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504 Exam


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-assume responsibility for oneself
-making informed choices
-feeling a sense of worth
-managing health care regimens (diabetic)
-managing stress
wellness behaviors
The behaviors that a person in stable health uses to maintain or improve that state over time. The continuity and harmony of health behaviors and beliefs.
Health Maintenance
Individual Perceptions ⬡ Modifying Factors ⬡ Likelihood of Action
perceived seriousness and susceptibility
modified by: demographics, sociopsychological variables, structural variables
AND cues to action: mass media, advice from others
Health Belief Model
1.perception of health: your opinion on your own health determines how much responsibility to take for your own health.
2.motivation to change direction, if necessary; internally generated
3.adherence to management goals
a. making a decisi
4 characteristics of normal health maintenance
Health Promotion Activities
Disease Prevention Activities
Health Protection Activities
3 Components of Health Maintenance
Approach behaviors that seek to expand a person’s level of health; associated with lifestyle choices. Implies a positive, multi-dimensional concept of health.
Health Promotion Activities
Avoidance behaviors that seek to prevent specific diseases or conditions. Implies health equals the absence of disease.
Disease Prevention Activities
Occur on a community level. Environmental or regulatory activities that seek to protect the health of a community or large population.
Health Protection Activities
These people want to move beyond absence of disease toward high-level wellness.
People who use health promotion behaviors
1. Behavior-specific cognitions
- benefits of action
- barriers to action
- perceived self-efficacy
- activity related affect (+/- feelings about activity)
- interpersonal influences
- situational influences
2. Individu
Pender’s Theory – 3 components:
Disease Prevention Levels
Seek to prevent a disease or condition at a prepathologic state; to stop something from happening. Ex: immunizations, fluoride supplements, car seats.
Primary Disease Prevention
Seek to identify specific illnesses or conditions at an early stage with prompt intervention to prevent or limit disability. Catastrophic effects could occur if proper attention and Tx not provided. Ex: physical assessment, screenings, preg-test.
Secondary Disease Prevention
Occurs after a disease or disability has occurred and the recovery process has begun; intent to halt diseases or injury and assist person in obtaining an optimal health status. Ex: habilitation for handicapped children, AA groups, diabetic education.
Tertiary Disease Prevention
Cognition and Perception
Age and Developmental Level
Previous Experience
Lifestyle and Habits
Economic Resources
Culture, Values and Beliefs
Roles and Relationships
Coping and Stress Tolerance
Factors affecting Health Maintenance
Chronic Illness – GI
Injuries – Car Accidents
Developmental Problems – growth retardation
Psychosocial Problems – anxiety and depression
Manifestations of Altered Health Maintenance
S & O from interview with Pt.
S: ID normal patterns of health maintenance, ID risk factors for altered health maintenance, and active health maintenance dysfuntion.
O: Many different interviews and tools, and diagnostic tools
Assessment for health promotion/prevention
1. Ineffective Health Maintenance – inability to ID, manage and/or seek out help to maintain health.
2. Health-Seeking Behaviors – a state in which a person in stable health is seeking ways to alter personal habits and / or environment to move t
Diagnosis for health promotion/prevention: 3 NANDA are appropriate
Clients will identify areas for improvement in health maintenance

Clients will adopt appropriate health seeking behaviors
Outcome Identification for health promotion/prevention
Evaluate Goals (short and long-term) – action, quantity, time
Evaluate Process – how the client succeeds with the plan on a day to day basis
Evaluate the outcome – behavior change, success, and health indicator changes
Evaluation (of the health maintenance plan) for health promotion/prevention
1. Increase the quality and years of healthy life
2. Eliminate health disparities

Current Health Indicators: physical activity, diet, obesity, etc.
Healthy People 2010: 2 overarching goals
Day 1 of the menstrual cycle: 1st day of menses
Day 14: 1 or more ovarian follicles mature and on day 14 the mature ones rupture, and ovulation occurs
Ferilization occurs in the fallopian tubes (would normally occur about day 14)
Menstrual Cycle with Fertilization
acts as the endocrine gland of pregnancy, releasing many hormones
This produces progesterone until 7 weeks, at which point the placenta takes over completely by week 10.
Corpus Luteum
280 days, 10 lunar months, or 9 calendar months
3 trimesters:
1st: 12 weeks
2nd: 13 – 27 weeks
3rd: 28 weeks to delivery

38-42 weeks is considered full-term
After 42 weeks the pregnancy is considered postdates.
Duration of Human pregnancy
1. Presumptive signs – those the woman experiences. Ex: nausea, fatigue, amenorrhea
2. Probable signs – detected by examiner. Ex: enlarged uterus
3. Positive signs – direct evidence of the fetus. Ex: FHTs or ultrasound.
Types of signs and symptoms to diagnose pregnancy
Hormone produced by the blastocyst which stimulates the ovary to produce progesterone. Serum hCG can become positive after 1st missed menses and detected in the urine.
(hCG) Human chorionic Gonadotropin
This occurs about 16-20 weeks.
Quickening (mother feels fetal movements)
Contains more minerals and protein but less sugar and fat than mature milk.
systolic: 8-10 mmHg lower
diastolic: 5-15 mmHg lower
How much the BP can drop during the 2nd trimester.
underweight women: 28 - 40 lbs
normal weight: 25 – 35 lbs
overweight: 15 – 25 lbs.
twins: 35 – 45 lbs.
Ranges of weight gain during pregnancy
1. menstrual history
2. gynecological history
3. obstetric history
4. present pregnancy
5. past medical history
6. family history
7. review of systems
8. nutritional history
9. environment/hazards
Prenatal Assessment: subjective data
Skin: linea nigra - line, cholasma – mask of pregnancy, striae – stretch marks
Prenatal Assessment: objective data: Skin
Mouth: mucus membranes red and moist; gums may bleed
Prenatal Assessment: Objective data: Mouth
Neck: thyroid, no nodules is normal
Prenatal assessment: objective data: Neck
Breasts: areolae and nipples enlarge, breasts enlarge and may be tender
Prenatal Assessment: objective data: breasts
Heart: systolic murmur may develop but will resolve after pregnancy
Prenatal assessment: objective data: heart
Lungs: clear; shortness of breath is common in 3rd trimester
Prenatal Assessment: objective data: lungs
peripheral vasculature: edema in lower extremeties; varicose veins
Prenatal Assessment: objective data: peripheral vasculature
neurologic: reflex hammer. 2+ or greater may indicate high BP
Prenatal Assessment: objective data: neurologic
Abdomen: measure the height of the fundus from the superior border of the symphysis to the top of the fundus. After 20 weeks, the number of centimeters should approximate the number of weeks gestation.
Leopold’s manuevers are used to determine:
Prenatal Assessment:objective data: abdomen
Chadwicks sign – bluish-purple color of external genitalia, vagina, and cervix
Hegar’s sign – uterus softens, flexes over the cervix
Goodell’s sign – cervix softens

effacement: (thinning)
dilation: opening
Prenatal Assessment: objective data: pelvic
chorionic villus sampling
percutaneous umbilical blood sampling
Biophysical Profile
fetal Movement Count
Nonstress Test
Contraction Stress Test
Test to validate the pregnancy
USN – gestational sac volume – 5-6 weeks after LMP by endovaginal wand
USN – crown-rump length – 6-10 weeks
BPD, femur length, abd circumference – 13-40 weeks
Test to determine gestation
USN: BPD – 20 weeks
USN:head:abdomen ratio – 13-40 weeks
USN: EFW – 24-40 weeks
Test to ID normal fetal growth
USN – 18-40 weeks
CVS – 8-12 weeks
fetoscopy – 2 or 3 trimesters
Tests to detect congenital abnormalities
BPP – 28 weeks
FMC – 28 weeks
NST – 28 weeks
CST – after 28 weeks
Tests to assess fetal status
fetal electrocardiography – 2 or 3 trimesters
Test to assess fetal cardiac problems
amniocentesis: - 33-40 weeks
L:S ratio – 33 weeks
phosphatidylgycerol – 33 weeks
phosphatidycholine – 33 weeks
Tests to assess fetal lung maturity
USN – prior to or during labor
Test to assess for breech presentation at labor
score of -1 to 5 on the following neuromuscular maturity signs:
square window (wrist)
arm recoil
popliteal angle
scarf sign
heel to ear

score of –1 to 5 on the following physical maturity signs:
Gestational Age Assessment of Newborn:
(the lower the total score, the younger the gestational age)
the only involuntary function we can consciously control.
to press tight, strangle, narrow, constricted. State in which individual feels uneasy and apprehensive and the ANS activates in response to a NONSPECIFIC threat.
- source: unknown, unrecognized
- communicated interpersonally
- contagiou
1. CNS -->Limbic System -->Sympathetic ANS arousal
2. CNS -->Hypothalamus -->Stimulates Pituitary
Physiology of Stress (real or perceived) Stimulates the CNS
-increases strength of skeletal muscles
-decreases blood clotting time
-increases heart rate
-increases sugar and fat levels in serum
-reduces intestinal movements
-inhibits tears, digestive secretions
-relaxes the bladder
Sympathetic ANS Arousal
ACTH-->Adrenal Gland -->synthesizes cortisol, releases oxytocin and vasopressin, stimulates thyroid
Pituitary Activity
-increases arterial blood pressure
-mobilzes fats and glucose from the adipose tissues
-reduces allergic reactions
-reduces inflammation and can decrease lymphocytes that are involved in dealing with invading particles or bacteria
-increases the metabolic rate
-raises blood sugar levels
-increases respiration/heart rate/blood pressure/and intestinal motility
-increased intestinal motility can lead to diarrhea
-it is worth noting that an over-active thyroid glan
causes contractions in uterus
increases permeability of the vessels to water therefore increasing blood pressure. Can lead to contraction of the intestinal musculature.
- heart rate drops
- blood pressure drops
- breathing rate and need for oxygen drop
- brain waves shift from alert beta-rhthym to relaxed alpha-rhythm
- blood flow to muscles decreases
- blood sent to brain and skin
Parasympathetic nervous system response
-rested state
-feeling of peace, satisfaction, inner balance
-relief from anxiety
-improved efficiency
-increased strength of immune system
-less fatigue and muscle tension
-increased ability for erection/vaginal lubrication
Benefits to Parasympathetic nervous system response
ways to withdraw from stress. Self-protective, unconscious processes enable people to cope with stressful encounters, thereby decreasing anxiety.
Defense Mechanisms
the attempt to achieve respect or recognition in one activity as a substitute for inability to achieve in another endeavor
Defense Mechanism: Compensation
refusing to believe or accept something as it is but rather as one wishes it to be
Defense Mechanism: Denial
transferring emotion away from the person or situation that incited the emotion to an inappropriate person or object
Defense Mechanism: Displacement
taking into one’s own personality the characteristics, emotions, or motives of another
Defense Mechanism: Introjection
attributing one’s own thoughts, emotions, characteristics, or motives onto another
defense mechanism: projection
concealing the motive for behavior by giving some socially acceptable reason for the action
Defense mechanism: rationalization
return to behaviors more appropriate to an earlier stage of development
defense mechanism: regression
immersing something in the subconscious or unconscious level of thought
defense mechanism: repression
release of libido in socially acceptable behavior rather than using it to obtain sexual gratification
defense mechanism: sublimation
consciously dismissing something from the mind and thoughts
defense mechanism: suppression
period of disorganization
- experience in which a person faces an obstacle to important life goals (body integrity, love or sense of connection, sense of security_ that is for a time insurmountable through the utilization of customary methods of pro
Baseline functioning -->hazardous event --> vulnerable state --> usual coping strategies --> helplessness, hoplessness --> improved functioning --> return to previous level --> reach a higher level

Nursing's usual goal: re
Journey of Crisis
1. anticipated/developmental
2. unanticipated/situational
3. unanticipated social crisis
Types of Crises
Assess the following:
1.Basic Conditioning Factors
2.Contributing Factors (*Stress rating scale)
3.Universal Self-Care Requisites (*Stress warning signals)
4.Self-Care Agency Strengths/Limitations (*Vulnerability scale)
Assessment for Stress/Anxiety
1.reduce impact of crisis
2.provide opportunity to use previous skills
3.assist return to precrisis level
Goals for reducing Stress/Anxiety/Crises
make free from disease-producing organisms
Microorganisms capable of harming people
the poisoning of tissues; used to describe the presence of infection
transport of infection or the products of infection throughout the body
person has a disease caused by microorganisms
displaying the manifestations of microbial destruction of tissues such as high fever or hypotension
practices to control the spread of microorganisms
hand washing, gloves and other barriers, disinfection equipment
Aseptic techniques
When should you wash your hands?
beginning and end of shift
before and after examining patient
between patients
before and after using the bathroom
after removing gloves
Sterile technique used to prevent the introduction of a microorganism from the environment into the client
surgical asepsis
physical removal of any dirt and debris by washing, dusting or mopping contaminated surfaces
chemical or physical processes used to reduce the numbers of potential pathogens on an object’s surface
a chemical used on a lifeless object
a chemical used on a living object
kills microorganisms
an agent that prevents bacterial multiplication but does not kill all forms of the organism
complete destruction of all microorganisms, including spores, leaving to viable forms of organisms; cannot be used on body tissues
-steam (supersaturated steam under pressure – autoclaving)
-potent chemicals
-gas – ethylene
techniques that prevent transfer of pathogens from one person to another
mask, gowns, equipment, refuse handling techniques
techniques used to prevent or limit the spread of infection
1.standard precautions – against undiagnosed and identified infections
2.transmission-based precautions – additional to standard, depending on the organism and its mode of transmis
Isolation Systems
methicillin-resistant S. aureus
Streptococcus pneumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Neisseria gonorrheae
Enterococcus species
Resistant strains of microbes
1.overprescription of antibiotics
2.use of inappropriate antibiotics for the infecting organism
3.incomplete use of antibiotic prescriptions
4.harboring and spreading of resistant organisms by carriers
5.increased use of antibiotics i
Factors that contribute to microbial resistance
1.Infectious Agent
3.Portal of Exit
4.Mode of Transmission
5.Portal of Entry
6.Susceptible Host
Chain of Infection
ability of agent to cause disease; pathgenicity, virulence, invasiveness, specificity
agents: bacteria, fungi, viruses, parasites
Chain of Infection: Infectious Agent
inanimate objects, humans, animals
Chain of Infection: Source
microbe leaves the source
sputum, emesis, stool, blood, genital secretions, wound drainage, animal excretions
Chain of Infection: Portal of Exit
the way a microbe moves or is carried: 5 ways
1. contact
2. droplet
3. vehicle
4. airborne
5. vectorborne
Chain of Infection: Mode of Transmission
permits microbe to gain entry into host
mucus membranes, body orifices, nonintact skin, GI tract, GU tract, respiratory tract, tubes
Chain of Infection: Portal of Entry
body unable to withstand infection
immunosuppressed, elderly, chronically ill, trauma, surgery
Chain of Infection: Susceptible Host
acquired in a hospital or healthcare setting
11th leading cause of death in the US
risk factors: environment (a resevoir), therapeutic regimen, client resistance to infection
Nosocomial Infection
Regulatory Agencies for the Control of Infections Disease
Center for Disease Control
Joint Commission on Accreditation of Healthcare Organizations
Occupational Safety and Health Administration
monitor and counsel personnel
transmissible diseases
significant exposure (needlesticks, gloves)
work restrictions
Employee Health
1. to make the outer reality of the loss into an internally accepted reality
2. to sever the emotional attachment to the lost person
3. to make it possible for the bereaved person to become attached to other people or objects
Normal Functions of Grief
the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the person’s life
the characteristic pattern of psychological and physiological responses a person experiences after the loss of a significant person, object, belief, or relationship. Grief encompasses the entire range of physical, psychological, cognitive, and behavioral
a state of desolation that occurs as the result of a loss, particularly the death of a significant other. Bereavement manifestations are the person’s total response to a loss and include emotional, physical, social and cognitive responses.
encompasses the socially prescribed behaviors after the death of a significant other. Such behaviors vary from culture to culture. Mourning behaviors are socially conventional bereavement behaviors and do not necessarily indicate the presence or absence
characteristic pattern of psychological and physiologic responses a person makes to the impending loss (real or imagined) of a significant person, object, belief, or relationship. It is generally believe that anticipatory grief facilitates coping with lo
Anticipatory Grief
falls outside the normal response; manifested as exaggerated, prolonged, or absence of grief. Person may be stuck in one stage of the grieving process. May lead to inability to carry out activities of daily living.
Dysfunctional Grief
1.Shock and disbelief
2.developing awareness
4.Resolving the loss
Engel’s Model of Grief
Parkes’ Model of Grief
Grief Cycle Model
Kubler-Ross Stages of Dying
concept/reaction to death – person is gone
Infant/Toddler concept/reaction to death
concept/reaction to death – death is temporary and reversible
Early Childhood concept/reaction to death
concept/reaction to death – death is irreversible, but not inevitable
School age concept/reaction to death
concept/reaction to death – death is irreversible, inevitable, universal
Adolescent concept/reaction to death
Grief responses of adults: which stage?
1.death of family/friends
2.end of schooling
(separation from peers)
3.broken relationships
4.failure in finding a satisfying job
Grief responses of adults
Young Adults, losses
Grief responses of adults, which stage?

1.untimely loss of child or spouse
Grief responses of adults: Middle Age Adults, losses
Grief responses of adults, which stage?

1.deaths of relatives/friends
3.impaired health
4.decreased economic resources
Grief responses of adults, Older Adults, losses
the essence of our being which permeates our living and infuses our unfolding awareness of who and what we are, our purpose in being, and our inner resources. It shapes our life journey.
encompasses the whole being
shapes the person’s view of the self, the workld and God or a higher power
-inner peace
-connection with an absolute
-sense of numinousness and mystery
connectedness with:
Elements of Spirituality
totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought.
large groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural background
-Often attributed to access to health care and socio-economic status
-Not often attributed to culture and ethnicity
Differences in health and health care
-Often attributed to ethnicity, culture, religion
-Not often attributed to socio-economic status
Differences in attitudes toward end-of-like care
-history of abuse – “Tuskegee”
-physician behavior may be negatively influenced by sterotypes
-ongoing disparities in access and Tx, including pain Tx
Why patients from minority cultures distrust medicine.
-prefer more life-support
-less likely to discuss EOL care
-report lower quality of communication
-more likely to feel talking about death will bring death closer
Difference in attitudes about end-of-life: African-American
African Americans
Some Native Americans
Immigrants from China, Korea. Mexico
Cultures that believe discussing death will bring it closer
US emphasizes ? in decisionmaking.
Europe/Asia emphasizes ? in decisionmaking.
US emphasizes autonomy in decisionmaking.
Europe/Asia emphasizes beneficience in decisionmaking.
US: patient
Asia: family
France: physician
Primary locus of decisionmaking.
-building trust with patient and family
-explicit discussion of misunderstanding
-involve community/religious leaders
-communicate in a caring manner
-follow through
Assessment of patient’s and families’ understanding and beliefs about end-of-life and spirituality
-end of life
-parents of fetal demise
-Tx for emotional or behavioral disorders
-Tx for addictions
Situations for which JCAHO standards require spiritual assessment.
meaning and purpose
love and belonging
forgiveness and reconciliation
What are spiritual needs?
-first must nurture my own spirit
-assess and investigate spirituality
-listen and being intentionally present
-using story and metaphor
-spiritual guides and instruments
Spirituality in Care


3.Stoll – Guidelines for Spiritual Assessment
-concept of God or deity
-source of hope and strength
Spiritual Assessment Tools
-active listening
-provide time and privacy
-complementary therapies
-all members of Tx team are responsible for meeting spiritual needs
-refer to religious professional when appropriate
Spirituality Interventions
-family involvement
-hospice (special issues)
-building trust across cultures
-understand and accommodate differences
-involve others
Spirituality: potential solutions
Health Care Systems

-health promotion
-health education
-specific protection
-early detection and Tx
-environmental protection

-emergency care
-acute and critical care
Levels of Healthcare

Nursing today is focused on SECONDARY level
Nursing care given in an institutional setting - hospital
Institutional Care
design,delivery, and evaluation of healthcare services developed with communities. Found wherever the people are.
Community-based healthcare

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