x N109 - Foundations in Nursing Practice Flashcards
Stage 1
Trust vs Mistrust
Infants. trust world? safe?
if fear = doubt, mistrust
Erikson’s 8 stages of Development: Stage 1
Trust vs Mistrust (infant 1-2yr)
Infants. trust world? safe?
if fear = doubt, mistrust
Erikson’s 8 stages of Development: Stage 2
Autonomy vs Shame/Doubt (early child 2-4)
Is it ok to be me? If yes, confidence, if not, shame/self doubt
Erikson’s 8 stages of Development: Stage 3
Initiative vs Guilt (pre school 4-5)
Pre School- Ok to do what I do? If so, follow interest, if not supported, guilt
Erikson’s 8 stages of Development: Stage 4
Industry vs Inferiority (5-12)
If recognized = industrious
if neg feedback = inferior, lose motivation
Erikson’s 8 stages of Development: Stage5
Identity vs Role Confusion (adolescence 13-19)
Go out and find our identity. If stifled, lost and confused.
Erikson’s 8 stages of Development: Stage 6
Intimacy vs Isolation (young adults 20-40)
can we love? long term commitment? if yes = happy, if not = lonely, isolated
Erikson’s 8 stages of Development: Stage 7
Generatively vs Stagnation (adulthood 40-65)
Able to lead next generation? Happy. If not, stagnant.
Erikson’s 8 stages of Development: Stage 8
Ego Integrity vs Despair (maturity 65 - death)
go over lives. if happy = integrity, if not happy = bitter, despair
Freud’s 5 Stages of Psychosexual Development
- Oral
- Anal
- Phallic
- Latency
- Genital
Oral
(I0-1)
Breastfeeding
pleseure in mouth
Anal
(2-3)
child discovers feces
learn to control bowel mvmts
Phallic
(3-6)
Discover genitals and pleasure that comes from them
Genital
(12+)
stage of sexual maturity. puberty. experiment, discover.
Healthy People 2020 Determinants
- Biological/Genetic Makeup
- Individual Behaviors
- Social Interactions and Norms
- Physical Environment
- Access to Healthcare Services
Piaget Cognitive Development
Sensorimotor Stage (baby)
experience world by touch.
Piaget Cognitive Development
Sensorimotor Stage (baby)
experience world by touch.
Sensorimotor Stage
(o-2)
baby
Pre-operatoinal Stage
(2-6) language foundational lack logical reasoning egocentrism unlimited imagination
ormal Operational Stage
(12+)
know bad vs good
moral reasoning
ormal Operational Stage
(12+)
know bad vs good
moral reasoning
Adolescence
10 - 19
Babinski Reflex
Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus.
The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.
This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.
Babinski Reflex
Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus.
The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.
This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.
Healthy People 2020 Overreaching goals
- Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
- Achieve health equity, eliminate disparities, and improve the health of all groups.
- Create social and physical environments that promote good health for all.
- Promote quality of life, healthy development, and healthy behaviors across all life stages.
Healthy People 2020 Overreaching goals
- Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
- Achieve health equity, eliminate disparities, and improve the health of all groups.
- Create social and physical environments that promote good health for all.
- Promote quality of life, healthy development, and healthy behaviors across all life stages.
Piaget: The child is better able to think about things and events that aren’t immediately present. She has difficulty conceptualizing time. Her thinking is influenced by fantasy. The child begins to think about death.
Intuitive Thought phase
Piaget: As the child learns to talk and communicate with others, he begins to use symbols to represent objects. Early in this stage he also personifies objects.
Preconceptual or Preoperational phase
Piaget: The child begins to cooperate and is less egocentric. The child develops the ability to think abstractly and to make rational judgments about concrete or observable phenomena.
Concrete Operations phase
Piaget: At this stage the individual is capable of hypothetical and deductive reasoning.
Formal Operations phase
Piaget: The child learns about his environment and himself through motor and reflex actions. Thought derives from sensation and movement.
Sensorimotor phase
Levels of Prevention/Care
- Primary: pre-dx, prent disease from occuring. health teach, immunizations, lifestyle changes
- Secondary: early detection, screenings, pap, montoux
- Tertiary: reduce complications once dx made
Loss
something/one w value and meaning permanently gone, taken from you or changed.
Anticipatory Loss
feels of loss before actual death. Sickness. Lengthy dying process.
Actual Loss
loss of individual/object that is obvious to others
Perceived Loss
experience can not be verified
Developmental Loss
empty nest, menopause, off to college
Situational Loss
alteration of life situation
Sources of Loss
.aspect of self
.object outside of oneself (theft)
. separation from familiar envt
.loss of loved ones
Grief Response
temporary/emotional repose to loss
Bereavement: overall reaction to loss
Mourning: cultural process enabling resolve of grief.
SS Grief
. talk about loss . crying . bad sleep . loss apetite . diff concentrating
Types of Grief
.Abbreviated
.anticipatory
.disenfranchised
.delayed
Dysfunctional Grieving
.Unresolved (unusual length and severity)
.Inhibited (not accepting it)
Somatic Response
physical canges
men have more difficulty coping with loss
.
Therapeutic Relationship
Helping Relationship: .trust .professionalism .mutual respect .caring .partnership
Intro phase: establish rapport
working phase: achieve goals
termination phase: eval
Kubler-Ross
DABDA
denial, anger, bargaining, depression, acceptance
Egel
shock and disbelief, developing awareness, restitution, resuscitation, recovery
Lindeman
shock disbelieve, acute mourning and resolution
'Grief Work' typical grief reactions 1. somatic 2. preoccupy w image of diseased 3. guilt 4. hostile reactions 5. loss
- Bowlby’s Stages of Mourning
4 stages of Mourning
- shock / numbness
- yearning / searching
- Despair / Disorganization
- Reorganization / recovery
worden
4 tasks to deal w loss
.accept
.experience
.adjust
.reinvest
Rando’s 6 R’s
.recognize loss .react .recollect and re-experience .relinquish .readjust .reivest
Martocchio’s 5 stages of Grief
.shock/disbelief .yearning/protest .anguish/disorganization/despair .identification .reorganization/restitution
Sanders Integrative Theory of Bereaement
.Shock .Awaremess of Shock .Conservation-withdrawal .Healing .Renewal
Factors influencing grief
.age/develop level .significance of loss .culture .spiritual beliefs .gender (mean don't cope as well) .socioeconomic status .support system .cause of loss
Death and Dying
developmental
infant-5: can't relate 5-9: death is final 9-12: higher level 12-18: feel invincible 18-45: a perceived future event 45-65: accepts own mortality 65+: fear prolonged illness. prefer to poor quality of life. lots of death around you
Death
cessationof apical pulse, repration and bp.
lack of response to external stim,
no breathing or musc mvmt, no reflexes, flat EKG
Cerebral Death
cerebral cortex destroyed
- Apnea
- absence of cephalic reflexes
- absence of purposeful responses to external stimuli
Dying Trajectory
. Sudden, unexpected
. steady decline w short terminal phase
. slow decline
Physiological needs of dying pt
airway clearance: fowlers/conscious, lateral/unconscious
. bathing/hygiene
. physical mobility
. nutrition
.constipation (fiber, colace)
.urinary fx
.sensory/perceptual changes (room lighting, touch, pn mgmt)
Cheyne Stokes breathing
see diagram
Care after Death
. treat body w respect and dignity .bath and put clean gown on body . remove dressings, tubes . place body in alignment . put dentures in . comb clients hair
Care after Death
. treat body w respect and dignity .bath and put clean gown on body . remove dressings, tubes . place body in alignment . put dentures in . comb clients hair
Body Changes after Death
Rigor Mortis: rigid 2-4hrs after death
Algor Mortis - gradual decrease in body temp. 1.8F until body temp
Livor Mortis: discoloration of tissue due to blood settling
Hospice
6mos or less to live
Palliative Care
care of whole person. goal: quality of life
enhances comfort and improves quality
available any time throughout illness. not only end of life, hospice.
Barriers to Hospice/Palliative
. medicine focus on cure and prolonging life
. insurance reimbursement
. public lack of understanding
. lo training of health prof
Edmonton Symptom Assessment Scale
1-10 various questions.
used to assess and track level of SS pts are experiencing on scale of 0-10
Admin by nurse first visit, then every 2 weeks.
Pt completes daily.
Symptom Assessment
START HERE slide 50
Brief Pain Inventory: completed by pt, details of pain
bedside confusion scale: simple tool for reassessing delirium and confusion
IMS Impaired Mental Status
- Hypoactive IMS (w/drawal, somnolence)
- Hyperactive IMS (anger, agitation)
- Possibly combative behaviour
- Restlessness
- Delirium
deal w patients experience loss
silence .attentive listening .open/closed listening .paraphrasing .clarify .summarize
Nurse facilitates the work of grieving
Respect
Educate
Encourage
Effective measures for providing comfort
acupuncture massage music art aroma relaxation guided imag pet
Do NOT SAY to dying patient
- I dont think things are really that bad.
- you don’t really mean that
- God will take you when he wants you
- you are doing so well
- let’s talk about something more positive
physiological needs
respiration fluid/nutrition mouth, eyes, nose mobility skin care elimination comfort physical envt
Somatic Pain
direct stimulation of intact nocicepters ad elec signals normally transmitted along fxing nerves
occus w tissue damage (i.e. bone metastasis, fractures, skin lesions
PAIN is dull, aching, gnawing, throbbing, localized and constant or intermittent
Tx: opioids, anti inflam agents, steroids, radiotherapy
pain syndromes: visceral gut pain sydrome:
stim of autonomic ns which provides connection to all organs
PAIN is sharp, aching, squeezig, cramping, pulling
TX:Opioids, anticholinergics
WHO Analgesic Ladder
Nurse: determine type of pain
pt description
TX for Cancer Pain
MILD: non opioids
MOD: opioids w or w/out steroids
SEVERE: opioids w/wout ster
Breakthrough doses for Pain Mgmt
BTD Breakthrough dose
pain mgmt best before pain reaches an intolerable level
mod to severe pain treated w immed release opiod q1-4hrs prn. then sustained release med
Breaktough Dose
Rescue Dose: 10% of total 24hr dose
Should be available q HR prn for oral meds and q 20m prn for SQ meds.
Dyspnea
-lo dose immediate release opioids .morphine drug of choice at end of life tx .expectorants .diuretics .corticosteroid
Anxiety
.Benzodiazepine
.Tranquilizers
Situational Anxiety: worry about physical condition, finances, fam, uncertain future
Drug related anxiety: worry about therapy use in palliative care, drug induced effects, withdrawal
Organic anxiety: result fr uncontrolled SS, pain, dyspnea, insomnia, hypoglycemia
Phsychologic anxiety: hoplessness, fears, death thoughts
Meds for N/V
.Decadron .Ativan .Benadryl 25mg .Metoclopramide 10mg / Haldol 1mg suppository .Octreotide per persistent vomiting
Lysaught Report (1970)
Lysaught Report (1970) prompted research-based education of nurses and research into nursing education. Now the Carnegie Foundation for the Advancement of Teaching has funded another watershed study: Educating Nurses: A Call for Radical Transformation (Benner, Sutphen, Leonard, & Day, 2010) finds that, although the U.S. nurse educators are very effective in teaching ethics and professionalism and are often successful when they integrate theory and clinical courses, they are “not generally effective in teaching nursing science, natural sciences, social sciences, technology, and humanities” (p. 12). At each turning point in the history of nursing education, nurse educators, have assessed learning outcomes and the methods used to achieve them with the same critical eyes that they apply to evidence-based clinical nursing practice. Today nurse educators are examining the field’s signature pedagogies, like clinical rotations and simulation, and are turning to new approaches, like narrative and problem-based pedagogies or study-abroad experiences.
Brown Report (1948)
In one of the seminal reports on nursing education, Esther Lucille Brown (1948) observed that the extant system of nursing education was totally inadequate to meet the needs of society for nursing care. … The public and professional response to the Brown report was business as usual.May 31, 2002
Chronic Illness
Illness permanent, leaves residual disability.
.6mos - life
.most common in older, possible in any age group.
.85% of 65yr old have at least 1 chronic condition
.slow onset
.periods of exacerbation and remission
Acute Illness
.SS occur suddenly, short course
. i.e Cough, cold, flu, appendicitis, acute MI, trauma
Chronic Illness, I.e.
.DM .Heart Disease .HTN .Visual Impairment .Osteoporosis/hop fractures .Alzheimer's Disease/Mem impairment .stroke .incontinence .depression .parkinson's .HIV
in 2010 48% or adult deaths from…
heart disease and cancer
health risks
.lack exercise .poor nutrition .smoking .ETOH .HBP .Hi LDL
Primary care
-pre-dx via education, immunizations, lifestyle
Secondary care
.early detection while ASYMTOMATIC and Tx can effect cure (ie. screenings, pap, Mantoux tests)
Tertiary Care
reduce complications once Dx made.
Trajectory Model of Chronic ILlness
.Corbin/Strauss
.IDs diff phases that client goes through
.anticipate potential probs that w need specific interventions
- 8 Phases of Trajectory Model of Chronic Illness
- Pre-trajectory (at risk, lifestyle, genetics, GOAL prevent onset)
- Trajectory onset (Dx, GOAL develop plan)
- crisis (GOAL remove threat)
- acute
- Stable (GOAL maintain)
- Unstable (GOAL return to stable)
- Downward (GOAL acceptance/address current issues)
- Dying (GOAL acceptance, peaceful death)
Chronic Care Model
Wagner - created HMO.
MD too busy to care about preventing illness and treating chronic dx. HMO creates team of professionals to manage health.
Signs of Imminent death
- skin becomes cool, mottled
- disorientation
- incontinence
- dyspnea, cheyne stokes breathing
- decrease in appetite/thirst
- loss of muscle tone
- decrease in consiousness
Off Label Drugs
Drugs approved for one prob but used for another
.Methadone for pain relief
.Valproic Acid and Gabapentin for neuropathic pain
.Ritalin to improve opioid analgesia andreduce sedaition
.Thalidomide for anorexia
.Paxil for pruritis
.Baclofen for hiccups
pain syndromes: Neuropathic Pain
probs w peripheral nervous system and may result of shingles, diabetic neuropathy
PAIN is burning, stabbing, shooting, tingling, numbness, radiating, electric like
TX: opioids, tricyclic antidepressants, anticonuvlsants
pain syndromes: Neuropathic Pain
probs w peripheral nervous system and may result of shingles, diabetic neuropathy
PAIN is burning, stabbing, shooting, tingling, numbness, radiating, electric like
TX: opioids, tricyclic antidepressants, anticonuvlsants
Meds for Constipation
.Corticosteroids
.Stool Softeners or laxatives
.docusate 100mg bid po, reduces cramping more than stimulant laxatives
.Senna (1-2 tabs hs)
.Fleet Enema or biscacodyl suppository if no BM in 3 days
Meds for Constipation
.Corticosteroids
.Stool Softeners or laxatives
.docusate 100mg bid po, reduces cramping more than stimulant laxatives
.Senna (1-2 tabs hs)
.Fleet Enema or biscacodyl suppository if no BM in 3 days
Assessment for pt w breathing diff
BREATH AIR
.bronchospasms .rales .effusions .airway obstruction .thick secretions .hemoglobin (low) .anxiety .interpersonal issues .religious concerns
Engel’s 5 stages of grieving
- Shock and Disbelief - a stunned/numb feeling; refusal to acknowledge loss
- Developing Awareness - begins to acknowledge loss; may feel helpless and angry
- Restitution - conducts rituals of mourning
- Resolution - preoccupied with the loss and will often idealize the person, object or skill that was lost
- Recovery - goes on with life while accepting the loss
Engel’s 5 stages of grieving
- Shock and Disbelief - a stunned/numb feeling; refusal to acknowledge loss
- Developing Awareness - begins to acknowledge loss; may feel helpless and angry
- Restitution - conducts rituals of mourning
- Resolution - preoccupied with the loss and will often idealize the person, object or skill that was lost
- Recovery - goes on with life while accepting the loss
Types of Loss
.anticipated .perceived .situational .actual .developmental .physical .psychological
Types of Loss
.anticipated .perceived .situational .actual .developmental .physical .psychological
Euthenasia
.Active euthanasia: doing something which directly/ intentionally leads to person’s death; act of commission with specific end in mind
.Passive euthanasia: act of omission; death allowed to occur by either withdrawing or withholding tx that might prolong life; intentional
.Voluntary euthanasia: when dying individual desires some control over the time and manner of death
.Involuntary euthanasia: 1994 Oregon approved the right to die law: physician-assisted suicide law
Pain Syndromes
SOMATIC pain: direct stimulation of intact nociceptors and electrical signals which are transmitted along normally functioning nerves
occurs with tissue damage (bone metastasis, fracture, skin lesion)
pain is dull, aching, gnawing or throbbing; localized and constant or intermittent
opioid therapy, anti-inflammatory agents, steroids, radiotherapy
VISCERAL gut pain syndrome: stimulation of the autonomic nervous system which provides the nervous system connection to all the organs
pain is sharp, aching or squeezing, cramping or pulling
opioids, anticholinergics
NEUROPATHIC pain: problem with the peripheral nervous system and may be the result of shingles, diabetic neuropathy
pain is burning, stabbing, shooting, tingling, numbness, radiating or electric like
opioids, tricyclic antidepressants, anticonvulsants
The Patient Self-Determination Act (1990)
intended to provide individuals with legal means to determine the circumstances under which life sustaining treatment should or should not be provided to them
Sensory Impairments
Unit 5, Class 4
.
Blindness
Clinical def of absolute blindness: absence of light perception
.BCVA from 20/400 to no light perception (NLP)
.Legal blindness BCVA does not exceed 20/200 in better eye adn widest visual field diamerter is 20degrees or less
Common causes of blindness
. Diabetic retinopathy
. macular degeneration
. glaucoma
. cataracts
Macular Degeneration
AMD, age related macular degeneration
associated w aging, gradually destroys sharp, central vision.
.leading cause of blindness in elderly
SS: blurry vision, distortion, gradual loss of central vision, decreased ability to distinguish colors
AMSLER grid, monitors progression of disease
Wet or Dry (most common) AMD
Dry AMD
Dry Age related Macular Degenration
light sens cells in macular break down, gradually blurring central vision.
Most common type
Tx: delay disease, HI Antioxidants and Zinc
Wet AMD
abnormal BV behind retina start to grow under macula, damages
Tx: may progress despite tx. injections to eye
Cataracts
.clouding of lens
.related to aging
.affects focus of sharp image on retina
SS: cloudy/blurry vision, poor night vision, increased glare, change i color values (blue/yellow), halo around light, double vision
Risk Factors: .women .exposure to UV light/Hi dose radiation .corticosteroids .phenothiazines .poor controlled DM .trauma to eyes .chemo agents
Tx: .new glasses .brighter light .anti-glare sunglasses .magnifying lenses .Sx to remove cloudy lens. replace with artificial
Types of Cataract Evaluation
.split-lamp exam
.binocular microscope mounted on table
.magnification 10-40x real image
.cataracts eval by changed angle of light
Retinopathy
any disease of retina
Cause: complications vascular disease, uncontrolled HTN, DM, Arteriosclerosis
SS: progressive loss of vision
Tx: treat underlying cause, stringent glucose control most effective for preventing /limiting disease.
4 stages of Diabetic Retinopathy
Mild nonproliferative retinopathy:
At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the tiny blood vessels of the retina.
Moderate nonproliferative retinopathy:
As the disease progresses, some blood vessels that nourish the retina are blocked.
Severe nonproliferative retinopathy:
Many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
Proliferative retinopathy:
At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. (See diagram above.)
By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can occur.
Glaucoma
group of eye conditions lead to damage of optic nerve
Cause: increased intraocular pressure (IOP)
NORMAL:10-21mm Hg
.IOP fluctuations w time of day, exertion, meds, diet
.IOP increase w blinking, tight lid squeeze, upward gaze
.Incrased IOP damages optic nerve by damaging retinal layer as it passes thru optic nerve head
4 types of Glaucoma
.Open-Angle
.angle-closure
.congenital
.secondary
Stages of Glaucoma
. Initiating events (long term use corticosteroids, congenital narrow angles, use of mydriatics
.Structural Alterations in aqueous outflow system
.Fx alteration, increased IOP or impaired blood flow
.Optic Nerve Damage, atrophy of optic nerve
.Vision Loss
Open-Angle Glaucoma
.chronic .most common cause .IOP pressure up over time .SS: -non until loss of peripheral vision begins -halos around lights Late SS: -central blindness
Tx: eye drops, BP meds to lower.
Angle-Closure Glaucoma
.acute
.w aqueous humour fluid is suddenly blocked
.quick, severe, painful rise in IOP
SS: sever pain, cloudy, colored halos around lights, N/V, decreased vision, enlarged fixed pupils, red eye
Permanent Blindness if IOP elevated for 24-48hrs
Tx: drops, pills, IV meds to lower pressure, iridotomy
Congenical Glaucoma
.hereditary (at birth)
.SS: cloudiness on front of eye, excessive tearing, enlarged eye
Tx: Sx to open outflow channels of the angle
Secondary Glaucoma
Causes: some drugs, other eye diseases, some systemic disease.
Glaucoma meds
Miotics: Pilocarpine, Carbachol ◦ Constrict pupil Cholinesterase Inhibitors: Humorsol, Eserine lowers intraocular pressure Beta Adrenergic Antagonists: Timoptic decrease intraocular pressure Carbonic Anhydrace Inhibitors: Diamox decrease aqueous humour production
Eye Drops Tx
constrict pupil and draw iris away from cornea
1.Osmotic agents such as Urea or Mannitol
2. Glycerol given systemically to lower
intraocular pressure
3. Acetazolamide (Carbonic anhydrase
inhibitor) to reduce fluid formation
Eye Drops:
Cholinergics
contrict pupil
. pilocarpnie and carbachol
SE: periorbital pain, blurry vision, bad night vision
Meds
Beta Blockers
.betaxolol / timolol
. decrease aqueous humor production
SE: bradychardia, pulmonary dx worse, hypotension
Contraindicated: pt w asthma, COPD, 2/3rd degree heart block, bradycardia, heat failure
Carbonic Anhydrase Inhibitors
lower aqueous humor prod
Actetazolamide, methazolamide
SE: anaphalactic reaction, electrolyte loss, depression, lethargy, gatsro upset, imptence, weidht loss
DO NOT GIVE pt =w Sulfa allergies, MONITOR electrolytes
Meds topical
Dorzolamide
topical allergy
Timolol
beta adrenergic blocking agent
Opthammic Meds
Myotic: constricts the pupil Mydriatics: dilate the pupil Analgesics Steroids Lubricants Anti-inflammatory
Retinal Detachment
not painful
seperation of retina from choroid because of hole in retina that allow liquid to lead between choroid and retina.
SS: painless, bridht flashes of light, floaters, blurry, partial visual field blidness
Tx: Sx reattachment. it not leads to blindness
Eye Sx Post Op care
.keep client in lowest position, side rails up. .assist w initial ambulation .admin cough meds and antiemetic .avoid staring, sneezing, cough, vomit .wear eye shield when sleeping .SS infections? .sterile technique eye care .admin abx eye drops.
Posterior Vitreous Detachment
.liquefaction and shrinkage of vitreous body
.May lead to retinal tears and detachment
.light lashes, cobwebs, floaters
Conjunctivitis
‘pink eye’
. inflammation of conjunctiva
Cause: viral/bac/allergies/chem exposure, contacts
. HIGHLY CONTAGIOUS
.SS: red eyes, thick discharge, sticky eyelids in am, eye pain, blurry, gritty, itchy, photophobia, tearing
Tx: Abx, corticosteroids
Enucliations
.removal of entire eye
Presbyopia
elasticity of lens slowly lost w age
.diff to see up close
Hyperopia
farsightedness; vision beyond
20 feet is normal, near vision is poor;
treatment is corrective lenses
Myopia
nearsightedness; near vision is
normal, distance is poor; treatment is
corrective lenses
Strabismus
inability of the eyes to focus in
the same direction
Photophobia
eye discomfort in bright
light; usually symptom of another eye
disorder; treat underlying disorder
Extracapsular Extraction
anterior portion of lens capsule and capsule contents are removed. leaves posterior lens capsule intact
Phacoemulsification
uses smaller incision with one
or two stitches
Intracapsular extraction
removal of entire lens and
its surrounding capsule using a freezing probe
(RARE)
Hyphema
.hemorrhage into anterior chamber of eye
Retinoblastoma
.malignant tumor in retina in children
.rare, 3% cancrs
.can spread to optic nuerve and invade brain, lymph, bond, facial bone
WW: whiteish/yello pupil (leukocoria, cat’s eye, instead of normal red reflex), visual acuity disturbances, inflammation, pain, hyphema
PERRLA
P-pupils E-equal in size R-round symmetrically R-reactive L-reacts with constriction to light A-pupils accommodate equally
Snellen Chart
visual acuity chart. (letters)
Air puff tonometer:
does not touch the eye, records
deflections of the cornea from the puff of
pressurized air
Schotz impression and tonometers
record the
pressure needed to indent or flatten the corneal
surface. Elevated pressure reveals glaucoma.
Deafness
.Moderate-severe loss 56-70dB range
.Severe loss 70-90dB range
.Profoundly deaf have greater than 91dB
Rinne Test
Compares air- and bone-conduction hearing;
tuning fork of 512 Hz is placed against the base
of your mastoid bone until sound no long heard
and then moves the tuning fork near the auditory
canal until sound is no longer heard
Rinne Test
Normal: air-conduction time is twice as long as boneconduction
◦ Sensorineural hearing loss: air-conduction is heard
longer than bone-conduction, but not twice as long
◦ Conductive hearing loss: the bone-conduction sound is
longer than or equal to the air-conduction sound
Weber Test
Method of assessing auditory acuity; the stem
of a vibrating 512 Hz tuning fork is placed on
the cent
Weber Test
Normal: loudness of sound is equal in both ears
◦ Sensorineural hearing loss: the unaffected ear
perceives the sound as louder
◦ Conductive hearing loss: sound is louder in the
affected ear
Myringotomy
Sx making incision in tympanic membrane thru which fluid may be suctioned.
Romberg Test
Indicatos loss of sense of position (proprioception)
Falls
second leading cause of accidental death in elderly
Culture and Diversity
set 5
Acculturation
process of adopting cultural traits of another group as result of prolonged contact w them
Ethnocentrism
belief in superiority of one’s own ethnic group
Cultural Blindness
not able to empathize with other cultures in specific situations
Cultural Competence
the nurse’s ability to
interact effectively with people of different
cultures and backgrounds;
Madeleine Leininger
saw importance of Transcultural Nursing
Spirituality
anything to do with one’s personal relationship with a higher life source.
Spiritual Health
universal spiritual needs for
purpose and meaning, love and belonging, and
forgiveness are met
Spiritual Distress
alteration in spiritual health
displayed by anxiety, guilt, loss, despair, anger,
spiritual pain or alienation
Role of RN
.Provider of Care
.Mgr of Care
.Teacher
.Client Advocate
Cultural Care Repartterning
i.e. Navajo have risk of heart disease – eat
fried bread (staple of diet); change – hang bread to
drain fat or place on paper towels
Community-Based Nursing Care
Section 6
Community
cluster of people with at least
one common characteristic such as location,
occupation, ethnicity, housing condition,
shared interests
William Rathbone
established modern concept of visiting nurses
Lillian Ward/Mary Brewster
established Visiting Nurses in NYC
Henry Street Settlement
1910 Nursing
90% care provided in home
1917, 1918
WWI sick began to go to the hospital
1950s
increase need for hospital care due to increased complexity in healthcare
1960-70s
pt stay 7-10 days in hospital for uncomplicated conditions and sx
1980s
health care costs UP = change in helath care delivery system and financing
1980s
nursing care back to the home
Ntl League of Nursing 1999 Trends (10)
- change in demographics and UP diversity
- tech explosion
- globalization of world economy and society
- Era of educated consumer, alt tx, palliative care
- shift to populations based care and UP complexity of pt care
- cost of health care
- Impact of health policy and reg
- growing need for intrdisciplinary educ for collab practice
- Current nursing shortage/opportunities for
lifelong learning and workforce
development - Significant advances in nursing science and
research
Acute Care
.ppl receiving intensive hospital care
.ambulatory clinic or day sx unit
. for very sick w life-threatening conditions
Healthy People 2020
Mission:
.Identify nationwide health improvement priorities.
Increase public awareness and understanding of
the determinants of health, disease, and disability
and the opportunities for progress.
Provide measurable objectives and goals that are
applicable at the national, state, and local levels.
Engage multiple sectors to take actions to
strengthen policies and improve practices that are
driven by the best available evidence and
knowledge.
Identify critical research, evaluation, and data
collection needs.
Health Protection
.envt regulatory measures .food/drug safety .Envt Health .Occ Safety/Health .Seat belt /car seat restraints .no smoking laws .pollution control
Secondary Prevention
.early detection
.screening
.
Tertiary Prevention
.rehab
Medicare
federally funded health insurance
for those over 65 or disabled
Medicaid
joint federal and state program
that provides assistance to lower income
Epidemiologic Triad
.Host
.Agent
.Environment
Dever’s Epidemiologic Model
.Human biological factors
◦ Environmental factors
◦ Lifestyle factors
◦ Health care system factors
Endemic
constant presence in certain geo location
Epidemic
rate of disease in excell than usual
Pandemic
worldwide
Mortality
risk of death
Morbidity
prevalence and incident rates
DTP
(diphtheria, tetanus, pertussis): 2, 4, 6 and 18
months
IPV
(trivalent inactivated poliovirus vaccine): 2, 4, 6, 18
months, and 4-6 years old; immunocompromised children
MMR
(measles, mumps, rubella): 12-15 months, booster
at school entry; don’t give to pregnant women
HiB
(haemophilus influenzae type B): 2, 4, 6 months,
booster at 15 months
HBV
(Hepatitis B vaccine): birth, 1 month, 6 months,
health care workers, prostitutes; injection drug users
Varicella
one dose at 12-18 months or one dose
from 19 months to 12 years or 2 doses, 4-8 weeks apart
for persons 13 years and older
Influenza vaccine
annually; children 6
months and older; 2 separate doses, 2 weeks
apart in first time recipients younger than 8
years old
Pneumococcal vaccine (PVC)
2-23 months
given at 2, 4 and 6 months with a 4th dose at
12 months; 24-59 months for those who
attend day care
Pneumonia vaccine
persons over 65 and
those with debilitating illness
Lead Poisoning SS
Burning in the mouth and esophagus Colic Constipation Diarrhea Mental disturbances Paralysis of extremities Convulsions Extreme irritability, anorexia and anemia: CHRONIC encephalopathy
Lead Poisoning: TX
Gastric lavage with magnesium or sodium
sulfate
Fluid therapy
Chelation
IM injections of calcium disodium edentate or
British antilewisite
Pew Commission
21 competencies that are required of healthcare
professionals in the 21st century
