531 final

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VASUpharm14
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531 final
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2010-12-07 16:50:16
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booyah im a beast! ... w.e. let's do this!!
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  1. World Health Organization (WHO)- "health is a state of complete emotional, mental, physical, and social well-being and not just the absence of disease or infirmity"
    Health
  2. "layman defined" reaction to perceived alteration in health physical and social meaning
    Illness
  3. "professional defined" diagnosis as basis of medical practice and therapy
    Disease
  4. view to help professionals understand why and under what conditions people take preventative health actions (behaviors)
    • Health Belief Model
    • 1. peoples psychological readiness for action
    • 2. degree to which a certain course of action has a beneficial effect on improving health
    • 3. motivating signs (seriousness, vulnerability)
  5. communication attending behaviors (4)
    • 1. eye contact
    • 2. attentive body language
    • 3. vocal qualities
    • 4. verbal tracking
  6. 3 results of good attending behaviors
    • 1. encourages patient to talk
    • 2. demonstrates you're interested, that you care
    • 3. establishes rapport
  7. professional borrows the patient's feelings to fully understand them but always are aware of own separateness
    empathy
  8. professional loses separate identity and takes in patient's feelings or circumstances
    sympathy
  9. 6 barriers to communication
    • 1. interrupting
    • 2. belittling
    • 3. moralizing
    • 4. lack of privacy
    • 5. impairments
    • 6. time contraints
  10. 2 types of questions
    • 1. open-ended - how and could
    • 2. closed-ended - why (avoid)
  11. 3 reasons to practice good questions
    • 1. brings out specifics about patient
    • 2. effectively diagnoses a patient's concerns
    • 3. guides the manner in which a client talks about an issue: what, how, why, could
  12. context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
    what
    leads to facts
  13. context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
    how
    leads to feelings or process (good choice)
  14. context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
    why
    leads to reasons (not a good choice, makes patients defensive)
  15. context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
    could
    considered maximally open (aka the best)
  16. 3 components of listening accurately
    • 1. encouraging
    • 2. paraphrasing
    • 3. summarizing
  17. 4 reasons to practice good listening
    • 1. communicates interest/caring
    • 2. clarifies for the patient what s/he said
    • 3. checks your accuracy
    • 4. communicates to the patient that they have been heard
  18. 7 ways Yalom (Curative Group Factors) to make people feel good about a group
    • 1. impart information
    • 2. instill hope
    • 3. universality, altruism
    • 4. correct family group problems
    • 5. socialization, interpersonal growth
    • 6. cohesion, catharsis (talk about concerns)
    • 7. imitative behavior
  19. "glue" to make group
    • cohesiveness
    • value group holds for members and member investment
    • enhances commitment
    • care of and care from group favors cohesion
  20. 4 factors favoring cohesiveness
    • 1. group tasks are within member expertise
    • 2. leader point out group accomplishments
    • 3. leader models empathy and gives feedback
    • 4. leader allows group tension at some point to reach goals
  21. "what" group does or discusses
    group content
  22. "how" group works"
    group process
  23. 3 phases of a group
    • 1. initiating
    • 2. working
    • 3. termination
  24. context: 3 phases of a group
    initiating
    • anxiety is felt
    • need acceptance and trust
    • establish group goals, power and control, testing
  25. context: 3 phases of a group
    working
    • work on group goals
    • out of conflict and agreement come
    • sharing
    • emotional growth
  26. context: 3 phases of a group
    termination
    • summarize feelings about goals and accomplishments
    • you will miss group members
  27. ideal size of working group
    • 6-10 is best for effective work
    • create subgroup if gets too large
    • can't attain group goals if too small
  28. 7 characteristics of an effective group
    • 1. goals clear and collaborative
    • 2. open goal directed feelings communicated
    • 3. power equally shared
    • 4. controversy is healthy
    • 5. balance tasks and maintain it
    • 6. diversity encouraged
    • 7. effective IPR
  29. what is a leader
    person who facilitates all phases of group development
  30. 2 roles of a leader
    • 1. intervene: silence, monopolizer
    • 2. member: orient, coordinate, initiate, comment, record, opinion seeker/giver, gate keeper, harmonizer
  31. What are group norms?
    • Group: behaviors expected of group members, people know how class graded, know expected dress, behaviors
    • Group specific: risk taking, humor, anger
  32. List Maslow's Hierarchy of Human needs according to which must be met first (bottom of pyramid): love and belonging, self-actualizing, safety and security, physiologic, self-esteem
    • physiologic < safety and security < love and belonging < self-esteem < self-actualizing
    • must meet basic needs before higher needs
  33. Hans Selye Stress Response for "General Adaptation Syndrome"
    • Alarm: adrenal cortex, defense
    • leads to:
    • 1) resistance and recovery OR
    • 2) exhaustion: toxic substance or stress overwhelms defenses
  34. 8 stages of Erik Erikson
    • 1. infancy (0-1 year)
    • 2. toddler (1-3 year)
    • 3. preschool (4-5 year)
    • 4. school age (6-12 year)
    • 5. adolescence (13-20 year)
    • 6. young adult (21-40 year)
    • 7. middle years (41-64 year)
    • 8. later adults (65 and older)
    • people usually master one stage before next and sometimes move fast or regress
  35. context: Erikson's 8 stages of man
    trust vs mistrust
    infancy (0-1 year)
  36. context: Erikson's 8 stages of man
    autonomy vs shame and doubt
    toddler (1-3 year)
  37. context: Erikson's 8 stages of man
    initiative vs guilt
    preschool (4-5 year)
  38. context: Erikson's 8 stages of man
    industry vs inferiority
    school age (6-12 year)
  39. context: Erikson's 8 stages of man
    identity vs role confusion
    adolescence (13-20 year)
  40. context: Erikson's 8 stages of man
    intimacy vs isolation
    young adult (21-40)
  41. context: Erikson's 8 stages of man
    generativity vs stagnation
    middle years (41-64 year)
  42. context: Erikson's 8 stages of man
    integrity vs despair
    later adults (65- up)
  43. what is goal of coping skills
    to develop more conscious coping skills to handle life issue
  44. 4 coping skills
    • 1. talking
    • 2. relaxing methods
    • 3. exercise
    • 4. balance work and play
  45. goals of coping with crisis
    • help patient and family
    • strengthen support systems
    • develop coping skills
    • view crisis realistically to reduce stress and achieve psychosocial growth
    • *crisis can be a turning point
  46. crisis
    reaction to threat, illness
  47. 5 stages of crisis
    • 1. shock
    • 2. denial
    • 3. distress
    • 4. disequilibrium
    • 5. stabilized
  48. 2 types of crisis
    • 1. developmental
    • 2. situational
    • ex: illness and resolving it can lead to personal growth for families and patients
  49. mostly unconscious mental processes that lessen anxiety
    defense mechanisms
  50. 7 types of defense mechanisms
    • 1. denial
    • 2. projection
    • 3. repression
    • 4. regression
    • 5. displacement
    • 6. reaction formation
    • 7. rationalization
  51. context: 7 defense mechanisms
    failure to recognize threat event
    denial
  52. context: 7 defense mechanisms
    attribute to others one's negative traits
    projection
  53. context: 7 defense mechanisms
    dismissing anxiety producing thoughts from awareness
    repression
  54. context: 7 defense mechanisms
    return to earlier pattern of behavior
    regression
  55. context: 7 defense mechanisms
    redirect feelings about one person to another
    displacement
  56. context: 7 defense mechanisms
    substitute opposite wishes for true wishes
    reaction formation
  57. context: 7 defense mechanisms
    substitute socially acceptable reason for real reason
    rationalization
  58. defense mechanism vs coping skills
    • unconscious vs conscious
    • goal is to develop conscious coping skills
  59. type of communication in family
    • open, clear, direct
    • not closed, confusing, indirect
  60. 4 types of family
    • 1. family of origin
    • 2. nuclear family
    • 3. blended family
    • 4. extended family
  61. context: 4 types of family
    family into which a person is born
    family of origin
  62. context: 4 types of family
    new family created by 2 partners
    nuclear family
  63. context: 4 types of family
    common people
    blended family
  64. context: 4 types of family
    family network
    extended family
  65. 8 problem responses to illness
    • 1. anxiety
    • 2. denial
    • 3. demanding
    • 4. controlling
    • 5. manipulation
    • 6. suspicious
    • 7. anger
    • 8. depression
  66. context: 8 problem responses to illness
    mild, moderate, severe panic
    • anxiety
    • RPh:
    • 1. recognize anxiety, search for cause, show calm and care
    • 2. teach stress reduction techniques
  67. context: 8 problem responses to illness
    minimizes fear and anxiety, avoid intolerable feelings which can be adaptive if it helps one initially get through trauma and maladaptive if it prevents acceptance of problem and need for treatment
    • denial (Don't Even kNow I Am Lying)
    • RPh:
    • 1. gentle, indirect approach
    • 2. comment on observed condition
  68. context: 8 problem responses to illness
    excessive need for dependency, "entitlement" attitude, fears abandonment
    • demanding
    • RPh:
    • 1. set limits in caring supportive manner, anticipate care needs
  69. context: 8 problem responses to illness
    rigid, needs lots of control, thinks rather than feels, and are driven to achieve
    • controlling
    • RPh:
    • 1. give control over schedule and treatment
    • 2. provide detailed teaching
  70. context: 8 problem responses to illness
    flattery, self-pity for self-gain, lying, threaten to harm, and takes advantage, play one staff against other
    • manipulation
    • RPh:
    • 1. confront behavior with clear limits
  71. context: 8 problem responses to illness
    questions caregivers intentions, complains about care, feels vulnerable and fearful
    • suspicious
    • RPh:
    • 1. recognize beliefs and feelings, but offer no challenge
  72. context: 8 problem responses to illness
    feelings of displeasure from injury, mistreatment, opposition, impulses to fight back
    • anger
    • RPh:
    • 1. calm appearance, speak softly, neutral comments
    • 2. listen, show respect
    • 3. don't make promises you can't keep
    • 4. talk about anger management
  73. context: 8 problem responses to illness
    feel helpless, hopeless, sad, worthless, may be suicidal in response to physical illness or disability
    • depression
    • RPh:
    • 1. provide safe environment
    • 2. listen
    • 3. encourage self-worth and life quality
    • 4. share concerns with team
  74. 9 barriers for the homeless
    • 1. effects of constant vigilance (sleep deficit, fear, suspicion)
    • 2. social isolation
    • 3. drugs, alcohol, "escapism"
    • 4. fear shelters and streets
    • 5. crisis oriented ED/fragmented care
    • 6. poor health, sickly, poor nutrition
    • 7. hopelessness, insecurity
    • 8. lack of medical care, access
    • 9. TB, AIDS, diabetes, alcoholism, hypertension, disabilities, dental
  75. 9 strategies for homeless care with major goal to have compliance
    • 1. simplify dosage
    • 2. secure place to store medications
    • 3. provide suitable containers
    • 4. communication with interdisciplinary team
    • 5. disorganize lifestyle
    • 6. written/verbal education and link (patient, caseworker, and RPh)
    • 7. assess need for fluids, food and protection from the elements
    • 8. homeless people need to feel productive and respected like all other people
    • 9. new resources for programs
  76. what types of people are homeless?
    • 1. 1/3-1/2 are mentally ill
    • 2. alcoholics and drug users
    • 3. lost job and home
    • 4. war veterans
    • 5. run away kids and adolescence
    • 6. victims of domestic violence, battered children
    • 7. displaced families
  77. 2 types of social support/systems
    • 1. formal system
    • 2. informal system
  78. context: 2 types of social support
    hospital, clinics, health care professionals, community agencies, home care agencies, professional counselors/therapists
    formal system
  79. context: 2 types of social support
    family members, friends, co-workers, neighbors, spiritual center
    informal system
  80. 2 types of groups for support in health care
    • 1. self-help
    • 2. support groups
  81. context: 2 types of groups for support in health care
    controlled and directed by individual members ex: Alcohol Anonymous
    self-help
  82. 3 goals of self-help groups of support in health care
    • 1. self-reliance
    • 2. hope
    • 3. improved morale
  83. context: 2 types of groups for support in health care
    led by health care professionals
    support group
  84. 4 goals of support groups for support in health care
    • 1. new knowledge and skills
    • 2. encouragement
    • 3. feedback on behavior
    • 4. normalization of the experience
  85. 5 common religions and beliefs
    • 1. Christianity
    • 2. Judaism
    • 3. Islam (Muslim)
    • 4. Buddhism
    • 5. Hinduism
    • **individual variation family practice or individual; do not assume; ask
  86. context: 5 common religions and beliefs
    Christianity
    • Western
    • largest group
    • Roman Catholics: Holy Days, Sacraments, birth control and abortion prohibited
    • Protestant: Methodist, Baptist, Lutheran, Presbyterian, Episcopal (specific denomination beliefs)
  87. context: 5 common religions and beliefs
    Judaism
    • Western
    • Known if Orthodox, Conservative, Reform
    • Holy Days: Rosh Hashanah (new year), Yon Kippur (day of atonement), Passover
    • Rabbi teacher not priest, Messiah to come. No medication restriction except no OC Orthodox
    • Circumcision is required
    • Torah is a book of prayer, one God
    • Diet restrictions such as kosher except if ill
  88. context: 5 common religions and beliefs
    Islam (Muslim)
    • Western
    • Mohammad (prophet of Allah) AD 580
    • 5 pillars: repetition creed Islam, daily prayer, give to poor, sacred month of fasting (Ramadan), Pilgrimage to Mecca
    • Koran: holy book of law
    • Prohibition of alcohol: lifted if sick
    • U.S. history Muslim slaves from Islamic West Africa
    • Prefer same gender care
  89. context: 5 common religions and beliefs
    Buddhism
    • Eastern
    • 600 BC Buddha (enlightened man), compassion, peace
    • rebirth in new life after death
    • can use medications, surgery, blood, birth control, if helps pursue enlightenment
    • avoid mind altering hallucinogens
  90. context: 5 common religions and beliefs
    Hinduism
    • Eastern
    • 1500 BC, Vedas, divine revelations, mind-body healing
    • prefer same gender care especially women
    • accept most medical practices
    • illness related to sins from earlier life
  91. context: religious and spiritual needs
    anything that pertains to a person's relationship with a non-material life force or higher power
    spirituality
  92. context: religious and spiritual needs
    organized system of belief's about a higher power
    religion
  93. 9 Roles of a pharmacist with religion
    • 1. consider: is patient angry at God, feeling punished, or a victim because of illness
    • 2. facilitate best care possible despite not understanding all patient's beliefs
    • 3. do not make generalizations on religious beliefs based on one member of a religion because each person is an individual
    • "ask the patient"
    • 4. not a clergy or counselor
    • 5. examine your spiritual and religious beliefs
    • 6. assess and respect spiritual needs and religious beliefs of patients
    • 7. educate self on major religions
    • 8. learn how patients views higher power
  94. 8 parts of cultural assessment
    • 1. language and communication style
    • 2. religious beliefs, needs, and practices
    • 3. healing beliefs and practices
    • 4. food practices
    • 5. cultural identity and practices
    • 6. illness-wellness behaviors
    • 7. nutritional needs
    • 8. role of family
  95. 3 barriers to communication and pharmaceutical care/ pharmacist barriers
    • 1. not speaking the language
    • 2. not understanding the culture or willing to modify health care to background
    • 3. stereotyping: apply positive or negative labels to a group
  96. 9 pharmacist interventions/strategies to achieve
    • 1. awareness and acceptance cultures different from yours
    • 2. learn about cultures (classes, expand circle of friends, involve in cultural centers and events)
    • 3. ask questions and pay attention
    • 4. keep mind open, do not stereotype
    • 5. carry a pocket translator
    • 6. auxiliary labels
    • 9. markings on measuring devices
    • 10. learn common phrases
    • 11. make person from another culture comfortable in your pharmacy
  97. T/F cultural competence is important and lasts for a short time
    false. lifelong
  98. cultural competence
    knowledge base and interpersonal skills that allow health care providers to understand, appreciate and work effectively with individuals from cultures that differ from their own
  99. 2 communication techniques
    • 1. non-verbal
    • 2. verbal
  100. context: 2 communication techniques
    cautious use of hand gestures, eye contact
    non-verbal
  101. context: 2 communication techniques
    show patience, avoid slang, speak slowly not loudly
    verbal
  102. Islam
    • second largest religion in the world with an estimated 1.4 billion adherents
    • Declaration of belief in one God, Allah, and that Muhammad is the messenger of God
    • pray 5 times a day -- at dawn, noon, midafternoon, sunset, and nightfall. Prayer, salah
  103. 2 Dietary Issues for Muslim
    • 1. fasting during Ramadan, the ninth month of the lunar Muslim calendar (it begins in October this year), from approximately an hour before sunrise until sunset, is compulsory for all healthy, adult Muslim
    • 2. fasting encompasses total abstinence from food, drink (including water), smoking, and sexual relations
  104. 4 gender issues for Muslim
    • 1. modesty is an important issue
    • 2. patients typically prefer same-gender providers
    • 3. don't shake hands or hug patients, unless patient initiates it
    • 4. female patients may wear an opaque black cape, or abaya, over their clothing and a head scarf, or hijab
  105. 3 stages of pregnancy
    • 1. first trimester
    • 2. second trimester
    • 3. third trimester
  106. context: 3 stages of pregnancy
    5 thoughts with first trimester
    • 1. hard to accept pregnancy
    • 2. pregnancy may be a surprise at "unplanned time"
    • 3. thinks of self
    • 4. pregnancy is a "condition"
    • 5. may be taking medications not knowing pregnant
  107. context: 3 stages of pregnancy
    3 thoughts with second trimester
    • 1. mom worries about effect of medications on baby
    • 2. worry about baby as separate individual
    • 3. mom also worries about food, fluids, and "am I doing all I can for baby"
  108. context: 3 stages of pregnancy
    3 thoughts with third trimester
    • 1. increased anxiety about role changes and impending delivery
    • 2. "baby comes first"
    • 3. bottom line questions from mom "can the medication wait until after delivery and will it hurt my baby"
  109. 3 postpartum (PP) disorders
    • 1. postpartum (PP) blues/ baby blues: 30-85% d/ 4-10
    • 2. PP depression: 10-16% 4 weeks PP with history and lack of support, dec. estrogen
    • 3. PP psychosis: rare, 0.1% -0.2% rapid developing 2-3 day up to 6 weeks (mood and behavioral changes, labile mood, delusions, hallucinations
  110. 3 roles of a pharmacist to intervene with PP issues
    • 1. assess medication intake: what medications, how much, how long, tetratogenecity risk
    • 2. support mom to feel she is doing all possible for baby
    • 3. counsel about effects of medication on baby
  111. name of a test to evaluate/screen potential PP depression
    The Edinburgh Postnatal Depression Scale
  112. 5 communication tips for pharmacist to care for children
    • 1. sit or kneel at child's level
    • 2. share observations to level "I don't like shot either" not over focus on self
    • 3. look what captures interest of child
    • 4. avoid comments to make child self conscious "you are getting big"
    • 5. normal tone of voice, do not talk down
  113. How do kids take medication?
    • pediatrics
    • teaching major role such as not putting medications in favorite foods
    • ice may numb tongue to bad tastes
    • don't tell kids early before medication is given
    • need trust with child as child may feel anxious and fearful about medication
  114. T/F match medications approaches with developmental age of child
    true
  115. 5 stages of death and dying by Kubler Ross
    • 1. denial or shock
    • 2. anger
    • 3. bargaining
    • 4. depression
    • 5. acceptance
  116. who is the best judge of patient pain?
    • Patient
    • patient's rights:
    • 1. to decide the duration and intensity of pain
    • 2. to be informed of all possible methods of pain relief
    • 3. to choose the pain control method
    • 4. to choose to live with or without pain
  117. how do we evaluate for pain what tests?
    • 1. assess:
    • -pain rating scares
    • - subjective evaluation of pain
    • 2. plan:
    • -non-pharmacological pain relief
    • -pharmacological pain relief
    • 3. implement:
    • -teach (patient, family, and staff)
    • -schedule medication
    • 4. evaluate:
    • -effectiveness of treatment
    • -notify prescriber for change
  118. 2 types of pain
    • 1. chronic
    • 2. acute
  119. context: 2 types of pain
    lasts less than 6 months, act as a warning signal to injury, has an identifiable cause
    acute pain
  120. context: 2 types of pain
    lasts more than 6 months past injury, has no apparent useful purpose, may or may not have an identifiable cause, mild to moderate intensity
    chronic pain
  121. 6 non-pharmacological interventions for pain
    • 1. cutaneous stimulation
    • -heat/cold
    • -massage
    • -tens
    • 2. distraction
    • 3. relaxation
    • 4. imagery
    • 5. hypnosis
    • 6. biofeedback
  122. 5 advantages for non-pharmacological interventions of pain
    • 1. inexpensive
    • 2. easy to perform
    • 3. low risks
    • 4. few side effects
    • 5. may not require a physician's order
  123. barriers for the visual and hearing impared
    • visual:
    • 1. psychosocial issues (depression, anxiety, denial, frustration)
    • 2. stigmas (mistaken as: completely helpless, can't hear, not intelligent, must have someone to help, can't work)
    • hearing:
    • 1. psychosocial fears (frustration, embarrassment, helplessness, alienation and isolation), unable to hear and must find other types of communication
  124. strategies to communication and serving with visual impaired person
    • visual:
    • -prescription delivery system
    • -take extra time to thoroughly explain prescription directions, interactions, etc. to patients, spouse, others
    • -patience, ask questions
    • -braille prescription and auxiliary labels
    • -pharmacy at front of store
    • -stock white canes
    • -discuss strategies to provide complete instructions to enhance compliance for ex- need for special services, work and family
    • -medical devices and boxes
  125. strategies to communication and serving with hearing impaired person
    • hearing:
    • -awareness causes of hearing loss
    • -don't assume lack of education
    • -learn to communicate by: signing, body language, written word, dec. distraction
    • -check to see if patient understands
    • -don't call name over loud speaker or speak from another room
    • -stock pharmacy hearing aide batteries
    • -words normal tone and slower
    • -get patient's attention by a light touch
    • -ensure that patient has necessary devices needed, email refills
    • -use simple sentences, avoid shouting, or using slang
    • -if necessary write down the message
    • -don't cover your mouth when talking, eating, chewing gum, drinking
  126. 4 physical aspects of people with decreased mobility
    • 1. hard to perform basic activities such as cooking, dishwashing, cleaning
    • 2. going through doors and elevators, getting things out or cupboard or refrigerator
    • 3. takes longer to get from point "A" to point "B"
    • 4. hard to ask for help
  127. 6 psychosocial aspects/needs of people with decreased mobility
    • 1. trust
    • 2. self-esteem
    • 3. control
    • 4. loss
    • 5. guilt
    • 6. intimacy
  128. 7 major fears of patient dying with an illness
    • fears:
    • 1. of the dying process and pain
    • 2. of loss of control
    • 3. of loss of loved ones
    • 4. of reaction of loved ones to dying
    • 5. of isolation
    • 6. of unknown
    • 7. that life will be meaningless
  129. 6 roles of a pharmacist in hospice care
    • 1. provide pain relief
    • 2. understand the symptoms and treatment
    • 3. reassure patient about availability of treatment for symptoms
    • 4. understand side effects of treatment
    • 5. monitor patient's response to treatment
    • 6. create patient-specific dosage forms
  130. Patient's rights' about terminal illness
    10 choices in the Bill of Last Rights
    • 1. right to be in control
    • 2. right to have a sense of purpose
    • 3. right to reminisce
    • 4. right to be comfortable
    • 5. right to touch and be touched
    • 6. right to laugh
    • 7. right to be angry and sad
    • 8. right to have a respected spirituality
    • 9. right to hear the truth
    • 10. right to be in denial
  131. stigma
    • sign of shame, disgrace, rejection, disapproval, or being shunned
    • -emerges if people feel embarrassed to discuss behaviors perceived as different
    • -linked to all mental illnesses - strong if illness causes unusual and severe behaviors
    • -we fear what we don't understand
    • -stigma causes more destruction than illnesses
  132. An important issue confronting the person with chronic mental illness and HIV includes ______ and need for __________.
    stigma ; confidentiality
  133. 5 health promotion interventions that pharmacists can teach patients regarding forms of cancer (testicular, breast, and skin) assessment
    • 1. teach signs
    • 2. encourage skin observations by patient and significant other
    • 3. RPh may be the first one patient asks about lesion
    • 4. sun protection: screen products, clothes
    • 5. encourage referrals
  134. ABCDs of Melonoma
    • A: symmetry of lesions
    • B: borders, irregular
    • C: color, blue/black or variegated
    • D: diameter, >6mm
    • E: evolving
    • sores that do not heal, persistent lump or swelling
  135. 6 fears of cancer patients and coping issues
    • 1. return of disease
    • 2. pain
    • 3. disfigurement/body image changes
    • 4. concern over the future
    • 5. loss of work role
    • 6. dependency/ loss of relationships/alienation
  136. 7 factors to improve cardiac health
    • 1. close friend or confidant
    • 2. pets
    • 3. follow spiritual and cultural practices
    • 4. healthy lifestyle
    • 5. some need SSRI-antidepressent (if depressed which is common early in disease like post-MI)
    • 6. relaxation, meditation
    • 7. support or therapy groups
  137. 8 common stressors for person with respiratory problems (COPD)
    • 1. carry 6-9 pounds of oxygen canister makes person appear invalid
    • 2. anxiety and panic from shortness of breath; frequent respiratory infections
    • 3. multiple inhalers
    • 4. need energy efficiency strategies
    • 5. break tasks into parts with rest breaks
    • 6. avoid lifting or reaching
    • 7. avoid polluted environments: need ventilation and climate control
    • 8. coughing and mucus can embarrass
  138. 5 common stressors for person with diabetes
    • 1. syringes vs pumps; injecting oneself
    • 2. diet and exercise; changes
    • 3. teach hypo and hyper blood sugar; need for education about medication, exercise, etc.
    • 4. disability due to complications; fear of secondary complications like amputations, blindness, renal disease
    • 5. effects on family
  139. 8 overall psychological impacts with chronic diseases and cancer
    • 1. think depression
    • 2. anxiety
    • 3. body image
    • 4. feeling lack of control
    • 5. fear of death/cancer
    • 6. diabetes fear of amputation
    • 7. renal disease
    • 8. blindness
  140. context: DSM-IV criteria for abuse and dependency
    maladaptive pattern substance use leading to clinically significant impairment or distress: 1 or more following past 12 months: failure to fulfill work, school home role, engaging in hazardous conditions like driving under influence (DUI), legal problems, continued despite problems
    drug abuse
  141. context: DSM-IV criteria for abuse and dependency
    maladaptive pattern substance use leading to clinically significant impairment or distress: 3 or more over 12 months "out of control" in use. tolerance - need for more to achieve effect. withdrawal syndrome for specific substance experienced if not available
    drug dependence
  142. T/F dependence is equal to addiction
    false. physical dependence does not equal addiction
  143. common test to evaluate substance abuse is CAGE
    • C: cut down on substance use
    • A: annoyed when people criticize your use
    • G: guilty about drinking
    • E: eye opener drink or drug
    • 2-3 yes = dependence
  144. 3 defense mechanisms overused by persons with a substance abuse problem
    • 1. denial = major defense
    • 2. projection
    • 3. rationalization
  145. conclusion of albrecht and havinghurst on aging? activity of youth and middle years
    • -elderly with more activities are happiest
    • -not just any activity, but those they are engaged in during the younger and middle years or substitute
    • activities to replace ones you can no longer do
    • -society disengages from elders
  146. T/F there is a decrease in alternative (complementary) integrative therapies used in the USA. because we have an increase in better drugs.
    • FALSE. there is an INCREASE in use.
    • 30-50% of all patients receiving conventional medical treatment co-treat themselves with alternative products or services. They use it when conventional therapies have less-than-desireable results or/and have unpleasant side effects, no known conventional therapy exists, or conventional therapy lacks emotional and spiritual benefits
    • Most patients do not tell their physicians they are using herbs or other alternative therapies nor does the physician ask

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