eyes?
    • Risk for Infection
    • Risk for Injury
  248. What should be included in the NURSING PLAN, in regard to the eyes?
    • The nurse identifies nursing activities that will assist the client to maintain the integrity of the eye structures
    • Prevent eye injury and infection
  249. How do you remove a HARD contact lens?
    Open eye wide and gently press from the top, down and the bottom, up, with both thumbs.
  250. How do you remove a SOFT contact lens?
    Gently pull down on conjunctival sac, have the client look up and with the other hand, pinch the contact lens at the bottom of the sac and pull straight out
  251. When IMPLEMENTING the nursing plan, what can be done to help the client care for their eyes?
    • Eye care
    • Eyeglass care
    • Contact lens care: Teach clients how to clean, insert, and remove contact lenses
    • Ways to protect the eyes from injury and strain
  252. In the NURSING EVALUATION of the eyes, what will the nurse want to look for?
    • Use data collected
    • Judge whether desired outcomes have been achieved: if not, explore why
    • Modify care plan if needed
  253. What is some general information about the ears?
    • Minimal hygiene
    • Clean auricles and excessive cerumen during bed bath
    • Hearing aids may require nursing assistance
    • Hearing aids are usually removed before surgery
  254. What do you have to be especially careful of with hearing aids?
    They are VERY expensive, be careful that they do not get lost!!
  255. What are the different types of hearing aids?
    • Behind-the-ear open fit
    • Behind-the-ear with earmold
    • In-the-ear aid
    • In-the-canal aid
    • Completely-in-the-canal aid
    • Eyeglasses aid
    • Body hearing aid
  256. What is some general information about the nose?
    • Usually cared for by client blowing into tissue
    • Clean with cotton-tipped applicator (not inserted farther than cotton tip) or saline
  257. How can the environment support hygiene?
    • Temperature
    • Ventilation
    • Noise
  258. What are the parts of the bed that support a hygienic environment?
    • Mattresses
    • Side rails
    • Footboard or footboot
    • Bed cradles
  259. What are the practice guidelines for making a bed?
    • Wash hands thoroughly after handling a client's bed linen
    • Hold soiled linen away from uniform
    • Never place linen for one client on another client's bed = cross contamination
    • Place soiled linen directly in a portable hamper or tucked into a pillow case at the end of the bed for disposal
    • Do not shake soiled linen into the air
    • Conserve time and energy; make one side of the bed first
    • Gather all linen before starting to strip a bed
  260. What are some points to remember about making an occupied bed?
    • 1. Maintain the client in good body alignment
    • 2. Move the client gently and smoothly
    • 3. Explain what you plan to do throughout the procedure before you do it?
    • 4. Use the bed-making time, like the bed bath time, to assess and meet the client's needs
  261. What should the nurse remember when delegating bed making?
    Bed making is usually delegated to the UAP - Both occupied and unoccupied
  262. When the nurse is delegating bed making to the UAP, what instruction should be given?
    • Instruct the UAP to report immediately any tubes or dressings that become dislodged
    • Stress the importance of having the call light available for the client out of bed.
  263. When the nurse is delegating making an occupied bed to the UAP, what instruction should be given?
    • Determine the extent to which the client can assest or the need for a second person to assist
    • Instruct in how to handle tubes or equipment as well as in need for special equipment (e.g. a footboard)
  264. What is the function of the RAS (retcular activating system)?
    It regulates the sleep/wake cycle through the release of certain neurotransmitters.
  265. What neurotransmitters and which hormone is involved in depression of the CNS resulting in sleep?
    • serotonin
    • GABA
    • melatonin
  266. What neurotransmitters and which hormones are involved in wakefulness?
    • acetylcholine
    • dopamine
    • noradrenaline
    • cortisol
  267. What is sleep?
    Sleep is an altered state of consciousness where perception of and reaction to environment decrease.
  268. What is the purpose of sleep?
    • Helps us cope with stresses
    • Prevents fatigue
    • Conserves energy
    • Restores normal levels of activity
    • Restores normal balance among parts of the nervous system
    • Necessary for protein synthesis
    • Psychological well-being
    • Restores mind and body so we can enjoy life more fully and enhances our daytime functioning
  269. What signals the release of melatonin by the pineal gland?
    • preparing for sleep
    • darkness
    • reduced activity
    • laying down
  270. What is Circadian Rhythm?
    24 hour internal biological clock
  271. Define circadian synchronization
    Biological clock coincides with sleep-wake cycle.-person is awake when body temp is the highest and asleep when body temp is lowest.
  272. How much of our lives are spent sleeping?
    • One third (1/3)
    • This is a universal biological need
  273. The cyclic nature of sleep is thought to be controlled by what?
    • The lower part of the brain: Neurons in reticular formation integrate sensory information from the PNS and relay it to the cerebral cortex.
    • Reticular activating system (RAS): is involved in the sleep/wake cycle
  274. What does serotonin do to the body?
    Thought to lessen response to sensory stimulation
  275. What does GABA do to the body?
    Thought to shut off activity in neurons of the RAS
  276. What do Acetylcholine, dopamine, and noradrenalin do to the body?
    They are associated with cerebral cortical arousal
  277. During sleep, ___A___ is inhibited and ___B___ is secreted?
    • A. Cortisol
    • B. Growth Hormone (GH)
  278. Darkness and preparing for sleep causes a decrease in stimulation of the ______.
    Reticular Activating System (RAS)
  279. What does the pineal gland secrete, that helps with sleep and what effect does it have?
    Melatonin: It makes a person feel less alert
  280. What is sleep architecture?
    Refers to basic organization of sleep
  281. What are the two types of sleep that alternate in cycles?
    • NREM - Non-rapid eye movement
    • REM - Rapid-eye movement
  282. In general what is NREM sleep?
    • Occurs when activity in RAS is inhibited
    • Constitutes 75% to 80% of sleep
    • Consists of four stages
  283. What is STAGE I of NREM?
    • Very light sleep and lasts only a few minutes
    • Feels drowsy and relaxed
    • Eyes roll from side to side
    • HR and RR drop slightly
    • Can be readily awakened and may deny sleeping
  284. What is STAGE II of NREM?
    • Light sleep lasts only about 10 to 15 minutes
    • Body processes continue to slow down
    • Eyes are generally still
    • HR and RR decrease slightly more
    • Body temperature falls
    • 44 to 55% of total sleep
    • Requires more intense stimuli to awaken
  285. What is STAGE III and IV of NREM?
    • Deepest stages of sleep (delta sleep or deep sleep)
    • HR and RR drop 20-30% below waking hours
    • Difficult to arouse
    • Not distribued by sensory stimuli
    • Skeletal muscles very relaxed
    • Reflexes are diminished
    • Snoring is likely to occur
    • Swallowing and saliva production reduced
    • Essentiaal for restoring energy and releasing important growth hormones
  286. What are the physiological changes that happen in NREM sleep?
    • BP and HR decrease
    • Peripheral blood vessels dilate
    • CO decreases
    • Skeletal muscles relax
    • BMR decreases 10-30%
    • GH levels peak
    • Intracranial pressure decreases
  287. What is REM sleep?
    • Occurs every 90 minutes
    • Lasts 5-30 minutes
    • AcH and dopamine increase
    • Most dreams take place in REM
    • Brain is highly active
    • Brain metabolism increases as much as 20%
    • Distinctive eye movements occur
  288. What are the physiological changes that happen in REM sleep?
    • Voluntary muscle tone dramatically decreased
    • Deep tendon reflexes absent
    • May be difficult to arouse or may wake up spontaneously
    • Gastric secretions increase (REST & DIGEST)
    • HR and RR often are irregular
    • Regions of brain associated with learning, thinking, organizing information stimulated
  289. Describe how the sleep cycles work
    • Usually last 90-110 minutes in adults
    • Usually four to six cycles during 7-8 hours of sleep
    • If awakened from any stage, must restart at stage I
    • As sleep progresses, less time in stages III and IV of NREM and more in REM, dreams become longer
  290. What are the sleep patterns of NEWBORNS?
    • Sleep 16-18 hours a day
    • Periods of 1 to 3 hours spent awake
    • Enter REM sleep immediately
    • 50% NREM and 50% REM
    • Sleep cycle ~ 50 minutes
  291. What are the sleep patterns of INFANTS?
    • Awaken every 3 to 4 hours, eat, and then go back to sleep
    • Periods of wakefulness gradually increase
    • By 6 months, most infants sleep through the night and establish a pattern
    • Establish a pattern of daytime naps
  292. What are the sleep patterns of TODDLERS?
    • 12 to 14 hours are recommended
    • Most still need an afternoon nap
    • Nighttime fears and nightmares are also common
  293. What are the sleep patterns of PRESCHOOLERS AND SCHOOL-AGE CHILDREN?
    • Preschool child (3-5 years) requires 11 to 13 hours of sleep: The sleep needs fluctuate in relation to activity and drowth spurts
    • School age child (aged 5-12) needs 10-11 hours of sleep: Most receive less than needed
  294. What are the sleep patterns of ADOLESCENTS?
    • Require 9-10 hours of sleep each night
    • Nocturnal emmissions (wet dreams) occur in boys
    • Circadian rhythms tend to shift: Tendency to stay up later and wake later
  295. What are the sleep patterns of ADULTS?
    • Most healthy adults need 7-9 hours of sleep
    • Individual variations
  296. What are the sleep patterns of ELDERLY?
    • Tendency toward earlier bedtime and wake times
    • May show an increase in disturbed sleep
    • With dementia: Sundowning syndrome may last through the night
    • The need for sleep does not decrease with age
  297. What are some factors that affect sleep?
    • Illness
    • Environment
    • Lifestyle
    • Emotional stress
    • Stimulants and alcohol
    • Diet
    • Smoking
    • Motivation
    • Medication
  298. What are some common sleep disorders?
    • Insomnia
    • Excessive daytime sleepiness
    • Parasomnia
  299. What is insomnia?
    • Difficulty falling alseep
    • Waking up frequently
    • Difficulty staying asleep
    • Daytime sleepiness
    • Difficulty concentrating 
    • Irritability
    • Risk factors: Older age and Female (menapause)
  300. What can insomnia cause?
    • Irritability
    • Behavioral treatment: 1) Stimulus control 2) Cognitive therapy 3) Sleep restriction
  301. What are some excessive daytime sleeping disorders?
    • Hypersomnia
    • Narcolepsy
    • Sleep apnea
    • Insufficient sleep
  302. Describe Hypersomnia
    • Sufficient sleep at night but cannot stay awake during the day
    • Caused by medical or psychological disorders
  303. Describe Narcolepsy
    • Caused by lack of hypocretin in CNS that regulates sleep
    • Clients have sleep attacks
    • Sleep at night usually begins with sleep onset REM period
    • NOTE: Should not be driving!!!
  304. Describe Sleep Apnea
    • Frequent short breathing pauses during the night
    • More than 5 apneic episodes > 10 sec/hr considered abnormal
    • Symptoms include snoring, frequent awakenings, difficulty falling asleep, morning headaches, memory and cognitive problems, irritability
    • May exhibit loud snoring
    • May experience major headaches
  305. What are the different types of sleep apnea?
    • Obstructive
    • Central 
    • Mixed
  306. Describe what Insufficient Sleep is.
    • Leads to sleepiness and fatigue during the day and may lead to attention and concentration deficits
    • 19 hours of wakefulness produces: the equivalent of 0.05 blood alcohol level
    • 24 hours of wakefulness produces: the equivalent of 0.1 blood alcohol level
  307. Define and list the Parasomnias
    • Behavior that may interfere with or occur during sleep: Arousal disorders (sleepwalking, sleep terrors, etc.)
    • Sleep-wake transition disorders (sleep talking)
    • Associated with REM sleep (Nightmares)
    • Others (Bruxism - grinding of the teeth, enuresis - bedwetting, periodic limb movement disorders, etc.)
  308. What happens to an individual who does not sleep (who is otherwise healthy)?
    • Experience sleepiness and fatigue during the day
    • Attention and concentration deficits
    • Reduced vigilance
    • Distractibility
    • Reduced motivation
    • Fatique, malaise, diplopia, dry mouth
  309. What is diplopia?
    Double vision
  310. What is included in the nurse's ASSESSMENT of an individual with a sleeping disorder?
    • Sleep history
    • Health history
    • Physical exam
    • NOTE: If warranted, a sleep diary and diagnostic studies
  311. What can the sleep history reveal about the client?
    • When the client usually goes to sleep
    • Bedtime rituals
    • Does the client snore
    • Whether or not the client can stay awake during the day
    • Whether they are taking any prescribed or OTC medications
  312. What can the health history reveal about the client?
    • Obtain information about medical or psychiatric problems that may influence sleep
    • Medication history
  313. What can the physical examination reveal about the client?
    • Enlarged and reddened uvula and soft palat
    • Enlarged adenoids and tonsils (children)
    • Obesity (adults)
    • Neck circumerence > 17.5 inches (men)
    • Deviated septum (occasionally)
    • NOTE: Rarely yields information unless the client has obstructive sleep apnea
  314. What kind of information is put in a sleep diary?
    • Time factors associated with sleep
    • Acitivites performed 2-3 hours prior to sleep
    • Consumption of caffeine or alcohol
    • Medications
    • Bedtime rituals
    • Difficulty remaining awake during the day
    • Any worries or fears that may be contributing
  315. What are Polysomnograhies?
    Sleep studies
  316. What are a few NURSING DIAGNOSES that can be used for sleep disorders?
    Disturbed Sleep Pattern: With specific descriptions such as "difficulty falling asleep" or "difficulty staying asleep" (various etiologies may be involved and specified)
  317. What are a few NURSING DIAGNOSES that can use sleep pattern disturbances as the etiology?
    • Risk for injury
    • Ineffective coping
    • Fatigue
    • Risk for impaired gas exchange
    • Deficient knowledge
    • Anxiety
    • Activity intolerance
  318. What is involved in the NURSING PLAN, when dealing with a sleep disorder?
    • Maintain (or develop) a sleeping patttern that provides sufficient energy for daily activities
    • Enhance feeling of well being
    • Improve the quality and quantity of the client's sleep
  319. What are involved in the NURSING INTERVENTIONS, when dealing with a sleep disorder?
    • Sleep hygiene (term used for interventions that promote sleep) include:
    • 1) Reducing environmental distractions
    • 2) Promoting bedtime rituals
    • 3) providing comfort measures
    • 4) Scheduling nursing care to promote uninterrupted sleep
    • 5) Teaching stress reduction, relaxation techniques or good sleep hygiene
    • 6) Sleep medications, if appropriate
  320. What would be included in the client education of an individual with a sleep disorder?
    • The importance of sleep
    • Conditions that promote sleep
    • Conditions that interfere with sleep
    • Safe use of sleep medications
    • Effects of prescribed medications on sleep
    • Effects of disease states on sleep
    • The importance of long periods of uninterrupted sleep
  321. What are some bedtime rituals that can help adults sleep better?
    • Listening to music
    • Reading
    • Soothing bath
    • Praying
  322. What are some bedtime rituals that can help children to sleep better?
    • Need to be socialized into presleep routine
    • Usually preceded by hygienic ritual (bathing)
  323. ___A____ or ___B____ bedtime routines can affect sleep.
    • A. Altering
    • B. eliminating
  324. What can help to promote a restful environment for sleeping?
    • Minimal noise
    • Comfortable room temperature
    • Appropriate ventilation (fan)
    • Appropriate lighting
    • White noise (fan)
  325. How can a nurse promote comfort and relaxation for an individual having trouble sleeping?
    • Ensure a safe environment
    • Display a concerned, caring attitude
    • Do some of the following for the client:
    • 1. Loose fitting nightwear
    • 2. Hygienic routines
    • 3. Smooth, clean, dry bed linens
    • 4. Encouragement to void
    • 5. Relaxation techniques, i.e., backrub, breathing
    • 6. Correct positioning
    • 7. Schedule medications for maximum effectiveness and least interference with sleep
    • 8. Listen to and deal with problems as they arise (Kathy's story of elderly woman who missed her husband - Turned her on her side, gave her a pillow to cuddle and a back massage)
  326. What type of medications can help with sleep?
    • Sedative - hypnotics (induce sleep)
    • Anti-anxiety or tranquilizers
    • Start with low dose
    • Avoid regular use and abrupt cessation
    • NOTE: Must be aware of the actions, effects, risks of specific medications
  327. What do sedative hypnotics do?
    Mildest form of CNS depression is sedation (diminishes physical and mental responses at lower dosages but does not affect consciousness)
  328. What is the primary ingredient in over the counter (OTC) sleep aids?
    • Benadryl (diphenhydramine)
    • It is a short acting hypnotic
  329. What might the patient experience when taking sedative hypnotics (Benedryl)?
    • (SEE Kee Book, p. 309, table 20-1)
    • Hangover
    • REM rebound
    • Dependence
    • Tolerance
    • Excessive depression
    • Respiratory depression
    • Hypersensitivity
  330. What are the different types of barbiturates?
    • (SEE Kee book, p. 312)
    • Long acting
    • Intermediate acting
    • Short acting
    • Ultrashort acting
  331. When were barbiturates introduced on the market?
  332. Define a long acting barbiturate.
    Usually used to control seizures (Phenobarbital)
  333. Define an intermediate acting barbiturate.
    • Useful as sleep sustainers (longer periods of sleep).
    • Should be closely monitored (Alurate, Butisol, etc.)
  334. Define a short acting barbiturate.
    • Used to induce sleep for insomnia.
    • Should be monitored (Seconal, Nembutal, etc.)
  335. Define a ultrashort acting barbiturate.
    Used as general anesthetic (Pentothal)
  336. What are Bensodiazepines?
    • (SEE Kee book, p. 314 and Mosby's 2012 Drug Reference)
    • Selected medications that are ordered as sedative-hypnotics for inducing sleep.
  337. How does the bensodiazepine medication Resoril (temazepam) work?
    • Can supress stage 4 of NREM sleep (may result in vivid dreams or nightmares
    • Can delay REM sleep
    • Special considerations: Patients with renal or hepatic dysfunction
  338. What is Ambien (zolpidem) used for?
    Usually used for short term treatment of insomnia (nonbensodiazepine)
  339. What will the nursing EVALUATION for an individual who has a sleeping disorder look like?
    • Using data collected during care and the desired outcomes developed during the planning stage as a guide, the nurse judges whether the client goals and outcomes have been achieved.
    • If the desired outcomes are not achieved, the nurse and client should explore the reasons.