Study guide for Unit 1

Review Maslow/Erickson for the middle Adult

1. Maslow a. physiological needs b. safety and security c. love and belonging d. self esteem e. self actualization 2. Ericksons stages: a. Trust vs mistrust b. autonomy vs shame and doubt c. initiative vs guilt d. industry vs inferiority e. identity vs role confusion f. intimacy vs isolation g. generativity vs stagnation h. ego integrity vs despair 3. Stages that deal with the middle adult: Generativity: concern for the next generation, having children, teaching, writing, productivity, creativity. Stagnation: self absorbtion, mid life crisis 4. Stages that deal with the older adult: Ego integrity: accepting ones own lifestyle, being in control of ones life Despair: results when older person feels dessatisfied and disappointed with his or her life and would live differently if given the choice.

Review changes/problems associated with middle adult:

1. Visible signs: a. weight gain b. dry skin c. wrinkles d. gray hair e. alopecia: hair loss 2. Physical: a. acute and chronic illnesses b. longer recovery time c. prolonged response to stressors d. decrease in cardiac output e. decrease in muscle mass f. increase in fatigue g. hot flashes and menopause h. andropause 3. Age-related changes in body systems (from book): Cardiovascular: decrease in cardiac output, diminished ability to respond to stress, HR and stroke volume do not incrase with maximum demand, slower heart recovery rate, increase BP Respiratory: increase in residual lung volume, decrease in vital capacity, decrease gas exchange and diffusing capacity, decreased cough efficiency Integumentary: decreased protection against trauma, sun exposure and temp extremes, diminished

secretions of natural oils. Reproductive: vaginal narrowing and decreased elasticity, decreased size of penis and testes Musculoskeletal: loss of bone density, muscle strength and size, degenerated joint cartilage Genitourinary: Male: BPH. Female: relaxed perineal muscles, urge incontinence, urethral dysfunction Gastrointestinal: decreased salivation, difficulty swallowing food, delayed esophageal and gastric emptying, and motility Nervous system: reduced speed of nerve conduction, increased confusion with physical illness, loss of environmental cues, reduced cerebral circulation 4. Emotional health problems a. empty nest syndrome b. widowhood c. aging parents d. retirement

Stages of illness:
First stage: development of signs and symptoms: pain/discomfort, change in body function or appearance, loss of strength and energy, anxiety/denial, guilt/shame

Second stage: client recognizes and acknowledges their illness, may be preoccupied with self and treatment, increased dependency Nurses role: Third stage: convalescent/resolution, health returns to normal or death occurs, client learns to cope in a healthy way Nurses role in illness: advocate, support system, security, self esteem, integrity and coping, health education

Selyes theory of illness:

General Adaptation syndrome: 1. Alarm: Fight or Flight 2. Resistance: struggle to overcome 3. Exhaustion: Crash, Fatigue, Errors, vulnerability to illness Diseases of maladaption (according to Selye): 1. hypertension 2. eclampsia 3. rhematoid arthritis 4. infections 5. inflammatory diseases of skin and eyes 6. allergies 7. mental disorders 8. cancer 9. digestive disorders Maladaptive responses: chronic, recurrent responses or patterns of response over time that do not promote the goals of adaptation. Goals of adaptation are somatic/physical health, sense of well being ect.

Maladaptive responses threaten these goals.

Enhancing client teaching, health promotion, and effective communication

adherence to a therapeutic regimen: many people do not adhere to their regiments, no one causative factor has been found as to why. Instead, a wide range of factors influence adherence: 1. demographic variables: age, gender, race, socioeconomic factors 2. illness variables: severity of illness 3. therapeutic regimen: complexity of regimen or side effects 4. psychosocial variables: intelligence, support, attitudes 5. financial Teaching programs are more likely to succeed if these variables are identified and considered in teaching plans. learning readiness: one of the most significant factors influencing the success of teaching, for the nurse one must find the teachable moment. Must be aware of the several factors: 1. culture 2. patient values: beliefs about behaviors that are desirable and undesirable 3. physical readiness: no acute pain present 4. emotional readiness: having the motivation to learn 5. feedback progresses learning: positive feedback to patient reinforces learning. the learning environment: minimize factors that interfere with the learning process (temperature, noise, light, ect.) gerontologic considerations: 1. must recognize that elderly can still learn 2. changes in cognition: slowed mental functioning, decreased short term memory, slowed reaction time 3. decrease in sensory functions: vision, hearing 4. involve family members when possible Health promotion: components of health promotion: 1. self responsibility: based on principle that the individual controls his or her life 2. nutritional awareness 3. stress reduction and management: studies show negative effects of stress on health 4. physical fitness: improves function of circulatory system, decrease cholesterol., delay degenerative changes, increases flexibility ect. examples of health promotion of the middle adult: 1. annual eye exam 2. biannual dental exam 3. physical every two years 4. age 50: colon/rectal exam, stool testing 5. maintain immunizations 6. women: mammograms (age 35), thyroid screening (age 50) 7. men: prostate specific antigen test, thyroid screening (age 50)

Physical assessment:
Health history: 1. the informant: may be the patient, or others such as family members 2. Cultural considerations: take into account differences when assessing pain/attitudes/beliefs 3. Biographical data: name, address, gender, marital status ect. 4. chief complaint

5. present health concern or illness 6. past health history 7. family history 8. review of systems: overview of general health related to each system 9. patient profile: past life events, education, occupation, environment, lifestyle, self concept, sexuality, risk for abuse, stress and coping response Physical Assessment: 1. Inspection: observations that can be charted from the beginning meeting 2. Posture: breathing difficulties, lying still, grimacing ect 3. Body Movements: generalized disruption of voluntary vs involuntary movement 4. Nutritional status: obesity, mal nutrition ect. 5. Speech pattern: possible CNS problems 6. Vital signs 7. Palpation: examples include superficial blood vessels, lymph nodes, thyroid gland, organs of abdomen and pelvis and rectum 8. Percussion: a. tympany: from air filled stomach b. resonance: dull sound often from liver c. hyperresonance: sound over inflated lung tissue such as COPD 9. Auscultation Nutritional assessment: measurement of BMI, waist circumference, biochemical measurements(albumin, globulin, transferin, electrolytes, hemoglobin, vitamin A, carotene, vitamin C), dietary data

Application of nursing process and nursing diagnosis to various situations

Nursing process: 1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation Three part nursing diagnosis (1) Diagnosis (2) related to (3) as evidenced by