Nurse Concepts III (revised III)

Who is Lillian Wald?

She created public health nursing

What makes a community?

People, Place, and Function

What is a aggregate?

a group of people with shared interests, concerns, and values

What is a community of solution?

people working together to address a common health problem

What are geopolitical boundaries?

City limits, census tracts, voting precincts, and school districts

What are non-geopolitical boundaries?

neighborhoods, dorm, camp

What are the core functions of public health?

1. Assessment

2. Policy Development

3. Assurance

What are the three common characteristics of community health?

Status, structure, process

What is public health?

community efforts designed to prevent disease and promote health. focuses on a whole population

What is community health?

health promotion in a specific area

What is population health?

Focuses on the needs of a specific group

What is community based care?

illness care in community

What is community oriented care?

nurses focus on making change in a whole population

What is utilitarianism?

maximize benefit and minimize harm

What is distributive justice?

treating people fairly and distributing resources

What is nonmaleficence?

Do no harm

What is beneficence?

maximize possible benefits and minimize harm

What is a downstream approach?

represents actions taken after disease or injury has occurred

What is an upstream approach?

focuses on eliminating the factors that increase risk to a population's health

What is level one/primary preventions?

prevention of problems before they occur: vaccinations

What is level two/secondary preventions?

Early detection and intervention

What is level three/tertiary preventions?

correction and prevention of deterioration of a disease state

What are social determinates of health?

1. Economic stability

2. Education

3. Health care system

4. Neighborhood and physical environment

5. Social and community context

6. Food

What is healthy people 2030?

Provides science-based, 10-year national objectives for improving the health of all Americans.

What is the asset based community development model?

focuses on the capacities and gifts people had to fix deficiencies and needs

What is the ecological model?

Recognizes that the same environment may have different impacts on individuals

What is the CHANGE model?

Community health assessment and group evaluation. Used to identify strengths and resources.

What is the vulnerability model?

includes four domains (biological. sociocultural, behavioral, and environmental) that contribute to what makes a vulnerable population

What is included in family structure?

number of members, age and gender, relationship between members, family interaction with society. *family roles may change over times

What are the characteristics of a healthy family?

commitment, appreciation and affection, positive communication, enjoyable time together, spiritual well-being, ability to cope with stress and crisis

What are the characteristics of a dysfunctional family?

arises with conflict, instability in family structure results in dysfunction, difficulty identifying/solving problems, may cause continual crises

What is family resilience?

ability to grow stronger, allows for healthy coping skills

What are approaches to family nursing?

family as context, family as client, family as system, family as component of society

What is family as context?

individuals as foreground, family as background

What is family as client?

family as foreground, individual as background

What is family as system?

interactional family

What is family as component of society?

the family is a unit of society that interacts with other units in our society to exchange or receive services

What are family genograms?

Used to asses and predict future family patterns

What are family ecomaps?

•Visual illustration of family in relation to community resources

•Type of line depicts strength of the relationship

•Depicts resources, strengths, and needs

What are methods of data collection in communities?

informant interviewing, participant observation, windshield surveys, secondary analyses of existing data, surveys, community forum, focus groups, needs assessment, capacity inventory (gifts/talents community has), photovoice (community given a topic and people take pictures of what they seem)

What is census data?

An official count of individuals in a population, occurring every 10 years

What are presumptive signs of pregnancy?

amenorrhea (absence of menstruation)

fatigue, nausea/vomiting

urinary frequency, breast changes

quickening (first feel of the baby, feels like a flutter)

uterine enlargement

What are probable signs of pregnancy?

Herger's sign (softening/compression of lower uterus)

Chadwick's sign (cervix gets dark blue/violet)

Braxton Hicks (false labor)

What are positive signs of pregnancy?

Positive pregnancy test

Fetal heart sounds

Visualization of ultrasound

Fetal movement

What is human chorionic gonadotropin (hCG)?

Basis for pregnancy testing and is produced in corpus luteum. Rises quickly very early in pregnancy (placenta function takes over)

What is progesterone?

Establishes placenta

Maintains health of uterine wall

Supports blood vessel growth

Prevents uterine contractions

What is estrogen?

Promotes blood vessel growth

Maintains uterine lining

Aids in fetal organ development

What is prolactin?

Simulates breast growth

Stimulates breastmilk production

What is relaxin?

Promotes uterine relaxation, cervical softening, and maternal vasodilation

What is oxytocin?

Stimulates uterine contractions

Release of prostaglandin

What is striae gravidarum?

Stretch marks

What is linea nigra?

Single dark vertical line on the abdomen

What is melasma?

hyperpigmentation associated with pregnancy

What happens to maternal blood volume during pregnancy?

Increases by about 20%

What happens to maternal heart rate during pregnancy?

It Increases

What happens to the clotting factor during pregnancy?

Increases, leads to 5x greater risk for blood clots

What happens to venous pressure in lower extremities during pregnancy?

Increase, leads to increased risk for varicose veins

What happens to peripheral vascular resistence during pregnancy?

It decreases, leads to a decrease in BP

What happens to hematocrit values during pregnancy?

It decreases, decreased blood viscosity

What happens to the respiratory system during pregnancy?

Has an increased need for O2, which leads to increased resp. rate

What happens to the gastrointestinal system during pregnancy?

Upward pressure from the uterus causing heart burn, decreased gastric emptying

What happens to the genitourinary system during pregnancy?

Increased cardiac output and blood volume leads to increase in kidney size by 30%, increase in urine output. *watch glucose and protein secretion

What happens to the cardiorespiratory system at eight weeks after fertilization?

Heartbeat is detectable with ultrasound

What happens to the cardiorespiratory system at 12 weeks after fertilization?

Heartbeat is detectable with doppler

What happens to the gentiourinary system at 12 weeks after fertilization?

Kidneys begin producing urine

Male and female external genitalia can be distinguished

What happens to the cardiorespiratory system at 20 weeks after fertilization?

Heartbeat is detectable with regular fetoscope

What happens to the musculoskeletal system at 20 weeks after fertilization?

Fetal movements felt by mothers and may be palpable by an experienced examiner

What happens to the integumentary system at 20 weeks after fertilization?

Skin is thin and covered with vernix caseosa. Brown fat production complete. Nipples begin to develop

What happens to the cardiorespiratory system at 24 weeks after fertilization?

Alveoli have developed. Surfactant production in lungs begins. Respiration is possible.

What happens to the cardiorespiratory system at 28 weeks after fertilization?

Sufficient alveoli, surfactant, and capillary network to allow respiratory function, although respiratory distress syndrome is common

What happens to the cardiorespiratory system at 32 weeks after fertilization?

Surfactant production nears mature levels. Respiratory distress is still possible. Fetal heart rate variability gradually increases towards full term.

What happens to the cardiorespiratory system at 38 weeks after fertilization?

Newborn infant has approximately one eight to one sixth the number of alveoli of an adult; well-developed ability to exchange gas

What happens to the gentiourinary system at 38 weeks after fertilization?

Both testes are palpable in scrotum at birth. The newborns girls ovaries contain approximately 1 million follicles.

What is pregnancy care for first trimester?

Present/past health history, family history, menstrual history, sexual history

What information is needed during a first prenatal visit?

obstetrical history

estimated date of birth

substance use

STI's

mental health history

partner violence (increases as pregnancy happens)

What is GTPAL?

G: Gravidity- includes all pregnancies, including present

T: Term pregnancies (38+weeks)

P: Preterm pregnancies (20-37 weeks)

A: Abortions/miscarried pregnancies (

What is Nagele's rule?

1st day of last menstrual cycle minus 3 months plus 7 days = estimated date of delivery

What are screenings and diagnostic tests preformed during the first trimester of pregnancy?

Urine pregnancy test

CBC with diff.

Blood type and Rh factors

Rubella titer

STI test

Pap test

Mental health

What is pregnancy education during the first trimester?

Weight gain/nutrition (25-35lbs during pregnancy) (15-25lbs if overweight, 35-45lbs if underweight)

Nausea, vomiting, and heartburn (bland diet)

Exercise (mild 2-3x per week)

Sleep (sleep on side)

Pets (cats, don't touch cat litter)

Sexual Intercourse (can continue throughout pregnancy)

Travel is fine

What is pregnancy care for second trimester?

Prenatal visits (every 4-6 weeks)

Physical examination (check weight, BP, HTN, preeclampsia, blood test, fundal ht., maternal screening)

Lab testing

Diagnostic testing

What are screenings and diagnostics done during second trimester?

Repeat CBC

1-hours glucose tolerance test

MSAFP screen

Mental health

What is alpha-fetoprotein screening?

AFP assessment is performed on maternal serum or amniotic fluid to identify open body wall defects (neural tube defects) and chromosomal anomalies (trisomy 21). Performed during week 16-18 of gestation. Requires a blood sample.

What risks come with amniocentesis?

Done at age 35 or older, if there were pregnancies with multiple spontaneous abortions, or is someone has a chromosomal abnormality in close family member.

Risk of contractions and early birth

What is second trimester pregnancy education?

Fetal movements (kick count, at least 10 in 12 hours)

Body changes and discomfort

Birth and newborn care (birthing classes)

Sexual intercourse (can continue)

Travel and vaccines (can travel as long as no complication, no longer than 4hr at a time)

Warning manifestations- Braxton hicks, bleeding, fluid leakage, preeclampsia (leakage, blurred vision, increased BP)

What is supine hypotension?

An abnormal reduction in blood pressure related to position (lying on the back).

Symptoms: faint, nausea, dizzy, lapse of consciousness

What is third trimester pregnancy care?

Prenatal care (every week after 36 weeks)

Physical examination (fundal ht, fetal HR, weight gain, fluid leakage, edema

Lab tests (ultrasound to check baby positioning)

Post term pregnancy

What are screenings and diagnostics for third trimester?

Group B strep testing at 36+ weeks

Screening and diagnostic ultrasound

Mental health

What is pregnancy education during the third trimester?

Body changes and discomfort

Fetal movement

Travel and vaccines (no travel)

Sexual activity (can continue)

Manifestations of labor (contraction, amniotic fluid leakage)

Birthing plan

What are the stages of labor?

Stage 1 - Early labor and active labor

Stage 2 - Child born

Stage 3 - Placenta

What is mechanical initiation of respiration for a newborn?

Contractions push on the baby's chest expelling fluid

*c-section may need more help expelling fluid due to less contractions

What is chemical initiation of respiration for a newborn?

The cord gets cut, O2 goes down and CO2 goes up which sends a signal to the brain to breathe

What is sensory initiation of respiration for a newborn?

Human touch, light, and noise causes baby to startle which makes them breathe

What is thermal initiation of respiration for a newborn?

The shift from warm fluid to cold room air

What are the five cardiovascular adaptations that happens to a newborn after birth?

1. Umbilical Cord

2. Ductus Venosus

3. Foramen Ovale

4. Ductus Arteriosus

5. Umbilical Artery

What happens with the umbilical cord that helps maintain the newborns circulatory system?

Brings up blood to the heart. When the cord is clamped it increase resistance so that the blood doesn't glow back and so the blood clots

What happens with the ductus venosus that helps maintain the newborns circulatory system?

Doesn't need to flow blood, so it clots off

What happens with the foramen ovale that helps maintain the newborns circulatory system?

Closes because there is more pressure on the left side of the heart than there is on the right side

What happens with the ductus arteriosus that helps maintain the newborns circulatory system?

Smooth muscle senses an increase in O2 levels and starts to constrict. Also senses placenta was removed by noticing decrease in prostaglandin levels.

What happens with the umbilical artery that helps maintain the newborns circulatory system?

Has smooth muscle that constricts until the resistance where the cord is and can't go past which creates a space

How many veins and arteries are there in the umbilical cord?

two arteries, one vein