x Nursing 104 Flashcards
Health
condition of physical, mental and social well being, not merely absence of disease.
-constant change and adaptation, NOT STATIC
Disease
dysfunction of body characterized by clinical SS’s.
Diagnosis implies…
course, duration, communicability, prognosis and treatment
Illness
when person feels unhealthy/ill, may or may not be related to disease.
-Only person can say they feel ill
Acute Illness
- rapid onset
- short duration
- usually reversible
- can be life threatening
Chronic Illness
- gradual
- long duration
- usually irreversible
- may have remission/exacerbations
Wellness
active state of being health
-physical/mental/emotional
Wellness per Anspaugh
- physical
- social
- emotional
- intellectual
- spiritual
- occupational
- environmental
Etiology
causation of disease
Etiology of Disease Stages
Stage 1: experience symptoms
2: assume sick role
3: assume dependent role
4: recovery/rehab
Travis Illness/Wellness Continuum
premature death Hi level wellness
Dunn on Wellness
Dunn (1980)
functioning to ones max potential while maintain balance and purposeful direction in envt.
-Good health is passive state when person is not ill (differentiated wellness from good health)
-encourage nurses to care for total person.
Dunn Hi Lev Wellness: WELLNESS
a continuous interaction btwn health and envt.
Dunn Hi Lev Wellness: HEALTH
peak wellness versus death
Dunn Hi Lev Wellness: ENVIRONMENT
very favorable vs very UNfavorable
Dunn Hi Lev Wellness: ENCOMPASSES
family, community, envt, societal issues that affect indiv health/wellness status
Dunn: 4 Levels of Wellness
- Hi Level Wellness in FAVorable envt
- Emergent Hi level wellness in UNfavorable envt
- Protected poor health in FAVorable health envt
- Poor health in UNfavorable envt
Rosenstock’s and Becker’s Health Belief Models
Assumed good health is goal of all people which could predict an individuals willingess to take advantage of preventive measures to maintain hi level of wellness
- Becker modified this to include: *Perceived susceptibility
- perceived seriousness
- perceived threat
Leavell and Clark’s Model (1965)
Agent - Host - Envt
good for examining causes of disease in individual
- Agent must be present of absent of illness to occur
- Host is living organism capable of being infected
- ALL interact with each other
- predicts illness rather than promote wellness
Pender, Murdaugh, Parsons (2006)
Health Promotion Model
-how people interact w environ as they pursue health
Levels of Prevention
- Primary: action to prevent occurrence of health probs (vaccine, annual phys)
- Secondary: early id and tx of specific health probs, early dx, prompt tx
- Tertiary: return client to highest level of fx possible, rehab
Defense Mechanisms
SEE
- N104 bk, pg 117-118
- levels of anxiety, pg 118
- health maintenance, Unit 4, study guide
Stress and Adaptation: Stimulus based model
Circumstances in life that produce physiological or psychological reactions that influence indiv response to illness
General Adaptation Syndrome (GAS)
Hans Selye
- biochemical model of stress
- physiological response to stress that results from physical and emotional stressors
- seen in severely injury or illness
- GAS is factor in mental illness, social isolation and loss of human relationship
GAS Stages
- Alarm: fight or flight
- Stage of resistance (physiological an psychological adaptation takes place)
- Stage of Exhaustion: body can’t maintain homeostasis
Local Adaptation Syndrome (LAS)
- localized response
- involve specific body part (tissue/organ)
- homeostatic short term adaptive response
- reflex pain/inflammatory response
LAS (Local Adaptation Syndrome) Responses
REFLEX:
- response of CNS to pain
- rapid/automatic
- protective mechanism to prevent injury
- require intact neurologic reflex arc (sensory and motor neurons)
INFLAMMATION
*local response to injury/infection
*localize and prevent spread, promote wound healing
*symptoms: pain, swelling, redness, heat, loss of functoin
Rubor, tumor, calor, dolor, loss fx
Pysical Illness associated w Stress
AUTOIMMUNE: *graves (hyper thyroid) *myasthenia gravis *psoriasis *ulcerative colitis *rheumatoid arthritis CARDIOVASCULAR *HTN *coronary artery disease RESPIRATORY *ashtma GASTRO *esophageal reflux *constipation *diarrhea *ulcerative colitis
Transaction Based Model of Stress
COGNITIVE affective coping response arise from person/envt transaction PHYSIOLOGICAL STRESSORS *chemicals (drugs, poison, etoh) PHYSICAL *heat, cold, radiation, trauma, elec shock) INFECTIOUS AGENTS *Virus, bacteria, fungi) IMMUNE GENETIC NUTRITIONAL HYPOXIA
Increased Stress S&S
- dilated pupils
- diaphoresis
- UP heart rate, cardiac output
- pallid skin
- UP BP
- UP Respiration
- Urinary Output decrease
- Mouth becomes dry
- Peristalsis decreases
- UP mental alertness
- UP motor activity
- UP Blood sugar
F to C
deduct 32, x 5, / by 9
C to F
x 9, / 5, +32
WATCH
VIDS, 44/68
5 types of Percussion sounds
- Flatness (dull sound, very dense, (muscular or bone))
- Dullness
- Resonance
- Resonance
- Hyperresonance
- Tympany
Forms of Communications
-Verbal
-Nonverbal
-
Denotative Meaning
literal definition of work
Connotative Meaning
Implied
Nonverbal Comm
- body language
- facial expression
- posture
- gait
- eye contact (know culture)
- touch (not on angry patient)
Verbal Comm
- vocabulary
- denotative/connotatie
- pacing
- intonation
- clarity/brevity
- timing/relevance
- humor (never AT the patient or their disease process)
- credibility
Therapeutic Comm
client centered
- establish therap relationship
- use of empathy, respect, genuineness, concrete (nurse maintain power and confidence), confrontation (say what you mean)
Phases of Therapeutic Relationship
-PRE-INTERACTION
-orientation (when meet, establish trust, mutual introductions, exchange info ie. chief complaint)
-working relationship(nurse comm caring, pts express thoughts)
Termination: conclusion of relationship. Review plan of care, summarize (end of shift, discharge, end of appt etc)
Communication Techniques
- Active Listening (open posture, eye contact)
- Establishing Trust (acknoledge, address by name, reply honestly, consistent)
- Being Assertive ( confident, controlling conversation)
- Restating Message
- Clarifying Messages
- Validating messages (am I making a correct interpretation)
- Interpreting body language and sharing observatoins
- Exploring issues
- ask OPEN ENDED questions
- Using Silence (remain attentive, demonstrates acceptance)
- Summarizing Convo
Therapeutic Comm Barriers
-asking too many questions (feel interrogated, suggest insensitivity)
-Fire-hosing Info: presenting lots of info
-Asking why? (criticism, try “what concerns do you have, tell me more about ….”)
-Changing subject inappropriately (try to redirect tangents smoothly)
-Failing to probe
-Express approval or disaproval
-Offering advice
-False Reassurance ( may feel dismissed, don’t say everything will be ok, we can’t promise that. do not mislead, instead say you are in good hands etc)
Stereotyping (don’t, can distort your assessment)
-Patronizing language (imply superiority)
Types of Stressors
- external (death, heat, hurricane)
- Internal (disease, anxiety, neg self talk)
- Developmental (predictable, various stages)
- Situational (auto accid, illness, natural disaster)
- Physiological: affect body structure of fx (chem, physical, mechanical, nutritional, biological, genetic, lifestyle)
- Pshchosocial
Response to stressors
GAS: General Adaptation Syndrome
- Alarm stage
- Resistance stage (adaptation)
- Exhaustion of Recovery
Alam Stage
- Shock phase: brain to endocrine and sympathetic system
2. Countershock phase: person deals with threat.
Resistance (Adaptaions)
Coping
Exhaustion Stage
class 6, pg 23
Local adaptation syndrome
class 6, pg 24
Levels of Anxiety
- MILD- heightened perception, optimal fxing
- MODERATE-perceptual field narrows, focus on self, need to relieve discomfort, shorter atten span, rapid speach, up HR, UP perspiration, gastric discomfort
- SEVERE - narrow focus. totally on themselves. concenration severly limited, prevents problmen solving, confusion : SS, ha, palpit, d/n/v, urinay freq, diar
- PANIC: terror, impending doom, dilated pupils, labored breathing, palpitation, diaphoresis
Sress Mgmt
discharging tension -exercise -Relations (progressive/passive) -Meditation -Visualization/Imagery -Biofeedback -Acupuncture etc
Progressive relaxation
-contract muscle then intentionally relax, can be done head to toe
Passive relaxation
-relaxing muscles without first contracting them
Types of Learning
- Cognitive
- Psycho motor (mental and physical activity. Include sensory awareness of cues. i.e. performing finger stick, admin injection
- Affective: changes in feeling, beliefs, attitudes, values. integrating new ideas in value system. i.e. chronic illness
Antidote for Aspirin
Dialysis
Antidote for Acetaminophen
N-Acetylcystine
Antidote for Digitalis
Lidocaine
CO
O2
Narcotic
Narcan
Cyanide
Sodium Nitrate
Iron
Deferoxamine
Ethylene Glycol
Ethanol
Sounds levels above ? is painful and cause hearing los
120 decibels
Disaster Level 1
local emergency response
Disaster Level 2
Regional efforts
Disaster Level 3
Local and regional AND statewide and federal aid
Malfeasance
Right Med, Wrong Route - cause death
5 rights
Right:
- Patient
- Medication
- Dose
- Route
- Time
5 rights
Right:
- Patient
- Medication
- Dose
- Route
- Time
Percutaneous
topical, effected through skin
Percutaneous
topical, effected through skin
USP NF
United States Pharmacopeia (USP) and the National Formulary (NF)
