Health and Trans - Final exam review.docx

Health and Trans - Final exam review Week 8-14 Older adult, Week 8/9: Categorizing by age: 60-74 years: the young old 75-84 years: the middle old 85 plus years: the old, old (frail elderly) Ageism: prejudice/discrimination against a category of people (ex, the older adult, young adult) E...

Health and Trans - Final exam review Week 8-14 Older adult, Week 8/9: Categorizing by age: 60-74 years: the young old 75-84 years: the middle old 85 plus years: the old, old (frail elderly) Ageism: prejudice/discrimination against a category of people (ex, the older adult, young adult) Everyone may be a target May not recognize it because it is more subtle Implicit ageism: Thoughts, feelings, behaviors towards elderly that exist and operate without conscious awareness Theories of aging: Stochastic theories: random cellular damage over time- accumulated damage leads to physical changes Nonstochastic theories: genetic programmed physiological mechanisms within the body control the process of aging Psychosocial theories: Disengagement theory: aging->health, energy, income, social roles leads to being withdrawn and isolated. Voluntary. Aging causes loosening of ties with other and smaller social networks Activity theory: continuing activities and interest is important to successful again, necessary to replace lost activities with others. Quality of activities is more important than quantity Continuity theory: individual remains essentially the same despite life changes (personally and behavior) Newer theory: Gerotranscendence theory: older adults deal with aging process by focusing on others and existential issues (ex, spirituality rather than on own limitations, decreased fear of death, greater need for solitude) Physiological changes-primary aging: integumentary Thinner of epidermis - cells produce slower, larger, irregular Melanocyte activity - ultraviolet ray protection, colourless hair Some melanocutes increase - brown spots Dermis thins, collagen, elastin = wrinkles, fragile Vascularity of dermis = slower to repair, meds absorb slower Decrease in Adiose tissue = folded, wrinkles, decrease in ability to maintain body temp Decrease in Sebaceous gland = dry itchy skin Sweat gland, decrease in regulate temp, intolerance to cold skeletal Loss of Ca, bones less strong, more brittle Less new bone growth Tendons and ligaments less flexible, decrease in ROM, stiffness Intervertbeal disc shrink, decrease in body height, decrease in thoracic spine curves Muscles 40yrs: number and diameter of muscle fibers decrease, smallr, dehydrated, weaker, replaced by connective tissue 80yrs: 50% muscle mass lost Mitochondrial function decrease Slowing muscle reflexes Nervous system Brain: beginning age 30, decrease in neurons, only small %, some effect on short term memory, impulse conduction speed, decrease slowing responses, reflexes Autonomic: increase synaptic delay, decrease flexes Sensory: loss taste, loss high pitched sounds, vision, larimal gland-> eyes dry Circulatory No change in resting cardiac output Exercise output, decrease cannot respond as quickly Muscle loses elasticity, more rigid, valves thicker, pacemaker cells, ability use 02 Increase BP Walls of arteries thicken, less elastic, decreasae blood flow to organs Respiratory Lung capacity decrease: less elasticity, deficiency of muscles Cillary activity declines, phagocytes less effective Number alveoli decrease: less oxygenation, more CO2 Digestive Muscle wall loses tone, slower peristalisis -> constipation Decrease in salvia, decrease in digestive enzymes, impairs absorption of vitamins and minerals Decrease in sense and smell Loss of teeth Weakened gag reflex Liver shrinks Urinary Bladder shrinks, less able to contract and reflex Weakening sphncter causes incontinence Enlarged prostate: difficulty voiding Reproductive Menopuasae: decrease menstrual periods cease, tissues become thinner, uterus shrinks Breast tissue: supporting ligaments weaken, fibrous cells replace glandular cells Tecsticular function declines: decrease testosterone Urge for sex could decline Cognitive changes: Intelligence increases into the 60s Cognitive function is related to use Processing and reaction times increase, with slower and more deliberate responses Decreased capacity for adaptation especially in stressful and unfamiliar places Memory loss may occur but long-term memory remains intact Dementias, delirium, and depression are common conditions affecting cognition The 3 D’s: Dementia: chronic, gradual onset, no fluctuations during the day, slow progression, lasts months to years Delirium: acute condition, short term, worse at night/darkness or upon waking, progresses quickly, lasts hours to less than one month Depression: chronic condition, worse in morning and has situational fluctuations, progression variable, lasts 6 weeks to several years Psychosocial changes: Erikson: integrity vs despair Older adults rflect on their life and feel satisfaction or disappointment Integrity: looks back on life with acceptance, see it as something that was an acceptable gift, finding comfortable relationships Despair: life was wasted, blew a great opportunity, too late to change now Health concerns of older adults: Illness: heart disease, cancer, CVA Nutrition Dental problems Exercise Arthritis Falls Sensory impairments Medication use Criteria for LTC: Over 18 - valid OHIP Care needs requiring 24 hr nursing or personal caare Frequent assistance with ADLs Monitoring to ensure safety and well being Need cannot be met in the community Have needs which can be met in LTC home Pregnancy, week 7: Pregnancy: 10 lunar months 9 calendar months 40 weeks 280 days (based on beginning of LMP) Term = 38 weeks Post term = 40 weeks Preterm = <37 weeks Signs of pregnancy: Amenorrhea Urinary frequency Fatigue Breast tenderness nausea/vomiting Quickening Objective Changes to cervix (internal examination) Enlargement of the abdomen Skin changes Braxton hicks contractions Pregnancy tests Positive Fetal heart tone Fetal movement Visualization of the fetus Estimating due dates: Count back 3 months from the first day of LMP, add 7 days (Naegles rule) Ultra sound Symphysis fundal height (after uterus becomes an abdominal organ) Pregnancy tests: Urine tests Done on early morning void Positive 10-14 days after first missed period Serum (blood) test Earlier detection: measures hCG enzyme OTC tests Detects enzymes, early results, sensitive, performed on urine Human chorionic gonadotrophin: hCG Produced by the embryo first (small amts) then the placenta (lg amts) Detected in blood 8-10 days, 26 days urine Prevents the involution of corpus luteum Causes corpus luteum to secrete increase amts of estrogen and progesterone to maintain pregnancy Continued to be produced until 3 months In male fetus - causes development of male sex organs Estorgen: After 11 weeks produced by placenta Increased growth of 1. Breasts, 2. mammary glands, 3. Uterus Increase vascularity and increased vasodilation of capillaries and pregnancy progresses Inhibits FSH production Stimulates LH production Progesterone: Essential for pregnancy Necessary for implantation to occur Decreased contractions and motility of uterus (affects smooth muscle throughout body) Increases breast glandular tissues in preparation for breastfeeding Human placental lactogen: Stimulates certain changes in the mothers metabolic processes Ensures that more protein, glucose and minerals are available for the fetus Insulun antagonist Minor discomforts of pregnacy: 1st trimester: Nausea and vomiting - multifactorial Urinary frequency Fatigue Increased estrogen and progesterone Nasal stuffiness and epistaxis Breast tenderness Increased vaginal secretions 2nd trimester Constipation Backache fainting/dizziness Heartburn Varicose veins Leg cramps Leukorrhea Hemorrhoids 3rd trimester Dyspnea Ankle edema Supine hypotension Ligament pain Headache Gravida: number of pregnancies including present one Parity: number of pregnancies beyond viability Viability: 20 weeks Primigravidia: prgenant for the first time Abortion: delivery prior to 20 weeks Stillbirth: infant born dead after 20 weeks G-TPAL: G: Gravida (number of pregnancies) T: Term P: Premature A: Abortion L: Living Maternal development tasks: 1st trimester: Disbelief and ambivalence Acceptance of the pregancy Women is introspective and self concerned 2nd trimester Perceives the fetus as a separate individual from herself Visualizes, dreams Questions ability to attain the maternal role - looks at own mother 3rd trimester Concerned about the “safe passage” separation for the fetus, fetal well being, labour/delivery, family adjustments Nesting Health progress in pregnancy: Appropriate weight gain Appropriate fetal growth Fetal movement - active Urine: negative for SAP Normal maternal vital signs Dealing with minor discomforts, psychological changes No development of “warning” signs Maternal weight gain: Female of “normal” weight pre pregnancy 11.5 kg to 16kg Obese women recommended weight gain is 6.8 kg to 11.5 kg Underweight women recommended weight gain is 12.7kg to 18kg First trimester 0.5kg to 2kg Second and third trimester 0.45kg per week Maternal nutritional requirements: Carbohydrates – increase last two semester to promote fetal growth Protein – amino acids – increase last ½ pregnancy – development maternal tissues Fats – unchanged for pregnancy Minerals – iron due to increased maternal blood volume, placenta, fetal growth Vitamins – increase water soluble vitamins C, B complex esp folic acid Fluid – non caffeinated beverages Fetal growth: Measured by fundal height once the uterus is above the symphysis pubis at 10 weeks gestation Fetal heart rate detected on average at 8 to 12 weeks gestation - range 110 to 160 beats/min Fetal movement/ activity monitored beginning week 28 Maternal vital signs: Blood volume increases - pulse increases slightly BP decreases slightly reaching lowest point in trimester 2 - then increases to pre-pregnancy level. (watch for supine hypotension) Respiration rate increases third trimester as fetus pushes up on the diaphragm Warning signs to monitor: Bleeding Fluid loss per vagina Pain Elevated temperature Dysuria Severe N&V Altered fetal movement Visual difficulties Headache Edema of hands and face Epigastric pain Decreased urine output Labour and delivery, week 9/10: Labour: process of moving the fetus, placenta and membranes out of the uterus through the birth canal True labour: Cervical changes Effacement Dilation Regular contractions becoming more frequent, stronger, lasting longer Rupture of membranes Critical factors in labour: Birth passage Size and shape of pelvis Inlet Pelvic cavity Outlet Cervix dilation and effacement Vaginal canal and opening Fetus Head size and presence of molding Lie Attitude Presentation Relationship between passage and fetus Engagment of presenting part Station Fetal position Physiologic forces of labour Frequency, duration, intensity of uterine contractions Pushing effort Duration Psychosocial considerations Physical preparations Sociocultural values, beliefs Previous childbirth experience Support Emotional status Stages of labour: 1st stage: from onset of regular uterine contractions until full dilation of the cervix (0 - 10 cm) Uterine contractions Effacement Dilatation May take up to 20 hours normally; average is 12 – 14 hours Divided into 3 phases: latent, active & transition Latent Phase of labour: 0-3 cm Last about 6-8 hours Contractions mild to moderate, q 30 – 5 minutes, 20 – 40 seconds in length Woman is alert, follows directions readily, excited Pain is controlled fairly well Nursing Assessments: On admission (& ongoing) Leopolds maneuvers Assessment of FHR & pattern Assessment of uterine contractions Frequency Duration Strength Resting tone Vaginal exam Effacement Dilation Fetal position & descent (station) Status of amniotic fluid & membranes Maternal vital signs Stage 1: Active Phase of labour: 4 – 7 cm Contractions moderate to strong Contractions coming q 3 -5 minutes, lasting 45-60 seconds Pink to bloody show More serious, doubts ability to control pain Stage 1: Transition Phase of labour: 8 – 10 cm Very strong contractions Frequency of contractions: q 2 - 3 min Duration: 45 – 90 seconds Copious bloody show Frustrated, fears loss of control, irritable, nausea, vomiting etc Nursing Care During Labour General hygiene Oral intake IV fluids Voiding Catheterization Bowel elimination Ambulation & positioning Support measures Management of pain Watch the labour positions youtube Fetal Assessment in Labour FHR is the most important factor in determining fetal status Normal range: 120 – 160 bpm Methods Intermittent Continuous External fetal monitoring Internal electronic monitoring Colour of amniotic fluid Meconium stained (green tinged) Next Stages of labour 2nd stage: from 10 cm to delivery of the fetus Descent through the birth canal May last up to 2 hours 3rd stage: from delivery of the fetus to delivery of the placenta Short time Oxytocic meds used 4th stage: 2 – 4 hours after delivery Homeostasis is being reestablished High risk for post partum hemorrhage 2nd stage nursing care Monitoring uterine contractions Assisting with “pushing” efforts Open glottis pushing Monitoring fhr Providing support - coaching Fluids (IV & oral) assessing perineum for evidence of fetal descent Note time of birth 3rd stage nursing care: Maternal Placental delivery “shiny” Schultze “dirty” Duncan Nursing care Vital signs Assist with delivery of placenta Administer Syntocinon Monitor for vaginal bleeding Episiotomies & lacerations 3rd stage nursing care: Neonate Establish respirations Stimulate Keep warm Oxygen prn Suction prn Apgar score (10) Respirations Heart rate Muscle tone Reflex response Colour Assess and give to mom/dad once stable 4th stage nursing care Time of highest risk for post partum hemorrhage q15 minute assessment Breasts Uterus (fundus) Bladder Bowel Lochia (flow) Episiotomy (lacerations) Vital signs Bonding Family and family assessments, week 10/11: Family: Various definitions: biological, legal, or social network with personally constructed ties and ideologies Nursing approach: set of relationships that the client identifies as famil or as a network of individuals who influence each others lives, does not need to hold biological or legal ties Family forms: Nuclear family Extended family Step family Blended family Lone parent family Other: grandparents, teens Family: statistics canada Refers to a married couple (with or without children of either or both spouses), a couple living common-law (with or without children of either or both partners) or a lone parent of any marital status, with at least one child living in the same dwelling. Exclusions Based on structure Reasons insurance, business purposes, schools, taxes, etc Structural Assessment: Refers to the nature of the relationships between and among members Describes who is in the family and how they are connected Considers composition, gender, rank order, subsystems and boundaries Boundaries can be diffuse, rigid or permeable Developmental Assessment Looks at the family’s development over time. Considers the processes of growth, aging, and change over the life span. Characteristics of Success Functional Assessment instrumental Aspects – activities of daily living. Expressive Functioning Communication Problem solving skills Roles Belief Influence Power structure Laforet-Fliesser & Ford-Gilboe (1996): What is the family working on or dealing with? How is the family going about it? What does the family want or what is it working toward? What resources is the family using and what other resources could be mobilized? What aspects of the broader context of family life might explain the family’s present health behavior or situation? Family Strengths: Communication skills Shared family beliefs Intra-family support Self-care abilities Problem-solving abilities Hardiness/Resiliency Resources & social support Postpartum care, week 11/12: Postpartum assessment: Breasts lungs/circulation Uterus Lochia Perineum Lower extremities Elimination Psychological adaptation Attachment Client education Breasts: Assess breast tissue and nipples Engorgement Breastfeeding vs non breastfeeding Lactation suppression Pumping Support Postpartum cardiovascular changes: Diuresis helps decrease extracellular fluid Cardiac output returns to normal by 6 to 12 weeks The most common neurologic symptom is a headache Uterus assessment: Fundus Position Firmness Descent Maintaining uterine tone Uterine contractions (afterpains) Cervix Assessment for postpartum hemorrhage Vital signs Lochia Postpartum uterine changes: The uterus decreases in size in a process called involution A spongy layer of the decidua is sloughed off The basal layer differentiates into two layers The outer layer sloughs off The inner layer begins the foundation for the new endometrium The placental site heals by exfoliation The uterus is the top portion of the uterus Fundus will be at the level of the umbilicus 6-12 hours postpartum The fundus will be 1 cm below the umbilicus on the first postpartum day The fundus will descent 1cm per day until it is in the pelvis on the 10th day The uterus will reach its pre-pregnancy size by 5-6 weeks Lochia: Uterine debris in the uterus is discharged through lochia Lochia Rubra is red (days 1-3 approx) Serosa is pink (days 3-10 approx) Alba is white (day 10 approx until healing has occurred) Color, amount, odor, clots Differentiating between lochial flow and non lochial flow Flow increases with activity, breastfeeding, and in PPH Postpartum bladder assessment: Voiding after delivery Initiating Emptying Dysuria Nursing interventions Effect of a full bladder on the fundus Postpartal diuresis Fluid intake Kegel exercises Postpartum bladder changes: Increased bladder capacity Swelling and bruising of tissues around the urethra Decrease in sensitivity to fluid pressure Decrease in the sensation of bladder filling Urinary output is greater due to puerperal diuresis Increased chance of infection due to dilated ureters and renal pelvises Postpartum vaginal changes: The vagina may be edematous, bruised with small superficial lacerations Size decreases and rugae reappear within 3 to 4 weeks Returns to pre-pregnant state by 6 weeks Assessment of Perineum Episiotomy/laceration wound is assessed for REEDAP: redness, edema, ecchymosis, discharge, approximation, and pain Hematomas sometimes occur Presence of hemorrhoids Efficacy of any comfort measures A site for infection to develop Perineal care Bowel: Risk for constipation related to Perineal discomfort Decreased oral intake in labor Side effects of narcotic analgesics Hemorrhoids Assessment of Lower Extremities Assess for signs of thrombophlebitis Some facilities have discontinued performing a Homans sign; supporters use it as a screening tool Assess legs for edema, redness, tenderness, and warmth Assess for return of sensation following anesthesia Ambulate to prevent thrombophlebitis; teach signs Postpartum Changes in Vital Signs Temperature may be elevated to 38°C for up to 24 hours after birth Temperature may be increased for 24 hours after the milk comes in Blood pressure (BP) rises early and then returns to normal Bradycardia occurs during the first 6 to 10 days Postpartum Changes in Lab Values Nonpathologic leukocytosis occurs in the early postpartum period Blood loss averages 200 to 500 mL (vaginal), 700 to 1000 mL (cesarean) Plasma levels reach the pre-pregnant state by 4 to 6 weeks postpartum Platelet levels will return to normal by the sixth week Emotional Comfort Engorgement Afterpains Perineum Rest/fatigue, activity Postpartum “blues”, depression Bonding Maternal Psychological Adjustment “Taking in” Woman tends to be passive, follows suggestions, hesitates to make decisions, preoccupied with their needs (food and sleep) “Taking hold” Ready to resume control of her body, her mothering, and life in general Breastfeeding worries Assessment of Early Attachment Is a mother attracted to a newborn? Is a mother inclined to nurture her baby? Does the mother act consistently? Is mothering consistently carried out? Is the mother sensitive to the newborn’s needs as they arise? Is the mother pleased with the baby's appearance and gender? Are there cultural factors at play? Giving birth in a New Land: strategies for service providers working with newcomers Indications of postpartum complications Temperature > 38° Celsius after 24 h Hypo or hypertension Uterus: boggy, deviated from the midline, above the umbilicus after 24 h Lochia: heavy, foul, bright red Breasts: cracks, fissures, red, warm Bladder: inability to void, symptoms of UTI Perineum: excessive edema, open, draining Energy: tired, no appetite, can’t sleep Family health and health care system, week 11: Health: Robert Labonte Feeling vital & full of energy Having good social relationships Experiencing a sense of control over one’s life & one’s living conditions Being able to do things that one enjoys Experiencing a sense of connectedness to the community Traits of Healthy Families: Good physical & emotional health habits Sound financial management Respect personality differences Family coherence Routines Celebrations Rituals Family hardiness/resiliency Control Challenge Commitment Adaptive & has the capacity to change Communication Support network Indicators for Family Assessment: Initial diagnosis of a serious physical or psychiatric illness/injury in a family member Family involvement and understanding are needed to support the recovery of the client Deterioration in a family member’s condition Illness in a child, adolescent, or cognitively impaired adult A child, adolescent, or adult child having an adverse response to a parent's illness Discharge from a health care facility to the home or an extended-care facility Death of a family member Health problems are defined by family as a family issue Indication of threat to relationship (abuse), neglect, anticipated loss of family member Canada Health Act Public Administration Comprehensiveness Universality Portability Accessibility The goal is to provide appropriate health care – the right service, right time, delivered by the right person, in the right place Levels of Health Care Health Promotion Disease and Injury Prevention Diagnosis and Treatment Primary care Secondary care Tertiary care Quaternary care Rehabilitation Supportive Care Issues in the Canadian Health Care System: Escalating costs Quality of care Fragmentation Accessibility