Week 1: Principles of Nursing (Chapters 1-4, 5, 7, 8) Flashcards
what is patient-centered care?
- who does it focus on?
- which model is used?
- focuses on patient themselves
- looks at Maslow’s Hierarchy of Needs
what is health?
state of complete physical, mental, & social well being, not just the absence of disease
what is wellness?
proactive in our self-care so its aimed at physical, social, spiritual & emotional well being
what does health promotion focus on?
potential for wellness
what is health care?
prevention & management of illness; providing support to patients; multiple providers
list the steps of the nursing process (6)
- which model is used for this?
- assess
- diagnose
- plan
- implement
- evaluate
- document
model: NCSBN clinical judgment measurement model
what is the difference between an ethic & a moral?
ethic: formal study of moral belief to understand, analyze, and evaluate matters of right & wrong
moral: specific value
what is an ethical theory?
greatest good for the greatest number of people (utilitarianism)
what is a moral situation?
conflict between two or more principles
what is medical-surgical nursing?
provides services to patients from adolescents all the way til the end of life
what is care transitioning nursing?
one that ensures consistency and coordination of care as the patient has moved between health care settings
what is critical care nursing?
provides services for the critically ill in an acute care setting
what is rehabilitation nursing?
provides holistic focused care for patients who’ve been incapacitated by injury or illness that are facing health altering life conditions
what is an adaptive device?
anything that helps people w disabilities to perform a task
what does debilitated mean? what is the diagnosis?
patients w impaired strength, severely weak, injured, or have a disability
diagnosis: commonly “failure to thrive”
what does prosthesis mean?
used to replace a body part
what is rehabilitation?
teaching the patient to relearn how to be able to function
what 3 components are part of rehabilitation nursing?
- goal-oriented
- team / holistic approach
- active participation
what type of process is rehabilitation? what does it require?
continuous process; requires active participation
what is a comprehensive assessment of functional capacity?
- what can this consist of?
person’s ability to perform activities
- activities of daily living
- instrumental activities of daily living
which tool is used to measure level of independence?
- give an EX
functional independence measure
- EX: are they able to feed themselves?
what does passive mean?
exercises carried out by the nurse, without assistance from the patient
what does active-assistance mean?
active exercises are performed by the patient, w assistance to increase muscle strength
what does isometric / muscle setting mean?
exercises that involve the contraction of muscles w out any movement in the surrounding joints
what is constancy?
fixicity of the internal environment despite changes in the external environment
what is homeostasis?
balanced internal state, steady state within the body
what is stress?
anything that upsets that balance in the body’s attempt to return the body to that steady state
what is adaptation?
desired goal of appraising & coping w changes in our environment
what is the definition of a stressor?
anything that can change the internal or external environment that creates a potential for physiologic, emotional, cognitive, or behavioral changes within our body
list & briefly describe the 3 types of stressors
physical: extreme hot or cold, chemicals
physiologic: pain, fatigue, raises BP, HR, or body temp
psychosocial: fear or anxiety
list & briefly describe the 4 temporal aspects of stress
day to day: frustrations
normal life transitions: childhood to adulthood, leaving home & moving to college
infrequent enduring: death of a spouse, permanent disability, chronic illness
major complex: war, terrorism, government
what is a stimulus for disease?
stress
list & briefly describe the 4 appraisals / responses of a stressful event
cognitive response (primary appraisal): situation that is going to be a stressor; identifying it
behavioral response (secondary appraisal): reaction to the situation
emotion-focused: anger, fear; seek to make the person feel better
problem-focused: make direct changes to environment to manage the event
describe general adaptation syndrome
- what does it affect?
- list & briefly describe the 3 phases
- affects the whole body
1. alarm phase: fight or flight response; inflammatory response
2. resistance phase: adaptation to the stressor; releases cortisol, increases activity
3. exhaustion phase: endocrine activity deceases & causes negative effects on the body
describe local adaptation syndrome
- what does it affect?
- what happens?
- give an EX
- affects only one part of the body
- inflammatory response & repair process are activated; if this effect is severe enough and let go for a long period of time, it can turn into a general adaptation syndrome
- EX: stepping on a nail
what chemical is stimulated in the SNS during stress?
norepinephrine
which chemicals are stimulated in the Sympathetic - adrenal - medullary response to stress?
epinephrine & norepinephrine
describe the hypothalamic-pituitary response to stress
hypothalamus receives message that there is a stressor going on; this triggers the anterior pituitary gland to release the adrenocorticotropic hormone to tell the adrenal cortex to release cortisol causing an increase in release of glucose in order for the body to deal w the current stress
how does chronic stress affect WBCs?
results in a low WBC; puts patients at high risk for developing infections
how does acute stress affect WBCs?
causes an increase in WBC & causes infection
describe a chronic recurrent stress response
patients that never give themselves a chance to adapt to the stressor & develop a disease overtime
how does type A behavior / personality R/T stress?
people w type A personality are at a high risk of stress related to their activities
describe denial avoidance maladaptive response to stress
not taking care of ourselves & avoiding going to the doctor
what can distancing as a maladaptive response lead to?
withdraw or depression
what is an example of an objective sign as identification of physiological & psychological stressors?
lab values
what is the difference between a chronic disease and a chronic illness?
chronic disease: medical or health problem w associated symptoms or disabilities that require long term management
chronic illness: perception of living w a chronic disease; person’s perception of the experience & their response to the disease
what is a cognitive disability? what types of patients can this occur in? (3)
limitations in mental functioning & difficulties w communication, self-care, and social skills
can occur in stroke, dementia, & traumatic brain injury patients
what is a developmental disability? when can this occur?
several disorders that are characterized by difficulty in one or more domains: cognitive, physical, or both
- can occur before the age of 22
what is an intellectual disability? when can this occur?
characterized by significant limitations in both intellectual and adaptive behavior; can occur before the age of 18
what are noncommunicable diseases?
conditions that are not caused by an infection or microorganism
what are secondary conditions or disorders? give an example
conditions that result from an initial disabling condition
EX: renal failure can be a secondary condition due to diabetes
what is a disability? when may it be defined as severe?
limitation in performance or function in everyday activities
- may be defined as severe if they have the inability to perform one or more activities, uses an assistive device, or needs help from others to accomplish basic activities
how does the world health organization define disability?
an umbrella term for impairments, activity limitations, participation restrictions, and environmental factors
what is the US definition of a disability?
physical or mental impairment that limits one or more major life activities, has a record of impairment, or regarded as having an impairment
is incidence of disabilities higher in men or women? which ethnicity has a higher incidence?
- higher in men under the age of 65
- higher in women over the age of 65
- ethnicity: American Indians / Alaskan Natives
list the 6 types of disabilities
- cognitive
- developmental
- intellectual
- physical
- sensory
- psychiatric
which model of disabilities is most closely aligned to nursing? explain this
interface model: want patients to achieve their independence as much as possible and help them to embrace that independence
give examples of the difference between a disability and a disabling disorder
disability: broken leg
disabling disorder: arthritis; patient has joint pain and are unable to walk
explain the roles of the Rehabilitation Act of 1973 & the ADA of 1990 for disability
Rehabilitation Act of 1973: protects people from discrimination
The ADA of 1990: mandates access to jobs
United Nations Convention on the Rights of Persons w disabilities
- right to receive highest standards of care without discrimination
what is the difference between medicare & medicaid?
Medicare: federal health insurance to those who are 65 or older, have permanent kidney injury, and / or have a qualified disability
Medicaid: a state & federal assistance program that is for low income families to provide medical care or insurance and to anyone w a disability; any age!
title II of the social security disability insurance
benefits of those to meet the criteria for disability who have worked 40 quarters of covered of employment & paid into social security taxes; these benefits go to people who are disabled since childhood who are under the age of 22 & are dependent on a parent w a disability or are dependent of a parent who has recently died
title XVI
provides supplemental social security income to people who are disabled & have limited income & resouces
what accounts for 80% of our medical costs in the US?
people living w multiple chronic conditions
what is health disparity?
preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by multiple factors like poverty, environmental threats, inadequate access to healthcare, individual & behavioral factors, and educational inequalities
describe the golf war illness in veterans
chronic syndrome related to terrorist attacks; creates symptoms like fatigue, depression, and elder cognition
describe chronic multisystem illness in veterans
set of nonspecific symptoms; may be moderate to severe & both may be a consequence from exposure to chemical & biological toxins
what is the trajectory model of chronic illness?
- how many phases?
- are they in chronological order?
the path or course that the chronic illness follows
- nine phases
- chronological order
what is ageism? give an example
a stereotyping or bias that discriminates, stigmatizes, and disadvantages older adults based on their chronological age
EX: assuming that all older adults are forgetful, confused, hard of hearing, or incontinent
what is comorbidity?
having more than one illness at the same time
what is the difference between delirium & dementia?
Delirium: a sudden onset of confusion that is a result of illness or injury and is generally reversible; can become fatal if not caught in time
Dementia: long term loss of memory, cognition, confusion; slow & progressive & irreversible
when patients have depression, they often have…
apathy (lack of interest)
what is a durable power of attorney?
a healthcare proficy; make healthcare decisions in the event that the sick person cannot make those decisions
list some tools used by NPs during a functional assessment (4)
Barthel index, Gordon’s functional patterns, Katz Index, Functional independence measure
list some tools used by NPs during a functional assessment (4)
Barthel index, Gordon’s functional patterns, Katz Index, Functional independence measure
list some tools used by NPs during a functional assessment (4)
Barthel index, Gordon’s functional patterns, Katz Index, Functional independence measure
list some tools used by NPs during a functional assessment (4)
Barthel index, Gordon’s functional patterns, Katz Index, Functional independence measure
what is the leading cause of death in older adults?
cardiovascular disease
what is the most common affective mood disorder of old age?
depression
what does “SIG E CAPS” stand for & used to measure?
- used to measure the emotional & physical well being of an older adult
S = sleep
I = interest
G = guilt
E = energy
C = concentration
A = appetite
P = psychomotor
S = suicidal thoughts
what is the difference between major & persistent depressive disorder?
major: severe symptoms; interferes w daily life
persistent: lasts at least 2 years; may have major depression alternating w periods of less severe depression
what is vascular depression?
a disorder of executive dysfunction, including difficulty with task completion and decision making
list 3 assessment tools w strong reliability & validity for depression in elderly
Depression Adjective check list, cornell scale for depression for dementia, Geriatric depression scale
list 7 anticholinergic effects from antidepressants
dilated pupils, vasodilation / flushing, hyperthermia, dry skin, hallucinations / agitation, ileus / urinary retention, tachycardia
what are 2 important cardiac effects to monitor when a patient is on antidepressants or antipsychotic drugs?
orthostatic hypotension & fall precautions
explain the difference & S/Sx of hyperactive & hypoactive delirium (4)
Hyperactive: increased psychomotor activity, rapid speech, irritability, restlessness
Hypoactive: lethargy, slowed speech, decreased alertness, apathy
list & briefly describe the 3 common forms of progressive dementia
- Alzheimer’s disease
- Vascular dementia: due to lack of blood flow to the brain cells caused by strokes or HTN
- Dementia w Lewy bodies: dementia that affects people at a younger age
what is neoplastic dementia caused by?
brain cancer
who is demyelinating dementia commonly seen in?
patients w MS
which 3 infections can cause infectious dementia?
sipilis, herpes & epilitis
explain the difference between familial & sporadic alzheimer’s
familial: (early onset): rare!
sporadic: (late onset)
which part of the brain does Alzheimer’s primarily occur in? cells that use ___ are mainly affected by AD
- cerebral cortex
- acetylcholine
which 3 conditions signify the components of the Geriatric Triad?
falls, urinary incontinence, changes in cognitive status
what is the most common form of elderly abuse?
neglect
what is the most common form of elderly abuse?
neglect
what is the most common form of elderly abuse?
neglect
what is premature institutionalization?
elder sent to a nursing home if they cannot be cared for at home due to the caregiver not able to cut hours or if family lives across the country
what does the patient self determination act say?
law that states that any facility that is funded by medicare must provide patients w information on advanced directives; if patients refuse, the nurse must document that the patient declined
