Finals

Therapeutic diets are ordered by person's primary care provider
• Soft, mechanical or pureed
• Liquid (HT, NTPT)
• Sodium-restricted [NAS (htn, kidney failure)]
• Carbohydrate-controlled or diabetic CCHO (diabetic)
• Calorie-restricted (immobility)
• "Heart Healthy" (CARDIAC)
• High-protein (wounds)

NAS = "no-added salt"
This happens with sodium restricted diets

Failure to take in enough of the right kind of nutrients to stay healthy

Difficulty swallowing
-Eating possibly difficult for a person receiving healthcare
-May require a great deal of physical effort to eat
-Person may be embarrassed about needing help
-Physical conditions (such as pain or nausea), emotional factors (such as
depression or loneliness), and the side effects of medications and
treatments can all negatively impact a person's appetite

-Check the name on the meal tray
-Check the diet to make sure it is the correct one for the person
-Help the person to eat shortly after delivering the meal
-Assist with opening cartons, cutting up food or identifying location of items
as needed
-Encourage use of assistive devices to promote independence

Fowler's position

Facing and feeding her on her stronger side

Fruits and vegetables have high water content. Soups, ice cream, and gelatin.

Too little fluids in the body

Monitoring of food intake
Estimate how much of total meal person ate
Report and record intake
Report intake of less than 70% to nurse

Enteral nutrition is also known as tube feeding. Fowler's position

A part of the large intestine or colon that is attached to the stoma (opening).

A condom-like device that is placed over a man's penis and is connected by tubing to a drainage bag to collect urine ; used in the management of incontinence

Difficult elimination of dry / hard feces

The elimination of solid waste from the body

The frequent passage of loose, watery feces

The introduction of fluid into the bowel through the anus to remove feces from the bowels

A serious form of constipation that occurs when constipation is not relieved and feces build up in the bowel until the bowel is almost completely blocked

Solid body waste

A pitcher-like device used for measuring fluids.

The inability to control the release of urine / feces

a small tube inserted through the urethra into the bladder that is left in place to drain urine from the bladder on a continuous basis

Medication that is taken orally to produce bowel movement

A pouch that is worn on the outside of the body, over a stoma, to collect feces / urine

A surgically created opening made in the abdominal wall to allow the elimination of waste

the elimination of liquid waste from the body

liquid body waste

Passage of urine; urination

When the person is able to get out of bed but not able to transfer the distance to the bathroom

Standard bedpan: narrow end pointing toward person's feet
Fracture pan: narrow end pointing toward person's head

-Normal structural changes such as a decrease in muscle tone and
elasticity
-Acute conditions such as urinary tract infection or diarrhea
-Certain medications
-Conditions such as confusion or dementia that affect the person's ability
to interpret the sensation of needing to use the bathroom, and/or perform
the tasks needed to use the bathroom
-Conditions such as arthritis that limit a person's mobility
-Brain, spinal cord or nerve damage that prevents the sensation of the
urge to go
-Muscle weakness that normally prevents the involuntary release of urine
or feces

-Pain or burning sensation when urinating
-Frequent and often urgent need to urinate
-Ability to pass only a small amount of urine, despite feeling the need to
urinate
-Cloudy, dark-yellow and possibly foul-smelling urine
-Mucus or blood in the urine
-Fever
-New unusual behaviors in a person with dementia
-Changes in mental status (especially in older people)

• Immobility
• Inadequate fluid intake
• Inadequate fiber intake
• Disruptions in person's normal bowel elimination pattern
• Changes in diet
• Aging
• Certain medications

Fecal impaction: more serious form of constipation occurring when
constipation not relieved; feces continue to build up until bowel
almost completely blocked

The amount of fluids lost is NOT equal to amount of fluids taken in

Keep the tubing lower than the person's bladder and the urine drainage bag lower than the tubing. Secure tubing with tape or strap to the top of the person's thigh.

Below the bladder

The graduate container

- All or part of the bowel is surgically removed
-Person who had their bladder removed

Point at which person becomes aware of the pain

Highest level of discomfort a person is willing to experience before seeking action to relieve it

Pain that occurs suddenly with injury, with illness or from surgery; last less than 6 months and lessens as tissues heal

Pain that lasts more than 6 months

One lasts more than another.

Pain is a subjective observation because it can't be directly observed by those who are not experiencing it

Wincing, grimacing, frowning or a worried facial expression
Rocking, pacing, restlessness
Rubbing the painful body part
Guarding (protecting) the painful body part
Moaning or crying
Resisting care
Aggressive behaviors (especially in response to attempts to give care)
Wakefulness
Loss of appetite

Facts to report:
Location
Characteristics
Intensity or level
Frequency

Icepacks and heatpacks

Check skin every 5 minutes. May reapply in 1 hour.

To communicate the intensity of the pain

A person's formal entry into the healthcare setting

The intial measurements that are taken to be compared with measurements taken later on

a person's formal release from the healthcare setting where he or she is currently receiving care

a process that involves identifying the person'’s ongoing care needs and making arrangments to have those needs met after the person leaves the facility

movement of a resident of a nursing home or a home health client may to another type of healthcare facility to receive care for an acute medical contion; expection that the person will return to the nursing home or to own home after receiving treatment for the acute medical condition

process of cleaning and disinfecting a room and its equipment in preparation for someone new

movement of a person from one part of a facility to another

a condition that causes joints to become inflamed, swollen, stiff, and painful

Safety because their bones are very fragile and brittle

an injury to the skin that often results in a break in the skin surface from either cutting the skin (surgical inceision), tearing (separation / ripping away of skin layers), puncturing the skin (trauma / stab wound), or prolonged pressure (damage to skin layers cause a break)

Open wound, closed wound, and existing wound?

A transient ischemic attack or mini-stroke.

Oncology

To reduce further trauma or infection. The skin is already dry and sensitive from radiation therapy.

When the patient is recieving chemotherapy

Age-related memory impairment
-Forgetfulness but no interference with daily life
-Result of gradual loss of brain cells and decrease in brain chemicals
Mild cognitive impairment
-Problems worse than age-related memory impairment
-Noticeable to others but no interference with daily life
-Some remain stable without experiencing further decline
-Regular exercise and control of blood pressure can help prevent
progression
-All people with this condition are at increased risk for developing
dementia

Group of symptoms occurring with a progressive decline in memory
and thinking

Dementia is not a specific disease rather there are many types of dementia.

Alzheimer's disease, Vascular Dementia, Mixed Dementia, and Parkinson's Dementia

-Early: changes occur gradually and may not be immediately noticeable to others
• Person completes ADLs and IADLs
• Possibly misinterpreted as normal changes of aging
• Person can often cover up their symptoms
• Social interactions become more challenging
• Person may forget to take medicines or pay bills
• If they drive, it is likely still safe
-Middle: symptoms worsen making it apparent that something is wrong
• Person's perceptions and understanding of the world change significantly
• ADLs and IADLs are affected
• Personality changes
• Safety becomes a priority
• Caring for the person at home becomes increasingly difficult for family and
friends
• Additional in-home or community support needed; consider admission to a
more supportive or assisted-living environment
• Typically the longest stage
-Late: significant decline; person becomes physically dependent on others for all aspect of care, needing round-the-clock support
• High risk for complications
• Problems with nutrition and fluid balance
• Language skills continue to decline
Physical condition progressively declines
• Care is directed toward promoting comfort at the end of life and supporting a
peaceful death

Rapid onset of change in cognition—occurring within a few days or even hours
-Related to chemical changes in the body
-Usually reversible

Often the first sign ot an infection
Other common causes include medications and their side effects,
lack of fluids, low blood sugar, lack of sleep, constipation,
metabolic changes, pain, major health issues (e.g., heart attack)
and changes in the person's environment
Number one underlying risk factor is dementia

Hallucinations
Inability to recognize familiar people
Extreme restlessness
Loss of short-term memory
Wandering
Inability to concentrate
Lethargy

Yes

-Memory (amnesia, from the Greek words meaning
without memory)
-Communication (aphasia, from the Greek words
meaning without speech)
-Senses (agnosia, from the Greek words meaning
without knowing)
- Tasks (apraxia, from the Greek words meaning
without doing) || notes:Amnesia: Problem with memory loss
Aphasia: Problem with communication resulting from damage ot the brian from injury / disease
Agnosia: Problem with the senses that causes inability to use the five senses to identiy an objet / family member. Unable to recognize pain
Apraxia: Problems with completing tasks. Inable to perform steps necessary to complete a task.

Validation therapy: communication technique where caregiver responds to
how the person is feeling or what the person believes to be true

Most often in middle stage of dementia
Commonly expressions of the person's fear and frustration
Wandering and pacing, hoarding, resisting care, inappropriate
sexual behaviors and sundowning

Catastrophic reaction: intense emotional and behavioral outburst
over a seemingly small event

Facts based on observations
Detection of pattern for recurrence of behavior
Pain often a trigger

Stop what you are doing and step back from the person. Refocus on the person and alter your approach to restore calm. Because the person is upset, respond with concern and comfort. If possible, leave the person alone for a few minutes. You may try to distract the person with another activity or change the topic and tone of the conversation to something pleasant. If the distraction isn't working, stop, leave the area and report your observation to the nurse.

Person as the focus, not the task
Be social first, rather than clinical
Minimize distractions
Adjust lighting
Avoid startling the person
Face person and use slow, clear speech with simple words and positively
worded sentences
Use gestures to help convey meaning

Bereavement care is care that is provided for people who are grieving after a person dies

Care that will make person more comfortable but not prolong life
-Oxygen therapy
-Pain medication
-Personal care
-Palliative care: care to relieve uncomfortable symptoms without curing
disease causing the symptoms

Do-not-resuscitate (DNR) order: specifies the person's wishes for no life
sustaining treatments or treatments that prolong life

Intense sadness that occurs as a result of loss.

Hospice: model of care focusing on providing comfort care and
supporting families during the end-of-life period

Treatments that will prolong life, such as cardiopulmonary resuscitation (CPR) or mechanical ventilation

-Palliative care: care to relieve uncomfortable symptoms without curing
disease causing the symptoms

Postmortem care: cleaning, positioning and identifying the body
-Washing the body and changing the clothing and linens
-Positioning the body properly
• Rigor mortis (stiffening of muscles)
• Discoloration of skin due to pooling

Stiffening of muscles

The body, after death, may be wrapped in a cloth covering called a shroud.

Illnesses for which there is no treatment and that are expected to lead to the person's death

Hospice: model of care focusing on providing comfort care and
supporting families during the end-of-life period

• Dying is a normal and expected part of the life cycle
• No separation of dying person from family and other support systems
• Care addresses person's and family's physical, emotional, social and
spiritual needs
• Care seeks to relieve pain and other distressing symptoms
• Help the person to die with dignity, honoring the person's preferences for
end-of-life care
• Support to family after person has died

Common caregiver concerns:
-What to say if person or family wants to talk about death
-Fear that person will die in caregiver's presence
-Worries aboug ability to handle emotional stress of losing people
-Fears related to caring for a deceased person's body

-Grief
-Sadness
-Fears related to death and dying
• Fear of the unknown
• Fear of dying alone
• Fear of experiencing pain
-Anger
-Denial
-Hope
-Acceptance

The ability to be a good listener

-Pain—most common and feared symptom
• Some assume uncontrolled pain is a normal part of the dying process
• Some daily tasks may be associated with pain
• Report concerns related to pain to the nurse so relief can be obtained
-Shortness of breath
• Proper positioning
• Fans
• Relaxation and special breathing techniques
• Oxygen therapy and medications (if severe)
-Digestive problems: use of medications to manage nausea, vomiting and
constipation
• Assist with repositioning according to the person's care plan
• Provide frequent skin care
• Provide frequent mouth care
•Report need for other comfort measures as appropriate
•Maintain a comfortable environment
•Provide privacy when providing care

-Rapid, weak or irregular pulse
-Decreased blood pressure
-Cool, moist and pale skin
-Coolness and mottling of hands and feet
-Incontinence
-Periods of increased, shallow respiration followed by periods of
decreased respiration
-A gargling sound with breathing
-Loss of, or a drifting in and out of, consciousness
-Loss of movement
-Loss of the ability to communicate

Emphasis on a working relationship between healthcare providers and family
•24-hour open visitation
•Sibling involvement
•Family conferences
•Family presence during procedures
•Family participation in decision making

Withdrawal of one's support or help from another person, despite having the responsibility to provide this support / help

adjective used to describe a person who is unable to leave his or her home without assistance

Triggers, you want to remove triggers

explain the steps and why

Log it but don't assign in expensive value. Keep it vague

100-105 but if kid than 95-100

Wounds

infection control and privacy (?)

be a good listener, and provide emotional support

no sodium diet

take them to a familiar place / objects they are familiar
with

every two hours

safety, don't want their bones to break

check for belongings

line the sink with a towel / washcloth so if you drop the
dentures they don't break because they are very expensive
to replace

looking for the bathroom

frequency, intensity, location of pain

report to your nurse

it should have been logged into the logging sheet so now
all it needs to do is be labeled

check for everythin in the bed

environmental services

they have cold and mottling hands

You can not leave early before the time allotted because
that is considered patient abandonment

catastrophic reaction

You can't take it however theres a loophole and if they put
it in an envelope then you can take it because you are
allowed to take an envelope

call for help then back blows and abdominal thrusts