Funds Exam 2

Modules 4,5,6

Morbidity

Morbidity

How frequently a disease occurs

Mortality

Number of deaths resulting from a disease

Wellness

an active state of being healthy by living
a lifestyle promoting good physical, mental, and
emotional health

Disease

medical term, referring to pathologic
changes in the structure or function of the body or mind

Illness

the unique response of a person to a
disease; an abnormal process involving changed level of functioning

Stages of Illness Behavior

Stage 1: Experiencing symptoms
Stage 2: Assuming the sick role
Stage 3: Assuming a dependent role
Stage 4: Achieving recovery and rehabilitation

Health Equity

attainment of the highest level of health for all
people

Health disparity

particular type of health difference that is
closely linked with social, economic, and/or environmental disadvantage

Social determinants of health

conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks

Human dimensions affecting health

Physical dimension—genetic inheritance, age,
developmental level, race, and gender

Intellectual dimension—cognitive abilities,
educational background, and past experiences

Intellectual dimension—cognitive abilities,
educational background, and past experiences

Emotional dimension—how the mind affects body function and responds to body conditions

Environmental dimension—housing; sanitation;
climate; pollution of air, food, and water

Sociocultural dimension—economic level, lifestyle, family, and culture

Spiritual dimension—spiritual beliefs and values

Modifiable risk factor

things a person can change

Nonmodifiable

things that cannot be changed

Primary Health Promotion

directed toward promoting health and
preventing the development of disease processes or injury

o Examples are immunization clinics, family
planning services, poison-control information,
and accident-prevention education

Secondary Health Promotion

focus on screening for early detection of
disease with prompt diagnosis and treatment of any found

o Examples are assessing children for normal
growth and development and encouraging
regular medical, dental, and vision examinations

Tertiary Health Promotion

Begins after an illness is diagnosed and
treated, with the goal of reducing disability and
helping rehabilitate patients to a maximum level of functioning

o Examples include teaching a patient with
diabetes how to recognize and prevent
complications, using physical therapy to prevent
contractures in a patient who has had a stroke
or spinal cord injury, and referring a woman to a
support group after removal of a breast because of cancer

Health Belief Model (Rosenstock)

• Concerned with what people perceive to be true about themselves in relation to their health

• Modifying factors for health include demographic,
  sociopsychological, and structural variables

• Based on three components of individual
  perceptions of threat of a disease
  o Perceived susceptibility to a disease
  o Perceived seriousness of a disease
  o Perceived benefits of action

Health Promotion Model (Murdaugh)

• Developed to illustrate how people interact with
  their environment as they pursue health

• Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivate health-promoting behavior

• Personal, biologic, psychological, and sociocultural factors are predictive of a certain health-related habit

• Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan

• Three additional variables:
  o Activity-related affect
  o Commitment to a plan of action
  o Immediate competing demands and preferences
  

• Behaviors may induce either a positive or a negative
  subjective response or affect

Health Illness Continuum

• Conceptualizes a person’s level of health

• Views health as a constantly changing state with high-level wellness and death on opposite sides of a
  continuum

• Illustrates the dynamic (ever-changing) state of health as a person adapts to changes in internal and external environments to maintain a state of well-being

Agent–Host–Environment Model (Leavell
and Clark)

• Views the interaction between an external agent, a susceptible host, and the environment as causes of
  disease in a person

• It is a traditional model that explains how certain factors place some people at risk for an infectious disease

• These three factors are constantly interacting, and a combination of factors may increase the risk of
  illness

• The use of this model is limited when dealing with noninfectious diseases

Stages of Change Model (Prochaska and
DiClemente)

• Used by counselors addressing behaviors including
  injury prevention, addiction, and weight loss

• Stages
  o Precontemplation
  o Contemplation
  o Determination: Commitment to Action
  o Action: Implementing the Plan

Maslow’s Hierarchy

• Physiologic

• Safety and Security

• Love and Belonging

• Self Esteem

• Self Actualization

Family

any group of people who live together and depend on one another for physical, emotional, and financial support

Nuclear family

traditional family; two parents and their
children

Extended family

includes aunts, uncles, and grandparents

Blended family

two parents and their unrelated children from
previous relationships

Single-parent family

may be separated, divorced, widowed, or
never married

Cohabitating adults

unmarried adults; communal or group
marriages

Rest

refers to a condition in which the body is in a
decreased state of activity, with the consequent feeling of being refreshed

Sleep

• is a state of rest accompanied by altered consciousness and relative inactivity

• Sleep is a period of inactivity and restoration of
  mental and physical function

Reticular activating system (RAS)

• Facilitates reflex and voluntary movements

• Controls cortical activities related to state of
  alertness

• Hypothalamus—control center for sleeping and waking

Non-rapid eye movement (NREM)

• Consists of four stages

• Stages I and II: 5% to 50% of sleep, light sleep

• Stages III and IV—10% of sleep, deep-sleep states (delta sleep)

Rapid eye movement (REM)

• 20% to 25% of a person’s nightly sleep time

• Pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase; skeletal muscle tone and deep tendon reflexes are depressed

Stage 2 sleep

• In stage II of NREM sleep, the person
  falls into a stage of sleep but can be aroused with ease.

• In stage I, the person is in a transitional stage
  between wakefulness and sleep.

• In stages III and IV, the depth of sleep increases, and arousal becomes increasingly difficult.

Sleep Cycle stages

• Wakefulness

• NREM 1

• NREM 2

• NREM 3

• NREM 4

• NREM 3

• NREM 2

• REM

• NREM 2

Barbiturates, amphetamines, and antidepressants increase REM sleep.

A. True
B. False

False

Effects of Insufficient Sleep

• May affect normal growth and development in children

• May increase obesity risk in both children and adults

• Lowers leptin levels and elevates ghrelin levels
  o Leptin: hormone that tells the brain to stop eating
  o Ghrelin: promotes continued eating

Lifestyle habits that affect sleep (exercise, dietary habits, smoking)

• Activity and exercise increase fatigue and can promote relaxation followed by sleep; increases both REM and NREM sleep; contributes to a more restful sleep

• Dietary habits:
  o Amino acid L-tryptophan promotes sleep
  o Small protein snack combined with a healthy complex carbohydrate before bed improves sleep
  o Large quantities of alcohol limit REM and delta sleep
  o Caffeine blocks the ability of adenosine to cause drowsiness

• Smoking and nicotine are associated with poorer sleep

Illnesses associated with sleep disturbances

• Gastroesophageal reflux

• Coronary artery diseases

• Epilepsy seizures

• Liver failure and encephalitis

• Hypothyroidism

• End-stage renal disease

Medications that Affect Sleep

• Amphetamines

• Antidepressants

• barbiturates

• Diuretics

• Caffeine

Insomnia

• Characterized by difficulty falling asleep, intermittent sleep or difficulty maintaining sleep, despite adequate opportunity and circumstances to
  sleep

• As many as 30% to 35% of adults in the United States complain of insomnia

• People with a history of depression are more likely to experience insomnia

• Many cases of insomnia are related to disruptions in circadian rhythms

• Insomnia may be short term or chronic in nature

Obstructive Sleep Apnea

• Characterized by five or more predominantly obstructive respiratory events

• The absence of breathing (apnea)

• Diminished breathing efforts (hypopnea)

• Respiratory effort-related arousals during sleep, accompanied by sleepiness, fatigue, insomnia, snoring

• Subjective nocturnal respiratory disturbance

• Observed apnea and associated health disorders

• Gasping for air during sleep

Idiopathic hypersomnia

Characterized by excessive sleep, particularly
during the day

Narcolepsy

• Characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep

• Up to 70% of people with narcolepsy also experience cataplexy, the sudden, involuntary loss of skeletal muscle tone lasting from seconds to one or two minutes

Characteristics of Circadian Rhythm
Sleep–Wake Disorders

• Chronic or recurrent pattern of sleep–wake rhythm disruption

• Primary causes:
  o An alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep–wake schedule desired or required

• A sleep–wake disturbance (e.g., insomnia or excessive sleepiness)

• Associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder)

Restless Legs Syndrome (RLS)

• Restless legs syndrome (RLS), also known as Willis– Ekbom disease (WED), is a common sleep-related
  movement disorder that affects up to 15% of the population, most often middle-aged and older adults

• People with RLS cannot lie still and report unpleasant creeping, crawling, or tingling sensations in the legs

• Nonpharmacologic treatments

Screening Tools to Assess Sleep
Disturbances

• Sleep Diary

• The Epworth Sleepiness Scale

• The Pittsburgh Sleep Quality Index (PSQI)

• STOP-Bang Questionnaire (OSA)

• Stanford Sleepiness Scale

Sleep Characteristics to Assess

• Restlessness

• Sleep postures

• Sleep activities

• Snoring

• Leg jerking

Key Findings of Physical Assessment

• Energy level

• Facial characteristics

• Behavioral characteristics

• Physical data suggestive of sleep problems

Nursing Interventions to Promote Sleep

• Prepare a restful environment

• Promote bedtime rituals

• Offer appropriate bedtime snacks and beverages

• Promote relaxation and comfort

• Respect normal sleep–wake patterns

• Schedule nursing care to avoid disturbances

• Use medications to produce sleep

• Teach about rest and sleep

Treatment for Dyssomnias

• Pharmacologic therapy
  - Sedatives
  - Hypnotics

• Nonpharmacologic therapy
  - Cognitive behavioral therapy (CBT)

• Progressive muscle relaxation measures

• Stimulus control
   Sleep restriction; sleep hygiene measures
   Biofeedback and relaxation therapy

Assessment

• Health history: Social,
  medical, family, surgical

• Objective vs subjective data

• “Normal” vs abnormal findings

• Source credibility

• Assumptions and
  inconsistencies

• Physical examination

• Consultations

• Lab and other diagnostics

• Therapies and other health care professionals

• Review of systems (ROS)
  

Nursing Diagnosis

• Two part: Problem and etiology

• Three part: Problem, etiology, signs/symptoms

• Descriptors: Decreased, dysfunctional, impaired, ineffective, or situational

A registered nurse is formulating nursing diagnoses for a patient with multiple fractures. Which actions does the nurse take during this step of the nursing process? Select all that apply.
A. Conducting a nursing interview to collect patient data
B. Analyzing data collected in the nursing assessment
C. Developing a care plan for the patient
D. Pointing out the patient’s strengths
E. Assessing the patient’s mental status
F. Identifying community resources to help the family cope

b, d, f. Diagnosing includes identifying actual or potential health problems for individuals, groups, or communities; identifying factors that contribute to or cause health problems (etiologies); and identifying resources or strengths the individual, group, or community can draw on to prevent or resolve problems. The nurse assesses and collects patient data in the assessment step and develops the care
plan during the planning phase of the nursing process

A nurse in the psychiatric clinic is developing a problem list for a patient. What statement best reflects a correctly written, two-part problem?
A. Difficulty Coping: Impaired Family Coping Etiology: inability to maintain marriage
B. Difficulty Coping: Impaired Acceptance of Health Status Etiology: anger management issues
C. Impaired Cognition: Distorted Thought Process Etiology: psychosis as evidenced by hallucinations
D. Impaired Cognition: Decisional Conflict Etiology: placement of parent in a long-term care facility

d. A correctly written two-part problem statement includes the health problem and the etiology or cause. The problem statement and etiology should avoid signs and symptoms,
medical diagnoses, and something that cannot be changed. Inability to maintain marriage and anger issues do not identify the underlying cause of the problem and may themselves reflect the true problem. Psychosis is a medical diagnosis, which should not be used to support a patient problem

A nurse is caring for a patient who has been admitted the second time this month for hypertensive emergency. The care plan contains the health problem: Nonadherence. Etiology: lack of knowledge of purpose
of medications. Signs and symptoms: BP, 220/112; readmitted for hypertensive crisis after 2 weeks. When meeting the patient, which action will the nurse take first?
A. Teach the patient that nonadherence may lead to stroke and heart disease
B. Discuss what will motivate the patient to adhere to the medication regimen
C. Explain that these medications are essential to their health and illness prevention
D. Determine the patient’s knowledge about the
medications and their side effects

d. Using the nursing process, the nurse first assesses the patient’s knowledge base; this also confirms the accuracy of the problem statement. Problem statements with
unclear etiologies may lead to inappropriate, erroneous, or unhelpful interventions. If the
patient has difficulty affording medications or is experiencing side effects, a collaborative
problem can be resolved jointly by the nurse, social worker, and health care provider.

Types of planning

• initial

• ongoing

• discharge

• standard care plan

SMART goals

• Specific

• Measurable

• Attainable

• Realistic

• Timely

A nurse is planning care for a patient admitted to the hospital for treatment of a drug overdose. What actions will the nurse take
during the outcome identification and planning step of the nursing process? Select all that apply.
A. Formulating nursing diagnoses
B. Identifying expected patient outcomes
C. Selecting evidence-based nursing interventions
D. Explaining the nursing care plan to the patient
E. Assessing the patient’s mental status
F. Evaluating the patient’s outcome achievement

b, c, d. During the outcome identification and planning step of the nursing process, the nurse, patient, and family collaborate to
establish priorities and identify and write expected patient outcomes. The nurse
selects evidence-based nursing interventions, and communicates the care plan. These steps may overlap; however, formulating and validating nursing diagnoses are typically performed during the diagnosing step. Assessing mental status is part of the assessment step, and evaluating patient outcomes occurs during the evaluation step of the nursing process

Protocols

written plans that detail the nursing activities to be executed in specific situations

Standing orders

• empower the nurse to initiate actions that ordinarily require the order or supervision of
  a health care provider
  - admission protocols for obstetrics
  - protocols for bowel programs
  - standard orders for narcotic overdoses
  - standard orders for pain management

Care Bundles

• Set of 3-5 EBP that when performed
  together are proven to improve patient
  outcomes

• Consistent completion
  Ties practices together into a package of interventions
  - Every client every time
  - Examples: Central line bundle, ventilator bundle

A nurse is caring for a group of patients. Which actions are appropriate to include in the implementation phase of care? Select all that apply.
A. Changing the dressings on a burn victim’s arm
B. Assessing a patient’s nutritional intake
C. Formulating a nursing diagnosis for a patient with epilepsy
D. Turning a patient in bed every 2 hours to prevent pressure injuries
E. Checking a patient’s insurance coverage at the initial interview
F. Determining availability of community resources for a patient with dementia

a, d, f. During the implementing step of the nursing process, nursing actions that were formulated during the planning process are carried out. The purpose of the implementation phase is to assist the patient in achieving valued health outcomes, for example
promote health, prevent disease and illness, restore health, and facilitate coping with altered functioning. Assessing a patient’s nutritional status or insurance coverage occurs in the assessment step, and formulating nursing diagnoses occurs in the diagnosing/analyzing step.

A visiting nurse is following up with a patient who was given a prescription for a diuretic and told to chart her weight daily. The patient’s weight has increased 5 lb since the nurse’s last visit. What actions will the nurse take first?
A. Explain to the patient that it is clear she is not adhering to her prescription and the health care provider will be notified
B. Document the 5-lb weight gain and ask the patient about sodium intake and medication side effects
C. Terminate the plan of care while determining the cause for the weight gain
D. Encourage the patient to continue the prescription and return in 1 week

b. The nurse documents the goal has not yet
been achieved and also suspects the patient
has not adhered to the prescription, perhaps
due to frequent urination or other side effects.
The nurse further assesses the patient’s
understanding of the medication’s purpose and
effects, understanding of the disease process
and complications

Freud Theory

Theory of Psychoanalytic development

Jean Piaget Theory

Theory of Cognitive Development

Erickson Theory

Theory of Psychosocial Development

Stages of Freud Psychosexual Theory (OAPLG)

• Oral Stage: birth to 18 months

• Anal Stage: 18 months to 3 years

• Phallic Stage: 3-7 years

• Latency Stage: 7-12 years

• Genital Stage: 12-20 years

Stages of Piaget’s cognitive development theory (SPCF)

• Sensorimotor: birth to 3 years

• Preoperational: 3-7 years

• Concrete Operational: 7-12 years

• Formal Operational

Stages of Erickson’s Development Theory (TAIIIIGE)

• Trust v mistrust: infant

• Autonomy v shame and doubt: toddler

• Initiative v guilt: preschool

• Industry v inferiority: school aged

• Identity v role confusion: adolescence

• Intimacy v isolation: young adult

• Generativity v stagnation: middle adulthood

• Ego integrity v despair: later adulthood

Freud Oral Stage

Birth to 18 months: infant uses mouth as the major source of gratification and exploration (biting, eating, chewing, sucking)

Freud Anal stage

18 months to 3 years: Bowel and bladder control

Freud Phallic stage

3-7 years: interest in sex differences

Freud Latency Stage

7-12 years: increased sex role identification

Freud Genital Stage

12-20 years: overt sexual relationships

Piaget’s Sensorimotor stage

Birth to 3 years: basic reflexes to beginning to develop reasoning and anticipate events

Piaget’s preoperational stage

3-7 years: Use of symbols; pictures and increased lang

Usage, play activities important

Piaget’s concrete operational stage

7-12 years: logical thinking develops, incorporate another’s perspective , feelings and thoughts are unique

Piaget’s formal operational stage

Abstract thinking/ deductive reasoning, test beliefs to establish values and meaning of life

Erickson’s trust V mistrust stage

Infant: rely on caregivers for basic needs

Erickson’s autonomy v. shake and doubt stage

Toddler: learn independence: dress, feeding, toileting self

Erickson’s initiative v guilt stage

Preschool: actively seeks out new experiences, gains confidence

Erickson’s industry v inferiority stage

School aged: gains pleasure from finishing projects and receiving recognition

Erickson’s identity v role confusion stage

Adolescence: hormonal and physical changes, rebellion

Erickson’s intimacy v isolation stage

Young adult: establish relationships

Erickson’s Generativity v stagnation stage

Middle adulthood: involvement with family, friends, and community, concern with the next generation/ make contribution to the world

Erickson’s integrity v despair stage

Later adulthood: sense of fulfillment and purpose