1390 Final
Implementation of client teaching
-Make sure the patient is comfortable ~General medication principles ~do's and don'ts ~Information specific to a particular medication ~Teaching methods-videos or pictures
tertiary prevention
-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury
Evaluation of learning
-written exams -oral evaluation -return demonstrations -check-off lists/rubrics -simulation
Cephalocaudal
"Head to tail" Lower part of body grows later than the head
Proximodistal
"Near to far" Extremities grow later than head, chest, and trunk
Stages of the Family Life Cycle
1. Married couples 2. Childbearing families (birth to 30 months) 3. Preschool families (21/2 - 6 years) 4. Schoolchildren (6-13 yrs.) 5. Teenagers (13-20 yrs.) 6. Launching centers 7. Middle-age parents 8. Aging family members
CDC suggests longevity depends on
19% genetics 10% access to high quality health care 20% environmental factors (toxins, pollution) 51% on lifestyle factors:* not smoking* diet* exercise
growth pattern size
2-2.5 in per year (1-2 feet by age 12) 4-7 pounds per year. Lean, with narrow hips and shoulders. Decrease in baby fat. Males - more muscle Females - more adipose. Growing pains
Vision
20/20 by age 8. Age 10 = adult size•Large print recommended for reading. Regular vision testing
Brain structure
3 sections: Cerebrum Directs motor activities Thalamus Connects spinal cord and cerebrum Emotions and expressions Cerebellum Muscular coordination/balance
Freud's Stages of Psychosexual Development Phallic Stage
4 to 6 years Genital region - penis, clitoris Activities: masturbation, fantasy, play activities, questioning Major conflict: Oedipus/Electra
Solid food introduction
4-6 mos. Cereals 5-7 mos. Vegetables and fruits. 6-8 mos. Protein foods (cheese, yogurt, cooked beans) 9-10 mos. Finely chopped meat, toast, crackers 10-12 mos. Egg
MUSCULOSKELETAL SYSTEM
45% increase in skeletal growth Hands and feet out of proportion to body Large muscle groups develop faster Poor posture, disrupted balance, decreased coordination
Freud's Stages of Psychosexual Development Latency
6 years to puberty No special body focus. Diffuse activity and relationships.
Nutritional needs
70 calories/kg daily (1400 to 2100 calories/day 28 grams of protein 800mg calcium half veggies, 1/4 starch, 1/4 protein
Sleep-Rest Pattern
8 to 12 hours of sleep/night Fewer difficulties with going to bed Sleeping arrangements Culturally influenced: Own bed vs. bed sharing Sleep disturbances: Sleepwalking and sleep talking Disorders of arousal: Immaturity of nervous system; most outgrow with CNS maturation Consider safety, relaxation techniques, sleep preparation consistency
Role of Spirituality/Religion in Recovery 2
95% of Americans believe in God and 92% are affiliated with a specific religion (CASA, 2001) In a study of recovering and relapsing adults, those in recovery for 2 years had greater levels of faith and spirituality than those continuing to relapse
fetal stages
9th week to birth zygote, morula, blastocyst, embryo, fetus
health promotion
A condition of being sound, in body, mind and spirit Freedom from illness and pain
What does it mean to say a family is a system?
A family is greater than the sum of its parts. As members of a family system every member is interconnected. Think about a mobile. When one piece moves, the whole mobile moves. Movement of one affect the whole system.
Level of functioning
A person's ability to remain self-reliance, to maintain a sense of control and independence over self and environment. Loss of function is a sign of disease, ill health. ex. At their optimal level, can have a disability, like being deaf and if they can do sign lanauage. That is their optimal level.
Adaptive Model of Health
A person's measure of health is his or her ability to adjust positively to social, mental, and physiological change. Illness occurs when the person fails to adapt or becomes maladaptive to these changes.
What is Culture?
A set of ideals, values and assumptions about life that are widely shared among a group of people Provides organizational structure Various elements
Placenta
A structure that allows an embryo to be nourished with the mother's blood supply
Nursing Process
A systematic, rational method of planning and providing nursing care. It is cyclical: components follow a logical sequence , but more than one may be involved at one time.
Homeostasis
A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level
perception of risk
A way of interpreting the risk EX. risky to get tanned to then have skin cancer
DURING PLANNING, THE NURSE WILL....
A.Establish Priorities B.Write Client Goals/Outcomes And Develop An Evaluative Strategy C.Select Nursing Interventions D.Communicate The Plan
Newborn Delivery Room Assessments
ABCs Thermoregulation Evaporation Convection Conduction Radiation
Motor Skills
Abilities that depend on the use and control of muscles Mobility adds opportunities for learning. Be sure that environment is safe.
Spiritual Needs
Acceptance Personal worth & identity Forgiveness Hope Love Humor Faith Worship Meditation & prayer Peace
Leading causes of death
Accidents AIDS Cancer Heart disease Suicide At age 35, this reverses and illness and disease become more likely causes (for the 1st time since infancy)
Vision Changes
Accommodation of eye experiences sharpest decline.Adaptation to dark and driving at night difficult.Color vision affected by lens yellowing.
TYPES OF NURSING DIAGNOSES
Actual- Present at time of assessment. Risk- Likely to develop Possible- Evidence incomplete or unclear. Syndrome- Associated with a cluster of dx. Wellness-Desires a higher level of wellness
The preschool age family
Adapting to the needs and interests of preschool children. Coping with energy depletion and reduced privacy. Teaching self-control and spontaneity in children.
Identity vs. Role Confusion
Adolescence (12 to 20 yrs.) To develop a lasting, integrated sense of self.
Generativity vs. Stagnation
Adults' desire to leave legacies of themselves to the next generation, achieving immortality. Stagnation develops when they sense that they have done nothing for the next generation.
Vital Signs and Cardiovascular
Affected by size, gender and activity.•Gradually approach adult norms Lung capacity proportional to adult norms. Heart:-Apex of heart normal -Small in relation to rest of body.
The Young Adult
Age group from 18 to 40 Major task: preparing to assume adult responsibilities, rights and privileges A time of many firsts!!
Stage One: Mobilization of Energy
All bodily activity is increased in response to a stressor. Symptoms: Increase heart rate Rapid breathing Sweating Decreased digestion rate.
secondary sexual characteristics
Also secondary sexual characteristics the non-reproductive traits such as breast and hips in girls and facial hair and deepening of voice in boys develop. Pubic hair and hair in armpit grow in both.
Problem qualifiers
Altered (change from baseline) Impaired (made worse, weakened, damaged, reduced, deteriorated) Decreased (smaller in size, amount, or degree) Ineffective Acute Chronic
Recommendations for Modification of Physical and Functional Environment
Ambulation Low beds Encouragement Reality Orientation Clocks Calendars Increased sensory stimulation Lighting Glasses/hearing aids Functional Change
What is Religion?
An affiliation or a membership in a particular faith community that shares a set of beliefs, rituals, morals and sometimes a health code centered on a defined higher or transcendent power most frequently referred to as God.
left hemisphere of brain
Analytical processing language right hand right body side time sequencing right visual field Math, science, writing, logic
Common Nursing Diagnoses
Anxiety/fear RT situational crisis, threat to role functioning, change in environment Powerlessness RT health care environment Interrupted family processes RT situational crisis Anticipatory grieving RT potential loss of child, imminent death of child Caregiver Role Strain r/t chronically ill loved one Parental Role Conflict
Cardiovascular Changes
Arterial walls thicken with fatty deposits and connective tissue. Heart muscles less elastic. BP rises to compensate for lowered O2. Takes longer for heart to respond to activity or stress.
Family Apgar
Assesses family function, ability to adapt, grow develop, and resolve issues.. Adaptation Partnership Growth Affection Resolve
Assessment for learning
Assessing learning needs, it starts with what the patient needs to know how to function more independently, Baseline knowledge Cultural and language needs Priorities
Steps in the Nursing Process ADPIE (A Delicious PIE)
Assessment Diagnosis Planning Implementation Evaluation
Constructing Reality
Assimilation Accommodation Adaptation
Andropause
Associated with decrease in testosterone•Symptoms are more gradual. At risk for osteoporosis and cardiovascular problems without treatment. Increase in sex hormone binding globulin (SHBG). Testosterone not affected by SHBG is available for use.
Puberty
Attainment of sexual maturity and the ability to have children. Females - Menarche Males - First emission of semen that contains viable sperm cells. Primary vs Secondary sex characteristics
Height Changes
Average newborn is 20 inches long. Average 1 year old is about 30 inches long. Hereditary factors more strongly influence height than weight.
Hispanics
Avoidance of eye contact sign of attentiveness and respect. Touching observed Curandero, espiritualista, yerbero Spiritual strength
Have you "ASKED" yourself the right questions??
Awareness Skill Knowledge Encounters Desire
The teenage family
Balancing freedom with responsibility as teen mature and emancipate themselves. Establishing post-child rearing interests as growing parents.
Blastocyst
Ball of cells formed from morula.
Family
Basic Social Unit Group of two or more persons related by birth, marriage, or adoption and living together. A group of intimates with a history and a future. Changes to reflect today's structural and functional changes.
Cultural Nursing Assessment
Be aware of the environment. Know about community social organizations. Select a strategy. Identify a confidante Know the appropriate questions Interview other professionals who have worked with the group.
Family Nursing Intervention Techniques
Behavior modificationCase management and coordination Collaborative strategies Contracting Counseling, including support, cognitive, reappraisal, and reframingEmpowering families through active participation Environmental modification Family advocacy Family crisis intervention Networking, including use of self-help groups and social support
Erikson's definition of love
Being able to put aside differences through a mutual devotion to each other. Can be found in the love of one's neighbor, coworker Must be reciprocal
Health Beliefs (hispanics)
Believed to be consequences of God's approval or disapproval of a person's behavior. Mal de ojo (evil eye) Santeria
HRT
Benefits Reduced osteoporosis, heart disease risk Reduced incontinence risk Decreased vaginal dryness & irritation. Decreased hot flashes. Increased energy. Risks Increased risk of endometrial and breast cancer. Increased risk of gallbladder disease. Potential side effects: Bloating, fluid retention, breast tenderness, headaches, mood changes, and nausea.
Components of a Nursing Health History:
Biographic Data Chief complaint History of present illness Past history Family history Lifestyle Social data Psychologic data Patterns of health care
Freud - Oral Stage
Birth to 18 months Interest in oral gratification from sucking, eating, mouthing, biting.
Visual Changes
Blurry at first. Within a week they can focus on objects that are 7 to 10 inches away. One month = 3 feet away 3 ½ months = almost as good as young adults.
Erikson - Intimacy vs. Isolation
Body and ego must be masters of organ modes and of other nuclear conflicts. Avoidance of experiences leads to isolation and self-absorption.
Stage Two: Exhaustion or consuming energy
Body begins to release stored sugars and fats, using up its bodily resources. Symptoms: Feeling driven Feeling pressured Tiredness and fatigueIncrease in smoking, coffee drinking and or alcohol consumption. Anxiety Memory loss Acute illnesses such as cold and flu
Growth Patterns
Body weight doubles Spend much energy on physical activity and play. Eat much more than preschoolers.
Basis of Freud's theory
Born with ID Pleasure principle Tension Primary process thinking EGO Reality principle Secondary process thinking
Nuclear families
Both natural parents and siblings
NEUROLOGIC SYSTEM
Brain is reshaped Neurons, gray matter, and synapses proliferate in cerebral cortex and then prune in adolescence.Myelin coat continues to accumulate Greater capacity for complex physical and cognitive skills
Neuromuscular
Brain is very active Glucose metabolism by brain cells is twice that of adult brain By age 12, brain is adult size.
How can you reduce stress?
Breathing exercises Stretching exercises Walking Sleep
Stressors
Can be both pleasant and unpleasant events Long-term, continuous exposure may result in a reduction of body's ability to deal with stress
Selective Attention
Can select, attend to, and coordinate impulses from all neurologic regions simultaneously through use of both active and inactive processes.
SYSTEM REPORTS....
Cardiac Pulmonary Gastrointestinal GenitourinaryImmune system Sensory Teeth
Cardiopulmonary changes
Cardiovascular disease increases considerably. Fatty deposits and scar tissue slowly accumulate in blood vessel linings. Blood pressure rises. About 55, proteins in lung tissue become less elastic
Nursing Roles
Care and education of the Mother Pregnancy related changes Consider issues of family Role changes Preparation for parenthood Care of the fetus as it transitions to a new born Safe Passage
Development
Changes in skill and capacity to function. Qualitative Maturation of physical and mental capacities and learning.
Growth
Changes in structure and size Patterns Quantitative
mortality rates
Chronic Disease main cause of death *Heart disease *Cancer *Cerebrovascular disease First half: cancer Second half: heart disease
Realistic approach
Client's energy level, Client's age, Client's emotional state
Sexuality
Climacteric - midlife transition when fertility declines Hormonal changes Menopause Andropause
The teaching methods are
Cognitive Affective Psychomotor
NURSING DIAGNOSIS
Communicate the professional judgments that nurses make every day to our patients, colleagues, members of other disciplines and the public. Define what we know - they are our words.
Cultural group variations
Communication Space Social organization Time perception Environmental control Biological variations Dietary practices Socioeconomic factors
Cognitive Development
Concrete Operations: the development of mental operations: cognitive actions that can be performed on objects or ideas that consistently yield results.
Musculoskeletal System
Continued Ossification Hand Manipulative skills similar to adults: females outperform males. Improved coordination Play advances brain development.
Negotiation
Contract how much you going to teach the patient. Lesson plan
Allantois
Contributes to cardiovascular system
The aging family
Coping with loss including health, job (retirement), loved ones and /or spouse, home, expectations.
Activity-Exercise Pattern
Critical time to acquire and foster activity behaviors Types of activities Group: Little League baseball, soccer Individual: Gymnastics, ballet Unorganized play: Bike riding, rollerblading•Play activities Promote social, personal, cognitive development Focus on fun, connections to peers and family
cognitive development
Crystallized intelligence - acquired store of information, skills, strategies - increases Fluid intelligence - ability to deal with new situations - declines.
The process of cultural competence in the delivery of Healthcare services
Cultural Awareness Cultural Encounters Cultural Knowledge Cultural Skill Bottom of the volcano: Cultural Desire
Developmental Testing
DDST Allow for Prematurity up to 24 months. Areas to assess: Gross Motor Language Fine Motor-Adaptive Personal- Social
immunization at 4 months
DTaP, RV, IPV, Hib, PCV
Human Ecology Theory
Deals with the relationship between humans and their (natural) environment. Human ecology investigates how humans and human societies interact with nature and with their environment. uses a holistic approach to help people solve problems and enhance human potential within their near environments - their clothing, family, home, and community.
Middle Adulthood: Age and Physical Changes
Decreased functional capacity Decreasing cardiac output. Decreased bone mass Osteopenia Osteoporosis
Digestive Changes
Decreased motility results in slower emptying of the stomach. Decreased digestive enzymes - poor appetite and digestive disturbances. Slowed gag reflex Slowed peristalsis
Role Performance Model of Health
Defines health in terms of individuals' ability to perform social roles. Illness would be the failure to perform roles at the level of others in society.
Sequential Trends
Definite, predictable sequence. Orderly and continuous.
Ears
Degenerative changes in bones of middle ear result in decrease of hearing ability. Difficult to locate sound Repeat words to ensure clear communication. A man's voice is easier to hear than the higher pitches of a woman's voice.
Mental Health
Depression Suicide Must be realistic, use strengths and coping strategies to deal with physiologic changes and set goals that are positive and attainable.
Health Responsibilities
Developing members' sense of personal identity and self-worth. Emotional support and guidance during life cycle transition. Socialization of family members to value and maintain health. Education about when and how to use the health care system. Care provision and management for chronically ill, disabled, and aging family members.
Teething
Development starts at 6th week of pregnancy. Baby teeth at about 2 to 7 months. Complete set in 20 weeks. (time varies) Teething can be painful.
Carnegie stages
Developmental stages in vertebrates Only covers embryonic development Does not cover fetal development Categorized by visible structures Applicable to a wide variety of species Applicable to different developmental rates Not days or size
Hearing
Develops in fetal development and is fully functioning at birth. Hearing testing done in newborn nursery.
Asians
Direct eye contact disrespectful Balance between the yin and yang energy forces. Hot and cold foods and states. Biological variations: Thalassemia Skin color Mongolian spots
Experience involving action
Discovery of properties of objects. Social interaction
Dementia
Disease marked by a gradual loss of cognitive functioning which can also incorporate losses of motor, emotional, and social functioning. Permanent and progressive...people unable to care for themselves. Most commmon Alzheimers lesser common: Vascular, Lewy body, Frontotemperol
Important Alternative Stages
Divorce Blending Relocating Working outside the home (after a period of near full-time parenting. Long-term illness or disability.
WHAT CAN YOU DO?
Don't criticize or compare to others. Encourage sleep. Model healthy eating habits. Encourage physical activity. Provide honest answers about sex. Understand need for physical space. Be patient with grooming habits.
WHAT CAN YOU DO? COGNITIVE DEVELOPMENT
Don't take it personally when teens discount your experience. Get teen involved in discussing their behavioral rules and consequences. Provide opportunities to participate in controlled risky behavior. Opportunities for community service.T alk about their views and be open to discussing your own. Build a genuine relationship with teen.
EMERGENCY ASSESSMENT
During any physiologic or psychologic crisis of the client. Identifies life-threatening problems. Example: Rapid assessment of person's airway during a choking episode.
Construction Ahead
During late childhood, neurons increase their number of connections. But around 11 - GIRLS; 12½ - BOYS Some of these connections are pruned off.
Basic Elements (Family systems theory)
Each action or change affects every other person in the family. It is a complex whole that cannot be understood by examining members separately. Roles: patterns of interaction become ingrained habits that make change difficult. Family rules are self-regulating and peculiar to itself. Boundaries must be maintained. Adaptation Changes are caused by normative and non-normative stresses.
Developmental Pace
Each child develops at their own pace. Some excel in language but are slower on motor skills and vice versa. What is really worrisome is if there is a reverse in developmental achievement.
Initiative vs. Guilt
Early childhood (preschool years, 3-5 yrs.) To develop the ability to try new things and to handle failure
Elimination Pattern (young adult)
Eating disorders - May persistCommon complaints:Constipation Hemorrhoids Occasional diarrhea Teaching Report changes in elimination patterns or blood in stool: though colon cancer risk low during this age group Adequate fluids, eating fruit/vegetables (high in fiber) to promote bowel health
secondary prevention
Efforts to limit the effects of an injury or illness that you cannot completely prevent. Ex. Labs- Blood work and mammograms
primary prevention
Efforts to prevent an injury or illness from ever occurring.
SUPEREGO
Ego Ideal Perfection to which one aspires Corresponds to what parents taught was good. Conscience Responsible for guilt feelings Corresponds to what parents taught was bad.
Other Important Issues to Consider
Elder Abuse Polypharmacy Placement Alternatives Nursing homes Assisted Living Independent apartments
Gastrula
Embryo composed of three tissues.
Principles of Elder Care
Encourage confidence. Raise self-image. Provide empowerment. Demonstrate kind, caring manner Identify and include family and support systems. Actively listen. Integrate spirituality, hope and faith. Assist in setting personal goals. Monitor exercise and nutrition. Follow-up on health concerns.
WHAT CAN YOU DO? TEENAGE BEHAVIORS ISSUES
Encourage involvement in multiple groups or activities. Praise teens for efforts as well as abilities Help explore career goals and options. Let them establish guidelines and consequences. Establish rituals for marking significant passages. Know peer group. Structured environment.
SAFETY ISSUES
Encouragedriver education; serve as positive role model. Teach safety rules for water sports. Needs guidance for safe and reasonable job rules. Sexual education. Drug and alcohol discussion.
Prostate changes
Enlarged Prostate 1 in 5 men
Teratogenic Effect
Environmental substance or agent that interrupts normal that interrupts normal development and causes malformations. Timing is more important than the nature of insult. Most critical embryonic period
Epigenetic Theory of Personality Development
Eric Erikson Personality develops in a series of stages. Describes the impact of social experience across the whole lifespan. Conflict presents a turning point.
Role allocation and accountability
Establish clear roles. Allow for flexibility. Allocate roles fairly. Be responsible in fulfilling family roles.
FIVE PSYCHOSOCIAL ISSUES
Establishing an identity Establishing autonomy Establishing intimacy. Becoming comfortable with one's sexuality. Achievement.
Structural-Functional Theory
Examines the family in terms of its relationship with other major social structures (institutions) Emphasis placed on basic functions of families How well structure allows the family to perform its functions.
Physical fitness
Exercise and diet are required to reach full potential. No more than 10% of Americans exercise enough to attain good physical shape. 150 minutes needed per week.
Growth
Exhibits considerable change in physical appearance. Hypertrophic (size) vs. hyperplastic Rate is slow and steady with accelerations in spring and fall and by rapid growth during preadolescence.
What is Spirituality?
Exploring the meaning of life. Expressing self through music, literature, art and nature Connecting with other people Communicating with a higher power Personal and universal
FICA spiritual assessment tool
F: Faith and beliefs I: Importance and influence C: Community A: Address
Sexuality: Older Adult
Factors that influence sexuality: Attitude/Interest Body image perception Mental function Social contact Environment/privacy Sexual Health Urinary function Mobility ED/menopause Illness Medications.
Family Systems Theory
Families are SYSTEMS of interconnected and interdependentindividuals. To understand the individual, we must understand the family system of that individual. People cannot be understood in isolation from one another.
Risk factors - Alzheimers
Family History - a clear inherited pattern exists in approximately 10% of cases Down's Syndrome - Nearly 100% of people who live into their 40's Chronic Hypertension - Treatment reduces the risk Head Injuries - Three times more likely to develop AD Gender - inclusive data. Some studies show a greater risk for females while others show an increased risk for males.
Developmental Family Theory
Family Life Cycle and developmental tasks. Explains patterned change, dynamic nature, and how change occurs in life cycle. Success= adapt to changing needs and demands and ensure family survival.
Effect on Growth and Development
Family Size Spacing of Siblings Divorce Stepchildren and Foster Children Chronic Illness Use of Health Care system
Theoretical Approaches to the Family
Family Systems Theory Developmental Theory Structural - Functional Theory Role Theory Human Ecology Theory
Roles-Relationships Pattern
Family environment Provides sense of security Increasing independence and maturity Begin to reduce parental authority/structure Broaden interests outside home Clubs, sports, gangs More responsibility in home and community Pets, chores, earn allowances
Assumptions Structural-Functional Theory
Family is a social system with functional requirements. Small group features. Social systems accomplish functions that serve individuals and society. Families socialize individuals with norms and values.
Cultural Values (Asians)
Family is extended. Family's interests and honor supersede those of individual. Elders are respected and unquestioned. Avoid conflict.
African Americans (family)
Family is the strongest institution. Extended kinship bonds. Consult family members and relatives before health care providers.
Friendships
Female: confide in one another about feelings problems and interpersonal relationships. Male: minimize discussions about relationships. Find things to do together of mutual interest.
NUTRITION
Females 11 - 14 need 2200 calories Females 15 - 18 need 2100 calories Males 11 - 14 need 2700 calories. Males 15 - 18 need 2800 calories. Protein 45 - 56 grams daily. Calcium 1200 mg daily.
Biological Agents
Fewer infections than preschool child Common infections Upper respiratory infections (viral) Streptococcal infection, otitis media (bacterial) Gastroenteritis (viral) Scabies/lice (skin infestations) AIDS Lower risk; education starting at age 8 recommended Immunization (late childhood/early adolescence) Meningococcal vaccination (age 11-12) Hepatitis B series, if not completed in early childhood Human papilloma virus (HPV) Varicella (if no history of chickenpox)
Generational changes
First generation Second generation Third generation
Yolk sac
First site of red blood cell formation.
The elementary school-age family
Fitting into the community of elementary school-age families in constructive ways. Encouraging educational achievement and working with school personnel.
Tanner stages
Five stages of sexual development in adolescence evaluating pubic hair, genitals and breast development
early stage of dementia
Forgetfulness to confusion to disorientation Check problem solving, judgment, decision-making, orientation, personality changes
PIAGET - FORMAL OPERATIONS
Form of intellectual processing that is abstract, speculative, and independent of the immediate environment and circumstances. Hallmark = logical and systematic hypothesis testing. Able to plan and think ahead.
The Body's Imbalance (hispanics)
Four body fluids (humors) Blood (hot & wet) Yellow bile (hot & dry) Phlegm (cold & wet) Black bile (cold & dry)
extraembryonic membranes
Four membranes (yolk sac, amnion, chorion, allantois) that support the developing embryo in reptiles, birds, and mammals.
First Habits and Primary Circular Reactions
From 1 to 4 months Begin to coordinate what where separate actions into single, integrated activities. Combines sucking with grasping or staring with touching.
Tertiary Circular Reactions
From 12 to 18 months Deliberate variation of actions that bring desirable consequences. Experiment to observe the consequences. Drops a toy repeatedly, varying the position, to see where it falls.
Beginnings of thought
From 18 months to 2 years. Capacity for mental representation or symbolic thought. Imagine where objects that they cannot see might be.
Coordination of Secondary Circular Reactions
From 8 to 12 months Begins to use more calculated approaches to producing events. Object permanence Pushes a toy out of the way to reach another.
Urinary System
Functionally mature during school years. Kidneys double in size between 5 and 10. Bladder capacity increased, especially in females.
Biological Theories of Aging
Genetic Programmed to age by biological clockWear and Tear Cells are damaged by over use and abuse. Neuroendocrine Drop in hormone level causes decline in ability to repair and regulate itself. Free Radical
Influences on growth
Genetic factors Prenatal and postnatal exposure Nutrition Environmental factors Health/Illness
Six causes of acne
Genetics Bacteria Hormones Lack of sleep Cosmetic Food
The Genogram: A Tool for Understanding Processes in the Family
Genograms are charts or graphs that diagram the biological and interpersonal relationships among family members across several generations. They identify significant events in intergenerational relationships that can have an influence on families and individuals.
Stages of Development
Germinal - 10 days to 2 weeks after fertilization Embryonic - 2 to 8 weeks Fetal - 8 weeks until birth
Perception
Getting and interpreting information from stimuli. By 2-4 months perception sophisticated. Depth perception in fourth month.
Healthy People 2020
Goal: Document and track population-based measures of health and well-being for early and middle childhood populations. Positive parenting Sleep quality School health education ADHD treatment Reduce frequent ear infections Reduce vision loss Reduce obesity
Motor Skills
Gross Motor By 6: hopping, jumping 6-7: climbing, pedaling/balancing on a bike 8-10: Better balance, coordination and strength. Fine motor: By 6-7: tie shoes, hold pencil as adults, fasten buttons, zippers, brush teeth, wash themselves, coordinate a knife and fork, skill at using chopstick improves.
Assumptions developmental family theory
Growth is going to happen. Change happens over a period of time. Consider the challenges they face, how well they resolve them, how they transition to the next stage. The family is dynamic and should be analyzed as to mastering tasks.
Head Development
Growth nearly complete. Loss of first baby tooth considered beginning of middle school years. Automatization = thoughts and actions become routine
COGNITIVE DEVELOPMENT
Have Developed Advanced reasoning skills Abstract thinking skills Ability to think about thinking = meta-cognition
Birth of the first child
Having, adjusting to, and encouraging development of infant. Becoming a parent. Maintaining spouse relationship
Patterns of Physical Development
Head to Foot (Cephalocaudal): Lift head, then arm control, hands follow and then walking around.
Health Concerns/ Risk Factors for the Young Adult
Health Risks Violence Substance Abuse Unwanted pregnancies STDs Occupational, environmental risk factors Lifestyle Concerns Smoking Stress Exercise patterns Personal hygiene Familial history Infertility
Age and Physical Changes
Healthiest period, optimal muscle strength (age 25 to 30), manual dexterity peaks. Gender difference Full growth: women age 17, men age 21 Longevity: women > men, women are biologically stronger than men, outlive men, outnumber men. Health care seeking: women > men Maternal mortality stable.
Types of acne pimples
Healthy whitehead blackHEAD Papule Pustule
PHYSICAL GROWTH (BY AGE 18)
Height and weight Spurt lasts 24 - 36 monthsStops at 16-17 girls, 18-20 boys Vital signs Approximately those of an adult.
HOW DO THESE CHANGES AFFECT TEENS? COGNITIVE DEVELOPMENT
Heightened level of self-consciousness. Tend to believe that no one else has ever experienced similar feelings and emotions. Personal fable beliefsVery cause-oriented. Exhibit justice orientation.
Helping People Learn to Nurture Their Spirits
Help them discover their purpose in life by tapping into what they are passionate about Teach them to pray and meditate Help them live one day at a time Help them realize that some parts of life can be managed and others cannot. Serenity is found when people understand and accept what can be controlled and what cannot
Helping People Learn to Nurture Their Spirits 2
Help them learn to transcend the material world•Help them feel okay about themselves Help them see how they are part of nature Show them how to focus their thoughts on triumph and hope rather than despair and defeat Help them not expect others to bring them happiness and make their lives complete Help them to count their blessings each day
Immunizations at birth
Hep B (1 of 3) usually before hospital discharge **If mom HBsAg-positive, administer immunoglobulin and vaccine within 12 hours of birth
What determines intellectual development?
Heredity: approximately 40-60%•Environment:-Early enrichment-Varied experiences-Preschool-Responsive parents
Changes in girls
Hips and thighs widen - to make room for baby Growth of pubic hair Warmth (primary) Visual indicator of sexual maturity collection of secreted pheromones Breast develop - to feed a baby
Cognitive-Developmental theory
How children construct knowledge and how their constructions change over time. Piaget Need adequate environmental stimuli and intact neurological system.
Nursing impact
How does illness alter family structure? What family roles were changed with the onset of a chronic illness?Intervention necessary when changes in family structure alter ability to function.
Hormonal Influences
Human Chorionic Gonadotropin (hCG) Progesterone Estrogen RelaxinRelaxin Human Chorionic Sommatotropin Human Placental
Taoism (Asians)
Humans are microcosms within universe. Yin = feminine, negative, dark and cold Yang = masculine, positive, light and warm. Chi = innate energy Jing = Sexual energy
Blood pressure risks
Hypertension results from increases in cardiac output, or increases in peripheral resistance, or a combination of both and is the 3rd leading cause of death worldwide. Goal BP 120/80 or less: risks begins at: - Systolic of 115 mm Hg - Diastolic of 75 mm Hg
Erikson - Industry vs Inferiority
I am what I can achieve... Needs to perform and produce good results. Try not to compare children or focus on failures.
ETIOLOGY (RELATED FACTORS AND RISK FACTORS)
Identifies one or more probable causes of the health problem Gives direction to the required nursing therapy Enables individualization.
Stage Three: Draining Energy Stores
If stressful situation is not resolved, you may become chronically stressed. The body's need for energy resources exceeds its ability to produce them. Symptoms: Heart disease Ulcers Mental illnessInsomnia Errors in judgment Personality changes.
Environmental Controls
Illuminate stairways and provide light switches at both the top and bottom of stairs. Avoid high-gloss floor finishes Nightlights Handrails Tack down carpeting, non-skid treads. No area rugs Grab bars on bathroom walls and nonskid mats in tubs.
Neurologic System
Immature but developing at a rapid rate... Constant stimulation is necessary to maintain growth and development or function is lost.
African Americans
Importance of prayer Touching hair is offensive. Direct eye contact is considered rude. Biological variations Keloid formations Mongolian spots Skin color
Client Education
Important to educate patients Teaching correctly helps reduce costs of health care and improve quality of care
beginnings of family systems theory
In the 1950s Dr. Murry Bowen introduced a transformational theory, family systems theory.
Metabolic syndrome
Includes a group of cardiovascular risk factors associated with overweight and obesity, in particular abdominal obesity Includes: lethal high lipid levels (hypercholesteremia) Insulin resistance (diabetes)High blood pressure (hypertension)Initial therapy: lifestyle alterations, weight management and increased physical activity
Extended families
Includes other people - grandparents, aunts/uncles, cousins
Other advantages to regular exercise
Increases cardiovascular fitness. Lung capacity increases. Muscles become stronger. Body becomes more flexible and maneuverable. Reduces osteoporosis Optimizes the immune response. Decreases stress, anxiety and depression. Increases sense of control and feelings of accomplishment. Increases longevity A lack of exercise may lead to poor health in general, but health risks in general, but health risks in general are low during early adulthood. Young adults are less susceptible to colds and illnesses. Good immune systems. Tendency to exercise More likely to die in accidents (usually car related) than most other causes.
BRAIN AND THE WHITE MATTER
Increases up to the age of 40. Composed of fatty myelin that surrounds and insulates nerve cells, allowing them to conduct information faster and more efficiently. Able to think and solve problems efficiently continues to expand. Not uniform: sensory coordination thought.
Trust vs. Mistrust
Infancy (first year) Develops trust of others to meet one's own needs and begins to trust oneself and others. World will be a good and pleasant place to live.
Embryonic disk
Inner mass of cells of blastocyst.
Religion (African)
Integral part of community. Second most important institution: Place to meet Provides social welfare services. Stabilizing force of community, Facilitates social action, Transmits cultural history Provides coping mechanisms.
Marriage
Investment in spouse as major emotional source Developing common expectations about parenthood. Interdependence.
Achievement
Involves a child's acquired competencies or performance.
Older Adult: Integrity vs. Despair
Involves the process by which people try to make sense of their lives. Life review Adjusting to retirement Adjusting to and accepting the frailties of aging and changes in physical appearance and lifestyles
Age 24
Judgment Emotion Motivation Physical coordination, sensory processing on balance
Rules to build the brain
Keep it simple and natural. Match experiences to mental capacities Practice makes perfect. Active involvement Provide variety without overwhelming themAvoid pushing the child Learn better if emotionally involved.
Integrity vs. Despair
Late Life (66 and older) To view one's life as satisfactory and worth living.
Cognitive-Perceptual Pattern (school age)
Learning disabilities (5%-10% of children) Attention-deficit/hyperactivity disorder (ADHD) Difficult to assess: varying symptoms in different settings with different people Treatment controversial: Behavior management, counseling, nutrition, medication Nurse's role varies Includes detection, referral, collaboration on plan, counseling, liaison with family Legislation Individuals with Disabilities Education Act of 1997 Section 504 of Rehabilitation Act of 1973
Role Theory
Life is structured according to roles that are ascribed or assumed. Complementary roles Role reciprocity Role conflict (forced to choose) Role strain (unable to fulfill) Role overload The establishment of clear roles within a family is directly connected to their ability to deal with day-to-day life, crises and changes.
Treatment
Lifestyle changes (increase exercise, stress reduction and good nutrition) Testosterone replacement Patches Gels Capsules Injections
Critical Period
Limited time in which an event can occur, usually to result in some kind of transformation.
Height and weight
Lose a half inch of height per decade beginning in their forties. Body fat is 20% or more. Many gain weight. If 30% or more overweight, probability of dying in middle adulthood increases by about 40%. Increases probability of chronic illnesses.
Eyes
Loss of cells in optic nerve makes it difficult to see details. Pupil opens and closes more slowly so need to adapt to surroundings. Cataracts develop.
Changes in Hearing
Loss of high-pitched sounds: Presbyopia Men are more prone to hearing loss than women Because the two ears are not always equally affected by hearing loss, sound localization diminished. Some can be helped by hearing aids.
Immune System
Lymphoid tissues reach height of dev't by 7. Enlargement of adenoids and tonsil normal Frontal sinuses potential for infection.
Health Traditions (African)
Maintained with a proper diet. Asafetida - prevent contagious illness Cod-liver oil - cold prevention Copper or silver bracelets protect wearer
Preventing Stress
Make decisions Avoid procrastination Delegate tasks.
Myelin and axons
Makes it easier for signal transmission. Axons coated at birth are those that control basic instincts. Motor abilities, vision and hearing coated first.
Hemispheric specialization
Makes the brain more efficient -Language, logic, memory, and spatial knowledge more complex. Prefrontal cortex development -Better control emotional outbursts and responds to routines.
Middle age :anticipatory guidance
Mammogram Hemoccult Colonoscopy Thyroid testing Lipid profile Bone Density Cardiovascular screening Vaccines: flu, tetanus/diphtheria, cocooning (pertussis)
Developmental Theories
Maslow - hierarchy of needs Freud- psychoanalysis, sexual Erikson - social development Piaget - cognitive development Focus on changes in physiology, psychology, and behavior. Influenced by culture, environment, past experiences, family, health status, and individual reactions.
Four Factors to Stimulate Mental Development
Maturation of nervous and endocrine systems which provides physical capabilities.
Maturity and Adulthood
Maturity is reached when a balance of growth in th physiological, psychosocial, and cognitive areas has been attained. Characteristics of Maturity Accepts constructive criticism Open to suggestion Learns from own and others experiences Accepts responsibility for their own mistakes
Values in Family Systems Theory
Means of interpreting events and information Pass from generation to generation Continually evolve Identify usability of information.
DURING EVALUATING, THE NURSE WILL...
Measure the Client's Achievement Of Desired Goals/Outcomes Identify Factors That Contribute To The Client's Success Or Failure Modify The Plan Of Care, If Indicated
Importance of Stimuli
Mechanisms: Progressive complex arborization of dendrites. Increase vascularization degree. Increase myelinization process.
Cultural competence Helps nurses to
Meet the cultural needs of clients who are from a different culture Decrease the cost of health care and increase opportunities for positive outcomes Facilitate achievement of specific objectives of Healthy people 2010.
Perimenopause
Menopause is the time when periods completely cease Perimenopause is the transitional period. 5-15 years Symptoms Changes in cycles.
School age years
Middle = 6 - 8 years Late = 8 - 12 years Juvenile Preadolescence-Prepubescence
Generativity vs. Isolation
Middle Adulthood (45 - 65 yrs.) To contribute to younger people, through child rearing, child care, or other productive work.
Physical Changes
Middle age is a window through which we can glimpse later life while there is still time to engage in prevention and to influence some of the course of aging. Changes are usually gradual, rates vary from one individual to another.
Industry vs. Inferiority
Middle and late childhood (elementary school years, 6 to puberty) To learn basic skills and to work with others.
Physical Development and Stress in Early Adulthood
Most people are at the peak of their physical capabilities. The brain continues to grow in both size and weight, reaching its maximum in early adulthood. Brain wave patterns show changes (more mature patterns). The senses are as sharp as they will ever be. No significant vision deterioration until 40's Hearing at its peak Taste, smell, sensitivity to touch good. Most professional athletes are at their peak during early adulthood.
Assessing Learning Readiness
Motivation Compliance Sensory and Physical State Literacy Level Age
Safety Promotion and Injury Control
Motor vehicle-Fires, falls, drownings, poisoning, bicycling, skateboards, roller skates, and sports equipment. High risk takers
Using a translator
Must have knowledge of health related terms. Watch for nonverbal behavior. Use family cautiously. Sexual questions by same gender Avoid jargon...Watch confidentiality.
Dependent (NURSING INTERVENTIONS)
Must have or obtain physician's order to implement this intervention.
Genital Utopia
Mutuality of orgasm with a loved partner of opposite sex with whom one is willing and able to share a trust and... With whom one is willing and able to regulate the cycles of work, procreation and recreation so as to secure to the offspring all the stages of satisfactory development.
Nervous System Changes
Neurons atrophy. Transmission sluggish. Blood flow slows due to fatty deposits within blood vessels. Motor responses and reaction time to stimulus is delayed. Maintaining environmental safety necessary.
How the brain works
Neurons sprout arms called dendrites and axons. Synapses are where messages are sent. The more times axon and dendrite connect, stronger and quicker messages.
Nursing Application
Nurses working with school-age children have a unique and exciting opportunity to engage the child in health-promoting behaviors These behaviors can be taught to the child through Spending time demonstrating, monitoring, and reinforcing preventive health practices Age-appropriate reading, materials, modeling, and role-playing
Role of Spirituality/Religion in Recovery
Nursing journals report religious patients and their families better able to cope with illness and less likely to commit suicide Belief in benevolence of God was related to positive mental health outcomes For many alcoholics, religion is an important part of the recovery process. Many recovering individuals acknowledge the role of spirituality in their ability to engage in and maintain sobriety
Nutritional-Metabolic Pattern
Nutritional guidelines Well-balanced diet: 1200 to 1800 kcal/day Factors influencing food intake Access to food: Lack of nutritious food, make own snacksMass media influence: Billboards, TV Contemporary busy lifestyles: Skip meals, eat out Nutritional educationSchool programs Dietary guidelines
Nutrition
One of the most important variables for fetal health and prevention of complications Weight gains Effects
PROBLEM-FOCUSEDASSESSMENT
Ongoing process integrated with nursing care. Determines the status of a specific problem identified in an earlier assessment. Example: hourly assessment of fluid intake and urinary output.
Freud's Stages of Psychosexual Development Oral
Oral 0 - 18 months Mouth is major source of gratification and exploration. Major conflict - weaning.
Major Health Risks
Osteoporosis Bone loss is most rapid in first 5 - 7 yrs after Heart Disease Leading cause of death Urinary Incontinence Thinning of urethra and bladder tissues Result = decreased bladder tone and frequency
TAKE HOME FOR PARENTS
P = Promote activities that capitalize on the strengths of the developing brain A = Assist your child with challenges that require planning R = Reinforce their seeking advice from you and other adults E = Educateabout risk taking and negative consequences N= Never underestimate alcohol effects on developing brain T = Tolerate the "oops" behaviors due to an immature brain
Risk Influences
Parental Age Teens Low birth weight Higher mortality Nutrition competition Elderly Prematurity Low birth weight Chromosomal problems Multiple pregnancy
Helping People Learn to Nurture Their Spirits 3
Participation in church, synagogue, or mosque services for those who find this important Help them figure out what gives them inner peace, comfort, strength, love, and a feeling of connection Help them figure out what moves them deeply Help them learn to be still and listen to inner voice Help them protect themselves against toxic people
Helping People Learn to Nurture Their Spirits 4
Participation in church, synagogue, or mosque services for those who find this important Help them figure out what gives them inner peace, comfort, strength, love, and a feeling of connection Help them figure out what moves them deeply Help them learn to be still and listen to inner voice Help them protect themselves against toxic people
Parts of a goal
Patient -centered Measureable action Specific time frame- SHORT TERM LONG TERM One goal should show problem resolution.The rest could be steps to resolution. Example: Patient will get out of bed by himself and into a chair by 0730 on Wednesday, September 16, 2020 Short terms: dangling, standing, moving to a chair.....
Family Assessment
Patient is the family Family APGAR Cultural/religious influences Support network Family type Communication patterns Functional burden
INITIAL ASSESSMENT
Performed within specified time after admission to a health care agency. Establishes a complete data base for problem identification, reference, and future comparison.
Senescence
Period in an adult's life in which the body begins to age and weaken. Young old: 65-75 Old: 76-84 Old- old: 85 - 99 Elite-old: 100 yrs +Geriatrics: the study of old age
COMMON HEALTH PROBLEMS
Physical Acne, STDs, HIV, unwanted pregnancy Chronic Diabetes, Cystic Fibrosis Behavioral Anorexia Nervosa, Bulimia, Substance Abuse, Attempted Suicide.
signs and symptoms
Physical No menses Thinning of genital-urinary tissues Hot flashes Night sweats/insomnia Less firm breasts Increased facial hair Thinning scalp hair Less elastic skin Decreased muscle mass & increased fat. Emotional Symptoms Fatigue caused by sleep deprivation Mood Swings Forgetfulness Decreased Sex Drive Depression
Interaction of many factors: Fetus
Physical Changes
Health maintenance for advanced old age
Physical Exercise Use it or lose it. Occupational activities. Adjusting to retirement. Nutrition Challenged by dental loss, denture adaptation, slowed digestion, constipation, and decline in ability to cook.
Elimination Pattern (school age)
Physical ability Most: Full bowel/bladder control Enuresis Primary vs. secondary Nocturnal vs. diurnal enuresis Behavior management strategies; drug therapy
Implications of Arrested Development for Adolescent Behavior
Physical activities benefit from earlier "back of the brain" development Complex, judgment-demanding thinking are compromised by later "front of the brain" development Preference for physical activity Poor planning and judgment More risky, impulsive behaviors Minimal consideration of negative consequences
FREUD - GENITAL STAGE
Physical focus: genitals Theme: maturation and creation and enhancement of life. Intellectual and artistic creativity. Balance of love and work achieved at the end.
SURVIVAL
Physical tasks of breathing, sucking, eating, digesting, eliminating and sleeping.
Growth and Development of the Young Adult
Physiological Few maturational changes Experience severe illness less Physical changes occur as middle age approaches Personal life-style assessment Cognitive Critical thinking abilities increase with experiences Develop problem solving skills Identify occupation
Simple reflexes
Piaget's first sensorimotor substage, which corresponds to the first month after birth. In this substage, sensation and action are coordinated primarily through reflexive behaviors.
Erikson - Trust vs. Mistrust
Positive Outcome: feelings of trust from environmental support. Negative: fear and concern regarding others.
Piaget
Post formal operational thought: integrating various points of view to develop knowledge and understanding. Able to problem solve.
Health perception-Maintenance pattern
Preventive care - Maximize health status, detect problems early, appropriate intervention Age 18: full health appraisal Repeat history/physical every 2 yearsScreenings: BSE, testicular exam, PAP smear - P.E. includes, height, weight, BMI, blood pressure, blood tests, counseling on avoidance of inactivity and obesity Over age 25: focus on coronary risk factors ● Cholesterol, diabetes, smoking, hypertension, metabolic syndrome, heart disease, chest pain ● No known risk factors: screen every five years at age 35 for men and 45 for women
SOURCES OF DATA
Primary is the client. Secondary: Family Support persons Health professionals Records and reports Laboratory and diagnostic analyses, Relevant literature
COLLECTING DATA
Process of gathering information about a client's health status. Must be systematic and continuous. Database: Health history Physician's hx and physical exam. Lab and dx tests Other material
Affective Roles
Provide emotional support and encouragement to family members.
Amnion
Provides fluid environment for developing embryo and fetus.
Nursing Process characteristics
Provides the framework in which nurses use their knowledge and skills to express human caring and help clients meet their actual and potential health problems.Client-centeredProblem solving techniques.
More Interventions
Providing information and technical expertise Role modeling Role supplementation Teaching strategies, including stress management, lifestyle modifications, and anticipatory guidance
Instrumental Roles
Provision of physical resources, decision-making and family management.
Interaction of many factors: Woman
Psychological changes Psychological changes
Cognitive Processes
Psychomotor Speed = speed at which a person can make a specific response. Memory Aging Differentiate between aging vs. disease effects.
Growth and Development of the Young Adult (psychosocial)
Psychosocial Emotional health r/t abilty to resolve personal/ social tasks Predictable trends 23-28- Refining self-perception and ability for intimacy 29-34- Directs energy toward achievement and mastery of surrounding world 35-45- Examining life goals and relationshipsMore attention devoted to occupational/ social pursuitsMay benefit from career counseling/ testing Trend is more women working while pregnant, men more aware of parental responsibilities
Freud's Stages of Psychosexual Development Genital Stage
Puberty and thereafter. Develop skills needed to cope with environment. Full sexual maturity and function.
PHYSICAL DEVELOPMENT
Rapid gains in height and weight. Development of secondary sex characteristics. Continued brain development.
Urinary Tract Chan
Rate that the kidneys filter the blood slows so medications and other substances take longer to leave the body. Bladder capacity decreases.
IMPLEMENTING
Reassessing the client. Determining the nurse's need for assistance. Implementing the nursing orders (strategies) Delegating and supervisingCommunicating the nursing actions.
TEENAGE BEHAVIORAL ISSUES
Rebelliousness Need for privacy Dishonesty Responsibility Curfews Friends
Breastfeeding
Recommended for first year of life. Not for: HIV +, taking antidepressants. Check effects of medications and foods on infant.
The empty nest family
Reestablishment of a more intensive husband/wife relationship Maintaining kin ties with older and younger generations.
Race
Refers primarily to a social classification that relies on physical markers. May be in same race but differ in ethnic affiliations
Cognitive
Refers to rational thought, what one generally considers "thinking"
Cognitive development
Reflective and relativisticRealistic, their idealism decrease Emotion and subjective factors can influence thinking. Main window for wisdom: expert knowledge about the practical aspects of life that permits excellent judgment about important matters.
Illness Prevention
Regular checkups Annual immunizations Pneumococcal, flu Close monitoring of chronic illnesses Providing access to care. Screenings Colon, breast, prostate, and lipid disorders.
Launching adult children
Relinquishing young adults into work, military service, college, training, marriage, etc. with appropriate rituals and assistance. Maintaining a supportive home base.
Testosterone
Responsible for deep voices, muscle mass, and facial and body hair patterns found in males As men get older, level of testosterone gradually becomes lower Decreases 10% every decade after age 30.
Piaget - Concrete Operations
Reversibility Decenter Reciprocity Conservation Concept of Number Classification Seriation Transitive Reasoning
Respiratory System Changes
Ribs and cartilage become more rigid. Lung tissue loses elasticity. More vulnerable to respiratory infections.
Interaction of many factors: Family
Role Changes Adaptation
Functional Families
Roles for healthy functioning: Provision of resources Nurturance and support Life skills development Maintenance and management of family system Sexual gratification of marital partners
MIDBRAIN REWARD SYSTEM
Romantic love and addictive drugs exert their powers. Teens hypersensitive to novel experiences Biological rhythms differ.
Stress and Coping in Early Adulthood
STRESS is the response to events that threaten or challenge an individual. Our lives are filled with events and circumstances known as stressors that cause threats to our well-being.
Strength, Joints, and Bones
Sarcopenia = age-related loss of muscle mass and strength. Muscle loss 1-2% per year past 50. Loss of strength - back and legs. Tendons and ligaments less efficient. Bone loss
Understanding Metaphors
School-age children comprehend and enjoy puns, unexpected answers to normal questions, and metaphors. New cognitive flexibility and social awareness make these funny.
Gastrointestinal System
Secretion, digestion, absorption and excretion become more efficient. By age 10 = 750 - 900 ml. Fewer stomach upsets and better glucose maintenance.
Social interaction
See a wide variety of behaviors and gain instruction and feedback. An internal self-regulation mechanism that responds to environmental stimuli.
Information Processing
Selective Attention Memory Organization Metamemory Metalinguistic Awareness Communicative Competence Syntax Understanding Metaphors Humor
TIME-LAPSED REASSESSMENT
Several months after initial assessment. Compares the client's current status to baseline data previously obtained. Example: reassessment of a client's health in a home care setting.
Freud - Latency
Sexual drive is dormant. Repression of sexual desires and erogenous impulses. Pour repressed energy into asexual pursuits.
Teach Back
Share information Confirm Understanding Rephrase or clarify Continue on
Ethnicity
Shared feeling of peoplehood among a group of individuals. Similar patterns that create a common history. Intraethnic variations
Secondary Circular Reactions
Shift cognitive horizons beyond themselves and begin to act on the outside world. Shakes rattles different ways to see how the sound changes. 4 to 8 months
Concrete Operational Thinking
Show the beginnings of adult logic; but generally focus on tangible objects rather than abstract ideas; this is why they are "concrete". Begin to understand events interpreted in different ways. Developed reversibility and flexibility in thinking.•Less egocentrism (can view the world from another's perspective). Engaging in decentration. Understanding conservation, transitivity, class inclusion.
Speech and Language
Shrill cry changes due to physical growth of the throat muscles, lips, teeth, and vocal cords. Milestones are guidelines for normal developmental patterns.
Health Problems (African)
Sickle Cell anemia Stroke mortality Coronary heart disease .Cancer Diabetes AIDS Homicide
DEFINING CHARACTERISTICS
Signs and symptoms that indicate the presence of a particular diagnostic label. Major and critical = must be present Minor = may or may not be present
OBJECTIVE DATA
Signs or overt data. Detectable by an observer or can be tested against a standard.. Seen, heard, felt or smelled . Obtained by observation or physical examination.
Formulas
Similar to each other and to human milk bur they are not exactly same. Special formulas Supplemental iron. Heating instructions
Growth features
Simple to complex General to Specific Cephalocaudal Proximodistal
Piaget - Sensorimotor Stage
Six Substages: Simple reflexes First habits and primary circular reactions. Secondary circular reactions Coordination of secondary circular reactions Tertiary circular reactions Beginnings of thought
Month 3
Size: about 1 inch (25 mm) long as month begins Nostrils, mouth, lips, teeth buds, and eyelids form Fingers and toes almost completeAll organs present, although immature
seven months
Size: about 10-12 inches long, about 1 1/2 -2 pounds as month begins Periods of activity followed by periods of rest and quiet can live outside the body but lil chance of survival checking up on lungs
8 months
Size: about 14-16 inches long, about 2 1/2 -3 pounds as month begins Weight gain continues rapidly May react to loud noises with a reflex jerking action Moves into a head-down position
9 months
Size: about 17-18 inches long, 5-6 pounds as month beginsWeight gain continues until the week before birth Skin begins more smooth as fat deposits continue Decends into pelvis, ready for birth
Month 4
Size: about 3 inches long, 1 ounce as month begins Can suck its thumb, swallow, hiccup, and move around Facial features become clearer
Month 5
Size: about 6 1/2-7 inches long, about 4-5 ounces as month begins around a pound can listen to the heart beat Hair, eyelashes, and eyebrows appear Teeth continue to develop Organs are maturingBecomes more active
six months
Size: about 8-10 inches, about 8-12 ounces as month begins starts hiccups Fat deposits under skin, but fetus appears wrinkled Breathing movements begin
Visible Signs
Skin begins to wrinkle and sag due to loss of fat and collagen in underlying tissues Aging spots Thinning, graying hair Fingernails and toenails develop ridges and are thicker and brittle.
HOW DO THESE CHANGES AFFECT TEENS?
Sleep longer.More clumsy because of growth spurts. Overly sensitive about weight. Develop at different rates. Feel awkward about demonstrating affection to opposite sex parent. Ask more direct questions about sex.
Smell and Taste
Smell develops after birth. Within 10 days they can distinguish mother from others. Taste develops rapidly.
Morula
Solid mass of cells resulting from
Grandparenting
Source of biological reward. Continuity Emotional self-fulfillment Styles: fun-seeking, formal
5 steps of the Teach Back Method
Speak slowly Teach back- make the PT say what you explained Encourage questions Plain language Show example
outcome identification and planning
Specification of (1) patient outcomes to prevent, reduce, or resolve the problems identified in the nursing diagnoses; and (2) related nursing interventions
How do these changes affect teens? TEEN BEHAVIORAL ISSUES
Spend more time with friends than family. More questions about sexuality. Begin to keep a journal. Lock bedroom doors.Become involved in hobbies or clubs. Become elusive and argumentative. May not want to be seen with parents in public.Begin to interact with parents as people.
Spiritual fitness guide
Spirituality may be used in a general sense to refer to that which gives meaning and purpose in life, or the term may be used more specifically to refer to the practice of a philosophy, religion, or way of living. FIT STRESSED DEPLETED DRAINED
Freud's Stages of Psychosexual Development Anal
Stage 18 mos - 3 yrs. Bowel and bladder are sources of sensual satisfaction, self-control and conflict. Major conflict: toilet training.
Stages of sleep
Stage 1 is a light sleep during which the muscles begin to relax and a person can be easily awakened. Stage 2 is when brain activity slows down and eye movement stops. Stage 3 and 4 comprise deep sleep, during which all eye and muscle movement ceases. It can be difficult to wake a person during deep sleep. (sleep walking and bedwetting during these stages. REM sleep is when the muscles of the body stiffen, eyes move, heart rate up, breathing becomes more rapid and irregular, and BP up. This is when people dream.
Simple to Complex
Start off sleeping and eating, then eating with fingers, and then use of a spoon or fork.
Near to Far (Proximodistal)
Starts at the trunk and moves outward. From waving their arms when they see what they want to picking it up.
Blended families
Step parents and step siblings
Fertilization
Steps of fertilization (Conception) Several sperm penetrate corona radiata. Several sperm attempt to penetrate zona pellucida One sperm enters egg and nuclei fuse, producing a producing a zygotezygote. Egg's plasma membrane and zona pellucida change to prevent change to prevent polyspermy
What are older adults like?
Stereotypes Life Expectancy Average Useful Maximum Factors: Genetic, environmental, ethnic, gender
Inhibitors
Stereotyping Prejudice and racism Ethnocentrism or cultural prejudice Cultural imposition Cultural conflict Cultural shock
Bonding
Strong emotional tie between parent and newborn. Attachment En face Touching
Structural-Functional
Structure: family's roles and relationships Function: process of continual change in the system
mid-life crisis
Suspended between the past and the future, trying to cope with this gap that threatens life's continuity.
SUBJECTIVE DATA
Symptoms or covert data Apparent only to the person affected Sensations, feelings, values, beliefs, attitudes, and perception of personal health status and life situation.
ASSESSING
Systematic and continuous collection, organization, validation, and documentation of data. Focus on a client's responses to a health problem not upon disease.
Aging and the Skin
Takes longer to repair and replace skin cells. Thinner with poor turgor. More vulnerable to skin injury, and slower wound healing. Decreased ability to perceive cold and hot. Decrease in number and function of sweat glands.
Tips for clearing acne
Talk to a dermatologist about prescription medications Try an OTC acne treatment Follow treatment instructions closely Avoid shaving pimples Avoid home remedies like toothpaste and lemon juice Develop a consistent skin care routine
Cultural Nursing Assessment part 2
Talk with community leaders to gain an understanding about community life aspects. Verify and cross check information. Avoid making premature generalizations. Be sincere, open and honest with oneself and the client.
How do you deal with stress?
Task-oriented- you may feel comfortable analyzing the situation and taking action to deal directly with the situation. Emotion-oriented - you may prefer to deal with your feelings and find social supports. Distraction-oriented - you may use activities or work to take your mind off the situation.
Nursing
Teaching Assessment Goal: Assisting each family to have a healthy pregnancy and birth outcome, lay the foundation for satisfactory parenting and family life.
Emotional and social development issues
Temperament Self-esteem development Body image School-age fears Peer relationships Teacher and school influences Family influences
Syntax
The arrangement of words and phrases to create well-formed sentences in a language. grammar
PLANNING
The establishment of client goals/outcomes Working with the client, to prevent, reduce, or resolve problems To determine related nursing interventions (actions) that are most likely to assist client in achieving goals This is about improving the quality of life for your patient. This is about what your patient needs to do to improve his health status or better cope with his illness.
Psychodynamic Theory - Freud
The interaction of various conscious and unconscious mental or emotional processes, especially as they influence personality, behavior, and attitudes. The study of personality and behavior in terms of such processes
EVALUATING
The measuring of the extent to which client goals have been met. Evaluation involves not only analyzing the success of the goals and interventions, but examining the need for adjustments and changes as well. The evaluation incorporates all input from the entire health care team, including the patient.
Affective Domain
The most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain.
Universally applicable
The nursing process allows nurses to practice nursing with well or ill people, young or old, in any type of practice setting
Systematic
The nursing process has an ordered sequence of activities and each activity depends on the accuracy of the activity that precedes it and influences the activity following it.
Dynamic
The nursing process has great interaction and overlapping among the activities and each activity is fluid and flows into the next activity
Goal-directed
The nursing process is a means for nurses and clients to work together to identify specific goals (wellness promotion, disease and illness prevention, health restoration, coping and altered functioning) that are most important to the client, and to match them with the appropriate nursing actions
Maslow
Theory of Motivation and Hierarchy of Needs. People are not static but are always in process of becoming different and better.
Ectodermderm, , mesomesodermderm, , endoendodermderm.
These are the foundation of the body systems (Germ Layer Theory)
Dysfunctional families
Those in which conflict, misbehavior and even abuse on the part of individual members of the family occur continually, leading other members to accommodate such actions.
Rest and Sleep
Three categories of sleep disorders: lack of sleep, disturbed sleep and too much sleep. Adults need about 7 to 8 hours of sleep a day. Falling asleep and waking up are governed by chemical changes in the brain and blood.
THE PURPOSE OF THE NURSING PROCESS
To Achieve Scientifically- Based, Holistic, Individualized Care For The Client To Achieve The Opportunity To Work Collaboratively With Clients, Others To Achieve Continuity Of Care
Maturation
To ripen Increase in competence and adaptability Able to function at a higher level.
Autonomy vs. Shame and Doubt
Toddler (1 to 3 yrs.) To realize that one is an independent person who can make decisions.
Pregnancy testing
Ultrasound Transvaginal transabdominal Biophysical Profile Amniocentesis
NUTRITIONAL PROBLEMS
Undernutrition Deficiencies: iron, iodine, vitamin A, calcium, other nutrients. Obesity
Car seat safety
Use rear-facing car seat in back seat, preferably the middle until age 2 or until the child reaches max height and weight
Piaget
Viewed children as biological organisms interacting with environment attempting to make sense of the world.
Cognitive-Perceptual Pattern (young adult)
Visual Acuity is highest at 20 and begins to decline at 40 when farsightedness frequently develops. Hearing is also best at 20.
Sleep
Wakeful periods more frequent and less deep sleep.
Adolescence is a period of profound brain maturation.
We thought brain development was complete by adolescence We now know... maturation is not complete until about age 24!!!
First Year Growth
Weight Sign of good health First 6 months gain 1 -2 pounds/month Last 6 months gain 1 pound per month Doubles in first few months and triples by end of first year.
Occurrence of Pregnancy
When a zygote begins dividing, it is termed an embryo Developing embryo travels down oviduct and eventually implants in endometrium (Implantation / pregnancy) Presence of human gonadotropic hormonehuman gonadotropic hormone (HCG) in the blood confirms pregnancy. If implantation does not occur, woman never knows fertilization took place.
ERIKSON - IDENTITY VS. ROLE CONFUSION
Who am I? Where am I going? Peer group is
NURSING ORDERS
Who? What? Where? When? How? Rationale = Why?
Intimacy vs. Isolation
Young adulthood (21-45 yrs) To commit to another in a loving relationship
Amniotic Sac
a fluid-filled sac that cushions and protects a developing embryo and fetus in the uterus
Independent (NURSING INTERVENTIONS)
able to be implemented without a physician's order
Clinical Model of Health
absence of disease (signs and symptoms) , prevention not emphasized
Vision problems
amblyopia (lazy eye) causes -crossed eyed - nearsightedness -Farsightedness -Astigmatism Uncorrected refractive errors or other eye defects Malalignment of the eyes (strabismus)
Planning teaching strategies
are lectures, discussion, demonstration, And role playing. Teaching aides like pamphlets, audiovisual aids, internet, and equipment & models.
Benefits of physical activity
cardiovascular fitness weight control emotional tension release development of leadership and following skills.
Collaborative (NURSING INTERVENTIONS)
combination of dependent/independent nursing intervention
Problem (COMPONENTS OF A NURSING DIAGNOSIS)
describes the health problem or response to therapy. Directs formation of goals and outcomes.
health-illness continuum
description of a person's health status as a range with anchors that include poor health or imminent death on one end of the continuum to high-level wellness on the other end
Care is
designed for the specific client.Based on the uniqueness of the person's culture and includes cultural norms and values. Designed to include empowerment strategies to facilitate client decision-making in health behavior. Provided with sensitivity to the cultural uniqueness of clients.
Single parent families
families in which one parent resides with and cares for one or more children
right hemisphere
global, holistic processing recognizing faces tone of voice visuospacial skills left hand left body- side musical ability emotions humor metaphors left visual field Dance, sculpture, art appreciation, musical appreciation, perception
Interpersonal
he nursing process ensures that nurses are client-centered rather than task-centered and encourages them to work to enhance client's strengths and meet human needs
Four types of assessments
initial, problem-focused, emergency, and time-lapsed.
Middle Age
is a mix of new opportunities and expanding resources accompanied by declines in physical abilities. Begins at approximately 40 years and extends to about 60 - 65.
Professional nurses are responsible for
making nursing dx. Describe a continuum of health states. Domain includes only those states that nurses are educated and licensed to treat. Is a judgment made only after thorough, systematic data collection.
Intelligence:
measure of a child's underlying competence or learning ability. Associated with academic success, advancement of the job and appropriate social behavior. Achievement
Psychomotor
mental processes that cause movement using your body to do something Ex. Giving a flu shot
MMSE
mini mental status exam
Chorion
outermost membrane, develops rom the trophoblast, contributes to the placenta.
bullying
physical verbal or psychological attacks or intimidation against a person who cannot properly defend themselves. It includes two key components. 1.Replace harmful acts 2. imbalance of power
Pruning starts at the back of the brain..and moves to the front
prefrontal cortex- judgement Amygdala- emotion Nucleus Accumbens- motivation Cerebellum- physical coordination Notice: Judgment is last to develop!
The purpose of quality client education is to
promote wellness (primary) Prevent or diagnose illness early (secondary) Restore optimal health and function (tertiary)
Genogram Symbols
square = male circle = female diagonal line thru symbol= death triangle = pregancy loss diagonal line thru connecting line = divorce SB = stillbirth
WHO DEFINITION OF HEALTH
state of complete physical, mental, and social well being. Not nearly the absence of disease or infirmary. To lead Social and economically productive time.
Vital signs of newborn
temp 97.6 to 98.6 F allixary 90.0 to 99.5 F rectal apical rate 100 to 160 beats/min 100 sleeping 160 crying respirations 30 -60 40 is average Systolic 60 - 80 mmhg Diastolic 40 - 50 mmhg bp 75/42
Communicative Competence
the ability to communicate in a personally effective and socially appropriate manner
selective attention
the ability to focus on only one stimulus from among all sensory input
metalinguistic awareness
the ability to reflect on the use of language how to get you point across
Healthy People 2020
the fourth set of health goals and objectives for the U.S. that defines the nation's health agenda and guides its health policy
Eudaimonistic model of health
the model of health emphasizing wholeness of the individual as being essential to maintaining good health
Consider- ACCULTURATION
the process of acquiring the behaviors, attitudes, and values of a different culture.
disease prevention
the process of reducing risks and alleviating disease to promote, preserve, and restore health and minimize suffering and distress 3 level of prevention activities
Body Proportions
the relationship of the sizes of one body part to another and to the rest of the body
Metamemory
understanding of processes of memory how it works
Consider-ASSIMILATION
when an individual, over time, gives up the values, traditions, and traditional ways of his or her native culture and conforms to the standards and behaviors of the new culture.
