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Excelsior Chronicity

Havighurst Developmental Task: Infancy and Early Childhood 0-5yrs eat solids, learn to walk, talk, relate emotionally to parents/siblings, control elimination, distinguish right & wrong, and sex differences
Havighurst Developmental Task: Middle Childhood 6-12yrs learn physical skills needed for games, to get along with age-mates, read, write, math, develop conscience, morals, value, personal independence
Havighurst Developmental Task: Adolescence 13-18yrs Accept body and use effectively, gender roles, emotional independence, prepare for career, marriage and family life, achieve socially responsible behavior, acquire ethical system as guide to behavior
Havighurst Developmental Task: Young Adult 19-29yrs Selecting mate, learn to live with mate, start family and rearing children, manage home, start occupation, take on civic responsibility, find social group
Havighurst Developmental Task: Middle Adult 30-60yrs accept physical changes, maintain occupation, assist children to become responsible adults, relate to spouse as person, adjust to aging parents, achieve social and civic responsibility
Havighurst Developmental Task: Later Maturity 61+yrs adjust to decreasing physical strength, health, retirement and reduced income, death of spouse, affiliate with age group, adjust socially, establish adequate living arrangements
Developmental Stage: Infancy Birth-1year rapid growth, head especially brain grows faster than other tissues, eyes focus, gross motorskills develop: feed self, crawl, use blocks
Developmental Stage: Toddler 1-3yrs slow growth, top-heavy trunk grows fastest (lumbar lordosis, protruding belly), uses fingers to pick up small objects, uses cup & spoon, bladder control day, turns pages of book
Developmental Stage: Pre-School Age 3-6yrs growth is slow and steady, erect posture, birth height doubled birth height by age 4, throw/catch ball, copying figures
Developmental Stage: School Age 6-12yrs Slow growth, long bones grow fastest, c/o growing pains, hold pencil, print, sex organs grow but are dormant, permanent teeth
Developmental Stage: Adolescence 12-19yrs rapid growth for trunk, including gonads and start puberty, primary changes (ovaries, breasts, uterus, testes, penis) secondary changes (pubic and facial hair, voice change, fat deposits)
Cognitive Development Theorist Piaget
Cognitive Development incorporates... new ideas, skills, and knowledge into patterns of thought and action, adapts to new problems by drawing on past experiences. 4 stages
Piaget Cognitive Stage 1 Sensorimotor (birth to age 2)
Sensorimotor Stage (birth to age 2) infant: pre-linguistic, syllable repetition (mamamama), babbling, imitation of sound, basic reflexes toddler: object perminance, follow simple commands, begins to reason and anticipate events, identify self and body parts, short sentences
Piaget Cognitive Stage 2 preoperational stage (age 2 to 7)
Preoperational Stage (age 2 to 7) Preschool age: egocentricity (child can't comprehend point of view different than own) time of magical thinking, can use symbols and language
Piaget Cognitive Stage 3 concrete operational stage (age 7 to 11)
Concrete Operational Stage (age 7 to 11) develops logical thinking, less self centered, sees other's perspective, uses deductive reasoning, tests beliefs and values
Piaget Cognitive Stage 4 formal operational thought stage (age 12 to 15)
Formal Operational Thought Stage (age 12 to 15) deductive, reflexive, hypothetical reasoning, long term goals can be set as concept of time, it's passage and the future become real, challenging authorities, imaginary audience and daydreaming
Psychosocial Development Theorist Erikson
Psychosocial Development personality changes occurring throughout a lifecycle. Passage from one stage to next depends on completion of previous stage. 5 stages
Erikson Psychosocial Stage 1 trust vs mistrust (birth to age 1)
Trust vs Mistrust (birth to age 1) child develops trust as primary caregiver meets needs. Feeding, diapering
Erikson Psychosocial Stage 2 autonomy vs shame and doubt (age 1 to 3)
Autonomy vs Shame and Doubt (age 1 to 3) independence:walk,eat,dress..says NO to try to have some control over environment VS non-independence-fearfull
Erikson Psychosocial Stage 3 initiative vs guilt (age 3 to 5)
Initiative vs Guilt (age 3 to 5) curiosity vs conscience, Reprimands/restrictions for seeking new experiences/learning will=guilt and hesitance in attempting more challenging experiences..highly imaginative
Erikson Psychosocial Stage 4 industry vs inferiority (age 6 to 12)
Industry vs Inferiority (age 6 to 12) focus on learning useful skills resulting in positive self esteem, emphasis on doing, succeeding, accomplishing
Erikson Psychosocial Stage 5 identity vs role confusion (age 12-19)
Identity vs Role Confusion (age 12-19) sexual maturity and develop sense of self,(who am I)answered, influenced by peers
Erikson Psychosocial Stage 6 intimacy vs isolation (age 20-39)
Intimacy vs Isolation (age 20-39) develop intimate relationships, career and civic responsibility or become isolated
Erikson Psychosocial Stage 7 generativity vs stagnation (age 40-55)
Generativity vs Stagnantion (age 56-64 establish guide for next generation, adjust to needs of aging parents, re-eval goals, if not achieved, becomes absorbed with own physical and emotional needs
Erikson Psychosocial Stage 8 ego inegrity vs despair (age 65 till death)
Ego Integrity vs Despair (age 65 till death) developes self-worth, acceptance of own life and death. reminiscence about life and fulfillment vs failure and regret
Psychosexual Development Theorist Sigmund Freud
Freud Psychosexual Stage 1 oral stage (birth to 1yr)
Oral Stage (birth to 1yr) strive for immediate gradification of needs, oral cavity primary source of gratification and exploration: nusing, sucking, putting things in mouth
Freud Psychosexual Stage 2 anal stage (age 1-3yrs)
Anal Stage (age 1-3yrs) increased muscule tone and sphincter control - toilet training
Freud Psychosexual Stage 3 phallic stage (age 3-7yrs)
Phallic Stage (age 3-7yrs) increased interest in sex differences, intimate possessiveness of opposite sex parent, curiosity about genitals and pleasure
Freud Psychosexual Stage 4 latency stage (age 7-12yrs)
Latency Stage (age 7-12yrs) increased sex-role identification, same sex parent prepares child for adult role relationships
Freud Psychosexual Stage 5 genital stage (age 12-20yrs)
Genital Stage (age 12-20yrs) sexual interests expressed in sexual relationships and experience conflicts and pressures
Adulthood Psychosocial Development Theorist Roger Gould
Gould Adult Psychosocial stage 1 ages 18-22 individuals struggle with leaving their parent's world and challenging false assumptions from their childhood and replacing with new ex: only parents can keep safe -to-rewards come automatically if we do what supposed to
Gould Adult Psychosocial Stage 2 ages 22-28 established as adults and separate from families but believe must demonstrate competence as adult to parents. want to enjoy present and build for future
Gould Adult Psychosocial Stage 3 ages 29-34 self acceptance increases, marriage and careers are well established, young parents accept own children without imposing rules
Gould Psychosocial Stage 4 ages 35-43 continually look inward and question themselves, values and life. see time as having an end and believe they have little time left to shape future of children
Gould Psychosocial Stage 5 ages 43-50 believes personalities are set, interested in active social life, church, community service, friends and spouse. life viewed as complex, causing periods of passivity, rage, depression
Gould Psychosocial Stage 6 ages 50-60 previous reflection and contemplation result in increased self-aproval and acceptance, increased marital happiness associated with seeing spouse as valued companion
Moral Development Theorist Lawrence Kohlberg
Kohlberg Preconventional Moral Stage Oriented to obedience and punishment stage 1: motivation for choice=fear of punishment/disapproval result of consequences develop sense of good/bad stage 2: thought of receiving reward overcome fear of punishment actions support desire for reward
Kohlberg Conventional Moral Stage identifying with significant others and conforming to their expectation stage 3: good/bad, person strives for approval in attempt to be viewed as "good" stage 4: law-and order, behavior follow social/religious rules from a respect for authority
Kohlberg Postconventional Moral Stage involves rational/internalized moral judgment of one's standards stage 5: correct behavior is defined in terms of society's laws stage 6: universal ethical principles, representing concern for all, guided by personal values regardless of society/laws
Female Moral Development Theorist Carol Gilligan
Gilligan Female Moral Development Level 1 selfishness: focus is on one's own needs. morality seen in terms of sanctions by society, relationships often disappointing and women may isolate to avoid getting hurt
Gilligan Female Moral Development Level 2 goodness: moral judgment based on shared norms/expectations, acceptance by others is critical, ability to care for others defines female's goodness
Gilligan Female Moral Development Level 3 nonviolence: changed understanding of self and morality allow reconciliation of selfishness and responsibility, nonviolence governs moral judgments and actions, care becomes obligation toward self and others
Spiritual Development Theorist James Fowler
Fowler Spiritual Stage 1 intuitive-projective faith (age 3-7yrs)
Intuitive-Projective Faith (age 3-7yrs) age 3-7yrs imitate religious gestures and behaviors of parents, does not understand religious concepts
Fowler Spiritual Stage 2 mythical-litral faith (age 7-12yrs)
Mythical-Literal Faith (age 7-12yrs) stories represent religious/moral beliefs, accepts existence of diety. possibility of life after death is accepted even if not understood
Fowler Spiritual Stage 3 synthetic-conventional faith (age 12-18yrs)
Synthetic-Conventional Faith (age 12-18yrs) has an emerging ideology, begins to question life-guiding values or religious practices in attempt to stabilize own identity
Fowler Spiritual stage 4 individuative-reflective faith (age 19-30yrs)
Individuative-Reflective Faith (age 19-30yrs) Become responsible for their own commitments, beliefs, and attitudes and less by the faith compositions of significant others, often abandon traditional religious practices
Fowler Spiritual Stage 5 conjunctive faith (age 40-65yrs)
Conjunctive Faith (age 40-65yrs) integrates other viewpoints about faith into one's understanding of truth, less rigid in beliefs
Fowler Spiritual Stage 6 universalizing faith (age 65yrs +)
Universalizing Faith (age 65yrs +) making tangible the values of absolute love and justice for humankind. actively being in relation to others we invest belief, love, anf hope for future regardless of religion or faith
Infant Health Problems failure to thrive, colic, gastroenteritis, SIDS, accidental injuries (choke, falls, strangulation), skin disorders (diaper rash, eczema, thrush)
Toddler Health Problems accidents (MVA, poisonings, burns, drowning, choking, falls), dental problems, respiratory/ear infections.....autism dx by age 3
Preschool Health Problems continued toddler issues, communicable disease from day care, accidents, dental cavities, speech disorders noticed
School Age Health Problems communicable diseases (scabies, impetigo, head lice) dental caries, accidents, ADD, LD, enuresis (bed wetting), chronic conditions (sickle cell, seizures, HTN, DM, obesity, scoliosis (girls 10-13yrs)
Adolescent Health Problems MVA, homicide/suicide, cardio disease, depression, dental problems (caries, gingivitis, misaligned), neglect, abuse (physical/substance), pregnancy, nutrition
Young Adult Health Problems accident, suicide, HTN, STDs, drugs, violence, malignancies
Middle Adult Health Problems MVA, occupational accidents, suicide, chronic disease: cardio/pulm diseases, CA, RA, DM, obesity, ETOH, depression, alcoholism, mental illness
Older Adult Health Problems accidents, hypothermia, chronic illness, drug/alcohol abuse, dementia, elder abuse
Factors Influencing Growth/Development: Genetic Factors temperament: easy temperament more likely to corporate when parent tries to encourage to walk
Factors Influencing Growth/Development: Sex cessation of sex in older adults from lack of partner vs lack of desire, males can father children late in life vs no children after menopause
Factors Influencing Growth/Development: Age pre/school age need more cognitive guidance to function, risk for falls greater in younger and older people
Factors Influencing Growth/Development: Individual Preferences of family style, older lives alone,cohabitate, communal. family units, homo, hetero, blended family
Factors Influencing Growth/Development: Physical Condition sleep-wake/physical activity patterns change with age, sensory perception changes, metabolism, bowel changes
Factors Influencing Growth/Development: Cultural/Spiritual illness viewed as punishment, strong spirituality may cope better
Factors Influencing Growth/Development: Socioeconomic Factors lower income may be obese, can't afford good nutrition
Factors Influencing Growth/Development: Environmental Factors older homes:risk for lead poisoning, exposure to sun: skin cancer, air quality
Factors Influencing Growth/Development: Psychological Factors suicide, alcohol/substance abuse, sex patterns young adults, depression, cognitive changes
Factors Influencing Growth/Development: Nutrition lack of fiber and water for older adults leads to problems, proper nutrition needed for healing
National Health Intiative for Health Promotion/Protection and Disease Prevention Healthy People 2010
Healthy People 2010: Leading Health Indicators physical activity, overweight/obese, tobacco, substance use, responsibile sex behaviors, mental health, injury/violence, environ quality, immunizations, access to health care
Interventions Healthy People 2010: Physical Activity promote increased physical activity to 30min a day 3-5days a week
Interventions Healthy People 2010: Overweight/Obese review basic nutrition with parents and families to improve nutrition, achieve BMI >25%
Interventions Healthy People 2010: Tobacco Use smoking cessation education
Interventions Healthy People 2010: Substance Abuse health assessment and education
Interventions Healthy People 2010: Responsible Sexual Behaviors discuss risks and benefits of sexual activity with teens, education begins in primary school
Interventions Healthy People 2010: Mental Health assessment/treatment for depression
Interventions Healthy People 2010: Injury/Violence assess for domestic violence, provide resources for help/safety
Interventions Healthy People 2010: Environmental Quality provide non-smoking area, support political initiatives for better air quality
Interventions Healthy People 2010: Immunizations assess and encourage recommended immunizations
Interventions Healthy People 2010: Access to Health Care improve continuum of care, provide increased vision/hearing screen for 5 and under
Steps to the Nursing Process assessment, analysis(diagnosis), planning,implimentation, evaluation
Nursing Process: Assessment gather and organize data in relation to patient's health status
Assessment Data to Collect health history, factors influencing pt's health, screens/scores, review diagnostic data
Assessment Data: Health History ADL, sleep/wake patterns, dietary patterns, smoking, alcohol, substance use, abuse, immunizations
Assessment Data: Factors Influencing Health risk behaviors, health promotion, physical activity level, sexual behaviors, family and support, hygiene habits
Assessment Data: Obtain Objective Data (screening and scores) FIM score, Barthel Index score, JAREL spiritual well-being ass, sex ass, nutritional ass, Denver DevelopmentalScreening Test...etc
Assessment Data: Review Diagnostic Data labs, imaging, vitals, screenings (CA)
Nursing Process: Analysis collaborate w/patient and health care team to determine patient's actual/potential health problem (nursing diagnosis)
Analysis Step 1: Identifying Nursing Diagnosis PROBLEM LIST! risk for falls related to degenerative joint disease
Analysis Step 2: Set Priorities based on Maslow's hierarchy of needs
Maslow's Hierarchy of Needs Physiological needs, safety, social needs, esteem, self-actualization
Maslow's Physiological Needs air, water, food, shelter, sleep, sex
Maslow's Safety Needs security of body, employment, resources, morality, the famliy, health, property
Maslow's Social Needs friendship, family, sexual intimacy
Maslow's Esteem Needs self-confidence, achievement, respect of others and by others
Maslow's Self-actualization morality, creativity in problem solving, acceptance of self and others, respect for all
Nursing Process: Planning collaborate with patient and health care team to specify 1. expected goal to reduce/resolve problem (pt will not fall) and nursing interventions to achieve it (will use call light)
Nursing Process: Implementing carry out plan of care, assist patient to achieve goal
Nursing Process: Evaluation reassess patient to determine response to interventions including progress toward goal
Pain an unpleasant sensory and emotional experience associated with actual or potential tissue damage.....what ever the patient says it is!
Characteristics of Pain onset, location, duration, intensity
Characteristics of Pain: Onset when pain starts, what brought it on
Characteristics of Pain: Location location of pain, which may or may not be actual source of pain (referred pain)
Characteristics of Pain: Duration low long it lasts
Characteristics of Pain: Intensity patient's use of verbal descriptors for the pain
Types of Pain: Acute rapid onset: warns individual of tissue damage, short duration: disappears once underlying cause is resolved, intensity: sharp, stabbing, shooting, location: anywhere in body
Types of Pain: Chronic lasts beyond the normal healing period, onset: slow, duration: can be daily nonmalignant (arthritis), daily malignant (cancer), or intermittent (migraines), intensity: dull achy (interferes with ADLs)
Types of Pain: Procedural short term pain experienced during a medical procedure
Types of Pain: Postoperative pain experienced from surgical procedure
Types of Pain: Intractable pain that persists despite variety of interventions
Types of Pain: Referred pain that is perceived in an area it is not originating from (pain from heart attack usually described as pain in neck, shoulder or left arm)
Types of Pain: Neuropathic nerve pain "neuralgia" caused by damage or injury to nerve fibers in the periphery or damage to CNS, sharp spasm like pain
Sources of Pain cutaneous: superficial-skin and subQ layers-localized somatic: tissues of body wall, and support-nonlocalized visceral: organs and their capsules-poorly localized
Nociceptor (or Pain Receptor) are free nerve ending found throughout the body, activated by stimuli that cause tissue damage
Nociception the process of transmitting a pain signal from site of injury to the brain
Nociception Activation Mediated 2 Ways chemically or mechanically
Chemical Activation of Nociceptors Initiated By cell wall destruction, inflammation, infection, nerve injury, extravasation of plasma from circulatory system
Mechanical Activation of Nociceptors Initiated By noxious stretch or pressure due to distention of viscera, facia, or periosteum, occlusion of GI/GU structures, obstruction of ducts
4 Stages of Nociception (Pain Process) transduction, transmission, perception, modulation
Transduction activation of pain receptors, conversion of painful stimuli to electrical impulses
Transmission electrical impulses are conducted along pathways to spinal cord and then higher centers
Perception persons interpretation of the pain (dependent upon person's pain threshold)
Modulation the process where the pain sensation is inhibited or modified by neuromodulators
A-Delta Fibers fast-conducting, transmit acute, well-localized pain, sharp....initiates the fast withdrawing reflex (touch hot stove)
C Fibers smaller slow-conducting, transmit slow, poorly localized pain, dull, throbbing.....the result of the injury (after touching the stove)
Chemicals That Mediate Nociception Are Called neurotransmitters-they either excite of inhibit target nerve cells
Examples Of Neurotransmitters Are: bradykinin, prostaglandins, substance P, histamine, serotonin, leukotrienes, nerve growth factor (NGF)
Bradykinin powerful vasodilator, released when cell wall destroyed, allows NA+ to flow across membrane and triggers release of histamine
Prostaglandins result from cell wall destruction, they sensitize receptors, making more responsive to other stimuli
Substance P released into peripheral tissue, need to transmit from periphery to higher brain centers
Histamine released from mast cells when inflammation is a component of the event
Serotonin released by platelets and mast cells, so if there is bleeding to the area, serotonin is released and causes neurons to fire =ing pain
Leukotrienes contribute to pain by attracting neutrophils to area of injury
Nerve Growth Factor (NGF) released when neurons are injured, causes them to sprout new axons and dendrites in greater numbers than existed before
Substances That Modify Or Inhibit Pain Sensation neuromodulators
Neuromodulators endogenous opioids (naturally present, morphine-like) chemical regulators in spinal cord and brain, have analgesic activity and alter perception of pain
Example of Neuromodulators endorphins, enkephalins
Endorphins produced at neural synapses at various points in CNS pathway, may be released when skin stimulation (massage) and relaxation are used, produces euphoria
Enkephalins widespread throughout the brain and dorsal horn of spinal cord, less potent, reduce pain by inhibiting release of substance P
Gate Control Theory theory that the transmission of pain and the amount that one can tolerate are related and regulated by opening and closing of a gateway.
Gate Control Theory Process small nerve fibers carry pain through dorsal horn in spine to brain, when too much information sent, substancia gelatinosa cells in dorsal horn close gate, prohibiting transmission, opening large fiber gate to open and carry non-pain impulses to brain
Pain Threshold the lowest amount of pain stimuli needed to register pain
The 3 Types of Responses to Pain physiologic, behavioral, affective
Physiologic Response to Pain moderate:^BP, HR, resp, muscle tension, sweating, anxiety, ^blood glucose Severe:N/V, fainting, decreased BP,P, rapid irregular breathing
Behavioral Response to Pain move from painful stimuli, grimace, moaning, crying, restless, guarding pained area, refusing to move, holding breath
Affective (Psychosocial) Response to Pain withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness
Factors Affecting Pain Response sex, age, culture, physical condition, socioeconomic, religious, environmental, psychological, past experience
Factors Affecting Pain Response: Sex ok for little girls to run home crying with skinned knee, but little boys are to tough it out, adult men are more stoic and do not vocalize pain
Factors Affecting Pain Response: Age need to be able to recognize non verbal cues in both infants and older adults that cannot cognitively express pain, use age appropriate scales and interventions. older people don't want to bother!
Factors Affecting Pain Response: Individual Preference past experiences with pain/relief, current pain management practices, alternative therapy practices
Factors Affecting Pain Response: Physical Condition activity level prior to pain, over all health, additional medical conditions, ability to rehab,
Factors Affecting Pain Response: Culture/Spiritual different cultures express pain in different ways, families in different cultures care for sick in differnt ways, ceremonies, rituals, prayer
Factors Affecting Pain Response: Socioeconomic/Support medication costs, lack of transportation, non-compliance, no ins, no family,
Factors Affecting Pain Response: Environmental presence of stairs, weather changes, time of day, temp, assistive devices
Factors Affecting Pain Response: Psychological chronic pain leads to isolation, depression, anxiety, fear of addiction
Myths About Pain pain is part of aging, no complaining means pain free, patients will become addicted, should wait until can't take pain, will be judged
Principles Related to Managing Pain better to stay ahead of than chase, use pharmacological and non-pharmacological treatments, use alternative therapies, treat before physically active, treat around clock vs PRN
Assessment of Pain obtain pain history: current pain, past pain, what methods relieve pain, what medications relieve pain, what influences the pain, physically assess
Analysis of Pain identify nursing dx: pain related to, risks of, set priorities: needs based on maslow's
Planning for Pain establish expected outcomes related to health promotion, maintenance, restoration, using nursing standards, plan interventions with rationale, assign appropriate task to staff
Implementation for Pain use nursing measure to reduce pain, heat/cold, position, confort, back rub, medication, alternative therapies, follow WHO pain ladder, technology (PCA, TENS), environment (noise,lighting,temp), educate, d/c planning
Evaluation of Pain reassess, document patient response to nursing interventions, revise plan of care based on outcome, re-implimenet if needed
Physical Comfort Needs free from pain, nausea, pruritis, position
Psychospiritual Comfort Needs feeling a sense of esteem
Social Comfort Needs relating to others
Environmental Comfort Needs sense of ease and rest in surroundings
Comfort Measures: Direct application of heat/cold, massage, meditation, relaxation
Confort Measures: Indirect maintaining quiet environment, supporting family members, discussion of fears, listening
Comfort Measures Through Caring Communication attentive listening, the helping relationship, barriers to communication (noise, distraction, stereotyping)
Factors Influencing Comfort age, sex, preference, environment (noise, sleep patterns), culture (eye contact, rituals), emotional (depressed, angry, bitter, anxiety), alternative therapies
Assessment: Comfort daily routines
Analysis: Comfort identify nursing diagnosis: impaired comfort, related to, set priorities based on maslow's
Planning: Comfort establish expected outcomes related to health promotion, maintenance, restoration using nursing standards and rationale
Implementing: Comfort use nursing measures to promote comfort: hygiene, alt therapies, position, medication, modify environment, promote safety, educate
Evaluation: Comfort reassess patient to determine response to interventions, document, revise and re-implement if needed
Disease refers to a condition that practitioners view from a pathophysiological model, such as an alteration in structure and function
Illness is the human experience of symptoms and suffering, and refers to how the disease is perceived, lived with and responded to by the individual and their family
Acute Illness typically a sudden onset, with sign and symptoms related to the disease process itself, resolves shortly with complete recovery
Chronic Illness continues indefinitely, no single onset pattern, can appear suddenly, have episodic flare-ups or exacerbations, or remain in remission without symptoms for long periods of time
Chronicity the irreversible presence, accumulation, or latency of disease states or impairments that involve the total human environment for supportive care and self-care, maintenance of function and prevention of further disability
Chronic Care Model Internal Components self-management support, decision support (clinical practice guidelines/education), delivery system redesign (planned visits, case management, primary care teams), clinical information systems (regestries, clinical feedback reminders)
Chronic Care Model External Components community resources, health care organizations
Chronic Illness Trajectory Phases (9) pretrajectory, trajectory, stable, unstable, acute, crisis, comeback, downward, dying
Pretrajectory Phase course of illness has not yet begun, but genetic factors or lifestyle behaviors put at risk for chronic condition (obese w/family hx cardiac disease and does not exercise)
Trajectory Phase signs and symptoms of disease appear and diagnostic work up may begin
Stable Phase illness symptoms under control, management of disease occurs at home
Unstable Phase period of inability to keep symptoms under control
Acute Phase brings severe or unrelieved symptoms or complications
Crisis Phase critical or life-threatening situation requiring emergency treatment
Comeback Phase gradual return to an acceptable way of life within limits imposed by disease or illness
Downward Phase progressive deterioration and an increase in disability or symptoms
Dying Phase rapid or gradual shutting down of body processes
Adjustment Pattern in Chronic Illness acceptance of illness, stigma, socialization, coping skills, resources, illness behavior (sick role)
Impaired or At Risk (Sick) Role a transition state, appropriate for conditions which prognosis is known/not grave. assumes 1. has impairment 2. expected to maintain normal behavior within limits of impairment (modify if necessary) 3. encouraged to make most of abilities
Disability Issues access to health care, discrimination, environmental barriers(wheel chair access), labels (person w/disability vs disabled person)
Common Problems Associated with Chronic Illness decreased self-care ability, deterioration and decline of health, quality of life, family/caregiver
Common Problems Associated with Chronic Illness: Decreased Self-Care Abilities physical limitations, hemiplegia, self-esteem, fatigue
Common Problems Associated with Chronic Illness: Deterioration and Decline of Health pt w/progressive oxygenation deficit, progressive neurological disorders
Common Problems Associated with Chronic Illness: Quality of life inability to enjoy life, sexual activity, financial inability to maintain self-care, decreased mobility, inability to feed self
Common Problems Associated with Chronic Illness: Family/Caregiver Dimensions lack of family or caregiver, family/caregiver fatigue, financial hardship on family or individual to pay for caregiver
Factors Influencing Patient Adjustment to Chronic Illness sex, age, individual preference, physical condition, role change, stigma, culture, socioeconomic, environmental, psychological, attitude of health care, alt therapy, politics
Factors Influencing Patient Adjustment to Chronic Illness: Sex caregiver expectations and gender roles
Factors Influencing Patient Adjustment to Chronic Illness: Age/Developmental Level child adapts to disability limitations whereas older adults sees as a loss of ability once had
Factors Influencing Patient Adjustment to Chronic Illness: Individual Preferences and Patterns family response pattern, relationship with health care providers, marriage and family planning
Factors Influencing Patient Adjustment to Chronic Illness: Physical Condition ability to adjust to fatigue, pain, decreased self-care ability, deconditioning
Factors Influencing Patient Adjustment to Chronic Illness: Role Changes conflict, strain, lack of role norms, insufficient ambiguity
Factors Influencing Patient Adjustment to Chronic Illness: Stigma and its Impact disregard:ignore negative stigma or limitations. isolation: grouping with own kind. secondary gains:using disability to get something out of it. resistance:speak out and challenge rules. passing:passing as normal. covering:hide their difference
Factors Influencing Patient Adjustment to Chronic Illness: Cultural/Spiritual/Religious interpretation of quality of life, expectation of family, response to illness, religious ritual healing as a pattern
Factors Influencing Patient Adjustment to Chronic Illness: Socioeconomical limited ability to perform job, loss of job, cost of supplies, health ins, family resources
Factors Influencing Patient Adjustment to Chronic Illness: Environmental wheelchair rams, transportation, occupational hazards, home setting and respite care
Factors Influencing Patient Adjustment to Chronic Illness: Psychological denial, anger, depression, regression, stigma, normalization, dissociation, overcompensation, learned helplessness
Factors Influencing Patient Adjustment to Chronic Illness: Alternative/Complimentary Therapies stress reduction, massage, biofeedback, herbal preps
Factors Influencing Patient Adjustment to Chronic Illness: Attitudes of Health Care devaluating, labeling, stereotyping, care vs cure
Factors Influencing Patient Adjustment to Chronic Illness: Policy and Politics federal initiatives, cost of chronic illness, health insurance, Medicare, supplemental security income
Assessment of Chronic Illness determine functional ability (cognitive/ADLs), determine risk for injury, determine position of illness trajectory, assess factors that affect adjustment of chronic illness, family situation
Analysis of Chronic Illness identify nursing diagnosis as relates to chronic illness: altered health maintenance R/T decreased mobility. set priorities according to maslow's
Planning for Chronic Illness establish outcomes for care related to health promotion, maintenance, restoration using nursing standards with rationales for interventions related to chronic illness
Implementation for Chronic Illness use therapeutic communication to educate/discuss, provide safety, promote resolution of exacerbation, provide assistive devices or needs
Evaluation of Chronic Illness reassess and document the outcome of the nursing interventions, revise and re-implement as needed
Loss occurs when a valued person, object or situation is changed or made inaccessible so that it's value is diminished or removed
Actual Loss can be recognized by others as well as person sustaining loss : loss of a limb, spouse, money, job
Perceived Loss felt by person but not recognized by others : loss of youth, of financial independence, of a valued environment (having to move in with children)
Psychological Loss caused by altered self-image and inability to return to occupation from actual loss (of limb)
Maturational Loss experienced as result of natural developmental process : first born experiencing a loss os status when second child born
Situational Loss experienced as a result of an unpredictable event : trauma, disease, death, national disaster
Anticipatory Loss when a person displays loss and grief behaviors for a loss that has not yet happened
Grief the emotional reaction to loss
Bereavement state of grieving during which a person goes through a grief reaction
Mourning the period of time during which the person learns to deal with the loss and develops acceptance
Normal Grief can be delayed, abbreviated or anticipatory, but are normal feelings, behaviors, reactions to loss: resentment, sorrow, anger, crying, loneliness, temp withdrawal from activities
Abbreviated Grief short duration but is genuine
Anticipatory Grief occurs before the actual loss
Dysfunctional Grief lasts more than 1 yr after the loss, abnormal or distorted, it may be either unresolved or inhibited
Unresolved Grief person may have trouble expressing feelings of loss or may deny them...a state of bereavement that extends over long time
Inhibited Grief person suppresses feelings of grief and may instead manifest somatic symptoms
Disenfranchised Grief grief that is not openly acknowledged, socially sanctioned or publicly shared.....grief over loss of pet
Medical Model of Grief proposed that grief is similar to a disease that exhibits symptoms. is it a physiologic stressor that contributes to the manifestation of physical and emotional symptoms that are normal and to be expected in bereavement
Signs and Symptoms of Normal Grieving verbalization of loss, crying, sleep disturbance, lack of appetite, difficulty concentrating
Signs and Symptoms of Dysfunctional Grieving extended time of denial, depression, severe physiological symptoms, thoughts of suicide
6 Stages of Grief Response shock/disbelief, developing awareness, restitution, resolving the loss, idealization, outcome
Stages of Grief Response: Shock and Disbelief refusal to accept fact of loss, followed by stunned/numb response
Stages of Grief Response: Developing Awareness physical and emotional response: anger, emptiness, crying
Stages of Grief Response: Restitution rituals surrounding loss: with death, religious, cultural, social expressions of mourning....funeral
Stages of Grief Response: Resolving the Loss dealing with void left by loss
Stages of Grief Response: Idealization exaggeration of good qualities that person/object had, followed by acceptance of loss and less need to focus on it
Stages of Grief Response: Outcome final resolution of grief process: dealing with loss as a common life occurrence
Factors Influencing Grief Response age, significance of loss, culture, spiritual, gender, socioeconomical, support systems, cause of loss
Factors Influencing Grief Response: Age children: to not understand death but may ask questions in attempt to understand, middle adult: prepares for loss of spouse, older adult: prepares for own death
Factors Influencing Grief Response: Family eldest child may feel need to be strong for rest of family, family of terminally ill child may feel guilt or question if somehow responsible
Factors Influencing Grief Response: Socioeconomic loss might have been sole financial provider, or health ins provider causing financial hardship
Factors Influencing Grief Response: Culture some cultures keep grief private shared only with family and other cultures whale openly in public
Factors Influencing Grief Response: Sex/Gender men are often stoic, do not cry in public whereas women may be viewed a cold if they do not cry in public
Factors Influencing Grief Response: Religious may play important role in expression of grief and provide comfort whereas others may blame God for their suffering and the death of a loved one and turn away from religion
Factors Influencing Grief Response: Cause of Loss death from disease can cause belief that death is a punishment (AIDS, drug users), fear/panic (plagues), guilt (when thought could have been prevented), accidental as bad luck, death while in military viewed as honorable
Death present when a person has sustained either 1. irreversible cessation of circulatory and respiratory functions or 2. irreversible cessation of all functions of entire brain
Developmental View of Death: Infant (Birth to 2yrs) sense of separation with no concept of death
Developmental View of Death: Early Childhood (2-5yrs) death perceived as temporary
Developmental View of Death: Later Childhood (6-12yrs) beginning awareness of reality of death
Developmental View of Death: Adolescence/Young Adult (13-25yrs) realization or mortality and eventual death death anxiety more prevalent, death perceived as future event
Developmental View of Death: Middle Age/Older Adult (26-65yrs) more awareness and acceptance of death
Death Trajectory death can be sudden, unexpected, a steady decline with a short terminal phase, a slow decline with periodic crises and then death
Physical/Physiological Problem of the Dying Patient Pian, dyspnea, nausea/vomiting, anorexia, constipation, mobility , hygiene, elimination, mental status change
Perideath Nursing 3 Phases: period right before death, actual death and care of the body after death
Signs of Imminent Death: Phase 1 skin: cool, mottled, sleep increased, intake/output decreased, congestion, breathing changes, disorientation, restless, withdrawal, vision changes, letting go, saying goodbye
Death: Phase 2 no heartbeat, release of bowels/bladder, non-responsive, eyes slight open, pupils fixed, dilated, jaw relaxed mouth slight open
After Death: Phase 3 post death care of patient and family, organ donation, autopsy
Organ Donation legally must notify transplantation organizations of possible donors
Autopsy examination of organs, tissues after death. consent required by patient or closest living family member unless death by accident, suicide, homicide, coroner can perform without consent
Palliative Care philosophy of "whole-person" caring of the terminally ill patient-mind, body, spirit, heart and soul
Hospice Care end-of-life care
Palliative Care Goals relieve suffering and improve quality of life for patients with chronic, serious and advanced disease and their families by aggressive management of symptoms
Palliative Care Principles respect goals of patient, look after medical, emotional, social, spiritual needs of patient, support needs of families, helps gain access appropriate providers, therapies and settings, provide excellent end-of-life care
Hospice Care Goals directed toward providing comfort until death rather than management of or reversing of disease process
Factors Promoting Growth of Hospice/Palliative Care the dying person's bill of rights and the right of any patient to refuse any and all medical treatments at anytime
Factors Promoting Barriers to Hospice/Palliative Care medicine's focus on cure and prolonging life, insurance reimbursement, public lack of knowledge of goals and qualifications for treatment
SUPPORT Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment
6 Components of a Good Death or Dying pain/symptom management, clear decision making, preparation for death, completion, contributing to others, affirmation of the whole person
Assessment of End of Life Care assessment those who are experiencing loss, grief and dying to determine the adequacy of the patient's/family's knowledge, perceptions and coping strategies, ways to provide support
Analysis of End of Life Care data collection of how a patient or family/caregivers are responding to loss, actual, anticipated or impending death, may lead to several nursing diagnoses
Planning for End of Life Care outcomes should be directed toward life closure, safe and comfortable death, effective grieving for grieving and dying patients and families....patient or family will.........
Implementing for End of Life Care in addition to promoting dignified, comfortable death, aimed at providing safety, support (emotional, spirit), education resources
Evaluation of End of Life Care plan is effective if patients die comfortably, family members resolve grief appropriately and resume life roles and activities
Sensory Dysfunction alterations or dysfunctions of the senses: vison, hearing, smell, taste, touch and balance
Vison how we see our surroundings and the world, alterations in vision affect every other sense
Function of the Eye to transform light energy to the cerebral cortex to be interpreted by brain
Structures of the Eye 3 layers, 2 chambers, orbit, eyelashes, eyelids
3 Layers of the Eye outer (protective): sclera and cornea middle (vascular): iris and ciliary body inner (neural): retina
2 Chambers of the Eye anterior and posterior
Outer Layer of Eye (Protective) sclera (covered by conjunctiva) and cornea
Middle Layer of Eye (Vascular) iris and ciliary body
Inner Layer of Eye (Neural) retina
Sclera "white of eye" helps maintain shape and protects intraocular contents from trauma, makes up posterior 5/6 of eye, connects to cornea
Cornea domed-shaped, bends/refracts light entering eye, problems w/shape can affect vision, behind lies anterior chamber
Uvea middle vascular layer of eye, housing iris, pupil, ciliary body, choroid
Iris colored part of eye, contains muscles that dilate or constrict pupil
Pupil window that dilates/constricts in response to light, normal are round and constrict symetrically
Ciliary Body produces aqueous humor (liquid that nourishes the cornea), maintains hydrostatic intraocular pressure IOP
Choroid thin, dark membrane containing blood vessles, lines internal surface of scera, prevents shattering of light
Retina neurosensory(3rd/inner/neural)layer, lines inside of eye, send signals to optic nerve, contains rods, cones and the macula
Rods found in retinal periphery, receptors for dim/night vision, distinguishes back from white
Cones found in macula of retina, receptors for bright/day light, distinguishes color and sharpness...damage could mean color blindness
Macula area of retina responsible for central vision
Segments of the Eye anterior/posterior
Anterior Segment of Eye space from posterior surface of cornea to lens, divided again into anterior chamber (between cornea and iris)and posterior chamber (between iris and lens), filled with aqueous humor
Posterior Segment of Eye space from posterior surface of lens to the retina, filled with gelatinous substance (vitreous humor) supports eye shape
Lens transparent, biconvex structure located behind iris and pupil attached to ciliary body by ligaments(zonules), refines refracted light to retnia, producing clear image
Function of Eyelashes trap foreign debris before it gets into eye
Function of Eyelids protect against foreign bodies and amount of light
Physiology of Vision light enters eye, cornea provides refractive change with the lens providing fine focus on to retina. can adjust to various distances by flattening and thickening of lens
Accomodation process by which the eye increases optical power to maintain clear image (focus) on an nearing object
Age-Related Changes in Vision presbyopia, changes in accomidation and color vision, age-related macular
Decrease in Lens Transparency lens density increases, opacity increases (cataract) effecting color vision problems and glare
Presbyopia loss of elasticity of the lens, inability to change focus (accommodate), see objects that are nearing
Blepharoptosis drooping eyelids-affects visual field
Senile Miosis small pupil-affects visual field and ability to adapt to dim light- impaired night vision
Ptosis drooping of one eyelid
Ectropion eversion of lower eyelid- cause tearing and irritation
Entropion turing in of eyelids-cause foreign body feeling from eyelashes rubbing against cornea
Dermatochalasis redundancy of upper or lower lid tissue from loss of elasticity
Astigmatism flattening of corneal surface refracting light at variing angles causing distorted and blurred vision
Exophalmos abnormal protusion of the eye. associated is graves disease
Enophthalmos when eyes sink into the orbit
Hyphema blood in eye
Hypopyon hazy or opaque aqueous, white cells probably present
Age-Related Macular Degeneration develops w/retinal degeneration, vessels develop in avascular area and leak and deposit waste- causes painless decrease of central vision, blurr, decrease ability to see color
Structural/Functional Alterations in Vision blindness, macular degeneration, cataracts, retinopathy, glaucoma, ocular injuries
Refractive Disorders disorders that include irregularities of the focusing ability of the lens, symptoms include blurred vision and headache
Types of Refractive Disorders myopia, hyperopia, astigmatism
Myopia nearsightedness, occurs when parallel rays of light focus in front of the retina when looking as distant objects
Hyperopia farsightedness, occurs when light rays focus in back of retina when looking at near object
Astigmatism caused by unequal curvature of cornea, light bent unevenly, does not focus on a single spot on retina
Presbyopia common problem caused by loss of elasticity in lens, inability to fine focus
Treatment of Refractive Disorders corrective lenses, surgery: photorefractive keratectomy (excimer laser reshapes surface of cornea)
Treatment of Age-Related Macular Degeneration no treatment for dry, small % with wet benefit from laser therapy to coagulate the abnormal vessels or PDT:photodynamic therapy (IV injection and laser render vessels inactive) *vision not restored w/either but additional loss reduced
Eye Infections/Inflammation can occur in any of the eye structures, caused by microorganisims, mechanical irritation, sensitivity to substances. INFLAMMATION most acute condition
Conjunctivitis: Infectious inflammation of the conjunctiva caused by bacteria: strep/staph, haemophilus influenza, chlamydia and gonorrhea. viral:herpes, EKC. *very contagious* PINK EYE
Conjunctivitis: Mechanical inflammation caused by eyelash rubbing against the conjunctiva, allergy to external irritant
Conjunctivitis: Symptoms and Treatment s/s: hyperemia (burning), injected (redend), mucoprulrnt exudate that crusts on eyelashes. viral: excessive tearing. tx: cleansing of eyelids/lashes, warm compresses (cold for viral EKC), ophthalmic antibiotics: bacitracin, cipro
Belpharitis inflammation of eyelids, caused by infection or dermatitis, begins in childhood, recurs, causes redness, scaling of upper/lower lids at lashes tx:shampoo to remove scales daily, antibiotics
Hordeolum "sty" staph infection of sebaceous glands of lid, creates pustules that resolve or rupture tx:warm compress, antibiotics or lancing if needed
Chalazion small, hard, cystic mass (granuloma), internal or external lid, puts pressure on eye, may affect vision tx: warm compress, antibiotics, surgical excision if needed
Corneal Abrasion superficial epithelial damage s/s: extreme pain, photophobia, tearing. if infected can lead to ulcer tx: minor heal on own, antibiotics and pain meds
Keratitis cornea inflammation, can be superficial/deep, acute/chronic, cause:infection, trauma, no tears s/s: pain, photophobia, blepharospasm. tx: steroid (if no infection), antibiotic/antiviral, cycloplegics:rest eye *left untreated could=vision loss/transplant
Trachoma chronic infectious for of conjunctivitis, cause chlamydia common in africa/asia, leading cause of blindness tx: hard to treat once chronic
Uveitis acute infla of uvea. cause: infection, allergy, toxins, systemic disorders. s/s:pain,photophobia, vision impairments tx:underlying cause, cycloplegics (rest eye), steroids
Eye Trauma and Injury accidents leading cause of visual impairments. types: burns (chemical, ultraviolet, thermal). trauma:lacerations (lids, ball, cornea), contusions can cause bleeding, conjunctival/corneal foreign bodies most common
Eye Trauma and Injury Protection orbital bone: protects from blunt trauma, tears: help flush away foreign substances/bodies. blink reflex: protects from most low impact forces
First Aid for Eye Injury: Burns flush eye X15 min with cool water or any nontoxic liquid-seek medical attention
First Aid for Eye Injury: Loose Foreign Bodies inspect upper/lower lid, irrigate, do not rub eye-seek medical attention if necessary
First Aid for Eye Injury: Contact Injury apply cold compress (if no laceration)(cover eye if laceration), seek medical attention
First Aid for Eye Injury: Penetrating Objects do not remove object, place protective shield over eye-seek medical attention
Glaucoma a group of eye diseases who features include increased IOP, causing damage to retina and optic nerve with loss of vision. a major cause of visual impairment and blindness world wide
Glaucoma Pathophysiology balance of production and drainage of aqueous humor keeps IOP constant. obstruction of any outflow channels=backup of fluid and increase IPO-sustained elevation gradually damages optic nerve and impairs vision
Glaucoma Types primary open-angle (chronic, simple),secondary open-angle primary angle-closure (narrow angle, acute),secondary angle closure congenital **primary when cause is unknown/secondary if results from other eye disorder**
Open-Angle Glaucoma 90% of all. CHRONIC slow progression of obstruction to trabecular meshwork and increased IOP, slow progressive loss of peripheral vision, tunnel vision, persistent dull brow pain, difficulty adjusting to darkness
Angle-Closure Glaucoma ACUTE outflow impaired from narrowing/closing angle, intermittent attacks (IOP norm when open), cause: ocular inflammation, neovascularization, trauma s/s: SEVERE PAIN, n/v, decreased vision, enlarged pupils, colored halos around lights, IOP >50mm Hg
Congenital Glaucoma abnormal development of filtration angle; can occur secondary to other systemic eye disorders
Glaucoma Diagnostic Tests tonometry, tonography, opthalmoscopy, perimetry, gonioscopy
Tonometry measurement of IOP
Tonography estimation of the resistance in the outflow channels by continuously recording the IOP over 2 to 4 min
Opthalmoscopy evaluation of color and configuration of the optic cup
Perimetry measurement of visual function in the central field of vision
Gonioscopy examination of the angle structures of the eye, where the iris, ciliary body, and cornea meet
Glaucoma Drug Treatment drug therapy is foundation of treatment. GOAL: decrease and keep IOP under damaging level, by increasing outflow of aqueous humor or decreasing production of it
Glaucoma Drug Types beta-adrenergic blockers and carbonic anhydrase inhibitors-decrease aqueous humor formation: Timoptic, Diamox prostaglandin agonist-increase outflow: Xalatan miotics-increase outflow
Miotics drugs that constrict pupil and contract ciliary muscles, which pull on trabecular meshwork, increasing outflow **not widely used anymore as pupil constriction affects night vision**
Glaucoma Surgery argon laser trabeculopasty (ALT)-laser burns some meshwork which changes structure and increases flow ability Treabulectomy-creates a fistula (opening) for flow Implants-tubes implanted to allow flow
Cataract clouding or opacity of the lens that leads to gradual painless blurring and eventual loss of vison
Types of Cataracts congenital- present at birth: mom's exposure to rubella 1st tri senile-associated with aging traumatic- associated with injury secondary- occurring after other eye or systemic disease-uveitis, diabetes
Cataract Diagnostic Tests direct inspection of lens through dilated pupil. testing before surgery: A-scan (us)-measures length of eye, keratometry-measures curvature of cornea, B-scan-detects health or retina, PAM test-measures functional retinal response
Cataract Surgery cataracts removed when interfere with ADLs, all or part of lens removed (different procedures), IOL implant needed with full lens removal **vision can be restored to 20/20**
Retinal Detachment occurs when outer pigmented layer and inner sensory layer of retina separate. primary cause: myopic degeneration, secondary: trauma, inflammation, vessel bleeding
Retinal Detachment Types rhegmatogenous, exudative, solid, traction
Rhegmatogenous Retinal Detachment
Exudative Retinal Detachment presence of inflammatory mass, blood clot separate retinal layers
Solid Retinal Detachment presence of tumor separates retinal layers
Traction Retinal Detachment seen when viterous bands (scars) form from diabetic retinopathy or after trauma and pull on retina
Retinal Detachment Diagnosis detachment may suddenly or slowly, s/s: showers of floating spots, flashes of light, progressive loss of vision. if detachment extends to macula, blindness results. **with rapid detachment, sensation a "curtain has been drawn before their eye", no pain**
Retinal Detachment Treatment holes or minor tears may be repaired by laser or cryopexy (cold) to produce inflammatory response to create adhesions (scars) between tears
Strabismus misalignment of eyes from imbalance if intraocular muscles
Esotropia one eye turns in (cross-eyed)
Exotropia one eye turns out (wall-eyed)
Hypertropia one eye turns up
Hypotropia one eye turns down
Amblyopia patching the good eye to strengthen the poor eye
Strabismus Treatment glasses with prisms to realign the eyes, patching the good eye to strengthen the bad, surgical correction of eye muscles: weakened (recession), tightened (resection), shifted (transposition). Botox used instead of surgery (strengthens antagonist muscle)
Corneal Transplant Care sutures stay in place for 12 to 18 mo. post op meds: mydratics (pupil dilators) for 2wks, topical steroids for 12 mo.
Eye Tumors may originate in eye or metastasize from other primary site. can be benign or malignant, detected by slit lamp and ophthalmoscopic examination, first detected symptom is vision change
Benign Eye Tumors benign neoplasms: lymphomas, hemangiomas and mucoceles from sinuses
Malignant Eye Tumors metastatic breast and lung tumors are the most common ocular lesion retinoblastoma is most common primary, congenital, intraocular tumor
Retinoblastoma diagnosed in childhood, one or both eyes 1/3 have bilateral is hereditable. parent usually notices "cat eye" reflex in child eye when dilated, strabismus may also be 1st indicator, excision preferred treatment
Photopobia sensitivity to light
Binocular Vision ability to maintain visual focus on an object with both eyes, creating one single image
Diplopia double vision
Photopsia bright flashes of light
Nystagmus repetitive rhythmic movements of one or both eyes
Retinopathy microaneurysms (hemorrhages) in retinal vessels. a complication of vascular disease from diabetes and uncontrolled HTN
Hemianopia when half of the visual field is missing- associated with stroke
Enucleation surgical removal of the eye
Mydriatic Drug causes pupil to dilate
Visual Acuity Tests Snellen chart 20/20 normal vision
Blindness inability to see. legal blindness: visual acuity with max correction 20/200 or less. and/or visual field reduction to range of 20 degrees (normal 180 degrees)
Hearing helps us interact with the environment, essential for the normal development of speech, provides warning of danger and adds aesthetic pleasure to our lives
Ear 2 major functions: hearing and balance
Binaural Hearing use of both ears simultaneously, allows person to detect direction of sound and maintain equilibrium
3 Main Parts of the Ear external ear, middle ear, inner ear
External Ear consists of the pinna or auricle and external auditory canal
Pinna or Auricle the skin covered cartilage attached to the head (the ear) which collects sound waves and channels it toward the tympanic membrane
External Auditory Canal in adults, extends in, forward, and down from concha (deepest part of pinna or the opening of the ear) to tympanic membrane, contains fine hairs and ceruminous glands
Cerumen "ear wax" sticky consistency, protective in nature, with the fine hairs, helps cleans and collects foreign matter, preventing entrance into ear
Tympanic Membrane "ear drum" membrane between outer and middle ear, protects middle ear and conducts sound vibration from external ear to ossicle
Middle Ear consists of an air filled cavity and it's contents: ossicles, oval and round window and the opening of the eustachian tube
Ossicles 3 smallest bones of body: malleus (hammer), incus (anvil), stapes (stirrup), joined together in movable chain, connects tympanic membrane to labyrinth. function:transfer air molecules of sound (ext) to fluid (int) and protect inner ear from loud sounds
Oval Window opening to inner ear, covered by footplate of stapes
Round Window a true window, provides exit for sound vibrations from inner ear
Eustachian Tubes channel that connects middle ear with nasopharynx, allows air to enter/leave middle ear, responsible for ventilation and pressure regulation, necessary for normal hearing
Inner Ear complex system of intercommunicating chambers and connecting tubes. 2 main structures: osseous and membranous labyrinth
Membraneous Labyrinth lies within osseous lab but does not completely fill inner ear. contains endolymph fluid and is continuously bathed in perilymph fluid
Osseous Labyrinth consists of: 3 semicircular canals, vestibule, cochlea
Vestibule connects semicircular canals to cochlea
Cochlea "snail" allows sound to enter/exit. has 2 compartments: upper (scala vestibuli) leads from oval window to apex of cochlea. lower (scala tympani) from apex of cochlea to round window
Organ of Corti the end organ for hearing. transforms mechanical sound vibrations into neural activity for transmission to the brain, also separates sound into frequencies
Three Semicircular Canals, Utricle, Saccule sense organs responsible for position and balance
Three Semicircular Canals arranged to sense rotational movement
Utricle and Saccule involved with linear movement
Sound Transmission tympanic mem conducts sound to ossicles, through, oval window, into perilymph, through vestibular mem, through cochlear duct, cause basilar movement, exit round window, organ of corti sends to brain
Age-Related Changes in Hearing loss linked to: diet, metabolism, exposure to loud music, presbycusis, arteriosclerosis, medications
Presbycusis most common hearing loss in older adults, decreased perception of high-frequency sounds (s,sh,ph,k). decrease perception of consonants can also occur (z,t,f,g)
Tinnitus sensation of buzzing or ringing in one or both ears, accompanies most sensorineural hearing loss so... is common in older adults
Presbyastasis or Presbyvertigo balance disorder of aging caused by general degenerative changes in labyrinth
Otalgia earache
Otorrhea drainage
Vertigo dizziness
Alterations in Hearing hearing impairment ranges from difficulty in understanding words or certain sounds to total deafness. Hearing loss is a symptom rather than a specific disease
Types of Hearing Loss conductive, sensorineural, neural, fluctuating, sensory, sudden, central, mixed, functional
Conductive Hearing Loss loss from mechanical problem in outer or middle ear that interferes with conduction of sound waves
Sensorineural Hearing Loss involving the cochlea and vestibulocochlear nerve
Neural Hearing Loss sensorineural hearing loss originating in nerve of brainstem
Fluctuating Hearing Loss sensorineural hearing loss that varies with time
Sensory Hearing Loss sensorineural, originating in cochlea and involving hair cells and nerve endings
Sudden Hearing Loss sensorineural, with sudden onset
Central Hearing Loss from damage to brain's auditory pathways or auditory center
Mixed Hearing Loss elements of both: conductive and sensorineural hearing loss
Functional Hearing Loss loss of hearing for which no organic lesion can be found
Deaf hearing loss of more than 80 dB (decibels) hearing loss of 15 to 50 dB :mild to moderate.."hearing impaired" Hearing loss of 50 to 80 dB :severe
Conductive Hearing Loss Pathophysiology interference w/conduction of sound through external auditory canal, tympanic mem, or ossicles of middle ear, caused by anything blocking the external ear: wax, infection, foreign body or retraction, scaring, perfing tympanic mem or ossicle damage
Sensorineural Hearing Loss Pathophysiology results from disease or trauma to inner ear, neural structures, or nerve pathways leading to brainstem, disease can be systemic or local
Systemic Disease Causing Sensorineural Hearing Loss diabetes, arteriosclerosis and infectious diseases: measles, mumps, meningitis
Local Disorders Causing Sensorineural Hearing Loss neuromas (of VIII cranial nerve), otospongiosis, trauma to head or ear, degeneration of organ of corti
Noise Induced Hearing Loss hearing loss that occurs overtime from long term exposure to loud noise
Acoustic Trauma hearing loss resulting from single exposure to sudden loud noise or blast
Central Auditory Dysfunction rare sensorineural loss (central deafness), hearing ability remain in tact but central nervous system is unable to interpret normal auditory stimuli- can result from tumors or stroke
Problems of External Ear external ear may be affected my masses, trauma, wax impaction, foreign bodies, pruritus (itching) and infection
External Ear Infection external otitis
External Otitis inflammation or infection of external auditory canal or pinna from bacteria, fungi or virus, common: swimmer's ear. if systemic disease present (DM) can spread to cartilage or bone "malignant external otitis"
External Otitis Symptoms and Treatment pain (otalgia) or tenderness when gently pulling on pinna pr putting pressure on tragus and itching in ear canal. Tx: depends on cause, local antibiotics and comfort measures
Problems of Middle Ear infection (most common) masses, traumas and perforated tympanic membrane
Middle Ear Infection otitis media
Otitis Media inflammation of the mucous membrane of middle ear, eustachian tubes and mastoid, the mucus mem are continuous with respiratory tract, so infection can ascend to ear
Types of Otitis Media acute: develops suddenly, short duration chronic: recurrent or untreated infection with drainage/perforation serous: collection of nonifectious fluid from allergen, obstruction of tube, resolving acute infection adhesive: from long-term blockage of tube
Otitis Media Symptoms and Treatment cond hearing loss from pressure behind drum, resolved post infection, s/s throb pain, fever, drainage, bulging drum tx: antibiotics/comfort
Myringotomy tiny incision in drum to suction fluid out, may have tubes placed to keep open, used for chronic tube obstruction, tubes fall out 3-12mo
Tympano-ossiculoplasty reapirs necrotic ossicles and creates new ear drum when medical means to treat infection fails and ossicles become necrotic
Cholesteatoma may result from chronic OM, collection of skin cells and cholesterol deposit in a sac of skin from external to middle ear via drum tear, may need to be excised if bothersome
Problems of Inner Ear sensorineural hearing loss most common disorder of inner ear, loss of discrimination (understanding of words) is characteristic
Acoustic Neuroma benign tumor of VIII cranial nerve, slow growing, occur at any age, can compress facial nerve and arteries which can affect function if untreated s/s: tinnitus, vertigo, loss of high pitch sounds, lower eye droop if facial nerve damaged tx:surgery
Meniere's Disease "idiopathic endolymphatic hydops" uncommon form of vertigo, from overproduction/malabsorption of endolymph, =ing pressure in labyrinth, dx:if has vertigo, hearing loss, tinnitus and pressure in ear, attacks last 2hrs-3weeks
Labyrinthectomy removal of labyrinth (partially or totally) through oval window or mastoid bone for tx of uncontrollable menieres disease. results in hearing loss of affected ear
Sensory Experience consists of two components: reception-process of receiving internal/external data about environment through senses reception-process of selecting, organizing, processing data from senses
Factors Influencing Perception intensity, size, change, representation of stimuli, past experience, knowledge, attitude
Sensory Deprivation when a person experiences decreased sensory input or input that is monotonous. the RAS can't project normal levels of activation to brain pt may hallucinate to maintain optimum level of arousal
Factors Contributing to Severe Sensory Alteration sensory overload, deprivation, sleep deprivation, cultural care deprivation
Sensory Deprivation Responses perceptual, cognitive, emotional
Perceptual Responses inaccurate perception of light, sound, taste, smells, body position, coordination, equilibrium mild: daydream, severe: hallucinations
Cognitive Responses inability to control direction of thought content, attention span and ability to concentrate decreased, difficulty with memory, task performing
Emotional Responses rapid mood changes, manifested by apathy, anxiety, anger, fear, belligerence
Sensory Overload when a person experiences so much sensory stimuli that the brain is unable to either respond meaningfully or ignore the stimuli
Proprioception sensory receptors within the body regarding spatial position and muscular activity
Mobility Alterations with Aging gait imbalances and changes as result of normal aging or sensory alterations
Gait Imbalance shortened and less steady
Antalgic Gait abnormality in heel strike through push-off action
Lurch swing phase abnormality
Falls second leading cause of accidental death in elderly
Neurovascular Deficits impaired pain perception and perception of temperature changes in extremities
Paresthesia burning, prickling, tingling sensation
Alterations in Mental Status confusion due to over or under stimulation with an inability to process stimuli
Disoriented awareness of time and place but self is impaired
Slowed Thought Process not a normal part of aging
Factors Influencing Response to Sensory Dysfunction: Sex color blindness more often in men, otosclerosis in young women
Factors Influencing Response to Sensory Dysfunction: Age young and old can be affected by sensory over/under load, otitis media and strabismus in children, macular degen and glaucoma in older
Factors Influencing Response to Sensory Dysfunction: Psychosocial stress from alteration of health, sensory over/under load, social isolation, paranoia
Factors Influencing Response to Sensory Dysfunction: Socioeconomical access to health care, access to assistive devices
Factors Influencing Response to Sensory Dysfunction: Economical sensory overload/deprivation, loud noises, exposure to fumes/toxins improper lighting, sport injury
Factors Influencing Response to Sensory Dysfunction: Impact of Other Illness diabetes and HTN affect vision and contributing to systemic diseases, physical trauma and nutritional impairments
Factors Influencing Response to Sensory Dysfunction: Impact of Medications ototoxic medications, medications that dilate/constrict the pupil, produce photophobia, medications that alter taste/smell
Assessment of Sensory Dysfunction obtain history, assess factors influencing response to dysfunctions, obtain physical assessment data: snellen, PERRLA, visual field, acuity, diagnostic data
Analysis of Sensory Dysfunction identify nursing diagnosis: risk for injury r/t sensory-perception disturbance, set priorities based of maslows
Planning for Sensory Dysfunction establish expected outcomes for care related to health promotion/maintenance/restoration, patient will: use assistive devices, using nursing standards and rationale, consider factors influencing dysfunction in planing
Implementation for Sensory Dysfunction initiate and complete nursing plans designed to move patient toward expected outcome, provide assistive devices, medications, minimize disconfort
Evaluation for Sensory Dysfunction reassess, document patient's responses to interventions, revise plan of care as needed
Culture integrated structures of knowledge, beliefs, behaviors, etc unique to a particular group of people
Dominant Group group within country or society that has most authority to control values and sanctions (usually largest group in society)
Minority Group group usually has some physical or cultural characteristics (race, religion, beliefs) that identify the people within it as different
Cultural Assimilation when members of minority group, living in dominant society lose parts of their own culture that once made them different and adopt values of dominant group
Cultural Diversity diverse groups in society, with varying racial class, origin, religion, etc
Ethnicity identification with a collective cultural group, based on group's common heritage
Race refers to grouping of people by biological similarities such as blood group, facial feature, hair/eye/skin color
Stereotyping when one assumes that all members of a culture or ethnic groups are alike. can be negative or positive
Cultural Imposition the belief that everyone should conform to the majority belief system
Cultural Blindness when one ignores differences and proceeds as though they don't exist
Oppression occurs when the rules, modes and ideals of one group are imposed on another group
Ethnocentrism an assumption of cultural superiority and inability to accept other cultures
Cultural Competency ability, knowledge, skill, of the nurse to provide safe and effective health care regardless of population or setting
Cultural Influences on Health Care physiologic/psychological characteristics, reactions to pain, mental health, gender roles, language/communication, orientation to space, food/nutrition, family, socioeconomic factors
Cultural Concern: Influence of Nurse personal value and beliefs affecting nursing care
Cultural Concern: Stereotyping all Italians: emotional, all german's: stoic, all elderly: senile, men: never cry
Cultural Concern: Gender Specific Issues african and european americans identify women as decision maker and dominant figure, arab identify males as dominant figure
Cultural Concern: Language and Communication patient who do not speak english, cultures that avoid eye contact, or direct eye contact, need for interpreter
Cultural Concern: Socioeconomic poverty, violence, lack of health care, poor nutrition, immigration
Cultural Concern: Age-Related asian and native americans view and respect older adults as symbolic leaders, hawaiians have a hierarchy of family structure
Cultural Concern: Time Orientation native and african americans time is present oriented
Cultural Concern: Personal Space african americans stand/sit close when communicating, asian and european place distance between self ad others
Cultural Concern: Food/Nutrition rice/vegies staple for asian diets, native american and hispanic eat two meals a day
Cultural Concern: Sexual Preferences issues with homo/bisexuality: discrimination, social barriers, parenting issues
Cultural Concern: Health Care Beliefs europeans believe illness has a known cause (body malfunction or microorganism) that can be treated or cured, others believe supernatural cause, or punishment, folk/faith healers
Spiritual Concepts spirituality, spiritual health, spiritual distress, relgion
Spiritual Practices Affecting Nursing: Holy Days and Sacred Writings muslims-ramadan, christians-christmas, jews-use torah, christians use different version of bible
Spiritual Practices Affecting Nursing: Sacred Symbols cross jewelry, tattoos, amulets that carry special spiritual significance
Spiritual Practices Affecting Nursing: Prayer and Meditation five daily prayers of the muslims, native american chants,
Spiritual Practices Affecting Nursing: Beliefs Related to Diet jews/muslims eat no shellfish or pork, catholics eat no meat on fridays in lent, mormons drink no caffeine or alcohol, vegetarians eat nothing with a face
Spiritual Practices Affecting Nursing: Beliefs Related to Dress islamic women cover body, amish dress simple with no buttons
Spiritual Practices Affecting Nursing: Beliefs Related to Birth baptism for christians, circumcision for jews, burying of placenta for hmong
Spiritual Practices Affecting Nursing: Beliefs Related to Death roman catholics: sacrament of the sick or last rights, muslims position of bed to face mecca; use of shrouds, view of cremation
Complementary and Alternative Medicines (CAM) holistic health/care/nursing, allopathic medicines, complementary therapies, alternative medicine
Alternative Medicine chinese medicine: acupuncture/acupressure/Tai chi, hindu: ayurvedic medicine, homeopathy:exposure to small amounts of the disease to build immunity to it, naturopathy:
Complementary Therapies mind-body, biologically based, manipulative and body based, energy therapies
Mind-Body Therapies hypnosis, imagery, meditation, music/art therapy, prayer, yoga, biofeedback, psychoneuroimmunology
Biologically Based Therapies herbal medicine, nutrition, aromatherapy, Bach flower remedies
Manipulative and Body-Based Therapies massage, chiropractic, craniosacral therapy, Trager (movement), Alexander technique (posture), reflexology, excercises
Energy Therapies therapeutic touch, healing touch, reike
Assessment of Culture obtain health history including cultural/spiritual beliefs, nutrition, use of CAMs, assess factors influencing health status, review diagnostic data to determine genetic factors that will affect care, review meds/herbs
Analysis of Culture identify nursing diagnoses of actual/potential problems; impaired verbal communication r/t shyness/cultural differences, set priorities based on maslow
Planning for Culture determine expected outcomes related to health promotion/maintenance/restoration. patient will....effectively communicate through interpreter , using nursing standards, with interventions to help patient move toward goals, considering cultural factors
Implementation for Culture use nursing measure to establish relationship with patient, enhance compliance, provide information, promote continuity of care at d/c (out pt resources), supervise patient care activities
Evaluation of Culture reassess patient response to nursing interventions (patient verbalizes understanding, is compliant with interventions and goals), revise plan of care and re-implement as needed
Community Nursing: Trends and Foundations history: shifting less time in hospital and more time healing at home, using out patient/community services
Community-Based Care versus Community Health Nursing CBN-focuses on health promotion and rehabilitation, health care provided in community: where pt live, works, play, schools CHN-public heath, protecting and improving health of population
Promoting and Preserving Health of Individuals and Families health promotion and disease prevention: Healthy People 2010
Healthy People 2010 provide information and knowledge how to improve health in a format that enables diverse groups to combine their efforts and work as team
Healthy People 2010: 2 Main Goals eliminate health disparities increase quality and years of healthy living
Healthy People 2010 Road Map for Improving Heath by health promotion, disease prevention and health protection
Health Promotion individual strategies/activities which have an influence over one's long-term health. No smoking, diet, exercise, healthy lifestyle
Disease and Injury Prevention intended to prevent future illness; screenings, education, immunizations
Levels of Disease Prevention primary, secondary, tertiary
Primary Disease/Injury Prevention prevention of initial occurrence of disease or injury: immunizations, family planning, well-child care, education, fluoride, fitness, substance awareness, seat belts, car seats
Secondary Disease/Injury Prevention early identification and treatment of disease or injury to limit disability: screenings-hearing/vision, breast CA, HTN, DM, skin cancer etc
Tertiary Disease/Injury Prevention maximizes recovery after injury or illness, rehabilitation the major focus-assisting clients to reach their maximum potential for self care despite presents of chronic illness
Health Protection relate to environmental/regulatory measures that protect large population: FDA, MVD,
Practice Roles and Settings for Community Care home care, clinics, nursing homes, residential centers, schools
Home Care home visits, block nurse:professional/volunteer provide support for elderly(deliver meals, yard work, arranging transport to apts), PICC/wound nurse, hospice, telehealth services
Clinics ambulatory, day surgery, community health centers, mental health centers, drug abuse centers, adult day care centers
Residential Centers nursing homes, retirement communities, SNFs, in pt rehab, camps, shelter, hospice, transitional housing
Schools and Industry first aid, emergency care, health education, health promotion, screening, case management, medication administration, counseling
Factors Influencing Community Health: Biological age, race, sex, behavioral choices, genetic factors
Factors Influencing Community Health: Social mobility, community groups, education, beliefs, transportation, welfare, religion, support systems, services
Factors Influencing Community Health: Physical geography, terrain, urban, rural, distance to health services, workplace hazards
Factors Influencing Community Health: Environmental living conditions and safety concerns, pollutants, air source, water/food contamination, structural barriers, sources of heat: cooking/warmth
Factors Influencing Community Health: Economic income, employment, job satisfaction, stress, ability to meet basic needs
Factors Influencing Community Health: Family family hx, ability to handle stress, major life changes, coping patterns, culture, care giver role and role strain, illegal individuals
Factors Influencing Community Health: Culture communication, space, time orientation, health beliefs/practices, biological risk factors, nutrition, pain, death/dying responses
Trends in Community-Based Nursing use of unlicensed assistive personnel, alternative therapies
Assessing for Community assess individual and community environment, determine family and patient's ability and willingness to promote/maintain health, assess access to health care
Analysis for Community identify nursing diagnosis of actual/potential problems: impaired home maintenance mgt r/t inadequate support systems, set priorities based on maslow
Planning for Community establish expected outcomes related to health promotion/maintenance/restoration using nursing standards and community based interventions. ex:prepare list of support/emergency contacts, plan for alt care (housekeeper, hospice)
Implementation for Community use nursing measures to obtain needed supplies, equipment, services in home or community, educate to meet physical care needs: wound care, self injections, glucose monitoring
Evaluation for Community reassess, document, report patient responses to nursing interventions, revise plan of care as needed and reimplement
Morbidity prevalence and incidence rates of disease
Mortality risk of death for a person in a population for that year
Prevalence measure of existing disease
Incidence reflects the number of new cases in the same population
Community Based Care: Infant immunization and well-care
Community Based Care: Toddler interventions of safety, prevent falls, choking, poisoning, burns, use of car seat
Community Based Care: School Age sport safety, nutrition and drug use
Community Based Care: Adolescence nutrition and substance abuse, risk behaviors, safe sex, pregnancy prevention
Community Based Care: Middle Aged health maintenance and screening for chronic disease
Community Based Care: Older Adult screening for loss of function, elder abuse, depression, self-care abilities
WHO Ladder 3 step analgesic ladder for treatment of mild to severe pain
WHO Ladder 5 Principles by mouth, by the clock, by the ladder, for the individual, attention to detail
WHO: "By Mouth" use the oral route whenever possible
WHO: "By the Clock" for persistant pain, give meds around the clock rather than PRN
WHO: "By the Ladder" follow the 3 step ladder
WHO: "For the Individual" titrate meds according to patient's pain
WHO "Attention to Detail" determine what patient knows, believes and fears about the pain and things that can relieve it. give precise instructions for taking meds
WHO: Step 1 for mild/moderate pain: start with nonopioid (tylenol, ASA, NSAID), use adjuvant (anti-depressant/anticonvulsant) if indicated **if presenting with mod/severe pain, start with step 2**
WHO: Step 2 when nonopoid do not relieve pain, add weak opoid/tylenol combo, (hydrocodone, codeine, tramadol, percocet), add/continue adjuvants is appropriate
WHO: Step 3 when non-opoid/opoid-combo fail or for sever pain, use strong opoid (non combo) morphine, oxycodone, hydromorphone, add/continue adjuvants if indicated
Created by: aaprice
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