Fundamentals of Nursing Exam 1

emotional responses to stressor,stress, and adaptation

Depressed mood Anger Anxiety (most common)

Core Elements of Gerontological Nursing Roles

* Evidence Based Practice using research and scientific information to guide actions* Standards desired, evidence-based expectations of care that serve as a model against which practice can be judged * Principles Proven facts or theories that guide nursing practice bases on scientific data

Role of Nurse within inter-professional team

*Caregiver *Communicator *Teacher/Educator *Counselor *Leader *Researcher *Advocate *Collaborator

Explain factors that can cause stress in nursing profession

Assuming responsibilities for which one is not prepared for Working with unqualified personnel Working in environment in which supervisors and administrators are not supportive Caring for a patient during cardiac arrest or for a patient who is dying Experiencing conflict with a peer Integrate knowledge

Auscultation techniques

Auscultation-the act of listening, either directly or through a stethoscope/other instrument, to sounds within the body as a method of diagnosis. Breath sounds Carotid arteries Heart sounds Blood Pressure Abdomen for bowel sounds Characteristics of sounds heard when using auscultation Pitch — ranging from high to low Loudness — ranging from soft to loud Quality — e.g., gurgling or swishing Duration — short, medium, or long HOWEVER for Abdominal Assessment: sequence is inspection, auscultation, percussion, then palpation

Describe various levels of nursing education and requirements for practice as a nurse

CNA-

Define health,illness,wellness, disease, exacerbation and remission

Heath-is a state of optimal functioning or well-being including physical, social, and mental components, not just merely the absence of disease or infirmity Wellness- an active state of being healthy, including living a healthy lifestyle that promotes goo physical, mental, and emotional health *Disease: pathological changes in the structure or function of the body or mind *Illness: Response to disease, Change in level of function Taylor 2019 p.51 *Remission: when the disease is present, but the person does not experience manifestations * Exacerbation: manifestations of the disease reappear

Discuss nursing interventions for patient experiencing physiological/psychological stress

Nurses, by recognizing the patient's needs and reactions, they should choose those interventions that it will be the most effective for the particular patient [40-44]. Most important intervention for alleviating stress are: anxiety reduction, anger management, relaxation and sleep, proper diet, physical exercise, relaxation techniques and effective time management [26,45 -47].

General Adaptation Syndrome (GAS)

Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion.physical response of entire body response to physical or emotional situation

Physical responses to stressor,stress, and adaptation

Sweaty palms, increased heart rate, trembling, shortness of breath, muscle tension

Describe Phases of Nurse-Patient Relationship

The phases are preorientation, orientation, working, and termination.

reflex pain response

automatic response of the central nervous system to the stimulus of pain

Describe the communication process

The process of exchanging information and the process of generating and transmitting meanings between two or more individuals The most primary aspect of a nurse-patient interaction Basic to human functioning and well-being. Essential component of life The foundation of society LEARNED SKILL The building blocks of the professional/ interpersonal relationships Primary aspect of a nurse-patient interaction Stimulus (Reference- ATI) Based on someone's need to communicate Sender (source or encoder): initiates or begins the communication process. Message (what is actually said or written): chart, nursing note, telephone conversation Channel (medium selected to send the message): words, cues, sight, observation, perception, touch) Receiver (decoder): translates and interprets the message Feedback (Message send by the receiver back to the sender): Verbal or none verbal (nod of the head, yawn) Noise (Environment ATI)- The emotional and physical climate in which the communication takes place. Factors that can distort message are noise (television, patient experiencing pain) Forms of communication The sending and receiving of messages is accomplished through verbal and nonverbal communication techniques. These can occur separately or simultaneously A person's use of written and spoken language reveals aspects of the persons intellectual development, educational level, and geographic and cultural origin Nurses must also consider whether English is a second language for the patient Nurses use verbal communication extensively when providing patient care including verbal interaction with the patient and family, giving oral report to other nurses, writing care plans, and writing nursing notes It often helps the nurse understands subtle and hidden meanings in what the patient is saying verbally Example a nurse asked the patient how they feel today the patient responds I feel all right but does not maintain eye contact and his facial expression is tense. This would indicate that the nurse should investigate further because the verbal communication (words) doesn't match the nonverbal communication ( body language) Electronic and Communication The Internet and a variety of social websites provide new and challenging opportunities for nurses to communicate and collaborate with other The challenges of using social media include Protecting patient privacy and confidentiality Preventing unintended use of patient information Preventing unintended consequences for the employer or nurse Social media are web-based technology that allow users to create , share and participate in dialogue in virtual communities and networks Social media networks allow nurses to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practice examples of common websites used by nurses: Facebook, Twitter, LinkedIn Concerns about social media occurs when nurses inadvertently reveal information about patients that compromise the patient's privacy. Even describing the patient using a room number or diagnosis rather than the name is still considered a breach of confidentiality and a violation of patient privacy Nurses must adhere to health insurance portability and accountability act *Verbal - Exchange of information using words, including both the spoken and written word *Non-Verbal -Non-verbal communication-body language; helps people understand subtle and hidden meanings in what is being said verbally -Information is exchanged through nonverbal communication in various ways. It is generally accepted that nonverbal communication expresses more of the true meaning of the message than verbal communication. Therefore nurses must be aware of both the nonverbal message they send and the nonverbal message they receive from patients Nurses working with patients from diverse cultural backgrounds should attempt to understand cultural variations to avoid misunderstanding nonverbal communication. -The transmission of information without the use of words (body language) -Examples- Touch, Eye contact, Facial expressions, Posture, Gait, Gestures, General appearance, Mode of dress and grooming, Sounds, Silence

Document nursing data steps

To report is to give an account of something that has been seen, heard, done, or considered Taylor Page 474-475 ▪ Reporting can be oral, written, or computer based ▪ Common methods ▪ Face-to-face meetings ▪ Telephone conversations ▪ Messengers ▪ Written messages ▪ Audiotaped messages ▪ Computer messages Transferring/Discharging ▪ Client's medical diagnosis and providers ▪ Review of health status(physical and psychosocial) plan of care, and recent progress. ▪ Care that is needed within the next few hours ▪ Most recent vital signs ▪ Medication currently prescribed and last dose administered including prn. ▪ Allergies ▪ Diet and activity orders ▪ Need for special equipment. ▪ Advance directives and resuscitation status ▪ Family involvement in care and health care proxy Consultations: the process of inviting another professional to evaluate and make recommendations for treatment ▪ Follow the facility policy and procedure ▪ Referrals: the process of sending or guiding the patient to another source for assistance ▪ Follow the individual the facility and the receiving facility policies ▪ Provide accurate and current information ▪ Patient must be informed and approve the referral to another facility or health personal Aims of Documentation ▪ Complete, accurate, concise, factual and organized ▪ The data is communicated in a timely and confidential manner to facilitate care coordinate and serve as a legal document If it wasn't charted it wasn't done!!!! Taylor p. 453 Factual, Accurate, Concise: ▪ Subjective (patient says) " I feel sick" ▪ Objective (nurse observers) Temperature 99.2 ▪ What the nurse sees, hears, feels, and smells without any interpretation/opinion ▪ Reflects the nursing process (assessment, intervention, and evaluation) ▪ Professional responsibility: only document the assessment, and intervention you preformed ▪ Avoid words "good", "average", "normal", "WNL" ▪ Use Facility approved Abbreviation and Symbols Taylor 2019 p.459 Box 19-3 Nursing Documentation is the written or electronic, legal record of all pertinent interaction with the patient. ▪ When you document effectively your patient's medical record reflects your professionalism. ▪ Documentation helps promote continuity of care 1 in 4 malpractice suits are decided on the basis of the information in the patients medical Records Remember if it is not documented, it's not done! Timing is important ▪ Time of documenting ▪ Time of assessment ▪ Time of intervention ▪ Time of evaluation ▪ Organized logical manner Complete and Current ▪ Begin each entry with Date and time of entry ▪ Never pre-chart assessments , interventions , evaluation ▪ Facility protocol Paper chart ▪ Correct chart & correct patient (pt.) ▪ Write legibly in non erasable black ink, sign all entries with full name and title ▪ Use correct grammar and standard terminology, never skip lines/draw a single line through blank space ▪ Never use white out of blacken out an entry, If a mistake is made, draw a single line through data, reason why and initial and date ▪ "Late entry" must include the time charting was done and the specific time the charting reflect Electronic medical records (EMR) or Electronic health record (EHR) ▪ Make sure the screen is open to the correct pt. ▪ Follow facility policy for documentation ▪ Do not leave the computer terminal unattended with pt. information displayed on it or where others may see it

local adaptation syndrome (LAS)

localized response of the body to stress, precipitated by trauma or pathology

inflammatory response

nonspecific defense against infection, characterized by redness, heat, swelling, and pain

pulse pressure

the difference between systolic and diastolic blood pressure

pulse deficit

the difference between the rate of an apical pulse and the rate of a radial pulse

ANA's standards of practicing for Gerontological Nursing

*A wide variety of specialty practice and special interest organizations provide information on specific areas of nursing, providing published work in the special area with EBP. Many involve certification *ANA set the Standards of practice for Gerontological Nurses bases on the nursing process Review pg.26

Difference between healing and curing

*Chronic disease care measures focus on helping patients effectively live in harmony with, rather than cure the condition * The goal is to maintain a high-quality, satisfying life and not be controlled by the disease *Healing: Implies the mobilization of the body, mind, and spirit to control symptoms *Goals -Maintain or improve self-care capacity -Manage the disease effectively -Boost the body's healing abilities -Prevent complications -Delay deterioration and decline -Achieve the highest possible quality of life -Die with comfort and dignity *Nurse Role in Managing Chronic Care • Facilitate the healing process • Guide individuals to achieve their maximum potential and highest attainable QOL • Create a therapeutic human and physical environment • Educate, empower, reinforce, affirm, validate, and remove barriers (Compare and contrast acute and chronic illness) *Acute Illness -Generally has a rapid onset of symptoms and lasts only a relatively short time -Person returns to normal function -Examples: Appendicitis, Pneumonia, Diarrhea, Common cold/Flu *Chronic Illness -A permanent change, irreversible, develops slowly & persist for a long period of time, often for the remainder of life -Periods of Remission & Exacerbation 3 months or longer -Examples: Diabetes COPD Arthritis Cystic Fibrosis

Scope of chronic conditions in older population

*Chronic illness is the leading health problem in the world: AIDS, Heart & lung diseases *Current trends that result in an increase in chronic illnesses include -Aging -Lifestyle choices (smoking, alcohol, & drug use) -Environmental factors (↑ air & water pollution) - And the effect of increasing obesity *Impact of medical technology on aging *Eighty percent of older adults have at least one chronic disease * Incidence of chronic disease is higher with advancing age *Impact on quality of life (QOL) * 7 in 10 people age 65 and older will need chronic illness care *Effects of Chronic illness - Physical suffering -Loss -Worry -Grief -Depression - Functional impairment -Dependency *Factors that Influence Chronic Illness -Age Obesity in youth -Health habits (smoking, alcohol , exercise, nutrition, lifestyle, occupation, environment) - Early prevention and physical activity can help prevent such declines.

Describe identifying factors that influence communication

*Developmental level: the rate of language development is directly correlated with the patient's neurologic competence (without deficits) and cognitive development. (intellectual ability-thinking, reasoning, etc.) As a nurse we must know each age group and this will guide your interactions with patients *Young children: concrete, simple terms (a 10 yr. old has limited understanding of what an infection is there fore explain in simple terms so that the child is cooperative with treatment is not frighten *Adolescents: are developing abstract thinking there fore using more detailed explanations can be used with this developmental level, being familiar with commonly used slang doesn't hurt either and usually helps with communicating with the adolescent *Adults can be detailed and accurate, they may have previous experiences with health care that was either positive or negative which influences communication with this developmental level as well Older adults may have deficits, e.g., difficulty with hearing, difficulty with sight, confusion, dementia, depression all which could effect good communication *Gender: Some believe that males and females communicate differently, others do not; females use language to seek confirmation, minimize differences, establish intimacy, males use language to establish their independence and to negotiate status activities in large groups. -Some believe that sexual roles are becoming less distinct; What ever the belief we as nurses need to be sensitive to any differences that may exist *Sociocultural differences: culture refers to the common lifestyles, languages, behavior patterns, traditions, and beliefs that are learned and passed from one generation to the next; provides each person with specific rules for dealing with the universal events of life. *The healthcare system is a culture with its own customs, values, and language all influencing communication Space & Territoriality: people are most comfortable in areas they consider their own. -Example this is my space! (This urge to maintain an exclusive right to a certain space is termed territorial.) *You will find that patients behave differently when being interviewed in their homes, and health fair in a mall, are in an institutional setting. It's important to understand how territoriality influences the nurse patient relationship -Public zone: 12-15 feet ( is used to communication when speaking) -Social zone 4 to 12 feet -Personal zone 1 ½ to 4 feet -Intimate zone 1 to 1 ½ feet -Social Zone: hands, arms, shoulders back -Private Zone: mouth, feet, face, neck, front of body, genitalia *Physical mental and emotional state: the degree to which people are physically comfortable and mentally and emotionally free to engage in interactions also influences communication. -A full bladder, a dull headache, crushing chest pain, anxiety about a pending diagnoses or concerns about what is happening at home or at work and fears can negatively influence communication -For example patients who think that a nurse wants to hurt them will be difficult to interview, be sensitive to the patient's physical mental and emotional barriers for effective communication -Cognitively impaired patients present special communication challenges. For example an older patient who has aphasia is agitated due to pain from an abscessed tooth may be unable to communicate with the nurse Values -Communication is influenced by the way people value themselves or one another. Nurses who believe that teaching is an important aspect of nursing and who value empowering patients will communicate that to the patient's -Conversely, a nurse who believes teaching is an unimportant chore is unlikely to be an effective teacher. -Similarly, patient's motivation or lack of motivation influence nurse patient communication Do they value the subject......do they perceive this as important Environment -Communication happens best when the environment facilitates the easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music and interior decorations might help put the patient at ease -Example patient with newly diagnosed HIV will find it difficult to discuss sexual history of genital warts in an area that lacks privacy A toddler might find it easier to communicate if a parent, favorite stuffed animal or blanket is nearby

Types of health assessments

*Integral component of preventative care -establishes a baseline *Establishes the nurse patient relationship *Gathers data about the patients general health status *Identify patients strengths *Identify actual and potential health problems *Establishes a base for the nursing process Health assessment: involves gathering information about the health status of the patient. - Health assessment consist of two parts Health history : includes a collection of subjective information that provides information about the patient's health Physical assessment: is a collection of objective data that provides information about the changes in the patient's body systems Comprehensive assessment: includes a health history and a complete physical examination. Ongoing partial assessment: is one that is conducted at regular intervals Focused assessment: is conducted to assess specific problem Emergency assessment: is a type of rapid focus assessment when addressing a life-threatening unstable situation.Precautions to prevent infection *Prevent patient to patient transmission *Personal protection *Prevents contamination from one body area to another *Infection control principles *Handwashing -Soap & water (necessary when hands are visible soiled with blood or body fluids) *Alcohol-based hand rubs *Use of gloves *Standard precaution (PPE) * Let patient know it is a protection for them from you Assessing level of awareness 1. Person: what is your name, How old are you? Who came to visit you this morning 2. Place: where are you now? What is the name of this city? What state are we in? 3. Time: what is todays date? What day of the week is it? What season of the year is this? What was the last holiday? 4. Event/ Situation: What is happening? What just happened? Alert and orientated times four (AAOX4)

Discuss effects of nursing organizations, nursing standards, nursing practice acts, and nursing process

*Nursing is a Profession * Well defined body of specific and unique knowledge *Professional organization that sets standards *Recognize authority by a professional group *Strong service orientation *Code of ethics * Ongoing research *Autonomy and self-regulation *Professional Organizations -Nurse Practice Act *Protect the public *State Board of Nursing *Requirments and titles RN &LPNS *Establish education and licensure for nurses -Nursing Process *Evaluation *Assessment *Nursing diagnosis *Planning *Implementation -American Nurses Association (ANA ) - Establish standards of nursing practice. Ensures knowledgeable, safe, and comprehensive nursing care Standards of Nursing Practice Review pg.18 box 1-4 Assessment Diagnosis Outcome Planning Implementation Evaluation Ethics Education EBP and Research Quality of practice Communication Leadership Collaboration Professional Evalutation Resource Utilization Environment Health Collegiality -National League of Nursing (NLN)-foster the development and improvement of all nursing services and nursing education. also the primary source of research data about nursing education -American Association of Colleges for Nursing(AACN)-establishing quality educational standards, influencing the nursing profession to improve healthcare, and promoting public support of BAand Graduate education, research, and nursing-practice -National Student Nurses Association(NSNA)-established in 1952 with the assistance of ANA and NSNA is the national organization for students enrolled in nursing education programs

Identify trends in nursing

*Nursing shortage-demand exceeds supply * Evidence-based practice (EBP) *Community-based nursing *Decreased length of hospital stay *Aging population * Increase in chronic care conditions *Independent nursing practice *Culturally competent care *Technological explosion

Describe 2021 National Patient Saftey Goals and Implementation for Patients

*The Joint Commission Accredits healthcare organizations such as ambulatory care, assisted living, -Long-term care (LTC) and Acute care -Established National Patient safety Goals (NPSG's)to improve quality of care and decrease medication errors NPG'S *Hospital/Acute Care - Identify patient correctly Use at least two ways to identify patients. For example, use the patient's name and date of birth. Make sure that the correct patient gets the correct blood when they get a blood transfusion. -Improve staff communication Report critical results of tests and diagnostic procedures on a timely basis. Get important test results to the right staff person on time. Hand off communication (SBAR) -Use Medicine safely Label medicines that are not labeled. Take extra care with patients who take medicines to thin their blood. Record and pass along correct information about a patient's medicines. (medication reconciliation) -Use Alarms Safely Make improvements to ensure that alarms on medical equipment are heard and responded to on time. -Prevent Infection Use the hand cleaning guidelines from the Centers for Disease Control Use proven guidelines to prevent infections Difficult to treat Central lines Surgical Catheter -Identify patient safety risk Find out which patients are most likely to try to commit suicide. -Prevent mistakes in surgery Make sure that the correct surgery is done on the correct patient and at the correct place on the patient's body. Mark the correct place on the patient's body where the surgery is to be done. Pause before the surgery to make sure that a mistake is not being made. * Nursing Care Center/Nursing home -Identify resident correctly Use at least two ways to identify patients. For example, use the patient's name and date of birth. Make sure that the correct patient gets the correct blood when they get a blood transfusion. -Use medication safely -Prevent infection -Prevent resident from falling -Prevent bed sores/pressure injury

Describe each level of Maslow's hierarchy of needs.

-Physiologic needs Oxygen, Water, Food, Temp, Elimination, Sexuality, Physical activity, & Rest Must be met at least minimally to maintain life Most basic & most essential to life and therefore have the highest priority Oxygen -most essential -Safety and security needs Hand washing, Sterile technique Using Electrical Equipment properly Administering Medication Knowledgeably Building a nurse /patient trusting relationship Skillfully moving and ambulating patien -Love & belonging needs Understanding and acceptance of others, giving and receiving love Feeling of belonging, to groups, family, peers, friends unmet -lonely, isolated, withdraw, overly demanding, critical Include family in care Establish NPR, Refer to support groups (AA) -Self-esteem needs Feel good about self, and sense of pride, Believe others respect and appreciate their accomplishments Altered with role changes or change in body image Nursing Activities Respect their values, beliefs; facilitate family support. Promote sense of worth and self acceptance -Self-actualization Morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts Respect for all people Ability to discriminate between good & evil Nursing intervention Focus on patients strengths, reminisce, discuss life's accomplishment

normal range of respiratory rate

12-20 adult 15-20 adolescent 15-25 school age child 20-40 toddler 30-80 newborn

Abbreviations and symbols used for nursing documentation

Abbreviation & Symbols: use only facility approved abbreviations & symbols ▪Examples ▪ AMB =ambulation ▪ PRN= as needed ▪ OOB= out of bed ▪ BP= blood pressure ▪ SOB= short of breath ▪ ABD= abdomen ▪ FUO=fever of unknown origin CBG-Capillary Blood Glucose Monitoring Ad-Lib- At one's liberty BS-Bowel Sounds Bs-Breath sounds PWD- Partial Weight Baring

anxiety

An emotional state of high energy, with the stress response as the body's reaction to it. Emotional response to stress Experienced by all Vague/uneasy feeling of discomfort/dread 4 levels Mild Anxiety Normal anxiety Increases alertness Motivates learning Signs and symptoms/manifestations = restlessness, difficulty sleeping, increased questioning Moderate Anxiety Focus on self and immediate concerns, narrows one's perceptual field Inattention to other communication or details Signs and symptoms/manifestations = shaking voice, tremors, "butterflies," slight increase in P, RR Severe anxiety Very narrow focus Concentration severely impaired/limited Behavior focused on getting relief Signs and symptoms/manifestations = difficulty communicating, rapid P, hyperventilation, increased motor activity Panic Loss of control Irrational, unreasonable Feeling of impending doom Can lead to exhaustion, death, mental illness Person unable to learn, concentrate only on present Signs and symptoms/manifestations = palpitations, chest pain, SOB, diaphoresis, very rapid RR Nursing Interventions - remain calm, stay with patient, reassure patient they are safe. Use simple, concrete words in a calm voic

Describe evidence-based practice (EBP) in nursing

Body of Knowledge- achieve provides the rational for for nursing intervention (EBP) Application of Knowledge- Art applied through clinical practice Traditional- passed down generation to generation Authoritative- comes from an expert and is accepted as truth Scientific (EBP)-obtained through the scientific method-through research-new ideas are tested and measured systematically using objective criteria

Coping and Defense Mechanisms

Coping Mechanisms Behaviors to reduce stress and anxiety: Crying, laughing, sleeping Physical activity, exercise Smoking, drinking Withdrawal Limiting relationships Task- Oriented Reaction to Stress Coping mechanisms used at higher levels of stress: Attack behavior Withdrawal behavior Compromise behavior Ego Defense Mechanisms Unconscious reactions to stress Useful in mild to moderate anxiety Extreme - can distort reality Common Defense Mechanisms Denial Displacement Compensation Rationalization Repression see Taylor text p 1666 for full list, responsible for all

Compare/contrast developmental and situational stress

Developmental stress- when a teenager transitions into adulthood (Infants learning to trust others) Situational stress- when a life event disrupts a person's psychological equilibrium (loss of job, death of a loved one, new job)

Discuss impact of aging population on healthcare system

Discuss the impact of an aging population on the health care system *Life expectancy has increased: 1930: 59.7 years 1965: 70.2 years Present: 78.2 years Life span currently is 122 years for humans Baby Boomers 1946-1964 *"Gerontological Explosion" What is the effect on healthcare and the nursing force? ▪ Older adult care workforce is dangerously understaffed and unprepared to care for growing numbers. ▪ Fewer younger adult ▪ Diminishing Financial support ▪ Gerontological Nurse are advocates in ensuring the cost containment efforts do not jeopardize the welfare of older adults ▪ There is a need for effective health practices to achieve wellness • What is the cause and effect relationship between services and wellness?

apply Maslow's Hierarchy of Needs to caring for older adults with chronic illness

During late adulthood, age 65 to death, the way people fulfill their needs can change dramatically. While some people do age "easily" not having many issues, some people have health problems as they age preventing them from filling their needs independently. Whether it is at an assisted living center or a retirement community, the elderly often need assistance. This picture shows an assisted living facility's dining room where they make sure the people that live in their community get the proper nutrients. Some elderly are on specific diets that require specialized meals. At assisted living centers they provide this. SAFETY NEEDS Picture As with protecting children from abuse, society starts to take the burden off of the elderly by addressing their safety needs as well. Health care is imperative for the elderly. Whether they are independent and relatively healthy, or suffering from an illness in an assisted living facility, the elderly are in constant need for health and prescription drug insurance. Some are lucky enough to have this provided by their old employer, but others often have fewer options. This is when society steps in with programs like Medicare to help fulfill these needs. Healthcare has become so expensive that even well off elderly people often have trouble providing it for themselves. The picture is of President Johnson signing the Medicare bill into law on June 30, 1965. This is one way some elderly fill the need for healthcare as a safety need. BELONGING AND LOVE NEEDS Picture Belonging and love needs can be a confusing thing for late adults. Some are losing their independence and many are experiencing the loss of loved ones and friends. There are many programs and activities for the elderly throughout most communities. Some places run day long bus trips to casinos or antique stores. Another way late adults cope with some of the loss is to be more involved with their church. Churches provide many opportunities for the elderly to socialize both with other elderly people and the young members of the church. Church can fill the need to feel like you belong. This picture shows how church can provide the elderly chances to get involved with younger and diverse people. It provides them with an opportunity to be out in the community and socialize. ESTEEM NEEDS Picture Esteem needs can be an important aspect for late adults. They tend to correlate respect with freedom. As their freedom and abilities decrease, the may feel less respected as well. This is particular true in the United States where getting old has a stigma attached to it. Elderly are often stereotyped and getting old is looked at negatively. On way for the elderly to gain or maintain respect is by sharing their wisdom and experience. Many elderly can be a wealth of information on specific topics and could share that with others interested in that topic. The people they share with will find respect in the elderly person. This picture is of an elderly person that has chose to be a professor. He shares his wisdom and is looked at with respect. Just because someone is "old" does not mean they are not of value. SELF-ACTUALIZATION Picture Late adulthood is where we see the most self-actualization. Elderly people seem to know who they are and their abilities. This makes sense because they have had the most time to figure it out. Elderly people tend to know how they feel about something or someone without much thought going into it. This is because they know and understand who they are, what they like, and what their abilities are. However in many cases, as late adults get closer to death, they can loose this perspective and not be self-actualized

Purpose of equipment used for health assessment

Equipment Required Thermometer & sphygmomanometer: body temperature and blood pressure Scale: measures height and weight Flashlight or pen light: view inside mouth & pupil reactions PERRLA Reaction Assessing papillary reaction to Light Pupils size Assessing normal size of pupils Aduly normal size- 2-4mm Light, 4-8mm Dark Ophthalmoscope: visualizes the interior structures of the eye Stethoscope: auscultate heart, lung, bowel sounds 1- diaphragm (bigger part) high frequency sounds lung sounds, heart sounds, bowel sounds 2- bell (smaller side) low pitch sounds ex: heart murmurs Eye chart: ( SNELLEN chart) screens for distance Tuning fork: test auditory function and vibratory perception Used to determine conductive versus sensorineural hearing loss Percussion hammer: test deep tendon reflexes and determines tissue density Used to test deep tendon reflexes. Test deep tendon reflexes: 1+: trace, or seen only with reinforcement 2+: normal 3+: brisk 4+: nonsustained clonus (i.e., repetitive vibratory movements) 5+: sustained clonus Nasal speculum: visualizes the lower & middle turbinate's of the nose Otoscope: external ear and tympanic membrane -Adults pull the auricle up and back may have pt. tilt head to opposite shoulder -Children (under 3yrs) pull pina down and back to straighten the canal Positioning and Draping Sitting—used to take vital signs Supine—allows relaxation of abdominal muscles, Laying flat upward facing Dorsal recumbent—used for patients having difficulty maintaining supine position (not for abdomen. assess) Knees up legs open hands above head Sim's—assessment of rectum or vagina- how you sleep in bed side lying shoulders and chest flat on bed leg bent in L shape over opposite leg Prone—assessment of hip joint and posterior thorax, laying on stomach hands at head/under head. Lithotomy—assessment of female rectum and vagina; used for brief period only feet on saddle straps, knees bent in air towards face/chest Knee-chest—assessment of the rectal area; used for brief period only Butt up in air head flat on surface Standing—assessment of posture, gait, and balance

Integrate knowledge of healthy lifestyle, support systems, stress management techniques, and crisis intervention into hospital-based and community-based care

Exercise (30-45 mins most days of the week) Rest and Sleep (7-9 hours) Nutrition (Eat more fruit and vegetables) Support systems (Alcoholics anonymous, Over-eaters anonymous) Relaxation (Rhythmic breathing, reduce muscle tension) Meditation

4 ways people can communicate non-verbally

FORMS of NON-VERBAL include: Touch-tactile, is a personal behavior and means different things to different people; touch is viewed as one of the most effective non-verbal ways to express feelings such as love, affection, anger, frustration, aggression, excitement and many others Eye Contact-communication often begins with eye contact, in many cultures eye contacts suggests respect and willingness to listen and keep communication open; its absence can indicate anxiety or defenselessness, or avoidance of communication Asian & Native Americans cultures view it as invasion of privacy. In other cultures people are taught to avoid eye contact or out of respect not to make eye contact with a superior, The eyes carry other nonverbal messages. For example the eyes fixed in a stare during anger tend to narrow in disgust, and ordinarily open wide in fear. Some people who experienced fear might be unable to speak and only their eyes send a message of anxiety A blank stare can indicate daydreaming or inattentiveness Facial Expressions-The face is the most expressive part of the body; NURSES NEED TO LEARN TO CONTROL THEIR OWN FACIAL EXPRESSIONS; negative facial communications can impact a patient's self esteem Facial expressions can show anger, joy, suspicion, sadness, fear, and contempt. Posture-The way a person holds the body carries nonverbal messages; people in good health & positive attitude usually hold their bodies in good alignment; depressed/tired people slouch; rigid & stiff appearance may be indicator of tension & pain Gait- a bouncy, purposeful walk usually carries a message of well-being. The less purposeful, shuffling gait often means the person is sad or discouraged. Certain Gates are associated with illnesses for example a patient recovering from recent abdominal surgery usually walk slightly bent over and slowly, a shuffling gait is usually associated with Parkinson's disease. Gestures-using various parts of the body can carrying numerous messages, for example thumbs-up means victory, kicking an object often expresses anger, wringing their hands or tapping of foot usually indicates anxiety or anger and waving hand serves to beckon someone to come. Gestures are often used extensively when two people speaking different languages attempt to communicate with each other General Physical Appearance-important : most illnesses cause at least some alteration in general physical appearance. Observing for change in appearance is an important nursing responsibility for detecting disease. for example a person with insufficient intake of fluid has dry skin wrinkles easily, eyes that might be sunken and dulling appearance, and poor muscle tone. On the other hand the person in good health tends to radiate a healthy status to general appearance Mode of Dress & Grooming, a person's clothing and grooming practice carries significant nonverbal messages. For example healthy people tend to pay attention to detail of dress and grooming. Whereas people feeling ill often demonstrate little interest in personal appearance. It is often a sign of returning health when the interest in one's physical appearance and mode of dress returns Sounds: Crying, moaning, gasping and sighing are oral but nonverbal forms of communication. Such sounds can be interpreted in numerous ways. For example a person may cry because of sadness or joy. Gasping often indicates fear, pain, or surprise. A Sigh might be a sign of reluctant agreement to do something or of relief Silence: periods of silence during a conversation often carry important nonverbal messages. A silence between two people might indicate a complete understanding of each other, or that they are angry with each other

Describe Historic Background of Nursing

Florence Nightinggale- mother of nursing, identified personal needs of patient and role of nurse in meeting the needs, Established stabdards for hosiptal management, established nursing education and promoted the publication of books about nursinf and healthcare, established respected occupation for women, recgonized two components of nursing 1.health 2.illness, believed nursing is seperated and distinct from medicine, recgonized nutrition as impotant to health, instituted occupational and recreational therapy for sick people (OT and PT), stressed need for continuing education for nurses, maintained accurate records/begining of nursing research

Various Gerontological Nursing Roles

Gerontological nurse, also known as geriatric nurses coordinate medical treatment for the elderly patients. They give care to the elderly who usually are in at higher risk of getting diseases such as Alzheimer's, osteoporosis or cancer and injuries because of their advanced age. The primary focus for geriatric nurses is to provide preventive care. They also help the patients and the families to develop coping mechanisms for specific medical conditions which develop at later stages of life. GERONTOLOGICAL NURSE TRAINING These nurses play a crucial role in coordinating medical treatments from the old patients. Gerontological nurses begin by training as registered nurses but decide to specialize after earning their nursing degrees and passing a certification examination. They take additional education and training to understand the basics as well as gain experience on how to serve the elderly patients. Some even go back to nursing school to pursue a gerontological nursing degree hence it is not the role e for all nurses but those with the right qualifications. The education that geriatric nurses receive trains them to understand and handle complex physical or mental health needs by the older people. They learn ways of protecting their health of their patients, coping with changes in physical and mental abilities for them to live an active and independent life for a long time. GERONTOLOGICAL NURSE WORKING CONDITIONS Geriatric conditions should be persons who enjoy working with the elderly. It requires patience; careful listening abilities and balancing skills to manage the patient needs with family demands that can at times become conflicting. Gerontological responsibilities can vary depending on the needs of a patient, the attending physician and medical facility. Gerontological nurses mainly train and work to help patient s who have challenges such as lost mobility or have impairment in their hearing, speaking or eyesight. Such patients require supervision for them to enjoy daily lives. ALSO READ:BEST NURSING ESSAY WRITERS GERONTOLOGICAL NURSE FUNCTIONS Many seniors with lifestyle health conditions do not need hospitalization but treatment through medication. Some take medicine to manage particular requirements for a long time. Others require changes in diet, use of equipment such as a walker or a blood sugar monitor, participation in daily exercises and other essential adaptations.It is the role of geriatric nurses to help in designing and explaining healthcare regimens to the patients and members of their family. They usually work as case managers by linking families with community resources that assist in taking care of the elderly. A gerontological nurse who works will perform these functions when working with patients: Assess the mental status and cognitive skills Discuss the common health concerns such as a change in sleep pattern, falls, incontinence and other dysfunctions. Frequent discussions help in understanding the acute and chronic health issues that affect a patient. Organize medications Explain how to use medicine, supervise to ensure adherence and recommend any essential adjustments to a regimen Educate patients about personal safety and prevention of disease Link patients with local resources that they may require GERONTOLOGICAL NURSE PRACTICE SETTINGS Geriatric nurses work in various practice settings including: 1. Nursing homes 2. Patient homes 3. Hospitals 4. Rehabilitation facilities 5. Senior centers and retirement communities A gerontological nurse in any of the settings works as a part of the care team that comprises of caring professionals such as nursing aides, social workers occupational and physical therapists. Geriatric care in hospitals is about working with treatment teams that offer services to a larger population of older patients. The care giving role for these patients is essential in geriatric mental health, cardiology, outpatient surgery, ophthalmology, rehabilitation and dermatology among others. Geriatric care is critical in the management of long-term conditions such as anxiety, depression and Alzheimer's. Gerontological nurses working in rehabilitation and long-term care facilities manage patient care from initial assessment, development, implementation, and evaluation of care plan. Some nurses go for advanced studies in geriatrics to work in leadership, administrative and training roles. A gerontological nurse takes responsibility for the well-being of the patients, maintains accurate medical records and coordinates care according to recommendations by treating physician.

HIPPA

Health Insurance Portability and Accountability Act (HIPAA) ▪ All information about a patient is considered private & confidential, whether written on paper, saved on a computer, or spoken aloud ▪ Name and all identifiers such as address, telephone number, fax number, Social Security number and any other personal information ▪ Diagnosis, treatment, medication, assessments, and plan of care, past medical history ▪ Protected under health insurance portability and accountability act of 1996 (HIPAA) Amended 2002 ▪ Violation of HIPAA is subject to fines, loss of job, jail time, and or all three ▪ Patients have a right to read and obtain a copy of their medical record follow your facilities policy Students HIPPA ▪ Use patient initials on your worksheet, never write patient's full name or medical record on your worksheet ▪ Log off from the computer before leaving the workstation ▪ Never share your user ID or password with anyone Must keep password private ▪ Shred any printed or written worksheet of patient information ▪ No part of the patient's record can be copied ▪ Patient information may not be disclosed to unauthorized individuals ▪ Communication about the patient should take place in a private setting ▪ Never leave a patient's chart or written protected health information (PHI) where others can access/see it ▪ Do not use or view social media in the clinical setting ▪ Do not take pictures of patients/clients or their family members ▪ Do not post information about: facility, clinical site, clinical experience, patient experience, healthcare staff or any information covered by HIPAA on any social media network or site ▪ Follow Facility policy/protocol related to HIPAA guidelines ▪ Patients have a right to their medical records, make sure you follow facility policy

helping relationship

Helping Built on patient's needs Does not occur spontaneously Purposeful and time-limited goals to be met Unequal sharing of information Person providing assistance is professionally accountable for the outcome-quality important A helping relationship contains many of the same qualities of a social relationship, they have in common the components of care, concern, trust, and growth. They are also very different The helping relationship does not occur spontaneously as do most social relationships. A helping relationship occurs for a specific purpose with a specific person The helping relationship is characterized by an equal sharing of information. The patient shares information related to personal health problems, where as the nurse shares information in terms of a professional role. The nurse assists the patient to identify and achieve goals that allow their needs to be met The helping relationship is built on the patient's needs, not on those of the helping person.

Mechanisms involved in maintaining physiological and psychological homeostasis

Homeostasis Physiologic mechanisms within the body respond to internal changes to maintain constancy in the internal environment Health = balanced state of both internal and external environments Physiologic and psychologic balance balance is achieved when the perception of the stressful ecent is realistic and support and coping mechanisms are adequate imbalance can occur if the preception of the event is exaggerated or if sources for support or coping mechanisms are inadequate Physiologic Homeostasis ANS and Endocrine System primary control Cardiac, renal, respiratory and GI systems also involved Self - regulating, acts without us knowing See Taylor, Table 42-1, p. 1662

Compare/contrast factors that increase or decrease temperature, pulse, respiration's, blood pressure and oxygen saturation levels.

How does body regulate temperature? Hypothalamus, (in brain) = thermoregulatory center, the body's thermostat Too hot - vasodilation and sweating Too cold - shivering and release of epinephrine to increase metabolism, vasoconstiction Factors Affecting Temperature Circadian rhythm Age and gender Environmental temperature hypothermia hyperthermia Exercise Factors Affecting Temperature Food/fluid malnutrition Emotion/stress 5 Increased Body Temperature Fever/pyrexia = temp above norm, febrile Hyperpyrexia = temp above 106 F S/S = decreased appetite, hot skin, flushed face, thirst, malaise Reportable temperature - 100.4 or > Decreased Body Temperature Hypothermia core body temp less than 95 F Severe hypothermia core body temp less than 82.4 F

Alternative therapies benefiting older adults with chronic conditions

Increasing knowledge • Informed patients are able to manage and prevent complications • Knowledge helps empower the patient • Organizations • Newspapers • Libraries • Internet Making smart lifestyle choices ▪ Compliance with treatment plan ▪ Dietary practices ▪ Regular exercise ▪ Stress management ▪ Assertiveness Complimentary & alternative therapies ▪ Utilization of the body's capacity to heal itself ▪ The patient is in charge of the healing process ▪ Need to discuss therapies with the health care provider Acupuncture • Aromatherapy • Guided imagery • Herbal medicine • Hypnotherapy • Massage therapy • Nutritional supplements • Yoga Qigong p ▪ Development of a healing attitude and mindset

Inspection techniques

Inspection—observation, assess size, color, shape, position, and symmetry; sight, smell, sound; visual observation compare bilateral -Inspection: Observations using all senses - Inspect for color, texture and moisture of body surfaces -Deliberate, purposeful observations done systematically -Use all senses for inspection: eyes, ears, nose to gather information - Begins with initial patient contact and continues through entire exam. -Inspect areas of body for size, color, shape, position, and symmetry. -Always compare bilaterally to clarify any abnormalities

Compare and contrast acute and chronic illness

Medical conditions are often categorized as acute or chronic. Find out how to tell the difference, including the causes, symptoms, and treatment. Learn more about what conditions are classified as acute and chronic diseases. If you're one of the 80% of older adults living with chronic illness, there are treatment options that can help you control your symptoms. From the flu and broken bones to arthritis and heart conditions, older adults experience it all. Why? Because as we age, our bodies—organs and immune systems—go through changes, sometimes making us more susceptible to illness. The conditions we develop are often categorized as either chronic or acute. So what's the difference? Acute illnesses generally develop suddenly and last a short time, often only a few days or weeks. Chronic conditions develop slowly and may worsen over an extended period of time—months to years. But of course, the differences are more than just that. Causes Acute conditions are often caused by a virus or an infection, but can also be caused by an injury resulting from a fall or an automobile accident, or by the misuse of drugs or medications. Chronic conditions are often caused by unhealthy behaviors that increase the risk of disease—poor nutrition, inadequate physical activity, overuse of alcohol, or smoking. Social, emotional, environmental, and genetic factors also play a role. As people age, they are more likely to develop one or more chronic conditions. Symptoms and treatment Acute diseases come on rapidly, and are accompanied by distinct symptoms that require urgent or short-term care, and get better once they are treated. For example, a broken bone that might result from a fall must be treated by a doctor and will heal in time. Sometimes, an acute illness, such as the common cold, will just go away on its own. Most people with acute illnesses will soon recover. Chronic conditions are slower to develop, may progress over time, and may have any number of warning signs or no signs at all. Common chronic conditions are arthritis, Alzheimer's disease, diabetes, heart disease, high blood pressure, and chronic kidney disease. Unlike acute conditions, chronic health conditions cannot be cured—only controlled. Living with chronic illness or managing the symptoms of a chronic condition can often be done by creating a health care plan in partnership with your physician—the plan may include taking medication, healthy eating, physical or occupational therapy, exercise, or complementary treatments, such as acupuncture or meditation. Frequently, chronic conditions can be prevented by practicing healthy lifestyle behaviors, such as staying physically active; maintaining a healthy weight and nutritional status; limiting sun exposure; and refraining from drugs, smoking, and excessive alcohol use. Examples of acute and chronic medical conditions Acute medical conditions Asthma attack Broken bone Bronchitis Burn Common cold Flu Heart attack Pneumonia Respiratory infection Strep throat Chronic medical conditions Alzheimer's disease Arthritis Chronic obstructive pulmonary disease (COPD) Depression Diabetes Heart disease High blood pressure High cholesterol Obesity Osteoporosis Stroke Why self-management matters If you are one of the 80% of older adults who has a chronic condition, talk to your doctor about potential treatment options that can help you control your symptoms. Managing your condition can keep your symptoms from getting worse.

Summarize role of nurse in promoting health and preventing illness

Nurses must take care of their own health to be able to give effective nursing care to others. Good personal health enables nurses not only to practice more efficiently but also to serve as role models for patients and families. Nurses can help patients acquire new health behaviors by modeling the very behaviors they are trying to promote. It is difficult for nurses to be sincerely attentive to the needs of patients when their own needs are not being met. Because no one is perfectly healthy all of the time, nurses who are preparing for professional practice should spend time getting to know themselves. From this self-knowledge should come a commitment to actively pursue holistic health. Know your resources available to that patient in that community. Ask social worker about recourses in the area if you don't know them.Knowledge of health care trends: You will receive mailings from the BON with new trends and changes to health care constantly.Knowledge of insurance companies: They are changing all the time and its up to us to know what is going on in the health care arena. So we can help the patient by talking to them about those changes.Know the changes and how they effect your patients.

Palpation techniques

Palpation—touching,assess temperature, turgor, texture, moisture, vibrations, and shape (touch); examine or explore by touching, hands & fingers sensitive tools Palpation .... Use of hands and fingers Temperature Turgor- pull skin and see how long it takes to return to smormal/ regain eleasticisty (tenting is sign of dehydration) Texture Moisture Vibrations Shape MAsses Palmar (front of hand) best to assess vibration Fingertips and finger pads: best for discriminatory sensation Ex: texture, vibration, presence of fluid, or size & consistency of a mass The dorsum (back of the hand) Assess surface temperatures Light palpation = < 1⁄2 inch **Palpate TENDER areas last** Area for Palpation lymph nodes pulses tenderness in abdomen liver for location, size, tenderness trachea and thyroid gland neck for tenderness-tonsils scrotum/testes for masses uterus/ovaries thorax for crepitus (crackling, clicking of joints, gas from intestines)

Communication Techniques for patients from different cultures, different languages, different age groups

Patients who do not speak English: Use interpreter whenever possible Use dictionary Simple sentences, normal tone of voice Use pantomime, gestures, drawings Be aware of nonverbal communication-many nonverbal cues are universal Different Culture Taylor 2019 pg. 164 Box 8-4 relating to patients from different cultures Assess own personal beliefs Assess communication variables from a cultural perspective what is ethnic identity what generation are they Modify communication approaches to meet cultural needs: watch for signs of fear, anxiety, confusion, be reassuring Communicate in nonthreatening manner Use validating techniques in communication Speak slowly, not louder Messages simple, repeat often, avoid medical terms Interpreters, dictionary

Percussion techniques

Percussion—tapping--assess location, shape, size, and density of tissues (sound); striking or tapping of surface of part of body to produce sound; sound waves produced by the striking action over body tissues known as percussion tonesPercussion: Act of striking one object against another to produce sound. Used to Assess Location Shape Size Density of tissues Technique Both hands Use of tapping using both hands and finger Produces a vibration Five different tones Resonant Flat/dull Dull/thud-like Hyperresonant Tympany

Explain how the human dimensions, basic human needs, holistic care and self-concept influence health and illness

Physical Dimension Ability to carry out daily tasks Achieve fitness Maintain nutrition Avoid abuses Social Dimension Interact successfully Develop and maintain intimacy Develop respect and tolerance for others Emotional Dimension Ability to manage stress Ability to express emotion Intellectual Dimension Ability to learn Ability to use information effectively Spiritual Dimension Belief in some force that serves to unite Occupational Dimension Ability to achieve balance between work and leisure Environmental Dimension Ability to promote health measure that improves Standard of living Quality of life Self-Conscept- incorperates both how someone feels about themselves(self-esteem) and their perception of their physical self (body-image). Illness can effect persons self concept as it affects roles, independence, and relationships with others.

Patient and environmental preparation for health assessment

Physical: Genetic inheritance, age, developmental level,race, and gender Emotional: how the mind affects body function and responds to body conditions Intellectual Cognitive abilities, educational background, and past experiences Environmental housing, sanitation, climate, pollution of air, food, and water Sociocultural economic level, lifestyle, family, and culture Spiritual/Cultural beliefs and values *Explain the process to the patient *Health assessment (non threatening data collection *Explain the physical assessment will not be painful ( decrease patients fear & anxiety) *Explain each procedure in detail as it is conducted *Ask the patient to change into a gown and empty bladder *Answer patients questions directly and honestly *Agree upon a time for the assessment -The time should not interfere with meals, daily routines, or visiting hours *Make sure patient if free of pain as possible *Prepare the examination room *Provide a gown and drape for the patient *Gather supplies and instruments as needed *Provide Privacy and respect (a curtain or a screen if area is open to others) *Quiet, low distraction, adequate light (natural light preferred), room temperature

Discuss nursing activities to meet Maslows hierarchy of needs

Physiological needs:Intake and elimination of fluids:measure intake and output, testing the resiliency of the skin, checking the condition of the skin and mucous membranes, and weighing the patient helps assess water balance.Food:assessing nutritional status with a variety of indicators, including weight, muscle mass, strength, and laboratory values temperature: assess as vital sign sexuality: persons age, socio-cultural background, self-esteem, and level of health. physical:intact and functioning neuromuscular and skeletal systems.rest and sleepage, environment, exercise, stress and drug use. Safety and security needs emotional- Involve both physical and emotional.Being protected from potential and actual harm.Emotional:Encouraging spiritual practices, allowing as much independent decision making and control as possible, and carefully explaining new and unfamiliar procedures and treatments. Love and belonging-Nurses should always consider this when developing a plan of care. Include family and friends in the care of the patient, establish a nurse-patient relationship based on mutual understanding and trust (demonstrate caring, encouraging communication, and respecting privacy), referring patients t specific support groups. Self Esteem Needs-Changes of a job, death of spouse, body image affect self esteem. The persons perception of the change rather that the actual change is what affects that individual's self esteem.Respecting patients values and beliefs, encouraging patients to set attainable goals, and facilitating support form family or significant others. Self-Actualization needs-Acceptance of self and others as they are, focus of interest on problems outside oneself, ability to be objective, feeling of happiness and affection for others, respect for all people, ability to discriminate between good and evil, uses creativity for solving problems and pursuing interest.

Describe levels of preventive care: primary, secondary, tertiary

Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Nursing activities at the primary level may focus on people or groups. Examples of primary-level activities are immunization clinics, family planning services, providing poison-control information, and accident-prevention education. Other nursing interventions include teaching about a healthy diet, the importance of regular exercise, safety in industry and farms, using seat belts, and safer sex practices.Health-risk assessments are an important part of primary health promotion and preventive care. A health-risk assessment is an assessment of the total person. The resulting "picture" of the person indicates areas of risk for disease or injury as well as areas that support health.Secondary health promotion and illness prevention focus on screening for early detection of disease with prompt diagnosis and treatment of any found. The goals of secondary preventive care are to identify an illness, reverse or reduce its severity or provide a cure, and thereby return the person to maximum health as quickly as possible.Examples of nursing activities at this level are assessing children for normal growth and development and encouraging regular medical, dental, and vision examinations. Otheractivities include screenings (e.g., blood pressure, cholesterol, and skin cancer), recommending gynecologic examinations and mammograms for women at appropriate ages, and teaching testicular self-examination to men. Direct nursing care interventions at the secondary level include administering medications and caring for wounds.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 on a tertiary level 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. Nurses play an important role in monitoring the responses of the patient to the prescribed therapy and in providing services to facilitate the patient's recovery or improve quality of life while living with the effects of an illness or injury.

Compare/contrast various types of nursing knowledge

Professionals define themselves in terms of what knowledge they possess and seek to acquire. Have you ever considered how bachelor's and master's degree registered nurses add to their knowledge base? Barbara Carper (1978) identified four fundamental patterns of knowing that form the conceptual and syntactical structure of nursing knowledge. These four patterns include: personal, empirical, ethical, and aesthetic knowing. Let's look at how these ways of knowing can assist you in your pursuit of knowledge as a nursing student. THE FOUR PATTERNS OF NURSING KNOWLEDGE PERSONAL KNOWING PERSONAL knowing refers to the knowledge we have of ourselves and what we have seen and experienced. This type of knowledge comes to us through the process of observation, reflection, and self-actualization. It is through knowledge of ourselves that we are able to establish authentic, therapeutic relationships as it propels us towards wholeness and integrity (Chinn & Kramer, 2015). When you began to study nursing, what knowledge did you possess? Consider what you have learned since-in your personal life, in school, and through practice. EMPIRICAL KNOWING We gain EMPIRICAL knowledge from research and objective facts. This knowledge is systematically organized into general laws and theories. One of the ways we employ this knowledge is through the use of evidenced-based practice (EBP). This way of knowing is often referred to as the "science" of nursing (Chinn & Kramer, 2015). Can you relate how study findings have changed your nursing practice? ETHICAL KNOWING ETHICAL knowing helps one develop our own moral code; our sense of knowing what is right and wrong. For nurses, our personal ethics is based on our obligation to protect and respect human life. Our deliberate personal actions are guided by ethical knowing . The "Code of Ethics for Nurses" (American Nurses Association, 2015) can guide us as we develop and refine our moral code. Can you think of an occasion that you needed to make an ethical decision? If you are like many practicing nurses, you make several every single day. AESTHETIC KNOWING The final way of knowing identified by Carper (1978) is AESTHETIC Knowing. Aesthetic knowing makes nursing an "art." It takes all of the other ways of knowing and through it creates new understanding of a phenomenon. Aesthetic knowing is that "aha" moment that we have when we uncovered something new; and just as an artist creates a painting, you are afforded the opportunity of new perspective. Consider a time when you had an "aha" moment. How did you come to that discovery? The practice of nursing is a holistic, human discipline. The ways of knowing allow us to understand ourselves and nursing practice at a much deeper level; to appreciate nursing as both an art and a science. Consider how the ways of knowing can assist you in being a better person, a better student, and a better nurse.

social relationship

Social Both needs are met Occurs spontaneously Ongoing overtime Equal sharing Interaction may be casual and without a purpose In a social relationship both participants needs are generally considered The nurse is professionally accountable for the outcomes of the relationship and the means (nursing interventions) to attain them; the nurse should be as honest as possible about what they can offer for assistance, and be honest about their abilities Patients are more likely to trust and value nurses who appear competent, confident and who are focused on the patient. Rudeness sloppiness inattentive to a person undermine the nurses professional image.

Stress and adaptation

Stress Disturbance in person's balanced state Can have positive or negative effects Responding to stress is essential to person's well-being Response to stress is individual Stressor Perceived as a challenge, danger, threat Disturbs equilibrium/balance Internal or External to individual Not positive or negative Can have positive or negative effects Types of Stressors: Physiologic - Can have specific or general effects Specific - alteration in normal body function General - stress response Psychosocial - So often a part of life, we often overlook Can be real or perceived Responses are continuous ie coping mechanisms Adaptation Change that occurs as a result of stress and coping Ongoing as person attempts to maintain balance Also happens in families and groups Necessary for normal growth and development

Short term effects on basic human needs health and illness and the family

Stress in a healthy person may promote health and prevent illness (fear of lung cancer, makes someone to stop smoking) Stress on a sick or injured person is usually negative- can cause illness and illness causes stress Long-term stress is a serious threat to physical and emotional health. As the duration, intensity, or number of stressors increases, a person's ability to adapt decreases (increases the risk of diseases and injury, contributes to the progress of autoimmune disorders. Alcoholism, drug abuse, depression, suicide, eating disorders are linked to high stress)

Objective vs subjective data

Subjective: (what the patient says) -Based on patient experiences and perception Individual describes feelings, sensations, expectation Document as quotes. The patient states " I feel nauseous" "I feel nervous" I am chilly" (cold) Objective: (what the nurse observes) -Observable, Measurable, Heard, Felt -Observation of general appearances, assess vital signs, listen to the heart and lungs, coughing, skin warm to Touch

Mind-Body Interaction

The body's response to threats as if they are real; preparation for resistance or flight.

Three Phases of Helping relationship

The orientation phase: Paves the way for developing trust and communicating care and respect The orientation phase ideally begins between the nurse and patient during the data gathering part of the nursing process. You and the patient meet and learn to identify each other by name. The following activities generally occur during the orientation phase of the helping relationship The roles of both people in the relationship are clarified An agreement or contract about the relationship is established. The agreement is usually a simple verbal exchange related to the goals and the means of achieving them or occasionally a written document. The patient is provided with an orientation to the healthcare facility, its services, admission routine, and any pertinent information the patient requires to decrease anxiety. The development of a trust relationship is critical to the development of a nurse patient relationship. The nurse wants to exhibit openness and interest in the concerns of the patient this paves the way for developing trust and communicating care and respect. Example Good morning, Mrs. Temple. My name is Cheryl Thompson I am a registered nurse and I am going to be your nurse for today. I'm going to be meeting with you today and tomorrow for about 30 min. to complete some information that would be helpful to the team. Any questions so far? Let's begin with how you are feeling this morning........... The working phase: Involves motivating the patient to learn and to implement health promotion activities The working phase is usually the longest phase of the helping relationship. During this phase the nurse works together with the patient to meet the patient's physical and psychosocial needs. Interaction is the essence of the working phase. The nurse patient interaction that occurs at this time are purposeful in that they are designed to ensure achievement of health goals, or objectives that were mutually agreed-upon. In addition the nurse as caregiver provides the patient with whatever assistance might be needed to perform activities of daily living. Example: Working phase If a patient with impaired mobility is unable to get out of bed to use a bedside commode, the nurse needs to help with daily hygiene needs. Another example would be a patient with a new ostomy is unable to change their ostomy bag, the nurse will demonstrate to the patient how to change the ostomy bag. The termination phase The termination phase occurs when the conclusion of the initial agreement is acknowledged. This might happen at change of shift, when the patient is discharged, or when the nurse leaves on vacation or for employment elsewhere. At this point you examine with the patient the goals of the helping relationship for indication of their attainment or evidence of progress towards them. The nurse can make suggestions for future goals if current goals are not met. Example: of termination phase Often emotions are associate with the termination of the helping relationship. Say good bye, ending a relationship elicit emotions- Encourage the patient to discuss their feelings

Effective interviewing strategies

Therapeutic communication: focus in on the patient and the patient's concerns Active listening: ability to focus on the patient and their perspectives Empathy: the ability to perceive, reason, and communicate understandings of another person feeling without criticizing False reassurance: to minimize uncomfortable feeling Professional Boundaries: avoid personal advice and personal conversation maintain a professional relationship

Describe nursing activities to promote/maintain health of individuals

There are basic human needs that are common to all people Nursing care is directed towards meeting unmet or threatened needs Nursing considers both physical and psychosocial needs of the individuals providing holistic care Some need are more basic or essential than other. nurses are the catalysts for healthier lifestyles through encouragement and teaching, helping patients to potentially receive preventative services such as counseling, screenings, and precautionary procedures or medications.

Explain the Aims of Nursing

To promote health, to prevent illness, to restore health, to facilitate coping with disability (support groups) or death (hospice)- Promote Health *Facilitate lifestyle decisions, INCREASE health awareness *Provide information that increases health awareness e.g. antismoking, healthy diets, daily work-outs, act as a role model-maintain health weight, eat a healthy diet *Teach that certain behavior can contribute to or can diminish health, *Prepare patients for tests, answer questions Prevent Illness *Objective: Reduce the risk for illness, Promote good healthy habits, Maintain optimal functioning *Activities: Educational Programs e.g. prenatal care, smoking sensation, stress reduction. Community Programs: e.g. Exercise classes, Swimming programs. Health assessments: e.g. Clinics Restore Health *Assessments Blood pressure Physical Assessments Blood sugar *Refer abnormal findings to others as appropriate *Provide direct/physical care: medications, procedures, treatments *Plan, Teach, Rehabilitate * Mental health/Chemical Dependency treatment Facilitate coping with disability or death *Referral to community support systems *End of life care (patients and families) *Cope with the end of life issues through teaching, referrals, direct care In meeting Aims of Nursing, Nurses use *Cognitive Function -Intelectual -Decision making -Critical thinking * Psychomotor (hands-on) and Technical *Interpersonal (communication) *Ethical/Legal *Science Rationals -Chemistry -Biology -Anatomy -Physiology -Psychology *Evidence-Based Practice (EBP)

Strategies used for patients with impaired verbal communication

Unconscious patient: Be careful of what is being said: hearing is believed to be the last sense lost, and therefore, the unconscious patient is often likely to hear; assume they can hear you, talk in normal tone, talk about things you ordinarily would Speak w/patient before touching; touch can be the most effective communication w/unconscious Keep environment noise at minimum-no distractions Patients who do not speak English: Use interpreter whenever possible Use dictionary Simple sentences, normal tone of voice Use pantomime, gestures, drawings Be aware of nonverbal communication-many nonverbal cues are universal Patients with physical Barrier Laryngectomy - surgical removal of the larynx (voice box) due to cancer. Alternative methods of speech include learning esophageal speech, by using an electronic device or by surgical implantation of a voice box Other forms may result in partial loss of voice Select one or more simple means of communication-blinking, writing pads, communication boards, flash cards, share info with patient, family, friends, caregivers Demo patience, takes time, reinforce efforts made by patient Ensure call bell/light available Patients who are cognitively impaired Establish and maintain eye contact to hold attention, quiet environment w/no noise/distractions Communication simple, concrete, pictures/drawings when needed Avoid open-ended questions-give choice: blue or green dress, not what do you want to wear? Be patient-2 min., if no response repeat it

SBAR how to utilize it

consistent, clear, structured, and easy-to-use method of communication between health care personnel; it organizes communication by the categories of: Situation, Background, Assessment, and Recommendations. SBAR technique ▪S- situation ▪B- background ▪A- assessment ▪R- recommendations Example ▪A night nurse noted that Justin Taylor who had been on the unit for 2 days seemed more tired than usual. Although the patient was usually responsive and animated, he did not seem as responsive during the evening shift. After checking on him twice, the nurse noted that thepatient seemed weak and confused. The nurse called the physician at 3 a.m. and described thepatient's general status change as being "not quite right" but did not provide a detailed reportor recommendation. The physician, frustrated, did not ask probing questions about the patient.The physician noted that it was 3 a.m., mentioned that perhaps the patient was tired, and instructed the nurse to monitor the patient. The next morning, the physician came in to do rounds and could not find a complete update from the previous evening. Upon assessing the patient, the physician ordered a stat MRI to rule out stroke. ▪The nurse experienced anxiety due to deterioration of patient status and inability to communicate with the physician. The physician was frustrated by not clearly receiving all of the relevant patient information during the first physician-nurse communication. The patient's stroke remained unidentified during evening shift. ▪ A night nurse noted that the patient Justin Taylor in room 222 bed B who was admitted with a diagnosis of cellulitis left lower extremity on 8-26-19 and who had been on the unit for 2 days seemed more tired than usual. PMH: DM and HTN. Although the patient was usually responsive and animated, he did not seem as responsive during the evening shift. After checking on him twice, the nurse noted that the patient seemed weak and confused. The nurse obtained his vital signs Temp 98.6, Apical pulse 100 irr/wk respiration 22, B/P 100/58 0s2 sat 92 on room air. The nurse called the physician at 3 a.m. and described the patient's general status and provided the physician with her assessment findings he provide the nurse provided their recommendation of a consult and lab work. The physician ordered a stat MRI, CBC and requested the patient be seen by an in house resident PA ▪ The next morning, the physician came in to do rounds and upon assessing the patient, foundthat the patient was identified has having a stroke and prompt intervention and early dentification of the situation end with a positive outcome for the patient ▪ Using SBAR reduces incidences of missed communication!!!!!

Apply the nursing process to patient with stress and anxiety

critical thinking -keep in mind the neurophysiological changes the patient may be experiencing (GAS)-*determine the patient's perception of the situation and his/her ability to cope (through the patient's eyes, individualized)-use clear communication principles-utilize nursing resources, such as the standards of care for psychiatric mental health nursing practice (ANA) nursing process - assessment -see through the patient's eyes*gather information (including patient perception)*synthesize the information*apply critical thinking-subjective findings-objective findings nursing process - nursing diagnosis nursing diagnoses for stress: anxiety, denial, fear, ineffective coping, powerlessness, stress overload nursing process - planning -goals and outcomes*examples of desirable outcomes--effective coping, family coping, caregiver emotional health--setting priorities - are there threats to personal safety?-teamwork and collaboration - may need to refer patient/family to other healthcare professionals-when stress overwhelms a person's usual coping mechanisms and demands mobilization of all available resources, the situation becomes a crisis nursing process - implementation health promotion [teach patients and families about health promotion and stress reduction/management]-regular exercise-rest-support systems-music-time management-etc nursing process - evaluation through the patients eyes:-has stress been reduced?-is the patient coping?

Compare/ contrast methods of nursing documentation

▪ Computerized documentation & Electronic health records (EHR)- EHR is the patient care record created when facilities under different ownership share data. goal is for sharing to be nationwide, creating a situation in which a person's healthcare record is accessible by desgnated health care ▪ Source-oriented records-paper format each health care group keeps data on its own seperate form-patient chart in nursing home ▪ Problem-oriented medical records (POMR)-organized around patient problems instead of sources of information. includes deined databas,problem list,careplans. and progress notes from all healthcare professionals on the same form. ▪ PIE charting (Problem, Intervention & Evaluation) ▪ Focus charting brings focus of care back to patient concerns and patient ▪ Charting by exception (CBE)-shorthand documentation method makes use of well defined standaRS of practice ongly significant findings or exceptions are documented ▪ Case management model 467-470 taylor

Purpose of patient records

▪ Primary purpose, is to communicate with other healthcare professionals to foster continuity of care. ▪ Financial billing/Reimbursement, (not documented no reimbursement) ▪ Education, Research (promotes evidence base practice), ▪ Quality improvement /Audit and monitoring (for evidence was standards of care met). ▪ Legal record of care ▪ Legal document admissible in a court of law ▪ Must be recorded in accurately (if care/treatment is not documented it is considered not done) ▪ Confidential and Permanent ▪ Essential to the continuity of "person centered care"