SAQ 203/201

psychosis

illness of mind - peoples experiences move away from regular perception

social determinants of psychosis

• poverty

• prison populations

• intellectual disability

signs and symptoms of psychosis

• differences or distortion in perception; hallucinations, delusions, changes in thought process, disorganised or abnormal motor behaviour

• can be isolated or multiple episodes

contributing factors for psychosis

physical illness, lack of sleep, trauma, drug use

treatment for psychosis

• medication

• talk therapy

• good sleep hygiene

• trauma informed care

• sensory modulation

• coping strategies

• therapeutic communication

• health promotion

bipolar disorder

extreme mood swings between mania and depression

signs and symptoms bipolar disorder

• mania. hypomania

• abnormally elevated expansive or irritable mood

• manic phase; impulse energetic

• contributing factors; biological issues, family issues, social issues worldwide view and spirituality of person

bipolar disorder treatment + nursing interventions

• medications - mood stabilisers

• sensory modulation

• coping strategies

• good sleep hygiene

• interpersonal relationships to support and connect

depression

negative change in mood that has persisted for atleast 2 weeks, usually withdrawn, thinking intact

depression treatment + nursing interventions

• medication - antidepressants

• talk therapy

• sensory modulation

• sleep hygiene

• coping strategies

strengths-based approach

focus on identifying and learning a person’s positive qualities, resources and capabilities to promote health and wellbeing

shifting the focus

focus emphasis on what’s right instead of what’s wrong

recovery

living a meaningful, satisfying , purposeful, hopeful life in the presence or absence of symptoms

motivational interviewing

patient centred approach supporting behaviour changes. uses basic communication skills of reflection rather than lead the patient towards healthier outcomes

recovery model

a person centred-approach that emphasises living a meaningful life despite mental illness.

mindfulness

strategies include mindful moments in the nature or during activities

self-awareness

head to toe body scan; tension + discomfort. reconnect with body, slow deep breathing

sensory modualation

therapeutic approach that focuses on using a person’s senses to promote mental wellbeing and balance

sleep hygiene

adopting healthy habits + behaviours and changing environmental factors for good sleep

• regular sleep pattern

• prepare bedroom for sleep

• be active in the day

• pay attention to what you eat/drink

What is the focus of rehabilitation?

Optimizing functioning and reducing disability by addressing the impact of health conditions on a person's everyday life.

Who might need rehabilitation?

Anyone who has experienced an injury, disease, illness, or age-related decline in functioning.

Give examples of conditions that may benefit from rehabilitation

Spinal cord injury, stroke, traumatic brain injury, amputation, burns, rheumatoid arthritis, COPD.

Outline rehabilitation principles.

Understanding the person in their own context, developing a plan together with family and healthcare professionals using SMART goals, and supporting safe discharge.

List the steps of the nursing process

Comprehensive assessment, nursing diagnosis, plan/goals, implementation, and evaluation.

What does the acronym SMART stand for in goal setting?

Specific, Measurable, Achievable, Realistic, Time-framed.

What are non-communicable diseases (NCDs)?

Chronic diseases of long duration resulting from a combination of genetic, physiological, environmental, and behavioral factors.

List the main types of NCDs.

Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.

What are the life stages of child development?

Neonatal, infant, toddler, preschool, childhood, early adolescence, middle adolescence, and late adolescence.

What are the four principles of child development?

Child development proceeds along a predictable pathway; the range of 'normal' development is wide; various factors can affect child development; the child's development level affects examination.

Acute Model

Disease centered, Doctor focused, Passive patient, Focus on individuals, Secondary care emphasis, Episodic care

NCD Model

Person-centered, Team approach, Expert patient, Population health approach, Primary care emphasis, proactive planned intervention, Prevention/management focus

prevention

the protection of health by personal and community wide efforts

primary prevention

avoidance and exposure reduction to prevent cancer

secondary prevention

detect, diagnose, and treat early to stop the spread of cancer

tertiary

management of diagnosed cases to prevent progression, improve quality of life and survivorship

modifiable risk factors

nutrition, exercise, smoking, weight, environment

non-modifiable risks

genetics, age, gender, ethnicity, chronic inflammation, reproductive history

risk factors

aging, family history, ethnicity - african descent at highest risk and asian descent at lowest risk

diagnosing

mpMRI is gold standard, biopsy, imaging

T1

confined to prostate; cannot feel or see on USS

T2

confined to prostate; can be felt or seen on USS

T3

tumour has spread beyond the prostate

T4

tumour has spread to other organs

N0

nearby lymph nodes don’t contain cancer

N1

cancer cells present in lymph nodes near the prostate

M0

no metastasis

M1

cancer has spread to other body parts

M1a

cancer in lymph nodes outside the pelvis

M1b

cancer in bones

M1c

cancer in other organs such as lungs

treatments

• surgery → radical prostatectomy, TURP

• radiation

• Brachytherapy

• Chemotherapy

• Hormonal therapy

• Palliative care

screening

done via prostate specific antigen (PSA), blood test and digital rectal exam

what is breast cancer

begins in cells lining the milk sacs (lobules) and tubes (ducts) that take milk to the nipple

stage 0

ductal carcinoma - cancer cells formed inside the duct

lobular carcinoma (lobular neoplasia)

indicates increased risk of developing breast cancer - not breast cancer

invasive cancer

spread from ducts or lobules into surrounding tissues

risk factors

aging (over 50), family history, oestrogen exposure, breast density, race and ethnicity, chest radiation treatment

symptoms

breast lump, breast skin thickening or dimpling, lump or swelling in either/both armpits, change in shape or size of breast, new nipple inversion, crust nipple rash. discharge or bleeding from nipple, breast pain/discomfort

diagnosis

imaging, biopsy

breast cancer stage

refers to size and if spread

breast cancer grade

how tumour looks compared to regular cells and how fast it is growing

stage I

tumour <2cm, no axillary lymph node movement and metastasis

stage II

tumour 2-5cm, axillary lymph nodes may be involved, no metastasis

stage III

tumour >5cm, axillary lymph nodes usually affected, no metastasis

stage IV

tumour of any size, axillary lymph nodes usually affected and cancer has metastasised

treatment

surgery, chemo, radiation, hormone therapy, targeted treatment, palliative care

common type of cervical cancer

squamous cell carinoma

less common type

adenocarcinoma - starts in mucous producing cells

causes of cervical cancer

HPV (persistent), genetics

how does HPV cause cancer

HPV gains access to basal cells through cuts, breaks and micro-abrasions. it can cause viral replication and act on tumour genes causing cell immortalisation Immortal cells convert to malignant type.

modifiable factors

• multiple sexual partners

• immunosuppression

• smoking

• vaccinations

• routine screening

symptoms

• vaginal bleeding after sex

• vaginal bleeding after menopause

• bleeding between periods or heavier/longer periods

• ongoing pelvic pain or pain during sex

• persisten abnormal vaginal discharge

when can you have screening

25-69, sexually active

stage 0

abnormal cells found in first layer of cells lining cervix

stage II

cancer spread beyond the cervix to upper part of vagina

stage III

cancer spread throughout the pelvis and may involve lower vagina, ureters, surrounding lymph nodes

stage I

cancer is found in cervix only

stage IV

cancer spread to nearby organs or other body parts

cone biopsy

abnormal cell tissue removed from cervix

trachelectomy

removal of cervix

total hysterectomy

removal of uterus and cervix

radical hysterectomy

removal of uterus, cervix, fallopian tubes, ovaries, part of vagina and surrounding tissues. may include lymph nodes

primary prevention

immunisation against HPV. regular screening, practice safe sex