NSG 201 Exam 2 Flashcards
(37 cards)
Subjective vs. Objective data
subjective: what the person says about themselves
objective: what you obtain from physical data
Genograms Purpose
- Accurate family outline of the hx of diseases, & conditions that could make the pt more vulnerable/susceptible to
- when they know they would be more vulnerable it leads to earlier screening and surveillance
- Includes: gender, age, relationship (imemdiate family and also the spouse to view prolonged disease exposure). relative medical conditions
Items included in the Health History
- Biographical data
-name, age, address, contact info, dob, gender/gender identification, occupation, marital partner status, race/ethnicity, primary language - Source of Health hx: who= source of info
primary= patient
secondary= other sources - Reason for seeking care
-the “cc” or chief complaint - Hx of presenting illness
-meds, current illness, allergies
-OLDCARTS—onset, location, duration, characteristics, aggravating factors, related symptoms, treatment, severity - Past health events
-childhood illnesses, accidents/injuries, hospitalizations, surgeries, obstetric hz, immunizations, last exam date, last menstrual period - Family hx- blood relative
-use a genogram
Functional, Personal, and Psychosocial Assessment
Psychosocial: personal status, relationships, nutrition, functional ability, mental health, substance abuse, health promotion, environment
Functional: ADLs (activities of daily living), spiritual assessment, for alcohol use
Review of Systems
- Address each body system
- use specific questions
- not objective data
- pt’s descriptions/perception of health
- terminology
Lifecycle Considerations
Children: most data obtained from an adult. By age 7, most can answer basic questions
Adolescence: may need alone time w/ the pt
Older adults: include ADLs, functioning
Cognitive Function Assessment
- Orientation- time/place/person/situation
- Attention span- ability to concentrate by noting complete thoughts: ability to concentrate w/ no distractibility
- Recent Memory- last 24 hours
- Remote Memory- verifiable, past events
- New learning- 3/4 unrelated words- requires more effort and avoids unverifiable material
Factors that Influence the Interviewing Process
- Age- usually teens and adults can handle questions, children need the assistance of a guardian and to use appropriate terms w/o talking down, and elders might need assistance
- Culture- Be respectful and don’t assume
- Language- LEP, use a certified translator
- Stress- limit the number of questions and think of the nature of the questions
- Sensory Impairment- Be patient
- Cognitive Impairment- we may need a second source of info
OLDCARTS
onset location duration characteristics aggravating factors related symptoms treatment severity
Interviewing based on G & D stage
-can be a good baseline to understand how to present questions & what goals are important to that age group, can also help if someone did not attain their goals in an age development stage and need to reframe questioning/interviewing to be more appropriate
Assessment Tools
CAGE- alcohol use- substance abuse screening tool w/ 4 questions, if score >2, significant clinical finding
FICA- spiritual assessment- looks at faith, importance, community, address issues
Katz- aka ADLs (activities of daily living)- scores how independently dependent individual is
MMSE- used to evaluate mental status; widely used as test of cognitive function in elderly
Levels of Prevention
- Primary- strategies that target modifiable risk factors
- prevention of diseases before any symptoms
* Immunizations, safe sex, smoking cessation, seat belts - Secondary- strategies focused on early disease detection
- screenings include:
* Cancer: mammogram, prostate markers
* Bone density
* colonoscopies
* BP
* Blood glucose - Tertiary- strategies minimize the damage after the onset of disease
- cardiac rehab, AA, support groups, any intervention focused on lessening disease complications
Domains of Learning & Strategies
Cognitive- knowledge Affective- emotional Psychomotor- self-reliance Srtategies: 1) VARK: Visual Auditory Reading/Writing Kinetic 2) Bloom's Taxonomy -create, evaluate, analyze, apply, understand, remember
SMART Goals
SMART- know exactly what you want to accomplish
Measurable- how will you know you met goals?
Achievable- make sure your goal is not too far to reach, but far enough away to be challenging
Relevant- link the goal to something important to you, something that inspires you
Timely- when do you want your goal to be met?
Bloom’s Taxonomy (Learning Domain Strategy)
- Create- produce new or original work
- design, assemble, construct, conjecture, develop, formulate, author, investigate - Evaluate- Justify a stand or decision
- appraise, argue, defend, judge, select, support, value, critique, weigh - Analyze- Draw connections among ideas
- differentiate, organize, relate, compare, contrast, distinguish, examine, experiment, question, test - apply- use info in new situations
- execute, implement, solve, use, demonstrate, interpret, operate, schedule, sketch - understand- explain ideas or concepts
- classify, describe, discuss, explain, identify, locate, recognize, report, select, translate - remember- recall facts and basic concepts
Prochaska’s stages of change: Readiness for change
- Pre-contemplation- do they see a health problem? Not willing to make a change
- Contemplation- become aware of the problem, but lacks a strong committment to make a change
- Preparation- begins to take small steps toward a change (set goals and priorities)
- Action- strong committment to change and taking consistent action
- Maintenance- client is stable and achieved gains- relapse is possible
Patient Teaching
-must be sufficient for client to make informed decision, must be in clear and understandable manner, must be documented, consider different patient learning styles and barriers to education/understanding
Biological Theories of Aging: the process of growing old
Predetermined
1. Programmed Longevity: timetable by cell division when replication stop
2. Immune System Control: decline over time which leads to increased vulnerability to the immune system - death by diseases
3. Neuroendocrine Control: biological is set through hormones when cells lose the ability to respond to hormones
Random/Stochastic
1. Error: a collection of errors that ends life
2. Somatic Mutation: what happens to our genes after we inherit and that when it divides it is exposed and mutate and then accumulate and cause problems
3. Free Radicals: super oxidize causes damage to components of cells, causing cells and organs to stop functioning
4. Crosslink: increase waste products in cells - links to waste instead of protein
5. Wear and Tear: vital parts of cells and tissue just wear out from repeated use
Psychosocial Theories of Aging
- DIsengagement- withdraw from society as one ages
- Activity- must be involved in order to be happy during the aging process
- Continuity- proceed in life as in previous ages
- Social Exchange- aging from an economic perspective - measures the cost and reward of a relationship
- Modernization - losing power and influencing society as modernization increases and status decreases - more social isolation
- Gerotranscendence - old person and the aging process itself - growing old and the positive characteristics - decreased interest in superficial interactions
- Socioemotional - life span theory of motivation - will prioritize information focused goals
Normal Physical Changes Associated with Aging
- vision changes (decreased ability, yellowing lens)
- decrease in all 5 senses
- decreased hearing
- diminished taste
- decrease on saliva production/sensitivity to sweet/salty flavors
- decreased smell
- decreased sensitivity to touch
- reduced capacity to sense pressure/pain
- decrease in nervous system responses
- reduction in neuron production/blood flow
- slower rxn and learning time
- difficulty with memory
- personality consistent w/ earlier years
- decrease in sleep and more arosuals in nighttime
- decrease in function of CV system
- stiffer/thicker heart valves
- increase systolic BP
- reduced lung size
- more rigid lungs and thoracic cage
- decrease in cough response
- atrophy of muscles
- porous bones
- shortening of vertebrae
- brittle teeth
- decrease in GI function
- weaker bladder, causing decreased capacity/increased retention/nocturia
- atrophy of reproductive systems
- hormone level changes, decrease in immune system responses, decreased skin elasticity, skin thinner/dryer
- altered thermoregulation, changes in pigmentation
End of Life Documents
-advanced directive: living will, DNR, POA
Living Will: legal document allows individuals to specify what type of medical treatment they would/ wouldn’t want if they became incapacitated/irreversible terminal illness; can direct physicians to withhold life sustaining measures, assist family members w/ making decisions for person in a coma/medically incapable; person must be competent to make a living will, can be revoked or changed at any time
DNR: “do not resuscitate order” - alerts medical personal that individual does not want cardiopulmonary resuscitation in the event the person stops breathing and has no heartbeat; should be an advanced directive forms and in medical chart
POA: “durable power of attorney”- competent individual can designate healthcare proxy/surrogate to make decisions about medical care if person becomes incapacitated; if no POA, a guardian may be appointed–guardianship is last resort
4 Generations of Today’s Elders
- Super Centenarians- age 110+, group emerged in the 1960s, exact # of people 110+ unknown; lived during WWI/WWII, Spanish Flu; most still functional/independent until age 105 ish
- Centenarians- age 100-109, majority btwn 100-104, WWII, Great Depression, expected that by 2050, millions will live into this range; had all or most childhoos diseases
- Baby Boomer- youngest of the oldest generation, born b/w 1946-1964; born after the end of WWII, differences in life expectancy significant, concerned w/tobacco use, diabetets, obesity, arthritis, heart disease
- In Between- born between 1930s and baby boomers; born at end of WWI/start of WWII, came of age during Civil Rights movement, Vietnam War, Polio Vaccine, population in this age group growing at an exponential rate
Frankel’s 5 Stages
- Self-sufficient- pt is self-reliant, good time to get affairs in order
- Interdependence- pt becomes reliant on others for assistance; at this time, older adults may consider independent living locations that offers help for meals/cleaning/laundry
- Dependency- dependent for help with basic things like bathing, eating; may require outside care for help
- Crisis Management- cost of upkeep is high so family members in crisis mode; physical & mental health has declined so elder is more dependent on family members/friends
- End of Life- move to nursing home/hospice/etc, ahve extensive nursing needs, require a lot of help from others
EAI Form
-elder assessment instrument- used as a comprehensive approach for screening suspected elder abuse in all clinical settings; includes general assessment, possible abuse indicators, possible neglect indicators, possible exploitation indicators, possible abandonment indicators, summary
