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sensoristasis
state of optimal arousal
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xerostomia
excessively dry mouth
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anosmia
loss of sense of smell
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hyperalgesia
extreme sensitivity to pain
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PCA
- pt controlled analgesia
- pain control pumps
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Parenteral meds
- meds that are injected or infused
- includes intradermal, sub-q, IM and IV
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Enteral meds
- meds that are absorbed in GI tract
- PO
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types of pain
- Cutaneous/superficial
- Visceral
- deep somatic pain
- radiating
- referred
- phantom
- psychogenic
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Visceral vs deep somatic pain
- 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.
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radiating vs referred
radiating starts at origin but extends to other locations
referred occurs in area distal from original site
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psychogenic pain
- pain that is believed to arise from the mind
- no physiological cause can be found
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types of duration of pain
- acute
- chronic
- Intractable pain is both chronic and highly resistant to relief
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how is pain classified
according to origin, cause, duration and quality
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what should be included in complete pain assessment
- Location
- Quality
- Rating
- Duration
- Exacerbating factors
- relieving factors
- pt goal
- follow up
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types of stressors
- distress/eustress
- external/internal
- developmental/situational
- physiological/psychosocial
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define distress & eustress stressors
distress threatens health
eustress is "good stress"
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examples of external & internal stressors
External would a death in the family, a hurricane, etc.
Internal stressors would be a disease, anxiety, negative self-talk
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Examples of developmental and situational stressors
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.
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Physiological stressors
- 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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define psychosocial stressors
external stressors that arise from work, family dynamics, living situations, social relationships, etc.
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major anions
- chloride (Cl)
- phosphate (PO)
- Bicarbonate (HCO)
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Cations/anions ICF and ECF
ICF is potassium (K), magnesium (Mg) and phosphate (PO)
ECF is sodium, chloride (Cl) and bicarbonate (HCO)
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how do fluids move in the body
active transport (requires energy)
Passive transport
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types of 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)
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types of solutes
crystalloids ~ small molecules, easily dissolved (electrolytes)
colloids ~ large molecules, don't dissolve easily (proteins)
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types of osmolality fluids
- 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)
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How does body regulate fluids
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)
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define fluid volume deficit
- hypovolemia
- S/S:
- dry mouth, skin, mucous membranes
- pallor, cool
- ↓ BP, HR and urine output
- ↑ constipation
- hypotension, dizziness, thirst
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define fluid volume excess
- hypervolemia
- S/S:
- ↑ BP and urinary output
- bounding pulse, neck veins distention
- edema
- pulmonary edema (crackles)
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Pulmonary ventilation vs. respiration
Ventilation is breathing in and out
Respiration is exchange of gases in lungs (O2 and CO2)
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define perfusion
supply of O2 to tissues and organs through circulation
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Factors that influence oxygenation
- developmental stage
- environment (pollution, allergies, stress)
- Lifestyle (obese, prego)
- Medications
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Hypoxia vs hypoxemia
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)
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nursing interventions to promote effective breathing
- 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
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Function of carbs
- 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
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Function of proteins
- tissue building
- metabolism
- immune system function
- fluid balance
- acid-base balance
- secondary energy source
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function of lipids
- 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
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function of vitamins
- 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
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function of minerals
- 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
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special diets
- 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
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explain structure and function of urinary system
- Kidneys filter and regulate
- Nephrons form urine
- ureters transport
- bladder stores urine
- urethra transports urine
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common urinary problems
- 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
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types of urinary incontinence
- 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
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promoting normal urination
- provide privacy
- assist w positioning
- facilitate toileting routines
- promote adequate fluids and nutrition
- assist w hygiene
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structure and function of bowel
- smooth-muscle tube, running through body from mouth to anus
- digest and absorb nutrients present in food
- elimiate food waste products as feces
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common bowel problems
- diarrhea
- constipation
- fecal impaction
- flatulence
- incontinence
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promoting normal defecation
- provide privacy
- assist w positioning
- consider timing
- support healthful intake of food/fluids
- encourage exercise
- manage flatulence
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assessing a stoma
- 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
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ethnicity
- 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
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socialization
- process of learning to become a member of a society or group
- person becomes socialized by learning social rules and roles, behaviors, values, norms
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cultural assimilation
occurs when new members gradually lean and take on the essential values, beliefs, and behaviors of the dominant culture
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acculturation
- 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
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health & illness practices of native american
- rituals and ceremonies
- chanting
- purification
- meds
- herbs
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health & illness practices of Asian/pacific islander
- acupuncture
- amulets
- moxibustion
- meditation
- herbs
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health/illness practices of black/AA
- prayer
- laying on of hands
- magic rituals
- voodoo
- herbs
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health/illness practices of hispanic
- prayer
- belief in miracles
- wearing religious metals/amulets
- religious relics in home
- herbs/spices
- rituals
- hot/cold therapy
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health/illness practices of white
- biomedical care
- home remedies
- religious traditions
- diet/exercise
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verbal forms of communication
- 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
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nonverbal forms of communication
- facial expression
- posture and gait
- personal appearance
- gestures
- touch
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5 key elements of therapeutic communication
- empathy
- respect
- genuineness
- concreteness
- confrontation (assertive)
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promoting therapeutic communication
- 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
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barriers to communication
- 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)
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