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stress crisis and surgery
Prof. Practice exam 2
54
Nursing
Undergraduate 3
10/02/2010

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Cards

Term
stressors
Definition
disruptive forces orperating within or on any system
Term
Appraisal
Definition
how people interpret the impact of the stressor on themselves, of what is happening, and what they are able to do about it.
Term
3 theoretical models of stress
Definition

1. stress as a stimulus

2. stress as a physical response

3. stress as transaction

Term
stress as a stimulus
Definition
Hans& Ray developed the life event scale. change in a life situation stimulates a stress
Term
Stress as a physcial response
Definition
Hans Selye developed the gerneral adaptation syndrome. Body responds and compensates physcially in response to stress
Term
Stress as transaction
Definition
Lazarus states stress is a subjective experience. for stress to occur there is a dynamic relationship with a situation in the environment an individual and their coping abilites
Term
General Adaptation syndrome
Definition
Three stage reaction to stress. discribes how the body responds to stressors through the alarm reaction, resistance stage, and exhaustion stage.
Term
endorphins
Definition
developed because of GAS. it is a hormone that act on the mind like morphine and opiates, produces a sense of well-being and reduce pain
Term
alarm reaction
Definition
rising hormone levels result in increase blood volume, blood glucose levels. this change in body systems prepares an individual for fight or flight and last for 1 minute to many hours
Term
resistance stage
Definition
body stabilizes and responds in an opposite manner to the alarm stage. hormone levels, heart rate, blood pressure return to normal. and the body repairs any damage that has occured.
Term
exhaustion stage
Definition
occurs when the body is no longer able to resist the effect of the stressor and when the body has depleted the energy neccessary to maintain adaptation.
Term
factors influencing the stress response
Definition
  • magnitude
  • meaning
  • number of stressors
  • developmental level
  • social support
  • previous experience
  • gender
Term
adaptive responses to stress
Definition
  • increased motivation
  • increased decision making
  • increased self control
  • use of relaxation response
  • use of support systems
Term

maladaptive responses to stress

 

Definition
  • increased heart rate
  • increased blood pressure
  • depression
  • smoking
  • alcohol consumption
  • change in weight
Term

How stress gets expressed

 

Definition
  • anxiety
  • fear
  • hostility
  • blaming others
  • grief
  • ego defense mechanisms
Term
Types of crisis
Definition

1. situational

2. developmental

Term

Situational crisis

 

Definition
external event, sudden and unexpected
Term
Developmental crisis
Definition

happen because of maturational changes

ericksons stages provide a freamwork for understanding these.

Term

nursing care planning in relation to crisis: assessment

 

Definition
  • assess patients safety
  • define the crisis problem
  • solicit releveant history
  • identify recent change sin patients behaviors
  • recognize perosonal strengths
  • identify social support
Term
Nursing care planning in relation to crisis: diagnosis
Definition

grieving

ineffective coping

anxiety

ineffective family coping

Term
Nursing care planning in relation to crisis: planning
Definition
  • done with everyone involved
  • taking control,so include the patient in your planning
  • venting feelings
  • providing anticipatory guidance
  • repeating information
  • setting priorites
Term
intervention 3 step model
Definition

1. engaging the patient

2. exploring the problem

3. developing alternatives

Term

engaging the patient

 

Definition
if patient feels supported and then the intensity of the crisis will decrease. use communication skills
Term
exploring the problem
Definition
help the patient identify the critical elements. break the problem down, be truthful, let them know there emotions are normal
Term
developing alternatives
Definition
which are realistic and goal directed toward resolutin of the emergency. will need follow up
Term
peri-operative
Definition
entire experience
Term
per-operative
Definition

preparation and teaching

 

Term
intra-operative
Definition
asepsis, homeostasis, safe anesthesia
Term
post-operative
Definition
prevention of complications
Term
pre-operative phase: what all surgical patients have in common
Definition
  • loss of control
  • invasion of the body
  • anestheasia
  • fear
Term
Major sugical risks
Definition
  • increased time on OR table
  • large blood loss
  • vital organs handled
  • co-morbidities
  • infected wounds
Term
Minor surgical Risks
Definition
  • short time on table
  • few or o morbidites
  • out-patient furgery
  • local versus general anesthesia
  • no infection

 

Term
factors associated with surgical risk
Definition
  • age
  • nutriional status
  • CV status
  • respiratory staus
  • medications
  • renal status
  • metabolic status
Term
8 to 10
Definition
post anesthesia score must be this before being dischaged from PACU
Term
Six W's to considter for fever
Definition
  1. wind: lung
  2. water: UTI, pyleonephritis
  3. walk: DVT, PE
  4. Wound: superfical infection
  5. Wonder drug: sulfonamides, PCN's
  6. Whole blood: transfusions of any blood product.
Term
Fever within six hours
Definition
rare but consier strep infection, thyroid crisis, transfusion reaction
Term
fever within 3 days
Definition
develop Atelectasis
Term
Fever 3-5 days
Definition

could develop pheumonia, wound infection

 

Term
fever in more then 7 days
Definition
could develop thrombophlebitis, DVT, anastamotic leak
Term
24 hours
Definition
when are dressings usually removed after surgery?
Term
serous
Definition
watery with decrease protein
Term
purulent
Definition
pus remains of WBC's
Term
sanguinous
Definition
Bloody red
Term
Serosanguinous
Definition
combination of blood and water= pink
Term
sugical binders
Definition

usually worn by obese patients with vertical abdominal incisions

should be worn most of the time and whenever patient sits up or ambulates

reduce the strain on the incision

Term
factors influencing healing
Definition

1.age

2 nutritional status

3. circulation

4. diabetes

5. infection

6.previously irradiated area

7. compromised immue system

Term

Surgical incision complications

(Dehiscence)

Definition
  • separtation of incision edges
  • midline abdominal incision most prone
  • if occrs take vital signs, call physician, may need special dressing changes.
Term

Sugical incisions complicaitons

(Evisceration)

Definition
  • is the protrusion of the abdominal contents out the incision
  • usualy occurs POD 6-7
  • cover the protruding coils with warm sterile saline dressing
  • patient will return to surgery for closure.
Term

surgical incision complications

(hemorrhage)

Definition
  • inscision should not bleed post-op
  • usually occurs within the first 48 hours
  • thick bulky duressing can mask this
Term

sugical incisions complications

(infection)

Definition
  • first sign is an increased temperature
  • wet dressing have an greater increase in this
  • incision becomes red, painful and may open and drain
Term
pain with fever
Definition
usually means infection so check lungs and incision
Term
pain with nausea and vomiting
Definition
usually means an anesthesia complicaiton or check the NG tube
Term
Pain with fullness in lower abdomen
Definition
usually means a paralytic ileus
Term
pain with coldness or numbness
Definition
means a circulatory problem
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