Exam 2 Flashcards
1
Q
community
A
a specific group of people who share social relationships and common interests
are arranged in social structure, according to relationships
variety of settings, including workplaces, schools
2
Q
healthy people 2030 highlights emphasis within
A
environmental and community context
3
Q
what group of people will continue to frame trends for older population
A
baby boomers
4
Q
what population will double from 52 mil (2019) to 95 million in 2060 and comprise 23% of total population
A
seniors
5
Q
what will happen to the population
A
become more diverse
6
Q
what social welfare programs will rise
A
social security and medicare epxenditures
7
Q
what does community health nursing combine
A
nursing practice and public health
8
Q
community health nursing promotes
A
promotion of health of populations but isn’t limited to a particular individual or group
9
Q
what do nurses provide for at-risk communities
A
educational information to develop health-oriented skills, attitudes, and related behavioral changes
10
Q
nurses develop essential relationships to promote
A
community health missions
11
Q
what is a nurse’s role in influencing health policy
A
advocate for justice in health care delivery by participating in policy decisions making and political action as it affects health of community
12
Q
lobbying
A
process of seeking to influence legislators’ views and votes
13
Q
what does ANA advocate for
A
collaboration with constituent organizations, specialty and on-nursing organizations
14
Q
what is causing a decrease in specialty organizations
A
high membership dues
15
Q
nurse’s role in community health nursing process
A
independent, interdependent, dependent functions
16
Q
nurses role in community health promotion (nursing process)
A
community participation, community assessment
targeted and measurable objectives, relevant interventions, evaluation
identify risk factors for health problems and disparities
17
Q
methods of data collection
A
observation data
interview data
18
Q
observation data
A
windshield survey
sight touch hearing smell taste
technological advances greatly assist this process
19
Q
windshield survey
A
use of sense to determine community appearance
20
Q
interview data - verbal statements
A
key informants: key community leaders
community residents can provide important info
health agency personnel
21
Q
measurement data
A
population statistics, morbidity/mortality rates, US census statistics, epidemiological and environmental data
22
Q
accessing data
A
internet, local community libraries, health dept., environmental protection agencies, police and fire departments, local health agencies, city or state planning
23
Q
sources of community information
A
census information
community agencies and local planning commissions
communities and states’ databases available for public use
24
Q
census information
A
located on-line in libraries and public agencies
most complete source for population information
25
what is an example of comunity agencies and local planning commisions
water safety concerns with local fracking
26
systems theory
interrelated, interacting parts (boundaries) that function via input and output
27
community structure
systems and subsystems (health care systems)
macrosystems - part of larger system (state)
exosystem- microsystem and the individual
demography- study of population
28
community function
process of dynamic change and adaptation
nurse functions as advocate - proactive planning
community liason - decision making, collaboration
29
clinical community integration model
displays the arrangment of the strong connections of family, individuals and health delivery in a community system
30
function of a community
refers to process of dynamic change
reflects adaptation in system's parts
community systems and subsistence interact
31
interaction
process where systems exchange matter, energy and information to make decisions
32
where emerges from interactions
health-related patterns
33
nurses match resources to
needs
34
what is the focus of the community developmental perspective
particular age groups in the community
35
what is the developmental perspective used for within a community
used to plan health promotion for groups
36
example of developmental perspective for a community
adolescent, single mothers
children prone to childhood accidents
37
what guides health promotion activity
demographics
38
risk-factor theory
focus is on risks affecting community health and illness
39
what does the community risk factor perspective look at
population risk factors (ie age, gender, race, geographical location, poverty, availability of health services, education, environmental risks)
example: genomics and community assessment
40
genomics
target populations include (sickle cell, tay sachs, CF)
genetics services in community settings for high-risk persons
41
health perception-health management pattern community
- community health status
- health promotion and disease prevention practices
- community member's perception of health (substance abuse, unwanted pregnancies, STIs)
-key community members interviews
-mortality and morbidity stats
- other public health information
42
nutritional - metabolic pattern community
community consumption habits ( availability of food stores or food programs)
indicators: adequate food intake, presence/absence of kitchen facilities, adequate plumbing
43
how would someone observe the nutritional-metabolic pattern within a community
driving/walking through community
government programs
private soup kitchens
food donations at houses of worship
44
elimination pattern in community
environmental factors
physical- air quality, humidity, inaccessible health care, exposure to pollutants
biologic: bacteria, viruses
data sources
obsesrvation; interviews with key informants
EPA;CDCP
45
activity and exercise pattern in community
physical activites/recreational options within communities
data sources
observation
interviews
46
sleep-rest pattern of community
community rhythm of sleep, resting, relaxing
threats to sleep-rest pattern:
ongoing activity from open businesses, highways/trains/airplane noise
data sources:observations interviews
47
cognitive perceptual pattern in community
problem solving and decision making
provides clues about health priorities and values
assessment: interaction w/ environment, effectiveness of strategies to meet health concerns
48
self-perception - self-concept pattern in community
community self-worth and self-identity
indicators:
housing conditions, buildings, cleanliness
school systems, crime rates, accidents
degree of competence with social/political issues
amount of community spirit
49
roles-relationships within community
communication syles: formal or informal relationships
-identity roles/relationships which affect community health
- patterns of crime
-racial incidients
-social network
data sources:interviews, media
50
health programs success are dependent on
support from prominent community members
51
sexuality-reproductive pattern in community
reproductive data of communities: birth stats, mother's age, ethnicity, marital status, prematurity, abortion rates
helps ID high-risk groups and mismatch between services and stats
data sources: meeting minutes, health records, stats, public documents
52
coping-stress tolerance pattern in community
community ability to cope or adapt
develop abilities to exchange good/services; foster goals, values, ideals; promote health
zoning, housing codes, industrial wastes
data: meeting minutes, public documents, health surveys and records, stats
53
values - belief pattern
family values, beliefs and goals
-ID of family values and beliefs
flexibility of rules
family view of spirituality; role of religion
cultural or ethnic practices; effect on illness/health
family practices
value conflicts within family
effect of values on health
54
analysis within community
identify community patterns
-subjective and objective data
-formulate hypothesis
-ID at risk-community groups
-establish probable causes/relationships
55
diagnosis within the community
apply theories, models, norms, standards
-broad knowledge needed
-databases: information to id health concerns/risks
id strengths and health concerns
-inferences made based on data interpretation
-determine status of problem and strategies indiciated
56
examples of community strengths
well child clinic available
feeding program for older adults
sex ed in schools
family planning services
fluoridated water system
open communication
interagency cooperation
adequate kitchen/plumbing
high interest health promotion
57
examples of community concerns
unavailable well child clinic
no feeding program for adults
no sex ed
no family planning services
non-fluoridated water system
dysfunctional communication
dysfunctional transactions
indequate kitchen and plumbing
lack of interst in health promotion
58
precontemplative
provide info and ID risk factors
raise doubts about current behaviors and future outcomes
59
contemplative
discuss risks of not changing, discuss benefits of changing
60
planning/preperation
help plan phases of change; help implement phases of change
61
action
help develop strategies to prevent relapse; offer encouragement
62
maintenance
highlight past success and future benefits
63
planning change with the community
prioritize problems, differntiate roles, ID goals and objectives, formalize plans
64
community nursing interventions
nurse-implemented behavior to achieve community health goals
consdier health belief models
communicate plans with other professionals
take steps to overcome resistance to change
65
evaluation with the community
actions: lead to desired outcomes-evaluate
directed at achievment of goals
results in continued cycle of nursing process
66
health people 2030 objective include
national and state partnerships that establish health objectives and sustain initiatives
67
preventative services are vital to
health promotion and disease prevention
68
who originally oversaw preventative services
CDC
69
screening
important tool to detect disease at early stage before it becomes both costly and threatens quality of life
70
what kind of prevention is screening
secondary
71
what is the primary objective of screening
detection of a disease in its early stages and treat disease and prevent progression
72
benefits of screening and early detection
reduce cost of disease management and avoid costly interventions required for later stages
73
some disease show a period called
latency where there are no symptoms
74
early detection of disease avoids
more intensive intervention and may allow for early isolation and mitigation
75
individual screening
one person tested; often chosen based on risk factors
76
group or mass screening
target population selected on basis of increased risk
77
one test disease specific screening
single test detects characteristic indicating high risk
78
multiple test screening
2 or more tests to detect one disease
79
advantages of screening
simple screening tests are cost-effective
can be applied to both individuals and larger populations
some screening is mandated by law
creates opportunity for health teaching
can be one test disease specific or multiple test
80
example of individual screening
BP check in primary care
81
example of population screening
community screening fairs
82
disadvantages of screening
uncertainty in scientific evidence- possibility of errors which can lead to:
false positives
false negatives
83
false positives can lead to
anxiety and unnecessary interventions
84
false negatives can lead to
disease being overlooked; missed opportunity for early intervention; false assurance
85
epidemiology
method used to find cause of disease and outcomes in populations
86
morbidity
disease state or disability from any cause
includes range or degree of illness
87
mortality
deaths in a given population as end outcome indices
88
incidence
rate of a new population problem and estimates risk of individual developing disease
89
prevalence
proportion of the poppulation with disease at any one point in time
90
quality of life is
subjective and difficult to assess
91
quality adjusted life year (QALY)
1 year of excellent health = 1 QALY
concern that it may be used to ration health care (not client focused, impersonal)
92
disability adjusted life year (DALY)
reflects a year spent in less than healthy life
gages burden of disease
little difference from QALY
93
detection
are there well documented diagnostic criteria
resources treatment available to support screening
94
diagnostic criteria
disease should have early asymptomatic state
who should be screened
95
screening measures
must be safe, cost-effective and accurate
96
reliability
reproducability of test results
97
interobserver
same results when 2 persons do test
98
intraobserver
same person able to reproduce results (if low, test may be faulty)
99
validity
accuracy, distinguish those with/without
100
new avenues for screening
23 and me
prenatal screening
101
development of community health program
lead agency: oversees development
partnerships with community stakeholders
community assessment - systematic data collection
target population resources, health needs, program strategies identified
program constraints (financial, accessibility, follow up services)
102
screening guidelines
US Preventative Services Task Force puts forth guidelines
103
how have mammography guidelines changed
kept getting false positives
104
controversies of screening results
false positives, false negatives; duty to inform?
cutoff points
borderline cases
105
costs of health screening
social and political forces becoming more cost conscious vs past practice
do costs result in improved health are benefits of screening worth the expenditures required
106
what are the three approaches to evaluate economic costs and ethics
cost benefit ratio
cost effectiveness
cost efficiency analysis
107
cost benefit ratio
allow comparison of various outcomes in monetary forms
cost screening vs cost of HPV vaccine for cervical cancer
chronic disease cost calculator - published by CDC is useful
108
cost effectiveness
detemines optimal use of resources to reach desired health outcome
if there are limited resources, must choose among various screening options
109
cost efficiency
budget limited funds toward optimizing goal
110
selection of a screenable population
descision based on incidence and prevalence
goal: minimize costs, maximize benefits
111
healthy people 2020 and 2030
establishes benchmarks and monitor progress
includes screening objectives
112
recommend screenings of US preventative services task force
part of agency for healthcare research and quality
ids specific population recommendations
113
US affordable care act and prevention
mandates coverage for preventative services
medicare advantage programs: enhanced coverage
114
affordable care act
passed in 2010 focuses on prevention and health promotion to allow preventative services to be covered without copay or coinsurance including medicare and private insurance
115
national prevention strategy
released in june 2011 still being implemented
addresses clean air and water, healthy foods, violence free environment, healthy homes
empower people in making health choices
eliminate health disparities
116
strategic direction recommendations
1. improve cardiovascular health
2. incorporate screening
3. reimbursement to encourage preventative services
4. reduce access barriers to preventative services
117
nurse's role
development and implementation of screening programs
decision maker
planner
education and counseling
follow-up
collaborate with other health care providers
focus and primary and secondary prevention
118
racial and ethnic considerations
CDC REACH
-breast and cervical CA prevention
-cardiovascular health
-diabetes management
119
stress
an expected or emotional reaction change that can cause or exacerbate health problems like heart disease, DM, and mental health issues
120
stress management
effective intervention for health promotion
121
management strategies
relaxation and imagery, self monitoring
goal setting, cognitive restructuring
mindfullness and problem solving
122
what is the goal of stress management
improve quality of life
coping reduces unhealthy consequences
123
stressor
any psychological ,environmental or physiological stimulus that disrupts homeostasis therby necessitating change or adaptation
124
homeodynamics
stress not necessarily bad or unhealthy - essential component of being alive
stress triggers adaptive response: positive or negative
describes continuously changing nature and interaction of life
125
stress threatens homeodynamics which triggers efforts to restore stability
physiological responses
behavioral responses
social responses
126
extrinsic factors
stressors over which individuals do not have control over
death of spouse, weather
127
modifiable facotrs
stressors which individual can modify through change environment, interactions, behavior
128
intrinsic factors
stressors created or exacerbated by individual response to stress
negative thinking, procrastination
129
general adaptation syndrome
Hans Selye in 1954
stress can be both useful and harmful
stress increases productivity to a point
130
eustress
challenging and useful stress; not destructive
131
distress
chronic or excessive stress; body unable to adapt; threatens homeostasis
132
sociophysiology
integrates social and biological models to see how social processes affect physiology of organism and how does altered physiology affect future social behavior
133
consequences of stress
physical, psychological, socio-behavioral, spiritual
homeodynamic interplay of factors has widespread effects
134
physiological effects of stress
neuroendocrine activation/behavior change
-fight or flight stress response
-hypothalamus signals sympathetic nervous system: epinephrine and norepinephrine
-increased metabolism, pulse, blood pressure, respiration, muscle tension, increased glucose
Maladaptive: cause/exacrebate disease or symptoms of disease
135
psychological effects of stress
contributory role in negative mood states (anxiety, depression, hostility, anger)
elevated cortisol levels; immune system response
affects health outcomes in key populations
-quality of life
-depressive symptoms
-degree of suffering
136
sociobehavioral effects of stress
stress response
-overeating
-excessive use alcohol/drugs
-smoking
-social isolation
unhealthy behaviors associated with increased morbidity/mortality
137
stress response
individual reliance on less health behaviors
138
what are healthy adaptations of sociobehavioral effects of stress
exercise
healthy diet
quit smoking
weight loss
social interactions
139
spiritual effects of stress
spirituality: feelings thoughts experiences and behaviors that arise from a search for meaning
stress response often feel disconnected from life's meaning/purpose
spirituality assists with coping with stress
promoting connection with life meaning and purpose: health benefits
140
assessment of stress
primary appraisal: descriptions of percieved actual/potential positive and negative outcomes
-negative outcomes (harm/injury,disease,death)
-positive outcomes (challenges which can be managed, promotion/graduation)
secondary appraisal : individuals identification of choices to cope with stress
-internal or external resources and responses
141
measuring of stress
standardized instruments are available
142
burnout
emotional exhaustion, depersonalization and sense of reduced accomplishment
- personal or work related
143
stress management interventions
self awareness one of the most effective tools
recognize signs (muscle tension resulting in backache, headache)
attend to cues to reduce negative mood states (anxiety symptoms) or symptoms (stretching for backache)
144
nursing role in stress-management interventions
assist people to identify stress signals, change response (breathe/relaxation), break stress cycle
145
physical symptoms of stress
headaches
indigestion
stomachaches
sweaty palms
sleep difficulties
dizziness
back pain
tight neck and shoulders
racing heart
restlessness
tiredness
ringing in ears
146
behavioral symptoms of stress
excess smoking
bossiness
compulsive gum chewing
attitude critical of others
grinding of teeth at night
overuse of alcohol
compulsive eating
inability to get things done
147
emotional symptoms of stress
crying
nervoussness and anxiety
boredom
edginess
feeling powerless
overwhelming sense of pressure
anger
lonliness
unhappiness for no reason
easily upset
148
cognitive symptoms of stress
trouble thinking clearly
lack of creativity
memory loss
forgetfullness
inability to make decisions
throughts of running away
constant worry
loss of sense of humor
149
spiritual symptoms of stress
emptiness
loss of meaning
doubt
unforgiving
martydom
looking for magic
loss of direction
cynicism
apathy
\needing to prove self
150
relational symptoms
isolation
intolerance
resentment
lonliness
lashing out
hiding
claming uo
lowered sex drive
nagging
distrust
lack of intamcy
using people
151
monitoring stress
negative stress cycles can be difficult to break
anxiety sensitivity: tendency to misinterpret physical anxiety cues
-anxiety related symptoms believed to be due to serious physical danger
relaxation response: measures to reduce stress
152
relaxation response technique
technique to help develop awareness/counter-negative effects of stress
reduces sympathetic arousal
153
what are the two components of the relaxation response technique
repition of word/thought/activity
passive disregard for everyday thought
154
mini relaxations
can be used throughout the day
keep initial stress symptoms form intensifying
155
relaxation techniques
yoga
deep breathing
mindfullness
conscious diaphragmatic breaths
quiet sitting
visualizations
156
alternative complementary therapies
acupuncture
hypnosis
reiki
reflexology
chiropractic
herbal
157
cognitive behavioral restructuring
modifies negative or exaggerated thinking to reduce stress
evaluates challenges thoughts; replaces with more rational responses
teaches patient to recognize negative thinking and replace with reframing or cognitive reappraisal
158
affirmations
positive thought (short phrase or saying) that has meaning for person
repeat affirmation through day- enhances self-esteem and reduces stress
159
social support
network of close family friends coworkers and professionals
number of supporters and quality of relationships important
160
steps of cognitive restructuring
stop
breath deep
reflect
what are my thoughts
choose more helpful thinking
161
empathy
consider another person's perspective and communicate understanding back to person
162
active listening
conscious empathetic nonjudemental awareness
163
additional modalities
clarifying values and beliefs
setting realistic goals
humor
engaing in pleasurable activies
164
health benefits of managing stress
stress managment is key to disease managment and better health outcomes
social support system protective vs stress related symptoms and disease
caregiver stress/burden is a major concern
165
effective coping
the art of finding a balance between acceptance and action between letting go and taking control
166
CAM therapies
date back 5000 years
167
national center for complementary and integrative health is one of NIH institutes
describes CAM as health practices other than those used in mainstream healthcare
addresses an ever increasing array of modalities
distinguishes complementary therapy alternative therapy and integrative therapy
168
complemntary therapy
non-mainstream practice that uses CAM in conjunction with allopathic traditional medicine
169
alternatie therapy
non-mainstream practice that uses CAM to substitue for standard medicine
170
integrative therapy
total approach that combines standard with CAM
171
allopathy
conventional biomedicine
172
holistic health
preventative care which considers whole individual
173
holism
focus on proactive healthy living
174
how is health defined
as the absence of disease
175
goals of holistic practice
support a person's natural healing systems
consider the whole person
consider the environment surrounding person
176
health policy for CAM
NCCIH has clinical practice guidelines for CAM
healthy people 2020 and 2030 support each others goals
Affordable Care Act mandates insurers not discriminate against liscensed provides including alt medicine providers
National Prevention Strategy tied to ACA
support prevntion
seeks to eliminate health disparities
177
holistic nursing
AHNA defines holistic nursing as a practice that heals the whole person
178
types of CAM interventions
whole medical system
biologically based practice
manipulatie body based practices
energy therapies
mind and body techniques and practices
ancient medical systems
179
ayrvedic medicine (india)
herbs, massage, doet, drugs
goal is mind-body harmony
180
traditional chinese medicine (china)
herbs, CAM treatments, accupuncture
balance yin and yang life forces
describes organs via fire, earth, metal, H2O, wood
181
naturopathy
combination of traditional and 19th century European modalities on healing power of nature
no prescriptions injections xrays or surgery
health lifestyle, cleansing regiments, diets, manipulation, and exersice
182
homeopathy
Hahnemann
administers small amounts of dilute pathogenic substances ot stimulate body's healing abilities
183
current biologically based practices
nutritional counseling
herbs, vitamins, minerals
probiotics
aromatherapy
hydrotherapy
184
manipulative and body based modalities
spinal or bone manipulation
cranial and carnio-sacral therapy
physcial therapy
massage
reflexology
185
spinal or bone manipulation
application of controlled force on bone or joint
chiropracters, physical therapists, and osteopathic physicans
spinal alignment
186
cranial and carniosacral therapy
focus on skull and flow of CSF
gentle pressure cranium spine and sacrum
goal to restore free movement of CSF
187
physical therapy
manipulation, massage, heat or cold, movement, electrical impulse
treat pain and restore function and ROM
188
massage
manipulation of msucle and soft tissue
reduce stress and enhance relaxation
189
reflexology
manipulation and energy fields
pressure to hands and feet
pressure points correspond to body organs
190
mind body medicine
visual guided imagery
meditation
hypnotherapy
biofeedback
neruolinquistic programming
191
visual guided imagery
focuses on calming thoguhts or experiences
promotes well being and relaxation
192
meditation
focused attention and mindfullness
quiets mind and reduces stress
breath, chosen word, walking
193
hyponotherapy
focused attention of unconscious mind
recall of suppressed events
194
biofeedback
relaxation technique
focus on vital function HR BP breathing rate
visualization to bring about change
195
neurolinquistic programming (NLP)
changes behavior via change in thinking and speaking
196
movement therapy
qigong (chinese)
tai chi (chinese martial art)
yoga (hindu)
dance therapy
197
qigong
chinese
relaxed movement with meditation
controlled breathing to move qi energy and increase vital energy
198
tai chi
chinese martial art
combined physical movement, breath control meditation
sequences of poses flows in unbroken rhythm to balance energy flow
moment to moment state of body
meditative state
199
yoga
involves positions and breath control
200
energy therapy
energy flows through body and nourishes organs/promotes optimal functioning
goal: energy work relases blockages to energy flow, rebalances life energy
chinese: chi or qi
japanese: ki
east indian: prana
201
acupunture
manipulates chi or qi on channels where chi travels
stimulation via needles, electrostimulation, laser, light, burning herbs (moxibustion)
202
acupressure
stimulation of meridian points by hand pressure
203
reflexology
deeply applied pressure to mapped points on feet and hands
applied with thumbs
pressure points correspond to organs of the body that will be stiulated by pressure
204
touch therapies
practioners use their hands to direct energy from environment to individual
goal is to restore balance and harmony
examples: theraputic touch, reiki, attunement, jin shin jyutsu, polarity therapy, healing touch
205
therapeutic tocuh
human energy fields interact with environmental energy fields
three elements:
centering of prationer
assesssment
treatment
206
energy therapy modalities
healing touch
qigong
pranic
riki
polarity therapy
jin shin jyutsu
207
prayer
different meanings to different people
commong belief aids in recovery
research mixed on therapuetic benefit
208
distant healing
prayer for others
method: praying circle
sharing energy and sending of energy to person in need
209
nursing presence
nurses presence can contribute to healing
attention focused vs attentive
touch caring vs task oriented
listen vs hearing
210
safety and effectiveness of CAM
lack strong scientific evidence based as many have not been studied with rigourous trials
some CAM providers are not credentialed
safety issues fr some CAM
211
growth and development is a framework for
health assessment and health promotion
addresses concepts and milestones normally achieved through various stages of life
includes both physical and psychosocial stages
212
life stages
infant: birth to 12 months
toddler: 12 months to 3 years
preschool child: 3-5 years
schoolaged child: 5-12 years
asolescent: 12-18 years
young adult: 18-35 years
middle-aged adult: 35-65 years
older adult: >65 years
213
growth
quantifiable change in structure
change increases number and size of cells
occurs throughout life
many facotrs impact and influence growth like gender, age, genetics, emotional health, environment, cultural practices
214
growth patterns
exist for all people
varying rates of growth throughout life
example: rapid in infancy, adolescent growth spurts
215
growth patterns in early life and in newborns
head is fastest growing section then trunk followed by arms and legs
newborn head is 1/4 overall body length vs 1/9 for adults
216
CDC recommends using 2006 WHO growth charts for age _____ months then use revised 2000 CDC charts for age ____
0-24 months, 2-20 years
217
CDC and WHO charts accounts for
weight, length, and BMI all for a given age including percentiles
218
development
refers to change and expansion of ability
advancement of skill
qualitative changes- not easily measured
process which follows certain sequencing patterns
rate of development will vary with individual
219
developmental patterns
cephalocaudal
proximodistal
differentiation
220
cephalocaudal
head to toe
221
proximodistal
midline to periphery
222
differentiation
simple to complex
223
learning and maturation
learning- process of gaining knowledge/skills from exposure, education, experience
maturation- increased competence
learning requires sufficient maturity to understand/control behavior
224
theories of development
erikson
piaget
vygotsy
kohlberg and gilligan
225
erikson's theory of psychosocial development
individual needs to develop sense of trust and personal worth
each stage requires a resolution of conflict between two opposing forces
a conflict once resolved may re-emerge
226
infancy
trust vs mistrust - faith and hope
227
toddler
autonomy vs shame and doubt - self-control, willpower
228
preschool
initiative vs guilt - direction and purpose
229
school age
industry vs inferiority - method and competence
230
adolesence
identity vs role confusion - devotion and fidelity
231
young adult
intamcy vs isolation - affiliation and love
232
middle adult
generativity vs stagnation - production and care
233
older adult
ego integrity vs despair - renunciation and wisdom
234
piaget's theory of cognitive development
uses term scheme to describe a pattern of action or tought
individuals strive to maintain balance between assimilation and accommodation
criticism - underestimated children's capabilities; does not address effect of culture
235
piagets stages of cognitive development
birth to 15 years
sensorimotor - birth to 2 years
preoperational - 2-7 years
concrete operations - 7-11 years
formal operations -11-15 years
236
sensorimotor (birth to 2 years)
reflexes decrease, voluntary acts develop
imitation predominates
though dominated by physical manipulation of objects
develops object permancence - forms mental images
237
preoperational (2-7 years)
no cause and effect reasoning, advanced use language
thought dominated by sense
egotistical, animistic, magical thinking
uses representational thought to learn
238
concrete operations (7-11 years)
can consider other points of view, collecting facts
assume logical approaches to problem solving including cause and efect
collecting and master facts; language perfected
thought influenced by social contacts
239
formal operations (11-15 years)
true logical thought and manipulation of abstract concepts emerge mortality established
240
vygotsky's theory
proposed that learning preceded devleopment vs piaget who proposed development must be reached before learning
learning pulls development
-individual process of making meaning or sense of experiences
-can learn by observation
241
kohlberg theory of moral development
based on piaget's theory of cognitive development
emphasizes an ethic of justice
stges of moral development proceed during school age adolescent and young adult years
242
preconventional (kohlberg)
avoiding punishment/gaining reward
243
conventional (kohlberg)
gaining approval/avoiding disapproval
244
postconventional
agreeing upon right
establishing personal moral standards
achieving justice
245
gilligan feminist theory of moral development
noted women scored lower vs men with kohlbergs tool
suggest a diffferent process of moral development exists in women
women are relationships based vs cognitive development- social relationships are key
women think and act based on caring and relationships
emphasis on individual moral situations
246
preconventional (gilligan)
what is practical to others and best for self
goal is individual survival
247
conventional (gilligan)
sacrifices wants and needs to fulfill others needs
goal: self-sacrifice is goodness
248
postconventional (gilligan)
moral equal of self and others
goal: principle of non-violence; do not hurt self or others
249
behavioral-biological development
nature vs nurtue
evidence suggests that environmental experiences can change gene functioning
brain plasticity theory: brain cell development can modify learning and environmental experience
250
infant refers to the time period of
birth to 12 months
251
determinants of health for an infant
socioeconomic status
physical and social environment
genetics and biological influences
access to health care
252
infants are
completly dependent on caregiversd
253
developmental landmarks
guide parents, nurse must know what behaviors to expect at certain age levels
physical growth landmarks
developmental tasks
254
physiological equilibrium
task of survival; basic physiological functions
oral stage of development
255
stimulation and environmental interaction
essential for infant development
progressive connection of dendrites
increase vascularization of brain structures
increases myelation of brain/nerves
256
infant should have what kind of stimuli
auditory and visual stimuli like radios spoken voice mobiles - touch is important
257
concepts of infant development
erikson: trust vs mistrust (psychosocial development)
trust influences future relationships
infant needs maximum gratification/minimum frustration
piaget: cognitive development
sensorimotor period
mastering simple coordination acitvities through senses and motor activity
reflexes
responses following stimulation
rooting and sucking reflex: assits survival
258
infant developmental theory
assessment tool that screens from birth to 18 months
monthly developmental milestones
259
Gender and Race
XY=male
XX= female
male: larger, more muscle mass, more motor activity
female: smaller but more physically mature at birth
race- universal norms do not exist
260
birth defect
abnormality structure, function or metabolism due to genetic or environment issue
maternal age: down syndrome > 35 years old
ethnic background
eastern european jews: tay sachs disease
blacks: sickle cell anemia
family history
- huntingtons chorea, hemophilia, mentardation
261
reproductive history
spontaneous abortions
stillbirths
previous children with genetic conditions
262
maternal disease
diabetes mellitus seizure disorder PKU
263
nurses role in genetics
case findings, referral, family education during genetic counseling process
264
health perception and helath management pattern for infant
health promotion through parents
promote competence in parent's ability to act to enhance infant's health
ID problems
help parents recognize infant susceptibility
teach characteristics that influence health
265
essential infant nurtients (nutritional metabolic pattern)
water: supplied by breast milk or formula
protein: high quality not over 20%
CHO 37% of calories in breast milk
fat: 40-50% of calories
vitamins and minerals (vitamin D, iron, vitamin C, flouride is not recommended for 6 months)
solid food not needed for first 6 months
avoid food additives
under and over nutrition
266
how is baby food cooked
home prepared is encomomical option: cook without salt or sugar then blenderized
commerical food is safe, nutritious and high quality
267
breastfeeding
optimum source of nutrition
preferred method first 6 monthhs
health people 2030 adress brest feed
AFA requires accomadations and coverage
268
solid foods for infant
cereals, particullarly rice, nonallergenic
fruits: peaches pears applesauce
vegetables: yellow veggies before green vegetables
strained meats, non allergenic lamb, veal
269
4-6 month food
iron-fortified rice ceral
270
5-7 months food
strained veggies fruits and juices
271
6-8 months
protein foods; cheese, meat, fish, yogurt
272
9 months
finely chopped meat, toast, crackers
273
10-12 months
whole egg, whole milk
274
weaning
gradual process of introducing infant to cup around 5-6 months
275
baby bottle syndrome
tooth decay
276
what is at risk when you prop baby bottles
aspiration danger
277
why can't infants have honey before 2 years old
risk botulism
278
elimination pattern
develops second week of life
breastfed stool - softer consistency, clean smell
- initial several stools daily; progress to once daily
bottlefed stool - harder consistency, smellier
-similar to infant on solid food
defecation involuntary- avoid toilet training till 18 months
279
urinary elimination
6-12 times/day first few months
irregularly after first few months
voiding involuntary
280
when does bladder sensation develop
2nd year
281
anticipatory guidance
teach parents regarding inability to control bladder so parental expectations are realistic
282
activity-exercise pattern in infants
activity through play
-exercise of sense
-solitary and repititious
-promoting play is important
activity through stimulation
-parental stimulation important to development
-singing, music, rocking
-mirrors, face-to-face interaction
283
sleep-rest pattern of infants
sleep needs correlate to rate of growth
-80% at birth - will sleep less over time
-12 hrs daily at 12 months
promote infants sleep patterns
-sensitivity to sleep cycles, develop rituals
-not firm schedule
sleep problems are highly prevalent
-bedtime routine helps
-brief arousals at night are normal for infants
-quiet room separate from parents is recommended
284
SIDS
sudden unexplained death of infant <1 year that mostly occurs before 6 months
risk factors: prone sleeping, exposure to tobacco smoke, soft sleeping surfaces, hyperthermia, bed sharing, lack of breast feeding, SIDS sibling, preterm
recommendations:
avoid risk factors
supine sleep position (place on back)
285
safe to sleep campaign
placing child on back vs prone for sleep
avoids one of risk factors for sids
has significantly reduced incidence of SIDS
increased incidence of occipital flattening
286
cognitive perceptual pattern
vision: eye muscle weak
-initially vision is unfocused without meaning
-eye movements coordinate by 3 months
-eye movements mature by 6 months
hearing-acute ability
-sound discrimination is important developmental task
smell-fully developed
-can differentiate odor of mothers milk from other at 2 weeks
taste-present at birth; salvation at 3 months of age
touch and motion
-tactile sensation well developed
-touch relieves infant tensions and speeds neuromuscular development
language development
-sensory stimulation important
287
language development in infants
cooing by 2 months
babbling at 6 months
single words by 12 months
expressive jargon 15-18 months
288
self perception - self concept pattern
separating me from non me
developed through feedback
-effect of crying/smiling on others
-ability to use body to influence others
-messages infant recieves from body
differentiates self in mirror images at 4 months
develops body image as he or she experiences the environment through senses
289
roles-relationship patterns in infants
attachment and bonding
theories of attachment: freudian psychoanalytic theory and social learning theory
difficulties with attachment: increased risk of child abuse, failure to thrive, behavior problems, poor growth
paternal attachemnet/bonding: engrossment
290
child abuse
active or passive abuse at hands of parents or caregivers
most common under age 2
response to inadequate parental coping - often socially isolated
intergenerational cycle of behavior
long term effect on child
291
prevention of child abuse
id of abuse when it occurs
protection of abuse/at-risk children
292
scope of child abuse
1 in 7 children or infants are victims of abuse
1700 children die from abuse or neglect
abused children commonly become abusing parents
293
sexuality-reproductive pattern of infants
sexual identity begins at birth
caretakers behavior secondary to gender
infants sexuality gives direction to own responses through life
infants characteristics
-oral sensivity
-enjoy skin to skin contact
-explores own body for pleasure in infancy
294
coping-stress tolerance in infants
developmental crisis
situational crisis- not anticipated as part of normal growth/development
-seperation from significant other
infants have little coping capability but they learn over time
295
protest
infant cries loudly; screams for mother
296
despair
stops crying withdrawn apathetic
297
withdrawl
ignores mother on her return
298
values-belief pattern of infants
parents' values and beliefs influence care and development of infant
nurse interventions
-works with parental framework
-serving as a consultant (listener)
-expressive values/attitudes
-remaining open to other approaches
299
physical agents
leading cause of death
falls
burns
swallowing and choking on foreign objects
300
biological agents
common indoor bacterial pathogens
-food, cribs, air, parents, siblings, pets
-bacteria and viruses
-immunizations helpful
common indoor pollutants
-kerosene oil, gas, tobacco, damp carpets, household cleaners, central air
301
HIV and AIDS
acquired immunodeficiency syndrome
transmission: pregnancy, delievery, breastfeeding
symptoms usually during first year: infections, developmental delays, failure to thrive
WHO and UNAIDS recommend circumcision
302
nursing role in HIV and AIDS
education of disease and transmission
prevention of AIDS transmission
303
immunization
ICDC and AAP recommended schedule
1,2,4,6,12 months
304
active immunization
live killed or attenuated organism that stimulates immune system to build immunity
tetanus, inactivated polio, measles, mumps, rubella
305
passive immunization
transient antibodies (mother)
naturally occurs in newborns from maternal antibodies
306
chemical agents
drugs
-asprin, acetaminophen, vitamins
-childproof packaging
prevention - safety measures enacted into law
poison prevention- children naturally explore
-plants can be poisonous
-cleaners, household supplies
toxins
pesticide
lead- slows mental development
asthma
indoor air pollutants
water pollution
307
car seats
infant on lap can project and is distracting
rear-facing safety seat for as long as possible
foward facnig care with harness as long as possible
belt positioned booster with 3pt restraint for 8-12 years
all children < 13 to ride in back seat
308
heat stroke
-if left unattended in motor vehicle
dangerous temps occur in 15-30 min
ambient temp 86 - internal temp 120-140
look before you leave routine
309
radiation exposure
natrual background radiation: cosmic rays, soil, water, air
human made radiation: microwaves, electronic devices, xrays, radiation emergencies
can cause rapid cell growth in infants
exposure to UV radiation alters development of immune system
310
day care
ideal for mother and child to be together for 4-6 months before day care
nurses role: help parents understand seperation and expected behaviors
311
culture and ethnicity influences from conception
power structure
breastfeeding decisions
traditional and folk beliefs
312
religion
impacts health
decisions on treatment
evaluation of health services
313
legistlation
health people 2020 and 2030 include initiatives to improve infant health
-family planning services
-pregnancy and infant services
-educational efforts on prenatal care
-immunization efforts
nursing's role
participate in development of health care policy
coordination of community resources
314
poverty for infants
infant mortality rates higher
higher disease
delayed language development
parents overwhelmed
315
nursing interventions for poverty
ID community resources; family advocate
participate in legislative process
well child visits promote and maintain health
316
nursing application for infants
primary role- provide the family with education
infancy is critical development period
additional:
focus on nutritional needs in first 18 months
anticipitory guidance to parents
routine well visits and immunizations
health promotion
support evidence based models of care
