1390 Final

Implementation of client teaching

-Make sure the patient is comfortable ~General medication principles ~do's and don'ts ~Information specific to a particular medication ~Teaching methods-videos or pictures

tertiary prevention

-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury

Evaluation of learning

-written exams -oral evaluation -return demonstrations -check-off lists/rubrics -simulation

Cephalocaudal

"Head to tail" Lower part of body grows later than the head

Proximodistal

"Near to far" Extremities grow later than head, chest, and trunk

Stages of the Family Life Cycle

1. Married couples 2. Childbearing families (birth to 30 months) 3. Preschool families (21/2 - 6 years) 4. Schoolchildren (6-13 yrs.) 5. Teenagers (13-20 yrs.) 6. Launching centers 7. Middle-age parents 8. Aging family members

CDC suggests longevity depends on

19% genetics 10% access to high quality health care 20% environmental factors (toxins, pollution) 51% on lifestyle factors:* not smoking* diet* exercise

growth pattern size

2-2.5 in per year (1-2 feet by age 12) 4-7 pounds per year. Lean, with narrow hips and shoulders. Decrease in baby fat. Males - more muscle Females - more adipose. Growing pains

Vision

20/20 by age 8. Age 10 = adult size•Large print recommended for reading. Regular vision testing

Brain structure

3 sections: Cerebrum Directs motor activities Thalamus Connects spinal cord and cerebrum Emotions and expressions Cerebellum Muscular coordination/balance

Freud's Stages of Psychosexual Development Phallic Stage

4 to 6 years Genital region - penis, clitoris Activities: masturbation, fantasy, play activities, questioning Major conflict: Oedipus/Electra

Solid food introduction

4-6 mos. Cereals 5-7 mos. Vegetables and fruits. 6-8 mos. Protein foods (cheese, yogurt, cooked beans) 9-10 mos. Finely chopped meat, toast, crackers 10-12 mos. Egg

MUSCULOSKELETAL SYSTEM

45% increase in skeletal growth Hands and feet out of proportion to body Large muscle groups develop faster Poor posture, disrupted balance, decreased coordination

Freud's Stages of Psychosexual Development Latency

6 years to puberty No special body focus. Diffuse activity and relationships.

Nutritional needs

70 calories/kg daily (1400 to 2100 calories/day 28 grams of protein 800mg calcium half veggies, 1/4 starch, 1/4 protein

Sleep-Rest Pattern

8 to 12 hours of sleep/night Fewer difficulties with going to bed Sleeping arrangements Culturally influenced: Own bed vs. bed sharing Sleep disturbances: Sleepwalking and sleep talking Disorders of arousal: Immaturity of nervous system; most outgrow with CNS maturation Consider safety, relaxation techniques, sleep preparation consistency

Role of Spirituality/Religion in Recovery 2

95% of Americans believe in God and 92% are affiliated with a specific religion (CASA, 2001) In a study of recovering and relapsing adults, those in recovery for 2 years had greater levels of faith and spirituality than those continuing to relapse

fetal stages

9th week to birth zygote, morula, blastocyst, embryo, fetus

health promotion

A condition of being sound, in body, mind and spirit Freedom from illness and pain

What does it mean to say a family is a system?

A family is greater than the sum of its parts. As members of a family system every member is interconnected. Think about a mobile. When one piece moves, the whole mobile moves. Movement of one affect the whole system.

Level of functioning

A person's ability to remain self-reliance, to maintain a sense of control and independence over self and environment. Loss of function is a sign of disease, ill health. ex. At their optimal level, can have a disability, like being deaf and if they can do sign lanauage. That is their optimal level.

Adaptive Model of Health

A person's measure of health is his or her ability to adjust positively to social, mental, and physiological change. Illness occurs when the person fails to adapt or becomes maladaptive to these changes.

What is Culture?

A set of ideals, values and assumptions about life that are widely shared among a group of people Provides organizational structure Various elements

Placenta

A structure that allows an embryo to be nourished with the mother's blood supply

Nursing Process

A systematic, rational method of planning and providing nursing care. It is cyclical: components follow a logical sequence , but more than one may be involved at one time.

Homeostasis

A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level

perception of risk

A way of interpreting the risk EX. risky to get tanned to then have skin cancer

DURING PLANNING, THE NURSE WILL....

A.Establish Priorities B.Write Client Goals/Outcomes And Develop An Evaluative Strategy C.Select Nursing Interventions D.Communicate The Plan

Newborn Delivery Room Assessments

ABCs Thermoregulation Evaporation Convection Conduction Radiation

Motor Skills

Abilities that depend on the use and control of muscles Mobility adds opportunities for learning. Be sure that environment is safe.

Spiritual Needs

Acceptance Personal worth & identity Forgiveness Hope Love Humor Faith Worship Meditation & prayer Peace

Leading causes of death

Accidents AIDS Cancer Heart disease Suicide At age 35, this reverses and illness and disease become more likely causes (for the 1st time since infancy)

Vision Changes

Accommodation of eye experiences sharpest decline.Adaptation to dark and driving at night difficult.Color vision affected by lens yellowing.

TYPES OF NURSING DIAGNOSES

Actual- Present at time of assessment. Risk- Likely to develop Possible- Evidence incomplete or unclear. Syndrome- Associated with a cluster of dx. Wellness-Desires a higher level of wellness

The preschool age family

Adapting to the needs and interests of preschool children. Coping with energy depletion and reduced privacy. Teaching self-control and spontaneity in children.

Identity vs. Role Confusion

Adolescence (12 to 20 yrs.) To develop a lasting, integrated sense of self.

Generativity vs. Stagnation

Adults' desire to leave legacies of themselves to the next generation, achieving immortality. Stagnation develops when they sense that they have done nothing for the next generation.

Vital Signs and Cardiovascular

Affected by size, gender and activity.•Gradually approach adult norms Lung capacity proportional to adult norms. Heart:-Apex of heart normal -Small in relation to rest of body.

The Young Adult

Age group from 18 to 40 Major task: preparing to assume adult responsibilities, rights and privileges A time of many firsts!!

Stage One: Mobilization of Energy

All bodily activity is increased in response to a stressor. Symptoms: Increase heart rate Rapid breathing Sweating Decreased digestion rate.

secondary sexual characteristics

Also secondary sexual characteristics the non-reproductive traits such as breast and hips in girls and facial hair and deepening of voice in boys develop. Pubic hair and hair in armpit grow in both.

Problem qualifiers

Altered (change from baseline) Impaired (made worse, weakened, damaged, reduced, deteriorated) Decreased (smaller in size, amount, or degree) Ineffective Acute Chronic

Recommendations for Modification of Physical and Functional Environment

Ambulation Low beds Encouragement Reality Orientation Clocks Calendars Increased sensory stimulation Lighting Glasses/hearing aids Functional Change

What is Religion?

An affiliation or a membership in a particular faith community that shares a set of beliefs, rituals, morals and sometimes a health code centered on a defined higher or transcendent power most frequently referred to as God.

left hemisphere of brain

Analytical processing language right hand right body side time sequencing right visual field Math, science, writing, logic

Common Nursing Diagnoses

Anxiety/fear RT situational crisis, threat to role functioning, change in environment Powerlessness RT health care environment Interrupted family processes RT situational crisis Anticipatory grieving RT potential loss of child, imminent death of child Caregiver Role Strain r/t chronically ill loved one Parental Role Conflict

Cardiovascular Changes

Arterial walls thicken with fatty deposits and connective tissue. Heart muscles less elastic. BP rises to compensate for lowered O2. Takes longer for heart to respond to activity or stress.

Family Apgar

Assesses family function, ability to adapt, grow develop, and resolve issues.. Adaptation Partnership Growth Affection Resolve

Assessment for learning

Assessing learning needs, it starts with what the patient needs to know how to function more independently, Baseline knowledge Cultural and language needs Priorities

Steps in the Nursing Process ADPIE (A Delicious PIE)

Assessment Diagnosis Planning Implementation Evaluation

Constructing Reality

Assimilation Accommodation Adaptation

Andropause

Associated with decrease in testosterone•Symptoms are more gradual. At risk for osteoporosis and cardiovascular problems without treatment. Increase in sex hormone binding globulin (SHBG). Testosterone not affected by SHBG is available for use.

Puberty

Attainment of sexual maturity and the ability to have children. Females - Menarche Males - First emission of semen that contains viable sperm cells. Primary vs Secondary sex characteristics

Height Changes

Average newborn is 20 inches long. Average 1 year old is about 30 inches long. Hereditary factors more strongly influence height than weight.

Hispanics

Avoidance of eye contact sign of attentiveness and respect. Touching observed Curandero, espiritualista, yerbero Spiritual strength

Have you "ASKED" yourself the right questions??

Awareness Skill Knowledge Encounters Desire

The teenage family

Balancing freedom with responsibility as teen mature and emancipate themselves. Establishing post-child rearing interests as growing parents.

Blastocyst

Ball of cells formed from morula.

Family

Basic Social Unit Group of two or more persons related by birth, marriage, or adoption and living together. A group of intimates with a history and a future. Changes to reflect today's structural and functional changes.

Cultural Nursing Assessment

Be aware of the environment. Know about community social organizations. Select a strategy. Identify a confidante Know the appropriate questions Interview other professionals who have worked with the group.

Family Nursing Intervention Techniques

Behavior modificationCase management and coordination Collaborative strategies Contracting Counseling, including support, cognitive, reappraisal, and reframingEmpowering families through active participation Environmental modification Family advocacy Family crisis intervention Networking, including use of self-help groups and social support

Erikson's definition of love

Being able to put aside differences through a mutual devotion to each other. Can be found in the love of one's neighbor, coworker Must be reciprocal

Health Beliefs (hispanics)

Believed to be consequences of God's approval or disapproval of a person's behavior. Mal de ojo (evil eye) Santeria

HRT

Benefits Reduced osteoporosis, heart disease risk Reduced incontinence risk Decreased vaginal dryness & irritation. Decreased hot flashes. Increased energy. Risks Increased risk of endometrial and breast cancer. Increased risk of gallbladder disease. Potential side effects: Bloating, fluid retention, breast tenderness, headaches, mood changes, and nausea.

Components of a Nursing Health History:

Biographic Data Chief complaint History of present illness Past history Family history Lifestyle Social data Psychologic data Patterns of health care

Freud - Oral Stage

Birth to 18 months Interest in oral gratification from sucking, eating, mouthing, biting.

Visual Changes

Blurry at first. Within a week they can focus on objects that are 7 to 10 inches away. One month = 3 feet away 3 ½ months = almost as good as young adults.

Erikson - Intimacy vs. Isolation

Body and ego must be masters of organ modes and of other nuclear conflicts. Avoidance of experiences leads to isolation and self-absorption.

Stage Two: Exhaustion or consuming energy

Body begins to release stored sugars and fats, using up its bodily resources. Symptoms: Feeling driven Feeling pressured Tiredness and fatigueIncrease in smoking, coffee drinking and or alcohol consumption. Anxiety Memory loss Acute illnesses such as cold and flu

Growth Patterns

Body weight doubles Spend much energy on physical activity and play. Eat much more than preschoolers.

Basis of Freud's theory

Born with ID Pleasure principle Tension Primary process thinking EGO Reality principle Secondary process thinking

Nuclear families

Both natural parents and siblings

NEUROLOGIC SYSTEM

Brain is reshaped Neurons, gray matter, and synapses proliferate in cerebral cortex and then prune in adolescence.Myelin coat continues to accumulate Greater capacity for complex physical and cognitive skills

Neuromuscular

Brain is very active Glucose metabolism by brain cells is twice that of adult brain By age 12, brain is adult size.

How can you reduce stress?

Breathing exercises Stretching exercises Walking Sleep

Stressors

Can be both pleasant and unpleasant events Long-term, continuous exposure may result in a reduction of body's ability to deal with stress

Selective Attention

Can select, attend to, and coordinate impulses from all neurologic regions simultaneously through use of both active and inactive processes.

SYSTEM REPORTS....

Cardiac Pulmonary Gastrointestinal GenitourinaryImmune system Sensory Teeth

Cardiopulmonary changes

Cardiovascular disease increases considerably. Fatty deposits and scar tissue slowly accumulate in blood vessel linings. Blood pressure rises. About 55, proteins in lung tissue become less elastic

Nursing Roles

Care and education of the Mother Pregnancy related changes Consider issues of family Role changes Preparation for parenthood Care of the fetus as it transitions to a new born Safe Passage

Development

Changes in skill and capacity to function. Qualitative Maturation of physical and mental capacities and learning.

Growth

Changes in structure and size Patterns Quantitative

mortality rates

Chronic Disease main cause of death *Heart disease *Cancer *Cerebrovascular disease First half: cancer Second half: heart disease

Realistic approach

Client's energy level, Client's age, Client's emotional state

Sexuality

Climacteric - midlife transition when fertility declines Hormonal changes Menopause Andropause

The teaching methods are

Cognitive Affective Psychomotor

NURSING DIAGNOSIS

Communicate the professional judgments that nurses make every day to our patients, colleagues, members of other disciplines and the public. Define what we know - they are our words.

Cultural group variations

Communication Space Social organization Time perception Environmental control Biological variations Dietary practices Socioeconomic factors

Cognitive Development

Concrete Operations: the development of mental operations: cognitive actions that can be performed on objects or ideas that consistently yield results.

Musculoskeletal System

Continued Ossification Hand Manipulative skills similar to adults: females outperform males. Improved coordination Play advances brain development.

Negotiation

Contract how much you going to teach the patient. Lesson plan

Allantois

Contributes to cardiovascular system

The aging family

Coping with loss including health, job (retirement), loved ones and /or spouse, home, expectations.

Activity-Exercise Pattern

Critical time to acquire and foster activity behaviors Types of activities Group: Little League baseball, soccer Individual: Gymnastics, ballet Unorganized play: Bike riding, rollerblading•Play activities Promote social, personal, cognitive development Focus on fun, connections to peers and family

cognitive development

Crystallized intelligence - acquired store of information, skills, strategies - increases Fluid intelligence - ability to deal with new situations - declines.

The process of cultural competence in the delivery of Healthcare services

Cultural Awareness Cultural Encounters Cultural Knowledge Cultural Skill Bottom of the volcano: Cultural Desire

Developmental Testing

DDST Allow for Prematurity up to 24 months. Areas to assess: Gross Motor Language Fine Motor-Adaptive Personal- Social

immunization at 4 months

DTaP, RV, IPV, Hib, PCV

Human Ecology Theory

Deals with the relationship between humans and their (natural) environment. Human ecology investigates how humans and human societies interact with nature and with their environment. uses a holistic approach to help people solve problems and enhance human potential within their near environments - their clothing, family, home, and community.

Middle Adulthood: Age and Physical Changes

Decreased functional capacity Decreasing cardiac output. Decreased bone mass Osteopenia Osteoporosis

Digestive Changes

Decreased motility results in slower emptying of the stomach. Decreased digestive enzymes - poor appetite and digestive disturbances. Slowed gag reflex Slowed peristalsis

Role Performance Model of Health

Defines health in terms of individuals' ability to perform social roles. Illness would be the failure to perform roles at the level of others in society.

Sequential Trends

Definite, predictable sequence. Orderly and continuous.

Ears

Degenerative changes in bones of middle ear result in decrease of hearing ability. Difficult to locate sound Repeat words to ensure clear communication. A man's voice is easier to hear than the higher pitches of a woman's voice.

Mental Health

Depression Suicide Must be realistic, use strengths and coping strategies to deal with physiologic changes and set goals that are positive and attainable.

Health Responsibilities

Developing members' sense of personal identity and self-worth. Emotional support and guidance during life cycle transition. Socialization of family members to value and maintain health. Education about when and how to use the health care system. Care provision and management for chronically ill, disabled, and aging family members.

Teething

Development starts at 6th week of pregnancy. Baby teeth at about 2 to 7 months. Complete set in 20 weeks. (time varies) Teething can be painful.

Carnegie stages

Developmental stages in vertebrates Only covers embryonic development Does not cover fetal development Categorized by visible structures Applicable to a wide variety of species Applicable to different developmental rates Not days or size

Hearing

Develops in fetal development and is fully functioning at birth. Hearing testing done in newborn nursery.

Asians

Direct eye contact disrespectful Balance between the yin and yang energy forces. Hot and cold foods and states. Biological variations: Thalassemia Skin color Mongolian spots

Experience involving action

Discovery of properties of objects. Social interaction

Dementia

Disease marked by a gradual loss of cognitive functioning which can also incorporate losses of motor, emotional, and social functioning. Permanent and progressive...people unable to care for themselves. Most commmon Alzheimers lesser common: Vascular, Lewy body, Frontotemperol

Important Alternative Stages

Divorce Blending Relocating Working outside the home (after a period of near full-time parenting. Long-term illness or disability.

WHAT CAN YOU DO?

Don't criticize or compare to others. Encourage sleep. Model healthy eating habits. Encourage physical activity. Provide honest answers about sex. Understand need for physical space. Be patient with grooming habits.

WHAT CAN YOU DO? COGNITIVE DEVELOPMENT

Don't take it personally when teens discount your experience. Get teen involved in discussing their behavioral rules and consequences. Provide opportunities to participate in controlled risky behavior. Opportunities for community service.T alk about their views and be open to discussing your own. Build a genuine relationship with teen.

EMERGENCY ASSESSMENT

During any physiologic or psychologic crisis of the client. Identifies life-threatening problems. Example: Rapid assessment of person's airway during a choking episode.

Construction Ahead

During late childhood, neurons increase their number of connections. But around 11 - GIRLS; 12½ - BOYS Some of these connections are pruned off.

Basic Elements (Family systems theory)

Each action or change affects every other person in the family. It is a complex whole that cannot be understood by examining members separately. Roles: patterns of interaction become ingrained habits that make change difficult. Family rules are self-regulating and peculiar to itself. Boundaries must be maintained. Adaptation Changes are caused by normative and non-normative stresses.

Developmental Pace

Each child develops at their own pace. Some excel in language but are slower on motor skills and vice versa. What is really worrisome is if there is a reverse in developmental achievement.

Initiative vs. Guilt

Early childhood (preschool years, 3-5 yrs.) To develop the ability to try new things and to handle failure

Elimination Pattern (young adult)

Eating disorders - May persistCommon complaints:Constipation Hemorrhoids Occasional diarrhea Teaching Report changes in elimination patterns or blood in stool: though colon cancer risk low during this age group Adequate fluids, eating fruit/vegetables (high in fiber) to promote bowel health

secondary prevention

Efforts to limit the effects of an injury or illness that you cannot completely prevent. Ex. Labs- Blood work and mammograms

primary prevention

Efforts to prevent an injury or illness from ever occurring.

SUPEREGO

Ego Ideal Perfection to which one aspires Corresponds to what parents taught was good. Conscience Responsible for guilt feelings Corresponds to what parents taught was bad.

Other Important Issues to Consider

Elder Abuse Polypharmacy Placement Alternatives Nursing homes Assisted Living Independent apartments

Gastrula

Embryo composed of three tissues.

Principles of Elder Care

Encourage confidence. Raise self-image. Provide empowerment. Demonstrate kind, caring manner Identify and include family and support systems. Actively listen. Integrate spirituality, hope and faith. Assist in setting personal goals. Monitor exercise and nutrition. Follow-up on health concerns.

WHAT CAN YOU DO? TEENAGE BEHAVIORS ISSUES

Encourage involvement in multiple groups or activities. Praise teens for efforts as well as abilities Help explore career goals and options. Let them establish guidelines and consequences. Establish rituals for marking significant passages. Know peer group. Structured environment.

SAFETY ISSUES

Encouragedriver education; serve as positive role model. Teach safety rules for water sports. Needs guidance for safe and reasonable job rules. Sexual education. Drug and alcohol discussion.

Prostate changes

Enlarged Prostate 1 in 5 men

Teratogenic Effect

Environmental substance or agent that interrupts normal that interrupts normal development and causes malformations. Timing is more important than the nature of insult. Most critical embryonic period

Epigenetic Theory of Personality Development

Eric Erikson Personality develops in a series of stages. Describes the impact of social experience across the whole lifespan. Conflict presents a turning point.

Role allocation and accountability

Establish clear roles. Allow for flexibility. Allocate roles fairly. Be responsible in fulfilling family roles.

FIVE PSYCHOSOCIAL ISSUES

Establishing an identity Establishing autonomy Establishing intimacy. Becoming comfortable with one's sexuality. Achievement.

Structural-Functional Theory

Examines the family in terms of its relationship with other major social structures (institutions) Emphasis placed on basic functions of families How well structure allows the family to perform its functions.

Physical fitness

Exercise and diet are required to reach full potential. No more than 10% of Americans exercise enough to attain good physical shape. 150 minutes needed per week.

Growth

Exhibits considerable change in physical appearance. Hypertrophic (size) vs. hyperplastic Rate is slow and steady with accelerations in spring and fall and by rapid growth during preadolescence.

What is Spirituality?

Exploring the meaning of life. Expressing self through music, literature, art and nature Connecting with other people Communicating with a higher power Personal and universal

FICA spiritual assessment tool

F: Faith and beliefs I: Importance and influence C: Community A: Address

Sexuality: Older Adult

Factors that influence sexuality: Attitude/Interest Body image perception Mental function Social contact Environment/privacy Sexual Health Urinary function Mobility ED/menopause Illness Medications.

Family Systems Theory

Families are SYSTEMS of interconnected and interdependentindividuals. To understand the individual, we must understand the family system of that individual. People cannot be understood in isolation from one another.

Risk factors - Alzheimers

Family History - a clear inherited pattern exists in approximately 10% of cases Down's Syndrome - Nearly 100% of people who live into their 40's Chronic Hypertension - Treatment reduces the risk Head Injuries - Three times more likely to develop AD Gender - inclusive data. Some studies show a greater risk for females while others show an increased risk for males.

Developmental Family Theory

Family Life Cycle and developmental tasks. Explains patterned change, dynamic nature, and how change occurs in life cycle. Success= adapt to changing needs and demands and ensure family survival.

Effect on Growth and Development

Family Size Spacing of Siblings Divorce Stepchildren and Foster Children Chronic Illness Use of Health Care system

Theoretical Approaches to the Family

Family Systems Theory Developmental Theory Structural - Functional Theory Role Theory Human Ecology Theory

Roles-Relationships Pattern

Family environment Provides sense of security Increasing independence and maturity Begin to reduce parental authority/structure Broaden interests outside home Clubs, sports, gangs More responsibility in home and community Pets, chores, earn allowances

Assumptions Structural-Functional Theory

Family is a social system with functional requirements. Small group features. Social systems accomplish functions that serve individuals and society. Families socialize individuals with norms and values.

Cultural Values (Asians)

Family is extended. Family's interests and honor supersede those of individual. Elders are respected and unquestioned. Avoid conflict.

African Americans (family)

Family is the strongest institution. Extended kinship bonds. Consult family members and relatives before health care providers.

Friendships

Female: confide in one another about feelings problems and interpersonal relationships. Male: minimize discussions about relationships. Find things to do together of mutual interest.

NUTRITION

Females 11 - 14 need 2200 calories Females 15 - 18 need 2100 calories Males 11 - 14 need 2700 calories. Males 15 - 18 need 2800 calories. Protein 45 - 56 grams daily. Calcium 1200 mg daily.

Biological Agents

Fewer infections than preschool child Common infections Upper respiratory infections (viral) Streptococcal infection, otitis media (bacterial) Gastroenteritis (viral) Scabies/lice (skin infestations) AIDS Lower risk; education starting at age 8 recommended Immunization (late childhood/early adolescence) Meningococcal vaccination (age 11-12) Hepatitis B series, if not completed in early childhood Human papilloma virus (HPV) Varicella (if no history of chickenpox)

Generational changes

First generation Second generation Third generation

Yolk sac

First site of red blood cell formation.

The elementary school-age family

Fitting into the community of elementary school-age families in constructive ways. Encouraging educational achievement and working with school personnel.

Tanner stages

Five stages of sexual development in adolescence evaluating pubic hair, genitals and breast development

early stage of dementia

Forgetfulness to confusion to disorientation Check problem solving, judgment, decision-making, orientation, personality changes

PIAGET - FORMAL OPERATIONS

Form of intellectual processing that is abstract, speculative, and independent of the immediate environment and circumstances. Hallmark = logical and systematic hypothesis testing. Able to plan and think ahead.

The Body's Imbalance (hispanics)

Four body fluids (humors) Blood (hot & wet) Yellow bile (hot & dry) Phlegm (cold & wet) Black bile (cold & dry)

extraembryonic membranes

Four membranes (yolk sac, amnion, chorion, allantois) that support the developing embryo in reptiles, birds, and mammals.

First Habits and Primary Circular Reactions

From 1 to 4 months Begin to coordinate what where separate actions into single, integrated activities. Combines sucking with grasping or staring with touching.

Tertiary Circular Reactions

From 12 to 18 months Deliberate variation of actions that bring desirable consequences. Experiment to observe the consequences. Drops a toy repeatedly, varying the position, to see where it falls.

Beginnings of thought

From 18 months to 2 years. Capacity for mental representation or symbolic thought. Imagine where objects that they cannot see might be.

Coordination of Secondary Circular Reactions

From 8 to 12 months Begins to use more calculated approaches to producing events. Object permanence Pushes a toy out of the way to reach another.

Urinary System

Functionally mature during school years. Kidneys double in size between 5 and 10. Bladder capacity increased, especially in females.

Biological Theories of Aging

Genetic Programmed to age by biological clockWear and Tear Cells are damaged by over use and abuse. Neuroendocrine Drop in hormone level causes decline in ability to repair and regulate itself. Free Radical

Influences on growth

Genetic factors Prenatal and postnatal exposure Nutrition Environmental factors Health/Illness

Six causes of acne

Genetics Bacteria Hormones Lack of sleep Cosmetic Food

The Genogram: A Tool for Understanding Processes in the Family

Genograms are charts or graphs that diagram the biological and interpersonal relationships among family members across several generations. They identify significant events in intergenerational relationships that can have an influence on families and individuals.

Stages of Development

Germinal - 10 days to 2 weeks after fertilization Embryonic - 2 to 8 weeks Fetal - 8 weeks until birth

Perception

Getting and interpreting information from stimuli. By 2-4 months perception sophisticated. Depth perception in fourth month.

Healthy People 2020

Goal: Document and track population-based measures of health and well-being for early and middle childhood populations. Positive parenting Sleep quality School health education ADHD treatment Reduce frequent ear infections Reduce vision loss Reduce obesity

Motor Skills

Gross Motor By 6: hopping, jumping 6-7: climbing, pedaling/balancing on a bike 8-10: Better balance, coordination and strength. Fine motor: By 6-7: tie shoes, hold pencil as adults, fasten buttons, zippers, brush teeth, wash themselves, coordinate a knife and fork, skill at using chopstick improves.

Assumptions developmental family theory

Growth is going to happen. Change happens over a period of time. Consider the challenges they face, how well they resolve them, how they transition to the next stage. The family is dynamic and should be analyzed as to mastering tasks.

Head Development

Growth nearly complete. Loss of first baby tooth considered beginning of middle school years. Automatization = thoughts and actions become routine

COGNITIVE DEVELOPMENT

Have Developed Advanced reasoning skills Abstract thinking skills Ability to think about thinking = meta-cognition

Birth of the first child

Having, adjusting to, and encouraging development of infant. Becoming a parent. Maintaining spouse relationship

Patterns of Physical Development

Head to Foot (Cephalocaudal): Lift head, then arm control, hands follow and then walking around.

Health Concerns/ Risk Factors for the Young Adult

Health Risks Violence Substance Abuse Unwanted pregnancies STDs Occupational, environmental risk factors Lifestyle Concerns Smoking Stress Exercise patterns Personal hygiene Familial history Infertility

Age and Physical Changes

Healthiest period, optimal muscle strength (age 25 to 30), manual dexterity peaks. Gender difference Full growth: women age 17, men age 21 Longevity: women > men, women are biologically stronger than men, outlive men, outnumber men. Health care seeking: women > men Maternal mortality stable.

Types of acne pimples

Healthy whitehead blackHEAD Papule Pustule

PHYSICAL GROWTH (BY AGE 18)

Height and weight Spurt lasts 24 - 36 monthsStops at 16-17 girls, 18-20 boys Vital signs Approximately those of an adult.

HOW DO THESE CHANGES AFFECT TEENS? COGNITIVE DEVELOPMENT

Heightened level of self-consciousness. Tend to believe that no one else has ever experienced similar feelings and emotions. Personal fable beliefsVery cause-oriented. Exhibit justice orientation.

Helping People Learn to Nurture Their Spirits

Help them discover their purpose in life by tapping into what they are passionate about Teach them to pray and meditate Help them live one day at a time Help them realize that some parts of life can be managed and others cannot. Serenity is found when people understand and accept what can be controlled and what cannot

Helping People Learn to Nurture Their Spirits 2

Help them learn to transcend the material world•Help them feel okay about themselves Help them see how they are part of nature Show them how to focus their thoughts on triumph and hope rather than despair and defeat Help them not expect others to bring them happiness and make their lives complete Help them to count their blessings each day

Immunizations at birth

Hep B (1 of 3) usually before hospital discharge **If mom HBsAg-positive, administer immunoglobulin and vaccine within 12 hours of birth

What determines intellectual development?

Heredity: approximately 40-60%•Environment:-Early enrichment-Varied experiences-Preschool-Responsive parents

Changes in girls

Hips and thighs widen - to make room for baby Growth of pubic hair Warmth (primary) Visual indicator of sexual maturity collection of secreted pheromones Breast develop - to feed a baby

Cognitive-Developmental theory

How children construct knowledge and how their constructions change over time. Piaget Need adequate environmental stimuli and intact neurological system.

Nursing impact

How does illness alter family structure? What family roles were changed with the onset of a chronic illness?Intervention necessary when changes in family structure alter ability to function.

Hormonal Influences

Human Chorionic Gonadotropin (hCG) Progesterone Estrogen RelaxinRelaxin Human Chorionic Sommatotropin Human Placental

Taoism (Asians)

Humans are microcosms within universe. Yin = feminine, negative, dark and cold Yang = masculine, positive, light and warm. Chi = innate energy Jing = Sexual energy

Blood pressure risks

Hypertension results from increases in cardiac output, or increases in peripheral resistance, or a combination of both and is the 3rd leading cause of death worldwide. Goal BP 120/80 or less: risks begins at: - Systolic of 115 mm Hg - Diastolic of 75 mm Hg

Erikson - Industry vs Inferiority

I am what I can achieve... Needs to perform and produce good results. Try not to compare children or focus on failures.

ETIOLOGY (RELATED FACTORS AND RISK FACTORS)

Identifies one or more probable causes of the health problem Gives direction to the required nursing therapy Enables individualization.

Stage Three: Draining Energy Stores

If stressful situation is not resolved, you may become chronically stressed. The body's need for energy resources exceeds its ability to produce them. Symptoms: Heart disease Ulcers Mental illnessInsomnia Errors in judgment Personality changes.

Environmental Controls

Illuminate stairways and provide light switches at both the top and bottom of stairs. Avoid high-gloss floor finishes Nightlights Handrails Tack down carpeting, non-skid treads. No area rugs Grab bars on bathroom walls and nonskid mats in tubs.

Neurologic System

Immature but developing at a rapid rate... Constant stimulation is necessary to maintain growth and development or function is lost.

African Americans

Importance of prayer Touching hair is offensive. Direct eye contact is considered rude. Biological variations Keloid formations Mongolian spots Skin color

Client Education

Important to educate patients Teaching correctly helps reduce costs of health care and improve quality of care

beginnings of family systems theory

In the 1950s Dr. Murry Bowen introduced a transformational theory, family systems theory.

Metabolic syndrome

Includes a group of cardiovascular risk factors associated with overweight and obesity, in particular abdominal obesity Includes: lethal high lipid levels (hypercholesteremia) Insulin resistance (diabetes)High blood pressure (hypertension)Initial therapy: lifestyle alterations, weight management and increased physical activity

Extended families

Includes other people - grandparents, aunts/uncles, cousins

Other advantages to regular exercise

Increases cardiovascular fitness. Lung capacity increases. Muscles become stronger. Body becomes more flexible and maneuverable. Reduces osteoporosis Optimizes the immune response. Decreases stress, anxiety and depression. Increases sense of control and feelings of accomplishment. Increases longevity A lack of exercise may lead to poor health in general, but health risks in general, but health risks in general are low during early adulthood. Young adults are less susceptible to colds and illnesses. Good immune systems. Tendency to exercise More likely to die in accidents (usually car related) than most other causes.

BRAIN AND THE WHITE MATTER

Increases up to the age of 40. Composed of fatty myelin that surrounds and insulates nerve cells, allowing them to conduct information faster and more efficiently. Able to think and solve problems efficiently continues to expand. Not uniform: sensory coordination thought.

Trust vs. Mistrust

Infancy (first year) Develops trust of others to meet one's own needs and begins to trust oneself and others. World will be a good and pleasant place to live.

Embryonic disk

Inner mass of cells of blastocyst.

Religion (African)

Integral part of community. Second most important institution: Place to meet Provides social welfare services. Stabilizing force of community, Facilitates social action, Transmits cultural history Provides coping mechanisms.

Marriage

Investment in spouse as major emotional source Developing common expectations about parenthood. Interdependence.

Achievement

Involves a child's acquired competencies or performance.

Older Adult: Integrity vs. Despair

Involves the process by which people try to make sense of their lives. Life review Adjusting to retirement Adjusting to and accepting the frailties of aging and changes in physical appearance and lifestyles

Age 24

Judgment Emotion Motivation Physical coordination, sensory processing on balance

Rules to build the brain

Keep it simple and natural. Match experiences to mental capacities Practice makes perfect. Active involvement Provide variety without overwhelming themAvoid pushing the child Learn better if emotionally involved.

Integrity vs. Despair

Late Life (66 and older) To view one's life as satisfactory and worth living.

Cognitive-Perceptual Pattern (school age)

Learning disabilities (5%-10% of children) Attention-deficit/hyperactivity disorder (ADHD) Difficult to assess: varying symptoms in different settings with different people Treatment controversial: Behavior management, counseling, nutrition, medication Nurse's role varies Includes detection, referral, collaboration on plan, counseling, liaison with family Legislation Individuals with Disabilities Education Act of 1997 Section 504 of Rehabilitation Act of 1973

Role Theory

Life is structured according to roles that are ascribed or assumed. Complementary roles Role reciprocity Role conflict (forced to choose) Role strain (unable to fulfill) Role overload The establishment of clear roles within a family is directly connected to their ability to deal with day-to-day life, crises and changes.

Treatment

Lifestyle changes (increase exercise, stress reduction and good nutrition) Testosterone replacement Patches Gels Capsules Injections

Critical Period

Limited time in which an event can occur, usually to result in some kind of transformation.

Height and weight

Lose a half inch of height per decade beginning in their forties. Body fat is 20% or more. Many gain weight. If 30% or more overweight, probability of dying in middle adulthood increases by about 40%. Increases probability of chronic illnesses.

Eyes

Loss of cells in optic nerve makes it difficult to see details. Pupil opens and closes more slowly so need to adapt to surroundings. Cataracts develop.

Changes in Hearing

Loss of high-pitched sounds: Presbyopia Men are more prone to hearing loss than women Because the two ears are not always equally affected by hearing loss, sound localization diminished. Some can be helped by hearing aids.

Immune System

Lymphoid tissues reach height of dev't by 7. Enlargement of adenoids and tonsil normal Frontal sinuses potential for infection.

Health Traditions (African)

Maintained with a proper diet. Asafetida - prevent contagious illness Cod-liver oil - cold prevention Copper or silver bracelets protect wearer

Preventing Stress

Make decisions Avoid procrastination Delegate tasks.

Myelin and axons

Makes it easier for signal transmission. Axons coated at birth are those that control basic instincts. Motor abilities, vision and hearing coated first.

Hemispheric specialization

Makes the brain more efficient -Language, logic, memory, and spatial knowledge more complex. Prefrontal cortex development -Better control emotional outbursts and responds to routines.

Middle age :anticipatory guidance

Mammogram Hemoccult Colonoscopy Thyroid testing Lipid profile Bone Density Cardiovascular screening Vaccines: flu, tetanus/diphtheria, cocooning (pertussis)

Developmental Theories

Maslow - hierarchy of needs Freud- psychoanalysis, sexual Erikson - social development Piaget - cognitive development Focus on changes in physiology, psychology, and behavior. Influenced by culture, environment, past experiences, family, health status, and individual reactions.

Four Factors to Stimulate Mental Development

Maturation of nervous and endocrine systems which provides physical capabilities.

Maturity and Adulthood

Maturity is reached when a balance of growth in th physiological, psychosocial, and cognitive areas has been attained. Characteristics of Maturity Accepts constructive criticism Open to suggestion Learns from own and others experiences Accepts responsibility for their own mistakes

Values in Family Systems Theory

Means of interpreting events and information Pass from generation to generation Continually evolve Identify usability of information.

DURING EVALUATING, THE NURSE WILL...

Measure the Client's Achievement Of Desired Goals/Outcomes Identify Factors That Contribute To The Client's Success Or Failure Modify The Plan Of Care, If Indicated

Importance of Stimuli

Mechanisms: Progressive complex arborization of dendrites. Increase vascularization degree. Increase myelinization process.

Cultural competence Helps nurses to

Meet the cultural needs of clients who are from a different culture Decrease the cost of health care and increase opportunities for positive outcomes Facilitate achievement of specific objectives of Healthy people 2010.

Perimenopause

Menopause is the time when periods completely cease Perimenopause is the transitional period. 5-15 years Symptoms Changes in cycles.

School age years

Middle = 6 - 8 years Late = 8 - 12 years Juvenile Preadolescence-Prepubescence

Generativity vs. Isolation

Middle Adulthood (45 - 65 yrs.) To contribute to younger people, through child rearing, child care, or other productive work.

Physical Changes

Middle age is a window through which we can glimpse later life while there is still time to engage in prevention and to influence some of the course of aging. Changes are usually gradual, rates vary from one individual to another.

Industry vs. Inferiority

Middle and late childhood (elementary school years, 6 to puberty) To learn basic skills and to work with others.

Physical Development and Stress in Early Adulthood

Most people are at the peak of their physical capabilities. The brain continues to grow in both size and weight, reaching its maximum in early adulthood. Brain wave patterns show changes (more mature patterns). The senses are as sharp as they will ever be. No significant vision deterioration until 40's Hearing at its peak Taste, smell, sensitivity to touch good. Most professional athletes are at their peak during early adulthood.

Assessing Learning Readiness

Motivation Compliance Sensory and Physical State Literacy Level Age

Safety Promotion and Injury Control

Motor vehicle-Fires, falls, drownings, poisoning, bicycling, skateboards, roller skates, and sports equipment. High risk takers

Using a translator

Must have knowledge of health related terms. Watch for nonverbal behavior. Use family cautiously. Sexual questions by same gender Avoid jargon...Watch confidentiality.

Dependent (NURSING INTERVENTIONS)

Must have or obtain physician's order to implement this intervention.

Genital Utopia

Mutuality of orgasm with a loved partner of opposite sex with whom one is willing and able to share a trust and... With whom one is willing and able to regulate the cycles of work, procreation and recreation so as to secure to the offspring all the stages of satisfactory development.

Nervous System Changes

Neurons atrophy. Transmission sluggish. Blood flow slows due to fatty deposits within blood vessels. Motor responses and reaction time to stimulus is delayed. Maintaining environmental safety necessary.

How the brain works

Neurons sprout arms called dendrites and axons. Synapses are where messages are sent. The more times axon and dendrite connect, stronger and quicker messages.

Nursing Application

Nurses working with school-age children have a unique and exciting opportunity to engage the child in health-promoting behaviors These behaviors can be taught to the child through Spending time demonstrating, monitoring, and reinforcing preventive health practices Age-appropriate reading, materials, modeling, and role-playing

Role of Spirituality/Religion in Recovery

Nursing journals report religious patients and their families better able to cope with illness and less likely to commit suicide Belief in benevolence of God was related to positive mental health outcomes For many alcoholics, religion is an important part of the recovery process. Many recovering individuals acknowledge the role of spirituality in their ability to engage in and maintain sobriety

Nutritional-Metabolic Pattern

Nutritional guidelines Well-balanced diet: 1200 to 1800 kcal/day Factors influencing food intake Access to food: Lack of nutritious food, make own snacksMass media influence: Billboards, TV Contemporary busy lifestyles: Skip meals, eat out Nutritional educationSchool programs Dietary guidelines

Nutrition

One of the most important variables for fetal health and prevention of complications Weight gains Effects

PROBLEM-FOCUSEDASSESSMENT

Ongoing process integrated with nursing care. Determines the status of a specific problem identified in an earlier assessment. Example: hourly assessment of fluid intake and urinary output.

Freud's Stages of Psychosexual Development Oral

Oral 0 - 18 months Mouth is major source of gratification and exploration. Major conflict - weaning.

Major Health Risks

Osteoporosis Bone loss is most rapid in first 5 - 7 yrs after Heart Disease Leading cause of death Urinary Incontinence Thinning of urethra and bladder tissues Result = decreased bladder tone and frequency

TAKE HOME FOR PARENTS

P = Promote activities that capitalize on the strengths of the developing brain A = Assist your child with challenges that require planning R = Reinforce their seeking advice from you and other adults E = Educateabout risk taking and negative consequences N= Never underestimate alcohol effects on developing brain T = Tolerate the "oops" behaviors due to an immature brain

Risk Influences

Parental Age Teens Low birth weight Higher mortality Nutrition competition Elderly Prematurity Low birth weight Chromosomal problems Multiple pregnancy

Helping People Learn to Nurture Their Spirits 3

Participation in church, synagogue, or mosque services for those who find this important Help them figure out what gives them inner peace, comfort, strength, love, and a feeling of connection Help them figure out what moves them deeply Help them learn to be still and listen to inner voice Help them protect themselves against toxic people

Helping People Learn to Nurture Their Spirits 4

Participation in church, synagogue, or mosque services for those who find this important Help them figure out what gives them inner peace, comfort, strength, love, and a feeling of connection Help them figure out what moves them deeply Help them learn to be still and listen to inner voice Help them protect themselves against toxic people

Parts of a goal

Patient -centered Measureable action Specific time frame- SHORT TERM LONG TERM One goal should show problem resolution.The rest could be steps to resolution. Example: Patient will get out of bed by himself and into a chair by 0730 on Wednesday, September 16, 2020 Short terms: dangling, standing, moving to a chair.....

Family Assessment

Patient is the family Family APGAR Cultural/religious influences Support network Family type Communication patterns Functional burden

INITIAL ASSESSMENT

Performed within specified time after admission to a health care agency. Establishes a complete data base for problem identification, reference, and future comparison.

Senescence

Period in an adult's life in which the body begins to age and weaken. Young old: 65-75 Old: 76-84 Old- old: 85 - 99 Elite-old: 100 yrs +Geriatrics: the study of old age

COMMON HEALTH PROBLEMS

Physical Acne, STDs, HIV, unwanted pregnancy Chronic Diabetes, Cystic Fibrosis Behavioral Anorexia Nervosa, Bulimia, Substance Abuse, Attempted Suicide.

signs and symptoms

Physical No menses Thinning of genital-urinary tissues Hot flashes Night sweats/insomnia Less firm breasts Increased facial hair Thinning scalp hair Less elastic skin Decreased muscle mass & increased fat. Emotional Symptoms Fatigue caused by sleep deprivation Mood Swings Forgetfulness Decreased Sex Drive Depression

Interaction of many factors: Fetus

Physical Changes

Health maintenance for advanced old age

Physical Exercise Use it or lose it. Occupational activities. Adjusting to retirement. Nutrition Challenged by dental loss, denture adaptation, slowed digestion, constipation, and decline in ability to cook.

Elimination Pattern (school age)

Physical ability Most: Full bowel/bladder control Enuresis Primary vs. secondary Nocturnal vs. diurnal enuresis Behavior management strategies; drug therapy

Implications of Arrested Development for Adolescent Behavior

Physical activities benefit from earlier "back of the brain" development Complex, judgment-demanding thinking are compromised by later "front of the brain" development Preference for physical activity Poor planning and judgment More risky, impulsive behaviors Minimal consideration of negative consequences

FREUD - GENITAL STAGE

Physical focus: genitals Theme: maturation and creation and enhancement of life. Intellectual and artistic creativity. Balance of love and work achieved at the end.

SURVIVAL

Physical tasks of breathing, sucking, eating, digesting, eliminating and sleeping.

Growth and Development of the Young Adult

Physiological Few maturational changes Experience severe illness less Physical changes occur as middle age approaches Personal life-style assessment Cognitive Critical thinking abilities increase with experiences Develop problem solving skills Identify occupation

Simple reflexes

Piaget's first sensorimotor substage, which corresponds to the first month after birth. In this substage, sensation and action are coordinated primarily through reflexive behaviors.

Erikson - Trust vs. Mistrust

Positive Outcome: feelings of trust from environmental support. Negative: fear and concern regarding others.

Piaget

Post formal operational thought: integrating various points of view to develop knowledge and understanding. Able to problem solve.

Health perception-Maintenance pattern

Preventive care - Maximize health status, detect problems early, appropriate intervention Age 18: full health appraisal Repeat history/physical every 2 yearsScreenings: BSE, testicular exam, PAP smear - P.E. includes, height, weight, BMI, blood pressure, blood tests, counseling on avoidance of inactivity and obesity Over age 25: focus on coronary risk factors ● Cholesterol, diabetes, smoking, hypertension, metabolic syndrome, heart disease, chest pain ● No known risk factors: screen every five years at age 35 for men and 45 for women

SOURCES OF DATA

Primary is the client. Secondary: Family Support persons Health professionals Records and reports Laboratory and diagnostic analyses, Relevant literature

COLLECTING DATA

Process of gathering information about a client's health status. Must be systematic and continuous. Database: Health history Physician's hx and physical exam. Lab and dx tests Other material

Affective Roles

Provide emotional support and encouragement to family members.

Amnion

Provides fluid environment for developing embryo and fetus.

Nursing Process characteristics

Provides the framework in which nurses use their knowledge and skills to express human caring and help clients meet their actual and potential health problems.Client-centeredProblem solving techniques.

More Interventions

Providing information and technical expertise Role modeling Role supplementation Teaching strategies, including stress management, lifestyle modifications, and anticipatory guidance

Instrumental Roles

Provision of physical resources, decision-making and family management.

Interaction of many factors: Woman

Psychological changes Psychological changes

Cognitive Processes

Psychomotor Speed = speed at which a person can make a specific response. Memory Aging Differentiate between aging vs. disease effects.

Growth and Development of the Young Adult (psychosocial)

Psychosocial Emotional health r/t abilty to resolve personal/ social tasks Predictable trends 23-28- Refining self-perception and ability for intimacy 29-34- Directs energy toward achievement and mastery of surrounding world 35-45- Examining life goals and relationshipsMore attention devoted to occupational/ social pursuitsMay benefit from career counseling/ testing Trend is more women working while pregnant, men more aware of parental responsibilities

Freud's Stages of Psychosexual Development Genital Stage

Puberty and thereafter. Develop skills needed to cope with environment. Full sexual maturity and function.

PHYSICAL DEVELOPMENT

Rapid gains in height and weight. Development of secondary sex characteristics. Continued brain development.

Urinary Tract Chan

Rate that the kidneys filter the blood slows so medications and other substances take longer to leave the body. Bladder capacity decreases.

IMPLEMENTING

Reassessing the client. Determining the nurse's need for assistance. Implementing the nursing orders (strategies) Delegating and supervisingCommunicating the nursing actions.

TEENAGE BEHAVIORAL ISSUES

Rebelliousness Need for privacy Dishonesty Responsibility Curfews Friends

Breastfeeding

Recommended for first year of life. Not for: HIV +, taking antidepressants. Check effects of medications and foods on infant.

The empty nest family

Reestablishment of a more intensive husband/wife relationship Maintaining kin ties with older and younger generations.

Race

Refers primarily to a social classification that relies on physical markers. May be in same race but differ in ethnic affiliations

Cognitive

Refers to rational thought, what one generally considers "thinking"

Cognitive development

Reflective and relativisticRealistic, their idealism decrease Emotion and subjective factors can influence thinking. Main window for wisdom: expert knowledge about the practical aspects of life that permits excellent judgment about important matters.

Illness Prevention

Regular checkups Annual immunizations Pneumococcal, flu Close monitoring of chronic illnesses Providing access to care. Screenings Colon, breast, prostate, and lipid disorders.

Launching adult children

Relinquishing young adults into work, military service, college, training, marriage, etc. with appropriate rituals and assistance. Maintaining a supportive home base.

Testosterone

Responsible for deep voices, muscle mass, and facial and body hair patterns found in males As men get older, level of testosterone gradually becomes lower Decreases 10% every decade after age 30.

Piaget - Concrete Operations

Reversibility Decenter Reciprocity Conservation Concept of Number Classification Seriation Transitive Reasoning

Respiratory System Changes

Ribs and cartilage become more rigid. Lung tissue loses elasticity. More vulnerable to respiratory infections.

Interaction of many factors: Family

Role Changes Adaptation

Functional Families

Roles for healthy functioning: Provision of resources Nurturance and support Life skills development Maintenance and management of family system Sexual gratification of marital partners

MIDBRAIN REWARD SYSTEM

Romantic love and addictive drugs exert their powers. Teens hypersensitive to novel experiences Biological rhythms differ.

Stress and Coping in Early Adulthood

STRESS is the response to events that threaten or challenge an individual. Our lives are filled with events and circumstances known as stressors that cause threats to our well-being.

Strength, Joints, and Bones

Sarcopenia = age-related loss of muscle mass and strength. Muscle loss 1-2% per year past 50. Loss of strength - back and legs. Tendons and ligaments less efficient. Bone loss

Understanding Metaphors

School-age children comprehend and enjoy puns, unexpected answers to normal questions, and metaphors. New cognitive flexibility and social awareness make these funny.

Gastrointestinal System

Secretion, digestion, absorption and excretion become more efficient. By age 10 = 750 - 900 ml. Fewer stomach upsets and better glucose maintenance.

Social interaction

See a wide variety of behaviors and gain instruction and feedback. An internal self-regulation mechanism that responds to environmental stimuli.

Information Processing

Selective Attention Memory Organization Metamemory Metalinguistic Awareness Communicative Competence Syntax Understanding Metaphors Humor

TIME-LAPSED REASSESSMENT

Several months after initial assessment. Compares the client's current status to baseline data previously obtained. Example: reassessment of a client's health in a home care setting.

Freud - Latency

Sexual drive is dormant. Repression of sexual desires and erogenous impulses. Pour repressed energy into asexual pursuits.

Teach Back

Share information Confirm Understanding Rephrase or clarify Continue on

Ethnicity

Shared feeling of peoplehood among a group of individuals. Similar patterns that create a common history. Intraethnic variations

Secondary Circular Reactions

Shift cognitive horizons beyond themselves and begin to act on the outside world. Shakes rattles different ways to see how the sound changes. 4 to 8 months

Concrete Operational Thinking

Show the beginnings of adult logic; but generally focus on tangible objects rather than abstract ideas; this is why they are "concrete". Begin to understand events interpreted in different ways. Developed reversibility and flexibility in thinking.•Less egocentrism (can view the world from another's perspective). Engaging in decentration. Understanding conservation, transitivity, class inclusion.

Speech and Language

Shrill cry changes due to physical growth of the throat muscles, lips, teeth, and vocal cords. Milestones are guidelines for normal developmental patterns.

Health Problems (African)

Sickle Cell anemia Stroke mortality Coronary heart disease .Cancer Diabetes AIDS Homicide

DEFINING CHARACTERISTICS

Signs and symptoms that indicate the presence of a particular diagnostic label. Major and critical = must be present Minor = may or may not be present

OBJECTIVE DATA

Signs or overt data. Detectable by an observer or can be tested against a standard.. Seen, heard, felt or smelled . Obtained by observation or physical examination.

Formulas

Similar to each other and to human milk bur they are not exactly same. Special formulas Supplemental iron. Heating instructions

Growth features

Simple to complex General to Specific Cephalocaudal Proximodistal

Piaget - Sensorimotor Stage

Six Substages: Simple reflexes First habits and primary circular reactions. Secondary circular reactions Coordination of secondary circular reactions Tertiary circular reactions Beginnings of thought

Month 3

Size: about 1 inch (25 mm) long as month begins Nostrils, mouth, lips, teeth buds, and eyelids form Fingers and toes almost completeAll organs present, although immature

seven months

Size: about 10-12 inches long, about 1 1/2 -2 pounds as month begins Periods of activity followed by periods of rest and quiet can live outside the body but lil chance of survival checking up on lungs

8 months

Size: about 14-16 inches long, about 2 1/2 -3 pounds as month begins Weight gain continues rapidly May react to loud noises with a reflex jerking action Moves into a head-down position

9 months

Size: about 17-18 inches long, 5-6 pounds as month beginsWeight gain continues until the week before birth Skin begins more smooth as fat deposits continue Decends into pelvis, ready for birth

Month 4

Size: about 3 inches long, 1 ounce as month begins Can suck its thumb, swallow, hiccup, and move around Facial features become clearer

Month 5

Size: about 6 1/2-7 inches long, about 4-5 ounces as month begins around a pound can listen to the heart beat Hair, eyelashes, and eyebrows appear Teeth continue to develop Organs are maturingBecomes more active

six months

Size: about 8-10 inches, about 8-12 ounces as month begins starts hiccups Fat deposits under skin, but fetus appears wrinkled Breathing movements begin

Visible Signs

Skin begins to wrinkle and sag due to loss of fat and collagen in underlying tissues Aging spots Thinning, graying hair Fingernails and toenails develop ridges and are thicker and brittle.

HOW DO THESE CHANGES AFFECT TEENS?

Sleep longer.More clumsy because of growth spurts. Overly sensitive about weight. Develop at different rates. Feel awkward about demonstrating affection to opposite sex parent. Ask more direct questions about sex.

Smell and Taste

Smell develops after birth. Within 10 days they can distinguish mother from others. Taste develops rapidly.

Morula

Solid mass of cells resulting from

Grandparenting

Source of biological reward. Continuity Emotional self-fulfillment Styles: fun-seeking, formal

5 steps of the Teach Back Method

Speak slowly Teach back- make the PT say what you explained Encourage questions Plain language Show example

outcome identification and planning

Specification of (1) patient outcomes to prevent, reduce, or resolve the problems identified in the nursing diagnoses; and (2) related nursing interventions

How do these changes affect teens? TEEN BEHAVIORAL ISSUES

Spend more time with friends than family. More questions about sexuality. Begin to keep a journal. Lock bedroom doors.Become involved in hobbies or clubs. Become elusive and argumentative. May not want to be seen with parents in public.Begin to interact with parents as people.

Spiritual fitness guide

Spirituality may be used in a general sense to refer to that which gives meaning and purpose in life, or the term may be used more specifically to refer to the practice of a philosophy, religion, or way of living. FIT STRESSED DEPLETED DRAINED

Freud's Stages of Psychosexual Development Anal

Stage 18 mos - 3 yrs. Bowel and bladder are sources of sensual satisfaction, self-control and conflict. Major conflict: toilet training.

Stages of sleep

Stage 1 is a light sleep during which the muscles begin to relax and a person can be easily awakened. Stage 2 is when brain activity slows down and eye movement stops. Stage 3 and 4 comprise deep sleep, during which all eye and muscle movement ceases. It can be difficult to wake a person during deep sleep. (sleep walking and bedwetting during these stages. REM sleep is when the muscles of the body stiffen, eyes move, heart rate up, breathing becomes more rapid and irregular, and BP up. This is when people dream.

Simple to Complex

Start off sleeping and eating, then eating with fingers, and then use of a spoon or fork.

Near to Far (Proximodistal)

Starts at the trunk and moves outward. From waving their arms when they see what they want to picking it up.

Blended families

Step parents and step siblings

Fertilization

Steps of fertilization (Conception) Several sperm penetrate corona radiata. Several sperm attempt to penetrate zona pellucida One sperm enters egg and nuclei fuse, producing a producing a zygotezygote. Egg's plasma membrane and zona pellucida change to prevent change to prevent polyspermy

What are older adults like?

Stereotypes Life Expectancy Average Useful Maximum Factors: Genetic, environmental, ethnic, gender

Inhibitors

Stereotyping Prejudice and racism Ethnocentrism or cultural prejudice Cultural imposition Cultural conflict Cultural shock

Bonding

Strong emotional tie between parent and newborn. Attachment En face Touching

Structural-Functional

Structure: family's roles and relationships Function: process of continual change in the system

mid-life crisis

Suspended between the past and the future, trying to cope with this gap that threatens life's continuity.

SUBJECTIVE DATA

Symptoms or covert data Apparent only to the person affected Sensations, feelings, values, beliefs, attitudes, and perception of personal health status and life situation.

ASSESSING

Systematic and continuous collection, organization, validation, and documentation of data. Focus on a client's responses to a health problem not upon disease.

Aging and the Skin

Takes longer to repair and replace skin cells. Thinner with poor turgor. More vulnerable to skin injury, and slower wound healing. Decreased ability to perceive cold and hot. Decrease in number and function of sweat glands.

Tips for clearing acne

Talk to a dermatologist about prescription medications Try an OTC acne treatment Follow treatment instructions closely Avoid shaving pimples Avoid home remedies like toothpaste and lemon juice Develop a consistent skin care routine

Cultural Nursing Assessment part 2

Talk with community leaders to gain an understanding about community life aspects. Verify and cross check information. Avoid making premature generalizations. Be sincere, open and honest with oneself and the client.

How do you deal with stress?

Task-oriented- you may feel comfortable analyzing the situation and taking action to deal directly with the situation. Emotion-oriented - you may prefer to deal with your feelings and find social supports. Distraction-oriented - you may use activities or work to take your mind off the situation.

Nursing

Teaching Assessment Goal: Assisting each family to have a healthy pregnancy and birth outcome, lay the foundation for satisfactory parenting and family life.

Emotional and social development issues

Temperament Self-esteem development Body image School-age fears Peer relationships Teacher and school influences Family influences

Syntax

The arrangement of words and phrases to create well-formed sentences in a language. grammar

PLANNING

The establishment of client goals/outcomes Working with the client, to prevent, reduce, or resolve problems To determine related nursing interventions (actions) that are most likely to assist client in achieving goals This is about improving the quality of life for your patient. This is about what your patient needs to do to improve his health status or better cope with his illness.

Psychodynamic Theory - Freud

The interaction of various conscious and unconscious mental or emotional processes, especially as they influence personality, behavior, and attitudes. The study of personality and behavior in terms of such processes

EVALUATING

The measuring of the extent to which client goals have been met. Evaluation involves not only analyzing the success of the goals and interventions, but examining the need for adjustments and changes as well. The evaluation incorporates all input from the entire health care team, including the patient.

Affective Domain

The most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain.

Universally applicable

The nursing process allows nurses to practice nursing with well or ill people, young or old, in any type of practice setting

Systematic

The nursing process has an ordered sequence of activities and each activity depends on the accuracy of the activity that precedes it and influences the activity following it.

Dynamic

The nursing process has great interaction and overlapping among the activities and each activity is fluid and flows into the next activity

Goal-directed

The nursing process is a means for nurses and clients to work together to identify specific goals (wellness promotion, disease and illness prevention, health restoration, coping and altered functioning) that are most important to the client, and to match them with the appropriate nursing actions

Maslow

Theory of Motivation and Hierarchy of Needs. People are not static but are always in process of becoming different and better.

Ectodermderm, , mesomesodermderm, , endoendodermderm.

These are the foundation of the body systems (Germ Layer Theory)

Dysfunctional families

Those in which conflict, misbehavior and even abuse on the part of individual members of the family occur continually, leading other members to accommodate such actions.

Rest and Sleep

Three categories of sleep disorders: lack of sleep, disturbed sleep and too much sleep. Adults need about 7 to 8 hours of sleep a day. Falling asleep and waking up are governed by chemical changes in the brain and blood.

THE PURPOSE OF THE NURSING PROCESS

To Achieve Scientifically- Based, Holistic, Individualized Care For The Client To Achieve The Opportunity To Work Collaboratively With Clients, Others To Achieve Continuity Of Care

Maturation

To ripen Increase in competence and adaptability Able to function at a higher level.

Autonomy vs. Shame and Doubt

Toddler (1 to 3 yrs.) To realize that one is an independent person who can make decisions.

Pregnancy testing

Ultrasound Transvaginal transabdominal Biophysical Profile Amniocentesis

NUTRITIONAL PROBLEMS

Undernutrition Deficiencies: iron, iodine, vitamin A, calcium, other nutrients. Obesity

Car seat safety

Use rear-facing car seat in back seat, preferably the middle until age 2 or until the child reaches max height and weight

Piaget

Viewed children as biological organisms interacting with environment attempting to make sense of the world.

Cognitive-Perceptual Pattern (young adult)

Visual Acuity is highest at 20 and begins to decline at 40 when farsightedness frequently develops. Hearing is also best at 20.

Sleep

Wakeful periods more frequent and less deep sleep.

Adolescence is a period of profound brain maturation.

We thought brain development was complete by adolescence We now know... maturation is not complete until about age 24!!!

First Year Growth

Weight Sign of good health First 6 months gain 1 -2 pounds/month Last 6 months gain 1 pound per month Doubles in first few months and triples by end of first year.

Occurrence of Pregnancy

When a zygote begins dividing, it is termed an embryo Developing embryo travels down oviduct and eventually implants in endometrium (Implantation / pregnancy) Presence of human gonadotropic hormonehuman gonadotropic hormone (HCG) in the blood confirms pregnancy. If implantation does not occur, woman never knows fertilization took place.

ERIKSON - IDENTITY VS. ROLE CONFUSION

Who am I? Where am I going? Peer group is

NURSING ORDERS

Who? What? Where? When? How? Rationale = Why?

Intimacy vs. Isolation

Young adulthood (21-45 yrs) To commit to another in a loving relationship

Amniotic Sac

a fluid-filled sac that cushions and protects a developing embryo and fetus in the uterus

Independent (NURSING INTERVENTIONS)

able to be implemented without a physician's order

Clinical Model of Health

absence of disease (signs and symptoms) , prevention not emphasized

Vision problems

amblyopia (lazy eye) causes -crossed eyed - nearsightedness -Farsightedness -Astigmatism Uncorrected refractive errors or other eye defects Malalignment of the eyes (strabismus)

Planning teaching strategies

are lectures, discussion, demonstration, And role playing. Teaching aides like pamphlets, audiovisual aids, internet, and equipment & models.

Benefits of physical activity

cardiovascular fitness weight control emotional tension release development of leadership and following skills.

Collaborative (NURSING INTERVENTIONS)

combination of dependent/independent nursing intervention

Problem (COMPONENTS OF A NURSING DIAGNOSIS)

describes the health problem or response to therapy. Directs formation of goals and outcomes.

health-illness continuum

description of a person's health status as a range with anchors that include poor health or imminent death on one end of the continuum to high-level wellness on the other end

Care is

designed for the specific client.Based on the uniqueness of the person's culture and includes cultural norms and values. Designed to include empowerment strategies to facilitate client decision-making in health behavior. Provided with sensitivity to the cultural uniqueness of clients.

Single parent families

families in which one parent resides with and cares for one or more children

right hemisphere

global, holistic processing recognizing faces tone of voice visuospacial skills left hand left body- side musical ability emotions humor metaphors left visual field Dance, sculpture, art appreciation, musical appreciation, perception

Interpersonal

he nursing process ensures that nurses are client-centered rather than task-centered and encourages them to work to enhance client's strengths and meet human needs

Four types of assessments

initial, problem-focused, emergency, and time-lapsed.

Middle Age

is a mix of new opportunities and expanding resources accompanied by declines in physical abilities. Begins at approximately 40 years and extends to about 60 - 65.

Professional nurses are responsible for

making nursing dx. Describe a continuum of health states. Domain includes only those states that nurses are educated and licensed to treat. Is a judgment made only after thorough, systematic data collection.

Intelligence:

measure of a child's underlying competence or learning ability. Associated with academic success, advancement of the job and appropriate social behavior. Achievement

Psychomotor

mental processes that cause movement using your body to do something Ex. Giving a flu shot

MMSE

mini mental status exam

Chorion

outermost membrane, develops rom the trophoblast, contributes to the placenta.

bullying

physical verbal or psychological attacks or intimidation against a person who cannot properly defend themselves. It includes two key components. 1.Replace harmful acts 2. imbalance of power

Pruning starts at the back of the brain..and moves to the front

prefrontal cortex- judgement Amygdala- emotion Nucleus Accumbens- motivation Cerebellum- physical coordination Notice: Judgment is last to develop!

The purpose of quality client education is to

promote wellness (primary) Prevent or diagnose illness early (secondary) Restore optimal health and function (tertiary)

Genogram Symbols

square = male circle = female diagonal line thru symbol= death triangle = pregancy loss diagonal line thru connecting line = divorce SB = stillbirth

WHO DEFINITION OF HEALTH

state of complete physical, mental, and social well being. Not nearly the absence of disease or infirmary. To lead Social and economically productive time.

Vital signs of newborn

temp 97.6 to 98.6 F allixary 90.0 to 99.5 F rectal apical rate 100 to 160 beats/min 100 sleeping 160 crying respirations 30 -60 40 is average Systolic 60 - 80 mmhg Diastolic 40 - 50 mmhg bp 75/42

Communicative Competence

the ability to communicate in a personally effective and socially appropriate manner

selective attention

the ability to focus on only one stimulus from among all sensory input

metalinguistic awareness

the ability to reflect on the use of language how to get you point across

Healthy People 2020

the fourth set of health goals and objectives for the U.S. that defines the nation's health agenda and guides its health policy

Eudaimonistic model of health

the model of health emphasizing wholeness of the individual as being essential to maintaining good health

Consider- ACCULTURATION

the process of acquiring the behaviors, attitudes, and values of a different culture.

disease prevention

the process of reducing risks and alleviating disease to promote, preserve, and restore health and minimize suffering and distress 3 level of prevention activities

Body Proportions

the relationship of the sizes of one body part to another and to the rest of the body

Metamemory

understanding of processes of memory how it works

Consider-ASSIMILATION

when an individual, over time, gives up the values, traditions, and traditional ways of his or her native culture and conforms to the standards and behaviors of the new culture.