NRSE210 FINAL (cultural, DV, Elder, breast exam)

Acculturation

adopting ones culture and behavior of the majority culture because of this increasing diversity

Culture

• learned and shared beliefs, values, and life of a group that influenced ones thinking and actions

• learned, shared, adapted

• subcultures exist within cultures

Goals of transculture care

1) help people of same/ different cultures maintain their health, prevent illness

2) use knowledge about a specific cultures to provide beneficial, relevant, holistic care

Ethnocentrism

the tendency to view your own way of life as the most desirable, acceptable or best and act in a superior manner toward another cultures way of life

Cultural imposition

the act of imposing ones own culture’s values, beliefs, or practices onto another, often without consent and by disregarding or undermining the recipient culture

Kleinman’s tool

elicit health benefits in clinical encounters

• cause of problem?

• why/when, what do you think caused?

• fears, important, treatment

more questions, asking the patient in more depth in their opinion

Spirituality

an individual, personal quest for meaning and connection to something larger than oneself

religion

organized, social institution with specific beliefs, doctrines, and practices

Disease Causation Theories: Biomedical

cause and effect that can provide physical and psychological illness (ex. germ theory)

Disease Causation Theories: Naturalistic

Belief in the forces of nature that there is balance in the universe

• health exists when there is harmony between a person and their environment

• (ex. yin and yang theory)

Disease Causation Theories: Magico- religious

supernatural forces dominate, resulting in good versus evil supernatural forces with inflict illness on humans, sometimes as punishment for sin, in the form of evil spirit or disease- bearing foreign objects (ex. voodoo)

Types of IPV (intimate partner violence)

• physical- use of force that can cause injury, death, disability

• sexual- attempted or completed sex acts without consent

• stalking- repeated unwanted attention that leads to fear

• psychological aggression- emotional abuse, aggressor uses verbal / non verbal communication to control/harm

Mandatory reporting qualifications

only need suspicion of an event, no hard proof is needed

Health effects of violence

depression, panic attacks, trouble sleeping, PTSD, suicide, addiction, neuro problems

Screening for IPV question

“because IPV is so common in our society, were are asking all women the following question…”

IPV HITs Tool

Hurt, insult, threaten, scream

• has your partner hurt you, insult you, threaten you, scream or curse

IPV AAS tool

abuse assessment screen, women answer yes to questions we need to find out how current, serious, show concern offer help

Bruise dating

not 100% accurate

• hand marks/ finger marks can be seen

• newer bruises: red and purple

• older bruises: brownish and yellowing

Elder abuse rising

• aging population

• economic stress, different tendencies, elderly more vulnerable, medications cause higher bleeding risk

• Routine screenings should be done to assess for effect or abuse

Emotional Abuse

inflicting mental pain, anguish, or distress on an person through verbal/ non verbal acts

Exploitation

Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder

Warning signs

bruising, withdrawal from normal activities, changes in financial situations, bedsores, behavior changes, strained relationships

Tail of Spence

upper outer quadrant, extends into axilla

Glandular tissue

15-20 lobes

• in each lobe are a cluster of alveoli that produce milk to drain from the nipple

Cooper’s ligament

bands that attach breast tissue to chest wall muscles

Adipose tissue

fat, bulk of breast

Screen for retraction (cause, positions)

can be caused by growing neoplasm

• 4 positions

• hands slowly over their head, hands at their hips, hands at the front and press palsm together, lean forward

Palpation of breast (position, technique, focus)

• patient lay supine, one arm under head

• use pads of fingers and make rotation motion on the breast

• either start outward and move in or do lawnmower method

• focus on the tail of Spence as well as behind the nipple

If lump is felt on breast note

Location, size, shape, consistency, moveable, distinctness, nipple, skin over lump, tenderness, lymphadenopathy

Gail model

website to see an individuals risk of breast cancer

Abnormal findings: dimpling

sign of skin retraction

Abnormal findings: Edema

lymph obstruction produced edema, thickens skin

Abnormal findings: deviation in nipple pointing

cancer can cause fibrosis in glands, can pull nipple in different directions

Abnormal findings: nipple retraction

inverted nipple

Breast lumps: benign breast disease

• fibrocystic breast disease

• 50% prevalence

• cyclic discomfort (mystalgia)

• diffuse bilaterally nodularity, rubbery

Breast lumps: fibroadenoma

solidary, non tender mass, firm (marble), 1-5 cm

• common in ages 15-30 years old

• usually benign but r/o with bx

Breast lumps: cancer

solidary, unilateral, non tender, irregular

• most common location is UOQ

Nipple discharge concerning symptoms

bloody, spontaneous, lump or redness, changes in appearance or feel

Pagets Disease

clear nipple discharge, scabing crusting nipple, red flaking, nipple can become eroded

• tinging, itching

Abnormalities in male breast: Gynecomastia and carcinoma

• Gynecomastia: enlargement in breast tissue, can be unilateral, temporary, during puberty

• Carcinoma: cancer