Professional Documents
Culture Documents
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Chapter 2
1. Community-based nursing: nursing care of indivudiuals and
families that is designed to promote and maintain health and
prevent disease. It is provided as patients transition through the
health care system to health-related services outside of the
hospital setting
2. Community hub: centralized networks with infrastructure focused
on coordinating health care and social services to reduce health
risks in a given community
3. Primary prevention: health care delivery focused on health
promotion and prevention of illness or disease
4. Secondary prevention: health care delivery focused on health
maintenance and aimed at early detection of disease, with
prompt intervention to prevent or minimize loss of function and
independence
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Substance abuse: a maladaptive pattern of drug use that
causes physical and emotional harm with the potential for
disruption of daily life
I.
Considerations for Conducting a Health Assessment
a. Role of Nurses
i. Health History
ii. Physical Examination
b. Effective communication
i. Establish rapport
ii. Take into consideration patient education and culture
iii. Avoid technical terms
c. Ethical use of data
i. Explain purpose of health history and physical exam
ii. HIPAA
d. Role of technology
i. EMR: standardization of medical terms
II.
Health History
a. Focus on impact of psychosocial, ethnic, and cultural
background on a persons health, illness, and health
promotion
b. Current health problems
c. Past medical history
d. Family history
e. Review of the persons functional status
f. Informant: may not always be the patient
g. Components of Health History
i. Baseline info
ii. Biographical data: name, birthday
iii. Chief complaint: why ya here?
iv. Present health concerns or illness: physical exam
important, correct selection of appropriate diagnostic
test
v. Past Health History: immunizations, allergies, last
physical exam, previous illness
vi. Family history: genetic, communicable, or
environmental in origin
vii. Review of system: overview of general health,
symptoms related to each body system: negative
and positive answers recorded
h. Patient Profile
i. Past Life events related to health
1. Brief life history
ii. Education and occupation
1. Job tells you education level and occupation
status
iii. Financial resources
III.
1. Insurance?
2. Are you poor?
3. Nah Im a rich nigga
iv. Environment
1. Where do you live? Is it safe?
2. Spirituality, faith, spiritual environment
3. Culture
4. Family structure: normal or odd
v. Lifestyleee
1. Do you drinkduh drugsnah
2. Alcohol abuse? Substance abuse?
3. Be a nonjudgmental betch
4. CAM therapies
5. Health promotions and screenings
vi. Disabilities
1. Need to address any limitations
2. Family members might be more helpful
vii. Self-concept
1. How do you feel about your life?
viii. Sexuality
1. Do you have sex?
2. Are you gay or straight? Or confused?
3. Nonjudgmental
ix. Risk for abuse
1. Physical, sexual, and psychological
2. Withhold meds?
x. Stress and coping resources
Physical Assessment: objective data
a. Complete exam not necessary every time
b. Health history guides the physical exam
c. Components of the Physical Exam
i. General observations: young, old, sick, healthy
ii. Posture
iii. Body movements: generalized disruption of voluntary
or involuntary movement/ asymmetry of movement
iv. Nutritional Status: obesity?
v. Speech pattern: slurred?
vi. Vital signs: bp, pulse, HR, RR, temp, pain
d. Focused assessment
i. All relevant body systems are tested
ii. Inspection
1. Observation of each relevant body system
iii. Palpation
1. Tactile fremitus and thrills
iv. Percussion
1. Physical force sound
II.
Fundamental concepts
a. Constancy and homeostasis
i. Claude Bernard: there must be a constancy or fixity
of the internal milieu despite changes in the
external environment
ii. When changes occur processes are initiated to
restore regular function
iii. Dysfunctional responses can lead to disease = threat
to steady state
b. Stress and Adaptation
i. Change that evokes stress= stressor
ii. Desired goal= adaptation
iii. Desired goals of adaptation: survival, growth, and
reproduction
Overview of stress
a. Types of stressors
i. Physical: cold, heat, and chemical agents
ii. Physiologic: pain, fatigue
iii. Psychological: fear
iv. Stressors: greater health impact than major life
events
1. Cause high BP, palpitations
b. Stress as a stimulus for disease
i. People under constant stress have a high incidence
of psychosomatic disease
c. Psychological responses to stress
i. Mediating process: after recognizing a stressor
person consciously or unconsciously reacts to
manage the situation
ii. Cognitive appraisal: process by which an event is
evaluated with respect to what is at stake (primary
appraisal) and what can be done (secondary
appraisal)
iii. Primary appraisal: nonstressful or stressful
iv. Secondary appraisal: what might and can be done
v. Reappraisal: change of opinion based on information
given
vi. Negative emotions accompany harm/loss appraisals
vii. Positive emotions accompany challenges
d. Coping with the stressful event
i. Emotion-focused coping: lessening the emotional
distress
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Chapter 7
1. Culture: the knowledge, belief, art, morals, laws, customs, and any
other capabilities and habits acquired by humans as members of
society
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Chapter 9
1. Chronic disease: medical or health problems with associated
symptoms or disabilities that require long0term management; has
also been referred to as noncommunicable disease, chronic
condition or chronic disorder
Overview of Chronicity
a. Some degree of disability is usually present in severe or
advanced chronic illness
b. Acute: curable, short disease
c. Chronic: long disease course, may be incurable
d. Psychological, emotional, and cognitive reactions to
chronic conditions are likely to occur at their onset
e. Definition of chronic diseases or conditions
i. Medical conditions or health problems with
associated symptoms or disabilities that require longterm management
ii. Irreversible, prolonged course, unlikely to resolve
spontaneously
f. As incidence of chronic diseases increasesthe cost
associated with theses chronic diseases also increase
g. Most diseases and complications of chronic illness are
preventable: Health promotion
h. Characteristics of chronic conditions
i. Managing chronic illness involves more than treating
medical problem
ii. Usually involve many different phases over the
course of a persons lifetime
iii. Keeping chronic conditions under control requires
persistent adherence to therapeutic regimens
iv. One chronic disease can lead to the development of
other chronic conditions
v. Affect the whole family
vi. Day-to-day management of illness is largely the
responsibility of people with the disorder and family
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Chapter 11
1. Activities of daily living (ADLs): basic personal care activates;
basic, dressing, grooming, eating, toileting, and transferring
2. Advance directives: a formal, legally endorsed document that
provides instructions for care (living will)
3. Ageism: a bias that discriminates, stigmatizes, and disadvantages
older people based solely on their chronologic age
4. Comorbidity: having more than one illness at the same time
5. Delirium: an acute, confused state that beings with disorientation
and if not recognized and treated early can progress to changes
in level of consciousness, irreversible brain damage, and
sometimes death
6. Dementia: broad term for a syndrome characterized by a general
decline in higher brain functioning, such as reasoning, with a
pattern of eventual decline in ability to perform even basic ADLs
7. Depression: the most common affective mood disorder of old age;
results from changes in reuptake of the neurochemical serotonin
in response to chronic illness and emotional stresses related to
the physical and social changes associated with the aging process
8. Durable power of attorney: a formal, legally endorsed document
that identifies a proxy decision maker who can make decisions if
the signer becomes incapacitated
9. Elder abuse: the physical, emotional, or financial harm to an older
person by one or more of the individuals children, caregivers, or
others; includes neglect
10. Geriatric syndromes: common conditions found in older adults
that tent to be multifactorial and do not fall under discrete
disease categories, such as falls, delirium, frailty, dizziness, and
urinary incontinence
11. Geriatrics: a field of practice that focuses on the physiology,
pathology, diagnosis, and management of the disorders and
disease of older adults
12. Gerontolgic/geriatric nursing: the field of nursing that relates to
the assessment, planning, implementation, and evaluation of
older adults in all environments, including acute, intermediate,
and skilled care as well as within the community
II.
Overview of Aging
a. Americans 65+ has tripled in the past 100 years
b. Life expectancies depends on: gender, race
i. White women!
c. Health status of the older adult
i. Most have at least one chronic illness
d. Nursing care of the older adult
i. Gerontology, geriatrics, geriatric nursing
ii. Acute care, skilled and assisted living, the
community, and home setting
iii. Aging is not synonymous with disease
iv. Functional assessment is a common framework for
assessing older people
e. Theories of aging
i. Functional Consequence Theory (Miller): challenges
nurses to consider the effects of normal age-related
changes as well as the damage incurred through
disease or environmental and behavioral risk factors
Age-related changes
a. Well-being of older people: physical, psychosocial, mental,
social, economic, and environmental factors
b. Physical aspects of aging
i. Intrinsic aging: changes caused by the normal aging
process that are genetically programmed and
essentially universal
ii. Extrinsic aging: influences outside the person
III.
2. Vision: presbyopia
a. Macular degeneration doesnt affect
peripheral vision
3. Hearing: presbycusis
4. Taste and smell
a. Sweet tastes are particularly dulled
c. Psychosocial aspects of aging
i. Ability to adapt to physical, social, and emotional
losses
ii. Ageism
iii. Stress and coping in the older adult
1. Impair physical function, activities, and
appearance
iv. Living arrangements
1. Living at home or with family
2. Continuing Care Retirement Communities
a. Independent single-dwelling
b. Assisted living- limited assistance
c. Skilled nursing service
3. Assisted living facilities
a. Minimal supervision or assistance
4. Long-term care facilities: offer continuous
nursing care
d. The role of the family
i. Planning for care and understanding the psychosocial
issues confronting older people
ii. Effective programs: 1. Psychoeducational skill
building 2. Cognitive behavioral therapy 3.
Combination of at least two approaches education,
family meetings, and skill building
e. Cognitive aspects of aging
i. Fluid intelligence- declines
ii. Crystallized intelligence- remains intact
f. Pharmacologic aspects of aging
i. Drug interactions and adverse effects
1. Polypharmacy
ii. Altered Pharmacokinetics
1. Alterations in absorption, metabolism,
distribution, and excretion
iii. Nursing implications
1. Start with a low dose, go slowly, keeping the
medication regimen simple
Mental health problems in the older adult
a. Depression: most common, sometimes confused for
dementia
b. Substance abuse: can be related to depression
IV.
c. Delirium
i. Stupor (hypoalert-hypoactive)
ii. Excessive activity (hyperalert-hyeractive): higher
mortality rate
d. Dementia
i. Alzheimers disease: gradual losses of cognitive
function
1. Patho: neuronal damage occurs in the cerebral
cortex, decreased brain size
2. Clinical manifestations: forgetfulness,
personality change, difficulty with everyday
activities
3. Assessment and Diagnostic Findings: autopsy
a. Diagnosis of exclusion
4. Medical management: manage the cognitive
and behavioral symptomsCHOLINESTERASE
INHIBITORS
5. Nursing management: assess signs, promoting
patients safety
a. Supporting cognitive function: active
participation, physical activity and
communication
b. Promoting physical safety: remove all
obvious hazards
c. Promoting independence in self-care
activities: keeping activities simple
d. Reducing anxiety and agitation
e. Improving communication
f. Providing for socialization and intimacy
needs
g. Adequate nutrition
h. Promoting balanced activity and rest
i. Supporting home and community basedcare
ii. Vascular dementia: cerebrovascular disease
1. Multi-infarct dementia
Geriatric syndromes
a. Geriatric triad: cognitive status, falls, incontinence
b. Impaired mobility
c. Dizziness
d. Falls
e. Urinary incontinence
f. Increased susceptibility to infection
g. Atypical responses: not the same as peds or adults
h. Altered emotional impact
i. Altered systemic response: homeostasis is jeopardized
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