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56 Cards in this Set
- Front
- Back
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What is Stigma? |
"A mark or sign of disgrace or discredit" "A mark of disgrace associated with a particular circumstance, quality or person" |
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What is Prejudice? |
A negative preconceived opinion |
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What is descrimination? |
unfavorable treatment based on our prejudices |
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What factors may influence stigma? |
- family -- role modeling/racism - media/news
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In health care, how can stigma towards a person affect access to health care? |
- Taking unnecessary precautions (eg. hep C, HIV) - Assumptions about drug seeking - "needy patients" -- ignored - purple dot
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Populations that have been stigmatized: |
- Elderly - ppl with AIDS - Immigrants - first nations - minorities - Ect. |
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What is Addiction? |
- A chronic, relapsing, treatable brain disorder that results from prolonged use of drugs and/or substances - A multi-factoral pathogenesis which may include a number or predisposing, precipitating factors. Addictive substances are used and misused for many reasons.
- If left untreated , it is the leading preventable cause of death in Canada. |
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What are some risk factors for addiction? |
- family hx/genetics - environment - peer pressure - personality (risk takers) - ethnicity - coping mechanisms - emotional health - mental health - lack of supports - stress - social determinants of health |
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Addiction theories: Biological Factors |
Addictive substances, when taken in excess, have in common the direct activation of the brain reward system. By increasing extracellular levels of dopamine and through chronic exposure to these substances, may lead to pervasive changes in brain function at structural and neurophysiologic levels. |
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Addiction theories: Genetic |
- For some people with alcohol use and dependence, there is a gene related to alcoholism - Cultural factors - 40-60% of addictions is related to genetics - 4 times more likely to become alcoholic if have alcoholic family |
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Addiction theories: Psychological factors |
- Some ppl are born with certain temperaments that make them more susceptible to addiction - Psychological factors contribute to initiation and maintenance of substance related disorders |
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Addiction theories: Behavioral Factors |
- Behavioral characteristics of childhood and adolescence might predispose a person to substance abuse - family disfunction |
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Addiction theories: Social Theories |
- Age of onset of substance abuse - Substance use/abuse in adolescence creates an increased risk to be addicted than if a person started using a substance later in life |
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Screening tools for substance abuse |
- CAGE - DAST - ASSIST |
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Assessment |
A thorough physical assessment on all clients will help identify substance abuse issues.
What findings may indicate a pt. might have substance abuse issues? - weight gain or loss - skin issues - hygiene - behaviour (lack of attention, irritability) - tremors/shaky - dehydration - malnourished - insomnia - headaches - appear older than they are - fatigue |
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Addictions treatment: |
- Tx. is complex, and no single treatment is appropriate for all clients. - To be effective there must be mutually agreed upon treatment plan between client and health care team. - May include at some point: abstinence, harm reduction, theory sessions, and pharmacotherapy interventions - Treatment is a process not an event |
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Goals of Addiction Treatment: |
Goal is to return to productive functioning 1) Retention - treatment retention 2) Reduction - reduction in severity and frequency of use 3) Management - of psychiatric and medical conditions 4) Improvement - of quality of life 5) Prevention - of relapse - relapse rates are similar for drug addictions as they are for other chronic illnesses eg. HTN, Asthma, ect. |
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Harm Reduction: |
- Refers to any program, policy, or intervention that seeks to reduce or minimize the adverse health and social consequences associated with drug use without discontinuing drug use. - The person is best to determine which approach might minimize the harm of substance abuse |
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How do you develop a therapeutic relationship with the addicted client? |
Nonjugment, presencing, listening, being transparent, being clear about our purpose, watching our language (not perpetuating the stigma) |
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Bariatric Nursing Care: Prevalance & Implications |
- 2 out of 3 canadian adults are overweight - 1 in 4 are obese implications: - Obesity causes 1-10 premature deaths in ppl aged 20-64 - Multiple health effects including CV, respiratory, integument - Increased risk of certain cancers |
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Obesity: |
- Can be defined as a heterogeneous complex disorder of multiple etiologies characterized by excess body fat that threatens or affects socioeconomic, mental, or physical health -"A complex, chronic, multifactoral disesae that develops from the interaction btwn genetics and the environment; manifests as an abnormal increase in the proportion of fat cells in the body." - Functional assessment: is it affecting their daily lives?
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Factors contributing to obesity: |
Lifestyle: - sedentary - diet -- foods, meal sizes - meal skipping - alcohol
Psychosocial: - self esteem/image - stress - social - depression/anxiety - coping - boredom - income - binge eating
Biomedical: - genetics - meds: cancer tx, estrogen-based, SSRIs - Disease - mobility issues - metabolism - environmental toxins
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Metabolism |
There are a number of hormones realted to huger and obesity. 2 hormones, ghrelin and leptin, appear to play a big role in how we know to continue to eat, feel hungry ect. |
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Hormone: Ghrelin: |
"hunger hormone" - makes food look appetizing - Peptide produced by cells in lining of the stomach - One role of ghrelin is to regulate hunger - When stomach is empty, cells that line stomach secrete ghrelin and send signal to hypothalamus, you then feel hungry. Once stomach is stretched with food, ghrelin production is stopped, no longer hungry, and hopefully stop eating. - Increases when sleep deprived |
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Hormone: Leptin |
"Satiety hormone" - Protein produced by adipose tissue to maintain levels of stored energy - Adjusts sensation of hunger and energy expenditures - Leptin is secreted into bloodstream and travels to hypothalamus. It tells the hypothalamus that we have enough fat, so you can stop eating. More fat you have, the more leptin you make so you should stop eating. - 2 theories for obestiy: 1) Leptin resistance: body does not listen to the signal because protein that carries leptin across BBB is not working/absent 2) Leptin deficient: not enough leptin produced by the stored fat to tell hypothalamus that food intake should stop. |
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Health Consequences: Cardiovascular |
At risk for compromise due to: a) incr. BMI --> Incr. bld vol --> incr. SV, preload, CO --> thicker ventricular wall (works harder) --> contractility impaired b) Incr. vol. overload: sodium & H2O c) Incr. risk for atrial fibrillation, due to stretching of atria --> incr. risk for stroke d) Ectopy |
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CV health issues: |
- Coronary artery disease - Hypertension - mild to moderate in 50-60% of pt.'s. severe HTN in 5-10% - Hyperlipidemia - Atherosclerosis - Dysrhythmias - DVT: decr. venous return, incr. blood viscosity, decr mobility - Peripheral vascular disease |
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CV Assessment |
- HR/pulse (apical harder with more tissue) - BP (cuff size) - edema - CWMS - Heart sounds - lab values, ECG - exercise/tolerance - DVT (sore, redness, warm spot - often subtle with obesity) |
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CV Interventions |
- Meds - ECG - Oxygen - incr. mobility - TEDs - Edema -->decr. fluid intake ad sodium - diet/lifestyle/education |
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Health Consequences: Respiratory |
At risk for compromise due to : - obesity related atelectasis - obesity hypoventilation syndrome - OSA |
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The impact on lung function is due to 3 different but related factors: |
1) Restrictive function 2) Metabolic differences -- O2 consumption and CO2 production 3) Decrease compliance |
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Restrictive Dysfunction: |
- Adipose tissue surrounds the thorax and ribs. This limits the depth of inspiration as they must work against the restrictive force. -Diaphragm descent restricted - Decrease in chest expansion with larger breaths |
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Metabolic differences: Oxygen Consumption |
- Oxygen consumption increases linearly with weight in an attempt to support the metabolic activity of excess tissue. (may increase 4 times or more) - Incr. O2 consumption is associated with incr. CO2 production |
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Decreased Compliance: |
- Decreased inspiratory compliance - Incr. BMI associated with decreased respiratory compliance - Two factors that contribute to atelectasis: 1) Adipose tissue on chest wall 2) Increased pulmonary blood volume |
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Repiratory Health Issues: |
- obesity related atelectasis - obesity hypoventilation syndrome - OSA |
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Respiratory Assessment: |
- RR --> SOB, Incr. RR due to compensation - Lung sounds (more difficult to landmark) - O2 sats - CWS (cyanosis) - Pulmonary edema - Immobility = pneumonia - WOB--> decr. chest compliance and lung capacity |
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Respiratory Interventions: |
- Mobility - O2 therapy: O2, DB&C, chest physio, CPAP, BIPAP - Repositioning |
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Health Consequences: Integuement |
At risk for skin breakdown - numerous factors increase risk: - decr. thermoregulation - Skin folds (pressure, friction, moisture) - Self-care deficits
Wound healing issues: at rick for poor healing |
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Chronicity: |
Obesity is a chronic condition with known health risks including: - type 2 diabetes - Gout - gallbladder disease - Certain types of cancer |
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Safety: of client and staff |
- Increase physical injury to staff and clients when moving heavy clients
Need: - proper equipment (lifts ect.) - appropriate number of staff - Universal fall precautions - Evacuation protocols in place - Larger diagnostic machines (MRI, CT) - Precautions when moving |
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Other Considerations: |
- Consider private room - Diagnostic procedures - Nutritional screening |
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Bariatric: Pharmacokinetics |
The bariatric pop. has marked changes in distribution, binding, and elimination of meds - minimal data for most meds -- treatments based on clinical outcomes - Distribution: Incr. in body mass + decr. i lean mass% and body water = changes in volume distribution - Dosing for meds is based on their affinity for water (hydrophilic) or adipose tissue (ipophilic). - Hydrophilic meds (water soluble): dosing based on actual body weight - Lipophilic meds (fat soluble): dosing based on ideal body weight
Nursing: - Communicate with the doc & pharmacy about what seeing with this pt. ie. respone to meds, report effectiveness - Needle length for injections - Ifrom other HCPs of body weight |
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Autism Spectrum Disorders: |
- A group of neurological disorders that causes developmental impairment in social interaction, communication and behaviors. - Average age of onset = 3yrs - 4-5% more common in boys, but if girls they are more effected. |
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The Three Main Pervasive Developmental Disorders: |
- Autistic Disorder - Pervasive Development Disorder Not Otherwise Specified (PPD-NOS) - Asperger's Syndrome |
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Autistic Disorder: |
"Classic Autism' - 80% diagnosed by age 3 - Often not apparent until 18-24 mo - Deficit in communication and social understanding - Unusual behaviours, restricted activities - doesn't pretend play at age 2, doesn't engage with environment - Theory of mind deficit: not being able to take another persons perspective Eg. I'm happy so everyone is happy. -- Must be taught this |
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Pervasive Developmental Disorder Not Otherwise Specified: (PDD-NOS) |
"atypical autism" - when they don't quite meet requirements of autism -- higher functioning that typical autistic - Some language delays - Impaired in social interactions - Restricted interest in activities - Diagnosed after 30 mo. - 2 times as likely to be diagnosed instead of autism. |
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Asperger's Syndrome: |
"like sheldon from big bang theory" - 5/10,000 Canadians - Usually diagnosed later in life, after 3 years - Mild to severe impairments in social interactions & understanding. - Cognitive ability not delayed - Often take things literally -- don't get jokes - perfectionists |
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Rett's Syndrome: |
- less common - Effects girls only -- genetic link - Normal development until about 18 months, then slowing of development - Affects all areas of development: Social, cognition, sensory, emotional - Delayed speech, cardiac and resp problems - Often confused with cerebral paulsy |
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Childhood Disintegrative Disorder: |
- Normal development, then acquired skills are lost between ages 2-10.
Severe deficits: - Cognitive - Usually diagnosed after age 3 up to 10. - Significant loss in social, behavioral and language development - Bowel/bladder issues |
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Early Theories on Autism: Causes |
Leo Kanner: - coined the term autism - Though it must be the parents fault -"Refrigerator mother" 1950-1970's - cold, doesn't engage with children -- stigma
MMR Vaccination Risk: - discredited link to a causative factor |
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Multi-factoral causes: |
ASD is not caused by a single factor, but is likely a result of a complex combination of genetic and environmental factors -- constantly changing: Includes: - Genetics: 100s of genes, not just 1; 10-30% related genetics - Exposure to toxins (pre and post-natal): heavy metals, air, pollution - Neural tube defects: lack of folic acid - Nutritional Deficiencies: in mum and child (B12, B6, zinc, ect.) - Dysfunctional GI symptoms: bad bacterias leaking into CNS, effecting brain development (after birth) |
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Defining Characteristics of ASD: |
Social interaction impairment: - hallmark feature of autism - look at toy as more of an object rather than something to play with.
Delay/lack of language and communication skills: - not meeting developmental milestones - sometimes don't refer to selves as "I", rather by their name
Repetitive and stereotypical patterns of behaviour, interest and activities: - routines - clapping, foot stomping, head banging = communication, self-soothing |
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Infancy - 1yr: |
- quiet (lack of babbling) - hard to console - undemanding - don't respond to cuddling, reaching arms, name - don't make eye contact when feeding - no pointing or waving goodbye - fixating on objects but don't follow with eyes - more irritable - no smiling - no peek-a-boo - repetitive movements "hands" - not engaging in enviro. |
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Preschool: |
- Delay in speech - clapping, - tantrums -- frustrated - parallel play - don't pretend play - parrot arms - difficulty following directions - problems taking turns (also typical for age group) - rocking, head banging, self-harm behaviours - "echolalia" = parroting back (1 word) - unusual pitch or tone - fixate on an activity
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School age: |
- obsessive behaviour - lack of pretend play - lack of social awareness (avoid interactions) - appear not to have feelings - may not seem sensitive to others - repetitive Qs - refer to themselves in 3rd person - tantrum like behaviour - poor eye contact - sensory issues/impairment -- enviro, textures, noise, lights - use items in wrong way eg. spoon - inflexable with routines - don't pick up on social nuances - literal understanding |
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Strengths on ASD Children: |
- Non-verbal reasoning skills - Reading skills - Perceptual motor skills - Drawing skils - Computer interest and skills - Exceptional memory - Visual Spatial abilities - Music skills |
