WEEK #2 NUR 100

how do nurse's use maslow's theory?

provides a framework for assessment and for understanding the needs of patients at all levels, so that the interventions to meet priority needs become a part of the care plan

what is maslow's hierarchy of basic human needs? (starting from lowest to highest)

physiologic -> safety and security -> love and belonging -> self-esteem -> self-actualization

physiologic needs consist of

oxygen, food, water; balance between intake & elimination of fluids; temperature; sexuality; physical activity; rest

the "ABC's"

Airway, Breathing, Circulation

safety and security needs consist of

both physical and emotional components; being protected from potential/actual harm

love and belonging needs consist of

understanding and acceptance of others in both giving and receiving love; groups such as families, peers, friends, a neighborhood and a community (often called higher-level)

self-esteem needs consist of

a person to feel good about oneself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments; facilitates the person's confidence and independence

self-actualization needs consist of

acceptance of self and others as they are; focus of interest on problems outside oneself; ability to be objective; feelings of happiness and affection for others; respect for all people; ability to discriminate between good and evil; creativity as a guideline for solving problems and pursuing interests

what are the stages of erikson's theory?

- intimacy vs. isolation (young adulthood)

- generativity vs. stagnation (middle adulthood)

- ego integrity vs. despair (older adulthood)

what is havighurt's theory of development?

- young adulthood

- middle adulthood

- later maturity/older adult

erikson vs havighurst psychosocial development of young adults

- erikson: intimacy vs. isolation; self-concept is established; peer group has most influence

- havighurst: masculine/feminine social role developed; set of values and ethical system internalized

health issues for adolescents/young adults (list at least 3)

injuries, substance use/misuse/abuse, suicide, pregnancy, nutritional problems, sexually transmitted infections, developmental and situational stressors

role of nurse: health promotion of young adults

- facilitating healthy family relationships

- focus education on safety

erikson vs havighurst psychosocial development of the middle-aged adult

- erikson: generativity vs. stagnation

- havighurst: learned behaviors arising from maturation, personal motives and values, and civic responsibility

havighurst defines middle-aged adults' psychosocial development as ...

accept and adjust to physical changes; maintain a satisfactory occupation; assist children to become responsible adults; adjust to aging parents; relate to one's spouse/partner as a person

the development of the middle adult include:

- physiologic: gradual internal and external physiologic changes occur

- cognitive: little changes from young adulthood; increased motivation to learn

- psychological: time of increased personal freedom, economic stability, and social relationships

health problems in middle adulthood (list at least 3)

malignant neoplasms, cardiovascular disease, injury, depression/suicide, diabetes mellitus, chronic lower respiratory disease, cerebrovascular causes, liver and kidney disease, obesity, alcoholism, arthritis

role of the nurse: health of the middle adult

- health-related screenings, examinations, and immunizations are important

- teach the dangers of substance use, smoking, and alcohol consumption

- teach adults to eat a diet low in fat and cholesterol

- teach the importance of regular exercise

erikson vs. havighurst psychosocial development of the older adult

- erikson: ego integrity vs. despair and disgust; life review

- havighurst: major tasks are maintenance of social contracts and relationships

physiologic changes of older adults

general status, integumentary system, musculoskeletal system, neurologic system, special senses, cardiopulmonary system, gastrointestinal system, dentition, genitourinary system

common myths of the older adults (ageism)

old age begins at 65 years, most are in long-term care facilities, sick and mental deterioration occurs, not interested in sex, do not care how they look and are lonely, bladder problems are a problem of aging, do not deserve aggressive treatment for illnesses, cannot learn new things

cognitive development in older adulthood

- intelligence increases into the 60's and cognition does not change appreciably with aging

- response/reaction times may increase

- mild short-term (recent) memory loss is common

- long-term memory usually remains intact

- dementia, alzheimer's disease, depression, and delirium may occur and cause cognitive impairment

role of the nurse: health of the older adult

promote health in older adults:

- physiologic function

- cognitive function

- psychosocial needs

- nutrition

- sleep and rest

- elimination

- activity and exercise

- sexuality

- safety->falls

adjusting to changes of older adulthood

physical strength and health; retirement and reduced income; health of spouse; relating to one's age group; social roles; living arrangements; family and role reversal

what is a theoretical model of health?

provide the how and why people behave to promote health and prevent illness

what is the purpose/usefulness of a theoretical model of health?

help healthcare providers understand health-related behaviors so that care can be adapted to meet needs of people from diverse economic and cultural backgrounds; allows healthcare disparities to be overcome

health-belief model

focuses on what people perceive/believe to be true about their health; perceived susceptibility, perceived seriousness, perceived benefits of actions

high level wellness

promotes good physical, mental, and emotional health

- functioning at one maximum potential

- involves being (separate individual), belonging (part of group), becoming (growth), and befitting (making personal choices for the future) (the 4 Bs)

one can be 'well' regardless of state of health

health continuum

this model views health as a constantly changing state, with high-level wellness and death at opposite ends of a graduated scale/continuum

holistic health

the whole person; intellectual, environmental, spiritual, sociocultural, emotional, and physical

a culturally competent nurse

care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society

culturally competent nursing care

- develop self-awareness

- demonstrate knowledge and understanding of patient's culture

- accept and respect cultural differences

- recognize health care provider's beliefs/values are likely different than those of patient

- resist judgmental attitudes

- be open to/comfortable with cultural encounters

- accept responsibility for one's own cultural competency

health

state of complete physical, mental, and social well-being, not just the absence of disease/infirmity; means different things to different people and includes family, cultural, community, societal influences

wellness

an active state of being healthy, including living a lifestyle that promotes good physical, mental, and emotional health; used interchangeably with health

illness

the response of the person to a disease; it is the process in which the person's level of functioning is changed when compared with a previous level; each person's response to illness is different--a person may have an illness/injury but consider themselves healthy

disease

pathological changes in structure/function of the body/mind

health disparity

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

influencing factors related to health disparity

race, ethnicity, poverty, biological sex, age, mental health, education level, disabilities, sexual orientation, health insurance, access to health care

social determinants of health (SDOH)

are 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

acute illness

- rapid onset of symptoms

- lasts relatively short time (

examples of acute illness

appendicitis, pneumonia, diarrhea, common cold

chronic illness

- usually slow onset

- permeant, irreversible change in anatomy and physiology

- special patient education

- long period of care/support--perhaps lifelong

- periods of remission and exacerbation

- leading cause of health problems in the world

- results in anxiety due to permeant changes in roles, finances, etc.

examples of chronic illness

diabetes mellitus, heart disease, arthritis, cancer, obesity

the three levels of health promotion and illness prevention

primary, secondary, tertiary

primary health promotion and illness prevention

activities directed toward PROMOTING health and PREVENTING the development of disease processes/injury

examples of primary health promotion and illness prevention

family-planning, vaccinations, bicycle helmets, car seats, healthy diets, etc.

secondary health promotion and illness prevention

care focuses on SCREENING for early detection of disease with prompt diagnosis and treatment of any found

examples of secondary health promotion and illness prevention

routine exams, colonoscopies, mammograms, oral exams, etc.

tertiary health promotion and illness prevention

TREATMENT of the illness with the goal of reducing disability, preventing complications, and rehabilitating patient to maximum level of functioning

examples of tertiary health promotion and illness prevention

medications, therapy, surgical treatment, rehab, physical therapy, occupational therapy, job training, etc.

blood tests

measures the amount, size, and shape of WBCs, RBCs, and platelets in the blood; measure hemoglobin and hematocrit levels

urine tests

- evaluates physical characteristics of urine; determines specific gravity and pH; detects and measures protein, glucose, bacteria, RBCs, nitrates, and ketone bodies

- screen urine for renal/urinary tract disease

- help detect metabolic disease (such as diabetes mellitus)/systemic disease

urinalysis: COCA stands for ...

Color, Odor, Clarity, Amount

sputum tests

- bacteriological examination

- to isolate and identify causes of pulmonary infections

- to help diagnose respiratory infections (TB, bronchitis, etc.)

x-ray

evaluates internal organs/structures; detect foreign bodies, cysts, tumors; planning care, aid in care/surgical/equipment placement

MRI

produces computerized images of internal organs and tissues, bones, and soft tissues not readily visible on standard x-ray

endoscopy

direct visualization of body cavity

angiograpy

contrast dye is injected through catheters and allows visualization of the vessel/organ that is being analyzed

EKG

records a person's heart rate and rhythm by measuring the electrical activity of the heart; identifies conduction abnormalities, cardiac arrhythmias, myocardial ischemia/infarction (MI) and to monitor recovery from a heart attack (MI)/surgery

health promotion model

illustrates how people interact with their environment as they pursue health

#1. individual characteristics and experiences (previous habits and personal factors predict current/future practices)

#2. behavior-specific knowledge and beliefs (self-efficacy, knowledge of positive outcome situation influences barriers to action)

response to illness (illness behaviors)

#1. experiencing symptoms (could end here)

#2. assuming the sick role

#3. assuming the dependent role

#4. achieving recovery and rehabilitation

inhibiting factors of culturally competent care

- stereotyping

- implicit bias (occurs automatically based on post experiences)

- culture conflict

- culture shock

- assimilation (adjusting to a culture)

- cultural imposition (enforcing one's culture onto another)

- culture blindness

expected adult temperature

35.8-37.5 C/96.4-99.5 F

expected pulse/heart rate (in adults)

60-100 beats/min

rate is either...

regular/irregular

count the beats/breaths for _____ seconds and _______ by ___

30; multiply, 2

expected respiratory rate (in adults)

12-20 breaths/min

if the beats/breaths are irregular count for _____ seconds

60

expected blood pressure (in adults) (S/D)

pulse strength (amplitude) grades and description

0: absent, unable to palpate; +1: diminished, weaker than expected; +2: normal/brisked, expected; +3: bounding

what tool is used when unable to feel a pulse

doppler

hypotension

a blood pressure

what is the first thing you do to treat hypotension?

identify the underlying cause

fever

is an elevation beyond the upper limit of a normal body temperature

another word for fever is

febrile

a fever over _____C/ _____F is concerning

40/104

a fever over _____C/_____F is a medical emergency

41/106

tachypnea

a rate raster than 20 breaths/min

brachypnea

a rate slower than 12 breaths/min

apena

absence of breathing and is often associated with other abnormal respiratory patterns

apical/apex pulse

the heartbeat felt at the apex of the heart, providing the most accurate measure of heart rate and rhythm

where do you find the apical pulse?

5th intercostal space, left midclavicular line

how do you find the apical pulse?

- locate the sternal notch

- slide fingers down to the 'angle of louis'

- find the second intercostal space

- move the fingers down the L side until you find the fifth intercostal space

- move finger to the midclavicular line

the sound 'lub' is...

S1, is the closing of the mitral and tricuspid valves (the AV valves)

the sound 'dub' is...

S2, is the shutting of the aortic and pulmonary valves (the semilunar valves)

count lub-dub as ___ beat

1

to make sure the blood pressure cuff fits properly it should...

fit 37%-50% width wise; 75%-100% bladder wise (around the arm); fit within 'range'