Basic Care and Comfort- Lecture

7/31/2019 Basic Care and Comfort- Lecture

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Nutrition

A. Food guidelines (illustration )

1. Nutritional needs through the life cycle

a. infants: fluid and protein needs 2.5x adultsb. breast milk or formula is adequate for first six months of life

i. whole milk is difficult for young infants to digest

ii. the first food introduced is cerealc. childhood: gradual increasing of all nutrients adults:

unchanged except for

i. pregnancy: add per day: 300 calories, 15 mg iron, 30

g protein, 400 g calcium, and 200ug folic acidii. lactation: add 500 calories, 2 quarts extra fluid

d. elderly over age 65: adequate protein to maintain immune

system

1. Factors affecting dietary patterns

a. health status

b. ability to chew, swallow, and drink

c. culture and religiond. socioeconomic status

e. personal preference

f. psychological factorsg. alcohol and drugs

2. Energy needs

a. basal metabolism energy required for ongoing internal

processes such as heartbeatb. basal metabolic rate (BMR) influenced by gender, age,

activity level, body composition

B. Essential nutrients

1. Carbohydrates

a. include sugars, starches and cellulose

b. simple sugars (monosaccharides) are most easily

metabolizedc. starches are more complex in structure and metabolism

d. functions of carbohydrates

i. quickest source of energy (4.1 kcal/gram)ii. main source of fuel for brain, peripheral nerves,

WBCs, RBCs, and healing wounds

iii. protein sparere. dietary sources: plant foods, except for lactose
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f. recommended daily intake:

i. factors influencing recommended intake ofcarbohydrates include body structure, energy

expenditure, basal metabolism and general health

statusii. ideally, 50 to 60% of total calories should be

complex carbohydrates

g. excessive carbohydrate calories are stored as fat

2. Lipidsa. basic lipids are composed of triglycerides and fatty acids

b. includes saturated fatty acids(from animal sources) and

unsaturated fatty acids (vegetables, nuts and seeds)c. essential unsaturated fatty acids - linoleic acid is the only

essential fatty acid in humans; linolenic acid and arachidonic

acid can be manufactured by the body when linoleic acid isavailable

d. deficiencies lead to skin, blood and artery problems

e. functionsi. most concentrated source of energy (nine kcal/gram)

ii. bodys major form of stored energyiii. insulation

iv. cell membrane componentv. carries fat-soluble vitamins A, D, E and K

vi. recommended dietary intake: no more than 30% total

caloric intake and low in saturated fats3. Proteins

a. complex organic compounds comprised of amino acids

b. body breaks protein down into 22 amino acidsc. all but eight amino acids are produced by the body

d. complete protein food contains the eight essential amino

acids not produced by the body (most meat, fish, poultry anddairy products)

e. incomplete protein food lacks one or more of the eight

amino acids (most vegetables and fruits)

f. incomplete proteins can be combined to yield a completeprotein: for example, beans and rice

g. functions of protein

i. secondary energy source (four kcal/gram)ii. essential for cell growth

iii. efficiency can affect all of body - organs, tissues,

skin, muscles

iv. recommended protein intake: 0.42 grams per 0.4 kgof body weight

v. the body's only source of nitrogen

vi. negative nitrogen balance can occur with infection,burns, fever, starvation, and injury
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4. Vitaminsa. organic substances essential for body growth and

metabolism

b. found only in plants and animals; body cannot synthesize

them; depends on dietary intakec. types (according to their solvent)

i. water soluble (B1, B2, B6, B12, C)I. cannot be stored in body; require daily intake

ii. fat soluble (A, D, E, K)

I. can be stored in body

5. Mineralsa. inorganic substances essential as catalysts in biochemical

reactions

b. form most inorganic material in the bodyc. functions:

i. catalyst for many body reactions such as regulation

of acid-base balance

ii. help cells metabolize, tissues absorb nutrients, andheart muscle respond

iii. minerals work synergistically; a deficiency of one

mineral can disturb the action of other mineralsiv. types - grouped according to amount found in body

I. major minerals - calcium, magnesium,

sodium, potassium, phosphorus, sulfur,

chlorine; function known

II. trace minerals - iron, copper, iodine,manganese, cobalt, zinc and molybdenum;

function unclear

III. another group of trace minerals; found ineven smaller amounts; function unclear

6. Water

a. critical body component essential for cell function

b. accounts for 60 to 70% total body weight in adults; 70 to75% children functions

c. provides normal turgor

d. regulates body temperature

e. dietary sources: liquids and solids, such as fresh fruits andvegetables

f. deficiency: severe deficiency leads to dehydration and death

g. fluid intake normally equals fluid output
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D. Fluid andelectrolyte balance

1. Total volume of fluid and amount of electrolytes remain relativelyconstant in the body

2. Fluid balance and electrolyte balance is interdependent

3. Body balances fluid and electrolytes primarily by adjusting output, and

secondarily by adjusting intake.

4. Fluid balance is also maintained by osmosis (illustration )

5. Major electrolytes

a. cations

i. sodium - most abundant cation in extracellular fluid

regulates cell size via osmosis

essential in maintaining water balance,

transmitting nerve impulses, and contracting

muscles regulates acid-base balance by exchanging

hydrogen ions for sodium ions in kidney

normal lab value for serum sodium is 135 to

145 mEq/L sodium is regulated by salt intake,

aldosterone, and urinary output

sources include table salt, processed meats,

snacks and canned food (illustration )

ii. potassium - most abundant cation of intracellular

fluid

potassium pump draws potassium into cell essential for polarization and repolarization

of nerve and muscle fibers

regulates neuro muscular excitability andmuscle contraction

sources include wholegrains, meat, legumes,

fruits and vegetables

regulated by kidneys

normal lab value for serum potassium is 3.5

to 5.3 mEq/Liii. calcium - essential for cell membrane integrity,

cardiac contraction, healthy bones and teeth, andfunctioning of nerves and muscles

iv. magnesium - normal constituent of bone; cofactor forenzymes in energy metabolism, neurochemical

activities, muscular excitability
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b. anions

i. chloride

most abundant anion in extracellular fluid

helps balance sodium

normal lab value for serum chloride is 100 to106 mEq/L

ii. bicarbonate - part of bicarbonate buffer system;

limits the drop in pH by combining with an acid toform carbonic acid and a salt

iii. phosphate - participates in cellular energy

metabolism, combines with calcium in bone, assists

in structure of genetic material

6. Maintenance of fluid volume

a. osmoreceptor system

i. balances fluid intake volume by the regulation ofwater output volume

ii. dehydration stimulates osmoreceptors which activate the

thirst control center; person feels thirsty and seeks water

iii. also stimulates antidiuretic hormone (ADH) secretionwhich decreases urinary output by causing the reabsorption

of water in the tubules

1. circulatory system

a. increases in fluidintake increase

circulatory volume

b. this increased volumestimulates the kidney

for an increased

glomerular filtrationrate

c. end result is an

increase in urine

output to decrease the

initial curculatoryvolume

2. thirst centera. located in

hypothalamus

b. stimulated by
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i. increased

plasmaosmolality

ii. angiotensin II

iii. dry pharyngealmuscous

membranes

iv. decreased

plasma volumev. depleted

potassium

vi. psychologicalfactors

ii. Maintenance of electrolyte balance

1. aldosterone - hormone(mineralcorticoid)

a. when extracellular

fluid sodium decreasesor potassium levels

increaseb. adrenal cortex secretes

aldosteronec. kidneys stimulated by

aldosterone to increase

reabsorbtion ofsodium and decreased

reabsorbtion of

potassiumd. results in water

reabsorption and

increased bloodvolume

2. parathyroid

a. parathyroid secretes

parthyroid hormone(PTH), also called

parathormone

b. stimulates release ofcalcium from bone,

reabsorbtion in small

intestine and kidney

tubulesc. when serum calcium

level is low, PTH

secretion increasesd. when serum calcium

level rises, PTH

secretion falls
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e. high levels of active

vitamin D inhibit PTHand low levels or

magnesium stimulate

PTH secretion

D. Normal and therapeutic diets

1. Guidelines:

a. dietary reference intakes (DRI's)- average daily nutrientintake of apparently healthy people over time.

i. recommended dietary allowance (RDA)

ii. adequate intake (AI)

iii. tolerable upper intake level (UL)

iv. estimated average requirement (EAR)

b. 2001 dietary guidlines for Americans

i. aim for fitness

ii. build a healthy base

iii. choose sensibly2. Therapeutic nutrition

b. modification of the nutritional needs based on disease

conditionc. considerations for administering therapeutic diets

i. condition of client - physical, emotional, mental

ability of client to tolerate dietii. willingness of client to comply with diet

d. types of therapeutic diets

i. diabeticI. goal is maintenance of normal weight

II. dietary ratio 5:2:1 (carbohydrates to fat toprotein)

III. level of activity determines energyrequirements

IV. non-insulin dependent diabetes mellitus

(NIDDM) can usually be controlled by diettherapy

V. diet individualized according to client's age,

build, weight, and activity levelVI. keeping a regular schedule of meals and

snacks is essential

ii. low protein dietI. for renal disease such as pyelonephritis,

uremia, kidney failure

II. normal protein intake 40 to 60 gm/day

III. restricted foods: meats and other foods highin protein such as legumes, fish, dairy

iii. high protein diet


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I. for conditions such as burns, anemia,

malabsorbtion syndromes, ulcerative colitisII. include high quality proteins or protein

supplements such as sustagen

iv. low calcium dietI. prevents formation of renal calculi

II. limit 400 mg per day instead of normal 800

mg

III. restricts dried fruits and vegetables, shellfish, cheese, nuts

v. acid ash diet

I. prevents stone formationII. restricts carbonated beverages, dried fruits,

banana, figs, chocolate, nuts, olives, pickles

vi. low purine dietI. prevents uric acid stone; used with gout

clients

II. lowers levels of purine, the precursor of uricacid

III. restricts glandular meats, gravies, fowl, fish,and high meat quantities

vii. low cholesterolI. used for cardiovascular disease, high serum

cholesterol levels

II. normal amount of cholesterol intake - 250 to300 mg/day

III. restricts eggs, beef, liver, lobster, ice cream

viii. low sodiumI. used in congestive heart failure, hypertension

II. used for correcting the retention of sodium

and waterIII. levels of restriction

I. mild (2 to 3 g sodium)

II. moderate (1000 mg sodium)

III. strict (500 mg)IV. restricts table salt, canned vegetables,

smoked meats, butter, cheese

ix. high fiber I. used to correct constipation, lower risk of

colon cancer

II. 30 to 40 gm fiber/day recommended

III. increased intake of fruits, vegetables, brancereals

x. low residue

I. used for conditions such as diarrhea,diverticulitis

II. foods high in carbohydrates are usually low

fiber


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III. increased use of ground meat, fish, broiled

chicken without skin, white breadxi. mechanical soft

I. used with difficulty in chewing, such as

poorly fitted dentures or endentulousII. includes any foods which can be easily

broken down by chewing

xii. puree diet

I. used with dysphagia or difficulty in chewingII. used for tube feedings, small babies

III. food is blended to smooth consistency

xiii. liquid dietsI. clear liquid consisting of nonirritating easily

digested and absorbed liquids

II. full liquid

3. Nutritional assessment: evaluate

a. weight changeb. appetitec. food intolerance

d. chewing and swallowing

e. indigestion

f. elimination habitsg. eating behaviors

h. nutrient-drug interacions

i. anthropometric measurements4. Feeding tubes

a. indications-inability to ingest, chew, or swallow food, but GI

tract intactb. tube inserted through nose into stomach or small bowel; or

inserted endoscopically; gastrostomy tube or PEG tube,

jejunostomy tube

c. types of tubes and feedingsi. small bore feeding tube: 8 to 12 Fr and 36 to 43

inches long

difficult to aspirate stomach contents

may be impossible to auscultate an air bolus;

or air bolus may be heard even when tube is

not in stomach

tubes may become displaced even whensecurely taped

hard to verify placement; best method is byxray

ii. enteral tube feedings

keep head of bed raised, to prevent aspiration

assess placement of tube
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inject ten ml air intonasogastric tube (ng

tube) and listen with stethoscope for rush ofair over stomach

o aspirate gastric contents and check if

pH is acidico radiologic confirmation

administer enteral feeding

o continuous

o to prevent bacterial growth, do nothang tube feeding for longer than

eight hours

assess gastric residual

o every four hours if continuous

feeding or

o before you begin intermittent

feedings

iii. tube feeding formulas

Vivonex, Isocal, Portagen, etc.

iv. complications

aspiration gastrointestinal complications (diarrhea)

electrolyte or metabolic problems

5. Nutritional supplements/liquids

a. dehydration/diarrhea:i. infants: Infalyte, Pedialyte, Ricelyte

ii. older children: sports electrolyte replacement drinks

iii. infant formulas: standard and high-calorieiv. specialty formulas:

predigested (e.g. Pregestamil, Nutramigen)

high-calorie supplements (Scandishakes,

Carnation instant breakfasts)6. Parenteral nutrition: see Lesson 6 of this course

7. Measures to improve nutrition intake of client

a. frequent small feedingsb. feeding assistance

c. offering preferred foods

d. ethnic foods

III. Mobility

A. Prevent complications of immobility

1. Skin changes - decubitus ulcers

a. turn client every two hours

b. use heel/elbow protectorsc. use alternate pressure mattress or other skin care devices

d. do not massage reddened areas; doing so increases damage

to tissues
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e. limit sitting in a chair to 2 to 4 hours or as tolerated with a

shift in weight at least every 30 to 60 minutes

2. Musculoskeletal changes-contractures

f. do range of motion exercises to joints on a scheduled basis

daily

g. provide foot board and/or foot cradle or high-topped tennis

shoes to prevent foot droph. reposition every 2 hours

i. maintain correct body alignment

3. Respiratory changes - pneumonia,atelectasis

j. instruct client to cough and deep breathe every two hours, ormore frequently

k. turn every two hours

l. suction if neededm. chest physiotherapy (physical therapy) as ordered

4. Cardiovascular system changes-decreased cardiac output, clots,emboli

n. orthostatic hypotension:

i. instruct client to change position slowlyii. highest risk is from supine to standing position

o. increased cardiac workload

i. reinforce for client to avoid bearing down or

valsalvar manueverii. minimize coughing

iii. limit sitting in high Fowler's position to one to two

hoursp. thrombus/emboli formation

i. apply thigh or knee-high antiemboic stockings as

orderedii. turn every tow hours

iii. monitor anticoagulation therapy, as indicated

iv. initiate ambulation or exercise of dorsi and plantarflexion of the foot

v. limit sitting with feet in a dependent position to 1 to

2 hours

5. Urinary changes: renal, calculi, urinary tract infection, glomerularnephritis

q. increase fluid intake (2000 - 3000 cc/day)

r. restrict foods that contribute to renal stone formation

6. Psychosocial changes:
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s. provide stimuli to maintain orientation

t. develop mutually with client, a schedule to maintain mentalsharpness

B. Types of exercise

1. Passive - carried out by the health care provider without assistance from

client; purpose is to retain joint mobility and blood circulation

2. Resistive - carried by the client working against resistance; purpose is toincrease muscular strength; enhance bone integrity

3. Isometric - carried out by the client with no assistance by contracting

muscle group for ten seconds and then relaxing muscle group; purpose is to

maintain muscular strength when the joint is immobilized

4.Range of motion (ROM) - joint is moved through entire range; purpose is

to maintain joint mobility

C. Use of mechanical aids to promote mobility

1. Crutches-support; balance feet, and legs during walking

u. keep tips of crutches 12 to 16 inches to side of feetv. adjust handbars to allow 15 to 30 degrees of elbow flexion

w. use well fitting shoes with nonslip soles

x. use rubber suction tips on crutchesi. inspect weekly

ii. replace when worn

y. may be used temporarily or permanently

z. teach client crutch walking4. Cane-provides stability when walking and relieves pressure on weight-

bearing jointsa. adjust cane with handle at level of greatertrochanter, elbow

flexed at 30 degree angle

b. teach client to hold cane close to body, and hold in hand on

stronger side.c. move cane at same time as the weaker leg.

5. Walker-assists in weight bearing and mobility

a. assists in weight bearing and mobilityb. teach client how to sit, stand and turn

6. Gait belta. leather or canvas belt around client's waist with handles

b. safety devices for ambulatory clients who may have some

balance problems

F. Prosthetic devices - used to replace a missing body partG. Brace - support for weakened muscles

IV. Elimination

E. Promotion of normal elimination
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3. Urination

a. adequate fluid intakeb. normal adult urinary output - 30 ml/hour

c. alternative methods to promote client voiding, such as

running water4. Bowel elimination

a. adequate fluid intake

b. regular exercise

c. regulate fruit juices, raw fruits and vegetables as neededd. normal bowel evacuation: varies in healthy individuals; no

more than 3 movements per day to 3 times a week

F. Urinary incontinence: involuntary release of urine3. Types

a. stress incontinence - sudden increase in intra-abdominal

pressure (such as sneezing, coughing) causes urine to leakfrom bladder

b. overflow (reflex) incontinence - bladder empties

incompletely, so urine dribbles constantlyc. urge incontinence - uncontrolled contraction of the bladder

results in leakage of urine before one reaches the bathroomd. functional incontinence - incontinence not due to organic

reasons; for instance, impaired mobility may prevent theclient from reaching the bathroom in time.

4. Diagnosis of urinary incontinence

a. history and physical examinationb. urinalysis - tells whether blood or infection present

c. cystoscopy - tells whether abnormalities are present

d. post-void residual - measures amount of urine remaining inbladder after voiding

e. stress test - determines if urine leaks after bladder is stressed

due to coughing, lifting etc.5. Treatment

a. drug therapy

i. antispasmodics and anticholinergics - relax and

increase capacity of bladderii. alpha-adrenergic agonists - increase urethral

resistance

b. kegel exercises - strengthen weak muscles around thebladder

c. behavioral training - client learns different way to control

urge to urinate

d. bladder retraininge. surgery - repair of weakened or damaged pelvic muscles or

urethra

6. Nursing interventions -a. provide skin care, protective undergarments

b. establish toileting schedule - provide easy access to

bathroom and privacyc. teach client Kegel exercises:
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i. stop and start urinary stream while voiding

ii. hold contraction for 10 seconds and relax for 10seconds

iii. work up to 25 repetitions three times a day

d. prevent infectioni. cleanse urethral meatus after each void

ii. acidify urine

iii. increase daily intake of fluids

G. Catheterization3. Purposes

a. relieve acute urinary retention

b. relieve chronic urinary retentionc. drain urine preoperatively and postoperatively

d. determine amount of post-void residual

e. accurately measure output in the critically illf. obtain sterile urine specimen

g. continuous or intermittent bladder irrigation (illustration )

4. Types of catheters and general guidelinesa. indwelling catheter

i. use a closed drainage systemii. advance catheter almost to bifurcation of catheter,

especially in male patients (illustration )

iii. inflate balloon within guidelines of manufacturer

only after urine is draining properly, then slightlywithdraw catheter

iv. secure catheter to patient's thigh, allowing for some

slack to accommodate movement and to lessen drag

on patientv. ensure tubing is over patient's leg

vi. care of indwelling catheter:

cleanse around area where catheter entersurethral meatus.

do this with soap and water during the daily

bathing routine and after defecation

do not pull on catheter while cleansing

do not use powder or spray around perineal

area

do not open the drainage system

avoid raising the drainage bag above the level

of the bladder

avoid clamping the drainage tubing

catheter is only irrigated when an obstruction,usually following prostate or bladder surgery

(e.g., potential blood clots) is anticipatedb. suprapubic catheter

i. placed to drain the bladder

ii. achieved via apercutaneouscatheter or by way of anincision through the abdominal wall

c. intermittent self-catheterization
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i. purpose: to drain the bladder

ii. employed by the client with Spina Bifida and otherneuromuscular diseases; can be taught to children

ages 6 to 8

iii. procedure:

gather equipment: catheter, water-soluble

lubricant, soap, water, urine collection

container

wash hands cleanse urethral meatus and surrounding area

lubricate tip of catheter

insert catheter until urine flows

withdraw catheter when urine flow stops

clean off residual lubricant from meatus

dispose of urine

wash hands

H. Ostomies

1.Types of ostomies

a. ileostomyi. liquid to semi-formed stool, dependent upon amount

of bowel removed

ii. may skew fluid and electrolyte balance, especially

potassium and sodiumiii. digestive enzymes in stool irritate skin

iv. do not give laxatives

v. ileostomy lavage may be done if needed to clear foodblockage

vi. may not require appliance; if continent ileal reservoir

or Kock pouchb. colostomy

i. ascending - must wear appliance - semi-liquid stool

ii. transverse - wear appliance - semi-formed stool

iii. loop stoma proximal end - functioning stoma

distal end - drains mucous

plastic rod used to keep loop out

usually temporary

iv. double barrel

2 stomas

similar to loop but bowel is surgicallysevered

v. sigmoid

formed stool

bowel can be regulated so appliance not

needed

may be irrigated


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3. Stoma assessment

a. color - should be same color as mucous membranesb. edema - common after surgery

c. bleeding - slight bleeding common after surgery

4. Psychological reation to ostomya. disturbed body image

b. anxiety related to feared rejection

c. ineffective coping related to ostomy care

V. Sleep

a. Factors affecting sleep

1. Physical illness

2. Drugs

3. Lifestyle4. Excessive daytime sleep

5. Emotional stress

6. Environment

7. Exercise/fatigue8. Food intake

B. Sleep disorders

1. Bruxism: tooth grinding during sleep2. Insomnia: chronic difficulty with sleep patterns

a. initial insomnia: difficulty falling asleep

b. intermittent insomnia: difficulty remaining asleepc. terminal insomnia: difficulty going back to sleep

3. Narcolepsy: fall asleep without warning

4. Sleep apnea: intermittent periods of not breathing while asleep; usuallydue to problems with upper airway; can be treated withCPAP

(continuous positive airway pressure) at bedtime5. Sleep deprivation: decrease in the amount and quality of sleep

6. Somnambulism: sleepwalking, night terrors, or nightmares7. Depression

a. secondary to disease process

b. can occur with any sleep disorderC. General nursing interventions for promoting restorative sleep

1. Comfort measures

2. Medications: sedatives, hypnotics3. Sleep routine

4. Encourage daytime activity

5. Eliminate naps6. Relaxation techniques7. Environmental control

8. Limit alcohol, caffeine, and nicotine in evening

VI. Pain

D. Theories of pain
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1. Specificity theory proposes that pain can be initiated only by painful

stimuli.2. Pattern theory - stimulus goes to receptors in the spinal cord, which

signals the brain to perceive pain and muscles to respond.

3. Gate control theory - pain impulses can be altered or regulated by gatingmechanisms along nerve pathways. This theory explains how past and

present experiences can influence the perception of pain.

E. Variables influencing the perception of pain

1. Culture and social groups shape attitude towards pain2. Religious beliefs regarding reasons for pain

3. Previous experience with pain

4. Age5. Sex

6. Coping style

7. Family supportF. Types of pain

1. Acute - pain episode lasting up to 6 months

2. Chronic - pain lasting longer than 6 months. May be intermittent orconstant.

G. Medical treatment1. Pharmacologic intervention (discussed in Lesson 6: Pharmacological

and Parenteral Therapies)2. Nonpharmacologic intervention

a. acupuncture

i. oriental method: insert fine needles at specified bodysites

ii. unknown how acupuncture works physiologically

b. relaxation techniques - biofeedback, visualization,meditation and hypnosis, to help client control anxiety

c. electronic stimulation such as transcutaneous electric nerve

stimulation (TENS) - electrodes applied over the painfularea or along nerve pathway

d. distraction - focusing client's attention on something other

than pain

e. massage - generalized cutaneous stimulation of the body.Makes the client more comfortable due to muscle relaxation

f. ice and heat therapies - effective in some circumstances. Ice

may decreaseprostaglandinswhich intensify the sensitivityof pain receptors

g. guided imagery - using one's imagination in a guided manner

to achieve a specific positive effect

3. Nursing interventions in paina. assess pain using pain assessment scale

b. assess client's coping strategies and factors that produce

ineffective copingc. teach client appropriate strategies to deal with pain
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VII. Communication

H. Cross-cultural communication - guidelines1. Findings of a lack of effective communication

a. efforts to change the subject - client may not understand

what the nurse is saying

b. lack of questions - client may not understand what was saidc. nonverbal cues such as blank expression, lack of eye contact

2. Nursing interventionsa. use simple sentence structure and pantomime while talking

b. use visual aids

c. discuss one topic at a time

d. use any words you know in the client's languagee. ask among the client's family and friends if anyone could

serve as interpreter

f. obtain phrase books or use flash cards3. Cultural interpretations

a. silence

b. touch

c. eye contactI. Client with hearing loss

1. Findings of hearing loss

a. speech deteriorationb. indifference

c. social withdrawal

d. suspicione. tendency to dominate conversation

2. Nursing interventions

a. speak slowly and distinctly; do not shout

b. face client directly

c. make sure your face is clearly visibled. before the discussion, tell client the topic you are going to

discusse. insure that client has access to hearing aid and that it is

functional

f. keep sentences short and simpleg. use written information to enhance spoken word

J. Client withaphasia

1. Injured cerebral cortex blocks some language-related functions

2. Nursing interventionsa. face client and establish eye contact

b. avoid completing client's statementsc. use gestures, pictures, and communication boardsd. limit conversation to practical matters

e. use the same words and gestures for objects

f. keep background noise to a minimumg. do not shout or speak loudly

h. give the client time to understand and respond

i. if client has problems speaking ask "yes" or "no" questions
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K. Client with stroke

1. Approach client from side of intact field of vision2. Remind client to turn head in direction of visual loss to compensate for

loss of visual field

3. Explain location of object when placing it near the client4. Always put client care items in same places

5. Put objects within client's reach, and on unaffected side

6. Encourage client to repeat sounds of the alphabet

7. Speak slowly and clearly8. Use simple sentences with gestures or pictures

9. Reorient client to time, place, and situation

10. Provide familiar objects11. Minimize distractions

12. Repeat and reinforce instructions

L. Client withdementia1. Be calm and unhurried

2. Keep conversations short and focused

3. Do not ask the client to make decisions4. Be consistent

5. Avoid distractions6. Use reality orientation techniques

VIII. Alternative and Complementary Medicine

M. Herbal therapy

1. Used as dried herbs in capsules or tablets, tinctures, teas, ointments

2. Use only products standardized with a specific amount of activeingredients

3. Some may interfere with medicationsN. Chiropractic treatment

1. Effective by manipulating the musculosketal system2. Manipulation to put the vertebrae in proper alignment

O. Acupuncture and acupressure

1. Based on belief that channels of energy are blocked causing diseases ordiscomfort

2. Acupuncture is primary treatment used by physicians of Chinese

medicinea. insert fine needles at specific points to open channels of

energy (meridians)

b. used to decrease pain and to treat or prevent illness3. Acupressure

a. uses gentle pressure at specific points

b. used for prevention and relief of muscle tension

P. Therapeutic massage1. Manipulates the soft tissue of the body and assists with healing

2. Can be either relaxing or energizing
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3. Is contraindicated for a client with phlebitis, thrombosis, or infectious

skin diseasesQ. Aromatherapy

1. Uses oils produced by plants for inhalation or topical application

2. Different scents are thought to produce different responses in the bodyR. Reflexology applies pressure to specific areas of the feet thought to

correspond with all the different parts of the body

S. Relaxation therapy

1. Rhythmic breathing2. Progressive relaxation

T. Yoga

1. Treatment of the mind-body connection2. Can tone the muscles that balance all parts of the body and control the

emotions and mind through correct posture and breathing

All individuals require the same nutrients, but the amounts vary according tofactors such as age, weight, activity level, and health state.

The energy value of foods is defined in calories; only proteins, fats and

carbohydrates provide calories.

The average adult drinks 2 to 3 liters of water per day.

The normal thirst mechanism in the elderly may be diminished and they may need

encouragement to drink sufficient water to prevent dehydration.

Discontinue ROM exercises at point of pain.

Use rubber suction tips on crutches and canes to prevent slipping.

Prevent deformities and complications such as contractures, thrombophlebitis, and

pressure ulcers by turning and positioning the client in good alignment.

There should be at least two inches between axilla and top of arm piece of crutch to

prevent pressure on the brachial plexus.

The majority of residents in nursing homes are incontinent. Incontinence is not a normal sequela of aging.

Initiate pain relief before the pain becomes unbearable.

Essential amino acids cannot be synthesized. They must be ingested daily.

Weight is maintained when daily food intake equals energy expenditure.

Age affects daily requirements: young, old, pregnancy, lactation.

Weight loss is a long-term process and patients need long-term support. Reconstructive surgery may be required after large amount of weight loss.

Support groups are available for patients losing weight.

Increased fiber in the diet may cause flatulence.

In constipation, increase fluid to 3000 cc/day (unless contraindicated).

Small frequent loose stools or seepage of stool are often indicative of a fecal

impaction.

Use transparent drainage bag initially for assessment of stoma and drainage.


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Avoid foods that cause odor, gas, diarrhea, or may block ileostomy.

Allow the client to rate his degree of pain and the degree of relief from pain reliefmeasures.

Self-control methods to manage pain: distraction, massage, guided imagery,

relaxation, biofeedback, hypnosis.

Change ostomy appliance as needed

Achalasia

Anabolism

Antioxidant

Beta-carotene

Diffusion

Emulsifier Ferritin

Flatulence

Hyperkalemia

Hypernatremia

Kilocalorie

Malnutrition

Nutrients

Osmosis

Tenesmus

Valsalva's maneuver
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Basic Care and Comfort- Lecture

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