Teaching Learning

Domains- Cognitive

Teaching Learning

Domains-Affective

Teaching Learning

Domains- Psychomotor

Urinary Elimination

Urinary retention

urine retained in bladder

• feeling of not emptying, urge to void
• bladder distended
• restless, diaphoretic
• increased risk for UTI
• more than 100ml left after voiding
• Causes- obstruction, surgery, blood clots, meds
• Post voiding residual (PVR)- 0-50ml(Normal) 50-200ml(needs evaluation) >200(needs treatment)

loss of urinary control

• functional-involuntary passage of urine in someone with no urinary system problem
• stress-leakage with increase abdominal pressure
• Urge-urge can't be delayed
• Reflex-Spinal cord injury, signals are interrupted and there is a loss of voluntary control
• Overflow-Urinary retention, over distended bladder that leaks small amounts of urine frequently

Levels of Communication

Intrapersonal

self talk, prayer, meditation

• positive self messages get positive results

Levels of Communication

Interpersonal

between 2 people, communicate face to face

• most common type of communication in nursing

Levels of communication

Small group

or family, make sure goals are explicit

• school or work interactions

level of communication

Public

Elements of Communication Process

Referent

Elements of Communication process

sender

Elements of communication process

Message

Elements of communication process

receiver

elements of communication process

feedback

elements of communication process

channel

senses used

Ex. telephone, internet, e-mail

Elements of communication process

Interpersonal variables

Phases of Interaction

Preinteraction

Phases of Interaction

Orientation

Phases of Interaction

Working Phase

Phases of Interaction

Termination

Loss, Death, Grieving Theorists

Engle

• shock and disbelief
• developing awareness of Loss
• restitution and reorganization

Loss, Death, Grieving Theorists

Kubler-Ross

• Most common
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
• Can go back and forth between, no certain order

Loss, Death, Grieving Theorists

Bowlby's Attachment Theory

• Numbing
• Yearning and searching
• disorganization and despair
• reorganization

Loss, Death, Grieving Theorists

Worden

• Grief is a work (task)
• T-E-A-R
• T-to accept reality of loss
• E-experience the pain of grief
• A-adjust to environment from which person and/or objects are missing
• R-reinvest emotional energy into new relationship

Dysfunctional Grieving

High Risk Deaths

• Death of a child-most intense grief of all
• Child loses parent or sibling
• sudden unexpected deaths- suicide, homicide, accident
• Multiple losses
• Over lengthy illness
• Survivor felt death of another was preventable
• Pt suffered greatly at end of death
• Survivor lacks adequate support
• Survivor and the deceased had a bad relationship upon death
• Lack of spirituality
• Elder men

• Survivor cannot openly acknowledge the loss of a loved one because relationship is unacceptable or marginalized
• "unsupported loss"

• Pt and family engage in grieving before the loss
• some work goes in to the loss before it happens

• normal grieving after a loss has occurred
• normal feelings, behaviors and reactions to loss

• can be loss of normalcy at developmental milestons
• milestones triggered by situations that bring to mind the person's losses

shortness and difficutly breathing

• caused by: anemia, tumor growth, ascites, anxiety, disease progression
• treat by managing the cause
• interventions: raise head of bed, blow electric fan into face

gurgling/rattle like noise produced close to death due to accumulation of excess respiratory secretions in throat

• accumulation dute to:dysphagia
• not harmful to pt, just scares the family
• interventions: raise head of bed and reposition on side

loss of appetite

• caused by: pain, medications, depression, nausea/vomiting, dysphagia, disease progression
• more distressing to family
• treat by managing pain and nausea
• Interventions: serve food cold/room temp, negotiate to eat less rather than none at all, offer alcohol, brush teeth before meals, no wrong food (give them what they are craving)

• decrease urine output and blood pressure
• cold extremities
• vital signs change-pulse and respirations increase
• respiratory congestions-death rattle
• restlessness, confusion, apnea

• absence of heartbeat and respirations
• fixed pupils
• color-waxy gray, back is purple due to blood setting
• body temp drops
• muscles and sphincters relax

• offer family to help-coping mechanism (not closure, closure is continuous)
• close eyes, bathe them
• call funeral home to pick up body
• Once body has been taken, ask family for permission to change bed linens
• make bed and leave an important item in place of lossed one on bed
• destroy meds
• initiate bereavement support for the family

Vital signs

Normal values

• Temp: 96.8-100.4
• Pulse:60-100 beats/min
• Respirations: 12-20 breaths/min
• Blood Pressure: 120/80

treat everyone as potentially infectious

• use barriers protection: gloves, gowns, masks, goggles, plastic bags, puncture resistant containers, private room if possible

used with and in addition to standard precautions

• airborne-N95 respirator for treatment (negative air pressure room)
• droplet- something in lungs (coughing, 2ft rule)
• Contact-must come into physical contact with infection

• Albumin 3.4-4.8
• Transferrin 250-450
• Lymphocytes 4.5-10
• Hgb 12-18
• Hct 37-52 (3x hgb)
• Serum Protein 6-8
• Nitrogen balance = "-"(starvation) & "+" (healthy diet)

route other than tube (large vessel; superior vena cava)

• label parenteral tube in documentation---IMPORTANT

use tube

• diarrhear is a common side effect of both types of feeding

not passing flatus, no bowel sounds

• can get serious enough for surgical removal