Unit VII Flashcards
Traditional Nuclear Family
Married couple and their biological children (only full siblings)
Nuclear Family
Two parents and their childen (biologic, adoptive, foster)
Single Parent Family
one parent and one or more children
Blended Family
at least one stepparent, step sibling, or half sibling
Extended Family
at least one parent, one or more children, and other individuals (might not be related)
Foster Family
one or more children who are placed in an approved living environment away from the famil of orgin, usually with one or two parents
Binuclear Family
Parents who have terminated spousal roles but continue their parenting roles
Communal Family
Individuals who share common ownership of property and goods, and exchange services without monetary consideration
Alternative families
include extended family members caring for children in the absence of biological parents
Barriers to healthcare
Economics, education, geography, language, stereotyping, prejuduce, discrimination, mis understandings
Economics
patients that cannot afford healthcare may wait until illness is life threatening because they cannot afford it
Education
The higher the education level the more healthcare is obtained. Those education tend to seek less medical help
Geography
Many rural areas have limited access to health-care. Many low income areas of larger cities have limited providers and facilities. Minority groups make up a greater percentage of low income populations in the united states, leading to decrease access to needed healthcare for those populations
Language
Always use an interpreter, interpreting computer program, never talk down
Stereotyping
can lead to mistreatment, never assume. Evaluate your own preceptions and beliefs regarding different ethinic groups or races
Prejuduce
a determination or judgement about a person or group based on irrational suspicion or hatred of a particular group, race, sexual orientation or religion.
Discrimination
unfair treatment of a certain group of people
Misunderstanding
Always verify a patients understanding “Do you understand?”
- Antiulcer agent
- People with GERD
- Tx for GI Bleeding
- Assess for abdominal pain and GI bleeding (Do an occult blood)
- Check pt for C. Diff if pt has diarrhea
- Admin in morning before food
- Mg levels may drop check mg prior to and during drug therapy
- Can cause drowsiness (fall precautions)
Omeprazole (prilosec)
Causes vitamin B 12 deficiency for pt’s using greater than 3 yrs
omeprezole or prilosec
Cannot be taken with St. John’s Wort or rilpivirine
Omeprezole or prilosec
Patient should be taught to avoid what when taking Omeprezole or Prilosec?
Alcohol, NSAID’s, and foods that may cause GI irritation
Patients taking prilosec or Omeprezole should be taught to monitor for what?
black tarry stools, diahrrhea, abdominal pain, or persistent headache or if fever or diahrhea develop. Pt should not tx diarrhea without consulting healthcare professional
What med can put pt at a high risk or hip, wrist, or spine fractures?
Omeprezole or prilosec
- Antiemetic tx for nausea and vomiting
- Used to tx nausea in chemo pts
- Can be used for post surgical pt’s as well
- Bowel function should be assessed and if there are any symptoms of bowel function problems report it
- Changes in electrolytes may occur, labs need to be done
- Can cause irregularly heart rates or arrhythmias
- ODT (orally disintegrating tablets)
Ondansteron or Zofran
When taking ondansteron or zofran with a hepatic impairment the daily doasage should not exceed what?
8mg
Ondansteon or zofran can cause…
QT interval prolongation Increased liver enzymes Consipation abdominal pain dry mouth diarrhea Extrapyramidal reactions Steven Johnson syndrome
How long before Chemo should Zofran or Onadesteron be taken?
30 mins before
When taking Zofran or Onadesteron you should notify doctor if these occur
Irregular heart beat
serotonin syndrome
Involuntary movement of eyes, face, or limbs occur
- Opioid analgesic
- Moderate to severe pain
- Respiratory rate needs to be monitored
- BP and HR needs to me monitored
- NO alcohol
- Can cause constipation
- HAS ACETAMINAPHIN IN IT
- Watch the use of MAO inhibitors to close to taking this
- Assess pain level prior to taking this; document pain scales used
- Highly addictive
- Pt should be assessed to see if they are taking any other opioids
- Capsule my be expelled in stool
- Encourage pt to take deep breaths often (TCD)
Oxycodone or Percocet
Oxycodone or Percocet contains what?
Acetaminophin
Some contradictions or preacautions of Percocet or Oxycodone:
Significant or respiratory depression Asthma Head trauma Increased intracranial pressure Severe rennal or hepatic disease Hypothyroidism Adrenal isufficiency Alcoholism Seizure disorders Difficulty swallowing
When administering Percocet or Oxycodone to a Geri pt a nurse should know…
The initial dose shold be decreased becuase they are at a greater risk of respiratory depression
HIGHLY ADDICTIVE and cannot be stopped abruptly
Oxycodone or percocet
To prevent atelectasis when taking Percocet or Oxycodone the patient should
Turn, cough, and deep breathe every 2 hr
Alcohol an other CNS depressants should be avoided when taking this medication…
Oxycodone or percocet
- Treats hypo kalemia
- Review appendix b
- If potassium levels drop too much a person could die
- Narrow range for theraputic lab value
- Review appendix k for potassium high foods
- If given IV must be given VERY SLOWLY and mixed it burns. If given too fast it can cause heart arrythmias. Pt should be on a heart monitor to watch for heart arrythmias, pulse rate and BP
- Labs should be checked after drug therapy to ensure pt is not hyper kalemic (review symptoms)
- For pt’s taking a diuretic hypo kalemia can be a side effect (flushes potassium out of system)
- DO not crush PO potassium (can be melted in water)
- S/S of GI distress and blood in stool
Potassium chloride or K-dur
Contradictions with Potassium Chloride:
hyperkalemia Renal impairment Untreated Addison's disease Pt with tartazine or alcohol intolerance CArdiac disease Diabetes mellitus Hypomagnesemia GI hypomotility Pt's recieving potassium sparing drugs
Adverse reactions or side effects of K-durr or potassium chloride
Confusion restlessness weakness Arrhythmias ECG changes Abdominal pain Diarrhea Flatulence nausea vomiting GI unceration Paralysis Paresthesia
When taking Potassium Chloride, you should take a missed dose
whithin 2 hr or return to regular dose schedule. Do not double dose.
Chewing Potassium Chloride or K-durr Enteric coated tablets can cause what?
GI irritation or ulceration
Patients taking K-durr or Potassium Chloride should avoid what?
Avoid salt substitues or low-salt milk unless approved by HCP
Pt should read all labels to prevent excess potassium intake.
Pt should monitor for and report these when takinf Potassium Chloride or K-durr:
dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of extremities. Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists. Dosage may require adjustment.
K-durr or potassium requires what?
Regular follow-up exams to monitor serum levels
- A steroid used to tx pt with asthma, and or other respiratory problems such as COPD
- Helps with pt’s who have adrenal gland insufficiency. Adrenal glands sit on the kidneys, helps with stress and production of sex hormones,
- Give to children based on weight in kg
- Give with food to help decrease GI distress.
- Should be given in the morning when the body produces cortisol because the production is highest in the morning.
- Should NOT be stopped suddenly. Can cause dyspnea, hypertension, hypoglycemia
- Steroids do raise glucose levels
- Therapy can last days or long term
- Diet is important if taking this long-term
Prednisone or Deltasone
Deltasone or prednisone can mask the signs of
Infection
Chronic prednisone use can lead to…
Adrenal supression; stay on the lowest possible dose for the shotest period of time.
Chronic pednisone or deltasone use can lead to what in Pedi pts?
Decreased growth; stay on lowest dose possible for the longest amount of time
What drug can cause adrenal supression and hypogycemia
Deltasone or prednisone
What drug can cause fluid retention (in long-term high doses), hyperkalemia, and hypokalemic alkalosis?
Prednisone or deltasone
What drug can cause acne, decreased wound healing, ecchmosis, fragility, hirutism, petechiae?
Deltasone or prednisone
What drug can cause Hypertension, cataracts, an dincreased intraocular pressure
Prednisone or deltasone
What drug can cause moonface, buffalo hump, chushingoid apperance, increased suseptability to infection?
Deltasone or prednisone
Patients on long-term prednisone therapy should ehat what kind of diet?
High protein, calcium, and potassium
Low Sodium, carbohydrates
Avoid alcohol
Patients on Deltasone should undersand the need for what?
Follow up appointments to assess the effectiveness or possible side effects and to do periodic lab tests and eye exams
PT taking prednisone or deltasone should contact doctor if any of these occur:
Black tarry stools swelling weight gain tiredness bone pain buising nonhealing sores visual disturbances behavioral changes
- Can be used for allergies, antihistamine, and an antiemetic
- Some people take it for motion sickness
- Give slowly by IV and mixed with another solution if given straight can destroy a vein
- Watch HR and BP if given IV
- If PO give with food to minimize GI distress
- Pt may become drowsy
- Causes dry mouth
- Photosensitivity (wear sunscreen)
- Avoid Alcohol
- Consider timing if taking for motion sickness
Promethazine or Phenergan
Uses for promethazine or phenergan
- Treatment of various allergic conditions and motion sickness.
- Preoperative sedation.
- Treatment and prevention of nausea and vomiting.
- Adjunct to anesthesia and analgesia.
Contradictions with promethazine
Bladder neck obstruction CV disease Impaired liver function Glaucoma Asthma Sleep Apnea Epilepsy Underlying bone marrow depression
When administering Promethazine or Phenergan to Pedi patients remember…
Can cause fatal repiratory depression in children <2 y/o
Give lowest effective dose
When taking Phenergan or Promethazine contact doctor if…
Dry mouth persists for more than two weeks, sore thoat, fever, jaundice, or uncontrolled movements are noticed
If pt is taking Promethazine or Phenergan encourage them to…
Wear sunscreen becuase it causes photosensitivity
- SSRI (antidepressant)
- For specific types of depression which include major depressive disorder, panic disorder, premenstrual dysphoric disorder
- Should not be used concurrently with MAO inhibitors
- Pt’s who have suicidal thoughts should be assessed before and during drug therapy. Pt who is on long-term therapy of this drug is at a high risk of suicide if drug is stopped suddenly. Pt needs to be whined of of this drug.
- Pt’s mental status needs to be assessed throughout therapy to ensure cognitive function is not being altered.
- Whatever reasons the medication is being given needs to be assessed before and during administration to see if it is helping the dx
- Should be taken at the same time daily
- May cause drowsiness
- Can cause dry mouth
- Pt should consider sunscreen (photosensitivity)
- Pt should be directed to psycho therapy
Sertraline (Zoloft)
When administering Zoloft or Sertaline know that the dose…
starts off small and increases by 200mg a day
Advise cliets taking Zoloft, family members, or caregivers to monitor for…
suicidal behaviors, anxiety, depression, agitation, restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, dangerous impulses, mania, changes in mood or behavior
When taking Sertaline or Zoloft avoid what herb?
St. John’s Wort
- Pain medication for moderate to severe pain
- Assess pain prior to administration and then 2-3 hrs after to ensure med was effective
- Seizures are a significant side effect esp in pt’s taking other antidepressants
- There is a risk for addiction, may be give on a schedule or PRN
- Can make pt dizzy
- Report seizures or symptoms of serotonin syndrome to PCP immediately
- Educate pt and care giver on what to do when seizures occur
- Time it, keep pt safe, move things away from pt, do not try to hold pt down, do not try to put anything in pt’s mouth.
Tramadol or Ultram
Tramadol can cause:
Orthostatic hypotension Drowsiness Addiction Seritonin syndrome Stelectasis
- An anticoagulant, helps prevent blood clots, helps reduce the risk of a MI or a stroke
- Bleeding precautions need to be taught to pt
- Pt bleeding times need to be checked (review values in appendix b)
- Labs will need to be continued with administration of this med to ensure theraputic range
- Pt needs to know they have routine follow up.
- Dosages may change every day based on labs
- Antagonist is vitamin k (review appendix k)
- If INR is too high Coumadin may be withheld or a vitamin K shot may be given
- Consult PCP before taking NSAIDS and or aspirin
Warfarin or Coumadin
Patients taking Coumadin or Warfarin should limit their intake of…
Vitamin K
Patients taking Warfarin or Coumadin should AVOID…
Cranberry Juice
- Sedative or hypnotic (makes you sleep)
- Only to be given short term
- Avoid alcohol and driving
- Assess sleep pattern, (Third shift workers)
- Take with water and no food for quicker results
Zolpidem or Ambien
Manifestations of Death
Sensation of heat when the body feels cold
Decreased sensation and movement in lower extremities
Loss of senses
Confusion or loss of consciousness
Decreased appetite and thirst
Swallowing difficulties
Loss of bowel and bladder control
Bradycardia hypotension
Chyene-stokes respirations
Pooling pulmonary and pharyngeal secreations can cause the “death rattle”
Birth to 18 months
Learn to trust others
Should be provided consistent affectionate care
Trust vs. Mistrust
3-5 yrs
Initiative activities and influence envirinment
Creativity should be encouraged, answer questions; do not threaten or label behavior as “bad”
Initiative vs. guilt
18 months to 3 yrs
Learn self-control and the ability to express oneself and cooperate
Nurse should Increase independence by providing praise and encouragement
Autonomy vs. Shame/doubt
5-12 yrs
develop sense of social skills an self-esteem
The nurse should keep realistic expectations for behavior and recognize accomplishments
Industry vs. Inferiority
12-18 yrs
Seek sense of self and plan according to one’s abilities
A nurse should assist with planning for future and help with decision making
Identity vs. Role Confusion
18-40 yrs
Develop intimate relationships and choose a career
The urse should avoid cirticizing relationships; teach how to establish realistic goals
Intimacy vs. Isolation
40-65 yrs
Become a productive member of society and establish a family
The nurse should recognize accomplishments and prvide emotional support
Generativity vs. Stagnation
65+
Accept worth, uniqueness, and death
The nurse should review accoomplishments made by person
Integrety vs. Despair
When thinking about ethical and cultural groups always remember
Always ask patients about their personal preferance. Never assume.
Healthcare beliefs often correlate with modern medicine
Believes illness can be the result of nonhuman spirits invading the body
Does not typically allow Euthanasia
Maintain good health through good deeds
Medications can be seen as harmful because of chemicals
Prefers tx by HCP of same gender
May decilne bovine-derived meds
Buddist beliefs about Healthcare
Dietary considerations for Buddist
Some Pt’s are vegitarians
Some avoid alcohol and tobacco
Pt may fast on holy days
Death Rituals for Buddhism
Some Pt’s are vegitarians
Some avoid alcohol and tobacco
Pt may fast on holy days
Religion
Health care beliefs often correlate with modern science
Pt’s often use CAM
Believe in “laying of hands” faith healing
Catholics; the anointing of the sick
Organ donation is generally allowed
Many believe in health maintanence
Christian beliefs about healthcare
Death rituals for Christianity
Most believe in hydration and nutrition therapies as long as possible
Religious rituals practiced by Christians
Some practice holy communion
Pt’s often have visits from spiritual leaders
Diet practiced by christians
Some avoid alcohol, tobacco, and caffine
Some fast during lent
Religion
Healthcare beliefs often correlate with modern medical science
Female clients ften prefer to be examined by females
Having to remove undergarments an be very disressing for some clients
Sikhism
Sikhism rituals
Clients my use religious symbols or devotional prayer
Clients my not permit the cutting or shaving of their hair
Religion
Health concepts can be a part of humanity and relate to the place of humans in the universe
Clients often view health holistically
Clients might adhear more to wellnessinterventions that disease prevention
Clients can attempt to correct poor health using symbols, stories, rituals, prayers, and paintings (a practice known as blessingway)
Navajo
Religion
Beliefs vary across castes
Healthcare beliefs often correlate with modern medical science
Illness can be a cause of past sins
Decisions might be made by the community, esp by senior family. Females defer to spouse or family to make decisions
Life-prolonging therapies might be discouraged
Clients might decline porcine-derived medications
Hinduism
Dietary rituals for people who practice Hinduism
Some pt’s are vegitarians due to an adherance to the concept of ahisma (nonviolence as applicable to food)
Religious rituals often observed by people who practice Hinduism
Some pt’s are vegitarians due to an adherance to the concept of ahisma (nonviolence as applicable to food)
When someone from the Hindu faith passes the family migh want to:
Pt’s might want to lie on the floor while dying, or the body might be placed on the floor following death with head facing north
Clients prepare for death if possible with prayer and meditation
Care for the body should be by those with the same gender
Cremation can be used as a way to purify the body following death
Religion
Cliets view of healthcare can be fatalistic, at times
Clents often have a belief in faith healing
Clients can avoid discussions about death, and see death as predetermined
Clients often avoid euthanasia and organ transplantation
Spirituality is often connected to health
Clients often make decisions within families, and might prefer for new information to be discussed in this manner
Clients view pain as cleansing
Clients might decline porcine-derived meds
Islam
Dietary considerations for people who practice Islam
Often avoid alcohol and Pork
Pt may fast during Ramadan
Death rituals often observe by Muslims
The body can be washed and wrapped in a cloth by someone of the same gender. The client might wish for someone from the Mosque to do this.
The face can be turned towards Mecca
Aprayer is often said
Autopsy may not be permitted
Burial is often preffered to cremation
Cliens often value having loved ones close by
Religious rituals often observed by muslims
Clients might practive Five Pillars of Islam
Clients oftn find strength in group prayer
Many clients pray five times a day facing Mecca
Religion
Clients might not accept blood transfusions, even in life-threatening situations
Can choose between burial or cremation
Jehovah’s witness
Dietary conserations for Jehovah’s Witnesses’
May avoid foods having or prepered with blood
Religion
Clients often in balance between God and medicine
Clients have an obligation to avoid substance abuse and stay healthy.
Clients might refuse tx on the Sabbath
Clients can feel an obligation to visit the ill
Euthanasia is often not permitted
Life support measures can be discouraged. Views very regarding hydration and nutrition at the end of life.
Judaism
What religion practices a Kosher diet
Judaism
If someone that practices Judaism passes the family may want to…
Someone often stay with the body.
Orthodox clients often have the body prepared by the Jewish Burial Society and do not typically permit an autopsy
Burial often occurs within 24hr, unless this is during the Sabbath
Cremation and embalming are
Special obilgations for people who practice Judaism
On the eighthday after birth, males are usually circumsized.
Observing sabbath is often important.
It is often an obligation to visit the sick.
Religion
Patients my avoid alcohol, tobacco use, and caffine
Children are baptised by immersion by age 8
Clients often have visit from spiritual leaders (local elders) for blessing.
Clients might prefer to wear temple undergarments.
mormonism
When a patient who practices Mormonism is dying consider:
Patients might recite a confessional or affirmation near death (the Shema)
Dying client is usually not left alone.
Last rites can include wearing temple clothes for burial
Burial is often preffered
Factors that influence growth and development
Biological and Hereditary factors Physical impairments Mental Impairments Illness that Delays progress of development Environmental factors
Principles of Growth and development
- Growth and development follow an orderly, predictable pattern
- Growth follows a cephalocaudal pattern
- Development starts in a proximodistal pattern
- Simple skills are learned independently, then become part of complex skills
- Development becomes more specific over time
- Certain stages of growth and development are more critical than others
What is family centered care?
This philosophy recognizes the family as the constant in the child’s life and that all members of the familyare affected by illness, injury, or hospitalization that the child is experiencing.
How can a nurse provide family centered care?
Involved nurses providing a safe, child friendly, and decorative environment, along with the support needed to assist the child and family as one unit.
When a nurse provides support based on respect, encouragement, the enhancement of strengths, and the encouagement of competence they are practicing what kind of care?
Family centered care
Age range for middle adults
40-65
Physical changes in middle adulthood
the capacity for physical exertion decreases somewhat. It is still important to engage in physical exercise to maintain CV health. Decrease in sensations, GI motility slows, loss of skin elasticity can lead to wrinkles, Hair begins to turn gray. Slight decrease in muscle tone and bone density. Decreased estrogen/testosterone
Psychosocial developmental changes in Middle adulthood
the capacity for physical exertion decreases somewhat. It is still important to engage in physical exercise to maintain CV health. Decrease in sensations, GI motility slows, loss of skin elasticity can lead to wrinkles, Hair begins to turn gray. Slight decrease in muscle tone and bone density. Decreased estrogen/testosterone
After a patient has passed and before the family views the body…
Postmortem care needs to be preformed
If a patient is having an autopsy done the a nurse should
Not remove any tubes or lines
