Nursing 204 Exam 1

Teaching

for the person to gain new knowledge through an interactive process

Learning

New knowledge or skills through practice and experience, applies information

Healthy literacy

Ability to find, understand, and act on health information

At risk for health literacy

elderly, minority, low income, chronic conditions, developmentally delayed

Strategies for health literacy

write everything at a 5th grade level, clear verbal and written communication, use preferred speaking and written language of the patient, reliable resources, encourage questions, use teach back method

Steps in the teaching-learning process

Assessment, diagnosis, planning, implementation, evaluation

Learning Domains

Cognitive (thinking) , affective (feeling), psychomotor (skills)

Cognitive

thinking, understanding information, describes, explains, lists ways of information taught. Teaching methods include lecture, discussion, printed materials

Affective

feeling, values beliefs, and attitudes. Positive feeling toward changing behavior. Teaching methods include role-playing, discussions, and simulations.

Psychomotor

skill, moving, practicing techniques, hands-on activities. Teaching methods include demonstrations, practice sessions, and return demonstrations.

Principles and methods of young & middle adults

learning must be relevant, see the need, peer education, encourage active & independent learning, sessions under an hour, practice skills in private

Principles and methods in older adults

Give time to process information and respond, teach when alert and rested, involve in discussion, focus on strengths, make adaptations for impaired senses, simple instructions, sessions short, one idea at a time, provide summary

Teaching older adults

talk slow and in a low tone, reduce noise level, comfortable temperature, lighting, privacy

Learning for Elders

teaching, time, relevance, roadblocks, sensory-perceptual deficits, cognitive declines, non-compliance
“The Teacher Really Really Says Poorly Decided Crazy Dumb Nerdy Catchphrases”

SMART objectives

Specific, measureable, attainable, realistic, timely

Assessment

Characteristics: age, developmental stage, level of education, health beliefs, motivation, health risks/problems
Needs: what patient knows and needs to know

Planning

Set goals with smart objectives

Implementation

make interventions to achieve the set goals

Evaluation

Teach back, have the needs been met

What is the order of the nursing process

ADPIE: Assess, diagnose, plan, implement, evaluate

Assess

Gather information about the patients condition

Diagnose

Identify the patient’s problems

Plan

Set goals fo care and desired outcomes and identify appropriate nursing actions

Implement

perform the nursing actions identified in planning

Evaluate

Determine if goals and outcomes are achieved

Primary patient data

directly from patient, anything the patient says

Secondary patient data

Anyone/anything except from the patient

Subjective data

Directly from patient, symptoms, what the patient says

Objective data

Nurses observations, signs, physical assessment, vital signs, labs, diagnostic tests

Maslows hierarchy of needs

physiological needs (air, water, food, shelter, sleep, clothing, reproduction)
Safety needs (personal security, employment, resources, health, property)
Love and belonging (friendship, intimacy, family, sense of connection)
Esteem (respect, self-esteem, status, recognition, strength, freedom)

Self-actualization (desire to become the most that one can be)

Independent implementation

does not require an order
Ex: vital signs, education, completing an assessment

Interdependent implementation

working with others on the healthcare team
Ex: working with PT, OT, pharmacy, lactation

Dependent implementation

requires an order
Ex: administering medications, drawing labs, sending patients for imaging

Clinical reasoning

how nurses think

Clinical judgement

how nurses decide

Primary prevention

doing anything to prevent getting an illness

Secondary prevention

interventions to detect and treat illness early like screenings

Tertiary prevention

treatments to help get rid of a disease

Healthy people

Health-promotion and disease prevention goals set by the US department of health and human services. Based every 10 years, these objectives aim to improve the health of the American population.

What is health?

State of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Holistic

Internal variables

developmental stage, intellectual background, perception of functioning, emotional factors, spiritual factors

External variables

family roles and practices, socioeconomic and psychosocial factors, cultural background

Health belief model

Perceived susceptibility, perceived seriousness, demographic variables, sociopsychological variables, percieved benefits, perceived barriers, likelihood of taking action, cues to action like social media

Transtheoretical model

Precontemplation: not consider changing >6months
Contemplation: considering changing within 6 months
Preparation: Actively considering changing in near or immediate future (30 days)
Action: Overt attempts to change; lasting less than 6 months
Maintenance: Change remains for longer than 6 months

Screening objectives

Primary: detection of a disease in its early stages
Secondary: reduce cost

Screenings

Done on asymptomatic individuals, determine risk and detect disease early, less invasive and simpler to perform

Diagnostic test

done on symptomatic individuals needing a diagnosis, provide accuracy and specificity with results, more invasive and complicated

Screening advantages

some are simple, can be cost effective, individual vs population, 1 test or multiple test screening, opportunity for health education

Screening disadvantages

false positives and false negatives

Morbidity

state of having a specific disease

Comorbidity

having more than one disease at the same time

Mortality

number of deaths that have occurred due to a specific disease

Incidence

rate of NEW cases of disease within a population over a defined period of time

Prevalence

proportion of the population that has disease including new and existing cases

Interobserver reliability

more than 2 people doing the screening, able to reproduce the same results

Intraobserver reliability

1 person does the screen

Sensitivity validity

positive results, produces very few false negatives

Specificty validity

negative results, produces very few false positives

USPSTF

independent panel that recommends screenings, preventive medication, and counseling services, recommends with a letter grade (A,B,C,D, I), does not consider costs, applies to people without signs/symptoms of a disease

Breast cancer

Mammogram: grade B for women aged 40-74, every other year screening. I statement for women aged 75 and older and women with dense breasts

STI behavioral counseling

Grade B for sexually active adolescents and older adults who are at risk for STIs

Folic acid

Grade A for a person who is planning or could become pregnant

Hearing loss in older adults

Grade I due to insufficient assessments of the balance of benefits and harms of screening for hearing loss aged 50 and older

Prostate cancer

Grade C for lose 55-69 and grade D for men over 70

Pancreatic cancer

Grade D for asymptomatic adults

Relaxation

exercises that decrease stress effects on mind and body, lowers BP and heart rate, decreases muscle tension, and promotes overall well-being.

Meditation/breath work

self-directed practice of relaxing the body and calming the mind using focused rhythmic breathing. Lowers BP, decreases depression, anxiety, and distress

Imagery

Concentrating on images to stimulate physical changes in the body. Control or relieve pain, decrease nightmares, improve sleep

Biofeedback

mind and body technique that uses instruments to teach self-regulation and self-control over physiological responses. Gives patients a sense of control over their physiological responses and emotions

Traditional Chinese Medicine

Ancient healing traditional focused on the yin/yan energy balance. 4 assessments that evaluate the whole person

Acupuncture

relieving pain pr altering function by inserting think needle along a series of lines aor channels to redirect energy

Therapeutic touch

Practitioner lays hands on or close to the body to direct energy flow

Chiropractic therapy

Manipulating the spinal column to promote healthy energy flow and restore structural and functional imbalances

Natural products/herbal therapy

plant-based therapies used for specific symptoms or issues

Stress

Response to an actual or alleged hazard to the balance of homeostasis, brought by an external factor, can be positive or negative

Anxiety

Excessive worries that don’t go away even in the absence of a stressor, triggers are internal, can interfere with how the individual lives

Alarm in the general adaptation syndrome

body reacts to stress with sympathetic nervous system response (fight/flight)

Resistance

Adaptation to stress with sustained release of cortisol and epinephrine

Exhaustion

Body’s resources are depleted and body cannot cope with long-term effects of stress

Acute symptoms of stress

Increased heart rate and respirations, increased serum glucose, increased muscular strength, decreased gastric movement, decreased urine production (antidiuresis), increased sweat

Chronic symptoms of stress

Sleep pattern changes, fatigue, digestion change, loss of sex drive, headaches, aches and pains, infections, indigestion, rashes, hypertension, depression, anxiety, autoimmune diseases

Mild level of anxiety

Irritability, restlessness, and insomnia

Moderate level of anxiety

An increase in physiological functions and psychomotor involvement, may experience headaches, stomach aches, palpitations at a mild rate, narrowed but present focus

Severe level of anxiety

Hyperactive with all energy aimed at relief of physical and emotional symptoms, panic, paralysis of functioning can occur, complete lack of focus

Responses to patients who have anxiety/stress

Keep yourself safe, apply therapeutic communication skills, modify environment to make it calm, offer spiritual support, encourage social support, consider therapy and medications

Compensation

using individual abilities/strengths to overcome feelings of inadequacy

Denial

Refusing to admit the reality of the situation/feeling

Displacement

transferring emotional energy away from an actual source of stress to person/object

Dissociation

experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings; disconnection from reality

Regression

Reverting to behaviors consistent with earlier stages of development

Repression

storing painful/hostile feeling in the unconscious causing them to be forgotten

Nonverbal communication

personal appearance, posture & gait, facial expressions, eye contact, gestures, sounds, territoriality & personal space (18-40 inches away)

Verbal communication

Vocabulary, pacing, tone, clarity & brevity, timing & relevance

Therapeutic communication

promotes personal growth, and helps patients reach their health-related outcomes. Develops in healthcare settings, distinct boundaries, focuses on the patient, topics are based on goals, confidential

Social communication

Develops in a multitude of settings, boundaries less clear, focuses on both parties, topics are ongoing, may consider private

Active listening

Sit at an angle facing the patient, legs and arms uncrossed, relax, eye contact, touch, your intuition

Sharing observations

Gently telling the patient what you notice about their behavior, appearance, or mood to help them feel seen and supported

Sharing empathy

Statements are a neutral and nonjudgmental recognition of the patient’s feelings; they demonstrate that you were listening help to establish trust

Sharing humor

Using light and appropriate jokes or laughter to help build connection, ease tension, and bring comfort to the patient

Sharing feelings

helping patients express emotions by making observations, acknowledging feelings, encouraging communication, giving permission to express negative feelings