N3033 Human Exp Final Study Guide

Obesity

- Diet high in nutrients such as fats, carbohydrates,or sodium - About 40% of adults in United States are obese - 1 in 10 children become obese as early as ages 2 to 5 - Obesity rates are highest - In the South - Among blacks and Hispanics - Among lower income and less educated Food intake: - Decreased: anorexia (lack of appetite) Increased: - Obesity (BMI ≥30) Body Mass Index: - Healthy goal is 18.5 to 24.9 for adults. - Weight (kg)/Height (m2) Underweight = BMI less than 18.5 kg/m2 - Normal = BMI 18.5 to 24.9 kg/m2 - Overweight = BMI 25 to 29.9 kg/m2 - Obese = BMI greater than 30 kg/m2 - Extremely obese = BMI greater than or equal to 40 kg/m2 Obesity Etiology and Pathophysiology of obesity: - Obstructive Sleep Apnea - Obsessive Compulsive Disorder - Organ damage - diabetes and HTN - Organ donation - Ottitis Media (Ear infection) - Otosclerosis Obesity Classification of Body Weight and Obesity: - Primary obesity: Excess caloric intake for body's metabolic demands - Secondary obesity: - Chromosomal and congenital anomalies - Metabolic problems - CNS lesions and disorders - Drugs (corticosteroids, antipsychotics) - Waist circumference - People with visceral fat with android obesity are at an increased risk for cardiovascular disease and metabolic syndrome - Men greater than 40" waist - Women greater than 35" waist - Waist-to-hip ratio (WHR) - Method of describing distribution of subcutaneous and visceral adipose tissue - Waist measurement/hip measurement - WHR less than 0.8 optimal - WHR greater than 0.8 at risk for health complications - Preferred tool when patient is predominantly muscular - Body shape - Apple-shaped body - Fat located primarily in abdominal area - Android obesity - Pear-shaped body - Fat located primarily in upper legs - Gynecoid obesity Obesity Genetic/ Biologic basis of obesity - Strong evidence of significant genetic/biologic susceptibility factors that are highly influenced by environmental and psychosocial factors - Factors can be considered individually but in reality they are interrelated - Research has identified several genes linked to obesity - "Energy-thrifty" genes - Strong link between FTO gene and BMI - People with a certain allele at the FTO gene appear to have an increased appetite, reduced satiety, and higher calorie intake Obesity Physiological Regulatory Mechanisms of Obesity: - Research focused on processes that control (Eating behavior, Energy metabolism, Body fat metabolism) - Leptin- (Suppresses appetite, Increases fat metabolism) - Ghrelin- (Regulates appetite by inhibiting leptin Thought to play a part in) Obesity Environmental Factors of Obesity: - Greater access to food with poor nutritional quality - Common to underestimate food and caloric intake - Lack of physical exercise - Low socioeconomic status - People use food for many reasons -Associations begin in childhood - Sense of satiety can be altered - Mindless eating - Eating is social and often associated with pleasure and fun Obesity Health Risks Associated With Obesity - Health problems occur at higher rates among the obese - Increased mortality, especially with increased visceral fat - Reduced quality of life - Most conditions can improve with weight loss obesity cardiovascular disease: - Obesity is a significant risk factor for cardiovascular disease and stroke - Android obesity patients at greater risk - Increased LDLs - High triglycerides -Decreased HDLs Obesity Diabetes: - Obesity is a major risk factor for developing type 2 diabetes - Excess weight makes drug treatment less effective - Hyperinsulinemia - Insulin resistance - Glucose intolerance Obesity GI and Liver Problems: - Gastroesophageal reflux disease (GERD) - Gallstones - Nonalcoholic steatohepatitis (NASH) - Can eventually lead to cirrhosis - Weight loss can improve NASH Obesity Respiratory and Sleep Problems: - Sleep apnea- (Snoring and hypoventilation) - Obesity hypoventilation syndrome- (Reduced chest wall compliance, Increased work of breathing, Decreased total lung capacity) - Weight loss can improve lung function - Individuals who report less than 6 hours of sleep a night have a higher body mass index (BMI) and are more likely to be obese Obesity musculoskeletal problems: - Osteoarthritis - Stress on weight-bearing joints - Knees and hips - Obesity triggers inflammatory mediators - Cartilage deterioration - Higher incidence of hyperuricemia and gout Obesity: - Obesity is 2nd of the most important preventable causes of cancer - Thyroid, liver, kidney, colorectal, breast, endometrial, and gallbladder cancers are linked to excess body fat Obesity Psychosocial Problems: - Stigmatization - Low self-esteem - Social isolation - Depression - Discrimination in employment, education, and health care Obesity Geriatric Considerations: - Number of older obese persons has risen - Obesity more common in women than men - Decreased energy expenditure and loss of muscle mass are important contributors to obesity - Obesity exacerbates age-related problems Nursing Assessment Obesity: - First step is to determine if conditions may be causing or contributing to obesity (Be sensitive and nonjudgmental, Clarify reason for questions about weight, dietary habits, and exercise, Address patient concerns) - Health history (Explore genetic and endocrine factors, Objective: (Laboratory tests of liver and thyroid function, fasting glucose and lipid panel - Height, weight, waist circumference, BMI) Obesity Planning: - Overall goals: - Modify eating patterns - Take part in a regular physical activity program - Achieve and maintain weight loss to a specified level - Minimize or prevent health problems Obesity Nursing Implementation: - Obesity = one of the most challenging health problems - hard and a lifelong project - begins with patients understanding their weight history and deciding on a plan that is best for them - An "ideal" BMI=not necessary and may not be realistic - Modest weight loss of 3% to 5% can have clinical benefits - Greater weight loss produces greater benefits - Average weight loss programs result in a 10% reduction of body weight - Explore motivation—it is key - Supervised plan of care should be directed toward - Successful weight loss - Requires a short-term energy deficit - Successful weight control - Requires long-term behavior changes Obesity Nutritional Therapy: - All diets can work if they achieve a reduced caloric intake compared to expenditure - Fruits and vegetables - Bulk to prevent constipation - Sufficient protein - Motivation is Key! - Success depends partly on amount of weight to be lost - Eating behaviors need examination - Goals need to be realistic and healthy - Calorie density is important - 2/3 or more of a person's diet should be plant-source foods and the other 1/3 from animal protein - 1 portion of animal protein = 3 oz - 1 portion of chopped vegetables = ½ cup - Appropriate amounts of water - Americanized diet has raised the obesity rate among Latinos and the health risks that go with it. Obesity Exercise: - Essential part of a weight loss program - Daily for 30 minutes to an hour - May diminish appetite - Reduces waist-to-hip ratio - Helps maintain weight loss - Psychological benefits Behavior Modification: - Assumption behind behavior modification for obesity (Learned disorder caused by overeating, Critical difference between an obese person and a person of normal weight is the cues that regulate eating behavior), - Useful basic techniques (Self-monitoring: Show what and when foods are eaten, Stimulus control: Eliminating cues in the environment that trigger eating, Rewards: Non-food incentives for weight loss) Obesity Support Groups: - Encourage person to join a support group of other obese persons who are receiving help to modify eating habits - Many self-help groups are available - Take Off Pounds Sensibly (TOPS) - Workplace-based programs Obesity Drug Therapy: - Never used alone - Used only in conjunction with calorie reduction diet, exercise, and behavior modification - Appetite-suppressing drugs - Sympathomimetic amines suppress appetite by stimulating the CNS through increased norepinephrine - Amphetamines - Higher abuse potential - Not recommended or approved by the FDA - Nonamphetamines Obesity Drug Therapy orlistat: - orlistat (Xenical, Allī [low-dose form available over-the-counter, Blocks fat breakdown and absorption in intestine. Inhibits the action of intestinal lipases, resulting in undigested fat excreted in feces) Bariatric Surgery for obesity: - Viable option for treating obesity - Currently only treatment found to have a successful and lasting impact on sustained weight loss for those with extreme obesity - Criteria for surgery: - BMI ≥40 kg/m2 - BMI ≥35 kg/m2 with other significant comorbidities - Hypertension, type 2 diabetes, heart failure, sleep apnea - Must be screened for: - Psychologic, physical, and behavioral conditions that have been associated with poor surgical outcomes - Illnesses known to reduce life expectancy are not likely to be improved with weight reduction Restrictive Surgery for obesity: - Adjustable gastric banding (AGB) - Limits stomach size with an inflatable band around fundus of the stomach - Connected to a subcutaneous port that can be inflated or deflated to meet patient's needs as weight is lost - Band creates sense of fullness Sleeve gastrectomy for obesity: - 75% of the stomach is removed - Not reversible - Stomach function is preserved - Results in elimination of hormones produced in the stomach that stimulate hunger - Ghrelin Combination of Restrictive and Malabsorptive Surgery for obesity: - Roux-en-Y surgical procedure (RYGB)—Gold standard - Has low complication rates - Excellent patient tolerance - Food bypasses 90% of the stomach, duodenum, and a small segment of jejunum - Dumping syndrome is a complication of the RYGB - Gastric contents empty too rapidly into small intestine - Avoidance of sugary foods is recommended - Maestro Rechargeable System for obesity - Pacemaker-like electrical pulse generator, wire leads, and electrodes implanted in abdomen - Sends intermittent electrical pulses to vagus nerve, which is involved in regulating stomach emptying and signaling feelings of emptiness or fullness to brain Lifestyle Changes Post-Bariatric Surgery: - Following bariatric surgery, patients find it challenging to maintain a prescribed diet - Patient now must reduce intake because of anatomic changes - Attention to nutrition is important to prevent early and/or late complications - Long-term follow-up care is important for physical and psychologic reasons - Old diet patterns - Issues related to return of fertility in women - New body image Expected Outcomes Post Bariatric Surgery - Long-term weight loss - Improvement in obesity-related co-morbidities - Integration of healthy practices into lifestyle - Monitor for possible adverse effects - Improved self-image BP and Obesity: - Associated with abnormalities of glucose, insulin and lipoprotein metabolism (common in primary hypertension) - Also increases workload of the heart, causing an enlarged heart and increases myocardial oxygen consumption.

Strabismus

- Strabismus—double vision - note eye patching for strabismus - Strabismus occurs when the eyes are unable to focus on an object

K- Potassium

3.5-5 BP and Excess Dietary Sodium High dietary Na+ intake increases blood volume and CO; poor intake of calcium, magnesium, and potassium can alter the activity of the renal sodium-potassium pump, and leading to Na+ retention. Hypertension diagnostic studies -do not use salt substitutes high in potassium ◦Hypokalemia - due to treatment of DK - loss of potassium - Measurement of serum electrolytes, especially potassium, is important to detect hyperaldosteronism, a cause of secondary hypertension. Blood glucose levels assist in the diagnosis of diabetes mellitus. - Macrominerals: calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium.

Yoga

A spiritual practice that combines exercise, controlled breathing, posture, and mental focus to bring about positive effects on the body and mind - Effects - Regulating blood pressure and heart rate - Increasing circulation - Aiding digestion - Healing chronic back pain - Helping with other disorders - Idea of harmony, health and balance - Prevents disease by keeping the energy meridians open - In the US thought of more as a form of exercise Benefits of Yoga for Individuals with health issues: asthma, cancer, cardiovascular function, cognition and quality of life, diabetes, elders' mobility and fear of falling, intellectual disabilities, low back pain, osteoarthritis, pain, physical inactivity, restless leg syndrome, smoking cessation, stress management, generalized inflammation..... Corpse Pose Lie on your back with your arms relaxed near your sides; palms up; and head, trunk, and legs straight. If you are uncomfortable, put a pillow or blanket under your head and/or knees. Close your eyes, relax, and let your body sink. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. When you are ready, open your eyes, bend your knees, turn to your right, and get up. Corpse Pose promotes deep relaxation and can decrease hypertension, anxiety, insomnia, stress, and fatigue Alternate Nostril Breathing Sit comfortably with a straight back. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. Place your right thumb on your right nostril, your ring finger on your left nostril, and inhale through both nostrils. Use your thumb to close your right nostril; exhale slowly through your left nostril, and then inhale slowly through your left nostril. Use your ring finger to close your left nostril; exhale slowly through your right nostril, and then inhale slowly through your right nostril. This sequence constitutes one round; repeat for five more rounds. This pranayama technique promotes balance, gives each side of the body equal time, and strengthens the breath in the weaker nostril YOGA: COMMON TYPES - Ashtanga: focuses on synchronizing breath with a fast-paced series of postures - Bikram: is done in a 105-degree studio with 26 set postures - Iyengar: focuses on proper alignment and holding poses for a relatively longer time - Kripaula, or "gentle yoga": focuses on relaxation and coming into balance Corpse Pose Lie on your back with your arms relaxed near your sides; palms up; and head, trunk, and legs straight. If you are uncomfortable, put a pillow or blanket under your head and/or knees. Close your eyes, relax, and let your body sink. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. When you are ready, open your eyes, bend your knees, turn to your right, and get up. Corpse Pose promotes deep relaxation and can decrease hypertension, anxiety, insomnia, stress, and fatigue Alternate Nostril Breathing Sit comfortably with a straight back. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. Place your right thumb on your right nostril, your ring finger on your left nostril, and inhale through both nostrils. Use your thumb to close your right nostril; exhale slowly through your left nostril, and then inhale slowly through your left nostril. Use your ring finger to close your left nostril; exhale slowly through your right nostril, and then inhale slowly through your right nostril. This sequence constitutes one round; repeat for five more rounds. This pranayama technique promotes balance, gives each side of the body equal time, and strengthens the breath in the weaker nostril YOGA: EIGHT LIMBS - 1. Ethical behavior (yama)—nonharming, truthfulness, nonstealing, responsible sexuality, and nonacquisitiveness - 2. Personal behavior (niyama)—purity, commitment, contentment, self-study, and surrender to the whole; niyama includes sattvic (pure) mind, food, beverages, air, and environment - 3. Posture (asana)—physical poses that stretch, condition, and massage the body - 4. Breath expansion (pranayama)—refinement of the breath to expand prana (life force) and get rid of toxins - 5. Sensory inhibition (pratyahara)—temporary withdrawal of the senses from the external environment to the inner self (e.g., by closing the eyes and looking inward) - 6. Concentration (dharana)—locking attention on the breath, mantra, image, or something else - 7. Meditation (dhyana)—increasingly sustained attention, leading to a profound state of peace and awareness - 8. Integration (samadhi)—a transcendent state of oneness, wisdom, and ecstasy

Viral Rhinopharyngitis

Acute Viral Rhinopharyngitis ◦"Common cold" ◦Transmission: Airborne droplets that transmit the virus. Virus can survive on inanimate objects up to 3 days leading to contact transmission. ◦Contagious: airborne droplets or contact and its sub-groups such as rhinovirus, coxsackie) ◦The incubation period: Usually between 1-4 days and illness lasts for 2-3 weeks. ◦Frequent in winter months—close contact ◦Also influenced by: fatigue, stress, allergies, and altered immune status ◦Duration: Usual recovery 7 to 10 days ◦Clinical features: begin with burning sensation at the back of nose soon followed by nasal stuffiness, rhinorrhea and sneezing. ◦General symptoms: chills, low grade fever, headache ◦Nasal discharge is watery and profuse but may become mucopurulent due to secondary bacterial infection. Symptoms can be more serious in patients who smoke, have gastric reflux, or anatomic abnormalities like deviated nasal septum, and chronic conditions like Obstructive Pulmonary Disease (COPD) and Cystic Fibrosis ◦Management ◦Symptom relief: rest, fluids, proper diet, antipyretics, analgesia, saline spray, gargle, lozenges, antihistamines, decongestant (no more than 3 days to prevent rebound), cough suppressants ◦Antibiotics are not indicated unless complications (bacterial infection develops) ◦Vitamin C, Echinacea, Zinc (Complementary and Alternative Therapies) ◦Monitor/teach to report secondary infection or worsening symptoms ◦Chronic disease—report: sputum changes, short of breath, chest tightness ◦Teach to avoid crowds/sick people and use good hand hygiene

Levels of anxiety

Anxiety - An unpleasant feeling of uneasiness, uncertainty, apprehension, dread, unexplained discomfort, tension, and/or helplessness. - A normal emotional response to a real or imagined threat or stressor - Diagnosis is made when individuals become overwhelmed and nonfunctional. - * Different than fear which is a feeling of dread in response to a known threat.* Purpose of Anxiety - Serves several purposes - A warning of impending danger - Mild anxiety can increase learning by enhancing concentration and focus - Uncontrolled anxiety often leads to ineffective and maladaptive behavior - A normal part of survival and growth - What are the disadvantages of having too much or too little anxiety? Too little anxiety can result in a lack of focus or recklessness; too much anxiety can lead to inability to accomplish important tasks. Continuum of Anxiety Responses - Reactions to anxiety occur along a continuum of behavioral responses. - Positively focused anxiety helps us to adapt, learn, and grow from our experiences. - Maladaptive responses to anxiety are ineffective attempts to cope. - Responses to anxiety occur on four levels, ranging from mild to panic. - Strive for emotional homeostasis Levels of anxiety - Levels of anxiety affects individuals physically, cognitively/perceptually, and emotionally/behaviorally Mild - Can motivate one to positively perform at a high level - Helps person to focus on the situation at hand Moderate - Narrowing of the perceptual field - Trouble attending to their surroundings - Can follow commands/direction - Quavering voice, tremors, increased muscle tension, increase in respirations and pulse, "butterflies in my stomach" feelings. Severe - Unable to attend to surroundings except for maybe a detail - Physical symptoms my develop - Anxiety relief is the goal - Difficulty communicating verbally, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation Panic Attack - Terror; only concern is to escape - Communication impossible at this point, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure. Self-Awareness and Anxiety - Anxiety is contagious - It is important for caregivers to recognize and cope effectively with their own anxieties - We may not choose our anxieties, but we do choose how we deal with them Types of Anxiety - Anxiety occurs as the result of a perceived threat to oneself. - Types of anxiety: Signal anxiety - Learned response to an anticipated event - Ex. Calm nursing student becomes nauseated during exams Anxiety state - Individual's coping abilities become overwhelmed and emotional control is lost - Ex. Emergencies, accidents, and traumas are associated with anxiety states. Anxiety trait - Persons typically react with anxiety in low stress situations; learned component of the personality - Ex. A person always giving reasons for behavior, even when not requested. Anxiety in Adulthood - Continue to use coping mechanisms established in childhood - Developmental tasks, such as establishing a career and family, present numerous stressors - Loss of income, spouse, physical ability can lead to severe anxiety - Fires, floods, earthquakes, wars result in long lasting anxiety - Unresolved anxiety can lead to PTSD and a number of mental health problems may result Anxiety in Older Adulthood - Elders often deny their anxiety - Somatization is the physical manifestation of psychological concerns. The physical symptoms, such as pain, are real though they have no underlying physical causes. - Socially, many were taught that it is inappropriate to share their fears and anxieties - Behaviors indicating anxiety: changes in eating, sleeping, ability to concentrate, impatience, fatigue - One of the most effective methods for assessing anxiety in older adults is to simply ask the client to explain his or her anxious feelings. - Older adults usually appreciate the interest of concerned caregivers Anxiety Disorders Diagnosis of an anxiety disorder is based on a description of the behaviors that express distress: - Generalized anxiety disorder - Panic disorders - Phobic disorders - Obsessive-compulsive disorder - Behavior al addictions - Traumatic stress reaction - Adjustment disorders - Post traumatic stress disorder Anxiety Disorder: Generalized Anxiety Disorder - Individual's anxiety is broad, long-lasting, and excessive - Worried and anxious more often than not Anxiety Disorder: Panic Disorders - More common than once thought - Two types of panic disorders - Associated with agoraphobia - Not associated with agoraphobia - agoraphobia is anxiety about possible situations in which a panic attack may occur. Individuals will avoid people, places and events from which escape would be difficult or embarrassing. Afraid to leave the house. - Panic attack: is a period of intense fear or discomfort in which at least four of the following symptoms develop abruptly and reach a peak within 10 minutes: - Palpitations - Sweating - Trembling or shaking - Feeling short of breath, smothering - Feeling of choking - Chest pain or discomfort - nausea or abdominal distress - feeling dizzy, unsteady, lightheaded, or faint - De-realization or depersonalization - Fear of losing control or going crazy - Fear of dying - Paresthesia - Chills or hot flushes Anxiety Disorder: Phobic Disorders - A phobia is an internal fear reaction - Phobias differ from common fears because they are obsessive in nature. - People with phobias handle their anxieties ineffectively - A phobia typically produces so high a level of anxiety that it is immobilizing - Characteristics of phobias vary with the culture - Social phobia is an unrealistic and persistent fear of any situation in which other people could be judging. Fear of looking foolish. Anxiety Disorder: Obsessive-Compulsive Disorder - Obsession is a distressing persistent thought. A compulsion is a distressing recurring behavior - Specific behaviors must be performed to reduce anxiety - Most common obsessions are related to cleanliness, dirt, and germs; aggressive and sexual impulses; health concerns; safety concerns; and order and symmetry - People with OCD are consumed by self destructive, anxiety reducing thoughts and actions. - People with OCD with the ego defense mechanism of repression to cope with distressing obsessions. - Difficult to maintain relationships because their compulsions are too time consuming or inappropriate. Anxiety Disorder: Behavioral Addictions - Obsessive-compulsive activities may also take the form of certain addictive behaviors: - Gambling/wagering - Shopping - Working - Sexual activity Anxiety Disorder: Traumatic Stress Reaction - Series of behavioral and emotional responses that follow an overwhelmingly stressful event - At risk: - Current mental problems - Victims or observers of violence - Victims of sexual assault - Victims of spouse abuse - Homeless people Anxiety Disorder: Adjustment Disorders - Distress that is out of proportion to the traumatic event - Symptoms occur within 3 months after event - Social and occupational function impaired - Depression and anxiety common - Increased risk for suicide Anxiety Disorder: Posttraumatic Stress Disorder - Occurs after witnessing or experiencing severe trauma - Reliving of traumatic events or situations - Anxiety, depression, and nightmares can complicate the picture - Flashbacks common - Flashbacks are vivid recollections of the event in which the individual relives. Flashbacks life threatening to the person. - Symptoms: intense fear, horror, helplessness, emotionally numb, extremely alert, guarded, agitated, easily startled, eating and sleeping disturbances - Isolation is common Anxiety: Treatment - Prevention is the most effective way to cope with anxiety. - Common medications to treat anxiety disorders: - Anti-anxiety drugs - Antidepressants - Antihistamines *** For the purposes of this course, we will not test on medication used to treat anxiety. Anxiety: Treatment - Mental health therapies: - Cognitive Behavioral Therapy (CBT): helps clients intellectually understand the ineffective behaviors used to cope with anxiety and replace them with more successful behaviors - Systematic desensitization: the clients learn to cope with one anxiety provoking stimulus at a time. This step by step method gradually removes the anxiety from the distress causing event and allows client to develop more effective ways of perceiving their anxiety. - Flooding: repeatedly exposes the person to the feared object or situation until anxiety levels diminish. Intense exposure to the phobic stimulus and no opportunity to escape. The idea is that the anxiety response can only be sustained for a finite amount of time. After a while the anxiety will subside and the person will relax and learn a new association between the phobic stimulus and the relaxed state. Nursing Process: Nursing Diagnoses r/t Anxiety - Anxiety - Risk for self or other directed violence - Rape-Trauma syndrome - Risk for post-trauma syndrome/Post trauma syndrome - Insomnia - Self care deficit - Powerlessness Nursing Process: Client Goal/Outcome The client will: - Remain free of destructive behavior toward self or others - Identify three concrete stress reduction techniques that are of interest - Identify cause of anxiety - Decrease level of anxiety by verbalizing feelings and using support systems - Develop effective methods of coping through problem-solving skills and anxiety-reducing techniques - Sleep a minimum of 6 or more hours every night Nursing Process: Coping Interventions - Cognitive approach - teaching the client or helping client think about the problem. (reframing) - Anticipatory guidance - Focuses on psychologically preparing a person for an unfamiliar or painful event - Biofeedback - a process that provides visual or auditory information about autonomic body functions. Nursing Process: Coping Interventions - Behavioral approach - encourage clients to engage in stress reducing behavior - Relaxation techniques - rhythmic breathing, reduced muscle tension, and altered state of consciousness. - Meditation - quiet surroundings, a passive attitude, a comfortable position, and a word or mental image on which to focus. - Guided imagery - a person creates a mental image, concentrates on the image, and becomes less responsive to other stimuli. - Journaling - practice of writing out one's thoughts and feelings as an exercise to identify and evaluate one's own sources of stress and coping strategies - Listening to music - helps anxious individuals distract and redirect their attentions - Interpersonal communication - essentially talking to a trusted source to help one process stressors and coping strategies - Pets - Therapy animals help anxious individuals feel more secure and help decrease many of the physical responses to stress Nursing Process: Coping Interventions - Teaching Healthy Activities of Daily Living: - Exercise - improves a person's general sense of well-being, relieves tension, and enables coping with day-to-day stressors. - Rest and sleep - help the body maintain homeostasis and restore energy levels; can insulate against stress; recommend 7-9 hours of sleep per day. - Nutrition - helps increase resistance to stress - Use of support systems - help a person identify and verbalize feelings associated with stress; safe environment to explore problem-solving methods and try out new coping skills; help maintain a positive self-concept and establish an avenue for new relationships and social roles. Nursing Process: Anxiety Interventions - Maintain a calm environment - Establish therapeutic relationship - Maintain open communication - Identify effective coping strategies - Observe for signs of suicidal thoughts - Client sign contract to refrain from violence - Reinforce personal strengths - Encourage client to establish and maintain relationships - Monitor medications for therapeutic response and for adverse reactions - Document any changes in behavior - Encourage client attend therapies and activities Priority Actions for a Client Experiencing Panic Attack - Provide a calm environment, decrease environmental stimuli, and stay with the client - Ask the client to identify what and how he or she feels - Administer anti-anxiety medication as ordered - Promote relaxation techniques such as breathing exercises or guided imagery - Listen to the client for expressions of helplessness and hopelessness - Document the event, significant information, actions taken and follow up actions and the clients responses

Stereotyping

Barriers To Cultural Care •Ethnocentrism: Believing one's ethnic group has rights or benefits over those of another group. •Can happen with race, religion, or culture group •Includes groups such as gangs, supremacist groups, and terrorist groups •Cultural Imposition: forcing cultural beliefs, values, and patterns on others •Cultural Bias: strong position that all decisions must be based on one's own values and beliefs •Cultural Ignorance: insufficient knowledge about a specific culture or provide safe and meaningful care Barriers to Cultural Care Stereotyping: an exaggerated belief about a group that assumes anyone from that group has a certain set of characteristics; is an oversimplified mental picture of a cultural group. •May be positive or negative •Negative includes racism, ageism, and sexism •Stereotyping may take negative, positive, or traditional forms Prejudice (extreme negative stereotyping) •Judging a person, group, or situation before knowing all the facts •Usually a negative connotation (although there are positive prejudices!) •Usually destructive •Usually hurtful •Restrictive to enrichment of society •Health care providers need to know and understand their own racial, ethnic, religious, and social stereotypes.

Mormons

Church of Jesus Christ of Latter Day Saints • Devout adherents believe in divine healing through the "laying on of hands," though many do not prohibit medical therapy. The Church maintains an extensive and well funded welfare system, including financial support for the sick. • Nursing Considerations:• Disapproved of alcohol, tobacco, and caffeinated beverages. • A special undergarment worn by some members should be removed only in an emergency. • Fasting is a tradition that is honored by Mormons, but if ill, fasting may be passed. • When caring for Mormons, it is important to realize that members look to local church leaders for support and comfort. Even if the Mormon patient is not in his/her home city, contacting a local Mormon leader is greatly appreciated. The Mormon Church also has an organized group of women called the "Relief Society" that provides help to families when dealing with difficult situations like illness. • The Mormon Church has arranged for many hospitals to have blessed oil on hand in the case of a hospitalized patient wanting blessing by the Mormon priesthood. It is necessary for non- Mormons to leave the room when a Mormon is being blessed.

Polyuria, Polydipsia, Polyphagia - clinical manifestations of diabetes

Clinical Manifestations of Diabetes: Polyuria Polydipsia Polyphagia Weakness/Fatigue Dry mouth Numbness in hands/feet High blood sugars Dry, itchy skin Cellulitis of the leg Infections/wounds that don't heal (Vaginitis, UTI's) Blurred Vision High blood pressure High Cholesterol Weight loss or gain Impotence

Sleep

Factors that decrease BMR Aging, prolonged fasting, and sleep Obesity Respiratory and Sleep Problems - Sleep apnea (Snoring and hypoventilation) - Obesity hypoventilation syndrome (Reduced chest wall compliance, Increased work of breathing, Decreased total lung capacity) - Weight loss can improve lung function Sleep - State in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused TYPES: - Insufficient sleep - Fragmented sleep - Nonrestorative sleep Sleep facts - Over a life span of 80 years, an average individual who sleeps 7 hours/night will spend approximately 24 years sleeping. - Sleep influences behavioral and physiologic functions including memory, mood, hormone secretion, glucose metabolism, immune function, and body temperature. - Most adults require 7-8 hours of sleep within a 24-hour period. - Adequate sleep is defined as the amount of sleep one needs to be fully awake and alert the next day. - Insufficient sleep: obtaining less than the recommended amount of sleep. - Fragmented sleep: frequent arousals or actual awakenings that interrupt sleep continuity. - Nonrestorative sleep refers to sleep that is of adequate duration, but does not result in the individual feeling refreshed and alert the next day. Physiology of Sleep - Reticular activating system (RAS) - Facilitates reflex and voluntary movements, Controls cortical activities related to state of alertness - Bulbar synchronizing region - Hypothalamus—control center for sleeping and waking Stages of Sleep - Non-rapid eye movement (NREM): Consists of four stages - Stages I and II: 5% to 50% of sleep, light sleep - Stages III and IV—10% of sleep, deep-sleep states (delta sleep) - Rapid eye movement (REM) - 20% to 25% of a person's nightly sleep time - Pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase; skeletal muscle tone and deep tendon reflexes are depressed. NREM stage 1 - 5% NREM Stage 2 - 50% NREM Stage 3 - 15% REM - 20% Wake after sleep onset - 5% Sleep Cycle - The person passes consecutively through four stages of NREM sleep. - The pattern is then reversed (Return from stage IV to III to II, Enter REM sleep instead of re-entering stage I) - The person re-enters NREM sleep at stage II and moves on to III and IV. NREM Sleep - 75% to 80% of sleep time - Divided into three stages - Stage 1- slow eye movements, occurs at the beginning of sleep, with slow eye movements, and is a transition phase from wakefulness to sleep. During this period, the person can be easily awakened. - Stage 2- HR and temperature decrease, comprises most of a night of sleep. This stage is associated with specific EEG wave forms that help to maintain sleep. - Stage 3- deep, or slow wave sleep (SWS) = delta waves. This stage is associated with large EEG wave forms, called delta waves, which are used as a measure of sleep intensity. SWS declines as people age such that most adults over 60 years of age have very little NREM stage 3 sleep REM Sleep - 20% to 25% of sleep - Occurs 3 to 4 times a night - Period when most vivid dreaming occurs - REM sleep follows NREM sleep in a sleep cycle. - Brain waves resemble wakefulness, and postural muscles are inhibited leading to greatly reduced skeletal muscle tone. - During REM sleep an individual cannot initiate muscle movement (e.g., cannot stand up). A Single Normal Sleep Cycle wakefulness NREM stage 1 NREM stage 2 NREM stage 3 NREM stage 4 NREM stage 3 NREM stage 2 REM NREM stage 2 Sleep Disturbances and Disorders - Sleep Disturbance (Conditions of poor sleep quality) - Sleep Disorders: -Abnormalities unique to sleep -Insomnia -Narcolepsy Sleep Disturbances and Disorders - About 30% of Americans report getting less than 6 hours of sleep per night. - An estimated 50-70 million people in the United States have a sleep disorder, and many are unaware that they have a problem. - Untreated sleep disorders cause considerable health, safety, and economic consequences. - Daytime sleepiness can be so severe that it interferes with work and social functioning. - People with chronic illness are at greatest risk for sleep disturbances. - Untreated sleep disorders pose considerable health and economic consequences. Driving while drowsy is related to 100,000 accidents and 1500 traffic fatalities per year. Sleep-Wake Cycle - Controlled by the brain - Wake behavior (RAS and various neurotransmitters, Orexin (hypocretin) - Complex networks in the brainstem, hypothalamus, and thalamus interact to regulate the sleep and wake cycles. - The reticular activating system (RAS) is associated with general cortical activation and behavioral arousal. - Various neurotransmitters (glutamate, acetylcholine, norepinephrine, dopamine, histamine, serotonin) promote wake behavior. - The sedating properties of many over-the-counter (OTC) medications (e.g., diphenhydramine [Benadryl]) result from inhibiting one of these arousal systems. - Orexin (also called hypocretin) is a neuropeptide found in the hypothalamus. Orexin is involved in regulating the sleep-wake cycle and plays a role in keeping people awake. - Decreased levels of orexin or its receptors lead to difficulties staying awake and the syndrome called narcolepsy. Sleep-wake cycle - Sleep behavior - Involves a variety of neurologic structures - Melatonin - Sleep-promoting neurotransmitters and peptides include γ-aminobutyric acid (GABA), galanin, melatonin, adenosine, somatostatin, growth-hormone-releasing hormone, delta-sleep-inducing peptide, prostaglandins, and proinflammatorycytokines. - When a person has an infection, proinflammatory cytokines (interleukin-1, tumor necrosis factor, interleukin-6) mediate symptoms such as sleepiness and lethargy. - Peptides, such as cholecystokinin, released by the gastrointestinal tract after food ingestion may mediate postprandial sleepiness (sleepiness after eating). - Melatonin is an endogenous hormone (from the amino acid tryptophan) produced by the pineal gland in the brain from the amino acid tryptophan. - Under normal day-night conditions, melatonin is released in the evening as it gets dark. Light exposure at night can suppress melatonin secretion. Circadian Rhythms - Managed by the suprachiasmatic nucleus (SCN) in hypothalamus - Synchronized through light detectors in retina - Light is the strongest time cue - Because the circadian (circa dian, about a day) rhythms are controlled by internal clock mechanisms, they persist when people are placed in environments free of external time cues. - SCN is the master clock of the body. - Light is the strongest time cue for the sleep-wake rhythm. Thus light can be used as a therapy to shift the timing of the sleep-wake rhythm. For example, bright light used early in the morning will cause the sleep-wake rhythm to move to an earlier time; bright light used in the evening will cause the sleep-wake rhythm to move to a later time. Sleep Architecture - Nighttime sleep recorded from physiologic measures recorded by PSG - Brain waves - Eye movements - Muscle tone - Sleep architecture refers to nighttime sleep recorded from physiologic measures of brain waves, eye movements, and muscle tone by polysonography (PSG). - Sleep consists of two basic states: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. During sleep, the body cycles between NREM and REM sleep. - Once asleep, the body goes through 4-6 NREM and REM sleep cycles. - REM sleep is thought to be important for memory consolidation and is the period when the most vivid dreams occur. Factors Affecting Sleep - Developmental considerations - Motivation - Culture - Lifestyle and habits - Environmental factors - Psychological stress - Illness - Medications Illnesses Associated With Sleep Disturbances - Gastroesophageal reflux - Coronary artery diseases - Epilepsy - Liver failure and encephalitis - Hypothyroidism - End-stage renal disease Classification of Sleep Disorders - Dyssomnias - Parasomnias - Sleep disorders associated with medical - or psychiatric disorders - Other proposed disorders Sleep Disorders - Dyssomnias: characterized by insomnia or excessive sleepiness - Parasomnias—patterns of waking behavior that appear during sleep Dyssomnias - Insomnia - Hypersomnia - Narcolepsy - Sleep apnea - Restless leg syndrome - Sleep deprivation Parasomnias - The parasomnia is generally goal directed, although the person is not aware or conscious of the act. - Unusual and often undesirable behaviors that occur while falling asleep, transitioning between sleep stages, or during arousal from sleep - Due to CNS activation - Sleepwalking and sleep terrors are arousal parasomnias that occur during NREM sleep and can range from sitting up in bed, moving objects, and walking around the room to driving a car. - In the ICU, a parasomnia may be misinterpreted as ICU psychosis. Sedated ICU patients can exhibit manifestations of a parasomnia. - Sleep terrors are characterized by sudden awakening from sleep along with a loud cry and signs of panic. - Nightmares are commonly reported by patients in the ICU and are probably due to medications, including sedative-hypnotics, beta-adrenergic antagonists, dopamine agonists, and amphetamines. REM sleep is often absent in critically ill patients. The longer the stay in the ICU, the more likely the patient is to have nightmares. Treatment for Dyssomnias - Pharmacologic therapy (Sedatives, Hypnotics) - Nonpharmacologic therapy (Cognitive Behavioral Therapy (CBT)) - Progressive muscle relaxation measures, Stimulus control, Sleep restriction; sleep hygiene measures, Biofeedback and relaxation therapy Effects of Sleep Deprivation and Sleep Disorders - Insufficient sleep and sleep disorders are associated with changes in body function and health problems. - Impaired cognitive function and performance on simple behavioral tasks occur within 24 hours of sleep loss. - Individuals who report less than 6 hours of sleep a night have a higher body mass index (BMI) and are more likely to be obese. - Risk for developing glucose intolerance and diabetes is increased in individuals with a history of insufficient sleep. - Chronic loss of sleep places older adults at risk for depression, impaired daily functioning, social isolation, and overall reduction in quality of life. - In patients with chronic illnesses, insomnia and sleep disordered breathing are associated with increased morbidity and mortality. Sleep Disturbances in the Hospital - Hospitalization associated with decreased sleep time - Environmental sleep-disruptive factors - Psychoactive medications - Acute and critical illness - Hospitalization, especially in the intensive care unit (ICU), is associated with decreased total sleep time and decreased SWS and REM sleep. - Patient symptoms, including pain, dyspnea, and nausea, can also contribute to sleep loss in the acutely ill patient. - Medications commonly used in acutely and critically ill patients can further contribute to sleep loss. - Hospitalized patients are also at risk for poor sleep because of circadian rhythm disruptions. - You have an important role in creating an environment conducive to sleep. This includes the scheduling of medications and procedures, including those performed by unlicensed assistive personnel (UAP). Reducing light and noise levels can promote opportunities for sleep. Hypnotic medications are often available on an as-needed basis. downloaded to a computer and analyzed. Activity corresponds to time spent awake, and continuous inactivity corresponds to time spent asleep. - Polysomnography: A PSG study is done only when symptoms or signs of another sleep disorder, such as sleep-disordered breathing, are evident. PSG simultaneously records muscle tone using electromyogram (EMG), eye movements via electro-oculogram (EOG), and brain activity via electroencephalogram (EEG). Sleep-Disordered Breathing (SDB) - The term sleep-disordered breathing (SDB) indicates abnormal respiratory patterns associated with sleep, including snoring, apnea (temporary cessation of respiration), and hypopnea (temporary restriction of respiration without full cessation) with increased respiratory effort leading to frequent arousals. SDB results in frequent sleep disruptions and alterations in sleep architecture. - Obstructive sleep apnea is the most commonly diagnosed SDB problem. Obstructive Sleep Apnea - obstructive sleep apnea-hypopnea syndrome (OSAHS) - Apnea is cessation of spontaneous respirations for longer than 10 seconds. - Hypopnea is shallow respirations (30% to 50% reduction in airflow). - Airflow obstruction in OSA occurs because of (1) narrowing of the air passages with relaxation of muscle tone during sleep and/or (2) the tongue and the soft palate falling backward to partially or completely obstruct the pharynx (Fig. 7-4). - Each obstruction may last 10 to 90 seconds. - Apnea and arousal cycles occur repeatedly. Apneic episodes occur most often during REM sleep when airway muscle tone is lowest. - Smokers are more likely to have OSA. - OSA is more common in men than in women until after menopause, when the prevalence of the disorder is the same in both genders. Women with OSA have higher mortality rates. OSA patients with excessive daytime sleepiness have increased mortality. How Sleep Apnea Occurs A, The patient predisposed to obstructive sleep apnea (OSA) has a small pharyngeal airway. B, During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneicepisodes. C, With CPAP, continuous positive airway pressure splints the airway open, preventing airflow obstruction. Obstructive Sleep Apnea Clinical manifestations - Frequent arousals during sleep - Insomnia - Excessive daytime sleepiness - Witnessed apneic episodes - Snoring - Morning headache - Irritability - The patient's bed partner may complain about the patient's loud snoring. - Morning headaches are related to hypocapnia or increased BP that causes vasodilation of cerebral blood vessels. Obstructive Sleep Apnea Complications - Complications that can result from untreated sleep apnea include hypertension, cardiac dysrhythmias, arteriosclerosis, heart failure, and cardiovascular-related mortality. - During PSG, the patient's chest and abdominal movement, oral airflow, nasal airflow, SpO2, ocular movement, and heart rate and rhythm are monitored. - A diagnosis of sleep apnea requires documentation of apneic events or hypopneas of at least 10 seconds' duration. OSA is defined as more than 5 apnea/hypopnea events per hour accompanied by a 3% to 4% decrease in oxygen saturation. Severe apnea can be associated with apneic events of more than 30 to 50 per hour of sleep. Sleep Apnea Nursing and Interprofessional Mgmt - Mild Sleep Apnea - Sleeping on one's side - Elevating head of bed - Avoiding sedatives and alcohol 3 to 4 hours before sleep - Weight loss - Oral appliance - Excessive weight worsens sleep apnea as the pressure of adipose tissue in the neck and on the chest restrict ventilation. - Oral appliances bring the mandible and the tongue forward to enlarge the airway space, thereby preventing airway occlusion. Sleep Apnea Nursing and Interprofessional Mgmt - With CPAP, a nasal mask is attached to a blower, which is adjusted to maintain sufficient positive pressure (5 to 25 cm H2O) in the airway during inspiration and expiration to prevent airway collapse. - To ensure successful adherence to CPAP treatment, patients needs to be involved in the selection of the mask and device before the start of therapy. - For those with difficulty with CPAP, bilevel positive airway pressure (BiPAP) can deliver a higher inspiration pressure and a lower pressure during expiration. - UPPP involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove obstructing tissue. - GAHM involves advancing the attachment of the muscular part of the tongue on the mandible. Devices for Sleep Apnea Examples of positive airway pressure devices for sleep apnea. A, Patient wearing a nasal mask and headgear (positive pressure only through nose). B, Patient wearing nasal pillows (positive pressure only through nose). C, Patient wearing a full facemask (positive pressure to nose and mouth). CPAP With Nasal Mask Management of sleep apnea often involves sleeping with a nasal mask in place. The pressure supplied by air coming from the compressor opens the oropharynx and nasopharynx. - Management of sleep apnea often involves sleeping with a nasal mask in place. The pressure supplied by air coming from the compressor opens the oropharynx and the nasopharynx Circadian Rhythm Disorders - Occur when the circadian time-keeping system loses synchrony with environment - Jet lag disorder - Shift work sleep disorder - Common symptoms - Insomnia, excessive sleepiness - Jet lag disorder occurs when an individual's travel results in the crossing of multiple time zones and one's body time is not synchronized with environmental time. The number of time zones crossed affects the severity of symptoms and the time it takes to recover. - Melatonin and exposure to daylight help to synchronize the body's rhythm - Nurses on permanent night or rapidly rotating shifts are at increased risk of experiencing shift work sleep disorder, insomnia, sleepiness, and fatigue. Narcolepsy - Brain unable to regulate sleep-wake cycles normally - Causes uncontrollable urges to sleep, often go directly into REM sleep - Cause unknown - Associated with destruction of neurons that produce orexin - Patients will fall asleep for a few seconds to several minutes. Going directly into REM sleep is unique to narcolepsy. - The onset of narcolepsy typically occurs in adolescence or early in the third decade. Head trauma, a sudden change in sleep-wake habits, and infection may trigger the onset of narcolepsy symptoms. - The cause is unknown. A deficiency of orexin (hypocretin) from the destruction of orexin neurons, a neuropeptide linked to walking, is associated with narcolepsy. The loss of neurons may be due to an autoimmune process. Narcolepsy Types Two types: - Type 1- with cataplexy - Type 2- without cataplexy Symptoms - Sleep paralysis - Cataplexy - Fragmented nighttime sleep - Cataplexy is a brief and sudden loss of skeletal muscle tone which can manifest as a brief episode of muscle weakness or complete postural collapse and falling. - Unwanted episodes of REM sleep occur throughout the day in patients with narcolepsy. These sleep episodes are usually of short duration but can last for longer than an hour, and patients feel refreshed afterward. - Narcolepsy is diagnosed on the basis of a history of sleepiness, PSG, and daytime multiple sleep latency tests (MSLTs). Narcolepsy Nursing and Interprofessional Management -Teach about sleep and sleep hygiene -Take naps -Avoid heavy meals and alcohol -Ensure patient safety - Narcolepsy cannot be cured. Management of narcolepsy is focused on symptom management. - Advise the patient with narcolepsy to take 3 or more short (15 minutes) naps throughout the day and to avoid large or heavy meals and alcohol. - Safety precautions, especially when driving, are critically important. Narcolepsy Drug Therapy - A nonamphetamine wake-promotion drug, modafinil (Provigil), is considered a first-line drug. - Sodium oxybate (Xyrem), a metabolite of GABA, is another wake-promoting medication that is used. - High doses of selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and venlafaxine (Effexor), may also be prescribed for cataplexy. - Drug therapy needs to be combined with behavioral therapy. The behavioral therapies for insomnia are also used for patients with narcolepsy. Gerontologic Considerations: Sleep Older age is associated with - Overall shorter total sleep time - Decreased sleep efficiency - More awakenings - Insomnia symptoms - Insomnia symptoms in older adults frequently occur with depression, cardiovascular disease, pain, and cognitive problems. - A common misconception is that older people need less sleep than younger people. However, the amount of sleep needed as a person ages remains relatively constant. - Cough and cold medications, especially those containing pseudoephedrine, caffeine-containing drugs, and drugs containing nicotine (e.g., nicotine gum, transdermal patches), are stimulants. Diphenhydramine alone or in combination with other drugs is sedating with anticholinergic effects. Any OTC medication labeled "PM" probably has diphenhydramine and should be used cautiously by older adults. - Older adults receiving benzodiazepines are at increased risk of daytime sedation, falls, and cognitive and psychomotor impairment. Obtaining a Sleep History - Nature of problem - Cause of problem - Related signs and symptoms - When the problem began and how often it occurs - How the problem affects everyday living - Severity of the problem and how it can be treated - How the patient is coping with the problem and success of treatments attempted Screening Tools to Assess Sleep Disturbances - The Epworth Sleepiness Scale - The Pittsburgh Sleep Quality Index (PSQI) - Sleep Disturbance Questionnaire Sleep Characteristics to Assess - Restlessness - Sleep postures - Sleep activities - Snoring - Leg jerking Information Recorded in a Sleep Diary - Time patient retires - Time patient tries to fall asleep - Approximate time patient falls asleep - Time of any awakening during the night and resumption of sleep - Time of awakening in morning - Presence of any stressors affecting sleep - Record of food, drink, or medication affecting sleep - Record of physical and mental activities - Record of activities performed 2 to 3 hours before bedtime - Presence of worries or anxieties affecting sleep Key Findings of Physical Assessment - Energy level - Facial characteristics - Behavioral characteristics - Physical data suggestive of sleep problems Sleep Common Etiologies for Nursing Diagnoses Disturbed sleep pattern related to - Physical or emotional discomfort or pain - Changes in bedtime rituals or sleep environment - Disruption of circadian rhythm - Exercise and diet before sleep - Drug dependency and withdrawal - Symptoms of physical illness Nursing Implementation to Promote Sleep - Prepare a restful environment. - Promote bedtime rituals. - Offer appropriate bedtime snacks and beverages. - Promote relaxation and comfort. - Respect normal sleep-wake patterns. - Schedule nursing care to avoid disturbances. - Use medications to produce sleep. - Teach about rest and sleep.

Xiphoid Process - finding respiration

It's made up of cartilage at birth but develops into bone in adulthood. It's located where the lower ribs attach to the breastbone. The tip of the xiphoid process resembles a sword. Although the xiphoid process is small, it serves as an attachment point for organs and large muscles that make the floor of the diaphragm.

Poisoning

Herbal Toxicity: - herbs do indeed have side effects and may be toxic or poisonous if not used appropriately. Consider the toxicity of widely used natural products such as coffee, cocaine, and tobacco. Another dilemma is patient use of herbs in lieu of their prescribed medications. Although herbs may be a good option in particular cases and conditions, the decision to decline medications should be based on fully informed judgments in partnership with a health professional. Safety Considerations for Toddlers/Preschoolers: Poisoning - Ingestion of injurious agents: - Cosmetics and personal care products - Cleaning products - Plants - Foreign bodies, toys, and miscellaneous substances - Hydrocarbons (gasoline) - Heavy metal poisoning - Most common is lead ingestion - Mercury toxicity (less frequently) - Act by changing cellular metabolism, causing damage to structures, or disturbing function. - Tend to alter a person's mental status = difficulty obtaining accurate health history. - Need to recognize the toxin and interrupt effect Safety Considerations for Toddlers/Preschoolers: Poisoning Treatment: - Identify Substance - Poison control center - Call first, before initiating any interventions - Gastric decontamination - - Induce vomiting, absorb toxin, or perform gastric lavage depending on agent ingested - Ipecac not recommended for in-home use - Activated charcoal usage - Treat as Indicated - Moved into fresh air, given supplemental oxygen, respiratory status closely monitored, watch for swelling, decrease pain. Prevention: - All medicines and pharmaceuticals, tobacco and e-cigarette products, alcohol, laundry and cleaning supplies, pesticides and insect repellents, batteries, oil or lubricant, hand sanitizer, personal care products and other chemicals should be stored away from food and where children cannot access them. (either up high or in a locked cupboard) - Educated children to not eat wild mushrooms or berries found outdoors - Install carbon monoxide detectors in home Safety Considerations for Toddlers/Preschoolers: Lead Poisoning Screening and Treatment Exposure: - Most common by peeling lead-based paint - Can be inhaled or ingested - Screening for lead poisoning at ages 1 and 2 years - Lead is a cumulative toxicant that affects multiple body systems and is particularly harmful to young children. - Lead in the body is distributed to the brain, liver, kidney and bones. It is stored in the teeth and bones, where it accumulates over time. Lead in bone is released into blood during pregnancy and becomes a source of exposure to the developing fetus. - There is no level of exposure to lead that is known to be without harmful effects. Safety Considerations for Toddlers/Preschoolers: Lead Poison Screening and Treatment Signs and Symptoms: - Rarely symptomatic - Affects renal, hematologic, and neurologic systems; developing brain and nervous systems are especially vulnerable - Long-term effects—behavioral and cognitive - Human exposure is usually assessed through the measurement of lead in blood. Venous blood sample of 10 mcg/dl Treatment: Chelation therapy with Calcium disodium edetate (EDTA)—IV or IM British antilewisite—IM (along w/EDTA) Succimer (DMSA)—Oral Prevention: - Test paint and dust in home for lead if you live in a home built before 1978. - Renovate safely - Remove recalled toys and toy jewelry from children and discard as appropriate Adults: - Use medication trays to avoid poisoning - Quadriplegia, Lead poisoning, - A leading cause of death in middle adulthood Among All Age Groups: Snakebites Safety Considerations: - Only a small percentage of snakebites are caused by poisonous snakes. - Culprit: coral snake and pit vipers which include rattlesnake, copperheads, and cottonmouth moccasins. - Snakebite leaves two small puncture wounds with surrounding discoloration, swelling, and pain; burning at the site. - interventions are focused on decreasing the circulation of venom throughout the patient's system by keeping the patient calm, immobilizing the affected part, extremities positioned below level of the heart - Wound sites should be cleaned with soap and water; do not irrigate or flush. Wound dressed in loose, clean dressing. Don't apply ice. - Assist with IV delivery of antivenin.

Morbidity and Mortality

Morbidity: how frequently a disease occurs / how common is it Mortality: the numbers of death

Myopia

Myopia, or nearsightedness, is the inability to accommodate for objects at a distance

Massage Therapy

MASSAGE THERAPY - Use of touch by stroking, pressure, friction, and kneading the muscles to relax muscles and decrease stress to achieve therapeutic results. Massage energizes tissue and helps to relieve pain, promote sleep, and improve well-being. - Used to relax muscles, reduce anxiety, increase circulation, and reduce pain - Stroking, kneading, friction, and vibration used to relieve muscle pain and promote comfort - Massage is used by nurses to promote health and wellness. It is used to increase circulation, relieve pain, induce sleep, reduce anxiety or depression, and improve quality of life. Massage produces therapeutic effects on multiple body systems: integumentary, musculoskeletal, cardiovascular, lymph, and nervous. Manipulating the skin and underlying muscle makes the skin supple. Massage increases or enhances movement in the musculoskeletal system by reducing swelling, loosening and stretching contracted tendons, and aiding in the reduction of soft tissue adhesions. Friction to the cutaneous and subcutaneous tissues releases histamines that, in turn, produce vasodilation of vessels and enhance venous return. - Massage is a proposed mechanism for relaxation to reduce psychological and physiological stress. Stress is also an individual subjective experience. When the body interprets a physiological or psychological response as stressful, the sympathetic nervous system stimulates the hypothalamic-pituitary-adrenal (HPA) axis in the brain. There is a release of stress hormones such as cortisol and epinephrine. Tactile stimulation in the body tissues causes neurohormonal responses throughout the nervous system. Mechanoreceptors cause impulses to travel from the peripheral nervous system, up the ascending spinal cord to the brain. The stimulus is then interpreted in the higher brain, resulting in a neurological or biochemical response. Massage activates the parasympathetic nervous system to decrease the heart rate, blood pressure, and respirations, resulting in relaxation. Techniques for Hand Massage - 255 - Each hand is massaged for 2½ minutes. Do not massage if the hand is injured, reddened, or swollen. Protocols from 5 to 10 minutes for each hand have also been recommended (Kolcaba et al, 2006; Remington, 2002). 1. Back of hand - Short, medium-length, straight strokes are done from the wrist to the fingertips; moderate pressure is used (effleurage). - Large, half-circle, stretching strokes are made from the center to the side of the hand, using moderate pressure. - Small, circular strokes are made over the entire hand, using light pressure (make small os with the thumb). - Featherlike, straight strokes are made from the wrist to the fingertips, using very light pressure. 2. Palm of hand - Short, medium-length, straight strokes are made from the wrist to the fingertips, using moderate pressure (effleurage). - Gentle milking and lifting of the tissue of the entire palm of the hand is done using moderate pressure. - Small circular strokes are made over the entire palm, using moderate pressure (making little os with index finger). - Large, half-circle, stretching strokes are used from the center of the palm to the sides, using moderate pressure. 3. Fingers - Each finger is gently squeezed from the base to the tip on both sides and the front and back, using light pressure. - Gentle range of motion is performed on each finger. - Gentle pressure is applied to each nail bed. 4. Completion - The patient's hand is placed on yours and covered your other hand. The top hand is gently toward you several times. The patient's hand is turned over, and your other hand is gently drawn toward you several times. MASSAGE THERAPY Advantages: - Relieves muscle tension and stress without meds - Stimulates the circulatory system - Produces endorphins Contraindicated in pts with: - Blood clots, certain cancers, certain heart dz, severe osteoporosis

Vitamins

Organic compounds needed in small amounts, most active as coenzymes, needed for metabolism of carbs, protein, fat. classified as water/fat soluble. absorbed through intestinal wall directly into bloodstream

Sign Language

Sign language is used as a form of communication for people with profound hearing impairment. - It involves gestures and facial features such as eyebrow motion and lip-mouth movements. - American sign language (ASL) is used in the United States and in English-speaking areas of Canada

Nutrition

Six classes of nutrients - supply energy: carbs, lipids, proteins - regulate body processes: vitamins, minerals, water Recommended Dietary Allowance (RDA) - level of nutrient that is adequate to meet the needs of all healthy people (not applied to ill) carbohydrates - sugars and starches - organic compounds composed of carbon, hydrogen, and oxygen - the structural framework of plants; lactose = only animal source - most abundant/least expensive source of cals - classified as simple/complex sugars - 90% of carb = ingested - converted to glucose for transport through blood - oxidize glucose = energy, CO2, H2O protein - required for formation of body structures - labeled complete (high qual, animal protein) / incomplete (low qual protein) based on amino acid comp. - tissues in constant state of flux + continuously being broken down (catabolism) and replaced (anabolism - rda: adults (0.8 g/kg of body weight, 10 to 35% calorie intake) fats -insoluble in water and blood -composed of carbon, hydrogen, and oxygen - 95% of lipids in diet = triglycerides -most animal fats = saturated -most vegetable fats=unsaturated -digestion = largely in small intestine -most concentrated source of energy -RDA not established, 20-35% total calorie intake vitamins Organic compounds needed in small amounts, most active as coenzymes, needed for metabolism of carbs, protein, fat. classified as water/fat soluble. absorbed through intestinal wall directly into bloodstream minerals - Organic elements in all body fluids and tissues - Some function to provide structure/ help regulate body processes - Contained in ash after digestion - Macrominerals: calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium. - Microminerals: iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine. water -50-60% of adult total weight -2/3 of body water is in cells (ICF) -remainder = extracellular fluid (ECF), body fluids (plasma, interstitial fluid) -provides fluid medium for chemical reactions -solvent, aids digestion, absorption, circulation, and excretion Components of Nutritional Assessment - history taking (dietary, medical, socioeconomic). physical assessment (anthropometric/clinical data and measurements - BMI, body comp, heigh/weight tables). lab data (protein status, body vitamin, mineral, trace element status - dietary status - 24 hour recall method, food diaries/calorie counts, food frequency record, diet history - body weight standards - Female: 100 lb + 5 lb. for each additional inch over 5 ft - Male: 106 lb +6 lb. for each additional inch over 5 ft - Add/Subtract 10% based on body frame food intake Decreased: anorexia (lack of appetite) Increased: Obesity (BMI ≥30) Body Mass Index - Healthy goal is 18.5 to 24.9 for adults. - Weight (kg)/Height (m2) - Underweight = BMI less than 18.5 kg/m2 - Normal = BMI 18.5 to 24.9 kg/m2 - Overweight = BMI 25 to 29.9 kg/m2 - Obese = BMI greater than 30 kg/m2 - Extremely obese = BMI greater than or equal to 40 kg/m2 Basal metabolic rate (BMR) - The energy required to keep the body functioning, including a beating heart, breathing lungs, and keeping the body temperature normal. Factors Affecting Basal Metabolic Rate (BMR) - Males have a higher BMR due to larger muscle mass - BMR is about 1 cal/kg of body weight per hour for men - BMR is about 0.9 cal/kg of body weight per hour for women Factors that increase BMR - Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones Factors that decrease BMR - Aging, prolonged fasting, and sleep Laboratory Tests for Nutritional Status (Serum) - Albumin: visceral protein status (useful for long-term monitoring) 3.5-5 g/dL - Prealbumin: visceral protein status (useful for short- term monitoring) 20-50 mg/dL - Lymphocyte count: immune function; > 1500 cells/mm - Transferrin: iron status (protein for iron absorption and transport); 30-40% - Hematocrit (HCT): % of blood that is composed of RBCs (low level may mean deficiencies in iron, Vit. B12 and folic acid) - Urine Specific Gravity: fluid deficit or excess; 1.010-1.020 - Blood Urea Nitrogen (BUN) - measures the amount of nitrogen in the blood that comes from the waste product, urea. Urea is made when protein is broken down. It is made in the liver & passed out into the urine. - Creatinine - formed when food is changed into energy. This is broken down into creatinine & passed out into urine - Hemoglobin (Hgb) - measures the blood's ability to carry oxygen throughout the body; Low levels can reflect deficiencies in iron, folate, Vit. B12 Laboratory Tests for Nutritional Status (Serum) - Total Cholesterol - Desirable: less than 200 mg/dL - Borderline high risk: 200-239 mg/dL - High Risk: 240 mg/dL or over - LDL (Low Density Lipoprotein) - "bad" cholesterol - optimal: < 100 mg/dL - near optimal: 100-129 mg/dL - borderline high: 130-159 mg/dL - high: 160-189 mg/dL - very high: ≥ 190 mg/dL Laboratory Tests for Nutritional Status (Serum) - HDL (High Density Lipoprotein) - "good" cholesterol - average: - 40-50 mg/dL (males) - 50-60 mg/dL (females) - high risk for heart disease: < 35 mg/dL - negative risk for heart disease: >60 mg/dL - More useful is the ratio of total cholesterol (TC) to HDL (TC:HDL) - Optimum: 3.5 to 4: 1 (example: TC = 200 mg/dL and HDL = 50 mg/dL. TC: HDL ratio is 4: 1) Laboratory Tests for Nutritional Status (Serum) - Triglycerides (fasting state) - Normal: < 150 mg/dL - Borderline high: 150-199 mg/dL - High: 200-499 mg/dL - Very high: ≥ 500 mg/dL Factors Affecting Nutritional Status - Physiological factors (healthy teeth, gums, abilities, state of health) , developmental factors (growth, pregnancy, activity, age, needs), physiological factors (why we eat), education, economic factors, meaning of food (tradition), culture (family, religion, schools) Risk Factors for Poor Nutritional Status - Developmental factors - Gender - State of health - Alcohol abuse - Medications - Megadoses of nutrient supplements Nursing Diagnosis - Health-seeking behaviors: nutrition - Need for proper nutrition - Imbalanced nutrition: less than body requirements - Nutritional deficiencies - Imbalanced nutrition: more than body requirements - Obesity - Diet high in nutrients such as fats, carbohydrates, or sodium Imbalanced nutrition: less than body requirements - Abdominal pain with or without pathology - Actual or potential metabolic needs in excess of intake with weight loss - Capillary fragility - Decreased serum albumin - Decreased serum transferrin or iron-binding capacity - Diarrhea and/or steatorrhea - Documented inadequate caloric intake - Dry, brittle, hair easily plucked from scalp - Excessive hair loss - Hyperactive bowel sounds - Loss of subcutaneous tissue - Loss of weight or without adequate caloric intake - Mental irritability or confusion - Muscle weakness and tenderness - Pale, dry skin - Paresthesias - Poor muscle tone - Red, swollen oral mucous membranes Imbalanced nutrition: less than body requirements related factors - Inability to absorb or metabolize foods (i.e. dysphagia) - Inability to digest foods (i.e. nausea and vomiting) - Inability to ingest foods (i.e. mouth discomfort) - Inability to procure adequate amounts of food - Increased metabolic needs caused by disease process or therapy (i.e. Increased protein and vitamin requirements for wound healing and decreased intake) - Unwillingness to eat - Knowledge deficit Imbalanced nutrition: less than the body goals and outcomes - Patient presents understanding of significance of nutrition to healing process and general health. - Patient or caregiver verbalizes and demonstrates selection of foods or meals that will accomplish a termination of weight loss. - Patient demonstrates behaviors, lifestyle changes to recover and/or keep appropriate weight. - Patient displays nutritional ingestion sufficient to meet metabolic needs as manifested by stable weight or muscle-mass measurements, positive nitrogen balance, tissue regeneration and exhibits improved energy level. - Patient shows no signs of malnutrition. - Patient takes adequate amount of calories or nutrients. - Patient maintains weight or displays weight gain on the way to preferred goal, with normalization of laboratory values. - Patient weighs within 10% of ideal body weight (IBW). Imbalanced nutrition: less than body requirements Interventions - Set appropriate short-term and long-term goals. - Provide good oral hygiene and dentition. - If patient lacks strength, schedule rest periods before meals and open packages and cut up food for patient. - Consider the use of seasoning for patients with changes in their sense of taste; if not contraindicated. - Consider six small nutrient-dense meals instead of three larger meals daily to lessen the feeling of fullness. - Determine time of day when the patient's appetite is at peak. Offer highest calorie meal at that time. - Encourage family members to bring food from home to the hospital. - Consider the possible need for enteral or parenteral nutritional support with the patient, family, and caregiver, as appropriate. - Validate the patient's feelings regarding the impact of current lifestyle, finances, and transportation on ability to obtain nutritious food. - Consider the possible need for enteral or parenteral nutritional support with the patient, family, and caregiver, as appropriate. Imbalanced nutrition: morethan body requirements Defining Characteristics - Body weight (20% over ideal for height and frame - Concentrating food intake at the end of the day - Eating in response to internal cues other than hunger (e.g., anxiety) - Eating in response to external cues (e.g., time of day, social situation) - Reported or observed dysfunctional eating pattern pairing food with other activities Imbalanced nutrition: morethan body requirements Related Body Factors - Deficient knowledge about nutritional needs, food intake, and/or appropriate food preparation - Excessive intake in relation to metabolic needs - Metabolic disorders - Poor dietary habits - Sedentary activity level - Use of food as coping mechanism Imbalanced nutrition: more than body requirements Goals and Outcomes - Patient claims ownership for current eating patterns. - Patient designs dietary modifications to meet individual long-term goal of weight control, using principles of variety, balance, and moderation. - Patient verbalizes accurate information about benefits of weight loss. - Patient verbalizes measures necessary to attain beginning weight reduction. - Patient states related factors contributing to weight gain. - Patient identifies behaviors that remain under his or her control. - Patient fulfills desired weight loss in a reasonable period (1 to 2 pounds per week). - Patient organizes relevant activities requiring energy expenditure into daily life. - Patient uses sound scientific sources to evaluate need for nutritional supplements. - Patient demonstrates appropriate selection of meals or menu planning toward the goal of weight reduction. Imbalanced nutrition: more than body requirements Interventions - Initiate a patient contract that includes rewarding and reinforcing progressive goal attainment. - Negotiate with the patient regarding the aspects of his or her diet that will need to be modified. - Suggest patient to keep a diary of food intake and circumstances surrounding its consumption (methods of preparation, duration of meal, social situation, overall mood, activities accompanying consumption). - Advise patient to measure food regularly - Weigh patient twice a week under the same conditions. - Educate patient about adequate nutritional intake. A total plan permits occasional treats. - Explain the importance of exercise in a weight control program. - Teach stress reduction methods as alternatives to eating.

Z-track for immunizations

Z-track method Position the ulnar side of the nondominant hand just below the site and pull the skin laterally. Hold this position until the medication is injected. With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle using a steady and smooth motion. Rationale: The Z-track technique creates a zigzag path through tissues that seals the needle track to avoid leaking of medication. A quick, dartlike injection reduces discomfort. Z-track injections may be used for all IM injections.

Quarantine

a state, period, or place of isolation in which people or animals that have arrived from elsewhere or been exposed to infectious or contagious disease are placed. Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Will, Living

a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation

Quality of life

as 'individuals' perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns.'

Rigor Mortis

begins within 4 hours of death, exaggerated contraction of the muscle fibers and immobilizes the joints

Kyphosis

excessive outward curvature of the spine, causing hunching of the back, leaning forward

X-ray for chest for respiratory infections

most common

Safety

safety - Safety—or freedom from danger, harm, or risk—is a paramount concern that underlies all nursing care. - The American Nurses Association (ANA) defines a culture of safety as an organizational environment where "core values and behaviors—resulting from a collective and sustained commitment by organizational leadership, manager and workers—emphasize safety over competing goals" (ANA, 2018, para 3). Important Terms Related to Environmental Health and Safety: - Environmental health - Environmental hazard - Sanitation - Pollution - Air - Land - Water - Noise - Ergonomics - Sentinel health event

Traditional Chinese Medicine

•Yin-yang theory: the concept of two opposing, yet complementary, forces that shape the world and life •Qi: a vital energy or life force that circulates in the body through a system of pathways called meridians •Eight principles: cold/heat, interior/exterior, excess/deficiency, and yin/yang (the chief principles) analyze symptoms and categorize conditions •Five elements: fire, earth, metal, water, and wood correspond to organs and tissues and explain how the body works •Focuses on looking for underlying causes of imbalance and patterns of disharmony in the body

Presbycusis

(hearing loss associated with aging)

Self-Awareness and Anxiety

*Anxiety is contagious* It is important for caregivers to recognize & cope effectively with their own anxieties. We may not choose our anxieties, but we do choose how we deal with them.

obtaining feedback

*check to see if you interpreted a message in the way the speaker meant it*Accomplished by rephrasing the meaning of the message or directly asking a feedback question.

Qi Gong

- A form of exercise (stimulation therapy) - System of posture - Exercise—gentle and dynamic - Breathing techniques - Visualization that regulates the qigong - Improves health by redirecting mental focus, controlling breathing, improving coordination, and promoting relaxation - Activates the natural currents that flow along the body's meridians to rebalance the body's own healing ability

Presbycusis

- Aging Hearing Loss and Deafness Presbycusis: - Presbycusis (hearing loss associated with aging) includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues. - Often, more than one type of presbycusis may be present in the same person. - The cause of presbycusis is related to degenerative changes in the inner ear. Noise exposure is thought to be a common factor related to presbycusis. - Presbycusis includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues. - Because consonants (high-frequency sounds) are the letters by which spoken words are recognized, the ability of the older person with presbycusis to understand the spoken word is greatly affected. Vowels are heard, but some consonants fall into the high-frequency range and cannot be differentiated. This may lead to confusion and embarrassment because of the difference in what was said and what was heard. - The prognosis for hearing depends on the cause of the loss. Hearing Loss and Deafness Presbycusis - sensory: atrophy of auditor nerve loss of sensory hair cells loss of high pitched sounds little effects of speech understanding good response to sound amplification - neural degenerative changes in cochlea and spinal ganglion loss of speech discrimination amplification alone not sufficient - metabolic atrophy of blood vessels in wall of cochlea w interruption of essential nutrient supply uniform loss for all frequencies accompanied by recruitment good response to hearing aid - cholera stiffening of basilar membrane, which interferes w sound transmission in cochlea and hearing loss increases from low to high frequency. speech discrimination affected w high frequency losses helped by appropriate forms of amplification - includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues.

Pollution

- Air pollution is the contamination of the air we breathe, indoors or outdoors, by any chemical, physical or biological agent that modifies its natural characteristics. Almost everybody is exposed to air pollution. Although a lot is being done to improve air quality, evidence of adverse health effects from air pollution persists in many parts of the world. - Land pollution, the deposition of solid or liquid waste materials on land or underground in a manner that can contaminate the soil and groundwater, threaten public health, and cause unsightly conditions and nuisances. - Noise pollution is an underestimated threat that can cause a number of short- and long-term health problems, such as for example sleep disturbance, cardiovascular effects, poorer work and school performance, hearing impairment, etc. - They set health-based recommendations on average environmental noise exposure of five relevant sources of environmental noise. These sources are: road traffic noise, railway noise, aircraft noise, wind turbine noise and leisure noise. - The WHO guidelines for community noise recommend less than 30 A-weighted decibels (dB(A)) in bedrooms during the night for a sleep of good quality and less than 35 dB(A) in classrooms to allow good teaching and learning conditions. - The WHO guidelines for night noise recommend less than 40 dB(A) of annual average (Lnight) outside of bedrooms to prevent adverse health effects from night noise. Water pollution: - is the contamination of water bodies, usually as a result of human activities. - Water bodies include for example lakes, rivers, oceans, aquifers, and groundwater. - Water pollution results when contaminants are introduced into the natural environment. For example, releasing inadequately treated wastewater into natural water bodies can lead to degradation of aquatic ecosystems. - This can lead to public health problems for people living downstream. They may use the same polluted river water for drinking or bathing or irrigation. Water pollution is the leading worldwide cause of death and disease, e.g. due to water-borne diseases.

Race - difference than culture; risk factor

- Describes a group of people who share distinct physical characteristics: Skin pigmentation, body stature, facial features, hair texture - Six major racial categories in the US: - American Indian or Alaska Native - Asian - Hispanic or Latino - Black or African American - Native Hawaiian or Other Pacific Islander - White or Caucasian Culture is NOT: - Based on color of skin - Based solely on country of origin - Race Healthy People 2020 Goals for Cultural Care Goal for decreasing health disparities: - Improve access to comprehensive, high quality health care for all regardless of race

Prayer

- Helps reduce stress, promotes healing, and may arrest disease - May be practiced individually or in groups as intercessory prayer - Prayer chains - Different people pray for a set time for an individual's recovery over a period of hours or days; considered beneficial by many people

Kidney damage

- In certain cultures the family may want to keep constant vigil in the room of a dying patient or in the waiting area. For example, some Jewish Americans believe that the spirit should not be alone when it leaves the body at the time of death. Therefore someone who is terminally ill should never be left alone. The Jewish culture believes all body tissues must be buried with the individual Flowers and Stones - Worldwide - Cicero of Rome describes flowers being planted around a grave to purify the ground of human remains.The Jewish tradition of leaving small stones on a grave is ancient. It can be traced back to a time when gravestones were not used-instead, small stones were piled to make a grave. As long as visitors tended the grave and left stones, the dead would be remembered - Eastern European Jews - cystic fibrosis, Gaucher's disease, spinal muscular atrophy, Tay-Sachs' disease.

(Acute) Pharyngitis

- Inflammation of pharyngeal walls; tonsils, palate, uvula - Causes: Viral (90%), bacterial (strep throat), fungal (candidiasis) - Other: dry air, smoking, GERD, allergy, postnasal drip, ETT, chemicals, cancer Manifestations: - sore throat - red, swollen pharynx - anterior cervical lymphadenopathy (lymph node enlargement) - Absent cough - neck, head & muscle pain - tonsils inflamed & covered with exudate - Rash may be present - Fever greater than 38° C - Fungal: white patches Diagnosis: - Rapid antigen test - Throat culture: used to confirm diagnosis-used when rapid antigen test is negative. Outcomes: - infection control, symptom relief, prevent complications - Viral—no antibiotics - Bacterial—antibiotics - Oral penicillin (PCN)- prompt response within 24 hours; non-infectious to others 24 hours after antibiotic is initiated - Take full course of antibiotics to avoid serious repercussions: rheumatic fever and post-streptococcal glomerulonephritis - Candida—antifungal (swish and swallow) - Implementation: Analgesia, warm salt water gargle, avoid irritating liquids such as carbonated beverages, lozenges, humidifier, soft food diet, drink warm liquids, rest, cool or warm compresses to the neck, sucking on ice chips.

Palliative Care

- Originated in the 1960s as care and emotional support for patient, family, and significant others during the terminal phases of serious life-limiting diseases - Need for this care is increasing - Demographic changes - Longer life expectancies - Improved health care technology - Increased health care utilization - Older adults living with multiple chronic illnesses - Care or treatment focusing on reducing the severity of symptoms - Begins during curative or restorative health care - Extends into end-of-life care - Bereavement care follows death - Chronic illness is debilitating, costly, and, along with terminal illness, can be a significant burden for caregivers. Therefore, palliative care can help: - Improves quality of life - Decreases costs of health care - Alleviates the burden of care - Palliative care is indicated when a diagnosis of a life-limiting illness is made and involves; example: cancer, heart failure, COPD, dementia, or ESRD can benefit from implementation of palliative care. - Communication is important for optimal care. - Ongoing communication - Patients may receive palliative care services in the home, long-term and acute care and mental health facilities, rehabilitation centers, and prisons. - Many institutions have established interprofessional palliative and hospice care teams. The interprofessional palliative care team includes physicians, nurses, social workers, pharmacists, chaplains, and others. - Palliative care is different from hospice; it allows a person to simultaneously receive curative and palliative treatments whereas hospice care is initiated only after the decision is made by the patient or a proxy not to pursue a cure. - Bereavement and grief counseling are core components of patient- and family-centered palliative care.

Sanitation

- Refers to the provision of facilities and services for the safe management of human excreta from the toilet to containment and storage and treatment onsite or conveyance, treatment and eventual safe end use or disposal. More broadly sanitation also included the safe management of solid waste and animal waste. - Inadequate sanitation is a major cause of infectious diseases such as cholera, typhoid and dysentery world-wide. - Safe sanitation in health centers is an essential component of quality of care and infection prevention and control strategies, - Sanitation measures to protect public health are both single- and multi-component, and include technologies, policies, regulations and financial and personnel resources, and sanitation behavior change. - Sanitation measures may target domestic, institutional and commercial premises, including households, schools, healthcare centers and other institutions (such as prisons), as well as work places and all other toilet facilities in public settings. They may be implemented at local, regional, national or international levels, through the health sector or other sectors.

Wight Coat Hypertension

- Useful for patients who have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere. This phenomenon is referred to as "white coat" hypertension. Other potential applications for ABPM include suspected antihypertensive drug resistance, hypotensive symptoms with antihypertensive drugs, episodic hypertension, or SNS dysfunction. - Older adults are more likely to have "white coat" hypertension

Vaccine

- Vaccination is important for caregivers & people at high risk of serious flu complications. ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Types: ◦Trivalent (3-strain) influenza vaccines include: ◦A trivalent influenza shot made with adjuvant (Fluad), licensed for people 65 years and older. A high-dose influenza vaccine (FluzoneHigh-Dose), licensed for people 65 years and older Influenza Management Management ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Types: ◦Quadrivalent (4-strain) flu vaccines include: ◦Standard-dose quadrivalent influenza shots that are manufactured using virus grown in eggs. These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, and Fluzone Quadrivalent. Different influenza shots are licensed for different age groups. Some are licensed for children as young as 6 months of age. Most influenza shots are given in an arm muscle with a needle. One quadrivalent influenza shot (Afluria Quadrivalent) can be given either with a needle (for people aged 6 months and older) or with a jet injector (for people aged 18 through 64 years only). ◦A quadrivalent cell-based influenza shot (Flucelvax Quadrivalent) containing virus grown in cell culture, which is licensed for people 4 years and older. This season, all four of the vaccine viruses used in Flucelvax have been grown in cells, making the vaccine totally egg-free. ◦Recombinant quadrivalent influenza shot (Flublok Quadrivalent), an egg-free vaccine, approved for people 18 years and older. ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Considerations: - People who have an allergy to eggs or any of the ingredients in the vaccine should talk to their healthcare provider before getting a flu shot. - People with egg allergies can receive a special vaccine. - People with a history of Guillain-Barré Syndrome need to consult their primary care provider before getting a flu shot. - People who are currently ill or have a fever need to wait till they are well before they get their flu shot. - Alternative delivery options are available upon request if patients meet criteria: nasal spray flue vaccine and intradermal flu vaccine. Management: oSymptom relief and prevent secondary infection: rest, fluid, antipyretic, analgesia oAntivirals: shorten duration of symptoms and reduce risk of complications ◦Zanamavir (Relenza) - drug of choice ◦Oseltamivir (Tamiflu) ◦Must be started within 48 hours of initial flu symptoms and used for 7 day Valsalva maneuver Valsalva maneuver = Reflex bradycardia (Syncope, Heart attack, Orthostatic intolerance) (Drop in blood pressure for 1 or 2 minutes when client stands (orthostatic or postural hypotension)

Weight Loss

- Weight loss can improve NASH - Weight loss can improve lung function - Modest weight loss of 3% to 5% can have clinical benefits - Greater weight loss produces greater benefits - Average weight loss programs result in a 10% reduction of body weight - Weight reduction has a significant effect on lowering BP in many people, and the effect is seen with even moderate weight loss. - A weight loss of 22 lb (10 kg) may decrease SBP by approximately 5 to 20 mm Hg. - Weight loss is the key to treatment for diabetes

Journaling

- provides an opportunity for individuals to reflect on and analyze their lives and events and people surrounding them to get in touch with their feelings. - Journaling is the practice of writing out one's thoughts and feelings as an exercise to identify and evaluate one's own sources of stress and coping strategies

Retinopathy - Diabetic

-Eye problems related to diabetes are also called "diabetic retinopathy." This condition can lead to vision loss and eventually blindness if it not treated. -Most common cause of new cases of blindness in persons ages 20-74. -Results from chronic hyperglycemia initial eye exam can be performed by a doctor who specializes in the eyes (called an ophthalmologist or optometrist) or by a trained retinal photographer who takes photographs of the retina (the back of your eye). The eye doctor uses medicated eye drops to dilate your pupils so the retina can be completely examined. Pupil dilation is not required for the retinal photographs. The photographs are interpreted by an eye doctor or by a computer. If there is evidence of diabetic retinopathy on the retinal photographs, you will need to have the full dilated eye exam by the eye doctor. Non-proliferative - most common form ◦Partial occlusion of small blood vessels in the retina -develop micro-aneurysms. Vision can be affected if macula is involved. Proliferative - most severe form ◦Retinal capillaries become occluded, hemorrhage. If blood vessels pull retina can cause a tear or partial or complete detachment of retina. Prevention is key ◦Control of Blood glucose Tight control of BS reduce risk by 76% compared to that of conventional therapy. ◦Control of hypertension ◦Cessation of smoking Medical Management ◦Medicated eye drops that decrease the pressure in the eye to slow/control damage to the small vessels and resulting vision loss ◦Intraocular injections ◦Laser eye surgery Retinopathy is microvascular damage to the retina that can lead to blurred and progressive vision loss. - It is often associated with diabetes mellitus and hypertension. - Nonproliferative diabetic retinopathy is characterized by capillary microaneurysms, retinal swelling, and hard exudates. It may be treated with laser photocoagulation. - Hypertensive retinopathy is caused by high BP that creates blockages in retinal blood vessels. - On examination, retinal hemorrhages and macula swelling are noted. - Sustained, severe hypertension can cause sudden visual loss with optic disc and nerve swelling. - Treatment focuses on lowering the BP. Retinal Detachment

blood pressure and sex

-HTN is more prevalent in men in young adulthood and early middle age. After age 55, hypertension is more prevalent in women.

Hyperglycemia Hyperosmolar Nonketotic Syndrome (HHNS)

-Serious condition - Blood Glucose 800-1000 mg/dL -Ketosis usually minimal or absent -Defect is usually lack of effective insulin (insulin resistance) -Persistent hyperglycemia causes osmotic diuresis which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. -With glycosuria and dehydration, hypernatremia and increased osmolarity occurs. -Usually occurs in older adults Causes: ◦Acute Illness ◦Medications that exacerbate hyperglycemia ◦Dialysis treatment Hyperglycemia HyperosmolarNonketotic Syndrome (HHNS) Signs and Symptoms ◦Hypotension ◦Profound dehydration ◦Tachycardia ◦Variable neurological signs ◦Mortality rate 10-40% Treatment ◦Fluid replacement ◦Correct electrolytes

Nutritional Therapy for Diabetes Sodium

-cut back on salt-eliminate salt used in cooking-look for low sodium products-request food to be prepared without salt-avoid fast food-do not use salt substitutes high in potassium -water softeners removed calcium and add sodium to drinking water-look at labels for over the counter meds-fresh fruits and veggies are low in sodium, use DASH diet (dietary approaches to stop hypertension)

Carbohydrate Counting meal plan

-dietitian can help patient figure out number of carbs they need-carb counting is important if patient takes insulin as they need to adjust insulin doses to carb content

FIVE KEY PATIENT TEACHING POINTSON HERBAL MEDICATION

1. Just because it is natural does not mean it is safe.2. Just because it is safe does not mean it is effective.3. Labels may not equal contents.4. Self-diagnosis and self-treatment can result in self-malpractice.5. Herbs are never a replacement for an emergency department.

DASH diet

DASH Eating Plan•The DASH eating plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts.•Compared with the typical American diet, the plan contains less red meat, salt, sweets, added sugars, and sugar-containing beverages.•The DASH eating plan significantly lowers BP and these decreases compare with those achieved with BP-lowering drug.•Additional benefits also include lowering of low-density lipoprotein (LDL) cholesterol.

Physiologic Homeostasis

•Local adaptation syndrome (LAS)—involves only one specific body part •Reflex pain response •Inflammatory response •General adaptation syndrome—biochemical model of stress (Hans Selye, 1976) •Alarm reaction •Stage of resistance •Stage of exhaustion

Physiologic Homeostasis

•Local adaptation syndrome (LAS)—involves only one specific body part•Reflex pain response•Inflammatory response•General adaptation syndrome—biochemical model of stress (Hans Selye, 1976)•Alarm reaction•Stage of resistance•Stage of exhaustion

gi gong QI GONG

breath work •A form of exercise (stimulation therapy)•System of posture•Exercise—gentle and dynamic•Breathing techniques•Visualization that regulates the qigong•Improves health by redirecting mental focus, controlling breathing, improving coordination, and promoting relaxation•Activates the natural currents that flow along the body's meridians to rebalance the body's own healing ability

Complementary and Alternative Medicine Use in the United States continues to

increase

herbal medicine

A common misconception regarding herbal medicines is that herbs have no side effects because they are natural. However, herbs do indeed have side effects and may be toxic or poisonous if not used appropriately. Consider the toxicity of widely used natural products such as coffee, cocaine, and tobacco. Another dilemma is patient use of herbs in lieu of their prescribed medications. Although herbs may be a good option in particular cases and conditions, the decision to decline medications should be based on fully informed judgments in partnership with a health professional.

Christianity

A monotheistic system of beliefs and practices based on the Old Testament and the teachings of Jesus as embodied in the New Testament and emphasizing the role of Jesus as savior. Cremation Worldwide Cremation is popular in religions such as Buddhism and Hinduism, and has historically been practiced all around the world. The Christian reverence for the physical body led to cremation being outlawed in many Western countries, but those laws have since been discarded. Body Positioning Important in Many traditions The position of the body in the grave or coffin is important in many traditions. Christian burials have been oriented with the he'd pointing west and the feet pointing east, according to the coming of Christ on Judgment Day. In Islam, bodies are perpendicular to Mecca, with the face looking towards it. In some cases, assassins, thieves, suicides, and other disrespected dead may be buried upside down or at crossroads.

What is A1C

A1c is a laboratory test in which the result is an average blood glucose level over a 3 month period A1C % Mean plasma glucose 6% 126 mg/d l7% 154 mg/dl 8% 183 mg/d l9% 212 mg/dl 10% 240 mg/dl 11% 269 mg/dl

Jehovah's Witnesses

What do Jehovah's Witnesses Believe? Witnesses believe in one God, not the Trinity. Like most Christians, they believe that Jesus Christ died for humankind's sins, however they do not believe that he was physically resurrected after his crucifixion. They believe that he was only spiritually resurrected.Jehovah's Witnesses is a millenarian restorationist Christian denomination with nontrinitarian beliefs distinct from mainstream Christianity.

Communication Skills

Active listening = concentration and focused energyusing all senses/ interprets verbal/ nonverbal messages (feedback).Listens for feelings + words.Maintains eye contact, not staring. conscious effort to block out distractions

Somatization

•Somatization is the physical manifestation of psychological concerns. The physical symptoms, such as pain, are real though they have no underlying physical causes.

Post-traumatic stress disorder PTSD

Anxiety Disorder: Posttraumatic Stress Disorder •Occurs after witnessing or experiencing severe trauma •Reliving of traumatic events or situations •Anxiety, depression, and nightmares can complicate the picture •Flashbacks common •Flashbacks are vivid recollections of the event in which the individual relives. Flashbacks life threatening to the person. •Symptoms: intense fear, horror, helplessness, emotionally numb, extremely alert, guarded, agitated, easily startled, eating and sleeping disturbances •Isolation is common

Accupressure

Blend of Acupuncture and pressure Instead of needles, uses pressure

Catholic religion

Branch of Christianity. Helped to expand the Spanish language in Latin America. Catholicism is the most widespread religion in this area today.

COMMON HERBAL MEDICATIONS

Caffeine •Effects: Weak CNS stimulant, Diuretic, Myocardial stimulant •Clinical symptoms and dependence develop with consumption greater than 350mg. •Over the counter analgesics, stimulants, appetite suppressants, and cold and flu preparations may contain caffeine as well •Withdrawal from caffeine causes mild to clinically significant distress and impairment of normal functioning. The severity of symptoms vary from individual to individual, and most commonly include a headache, fatigue, decreased energy/activeness, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, and feeling foggy/not clearheaded. The severity of symptoms varies from mild to extreme. •Re-administration of caffeine typically reverses withdrawal symptoms rapidly. Over the counter medications can be used to manage symptoms. •In the case of caffeine overdose, seizures may occur, as caffeine is a central nervous system stimulant. Agitation, anxiety, restlessness, insomnia, tachycardia, tremors, tachycardia, psychomotor agitation, and, in some cases, death can occur, depending on the amount of caffeine consumed. COMMON HERBAL MEDICATIONS Echinacea •is used as a dietary supplement for the common cold and other infections, based on the idea that it might stimulate the immune system to more effectively fight infection. •Taking echinacea after you catch a cold has not been shown to shorten the time that you'll be sick. •Taking echinacea while you're well may slightly reduce your chances of catching a cold. COMMON HERBAL MEDICATIONS Garlic •is used as a dietary supplement for many purposes, including high blood cholesterol, high blood pressure, and the common cold, as well as in attempts to prevent cancer and other diseases. •Garlic is probably safe for most people in the amounts usually eaten in foods. •Side effects include breath and body odor, heartburn, and upset stomach. COMMON HERBAL MEDICATIONS Gingko is used as a dietary supplement for many conditions, including dementia, eye problems, intermittent claudication (leg pain caused by narrowing arteries), tinnitus, and other health problems. There's no conclusive evidence that ginkgo is helpful for any health condition. Specifically, there is no studies showing that gingko helps with memory enhancement or prevents/slows dementia or cognitive decline. COMMON HERBAL MEDICATIONS St. John's Wort is most often used as a dietary supplement for depression. People also use it as a dietary supplement for other conditions, including menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder. CAUTION WITH HERBAL REMEDIES •Herbs can alter the effects of prescribed, conventional drugs •Herbs ACT LIKE "drugs" •Many interact with Western Medicine •Herbs are not regulated by FDA; considered dietary supplements in U.S.

The Nature of Culture

Culture is a total way of life. •Culture is a social phenomenon learned through life experiences. •Shared system of values that provides a framework for who we are. •Culture is an abstract concept, composed of the values, beliefs, roles, and norms that make groups of people band together •Cultural values strongly influence thinking and actions. •A culture's belief system develops over generations. •Formed by feelings and convictions that are believed to be true. •May or may not include a religion •Provides social structure for daily living •Defines roles and interactions with others and in families and communities •Culture reflects its members; it is dynamic, changing, and adaptive. •Apparent in the attitudes and institutions unique to the culture •An individual's behavior may or may not represent the culture.

Mormons

Church founded by Joseph Smith in 1830 with headquarters in Salt Lake City, Utah, religious group that emphasized moderation, saving, hard work, and risk-taking; moved from IL to UT

Conjunctivitis

Conjunctivitis is infection or inflammation of the conjunctiva. • Acute bacterial conjunctivitis (pinkeye) is common. It occurs initially in one eye and can spread rapidly to the unaffected eye. It is usually self-limiting, but antibiotic drops shorten the course of the disorder chronic conjunctivitis caused by Chlamydia trachomatis, which is transmitted mainly by hands and flies

Coping Responses

Coping Responses •Problem solving •Using social support -> ADAPTIVE •Reframing •Avoidance •Self-blame -> MALADAPTIVE •Wishful thinking

Factors Affecting Communication

Cultural differences, Past experiences, Emotions and mood, Attitude of the individual

How we perceive what is communicated to us depends on

Cultural values, Level of education, familiarity with the topic, Occupation, Previous life experiences

culturally competent care

Culturally Competent Care •Cultural beliefs affect understanding of and reaction to death or loss AND treatment decisions. •Avoiding stereotypes •Make nursing assessment of beliefs and preferences on an individual basis •Attitudes toward death and suffering •Gather early input from patient and family for care before death and care of the body after death •Accommodating language, diet, and cultural beliefs and practices Culturally Competent Care •Preferences for information •Ensure adequate information for those who don't speak English •Families with non-English-speaking members are at risk for receiving less information about their family member's critical illness and prognosis. •Using medical interpreter services when indicated. •Pay attention to nonverbal cues •Providing culturally competent care requires assessment of nonverbal cues such as grimaces, body position, and decreased or guarded movements. •Cultural variations also exist in symptom expression (e.g., pain expression) and use of health care services. Culturally Competent Care •Rituals associated with dying are part of all cultures •In certain cultures the family may want to keep constant vigil in the room of a dying patient or in the waiting area. For example, some Jewish Americans believe that the spirit should not be alone when it leaves the body at the time of death. Therefore someone who is terminally ill should never be left alone. The Jewish culture believes all body tissues must be buried with the individual. •Once a death has occurred, some cultures, such as the Puerto Rican American culture, may want to kiss and touch the body to say goodbye. •In the Islamic cultures the traditional rites of washing, shrouding, funeral prayers, and burial are done as soon as possible. •Other rituals can include: •Mantra is changed •No embalmment •Huma fire ritual •Ritual impurity •Bone-gathering ceremony •Memorials •Funeral rites can be simple or complex depending on the customs, means, and ability of the family.

Neuropathy - Diabetic

Diabetic Neuropathy - About 60-70% of people with diabetes have mild to severe forms of nervous system damage: - Impaired sensation or pain in the feet or hands - Slowed digestion of food in the stomach - Carpal tunnel syndrome - Other nervous problem - More than 60% of non-traumatic lower limb amputations in the US occur among people with diabetes - Can be a leading cause of sexual dysfunction for patients with diabetes Diabetic Neuropathy Complications: - Diabetic Foot Ulcers - Begins with soft tissue injury of foot - Formation of fissure between toes or in area of dry skin - Formation of callus - Ingrown toenails - Cracks in skin - Venous insufficiency is a contributing cause of foot ulcers Injuries: Chemical, traumatic, thermal Foot infections - Drainage, swelling, redness, gangrene, - Bed rest, antibiotics, debridement - Good control of BS - Hyperbaric oxygen chamber - Potentially amputation

Effective vs. Ineffective Coping

Effective coping •Adaptation is behaviour that maintains integrity of the individual•Person utilizes active problem solving - This coping mechanism involves identifying a problem that is causing stress and then developing and putting into action some potential solutions for effectively managing it.•Lead to healthy choices Ineffective coping •Maladaptation is UNHEALTHY behavior that disrupts the integrity of the individual.•Person utilizes withdrawal, compromise or avoidance,•Excessive use of the defense mechanisms can lead to negative impact on mental and emotional well-being

bereavement

Death of a loved one •The period of time following the death of a loved one•The time spent in bereavement depends on a number of factors, including how attached one was to the person who died and how much time was spent anticipating the loss. •Although often used interchangeably, bereavement refers to the state of loss and grief refers to the reaction to loss.

Anxiety Disorders

Diagnosis of an anxiety disorder is based on a description of the behaviors that express distress: •Generalized anxiety disorder •Panic disorders •Phobic disorders •Obsessive-compulsive disorder •Behavior al addictions •Traumatic stress reaction •Adjustment disorders •Post traumatic stress disorder

Nursing Process: Coping Evaluation

Did the client: •The patient verbalizes the causes and effects of stress and anxiety. •The patient identifies and uses sources of support. •The patient uses problem solving to find a solution to stressors. •The patient practices healthy lifestyle habits and anxiety-reducing techniques. •The patient verbalizes a decrease in anxiety and increase in comfort.

Effective vs. Ineffective Coping

Effective coping •Adaptation is behaviour that maintains integrity of the individual •Person utilizes active problem solving - This coping mechanism involves identifying a problem that is causing stress and then developing and putting into action some potential solutions for effectively managing it. •Lead to healthy choices Ineffective coping •Maladaptation is UNHEALTHY behavior that disrupts the integrity of the individual. •Person utilizes withdrawal, compromise or avoidance, •Excessive use of the defense mechanisms can lead to negative impact on mental and emotional well-being

Reiki

Energy Fields - A practitioner acts as a conduit for healing energy that is directed into the patient's energy field or body - Channels energy to the patient, and the patient's body does the healing - Uses a person's or practitioner's energy field to direct healing - The Reiki principles: - Just for today, I will live in the attitude of gratitude. - Just for today, I will not worry. - Just for today, I will not be angry. - Just for today, I will do my work honestly. - Just for today, I will show love and respect for every living being. Reiki is an energy-healing method that can be used as an integrative therapy for a broad range of acute and chronic health problems. Increasingly, it is gaining acceptance as an adjunct to the management of chronic conditions: pain management, oncology, hospice and palliative care, and stress reduction

Essentials of Foot Care

Examination: •Annually for all patients •Patient with neuropathy - visual inspection of feet at every doctor's visit •A mono-filament (stick with a wire on the end) is poked at 5 pressure points on the bottom of the foot to see if the patient can feel it. This exam is used to assess the status and progression of nerve damage. Advise patients to: •Use lotion to prevent dryness and cracking •File calluses with a pumice stone •Cut toenails weekly or as needed •Always wear socks and well-fitting shoes •Notify their health care provider immediately if any foot problems occur Diabetic Neuropathy Complications: •Diabetic Foot Ulcers •Begins with soft tissue injury of foot •Formation of fissure between toes or in area of dry skin •Formation of callus •Ingrown toenails •Cracks in skin •Venous insufficiency is a contributing cause of foot ulcers Injuries: Chemical, traumatic, thermal Foot infections •Drainage, swelling, redness, gangrene, •Bed rest, antibiotics, debridement •Good control of BS •Hyperbaric oxygen chamber •Potentially amputation

Which theory of aging focuses primarily on cell metabolism and function?

Free radical theory

Ageism

Fundamental to ageism is the view that older people are different than younger people; therefore, they do not experience the same desires, needs, and concerns as other age groups.

Garlic

Garlic•is used as a dietary supplement for many purposes, including high blood cholesterol, high blood pressure, and the common cold, as well as in attempts to prevent cancer and other diseases.•Garlic is probably safe for most people in the amounts usually eaten in foods.•Side effects include breath and body odor, heartburn, and upset stomach.

Gingko

Gingkois used as a dietary supplement for many conditions, including dementia, eye problems, intermittent claudication (leg pain caused by narrowing arteries), tinnitus, and other health problems.There's no conclusive evidence that ginkgo is helpful for any health condition. Specifically, there is no studies showing that gingko helps with memory enhancement or prevents/slows dementia or cognitive decline

Therapeutic relationship and environment

Goals of therapeutic relationship Directed energy exchange between two people •A flow that moves clients toward constructive ways of thinking and effective ways of coping •Helping Relationship •Client focused relationship in which nurse helps client reach mutually determined goals. •Client Growth is a major goal Dynamics of the therapeutic relationship Interactions that occur among various forces •Three types: 1.Social relationship 2.Work relationship 3.Therapeutic relationship •The three elements of a therapeutic relationship are: the nurse, the client, and the communication between the nurse and client the five dynamic components of the therapeutic relationship inclu Trust: Assured belief that others are capable of assisting in times of distress and will probably do so. •Empathy: Ability to walk a mile in another person's shoes. •Autonomy: Ability to direct and control one's activities and destiny. •Caring : Energy that allows caregivers to unconditionally accept all people, even when they are most unlovable. •Hope: Expectation of achieving a future goo Characteristics of the Therapeutic Relationship Acceptance: Receive what is being offered,Remember that it is the person who must be accepted, not the behaviors or the attitudes. •Rapport: Essentially the same as "mutuality" with understanding, confidence, respect and harmony, Ability to establish a meaningful connection with clients; nurse - patient bond. •Genuineness: Be open, honest, and sincere in the relationship. While being genuine, remember that the client is the primary focus. •Confidentiality: The legal and ethical responsibility to keep information about a client private Therapeutic use of self •The most therapeutic tool of any care provider is the self. •Caregivers are role models. •Caregivers direct themselves therapeutically by focusing energies on the client. Develop an awareness of how your actions, gestures, and expressions affect other people and feel good about self Phases of the Therapeutic Relationship 1. Preparation (Pre Orientation) phase: The caregiver gathers data and prepares for the relationship. 2.Orientation phase: The caregiver and the client become acquainted, agree to work with each other, and establish the purpose for the relationship. 3. Working phase: The client and caregiver work toward the goals in the client-caregiver agreement. 4. Termination phase: Goals are completed, and the client and caregiver share a sense of accomplishment Problems Encountered in the Therapeutic Relationship environmental (lack of privacy, furniture, light, temp, noise). problems w care providers (attitude, boundaries, countertransference). clients: stall effectiveness, resistance, transference, noncompliance) Therapeutic environment (milieu) describes certain settings or environments designed to help clients replace inappropriate behaviors with more effective personal and psychosocial skill goals of a therapeutic environment (milieu) optimal safety and healing, engage and support all concerns with family, friends, other health professionals Variables of the Therapeutic Environment assisting clients w ADLs and monitors steps towards goals. Admission and discharge: clients expected to follow rules and engage in appropriate activities, effort to support client, process of preparing for discharge begins at admission. Compliance: Clients follow prescribed meds. Forty to eighty percent of clients do not comply with their prescribed therapeutic course. •show genuine concern

Kubler-Ross - Five Stages of Grief

Grief - Grief is the normal process of reacting to loss - Dynamic process - Includes both psychologic and physiologic responses - Grief occurs in response to real loss as well as what might have been. - Psychologic responses include anger, guilt, anxiety, sadness, depression, and despair. - Physiologic reactions include sleeping problems, changes in appetite, physical problems, and illness. - Complex and intense emotional experience that affects all aspects of life - Priority interventions provide for patient to express feelings Grief - Many factors shape the manner in which a person grieves - Grief is influenced by: - Relationship with the person who has died (spouse, parent, child, etc.) - Physical and emotional coping resources - Concurrent life stresses - Cultural beliefs - Personality - Mental and physical health - Economic resources - Religious influences and spiritual beliefs - Family relationships and conflicts - Social support - Time spent preparing for the death Models of Grief Kubler-Ross — Five Stages of Grief - Not everyone experiences all the stages and not necessarily in progressive order. 1. Denial - may last minutes to months and be characterized by withdrawal. 2. Anger - may be focused in any number of directions: - The person who inflicted the hurt - At the world for letting it happen - At oneself even though nothing could have been done to stop an event from happening (car accident). 3. Bargaining - for more time or something other than the death 4. Depression - may be expressed in numbness, anger, or sadness. 5. Acceptance - admitting the reality of the loss results in a calmer phase known as acceptance. Anticipatory Grief - Is what happens when you know there will be a loss, but it has not yet occurred. - Caregivers of patients with chronic illness often begin to grieve long before the actual death; grief grows worse with each downturn in patient status. - People say they feel like they are living with a "pit" in their stomach that won't go away. - Attempting to cope with fear of death may cause personality changes from day to day, or even moment to moment. - Perhaps the most difficult.... Tolerating living in a state of emergency for an extended period of time. The mind can only take so much "angst." - May struggle to spend the remaining time together in the most meaningful way, keeping the lines of communication open, overcoming the feeling of "giving up," and self acknowledgement that that these feelings are normal and allowed when processing grief. Models of Grief Engel's Six Stages of Grief - "Loss of a loved one is psychologically traumatic to the same extent that being severely wounded or burned is physiologically traumatic." - The process of mourning is parallel to the process of physical healing. - Shock and disbelief - refuses to accept loss, has stunned feelings, accepts the situation intellectually, but denies it emotionally. - Developing awareness - reality of loss begins to penetrate consciousness, anger may be directed at agency/nurse/other. - Restitution - conducts ritual of mourning; actions and expressions of grief, including the symbols and ceremonies that make up outward expression of grief - Resolving the loss - attempts to deal with painful void, still unable to accept new love object to replace lost person or object, may accept more dependent relationship with support person, thinks over and talks about memories of lost object. - Idealization - produces images of lost object that is almost devoid of undesirable features, represses all negative and hostile feelings toward lost object, may feel guilty and remorseful about past inconsiderate or unkind acts to lost person, unconsciously internalizes admired qualities of lost object, reminders of lost object evoke fewer feelings of sadness, reinvests feelings in other. - Outcome - behavior influenced by several factors, importance of lost object as source of support, degree of dependence on relationship, degree of ambivalence toward lost object, number and nature of other relationships, and number and nature of previous grief experiences. Adaptive Grief - Grief that helps accept the reality of death - Working in a positive way through the grief process helps to adapt to the loss. - May occur before death actually occurs or when death becomes inevitable. - Healthy process - Revealed in positive memories and seeing some good from the death Dysfunctional Grief - Prolonged grief disorder - Extended and intense mourning - Recurrent and severe distressing emotions - Intrusive thoughts about the loss - Self-neglect - Denial of the loss for >6 months - Estimates indicate 1 in 5 bereaved individuals experiences prolonged grief disorder - At greater risk for illness, work, and social impairment. Grief Support - Bereavement and grief counseling are core components of patient- and family-centered palliative care. - The grieving process takes time, energy, and work. - The process of resolution in normal grief may take months to years. - Grief counseling facilitates discussion of feelings and cultivates an environment for open expression of all feelings (anger, fear, guilt). - Respect for privacy and desire to talk or not to talk is important. - Honesty in answering questions and giving information is essential. - Should be integrated into the plan of care before as well as after the death Factors Affecting Grief and Dying - Developmental considerations - Previous experience with grief and loss - Presence of concurrent losses and/or other stressors - Mental health prior to the loss - Intellectual disabilities - Developmental stage of life - Erikson's - Family - Socioeconomic factors - Cultural, gender, and religious influences - Nature and circumstances of the loss - Degree of suddenness - Length of illness prior to the death - Perception of preventability - Psychosocial context of the death - Relationship with the deceased - Security of the attachment - Amount of unfinished business between the deceased and the living - Level of ambivalence in the relationship - Roles of the deceased in the living's life and social system. Definition of Death - Uniform Definition of Death Act: An individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead.

Adaptive Grief

Grief that helps accept the reality of death•Working in a positive way through the grief process helps to adapt to the loss.•May occur before death actually occurs or when death becomes inevitable.•Healthy process•Revealed in positive memories and seeing some good from the death

Lifespan

Health Promotion Model (Pender): - Illustrates how people interact - Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs to motivate health promoting behavior - Personal, biologic, psychological, and sociocultural factors are predictive of a certain health-related habit. - Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan. - People will not invest in a goal they find impossible to achieve. - Self-efficacy & environmental influence determine likelihood of change. - Value expectancy: the idea that a person has of whether a behavior is rational & economical. - Behaviors may induce either a positive or negative subjective response or affect

World Health Organization- definition of health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. WHO (World Health Organization) - Provide leadership on matters critical to health and engaging in partnerships where joint action is needed - Shape the research agenda and stimulate the generation, translation and dissemination of valuable knowledge - Set norms and standards and promote and monitor their implementation - Articulate ethical and evidence-based policy options - Provide technical support, catalyze change, and build sustainable institutional capacity - Monitor the health situation and assess health trends WHO (World Health Organization) jobs - Monitor disease outbreak - Assess the performance of health systems around the world - Global health topics -Aging -Mother/child -Immunizations -Human genetics -HIV/AIDS Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. This definition excludes behavior not related to environment, as well as behavior related to the social and cultural environment, and genetics. - World Health Organization WHO is implementing a Global Plan of Action on Workers' health 2008-2017 endorsed by the World Health Assembly in 2007 with the following objectives: - devising and implementing policy instruments on workers' health; - protecting and promoting health at the workplace; - improving the performance of and access to occupational health services; - providing and communicating evidence for action and practice; and - incorporating workers' health into other policies.

hearing loss

Hearing Loss Classifications Hearing loss can also be classified by the decibel (dB) level or loss as recorded on the audiogram. Normal hearing is in the 0- to 15-dB range slight 16-25 mild 26-40 41-55 moderate 56-70 moderately severe 71-90 severe >90 profound Hearing Loss Clinical Manifestations •Early signs of hearing loss often go unnoticed by patient •Early signs of hearing loss include asking others to speak up, answering questions inappropriately, not responding when not looking at speaker, straining to hear, reading lips, and increasing sensitivity to slight increases in noise level. •Pressure by others is a significant factor in whether help is sought •Often the patient is unaware of minimal hearing loss. Family and friends who get tired of repeating or talking loudly are often the first to notice hearing loss. Pressure exerted by significant others is a significant factor in whether the patient seeks help for hearing impairment. Hearing Loss Clinical Manifestations •The unseen handicap •Deafness is often called the "unseen handicap" because it is not until conversation is initiated with a deaf person that the difficulty in communication is realized. •Understanding should be validated in patient teaching interactions •Be aware of the need for thorough validation of the deaf person's understanding of health teaching. Descriptive visual aids can be helpful. •Obtain interpreter assistance •If the significantly hearing-impaired individual uses sign language to communicate, the Americans with Disabilities Act requires providing an interpreter when significant information is presented such as for patient consent or discharge teaching. Hearing Loss Clinical Manifestations •Interference in communication and interaction with others can be the source of many problems for the patient and caregiver. •Signs of hearing loss include asking others to speak up, answering questions inappropriately, not responding when not looking at speaker, straining to hear, and increasing sensitivity to slight increases in noise level. •Often the patient refuses to admit or may be unaware of impaired hearing. Irritability is common because of the concentration with which the patient must listen to understand speech. •The loss of clarity of speech in the patient with sensorineural hearing loss is most frustrating. •Withdrawal, suspicion, loss of self-esteem, and insecurity are commonly associated with advancing hearing loss. Hearing Loss and Deafness Tinnitus •Tinnitus is the perception of sound in the ears where no external source is present. It is "ringing in the ears" or "head noise" (www.ata.org). Tinnitus is sometimes the first sign of hearing loss, especially in older people. It may be soft or loud, high pitched or low pitched. •Tinnitus and hearing loss are directly related. Both are caused by inner ear nerve damage. The main difference between tinnitus and hearing loss is the extent of the damage (as tinnitus can still be heard). •Although the most common cause of tinnitus is noise, it can also be a side effect of medications. More than 200 drugs are known to cause tinnitus.

Rubella Immunization to prevent hearing loss

Hearing Loss and Deafness Health Promotion - Promote childhood and adult immunizations, including the measles, mumps, and rubella (MMR) immunization. - Rubella infection during the first 8 weeks of pregnancy is associated with a high incidence of congenital rubella syndrome, which causes sensorineural deafness. - Women of childbearing age should be tested for antibodies to these viral diseases. Various viruses can cause deafness as a result of fetal damage and malformations affecting the ear. - Women should avoid pregnancy for at least 3 months after being immunized. - Immunization must be delayed if the woman is pregnant. - Women who are susceptible to rubella can be vaccinated safely during the postpartum period.Hearing Loss and Deafness Health Promotion - Promote childhood and adult immunizations, including the measles, mumps, and rubella (MMR) immunization. - Rubella infection during the first 8 weeks of pregnancy is associated with a high incidence of congenital rubella syndrome, which causes sensorineural deafness. - Women of childbearing age should be tested for antibodies to these viral diseases. Various viruses can cause deafness as a result of fetal damage and malformations affecting the ear. - Women should avoid pregnancy for at least 3 months after being immunized. - Immunization must be delayed if the woman is pregnant. - Women who are susceptible to rubella can be vaccinated safely during the postpartum period.

Tinnitus

Hearing Loss and Deafness Tinnitus - Tinnitus is the perception of sound in the ears where no external source is present. It is "ringing in the ears" or "head noise" (www.ata.org). Tinnitus is sometimes the first sign of hearing loss, especially in older people. It may be soft or loud, high pitched or low pitched. - Tinnitus and hearing loss are directly related. Both are caused by inner ear nerve damage. The main difference between tinnitus and hearing loss is the extent of the damage (as tinnitus can still be heard). - Although the most common cause of tinnitus is noise, it can also be a side effect of medications. More than 200 drugs are known to cause tinnitus

BP and Excess Dietary Sodium

High dietary Na+ intake increases blood volume and CO; poor intake of calcium, magnesium, and potassium can alter the activity of the renal sodium-potassium pump, and leading to Na+ retention.Excess dietary sodium•High sodium intake can contribute to hypertension in salt sensitive patients.•Decrease the effectiveness of certain antihypertensive drugsWater and Sodium Retention•Excessive sodium intake is linked to the development of hypertension. Although most people consume a high-sodium diet, only one in three will develop hypertension.•A high sodium intake may activate a number of systemic mechanisms.•In clinical practice, there is not an easy or simple test to identify individuals whose BP will rise with even a small increase in salt intake (salt sensitive) versus those who can ingest large amounts of sodium without much change in BP (salt resistant).•The effect of sodium on BP has a strong genetic component. Additionally, the effect of sodium is greater in African Americans and in middle-aged and older adults.Proposed link among salt intake, blood pressure, and changes in the heart. High dietary salt intake exerts hypertrophic effects on the left (and potentially also on right) ventricle. Ventricular fibrosis can also result from the high salt intake through mechanisms mediated by the renin-angiotensin-aldosterone system (RAAS). Transforming growth factor-β1 (TGF-β1) is a multifunctional cytokine with fibrogenicproperties. Overproduction of TGF-β1 (in part mediated by angiotensin II) results in fibrosis and ventricular dysfunction. ◦Hypokalemia - due to treatment of DK - loss of potassium

Homeostasis

Homeostasis the body's ability to maintain a relatively stable internal environment where body wants to get to (neutral pH balance, osmolality) Homeostasis: various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment.

Hospice Care

Hospice Care•Hospice care is provided when curative care is forgone. Palliativecare is different in that it allows a person to simultaneously receive curative and palliative treatments whereas hospice care is initiated only after the decision is made by the patient or a proxy not to pursue a cure. •Requires physician certification that life expectancy is 6 months or less •Hospice care is underutilized •Patients should be referred as soon as possible to facilitate care at the end of life •Patients do not need to be actively dying Hospice Care •Approximately 1.5 million patients receive hospice services each year •More than ¾ of hospice patients are over age 65. •The majority are white. •Most common diagnoses are cancer and heart disease. •The median length of stay in a hospice program is currently 21 days. •Almost half of patients who die in the United States are under the care of a hospice program. Hospice Care •Concept of care that provides compassion, concern, and support for persons in the last phases of a terminal disease •Hospice programs focus on: •symptom management •advance care planning •spiritual care •family support •palliative rather than curative care •quality rather than quantity of life. •Available 24 hours/day, 7 days/week •Provided by medically supervised professional teams and volunteers •Hospice nurses are pivotal •Pain control, symptom management, spiritual assessment, assessment and management of family needs •Hospice nurses play a pivotal role in coordination of the hospice team and need excellent teaching skills, compassion, flexibility, cultural competence, and adaptability. Hospice Care •Some cultural/ethnic groups may underutilize hospice because of lack of information about hospice services, desire to continue with curative therapies, and concerns about lack of minority hospice workers. •Physicians may be reluctant to refer patients because sometimes they view a patient's decline as their personal failure. •Some patients or families see it as giving up. •Potential barriers to care in vulnerable populations •Veterans •Homeless •Impoverished •Disabled •Institutionalized Hospice Care •Admission has two criteria: 1. Patient must desire services - •To quality, the patient must desire the services and agree in writing that only hospice care (not curative care) can be used to treat their illness. They can withdraw from the program at any time (if their condition unexpectedly improves, etc.) 2. Patient must be eligible for services •Hospice services are covered by Medicare, Medicaid, and many private insurance agencies. •Patients can receive care for other health problems that are not related to the terminal illness, but those services may not be covered by the hospice, Medicare, Medicaid, or by the patient's insurance company. •Eligibility requires that 2 physicians certify that the patient's prognosis is terminal, with less than 6 months to live. Recertification only requires 1 physician. •Care may be provided for extended periods of treatment if the patient still meets enrollment criteria but lives past the expected 6 month survival expectation. •If a patient's condition stabilizes, he or she could be discharged.

Hypoglycemia

Hypoglycemia - abnormally low blood glucose level (<70 mg/dL) ◦Causes: Too much insulin or oral hypoglycemic agent Too little food or excessive exercise Delayed or skipped meals ◦Categories -Adrenergic -Mild hypoglycemia - sympathetic nervous system stimulated - surge of epinephrine and norepinephrine. -S/S - sweating, tremor, tachycardia, palpitations, nervousness, and hunger -Central Nervous System -Moderate hypoglycemia - deprives the brain cells of needed fuel for functioning -S/S - inability to concentrate, headaches, lightheadedness, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision and drowsiness Hypoglycemia ◦Management: Teach patients to carry some form of simple sugar with them at all times Avoid over treating hypoglycemia Consistent pattern of eating and administering insulin ◦Emergency measures For patients who are unconscious or cannot swallow - Glucagon 1 mg injection can be given SubQ. ◦Hypoglycemia Unawareness No warning signs and symptoms of hypoglycemia Increased risk of dangerously low BS Related to autonomic neuropathy.

Hearing Loss and Deafness Assistive Devices

Implantable hearing device or aid •An implantable hearing device or aid is available to patients who cannot or will not use traditional hearing aids or cochlear implants. •Implanted hearing devices amplify sound and transmit the sound vibrations through the ear. •The system consists of an external microphone placed behind the ear, a speech processor and a transmitter implanted under the skin that change sounds into electrical impulses, and a group of electrodes placed within the cochlea that stimulate the auditory nerves in the ear. •Cochlear implants send information that covers the entire range of sound frequencies. Hearing Loss and Deafness Assistive Devices •The cochlear implant is used as a hearing device for people with severe to profound sensorineural hearing loss in one or both ears. •The ideal candidate is one who has become deaf after acquiring speech and language. •For patients with conductive and mixed hearing loss, the cochlear Baha system may be surgically implanted. The system works through direct bone conduction and integrates with the skull bone over time. •Extensive training and rehabilitation are essential to receive maximum benefit from these implants. •The positive aspects of a cochlear implant include providing sound to the person who heard none, improving lip-reading ability, monitoring the loudness of the person's own speech, improving the sense of security, and decreasing feelings of isolation. With continued research, the cochlear implant may offer the possibility of aural rehabilitation for a wider range of hearing-impaired individuals. cochlear implant a device for converting sounds into electrical signals and stimulating the auditory nerve through electrodes threaded into the cochlea Hearing Loss and DeafnessAssistive Devices •Types: •Fully implantable •Nothing externally visible •Partially implantable •Have an external component worn behind or in the ear Hearing Loss and Deafness Assistive Devices Other: •Numerous devices are now available to assist the hearing-impaired person. Direct amplification devices, amplified telephone receivers, alerting systems that flash when activated by sound, an infrared system for amplifying the sound of the television, and a combination FM receiver and hearing aid are all aids that you can explore based on patient needs. •Persons with profound deafness may be assisted by text-telephone alerting systems that flash when activated by sound, closed captioning on television, and a specially trained dog. The dogs are trained to alert their owners to specific sounds within the environment, thus increasing safety and independence for the individual. Hearing Loss and Deafness Assistive Techniques •Speech reading, commonly called lip reading, can be helpful in increasing communication. •The patient is able to use visual cues associated with speech, such as gestures and facial expression, to help clarify the spoken message. •In speech reading, many words will look alike to the patient (e.g., rabbit, woman). •Help the patient by using and teaching verbal and nonverbal communication techniques as described in Table 21-14. •Sign language is used as a form of communication for people with profound hearing impairment. •It involves gestures and facial features such as eyebrow motion and lip-mouth movements. •American sign language (ASL) is used in the United States and in English-speaking areas of Canada Hearing Loss and Deafness Otosclerosis •Otosclerosis is a hereditary disease that causes abnormal bone growth in the middle ear, resulting in conductive hearing loss. •The most common cause of hearing loss in young adults •Usually bilateral but may progress faster in one ear •Often not diagnosed until communication is already impaired •On examination with an otoscope, a reddish blush of the tympanum (Schwartz's sign) is evident from the vascular and bony changes in the ear. •Tuning fork test and an audiogram demonstrate good bone but poor air conduction. •It is treated by medications that slow bone resorption, hearing aids, and surgery. •The first ear to be repaired is the one with the poorer hearing; the second ear is repaired after the first heals. •The procedures is usually performed under conscious sedation. •Significant hearing improvement is usually immediate with gradual full recovery of hearing as fluid in the middle ear resorbs. •Special post-op care involves minimizing sudden movements to avoid vertigo and actions that increase inner ear pressure such as coughing, sneezing, lifting, bending, and straining during BMs. Hearing Loss and DeafnessPresbycusis •Presbycusis (hearing loss associated with aging) includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues. •Often, more than one type of presbycusis may be present in the same person. •The cause of presbycusis is related to degenerative changes in the inner ear. Noise exposure is thought to be a common factor related to presbycusis. •Presbycusis includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues. •Because consonants (high-frequency sounds) are the letters by which spoken words are recognized, the ability of the older person with presbycusis to understand the spoken word is greatly affected. Vowels are heard, but some consonants fall into the high-frequency range and cannot be differentiated. This may lead to confusion and embarrassment because of the difference in what was said and what was heard. •The prognosis for hearing depends on the cause of the loss. Hearing Loss and Deafness Presbycusis sensory: atrophy of auditor nerve loss of sensory hair cells loss of high pitched sounds little effects of speech understanding good response to sound amplification neural degenerative changes in cochlea and spinal ganglion loss of speech discrimination amplification alone not sufficient metabolic atrophy of blood vessels in wall of cochlea w interruption of essential nutrient supply uniform loss for all frequencies accompanied by recruitment good response to hearing aid cholera stiffening of basilar membrane, which interferes w sound transmission in cochlea and hearing loss increases from low to high frequency. speech discrimination affected w high frequency losses helped by appropriate forms of amplification Gerontologic Considerations •Presbycusis—hearing loss due to aging •Tinnitus—ringing in ears •Reduced transmission of sound— atrophy of cerumen glands; dry earwax •Balance—atrophy of vestibular structures, slow motor responses, and musculoskeletal limitations Gerontologic Considerations •Sound amplification with the appropriate device is often helpful in improving the understanding of speech. In other situations, an audiologic rehabilitation program can be valuable. •The older adult is often reluctant to use a hearing aid for sound amplification.Reasons cited most often include cost, appearance, insufficient knowledge about hearing aids, amplification of competing noise, and unrealistic expectations. •Most hearing aids and batteries are small, and neuromuscular changes such as stiff fingers, enlarged joints, and decreased sensory perception often make the care and handling of a hearing aid a difficult and frustrating experience for an older person. •Some older adults may also tend to accept their losses as part of getting older and believe there is no need for improvement.

deafness

Implantable hearing device or aid •An implantable hearing device or aid is available to patients who cannot or will not use traditional hearing aids or cochlear implants. •Implanted hearing devices amplify sound and transmit the sound vibrations through the ear. •The system consists of an external microphone placed behind the ear, a speech processor and a transmitter implanted under the skin that change sounds into electrical impulses, and a group of electrodes placed within the cochlea that stimulate the auditory nerves in the ear. •Cochlear implants send information that covers the entire range of sound frequencies. Hearing Loss and Deafness Assistive Devices •The cochlear implant is used as a hearing device for people with severe to profound sensorineural hearing loss in one or both ears. •The ideal candidate is one who has become deaf after acquiring speech and language. •For patients with conductive and mixed hearing loss, the cochlear Baha system may be surgically implanted. The system works through direct bone conduction and integrates with the skull bone over time. •Extensive training and rehabilitation are essential to receive maximum benefit from these implants. •The positive aspects of a cochlear implant include providing sound to the person who heard none, improving lip-reading ability, monitoring the loudness of the person's own speech, improving the sense of security, and decreasing feelings of isolation. With continued research, the cochlear implant may offer the possibility of aural rehabilitation for a wider range of hearing-impaired individuals. cochlear implant a device for converting sounds into electrical signals and stimulating the auditory nerve through electrodes threaded into the cochlea Hearing Loss and DeafnessAssistive Devices •Types: •Fully implantable •Nothing externally visible •Partially implantable •Have an external component worn behind or in the ear Hearing Loss and Deafness Assistive Devices Other: •Numerous devices are now available to assist the hearing-impaired person. Direct amplification devices, amplified telephone receivers, alerting systems that flash when activated by sound, an infrared system for amplifying the sound of the television, and a combination FM receiver and hearing aid are all aids that you can explore based on patient needs. •Persons with profound deafness may be assisted by text-telephone alerting systems that flash when activated by sound, closed captioning on television, and a specially trained dog. The dogs are trained to alert their owners to specific sounds within the environment, thus increasing safety and independence for the individual. Hearing Loss and Deafness Assistive Techniques •Speech reading, commonly called lip reading, can be helpful in increasing communication. •The patient is able to use visual cues associated with speech, such as gestures and facial expression, to help clarify the spoken message. •In speech reading, many words will look alike to the patient (e.g., rabbit, woman). •Help the patient by using and teaching verbal and nonverbal communication techniques as described in Table 21-14. •Sign language is used as a form of communication for people with profound hearing impairment. •It involves gestures and facial features such as eyebrow motion and lip-mouth movements. •American sign language (ASL) is used in the United States and in English-speaking areas of Canada Hearing Loss and Deafness Otosclerosis •Otosclerosis is a hereditary disease that causes abnormal bone growth in the middle ear, resulting in conductive hearing loss. •The most common cause of hearing loss in young adults •Usually bilateral but may progress faster in one ear •Often not diagnosed until communication is already impaired •On examination with an otoscope, a reddish blush of the tympanum (Schwartz's sign) is evident from the vascular and bony changes in the ear. •Tuning fork test and an audiogram demonstrate good bone but poor air conduction. •It is treated by medications that slow bone resorption, hearing aids, and surgery. •The first ear to be repaired is the one with the poorer hearing; the second ear is repaired after the first heals. •The procedures is usually performed under conscious sedation. •Significant hearing improvement is usually immediate with gradual full recovery of hearing as fluid in the middle ear resorbs. •Special post-op care involves minimizing sudden movements to avoid vertigo and actions that increase inner ear pressure such as coughing, sneezing, lifting, bending, and straining during BMs. Hearing Loss and DeafnessPresbycusis •Presbycusis (hearing loss associated with aging) includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues. •Often, more than one type of presbycusis may be present in the same person. •The cause of presbycusis is related to degenerative changes in the inner ear. Noise exposure is thought to be a common factor related to presbycusis. •Presbycusis includes loss of peripheral auditory sensitivity, decline in word recognition ability, and associated psychologic and communication issues. •Because consonants (high-frequency sounds) are the letters by which spoken words are recognized, the ability of the older person with presbycusis to understand the spoken word is greatly affected. Vowels are heard, but some consonants fall into the high-frequency range and cannot be differentiated. This may lead to confusion and embarrassment because of the difference in what was said and what was heard. •The prognosis for hearing depends on the cause of the loss. Hearing Loss and Deafness Presbycusis sensory: atrophy of auditor nerve loss of sensory hair cells loss of high pitched sounds little effects of speech understanding good response to sound amplification neural degenerative changes in cochlea and spinal ganglion loss of speech discrimination amplification alone not sufficient metabolic atrophy of blood vessels in wall of cochlea w interruption of essential nutrient supply uniform loss for all frequencies accompanied by recruitment good response to hearing aid cholera stiffening of basilar membrane, which interferes w sound transmission in cochlea and hearing loss increases from low to high frequency. speech discrimination affected w high frequency losses helped by appropriate forms of amplification Gerontologic Considerations •Presbycusis—hearing loss due to aging •Tinnitus—ringing in ears •Reduced transmission of sound— atrophy of cerumen glands; dry earwax •Balance—atrophy of vestibular structures, slow motor responses, and musculoskeletal limitations Gerontologic Considerations •Sound amplification with the appropriate device is often helpful in improving the understanding of speech. In other situations, an audiologic rehabilitation program can be valuable. •The older adult is often reluctant to use a hearing aid for sound amplification.Reasons cited most often include cost, appearance, insufficient knowledge about hearing aids, amplification of competing noise, and unrealistic expectations. •Most hearing aids and batteries are small, and neuromuscular changes such as stiff fingers, enlarged joints, and decreased sensory perception often make the care and handling of a hearing aid a difficult and frustrating experience for an older person. •Some older adults may also tend to accept their losses as part of getting older and believe there is no need for improvement.

Antyesti

IndiaThis Hindu practice literally translates to "last sacrifice". Depending on the caste, gender, and age of the deceased, they are symbolically returned to the elements of creation in a specific ritual. It is common that a funeral pyre is used in at least one part of this practice.

Poverty

Influencer of Culture: Poverty - Poverty causes inequitable access to health care because of factors like: - Trying home remedies before paying for institutional health care - Transportation issues - Medication costs - Time off work to attend visits - Finances to invest in preventative measures - Poverty is associated with feelings of despair, resignation, and fatalism - Day-to-day attitude toward life; no hope for future - Unemployment and need for financial or government aid - Unstable family structure; possibly characterized by abusiveness and abandonment - Decline in self-respect and retreat from community involvement

Hopelessness and Powerlessness:

Related to: •Overwhelming stress from impending death • Inability to alter course of events •Nursing interventions: •Encourage realistic hope within the limits of the situation •Encourage spirituality as a source of support for hopelessness •Decision making about care can foster a sense of control and autonomy

Jehovah's Witnesses

Jehovah's Witnesses • They oppose the "false teachings" of other sects; opposition often extends to modern science including medicine. • Nursing Considerations:• Blood transfusions violate God's laws and therefore are not allowed. • The courts have not supported the right of Jehovah's Witness parents to refuse lifesaving treatment for their children • Use of alcohol and tobacco are discouraged. • Birth control methods that effectively terminate a pregnancy are avoided. In vitro fertilisation involving eggs and sperm from unmarried people is unacceptable as it is considered adultery, as is gestational surrogacy.

Kohlberg - moral development

Kohlberg's Stages of Moral Development - Preconventional level - Conventional level - Postconventional level Kohlberg's stages of moral development preconventional - stage 1: obedience and punishment driven (what is right and wrong is determined by what is punishable, moral action is essentially the avoidance of punishment) - stage 2: self interest driven - (what is right and wrong is determined by what brings rewards and what people want. others peoples wants and needs come into the picture but only in a reciprocal sense) level 2 conventional - Stage 3: Interpersonal Accord - Conformity driven - being moral is a being a good person in your own eyes and those of others. what the majority thinks is right is right by definition - Stage 4 - System Maintenance - Upholding duties, laws, authority and social order obedience driven (being good means doing ones duty and showing respect for authority and maintaining social order. laws are unquestionably accepted and obeyed post conventional - stage 5: social contract driven (individuals are viewed as holding different opinions and values. laws are regarded as social contracts rather than rigid dictums, although laws should be respected, individual rights can sometimes supersede these laws is they become too destructive or restrictive - stage 6: universal ethical principles driven (moral actions determined by our inner conscience and may or may not be in agreement with public opinion or society's laws. moral reasoning is based on abstract reasoning using universal ethical principles. ethical actions are not instrumental or a mean to something else; they are an end in themselves women's conceptions of morality - orientation to self : reference is to self interest and individual survival - morality of care: reference is to others, focus on social participation self sacrifice and responsibility for protection of dependent and unequal - morality of nonviolence: reference to both self and others; focus on independent arbitration of conflicts

Kohlberg

Kohlberg's Stages of Moral Development •Preconventional level •Conventional level •Postconventional level Kohlberg's stages of moral development preconventional stage 1: obedience and punishment driven (what is right and wrong is determined by what is punishable, moral action is essentially the avoidance of punishment) stage 2: self interest driven (what is right and wrong is determined by what brings rewards and what people want. others peoples wants and needs come into the picture but only in a reciprocal sense) level 2 conventional Stage 3 - Interpersonal Accord - Conformity driven - being moral is a being a good person in your own eyes and those of others. what the majority thinks is right is right by definition Stage 4 - System Maintenance - Upholding duties, laws, authority and social order obedience driven (being good means doing ones duty and showing respect for authority and maintaining social order. laws are unquestionably accepted and obeyed post conventional stage 5: social contract driven (individuals are viewed as holding different opinions and values. laws are regarded as social contracts rather than rigid dictums, although laws should be respected, individual rights can sometimes supersede these laws is they become too destructive or restrictive stage 6: universal ethical principles driven (moral actions determined by our inner conscience and may or may not be in agreement with public opinion or society's laws. moral reasoning is based on abstract reasoning using universal ethical principles. ethical actions are not instrumental or a mean to something else; they are an end in themselves

Models of Grief

Kubler-Ross — Five Stages of Grief•Not everyone experiences all the stages and not necessarily in progressive order.1. Denial - may last minutes to months and be characterized by withdrawal.2. Anger - may be focused in any number of directions:•The person who inflicted the hurt•At the world for letting it happen•At oneself even though nothing could have been done to stop an event from happening (car accident).3. Bargaining - for more time or something other than the death4. Depression - may be expressed in numbness, anger, or sadness.5. Acceptance - admitting the reality of the loss results in a calmer phase known as acceptance.

MASSAGE THERAPY

MASSAGE THERAPY Advantages: Relieves muscle tension and stress without meds Stimulates the circulatory system Produces endorphins Contraindicated in pts with: Blood clots, certain cancers, certain heart dz, severe osteoporosis •Use of touch by stroking, pressure, friction, and kneading the muscles to relax muscles and decrease stress to achieve therapeutic results. Massage energizes tissue and helps to relieve pain, promote sleep, and improve well-being. • •Used to relax muscles, reduce anxiety, increase circulation, and reduce pain • •Stroking, kneading, friction, and vibration used to relieve muscle pain and promote comfort Massage is used by nurses to promote health and wellness. It is used to increase circulation, relieve pain, induce sleep, reduce anxiety or depression, and improve quality of life. Massage produces therapeutic effects on multiple body systems: integumentary, musculoskeletal, cardiovascular, lymph, and nervous. Manipulating the skin and underlying muscle makes the skin supple. Massage increases or enhances movement in the musculoskeletal system by reducing swelling, loosening and stretching contracted tendons, and aiding in the reduction of soft tissue adhesions. Friction to the cutaneous and subcutaneous tissues releases histamines that, in turn, produce vasodilation of vessels and enhance venous return. Massage is a proposed mechanism for relaxation to reduce psychological and physiological stress. Stress is also an individual subjective experience. When the body interprets a physiological or psychological response as stressful, the sympathetic nervous system stimulates the hypothalamic-pituitary-adrenal (HPA) axis in the brain. There is a release of stress hormones such as cortisol and epinephrine. Tactile stimulation in the body tissues causes neurohormonal responses throughout the nervous system. Mechanoreceptors cause impulses to travel from the peripheral nervous system, up the ascending spinal cord to the brain. The stimulus is then interpreted in the higher brain, resulting in a neurological or biochemical response. Massage activates the parasympathetic nervous system to decrease the heart rate, blood pressure, and respirations, resulting in relaxation. Techniques for Hand Massage 255 Each hand is massaged for 2½ minutes. Do not massage if the hand is injured, reddened, or swollen. Protocols from 5 to 10 minutes for each hand have also been recommended (Kolcaba et al, 2006; Remington, 2002). 1. Back of hand Short, medium-length, straight strokes are done from the wrist to the fingertips; moderate pressure is used (effleurage). Large, half-circle, stretching strokes are made from the center to the side of the hand, using moderate pressure. Small, circular strokes are made over the entire hand, using light pressure (make small os with the thumb). Featherlike, straight strokes are made from the wrist to the fingertips, using very light pressure. 2. Palm of hand Short, medium-length, straight strokes are made from the wrist to the fingertips, using moderate pressure (effleurage). Gentle milking and lifting of the tissue of the entire palm of the hand is done using moderate pressure. Small circular strokes are made over the entire palm, using moderate pressure (making little os with index finger). Large, half-circle, stretching strokes are used from the center of the palm to the sides, using moderate pressure. 3. Fingers Each finger is gently squeezed from the base to the tip on both sides and the front and back, using light pressure. Gentle range of motion is performed on each finger. Gentle pressure is applied to each nail bed. 4. Completion The patient's hand is placed on yours and covered your other hand. The top hand is gently toward you several times. The patient's hand is turned over, and your other hand is gently drawn toward you several times.

Nephropathy-Diabetic

Nephropathy - Diabetes can alter the normal function of the kidneys. The medical term for kidney problems related to diabetes is "diabetic nephropathy." Over time, this can lead to chronic kidney disease and even kidney failure. - Microvascular complication - damage to small blood vessels that supply glomeruli of the kidney. - Leading cause of end-stage renal disease - Treatment: - Aggressive BP management with medication - Glycemic control - Yearly screening for microalbuminuria in the urine. To check kidney function,the health care provider can order a urine test that measures the amount of protein in the urine. When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine (even in very small amounts) may be an early sign of kidney damage. - If progresses to ESRD: hemodialysis, peritoneal dialysis, or kidney transplantation

Diagnosis of Diabetes

Normal BG: -A1C: 4-6% -FBG 70-99 mg/dl -2 hr. after meals<140 mg/dl Pre-Diabetes:-A1C 5.7%-6.4% -FBG 100-125 mg/dl -2 hr. after meals140-199 mg/dl Diabetes: -A1C> 6.5% -FBG> 126 mg/dl -2 hr. after meals> 200 mg/dl

Vital Signs

Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: Blood pressure: 90/60 mm Hg to 120/80 mm Hg Breathing: 12 to 18 breaths per minute Pulse: 60 to 100 beats per minute Temperature: 97.8°F to 99.1°F; average 98.6°F

coping interventions

Nursing Process: Coping Interventions •Cognitive approach - teaching the client or helping client think about the problem. (reframing) •Anticipatory guidance - Focuses on psychologically preparing a person for an unfamiliar or painful event •Biofeedback - a process that provides visual or auditory information about autonomic body functions. Nursing Process: Coping Interventions •Behavioral approach - encourage clients to engage in stress reducing behavior •Relaxation techniques - rhythmic breathing, reduced muscle tension, and altered state of consciousness. •Meditation - quiet surroundings, a passive attitude, a comfortable position, and a word or mental image on which to focus. •Guided imagery - a person creates a mental image, concentrates on the image, and becomes less responsive to other stimuli. •Journaling - practice of writing out one's thoughts and feelings as an exercise to identify and evaluate one's own sources of stress and coping strategies •Listening to music - helps anxious individuals distract and redirect their attentions •Interpersonal communication - essentially talking to a trusted source to help one process stressors and coping strategies •Pets - Therapy animals help anxious individuals feel more secure and help decrease many of the physical responses to stress Nursing Process: Coping Interventions •Teaching Healthy Activities of Daily Living: •Exercise - improves a person's general sense of well-being, relieves tension, and enables coping with day-to-day stressors. •Rest and sleep - help the body maintain homeostasis and restore energy levels; can insulate against stress; recommend 7-9 hours of sleep per day. •Nutrition - helps increase resistance to stress •Use of support systems - help a person identify and verbalize feelings associated with stress; safe environment to explore problem-solving methods and try out new coping skills; help maintain a positive self-concept and establish an avenue for new relationships and social roles.

Gerontologic Considerations: Sleep

Older age is associated with •Overall shorter total sleep time •Decreased sleep efficiency •More awakenings •Insomnia symptoms •Insomnia symptoms in older adults frequently occur with depression, cardiovascular disease, pain, and cognitive problems. •A common misconception is that older people need less sleep than younger people. However, the amount of sleep needed as a person ages remains relatively constant. •Cough and cold medications, especially those containing pseudoephedrine, caffeine-containing drugs, and drugs containing nicotine (e.g., nicotine gum, transdermal patches), are stimulants. Diphenhydramine alone or in combination with other drugs is sedating with anticholinergic effects. Any OTC medication labeled "PM" probably has diphenhydramine and should be used cautiously by older adults. •Older adults receiving benzodiazepines are at increased risk of daytime sedation, falls, and cognitive and psychomotor impairment.

Relaxation Techniques

PROGRESSIVE MUSCLE RELAXATION - Progressive Muscle Relaxation - Alternately tensing and relaxing muscles - Systematic-head to toe - Helps person identify tension and learn to relax - Relaxation induces a light state of altered consciousness through refocusing, conscious breathing, and body awareness Guidelines for Progressive Muscle Relaxation for 14 Muscle Groups Instruct patients to tense a specific muscle group when they hear "tense" and to release the tension when they hear "relax." Tension is held for 7 seconds. Draw attention to the feeling of tension and relaxation. When muscles are relaxed, attention is drawn to the differences between the two states. Tensing Specific Muscle Groups Dominant hand and forearm: Make a tight fist and hold it Dominant upper arm: Push elbow down against the arm of the chair Repeat instructions for the nondominant arm Forehead: Lift eyebrows as high as possible Central face (cheeks, nose, eyes): Squint eyes and wrinkle nose Lower face and jaw: Clench teeth and widen mouth Neck: Pull chin down toward chest but do not touch chest Chest, shoulders, and upper back: Take deep breath and hold it, pull shoulder blades back Abdomen: Pull stomach in and try to protect it Dominant thigh: Lift leg and hold it straight out Dominant calf: Point toes toward ceiling Repeat instructions for the nondominant side. BENEFITS OF RELAXATION FOR PATIENTS Reduces anxiety Reduces muscle tension and pain Improves function of immune system Enhances sleep and rest Improves sense of well-being IMAGERY - Guided Imagery - Uses mental images to promote healing or changes in behaviors - Uses all the senses - Useful in decreasing pain, and can be particularly helpful to patients undergoing painful procedures Imagery is the formation of a mental representation of an object, place, event, or situation that is perceived through the senses. It is a cognitive behavioral strategy that uses the individual's own imagination and mental processing and can be practiced as an independent activity or guided by a professional. Imagery uses all the senses—visual, aural, tactile, olfactory, proprioceptive, and kinesthetic. Although imagery is often referred to as visualization, it includes imagining through any sense and is not just being able to see something in the mind's eye. While inducing imagery, the individual often imagines seeing, hearing, smelling, tasting, and/or touching something in the image. Although for many participants physical and mental relaxation tend to facilitate imagery, this is not necessary—particularly 82for children, who often do not need to be in a relaxed state. Imagery may be receptive or active. In receptive imagery, the individual pays attention to an area of the body or a symptom and mentally explores thoughts or feelings that arise. In active imagery, the individual evokes thoughts or ideas. Active imagery can be outcome or end-state oriented, in which the individual envisions a goal, such as being healthy and well; or it can be process oriented, in which the mechanism of the desired effect is imagined, such as envisioning a strong immune system fighting a viral infection or tumor. A key mechanism by which imagery modifies disease and reduces symptoms is thought to be by reducing the stress response, which is triggered when a situation or event (perceived or real) threatens physical or emotional well-being or when the demands of the situation exceed available resources. It activates complex interactions between the neuroendocrine system and the immune system. Emotional responses to situations trigger the limbic system and signal physiologic changes in the peripheral and autonomic nervous systems, resulting in the characteristic fight-or-flight stress response. Over time, chronic stress results in adrenal and immune suppression and may be most harmful to cellular 83immune function, impairing the ability to ward off viruses and tumor cells (Pert, Dreher, & Ruff, 1998). Once the participant is in a relaxed or "altered" state, the practitioner suggests an image of a relaxing, peaceful, or comforting place or introduces an image suggested by the client. Scenes commonly used to induce relaxation include watching a sunset or clouds, sitting on a warm beach or by a fire, or floating through water or space. Relaxation with imagery decreases pain directly by reducing muscle tension and related spasms and indirectly by lowering anxiety and improving sleep. Imagery also is a distraction strategy; vivid, detailed images using all senses tend to work well for pain control. As a low-cost, noninvasive intervention, imagery has the potential to be effective in reducing symptoms and distress across several conditions: cancer, procedural pain, PTSD, headaches, osteoarthritis, depression, asthma, pregnancy, and all forms of pain conditions. General Guided-Imagery Technique 1. Achieving a relaxed state a. Find a comfortable sitting or reclining position. b. Uncross any extremities. c. Close your eyes or focus on one spot or object in the room. d. Focus on breathing with your abdominal muscles—being aware of the breath as it enters through your nose and leaves through your mouth. With your next breath let the exhalation be longer and notice how the inhalation that follows is deeper. And as you notice that, let your body become even more relaxed. Continue to breathe deeply; if it is comfortable, gradually let the exhalation become twice as long as the inhalation. e. If your thoughts roam, bring your mind back to thinking about your breathing and your relaxed body. 2. Specific suggestions for imagery a. Picture a place you enjoy and where you feel good. b. Notice what you see, hear, taste, smell, and feel. c. Let yourself enjoy being in this place. d. Imagine yourself the way you want to be (describe the desired goal specifically). e. Imagine what steps you will need to take to be the way you want to be. f. Practice these steps now—in this place where you feel good. g. What is the first thing you are doing to help you be the way you want to be? h. What will you do next? i. When you reach your goal of the way you want to be, notice how you feel. 3. Summarizing process and reinforce practice a. Remember that you can return to this place, this feeling, and this way of being anytime you want. 85 b. Allow yourself to feel this way again by focusing on your breathing, relaxing, and imagining yourself in your special place. c. Come back to this place and envision yourself the way you want to be every day. 4. Returning to present a. Be aware again of the favorite place. b. Bring your focus back to your breathing. c. Become aware of the room you are in (drawing attention to the temperature, sounds, or lights). d. Let yourself feel relaxed and refreshed and be ready to resume your activities. e. Open your eyes when you are ready. MEDITATION Involves focusing attention on a single repetitive stimulus, thereby decreasing all other stimuli Alters consciousness and can bring a beneficial mind-body response Induces a restful state and lowers heart and respiratory rates; may reduce anxiety Meditation can be defined as a set of attentional practices leading to an altered state or trait of consciousness characterized by expanded awareness, greater presence, and a more integrated sense of self . These practices are used to self-regulate the mind and body, thereby affecting mental events by engaging a specific attentional set. Primary reasons for meditating are to enhance well-being, mitigate symptoms such as anxiety or pain, and self-manage chronic conditions HYPNOTHERAPY - Used to alter behavior, retrieve memories, induce anesthesia - A hypnotic state is created in which suggestions are implanted that remain during the posthypnotic period - Can help with wt loss and to stop smoking - Can undergo surgery during a deep hypnotic state - Not everyone can be hypnotized. biofeedback - Technique that trains patient to lessen symptoms - Learn to control particular internal physiologic processes that normally occur involuntarily, such as heart rate or blood pressure - Internal activity (heart rate for example) is shown on a monitor - With practice, a person can use this information to gain control over the "involuntary" activity - Specialists in many different fields use biofeedback to help their patients cope with pain. Biofeedback is a technique that teaches people how to gain more control of involuntary bodily functions. Electronic sensors applied to the body allow a person to become more aware (feedback) of processes in his or her body (bio). Many different types of healthcare professionals rely on biofeedback to help their patients cope with a variety of conditions such as chronic pain, regain movement in paralyzed muscles, and learn to relax. Patients who suffer from migraine headaches, high blood pressure, and incontinence are just a few examples of those who can benefit from biofeedback therapy. Biofeedback is based on holistic self-care perspectives in which (a) the mind and body are not separated and (b) people can learn ways to improve their health and performance. Biofeedback therapists use instruments and teach self-regulation strategies to help individuals increase voluntary control over their internal physiological and mental processes. Biofeedback instruments measure physiological activity such as muscle tension, skin temperature, cardiac activity, and brainwaves and then provide immediate and real-time feedback to the people in the form of visual and/or auditory signals that increase their awareness of internal processes. The biofeedback therapist then teaches individuals to change these signals and to take a more active role in maintaining the health of their minds and bodies. The holistic and self-care philosophies underlying biofeedback and its focus on helping subjects gain more control over personal functioning make the intervention an appropriate one for nurses to use. Over time, a person can learn to maintain these changes without continued use of a feedback instrument. Parameters Used for Feedback to Patients 168 Airway resistance Blood pressure Blood volume Bowel sounds EEG neurofeedback EMG muscle feedback Forced expiratory volume Galvanic skin response Gastric pH Heart rate Heart rate variability Peripheral skin temperature Pneumography Tidal volume Tracheal noise Vagal nerve stimulation HUMOR - Humor is defined as "simply one element of the comic—as are wit, fun, nonsense, sarcasm, ridicule, satire, or irony—and basically denotes a smiling attitude toward life and its imperfections: an understanding of the incongruities of existence" - Increases circulation - Aids in breathing - Natural stress reliever - May help control pain - Exercises certain muscles - Lowers B/P - Improves immune system PRAYER - Helps reduce stress, promotes healing, and may arrest disease - May be practiced individually or in groups as intercessory prayer - Prayer chains - Different people pray for a set time for an individual's recovery over a period of hours or days; considered beneficial by many people YOGA - A spiritual practice that combines exercise, controlled breathing, posture, and mental focus to bring about positive effects on the body and mind - Effects - Regulating blood pressure and heart rate - Increasing circulation - Aiding digestion - Healing chronic back pain - Helping with other disorders - Idea of harmony, health and balance - Prevents disease by keeping the energy meridians open - In the US thought of more as a form of exercise Benefits of Yoga for Individuals with health issues: asthma, cancer, cardiovascular function, cognition and quality of life, diabetes, elders' mobility and fear of falling, intellectual disabilities, low back pain, osteoarthritis, pain, physical inactivity, restless leg syndrome, smoking cessation, stress management, generalized inflammation..... Corpse Pose Lie on your back with your arms relaxed near your sides; palms up; and head, trunk, and legs straight. If you are uncomfortable, put a pillow or blanket under your head and/or knees. Close your eyes, relax, and let your body sink. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. When you are ready, open your eyes, bend your knees, turn to your right, and get up. Corpse Pose promotes deep relaxation and can decrease hypertension, anxiety, insomnia, stress, and fatigue Alternate Nostril Breathing Sit comfortably with a straight back. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. Place your right thumb on your right nostril, your ring finger on your left nostril, and inhale through both nostrils. Use your thumb to close your right nostril; exhale slowly through your left nostril, and then inhale slowly through your left nostril. Use your ring finger to close your left nostril; exhale slowly through your right nostril, and then inhale slowly through your right nostril. This sequence constitutes one round; repeat for five more rounds. This pranayama technique promotes balance, gives each side of the body equal time, and strengthens the breath in the weaker nostril YOGA: COMMON TYPES - Ashtanga: focuses on synchronizing breath with a fast-paced series of postures - Bikram: is done in a 105-degree studio with 26 set postures - Iyengar: focuses on proper alignment and holding poses for a relatively longer time - Kripaula, or "gentle yoga": focuses on relaxation and coming into balance Corpse Pose Lie on your back with your arms relaxed near your sides; palms up; and head, trunk, and legs straight. If you are uncomfortable, put a pillow or blanket under your head and/or knees. Close your eyes, relax, and let your body sink. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. When you are ready, open your eyes, bend your knees, turn to your right, and get up. Corpse Pose promotes deep relaxation and can decrease hypertension, anxiety, insomnia, stress, and fatigue Alternate Nostril Breathing Sit comfortably with a straight back. Breathe in a circular manner: slowly, evenly, deeply through your nostrils, from your abdomen, with your in-breath the same length as your out-breath, and no break in between. Place your right thumb on your right nostril, your ring finger on your left nostril, and inhale through both nostrils. Use your thumb to close your right nostril; exhale slowly through your left nostril, and then inhale slowly through your left nostril. Use your ring finger to close your left nostril; exhale slowly through your right nostril, and then inhale slowly through your right nostril. This sequence constitutes one round; repeat for five more rounds. This pranayama technique promotes balance, gives each side of the body equal time, and strengthens the breath in the weaker nostril OTHER THERAPIES Music Therapy Uses the healing elements of music to meet the specific and individualized needs of patients. Can help patients relax, distract, stimulates and invigorates. Music and physiological processes (including heartbeat, blood pressure, brain waves, body temperature, digestion, and adrenal hormones) involve rhythms and vibrations that occur in a regular, periodic 111 manner and consist of oscillations. The rhythm and tempo of music can be used to synchronize or entrain body rhythms (e.g., heart rate and respiratory pattern), with resultant changes in physiological states. Certain properties of music (less than 80 beats per minute with fluid, regular rhythm) can be used to promote relaxation by causing body rhythms to slow down or entrain with the slower beat and regular, repetitive rhythm. Music can decrease anxiety by occupying attention channels in the brain with meaningful, distractive auditory stimuli. Music intervention provides a patient with a familiar, comforting stimulus that can evoke pleasurable sensations while focusing the individual's attention onto the music (distraction) instead of on stressful thoughts, pain, discomfort, or other environmental stimuli. Techniques The use of music for intervention can take many forms, such as (passive) listening to selected compact discs (CDs) or individual music downloads from the Internet, as well as actively singing or drumming. A number of factors should be kept in mind when considering the specific technique: the type of music and personal preferences, active music making versus passive listening, individual versus group involvement, length of time involved with the music, and desired outcomes. Two of the more commonly used music-intervention techniques are discussed here: individual listening and group music making Decreasing Anxiety and Stress One of the strongest effects of music is anxiety reduction. Music can enhance the immediate environment, provide a diversion, and lessen the impact of potentially disturbing sounds for patients experiencing a variety of endoscopic procedures and surgical procedures. The effect of music intervention on the stress response has been documented in cardiac surgery patients and in ventilator-dependent ICU patients. Empowering ICU patients receiving mechanical ventilator support to 117self-manage anxiety levels with their preferred relaxing music results in the need for less intense sedative medication regimens. Music can be an efficient intervention for enriching the NICU environment and reducing stress with improvements such as enhanced oxygenation during suctioning and increased feeding rates. Listening to specially composed sedating piano music has been found to induce relaxation and promote sleep in a small sample of patients in a medical ICU. Distraction Music is an effective adjunctive intervention for creating distraction, particularly for procedures that induce untoward symptoms and distress, such as pain and anxiety with hemodialysis and in patients undergoing endoscopy. Music listening can effectively distract anticipatory anxiety while awaiting a dental hygiene procedure. It has been found to be an adept diversional adjunct in the care of individuals with burns, in the management of nausea and pain intensity after bone marrow transplantation, in people undergoing regular hemodialysis, and for reduction in the amount of sedation required for adults during colonoscopy. https://www.youtube.com/watch?v=KNuT3x4KJsY Journaling provides an opportunity for individuals to reflect on and analyze their lives and events and people surrounding them to get in touch with their feelings. Animal/Pet Therapy Pets can provide companionship, promote dialogue and social interaction, facilitate exercise, increase feelings of security, mitigate the effects of stress, be a source of consistency, and be a comfort to touch (Arkow, 2015). The healing power of pets is "their capacity to make the atmosphere safe for emotions, the spiritual side of healing; whatever you are feeling, you can express it around your pet and not be judged" What are some patient conditions that would benefit from animal therapy? Cardiac health, seizure disorders, dementia, pain management, substance abuse recovery, veterans experiencing psychological effects from their experiences in war, ...... Art therapy helpful when the person has difficulty expressing feelings verbally. Dance therapy promotes recognition of feelings and awareness of the body. An artistic medium is used to help the individual neutralize conflict or work through a problem. - Oils from plants - Absorbed through the skin - Inhaled - Thought to act on the brain to evoke pleasant feelings related to past experiences and emotions . It is important to remember that the widespread use of synthetic scents in household and personal products is not considered aromatherapy. Styles (1997) defined aromatherapy as the use of essential oils for therapeutic purposes that encompass mind, body, and spirit—a broad definition that is consistent with holistic nursing practice. The National Cancer Institute (NCI, 2012) defines aromatherapy as the "therapeutic use of essential oils from flowers, herbs, and trees for the improvement of physical, emotional, and spiritual well-being." Buckle (2000) defined clinical aromatherapy in nursing as the use of essential oils for expected and measurable health outcomes. Although essential oils are not always pleasant smelling, inhalation is one of the simplest and most direct application procedures. With this method, one to five drops of an essential oil can be placed on a tissue or floated on hot water in a bowl and then inhaled for 5 to 20 minutes. Other inhalation techniques include the use of diffusers, burners, nebulizers, and vaporizers that can be operated by heat, battery, or electricity and may or may not include the use of water. Larger, portable aroma-inhalation systems are available commercially to provide a controlled release of essential oils into rooms of any size. Inhalation, as well as skin, effects are experienced when essential oils are used in a bath. Baths have been found especially helpful for promoting relaxation and sleep in care settings and in the home. Lavender (L. angustifolia) is the essential oil most commonly used for these purposes, not only because it promotes relaxation, but also because it is generally well tolerated on the skin. For bath-use techniques, see Exhibit 19.2. Compresses can be a useful method for applying essential oils to treat skin conditions or minor injuries. To prepare a compress, the nurse adds four to six drops of essential oil to warm water, soaks a soft cotton cloth in the mixture, wrings it out, and applies the cloth to the affected area, contusion, or abrasion. The nurse then covers the compress with plastic wrap to retain moisture, places a towel over the plastic wrap, and keeps it in place for as long as desired (up to 4 hours) (Buckle, 2003). Massage also can facilitate the absorption of essential oils through the skin and can reduce the patient's perceived stress, thus enhancing the healing process and possibly communication. To create a mixture for massage, the nurse can dilute one to two drops of an essential oil in a teaspoon (5 mL) of cold-pressed vegetable oil and organic and scent-free lotion, cream, or gel. Mixtures for massage are generally 1% to 3% essential oil concentration (Tisserand & Young, 2014), using very low concentrations when massaging large areas of the body. Many health outcomes that fall within the domain of nursing practice can be addressed with essential oils, either alone or combined with other approaches. Essential oils can affect people psychologically and physically. They can increase or decrease sympathetic activity in individuals, affecting heart rate, blood pressure, plasma adrenaline, and plasma catecholamine levels (Chuang, Chen, Liu, Chuang, & Lin, 2014; Menezes, Barreto, Antoniolli, Santos, & de Sousa, 2010; Watanabe et al., 2015). The effect of essential oil odors can be relaxing or stimulating, depending on a person's previous experiences, likes and dislikes, and the chemistry of the essential oil used; therefore, it is important to explore patient preference and the purpose for which the oil is being used when selecting essential oils for therapeutic purposes. Essential oils are used therapeutically to address a broad range of symptoms and body systems, and there are many aromatherapy texts describing their uses and recommending particular essential oils for specific conditions or symptoms. It is difficult to identify evidence other than case studies or historical anecdotes for some of these uses; however, with increased clinical use in recent years there is a more robust evidence base for a number of essential oils and clinical outcomes. The main applications of essential oils in conventional healthcare settings are to help address pain, symptoms of anxiety or depression, nausea, sleeplessness, or agitation and to prevent or treat infections. MANIPULATIVE AND BODY-BASED THERAPY ACUPRESSURE ACUPUNCTURE MASSAGE THERAPY ACUPRESSURE Blend of Acupuncture and pressure Instead of needles, uses pressure ACUPUNCTURE - Qi flows vertically through body through 12 meridians - Places thin needles at particular acupoints to change flow of energy and restore the balance of yin and yang - Process: - Inserting fine needles into points located along energy pathways called "meridians." - Needles are inserted along theses pathways and swirled to remove blockages - Reduces pain, promotes adherence to substance abuse programs, minimizes nausea and vomiting The term acupuncture describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of TCM ENERGY FIELDS - A practitioner acts as a conduit for healing energy that is directed into the patient's energy field or body - Channels energy to the patient, and the patient's body does the healing - Uses a person's or practitioner's energy field to direct healing - The Reiki principles: - Just for today, I will live in the attitude of gratitude. - Just for today, I will not worry. - Just for today, I will not be angry. - Just for today, I will do my work honestly. - Just for today, I will show love and respect for every living being. Reiki is an energy-healing method that can be used as an integrative therapy for a broad range of acute and chronic health problems. Increasingly, it is gaining acceptance as an adjunct to the management of chronic conditions: pain management, oncology, hospice and palliative care, and stress reduction. THERAPEUTIC TOUCH - Alters body energy fields to restore natural healing powers - The hands of the practitioner are passed over the patient to ascertain where tensions or excessive energies exist - Touch may be used to redirect energies and reestablish energy balance - Four Scientific Premises of Therapeutic Touch: - A human being is an open energy system. - Anatomically, a human being is bilaterally symmetrical. - Illness is an imbalance in an individual's energy field. - Human beings have a natural ability to transform and transcend their conditions of living. HT is a type of therapy that works in harmony with and is complementary to standard medical care. HT uses gentle touch to balance physical, mental, and emotional well-being, as well as energy-based techniques to influence and support the human biofield, within the body (energy centers) and surrounding the body (energy fields), supporting the body's natural ability to heal. Based on a holistic view of health and illness, HT focuses on creating an energetic balance of the whole body at the physical, emotional, mental, and spiritual levels rather than 388on dysfunctional parts of the body. Through this process of balancing the energy system and therefore opening energy blockages, an environment is created that is conducive to self-healing. Through the interaction of the energy fields between practitioner and client, the use of the HT practitioner's hands, an intention focusing on the client's highest good, and a centering process, noninvasive HT techniques specific for the client's needs are used to create this energetic balance describes the centering process as a meditation in which one eliminates all distractions and concentrates on that place of quietude within which one can feel truly integrated, unified, and focused. Finding this "place of quietude within" is achieved by many through deep belly breathing, prayer, meditation, or any other technique that slows one down, calms the mind, and accesses a deeper spirit of compassion and strength. To be centered is to be fully present with another person or situation and engaged with heart and mind, deeper feelings, and thoughts. The centered state of mind is maintained throughout the HT treatment. The common thread that exists among these modalities lies in their capacity to reduce stress, promote relaxation, and mitigate pain. All three of these energy practices have been introduced into clinical care over the past few decades, representing a renewed interest in the therapeutic use of intentional touch in clinical practice. An additional important consideration is the high safety profile that exists with energy-healing practices. OTHER THERAPIES - Magnetic Therapy - The use of magnets on a body part to relieve pain is an example of a bioelectromagnetic therapy. - Light Therapy - Light therapy is defined as daily exposure to full-spectrum or bright light as a standard treatment for SAD as well as nonseasonaldepression. - Reflexology MISC THERAPY-AQUATHERAPY - Relaxing/Sitting in a warm tub - Good due to warmth, water movement causes massage, and buoyancy - Releases endorphins - Increases blood flow due to vasodilation caused by the warm water—increases tissue healing

relaxation techniques

PROGRESSIVE MUSCLE RELAXATION •Progressive Muscle Relaxation •Alternately tensing and relaxing muscles •Systematic-head to toe •Helps person identify tension and learn to relax •Relaxation induces a light state of altered consciousness through refocusing, conscious breathing, and body awareness Guidelines for Progressive Muscle Relaxation for 14 Muscle Groups Instruct patients to tense a specific muscle group when they hear "tense" and to release the tension when they hear "relax." Tension is held for 7 seconds. Draw attention to the feeling of tension and relaxation. When muscles are relaxed, attention is drawn to the differences between the two states. Tensing Specific Muscle Groups Dominant hand and forearm: Make a tight fist and hold it Dominant upper arm: Push elbow down against the arm of the chair Repeat instructions for the nondominant arm Forehead: Lift eyebrows as high as possible Central face (cheeks, nose, eyes): Squint eyes and wrinkle nose Lower face and jaw: Clench teeth and widen mouth Neck: Pull chin down toward chest but do not touch chest Chest, shoulders, and upper back: Take deep breath and hold it, pull shoulder blades back Abdomen: Pull stomach in and try to protect it Dominant thigh: Lift leg and hold it straight out Dominant calf: Point toes toward ceiling Repeat instructions for the nondominant side. BENEFITS OF RELAXATION FOR PATIENTS Reduces anxiety Reduces muscle tension and pain Improves function of immune system Enhances sleep and rest Improves sense of well-being IMAGERY •Guided Imagery •Uses mental images to promote healing or changes in behaviors •Uses all the senses •Useful in decreasing pain, and can be particularly helpful to patients undergoing painful procedures Imagery is the formation of a mental representation of an object, place, event, or situation that is perceived through the senses. It is a cognitive behavioral strategy that uses the individual's own imagination and mental processing and can be practiced as an independent activity or guided by a professional. Imagery uses all the senses—visual, aural, tactile, olfactory, proprioceptive, and kinesthetic. Although imagery is often referred to as visualization, it includes imagining through any sense and is not just being able to see something in the mind's eye. While inducing imagery, the individual often imagines seeing, hearing, smelling, tasting, and/or touching something in the image. Although for many participants physical and mental relaxation tend to facilitate imagery, this is not necessary—particularly 82for children, who often do not need to be in a relaxed state. Imagery may be receptive or active. In receptive imagery, the individual pays attention to an area of the body or a symptom and mentally explores thoughts or feelings that arise. In active imagery, the individual evokes thoughts or ideas. Active imagery can be outcome or end-state oriented, in which the individual envisions a goal, such as being healthy and well; or it can be process oriented, in which the mechanism of the desired effect is imagined, such as envisioning a strong immune system fighting a viral infection or tumor. A key mechanism by which imagery modifies disease and reduces symptoms is thought to be by reducing the stress response, which is triggered when a situation or event (perceived or real) threatens physical or emotional well-being or when the demands of the situation exceed available resources. It activates complex interactions between the neuroendocrine system and the immune system. Emotional responses to situations trigger the limbic system and signal physiologic changes in the peripheral and autonomic nervous systems, resulting in the characteristic fight-or-flight stress response. Over time, chronic stress results in adrenal and immune suppression and may be most harmful to cellular 83immune function, impairing the ability to ward off viruses and tumor cells (Pert, Dreher, & Ruff, 1998). Once the participant is in a relaxed or "altered" state, the practitioner suggests an image of a relaxing, peaceful, or comforting place or introduces an image suggested by the client. Scenes commonly used to induce relaxation include watching a sunset or clouds, sitting on a warm beach or by a fire, or floating through water or space. Relaxation with imagery decreases pain directly by reducing muscle tension and related spasms and indirectly by lowering anxiety and improving sleep. Imagery also is a distraction strategy; vivid, detailed images using all senses tend to work well for pain control. As a low-cost, noninvasive intervention, imagery has the potential to be effective in reducing symptoms and distress across several conditions: cancer, procedural pain, PTSD, headaches, osteoarthritis, depression, asthma, pregnancy, and all forms of pain conditions. General Guided-Imagery Technique 1. Achieving a relaxed state a. Find a comfortable sitting or reclining position. b. Uncross any extremities. c. Close your eyes or focus on one spot or object in the room. d. Focus on breathing with your abdominal muscles—being aware of the breath as it enters through your nose and leaves through your mouth. With your next breath let the exhalation be longer and notice how the inhalation that follows is deeper. And as you notice that, let your body become even more relaxed. Continue to breathe deeply; if it is comfortable, gradually let the exhalation become twice as long as the inhalation. e. If your thoughts roam, bring your mind back to thinking about your breathing and your relaxed body. 2. Specific suggestions for imagery a. Picture a place you enjoy and where you feel good. b. Notice what you see, hear, taste, smell, and feel. c. Let yourself enjoy being in this place. d. Imagine yourself the way you want to be (describe the desired goal specifically). e. Imagine what steps you will need to take to be the way you want to be. f. Practice these steps now—in this place where you feel good. g. What is the first thing you are doing to help you be the way you want to be? h. What will you do next? i. When you reach your goal of the way you want to be, notice how you feel. 3. Summarizing process and reinforce practice a. Remember that you can return to this place, this feeling, and this way of being anytime you want. 85 b. Allow yourself to feel this way again by focusing on your breathing, relaxing, and imagining yourself in your special place. c. Come back to this place and envision yourself the way you want to be every day. 4. Returning to present a. Be aware again of the favorite place. b. Bring your focus back to your breathing. c. Become aware of the room you are in (drawing attention to the temperature, sounds, or lights). d. Let yourself feel relaxed and refreshed and be ready to resume your activities. e. Open your eyes when you are ready. MEDITATION Involves focusing attention on a single repetitive stimulus, thereby decreasing all other stimuli Alters consciousness and can bring a beneficial mind-body response Induces a restful state and lowers heart and respiratory rates; may reduce anxiety Meditation can be defined as a set of attentional practices leading to an altered state or trait of consciousness characterized by expanded awareness, greater presence, and a more integrated sense of self . These practices are used to self-regulate the mind and body, thereby affecting mental events by engaging a specific attentional set. Primary reasons for meditating are to enhance well-being, mitigate symptoms such as anxiety or pain, and self-manage chronic conditions HYPNOTHERAPY •Used to alter behavior, retrieve memories, induce anesthesia • •A hypnotic state is created in which suggestions are implanted that remain during the posthypnotic period • •Can help with wt loss and to stop smoking • •Can undergo surgery during a deep hypnotic state • •Not everyone can be hypnotized. biofeedback •Technique that trains patient to lessen symptoms •Learn to control particular internal physiologic processes that normally occur involuntarily, such as heart rate or blood pressure •Internal activity (heart rate for example) is shown on a monitor •With practice, a person can use this information to gain control over the "involuntary" activity •Specialists in many different fields use biofeedback to help their patients cope with pain. Biofeedback is a technique that teaches people how to gain more control of involuntary bodily functions. Electronic sensors applied to the body allow a person to become more aware (feedback) of processes in his or her body (bio). Many different types of healthcare professionals rely on biofeedback to help their patients cope with a variety of conditions such as chronic pain, regain movement in paralyzed muscles, and learn to relax. Patients who suffer from migraine headachese to breathe deeply; if it is comfortable, gradually let the exhalation become twice as long as the inhalation. e. If your thoughts roam, bring your mind back to thinking about your breathing and your relaxed body. 2. Specific suggestions for imagery a. Picture a place you enjoy and where you feel good. b. Notice what you see, hear, taste, smell, and feel. c. Let yourself enjoy being in this place. d. Imagine yourself the way you want to be (describe the desired goal specifically). e. Imagine what steps you will need to take to be the way you want to be. f. Practice these steps now—in this place where you feel good. g. What is the first thing you are doing to help you be the way you want to be? h. What will you do next? i. When you reach your goal of the way you want to be, notice how you feel. 3. Summarizing process and reinforce practice a. Remember that you can return to this place, this feeling, and this way of being anytime you want. 85 b. Allow yourself to feel this way again by focusing on your breathing, relaxing, and imagining yourself in your special place. c. Come back to this place and envision yourself the way you want to be every day. 4. Returning to present a. Be aware again of the favorite place. b. Bring your focus back to your breathing. c. Become aware of the room you are in (drawing attention to the temperature, sounds, or lights). d. Let yourself feel relaxed and refreshed and be ready to resume your activities. e. Open your eyes when you are ready. MEDITATION Involves focusing attention on a single repetitive stimulus, thereby decreasing all other stimuli Alters consciousness and can bring a beneficial mind-body response Induces a restful state and lowers heart and respiratory rates; may reduce anxiety Meditation can be defined as a set of attentional practices leading to an altered state or trait of consciousness characterized by expanded awareness, greater presence, and a more integrated sense of self . These practices are used to self-regulate the mind and body, thereby affecting mental events by engaging a specific attentional set. Primary reasons for meditating are to enhance well-being, mitigate symptoms such as anxiety or pain, and self-manage chronic conditions HYPNOTHERAPY •Used to alter behavior, retrieve memories, induce anesthesia • •A hypnotic state is created in which suggestions are implanted that remain during the posthypnotic period • •Can help with wt loss and to stop smoking • •Can undergo surgery during a deep hypnotic state • •Not everyone can be hypnotized. biofeedback •Technique that trains patient to lessen symptoms •Learn to control particular internal physiologic processes that normally occur involuntarily, such as heart rate or blood pressure •Internal activity (heart rate for example) is shown on a monitor •With practice, a person can use this information to gain control over the "involuntary" activity •Specialists in many different fields use biofeedback to help their patients cope with pain. Biofeedback is a technique that teaches people how to gain more control of involuntary bodily functions. Electronic sensors applied to the body allow a person to become more aware (feedback) of processes in his or her body (bio). Many different types of healthcare professionals rely on biofeedback to help their patients cope with a variety of conditions such as chronic pain, regain movement in paralyzed muscles, and learn to relax. Patients who suffer from migraine headaches OTHER THERAPIES Music Therapy Uses the healing elements of music to meet the specific and individualized needs of patients. Can help patients relax, distract, stimulates and invigorates. Music and physiological processes (including heartbeat, blood pressure, brain waves, body temperature, digestion, and adrenal hormones) involve rhythms and vibrations that occur in a regular, periodic 111 manner and consist of oscillations. The rhythm and tempo of music can be used to synchronize or entrain body rhythms (e.g., heart rate and respiratory pattern), with resultant changes in physiological states. Certain properties of music (less than 80 beats per minute with fluid, regular rhythm) can be used to promote relaxation by causing body rhythms to slow down or entrain with the slower beat and regular, repetitive rhythm. Music can decrease anxiety by occupying attention channels in the brain with meaningful, distractive auditory stimuli. Music intervention provides a patient with a familiar, comforting stimulus that can evoke pleasurable sensations while focusing the individual's attention onto the music (distraction) instead of on stressful thoughts, pain, discomfort, or other environmental stimuli. Techniques The use of music for intervention can take many forms, such as (passive) listening to selected compact discs (CDs) or individual music downloads from the Internet, as well as actively singing or drumming. A number of factors should be kept in mind when considering the specific technique: the type of music and personal preferences, active music making versus passive listening, individual versus group involvement, length of time involved with the music, and desired outcomes. Two of the more commonly used music-intervention techniques are discussed here: individual listening and group music making Decreasing Anxiety and Stress One of the strongest effects of music is anxiety reduction. Music can enhance the immediate environment, provide a diversion, and lessen the impact of potentially disturbing sounds for patients experiencing a variety of endoscopic procedures and surgical procedures. The effect of music intervention on the stress response has been documented in cardiac surgery patients and in ventilator-dependent ICU patients. Empowering ICU patients receiving mechanical ventilator support to 117self-manage anxiety levels with their preferred relaxing music results in the need for less intense sedative medication regimens. Music can be an efficient intervention for enriching the NICU environment and reducing stress with improvements such as enhanced oxygenation during suctioning and increased feeding rates. Listening to specially composed sedating piano music has been found to induce relaxation and promote sleep in a small sample of patients in a medical ICU. Distraction Music is an effective adjunctive intervention for creating distraction, particularly for procedures that induce untoward symptoms and distress, such as pain and anxiety with hemodialysis and in patients undergoing endoscopy. Music listening can effectively distract anticipatory anxiety while awaiting a dental hygiene procedure. It has been found to be an adept diversional adjunct in the care of individuals with burns, in the management of nausea and pain intensity after bone marrow transplantation, in people undergoing regular hemodialysis, and for reduction in the amount of sedation required for adults during colonoscopy. Journaling provides an opportunity for individuals to reflect on and analyze their lives and events and people surrounding them to get in touch with their feelings. Animal/Pet Therapy Pets can provide companionship, promote dialogue and social interaction, facilitate exercise, increase feelings of security, mitigate the effects of stress, be a source of consistency, and be a comfort to touch (Arkow, 2015). The healing power of pets is "their capacity to make the atmosphere safe for emotions, the spiritual side of healing; whatever you are feeling, you can express it around your pet and not be judged" What are some patient conditions that would benefit from animal therapy? Cardiac health, seizure disorders, dementia, pain management, substance abuse recovery, veterans experiencing psychological effects from their experiences in war, Dance therapy promotes recognition of feelings and awareness of the body. An artistic medium is used to help the individual neutralize conflict or work through a problem Each hand is massaged for 2½ minutes. Do not massage if the hand is injured, reddened, or swollen. Protocols from 5 to 10 minutes for each hand have also been recommended (Kolcaba et al, 2006; Remington, 2002). 1. Back of hand Short, medium-length, straight strokes are done from the wrist to the fingertips; moderate pressure is used (effleurage). Large, half-circle, stretching strokes are made from the center to the side of the hand, using moderate pressure. Small, circular strokes are made over the entire hand, using light pressure (make small os with the thumb). Featherlike, straight strokes are made from the wrist to the fingertips, using very light pressure. 2. Palm of hand Short, medium-length, straight strokes are made from the wrist to the fingertips, using moderate pressure (effleurage). Gentle milking and lifting of the tissue of the entire palm of the hand is done using moderate pressure. Small circular strokes are made over the entire palm, using moderate pressure (making little os with index finger). Large, half-circle, stretching strokes are used from the center of the palm to the sides, using moderate pressure. 3. Fingers Each finger is gently squeezed from the base to the tip on both sides and the front and back, using light pressure. Gentle range of motion is performed on each finger. Gentle pressure is applied to each nail bed. 4. Completion The patient's hand is placed on yours and covered your other hand. The top hand is gently toward you several times. The patient's hand is turned over, and your other hand is gently drawn toward you several times. MASSAGE THERAPY Advantages: Relieves muscle tension and stress without meds Stimulates the circulatory system Produces endorphins Contraindicated in pts with: Blood clots, certain cancers, certain heart dz, severe osteoporosis

holistic approach

Palliative care is a holistic approach to care or treatment that focuses on reducing the severity of disease symptoms, rather than trying to delay or reverse the progression of the disease itself or provide a cure. Treatment should align with the patients' preferences for care and cultural beliefs and values. • The overall goals of palliative care are to (1) prevent and relieve suffering and (2) improve quality of life for patients with serious, life-limiting illnesses. • Palliative care includes curative care, hospice, end of life, and bereavement following death. -folk medicine is a holistic approach to healing

adjusting style

Patient's style and level of usual communication should be considered when interacting If the person is a slow, calm communicator, adjust to that pace If a response is slow in coming, allow plenty of time for consideration and a response

Sentinel Health Event

Per Joint Commission, a sentinel event is a patient safety event (not primarily related to the natural course of the patient's illness or underlying condition) that reaches a patient and results in any of the following: •Death •Permanent harm •Severe temporary harm An event is also considered sentinel if it is one of the following: •Suicide of any patient receiving care, treatment, or services in a staffed around the clock care setting or within 72 hours of discharge, including from the organization's emergency department (ED) •Unanticipated death of a full-term infant •Discharge of an infant to the wrong family •Abduction of any patient receiving care, treatment, or services The Joint Commission tracks events in a database to ensure events are adequately analyzed and undesirable trends or decreases in performance are caught early and mitigated.

Play

Physical and motor skill markers: Able to turn a door knob. Can look through a book turning one page at a time. Can build a tower of 6 to 7 cubes. Can kick a ball without losing balance. Can pick up objects while standing, without losing balance. (This often occurs by 15 months. It is a cause for concern if not seen by 2 years.) Can run with better coordination. (May still have a wide stance.) May be ready for toilet training. Should have the first 16 teeth, but the actual number of teeth can vary widely. At 24 months, will reach about half final adult height. Sensory and cognitive markers: Able to put on simple clothes without help. (The child is often better at removing clothes than putting them on.) Able to communicate needs such as thirst, hunger, need to go to the bathroom. Can organize phrases of 2 to 3 words. Can understand 2-step command such as, "Give me the ball and then get your shoes." Has increased attention span. Vision is fully developed. Vocabulary has increased to about 50 to 300 words, but healthy children's vocabulary can vary widely. Play recommendations: Allow the child to help around the house and take part in the daily family chores. Encourage active play and provide enough space for healthy physical activity. Encourage play that involves building and creativity. Provide safe copies of adult tools and equipment. Many children like to mimic activities such as cutting the grass or sweeping the floor. Read to the child. Try to avoid television watching at this age (recommendation of the American Academy of Pediatrics). Control both the content and quantity of television viewing. Limit screen time to less than 3 hours per day. One hour or less is better. Avoid programming with violent content. Redirect the child to reading or play activities. Control the type of games the child plays.

Ventilation

Physiology of Breathing:Pulmonary Ventilation Inspiration: the active phase of ventilation ◦Involves movement of muscles and the thorax to bring air into the lungs Expiration: the passive phase of ventilation ◦Movement of air out of the lungs Alterations in Respiratory Function - Hypoventilation: The state in which a reduced amount of air enters the alveoli in the lungs, resulting in decreased levels of oxygen and increased levels of carbon dioxide in the blood. Hypoventilation can be due to breathing that is too shallow (hypopnea) or too slow (bradypnea), or to diminished lung function. - Hyperventilation: Refers to overbreathing, in which ventilation exceeds the metabolic demand causing abnormally low levels of carbon dioxide in the blood, and its related physiologic sysmptoms. - Dyspnea: difficulty breathing, shortness of breath, air hunger - Hypoxia: inadequate amount of oxygen available to the cells in your tissues; the state in which the PaO2 has fallen sufficiently to cause signs and symptoms of inadequate oxygenation. - Hypoxemia: is a below-normal level of oxygen in your blood, specifically in the arteries. - Hypercapnia: greater than normal amounts of carbon dioxide in the blood; usually the result of hypoventilation. - Bronchoconstriction: is the constriction of the airways in the lungs due to the tightening of surrounding smooth muscle, with consequent coughing, wheezing, and shortness of breath. - Bronchodilation: An expansion of the air passages through the bronchi of the lungs. A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. - Hemoptysis: is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. - Atelectasis: collapsed alveoli

Prejudice

Prejudice (extreme negative stereotyping) •Judging a person, group, or situation before knowing all the facts •Usually a negative connotation (although there are positive prejudices!) •Usually destructive •Usually hurtful •Restrictive to enrichment of society •Health care providers need to know and understand their own racial, ethnic, religious, and social stereotypes

Safety Considerations for Adolescents:Distracted Driving

Prevention:•Fully focus on driving:•Stow all electronics: no cell phones•Store loose gear and possessions so you don't feel tempted to reach for them•Finish dressing and grooming at home: no putting on make up and changing clothes while behind the wheel.•Try to avoid eating and driving•If you have passengers, enlist their help so you can focus on driving•Pull off the road to answer a phone call or adjust the radio•If you are drowsy, pull off the road.•Limit the amount of activity happening inside the care•Program navigation/direction before leaving

Coping Responses

Problem solving •Using social support -> ADAPTIVE•Reframing Avoidance •Self-blame -> MALADAPTIVE•Wishful thinking

Respiratory Defense Mechanisms

Protect lungs by.... ◦Filtration of air◦Mucociliary clearance◦System -escalator◦Cough reflex◦Reflex bronchoconstriction◦Alveolar macrophages

Radiology: Chest x-ray

Radiology—no metal; check pregnancy

Religion

Religion: - Spirituality and religion play important roles in the concept of culture - Defined as belief in a higher power (not the same for everyone) ; greater than any human being. - Religion relates to a defined, organized, and practiced system of worship. - Deeply rooted and often stereotyped - Important to some patients and nonexistent to others - Religion may: - Influence the procedures a patient will allow - Determine who is allowed to care for that patient - Require services/ceremonies to be done at the bedside - Nurses need to be comfortable discussing patients' needs pertaining to their spirituality or offer to get assistance from others who can help (chaplain, social worker, etc.) Death is a universally shared event with all cultures and religions having beliefs and rituals to explain and cope with death, loss, and grief Burial At Sea This is an ancient tradition with roots so deep, they're difficult to trace. Most major religions have their own specific customs for performing a burial at sea. Sometimes, when a body cannot be located, a cenotaph, rather than a body, may be symbolically thrown into the sea. Cremation Worldwide Cremation is popular in religions such as Buddhism and Hinduism, and has historically been practiced all around the world. The Christian reverence for the physical body led to cremation being outlawed in many Western countries, but those laws have since been discarded.

Shamanism

SHAMANISM - It is the most widely practiced medical system. - Illness is thought to originate in the spirit world. - The healer accesses the spirit world to obtain information on the proper treatment. - Treatment may consist of retrieving lost soul energy, restoring the individual to right relationship with the spirit world, and treating symptoms. - Healing techniques involve native plants and herbs, animals, rituals, ceremonies, and purification techniques The shaman uses techniques to achieve a non-ordinary reality, or a "shamanic" state of consciousness - May perform various ceremonies including burning particular plants and herbs to bring about the rebalancing of the individual with nature - The shamanic journey is the most common practice of the traditions. - The journey is usually induced by rhythmic drumming or other percussive sounds. - Involves the acquisition of power through interaction with spirits. - The shaman maintains a relationship with "spiritual helpers" to receive instruction and information to help patients.

Stress

Safety Consideration for Adults: Stress The Occupational Safety and Health Administration (OSHA) declared stress a hazard of the workplace. Stress costs American industry more than $300 billion annually. Effects of stress overtime: •Increased number of headaches per month •Linked to impaired memory •Increased risk of developing sleep problems •Double the risk of asthma exacerbation •Greater hair loss and thinning •Increase in acne •More likely to have a heart attack •Increased cravings for sweet and fatty foods •Interfere with sexual function and prevents arousal •Linked to chronic back pain •Disturbs the balance of microorganisms in gut causing digestive problems •Chronic fatigue •Lowers immunity •Premature aging •Cause blood sugars and blood pressure to rise Stress •Is a condition in which the human system responds to changes in its normal balanced state. •Results from a change in a person's internal or external environment that is perceived as a challenge, a threat, or a danger. •Stress is unavoidable •Each person has a different perception of stress •Stress should only last for a brief period •If stress lasts for a long period, the affected person should be concerned •Usual association is negative •Seldom association with positive (e.g., wedding) •Stress produces anxiety •Eustress is the term used for short-term stress that promotes positive emotional, intellectual, and physiologic adaptation and development. Stress Continuum It's intended to be used as an example of how stressors impact your people and actions you can take to help them...not as a diagnostic tool. If you or your people need help dealing with stress,please seek assistance from the appropriate agencies low: healthy tension and peak performance, stress level high = imbalance and breakdown Examples of Physiologic Stressors Chemical agents •Medications •Caffeine •Alcohol Physical agents •Illness •Injury •Surgery •Pain •Heat or cold Infectious agents •Viruses •Bacteria Nutritional imbalances •Poor diet •Hypoxia •Genetic or immune disorders •Too much or too little exercise •Lack of relaxation Examples of Psychosocial Stressors •Accidents •Major cataclysmic changes affecting large numbers of people like war, floods, hurricane, war •Stressful or traumatic experiences of family members and friends •Horrors of history •Fear of aggression or mutilation •Events of history that are brought into our homes through television and the internet •Rapid changes in the world •Economic •political •Divorce •Death of a loved one, bereavement Examples of Developmental Stressors •Starting school •Playing and working with peers •Puberty •Education •Work responsibilities •Financial responsibilities •Marriage •Parenthood •Aging Adaptation •Is the change that takes place as a result of the responses to a stressor. •Can occur individually, in families, and groups •Necessary for normal growth and development, the ability to tolerate changing situations, and to respond to physical and emotional stressors •Homeostasis: various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment. Components of a System of Balances During Stress a balance is achieved when the perception of the stressful event is realistic and support coping mechanisms an imbalance can occur if the perception of the event is exaggerated or if sources for support or coping mechanisms are inadequate Physiologic Homeostasis •Local adaptation syndrome (LAS)—involves only one specific body part •Reflex pain response •Inflammatory response •General adaptation syndrome—biochemical model of stress (Hans Selye, 1976) •Alarm reaction •Stage of resistance •Stage of exhaustion Local Adaptation Syndrome •Localized response of the body to stress •Involves only a specific body part (such as a tissue or organ) instead of the whole body •Stress precipitating the LAS may be traumatic or pathologic •Primarily homeostatic short-term adaptive response •Two types: reflex pain response and inflammatory response •Reflex Pain Response: is the response of the central nervous system to pain; rapid; automatic; serves as protective mechanism to prevent injury. •Inflammatory Response: is a local response to injury or infection; serves to localize and prevent the spread of infection and promote wound healing. The General Adaptation Syndrome (General Response to Stress) •A biochemical model describing the body's general response to stress; developed by Selye (1976). •Stages occur with either physical or psychological damage to the person. •Resisting or adapting to stress: •According to the GAS model, if a person continues to resist, he/she eventually becomes exhausted, which can affect the person's immune system •Ultimately, this can lead to death alarm reaction •Person perceives stressor, defense mechanisms activated •Fight-or-flight response •Hormone levels rise, body prepares to react •Shock and counter-shock phases Stage of Resistance •Body attempts to adapt to stressor •Vital signs, hormone levels, and energy production return to normal •Body regains homeostasis or adaptive mechanisms fail Stage of Exhaustion •Results when adaptive mechanisms are exhausted •Body either rests and mobilizes defenses to return to normal or dies Psychological Homeostasis •To maintain mental well-being, humans also must maintain psychological homeostasis. •Refer to Maslow's Hierarchy of Needs: •Love and belonging needs •Safety and security needs •Self-esteem needs •If the person has the necessary resources, adaptation takes place and balance is maintained. •Adaptive responses include: •The mind-body interaction •Anxiety •Coping or defense mechanisms Mind-Body Interaction •Relationship between psychological stressors and the physiological stress response •A person perceives the threat on an emotional level, and the body prepares itself either to resist the danger or to run away from it. •Indicators of stress: •Physiological Indicators Psychoemotional Indicators • Anxiety • Fear • Anger • Depression Cognitive Indicators • Problem solving • Structuring • Self-control • Suppression • Fantasy Examples of Physical Illnesses Associated with Stress Autoimmune Disorders •Graves' disease (hyperthyroidism) •Myasthenia gravis •Psoriasis •Rheumatoid arthritis •Systemic lupus erythematosus •Ulcerative colitis Cardiovascular and Hematologic Disorders •Coronary artery disease •Hypertension •Sickle Cell Disease Gastrointestinal Disorders •Constipation •Diarrhea •Esophageal reflux Respiratory Disorders •Asthma Coping •Behaviors used to decrease stress and anxiety; ability to adapt to a stressor. •Conscious, learned behaviors based on a person's family, past experiences, religion, sociocultural influences and expectations. •Affected by one's personal choice •Can include behaviors like: Laughing, crying, sleeping, cursing, physical activity, exercise, smoking, drinking, lack of eye contact, withdrawal, limiting relationships to those with similar values and interest, et. •Physical - directly handle problem •Intellectual - changing perception •Spiritual - prayer, faith, rituals •Emotional - crying, communicating Task-Oriented Reactions to Stress •Attack behavior •Withdrawal behavior •Compromise behavior Coping vs. Adaptation Sometimes, the terms 'adaptation' and 'coping' are used interchangeably. This has led to a lot of confusion. Comparing and contrasting characteristics is one way to understand their similarities and difference COPING •Short-term and immediate •Oriented towards survival •Not continuous •Motivated by crisis; reactive •Often degrades the resource base •Prompted by a lack of alternatives •ADAPTATION •Practices and results are sustained •Oriented towards longer-term livelihood security •A continuous process •Involves planning •Uses resources efficiently and sustainably •Focused on finding alternatives •Combines old and new strategies and knowledge Effective vs. Ineffective Coping Effective coping •Adaptation is behaviour that maintains integrity of the individual •Person utilizes active problem solving - This coping mechanism involves identifying a problem that is causing stress and then developing and putting into action some potential solutions for effectively managing it. •Lead to healthy choices Ineffective coping •Maladaptation is UNHEALTHY behavior that disrupts the integrity of the individual. •Person utilizes withdrawal, compromise or avoidance, •Excessive use of the defense mechanisms can lead to negative impact on mental and emotional well-being Coping Responses •Problem solving •Using social support -> ADAPTIVE •Reframing •Avoidance •Self-blame -> MALADAPTIVE •Wishful thinking What type of coping behavior is being used? A nurse is yelling at a CNA for charting vitals on the wrong chart..... •Maladaptive problem-solving A person is sensitive to strong perfumes and leaves the room..... •Adaptive withdrawal Defense Mechanisms •Protect a person's self -esteem and are useful in mild to moderate anxiety. •Are mental pressure valves •Are considered to be "unconscious" •Give the illusion of being helpful, when in reality theymask the stress and may actually increase it •When used in small "doses" may be helpful for short-term stress relief •When used to excess, become ineffective and may lead to breakdown of personality and relationships. Effects of Stress on Basic Human Needs Physiologic Needs •Change in appetite, activity, or sleep •Change in elimination patterns •Increased pulse, respirations, blood pressure Safety and Security •Feels threatened or nervous •Uses ineffective coping mechanisms •Is inattentive Love and Belonging •Is withdrawn and isolated •Blames others for own faults •Demonstrates aggressive behaviors •Becomes overly dependent on others Self-Esteem •Becomes a workaholic •Exhibits attention-seeking behaviors Self-Actualization •Refuses to accept responsibility •Centers on own problems •Demonstrates lack of control • *** As a person strives to meet basic human needs at each level, stress can be either a stimulus or a barrier. Stress in Health and Illness •Adaptation to Acute or Chronic Illness 1.General tasks: for example, maintaining self-esteem and personal relationships 2.Illness-related tasks: for example, handling pain and disability •Effects of stress in healthy persons may promote health and prevent illness; whereas, the effects of stress on a sick or injured persons are usually negative. Effects of Long-Term Stress •Affects physical status •Increases risk for disease or injury •Compromises recovery and return to normal function •Is associated with specific diseases Family Stressors •Changes in family structure and roles •Anger and feelings of helplessness and guilt •Loss of control over normal routines •Concern for future financial stability Crisis •Is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a threat to self. •Person's usual methods of coping are ineffective and this failure produces high levels of anxiety, disorganized behavior, and an inability to function adequately. •One's ability to cope with anxiety is overwhelmed. •New coping behaviors must be developed to successfully resolve the source problem. Factors Affecting Stress and Adaptation Sources of stress •Developmental stress: occurs when person progresses through stages of growth and development •Situational stress: does not occur in predictable patterns •E.g. illness or traumatic injury, marriage or divorce, loss, new job, role change Personal factors •The ability to adapt is lower in the very young, very old, and those with altered physical health who do not have the necessary physiologic reserves to cope with physical changes. •People with mental health issues may lack adaptability and flexibility •People with strong support systems and relationships are better able to adapt to stress and remain healthy. Individual Stress Variation •Stressors themselves do not cause disease; individuals respond differently to different stressors. •Stress response depends on the person's perception of an event. •Factors influencing person's perception/reaction to stressors: • Age • Maturity • Culture •Life experiences • Personality traits

Venom

Safety Considerations Among All Age Groups: Insect Stings or Bites - Localized pain, swelling, heat, and redness - Culprits: bees, wasps, yellow jackets, hornets, certain ants, scorpions, spiders - Treatment: ice to the site, elevate the affected part, remove stinger by gently scraping it off the skin (don't use tweezers or forceps because the squeezing the stinger will release more venom into the patient), antivenin for black widow and brown recluse spider bites. Prevention: - Insect repellant - Remaining aware of environment - Having home treated for any infestation Among All Age Groups: Snakebites Safety Considerations - Only a small percentage of snakebites are caused by poisonous snakes. - Culprit: coral snake and pit vipers which include rattlesnake, copperheads, and cottonmouth moccasins. - Snakebite leaves two small puncture wounds with surrounding discoloration, swelling, and pain; burning at the site. - Interventions are focused on decreasing the circulation of venom throughout the patient's system by keeping the patient calm, immobilizing the affected part, extremities positioned below level of the heart. - Wound site should be cleaned with soap and water; do not irrigate or flush. Wound dressed in loose, clean dressing. Don't apply ice. - Assist with IV delivery of antivenin.

Rape

Safety Considerations for Adolescents: Rape and Sexual Violence - TIPS FOR TALKING TO YOUR TEEN ABOUT SEXUAL VIOLENCE - Talk to your teen about sex early. Talk often. Give your child the facts about sex, sexual coercion and assault before they obtain misinformation from peers. Start talking long before your teen begins dating. - It's never too late to start the conversation. Young women are at the most risk for sexual assault between ages 16-24. - Remember that teens are craving factual information about sex from someone they trust - even if they act like they don't want to talk to you. - Talk to them when you can both be as attentive as possible. The car may be a great place. - Don't make it a joke. Rape is not funny - ever. Don't skirt the issue by sandwiching this message between playful topics. Sexual violence is a serious issue and should be handled that way. If you approach it as a joke, your teen will too. - Use media stories to start the conversation. "What do you think about the case in the news? What are you hearing at school about this? What do you think about it?" It is easier for them to open up about what other people think first. Then you can share your message: "If anyone has ever or anyone ever does hurt you, you can talk to me."

Substance Abuse

Safety Considerations for Adolescents: Substance Abuse •Individuals who begin using drugs as juveniles are at greater risk of becoming addicted compared to those who begin drug use as an adult due to the immaturity of the teenage brain, particularly of that part of the brain that controls impulses. •The symptoms of drug abuse include tolerance to a substance, withdrawal episodes, using more drugs for longer periods of time, and problems managing life issues due to the use of a drug. •Substances: Tobacco, Alcohol, Marijuana, Cocaine, Narcotics, Mind-altering drugs Effects: •Drugs of any kind decreases teens' ability to pay attention. •Juveniles who use drugs are more likely to have unprotected sex, sex with a stranger, as well as to engage in sexual activity at all. •Substance use can cause or mask other emotional problems, like anxiety, depression, mood swings, or hallucinations. Those illnesses can result in death by suicide or homicide. •Long term damage to multiple body systems can occur. Prevention: •Clear communication by parents and adults about the negative effects of drugs •Adequate parental supervision •Closely monitor the alcohol and medications kept in the home •Participation in extracurricular activities provides mental distraction and accountability

Coping vs. Adaptation

Sometimes, the terms 'adaptation' and 'coping' are used interchangeably. This has led to a lot of confusion. Comparing and contrasting characteristics is one way to understand their similarities and difference COPING •Short-term and immediate•Oriented towards survival•Not continuous•Motivated by crisis; reactive•Often degrades the resource base•Prompted by a lack of alternatives ADAPTATION •Practices and results are sustained•Oriented towards longer-term livelihood security•A continuous process•Involves planning•Uses resources efficiently and sustainably•Focused on finding alternatives•Combines old and new strategies and knowledge

Suicide

Safety Considerations for Adolescents: Suicide •Many teens who attempt or die by suicide have a mental health condition. As a result, they have trouble coping with the stress of being a teen, such as dealing with rejection, failure, breakups and family turmoil. They might also be unable to see that they can turn their lives around — and that suicide is a permanent response, not a solution, to a temporary problem. Methods: •Firearms •Hanging •Overdose Safety Considerations for Adolescents: Suicide Ways to Protect you Teen from Suicide: •Address depression or anxiety. Don't wait for your teen to come to you. If your teen is sad, anxious or appears to be struggling — ask what's wrong and offer your help. •Pay attention. If your teen is thinking about suicide, he or she is likely displaying warning signs. Listen to what your child is saying and watch how he or she is acting. Never shrug off threats of suicide as teen melodrama. •Discourage isolation. Encourage your teen to spend time with supportive friends and family. •Encourage a healthy lifestyle. Help your teen eat well, exercise and get regular sleep. •Support the treatment plan. If your teen is undergoing treatment for suicidal behavior, remind him or her that it might take time to feel better. Help your teen follow his or her doctor's recommendations. Also, encourage your teen to participate in activities that will help him or her rebuild confidence. •Safely store firearms, alcohol and medications. Access to means can play a role if a teen is already suicidal. Safety Consideration for Adults •Remind them of effects of stress on lifestyle and health. •Counsel about unsafe health habits (reliance on drugs and alcohol). •Counsel about domestic violence. •Risk of trauma from accidents

Neglect and Abuse

Safety Considerations for School-Aged Children: Neglect and Abuse Physical neglect - Deprivation of food, clothing, shelter, supervision, medical care, and education Emotional neglect - Lack of affection, attention, and emotional nurturance - Emotional abuse—destroy or impair child's self-esteem - Physical abuse—deliberate infliction of physical injury on a child - Sexual abuse of children - defined as "the use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) or producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children" Prevention - Strengthen economic support of families to meet basic needs - Encouraging family friendly work policies - Changing social norms to encourage positive parenting - Provide quality care and education early in life - Enhance parenting skills through education, community support, home visits to promote healthy child development - Intervene to lessen harm and prevent future risk Elder Abuse - Based on recent studies, it is estimated that 10% of adults aged 60 or older who live in the community are abused (Lachs & Pillemer, 2015). - Victims are more likely to be women, young-old, lower income, or isolated, with a lack of social support (Lachs & Pillemer, 2015). - Elder abuse includes physical abuse, sexual abuse, psychological or emotional abuse, financial abuse or exploitation, and neglect (Hall, Karch, & Crosby, 2016).

sexual violence

Safety Considerations for School-Aged Children: Neglect and Abuse Physical neglect •Deprivation of food, clothing, shelter, supervision, medical care, and education Emotional neglect •Lack of affection, attention, and emotional nurturance •Emotional abuse—destroy or impair child's self-esteem •Physical abuse—deliberate infliction of physical injury on a child •Sexual abuse of children - defined as "the use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) or producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children" Prevention •Strengthen economic support of families to meet basic needs •Encouraging family friendly work policies •Changing social norms to encourage positive parenting •Provide quality care and education early in life •Enhance parenting skills through education, community support, home visits to promote healthy child development •Intervene to lessen harm and prevent future risk Elder Abuse •Based on recent studies, it is estimated that 10% of adults aged 60 or older who live in the community are abused (Lachs & Pillemer, 2015). •Victims are more likely to be women, young-old, lower income, or isolated, with a lack of social support (Lachs & Pillemer, 2015). •Elder abuse includes physical abuse, sexual abuse, psychological or emotional abuse, financial abuse or exploitation, and neglect (Hall, Karch, & Crosby, 2016).

Near-Drowning

Safety Considerations for School-Aged Children:Near-Drowning - Used to describe submersion with at least temporary survival of the victim of asphyxiation. - Asphyxia - insufficient oxygen intake; can cause death. - Symptoms: mild dyspnea, death-like appearance with blue or gray skin color, apnea or tachycardia, hypotension, slow heart rate, cold skin temperatures, dilated pupils, hypothermia, and vomiting. Prevention - Reduce exposure to water hazards through strategic use of barriers like pool gates fence or self-latching gates and childproof covers. - Close and capable adult supervision for young children - Adults avoid distractions like cell phones, tablets, and group conversations. - Equip kids with swimming and water safety skills through lessons and practice. - Requirements for use of personal flotation devices like Coast Guard approved life vest if they are not good swimmers. - Put pool toys away when you leave the pool so that children don't go back for them. - Don't rely on floaties and inner tubes to keep children from drowning - Cover drains and instruct children to stay away from them. - never leave your child alone in the bathtub or near a body of water - Stay within an arm's reach of children in the water - Inforce rules about rough play in the water and pool area - Teach about safe diving depths

Self Esteem

Self Esteem •Refers to how people feel about themselves •Is how you feel about those things you know, like whether you enjoy the fact that you are talkative at parties (high self esteem) or you think that you are annoying and need to learn to shut up sometimes (low self esteem). •Individuals have a concept of self based on who they think they are (the actual self) and a concept of who they think they would like to be (ideal self). Maslow's Subsets of Esteem Needs •Self-esteem: Is the need that people have to feel good about themselves and to believe that others hold them in high regard. •Strength, achievement, mastery and competence, confidence in the face of the world, independence, freedom •Self-actualization: Is the need for people to reach their full potential through development of their unique capabilities. •Respect needs: Status, dominance, recognition, attention, importance, appreciation Coopersmith's Four Bases of Self-Esteem 1.Significance - a feeling of being loved and cared about by the people important to you. •"Are there people in your life with whom you share a close relationship?" •"To what extent do you feel loved and approved of by the key people in your life?" •"Does it bother you when you feel unloved or when others fail to appreciate you?" •"In what ways do you let family members and friends know that you like them or are proud of their accomplishments?" 2.Competence - depends on whether a person compares themselves well with others •"What are the things you need to do to feel important?" •"Is anything interfering with your ability to execute these tasks? How does this make you feel?" •"How important to you is it to feel that others value your work?" 3. Virtue - I am a good person •"Tell me something about the moral-ethical principles that govern your life." •"How must you live to describe yourself as a 'good' person?" •"Describe any difficulties you experience in living up to your moral principles that you would like to discuss." •"In what ways can the nurses help you to live better according to your moral standards?" 4. Power - having some control over being who you are •"How important is it to you to 'be in control' of your life (health)?" •"To what extent did you feel 'in control' of you life (health) before this illness (trauma, crisis)?" •"To what extent do you feel 'in control' of your life (health) currently?" •"What is it that makes you feel not in control?" •"How might you change this? How can nurses help you develop and gain more control?" Self Esteem •Building Self-esteem •Find a good role model •Praise and compliments •Focus on the positive •Keep criticism to a minimum •Set and achieve goals •Perfect your skills •Destroying Self-Esteem •Comparing yourself to others •Putting yourself down •Surrounding yourself with negative people •Letting negative self-talk control your brain •Believing failure is the worst thing ever •Assuming nobody likes you •Constantly aiming for perfection Three Major Self-Evaluation Feelings •Pride: based on positive self-evaluation •Guilt: based on behaviors incongruent with the ideal self •Shame: associated with low global self-worth

Self-concept

Self concept is an individual's perception of self and is what helps make each individual unique. - Encompasses what people know and believe about themselves - Positive and negative self-assessments in the physical, emotional, intellectual, and functional dimensions change over time. - Self concept affects the ability to function and greatly influences health status. - Includes all notions, beliefs, and convictions that constitute an individual's self knowledge and that influence that individuals relationships with others. Continuum of Self-concept responses at the adaptive end, a healthy self concept leads one toward self-actualization. Low self concept results in maladaptive behavioral responses as individuals struggle to define who they are. Positive Self Concept - I have a healthy body - I am an attractive person - I am confident in social situations because I usually get along well with people - I am optimistic and generally happy with life - I am an honest person - Religion is my guide in everyday life - I am a cheerful person - I am from a happy family - I am motivated to do something because I have often been successful. - I have enough self confidence to cope with new challenges and to view them positively Negative Self Concept - I am not loved by my family - I hate myself - I hate how my body looks - No one will ever love me. - I am broken. - I am sensitive and passive. - I lack motivation because when I have tried new things before, I often did not do very well. - I lack confidence, especially when meeting new people, new people make me anxious as I fear I will have nothing to say - I am unhappy a lot of the time - I often find life difficult and do not enjoy new challenges, I am afraid of failure Three Dimensions of Self-Concept - Self-knowledge: "Who am I?" - Sex, age, race, occupation, cultural background, sexual orientation - Person's position within social groups - Qualities or traits that describe typical behaviors, feelings, moods, and other characteristics - Self-expectation: "Who or what do I want to be?" - Self-evaluation: "How well do I like myself?" - Self esteem is the evaluative and affective component of self concepts. Self Esteem - Refers to how people feel about themselves - Is how you feel about those things you know, like whether you enjoy the fact that you are talkative at parties (high self esteem) or you think that you are annoying and need to learn to shut up sometimes (low self esteem). - Individuals have a concept of self based on who they think they are (the actual self) and a concept of who they think they would like to be (ideal self). Maslow's Subsets of Esteem Needs - Self-esteem: Is the need that people have to feel good about themselves and to believe that others hold them in high regard. - Strength, achievement, mastery and competence, confidence in the face of the world, independence, freedom - Self-actualization: Is the need for people to reach their full potential through development of their unique capabilities. - Respect needs: Status, dominance, recognition, attention, importance, appreciation Coopersmith's Four Bases of Self-Esteem 1.Significance - a feeling of being loved and cared about by the people important to you. - "Are there people in your life with whom you share a close relationship?" - "To what extent do you feel loved and approved of by the key people in your life?" - "Does it bother you when you feel unloved or when others fail to appreciate you?" - "In what ways do you let family members and friends know that you like them or are proud of their accomplishments?" 2.Competence - depends on whether a person compares themselves well with others - "What are the things you need to do to feel important?" - "Is anything interfering with your ability to execute these tasks? How does this make you feel?" - "How important to you is it to feel that others value your work?" 3. Virtue - I am a good person - "Tell me something about the moral-ethical principles that govern your life." - "How must you live to describe yourself as a 'good' person?" - "Describe any difficulties you experience in living up to your moral principles that you would like to discuss." - "In what ways can the nurses help you to live better according to your moral standards?" 4. Power - having some control over being who you are - "How important is it to you to 'be in control' of your life (health)?" - "To what extent did you feel 'in control' of you life (health) before this illness (trauma, crisis)?" - "To what extent do you feel 'in control' of your life (health) currently?" - "What is it that makes you feel not in control?" - "How might you change this? How can nurses help you develop and gain more control?" Self Esteem - Building Self-esteem - Find a good role model - Praise and compliments - Focus on the positive - Keep criticism to a minimum - Set and achieve goals - Perfect your skills - Destroying Self-Esteem - Comparing yourself to others - Putting yourself down - Surrounding yourself with negative people - Letting negative self-talk control your brain - Believing failure is the worst thing ever - Assuming nobody likes you - Constantly aiming for perfection Three Major Self-Evaluation Feelings - Pride: based on positive self-evaluation - Guilt: based on behaviors incongruent with the ideal self - Shame: associated with low global self-worth Formation of Self-Concept - Self concept evolves throughout life and depends to an extent on an individual's developmental level. - Infant learns physical self different from environment. - If basic needs are met, child has positive feelings of self. - Child internalizes other people's attitudes toward self. - Child or adult internalizes standards of society. Stages in Development of Self - Self-awareness (infancy) - Self-recognition (18 months) - Self-definition (3 years) - Self-concept (6-7 years) Infancy - Changes Affecting Self- Concept: - No self-concept at birth; beginning differentiation of self and non-self. - Nursing Implications: - Teach parents the critical importance of providing consistent and affectionate parenting. - Assess whether the parents have reasonable expectations of the infant: sleeping, eating, and other awake behaviors. - Potential Causes of Disturbances in Self-Concept: - Unmet basic human needs - Lack of adequate body and sensory stimulation - Parent's lack of acceptance of the infant's appearance or behavior. - Poor match between parent's and child's temperament or needs. Childhood Changes Affecting Self- Concept: - An intact body is important to the young child, who fears bodily mutilation. - During middle childhood, a sense of being trusted and loved, of being competent and trustworthy develops. - Differences between self and others are strong. - Nursing Implications: - If invasive procedures are indicated, explain simply to the child what is being done and offer the child support. - Assess the parent's ability to provide the type of developmental environment in which the child's self-concepts can evolve positively. - Potential Causes of Disturbances in Self-Concept: - Dysfunctional family - Too much or too little structure - Sensory perceptual impairments Psychological conditions that foster healthy development of the self in children include: - emotional warmth and acceptance. - effective structure and discipline. - clearly defined standards and limits, so that children understand what goals, procedures, and conduct are approved. - adequately defined roles for both older and younger members of the family. - established methods of handling children that produce the desired behavior, discourage misbehavior, and deal with infractions when they occur. - encouragement of competence and self-confidence helpingchildren meet challenges. - appropriate role models (usually parents). - a stimulating and responsive environment. Adolescence - Changes Affecting Self- Concept: - Development of secondary sex characteristics, rapid body changes - Sense of self is consolidated - Emphasis on sexual identity - Parental influences on self-concept are often rejected; peers become more important; movement toward development of own identify - Nursing Implications: - Assess adolescent's self knowledge and understanding of body changes - Counsel adolescent regarding mature and health use of independence he or she craves - Provide anticipatory guidelines regarding hazards to life, health, human functioning. Potential Causes of Disturbances in Self-Concept: - Inability to accept body - Inability to resolve competing pulls to be both a child and an adult - Unhealthy peer pressure - Identity confusion Adulthood Changes Affecting Self- Concept: - Society places emphasis on intactness of body, fitness, energy, sexuality, style, productivity, sophistication, beauty. - Important to meet role expectations well. Nursing Implications: - Assess how realistic the adult's expectations are and the incentive they provide for growth and development. - Assist patient to deal constructively with negative influences in self-image. - Preretirement counseling. Potential Causes of Disturbances in Self-Concept: - Inability to fulfill conflicting role expectations - Failure to accept role responsibility (e.g. parenting responsibilities.) - Unreasonable expectations - Irreversible body changes related to trauma, illness - Unsatisfying job - Failure to develop new goals to give meaning and purpose to life - Multiple stressors Later Adult Years Changes Affecting Self- Concept: - Declining physical and possibly mental abilities - Multiple losses - Increasing dependency - Impending death - Diminished choices/options Nursing Implications: - Assess how the older adult is adjusting to effects of aging. - Counsel regarding meaningful use of time. - Explore resources - Assess depression, substance abuse. - Recognize and value older adults' life experiences Potential Causes of Disturbances in Self-Concept: - Loss of significant work (retirement); feelings of uselessness - Death of spouse or significant others - Diminished physical attractiveness, strength, overall health - Multiple stressors - Fear of dependency - Change may be more difficult. Factors Affecting Self-Concept - Developmental considerations - Culture - Internal and external resources - History of success and failure - Crisis or life stressors - Aging - Illness - Trauma Six variables that influence self-esteem - Socialization - Communication - Significance - Competence - Virtue - Power Nursing Assessment Assessing Personal Identity: - "How would you describe yourself to others?" - High Risk Factors: developmental changes, trauma, biological sex dissonance, and cultural dissonance. Assessing Body image: - "Describe your body to me." - "What do you like most/least about your body?" - "Is there anything about your body that you would like to change?" - High Risk Factor: loss of body part or function, disfigurement, developmental changes Assessing Self Esteem: - "Tell me what you like about yourself." - "What would you change about yourself if you could?" Assessing Self-Expectations: - "You've told me something about who you are and how you view yourself now. Tell me who you would like to be in the future." - "What life goals are important to you?" - "Are these expectations realistic?" - "Are your expectations stemming from who you would like to be or from who you think you should be?" - "Who or what has influenced your self-expectations?" Assessing Interpersonal Relationships: - "Who do you feel is important to you?" - "Is there anyone you feel you can depend on for help if you need it?" - "How do you feel about your relationships?" - "Tell me about changes you've noticed in your ways of meeting and interacting with others?" - "Many people have 'people' problems. Are your relationships causing you any problems right now?" Assessing Feelings of Significance: - "Are there people in your life with whom you share a close relationship?" - "To what extent do you feel loved and approved of by the key people in your life?" - "Does it bother you when you feel unloved or when others fail to appreciate you?" - "In what way do you let family members and friends know that you like them or are proud of their accomplishments?" Assess Feelings of Competence: - "What are the things you need to do to feel important?" - "Is anything interfering with your ability to execute these tasks? How does this make you feel?" - "How important to you is it to feel that others value your work?" Assess Sense of Virtue: - "Tell me something about the moral-ethical principles that govern your life?" - "How must you live to describe yourself as a 'good' person?" - "Describe any difficulties you experience in living up to your moral principles that you would like to discuss?" - "In what ways can the nurses help you to live better according to your moral standards?" Assess Sense of Power: - "How important is it to you to 'be in control' of your life (health)?" - "To what extent did you feel 'in control' of your life (health) before this illness (trauma, crisis)?" - "To what extent do you feel 'in control' of your life (health) currently?" - "How might you change this? How can nurses help you to develop and gain more control?" Assess Compromised Role Performance: - "What major roles describe you - son, daughter, spouse, parent, employer or employee, student, etc?" - "How important is it to you to be good in each of these roles?" - "Tell me how successful you think you are in each of these roles." - "What roles or expectations would you change if you could?" - "What new skills or behaviors might be necessary to help you resume or modify current roles?" - "What is it for you to lose a role that's been important to you?" - "How can I help you identify other role options or direction?" Nursing Diagnosis - Disturbed Body Image: The state in which a person experiences confusion in the mental picture of his or her physical self. - Chronic (or Risk for Chronic) Low Self-Esteem or Situational (or Risk for Situational) Low Self-Esteem: The state in which a person experiences, or is at risk for experiencing negative self-evaluation about self or capabilities. - Ineffective Role Performance: The state in which a person experiences, or is at risk for experience, a disruption in the way that a person perceives his or her role performance. - Disturbed (or Risk for Disturbed) Personal Identity: The state in which a person experiences, or is at risk for experiencing, an inability to distinguish between self and non-self. - Impaired Social Interaction: insufficient or excessive quantity or ineffective quality of social exchange - Ineffective Coping Disturbed Body Image - Related to.... - Alteration in self-perception - Cultural incongruence - Spiritual incongruence As Evidenced by.... - Absence of body part or in body function or body structure - Alteration in view of one's body - Avoids looking at one's body - Avoids touching one's body Risk of Situational Low Self Esteem - Related to..... - Alteration in body image - Alteration in social role - Behavior inconsistent with values - Decrease in control over environment - Inadequate recognition - Pattern of helplessness - Unrealistic self-expectations Readiness for Enhanced Self-Concept - Evidenced by..... - Acceptance of limitations - Acceptance of strengths - Actions congruent with verbal expressions - Expresses confidence in abilities - Expresses desire to enhance role, performance or self concept - Expresses satisfaction with sense of worth Outcome Identification and Planning - The patient will.... - Describe self realistically, identifying both strengths and deficiencies. - Verbalize realistic expectations for self, based on who the patient would like to be. - Verbalize that self is liked, or at least "OK." - Communicate feelings and needs in a way that is comfortable and effective in meeting needs. - Nurture relationships in which needs for love and worth are mutually met (significance). - Assume role related responsibilities with confidence (competence). - Express satisfaction with ability to live according to his or her moral-ethical standards (virtue). - Demonstrate confidence in ability to accomplish what is desired (power) - Report feeling better about him or her self. - Identify faulty thinking that reinforces a negative self concept Nursing Interventions Nursing Strategies to Identify Personal Strengths..... - Helping patients identify and use personal strengths - Helping at-risk patients maintain a sense of self - Enhancing or modifying the self-concept - Developing a positive body image - Working with parents and educators to develop self-esteem in children, adolescents, and older adults Helping Patients Maintain Sense of Self..... - Communicate worth with looks, speech, and judicious touch. - Acknowledge patient status, role, and individuality. - Speak to the patient respectfully. - Offer simple explanations for procedures. - Move the patient's body respectfully, if necessary. - Respect the patient's privacy and sensibilities. - Acknowledge and allow expression of negative feelings. - Help the patient recognize strengths and explore alternatives. - Helping patients identify and use their own strengths - Encourage the client to adopt active coping strategies - Offer emotional support, active listening, and coping assistance - Spend one on one time with the client - Use empathy - Communicate understanding to the client - Non-judgmental environment - Provide empowerment based educational preparation for clients on body satisfaction - Encourage clients to consider a web-based support program - Teaching self-compassion - Assist client to modify negative self concept - Help the client explore the positive dimensions of the self that the patient wishes to develop and incorporate this new knowledge into the self concept. - Encourage self affirmations by reflecting on values and strengths, in response to daily threats. - Teach the client mindfulness techniques to cope more effectively with strong emotional responses. - Assist with expressions of gratitude through a gratitude journal or kind acts - Encourage realistic and achievable goal setting and resources and identify impediments to achievement Validate the effects of negative past experiences on self esteem and work on corrective measures. - reframe the client's thinking about the situation Evaluation - Is the client comfortable with body image and able to use it effectively to meet human needs? - Is client able to describe self positively? - Is the client able to meet realistic role expectations without undue anxiety and fatigue? - Is the client capable of interacting appropriately with environment while recognizing self to be a separate and distinct entity? Response to Deformity or Limitation - Adaptive responses: Patient exhibits signs of grief and mourning (shock, disbelief, denial, anger, guilt, acceptance) - Maladaptive responses: Patient continues to deny and to avoid dealing with the deformity or limitation, engages in self-destructive behavior, talks about feelings of worthlessness or insecurity, equates deformity or limitation with whole person, shows a change in ability to estimate relationship of body to environment Development of the Older Adult - Physiologic: All organ systems undergo some degree of decline; body less efficient - Cognitive: Does not change appreciably, may take longer to respond and react - Psychosocial: Self-concept is relatively stable throughout adult life. - Disengagement theory: An older adult may substitute activities but does disengage from society. - Erikson: Ego integrity versus despair and disgust; life review - Havighurst: Major tasks are maintenance of social contacts and relationships Psychosocial Development of Adolescent/Young Adult - Freud: genital stage, capable of full sexual function - Erikson: identity versus role confusion; self-concept is stabilized; peer group has most influence - Havighurst: masculine or feminine social role developed; set of values and ethical system internalized - Levinson: early adult transition—making initial career choices, establishing personal relationships, and selecting personal values and lifestyles - Gould: theory of transformation—young adults establish their own control as adults separate from family

sensory deprivation

Sensory Deprivation •Sensory Deprivation occurs when the client does not get enough sensory stimuli to sustain the person in a state of balance. •Occurs when the client is deprived of normal level of sensory stimulation as can occurs among inmates and prisoners in isolation as well as residents in a private isolation rooms without visitors and socialization. Factors Contributing to Sensory Deprivation •Decreased environmental stimuli: Institutionalized environment; separation from significant others and usual sources of stimuli; treatment that decreases access to stimuli like bed rest or isolation. •Impaired ability to receive environmental stimuli: impaired vision, hearing, taste, smell, touch; treatment like bandages or body casts that interfere with reception of stimuli; result of depression and/or affective disorders. •Inability to process environmental stimuli: spinal cord injuries, brain damage, confusion, dementia, medication that depress the CNS. Effects of Sensory Deprivation •Perceptual responses: inaccurate perception of sight, sounds, tastes, smell and body position, coordination and equilibrium. •Cognitive responses: patients inability to control the direction of the thought content, attention span and ability to concentrate is decreased, patient may demonstrate difficulty with memory, problem solving and task performance. •Emotional Responses: include apathy, anxiety, fear, anger, panic, depression, rapid mood changes occur. Patient Outcomes for Sensory Alterations •Developmentally stimulating and safe environment •Level of arousal enabling brain to receive and organize stimuli •Intact functioning of the senses •Orientation to time, place, and person Improving Sensory Functioning •Teach patients and significant others methods for stimulating the senses. •Teach patients with intact and impaired senses self-care behaviors. •Interact therapeutically with patients with sensory impairments. Preventing Sensory Alterations •Control patient discomfort whenever possible. •Offer care that provides rest and comfort. •Be aware of need for sensory aids and prostheses. •Use social activities to stimulate senses and mind. •Enlist aid of family members to participate in or encourage activities. •Encourage physical activity and exercise. •Provide stimulation for as many senses as possible.

Socio-cultural impact

Sociocultural Dimension - Health practices and beliefs are influenced by: -Economic level, Life style, Family, Culture personal, biologic, psychological, and sociocultural factors are predictive of a certain health-related habit.

Coping vs. Adaptation

Sometimes, the terms 'adaptation' and 'coping' are used interchangeably. This has led to a lot of confusion. Comparing and contrasting characteristics is one way to understand their similarities and difference COPING •Short-term and immediate •Oriented towards survival •Not continuous •Motivated by crisis; reactive •Often degrades the resource base •Prompted by a lack of alternatives •ADAPTATION •Practices and results are sustained •Oriented towards longer-term livelihood security •A continuous process •Involves planning •Uses resources efficiently and sustainably •Focused on finding alternatives •Combines old and new strategies and knowledge

Spirituality

Spirituality is defined as those beliefs, values, and practices that relate to the search for existential meaning and purpose and that may or may not include a belief in a higher power. - Note the patient's and family's preferences related to spiritual guidance or pastoral care services. - Encourage spirituality as a source of support for hopelessness Spiritual Dimension - Spiritual beliefs and values are incorporated into health and illness behaviors - Baptism - Kosher dietary laws - Opposition to blood transfusions COMPLEMENTARY/ALTERNATIVE MEDICINE - Mind, body, and spirit are integrated and contribute to health and illness. - Health is balance of body systems: mental, social, and spiritual, as well as physical. AMERICAN INDIAN MEDICINE - Healing herbs and ceremonies combined with a spiritual emphasis are used to treat ailing patients - Therapies based on the belief that spirit, mind, and emotions all interact with the environment - Rituals and Practices - Sweat lodge, herbal remedies, medicine wheel, the sacred hoop, the "sing," shaking rattles - Patient's disease or disorder is believed to be caused by a disharmony in the patient's connection to nature and the spirit world - Varies from tribe to tribe - May also use western medicine as well - Therapeutic approach combines spirituality, herbalism, and magic. - Used to treat a wide range of physical and emotional ailments, from the common cold to depression. OLK MEDICINE - A holistic approach to healing practiced throughout Latin America - Illness is seen as an imbalance - Hot and cold - Patient and the environment - Parts of the body - Patient and the spiritual realm - Biologic compounds, foods, and herbs are used to treat the physical components of the illness - A curandero treats the supernatural components - Curanderismo uses natural ingredients like herbs as remedies. SHAMANISM - It is the most widely practiced medical system. - Illness is thought to originate in the spirit world. - The healer accesses the spirit world to obtain information on the proper treatment. - Treatment may consist of retrieving lost soul energy, restoring the individual to right relationship with the spirit world, and treating symptoms. - Healing techniques involve native plants and herbs, animals, rituals, ceremonies, and purification techniques The shaman uses techniques to achieve a non-ordinary reality, or a "shamanic" state of consciousness - May perform various ceremonies including burning particular plants and herbs to bring about the rebalancing of the individual with nature - The shamanic journey is the most common practice of the traditions. - The journey is usually induced by rhythmic drumming or other percussive sounds. - Involves the acquisition of power through interaction with spirits. - The shaman maintains a relationship with "spiritual helpers" to receive instruction and information to help patients. AYURVEDA MEDICINE - - Ancient Hindu Medicine/Traditional Medicine from India - Uses combinations of herbs, minerals, purgatives, massage, meditation, special diets - Focuses on restoring and strengthening the body, mind, and spirit - Healing focus is on maintenance of balance and wholeness to prevent illness - Central is patient's basic constitution—dosha - Vata (changeable), pitta (intense), kapha (relaxed) - Practitioner: Ayurvedic Doctor - Therapies: diet, herbal remedies, breath work, physical exercise, yoga, meditation, massage, detoxification program Originated in Vedic civilization of India Balance among people, environment, and larger cosmos integral to health Goal: maintain the health of healthy people and cure the sick Illness is a result of falling out of balance with nature It is a way of life YOGA - A spiritual practice that combines exercise, controlled breathing, posture, and mental focus to bring about positive effects on the body and mind PRAYER - Helps reduce stress, promotes healing, and may arrest disease - May be practiced individually or in groups as intercessory prayer - Prayer chains - Different people pray for a set time for an individual's recovery over a period of hours or days; considered beneficial by many people - Spiritual - prayer, faith, rituals Moral and Spiritual Development of Older Adults - Kohlberg: Older adults have completed their moral development and most are at a conventional level. - Spiritually, an adult may be at an earlier level, often at the individuative-reflective level. - Many adults demonstrate conjunctive faith and trust in a greater power. - Self-transcendence is characteristic of later life. - Gerotranscendence: describes the transformation of a person's view of reality from a rational, social, individually focused, materialistic perspective to a more transcendent vision. Spiritual Needs - Spirituality is those beliefs, values, practices that relate to the search for existential meaning and purpose - At the end of life, many patients question their beliefs about a higher power, their own journey through life, religion, and an afterlife - May or may not include a belief in a higher power - Does not necessarily equate to religion - Preferences should be noted - Spirituality is associated with decreased despair at EOL - Spiritual distress may occur Psychopomps The Philippines, Worldwide Psychopomps are spirits, angels, or deities who guide the souls o f the deceased to the underworld. In Filipino culture, dead relatives act as psychopomps. On a persons' deathbed, if they call out for a relative, it is said that the spirit of that relative is waiting for them at the foot of their bed to guild them into the afterlife. The Ka-Statue Ancient Egypt These stone or wooden statues were used as conduits for the spirits of the dead. A ritual called the Opening of the Mouth Ceremony would be performed by priests to give the statues (and the spirits that inhabited them) the ability to see, breath, smell, and hear. Sometimes they were carved into a particular likeness, but other times general statues were created for roving spirits to partake in festivals Spirit Offerings Worldwide Offeriengs such as alcohol, rice, food, money, cars, and other things are sometimes symbolically or literally given to the dead. "Hell money" a specific kind of counterfeit currency, is often burned for the dead during East Asian funerals. Edgar Allen Poe's "Poe Toaster" was famous for leaving a spirit offering of roses and cognac at Poe's cenotaph. Spiritual Distress: - Related to: sudden and unexpected death, prolonged suffering before death, questing the death and meaning of one's own existence Needs of Dying Patients Care at the End of Life Spiritual needs: patient needs meaning and purpose, love and relatedness, forgiveness and hope

Sputum Study

Sputum studies - Expectoration, suctioning, or bronchoscopy for sample; or induced, Nursing: teach effective specimen production Skin tests—intradermal injection, Allergies, TB, Nursing: read induration, not reddened area for interpretation ◦Sputum abnormalities: oQuantity oConsistency oColor oOdor ◦Coughing ◦Absent ◦ineffective ◦Hemoptysis ◦Fatigue Altered levelSputum studies - Expectoration, suctioning, or bronchoscopy for sample; or induced, Nursing: teach effective specimen production Skin tests—intradermal injection, Allergies, TB, Nursing: read induration, not reddened area for interpretation ◦Sputum abnormalities: oQuantity oConsistency oColor oOdor ◦Coughing ◦Absent ◦ineffective ◦Hemoptysis ◦Fatigue Altered level

St. Johns Wort

St. John's Wort is most often used as a dietary supplement for depression. People also use it as a dietary supplement for other conditions, including menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder.

Safety Consideration for Adults: Domestic Abuse

Studies indicate that each year, more than 10 million adult men and women in the United States are victims of intimate partner violence (IPV), which involves "physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner (i.e., spouse, boyfriend/girlfriend, dating partner, or ongoing sexual partner)" . Safety while living with an abusive partner: remove weapons, keep phone accessible, develop a signal to notify trusted friends and family, teach your children how to get help and how to get out safely, keep the car keys accessible and the car full of gas, do not wear jewelry or scarves that could pose a threat to your safety, keep copies of important documents •Safety planning with children: teach them how to call 911, teach them not to intervene, involve them in the plans for physical safety, teach them IPV is not their fault •Safety planning for pets: stock extra supplies, copy their medical records •Safety planning during pregnancy: recognize the heightened risk, utilize time with your provider to discuss IPV issues, take a women-only prenatal class •Leaving a relationship: keep evidence of abuse, plan with your children, contact a local shelter or other community resource, pack and take essential items, communicate your history and needs to new support systems, protect yourself and avoid the perpetrator after leaving, consider your legal options

Therapeutic Touch

THERAPEUTIC TOUCH •Alters body energy fields to restore natural healing powers •The hands of the practitioner are passed over the patient to ascertain where tensions or excessive energies exist •Touch may be used to redirect energies and reestablish energy balance •Four Scientific Premises of Therapeutic Touch: •A human being is an open energy system. •Anatomically, a human being is bilaterally symmetrical. •Illness is an imbalance in an individual's energy field. •Human beings have a natural ability to transform and transcend their conditions of living. - HT is a type of therapy that works in harmony with and is complementary to standard medical care. HT uses gentle touch to balance physical, mental, and emotional well-being, as well as energy-based techniques to influence and support the human biofield, within the body (energy centers) and surrounding the body (energy fields), supporting the body's natural ability to heal. Based on a holistic view of health and illness, HT focuses on creating an energetic balance of the whole body at the physical, emotional, mental, and spiritual levels rather than 388on dysfunctional parts of the body. Through this process of balancing the energy system and therefore opening energy blockages, an environment is created that is conducive to self-healing. Through the interaction of the energy fields between practitioner and client, the use of the HT practitioner's hands, an intention focusing on the client's highest good, and a centering process, noninvasive HT techniques specific for the client's needs are used to create this energetic balance describes the centering process as a meditation in which one eliminates all distractions and concentrates on that place of quietude within which one can feel truly integrated, unified, and focused. Finding this "place of quietude within" is achieved by many through deep belly breathing, prayer, meditation, or any other technique that slows one down, calms the mind, and accesses a deeper spirit of compassion and strength. To be centered is to be fully present with another person or situation and engaged with heart and mind, deeper feelings, and thoughts. The centered state of mind is maintained throughout the HT treatment. - The common thread that exists among these modalities lies in their capacity to reduce stress, promote relaxation, and mitigate pain. All three of these energy practices have been introduced into clinical care over the past few decades, representing a renewed interest in the therapeutic use of intentional touch in clinical practice. An additional important consideration is the high safety profile that exists with energy-healing practices.

Weber's test

The Weber test is a screening test for hearing performed with a tuning fork. It can detect unilateral (one-sided) conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). Conductive hearing ability is mediated by the middle ear composed of the ossicles: the malleus, the incus, and the stapes. Sensorineural hearing ability is mediated by the inner ear composed of the cochlea with its internal basilar membrane and attached cochlear nerve (cranial nerve VIII). The outer ear consisting of the pinna, ear canal, and ear drum or tympanic membrane transmits sounds to the middle ear but does not contribute to the conduction or sensorineural hearing ability save for hearing transmissions limited by cerumen impaction

Nursing Process: Client Goal/Outcome

The client will: •Remain free of destructive behavior toward self or others •Identify three concrete stress reduction techniques that are of interest •Identify cause of anxiety •Decrease level of anxiety by verbalizing feelings and using support systems •Develop effective methods of coping through problem-solving skills and anxiety-reducing techniques •Sleep a minimum of 6 or more hours every night

choking

The danger signs of choking are:•Bluish skin color•Difficulty breathing - ribs and chest pull inward•Loss of consciousness if blockage is not cleared•Inability to cry or make much sound•Weak, ineffective coughing•Soft or high pitched sounds while inhaling. Safety Considerations for Neonates: Choking •Choking hazards for children include food, toys and household items Prevention: •Parents should always supervise feeding times •Offer foods that are easy to chew and swallow, cut into small pieces and cook till soft •Meal times at a table to prevent running and walking while eating •Offer small amount of food at a time •Encourage children to chew their food thoroughly and to swallow it before talking or laughing •Assess living environment regularly throughout the day for small items or materials the infant might try to place in their mouth

Snellen chart

The familiar eye chart used to measure visual acuity and how well you see at various distances. Snellen's chart is imprinted with block letters that line-by-line decrease in size, corresponding to the distance at which that line of letters is normally visible. The letters on Snellen's chart are, not surprisingly, called Snellen's test type. Each block letter is quite scientific in design (so that at the appropriate distance the letter subtends a visual angle of 5 degrees and each component part subtends an angle of 1 minute).

Ergonomics

The goal of ergonomics (i.e. the scientific study of people at work) is to prevent soft tissue injuries and musculoskeletal disorders (MSDs) caused by sudden or sustained exposure to force, vibration, repetitive motion, and awkward posture. To create an ergonomically sound work environment, National Institute of Occupational Safety and Health (NIOSH) ergonomists and industrial hygienists recommend designing tasks, work spaces, controls, displays, tools, lighting, and equipment to fit employee's physical capabilities and limitations.

Warfarin counteracts with Herbal medications

Warfarin is used to prevent blood clots from forming or growing larger in your blood and blood vessels. It is prescribed for people with certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves, and people who have suffered a heart attack. Warfarin is also used to treat or prevent venous thrombosis (swelling and blood clot in a vein) and pulmonary embolism (a blood clot in the lung). Warfarin is in a class of medications called anticoagulants ('blood thinners'). It works by decreasing the clotting ability of the blood. tell your doctor and pharmacist what herbal or botanical products you are taking, especially coenzyme Q10 (Ubidecarenone), Echinacea, garlic, Ginkgo biloba, ginseng, goldenseal, and St. John's wort. There are many other herbal or botanical products which might affect your body's response to warfarin. Do not start or stop taking any herbal products without talking to your doctor. Side effects gas abdominal pain bloating change in the way things taste loss of hair feeling cold or having chills

Sexual Development

Three Stages of Puberty Prepubescence •Secondary sex characteristics begin to develop. •Reproductive organs do not function yet. Pubescence •Secondary sex characteristics continue to develop. •Ova and sperm begin to be produced. Postpubescence Reproductive functioning and development of secondary sex characteristics reach adult maturity Downy pubic hair first appears in the pubescence stage of adolescent sexual development. False Rationale: Downy pubic hair first appears in the prepubescence stage of adolescent sexual development. Physiologic Development of the Adolescent •Feet, hands, and long bones grow rapidly; there is an increase in muscle mass. •Primary and secondary development occurs (puberty). •Puberty begins at 9 to 13 years in girls, 10 to 14 years in boys. •Sebaceous and auxiliary sweat glands become active. •Full adult size is usually reached. Psychosocial Development of Adolescent/Young Adult •Freud: genital stage, capable of full sexual function

Sky Burial

Tibet In most forms of Buddhism, bodies are meant to be cremated or given over to animals in an act of charity. Since there is little wood for burning bodies in Tibet, a practice of allowing vultures to pick the bodies clean evolved. Once picked clean, the bones are ground up and fed to crows.

Transcultural Nursing

Transcultural nursing is culturally specific & competent care provided to clients from a culture that is different from that of the nurse - Culturally based knowledge used in creative, congruent, and meaningful ways to provide beneficial and satisfying health care to diverse cultures. - Part of a nurse's role is to learn about traits that are common among people as well as those that are different - Nursing interventions must fit cultural values, beliefs and practices to be effective and acceptable to the client, family, and community. Transcultural Nursing Interventions - Developing self-awareness: Recognize own heritage and values and the importance of them to yourself. - Demonstrating knowledge and understanding of a patient's culture - Accepting and respecting cultural differences - Sensitivity to different meanings of behavior - Understanding how culture impacts a person's sense of time management and communication preferences. - Not assuming that the health care provider's beliefs and values are the same as the client's - Resisting judgmental attitudes such as "different is not as good" - Being open to and comfortable with cultural encounters - Accepting responsibility for one's own cultural competency Transcultural Nursing Interventions - Listen attentively to complaints and encourage conversation. - Important not to be condescending. - Listen to the patient's understanding of problems. Explain your perception of problems - Acknowledge and discuss similarities and differences - Use teaching material consistent with the client's vocabulary. - Use interpreter when needed - do not use family members as interpreters --this breaks confidentiality - Attend to dietary and spiritual needs. - Focus on the capabilities, rather than the losses, within the client's sociocultural environment. - Know about the interrelationships of all client's personal dimensions when making health care decisions

Triage

Triage is sorting casualties for the purpose of assigning priority for care. Disaster Triage - Red: Immediate stabilization is required. - This applies to victims who have: - Shock due to any cause - Breathing difficulty with possible respiratory failure - Profuse external bleeding Head trauma with signs of altered consciousness, such as: - disorientation (cannot obey simple commands) - unconsciousness (cannot respond to verbal and/or painful stimuli) - asymmetrical pupils (sign of cerebral hernia) - Stabilize these patients so they can receive further care. After stabilization, reclassify. Disaster Triage Yellow - Yellow: Delayed treat men t may be appropriate. Monitor closely, insert a line if uncertain about circulatory status, but defer care initially. This category includes victims who, despite not fulfilling the criteria for inclusion in the red group, have - Shock risk (e.g., heart attack, abdominal trauma) - Open fractures - Femur or pelvis fracture - Severe burns - Head trauma but responsive to verbal or painful stimuli - Uncertain diagnoses Disaster Triage Green - Green: These victims can wait or do not require treatment. This category includes those who are ambulatory and have: - Minor fractures - Minor wounds or burns - After on-site care has been completed, transport victims who have been classified as yellow or red to a hospital. They should be re-triaged on arrival. - Black: Deceased. Disaster Triage - Red: These victims have the highest priority for transport, preferably with a specialized crew to a tertiary hospital because they require surgery for survival or organ-function preservation or need ICU services. - Yellow: These victims have the second highest priority for transport, which includes victims who are currently stable but may decompensate or require urgent but not emergent surgery. - Green: These victims may be discharged on-site, if possible, after being checked and reassured. Those with minor injuries should be treated or sent to a primary care facility if available. - Black: Transportation to the morgue. Disaster Triage - Clearly establish the treatment areas in the hospital and provide the necessary staffing. Treatment area designation should reflect triage levels, e.g., red treatment area for victims triaged in the red category. - An emergency medicine physician or an anesthesiologist will be in charge of the red treatment area and should be prepared to treat patients with extremely severe injuries. An additional triage can determine the order of these red patients that need operative interventions. - Victims triaged as yellow should be re-evaluated by a physician and provided care or observation as needed. If their condition worsens, transfer them to the red treatment area. - Victims with no hope for survival require only supportive care. These patients should be kept in a separate ward. - Have an area ready for deceased victims if the hospital morgue is overwhelmed.

the five dynamic components of the therapeutic relationship inclu

Trust: Assured belief that others are capable of assisting in timesof distress and will probably do so.•Empathy: Ability to walk a mile in another person's shoes.•Autonomy: Ability to direct and control one's activities and destiny.•Caring : Energy that allows caregivers to unconditionally accept all people, even when they are most unlovable.•Hope: Expectation of achieving a future goo

Upper Respiratory Infection

Upper Respiratory Infection Signs and Symptoms of URI: - Cough - Nasal Discharge - Erythematous Pharynx - Conjunctivitis - Laryngitis - Low-grade Temp - General Malaise - Rhinitis - Sore Throat - Watery eyes Upper Respiratory Infection Management of URI: - Fluid intake - Frequent rest periods - Medications to control signs/symptoms - Antipyretics/analgesics (acetaminophen, ibuprofen, naproxen, ASA) - Decongestants (pseudophedrine, phenylephrine and/or antihistamine (diphenhydramine) - Cough expectorants: guaifenesin - Cough suppressants (antitussives): dextromethorphan - Hand washing - Breathe through nose; nose & upper airway removes particulate matter from inspired air ® acts as a filter - Avoid crowded places if URI present - Cover nose & mouth when coughing/sneezing Allergic Rhinitis ◦Inflammation of nasal mucosa ◦Cause: seasonal (pollen) or perennial (environmental) allergen ◦Frequency of symptoms ◦Episodic—sporadic exposure ◦Intermittent—less than 4 days/week or less than 4 weeks/year ◦Persistent—greater than 4 weeks/year ◦Exposure leads to IgE and inflammation Manifestations: ◦ Sneezing; watery, itchy eyes and nose; congestion, decreased smell, thin watery nasal drainage ◦Pale, boggy, swollen turbinates ◦Chronic exposure: headache, nasal congestion and sinus pressure, hoarseness; cough due to nasal polyps and post nasal drip Management: ◦Identify and avoid triggers ◦Reduce inflammation and symptoms ◦Corticosteroids; nasal and/or oral ◦Antihistamines; decongestants, LTRAs ◦Immunotherapy: allergy shots ◦Patient education: medications Acute Viral Rhinopharyngitis ◦"Common cold" ◦Transmission: Airborne droplets that transmit the virus. Virus can survive on inanimate objects up to 3 days leading to contact transmission. ◦Contagious: airborne droplets or contact ◦Organism: greater than 200 viruses; (coronavirus, adeno virus, picorna virus, and its sub-groups such as rhinovirus, coxsackie) ◦The incubation period: Usually between 1-4 days and illness lasts for 2-3 weeks. ◦Frequent in winter months—close contact ◦Also influenced by: fatigue, stress, allergies, and altered immune status ◦Duration: Usual recovery 7 to 10 days ◦Clinical features: begin with burning sensation at the back of nose soon followed by nasal stuffiness, rhinorrhea and sneezing. ◦General symptoms: chills, low grade fever, headache ◦Nasal discharge is watery and profuse but may become mucopurulent due to secondary bacterial infection. Symptoms can be more serious in patients who smoke, have gastric reflux, or anatomic abnormalities like deviated nasal septum, and chronic conditions like Obstructive Pulmonary Disease (COPD) and Cystic Fibrosis ◦Management ◦Symptom relief: rest, fluids, proper diet, antipyretics, analgesia, saline spray, gargle, lozenges, antihistamines, decongestant (no more than 3 days to prevent rebound), cough suppressants ◦Antibiotics are not indicated unless complications (bacterial infection develops) ◦Vitamin C, Echinacea, Zinc (Complementary and Alternative Therapies) ◦Monitor/teach to report secondary infection or worsening symptoms ◦Chronic disease—report: sputum changes, short of breath, chest tightness ◦Teach to avoid crowds/sick people and use good hand hygiene Influenza ◦Highly contagious; increased morbidity and mortality ◦Peak season: December to February ◦Classified by serotypes (A, B, C, D)-A subtypes: H and N antigens (e.g., H1 N1) ◦Influenza A—most common and virulent: Mutated viruses —no immunity, Pandemics (worldwide spread), Epidemics (localized outbreaks) ◦Transmission: infected droplets = 1 day before onset symptoms—5 to 7 days Influenza At Risk Populations: - Children under the age of two; especially those under the age of 6 months since they aren't eligible to receive the vaccine and haven't likely been exposed to it before. - Adults over the age of 65 since immune system gradually weakens with age; also more vulnerable to complications and prolonged recovery time. - People living in institutional settings like group homes, assisted living facilities, nursing homes, dormitories, prisons, orphanages, etc. - People with chronic diseases; especially, heart disease, chronic lung disease, diabetes, obesity, and autoimmune disorders. - Pregnant women are more at risk for a severe case of the flu and suffering complications to the unborn baby. - People with weakened or compromised immunes systems like those with cancer or HIV. - Healthcare and emergency response personnel Manifestations ◦Abrupt onset—~ 7 days: chills, fever, myalgia, headache, cough, sore throat, fatigue ◦Complications: pneumonia, ear or sinus infections; Older adults—weak and lethargic ◦Diagnostic Studies ◦H and P, prevalence in community ◦Viral cultures ◦Rapid influenza diagnostic tests (RIDTs) Management ◦Prevention: Influenza Vaccine (flu shot) - Inactivated or live attenuated Need annual vaccine - Takes 2 weeks for antibody production - Advocate vaccine for those greater than 6 months and high risk (e.g., HCW and long term care residents) - CDC recommends a yearly vaccine as the most important step in protecting against seasonal influenza. Everyone 6 months of age and older should get an influenza vaccine every season with rare exception. - While there are many different flu viruses, the seasonal flu vaccine protects against three or four specific strains (research suggests that these will be most common). - Vaccination is important for caregivers & people at high risk of serious flu complications. ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Types: ◦Trivalent (3-strain) influenza vaccines include: ◦A trivalent influenza shot made with adjuvant (Fluad), licensed for people 65 years and older. A high-dose influenza vaccine (FluzoneHigh-Dose), licensed for people 65 years and older Influenza Management Management ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Types: ◦Quadrivalent (4-strain) flu vaccines include: ◦Standard-dose quadrivalent influenza shots that are manufactured using virus grown in eggs. These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, and Fluzone Quadrivalent. Different influenza shots are licensed for different age groups. Some are licensed for children as young as 6 months of age. Most influenza shots are given in an arm muscle with a needle. One quadrivalent influenza shot (Afluria Quadrivalent) can be given either with a needle (for people aged 6 months and older) or with a jet injector (for people aged 18 through 64 years only). ◦A quadrivalent cell-based influenza shot (Flucelvax Quadrivalent) containing virus grown in cell culture, which is licensed for people 4 years and older. This season, all four of the vaccine viruses used in Flucelvax have been grown in cells, making the vaccine totally egg-free. ◦Recombinant quadrivalent influenza shot (Flublok Quadrivalent), an egg-free vaccine, approved for people 18 years and older. ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Considerations: - People who have an allergy to eggs or any of the ingredients in the vaccine should talk to their healthcare provider before getting a flu shot. - People with egg allergies can receive a special vaccine. - People with a history of Guillain-Barré Syndrome need to consult their primary care provider before getting a flu shot. - People who are currently ill or have a fever need to wait till they are well before they get their flu shot. - Alternative delivery options are available upon request if patients meet criteria: nasal spray flue vaccine and intradermal flu vaccine. Management: oSymptom relief and prevent secondary infection: rest, fluid, antipyretic, analgesia oAntivirals: shorten duration of symptoms and reduce risk of complications ◦Zanamavir (Relenza) - drug of choice ◦Oseltamivir (Tamiflu) ◦Must be started within 48 hours of initial flu symptoms and used for 7 days Acute Pharyngitis Inflammation of pharyngeal walls; tonsils, palate, uvula ◦Causes: Viral (90%), bacterial (strep throat), fungal (candidiasis) ◦Other: dry air, smoking, GERD, allergy, postnasal drip, ETT, chemicals, cancer Manifestations: - sore throat - red, swollen pharynx - anterior cervical lymphadenopathy (lymph node enlargement) - Absent cough - neck, head & muscle pain - tonsils inflamed & covered with exudate - Rash may be present - Fever greater than 38° C - Fungal: white patches Diagnosis: - Rapid antigen test - Throat culture: used to confirm diagnosis-used when rapid antigen test is negative. Outsomes: infection control, symptom relief, prevent complications ◦Viral—no antibiotics ◦Bacterial—antibiotics ◦Oral penicillin (PCN)- prompt response within 24 hours; non-infectious to others 24 hours after antibiotic is initiated ◦Take full course of antibiotics to avoid serious repercussions: rheumatic fever and post-streptococcal glomerulonephritis ◦Candida—antifungal (swish and swallow) ◦Implementation: Analgesia, warm salt water gargle, avoid irritating liquids such as carbonated beverages, lozenges, humidifier, soft food diet, drink warm liquids, rest, cool or warm compresses to the neck, sucking on ice chips. Potential Nursing Diagnosis for Patient's with Upper Respiratory Disorders: ◦Risk for aspiration r/t inability to coordinate breathing, coughing, swallowing ◦Impaired oral mucous membrane integrity r/t inflammation or infection of oral cavity ◦Impaired swallowing r/t irritation of oropharyngeal cavity ◦Imbalanced nutrition: less than body requirements r/t loss of appetite ◦Anxiety r/t breathlessness, change in health status ◦Fear r/t oxygen deprivation, difficulty breathing, threat to state of wellbeing ◦Impaired comfort r/t sore throat ◦Ineffective health maintenance r/t ◦Knowledge deficit regarding transmission, symptoms, and treatment ◦Lack of knowledge regarding preventative immunizations ◦Ineffective Protection r/t inadequate nutrition, abnormal blood profiles, drug therapies, treatments ◦Fatigue r/t increased energy requirements and metabolic demands ◦Insomnia r/t difficulty breathing, positioning required for effective breathing ◦Activity intolerance r/t imbalance between oxygen supply and demand ◦Deficient knowledge r/t treatment, relief of symptoms ◦Readiness for enhanced knowledge: expresses desire for information regarding prevention and treatment. Respiratory Function Across the Lifespan Toddler Abnormal Respiratory Presentation: Upper Respiratory Infections - Nasopharyngitis - Pharyngitis - Tonsillitis - Haemophilus influenza Upper Respiratory Disorders - Problems of the upper respiratory tract include disorders of the nose, pharynx, adenoids, tonsils, epiglottis, larynx, and trachea. - Primarily viral infections - Responsible for 30-50% of time lost from work for adults & 60-80% time lost from school for children This course will only cover a few: - Upper Respiratory Infection - Allergic Rhinitis - Acute Streptococcal Pharyngitis - Viral Rhinopharyngitis - Influenza

Modifications of Home for vision and hearing loss

Vision loss Home Modifications: - Use contrast to increase visibility of items - Ex. Place a dark background around the light switch so that it can be located more easily - Place red, yellow, or orange identifiers on important items that need to be seen - Ex. A red strip at the edge of steps, a red dot on a stove or washing machine to indicate how far to turn the knob - Use a watch or clock that verbally tells time and a phone with large numerals and emergency numbers programmed into it - Speaking Freeview digital boxes to give an auditory version of what is on the television - Use of memory photo dial pad so that clients can use the telephone to maintain contact with others - Use motion lights that turn on automatically when a person enters the room for nighttime use - Apply indoor strip or "runway" lighting to baseboards - Increase lighting in the home to help vision in the following ways: - Ensure adequate illumination of the entire home - Decrease glare where light reflects on shiny surfaces Hearing Loss - Home modifications - Avoid glossy walls - Avoid high and reflective ceilings - Avoid reflective glass counters - Avoid tile floor - Use acoustic paneling if needed - Installation of devices such as: - Strobe lights for the telephone, alarm clock, fire alarms, and doorbell - Sensors that detect an infant's cry - Alarm clocks that vibrate the bed - Closed caption decoders for television sets - Telephone amplifiers, speakerphones, cell phones with text messaging - Pocket talker personal listening systems - Typewriter keyboard with an alphanumeric display that allows the hearing impaired person to send typed messages over the telephone line - FM and infrared amplification systems that connect directly to a television or audio output jack.

Manifestations of Vision Impairment

Visual Impairment - Vision that cannot be fully corrected - Low vision—some good usable vision - Severe vision impairment—unable to read newsprint; may/may not be legally blind - Legal blindness—central visual acuity of 20/200 or less in better eye with correction or peripheral field vision of 20 degrees or less - Most blindness in United States results from: cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy Manifestations of Vision Impairment - Signs and Symptoms of Vision problems: - Difficulty following an object with eyes - Blinking or rubbing eyes a lot - Crossed eyes or one eye pointing the wrong way - Watery, red eyes, or pain when exposed to light - Holding things close to eyes when looking at them - Problems with reading, watching TV, and body movement and sports requiring hand eye coordination. - Short attention span - Cranky demeanor, easily agitated - Complaints of headache,

Unitarian Universal Association of Churches

What Is Unitarian Universalism? Unitarian Universalism is a liberal religion that encompasses many faith traditions. Unlike most religions, it is not centered on specific theological beliefs. Unitarian Universalists are free to search for truth on many paths. The Seven Principles Although our individual religious beliefs vary, Unitarian Universalists uphold a set of shared principles. We affirm and promote: - The inherent worth and dignity of every person. - Justice, equity, and compassion in human relations. - Acceptance of one another and encouragement to spiritual growth in our congregations. - A free and responsible search for truth and meaning. - The right of conscience and the use of the democratic process within our congregations and in society at large. - The goal of world community with peace, liberty, and justice for all. - Respect for the interdependent web of all existence of which we are a part.

Why is it important for nurses' to learn about complementary and alternative therapies?Have you used any alternative or complementary modalities? What were the results?

Why is it important for nurses' to learn about complementary and alternative therapies? In the United States, slightly more than 30% of adults report use of complementary therapies (NCCIH, 2016). Interest in the use of complementary therapies is a phenomenon found not only in the United States, but also in many other countries. The growing interest in and use of complementary therapies has prompted groups to explore why people elect to use a complementary or integrative health practice. Complementary and integrative health therapies often target the whole person rather than a specific symptom or disease; often the person who is treated reports a greater sense of harmony or balance.Culture-related aspects of complementary therapies: Nurses may not know exact details of healing traditions in other cultures, it is helpful for them to gain some knowledge about the specific heritage of a patient. With today's technology, key points about the health practices of the culture can be obtained from web sources. When nurses are familiar with the patient's worldview, they can ask patients and family members about specific needs and preferences that are natural parts of the individual's or the family's healing traditions.

Cremation

Worldwide Cremation is popular in religions such as Buddhism and Hinduism, and has historically been practiced all around the world. The Christian reverence for the physical body led to cremation being outlawed in many Western countries, but those laws have since been discarded.

Cremation

WorldwideCremation is popular in religions such as Buddhism and Hinduism, and has historically been practiced all around the world. The Christian reverence for the physical body led to cremation being outlawed in many Western countries, but those laws have since been discarded.

cochlear implants

a device for converting sounds into electrical signals and stimulating the auditory nerve through electrodes threaded into the cochlea •Cochlear implants send information that covers the entire range of sound frequencies. •The cochlear implant is used as a hearing device for people with severe to profound sensorineural hearing loss in one or both ears.•The ideal candidate is one who has become deaf after acquiring speech and language.•For patients with conductive and mixed hearing loss, the cochlear Baha system may be surgically implanted. The system works through direct bone conduction and integrates with the skull bone over time.•Extensive training and rehabilitation are essential to receive maximum benefit from these implants.•The positive aspects of a cochlear implant include providing sound to the person who heard none, improving lip-reading ability, monitoring the loudness of the person's own speech, improving the sense of security, and decreasing feelings of isolation. With continued research, the cochlear implant may offer the possibility of aural rehabilitation for a wider range of hearing-impaired individuals.

caffeine

a stimulant drug and chemical agent found in coffee, tea, cola drinks, chocolate, and many over-the-counter medications Caffeine •Effects: Weak CNS stimulant, Diuretic, Myocardial stimulant •Clinical symptoms and dependence develop with consumption greater than 350mg. •Over the counter analgesics, stimulants, appetite suppressants, and cold and flu preparations may contain caffeine as well •Withdrawal from caffeine causes mild to clinically significant distress and impairment of normal functioning. The severity of symptoms vary from individual to individual, and most commonly include a headache, fatigue, decreased energy/activeness, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, and feeling foggy/not clearheaded. The severity of symptoms varies from mild to extreme. •Re-administration of caffeine typically reverses withdrawal symptoms rapidly. Over the counter medications can be used to manage symptoms. •In the case of caffeine overdose, seizures may occur, as caffeine is a central nervous system stimulant. Agitation, anxiety, restlessness, insomnia, tachycardia, tremors, tachycardia, psychomotor agitation, and, in some cases, death can occur, depending on the amount of caffeine consumed.

MANIPULATIVE AND BODY-BASED THERAPY

acupressure, acupuncture, massage therapy

if the person has necessary recourses

adaption takes place and balanced is maintained

Allopathic/Western Medicine:

also called conventional or mainstream medicine; a method of treating disease with remedies that produce effects different from those caused by the disease itself.

Advance directives

are written statements of a person's wishes about medical care, including the desire to withhold or withdraw treatments.

other communications

communicating with elderly: Assess for hearing deficits,Assess for visual deficits,Give time for elders to formulate responses,Wait for an answer to one question before asking another,Obtain feedback Communicating with Children Approach at eye level. Use a calm, friendly voice. Keep parent in the room when possible. Use short sentences. Give simple explanations and demonstrations. Allow child to handle equipment Communicating with People from Other Cultures -Determine the language spoken, Obtain an interpreter if necessary, Enlist the aid of a family member if appropriate. Give printed materials if available and answer questionsBeware of cultural differences in:Eye contact Personal space Communicating with Health Care Team Members: •Nurses' notes•Physician's orders and progress notes•Dietitian's notes•OT, PT, and speech therapy notes•Shift report•Radiology and laboratory findings computer communication: •essential•Transmit requests for laboratory, dietary, radiology, physical therapy, respiratory therapy, and other services•Medication orders•Supplies for patient care•Update patient care plans•Computerized form of charting communication in the home and community: •essential•Transmit requests for laboratory, dietary, radiology, physical therapy, respiratory therapy, and other services•Medication orders•Supplies for patient care•Update patient care plans•Computerized form of charting

Palliative care includes

curative care, hospice, end of life, and bereavement following death.

Algor Mortis

due to lack of circulation the skin looses natural elasticity as the body cools; the person may lose excess fluid through skin.

Lifespan

espiratory Function Across the Lifespan Infant Normal Presentation: •Lungs are transformed from fluid-filled structures to air-filled organs. •The infant's chest is small, airways are short, and aspiration is a potential problem. •Respiratory rate is rapid and respiratory activity is primarily abdominal. •Crackles heard at the end of deep respiration are normal. Abnormal Respiratory Presentation: •Apnea of prematuriy: treat with stimulation, CPAP, caffeine •Respiratory Distress Syndrome: condition of surfactant deficiency and physiologic immaturity of the thorax; treat with exogenous surfactant at birth to reopen the alveoli (Survanta®, etc.) •Patent Ductus Arteriosus: in response to lowered oxygen tension associated with preterm respiratory impairment, the ductus reopens and causes increased work of breathing and recurrent apnea; treat with indomethacin and surgery. Respiratory Function Across the Lifespan Toddler Abnormal Respiratory Presentation: Upper Respiratory Infections •Nasopharyngitis •Pharyngitis •Tonsillitis •Haemophilus influenza Airway obstruction •Asthma •Choking episodes •Accidental Suffocation •Accidental Aspiration •Accidental Poisoning Respiratory Function Across the Lifespan Child Normal Presentation: •Some subcutaneous fat is deposited on the chest wall, making landmarks less prominent. •Eustachian tubes, bronchi, and bronchioles are elongated and less angular. •The average number of routine colds and infections decreases until children enter daycare or school. •Good hand hygiene and tissue etiquette are encouraged. •By the end of late childhood, the immune system protects from most infections. Respiratory Function Across the LifespanChild & Adolescents Respiratory Risk Factors: • Exposure to second hand smoke •Smoking at an early age Using dangerous inhalants: "Huffing" •Spray paint •Paint thinner •Aerosol fumes Respiratory Function Across the Lifespan Older Adult Normal Age-Related Presentation: Chest Wall • ↓Elastic Recoil • ↓ Compliance • up Anteroposterior Diameter •↓ Cough Force Alveoli •↓ Surfactant •↓ Diffusion of gases •↓Response to Hypoxemia and Hypercapnia • ↓ Immunity & Specific Antibodies • ↓ Cilia Function • ↓Alveolar Macrophage Function Respiratory Function Across the Lifespan Older Adult •Bony landmarks are more prominent due to loss of subcutaneous fat. •Kyphosis contributes to appearance of leaning forward. •Barrel chest deformity may result in increased anteroposterior diameter. •Older adults have an increased risk for disease, especially pneumonia. •Reduced immune system

interpersonal communication

essentially talking to a trusted source to help one process stressors and coping strategies

morbidity and mortality

morbidity (illness- how frequently a disease occurs / how common is it) and mortality (numbers of death) •In patients with chronic illnesses, insomnia and sleep disordered breathing are associated with increased morbidity and mortality. Health Disparities •Differences in the incidence, prevalence, mortality rate, and burden of diseases -increased mortality of obesity -insomnia and sleep disorder breathing are associated w increased morbidity and mortality -women with OSA have higher mortality •Complications that can result from untreated sleep apnea include hypertension, cardiac dysrhythmias, arteriosclerosis, heart failure, and cardiovascular-related mortality. •African-Americans have the highest incidence of hypertension and a higher mortality rate r/t Influenza ◦Highly contagious; increased morbidity and mortality Hyperglycemia HyperosmolarNonketotic Syndrome (HHNS) Signs and Symptoms◦Hypotension◦Profound dehydration◦Tachycardia◦Variable neurological signs◦Mortality rate 10-40%Treatment◦Fluid replacement◦Correct electrolytes

mortality

numbers of death

Cheyne-Stokes respiration

pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea

Respecting cultural differences

personal space, some cultures avert direct eye contact, yes may not mean yes, older adults may not want younger help, religious beliefs

nonverbal messages

posture,gestures,tone,smiling or frowning,facial expression,eye contact

journaling

provides an opportunity for individuals to reflect on and analyze their lives and events and people surrounding them to get in touch with their feelings. practice of writing out one's thoughts and feelings as an exercise to identify and evaluate one's own sources of stress and coping strategies

types of communication processes

spoken or written. nonverbal = no words by gestures, body posture, intonation, general appearance

Systematic desensitization:

the clients learn to cope with one anxiety provoking stimulus at a time. This step by step method gradually removes the anxiety from the distress causing event and allows client to develop more effective ways of perceiving their anxiety.

aging

the combination of biological, psychological, and social processes that affect people as they grow older

therapeutic communication

used by nurses/people in helping professions referred to as "active" or "purposeful" communication. requires "active listening"/"listening between the lines"

Zovirax - Acyclovir

used to treat infections caused by certain types of viruses. It treats cold sores around the mouth (caused by herpes simplex), shingles (caused by herpes zoster), and chickenpox.This medication is also used to treat outbreaks of genital herpes. In people with frequent outbreaks, acyclovir is used to help reduce the number of future episodes. Nausea, diarrhea, headache, or vomiting may occur Some products that may interact with this drug include: other drugs that may cause kidney problems (including nonsteroidal anti-inflammatory drugs-NSAIDs such as ibuprofen, naproxen). Acyclovir is very similar to valacyclovir. Do not use medications containing valacyclovir while using acyclovir.

Vision

visual system The visual system is part of the central nervous system. It consists of 2 main parts, the eyes, which contain the image receptors, and the brain, which functions to process and interpret the information transmitted from the receptors into images. Structures that play an important role in protecting the eye include the eyebrows, eyelids, eyelashes, and lacrimal system. Eyebrows, eyelids, and eyelashes provide a physical barrier to dust and foreign particles. The lacrimal system includes the structures necessary for tear production and drainage. The eyeball, or globe, is composed of 3 layers. The tough outer layer is composed of the cornea, conjunctiva, and sclera. The middle layer consists of the uveal tract (iris, choroid, and ciliary body), and the innermost layer, the retina. The anterior cavity is divided into the anterior and posterior chambers The iris provides the color of the eye. It has a small round opening in the center, the pupil, which allows light to enter the eye. The pupil constricts by action of the iris sphincter muscle and dilates by action of the iris dilator muscle to control the amount of light that enters the eye. The ciliary body contains the ciliary muscle and ciliary processes and is located behind the iris. The ciliary muscle is responsible for focus of the eye by changing the shape of the lens to refract light onto the retina. Aqueous humor fills the anterior segment of the eye and nourishes the nonvascular structures of the anterior chamber, such as the lens and endothelium of the cornea. The primary function of the lens is to change shape to change the focal distance of the eye. It works together with the cornea to refract, or bend light. The retina has specialized nerve cells that are responsible for color vision and translating visual images into stimuli that the brain can interpret Pathway of vision Light -> Cornea -> Pupil/Iris -> Lens -> Retina -> Rods/Cones -> Bipolar Cells -> Ganglion Cells -> Optic Nerve -> Optic Chiasm -> Occipital Lobe Structures of the Visual System lacrimal caruncle, lacrimal canals, lacrimal space, punch, nasolacrimal duct, lacrimal gland, lacrimal duct Structures and Functions of Visual System cornea iris and lens and retina and all parts of eyes helping w vision Visual Problems - Refraction—eye's ability to bend light rays so they fall on retina; create sharp image - Refractive errors—blurred vision - Myopia—nearsighted - Hyperopia—farsighted - Presbyopia—loss of accommodation - Astigmatism—visual distortion - Aphakia—absence of lens - Strabismus—double vision - Can't focus both eyes simultaneously - One eye deviates in (estropia), out (exotropia), up (hypertropia), or down (hypotropia) Visual Problems - Nonsurgical corrections: - Corrective glasses - Myopia, hyperopia, presbyopia (readers), astigmatism - Combined presbyopia and other refractive errors—bifocals or trifocals - Contacts lenses - Know pattern of wear; daily versus extended - Monitor for complications—keratitis - Patient education—proper care and reporting Visual Problems - Surgical therapy - Laser - Laser-assisted in situ keratomileusis (LASIK) - Photorefractive keratectomy (PRK) - Laser-assisted subepithelial keratomileusis (LASEK) - Implant - Refractive intraocular lens (refractive IOL) - Phakic intraocular lens (phakic IOL) Visual Impairment - Vision that cannot be fully corrected - Low vision—some good usable vision - Severe vision impairment—unable to read newsprint; may/may not be legally blind - Legal blindness—central visual acuity of 20/200 or less in better eye with correction or peripheral field vision of 20 degrees or less - Most blindness in United States results from: cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy Gerontologic Considerations: Visual Impairment - Increased risk for vision loss - Alters ability to function; may have other deficits - Societal devaluation—impacts self-esteem; isolation - Inadequate finances - Increased fall risk - Concerns with independence; self-image - Dexterity: administration of eye drops or other medications Vision Loss Related Factors: - Aging - Diabetes mellitus - Exposure to ultraviolet (UV) light - Imparied visual function - Impaired visual integration - Impaired visual reception - Imparied visual transmission - Nutritional deficiency Defining Characteristics: - Change in behavior pattern - Change in problem-solving abilities - Disorientation - Decreased visual acuity - Loss of vision - Visual hallucinations Visual loss Outcomes: - Demonstrate relaxed body movements and facial expressions - Remain as independent as possible - Explain plan to modify lifestyle to accommodate visual impairment - Incorporate use of lighting to maximize visual abilities - Demonstrate familiarity with vision assistive devices - Remain free of physical harm resulting from loss of vision Visual Loss Nursing Interventions: - Create trust by building partnership and shared decision making. - Knock before entering and address the client by name - Always introduce yourself, role, and intent. - Narrate your actions and explain location of call light, bed controls, etc. - Explain the reason for touching the patient before doing so. - Keep room free of clutter to prevent falls - Orient the patient to the room arrangement and furnishings. - Orient the patient to sounds in the environment. - handing an item, place it directly into the client's hand or place the client's hand on top of the item. - Provide environmental predictability and tell the client when something is added or removed from the environment - Ensure easy access to eyeglasses and magnifying devices. - Keep the environment quiet, soothing, and familiar. - Use consistent caregivers - Provide diversion using other senses. - Indicate conversation has ended when leaving room. - Assist with ambulation by walking slightly ahead of the patient. - Stay in the patient's field of vision if he or she has partial vision. Vision Loss Patient Education: - Teach blind clients how to feed themselves; associate food on the plate with hours on a clock so that the client can identify the location of food. - Use a magnifying mirror to shave or apply makeup - Put personal care products in brightly colored pump containers for identification. - Use tactile clues such as safety pins or buttons placed in hems to help clients match clothing, or place matching outfits of clothing in separate plastic bags - Use a prefilled medication organizer with large lettering or three dimensionalmarkers - Reminders to wear hat and sunscreen when out in public - Safe sources of transportation - Read education and discharge information to the client - Teach the client methods to preserve remaining vision as much as possible, including avoid smoking or breathing second hand smoke, protecting eyes from sunlight, including fish and leafy green vegetables in the diet - Driving contraindications must be heeded for safety if vision loss is progressing. Vision loss Home Modifications: - Use contrast to increase visibility of items - Ex. Place a dark background around the light switch so that it can be located more easily - Place red, yellow, or orange identifiers on important items that need to be seen - Ex. A red strip at the edge of steps, a red dot on a stove or washing machine to indicate how far to turn the knob - Use a watch or clock that verbally tells time and a phone with large numerals and emergency numbers programmed into it - Speaking Freeview digital boxes to give an auditory version of what is on the television - Use of memory photo dial pad so that clients can use the telephone to maintain contact with others - Use motion lights that turn on automatically when a person enters the room for nighttime use - Apply indoor strip or "runway" lighting to baseboards - Increase lighting in the home to help vision in the following ways: - Ensure adequate illumination of the entire home - Decrease glare where light reflects on shiny surfaces Diabetic Retinopathy -Eye problems related to diabetes are also called "diabetic retinopathy." This condition can lead to vision loss and eventually blindness if it not treated. -Most common cause of new cases of blindness in persons ages 20-74. -Results from chronic hyperglycemia Diabetic Retinopathy The initial eye exam can be performed by a doctor who specializes in the eyes (called an ophthalmologist or optometrist) or by a trained retinal photographer who takes photographs of the retina (the back of your eye). The eye doctor uses medicated eye drops to dilate your pupils so the retina can be completely examined. Pupil dilation is not required for the retinal photographs. The photographs are interpreted by an eye doctor or by a computer. If there is evidence of diabetic retinopathy on the retinal photographs, you will need to have the full dilated eye exam by the eye doctor. Non-proliferative - most common form ◦Partial occlusion of small blood vessels in the retina -develop micro-aneurysms. Vision can be affected if macula is involved. Proliferative - most severe form ◦Retinal capillaries become occluded, hemorrhage. If blood vessels pull retina can cause a tear or partial or complete detachment of retina. Diabetic Retinopathy Prevention is key ◦Control of Blood glucose Tight control of BS reduce risk by 76% compared to that of conventional therapy. ◦Control of hypertension ◦Cessation of smoking Medical Management ◦Medicated eye drops that decrease the pressure in the eye to slow/control damage to the small vessels and resulting vision loss ◦Intraocular injections ◦Laser eye surgery Causes of Accidental Injuries in Older Adults - Changes in vision and hearing

Water

water -50-60% of adult total weight -2/3 of body water is in cells (ICF) -remainder = extracellular fluid (ECF), body fluids (plasma, interstitial fluid) -provides fluid medium for chemical reactions -solvent, aids digestion, absorption, circulation, and excretion Water pollution - is the contamination of water bodies, usually as a result of human activities. Water bodies include for example lakes, rivers, oceans, aquifers, and groundwater. - Water pollution results when contaminants are introduced into the natural environment. For example, releasing inadequately treated wastewater into natural water bodies can lead to degradation of aquatic ecosystems. - This can lead to public health problems for people living downstream. They may use the same polluted river water for drinking or bathing or irrigation. Water pollution is the leading worldwide cause of death and disease, e.g. due to water-borne diseases

Post mortem care

• Algor Mortis - due to lack of circulation the skin looses natural elasticity as the body cools; the person may lose excess fluid through skin. • Postmortem Decomposition - refers to bruising and softening for the body that is related to the breakdown of red blood cells; body takes on a gray hue. • Rigor Mortis - begins within 4 hours of death, exaggerated contraction of the muscle fibers and immobilizes the joints. • After death is pronounced, the nurse prepares or delegates preparation of the body for immediate viewing by the family • Follow local law if patient died of communicable disease • Check Cultural Preferences • Close patient's eyes • Remove Tubes and Equipment • Wash and position body • Place the body in anatomic position, replace dressings, and remove tubes (unless there is an autopsy scheduled). • Replace dentures • Use Dressings or Diapers PRN • Place identification tags on the body. • Allow Family Time with Deceased -- as much time as they need with deceased person • Provide family privacy • Maintain respect for patient and family • Family members may assist with or perform the preparation of the body or the nurse may prepare the body for the family to come say goodbye and for removal to the morgue or undertaker

HOMEOPATHIC MEDICINE

•"Like cures like": the notion that a disease can be cured by a substance that produces similar symptoms in healthy people • "Law of minimum dose": the notion that the lower the dose of the medication, the greater its effectiveness; many homeopathic remedies are so diluted that no molecules of the original substance remain •Tiny doses of the substance that creates the symptoms of disease in a healthy person will cure the sick person •"like cures like," the greater the dilution of the remedy, the greater its potency, & illness is specific to the individual. •A traditional Western physician may practice homeopathic medicine •Anyone can study homeopathic medicine Teaches that symptoms are signs of the body's effort to get rid of disease Disease can be cured by giving small doses of substances that produce symptoms of the disease Stimulates a person's natural defenses, alleviating the problem Three principles: Like cures like The greater the dilution of the remedy, the greater its potency Illness is specific to the individual Homeopathic medicine: •stimulates the patient's natural defenses to alleviate the problem caused by a disease or disorder. •focuses on the belief that energy or a "vital force" exists in plants, minerals, and other natural substances. An example of how homeopathic medicines work is the similarly of symptoms between a bee sting and a rash. A bee sting swells and itches. If similar symptoms appear from perhaps hives, a rash or even another insect bite, the homeopathic medicine most appropriate to treat these symptoms is actually made from a tiny amount of a bee. Instead of masking symptoms, the medicine sends the body a signal to help it rebalance and heal. An example of this principle is coffee. Coffee can aggravate some people who are sensitive to its stimulating effects. These people may experience increased mental and physical alertness, along with an exaggerated response to stimuli. People who present at a homeopathic clinic with symptoms of insomnia, headache, irritability and an overstimulated nervous system may be prescribed a dose ofCoffeacruda,which has been prepared according to homeopathic principles. Practitioners believe that this will settle the symptoms of insomnia in these people.

hypertension

•83% of people > age 20 with hypertension are aware they have high BP •76% are being treated •48% of those aware do not currently have their BP well controlled •The National Health and Nutrition Examination Survey (NHANES) tracks prevention, treatment, and control of hypertension. •Data from NHANES showed that 83% of people 20 years of age and older with hypertension were aware that they had high BP. •Of these people, 76% were being treated.•Of those aware of their hypertension, 48% did not currently have their BP well controlled. •The American College of Cardiology Foundation and the American Heart Association (AHA) provide performance measures for hypertension management that address not only treatment, but also control of BP to target goals.•Target goals have been updated with new information from the evidence-based Guideline for the Management of High Blood Pressure in Adults report from the Eighth Joint National Committee (JNC 8). Target goals take into consideration both age and comorbidities when recommending treatment options.•National guidelines are designed to apply to all racial and ethnic groups. However, certain groups have a higher incidence of risk factors.

The General Adaptation Syndrome (General Response to Stress)

•A biochemical model describing the body's general response to stress; developed by Selye (1976). •Stages occur with either physical or psychological damage to the person. •Resisting or adapting to stress: •According to the GAS model, if a person continues to resist, he/she eventually becomes exhausted, which can affect the person's immune system •Ultimately, this can lead to death

The General Adaptation Syndrome (General Response to Stress)

•A biochemical model describing the body's general response to stress; developed by Selye (1976). •Stages occur with either physical or psychological damage to the person.•Resisting or adapting to stress: •According to the GAS model, if a person continues to resist, he/she eventually becomes exhausted, which can affect the person's immune system•Ultimately, this can lead to death

Disaster Response

•A disaster is defined as any event that overwhelms existing personnel, facilities, equipment, and capabilities of a responding agency, institution, or community.•Sources: fire, explosions, floods, storms, earthquakes, tornados, hurricanes, tsunamis, motor vehicle accidents, plane crashes, and acts of terrorism.•Victims of a disaster are called casualties when they are injured.•Triage is sorting casualties for the purpose of assigning priority for care.

Anxiety Disorder: Phobic Disorders

•A phobia is an internal fear reaction •Phobias differ from common fears because they are obsessive in nature. •People with phobias handle their anxieties ineffectively •A phobia typically produces so high a level of anxiety that it is immobilizing •Characteristics of phobias vary with the culture •Social phobia is an unrealistic and persistent fear of any situation in which other people could be judging. Fear of looking foolish.

Influencer of Culture: Refugees and Immigrants

•A refugee is a person who, because of war or persecution, flees from his or her home or country and seeks refuge elsewhere.•Obtain immigration history and a history of arrival to the new country, time, and who or what was lost.•Refugees tend to have a greater incidence of grief, post-traumatic stress, depression, and anxiety.•They face heightened threats of human trafficking, abduction, sexual violence, exploitation, and abuse.•Greatest risk physically:•Infectious diseases: tuberculosis, malaria, intestinal parasites.•Malnutrition•Poor living conditions threaten basic human needs for access to sanitation, protection from the elements, housing, water, and food.

Stress in Health and Illness

•Adaptation to Acute or Chronic Illness 1.General tasks: for example, maintaining self-esteem and personal relationships 2.Illness-related tasks: for example, handling pain and disability •Effects of stress in healthy persons may promote health and prevent illness; whereas, the effects of stress on a sick or injured persons are usually negative.

Response to Socialization and Communication

•Adaptive responses: Maintains usual social patterns, communicates needs and accepts offers of help, serves as support for others.•Maladaptive responses: Isolates self, exhibits superficial self-confidence, is unable to express needs (becomes hostile, ashamed, frustrated, depressed.)

Advance Directives

•Advance care planning is a process that involves having patients think through, talk about, and document their values and goals for treatment •Advance directives are the written documents of those wishes and the designated spokesperson •Indicate who will make decisions for the patient in case the patient is unable. •Indicate the kind of medical treatment the patient wants or doesn't want. •Indicate how comfortable the patient wants to be.•Indicate how the patient wants to be treated by others. •Indicate what the patient wants loved ones to know.

blood pressure and ethnicity

•African-Americans have the highest incidence of hypertension and a higher mortality rate r/t hypertension than Caucasians, in the United States. •Hispanics have a lower incidence of hypertension compared to Caucasians.

Factors Affecting Blood Pressure

•Age, gender, race•Circadian rhythm•Food intake•Exercise•Weight•Emotional state•Body position• Drugs/medications-Sympathetic nervous system (SNS)-Baroreceptors-Vascular endothelium-renal system-endocrine system

Basis for Teaching Plan for Older Adults

•Aging is a normal process, and chronic illness is a pathologic process, but both often occur at the same time .•Meeting expenses of health care is often difficult. •Medication costs, hospitalization costs, and costs of special equipment and supplies •Family members must learn to cope with needs of the ill person. •Family members must adapt to psychological stressors

Anxiety

•An unpleasant feeling of uneasiness, uncertainty, apprehension, dread, unexplained discomfort, tension, and/or helplessness. •A normal emotional response to a real or imagined threat or stressor•Diagnosis is made when individuals become overwhelmed and nonfunctional. •* Different than fear which is a feeling of dread in response to a known threat.*

AYURVEDA MEDICINE

•Ancient Hindu Medicine/Traditional Medicine from India •Uses combinations of herbs, minerals, purgatives, massage, meditation, special diets •Focuses on restoring and strengthening the body, mind, and spirit •Healing focus is on maintenance of balance and wholeness to prevent illness •Central is patient's basic constitution—dosha •Vata (changeable), pitta (intense), kapha (relaxed) •Practitioner: Ayurvedic Doctor •Therapies: diet, herbal remedies, breath work, physical exercise, yoga, meditation, massage, detoxification program Originated in Vedic civilization of India Balance among people, environment, and larger cosmos integral to health Goal: maintain the health of healthy people and cure the sick Illness is a result of falling out of balance with nature It is a way of life

AYURVEDA MEDICINE

•Ancient Hindu Medicine/Traditional Medicine from India •Uses combinations of herbs, minerals, purgatives, massage, meditation, special diets •Focuses on restoring and strengthening the body, mind, and spirit •Healing focus is on maintenance of balance and wholeness to prevent illness •Central is patient's basic constitution—dosha •Vata (changeable), pitta (intense), kapha (relaxed) •Practitioner: Ayurvedic Doctor •Therapies: diet, herbal remedies, breath work, physical exercise, yoga, meditation, massage, detoxification programOriginated in Vedic civilization of India Balance among people, environment, and larger cosmos integral to health Goal: maintain the health of healthy people and cure the sickIllness is a result of falling out of balance with natureIt is a way of life

Types of Anxiety

•Anxiety occurs as the result of a perceived threat to oneself. •Types of anxiety: Signal anxiety •Learned response to an anticipated event •Ex. Calm nursing student becomes nauseated during exams Anxiety state •Individual's coping abilities become overwhelmed and emotional control is lost •Ex. Emergencies, accidents, and traumas are associated with anxiety states. Anxiety trait •Persons typically react with anxiety in low stress situations; learned component of the personality •Ex. A person always giving reasons for behavior, even when not requested.

Nursing Process: Nursing Diagnoses r/t Anxiety

•Anxiety•Risk for self or other directed violence •Rape-Trauma syndrome •Risk for post-trauma syndrome/Post trauma syndrome •Insomnia •Self care deficit •Powerlessnes

hypertension

•As BP increases, so does the risk of •MI •Heart failure •Stroke •Renal disease •Affects 1 in 3 adults in United States •High priority health concern identified in Healthy People 2020 •Hypertension, or high blood pressure (BP), is one of the most important modifiable risk factors that can lead to the development of cardiovascular disease (CVD). •As BP increases, so does the risk of myocardial infarction (MI), heart failure, stroke, and renal disease. •Heart disease, often directly related to hypertension, accounts for 23.7% of all deaths each year in the United States. •Healthy People 2020 lists the number of adults with hypertension whose BP is under control as one of the 26 high-priority, leading health indicators for the coming decade. Hypertension •83% of people > age 20 with hypertension are aware they have high BP •76% are being treated •48% of those aware do not currently have their BP well controlled •The National Health and Nutrition Examination Survey (NHANES) tracks prevention, treatment, and control of hypertension. •Data from NHANES showed that 83% of people 20 years of age and older with hypertension were aware that they had high BP. •Of these people, 76% were being treated. •Of those aware of their hypertension, 48% did not currently have their BP well controlled. •The American College of Cardiology Foundation and the American Heart Association (AHA) provide performance measures for hypertension management that address not only treatment, but also control of BP to target goals. •Target goals have been updated with new information from the evidence-based Guideline for the Management of High Blood Pressure in Adults report from the Eighth Joint National Committee (JNC 8). Target goals take into consideration both age and comorbidities when recommending treatment options. •National guidelines are designed to apply to all racial and ethnic groups. However, certain groups have a higher incidence of risk factors.. Hypertension Classification •Hypertension is defined as a persistent systolic BP (SBP) of 140 mm Hg or more, diastolic BP (DBP) of 90 mm Hg or more, or current use of antihypertensive medication. •Prehypertension is defined as SBP of 120 to 139 mm Hg or DBP of 80-89 mm Hg. •Isolated systolic hypertension (ISH) is defined as an average SBP of 140 mm Hg or more, coupled with an average DBP of less than 90 mm Hg. SBP increases with aging. DBP rises until approximately age 55 and then declines. Control of ISH decreases the incidence of stroke, heart failure, and death. •BP classification is based on the confirmation of office BP readings with ambulatory BP monitoring. Etiology of Hypertension •Primary (essential or idiopathic) hypertension is elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. •Although the exact cause of primary hypertension is unknown, there are several contributing factors. These include changes in endothelial function related to either vasoconstricting or vasodilating agents, increased SNS activity, overproduction of sodium-retaining hormones, increased sodium intake, greater-than-ideal body weight, diabetes, tobacco use, and excessive alcohol intake. •Secondary hypertension is elevated BP with a specific cause that often can be identified and corrected. •This type of hypertension accounts for 5% to 10% of hypertension in adults. •Secondary hypertension should be suspected in people who suddenly develop high BP, especially if it is severe. •Clinical findings that suggest secondary hypertension will relate to the underlying cause. For example, an abdominal bruit heard over the renal arteries may indicate renal disease. •Treatment of secondary hypertension is aimed at removing or treating the underlying cause. •Secondary hypertension is a contributing factor to hypertensive crisis. Physiologic Factors Impacting Hypertension: Systemic Vascular Resistance • •The hemodynamic hallmark of hypertension is persistently increased SVR. •BP rises with any increase in cardiac output (CO) and/or SVR. •Increased CO is sometimes found in the person with prehypertension. Later in the course of hypertension, the SVR rises and CO returns to normal. This persistent elevation in SVR may occur in various ways. •Abnormalities in any mechanisms involved in maintenance of normal BP Physiologic Factors Impacting Hypertension: Altered Renin-Angiotensin-Aldosterone System Altered Renin-Angiotensin-Aldosterone System (RAAS) •Mediated by the angiotensin converting enzyme in the lungs, Angiotensin I is converted to Angiotensin II. Angiotensin II is a powerful vasoconstrictor. Vasoconstriction stimulates the SNS to release epinephrine and norepinephrine which causes: •increase HR •increased cardiac contractility •widespread vasoconstriction in peripheral arteries •promotes release of renin •prevents the release of endogenous vasodilators (prostaglandins & endothelial nitric oxide) Increased vascular resistance means decreased blood flow to kidney, which results in decreased filtering of water and sodium out of bloodstream. As a result, the kidney requires a higher level of arterial pressure to stimulate it, in order for it to excrete Na+ and water. Physiologic Factors Impacting Hypertension: Endothelial Dysfunction Endothelium Dysfunction •Endothelial dysfunction is recognized as a marker for CVD including primary hypertension. •Hypertension can present as a prolonged vasoconstriction response or as a reduced vasodilator response. •Prolonged vasoconstriction may be caused by high levels of endothelin (ET). •Vasodilation effects can be altered by oxygen free radicals, which impair the bioavailability of nitric oxide (NO). •This leads to cellular dysfunction and an imbalance of the vasodilation and vasoconstriction mechanisms in the endothelium. Risk Factors for Primary Hypertension •Age •Alcohol •Tobacco use •Diabetes mellitus •Elevated serum lipids •Excess dietary sodium •Gender •Family history •Obesity •Ethnicity •Sedentary lifestyle •Socioeconomic status •Stress

hypertension

•As BP increases, so does the risk of •MI •Heart failure •Stroke •Renal disease •Affects 1 in 3 adults in United States •High priority health concern identified in Healthy People 2020 •Hypertension, or high blood pressure (BP), is one of the most important modifiable risk factors that can lead to the development of cardiovascular disease (CVD). •As BP increases, so does the risk of myocardial infarction (MI), heart failure, stroke, and renal disease.•Heart disease, often directly related to hypertension, accounts for 23.7% of all deaths each year in the United States. •Healthy People 2020 lists the number of adults with hypertension whose BP is under control as one of the 26 high-priority, leading health indicators for the coming decade.

Blood pressure and obesity

•Associated with abnormalities of glucose, insulin and lipoprotein metabolism (common in primary hypertension) •Also increases workload of the heart, causing an enlarged heart and increases myocardial oxygen consumption.

Behavior Modification

•Assumption behind behavior modification for obesity(Learned disorder caused by overeating, Critical difference between an obese person and a person of normal weight is the cues that regulate eating behavior), Useful basic techniques(Self-monitoring: Show what and when foods are eaten, Stimulus control: Eliminating cues in the environment that trigger eating, Rewards: Non-food incentives for weight loss)

Communicating with Patients with Laryngectomies

•Communication Boards •Voice Prosthesis

Tertiary Health Promotion and Illness Prevention

•Begins after and illness •Goal to reduce disability and rehabilitate patients to maximum level of functioning. •Examples: education, medical therapy, surgical treatment, rehab, PT, support groups, job training, occupational therapy

Coping

•Behaviors used to decrease stress and anxiety; ability to adapt to a stressor. •Conscious, learned behaviors based on a person's family, past experiences, religion, sociocultural influences and expectations. •Affected by one's personal choice •Can include behaviors like: Laughing, crying, sleeping, cursing, physical activity, exercise, smoking, drinking, lack of eye contact, withdrawal, limiting relationships to those with similar values and interest, et. •Physical - directly handle problem •Intellectual - changing perception •Spiritual - prayer, faith, rituals •Emotional - crying, communicating

Grief Support

•Bereavement and grief counseling are core components of patient- and family-centered palliative care.•The grieving process takes time, energy, and work.•The process of resolution in normal grief may take months to years.•Grief counseling facilitates discussion of feelings and cultivates an environment for open expression of all feelings (anger, fear, guilt).•Respect for privacy and desire to talk or not to talk is important.•Honesty in answering questions and giving information is essential.•Should be integrated into the plan of care before as well as after the death

Stage of Resistance

•Body attempts to adapt to stressor•Vital signs, hormone levels, and energy production return to normal•Body regains homeostasis or adaptive mechanisms fail

Respiratory Function Across the Lifespan Older Adult

•Bony landmarks are more prominent due to loss of subcutaneous fat.•Kyphosis contributes to appearance of leaning forward.•Barrel chest deformity may result in increased anteroposterior diameter.•Older adults have an increased risk for disease, especially pneumonia.•Reduced immune system

Communicating with Patients with Visual Impairments

•Braille-prepared computers •Ensure well-lit, glare-free examination rooms• Avoid loud noises and unexpected movement •Use large type and clear handwriting•Use large pictures and videos •Dysphasic: objects, spelling boards, computers....

Resuscitation

•Cardiopulmonary Resuscitation (CPR) •Patients and families have the right to decide whether CPR will be used •Physician's orders should specify •Full Code •Chemical Code •No Code - DNR or AND •Do Not Resuscitate Orders (DNRs)

Causes of Accidental Injuries in Older Adults

•Changes in vision and hearing•Loss of mass and strength of muscles•Slower reflexes and reaction time•Decreased sensory ability•Combined effects of chronic illness and medications•Economic factors

communication with the haring impaired

•Changing the subject •Offering false reassurance •Giving advice •Making defensive comments •Asking prying or probing questions •Not listening attentively •Using clichés •The word "why" •Minimizing/belittling •Closed-ended questions •Agreeing/disagreeing

Blocks to Effective Communication

•Changing the subject •Offering false reassurance •Giving advice •Making defensive comments •Asking prying or probing questions •Not listening attentively •Using clichés•The word "why" •Minimizing/belittling •Closed-ended questions •Agreeing/disagreeing

Mental Impairment in Older Adults

•Dementia•Alzheimer disease•Sundowning syndrome•Cascade iatrogenesis

TERMINOLOGY

•Complementary: Used in addition to a conventional therapy. •Alternative: Used instead of a conventional therapy. •Holism: connection and interactions between parts of the whole •Integrated Healthcare: term used to describe the use of Western Medicine and Complementary and Alternative Medicine (CAM) in coordinated ways •Allopathic/Western Medicine: also called conventional or mainstream medicine; a method of treating disease with remedies that produce effects different from those caused by the disease itself. •Practitioners include medical doctors, nurses, and allied healthcare providers •Therapies: drugs, surgery, radiation, etc. •Evidence-based practice.

Health Belief Model (Rosenstock)

•Concerned with what people perceive, or believe, to be true about themselves in relation to their health •Explains why some people act to prevent/treat illness and others do not •People will change if they feel the benefits of change outweigh the risks •4 Components: •Perceived severity to a disease - will or will not contract the disease, threat posed •Perceived benefits - effectiveness of measures •Perceived barriers •Self-efficacy or ability to perform change

Anxiety in Adulthood

•Continue to use coping mechanisms established in childhood •Developmental tasks, such as establishing a career and family, present numerous stressors •Loss of income, spouse, physical ability can lead to severe anxiety •Fires, floods, earthquakes, wars result in long lasting anxiety •Unresolved anxiety can lead to PTSD and a number of mental health problems may result

Normal Insulin Metabolism

•Counter-regulatory hormones. They work to oppose the effects of insulin. These hormones work to increase blood glucose levels by stimulating glucose production and output by the liver and decreasing the movement of glucose into the cells. •Glucagon •Epinephrine •Growth hormone •Cortisol Hormonal Control of Metabolism •Insulin •A hormone secreted by the beta cells in the islet of Langerhans •Insulin is normally secreted by the beta cells (a type of islet cells) of the pancreas •Normally released in small increments when food is ingested •Stimulus for insulin is high blood glucose levels •Controls blood glucose levels by regulating glucose production and storage •Insulin is regulated by serum glucose levels •Consist of 2 polypeptide chains •The amount of insulin a person is secreting can be tested by checking the levels of C peptide •Rise in plasma insulin after a meal stimulates storage of glucose as glycogen in the liver and muscle. It also inhibits gluconeogenesis and enhances fat deposition (enhances fat to be placed/stored in the adipose tissue) in the adipose tissue and increase protein synthesis. •The fall in insulin levels during the night when you're not eating facilitates the release of the stored glucose from the liver, protein from the muscles and fat, and that's how it kind of compensates for your hypoglycemia.

Cultural Assessment

•Cultural assessments allow us to learn how clients perceive and cope within their world. •Communication •Verbal and nonverbal components •Environmental control •How the individual perceives he or she controls the environment •Space, territory, and time •Space comforts, control over space, concept of time •Social organization •Includes family and the meaning to the client of work, gender roles, friends, and religion •Biological factors •Biological or physical differences that exist among different cultural groups questions: ● We are interested in honoring your values and beliefs. Are there any that you would like for us to know about to help you to regain/maintain your health? ● How many meals per day do you normally eat? At what times? ● Tell me about the foods that you normally eat at mealtime. ● Are there foods that you do not eat ever or don't eat at certain times? Why? ● With whom do you usually eat your meals? ● What is your usual bedtime? Is there anything that helps you to sleep better or worse? ● Many people have a 'routine' at home. Is there any part of your routine that you would like to keep the same, if possible, while you are here such as the time you take your shower/bath, etc.? ● What helps you to stay well? ● Tell me about things you do to help yourself feel better when you are feeling ill

The Nature of Culture

•Culture is NOT:•Based on color of skin•Based solely on country of origin•Race•Beliefs about health and illness have a strong impact on outcomes of treatment.•Values and beliefs help to define norms, which are a culture's behavioral standards.•Norms are the established rules of conduct that define which behaviors are encouraged, accepted, tolerated, and forbidden within a culture.•A role is an expected pattern of behaviors associated with a certain position, status, or gender.

Factors Affecting Grief and Dying

•Developmental considerations•Previous experience with grief and loss•Presence of concurrent losses and/or other stressors•Mental health prior to the loss•Intellectual disabilities•Developmental stage of life - Erikson's•Family•Socioeconomic factors•Cultural, gender, and religious influences•Nature and circumstances of the loss•Degree of suddenness•Length of illness prior to the death•Perception of preventability•Psychosocial context of the death•Relationship with the deceased•Security of the attachment•Amount of unfinished business between the deceased and the living•Level of ambivalence in the relationship•Roles of the deceased in the living's life and social system.

Nephropathy

•Diabetes can alter the normal function of the kidneys. The medical term for kidney problems related to diabetes is "diabetic nephropathy." Over time, this can lead to chronic kidney disease and even kidney failure. •Microvascular complication - damage to small blood vessels that supply glomeruli of the kidney. •Leading cause of end-stage renal disease •Treatment: •Aggressive BP management with medication •Glycemic control •Yearly screening for microalbuminuria in the urine. To check kidney function,the health care provider can order a urine test that measures the amount of protein in the urine. When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine (even in very small amounts) may be an early sign of kidney damage. •If progresses to ESRD: hemodialysis, peritoneal dialysis, or kidney transplantation Diabetic Neuropathy •About 60-70% of people with diabetes have mild to severe forms of nervous system damage: •Impaired sensation or pain in the feet or hands •Slowed digestion of food in the stomach •Carpal tunnel syndrome •Other nervous problem •More than 60% of non-traumatic lower limb amputations in the US occur among people with diabetes •Can be a leading cause of sexual dysfunction for patients with diabetes

Health Disparities

•Differences in the incidence, prevalence, mortality rate, and burden of diseases •Affect population groups based on age, gender, ethnicity, socio-economic status, sexual orientation, disability•Occur when on group has a higher incidence than another •Ethnicity, race and culture•Geographic location•Income•Education•Occupation•Health literacy•Gender•AgeHealth care provider attitudes What can we do to reduce Health Disparities? •1st Step-Assess your own cultural background, values, and beliefs•You HAVE to know yourself before you can know someone else Impact of Ethnicity on Health: Health Disparities •Health Disparities:•Population-specific differences in the presence of disease, health outcomes, or access to health care•Recent study showed that where you access health care can make a difference in the care you receive•those hospitals that treat a higher percentage of minorities also have a higher nurse/client ratio•Standards of care can vary•Less access to healthcare providers and facilities•Minorities have higher incidence of many cancers due to lack of prevention such as pap smears and mammograms •Goal for decreasing health disparities:Improve access to comprehensive, high quality health care for all regardless of race Impact of Ethnicity on Health: Health Disparities •Health Disparities:•Population-specific differences in the presence of disease, health outcomes, or access to health care•Recent study showed that where you access health care can make a difference in the care you receive•those hospitals that treat a higher percentage of minorities also have a higher nurse/client ratio•Standards of care can vary•Less access to healthcare providers and facilities•Minorities have higher incidence of many cancers due to lack of prevention such as pap smears and mammograms •Native Americans and Alaska Natives - heart disease, cirrhosis of the liver, diabetes mellitus, fetal alcohol syndrome.•African Americans - hypertension, stroke, sickle cell anemia, lactose intolerance, keloids.•Asians - hypertension, cancer of the liver, lactose intolerance, thalassemia.•Hispanics - diabetes mellitus, lactose intolerance.•Whites/Caucasians - breast cancer, heart disease, hypertension, diabetes mellitus, obesity.•Eastern European Jews - cystic fibrosis, Gaucher's disease, spinal muscular atrophy, Tay-Sachs' disease.

Anxiety Disorder: Adjustment Disorders

•Distress that is out of proportion to the traumatic event •Symptoms occur within 3 months after event •Social and occupational function impaired •Depression and anxiety common •Increased risk for suicide

Anxiety in Older Adulthood

•Elders often deny their anxiety •Somatization is the physical manifestation of psychological concerns. The physical symptoms, such as pain, are real though they have no underlying physical causes. •Socially, many were taught that it is inappropriate to share their fears and anxieties •Behaviors indicating anxiety: changes in eating, sleeping, ability to concentrate, impatience, fatigue •One of the most effective methods for assessing anxiety in older adults is to simply ask the client to explain his or her anxious feelings. •Older adults usually appreciate the interest of concerned caregivers

Erickson

•Erickson: theory of psychosocial development •Havighurst: theory based on developmental tasks •Gould: theory based on specific beliefs and developmental phases •Levinson: theory based on the organizing concepts of individual life structure

Ethnicity

•Ethnicity is a sense of identification with a collective cultural group. •Associated with the customs, cultural habits, and socialization patterns of a particular group. •Largely based on group's common heritage •One can belong to an ethnic group through birth or adoption of characteristics of that group. •Groups share unique cultural and social beliefs and behavior patterns. •Largely develops through day-to-day life with family and friends within the community •Ethnicity defines one's personal traits •Values, traditions, expectations, and customs are passed from one generation to another. •Skin color, country of origin, and language are part of one's ethnicity •May be many ethnic groups within a culture

Barriers To Cultural Care

•Ethnocentrism: Believing one's ethnic group has rights or benefits over those of another group. •Can happen with race, religion, or culture group •Includes groups such as gangs, supremacist groups, and terrorist groups •Cultural Imposition: forcing cultural beliefs, values, and patterns on others •Cultural Bias: strong position that all decisions must be based on one's own values and beliefs •Cultural Ignorance: insufficient knowledge about a specific culture or provide safe and meaningful care Barriers to Cultural Care Stereotyping: an exaggerated belief about a group that assumes anyone from that group has a certain set of characteristics; is an oversimplified mental picture of a cultural group. •May be positive or negative •Negative includes racism, ageism, and sexism •Stereotyping may take negative, positive, or traditional forms Prejudice (extreme negative stereotyping) •Judging a person, group, or situation before knowing all the facts •Usually a negative connotation (although there are positive prejudices!) •Usually destructive •Usually hurtful •Restrictive to enrichment of society •Health care providers need to know and understand their own racial, ethnic, religious, and social stereotypes. Culture has a strong influence on dietary preference and meal preparation-Explore influences of culture on food choices, meal planning, and use of medications-Socioeconomic and age-related variables will also influence meal planning, medications, and blood glucose monitoring

healthy people 2020

•Healthy People 2020 lists the number of adults with hypertension whose BP is under control as one of the 26 high-priority, leading health indicators for the coming decade. Healthy People 2020: Tobacco Use •These objectives address tobacco use in the areas of (not all inclusive):•Tobacco use during pregnancy•Sale of tobacco to minors•Insurance coverage for those who need smoking cessation treatment•Secondhand exposure to tobacco smoke•Tobacco-free environments (public places, worksites & homes)•Tobacco advertising and promotion•Tobacco tax and toxic chemicals in tobacco products Department of Health and Human Services:Healthy People 2020 Environmental Health Objectives: •Reduce deaths from work-related injuries •Reduce nonfatal work-related injuries •Reduce sleepiness at work and sleep disturbances caused by shift work •Reduce occupational skin diseases or disorders among full-time workers •Reduce work-related assaults •Increase the proportion of employees who have access to workplace programs that prevent or reduce employee stress •Reduce new cases of work-related, noise-induced hearing loss •Reduce the proportion of persons who have elevated blood lead concentrations from work exposures Healthy People 2020 Goals for Cultural Care: •Goal for cultural competence:Use communication strategically to improve health•Goal for decreasing health disparities:Improve access to comprehensive, high quality health care for all regardless of race

Safety Considerations for Older Adults: Falls

•Falls are the second leading cause of accidental or unintentional injury deaths worldwide. •Each year an estimated 646 000 individuals die from falls globally of which over 80% are in low- and middle-income countries. •Adults older than 65 years of age suffer the greatest number of fatal falls. •37.3 million falls that are severe enough to require medical attention occur each year. •Prevention strategies should emphasize education, training, creating safer environments, prioritizing fall-related research and establishing effective policies to reduce risk. Factors That Contribute to Falls •Age >65 •History of falls •Impaired vision or balance •Altered gait or posture, impaired mobility •Medication regimen •Postural hypotension •Slowed reaction time; weakness, frailty •Confusion or disorientation •Unfamiliar environment Prevention •screening within living environments for risks for falls; •clinical interventions to identify risk factors, such as medication review and modification, treatment of low blood pressure, vitamin D and calcium supplementation, treatment of correctable visual impairment; •home assessment and environmental modification for those with known risk factors or a history of falling; •prescription of appropriate assistive devices to address physical and sensory impairments; •muscle strengthening and balance retraining prescribed by a trained health professional; •community-based group programs which may incorporate fall prevention education and Tai Chi-type exercises or dynamic balance and strength training; •use of hip protectors for those at risk of a hip fracture due to a fall. •Stay physically active so that muscles stay strong; tendons and joints and ligaments stay flexible. •Have eyes and hearing tested regularly and glasses or hearing aids if needed •Be aware of side effects of your medication •Get enough sleep •Change positions slowly so that blood pressure has time to adjust •Stay hydrated •Avoid alcohol and sedative drugs •Manage chronic pain prior to activity •Wear non-skid, rubber soled, low-heeled shoes that fully support feet •Utilize prescribed assistive devises: walkers, canes, and railing •Make your home safer. • Remove items that you can trip over like rugs and excess furniture. •Avoid clutter, piles, and hoarding. •Add grab bars inside and outside your tub or shower and net to the toilet. •Put railings on both sides of stairs. •Make sure your home has lots of light

Crisis Intervention

•Five-step problem-solving technique designed to promote a more adaptive outcome, including improved abilities to cope with future crisis.1.Identify the problem2.List alternatives3.Choose from among alternatives4.Implement the plan5.Evaluate the outcomes•Promoting safety is an overriding priority in crisis management.•Ensure safety to self and others

Secondary Health Promotion and Illness Prevention

•Focuses on screening for early detection of disease •Identifies an illness and reverse and reduce severity or provide a cure •Assessment of children for normal growth and developmentexample: health screenings, dental visits for cleanings/cavity check, blood pressure screening, vision exams

Healthy People 2010-2020-2030

•Focuses on the Health of the people of the United States of America•Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:•Encourage collaborations across communities and sectors.•Empower individuals toward making informed health decisions.•Measure the impact of prevention activities.

For auscultatory measurement in blood pressure

•For auscultatory measurement, estimate SBP by palpating the radial pulse and inflating the cuff until the pulse disappears. Inflate the cuff 20-30 mm Hg above this level.•Deflate the cuff at a rate of 2-3 mm Hg/sec.•Record the SBP and DBP. Note the SBP when the first of two or more Korotkoff sounds is heard and the DBP when sound disappears.•Average two or more readings (taken at intervals of at least 1 min). Obtain additional readings if the first two readings differ by more than 5 mm Hg.•Can use forearm if needed•Document site•Assess for orthostatic hypotension•BP and HR supine, sitting, and standing•Measure within 1 to 2 minutes of position change•Positive if ↓ of 20 mm Hg or more in SBP, ↓10 mm Hg or more in DBP, or ↑ 20 beats/minute or more in heart rate•If neither upper arm can be used to measure BP (e.g., presence of IV lines, fistula), or if a maximum size BP cuff does not fit the upper arm, use the forearm. In this case, position the proper size cuff midway between the elbow and the wrist. Auscultate Korotkoff sounds over the radial artery or use a Doppler device to note systolic BP. Use of an oscillometric device on the forearm is acceptable. Forearm and upper arm BPs are not interchangeable. If using the forearm for BP measurement, always document the site.•Assess for orthostatic (or postural) changes in BP and pulse in older adults, in people taking antihypertensive drugs, and in patients who report symptoms consistent with reduced BP on standing (e.g., light-headedness, dizziness, syncope).•Measure serial BP and HR with the patient in the supine, sitting, and standing positions. First, measure BP and HR with the patient in the supine position after at least 2 to 3 minutes of rest. Reposition the patient in the sitting position with legs dangling and measure BP and HR again within 1 to 2 minutes. Last, reposition the patient to the standing position and measure the BP and HR within 1 to 2 minutes.•Usually the SBP decreases slightly (less than 10 mm Hg) on standing, whereas the DBP and pulse increase slightly. Orthostatic hypotension occurs when a patient moves from a supine to standing position and there is a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in the heart rate of 20 beats/min.Common causes of orthostatic hypotension include dehydration and inadequate vasoconstrictor mechanisms related to disease or drugs.

Theories of Aging

•Genetic: genes control "genetic clocks" •Immunity: focuses on the functions of the immune system •Cross-linkage: chemical reaction produces damage to the DNA and cell death •Free radical: molecules with separated high-energy electrons have adverse effects on adjacent molecules

Grief

•Grief is the normal process of reacting to loss •Dynamic process •Includes both psychologic and physiologic responses •Grief occurs in response to real loss as well as what might have been. •Psychologic responses include anger, guilt, anxiety, sadness, depression, and despair. •Physiologic reactions include sleeping problems, changes in appetite, physical problems, and illness. •Complex and intense emotional experience that affects all aspects of life •Priority interventions provide for patient to express feelings Grief •Many factors shape the manner in which a person grieves •Grief is influenced by: •Relationship with the person who has died (spouse, parent, child, etc.) •Physical and emotional coping resources •Concurrent life stresses •Cultural beliefs •Personality •Mental and physical health •Economic resources •Religious influences and spiritual beliefs •Family relationships and conflicts •Social support •Time spent preparing for the death Models of Grief Kubler-Ross — Five Stages of Grief •Not everyone experiences all the stages and not necessarily in progressive order. 1. Denial - may last minutes to months and be characterized by withdrawal. 2. Anger - may be focused in any number of directions: •The person who inflicted the hurt •At the world for letting it happen •At oneself even though nothing could have been done to stop an event from happening (car accident). 3. Bargaining - for more time or something other than the death 4. Depression - may be expressed in numbness, anger, or sadness. 5. Acceptance - admitting the reality of the loss results in a calmer phase known as acceptance. Models of Grief Engel's Six Stages of Grief •"Loss of a loved one is psychologically traumatic to the same extent that being severely wounded or burned is physiologically traumatic." • The process of mourning is parallel to the process of physical healing. •Shock and disbelief - refuses to accept loss, has stunned feelings, accepts the situation intellectually, but denies it emotionally. •Developing awareness - reality of loss begins to penetrate consciousness, anger may be directed at agency/nurse/other. •Restitution - conducts ritual of mourning; actions and expressions of grief, including the symbols and ceremonies that make up outward expression of grief •Resolving the loss - attempts to deal with painful void, still unable to accept new love object to replace lost person or object, may accept more dependent relationship with support person, thinks over and talks about memories of lost object. •Idealization - produces images of lost object that is almost devoid of undesirable features, represses all negative and hostile feelings toward lost object, may feel guilty and remorseful about past inconsiderate or unkind acts to lost person, unconsciously internalizes admired qualities of lost object, reminders of lost object evoke fewer feelings of sadness, reinvests feelings in other. •Outcome - behavior influenced by several factors, importance of lost object as source of support, degree of dependence on relationship, degree of ambivalence toward lost object, number and nature of other relationships, and number and nature of previous grief experiences.

guided imagery

•Guided Imagery•Uses mental images to promote healing or changes in behaviors•Uses all the senses•Useful in decreasing pain, and can be particularly helpful to patients undergoing painful proceduresImagery is the formation of a mental representation of an object, place, event, or situation that is perceived through the senses. It is a cognitive behavioral strategy that uses the individual's own imagination and mental processing and can be practiced as an independent activity or guided by a professional. Imagery uses all the senses—visual, aural, tactile, olfactory, proprioceptive, and kinesthetic. Although imagery is often referred to as visualization, it includes imagining through any sense and is not just being able to see something in the mind's eye. While inducing imagery, the individual often imagines seeing, hearing, smelling, tasting, and/or touching something in the image.Although for many participants physical and mental relaxation tend to facilitate imagery, this is not necessary—particularly 82for children, who often do not need to be in a relaxed state. Imagery may be receptive or active. In receptive imagery, the individual pays attention to an area of the body or a symptom and mentally explores thoughts or feelings that arise. In active imagery, the individual evokes thoughts or ideas. Active imagery can be outcome or end-state oriented, in which the individual envisions a goal, such as being healthy and well; or it can be process oriented, in which the mechanism of the desired effect is imagined, such as envisioning a strong immune system fighting a viral infection or tumor.A key mechanism by which imagery modifies disease and reduces symptoms is thought to be by reducing the stress response, which is triggered when a situation or event (perceived or real) threatens physical or emotional well-being or when the demands of the situation exceed available resources. It activates complex interactions between the neuroendocrine system and the immune system. Emotional responses to situations trigger the limbic system and signal physiologic changes in the peripheral and autonomic nervous systems, resulting in the characteristic fight-or-flight stress response. Over time, chronic stress results in adrenal and immune suppression and may be most harmful to cellular 83immune function, impairing the ability to ward off viruses and tumor cells (Pert, Dreher, & Ruff, 1998).Once the participant is in a relaxed or "altered" state, the practitioner suggests an image of a relaxing, peaceful, or comforting place or introduces an image suggested by the client. Scenes commonly used to induce relaxation include watching a sunset or clouds, sitting on a warm beach or by a fire, or floating through water or space.Relaxation with imagery decreases pain directly by reducing muscle tension and related spasms and indirectly by lowering anxiety and improving sleep. Imagery also is a distraction strategy; vivid, detailed images using all senses tend to work well for pain control. As a low-cost, noninvasive intervention, imagery has the potential to be effective in reducing symptoms and distress across several conditions: cancer, procedural pain, PTSD, headaches, osteoarthritis, depression, asthma, pregnancy, and all forms of pain conditions.General Guided-Imagery Technique1. Achieving a relaxed statea. Find a comfortable sitting or reclining position.b. Uncross any extremities.c. Close your eyes or focus on one spot or object in the room.d. Focus on breathing with your abdominal muscles—being aware of the breath as it enters through your nose and leaves through your mouth. With your next breath let the exhalation be longer and notice how the inhalation that follows is deeper. And as you notice that, let your body become even more relaxed. Continue to breathe deeply; if it is comfortable, gradually let the exhalation become twice as long as the inhalation.e. If your thoughts roam, bring your mind back to thinking about your breathing and your relaxed body.2. Specific suggestions for imagerya. Picture a place you enjoy and where you feel good.b. Notice what you see, hear, taste, smell, and feel.c. Let yourself enjoy being in this place.d. Imagine yourself the way you want to be (describe the desired goal specifically).e. Imagine what steps you will need to take to be the way you want to be.f. Practice these steps now—in this place where you feel good.g. What is the first thing you are doing to help you be the way you want to be?h. What will you do next?i. When you reach your goal of the way you want to be, notice how you feel.3. Summarizing process and reinforce practicea. Remember that you can return to this place, this feeling, and this way of being anytime you want.85b. Allow yourself to feel this way again by focusing on your breathing, relaxing, and imagining yourself in your special place.c. Come back to this place and envision yourself the way you want to be every day.4. Returning to presenta. Be aware again of the favorite place.b. Bring your focus back to your breathing.c. Become aware of the room you are in (drawing attention to the temperature, sounds, or lights).d. Let yourself feel relaxed and refreshed and be ready to resume your activities.e. Open your eyes when you are ready.

Blood pressure and Family History

•Having one or more close family members with high blood pressure before the age of 60 means you have two times the risk of having it also. A strong family history means you have 3 or more relatives who had high blood pressure before 60. Children and siblings of persons with hypertension should be screened and strongly advised to adopt healthy lifestyles to reduce their risk of hypertension• Genetic links•Genetics: accounts for 30% - 40% of cases•Different sets of genes regulate BP at different times•Defective genes in renin-angiotensin- aldosterone system lead to increased conversion of Angiotensinogen to Angiotensin I (a weak vasoconstrictor).

Impact of Ethnicity on Health: Health Disparities

•Health Disparities: •Population-specific differences in the presence of disease, health outcomes, or access to health care •Recent study showed that where you access health care can make a difference in the care you receive •those hospitals that treat a higher percentage of minorities also have a higher nurse/client ratio •Standards of care can vary •Less access to healthcare providers and facilities •Minorities have higher incidence of many cancers due to lack of prevention such as pap smears and mammograms

BMI (body mass index)

•Healthy goal is 18.5 to 24.9 for adults. •Weight (kg)/Height (m2) •Underweight = BMI less than 18.5 kg/m2 •Normal = BMI 18.5 to 24.9 kg/m2 •Overweight = BMI 25 to 29.9 kg/m2 •Obese = BMI greater than 30 kg/m2 •Extremely obese = BMI greater than or equal to 40 kg/m2

The communication process

•Humans must communicate•Interpersonal communication = complex process •Communication = 1 person sends a message, another receives, processes, indicates that message=interpreted •continual circular process •verbal or nonverbal

hypertension classification

•Hypertension is defined as a persistent systolic BP (SBP) of 140 mm Hg or more, diastolic BP (DBP) of 90 mm Hg or more, or current use of antihypertensive medication. •Prehypertension is defined as SBP of 120 to 139 mm Hg or DBP of 80-89 mm Hg.•Isolated systolic hypertension (ISH) is defined as an average SBP of 140 mm Hg or more, coupled with an average DBP of less than 90 mm Hg. SBP increases with aging. DBP rises until approximately age 55 and then declines. Control of ISH decreases the incidence of stroke, heart failure, and death.•BP classification is based on the confirmation of office BP readings with ambulatory BP monitoring.

hypertension (HTN)

•Hypertension, or high blood pressure (BP), is one of the most important modifiable risk factors that can lead to the development of cardiovascular disease (CVD).

Alterations in Respiratory Function

•Hypoventilation: The state in which a reduced amount of air enters the alveoli in the lungs, resulting in decreased levels of oxygen and increased levels of carbon dioxide in the blood. Hypoventilation can be due to breathing that is too shallow (hypopnea) or too slow (bradypnea), or to diminished lung function. •Hyperventilation: Refers to overbreathing, in which ventilation exceeds the metabolic demand causing abnormally low levels of carbon dioxide in the blood, and its related physiologic sysmptoms. •Dyspnea: difficulty breathing, shortness of breath, air hunger •Hypoxia: inadequate amount of oxygen available to the cells in your tissues; the state in which the PaO2 has fallen sufficiently to cause signs and symptoms of inadequate oxygenation. •Hypoxemia: is a below-normal level of oxygen in your blood, specifically in the arteries. •Hypercapnia: greater than normal amounts of carbon dioxide in the blood; usually the result of hypoventilation. •Bronchoconstriction: is the constriction of the airways in the lungs due to the tightening of surrounding smooth muscle, with consequent coughing, wheezing, and shortness of breath. •Bronchodilation: An expansion of the air passages through the bronchi of the lungs. A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. •Hemoptysis: is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. •Atelectasis: collapsed alveoli

allopathic medicene

•Illness occurs in either the mind or body, which are separate entities. •Health is the absence of disease. •The main causes of illness are pathogens. •Curing seeks to destroy the invading organism or repair the affected part.•Emphasis is on disease and high technology (drugs, surgery, and radiation are key tools). Dominant for about 100 yearsSpearheaded remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches, and diagnostic tools

Health Promotion Model - Pender, Murdaugh, & Parsons

•Illustrates how people interact •Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs to motivate health promoting behavior •Personal, biologic, psychological, and sociocultural factors are predictive of a certain health-related habit. •Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan. •People will not invest in a goal they find impossible to achieve. •Self-efficacy & environmental influence determine likelihood of change. •Value expectancy: the idea that a person has of whether a behavior is rational & economical. •Behaviors may induce either a positive or negative subjective response or affect

Nursing Diagnosis r/t Cultural Considerations

•Impaired social interactions •Social Isolation •Impaired comfort •Powerlessness •Compromised family coping •Impaired individual resilience •Decisional conflict •Risk-prone health behavior •Ineffective health maintenance •Risk for complicated immigration transition •Risk for compromised human dignity •Risk for loneness •Readiness for enhanced power •Ineffective relationships •Readiness for enhanced relationships •Stress Overload

cultural

•In the Islamic cultures the traditional rites of washing, shrouding, funeral prayers, and burial are done as soon as possible.•Other rituals can include:•Mantra is changed•No embalmment•Huma fire ritual•Ritual impurity•Bone-gathering ceremony•Memorials•Funeral rites can be simple or complex depending on the customs, means, and ability of the family. In Islam, bodies are perpendicular to Mecca, with the face looking towards it. In some cases, assassins, thieves, suicides, and other disrespected dead may be buried upside down or at crossroads.

Gerontologic Considerations: Visual Impairment

•Increased risk for vision loss•Alters ability to function; may have other deficits•Societal devaluation—impacts self-esteem; isolation•Inadequate finances•Increased fall risk•Concerns with independence; self-image•Dexterity: administration of eye drops or other medications GERONTOLOGIC CONSIDERATIONS: VISUAL IMPAIRMENT • Older adults are at risk for vision loss caused by a variety of eye diseases, which may be compounded by other deficits. • Vision loss in older adults increases the risk for falls and confusion or disorientation. EYE TRAUMA • Everyday activities can result in ocular trauma, including sports and leisure activities, work-related situations, and automobile injuries. • Your role in individual and community education is extremely important in reducing the incidence of ocular trauma. EXTRAOCULAR DISORDERS Inflammation and Infection • A hordeolum (sty) is an infection of sebaceous glands in the lid margin. • A chalazion is a chronic inflammatory granuloma of meibomian (sebaceous) glands in the lid

Anxiety Disorder: Generalized Anxiety Disorder

•Individual's anxiety is broad, long-lasting, and excessive •Worried and anxious more often than not

Juvenile Diabetes

•Insulin resistance and hyperinsulinemia •High insulin levels stimulate SNS activity and impair nitric oxide-mediated vasodilation Diabetes mellitus •Hypertension is more common in diabetics .•When hypertension and diabetes coexist, complications (e.g., target organ disease) are more severe. Insulin Resistance and Hyperinsulinemia •Defects in glucose, insulin, and lipoprotein metabolism are common in primary hypertension. These defects are not present in secondary hypertension and do not improve when primary hypertension is treated. Insulin resistance is a risk factor in the development of hypertension and CVD. High insulin levels stimulate SNS activity and impair NO-mediated vasodilation. Additional pressor effects of insulin include vascular hypertrophy and increased renal sodium reabsorption.

Crisis

•Is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a threat to self. •Person's usual methods of coping are ineffective and this failure produces high levels of anxiety, disorganized behavior, and an inability to function adequately. •One's ability to cope with anxiety is overwhelmed. •New coping behaviors must be developed to successfully resolve the source problem.

Bioterrorism

•Is a type of warfare that makes use of biological agents (biological weapons) to inflict harm to the enemy. Biological weapons use toxins or chemicals produced by microorganisms, plants or animals. Infectious agents such as bacteria, viruses, protozoans or fungi are intentionally used to inflict harm to others. These agents are invisible and microscopic, yet, deadly.•Early recognition can be challenging because the patients present for medical care can initially have nonspecific symptoms.•Terrorist are attracted to biological agents because they are stable, agents can be easily spread, clinical symptoms can last days to weeks, difficult to trace the origin of the infecting agent, undetectable release.

Adaptation

•Is the change that takes place as a result of the responses to a stressor.•Can occur individually, in families, and groups•Necessary for normal growth and development, the ability to tolerate changing situations, and to respond to physical and emotional stressors•Homeostasis: various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment.

Anticipatory Grief

•Is what happens when you know there will be a loss, but it has not yet occurred.•Caregivers of patients with chronic illness often begin to grieve long before the actual death; grief grows worse with each downturn in patient status.•People say they feel like they are living with a "pit" in their stomach that won't go away.•Attempting to cope with fear of death may cause personality changes from day to day, or even moment to moment.•Perhaps the most difficult.... Tolerating living in a state of emergency for an extended period of time. The mind can only take so much "angst."•May struggle to spend the remaining time together in the most meaningful way, keeping the lines of communication open, overcoming the feeling of "giving up," and self acknowledgement that that these feelings are normal and allowed when processing grief.

focusing

•Keep attention focused on the communication task at hand•Continually check to see that the patient is still the topic of the interaction

Theories of Development #2

•Kohlberg: theory of moral development •Gilligan: conception of morality from the female viewpoint •Fowler: theory of faith development

Manifestations of Hearing Impairment in Infancy

•Lack of startle reflex•Absence of babbling by age 7 months•General indifference to sound•Lack of response to the spoken word

Subculture

•Large group of people who are members of a larger cultural group•Members have certain ethnic, occupational, or physical characteristics not common to the larger culture

Safety Concerns Across the Lifespan

•Lets take a detailed look at safety considerations for people at different stages in their development.•Many of these safety concerns has the potential to happen at any age, but are grouped under the developmental age that has the greatest number of occurrences and/or greatest risk for situation arising.

Levels of anxiety

•Levels of anxiety affects individuals physically, cognitively/perceptually, and emotionally/behaviorally Mild •Can motivate one to positively perform at a high level •Helps person to focus on the situation at hand Moderate •Narrowing of the perceptual field •Trouble attending to their surroundings •Can follow commands/direction •Quavering voice, tremors, increased muscle tension, increase in respirations and pulse, "butterflies in my stomach" feelings. Severe •Unable to attend to surroundings except for maybe a detail •Physical symptoms my develop •Anxiety relief is the goal •Difficulty communicating verbally, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation Panic Attack •Terror; only concern is to escape •Communication impossible at this point, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure.

Levels of anxiety

•Levels of anxiety affects individuals physically, cognitively/perceptually, and emotionally/behaviorallyMild•Can motivate one to positively perform at a high level•Helps person to focus on the situation at handModerate•Narrowing of the perceptual field•Trouble attending to their surroundings•Can follow commands/direction•Quavering voice, tremors, increased muscle tension, increase in respirations and pulse, "butterflies in my stomach" feelings.Severe•Unable to attend to surroundings except for maybe a detail•Physical symptoms my develop•Anxiety relief is the goal•Difficulty communicating verbally, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilationPanic Attack•Terror; only concern is to escape•Communication impossible at this point, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure.

Local Adaptation Syndrome

•Localized response of the body to stress •Involves only a specific body part (such as a tissue or organ) instead of the whole body •Stress precipitating the LAS may be traumatic or pathologic •Primarily homeostatic short-term adaptive response•Two types: reflex pain response and inflammatory response vThe General Adaptation Syndrome (General Response to Stress)•Reflex Pain Response: is the response of the central nervous system to pain; rapid; automatic; serves as protective mechanism to prevent injury.•Inflammatory Response: is a local response to injury or infection; serves to localize and prevent the spread of infection and promote wound healing.

local adaptation syndrome (LAS)

•Localized response of the body to stress•Involves only a specific body part (such as a tissue or organ) instead of the whole body •Stress precipitating the LAS may be traumatic or pathologic •Primarily homeostatic short-term adaptive response •Two types: reflex pain response and inflammatory response •Reflex Pain Response: is the response of the central nervous system to pain; rapid; automatic; serves as protective mechanism to prevent injury. •Inflammatory Response: is a local response to injury or infection; serves to localize and prevent the spread of infection and promote wound healing

Nursing Process: Anxiety Interventions

•Maintain a calm environment •Establish therapeutic relationship •Maintain open communication •Identify effective coping strategies •Observe for signs of suicidal thoughts •Client sign contract to refrain from violence •Reinforce personal strengths •Encourage client to establish and maintain relationships •Monitor medications for therapeutic response and for adverse reactions •Document any changes in behavior •Encourage client attend therapies and activities

Insomnia Complementary and alternative therapies

•Melatonin is effective for improving sleep disturbance related to jet lag and shift work but is not considered effective for improving nighttime sleep.•Valerian is a herb used as a sleep aid and to decrease anxiety. It is safe but not effective in treating insomnia.•Additional sleep aids include white noise devices or relaxation strategies.

Anxiety: Treatment

•Mental health therapies: •Cognitive Behavioral Therapy (CBT): helps clients intellectually understand the ineffective behaviors used to cope with anxiety and replace them with more successful behaviors •Systematic desensitization: the clients learn to cope with one anxiety provoking stimulus at a time. This step by step method gradually removes the anxiety from the distress causing event and allows client to develop more effective ways of perceiving their anxiety.•Flooding: repeatedly exposes the person to the feared object or situation until anxiety levels diminish. Intense exposure to the phobic stimulus and no opportunity to escape. The idea is that the anxiety response can only be sustained for a finite amount of time. After a while the anxiety will subside and the person will relax and learn a new association between the phobic stimulus and the relaxed state.

COMPLEMENTARY/ALTERNATIVE MEDICINE

•Mind, body, and spirit are integrated and contribute to health and illness.•Health is balance of body systems: mental, social, and spiritual, as well as physical.•Illness is a manifestation of imbalance or disharmony.•Symptoms are a sign or reflection of a deeper instability within the person; restoring physical and mental harmony will alleviate the symptoms.•Emphasis is on health, healing is done by the patient, care is individualized.

WHO (World Health Organization) jobs

•Monitor disease outbreak•Assess the performance of health systems around the world•Global health topics-Aging-Mother/child-Immunizations-Human genetics-HIV/AIDS

Anxiety Disorder: Panic Disorders

•More common than once thought •Two types of panic disorders •Associated with agoraphobia •Not associated with agoraphobia •agoraphobia is anxiety about possible situations in which a panic attack may occur. Individuals will avoid people, places and events from which escape would be difficult or embarrassing. Afraid to leave the house. •Panic attack: is a period of intense fear or discomfort in which at least four of the following symptoms develop abruptly and reach a peak within 10 minutes: •Palpitations •Sweating •Trembling or shaking •Feeling short of breath, smothering•Feeling of choking •Chest pain or discomfort • nausea or abdominal distress• feeling dizzy, unsteady, lightheaded, or faint •De-realization or depersonalization •Fear of losing control or going crazy •Fear of dying •Paresthesia •Chills or hot flushes

Sedentary lifestyle

•Most women, sedentary men, and adults over 55 years - 13 calories per pound •Sedentary women, obese adults - 10 calories per pound A sedentary lifestyle is a lifestyle type in which little to or no physical activity and exercise is done

NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

•NCCAM is one of the centers that make up the National Institutes of Health (NIH). The NIH is an agency under the Public Health Service (PHS) in the Department of Health and Human Services (DHHS). NCCAM MISSION: •RESEARCH: Conduct & support research of complementary and alternative healing practices •TRAIN: complementary and alternative medicine researchers •DISSEMINATE: authoritative information to the public and professionals •A wholeness orientation in health care delivery•Evidence of safety and efficacy•The healing capacity of the person•Respect for individuality•The right to choose treatment•An emphasis on health promotion and self-care•Partnerships as essential to integrated health care•Dissemination of comprehensive and timely information•Integral public involvement

Anxiety Disorder: Obsessive-Compulsive Disorder

•Obsession is a distressing persistent thought. A compulsion is a distressing recurring behavior •Specific behaviors must be performed to reduce anxiety •Most common obsessions are related to cleanliness, dirt, and germs; aggressive and sexual impulses; health concerns; safety concerns; and order and symmetry •People with OCD are consumed by self destructive, anxiety reducing thoughts and actions. •People with OCD with the ego defense mechanism of repression to cope with distressing obsessions. •Difficult to maintain relationships because their compulsions are too time consuming or inappropriate.

Anxiety Disorder: Behavioral Addictions

•Obsessive-compulsive activities may also take the form of certain addictive behaviors: •Gambling/wagering •Shopping •Working •Sexual activity

Anxiety Disorder: Posttraumatic Stress Disorder

•Occurs after witnessing or experiencing severe trauma •Reliving of traumatic events or situations •Anxiety, depression, and nightmares can complicate the picture •Flashbacks common •Flashbacks are vivid recollections of the event in which the individual relives. Flashbacks life threatening to the person. •Symptoms: intense fear, horror, helplessness, emotionally numb, extremely alert, guarded, agitated, easily startled, eating and sleeping disturbances•Isolation is common

Impact of Culture on Health

•Perceptions or explanations of disease and treatment can vary due to educational level, religious beliefs, alternative health system belief On response to pain •Recognize that each person holds various beliefs about pain and that pain is what the patient says it is. •Respect the patient's right to respond to pain in one's own fashion. •Never stereotype a patient's responses to pain based on the patient's culture. •Be sensitive to nonverbal signals of discomfort, such as holding or applying pressure to the painful area or avoiding activities that intensify the pain. On sleeping practices •Be aware that cultural sleep practices may alter the kinds of environmental sleep disruption that require management. •Assess cultural tendencies to co-sleep or bed-share with infants and children. On body hygiene •Ask the patient for input on bathing habits and cultural bathing preferences. •In many cultures, body odor is offensive, but some see it as natural. •In many Asian cultures, it is customary to not shower or bathe for 1 full month after giving birth. Impact of Culture on Health on food and nutrition •In many cultures food has a social or ceremonial role. Certain foods are highly prized; others are reserved for special holidays or religious feasts; still others are a mark of social position. There are cultural classifications of food such as 'inedible', 'edible by animals', 'edible by human beings but not by one's own kind of human being', 'edible by human being such as self', 'edible by self'. In different cultures, certain foods are considered 'heavy', some are 'light' some as 'foods for strength'; some as 'luxury', etc1. •Different cultures can produce people with varying health risks, though the role of diet is not always clear. For example, African-Americans and many Southerners are at greater risk for ailments such as heart disease and diabetes, but Southern-style fried foods, biscuits and ham hocks might not be the only culprits. Income levels, limited access to healthier foods and exercise habits might play a role as well. Menus stressing lower-fat foods and lots of vegetables, such as those of many Asian cultures, can result in more healthful diets, even reducing the risks for diseases such as diabetes and cancer •As people from one culture become assimilated into another, their diets might change, and not always for the better. A good example is the shift away from traditional eating patterns among Latinos in the United States. Besides the well-known emphasis on ingredients such as hot chiles and cilantro, traditional, nutritious Latino meals include corn, grains, tubers such as potatoes and yucca, vegetables, legumes and fruits. But a shift to a higher-fat, Americanized diet has raised the obesity rate among Latinos and the health risks that go with it. Impact of Culture on Health On conventional health care •Culture has no impact on disease, but illness and its attendant behaviors are strongly influenced by culture. •Degree of acceptance of Western versus folk medicine and treatment •pharmacologic versus holistic •Degree of trust or suspicion of care providers - could have a history of suffering mistreatment or discrimination •Who makes the health care decisions (not always the patient) •Gender roles •Family support Impact of Culture on Health On mental illness •Clients and their care providers may have very different belief systems about mental disorders. •Members of a culture may define normal and abnormal behaviors differently from those outside the culture. •Cultural descriptions of mental dysfunction are classified as naturalistic illness or personalistic illness. On stress and coping •Cultures classify members by gender and age. •In many cultures, adolescence can be a stressful time. •Women often are placed in stressful roles as a result of their cultures. •Ways of coping with stress are culturally determined. Impact of Culture on Health On physical, sexual, mental, emotional, and substance abuse •Growing in frequency in our society •A learned behavior in most cases (most abusers have at one time been abused)

Culturally Competent Care

•Rituals associated with dying are part of all cultures•In certain cultures the family may want to keep constant vigil in the room of a dying patient or in the waiting area. For example, some Jewish Americans believe that the spirit should not be alone when it leaves the body at the time of death. Therefore someone who is terminally ill should never be left alone. The Jewish culture believes all body tissues must be buried with the individual.•Once a death has occurred, some cultures, such as the Puerto Rican American culture, may want to kiss and touch the body to say goodbye.•In the Islamic cultures the traditional rites of washing, shrouding, funeral prayers, and burial are done as soon as possible.•Other rituals can include:•Mantra is changed•No embalmment•Huma fire ritual•Ritual impurity•Bone-gathering ceremony•Memorials•Funeral rites can be simple or complex depending on the customs, means, and ability of the family. Flowers and Stones WorldwideCicero of Rome describes flowers being planted around a grave to purify the ground of human remains.The Jewish tradition of leaving small stones on a grave is ancient. It can be traced back to a time when gravestones were not used-instead, small stones were piled to make a grave. As long as visitors tended the grave and left stones, the dead would be remembered.

Development of the Older Adult

•Physiologic: All organ systems undergo some degree of decline; body less efficient •Cognitive: Does not change appreciably, may take longer to respond and react •Psychosocial: Self-concept is relatively stable throughout adult life. •Disengagement theory: An older adult may substitute activities but does disengage from society. •Erikson: Ego integrity versus despair and disgust; life review •Havighurst: Major tasks are maintenance of social contacts and relationships

Gerontologic Considerations

•Presbycusis—hearing loss due to aging •Tinnitus—ringing in ears •Reduced transmission of sound— atrophy of cerumen glands; dry earwax •Balance—atrophy of vestibular structures, slow motor responses, and musculoskeletal limitations •Sound amplification with the appropriate device is often helpful in improving the understanding of speech. In other situations, an audiologic rehabilitation program can be valuable. •The older adult is often reluctant to use a hearing aid for sound amplification.Reasons cited most often include cost, appearance, insufficient knowledge about hearing aids, amplification of competing noise, and unrealistic expectations. •Most hearing aids and batteries are small, and neuromuscular changes such as stiff fingers, enlarged joints, and decreased sensory perception often make the care and handling of a hearing aid a difficult and frustrating experience for an older person. •Some older adults may also tend to accept their losses as part of getting older and believe there is no need for improvement.

Anxiety: Treatment

•Prevention is the most effective way to cope with anxiety. •Common medications to treat anxiety disorders: •Anti-anxiety drugs •Antidepressants•Antihistamines*** For the purposes of this course, we will not test on medication used to treat anxiety.

etiology of hypertension

•Primary (essential or idiopathic) hypertension is elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. •Although the exact cause of primary hypertension is unknown, there are several contributing factors. These include changes in endothelial function related to either vasoconstricting or vasodilating agents, increased SNS activity, overproduction of sodium-retaining hormones, increased sodium intake, greater-than-ideal body weight, diabetes, tobacco use, and excessive alcohol intake. •Secondary hypertension is elevated BP with a specific cause that often can be identified and corrected. •This type of hypertension accounts for 5% to 10% of hypertension in adults.•Secondary hypertension should be suspected in people who suddenly develop high BP, especially if it is severe.•Clinical findings that suggest secondary hypertension will relate to the underlying cause. For example, an abdominal bruit heard over the renal arteries may indicate renal disease. •Treatment of secondary hypertension is aimed at removing or treating the underlying cause.•Secondary hypertension is a contributing factor to hypertensive crisis.

Dysfunctional Grief

•Prolonged grief disorder•Extended and intense mourning•Recurrent and severe distressing emotions•Intrusive thoughts about the loss•Self-neglect•Denial of the loss for >6 months•Estimates indicate 1 in 5 bereaved individuals experiences prolonged grief disorder•At greater risk for illness, work, and social impairment.

Primary Health Promotion & Illness Prevention

•Promotes health •Prevents diseases and/or injuries •Examples: Immunization clinics, Family planning services, Providing poison control information, Accident prevention education

Anxiety Disorder: Traumatic Stress Reaction

•Series of behavioral and emotional responses that follow an overwhelmingly stressful event •At risk: •Current mental problems •Victims or observers of violence •Victims of sexual assault •Victims of spouse abuse •Homeless people

Purpose of Anxiety

•Serves several purposes •A warning of impending danger •Mild anxiety can increase learning by enhancing concentration and focus •Uncontrolled anxiety often leads to ineffective and maladaptive behavior •A normal part of survival and growth •What are the disadvantages of having too much or too little anxiety? Too little anxiety can result in a lack of focus or recklessness; too much anxiety can lead to inability to accomplish important tasks.

Assessing Blood Pressure

•Proper size and correct placement of the BP cuff are critical for accurate measurement. Place the cuff snugly around the patient's bare upper arm with the midline of the bladder of the cuff (usually marked on the cuff by the manufacturer) placed in line with the brachial artery. Place the patient's arm at the level of the heart during BP measurement. For BP measurements taken in the sitting position, raise and support the arm at the level of the heart. For measurements taken in a supine position, raise and support (e.g., with a small pillow) the arm at heart level. If the arm is resting on the bed, it will be below heart level.•BP cuffs that are too small or too large will result in readings that are falsely high or low, respectively.•If bilateral BP measurements are not equal, document this finding and use the arm with the highest BP for all futuremeasurements.•Provide the patient (verbally and in writing) with the BP reading, BP goal, and recommendations for follow-up.•Clean BP cuffs between patients according to agency infection control guidelines.•Listening for Korotkoff sounds with stethoscope•Estimate SBP by palpating radial pulse and inflating cuff until pulse disappears. First sound is systolic pressure.•Inflate cuff 20-30 mm Hg above this level•Deflate cuff at a rate of 2-3 mm Hg/sec•Change or cessation of sounds occurs—diastolic pressure.•The brachial artery and popliteal artery are commonly used.

defense mechanisms

•Protect a person's self -esteem and are useful in mild to moderate anxiety.•Are mental pressure valves•Are considered to be "unconscious"•Give the illusion of being helpful, when in reality theymask the stress and may actually increase it•When used in small "doses" may be helpful for short-term stress relief•When used to excess, become ineffective and may lead to breakdown of personality and relationships. •Excessive use of the defense mechanisms can lead to negative impact on mental and emotional well-being •People with OCD with the ego defense mechanism of repression to cope with distressing obsessions.

Priority Actions for a Client Experiencing Panic Attack

•Provide a calm environment, decrease environmental stimuli, and stay with the client •Ask the client to identify what and how he or she feels •Administer anti-anxiety medication as ordered •Promote relaxation techniques such as breathing exercises or guided imagery •Listen to the client for expressions of helplessness and hopelessness •Document the event, significant information, actions taken and follow up actions and the clients responses

ACUPUNCTURE

•Qi flows vertically through body through 12 meridians •Places thin needles at particular acupoints to change flow of energy and restore the balance of yin and yang •Process: •Inserting fine needles into points located along energy pathways called "meridians." •Needles are inserted along theses pathways and swirled to remove blockages •Reduces pain, promotes adherence to substance abuse programs, minimizes nausea and vomiting The term acupuncture describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of TCM

Continuum of Anxiety Responses

•Reactions to anxiety occur along a continuum of behavioral responses. •Positively focused anxiety helps us to adapt, learn, and grow from our experiences •Maladaptive responses to anxiety are ineffective attempts to cope. •Responses to anxiety occur on four levels, ranging from mild to panic. •Strive for emotional homeostasis

Manifestations of Vision Impairment

•Signs and Symptoms of Vision problems:•Difficulty following an object with eyes•Blinking or rubbing eyes a lot•Crossed eyes or one eye pointing the wrong way•Watery, red eyes, or pain when exposed to light•Holding things close to eyes when looking at them•Problems with reading, watching TV, and body movementand sports requiring hand eye coordination.•Short attention span•Cranky demeanor, easily agitated•Complaints of headache,

Disaster Triage

•Red: Immediate stabilization is required.•This applies to victims who have:• Shock due to any cause•Breathing difficulty with possible respiratory failure•Profuse external bleedingHead trauma with signs of altered consciousness, such as:•disorientation (cannot obey simple commands)•unconsciousness (cannot respond to verbal and/or painful stimuli)•asymmetrical pupils (sign of cerebral hernia)•Stabilize these patients so they can receive further care. After stabilization, reclassify. Disaster Triage Yellow •Yellow: Delayed treat men t may be appropriate. Monitor closely, insert a line if uncertain about circulatory status, but defer care initially. This category includes victims who, despite not fulfilling the criteria for inclusion in the red group, have•Shock risk (e.g., heart attack, abdominal trauma)•Open fractures•Femur or pelvis fracture•Severe burns•Head trauma but responsive to verbal or painful stimuli•Uncertain diagnoses Disaster Triage Green •Green: These victims can wait or do not require treatment. This category includes those who are ambulatory and have:• Minor fractures• Minor wounds or burns•After on-site care has been completed, transport victims who have been classified as yellow or red to a hospital. They should be re-triaged on arrival.•Black: Deceased. Disaster Triage •Red: These victims have the highest priority for transport, preferably with a specialized crew to a tertiary hospital because they require surgery for survival or organ-function preservation or need ICU services.•Yellow: These victims have the second highest priority for transport, which includes victims who are currently stable but may decompensate or require urgent but not emergent surgery.•Green: These victims may be discharged on-site, if possible, after being checked and reassured. Those with minor injuries should be treated or sent to a primary care facility if available.•Black: Transportation to the morgue. Disaster Triage •Clearly establish the treatment areas in the hospital and provide the necessary staffing. Treatment area designation should reflect triage levels, e.g., red treatment area for victims triaged in the red category.•An emergency medicine physician or an anesthesiologist will be in charge of the red treatment area and should be prepared to treat patients with extremely severe injuries. An additional triage can determine the order of these red patients that need operative interventions.•Victims triaged as yellow should be re-evaluated by a physician and provided care or observation as needed. If their condition worsens, transfer them to the red treatment area.•Victims with no hope for survival require only supportive care. These patients should be kept in a separate ward.•Have an area ready for deceased victims if the hospital morgue is overwhelmed.

visual problems

•Refraction—eye's ability to bend light rays so they fall on retina; create sharp image •Refractive errors—blurred vision •Myopia—nearsighted is the inability to accommodate for objects at a distance. •Hyperopia—farsighted •Presbyopia—loss of accommodation •Astigmatism—visual distortion •Aphakia—absence of lens •Strabismus—double vision •Can't focus both eyes simultaneously •One eye deviates in (estropia), out (exotropia), up (hypertropia), or down (hypotropia)

Equipment for Assessing Blood Pressure

•Stethoscope and sphygmomanometer•Doppler ultrasound•Electronic or automated devices

Insomnia

•Symptoms include: •Difficulty falling asleep •Difficulty staying asleep •Waking up too early •Complaints of waking up feeling unrefreshed •Insomnia is a common problem experienced by one in three adults. •The main complaint of people with insomnia is overall dissatisfaction with sleep quality and quantity. -Aggravated by inadequate sleep hygiene (Stimulants, Medications, Using alcohol to induce sleep, Irregular sleep schedules, Nightmare, Exercising near bedtime, Jet lag) Acute Insomnia Difficulty falling asleep or remaining asleep for at least 3 nights/wk for less than a month •Symptoms include fatigue, poor concentration, interference with social or family activities. Chronic Insomnia •Same symptoms as acute •Daytime symptoms that persist for 1 month or longer •Daytime complaints are the same as those for acute insomnia. •Chronic insomnia occurs in 10% to 15% of Americans and is more common in women than in men. •Insomnia is more common in people who are divorced, widowed, and separated than in those who are married. Insomnia is more prevalent in individuals with low socioeconomic status and less education. ETIOLOGY: •Often no known cause •Stressful life event •Psychiatric illness or medical condition •Medications or substance abuse •The diagnosis of primary insomnia occurs after medical, neurologic, and psychiatric causes have been excluded. •Chronic insomnia often has no known medical or psychologic cause. •Often individuals report that the onset occurred after a stressful life event (e.g., loss of loved one). •In other cases, the onset of insomnia may be precipitated by psychiatric illnesses, medical conditions, medications, or substance abuse. Patients with psychiatric or medical conditions are more likely to have insomnia than individuals without these conditions. •Once chronic insomnia manifests, symptoms are likely to persist over time. Individuals may engage in behaviors that perpetuate disturbed sleep by keeping irregular sleep-wake schedules, using OTC medications or alcohol as sleep aids, and spending more time in bed trying to sleep. insomnia contributing factors •Behaviors, lifestyle, diet, physical and mental conditions, and medications contribute to insomnia. •Insomnia is exacerbated or perpetuated by behaviors such as varying one's bedtime and rise time, taking long naps in the afternoon, sleeping late in the morning, and exercising near bedtime. •Stimulants include caffeine, nicotine, methamphetamines. •Medication such as antidepressants, antihypertensives, corticosteroids, psychostimulants, and analgesics can cause insomnia. •Long naps in the afternoon or sleeping in in the morning can cause nighttime insomnia. Insomnia Clinical Manifestations •Clinical manifestations •Difficulty falling asleep (long sleep latency) •Frequent awakening (fragmented sleep) •Prolonged nighttime awakenings •Feeling unrefreshed on awakening (nonrestorative sleep) •Clinical manifestations include one or more of the symptoms listed. •Daytime or functional consequences of insomnia include fatigue, having trouble concentrating at work or school, and altered mood. •Behavioral manifestations of poor sleep include irritability, sleepiness during the day, forgetfulness, and attention and concentration problems. Insomnia diagnosis •Self-report: The diagnosis of insomnia is made on the basis of subjective complaints and evaluation of a 1- or 2-week sleep diary completed by the patient. •In ambulatory care settings, the evaluation of insomnia requires a comprehensive sleep history to establish the type of insomnia and to screen for possible psychiatric, medical, or other sleep disorders that would require specific treatment. •Questionnaires, such as Pittsburgh Quality Sleep Index, Insomnia Severity Index, and Epworth Daytime Sleepiness, are commonly used to assess sleep quality and negative daytime symptoms related to insomnia. •Ask students to formulate questions to ask the patient to obtain a sleep history. •Actigraphy: An actigraph is a device that measures gross motor activity. It is worn on the wrist like a watch and is about the same size and shape. The unit continuously records the patient's movements, producing data that are downloaded to a computer and analyzed. Activity corresponds to time spent awake, and continuous inactivity corresponds to time spent asleep. •Polysomnography: A PSG study is done only when symptoms or signs of another sleep disorder, such as sleep-disordered breathing, are evident. PSG simultaneously records muscle tone using electromyogram (EMG), eye movements via electro-oculogram (EOG), and brain activity via electroencephalogram (EEG). insomnia interprofessional care •Education •Sleep hygiene •Cognitive-behavioral therapy for insomnia (CBT-I) •Drug therapy •Complementary and alternative therapies •Provide education about sleep along with behavioral strategies. Sleep hygiene is a variety of practices that are important to normal, quality sleep (Table 7-3). •Have students discuss their own nighttime rituals for sleep. •individuals with chronic insomnia require more in-depth cognitive-behavioral therapy for insomnia (CBT-I). •The cognitive part of CBT-I may include stress management techniques (e.g., relaxation breathing, imagery) or cognitive strategies to address misconceptions about sleep. •Behavioral part of CBT-I includes instructions to limit the amount of time in bed, maintain a scheduled time to get up in the morning, go to bed only when feeling sleepy, and get out of bed when unable to sleep. •Individuals with insomnia are encouraged not to read or watch TV in bed, limit naps to 15 to 20 minutes once per day, and avoid consumption of large meals, alcohol, and stimulants. Insomnia Drug Therapy •Medications that treat insomnia can cause next-day drowsiness and impair driving and other activities that require alertness. People can be impaired even when they feel fully awake. •Many individuals with insomnia become accustomed to taking OTC or prescription medications to treat insomnia and risk becoming dependent upon them, both psychologically and physically. •Rebound insomnia is common with abrupt withdrawal of hypnotic medications. •Benzodiazepines, such as diazepam (Valium), activate the GABA receptors to promote sleep. Their prolonged half-life can result in daytime sleepiness, amnesia, dizziness, and rebound insomnia. Tolerance develops, and there is risk for dependence with these agents. •Benzodiazepine-receptor-like agents, zolpipidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), are drugs of first choice for insomnia. These drugs have a short half-life, shorter duration of action, and are effective and safe for use from 6 months to a year. •Suvorexant (Belsomra) is the first approved orexin receptor antagonist. It promotes sleep by blocking the effects of orexin. •Melatonin-receptor agonist, ramelteon (Rozerem), has a rapid onset that is effective for sleep onset, but it has a short duration of action. It is not always effective for improving sleep quality. •Antidepressants, such as trazodone (Desyrel), have sedative properties. The insomnia dose is much lower than the antidepression dose. Trazodone is commonly prescribed, especially for older adults, although use in older adults is controversial. Doxepin (Sinequan) and amitriptyline (Elavil) are tricyclic antidepressants that may be used to treat insomnia. Doxepin improves sleep without next-day drowsiness in older and middle-aged adults with chronic primary insomnia. •Antihistamines, such as diphenhydramine (Benadryl), are a common component of OTC sleep aids. They are less effective than benzodiazepines, and tolerance develops quickly. In addition, anticholinergic side effects include daytime sleepiness, impaired cognitive function, blurred vision, urinary retention, constipation, and risk for increased intraocular pressure. Insomnia Complementary and alternative therapies •Melatonin is effective for improving sleep disturbance related to jet lag and shift work but is not considered effective for improving nighttime sleep. •Valerian is a herb used as a sleep aid and to decrease anxiety. It is safe but not effective in treating insomnia. •Additional sleep aids include white noise devices or relaxation strategies. Insomnia Nursing Assessment •A sleep history includes characteristics of sleep such as the duration and pattern of sleep and daytime alertness. Before using any questionnaire, assess the patient's cognitive function, reading level (if a paper form is used), and language ability. •Ask about sleep aids, including OTC and prescription medications. Note the dose and frequency of use, as well as any side effects (e.g., daytime drowsiness, dry mouth). Many individuals also consume herbal or dietary supplements that they believe improve sleep, including valerian, melatonin, hops, lavender, passion flower, kava, and skullcap. Inform the patient that many of these products are sold as dietary supplements and do not have FDA approval or regulatory oversight. Certain agents such as kava are associated with liver toxicity. •A sleep diary should include when the individual goes to sleep, when they wake up, and how long they were awake during the night. The number and duration of naps should also be recorded. •Medical history can provide important information about factors that contribute to poor sleep. •In addition, ask about work schedules, including shift work, and travel. Insomnia Nursing Diagnosis •Insomnia •Sleep deprivation •Disturbed sleep pattern •Readiness for enhanced sleep Insomnia Nursing Implementation •Optimally, healthy adults should have 7 to 8 hours of sleep a night. •Although education about sleep hygiene practices is beneficial, individuals with chronic insomnia will require in-depth training in cognitive-behavioral (CBT-I) strategies. •Sleep hygiene includes decreasing dietary intake of substances containing caffeine and avoiding consumption of caffeinated beverages after 12 o'clock. Also, suggest reducing light and noise levels and keeping the bedroom dark and cool. Awareness of time passing and watching the clock add to anxieties about not falling asleep or returning to sleep. •With benzodiazepines, nonbenzodiazepines, and melatonin agonists, teach the patient to take the drug right before bedtime, to be prepared to get a full night's sleep of at least 6 to 8 hours, and to not plan activities the next morning that require highly skilled psychomotor coordination. Advise patients not to take these medications with high-fat food (delays absorption), alcohol, or other CNS depressants.

biofeedback

•Technique that trains patient to lessen symptoms •Learn to control particular internal physiologic processes that normally occur involuntarily, such as heart rate or blood pressure •Internal activity (heart rate for example) is shown on a monitor •With practice, a person can use this information to gain control over the "involuntary" activity •Specialists in many different fields use biofeedback to help their patients cope with pain. Biofeedback is a technique that teaches people how to gain more control of involuntary bodily functions. Electronic sensors applied to the body allow a person to become more aware (feedback) of processes in his or her body (bio). Many different types of healthcare professionals rely on biofeedback to help their patients cope with a variety of conditions such as chronic pain, regain movement in paralyzed muscles, and learn to relax. Patients who suffer from migraine headaches, high blood pressure, and incontinence are just a few examples of those who can benefit from biofeedback therapy. Biofeedback is based on holistic self-care perspectives in which (a) the mind and body are not separated and (b) people can learn ways to improve their health and performance. Biofeedback therapists use instruments and teach self-regulation strategies to help individuals increase voluntary control over their internal physiological and mental processes. Biofeedback instruments measure physiological activity such as muscle tension, skin temperature, cardiac activity, and brainwaves and then provide immediate and real-time feedback to the people in the form of visual and/or auditory signals that increase their awareness of internal processes. The biofeedback therapist then teaches individuals to change these signals and to take a more active role in maintaining the health of their minds and bodies. The holistic and self-care philosophies underlying biofeedback and its focus on helping subjects gain more control over personal functioning make the intervention an appropriate one for nurses to use. Over time, a person can learn to maintain these changes without continued use of a feedback instrument. Parameters Used for Feedback to Patients 168 Airway resistance Blood pressure Blood volume Bowel sounds EEG neurofeedback EMG muscle feedback Forced expiratory volume Galvanic skin response Gastric pH Heart rate Heart rate variability Peripheral skin temperature Pneumography Tidal volume Tracheal noise Vagal nerve stimulation

Physiologic Factors Impacting Hypertension: Systemic Vascular Resistance

•The hemodynamic hallmark of hypertension is persistently increased SVR.•BP rises with any increase in cardiac output (CO) and/or SVR.•Increased CO is sometimes found in the person with prehypertension. Later in the course of hypertension, the SVR rises and CO returns to normal. This persistent elevation in SVR may occur in various ways.•Abnormalities in any mechanisms involved in maintenance of normal BP

Blood Pressure

•The mechanisms that regulate BP can affect either CO or SVR, or both. •Regulation of BP is a complex process involving both short-term (seconds to hours) and long-term (days to weeks) mechanisms. •Short-term mechanisms, including the sympathetic nervous system (SNS) and vascular endothelium, are active within a few seconds. •Long-term mechanisms include renal and hormonal processes that regulate arteriolar resistance and blood volume. In a healthy person, these regulatory mechanisms function in response to the demands of the body. (Each mechanism is more fully described in the following slides.)

Adaptive responses include:

•The mind-body interaction•Anxiety•Coping or defense mechanisms

Euthanasia

•The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. -- Deliberate act of hastening death•The practice is illegal in most countries. Euthanasia is illegal in the United States but, assisted suicide is legal in three states: Washington, Oregon, and Montana.•The difference between the two is who administers the lethal dose of medication. When a doctor or nurse or other third party gives the final dose, it is "euthanasia." Assisted suicide, also know as physician aid-in-dying (PAD) means the mentally competent, terminally ill adults request their physician provide a prescription for medication that the patients can, if they choose, self-administer to bring about a peaceful death.Controversy surrounds both topics at every turn.•The ANA statement on active euthanasia states that the nurse should not participate in active euthanasia

Blood pressure and Socioeconomic status and education

•The percentage of adults with hypertension differs according to selected socioeconomic characteristics.•The percentage among adults with less than a high school education was about 30 percent greater than for adults with a college education.•Differences also existed by income (29.6 percent among low income adults versus 23.8 percent among high income adults). •The uninsured are substantially less likely to have ever been diagnosed with hypertension than adults covered only by public health insurance or covered by any private health insurance.

CHIROPRACTIC MEDICINE

•Therapy: manual adjustments and manipulation of vertebral column and the limbs to relieve pressure on the nerves. Brings the spinal components back into correct alignment, thereby decreasing or eliminating pain. Exercise, ice, heat, electrical stimulation, and massage may be used in conjunction with spinal manipulation •Based on the belief illness is a result of a nerve dysfunction; belief the body can heal itself. •Practitioner: Chiropractor •Not always appropriate for patients who have •Osteoporosis •Cancer •Back surgery Spinal adjustment Heat and ice Electrical stimulation Relaxation techniques Rehabilitative and general exercise Counseling about diet, weight loss, and other lifestyle factors Dietary supplements

Psychological Homeostasis

•To maintain mental well-being, humans also must maintain psychological homeostasis.•Refer to Maslow's Hierarchy of Needs:•Love and belonging needs•Safety and security needs•Self-esteem needs•If the person has the necessary resources, adaptation takes place and balance is maintained.•Adaptive responses include:•The mind-body interaction•Anxiety•Coping or defense mechanisms

Tobacco effects on BP and HPTN

•Tobacco use •Smoking tobacco greatly ↑ risk of cardiovascular disease. •People with hypertension who smoke tobacco are at even greater risk for cardiovascular disease. •Nicotine is a vasoconstrictor that increases both systolic and diastolic B/P. •stimulates release of catecholamine (epinephrine and norepinephrine), which increases HR and SVR. •causes endothelial dysfunction and increases vessel wall thickness •Increases platelet adhesiveness, thereby increasing the risk of clot formation within the arteries. Habitual smoking is associated with a high incidence of severe HTN, myocardial hypertrophy, and death resulting from CAD Hypertension Lifestyle Modifications Avoidance of Tobacco Products •Nicotine contained in tobacco causes vasoconstriction and increases BP, especially in people with hypertension. •Smoking tobacco is also a major risk factor for CVD. •The cardiovascular benefits of stopping tobacco use are seen within 1 year in all age groups. Strongly encourage everyone, especially patients with hypertension, to avoid tobacco use. Advise those who continue to use tobacco products to monitor their BP during use. Management of Psychosocial Risk Factors •Psychosocial risk factors can contribute to the risk of developing CVD and to a poorer prognosis and clinical course in patients with CVD. •These risk factors include low socioeconomic status, social isolation and lack of support, stress at work and in family life, and negative emotions such as depression and hostility. Frequently, these risk factors are clustered together. For example, there tends to be higher rates of depression in individuals who experience job stress. •Psychosocial risk factors have direct effects on the cardiovascular system by activating the SNS and stress hormones. This can cause a wide variety of pathophysiologic responses, including hypertension •Psychosocial risk factors can contribute to CVD indirectly as well, simply by their impact on lifestyle behaviors and choices. Screening for psychosocial risk factors is important. Make appropriate referrals (e.g., counseling), when indicated. Suggest behavioral interventions such as relaxation training, stress management courses, support groups, and exercise training for individuals who are not in acute psychologic distress.

Definition of Death

•Uniform Definition of Death Act: An individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. •Medical criteria used to certify a death: cessation of breathing, no response to deep painful stimuli, and lack of reflexes (such as the gag or corneal reflex) and spontaneous movement, flat encephalogram. Definition of Death •Exact definition of death can be controversial •Technological developments in life support have led to questions about when death actually occurs: •When the whole brain (cortex and brainstem) ceases activity •Or when function of the cortex alone stops. •The American Academy of Neurology developed the diagnostic criteria that must be validated by a physician: •Coma or unresponsiveness •Absence of brainstem reflexes •Apnea •Currently legal and medical standards require that all brain function must cease for brain death to be pronounced and life support to be disconnected. •In some states and under specific circumstances, registered nurses are legally permitted to pronounce death. Diagnosis of brain death is of particular importance when organ donation is an option Components of a Good Death •Patients Want: •Pain and Symptom Management •Ability to Make Own Decisions •Avoidance of Prolonged Dying Process •Minimal Burden on Family •Remaining Time for Relationships •Preparation for death •Opportunity to have a sense of completion of one's life •Good relationship with health care professionals

HYPNOTHERAPY

•Used to alter behavior, retrieve memories, induce anesthesia •A hypnotic state is created in which suggestions are implanted that remain during the posthypnotic period •Can help with wt loss and to stop smoking •Can undergo surgery during a deep hypnotic state •Not everyone can be hypnotized.

Safety Considerations for School-Aged Children:Near-Drowning

•Used to describe submersion with at least temporary survival of the victim of asphyxiation.•Asphyxia - insufficient oxygen intake; can cause death.•Symptoms: mild dyspnea, death-like appearance with blue or gray skin color, apnea or tachycardia, hypotension, slow heart rate, cold skin temperatures, dilated pupils, hypothermia, and vomiting.Prevention•Reduce exposure to water hazards through strategic use of barriers like pool gates fence or self-latching gates and childproof covers.•Close and capable adult supervision for young children•Adults avoid distractions like cell phones, tablets, and group conversations.•Equip kids with swimming and water safety skills through lessons and practice.•Requirements for use of personal flotation devices like Coast Guard approved life vest if they are not good swimmers.•Put pool toys away when you leave the pool so that children don't go back for them.•Don't rely on floaties and inner tubes to keep children from drowning•Cover drains and instruct children to stay away from them.• never leave your child alone in the bathtub or near a body of water•Stay within an arm's reach of children in the water•Inforce rules about rough play in the water and pool area•Teach about safe diving depths

Coping Mechanisms:

•Usual coping behaviour - "What do you usually do when something like this happens?" • Coping strategies - "Can you think of anything to do about this?" • Social support - "Whom can you call on to help you with this?"

hope

•Victims with no hope for survival require only supportive care. These patients should be kept in a separate ward.

Therapeutic Communication Techniques

•communication between sender and receiver, obtaining feedback •Focus on communicator •Use silence •Restate message/Stating implied thoughts and feelings •Use therapeutic touch •Clarify terms •Reflect •Open-ended questions (the essence of successful communication): -Require more than a "yes" or "no" answer •Asking for what you need •Identifying thoughts and feelings •Empathy (not sympathy) •Using general leads •Giving information (not advice) -Giving general leads -Offering self Encouraging elaboration -Giving information -Looking at alternatives Summarizing

Psychological conditions that foster healthy development of the self in children include:

•emotional warmth and acceptance.•effective structure and discipline.•clearly defined standards and limits, so that children understand what goals, procedures, and conduct are approved.•adequately defined roles for both older and younger members of the family.•established methods of handling children that produce the desired behavior, discourage misbehavior, and deal with infractions when they occur.•encouragement of competence and self-confidence helpingchildren meet challenges.•appropriate role models (usually parents).•a stimulating and responsive environment.

Echinacea

•is used as a dietary supplement for the common cold and other infections, based on the idea that it might stimulate the immune system to more effectively fight infection.•Taking echinacea after you catch a cold has not been shown to shorten the time that you'll be sick.•Taking echinacea while you're well may slightly reduce your chances of catching a cold.

Influenza

◦Highly contagious; increased morbidity and mortality ◦Peak season: December to February ◦Classified by serotypes (A, B, C, D)-A subtypes: H and N antigens (e.g., H1 N1) ◦Influenza A—most common and virulent: Mutated viruses —no immunity, Pandemics (worldwide spread), Epidemics (localized outbreaks) ◦Transmission: infected droplets = 1 day before onset symptoms—5 to 7 days Influenza At Risk Populations: •Children under the age of two; especially those under the age of 6 months since they aren't eligible to receive the vaccine and haven't likely been exposed to it before. •Adults over the age of 65 since immune system gradually weakens with age; also more vulnerable to complications and prolonged recovery time. •People living in institutional settings like group homes, assisted living facilities, nursing homes, dormitories, prisons, orphanages, etc. •People with chronic diseases; especially, heart disease, chronic lung disease, diabetes, obesity, and autoimmune disorders. •Pregnant women are more at risk for a severe case of the flu and suffering complications to the unborn baby. •People with weakened or compromised immunes systems like those with cancer or HIV. •Healthcare and emergency response personnel Manifestations ◦Abrupt onset—~ 7 days: chills, fever, myalgia, headache, cough, sore throat, fatigue ◦Complications: pneumonia, ear or sinus infections; Older adults—weak and lethargic ◦Diagnostic Studies ◦H and P, prevalence in community ◦Viral cultures ◦Rapid influenza diagnostic tests (RIDTs) Management ◦Prevention: Influenza Vaccine (flu shot) •Inactivated or live attenuated Need annual vaccine •Takes 2 weeks for antibody production •Advocate vaccine for those greater than 6 months and high risk (e.g., HCW and long term care residents) •CDC recommends a yearly vaccine as the most important step in protecting against seasonal influenza. Everyone 6 months of age and older should get an influenza vaccine every season with rare exception. •While there are many different flu viruses, the seasonal flu vaccine protects against three or four specific strains (research suggests that these will be most common). •Vaccination is important for caregivers & people at high risk of serious flu complications. ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Types: ◦Trivalent (3-strain) influenza vaccines include: ◦A trivalent influenza shot made with adjuvant (Fluad), licensed for people 65 years and older. A high-dose influenza vaccine (FluzoneHigh-Dose), licensed for people 65 years and older Influenza Management Management ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Types: ◦Quadrivalent (4-strain) flu vaccines include: ◦Standard-dose quadrivalent influenza shots that are manufactured using virus grown in eggs. These include Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, and Fluzone Quadrivalent. Different influenza shots are licensed for different age groups. Some are licensed for children as young as 6 months of age. Most influenza shots are given in an arm muscle with a needle. One quadrivalent influenza shot (Afluria Quadrivalent) can be given either with a needle (for people aged 6 months and older) or with a jet injector (for people aged 18 through 64 years only). ◦A quadrivalent cell-based influenza shot (Flucelvax Quadrivalent) containing virus grown in cell culture, which is licensed for people 4 years and older. This season, all four of the vaccine viruses used in Flucelvax have been grown in cells, making the vaccine totally egg-free. ◦Recombinant quadrivalent influenza shot (Flublok Quadrivalent), an egg-free vaccine, approved for people 18 years and older. ◦Prevention: Influenza Vaccine (flu shot) ◦Vaccine Considerations: •People who have an allergy to eggs or any of the ingredients in the vaccine should talk to their healthcare provider before getting a flu shot. •People with egg allergies can receive a special vaccine. •People with a history of Guillain-Barré Syndrome need to consult their primary care provider before getting a flu shot. •People who are currently ill or have a fever need to wait till they are well before they get their flu shot. •Alternative delivery options are available upon request if patients meet criteria: nasal spray flue vaccine and intradermal flu vaccine. Management: oSymptom relief and prevent secondary infection: rest, fluid, antipyretic, analgesia oAntivirals: shorten duration of symptoms and reduce risk of complications ◦Zanamavir (Relenza) - drug of choice ◦Oseltamivir (Tamiflu) ◦Must be started within 48 hours of initial flu symptoms and used for 7 days

Allergic Rhinitis

◦Inflammation of nasal mucosa ◦Cause: seasonal (pollen) or perennial (environmental) allergen ◦Frequency of symptoms ◦Episodic—sporadic exposure ◦Intermittent—less than 4 days/week or less than 4 weeks/year ◦Persistent—greater than 4 days/week or greater than 4 weeks/year ◦Exposure leads to IgE and inflammation Manifestations: ◦ Sneezing; watery, itchy eyes and nose; congestion, decreased smell, thin watery nasal drainage ◦Pale, boggy, swollen turbinates ◦Chronic exposure: headache, nasal congestion and sinus pressure, hoarseness; cough due to nasal polyps and post nasal drip Management: ◦Identify and avoid triggers ◦Reduce inflammation and symptoms ◦Corticosteroids; nasal and/or oral ◦Antihistamines; decongestants, LTRAs ◦Immunotherapy: allergy shots ◦Patient education: medications