Unit III, Learning Outcomes Part 1

Describe caring and holistic nursing strategies that are effective in resolving self-concept problems.

- One way to help with resolve self-concept is using a cognitive-behavioral approach to assist the patient in modifying self-concept. The general principle is to help the patient alter his or her perspective of a situation from a more negative view to a more positive view, a process known as "reframing." Once a person can view his or her situation more positively, a wider variety of behavioral options, coping mechanisms, or internal or external supports can be identified and activated. - Helpful nursing interventions include the following: 1: Help the patient identify and describe in detail how the patient thinks and feels about situations related to self-concept. Identify the patient's faulty thinking patterns. 2: Explore with the patient alternative ways of viewing the same situation—that is, reframe the patient's thinking about the situation. 3: Teach the patient to "red flag" faulty thinking behavior as soon as the patient is aware of it. The goal is to replace the negative thinking and self-talk with thinking and self-talk that will develop a more positive self-image. 4: Help the patient explore the positive dimensions of the self that the patient wishes to develop, and incorporate this new knowledge into the self-concept.

Describe caring nursing interventions to help patients achieve their nutritional goals.

1: Altered ability to chew related to loss of teeth, ill-fitting dentures, and gingivitis, - Encourage and instruct patient to care for and retain own teeth and dentures. - Encourage proper tooth brushing and use of special toothpaste if gums and teeth are sensitive. - Chop, shred, or puree foods that are difficult to chew. - Select ground meat, fish, or poultry as protein sources more easily chewed. 2: Loss of senses of smell and taste, - Serve food that is attractive and at proper temperature. - Serve one food at a time rather than mixing foods. - Serve foods with different textures and aromas. 3: Decreased peristalsis in the esophagus, - Avoid cold liquids. - Avoid emotional upsets and stress-producing situations. - Take anticholinergic drugs as ordered by physician. 4: Gastroesophageal reflux, - Avoid overeating. - Avoid juices, chocolate, and fat. - Avoid alcohol and smoking. - Elevate the head of the bed 30 to 40 degrees when sleeping. - Lose weight if necessary. - Avoid bending over. - Take antacids or other medications as ordered by physician. - Avoid eating right before bedtime. 5: Decreased gastric secretions, - Chew food thoroughly. - Eat meals on a regular schedule. - Use antacids or other medications as prescribed by physician. - Be alert for symptoms of deficiency of nutrients, particularly iron, calcium, fat, protein, and vitamin B12. 6: Slowed intestinal peristalsis, - Eat a high-fiber diet. - Remain as active as possible. - Increase fluid intake. - Avoid laxative use. - Eat meals at a regular time. - Drink prune juice or eat prunes every morning. 7: Lowered glucose tolerance, - Eat more complex carbohydrates. - Avoid sugar-rich foods. 8: Reduction in appetite and thirst sensation, - Offer fluids at regular intervals and at preferred temperature. - Be alert for symptoms of dehydration and electrolyte imbalance. - Offer small meals at frequent intervals. 9: Nutritional deficiencies related to alcohol intake, - Encourage diet high in protein and carbohydrates. - Offer small, frequent meals to maintain caloric intake. - Restrict sodium and fluids if edema is present. - Take multivitamin supplements, as ordered by physician. 10: Loss of appetite associated with depression and loneliness, - Promote mealtime as a social event. - Set an attractive table in a pleasant setting. - Eat outdoors whenever possible. - Invite guests as often as possible. - Participate in special programs for senior citizens. 11: Physical disability, - Open cartons and assist with setup of meal. - Arrange for home-delivered meals. - Conserve energy when preparing meals (sit on a stool, etc.). - Provide transportation and assistance to obtain food. 12: Low income, - Buy specials when available at food store. - Use generic brands. - Use coupons. - Cook larger quantities than necessary and freeze the leftovers for future use. - Substitute eggs, skim milk powder, and beans for meat. - Check for any community resources available to older adult. 13: Malnutrition, - Eat essential foods first. - Select nutrient-dense foods. - Monitor for signs of nutritional deficiencies. - Encourage eating by planning special events. 14: Increased risk for drug-nutrient interactions, - Avoid unnecessary drugs; monitor for polypharmacy. - Be aware of drug actions and interactions. - Check with pharmacist to determine if medication may or may not be taken with food. - Assess for confusion and inability to manage medication regimen.

Examples of physical illnesses associated with stress

1: Autoimmune Disorders, - Graves' disease (hyperthyroidism). - Myasthenia gravis. - Psoriasis. - Rheumatoid arthritis. - Systemic lupus erythematosus (SLE). - Ulcerative colitis. 2: Cardiovascular and Hematologic Disorders, - Coronary artery disease. - Hypertension. - Sickle cell disease. 3: Gastrointestinal Disorders, - Constipation. - Diarrhea. - Esophageal reflux. 4: Respiratory Disorders, - Asthma.

List the six classes of nutrients, explaining the significance of each.

1: Carbohydrates: commonly known as sugars and starts, are organic compounds composed of carbon, hydrogen, and oxygen. They serve as the structural framework of plants. The only animal source of carbohydrate in the diet is lactose, or "milk sugar". They are essential nutrients that supply energy and build tissue. Macronutrients. The number of molecules within the structure determines the classification of carbohydrates. They are classified as simple (monosaccharide and disaccharide) or complex (polysaccharide) sugars. Carbohydrates are more easily and quickly digested than protein and fat. Ninety percent of carbohydrate intake is digested. The main job is supplying ENERGY. 2: Protein: is a vital component of every living cell. More than 1,000 different proteins are made by combining various amounts and proportions of the 22 basic building blocks known as amino acids. They are essential nutrients that supply energy and build tissue. Macronutrients. Proteins are required for the formation of all body structures, including genes, enzymes, muscle, bone matrix, skin, and blood. The major function of protein is to maintain body tissues that break down from normal wear and tear and to support the growth of new tissue. 3: Lipids (fats): essential nutrients that supply energy and build tissue. Macronutrients. They are insoluble to water and therefore insoluble in blood. Like carbohydrates, they are composed of carbon, hydrogen, and oxygen. Ninety-five percent of the lipids in the diet are in the form of triglycerides, the predominant form and the main storage form of fat in the body. Fats are the most concentrated source of energy in the diet, providing 9 calories for every gram. Fat increases the palatability of the diet and has a high satiety value because it delays gastric emptying time. 4: Vitamins: required in smaller amounts to regulate and control body processes. They are needed for metabolism of energy nutrients. Micronutrients. They are organic compounds needed by the body in small amounts. Most vitamins are active in the form of coenzymes, which, together with enzymes, facilitate thousands of chemical reactions in the body. Vitamins are classified as either water soluble or fat soluble.Vitamins A, D, E, and K, the fat-soluble vitamins, are absorbed with fat into the lymphatic circulation. Like fat, they must be attached to a protein to be transported through the blood. 5: Minerals: required in smaller amounts to regulate and control body processes. They are needed for metabolism of energy nutrients. Micronutrients. They are inorganic elements found in all body fluids and tissues in the form of slats (sodium chloride) or combined with organic compounds (iron in hemoglobin). 6: Water: required in smaller amounts to regulate and control body processes. They are needed for metabolism of energy nutrients. Micronutrients. It is the major body constituent present in every body cell. Water accounts for between 50% and 60% of the adults total weight.

Defense mechanisms

1: Compensation: a person attempts to overcome a perceived weakness by emphasizing a more desirable trait of overachieving in a more comfortable area. 2: Denial: a person refuses to acknowledge the presence of a condition that is disturbing. 3: Displacement: a person transfers (displaces) an emotional reaction from one object or person to another object or person. 4: Introjection: a person incorporates qualities or values of another person into one's own ego structure. This mechanism is important in the formation of conscience during childhood. 5: Projection: a person attributes thoughts or impulses to someone else. 6: Rationalization: a person tries to give a logical or socially acceptable explanation for questionable behavior (behavior justification). 7: Reaction formation: a person develops conscious attitudes and behavior patterns that are opposite to what he or she would really like to do. 8: Regression: a person to a earlier method of behaving. 9: Repression: a person voluntarily excludes an anxiety-producing event from conscious awareness. 10: Sublimation: a person substitutes a socially acceptable goal for one whose normal channel of expression is blocked. 11: Undoing: a person uses an act or communication to negate a previous act or communication.

The different types of diets

1: Consistant-carbohydrate diet: total daily carbohydrate content is consistent; emphasizes general nutritional balance. Calories based on attaining and maintaining health weight. High fiber and heart healthy fats encouraged; sodium and saturated fats are limited. - Implications: type 1 and 2 diabetes, gestational diabetes, impaired glucose tolerance. 2: Fat restricted diet: low-fat diets are intended to lower the patient's total intake of fat. - Implications: chronic cholecystitis (inflammation of the gallbladder) to decrease gallbladder stimulation, cardiovascular disease, to help prevent atherosclerosis. 3: High fiber diet: emphasis on increased intake of foods high in fiber. - Implications: prevent or treat constipation, irritable bowel syndrome, diverticulosis. 4: Low fiber: fiber limited to <10 g/day. - Implications: before surgery, ulcerative colitis, diverticulitis, crohn's disease. 5: Sodium restricted diet: sodium limit may be set at 500-3,000 mg/day. - Implications: hypertension, heart failure, acute or chronic renal disease, and liver disease. 6: Renal diet: reduce workload of kidneys to delay or prevent further damage; control accumulation of uremic toxins. Protein restrictions 0.6-1 g/kg/day; sodium restriction 1,000-3,000 mg/day; potassium and fluid restrictions dependent on patient situation - Implications: nephrotic syndrome, chronic kidney disease, diabetic kidney disease. 7: Clear liquid diet: composed only of clear fluids or food that become fluid at body temperature. Requires minimal digestion and leaves minimal residue. Includes clear broth, coffee, tea, clear fruit juices, (apple, cranberry, grape) gelatin, popsicles, commercially prepared clear liquid supplements. - Implications: preparation for bowel surgery and lower endoscopy, acute gastrointestinal disorders, initial postoperative diet. 8: Pureed diet: also known as a blenderized liquid diet because the diet is made up of liquids and foods slenderized to liquid form. All foods are allowed. - Implications: after oral or facial surgery, chewing and swelling difficulties. 9: Mechanically altered diet: regular diet with modifications for texture. Excludes most raw fruits and vegetables and foods with seeds, nuts, and dried fruits. Foods are chopped, ground, mashed, or soft. - Implications: chewing and swelling difficulties, after surgery to the head, neck, or mouth.

Explain the uses for copper, zinc, chromium, and selenium.

1: Copper: is an essential nutrient for the body. Together with iron, it enables the body to form red blood cells. It helps maintain healthy bones, blood vessels, nerves, and immune function, and it contributes to iron absorption. Sufficient copper in the diet may help prevent cardiovascular disease and osteoporosis. It is an essential trace element vital to the health of all living organisms. Research has revealed that copper is vital for the optimal health of the human body. 2: Zinc: is found in cells throughout the body. It is needed for the body's defensive (immune) system to properly work. It plays a role in cell division, cell growth, wound healing, and the breakdown of carbohydrates. Zinc is also needed for the senses of smell and taste. Side note: Zinc is vital to the development and function of the male sex organs. 3: Chromium: is important in the metabolism of fats and carbohydrates. It stimulates fatty acid and cholesterol synthesis, which are important for brain function and other body processes. Chromium also aids in insulin action and glucose metabolism. 4: Selenium: is a powerful mineral that is essential for the proper functioning of the body. For starters, it plays a critical role in metabolism and thyroid function. It also helps protect the body from damage caused by oxidative stress.

Compare and contrast developmental and situational stress, incorporating the concepts of physiologic and psychosocial stressors.

1: Developmental stress: occurs as a person progresses through the normal stages of growth and development from birth to old age. Some stages of growth and development are: - The infant learning to trust others. - The toddler learning to control elimination. - The school-aged child socializing with peers. - The adolescent striving for independence. - The middle-aged adult accepting physical signs of aging. - The older adult reflecting on past life experiences with satisfaction. 2: Situational stress: It does not occur in predictable patterns as a person progresses through life. Situational stress can occur at any time, although the person's ability to adapt may be strongly influenced by his or her developmental level. Examples of situational stress, which may be either positive or negative are: - Illness or traumatic injury. - Marriage or divorce. - Loss (of belongings, relationships, family member). - New job. - Role changes. A person's physical and psychosocial capacities to cope with the situation depend not only on stage of maturation, but also on the support systems available.

Summarize knowledge of the theories that describe how and why aging occurs.

1: Erikson psychosocial: Erikson included cultural and social influences in addition to biologic processes. His psychosocial theory is based on four major organizing concepts: - Stages of development. - Developmental goals or tasks. - Psychosocial crises. - Process of coping. He believed that development is a continuous process made up of distinct stages, characterized by the achievement of developmental goals that are affected by the social environment and significant others. He identified eight stages that progress from birth to old age and death. Unsuccessful resolution at any one stage may delay progress through the next stage, but mastery can occur later. - Middle adult years: generatively versus stagnation: establishment of career, relationships, family, and societal engagement; development of care. - The middle adult years are marked by involvement with family, friends, and community. This is also a time for becoming concerned for the next generation and desiring to make a contribution to the world. If this task is not met, stagnation occurs, and the person becomes self-absorbed and obsessed with his or her own needs, or regresses to an earlier level of coping. - Older adult years: ego versus despair: change in productivity goals and evaluation of success; development of wisdom. - As a person enters the older years, reminiscence about life events provides a sense of fulfillment and purpose. Some older adults may not be fearful of dying if they feel they have achieved integrity. If a person believes that his or her life has been a series of failures or missed directions, a sense of despair may prevail. 2: Havighurst developmental: he believed that living and growing are based on learning, and that a person must continuously learn to adjust to changing conditions. He described learned behaviors as developmental tasks that occur at certain periods in life. Successful achievement leads to happiness and success in later tasks, whereas unsuccessful achievement leads to unhappiness, societal disapproval, and difficulty in later tasks. The developmental tasks arise from maturation, personal motives, and values that determine occupational and family choices and civic responsibility. - Middle adult years: achieving social and civic responsibility; accepting and adjusting to physical changes. Developmental task include: - Accepting and adjusting to physical changes. - Attaining and maintaining a satisfactory occupational performance. - Assisting children to become responsible adults. - Relating to the spouse as a person. - Adjusting to aging parents. - Achieving adult social and civic responsibility. - Older adult years: adjusting to decreasing physical status and health; adjusting to retirement. Developmental task include: - Adjusting to decreasing physical strength and health. - Adjusting to retirement and reduced income. - Adjusting to death of a spouse. - Establishing an explicit affiliation with the person's age group. - Adjusting and adapting social roles in a flexible way. - Establishing satisfactory physical living arrangements.

Physical changes in the middle adult years

1: Fatty tissue is redistributed; men tend to develop abdominal fat, women thicken through the middle. 2: Skin is drier. 3: Wrinkle lines appear on the face. 4: Gray hair appears, and men may lose hair on the head. 5: Cardiac output begins to decrease. 6: Muscle mass, strength, and agility gradually decrease. 7: There is a loss of calcium from bones, especially in peri menopausal women. 8: Fatigue increases. 9: Visual acuity diminishes, especially for near vision (presbyopia). 10: Hearing acuity diminishes, especially for high-pitched sounds (presbycusis). 11: Hormone production decreases, resulting in menopause or andropause.

Discuss the integration of healthy lifestyle, support systems, stress management techniques, and crisis intervention into hospital-based and community-based care.

1: Healthy lifestyles: some healthy lifestyles are, - Exercise: 30 to 45 minutes of moderate activity is good for your body. - Rest and sleep: you need about 7-9 hours of sleep each night. - Nutrition: some good food to have are a variety of vegetables and whole fruits, whole grains, fat-free or low-fat dairy, including milk, yogurt, cheese, or fortified soy beverages, protein-rich foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products. 2: Support systems: families and support groups provide emotional support that can help a person identify and verbalize feelings associated with stress. In addition, families and support groups provide an accepting environment, allowing the person to explore problem-solving methods and try out new coping skills. Support groups may help a person maintain a positive self-concept and establish an avenue for new relationships and social roles. Some different support groups: - Alcoholics Anonymous. - Assertiveness training groups. - Child abuse support groups. - Ostomy clubs. - Overeaters Anonymous. - Parents Without Partners. - Reach to Recovery (cancer). - Stroke clubs. - Sudden infant death support groups. - Weight Watchers. 3: Stress management techniques: some techniques are, - Relaxation techniques: use deep breathing or progressive muscle relaxation. - Mediation: do meditation 20 to 30 minutes twice a day. Four components are quiet surroundings, a passive attitude, a comfortable position, and a word or mental image on which to focus. - Anticipatory guidance: nurses use this technique when they teach patients about procedures and the surgical experience. - Guided imagery. - Biofeedback. 4: Crisis interventions: interventions come in five steps, - Identify the problem: this may be more difficult than it appears, as the cause of the crisis is often difficult for the person to identify accurately. Until it is clear, a solution is impossible. - List alternatives: all possible solutions to the problem need to be listed. An appropriate solution to a problem is much more likely if many options are considered. - Choose from among alternatives: each option needs to be carefully considered, using "what would happen if" approach. The alternative chosen will be highly individualized, based on the person's priorities and values. - Implement the plan: the alternatives chosen is put into action. The nurse may need to provide support and encouragement so that action is taken. - Evaluate the outcome: in this final step, the effectiveness of the plan needs to be carefully considered. If it did not work as well as expected, another alternative should be tried. If it did work, it has the positive benefit of improving self-confidence and future problem-solving efforts.

Biochemical data with nutritional implications

1: Hemoglobin, - Normal is 12-18 g/dL. - Decreased is anemia. 2: Hematocrit, - Normal is 40-50%. - Decreased is anemia. - Increased is dehydration. 3: Serum albumin, - Normal is 3.5-5.5 g/dL. - Decreased is malnutrition (prolonged protein depletion), malabsorption. 4: Prealbumin, - Normal is 23-43 mg/dL. - Decreased is protein depletion, malnutrition. 5: Transferrin, - Normal is 240-480 mg/dL. - Decreased is anemia, protein deficiency. 6: Blood urea nitrogen, - Normal is 17-18 mg/dL. - Increased is starvation, high protein intake, severe dehydration. - Decreased is malnutrition, over hydration. 7: Creatinine, - Normal is 0.4-1.5 mg/dL. - Decreased is reduction in total muscle mass, severe malnutrition.

Discuss the four justifications for the use of vitamin supplements.

1: Inadequate absorption. 2: Inability to use vitamins. 3: Increased vitamin losses. 4: Increased vitamin requirements.

Explain the need for iron and foods that are high in iron.

1: Iron: is a mineral, and its main purpose is to carry oxygen in the hemoglobin of red blood cells throughout the body so cells can produce energy. Iron also helps remove carbon dioxide. When levels of iron are low, fatigue, weakness and difficulty maintaining body temperature often result. 2: Foods that are high in iron, - Shellfish. - Spinach. - Liver and other organ meats. - Legumes. - Red meat. - Pumpkin seeds. - Quinoa. - Turkey. - Broccoli. - Tofu. - Dark chocolate.

Differentiate the physical and emotional responses to stress, including local adaptation, general adaptation syndrome, mind-body interaction, anxiety, and coping and defense mechanisms.

1: Local Adaptation Syndrome (LAS): is a localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body. The stress can be either traumatic or pathologic. LAS is a primary homeostatic, short term adaptive response. The two most common responses are the REFLEX PAIN response and the INFLAMMATORY response. - Reflex pain: it is rapid and automatic that serves as protecting. If you step into a bathtub or dangerously hot water, sensors in your skin detect heat and immediately send a message to the spinal cord. Message then sent to motor nerve which pull your leg back out of the water. Before you consciously realize the water is to hot. - Inflammatory: serves to localize and prevent the spread of infection and promote wound healing. When you cut your finger, for example, you often develop the symptoms of the inflammatory response: pain, swelling, heat, redness, and changes in function. 2: General Adaptation Syndrome (GAS): describes the body's general response to stress, a concept essential in all areas of nursing care. It is a physiologic response to stress but the response results from emotional and physical stressors. The three stages are alarm reaction, stage of resistance, and stage of exhaustion. - Alarm reaction: short, minutes to hours. Alarm is initiated when a person perceives a specific stressor and various defense mechanisms are activated. The perception of threat may be conscious or unconscious. The body stimulates the sympathetic nervous system (fight-or-flight). This phase of the alarm reaction, called the shock phase, is characterized by an increase in energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness. - Resistance: having perceived the threat and mobilized its resources, the body now attempts to adapt to the stressor. Vital signs, hormone levels, and energy production return to normal. Your body will either return to normal homeostasis or go on to the exhaustion stage. - Exhaustion: it results when the adaptive mechanisms can no longer provide defense. This depletion of resources results in damage to the body in the form of wear and tear or systemic damage. The body will either get to rest or will be too exhausted and die. 3: Mind-body interaction: illustrate the relationship between psychological stressors and the physiologic stress response. Each person reacts in her or his own way to prolonged stress. Some may develop chronic diarrhea, while others may develop nausea or heart palpitations. Such illnesses are real and are called psychosomatic disorders. Another component of mind-body interaction is the effect of life changes on a person. Researchers have found that the number of changes a person has in life (both positive and negative) can be correlated with illness. 4: Anxiety: is the most human response to stress. Anxiety is a vague, uneasy feeling of discomfort or dread from an often unknown or nonspecific. It is also a feeling of apprehension caused by anticipating a danger. Anxiety is experienced at some time by all people and can involve one's body, self-perceptions, and social relationships. It is an altering signal that warns of impending danger and enables the person to take measures to deal with threat. There are four levels of anxiety. They are mild, moderate, severe, and panic. - Mild level: anxiety can have a positive effect; for example, mild anxiety about an upcoming examination can motivate a student to do the required reading and review. Anxiety beyond that level is generally negative. Although mild anxiety may interfere with sleep, it also facilitates problem solving. Mild anxiety is often manifested by restlessness and increased questioning. - Moderate level: anxiety narrows a person's perceptual fields so that the focus is on immediate concerns. It is manifested by a quavering voice, tremors, increased muscle tension, a complaint of "butterflies in the stomach," and slight increases in respirations and pulse. - Severe level: it creates a very narrow focus on specific details, causing all behavior to be geared toward getting relief. Severe anxiety is characterized by extreme fear of a danger that is not real, by emotional distress that interferes with everyday life, and by avoiding situations that cause anxiety. It results in maladaptive behaviors and emotional disability that signal the presence of an anxiety disorder. - Panic level: it causes the person to lose control and experience dread and terror. This level of anxiety can lead to exhaustion and death. 5: Coping and defense mechanisms: - Coping: are behaviors used to decrease stress and anxiety. Many coping behaviors are learned, based on one's family, past experiences, and sociocultural influences and exceptions. They can be positive or negative in terms of how they affect health. Coping mechanisms often used at higher levels of anxiety are categorized as task-oriented reactions.Typical coping behaviors include the following: - Crying, laughing, sleeping, cursing. - Physical activity, exercise. - Smoking, drinking. - Lack of eye contact, withdrawal. - Limiting relationships to those with similar values and interests. - Defense: protect one's self-esteem and are useful in mild to moderate anxiety. When extreme, however, they distort reality and create problems with relationships. At that point, the mechanisms become maladaptive instead of adaptive.

Describe common health problems of middle and older adults.

1: Middle adults: malignant neoplasms, cardiovascular disease, unintentional injury, including poisoning, motor vehicle accidents, and falls, liver disease; diabetes mellitus, suicide, chronic lower respiratory disease, cerebrovascular causes, septicemia (infection), nephritis (kidney disease), rheumatoid arthritis, obesity, alcoholism, and depression. 2: Older adults: heart disease, cancer, chronic respiratory disease, stroke, AD, diabetes, dementia, delirium, depression, accidental injuries, and elder abuse.

Describe caring nursing interventions to promote health for middle and older adults.

1: Middle adults: the nurse has a major role in promoting health and preventing illness in middle adults by teaching, serving as a role model, and encouraging self-care responsibilities. Health-related screenings, examinations, and immunizations are recommended. The middle-aged adult needs to know the dangers of substance abuse. Referrals to support groups and individual counseling may be necessary to strengthen a middle adult's coping mechanisms and promote acceptance of personal and family changes. The middle adult can: - Eat a diet low in fat and cholesterol, including fruits, vegetables, and fiber; us sugar, salt, and sodium in moderation. - Make regular exercise a part of life. - Drink alcohol in moderation, if at all. - Do not smoke. 2: Older adults: the nurse should teach the older adult patient and family general health-promotion activities. This is important because older people often believe themselves "too old" to worry about nutrition, exercise, health screenings, and immunizations. In addition to the recommended screenings, examinations, and immunizations, the following should be emphasized, - Eat a diet that includes all food groups; is low in fat, saturated fat, and cholesterol; balance calories with physical activity; has recommended amounts of fruits, vegetables, and grains; and uses sugar and salt in moderation. - Make exercise a part of daily activities. This will decrease your risk of falls and may improve your strength and focus. - Discuss with your primary provider whether to include a vitamin D supplement as part of your daily routine. Vitamin D may be used to treat or prevent osteoporosis. - Drink alcohol in moderation. - Do no smoke. Nursing actions to promote are: - Physiologic. - Cognitive. - Psychosocial. - Nutrition. - Rest and sleep. - Elimination. - Activity and exercise. - Sexuality. - Meeting developmental tasks.

Describe common myths and stereotypes that perpetuate ageism.

1: Old age begins at 65 years of age. 2: Most older adults live in long-term care facilities. 3: Most older adults are sick. 4: Old age means mental deterioration. 5: Older adults are not interested in sex. 6: Older adults don't care how they look. 7: Most older people are a isolated and lonely. 8: Bladder problems are a problem of aging. 9: Older adults do not deserve aggressive treatment for serious illnesses. 10: Older adults cannot learn new things.

Guidelines for health-care related screenings, examinations, and immunizations of the aging adult

1: PHYSICAL EXAMINATION: - Every 3 years until age 40. - Every year after age 40. 2: BREAST CANCER SCREENING (FOR AVERAGE-RISK WOMEN): - Emphasis on knowing one's breasts and reporting any changes. - Mammography screening may be offered beginning at age 40, but should be initiated every year beginning at age 45 or age 50; women 55 and older can switch to mammograms every 2 years. 3: CERVICAL CANCER SCREENING (WOMEN, BEGINNING AT AGE 21): - Pelvic examination with Papanicolaou (Pap) exam every 3 years for ages 21 to 29, and every 5 years for ages 30 to 65. - Women who have had a total hysterectomy (removal of the uterus and cervix) do not need cervical cancer screening, unless the surgery was for cervical precancer or cancer. - Women over age 65 with no abnormal Pap tests in the last 10 years should consult with their health care provider about continuing cervical cancer screening. 4: PROSTATE EXAM (MEN, BEGINNING AGE 50): - Prostate-specific antigen (PSA) test should be discussed with provider; recommend this conversation at age 45 if African American or a family history of prostate cancer. - Digital rectal examination (DRE) every year. - Screening is individualized based on health care provider and the person's concerns. 5: TESTICULAR CANCER SCREENING (MEN): - Emphasis on knowing the testicles and reporting any changes. - Testicular clinical examination as part of general physical exam. 6: COLORECTAL CANCER TESTING (MEN AND WOMEN, BEGINNING AGE 45): - Fecal occult blood test every year. - Digital rectal examination (DRE) every year. - Flexible sigmoidoscopy every 5 years or - Colonoscopy every 10, or - Double contrast barium enema every 5 years, or - CT colonography (virtual colonoscopy) every 5 years. - For people ages 76 through 85, talk with your health care provider about whether continuing to get screened is right for you. - People over 85 should no longer get colorectal cancer screening. 7: SKIN CANCER EXAM (MEN AND WOMEN): - Self-examination every month. - Clinical skin examination as part of general physical exam. 8: ORAL CANCER EXAM (MEN AND WOMEN): - Every year as part of medical or dental checkups. 9: BONE DENSITY TESTING: - Menopausal and postmenopausal women under age 65 with risk factors, or over age 65. - Men aged 50 to 69 with risk factors, or over age 70. - Fracture after age 50. - Height loss. 10: VISION EXAM: - Eye examination, with a test for glaucoma, every 1-2 years. 11: IMMUNIZATION: - TDAP TD: administer one dose Tdap, then Td booster every 10 years. - MMR VACCINE: administer one dose of MMR to adults who previously received ≤2 doses of mumps-containing vaccine and are identified by a public health authority to be at increased risk during a mumps outbreak. - INFLUENZA: administer one dose every year. - PNEUMOCCAL VACCINE: administer one dose of PCV13 (13-valent pneumococcal conjugate vaccine) for adults age 65 and older if not previously received, followed by one dose of PPSV23 (23-valent pneumococcal polysaccharide vaccine) 1 year after dose of PCV13. For adults with certain medical conditions who received a dose of PPSV23 at ages 19 to 64, administer a second dose of PPSV23 at age 65, followed by a dose of PCV13 1 year later (if not previously received). - ZOSTER VACCINE LIVE (ZVL) OR RECOMBINANT ZOSTER VACCINE (RZV): administer two doses of RZV (Shingrix) 2-6 months apart to adults aged 50 years or older regardless of past episode of herpes zoster or receipt of ZVL (Zostavax). Administer two doses of RZV 2-6 months apart to adults who previously received ZVL at least 2 months after ZVL. For adults aged 60 years or older, administer either RZV or ZVL (RZV is preferred).

Explain the pharmacokinetics and pharmacodynamics of the older adult as they relate to drug dosing.

1: Pharmacodynamics: is the effect that drugs have on the body. It is the science or study of how the body reacts to drugs. This relates to drug dosing in older adults because one needs to know the proper amounts of dosages as well as the side effects of the drug one is using. 2: Pharmacokinetics: is the study of the way in which drugs move through the body during absorption, distribution, metabolism and excretion. Before a drug can begin to exert any effect on the body it has to be absorbed into the body systems. Physiological changes that affect drug pharmacokinetics in older adults is mainly the kidney. The kidney is the main organ involved in drug excretion; therefore the pharmacokinetics of aging induced change mainly results from reduced kidney functionality. It is the most important factor in producing toxic drug reactions in the elderly. Aging affects pharmacokinetics in which it is associated with some reduction in first-pass metabolism, bioavailability of a few drugs can be increased. Body fat increases and total body water as well as lean body mass decrease. This is important because one needs to know what happens to the body and what to watch for if something goes wrong (Ex. kidney problems).

Identify the risk factors for poor nutritional status.

1: Physiologic and physical factors, - Developmental considerations. - Biological sex. - State of health. - Alcohol abuse. - Medication. - Megadoses of nutrient supplements. 2: Physical, Sociocultural, and Psychosocial Factors, - Economic factors. - Religion. - Meaning of food. - Culture. - Additional sociocultural factors affecting nutritional intake. 3: Food intake, - Decreased food intake. - Increased food intake. 4: Other reasons, - Altered ability to chew related to loss of teeth, ill-fitting denture, and gingivitis. - Loss of senses of smell and taste. - Decreased peristalsis in the esophagus. - Gastroesophageal reflux. - Decreased gastric secretions. - Slowed intestinal peristalsis. - Lowered glucose tolerance. - Reduction in appetite and thirst sensation. - Nutritional deficiencies related to alcohol. - Loss of appetite associated with depression and loneliness. - Physical disability. - Low income. - Malnutrition.

Describe major physiologic, cognitive, psychosocial, moral, and spiritual developments and tasks of middle and older adulthood.

1: Physiologic development: - Middle adults: as time passes, gradual internal and external physiologic changes occur. These are not pathologic changes, but normal changes that result from aging. The person must modify self-image and self-concept to adapt successfully to and to accept these normal changes. Hormonal changes happen in men and women (women undergo menopause with decreased estrogen and progesterone) (men undergo andropause. Androgen levels diminish slowly; the man may have some loss of sexual potency, but is still capable of reproduction). - Older adults: In older adults, all organ systems undergo some degree of decline in overall functioning, and the body becomes less efficient. Body functions that require integrated activity of several organ systems are affected the most. Most older adults regard themselves as healthy. There is a trend in health care today toward fostering increasing independence and self-care in older adults. Most older adults continue their activities from middle age and adapt intuitively to the gradual limitations of aging; it may take longer to complete an activity, or the activity may need to be modified. The greatest threat to the health of older adults is loss of the physiologic reserve of the various organ systems. When illness occurs, increased physical and emotional stress place an older adult at risk for complex reactions. An older adult is more likely to develop complications and to recover more slowly. Sarcopenia is common. 2: Cognitive development: - Middle adults: little changes in cognitive and intellectual from young adulthood. There is often a increased motivation to learn, especially if the knowledge gained can be applied immediately and has personal relevance. Problem solving abilities remain throughout adulthood, although response time may be slightly longer. This is not due to any decreased ability but, rather, to a longer search through more memories and to a desire to thing a problem through before responding. - Older adults: intelligence increases into the 60s, and learning continues throughout life. It is normal for an older adult to take longer to respond and react, particularly in new or unfamiliar surroundings. Mild short-term (recent) memory loss is common but can be remedied by an older adult using notes, schedules, and calendars. Long-term memory usually remains intact. 3: Psychosocial development: - Middle adults: a time of increased personal freedom, economic stability, and social relationships. It is a time for increased responsibility and an awareness of one's own mortality. The middle adult realizes that his or her life may be half or more past and may feel many things are still undone. It is a period of generativity versus stagnation. (Havighurst's theory). - Older adults: an older adult who has a strong sense of self-identity and has successfully met challenges earlier in life will probably continue to do so. Depending on the person's outlook on life and past ability to cope, events such as retirement, loss of health or income, loss of ability to operate a motor vehicle, and isolation can be devastating. The loss of the privilege of driving has serious repercussions for older adults. Erikson's therory (older adults continue to look forward, but now also look back and begin to reflect on their lives. It is a time for realization of a wholeness perspective, with an inner search for meaning and order in the life cycle) ego integrity versus despair. Life review and reminiscence is common and normal. (Havighurst's theory). 4: Moral development: - Middle adults: a middle-aged adult may either remain at the conventional level or move to the postconventional level. The person who has had sustained responsibility for the welfare of others and has consistently applied ethical principles developed in adolescence is more likely to move to the postconventional level. At this level, the adult believes that the rights of others take precedence, and takes steps to support those rights. - Older adults: moral development is completed in older adults. Most are at the conventional level. 5: Spiritual development: - Middle adults: not everyone might reach spiritual development. Most middle adults are less rigid in their beliefs, and many have increased faith in a supreme being as well as trust in spiritual strength. - Older adults: spiritually may remain at an earlier level often at the individuative-reflective level. Many older adults, however, demonstrate conjunctive faith, where they integrate faith and truth to see the reality of their own beliefs, or universalizing faith, where they trust a greater power and believe in the future.

Summarize the mechanisms involved in maintaining physiologic and psychological homeostasis.

1: Physiologic homeostasis: the regulatory mechanisms of the body are reacting constantly to internal changes to maintain homeostasis and health. The autonomic nervous system and the endocrine system primarily control homeostatic mechanisms. Involved to a lesser degree are the respiratory, cardiovascular, gastrointestinal, and renal systems. These mechanisms are self-regulating, organized, and coordinated; they occur without conscious thought, and defend against change to the body's internal environment. A example of physiologic homeostasis is the negative feedback system. It is involved in short and long term stress which can threaten physiologic homeostasis resulting in illness. Allostasis is part of this. The mechanisms used for physiologic homeostasis are, - Local adaptation syndrome (LAS). - General adaptation syndrome (GAS). 2: Psychological homeostasis: a person needs to feel loved and a sense of belonging, to feel safe and secure, and to have self-esteem. When these needs are not met or a threat to need fulfillment occurs, homeostatic measures in the form of coping or defense mechanisms help return the person to emotional balance. A person's perception of these changes may be conscious or unconscious. If the person has the necessary resources, adaptation takes place and balance is maintained. If the resources cannot reestablish balance, a state of stress results. The mechanism used for psychological homeostasis are, - Mind-body interaction. - Anxiety. - Coping or defense mechanisms.

Plan, implement, and evaluate nursing care related to select nursing diagnoses for disturbances in self-concept.

1: Planning and outcomes: with all patients some outcomes are, - Describe self realistically, identifying both strengths and deficiencies. - Verbalize realistic expectations for self, based on who the patient would like to be. - Verbalize that self is liked, or at least "OK." - Communicate feelings and needs in a way that is comfortable and effective in meeting needs. - Nurture relationships in which needs for love and worth are mutually met (significance). - Assume role-related responsibilities with confidence (competence). - Express satisfaction with ability to live according to his or her moral-ethical standards (virtue). - Demonstrate confidence in ability to accomplish what is desired (power). Some sample outcomes for patients with specific disturbances in self-concept are, - Describe the relation between self-concept and behavior. - Identify faulty thinking that reinforces a negative self-concept (distortions and denials, faulty categorizing, inappropriate standards). - Integrate positive self-knowledge into self-concept. - Report feeling better about himself or herself. 2: Implementation: specific nursing strategies that are good to use include, - Helping patients identify and use personal strengths: as a nurse you might have to remind the patient about their strengths or have them tell you what they think their strengths are. - Helping at-risk patients maintain a sense of self: many patient separate from their real sense of self. They are removed from their personal roles, environments, and belongings, and stripped of their individuality by staff caring for them. As nurses, we need to remember this and help our patient maintain their sense of self in the hospital. - Enhancing or modifying the self-concept: (discussed in another questions). - Developing a positive body image: don't focus on the negative attributes of the patient but instead list the positive and have the patient participate. Have the patient explore their feeling and don't condemn them. - Working with parents and educators to develop self-esteem in children, adolescents, and older adults: important learning tasks for children and adolescents include understanding and accepting themselves, their feelings, and others; independence; goals and purposeful behavior; mastery, competence, and resourcefulness; emotional maturity; and choices and consequences. Some strategies to use are: looking at the positive and negative, listening, using the language of self-esteem, helping children meet expectations, and promote a feeling of success. For older adults, assist the person to identify strengths and coping mechanisms to deal with problems, provide a safe environment for older adults to communicate such concerns as interpersonal or physical loss, feelings about illness and death, sexuality, or financial issues, encourage sharing of life experiences, and don't forget to identify your own attitudes and feelings about aging and older adults. - Teaching self-compassion: involves acting the same way toward yourself when you are having a difficult time, fail, or notice something you don't like about yourself. 3: Evaluation: when the care plan includes specific interventions to assist patients with disturbances in body image, self-esteem, role performance, and personal identity, listen carefully to the patient's self-report and observe patient behaviors to see if the disturbances are being resolved. Some outcomes to look for are: being comfortable with body image and able to use it effectively to meet human needs, able to describe self positively, able to meet realistic role expectations without undue anxiety and fatigue, and capable of interacting appropriately with environment while recognizing self to be a separate and distinct entity.

Plan, implement, and evaluate nursing care related to select nursing diagnoses that involve nutritional problem.

1: Planning: the goal is to maintain or restore optimal nutritional status using foods the patient likes and tolerates as appropriate for their situation. Goals should also include those to alleviate symptoms or side effects of disease or treatment and to prevent complications or diet-related chronic diseases. Outcomes are: - Attain and maintain ideal body weight, as indicated by BMI and waist circumference. - Eat a diet adequate but not excessive, in all nutrients, based on the my plate food guidance system, the DRIs, and dietary recommendations and guidelines issued from health and U.S. governmental agencies. - Eat a variety of food in each of three or more meals. - Follow the appropriate modified diet, when necessary, to restore health, avoid disease recurrences, and prevent or delay potential complications. 2: Implementation: the nurse is responsible for screening patients at home who are at nutritional risk, observing intake and appetite, evaluating the patient's tolerance, and assisting the patient with eating. Other nursing interventions related to meeting patients' nutritional needs may include administering enteral and parenteral feedings, consulting with the dietitian and primary care provider when dietary problems arise, addressing the potential for drug-nutrient reactions, obtaining more food or snacks for the patient when appropriate, monitoring food brought by visitors, and participating in nutrition education efforts. Nursing interventions are: - Nutrition management. - Weight management. - Nutritional counseling. - Nutritional monitoring. - Stimulating the appetite. - Assisting with eating. - Providing oral nutrition. - Education: include information about food safety issues in patient teaching. This includes safe handling of foods, food storage, and preventing food-borne illness. Encourage patients to wash hands and clean food contact surfaces frequently when handling and preparing foods. Wash fruits and vegetables before eating or preparation. This helps prevent contamination of food with bacteria and viruses. Teach patients to cook foods to a safe temperature to kill microorganisms. 3: Evaluation: on an ongoing basis, the nurse accomplishes the following: - Evaluates the patient's progress toward meeting nutritional outcomes. - Evaluates the patient's tolerance and adherence to the prescribed diet, when appropriate. - Assesses the patient's level of understanding of the diet and/or dietary-related interventions and the need for further instruction or reinforcement. - Communicates findings to other members of the health care team. - Revises the plan of care, as needed, or terminates nursing care.

Identify three dimensions of self-concept: self-knowledge, self-expectations, and self-evaluation (self-esteem).

1: Self-knowledge: "Who am I?": composite of all the basic facts, qualities, traits, images, and feelings one holds about oneself (Global self). A person's self-knowledge includes: - Basic facts (sex, age, race, occupation, cultural background, sexual orientation). - The person's position within social groups. - Qualities or traits that describe typical behaviors, feelings, moods, and other characteristics (e.g., generous, hotheaded, ambitious, intelligent, sexy). Besides like age or sex, self-knowledge can change. 2: Self-expectations: "How well do I like myself?" develops unconsciously early in childhood and are based on images of role models such as parents, other caregiving figures, and public figures. These personal expectations can be either healthy or unhealthy. 3: Self-evaluation: "How well do I like myself?": sometimes termed self-respect, self-approval, or self-worth. According to Maslow's, all people "have a need for a stable, firmly based, usually high evaluation of themselves, for self-respect or self-esteem, and for the esteem of other". There are two different areas, - Self esteem needs (strength, achievement, mastery and competence, confidence in the face of the world, independence, freedom). - Respect needs or the need for esteem from others (status, dominance, recognition, attention, importance, appreciation). For Maslow, self-esteem comes from two major sources: how competent children think they are in various aspects of life and how much social support they receive from other people. One's self-esteem, like the various self-images that make up one's self-concept, varies considerably depending on a specific relationship or situation. With healthy self-esteem, you're, - Assertive in expressing your needs and opinions. - Confident in your ability to make decisions. - Able to form secure and honest relationships—and less likely to stay in unhealthy ones. - Realistic in your expectations and less likely to be overcritical of yourself and others. - More resilient and better able to weather stress and setbacks. Three major self-evaluation feelings or affects found in people are, - Pride, based on a positive self-evaluation. - Guilt, based on behaviors incongruent with ideal self. - Shame, associated with low global self-worth.

Discuss the effects of short-term and long-term stress on basic human needs, health and illness, and the family.

1: Short-term stress: is acute stress. Short-term stress can lead to psychological distress, tension headaches, upset stomach, and other symptoms. This stress is recognized by many people. Activation of the fight-or-flight will happen during short-term stress. 2: Long-term stress: it poses a serious threat to physical and emotional health. It affects physical status, increasing the risk for disease or injury. Recovery and return to normal function are also compromised. High levels of ongoing stress are associated with multiple health disorders. Alcoholism and drug abuse, depression, suicide, accidents, and eating disorders have also been associated with chronic stress. Researchers have confirmed that chronic stress affects the ability of immune cells to respond to the hormones that normally regulate inflammation, thus allowing the development and progression of some diseases. Stress has negative effects on the entire body-the cardiovascular, respiratory, musculoskeletal, endocrine, gastrointestinal, nervous, and reproductive systems. Under normal circumstances, cortisol, an anti-inflammatory hormone released by the adrenal glands, regulates the inflammatory response, but prolonged stress may decrease the effectiveness of cortisol, or the immune cell may be resistant to its effects. 3: Health and Illness: health and homeostatic balance are at one extreme of the continuum; exhaustion and death are at the other extreme. Adaptation to acute and chronic illness or to traumatic injury involves two sets of adaptive tasks: general and illness-related. - General: (as in the case of any situational stress) involve maintaining self-esteem and personal relationships and preparing for an uncertain future. - Illness-Related: includes such stressors as losing independence and control, handling pain and disability, and carrying out the prescribed medical regimen. 4: Family: when the family is viewed as a system, the behavior of the individual is influenced by his or her family, and any alterations in the individual's behavior in turn affect the family. Stressors for the family include changes in family structure and roles, anger and feelings of helplessness and guilt, loss of control over normal routines, and concerns for financial stability. The family can provide the social support necessary to help the patient manage and adapt to stress as well as emotional support. Caring for a family member at home for long periods can also cause prolonged stress which is called caregiver burden.

Explain the interdependent nature of stressors, stress, and adaptation.

1: Stressors: are perceived as challenging, threatening, or demanding that trigger a stress reaction. Stressors may be internal or external. The perception and effects of the stressor are highly individualized. Stressors themselves are neither positive nor negative, but they can have positive or negative effects as the person responds to change. There are two types of stressors, - Physiologic: include a specific effect and a general effect. The specific effect is an alteration of normal body structure and function while the general effect is the stress response. The primary ones are chemical agents, physical agents, infectious agents, nutritional imbalances, hypoxia, and genetic or immune disorders. - Psychosocial: include both real and perceived threats. The person's responses are continuous and include individualized coping mechanisms for responding to anxiety, guilt, fear, frustration, and loss. These mechanism serve to maintain psychological homeostasis. 2: Stress: is a condition in which the human system responds to changes in its normal balanced state. Everyone experiences stress and the experiences of stress and responses to it are unique to each person. The process of responding to stress in content and dynamic and is essential to a person's physical, emotional, and social well-being. It affects the whole person positively or negatively. It is a major component in health and illness. Stress results from a change in a person's internal or external environment that is perceived as a challenge, a threat, or a danger. The major sources of stress in our society arise from interpersonal relationships and performance demands rather than from actual physical threats 3: Adaptation: is a involuntary response when a person is in a threatening or otherwise stressful situation and a immediate response occurs. It is the change that takes place as a result of the response to a stressor. Adaptation is, to some degree, an ongoing process as a person strives to maintain balance in his or her internal and external environments. It occurs in families and groups. Adaptation is necessary for normal growth and development, the ability to tolerate changing situations, and the ability to respond to physical and emotional stressors.

Describe nursing implications related to drug therapy in the older adult.

1: The need for education and counseling of older adults on potential issues to minimize the risk for adverse effects, toxicities, and drug-drug interactions. 2: Nurses must be able to recognize adverse drug reactions in the older adult population instead of mistaking them for age-related changes. 3: Education of the family members is important. These needs include personal hygiene, medication administration, special diets, elimination, activities of daily living, and recognition of symptoms that necessitate medical attention. 4: Polypharmacy requires careful monitoring to minimize the risk for adverse effects, toxicities, and drug-drug interactions.

Discuss reasons for noncompliance to a drug regimen by the older adult.

1: The need for multiple drug therapy with complex medication regime. 2: Increasing cost of therapy. 3: Adverse effects. 4: Drug interactions. 5: Forgetfulness. 6: Lack of familial and social support and care. 7: Elderly patients may not be fully compliant to long term medications. 8: Polypharmacy. 9: Drug duplication.

Relate food sources and deficiency conditions associated with each vitamin.

1: Vitamin A, Food sources are: - Fruits. - Yellow and green vegetables. - Fish. - Dairy products. Deficiency conditions: - Inadequate intake. - Fat malabsorption. - Liver disorders. - Immunity - Hematopoiesis - Rashes. - Typical ocular effects (eg, xerophthalmia, night blindness). 2: Vitamin D, Food sources are: - Dairy products. - Nonhydrogenated margarine. Deficiency conditions: - Getting sick or infected often. - Fatigue and tiredness. - Bone and Back Pain. - Depression. - Impaired Wound Healing. - Bone Loss. - Hair Loss. - Muscle Pain. - Fractures. - Osteoporosis. - Loss of bone density. 3: Vitamin E, Food sources: - Oils. - Nonhydrogenated margarine. - Milk. - Grains. - Meats. - Dark leafy greens. Deficiency conditions: - Disorientation. - Vision problems. - Muscle weakness. - Weakened immune system. 4: Vitamin K, Food sources: - Green leafy vegetables. - Meats. - Eggs. - Dairy products. Deficiency conditions: - Easy bruising. - Oozing from nose or gums. - Excessive bleeding from wounds, punctures, and injection or surgical sites. - Heavy menstrual periods. - Bleeding from the gastrointestinal (GI) tract. - Blood in the urine and/or stool. 5: Vitamin B: Food sources: - Whole grains. - Meat. - Eggs and dairy products. - Legumes. ​- Seeds and nuts. - Dark, leafy vegetables. Deficiency conditions: - Weakness, tiredness, or lightheadedness. - Heart palpitations and shortness of breath. - Pale skin. - A smooth tongue. - Constipation, diarrhea, loss of appetite, or gas. - Nerve problems like numbness or tingling, muscle weakness, and problems walking. - Vision loss. 6: Vitamin C: Food sources: - Vegetables. - Fruits. Deficiency conditions: - Scurvy. - Rough bumpy skin. - Corkscrew-shaped body hair. - Bright red hair follicles. - Spoon-shaped fingernails with red spots or lines. - Dry, damaged skin. - Easy bruising. - Slowly healing wounds. - Painful, swollen joints. - Weak bones. - Bleeding gums and tooth loss. - Poor immunity. - Persistent iron deficiency anemia. - Fatigue and poor mood. - Weight gain. - Chronic inflammation and oxidative stress.

Differentiate between water-soluble and fat-soluble vitamins.

1: Water-soluble: vitamins B and C are easily absorbed into the body If you consume more of a water-soluble vitamin than you need, the excess will be excreted in urine, not stored. The risk of overdose is low. 2: Fat-soluble: vitamins A, D, E, and K. These require bile acids to help absorb them, but your body keeps stocks of the excess for ready use. They are absorbed in the small intestine. Once in the body, they are stored primarily in the liver and in fatty (adipose) tissues. These can be more toxic and you need to take them in moderation. Side note: vitamin E can become water-soluble.

Explain factors that cause stress in the nursing profession.

Factors that can cause stress in the nursing profession are: 1: Assuming responsibilities for which one is not prepared. 2: Working in an environment in which supervisors and administrators are not supportive. 3: Working with unqualified personnel. 4: Caring for a patient during a cardiac arrest or for a patient who is dying. 5: Experiencing conflict with a peer. 6: Caring for a patient who is suffering, and caring for the patient's family. 7: Providing care to a patient who is disengaged, nonadherent, or lacks the resources to participate in his or her care. 8: Knowing the correct, right, or ethical course of action in a situation, but being unable to take that action (moral distress). 9: Incivility: encompasses rude or discourteous actions that negatively affect others. It can escalates to bullying, which can be defined as repeated ongoing actions that intend to harm another person, such as humiliation, offensive speech or actions, or other methods of causing distress. 10: Workplace violence: which consists of actions that cause psychological or physical damage, can be perpetrated by: (1) someone who has no relationship with the victim (crime-based); (2) a customer, client, or patient; (3) a co-worker who may or may not be a peer; or (4) someone involved in a personal relationship with the victim. Those kinds of stresses are even higher for two groups: new graduates and nurses who work in settings such as intensive care and emergency care. Stress for nursing students are: 1: Fear of failing the classroom or clinical. 2: Fear of failing the licensure examination after graduation. 3: The demands of the nursing program. 4: Fear of injuring patients. 5: The need to balance work and study. 6: The need to meet financial and family responsibilities. 7: The physical, emotional, cognitive, and psychological demands of the nursing program.

Develop nursing diagnoses to identify disturbances in self-concept (body image, self-esteem, role performance, personal identity).

Five nursing diagnostic labels describe specific disturbances in self-concept that can be treated by independent nursing interventions: 1: Disturbed body image: the state in which a person experiences confusion in the mental picture of his or her physical self 2: Chronic (or risk for chronic) low self-esteem or situational (or risk for situational) low self-esteem: the state in which a person experiences, or is at risk for experiencing, negative self-evaluation about self or capabilities 3: Ineffective role performance: The state in which a person experiences, or is at risk for experiencing, a disruption in the way that a person perceives his or her role performance 4: Disturbed (or risk for disturbed) personal identity: The state in which a person experiences, or is at risk for experiencing, an inability to distinguish between self and non-self. 5: Readiness for enhanced self-concept: describes a pattern of perceptions and ideas about the self that is sufficient for well-being and can be strengthened. This is a health promotion diagnosis. SIDE NOTE: when assessment data point to an alteration in self-concept, the first task is to determine whether the altered self-concept is the problem, the cause of the problem (etiology), or merely a sign that a problem exists (defining characteristics). It is important to make an accurate determination because this directs the outcomes developed for the patient and related nursing interventions.

Develop nursing diagnoses that correctly identify nutritional problems that may be treated by independent nursing interventions.

Imbalanced nutrition as the problem: - Imbalanced nutrition less that body requirements related to nothing by mouth, inadequate tube feeding, prolonged use of a clear liquid diet, numerous food intolerances or allergies, excessive dieting, anorexia, chewing or swallowing difficulties, nausea, vomiting, chronic diarrhea, malabsorption, psychological eating disorders, alcoholism, metabolic and endocrine disorders, inappropriate use of supplements. - Imbalanced nutrition more than body requirements related to overeating, inactivity, metabolic and endocrine disorders, inappropriate use of supplements. - Risk for imbalanced nutrition more than body requirements related to inappropriate eating, closely spaced pregnancies, metabolic and endocrine disorders, inappropriate use of supplements. Imbalanced nutrition as the etiology: - Ineffective health maintenance related to lack of knowledge about adequate nutrition. - Constipation related to inadequate fluid or fiber intake. - Deficient fluid volume related to inadequate fluid intake. - Risk for infection related to inadequate calorie, intake, inadequate protein intake. - Impaired home maintenance management related to inability to purchase, store, or prepare food for family. - Constipation, fatigue, and risk for skin integrity. Wellness diagnosis: - For patients who are incorporating sound nutritional practices in their daily routine, the following wellness diagnosis may be appropriate: Readiness for Enhanced Nutrition. Nursing diagnoses: 1: Imbalanced nutrition: less than body requirements, - Related risk factors are insufficient dietary intake 2: Impaired swallowing, - Related risk factors are neuromuscular impairment. 3: Risk for overweight, - Related risk factors are excessive food intake in relation to physical activity, sedentary behavior occurring for >2 hours/day, BMI 24, waist circumference 39 in.

Discuss the components of a nutritional assessment.

Nutritional status has a significant impact on both health and disease. For well patients, good nutritional status can help to maintain health, promote normal growth, and development, and protect against disease. During illness, good nutritional status can reduce the risk for complications and speed up the recovery time. Conversely, poor nutritional status can increase the risk for illness or death. Like other aspects of nursing care, nutritional assessment is a systematic approach used to identify the patient's actual or potential needs, formulate a plan to meet those needs, initiate the plan or assign others to implement it, and evaluate the effectiveness of the plan. The level of assessment may range from simple screening to a comprehensive, in-depth assessment, depending on individual circumstances. Regardless of the level of assessment, nutritional assessment is appropriate for all patients. Nurses can collect assessment data through history taking (dietary, medical, socioeconomic data), physical assessments (anthropometric and clinical data), and laboratory data. Dietary data: - Nutritional screening is an important part of the nursing assessment. Screening looks for cues associated with nutrition problems to determine if a person is malnourished or at risk for malnutrition. The Mini Nutritional Assessment tool (MNA) is an example of a screening tool used to detect older adults at risk for malnutrition before changes in albumin level and the BMI. - Medical and socioeconomic data. - Anthropometric data: obtain height and weight, the most common anthropometric measurements, when the patient is admitted to the health care facility and periodically thereafter or assess height and weight in a home care environment. - Body mass index and waist circumference. - Clinical data: (looking at the body). - Biochemical data. To assess the dietary intake, use the - 24 hour recall method. - Food diaries/calorie counts: usually 3 to 7 days are recorded. - Food frequency record. - Diet history: a more comprehensive approach to diet assessment is a full diet history. In addition to a 24-hour food recall, calorie counts/food diaries, and food-frequency record, interview questions are geared to provide information on past and present food intake and habits. Factor to assess are: - Usual dietary intake. - Food allergies or intolerances. - Food preparation and storage. - Type of dietary practices. - Eating disorder patterns. A physical or economic assessment is: - Ability to chew and swallow, including condition of mouth, missing teeth, or denture. - Appetite, food intolerance and allergies, and bowel habits. - Source of income. - Food budget. Nutritional considerations to look at older adults are: - Biochemical data: low serum albumin (<3.5 mg/dL) may be a reflection of the aging process rather that a nutritional risk factor. Albumin synthesis declines with age. Hemoglobin levels that are lower than normal may only reflect anemia observed in older people as part of the aging process. - Dietary data: dietary recall may be inaccurate because of vision and memory problems. Question use of vitamin and mineral supplements. Gather information concerning medication regimen (prescribed and over-the-counter) to assess for food-drug interactions and adverse effects of medication. Side note: laboratory tests, which measure blood and urine levels of nutrients or biochemical functions that depend on an adequate supply of nutrients, can objectively detect nutritional problems in their early stages. Most routine biochemical tests measure protein status; measures of body vitamin, mineral, and trace element status are also available. Hemoglobin, the oxygen-carrying protein of the red blood cells, and hematocrit, the volume of red blood cells packed by centrifugation in a given volume of blood, are measures of plasma protein that also reflect a person's iron status. Protein status can also be determined by measuring serum albumin and transferrin levels and by a total lymphocyte count. Serum albumin levels are a good indicator of a patient's nutritional status a few weeks prior to when the blood is drawn and can help identify chronic nutrition problems. The albumin level does not change with increasing age, but malnutrition and various disease states cause its level to decrease. Serum albumin levels can also be affected by the patient's hydration status; overhydration can cause a low albumin level and dehydration may cause a very high level. Prealbumin levels indicate short-term nutritional status, can be used to detect daily changes in a patient's protein status, and are an excellent marker for malnutrition. Transferrin acts as an iron-transporting protein, but because it is related to iron levels may not always be an accurate indicator of nutritional status. The total lymphocyte count reflects immune status and is directly affected by impaired nutritional states. Blood glucose, blood cholesterol, and blood triglycerides are additional laboratory tests relative to nutritional status. Twenty-four-hour urine tests used to measure protein metabolism include urine creatinine excretion and urine urea nitrogen. Urea, a breakdown product of amino acids, can be measured in the urine and blood. It reflects protein intake and the body's ability to detoxify and excrete this metabolic byproduct. Creatinine levels are directly proportional to the body's muscle mass; a reduction in this value reflects severe malnutrition.

Differentiate positive and negative self-concept and high and low self-esteem.

Positive self-concept goes with high self-esteem while negative self-concept goes with low self-esteem. Whether self-concept and esteem is positive or negative can influence important areas of a child's development and achievement. It also affects the quality of family life. 1: Positive self-concept and high self esteem: you are aware of oneself and have a concept of oneself. When you value yourself and have good self-esteem, you feel secure and worthwhile. You have generally positive relationships with others and feel confident about your abilities. You're also open to learning and feedback, which can help you acquire and master new skills. 2: Negative self-concept and low self esteem: negative self-concept and low self-esteem is characterized by a lack of confidence and feeling badly about oneself. People with low self-esteem often feel unlovable, awkward, or incompetent. Low self-esteem or self-concept can cause people to experience problems in their relationships; negatively affect their performance at their job or with their school work; increase their likelihood of depression; cause high levels of stress, loneliness and anxiety and lead to high risks of alcohol and drug abuse.

Describe major steps in the development of self-concept.

Self-concept is a mental image or picture of self; includes body image, subjective self, ideal self, and social self. The major steps are, 1: Self-awareness (infancy): 2: Self-recognition (18 months): 3: Self-definition (3 years): 4: Self-concept (6-7 years): Psychological conditions that foster healthy development of the self in children include: - Emotional warmth and acceptance. - Effective structure and discipline. - Clearly defined standards and limits, so that children understand what goals, procedures, and conduct are approved. - Adequately defined roles for both older and younger members of the family. - Established methods of handling children that produce the desired behavior, discourage misbehavior, and deal with infractions when they occur. - Encouragement of competence and self-confidence. - Helping children meet challenges. - Appropriate role models. - A stimulating and responsive environment.

Identify six variables that influence self-concept.

Six variables that influence self-concept are, - Developmental considerations. - Culture. - Internal and external resources. - History of success and failure. - Stressors. - Illness or trauma.

Discuss the use of appropriate interview questions and observations to assess a patient's self-concept.

The nurse assessing a patient's self-concept focuses on personal identity, personal strengths, body image, self-esteem, and role performance. 1: Personal identity: risk factors to look for are, - Developmental changes. - Trauma. - Biological sex dissonance. - Cultural dissonance. 2: Body image: is the person's subjective view of his or her physical appearance. Body image disturbances can be expected with any alteration in bodily appearance, structure, or function. Risk factors to look for are, - Loss of body part or function. - Disfigurement. - Developmental changes. 3: Self-esteem: you can obtain a quick indication of a patient's self-esteem by using a graphic description of self-esteem as the discrepancy between the "real self" (who we think we really are) and the "ideal self" (who we think we would like to be). Have the patient plot two points on a line—real self and ideal self. The greater the discrepancy, the lower the self-esteem; the smaller the discrepancy, the higher the self-esteem. Risk factors to look for are, - Unhealthy interpersonal relationships. - Failure to achieve developmental milestones. - Failure to achieve life goals. - Failure to live up to personal moral code. - Sense of powerlessness. 4: Role performance: risk factors to look for are, - Loss of valued role. - Ambiguous role expectations. - Conflicting role expectations. - Inability to meet role expectations. 5: Personal strengths: many patients focus naturally on their deficiencies; asking pointed questions about personal strengths can help a patient identify positive factors.

Crisis

There are three types of crisis': 1: Maturational: crisis occur during developmental events that require role changes, such as when a teenager transitions into adulthood. 2: Situational: crisis occurs when a life event disrupts a person's psychological equilibrium, such as loss of a job or death of a loved family member. 3: Adventitious: crisis are accidental and unexpected events, resulting in multiple losses, and major environmental changes-such as fires, earthquakes, and floods-that involve not only individuals but also entire communities.