Upgrade to remove ads
Only $35.99/year

NURS 251- exam #2

Terms in this set (126)

-referent
-sender & receiver
-message
-channels
-feedback
-interpersonal variables
-environment
what are the basic elements of communication?
motivates one to communicate with another
what does the basic element of communication "referent" mean?
one who encodes & one who decodes the message
what does the basic element of communication "sender and receiver" mean?
content of the message
what does the basic element of communication "message" mean?
means of conveying and receiving messages
what does the basic element of communication "channels" mean?
message the receiver returns
what does the basic element of communication "feedback" mean?
factors that influence communication
what does the basic element of communication "interpersonal variables" mean?
the setting for sender-receiver messages
what does the basic element of communication "environment" mean?
1:1 interaction between 2 people
what is the "interpersonal" level of communication?
occurs w/in an individual
what is the "intrapersonal" level of communication?
interactions w/ a person's spiritual domain
what is the "transpersonal" level of communication?
interactions w/ a small number of people
what is the "small group" level of communication?
interaction w/ an audience
what is the "public" level of communication?
-intrapersonal
-Interpersonal
-transpersonal
-small group
-public
what are the levels of communication?
-0-18 in.
-used for physical assessment
what is the measurements of "intimate" personal space?
-18 in-4 ft
-used for talking
what is the measurements of "personal" personal space?
-4-12 ft
-used for making pt rounds
what is the measurements of "social" personal space?
-12 ft or greater
what is the measurements of "public" personal space?
-permission is not needed
-hands & arms
what is the social zone?
-permission needed
-wrist, mouth, & feet
what is the consent zone?
-special care needed
-neck & front of body
what is the vulnerable zone?
-great sensitivities needed
-genitals
what is the intimate zone?
-perceptions
-values
-emotions
-sociocultural background
-knowledge level
-roles and relationships
-environments
-space and territory
what are factors that influence communication?
-assumptions may lead to misinterpretation
how do perceptions influence communication?
-disagreements may occur involving opinions, which may cause shut down
how do values influence communications?
-a person may be closed down if they a certain emotion
how do emotions influence communication?
-specific responses that encourage the expression of feelings and ideas and convey acceptance and respect
what is therapeutic communication?
-SOLER
-silence
-touch
-clarify/restate
-open ended questions
what are examples of therapeutic communication?
-empathy (understanding, validating feelings)
-respect (addressing pt, privacy, valuing pt)
-genuineness (honesty, trust, share who you are w/in reason)
-concrete and confrontation
what are some characteristics of therapeutic communication?
-S: sit facing the pt
-O: observe an open posture
-L: lean toward pt
-E: establish and maintain intermittent eye contact
-R: relax
what is SOLER?
90%
what percent of the time should you spend giving eye contact when LISTENING?
70%
what percent of the time should you spend giving eye contact when SPEAKING?
-person questions
-changing the subject
-giving false reassurance
-laugh nervously
-being sarcastic
-giving defensive responses
-looking busy or uncomfortable
what should you avoid doing, as they are considered "non-therapeutic communication techniques"?
-being organized in thought
-possessing technical and social competence
-seeking common understanding, ownership, and value from all members of the team
-start with the phrase, "I am concerned..."
how can you demonstrate being assertive in the clinical setting?
-dont rush
-approach pt directly
-reduce environmental distractions
-limit choices
-use short sentences
-talk first, touch second
what are some communication interventions used for patients w/ impaired cognition?
-situation (current)
how is the S in SBAR used to document?
-background (limit to essential information)
how is the B in SBAR used to document?
-assessment (your assessment of data)
how is the A in SBAR used to document?
-recommendation (you suggest next steps/what you need to happen and when)
how is the R in SBAR used to document?
-an unpleasant sensory and emotional experience association w/actual or potential tissue damage, or described in terms of such damage
define pain
-cutaneous or superficial pain, visceral pain, deep somatic pain, radiating pain, referred pain, phantom pain, psychogenic pain
classify the types of pain according to origin
-arises in the skin or the subcutaneous tissue (ex. paper cut)
define cutaneous or superficial pain
-caused by the stimulation of deep internal pain receptors. Often experienced in the abdominal cavity, cranium, or thorax
(ex. Menstrual cramps, labor pain, gastrointestinal infections, organ cancers)
define visceral pain
-originates in the ligaments, tendons, nerves, blood vessels, and bones
(ex. Fracture or sprain, arthritis, bone cancer)
define deep somatic pain
-starts at the origin but extends to other locations
(ex. Pain of severe sore throat, gastroesophageal reflux)
define radiating pain
-occurs in an area that is distant from the original site
(ex. Pain from a heart attack maybe experienced down to the left arm)
define referred pain
-pain that is perceived to originate from an area that has been surgically removed
(ex. Patients w/amputated limbs may still perceive that the limb exists & experience burning, itching, & deep pain in that area)
define phantom pain
-refers to pain that is believed to arise from the mind
define psychogenic pain
-nociceptive pain, visceral pain, somatic pain, neuropathic pain
classify the types pain according to cause
-refers to the site where pain is felt and not necessarily the source of pain
what does origin of pain?
-physical pain can either be nociceptive or neuropathic
what does cause of pain mean?
-most common type of pain experienced, which are called nociceptors, respond to stimuli that are potentially damaging
what is nociceptive pain?
-visceral & somatic pain
which two types of pain are associated w/ nociceptive pain?
-pain originating from internal organs
what is an example of visceral pain?
-pain originating from the skin, muscles, bones, or connective tissue
what is an example of somatic pain?
-complex & often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli
(ex. Stroke, diabetes, alcoholism, amputation)
what is neuropathic pain?
-acute and chronic pain
what two types of pain are associated with duration of pain?
-short duration & is generally rapid in onset, intensity (ex. injury or surgery)
define acute pain
-pain that has lasted 6 months or longer & often interferes w/daily activities (ex. progressive disorders like cancer, arthritis)
define chronic pain
-both chronic & highly resistance to relief
what is intractable pain?
-the words patients use to describe the quality of their pain help care providers to determine the probable cause & most effective treatment
what is quality of pain?
-fear, confusion & helplessness, anxiety & depression, previous pain experience
describe the physiological changes that occur w/pain
-endogenous analgesia system & gate control theory of pain modulation
what are two physiological mechanisms involved in pain modulation
-changes the perception of pain by either facilitating or inhibiting pain signals through the endogenous analgesia system & the gate control mechanism
what does modulation mean?
-neurons in the brain stem activate descending nerve fibers that conduct impulses back to the spinal cord. These impulses trigger the release of endogenous opioids & other substances to block the continuing pain impulses & provide pain relief
what is the Endogenous analgesia system?
-describes the mechanism of pain sensation, based on the idea that the perception of pain does not occur by direct simulation of only nociceptors (pain-producing fiber). Pain is perceived by the interplay between two different kinds of fibers- those that produce pain & those that inhibit pain
what is the Gate control theory of the pain modulation?
-ongoing pain triggers excessive release of hormones (ACTH, ADH, & insulin & testosterone levels decrease). The hormone shifts activate carbohydrate, protein, & fat catabolism (breakdown). Hyperglycemia, & poor glucose use.
what effect does unrelieved pain have on the endocrine system?
-unrelieved pain leads to hypercoagulation & an increase in HR, BP, cardiac overload, & oxygen demand. The combination of hypercoagulation & increased cardiac workload may lead to unstable angina, intracoronary thrombosis (clot formation in the vessels that supply the heart) & myocardial ischemia & infraction
what effect does unrelieved pain have on the cardiovascular system?
-causes impaired muscle function, fatigue, & immobility.
what effect does unrelieved pain have on the musculoskeletal system?
-patients in pain tend to breathe shallowly- to limit thoracic & abdominal movement in an effort to reduce pain, which is called splinting. This reduces tidal volume (air exchanged w/each breath). Can lead to pneumonia, atelectasis, underventilation, respiratory acidosis
what effect does unrelieved pain have on the respiratory system?
-unrelieved pain can release excessive amounts of catecholamines, aldosterone, ADH, cortisol, angiotensin II, & prostaglandins. These lead to decreased urinary outputs/retention, fluid overload, hypokalemia/tension, and increased cardiac output
what effect does unrelieved pain have on the genitourinary system?
-intestinal secretions & smooth muscle tone increase, and gastric emptying & motility decrease
what effect does unrelieved pain have on the gastrointestinal system?
-Cutaneous stimulation, TENS Unit (transcutaneous electrical nerve stimulator), PENS Unit (Percutaneous electrical stimulation), spinal cord stimulator, acupuncture/acupressure, massage, heat & cold, contralateral stimulation, distraction, sequential muscle relaxation (SMR), guided imagery
discuss nonpharmacological pain relief measures
-medication that relieve mild to moderate pain, also reduce inflammation & fever
-Acetaminophen, aspirin, ibuprofen, naproxen (all may be used for acute & chronic pain)
what are nonopioid analgesics and give examples
-reduce the amount of opioid the patient requires, may be used as a primary therapy for mild pain or in conjunction w/opioids for moderate to severe pain.
>>Frequently used in managing neuropathic pain
-Anticonvulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosteroids
what are Co-adjuvant adjuvant analgesics and give examples
-morphine, hydromorphone, fentanyl, methadone, oxycodone.
what opioid analgesics are given for severe pain?
a. Chemical pain relief measures: nerve blocks & epidural injection are types of regional anesthesia
>most nerve blocks may affect a network of nerves called a plexus
>>local anesthesia: injection of local anesthetics into body tissues
1. short-acting: lidocaine
2. long acting: Marcaine
>>>topical anesthesia: applying an agent that contains cocaine, lidocaine, or benzocaine directly to the skin, mucous membranes, wounds or burns. For mild to moderate pain
describe chemical pain relief measures
-cordotomy, rhizotomy, neurectomy, sympathectomy
describe surgical pain relief measures
-interrupts pain and temperature sensation below the tract that is severed (most frequently done for leg & trunk pain)
define what cordotomy does for pain relief
-interrupts the anterior or posterior nerve route that is located between the ganglion and the cord. Anterior interruption is generally used to stop spastic movements that accompany paraplegia and posterior interruption eliminates pain in the area innervated
define what rhizotomy does for pain relief
-used to eliminate intractable localized pain
define what neurectomy does for pain relief
-severs the paths to the sympathetic division of this procedure are improvement in vascular blood supply & elimination of vasospasm. (ex. Raynaud's disease)
what does sympathectomy do for pain relief?
-Pain reveals a lot about a patient's health. Pain is not only affecting their physical health but their mental health as well (mood, activity, sleep, hygiene, appetite)
Explain why pain should be considered the fifth vital sign
a. Insert the medication cartridge/syringe into the pump, prime the connecting tubing and lock the pump
b. Set the pump for the demand dose, the lockout interval, loading dose (if prescribed), basal rate (if prescribed), and the 1-hour or 4-hour lockout dose limit
c. Connect the tubing into the patient's maintenance IV line
d. Place the button that controls dosing within reach of the patient
Change tubing per facility protocol
explain how to use a patient-controlled analgesia (PCA) system
-natural & synthetic compounds that relieve pain through a variety of potency
define what an opioid analgesic is
-codeine, hydrocodone, tramadol
what opioid analgesics are used for moderate pain?
-occurs in the spinal cord, causing muscles to contract reflexively, moving the body away from the painful stimuli
what is modulation
-the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers (nociceptors)
define transduction
-age, fatigue, genetic sensitivity, cognitive function, prior experiences, anxiety and fear, culture
factors that affect pain experience includes
-BP, pulse, RR increase w/acute pain but the increase in vital signs will stabilize despite the persistence of pain
expected findings when assessing pain include
-hyperalgesia
a heightened sense of pain is called?
-condition in which the client experiences pain following experiences that are not usually painful (when wearing clothes or feeling the wind blow)
define allodynia
-sympathetic nervous system responses, increased pulse rate & RR, elevated BP, diaphoresis, dilated pupils, related to tissue injury; resolves w/healing
describe the physiological changes that occur w/ acute pain
-parasympathetic nervous system responses, vital signs normal, dry,warm skin, pupils normal or dilated, depressed & withdrawn, patient does NOT mention pain unless asked, pain behavior often absent
describe the physiological changes that occur w/ chronic pain
-phenomenon of patients with pain being under-treated. The idea is that patients with legitimate pain that could be alleviated with opioid painkillers exhibit drug-seeking behavior that is misinterpreted as addiction
Differentiate tolerance, physical dependence, pseudo-addiction, and addiction.
(pseudo-addiction)
-a person no longer responds to a drug in the way they did at first. So it takes a higher dose of the drug to achieve the same effect as when the person first used it
Differentiate tolerance, physical dependence, pseudo-addiction, and addiction.
(tolerance)
-when a person stops using a drug, their body goes through withdrawal
-symptoms include muscle-bone pain, sleep disturbance, diarrhea/vomiting, cold flashes
Differentiate tolerance, physical dependence, pseudo-addiction, and addiction.
(physical dependence)
-Repeated misuse of prescription opioids can lead to substance use disorder
Differentiate tolerance, physical dependence, pseudo-addiction, and addiction.
(addiction)
-lowers risk for early death, heart disease, stroke, type II diabetes, hypertension, hyperlipidemia, metabolic syndrome, colon & breast cancer, & depression
what does physical activity do to benefit you physiologically & psychologically?
-promotes weight loss & maintains normal weight when combined w/ diet
-Improves strength, balance, & muscle tone to prevent falls & improve overall physical stamina
for older adults, how does walking 30 min per day help their joints?
-perform weight bearing exercises
what can an older adult do to reduce loss of bone density?
-improves pumping action of heart
-decreases heart rate, HR variability, & blood pressure
-decreases low density lipoproteins (LDP's) & total cholesterol
-decreases risk of thrombophlebitis
how does exercise, activity, & movement benefit the cardiovascular system?
-improves pulmonary circulation
-improves gas exchange at the alveolar
-dilates bronchioles to increase ventilation
how does exercise, activity, & movement benefit the respiratory system?
-improves skeletal development in children
-increases flexibility & coordination
-improves bone mass & mineral density
-improves gate speed, stability, & balance
-improves bone mass w/ aging
-reduces risk of osteoporosis
how does exercise, activity, & movement benefit the musculoskeletal system?
-speeds nerve impulse transmissions
-reduces sympathetic response to exercise
-improves reaction time
how does exercise, activity, & movement benefit the nervous system?
-increases sensitivity to insulin at the receptor sites
-increases efficiency of metabolic processes
-improves temperature regulation
how does exercise, activity, & movement benefit the endocrine system?
-improves appetite & abdominal muscle tone
-decreases risk of colon cancer
how does exercise, activity, & movement benefit the gastrointestinal system?
-increases efficiency of kidney function
how does exercise, activity, & movement benefit the urinary system?
-improves skin tone as a result of improved circulation
how does exercise, activity, & movement benefit the integumentary system?
-boosts energy levels
-can be a source of social interaction
-improves self-esteem & body image
-provides a non pharmacological way to relieve symptoms of anxiety & depression
how does exercise, activity, & movement benefit mental health?
-shoulders & hips are level
-toes are pointed forward
-spine is straight & has no abnormal curvatures noted
-the posture is not slumped
during an assessment of body alignment, what should you check for while the patient is STANDING?
-does the pt have difficulty lowering their torso?
-can the pt control the movement?
-Is the pt able to get into position w/ ease?
-when the pt sits, do they slump?
during an assessment of body alignment, what should you observe of the patient while he/she is SITTING?
-assess pt alignment in bed
-look for ability to move in bed
-observe posture the patient maintains
during an assessment of body alignment, how do you make your assessment if the pt cannot sit or stand?
-FIM scale
what is used to assess the severity of pt disability & how much assistance is required for the pt to carry out ADL's?
-limp to avoid pain when bearing weight on the affected side
what does an antalgic gait look like?
-a stooped, rigid posture w/ the head & neck bent forward
-movement is forward by small, shuffling steps w/ involuntary acceleration
what does a propulsive gait look like?
-legs flexed slightly at the hips & knees w/ the thighs crossing in a scissor like movement
-common in cerebral palsy, stroke, or spinal tumor
what does a scissors gait look like?
-a stiff, foot dragging walk caused by one sided, long term muscle contraction
-seen w/ cerebral palsy, head trauma, or brain tumors
what does a spastic gait look like?
-an exaggerated motion of lifting the leg to avoid scraping the toes of a foot w/ footdrop
what does a steppage gait look like?
-a distinctive rolling motion in which the opposite hip drops
-seen in pt's w/ muscular dystrophy or developmental dysplasia of the hip
-characteristic gait in late pregnancy
what does a waddling gait look like?
-leads to isolation & mood changes
-depression, anxiety, sleep disturbances, hostility, changes in ability to perform self care, disorientation, apathy, altered body concept, & diminished concentration
what are some changes in physiological & psychological function that are associated w/ immobility?
-identify complications of immobility (skin breakdown, contractures, etc)
-assess client for mobility, gait, strength, & motor skills
-perform skin assessments & implement measures to maintain skin integrity & prevent skin breakdown
-apply, maintain, or remove orthopedic devices (traction, splints, braces, casts)
-apply & maintain devices used for venous return (SCD's, TED hose)
-apply measures to promote circulation (ROM, positioning, mobilization)
what are examples of interventions used to counter the effects of immobility?
-a state in which a pt has insufficient physical or psychological energy to carry out daily activities
what is activity tolerance?
-limitation of independent purposeful movement of the body
what is impaired physical mobility?
-exists when a pt's prescribed or unavoidable inactivity creates the risk for deterioration of other body systems
what is "risk for disuse syndrome"?
-a habit of life that is characterized by a low physical activity level
what is a sedentary lifestyle?
Other sets by this creator