NSG 201 Exam 2 Flashcards
Subjective vs. Objective data
subjective: what the person says about themselves
objective: what you obtain from physical data
Genograms Purpose
- Accurate family outline of the hx of diseases, & conditions that could make the pt more vulnerable/susceptible to
- when they know they would be more vulnerable it leads to earlier screening and surveillance
- Includes: gender, age, relationship (imemdiate family and also the spouse to view prolonged disease exposure). relative medical conditions
Items included in the Health History
- Biographical data
-name, age, address, contact info, dob, gender/gender identification, occupation, marital partner status, race/ethnicity, primary language - Source of Health hx: who= source of info
primary= patient
secondary= other sources - Reason for seeking care
-the “cc” or chief complaint - Hx of presenting illness
-meds, current illness, allergies
-OLDCARTS—onset, location, duration, characteristics, aggravating factors, related symptoms, treatment, severity - Past health events
-childhood illnesses, accidents/injuries, hospitalizations, surgeries, obstetric hz, immunizations, last exam date, last menstrual period - Family hx- blood relative
-use a genogram
Functional, Personal, and Psychosocial Assessment
Psychosocial: personal status, relationships, nutrition, functional ability, mental health, substance abuse, health promotion, environment
Functional: ADLs (activities of daily living), spiritual assessment, for alcohol use
Review of Systems
- Address each body system
- use specific questions
- not objective data
- pt’s descriptions/perception of health
- terminology
Lifecycle Considerations
Children: most data obtained from an adult. By age 7, most can answer basic questions
Adolescence: may need alone time w/ the pt
Older adults: include ADLs, functioning
Cognitive Function Assessment
- Orientation- time/place/person/situation
- Attention span- ability to concentrate by noting complete thoughts: ability to concentrate w/ no distractibility
- Recent Memory- last 24 hours
- Remote Memory- verifiable, past events
- New learning- 3/4 unrelated words- requires more effort and avoids unverifiable material
Factors that Influence the Interviewing Process
- Age- usually teens and adults can handle questions, children need the assistance of a guardian and to use appropriate terms w/o talking down, and elders might need assistance
- Culture- Be respectful and don’t assume
- Language- LEP, use a certified translator
- Stress- limit the number of questions and think of the nature of the questions
- Sensory Impairment- Be patient
- Cognitive Impairment- we may need a second source of info
OLDCARTS
onset location duration characteristics aggravating factors related symptoms treatment severity
Interviewing based on G & D stage
-can be a good baseline to understand how to present questions & what goals are important to that age group, can also help if someone did not attain their goals in an age development stage and need to reframe questioning/interviewing to be more appropriate
Assessment Tools
CAGE- alcohol use- substance abuse screening tool w/ 4 questions, if score >2, significant clinical finding
FICA- spiritual assessment- looks at faith, importance, community, address issues
Katz- aka ADLs (activities of daily living)- scores how independently dependent individual is
MMSE- used to evaluate mental status; widely used as test of cognitive function in elderly
Levels of Prevention
- Primary- strategies that target modifiable risk factors
- prevention of diseases before any symptoms
* Immunizations, safe sex, smoking cessation, seat belts - Secondary- strategies focused on early disease detection
- screenings include:
* Cancer: mammogram, prostate markers
* Bone density
* colonoscopies
* BP
* Blood glucose - Tertiary- strategies minimize the damage after the onset of disease
- cardiac rehab, AA, support groups, any intervention focused on lessening disease complications
Domains of Learning & Strategies
Cognitive- knowledge Affective- emotional Psychomotor- self-reliance Srtategies: 1) VARK: Visual Auditory Reading/Writing Kinetic 2) Bloom's Taxonomy -create, evaluate, analyze, apply, understand, remember
SMART Goals
SMART- know exactly what you want to accomplish
Measurable- how will you know you met goals?
Achievable- make sure your goal is not too far to reach, but far enough away to be challenging
Relevant- link the goal to something important to you, something that inspires you
Timely- when do you want your goal to be met?
Bloom’s Taxonomy (Learning Domain Strategy)
- Create- produce new or original work
- design, assemble, construct, conjecture, develop, formulate, author, investigate - Evaluate- Justify a stand or decision
- appraise, argue, defend, judge, select, support, value, critique, weigh - Analyze- Draw connections among ideas
- differentiate, organize, relate, compare, contrast, distinguish, examine, experiment, question, test - apply- use info in new situations
- execute, implement, solve, use, demonstrate, interpret, operate, schedule, sketch - understand- explain ideas or concepts
- classify, describe, discuss, explain, identify, locate, recognize, report, select, translate - remember- recall facts and basic concepts
Prochaska’s stages of change: Readiness for change
- Pre-contemplation- do they see a health problem? Not willing to make a change
- Contemplation- become aware of the problem, but lacks a strong committment to make a change
- Preparation- begins to take small steps toward a change (set goals and priorities)
- Action- strong committment to change and taking consistent action
- Maintenance- client is stable and achieved gains- relapse is possible
Patient Teaching
-must be sufficient for client to make informed decision, must be in clear and understandable manner, must be documented, consider different patient learning styles and barriers to education/understanding
Biological Theories of Aging: the process of growing old
Predetermined
1. Programmed Longevity: timetable by cell division when replication stop
2. Immune System Control: decline over time which leads to increased vulnerability to the immune system - death by diseases
3. Neuroendocrine Control: biological is set through hormones when cells lose the ability to respond to hormones
Random/Stochastic
1. Error: a collection of errors that ends life
2. Somatic Mutation: what happens to our genes after we inherit and that when it divides it is exposed and mutate and then accumulate and cause problems
3. Free Radicals: super oxidize causes damage to components of cells, causing cells and organs to stop functioning
4. Crosslink: increase waste products in cells - links to waste instead of protein
5. Wear and Tear: vital parts of cells and tissue just wear out from repeated use
Psychosocial Theories of Aging
- DIsengagement- withdraw from society as one ages
- Activity- must be involved in order to be happy during the aging process
- Continuity- proceed in life as in previous ages
- Social Exchange- aging from an economic perspective - measures the cost and reward of a relationship
- Modernization - losing power and influencing society as modernization increases and status decreases - more social isolation
- Gerotranscendence - old person and the aging process itself - growing old and the positive characteristics - decreased interest in superficial interactions
- Socioemotional - life span theory of motivation - will prioritize information focused goals
Normal Physical Changes Associated with Aging
- vision changes (decreased ability, yellowing lens)
- decrease in all 5 senses
- decreased hearing
- diminished taste
- decrease on saliva production/sensitivity to sweet/salty flavors
- decreased smell
- decreased sensitivity to touch
- reduced capacity to sense pressure/pain
- decrease in nervous system responses
- reduction in neuron production/blood flow
- slower rxn and learning time
- difficulty with memory
- personality consistent w/ earlier years
- decrease in sleep and more arosuals in nighttime
- decrease in function of CV system
- stiffer/thicker heart valves
- increase systolic BP
- reduced lung size
- more rigid lungs and thoracic cage
- decrease in cough response
- atrophy of muscles
- porous bones
- shortening of vertebrae
- brittle teeth
- decrease in GI function
- weaker bladder, causing decreased capacity/increased retention/nocturia
- atrophy of reproductive systems
- hormone level changes, decrease in immune system responses, decreased skin elasticity, skin thinner/dryer
- altered thermoregulation, changes in pigmentation
End of Life Documents
-advanced directive: living will, DNR, POA
Living Will: legal document allows individuals to specify what type of medical treatment they would/ wouldn’t want if they became incapacitated/irreversible terminal illness; can direct physicians to withhold life sustaining measures, assist family members w/ making decisions for person in a coma/medically incapable; person must be competent to make a living will, can be revoked or changed at any time
DNR: “do not resuscitate order” - alerts medical personal that individual does not want cardiopulmonary resuscitation in the event the person stops breathing and has no heartbeat; should be an advanced directive forms and in medical chart
POA: “durable power of attorney”- competent individual can designate healthcare proxy/surrogate to make decisions about medical care if person becomes incapacitated; if no POA, a guardian may be appointed–guardianship is last resort
4 Generations of Today’s Elders
- Super Centenarians- age 110+, group emerged in the 1960s, exact # of people 110+ unknown; lived during WWI/WWII, Spanish Flu; most still functional/independent until age 105 ish
- Centenarians- age 100-109, majority btwn 100-104, WWII, Great Depression, expected that by 2050, millions will live into this range; had all or most childhoos diseases
- Baby Boomer- youngest of the oldest generation, born b/w 1946-1964; born after the end of WWII, differences in life expectancy significant, concerned w/tobacco use, diabetets, obesity, arthritis, heart disease
- In Between- born between 1930s and baby boomers; born at end of WWI/start of WWII, came of age during Civil Rights movement, Vietnam War, Polio Vaccine, population in this age group growing at an exponential rate
Frankel’s 5 Stages
- Self-sufficient- pt is self-reliant, good time to get affairs in order
- Interdependence- pt becomes reliant on others for assistance; at this time, older adults may consider independent living locations that offers help for meals/cleaning/laundry
- Dependency- dependent for help with basic things like bathing, eating; may require outside care for help
- Crisis Management- cost of upkeep is high so family members in crisis mode; physical & mental health has declined so elder is more dependent on family members/friends
- End of Life- move to nursing home/hospice/etc, ahve extensive nursing needs, require a lot of help from others
EAI Form
-elder assessment instrument- used as a comprehensive approach for screening suspected elder abuse in all clinical settings; includes general assessment, possible abuse indicators, possible neglect indicators, possible exploitation indicators, possible abandonment indicators, summary
Ethnocentrism
feeling superior to another, your beliefs are the only beliefs; barrier in providing nursing care across cultures
Assimilation
becoming more similar to another culture, absorbibg their ideas/practices
Acculturation
adoption of the behavior patterns of surrounding culture
Normal G & D in spiritual development and prayer
prayer/spirituality can be incorporated into Maslow and Erikson’s stages of development
Infant
Learn right from wrong
Toddler
Intimate parents
Pre-schooler
Ask questions
School Age
Parents have greatest influence
Around 16
Learn that no is sometimes the answer to prayers
Young Adult to Old
Young: answering own children’s questions
Middle: more time for spiritual activities
Old: comfortable with values
Use of an Interpreter
all healthcare settings should have access to an interpreter–consider it is scary for patients to be in setting where no one knows their native language, communication barriers, how to ensure the translator shared the proper message, how you should give the message to the translator to ensure proper info/easier translation process
Characteristics Associated w/ each minority group
1) Hispanic Latino
Largest group
Family is the center of life
Illness is seen as losing favor with God
Healing, powers from saints, candles, medicines, ointments.
Providers use a combination of prayers and hot-cold remedies.
The low incidence in chronic diseases except for diabetes
Sad is a term for depression
Women are modest
Will share medications
2) African American
2nd largest group
1/3 live in poverty
Women as head of the family
Church is community
Mistrust in the healthcare system
The family wants to be involved
Many health disparities than any other minority group
High incidences of HTN, DM, teen pregnancy, CVD, and cancer in males
Must build trust
3) Native American
Specific tribe
Multiple health problems
High rates of TB, alcohol abuse, pneumonia, DM
Illness is punishment
The patient must be cleansed of evil spirit
Death is natural
Respect, no direct eye contact, no small talk, private
4)Asian
Fastest growing
32 ethnic groups
Value hard work and education
The husband is the decision-maker
Do not prevent death
Balance of yin and yang
Practice acupuncture, herbs, massage, and therapeutic touch
The most common diseases are TB, Hep B, Liver Cancer
Be formal in communication
Use of LEARN
-frames clinical teaching and coaching encounters with culturally diverse patients
L- listen carefully to pt perceptions and the words the pt uses
E- explain what the pt needs to understand abt his/her condition or treatment, incorporating pt’s words and explanatory models
A- acknowledge cultural differences b/w nurse and pt viewpoints w/o devaluing the pt’s viewpoint
R- recommend what the pt should do
N- negotiate with pt to culturally adapt constructive self-management strategies based on pt input-fundamental to pt complaint
Culture competency:
Understand yourself
Identify the meaning of health to the other person
Understand the health care delivery system
Enculturation
The social process by which culture is learned and transmitted across generations
Ethnicity
shared social identification, it is learned behavior, beliefs, and experiences
Modifiable vs non modifiable risk factors
Modifiable- meaning you can take measures to change them
Nonmodifiable- which means they cannot change nor be controlled by you
Programmed Theory
assert that aging is an essential and innate part of the biology of humans
and that aging is programmed into our body systems
Continuity Theory
Understand yourself
Identify the meaning of health to the other person
Understand the health care delivery system
