Foundations Nursing Practice Unit 1 Exam
Health Belief Model
" If you believe it, you'll do something about it" This model is based on three components of individual perceptions of threat of a disease: (1) perceived susceptibility to a disease, (2) perceived seriousness of a disease, and (3) perceived benefits of action.
Four concepts common in nursing theory that influence and determine nursing practice are
(1) the person (patient), (2) the environment, (3) health, and (4) nursing.
The following cautions may be of assistance when OTC preparations are considered:
* Delay in professional diagnosis and treatment of serious or potentially serious conditions may occur if the patient self prescribes OTC drugs. * Symptoms may be masked making diagnosis more complicated *Labels and instructions should be followed carefully * The patients health care provider or pharmacist must be consulted before OTC preparations are taken *Ingredients in OTC products may interact with medications prescribed by the health care or self prescribed by the patient *Inactive ingredients (e.g alcohol, dyes, preservatives) may result in adverse reactions. *Potential for overdose exists because of the use of several preparations with similar active ingredients. A double dose does not translate into a quicker recovery. *The risk for adverse drug reactions and drug-drug interactions will increase as more medications, whether prescription or OTC are added to drug therapy regimens.
Physically, the family provides a safe, comfortable environment necessary for growth, development, and rest or recuperation. Economically, the family provides financial aid to family members and also helps meet society's needs. The reproductive function of many families is to have and raise children. The affective and coping functions of the family provide emotional comfort to family members and help members establish their identity and maintain it in times of stress. Finally, through socialization, the family teaches; transmits beliefs, values, attitudes, and coping mechanisms; provides feedback; and guides problem solving
5 major areas of family functions
Skin Problem: Acne
A skin condition that is characterized by clogged pores (blackheads, whiteheads, pimples), caused by dead skin cells and sebum (oil) sticking together in the pore. Sometimes bacteria that live on the skin also get inside the clogged pore. Inside the pore, the bacteria have a perfect environment for multiplying very quickly. With a large amount of bacteria inside, the pore becomes inflamed (red and swollen). If the inflammation goes deep into the skin, an acne cyst or nodule appears. Acne can appear on the face, back, chest, neck, shoulders, upper arms and buttocks.
HEALTHY PEOPLE 2010: LEADING HEALTH INDICATORS
Access to health services Clinical preventive services Environmental quality Injury and violence Maternal, infant, and child health Mental Health Nutrition, physical activity and obesity Oral health Reproductive and sexual health Social determinants Substance abuse Tobacco
is the protection and support of another's rights. This role is increasingly important because of patients' changing expectations and demands, and because in our increasingly market-driven health care economy there are no guarantees that the health care system will work to secure their safety and health
Advocacy
Major Areas of Risk Factors
Age School-aged children are at high risk for communicable diseases. After menopause, women are more likely to develop cardiovascular disease. Genetic factors A family history of cancer or diabetes predisposes a person to developing the disease. Physiologic factors Obesity increases the possibility of heart disease. Pregnancy places increased risk on both the mother and the developing fetus. Health habits Smoking increases the probability of lung cancer. Poor nutrition can lead to a variety of health problems. Lifestyle Multiple sexual relationships increase the risk for sexually transmitted infections (e.g., gonorrhea or AIDS). Events that increase stress (e.g., divorce, retirement, work-related pressure) may precipitate accidents or illness. Environment Working and living environments (such as hazardous materials and poor sanitation) may contribute to disease.
Use these for patients who have infections that spread through the air such as tuberculosis, varicella (chicken pox), rubeola (measles), and possibly SARS (severe acute respiratory syndrome).
Airborne Precautions
is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse's concern for the welfare of patients, other nurses, and other health care providers. Sample professional behaviors include the following: Demonstrates understanding of cultures, beliefs, and perspectives of others Advocates for patients, particularly the most vulnerable Takes risks on behalf of patients and colleagues Mentors other professionals
Altruism
Exogenous infection
An ? infection is referred to as when the causative organism is acquired from other people.
iatrogenic infection
An infection is referred to as ? when it results from a treatment or diagnostic procedure
these groups of people tend to avert their eyes while speaking
Asians, Native Americans, Indochinese, Arabs, and Appalachians
Healthy People 2020 establishes health promotion guidelines for the nation as a whole. What are the 4 goals?
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages.
Respect the rights of patients or their surrogates to make health care decisions
Autonomy
is the right to self-determination. Professional practice reflects ? when the nurse respects patients' rights to make decisions about their health care. Sample professional behaviors include the following: Plans care in partnership with patients Honors the right of patients and families to make decisions about health care Provides information so that patients can make informed choices
Autonomy
Skin Problem: Acne Treatment
Avoid squeezing or picking infected areas because this can spread the infection and cause scarring. Gently wash the face twice a day with a mild cleanser and warm (not hot) water. Use oil-free, water-based moisturizers and make-up. Look for products that are "noncomedogenic" or "nonacnegenic." Use cosmetics sparingly to avoid further blockage of the sebaceous ducts. Keep hair off the face and wash hair daily. Some acne treatments (both over-the-counter and prescription) can increase the skin's sensitivity to sunlight and ultraviolet light. Avoid sun/tanning booth exposure; use sunscreen. Patients with a lot of acne, cysts, or nodules should consider consulting a dermatologist.
Physical dimension
Basic Human Need: Physiologic needs i.e: Breathing Circulation Temperature Intake of food and fluids Elimination of wastes Movement
Cleansing the skin Acting as a skin conditioner Helping to relax a restless person Promoting circulation by stimulating the skin's peripheral nerve endings and underlying tissues Serving as a musculoskeletal exercise through activity involved with bathing, thereby improving joint mobility and muscle tonus Stimulating the rate and depth of respirations Promoting comfort through muscle relaxation and skin stimulation Providing sensory input Helping to improve self-image Providing an excellent opportunity to strengthen the nurse-patient relationship, to thoroughly assess the patient's integumentary system, to observe the patient's physiologic and emotional status closely, to teach the patient as indicated, and to demonstrate care and interest in the patient's general welfare
Bathing serves a variety of purposes, including:
Cultural Norms of the Health Care System
Beliefs Standardized definitions of health and illness Omnipotence of technology
Benefit the patient, and balance benefits against risks and harms.
Beneficence
Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. Nurses have the right to a work environment that is safe for themselves and their patients. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.
Bill of Rights Nurses
Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution
Bill of rights nurses
where divorced parents assume joint custody of children
Binuclear Family
Birth defects Mental retardation Genetic predisposition to certain diseases, including cardiovascular diseases and cancer
Biologic Risks
is another form of a nuclear family, formed when parents bring unrelated children from previous relationships together to form a new family.
Blended Family
Oste
Bone
Whites
Breast cancer Heart disease Hypertension Diabetes mellitus Obesity
Culture helps shape what is acceptable behavior for people in a specific group. It is shared by, and provides an identity for, members of the same cultural group. Culture is learned by each new generation through both formal and informal life experiences. Language is the primary means of transmitting culture. The practices of a particular culture often arise because of the group's social and physical environment. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. Culture influences the way people of a group view themselves, have expectations, and behave in response to certain situations. Because a culture is made up of individuals, there are differences both within cultures and among cultures.
Characteristics of culture
are individuals who choose to live together for a variety of reasons, including relationships, financial need, or changing values include unmarried adults who choose not to marry but live together.
Cohabiting Family
Place the patient in a private room, if available. Wear PPE whenever you enter the room for all interactions that may involve contact with the patient and potentially contaminated areas in the patient's environment. Change gloves after having contact with infective material. Remove PPE before leaving the patient environment, and wash hands with an antimicrobial or waterless antiseptic agent. Limit movement of the patient out of the room. Avoid sharing patient-care equipment.
Contact Precautions
Use these for patients who are infected or colonized by a multidrug-resistant organism (MDRO).
Contact Precautions
? is the recovery period from the infection.The signs and symptoms disappear, and the person returns to a healthy state. However, depending on the type of infection, there may be a temporary or permanent change in the patient's previous health state even after the ?
Convalescent Period
Family planning clinics Prenatal classes Well-child clinics Vision and hearing screenings Dental health information Parent support groups Safety in the home, daycare, school, neighborhood, and community
Couple and family with young children
Beliefs Standardized definitions of health and illness Omnipotence of technology
Cultural Norms of the healthcare system
Customs Professional deference and adherence to the pecking order found in autocratic and bureaucratic systems Use of certain procedures attending birth and death
Cultural Norms of the healthcare system
Dislikes Tardiness Disorderliness and disorganization
Cultural Norms of the healthcare system
Habits Documentation Frequent use of jargon Use of a systematic approach and problem-solving methodology
Cultural Norms of the healthcare system
Likes Promptness Neatness and organization Compliance
Cultural Norms of the healthcare system
Practices Maintenance of health and prevention of illness Annual physical examinations and diagnostic procedures
Cultural Norms of the healthcare system
Communicate __________ with healthcare team to make sure it does not effect plan of care.
Cultural practices
Cultural Norms of the Health Care System
Customs Professional deference and adherence to the pecking order found in autocratic and bureaucratic systems Use of certain procedures attending birth and death
When cleaning ? , put on gloves and hold them over a basin of water or a sink lined with a washcloth or soft towel so that if they slip from your grasp, they will not fall onto a hard surface and break. If necessary, grasp the dentures with a 4" × 4" piece of gauze to help prevent them from slipping out of your gloved hands. Use cool or lukewarm water to cleanse them. Hot water may warp the plastic material of which most ? are made. Use a soft toothbrush and toothpaste. ? may be soaked in commercial preparations to help remove stains and hardened particles and then rinsed well after cleaning. Give the patient the opportunity to brush the gums and tongue and rinse the mouth before the ? are replaced. Assist the patient with care as necessary. Store ? in cold water when not in the patient's mouth. Leaving ? to dry can cause warping, leading to discomfort when worn.
Denture Care
Children learn hygiene practices while growing up. Family practices often dictate hygiene habits, such as morning or evening baths; the frequency of shampooing, tooth brushing, and clothing changes; feelings about nudity; and so on. As adolescents become more concerned about their personal appearance, they may adopt new hygiene measures, such as taking showers more frequently and wearing deodorant
Developmental Level
Families who have new babies, especially if support systems are unavailable Older people, especially those living alone or on a fixed income Unmarried adolescent mothers who lack personal, economic, and educational resources
Developmental Risk Factors
Hispanics
Diabetes mellitus Lactose intolerance
Cultural Norms of the Health Care System
Dislikes Tardiness Disorderliness and disorganization
Pharm: The process by which the drug becomes available to body fluids and body tissues.
Distribution
Use a private room, if available. Door may remain open. Wear PPE upon entry into the room for all interactions that may involve contact with the patient and potentially contaminated areas in the patient's environment. Transport patient out of room only when necessary and place a surgical mask on the patient if possible. Keep visitors 3 feet from the infected person
Droplet Precautions
Use these for patients with an infection that is spread by large-particle ? such as rubella, mumps, diphtheria, and the adenovirus infection in infants and young children.
Droplet Precautions
is the length of time the drug has a pharmacologic effect.
Duration of action
which the couple chooses not to have children
Dyadic Nuclear
Lack of knowledge or finances to provide safe and clean living conditions Work or social pressures that cause stress Air, water, or food pollution
Environmental Risk Factors
Skin Problem: Skin Rashes
Eruptions or inflammations of the skin that may be found anywhere on the body. May be precipitated by skin contact with an allergen, overexposure to the sun, and/or systemic causes, like a reaction to a medication.
Couple and family with young children
Establish a mutually satisfying marriage Plan to have or not to have children Have and adjust to infant Support needs of all family members Adjust to cost of family life Adapt to needs and activity of children Cope with loss of energy and privacy Encourage and support growth and development and educational achievements
nuclear family and other related people
Extended Family
_____ responsibility to ensure that all drugs are tested for harmful effects, have labels with accurate information and enclosed detailed literature in the drug packaging that explains adverse effects.
FDA
any group of people who live together and depend on one another for physical, emotional, and financial support.
Family
Maintain open communications Support moral and ethical family values Balance teenagers' freedom with responsibility Maintain supportive home base Strengthen marital relationships
Family with adolescents and young adults
Maintain ties with younger and older generations Prepare for retirement
Family with middle-aged adults
Blood pressure screenings Screening for chronic illness,Stage-Specific Nursing Interventions/Referrals
Family with middle-aged adults,Stage-Specific Nursing Interventions/Referrals
Depression Exposure to environmental or work-related health risks, such as sunlight, asbestos, radiation, coal dust, and air or water pollution
Family with middle-aged adults,Stage-Specific Risk Factors
Adjust to retirement Adjust to loss of spouse May move from family home
Family with older adults
First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become involved in the illness. Second, because there is a strong relationship between the family and the health status of its members, the role of the family is essential in every level of nursing care. Third, the level of health of the family and in turn each of its members can be significantly improved through health promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members. Through assessment and intervention, the nurse can assist in improving the health status of all family members.
Family-centered nursing care in four ways
Keep promises.
Fidelity
This act allows the FDA to mandate postmarketing safety studies and to affect the distribution of drugs that are found to be not as safe as premarket studies indicated.
Food and Drug Administration Amendments Act
Only _____(drugs not bound to protein) are active and can cause pharmacologic response.
Free Drugs
The presence of specific signs and symptoms indicates the ? The type of infection determines the length of the illness and the severity of the manifestations. Symptoms that are limited or occur in only one body area are referred to as localized symptoms, whereas symptoms manifested throughout the entire body are referred to as systemic symptoms.
Full Stage of Illness
Cultural Norms of the Health Care System
Habits Documentation Frequent use of jargon Use of a systematic approach and problem-solving methodology
Metabolism and elimination affect the _____ of a drug.
Half life
The _____ of a drug is the time it takes for one half of the drug concentration to be eliminated.
Half-life
is the most effective way to help prevent the spread of infectious agents.
Hand Hygiene
Wash at least 1 inch above area of contamination. If hands are not visibly soiled, wash to 1 inch
Handwashing
men may avoid direct eye contact with women
Hasidic Jewish
Disease, surgery, or injury may reduce a person's ability to perform hygiene measures or motivation to follow usual hygiene habits. Weakness, dizziness, and fear of falling may prevent a person from entering a tub or shower or from bending to wash the lower extremities. Illness may also create a demand for new or modified hygiene measures. For example, peripheral vascular complications that often accompany diabetes mellitus require meticulous foot care.
Health State
Sociocultural Dimension
Health practices and beliefs are strongly influenced by a person's economic level, lifestyle, family, and culture. In general, low-income groups, racial and ethnic minorities, and other underserved populations are less likely to seek medical care to prevent illness and have fewer treatment options, while high-income groups are more prone to stress-related habits and illness. Examples are an adolescent who sees nothing wrong with smoking or drinking because her parents smoke and drink, parents of a sick infant who do not seek medical care because they have no health insurance, a single parent (abused as a child) who in turn physically abuses her own small son, and a person of Asian descent who uses herbal remedies and acupuncture to treat an illness.
Native Americans and Alaska Natives
Heart disease Cirrhosis of the liver Diabetes mellitus Fetal alcohol syndrome
may look downward in deference to age, gender, social position, economic status, or authority.
Hispanics
Stage 1: Experiencing Symptoms
How do people define themselves as "sick"? The first indication of an illness usually is recognizing one or more symptoms that are incompatible with one's personal definition of health. Although pain is the most common symptom indicating illness, other common symptoms include a rash, fever, bleeding, or a cough. If the symptoms last for a short time or are relieved by self-care, the person usually takes no further action. If the symptoms continue, however, the person enters the next stage.
Emotional Dimension
How the mind affects body functions and responds to body conditions also influences health. Long-term stress affects body systems, and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change the body's responses to illness. As examples of the negative effects of emotions,a student may always have diarrhea before examinations and an adolescent with poor self-esteem may begin to experiment with drugs. The positive effects of emotions include reducing surgical pain with relaxation techniques and reducing blood pressure with biofeedback skills.
is respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human dignity is reflected when the nurse values and respects all patients and colleagues. Sample professional behaviors include the following: Provides culturally competent and sensitive care Protects the patient's privacy Preserves the confidentiality of patients and health care providers Designs care with sensitivity to individual patient needs
Human Dignity
Asians
Hypertension Cancer of the liver Lactose intolerance Thalassemia
African Americans
Hypertension Stroke Sickle cell anemia Lactose intolerance Keloids
Florence Nightingale's contributions include:
Identifying the personal needs of the patient and the role of the nurse in meeting those needs Establishing standards for hospital management Establishing a respected occupation for women Establishing nursing education Recognizing the two components of nursing: health and illness Believing that nursing is separate and distinct from medicine Recognizing that nutrition is important to health Instituting occupational and recreational therapy for sick people Stressing the need for continuing education for nurses Maintaining accurate records, recognized as the beginnings of nursing research
Common Causes of Diseases
Inherited genetic defects Developmental defects resulting from exposure to such factors as virus or chemicals during pregnancy Biologic agents or toxins Physical agents such as temperature, chemicals, and radiation Generalized tissue responses to injury or irritation Physiologic and emotional reactions to stress Excessive or insufficient production of body secretions (hormones, enzymes, and so forth)
Give each his or her due; act fairly
Justice
Treatment Dry Skin
Keep baths or showers short, and/or bathe less frequently. Use warm, not hot water to bathe. Use as little soap as possible. Try mild cleansers or soaps. Dry skin thoroughly and gently. Use moisturizers at least daily. Drink plenty of water throughout the day. Use a humidifier if the air is dry.
Maslow's Hierarchy
Level 1: Physiologic needs Level 2: Safety and security needs Level 3: Love and belonging needs Level 4: Self-esteem needs Level 5: Self-actualization needs
Lack of knowledge about sexual and marital roles, leading to teenage marriage and pregnancy; divorce; sexually transmitted infections; child, spouse, or elder abuse; and lack of prenatal or childcare Alterations in nutrition—either more or less than body requirements at any age Chemical dependency, including the use of alcohol, drugs, and nicotine Inadequate dental care and hygiene Unsafe or unstimulating home environmen
Lifestyle Risk Factors
Cultural Norms of the Health Care System
Likes Promptness Neatness and organization Compliance
Minimum Toxic Concentration
MTC
Tertiary
Medication Medical therapy Surgical treatment Rehabilitation Physical therapy Occupational therapy Job training
process by which the body inactivates or bio transforms drugs.
Metabolism
women often indicate modesty by avoiding eye contact with men,
Muslim/Arab
Avoid causing harm.
Nonmaleficence
also called the traditional family, is composed of two parents and their children or "two or more persons who depend on one another for emotional, physical, or financial support."
Nuclear Family
Mortality
Number of deaths resulting from disease
Make sure that their loyalty to their employing institution or colleagues does not compromise their primary commitment to the patient Give priority to the good of the individual patient rather than to the good of society in general Carefully evaluate the competing claims of the patient's autonomy (self-determination) and the patient's well-being
Nurses who value patient advocacy:
the time it takes to reach the minimum effective concentration after a drug is administered.
Onset of action
PICO
P= Patient, population, or problem of interest Need for explicit description; may include setting, limiting to subgroups (such as by age). I= Intervention of interest The more defined, the more focused the search of the literature will be; may include exposure, treatment, patient perception, diagnostic test, or predicting factor. C= Comparison of interest Usually the comparison is to another treatment or the usual standard of care. O= Outcome of interest Specifically identifying the outcome to enable a literature search to find evidence that examined the same outcome, perhaps in different ways.
Remove respirator after leaving the patient's room and closing the door, Slide fingers of ungloved hand under the remaining glove at the wrist, taking care not to touch the outer surface of the glove, Outside of goggles or face shield is contaminated; Do not touch. Handling by headband or earpieces and lifting away from face prevents transmission of microorganisms. Proper disposal prevents transmission of microorganisms,To remove gown: Unfasten ties, if at the neck and back. Allow the gown to fall away from shoulders. Touching only the inside of the gown, pull away from the torso. Keeping hands on the inner surface of the gown, pull gown from arms. Turn gown inside out. Fold or roll into a bundle and discard, To remove mask or respirator: Grasp the neck ties or elastic, then top ties or elastic and remove. Take care to avoid touching front of mask or respirator. Discard in waste container. If using a respirator, save for future use in the designated area, Front of mask or respirator is contaminated; Do not touch. Not touching the front and proper disposal prevent transmission of microorganisms.
PPE
Algia
Pain
dys
Painful, difficult, abnormal
occurs when the drug reaches its highest blood or plasma concentration
Peak Action
The highest plasma concentration of drug at a specific time and indicate the rate of absorption.
Peak drug level
People have different preferences with regard to hygiene practices such as taking a shower versus a tub bath, using bar soap versus liquid soap, and washing to wake oneself or to relax before sleep. A person's self-concept and sexuality also influence personal hygiene practices. For example, in an effort to promote a positive self-image, older adults may use skin care products advertised to prevent wrinkles and diminish signs of aging.
Personal Preferences
The study of the way drugs affect the body
Pharmacodynamic Phase
Airborne Precautions
Place patient in a private room that has monitored negative air pressure in relation to surrounding areas, 6 to 12 air changes per hour, and appropriate discharge of air outside or monitored filtration if air is recirculated. Keep door closed and patient in room. Wear a mask or respirator when entering room of patient with known or suspected tuberculosis. If patient has known or suspected rubeola (measles) or varicella (chicken pox), respiratory protection should be worn unless the person entering room is immune to these diseases. Transport patient out of room only when necessary and place a surgical mask on the patient if possible.
Cultural Norms of the Health Care System
Practices Maintenance of health and prevention of illness Annual physical examinations and diagnostic procedures
Inadequate childcare resources, when both parents work, for preschool and school-aged children Inadequate income to provide safe housing, food, clothing, and health care Conflict between family members
Psychosocial Risk Factors
Stage 4: Achieving Recovery and Rehabilitation
Recovery and rehabilitation might begin in the hospital and conclude at home, or may be totally concluded at a rehabilitation center or at home. Most patients complete this final stage of illness behavior at home. In this stage, the person gives up the dependent role and resumes normal activities and responsibilities. If the plan of care includes health education, the person may return to health at a higher level of functioning and health than before the illness.
Secondary
Screenings (Blood pressure, cholesterol, glaucoma, HIV, skin cancer) Pap smears Mammograms Testicular examinations Family counseling
is upholding moral, legal, and humanistic principles. This value is reflected in professional practice when the nurse works to assure equal treatment under the law and equal access to quality health care. Sample professional behaviors include the following: Supports fairness and nondiscrimination in the delivery of care Promotes universal access to health care Encourages legislation and policy consistent with the advancement of nursing care and health care
Social Justice
person's _____ class and financial resources often define the hygiene options available to that person. For example, someone renting a room in a boarding house may have limited or no access to a tub or shower and may have limited finances to buy soap, shampoo, shaving cream, and deodorant.
Socioeconomic
including religious beliefs, may dictate ceremonial washings and purifications, sometimes as a prelude to prayer or eating. For example, in the Orthodox Jewish tradition, ritual baths are required for women after childbirth and menstruation. In some religions, contact with a deceased person or a deceased animal may make a person "unclean." Other religions dictate that no modern facilities be installed in homes. This would prohibit some people from having running water and toilets in their homes. As a result, they may bathe infrequently.
Spiritual Practices
Spiritual Dimension
Spiritual beliefs and values are important components of a person's health and illness behaviors. It is important that nurses respect these values and understand their importance for the individual patient. Examples include the Roman Catholic requirement of baptism for both live births and stillborn babies; kosher dietary laws, prohibiting the intake of pork and shellfish, practiced by Orthodox and Conservative Jews; and opposition to blood transfusion, common to Jehovah's Witnesses.
Accident prevention programs Sex education Mental health programs Screening for chronic illness
Stage-Specific Nursing Interventions/Referrals, Family with adolescents and young adults
Screening for chronic illness Home safety information Retirement information Pharmacology information
Stage-Specific Nursing Interventions/Referrals, Family with older adults
Inadequate knowledge of contraception and family Inadequate knowledge of sexual and marital roles Lack of knowledge about child safety and health Child abuse and neglect First pregnancy before age 16
Stage-Specific Risk Factors Couple and family with young children
Family of origin Family value of aggressiveness Inadequate problem-solving abilities Conflict between family members Physical or sexual abuse Sexually transmitted diseases
Stage-Specific Risk Factors Family with adolescents and young adult
Increasing age with loss of physical function Chronic illness Depression Death of spouse
Stage-Specific Risk Factors,Family with older adults
It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It is the profession's nonnegotiable ethical standard. It is an expression of nursing's own understanding of its commitment to society.
The Code of Ethics for Nurses serves the following purposes
is the interval between the pathogen's invasion of the body and the appearance of symptoms of infection. During this stage, the organisms are growing and multiplying.
The Incubation Period
A person is most infectious during the ? Early signs and symptoms of disease are present, but these are often vague and nonspecific, ranging from fatigue and malaise to a low-grade fever. This period lasts from several hours to several days. During this phase, the patient often is unaware of being contagious. As a result, the infection spreads.
The Prodromal Stage
Leader
The assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups
Collaborator
The effective use of skills in organization, communication, and advocacy to facilitate the functions of all members of the health care team as they provide patient care
HUMAN DIMENSIONS
The factors influencing a person's health-illness status, health beliefs, and health practices relate to the person's
Reseacher
The participation in or conduct of research to increase knowledge in nursing and improve patient care
STAGE 2: ASSUMING THE SICK ROLE
The person now self-defines as being sick, seeks validation of this experience from others, gives up normal activities, and assumes a "sick role." At this stage, most people focus on their symptoms and bodily functions. Depending on individual health beliefs and practices, the person may choose to do nothing, may research symptoms on Internet sources, may buy over-the-counter medications, may try alternative remedies to relieve symptoms, or may seek out a health care provider for diagnosis and treatment. In our society, an illness becomes "legitimate" when a health care provider diagnoses it and prescribes treatment. After seeking help from the health care provider, the person becomes a patient and enters the next stage.
Advocate
The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives
Caregiver
The provision of care to patients that combines both the art and the science of nursing in meeting physical, emotional, intellectual, sociocultural, and spiritual needs. As a ?, the nurse integrates the roles of communicator, teacher, counselor, leader, researcher, advocate, and collaborator to promote wellness through activities that prevent illness, restore health, and facilitate coping with disability or death. The role of ? is the primary role of the nurse.
Standard 2. Diagnosis
The registered nurse analyzes the assessment data to determine the diagnoses or issues.
Standard 1. Assessment
The registered nurse collects comprehensive data pertinent to the patient's health or the situation.
Standard 4. Planning
The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
Standard 6. Evaluation
The registered nurse evaluates progress toward attainment of outcomes
Standard 3. Outcomes Identification
The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.
Standard 5. Implementation
The registered nurse implements the identified plan, coordinates care delivery, employs strategies to promote health and a safe environment (the advanced practice registered nurse [APRN] also provides consultation and uses prescriptive authority and treatment).
Dry Skin
The skin loses moisture and may crack and peel, or become irritated and inflamed. Symptoms include scaling, flaking, itching, and cracks in the skin.
Skin Problem :Dry Skin
The skin loses moisture and may crack and peel, or become irritated and inflamed. Symptoms include scaling, flaking, itching, and cracks in the skin.
Teacher/Educator
The use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families
Communicator
The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of health care settings
Counselor
The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate the patient's problem-solving and decision-making skills
Estimates the margin of safety of a drug through the use of a ratio that measures the effective (therapeutic) dose (ED) in 50% of people (ED) and the lethal dose in 50% of people.
Therapeutic Index (TI)
"Five Moments for Hand Hygiene."
These include: Moment 1 - Before touching a patient Moment 2 - Before a clean or aseptic procedure Moment 3 - After a body fluid exposure risk Moment 4 - After touching a patient Moment 5 - After touching patient surroundings
STAGE 3: ASSUMING A DEPENDENT ROLE
This stage is characterized by the patient's decision to accept the diagnosis and follow the prescribed treatment plan. The person may initially have difficulty conforming to the recommendations of thehealth care provider and may decide to seek a second opinion or deny the diagnosis. The lack of independence is more troubling for some people who, based on their diagnosis, often require assistance in carrying out activities of daily living, and need emotional support through acceptance, approval, physical closeness, and protection.
Four broad aims of nursing practice
To promote health To prevent illness To restore health To facilitate coping with disability or death
Keep baths or showers short, and/or bathe less frequently. Use warm, not hot water to bathe. Use as little soap as possible. Try mild cleansers or soaps. Dry skin thoroughly and gently. Use moisturizers at least daily. Drink plenty of water throughout the day. Use a humidifier if the air is dry.
Treatment for Dry skin
four categories that are responsible for a majority of HAIs in the acute care hospital setting. These include:
Urinary tract infections Surgical site infections Bloodstream infections Pneumonia
Skin Problem: Skin Rashes Treatment
Wash area thoroughly with a mild cleansing agent and rinse well. Use a moisturizing lotion on a dry rash to prevent itching and promote healing. Use a drying agent on a wet rash. Try tepid baths to help relieve inflammation and itching. Use antiseptic sprays or lotions to help lessen itching, promote healing, and prevent skin breakdown. Avoid exposure to causative agent, if known. See a health care provider if symptoms do not respond to treatment or become worse.
Primary
Weight loss Diet Exercise Smoking cessation Reduced alcohol consumption Avoidance of illicit drugs Farm safety Seat belts and child safety seats Immunizations Water treatment Safer sex practices Effective parenting
Wellness
a term that is often associated with health, is an active state of being healthy by living a lifestyle that promotes good physical, mental, emotional, and spiritual health.
A skin condition that is characterized by clogged pores (blackheads, whiteheads, pimples), caused by dead skin cells and sebum (oil) sticking together in the pore. Sometimes bacteria that live on the skin also get inside the clogged pore. Inside the pore, the bacteria have a perfect environment for multiplying very quickly. With a large amount of bacteria inside, the pore becomes inflamed (red and swollen). If the inflammation goes deep into the skin, an ? cyst or nodule appears. ? can appear on the face, back, chest, neck, shoulders, upper arms and buttocks.
acne
Prescriptive theories
address nursing interventions and the consequences of those interventions; they are designed to control, promote, and change clinical nursing practice.
Standards
allow nurses to carry out professional roles, serving as protection for the nurse, the patient, and the institution where health care is provided
Prevention
anticipatory action taken to prevent the occurrence of an event or to minimize its effects after it has occurred"
Health Promotion
behavior of an individual motivated by a personal desire to increase well-being and health potential
To meet the 4 broad aims of nursing practice, a nurse must use 4 blended competencies
cognitive,technical,interpersonal, and ethical/legal.
Authoritative
comes from an expert and is accepted as truth based on the person's perceived expertise—for example, when a senior staff nurse teaches a new graduate nurse a more efficient method of doing a technical procedure, such as inserting an intravenous catheter.
Descriptive theories
describe a phenomenon, an event, a situation, or a relationship. They further identify the properties and components of each of these as well as the circumstances in which it occurs.
Abraham Maslow
developed a hierarchy of basic human needs that describes which needs of a person are the most important at any given time.
Nursing Theory
differentiates nursing from other disciplines and activities by serving the purposes of describing, explaining, predicting, and controlling desired outcomes of nursing care practices
An increasing number of health care institutions have developed ethics committees whose chief functions include
education, policy making, case review, consultation, and in some cases research.
Intellectual Dimension
encompasses cognitive abilities, educational background, and past experiences. These influence the person's responses to teaching about health and reactions to nursing care during illness. They also play a major role in health behaviors. Examples involving this dimension include a young college student with diabetes who follows a diabetic diet but drinks beer and eats pizza with friends several times a week, and a middle-aged man who quits taking his high-blood-pressure medication after developing unpleasant side effects.
Nursing Process; ADPIE
five-step systematic method for giving patient care; involves assessing, diagnosing, planning, implementing, and evaluating
Morbidity
frequency that a disease occurs
Environmental Dimension
has many influences on health and illness. Housing, sanitation, climate, and pollution of air, food, and water are elements in the environmental dimension. Examples include deaths in older adults from inadequate heating and cooling, an increased incidence of asthma and respiratory problems in large cities with smog, and an increased incidence of skin cancer in people who live in hot, sunny areas of the world.
Holistic Care
health care that takes into account the whole person interacting in the environment
Drugs that are greater than 89% bound to protein are known as
highly protein bound drugs
Evidence based practice
in nursing is a problem-solving approach to making clinical decisions, using the best evidence available (considered "best" because it is collected from sources such as published research, national standards and guidelines, and reviews of targeted literature).
Love and belonging needs
include the understanding and acceptance of others in both giving and receiving love, and the feeling of belonging to groups such as families, peers, friends, a neighborhood, and a community. Nursing interventions such as: Including family and friends in the care of the patient Establishing a nurse-patient relationship based on mutual understanding and trust (by demonstrating caring, encouraging communication, and respecting privacy) Referring patients to specific support groups (such as a cancer support group or Alcoholics Anonymous)
Physical Dimension
includes genetic inheritance, age, developmental level, race, and gender. These components strongly influence the person's health status and health practices. For example, inherited genetic disorders include Down syndrome, hemophilia, cystic fibrosis, and color blindness. Toddlers are at greater risk for drowning, and adolescents and young adult males are at greater risk for automobile crashes from excessive speed. There are specific racial traits for disease, including sickle cell anemia, hypertension, and stroke. A young woman whose mother and grandmother had breast cancer is more likely to have an annual clinical breast examination and mammogram
disease state that results from the presence of pathogens in or on the body
infection
Chain of infection
infectious agent > reservoir > Portal of exit from reservoir > means of transmission > portals of entry > susceptible host
Florence Nightingale
influenced nursing knowledge and practice by demonstrating efficient and knowledgeable nursing care, defining nursing practice as separate and distinct from medical practice, and differentiating between health nursing and illness nursing
Chronic Illness
irreversible illness that causes permanent physical impairment and requires long-term health care
Disease
is a medical term, referring to pathologic changes in the structure or function of the body or mind.
Process
is a series of actions, changes, or functions intended to bring about a desired result.
Health
is a state of optimal functioning or well-being;one's ___ includes physical, social, and mental components and is not merely the absence of disease or infirmity
Integrity
is acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Sample professional behaviors include the following: Provides honest information to patients and the public Documents care accurately and honestly Seeks to remedy errors made by self or others Demonstrates accountability for own actions
Theory
is composed of a group of concepts that describe a pattern of reality. Concepts, like ideas, are abstract impressions organized into symbols of reality.
Illness
is the response of the person to a disease; it is an abnormal process in which the person's level of functioning is changed when compared with a previous level
Philosophy
is the study of wisdom, fundamental knowledge, and the processes used to develop and construct one's perceptions of life
nosocomial
is used specifically to indicate something originating or taking place in a hospital. The source of infection may be either exogenous or endogenous.
Scientific
knowledge obtained through the scientific method (implying thorough research). New ideas are tested and measured systematically using objective criteria.
Nurse Practice Acts
laws established in each state in the United States to regulate the practice of nursing. They are broadly worded and vary among states, but all of them have certain elements in common, such as the following: Protect the public by defining the legal scope of nursing practice, excluding untrained or unlicensed people from practicing nursing. Create a state board of nursing or regulatory body having the authority to make and enforce rules and regulations concerning the nursing profession. Define important terms and activities in nursing, including legal requirements and titles for RNs and LPNs. Establish criteria for the education and licensure of nurses.
drugs that are less than 30% bound to protein are
low protein bound drugs
Drugs that are 61% to 89% bound to protein are
moderately highly protein bound
drugs that are 30% to 60% bound to protein
moderately protein bound drug
Physiologic Needs
need for oxygen, food, water, temperature, elimination, sexuality, activity, and rest; these needs have the highest priority and are essential for survival
Science
observing, identifying, describing, investigating, and explaining events and occurrences that are perceived in the world
endogenous infection
occurs when the causative organism comes from microbial life harbored in the person.
(disease-producing microorganisms
pathogens
Patients with urinary or fecal incontinence are at risk for
perineal skin damage.
Remission
period in a chronic illness when the disease is present, but the person does not experience symptoms of the disease
Exacerbation
period in chronic illness when the symptoms of the disease reappear
Safety and Security Needs
person's need to be protected from actual or potential harm and to have freedom from fear Examples:Using proper hand hygiene and sterile techniques to prevent infection Using electrical equipment properly Administering medications knowledgeably Skillfully moving and ambulating patients Teaching parents about household chemicals that are dangerous to children
Tertiary health
promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate patients to a maximum level of functioning.Nursing activities include teaching a patient with diabetes how to recognize and prevent complications, using physical therapy to prevent contractures in a patient who has had a stroke or spinal cord injury, and referring a woman to a support group after removal of a breast because of cancer.
Acute Illness
rapidly occurring illness that runs its course, allowing a person to return to one's previous level of functioning
Eruptions or inflammations of the skin that may be found anywhere on the body. May be precipitated by skin contact with an allergen, overexposure to the sun, and/or systemic causes, like a reaction to a medication.
skin rashes
Remission
slowing or improvement of a disease process
Traditional
that part of nursing practice passed down from generation to generation; When questioned about the origin of such nursing practices, nurses might reply, "We've always done it this way."
The _____ of a drug concentration in plasma is the level of drug between the minimum effective concentration in the plasma for obtaining desired drug action and the minimum toxic concentration (the toxic effect).
therapeutic range (therapeutic window)
The primary objectives of the nurse as caregiver are to
to prevent illness, to restore health, and to facilitate coping with illness, disability, or death
Knowledge comes from a variety of sources
traditional, authoritative, or scientific.
Two types of bacterial flora are normally found on the hands:
transient bacteria and resident bacteria
To encourage health care professionals to respect and accept the individuality of patients, some educators have advised that professionals be ______ and _________ in their professional roles.
value neutral and nonjudgemental
Self Esteem Needs
which include the need for a person to feel good about oneself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments. Positive self-esteem facilitates the person's confidence and independence.When a person's role changes (e.g., through illness or the death of a spouse), self-esteem can be seriously altered because the person's responsibilities and relationships also change. A change in body image, such as the loss of a breast, an injury, or a growth spurt during puberty, may also affect self-esteem. Nurses must remember that the person's perception of the change—rather than the actual change itself—is what affects that individual's self-esteem (
Self-Actualization Needs
which include the need for individuals to reach their full potential through development of their unique capabilities. In general, each lower level of need must be met to some degree before this need can be satisfied. The process of self-actualization continues throughout life. Maslow lists the following qualities that indicate achievement of one's potential: Acceptance of self and others as they are Focus of interest on problems outside oneself Ability to be objective Feelings of happiness and affection for others Respect for all people Ability to discriminate between good and evil Creativity as a guideline for solving problems and pursuing interests To help meet patients' self-actualization needs, the nurse focuses on the person's strengths and possibilities rather than on problems.
Self Concept
which incorporates both how they feel about themselves (self-esteem) and the way they perceive their physical self (body image
Steps in Implementing EBP
• Step 1: ask a question about a clinical area of interest or an intervention. PICO format • Step 2: collect the most relevant and best evidence • Step 3: critically appraise the evidence • Step 4: integrate the evidence with clinical expertise, patient preferences, and values in making a decision to change • Step 5: evaluate the practice decision or change