NR 226 Exam 2
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Chamberlain University
NR-226: Fundamentals – Patient Care
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Date
Exam #2 J. Lane Study Guide
Chapter 14: Assessing and Communicating With Older Adults
Required when interviewing the older adult
When communicating with older adults, nurses must avoid rushing the interaction. This population often needs additional time to organize their thoughts and recall information. Allowing moments of silence and demonstrating patience fosters trust and enhances accuracy of responses.
Where to interview the older patient with a hearing impairment
The ideal setting for interviewing an older adult with hearing difficulties is one-on-one in a quiet, private room. This minimizes background noise and distractions, enabling the patient to concentrate on the conversation.
Where should the nurse sit when interviewing a patient with visual impairments?
For patients with vision loss, the nurse should position themselves at eye level and directly facing the patient. This allows the patient to localize the speaker’s voice and read non-verbal cues such as facial expressions or lip movement.
SPICES Framework for Older Adult Assessment
The SPICES tool is used to identify common geriatric syndromes that can indicate the need for further assessment or intervention.
| SPICES Category | Description |
|---|---|
| Sleep disorders | Difficulty initiating or maintaining sleep |
| Problems with eating/feeding | Poor appetite, swallowing difficulties, or unintentional weight loss |
| Incontinence | Loss of bladder or bowel control |
| Confusion | New or worsening cognitive changes |
| Evidence of falls | History or physical signs of falling |
| Skin breakdown | Pressure injuries, ulcers, or fragile skin |
Common Physiological Changes in Older Adults
Aging is associated with predictable physical changes, many of which increase vulnerability to illness or injury. These include:
- Skin becomes thinner and less elastic, making it prone to injury.
- Salivary production decreases, contributing to dry mouth.
- Diminished senses of taste and smell, affecting nutrition.
- Yellow discoloration of the sclera due to lipid deposition.
Cognitive and Mental Status Changes
| Term | Definition |
|---|---|
| Delirium | Sudden onset of confusion, often reversible, linked to an underlying cause |
| Dementia | Progressive and irreversible decline in cognitive function affecting daily life |
| Depression | Mood disorder that may occur following major life changes |
Key distinctions:
- Delirium develops quickly and is typically reversible.
- Dementia progresses slowly over years and is permanent.
- Depression may mimic cognitive decline but improves with treatment.
Elder Abuse
Definition: Any deliberate action or neglect that results in harm, injury, or distress to an older adult.
Forms include physical abuse, emotional abuse, neglect, financial exploitation, and sexual abuse.
Therapeutic Approaches in Geriatric Care
- Reality orientation: Providing cues to time, place, and situation to reduce confusion.
- Validation therapy: Accepting the patient’s perceived reality without confrontation.
- Reminiscence therapy: Encouraging patients to share past experiences, which can promote meaning and emotional healing.
Common Spinal Curvatures
| Condition | Description |
|---|---|
| Kyphosis | Forward rounding of the upper back |
| Scoliosis | Lateral curvature of the spine in an “S” shape |
| Lordosis | Excessive inward curvature of the lower back |
Chapter 36: Loss, Grief, and End-of-Life Care
Definitions and Key Concepts
Emotion in response to significant loss
Grief is the emotional suffering experienced after the loss of someone or something meaningful. It involves deep sadness, yearning, and a sense of emptiness.
Outward social expressions of grief associated with loss
Mourning refers to the public and cultural expression of grief, which may include rituals, ceremonies, and specific mourning behaviors based on cultural norms.
Grief and mourning together
Bereavement encompasses both the internal grief process and the external expressions of loss. It includes emotional, behavioral, and social responses.
NR 226 Exam 2
Types of Grief
| Type of Grief | Description | Example |
|---|---|---|
| Normal (uncomplicated) | Natural and expected response to loss; may involve sadness, anger, and eventual adaptation | Loss of a grandparent after a long illness |
| Anticipatory | Grief experienced before the actual death or loss | Knowing a loved one is in the final stages of terminal illness |
| Disenfranchised | Grief that cannot be openly acknowledged or socially validated | Death of a secret partner or extramarital affair |
| Ambiguous | Loss where the person is physically present but psychologically absent, or vice versa | Dementia, prisoner of war, missing persons |
| Complicated | Intense and prolonged grief interfering with daily functioning | Loss of a child or death from violent events |
| Chronic | Persistent grief lasting years to decades | Still grieving a spouse 20 years after death |
| Exaggerated | Grief with self-destructive or obsessive behaviors | Depression leading to suicidal ideation after a loss |
| Delayed | Suppression of grief with later overwhelming emotional response | Experiencing grief years later when triggered by a related event |
Stages of Dying (Kübler-Ross Model)
- Denial – Refusal to accept the reality of the loss.
- Anger – Feelings of resentment, frustration, or blame.
- Bargaining – Attempting to negotiate for more time or a different outcome.
- Depression – Deep sadness as the reality of the loss sets in.
- Acceptance – Coming to terms with the inevitable.
Palliative and Hospice Care
| Aspect | Palliative Care | Hospice Care |
|---|---|---|
| Focus | Relief of symptoms and improvement of quality of life for patients with serious illness | Comfort and dignity for patients in the final stages of life |
| Timing | Can be initiated at any stage of illness | Provided when life expectancy is ≤ 6 months |
| Goal | Enhance life quality, manage pain, and address emotional/spiritual needs | Comfort-focused care without curative intent |
| Death Timeline | Not intended to hasten or delay death | Accepts death as a natural process |
Chapter 43: Sleep and Rest
Sleep Cycles
- NREM (Non-Rapid Eye Movement) Sleep: Comprises four stages and occurs in cycles lasting about 90 minutes. It is associated with physical restoration.
- REM (Rapid Eye Movement) Sleep: Occurs at the end of each 90-minute cycle. Characterized by rapid eye movement, dreaming, and temporary muscle paralysis (atonia).
Note: Dreaming occurs in both NREM and REM phases, though REM dreams are often more vivid.
Common Sleep Disorders and Considerations
| Condition | Description |
|---|---|
| Nocturia | Frequent urination during the night |
| Insomnia | Difficulty falling asleep, staying asleep, or obtaining restorative sleep |
| Sleep apnea | Breathing repeatedly stops and starts during sleep |
| Narcolepsy | Sudden, uncontrollable episodes of sleep during waking hours; often with daytime sleepiness |
Tip for respiratory patients: Elevating the head with pillows or sleeping in a reclined chair can reduce nighttime breathing difficulty.
Chapter 44: Pain Management
Types of Pain
| Pain Type | Description |
|---|---|
| Acute pain | Sudden onset, identifiable cause, short duration |
| Chronic pain | Persists for months or years, often without full resolution |
| Episodic pain | Reoccurs intermittently over an extended period |
| Cancer pain | Related to tumor growth, treatment, or infection |
| Referred pain | Felt in an area away from the source of injury |
| Idiopathic pain | Persistent pain without a clear cause |
| Nociceptive pain | Caused by activation of pain receptors in peripheral tissues |
| Neuropathic pain | Caused by damage or disease affecting the somatosensory nervous system |
Pain Assessment and Management
- Most reliable indicator of pain: The patient’s self-report.
- Comprehensive assessment includes:
- Palliative/Provocative factors
- Quality
- Region/Radiation
- Severity
- Timing
ABC Pain Management in Home Care:
Ask about pain, Believe the patient, Choose the best intervention, Deliver interventions promptly, Empower patients and families.
Chapter 42: Fluid and Electrolyte Balance
Tonicity of Solutions
Tonicity describes the concentration of solutes in a fluid relative to plasma, which affects water movement across cell membranes.
| Solution Type | Description | Effect on Cells | Examples |
|---|---|---|---|
| Hypotonic | Lower solute concentration than plasma | Water moves into cells → cells swell | ½ NS, D2.5W |
| Isotonic | Equal solute concentration as plasma | No net water movement | NS (0.9% NaCl), D5W, LR |
| Hypertonic | Higher solute concentration than plasma | Water moves out of cells → cells shrink | D10W, 3% NS, D5NS |
Clinical Uses of Solutions
| Condition | Solution Type | Rationale |
|---|---|---|
| Blood loss | Isotonic | Replaces extracellular fluid without altering cell size |
| Hypovolemia | Hypertonic | Draws fluid into the intravascular space to increase volume |
| Dehydration | Isotonic or Hypotonic | Restores fluid balance; hypotonic rehydrates cells |
| Burns | Isotonic | Restores vascular volume without causing osmotic shifts |
| Hyponatremia | Hypertonic | Raises serum sodium concentration |
| Surgery | Isotonic | Maintains stable intravascular volume |
| Cerebral edema | Hypertonic | Reduces swelling by drawing water from brain cells |
| DKA/HHS | Hypotonic | Hydrates cells and corrects hyperosmolarity |
Note: Hypertonic solutions are best given via central line to reduce vein irritation.
Electrolyte Imbalances and Functions
| Electrolyte | Normal Range | Hypo-Condition | Hyper-Condition | Key Role |
|---|---|---|---|---|
| Sodium (Na⁺) | 135–145 mEq/L | Hyponatremia (<135) | Hypernatremia (>145) | Regulates fluid balance and nerve impulses |
| Potassium (K⁺) | 3.5–5.0 mEq/L | Hypokalemia (<3.5) | Hyperkalemia (>5.0) | Maintains muscle contraction, especially in the heart |
| Calcium (Ca²⁺) | 9–11 mg/dL | Hypocalcemia (<9) | Hypercalcemia (>11) | Muscle contraction, nerve excitability, bone health |
| Magnesium (Mg²⁺) | 1.5–2.5 mEq/L | Hypomagnesemia (<1.5) | Hypermagnesemia (>2.5) | Neuromuscular function, enzyme activity |
| Phosphate (PO₄³⁻) | 2.5–4.5 mg/dL | Hypophosphatemia (<2.5) | Hyperphosphatemia (>4.5) | Energy production (ATP synthesis), bone mineralization |
Arterial Blood Gas (ABG) Interpretation
Normal ABG Values
- pH: 7.35 – 7.45
- PaCO₂: 35 – 45 mmHg (respiratory component)
- HCO₃⁻: 22 – 26 mEq/L (metabolic component)
- PaO₂: 80 – 100 mmHg
pH interpretation:
- pH < 7.35 = Acidosis
- pH > 7.45 = Alkalosis
Compensation status:
- Fully compensated: pH is normal, but PaCO₂ and/or HCO₃⁻ are abnormal.
- Partially compensated: All values are abnormal.
- Uncompensated: pH abnormal, one value abnormal, and the other normal.
ABG Disorders and Symptoms
| Disorder | Common Symptoms |
|---|---|
| Respiratory Acidosis | Headache, hypotension, hyperkalemia, hypoventilation, drowsiness, confusion |
| Respiratory Alkalosis | Hyperventilation, tachycardia, paresthesia, lightheadedness, nausea |
| Metabolic Acidosis | Warm flushed skin, nausea, diarrhea, Kussmaul respirations, confusion |
| Metabolic Alkalosis | Hypoventilation, muscle twitching, nausea, tremors |
ABG Interpretation Examples
| ABG Values | Interpretation |
|---|---|
| pH 7.28, PaCO₂ 24, HCO₃ 15 | Partially compensated metabolic acidosis |
| pH 7.37, PaCO₂ 52, HCO₃ 30 | Fully compensated respiratory acidosis |
| pH 7.48, PaCO₂ 32, HCO₃ 25 | Respiratory alkalosis |
| pH 7.32, PaCO₂ 37, HCO₃ 16 | Metabolic acidosis |
| pH 7.45, PaCO₂ 50, HCO₃ 35 | Metabolic alkalosis |
| pH 7.33, PaCO₂ 40, HCO₃ 19 | Metabolic acidosis |
| pH 7.37, PaCO₂ 29, HCO₃ 16 | Metabolic acidosis |
| pH 7.50, PaCO₂ 30, HCO₃ 25 | Respiratory alkalosis |
| pH 7.46, PaCO₂ 42, HCO₃ 32 | Metabolic alkalosis |
| pH 7.52, PaCO₂ 25, HCO₃ 25 | Respiratory alkalosis |
| pH 7.28, PaCO₂ 34, HCO₃ 20 | Partially compensated metabolic acidosis |
| pH 7.20, PaCO₂ 58, HCO₃ 26 | Respiratory acidosis |
| pH 7.35, PaCO₂ 50, HCO₃ 30 | Respiratory acidosis |
| pH 7.55, PaCO₂ 40, HCO₃ 32 | Metabolic alkalosis |
References
American Nurses Association. (2021). Gerontological nursing: Scope and standards of practice (2nd ed.). ANA.
Kübler-Ross, E., & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. Scribner.
NR 226 Exam 2
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.
U.S. National Library of Medicine. (2023). Electrolytes and fluid balance. MedlinePlus.