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75 Cards in this Set

  • Front
  • Back
Trends in Healthcare (5)
Health promotion (prevention)
Early diagnosis & treatment
Management (living with chronic illness/disability)
QOL (quality of life)
EOL (coping with end of life)
Chronic conditions of children (definition)
health problem that lasts over 3 months

affects normal child activities

requires lots of hospitalizations / home HC / extensive medical care
Chronic conditions of children (list of illnesses)
Asthma (most common!)
Diabetes
Cerebral palsy
Cystic Fibrosis
Cancer
AIDS
Epilepsy
Spina bifida
Congenital heart problems
Dental caries
Challenges for Chronic Children are...
Lack of Understanding (both parent and child)
Adolescent Turmoil (adherence falls off here)
Depression and Anxiety (unable to cope)
Overwhelming $$$
Society (discrim, devaluing children, lack of understanding)
Transition to Adult Care
Support for families with chronic children
-American Family of Pediatrics
-Ronald McDonald
-Air Charity Network (Angel Flights - free flights!)
-Shriner's Charities
-SSI (supplemental security income)
-Catastrophic Illness in children Relief Fund
-Disability
-Fundraising
Chronic older adult
-Adult onset diabetes
-Arthritis
-Kidney / bladder problems
-Dementia
-Parkinson's
-Lung disease
-Cataracts
-Osteoporosis
-Enlarged prostate
-Alzheimer's
-Macular degeneration
-Depression
-Cardiovascular disease
Primary Prevention,
Secondary,
Tertiary
Primary:
protect healthy people from getting disease

Secondary:
After illness or risk factors are diagnosed, to halt or slow the progress of disease

Tertiary:
Helping people manage complicated, long-term health problems like diabetes, heart disease, cancer and chronic musculoskeletal pain
Health literacy
the ability to read, understand, and effectively use basic medical instruction and information
For the elderly, use language that is at...
A 6th grade level.

sit at eye level, safe environment, use visual models, do teach back, bring a friend/family member, make list of concerns, write on chalkboard
FIRST THING YOU DO, before any teaching/learning assessment for the elderly.....
Ask if they need glasses or hearing aids!
ASK ME THREE Approach
assess Health Literacy (the new vital sign)

teach so patient knows:
1) what is my main problem?
2) what exactly do i need to do?
3) why is it important for me to do this?
When talking with children and families...
-Communicate attitude of CALM
-Establish trust
-Encourage parents to stay with child
-Designate one person as family liaison
-Tell TRUTH
-provide INCENTIVES, REWARDS
-Assess child's nonverbals
-PARENTS ARE EXPERTS on what is normal/abnormal in child
Nonverbal communication with kids
-go to EYE LEVEL
-no awkward angles
-SOFT voice, MODERATE pace, interrupt ONLY when/if necessary
-Infants less than 6mo, touch anywhere, but do painful one last!
-touch only as needed, watch your facial expressions
Parents of kids...
-know normal or abnormal in kids
-having parent with child reduces PAIN in kid!
-seperation = anxiety and stress for both parent and child
-treat children as people
-don't have parents do something painful to kids
-parents shouldn't react when kid falls on face in store
Treat every child....
as if they were the most special, beautiful, smartest childin the world - compliment them for something
Guilt of parents
parents feel guilty even if it's not their fault...
-responsible for illness/injury
-causing pin
-don't know enough to make a decision
Ages and stages of life
Infant 1mo-12mo
Toddler 1yr - 3yr
Preschool 3yr - 6yr
School Age 6yr - 12yr
Adolescent 12yr - 21yr
Young Adult 19yr - 44yr
Middle Adult 44yr - 64yr
Older Adult 64yr+
Frail Older Adult is over 80yr
Infant growth
0-6mo gain 1-2lb per month, increase length 1" per month

6-12mo gain 1lb per month, increase length 1/2" per month

Double birth weight by 6mo & Triple birth weight by 1yr

Increase length by 50% by age 1yr

Head circumference growth: 1cm/month for first year
Infant development
Erickson: Trust vs Mistrust (if needs are met, they learn to trust!)

Piaget: Sensorimotor

Kohlberg: Stage 0. what i want! (moral development)

Parent/Infant attachment is critical (should respond different to a stranger)

LANGUAGE DEVELOPMENT is critical indicator of normal development over first year. otherwise brain/growth problems:(
2 month old
-may lift head, still head lag

-primitive reflexes present

-posterior fontanel closes by 2-3months

-hands are often open (grasp reflex fading)

-begins to follow objects

-begins to smile to stimuli
3 month old
-smiles in response to others
-tracks with eyes
-babbles, coos
-decreased head lab, holds head in place when you pull arms!
-focuses on visual object and reaches
-sucking to soothe
-holds objects placed in hands
4 month old
-flipping! (front to back, then stuck and cry)
-plays with feet
-begins reaching/grasping objects
-mouth to explore environment
-brings hands to midline
-recognizes faces, parent voice
-differentiated cries!
-sleeps at least 6hours
-smiles, laughs, squeals
-controls head WELL, bears weight on forearms, lifts chest 90 degrees
-can start with cup
6 month old
-rolls over! (front to back, back to front)
-dada! baba!
-NO head lag when pulled!
-sits with support
-grasps and mouths objects
-starts to self-feed
-transfers small from hand to hand
-rakes in small objects (object permanence)
-turns to sounds
-stranger anxiety
-first tooth erupts! usually
-lifts head, chest, upper abdomen and can bear weight on hands at 6mo, facilitates turning from abdomen to back!
4-6 months
back is rounded only in lumbar area (when sitting), infant able to sit erect with good head control at 4 months!
6-7 months old
tripod sitting!
7 month old
infant bears full weight on feet by 7 months
8 month old
sits without support!
9 month old
-responds to own name
-knows "no-no", "bye-bye", "bottle"
-imitates vocalizations
-crawls, creeps, scoots
-sits independently
-may pull to a stand
-shakes bangs throws drops objects
-peek-a-boo, pat-a-cake
-feeds self with fingers
-drinking cup - interested constantly!
-sleeps 6-8 hours
-stranger anxiety can peak here!
Infant health promotion
immunizations
hearing screening
feeding
sleeping on back!
safety (burns, poisoning, falls, asphyxiation)
prevent lead
age approp toys
DO NO USE WALKERS
Car seats
Rear facing up to 2yrs and 30lbs, in BACK SEAT!!
Toddler (general thoughts)
Playing pretend, it's all about me

favorite word is "no"

has stranger anxiety
Toddler growth
physical growth slows
weight gain 5lb/yr
height 3"/year
at 2yo, head circum is 90% of adult
overall head growth 1.5" during toddler years
immature ab muscles and exaggerated lumbar curve
Toddler Development
Erickson: Autonomy vs. Shame/Doubt (i want to do it all by myself, if I can't then i feel bad about myself)

Piaget: Sensorimotor to Preoperational

Kohlberg: Punishment-Obedience

language accelerates to 300 words by age 2

learning via trial/error, play, exploring

expand motor skills
Toddler cup / bottle rule
Get bottle away between 12-15 months
Toddler potty training rule
at 2yrs, toddler will have physiologic skills to go.
Not before.
Tooth care for infant and toddler
Infant: rub tooth with wet wash cloth

Toddler: start brushing
Average age of potty training for girls, boys
Girls: 2 years

Boys: 3 years
Toddler Health Promotion
-SAFETY (curious, mobile, unaware of danger, burns, homocide due to tantrums, drowning, pedestrian, car, falls, choking, electrocution, strangulation blind curtains, firearms, bike injuries, sun)
Preschooler (3-6) : Growth
-Slow, steady growth
-Weight gain = 2.25kg (5lbs) per year
-Height = 5 - 7.5 cm (2 - 3inches) per year
-Appetite decreases
-Slimmer, more agile appearance
-Vital capacity increases, RR slows
-Cardio maturation = participate in sustained activity
-20 deciduous teeth by age 3!
Preschooler Development
-Erickson: Initiative vs. Guilt
-Piaget: Preoperational
-Kohlberg: Premorality
-Fine and gross motor ability improve
-Handedness by 3yrs
-ADL (activities of daily life) by 4-5yrs
>2100 words by 5yrs
-Rhymes and silly words by 4yrs
-Imaginative and imitative play!
-Body integrity IMPORTANT (A CUT=INSIDES WILL LEAK OUT. Band aid is very important!! draw a picture on it!)
-Enjoy helping adults, will try new foods if helped prepare it
-Enjoy sense of accomplishment from activities (building blocks)
Preschooler Health Promotion
-Need 10-12 hours sleep
-Nightmares/night terrors
-Magical thinking accidents - superman can fly so they jump
-Provide simple, concrete answers (no double meanings)
-Gun safety, stranger awareness, good touch bad touch
-Water safety
-School readiness
-Booster seat in car (car seat up to 40lbs)
-Appropriate child care
Proper car seat for preschoolers?
Booster seat, up to 40lbs.
School Age (6-12)
-Erickson: Industry vs. Inferiority
-Piaget: Concrete operations
-Kohlberg: Morality of Conventional Role Conformity (concrete thinkers, FOLLOW THE RULES!)
-Increased mastery of language
-Emergence of logic ( 2+3=5! 5-3=2! )
-Self-esteem development
-Friendship skills established! (usually same sex)
-Assume responsibility (load dishwasher)
-Music is favorite form expression (trumpet/guitar)
-Avid collectors! stamps!
School Age Health Promotion
-20 primary teeth lost, replaced with 20 permanent!
-Reading improves language
-HELMET USE
-Overestimate ability and maturity
-School refusal
-Obesity
-Regular sleep
-Supervise activities
-Limit TV/videogames
-Media influence
-Emotional support
-Sex education
School Age Safety
-Able to recognize danger
-Learn/get rules
-Best time to learn safety/role model is parent
-Peer pressure > risk taking
-Pedestrian injuries
-Car safety
-Burns
-Homocides (preteen suicide)
-Fireworks/firearms
-Falls from roofs/playground/trees
-Sports injuries
-Poisoning
-Start to smoke/drugs/booze (focus on impact of bad breath, smell)
Adolescent Growth
-Rapid gains in height weight (3.5-4" in one year, and weight too. girls usually grow faster. boys muscle, girls body fat)
-Development of secondary sex characteristics
-Continued brain development (teens brains not fully developed til late adolescence)
-BODY IMAGE IMPORTANT HERE
Adolescent Development
Erickson: Identity vs. Role Diffusion
Piaget: Formal Operations
Kohlberg: Higher Law and Conscience
Adolescent Health Promotion
-Healthy habits
-Injury/violence prevention
-Mental health
-Nutrition
-Sex ed
-Prevent substance abuse
-Address issues of fatigue
-Promote physical activity
-Assess/discuss risk behaviors
-Violence (homicide)
-Sun protection
-Abstinence/contraception
-STD ed
-Psychosocial support/listening
-Car: NO TEXTING! / SEAT BELTS!
-Consequences of decisions/making good decisions
Adolescence : Safety
-Drugs, alcohol, tobacco
-Teens are risk takers
-Strong peer pressure
-Age of REBELLION
-Motor vehicle
-Homocide/suicide
-Bicycle/motorcycle
-Drowning
-Pedestrians
-Guns/explosives
-Assault
-Sports
Young Adulthood Development
-Erickson: Intimacy vs. Isolation
-Complete process of physical maturation
-Adult roles, learn a trade, higher education
-Understand abstract concepts, career goals, autonomy, hobbies
-Adult relationships, feel empathy, intimacy skills, values, some invincibility, establish body image
Middle Adulthood
Ego development: Generativity vs Self Absorption/Stagnation

Production and Care

children leave home, relationships/goals change, major life changes, mid-life crisis, stuggle with new meanings/purposes
Aging/Care of Older Adults: Issues
-Everyone who lives long enough gets old
-Aging and disease not synonymous
-Body more fragile, mind/spirit/creativity need not decline
-Aging population will transform society & HC system
-More HC providers needed
Aging/Care of Older Adults: Misperceptions
Older adults are just adults who are older

Care for older adults is less challenging

Only need to know gerontology is one works in nursing home
Aging/Care of Older Adults: Differences
-More fragile, homeostatis harder to maintain
-Body functions less efficient
-Not homogenous as a group or by body system
-Atypical presentation
-Focus on fuction
-Live with chronic conditions, co-morbidities
-More complex
Hospitalized Elderly issues to consider
-Physiologic changes (non-classic): pain, don't spike temps, lab counts less altered, SOB yes / but pain chest pain no. experiences pain in different ways than child and adult

-Cascade disease patterns

-Inevitable decline (functional status)

-Comorbid conditions
Aging Changes
-Cardiovasc (decreased baroreceptor, calcification, stiffening, dilation of aortic & mitral valves)
-Respiratory (decreased ciliary & cough reflex, alveoli less elastic)
-Genitourinary(decreased GFR, reduced bladder elasticity/tone/capacity)
-Integumentary (decreased subcut fat, capillary fragile)
-GI (decreased thirst sensation, decreased esoph motility)
-Musculoskel (tendon/ligament stiffens, narrowed intervertebral disks)
-Sensory (decreased periph vision, hearing)
-Endocrine (reduced insulin, decreased Vit D synthesis)
-Nervous (decrease in neurons & NTs, slowed nerve impulses)
-Cognition (stable crystallized intelligence, some decline in multitasking, increased time to learn/process new, some decline in retrieving info)
Cascade Disease Patterns:

Elderly client diagnosed with hypertension
Educate individual re diet and exercise

participation in health promotion activities
Cascade Disease Patterns:

Started on antihypertensive therapy
Educate about orthostasis and importance of dangling/leg exercises when getting up
Orthostasis
head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching. In medical terms, it is defined as a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg when a person assumes a standing position.
Cascade Disease Patterns:

Syncopal episode with fall
Acute care interventions

referral for home health

assessment of home for safety issues
Cascade Disease Patterns:

Fall with hip fracture; arthroplasty
Acute care interventions and rehabilitation
Cascade Disease Patterns:

Deconditioning and inactivity,
Immobility and skin breakdown
Rehabilitation

mobility activities
Challenges to Independence in Older Adult
Physical and cognitive decline

Role changes/transitions/reversals
-Retirement / economic decline: The effect of Social Security on the economic well-being of older adults
-Health decline
-Loss of spouse/friends
-Driving privileges
Support for independent living in the community
Social security and Medicare
-Part A: Hospitalization
-Part B: Medical insurance
-Part C: Private insurance (A&B)
-Part D: Prescription drug coverage

Medicaid
-State Children’s Health Insurance Plans (S-CHIPS)

The community
Nursing Issues in Caring for the Elderly
Attend to primary expressed need first
-Pain
-Fear
-Anxiety

Unless it’s a real emergency
-time = worse outcome
-deal with both at once
Goal of Elderly Care
STABILIZE or CURE underlying condition, maintain QOL, preserve functional status

Recalibrate your pace as RN, be patient, don’t rush, provide encouragement
-adjust to their Motor abilities
-adjust to their Cognitive abilities
Elderly Assessment Tools
FIM (functional independence measure) used in rehab
Health promotion for Elderly
POLYPHARMACY
AGEISM
Physical activity
Nutrition
Tobacco
Falls
Immunizations
Older Adult issues / health realities
-Lose sense of taste
-On crazy diets from comorbidities
-Thirst reflex diminishes
-GI slows
-Dentitia (lose weight and dentures don't fit)
-Do dietary recall for a week!
-At risk for aspiration
-GERD (a reason they could lose weight)
What to do/reference with Polypharmacy?
BEERS CRITERIA (a list of PIMS - potentially inappropriate medications) for the elderly. A PDF document online
why elderly don't adhere to meds?
Decreased motor skills

Forgetful

Finances

-find out real problem, ask them
Elderly immunizations
Herpes
Flu
Pneumovac
Safety for Elderly
-Unintentional injury at home (falls, struck by something, motor injury, cutting/piercing, animal/insect, fire/burns)

-Unintentional injury in hospital (aspiration/pressure ulcers/patient falls/UTI/hospital acquired infection)

-Adverse events (harm to P due to medical care=infections)

-Never events (serious events that should never occur in health care setting)
Geriatric syndromes
-Delirium
-Fall Risk
-Incontinence
-Pressure ulcers
-Sleep disturbances
-Depression
-Nutrition/weight loss
-Polypharmacy

Also: Agism, Successful Aging
Successful Aging: what do patients want?
1) Stay healthy
2) Live well and cope with illness and disability
3) Cope with End of Life