OB, Psych and Crisis

Management of changes, GI

Diet high in protein, stool softeners. Fluids.

Hospitalized, Adolescent

Identity vs. role confusion. Use correct terms, reflecting isn't going to work - seen as sarcastic. Try clarifying with this group.

Brief Psychotic Disorder

Lasts less than a month this can happen to someone after they have had a major death in their family. -Sudden onset of symptoms -May or may not be preceded by a severe psychosocial stressor -Lasts less than 1 month -Return to full premorbid level of functioning

Gravida

Number of times a woman has been pregnant

Salad Bowl

The cultural concept has changed to that of "salad bowl" where cultural values and traditions are "tossed together"

Learning

The process by which person acquires or increase knowledge or changes behavior in a measurable way as a result of an experience

VEAL CHOP

Variable is the cord Early is the head accels are OK Late is the placenta

Ectopic pregnancy

a pregnancy anywhere outside the uterus. Diagnosed via ultrasound.

Primary Care

aims to prevent disease or injury before it ever occurs ex: altering unhealthy behaviors that lead to disease or injury. Legislation and enforcement controlling use of hazardous products ex: bike helmets, asbestos regulation

Managing afterpain, narcotics & analgesics

ibuprofen, Percocet, morphine sulfate, hydromorphone (Dilaudid)

AFP, alpha-fetal protein

look for neural tube defects, look for spinabifida. If down it's down snydrome.

Management of system changes, urinary

promote bladder emptying

Stork bites

usually on the nape of the neck, or eyelids.

Interventions (mainly anorexia)

•May need to replace nutrition via N/G tube •Consult dietitian •Do not discuss food or eating-offer positive reinforcement •Keep strict I & O and calorie count - percentage •Weigh daily - same clothes •Assess V/S- hypotension d/t lack of nutrients •Assess skin turgor, condition of skin •Sit with client during meal time - sit with them for 30min, and an hour after •Observe client for at least one hour following meals For the client who is emaciated and is unable or unwilling to maintain an adequate oral intake, the physician may order a liquid diet to be administered via nasogastric tube. Without adequate nutrition, a life-threatening situation exists. Nursing care of the individual receiving tube feedings should be administered according to established hospital procedures. For the client who is able and willing to consume an oral diet, the dietitian should determine the appropriate number of calories required to provide adequate nutrition and realistic (according to body structure and height) weight gain. Explain the program of behavior modification to client and family. Explain that privileges and restrictions will be based on compliance with treatment and direct weight gain. Do not focus on food and eating specifically. Instead, focus on the emotional issues that have precipitated these behaviors. Do not discuss food or eating with the client once protocol has been established. Do, however, offer support and positive reinforcement for obvious improvements in eating behaviors. Keep a strict record of intake and output. Weigh the client daily immediately on arising and following first voiding. Always use the same scale, if possible. Weighing a client in such a way that the client cannot see the numbers on a scale may be beneficial in reducing his or her focus on daily weight fluctuations or evidence of weight gain. Assess vital signs, including blood pressure with positional changes to evaluate for orthostatic hypotension and pulse to evaluate for bradycardia. Bradycardia may be more pronounced at rest, so regular assessment during these times is especially important. Assess skin turgor and integrity regularly. Assess moistness and color of oral mucous membranes. The condition of the skin and mucous membranes provides valuable data regarding client hydration. Discourage the client from bathing every day if the skin is very dry. Sit with the client during mealtimes for support and to observe the amount ingested. A limit (usually 30 minutes) should be imposed on time allotted for meals. Without a time limit, meals can become lengthy, drawn-out sessions, providing the client with attention based on food and eating. The client should be observed for at least 1 hour following meals. The client may use this time to discard food that has been stashed from the food tray or to engage in self-induced vomiting. He or she may need to be accompanied to the bathroom if self-induced vomiting is suspected. If weight loss occurs, enforce restrictions. Restrictions and limits must be established and carried out consistently to avoid power struggles and encourage client compliance with therapy. Ensure that the client and family understand that if nutritional status deteriorates, tube feedings will be initiated. This is implemented in a matter-of-fact, nonpunitive way, for the client's safety and protection from a life-threatening condition. Encourage the client to explore and identify the true feelings and fears that contribute to maladaptive eating behaviors. Emotional issues must be resolved if these maladaptive responses are to be eliminated.

Breathing pattern

Babies have an irregular breathing pattern. Need to listen to all their lung fields and count RR for a full minute by listening to their breathing - not looking. Want to look to make sure their breathing is equal bilaterally.

Impaired Health Professional

"Diversion occurs when a controlled substance or a drug having a similar effect is not used as prescribed. Drug diversion includes obtaining a controlled substance or drug having similar effects from wastage." www.nysna.org/span/main.htm NYSNA established SPAN, the Statewide Peer Assistance for Nurses program.

Rheumatic Heart Disease, Nursing Interventions

-Antiinflmmatory meds -Antibiotics -Prepare child for possible admission to hospital and surgery -Detailed info to family regarding prevention and reoccurence of symptoms

Separation Anxiety Stages

-Protest -Despair -Denial

Concrete Language, Avoid

-Take -Dye -Stick -Injection will be a "sting"

Biophysical profile

8-10 is good, 6-8 is equivocal, <6 need to get baby out

Positive signs of pregnancy

An ultrasound showing fetal parts, fetal HR, fetal movements or parts palpated by examiner

The desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety is: A.The individual will experience no anxiety. B.The individual will demonstrate hope for the future C.The individual will maintain anxiety at a manageable level. The individual will verbalize acceptance of self as worthy

Answer C

Role of Home Health Care Nurse, Caregiver

Assess clients actual and potential health problems, plan care and evaluate clients outcomes. Ex: bathing, changing linens, feeding

Pregnancy at Risk: Hemmorhagic complications - Inevitable abortion

Cramping and bleeding is heavier with an open cervix

Hemorrhage Management

Fundal massage stay w/ pt! •Meds: Bolus IV fluids w/oxytocin, Prostaglandin derivatives: Tromethamine (Hemabate) IM & Mesoprostal RECTAL (Cytotec), Ergot compounds Methylergonovine maleate IM (Methergine) •SE's of all: hypertension, Prostaglandins: N/V

Disaster management

It is unique in that it requires a change in paradigm of providing the greatest number of resources for the greatest good of each individual, to allocation of limited resources for the greatest good for the greatest number of casualties.

Disasters are assigned level designations based on Anticipated level of response needed. A disaster that requires state and federal assistance would be classified as:

Level III

Home Health Nursing

Nursing services and products provided to clients in their homes that are needed to maintain, restore or promote physical, psychological and social well being. ex: visiting nurses

Prolapsed Cord

OB emergency, cord comes out before the baby. Can be obvious or an occult cord, the cord didn't come out of the vagina. Can be prevented via not breaking water unless baby is engaged in the pelvis.

Pregnancy at Risk: Hemmorhagic complications - Complete abortion

Pass all the products of conception

A postpartal woman is having difficulty voiding following delivery. What should the nurse expect as the most reasonable cause for the difficulty voiding?

Perineal edema makes voiding difficult.

Moro

Startle Reflex

MICHIGAN ALCOHOLISM SCREENING TEST (MAST)

The MAST Test is a simple, self scoring test that helps assess if you have a drinking problem. Please answer YES or NO to the following questions: MICHIGAN ALCOHOLISM SCREENING TEST (MAST) Assessment questions When did you last have a drink? (This question has highest priority) What did you drink? How much do you usually drink? How long have you been drinking?

Tonic Neck

This is called fencing, looks like they are in a fencing position. Head turned towards outstretched arm and other side is flexed.

CNS Depressants

Tranquilizing relief to anesthesia Barbiturates-nembutal, seconal, amytol, phenobarbital Non barbituates-Dalmane, Restoril, Halcon Anti-anxieties-valium, librium, xanax, ativan Club drugs- rohypnol, GBH gamma hydroxybutric acid

PIH, mild treatment

When find mom in mild want to keep her in mild, will send her home and have her check her BP at home. Will give her warning signs of what to look for with worsening. Want mom to rest on her left side. Come back in a few days to see how she's doing. Might have to admit mom to hospital on bed-rest.

A client's learning outcome is, "Client will verbalize medication name, purpose, and appropriate precautions." Which documented statement reflects evidence of learning?

Written information about the medication provided and reviewed, correct responses were given to follow up questions.

Breast Fed Stool

Yellow and seedy stool. Stool looks like it has little seeds. Has less of an odor than bottle fed

Tertiary Care

aims to soften impact of an ongoing illness or injury that has lasting effects; ex: helping people manage long term problems, ex: cardiac rehab, support groups

3rd Degree Tear

also inclused external anal sphincter

Management of changes, circulatory

assist and promote early ambulation. Range of motion. Lovenox and heparin can also be used.

Pregnancy at Risk: Hemmorhagic complications - Threatened abortion

bleeding early in the pregnancy. A woman starts to bleed, cramping, mild bleeding. Key is that she has a closed cervix.

False labor

contractions can be regular, are generally irregular. Mom being dehydrated can cause braxton hicks contractions. Will stop with activity or comfort measures. No cervical changes.

Eye prophylaxis

helps protect against STI's - erythromycin 0.5%. Practice is becoming obsolete in Eurpoe, this is because contagious things are tested for ahead of time. If mom does have an active disease they will deliver via c-section. May still need in case of precipitous labor.

Homeostasis

is LOST (due to sudden or unplanned event) Usual coping mechanisms do not work It is a sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem

Gestational Assessment, Genitalia

male, look at rugae (few and smooth or extensive) and female is labia (covering the minora)

Placenta previa: low-lying

normally the placenta starts low and then it moves up. Just encroaches upon cervical opening.

Energy Release Play

play doh, toys they can help to shape or hit helps release frustrations and anger

Placenta Abruptio: causes

severe HTN, lack of protein, cocaine abuse (due to increase of BP)

Role of Home Health Care Nurse, Educator

teaching illness care, prevention of problems, promotion of optimal wellness or well-being to clients and family. Ex: guiding health and development of newborns

Precipitous birth

under 3 hours

External monitoring

use tocos on the outside. Need two, one for FHR and one for contractions

Autocratic leadership style

uses authoritarian approach, make most of the decisions without input from others. High productivity, Low morale

Hypertonic Contractions

very little resting tone, one contraction on top of another. Will stop pitocin, give fluids

Metabolic Changes

weight loss and exhaustion due to hormones

Anxiety

•A feeling of discomfort, apprehension, or dread •Neurotransmitters: Serotonin, norepinephrine, gamma-aminobutyric

Chemical Agents/Weapons

•Can be solids, liquids, or gases •Designed to irritate, incapacitate, and kill •Many don't have antidotes, care is supportive

Differences in Hospital & Home Care

•Wound care: clean versus sterile technique MAY be used •Conserve supplies •Pt & family have more "say" in care •Need to provide detailed instructions on IV, PCA, tube & dressing management •Intermittent catheterization = clean technique

Narcistic personality disorder

•a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. difference between these two as this: a person with histrionic personality disorder is always trying to seek attention from others, while a person with narcissistic personality disorder doesn't try to seek approval because they believe they already have everyone's attention

Types of Crisis

1. Dispositional Crisis external stressor = acute response text uses abusive example...another one would be unreasonable road rage..i.e.: driver ahead needs to stop suddenly to avoid hitting someone but person behind said driver get furious 2. Crisis of Anticipated Life Transitions aka normal life-cycle transitions feeling lack of control over a life transition = acute response birth of a child is anticipated but once child arrives, parent may fell helpless examples of life transitions: Adolescence, Parenthood, Marriage, Midlife, Retirement 3. Crisis d/t Traumatic Stress aka Situational Crisis no control over an unexpected external stressor = acute response recent hurricane w/ loss of homes examples of traumatic stress: loss of a job, loss of a loved one, onset or worsening of a medical condition, divorce 4. Maturational/Developmental Crisis unresolved internal stressor triggered = acute response life situation triggers unresolved developmental/maturational issue - example in book where man could never, as a boy yell back @ domineering father so now yells @ boss 5. Crisis Reflecting Psychopathology pre=existing psychopathology cause crisis or psychopathology impairs ability to resolve crisis •Previous adaptive resolutions can not repair crisis 6. Psychiatric Emergencies severely impaired functioning = crisis drug overdose w/ unconscious person ex: acutely suicidal individuals acute psychosis (PP psychosis - baby in microwave) uncontrollable anger ETOH intoxication

The components of an emergency operation Plan (EOP) include but are not limited to: (select all that apply)

1.A plan for coordinated care 2.A plan for traffic flow 3.Deactivation response 4.Incident command center

Whether a crisis develops or not is dependent on 3 balancing factors

1.Individual's perception of event realistic view of event - effective/usual coping techniques work whereas w/ a distorted view of event - problem solving techniques do not work 2.Availability of situational supports who are they? available people in environment who can be depended on to help...that available person may be RN! - without support = alone & overwhelmed 3.Availability of adequate coping mechanisms any past behavioral strategies that worked & can be drawn on? - if so, crisis can be diverted. If not, homeostasis not resolved, crisis continues

Management of reproductive changes, fundus

1.Ineffective involution can be caused by following things. Treat this by nipple stimulation or breastfeeding, uterine massage, empty the bladder. Kegals strengthen the pelvic floor muscles - start these when she goes home. 1.Large uterus 2.Full bladder 3.Excessive analgesia 4.Long labor

Management of reproductive changes, breasts

1.Wear a supportive bra if they are breastfeeding, will help with engorgement 2.A tight-fitting bra will constrict milk production 3.If not breastfeeding a tight bra will help with engorgement 4.Ice packs after feedings, can be used during engorgement which usually happens when mom is home. 5.Educate mom that during engorgement breastfeeding will help, body will adjust breast milk to supply/demand and it will get better.

Phases in Development of a Crisis & responses

1.exposure to precipitating stressor this causes anxiety ↑ - causes person to try previous problem solving techniques 2.previous problem solving techniques do not work - severe discomfort/helplessness results progressing to confusion/disorganization 3.all internal & external resources called on (development of new coping mechanisms) person views problem from different perspective OR overlook parts of problem. If new techniques used & effective, resolution can occur AND individual @ lower level, same level or better level of pre morbid functioning 4 if above do not work...breaking point occurs = psychological disorganization anxiety @ panic level 6 Different types (classes of crisis) - progress by degree of severity (will discuss further on upcoming slides) 1. Dispositional 2. Anticipated Life Transitions 3. Traumatic Stress 4. Maturational development 5. Reflecting Psychopathology 6. Psychiatric emergencies

Reproductive system changes, lochia

1.three types. Plum sized clots are a sign of hemorrhage. Look at the amount and type. Scant, moderate, large. Moderate amount is a heavy period. Heavy is saturating a pad in a hour. Scant/Moderate is OK. Looking for presence of clots, dime-sized is OK and this is seen more when she has been sitting for a while. 1.Lochia Rubra: Birght red 2.Lochia Serousa: Serosanguineous, pink tinged discharge 3.Lochia Alba: Yellowish-white discharge.

Pregnancy at Risk: Hemmorhagic complications - Missed abortion

Happens later in pregnancy. Go in to MD and find no heartbeat.

Hospitalized, Infant Stage

Trust vs. mistrust. Make sure giving tactile contact, meet their needs, use a soft voice. Swaddle them, pick them up, feed when hungry.

Conflicts trigger strong emotions

If you aren't comfortable with your emotions or able to manage them in times of stress, you won't be able to resolve conflict successfully.

Level III Disaster

Local & Regional assets are overwhelmed, Statewide or Federal assistance are required.

3rd Period of Reactivity

3rd is the 2nd period of reactivity. Alert and responsive, can be mucousy. Might see the first meconium passed.

Psychotic Disorder Associated with Another Medical Condition

Look at page 465!! -Prominent hallucinations and delusions are directly attributable to a general medical condition. -Pg 466 gives a list

Pregnancy at Risk: Hemmorhagic complications - Incomplete abortion

Something, parts of conception, is left inside

Kawasaki Symptoms

5 days or more spiking to 104°F (40°C) and the child has four of the following five signs: -Bilateral conjunctivitis without exudate -Painful joints -Red lips, strawberry tongue, congested oral pharynx -Enlarged lymph nodes—cervical lymphadenopathy (one lymph node larger than 1.5 cm) -Nonspecific groin rash -Edematous and red (erythema) of hands and feet -Mimics scarlet fever rash—diffuse polymorphous rash -Increased white blood cell count -Extreme irritability -Cardiac involvement —myocarditis, pericarditis, coronary artery aneurysm, valvular regurgitation, systemic artery aneurysms

Secondary Care

aims to reduce impact of disease or injury that already occurred, ex: regular exams and screening to detect in early stages; mammograms, low dose ASA use

Dramatic Play

allows to act out anger using life-like toys

Treatment - anorexia or bulimia

Adequate Nutrition Weight daily Explore and identify feelings and fears that contribute to maladaptive eating behaviors Cognitive-Behavioral Therapy-helps client perceive they are in control of their treatment options Family Treatment: Maudsley •Psychopharmacology * Fluoxetine (Prozac) (more useful for Bulimia) decrease cravings for carbohydrate * Amitriptyline (Elavil), imipramine Tofranil) antidepressants * Phenelzine (Nardil) antidepressants Cognitive behavioral therapy - 1 on 1. Modify as they progress. Cognitive theorists believe the cognitive distortions and dysfunctional thoughts contribute to disordered eating patterns Cognitive characteristics include selective abstraction, overgeneralization, distorted body-image Cognitive behavior therapy- individualized treatment. It is designed to fit the person's difficulties like a glove and be modified in light of his or her progress. it functions on the idea that all behaviors are learned and that unhealthy behaviors can be changed. The client contracts for privileges based on weight gain, the client has input knows what the choices are. Restore nutritional status Change the maladaptive eating behaviors: In control Maudsley: for anorexia nervosa, behavior modification for weight restoration only-Parents are guided in the fundamentals of helping their loved one eat (and/or prevent purging and over-exercising) and siblings are supported in collaborating with the patient. Sessions periodically entail a family meal under the guidance of a therapist who can assist in recognizing the various dynamics of the family around the meal. system of rewards and goal setting, three phases, 15-20 treatments over 12 mths Phase I: Weight restoration-parents are actively engaged in establishing the rules and guidelines around eating Phase II: Returning control over eating to the adolescent Phase III: Establishing healthy adolescent identity after maintained 95% of weight and no self starvation Fluoxetine has been found useful in the treatment of bulimia nervosaA dosage of 60 mg/day (triple the usual antidepressant dosage) was found to be most effective. It is possible that fluoxetine, an SSRI, may decrease the craving for carbohydrates, thereby decreasing the incidence of binge eating, which is often associated with consumption of large amounts of carbohydrates. Other antidepressants, such as imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), nortriptyline (Aventyl), and phenelzine (Nardil), High-dose SSRIs have demonstrated some efficacy in promoting weight loss for clients with binge eating disorder, but the weight loss was temporary and weight gain typically occurred after the medication was discontinued (Sadock et al., 2015). Remember, too, that weight loss is a secondary symptom of binge eating disorder. An effective medication needs to also manage the symptom of binging. Two medications, topiramate and lisdexamfetamine (a dopamine-norepinephrine reuptake inhibitor, originally used in the treatment of attention-deficit/hyperactivity disorder) have demonstrated benefits in reducing incidents of both binge eating and weight loss (Balodis et al., 2015). Most studies reveal that medication in combination with CBT is more beneficial than medication alone (Sadock et al., 2015).

assuring and giving approval

Assuring- "You are doing just fine" "Everything will work out " Please don't tell me im doing fine when I feel terrible Giving reassurance may discourage client from further expression of feelings if client believes the feelings will only be belittled Giving Approval-" I'm glad you decided to ...." "That was the right decision" Giving approvalimplies that the nurse has the right to pass judgment on the "goodness" of client's behavior. Its not our place to approve or disapprove

Taking Hold

A time of action. When mom starts to do her peri-care and newborn care. A time of action. When she learns and applies infant and self care. Can start hours after birth or up to a day after birth. Want them in this stage quickly because they go home quickly. Time of teaching, demonstrating with return demonstration and praise.

Mild depression

•Symptoms of mild depression are identified by clinicians as those associated with normal grieving •Affective: Anger, anxiety •Behavioral: Tearful, regression •Cognitive: Preoccupied with loss •Physiological: anorexia, insomnia

A nurse is scheduling a teaching situation. Which client is most ready to learn?

A.A 3-year old child whose parents are reading a story book about going to the hospital.

Pathologic Jaundice, causes

ABO incompatability: Most commonly seen with mom's who are O and baby is B Less common is Rh incompatibility, this is what we use Rhogam for. Use it to protect the next baby. Fetal blood enters maternal blood mom will make antigens and those antigens will attack next baby.

What Is Nursing Informatics?

ANA definition of nursing informatics: ◦"A specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice" (ANA, 2008, p. 1). The longitudinal electronic health record (EHR) has become the ultimate goal of health care organizations The demand for health care professionals who are knowledgeable in the application of this technology is rapidly growing. A field in of itself. The good news: While technology will continue to change and become more robust, the fundamentals of nursing care do not, and that technology is just a tool that should never replace our critical thinking and nursing judgment. 1994 the ANA recognized the field of nursing informatics, and in 2008 updated the definition and branched into 2 fields.

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediately report to the ED physician? A. Antecubital bruising B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

ANS: B The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

The Muppets personified excellent group dynamics

At its most basic level, a group usually has two major goals:..........1. To get things done..........2. To get along as a group To be a successful group, you need both of these things. If you don't get much done but have a great time partying, then you're an awesome bunch of friends but you'll never organize anything. On the other hand, if you get a lot done but are always really formal and polite, or secretly hate each other, it won't be long before you're burnt out and sick of being part of this group, no matter how much you accomplish. Have you had any past experiences when you did not work well with your group? Did you accomplish what you needed to? ie: Clinical- if your group does not get along, you miss out on some great learning experiences

leadership styles

Autocratic uses authoritarian approach, make most of the decisions without input from others. Democratic the people have a more participatory role in the decision making process. One person retains final say over all decisions but allows others to share insight and ideas. Laissez faire Non-authoritarian leadership style. (French for, allow to pass or let go) leaders try to give least possible guidance to subordinates, and try to achieve control through less obvious means. They believe that people excel when they are left alone to respond to their responsibilities and obligations in their own ways Autocratic - ↑ productivity, ↓ morale Democratic - ↓ productivity, ↑ morale Laissez faire - ↓ productivity, ↓ morale

Hospitalized, Toddler/Preschool

Autonomy vs shame and doubt / Initiative vs. guilt. May need to maintain distance, talk to the parents first. Once parents trust you the child is more likely to accept you. Don't give lengthy explanations. Give child a chance to size-up the nurse first.

Which intervention used for clients diagnosed with thought disorders is a behavioral therapy approach? A. Offer opportunities for learning about psychotropic medications. B. Attach consequences to adaptive and maladaptive behaviors. C. Establish trust within a relationship. D. Encourage discussions of feelings related to delusions.

B. When the nurse attaches consequences to adaptive or maladaptive behaviors, the nurse is using a behavioral therapy approach. Behavior therapy can be a powerful treatment tool for helping clients change undesirable behaviors.

Third Stage

Begins with delivery of the baby and ends with delivery of the placenta The shortest stage, usually lasts about a half hour Never pull on the cord - it can cause bleeding Placenta is ready: cord lengthens and you get a gush of blood from the vagina, then you can ease the placenta out

Belittling Feelings and Making Stereotypical Comments

Belittling Feelings that were Expressed- "Everyone feels depressed at times" "It's normal to feel anxious in the hospital" Belittling feelings expressed causes the client to feel insignificant or unimportant. My depression and my anxiety is very important to me. While you might have seen worse... Making Stereotypical Comments "This is for your own good" "We are only trying to help you feel better" Making stereotyped comments, clichés, and trite expressions are meaningless in a nurse-client relationship

Position

Best position for labor is however mom is comfortable. Would suggest mom tries different positions to see which is most comfortable. Moving around will help cervix efface and dilate much quicker. Women innately will find many different positions. For birth the squatting position is the best because it opens the pelvis 30%

causes of schizophrenia

Biochemical - too much dopamine or too many dopamine receptors and medication fixes this. Genetic - Psychosocial - stress

The nurse responds to the client; "I do not hear a noise or see the lights blinking." This type of therapeutic communication is know as: •A. Informing •B. Clarifying •C. Presenting reality •D. Sharing observations

C A is the time is... B is I'm not sure I understand what you are saying D is You appear anxious. I noticed youhavent been coming to lunch group.

During a meeting of the quality assurance committee, a member of the group pauses to outline tasks and propose a method for solution to the problem of data collection. This group members role is defined as: a.Coordinator b.Gatekeeper c.Initiator d.Blocker

C Coordinator clarifies ideas, brings people together pursue common goals Gatekeeper encourages acceptance of and participation by all group members Blocker resists group efforts, rigid and irrational behaviors that impede progress

A client has recently been diagnosed with mild to moderate NCD due to AD. Which medication would the nurse expect the physician to order for this client's cognitive impairment a)Nortriptyline (Pamelor) b)Zaleplon (Sonata) c)Donepezil (Aricept) d)Quetiapine (Seroquel)

C •Donepezil is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer's disease. •Its action improves cholinergic function by inhibiting acetylcholinesterase.

effects on the body - cannabis (marijuana, hashish)

CV effects - Increased HR Respiratory effects - COPD secondary to tar build-up Reproductive effects - Decreased sperm count, suppression of ovulation CNS effects - Euphoria, relaxed inhibitions, disorientation, relaxation, depersonalization, impaired judgment/memory, learning ability-pain reliever GI effects - Increased appetite, antiemetic Sexual functioning - Intensified sensory awareness, increased sexual satisfaction

Effects on body CNS stimulants

CNS CNS effects CV/Pulmonary effects GI effects Renal effects Sexual functioning Stimulants Tremor, anorexia, insomnia, agitation, increased motor activity Increased sys/diastolic BP, HR, cardiac arrhythmias, myocardial O2 demand Constipation, diarrhea, Caffeine-diuretic, nicotine reduces UO Promotes coital urge in men and women, aphrodisiac effect Intoxication-euphoria affective blunting (a lack of emotional reactivity on the part of an individual. It is manifest as a failure to express feelings either verbally or non-verbally), hypervigilance, anxiety, tension, anger, impaired judgment. Withdrawal- dysphoria, fatigue, vivid bad dreams, insomnia/hypersomnia, increased appetite, Psychomotor retardation/impairment (a visible slowing of physical and emotional reactions, including speech and affect, involves a slowing-down of thought and a reduction of physical movements in an individual) and agitation

Effects on the Body - CNS depressants

CNS Sleep & Dreaming Respiratory depression CV Effects Renal function Hepatic effects Body temperature Sexual functioning Depressants Decreases sleep, vivid dreams, insomnia Respiratory depression Hypotension, decreased cardiac output High dose supresses renal function Jaundice Decrease body temperature Increased libido leads to decreased libido Intoxication=inappropriate sexual behavior, aggressive behavior, mood lability (Of or characterized by emotions that are easily aroused or freely expressed, and that tend to alter quickly and spontaneously; emotional...impaired judgement Withdrawal=autonomic hyperactivity(sweating, HR greater than 100), hand tremors, insomnia, N/V, hallucinations, illusions, psycho motor agitation, anxiety, grand mal seizures

Assess for use of Complimentary Alternative Medicine

COMPLIMENTARY: used in conjunction with mainstream treatments ALTERNAIVE: used instead of mainstream INTEGRATIVE: those for which there is some scientific basis for usage ( Chiropractic, Acupuncture, Homeopathy, Herbal or Aroma therapy, Healing touch, Reike, Therapeutic touch, massage, yoga, spiritual or folk healers)

3.The nurse is performing an initial assessment on a newly admitted client who is oriented times four. Which of the following communication techniques would best facilitate obtaining accurate and complete client data? A. Closed-ended questions B. Requesting an explanation C. Open-ended questions D. Interpreting

Correct answer: C Open-ended questions are phrased in a way that gathers as much information as possible. By the use of phrases such as "Tell me about" or "Describe to me" a varied and rich body of information can be assessed.

. Which of the following are typical behaviors observed in clients with frotteuristic disorder? a)The sexual focus is on nonliving objects. b)Exposure of one's genitals to an unsuspecting stranger. c)Observation of an unsuspecting person who is naked. d)Touching and rubbing against a nonconsenting person.

Correct answer: D Touching and rubbing against a nonconsenting person describes a person with frotteruistic disorder.

When working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action? a)Avoid discussing social and personal problems. b)Focus on the physical symptoms. c)Always meet the client's dependency needs. d)Gradually minimize time focusing on physical symptoms.

D The nurse's attention should be on the client's social and personal problems, which are the underlying cause of the somatic symptom disorder. Time focused on physical symptoms should be minimized to avoid reinforcement.

According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in a client with dissociative amnesia? a)Suppression b)Sublimation c)Displacement d)Repression

D •Repression, which is the involuntary blocking of unpleasant feelings and experiences from one's awareness, is the defense mechanism most used by clients experiencing amnesia. •Freud believed that dissociative behaviors, including amnesia, occurred when individuals repressed distressing mental contents from conscious awareness. •He believed that this mechanism protected the client from emotional pain.

Which atypical antipsychotic medication has the highest potential for a client to experience serious side effects? A. Haloperidol (Haldol). B. Chlorpromazine (Thorazine). C. Risperidone (Risperdal.) D.Clozapine (Clozaeil).

D. Clozapine (Clozaril), an "atypicial" antipsychotic, has effects including sedation, weight gain, and hypersalivation. These side effects and the life-threatening side effect of agranulocytosis, clozapine usually is used as a last resort after other failed medication trials

client begins to cry during evening therapy. Which question by the nurse would be most appropriate and solicit the best response? •A. "Why are you crying?" •B. "What's the matter with you? You cried yesterday too." •C. "You're not going to cry again?" •D. "You seem sad. Can you tell me what's bothering you?"

D. Avoid asking why? It puts the pt in the position to defend their behavior instead of explain it their feelings. Why questions are threatening and decrease self esteem. Open ended questions identify the problem, convey concern, and produce more information

Alcohol is a food because...

Does not require digestion Is not converted to glycogen It can not be stored Provides calories but no vitamins or minerals by stomach & intestine Accelerated by empty stomach & ↑ concentrations The more you drink in a given period of time, the higher your BAL (blood alcohol level) will be. Because it contains calories. Alcoholism Is a disease. DSM-IV-TR criteria for alcohol abuse and dependence are similar to those for other substances. A Abuse = work problems, hazardous practices, legal difficulties or continuing use in the face of physical and or social problems. Alcohol dependence is based on 3 or more symptoms from a list that includes WD, tolerance, greater than intended use, unsuccessful attempts to control use, giving up other activities

Encouraging evaluation

Encouraging Evaluation "How do you feel about . . . . . ." "Does this (specific situation) make you feel uncomfortable?"

ABCDE of caring

¢A Alone: ¢B Believe: ¢C Confidentiality: ¢D Document: ¢E Educate: ¢S Safety:

Medical Treatment Modalities for Somatic Symptom Disorders

•The nurse's attention should be on the client's social and personal problems, which are the underlying cause of the somatic symptom disorder. Time focused on physical symptoms should be minimized to avoid reinforcement. • Individual psychotherapy •Group psychotherapy - clients get support knowing they are not the only person having this •Cognitive behavior therapy (CBT) and psychoeducation •Psychopharmacology Psychoeducation - teaches the pt that the symptoms are brought on, no by physical cause, but by stress and anxiety in life Pharmacology - lorazepam for anxiety SSRIs - by increasing their serotonin will decrease their depression Lexapro, sertraline,

Postpartum Blues

-If they don't get rectified can progress into depression. Depression can progress into psychosis. Psychosis can progress into crisis. -Also called adjustment reaction with depression -Mom will feel overwhelmed, mild depression and crying. Interspersed with happier emotions. -Related to rapid alterations in levels of estrogen, progesterone and prolactin. -More common in first time moms. -May be exacerbated if mom doesn't have adequate help at home in the first couple of weeks -Teach that the s/s are a normal reaction and help mom with self/infant care when experiencing periods of sadness -If this doesn't correct itself can progress to depression

Stool Info

-If under phototherapy lights their stool can be bright green, due to excretion of bili. - -If clay colored stools may be a possible bild duct obstruction. - -Mucous or loose stool can indicate possible milk allergy,

School Age Response to Health Care Environment, Promote Adaptation

-Industry (Erikson) -Set limits -Involve in care -Some scientific terms okay -Access to friends (phone, text, computer) -Possible tutor -Allow Independence -Do not judge regressive behavior

Rheumatic Heart Disease, Diagnostic Tests

-Jones criteria, established in 1944 and continually updated. Must be 2 of the major criteria or 1 major and 2 of the minor with the strep infection -Major: symptoms such as polyatrhritis, carditis, subcutaneous nodules, non-puritic ring rash usually on trunk or arms -Minor: history of this, increase in C-reactive protein, fever >38.5, evidence of heart block -Blood tests for exposure to strep, EKG, Echo, Chest X-ray to rule out enlarged heart and CHF

A client is scheduled to have a diagnostic procedure. Which questions by the nurse will most likely produce a teachable moment? Select all that apply

"What are you concerns about this procedure? "What would you like to know about this procedure?" "What have you heard or read about the procedure?"

Indicating the Existence of an External Source

"Who told you that you could fly?" "What message do you think the newsman was trying to tell you?" Indicating the existence of an external source of power encourages the client to project blame for his or her thoughts or behaviors on others.

A postpartal woman tells you that her room must be too warm because she has been perspiring excessively since delivery. Which of the following is your best response?

"Your body is excreting the increased fluid accumulated during pregnancy

Kawasaki Pathophysiology

-Leading cause of acquired heart disease in children in the developed world -Multisystem disease that can lead to coronary artery aneurism -Results in acute febrile inflammation of the vasculature, primarily affect kids younger than 5 with a peak in kids younger than 2 -Not contagious or congenital. Thought to be caused by an infective organism that is seen seasonally in affected areas. Mortality results from scarring, stenosis of main coronary arteries or MI due to coronary thrombosis. -Mimics measles or scarlet fever -Diagnosis of exclusion S/S last longer than 5 days: high fever (>101.3) and at least 4 symptoms from the list.

Physical Care when Mom arrives in L&D

-Let mom get comfortable -Limit their food and fluids -Start an IV, negotiable with provider if taking enough PO to stay hydrated. Will hang D5 for sugar is not drinking enough PO -Void every 2 hours -Up and ambulate -Look at birth plan

Male Infant Findings

-Look at the scrotum, it may be edematous. This is called hydrocele. Should have wrinkled scrotal skin. -Make sure testicles are descended. -Epispadia, meatus is on the ventral side of the penis -Hypospadia, meatus is on the dorsal side of the penis -Circ. Assessment, look for oozing, lot of bleeding. Worry about infection, healing and injury. Make sure baby is peeing - note voids after circumcision.

Hemophilia, diagnostic tests

-Look at their clotting cascade. -PTT, will be prolonged, indicating ineffective clotting factors -Low level of factor 7 or 9 coagulant -Usually don't show bleeding in first year of life and they start walking and fall -First injury is oral mucosa bleeding

Play in the Health Care Setting

-Make sure the toys are age-appropriate -Infants soft toys, blocks rattles (no toys 1" diameter or <) -Toddlers: fill/empty & push pull -Preschoolers: role play toys, large crayons & paper to draw -School age: board & video games, computers -Adolescents: computers, video games

People at risk for DVT

-Mom with history of DVT -Obesity -Smoker -Prolonged 2nd stage of labor. This is because legs are up and flexed for so long.

Maternal Adaptation to pregnancy, GI System

-Morning sickness, nausea & vomiting -Bleeding gums -Pyrosis (heartburn): stay upright for an hour after you eat and don't eat large meals -Gastric emptying is delayed -Constipation -Estrogen and Progesterone make gallbladder sluggish, prone to cholelethiasis

Kawasaki, complications

-Myocarditis -Pericarditis -Leaky valves -Pericardial effusion -CHF -MI occurs in 73% of children within first year of diagnosis

CL & CP, Post-Op

-NPO for 4 hours -Progress on special feeder -Liquids for 3-4 days -Main goal is preventing incision injury, prevent as much scaring as possible -Steri-strips over incision, clean after feeds. If a crust forms it's going to increase risk of scaring. Food on incision can cause infection. -No hard/sharp things that could injury incision. -No straws/sippy cups; could put pressure on lips/palette -Pain/crying can cause pressure on incision line

The Pregnant Adolescent

-Need to teach kids young -Pregnant adolescent: financial problems -Being pregnant makes you an emancipated minor -Health problems, their body isn't ready for pregnancy -CPD, head-pelvic disproportion -Poor prenatal care -Not hitting their trimester tasks -Problem is they are young and we expect them to act like adults. When they are in labor they act like a child. -Adolescent diet is awful -PIH is 3x more in adolescents

Signs preceeding labor

-Nesting (a hormone change) -Increased fatigue -Braxton hicks contractions -Flu-like symptoms (nausea, diarrhea) to clean out your system

Crisis Characteristics

"equal opportunity problem"....occurs to all of us! caused by specific event or "perceived event" examples from every day life? examples from clinical? crisis are personal...specific to that person..but what does that mean? most likely you have experienced this personal aspect of crisis For example: Pt has severe wound that needs a dressing, you as student saw this wound as more of a crisis that the pt! Another example:patient is upset about small abdominal scar...you are wondering why? crisis is an acute problem...it will be resolved one way or the other....the crisis, by it's very nature cannot go on & on, it is acute..the key is will it be resolved positively or negatively??? Crisis can cause psychological growth or deterioration..either "better or worse" in book is Chinese symbol for crisis - 2 symbols which stand for danger & opportunity Danger- dangers overshadow any potential growth resulting in dysfunctional behavior and maladaptive coping

The American Society for Pain Management Nursing (ASPMN) position is that:

"patients with addictive disease and pain have the right to be treated with dignity, respect, and the same quality of pain assessment and management as all other patients. This includes maintaining a balance between provision of pain relief and protection against inappropriate use of prescribed medications. Nurses are well positioned and obligated to advocate for pain management across all treatment settings for patients actively using alcohol or other drugs, patients in recovery, or those receiving methadone for opioid dependence."

Antipsychotic MedicationsNeuroleptic Malignant Syndrome

**********MEDICAL EMERGENCY********** Notify the MD stat is any symptoms Discontinue neuroleptic med immediately Treatment: dantrolene (Dantrium) bromocriptine (Parlodel) antipyretics, electrolytes Transfer to intensive care Rare but potentially fatal

Placenta previa: clinical manifestations

**Previa is painless bleeding** 3rd trimester is usually when the bleeding happens

A disaster is

*A sudden natural or man made event that causes widespread destruction and distress. *They often result in numerous injuries, food and water shortages, infection and vector-borne diseases, and loss of homes.

Concrete Language, Terms to Use

-"See how...working" -"Measure your Blood pressure"

Hemophilia, safety

-A child's recreation should include other kids to help with development -Feel like nothing will ever happen to me, encourage their involvement in their care allowing them as much control as possible -Isolation may cause a loss of independent functioning -Teach them smart choices and the risks

Hemophilia, nursing interventions

-Administer Factor 8 from pooled plasma -Administer DDAVP, synthetic form of vasopressin used to increase Factor 8 -Corticosteroids for hemarthrosis -NASID's for pain relief, avoid ASA -Supportive care, exercise and PT

Afterpain

-Afterpains are increased with multipara's -Heating pads are good for contracting pain -Motrin is good to help with pain -Prone position will help

Kawasaki, nursing implications

-Anti-inflammatory meds, antiplatelet meds -Ivgg, given for first 10 days after onset of symptoms to prevent coronary aneurism -Monitor cardiac status closely for s/s CHF -Care aimed at symptom relief

Toddler Response to Health Care Environment, Promote Adaptation

-Autonomy (Erikson) via routines -transitional objects from home -Parental rooming in -Teach parents how to 'leave" as needed -Prep: books, dolls, toy equipment (older toddler)

Abdomen/Cord

-Babies have a protuberat abdomen. Should not be distended but nice and round. -Cord should have 3 vessels, only have the opportunity at birth because after this it dries out. This gives us info for circulation and nutrition. -Cord as base shouldn't have oozing, red/swollen or inflammed.

Adolescent, Response to Health Care Environment, Response

-Body image/privacy threatened -Hospital can adversely affect need to separate form parents -Respond well to technical explanations

Cleft Lip and Cleft Palate

-CL more prevalent in boys -CP is more in girls -Highhest in Asian and lowest in African American -Usually see one or the other, not common to have them together (1:1000) -All of this occurs in the first trimester. CL occurs at 5-8 weeks, CP is at 9-12 weeks -Caused by genetic or teratogenic (dilantin for seizures) -Can be caused by smoking, binge drinking, hyperthermia (hot tubs), maternal obesity or stress

Maternal Nutrition

-Calories, before pregnant is 2200 and during pregnancy is 2500 -Protein, 46g before pregnant and 71 pregnant -Iron, 18mg before pregnant and 30-60mg pregnant -Omega-3 200-300mg/day while pregnant -Folic acid is 400mcg/day while pregnant

Maternal Adaptation to pregnancy, Integumentary system

-Can get cholasma/melasma, a darkening or hyperpigmentation on the bridge of nose/cheeks -Linea nigra, the dark line down the center of the abdomen due to hormonal changes -Straia gravidarum, stretch marks of pregnancy. Some women are more prone to them than others.

Preschool Response to Health Care Environment, Promote Adaptation

-Concrete language (next slide) -Nightlight -Play -Independence -Prep: Books, "role play", pictures, puppets

Lab Changes

-Decreased H&H -WBC increased initially. Can go as high as 20,000-30,000, called non-pathologic leukocytosis. Will normalize by the end of the first week. -Platelets, going to be high so watch for DVT. Will return to normal by the end of the 6th week.

Foods to Avoid

-Deli meat due to listeria -No raw fish -Soft cheese, unpasturized -Alcohol -Fatty fish, shark, macrel and swordfish -No raw eggs -Artificial sweeteners (avoid saccharine)

Newborn screening, Cardiac

-Done at 24 hours old. Use a pulse-ox on R upper and R lower extremity, should be over 95% and equal in both. If a failure will repeat the screen in 1 hour if both are between 90-94% or the difference is >3%. -Pass and equal, difference is <3% and over 95% saturation -Positive for cardiac problem is >3% difference, or less than 95% saturation

CL & CP Repair

-Early CL repair is done before infant is at risk for imbalanced nutrition. Can't form a good seal and hinders suck. -CP is done to prevent speech difficulties

Postpartum Depression

-Extreme sadness, anxiety regarding self and baby -Will see poor decision making -Can occur up to one year after birth but most commonly see at 4 weeks after birth -Treat this with talk therapy and meds -Teach s/s before discharge. Assess for any risks they may have before discharge. -Also assess at post-partum and well-baby visits (at pediatrician).

Additional Fears of Hospitalized Child

-Fear of injury and pain -Fear of loss of control -Fear of unknown Common Response: -Regression: regressive behavior usually resolves at discharge

Rheumatic Heart Disease, Caregiver Education

-Finish all antibiotics -Be seen when child has a sore throat -Regular checkups with cardiologist -Encourage immunizations and flu shot -Provide education related to prophylatic antibiotics needs for dental work

Postpartum infection, perineal

-Gain entry through episiotomy or laceration suture site

Maternal Adaptation to pregnancy, Respiratory system

-Get sniffles due to hormones, estrogen and progesterone make membranes thin -Thoracic breathing, shallow and rapid -Oxygen consumption increases 20%

Maternal Adaptation to pregnancy, Cardiovascular system

-HR increases -Blood volume increases by up to 50% by 3rd trimester. This can create pseudoanemia due to hemodilution. This is why we tell women to take multivitamin. -Poor venous return, can get clots from venous stasis and varicosities (on the legs and calves, also get hemorrhoids) -Moms can develop vena-caval syndrome. This is when they are in supine position, pressure on major vessels and when they get up they have supine hypotension. Tell women to sit up slowly. -Pulse 10-15bpm -Cardiac output increase 50%

Newborn screening, Hearing

-Hearing at 24 hours old, or before discharge -Know that we are concerned about a fail because the ears/kidneys develop the same day so an ear problem can indicate a kidney problem. -Can have a false failure, could be due to overstimulation or fluid in the ears. -Baby has to be still/quiet during test.

Hemophilia, assessment

-History of bleeding (nose bleeds or bruising), can be seen with circumcision -Older they get the more bleeding they have with injury -Hemearthrosis, into joint cavity (knee, elbows) - pain and swelling -Limited motion in joints, synovitis -Spontaneous hematuria

Adolescent, Response to Health Care Environment, Promote Adaptation

-Identity (Erikson) -Privacy -Personalize room -Allow street clothes -Use correct Medical terms

A staff nurse (RN) delegates care of clients to the CNA and LPN. Which tasks should the nurse (RN) assign to the CNA and LPN?

CNA-check vital signs; LPN-give oral medications to assigned clients

effects on the body - opioid

CNS effects - uEuphoria, mood changes, mental clouding, drowsiness, pain reduction GI effects - uIntestinal tone increased, constipation and fecal impaction CV effects - uHypotension Sexual functioning - uDecreased sexual function, diminished libido Addiction can occur similarly to CNS depressants either obtained legally with increased usage or illegally/recreationally. Vicadins/oxy's is often obtained by teenagers by simply going to mom and dads medicine chest! Intoxication-euphoria followed by apathy, dysphoria (a state or mood of dissatisfaction, restlessness, or anxiety), psychomotor agitation/retardation, impaired judgement Withdrawal-dysphoric mood, N/V, muscle aches, lacrimation, rhinorrhea, pupillary dilatation, piloerection (goose bumps) sweating 1st sign of WD, abd. Cramps, diarrhea, yawning, fever, insomnia Treat addiction with Methadone, Levo-alpha Acetyl Methadol (LAAM) less frequent treatment, Buprenorphine (subutex, butrans, buprenex), Clonidine - effective when combined with trexan Clonidine works on specific nerve cells in the brain that are responsible for lowering blood pressure, slowing heart rate, and decreasing the body`s reaction to the withdrawal of chemicals like alcohol, opiates, cocaine, and nicotine. Because of this, clonidine is often used to treat the symptoms of drug, alcohol, and nicotine withdrawal. Clonidine is beneficial in opiate withdrawal because it treats symptoms that are commonly associated with that condition (watery eyes and nose, diarrhea, irritability). For this condition, clonidine is often used alone. For the treatment of alcohol withdrawal, clonidine is sometimes combined with benzodiazepine tranquilizers such as Librium, Valium, Xanax, or Ativan.

Psyche

Can almost predict how labor is going to go when mom comes in. How mom feels about labor is how it will go. Mom's with a better attitude will have an easier labor. **Normal FHR is 110-160**

cannabis (marijuana, hashish)

Can be smoked or ingested orally, second only to alcohol as most widely abused drug in US. Intoxication-impaired motor coordination, euphoria, anxiety, impaired judgment Withdrawal-restlessness, insomnia, irritability. Loss of appetite Therapeutic effect-medical marijuana (marinol-synthetic) treatment HIV, chemo clients

The Atonic Features Specifier

Catatonic features may be associated with other psychotic disorders, such as brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance induced psychotic disorder. Symptoms of catatonic disorder include: •Stupor and muscle rigidity or excessive, purposeless motor activity •Waxy flexibility, negativism, echolalia, echopraxia For catonic patient: 1st is safety 2nd is hydration Make sure to talk to these people, try to bring them back to reality

Challenging and Testing

Challenging "How could you possibly think of getting your own apartment and taking your meds on your own?" "That just won't happen for you!" Testing "Do you even have any idea what day it is?" "What makes you think you could find your way to the recreation room?"

Legal ramifications when teaching

Characteristics of the patient is patient alert, awake, non sedated, hearing aid in, glasses on..if any teaching done with these issues present, RN could be liable if pt has subsequent problems r/t not understanding the information provided Appropriate language of the information avoid complex medical terms..pt's can even be confused with the work "void" Timing of presenting the information is it late at night, early am, when pt has visitors waiting And of course.... "not documented, not done"

Histrionic personality disorder

Characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people •Behavior is •Excitable •Emotional •Colorful •Dramatic •Extroverted Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance. A person with histrionic personality disorder seeks attention, talks dramatically with strong opinions, is easily influenced, has rapidly changing emotions, and thinks relationships are closer than they are. Individuals with histrionic personality disorder use manipulative and exhibitionistic behaviors in their demands to be the center of attention. People with histrionic personality disorder often demonstrate what our society tends to foster and admire in its members: to be well liked, successful, popular, extroverted, attractive, and sociable. However, beneath these surface characteristics is an all-consuming need for approval and a desperate striving to be conspicuous and to evoke affection or attract attention.

A common chemical agent that causes harm by separating the Alveoli from the capillary bed is?

Chlorine

PIH, risk factors

Chronic HTN, obesity, diabetes, family link (paternal mom), multiple gestations, young (under 20) or old (over 35)

Bloom's Domains of Learning

Cognitive Domain of Learning - the thinking domain- knowing, comprehending, applying ,analyzing, synthesizing & evaluating" we know something such as insulin is to lowers blood sugar by permitting glucose to enter cells or antibiotics work by lowering the amount of infecting m/o so the immune system can fight them Affective Domain of Learning - attitudes, emotions, values & feelings "I believe now that calmly talking to a patient who is throwing things is a more effective initial intervention that just telling them to "Stop it"! PsychomotorDomain of Learning- fine& gross motor skillsone cannot learn to change a wet to dry dressing by watching a DVD only!

Treatment for Trauma-and Stress-Related Disorders

Cognitive therapy For PTSD and ASD, cognitive therapy strives to help the individual recognize and modify trauma-related thoughts and beliefs The individual learns to modify the relationships between thoughts and feelings, and to identify and challenge inaccurate or extreme automatic negative thoughts. Goal is to replace these negative thoughts with more accurate and less distressing thoughts, and cope more effectively with feelings such as anger, guilt, and fear. Prolonged exposure therapy (PE) PE a behavioral therapy similar to implosion therapy or flooding. Conducted in an imagined or real (in vivo) situation PE has four main parts. 1.Education about the treatment 2.Breathing retraining for relaxation 3.Imagined exposure through repeated discussion about the trauma with a therapist 4.Exposure to real-world situations related to the trauma Group/family therapy Strongly advocated for clients with PTSD and has proved especially effective with military veterans Share their experiences with empathetic fellow veterans Talk about problems in social adaptation Discuss options for managing aggression toward others has been emphasized Psychopharmacy; (alleviate symptoms) Antianxiety, antidepressants, anxiolytics, antihypertensives

Crisis Assessment

Collect data concerning: Precipitating event or stressor...."What happened & when?" a/o "Has it ever happened before?" Explore needs, events that threaten needs, time event occurred & sx's developed Needs are related to: Self-esteem, Role mastery, Dependency & Biological function Precipitating event could be : * d/t threat to self esteem - "My girlfriend broke up with me...I'm worthless" *d/t unable to be a mother..premie baby...nurses must care for baby *d/t "I can't walk....who will help me?" *d/t loss of biological function..."I have a colostomy...how will I take care of this Availability/Adequacy of support systems.... "Who do you usually talk to when you are upset?" Who does the patient live with? Who are they close with? Coping resources/previous coping mechanisms.... "How have you dealt with problems before?" Are you having trouble sleeping?" "Are you thinking of hurting yourself?" Personal strengths & limitations..... "What things are you good at?" a/o "What has always overwhelmed you?"

Trends

Computer literacy required as you advance through nursing Use of Internet to communicate and provide patient self-care Evaluation of Internet resources Use of patient digital assistants (PDAs) Information technology is included as a subcategory on the 2013 NCLEX-RN® Detailed Test Plan. Computer literacy required as you advance through nursing Use of Internet to communicate and provide patient self-care Evaluation of Internet resources Use of mobile computing devices Box 23-4 Page 547 Test plan for 2013 NCLEX Barriers: Lack of standardization (some still using paper charting), funding (costly to invest in these newer models of technologies), etc.

Medication Centered Problems -VOLUNTEERING -DISCREPENCIES IN CHARTING -CREATIVE WAYS OF DOSAGE ADMINISTRATION -DEFENSIVE WHEN QUESTIONED

Consistently volunteering to be the medication nurse. Offering to hold narcotic keys during report. Volunteering to work with patients who receive regular or large amounts of pain medication. Frequently found around medication room or cart. Insists on administering drugs via IM when other nurses give it PO to same patient. Patient charting reflects excessive use of PRN pain medication compared to shifts when other nurses are assigned to the same patient. Patients complaining of little or no relief from pain medications when nurse is assigned to patient Use of two smaller tablets of medication to give prescribed dose (two 30mg codeine tablets instead of one 60 mg tablet). Use of larger than necessary dose, wasting the rest (100mg Demerol when patient is to receive only 50mg). Missing drugs or unaccounted doses. Frequently reporting spills, wastage or breakage of medications. Charting errors include medication errors. Defensive when questioned about medication errors.

Placenta Abruptio: clinical manifestations

Contracted belly will release while an abruption won't get soft again

First stage, latent phase

Contractions 5-7min apart 1-3cm dilated 20-40sconds duration During this phase -Comfort measures such as walking, resting, massage -Look at birth plan Happening: mom is very sociable, pain scale is about a 2. Make sure to visit with mom and remind her not to expend energy during this phase as she will need it later

Member Roles Within the Group

Coordinator clarifies ideas & suggestions, brings people together pursue common goals (critic) Evaluator looks at group plans and performance, measures against group standards and goals Elaborator explains and expands ideas- takes ideas and develops certain plans id idea were adopted Energizer encourages and motivates optimum potential Initiator outlines task and proposes method for solution Orienter maintains direction within group- keeps focused Compromiser relieves conflict assisting to reach a compromise agreeable to all Encourager recognizes and accepts other's ideas Follower passive participant, listens attentively (can be useful for who said what) Gatekeeper encourages acceptance of and participation by all group members Harmonizer minimizes tension by intervening when disagreements produce conflict (everybody make nice) Aggressor negative and hostile, may use sarcasm in effort to degrade the status of others Blocker resists group efforts, rigid and irrational behaviors that impede progress Dominator manipulates others to gain control, authoritarian (who died and left you in charge?) Help-seeker uses group to gain sympathy, increase self confidence via group feedback, lacks concern for others or group as a whole Monopolizer maintains control of group by dominating conversation Mute does not participate, may feel uncomfortable with self disclosure or seek attention thru silence Recognition seeker discusses personal accomplishments to gain attention for self Seducer shares intimate details about self, least reluctant of group to do so, may inhibit (prevent or hinder) others by early self disclosure

Respiratory homeostasis

Cord clamping MOdified trenndelenburg

As the move-out date to leave the shelter gets closer, a battered wife states, "I'm afraid to leave here. I'm afraid for my safety and the safety of my children." Which nursing statement is most supportive? A."This is a difficult transition. Let's formulate a plan to keep you all safe in the community." B."It's the policy that clients can only live here 30 days. Maybe we can ask for more time." C."You've had a month to come up with a plan for keeping you and your family safe." D."Hopefully, your husband has been in counseling. I'm sure this will work out fine."

Correct answer: A The nurse is using the therapeutic techniques of "reflection" and "formulating a plan of action." The use of these communication facilitators indicates that the nurse is supportive of the client's feelings and appreciates the need for a safety plan.

A nursing instructor is teaching a class about normal human sexuality. Which of the following information should be included? a)Gender identity develops during adolescence. b)Sexual drives remain consistent throughout the life span. c)Many medications can impact sexual functioning. d)The elderly have little interest in sexual activity.

Correct answer: C Medications, such as antihypertensives, mood stabilizers, and antidepressants, can impede sexual functioning.

defending and requesting and explanation

Defending "Your doctor knows exactly what to do for you" "All the nurses know how to take care of you" "Your doctor has an excellent reputation" Defending means to defend what the client has criticized implying that the client has no right to express ideas, opinions, or feelings Requesting an Explanation- "Why did you do that?" "Why do you think your food is poisoned?" Requesting an explanation. Asking "Why?" implies that the client must defend his or her behavior or feelings. Never say why? It makes the client have to explain,

Delusional Disorder

Delusions last for a month Erotomanic Type - think famous person loves them Grandiose Type - irrational ideas about own worth. Jealous Type - thinks husband is up to something Persecutory Type - prolonged period where you think people are plotting against you. Somatic Type - somatic: false believes that they have medical issue like their kidneys are failing. Mixed Type - all of the types.

The National Medical Response Team for Weapons of Mass Destruction is a sub-branch of the:

Department of Health and Human Services

Clinical Information Systems

Development and application of clinical information systems (CIS) are essential for health care to leverage state-of-the-art technology to deliver highest-quality, lowest-cost patient care Clinical information systems have replaced paper-and-pencil charting CIS can utilize computers to provide and store information and data about patients from departments that are patient-focused or department-focused Technology is changing the ways that health care is delivered in all areas.

Gestational Diabetes, diagnosis

Diagnose via GTT, screening of all pregnant women. Once diagnosed adjust diet and exercise.

Crisis Intervention

Disequilibrium - Assistance - Recovery This is a dramatic illustration of a crisis Crisis 'occur everyday in all health care settings. Crisis intervention must be quick and effective-individual must experience some degree of relief almost from the first interaction

Hallucinogens

Distort a persons percception of reality altering sensory perception and induced hallucinations. Natural-Mescaline (peyote cactus). Psilocybin (PCB) Synthetic-LSD, DET, PCP, Ketamine Hallucinogenic drugs distort one's perspective of objective reality. If taken in high quantities, delusions and hallucinations are characteristic of this class of drugs. It is also common for a user to experience unpleasant psychological reactions, including panic, anxiety, loss of control, and disorienting flashbacks. Hallucinogens commonly seen by the laboratory include: lysergic acid diethylamine (LSD), psilocybin mushrooms, phencyclidine (PCP), and mescaline (peyote cactus).

Assessment: Positive Symptoms

Disturbance in thought Delusions: false personal beliefs Religiosity: excessive demonstration of obsession with religious ideas and behavior Paranoia: extreme suspiciousness of others Magical thinking: ideas that one's thoughts or behaviors have control over specific situations Positive symptoms are present in ppl with schizophrenia and not in people without the disease schizophrenia. - Will have major disturbances in thought Associative looseness (also called loose association): a shift of ideas from one unrelated topic to another Neologisms: made-up words that have meaning only to the person who invents them Clang associations: choice of words is governed by sound (often rhyming) Associative looseness: today is Tuesday and the sky blue. It has nothing to do with each other •Word salad: group of words put together in a random fashion •Circumstantiality: delay in reaching the point of a communication because of unnecessary and tedious details •Tangentiality: inability to get to the point of communication due to introduction of many new topics •Mutism: inability or refusal to speak •Perseveration: Persistent repetition of the same word or idea in response to different questions •Disturbance in Perception: interpretation of stimuli through the senses •Hallucinations: false sensory perceptions not associated with real external stimuli •Auditory •Visual •Tactile •Gustatory •Olfactory •Illusions: misperceptions of real external stimuli

Gestational Assessment, Foot Crease

Dothey have anterior/trasnverse crease only (small for gestational age) or is the whole foot covered in creases

Managing Alcohol Withdrawal with Medications

Drugs depend upon level of agitation, anxiety, and BP Calm environment Antipsychotic/anti emetic/antidopaminergic - inapsine Antihypertensive/opiod detox - catapress Clonidine works on specific nerve cells in the brain that are responsible for lowering blood pressure, slowing heart rate, and decreasing the body`s reaction to the withdrawal of chemicals like alcohol, opiates, cocaine, and nicotine. Because of this, clonidine is often used to treat the symptoms of drug, alcohol, and nicotine withdrawal. Thiamine - 100mg IM or IV & folic acid 1mg po prevent encephalopathy Benzodiazepines - (Ativan, Librium,) Haldol, Catapres, Inapsine (IV PO IM) Mag Sulfate - raise seizure threshold (know antagonist)- Calcium gluconate Anti-convulsants - valium or phenobarbitol uFluids & lytes - monitor K.--- fluid loss occurs as BAL rises. Fl. Retention occurs as BAL falls Dextrose - hypoglycemia / malnourished

Extrapyramidal Side Effects (EPS) Treatment EPS symptoms- Antiparkinsonian

Drugs: anticholinergics benztropine (Cogentin) trihexphenidryl (Artane) beperiden (Akineton) procyclidine (Kemadrin)

encouraging comparison and restating

Encouraging Comparison -"Have you had a similar experience?" "Was this something like you felt when . . . ." Encouraging comparison asks the client to compare similarities and differences in ideas, experiences, or interpersonal relationships. Help client to remember other life experiences that recur Restating (Repeat Main Idea) - Has statement been perceived or understood correctly Patient: "I can't relax" Nurse: "You are having difficulty relaxing?" Restating lets the client know whether an expressed statement has or has not been understood.

Encouraging Formation of Plan of Action

Encouraging Formation of Plan of Action "Next time you feel anxious, what do you think you can do to help you calm down?" "When you feel angry, how can you deal with it without harming anyone?" Formulating a plan of action strives to prevent anger or anxiety from escalating to an unmanageable level the next time the stressor occurs

Maternal Adaptation to pregnancy, endocrine system

Endocrine System -Normal weight gain is 25-35lbs but this depends on her starting weight. Fluffy should gain less. -1st trimester, 3-5lbs -2nd and 3rd trimester is 12-15lbs each

Physiological Effects of Alcoholism

Esophagitis -inflammation & pain of esophagus, also secondary to frequent vomiting Gastritis -inflammation of stomach lining, N/V, distention, alcohol eats away mucosal barrier-ulcers, hemorrhage Pancreatitis -acute or chronic, severe epigastric pain, N/V, abd. Distention Chronic-steatorrhea (fat in feces), malnutrition, weight loss, DM Hepatitis -enlarged and tender liver (inflammation), N/, lethargy, anorexia, increased WBC, fever, jaundice Cirrhosis of liver -end stage of alcoholic liver disease, fibrous scarring, N/V, anorexia, anemia, bld clotting abnormalities, pain, jaundice, edema, (portal htn, acities, esophageal varices, hepatic encephalopathy) Keep in mind -Nutritional deficiencies are common secondary to malnutrition/anorexia, abd. Pain Alcohol myopathy -breakdown of myoglobin results in muscle pain, weakness, bld. In urine, rapid rise in muscle enzymes (elevations in CPK, LDH, AST) Peripheral neuropathy deficiency in b vitamins (thiamine) nerve damage, pain, burning, tingling Wernicke's Encephalopathy -thiamine deficiency, paralysis of ocular muscles, diplopia, ataxia, stupor Karsokoff's psychosis -confusion, recent loss of memory, confabulation (Confabulation is defined as the spontaneous production of false memories: either memories for events which never occurred, or memories of actual events which are displaced in space or time. These memories may be elaborate and detailed. Some may be obviously bizarre, as a memory of a ride in an alien spaceship; others are quite mundane, as a memory of having eggs for breakfast, so that only a close family member can confirm that the memory is in fact false) Leukopenia wbc production, function andmovement impaired Thrombocytopenia impaired platelet production

Alcohol acts as CNS depressant

Excessive habitual consumption of alcoholic beverages despite physical, mental, social, or economic harm (e.g., cirrhosis, drunk driving and accidents, family strife, frequently missing work). It is usually considered an addiction and a disease. The causes are unclear, but there may be a genetic predisposition. Alcoholism occurs in about 4.2% of adults in the U.S. It is more common in men, but women are more likely to hide it. Treatment may be physiological (with drugs that cause vomiting and a feeling of panic when alcohol is consumed; not an effective long-term treatment), psychological (with therapy and rehabilitation), and/or social (with group therapies). Group therapies such as Alcoholics Anonymous are the most effective treatments. Suddenly stopstopping heavy drinking can lead to withdrawal symptoms, incl. delirium tremens.

Overall outcome (goal) for nursing diagnosis related to Crisis

Expected outcome: Patient will recover from the crisis & return to a pre-crisis level of functioning

Exploring and giving information

Exploring- "Please tell me more about. . . . . ""How would you describe your feeling when. . ." Exploring is delving further into a subject, idea, experience, or relationship Helps to dig deeper into idea or thought process, always refrain form pushing too hard, may shut down client Giving information- "Hello, my name is . . . .""I will be your nurse today" "Today you will be going for. . . . Test"

factitious disorder

Factitious disorder •Conscious, intentional feigning of physical and/or psychological symptoms •Individual pretends to be ill to receive emotional care and support commonly associated with the role of "patient." •The disorder may also be identified as Munchausen syndrome. •The disorder may be imposed on another person under the care of the perpetrator (formerly called Factitious Disorder by Proxy).

Treatment Modalities (cont'd)

Female and male orgasmic disorders •Sensate focus exercises •Directed masturbation training Early ejaculation •Sensate focus exercises "Squeeze" technique Genito-pelvic pain/penetration disorder •Physical and gynecological examination •Education of the woman and her partner regarding the anatomy and physiology of the disorder •Systematic desensitization with dilators of graduated sizes •Identification and treatment of any relationship problems

Sympathetic Nervous System side effects

Fight or Flight Secretes the main neurotransmitters adrenaline (epinephrine)/norephinephrine, And dopamine, seratonine AKA sympathomimetic/adrenergic Effects on the body: 1.Vasoconstriction (raises blood pressure/pulse 2.Bronchodilates 3.Dilates the pupils 4.Decreases peristalsis 5.Bladder relaxed/decreased urinary output 6.Liver releases glucose (glucagon) for energy 7.Saliva decreases

Gestational Assessment, Breast Tissue

Fine and fuzzy or coarse and silky

Gestational Assessment, Hair

Fine and fuzzy or coarse and silky

What is the first breath

First breath requires major undertaking by infant. It's influenced by cold receptors, extrauterine world is much colder than uterine life. Outside temp stimulates their brain to take their first breath in. Clamping the cord causes their CO2 to rise and encourages the respiratory center of medulla to be stimulated and take a breath. First time the alveoli is inflated requires

How is fluid removed from a babies lungs

Fluid is removed from lungs by 1/3 is from movement through the vagina, squeezed through the birth canal. This is why c-section babies are wetter - they don't get squeezed 2/3 is absorbed by lung vessels and lymphatic system Need to monitor baby for the first few days because they can choke quickly, educate on how to use bulb suction

"No excuses interventions"

Focus on "here and now" Panic anxiety -DO NOT leave patient! Accept how they are coping (however ineffective it may be) AND NO lengthy explanations! Firm limits on aggressive a/o destructive behavior "I see you are angry but yelling and throwing is not okay. I may need to call security to protect you and help you stop." Clarify the problem & cause "I know you & your wife planned on a natural birth. It's hard when goals aren't met." Guide through problem solving "You feel out of control, about the C-section. I will tell you how you can participate." Old slide: go over if time Techniques of crisis intervention Catharsis Clarification Suggestion Reinforcement of behavior Support of defenses Raising self-esteem Exploration of solutions

The graduate nurse has learned that to optimize time management skills for client care they must: (Select all that apply)

Formulate a shift action plan & A.Make client rounds & A.Set priorities

Vitamin K

Given IM because babies are lacking intrinsic factor. Give until the gut has microorganisms that can make intrinsic factor. Intracranial bleeding is a huge risk if this isn't given.

Rhogam

Given at 28 weeks and post-partum if baby has a positive blood type.

giving literal responses and using denial

Giving Literal Responses- While this may be funny, sounding glib is inappropriate Using Denial Patient: "I'm very nervous" Nurse: "You look very calm to me" Using denial blocks discussion with the client and avoids helping him or her identify and explore areas of difficulty.

Therapeutic communication - giving recognition and offering self

Giving recognition- "Good evening Ms. Light.....I see that you were able to get up by yourself" Acknowledging, better than complimenting Giving recognition is acknowledging, indicating awareness. Offering Self- "I will stay with you" "I'm interested in hearing how you feel" is making oneself available increases feelings of self-worth

First Stage, Transitional Phase

Goes from 8-10cm Lots of bloody show The shortest phase of labor, usually less than 1 hour but the most intense Contractions are 2-3 minutes apart, 60—70 seconds long. Contractions on a pain scale is a 12. Very intense. Don't talk during the contractions, don't touch either Quietly assist the laboring mom. Do as you're told by the mom. As she gets close to full dilation may feel an urge to bear down. Check mom vaginally to make sure she's fully dilated, if not fully dilated have her breathe - if push on cervix early the cervix will swell and will prolong transition

Grasping/Plantar Reflex

Grasping Put finger in their hand and their fingers curl Plantar Put finger at base of toes and their toes curl

Therapeutic Groups: whats the difference?

Group therapy: psychosocial treatment, meet with therapist, sharing, gaining, personal insight, improving interpersonal coping strategies Therapeutic group: teach participants effective ways of dealing with emotional stress arising from situational or developmental crisis. ----selected issue- focus of therapeutic is group issues ie: loss, grieving Open ended: members leave and others join at any time while the group is active. Close ended: predetermined time frame, all members join & terminate at same time, usually have common issues ie: time frame= lamaze Self-help groups AA, WW, OA (over-eaters anonymous), usually run by members, leadership often rotates 7-8 members

Substance/Medication Induced Psychotic Disorder

Hallucinations Delusions Attribute to drugs, medications or toxins

Fetal Station

Has to do with where the baby's head is within the pelvis **Head at ischeal spine is zero station, engaged** Negative 1-3 is head above the ischeal spine Plus 1-3 is head below the isceheal spine +4 is crowning, the widest diameter of the head is in the opening of the vagina

Placenta Abruptio: treatment

Have to birth mom right away, c-section usually, because the baby and mom can both die. Need to watch her counts. Mom can go into shock. Need to watch her contraction pattern. Replace blood loss, deliver baby and make sure baby is doing OK

Early Decelerations

Head is way down in the pelvis and there is head compression. Baby is probably ready to be born. Check to see if mom is ready to push the baby out. Nothing to be worried about. The deepest part of the decel is at the peak of the contraction. Looks like hourglass.

HELLP

Hemolysis Elevated Liver enzymes Low Platelets All based on bloodwork. Need to have all 3 parts. Platelets generally <100,000 AST/ALT are elevated AST: 7-34 ALT: 10-30

Hydatiform Mole: signs and symptoms

High HcG, hyper emesis, elevated BP, prune juice drainage, uterus grows out of proportion to stated dates (larger). Mom isn't pregnant but used to be. It's an ovular defect. No baby, baby never grew. Choriocarcinoma is a side-effect, lethal second only to ovarian cancer.

Horizontal Violence

Horizontal violence is a harmful behavior, via attitudes, actions, words and other behavior, that is directed toward us by colleagues. It controls, humiliates, denigrates, and injures the dignity of another. It indicates a lack of mutual respect and value for the worth of the individual and denies another's fundamental human rights. It is a self-serving, nonproductive response that perpetuates an escalating cycle of resentment and retaliation. It may or throwing objects. be overt or covert. It is generally non-physical, but may involve shoving, hitting

Parasympathetic Nervous System (side effects)

House keeper (controls the body at rest) Secretes the neurotransmitter acetylcholine (muscle movement!!)) AKA cholinergic Effects on the body: 1.Vasodilates (decreases blood pressure/pulse) 2.Bronchoconstricts 3.Constricts the pupil 4.Increases peristalsis 5.Increases bladder muscle tone/increases urinary output 6.No effect on glucose 7.Salivary production increases

Neuroleptic Malignant SyndromeMedical Emergency

Hyperpyrexia Muscle rigidity Increased pulse and respirations Fluctuating BP Mental Status Changes- stupor-coma Diaphoresis Elevated CPK, WBC

GI Changes

Hypoactive bowel sounds, things slow down. Increased appaetite. This puts them at risk for constipation, exacerbated by hemorrhoids. Can give fluids, stool softeners (colace, senna), encourage movement.

What Are Regulatory and Accreditation Requirements?

IN and INS have clear understanding of regulations to guide organization within boundaries HIPAA: ensures that health care organizations collect right data in common format, so that the data can be shared, privacy protected and secured. The Joint Commission: inspects and reviews variety of areas within each organization

Heart Disease and Pregnancy, mom

If mom is complicated with heart disease: -Have to make sure to work with a cardiologist, baseline echo to know where she stands -Worry about the blood volume increase -Watch symptoms carefully -May need a few stress tests to make sure she's OK -Valsalva maneuver will kill her, don't want her to have to push

Somatic Symptoms Disorders Include:

Illness Anxiety Disorder •Conversion Disorder: unexplained sensory or motor deficit, associated with psychological factors. it typically involves slight functional impairment. •Factitious Disorder (Munchausen Syndrome) the conscious decision by the client •Factitious Disorder imposed on another (Munchausen syndrome by proxy) a vulnerable person (usually parent to child) Examples: •Pain in my toe, id say omg omg I must have MS or something •Extremely stressed person, they get back pain... just bc their muscles are really tensed. •Acts out of character • •me or another adult •Caretaker puts the symptoms that are not there (abuse, reportable)

The Joint Commission

Implemented information management (IM) standards in the mid-1990s Ensures that facilities are meeting high performance standards through certification Need for information management regulation Sends out a team of experts to review the HCO and inspects and reviews areas within each organization Implemented information management (IM) standards in the mid-1990s Total of 10 standards Information management has been woven throughout the various standards and the National Patient Safety Goals.

improving communication in group meetings

Improving communication in group meetings: Come prepared Listen Keep on task (no side bars or war stories) Present your ideas or opinions State disagreements Clarify when necessary Be respectful of other group members!

Job Performance (Impaired health Professional)

Inconsistent work quality, alternate periods of high and low efficiency. Increased difficulty meeting deadlines. Unrealistic excuses for lowered work quality. Job shrinkage, doing the minimum work necessary for the job. Sloppy or illogical charting. An excessive number of mistakes or errors of judgment in patient care. Long breaks or lunch hours. Frequent or unexplained disappearances during the shift. Lateness for work and/or returning from lunch. Volunteering to work overtime despite difficulty showing for scheduled shifts. Excessive use of sick time, especially following days off. Absences without notice or last minute requests for time off. Repeated absences due to vaguely defined illnesses.

Psychological Treatments - Primary Focus is to decrease anxiety and establish trust

Individual psychotherapy: long-term therapeutic approach; is difficult because of client's impairment in interpersonal functioning Group therapy: some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment Behavior therapy: chief drawback has been inability to generalize to community setting after client has been discharged from treatment Social skills training: use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture, etc.; it is aimed at improving relationship development. Social Treatments uMilieu therapy: best if used in conjunction with psychopharmacology uFamily therapy: aimed at helping family members cope with long-term effects of the illness

Hospitalized, School Age

Industry vs. inferiority. Written materials are ok as long as at their reading level. School-age will regress a lot while in the hospital, especially with potty training. Don't judge for regressed behavior.

Nursing Diagnosis for Substance Related Disorders

Ineffective denial Ineffective coping Imbalanced nutrition (less than) Risk for Infection Chronic low self esteem Knowledge deficit Risk for injury (risk for falls) Risk for suicide Dysfunctional family processes Disturbed sleep pattern Insomnia Impaired memory Anxiety Fear Hopelessness Risk for loneliness Risk for situational low self esteem Ineffective role performance Impaired parenting Social isolation

G&D Pain Assessment

Infancy demonstrate pain with physiological changes & movement 1.Cries - neonates 2.Comfort- young infants 3.FLACC Toddlers/Preschoolers limited verbal skills to describe 1.FLACC 2. Wong Baker Faces 3 yrs or> School Age younger school age may regress & not verbalize, older can understand words like sharp & dull 1.Wong Baker Faces younger 2.Numerical older Adolescents 1.Numerical 2.Adolescent tools

Gestational Diabetes, complications

Infection is more common, polyhydramnios is more common, PIH is more common

Considerations for the Adult learner

Information taught ü MUST be relevant do not discuss other types of dressing procedures, just discuss what the pt needs to learn üInformation must be what the learner wants to know so must always ask, "What do you know about this subject?" üInformation must be provided when the due to time constraints of the nurse, cannot be completely flexible... ask...is 1 pm or 2pm better?

Yalom's Therapeutic factors/ Curative Factors of Groups

Instillation of hope - That problems can be resolved - encouragement that recovery is possible Universality - individual is not alone in their problems Imparting of Information - Share information & pass it on Altruism mutual sharing and concern for each other, support for others creates positive self image Recapitulation of Family group re-experience early family conflicts that remain unresolved, attempt at resolution- to restate/summarize Development of social techniques Learn new social skills- new ways to talk about feelings/observations Imitate behavior one can be a positive role model- modeling anothers manners & recovery skills Interpersonal learning varied opportunities for interacting with others - communication of information Group cohesiveness sense of belonging - value in the group Catharsis express positive and negative feelings in a non threatening atmosphere- release tension Existential factors help individual members take direction of their own lives- life & death are realities

Functions of groups: interpersonal perspectives and functional perspectives

Interpersonal Perspectives: Affection fulfill need for association or connection with one another Affiliation provide opportunity to develop emotional relationships with one another Socialization socializing into culture of organization (primary) socialization in G&D Support social support for members, a source of collegiality or of help when needed Camaraderie feeling of goodwill among the members Power opportunity for individuals to exercise their need for power over others Functional Perspectives: Task completion completion of tasks that are beyond the scope of any one individual Information setting performance goals, establishing priorities, sharing special knowledge Normative function develop definitions and standards and enforce those standards encouraging compliance Empowerment empower group members and thereby encourage change Governance provide involvement in decision making and serving as a source of governance within organization

interpreting and introducing an unrelated topic

Interpreting-"What you really meant to say was . . . . . . ." Interpreting results is the therapist's telling the client the meaning of his or her experience Do not put words in the clients mouth! Introducing an Unrelated Topic Patient: "I don't want to live anymore" Nurse: "Do you have a good time today in the art therapy group? Introducing an unrelated topic causes the nurse to take over the direction of the discussion. Introducing an Unrelated Topic- Don't come out of left field

Nuclear

Ionizing Radiation •Alpha particles •Beta particles •Gamma rays •X-rays •Neutrons

Anxiety and increased emotional arousal:

Irritability or anger Overwhelming guilt or shame Self-destructive behavior Trouble sleeping Being easily startled or frightened Hearing or seeing things that aren't there (Hallucinations)

Determine Area that needs are not met

Issues of self image & self esteem "How is it for you when you look at your wound?" , "Have you ever used a walker before?" Areas of life that are considered a success "Do you work?", "What hobbies do you enjoy?" Relationships with others "Tell me about your family a/o friends?" Degree of safety and security in life

NAS

Know what they are withdrawing from. Have a quiet low-stimulating environment. Dark, quiet environment. Make sure they are swaddled and have something to suck. May need to go to NICU. Nicotine will go away over time

LGA and hypoglycemia

LGA need more nutrition to help maintain their weight. If due to diabetes infant is used to high glucose levels and need more (macrosomia).

Prepare for Birth

Lamaze is all about education about birth and teaching women what to expect Women who are educated feel more empowered and more relaxed during labor Teach them to relax Breathing patters prevent breath holding and hyperventilating

Phase II Prodromal Phase

Lasts from a few weeks to a few years Deterioration in role functioning and social withdrawal Substantial functional impairment Sleep disturbance, anxiety, irritability Depressed mood, poor concentration, fatigue(50%) Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis Signs more clearly manifest as signs of developing schizophrenia.

Humanistic theory

Learner encouraged to identify learning needs and take responsibility for them "Look at the syringe and tell me what you don' t understand." you may recall some of this strategy in N1..it is initially very frustrating to nursing students Nurse focuses on feelings & attitudes of learner "You look nervous holding the syringe" usually helps students focus on anxiety & manage it Nurse facilitates learning rather than "tells" "I will watch you draw up the medication and assist as needed." Focus of learning is to achieve full potential "We will have at least 2 practice sessions so you will develop competence."

Cognitive Theory

Learning is a mental/intellectual thinking process .... we listen & think! we "process" information in our minds Developmental readiness is a key factor of the cognitive approach ...4 year olds cannot learn by reading playing with toy imitations of equipment to be used can help them understand The teacher recognizes learning occurs & is influenced by the social, emotional & physical environment .... Teaching an upset 14 yr old male in a room w/ a 16 yr old roommate watching a loud TV is not going to promote cognitive learning in contrast, explaining same info to pt when NOT upset and who is in a quiet room with no loud TV & whose roommate is not there to increase risk of patient being embarrassed should work better The learners cognitive development is evaluated "Can you tell me the steps to pack the wound with saline gauze?"

Teaching strategies

Lecture - will remember 20% of what was heard See - will remember 30% of what was seen See & hear - will remember 50% of what was seen AND heard Say or write it - will remember 70% of what was written or said aloud Say and do - will remember 90% of what was said AND done

LEARN Communication Tool for cultural assessment

Listen with empathy to clients perception of the problem Explain what you heard: clarify, validate Acknowledge the importance of what is said and what it means Recommend inclusive strategies Negotiate plan of care by collaborating with client and others

Level I Disaster

Local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath

Incompetent Cervix

Make a diagnosis based on Mom's history, she will have a loss. She has a floppy/weak cervix. Usually occurs once the baby has weight to it, around 14-16 weeks, baby gets heavy and the cervix gives way and the baby comes out.

making observations or encouraging descriptions of perceptions

Making Observations "You appear to be very anxious" "I notice that you are biting your nails" Making observations is verbalizing what is observed or perceived. Encouraging Description of Perceptions "What is the voice saying to you?" "What are you feeling now?" "What is happening?" Encouraging description of perceptions is asking client to verbalize what is being perceived. Encouraging Description of Perceptions - Often used with client with hallucinations

Non Pathologic Jaundice, Managment

Management: frequent feeding (every 2-3 hours), may require phototherapy (usually use with levels of 10-12) which stimulates liver function. Lights: 12-30 inches from the light, have baby down to a diaper only and is wearing eye protection. Take them out for feedings.

HELLP Complications

Maternal morbidity can be high as 24% Renal failure, pulmonary edema, DIC, abruptio Treat with c-section

Psychological Aspects of Aging

Memory functioning •Short-term memory seems to deteriorate with age •Long-term memory does not show similar changes •Time required for memory scanning is longer for both recent and remote recall among older people •Mentally active people show less memory decline than those who are not mentally active Intellectual functioning •Intellectual abilities of older people do not decline but do become obsolete. •The age of their formal educational experiences is reflected in their intelligence scoring. Learning ability •Ability to learn continues throughout life, although it is strongly influenced by interests, activity, motivation, health, and experience. Adjustments need to be made in teaching methodology and time allowed for learning Adaptation to the tasks of aging: Loss and grief Grief is cumulative; this can result in bereavement overload, which has been implicated in the predisposition to depression in the elderly. Attachment to others: Social networks contribute to well-being of seniors by promoting socialization and companionship, elevating morale and life satisfaction Maintenance of self-identity •Maintaining a positive self-concept and identity is important in successful aging. •Individuals who tend toward a rigid self-identity and a negative self-concept will no doubt struggle with any changes and adaptations faced in the aging process. Dealing with death •Studies show that elderly people do not fear death itself. •They fear abandonment, pain, and confusion. •Death anxiety among the aging is apparently more of a myth than a reality.

Meds for PIH

MgSO4 - magnesium sulfate given for severe pre-eclampsia. A very powerful drug. An anticonvulsant, a very potent vasodilator and CNS depressant. Given IV, a bolus then a drip. Need to have 10% Calcium gluconate at bedside. Must have output >30ml/hour, RR of >12/min, and presence of DTR (patellar easiest to grab). Therapeutic is 5-7, once at 10 the DTR is depressed, 12 DTR fade and mom arrests. Also have to get the baby delivered. Give betamethasone IM to accelerate surfactant in the baby's lungs. Always give MgSO4 as piggyback. Test babys lungs, mature is a 2:1 ratio

Lithium toxicity

Mild Toxicity (<1.6 mmol/L) apathy irritability lethargy muscle weakness nausea Moderate Toxicity (<2.5 mmol/L) blurred vision confusion drowsiness progressing tremors slurred speech unsteady gait severe toxicity (>2.5 mmol/L) cardiovascular collaspe coma seizure

Symptoms of Alcohol Withdrawal

Mild to moderate physical symptoms: Headache - general, pulsating Sweating, especially the palms of the hands or the face Nausea and Vomiting Loss of appetite Insomnia, sleeping difficulty Paleness Rapid heart rate (palpitations) Eyes, pupils different size (enlarged, dilated pupils) Skin, clammy Abnormal movements Tremor of the hands Involuntary, abnormal movements of the eyelids Severe Symptoms: A state of confusion and hallucinations (visual) -- known as delirium tremens Agitation Fever Convulsions "Black outs" -- when the person forgets what happened during the drinking episode Can occur within 4-12 hours after last drink or reduction in heavy or binge drinking. Elevated VS (BP, HR, RR, diaphoreses, DeliriumTremens-disorientation, delusions, hallucinations (most often visual but can be tactile) severe agitation, petite mal or grand mal seizures (life threatening situation) Neuro assessment, LOC, resp. assessment secondary to CNS depression, airway, EKG, fluid status secondary to vomiting, perspiration, dehydration (alcohol decreases ADH), hypoglycemia secondary to alcohol depleting liver glycogen reserves.

social treatments

Milieu therapy: best if used in conjunction with psychopharmacology Family therapy: aimed at helping family members cope with long-term effects of the illness

Potential Feelings for Mom

Mom feels abandoned because all the attention was on her and now it's all on the baby. Disappointment because of trouble breastfeeding, using meds during birth, gender, baby doesn't come out cute (slimy, covered in vernix). Encourage mom to verbalize her feelings.

Gestational Diabetes, Mom

Mom in postpartum period, takes a while for her hormone levels to come down and treat her accordingly in postpartum period. Takes a while for diabetes to go away - may be at greater risk for developing diabetes later in life.

Placenta previa: management

Mom will need to be delivered with c-section for complete previa. Book says <30% coverage can be delivered vaginally, most doctors won't take that chance Low-lying can be delivered vaginally Bedrest, watch her counts. Profound bleeding will result in mom being in the hospital

First Stage, Active phase

More rapid cervical dilation, 4-7cm Fetus is descending down into the pelvis Contractions are 40-60seconds long, 3-5minutes apart Mom is serious during contractions Make sure mom is educated on labor, coping mechanisms, hydrotherapy (will help mom relax) During this phase we need to talk about meds

Breastfeeding Holds

Most common is the cradle hold but it's the hardest position to establish breastfeeding Football hold is good for tiny babies and mom's who have big breasts. Also good for twins because mom can do tandem feeds Side lying is good for an established breast feeder - good for middle of the night. Also good for a mom who is having a spinal leak and can't sit up Cross cradle is the best hold. It allows you to use a pillow/boppy to position the baby and have your hands free

How do drugs work in the brain to produce pleasure?

Most drugs of abuse directly or indirectly target the brain's reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior. How does stimulation of the brain's pleasure circuit teach us to keep taking drugs? Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way. Site of the rewarding effects of all the major classes of addictive drugs Drug abusers become used to ↑ dopamine levels ↓ dopamine causes an ↑ in sadness, depression and craving ↑ neurotransmitters brain chemistry changes Neurons ↓ the number of receptors Neurons make fewer neurotransmitters (down regulation) Some drugs are highly toxic and may cause neurons to die. (Alcohol & Cocaine)

PIH s/s

Multi-system, vasospastic, characterized by -High BP (140/90 or 30mmHg/15mmHg above baseline) -Proteinuria -Edema

Lewy Body Dementia

NCD due to Lewy body disease: •Similar to AD, but progresses more rapidly •Appearance of Lewy bodies in the cerebral cortex and brainstem •Progressive and irreversible •May account for 25 percent of all NCD cases Visual hallucinations, parkinsonian features

Opioid abuse

Natural-opium, morphine, codeine Derivatives-heroin, percodan, vicodin Synthetic-demerol,methadone,fentanyl Americans smoke opium in a Chinese-run opium den in New York, 1925.

Formula

Need to use commercial formula for the 1st year. Types -Modified milk-based -Lactose free -Soy based for allergies to cow milk protein -Elemental for newborns with protein allergy How much you feed them is 75-90ml/pound/24 hours

Antipsychotic Medications(Neuroleptics)

New meds effect both dopamine and serotonin Atypical Antipsychotics (AAP): clozapine (Clozaril) risperidone (Risperdal) olanzapine (Zyprexa) quetiapine (Seroquel) ziprasidone (Geodon) aruororazike (Abilify) paliperidone (Invega)

Models and Theories

Nomenclature, classification, and taxonomy - is a recognized systematic classification and consistent method of describing our nursing practice using descriptors or labels. Nomenclature - descriptors or labels Classifications- groups or class entities Taxonomy - the study of the classifications The ANA approved Nursing information and data set evaluation center to formulate all the information systems, defined criteria, etc. Three most commonly used: NIC, NOC, Nanda NANDA- North American nursing diagnosis association (Nursing dx, definitions, classifications) NIC- Nursing interventions classification system NOC- Nursing outcomes classifications. Without using this common language universally, data cannot be aggregated rendering it useless.

Laissez faire

Non-authoritarian leadership style. (French for, allow to pass or let go) leaders try to give least possible guidance to subordinates, and try to achieve control through less obvious means. They believe that people excel when they are left alone to respond to their responsibilities and obligations in their own ways. Low productivity, High Morale

Role of the Nurse

Nurse's responsibility 1)Medication administration 2)Development of a one-to-one relationship 3)Setting limits on unacceptable behavior 4)Client education

Phases of Nurse-Client Relationship

Nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse client relationship Prepare for first encounter, obtain information on client, examine your feelings fears, etc Become acquainted Maintain trust and rapport Mutually agreed upon goals have been met or discharge form facility.

Probable signs of pregnancy

Objective; enlarged belly, areola darkens (this makes the nipples tougher and not as sore), montgomery tubercles (little bumps on the breast, they secrete oil so the nipple stays good), pregnancy test, Goodell's sign (softening of the cervix, it gets soft and squishy.), Chadwick's sign (a purplish color to the cervix, vagina and vulva. This is due to increased blood supply.), Hegar's sign (The isthmus of the cervix gets soft.), braxton-hicks contractions, uterine soufle (will hear a wooshing sound with stethascope on uterus), ballotment

Nasal Breathing

Obligatory nose breather, make sure their nose stays clear. Nasal patency test to make sure their nose is clear. Look for flaring which is a symptom of resp. distress in the infant.

Letting Go

Occurs after the hospital. A time of redefining their role. Going from a person with no kids to a mom, a mother of one to a mother of two. Accepting the baby as real vs. a fantasy. May require some grief work - council on postpartum blues/depression.

Non Pathologic Jaundice, causes

Occurs in less than 24 hours and usually due to feeds or red blood cells. Common cause is hyperbilirubenanemia on the 2nd to 3rd day and occurs in 50% of infants due to breakdown of red blood cells. Broken down into iron which breaks down into indirect bili not excreted by kidneys. Must be converted to direct bili by liver and then incorporated into stool and pooped out. Babies have immature liver function. If levels are <7 it develops, starts at head and goes down If >20 have a risk of kernicterus and have a risk for brain damage. This means is crosses the blood-brain barrier. Risks, bruising from birth, infrequent feedings, cephalohematoma.

leadership

Occurs when a person attempts to influence the behaviors, beliefs, and opinions of another person or group

Facts of Schizophrenia

Of all mental illnesses, schizophrenia causes more: Lengthy hospitalizations Chaos in family life Exorbitant costs to people and governments Fears Schizophrenia causes disturbances in: — Thought processes — Perception — Affect (feelings and emotions) -Lengthy hospitalizations are due to the time it takes to treat. -Treatment can include pharmacology, rehab, therapies, recovery support, and can also be family therapy. -Affect: they can kill their child and they won't even feel sorry.

Offering broad openings or offering general leads

Offering Broad Openings- "Tell me what happened when . . . . . ." "How did that make you feel? ". . . . . . . . "What are your thoughts about" . . . . . . . . Giving broad openings allows the client to select the topic. Allows client to expand on what they think about a given topic You can make it less specific by saying: tell me what happened? Offering General Leads- "Please continue" . . . . . . "What happen after you were diagnosed" . . . . "Please tell me more about that" . . . . . . . Offering general leads encourages the client to continue Encourages client to continue and stay on track

Heart Disease and Pregnancy, Delivery

Once she comes to term can be delivered vaginally, c-section is worse for her heart. Will encourage pain meds in the form of an epidural. Will probably have an assisted birth via forceps or a vacuum.

opioid overdose treatment approach

Opioid overdose causes CNS depression and respiratory depression. Supportive ventilation is usually sufficient to prevent death but may be avoided by cautious antidote administration. Ventilatory support is the most important intervention and may be life-saving on its own. Patients should be ventilated with 100% oxygen prior to administration of naloxone to decrease the likelihood of precipitation of acute lung injury, which may be associated with reversal in the presence of hypercarbia. Clients who present with acute lung injury may require more supplemental oxygen and should be managed with supportive care and low tidal volume ventilation and PEEP. Any patient who presents with signs of opioid overdose, or when this is suspected, should be treated with the opioid antagonist drug naloxone. The endpoint of naloxone therapy should be the restoration of adequate spontaneous ventilation but not necessarily complete arousal. Naloxone can be given subcutaneously or intravenously every 2 to 3 minutes. Most patients respond with the return of spontaneous respirations and minimal withdrawal symptoms. Opioid-naive patients may be given starting doses of up to 2 mg without concern of precipitating withdrawal symptoms. If patients do not respond to this regimen, then it is unlikely that the cause of the clinical syndrome is opioid related.

verbalizing the implied

Patient: "I don't want to talk to you because it is a waste of time" Nurse: "Is it your feeling that no one understands?" Verbalizing the implied is putting into words what client has only implied What could this client really be trying to say???? Explicit is clearly expressed Implicit is implied although not plainly expressed

Attempting to translate into feelings

Patient: "I'm dead" Nurse: "Is it your feeling that life is without meaning?" or "Are you suggesting you feel lifeless?" Or are you saying, I wish I was dead? Attempting to translate words into feelings is putting into words the feelings the client has expressed only indirectly.

4 Phases of Alcoholic Pattern of Drinking

Phase I - Pre-alcoholic phase - Phase II - Early alcoholic phase Phase III - Crucial phase Phase IV - Chronic phase 1. Use to relieve stress. Remember socioculteral? Role models? as a child may have observed this was a stress reliever for parents 2. (blackouts, sneaking drinks, gulping drinks) becomes a required drug, maintaining a supply of alcohol 3. Loss of control, physiological must drink, physiological dependence, binge drinking, loc. By this phase common to have lost job, marriage, family, friends (unless they drink with said individual. 4. Drunk more than sober, emotional and physical disintergration, life threatening physical manifestations

Phases of Group Development

Phase I - initial/orientation phase Group Activities rules and goals of group are established Leader Activities orient group to group process, encourage participation, ensure rules are followed Member Behaviors overly polite secondary to trust not being established yet, compliment leader (brownnose), power struggle may ensue as members compete for "pecking order" Phase II - middle/working phase Group activities working cohesiveness has been established, productive work toward completion of task, mature group cooperation can occur, differences can be confronted and resolved Leader expectations becomes facilitator, some leadership functions can be shared, leader helps to resolve conflict and foster cohesiveness Member behaviors trust has been established,, accept criticism from each other, sometimes subgroups develop and members conspire with exclusion of rest of group Phase III- Final/termination Phase Group activities longer the group is formed the more difficult it is to terminate, sense of loss can precipitate grief. Terminations should be discussed weeks before final session Leader expectations encourages group to reminisce, review goals and discuss outcomes, encourage members to provide feedback to each other, discuss loss/grief if necessary Member behaviors surprised its almost over=grief response to denial > anger may reflect abandonment. Previous losses may be discussed among members and lead to develop skills needed

Crystals in Urine

Pink/crystals in birth. This is uric acid crystals formed in the bladder in-utero - parents get worried when they see this. As babies get older the ability to concentrate urine improves

Heart Disease and Pregnancy, Postpartum

Postpartum period -Mom will diures a lot -Fluid & electrolyte imabalance -Watch an extra 24 horus in postpartum period

Teaching Tips

Present critical info first @ times this is pt driven - consider a patient who needs to manage a PICC line @ home - RN priority may be learning to get air out of syringe...pt priority may be how long I scrub the hub with alcohol..if you do not address this first, pt will not "hear" subsequent info Use everyday language avoid "void", "output", Involve the pt, & SO's (if applicable) Review/Repeat If low reading level: use short familiar words, no medical terms, 15 word or < sentences active voice, write 3 ( not "three") Recognize a "teachable moment" when giving medications, Pt asks, "What are these medications for?" or while doing the sterile dressing procedure, state/ask "What are your thoughts about learning to do this dressing/" Back up verbal with written hospitals/health care facilities have printed teaching forms on computer..be sure pt gets any printed material before d/c Verify what you taught "Tell me 3 things you remember about taking Digoxin." Provide a contact for follow up questions Many Hospital give follow up numbers...all ambulatory surgery centers do! Do not skimp on documentation will discuss detail on a later slide

presenting reality and or voicing doubt

Presenting Reality- "I do not see anything on the wall" "That was a TV voice that you heard" Presenting reality clarifies misconceptions that client may be expressing. Define reality or gives their perception of reality Voicing Doubt-"Isn't that unusual?" "That is hard to believe" Voicing doubt expresses uncertainty as to the reality of client's perception. expressing uncertainty

Prevent hypoglycemia

Prevent with frequent feedings. Feed every 2-3 hours and maintain their temperatures. If hypoglycemic will transfer to NICU. Want BG >40, anything <40 is hypoglycemia

Critical Incident Stress Management (CISM)

Preventing and treating the emotional trauma that can affect emergency responders as a consequence of their jobs

Types of groups: Primary and Secondary

Primary group is Small intimate group (study group) in which relationships among members are personal, spontaneous, cooperative, and inclusive i.e. Family, playgroup of children, informal work groups and friendship groups. Not only set standards of behavior they support each other in stressful situations. The group has a sense of "we" and "our" in contrast to "I". The role of the primary group, particularly the family in health care has increasingly been recognized. AKA family support Secondary group (clinical groups or BEAPS) larger more impersonal "meeting secondary needs for control and problem solving". i.e. professional associations task groups, ad-hoc committees, political parties & business groups. Members view these groups as a means of getting things done. Once the goals of the group have been achieved the interaction is discontinued. Ad-hoc- latin phrase meaning "for this" specific problem or task committee

Powers

Primary powers are responsible for dilating cervix from 1-10, also responsible for effacement of cervix. Effacement is the thinning of the cervix. Normal is 0% effaced (thick) to 100% effaced (thin as a sheet of paper). Secondary powers are the involuntary urge to bear down.

Ethics

Privacy and confidentiality—Health care organization must have good control of its information systems Security policies must be explicit and well defined Confidentiality agreements should be reviewed and signed upon hire and yearly thereafter Breaches of security, confidentiality, or privacy should be dealt with quickly

Signs of Strangulation

Pronounced petechiae in the whites of the eyes and on the cheeks/face

Recommendations for patients who are actively using, in addition to the recommendations for all patients with addictive disease:

Pseudoaddiction: An iatrogenic syndrome created by the undertreatment of pain. It is characterized by patient behaviors such as anger and escalating demands for more or different medications and results in suspicion and avoidance by staff. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated -Assess for and treat symptoms of withdrawal from alcohol or other drugs. ** -If the patient acknowledges inappropriate use of prescribed medication or non-prescribed substances, openly discuss this and encourage the patient to express any fear of how this may affect pain management and treatment by staff. -Assess for psychiatric co-morbidity (e.g., anxiety, depression) and obtain treatment if needed. If the patient is physically dependent on morphine-like opioids, do not treat pain with an opioid agonist-antagonist (e.g., nalbuphine, butorphanol, buprenorphine, pentazocine) because it will precipitate acute withdrawal. -Once pain is controlled, provide information on treatment options for addictive disease. **

The Normal Aging Process

Psychiatric disorders in later life •Neurocognitive disorders •Delirium •Depression •Schizophrenia •Anxiety disorders •Sleep disorders

High Risk Intrapartum

Put them on bedrest Terbutaline, give to stop contractions and is patient friendly. She can titrate her dose based on how many contractions/hour she's having Magnesium Want to keep baby inside as long as possible. If we can't keep inside give rescue meds give betamethasone and baby might have to go to NICU Tocolytics stop labor

Reproductive system changes, perineum

REEDA acronym. Redness, edema, ecchymosis (tells us there is a hematoma), discharge (purulent discharge with sutures), approximation of sutures - after 24 hours no longer visible. DO pericare every time mom goes to the bathroom. Do this to prevent infection . Can use ice packs for edema, witch hazel (tucks pads), dermaplast spray, hemorrhoid cream, sitz bath (after 24 hours). Use motrin, ibuprofen - helps with swelling, is an NSAID, helps with cramping.

Role of Home Health Care Nurse, Advocate

RN explores and supports client's choices in healthcare. ex: having discussions about pt rights, advance medical directives, living wills and power of attorney for healthcare, hospice

Conditions essential to development of a therapeutic relationship

Rapport creates a sense of harmony based on knowledge and appreciation of each individual's uniqueness Trust is the initial developmental task described by Erickson (trust vs. mistrust). Confidence in the persons presence, reliability, integrity, & veracity. Confidence in the persons presence, reliability, integrity & veracity (actuality/sincerity) Respect is to believe in the dignity and worth of an individual regardless of their unacceptable behavior. Genuineness is ability to be open, honest, and real with the patient. Empathy is to see beyond outward behavior and to understand form the patients point of view.

reflecting and or focusing

Reflecting- Patient: "Do you think I should tell my doctor?" Nurse: "What do you think you should do?" Often most highly utilized communication between client and therapist. Has been previously discussed in nsg I Reflecting directs questions or feelings back to client so that they may be recognized and accepted. Focusing- Let's talk about what you just said Focusing is taking notice of a single idea or even a single word. Good for client who moves rapidly with flight if ideas Not Good for anxious client until calm

Level II Disaster

Regional efforts and aid from surrounding communities are sufficient to manage the effects of the disaster

Rejecting and disapproving

Rejecting- "Let's not talk about that now" "I don't have time to listen to you now" Rejecting is refusing to consider client's ideas or behavior. This clearly reject the client from discussing what's troubling them and also puts your therapeutic relationship in jeopardy Disapproving-"I think you made a mistake by not taking that therapy now" "You did not make a good decision" disapproval implies that the nurse has the right to pass judgment on "badness" of client's behavior Not our place!

Examples of risk and protective factors

Risk Factors Early Aggressive Behavior Poor Social Skills Lack of Parental Supervision Substance Abuse Drug Availability Poverty Domain Individual Individual Family Peer School Community Protective Factors Self-Control Positive Relationships Parental Monitoring and Support Academic Competence Anti-Drug Use Policies Strong Neighborhood Attachment

Special Concerns of Elderly People - Long-term care

Risk factors for institutionalization Age Health Mental health status Socioeconomic and demographic factors Marital status, living arrangement, and the informal support network Attitudinal factors Negative perception of nursing homes as places to go to die

Secondary Prevention

Rn's can assist with active listening, provide emotional support and give information to referral to social workers

Ruddy Complexion

Ruddy complexion - not always healthy pink, usually a deep red. This is because of the increased maternal red blood cells, this is how the baby was fed and thrived while in-utero. This puts them at risk for jaundice at 48 hours because the extra cells are being destroyed and eliminated by the body.

Nonverbals for attentive listening SOLER

S - sit squarely facing the client O - open posture L - lean forward toward the client E - eye contact R - relax

S/S of hypoglycemia

S/S: tremors or jittery. Refusing to feed, vomiting, seizures

SGA/LGA

SGA - small gestational age LGA - large gestational age

SGA and Hypoglycemia

SGA, at risk for heat loss due to low amount of subcutaneous fat. Their metabolic rate increase to produce heat which causes their BG to go down. Preterm infant lacks enzyme needed for gluconeogenesis.

Internal monitoring

Same thing as external except use a scalp electrode and get rid of tocos. Gives us a direct lead to tell us exactly what the baby is doing.

Schizoaffective Disorder

Schizophrenic symptoms accompanied by a strong element of symptomatology associated with the mood disorders, either mania or depression.

seeking consensual validation

Seeking Consensual Validation "When you use (this word) are you trying to say that . . . . . ." "Tell me if my understanding agrees with yours" Clarify & validate that which the client said. Looking for mutual understanding I often do this when someone has difficulty expressing what they want to say. I might say why don't you just say what you think it is and we can go from there....

seeking clarification

Seeking clarification and validation strives to explain what is vague and searches for mutual understanding. Searching for mutual understanding, especially something that's vague or incomprehensible

dysfunctional group personalities

Self servers -rules of the group do not apply to them, late and are usually unprepared (they think they are special), if they are not functional you may need to ask them to leave. Critical conservative -No it will not work! Criticize all suggestions but their own, not very good at change, my way or the highway. Motor mouths never shut up, they love to hear themselves talk, interrupt, will talk over speaker's words, may talk about unrelated issues Mouse is silent, afraid to voice an opinion (can be real asset if they are listening)- b/c the mouse can often hold the answers Defensive group members tend to be unproductive, time consuming and inappropriate to the function of the group. Can conflict occur in a group? Yes, that can be when it gets interesting. 1.Been given an impossible task 2.Main concern of member is to find status in the group and deal with their own agenda instead of group agenda 3.Members are operating from their own unique unshared points of view and may have competing loyalties

screening tests for alcoholism

Serum Gamma-Glutamyl Transferase ↑ SGGT - elevation occurs in alcoholic with no other liver abnormality ↑ Amylase ↑ Uric Acid ↑MCV - mean corpuscular volume

Crisis Intervention Goal

Short-term therapy need to KNOW what to do..no time for "team meeting" Focus on solving the immediate problem this is not the time for psychotherapy Individual will return to pre-crisis level of functioning this is the outcome you want - if it has not been met, you need to intervene fast before disorganization occurs Aguilera's 4 specific phases in crisis intervention 1. Assessment - gathering info regarding the event/crisis 2. Planning therapeutic intervention - planning DX. Outcomes, goals, interventions 3. Intervention - p. 244 - Know what works! 4. Evaluation

Flexed Posture

Should have a flexed posture, might look like a frog when turned on their belly. Anything not flexed/limp is considered small for gestational age (a maturational assessment).

Neuro Newborn Assessment

Should have symmetrical flexion of bilateral upper and lower extremities. May not always be CNS if not symmetrical. Upper extremities check the clavical, lower check for hip displasia.

Anthrax acquired by which of the following methods develops into the most severe form?

Skin exposure

Promote thermoregulatory homeostasis

Skin to skin with mom will help with their radiant body temp. As will double blankets and radiant warmer.

Which of the following statements reflect the patient Management of smallpox?

Smallpox spreads rapidly and requires immediate isolation

Late Decelerations

Something is wrong with placenta perfusion. Deepest part of the decel is after the peak of the contraction. Something is wrong with the placenta, give mom oxygen and change her position. Never normal. Can sit on them for a few times but if they don't resolve we need to get the baby out.

Stages of group dynamics

Stages of group development Bruce Tuckman (1965) developed a 4-stage model of group development. He labelled the stages, Dr Suess-style: 1. Forming: The group comes together and gets to initially know one other and form as a group. 2. Storming: A chaotic vying (competing)for leadership and trialing of group processes 3. Norming: Eventually agreement is reached on how the group operates- discussing mutual objectives and working collectively as a group (planning phase) 4. Performing: The group practices its craft and becomes effective in meeting its objectives. (implementation phase) Tuckman added a 5th stage 10 years later: 5. Adjourning: The process of "unforming" the group, that is, letting go of the group structure and moving on. (onto your next semester or rotation)

Robert's & Ottens (2005) developed a 7-stage model of crisis intervention (See text - Townsend 222)

Stages: 1.Psychosocial/Lethality Assessment pt words/ anxiety? figure out how serious...assess degree of anxiety....severe levels = limited attention span w/ physical sx's of h/a, palpitations, dread, horror panic levels cannot focus at all, not in touch with reality, hallucinations, delusional 2.Rapidly Establish Rapport People react to stressful situations in different ways" make eye contact, be non-judgmental...how? watch non verbals such as NO hands on hips, do not "tower over" pt, low pitched voice 3.Identify Crisis Precipitant "Can you put into words what is concerning you?" 4.Address Emotions "Your heart rate is fast and you are tapping your foot....you seem very anxious."....or "I can't know how you are feeling or what you are thinking unless you tell me" 5.Generate (find) Alternatives "Distracting your self with the TV can help when the dressing is changed"....or "What have you done when you were this upset before?" 6.Implement Plan You are concerned about hurting yourself so I will have some stay with you." 7.Follow-up

HIPAA (Health Insurance Portability and Accountability Act)

Standards signed into law that protect the privacy and security of patient data Implications of mobile computing Standards signed into law that protect the privacy and security of patient data Health information privacy law Data security standards Electronic transaction standards Implications of mobile computing Tablet computers and smartphones are creating new implications for protection of privacy and security In January 2013, the new rule helps protect patient privacy and safeguard patients health information in our ever expanding digital age. Increased penalities to noncompliance and negligence of the laws up to 1.5 million per violation. According to a 2012 research study (in the book), on pt privacy and data security, 94% of the organizations involved in the study had a data breach with a cost impact between $10,000 to over a million, over a 2 year period. You can violate an organizations HIPAA policies and not even realize it.

Meconium Stool

Sticky and tar like

What Is the Electronic Health Record (EHR)?

Still debate over EHR and EMR are same or different. EHR is part of CIS Web-based system Handheld or wireless system EHR is different from electronic medical record (EMR) EHR- focuses on the total health of the patient and gives a broad view of the patients care. They are built to collect and compile health information that can be shared with other HCP involved in that pts care. P. 542 box 23-2 Advantages of EHR Simultaneous and remote access from all locations Legibility of the record (no handwriting), Etc EMR - comprised of data from multiple software applications used by a facility such as a hospital or provider officer to order, document, and store patient information just as a paper medical record did so in the past. EMR- Digital version of the paper pencil chart, which contain past medical HX, treatment plans, meds, etc. from one practice, and cannot be traveled out easily to other physicians (ex: hospital medical record being transferred to pts PCP). It doesn't include the whole picture. Only snippits of the patients current situation from one physician. Personal health record gives the patient the ability to manage, track, and upload personal health information. Mycaredot.com (blood glucose monitoring, VS, real time data) which is transferred from PHR to EMR

Presumptive signs of pregnancy

Subjective; morning sickness, sore breasts, fatigue, frequent urination, amenorrhea (missed period). These are the least reliable.

suggesting collaborations and summarizing

Suggesting Collaboration: Can we work together and discuss what is causing you to feel anxious? Summarizing: You and I have just discussed . . . . You've just said that . . . . I want to verify that I understand what you just said Summarizing- This summarizing can then be utilized to address what will be discussed in next therapy.

Phase IV Residual/recovery

Symptoms similar to those of the prodromal phase Flat affect and impairment in role functioning are prominent Therapy is in place With treatment, the majority of schizo patients recover from their first psychotic phase and they move forward with their life.

Anabolic Androgenic Steroids

Synthetic formulation of Testosterone Continued use leads to: rage, depression, psychosis impotence, amenorrhea, jaundice, liver failure, hypertension, infertility, baldness & development of breasts in men.

Antipsychotic MedicationsSide Effects

Tardive Dyskinesia: •Abnormal bizarre face and tongue movements. •Potentially irreversible unless caught early and drug discontinued •Assess for first sign - vermiform movements of tongue

Five rights of delegation

Task, circumstances, person, direction/communication, supervision/evaluation

Nagel's Rule

Tells you when you are due. Need the first day of the last menstrual period. Subtract 3 months and add 7 days. This will give us EDB (estimated date of birth) EDD (estimated date of delivery) or EDC (estimated date of confinement). -Ex. June 19 LMP, due March 25

Delegation is based on the RN judgement of...

The patients condition Competence of the members of the nursing The amount of supervision that will be required if the task is delegated

Fetal Lie

The relationship of the long-axis of the baby to the long-axis of the mom. This is spine to spine. Horizontal or vertical

Schizophrenia Spectrum and other Psychotic Disorders

Therapeutic communication: DO: -Respond with feeling tone -Provide info to the patient -Focus on the client -Use silence and presence - - DO NOT: -Do not Ask why -Don't ask closed ended questions that can be answered with yes or no. -Do not Explore - always reorient to reality -Do not Focus on nurse -Do not ever say don't worry - The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind). Psychosis is a severe mental condition in which there is disorganization of the personality, deterioration in social functioning - Can sometimes appear like mania until you find out it really is an issue with personality.

Theories

There are 3 most common theories to nursing informatics: General systems theory, Rogers Diffusion of innovation theory and change theory. General systems: produced a product that organizes independent parts working together includes 6 elements: Interdependent parts—elements of system interacting for processing Input—any outside element brought into system Process—activity within system Output—any product of processing activity Control—rules or procedures within system Feedback—reusing output from system as input back into system for validation or correction

Bottle Fed Stool

Thick stool with more of a pungent odor

Fetal Position

Three letters, where is the occiput (back of head) First letter denotes which side of mom's pelvis the occiput is Second letter has to do with the presenting part This letter is anterior or posterior If posterior you can see their face - sunny side up or "stargazer babies" If anterior their face is in the back Posterior is going to have tremendous back labor. Put her on all 4's or a position that hangs the baby down. Need to know this for labor to know what to expect from the baby and for mom Also need to know this for monitoring of the baby on where to place the transducer

How to check adaptation to extrauterine life

Three main ways to check adaptation to extrauterine life for baby. 1. Pink (color) 2. Peeing 3. Pooping -We also look at thermoregulation, make sure they are getting enough fluids, also look at infant safety/security

Assessment of Jaundice

Timing of when it develops First 24 hours is pathologic Day 2-3 is physological Transcutaneous bilirubinometry: use a device to get blood and check bili level Skin assessment: look at head and see if yellow is spreading down Coombs, a blood test to check for jaundice

Alcohol Treatment Drugs

To date, three medications—disulfiram (Antabuse), naltrexone (ReVia), and acamprosate (Campral)—have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence. Medications for treating alcohol dependence primarily have been adjunctive interventions, and only three medications—disulfiram, naltrexone, and acamprosate—are approved for this indication by the U.S. Food and Drug Administration. Disulfiram, an aversive agent that has been used for more than 40 years, has significant adverse effects and compliance difficulties with no clear evidence that it increases abstinence rates, decreases relapse rates, or reduces cravings. In contrast, naltrexone, an anticraving agent, reduces relapse rates and cravings and increases abstinence rates. Acamprosate also reduces relapse rates and increases abstinence rates. Serotonergic and anticonvulsant agents promise to play more of a role in the treatment of alcohol dependence. Although not approved by the U.S. Food and Drug Administration for this indication, the anticonvulsant topiramate and several serotonergic agents (e.g., fluoxetine(prozac), ondansetron(zofran)) have been shown in recent studies to increase abstinence rates and decrease drinking.

Typical (Neuroleptics)

Traditional meds block receptors for neurotransmitter dopamine in the brain ê dopamine in brain chlorpromazine (Thorazine) fluphenazine (Prolixin) thioridazine (Mellaril) trifluoperazine (Stelazine) haloperidol (Haldol) Greatest risks of side effects

Ectopic pregnancy: treatment

Treat before rupture: can preserve the tube. Give Mom methotrexate which will kill the embryo and dissolve it Treat after rupture: lose the tube

Hydatiform Mole: management

Treat this with D&E, dilatation and evacuation (with suction). Preserve the myometrium. Now Mom is told not to get pregnant again for at least a year. This is because we need to make sure she's safe from choriocarcinoma via serial blood values (a stable high Hcg is positive for choriocarcinoma).

Paraphilic Disorders (cont'd) - types

Types of paraphilic disorders: •Exhibitionistic disorder •Fetishistic disorder •Frotteuristic disorder •Pedophilic disorder •Sexual masochism disorder •Sexual sadism disorder •Transvestic disorder •Voyeuristic disorder

Therapeutic communication - using silence and accepting

Using Silence- allows the client to take control of the discussion, if he or she so desires. Allows pause for thoughts Nurse silent, patient can talk and lead Accepting - conveys positive regard Yes, Uh hum, I follow what you said, Nodding Be mindful of your: tone of voice, gestures and posture!

Fetal presentation

Vertex means the head is down Breech is the butt first Transverse is sideways

Babinski Reflex

Want it to be positive. Line up the foot, heel to toes, look for fanning of toes. Goes away at 12-18 mos.

Fontanels

Want to make sure they are open and soft. Anterior closes at 12-18mos. Posterior closes at 2mos. Posterior closes first, need to deliver that information because parents need to know when they should close. Parents also need to make sure baby is getting interaction and not just laying, if baby is just laying the fontanel may not close. Palpate to make sure it's soft, not depressed or bulging (hydrocephalus).

Using the Internet

We rely heavily on the internet and connection to social media. However educate patients to use caution when surfing the internet for information. Be sure it is a reliable valid source. Next generation of health care delivery Health information on the Internet can dramatically improve patients' ability to manage their own health—but users must remember to proceed with caution! In near future patients will have accessible online medical records

Weight and Length

Weight because we need to track it for adequate feeding/growing for the infant. Length so we can make sure they are growing. Supplement if baby loses more than 10% of birth weight.

Para

What happened to these pregnancies. Has 4 numbers after this. T - Term pregnancies (37-42 weeks) P - Preterm weeks (20 weeks - 37 weeks) A - Abortion, including spontaneous abortion and elective abortions L - Living, how many living children M - Multiples

What is a group?

What is a Group? A group is: Two or more people who share a common definition and evaluation of themselves and behave in accordance with such a definition a collection of people who interact with one another, accept rights and obligations as members and who share a common identity. Criteria for a group include: formal social structure face-to-face interaction 2 or more persons common fate common goals Interdependence- relationship where each member is mutually dependent on each other self-definition as group members recognition by others Societies can be seen as large groups consisting of a myriad of sub-groups.

What is drug addictions? Risk factors?

What is drug addiction? Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain - they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs Genetic evidence supports hereditary factors especially with alcoholism ( could argue is it environmental or genetic) Biochemmical effect selected neurotransmitter systems causing addiction Developmental associated with psychodynamic factors such as the a punitive superego and fixation at the oral stage Personality traits such as low self esteem, passive, frequent depression, anti social (also referred to as the addictive personality) Sociocultural (environmental influence) modeling, imitation, identification of behaviors learned early in childhood. Conditioning as in pleasurable experience, Cultural/Ethnic i.e. italians and french drink wine early in life, native am, high incidence of abuse, is it due to low tolerance for alcohol, unemployment, poverty?

Conflicts are an opportunity for growth

When you're able to resolve conflict in a relationship, it builds trust. You can feel secure, knowing your relationship can survive challenges and disagreements.

Behavior, Attitude, Mood and Mental Status

Wide mood swings from isolation to irritability and outbursts Difficulty in concentration. Marked nervousness on the job. Decrease in problem solving ability. Diminished alertness, confusion, frequent memory lapses Difficulty in determining or setting priorities Isolates from others, eats alone, avoids informal staff get-togethers, or requests transfer to the night shift. Unwillingness to cooperate with co-workers or inability to compromise. Avoids contact with supervisor. Over reaction to real or imagined criticism. On the unit when not on duty.

Integumentary Changes

Will see diaphoresis because of the fluid changes. Could have a surgical incision - make sure dressing is clean, dry and intact. Supposed to have sequentials to prevent DVT, especially for a c-section due to anesthesia used.

Caput

a common finding. Not detrimental to the baby health. Edema on the presenting part (usually the head) that crosses the suture line. Usually resolves by the time baby goes home.

A nurse manager needs to determine the staff mix for the unit. What should the manager do first?

a.Assess type of care required by clients.

The nurse leader who empowers staff to participate in decision making activities is exhibiting which of the following leadership styles?

a.Democratic

The nursing manager on a medical-surgical unit evaluates a new staff nurse on the night shift as being a born "leader," based on which of the following leadership qualities?

a.The new staff nurse has scheduled staff journal club discussion once a month to increase current knowledge on evidence based practice.

Variable Decelerations

abrupt decrease in HR with an abrupt return to baseline. Looks like a V, change mom position to get baby off cord

Culturally diverse nursing care is

an optimal mode of health care delivery, refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individuals cultural values, beliefs, and practices including sensitivity to the environment from which the individual comes and to which the individual may ultimately return. (Leininger, 1985)

What is domestic violence?

any behavior that is intended to control an suppress another human being through the use of fear, humiliation, and through use of verbal or physical assault [Susan Forward, PhD, Psychologist and author], ( Berry, 2000). An abuser wears down his partner by unrelenting criticism and fault-finding. According to Centers for Disease Control (CDC), domestic violence is a serious, preventable public health problem affecting more than 10% of the U.S. population, and is reported only a 1/3 of the time. (www.wikipedia.com) p. 45

Nurses with leadership ability...

are able to guide and influence members of the health care team to accomplish goals

Which of the following medications is appropriate in the treatment of male erectile disorder? a)Rivastigmine (Exelon) b)Tadalafil (Cialis) c)Somatropin (Zorbtive) d)Phenelzine (Nardil)

b. Tadalafil's therapeutic effects enhance blood flow to the corpus cavernosum, resulting in an erection sufficient to allow sexual intercourse.

. Hospitalized and diagnosed in the fourth stage of NCD due to AD, a client, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the client exhibiting? a)Aphasia b)Confabulation c)Delirium d)Apraxia

b. Confabulation Confabulation is a behavioral reaction to memory loss in which the client fills in memory gaps with information about events that have not occurred. •During the fourth stage of Alzheimer's dementia, a client will use confabulation in an effort to maintain self-esteem.

We respond to conflict....

based on our perceptions of the situation, not necessarily to an objective review of the facts. Our perceptions are influenced by our life experiences, culture, values, and beliefs.

Urinary Changes

bladder distention. Peeing a lot, diuresis and diaphoresis because all that pregnancy fluid is no longer needed. Output is about 2-5L/day. Mom can void 500ml+ at a time. Make sure doing good I&O initially, to make sure she's losing some of that fluid.

Motivational theory of management

blends previous theories to determine what best motivates people for best possible outcomes

Cephalhematoma

blood between the periosteum and the skill that doesn't cross the suture line. Just on one part of the bone. At risk for jaundice because this is blood, will usually resolve in about 2 weeks.

Creative Play

can draw how they are feeling

Sexual abuse

coercion to engage in sex against his or her will ( ), examine or smell the partner's body etc in an attempt to find out If the victim had sex with another person. Financial abuse: the abuser limits the partner's access to money as a way of exerting control. "It has only been in the past 20 years that any real progress has been made in using, changing, and expanding the law toward greater justice for victims of domestic violence," Berry, p. 23, 2000).

Emotional/psychological and verbal abuse

commonly accompany physical abuse and may be more damaging (coercion, manipulation, isolation, intimidation, mocking, criticism of physical appearance, humiliation, screaming, threats to kill or destroy property, reputation, threatening nonverbal behavior such as gestures, facial expressions).

Circulatory Changes

decreased blood volume causes decreased H&H. As risk for DVT. Blood loss of a vaginal birth is about 300-500ml, c-section is about 500-1000ml. Baseline CBC is important to compare. WBC will initially be high and then come down due to immune response, trauma. Thrombus risks, elevated fibrinogen. Encourage PO fluids, change position slowly. Will only transfuse is mom is symptomatic with CBC changes; most moms tolerate the changes pretty well.

Head Lag

don't have muscle control. Develop from their head to their toes. Amount of head lag (head stays behind when baby is lifted with their hands/arms) is different for different gestational age.

Head circumference

done in cm. Usually 34-35cm, smaller worries us as does larger (hydrocephalus)

Non-stress test

done with using baby HR and a button for mom to press when baby moves. A reative means baby HR changes with movement

Desquamation

dry/peeling skin. Usually seen on palms and soles of the feet. Post dates babies come out very dry. Don't treat it unless the skin becomes cracked. If it becomes cracked may need some lotion.

What Is e-Health?

e-Health—the current term used to refer to all fields related to computers and medicine Replaces the older term telehealth Way of thinking that focuses on improvement of health care through information and communication technology Electronic prescription (e-prescription) ◦Software guarantees that all necessary information is filled out legibly ◦Correlates the patient's prescription with his or her medical history. ◦ Having detailed information at your fingertips EMAR & BCMA mar-coded administration - Helps prevent errors and identify problems (Medication contraindications). Taking the extra step to preserve our license. Computerized provider order entry (CPOE) Patient care orders entered directly into computer Reduces medication transcription errors Increases transmission and processing time from pharmacy Clinical decision support systems Improves patient outcomes Promotes patient safety Reduces financial costs incurred by health care facility

CVS to evaluate fetal wellbeing

early test, can cause contractions and miscarriage. Gives good info

Nuchal Translucency Test

fat pad on a baby neck. Measure via u/s leads to diagnosis of downs syndrome.

Interactional leadership

focuses on development of trust in a relationship. Compare to me as clinical instructor. More so because it relates to the theory that these behaviors can be learned and taught.

Community Nursing

focuses on promoting and preserving the health of the population groups

Sexual abuse

forced or exploitative sexual conduct or activity; demand for sexual favors by the use of force or threat. anyone can be a sexual perpetrator, including family members, caretakers, HCP's, criminal sexual predators, or other persons with access to the elderly person.

Forceps Marks

from a foreceps delivery - assess head and face for the marks from the forceps. Also want to look for facial symmetry to make sure cranial nerves weren't irritated from this.

Behavioral theory of management

humanistic side of employees needed to be addressed (union development began) (humanistic theory in teaching and learning- focus on values, attitudes, and beliefs)

Systems theory of management

inputs, transformation, outputs, & feedback. One managers decision on another manager/department.

Transformational leadership

is a concern for people. Hence the leader spends much time talking to his followers and trying to learn more about their goals, or problems. Spends time listening. It represents a leadership attitude that is rather future-oriented: the focus lies more on potentiality than on current reality. Changes the way things are currently done

Erythema Toxicum

is a newborn rash. Usually appears on the 1st to 4th day. All babies have different rashes, due to eosinophils reacting to the environment.

Acculturation

is a term used to describe the degree to which an individual from one culture has given up the traits of that culture and adopted the traits of the dominant culture

Contingency leadership

is flexible enough to address the variables in a given situation. Compare to client care in how in we change our plan of care depending on client status.

Transactional leadership

is focused on the current work process and results and is therefore presence-oriented. The features of presence-oriented individuals include a practical attitude, a focus on reality rather than on potentiality

Situational leadership

is functioning more closely to the situation being addressed at the moment (current situation) & selects the most appropriate leadership style. Depends on competencies of the group/people. Compare to team leader in how you assign work to others.

Lanugo

is hair covering the baby. Might see it on the back, shoulders and upper arms. Fine downy hair., like peach fuzz. Less gestational age the more lanugo they have. Preemies are usually very hairy. Goes away in about 2 weeks. Full term baby probably won't have this everywhere.

Passive neglect

is the non-willful failure to fulfill care-taking responsibilities because of inadequate caregiver knowledge, infirmity, or disputing the value of prescribed services

Physical abuse

is the use of physical force that causes injury or the risk of injury, restraint to murder; hiding medications and hindering a person from taking medications.

Active Neglect

is the willful failure by a caregiver to fulfill care-taking functions and responsibilities. This includes, but is not limited to, abandonment, deprivation of food, water, heat, cleanliness, eyeglasses, dentures, or health-related services.

Assimilation

is viewed as the social, economic, and political integration of a cultural group into a mainstream society to which it may have emigrated.

Teaching is a function of the RN is in Nurse Practice Acts

it is an independent nurse function...in other words other health care practitioners do not have to do it with the RN...however if some of the content is related to, for example surgery, what is taught related to the follow up guidelines after surgery may be specified by the physician of a group of physicians For example: all orthopedic physicians may want driving guidelines following hip replacement surgery to be the same

To deliver culturally competent care

lEstablish trust - use communication techniques that align with client's culture- Mr/ Mrs/Miss lKnow patient's primary language lBe astute to non-verbals & eye contact lClarify details you do not know about patient's culture lWhat is client's perception of illness? l Control your own non-verbal's that could show disapproval lDon't generalize..what does this really mean?

Intermittent Auscultation

listen to the baby and grab a HR intermittently. Should be 110-160

Gestational Assessment, Ears

look for the pliability. How fast does it recoil. Fold the pinna and let it go to see how pliable it is. Should be nice and stiff. If very pliable, means there isn't a lot of cartilage.

Mongolian Spots

look like bruising, blueish black/gray dorsal area or butt. Fade in 1-2 years. Usually seen in non-caucasian babies.

McDonalds Rule

measure of the synthesis pubis to the fundus. Should measure to weeks pregnant, up to 31 weeks. After that the baby can change position and change the measurement.

Quad marker

measures estriol, placental function

Conflict is....

more than just a disagreement. It is a situation in which one or both parties perceive a threat (whether or not the threat is real).

Port-Wine Stain

nevus-flamins which is a red/purple non-raised capillary area usually seen on the face. Don't fade over time.

Strawberry mark

nevus-vasculosis, raised enlarged capillaries in the dermis or sub-dermis. Disappear in around 7-10 years.

Effects on the body - hallucinogens

physiological N/V Chills Pupil dilation Increased HR, BP, temp Dizziness Trembling Loss of appetite Insomnia Sweating Decreased respirations Increased BG psychological Heightened response to color, texture, sound, body awareness Distortion of vision slowing of time Magnified feelings of love, hate, anger lust Fear of loosing control, paranoia, panic Increased libido Depersonalization Euphoria, bliss Effect are very unpredictable, it depends on the individual, their frame of mind at the time of ingesting the drug. Panic reaction is referred toa "bad trip" and flash backs to previous trips are common.

Traditional theory of management

promotes the highest productivity based on hierarchy, follows rules, chain of command. Behavioral theory humanistic side of employees

Public Health Nursing

provide interventions targeted for individual and family ex: case management

"Other" Childhood Disorders

safety is a big goal*** §Oppositional Defiant Disorder (ODD): Developmental disorder diagnosed in children who display extreme disobedient behavior •Conduct Disorder: A serious behavioral and emotional disorder that can occur in children and teens. Displays a pattern of disruptive and violent behaviors, problems following rules. •Separation Anxiety Disorder-A child becomes fearful and nervous when away from home or separated from a loved one-usually a parent or other caregiver-to whom the child is attached. •Tourette's Syndrome-multiple motor and or verbal tics

Percutaneous Blood Sampling

sample out of the umbilical cord, for hemolytic studies. Can give blood to baby

Stress test

see how baby tolerates labor. Give mom contractions and watch baby HR, if late decels don't put mom through stress of labor

Chest circumference

should be 2cm less than head circumference. Equal could be hyperinflation.

Reproductive system changes, breasts/nipples

size, tenderness, engorgement. Withdrawal of estrogen and progesterone tells brain to release prolactin and initiate breastfeeding. After lactation is initiated colostrum is released - breasts look/feel the same for 2 days after delivery. Want to assess temperature, firmness, assess nipple and areola for breakdown. Make sure baby is latched correctly for good nutrition.

Milia

small white dots on the chin or bridge of the nose. Maybe under the skin. Plugged sebacous glands, just document this is there.

Reproductive system changes, cervix

the internal and external os is open. By the end of the 7th day the cervix shrinks down to the size of a pencil tip.

Democratic leadership

the people have a more participatory role in the decision making process. One person retains final say over all decisions but allows others to share insight and ideas. High Productivity, High Morale

Reproductive system changes, fundus

the top of the uterus. Assess for the process of involution (shrinking back to size). Should descend one finger breath per day down from the umbilicus. At delivery is usually 2 above the belly-button, should be back at umbilicus by post-partum floor. If deviated to R or L, can be a sign of a distended bladder which can cause uterine atony (uterus stops contracting). Could also be due to sigmoid colon pressing on uterus during pregnancy. Location of the fundus, also the consistency. It should be firm like a grapefruit. A boggy uterus is bad. Means the uterus isn't contracting and is uterine atony (most dangerous the first hour after birth so lacking the thrombi at placental site). If uterine atony (boggy) massage the uterus, call for help.

Financial abuse

theft or conversion of money or anything of value belonging to the elderly person. The theft may be accomplished by force, stealth thru deceit, misrepresentation, fraud, or undue influence on financial decisions mad by the elderly person

Sutures

they can overlap to allow baby to come through birth canal - called molding.

Cerclage

tighten the cervix with a suture after 12weeks of pregnancy. After 12 weeks due to not wanting to preventing a spontaneous abortion. This is done in the office. Watch mom for 6-12 hours to make sure she doesn't bleed or start having contractions. Then mom is sent home. Once Mom has a cerclage, no sex until the baby is born. Wait and see what kind of job she has , no more prolonged standing - may need light duty. At delivery cerclage needs to be cut. Mom will still delivery vaginally.

Conflict continues....

to fester when ignored. Because conflicts involve perceived threats to our well-being and survival, they stay with us until we face and resolve them.

PIH, mild

treated with diet (take away overtly sodium-laden foods), increase protein, a healthy diet. Edema of upper extremities is never normal. Once your face starts to change it's significant.

True Labor

true contractions have progressive effacement and dilation of the cervix. Generally contractions start in the back and radiate to the lower portion of the abdomen. They are more intense with walking. Contractions are regular and get increasingly stronger, longer and closer together. Will continue regardless of comfort measures.

Substance abuse - did you know?

uIn 19th century neither alcohol, cocaine or opiates were restricted in any effective way and adults and children had relatively free access to these substances. uMorphine was widely used during the Civil War. uBy the end of the 19th century, 500,000 lbs of opium were imported yearly into the US and distributed readily as opium, codeine or morphine. uPure preparations of cocaine became readily available after the 1880's. Coca Cola was only one of many cocaine containing tonics advertised and marketed as stimulants. Coca cola voluntarily took cocaine out of its formula in 1903. The old testament vividly describes drunkedness. Coca use is documented in Peru 5000 years ago. Evidence of tabacco use is 7000 years ago. The cultivation of poppies in Europe goes back to Neolithic times. So whats the big deal?

Somatic Symptom Disorder

uSomatic symptom disorder (SSD formerly known as "somatization disorder" or "somatoform disorder) is a form of mental illness that causes one or more bodily symptoms, including pain. uSomatic symptom disorders occur when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life. uThe inability of modern medicine to determine the existence of pathophysiology to explain a client's symptoms is not sufficient to diagnose him or her with a mental illness.

Ectopic pregnancy, signs & symptoms

unilateral pain, bleeding (once it ruptures), amenorrhea. No s/s until it stretches the lumen of the fallopian tube. The MD could save the tube if caught early. If it ruptures the tube needs to be removed surgically.

Leopolds maneuver

use hands to see what position baby is in. Feel for round spots, head and butt. If move butt the whole body goes but the head doesn't cause the whole body to move

Reproductive system changes, vagina

vaginal wall is thin due to few rugae until 6 weeks postpartum. This is why no sex due to risk for tearing/infection.

Hypotonic Contractions

weak ineffective contractions that do nothing to the cervix. Give pitocin

1st Degree Tear

when the perineal skin and mucous is lacerated

Vernix

white cheesy substance covering the baby. Usually in the folds. Goin, labia, neck. It lubricates baby in-utero. Wear gloves. Teach parents not to scrub it off, will fade over time.

Managing afterpains, topicals

witch hazel pads, dermoplast, ice, ice peri pads, sitz baths

The CARS Checklist

}CARS—another tool designed to help you evaluate a website ◦C ◦A ◦R ◦S CARS—another tool designed to help you evaluate a website Credibility—authoritative source? Accuracy—correct today? Reasonableness—engages subject thoughtfully, reasonably, truthfully? Support—triangulated sources?

How Can a Smartphone or PDA Help Me?

}Can use to monitor: ◦Blood glucose levels ◦Blood pressure ◦Diet ◦Activity }Calculate dosages }Analyze lab results }Access reference materials }Check for drug interactions }Schedule procedures }Order prescriptions Smartphones can run applications that can perform cardiac monitoring, etc, however be careful not to violate HIPAA if using personal phones.

Smartphones and Tablet Computers

}Cell phones and PDAs have merged together to create a new category - smartphones }Mobile clinical assistant (MCA) ◦Incorporates a camera, bar code scanner, and digitizer pen data entry in a fully functional Windows-based slate tablet computer; access to EHR. Tablets used more so in primary offices and not so much hospital setting. Nurses now have zone phones, therefore we are moving in that direction. Smartphones can run applications that can perform cardiac monitoring, etc, however be careful not to violate HIPAA if using personal phones. Point of care (POC) documentation Reduces data latency and data errors Includes mobile devices and computer workstations Positive attributes of both MCA and smartphone ØConserves time and reduces steps to and from nurses' station ØOffers easier information transmission between workers ØPortability and information at your fingertips

What Do I Need to Know to Evaluate an Internet Resource?

}Confine your Internet searches to well-known and reputable sites ◦Office of the Surgeon General ◦National Human Genome Research Institute (NHGRI) ◦Centers for Disease Control and Prevention (CDC) ◦Agency for Healthcare Research and Quality (AHRQ) ◦Health Resources and Services Administration (HRSA)

Committee or Teams

}Consists of a group of people who have been selected to manage a particular topic or issue. }Examples are: policy committee, quality improvement committee, healthcare planning committee, nursing organization committee. }Can be referred to as teams: wound care team, fall prevention team Most common type of work related groups Common purpose, hold themselves mutually accountable Usually have a specific purpose that is part of organizational structure Effective keys to meetings are: planning, organization (reserve room for meeting), send out agenda ahead of time, clear purpose, take minutes, summarize at end of meeting and ID plan of action.

Nursing Informatics

}Define nursing informatics }Discuss the necessity of using recognized taxonomies and standardized nursing languages in nursing documentation. }Discuss trends associated with the computerized electronic record, e-health, mobile devices. }Describe what a nurse specializing in nursing informatics might do. }Review the steps in evaluating the validity of a website. }Discuss future trends in nursing informatics.

E-mail

}Few doctors currently communicate with their patients through e-mail }Could help to avoid "phone tag" with patients and improve efficiency }Drug-refill requests and educational information could be accessed Drug-refill requests are currently in process (CVS). More than 78% of people in the US use the internet and email daily, however, physicians have yet to jump on the band wagon as this being a means of communication with their patients. May be due to reasons as HIPAA. However, can use protected source my mycare.dot, or some sort of portal to ensure privacy and security. Also, E-mail is being supplemented by texting and other social media services in today's society

Evaluate an Internet Resource

}Remember café—advice for dealing with information obtained from Internet: ◦C ◦A ◦F ◦E Remember café—advice for dealing with information obtained from Internet: Challenge information and demand accountability Adapt and require more credibility and evidence for stronger claims—be skeptical of information File new information in your mind rather than immediately believing or disbelieving Evaluate and reevaluate regularly—recognize dynamic, fluid nature of information

Nurse Roles in Informatics

}Two distinct roles ◦1. Informatics nurse (IN) - ◦2. Informatics nurse specialist (INS) - ◦ ◦ ◦Nurses in both roles "...support consumers, patients, clinical nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology" (ANA, 2008, p. 1) Informatics nurse (IN) - has experience in nursing informatics but does not have an advanced degree in the specialty Informatics nurse specialist (INS) - has graduate level education in informatics or a related field IN and INS must have basic knowledge of how computer works IN and INS must be able to converse with technology staff on intellectual level about hardware, software, communications, data representation, and security In 1994, the ANCC (American Nursing Credentialing Center) provided certification for informatics, with a baccalaureate as a minimum (RN, BC)

Neglect

¢A type of passive abuse that my include withholding medication, medical treatment, food, and personal care necessary for the well-being of the elderly person. also include behaviors that ignores the person's obvious need even though the neglectful person is present.

Elder Abuse: Definitions

¢Abuse: act of physical or mental maltreatment that threatens or causes harm to an elderly person whether by action or inaction. ¢Battery: unwanted or offensive touching, can include acts of violence, hitting, pushing, or throwing objects; may also be non-injurious touching.

Advocacy

¢Advocate: one who pleads for, supports, or recommends on behalf of another ¢Surrogate: acting as an agent or proxy for another such as a patient. one who represents and acts for a patient in making health care decisions ¢Nurse advocate: nurse who acts in an advocacy role in the professional health care situation. Support of client as a free agent with the right of self-determination. the ANA in its code of ethics promote nurse advocacy for all pts. Advocacy should not be confused with paternalism. Paternalism means treating others as if they were unable to make decision on their own. The advocate supports and represents the patient's wishes.

Horizontal violence Includes

¢Belittling gestures: Deliberate rolling of eyes, folding arms, staring into space when communication is being attempted (In other words body language designed to discomfort others) ¢Verbal abuse: Including name calling, threatening, intimidating, dismissing, belittling, undermining, or humorous put downs ¢Gossiping: Destructive negative nasty talk-talking behind ones back, backstabbing/backbiting. My new attitude is: If you will not say it to some ones face, don't say it! ¢Sarcastic comments ¢Fault finding (nitpicking): Nitpicking is different to those situations where professional and clinical development is required ¢Ignoring or minimizing another's concerns ¢Sending to 'Coventry', (freezing out): Excluding from activities and conversation-work related and social ¢Comments that devalue: peoples area of practice, women or others that are different from norm (Keep in mind some of which IS or could be covered by a harassment policy. Negative comments that belittle a persons gender, ethnicity, religion, and disability are covered by civil rights laws.

Horizontal Violence - Bullying - Mobbing or Workplace Aggression

¢Defined as repeated and persistent non-physical mistreatment of a person. ¢It is a sub-lethal form of workplace violence. ¢It is unwanted, negative behavior unilaterally instigated by one or more perpetrators over a prolonged period of time, manifested as verbal and non-verbal behaviors or sabotaging tactics which prevent the targeted person's from performing satisfactorily. (Namie & Namie, 09) It may be conscious or unconscious behavior. It is generally psychologically, emotionally, and spiritually damaging behavior and can have devastating long term effects on the recipients.

Self-Neglect

¢Generally a function of diminished physical or mental ability. includes not taking medication, avoiding medical treatment, being unable or unwilling to provide for food and personal hygiene. In this situation there may be ethical questions of how much to intervene with self neglect behavior if the elderly person is competent and simply chooses not to perform this care.

If an Individual is Sexually Assaulted

¢It is important that the victim of sexual assault understand that no matter where they were, the time of day or night assaulted, what they were wearing, or what they said or did, if they did not want the sexual contact, then the assault was in no way their fault. ¢Persons who commit sexual assault do so out of a need to control, dominate, abuse and humiliate. Sexual assault is the articulation of aggression through sex, and has little to do with passion, lust, desire, or sexual arousal.

Psychological (mental/emotional ) abuse

¢May include; name calling, verbal assault, threats of violence, neglect, or institutionalization. ¢May include a deliberate effort to dehumanize the elderly person with the intent to drive the person to mental illness or suicide.

Abuser Profile

¢Most abusers were abused themselves or witnessed abuse ¢Traits: personality d/o, substance abuse, aggressive behavior, low self-esteem, excessive jealousy, rigid sex role stereotypes. ¢Many are extremely seductive, possessive and manipulative. ¢Incidence higher among unemployed or have low prestige jobs

Victim Profile

¢Rigid traditional values ¢Exposure to violence ¢Traits of dependency, passivity, submissiveness and low self-esteem

Examples of Horizontal Violence

¢Withholding information: is extremely dangerous in particular fields of practice however time consuming and NOT cost effective in the very least in the world of business and academia. ¢Limiting right to free speech and right to have an opinion: Have you ever been deliberately interrupted during a meeting or overlooked when attempting to voice a thought or an opinion? ¢Behaviors which seek to control or dominate: Power over rather than power with... ¢Elitist attitudes regarding work area, education, or experience: A "better than" attitude. My thoughts are if you think you ARE better than that particular person why not share your expertise? Help that individual whom you are better than. Keep your holier than thou attitude just share all that good experience. But unfortunately that does not happen with this individual because they also believe in what's call the "sorority sister syndrome"! ¢Taking credit for some one else's work: Not giving credit where credit is due! I'm nota wimpy person however this has happened to me several times and I have not always spoken up. Why might you ask? Because when you work in a hostile environment you need to choose your battles, all of which takes a lot of energy and can be downright exhausting. ¢Sabotaging someone's work ¢Setting someone up for failure ¢Continual criticism

Consider non-verbal clues in Evaluation of learning

ØBody language leaning forward, looking at RN, nodding Hands clasped in front of the body Hands on hips (angry, annoyed) Arms folded across chest (tense, not open to new ideas) Rubbing cheek or forehead (confused) When seated listeners move their legs (anxious) Hands fall to side of body (relaxed) Hands hovering around face (afraid) Bring hand to back of neck (confused) ØVoice tone not high pitched (indicates anxiety or anger), no rapid speech ØFacial expression no frown or grimace

Gender Dysphoria in Adolescents or Adults

•* Individual has self-perception of being of opposite gender •* Does not feel comfortable wearing the clothing of assigned gender and • often engage in cross-dressing •* May find his or her own genitals repugnant •* May repeatedly submit requests to health-care system for hormonal and surgical gender reassignment •* Depression and anxiety are common

Intellectual Disability (IDD)

•A condition diagnosed during the developmental period that includes below-average general intellectual functioning and a lack of the skills necessary for daily living. •Intellectual and adaptive functioning deficits in conceptual, social, and practical domains. •Below-average intellectual functioning •IQ less than 70 accompanied by significant limitations in: •Communication skills •Self-care •Home living •Social/interpersonal skills •Work •Leisure •Health and safety •Page 735 Level (IQ)

Adjustment disorders/Stress disorder

•A group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after a person goes through a stressful life event. •The symptoms occur because they are having a hard time coping. The reaction is stronger than expected for the type of event that occurred PTSD symptoms can also seem similar to an adjustment disorder because both are linked with anxiety that develops after exposure to a stressor. With PTSD, this stressor is a traumatic event. With adjustment disorder, the stressor does not have to be severe or outside the "normal" human experience.

Conversion disorder

•A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism •Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. •Some instances of conversion disorder may be precipitated by psychological stress. Examples: they get paralysis called aphonia, don't have the ability to verbalize anything. Have seizure activities, diff swallowing, urinary retention, become blind/deaf, cant smell, no pain, can hallucinate,

Borderline personality disorder

•A mental disorder characterized by unstable moods, behavior, and relationships. •Impacts the way a person thinks and feels about themselves and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships. •Symptoms include emotional instability, feelings of worthlessness, insecurity, impulsivity, clingy behavior, and impaired social relationships. These individuals are impulsive, are directly and indirectly self-destructive, and lack a clear sense of identity. Rotate staff members to avoid clinginess .

Phobias

•A persistent, intensely felt, and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus •Responses typically include intense anxiety or panic attacks •Agoraphobia •Social Anxiety Disorder •Specific ie. •Gamophobia (fear of marriage!!!) •Table 27-1 has a great list Therapies are antianxiety meds and desensitation, slowly exposing the person to their fear.

Schizotypal personality disorder

•A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: •Neither desires nor enjoys close relationships, including being part of a family •Almost always chooses solitary activities • Has little, if any, interest in having sexual experiences with another person • Takes pleasure in few, if any, activities •Lacks close friends or confidants other than first-degree relatives •Appears indifferent to the praise or criticism of others •Shows emotional coldness, detachment, or flattened affectivity •Behavior is odd and eccentric The difference between the two seems to be that those labeled as schizotypal avoid social interaction because of a deep-seated fear of people. The schizoid individuals simply feel no desire to form relationships, because they see no point in sharing their time with others.

Teaching

•A planned method or series of methods used to help someone learn

Special Concerns of Elderly People - •Elder abuse

•Abuse of elderly individuals is a serious form of family violence. •Statistics regarding the prevalence of elder abuse are difficult to determine. •Estimated that annually up to 2 million older adults in the United States are victims of abuse. •The abuser is often a relative who lives with the elderly person and may be the assigned caregiver.

Acute Radiation Syndrome

•Acute illness that follows a predictable course •Affects rapidly proliferating cells •Symptoms are dose-dependent •Survivability -probable -possible -improbable Probable- no s/s, resolve with in few hours Possible- n/v, 24/48 hours, blood products Improbable: acute n/v, diarrhea, shock, blood infusion S/S:: decreased CBC, WBC, RBC, Neutrophils, Platelets within a week causing hemorrhagic shock and possible complications of fever sepsis

Acute Stress Disorder

•Acute stress disorder (ASD) is similar to PTSD in terms of precipitating traumatic events and symptomatology. •Symptoms are time limited. •Up to 1 month following the trauma •If symptoms last longer than 1 month, the diagnosis is PTSD. rectly experiencing the traumatic event(s). Witnessing, in person, the event(s) as it occurred to others. Learning that the event(s) occurred to a close family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse) NURSES Acute stress disorder (ASD) is a mental disorder that can occur in the first month following a trauma. The symptoms that define ASD overlap with those for PTSD. One difference, though, is that a PTSD diagnosis cannot be given until symptoms have lasted for one month

Antisocial personality disorder/conduct disorder

•Adults with antisocial personality disorder typically show symptoms of conduct disorder before the age of 15. Signs and symptoms of conduct disorder include serious, persistent behavior problems, such as: •Aggression toward people and animals •Destruction of property •Deceitfulness •Theft •Serious violation of rules

Medical Treatment Modalities

•Agitation, aggression, hallucinations, thought disturbances, and wandering •Pimavancerin (Nuplazid) was approved by the FDA specifically for treatment of hallucinations and delusions in Parkinson's disease psychosis. •The mechanism of action is unknown but it is thought to provide benefit through its serotonin agonist and antagonist activities.

schizoid personality clinical picture

•Aloof and indifferent to others •Emotionally cold •No close friends; prefers to be alone •Appears shy, anxious, or uneasy in the presence of others •Inappropriately serious about everything and difficulty acting in a light-hearted manner •Possible hereditary factor •Childhood has been characterized as •Bleak •Cold •Unempathic •Notably lacking in nurturing People with schizoid personality disorder appear cold, aloof, and indifferent to others. They typically have a long-standing history of engaging in primarily solitary activities or engaging more with animals than people. They prefer to work in isolation and are unsociable, with little need or desire for emotional ties. They are able to invest enormous affective energy in intellectual pursuits. In the presence of others, they appear shy, anxious, or uneasy. They are inappropriately serious about everything and have difficulty acting in a lighthearted manner. Their behavior and conversation exhibit little or no spontaneity. Typically, they are unable to experience pleasure, and their affect is commonly bland and constricted.

Avoidant Personality Disorder

•Also called anxious personality disorder •characterized by social discomfort and avoidance of interpersonal contact. called anxious personality disorders, which are marked by feelings of nervousness and fear. People with avoidant personality disorder have poor self-esteem. They also have an intense fear of rejection and being negatively judged by others. people with Avoidant Personality Disorder have fundamental feelings of inadequacy and inferiority that drive them toward extreme social inhibition as they seek to avoid rejection, embarrassment, and judgment. The individual with avoidant personality disorder is extremely sensitive to rejection and because of this may lead a very socially withdrawn life. It is not that he or she is asocial; in fact, there may be a strong desire for companionship. The extreme shyness and fear of rejection, however, create needs for unusually strong assurances of unconditional acceptance. Prevalence of the disorder in the general population is about 2 to 3 percent, and it appears to be equally common in men and women.

Binge eating disorder (BED)

•An eating disorder that can lead to obesity. •Individual binges on large amounts of food, as in bulimia nervosa. •BED differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the excess calories. •50 percent of individuals with BED have a history of depression. No purging. Eat and eat all day. Con't until they feel uncomfortably full. Interpersonal stressors, low self-esteem and boredom are identified as possible triggers. Identify the symptoms of binge eating disorder. Individuals with binge eating disorders have episodes of binge eating that may be similar to those with bulimia nervosa, however there is an absence of purging. As a result, this client is at risk for substantial weight gain. The episodes of eating are referred to as binges when they occur over a discreet period of time, usually defined as less than 2 hours. Food consumption not only is rapid but often continues to the point that the individual feels uncomfortably full. Interpersonal stressors, low self-esteem, and boredom are identified as possible triggers. Typically, clients describe their eating as out of control. There is often accompanying guilt and depression. As many as 50 percent of individuals with binge eating disorder have a history of depression

Therapeutic Relationship

•An interaction between two people in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention. •Therapeutic relationships are goal oriented

Psychomotor Behavior

•Anergia: deficiency of energy •Waxy flexibility: passive yielding of all movable parts of the body to any effort made at placing them in certain positions •Posturing: voluntary assumption of inappropriate or bizarre postures •Pacing and rocking: pacing back and forth and rocking the body

Eating Disorders

•Anorexia nervosa •Bulimia nervosa •Binge eating disorder

Biological Agents

•Anthrax •Plague •Smallpox •Ricin •Botulinum Bubonic Plague: transmitted through flea bites Pneumonic: transmitted through respiratory droplet contact •Require high index of suspicion •Observe for patterns - large number of patients presenting with similar signs and symptoms - Unusual age distribution for a common disease

Treatment for EPS

•Antiparkinsonian agents may be prescribed to counteract EPS. •**May need STAT intervention for Dystonia: • IV or IM diphenhydramine (Benadryl) or IM benzotropine (Cogentin)***

Psychopharmacology

•Antipsychotics- NeurolepticsUsed to decrease agitation and psychotic symptoms of schizophrenia and other psychotic disorders •The main goal is to manage symptoms of psychosis such that the pt. can function independently and accomplish ADL's with minimal assistance. ** clozapine - commonly used because it has the least potential side effects. Apiprazole Asenapine Lurasidone Olanzapine Haldol can be given iv, po, im...

Cluster B: Behaviors described as dramatic, emotional, or erratic

•Antisocial Personality Disorder •Borderline Personality Disorder •Histrionic Personality Disorder •Narcissistic Personality Disorder

Anxiety

•Anxiety is usually considered a normal reaction to a realistic danger or threat to biological integrity or self-concept. Normal anxiety dissipates when the danger or threat is no longer present •Is the anxiety out of proportion to the situation??

Evaluation

•Are adaptive coping strategies present? asking for help, verbalizing distress, exercising when angry A coping strategy (coping mechanism) is a natural or learned way of responding to a changing environment or specific problem or situation. Adaptive coping helps person deal with stress & minimizes distress. Maladaptive coping results in unnecessary distress examples of Ineffective coping techniques: screaming, hitting, demeaning Review defense mechanisms...they are coping techniques that are not right or wrong but they can be ineffective and do not help resolve the crisis... denial, displacement... "It is the nurses fault my husband is not better." Reaction formation: "I'm not anxious." Crisis symptoms resolved? BP & heart rate WNL's? calm voice, no pacing Support systems present? Family/friends involved and plan in place Implement health teaching about continuing use of effective ways to cope Referral necessary? Is psych or SW referral needed?

NCD con't

•As the disease progresses, symptoms may include •Aphasia •Apraxia •Irritability and moodiness, with sudden outbursts over trivial issues •Inability to care for personal needs independently •Wandering away from the home •Incontinence •The reversibility of NCD is dependent on the cause

Interventions for the client with binge eating disorder and associated obesity:

•Assess the client's feelings and attitudes about overeating and obesity. •Have the client recall coping patterns related to food in family of origin, and explore how these may affect current situation. •Determine the client's motivation for developing healthier patterns of eating • Help the client identify positive self-attributes. •Refer the client to a support or therapy group

Healthy People 2020 Overall Goals

•Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; •Achieve health equity, eliminate disparities, and improve the health of all groups; •Create social and physical environments that promote good health for all; and •Promote quality of life, healthy development, and healthy behaviors across all life stages.

Cluster C: Behaviors described as anxious or fearful

•Avoidant Personality Disorder •Dependent Personality Disorder •Obsessive-Compulsive Personality Disorder

Avoidant personality disorder (cont'd) - clinical picture

•Awkward and uncomfortable in social situations •Desire close relationships but avoid them because of fear of being rejected •Perceived as timid, withdrawn, or cold and strange •Often lonely and feel unwanted •View others as critical and betraying Individuals with this disorder are awkward and uncomfortable in social situations. From a distance, others may perceive them as timid, withdrawn, or perhaps cold and strange. Those who have closer relationships with them, however, soon learn of their sensitivities, touchiness, evasiveness, and mistrustful qualities. Their speech is usually slow and constrained, with frequent hesitations, fragmentary thought sequences, and occasional confused and irrelevant digressions. They are often lonely, and express feelings of being unwanted.

Treatment for Paraphilic Disorders

•Biological treatment •The focus of this therapy is on blocking or decreasing the level of circulating androgens. •Psychoanalytic therapy •Client is helped to identify unresolved conflicts/traumas from early childhood, resolving the anxiety that prevents him or her from forming appropriate sexual relationships. •Behavioral therapy •Aversion techniques •Imagry desensitation •Satiation

Triage categories

•Black-expectant or deceased. Unresponsive, head wounds, spinal cord injury • •Red- Emergent, immediate. Shock, Airway obstruction, Tension Pneumothorax • •Yellow- Urgent, delayed. Stable abdominal wounds, vascular injuries with adequate blood flow • •Green- non-urgent, minor. Upper extremities fracture, minor burns and sprains

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)

•C. Benztropine (Cogentin) is an anticholinergic medication used for the treatment of exprapyramidal symptoms such as akathisia.

Caregivers

•Can problem-solve effectively regarding care of the elderly client •Demonstrate adaptive coping strategies for dealing with stress of caregiver role •Openly express feelings •Express desire to join a support group of other caregivers

Anorexia Nervosa

•Characterized by a morbid fear of obesity •Intense fear of gaining weight or becoming fat •Symptoms include: • gross distortion of body image •preoccupation with food • refusal to eat. •Weight loss is extreme, usually more than 15 percent of expected weight. Anorexia refers to a prolonged loss of appetite. Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. The distortion in body image is manifested by the individual's perception of being fat when he or she is obviously underweight or even excessively thin. Weight loss in clients with anorexia nervosa is usually accomplished by reduction in food intake and often extensive exercising. Self-induced vomiting and the abuse of laxatives or diuretics also may occur.

Dependent personality disorder

•Characterized by a pattern of relying on others for emotional support •Relatively common within the population •More common in women than in men •More common in the youngest children of a family than in the older ones •Avoid positions of responsibility and become anxious when forced into them •Have a notable lack of self-confidence apparent in •Posture •Voice •Mannerisms •Overly generous and thoughtful, while underplaying own attractiveness and achievements •Low self-worth and easily hurt by criticism and disapproval •Assume passive and submissive roles in relationships Dependent personality disorder is characterized by lack of self-confidence and extreme reliance on others to take responsibility for them. This mode of behavior is evident in the tendency to allow others to make decisions, to feel helpless when alone, to act submissively, to subordinate needs to others, to tolerate mistreatment by others, to demean oneself to gain acceptance, and to fail to function adequately in situations that require assertive or dominant behavior. Individuals with dependent personality disorder have a notable lack of self-confidence that is often apparent in their posture, voice, and mannerisms. They are typically passive and acquiescent to the desires of others. They are overly generous and thoughtful and underplay their own attractiveness and achievements. They may appear to others to be happy, but when alone, they may feel pessimistic, discouraged, and dejected. Others are not made aware of these feelings.

•Depersonalization-derealization disorder

•Characterized by a temporary change in the quality of self-awareness, which often takes the form of: •Feelings of unreality •Changes in body image •Feelings of detachment from the environment •A sense of observing oneself from outside the body •Depersonalization is defined as a disturbance in the perception of oneself. •Derealization is described as an alteration in the perception of the external environment. Soldier describes himself from a distance, wondering what he would do but he was actually in the situation

Generalized Anxiety Disorder

•Characterized by chronic, unrealistic, and excessive anxiety and worry and restlessness •Occurs most days for at least 6 months •Causes significant impairment in work and social life. Seeks reassurance from others & procrastinates when making decisions

Panic Disorder

•Characterized by recurrent panic attacks, the onset of which is unpredictable •They are not triggered by situations •Sudden overwhelming feeling of terror or impending doom •This most severe form of emotional anxiety is usually accompanied by behavioral, cognitive, and physiological signs and symptoms considered extremely intense and frightening.

Schizoid personality disorder

•Characterized primarily by a profound defect in the ability to form personal relationships •Failure to respond to others in a meaningful emotional way •Diagnosis occurs more frequently in men than in women •Prevalence within the general population has been estimated at 3 to 5 percent People with schizoid personality disorder appear cold, aloof, and indifferent to others. They typically have a long-standing history of engaging in primarily solitary activities or engaging more with animals than people. They prefer to work in isolation and are unsociable, with little need or desire for emotional ties. They are able to invest enormous affective energy in intellectual pursuits. In the presence of others, they appear shy, anxious, or uneasy. They are inappropriately serious about everything and have difficulty acting in a lighthearted manner. Their behavior and conversation exhibit little or no spontaneity. Typically, they are unable to experience pleasure, and their affect is commonly bland and constricted. Schizoid personality disorder is characterized primarily by a profound defect in the ability to form personal relationships and others often see them as eccentric, isolated, or lonely. These individuals display a lifelong pattern of social withdrawal, and their discomfort with human interaction is apparent. The prevalence of schizoid personality disorder is difficult to. Estimates within the general population vary from between 3 and 5 percent. Significant numbers of people with the disorder are never observed in a clinical setting. Gender ratio of the disorder is unknown, although it is diagnosed more frequently in men.

Pulmonary Agents

•Chlorine and Phosgene • •Exposure most likely from inhalation • •Pulmonary symptoms manifest quickly •Aggressive airway and breathing management S/S: Pulmonary Edema, SOB, INITIAL is Hacking Cough!! Treatment- Decontamination: airway management; vent support; bronchoscopy

Cluster A Personality Disorders

•Cluster A: Behaviors described as odd or eccentric •Paranoid personality disorder • Schizoid personality disorder • Schizotypal personality disorder Reality base paranoid schizophrenia. I know you think you see things in the corner but they are not therer

Complicated Grieving

•Complicated Grieving •Defined as "a disorder that occurs after death of a significant other in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment" Acknowledge feelings of guilt or self-blame the client may express. Guilt at having survived a trauma in which others died is common. The client needs to discuss these feelings and recognize that he or she is not responsible for what happened but must take responsibility for his or own recovery. Assess stage of grief in which the client is fixed. Discuss normalcy of feelings and behaviors related to stages of grief. Knowledge of grief stage is necessary for accurate intervention. Guilt may be generated if client believes it is unacceptable to have these feelings. Knowing they are normal can provide a sense of relief. Assess impact of the trauma on the client's ability to resume regular activities of daily living. Consider employment, marital relationship, and sleep patterns. Following a trauma, individuals are at high risk for physical injury because of disruption in ability to concentrate and problem-solve and lack of sufficient sleep. Isolation and avoidance behaviors may interfere with interpersonal relatedness. Assess for self-destructive ideas and behavior. The trauma may result in feelings of hopelessness and worthlessness, leading to high risk for suicide. Assess for maladaptive coping strategies such as substance abuse. These behaviors interfere with and delay the recovery process. Identify available community resources from which the individual may seek assistance if problems with complicated grieving persist. Support groups for victims of various types of trauma exist within most communities. The presence of support systems in the recovery environment has been identified as a major predictor in the successful recovery from traum

Blood Agents

•Cyanide •Interferes with oxygen at the cellular level •Found in consumer products and pesticides •Treatment- Amyl nitrate, sodium nitrate- cyanokit (Sodium Thiocyanate) Results in Asphyxiation through hemoglobin Treatment: Cyanokit and Intubation

Which symptom experienced by a client diagnosed with schizophrenia would predict a less positive prognosis? A. Hearing hostile voices. B. Thinking the TV is controlling their behaviors. C. Continuously repeating what has been said. D. Having little or no interest in work or social activities.

•D. Positive symptoms of schizophrenia tend to reflect an excess or distortion of normal function, whereas negative symptoms reflect a diminution or loss of normal function. When a client has little or no interest in work or social activities, the client is exhibiting the negative symptom of apathy. Apathy is indifference to, or disinterest in, the environment. Flat affect is a manifestation of emotional apathy. Because this client is exhibiting a negative symptom, the client has the potential for a poorer prognosis.

Post trauma Syndrome

•Defined as "a sustained maladaptive response to a traumatic, overwhelming event" •Trying to stay with clients with nightmares/terrors •Offer reassurance •Encourage client to talk about their trauma at their own place •Acknowledge clients feelings (what you're feeling is real, we are here to support you) •Assist individual to try to understand trauma - find your new normal A posttrauma client may be suspicious of others in his or her environment. Establishing a trusting relationship with this individual is essential before care can be given. To promote trust, assign the same staff as often as possible. Use a nonthreatening, matter-of-fact but friendly approach. Ask for permission before using touch as an intervention. Respect the client's wishes regarding interaction with individuals of opposite gender at this time (especially important if the trauma was rape). Be consistent and keep all promises, and convey an attitude of unconditional acceptance. Stay with the client during periods of flashbacks and nightmares. Offer reassurance of safety and security and that these symptoms are not uncommon following a trauma of the magnitude he or she has experienced. The presence of a trusted individual may help to calm fears for personal safety and reassure the anxious client that he or she is not "going crazy." Obtain an accurate history from significant others about the trauma and the client's specific response. Various types of traumas elicit different responses in clients. For example, human-engendered traumas often generate a greater degree of humiliation and guilt in victims than does trauma associated with natural disasters. Encourage the client to talk about the trauma at his or her own pace. Provide a nonthreatening, private environment, and include a significant other if the client wishes. Acknowledge and validate the client's feelings as they are expressed. This debriefing process is the first step in the progression toward resolution. Discuss coping strategies used in response to the trauma, as well as those used during stressful situations in the past. Determine those that have been most helpful and discuss alternative strategies for the future. Clients who have suffered multiple or sustained traumas may find longer-term PTSD-focused therapy to be beneficial. Include available support systems, including religious and cultural influences. Identify maladaptive coping strategies, such as substance use or psychosomatic responses, and practice more adaptive coping strategies for possible future posttrauma responses. Resolution of the posttrauma response is largely dependent on the effectiveness of the coping strategies employed. Assist the individual to comprehend the trauma if possible. Discuss feelings of vulnerability and the individual's "place" in the world following the trauma. Posttrauma response is largely a function of the shattering of basic beliefs the survivor holds about self and world. Assimilation of the event into one's persona requires that some degree of meaning associated with the event be incorporated into the basic beliefs, which will affect how the individual eventually comes to reappraise self and world (Epstein, 1991).

Obesity

•Defined as a condition in which an individual accumulates abnormal or excessive fat for age and gender that exceeds overweight •Encourage diary of food intake •Goals (includes what must be done to change their weight) and interventions (discuss their feelings and emotions associated with eating. Formulate an eating plan and identify realistic goals for weekly weightloss) Goals should include verbalizing an understanding of what must be done to lose weight and changing eating patterns to result in steady weight loss. Interventions should include discussing feelings and emotions associated with eating, formulating an eating plan, and identifying realistic goals for weekly weight loss.

•Dissociative amnesia

•Defined as an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness, and which is not due to the direct effects of substance use or a neurological or other medical condition •Onset usually follows severe psychosocial stress. Freud believed that dissociative behaviors, including amnesia, occurred when individuals repress distressing mental contents from conscious awareness. •He believed that this mechanism protected the client from emotional pain. Partial or total permanent damage or loss of memory Forget recent events Common in women that have been raped

Phase III Acute Psychotic Phase

•Delusion •Hallucinations • Impairment in work, social relations, and self-care These patients will be on crisis unit. Differences: -Hallucinations are not really there ex: 100 elephants on campus -Delusion is improper thought, example teacher says they are there to help and you think oh she is here to harm me.

Denial

•Denial is a coping mechanism that gives the person time to adjust to distressing situations . When in denial, they are trying to protect themselves by refusing to accept the truth about something that's happening in their life. •Establish trusting relationship •Avoid arguing or bargaining with • the client Goals should include understanding the correlations between emotional issues and eating behaviors and to cope with emotional issues in a more adaptive manner. Interventions should include acknowledging the client's anger at feelings of loss of control and encouraging the client to verbalize feelings.

Triage and Treatment - Disaster

•Different from standard triage "Greatest good for the greatest number" •Traumatic injury is common after disaster •Expect exacerbations of pre-existing conditions

S/S of ADHD

•Difficulty in performing age-appropriate tasks •Hyperactivity-boundless activity/highly distractible •Limited attention span •Impulsive •Difficulty forming friendships •Disruptive/intrusive •No one treatment effective •Goals: managing symptoms, reducing hyperactivity and impulsivity, increasing child's attention •Combination of medications, behavioral, psychosocial, and educational interventions Dietary changes and exercise is very important!!

Delirium - Symptoms

•Difficulty sustaining and shifting attention •Extreme distractibility •Disorganized thinking •Speech that is rambling, irrelevant, pressured, and incoherent •Impaired reasoning ability and goal-directed behavior •Disorientation to time and place •Impairment of recent memory •Misperceptions about the environment, including illusions and hallucinations •Disturbances in the sleep-wake cycle, sometimes can be up for 3d •Psychomotor activity that fluctuates between agitation and restlessness and a vegetative state •State of awareness may range from hypervigilance to stupor or semicoma •Sleep may fluctuate between hypersomnolence and insomnia •Sleep x3d up for 5d •Vivid dreams and nightmares are common •Usually begins abruptly •Can have a slower onset if underlying etiology is systemic illness or metabolic imbalance •Duration is usually brief and subsides completely on recovery depending on the cause

Cluster b - Antisocial personality disorder S/S

•Disregard for right and wrong •Persistent lying or deceit to exploit others •Being callous, cynical and disrespectful of others •Using charm or wit to manipulate others for personal gain or personal pleasure •Arrogance, a sense of superiority and being extremely opinionated •Recurring problems with the law, including criminal behavior •Repeatedly violating the rights of others through intimidation and dishonesty •Impulsiveness or failure to plan ahead •Hostility, significant irritability, agitation, aggression or violence •Lack of empathy for others and lack of remorse about harming others •Unnecessary risk-taking or dangerous behavior with no regard for the safety of self or others •Poor or abusive relationships •Failure to consider the negative consequences of behavior or learn from them •Being consistently irresponsible and repeatedly failing to fulfill work or financial obligations A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following: Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure Impulsivity or failure to plan ahead Irritability and aggressiveness, as indicated by repeated physical fights or assaults Reckless disregard for safety of self or others Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another Individual is at least 18 years.

Dissociative Disorders

•Dissociative disorders are defined by a disruption in the usually integrated functions of consciousness, memory, and identity. •Dissociative responses occur when anxiety becomes overwhelming and the personality becomes disorganized. •Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self. Dissociative symptoms can potentially disrupt every area of mental functioning. Amnesia - complete loss, no knowledge Gets very disorganized in their minds Defense mechanism in their body

Negative Symptoms

•Disturbance in Affect: the feeling state or emotional tone •Inappropriate affect: emotions are incongruent with the circumstances •Bland affect: weak emotional tone •Flat affect: appears to be void of emotional tone Negative symptoms: things that are taking them away from the real world. Disturbance in Affect (cont.) Apathy: disinterest in the environment Avolition- impaired Volition: impairment in the ability to initiate goal-directed activity Anosognosia- unaware of having an illness Anergie-lack of energy to carry on ADL's Anhedonia- inability to experience pleasure

Natural Disasters

•Earthquakes •Hurricanes •Tornados •Floods •Tsunami •Fire

Botulinum

•Effects are dose dependent •Exposure by ingestion, inhalation, inoculation •Signs and symptoms will vary by dose and route of exposure descending flaccid paralysis from lack of acetylcholine Not Contagious Oral S/S: abdominal cramps, n/v, diarrhea Inhalation S/S: fever, Paralysis dsyphygia, dry mouth Treatment: intubated support, fluids Skin Treatment: SOAP & WATER

Causes of Adjustment disorder can be:

•Ending of a relationship or marriage •Losing or changing job •Death of a loved one •Developing a serious illness (yourself or a loved one) •Being a victim of a crime •Having an accident •Undergoing a major life change (such as getting married, having a baby, or retiring from a job) •Living through a disaster, such as a fire, flood, or hurricane

•Types of sexual dysfunction

•Erectile disorder •Female orgasmic disorder •Delayed ejaculation •Early ejaculation •Female sexual interest/arousal disorder •Male hypoactive sexual desire disorder •Genito-pelvic pain/penetration disorder •Substance/medication-induced sexual dysfunction

Attention-Deficit/Hyperactivity Disorder (ADHD)

•Excessive motor activity/Inattentiveness, overactivity, impulsiveness; persistent pattern of inattention and/or hyperactivity and impulsivity •Often diagnosed when child starts school •Fidgeting, noisy, disruptive, unable to complete tasks, failure to follow directions, blurting out answers, lost or forgotten homework •Possible ostracize/ridicule by peers Explore childs world before jumping to this diagnosis

Bulimia Nervosa

•Excessive, insatiable appetite •Episodic, uncontrolled, compulsive, rapid ingestion of food-Binging •To rid the body of the excessive calories, individual engages in purging behaviors (self-induced vomiting, or the misuse of laxatives, diuretics, or enemas) •Fasting or excessive exercise may also occur. •Most patients with bulimia are within a normal weight range, some slightly underweight, and some slightly overweight. •Depression, anxiety, and substance abuse are not uncommon. Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalances Bulimia refers to an excessive, insatiable appetite. Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (binging), followed by inappropriate compensatory behaviors to rid the body of the excess calories. The food consumed during a binge often has a high caloric content, a sweet taste, and a soft or smooth texture that can be eaten rapidly, sometimes even without being chewed. The binging episodes often occur in secret and are usually only terminated by abdominal discomfort, sleep, social interruption, or self-induced vomiting. Although the eating binges may bring pleasure while they are occurring, self-degradation, guilt and depressed mood commonly follow.

Blister Agents/Vessicants

•Exposure is topical or by inhalation • •Blistering of skin and mucous membranes is most common sign •Anticipate aggressive airway management •Decontamination- thorough washing of skin Soap & Water Vessicants: blister agent causing severe skin, eye and mucosal pain Progresses over hours- can lead to pneumonia

•Pharmaceutical agents for sleep disturbances (for short-term therapy only)

•Flurazepam (Dalmane) •Temazepam (Restoril) •Triazolam (Halcion) •Zolpidem (Ambien) •Zaleplon (Sonata) •Ramelteon (Rozerem) •Eszopiclone (Lunesta) •Trazodone (Desyrel) •Mirtazapine (Remeron)

•Dissociative identity disorder (DID)

•Formerly called multiple personality disorder •https://youtu.be/HJe0_pPA0x8 •Characterized by the existence of two or more personality states in a single individual •Transition from one personality state to another may be sudden or gradual, and is sometimes quite dramatic Everything about the person changes from one person to another Often starts with a twitch - eye or shoulder, then theres somebody else

Safety for the patient

•Furniture, floor hazards, electrical hazards •Sanitary hazards- always apply barrier between your belongings and surface. Ex: use newspaper under bag on fabric couch. •Best place to put your belongings would be on a surface that is not permeable ex: wood side table or kitchen counter.

Gender Definitions

•Gender identity •Internal Sense of knowing whether one is male or female •Cisgender •Identity that is the same as the gender assigned at birth •Transgender •An individual experiences is not the same between his or her biological/assigned gender and gender identity. •Gender dysphoria •Involves a conflict between a person's physical or assigned gender and the gender with which he/she/they identify

Triage Principles

•Goals of triage -rapid assessment -determination of severity -need for emergency care •Non-disaster triage -most resources for each patient •Disaster triage -maximize resources for the most patients

Narcistic personality disorder con't

•Grandiose sense of self-importance •Lives in a fantasy world that supports their delusions of grandeur •Needs constant praise and admiration •Sense of entitlement •Exploits others without guilt or shame •Frequently demeans, intimidates, bullies, or belittles others •Predisposing factors •As children, fears, failures, or dependency needs were responded to with criticism, disdain, or neglect •Parents were often narcissistic themselves •Parents may have overindulged the child and failed to set limits on inappropriate behavior Several psychodynamic theories exist regarding the predisposition to narcissistic personality disorder. Skodol and Gunderson suggest that, as children, these individuals had their fears, failures, or dependency needs responded to with criticism, disdain, or neglect. They grow up with contempt for these behaviors in themselves and others and are unable to view others as sources of comfort and support. Martinez-Lewi suggests that the parents of individuals with narcissistic personality disorder were often narcissistic themselves. The parents were demanding, perfectionistic, and critical, and they placed unrealistic expectations on the child. Narcissism may also develop from an environment in which parents attempt to live their lives vicariously through their child. They expect the child to achieve the things they did not achieve, possess that which they did not possess, and have life better and easier than they did.

Outcome for clients with eating disorders

•Has achieved and maintained an expected BMI for age with consideration for body build, weight history, and any physiological disturbances •Has vital signs, blood pressure, and laboratory serum studies within normal limits •Verbalizes importance of adequate nutrition • Verbalizes knowledge regarding consequences of fluid loss caused by self-induced vomiting (or laxative/diuretic abuse) and importance of adequate fluid intake (anorexia nervosa, bulimia nervosa) •Verbalizes events that precipitate anxiety and demonstrates techniques for its reduction •Verbalizes ways in which he or she may gain more control of the environment and thereby reduce feelings of powerlessness • Expresses less preoccupation with own appearance (anorexia nervosa, bulimia nervosa) • Demonstrates ability to take control of own life without resorting to maladaptive eating behaviors (anorexia nervosa, bulimia nervosa, binge eating disorder) •Has established a healthy pattern of eating for weight control, and weight loss toward a desired goal is progressing (binge eating disorder) • Verbalizes plans for maintenance of weight control and relapse prevention (binge eating disorder) For client with anorexia nervosa or bulimia •Promote feelings of control •Help client realize perfection is unrealistic For client with BED •Help identify positive attributes •Refer client to a support or therapy group Goals should include verbally acknowledging misperception of body image, and demonstrating an increase in self-esteem, and pursuing weight loss. Interventions include helping the client develop a realistic perception of body image. Promoting feelings of control, have the client recall coping patterns, and determining the client's motivation for developing healthier patterns.

Explosives/Blast Injury

•High mortality rate •Unintentional or intentional •Mechanisms of blast injury -primary -secondary-Injury due to blast - tertiary -quaternary -quinary

Nerve Agents

•Highly toxic systemic effects similar to organophosphate poisoning (pesticide) •V-series and G-series Sarin gas •Exposure results in cholinergic crisis •Antidotes: Atropine (anticholernigic) Pralidoxime/Benzodiazepine Soap & Water 30mins - 18 hours after exposure: visual disturbances, n/v, bradycardia, av block, weakness---- if untreated: lethal s/s LOC, seizure, flaccid muscle and apnea

Treatment Modalities for Sexual Dysfunction - •Sexual Desire Disorders

•Hypoactive sexual desire disorder •Testosterone •Cognitive therapy •Behavioral therapy •Relationship therapy • •Female sexual interest/arousal disorder •Sensation focus exercises

•Most common types of dissociative amnesia

•In localized amnesia, the individual is unable to recall all incidents associated with a stressful period. •In selective amnesia, the individual can recall only certain incidents associated with a stressful event for a specific period after the event. •In the generalized type, the individual has amnesia for his or her identity and total life history. Unable to recall Confused, wandering around •A specific subtype of dissociative amnesia is with dissociative fugue. •Characterized by a sudden, unexpected travel away from customary places or by bewildered wandering, with the inability to recall some or all of one's past •An individual in a fugue state may not be able to recall personal identity and sometimes assumes a new identity.

Severe depression

•Includes symptoms of major depressive disorder and bipolar depression •Affective: Feelings of total despair, worthlessness, flat affect •Behavioral: Psychomotor retardation, curled-up position, absence of communication •Cognitive: Prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal thoughts •Physiological: a general slow-down of the entire body

nursing diagnosis

•Ineffective coping this is a common dx as crisis precipitated when usual coping mechanisms do not work...client needs help finding NEW, EFFECTIVE coping mechanisms •Anxiety this dx occurs b/c anxiety results when usual coping mechanisms do not WORK •Disturbed thought-processes these sx's will occur if client does not get help with crisis and disorganization results •Fear real or perceived threats cause fear •Risk for post-trauma syndrome

Disaster Child Reactions

•Infants- 6 years- crying, fear of separation, regression, difficulty sleeping Accept clinging, hold, cuddle by primary caregiver if possible. Limit exposure to media, coverage of event

Anthrax

•Infectious disease •Exposure-Skin contact, inhalation, GI Ingestion •Signs and symptoms •Treatment S/S: hemmorrhage, edema, necrosis (Common: skin lesions causing vessicles), n/v. abdominal pain,---- death Treatment: Standard Precautions- Not contagious There is a vaccine but only used in Military

Smallpox

•Infectious disease •Signs and symptoms •No cure Contagious (Only after the rash Appears) S/S: increased fever, malaise, headache, backache After 1-2 days rash appears beginning at face, mouth, arms, legs Treatment: ABX- if death occurs- body needs to be cremated due to virus in scabs can last up to 13 years

Dependent Personality Disorder

•Is an anxious personality disorder characterized by an inability to be alone. People with DPD develop symptoms of anxiety when they're not around others. They rely on other people for comfort, reassurance, advice, and support Dependent personality disorder is characterized by lack of self-confidence and extreme reliance on others to take responsibility for them. This mode of behavior is evident in the tendency to allow others to make decisions, to feel helpless when alone, to act submissively, to subordinate needs to others, to tolerate mistreatment by others, to demean oneself to gain acceptance, and to fail to function adequately in situations that require assertive or dominant behavior

Medical Treatment Modalities •Depression

•It is estimated that up to 40 percent of people with AD also suffer from major depression. •Recognizing the symptoms of depression in these individuals is often a challenge. •It is difficult to distinguish from NCD. •Clearly, the existence of depression in the client with NCD complicates and worsens the individual's functioning.

Variations in Sexual Orientation

•LGBTQIA acronym describes range of preferences •Lesbian •Gay •Bisexual •Transgender •Queer •Intersex Asexual •Homosexuality •Same-sex relationships •Bisexuality •Client engages in sexual activity with members of both genders •More common than exclusive homosexuality

Behaviorist Theory

•Learning occurs when an unmet need produces sufficient motivation to satisfy that need •Behaviorist theory •Allow trial & error •Use specific teaching strategies to evoke desired response •Positive Reinforcement promotes learning •Evaluation of learning looks for "Change in Behavior"

Safety for the Nurse

•Leave schedule of visits with main office •Escorts in unsafe neighborhoods •Elevator safety •Dealing with threats •Protecting equipment •Safety Plan •Cell phone with emergency numbers •Let agency know schedule •Know the area •Park near home and Lock car •Don't wear expensive jewelry •Carry agency ID •Schedule visits during the day light •If family member or client is intoxicated, reschedule and leave

Lithium

•Lithium was first identified as an anti-manic but was successful for stabilizing the mood swings of bipolar disorder .As lithium is a salt, anything that depletes sodium will make more receptors sites available and increase the risk for lithium toxicity. •Lithium toxicity •Therapeutic range •1.0-1.5 mEq/L (acute mania) •0.6-1.2 mEq/L (maintenance) •Another generally undesirable side effect of lithium is weight gain. •Ensure that client consumes adequate sodium and fluid in diet.

Epidemiological Statistics

•Living arrangements •The majority of individuals age 65 years or older live alone, with a spouse, or with relatives. •Economic status •More than 4.5 million (10%) individuals age 65 or older were below the poverty level in 2014. •Older women had a higher poverty rate than older men. •Older Hispanic women living alone had highest poverty rate.

Medical Treatment Modalities for Dissociative Amnesia

•Many cases resolve spontaneously when individual is removed from the stressful situation. •For more stubborn conditions, intravenous administration of amobarbital is useful in retrieval of lost memories. •Psychotherapy is used as the primary treatment. •Techniques of persuasion and free association help the client remember. •Hypnosis may be required to mobilize memories. Uncommonly used Give therapy and support

•Childhood disintegrative disorder:

•Marked regression in multiple areas of functioning after 2 years of normal growth and development. Typically includes symptoms of nonspecific anxiety and agitation

Medications to treat ADHD

•Medications (Refer to Table 33-5, page 750): Stimulants •Amphetamines- lisdexamfetamine (Vyvance) •Miscellaneous- methylphenidate (Ritalin) • Amphetamine mixture (Adderall), Antidepressants as second choice Non-stimulant (Selective norepinephrine reuptake inhibitors-SNRI): atomoxetine (Strattera) Antihypertensives Alpha Agonist- clonidine (Catapres), guanfacine (Intuniv) Amphetamine mixture will be on NCLEX - these kids will have weight loss due to the medication because it causes to lose appetite. Know Strattera (antomexetine) is not a stimulant and it takes 2-4 weeks to work. Stimulants start to work in 1 hour.

Interventions/Treatments

•Milieu Therapy/Safe Environment •Risk for Suicide •Group Therapy •Family Therapy •Cognitive Therapy

Bipolar and Related Disorders

•Mood Swings from profound depression to extreme euphoria (mania). •Bipolar I Disorder •Bipolar II Disorder •Cyclothymic Disorder

Man made disasters

•Multi vehicle collisions •Hazardous materials •Chemical, biological, radiological, nuclear, explosive incidents

•Rett's disorder:

•Multiple deficits after period of normal functioning; almost exclusively in girls

Similarities in Hospital & Home Care

•Multiple health care providers •Acute care provided: IV therapy (PICC, Central Venous catheters, implanted ports), PCA complex dressings, wound vacs, tubes (nephrostomy, hemovacs, pleurevacs, tracheotomies) •Must adhere to IV surgical asepsis principles in both settings

Neurocognitive Disorder

•Neurocognitive •A term that is used to describe cognitive functions closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning, and speaking •Neurocognitive disorder (NCD) •Impairment in the cognitive functions of thinking, reasoning, memory, learning, and speaking • •Great assessment for neurocognitive disorder • Box 22-3 pg 375-377 •Neurocognitive disorder (NCD) classified as mild or major •Mild NCD has also been called mild cognitive impairment. AKA Dementia •A disease process in which there is progressive decline in cognitive ability in the presence of clear consciousness •Involves many cognitive deficits and significantly impairs social and occupational functioning •Reversible NCD may be more appropriately termed temporary dementia. •It can occur as a result of •Stroke •Depression •Side effects of medications •Nutritional deficiencies •Metabolic disorders •Cerebral lesions •Vit deficiency - b12 or folate •Impairment is evident in abstract thinking, judgment, and impulse control. •Social conduct are often disregarded. •Behavior may be uninhibited and inappropriate. •Personal appearance and hygiene are often neglected. •Language may or may not be affected. •Personality change is common.

Neurocognitive disorders

•Neurocognitive disorders include those in which a clinically significant deficit in cognition or memory exists, representing a significant change from a previous level of functioning •Delirium is a mental state characterized by an acute disturbance of cognition, manifested by short-term confusion, excitement, disorientation, and clouded consciousness •Hallucinations and illusions are common

Psychopharmacological Intervention for ASD

•No medications to treat core symptoms. •Two medications approved for tx of irritability associated with ASD •1) risperidone- (atypical antipsychotic) ages 5-16 yrs. old •2) aripiprazole-6-17 yrs. old Foucses on aggression, self harm and temper tantrums Most common side effects - drowsiness or sedation, weight gain, more appetite, nasal congestion, fatigue, constipation and drooling May also have hyperglycemia

Nursing Care

•Nursing care of the aging individual •Protection from injury caused by age-related physical changes or altered thought processes related •The nurse is also concerned with preserving dignity and self-esteem. •Assistance is provided with self-care deficits while encouraging independence. •Reminiscence therapy is encouraged.

Obsessive-Compulsive Disorder

•Obsessions •Recurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning •Compulsions •Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation •The behaviors or mental acts are aimed at preventing or reducing anxiety or distress

Mastitis

•Onset 1 week or > after birth •Cracked/fissured nipples common entry point •Usually unilateral •Swollen & reddened breast with fever •Breastfeeding may continue •Antibiotics: dicloxacillin & cephalosporins •May resolve in 2 - 3 days

•NCD due to Alzheimers Disease (AD)

•Onset is slow and insidious •Course of the disorder is generally progressive and deteriorating •Memory impairment is an early and prominent feature

Paranoid personality disorder

•Paranoid personality disorder •Characterized by a pervasive, persistent, and inappropriate mistrust of others •Individuals with this disorder are suspicious of others' motives and assume that others intend to exploit, harm, or deceive them. •The disorder is more common in men than in women. Individuals with paranoid personality disorder are constantly on guard, hypervigilant, and ready for any real or imagined threat. They appear tense and irritable. They have developed a hard exterior and become immune or insensitive to the feelings of others. They always feel that others are there to take advantage of them. They are extremely oversensitive and tend to misinterpret and distort even minute cues within the environment into thoughts of trickery and deception. Because they trust no one, they are constantly "testing" the honesty of others. Clinical picture •Constantly on guard •Hypervigilant •Ready for any real or imagined threat •Trusts no one •Constantly tests the honesty of others •Insensitive to the feelings of others •Oversensitive •Tends to misinterpret minute cues •Magnifies and distorts cues in the environment •Does not accept responsibility for his or her own behavior •Attributes shortcomings to others Individuals with paranoid personality disorder do not accept responsibility for their own behaviors and project this responsibility on to others. They are envious and hostile toward others who are highly successful and believe the only reason they are not as successful is because they have been treated unfairly. People who are paranoid are extremely vulnerable and constantly on the defensive. The desire for reprisal and vindication is so intense that a possible loss of control can result in aggression and violence. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia than among control subjects. Psychological predisposing factors, as is the case with many personality disorders, include a history of childhood trauma including neglect. People with paranoid personality disorder may have been subjected to parental antagonism and harassment. They learned to perceive the world as harsh and unkind, a place calling for protective vigilance and mistrust. Individuals with paranoid personality disorder are constantly on guard, hypervigilant, and ready for any real or imagined threat. They appear tense and irritable. They have developed a hard exterior and become immune or insensitive to the feelings of others. They avoid interactions with other people lest they be forced to relinquish some of their own power. They always feel that others plan to take advantage of them. They are extremely oversensitive and tend to misinterpret even minute cues within the environment, magnifying and distorting them into thoughts of trickery and deception. Because they trust no one, they are constantly "testing" the honesty of others. Their intimidating manner provokes exasperation and anger in almost everyone with whom they come in contact. Individuals with paranoid personality disorder maintain their self-esteem by attributing their shortcomings to others. They do not accept responsibility for their own behaviors and feelings and project this responsibility onto others. They are envious and hostile toward those who are highly successful and believe the only reason they are not as successful is because they have been treated unfairly. People who are paranoid are extremely vulnerable and constantly on the defensive. Any real or imagined threat can release hostility and anger fueled by animosities from the past. The desire for reprisal and vindication is so intense that a possible loss of control can result in aggression and violence. These outbursts are usually brief, and the paranoid person soon regains the external control, rationalizes the behavior, and reconstructs the defenses central to his or her personality pattern.

Personality Disorders- (Ch. 32)

•Personality traits may be defined as characteristics with which an individual is born or develops early in life. They influence the way he or she perceives and relates to the environment and remain stable over time. •Personality disorders occur when these traits deviate markedly from the expectations of the individual's culture, become rigid and inflexible, contribute to maladaptive patterns of behavior or impairment in functioning, and lead to distress All personality disorders share characteristics of inflexibility and difficulties in interpersonal relationships that impair social or occupational functioning. that an individual can behave irrationally even when the powers of intellect are intact.

Special Concerns of Elderly People - •Suicide

•Persons 65 years of age and older represent a disproportionately high percentage of individuals who commit suicide. •The highest number of suicides (19.3 percent) occurred among those 85 years of age and older. •The group at highest risk appears to be white men experiencing loneliness, financial problems, physical illness, loss, and/or depression.

Autism Spectrum Disorder (ASD)

•Pervasive, usually severe impairment of reciprocal social interaction skills, communication deviance, restricted stereotypical behavioral patterns •Autism spectrum disorders •Autism (classic autism) •Rett's disorder •Childhood disintegrative disorder •Asperger's disorder Have trouble communicating and looking at people in the eye It varies from child to child. Has a lot of fantasy These kids are very restricted to the activities they like or only 1 or 2 things. •Present by early childhood;5 times more with boys than girls •Little eye contact, few facial expressions, limited gestures to communicate, limited capacity to relate to peers or parents, lack of spontaneous enjoyment, apparent absence of mood and affect, inability to engage in play or make-believe with toys, little intelligible speech, stereotyped motor behaviors (hand flapping, body twisting, head banging) •Genetic link; controversy with MMR vaccine •Tendency to improve; traits persist into adulthood •Goals: reduce behavioral symptoms, promote learning and development •Special education, language therapy; medications for target symptoms

Medical Treatment Modalities - NCD

•Pharmaceutical agents for cognitive impairment. Hopefully these drugs will help with memory, and the ability to continue to do ADL's •Physostigmine (Antilirium) •Tacrine (Cognex) •Donepezil (Aricept) •Rivastigmine (Exelon) can be patches •Galantamine (Razadyne) Memantine (Namenda) •Antipsychotics for agitation, aggression, hallucinations, thought disturbances, and wandering. •Risperidone (Risperdal) •Olanzapine (Zyprexa) •Quetiapine (Seroquel) •Ziprasidone (Geodon) −These drugs cause fewer anticholinergic and extrapyramidal side effects (EPS) than do older antipsychotics. −They carry a black box warning that all atypical antipsychotics are associated with an increased risk of death in elderly patients with dementia.

Post-Traumatic Stress Disorder (PTSD)

•Post-traumatic stress disorder (PTSD) is a reaction • to an extreme trauma, which is likely to cause • extreme distress to almost anyone •Causes such as natural or manmade disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, • or other crimes can cause the reaction •May begin within the first 3 months after the trauma •May be a delay of several months or even years

C-section, post-op

•Postop assessment & management: same as abdominal surgery pts PLUS: •Reproductive assessment •Lochia •IV pain management

Trauma-and Stressor-Related Disorders (Ch. 28)

•Posttraumatic Stress Disorder •Acute Stress Disorder •Adjustment Disorder

•NCD due to Prion disease

•Prion disease is a group of disorders caused by infectious agents called prions, characterized by its insidious onset and rapid progression. •Manifestations include problems with coordination and other movement disturbances along with rapidly progressing dementia. •Five to 15 percent of cases of prion disease have a genetic component. •Symptoms may develop at any age in adults, but typically occur between 40 and 60 years. •Clinical course is extremely rapid, with the progression from diagnosis to death in less than two years. •Most common form of prion disease in humans is Cruetzfeldt-Jakobs disease

Clinical Manifestations - anorexia

•Prolong loss of appetite •Dehydration/Malnutrition leading to: •Hypothermia - no body fat for insulation •Bradycardia •Hypotension •Peripheral edema- low albumin levels (albumin holds fluid in) •Lanugo - fine hair •Amenorrhea - absence of menses •Obsessed with food - •Electrolyte Imbalances - potassium levels below 3 leads to cardiac arythmias •Dehydration/Malnutrition Elevated BUN Malnutrition: Twenty percent below expected weight for height recommended for inpatient treatment; 30 percent below expected weight for height recommended for long-term intensive treatment (Sadock et al., 2015) Dehydration: Assessment includes thirst, orthostatic hypotension, tachycardia, elevated sodium levels, and other symptoms Severe bradycardia: Below 50 beats per minute Hypothermia: Body temperature below 96.8 Hypotension: A pattern of low blood pressure or orthostatic hypotension (20 mm Hg or greater drop in systolic blood pressure with positional changes and pulse rate increase by 20 or more beats) Suicidal ideation (see Chapter 17, Suicide Prevention, for an in-depth discussion of suicide risk assessment)Weight loss is excessive. For example, the individual may present for healthcare services weighing less than 85 percent of expected weight. Other symptoms include hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, lanugo (fine, neonatal-like hair growth), and a variety of metabolic changes. Amenorrhea (absence of menstruation) usually follows weight loss, but sometimes it happens early on in the disorder, even before severe weight loss has occurred. Individuals with anorexia nervosa may be obsessed with food. For example, they may hoard or conceal food, talk about food and recipes at great length, or prepare elaborate meals for others, only to restrict themselves to a limited amount of low-calorie food intake. Compulsive behaviors, such as hand washing, may also be present. Severe electrolyte imbalance: Potassium levels below 3 mmol/L, phosphate levels below 3 mg/dL, magnesium levels below 1.4 mEq/L Cardiac arrhythmia: ST segment and T wave changes usually related to electrolyte imbalances Age at onset is usually early to late adolescence and psychosexual development is often delayed. Feelings of depression and anxiety often accompany the disorder.

Interdisciplinary Treatment Team

•Psychiatrist •Psychologist •Mental Health Technician (MTH) •Social Worker •Occupational Therapist •Recreational Therapist

Triage Categories

•RED- airway obstruction, shock, tension pneumothorax, unstable chest/abdominal wounds, incomplete amputations, open long bone fx, 2-3 degree burns to 15-40% BSA •YELLOW- stable abdominal wounds without hemmorrhage, soft tissue injury, fx requiring ORIF, vascular injuries with adequate circulation •GREEN- upper extremity fx, minor burns, sprains, lacerations, behavioral or psychological disturbances •BLACK- unresponsive wit penetrating head wounds, high spinal chord injuries, wounds with multiple sites and organs, 2-3 degree burns >60% BSA, pupils fixed, dilated, cheyne stokes breathing

Clinical Manifestations (PTSD)

•Re-experiencing the traumatic event/flashbacks •Sustained high level of anxiety or arousal •General numbing of responsiveness •Intrusive recollections or nightmares •Amnesia to certain aspects of the trauma •Depression •Survivor's guilt •Substance abuse •Anger and aggression •Relationship problems Stay with client and reassure safety during a flashback General numbing- staring off into space May have thoughts of hurting themselves

Decontamination

•Recognition of unusual substance •Containment of harmful substances •Elimination of harmful substances from skin, hair, mucosa, GI tract •Pt go from dirty to clean •Decontamination zones -hot zone -warm zone -cold zone 1- Remove Clothes 2- Soap & Water- wash and rinse

Management of breast feeding

•Reinforce advantages for mom & newborn •Breast care •Preventing/managing cracked nipples •Infant Positioning techniques next 4 slides •Contraindications breast cancer, HIV +, some meds

Special Concerns of Elderly People

•Retirement •Social implications •Economic implications

Ethical And Legal Issues

•Right to Refuse Medications, treatments •Right to the least restrictive treatment •Receipt of unopened mail •Visits by health care providers, attorney, clergy •Daily interaction with visitors/phone access •Right to make wills and contracts •Right to sue, or be sued, including challenging one's hospitalization

Planning and Implementation

•Risk for trauma •Because the individual has impairments in cognitive and psychomotor functioning, it is important to ensure that the environment is as safe as possible to prevent injury. •NANDA defines Risk for Trauma as "vulnerable to accidental tissue injury which may compromise health." •Disturbed thought processes/impaired memory and disturbed sensory perception •Short-term goals •Client will utilize measures provided to maintain reality orientation. •Client will experience fewer episodes of acute confusion. •Long-term goal •Client will maintain reality orientation to the best of his or her cognitive ability. •Interventions Interventions to keep safe and reality orient: Keep them close to nurse station Calendar Clock To-do list Care taker names on board

Disaster, Child 11 and older

•Risk taking or fear of leaving home •Increased irritability arguments •Peers are very important •May want help to explore feelings from school

Medical Treatment Modalities - •Delirium

•Room with low stimulus level •Lose dose antipsychotic - halidol, lorazepam •Guided imagery •Low-dose antipsychotic agents to relieve agitation and aggression. •Benzodiazepines commonly used when cause is substance withdrawal.

C-Section, pre-op

•Routine Pre-op teaching • •Sodium Citrate (Bicitra) or metrocholpromide (Reglan) or an H2 blocker • •LR 1 liter IV bolus pre epidural or spinal

Disaster, Child 7-10

•Sadness or anger, fear it will happen again, decreased attention, concentration •Explain what happened, answer questions •Help child express emotions- drawing, storytelling play. •Explain crying, anger, sadness are normal

Schizophreniform Disorder

•Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months.

•Pharmaceutical agents for depression

•Selective serotonin reuptake inhibitors •Often considered first-line due to favorable side effect profile •Tricyclic antidepressants •Often avoided due to anticholinergic and cardiac side effects •Trazodone (Desyrel) •Good choice for clients with insomnia •Dopaminergic agents •Helpful in treatment of severe apathy (lack of feeling, emotion, or interest)

Treatment Modalities for Sexual Dysfunction - •Erectile disorder (ED)

•Sensation focus exercises •Group therapy •Hypnotherapy •Testosterone, yohimbine •Sildenafil, tadalafil, vardenafil •Penile implantation

Some Predisposing Factors to Sexual Dysfunctions

•Sexual pain disorders •In women •Intact hymen •Episiotomy scar •Vaginal or urinar tract infection •Ligament injuries •Endometriosis •Ovarian cysts or tumors −In men Infections Phimosis Prostate problems

Goal for a client with Anorexia nervosa or Bulimia

•Short-term goals The client will gain ___ pounds per week (amount to be established by client, nurse, and dietitian). The client will drink 125 mL of fluid each hour during waking hours. •Long-term goal By time of discharge from treatment, the client will exhibit no signs or symptoms of malnutrition or dehydration. The client will gain up to 80% of body weight for age and size

•Asperger's disorder

•Similar to autism disorder; no language or cognitive delays; motor clumsiness is common; occurs more frequently in boys

Radiological Weapons

•Simple radiological device •Radiological dispersal device "dirty bomb"-conventional bomb (dynamite) •Reactor attack or malfunction •Improvised nuclear device

The Normal Aging Process

•Skin (wrinkles L ) •Cardiovascular system •Respiratory system •Musculoskeletal system •Gastrointestinal system •Endocrine system •Genitourinary system •Immune system •Nervous system •Sensory system Biological aspects of aging include observable changes

•Sleep disturbances

•Sleep problems are common in clients with NCD and often intensify as the disease progresses. •Wakefulness and nighttime wandering create much distress and anguish in family members who are charged with protection of their loved one. •Sleep disturbances are among the problems that most frequently initiate the need for client placement in a long-term care facility.

•Progressive symptoms of Alzheimer disease (AD) is described according to stages.

•Stage 1: No apparent symptoms, changes starting to occur •Stage 2: Forgetfulness •mom looks at me and wont know my name •Stage 3: Mild cognitive decline •Interference at work •Gets lost when driving a car •Stage 4: Mild-to-moderate cognitive decline •Forgets a lot of major events in their history •They can tell you a whole story and completely forget and start making things up •Stage 5: Moderate cognitive decline •Lose ability to perform some ADLs independently •May become disoriented about place and time •Stage 6: Moderate-to-severe cognitive decline - long term care •Unable to recall major life events •May not recall spouses name •Sleeping becomes a problem •Stage 7: Severe cognitive decline •Bedfast •Aphasic Trouble moving

Some Predisposing Factors

•Substance-induced NCD •NCD can occur as the result of substance reactions, overuse, or abuse. •Alcohol, sedatives, hypnotics, anxiolytics, and inhalants •Drugs that cause anticholinergic side effects •Toxins, such as lead and mercury they sober up and the symptoms continue

Risk Factors For Suicide

•Suicide rates •For single, never-married persons is twice that for married persons •Divorce increases risk for suicide particularly among men, who are three times more likely to take their own lives than are divorced women •Evidence supported that divorced men are twice as likely to die by suicide than married men. •Widows and widowers have also been identified at higher risk. •Age •Risk of suicide increases with age, particularly among men. •Highest rate of suicide •Occurred in the 45- to 64-year-old age group •Among those 85 or older •Most common method of completed suicide •For adolescent males is firearms •For adolescent females, it is suffocation •Socioeconomic status •Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class. •Occupation suicide rates are higher among physicians, artists, dentists, law enforcement officers, lawyers, and insurance agents. •More suicides among the unemployed than among the employed. •Individuals hospitalized for a psychiatric illness have a five to ten times greater suicide risk than those with psychiatric illness in the general population. •Suicide risk may increase early in treatment with antidepressants. •Schizophrenia, bipolar disorders, personality disorders, eating disorders, anxiety disorders, and substance use disorders. •Severe insomnia is associated with increased risk of suicide. •Use of alcohol and barbiturates •Psychosis with command hallucinations •Affliction with a chronic, painful, or disabling illness •Studies indicated a higher risk factor for suicide among gay men, lesbians, and transgender (LGBT) individuals •Higher risk is also associated with a family history of suicide •Loss of a loved one through death or separation •Lack of employment or increased financial burden •41 percent of youth are victims of physical bullying (most often boys). •17 percent are victims of cyberbullying. •Girls are more likely to be victims of psychological bullying. •Ideation •Substance abuse •Purposelessness •Anxiety Trapped •Hopelessness •Withdrawal •Anger •Recklessness •Mood Changes

Gender Dysphoria in Children

•Symptomatology •Some children may resist wearing clothing or playing with toys that are typical for their assigned genders. •This is often part of normal childhood behavior unless the behaviors persist into later childhood and adolescence, they may indicate a stable gender identity. •Gender dysphoria is not diagnosed unless symptoms of distress emerge. •Distress with gender identity, depression related to desire to be opposite gender, disgust with one's own genitals, or fear and anxiety related to others learning about their gender identity.

Moderate depression

•Symptoms associated with dysthymic disorder •Affective: Helpless, powerless •Behavioral: Slowed physical movements, slumped posture, limited verbalization •Cognitive: Retarded thinking processes, difficulty with concentration •Physiological: Anorexia or overeating, sleep disturbance, headaches

Transient depression

•Symptoms at this level of the continuum are not necessarily dysfunctional •Affective: The "blues" •Behavioral: Some crying •Cognitive: Some difficulty getting mind off of one's disappointment •Physiological: Feeling tired and listless

Schizotypal personality disorder - symptoms

•Symptoms include •Magical thinking •Ideas of reference •Illusions •Depersonalization •Superstitiousness •Withdrawal into self •Believe they have clairvoyant abilities and sixth sense Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. They often talk or gesture to themselves, as if "living in their own world." Magical thinking (is the belief that one's own thoughts, wishes, or desires can influence the external world. It is common in very young children. A four-year-old child, for example, might believe that after wishing for a pony, one will appear at his or her house, ) ideas of reference,(An idea of reference—sometimes called a delusion of reference—is the false belief that irrelevant occurrences or details in the world relate directly to oneself. For example, a person shopping in a store might see two strangers laughing and believe that they are laughing at him or her when in reality the other two people do not even notice the person. illusions,(For example, a child who perceives tree branches at night as if they are goblins may be said to be having an illusion.) and depersonalization Depersonalization disorder is marked by periods of feeling disconnected or detached from one's body and thoughts (depersonalization). The disorder is sometimes described as feeling like you are observing yourself from outside your body or like being in a dream) are common. Examples include superstitiousness, belief in clairvoyance, (he supposed faculty of perceiving things or events in the future or beyond normal sensory contact. "she stared at the card as if she could contact its writer by clairvoyance" telepathy, or "sixth sense;" and beliefs that "others can feel my feelings."

•Anxiety

•The progressive loss of mental functioning is a significant source of anxiety in the early stages of NCD. •It is important that clients be encouraged to verbalize their feelings and fears associated with this loss. These interventions may be useful in reducing the anxiety of clients with NCD •Benzodiazapines for anxiety (should not be used routinely for prolonged periods) •Chlordiazepoxide (Librium) •Alprazolam (Xanax) •Lorazepam (Ativan) •Oxazepam (Serax) Diazepam (Valium)

Suicide

•The second-leading cause of death (behind unintentional injuries) among young Americans ages 10 to 34 years •The fourth-leading cause of death for ages 35 to 54 •The eighth-leading cause of death for individuals age 55 to 64 •The tenth-leading cause of death overall •Gunshot wounds are the leading cause of death among suicide victims.

Sexual Disorders: Paraphilic Disorders

•The term "paraphilia" is used to identify repetitive or preferred sexual fantasies or behaviors that involve: •Nonhuman objects •Suffering or humiliation of oneself or one's partner •Nonconsenting persons •Paraphilia is only labeled a paraphilic disorder: •When specific types of sexual fantasies or behaviors are recurrent over a period of at least 6 months •It causes the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning

Ricin

•Toxic poison- interferes with cellular protein synthesis (cell death) •Oral or parenteral routes of exposure •s/s dependent on route of exposure From Castor Beans s/s Inhalation: 4-8 hours after exposure, repiratory distress, fever, cough, nausea, heavy sweating, waste eyes s/s ingestion: vomiting, diarrhea, severe dehydration Treatment: NO ANTIDOTE, activated charcoal, intubates,

Gender Dysphoria in Adolescents or Adults (cont'd) - treatment

•Treatment issues •There is evidence that the longer people live with gender dysphoria before seeking treatment, the greater likelihood of suicide attempts and completions. •Some seek therapy to learn how to cope with altered sexual identity. •Some desire hormonal therapy and surgical gender reassignment. •Extensive psychological testing and counseling •Live in the role of the desired gender for 2 years •Hormonal therapy

Gender Dysphoria in Children - treatment

•Treatment must be a matter of personal choice. •Issues with depression, anxiety, social isolation, anger, self-esteem, and parental conflict must be addressed. •Children who demonstrate gender nonconforming behaviors are often targets of bullying and violence. •Nurses can play a key role in educating families and providing support to identify safe, supportive peer groups for these children.

Treatment-Psychopharmacology

•Tricyclic (TCA) •Amitriptyline (Elavil) • Monoamine oxidase Inhibitors (MAOIs) •Isocarboxazid (Marplan) •Selective serotonin reuptake inhibitors (SSRIs) •Citalopram (Celexa) •Atypical Antidepressants •Bupropion (Wellbutrin) •Seratonin Norepinephrine Inhibitors (SNRIs) •Duloxetine (Cymbalta)

•Psychopharmacology (cont.) •Action

•Typicals: Block dopamine receptors in the limbic system (but also blocks receptors outside the limbic system causing major side effects-most specifically muscarinic) •Atypicals:-works on both dopamine AND serotinin (side effects not so severe)

Sexual Dysfunctions

•Usually occur as a problem in one of the following phases of the sexual response cycle •Phase I: Desire •Phase II: Excitement •Phase III: Orgasm •Phase IV: Resolution Know that if a patient has an erectile disorder let them know that it is either medication or street drug that cause that.

Medical Treatment Modalities for Depersonalization-Derealization Disorder

•Various psychiatric medications have been tried. •Antidepressants, mood stabilizers, anticonvulsants, and antipsychotics •Hypnotherapy •CBT (Cognitive Behavioral Therapy)

Clinical Manifestations - bulimia

•Weight fluctuations •Erosion of tooth enamel •Gastric/Esophageal mucosa •Calluses (Russell's Sign) •Substance Abuse - b/c of guilt •Electrolyte Imbalances - low potassium Cardiac Dysthymias To rid the body of the excessive calories, the individual may engage in purging behaviors such as self-induced vomiting, or the misuse of laxatives, diuretics, or enemas. Other inappropriate compensatory behaviors include fasting or excessive exercise. There is a persistent overconcern with personal appearance, particularly regarding how they believe others perceive them. Weight fluctuations are common because of the alternating binges and fasts. Gastric acid in the vomitus also contributes to the erosion of tooth enamel. In rare instances, the individual may experience tears in the gastric or esophageal mucosa. Some individuals develop calluses on the dorsal surface of their hands, typically on knuckles. This feature is called Russell's Sign after the British psychiatrist who first described it.

Secondary NCDs

•are caused by or related to another disease or condition, such as human immunodeficiency virus (HIV) disease or a cerebral trauma or syphilis

Primary NCDs

•are those such as Alzheimer's Disease (AD), in which the NCD itself is the major sign of an organic brain disease not directly related to any other organic illness

Nuclear Explosion Priorities

•irradiated patients • •Contaminated patients -staff protection -define dirty and clean zones -decontaminate with soap and water

Cluster B - Antisocial personality disorder

•sometimes called sociopathy, •is a mental disorder in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. • People with antisocial personality disorder tend to antagonize, manipulate or treat others harshly or with callous indifference. • They show no guilt or remorse for their behavior. •Show signs of irritability and aggression

Medication Options

-Nitris oxide first, least invasive. Given by inhalation, given by mom. -IV pain meds, narcotics. One used most frequently is Nalbuphine, IV push. This is nubain. 10-20mg IV push. Has parameters, crosses the placenta. This makes you feel sleepy so won't give if >8cm because don't want to birth a sleepy baby. Nubain works by raising the mothers pain threshold. -Epidural, pain receptors gone so don't feel contractions. Make partner leave for mom to get epidural. Need to take BP every 15 minutes, baby has to be monitored continuously. Mom has to stay in bed. Her fluids have to be changed to LR because her BP drops way down and we need a volume expander to bring her BP back up. Have to have a catheter, she can't feel her bladder get full and a baby won't go past a full bladder. Mom needs to be repositioned every 2 hours to keep pressure on cervix to dilate. Difficult to push, need to help.

Administering Meds to Kids

-No SL drugs if < school-age -Oral tablets: 9 yrs old or > -Oral liquids: use medicine dropper, oral syringe, med cup (no supine position) -Intranasal/Ophthalmic: < 6yrs- restrain? -Rectal: suppository form often given to infants & toddlers d/t better absorption -No IM's in ventrogluteal site if < 1 year Suggest: vastas lateralis up to school age

Rheumatic Heart Disease, Assessment

-Nose bleeds, chest pain and palpitations, paroximal nocturnal dypsia (waking from sleep with the need to sit or stand up), abdominal pain

Postpartum infection, endometritis

-Once ruptured bacteria has a direct line to the endometrium -Make sure to do sterile cervical checks

How to prevent post-partum infection

-Pad changes -Linen changes -Diet high in iron -Possibly may need antibiotics (IV) First thing we see is a fever greater than 100.4

Psychological Adaptation, 3rd Trimester

-Preparation, ready for it to be done. Worried about birth and the baby. Teaching should be done at this time. -Task is preparing for parenthood.

Toddler Response to Health Care Environment, Response

-Protest better, louder, stronger than infants! -Regression -No understanding of time

Female Infant Findings

-Pseudomenstruation, due to maternal hormones -May have swollen vulva, labia majora should cover labia minora.

Prolapsed cord, management

-Put mom in trendelenburg, gravity brings baby off the cord -Have mom on a monitor and listen for FHR -Put hand in and push baby head up off the cord, leave your hand there until delivery

Maternal Adaptation to pregnancy, musculoskeletal system

-Relaxin makes all joints really lose and lubricated. Makes you feel arthritic and achy. -Center of gravity changes. This can cause a woman to develop a backache. -Diastesis recti

Postpartum infection, peritonitis

-Rigid abdomen -S/S similar to a paralytic ileus (complication of endometritis)

Who is most at risk for post-partum infection

-Rupture of membrane for more than 24 hours -Those who have had a retained placenta -Post-partum hemorrhage -Instruments used during labor or prolonged labor -Internal fetal heart monitoring

Psychological Adaptation, 2nd Trimester

-See the baby as a separate person. You have quickening at 16weeks, fetal movements. -Task is accepting the baby.

Preschool Response to Health Care Environment, Response

-Separation anxiety (cries loudly if scared of tx's) -Fear of injury & the dark -Fear of mutilation -Magical thinking -Limited concept of time

First Void

-Should have first void in 24 hours, many void at birth -Should have light yellow, odorless urine. -Should have 6-8 wet diapers per day

Phase I The Premorbid Phase

-Social maladjustment -Antagonistic thoughts and behavior -Shy and withdrawn -Poor peer relationships -Doing poorly in school -Antisocial behavior

School Age Response to Health Care Environment, Response

-Some separation concerns, fear of injury -Like to be in control -Tend to dawdle

Late Hemorrhage, causes

-Subinvolution -Uterus doesn't shrink back to it's normal size -Infection -Retained placental fragments -This can be 6 weeks out and still bleeding heavily, treat with a D&C to scrape out the fragments -First we need to assess, then massage the fundus - stay with the patient. Check for a full bladder, while palpating check for clots coming out. Vitals every 5 minutes. Oxygen. Legs up to increase venous return.

Rheumatic Heart Disease, Pathophysiology

-Systemic heart disease that occurs in response to Group A beta-hemolytic strep -Left untreated or partially treated spreads to bloodstream and can lead to bacterial or fungal clumps that can travel to heart, brain, lungs, kidneys. Damage to heart valve ensues. -Antibodies are produced and lesions happen in joints -Disease is familial -Occurs in children between 5-15 years of age in lower socioeconomic situations. Prevalent in winter and spring.

Fetal HR Patterns

-Tachycardia: >160 -Bradycardia: <110 -Variable: HR changes from beat to beat. If minimal variability baby could be sleeping, sleep in 20 minute increments. -Accelerations: want baby HR to increase with movement, these are good

VItal Sign Changes

-Temp can be normal, can be up to 100.4 within first 24 hours after birth. However, anything above 100.4 is considered febrile. -Pulse should be normal -BP, watch for hypotension or hypertension due to bloodloss -Pre-eclampsia, hypertension is a sign of this. Still a concern for 24-48 hours within birth.

Psychological Adaptation, 1st Trimester

-Tend to be very self-focused and most women will fluctuate between disbelief and ambivalence because it's such a big role change. Mom is coming to grips with this big life change. -Task is accepting the pregnancy.

Postpartum Psychosis

-This is one of the psychotic breakdown -Usually see a mom having halucinations/delusions of harming the child -Mom could harm the baby

Kawasaki, tests

-Through exclusion because it mimics scarlet fever -High WBC, lymphocytosis, thrombocytosis, high fever not resolved by antibiotics or antipyretics -Coronary artery aneurism, need a baseline echo and again at 6-8 weeks after onset of symptoms

Infant Response to Health Care Environment, Promote Adaptation

-Trust (Erikson) -Parents room in -Anticipate needs -Swaddle -Allow sucking -Quiet, soothing voice & environment -If stranger anxiety, assign consistent RN's

Maternal Adaptation to pregnancy, Urinary tract

-Urinating a lot during 1st and 3rd trimesters. During the 1st this is because uterus is congested with blood and puts pressure on the bladder. 3rd trimester is because the baby head is putting pressure on the bladder.

CL & CP, Pre-Op

-Use a special bottle with soft, elongated nipple -Breast is good, can help to form a good seal -Feed upright due to aspiration risk, may need a g-tube -Elbow restraints, this is so baby gets used to them because they are required post-op

Hemophilia, caregiver education

-Use helmet -medical alert tag -Avoid contact sports -anticipate prohylaxis, periodic replacment of factor 8 -Avoid injury -refer to community resources -anticipate how this will affect family dynamics

Early hemorrhage, causes

-Uterine atony (the most common) -Trauma causing lacerations (cervical lacerations from delivery) -Any slow trickle or gushing can be indicative of laceration. This may require packing to help stop the bleeding -Uterine rupture or inversion. Important to support the uterus when palpating the fundus. -Hematomas -Visualize and mark, similar to marking a dressing for shadowing. -Mark using a surgical marker. -Can range from 2-8cm -Ecchymosis with significant increase with perineal pain or pressure between legs, think hematoma

Maternal Adaptation to pregnancy, Reproductive system

-Uterus enlarges -You cease ovulation. The uterus is usually the size of a tight fist, 2x4 typically and 10x14 at term. Normally the uterus is able to accommodate 10ml of blood, at the end of pregnancy can accommodate 5L of blood -Blood flow to uterus is 15-20ml/min and at term is 750ml/min -Breasts are creating colostrum

Passageway

-Want a stretchy vagina with a lot of rugae; allows it to expand and then go back -Entroitus: the opening of the vagina. Worry about tearing. Episotomy, these aren't done anymore. Warm compress and lots of amniotic fluid/mucous that comes out helps prevent tearing.

Infant Response to Health Care Environment, Reponse

-Will show some distress @ 4 months if caregiver leaves -> distress with onset of stranger anxiety 8 months

Which of the following instructions should the nurse include in a teaching session about panic disorder for clients and their families? 1.Identifying when anxiety is escalating. 2.Determining how to stop a panic attack. 3.Addressing strategies to reduce physical pain. 4.Preventing the client from depending on others.

1

Which of the following nursing interventions is given priority in a care plan for a person having a panic attack? 1.Instruct the client to take deep breaths. 2.Have the client talk about the anxiety. 3.Encourage the client to verbalize feelings. 4.Ask the client about the cause of the attack .

1

Interventions/Treatments

1)Electroconvulsive Therapy (ECT) 2)Transcranial Magnetic Stimulation(TMS) 3)Light Therapy

CNS Stimulants

1. Amphetamines 2. Non-amphetamines 3. Cocaine 4. Caffeine 5. Nicotine Amphetamine and methamphetamine were particularly popular in most major forces of World War II, used to prevent fatigue. Increased behavioral stimulation and psychomotor agitation Amphetamines-dexedrine, desoxxyn ( methamphetamine) Non -Ritalin, Provigil, Meridia Two most widely used are caffeine and nicotine Original prescribed was for wt control

Things that affect labor

1. Passenger: the baby. Their head is the biggest. Head can mold because of unfused sutures and fontanel's. Anterior fontanel is diamond and posterior is triangle shape. Capit is modling, crosses the suture line Cephalohematoma doesn't cross the suture line 2. Passageway 3. Powers 4. Position 5. Psyche

3 Immediate Interventions

1. Promote circulatory homeostasis 2. Promote respiratory homeostasis 3. Promote thermoregulatory homeostasis -These are the 3 most important things for Maslow's hierarchy of needs. -These are all done within the first hour of birth

Risk Factors for elder Abuse

1.Decreased Physical Health and Mobility 2.Declining Mental Status 3.Social Isolation 4.Web of Dependency 5.Caregiver Stress 6.Impairment of Either Caregiver or Elder 7.Substance Abuse

Cardinal movements

1.Descent 2.Flexion 3.Internal rotation 4.Extension 5.External rotation 6.Restitution 7.Expulsion

inhalants

1.Fuel 2.Solvents 3.Adhesives 4.Aerosol propellants 5.Paint thinners Examples-Gasoline, varnish, glue, cleaning fluid, spray paint Aliphatic (no benzene ring) and aromatic hydrocarbons provide high. 2 or more of the following signs are present Intoxication=dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, muscle weakness, blurred vision, coma, euphoria, May cause cardiac arrest, permanent brain damage, May be early marker of substance abuse

1st Period of Reactivity

1st is when we put baby on the breast. Want them to breastfeed within the first hour. Usually within first 30 minutes. Baby is most awake in their period, so initiate breastfeeding within this first hour. HR may go up to 180, suctioning and crying can cause it to increase. RR can be as high as 90 especially if mucousy. Promote feeding at this time.

Which of the following questions should a nurse ask to determine how agoraphobia affects the life of a client who has panic attacks? 1.How realistic are your goals? 2.Are you able to go shopping? 3.Do you struggle with impulse control? 4.Who else in your family has panic disorder?

2

2nd Period of Reactivity

2nd is the resting period. Baby will fall back to sleep. During this period their v/s will stabilize because they are sleeping

Pregnancy at Risk: Hemmorhagic complications - Habitual abortion

3 or more abortions, usually due to I.C.

A client, experiencing lower extremity paralysis, is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder a)Conversion disorder b)Illness anxiety disorder c)Malingering d)Somatic symptom disorder

A •Conversion disorder is a loss or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder. •The situation presented in the question describes a conversion disorder.

During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? a."Don't worry. Everything will be alright." b."You appear uptight." c."I notice you have bitten your nails to the quick." d."You are jumping to conclusions."

A this statement is and ex of non-therapeutic communication block of belittling, occurs when the nurse misjudges the degree of the clients discomfort, thus a lack of empathy may be conveyed. This could also be used as assuring...

Prolonged Decelerations

A decel that lasts at least 2 minutes, need to know how long the contractions are. No return to baseline within those 2 minutes.

Placenta previa: marginal (partial)

A portion of the placenta encroaches the cervical opening.

Milieu Therapy

A structuring of the environment so that all aspects of the client's hospital experience are considered therapeutic. Within this therapeutic community setting, the client is expected to learn adaptive coping, interaction, and relationship skills that can be adapted to other aspects of his or her life.

Taking In

A time for mom to rest and recovery, reflect on what has been through. Mom has passive-like behaviors. Reflects on the whole experience. This can last from a few hours up to 3 days. This isn't a good time for education because of passive behaviors. This can be due to stress, exhaustion, stress, uncertainty with newborn care. Meet mom's physiological needs: pain relief, food and fluids, psychosocial needs (positive reinforcement and get her to verbalize her feelings of pregnancy labor and birth)

}The nurse is explaining the curative factors of group participation to a client who was recommended to attend a therapeutic group session. Which group curative factors are applicable? (choose all that apply) }A. Cartharsis }B. Instillation of hope }C. Instillation of humility }D. Dissolution of family group }E. Communication of information

A, B, E D = Recapitulation of family group E = Interpersonal learning

A client is telling the nurse that an actress is sending messages to him through a television broadcast. The nurse would be correct in suspecting that the client is experiencing which of the following? A.Ideas of reference B.Hallucination C.Delusion Flight of Ideas

A. Ideas of reference refer to the mistaken belief that neutral stimuli have special meaning to the individual, such as the television newscaster sending a message directly to the individual. A delusion is a false belief that is not specific to this client's thinking. A hallucination is a sensory perception, such as hearing voices, or seeing objects that only the clients experiences. Flight of ideas is a speech pattern when the client jumps from one topic to the next and are unrelated.

A client is newly diagnosed with secondstage NCD due to AD. Which cognitive change would a nurse observe? a)Memory disturbance b)Confabulation c)Apraxia d)Inability to plan or organize

A. •In the second stage of the illness, losses in short-term memory are common, and the individual may begin to lose things or forget names of people. •It's at this stage that a diagnosis may be considered.

Newborn Screening Phenylketonuria (PKU)

Absence of enzyme required to covert phenylalanine to tyrasena. Infant must eat for 24 hours to testing. Ideal testing is 48-72 hours after birth. Usually done at 24 hours. Heel stick puncture, fill up bubbles on a sheet and it gets set in. Increase in phenylalanine can cause brain damage, seizures. Autosomal recessive disorder, both parents must have it. If positive, need to restrict phenylalanine foods. Eggs, cheese....

distinguish

Abuse To use wrongfully or in a harmful way, Improper treatment or conduct that may result in injury. (not fulfilling role obligations of work or school, could be physically hazardous such as DWI, legal problems, with continued use regardless) Craving Strong overpowering urge, desire to use any abused substance at any time. Can be particularly associated with opiates Dependence A compulsive r chronic requirement. The need is so strong as to generate distress if left unfulfilled. Can be physical or psychological. There can be evidence of tolerance (need more to get less buzz), withdrawal, persistent desire to cut back, requires much of your time acquiring, give up or reduce participation in important activities, use is consistent and persistent regardless. Addiction difficult to define however term I used interchangably with dependence. DSM does not use this term however others have defined as tolerance and withdrawal is present or when there is combo of craving, compulsive use and relapse after WD. Intoxication Physical and mental state of exhilaration and emotional frenzy or lethargy. The onset of a reversible substance specific syndrome. i.e. alcohol-belligerence, impaired judgment, or happy drunk all of which changes when sober. LSD trip. Symptoms not due to medical condition. Withdrawal Physical and mental readjustment that accompanies the stopping of a substance. Development of a substance specific syndrome (tremors, hallucinations)

What learning activity reflects Bloom's affective domain?

Accepting the loss of a limb

Group processing skills

Active Listening Focus discussion on purpose Check perceptions of group Look at peoples reactions (body language, side bars) when something is suggested/discussed Reflecting ability to convey the essence of what a group member has said so that others can understand Clarifying focusing on key underlying issues and sorting out confusing and conflicting feelings Summarizing restating, reflecting, and summarizing major ideas points Facilitating assisting the members to express their feeling and thoughts openly Interpreting offering possible explanations Questioning if overused one can become frustrated and annoyed with continued questions Encouraging I see, that's interesting

Substance Abuse and the Surgical Client

Acute alcohol withdrawal syndrome 48-72 hrs and is associated with high mortality rate. Anesthetic may have a prolonged sedative effect if there is liver dysfunction ↑ susceptibility to cardiac & respiratory depression If cross tolerant may need ↑ anesthetic & ↑ pain meds Withdrawal symptoms may be delayed up to 5 days due to pain medication. Reduce dosage of pain med gradually

advising and probing

Advising "If I were you I would . . . ." "Why don't you . . . . . . " Giving advice implies that the nurse knows what is best for the client and that the client is incapable of any self-direction Probing "What did you discuss with your doctor when I was out of the room?" "Tell me what your friend told you on the phone?" Probing is pushing for answers to issues the client does not wish to discuss and causes the client to feel used and valued only for what is shared with the nurse.

Factors that Influence Learning

Age & Developmental stage 20 yr old mentally challenged patient will need different teaching strategies than a developmentally appropriate 20 yr old ØMotivation & readiness indicators of motivation include comments such as "I really need to get used to this external fixator." OR "If learning this pin care means I can go home, then let's do it." Nurses can improve motivation by relating the learning to something the patient values "If you learn how to use the glucometer to check you blood sugar, you will be able to include & balance the carbohydrates in your diet." Indicators of readiness: awake, alert, asking questions, no distracters, no visitors Active Involvement & relevance pt encouraged to ask questions, touch & see materials, information is something they feel they need to learn Non-judgmental feedback praise or positively worded corrections: "You moistened the saline gauze correct, let me re-demonstrate how to avoid contaminating the gauze." Start with the simple before the complex "I will show you how to draw medicine into the syringe first, then you can practice accurate measurement" Repetition & timing learn best when information said > once & the time between showing & doing is short..do not teach insulin administration on Monday for d/c on Friday! Physical & Emotional State & Psychomotor skills pain, weakness, fear, anger, anxiety (mild-moderate level= increases alertness, High & Low levels= diminishes learning), & poor psychomotor skills all affect ability to learn Culture Mediterranean - very passionate..respond well to caring, tactile approach, South America - macho, Japanese - formal, do not tell jokes English as a second language - do not use slang

Aggressive communication

Aggressive communication is a method of expressing needs and desires that do not take in to account the welfare of others, forcing their wishes or ideas on others. Those who communicate in an aggressive manner are generally perceived as selfish and unwilling to compromise. An aggressive communication style is usually linked to a desire to hurt others or exact revenge, or may reflect poor emotional development. Assertive communication always requires congruence between verbal and non-verbal messages. Being assertive involves both rights and responsibilities: you have to speak up, but must also be prepared to listen to the response and...take constructive criticism!

Agreeing and disagreeing

Agreeing "You did select the right doctor" "I think you should have the surgery" Disagreeing "You will be sorry that you did not . . ." "I can't believe that you would not . . . ." Agreeing/disagreeing implies that the nurse has the right to pass judgment on whether client's ideas or opinions are "right" or "wrong."

}How can I safeguard patient data when using high-tech handheld devices such as PDAs, tablet computers, and smartphones?

All in all, with new technologies emerging and informatics taking off, our patient safety and outcomes are improved tremendously, however with this comes a price tag of potential for exposing patient confidentiality. Need to take approaches to safeguard confidentiality of information when using devices: Keep careful physical control of the device at all times Use data encryption technology to protect data Use a password when turning on the PDA and a time-out to reactivate the password Disable the infrared ports except during use (WIFI) Do not send infrared transmissions in public locations (Pancoast and colleagues, 2003)

Placenta previa: complete

All of the placenta encroaches the cervical opening.

Cocaine Overdose Immediate management

All patients should be monitored in the emergency department and given supportive care. Ensure adequate ventilation if patient is unconscious. Volume depletion, cardiac arrhythmias, seizures, hypertension, agitation, and hyperthermia should be managed symptomatically. Benzodiazepines are the drugs of choice for the management of patients with agitation, seizures, tachycardia, and hypertension. Hypertension usually settles after administration of the benzodiazepine; however, if it persists, specific antihypertensive therapy (e.g., intravenous nitrates or calcium-channel blockers) can be given. Beta-blockers should be avoided owing to the risk of coronary vasoconstriction and paradoxical hypertension. If the patient is volume depleted this is corrected with intravenous isotonic saline. Temperature >39 °C (102.2 °F) is associated with poor outcome. If temperature is >41.2°C (>106°F), rapid cooling (ice water immersion produces more rapid cooling than evaporative methods) should be started promptly

Hydatiform Mole: etiology

Also called gestational molar pregnancy. Happens about 1:2000 pregnancies Instead of the baby growing there is blebs, large fluid filled sacs. Dark, look like bubble tea. Gelatinous fluid filled sac. Grow very rapidly.

2nd Degree Tear

Also includes the fascia and muscle

4th Degree Tear

Also includes the rectal sphincter and rectal mucous membranes

Blood alcohol level (BAL) depends on

Amount ingested Weight of the individual Amount of time between drinks Amount of food eaten before or while drinking Your use of medication Your mood changes Your personal metabolism rate Measured by amount of alcohol you consume. Measured in Mg of Alcohol per 100 ML of blood DWAI = driving while ability impaired in New York = 0.05-0.07 DWI = driving while intoxicated in New York = 0.08 1 ounce of 80 proof liquor 4 ounces of 24 proof table wine 12 ounces of beer 12 ounces of a wine cooler All contain the same amount of alcohol

Marie, 56 yrs. has never worked outside the home & has devoted her life to her husband & 5 children. Her youngest child lived at home while attending college. She recently graduated and accepted a job in another state. Since then, Marie has become very despondent. Her concerned husband takes her to the mental health clinic. What type of crisis is Marie experiencing? A.Dispositional Crisis B.Crisis of anticipated life transitions C.Psychiatric Emergency crisis D.Crisis resulting from traumatic stress

Answer: B - normal life cycle transitions that me be anticipated but individual may feel lack of control (being despondent) low spirits, loss of hope/courage

Which of the following is a correct assumption regarding the concept of crisis? A- equal opportunity problem B- stressful events can be natural disasters, etc C- correct answer- Chinese symbol (danger & opportunity) D- crisis are acute, not chronic and will be resolved one way or another within a brief period

Answer: C

Antipsychotics - SIDE EFFECTS

Anticholinergic effects Nausea; GI upset Skin rash Sedation Orthostatic hypotension Photosensitivity Hormonal effects ECG Changes Hypersalivation Weight gain Hyperglycemia/diabetes Increased risk of mortality in elderly clients with eurocognitive disorder Reduction in seizure threshold Agranulocytosis Extrapyramidal symptoms Tardive dyskinesia - permanent if left untreated Neuroleptic malignant syndrome Extrapyramidal symptoms (EPS) include: Pseudoparkinsonism - permanent if left untreated Akinesia Akathisia Dystonia Oculogyric crisis Tardive dyskinesia

Responsibilities of Group leader

Ask open ended questions to begin discussion Encourage questions from group Respond with positive statements or a summary each time a participant makes a contribution - "Thank you for your input.....this is what im hearing......so, what do you think" Reinforce participants contributions by giving them your full attention

Assertive communication

Assertive communication is the straightforward and open expression of your needs, desires, thoughts and feelings. Assertive communication involves advocating for your own needs (as well as your patients) while still considering and respecting the needs of others.

You assess a postpartal woman's fundal height every 15 minutes during the first hour postpartum. At which of the following locations would you expect to assess the height of her fundus?

At the umbilicus

Leadership Responsibilities

Avoid making negative comments about group members contributions. Instead summarize or restate them and ask other team members for their thoughts about the idea. Avoid taking sides on issues. Instead, summarize differences of opinion, stress issues can be viewed from different perspectives and emphasize relative consensus.

uWhen reviewing a clients chart the nurse notes the client had previously been on disulfram (Antebuse). The nurse know that this drug is used to treat: A. anxiety B. alcoholism C. depression D. schizophrenia

B. antebuse, Alcoholism

NAS, s/s withdrawl

Babies can have withdrawl symptoms. Know symptoms of withdrawl Irritable, frequent sneezing, high-pitched shrill cry, tachypnea, vomiting, diarrhea, disturbed sleep patterns, constant movemnet, tremors, hyperreflexia, clonus

Gestational Diabetes, Baby

Baby can be large because it produces fetal insulin to bring BS down and it acts as a growth factor for them. This is macrosomia. Once out the cord is cut and it no longer has extra sugar but it's still making extra insulin causing baby sugar to go down - need to check their BS and feed them right away.

Second Stage

Begins with 10cm and ends with a baby Can last up to 3 hours Generally multips push quicker than prim. Contractions are 5 minutes apart, when they come they are strong and mom will actively push with each contraction Push: bear down. Don't talk about poop. Push with an open glottis because everything else is open. Push in 4-6 second spurts and grunt the baby out.

Teaching evaluation

Best Method of teaching evaluation = demonstration

Transitional Stool

Between period of meconium and whatever food they are getting. Usually between 2-3 days. If baby had meconium stained fluids may see this earlier.

Gestational Diabetes

Blood sugar in the beginning of the pregnancy is low, in the middle it's OK but mom starts to produce HPL and Insulinase. These two substances affects the way mom can utilize her own insulin. Some people are more sensitive to these enzymes so this is why not everyone gets gestational diabetes.

Rooting/Sucking Reflex

Brush their cheek and they should turn towards that side. Usually a hunger cue. Make sure they have a suck reflex, make sure it's strong. Could have absent or weakened suck reflex.

When interviewing a client, which nonverbal behavior should the nurse employ?

C is positive nonverbal behavior a.Maintaining indirect eye contact with client b.Providing space by leaning back away from client c.Sitting squarely, facing the client d.Maintaining open posture with arms and legs crossed