Unit 2 Theory Objectives

Describe the three parts for writing nursing diagnosis.

"PES" P- Problem (NANDA Label) Describes a response for which nursing care is given Looks at ALL the data, & summarizes E- Etiology (Related to (r/t) Identifies one or more probable causes of a health problem Gives DIRECTION to the required nursing therapy Individualizes client's care S- Symptoms (Defining characteristics) Cluster of Signs & Symptoms that indicate the presence of a particular diagnostic label. Problem focused (actual) diagnoses signs & symptoms present Risk diagnoses No objective or subjective signs present Factors that demonstrate client is at HIGHER than usual risk (PES)

Explain the client's right to refuse medication/treatments.

A patient has the right: To be informed about a medication To refuse a medication To have a medication history To be properly advised about experimental nature of medication To receive labeled medications safely To receive appropriate supportive therapy To not receive unnecessary medications To be informed if medications are part of a research study

Discuss developmental factors that influence pharmacokinetics.

Absorption Factors that influence absorption: Route of administration Ability of a medication to dissolve Blood flow to the site of administration Body surface area Lipid solubility Bioavailability- How much of the drug actually absorbs into bloodstream. Food can alter this. Give 1 hour before a meal, or 2 hours after to give food on an empty stomach. Distribution- Dependent on the physical & chemical properties of the medication Physiology of the person taking the medication Circulation Membrane permeability Protein binding Metabolism Biotransformation- enzymes break down medications First‐pass effect Factors that affect Metabolism Age Nutrition Other drugs Excretion Medication exits the body through the Kidney Liver Bowels Lungs Exocrine glands

Erik Erikson's Theory

According to Erikson's theory of psychosocial development, individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one.Erikson's eight stages of life are described here. Trust vs. Mistrust (Birth to 1 Year). 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 himself, in others, and in the world. Autonomy vs. Sense of Shame and Doubt (1 to 3 Years). 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. 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. Initiative vs. Guilt (3 to 6 Years). Children like to pretend and try out new roles. 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. Industry vs. Inferiority (6 to 11 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. 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 as actively as possible in his or her treatment. For example, some children enjoy keeping a record of their intake and output. Identity vs. Role Confusion (Puberty). Dramatic physiological changes associated with sexual maturation mark this stage. There is a marked preoccupation with appearance and body image. This stage, in which identity development begins with the goal of achieving some perspective or direction, answers the question, "Who am I?" There are also new social demands, opportunities, and conflicts that relate to the emergent identity and separation from family. Nurses provide education and anticipatory guidance for parents about the changes and challenges to adolescents. Nurses also help hospitalized adolescents deal with their illness by giving them enough information to allow them to make decisions about their treatment plan. 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. If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment Nurses must understand that during hospitalization a young adults' need for intimacy remains present; thus young adults benefit from the support of their partner or significant other during this time. 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 (Santrock, 2012a). 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. 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. Because the aging process creates physical and social losses, some adults also suffer loss of status 135and function (e.g., through retirement or illness). 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

Describe the characteristics of middle adulthood that influence health promotion activities.

Adults in middle adulthood are typically "sandwiched" in taking care of their children and their aging parents, making them at risk of not having the time or energy to focus on their own needs. Descrease in metabolism speeds in middle aged adults causes the need for adults to be more aware of their diet and exercise habits (ex. lower cholesterol intake). Women who experience menopause have a decrease in hormones such as estrogen which can cause infertility, weak bones, painful intercourse, depression, and an increase in UTI's. Men who go through andropause have a decreased production of testosterone which leads to less sexual activity and sexual dysfunction. The overall decline in hormone production can cause depression which might alter a client's desire to pursue health promotion activities.

Identify environmental factors that influence health outcomes for the middle adult.

Air pollution or proximity to toxic sites Ease of access to various health-related resources (doctor's office, dentist, eye doctor) Cleanliness of cities Access to clean water Natural disasters

Medication Forms

Aqueous solution-Dissolved in water and syrups Elixir- Clear fluid containing water and or alcohol Capsule- encased in a gelatin shell Ointment- Semi solid applied externally Suppository- Solid form mixed with jelly for insertion into body cavity Syrup- Dissolved in a concentrated sugar solution Tablet- Powdered medication can be scored or enteric coated Lozenge- dissolves in mouth

Describe how evaluation leads to discontinuation, revision, or modification of a plan of care.

As you evaluate patient care, your reflection-in-action helps you determine if the plan of care continues or if revisions are necessary. You must sometimes redefine priorities according to changes in patient condition, evaluation findings, or changes in the medical plan of care. Discontinuation: When pt meets goals and expected outcomes Modification:When pt does not meet goals or outcomes you.... Reassessment Redefining Diagnosis Edit goals/expected outcomes Intervention effectiveness (Correct intervention, correct application?)

Discuss factors to include in assessing a patient's needs for and response to medication therapy.

Assessing Pt need for Med: Consider pt preferences, values, and needs while determining their needs for meds Take pt history to understand indications or contraindications of med Allergies Medication they are currently taking Diet history Pt ability to self prepare dose and administer med Pt current condition Pt attitude about medication use Factors affecting adherence to medication therapy Pt learning needs Response to medication therapy: Nurses need to use variety of measures to evaluate pt response to meds such as Direct observation or physiological measures (BP, Labs) Behavioral responses (Agitation) Rating scales (rating on pain/nausea scale) *Most common measure is the physiological measure

Differentiate among the five steps of a systematic process, which includes assessment, analysis, planning, implementation and evaluation.

Assessment Gathering and analysis of pt info and condition. Critical thinking is vital in assessment! 2 Stages of Assessment: (Collection and verification of data) and (Analysis of data) Analysis (Diagnosis) Medical Diagnosis: Identification of a disease condition, For physician use or APRN Nursing Diagnosis: Clinical judgment concerning human response to health/life processes Can be: Problem Focused, Risk, or Health Promotion Planning Implementation Evaluation

Identify essential guidelines for writing nursing care plans.

Assessment Data relevant to corresponding diagnosis Goals/Outcomes for pt Implementation for plan of care Scientific rationales- the reason you chose this nursing action based on evidence Evaluate care given

Discuss factors influencing growth and development.

Biological changes Socioeconomic changes Cognitive changes Success/Failure experiences IF individual has repeated failures, inadequacies result If individual has repeated success, health is promoted EX) A child who does not walk by 20 months shows delayed gross motor ability that slows exploration/manipulation of environment

Describe biophysical developmental theories.

Biophysical Development: How our physical bodies grow and change Providers are able to quantify and compare the changes that occur as a newborn infant grows against established norms.

Discuss developmental milestones from birth though adolescence

Birth to 1 month Reflexive grasp 2-4 months o When prone, lifts head and chest and bears weight on forearms o With support able to sit erect with good head control o Can turn from side to back o Holds rattle for short periods o Look at and plays with fingers o Able to bring objects form hand to mouth 4-6 months o Turns from abdomen to back at 5 months o Can support much of own weight when pulled to stand o Grasps objects at will and can drop them to pick up another object o Can hold baby bottle o Pulls feet to mouth to explore 6-8 months o Sits alone without support o Can stand while holding on to furniture o Can move from sitting to kneeling position o Bangs objects together o Pulls a string to obtain an object o Transfers objects from hand to hand 8-10 months o Crawls or drags body along floor o Pulls self to standing or sitting o Picks up small objects o Uses pincer grasp well o Shows hand preference 10-12 months o stands alone o walks holding furniture o sits down from standing position o can place objects into containers o able to hold crayon or pencil and make a mark on paper Toddler 12-36 months Preschoolers School-Age Adolescents

Discuss the influences of the client's age on the effects of drugs and drug responses.

CHILD PRECAUTIONS Developmental level Smaller doses Liquid forms are safer to swallow vs. pills If mixing in foods; use only a small amount of food Use caution when selecting intramuscular sites Use appropriate restraints if needed to administer an injection (not the parent if possible) ELDERLY PRECAUTIONS Cumulative effects and toxicity Drug interactions Smaller doses Stay with patient Explain and teach Discharge: special containers, forgetful

List and discuss major life events of young adults and the childbearing family.

Career Stress may come from transfering jobs, increased use of energy, child demands, household needs Parenthood Social pressure can influence family choices Economics come into play because of the expense of childbearing Substance Abuse Can lead to accidental death Not always diagnosable Use nonjudgmental questions when assessing Human Trafficking Some runaways or homeless resort to dangerous activities to survive and may be at risk for trafficking Unplanned Pregnancies Often young adults have educational/career goals that take over family Assess financial aspects, career, living accomodations, family support, depression, and coping mechanisms

Identify essential guidelines for implementing nursing strategies.

Characteristics of nursing diagnosis Goals and expected outcomes Evidence base for interventions Feasibility of the interventions Acceptability to the patient Nurse's competency

Explain the difference between clinical experience and critical thinking.

Clinical Experience: Clinical learning experiences are necessary to acquire clinical decision-making skills. In clinical situations you learn from observing, sensing, talking with patients and families, and reflecting actively on all experiences. Clinical experience is the laboratory for developing and testing approaches that you safely adapt or revise to fit the setting, a patient's unique qualities, and the experiences you have from caring for previous patients. With experience you begin to understand clinical situations, anticipate and recognize cues of patients' health patterns, and interpret the cues as relevant or irrelevant. Critical Thinking: Critical thinking involves open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant a way of thinking about a situation that always asks "Why?", "What am I missing?", "What do I really know about this patient's situation?", and "What are my options?"

Compare closed and open-ended questions, providing examples and listing advantages and disadvantages of each.

Close-Ended Questions Limit answers to "yes" or "no" Advantages: Specific info Disadvantage: Does not encourage pt to add more info than asked Ex: "Do you have pain or cramping?" Open-Ended Questions Prompts pt to describe a situation in more than one or two words Advantages: Shows you care, you get more data Disadvantages: Have to pick out relevant data Ex: "So tell me more about..."

Explain the differences among comprehensive, problem-oriented, and focused assessments.

Comprehensive A comprehensive assessment moves from the general to the specific. For example, start by assessing a patient using all of Gordon's 11 functional health patterns and then determine if patterns or problems appear in your data. Problem Oriented You focus on a patient's presenting situation and begin with problematic areas such as incisional pain or limited understanding of postoperative recovery. You ask the patient follow-up questions to clarify and expand your assessment so you can understand the full nature of the problem. Focused Assessment Later your physical examination focuses on the same problem areas to further confirm your observations.

Demonstrate critical thinking and clinical reasoning.

Critical Thinking Knowing how to learn, reason, think creatively, generate ideas, make decisions, and solve problems 3 LEVELS OF CRITICAL THINKING: Basic Critical Thinking: Trust experts, Does everything by book Complex Critical Thinking: Separation from experts, More than one approach Commitment: Action and accountability for independent decisons Clinical Reasoning Problem solving activity in which critical thinking is used to examine patient care issues

Discuss cultural & psychosocial aspects of the pain experience across the lifespan.

Culture shapes the experience of pain including its expression, pt behaviors, or coping responses Culture affects lay remedies, help-seeking activities, and receptivity to medical treatment Some HC workers undertreat pain because they do not understand cultural effects on perception of pain intensity Implications: Use culturally appropriate assessment tools such as tools written in the patient's native language to assess pain (Pasero and McCaffery, 2011). Assess the patient's health literacy level because this affects your ability to provide appropriate education about pain management and therapies. Recognize variations in subjective responses to pain. Some patients are stoic and less expressive, whereas others are emotive and more likely to verbalize pain. Be sensitive to variations in communication styles. Some cultures believe that nonverbal expression of pain is sufficient to describe the pain experience, whereas others assume that, if pain medication is appropriate, the nurse will bring it; thus asking is inappropriate. Understand that expression of pain is unacceptable within certain cultures. Some patients believe that asking for help indicates a lack of respect, whereas others believe acknowledging pain is a sign of weakness. The meaning of pain varies among cultures. Pain is personal and related to religious beliefs. Some cultures consider suffering a part of life to be endured to enter heaven. Use knowledge of biological variations of pain. Significant differences in drug metabolism, dosing requirements, therapeutic response, and adverse effects occur in cultural groups. A wide range of responses is also possible within this group. Therefore assess each patient's response to pain medication carefully. Develop a personal awareness of your own values and beliefs that affect your responses to patients' reports of pain.

List benefits of the nursing process to the client and the nurse.

Cyclic & dynamic, Client centered, Adaptation of problem solving, Decision making, Interpersonal & collaborative, and Universally applicable.

Young Adult: Describe key concepts of sexual development across the lifespan.

Development of secondary sex characteristics happens during adolescent years Physical development is accompanied by sexual maturation Encourage adults to explore sexuality STI education Sexual activity is defined as a basic need at this age

Evaluate client and family responses to therapeutic interventions.

Did pt meet the goal? Did the family meet the goal? Patient Adherence: Patient and family invest time into carrying out required treatments.

State the purposes of establishing client goals.

Direct nursing care/Individualization Continuity of care

Relate normal emotional and sexual development to strategies designed to promote sexual health in young adults.

Emotional development: longing to make connections, find partners, get in relationships. Sexual development: desire for intimacy, experimenting with different sexual activities. Strategy: Sex education, use of protection, routine check ups.

Describe reasons for the procedures for medication standards.

Ensuring meds are safe and effective Ensure all meds free of impure products Local governments regulate use of alcohol/tobacco Control unnecessarily prolonged medication therapy Protect public from unskilled, uneducated, and unlicensed personnel

List common errors in writing diagnostic statements.

Errors occur during: Data collection During assessment be knowledgeable, thorough, and skillful. Avoid inaccurate or missing data and collect data in an organized way For example, if a patient describes a problem swallowing, gather data about the types of food the patient can or cannot eat; whether there is pain in the mouth or throat; a thorough description of the pain; and what, if anything, improves swallowing. Be exhaustive in collecting data applicable to the problem. Application of intellectual standards for critical thinking will help you gather the comprehensive information you need. Interpretation and analysis of data Following data collection, review your database to decide if it is accurate and complete. Validate that measurable, objective physical findings support subjective data. For example, when a patient reports "difficulty breathing," you also listen to lung sounds, assess respiratory rate, and measure the patient's chest excursion When you are unable to validate data, it signals an inaccurate match between clinical cues and the nursing diagnosis. Begin interpretation by identifying and organizing relevant assessment patterns to support the presence of patient problems. Be careful to consider conflicting cues or decide if there are insufficient cues to form a diagnosis. It is important to consider a patient's cultural background or developmental stage when interpreting the meaning of cues. For example, a male patient may express pain differently than a female patient. Thus misinterpreting how a male patient expresses pain could easily lead to an inaccurate diagnosis. Clustering Errors occur when you cluster data prematurely, incorrectly, or not at all. Premature clustering occurs when you make a nursing diagnosis before grouping all data. For example, a patient has urinary incontinence and states that he has dysuria. You cluster the available data and identify Impaired Urinary Elimination as a probable nursing diagnosis. Incorrect clustering occurs when you try to make a diagnosis fit the signs and symptoms that you obtain. In this example further assessment reveals that the patient also has bladder distention and dribbling; thus the correct diagnosis is Urinary Retention. Always identify a nursing diagnosis from the data, not the reverse. An incorrect nursing diagnosis affects quality of patient care. Diagnostic statement Identify the patient's response, not the medical diagnosis. Identify a NANDA-I diagnostic statement rather than the symptom. identify a treatable cause or risk factor rather than a clinical sign or chronic problem that is not treatable through nursing intervention. Identify the problem caused by the treatment or diagnostic study rather than the treatment or study itself. Identify the patient response to the equipment rather than the equipment itself. Identify the patient's problems rather than your problems with nursing care. Identify the patient problem rather than the nursing intervention. Identify the patient problem rather than the goal of care. Make professional rather than prejudicial judgments. Avoid legally inadvisable statements. Identify the problem and its cause to avoid a circular statement. Identify only one patient problem in the diagnostic statement.

Discuss the relationship between critical thinking and evaluation.

Evaluation requires more than making a quick check of a patient to be sure that he or she is stable or without further problems. It is a methodical approach for determining if nursing implementation effectively influenced a patient's progress or condition favorably 4 indicators reflecting a nurse's ability to perform evaluation: Examine the results according to clinical data collected. Compare achieved effect with goals and expected outcomes. Recognize errors. Understand a patient situation, participate in self-reflection, and correct errors

Describe components of the evaluation process.

Examine Results Recognize errors or unmet outcomes Self Reflection/ Correction of Errors Care Plan Revision Collaborate and evaluate effectiveness of interventions Document Results

Briefly discuss the important components of drug legislation that affect the nurse.

Federal Regulations Nurse reports when medication event causes harm to pt by completing Medwatch form Health Care Institution and Medical Laws Health care agencies establish policies to meet federal, state, and local regulations Medication Regulations and Nursing Practice NPA'S - State nurse practice acts: Defines scope of nurse professional functions and responsibilities. Legal provisions when administering controlled substances such as opioids Controlled Substances Sign; wasting; forms Count at end of shift Violations: Fine, imprisonment, or both May lose license

Describe the significance of the first-pass effect.

First Pass Effect: The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream. Drug administered must pass through the liver before entering circulation. If a large portion of a drug is chemically changed into inactive metabolites in the liver, then a smaller amount will ACTUALLY go into circulation. PO meds have a bioavailability of less than 100% Iv meds are 100% bioavailable

Discuss nursing roles and responsibilities in medication administration.

First determine if med ordered is the correct one Assess pt if they need med at this time Administer correctly and monitor effects Educate pt and family on med Instructions on meds to be taken home

Sigmund Freud and psychoanalysis

Freud's psychoanalytical model of personality development states that individuals go through five stages of psychosexual development and that each stage is characterized by sexual pleasure in parts of the body: the mouth, the anus, and the genitals. Stage 1: Oral (Birth to 12 to 18 Months). Initially sucking and oral satisfaction Late in this stage the infant begins to realize that the mother/parent is something separate from self. (e.g., inadequate bonding or chronic illness) could affect an infant's development. Stage 2: Anal (12 to 18 Months to 3 Years). The focus of pleasure changes to the anal zone. Children become increasingly aware of the pleasurable sensations of this body region with interest in the products of their effort. Through the toilet-training process the child delays gratification to meet parental and societal expectations. Stage 3: Phallic or Oedipal (3 to 6 Years). The genital organs are the focus of pleasure during this stage. The boy becomes interested in the penis; the girl becomes aware of the absence of the penis, known as penis envy. Child fantasizes about the parent of the opposite sex as his or her first love interest, known as the Oedipus or Electra complex. Stage 4: Latency (6 to 12 Years). children repress and channel sexual urges from the earlier Oedipal stage are repressed and channeled into productive activities that are socially acceptable. Stage 5: Genital (Puberty Through Adulthood). In this final stage sexual urges reawaken and are directed to an individual outside the family circle. Freud believed that the components of the human personality develop in stages the id, the ego, and the superego. The id (i.e., basic instinctual impulses driven to achieve pleasure) is the most primitive part of the personality and originates in the infant. The ego represents the reality component, mediating conflicts between the environment and the forces of the id. It helps people judge reality accurately, regulate impulses, and make good decisions. Ego is often referred to as one's sense of self. The third component, the superego, performs regulating, restraining, and prohibiting actions. Often referred to as the conscience, the superego is influenced by the standards of outside social forces (e.g., parent or teacher). Some of Freud's critics contend that he based his analysis of personality development on biological determinants and ignored the influence of culture and experience. Others think that Freud's basic assumptions such as the Oedipus complex are not applicable across different cultures.

Discuss the significance of family in the life of the young adult.

Fulfilling the biologic function of perpetuation the species, responsible for: personality development, productive unit providing for material needs, social unit interacting with the larger society, and creating cultural values and identity. The most common types of relationships are consanguineous (blood relationships), affinal (marital relationships), and family of origin (family unit a person is born into).

Describe several factors that affect growth and development.

Genetics Nutrition Prenatal and environmental factors Health status Family and culture

Discuss the use of standards of nursing care to evaluate responses to interventions.

Goal met Terminate the plan. If the person has achieved outcomes, has no new problems or risk factors, and demonstrates ability to care for him/herself Goal partially met Continue the plan. If the person hasn't achieved outcomes, but you haven't identified any factors that impeded or enhanced care and simply need more time. Goal unmet Modify the plan .Outcomes haven't been achieved, when you ID new problems or risk factors, or when you ID ways to make care more effective.

Differentiate between goals and outcome criteria.

Goals: Broad statement that describes a desired change in a pt condition, perceptions, or behavior. Outcome Criteria: Measurable change that must be achieved to reach a goal. ***For our class, "goal" and "outcome" are interchangable

Describe normal physical changes in middle adulthood.

Greying of hair Skin wrinkles Thickening of waist Decreases in hearing/vision Menopause/Climacteric

Discuss methods to educate patients about prescribed medications.

Have to explain their medication schedule for a typical day Have pt read medication label and explain it Have a pt show how to give med dose Teach about med purpose, action, timing, dose, and side effect Offer easy to read teaching sheets Teach back method! Aseptic technique Teach family members too incase pt is ill or physically unable to handle med

Compare and contrast the roles of the health care provider, pharmacist, and nurse in medication administration.

Health Care Provider Prescribes meds by written(hand or electronic)verbal, or telephone order or talking to nurse in person Read back all orders and chart weather order was TO or VO (telephone or verbal order) Pharmacist Prepares and distributes meds Fill prescriptions and validate them Proper dosage with accurate labels Provide info about side effects, toxicity, interactions, and incompatibilities Nurse Medication Reconciliation Administering meds Assess pt ability to self administer Assess pt before giving med Monitor effects of med Proper family/pt med education Do not delegate administration process to NAP

Discuss criteria used in priority setting.

High (EMERGENT- ABC'S) Intermediate (Non-life threatening) Low (For patients well-being)

Describe occurrence of, signs and symptoms of, nursing responsibilities for, and strategies to reduce or prevent abuse and intimate partner violence (IPV).

IPV- Formerly known as domestic violence Begins with emotional or mental abuse and may progresses to physical or sexual assault Injuries range from minor cuts/bruises to broken bones, internal bleeding, head trauma, etc IPV is linked to harmful health behaviors such as smoking, alcohol abuse, drug use, and risky sexual activity Risk Factors: Using drugs/alcohol Heavy drinking Unemployment Low self-esteem Antisocial traits Desire for power/control Being a past victim NURSING RESPONSIBILITIES: Act as an advocate for the patient. When assessing a patient, look for warning signs of IPV. Educate the client on the availability of resources to help with IPV such as hotline numbers, refer to counseling, or the police.

Identify the purpose of assessing.

Identify the patient's healthcare needs & strengths, Support or even negate Subj data Identify and confirm Nursing Dx. Evaluate the effectiveness of the plan to meet the outcomes. Use critical thinking in clinical judgment throughout the process. To establish baseline information on the client. To determine the client's risk for dysfunction.

11. Describe key concepts of sexual development across the lifespan.

Infancy and Early Childhood Gender Identity Child identifies with parent of same sex Aware of differences in sex, and interpret behavoirs as male or female School-Age Years Questions reguaring physical/emotional aspects of sex Need accurate information about changes in bodies and emotions during this time to prepare for puberty Puberty/Adolescence Constant anxiety of "Am i normal?" "Will I be accepted?" Need accurate information on topics such as body changes, sexual activity, emotional responses, STI, contraception, pregnancy Parents need to understand importance of educating children Explore sexual orientation LBGT Young Adulthood Matured physically, but explore and mature emotionally in relationships Sexual activity is a basic need for this age group Middle Adulthood Changes in appearance lead to concerns about sexual attractiveness Decreasing levels of estrogen in perimenopausal women lead to decreased vaginal lubrication and elasticity Children leaving home changes intimacy in relationships Older Adulthood Sexuality is important in older adults Factors that determine older adult sexual activity is: Present health status, meds, past life, present life, and status of intimate relationships

Discuss the skills and attitudes of critical thinking.

Interpretation: Be orderly in collecting data about patients. Apply reasoning while looking for patterns to emerge. Categorize the data (e.g., nursing diagnoses. Gather additional data or clarify any data about which you are uncertain. Analysis: Be open-minded as you look at information about a patient. Do not make careless assumptions. Does the data reveal a problem or trend that you believe is true, or are there other options? Inference: Look at the meaning and significance of findings. Are there relationships among findings? Does the data about the patient help you see that a problem exists? Evaluation: Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior. Explanation: Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients. Self-regulation: Reflect on your experiences. Be responsible for connecting your actions with outcomes. Identify the ways you can improve your own performance. What will make you believe that you have been successful? Confidence: Learn how to introduce yourself to a patient; speak with conviction when you begin a treatment or procedure. Do not lead a patient to think that you are unable to perform care safely. Always be well prepared before performing a nursing activity. Encourage a patient to ask questions. Thinking independently: Read the nursing literature, especially when there are different views on the same subject. Talk with other nurses and share ideas about nursing interventions Fairness: Listen to both sides in any discussion. If a patient or family member complains about a coworker, listen to the story and speak with the co-worker as well. If a staff member labels a patient uncooperative, assume the care of that patient with openness and a desire to meet the patient's needs. Responsibility and authority: Ask for help if you are uncertain about how to perform a nursing skill. Refer to a policy and procedure manual to review steps of a skill. Report any problems immediately. Follow standards of practice in your care. Risk taking: If your knowledge causes you to question a health care provider's order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with patients. Discipline: Be thorough in whatever you do. Use known scientific and practice-based criteria for activities such as assessment and evaluation. Take time to be thorough and manage your time effectively. Perseverance: Be cautious of an easy answer. If co-workers give you information about alo patient and some fact seems to be missing, clarify the information or talk to the patient directly. If problems of the same type continue to occur on a nursing division, bring co-workers together, look for a pattern, and find a solution. Creativity: Look for different approaches if interventions are not working for a patient. For example, a patient in pain may need a different positioning or distraction technique. When appropriate, involve the patient's family in adapting your approaches to care methods used at home. Curiosity: Always ask why. A clinical sign or symptom often indicates a variety of problems. Explore and learn more about a patient so as to make appropriate clinical judgments. Integrity: Recognize when your opinions conflict with those of a patient; review your position and decide how best to proceed to reach outcomes that will satisfy everyone. Do not compromise nursing standards or honesty in delivering nursing care. Humility: Recognize when you need more information to make a decision. When you are new to a clinical division, ask for an orientation to the area. Ask registered nurses (RNs) regularly assigned to the area for assistance with approaches to care. Critical thinking attitudes are NOT the same as skills. They are more like feelings and traits of mind

Describe methods of data collection

Interview Patient centered Planned communication Conversation with a purpose During assessment, the primary purpose is to gather data Physical Exam Inspection Auscultation Palpation Percussion Periodic assessment

Examine health promotion strategies and nursing responsibilities for young adults

Lifestyle choices (alcohol/tobacco) are a risk for illness at his age Susceptibility to chronic disease such as DM and Hypercholesterolemia by genetics Encourage self exams Self breast exams Safe sex education Education on STDs

Compare medical and nursing diagnosis.

Medical Diagnosis Disease process Condition ONLY a physician can treat Is the identification of a disease condition based on a specific evaluation of physical signs and symptoms, a patient's medical history, and the results if diagnostic tests and procedures. A medical diagnosis stay constant as a condition remains Nursing Diagnosis Clinical judgment by nurse Directs nursing interventions Classifies health problems within the domain of nursing (the problems that nurses can treat and manage) Clinical judgment concerning a human response to health conditions/life processes, or vulnerability for that response by an individual, family, or community that a nurse is licensed and competent to treat. Nursing diagnostic is unique because it has patients actively involved whenever and as much as possible Types of Nursing Diagnoses Problem Focused describes a clinical judgment concerning an undesirable human response to a health condition/life process that exists in an individual, family, or community. There are Defining characteristics (observable assessment cues such as patient behavior, physical signs) that support each problem-focused diagnostic judgment The selection of a problem-focused nursing diagnosis indicates that there are sufficient assessment data from the defining characteristics to establish the nursing diagnosis. In addition, a problem-focused nursing diagnosis includes a related factor. A related factor is an etiological or causative factor for the diagnosis (i.e., the data that appear to show some type of patterned relationship with a nursing diagnosis) Risk No defining characteristics or related factors because they have not yet occurred. Instead it has a RISK FACTOR Risk factors are the environmental, physiological, psychological, genetic, or chemical elements that place a person at risk for a health problem The key assessment for a risk diagnosis is the presence of risk factors (e.g., an incision and the hospital environment) that support a patient's vulnerability. The risk factors are the diagnostic-related factors that help in planning preventive health care measures. Health Promotion Is a clinical judgment concerning a patient's motivation and desire to increase well-being and actualize human health potential You make this type of diagnosis when patients in any health state express a readiness to enhance specific health behaviors. Health promotion diagnoses may apply to an individual, family, group, or community. The diagnoses have only defining characteristics, although you may use a related factor to improve understanding of the diagnosis Pt desire to increase well being

Discuss factors that influence medication actions and interactions.

Medication Interaction: When one med modifies the action of another. Factors that Influence: Pt that takes several meds Alcohol Synergistic Effect: When two meds have a combined effect greater than the meds given separately.

Describe the procedure of administration of medications.

Medication information Drug action Interactions Side effects Adverse reactions Teaching needs Medication Set Up: Pour tablet into cap lid and then pour into pill cup Do not open individual dose packages until at the bedside Check expiration date - DO NOT USE IF EXPIRED Dropped pills - DO NOT ADMINISTER, WASTE IT

Describe Piaget's theory of cognitive development.

Most interested in the development of children's intellectual organization: how they think, reason, and perceive the world. 4 Periods: Period I: Sensorimotor (Birth-2 Years) Infants develop a schema or action pattern for dealing with environment Schemas include: hitting, looking, grasping, kicking Successful achievements lead to greater exploration During this stage a child learns about himself and his environment through motor/reflex actions Period II: Preoperational (2-7 Years) Children learn to think with use of symbols and mental images "Egocentrism" - See things only from their own perspective "Animism" - Personify objects Have difficulty conceptualizing time Nurses recognize use of play Period III: Concrete Operational Children able to perform mental operations Can describe process without doing it Reversibility! Ability to classify objects according to quantitative dimensions "Seriations" Understand quantity Period IV: Formal Operations (11 Years to Adulthood) Transition from concrete to formal operational thinking Demonstrate feelings/behaviors characterized by self consciousness Risk Taking behaviors Learn that same thoughts/feelings are similar to others

Discuss the importance of coordinating the plan of care for clients and families.

Mutual goal setting includes the patient and family (when appropriate) in prioritizing the goals of care and developing a plan of action.

Describe publications that list official medications.

National Formulary Institute for Safe Medication Practices (ISMP) Sources of medication information : Physician's Desk Reference Hospital formularies Medication handbooks Pharmacist and package insert

Identify health -promoting activities that are essential for the normal growth and development of infants and children.

Newborn: Screenings To identify serious or life threatening conditions before symptoms begin Car Seats Cribs/Sleep Snug mattress Remove mobiles when baby can grab them Infants: Nutrition Breast milk recommended due to nutrients of protein, fats, carbs, and immunoglobulins Supplementation Needs for dietary vitamin supplements depends on baby's diet Immunizations Sleep Sleep 15 hours a day, 2-3 naps Toddler: Nutrition Children establish lifetime eating habits in early childhood "Food jags" eating same food Toilet Training Preschooler: . Nutrition -1800 calories a day -They should consume half of average adult portion sizes .Sleep -12 hours of sleep a night and take infrequent naps .Vision -Do regular intervals of vision screening in the preschool years. -Early detection and treatment of strabismus are essential by age 4 to 6 School Age/Adolescent: Perceptions Health Education Health maintenance Safety Nutrition

Describe strategies to reduce accidental death in young adults.

No drinking/driving Stop smoking Stop recreational drugs No texting and driving

Identify client risk factors in the area of sexual health.

Not using contraceptives Number of partners History of STD's Unwanted pregnancy Unwanted sex

Discuss the differences between nurse-initiated, physician-initiated, and collaborative interventions.

Nurse Initiated:Independent—Actions that a nurse initiates Physical care Ongoing assessment Emotional support & comfort Teaching Counseling Environmental management Referrals Physician Initiated: Dependent—Require an order from a physician or other health care professional Medications IV Therapy Diet Activity Collaborative: Interdependent—Require combined knowledge, skill, and expertise of multiple health care professionals

Discuss nursing implications for the application of developmental principles to client care.

Nurses need to know their own moral reasoning level - it is essential to be able to separate your own beliefs from others Ideally all HC members are on the same level, creating a unified outcome Autonomy, Beneficence, Nonmaleficence, Justice, Critical thinking

Identify barriers to effective pain management.

Patient Barriers: Fear of addiction. Worry about side effects. Fear of tolerance (won't be there when I need it) Takes too many pills already. Fear of injections. Concern about not being a "good" patient. Doesn't want to worry family and friends. May need more tests. Needs to suffer to be cured. Inadequate education. Reluctance to discuss pain. Pain inevitable. Pain part of aging. Fear of disease progression. Believes health care providers and nurses are doing all they can. Just forgets to take analgesics. Fear of distracting health care providers from treating illness. Believes health care providers have more important or sicker patients to see. Suffering in silence noble and expected. Health Care Provider Barriers: Inadequate pain-assessment skills. Concern with addiction or accidental overdose (could also use opioid-related adverse effect). Concern with co-morbid mental health conditions. Opiophobia, fear of opioids. Fear of legal repercussions. No visible cause of pain. Belief that patients need to learn to live with pain. Reluctance to deal with side effects of analgesics. Not believing patient's report of pain. Fear that giving a dose will kill patient. Time constraints. Inadequate reimbursement. Belief that opioids "mask" symptoms. Belief that pain is part of aging. Overestimation of rates of respiratory depression Health Care System Barriers: Concern with creating "addicts". Difficulty in filling prescriptions. Absolute dollar restriction on amount reimbursed for prescriptions. Mail-order pharmacy restrictions. Advanced practice nurses not used efficiently. Extensive documentation requirements. Poor pain policies and procedures regarding pain management. Lack of money. Inadequate access to pain clinics. Poor understanding of economic impact of unrelieved pain

Differentiate nutritional requirements for normal growth and development.

Pediatric Nutrition • Carbohydrates provides most of energy needed to maintain a healthy body . - Complex carbohydrates (cereal, roots and grains). • Fats secondary source of energy (30% or < of the daily caloric intake). • Protein is necessary for building and maintaining body tissues. • Vitamins and minerals Infants: Breastfeeding- milk contains nutrients, proteins, carbs, and immunoglobulins for development Toddlers: Balanced diet of of bread/grains, veggies, fruits, dairy products, and proteins Do not give skim or low fat milk until age 2 so they get necessary fats for growth Foot jags common Need for iron, calcium, phosphorus may be difficult to meet Preschool: Vary little from toddler 1800 cal intake Quality is more important than quantity School Age Children: Develop eating patterns that are independent of parental supervision Harder to make healthy choices Childhood obesity is common Children need adequate intake accompanied by activity to grow Adolescents: Calorie and protein requirements increased Highly sensitive to calorie restrictions Insufficient proteins Balanced diet necessary Need for calcium, iron, and zinc

List and discuss major life events of middle adults and the childbearing family.

Perimenopause/Menopause Perimenopause: Ovary function declines resulting in irregular menstrual cycles Menopause: Ovaries no longer produce estrogen/progesterone Menopause occurs between 45-60 years Some experience no changes other than no more periods- some have severe changes that affect ADL'S Climacteric Occurs in men in late 50's Decreased level of Androgens cause this Penile erection is less firm ,sperm still produced, and refractory period is longer Career Transition Can result in stress that affects health, self concept, and relationships Sexuality Woman have increased suexual activity Erectile Dysfunction Stress can cause sexual dysfunction

Understand the general concepts pharmaceutics, pharmacokinetics, and pharmacodynamics and their application in drug therapy and the nursing process.

Pharmaceutics: The science of preparing and dispensing drugs, including dosage form design. Pharmacokinetics: The study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacokinetics represent the drug absorption into, distribution and metabolism within, and excretion from the body. Pharmacodynamics: The study of the biochemical and physiologic interactions of drugs at their sites of activity. It examines the effect of the drug on the body. Agonist- Creates a response (ex-insulin) Antagonist- Attach to receptor and not cause response (ex-narcan,benadryl) Enzyme Interaction- Body creates angiotensin I that converts to angiotensin ii than vasoconstricts and raises BP Non Selective Interactions- Antibiotics

Implement nursing actions to prevent medication errors.

Prepare medications for only one patient at a time. Follow the six rights of medication administration. Be sure to read labels at least 3 times (comparing medication administration record [MAR] with label) before administering the medication. Use at least two patient identifiers and review the patient's allergies whenever administering a medication. Do not allow any other activity to interrupt administration of medication to a patient (e.g., phone call, pager, discussion with other staff) (Hopkinson and Jennings, 2013). Double-check all calculations and other high-risk medication administration processes (e.g., patient-controlled analgesia) and verify with another nurse. Do not interpret illegible handwriting; clarify with health care provider. Question unusually large or small doses. Document all medications as soon as they are given. When you have made an error, reflect on what went wrong and ask how you could have prevented the error. Complete an occurrence report per agency policy. Evaluate the context or situation in which a medication error occurred. This helps to determine if nurses have the necessary resources for safe medication administration. Attend in-service programs that focus on the medications commonly administered. Ensure that you are well rested when caring for patients. Nurses make more errors when they are tired (Murphy and While, 2012). Involve and educate patients when administering medications. Address patients' concerns about medications before administering them (e.g., concerns about their appearance or side effects). Follow established agency policies and procedures when using technology to administer medications (e.g., automated medication dispensers [AMDs] and bar-code scanning). Medication errors occur when nurses "work around" the technology (e.g., override alerts without thinking about them)

Describe important aspects of conducting a client-centered interview.

Primary Objective of a client centered interview is to discover details about pt concerns, explore expectations for encounter, and display interest for partnership. Should be patient centered and planned communication. Communication Skills Courtesy Comfort Connection Confirmation Phases of Interview Orientation Working Termination Interview Techniques Observe non verbal behaviors Open/Close ended questions Leading question Back Channeling (Active listening "SOLER") Probing Include all dimensions: physical, developmental, emotional, intellectual, social, and spiritual dimensions. COLDSPA and PQRST Assessment is ongoing, every encounter matters!

Identify other health care providers and community resources available to help clients resolve sexual concerns that are outside the nurse's level of expertise.

Primary care providers, such as internists, family doctors, general medicine doctors, nurse practitioners, physician assistants, and nurse-midwives Specialists, such as obstetricians and gynecologists (OB/GYNs), urologists, and women's health nurse practitioners Mental health professionals, such as therapists, counselors, psychologists, social workers, sex therapists, and psychiatrists

Define terms related to growth and development.

Proportional changes Maturation of Systems Fine-Motor Development Includes use of hands/fingers to grasp Gross-Motor Development Sense of Autonomy Spiritual Development Cognitive Development Moral Development

Discuss the differences between protocols and standing orders.

Protocols A systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations Standing Orders Preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problem

Describe the use of Maslow's hierarchy of needs as a basis for determining priorities and organization of nursing care.

Pt must achieve lower levels before attempting to reach self actualization

Describe characteristics of a critical thinker.

Rationality, Reflection, Skepticism, Autonomy, Creative Thinking, Fair Thinking, Truth seeking, Analytical Inquisitive, Open-minded, Systematic in thinking, Mature.

Identify essential aspects of implementing.

Reassessing, Reviewing/Revising, Organizing/Care Delivery, Anticipating/Preventing complications Direct care: Treatments performed through pt interaction (meds, starting IV) Indirect care: Treatments performed away from pt but on behalf of pt. (hand hygiene, consults)

Discuss the nurse's responsibility in making clinical decisions.

Responsible for correctly performing nursing care activities on the basis of following standards of practice, No shortcuts, Accountable for your decisions and outcomes, Ask if uncertain!! A critical thinker considers what is important in each clinical situation, imagines and explores alternatives, considers ethical principles, and makes informed decisions about the care of patients, The use of evidence-based knowledge, or knowledge based on research or clinical expertise, makes you an informed critical thinker, RNs are responsible for making clinical decisions to take immediate action when a patient's condition worsens. Nurses are responsible for assessing their own patients to make decisions.

Identify the six rights of medication administration and apply them to the clinical setting.

Right patient Right Med Right Route Right Dose Right Time Right Documentation

Identify guidelines for writing SMART goals and outcome criteria.

S- Specific Single goal Precise Address only one behavior perception, or physiological response M- Measurable Measurable Verbs: Identify Hold Demonstrate Verbalize Communicate Exercise Discuss Express A- Attainable The client must be able to attain and realistically reach the goal Collaborate with the client to determine goals R- Realistic Must be realistic T- Timed Short term or Long term goals Short term- by end of shift Long term- over extended period of time

Describe effective responses to sexual harassment by clients or colleagues.

Say no. One legal requirement for sexual harassment is that the conduct be "unwelcome." Make sure the harasser knows that his or her conduct is unwelcome. Report harassment to your employer. Write it down. As soon as you experience the harassment, start writing down exactly what happened. Be as specific as possible: write down dates, places, times, and possible witnesses to what happened. Keep your work records. A harasser may try to defend him or herself by attacking your job performance. Keep copies of any records of your work performance Talk to others. If you can do so safely, talk to other people at work about the harassment. You may find witnesses, allies, or others that have been harassed by the same person or who would be willing to help support you.

Describe the essential aspects of the planning phase of the nursing process.

Setting priorities (ABCs etc.) Establishing client goals/desired outcomes Selecting interventions

Discuss the significance of family in the life of the middle adult.

Singlehood Can feel isolated during holidays Marital Changes Death of spouse, separation, divorce, remarrying, staying single Windowed pt have to adapt Family Transitions Departure of last child from home causes stressors Empty Nest Syndrome: term to describe sadness and loneliness when child leaves home Care of Aging Parents Can be stressful to the "sandwiched" generation

Discuss the etiology and prevention of childhood injuries.

Standing of developmental accomplishments allows for injury-prevention planning As a child gains motor development, they become more curious. Supervision is CRITICAL for injury prevention Locking up/removing dangerous potential poisons Safe environment Health promotion Adolescents think they are indestructible- leading to accidents Referral for HC providers Education on sex

Types of Orders.

Standing/Routine Single/One Time Now PRN STAT Prescriptions

Differentiate between subjective and objective data.

Subjective Data: What it says is wrong. Ex. Headache, leg pain (Symptoms) Objective Data: Data observed or measured by nurse. Ex.Vitals, Altered gait (Signs)

Using NANDA, describe the characteristics of a correctly stated nursing diagnosis.

The NANDA-I classification of nursing diagnoses provides the standards for the patterns of data for each nursing diagnosis These standards are the defining characteristics or risk factors described earlier. Defining characteristics are the observable assessment cues that cluster as manifestations of a problem-focused or health promotion nursing diagnosis. The cues have been found through research to support a specific NANDA-I approved nursing diagnosis. Each NANDA-I-approved health promotion or problem-focused nursing diagnosis has an identified set of defining characteristics that support identification of the nursing diagnosis The first diagnosis, Deficient Knowledge, is a problem-focused diagnosis. The second, Readiness for Enhanced Knowledge, is a health promotion diagnosis. The defining characteristics in both have similarities such as patient behaviors and self-reported information Ex] Readiness for enhanced Breastfeeding Ex] Readiness for enhanced Coping However, Deficient Knowledge results from the absence or deficiency of information about a topic. The second diagnosis of Readiness for Enhanced Knowledge applies when a patient wants to learn more about a topic. As you gather cues and see clusters of data forming patterns, confirm your data with your source of information on NANDA-I diagnoses.

Differentiate among the nursing process, critical thinking, and specific critical thinking.

The Nursing Process - "ADPIE" Provides a framework for decision making, which helps to guide care and promote critical thinking It is a systematic and goal-oriented framework for problem solving. Cost efficient and a part of the standard of care. The purpose is to diagnose and treat human responses (e.g., patient symptoms, need for knowledge) to actual or potential health problems. Use of the process allows nurses to help patients meet agreed-on outcomes for better health Critical Thinking: Scientific method/Clinical problem 1. Identify problem 2. Collect data 3. Research Question 4. Answer question 5. Evaluate study 6. Problem Solving Involves evaluating a situation over time, identifying possible solutions, and trying a solution over time to make sure that it is effective. It becomes necessary to try different options if a problem recurs. Decision Making: Is a product of critical thinking that focuses on problem resolution. Following a set of criteria helps you make a thorough and thoughtful decision. The criteria may be personal; based on an organizational policy; or in the case of nursing, professional standard Specific Critical Thinking: Diagnostic reasoning & inference Diagnostic reasoning: Analytical process for determining pt health problems. Accurate recognition of a patient's problem is necessary before you decide on solutions and implement action. It requires you to assign meaning to the behaviors and physical signs and symptoms presented by a patient. Begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a patient situation, observes patterns and themes, and makes decisions quickly. Diagnostic reasoning helps health care providers pinpoint the nature of a problem more quickly and select proper therapies. Clinical Inference: The process of drawing conclusions from related pieces of evidence and previous experience with the evidence. When making an inference, you form patterns of information from data before making a diagnosis. Clinical Decision Making. Requires careful reasoning, Knowing your patient, Individualized pt care

Discuss the relationship of critical thinking to the nursing diagnostic process.

The diagnostic process requires you to use critical thinking Critical thinking helps you to be thorough, comprehensive, and accurate when identifying nursing diagnoses that apply to your patients. Critical thinking is necessary in identifying nursing diagnoses and collaborative problems so you appropriately individualize care for your patients.

Describe the different indications for administering medication.

The indication is the appropriateness for administering a medication to a pt Confirm the rationale for use through researching pt history while asking asking out why they are taking the drug Understanding the indication helps nurses catch potential errors, provide explanations to family/pt, and decrease challenges to medication reconciliation

Describe the importance of assessing to nursing diagnosis.

The information you gather during assessment by gathering cue clusters leads to your nursing diagnosis

Describe how the nursing process is a framework for accountability and responsibility.

The nursing process provides an organizing framework for meeting the individual needs of the client, the client's family/significant others, and the community. The steps of the nursing process focus the nurse's attention on the "individual" human responses of a client/group to a given health situation, resulting in a holistic plan of care addressing the specific needs of the client/group. The nursing process provides an organized, systematic method of problem-solving (while still allowing for creative solution) that minimize dangerous error or omission in caregiving and avoid time-consuming repetition in care and documentation

Describe the physiology of pain.

Transduction: Thermal, chemical, or mechanical stimuli usually cause pain. Transduction converts energy produced by these stimuli into electrical energy. It begins in the periphery when a pain-producing stimulus (e.g., exposure to pressure or a hot surface) sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential. Transmission: Cellular damage caused by thermal, mechanical, or chemical stimuli results in the release of excitatory neurotransmitters such as prostaglandins, bradykinin, substance P, and histamine. The neurotransmitters affect the sending of nerve stimuli. They either excite during transmission or inhibit during modulation. Excitatory neurotransmitters send electrical impulses across the synaptic cleft between two nerve fibers, enhancing transmission of the pain impulse. These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response. The pain stimulus enters the spinal cord via the dorsal horn and travels one of several routes until ending within the gray matter of the spinal cord. At the dorsal horn substance P is released, causing a synaptic transmission from the afferent (sensory) peripheral nerve to spinothalamic tract nerves, which cross to the opposite side. Nerve impulses resulting from the painful stimulus travel along afferent (sensory) peripheral nerve fibers. Two types of peripheral nerve fibers conduct painful stimuli: the fast, myelinated A-delta fibers and the very small, slow, unmyelinated C fibers. For example, after stepping on a nail, a person initially feels a sharp, localized pain, which is a result of A-fiber transmission, or first pain. Within a few seconds the whole foot aches from C-fiber transmission, or second pain. After the pain impulse ascends the spinal cord, the thalamus transmits information to higher centers in the brain, including the reticular formation, limbic system, somatosensory cortex, and association cortex. Perception: Once a pain stimulus reaches the cerebral cortex, the brain interprets the quality of the pain and processes information from past experience, knowledge, and cultural associations in the perception of the pain. The somatosensory cortex identifies the location and intensity of pain, Whereas the association cortex, primarily the limbic system, determines how a person feels about it. There is no single pain center. Modulation: Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), which hinder the transmission of pain and help produce an analgesic effect . This inhibition of the pain impulse is the fourth and last phase of the normal pain process known as modulation. A-delta fibers send sensory impulses to the spinal cord, where they synapse with spinal motor neurons. The motor impulses travel via a reflex arc along efferent (motor) nerve fibers back to a peripheral muscle near the site of stimulation, thus bypassing the brain. Contraction of the muscle leads to a protective withdrawal from the source of pain. For example, when you accidentally touch a hot iron, you feel a burning sensation, but your hand also reflexively withdraws from the surface of the iron. Pain processes require an intact nervous system and spinal cord. Common factors that disrupt the pain process include trauma, drugs, tumor growth, and metabolic disorders.

Explain how play enhances growth and development

Use their senses and own bodies to identify objects of interest Promotes development milestones Manipulation with hands "Make believe" allows child to understand different POV Problem solving skills Creativity

Describe normal physical changes in young adulthood and pregnancy.

Young adult completes physical growth by 20, an exception is a pregnant or lactating woman Physical changes are minimal at this time, however weight and muscle mass change as a result of diet, exercise, and lifestyle

Assess a patient experiencing pain across the lifespan.

Young to Older Infant: Loud cry. Rigid body or thrashing. Local reflex withdrawal from pain stimulus. Eyes tightly closed, mouth open in a squeamish shape, eyebrows lowered and drawn together Lack of association between stimulus and pain. Facial expressions Toddler: Loud cry or screaming. Verbal expressions of pain. Thrashing of extremities. Attempt to push away or avoid stimulus. Uncooperative. Clinging to significant person School age child: Stalling behavior. Muscular rigidity. Any behavior of the toddler, but less intense in the anticipatory phase and more intense with painful stimuli Adolescent: More verbal expressions of pain with less protest. Muscle tension with body control Through Pt Eyes: Learn pt values/beliefs and ideals of pain management. Be sensitive to level of discomfort and determine which level your pt will function. Determine health literacy.

Define pain.

• "An unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage" - International Association for the Study of Pain (IASP) • "Pain is whatever the experiencing person says it is, existing whenever he says it does"

Differentiate among the different types of pain.

• Acute- Protective, usually has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. Warns people of injury or disease • Chronic- Not protective, has a dramatic effect on a person's quality of life. Lasts longer than 6 months. • Chronic Episodic- Pain that occurs sporadically over an extended period of time. Pain episodes last for hours, days or weeks. Ex- Migraine • Cancer-related- Not all pt with cancer experience pain. Usually caused by tumor progression and related pathological processes, invasive procedures, toxicities of chemo, infection, and physical limitations. • Idiopathic- Chronic pain in the absence of an identifiable cause or pain perceived as excessive for the extent of an organic pathological condition. Ex- CRPS (Complex regional pain syndrome) • Neuropathic-??????? • Referred- Sensation of pain extending from initial site of injury to another body part

Pediatric Ages

• Fetus - Eighth gestational week to birth • Toddler - 1 to 3 years • Neonate (Newborn) - First 28 days of life • Preschool - 3 to 6 years • Infant - 4 weeks to 1 year • • School age - 6 to 12 years Adolescent - 12 to 18 years