Random Flashcards
Piaget formal operations stage
11-17yr, cooperative, beginning to see others point of view. Think they are invincible. Bring in role models: peer group works best, not a parent
Abstract reasoning, logical, can see possibilities beyond reality
Recommended lesson plan times for lower elementary school
15min preschoolers
30min 1-3 grade
45min 4-5grade
60min middle schoolers
Piaget concrete operational phase
7-11 yr
What they see is reality to them. Not abstract. Very visual. “Grandma died bc I was bad”
Egocentric/literal interpretation
Lower elementary students
Preschool thru 2’s grade.
Love stories, pictures, poems, songs. Very visual and go by rule governed thought.
Middle school and high school students
Eriksons stage - Identity vs role confusion: 12-18 years old. “See themselves as immune to consequences, and self as special unique and exceptional. Peer teaching is most effective. “Everybody’s doing it” need to combat this with normative education.
Middle and high schoolers
Teach short and long term but focus on short term that can happen immediately do they will identify more.
Smoking= talk about $$, smell more. (Short term). Not about lunch cancer (long term)
Animistic thinking
Naming toothbrush or puppets. Assigning human attributes to inanimate objects.
Middle and high schoolers
Better able to problem solve but don’t always do so, peer pressure.
**practice role playing and decision making with refusal skills in a safe environment so they can recall what they’ve practiced. —practice!! Give them the instincts to say no.
As nurse, don’t butt in as a facilitator; let them learn from each other. Informal situation so they can be comfortable.
Concrete stage teaching examples
Lower elementary students.
visual “jar of tar” to show how much from smoking one pack a day
Using black light to show how well they washed hands.
Hairy meets Horace the health hound and Merle the shy turtle (animistic thinking
Dental diary/worksheet or snack attack pledge
Upper elementary school students
3-5th grade. Can still be egocentric but with role play can get better at seeing other viewpoints, still not perfectly though. Use role play to practice stating their own feelings, basic refusal skills.
Upper elementary school students
Erikson stage industry vs inferiority
Try to come up with activities they can do, make, perform. Construct models, experiments, present plays or songs, draw ads for health or organize campaigns. Writing own songs/performing it so it’s meaningful.
Upper elementary students
Have them give you the issue they want to talk about, keep them more interested! at this age, they can begin to understand cause and effect and to problem solve.
–pull in values, have them choose what’s important to them
Upper elementary
Use exercises that help kids realize effort media has on our perceptions of so many things.
- this age is highly affected by movies, TV and magazines
- at his age, always include concept of peer pressure
Purpose of health promotion
Health maintenance and wellness
Prevention of illness
Restoration of health
Coping with impaired functioning
Benefits of teaching/health promotion
Quality control- when you teach you increase quality of. Care. When you increase quality of care you increase quality of life.
Cost control- teaching will prevent illnesses that may mean expensive care. Prevents readmission. Helps them recognize problems early and seek prompt care. Prevents long hospital stays by increasing self care that can be done at home.
Never events
Teaching prevents never events!!
Ex. Hospital acquired infections, falls or trauma, bed sores, or wrong side amputation
Encourage patient to speak up for their health to also help prevent never events
Ineffective behavioral change strategies
Fear (you’re gunna fiend you don’t xyz…) coercion/confrontation, paternalism (giving advice or telling client what is best)
Effective behavioral change strategies
- Stage of change based interventions. 2. Motivational interviewing ( helping client resolve ambivalence about change). 3. Cognitive behavioral therapy
3 learning domains
1 cognitive (understanding). 2. Affective (attitudes) 3. Psychomotor (motor skills)
Cognitive domain
The thinking domain/understanding.
Ability to make sense of and use information. (Learn and apply then comprehends) *like us students.
Acquiring knowledge, able to analyzed synthesize and evaluate based on knowledge obtained
Affective domain
The “feeling” domain. Includes feelings values and beliefs associated with info received:
- willing to listen/discuss feelings. Moves clients to attach worth to information, shown by choosing a particular action from a month alternatives
Ex. Lifeboat - which 10 get in lifeboat?
Psychomotor domain
The skull domain. Includes physical and motor skills. Uses cues from environment.
Performance of skill moves from imitation to creation of a new way to perform skill. Must have physical, mental and emotional readiness. Still have to know cognitive but also involves skill. Similar to lab
Learning to give meds, or start IV, or catheterize someone..
Cognitive verbs
“Client will list side effects” client will describe symptoms.
Categorize explain, identify, label, name, prepare, write, define. Differentiate
Planning objectives
Specific statements used to evaluate learning. avoid vague terms. Client centered. More short term than goals. Include only one behavior per objective
Planning goals
More long term and broader than objectives. Set in terms of “the client will”
Problem identification
1 deficient knowledge
- Altered or deficient health maintenance - difficulty adapting behavior or managing healthy behaviors. Not seeing Dr regularly
- Health seeking behavior. Client needs to alter health habits, may need to modify or avoid environmental factors
Older adults and teaching
Intelligence same, just need more time to process and respond. Simple instructions, teach only what is necessary and keep seasons 30 min or less. Teach one thing at a time and get something in writing. Teach when alert and rested
Principles of teaching and learning
Deal with any anxiety before teaching!!!!! Patient can’t learn if anxious.
Teach in order of maslows hierarchy
Establish therapeutic relationship first. Start simple then more complex. Repetition. Match with learning style. Active participation. Relate teaching to prior life experiences (specially for older adults)
Teaching young and middle adults
Try to keep sessions under 1 hour. Learning must be practical and relevant. Learner must see the need. Give time to practice skills in private. Often motivated by social task mastery so relate to those (work play or relationships)
Appropriate teaching methods for cognitive learning
Discussion lecture question and answer session
Role play/ discovery
Independent project or field experience
Teaching methods for affective learnig
Role play (allows expression of values and feelings). discussion groups, (support groups for women who are victims of domestic violence) discussion one on one.
Teaching for psychomotor learning
Demonstration like lab, practice, return demonstration , independent project or games
Precontemplation
sees no need for a change. Not ready to make a change for 6 months. May not realize the need.
Tasks: goal is to get them ready/motivate and encourage them to think about making a change.
- Awareness of need to change. 2. increase concern about current behavior. 3. envision change as a possibility.
Emotional Arousal: “Your wife has COPD and is getting sicker from the second hand smoke.”
Help client identify benefits to changing. (save money by not having to buy cigs!)
Contemplation
Sees the need for some change and has some desire. Ready to make a change in the next 6 months.
Tasks: 1. Analyze pros and cons of current behavior. 2. Weigh costs and benefits. 3. Struggle with ambivalence.
Interventions: self assessment and environmental evaluation, pros over cons (how quitting fits with values and life goals), help consider barriers and ways they can over come them!
social liberation: realization that behavior change is acceptable in larger society
Preparation
Intending to make a change in immediate future: within next 30 days! Plans to make a change soon, may even make small attempts at change. “Am I going to be successful?”
Tasks: increase commitment to change and design a plan for change.
Interventions: identify connection between stimulus and behaviors, contracting with self to stop, help client recall past successes, provide info on effective ways to make change. Helping relationships in community, and help client stop negative thoughts!
Action
Has made a behavior change within the past 6 months. VISIBLE commitment to change.
Tasks: Implement strategies for change, revise or change plan, sustain commitment in the face of difficulties.
Interventions: help monitor change (journal), rehearse approaches to problems, reinforcement management (change environment, no smoke break with friends,) Continue to point out benefits and be supportive and point to resources. *Help them with how to sub newer healthier behaviors for old bad behaviors!
Maintenance
Change lasted 6 months.
Tasks: sustain change, avoid relapse, integrate new behavior into life.
Intervention: applaud continuation, help client relabel, continue supportive relationship.
Messages should begin to focus on skills needed o create and maintain action plan for change. Pt aware of situation that could cause relapse!
SPICES
Overall assessment tool for elder adults.
S- sleep disorders. P- problems with eating and feeding. I- incontinence - (nocturia/toileting regimen) C- confusion - (from pain or meds) E-evidence of falls, (gait, assistive devices, walking with furniture, S - skin breakdown (ulcers or thin skin or bruises)
Factors influencing aging
heredity, environment, lifestyle, nutrition, medical history, psych factors, support system, socioeconomic resources, education bc it impacts income
Aging in the US
> 65 = older adult
Women tend to live longer!
Top two causes of death, 1. cardiovascular disease. 2, cancer. Prevention of death: health promotion and management of chronic disease
Never too old for a change!
Frail adult
Having any of the combo of the following two things *Vulnerable and may need help or outside interventions!!
-over 75 falling frequently, losing weight or poor nutrition mild memory loss no close family in community depressed bc of losses hospitalized 3x's in 2mo taking >5 meds regularly and getting confused needs health teaching
Goals of elder assessment
Maintain health, minimize hospitalizations, establish diagnosis’s that are often overlooked, and decrease over prescription of meds.
Elder assessment
holistic, person centered, individualized, multidisciplinary
“How do you manage to cook 3 meals a day?” NOT “How do you cook dinner?”
Focus on functional ability!!!
Elder Assessment
Start with a persons concern, plan time and match pace with the person. Be aware of energy level. Get rid of anxiety first! This will affect teaching. Establish rapport. Most have more than one problem. Screen for high prevalence problems and be alert for typical signs and symptoms of illness.
Elder Assessment
Modify environment: NOT CLIENT. Reduce noise, temp, lighting, privacy, turn radio off for hearing/distraction
consider persons comfort: provide assistive devices, dont rush things, allow time to answer. face them bc they may have hearing problems.
have person demonstrate activity: GOOD OBJECTIVE DATA! observe gait/communication with others ^all the most reliable method of data collection.
If you cant ask them to do the above, ask them to take off their shoes = its a good indicator of functional ability
Why is there an increase of elder adults?
Improved nutrition, improved standard of living, progress of medical care, and increased health consciousness due to health promotion efforts
Who is old?
65 is the standard for old. (Chronological age!) Functional age considers functional health or ability to self care. Its better to use this to assess.
Categories: ABLE - to take care of themselves. FRAIL - >75 and have a variety of health concern and increasing vulnerability to disease.
Categories of Old age:
Young Old - 65-74
Middle Old - 75-85
Old Old - 85 +
Young Old
65-74, live independently, involved in community, employed or volunteer, usually financially stable and travel. BIG CONSUMER OF AMBULATORY HC benefit the most from preventative healthcare!
Middle Old
75-85, incidence of chronic disease is higher, may move in or closer to children or family, or into retirement communities in preparation of getting older and increasingly frail. Only 5% in nursing homes.
Many are still active and drive, active in senior clubs and churches. Women at this stage outnumber 3:2, starting to see losses that can lead to depression. HEAVY USE OF HOME HEALTH CARE *Dementia starts
Old Old
85+ years, older than average! Generally have good genetics and typically have avoided smoking and had healthy diet, and social support base.
About half will suffer from some kind of dementia
Developmental Tasks of Older adults 65-74
Adjusting to:
- Decreasing physical strength and health.
- Retirement and lower/fixed income.
- Death of parents, spouses, and friends
- New relationships with adult children
- Leisure time
- Slower physical and cognitive responses
- Keeping active and involved
- Making satisfying living arrangements
Developmental Tasks of older adults 75+
- Adapting to living alone
- Safeguarding physical and mental health
- Adjusting to the possibility of moving into nursing home
- Remaining in touch with other family members
- Finding meaning in life
- Adjusting to ones own death
Dementia
Caused by physical issue, most common: Alzheimers. Frequent healthcare problem for elderso
Functional status
abililty to perform ADL (bathing, toileting) and IADLS (instrumental; keep them living independently like paying bills, grocery shopping, cook, clean)
ability to adapt to stressors: can they change to deal and cope with stress?
Functional decline: slowly lose ability to care for themselves independently
Elder Risk for Falls
Risk greater for senior who has multiple medical problems or functional disabilities!
Other risk factors: confusion, corrective lenses, nocturia, gait problems, use of assistive devices, or history of falls, and polypharmacy
Observe their gait - do they use furniture to walk? Ask them what do you think happened to make you fall?
May be able to tell cause of fall by the type of injury: if hand/wrist, balance issue. head or face = syncope.
Quality of Life Triangle
As CHRONIC DISEASE goes up and PHYSICAL HEALTH declines, there is an increased risk for FUNCTIONAL IMPAIRMENT (status) and quality of life is threatened.
Elder Assessment
Goal: Improve QOL, decrease polypharmacy, minimize hospitalizations, and maintain health! Identify their strengths and weaknesses and develop a plan of care that corrects problems.
Frequently overlooked Diagnosis in Older Adults
Hearing impairment, vision deficits, early dementia, depression, poor nutrition, and falls
Frequent HC Probs for Older Adults
Safety: falls/accidents, fire, carbon monoxide poisoning, drowning, seatbelt use, vision when driving
Polypharmacy- they are on multiple meds and make them more sensitive and prone to adverse reactions. This also increases their risk of falls and accidents, and also medication errors from improper storage., vision problems, or memory loss. EVEN OTC MEDS NEED TO BE CHECKED IN WITH THE DR.
Immobility - this is a nursing goal, keep them mobile! teach about fall prevention or rehabilitation afterward. Stroke (increase risk of bedsores and constipation) Short term immobility: broken hip. Long term: stroke.
Nutrition: #1 cause of malnutrition is socially caused, or poverty. Lack of ability to self care or transport self to buy food, or just psychological/depressed with decreased appetite. Stroke, difficulty chewing with lost teeth or ill fitting dentures
Anorexia of aging
lose senses/decreased senses so they lose interest in eating
Growth and Development
Growth: change in cell # or cell size or physical size. changes in height, weight, BP Pulse etc.
Development: Change in capacity to function enhancement of skill
Maturation: enhancement in competence and adaptability.
–all occure simultaneously and ongoing thru lifetime.
cephalocaudal pattern of growth and development
Head to toes - you have to hold head up straight before you can sit up, before you can walk…
precedes proximodistally
proximodistal pattern of growth and development
from the middle to the extremities, babies gain control of trunk before arms, and control of arms before fingers.
Differentiation pattern of growth and development
Simple operations before complex, i.e. babies coo, then babble, then words, then sentences
Developmental stages - Infancy
0-12m
neonatal - 0-1m, infancy 1-12m
toddler period
1-3 yr
preschool period -
3-6yr
school age period
6-12 yr
adolescence period
12-18yr
young adult period
18-35
middle age adult period
35-65
older adult period
> 65
growth charts
0-3 yr, weight height and head circumference
2-20yr, height, weight, BMI
Age, gender, and sometimes ethnic specific. Middle line on chart is average for that age`
CDC weight classifications
or = 95% is obese
Erik Erikson Psychosocial theory
*Believed that development is lifelong. Emphasized that at each stage, the child acquires attitudes and skills resulting from the successful negotiation of the psychological conflict.
-Identified into 8 stages, each stage has a task.
Infancy: trust vs. mistrust (faith and optimism)
Toddler: autonomy vs shame and doubt (self control and willpower)
Jean Piaget Cognitive Development Theory
important int he field of education, learn how to teach kids in a cognitive way/how kids think and learn, how they use assimilation and accommodation (Adapt). Up to age 15
Kohlbergs Theory of moral reasoning
Why do people do the right thing? Based on interviews with people at various age groups. Develops during school age and progresses through adult years.
Focus is on moral thinking and judgement
Albert Bandura Social Learning Theory
Kids learn what they observe and imitate! They learn by observation.
Positive reinforcement - good and bad - leads to repeat of those behaviors.
Self efficacy: give kids the expectation that they can do it, the more likely they are able to do it.
Infants growth and development
Growth is very rapid during first year!
5-7oz weight gain per week (1-6m)
3-5oz weight gain per week (6-12m)
*DOUBLE BIRTH WEIGHT BY 6M, TRIPLE BIRTH WEIGHT BY 1 YEAR.
Height increases by 1 inch per month. 0-12m
Maturation of infants systems
More disposed to respiratory issues/small airway.
Receive immunity from mom till 3 month - there is a gap before they get their own immunity from like 3-6 months so they are likely to get colds.
-By 4m they used up all iron stores from mom, so they need iron in their diet if breastfed.
-Swallow anything at birth is a reflect, about 6 month start to spit back at you.
Fontanels
Anterior/Front closes 18m, posterior/back closes at 2mo.
Sensory Infants
vision 20/100-20/400., by age 12m 12/40. Hold them close so they can see you!
Binocularity- by 6m, see one image/coordinate vision and pupils line up.
Hearing: acuity similar to adult, localization and discrimination lacking.
Touching: hands, face, and soles of feet most sensitive.
Childrearing practices related to temperament
If difficult: structured routines.
Highly distractible: additional soothing measures.
High Activity: more opportunities for gross motor activities and extra watching.
Slow to warmup: gradual and frequent preparation to new situations
Easy: may need to be awakened to eat.
INFANCY Pyschosocial
erikson trust vs mistrust - if infant cant develop trust, will have mistrust for the rest of life - he will have trust as long as needs are met and interacted with in a positive manner.
If not, risk of reactive attachment disorder (lifelong problems of being unable to form relationships)
infancy cognitive development
Piaget - sensorimotor phase
- Birth -1m: reflex stage (nothing deliberate!)
- 1-4m: primary circular reactions (starts to replace reflex with voluntary reaction; will hold rattle)
- 4-8m- seondary circular; (will imitate, start to play/have an affect) infant will shake rattle to make noise.
- 8-12 coordination of secondary reactions, pick up rattle and shake it, then shake other toys to see if it also makes a noise.
Toddler growth
4-6lb a year. Quadruple birth weight by 2.5.
Height increases 2-4inch a year
At 2 year, typically attained half of adult height
12-36m
Voluntary control of elimination
Sphincter control at 18:24 m, when myelinazation of spinal cord is complete
Erikson toddler stage
Autonomy vs shame and doubt. Like ritualism. Negativism, say no a lot. Play is parallel, play alongside each other but not with each other. Transitional objects become important.
Toddler 19-24m
Object permanence solidifies, actively searches for an object. Imitation of behaviors , domestic mimicry, no concept of time
Transductive reasoning toddler preconceptual
Reasoning from the particular to the particular. (Lady in White coat gives shots, so everyone in white coat must give shots)
Global organiZation
A change in any one part changes the whole. If you move bed or get new curtains, it’s not their room anymore.
Centration
Focus on one aspect of a situation rather than considering all factors. Gave red medicine and it tasted bad, won’t drink anything period that’s red
Tertiary circular reactions Piaget
Pick this up and see if it makes a noise bc the other one made a noise. Awareness of causal relationships. 13-18 months
Vaccines
Live - more effective but can be dangerous.
Killed- have to give more doses for it to be effective.
When to withhold shots?
Serious illnesses only, neurological unstable conditions or prior allergic reaction. Withhold live vaccines from immunosuppressed people.
Flu shot
No nasal flu shot until 2yr. Can get regular flu shot at 6months.
2-50yr old bc nasal is live!
Live vaccines
Rotavirus, varicella , mmr, flu. Can’t give to kids with compromised immune system
Infant nutrition
4-6 m need iron and fluoride supplement. BF kids need vitamin D supplement. No extra water. No juice for 6m and then no more than 4oz a day. Solids at 4-6m. Meats at 10m. 5/6m weaning/introduce cups
Infants and sun
Out when Sunnis hottest, 10-3. After 6m can use sunscreen that’s PABA free and > SPF 15
Car seats
rear face till two, but if you do switch, minimum of 12m and 20lbs. 40lb for booster
Lead explosure
Homes constructed before 1960.dirt, soil, water, toys. Boil water for 20 min before giving to infant
Passive immunities
When you inject blood from a persons or animals and give them to a person who’s been exposed to disease. (Lasts 6m,) mom/newborn/breastsmilk, tetanus or varicella. Temporary!!!
Attenuated vaccine
Live! Use pathogens that a re active but have reduced virulence so they don’t cause disease. The process of reducing virulence us attenuation. Can cause mild infections but no disease. With live, vaccinated peeps can infect those around them providing herd immunity
Not good for immunosuppressed proper or pregnant woken bc it might cause disease
Inactivated vaccines
Killed. safer than live but don’t cause as strong of an immune reaction. Do not stimulated herd immunity! Produce less strength of immune response so need more doses. More high doses means more adverse reactions. May stimulate inflammatory response(more local and allergic reactions)
