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Excelsior Chronicity
| Question | Answer |
|---|---|
| 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 |
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