Nursing Practice III_ Integrated Care (Semester 2).pdf

Nursing Practice III: Integrated Care (Semester 2) Module Notes Week 1 – Maternal, Infant & Child Health Week 1 (S2): Perinatal Care 17th July 2024 Definitions – A continuum of care Perinatal c...

Nursing Practice III: Integrated Care (Semester 2) Module Notes Week 1 – Maternal, Infant & Child Health Week 1 (S2): Perinatal Care 17th July 2024 Definitions – A continuum of care Perinatal care can begin at the preconception stage For the mother, achieving an optimal health state for pregnancy involves several key factors: a) Healthy weight: Maintain a body mass index. Both underweight and overweight conditions can impact fertility and pregnancy health. b) Balanced diet: Consume a diet rich in fruits, vegetables, whole grains, and lean proteins. Avoid excessive caffeine and ensure adequate intake of essential nutrients like folic acid. c) Regular exercise: Engage in regular physical activity to maintain fitness and manage weight. d) Avoid harmful substances: Cease nicotine containing products, avoid alcohol and recreational drugs. e) Medical conditions management: If you have existing health conditions such as diabetes, heart disease, or thyroid issues, ensure they are well managed and controlled before conceiving. f) Mental health: Address and manage any mental health concerns, as stress and mental health conditions can impact fertility and pregnancy health. Maternity care in NZ LMC (Lead Maternity Carers) is a midwife, GP or obstetrician who provides maternity cate to pregnant women The nursing role - Theatre – pre-op, circulating nurse, scrubs nurse - Recovery – post-op assessment, stabilisation - Emergency department - Mental health nursing - Primary health care - Acute car - NICU/SBU - Maternity wards Conception Fertilisation occurs in the outer third uterine tube, this requires the lumen of the uterine to remain patent. - Fertility issues may arise if there is scar tissue (adhesions_ or fibroids (non-cancerous growths) banding around or blocking these tubes, thus inhibiting the passage of sperm to the oocyte (non-fertilised egg). - Now take not of where the fertilised and already dividing egg (blastocyst) implants – on the endometrial layer of the uterus. Occasionally – the egg may implant within the uterine tune, causing an ectopic pregnancy. - Ectopic pregnancies are not viable and may cause severe complications such as rupture and haemorrhage leading to high morbidity and mortality rates without prompt intervention. Signs and symptoms of an ectopic pregnancy emergency: a) Light vaginial bleeding and pelvic blood – often the first warning sign b) Shoulder pain – can occur if blood leaks from the fallopian tube and irritates the diaphragm (referred pain) c) Sharp, sudden and intense abdominal pain d) Feeling dizzy or fainting – can indicate severe internal bleeding e) nausea , vomiting and pallor – can also indicate significant internal bleeding f) Severe bleeding – if the fallopian tube ruptures, it can cause potentially life threatening bleeding  Stages of pregnancy Signs and symptoms of normal pregnancy within either trimester: First trimester – weeks 1-12 a) Extreme tiredness b) Tender, swollen breasts c) Nausea +/- vomiting (morning sickness) d) Cravings or distaste for certain foods e) Mood swings f) Constipation g) Need to pass urine more often h) Headache i) Indigestion j) Weight gain or loss Discomfort may go away as pregnancy progresses OR some do not feel discomfort at all Second trimester – weeks 13-28 1) More noticeable changes to the body to make room for growing baby 2) Body aches, such as back, abdomen, groin, or thigh pain 3) Stretch marks or abdomen, breasts, thighs, or buttocks – striae gravidarum 4) Darkening of skin around nipples 5) Line on skin running from bully button to pubic area – linea negra 6) Patches of darker skin, usually over the cheeks, forehead, nose or upper lip – mask of pregnancy 7) Numb or tingling hands – carpal tunnel syndrome 8) Many women find the 2nd trimester easier than the first Third trimester – weeks 29-40 a) Shortness of breath b) Increased frequency of urination c) Heartburn d) Swelling of the ankles, fingers, and face (sudden or extreme swelling or woman gains a lot of weight rapidly – could be a sign of preeclampsia)  e) Tender breasts, which may leak a watery, yellowish milk called colostrum f) Navel may ‘pop out’ g) Trouble sleeping h) Haemorrhoids i) Baby “dropping”, or moving lower in the abdomen j) Contractions, which can be a sign of labour (Braxton Hicks) As a women nears her due date, cervix becomes thinner and softer (called effacing) Stages of birth Vaginal birth is divided into 3 stages: 1) Stage one is where contractions intensify, and where the cervix dilated to 10 cm to allow for passage of the newborn. In a first pregnancy, the time from the start of established labour to being fully dilated is usually 8 to 18 hours. It’s often quicker (around 5 to 12 hours), in a 2nd or 3rd pregnancy. 2) In stage 2, the babies head (ideal) or bottom (breach) crowns and the baby is delivered with some level of assistance from the LMC. This could be as simple as guiding limbs out, or using instruments such as forceps or a ventouse (a kind of suction cup applied to the newborn head). Sometimes the LMC may need to make an incision down the perineum to allow passage (episiotomy) to prevent perineal tears during birth. Stage 2 may take a few minutes to a few hours. 3) In stage 3, the placenta detaches from the uterus lining and is delivered. Sometimes drugs are required to assist placental detachment (synthetic IV oxytocin). Stage 3 is usually quick and may take around 30 minutes. It is important to assess the placenta to ensure pieces of it have not been left behind, as this would risk haemorrhage and/or infection (sepsis). Newborn assessment APGAR score Appearance Pulse Grimace Activity Respiration Generally the test is completed at 1 and 5 minutes after birth and may be repeated later (PRN) if the score remains low: - Scores of 7 and above are generally normal - 4-6, fairly low - 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts - A low score on the 1-minute mark may show the neonate requires medical attention, but does not necessarily indicate a long-term problem, particularly  if the score improves at the 5-minute mark - An APGAR score that remains below 3 at later times, such as 10, 15, or 30 minutes, may indicate longer-term neurological damage Alongside the APGAR, the newborn will have a head to toe examination which covers: - Vital signs - Weight, length and head circumference - Systems assessment (respiratory, cardiac, abdominal, oral cavity, integument) - Musculoskeletal assessment (peripheries and digits, hip dysplasia) - Neurological reflexes: Week 1 (S2): Well-child – Tamariki Ora RNs need some level of human development foundational knowledge due to: a) Assessment and care planning: Knowledge of human development helps nurses assess which developmental stage a patient has reached, allowing them to tailor care plans that meet the patients specific needs and developmental milestones. b) Effective communication: Understanding different stages of development enables nurses to communicate effectively with patients of all ages, addressing their cognitive and emotional needs appropriately. c) Holistic care: Nurses can provide more holistic and patient-centred care by considering the physical, emotional, social development of their patients, which enhanced the overall quality of care. d) Early detection and intervention: Knowledge of typical developmental milestones allows nurses to identify and address any delays or abnormalities, which is crucial for timely intervention and support. e) Support across lifespan: Understanding human development enables nurses to support patients at different stages of life, from infancy to old age, adapting their care strategies to suit the developmental context of each age group. The first 1000 days The first 1000 days of life, from conception to age 2, is the most critical developmental phase for child’s development. - During this period the brain grows rapidly. Laying the foundations for cognitive and socio-economic health. - Proper nutrition, caregiver attachment and care are essential to support growth, influencing a child’s long-term health and potential. Many challenges in adult society have their roots in early life, including:  a) Heart disease b) Obesity c) Mental health and addiction problems d) Criminality e) Poor literacy/numeracy f) Impaired economic participation ACEs Adverse childhood experiences (ACEs) refer to traumatic events occurring between the ages of 1 and 17 that can have significant impacts on a child development and overall health. These experiences are characterised into 3 main categories: 1) Abuse a) Emotional: recurrent threats, humiliation b) Physical: beating, not spanking c) Sexual: contact sexual 2) Neglect a) Physical b) Emotional 3) Household dysfunction a) Mother treated violently b) Household member was drug or alcohol abuser c) Household member was imprisoned d) Household member with chronic illness e) Not raised by both biological parents Examples include: domestic violence, parental separation, substance abuse, mental illness in the household, and physical or emotional neglect. - ACEs are linked to toxic stress, which can disrupt brain development and affect various cognitive, emotional, and physical functions. This can lead to long-term health problems such as: increased risk for chronic diseases, mental health issues, and behavioural problems. - Studies have shown that individuals with a higher number of ACEs have a greater likelihood of experiencing difficulties in adulthood, including poor academic achievement, substance abuse, and interpersonal u=issues. Family assessment Genograms and Ecomaps Genogram – can be used to document family relationships, histories and to illustrate patterns of family interactions - Genograms are a graphic representation of a family that provides invaluable information about family history and structure. Ecomap – is a visual means of facilitating discussions around the structure and strengths of networks - Ecomaps are used to document the family unit’s relationships to outside services and demonstrates a network of people around a child/young persons, which should include family, friends, and professionals. There are 3 key elements of ecomaps: 1) Relationships: An interpersonal interaction or sense of connection arising from mutual feelings or interactions which can change or adapt over time. 2) Social network: Cooperating with a group of significant others whom a person interacts with in their daily life. 3) Supportive network: Those whom a person nominates as having positive or beneficial influence in the lives. Ecomaps are used to help identify the supports and social networks that sit beyond the family. Ecological systems theory This theory maps development across 5 environmental layers: 1) Microsystem: The immediate environment where a person has direct interactions, such as family, shool, and peers. 2) Mesosystem: The interconnections between various microsystems, like the relationship between a child’s home and school. 3) Exosystem: External settings that indirectly influence development, such as a parent’s workplace. 4) Macrosystem: The broader cultural and societal context, including laws, norms, and cultural values. 5) Chronosystem: The dimension of time, reflecting the impact of life transitions and historical events over a person’s lifespan. This theory emphasises that development is a complex interplay between the individual and their environment, both immediate and broad. Developmental history Human development can be divided into 3 domains: 1) Physical 2) Cognitive 3) Socio-emotional Factors that can affect development: - Genetics - The environment - Illness, injury and disability - Premature birth - Maltreatment - Experience and trauma Importance of developmental history: - Provides important contextual information to help understand current presentation - Identifies early red flags - Identifies the beginning of current concerns - Tracks changes over time - Explores interventions tried - Can help parents and caregivers feel heard and validated Cognitive development Cognitive development refers to the growth and maturation of an individuals thinking processes and intellectual capabilities. This includes: the development of abilities such as perceiving, remembering, concept formation, problem-solving, imagining, and reasoning. 1) Sensorimotor Stage (0-2 years): In this stage, infants learn about the world through their senses and actions. They develop object permanence, the understanding that objects continue to exist even when they are not seen 2) Preoperational Stage (2-7 years): During this stage, children begin to use language and think symbolically, but their thinking is still intuitive and egocentric. They struggle with understanding other perspectives and exhibit centration, focusing on one aspect of a situation at a time 3) Concrete Operational Stage (7-11 years): Children start thinking logically about concrete events. They gain a better understanding of the concept of conservation (the idea that quantity remains the same despite changes in shape or appearance) and can perform mental operations on concrete objects and events  4) Formal Operational Stage (12 years and up): In this final stage, individuals develop the ability to think abstractly, reason logically, and plan systematically. They can understand hypothetical situations and use deductive reasoning Socio-emotional development  Week 2 – Challenging Behaviour, Adolescence & Risk Week 2 (S2): Adolescence 24th July 2024 Adolescence is the developmental period between childhood amd adulthood – beginning with changes associated with puberty and culminating in the acquisition of adult roles and responsibilities. Adolescence is a dynamic period of development characterised by rapid change in several areas: a) Physical – the onset of puberty (physical growth, development of secondary sexual characteristics and reproductive capability) b) Psychological – the development of autonomy, independent identity and value system c) Cognitive – moving from concrete to abstract though d) Emotional – moodiness; shifting from self-centredness to empathy in relationships e) Social – peer group influences, formation of intimate relationships, decisions about future vocation Stages of Adolescent Development It is believed that a wide range of mental health disorders that begin during adolescence (anxiety, depression, ADHD) have undergone less pruning of synaptic connections between neurons. First sign of adolescence maturation: In males – testicular enlargement In females – development of breast bud tissue Practical Points for Communicating and Working with Adolescents - See young people by themselves as well as with their parents. - Be empathetic, respectful, and non-judgemental. - Assure confidentiality in all clinical settings. - Be yourself. - Try to communicate and explain in a manner appropriate to their development. - If appropriate, take a full adolescent psychosocial history (the HEADSS protocol). Week 2 (S2): Dementia and Challenging Behaviour Challenging behaviour is any behaviour which causes significant destress by the person which does not appear to be minimised by interventions. It is increasingly recognised that challenging behaviour in dementia is often an attempt at communicating an ‘unmet need’. The Newcastle model is a biopsychosocial, person-centred, approach that aims to support health professionals in order to manage challenging behaviours by identifying and fulfilling unmet needs of the person with dementia. The Newcastle model looks at: a) The behaviour b) Vocalization c) Appearance observed during an episode of challenging behaviour And combines it with the background information mental health, physical health and social history etc to try to understand what is causing the problem to identify the unmet need. Common causes of challenging behaviours in all people: Lab Content A person with dementia often needs to be persuaded either to start a behaviour or stop a behaviour. Simple ways to engage with people with dementia include: a) Checking that people’s glasses or hearing aids are available and working so that they can participate in conversations. b) Using the person with dementias name and introducing yourself to them by name. c) Showing active listening through positioning and facial expression. d) Using positive language. e) Having a plan for how the conversation will end. HEADSSS Assessment HEADSSS is an acronym for a comprehensive psychosocial assessment tool identifying risk and protective factors, and assists health professionals formulate a plan in partnership with the young person.  Week 3 – Substance Use & Depression Week 3 (S2): Addictions 31st July 2024 Motivational Interviewing – MI MI is an intervention that was first developed to work with people with substance abuse disorders. - MI is a type of counselling that is person-centred, goal-directed, and puts the person in charge of their change in behaviour. Motivational interviewing has 4 main core skills made easy to remember through the acronym OARS: Open-ended questions Affirmation – acknowledging hard work and difficulties Reflective and active listening Summary Alcohol and Pregnancy Fetal Alcohol Syndrome Fetal alcohol spectrum disorder (FASD) is a diagnostic term used to describe impacts on the brain and body of individuals prenatally exposed to alcohol during pregnancy. Individuals with FASD may experience challenges in their daily living, and need support with motor skills, physical health, learning, memory. Attention, emotional regulation, and social skills. First Trimester: - Generally, women think it is not okay to drink during the first trimester because of the critical stage of development. However, some women with unplanned pregnancies will have drunk alcohol or binge drink prior to learning about the pregnancy. Second Trimester: - The second trimester is usually regarded as the safest time to drink, as women are generally feeling well and the baby is settled. Third Trimester: - Again, most women will think drinking during the third trimester is okay. However, some attitudes and behaviours will change as some women might think drinking will ead to labour complications and other will refrain from drinking because the reality of motherhood is more obvious. Prevalence of Co-occurring Disorders The terms comorbidity, co-existing or co-occurring or dual diagnosis of two or more mental disorders within one individuals, either at the same time or within a specified period such as 12 months or over the lifeline. - Among people with anxiety disorders, 9.4% has a coexisting substance disorder and 29% of people with a 12-month substance use disorder had a coexisting mood disorder compared with only 7.9% of the general population who experienced a mood disorder. Treatment for coexisting disorders involves 3 distinct models of care: 1) Sequential treatment – one condition treated before the other 2) Parallel treatment – treated simultaneously but two treatment providers 3) Integrated treatment – treated simultaneously by the same provider Most services in NZ will do either parallel or integrated treatment.  Substance Abuse Historically, addiction was defined as the physical and/or psychological dependence on a substance. Recently, addiction is defined as the continued involvement or compulsion with an activity, behaviour or substance, despite experiencing negative consequences. Drug Related Harms a. Substance use exists on a continuum b. People use drugs to change how they feel – they want to feel better or different. They use drugs for the perceived benefits not the potential harm c. No drug leads to immediate dependence however drug related harm can happen at all levels of use, rom initial use to dependent use d. Harms. The 5 L’s – liver, lover, livelihood, law, losing it What Constitutes a Problems? a) Experimental use i) Experimental use tends to be random, a person tries out a particular drug within a social situation. b) Recreational use (social drug use) i) A person uses a drug in a deliberate but controlled way. This could be few times a year or weekly on weekends. c) Situational use i) A person uses drugs to cope with the demands of a particular situation. For example smoking when stressed. d) Intensive use (binge use) i) A person consumers a large amount of drugs over a short period of time, or uses continuous over a number of days or weeks. e) Dependent use i) A person feels they have little or no control over their drug use. They feel compelled to use in order to feel normal and cope. Nursing Screening CAGE Questions for Screening for Alcohol - Have you ever felt that you should CUT down on your drinking? - Have people ANNOYED you by criticising your drinking? - Have you ever felt bad or GUILTY about your drinking? - Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (known as an EYE-opener)? The Level NZ – test your drug use assessment Nursing Interventions - Harm reduction/harm minimisation - Management of the intoxicated client - Detox - Brief interventions – MI - Education - Rehabilitation - E-interventions - Case management Nursing Responsibilities for Withdrawal or Detox - If an inpatient – complete MSE and monitor vital signs regularly throughout the shift  - Administer medication as prescribed to treat severity of symptoms - If patient has nutritional deficits and is a heavy user of alcohol ensure that the patient is prescribed and given Thiamine – Vitamin B1 - Complete a CIWA assessment at least once a shift or any time symptoms worsens – for alcohol withdrawal Recovery and Stages of Change Recovery can be a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential. Stages of Change Model – Prochaska and Diclemente Nursing Interventions a) Precontemplation – raise doubt. Increase the clients perception of risks and problems with current behaviour. b) Contemplation – tip the balance. Evoke reasons for change and risks of not changing. Strengthen the client’s self-efficiency for change of current behaviour. c) Preparation/Determination – help the client to determine the best course of action to take in seeking change. d) Action – help the client to take steps forward. e) Maintenance – help the client to identify and use strategies to prevent relapse. f) Relapse – help the client renew the process of contemplation, preparation and action, without becoming stuck or demoralised because of the relapse. Week 3 (S2): Depression What is Depression? - Clinical depression is different from dysphoria – everyday unhappiness. - Clinical depression is a type of mood disorder. The medical term is major depressive disorder. - To be diagnosed with depression the person must have been experiencing symptoms for at least two weeks. - Depression effects emotions, behaviours, physical well-being, ability to study, work and to have satisfying relationships. - In any one year, mood disorders affect around 8% of adults aged 16+ – more females than males (5.7% for major depressive disorder) - 50% of people who experience depression will have their first episode by aged 31. Primary depression: Problems associated with mood are the central issue. Secondary depression: Emotional problems associated with other neurological or brain disorders e.g. Huntington’s Disease, Parkonsin’s, Dementia or are side effects to medications such as steroids, phenothiazines etc. Dysphoria (everyday unhappiness) or sadness is characterised by deep dissatisfaction with life, and is considered a symptoms of depression, not a condition. - Depression or other mood disorders can cause dysphoria, but more often than not, dysphoria is situational. Grief is often experienced in waves, which are triggered by specific losses that may be unpredictable sometimes. The intensity of grief will diminish over time although patients may hav episode of severity. Depression is present with persistent flat affect. Nursing Assessments a) PHQ9 b) Strength and Difficulties Questionnaire c) Gereatric Depression Scale d) Edinburgh Depression Scale – for postnatal depression Below you will find a quick guide on how to assess and what to think about when assessing a person for depression. How to assess depression 1) Identify the patient’s risk factors for depression. Remember, Long-term diseases (e.g., cardiovascular disease, Parkinson disease, kidney disease, stroke, diabetes) and Certain conditions, such as hypothyroidism, delirium, or dementia, can mimic depression. On top of all the other risk factors such as age, family history, substance use, poverty, Traumatic experiences. Rationale: Identifying patients at high risk allows the health care team member to monitor them for signs of depression. If risk factors for depression have been identified, provide the patient with appropriate materials i.e. a) Patient education materials on depression or mood disorders b) Information on enhancing well-being (e.g., sleep hygiene to promote natural sleep) 6. Communicate the assessment findings to other members of the health care team. 2) Ask Screening questions that help identify signs of depression. · “Have you been unhappy with your life recently?” · “Have you experienced a lack of pleasure in things that you previously enjoyed?” Can use an Depression focussed assessment as well. Rationale: If depression screening is positive, the patient needs further evaluation by a Clinical Psychologist, Psychiatrist or GP. All members of the health care team who are directly caring for the patient should contribute to the ongoing assessment of the patient’s mental and physical status. 3) Obtain a patient history of depressive episodes and current treatment by asking the types of questions below. a. “Sometimes people who are ill may feel blue or down. You appear teary; would you like to talk?” b. “Have you ever been told you have depression?” c. “Have you been told you have manic-depressive illness or bipolar disorder?” d. “Are you currently being treated for depression?” e. “Are you receiving counselling for depression?” f. “Are you taking medicines for depression?” 4) Assess the patient for suicidal or homicidal ideation or thoughts of self-harm. Use an organization-approved standardized tool for suicide assessment. If homicidal or suicidal ideation is present, implement appropriate precautions based on the patient's status, including constant or enhanced visual observation or routine safety checks, per the organization’s practice. Rationale: Patients who are experiencing an exacerbation of psychiatric symptoms maybe at risk for self-harm. 5) Discuss with patient any treatment options the team have decided is appropriate and ensure that culturally appropriate treatment and interventions are implemented. 6) Prepare the patient for discharge by providing information about community resources (e.g., support groups) and crisis numbers to call in case of an emergency. 7) Document the strategies in the patient’s record. Treatment of Depression Pharmacological – SNRI’s, SSRI, Tricyclics, MAO’s. Non-pharmacological – Behavioural, activation, diet, sleep, exercise, relaxation. Talking Therapies – cognitive behavioural therapy, mindful-ness-based CBT, counselling. In talking therapies the focus is on: a) Explore the problem – The person or family’s primary concern and ask for examples of the issue. b) Explore the attempted solutions – Efforts to resolve the issues, outcome of those efforts. c) Explore the visions of improvement – What will it be like in the future without the problem? d) Make an intervention – Reframe the problem in a different way that can lead to a new action or outcome. Suggest a specific activity to help. Other: ECT – Electroconvulsive Treatment, Herbal Medications – St Johns Wort, Omega-3 Fish Oil, S-Adenosyl Methionine, High Density Negative Ion Therapy, Light Therapy, Microdosing of Class A Drugs – Ketamine or Psilocybin (mushrooms) Remember to focus on the person's strengths: - What validates the persons abilities and solutions? - What keeps the person going? - Discussion enables a person to think in terms of regaining control or their situation. Week 4 – Communicable Diseases, Sexual Health & Cancer Week 4 (S2): Communicable Diseases and Sexual Health (Part A) 6th August 2024 Population health – aimed at improving health of an entire population Health protection – control of communicable and non-communicable illness and environmental protection Epidemiology – study of distribution and determinants of health-related states and event in specified populations Pertussis (Whooping Cough): Symptoms: problems relating to difficulties breathing, feeding and drinking, vomiting at the end of coughing fits, pneumonia, 6/10 admitted to hospital Vaccination: Adacel, Boostrix, Infanrix–IPV,Infanrix–hexa Measles: Symptoms: fever, cough, runny nose, conjunctivitis, Koplik spots in the mouth, rash appears 2-4 days after the first symptoms. Common complications: ear infections, diarrhoea, pneumonia, brain inflammation and brain damage. Measles infection causes loss of immune memory and protections from other diseases – leads to higher rates of infectious diseases. Vaccines: Priorix Diphtheria and Polio: Symptoms: sore throat, breathing problems, bloody r watery drainage from the nose, a bark-like cough. Diphtheria toxin can cause significant damage to the heart, nerves and kidneys. 5-10% of those infected die. Vaccines: Boostrix, Infanrix–hexa, Infanrix–IPV, Adacel, IPOL Haemophilus Influenza Type B (Hib): Outcomes: septicemia, severe throat swelling affecting breathing, pneumonia, pericarditis. Spread through coughing, sneezing or contact with a contaminated surface. Vaccines: Infanrix-hexa, Hiberix Mumps: Symptoms: swelling and tenderness of the salivary glands. Fever, headache, muscle aches, poor appetite, swelling and tenderness just below the ear lobe. Can cause brain inflammation and deafness. Vaccines: Priorix Covid–19: Symptoms: cold and flu-like symptoms, loss of smell, altered taste, gastrointestinal symptoms, headache and muscle aches, chest pain. Long COVID symptoms: fatigue, breathing issues, cognitive issues. Serious complications: pneumonia, severe inflammatory disease, these can lead to respiratory failure and death. High risk: older adults, pregnant women, people with comorbidities, unvaccinated people. A respiratory infections caused by the SARS–CoV–2 virus, a highly transmissible, newly identified corona virus. Spread mainly through coughing, sneezing and even talking. Vaccines: Comirnaty 30mcg XBB.1.5 grey cap, Comirnaty 10mcg VBB.1.5 blue cap Vaccinations in Pregnancy The CDC have 8 key considerations: All revolve around safety of mother and baby 1. Vaccines protect mother and baby 2. Flu, Tdap and Covid-19 while pregnant can help keep mother and baby safe 3. Tdap protects against whooping cough 4. Changes in mother’s immune, heart and lung functions during pregnancy make them more likely to get seriously ill from flu.  5. A person who is pregnant, or were recently pregnant, is more likely to get very sick from Covid-19 than people who are not pregnant. 6. Timing of vaccinations is everything! 1. Flu vax usually available late autumn 2. Tdap recommended between 27th and 36th weeks 3. Covid-19 at any point in pregnancy 7. Anyone who is around the baby needs vaccines too – any updates 2-weeks before interacting with baby 8. A person who gets pregnant again needs a Tdap with each pregnancy Anaphylaxis is an acute life-threatening allergic reaction that typically is an immunologic reaction that causes systemic vasodilation and bronchoconstriction. 2 types: immunologic anaphylaxis (most common) and non-immunologic anaphylaxis. Anaphylaxis treatment: Week 4 (S2): Sexual Health Part B Sexuality and Sexual Health  Sexuality is about yout sexual feelings, thoughts, attractions and behaviours towards other people. Sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. - Transgender and non-binary people are individuals whose gender identity does not align with the sex that was assigned to them at birth. - Rainbow is an umbrella term, recognising that people may describe themselves in many ways. Week 4 (S2): Cancer as a Long-Term Condition Cancer is a complex disease that affects 1 in 3 people. Patient centred care: values, needs and preferences among patients during caring treatment Themes Subthemes Patient excerpt Values The need for autonomy “Sincerity is something one realizes subsequently; for, Being involved during the moment when it is verified that the things the Concern for family doctor said really are what he said they would be, one Hope – positive outlook understands a posteriori the sincerity of the doctor. A Normality and patients desire priori, a stronger act of trust is needed; for this it is for this important to have an empathetic rapport with patients.” Sincerity – important to confirm trustworthiness Needs Care coordination “I want to ask, like, do I need to get my affairs in order. Information Am I going to die? You want the doc to bring it up Privacy almost so you don't have to. But when he don't, then, Support of physical it's on us to ask and I don't know how to bring it up” well-being Emotional support (family/friends) Emotional support (peer) Emotional support (provider) Self-support Preference Care coordination “Only patients with similar experience can understand Decision-making me. I have encountered difficulties… I really want to Information delivery know how others deal with the difficulties” Source of social support Treatment Cancer care context Psychological response to “…[a]nd ahead of the tests, I can tell you that diagnosis they…[t]hey do affect me. It feels like there's some kind Treatment planning and of…[t]here's a wall you have to get past, and it's been selection like that all the way from the very beginning … It grows “transition from well to ill” and gets higher and higher, …the closer I get to the test, Waiting the heavier it feels and…[t]here's a certain concern or something, but at the same time you want to get it over with and get the results” Cancer survivorship Cancer survivorship is widely recognised as an important stage of lining with cancer, it represents the state of process of living beyond cancer.