CH 9-20 TEST 2 Review

1. Orientation & Setting an Agenda

Begin by introducing yourself, and explain why you are collecting data. Assure patients that information will be kept confidential. Your aim is to set an agenda for the interview, including how you will gather information about a patient's chief concerns or problems (e.g., asking questions and performing a physical exam). Focus on a patient's goals, preferences, and concerns, not your personal agenda. This is a time that allows a patient to feel comfortable speaking with you and becoming an active partner in decisions about care. The professionalism and competence that you show when interviewing strengthens the nurse-patient relationship.

Primary Source of Info

- A patient is the primary source of assessment information. Be sure to consider the setting for your assessment and your patient's condition. -Family caregivers, other family members, and significant others are primary sources of information for infants or children, critically ill adults, and patients who have intellectual disabilities or cognitive impairments. In cases of severe illness or emergency situations, family members are often your only source of information.

Birth to 1 month Gross/ Fine Motor Infancy

- Gross Motor Skill:Complete head lag persists Cannot sit upright Primitive reflexes present -Fine Motor Skill : Reflexive Grasp

S/S of a weak bladder

- MEN Hypertrophy of the prostate gland is frequently seen in older men. This hypertrophy enlarges the gland and places pressure on the neck of the bladder. As a result, urinary retention, frequency, incontinence, and UTIs occur. In addition, prostatic hypertrophy results in difficulty initiating voiding and maintaining a urinary stream and does not always indicate a malignancy. However, when men develop symptoms of prostatic hypertrophy, it is important that this condition is evaluated by a health care provider to differentiate benign prostatic hypertrophy (BPH) from cancer of the prostate. - WOMEN - Urinary incontinence is an abnormal and typically embarrassing condition. Older women, particularly those who have had children, experience stress incontinence, an involuntary release of urine that occurs when they cough, laugh, sneeze, or lift an object. This is a result of a weakening of the perineal and bladder muscles. Other types of urinary incontinence are urgency, overflow, functional, and mixed incontinence. The risk factors for urinary incontinence include age, menopause, diabetes, hysterectomy, stroke, and obesity.

PIAGET'S THEORY OF COGNITIVE DEVELOPMENT (2) includes four periods that are related to age and demonstrate specific categories of knowing and understanding

- Period I: Sensorimotor (Birth to 2 Years) - **Period Ii: Preoperational (2 to 7 Years) - Period Iii: Concrete Operations (7 to 11 Years) -Period Iv: Formal Operations (11 Years to Adulthood)

Older Adults; different therapies that could them physically & emotionally

- Therapeutic Communication -Touch -Reality Orientation - Validation Therapy - Reminiscence -Body Image Interventions

Erikson's theory of psychosocial development (2) (individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one)

- Trust vs. Mistrust (Birth to 12 to 18 months) - Autonomy vs. Sense of Shame and Doubt (18 Months to 3 Years) -Initiative vs. Guilt (3 to 6 Years) -Industry vs. Inferiority (6 to 12 Years) - Identity vs. Role Confusion (Puberty) -Intimacy vs. Isolation (Young Adult) -Generativity vs. Self-Absorption and Stagnation (Middle Age) - Integrity vs. Despair (Old Age)

Writing goals and expected outcomes: (S.M.A.R.T)

- Use the SMART acronym ( S pecific, M easurable, A ttainable, R ealistic, T imed) to write goals and outcome statements.

Sandwich Generation

- composed of the children of older adults. - These individuals, who are usually in their middle years, must meet their own needs along with those of their children and their aging family members. This balance of needs often occurs at the expense of their own well-being and resources. -hey also begin to help aging parents while being responsible for their own children, placing them in the sandwich generation.

SIDS (sudden infant death syndrome)

- position infants for sleep on their backs on a firm sleep surface to decrease the risk of (SIDS). - Co-sleeping or bed sharing is associated with an increased risk for SIDS -Safeguards to reduce the risk for SIDS include proper positioning; removing stuffed animals, soft bedding and crib bumper pads, and pillows; and avoiding overheating the infant. Individuals should avoid smoking during pregnancy and around the infant because it places the infant at greater risk for SIDS

Car Seats for infants

-Parents need to learn how to fit the child in the restraint and install the car seat properly. All infants and toddlers should ride in a rear-facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer or their car safety seat -Placing an infant in a rear-facing restraint in the front seat of a vehicle is extremely dangerous in any vehicle with a passenger-side air bag. Nurses are responsible for providing education on the use of a car seat before discharge from the hospital.

Older Adults - Therapeutic Communication

-Therapeutic communication skills enable you to perceive and respect the older adult's uniqueness and health care expectations. A caring nurse expresses attitudes of concern, kindness, and compassion.However, you cannot simply enter an older adult's environment and immediately establish a therapeutic relationship. First, you have to be knowledgeable and skilled in communication techniques (see Chapter 24). Sitting down and engaging an older adult eye to eye goes a long way in establishing a therapeutic relationship.

Secondary Source of Info

-secondary sources (e.g., family caregiver, family members or friends, health professionals, medical record). - The family and significant others are also important secondary sources of information for alert and responsive patients. They confirm findings or identify important health patterns (e.g., whether a patient takes medications regularly, is able to sleep well, and the type of diet the patient regularly eats).

1. Specific

1. Specific—Outcomes and goals reflect a specific patient behavior or response. A correct goal statement is: "Patient will ambulate independently in 3 days." A correct outcome statement is: "Patient ambulates in the hall 3 times a day by 4/22." A common error is to write an intervention: "Ambulate patient in the hall."

2. Measurable

2. Measurable—You must be able to measure or observe whether a change takes place in a patient's status. Changes occur in physiological findings and in a patient's knowledge, perceptions, and behavior. Examples such as "Body temperature will remain below 98.6°F (37°C)" and "Apical pulse will remain between 60 and 100 beats/min" allow you to objectively measure physical changes in a patient's status.

3. Attainable

3. Attainable—A goal and an outcome are more attainable or achievable when you mutually set them with a patient. This ensures that you and your patient agree on the direction and time limits of care. Mutual goal setting (e.g., distance to walk, topics to learn about, medications) increases a patient's motivation and cooperation. As a patient advocate, apply standards of practice, evidence-based knowledge, safety principles, and basic human needs when helping patients set goals.

4. Realistic

4. Realistic—Set goals and expected outcomes that are realistic or relevant for patients. Consider the patient's preferences and needs and the resources of the health care agency, family, and patient. Be aware of a patient's physiological, emotional, cognitive, and sociocultural potential and the economic cost and resources available to reach expected outcomes in a timely manner. For example, are the patient's cultural beliefs reflected in the goals you set? Does the patient have a family caregiver to assist with an intervention to be performed in the home? You set realistic goals and outcomes within the patient's limitations and abilities. For example, an initial goal is 246"Patient will wash hands and face in 72 hours."

5. Timed

5. Timed—Set a time for each goal and outcome to be met. This helps the health care team collaborate to resolve patient problems. For example, the goal of "patient will achieve pain relief" for Mr. Lawson is complete by adding the time frame "by day of discharge." With this goal in place, all members of the nursing team will aim to manage and reduce the patient's pain while he is hospitalized. At the time of discharge, evaluation of expected outcomes (e.g., pain-rating score, signs of grimacing, level of movement) show whether the goal was met. Always collaborate with patients to set realistic and reasonable time frames. Time frames also help you and a patient determine whether the patient is making progress at a reasonable rate. If not, you must revise the plan of care. Time frames also promote accountability in delivering and managing nursing care.

Purpose of nursing diagnosis

A nursing diagnosis is a clinical judgment made by a nurse to describe a patient's response or vulnerability to health conditions or life events that a nurse is licensed and competent to treat. It is a diagnostic label that classifies an individual's, family's, or community's response to illness so that all nurses understand a specific patient's health care needs.

Diagnosis

A nursing diagnosis is made when a nurse identifies a health-related problem or the potential to develop a problem based on patient data. Nursing diagnosis is the second step of the nursing process. Nurses deliberately use critical thinking to make nursing diagnoses that accurately identify a patient's responses to illness. When making a diagnosis, a clear label or term that is familiar to all those involved in a patient's care is necessary to understand a patient's needs. For example, the terms anger or impaired breathing are terms that will prompt nurses to consider similar problem areas: emotional and behavioral versus respiratory or ventilatory

PT Centered Interview

A patient-centered interview is relationship based and is an organized conversation focused on learning about a patient's concerns and needs. An empathic, patient-centered interview strengthens a patient's sense of self-esteem and lessens the feelings of helplessness that often accompany an episode of illness. The most extensive patient-centered interview is the one used during collection of a nursing history. Primary objectives while taking an initial nursing history are to discover details about a patient's concerns, explore expectations for the health care visit, and display genuine interest and partnership.

Attachment Process between newborn & mom

After immediate physical evaluation and application of identification bracelets, the nurse promotes early parent-child contact to encourage parent-child attachment. -Close body contact, often including breastfeeding, is a satisfying way for most families to start bonding through eye-to-eye contact and touch. If immediate contact is not possible, incorporate it into the care plan as early as possible, which means bringing the newborn to an ill parent or bringing the parents to an ill or premature child. Attachment is a process that begins during pregnancy and continues for many months after birth

Planning

After identifying a patient's nursing diagnoses and collaborative problems, you begin the planning step of the nursing process. Planning involves setting priorities based on patient diagnoses and collaborative problems, identifying patient-centered goals and expected outcomes, and prescribing nursing interventions appropriate for each diagnosis. The most important principle in planning is the individualization of a patient-centered plan of care for each patient's unique needs. The patient's nursing diagnoses direct 241your mutual selection of nursing interventions and the goals and outcomes you hope your patient achieves

Discontinuing a care plan

After you determine that your patient met expected outcomes and goals, confirm your evaluation with the patient when possible. If you and the patient agree, you discontinue that part of the care plan. Documentation of a discontinued plan ensures that other nurses will not unnecessarily continue interventions for that part of the plan. Continuity of care assumes that care provided to patients is relevant and timely. You waste time and energy when you do not communicate achieved goals with other nurses.

2. Autonomy vs. Sense of Shame and Doubt (18 Months to 3 Years) Erikson

By this stage a growing child is more accomplished in some basic self-care activities, including walking, feeding, and toileting. This newfound independence is the result of maturation and imitation. A toddler develops his or her autonomy by making choices. Choices typical for the toddler age-group include activities related to relationships, desires, and playthings. There is also opportunity to learn that parents and society have expectations about these choices. Limiting choices and/or enacting harsh punishment leads to feelings of shame and doubt. A toddler who successfully masters this stage achieves self-control and willpower. The nurse models empathetic guidance that offers support for and understanding of the challenges of this stage. Available choices for the child must be simple in nature and safe.

3. Initiative vs. Guilt (3 to 6 Years)

Children like to pretend and try out new roles. Fantasy and imagination allow them to further explore their environment. Also at this time they are developing their superego, or conscience. Conflicts often occur between a child's desire to explore and the limits placed on his or her behavior. These conflicts sometimes lead to feelings of frustration and guilt. Guilt also occurs if a caregiver's responses are too harsh. Preschoolers learn to maintain a sense of initiative without imposing on the freedoms of others. Successful resolution of this stage results in direction and purpose. Teaching a child impulse control and cooperative behaviors helps a family avoid the risks of altered growth and development. Preschoolers frequently engage in animism, a developmental characteristic that makes them treat dolls or stuffed animals as if they have thoughts and feelings. Play therapy is also instrumental in helping a child successfully deal with the inherent threats related to hospitalization or chronic illness.

Period Iii: Concrete Operations (7 to 11 Years) (Piaget)

Children now are able to perform mental operations. For example, the child thinks about an action that before was performed physically. Children are now able to describe a process without actually doing it. At this time they are able to coordinate two concrete perspectives in social and scientific thinking, so they are able to appreciate the difference between their perspective and that of a friend. Reversibility is one of the primary characteristics of concrete operational thought. Children can now mentally picture a series of steps and reverse the steps to get back to the starting point. The ability to mentally classify objects according to their quantitative dimensions, known as seriation, is achieved. They are able to correctly order or sort objects by length, weight, or other characteristics. Another major accomplishment of this stage is conservation, or the ability to see objects or quantities as remaining the same despite a change in their physical appearance

Delirium

Delirium, or ACUTE confusional state, is a potentially reversible cognitive impairment that occurs suddenly and worsens at night. The presence of delirium is a medical emergency and requires prompt assessment and intervention. Nurses are at the bedside 24/7 and in a position to recognize delirium development and report it. The cognitive impairment usually reverses once health care providers identify and treat the cause of delirium. -ONSET: Sudden/abrupt; depends on cause - COURSE: Short, daily fluctuations in symptoms; worse at night, in darkness, and on awakening - PROGRESSION: Abrupt -DURATION: Hours to less than 1 month; longer if unrecognized and untreated - CONSCIOUSNESS: Reduced/disturbed - ORIENTATION: Generally impaired; severity varies -SPEECH: Often incoherent; may call out repeatedly or with the same phrase - AFFECT: Variable, but may appear disturbed, frightened Physiological causes include electrolyte imbalances, untreated pain, infection, cerebral anoxia, hypoglycemia, medication effects, tumors, subdural hematomas, and cerebrovascular infarction or hemorrhage. A new onset of delirium should trigger the nurse to assess for signs and symptoms of infections such as pneumonia and UTI.

Dementia

Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. It is an umbrella term that includes Alzheimer's disease (most common type), Lewy body disease, frontal-temporal dementia, and vascular dementia . Cognitive function deterioration leads to a decline in the ability to perform basic ADLs and IADLs. Unlike delirium, dementia is characterized by a GRADUAL, PROGRESSIVE , and IRREVERSIBLE decline in cerebral function. Because of the similarity between delirium and dementia, you need to assess carefully to rule out the presence of delirium whenever you suspect dementia. - ONSET : Insidious/slow and often unrecognized - COURSE: Long, no diurnal effects; slow progression over time; some deficits with increased stress - PROGRESSION: Slow over months and years -DURATION: Months to years - CONSCIOUSNESS: Awake - ORIENTATION: Generally normal to person but not to place or time -SPEECH: Difficulty finding words; perseveration - AFFECT: Slowed response; may be labile

Assessment

During the first step of assessment, you collect a comprehensive set of data about a patient and recognize and identify patterns that begin to reflect the meaning of a patient's response to health problems. Having an accurate and complete database about a patient allows you to make a clinical judgment in the form of a nursing diagnosis and then plan and implement relevant and appropriate nursing interventions. Critical thinking is a vital part of assessment . While gathering data about a patient, you synthesize relevant knowledge, recall prior clinical experiences, apply critical thinking standards and attitudes, and use professional standards of practice to direct your assessment in a meaningful and purposeful way.

***Period Ii: Preoperational (2 to 7 Years) (Piaget)

During this time children learn to think with the use of symbols and mental images. They exhibit "egocentrism" in that they see objects and people from only one point of view, their own. They believe that everyone experiences the world exactly as they do. Early in this stage children demonstrate "animism," in which they personify objects. They believe that inanimate objects have lifelike thought, wishes, and feelings. Their thinking is influenced greatly by fantasy and magical thinking. Children at this stage have difficulty conceptualizing time. Play becomes a primary means by which they foster their cognitive development and learn about the world (Fig. 11.2). Nursing interventions during this period recognize the use of play as the way the child understands the events taking place. Play therapy is a nursing intervention that helps the child work through invasive and intrusive procedures that may occur during hospitalization. In addition, play therapy helps the ill child progress developmentally.

Problem Solving

Effective problem solving requires one to obtain information that clarifies the nature of a problem, suggest possible solutions, and try the solution over time to make sure that it is effective. In the case of patient care, a solution to a problem should be consistently effective, allowing a patient to return to a stable condition or situation. It becomes necessary to try different options if a problem recurs.

Evaluate

Evaluation is the crucial fifth step of the nursing process that determines whether a patient's condition or well-being improved after nursing interventions were delivered. Evaluation monitors the progress of each of your patients and gives you valuable information about the efficacy of your interventions.

Cribs

Federal safety standards now prohibit the manufacture or sale of cribs with drop-side rails and require more durable mattress supports and crib slats. Unsafe cribs that do not meet the safety standards should be disassembled and thrown away . Parents also need to inspect an older crib to make sure the slats are no more than 6 cm (2.4 inches) apart. The crib mattress should fit snugly, and crib toys or mobiles should be attached firmly with no hanging strings or straps. Instruct parents to remove mobiles as soon as the baby is able to reach them.

7. Generativity vs. Self-Absorption and Stagnation (Middle Age)

Following the development of an intimate relationship, an adult focuses on supporting future generations. The ability to expand one's personal and social involvement is critical to this stage of development. Middle-age adults achieve success in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement. Achieving generativity results in caring for others as a basic strength. Inability to play a role in the development of the next generation results in stagnation . Nurses help physically ill adults choose creative ways to foster social development. Middle-age people often find a sense of fulfillment by volunteering in a local school, hospital, or church.

**6 to 8 months Gross/Fine Motor Infancy

Gross : **sits alone without support - Bears full weight on feet & can hold on to furniture while standing - Fine : Bangs objects together - Transfers objects from hand to hand

**2 to 4 months Gross/fine Motor Infancy

Gross : when Prone, lifts head & chest & bears weight on forearms. **-With Support, able to sit erect with good head control. -Can Turn from back to side — Fine : Holds rattle for short periods but cannot pick it up if dropped. - Looks at & plays its hand -Able to bring objects to mouth

**4 to 6 months Gross/ Fine Motor Infancy

Gross: **Turns from abdomen to back at 5 months & then back to abdomen at 6. - Can support much of own weight when pulled to stand -No head lag when pulled to sit - Fine Motor : Grasp objects at will & can drop them to pick up another object - Pulls feet to mouth to explore - can hold a bottle

8 to 10 months Gross/ Fine Motor Infancy

Gross: scoots or crawls on hands & knees - Pulls self to standing position - Fine : Picks up small objects -begins to use pincer grasp - Shows hand preference

10 to 12 months Gross/ Fine motor Infancy

Gross: walks holding onto furniture - Stands alone, for short periods - May attempt first step alone - FINE : Can place objects into containers - Can turn book pages (more than one page at a time)

How to do a cultural Assessment?

Health Beliefs and Practices • How does the patient define health and illness? How are feelings concerning pain, fatigue, and illness in general expressed? • Are particular methods used for the treatment of illness? • What is the attitude toward preventive health measures such as immunizations? • Are there restrictions imposed by modesty that must be respected (e.g., constraints related to exposure of parts of the body, discussion of sexual health)? • What are attitudes toward mental illness, pain, chronic disease, being handicapped, and death and dying? • Is there a person in the family responsible for health-related decisions? • Does the patient prefer a health professional of the same gender, age, and ethnic and racial background? Faith-Based Influences and Special Rituals • Is there a religion or faith to which the patient adheres? • Is there a significant person to whom the patient looks for guidance? • What events, rituals, and ceremonies are important within the life cycle of birth, puberty, marriage, and death? Language and Communication • What language is spoken in the home? • How well does the patient understand spoken and written English? • Are there special signs of demonstrating respect or disrespect? • Is touch an acceptable form of communication? Parenting Styles and Family Roles • Who makes the decisions in the family? • What is the composition of the family? How many generations are considered to be a single family? • What is the role of and attitude toward children in the family? • When do children need to be disciplined or punished, and how is this done? • Do family members show physical affection toward each other and their children? • What major events are important to the family, and how do they celebrate? Sources of Support Beyond the Family • Are there ethnic organizations that may influence the patient's approach to health care? • Are there individuals in the patient's social network that influence perception of health and illness? • Is there a particular cultural group with which the patient identifies? Dietary Practices • What does the family like to eat? Does everyone in the family have similar tastes in food? • Who is responsible for food preparation? • Are any foods forbidden by the culture, or are some foods a cultural requirement in observance of a rite or ceremony? • How is food prepared and eaten? • Are there periods of required fasting?

Dependent Nursing Interventions

Health care provider-initiated interventions are dependent nursing interventions that require an order from a health care provider. The interventions are based on a physician's or nurse practitioner's choices for treating or managing a medical diagnosis. Advanced practice nurses who work under collaborative agreements with physicians or who are licensed independently by state practice acts are able to write dependent interventions. ***As a nurse you intervene by carrying out the health care provider's written and/or verbal orders. Administering a medication, implementing an invasive procedure (e.g., inserting a Foley catheter, starting an IV infusion), and preparing a patient for diagnostic tests are examples of health care provider-initiated interventions. You perform dependent nursing interventions, like all nursing actions, with appropriate knowledge, clinical reasoning, and good clinical judgment.

Teachings for STD's , Young Adults

Help middle adults consider factors such as avoidance of STIs, prevention of opioid and substance abuse, and accident prevention in relation to decreasing health risks. For example, provide patients with information on STI causes, symptoms, and transmission. Discuss methods of protection during sexual activity with a patient in an open and nonjudgmental manner and reinforce the importance of practicing safe sex. STIs are a major health problem in young adults. Examples of STIs include syphilis, chlamydia, gonorrhea, genital herpes, human papillomavirus (HPV), and acquired immunodeficiency syndrome (AIDS). STIs have immediate physical effects such as genital discharge, discomfort, and infection. They also lead to chronic disorders, cancer, infertility, or even death. They remain a major public health problem for sexually active people, with almost half of all new infections occurring in men and women younger than 24 years of age. As young people enter sexual relationships, it is important that health care providers acknowledge the normalcy of these relationships and assess which types of sexual activity young adult patients engage in to determine appropriate screening tests and preventive measures. Also routinely screen for interpersonal violence and refer patients to appropriate community resources.

Implementation

Implementation, the fourth step of the nursing process, begins after you develop a patient's plan of care. It involves the performance of nursing and collaborative interventions necessary to achieve the goals and expected outcomes needed to support or improve a patient's health status. A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes.

Period I: Sensorimotor (Piaget)(Birth to 2 Years)

Infants develop a schema or action pattern for dealing with the environment (Box 11.1). These schemas include hitting, looking, grasping, or kicking. Schemas become self-initiated activities (e.g., the infant learning that sucking achieves a pleasing result generalizes the action to suck fingers, blanket, or clothing). Successful achievement leads to greater exploration. During this stage a child learns about himself and his environment through motor and reflex actions. He or she learns that he or she is separate from the environment and that aspects of the environment (e.g., parents or favorite toy) continue to exist even though they cannot always be seen. Piaget termed this understanding that objects continue to exist even when they cannot be seen, heard, or touched object permanence and considered it one of the child's most important accomplishments.

Collaborative Interventions

Interprofessional collaboration is a complex process that is formed between two or more people from various professional fields to achieve common goals for a patient

Causes of Obesity for Middle Age Adult

It is a complicated, multifactorial disease, with genetic, behavioral, socioeconomic, and environmental origins; obesity reduces quality of life and increases the risk for many serious chronic diseases and premature death . Health consequences of obesity include high blood pressure, high blood cholesterol, type 2 diabetes, coronary heart disease, osteoarthritis, and obstructive sleep apnea. Research shows that the type of diet a patient chooses to follow is not as important as caloric restriction, which is associated with better weight outcomes

Inference

Look at the meaning and significance of findings. Are there relationships among findings? Do data about the patient help you see that a problem exists? Clinical inference is part of the clinical decision-making process that occurs before you determine what your patient's problems are

8. Integrity vs. Despair (Old Age)

Many older adults review their lives with a sense of satisfaction, even with their inevitable mistakes. Others see themselves as failures, with their lives marked by despair and regret. Older adults often engage in a retrospective appraisal of their lives. They interpret their lives as a meaningful whole or experience regret because of goals not achieved (Berger, 2017). Because the aging 138process creates physical and social losses, some adults also suffer loss of status and function (e.g., through retirement or illness). You can enhance feelings of integrity by encouraging older adults to reflect on their meaningful relationships, such as relationships with a higher power, family members, or the community . These external struggles are met with internal struggles, such as the search for meaning in life. Meeting these challenges creates the potential for growth and the basic strength of wisdom

Independent Nursing Interventions

Nurse-initiated interventions are the independent nursing interventions that a nurse initiates in response to a nursing diagnosis without supervision, direction, or orders from others. ***Examples include positioning patients to prevent pressure injury formation, initiating early mobility protocols, offering counseling for coping, or instructing patients in side effects of medications. Nurse-initiated interventions are autonomous actions based on scientific rationale.

Depression

Older adults sometimes experience late-life depression, but it is not a normal part of aging. Depression is the most common, yet most undetected and untreated, impairment in older adulthood. It sometimes exists and is exacerbated in patients with other health problems such as stroke, diabetes, dementia, Parkinson's disease, heart disease, cancer, and pain-provoking diseases such as arthritis.-ONSETterm-64: Happens with major life changes; often abrupt but can be gradual. Clinical depression is treatable. Treatment includes medication, psychotherapy, or a combination of both. Electroconvulsant therapy (ECT) is sometimes used for treatment of resistant depression when medications and psychotherapy do not help. - COURSE: Diurnal effects, typically worse in the morning; situational fluctuations but less than with delirium - PROGRESSION: Variable; rapid or slow but even -DURATION: Variable; may be chronic - CONSCIOUSNESS: Awake - ORIENTATION: Usually normal -SPEECH: May be slow - AFFECT: Flat

Diagnostic Reasoning

Once you gather information about a patient, diagnostic reasoning begins. It is a form of decision making. Diagnostic reasoning involves being able to understand and think through clinical problems, look for clues, understand the meaning of evidence, and know when there is enough information to make an accurate diagnosis, consider different causes of the problem, and then select interventions that best meet the needs of a patient

Older Population & Proper Med Use

One of the greatest challenges for older adults is safe medication use. Medication categories such as analgesics, anticoagulants, antidepressants, antihistamines, antihypertensives, sedative-hypnotics, and muscle relaxants create a high likelihood of adverse effects in older adults. They are at risk for adverse medication effects because of age-related changes in the absorption, distribution, metabolism, and excretion of drugs, collectively referred to as the process of pharmacokinetics. Medications sometimes interact with one another, adding to or negating the effect of another drug. Examples of adverse effects include confusion, impaired balance, dizziness, nausea, and vomiting. Because of these effects, some older adults are unwilling to take medications; others do not adhere to the prescribed dosing schedule, or they try to medicate themselves with herbal and over-the-counter medications. Your role as a nurse is to ensure the greatest therapeutic benefit with the least amount of harm by educating patients about safe medication use. You need to question the efficacy and safety of combinations of prescribed medications by conferring with pharmacists or health care providers. Advocate for the older adult to prevent adverse reactions. Older adults often use over-the-counter or herbal medications. The mix of over-the-counter and herbal medications with prescription medications can create serious adverse reactions.

Teach back technique

One way to evaluate patient understanding is with the teach-back method. Teach-back is a closed-loop communication technique that assesses patient retention of the information given during a teaching session. To perform teach-back, ask the patient to explain material that was discussed, such as the role of diet and exercise in managing blood glucose levels, or to demonstrate a skill, such as self-monitoring blood glucose. The response allows you to determine the degree to which the patient remembers and understands what was taught or demonstrated. Examples of teach-back prompts and questions include: 1. "Tell me in your own words how you will take this medication at home." 2. "Please demonstrate how to use this blood glucose monitor." 3. "What are some of the side effects that you should watch for?" 4. "When will you call the office regarding your blood pressure?" 5. "Please show me how to request a refill of this medication online." If the patient has difficulty recalling the material or demonstrating a skill, modify and repeat the content and reassess his or her retention. Also, take ownership of the teaching experience by responding, "I must not have explained stroke symptoms very well. Let me try again." Patient understanding is confirmed when the patient can accurately restate the information in his or her own words

Open-Ended Questions

Open-ended questions elicit the patient's unique story. An open-ended question gives a patient discretion about the extent of his or her answer. - For example, "So, tell me more about ...." or "What are your concerns about this?". The use of open-ended questions prompts patients to describe a situation in more than just one or two words, allowing patients to actively describe their health status.

Goal of PT Centered Care

Patient-centered care is achieved only when a patient and family are actively involved in the evaluation process. This requires you to consider what is important to your patients, including their values, preferences, and expressed needs. When you develop patient care goals and expected outcomes with patients, they are an important resource for being able to tell you whether outcomes are being met.

what happens with perimenopause ?

Perimenopause is the period during which ovarian function declines, resulting in a diminishing number of ova & irregular menstrual cycles; it generally lasts 1 to 3 years.

Priority Question

Prioritize nursing diagnoses first by considering patients' immediate needs based on ABC (airway, breathing, and circulation) . The highest priority can also be determined by using Maslow's hierarchy of needs. For example, Risk for Violence, Impaired Gas Exchange, and Impaired Cardiac Function are examples of high-priority nursing diagnoses that drive the priorities of safety, adequate oxygenation, and adequate circulation.

Reality Orientation

Reality orientation is a communication technique that makes an older adult more aware of person, place, and time. The purposes of reality orientation include restoring a sense of reality; improving the level of awareness; promoting socialization; elevating independent functioning; and minimizing confusion, disorientation, and physical regression. The older adult experiencing a change in environment, surgery, illness, or emotional stress is at risk for becoming disoriented. Environmental changes such as bright lights, unfamiliar noises, and lack of windows in specialized units of a hospital often lead to disorientation and confusion. Absence of familiar caregivers is also disorienting. The use of anesthesia, sedatives, tranquilizers, analgesics, and physical restraints in older patients increases disorientation. Anticipate and monitor for disorientation and confusion as possible consequences of hospitalization, relocation, surgery, loss, or illness, and incorporate interventions on the basis of reality orientation into the plan of care. The key elements of reality orientation include frequent reminders of person, place, and time; the use of familiar environmental aids such as clocks, calendars, and personal belongings; and stability of the environment, routine, and staff

Reminiscence

Reminiscence is recalling the past. Many older adults enjoy sharing past experiences. As a therapy, reminiscence uses the recollection of the past to bring meaning and understanding to the present and resolve current conflicts. Looking back to positive resolutions of problems reminds an older adult of coping strategies used successfully in the past. Reminiscing is also a way to express personal identity. Reflection on past achievements supports self-esteem. For some older adults the process of looking back on past events uncovers new meanings for those events.For example, have a patient talk about a previous loss to assess coping. You can also reminisce during direct care activities. Taking time to ask questions about past experiences and listening attentively conveys to an older adult your attitudes of respect and concern. Although many use reminiscence in a one-on-one situation, it is also used as a group therapy for older adults who are cognitively impaired or depressed

Interview Preparation

Review a patient's medical record when information is available.If your interview is performed at patient admission, there may be little information in the record except for an admitting diagnosis and the patient's chief complaint. In other cases review the previous medical entries or nurses' notes.

Rigid Structure

Rigid structures specify who accomplishes different tasks and limit the number of people outside the immediate family allowed to assume these tasks. For example, in one family with a rigid structure, the mother is the only acceptable person to provide emotional support for the children and/or to perform all the household chores. The father is the only acceptable person to provide financial support, maintain the vehicles, do the yard work, and make all the home repairs. A change in the health status of the person responsible for a task places a burden on a rigid family because no other person is available, willing, experienced, or considered acceptable to assume that task

4. Industry vs. Inferiority (6 to 12 Years)

School-age children are eager to apply themselves to learning socially productive skills and tools. They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or if skills are too difficult, they develop a sense of inadequacy and inferiority. Children at this age need to be able to experience real achievement to develop a sense of competency. Erikson believed that an adult's attitudes toward work are traced to successful achievement of this task (Erikson, 1963). During hospitalization it is important for a school-age child to understand the routines and participate, when possible, in his or her treatment. For example, some children enjoy keeping a record of their intake and output.

5. Industry vs. Inferiority (6 to 12 Years)

School-age children are eager to apply themselves to learning socially productive skills and tools. They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or if skills are too difficult, they develop a sense of inadequacy and inferiority. Children at this age need to be able to experience real achievement to develop a sense of competency. Erikson believed that an adult's attitudes toward work are traced to successful achievement of this task (Erikson, 1963). During hospitalization it is important for a school-age child to understand the routines and participate, when possible, in his or her treatment. For example, some children enjoy keeping a record of their intake and output.

Family Stress - Young Adult

Situational family stressors occur during events such as births, deaths, illnesses, marriages, and job losses. Stress is often related to a number of variables, including the career paths and job stressors for both partners, and leads to dysfunction in the young-adult family. Each family member has certain predictable roles or jobs. These roles enable a family to function and be an effective part of society. When they change as a result of illness, a situational crisis often occurs. Assess environmental and familial factors, including support systems and coping mechanisms commonly used by family members.

Job Stress - Young Adult

Situational job stress can occur when a new boss enters the workplace, a deadline is approaching, the worker has new or greater numbers of responsibilities, or there is a risk for or actual corporate downsizing. Job stress affects health behaviors, and there is greater use of tobacco and alcohol, poor eating habits, impaired sleeping, and lack of exercise. Your assessment of a young adult includes a description of the usual work performed, changes in job demands, changes in sleep or eating habits, and evidence of an increase in irritability or nervousness.

Family Structures

Structure is based on the ongoing membership of the family and the pattern of relationships, which are often numerous and complex. Each family has a unique structure and way of functioning.

Interpreters; when & who?

The National CLAS Standards, ensure that qualified translators (written words) and interpreters (verbal words) be provided to patients with limited English proficiency. If a health care setting does not have timely access to an interpreter, a more feasible option is the use of a telephone service that provides an on-call trained interpreter connected by phone. Ensure that interpreters are competent in medical terminology and understand issues of confidentiality and impartiality. If available, a cultural broker may be utilized as an interpreter, advocate, or mediator that bridges between the individual or group. Do not use a patient's family members to interpret for you or other health care providers. When you begin a patient interview with an interpreter present, you should speak in the first person ("I" statements), not the third person (e.g., "tell her," "he said"), and speak directly to the patient, as the interpreter functions as an inconspicuous participant for the conversation. Have the interpreter sit next to or slightly behind the patient. Look at the patient instead of looking at the interpreter and speak in short sentences; then wait for the interpreter to convey them

What causes stress? - Young Adult (Young adulthood is the period between the late teens and the mid to late 30s)

The psychosocial health concerns of the young adult are often related to job (money and job stability) and family stressors.

Revising the Care Plan

The result of an evaluation helps you decide whether to continue, discontinue, or revise the plan of care. If your patient meets a goal successfully, either maintain treatment as planned or discontinue that part of the care plan if intervention is no longer required. For example, in the case of a patient achieving a desired level of exercise, you will still continue an exercise regimen. In the case of a patient who is able to demonstrate knowledge of a topic after instruction, further instruction is not needed. When there are unmet or partially met goals, or if you determine that perhaps a new problem has developed, reassessment is necessary. If outcomes have not been met, it is helpful to consider the SMART acronym

Period Iv (Piaget): Formal Operations (11 Years to Adulthood)

The transition from concrete to formal operational thinking occurs in stages during which there is a prevalence of egocentric thought. This egocentricity leads adolescents to demonstrate feelings and behaviors characterized by self-consciousness: a belief that their actions and appearance are constantly being scrutinized (an "imaginary audience"), that their thoughts and feelings are unique (the "personal fable"), and that they are invulnerable . These feelings of invulnerability frequently lead to risk-taking behaviors, especially in early adolescence. As adolescents share experiences with peers, they learn that many of their thoughts and feelings are shared by almost everyone, helping them to know that they are not so different. As they mature, their thinking moves to abstract and theoretical subjects. They have the capacity to reason with respect to possibilities.

Body image interventions

The way older adults present themselves influences body image and feelings of isolation. Some physical characteristics of older adulthood such as distinguished-looking gray hair are socially desirable. Other features, such as a lined face that displays character or wrinkled hands that show a lifetime of hard work, are also impressive. Consequences of illness and aging that threaten an older adult's body image include invasive diagnostic procedures, pain, surgery, loss of sensation in a body part, skin changes, and incontinence. The use of devices such as dentures, hearing aids, artificial limbs, indwelling catheters, ostomy devices, and enteral feeding tubes also affects body image. When older adults have acute or chronic illnesses, the related physical dependence makes it difficult for them to maintain body image. Help them with grooming and hygiene. It takes little effort to help an older adult comb hair, clean dentures, shave, or change clothing.Be sensitive to odors in the environment. Odors created by urine and some illnesses are often present. By controlling odors you may prevent visitors from shortening their stay or not coming at all.

Nursing Process (ADPIE)

the five-step nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation. The purpose of the nursing process is to diagnose and treat human responses (e.g., patient symptoms, need for knowledge) to actual or potential health problems

closed-ended questions

This problem-seeking technique reveals details to identify a patient's specific problems accurately and more fully. asking closed-ended questions that limit answers to one or two words such as "yes" or "no" or a number or frequency of a symptom. For example, the nurse asks, "How often does the diarrhea occur?" and "Do you have pain or cramping?"

Older Adults - Touch

Touch is a therapeutic tool that can be used to help comfort older adults. It provides sensory stimulation, induces relaxation, provides physical and emotional comfort, conveys warmth, and communicates interest. It is a powerful physical expression of a relationship. In addition, gentle touch is a technique to use when administering any type of procedure that requires physical contact or repositioning and moving a patient.When you use touch, be aware of cultural variations and individual preferences. Use touch to convey respect and sensitivity. Do not use it in a condescending way such as patting an older adult on the head. When you reach out to an older adult, do not be surprised if he or she reciprocates.

Older Adults - validation therapy

Validation therapy is an alternative approach to communication with an older adult who is confused. Whereas reality orientation insists that the confused older adult agree with statements of time, place, and person, validation therapy accepts the description of time and place as stated by the older adult. You do not challenge or argue with statements and behaviors of the older adult. Instead the focus is the emotional aspect of the conversation, which represents an inner need or feeling. For example, a patient insists that the day is actually a different day because of high anxiety. Validation does not involve reinforcing the older adult's misperceptions; it reflects sensitivity to hidden meanings in statements and behaviors. Validating or respecting older adults' feelings in the time and place that is real to them is more important than insisting on the literally correct time and place.

Older Adult; Dementia & how to maintain nutrition

When caring for older adults with dementia and other chronic conditions, routinely monitor weight and food intake; provide small, frequent meals and serve food that is easy to eat such as finger foods (e.g., chicken strips, sandwiches, cut-up vegetables, and fruit), provide assistance with eating, and offer food supplements that the patient likes and are easy to swallow. Consult with a registered dietitian when planning nutritional interventions for your patients.

Modifying a Care Plan

When patients do not meet goals and outcomes, you perform a reassessment and identify the factors that interfere with their achievement. Usually a change in a patient's condition, needs, or abilities makes alteration of the care plan necessary. This will require you to continue interventions either as planned or less/more often, or you will choose to add interventions focused on the factors affecting goal achievement. - **When a goal is not met, no matter what the reason, repeat the nursing process sequence for that nursing diagnosis. Reassess the patient; determine accuracy of the nursing diagnosis; and establish a plan with new goals, expected outcomes, and appropriate priority interventions.

3 phases of the interview process

When you begin a formal patient-centered interview for the purpose of collecting a nursing history, you will go through the traditional three interview phases: (1) orientation or setting an agenda, (2) working phase—collecting assessment data, and (3) termination of the interview

Caregivers Role strain (what can we do to help?)

You support a family caregiver in many ways. For example, listen to a caregiver's stories and help the caregiver continue to meet the demands of his or her usual lifestyle (e.g., working, raising children). Establish a caregiving schedule that enables all family members to participate, help patients to identify family members who can share the burdens posed by caregiving, and encourage distant relatives to communicate their support. Teach family caregivers to provide physical care for their family member. Recognize that family caregivers also have their own physical and emotional needs. Teach them how to meet their needs and set up respite times as appropriate to allow them time to care for themselves. BOX 10.6 Teaching Strategies • Explain to all family caregivers the signs and symptoms of caregiver role strain such as: • Change in caregiver's appetite/weight, sleeping, or leisure activities. • Social withdrawal, irritability, anger, or changes in the caregiver's overall level of health. • Loss of interest in personal appearance. • Discuss situations in which caregiver role strain may intensify (e.g., if the patient's health status changes or the patient needs to be hospitalized). • Describe the importance of having family members set up alternating schedules to give the primary caregiver some rest. • Provide information about community resources for transportation, respite care, and support groups. • Offer an opportunity to ask questions and, when possible, provide a phone number for questions and assistance. • Provide family members with the contact information of the patient's health care provider and instruct them to call if the caregiver has health problems, the caregiver seems overly exhausted, or they observe changes in the caregiver's interactions and attention to normal activities.

6. Intimacy vs. Isolation (Young Adult)

Young adults, having developed a sense of identity, deepen their capacity to love others and care for them. They search for meaningful friendships and an intimate relationship with another person. Erikson portrayed intimacy as finding the self and then losing it in another . If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment (Berger, 2017). Nurses must understand that during hospitalization a young adult's need for intimacy remains present; thus young adults benefit from the support of their partner or significant other during this time.

Extremely flexible family structure

also presents problems for the family. The absence of stability sometimes prevents other family members from taking action during a crisis or rapid change.

1. Trust vs. Mistrust (Birth to 12 to 18 months) Erikson

establishing a basic sense of trust is essential for the development of a healthy personality. An infant's successful resolution of this stage requires a consistent caregiver who is available to meet his needs. From this basic trust in parents, an infant is able to trust in herself or himself, in others, and in the world. The formation of trust results in faith and optimism. A nurse's use of anticipatory guidance helps parents cope with the hospitalization of an infant and the infant's behaviors when discharged to home.

Interdependent interventions

interdependent interventions, are therapies that require the combined knowledge, skill, and expertise of multiple health care providers. Typically when you plan care for a patient, you review the necessary interventions and determine whether the collaboration of other health care disciplines (e.g., social work, rehabilitation, pharmacy) is necessary. A patient care conference with an interprofessional health care team results in selection of interdependent interventions.

2. Working Phase—Collecting Data

the working phase of a relationship involves gathering accurate, relevant, and complete information about a patient's condition. Beginning an interview with open-ended questions allows patients to describe their concerns and problems clearly. For example, begin by having patients explain their symptoms or physical or psychological concerns.

Cultural Assessment

to understand how the patient's religious values will affect her willingness to receive care.

3. Termination Phase

you summarize your discussion with a patient and check for accuracy of the information you collected during the termination phase of an interview. Let your patient know when the interview is coming to an end. For example, say, "I have just two more questions. We'll be finished in a few more minutes." This helps a patient maintain direct attention without being distracted by wondering when the interview will end. This approach also gives the patient an opportunity to ask additional questions. End the interview in a friendly manner, telling the patient when you will return to provide care.