PNUR 104 Week 1-5 NOTES Latest updated 2022/2023,100% CORRECT

PNUR 104 Week 1-5 NOTES Latest updated 2022/2023 WEEK 1 1) Develop and discuss personal definitions of health. a) Health = State of being well + use every power to fullest extent 2) Define health as one of the concepts/components of the Nursing Metaparadigm. a) Nursing Metaparadigm consists of nursing theories addressing + specifying the r/s among 4 major abstract concepts 1) Person / Client → recipient of nursing care, person receiving care 2) Environment → internal (physical body) / external (family, trees) surroundings that affect client 3) Health → degree of wellness / wellbeing client experiences 4) Nursing → attributes, characteristics, actions of a nurse providing care on behalf of, or working with or in partnership, with the client to achieve health 3) Distinguish between the terms health, wellness, well-being, illness and disease. a) Health → state of being well + use of every power to fullest extent b) Wellness → state of well-being c) Well-being → refers to one’s quality of life; one’s perception of being well i) the well-being of an individual refers to their r/s w/ friends, family, etc. ii) the well-being of society refers to people and the quality of interactions b/w such as the education system or health care system d) Illness → highly personal state + subjective; state of person’s physical, emotional, intellectual, social, developmental, or spiritual functioning thought to be diminished (ex. A cold) e) Disease → changes in body functions resulting in reduction in abilities or shortening of life (ex. diabetes) 4) Identify the indicators of well-being. a) Work - may give purpose in life b) Housing - affects well-being c) Family - provides social, physical, + emotional support d) Social Participation - strengthens social networks e) Leisure - enjoyable activities reduce stress f) Health - include mental + physical well-being g) Security - threats to safety affects well-being h) Environment - physical surrounding environment affect well-being i) Financial Security - income affects well-being j) Learning - education can improve quality of life 5) Review and differentiate between various historical models of health and wellness. 1. Clinical Model of Health a. Health → absence of signs + symptoms of disease/injury b. Illness → presence of signs + symptoms of disease/injury c. People viewed as physiological systems w/ related functions d. Focus on relief of signs/symptoms + elimination of malfunction/pain 2. Role Performance Model of Health a. Health → individual’s ability to fulfill societal roles, to perform their work, regardless if they have a clinical illness (ex. Deaf person) b. Illness → inability to perform work 3. Agent-Host-Environment Model a. Agent → environmental factor/stressor that w/ its presence/absence can lead to illness/disease (ex. ebola) b. Host → person who may or may not be at risk of a disease; factors influence host’s reaction agent (ex. Someone in contact w/ someone w/ ebola) c. Environment → external factors; can influence person’s development of disease; physical vs. social 4. Illness-Wellness Continuum Model a. Health → changing increasing levels of health + well-being + varies on continuum; improvement in health occurs thru education, growth, + awareness b. Illness → decreasing levels of health/well-being; development of S&S, disability, premature death 6) Discuss a brief overview of the contributions of selected Canadian documents to the socio-environmental conceptualization of health (i.e. Lalonde Report, Epp Report, Ottawa Charter, Population Health, Toronto Charter, Jakarta Declaration, Public Health Goals for Canadians) a) Lalonde Report → Behaviour/Lifestyle, NO medicine; 4 Elements of Health: 1. Biology → genetics, family history, physical/mental health 2. Lifestyle → behaviour, response to internal/external stimuli 3. Environment → physical + social; surrounding individuals 4. Health care organizations → human/physical resources affecting access + provision of healthcare services b) Epp Report → challenges to health + inequities i) 3 Promotional challenges (1) Reducing inequities (2) Increasing prevention (3) Enhance coping ii) 3 Health promotional mechanisms (1) Self care (2) Mutual aid (3) Health environments iii) 3 Health promotion implementation strategies (1) Fostering public participation (2) Strengthening community health services (3) Coordinating health public policy c) Ottawa Charter → Health = Resource of everyday living i) Important for health → importance of a socio environmental approach, stressed individuals + gov. / nongov. agencies need to work together in partnership for health ii) Individuals + gov. + nongov. are responsible for one’s health d) Strategies for Population Health / Population Health Promotion Model → determinants of health = factors that affect/change health of a person; center of framework for Population Health e) Jakarta Declaration → Primary Health Care, Social Justice, Community Empowerment f) Toronto Charter → Social determinants of health + policy department g) Population Health Approach Framework → identified elements that improve or increase health h) Public Health Goals for Canada → Present i) PAST to achieve population health + not just for individual health → PRESENT social health determinants ii) 7) Know the 15 Social Determinants of Health (HAS HUNGER IS FEED) WEEK 2 1) Key social health determinants in terms of their influence (positive or negative) in achieving health. 1. see Week 1 #7 2) Differentiate between health promotion, health protection, disease prevention, levels of prevention, types and levels of health care services. a) Health Promotion - services to help client improve/increase health (ex. Drug abuse programs) b) Health Protection - activities; prevent/minimize injuries by modifying environment (ex. occupational health safety) c) Disease Prevention - measures to control risk factors by modifying environment (ex. Flu shots, wearing a helmet) d) Levels of Prevention i) Primary - health promotion + protection against specific health problem / disease; prior to disease/dysfunction + applied to generally healthy individuals ii) Secondary - early identification of health problem’ prompts intervention to rid of health problem + limit future disability iii) Tertiary - restoration, rehabilitation to optimal levels of functioning; begins after illness, when defect/disability is stabilized or determined to be irreversible e) Types of Healthcare Services i) Health Promotion + Illness Prevention - improve/increase health, avoid or stop from getting sick ii) Illness Diagnosis + Treatment - identifying + taking action to deal w/ issue iii) Rehabilitation + Health Restoration → help return to previous level of health / optimal level of health or functioning iv) Hospice-Palliative or End-of-Life Care - care for dying / compassionate care due to no chance of surviving illness f) Levels of Healthcare Services i) Primary - health promotion, preventative care, health education, etc. ii) Secondary - diagnosis + treatment iii) Tertiary - rehab; hospital palliative care units/hospices; acute care 3) Discuss how the current funding priorities affect health promotion and the role of the nurse in in health promotion teaching. a) Current funding priorities affect health promotion since it resulted in inequities in health; the goal for Canada was to be among the healthiest in the world but there has been inequities in treatment or the access to treatment b) Role of Nurses in Health Promotion - make opportunities to promote health i) Role Model - healthy lifestyle / behaviours / attitudes ii) Facilitate - client involvement / coordinate services in assessment, implementation + evaluation of health goals iii) Teach - clients self-care strategies to increase health iv) Educate - clients to be effective health care consumers v) Guide - clients’ development in effective problem solving + decision making vi) Reinforce - clients’ personal + family health-promoting actions vii) Advocate - in community for changes, promoting healthy environment, speak on behalf of client or speak on their wishes 4) Major issues in global health and the impact on unique communities (ie. Indigenous communities). a) Major Issues in Global Health i) Migration - lifestyle changes that body isn’t used to so a weaker immune system which results in illnesses occurring ii) Indigenous People - lack of proper nutrition and poverty that is rampant in indigenous communities increase health risks… also negatively impacts mental health iii) Poverty and Inequality - lack of proper nutrition, increased risk of illnesses + diseases due to lack of cleanliness that is often related to poverty iv) Food Security - lack of proper nutrition can result in a weakened immune system which results in increased risk of certain illnesses + diseases v) Disasters - increased risk of the spreading of certain illnesses + diseases, lack of proper nutrition that can result in disasters ruining people’s lives (ex. Ruined homes, increased poverty due to damaged property/economy/etc.) vi) Infectious Diseases - threat to public health, increased risk of illnesses + diseases spreading vii) Gender - mental health impacted (think of society norms, standards/expectations) viii) Women’s Health - lack of support for women’s health (ex. Lack of abortion clinics in certain areas or the lack of the option to which can affect a woman’s health if the woman isn’t ready to have a baby) b) Impact on Unique Communities i) An organized group of ppl bound together by social, ethnic, cultural, or occupational ties, or by geographic location; ii) Ex. Indigenous people - issues w/ lack of clean water + proper housing iii) Ex. African-Americans - BLM, casual racism towards them iv) Ex. Mexicans illegally crossing border for better life → kept in camps (?) 5) Definitions of nursing and Roach’s attributes of professional caring to create a caring environment. a) Nursing = person trained/educated to care for sick; promotes health; concerned w/ well + ill clients; collaborative care of individuals; use environment to care b) Roach's 5 C's 1. Compassion - awareness of one’s r/s to others 2. Competence - having knowledge/skills to respond properly 3. Confidence - fosters trusting r/s, comfort w/ self, client+family 4. Conscience - morals, ethics, etc. 5. Commitment - sense of obligation 6. Comportment - presenting oneself as someone who respects others 6) Discuss nursing best practice of ensuring compassion in care giving of patients, families and SOs a) As nursing best practice in care of patients, families and significant others b) COMPASSION i) Difficult since you’re going to difficult places where clients are weakest ii) Results in a clinical imperative (necessary to do); means our presence is more valuable to practice 7) Define nursing as one of the concepts/ components of the Nursing Metaparadigm. a) Consists of PERSON, ENVIRONMENT, HEALTH, + NURSING b) PERSON = person receiving care; individuals, families, groups, communities 8) Discuss the nurse's commitment to care of patient/significant others, groups and community. a) 9) Identify health care settings, members of the inter-professional and the health care teams. ● Alternative Care Providers ie. Chiropractor, Massage Therapist (pg.151) ○ Dentist - diagnose + treat diseases, conditions, disorders of teeth/mouth/surrounding tissues + structures ○ Dietician / Nutritionist - plan, implement, manage nutritional support ■ Laboratory or Radiologic Technologist - assist or complete tests - lab or radiology tests ■ Nurse - care for the sick ■ Nurse Practitioners - diagnose + treat human illness + assist in rehab, w/ their role expected to be holistic + health promotive ● Occupational Therapist - primary goal of occupational therapists is to enable people to participate in activities of daily living (work or self-care ADL issues) ● Paramedical Technologists, Emergency & Ambulance Attendants - first-response health care personnel deliver on-side first-aid to ill or injured persons + transport them to hospitals ● Pharmacist - dispense medications + help ppl understand/use their meds safely to achieve desired health outcomes ● Physiciens (ie. Surgeon, Psychiatrist, Oncologist) - diagnose + treat human illnesses + assist rehab after onset of disease/injury ● Physiotherapist - analyze + address impact of injuries, diseases, disorders on movement + physical functioning ● Respiratory Technologist - assist in diagnosis + treatment of lung disorders ● Social Worker - seek to improve social health + wellbeing of individuals/families 10) Roles of the practical nurse and the interprofessional health care team in the continuum of care. a) Caregiver - assist client physically + psych while preserving client’s dignity b) Communicator c) Educator (Teacher/Mentor/Preceptor) - works w/ pre-grad students d) Client Advocate - represents client’s wishes/needs e) Counsellor - helping others cope w/ stressful events f) Change Agent - helping clients to change behaviour 11) Define WHO (World Health Organization) and discuss WHO definition of interprofessional team. a) World Health Organization; specialized agency concerned w/ intl. public health b) Interprofessional Team → when multiple health workers from diff. backgrounds work together w/ patients, families, caregivers, + communities to deliver highest quality of care 12) Discuss WHO definition of Palliative Care in the continuum of care. a) WHO in Palliative Care i) Approach that improves quality of life of patients/families facing problems w/ a life-threatening illness (1) Involves relief of suffering by early intervention + assessment (2) Includes treatment of pain + others (physical, psych, + spiritual) 13) Define person/client as one of the concepts/ components of the Nursing Metaparadigm. a) PERSON = one who is receiving care; individuals, families, groups, communities 14) Explain the relationship of individuality and holism to nursing practice. a) Individuality → Different thru genetics, lived experiences, environmental interactions b) Holism → Whole person; Consider them as a whole, their r/s to surroundings + to others 15) Identify factors influencing the impact of illness on individuals and families/significant others. / Discuss the impact of illness on the client and identify strengths and challenges for clients, families and their significant others. 1. The meaning of illness to the individual; what does it mean to the client? a. How would they prefer to be treated or what they’re form of treatment is? 2. The nature (severity) of the illness ie minor to life threatening; a. Minor -> life threatening 3. The duration of the illness (how long it lasts) from short to long term 4. The residual effects (lasting impact) of the illness ie none to permanent disability 5. The financial and social impact of the illness on the individual 6. The impact of the illness on the individual`s family 16) See #3 ^^ 17) Discuss considerations for assessing health of individuals. 1. Health Appraisal (includes illness narratives/stories; patient’s story of what happened, their symptoms, their values/beliefs) 2. Health Beliefs – may reflect lack of information or misinformation about health 3. Coping Mechanisms -behaviors used to deal with stress pg. 214 Box 12.3 4. Risk of Health Problems a. Developmental Factors b. Hereditary Factors c. Gender or Race d. Cultural Factors e. Sociological Factors f. Lifestyle Factors 5. Identify Areas of Strengths - of adapting well to tragedy or stress (= Resilience, what things helped them deal with the situation?) pg. 216 Box 12.4 18) Discuss client- centered care using the RNAO Best Practice Guidelines (BPG) related to "Person and Family Centered Care". a) 19) Define family, family functions and various types of families. a) Family → Any combo of 2 or 2+ persons, bound together over time by ties of mutual consent, birth/adoption, placement; who assume responsibilities b) Family Functions i) Physical Maintenance Care ii) Addition of New Members iii) Socialization of Children iv) Social Control of Members v) Production, Consumption, Distribution of Goods / Services vi) Affective Nurturance (Love) c) Types of Families i) Traditional Family - both parents reside in home w/ children; mother = nurturing role, father = provides economic necessities ii) Single or Two Career Family - both husband + wife are employed iii) Lone or Single Parent Family - 1 parent w/ children iv) Adolescent Family - infant born to adolescent parents v) Blended Family - existing families that join together to form a new one vi) Cohabiting Family - unrelated individuals or families who live under 1 roof vii) Adoptive Family - children adopted by parents viii) Mixed Race Family - parents or children of diff. ethnicities ix) Nuclear Family - parents/children from same generation x) Mixed Generation Family - parents/children from several generations xi) Gay or Lesbian Family – same-sex couple 20) Differentiate between family, caregiver, health care worker and health care provider. a) Family b) Caregiver c) Health Care Worker d) Health Care Provider 21) Discuss family health, family nursing and the impact of illness on the family. a) Family Nursing → Focus on individuals (foreground) + families (background) i) Relational practices involving family members in care; respond to their concerns; or provide info + emotional support b) Impact of Illness on Family i) Role changes, increased stress ii) Financial problems iii) Loneliness, changes in social customs/values iv) Decreased hospital stays → shift in increased care by families 22) Define Genogram and discuss use of various symbols. a) Genogram → Concise visual depiction of the family structure + relevant situational information that can be sketched on nursing admission forms or progress notes and used in numerous areas of nursing b) Symbols i) male or female ii) client indicated by double lines (circle or square) iii) married, common law relationship, separated, divorced iv) children, parents v) death, abortion vi) medical information 23) Using a video and family case studies, complete a Family Assessment Guide and Genogram, to identifying strengths and challenges of the family. 1. Family Structure (include a genogram) a. Size + type: nuclear, extended, etc. b. Age, gender of each member 2. All the Roles of a Family & its Functions a. Type of work + satisfaction with it b. Household roles + responsibilities, how tasks are distributed c. Ways childbearing responsibilities are shared d. Major decision maker + methods of decision making e. Family members’ satisfaction w/ roles, the way tasks are divided, way decisions are made 3. Member’s Health / Physical Health Status of each member – health care practices a. Physical health status of each member b. Perceptions of own health + member’s health c. Preventive health practices d. Routine health care, when, why physician last seen 4. Interaction Patterns – communication (openness), methods of expressing emotions a. Ways of expressing affection, love, sorrow, anger, + etc. b. Most significant family member in person’s life c. Openness of communication w/ all family members 5. Look at Family Values – cultural, religion, leisure time, education, health promotion a. Cultural + religious orientations; degree to which cultural practices are followed b. Use of leisure time + whether leisure time is shared w/ total family unit c. Family’s view of education, teachers, + school system d. Health values: emphasis put on exercise, diet, preventive health care 6. Yell or Cope / Coping Resources – emotional support, stress, finances a. Degree of emotional support offered to e/o b. Availability of support persons/affiliations outside family c. Methods of handling stressful situations + conflicting goals of family members d. Financial ability to meet current/future needs 24) Discuss the importance of illness narratives and the lived experience of illness for the individual and family (phenomenology) and/or for nursing care. a) Illness Narratives i) To seek understanding of person’s/family’s experience of illness in the ordinary acts of everyday living; the influence of illness on r/s w/ family, friends, + workmates; ill person’s ability to gain influence over impact of illness in their lives; + stories told of encounters w/ the health care system b) Phenomenology → lived experiences of illness for individual + family i) Consideration should be given to the impact of the lived experience of health, wellness, illness, + diseases on both individual and/or family. It’s important since it aids us in giving competent and quality health care services to the individual and/or family. 25) Define environment as one of the concepts /components of the Nursing Metaparadigm. a) Internal (mental health, emotions) + External (people, nature) surroundings 26) Discuss health promotion and the need for use of community resources (out vs in- patient settings). a) Health Promotion Community Programs i) Inpatient - Services provided when a client is admitted to hospital ii) Outpatient - Services provided when a client is not admitted to hospital 27) Discuss inter-professional services for "Health" and "Older Adults" using the web-site for the "Blue-book of Community Services. a) Health i) Community health centres, Finding a medical professional, Health / developmental disabilities, Health + physical disabilities, Home support programs, Homeless health programs, hospice/palliative care, hospital emergency/urgent care, hospital, Local health integration networks, Long term care homes, pregnancy/postnatal b) Older Adults i) elder abuse, Geriatric psychiatry, Home support programs,Income programs for older adults, Long term care homes, Meals for seniors/people w/ disabilities, Recreation for older adults, Retirement homes, Senior apartments 28) Using family case studies, identify inter- professional community resources to assist families with existing and potential health a) Week 3 1) Differentiate between growth and development. a) GROWTH → physical changes, increase in size b) DEVELOPMENT → changes in behaviour, increases in abilities/skills 2) Review the principles of growth and development. 1. Predictable Sequence 2. Characteristics of Each Stage 3. Cephalocaudal Direction 4. Proximodistal Direction 5. Sequential Process 6. Simple to Complex 7. Generalized to Skilled Responses 8. Certain Critical Stages 9. Pace is Uneven 3) Identify and discuss the stages and four components of growth and development for all ages. a) Psychosocial - development of PERSONALITY, expression of self b) Cognitive - to THINK + REASON, process info, use language c) Moral - behaviour viewed by society as RIGHT / WRONG d) Spiritual - development of r/s + perceptions of MEANING IN LIFE 4) Compare the four major developmental theories of psychosocial, cognitive, moral and spiritual (ie. Havighurst, Freud, Erikson, Peck, Gould, Piaget, Kohlberg, Gilligan, Fowler, Westerhoff) related to infancy, childhood, adolescence and adulthood (across the lifespan). a) Psychosocial Theories i) Havighurst - lifelong learning 6 stages w/ 6-10 tasks to learn; tasks for infancy, early childhood, middle childhood, adolescence, early adulthood, middle age, + later maturity ii) Other Psychosocial Theories → dev. of personality + intra personal self (1) Freud - ID, ego, super ego, libido (2) Erikson - adapted Freud’s work + expanded; more stages (3) Peck - divided Erikson’s last phase for Elderly into 3 phases (4) Gould - transformation is central theme during adulthood; 7 stages of adult development b) Cognitive Theories i) Piagnet - how ppl think, reason, + use language c) Moral Theories → right/wrong; morality; moral behaviour; moral development i) Kohlberg - reason for decision; 3 lvls w/ 6 stages ii) Gilligan - studied women + didn’t follow Kohlberg’s phases; stages should be “ethics of care”; men vs. women think differently; men = principles of justice + fairness; women = no violence / no harm d) Spiritual Theories i) Fowler - r/s w/ universe + perceptions of meaning of life ii) Westeroff - faith = way of being + behaving; guidance form parents + others is internalized in adulthood 5) Identify norms of young, middle and older adults and related health problems and promotion guidelines G&D Study Comparison Chart Topic Young Adult (20-40) Middle Adult (40 – 65) Older Adult (65+) Physical: Cardiovascular (CS) - Vital signs (ex. BP 337 Table 19.1, 340 Box Integumentary 348-349 Table 20.2, 348-352, 355 Box Integumentary Integumentary MS = Musculoskeletal CV = Cardiovascular Sensory GI = Gastrointestinal GU = Genital/Urinary Reproductive within norms) Sensory - Vision + hearing within norms Reproductive - Pregnancy - decrease in skin turgor (elasticity) & moisture-> drier skin - decreased subcutaneous fat (sensitive to cold) - wrinkling occurs - fat deposits in abdominal area -hair begins to thin & becomes grey Musckleoskeletal (MS) - muscle bulk decreases at age 60 - thinning of discs -> decrease in height of 2-3 cm -calcium loss from bone in postmenopausal women - muscles growth continues if muscles maintained or used Cardiovascular (CS) - blood vessels loose elasticity - thickened blood vessels -heart works harder - BP within norms for age Sensory decrease in visual acuity for near vision in late 40s -hearing for high frequency decreases -taste decreases Gastrointestinal (GI) - decrease in tone of large intestine -> can lead to constipation Genital / Urinary nephron units of kidneys are lost - decrease in glomerular filtration rate Reproductive - decrease in hormones in both men & women - hormonal changes & decease in ovarian activity -> menopause around age 45-55 - decrease in sexual activity in men - men may have difficulty getting due to stress - skin dryness, pallor, fragility, wrinkling & sagging skin due to loss of elasticity & subcutaneous fat, brown “age spots” - deceased perspiring due to reduced function of sweat glands - thinning & greying of scalp, pubic & axillary hair - facial hair in women - slower nail growth, thicken & brittle, ridges Musckleoskeletal (MS) - decrease speed & power of muscles due to decrease in muscle fibers - slower reaction time & decreased muscle tone - loss of height due to atrophy of dics -loss of bone mass–> osteoporosis -> need for calcium & Vit D - joint stiffness - impaired balance Cardiovascular (CS) - decreased lung expansion & ability to expel objects - decrease cardiac output -> shortness of breath=SOB - pooling of blood in legs - increase in BP due to decreased elasticity & increased rigidity of arteries - orthostatic hypotension Sensory - all senses decrease - loss of hearing, vision, taste, smell, sensations - increased sensitivity to glare & decreased acuity& ability to adjust to darkness Gastrointestinal (GI) - delayed swallowing time - tendency for indigestion due to decrease in digestive enzymes - tendency for constipation due to decreased muscle tone of intestines, decrease in peristalsis, decreased body fluids Genital / Urinary - reduced filtering & impaired renal function due to decreased # functioning nephron - decrease in concentration of urine & tubular function - urinary urgency & frequency due to enlarged prostrate in men & in women weakened muscle in bladder & urinary spincter -noctural frequency & retention due to decreased bladder capacity & tone -> bladder infections Reproductive - prostrate enlarged -shrinking & atrophy of cervix, uterus & ovaries - vaginal dryness, decreased lubrication & elasticity due to loss of estrogen effect - decrease in hormones - increased t ime for sexual arousal & decreased firmness of erection due to decreased blood supply to penis Psychosocial: Personality (Erikson) Havighurst Dev. Tasks Intimacy vs. Isolation ie. choice of career, partner & family Generativity vs. Stagnation ie concern for guiding next generation-> volunteer work, comfort with lifestyle Integrity vs. Despair ie acceptance of one’s life cycle & death as a completion of life vs regrets Cognitive: Formal operations Post operations 354 -decline in short term memory, slower learning Moral: Post conventional Spiritual: Reflective 333 - Reflection, accept or redefine teachings of childhood 338 -religion offers comfort Health Risks or Problems 333-336 - injury & violence - suicide - substance abuse - STD -eating disorders (anorexia etc.) - obesity - malignancy - partner abuse - environmental exposure - immunizations - caffeine use 338-340 - injuries - alcoholism - cardiovascular disease - obesity - alcoholism - cancer - mental health issues -sustained happiness 356-358 - injuries - mental health illness - addiction problems - dementia - drug use & misuse - chronic illness - cancer - mistreatment of older adults Health Promotion: Exercise Nutirion Sensory Safety Screening Hobbies Friends/Family Spiritual 336 Box Exercise - active sports Nutrition - need for iron (females) due to blood loss with menstrual cycle - intake of foods that are high in cholesterol or fat Sensory - protection from sun, glasses Safety - Motor Vehicle (MV) safety with designated drivers when drinking, no texting or phone use when driving a car, maintaining brakes & tires -sun protection -workplace & child proof safety -water safety (no diving in shallow water) Screening - Routine physical exams -Immunizations & HPV - Dental Assessments - Vision, Hearing Tests - Pap Smears & STD - Breast Exam *F & M - Testicular Exam, STD - Rectal Exams - BP & Cholesterol - Blood Sugar, Thyroid - Electrocardiogram (ECG for heart) - TB Test every 2 yrs. - Smoking history Hobbies - development of Friends/Family -friends & family -goals for work & career Spiritual - redefining 340 Box Exercise - daily exercise program for skill & coordination for min. of 30 minutes a day Nutrition need for fiber, protein, calcium & Vitamin D (helps increases calcium absorption) -avoid excessive intake of caffeine - decease fat & cholesterol in diet Sensory - reading glasse Safety MVsafety with driving at night - workplace & home safety, decrease repetitive strain - lighted hallways & stairways - smoke & carbon dioxide detectors -non-skid mats & handrails(bathroom) Screening - Immunizations & TB booster every 10 years, routine physical exams for BP & ECG, cholesterol levels, dental, mammogram, colorectal, breast, cervical, uterine, testicular, prostrate, rectal cancers - Skin, dental, eye Exams, TB Test every 2 years Hobbies - renew and expand previous interests - retirement planning of activities Friends/Family -mid-life crisis -retirement planning with partner Spiritual - status 359 Box Exercise - moderate exercise to maintain joint mobility, muscle tone, bone calcification ie, walking, swimming Nutrition - need for calcium & *Vit D to prevent Osteoporosis, - need for f ewer calories due to lower metabolic rate & decreased activity - increase f iber (roughage), fluids & exercise to prevent constipation - lower salt or no added salt (NAS) diet Sensory - cataracts, glaucoma Safety - need for calcium & *Vit D to prevent Osteoporosis, - need for fewer calories due to lower metabolic rate & decreased activity - increase f iber (roughage), fluids & exercise to prevent constipation - lower salt or no added salt (NAS) diet Screening Screening for family violence - Annual Health Exams, BP, Cholesterol, ECG, Type 2 Diabetes, Smoking, Immunizations, TB booster every 10 years, flu vaccine - Mammogram - Colorectal, Breast, Cervical, Uterine, Rectal, Testicular, Prostrate Cancer - Skin, dental,& eye exams for glaucoma - Screening for depression Hobbies - recreational activities - community center programs, support groups for older adults Friends/Family - family & friends - support groups for seniors Spiritual - renewal Week 3 CONT. 6) Define critical thinking. a) a Systematic Process to make more informed choices; analysis + evaluation 7) Identify attitudes that foster critical thinking and apply to a video case study. 1. Independence (of thought) - to think for themselves; consider ideas, learn from them, state own perspective, + make own judgements 2. Fair mindedness - assess all viewpoints against same standards + not basing judgements on personal / group bias or prejudice 3. Insight ( into own biases) - open to possibility that their personal biases, social pressures, customs, + cultural background affect their thinking 4. Intellectual humility - having awareness of limits of one’s own knowledge 5. Intellectual courage - people willing to consider + examine own ideas/views; recognizing values, beliefs, or assumptions are acquired through one’s life experience 6. Integrity - requires individuals to apply the same rigorous standards of proof to their own knowledge/beliefs as to knowledge/beliefs of others 7. Perseverance - seeking effective solutiosn to client / nursing problems 8. Confidence (in thinking process) - well-reasoned thinking will lead to trustworthy conclusions 9. Curiosity – ask questions; apply the questions + strategies to practice issues 8) How to develop critical thinking attitudes and clinical reasoning to use with the nursing process. 1. Critical Analysis (pg. 407/**pg. 367) a. Application of questions to a particular situation or idea to determine essential elements + discard superfluous info/ideas 2. Socratic Questioning (pg. 407, pg. 408 Box 21.3) /** pg. 367 Box 21.2) a. **examine different points of view b. Technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple POV, + differentiate what is known from what is merely believed 3. Inductive Reasoning (pg. 407/**pg. 368) a. **conclusions drawn from facts or observed 4. Deductive Reasoning (pg. 408/**pg. 368) a. reasoning from general to specific 5. Reasoning Process (pg. 408/**pg. 368-369) a. a clear reasoning process that includes… a) Purpose of critical thinking b) Question/Issue/Problem that requires resolution c) Assumptions about the Problem d) Analysis of own and others’ points of view e) Data and Evidence to support f) Concepts & Theories used (discussed in **Research Course) g) Inferences and conclusions based on given data h) Implications and consequences of reasoning 9) Discuss the relationship between the nursing process, critical thinking, problem- solving process and decision-making process. a) 10) Discuss use of Maslow's hierarchy of needs for establishing priorities of nursing care. a) Hierarchy of Needs Include… i) Physiological Needs (highest need) includes: air, food, water, shelter, sleep, activity, etc. Needs crucial for survival ii) Safety & Security Needs includes: Feelings of safety, physical environment + in relationships iii) Love & Belonging Needs includes: giving + receiving affection, attaining a place in a group, + maintaining the feeling of belonging iv) Self- Esteem Needs includes: self-esteem such as feelings of independence, competence, + self- respect… feelings of esteem from others such as recognition, respect, + appreciation v) Self-Actualization Needs (lower priority need) includes: when need for self-esteem is satisfied, the need for self-actualization occurs; need for a person to develop their maximum potential + realize abilities/qualities b) Order of Priorities i) High-> usually life-threatening problems are high priority ii) Medium -> may result in delayed development or cause bad physical/emotional changes iii) Low priorities -> from normal developmental needs or requires only minimal support 1. Life Threatening - ex. loss of respiratory or cardiac function 2. Health Threatening - ex. acute illness, anxiety, lower coping ability 3. Developmental Needs - ex. disturbed sleep pattern 11) Identify various factors to consider when establishing priorities in nursing careI 1. Urgency of the health problem a. Life-threatening situations require nurses to assign them as high priority 2. Medical treatment plan a. Priorities for treating health problems must be congruent w/ treatment by other health care professionals 3. Client health values & beliefs a. Ex. a client may believe being home for the children to be more urgent than a health problem which can factor in the number of options the nurse can take 4. Client’s priorities a. enhances collaboration; sometimes client’s perception of what’s important conflict’s w/ nurse’s knowledge of potential problems/complications 5. Resources available a. If money, equipment, etc are scarce, nurse needs to use critical thinking, clinical reasoning, + creative measures address nursing diagnoses Week 4 1. Define the Nursing Process. a. 5 phases describing the nursing practice b. Systematic client-centered method of planning + providing individualized nursing care 2. Identify some of the characteristics of the nursing process (NP) a. Cyclic + Dynamic → NP = Repeated event, always changing b. Client-Centered → Plan of Care = Organized according to identified client problems c. Focus on Problem Solving → Techniques + Systems Theory to organize care d. Focus on Decision Making → Apply own skills; Determine how to intervene based on client e. Interpersonal + Collaborative Style → Communicate w/ clients to meet needs + f. Use of Critical Thinking Skills → Process using problem solving + decision making 3. Identify and discuss the five phases of the nursing process. 1) Assessment → systematic collecting, organizing, validating, documentation of info/data 2) Diagnosis → analyze data; identify; formulate diagnostic statements 3) Planning → prioritize problems/diagnosis; nursing interventions 4) Implementation → reassess clients; determine need for help; document activities 5) Evaluation → collect data; relate actions to client goals; draw conclusions; continue, modify, terminate client care plan 4. Define assessment as part of the nursing process. a. Definition i. systematic collection, organization, validation and documentation of data; ii. is continuous and carried out during all phases of the nursing process b. Data Collection in relation to assessment i. Is systematic, continuous collection of info, reflects client's changing health status ii. Database = all info about client (ex. health history, physical assessment, lab/diagnostic tests → helps w/ determining changes) iii. Centennial uses Needs Assessment framework for data collection 5. Discuss types of assessment. a. Initial - performed within certain time after admission (ex. 24 hours) to create a complete database (ex. Vital signs such as pulse or temperature) b. Problem Focused - on-going process; part of nursing care to identify status of a problem or identify new/evolving problem (ex. taking client’s temperature) c. Emergency - during any physical/psychological crisis, to identify anything life-threatening problem whether its new or overlooked (ex. patient starts bleeding) d. Time Lapsed - follow-up after several months after initial admission to compare current status to previous baseline data (ex. take weight of patient) 6. Define the types and sources of data. a. Types i. Subjective → symptoms / subjective data (apparent only by person experiencing it, what they say they feel or found, described/verified by patient themselves) ii. Objective → signs / detectable by observer; can be tested or measured for; seen, heard, felt, smelled; physical examination 1. **obtained to validate (proof of) subjective data b. Sources i. Primary → from patient themselves + considered most accurate ii. Secondary → indirect sources (ex. family members, client records, lab reports, health team); can also be from literature (ex. looking up meds or cultural beliefs) 7. Identify methods of data collection. a. Observation → use of senses (vision, hearing, smelling, touch) b. Examination → Sight or inspection (see), smell, hearing (listen) / auscultation, palpation (feel / touch) + percussion c. Interviewing → direct + indirect questioning; validate objective + subjective data match 8. Identify methods of organizing data using the data collection tools of “Needs Assessment Guides". a. Maslow’s Hierarchy of Needs (establishing priorities) b. Needs Assessment Guides i. guides used will assist in collecting data according to “Needs Assessment Guides” ii. each guide will outline the usual data for the need, under subjective, objective and diagnostic tests. Data to collect for the Need of (one of 11 Needs) Data Analysis (helps to develop nursing diagnosis) Subjective Objective (Physical) Diagnostic tests 9. Discuss the importance of validating data when developing a nursing care plan. a. ensure that the information is complete b. ensure subjective & objective data agree c. obtain additional information that may have been missed initially d. differentiate between cues (hints from data) and inferences (conclusions) e. avoid jumping to conclusions and focusing too quickly on the obvious problems 10. Review use of Maslow's hierarchy for establishing nursing priorities for organizing data. a. Hierarchy of Needs Include… i. Physiological Needs (highest need) includes: air, food, water, shelter, sleep, activity, etc. Needs crucial for survival ii. Safety & Security Needs includes: Feelings of safety, physical environment + in relationships iii. Love & Belonging Needs includes: giving + receiving affection, attaining a place in a group, + maintaining the feeling of belonging iv. Self- Esteem Needs includes: self-esteem such as feelings of independence, competence, + self- respect… feelings of esteem from others such as recognition, respect, + appreciation v. Self-Actualization Needs (lower priority need) includes: when need for self-esteem is satisfied, the need for self-actualization occurs; need for a person to develop their maximum potential + realize abilities/qualities 11. Define nursing diagnosis + differentiate between the common types of Nursing Diagnosis. a. Definition i. Clinical judgement about individual response to health problem ii. About client / family / group iii. Problem statement, describing client’s health problem or response iv. Provides basis for client goals/outcomes + nursing orders/interventions b. Types of “Nursing Diagnosis” + Differences i. Actual → client problem, present at assessment time or exists at the moment ii. Risk → based on clinical judgement 1. **although problem doesn’t exist now, there are risk factors present that indicate the likelihood of development unless nurse intervenes (possibility of developing the future) iii. Possible → Problem NOT present; evidence incomplete but based on “professional hunch”; problem could be present or could develop iv. Wellness → describes human responses that are positive + improve their health 12. Discuss the differences between Nursing Diagnosis and Medical Diagnosis. a. Nursing Diagnosis i. Human responses to illness ii. Oriented to an individual iii. Changes as client’s response changes iv. Guides independent nursing actions v. Classification system made but not universally accepted (ex. NANDA) b. Medical Diagnosis i. Describes specific disease processes ii. Oriented to pathology iii. Constant for duration of illness iv. Guides medical treatment, some of which nurses carry out v. Well developed classification system by medical profession 13. Discuss the diagnostic process and the steps of analysis. a. Critical thinking is used to analyze data in order to determine data that supports a nursing diagnosis or is the reason (facts) of why a certain nursing diagnosis is appropriate b. Diagnostic Process i. c. How to Analyze / Steps of Analysis 1. Compare data to Norms/Standard a. Find significant data cues b. Decide if data is SAMe or has VARIED from accepted “norm”/”abnormal” c. Based on growth + developmental norms, lab values, vital sign norms d. If any deviation, identify if less or more + relevance + significance to patient or nurse 2. Clustering Cues (data) + Identify Patterns a. Grouping data that interrelates or is related to e/o b. Does it form a pattern? Decide if pattern is significant c. Make inferences/conclusions using critical thinking d. Put possible meaning to pattern + identify source or rationale for thinking 3. Identifying Data Gaps + Inconsistencies a. Continue validating (collect evidence) data + hunches 4. Cues + Inferences/Conclusions a. What clues are there? What inferences can you draw from the facts? b. Example: validate cue of “red face” by checking the temperature of client i. If T = 39 (fact) → I can infer that the client has a fever from their red face and due to their higher than normal temperature 14. Discuss how analysis leads to the Nursing Diagnosis. a. Analysis of data collected help determine… i. The Problem(s) ii. The Factors Contributing to the Problem iii. The Evidence that Identifies the Existing Problem 15. Identify the components of a Nursing Diagnosis using the NANDA format. a. Defining Characteristics → cluster of signs/symptoms that indicate problem (evidence) b. Guidelines for Writing Nursing Diagnosis i. It reflects data collected / in case study ii. State in terms of a problem, not a need iii. Statement is legally advisable iv. Both problem + related factors are different + don’t say the same thing v. Factors correctly stated from data vi. Specific + Precise → Provides direction for goals + nursing orders vii. Nursing Terms only NOT medical viii. Follows NANDA list c. Problem Statement Example / Diagnostic Statement i. “Related to” → Constipation related to prolonged laxative use ii. “Shown by” → ineffective breastfeeding related to breast engorgement d. The Problem (diagnostic label) i. S/t client experiences (a response) ii. S/t nurses can do s/t about iii. Specific → Use qualifiers (altered, low, high, etc.) iv. Gives directions for patient goals e. Related Factors i. Related factors causing or leading to problem ii. Probable cause iii. Gives direction for nursing actions iv. Enables individual client’s care 16. Apply critical thinking and problem solving using a case study to practice developing and writing analysis, Nursing Diagnosis (using the NANDA format) in the development of a Nursing Care Plan a. Week 5 1) Identify the significance of the Need of Activity and Exercise with regard for health promotion a) Benefits of Exercise → Essential for healthy functioning b) Benefits of Activity + Exercise (each system) i) Musculoskeletal - maintains muscle tone and flexibility of joints/bones ii) Cardiovascular - promotes efficient circulation iii) Respiratory - enhances lung expansion iv) Gastrointestinal - improves GI function/peristalsis & bowel movements v) Metabolic - increases metabolism vi) Urinary - prevents urinary stasis that could lead to kidney stones vii) Immunity - pumps lymph fluid thru body -> increased immunity viii) Psychological - more pleasing appearance, mood, self esteem etc 2) Discuss factors, current issues and trends that impacts the Need for Activity and Exercise. Growth + Development Maturity → gain motor control; Posture + bone density alters w/ ageing Nutrition Under nourishing vs over nourished Personal Attitudes/Values Own desire to be active; values about appearance; family influence; sedentary lifestyle External Factors Available recreational activities, money for gym, safety of environment, temperature Prescribed Limitations May be needed for a certain period of time to promote healing (ex. Doctor’s orders) Physical Health illness limits O2 + nutrients needed for muscle contraction → activity intolerance Mental Health Depression alters activity desire 3) Differentiate activity from exercise and define the four basic elements of normal movement. a) ACTIVITY - body movement, needing energy expenditure (it takes/spends energy) b) EXERCISE - planned activity structured for repetitive movements; improving fitness c) ACTIVITY TOLERANCE = type + amount of exercise or daily activities once can perform w/o experiencing adverse effects d) 4 Basic Elements of Normal Movement i) Alignment of Body / Posture - body parts in line, promotes optimal balance/function (1) line of gravity → middle of head to down thru shoulders (2) centre of gravity → center of pelvis (3) base of support → foundation ii) Joint Mobility - inactivity = bent/flexed joint; contracture can develop / shortening of muscles + fixed in flexed position; ROM is the max. movement meant for the joint; varies in ppl, genetics, develop patterns, disease, + activity iii) Balance/Stability - maintained by mechanisms of balance sense; depend on stimuli of inner ear iv) Coordinated Movement - balanced; functioning of cerebral cortex, cerebellum, + basal ganglia 4) Differentiate between isometric, isotonic and isokinetic types of exercises and state the rationale for which client situation that each exercise would be appropriate. Types of Exercises → is classified according to types of muscle contractions Isotonic = dynamic “tone = tonic” - muscles shorten + produce active movement (ex: run, walk, cycle, swim) - to increase tone, mass, + strength; joint mobility + flexibility - improve circulation + blood flow Isometric = static/setting “measure = metric” - change in muscle tension, not in length/movement (ex. Quad Setting) - to strengthen specific muscle, increase HR but not blood flow Isokinetic = resistive - muscle contraction/tension against resistance = isometric or isotonic - both → person moves (isotonic) then tenses (isometric) against resistance - ex: lifting weights to build muscles Aerobic = O2 intake ≥ body’s need “got lots of ‘air’ = aer-” - activities require less O2 than blood supply (ex: walk, jog, dance, ski) - O2 supplies used up slowly - to condition + fitness Anaerobic = activities need O2 > body’s supply - O2 supplies used up quickly (ex: sprinting) + to train for endurance 5) Differentiate between active and passive Range of Motion Exercise in terms of the benefit for the client. a) ACTIVE → maintain / increase muscle strength b) PASSIVE → maintain joint flexibility 6) Define frailty and discuss use of a Frailty Scale in relationship to the Need for Activity and Exercise. a) Frailty → term used in referring to older adults physical functioning i) incl. muscle weakness, slow walking speed, low energy, low physical activity levels or unintentional weight loss b) Frailty Scale → need to observe person and activities i) #1 Very Fit - active, energetic, exercise regularly ii) #2 Well – no active disease but less fit than #1 iii) #3 Well with treated disease – has controlled symptoms iv) #4 Vulnerable – complains of being slowed down v) #5 Mildly Frail – limited dependence on others vi) #6 Moderately Frail – needs help with ADL vii) #7 Severely Frail – completely dependent on others 7) Review the Lab (PNUR 105) content on the use of assistive devices (ie. canes, walkers and crutches)in helping clients with ADL's (activities of daily living) to meet the Need for Activity and Exercise. a) Body Mechanics – lifting, moving, pulling, pushing, pivoting b) Preventing Back Injuries c) Support Devices d) Positioning – positioning patient with pillows for support e) Moving & Turning & Transferring Patients f) Exercises – for isometric, isotonic, isokinetic g) ROM – active & passive with examples for both h) Ambulating & **Pre-Ambulatory Exercises i) Controlling Orthostatic Hypotension - drop in BP; dizziness; imbalanced j) Use of Canes k) Use of Walkers l) Use of Crutches 8) Apply critical thinking and problem solving using a case study to develop a nursing care plan using the Needs Assessment Guide for Activity and Exercise. a) Diagnosis → IMPAIRED PHYSICAL MOBILITY (problems w/ movement) or ACTIVITY INTOLERANCE (problems w/ doing activity) i) Related to (what factors could cause this problem?) ii) Shown by (what could be proof or evidence that shows problem exists?) b) Review Benefits of Activity / Exercise + Systems for Analysis i) See Wk5 1b for FACTORS (related to) c) Physical Examination - *Need to know Norms* to understand case studies - **Body Alignment - posture; good trunk alignment vs. poor trunk alignment (pelvis tilted) - **Gait - **the way they walk; heel of foot strikes ground, arm movement, chin level, gaze - **Pace - speed of walk; **Normal = 70-100 steps/minute; Older Adult = 40 steps/minute - Appearance & Movement of Joints - redness, swelling, *crepitation sound (clicking) - Capabilities & Limitations of Movement - mental alertness; balance/coordination; vision - Muscle Mass & Strength - compare sides if equal - Activity Tolerance - **S&S to stop activity ie. sudden pallor, feeling dizzy or weak - Problems Related to Mobility - Clients at risk of developing (ex: poor nourishment, decreased pain tolerance or temp or pressure)