HEALTH PROM AND MAINTENANCE Before Birth Early and regular antepartal (before-birth) care is critical.

. First trimester health directly influences the development of organs in embryo and fetus. To identify risks, nurses need both subjective (client's) and objective (the nurse's own) assessment data. Prescribed medications, over-the-counter drugs, alcohol and tobacco may lead to problems for the fetus and woman. Pregnancy diet must include increased calcium, protein, iron and folic acid. If the client's situation warrants, suggest ways to adapt activity, employment, and travel. It is helpful if the woman can have the same support person throughout pregnancy and birthing classes. Labor Maintain safety and asepsis (sterilize instruments; wear gown, gloves, mask) through the labor and birth process to reduce risks to mother and fetus/newborn. Ideally, same caregivers stay through all stages of labor. Recognize urgent signs and act promptly. Constantly assess and analyze problems to prioritize actions. Reinforce the childbirth preparation techniques practiced by the couple during pregnancy. Effective teaching during labor must be flexible. Mother will have shorter attention span, increasing discomfort, and emotional responses to labor. Promote privacy of the woman and support person as much as possible. Respect the cultural and religious beliefs of the woman and partner. Involve the family in the birth process as noted in their birth plan or special requests. Provide for the woman's needs and comfort. Communicate caring and concern to the woman and her family through therapeutic techniques. Document assessments, changes in condition and care as promptly as possible. Postpartum Teach (by demonstration and praise) self assessment and care. Start soon after birth. The newborn is first of all a family member. Share your assessments and plans with parents; welcome their input. Respect culture and religious beliefs of the family. Praise the parent's skills. Media and pamphlets are useful teaching aids if the parent has a chance to discuss them. Visits and Teachings Mothers are discharged quickly, so you must teach accordingly. Home visits and follow-up telephone calls let the nurse and parents discuss adaptations, questions and concerns. Postpartum teaching should include women's health promotion. The adolescent mother benefits from developmentally appropriate teaching and referral to community resources, including parenting classes. Growth and Development Normally proceed in a regular fashion from simple to complex and in cephalocaudal and proximodistal patterns. Are orderly, directional, predictable, interdependent and complex processes. Are unique to individuals and their genetic potential. Occur through conflict and adaptation. Growth and development are impacted by genetics, environment, health status, nutrition, culture, and family structures and practices. Growth should be measured and evaluated at regular intervals throughout childhood. Deviations from normal growth and development should be thoroughly investigated and treated as quickly as possible. In the care of children, key concepts are anticipatory guidance and prevention of disease. Major developmental tasks of infancy are: increase in mobility, separation, and establishment of trusting relationships. In both toddlerhood and adolescence, hallmarks are development of independence and further separation. Children and adolescents grow rapidly, so nurses must stress optimum nutrition and give anticipatory guidance related to nutrition. In children over one year of age, the leading cause of death is injuries.

GERONTOLOGY AND GERIATRICS

Elder Adults Elder adults must adjust to lessening physical and cognitive abilities. Over 85% have some type of chronic disease. When elder adults experience cognitive changes, check for possible substance abuse or polypharmacy. Cognitive impairment can be acute and reversible, or it can be chronic and irreversible. Up to 60% of older adults have some impairment in performance of activities of daily living. Some physiologic changes are a normal part of the aging process and do not signal disease. Elder adults need more time to complete tasks. Age is a weak predictor of survival in traumatic injury and critical illness. Health Risks in Elder Adults Major health problems typically include cardiovascular, cerebrovascular, and respiratory diseases; diabetes; and cancer. The elder adult will change social roles, and these changes may affect psychological health, leading to depression. Elder adults need the same nutrition as other adults, but more bulk and fiber, calcium, and vitamins C and A. Contraindications for estrogen replacement therapy include hypertension thrombophlebitis cardiac dysfunction family history of breast or uterine cancer Elder adults clear drugs from kidney and liver more slowly; so medications have longer half-lives, and they can bring on side effects and toxicity at lower doses. Health Promotion: Health Assessment Measure vital signs when the client is at rest Compare both sides of the body for symmetry Assess the systems related to the clients major complaint first Offer rest periods if client becomes tired Culture and religious beliefs may play a role in observed differences Warm hands and equipment such as stethoscope before touching client Tell client what you are going to do before touching client Normal variations exist among clients and there is a range of normalcy for all physical findings Maintain the clients privacy throughout the examination Control for environmental factors which may distort findings Check equipment prior to exam for functioning Consider growth and developmental needs when assessing specific age groups Integrate client teaching throughout the exam Vasculature Compare blood pressure in arms left versus right Compare blood pressure with client lying, sitting and standing Lungs - Airway Anemic patients may never become cyanotic Polycythemic patients may be cyanotic, even when oxygenation is normal Cough results from stimulation of irritant receptors, with implications of either acute or chronic etiology. Cyanosis indicates decreased available oxygen. Etiology can be either peripheral or central in origin. Wheezes indicates narrowing/inflammatory process of lower airways Stridor harsh sound produced near larynx by vibration of structures in upper airway. Classic "barky cough" Crackles or rales adventitious sounds, usually on inspiration and indicating inflammation Breast Breast tissue shrinks with menopause Teach client breast self examination Abdomen - Reproductive System Auscultation should be performed before palpation to prevent distortion of bowel sounds Tightening of abdominal muscles hinders accuracy of palpation and auscultation Warm hands before touching clients abdomen. Men breathe abdominally; women breathe costally. Auscultate all four quadrants for bowel sounds Auscultate abdomen between meals Musculoskeletal Older adults walk with smaller steps and need a wider base of support Neurological Glasgow Coma Score

 not valid in patients who have used alcohol or other mind-altering drugs possibly not valid in patients who are hypoglycemic, in shock, or hypothermic (below 34C) should be compared to total of 10 when client is intubated Reflexes are normally less brisk or even absent in older clients Reflex response diminishes in the lower extremities before the upper extremities are affected Absent reflexes may indicate neuropathy or lower motor neuron disorder Hyperactive reflexes suggest an upper motor neuron disorder Teaching client and family Teaching-learning process mirrors the nursing process Select teaching strategies that are compatible with the clients learning style, age, culture, level of education Client teaching should be multi-sensory Always confirm the clients understanding of the information presented Teaching must be geared to the level of the learner Repeat key information and summarize main points at intervals Explain medical terminology in lay terms Determine the clients learning style and gear teaching methods to using that style Sequence information the way the client will use it Be concrete and use the simplest words and the shortest sentences when teaching low literacy clients, or any client under stress

ADULT/ELDERLY HPN , DM, HEARING AND VISION PROSTATE ANNUALLY@40 Ca CHECK-UPS-Q3Y-20YO ; QY 40 YO SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS FECAL OCCULT BLOOD TEST- > 50 = ANNUALLY DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY PELVIC EXAM 18-40 Y.O. =PERFORMED Q 1 3 YEARS WITH PAP TEST MAMMOGRAM 35-39 = BASELINE 40-49 = Q2Y 50 AND OLDER = QYEAR

END OF LIFE/HOSPICE CARE

Nursing care involves the support of general well-being of our patients, the provision of episodic acute care and rehabilitation, and when a return to health is not possible, a peaceful death. Dying is a profound transition for the individual. As healthcare providers, we become skilled in nursing and medical science, but the care of the dying person encompasses much more. Certain aspects of this care are taking on more importance for patients, families, and healthcare providers. These include pain and other symptom management; psychological, spiritual, and grief/bereavement support. Recent studies have identified barriers to end-of-life care including patient or family members avoidance of death, influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided. The best opportunity for quality care occurs when patients facing death, and their family, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.

CARE SETTING
Much of the care of the dying is still provided by nurses in hospitals, primarily in oncology and critical care areas. However, other care settings are becoming more common, e.g., the home, assisted living/extended care setting, or hospice inpatient unit.

RELATED CONCERNS
Cancer Extended care Psychosocial aspects of care Care Plan(s) reflecting underlying pathology of terminal condition

Patient Assessment Database

Data depend on underlying terminal condition and involvement of other body systems.

EGO INTEGRITY
May report: Stress related to recent changes in ability to care for self and decision to accept hospice services Feelings of helplessness/hopelessness, sorrow, anger; choked feelings Fear of the dying process, loss of physical and/or mental abilities Concern about impact of death on SO/family Inner conflict about beliefs, meaning of life/death Financial concerns; lack of preparation (e.g., will, power of attorney, funeral) Deep sadness, crying, anxiety, apathy Altered communication patterns; social isolation; withdrawal

May exhibit:

SOCIAL INTERACTION
May report: May exhibit: Apprehension about caregivers ability to provide care Changes in family roles/usual patterns of responsibility Difficulty adapting to changes imposed by condition/dying process

NURSING PRIORITIES
1. 2. 3. 4. Control pain. Prevent/manage complications. Maintain quality of life as possible. Plans in place to meet patients/familys last wishes (e.g., care setting, Advance Directives, will, funeral).