Module 2 - N113/N114

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khonka
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Module 2 - N113/N114
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2011-10-15 02:49:55
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Health History, General Survey, Nursing data base (doc of assessment findings)
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  1. Erikson's 8 stages of ego development
    • Stage 1: Trust Versus Mistrust (birth to about 18 months).
    • The child develops a sense of trust in himself and the external world as a result of having his needs consistently met. This is the beginning of self-confi dence. An infant who does not have his needs met develops a sense of mistrust and suspiciousness in others that will affect future interpersonal relationships.
    • Stage 2: Autonomy Versus Shame and Doubt (about
    • 18 months to 3 years). The goal is for the child to develop self-control and independence while maintaining self-esteem. This requires an ability to cooperate and express feelings and thoughts. Failure to successfully negotiate this stage will lead to an adult who lacks self-confi dence and feels controlled by others and who may exhibit extreme compliance (selfrestraint) or defi ance.
    • Stage 3: Initiative Versus Guilt (3 to 5 years). The focus of this stage is to develop initiative by gradually assuming responsibility and developing self-discipline. During this stage, the superego (conscience) develops, and the
    • child learns to manage impulses. Failure to develop initiative leads to guilt, limited creativity, lack of selfconfi dence, and pessimism.
    • Stage 4: Industry Versus Inferiority (6 to 11 years).
    • In this stage, the child learns that recognition comes throug achievement and completion of tasks. This success occurs primarily in school. The adult who has not fulfi lled the tasks of this stage will demonstrate a sense of inadequacy in all areas of life.
    • Stage 5: Identity Versus Role Confusion (11 to 21 years
    • This stage coincides with puberty. The adolescent develops a sense of self and begins to make decisions about the future. Social groups serve as a place to test out ideas and behaviors. Healthy role models facilitate the development of identity. Failure to recognize one’s abilities and sense of self results in an individual without a solid place in the world. This is manifested by dysfunctional interpersonal relationships and occupational performance. Delinquent and rebellious behavior may be prominent when the task of identity formation is not met.
    • Stage 6: Intimacy Versus Isolation (21 to 40 years)
    • Erikson (1963) defi ned intimacy as “the capacity to commit himself to concrete affi liations and partnerships and to develop the ethical strength to abide by such commitments” (p. 263). Isolation is the avoidance of intimacy. The task at this stage is to develop a commitment to work and relationships. Failure to do so will result in impersonal relationships and diffi culty with maintaining a job.
    • Stage 7: Generativity Versus Stagnation (40 to 65 years).
    • The goal of this stage is to be creative and productive. Often
    • this is accomplished through work or relationships, such as raising healthy, functional children or contributing to society by developing a distinguished career, for example in nursing. The person who fails to achieve generativity
    • may manifest stagnation in the form of superfi cial relationships and self-absorption. Simply having children does not guarantee generativity.
    • Stage 8: Ego Integrity Versus Despair (over 65 years).
    • The task of this stage is the acceptance of one’s life, worth, and eventual death. Ego integrity refl ects a satisfaction with life and an understanding of one’s place in the life cycle. A sense of loss, discomfort with life and aging,
    • and a fear of death are seen in despair.
  2. Developmental stage for young adults?
    • According to Erikson, the developmental stage of the young adult is known as intimacy versus isolation.
    • Physical development: Young adulthood is usually the healthiest stage of a person’s life. Maturation of the body systems is complete. Peak bone density is achieved for both females and males by age 25. Vision and hearing are typically acute. For women, the ages between 20 and 30 years are the optimal years for childbearing. For men, male hormone levels that surged in adolescence begin to slowly decrease and stabilize around age 24.
    • Cognetive development: developed by age 15. additional stage post-formal operations - the complex thinking.
    • Psychosocial: Young adults begin to explore options for careers and intimate relationships (Figure 9-15). They strive to become less dependent and more self-suffi cient. Around age 30, most young adults experience a period of selfevaluation. This often results in job, career, or relationship changes. Erikson describes this period as the stage of intimacy versus isolation. Successful completion of this phase requires establishment of lasting friendships and associations. Freud described this phase of life as the genital stage. He believed that young adults are instinctively driven to form a sexually intimate relationship.
  3. Development of middle age adults
    • Physical: loss of elasticity of the blood vessels, a loss of muscle tone, a decrease in skin moisture and turgor, graying hair, a decrease in bone mass that causes a slight loss of height, and a decrease in gastrointestinal (GI) motility.
    • Manopause and Andropaouse
    • Cognitive: moves freely between formal operations, concrete operations, and problem solving as the task demands. The middle adult is able to refl ect on the past and anticipate the future. Creativity may reach its peak during this stage. Memory is intact, but reaction time begins to diminish because of a decrease in nerve impulses.
    • Psychocosial: Could have midlife crises depends on how he is able to cope with the fact of aging and short time left to live. Guiding next generation. Transions of life. Care for aging paretn. Decling in energy.
  4. Develpmetn fr Older adults
    • 65 and over
    • Physical: all body systems changes
    • Cognitive: Reaction time slows in older adults, and short-term memory declines; it takes longer to respond to a timulus, and it takes more time to process incoming information. Thus, older adults learn new material more slowly. However, there is no loss of intelligence as a person ages. Short tierm memroy loss.
    • Psychosocial: life had meaning and accpetance of death as port of life. Gaining wisdom.

  5. Required adaptations that mey be required when you examine older adults
    • Vol 1 pg. 377-378 and Vol 2 pg. 237
    • Use SPICE
    • assess energy level
    • support system
    • sequence the exam if tires easily
  6. Range for vital signs is different
    • Screning for mood, acitivites and abilities to perform ADLs
    • Hight comparison - screening for osteoporosi.
    • BMI
    • Lypid and Glucose screening
    • Reccomand to have annual physical examinations
    • Stool screan for colon cancer
    • Depression scale
    • Mental Scale to determine aspects of cognitions and memory loss
    • Assessing abuse
  7. Conditions that ifnluences the growth and development of older adults
    • Theories of aging
    • PHysical activities
    • Health
  8. Componenets of General survey
    • Physical appearence
    • Affect/Mood/Behavior
    • Mental Status
    • Speech
    • Body Structure
    • Mobility/Movements
    • see. my hand made flashcards for descirptions of above components.
    • Vol 2. pg. 237-240, Vol 1. p 379, ch 16.
  9. General Survey continues..
    • Identify signs of distress(pain, fear, or anxiety. If client in no apparent distress. The client appears relaxed, with no evidence of pain, fear or anxiety
    • abn findings: pain, griamcing, breathing problems, skin color changes.
  10. Describe a database and its use
    • a format which allowes you to collect data in predeterimined categories not just at random
    • a format which uses an approved format or a framework that guides you in what is important and not
    • A format that allowes you to cluster data in a way that makes sense
    • There are many modesl and frameworks available
  11. Describe 10 elements of a nursing health history?
    • Biographical data. Provides basic information about the client. The person's responses to these questions reflect his mental status and ability to communicate.
    • Chief complaint/reason for seeking healthcare. This is the client's perception or reason for seeking medical or nursing advice. From this, you will be able to target your assessment to gather the most relevant and important data.
    • History of present illness. This provides details about the client's current health problem.
    • Client's perception of health status and expectations for care. This will give you insight into the client's view of his health problem and what he expects to be done for him. Document in clients words. 'tell my why you have come to the hospital today?"
    • Past health history. The past health (medical) history will help guide your assessment and help you to understand some of the data you obtain.
    • Family health history. This includes data on first-degree blood relatives such as mother, father, siblings, and maternal and paternal grandparents. It includes data about diseases relatives have had, their current state of health, whether they are alive, and cause if death if they are not. Risk factors for various illnesses and disorders (e.g., hypertension, allergies) are often tied to multigenerational problems.
    • Social history. This includes information about family and other relationships, economic status, occupations, exposure to toxic materials, home and neighborhood conditions, and ethnicity. It also includes data about tobacco, alcohol, and drug use as well as exercise habits.
    • Medication (nutritional supplements, herbs) history and medical device use. Current and past medication usage may uncover some medical history the client has forgotten to disclose. Current medications are of utmost importance because (1) they may interact with newly prescribed medications and (2) some may affect certain body symptoms, causing abnormalities in your assessment findings (e.g., skin color, laboratory values). Also inquire about vitamin and nutritional supplements and the use of alternative therapies, as they may interact with the allopathic treatment plan. A thorough health history includes use of medical devices, such as bracing, inhalers, home CPAP.
    • Complementary/alternative modalities. These therapies can support or interfere with conventional therapies.
    • Review of body systems and associated functional abilities. This is subjective data regarding body systems, as well as functional abilities. This review provides information on the client's concerns and the effect of illness on the client's life.
  12. Gordon's assessment model
    • Gordon's Functionla Health Pattern: Is used for clinical database you will be using. Describes common patterns of behavior and describes them as functionla or dysfunctional. Is intended as a modle for nsing assessment and diagnosisi, not a complete nursing theory.
    • 11 Categories:
    • Cognitive/perceptual
    • Activity/exercise
    • Nutritional/metabolic
    • Elimination
    • Sleep/Rest
    • Health Perception ?health management
    • Self Pereption/Self-concept
    • role/relationship
    • Sexula/reproductive
    • Stressors/copoing
    • values/belief
  13. Define the major conepts of other assessment modles
    • The NANDA Nursing Diagnosis Taxonomy II: functional patterns and is a modified version of Gordon model. For categorizing nursing diagnoses
    • The Taxonomy of Nursing Practice (NANDA/NOC/NIC): Model for categorizing nursing diagnoses, client outcomes(NOC), nursing interventions(NIC) 4 domains - Functional, Physical, Psychosocial, environmental.
    • The Roy Adaptation Model: Conceptualized patients as adapting constantly to internal andexternal demands within a biological and psychosocial context. Person's ability to achieve balance in the 12 "adaptive modes"
    • Orem's Self-Care Model: Conceptualizes health as the ability to perform self-care. You would identify self-care deficits that required nursing assistance.
  14. Identify conditions that influence growth and development of all ages?
    • I think physical ability and health
    • Development: process of adapting to one's environment overtime.
    • Growth: physical change that ocure overtime. ex. increase in height, saxual maturation, gains in weight and muscle tone
  15. Adaptations that maybe required when you examine clients of different ages
    • INFANTS: have parent hold
    • Toddler:
    • - allow to sit on parent lap
    • - allow choices; use praise
    • - invasive assessments last
    • Preschooler:
    • - demo assessment on doll
    • - let child help
    • - give reassurance
    • School-age Child:
    • - develop rapport
    • - allow independence
    • - demo equipment
    • Adolescent:
    • - no parent/sibling present
    • - respect privacy during exam
    • - emphasize healthy lifestyle habits
    • - assess for suicide potential
    • Young/Middle-aged adult:
    • - no specific modifications unless
    • acute/chronic disease
    • Older Adult:
    • - tailor exam to energy and
    • mobility levels
    • - adapt techniques for vision &
    • hearing changes
  16. How to prepare for an interveiw
    • Be sure you know the purpose of the interview and how the data will be used.
    • Read the client's health record.
    • Form some goals and think of some opening questions for the interview.
    • Schedule enough uninterrupted time.
    • Gather the necessary assessment forms and equipment.
    • Take a deep breath and compose yourself before entering the room
    • Prepare the Space
    • Provide privacy
    • remove distructions
    • Position yourself at the same level as your clinet
    • Preparing the patient:
    • Introduce yourself
    • Call the patient by name; ask waht name the patient prefers
    • Tell the patient what you will be doing and why. Explain that you will be taking notes and that you will keep all informatin confidential.
    • Assess readiness to discuss health issues
    • Provide comfort
    • Assess anxiety
    • Use active listening
    • Do not get caught up in the notes
    • Pay attention to non-verbal communication
    • Use opne-ended questions
    • Do not too many questions
    • Use neutral statements istead of questions ex"tell me about your family"
    • Avoid asking why
  17. when should you validate data? list 3 circumstances.
    • 1. Validation should be done when subjective and objective data do not make sense. For instance, it is inconsistent data when the patient feels feverish and you obtain a normal temperature. The other distractors do not offer conflicting data. Validation is not usually necessary for laboratory test results.
    • 2.The patient's statements differ at different times in the interview
    • 3. The data fall far outside normal range. ex. patient has no sing of infection and you obtain a temp of 106.

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