Exam 1 Flashcards
What is the backbone of nursing?
Health + Health promotion
How are we doing as a country as far as health promotion goes?
Good workout culture: exercise is more important now
screenings + reminders to be proactive with health
better vaccines
seatbelt wearing + Better DUI reminders
Smoking is less common (cant smoke just anywhere)
Bad:
decrease in diet + quality foods (childhood obesity)
sedentary lifestyles
increase in domestic, gun violence
increase in teen pregnancy: infant mortality; STD
Cause of death: early mid 1900s
infectious disease; young adults + children
Health was the absence of disease
people did not live long enough to die from other disease
Cause of death: Today
large change to healthcare delivery system
person centered care = teaching pts about lifestyle
heart disease, chronic conditions, diabetes, cancer
50% of early death = lifestyle
chronic = older
accidents = younger
What is the nursing role?
health promotion and disease and more important than ever
What are the nursing roles?
Interprofessional practice = nurse play a variety of roles
Educator: risk, managing
Advocacy: helps individuals obtain what they are entitled to receive from health care system, tries to make the system more responsive to individual and community needs, helps persons develop the skills to advocate for themselves (voice for someone else)
Care Manager: act to prevent duplication of services and cost; navigating health care
consultant: sharing specialized knowledge/ expertise to promote health and prevent disease to individuals/ groups
delivererer of services: health education, influenza vaccine, counseling in health promotion, screenings (BP + cholesterol)
Healer: integrate + balance parts of lives
Researcher: interpret research finding (evidence- based findings)
What are the 4 concepts of health?
Clinical
Role Performance
Adaptive
Eudaimonistic
What is the clinical concept of health?
health is the absence of disease: signs + symptoms
Illness = presence of signs + symptoms of disease
do not use preventative health services/ wait until they are very ill
conventional model of discipline of medicine
What is the role performance concept of health?
if you can perform your role in society you are “healthy”
role performance = work, family, social role
illness= failure to perform roles of other in society
basis = occupational, school, physical, physician- excused
“sick role” = vital component of role performance model
What is the adaptive concept of health?
“health” is the ability to adjust positively to social, mental, and physiological changes
illness= person fails to adapt/ maladaptive changes
What is the Eudaimonistic concept of health?
“health = wellbeing” interaction between physical, social, psychological, and spiritual aspects of life + enviroment
illness= denervation/ langusihing; lack of involvement
people dying of cancer = healthy of they find meaning
“holisitic health”
acupunture, chiropractor
What is the definitions of health?
health is now defined as a state of physical, mental, spiritual and social functioning that realizes a person potential and is experienced in a developmental context
WHO: health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease
What is the primary level of prevention?
things that are done before a disease sets in, serves to prevent disease. Interventions that prevent and defend the body; decreases chance of getting disease
health education
immunizations
specific nutrients
protection from carcinogen
thing that build up defenses, make pts stronger
What is secondary level of prevention:
goal is to find a disease early; interventions that serve to identify and detect disease at an early state; involves cure therapy
to find out; (something is starting)
screenings; breast exams
What tertiary level of prevention:
restore and rehabilitate when disability is permanent; maximize what is left
optimize functioning
if patient has chronic disease
What is the primordial stage of prevention?
using policy to prevent actual risk factors themselves
actions taken to modify the social and enviromental conditions which foster the risk factor
primary + policy
time frame before risk factor develops and before disease occurs
healthy eating school-based programs, reduction of sodium in food supply, creating bike + walking path
begins in early childhood/ prenatally
What is healthy people 2030?
follows healthy people; call to action by US dept of health
set national goals aimed at improving health of country, focus on health promotion activites
health care not illness care
consist of several focus areas, objectives are very specific + measureable
Overarching goals for healthy people 2030:
attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death
eliminate health disparites, achieve healthy equity, and attain health literacy
create social, physical, and economic enviroments that promote attaining the full potential for health and well-being for all
promote healthy development, healthy behaviors, and well-being across all life stages
engage leadership, key consituents, public across multiple sectors to take action, and design policies that improve health and well- being
disease:
something that cause Dis Ease, an imbalance of sort, affecting the mind or body in some negative way: failure of person adaptive mechanism
Illness:
when a person has some type of disease and know it and is affected negatively by it; subjective experience associated with disease
What level of prevention is health screenings:
secondary; to find out
screening test:
to prevent or delay disease in early stages (before symptoms being) deter progression
Validity:
how well the test distinguishes between disease and non-diseased states…. ideal test is 100% valid
sensitivity:
proportion of people with a conditions who correctly test positive
if test has poor senstivity, more false negatives
Specificity:
proportion of people without a condition who correctly test negative
if the test has poor specificity there will be a lot of false positives
Reliability:
an assessment of reproductivity of test results when different test at different times + conditions
” how likely will the results will stay the same”
What to consider when selecting of a screenable population:
Age: risk changes with age
Gender: risk different for males + females
men= prostate + women= mammogram
Ethnic Group: hypertension for African American men
hispanic = diabetes
Education/Income level:
disadvantaged need more screenings
Also consider: how common is the condition
Epidemiology:
the study of the distrubution (frequency, rate, incidence, prevalence- the where, who, the when) and detrminants (cause + WHY)
Incidence:
number of new cases
Prevalence:
number of existing cases
Morbidity:
disease + disability rates
Mortality:
death rates
Who recommends screening criteria?
Organizations put guidelines out
American Cancer Society
CDC
American Heart Organization
What is the gold standard?
U.S preventable services task force…. recommendations based on available evidence
a, b, c, D, I
Breast cancer screening:
most common cancer among American women
Risk:
strong family history
early 1st menstrual cycle; late menipause
first baby after 30
American Cancer society (ACA) recomendations:
Average risk: yearly mammogram by age 45 but if higher risk talk to doctor
Age 55 + every 2 years but talk to doctor if high risk
USPSTF:
40-49 individual decision with PCP
50-74: every 2 years
over 75: no recommendation
Mammogram: secondary prevention
Cervical Cancer screening:
screened by pap test
Risks: early 1st intercourse; multiple partners, smoking, HPV virus
Screening recommendations
ACOG + USPSTF: start at 21, then every 3 years
ACA: start at 25
Colorectal Cancer screening:
third leading cause of cancer deaths
Risk: strong family history
chrohns disease
American Cancer Society;
normal: periodic routine screening at age 45-75
75-85: depends (talk with doctor)
Home FOBT: fecal occult blood test q yr
Home FIT test: more sensitive
Colonscopy q 10 years Or
virtual coloscopy or flex sig q 5 years
Prostate Cancer screening:
2nd leading cause of cancer deaths in males
Risk: positive family history, African American, Advancing age
Screening Recs: no longer widely recommended for asymptomatic and/or low risk men
ACA: discuss with PCP
50: if average risk
45: high risk
40: if higher risk
DRE (digital rectal exam)
PSA (prostate specific antigen) poor specificity
Cholesterol screening
a major modifiable risk factor for CHD
TC=total cholesterol (less 200)
HDL: high density lipoprotein (40 for men; 50 for women)
LDL: low density lipoprotein (less than 100)
Triglycerides: less than 150
Screening: CDC
every 4-6 years
begin earlier if risk..
diabetes, heart disease, hypertension, family history, sedentary lifestyle
HTN screening:
leading cause of CHF, heart failure, CVA, MI, kidney disease,
Screening:
over 40 get blood pressure taken
HIV screening:
goal to detect at earliest stage possible, decrease transmission
assess patient for risk
CDC guidelines screen everyone 13-64 regardless of risk
Diabetes Type 2
can go years w/out being diagnosed
POC testing Fasting blood sugar
Risk:
obesity
sedentary lifesyle
poor diet
family history
age
hispanics
PKU
baby lacks enzyme to metabolize an important amino acid called phenylalaine
if you cant metabolize it builds up in the brain + causes brain damage
Screening
between 24- 7 days of life
If first test is less than 24 hours rescreen in 2 weeks
What is family health?
As a dynamic state of wellbeing which includes the biological, psychological, spiritual, sociological, and cultural factors of individual member of whole family
What are characteristic of a healthy family?
good communication
express feelings
spend time together
role modeling
express appreciation
support each other
role flexability
listen
trust
share responsiblity
moral compass
ritual/traditions
privacy
humor
achknowledge problems
why do we study the family?
family greatly influences an individuals state of health
the individual greatly influences the family state of health
health and illness are FAMILY events
types of family:
extended family
traditional/nuclear family
single parent family
adoptive family
same sex family
foster family
blended family
dual income; no kids
Family definition
two or more individuals that ….
believe they are family
have some degree of interdependence with each other in regards to needs
Family systems Theory:
looking at family from a “system” point of view
all rely on one another to function
patterns of living among individuals within family
unique culture, value system, history
all parts are connected (interacting parts)
works together to function (role flexability)
Developmental Theory:
looking at family from developmental point of view
focus on different stages family go through
stages build on each other
failure in earlier stages may lead to difficulty in later stages
does not account for diversity
family stress is greater in transition phase
Risk Factor Theory:
looking at family from a risk factor point of view
lifestyle: active, nutrition, smoking
biological: genetic makeup
enviromental: safe water, air, housing (lead)
social, psychological, culture, spiritual: abuse, isolation, no support
healthcare system: insurance, access issue
assessing risks
What family health responsibilites:
family provides most care
develop members sense of identity and self worth
emotional support and guidance during life cycle transitions
sociallization of family members to both value and maintain health
education about when and how to use health care system
care provisions and management for chronically ill, disablied, and aging family member
Role of nurse (family)
help family attain, maintain, regain, highest level of health possible
Family Assessment
gathering data so that nurse gains insight into family process
after assessment: nurse can determine how well the family is meeting family health respobsibility
can generate a family nursing diagnosis and plan interventions geared toward improving overall health
Ways to gather data from famiilies:
Gordon’s functional health patterns
health perception/health management
nutrition/ metabolic
elimination
activity/ exercise
sleep-rest
cognitive-perceptual
self perception/self concept
sexuality/ reprodutvie
coping-stress
values- belief
Considering enviroment with family assessment
important
quality of housing
temp of the house
phones
bugs
pools
sleeping situation
smoke detector
- planning: (family assessment)
planning process should always include family
provides direction for implementation and framework for evalution
should include….
prioritizing problems or potential problems
identification of items that can be handled by the nurse and family and those that need to be referred out
actions and expected outcomes
4: intervention (family assessment)
home visits
referrals
education
empowerment
advocacy
counseling
5: evalution ( family assessment)
determine how the family responded to interventions and if they were successful
five measures can be used to determine effectiveness…
changes in interaction patterns
effective communication
ability to express emotions
responsiveness to need of members
problem solving ability
goals of health education:
help individuals, family, communites, achieve through own actions optimize states of heath; better health outcomes
4 steps in teaching process:
- assess the learners
- determine expected outcomes; setting goals involve learner, measureable, “smart goals” 3 domains of learning
3; selecting content + learning stratigies
4: evaulate teaching + learning process
What comes into play when nurse engage health promtion?
knowledge + motivation
Step 1 in health education:
assessing the learner and his/her needs
age, developmental stage, level of education
health beliefs
motivation, readiness to learn
health risk
current knowledge and skills
Health belief model:
peoples belief about something influence their behavior
used to predict + explain health behavior
explains role + beliefs
HBM great framework to use to assess learner
helps choose effective educational stratigy
guides nurses in education plan
components:
perceived susceptability to health problem
perceived seriousness of disease level
percieved benefits of making change
percieved barriers to making action
cues to action: triggers someone to make change
self efficacy: individual belief in his or her capacity
Transtheoretical Model of change:
another useful model to consider when working with patients making a change
helps determine where person is in relation to making behavior change
assesses client readiness for change
stages:
precontemplation: not considering change
contemplation: seriously considering specific behavior change in next 6 month
planning: starting to change or seriously thinking about making change in next month
Action: made behavior change; persisted for 6 month
maintance: 6 months after action started, continuing indefinetly
incorporates cues to action + self-efficacy
Step 2 (health education)
set goals, determine outcomes, involve patient
goals should be measureable and specific
Smart goals
SMART Goal outline
S: specific
M: measurable
A:attainable
R: relevant
T: time bound
Domains of learning:
cognitive (thinking); knowledge
Affective (feeling)
Psychomotor (acting.doing) physical doing/ motor skills
Step 3 (health education)
select content and strategies/ resources
begin process of working together with your client to reach goal
use methods that simulate variety of sense
involve person in learning process
establish a comfortable learning enviroment
given info that is clear and understandable
credible sources: website, pamphlets, apps, youtube
making learning fun and engaging
providing info that is clear and easy to understand
use those cues to action
consider health literacy
motivational interviewing as specaility strategy
Motivational interviewing:
tool to use when we work with our client to help with behavior change
MI is not telling patient what to do
MI is based on empathy
Open ended question
affirmation
reflection
summary
Health literacy:
the ability to fully understand medial language, instruction, dosage
viewed as strong predictor of health and wellness, more than age, income, eduation levels alone
health insurance is confusing
consent forms
understanding diagnosis
Implications of poor health literacy:
patients are less likely to seek care
med administration errors
problems describing PMH, FH, meds, symptoms accurately
consent issue
missed appointments
Step 4 evalution (health education)
ways:
measurements
teach back
journal/ progress not
quiz
observations
review
conversations
Web based learning
evaluating health information on internet
be sure the site makes it clear who is responsible for site and information
sites should provie information regarding credentials of those who prepared and review content
sources of information should be included if site personnel themselves did not write it
purpose of the site
references
how current is the information
What is infancy?
Birth - 18 months
What are normal respirations + Heart rate for infants + blood pressure?
120-160 Heart rate
30-60 respirations
80/40 BP
What are normal growth rates for infants?
baby increase by 1 inch every month
increasing by 50% in first 6 months
triples by 12 months
Developmental Landmarks
1 Month: lifts head when prone
Month 2: has social smile
Month 4: squeals
Month 5: rolls from front to back
Month 8-9: uses pincer grasp to feed self
Month 10: pulls self to standing position
11-12: initiations vocalization
12-15; walk
15: drinks from cup
18: mimics household chores
Psychosocial Development Erikson:
trust vs mistrust
trust influences future reationships
infant needs maximum gratification/miminum frustration
Cogntive development: (pigets)
sensiormotor period
mastering simple coordination activities through senses + motor ability - allows interaction (learn from senses + motor skills)
What supplements do infants need?
Iron after 6 months of age
can be found in infant cereal
What can infants not eat?
Honey before 1 year
cows milk until 1 year (needs to be whole milk)
What bowel movements are normal for infants?
develops pattern within 2 weeks
breastfed infant: loose, golden poop:
Bottle: firm, smelly, go less often
Sleep Infants:
parents promote sleep patterns
needs to correlate to rate of growth
80% at birth
12 hours daily at 12 months
Vision Infants:
inital: eye muscles weak, vision unfocused, without meaning
eye movement corrdinates at 3 month
mature by 6 months
Hearing Infants
acute ability, sound discrimination important developmentally
Smell Infants
fully developed; can differentiate odor for mother milk at 2 weeks
Taste infants
present at birth; salvation at 3 months
Touch Infants
tactile sensation well developed
relieves infant tensions
can feel pain
explore world through mouth
