conception; this marks the beginning of prenatal development
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stages of life
prenatal, newborn, infancy, childhood, adolescence, adulthood, late adulthood
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how is each life stage characterized
by unique physical, cognitive, and emotional changes
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cephalocaudal principle
development is head to toe progression
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proximodistal principle
development is from the center of the body outward
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simple to complex principle
development is in an orderly fashion from simple to complex
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continuous principle
development is a continuous process characterized by periods of growth and then periods of slow/steady growth
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general to specific principle
development occurs from large to small muscle movement
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Large: move arm Small: writing
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individualized rates principle
development varied from individual to individual (own growth timetable, own rate of development)
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Toddlerhood
12-36 months (time of great physical, cognitive, and psychosocial development)
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Adolescents
dramatic physical, cognitive, and psychological growth (a transition period between the onset of sexual maturity and ending growth with movement toward emotional maturity)
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young adults
complete physical growth by 20yrs old, all organs are fully developed (brain continues until 25)
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Age 65+
fastest growing age demographic in the US
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Freudian Theory
adult personality is the result of moving successfully from one psychosexual stage to another and that failure to resolve conflicts or being fixed in any of the stages results in personality changes
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Erikson Theory
8 staged of psychosocial development, each stage has a unique crisis that builds on the tasks of previous stage/successful resolution of the crisis at each leads to psychosocial growth and development
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Piaget's Theory
theory on cognitive development is based on how an individual acquires knowledge/intellect and cognition over time
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Kohlberg Theory
believed that children progressively develop moral reasoning as they gain the ability to think logically and contended that moral development continued throughout the lifespan
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Hospice care
administration of medical care to support the client who has a terminal illness, so they can live the last days of their life as best they can for as long as they can
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When is hospice care provided
when treatment will no longer cure or control the illness
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hospice care was originally offered to
clients with terminal cancer but it has now grown to include any client with a terminal illness
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what is admission to hospice dependent on
the client meeting specific criteria and the provider making a diagnosis of life expectancy of fewer than 6 months
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what is palliative care
holistic care provided throughout the lifespan for clients experiencing severe medical illness particularly for clients approaching end of life
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what is palliative care concentrated on
lessening client suffering at the end of life, current best practices dictates it be implemented earlier in the course of life threatening health events
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how is palliative care different from hospice
palliative care is provided while the client is still engaging in curative treatments
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what is the terminal phase of a clients life called
actively dying/imminent death
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what happens to breathing at the end of life
dyspnea occurs, retention of secretions (death rattle), Cheyen Stokes
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what is Cheyen Stokes
irregular respirations that fluctuate between several quick breaths followed by periods of apnea
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what pain at the end of life caused by
nerve injury, organs being stretched and compressed and or bone pain
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what happens to body temperature do at the end of life
the nervous systems ability to regulate body temp diminishes; causing clients to experience both increased and decreased temps
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what is Mottling
happens hours or days before death, with the upper and lower extremities becoming cool to the touch (hearts inability to pump blood effectively)
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what happens to vision/hearing at the end of life
clients may experience hallucinations or report hearing and seeing people who have already died
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what is dignity
an everyday necessity that is essential to the well-being of all clients (most complaints are associated with a lack of caring)
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what is the health care team responsible for when a patient is actively dying
for providing a "good death" for the client
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what does a "good death" involve
pain management, planning for death, closure at the end of life
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what is postmortem care
physical care performed after death to prepare a body for viewing, autopsy, or release to the funeral home
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name somethings that are included in postmortem care
washing the body, accounting for possessions, removing invasive devices (catheter/IV), placing 2 ID tage
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organ tissue donation is
voluntary; the donor must give authorization before death or a surrogate can give permission
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who is allowed talk about organ donation
professionals who have completed a course
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A NURSE IS NOT ALLOWED TO TALK ABOUT IT
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what is the nurses role during organ donation
assist family who are dealing with this challenging decision
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what is grief
the feelings or reactions an individual has to a loss in one's life
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normal grief
uncomplicated; caused by the loss of someone very close, through death or the ending of a relationship
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anticipatory grief
grief that is experienced before the expected loss of someone
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prolonged grief
complicated; longer than 6 months; significant it can affect the clients ability to function
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disenfranchised greif
related to a relationship that does not coincide with what is considered by society to be a recognized or justified loss
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Kubler-Ross 5 stages of grief
denial, anger, bargaining, depression, acceptance
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Denial
client refuses to believe the truth (helps lessen the pain of loss)
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Anger
client trying to adjust to the loss and is feeling severe emotional distress "why me"
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Bargaining
involves barging with a higher power by making a promise to do something in exchange for a different outcome
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Depression
reality sets in and the loss of the loved one or thing is deeply felt
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Acceptance
client still feels the pain of the loss but realizes they will be all right
what should you check the medication against to make sure it is correct
the medication administration report upon removal from the dispensing device
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what also should be checked for additional medication safety
check drug upon preparation, and check the drug just prior to administration
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when does reconciliation occur
anytime the client is transferred from one health care professional to another
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what does reconciliation include
reviewing the clients current medication then addressing omissions and dupilcates
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what is pharmacodynamics
the study of how a drug works in its relationship to drug concentrations and how the body response
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Peak Plasma Levels
when a drug is at its highest concentration not necessarily at its most therapeutic level
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Trough Serum Levels
the lowest level if concentration of a medication correlates to the rate of elimination
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what is pharmacokinetics
the study of the absorption, metabolism, distribution, and excretion of drugs in the human body
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what is the dissolution of medication dependent on
its initial state and route of administration
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Oral and enteral routes provide what
much slower rate of absorption than IV
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what is distribution of med
the process of drug delivery to the target organ or tissues that occur before metabolism and excretion
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what is metabolism and biotransformation
the process of converting a medication to a form that is easily excreted from the body
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most drugs are metabolized in the
liver
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what also has a small responsibility for drug metabolism
the kidneys and small intestines
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the flow or oral meds to the liver
stomach to the small intestine and pass through the small intestine to the hepatic circulation via the mesenteric vein and portal vein flowing into the liver
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The first pass effect
results in a lower concentration of the medication in the systemic circulation
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what is excretion
the process of removing drugs from the body
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Primary organ responsible for excretion
kidneys
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what organs perform excretion to a lesser extent
skin, lungs, endocrine glands, intestines
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drug toxicity
develops when the body is unable to metabolize and excrete a drug
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what should a complete medication order contain
client name, date/time order written, drug name (generic) dosage, route of admin, frequency, indication for use, provider signature
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enteral route
administered directly into the gastrointestinal tract (feeding tube)
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Topical route
applied to the skin/mucous membranes, eyes, nose, respiratory tract, vagina, rectum
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parental route
by injection using a needle and syringe
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what is an ADR
an adverse drug reaction and they are unintended and nontherapeutic/ they range from tolerable to irreversible damage
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How does the nurse asses the client after/during a ADR
by reviewing any contraindication to reviewing the medication/lab values/vital signs/allergies/potential medication interaction
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what is an ADE
adverse drug effect; a life threatening reaction that requires medical intervention to prevent death or permanent damage
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what has to be reported to the FDA
ADE; adverse drug effects
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what does the FDA do with the report
improve safety outcomes, revise drug labels, when needed withdraw drugs from the market
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what is a black box warning
issued on medications that may produce lethal and iatrogenic results
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when does a hypersensitivity reaction start
when the body perceives a foreign substance (med) as an allergen, this produces antibodies to counteract the allergen
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what are the 4 types of hypersensitivity rxn
Allergic, Cytotoxic, Immune complex, Delay (ACID)
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anaphylaxis
severe life-threatening rxn resulting from histamine release producing dyspnea, hypotension and tachycardia
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Stevens-Johnson Syndrome (SJS)
develops 1-4 days after the admin of drug: respiratory distress, fever, chills, a diffuse fine rash that may turn into blisters
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tolerance (drug)
a diminished response to a drug when the drug is repeatedly used the body adapts
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resistance (drug)
the ability of microorganisms or cells to withstand the effects of a drug usually effective against them
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what are high alert medications
drugs that are associated with an increased risk for causing considerable client harm when they are administered in error
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