Exam 2 Flashcards
Family definition
2 or more individuals who are joined by marriage, birth or adoption and live together.
What does dynamic mean
Changing system can by influenced from outside or within
What are the roles of a family
- Caring, nurturing, educating children
- Maintaining the continuity of society by transmitting the family’s customs and values to children
- Receiving and giving love
- Preparing children to become productive members of society
- Meeting the needs of its members
- Serving as a buffer between its members and environmental/societal demands while advocating the interests and need of the individual family members
Family centered care
Philosophy in which a mutually beneficial partnership develops between families and the nurse or other health care providers
Promoting family centered care
- Family at the center
- Family professional collaboration and communication
- Cultural diversity of families
4: coping differences and support - Family centered peer support
- Specialized service and support systems
- Holistic perspective of family centered care
Nuclear family
Mom dad kids
Blended family
“Brady bunch” style
Extended family
Aunt, uncle, grandparents in house
Single-parent family
Just one parent present
Binuclear family
Mom and dad are split, kids rotate between both sets of parents, 4 parents total
Heterosexual cohabiting family
Not married
LGBT family
Same sex couple etc.
Parenting is what?
Leadership role
Includes parental warmth and parental control
Authoritarian parent
High control
Low warmth
Authoritative parenting
Moderately high control
High warmth
Permissive parenting
Low control
High warmth
Indifferent parenting
Low control
Low warmth
Family theories are good for what?
- Understanding family functioning
- Environment-family interchange
- Family changes over time
- Family response to health and illness
Family development theory stages
Stage 1: beginning family, newly married couples
Stage 2:childbearing family
Stage3: families with preschool children
Stage 4: families with school aged children
Stage 5: families with teenagers
Stage 6: families launching young adults
Stage 7: middle-aged parents
Stage 8: family in retirement and old age
Family systems theory?
Interaction between components of the system and between the system and the environment
Any change or stressor by one member of the family can cause the entire family disruption.
Family stress theory
Focuses on the family response to unexpected or unplanned events.
Routine stressors
Non routine stressors - positive stressors or unexpected stressors.
Family assessment?
Identify strategies for coping
Strengths : Communication skills Shared family values and beliefs Intrafamily support Self-care abilities Problem-solving skills Community linages
Family support services
Head start and early head start Before and after school programs Play groups Peer support groups Social service programs Home visits Job skills training or adult education Crisis care and respite care.
Nursing interventions
- Identify primary decision maker
- Discuss the family’s goals for managing care in the home setting
- Consider how the family’s strengths and previous experiences can be integrated into the intervention
- Consider family’s ethnic and religious background
- Offer the family one or more potential interventions instead of trying to force one intervention
- Identify what type of support or assistance the family would like to have.
- Identify potential community resources
- Provide the family with a care coordinator
Cultural considerations
Family roles and organization Communication Time orientation Nutrition Health beliefs,approaches, and practices.
Genetics/genomics
Genome
Genetics
ANA scope and standards of practice.
Stages of development
Infancy- birth to 12mo Toddler- 1-3 yr Preschool- 3-6 yr School age- 6-12 yr Adolescence- 12-18 yr
Principles of growth and development
Development is orderly and sequential Development is directional Development is unique for each child Development is interrelated Development becomes increasingly differentiated Development becomes increasingly integrated and complex Children are competent New skills are predominate
Cephalocaudal growth
Growth is from head down
Proximodistal growth
Growth from the center of the body outwards
Nature vs nurture
Nature is genetic or hereditary capability of an individual
Nurture is the effects of the environment on a persons performance.
Freuds theory- infant
Oral phase- derives pleasure from the mouth with sucking and eating as primary desires.
Eriksons theory- infant
Trust vs mistrust- establish trust with care providers
Piagets theory- infant
Sensorimotor stage- infant learns from movement and sensory input
Cause and effect
Object permanence
Infant growth
- birthweight doubles by 6 months
- birth weight triples by 1 yr
- length increases by about 50% by 1 yr
- rapid head growth
- teeth erupt at about 6 mo
- posterior fontanel closes by 6-8 wks
- anterior fontanel closes by 12-18 mo
Infant fine motor ability
- birth to 1 mo- holds hands as fist
- 2-4 mo - holds rattle when placed in hand
- 4-6 mo- mouths objects
- 6-8 mo- transfers object one hand to another
- 8-10 mo- picks up small objects
- 10-12 mo- holds crayon and makes marks on paper
Infant gross motor Ability
- birth to one month- reflexes present and may briefly lift head in prone
- 2-4 mo turns from side to back
- 4-6 mo head remains steady while sitting
Infant communication
0-3months coos babbles cries
3-6months squeals and pleasure sounds
6-9months links syllables together
9-12months understands “no” and other simple commands, says mama and dada
Infant injuries
Falls Burns Drowning Poisoning Choking Suffocation Strangulation Motor vehicle crashes- rearfacing until 20lbs, 2yrs preferred
Toddler growth
Growth slows considerably
- quadruple birth weight by age 2
- age 2 is 1/2 of adult height
- chest circumference begins to exceed the heads
- pot belly appearance and wide stance
- brain growth is 75% complete by age 2
Freud theory toddler
Anal stage- body control is prime force in behavior
Erickson theory toddler
Autonomy vs Shame and doubt
Increasing independence.
Piaget theory toddler
Sensorimotor stage (end)
Increasing curiosity and exploration
Improvement in language skills
Gross motor skills toddler
12-13 mos walk alone using wide stance 18mo try to run but falls easy 2yr walk up and down stairs 2.5yr jump, tiptoes briefly, kick ball 3yr walk on tiptoes, climb stairs with alternate footing, overhand throws balls
Fine motor ability toddler
1-2 yr builds tower of blocks, scribbles on paper, can undress self, throws ball
2-3yr draws a circle and other forms, learns to pour, learning to dress self.
Language toddler
- 300 words by age 2
- Much greater ability to comprehend language
- 1yr one word sentences 25% intelligible
- 2yr 2-3 word sentences 65% intelligible
- 3yr simple sentences (3-4 words) begins to master grammatical rules, acquires 5-6 new words daily
Injuries toddler
Injuries cause more deaths than any group except adolescence
Traumatic injury is leading cause of death
Movement plus no knowledge of dangers is bad mixture
Falls and burns
Drowning and poisoning
Preschooler growth
Physical growth slows and stabilizes
Physical proportions are now sturdy, graceful, agile, and posturally erect
Freud theory preschooler
Phallic stage- working out relationship with parents
Begins by identifying with parent of opposite sex but ends by identifying with parent of same sex
Erickson theory preschooler
Initiative vs guilt
Child likes to initiate play
Piaget theory preschooler
Preoperational stage- increasingly verbal limitations in thought process
Often confused
Transductive reasoning
Centration
Magical thinking
Animism
Fine motor ability preschooler
Uses scissors Draws shapes and 6 part person Learns to tie shoes and button clothing Brushes own teeth Use spoon fork knife
Language preschooler
More than 2100 words by age 5
Age 3-4 sentences of 3-4 words, ask many questions, give and follow simple commands
Age 4-5 sentence of 4-5 words, can answer questions, repeat questions until given answer
Age 6- can define simple objects and actions, can give opposites
Growth school age
First growth spurt
Body organs and immune system mature
Freud theory school age
Latency stage- privacy and understanding their body
Erickson theory school age
Industry vs inferiority
Development of new interests and activities
Begins to take pride in accomplishment
Piaget theory school age
Concrete operational stage
Concept of conservation
Better understanding of cause and effect
Gross motor ability school age
Rides two wheeler
Jumps rope
Roller or ice skates
Fine Motor ability school age
Craft projects
Board games
Play school age
Cooperative play, rules, other skills like dance karate music reading games. Etc
Language school age
Being to use more complex grammatical forms
Narrative skills improve
Begins to understand play on words, sounds,double meanings, metaphors and figurative statements
Growth adolescents
Period of transition between childhood and adulthood
Sexual maturity
Sophisticated reasoning abilities
Make educational/occupational decisions
Freud theory adolescents
Genital stage- focus on genital function and relationships
Erikson theory adolescents
Identity vs role confusion
Self identify leads to independence from parents
Begins relying on peers
Piaget theory adolescents
Formal operations stage
Capable of mature abstract thought
Injury adolescents
Injury is leading cause.
Motor vehicle
Homicide and suicide
Sporting Injury
Substance abuse
Young adulthood
25-45 yrs of age
Time of stabilization
Young adulthood developmental tasks
- choose vocation
- get appropriate education
- establish residence
- formulate ideas about selection of mate or relationship
Generation X
Born in 1965-1980
Well educated
Concerned about family life and divorce rates, wants jobs to accommodate
Perceived by elders as uncommitted and indecisive
Cognitive development young adults
Time for achievement
Learning continues
Brain continues to change in structure and complexity
Brain development permits more integrated modes of social response and stable intellectual functions
Erikson theory young adult
Intimacy vs isolation
More objective, realistic, and less egocentric
Creative thought-reality considered only a part of all that is possible.
Emotional health young adults
Stress and depression Suicide is 5th leading cause of death Alcoholism Drug abuse Eating disorders Smoking
Domestic violence
Deliberate violence resulting in severe injury more than 3 times. Establishing control through fear and intimidation
1 woman every 15 seconds in USA
Called IPV intimate partner violence
Causes of family violence
Financial pressures Family separation Loss of Friends and social support. Isolation and communication barriers Cultural differences Lack of family support Living abroad Inability to separate work and home Lack of privacy Job pressures
Divorce
If marriage occurs before sense of identity: intimacy cannot evolve
Most divorces occur during first 3-5 yrs of marriage and involve people less than 29 yrs old.
Median length of first marriage is 7yrs
Frequently married at young age
Less education, money, and personal resources.
1/4 children live with single parent.
Middle age person
- 45-65 or 70 yrs old
- 76 million Americans born between 1946 and 1964
- middle aged earn most of the money, pay most of the bills and taxes, and make many of the decisions
- leads to power in government, politics, education, religion, science, business, industry
Middle aged relationship with children
Generation gap
Blurring of generation lines
Cultural emphasis on youth, beauty vs more traditional society
More informal society
Social mobility- child moves away from social position, education level, class, occupational ethnicity
Young adults may return home.
Relationship with spouse middle aged
Married couples have generally more money saved and less debt than other groups
Empty nest- transition in behavior but no crisis in negative sense.
When middle age loses spouse
Lose partner, lover, caretaker, and companion
Lose audience for conversation
Lose handyman, helper, accountant, and cook
Financial problems
Reduced income may lead to change in residence or lifestyle
Return to work force
Give up things previously taken for granted
Changes in social role
Effects on physical health
Depression
Developmental tasks of family middle aged
Maintain pleasant and comfortable home
Assure financial and emotional security for later life
Share household and other responsibilities
Maintain intimacy
Maintain contact with grown children and families
Cognitive development middle aged
Gradual lifetime neuron loss does not effect cognitive functions
Research- IQ scores increased in all 4 areas.
Physical fitness in men = higher IQ
Creativity increases.
Emotional development middle aged
Transitional period
Time is finite
Serve as mentors, coaches, tutors, Role models and sponsors
Midlife crisis
Major Turning point. Changes in commitments to career, spouse, children, significant emotional turmoil.
What is maturity
Deal constructively with reality Adapt to change Little tension or anxiety Gives rather than receives Relates to others with mutual satisfaction Directs hostile energy into creativity Ability to love Use intuition to comprehend life events and formulates answers.
Later adulthood
Age span is continually changing Ego integrity vs despair Outcome=wisdom Influenced by evaluation of previous life Enriched perspective of life and death Accepts self
Fastest growing segment of U.S. population.
2030 they will be 25% of population
Biological age
Present position compared to potential life span. What shape your body and organs are in
Social age
Roles and habits compared to other members of society
Act your age
Psychological age
Behavioral capacity to adapt to environment
Cognitive age
Age person feels and looks to self
As old as you feel
Senescence
Mental and physical decline associated with aging
Elder abuse and neglect
2million people annually
Typical victim is Caucasian female over 70 with moderate to severe physical or mental impairments.
Causes of elder abuse
Dependent or disabled Economic stress Caregiver exhausted Adult offspring mental Ill or substance abuser. Pattern of violence in family past Man previously abusive to co workers now abuses wife Elder abandoned by children Victim does not report abuse.
Types of elder abuse
Physical- neglect of physical care
Psychological- verbal, name calling, threats
Financial- confiscation of income, force turn over of checks and trusts
Social- forced isolation from family, friends, constant provider switching, refusal of assistance
Memory strategies older adult
Selective encoding- creatively trying to find meaning, underline, outline, summarize main points.
Elaboration- metaphors,analogy, paraphrase in own words
Organization- understand how information is organized. Related items cue memory
External representation- take notes, outline, make charts, diagrams, graphs
Monitoring-test self, check where errors make, correct errors
Grief
Emotional suffering caused by bereavement
Mourning
Process for resolution of grief
Bereavement
Subjective response to loss of a significant other.
Uniform determination of death act
Irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the brain, including the brain stem.
Brain death
Underlying cause of brain injury must be known and irreversible.
Patient can not be suffering from hypothermia or receiving CNS depressants
Must manifest cerebral unresponsiveness and no reflexes.
Apnea testing must not produce spontaneous respiration
Euthanasia
Act or practice of painlessly putting to death persons suffering from incurable or distressing diseases.
Palliative care
Opportunity for nurse to respond genuinely, as authentic care giver
Healing of body, mind and spirit can occur if patient is dying.
Hospice care
Help client accept and cope with dying process
Foster communication between client and family.
Enhance clients autonomy, relieve physical pain and other symptoms
Work with psychological aspects of late stage cancer or other disease.
Awareness of death
Closed awareness-dying but doesn’t know it
Suspicious awareness-has not been told, but recognizes physical and other cues
Mutual pretense-everyone knows but pretends otherwise
Open awareness- all aware and makes plans for dying, death, business etc
5 stages of death
Denial and isolation
Anger
Bargaining
Depression
Preparatory depression
Acceptance.
Caregivers of older adults
Usually wife or female child
Sons tend to provide less direct care and become less involved
Elderly person caring for disabled or ill spouse is a hidden victim. At risk for physical or emotional stress
Support groups.
Poly-pharmacy
Taking excess and unneeded combination of drugs
Successful aging
High degree of life satisfaction. Life was rewarding. Few regrets. Positive attitude. Good health habits.
Extended care
Less custodial, more homelike, holistic, community focused.
Assisted living
Alternative to medical model of institutionalization
Translocation syndrome
Physical and emotional deterioration as result of changes or movement.
Visually impaired communication
Identify self each time
Tell when leaving.
Maximize lighting
Don’t move belongings without asking
Hearing impaired communication
Be at individuals level Speak moderate speed Clearly Use short sentences Don't shout.
Aspects of grief
Prompted by loss. Need not only involve death. Can be a loss of health
Normal and expected process
Self healing and under normal conditions will resolve.
Developmental concepts of death
Younger than five think death is reversible.
5-9 final, irreversible and universal, death may be personal, angel, monster etc.
After 9 inevitable will happen one day to self. End of life
Adolescents have a low tolerance for accepting death. Views self as invincible. May not cry at loss of loved one.
Delayed grief response
No anticipatory grief or expression of grief at death
Complicated grief response
Unresolved issues with past. Withdraw and intense grief.
Dysfunctional grief response
Death complicated by uncertain sudden events, or less socially appeared or negative events.
Pathologic grief response
Grief to point of being overwhelmed with prolonged and maladaptive behavior.
Normal physical responses to grief
Stomach hollowness Chest, throats pain, tightness, breathlessness Dry mouth Sweating Shakiness Headache Lack of energy Weakness Overly sensitive to noise. Depersonalization Same physical symptoms of deceased.
Behaviors of grief
Sleep and appetite disturbances Crying and sighing Absent nudes Searching or expecting the deceased Social withdraw Increase or decrease in activity Increase in illness or accidents. Change in work performance Yelling Increases alcohol, nicotine or drug use Sloppy dressing and poor hygiene Activities regarding the deceased
Growth
Quantitative
Development
Qualitative
Factors influencing growth and development
Genetics
Environment
Culture
Ethnicity
Gesell theory
Biophysical
Piaget theory
Cognitive
Erikson theory
Psychosocial
Bowlby attachment theory
Stranger anxiety in Children
Children bond with care takers
Development
Qualitative
Factors influencing growth and development
Genetics
Environment
Culture
Ethnicity
Gesell theory
Biophysical
Erikson theory
Psychosocial
Piaget theory
Cognitive
Bowlby attachment theory
Stranger anxiety in Children
Children bond with care takers
Erikson theory middle age
Generativity vs self absorption
Erikson theory old age
Integrity vs despair
Health promotion and anticipatory guidance
Infants : safety. SIDS, tobacco smoke, infection
Toddlers : mobility. Falls, burns, drowning, choking, poisoning, Motor vehicle crash
Preschoolers : booster seat at 40 inches, pedestrian rules.
School age : sports safety, Swim safety, gun safety
Adolescents : accidents, injury, suicide, driving
