Inter 3

state of optimal arousal

excessively dry mouth

loss of sense of smell

muscle sense

extreme sensitivity to pain

• pt controlled analgesia
• pain control pumps

• meds that are injected or infused 
• includes intradermal, sub-q, IM and IV

• meds that are absorbed in GI tract
• PO

• Cutaneous/superficial
• Visceral
• deep somatic pain
• radiating
• referred
• phantom
• psychogenic

• Visceral pain is caused by stimulation of deep internal pain receptors (organ pain) (ex: menstrual cramps, labor pain, GI discomfort)
• Deep somatic pain is similar to visceral in being deep, but it originates in ligaments, tendons, nerves, blood vessels and bones.

radiating starts at origin but extends to other locations

referred occurs in area distal from original site

• pain that is believed to arise from the mind
• no physiological cause can be found

• acute
• chronic
• Intractable pain is both chronic and highly resistant to relief

according to origin, cause, duration and quality

• Location
• Quality
• Rating
• Duration
• Exacerbating factors
• relieving factors
• pt goal 
• follow up

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• distress/eustress
• external/internal
• developmental/situational
• physiological/psychosocial

distress threatens health

eustress is "good stress"

External would a death in the family, a hurricane, etc. 

Internal stressors would be a disease, anxiety, negative self-talk

developmental are those that can be predicted to occur at various stages of a person's life

situational stressors are unpredictable, such as a car accident, natural disaster or an illness.

• chemical - poison, meds
• physical - trauma, cold
• nutritional - vitamin def, high fat diet
• biological - viruses, bacteria
• genetic - inborn errors of metabolism
• lifestyle - obesity, sedentary lifestyle

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external stressors that arise from work, family dynamics, living situations, social relationships, etc.

• Na 
• K
• Ca
• Mg

• chloride (Cl)
• phosphate (PO) 
• Bicarbonate (HCO)

ICF is potassium (K), magnesium (Mg) and phosphate (PO)

ECF is sodium, chloride (Cl) and bicarbonate (HCO)

active transport (requires energy)

Passive transport

osmosis ~ movement of fluids across membrane to dilute high concentration of solutes to low concentration

Diffusion ~ movement of molecules, from high concentration to low concentration

Filtration ~ Movement of water and crystalloids going from high pressure to low pressure (pressure in kidneys)

crystalloids ~ small molecules, easily dissolved (electrolytes)

colloids ~ large molecules, don't dissolve easily (proteins)

• isotonic ~ same osmolality as blood (low blood volume)
• hypotonic ~ water moves from vascular system into cells  (dehydration)
• hypertonic ~ water moves from cells into ECF (edema)

Intake: water/fluids, thirst is major regulator. Includes IV fluid, PO and irrigation

• Output: Urine, feces, perspiration, wound vac, emisis
• *sensible fluid loss is measurable and perceived
• Insensible fluid loss we do not perceive, not easily measured (occurs primarily by diffusion and evaporation through skin and lungs)

• hypovolemia
• S/S:
• dry mouth, skin, mucous membranes
• pallor, cool
• ↓ BP, HR and urine output
• ↑ constipation
• hypotension, dizziness, thirst

• hypervolemia
• S/S:
• ↑ BP and urinary output
• bounding pulse, neck veins distention
• edema
• pulmonary edema (crackles)

Ventilation is breathing in and out

Respiration is exchange of gases in lungs (O₂ and CO₂)

supply of O₂ to tissues and organs through circulation

• developmental stage
• environment (pollution, allergies, stress)
• Lifestyle (obese, prego)
• Medications

Hypoxia is low oxygen in body tissues. will show low LOC.  Low SPO₂ isnt necessarily hypoxia

Hypoxemia is low oxygen in blood, caused by poor circulation, diffusion into blood or other disorders. (Think blood)

• admin meds as ordered
• Prevent resp infections (URI's, flu & pneumonia)
• support smoking cessation
• position for max ventilation
• assist with I.S. (Incentive spirometer)
• Take aspiration precautions
• Mobilize secretions: teach coughing/deep coughing, maintain hydration, perform chest physiotherapy
• Ambulation
• HYDRATION

• primary energy source
• supply energy for muscle and organ function
• Spare protein
• enhance insulin secretion
• increase satiety
• improves absorption of Na and excretion of Ca

• tissue building
• metabolism
• immune system function
• fluid balance
• acid-base balance
• secondary energy source

• supply essential nutrients
• energy source
• flavor and satiety
• body fat provides insulation, protests vital organs, aids in temp regulation, enables accurate nerve-impulse transmission
• also helps with cholesterol function

• necessary for metabolism or preventing a particular deficiency disease 
• critical in building and maintaining body tissues
• supporting immune system
• ensuring healthy vision
• help use energy from carbs, protein and lipid

• assist in fluid regulation, nerve impulse transmission and energy production
• essential to health of bones
• help rid body of by-products of metabolism
• play key roles in disease prevention and treatment

• diets modified by consistency
• diets modified for disease:
• calorie, fat or sodium restriction
• diabetic
• renal diet
• protein controlled
• antigen-avoidance diets (allergies)
• Calorie-protein push

• Kidneys filter and regulate
• Nephrons form urine
• ureters transport
• bladder stores urine
• urethra transports urine

• UTI
• Urinary retention ~ an inability to empty the bladder completely. could be from obstruction, inflammation, neurological, meds and anxiety

Urinary incontinence ~ lack of control over urination

• urge incontinence ~ involuntary loss of urine accompanied by strong urge. also called overactive bladder
• stress incontinence ~ invol loss of small amounts w activities that increase intraabd pressure: coughing, laughing, sneezing
• Mixed ~ combo of urge and stress
• Overflow ~ loss of urine in combination with distended bladder (could be caused by fecal impaction, enlarged prostate, neuro disorder)
• Functional incontinence: untimely loss of urine when no urinary or neuro cause is involved
• Reflex ~ loss of urine when person doesn't realize bladder is full & no urge to void

• provide privacy
• assist w positioning
• facilitate toileting routines
• promote adequate fluids and nutrition
• assist w hygiene

• smooth-muscle tube, running through body from mouth to anus
• digest and absorb nutrients present in food
• elimiate food waste products as feces

• diarrhea
• constipation
• fecal impaction
• flatulence
• incontinence

• provide privacy
• assist w positioning
• consider timing
• support healthful intake of food/fluids
• encourage exercise
• manage flatulence

• healthy stoma ranges in color from deep pink to brick red; pallow or blud indicates ischemia, dark brown-black indicates necrosis.
• Need to monitor output in amt and type
• pay close attention to skin surrounding stoma for signs of irritation or breakdown

• similar to culture as it refers to groups whose members share common social/cultural heritage passed down from gen to gen
• an ethnic group have some characteristics in common (race, ancestry, phys characteristics, geographic, lifestyle, religion) that isn't shared or understood by outsiders

• process of learning to become a member of a society or group
• person becomes socialized by learning social rules and roles, behaviors, values, norms

occurs when new members gradually lean and take on the essential values, beliefs, and behaviors of the dominant culture

• process in which immigrants (new members of group) assume the characteristics of that culture through a learning process
• person accepts both his own and new culture, adopting both elements

• rituals and ceremonies
• chanting
• purification
• meds
• herbs

• acupuncture
• amulets
• moxibustion
• meditation
• herbs

• prayer
• laying on of hands
• magic rituals
• voodoo
• herbs

• prayer
• belief in miracles
• wearing religious metals/amulets
• religious relics in home
• herbs/spices
• rituals
• hot/cold therapy

• biomedical care
• home remedies
• religious traditions
• diet/exercise

• vocabulary
• denotation meaning of word(literal meaning of word)
• connotative meaning (implied or emotional meaning)
• pacing
• intonation (tone of voice)
• clarity and brevity (fewest words poss)
• timing & relevance
• credibility
• Humor

• facial expression
• posture and gait
• personal appearance
• gestures
• touch

• empathy
• respect
• genuineness
• concreteness
• confrontation (assertive)

• active listening
• establishing trust
• being assertive (able to express yourself while still respecting others veiwpoints)
• restating, clarifying, and validating messages
• interpreting body language & sharing observation
• exploring issues
• using silence
• summarizing the conversation
• process recordings

• asking too many questions
• asking why
• fire-hosing info (too much info too fast)
• changing the subject inappropriately
• failing to probe
• offering advice
• providing false reassurance
• stereotyping 
• using patronizing language (you know better)