Sexuality, Human Development, Interpersonal Relationships, Immunity - 1538

Immunity attributes

- Lab-normal WBC and Differential Counts - Negative Bacterial & Viral Cultures - Soft, Non-Tender Lymph Nodes - Recognition of Self - Recognition of Foreign Proteins (Antigens)

Anaphylaxis - Treatment

-1st line - Epinephrine = vasoconstrictor (increase BP) and bronchodilator -Epinephrine (SQ, .2 mg - .5 mg) may be followed with IV EPI -IV fluids - Isotonic solution = LR, NS -Albuterol treatments with NEBULIZER -Antihistamines - Benadryl, zyrtec -Corticosteroids - to prevent further attacks, and decrease inflammation WATCH this patient, they can react AGAIN!

**SLE - Diagnostic Tests

-ANA (antinuclear antibody) - positive in more than 90% of patients w/SLE -Anti-DNA antibody(antibody that develops against the patient's own DNA) -CBC w/differential (leukopenia, anemia, thrombocytopenia) -ESR (erythrocyte sedimentation rate)- generally elevated (monitors inflammation) -Urinalysis - hematuria, proteinuria -24-hour urine test for protein and creatine -Serum BUN and creatinine

Anaphylaxis - Pathophysiology

-Anaphylaxis - IgE allergic reaction to an antigen, this requires sensitization -Anaphylactoid Reaction - non IgE reaction, no sensitization is required. (initial reaction to an allergen) -Mast cells and basophils react to the allergen by causing a release of mediators which are: histamine, prostaglandins, inflammatory leukotrienes -Vasoactive mediators cause vasodilation and decrease in Blood pressure -Decrease in BP causes increase in Pulse = decrease in cardiac output -increase in capillary permeability (fluid moves from intravascular to interstitial space) = edema = bronchospasms /laryngeal spasms -Increase in GI secretions - N,V,D

Aging - Nursing Interventions, Patient Teaching, Community Resource

-Assess the support system -Don't judge the family, provide supportive information and help -Give family as much information about patient's condition. -Demonstrate use of equipment. -Transfer and mobility skills -Making a safe environment. -Instruct on new diet, new medications -How to obtain medical supplies and DME (durable medical equipment) -Advise on support groups and resources for recreation

Menopause - Clinical Manifestations

-Brain and CNS: hot flashes and night sweats (vasomotor symptoms), disturbed sleep, mood and memory problems, depression/anxiety, loss of libido -Cardiovascular: lower levels of HDL and increased risk of CVD, heart palpitations -Eyes: dryness -Skeletal: rapid loss of bone density that increases the risk of osteoporosis -Breasts: replacement of duct and glandular tissues by fat -Genitourinary: vaginal dryness and loss of elasticity, stress incontinence, cystitis -Gastrointestinal: less absorption of calcium from food, increasing the risk for fractures -Integumentary: dry, thin skin and decreased collagen levels -Body shape: more abdominal fat; waist size that swells relative to hips, water retention, weight gain

Tuberculosis - Pathophysiology

-Caused by Mycobacterium tuberculosis -Airborne droplet transmission -May affect any organ - lungs and lymphatics most common -T cells and macrophages incase the bacteria and a fibrotic and calcified nodule develop with the bacteria dormant in the center - Ghon complexes Active: Body is exposed to bacteria, body's immune system responds by initiating an inflammatory reaction. Neutrophils and macrophages engulf the bacteria if you are susceptible then you will have infection about 2-10 weeks after exposure. Latent - If your immune system is strong enough to fight off infection, it will encase the bacteria forming Ghon Tubercles. Disease becomes dormant or latent and is not transmissible. However, later in life if your body becomes immunocompromised you can develop the disease. The Ghon complexes release the cheesy material into the bronchi. High Risk Populations: -Homeless -Poverty -Immunocompromised -Crowded environments - prison, nursing homes -Advanced age -Travel outside of USA - especially in countries with high TB -Substance Abuse -High risk occupations (RT) Complications: -Hepatotoxicity - fatigue, malaise, nausea, jaundice anorexia -Make sure there is a baseline liver function test -Neurotoxicity - tingling in hands and feet, give B6 to prevent -Pericarditis - TB gets into blood stream and spreads to heart and other organs.

Menopause - Pathophysiology

-Cessation of menstrual cycle (absent for 12 months or more) -Average age 51.4 -Peri-menopause - transition period from reproductive phase to final menstrual cycle -dramatic decline in estrogen affecting reproductive organs and other body systems

Rheumatoid Arthritis - Pathophysiology

-Chronic, systemic autoimmune disease involving inflammation and degeneration of the joints. -Onset can be acute or insidious, the course is marked by periods of remission and exacerbation. -Permanent changes and disability can result. -Incurable with debilitating signs and symptoms that negatively affect a person's quality of life. -Symptoms are symmetrical - both sides -Exact Cause is unknown. -Familial history -Activation of T-cell mediation in response to some sort of immunologic trigger. -More women are affected than men. -Affects tissues and organs but primarily the joints. The inflammation causes synovitis > thickens the joint and extends to the cartilage, bone, tendons and ligaments surrounding the joint -Initially affects small joints of hands, wrists and feet. -Progresses to knees, shoulders, hips, ankles and spinal processes and temporomandibular joints -Deformities of hands and feet are common (Subluxation, Boutonniere, Swan-neck) -25% will develop rheumatoid nodules - palpable nodules over bony prominences as elbows -RA autoimmune properties can affect other systems including the eyes, lungs, heart blood vessels, salivary glands, CNS and PNS and bone marrow.

**Autism - Nursing Interventions and Patient/Family Education

-Determine the child routine, maintain consistency, determine specific ways the child communicates and use those ways -Avoid placing demands on the child, implement safety precautions for self injury behaviors, refer for support. -Emotional support, professional guidance, and education about disorder for parents of newly diagnosed child -Assess parent need for respite care and make referrals accordingly -Provide positive feedback to parents -Stress importance of rigid, unchanging routines to avoid acting out behaviors -Position self at child's level, explain every procedure, demonstrate on self or parent, provide calm inviting atmosphere, avoid loud noises, radio/TV, talking

Inflammatory Bowel Disease: Crohn's - Nursing Interventions/Education

-Diet - low fiber, high protein, small frequent meals, with vitamin and iron supplements -Avoid allergens - milk, wheat, help ID foods that irritate patient -No smoking -Monitor lab for malnutrition -No caffeine, no Alcohol -Administer meds - give antidiarrheals 30 mins before eating, administer pain meds -Assess stools - amount, frequency, consistency, blood, pus, mucous and fat -Assessment - family history, abdominal pain, wight loss, alcohol/caffeine/nicotine use, allergies to food or intolerance -Assess anxiety -Provide easy access to BR, keep room odor free and clean -Monitor for dehydration, watch for S/S of electrolyte imbalance -Dehydration > Cardiac dysrhythmias -I&O, weights, assess mucous membranes, oliguria, fatigue, low BP -Start IV's -Monitor Skin - for impaired integrity -Administer PTN when indicated - central line or PICC -Monitor for Toxic Megacolon - abdominal distention, low or absent BS, change in mental status (because of overproduction of ammonia in bowel from e-coli), fiver, increase in pulse and decrease in BP -Treatment - NG suction, IV fluids and electrolytes, corticosteroids, antibiotics, if no response in 72 hours > surgery -Monitor for GI bleeding - perforation of bowel - acute abdominal pain, ridged abdomen, vomiting , drop in BP -Monitor for anemia -Promote rest w/active exercises in bed -Surgery - prepare for surgery, consents, IV's and antibiotics, emotional support -Consultation for wound/ostomy nurse Educate patient: -medication usage and S/E -optimum nutrition, fluids, activity and rest -self care of ostomy -stress/anxiety management -coping techniques

Inflammatory Bowel Disease: Ulcerative Colitis - Nursing Int/Education

-Diet - low fiber, high protein, small frequent meals, with vitamin and iron supplements -Avoid allergens - milk, wheat, help ID foods that irritate patient -No smoking -Monitor lab for malnutrition -No caffeine, no Alcohol -Administer meds - give antidiarrheals 30 mins before eating, administer pain meds -Assess stools - amount, frequency, consistency, blood, pus, mucous and fat -Assessment - family history, abdominal pain, wight loss, alcohol/caffeine/nicotine use, allergies to food or intolerance -Assess anxiety -Provide easy access to BR, keep room odor free and clean -Monitor for dehydration, watch for S/S of electrolyte imbalance -Dehydration > Cardiac dysrhythmias -I&O, weights, assess mucous membranes, oliguria, fatigue, low BP -Start IV's -Monitor Skin - for impaired integrity -Administer PTN when indicated - central line or PICC -Monitor for Toxic Megacolon - abdominal distention, low or absent BS, change in mental status (because of overproduction of ammonia in bowel from e-coli), fiver, increase in pulse and decrease in BP -Treatment - NG suction, IV fluids and electrolytes, corticosteroids, antibiotics, if no response in 72 hours > surgery -Monitor for GI bleeding - perforation of bowel - acute abdominal pain, ridged abdomen, vomiting , drop in BP -Monitor for anemia -Promote rest w/active exercises in bed -Surgery - prepare for surgery, consents, IV's and antibiotics, emotional support -Consultation for wound/ostomy nurse Educate patient: -medication usage and S/E -optimum nutrition, fluids, activity and rest -self care of ostomy -stress/anxiety management -coping techniques

**Disability of Newborn - Nursing Interventions

-Evaluate mom for her understanding of the diagnosis (assess) -Teach mom and involve family, respite care -Is she wanting to learn? -What's her support system? Friends, family, support groups/resources

**Autism - Pathophysiology and Risks

-Exact etiology is unknown, although genetic causes or issues with brain connectivity are most likely (other possible causes - altered chemistry, a virus, toxic chemicals) -It is a spectrum disorder ranging from mild (Aspergers) to severe -Can cause severe intellectual disability, requiring lifelong supervision -Other children with ASD display normal to high intelligence -Onset is in infancy or early childhood (affects 1 in 68 children) -Display impaired social interactions and communication -Developmental delays noticed between 12-36 months - child may regress or lose previously acquired skills

**Rheumatoid Arthritis - Clinical Manifestations

-Inflammation -Autoimmunity -Degeneration of articular cartilage -Most common symptom is Pain Other symptoms: -joint swelling w/edema (bilateral, worse in morning) -warm to touch -erythema -limited movement >loss of joint function > Contractures -stiffness (especially morning stiffness) -Weakness -Fatigue -Palpation of joints have a boggy or spongy feel and fluid can be aspirated from affected joint. -S/S are typically gradual and symmetrical(both sides)

**Inflammatory Bowel Disease: Crohn's - Pathophysiology

-Inflammation that affects the whole GI Tract, from mouth to rectum. But tends to stay at Ileum and beginning of ascending colon. -Affects all layers of intestine but affects different parts. -Have good parts mixed in with bad parts.

**Inflammatory Bowel Disease: Ulcerative Colitis - Pathophysiology

-Inflammatory disease of submucosa/mucosal layer of colon and rectum. -Starts low in rectum and works it way progressively up. Can affect the whole colon.

Rheumatoid Arthritis - Nursing Interventions/Patient Education

-Inspect Joints for edema, nodules and deformities -Ask about pain and stiffness -Assess gait stability and hand dexterity, ability to perform ADLs -Assess environment for safety, in hospital and at home -Assess nutritional status, is feeding self difficult? Is there GI upset from meds? -Encourage small frequent meals, high in protein and vitamins -Obtain consults for PT, OT, and dietary intervention -Monitor lab - ESR,CBC, CRP, ANA -Monitor injection site for persistent redness, pain, edema -Monitor for mood changes and depression -Refer to RA support groups

Menopause - Nursing Interventions and Patient Education

-Instruct on HRT medication. -Instruct on S/S of deep vein thrombosis - leg redness and pain or tenderness. (dorsiflex the foot Homan's sign - if pain, then contraindicated) -Instruct o S/S of pulmonary embolism - chest pain, shortness of breath -Need for weight bearing exercises, and regular exercise. -Smoking cessation, and limited alcohol consumption. -Must have annual mammograms (40) and breast exams -Take Calcium and Vitamin D supplements (to avoid osteoporosis)

Gender Dysphoria - Pathophysiology and Risks

-It is the distress a person feels due to their birth assigned sex and gender not matching their gender identity. -Gender nonconformity is not the same as Gender Dysphoria. Complications and Risks: -Eating disorders -Depression anxiety -Stress -Poor self esteem -Substance abuse -Social Isolation - Most common complaint -Suicide - high rates

Multiple Sclerosis - Diagnostic Tests

-Neuro exam -Symptoms -MRI - looking for nerve damage, plaques on brain -Spinal Tap - CSF will have oligo clonal bands, suggests inflammation in CNS. Established biomarkers for MS -Electrical Studies - assess nerve response -Blood test to r/o alternative diseases

**Rheumatoid Arthritis - Treatment

-No cure, but treatment focuses on preventing and limiting joint damage, loss of function, and managing pain. -Balance Exercise with rest. Program includes ROM and muscle-strengthening. -Healthy diet high in vitamins, protein and iron -Relaxation techniques, heat applications, splints and assistive devices Medications -NSAIDs, salicylates - anti-inflammatory and analgesic Side Effects - GI distress, GI bleeding, nausea, diarrhea, constipation -Corticosteroids - anti-inflammatory Side Effects: Sodium retention, GI perforation, osteoporosis, mood swings, depression, susceptibility to infection -DMARDs - Disease modifying antirheumatic drugs - suppress overactive immune and inflammatory system Side Effects: risk of infection, liver or renal toxicity, PE, GI upset

Tuberculosis - Nursing Interventions/Patient Education

-Proper hand hygiene/PPE -Mask N95 hepa filter mask -Negative Pressure room, airborne isolation -If transporting - use mask on patient -No touch receptacles, tissue in plastic bags -Nutrition - increase protein and increase calories -Social service - need funds for meds, f/u care, resources -Family - test everyone, educate everyone -F/U sputum's Q2-4 weeks -Patient education regarding transmission -Medications - consistent use after 2-3 weeks probably not infectious -Must take 6-12 months up to 2 years to avoid drug resistance -heated humidified O2 therapy -teach about meds and need for Vitamin B6 -Baseline LFT, and monitor throughout treatment -If active must wear a mask -S/S neurotoxicity -S/S hepatotoxicity

SLE - Nursing Interventions/Patient Education

-Reduce Pain - provide pain mediations, uses of hot or cold applications, relaxation techniques and nonstrenuous exercises -Reduce Fatigue - encourage rest periods, exercise according to body's tolerance, teach relaxation techniques -Monitor urinary status - I&O, specific gravity, monitor urine protein and serum BUN and creatine -Monitor V/S, edema, breath sounds -Monitor change in mental status -Encourage good nutrition, sleep habits, rest and relaxation -Maintain skin mucous membrane integrity - apply topical corticosteroids to skin as ordered, Avoid hot or spicy foods that may irritate oral ulcers, topical pain meds or analgesics to reduce pain and promote eating -Suggest alternative hairstyles, scarves and wigs to cover significant alopecia Patient education to include: -Prevention of infection and signs/symptoms of infection -Action/rationale and side effects/adverse reactions of drugs prescribed -Avoidance of sun or UV exposure and use of sunscreens, wear protective clothing and hats, avoid tanning beds -Recognition and prevention of disease flares -Avoidance of pregnancy and use of estrogen (if applicable) -Identify complications of disease -Stress f/u is essential -Advise about reproduction - avoid pregnancy during times of severe disease activity

Rheumatoid Arthritis - Diagnostic Tests

-Rheumatoid Factor (RF) - determines presence of abnormal antibodies; positive titer >1:80, present in 80% of RA patients -ACPA: Anti-citrullinated protein antibodies - marker for RA found in 69-70% of RA patients -ESR - erythrocyte sedimentation rate - inflammation (increased) -C-reactive protein (CRP) shows presence of abnormal glycoprotein due to inflammatory process - positive indicates active inflammation -ANA - antinuclear antibody - measures antibodies that act with nuclear antigens - maybe positive -Synovial fluid - cloudy, dark yellow or milky w/ inflammatory biomarkers, like WBCs (Athrocentesis) -Radiologic tests- bony erosions and narrowed joint spaces

Multiple Sclerosis - Nursing Interventions/Patient Education

-Safety -Prevention of increase in symptoms -Assistive devices -Bladder and Bowel Care -Cognitive function -Medications Recommend a healthy lifestyle -No smoking - smoking increases disability and disease progression -Healthy diet -Exercise - swimming

Anaphylaxis - Clinical Manifestations

-Symptoms can be Mild, Moderate or Severe -The faster the onset, the more severe the reaction. -The severity of the previous reaction does not determine the severity of subsequent reactions. -Respiratory - bronchoconstriction, dyspnea, wheezing, swelling, upper airway tightness, coughing, watery eyes and stuffy nose -Cardiac - hypotension, tachycardia, possible loss of consciousness -GI - vomiting, nausea, diarrhea, pain -Skin - flushing, itchy, red, swollen

SLE - Pathophysiology

-Systemic lupus erythematosus - affects the connective tissues of multiple organs systems and can lead to organ failure -Autoimmune disorder -Characterized by remissions and exacerbations Other types -Discoid lupus erythematosus - only affects the skin -subacute cutaneous lupus erythematous - affects sun exposed areas with sores -Medication-induced lupus erythematosus - caused by medications (procainamide, hydralazine, isoniazid) and resolves when the medication is discontinued. Affects women 6-10 times more frequently than men, affects African American (people of color) more than Caucasians. Causes: Genetic, immunologic, hormonal and environmental

**Tuberculosis - Treatment

-TB has become increasingly resistant -4 first line meds are: -Isoniazid - Hepatoxicity, Neurotoxicity -Rifampin - Hepatoxicity, urine changes -Pyrazinamide - Hepatoxicity -Ethambutol - Hepatoxicity, visual changes -CDC says give all 4 for first 8 weeks, with Vitamin B6 50 mg -Then only Isoniazid and Rifampin for 18 weeks or longer -Must take consistently 4-7 months, can be up to 2 years -All are taken once a day by mouth -Give supplemental Vitamin B6 to prevent neuropathy -Take on empty stomach, 1 hour before meals, once a day, usually at the same time every day -Usually considered non-infectious after 2-3 weeks of consistent medication use and/or after 3 consecutive days negative sputum cultures -Sputum samples are needed every 2-4 weeks to monitor therapy effectiveness and adherence to treatment

How do we promote health and prevent common STI's (patient education)? How do contraceptives play a role in STI prevention?

-Use of barrier contraception (female/male condom) -Limiting sexual partners -Abstinence -Get STI evaluations annually if sexually active and under age 25, or if new or multiple sexual partner and older than 25, or any age if with sex partner who has STI -STI education for adolescents -Nurses must have conversations with patients about sexual activity and STI evaluations

Social Anxiety Disorder - Nursing Interventions and Patient Education

-assess level of anxiety -provide education about medications and therapies (this can only happen when anxiety is low or absent) -for severe anxiety assist in lowering anxiety with low, calm, soothing voice and remain with patient -help patient take deep breaths -for moderate anxiety speak in short simple easy to understand sentences -administer anxiolytic medications as prescribed

**Tuberculosis - Clinical Manifestations

-low-grade fever -night sweats -fatigue and lethargy -weight loss and anorexia -Persistent cough lasting longer than 3 weeks -Cough - may be nonproductive, or mucopurulent sputum may be expectorated -Hemoptysis also may occur

**ADHD & ADD - Nursing Intervention & Patient and Family Education

-parent and patient education about medication (dosage, timing (am/after meals), side effects, store drug securely) and behavior goals -monitor for weight loss -important to collaborate with school and other caregivers -use positive reinforcement and reward system -age appropriate consequences -refer families to support resources

Erectile Dysfunction - Diagnostic Tests

-sexual and medical history -physical and neurological examination -assessment of medications, alcohol and drug use -lab tests -psychological assessment -nocturnal penile tumescence test - measures erections at night, if within normal range, then ED is not organic

Immunity Antecedents

1. Intact non-specific defenses or barriers 2.functional lymphatic system, 3. optimal innate immune response, 4. functional inflammatory response, 5. appropriate adaptive or acquired immune response which is passive and active

Erectile Dysfunction - Treatment (Pharm and Non-pharm)

1st line treatment: phosphodiesterase-type 5 (PDE-5) = siłdenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis): causes relaxation of smooth muscle allowing for blood flow to penis side effects: headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness Taken orally 1 hour before sexual activity. Only one dose per 24 hours Erection can last up to 1-2 hours There must be sexual stimulation to produce an erection Other treatment options: intravenous injection therapy, urethral suppository, negative pressure (vacuum) device, penile implants, semi-rigid implant, inflatable implant, surgical reconstruction

Multiple Sclerosis - Pathophysiology

A progressive demyelination of the neurons of the brain, spinal cord, and cranial nerves. Loss of myelin interferes with the conduction of impulses in the affected fibers. Affects all types of nerves- motor, sensory, and autonomic. If inflammation is brief or only causes small plagues(scars), neural function may return to normal state. Large plaques cause irreversible damage. -Autoimmune (T-cell mediated immune response), Chronic and it's progressive -Causes both Sensory and Motor Problems -Scarring will determine your symptoms -Will have relapses and remissions, but after each relapse they may not return to previous level of function -Cause: Genetic Predisposition and environmental factors -Affects both males and females, but affects women 2X's more -Average age of onset is between 20-40 4 types -Relapsing-remitting - acute attacks with full recovery or residual deficit upon recovery (most common type) -Primary progressive - progression of disability from onset, w/o plateaus and minor improvements (gradual progression of the disease with No relapses and remission) -Secondary Progressive - starts as RR then progression occurs with and w/o relapses (Steady progression of neurological damage with or without superimposed relapses with minimal remission) -Progressive relapsing - relapses with continuous disabling progression between exacerbations. (steady neurological damage)

**SLE - Clinical Manifestations

Affects all body systems Most common symptoms -Fever -Fatigue/malaise -Anorexia/weight loss -Joint pain arthritic however, no joint erosion - bilateral -Butterfly (malar) rash across cheeks and nose Skin manifestations -Butterfly shaped rash of the malar region of the face characterized by erythema and edema. -Discoid lesions are scarring, ring shaped, involving the shoulders arm and upper back. -Discoid lesions may result in erythematous, scaly plaque on the face, scalp, external ear, and neck, resulting in alopecia. -Photosensitivity

Interpersonal Relationships - antecedents and attributes

Antecedents: -Ability to Trust -Feelings of Safety/Security -Ability to Respect Boundaries -Ability to Communicate (Verbal/Nonverbal) Attributes: -Ability to reciprocate the feelings and ideas of others -History of healthy relationships -Longevity (lifetime rapport) repetitive positive interactions with two or more people

Antecedent and Attributes of Human Development

Antecedents: -Normal Biological/Genetic Factors -Good Nutritional Status -Healthy Environment -Good Health Status Attributes: Meeting developmental milestones and developmental tasks appropriate for developmental age

Antecedents and Attributes of Sexuality

Antecedents: -Sexual attitudes & behaviors -Normal hormones -Normal sexual physiology -Acceptance of self (authenticity) Attributes: -Sexual response cycle -Health (physical, sexual, psychological) -Healthy sexual relationships -Sexual desire/connection -Consent/choice -Positive sexual self-concept

Social Anxiety Disorder - Pathophysiology and Risks

Anxiety provoked by certain social or performance situations -Brain structure: heightened response causing increased anxiety in social situations -Environmental: Parents who are more controlling and protective of their children -Inherited: genetics (biological parents/siblings) and learned behavior -Social factors a) negative experiences - bullying, rejection, humiliation, ridicule; b) temperament - shy, withdrawn, retrained -Anxiety trigger: a) health condition that draws attention: Parkinson's disease, facial disfigurement (self conscious) -New social/work demand: meeting with people, giving speech, presentation

**Multiple Sclerosis - Clinical Manifestations

Can Be vague, which can delay diagnosis. Can be varied and multiple, depending on location of lesion/lesions. Main Symptoms: -Fatigue, especially of lower legs -Muscle spasticity - 90% present, especially of lower legs -Muscle weakness - progress to paralysis . -Vertigo: sudden spinning -Pain or Paresthesia -Difficulty in coordination, loss of balance Other symptoms: -Dysphagia and dysarthria -Visual disturbances - diplopia, nystagmus -Tinnitus, vertigo, decrease in hearing -Uhthoff's sign (increase in temperature causes visual disturbances) -Lhermittle sign: electrical shock when they move their head -Memory loss, impaired judgement, trouble thinking -Bowel dysfunction - constipation, fecal incontinence -Bladder dysfunction - urgency, nocturia, retention -Sexual dysfunction - difficulty achieving an orgasm, loss of libido

Aging Family Member - Expected Changes

Cardiovascular - Decreased cardiac output; diminished ability to respond to stress; heart rate and stroke volume do not increase with maximum demand; slower heart recovery rate; increased Respiratory System - Increase in residual lung volume; decrease in muscle strength, endurance, and vital capacity; decreased gas exchange and diffusing capacity; decreased cough efficiency Integumentary System - Decreased subcutaneous fat, interstitial fluid, muscle tone, glandular activity, and sensory receptors, resulting in atrophy and decreased protection against trauma, sun exposure, and temperature extremes; diminished secretion of natural oils and perspiration; capillary fragility Reproductive System - Female: Vaginal narrowing and decreased elasticity; decreased vaginal secretions Male: Gradual decline in fertility, less firm testes, and decreased sperm production Male and female: Slower sexual response Musculoskeletal System - Loss of bone density; loss of muscle strength and size; degenerated joint cartilage Genitourinary System - Decrease in detrusor muscle contractility, bladder capacity, flow rate, ability to withhold voiding; increase in residual urine Male: Benign prostatic hyperplasia Female: Relaxed perineal muscles; detrusor instability leads to urge incontinence; urethral dysfunction (stress urinary incontinence) Gastrointestinal System - Decreased sense of thirst, smell, and taste; decreased salivation; difficulty swallowing food; delayed esophageal and gastric emptying; reduced gastrointestinal motility Nervous System - Decrease in brain volume and cerebral blood flow. Reduced speed in nerve conduction Vision - Presbyopia; diminished ability to focus on close objects; decreased ability to tolerate glare; pupils become more rigid and lenses more opaque; decreased contrast sensitivity; decrease in aqueous humor Hearing - Presbycusis; decreased ability to hear high-frequency sounds; tympanic membrane thinning and loss of resiliency; difficulty with sound discrimination especially in noisy environment Taste and Smell - Decreased ability to taste and smell

Dyspareunia - Treatment (Pharm and Non-pharm)

Depending on the cause of dyspareunia, counseling, extra lubrication, or antidepressant medication may be prescribed. If caused by vaginal dryness in menopause, hormone replacement therapy (estrogen) can help with vaginal lubrication. Estrogen supplements come as vaginal ring, vaginal suppository, Premarin cream, skin patches Estrogen is contraindicated in women who smoke, previously had breast cancer or history of DVT. Non-pharmacologic: communicate with partner, longer foreplay, intimacy without penetration, sex therapy or counseling

ADHD & ADD - Clinical Manifestations

Diagnosis - presence of 6 or more of these symptoms -failure to pay close attention -careless mistakes in schoolwork -difficulty paying attention to tasks or play -doesn't listen -doesn't follow through -doesn't complete tasks -doesn't understand instructions -poorly organized -avoids, dislikes, or fails to engage in activities requiring mental effort -loses things needed for task completion -easily distracted -fidgety or squirmy -often out of seat -activity inappropriate to the situation -cannot engage in quiet play -always on the go -talks excessively -blurts out answers -has difficulty waiting his/her turn -often interrupts or intrudes on others These symptoms are present in 2 or more settings, began prior to age 7 and persisted for more than 6 months

ADHD & ADD - Diagnostic Tests

Diagnosis must be by pediatric psychiatrist or neurologist evaluation and can include the following assessments: -Child Behavior Checklist -Teacher Report Form -Youth Self Report -ADHD-FX

Dyspareunia - Pathophysiology and Risks

Difficult or painful sexual intercourse Caused by: -STI's, infections, UTI's, PID -History of incest, rape, abuse (PTSD) -Endometriosis -Fibroids -Vulvodynia (chronic pain around the opening of Vulva) -Childbirth injury (vaginal tear, episiotomy) -Lack of vaginal lubrication due to menopause or breastfeeding

**Disability of Family Member - Nursing Interventions

Disability (treat others as you want to be treated) Only help if help is wanted Goal - return home after learning to manage disability What does manage disability involve? ADL's, Personal care meal prep (fully cooked, not over or under cooked, and the preferences of the patient) Physical therapy/exercise programs Doctor's appointments: geriatric and specialty doctors

**Autism - Clinical Manifestations

Early warning signs: -Not babbling by 12 months -Not pointing or using gestures by 12 months -Lack of eye contact -consistent failure to orient to own name -No single words by 16 months -No two-word utterances by 24 months -Losing language or social skills at any age -hypersensitive to touch -hyposensitive to pain -lack of or little facial expression As with all developmental problems, EARLY INTERVENTION AND DIAGNOSIS IS KEY!

Erectile Dysfunction - Pathophysiology and Risks

Erectile dysfunction - also called impotence -Inability for male to achieve or maintain an erect penis -more than 50% of men 40-70 are unable to maintain an erection sufficient for satisfactory sexual performance -can be caused by psychogenic and organic causes: Psychogenic causes: anxiety, depression, fatigue, pressure to perform sexually, negative body image, absence of desire, privacy, trust and relationship issues Organic causes: cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism and hypothyroidism), cirrhosis, chronic kidney injury, genitourinary conditions, hematologic conditions (Hodgkin lymphoma, leukemia), neurologic disorders (neuropathy, Parkinsonism, spinal cord injury, multiple sclerosis), smoking, alcohol, drug abuse and some medications Physiology of an erection: -involves parasympathetic and sympathetic components -release of nitric oxide into corpus cavernous during sexual stimulation, which activates cyclic guanosine monophosphate (cGMP), causing smooth muscle relaxation -muscle relaxation allows for blood flow into corpus cavernous, resulting in erection

**Expanding Family (Birth, Adoption, Blended Family) - Nursing Interventions, Family Education & Community Resources

Expanding Family through Childbirth Sibling Rivalry suggestions -Expect and tolerate regression (acting like a child) -Encourage discussion -Encourage siblings to participate in decisions -Spend special time with sibling/s -What's the support system? Encourage parents to talk to other parents, grandparents. -Serve as a mentor, teach baby care, breastfeeding, provide information. -Provide infant interaction as much as possible, praise their efforts Expanding Family through Adoption -Encourage to recognize racial differences -Encourage to assist child to learn about their heritage, culture or ethnic group. -Prepare that child may some day want to look for biological parent. -Clear, open, honest communication is important. -Provide reassurance and understanding when there is lack of health information. Expanding Family Through Blended Family -Encourage mutal respect -Open honest communication -Responsibilities for parenting must be shared -Assess for lack of support, poor attachment and negative behaviors -Make referrals as needed.

**Expanding Family (Birth, Adoption, Blended Family) - Psychosocial Impact

Expanding family through childbirth -Fantasy to real life (adulting) -Struggle to adapt to parenthood - it's not easy -Partner struggles -Father involvement -Sibling Jealousy (ongoing conflict between how children are raised in the same family) Expanding Family through Adoption Unique issues: -Medical, developmental, behavioral, educational and psychological issues -Lack of history -Difference in culture, ethnicity or race Expanding Family through Blended Family -Transition takes time -Children may feel jealous of stepparent or disloyal to biological parent -Competition and rivalry among stepchildren

Definition of Sexuality

Factors that facilitate an individual's gender identity as well as their ability to experience and express themselves

Interpersonal Relationships - definition

Factors that facilitate and/or impair effective social associations, connections, or affiliations between two or more people.

**Autism - Treatment (Pharm and Non-pharm)

Goal is optimal functioning with individualized treatment -No cure -Behavior and communication therapies -Structured educational environments -Limited stimulation, new environments and new people -Stimulants may be used to control hyperactivity -Antipsychotic medications for repetitive or aggressive behaviors

Menopause - Treatment (Pharm and Non-pharm)

Hormone Replacement Therapy approved for relief of vasomotor symptoms and prevention of osteoporosis. -Estrogen, or estrogen plus progestin -Give the lowest effective dose for the shortest duration -Thromboembolic disease and breast cancer are risks for combined HRT -Local Estrogen is recommended for isolated atrophic vaginal symptoms. -Uterus give both, no Uterus only Estrogen -Unopposed Estrogen causes hyperplasia of uterine lining, increase risk for uterine cancer HRT is contraindicated in women with: -History of breast cancer -Vascular thrombosis -Impaired liver function -Uterine cancer -Undiagnosed uterine bleeding

Anaphylaxis - Nursing Interventions/Patient Education

INTERVENTIONS -Assess and document all allergies -V/S -Assess airway and breathing -Observe for increasing edema and respiratory distress -Stop the allergen (antibiotic, blood) -Emergency - give EPI, start IV lines, give fluids -Give O2, call rapid response team TEACH -Wear alert bracelet -Have more testing for other allergens -Make everyone aware of allergy especially for children -Always carry an epi-pen, know when it expires and replace -Teach how to use epi-pen and have them demonstrate its use Epi-pen -Can be given through clothes -Give at a 90-degree angle -Leave in place for 10 seconds -Call 911 or get to hospital

**Multiple Sclerosis - Treatment

Immunosuppressive to decrease frequency of Relapses (not for pregnant-use non hormonal contraceptive) -Azathioprine and Cyclosporin S/E: Watch for infections Corticosteroids - to decrease the Inflammation -Prednisone S/E: Watch for infections, risk for hyperglycemia, GI bleed, personality changes and weight gain Antispasmodics -Valium (Diazepam) -Baclofen - watch for muscle weakness DMARDS (Immunosuppressive/Immunomodulators) - help regulate immune system; decrease frequency of relapse and duration of relapses and decrease plaques in brain -Immunomodulators - Interferon Bet-1A (Avonex) and Beta 1b (Betaseron) S/E: flu like symptoms Anticonvulsants - used to stop paresthesia -Carbamazepine -Stool softeners - constipation -Anticholinergics - oxybutynin for overactive bladder - relaxes bladder muscle -Cholinergic - Bethanechol - muscle stimulate - helps empty bladder -Propanol (Beta Blocker) - for tremors - blocks nerve impulse to muscles, used for elevated BP so monitor BP -Benzodiazepine - Clonazepam, Diazepam - uses as muscle relaxant

Social Anxiety Disorder - Clinical Manifestations

In social phobia, aka social anxiety disorder, the person becomes severely anxious to the point of panic or incapacitation when confronting situations involving people. Examples include making a speech, attending a social engagement alone, interacting with the opposite sex or with strangers, and making complaints. The fear is rooted in low self-esteem and concern about others' judgements. The person fears looking socially inept, appearing anxious, or doing something embarrassing such as burping or spilling food. Other social phobias include fear of eating in public, using public bathrooms, writing in public, or becoming the center of attention. A person may have one or several phobias; the latter is known as generalized social phobia

Inflammatory Bowel Disease: Crohn's - Diagnostic Tests

Labs: -ESR - Inflammation -C-Reactive Protein - Inflammation -Serum Albumin - Malnutrition -K, Mg, Ca levels -Stools for blood -CBC -Chemistry panel Diagnostic Tests: -MRE - magnetic resonance enterography -MRI/CT Scan -Sigmoidoscopy -Colonoscopy -For Crohn's - Endoscopy

Inflammatory Bowel Disease: Ulcerative Colitis - Diagnostic Tests

Labs: -ESR - Inflammation -C-Reactive Protein - Inflammation -Serum Albumin - Malnutrition -K, Mg, Ca levels -Stools for blood -For UC - they will check for parasites or microbes -CBC -Chemistry panel Diagnostic Tests: -MRE - magnetic resonance enterography -MRI/CT Scan -Sigmoidoscopy -Colonoscopy

**Autism - Diagnostic Testing

M-Chat-R questionnaire (modified checklist for autism in toddlers revised) - administer by 18 months, then again at 24-30 months Additional screening tools: -Social Communication Questionnaire (SCQ) -Pervasive Developmental Disorders Screening Test II (PDDST-II)

Social Anxiety Disorder - Treatment (Pharm and Non-pharm)

MEDICATION -Benzodiazepine - sedative effect -Beta blockers: Propranalol -SSRI: Zoloft, Prozac (can create opposite effect) Prognosis, if not treated -Un achievers -Risk for alcoholism -Major suicidal depression BEHAVIORAL THERAPY -teach what anxiety is and helping client identify anxiety response -relaxation techniques -setting goals and discussing methods to reach goals -visualizing phobic situations -self esteem and self-control development therapies -CBT (cognitive behavioral therapy)

Erectile Dysfunction - Nursing Interventions and Patient Education

Medication teaching: -Contraindicated in men who take Nitrates -Do not take if you have uncontrolled HTN or had a heart attack in the past 6 months -Do not take if you have been diagnosed with cardiac dysrhythmia or kidney or liver dysfunction Other treatment methods: go over benefits and risks, instructions to use, etc.

Inflammatory Bowel Disease: Ulcerative Colitis - Treatment

Medication: -Corticosteroids, aminosalicylates (sulfasalazine) useful in preventing recurrence -Immunomodulators (e.g., azathioprine) or monoclonal antibodies (e.g., infliximab, adalimumab) may be tried if refractory to corticosteroids and aminosalicylates -Bulk hydrophilic agents -Antibiotics Non-pharmacologic treatments: -Low fiber, high protein, high calorie diet with supplemental vitamin therapy and iron replacement -Avoid cold foods and smoking as they increase GI motility -Avoid trigger foods -Colectomy with ileostomy -Proctocolectomy -Proctocolectomy w/ileostomy -Rectum can be preserved in only a few patients "cured" by colectomy

**ADHD & ADD - Treatment (Pharm and Non-Pharm)

Medications are not a cure, but help increase attention and decrease impulsivity Stimulants: methylphenidate - Ritalin amphetamine sulfate - Adderall dextroamphetamine - Dexedrine or Non-stimulant: antidepressant - Straterra Side effects of drugs: - Medication with behavior therapy work best! -Maintain set schedules at school, home: meals, activities -Plan changes ahead of time as ADHD children do not tolerate changes well -Communicate regularly with child's teacher, caregivers, and therapist -Minimize child's environmental distractions -Healthy nutritional choices: basic nutrients with plenty of fiber -Establish good behavior, praise and positive reinforcement -Provide clear and consistent rules for the child

Inflammatory Bowel Disease: Crohn's - Treatment

Medications: -Corticosteroids, aminosalicylates (sulfasalazine) -Immunomodulators (e.g., azathioprine) or monoclonal antibodies (e.g., infliximab, adalimumab) may be tried if refractory to corticosteroids and aminosalicylates -Antibiotics Non-pharmacologic treatment: -Low fiber, high protein, high calorie diet with supplemental vitamin therapy and iron replacement -Avoid cold foods and smoking as they increase GI motility -Avoid trigger foods -Parenteral nutrition -Partial or complete colectomy, with ileostomy or anastomosis -Rectum can be preserved in some patients -Recurrence common

Attention-Deficit Hyperactivity Disorder (ADHD & ADD) - Pathophysiology

Neuro-developmental disorder of childhood, characterized by inattention, impulsivity, distractibility, and hyperactivity. Three subtypes: 1) predominantly inattentive, 2) predominantly hyperactive and impulsive, and 3) all symptoms -Exact cause is unknown: it's thought there is an alteration in the dopamine and norepinephrine neurotransmitter system. -Symptoms begin before 7 years of age and persist longer than 6 months. -Boys are 3 times more likely than girls -Genetic: Brain structure, runs in the family -Exposure to chemicals: PCBS, lead -Symptoms exist in all areas of child's life

**Tuberculosis - Diagnostic Tests

PPD/Mantoux test - 0.1 ml tuberculin purified protein (PPD) derivative, injected in forearm, make a 6-10mm wheel and read in 48-72 hours. -Positive test > 10 mm, it will palpable, raised, harden area of soft tissue (induration) -Positive test >5 mm if patient is immunocompromised or living w/person with TB -If have received BCG vaccine (Bacillus Calmette-Guerin) it will give you a False positive. -This is a vaccine given to children in countries with high TB rates, not used in US unless child can't be protected. It's a TB vaccine, know to give 60-80% protection. QuantiFERON TB-Gold and T-Spot blood test - blood draw, more accurate and does not need a second reading. Ready in 24-36 hours. -Positive means they have been infected & need additional test -Negative means not likely to have active or Latent TB infection Chest X-Ray - looking for Ghon Tubercles Acid Fast Bacilli Culture - Get AM sputum - usually 3, for 3 consecutive days. This confirms diagnosis. If positive, then you have active disease

Chlamydia

Pathophysiology: Causative organism - Chlamydia trachomatis (bacteria). Diagnostic test: culture from urethra and anus from men, endocervical from women Urine - NAAT (nucleic acid amplification and testing) Conjunctival secretions in neonates Mode of transmission: vaginal, anal, oral sex and childbirth Clinical Manifestations: asymptomatic infection is common among men and women(70-80%). Symptoms include dysuria for men and women. -Female: Urinary frequency, dyspareunia, cervical discharge - mucous or pus, endocervicitis. Can lead to PID, ectopic pregnancy and infertility -Male - urethral itching, penile discharge- mucous or pus, urethral tingling. Can lead to epididymitis or sterility -Can cause inflammation of rectum and can infect the throat from oral sex. -Newborn effects - neonatal conjunctivitis, pneumonia, low birth weight, and increase risk for PROM, preterm birth and still birth Treatment: Azithromycin (Zithromax) - 1 Gram po X1 Doxycycline (Vibramycin) - 100 mg BID X 7days Erythromycin base - 500 QID x 7days Nursing Interventions/Patient Education: -CDC recommends abstinence from sexual activity for 7 days post first pill (treatment). sexual partner needs evaluation, testing and treatment, retest in 3 months. -CDC recommends yearly chlamydia screening of all sexually active women younger than 25, as well as older women with risk factors such as new or multiple partners, or a sex partner who has a sexually transmitted infection.

Gonorrhea

Pathophysiology: Causative organism - Neisseria gonorrhoeae (bacteria), Diagnostic test - Culture or NAAT test Mode of transmission: Vaginal, anal and oral sex and by childbirth. Female Clinical Manifestations: -May be asymptomatic or no recognizable symptoms (50-90%) until serious complications such as pelvic inflammatory disease -Dysuria -Urinary frequency -Vaginal discharge (yellow and foul) -Dyspareunia -Endocervicitis -Arthritis -May lead to pelvic inflammatory disease, ectopic pregnancy, infertility -Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood Male Clinical Manifestations: -Most produce symptoms, but can be asymptomatic -Dysuria -Penile discharge (pus) -Arthritis -May lead to epididymitis and sterility -Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood Newborn Clinical Manifestations: Gonococcal ophthalmia neonatorum can lead to blindness and sepsis. Arthritis, meningitis, Rhinitis, vaginitis, urethritis, inflammation of sites of fetal monitoring. Increased risk of miscarriage, PROM, and preterm birth Treatment: There is concerns about resistant N. gonorrhoeae to certain antimicrobials, so CDC recommends only one regimen: Ceftriaxone 250 mg IM X1 and Azithromycin 1Gram PO X1, taken together. Nursing Interventions/Patient Education: -Frequency of exam - CDC recommends annual screening for all sexually active women aged <25 years, as well as older women with risk factors such as new or multiple partners, or a sex partner who has a sexually transmitted infection. -Sexual partners need evaluation, testing and treatment. -Abstinence from sexual activity for 7 days post treatment and no signs of symptoms. -Retest in 3 months. -Co-infection with Chlamydia is common (45%) - test for both gonorrhea and chlamydia

Trichomoniasis

Pathophysiology: Causative organism - trichomonas vaginalis (protozoa). Diagnostic Testing - NAAT, microscopic evaluation of vaginal secretions or culture Mode of Transmission:Vaginal intercourse with an infected partner. May be picked up from direct genital contact with damp or moist objects, such as towels or wet clothing Clinical Manifestations: Women: Some women have symptoms, but some may be asymptomatic. Symptoms include dysuria, urinary frequency, vaginal discharge (yellow, green, or gray and foul odor), dyspareunia (painful intercourse), and irritation or itching of genital area Men: most are asymptomatic, but could have dysuria or penile discharge (watery white) Treatment: Metronidazole 2 grams PO X1 Tinidazole 2 g po X1 Metronidazole 500mg PO BID for 7 days Nurse Interventions/Patient Education: prevention - use barrier contraception. If sexually active get annual STI evaluation

Condyloma (venereal warts)

Pathophysiology: caused by the human papilloma virus (HPV), not curable. HPV is also the #1 cause of cervical cancer Mode of transmission: Vaginal, anal, or oral sex with an infected partner Clinical Manifestations/diagnostic test: visual inspection shows genital warts, +HPV on Pap smear, Treatments: remove the lesion (freezing, surgical removal, chemical removal) Patient Education: counsel patient about using barrier contraceptive method, get annual Pap smear over 21 if sexually active,

**Syphilis

Pathophysiology: caused by treponema palladium (spirochete bacteria) Mode of transmission: Vaginal, anal, and oral sex, and by childbirth -Primary stage: appearance of single chancre at the location where the bacteria entered, lip, penis, vagina (firm, round and painless) lasts 3-6 weeks and then heals (with or without treatment) - TREATABLE AT THIS STAGE -Secondary stage: Development of a maculopapular rash on one or more areas of the body, palms of hands and on bottom of feet. Can appear while the primary chancre is healing or several weeks after the chancre has healed. TREATABLE AT THIS STAGE -Latent stage: No symptoms and can last 1-2 years -Tertiary Stage: Is rare and can appear 10-30 years after infection was first acquired. Can be fatal. Can affect multiple organ systems, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Symptoms depending on the organ system affected. Usually not reversible at this stage. Diagnostic testing: Non-treponemal screening test VDRL, RPR, and treponemal test FTA-ABS (florescent treponemal antibody absorption) and Darkfield examination Treatment: -Benzathine penicillin G 2.4 million units IM in single dose for Primary, secondary or early latent syphilis -Late latent syphilis or latent syphilis of unknown duration is Benzathine penicillin G 2.4 million units IM Q Week for 3 weeks. -If penicillin allergy, doxycycline, tetracycline, or erythromycin. Patient education: Sexual partners need evaluation and testing

**HSV-2 (herpes simplex virus type 2)

Pathophysiology: sexually transmitted virus with ulcer-like lesions of the genital and anorectal skin and mucosa. After initial infection, the virus lies dormant in the nerve cell root and may recur at times of stress. not curable. diagnosis is made by visual inspection along with symptoms, or culture (may also diagnose through polymerase chain reaction or serologic tests, such as antibody-based testing) Mode of transmission: Vaginal, anal, and oral sex, and by childbirth. spreads when virus is being shed, which occurs during an active outbreak and even sometimes when the virus is in a dormant stage. Clinical Manifestations: for both men and women - Initial symptoms include itching, tingling, and PAIN in genital area followed by small pustules and blister-like genital lesions that then crust over and gradually heal. -Recurrence episodes are usually milder than the initial episode -Dysuria, dyspareunia, and urine retention -Fever, headache, malaise, muscle aches Treatment: No cure, only control of symptoms. antivirals used to treat first and recurrent episodes and for suppression. Acyclovir, Valacyclovir, Famciclovir for 7-10 days. Longer if symptoms continue Nursing Interventions/Patient Education: take medications for the full length of time. Tell all sexual partners about herpes virus. Use

**SLE - Treatment

Recognition and avoidance of disease flares -Prevention of infection -Nutritional therapy -Physical therapy -Stress reduction -Avoidance of UV light -Pharmacologic intervention -Supportive care - NSAIDS for fever, arthralgias, arthritis; ASA prevent thrombosis -Hydroxychloroquine (Plaquenil) - antimalaria drug effective for skin and arthritic manifestations -Corticosteroid therapy in high doses -Immunosuppressive agents - methotrexate and azathioprine

**Inflammatory Bowel Disease: Crohn's - Clinical Manifestations

Symptoms: -Inflammation -Fistulas, Fissures, abscess (skip lesions) - Approx. 5 stools/day w/steatorrhea -Eat, cramp, have a stool -Right lower quadrant pain -Ulcers -Abdominal distension and or firmness on palpation -High pitched BS -Weight loss, anorexia Complications: -Deterioration of bowel -Bleeding -Malnutrition -Dehydration > Electrolyte Imbalance -Peritonitis from perforations -Affects different parts giving a patchy or "cobblestone appearance". -As progresses will thicken wall causing strictures. -Have MORE MALNUTRITION than UC, requiring supplemental vitamins, minerals and B12 injections

**Inflammatory Bowel Disease: Ulcerative Colitis - Clinical Manifestations

Symptoms: -Rectal bleeding -Inflammation -Edematous, red bleeding colon -Can lead to abscess formation -Up to 15-20 watery liquid stools/day -Stools are urgent, have mucous, pus, blood -Pain is lower left quadrant -Ulcers -Abdominal distension and/or firmness on palpation -High pitched BS -Weight loss, anorexia Complications: -Deterioration of bowel -Bleeding -Malnutrition -Dehydration > Electrolyte Imbalance -Peritonitis from perforations -Loss of Haustra - a "smooth lead pipe" appearance, that is red and edematous -Toxic Megacolon - Inflammation causes dilation of colon, affecting musculature, making it unable to contract > distended > paralyzed

Definition of Human Development

The sequence of biophysical, psychosocial, and cognitive developmental changes over the human lifespan that allow the individual complex adaptations to the environment in order to function within society

Gender Dysphoria - Treatment (Pharm and Non-pharm)

Treatment -Supportive while in transition -Laser hair removal or electrolysis -Surgery - genital surgery, chest and breast surgery, Adam's apple shaving, body contouring, change in facial features -Medications - androgens, antiandrogens, estrogen, testosterone -Behavioral therapy - not to alter your gender identity but to explore gender concerns and find ways to lessen gender dysphoria. The goal is to become comfortable with their gender identity expression and reduce the guilt of wanting to be another sex. Nursing - Acceptance, leave your biases at the door.

Altered Libido - Causes

Women - loss of partner, decrease in estrogen Men - decrease in testosterone, more likely due to smoking, obesity, CVD, poor health, medications, Both - takes longer to become aroused, longer to complete intercourse, less intense and longer before sexual arousal can happen again

Immunity

a physiologic process that provides an individual with protection or defense from disease

Altered Libido - Definition

decrease in sexual desire (deficiency/absence of sexual fantasy or absence of desire for sexual activity)

Erectile Dysfunction - Clinical Manifestations

inability to achieve or maintain an erection

Altered Libido - Treatment (Pharm and Non-pharm)

medications for erection (male), estrogen and lubricants (women) counseling (sex therapy)

Dyspareunia - Clinical Manifestations

painful or difficult penile-vaginal intercourse. Can be superficial, deep, primary, or secondary and may occur at the beginning of, during or after penile-vaginal intercourse

Aging Family Member - Psychosocial impact on individual/family

successful psychological aging: -ability to adapt to physical, social and emotional losses -achieve life satisfaction -resiliency and coping skills to deal with stressors and change Ageism predominates most societies with myths about aging -negative stereotypes -nonproductive citizens of society -draining economic resources -competition with children for resources Nurses can facilitate successful aging by recommending health promotion strategies such as anticipatory planning for retirement, i.e. adequate income, developing new routines not associated with work, replacing work friends with new acquaintances, and relying on other people and groups in addition to spouse to fill leisure time.

Altered Libido - Nursing Interventions and Patient Education

teach patients about prescribed medication offer resources for counseling

Anaphylaxis - Causes

•Foods - peanuts or tree nuts, shellfish (fish), tomatoes, strawberries •Medications - PCN, contrast dyes, betadine •Insects - bees, wasps, red ants •Latex •Skin contact with poisonous plants or animals