Assessment & Client's Response to Illness: Exam 1 Flashcards
Described psychosocial development in terms of developmental tasks to accomplish at each stage (see Videbeck TABLES 7.1 and 7.2, p. 117)
Theorized that people may get “stuck” at any age of development
Negotiating these developmental tasks and nonresolution of any stage can affect how a person responds to illness
Erik Erikson
Impact of Biologic Makeup and Physical Health on Emotional Responses
Heredity and biologic factors are not under voluntary control
Genetic makeup tremendously influences response to illness and treatment
Family history and background are essential parts of the nursing assessment
In general, the healthier =
better coping with stress or illness
Biologic differences can affect a person’s response to medication, specifically psychotropic drugs
-Ethnic groups differ in the metabolism and efficacy of psychoactive compounds
-Some ethnic groups metabolize drugs more slowly
-Slow drug metabolism increases the frequency and severity of side effects
Clients who __________ drugs more slowly need lower doses to produce desired effect
When evaluating psychotropic drug efficacy, the nurse must be alert to side effects and serum drug levels in clients from different _______ backgrounds
Metabolize
Ethnic
Personal abilities and efforts affect events in one’s life
Self-efficacy
The ability to resist illness when under stress
Hardiness
Healthy responses to stressful or risky situations
Resilience
Problem solving and the ability to cope with adverse situations
Resourcefulness
The essence of a person’s being and beliefs about life’s meaning and the purpose for living
Spirituality
Importance of Personal Characteristics:
Self-efficacy
Hardiness
Resilience
Resourcefulness
Spirituality
Influence of Interpersonal Factors
Sense of belonging
Social networks
Social support
Family support
The feeling of connectedness in an environment of which a person feels an integral part: Value and Fit
Sense of belonging
Groups of people with whom one feels connected
Social networks
Emotional sustenance that comes from friends, family, etc., who help a person when problems arise
Social support
Not always a positive resource in mental health, but most often an important part of recovery
Family Support
the client must perceive that the social support system bolsters confidence and self-esteem and provides stress-related help
Value
the support systems actions are consistent with the client’s desires and expectations
Fit
Beliefs about what causes illness:
Natural
Unnatural/personal
natural conditions (cold, heat, wind, dampness) causes illness
Natural
illness is caused by active, purposeful intervention of a spirit, supernatural force or deity
Unnatural/Personal
Factors in cultural assessment:
Communication
Physical distance
Social organization
Time organization
Environmental control
Biologic variations
Income, education, and occupation influences whether or not a person has health insurance and access to health care
Socioeconomic status
Cultural Factors
Beliefs about what causes illness
Factors in cultural assessment
Socioeconomic status
Culturally Responsive Nursing:
- Incorporate knowledge of cultural patterns as a starting point
- Individualize assessment to provide holistic care
- Open and objective approach is essential
- Wide variations exist among people from any culture
-Avoid assumptions
-Be aware of avoiding assumptions when the nurse is of the same culture as the client
Factors Influencing Assessment:
-Client participation and feedback
-Clients health status
-Clients previous experiences/misconceptions about health care
-Clients ability to understand
-Nurses attitude and approach
The Interview must include…
Environment
Input from family and friends
Phasing questions
Nonjudgemental language and matter-of-fact-tones
Must be comfortable private and safe
Environment
Obtain their perceptions of the client’s behavior and emotional state
Input from family and friends
Open-ended (tell me what has been happening to you)
Closed-ended (have you been thinking about suicide)
Phrasing Questions
Avoids giving the client verbal cues to become defensive
Nonjudgmental language and Matter-of-fact tone
9 areas identified as the framework for psychosocial assessments
History
General appearance and motor behavior
Mood and affect
Thought process and content
Sensorium and intellectual processes
Judgment and insight
Self-concept
Role and relationships
Physiologic and self-care concerns
Assessment Content:
Ask client directly
Assess for anger, hostility or threats toward others
Ask if the client has a plan
Involves the overall assessment rather than focusing on isolated bits of information
The nurse looks for patterns or themes in the data to determine client’s strengths and needs
Assessments in a variety of areas are needed to support nursing diagnoses
Data Analysis
The nurse will assess and reassess for:
Care planning
Evaluating treatment
Discharge planning
Follow-up care in the community
Psychological test:
Intelligence Test
Personality Test
to evaluate cognitive abilities and intellectual functioning
Intelligence test
reflect the client’s personality in areas such as self-concept, impulse control, reality testing, and major defenses
Personality Test
Psychiatric diagnoses are diagnosed by using the ____________.
DSM-5
Mental Status Examination:
A cursory abbreviated exam
Focuses on cognitive abilities
Mental Status Examination: components include
Orientation (person, time, place)
Ability to interpret proverbs
Ability to perform math calculations
Memorization and short-term recall
Identification of common objects
Ability to follow multistep commands
Ability to write or copy a simple drawing
