NURSING MODULE 2
1. According to Maslow's hierarchy of basic needs, self-esteem is considered the highest basic need (Level 5)
.true
Delirium
Delirium involves a disturbance of consciousness with a change in cognition Development is usually rapid and may fluctuate over the course of the day -Difficulty paying attention -Easily distracted -Disoriented (don't know where they are) -Sensory disturbances (illusions/hallucinations) -May have anxiety, fear, irritability, euphoria
Healthcare Adherence
Factors Influencing ´Patient's motivation to become well ´Inconvenience of illness/ treatment ´Difficulty understanding & performing treatment recommendations ´Amount of lifestyle change needed ´Values/ Beliefs/ Cultural patterns about treatments ´Relationship with healthcare provider ´Complexity/ Side effects/ duration of treatment and meds ´Cost$$$$
KEY CONCEPTS CH 21 The processes of growth and development result from the interaction between heredity and environment. Growth and development are orderly and sequential as well as continuous and complex. Many factors influence growth and development, such as genetics, environment, and nutrition. Genetics, genomics, and epigenetics affect growth and development, including the expression of risk factors and manifestations of specific disease processes. Multiple theorists have developed theories to explain human responses at certain ages during life.
Sigmund Freud's theory of psychoanalytic development emphasizes the effect of instinctual human drives on behavior. Jean Piaget developed a theory of cognitive development that progresses from infancy through adolescence.
wellness
an overall active state of well-being or total health -vitamins -exercise -sleep -you participate in your health
Erik Erikson
explains eight stages through which a healthily developing human should pass from infancy to late adulthood. Erikson assumes that a crises occurs at each stage of development; these crises are of a psychosocial nature because they involve psychological needs of the individual (i.e. psycho) conflicting with the needs of society (i.e. social). According to the theory, failure to successfully complete a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self.
1. Community-based nurses are employed in hospital emergency departments, home health care, school nursing, and occupational nursing.
false
´Secondary Prevention ´
focus on screening for early detection of disease with prompt diagnosis and treatment of any found. ´Screening ´Cure of disease process ´Preventing complications
chronic illness
irreversible illness that causes permanent physical impairment and requires long-term health care -periods of remission
An example of Erikson's stages
is the age of maturity where the crisis is ego integrity versus despair. Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair. When you write your Older Adult case study you will discuss this stage as it applies to your patient.
Carol Gilligan theory views girls and women as developing a morality of response and care, and boys and men as developing a morality of justice.
men and women have different ways of looking at the world. Men are more likely to associate morality with obligations, rights, and justice, whereas women are more likely to see moral requirements emerging from the needs of others within the context of a relationship. This moral orientation of women is called the ethic of care, which develops through three levels.
Maslow's Hierarchy of Needs
physiological, safety, love/belonging, esteem, self-actualization
Remission
the temporary, partial, or complete disappearance of the symptoms of a disease without having achieved a cure
Factors that affect growth & development
•Genetics •Prenatal, individual, & caregiver factors •Environment and nutrition •Culture
What is Gerontological nursing?
•Gerontology the scientific and behavioral study of all aspects of aging and its consequences •Gerontological nursing combines the basic knowledge and skills of nursing with a specialized knowledge of aging in both illness and health. •Geriatrics or geriatric medicine •specialty that focuses on health care of elderly people
GROWTH
•Increase in body size or changes in body cell structure, function, and complexity (first 20 years) •Measurable (in kg., cm., in., etc.)
DEVELOPMENT
•Increase in complexity of function/skill progression/adapting to the environment •Measured by observation
ADULTHOOD
•Young adulthood - 20's and 30's •Middle adulthood- 40's, 50's •Older adulthood- usually refers to 65 and over •Young-old- 60-74 •Middle-old- 75-84 Old-old- 85 and older
Maslow's Hierarchy of Needs pg 67-68
----lower level physiological, safety, love/belonging, -----higher level self esteem, self-actualization
Key Points of Moral and Faith Developmental Theories Fowler: Faith Development
Fowler's six stages may occur over the course of a person's adult life. Prestage: Undifferentiated faith—Centers on relationship with primary caregiver and the safety of the environment Stage 1: Intuitive-predictive faith—Imitates religious behaviors of others; learning also occurs through stories and images Stage 2: Mythic-literal faith—Accepts existence of deity; strong belief in justice; metaphors and symbolism often taken literally Stage 3: Synthetic-conventional faith—Selection of principles to follow; development of a personal identity; concern for the rights and needs of others stage 4: Individuative-reflective faith—Angst possible; personal accountability for beliefs and feelings; awareness of conflicts in the complexities of faith Stage 5: Conjunctive faith—Conflicts resolved; identification of truth Stage 6: Universalizing faith—Enlightenment; universality of faith and principle
1. A __________ refers to the DNA in an organism, including its genes.
GENOME -25% chance, what are your plans -LOOK AT IT TO SEE WHAT RISK FACTORS YOU HAVE
Morbidity
Refers to ill health in an individual and the levels of ill health in a population or group. -how frequent a disease occurs
Wellness CHAPTER 3
Wellness CHAPTER 3
1. Illnesses defined as ______ are the leading health problem in the world today.
_CHRONIC__PG 51__
1. Work or social pressures that cause stress are ______________ risk factors for altered family health.
environmental
Health-Illness Continuum
´Measure person's perceived level of wellness ´Health and illness/disease opposite ends of a health continuum ´Move back and forth within this continuum day by day Wide ranges of health or illness
• Changing Health behaviors -
- Pre-Contemplation: no intention of changing (denies having a problem) - Contemplation: Acknowledges a problem, considering change but still ambient - Preparation - Making small changes in prep, understands the benefits in making change - Action - actively engaging in change strategies (Ex. Having a quit day for smoking) - Maintenance - Sustained change over time, stage lasts until the person no longer has temptations to return to that habit or lifestyle. - Termination - No fear of relapse, adapts to new lifestyle
Which of the following is an example of an acute illness? Diabetes Rheumatoid arthritis Pneumonia Osteoporosis
. Pneumonia Pneumonia is an acute illness that has a rapid onset of symptoms and lasts only a relatively short time. Diabetes, rheumatoid arthritis, and osteoporosis are chronic illnesses that cause a permanent change, require special patient education for rehabilitation, and require a long period of care or support.
1. According to Carol Gilligan's theory, the moral orientation of females is called the "ethic of care."
1. TRUE PG 521
Which one of the following individuals appears to have "taken on" the sick role? 1.An obese client states, "I deserve to have a heart attack." 2.A mother is ill and says, "I won't be able to make your lunch today." 3. A man with low back pain misses several physical therapy appointments. 4. An elder states, "My horoscope says I will be well again."
1.A mother is ill and says, "I won't be able to make your lunch today." 1.The mother has taken on the sick role by expecting to be excused from her usual role responsibilities.
Which one of the following is an example of the emotional component of wellness? 1.The client chooses health foods. 2.A new father decides to take parenting classes. 3.A client expresses frustration with her partner's substance abuse. 4.A widow with no family decides to join a bowling league.
3.Correct. Frustration is an example of an emotion.
•The adolescent has many physical changes occurring as they transition from childhood to adulthood. Hormonal changes produce secondary sex characteristics and mood swings. According to Erikson, role confusion occurs if A. The adolescent is unable to establish an identity B. There are no parents around C. They have rebellious friends D. They make sound decisions about their future
A
Key Concepts Chapter 4 Health of the Individual, Family, and Community Family patterns of behavior, the environment in which the family lives, and genetic factors can all place family members at risk for health problems.
A community is a specific population or group of people living in the same geographic area under similar regulations and having common values, interests, and needs. Nurse-managed centers in communities offer high-quality care to underserved populations in a cost-effective manner.
social determinant of health
Aspects of society and the social environment that impact on health, such as poverty, early life experiences, social networks and support. -conditions in which people are born,live,work,and play -not enough money to buy a car -trails/parks encourage people to go outside
Two continual processes of restructuring knowledge—assimilation and accommodation—stimulate intellectual growth in the child.
Assimilation is the process of integrating new experiences into existing schemata. Accommodation is an alteration of existing thought processes to manage more complex information.
1. According to Kohlberg's theory of moral development, a child's beginnings of moral development result from caregiver-child communications during the early childhood years.
BORN WITH A BLANK SLATE/OBTAIN MORAL DEVELOPMENT FROM PARENTS/FAM ----TRUE (morals)
•Adjusting to decreasing physical strength and health, establishing an explicit affiliation with one's age group, adjusting to death of a spouse, & establishing satisfactory physical living arrangements are developmental tasks for A. adolescence. B. young adulthood. C. middle adulthood. D. later maturity.
C
1. Growth is an increase in body size, structure, and function, whereas ___________ is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning.
DEVELOPMENT __PG 509 CH21
1. According to Havighurst's theory of psychosocial development, the ability to form concepts and distinguish between right and wrong develops during adolescence.
FALSE -early childhood -PG 517
1. The agent--host--environment model of health views health as a constantly changing state, with high-level wellness and death being on opposite ends of a scale.
FALSE -HEALTH ILLNESS CONTINUUM PG 60
1. Illness is a medical term meaning that there is a pathologic change in the structure or function of the body or mind.
FALSE =DISEASE
1. According to Piaget's theory of cognitive development, individuals in the adolescent to adult years integrate others' viewpoints into their own understanding of the truth.
FALSE-TRYING TO FORM THEIR OWN OPINION
The Family in Health and Illness Friedman and associates (2003) identified the importance of family-centered nursing care in four ways.
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.
holistic
dealing with something as a whole rather than by its individual parts -give report -patient centered care where they feel involved
Mortality
death rate The number of deaths resulting from a disease
Lawrence Kohlberg
developed a theory of moral development using levels that closely follow Piaget's theory of cognitive development - recognized that a person's moral development is influenced by cultural effects on the person's perceptions of justice in relationships. A child's beginnings of moral development result from caregiver-child communications during the early childhood years, The concept of morality emerges as a subset of a person's beliefs or values and governs choices made throughout life.
The Health Promotion Model
developed to illustrate how people interact with their environment as they pursue health. The modeterm-60l incorporates individual characteristics and experiences, as well as behavior-specific knowledge and beliefs, to motivate health-promoting behavior. Nurses can use the components of the model to design and provide interventions to promote health for people, families, and communities.
1. Toddlers tend to seek out new experiences during the developmental stages of initiative versus _________, according to Erickson.
guilt
James Fowler Faith is a person's or group's way of moving into the force field of life. It is our way of finding coherence in and giving meaning to the multiple forces and relations that make up our lives. Faith, therefore, is not necessarily religious, but it comprises the reasons one finds life worth living.
his theory is composed of a prestage and six stages of faith development The age when a certain stage occurs varies, but the sequence does not. Fowler explained that a relationship among self, shared causes or values, and others is the unifying factor in all stages and is based on trust. Equilibrium, or a plateau in faith development, can occur at any stage from stage 2 and beyond.
1. The nurse is practicing _____________ nursing when individualized, health-oriented care considers how all human dimensions affecting the patient's basic human needs are met.
holistic
Jean Piaget
learning occurs as a result of the internal organization of an event, forming a mental schema (plan) and serving as a base for further schemata as one grows and develops. Intellectual growth is a continual restructuring of knowledge to progress to higher levels of problem solving and critical thinking.
Examples of models of health promotion and illness prevention include
the health belief model, the health promotion model, the health-illness continuum, and the agent-host-environment model. Many nurse-led initiatives are helping underserved populations deal with illnesses.
1. A family can be defined as any group of people who live together and depend on one another for physical, emotional, and financial support.
true
1. A traditional family with two parents and their children is known as a nuclear family.
true
1. Nursing care provided within a community must be culturally competent and family centered.
true
A family can be defined as any group of people who live together. 1. True 2. False
true ***on test***
The nurse is reviewing the medication profile for an older client who is being evaluated for possible dementia. Which medication(s) could impair the client's cognitive status? Select all that apply. warfarin digoxin acetaminophen theophylline cimetidine
warfarin digoxin theophylline cimetidine There are several medications that can have anticholinergic effects that in the presence of dementia can lead to an increased impact on cognitive status. Medications such as warfarin, digoxin, theophylline, and cimetidine should be reviewed both for clinical indication and dosages. Aspirin rather than acetaminophen can be a concern.
health equity
when all people have the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance
Disease
´A Disease is an alteration in body functions that results in reduced capacities or shorter life span. ´ Etiology= cause of the disease ´ Acute Illness- short-term and severe (ex: flu) ´Chronic Illness-persists >6 months (ex: Leukemia) ´Exacerbations ´Remissions
Neurocognitive Disorders
´A cognitive disorder is a disruption or impairment in the higher level functioning of the brain ´Adult cognitive disorders have been reconceptualized as neurocognitive disorders ´The neurocognitive disorder (NCD) we will be focusing in this module is Dementia. Delirium and Confusion will be briefly mentioned as well.
Illness
´A state in which a person's physical, emotional, intellectual, social, or spiritual functioning is diminished or impaired compared with previous experience. ´Illness is NOT synonymous with disease. ´Nurse focuses on the disease plus the effects of the disease on the person's functioning.
Nursing Process for Dementia
´Assessment by the Nurse: -Obtain a history from family if patient is unable to give information -Appearance and Behavior -Mood and Affect -Thought Processes (first affects recent/immediate memory) -Sensorium and Intellectual Processes -Judgement/Insight -Self (awareness) Concept -Roles & Relationships -Physiologic & Self Care issues
Etiology & Common Types of Dementia
´Causes vary but clinical picture is similar ´ Genetic component has been identified for some dementias (Huntington's disease and Alzheimer's disease ´ May be related to infection such as human immunodeficiency disease or Creuzfeldt Jakob disease ´Most common types of dementia *Alzheimer's disease *Prion diseases (Creuzfeldt-Jakob) *Lewy body dementia *Parkinson's disease *Vascular dementia *Huntington's disease *Frontotemporal lobar degeneration * HIV, TBI (traumatic brain injury
Dementia Onset and Clinical Course
´Clinical course of dementia is progressive ´Described in stages: Mild - forgetfulness that exceeds normal, occasional forgetfulness frequent loosing things; difficulty finding words; remains in the home/community Moderate - apparent confusion; can't perform complex tasks; still oriented to person/place and familiar people; looses ability to live independently Severe - personality/emotional changes occur; may wander, have delusions, forget family members' names; require assistance with ADLs; most live in nursing facilities at this stage
Dementia
´Dementia is defined as a progressive cognitive impairment with no change in the level of consciousness ´Cognitive deficits associated with dementia: Early sign: memory impairment Late: cognitive disturbances: aphasia, apraxia, agnosia and impaired executive functioning Deficits must show a decline from patient's previous functioning and must be severe enough to impair social or occupational functioning
Treatment & Prognosis of Dementia
´Dementia of the Alzheimer's type is the most common type (60% of all dementia's) in North America ´ More common in women ´ Treatment starts with identifying the underlying cause in order to differentiate which type of dementia (Alzheimer's vs vascular etc.) ´Prognosis involves progressive deterioration od physical and mental abilities until death ´ Patients become totally dependent on caregivers ´ Neurotransmitters are decreased in dementia: medications that "replenish" acetylcholine, cholinergic agonists and cholinesterase inhibitors (Aricept, Exelon, Reminyl, Razadyne, Cognex, Namenda) show modest therapeutic effects ´Behaviors can be treated symptomatically: antidepressants, antipsychotics
Risk Factors
´Identifying risk factors is the first step in health promotion, wellness education, and illness prevention activities. ´Nurse help patients to modify risk factors. Age and gender, and genetics are risk factors that cannot be modified.
Tertiary Prevention
´It occurs when a disability/defect has occurred and further disability is prevented. Nursing activities include: ´after an illness is diagnosed and treated, all forms of rehabilitation -medications -medication treatment -surgery
Treatment and Prognosis
´Primary treatment relies on precise identification of causal factors ´True delirium is almost always transient and will clear with treatment of the cause ´Depending on the cause, the patient may be cured completely with proper medical treatment or in the case of head injury or encephalopathy, may be left with residual impairment ´Psychopharmacologic treatment varies depending on the symptoms the patient exhibits. Mild "hypoactive" delirium usually needs no pharmacologic treatment ´Patients with agitation, psychosis or insomnia interfering with treatment may require sedation to prevent inadvertent injury ´Short-acting benzodiazepines (Ativan) are preferred; long-acting benzos are to be avoided as they may worsen delirium
Alzheimer's disease
´Progressive disorder ´Gradual onset with increasing decline in function ´May loose speech, motor function, have personality and behavior changes like paranoia, delusions (altered reality), hallucinations ´ Exhibits belligerence ´ Neglects hygiene ´ Risk for development increases with age ´Post mortem evaluation shows atrophy of cerebral neurons, plaque deposits and 3rd/4th ventricle enlargement
Nursing Interventions for Patients with Dementia
´Promoting patient safety is a priority: protecting against injury and managing risks ´Promoting adequate nutrition, hygiene, sleep and activity ´Providing a structured environment and routine ´Providing emotional support and reassurance ´Promoting Involvement
Etiology of Delirium
´Results from an identifiable physiologic, metabolic or cerebral disturbance or disease ´ ´May result from drug/alcohol intoxication or withdrawal ´Multiple causes may be responsible requiring careful physical examination and diagnostic testing
Cognition
´The brain's ability to process, retain and use information ´Abilities include reasoning, judgement, perception, attention, comprehension, memory ´These cognitive abilities are essential for things like making decisions, solving problems, interpreting the world around us and processing new information
Sociologic Theories of Aging
•Activity theory •Older people should continue a middle-aged lifestyle, denying the existence of old age as long as possible •Continuity/developmental theory •Personality and basic patterns of behavior developed over lifetime will determine whether individuals remain engaged or become disengaged •Disengagement theory •Views aging as a process in which society & individual gradually withdraws from each other to the mutual satisfaction of each other. •Subculture theory •Older adults as a group have a distinct norms, beliefs, expectations, habits, & issues that separate them from the rest of the society •Age stratification theory •Society is stratified by age groups and persons within a similar age group generally have similar experiences, beliefs, attitudes, & life transitions that offer them a unique shared history.
Promoting Growth and Development
•Adults •Support role transitions (marriage, disability, retirement, widowhood "generations sandwich", "empty-nest syndrome"). •Be aware that illness, hospitalization, or changes in living arrangements are major stressors, particularly for older adults. •Encourage self-care and use of support systems. •Encourage life review and reminiscence.
5 leading chronic conditions affecting the older population.
•Arthritis, hypertension, hearing impairments, heart conditions, & visual impairments
Biologic Theories of Aging
•Biologic aging is related to many factors, internal and external to the human body. •Examples •Genetic theory •role of the "genetic clock" on lifespan •Immunity theory •decline of immune system in aging •Cross-linkage theory •accumulation of cross-links that cause damage •Free radical theory •free radicals cause damage over time •Wear and tear theory •aging is due to repeated use and injury of the body over time •
ADOLESCENCE (12-18 years)
•Biophysical: Period during which the person becomes physically and psychologically mature •Puberty is the first stage of adolescence, the time when the ability to reproduce begins. •Girls 9-13, boys 11-14 •First noticeable sign of puberty •Boys: appearance of pubic hair and enlargement of scrotum/testes; milestone is first ejaculation •Girls: appearance of breast buds although appearance of pubic hair may precede this; milestone is menarche
•Infancy (birth to 18 months) •CRISIS: Trust vs. Mistrust Children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust
•Early Childhood (2 to 3 years) •CRISIS: Autonomy vs. Shame and Doubt •Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.
Psychological Theories of Aging
•Erikson's developmental theory •Healthy psychological aging is the result of the successful fulfillment of developmental tasks •Robert Peck refined Erikson's theory by detailing 3 specific challenges facing the older adults that influence the outcome of ego integrity and despair •Ego differentiation vs. role (e.g. parental or occupation) preoccupation •Body transcendence vs. body (absorbed with health problems or physical limitations) preoccupation •Ego transcendence vs. ego preoccupation •To achieve satisfaction through reflection on one's past life and accomplishments rather than be preoccupied with the finite number of years left to live •Robert Butler & Myrna Lewis outlined additional developmental tasks for later life •Adjusting to one's infirmities, developing a sense of satisfaction with the life that has been lived, & preparing for death
•Middle Adulthood (40 to 65 years) •CRISIS: Generativity vs. Stagnation •Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.
•Maturity(65 to death) •CRISIS: Ego Integrity vs. Despair •Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.
SPIRITUAL DEVELOPMENT according to James Fowler
•Prestage-undifferentiated (infant) •Stage 1 -intuitive-projective faith (3-7 year olds) •Stage 2- mythical-literal faith (school-age) •Stage 3 synthetic-conventional faith (adolescents) •Stage 4-individuative-reflective faith (older adolescents/young adults) • Stage 5 conjunctive faith Stage 6 universalizing faith
•Preschool (3 to 5 years) •CRISIS: Initiative vs. Guilt •Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt.
•School Age (6 to 11 years) •CRISIS: Industry vs. Inferiority •Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.
•Adolescence (12 to 18 years) •CRISIS: Identity vs. Role Confusion •Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self.
•Young Adulthood (19 to 40 years) •CRISIS: Intimacy vs. Isolation. Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.
Growth and Development
•are orderly and sequential as well as continuous and complex. •follow regular and predictable trends. •both differentiated and integrated. •Different aspects of G & D occur at different stages and at different rates, and can be modified. The pace of G & D is specific for each person.
Key Concepts Chapter 3 Health, Wellness, and Health Disparities Health of the public is measured by morbidity (how frequently a disease occurs) and mortality (number of deaths). Wellness is an active state that is facilitated by living a lifestyle that promotes good physical, mental, and emotional health. Disease is a pathologic change in the structure or function of the body or mind; illness is the response of the person to a disease. Illnesses are classified as acute or chronic.
People's racial/ethnic group, poverty, biological sex, age, mental health, educational level, disabilities, sexual orientation, health insurance, and access to health care can lead to health disparities. Basic human needs and human dimensions influence a person's behaviors in health and illness. Health promotion refers to a person's behaviors motivated by a personal desire to increase well-being and health potential.
Cognitive Development is the manner in which people learn to think, reason, use language.
Piaget's Developmental Theory (based only on study of children)
Key Points of Moral and Faith Developmental Theories Kohlberg: Moral Development
Preconventional, stage 1: Punishment and obedience—Oriented to obedience and punishment; right and wrong defined by punishments Preconventional, stage 2: Instrumental-relativist—Defines acts satisfying to self and some satisfying to others as right Conventional, stage 3: Interpersonal concordance—Morality of maintaining good relations and approval of others; right and wrong are determined by the majority Conventional, stage 4: Law and order—Being good extends to a person's duty to society; aware of need to respect authority Postconventional, stage 5: Social contract—"Right" and "wrong" determined by personal values; laws are considered, but may be ignored or discounted Postconventional, stage 6: Universal ethical principle— Deeply held moral principles are in accordance with a sense of self and are more important than laws. Few adults ever reach this stage of development
ADOLESCENCE (12-18 years)
Psychosocial Erikson: establishment of identity versus role confusion Havighurst: 7 development tasks (Taylor p.517) Peer groups assume greatest importance Cognitive Piaget: Formal operations (think beyond the present and beyond the world of reality) Moral : Kohlberg (conventional level- "it is the law") spiritual: Fowler (individuating-reflective) May temporarily abandon traditional religious practices
•SIX major stages •Example of developmental tasks for middle age •36-60 years of age Maintaining economic standard of living Performing civic and social responsibilities Relating to spouse as a person Adjusting to physiological changes Assist children to become responsible adults Adjusting to aging parents
QUESTION: How will illness and hospitalization affect the achievement of these tasks?
´Risk factors increase the chances that the person will experience a particular disease. ´
Risk factors are identified on a health history ´Age- very young/old ´Gender- breast cancer in women ´Genetics -sickle cell trait ´Physiologic-obesity ´Health habits- smoking ´Lifestyle- sedentary/ stressful ´Environment- poor sanitation/ air quality
Secondary
Screenings (blood pressure, cholesterol, glaucoma, HIV, skin cancer) Pap smears Mammograms Testicular examinations Family counseling
Key Concepts Chapter 4 Health of the Individual, Family, and Community Meeting basic human needs is essential to the health and survival of all people. Abraham Maslow developed a hierarchy of basic human needs. Physiologic needs that must be minimally met include oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest. Safety and security needs are the next priority, which involve both physical and emotional components. Love and belonging needs include the understanding and acceptance of others in both giving and receiving love, as well as the feeling of belonging to families, peers, friends, a neighborhood, and a community.
Self-esteem needs include the need for a person to feel good about oneself, to feel pride and a sense of accomplishments, and to believe that others also respect and appreciate those accomplishments. Self-actualization needs are the highest level on the hierarchy and include the need for individuals to reach their full potential through development of their unique capabilities. A family is a group of people who live together and depend on one another for physical, emotional, or financial support. Family structures include nuclear families, single-parent families, and other nontraditional family structures.
A client is diagnosed with dementia related to Parkinson's disease. While at a clinic visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to achieve which goal?
Slow deterioration of memory and function Compelling evidence shows that drugs that inhibit acetylcholine (ACh) destruction or increase cholinergic activity can slow deterioration of memory and function. Cholinesterase inhibitors increase availability of ACh by interfering with the enzyme that breaks it down. These centrally acting drugs help elevate the level of ACh by decreasing the binding sites of acetylcholinesterase, which lengthens the potential for cholineregic activity.
1. Everyone's physical development has a predetermined genetic base because of inheritance patterns carried on the chromosomes.
TRUE
Each person defines health in terms of one's own values and beliefs
TRUE
1. An example of a health disparity is the higher incidence of diabetes in the African American and Hispanic populations compared to the White population.
TRUE=DISPARITY-NOT FAIR / (OPPOSITE-EQUALITY) PG 53
Holism
The anthropological commitment to consider the full scope of human life, including culture, biology, history, and language, across space and time.
higher level needs self-esteem needs, which include the need for a person to feel good about himself or herself, 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.
The highest level on the hierarchy of needs is self-actualization needs, which include the need for people 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
1. Chronic illnesses usually have a slow onset and many have periods of ___________ (when the disease is present, but the person does not experience symptoms).
_REMISSION
1. Physical therapy after a stroke is an example of the _____________ level of preventive care.
_TERTIARY__PG 59
health
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
1. Sweating or ____________ are two examples of homeostatic mechanisms that help maintain body temperature within a narrow and safe temperature range.
shivering
´A complex concept ´No universally accepted definition. ´Florence Nightingale, "a state of being well and using every power the individual possess to the fullest extent." ´
WHO "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." ´Models of health depict health as relative (not absolute) and dynamic (not static). Health is a highly individualized perception.
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
health disparities
preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations
´Levels of Prevention ´Primary Prevention ´
preventing the development of disease processes or injury ´ Nursing activities at this level include ´providing health education programs ´providing immunization ´genetic screening ´Examples: Advising people to not smoke/ use sunscreen
1. As human beings, our behaviors, our feelings, and our values all relate to our physiologic and _____________needs.
psychosocial
acute illness
rapidly occurring illness that runs its course, allowing a person to return to one's previous level of functioning
Agent-Host-Environment Model
refers to the interaction of the agent, host, and environment creating risk factors that must be examined -these things may cause a disease
1. Diet, exercise, and weight loss are three examples of primary health promotion.
TRUE
Which of the following is an example of a primary prevention activity? 1.Antibiotic treatment of a suspected urinary tract infection. 2.Occupational therapy to assist a client in adapting his or her home environment following a stroke. 3.Nutrition counseling for young adults with a strong family history of high cholesterol 4.Removal of tonsils for a client with recurrent tonsillitis.
Actions such as diet modification that help to prevent an illness or detect it in its early stages are primary prevention
•A child learns to conform to rules imposed by authority figures such as parents. What is the child's level of moral development? A.pre-conventional B.conventional C.post-conventional
At the preconventional level, morality is externally controlled. Rules imposed by authority figures are conformed to in order to avoid punishment or receive reward
SENSORIMOTOR STAGE (BIRTH TO 2 OR 3 YEARS) This stage is marked by progression through a series of six substages with specific developmental taskS PREOPERATIONAL STAGE (AGES 2 OR 3 TO 6 OR 7 YEARS) use of symbols, through increased language skills and pictures, to represent the preschooler's world (Fig. 21-2). This stage is divided into two parts: the preconceptual stage (ages 2 to 4 years) and the intuitive stage (ages 4 to 7 years). Play activities during this time help the child understand life events and relationships.
CONCRETE OPERATIONAL STAGE (AGES 6 OR 7 TO 11 OR 12 YEARS) Logical thinking is developing, relations between numbers, and loss of egocentricity, in addition to the ability to incorporate another's perspective. -become aware of external events, and realize that their feelings and thoughts may not be the same as those of other children their age. FORMAL OPERATIONAL STAGE (AGES 11 OR 12 TO 14 OR 15 YEARS) use of abstract thinking and deductive reasoning. General concepts are related to specific situations and alternatives are considered. The world is evaluated by testing beliefs in an attempt to establish values and meaning in life.
Abraham Maslow (1968) developed a hierarchy of basic human needs
Certain needs are more basic or essential than others and must be at least minimally met before other needs can be considered -useful for understanding relationships among basic human needs and for establishing priorities of care.
Chapter 24 Cognitive Disorders
Chapter 24 Cognitive Disorders
community-based nursing is centered on the health care needs of individuals and families. Nurses practicing community-based nursing provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Nursing care provided within a community must be culturally competent and family centered. community-based nursing focuses on the members of the population, specifically the individuals and families within the population
Community health nursing focuses on whole populations;
Kholberg= Moralterm-114 Fowler= Faith Piaget= Cognitive
Gilligan= women Freud= Psychosexual
The client is an 84-year-old suffering from delirium. The client has been in a nursing home for the past 2 years but recently is becoming combative and has become a threat to staff. Which medication would the client most likely receive for these symptoms? Galantamine Haloperidol Rivastigmine Tacrine
Haloperidol Staff members must seriously consider this option when a client's behavior threatens the safety of self, family, or staff. Haloperidol, a neuroleptic given either orally or by injection, is most commonly used for symptoms of delirium.
1. The four major components of Freud's theory of psychoanalytic development are the unconscious mind, the _______, the ego, and the superego.
ID PSYCHOSEXUAL DEVELOPMENT
ORAL STAGE (AGES 0 TO 18 MONTHS) the infant uses the mouth as the major source of gratification and exploration. Pleasure is experienced from eating, biting, chewing, and sucking ANAL STAGE (AGES 8 MONTHS TO 3 YEARS) development of neuromuscular control to allow control of the anal sphincter. Toilet training is a crucial issue that requires delayed gratification as the child compromises between enjoyment of bowel function PHALLIC STAGE (AGES 3 TO 7 YEARS) The child experiences conflict and resolution of that conflict with the parent of the same sex (named the Oedipus complex in boys and the Electra complex in girls, based on feelings of intimate sexual possessiveness for the opposite-sex parent). Curiosity about the genitals and masturbation increase during this stage.
LATENCY STAGE (AGES 7 TO 12 YEARS) This stage marks the transition to the genital stage during adolescence. Increasing sex-role identification with the parent of the same sex prepares the child for adult roles and relationships. GENITAL STAGE (AGES 12 TO 20 YEARS) At this stage, sexual interest can be expressed in overt sexual relationships. Sexual pressures and conflicts typically cause turmoil as the adolescent makes adjustments in relationships.
LEVEL 1—PRECONVENTIONAL: SELFISHNESS In level 1, the focus is on the girl's or woman's own needs. Should and would are the same. Morality is seen in terms of sanctions by society. Relationships are often disappointing, and as a result, a woman may isolate herself to avoid getting hurt. The transition that follows this level is characterized by the move from selfishness to responsibility—a move that integrates the responsibility to care for oneself with the desire to care for others.
LEVEL 2—CONVENTIONAL: GOODNESS In level 2, moral judgment is based on shared norms and expectations, and societal values are adopted. Acceptance by others becomes critical, and the ability to protect and care for others becomes the defining characteristic of female goodness. This characteristic is upheld through beliefs that person is responsible for the actions of others but that others are responsible for the choices they make. As a woman examines her self-sacrifice, the second transition occurs, with the woman asking if her own needs are not also important. A shift from goodness to truth (as well as a new conception of goodness) takes place.
KEY CONCEPTS CH 21 The theories of psychosocial development proposed by Erik Erikson are based on stages of development, developmental goals or tasks, psychosocial crises, and the process of coping. Robert Havighurst believed that living and growing are based on learning and adjustment to changing social conditions.
Laurence Kohlberg's theory of moral development recognized the influence of cultural effects on a person's perception of justice in interpersonal relationships. James Fowler's theory focuses on the spiritual identity of humans. Nurses must plan care based on a person's general and unique health needs with attention to growth and development processes and alterations in health status.
Tertiary
Medication Medical therapy Surgical treatment Rehabilitation Physical therapy Occupational therapy Job training
1. A family history of cancer is considered a ____________ risk factor for illness.
NONMODIFIABLE PG 55_
Applying Maslow's Theory
Nurses can apply Maslow's hierarchy of basic needs in the assessment, planning, implementation, and evaluation of patient care. The hierarchy can be used with patients at any age, in all settings where care is provided, and in both health and illness. It helps the nurse identify unmet needs as they become health care needs. The hierarchy of basic needs allows the nurse to locate the patient on the health-illness continuum and to incorporate the human dimensions and health models into meeting needs
Nurses evaluate patients' (Physiologic Needs ) oxygen needs by assessing skin color, vital signs, anxiety levels, responses to activity, restlessness, and mental responsiveness, body temperature as a vital sign,weighing the patient help assess a patient's water balance,nutritional status is assessed with a variety of indicators, including weight, muscle mass, strength, and laboratory values. Nurses can help meet (Safety and Security Needs) by encouraging spiritual practices that provide strength and support, by allowing as much independent decision making and control as possible, and by carefully explaining new and unfamiliar procedures and treatments.
Nurses should always consider love and belonging needs when developing a care plan, including interventions such as: Including family and friends in the care Establishing a nurse-patient relationship based on mutual understanding and trust (by demonstrating care, encouraging communication, and respecting privacy) Referring patients to specific support groups (such as a cancer support group or Alcoholics Anonymous Nurses can help meet patients' self-esteem needs by respecting their values and beliefs, encouraging patients to set attainable goals, and facilitating support from family or significant others. These actions promote a sense of worth and self-acceptance. To help meet patients' (self-actualization needs), the nurse focuses on the person's strengths and possibilities rather than on problems. The following is an example of a nurse assisting a patient to meet self-actualization needs:
1. According to Erickson's theory of psychosocial development, the school-aged stage is characterized by the theme of __________ versus inferiority.
PG 516 INDUSTRY
PRECONVENTIONAL LEVEL Kohlberg's preconventional level of moral development is based on external control, as the child learns to conform to rules imposed by authority figures. At stage 1, punishment and obedience orientation, the motivation for choices of action is the fear of physical consequences of authority's disapproval CONVENTIONAL LEVEL The conventional level of moral development involves identifying with significant others and conforming to their expectations. The person respects the values and ideals of family and friends, regardless of consequences.
POSTCONVENTIONAL LEVEL The postconventional level of moral development involves moral judgment that is rational and internalized into standards or values. At stage 5, social contract and utilitarian orientation, correct behavior is defined in terms of society's laws. Laws can be changed, however, to meet society's needs while maintaining respect for self and others.
• Illness behaviors -
People who are ill generally act in a certain way, these behaviors are a coping mechanism, illness behaviors are affected by internal variable (Perceptions of the illness) or external variables (Culture, Finances
The Health Belief Model focuses on what people perceive or believe to be true about themselves in relation to their health. (1) perceived susceptibility to a disease, (2) perceived seriousness of a disease, and ( 3) perceived benefits of action.
Perceived susceptibility to a disease is the belief that one either will or will not contract a disease. It ranges from being afraid of developing a disease to completely denying that certain behaviors may cause illness. Perceived seriousness of a disease concerns the person's perception of the threat that disease poses to health and its effects on the person's lifestyle. Perceived seriousness depends on how much the person knows about the disease and can result in a change in health behavior. The perceived benefits of action are the person's beliefs about how effectively measures will prevent illness. This factor is influenced by the person's conviction that carrying out a recommended action will prevent or modify the disease and by the person's perception of the cost and unpleasant effects of performing the health behavior (compared with not taking any action).
Which of the following is an example of a nursing activity that promotes secondary prevention as a level of preventive care? 1. Conducting a smoking cessation class-education 2. Performing a blood pressure screening at a local mall-secondary 3. Performing range-of-motion exercises on a bedridden patient-tertiary 4. Promoting safer sex practices in school settings-primary
Performing a blood pressure screening at a local mall-secondary Secondary preventive care focuses on early detection of disease, such as the heart disease in this example. Primary preventive care is directed toward promoting health and preventing diseases. Tertiary care begins after an illness is diagnosed to reduce disability and rehabilitate patients.
lower level needs
Physiologic needs—for oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest—must be met at least minimally to maintain life. These needs are the most basic in the hierarchy of needs and the most essential to life, and therefore have the highest priority. Safety and security needs come next in priority after physiologic needs, and have both physical and emotional components. Physical safety and security means being protected from potential or actual harm.Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. 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.
The ego includes intelligence, memory, problem solving, separation of reality from fantasy, and incorporation of experiences and learning into future behavior
The superego is the part of the mind commonly called the conscience. It develops from the ego during the first year of life, as the child learns praise versus punishment for actions. The superego represents the internalization of rules and values so that socially acceptable behavior is practiced.
The four major components of the mind according to Freud's theory are the unconscious mind, the id, the ego, and the superego:
The unconscious mind contains memories, motives, fantasies, and fears that are not easily recalled but that directly affect behavior. The id is the part of the mind concerned with self-gratification by the easiest and quickest available means. Defense mechanisms are a means of unconscious coping to reduce stress in the conscious mind when the id's impulses cannot be satisfied The ego is the conscious part of the mind that serves as a mediator between the desires of the id and the constraints of reality so that a person can live effectively within his or her social, physical, and psychological environment.
Robert J. Havighurst- "Developmental Tasks" living and growing are based on learning, and that a person must continuously learn to adjust to changing conditions. He described learned behaviors as developmental tasks that occur at certain periods in life. Successful achievement leads to happiness and success in later tasks, whereas unsuccessful achievement leads to unhappiness, societal disapproval, and difficulty in later tasks.
one that arises at a certain period in life, the successful achievement of which leads to happiness and success with later tasks; qTasks that arise from physical maturation ("bio"). qFor example, learning to walk, talk, and behave in an acceptable way sexually during adolescence; adjusting to menopause during middle age. personal sources ("psycho"). qFor example, those that emerge from the maturing personality and take the form of personal values and aspirations, such as learning the necessary skills for job success. the pressures of society ("social"). For example, learning to read or learning the role of a responsible citizen.
