501 Exam 1.txt

sufficient O₂, nutrition, temp.,

• Activity and Exercise
• Medication History
• Fall history
• Home Maintenance and Safety

• Environmental
• Electrical
• Fire
• Fall risks
• Food
• Medication
• Infection
• Special concerns – home oxygen therapy

• Falls
• Medications
• Fires
• Electrical hazards
• Misc.

• minimizing falls,
• patient-inherent accidents,
• procedure-inherent accidents, and
• equipment-related accidents.

Children younger than 5 years of age

Adolescents

an adult’s

• developmental stage,
• lifestyle,
• and environment.

• the number of organisms,
• virulence,
• ability to enter and survive in a host,
• and susceptibility of the host.

• the urinary tract and
• respiratory tracts,
• bloodstream, and
• surgical or traumatic wounds.

• treatments or conditions that compromise the immune response
• Increasing age,
• poor nutrition,
• stress,
• inherited conditions,
• chronic disease,

• Invasive procedures,
• medical therapies,
• long hospitalization,
• and contact with health care personnel

• Infectious agent
• Reservoir
• Mode of transmission
• Portal of exit
• Portal of entry
• Susceptible host

delivery of health care service in a healthcare facility

• Iatrogenic
• Exogenous
• Endogenous

from a diagnostic or therapeutic procedure

from microorganisms found outside the body ex. salmonella

occurs when part of the pt's flora becomes altered and overgrown

• Urinary tract
• Surgical or traumatic wound
• Respiratory tract
• Bloodstream

5,000-10,000/mm³

• Increased - acute infection
• decreased- certain viral or overwhelming infections

• Up to 15mm/hr for men
• 20mm/hr for women

elevated in presence of inflammatory process

60-90g/100mL

decreased in chronic infection

normally sterile, without microorganism growth

presence of microorganism growth

Absence of pathogenic (diseaseproducing)microorganisms.

Practices/ procedures thatassist in reducing the risk for infection

includesprocedures for reducing the number of organismspresent and preventing the transfer of organisms

prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment,and maintains a sterile field for surgery.

the removal of all soil from object &surfaces

a process that eliminates many or allmicroorganisms, with the exception of bacterialspores, from inanimate objects

the complete elimination ordestruction of all microorganisms, including spores

• Standard Precautions
• Used with all patients
• Includes hand hygiene techniques
• Includes use of personal protective equipment as needed(gloves etc.)
• Includes cough etiquette

• Disease/condition specific precautions
• Precautions for highly transmissible pathogens
• Airborne, droplet, contact, and protective

• Patient-centered Care
• Teamwork and Collaboration
• Evidence-based Practice (EBP)
• Quality Improvement (QI)
• Safety
• Informatics

• Social practices
• Personal preferences
• Body image
• Socioeconomic status
• Health beliefs & motivation
• Cultural variables
• Developmental stage
• Physical condition

• Do any cultural or religious practices affect your personal hygiene care?
• How can i include these in you care?

• Do hygiene activities cause any symptoms such as shortness of breath, pain or fatigue?
• What can I do to min. these symptoms?
• Which aspect of hygiene care worsen you discomfort or make you fatigued?

do you use any aids to help you with your bath such as grab bars in you tub or shower?

Do you prefer someone of the same gender to assist in you hygiene care?

Which parts of personal hygiene can you do for yourself? Which parts do you need help with?

Which type of bath do you prefer?

How often and when do you usually bathe?

What kind of soap and lotion do you use?

Have you noticed any skin changes or irritation?

Do you have any known allergies or reactions to soaps, cosmetics, or skin care products?

Do you have any mouth pain or toothaches, or have you noticed any sores in your mouth?

Do you wear dentures or a partial plate?

how do you usually care of your feet and nails?

Do you soak your feet?

Do you file or trim your own fingernails and toenails?

Have you recently experienced itching of the scalp or noticed flaking or dandruff?

Have you noticed any changes in the texture or thickness of your hair?

• Protection
• Secretion,
• Excretion
• Temperature regulation
• Sensation

• Color
• Texture
• Thickness
• Turgor
• Temperature
• Hydration
• Determine degree of cleanliness

• Immobilization
• Reduced sensation
• Nutrition and hydration
• Secretions/excretions from skin
• Vascular Insufficiency
• External devices
• Altered cognition

• Dryness
• Inflammation
• Cracking
• Lesions

• Lesions
• Dryness
• Inflammation
• Cracking

• Callus
• Corn
• Plantar wart
• Athlete’s foot
• Ingrown nails
• Foot odor

• glistens,
• pink,
• soft,
• moist,
• smooth,
• and without lesions

• white,
• smooth,
• shiny,
• & properly aligned

• Color
• Hydration
• Texture
• Lesions

• Glossitis
• Halitosis
• Xerostomia
• Gingivitis
• Lesions (benign & malignant)

• Dandruff
• Ticks
• Pediculosis (Capitus, Corporis, Pubis)
• Alopecia

• Check for function and/or patency
• Check for need for assistive devices
• Assess for:
•       Inflammation
•       Swelling
•       Drainage
•       Lesions

• Wash face and hands
• Oral care
• Offer bedpan/urinal

• Offer bedpan/urinal
• Bath (including perineal, foot, nail & hair care & backrub)
• Oral care
• Clean gown and linens
• Tidy up room

• Offer bedpan/urinal
• Oral care
• Straighten linens

• Wash face and hands
• Oral care
• Offer bedpan/urinal
• Backrub
• Change gown and linens as needed
• Offer beverage to drink

• Complete bed bath
• Partial bed bath
• Sponge bath at sink
• Tub bath
• Shower
• Bag bath/travel bath

term used to describe the coordinated efforts of the musculoskeletal and nervous system

the individuals center of gravity is stable

exercise

posture

activities of daily living (ADLs)

muscle tone

center of gravity

body alignment

body balance

friction

activity tolerance

isotonic contraction

isometric contraction

footboards

joint

fibrous joints

cartilaginous joints

synovial joints

ligaments

tendons

cartilage

antagonistic muscles

synergistic muscles

antigravity muscles

proprioception

hemiplegia

range of motion (ROM)

hemiparesis

mobility

crutch gait

gait

• Postural Abnormalities
• Muscle Abnormalities
• Central Nervous System Damage
• Trauma to Musculoskeletal System

Inclining of head to affected side, in which sternocleidomastoid muscle is contracted

Congenital or acquired condition

Surgery, heat, support, or immobilization depending on cause and severity, gentle ROM

Exaggeration of anterior convex curve of lumber spine

Congenital ConditionTemporary Condition (e.g. pregnancy)

Spine-Stretching exercises, sleeping without pillows, using bed board, bracing, spinal fusion (based on cause and severity)

Lateral "S" or "C" shaped spinal column with vertebral rotation, unequal heights of hips and shoulders

Sometimes a consequence of numerous congenital, connective tissue, and neuromuscular disorders

Approximately half of children with scoliosis require surgeryNonsurgical treatment is with braces and exercises

Hip instability with limited abduction of hips and occasionally adduction contractures (head of femur does not articulate with acetabulum because of abnormal shallowness of acetabulum)

Congenital Condition (more common with breech deliveries)

Maintenance of continuous abduction of thigh so head of femur presses into center of acetabulumAbduction splints, casting, surgery

Legs curved inward so knees come together as person walks

Congenital Condition Rickets

Knee braces, surgery if not corrected by growth

One or both legs bent outward at knee, which is normal until 2 to 3 years of age

Congenital Condition Rickets

Slowing rate of curving if not corrected by growthWith Rickets, increase of vitamin D, calcium, and Phosphorus intake to normal ranges

95%: medial deviation and plantar flexion of foot (equinovarus)5%: lateral deviation and dorsiflexion (calceneovalgus)

Congenital Condition

Casts, splints such as Denis Brown splint and surgery (based on degree and rigidity of deformity)

Inability to dorsiflex and invert foot because of peroneal nerve damage

Congenital ConditionTraumaImproper position of immobilized patient

• None (cannot be corrected)
• Prevention through physical therapy
• Bracing with ankle-foot orthotic (AFO)

Internal rotation of forefoot or entire foot, common in infants

Congenital Condition Habit

Growth, wearing reversed shoes

• (Systemic)
•    -Metabolic changes
•    -Respiratory changes
•    -Cardiovascular changes
•    -Musculoskeletal changes
•    -Urinary changes
•    -Integumentary changes
• Psychosocial effects

• Prolonged immobility delays:
• gross motor skills,
• intellectual development, or
• musculoskeletal development

• Delayed in gaining independence and in accomplishing skills
• Social isolation can occur

• Physiological systems are at risk
• Changes in family and socialstructures

• Decreased physical activity
• Hormonal changes
• Bone reabsorption

• Changes when walking or caring for self ?
• Stiffness, swelling, pain, difficulty moving ?
• Shortness of breath?

• Normal activity; recent changes?
• Appetite/diet changes?
• Normal diet?
• Perception of length of day?
• Quality of night sleep?
• Red or open areas on skin?
• Bowel or urination changes?

• ANS: A
• In concentric tension, increased muscle contraction causes muscle shortening, resulting in movement. Eccentric tension helps control the speed and direction of movement. Concentric and eccentric muscle actions are necessary for active movement and are referred to as dynamic or isotonic contraction. Isometric contraction (static contraction) causes an increase in muscle tension or muscle work but no shortening or active movement of the muscle.

• ANS: B
• Leverage is an inducing or compelling force that occurs when specific bones, such as the humerus, ulna, and radius, and associated joints, such as the elbows, act together as a lever. Posture is the position of the body in relation to the surrounding space. Isometric contraction causes an increase in muscle tension but no active movement. Muscle tone is the normal state of balanced muscle tension.

• ANS: C
• Through a complex process, neurotransmitters, or chemicals such as acetylcholine transfer electrical impulses from the nerve across the neuromuscular junction to the muscle. The neurotransmitter reaches a muscle and stimulates it. Ligaments are white, shiny, flexible bands of fibrous tissue that bind joints together and connect bones and cartilages. Tendons connect muscle to bone. Cartilage is nonvascular, supporting connective tissue located chiefly in the joints and in the thorax, trachea, larynx, nose, and ear.

• ANS: D
• Although isometric contractions do not result in muscle shortening, energy expenditure increases. It is important to understand the energy expenditure associated with isometric exercises because they are sometimes contraindicated in certain illnesses. Isometric contractions increase muscle tension but not active movement of the muscle.

• ANS: D
• The synovial joint, or true joint, is a freely movable joint in which contiguous bony surfaces are covered by articular cartilage and are connected by ligaments lined with a synovial membrane. The synostotic joint refers to bones jointed by bones. No movement is associated with this type of joint. In the cartilaginous joint, or synchondrosis joint, cartilage unites bony components. When bone growth is complete, the joints ossify. The fibrous joint, or syndesmosis joint, is a joint in which a ligament or membrane unites two bony surfaces, permitting a limited amount of movement only.

• ANS: B
• The terms body alignment and posture are similar and refer to positioning of the joints, tendons, ligaments, and muscles while standing, sitting, and lying. Weight is the force exerted on a body by gravity. Friction is a force that occurs in a direction to oppose movement. Body mechanics is a term used to describe the coordinated efforts of the musculoskeletal and nervous systems.

• ANS: D
• Without balance control, the center of gravity is displaced, thus creating risk for falls and subsequent injuries. Balance is enhanced by keeping the center of gravity of the body low with a wide base of support and by maintaining correct body posture.

• ANS: B
• Renal calculi are calcium stones that lodge in the renal pelvis or pass through the ureters. Immobilized patients are at risk for calculi because they frequently have hypercalcemia. Osteoporosis is caused by accelerated bone loss. A pressure ulcer is an impairment of the skin that results from prolonged ischemia (decreased blood supply) within tissues. A thrombus is an accumulation of platelets, fibrin, clotting factors, and cellular elements of the blood attached to the interior wall of a vein or artery, which sometimes occludes the lumen of the vessel

• ANS: C
• Immobility disrupts normal metabolic functioning: decreasing the metabolic rate, altering the metabolism of carbohydrates, fats, and proteins (nutritional function); causing fluid, electrolyte, and calcium imbalances; and causing gastrointestinal disturbances such as decreased appetite and slowing of peristalsis.

• ANS: C
• The immobilized patient often becomes depressed because of changes in role and self-concept. Every patient responds to immobility differently. Immobility or bed rest frequently affects coping and creates sleep-wake alterations because of changes in routine or in the environment. Because immobilization removes the patient from a daily routine, he or she has more time to worry about disability. Worrying quickly increases the patient's depression, causing withdrawal. Withdrawn patients often do not want to participate in their own care.

• ANS: C
• Immobility is a major risk factor for pressure ulcers. Any break in the integrity of the skin is difficult to heal. Preventing a pressure ulcer is much less expensive than treating one; therefore, preventive nursing interventions are imperative. An older adult who is immobilized can develop skin breakdown within 3 hours. Tissue metabolism depends on the supply of oxygen and nutrients to and the elimination of metabolic wastes from the blood. Pressure affects cellular metabolism by decreasing or totally eliminating tissue circulation.

• ANS: A
• Nurses should encourage the patient to perform as many self-care activities as possible, thereby maintaining the highest level of mobility. Sometimes nurses inadvertently contribute to a patient's immobility by providing unnecessary help with activities such as bathing and transferring. Placing the patient on bed rest without sufficient ambulation leads to loss of mobility and functional decline, resulting in weakness, fatigue, and increased risk for falls. Anorexia and insufficient assistance with eating lead to malnutrition.

• ANS: B
• When the patient is observed laterally, the head is erect and the spinal curves are aligned in a reversed "S" pattern. When observed posteriorly, the shoulders and hips are straight and parallel. The arms hang comfortably at the sides. The feet are slightly apart to achieve a base of support, and the toes are pointed forward.

• ANS: B
• Both feet are supported on the floor, and the ankles are comfortably flexed. With patients of short stature, a footstool is used to ensure that the ankles are comfortably flexed. Body weight is evenly distributed on the buttocks and thighs. A 1- to 2-inch space is maintained between the edge of the seat and the popliteal space on the posterior surface of the knee to ensure that no pressure is placed on the popliteal artery or nerve. The patient's forearms are supported on the armrest, in the lap, or on a table in front of the chair.

• ANS: D
• Assess body alignment for a patient who is immobilized or bedridden with the patient in the lateral position, not supine. Remove all positioning support from the bed, except for the pillow under the head.

• Examine movement around 3 body planes (frontal, sagittal,transverse)
• Assess/ask about stiffness, swelling, pain, limited movement,& unequal movement

Pivotal

1. Flexion: bring chin to rest on chest: 45^o; Sternocleidomastoid

2. Extension: Return head to erect position; 45o; Trapezius

3. Hyperextension: bend head back as far as possible 10^o; Trapezius

4. Lateral Flexion: Tilt head as far as possible toward each shoulder; 40-45^o; Sternocleidomastoid

5. Rotation: turn head as far as possible in circular mvmt.; 180^o; Sternocleidomastoid & Trapezius

1. Flexion: raise arm from side position forward to position above head; 180^o; coracobrachialis, biceps brachii, deltoid, pect. major

2. Extension: return arm to position at side of body; 180^o; latissmus dorsi, teres major, triceps brachii

3. hyperextension: move arm behind body, keeping elbow straight;45-60^oLatissimus dorsi, teres major, deltoid

4. abduction: raise arm to side to position above head with palm away from head; 180^o; deltoid; supraspinatus

5. adduction: lower arm sideways and across body as far as possible;320^{o; pect. major.}

6. internal rotation: with elbow flexed, rotate shoulder by moving arm until thumb is turned inward and toward back; 90^o; pect. major, latissimus dorsi, teres major. subscapularis.

7. External rotation: with elbow flexed, move arm until thumb is upward and lateral to head;90^o; infraspinatus, teres major, deltoid

8. Circumduction: Move arm in full circle; 360^o; deltoid, coracobrachialis, latissimus dorsi, teres major.

Ball and socket

Hinge

1. Flexion: bend elbow so lower arm moves toward its shoulder joint and hand is level w/ shoulder 150^o; Triceps Brachii, brachialis, brachioadalis

2. Extension: straighten elbow by lowering hand;150^o; Triceps Brachii

Pivotal

1. Supination: turn lower arm and hand so palm is up; 70-90^o; supinator, biceps brachii

2. pronation; Turn lower arm so palm is down; 70-90^o; pronator teres, pronator quadratus

condyloid

• 1.Flexion: move palm toward inner aspect of forearm; 80-90^o,
• 2.extension: move fingers and hand posterior to mideline,80-90^o 
• 3.hyperextension: bring dorsal surface of hand back as far as possible; 80-90^o
• 4.Abduction:place hand w/ palm down and extend wrist laterally toward 5th finger; up to 30^o
• 5. Adduction:Place hand w/ palm down and extend wrist medially toward thumb; 30-50^o

Condyloid hinge

• 1. Flexion; make fist, 90^o 
• 2. extension; straighten fingers; 90^o
• 3. hyperextension: bend fingers back as far as possible; 30-60^o
• 4.abduction: spread fingers apart; 30^o
• 5.adduction: bring fingers tog; 30^o

• flexion: (move thumb across palmar surface of hand),90^o
• extension (move thumb straight away from hand), 90^o
• abduction (extend thumb laterally)30^o,
• adduction (move thumb back toward hand)30^o, opposition (touch thumb to each finger of same hand)

Saddle

Ball and socket

• 1. Flexion (move leg forward and up)90-120,
• extension (move back beside other leg)90-120,
• 2. hyperextension (move leg behind body),30-50
• abduction (move leg laterally away from body),30-50
• 3. adduction (move leg back toward medial position and beyond if possible),30-50
• 4. Internal rotation (turn foot and leg toward other leg),90
• 5. external rotation (turn foot and leg away from other leg),90
• 6. circumduction (move leg in circle),

hinge

• Flexion (bring heel back toward back of thigh),120-130
• extension (return leg to floor)120-130

hinge

• dorsal flexion (move foot so toes are pointed upward),20-30
• plantar flexion (move foot so toes are pointed downward)45-50

gliding

inversion (turn sole of foot medially) 10 or less, eversion (turn sole of foot laterally) 10 or less

Condyloid

• flexion (curl toes downward),30-60
• extension (straighten toes),30-60
• abduction (spread toes apart),15 or less
• adduction (bring toes together)15 or less

Assessment allows nurse to draw conclusions about balance,posture, safety, & ability to walk without assistance

Monitor for symptoms such as dyspnea, fatigue, chest pain,and vital sign changes

Assess Standing, sitting, lying

• slowed wound healing
• abnormal lab data
• muscle atrophy
• decreased amt. of subcut. fat
• generalized edema

• asymmetrical chest wall movement,
• dyspnea,
• increased resp. rate
• crackles
• wheezes

• orthostatic hypotension
• increased heart rate
• 3rd heart sound
• weak peripheral pulses
• peripheral edema

• decreased ROM
• erthema
• increased diameter in calf or thigh
• joint contracture
• activity intolerance
• muscle atrophy

Breaks in skin integrity

• decreased urin output
• cloudy or concentrated urin
• decreased frequency of bm
• distended bladder and abdmone
• decreased bowel sounds.

• Have the patient’s goals been met?
• Have outcomes been met? If not, ask questions:
• Are there ways we can assist you to increase your activity?
• Which activities are you having trouble completing right now?
• How do you feel about not being able to dress yourself and make your own meals?
• Which exercises do you find most helpful?
• What goals for your activity would you like to set now?

• Communicate clearly.
• Mentally review transfer steps.
• Assess patient mobility and strength.
• Determine assistance needed.
• Raise side rail on opposite side of bed.
• Arrange equipment.
• Evaluate body alignment.
• Understand use of equipment.
• Educate patient.

• Mental relaxation
• Freedom from anxiety
• State of mental, physical, and spiritual activity

does not

16 hours a day

8 to 10 hours at night + naps =total of 15 hours per day

Total 12 hours a day (night &naps)

12 hours a night(naps rare by 5 yrs)

• Younger 11 – 12 hrs (6yrs)
• Older 9 to 10 hours (11 yrs)

Get ~7½ hours

Get 6 to 8½ hours

• Total number of hours declines
• Progressive decline in stage 3 & 4

Physical illness: Hypertension, respiratory, musculoskeletal, chronic illness, GI, nausea

Drugs and substances: Hypnotics, diuretics, narcotics,antidepressants, alcohol,caffeine, beta-blockers,anticonvulsants

Lifestyle:Work schedule, social activities, routines

Usual sleep patterns: May be disrupted by social activity or work schedule

Emotional stress Worries, physical health, death,losses

Environment Noise, routines

Exercise and fatigue: Moderate exercise and fatigue cause a restful sleep

Food and calorie intakeTime of day, caffeine, nicotine,

• interfere w/ reaching deeper sleep
• provide only temp. (1 week) increase in quantity of sleep
• eventually cause "hangover" during day. (excess drowsiness, confusion, decreased energy)
• sometimes worsen sleep apnea in older adults.

• suppress REM sleep
• decrease total sleep time

• speeds onset of sleep
• reduces REM sleep
• awakens person during night and causes difficulty returning to sleep

• prevents person from falling asleep
• causes person to awaken during night
• interferes with REM sleep

nighttime awakenings caused by nocturia

• cause: nightmares
• insomnia
• awakening from sleep

• alter REM sleep
• increase sleep time
• increase daytime sleepiness

• decreased total sleep time
• decreased REM sleep time
• causes awakenings from sleep
• causes difficulty staying asleep

• suppress REM sleep
• cause increase daytime drowsiness

• decreased REM sleep time
• cause daytime dorwsiness

Affected by light, temperature, social activities, and work routines.

• Remains unclear
• Physiological and psychological restoration
• Maintenance of biological functions

• Respiratory disorders
• Nocturia
• Pain
• Restless leg syndrome (RLS)
• Thyroid conditions
• PUD

• Hypertension
• Nocturnal angina
• Tachycardia
• ECG changes
• Stroke

Excessive sleepiness.

involves the use of electroencephalography (EEG), electromyography (EMG), and electro-oculography (EOG) to monitor stages of sleep and wakefulness during nighttime sleep.

Practices that a patient associates with sleep.

is sudden muscle weakness during intense emotions such as anger, sadness, or laughter; it can occur at any time during the day.

is the feeling of being unable to move or talk just before waking or falling asleep.

• Characterized by difficulty falling asleep, frequent wakening, and/or short sleep (non-restorative)
• Causes – situational stresses, poor sleep hygiene or underlying physical/psychological disorder

• Characterized by lack of airflow through nose/mouth for 10 seconds or longer during sleep
• Types – central, obstructive, & mixed
• Most common is obstructive sleep apnea (OSA)

• MAJOR: obesity, hypertension
• OTHER –smoking, heart failure, Type 2 DM, alcohol, family history

muscles/structures of oral cavity or throat  relax during sleep. Upper airway becomes blocked diminishing or stopping nasal airflow….decline inarterial oxygen levels

excessive daytime sleepiness

• – cardiac dysrhythmias,
• R heart failure,
• pulmonary hypertension,
• stroke, & angina

dysfunction of mechanisms regulatingsleep/wake states

excessive daytime sleepiness, cataplexy, sleepparalysis

– stimulants , antidepressants, brief daytime naps(20 min), good sleep hygiene, dietary measures, &avoid factors increasing drowsiness

• s/s of various illnesses, stress, medications
• environmental andshift work
• S/S – may be physiological or psychological

Occur more often in children; if in adulthood often indicate more serious disorder

– SIDS, somnambulism, night terrors,nightmares, enuresis, body rocking, bruxism

varies with disorder; maintaining safety a big issue

• Description of sleep problems
• Usual sleep pattern
• Presence of illness
• Current life events
• Emotional/mental status
• Bedtime routine and environment
• Behaviors of sleep deprivation

• Nature of problem
• Signs and symptoms
• Onset and duration of signs/symptoms 
• Severity 
• Predisposing factors
• Effect on Patient

• Environmental controls
• Promote bedtime routines
• Promote safety
• Promote comfort
• Establish rest/sleep periods
• Reduced stress 
• Bedtime snacks 
• Pharmacologic measures

• A subjective sense of self and a complex mixture of unconscious and conscious thoughts,attitudes, and perceptions
• A positive self-concept gives a sense of meaning, wholeness, and consistency to a person.
• A healthy self-concept has a high degree of stability and generates positive feelings toward the self.
• Self-esteem is closely related.

• Identity
• Body image
• Role performance
• Self esteem

– any real or perceived change that threatens identity, body image, and role performance.

individual’s perception

• Number of stressors
• Duration of stressor
• Health status

positive self concept

negative self concept

– individual must assume 2 or more rolesthat are inconsistent, contradictory or mutuallyexclusive

– expectations or others & society of how onebehaves when ill

– unclear role expectations

– combines role conflict & ambiguity

• inability to meet parental expectations,
• harsh criticism,
• inconsistent discipline,
• sibling rivalry

unique self-concept stressors

• failure in work,
• unsuccessful relationships

• health issues,
• declining socioeconomicstatus,
• spousal loss/bereavement,
• loss social support

• Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgments:
•    Use a positive and matter of fact approach.
•    Build a trusting relationship.
•    Be aware of facial and body expressions.

•  How would you describe yourself?
•  What aspects of your appearance do you like?
•  Tell me about the things you do that make you feel good about yourself.
•  Tell me about your primary roles.
• How effective are you in carrying them out?

•  When did you start feeling differently about your self?
•  How long have you struggled with ____________?
•  Can you remember a time when you felt good about yourself?

•  Tell me how your self-concept affects your ability to take care ofyourself
•  What impact does your self-esteem have on relationships?
•  How does your self esteem affect other areas of your life?

• Avoidance of eye contact
• Slumped posture
• Unkempt appearance
• Overly apologetic
• Hesitant speech
• Overly critical or angry
• Frequent or inappropriatecrying
• Negative self-evaluation
• Excessively dependent
• Hesitant to express viewsor opinions
• Lack of interest in what is happening
• Passive attitude
• Difficulty in making decisions