VIH ONE DRIVE 1-4.pdf

VIH Class 1: Introduction to Pathophysiology and Disease 1. Holistic Integration of holistic philosophies into nursing care, or when considering care plans for an indiv. Nursing Acknowledgement of cultural diversity of client (Lewis, 2024, pp.___)...

VIH Class 1: Introduction to Pathophysiology and Disease 1. Holistic Integration of holistic philosophies into nursing care, or when considering care plans for an indiv. Nursing Acknowledgement of cultural diversity of client (Lewis, 2024, pp.___) Lewis (2024): Members: ○ Holism: Considers person as a whole (mind, body, spirit) ○ Ex of spiritual healing: sage practices ○ Considers how indiv interacts in their community/enviro ○ Humanism: person-focused, build relationship with client ○ Considers cultural practices (e.g. speaking with elders) ○ Practiced by Indigenous peoples, certain religions (ex prayer for healing). Chinese med (acupuncture) Lewis (2024, pp.___): 1. Accepts patients as they are, no judgement, with compassion 2. Nurses care is based on holism and integrates the mind body and spirit principles 3. Nurse serves as a facilitator recognizing the client’s capacity for self-healing 4. Nurse incorporates self-care+self-responsibility, recognizing the interconnectedness of all indivs. 5. Nurse’s practice is guided by holistic education and research 2. Health and ○ Health: “a state of complete physical, mental, and social well-being and not merely the illness & Illness absence of disease or infirmity.” (Gallon, R 2024) and Disease ○ Illness: human experience of symptoms+suffering; expressed by person (Gallon, R, 2024) ○ symptomatic Members: Alice, ○ how disease is perceived Jeanelle, Ava ○ Disease: an objective state of illness thats measurable by certain tools (Lewis, 2024, p. ___). ○ objective (measurable) ○ disruption of homeostasis ○ diagnosed to get cause 3. Modifiable and Risk Factor: A variable linked with incr risk of illness, “both individuals and communities may non-modifiable risk possess risk factors for the development of chronic illness” (Lewis et al., 2019, p. 65) factors Modifiable risk factors: Factors that can be changed to reduce the risk of developing an illness Members: - ex. tobacco use, diet, physical activity, alcohol use, poverty, employment (Lewis et al., 2024 p._) Kristine, Mervi Individual risk factors: background, behaviour, or intermediate Background characteristics: sex, age, lvl of education, genetic characteristics (Lewis et al., 2024, ) Intermediate risk factors: Comorbid conditions (diabetes, hypertension, obesity) (Lewis et al., 2024, pp___) Community-level risk factors: social + economic conditions (poverty, employment, family composition; environmental conditions (climate and air pollution) Cultural conditions - practices, norms, and values; urbanization (Lewis et al., 2024, pp___) Non modifiable risk factors: Factors that contribute to development of illness but cant be changed - ex. age, sex, genetics, climate (Lewis et al., 2024, p._____) 4. a) Acute Disease Chronic – long term illness + persistent over an extended period; genetics, doesn’t go away & Chronic Disease completely (diagnosed when illness is > 6 mo) (Lewis, 2019, p. 63) E.g. Cardiovascular diseases, diabetes, cancer, arthritis (Lewis, 2019, p. 64) Illness behavior: how an indiv reacts to physical symptoms (Lewis, 2019, p. 63) Empowerment: The patient plays a proactive and responsible role in taking control of their own health/health condition (Bard, MacMullin & Williamson, 2020, p. 418) b) Illness Example of illness behavior: sick role vs. Empowerment Behaviour & The patient gets a cancer diagnosis Empowerment A patient plays a sick role by succumbing to the depressing nature of their diagnosis. Stays in bed and feels extremely hopeless. In contrast, an empowered patient sees their diagnosis as an opportunity to go out and travel the Members: world and make the most out of their time Kristina, Mari Compare and Contrast: Both acute and chronic disease are sudden onset of illness Difference is the duration of the diseases. Chronic is usually longer than 6 months while acute is usually less than 6 months. 5. Health equity, Health Equity Health Inequity & ○ Achieved when people can attain full potential for health and well-being Health Disparity ○ Determined by conditions in which people are born, grow, live, work and age plus biological determinants that are influenced by distribution of power and resources that are shaped by structural Members: Sam & determinants such as social norms and institutional processes Julia Health Inequity ○ A difference in health out outcomes due to factors such as income, location, race, and gender. People who do not have access to healthy food because of monetary reasons is an example health inequity. ○ Health Disparity ○ Take place when people experience higher rates of certain diseases such as breast cancer, obesity or heart disease for reasons that include race, ethnicity, access to care, poverty, and environmental risk 6. Stereotyping & Stereotyping: Cultural It happens when individuals from a group (culture, race, ethnic) are assumed to have certain Competence characteristics. These characteristics are imposed on individuals without getting to know what that specific Members: person is like. Randi Severinski, Ex. positive or negative generalizations. Automatically assumed or oversimplified approach that disregards individual difference, Li Yang Yu imposes a belief, and leads to false assumptions Cultural competence: Process wherein healthcare providers recognize the need for knowledge and skills to modify assessment and intervention strategies to achieve equity in health delivery and outcomes. (Lewis pg. 24) ○ The approach to meet the social, cultural, and linguistic needs of patients. Lack of proper cultural competence in health care tends to undermine patient values leads to reduced level of patient satisfaction and compromises healing for certain individuals. (Dreher et. Al, 2002) Training providers in becoming competent in various cultures presents the risk of stereotyping, stigmatizing, and can result in projecting racist attitudes and behaviors, (Lekas et. Al., 2020). Consequences in disrespecting cultural competence and how cultures interact with patients can undermine the provider’s recognition that patients inhabit multiple social statuses that potentially have shaped their beliefs, values, and behavior, (Lekas et. Al, 2020). 7. Explain What is Traditional Healing? Traditional Healing ○ Traditional healing involves cultural methods and experiences to heal. That includes ○ Why is Indigenous practices, Chinese medicine, etc. Some methods used include herbs, smudging, scent, Traditional Healing food, and spiritual guidance. Important ○ Is the incorporation of First Nation practices such as ceremonies, plant, animal or ○ Show mineral-based medicines, energetic therapies or physical techniques; for their health and wellness. Wellness Diagram ○ Is important for people who identify as a part of the First Nation community who (paste on this incorporate specific First Nation Practices as part of their health and well-being. Which are often document) overlooked by traditional medicine. Members: Olivia, Emilie Center = “Human Beings”; self-responsibility for their own health and wellness Second Circle = “Mental, Emotional, Spiritual, and Physical”; holistic level of wellbeing Third Circle = “Respect, Wisdom, Responsibility, and Relationship”; adding in values Fourth Circle = “Family, Land, Nations, Community”; people who surround us and the places where we come from Fifth Circle = “Social, Environmental, Cultural, Economic”; determinants of our health and well-being 8. Cellular What is Cellular Adaptation to Injury? Adaptation to ○ cellular adaptation refers to changes made by a cell in response to adverse or varying Injury environmental changes ○ Cell Injury can be lethal or sublethal. Sublethal injury alters the function without causing Members: Shelly cell destruction. Lethal injury is an irreversible process that causes cell death. Kalisha ○ Cellular adaptation can be changed or induced; changes can be categorized as atrophy, hyperplasia, hypertrophy, metaplasia, dysplasia (R. Gallon, 2024) ○ cellular adaptation refers to changes made by a cell in response to adverse or varying environmental changes. Cellular adaptation ○ Cell Injury can be lethal or sublethal. Sublethal injury alters the function without causing cell destruction. Lethal injury is an irreversible process that causes cell death. ○ Types of morphological adaptations include atrophy, hypertrophy, hyperplasia, metaplasia and dysplasia. Atrophy: decrease in the size/weight of an organ or tissue due to decrease in number or size of individual cells. E.g., Decrease in muscle size due to inactivity Hypertrophy: expansion in cell size resulting in increased tissue mass without cell division. Eg. enlargement of heart ventricles with severe hypertension due to increased cardiac workload. Hyperplasia: Multiplication of cells as a result of increased cellular division Eg. Endometrial hyperplasia due to excessive estrogen secretion Metaplasia: transformation of one cell type into another type in response to change in physiological condition or external irritant. E.g. Pseudostratified columnar epithelium of the bronchi to squamous epithelium in response to chronic cigarette smoking.  Dysplasia: Abnormal differentiation of dividing cells results in changes in their size, shape and appearance. E.g. Cervical dysplasia due to abnormal growth of cells on cervix 9. Evidence- based Evidence-based practice is based on research studies that should be no more than 5 years as Practice & Decision information may change and evolve making - Evidence-based decision-making is the continuous practice used by the nurses to provide care for their patients based on the recent most accurate research and evidence Members: Matthew Bui, 5 steps of EBP: Sandra 1. Research the statement- ask a question that clearly presents the clinical problem (based on PICO): P- pt population of interest I-intervention C-comparison of interest O-outcome 2. Collect the best research- identify and gather the most relevant and best evidence 3. Critique the evidence- critically appraise the evidence 4. Incorporate and integrate the evidence- integrate all evidence with clinical expertise, patients’ preference and patients’ values to make a practice decision or change 5. Evaluate- evaluate the outcome of the practice decision or change 10. Reviewing How to read research reports Research Article ○ Read the title and abstract first to check if relates to your clinical issue. ○ Scan the article: briefly read the introduction and discussion sections. [On Moodle- “How ○ Study the methods: ask how the study setting compares to the real world and whether the to Read Research study methods (design, sample size, data collection and data analysis) could affect the findings. Reports”] ○ Read the results: interpret the results, explain their significance, and mention any limitations to this study. Members: Luke ○ Analyze the findings: connecting the findings to practical setting. and Ravneet ○ Consider issues that can affect your findings before they can be incorporated into practice ○ Share the information with your colleagues and join a research project team, if possible, to build confidence. 11. Evidence-based Main points of the Study Findings: health care ○ Misconception: Participants were having a hard time to understand the concepts and terms due to the lack of familiarity. Terms such as: “medical evidence” and “quality guidelines”. ○ Ex: use of too many medical jargons. (As cited in Kristen L. Carman et al. 2010, pg. 1402) Members: Sarah, ○ Beliefs and Values: The participants were having difficulty believing that the health care Yun-Chieh Leu providers will deliver standard care and that there are rules that interfere with what the health care (Angel) providers can provide. (As cited in Kristen L. Carman et al. 2010, pg. 1402) ○ Example: The lack of treatment that hospitals can provide. (Such as beta blockers not being provided to some heart patients when that represents their accepted standard) ○ Behaviors in the medical encounters: More than half of the participants do not engage in discussions during appointments and are reluctant to ask questions or concerns with their health, because they believe that it’s their providers who are “the expert” and should be held “accountable” they do not bring any sources to discuss, they don’t take notes or ask questions. (As cited in Kristen L. Carman et al. 2010, pg. 1402-1403) 12. Evidence-based The Evolution Practice ○ Has existed philosophically since mid-19th C Paris ○ Term was first used in the 1980s, but gained attention in the medical field in 1992 when the Members: Alexz, Evidence-Based Medicine Working Group published an article on its role in medical education Ronnie, Piotr ○ Most discussions stem from a medical approach i.e.: efficacy of a medication, yet a contemporary approach focusses on multi-component services for the aging population ie: diabetes management program that includes exercise + nutritional education The Advantages ○ The advantages of evidence-based practice is the increase of available research that prompts better practices. ○ Make scientific literature more relevant to health care providers ○ The increase of improved care for clients ○ Advanced the methods used to make research more reliable: randomized and controlled trials. The Challenges ○ The increase in continuous quality improvement practices, by tracking the effects of treatments to improve services ○ Hard for professionals to keep up with new information ○ Tension between well informed medical professionals with the majority of health consumers in integrating new innovations or ideas, due to fundamental differences in perspective in efforts to make practices and programs more evidence-based ○ Educators have concerns that the teaching of EBP to new social service providers is subsiding, and is a sometimes-naïve acceptance of poorly tested interventions (non-appropriate skepticism) ○ The importance over scientific evidence, rather rational argument (Rahman and Robert, 2010, pp. 6 – 9) Class 2: Research Topic: Physical and Psychosocial Stressors  1. General Adaptation Definition: “General Adaptation Syndrome is composed of three stages: alarm reaction, stage of Syndrome resistance, and stage of exhaustion. Once the environmental event or stressor stimulates the central ○ Define the nervous system, multiple responses occur because of the activation of the hypothalamic -pituitary- concept; identify adrenal axis and the autonomic nervous system.” (Lewis, et al. 2024, p.) and explain 3 stages of this Identify and explain 3 stages of this syndrome: syndrome Alarm reaction: “Analogous to Cannon’s fight-or-flight response to stress. In this stage, Members: Alexz, complex physiological changes help the organism mobilize energy and react to the stressor.” (Potter ronnie,jessa,ameli et al, 5th edition, p.___). a Hence, the alarm reaction is the body’s initial physiological response to stressors or threats. Resistance: This is also known as the adaptation phase wherein the body tries to resist and compensate in response to stress. This adaptation is overruled by the PNS in response to maintaining homeostasis. (Potter et. al., ) Exhaustion: “Final stage of stress response. It occurs when all of the energy for adaptation has been expended.” (Lewis et.al, 2024, p. ___) This usually occurs shortly before death in a terminally ill person or after going to extreme stress; can be reversible by external sources such as medication or psychotherapy. 2. Effects of stress Sympathetic Nervous System (SNS) on health ○ Fight or flight response. ○ Explain the ○ Certain systems and organs are activated while others that are not needed as urgently are physiological inhibited effects of each part ○ Examples can include increase heart rate, dilation of bronchi, pupil dilation, blood of the nervous pressure increase). system (1:49 - ○ Some systems/organs that are inhibited include; decreased saliva production, decreases http://www.youtube digestion, decreased urine production, inhibits liver.com/watch?NR=1 Parasympathetic Nervous System (PNS) &feature=fvwp&v= ○ Rest and Digest J968Wco1u0s); ○ Increased action seen in systems that were inhibited by the SNS. Examples include increased identify and digestive process, increase urine production, increased liver and kidney functions, increased saliva describe the production physiological and ○ Systems/Organs that are slowing down include: decrease heart rate, decreased blood cognitive effects of pressure, pupils constrict, bronchi constriction. stress; list several (Comparison of the sympathetic and parasympathetic nervous systems (simple & funny) Dr/ Aidy - diseases/disorders Youtube video) believed to be caused or made Stress is seen physiologically mainly due the sympathetic nervous system action. worse by stress. Some cognitive effects that are seen due to stress includes: Members: Sam, ○ anxiety, depression, difficulty in concentration, irritability, loss of memory. Jeanelle, Faye Some diseases and conditions that are seen through exacerbation of stress include: obesity, hypertension, diabetes. (Potter & Perry, p.___) Stress-Related Disorders Acute Stress Disorder: arises when there is exposure to one or more traumatic events and is seen when stress lasts at least 3 days to one month. Some symptoms include dissociative symptoms, flashbacks, avoidance of stimuli that arouse the memory, sleep disturbance, angry outburst. PTSD (post-traumatic stress disorder): when stress from a traumatic event lingers for more than one month. It is similar to acute stress disorder but there is less emphasis on dissociative symptoms. (Potter & Perry, p.___) 3. Techniques for 1. Appraisal – event circumstance is an ongoing perceptual process coping with stress Primary Appraisal – evaluate an event for personal meaning and evaluate the circumstance as ○ Identify harm, loss, threat of challenge the person will experience stress. and briefly explain i.e. how does this event affect my life and relationships? several strategies Secondary Appraisal – if stress is present, focus on possible strategies to help manage the that your clients or circumstances. i.e. what can I do to help change the circumstance? student colleagues COPING - active process of managing taxing circumstances, expending effort to solve could use to help personal/interpersonal problems and seek to master, minimize, reduce or tolerate stress or conflict minimize the effects of stress on Internal coping resources: the body ○ Health, spirituality, high energy, social skills, compatibility External coping resources: Members: Randi, ○ Social networks (family members, coworkers) Kristine, Aya ○ Self-help books, finances, social agencies Emotion and Problem Focussed Strategies can be employed alone or in combination to cope with the same stressor (Lewis et., al) Problem focused coping targets the causes of stress in practical ways.These techniques are objective, cognitive approaches in which a person attempts to find solutions to the problems causing their stress Lewis et., al) Examples include: Setting health goals and priorities to find solutions to the problems causing stress. You can do this by finding information about your health and coming up with relevant solutions Preparing advanced health care directives Quitting unhealthy lifestyles/making good lifestyle changes such as quitting smoking or less “junk food”. Finding resources to support your health solutions ie. finding drivers to appointments, finding a caretaker, childcare (Lewis et al.,) The end goal of problem focussed coping is to directly remove or reduce the cause of the stressor. (Lewis et al.,) Emotion focused coping: a way of managing negative emotional responses to stressors such as stress, anxiety, depression, etc (Lewis et al., ). This coping mechanism tackles threats to an individual’s mental, emotional, or spiritual well-being, but not the problem itself (Lewis et al., ). An example of emotional stressors are: Diagnosis of cancer Family problems Failing exams Financial problems Grief (Lewis et al.,) Different ways to cope with emotional stress: Join a support group Attend therapy Communicate with family and friends Seek spiritual guidance based on beliefs Watch tv shows Listen to relaxing music (Lewis et al.,) Scenarios outlining the difference between emotional focussed coping and problem focussed coping: You’re diagnosed with severe Asthma. Problem focussed: A problem focussed coping technique would be to quit smoking. Emotion focussed: Enjoying a hobby or relaxing movie during your Nebulizer session A patient is diagnosed with Diabetes. A problem solving technique can be: Healthy lifestyle, exercise, good diet, consulting a dietitian, having an alert on your phone for when you need to take your glucose level or inject insulin. Emotion focussed: Joining a support group, seeking spiritual guidance(ie. church), maintaining social interactions with all friends and family. Stress management: In order to manage stress, there are multiple techniques that may be used to reach the relaxation response Relaxation response: state of physiological and psychological deep rest, decreasing CNS and SNS activity ○ Can be achieved through relaxation strategies, imagery, muscle relaxation, prayer and physical exercise (Lewis et al.) Stress management techniques: ○ Thought stopping, humour, assertive behaviour, yoga, social support, journal keeping, colouring, biofeedback (Lewis et al.,) Relaxation strategies: ○ Rhythmic breathing: quiet environment, seat or lay down comfortably, close eyes and breathe in and out slowly while counting out loud Inhale through nose and exhale through mouth (Lewis et al.,) ○ Sensory pacing: look at surroundings and list what you are seeing, feeling and hearing - Repeat 4x, 3x, 2x, then 1x (Lewis et al.) ○ Progressive relaxation: perform rhythmic breathing, tighten and relax muscles starting from the feet and upwards Allow body to feel relaxed muscles and continue to breathe slowly and deeply until feeling better (Lewis et al., p. ) ○ Modified autogenic relaxation: follow rhythmic breathing, repeat beginning of phrase while breathing in, hold breath for 2-3 secs, breathe out while repeating last part of phrase (“Breathing in Breathing Out Table”) (Lewis et al.) 4. Kubler-Ross’s 5 Stages of Stages of Grief/Dying (not in any particular order) Grief/Dying ○ Identify 1. Denial - An individual acts as though nothing has happened and may refuse to believe or and describe Dr. understand that a loss has occurred. Elizabeth Kubler-Ross’s 5 Ex- “I can’t believe this is happening” stages of Grief; identify and 2. Anger - The individual resists the loss and may strike out at everyone and everything describe Worden’s Four Tasks of EX. “Why me?” Mourning 3. Bargaining - the individual postpones awareness of the reality of the loss and may try to Members: deal in an overt way as though the loss can be prevented Mari, Sarah, Anela EX. finding God to be a better person 4. Depression - the individual may feel overwhelmingly lonely and will withdrawal from interpersonal interaction EX:not engaging in regular day-to-day activities 5. Acceptance - the individual accepts the loss and begins to look to the future EX. returning to a normal lifestyle, adjusting to the new normal Four Tasks of Mourning (Worden 1991) 6. Accepting the reality of loss This task involves the processes required to accept that the person or object is gone and will not return 7. Working through the pain of grief Denying or shutting down your grief will prolong the process of healing; it is important to find good coping mechanisms to help work through grief 8. Adjusting to the environment without the deceased People completing this task must take on roles formerly filled by the deceased, including some that they never fully appreciated 9. Emotionally relocating the deceased and moving on with life The goal of this task is not to forget or move on from your relationship with the deceased but to have a new, less prominent place in a person’s emotional life. This is the most difficult task to complete due to an individual's attachment they hold, however you know you have moved on from this stage when the individual realizes they can love other people without loving the deceased less (Potter et. Al)  Bereavement: 5. Factors it refers to the state of having lost someone close to you through death. Influencing Loss It's the period during which one experience grief and mourning. and Grief Grief: Grief is basically an emotional response to the loss of someone or something significant. It can encompass a range of feelings from deep sadness to anger. ○ Example: feeling low or sad, crying unexpectedly. Members: Mervi, Mourning: Emilie and Kalisha refers to the state of expressing grief, basically outward expression of grief. ○ For example: wearing black clothes while participating in any memorial services. William Worden created a counselling model to assist people who are coping with grief. Worden’s 4 tasks of Mourning (Lewis’s Page 242): To accept the reality of the loss To work through the pain of grief To adjust to an environment in which the deceased is missing To find an enduring connection with the deceased while moving forward. 1. To accept the reality 4 types of Grief: 1. Anticipatory grief - experience with losses often during the terminal phase of an illness, before the actual death -commonly experienced by caregivers of persons with dementia because the trajectory of dementia is experienced as a series of losses pre-death (Potter & Perry, 2024, Pg 437) 2. Adaptive Grief - A healthy response to grief. The type of grief that helps the person accept the reality of death. 3. Disenfranchised Grief - experience of grief that is not openly acknowledged, publicly mourned, or socially supported. - difficult to express, and it may become complicated grief because societal rules exist to whom has the right, when or how, and for how long to grief Example: a) loss of a partner from an accidental drug overdose and patient with HIV 4. Prolonged Grief - Formerly called complicated grief. - Prolonged and intense mourning. - Symptoms include recurrent and severe distressing emotions, self-neglect, and denial for longer than 6 months (Lewis’s 5th Edition page 203) 4 types of complicated grief: (Taken from National Library of Medicine) 1. Chronic Grief Normal Grief reaction. Do not subside and continue over long periods of time. Example: Isolation 2. Delayed Grief Normal grief reactions that are delayed to avoid pain of the loss - Example: Anxiety, difficulty concentrating 3. Exaggerated Grief Intense reaction to grief. Examples: Nightmares, Delinquent behaviors, suicidal thoughts 4. Masked Grief Grief that happens when the person is not aware of the behaviors that interfere with normal functioning due to the loss Example: Difficulty identifying or expressing emotions 6. Pain - Definition of Pain: “Pain is what-ever the experiencing person says it is, existing whenever he ○ Define says it does” (McCaffery, 1968) pain according to McCaffery and Why is this a controversial definition? Pasero and ○ It cannot be measured or found through evidence-based practice brainstorm the ○ Interaction of psychological and cognitive factors affects pain perception. (Potter & Perry reasons WHY pg.605) THIS MIGHT BE ○ A person’s cultural background influences the meaning of pain, and it is expressed. (Potter & A Perry pg.605) CONTROVERSI Defence of definition (3 statements): AL DEFINITION ○ One individual's perception of pain varies and differs from another individual's perception of pain, pain is a subjective experience. Members: ○ Tolerance is a main factor that plays a role in pain, and depending on the experiences that Sandra, Shelley, individual has had, Will change or adapt to pain. This explains why the definition entails that it is and Julia subjective because no one experiences the same level of pain and is more of a subjective experience than a subjective ○ This statement should guide nursing practice as it is crucial to know how the patient's subjective experience with pain is affecting them. By only facing pain as an objective standpoint, you cannot access levels of pain that are directly from the patient's feedback during your assessment and diagnosis of the patient. Against Definition (3 statements): ○ With this definition, anyone can describe any feeling as pain, it is not describing a particular sensation ○ It is impossible to measure pain accurately with this definition, it is not evidence passed theory. ○ This statement should not be implemented to guide nursing practice as it is not a defined way of measuring factors of pain and how it affects a patient. Pain should be considered objective as there are different levels of pain that are related to your nervous system and how it is affected during surgery, injections, etc. 7. Cultural Factors IS related Pain: an unpleasant, subjective sensory and emotional experience associated with actual or potential to Pain tissue damage ○ Distinguish between ‘pain’ and Suffering: the active state of undergoing/experiencing pain, distress or hardship ‘suffering’; briefly describe how How culture influences the experience of pain culture influences the experience of Culture affects behaviour responses to pain and treatment preferences. pain; describe the Implications for ○ For example, the Chinese culture includes the belief Confucianism which highlights pain as Practice; review an essential element of life. Therefore, a patient with this belief would rather endure pain and not P&P Box 31-5 with report it to a health professional the large group ○ As nurses, we must be sensitive to the differences among all individuals by seeking Members: information from each patient and family regarding their beliefs Ravneet, Alice, Li Yang Implications for Practice: Emotional and cognitive responses to pain (overt, stoic) vary between and within cultures. Words used to express pain vary among cultures (hurt, ache, discomfort) Personal and social meanings of pain and past pain experiences affect pain perception The meaning of pain may influence the perception of pain intensity. Health care providers’ beliefs and expectations regarding expression influence the use of pain management strategies. Therapeutic goals of pain management are influenced by cultural beliefs Be aware of perceived causal factors of pain (fate, lifestyle, punishment, witchcraft.) Believe patients’ reports about their perceived pain; do not act on your own beliefs about a patient’s pain. Seek information about the cultural backgrounds of your patients through discussion with your patients and families and research of the best published evidence. 8. Non-Pharmacolog 1)Cutaneous stimulation ical Pain relief strategies -’touch-healing’ therapies that stimulate skin to relieve pain ○ List and -reduce muscle tension and pain reception; promote healing briefly describe 9 -example: warm bath, ice pack, massage, transcutaneous electrical nerve stimulation (TENS) non-pharmacologic 2) Herbal supplements al methods for Clients use for self-meditate purposes reducing or Echinacea, ginseng, ginkgo and garlic are most commonly used; however, they may interact eliminating pain with prescribed medication. Consult with the doctor before taking (maximum of 2-3 points each). 3) Reducing pain perception Members: Olivia, Remove painful stimuli to reduce perception Matthew, Angel Examples: dim the lights and lower the noise/sound, change wet dressing frequently, avoid Leu exposing wound to irritant such as urine or stool. Position client correctly on bed to ensure they feel comfortable 4) Relaxation: Mental and Physical freedom from tension or stress. Relaxation techniques include meditation. yoga, guided imagery, and progressive relaxation exercises. Progressive relaxation exercise takes about 15 minutes to do and can be difficult because the patient must be willing to participate and cooperate for this exercise to work. If the patient becomes agitated or uncomfortable, it is best to stop the exercise and that this exercise can be stopped at any time.(Perry & Potters 6th edition, pg 594) 5) Guided Imagery: The patient creates an image in his or her mind, concentrates on that image, and gradually becomes less aware of the pain. The nurse helps guide patient to create a pleasant scene for them in their head 6) Distraction: The reticular activating system inhibits painful stimuli if a person receives sufficient or excessive sensory input Boredom and isolation may cause patients to focus on their pain. Pleasurable stimuli cause the release of endorphins that help a person ignore or become unaware of pain. Examples of distractions is praying, describing photos or pictures aloud, listening to music, using therapeutic humour, and playing games, some involving the use of virtual reality. 7) Music music can promote relaxation and decrease psychological pain, stress, and anxiety by diverting attention away from pain although the benefits of music therapy can be achieved, the evidence is weak to moderate regarding effects of music therapy on reducing acute pain 8) Acupuncture involves the insertion of acupuncture needles into specific “acupuncture points” on the patient’s body and twisting the needle up and down by hand can reduce chronic and acute pain, effective for emesis developing after chemotherapy or surgery, dental pain, and nausea associated with pregnancy activates endogenous opioid mechanisms and may stimulate gene expression of neuropeptides 9) Biofeedback behavioural therapy that involves giving individuals information about physiological responses like blood pressure or tension and ways to exercise voluntary control over those responses effective for managing regional pain syndrome  Ex. treatment of headaches, the patient learns to achieve optimal relaxation by lowering the actual level of tension experienced, using feedback from the polygraph which visibly records tension levels for the patient to see 9. Assessing pain in Goals of pain assessments (Lewis et al., pp. ) the client with ○ Determine the patient’s sensory, behavioural, and sociocultural pain to implement cognitive appropriate pain management techniques impairment ○ To identify the patient’s goals for therapy and the resources and techniques they need for ○ (Lewis, p. effective self-management 125 (start at Barriers to identifying pain: Gerontologic ○ Pain is normalized in older people as it is seen as a natural part of growing older. Considerations: ○ The older generation tends to tolerate and underreport pain because they do not want to be a Pain to the end of “burden” to the health care system. Table 8-18; see ○ -It is difficult for cognitively impaired individuals and elderly people to communicate their Moodle for pain levels due to cognitive impairments which affect ability to process information. handout) – describe indications For cognitively impaired individuals, it is important for a nurse to recognize behavioural symptoms that a client who is as they might not be able to communicate well (Lewis et al, pg. 163) cognitively impaired might be ○ Behavioural and physiological changes may be the only indicators that they are in pain. in pain; show “Pain Assessment Tool for the Cognitively How to assess pain according to common behavioral indicators: (Lewis et al.,) Impaired” to classmates and ○ Vocalization: moaning, grunting, crying, sighing explain it. ○ Facial Expression: grimacing, frowning, wincing, clenching teeth ○ Breathing: noisy or laboured ○ Body movements: restlessness, rocking, pacing Members: ○ Body Tension: clenching fist, resisting movements, Kristina, Luke, ○ Consolability: inability to be consoled or distracted Piotr Pain Assessment in Advanced Dementia (PAINAD) Scale ○ The behavioural indicators will be observed and used to scale the severity of pain. Ex. For Breathing independent of vocalization: ○ Normal is scored 0 ○ Occasional labored breathing + short period of ventilation is scored 1 ○ Noisy labored breathing and long hyperventilation is scored 2 ○ Once all the scoring for the indicators have been completed add all to get the Total Score. ○ Total score of the scale: 0 means “no pain” and 10 means “severe pain” ○ High scoring clients indicates a more severe pain Initial pain Assessment (OPQRSTUV) Onset – when pain is active, or resting, acute or chronic Provocative/Palliative - Does pain incr? (identify quality of pain) Quality of pain – what does the pain feel like? Region of pain – where is your pain? Severity of pain – how would you rate your pain on intensity scale? Treatment/timing - what treatments have worked in the past? Understanding of pain – patient history? Values – what is an acceptable level for this pain?  VIH 1 Class 3 Research Topics: TRADITIONAL, COMPLEMENTARY AND ALTERNATIVE THERAPIES 1. Natural health Regulations: Product ○ To be legally sold in Canada must have product license Licensing and ○ Specific labelling + packing requirements must be met, good manufacturing practices must be Vitamin Therapy followed, proper safety + efficacy must be provided Members: Licensing Requirements: Jeanelle, Luke, ○ Everything sold in Canada must be licensed Amelia, Shelly ○ Must have detailed info about medical/non-medical ingredients, source, dose, potency + recommended use ○ Once Health Canada assess the safety + efficacy of a product a license will be issued a Natural Product Number (NPN) ○ The safety and efficacy of NHPs and their health claims must be supported by proper evidence Adverse Reaction Reporting: ○ License holders must report serious adverse reactions to Health Canada ○ It helps Health Canada to make changes in product safety information, issue public warnings and advisories, and/or remove unsafe products from the Canadian market. Clinical Trials: ○ Testing is done on human subjects. ○ To study NHPs absorption, distribution, metabolism, excretion and safety ○ To study adverse reactions Vitamin Therapy: ○ Vitamin D- Toxicity is manifested as hypercalcemia, hypercalciuria, and hyperphosphatemia, Assess for appearance of nausea, vomiting, anorexia, weakness, constipation, headache, bone pain, and metallic taste ○ Vitamin E- Toxicity leads to bleeding, muscle weakness, nausea and diarrhea, impair the therapeutic response to iron. 2. Herbal therapy: Arnica ○ Uses- insect bites and muscle and joint pain Members: ○ Action/effects in the body- may increase the risk of bleeding. Jessa, Kristina, ○ How it interacts with other drugs- increases the effect of bleeding and how it interacts with Emilie warfarin therapy Garlic ○ Uses- hypertension (high BP) and fungal infections ○ Action/effects in the body- reduces oxidative stress, stimulates immune system, inhibits platelet aggregation ○ How it interacts with other drugs- may increase the risk of bleeding Ginger ○ Uses- can lessen nausea and vomiting ○ Action/effects in the body- distress can occur if taken in large quantities ○ How it interacts with other drugs- may increase the risk of bleeding  Allopathic medicine: 3.Complementary ○ Traditional Western medicine which focuses on treating the physical body (e.g., drugs, and Alternative physical exams, and surgeries) Alternative therapies: Used to replace conventional medical treatment, Medicine categories and are used instead of traditional therapies Examples: having a special diet, meditation, yoga, hypnosis, and homeopathy Members: Olivia, Randi, Piotr Complementary therapies: ○ accompany with or may even contribute to enhance conventional medical treatments. Examples: imagery, acupuncture, massage, music, dance, and aromatherapy (Potter and Perry, 2019, P. 815-818) 6 categories of CAM ○ Natural Products: Approaches use substances found in nature. Examples: herbal medicine (botanicals), vitamins, minerals, dietary supplements, probiotics. ○ Mind–Body Approaches: Interventions use a variety of techniques to enhance the mind's ability to affect body functions and symptoms. Examples: imagery, meditation, yoga, music therapy, prayer, journalling, biofeedback, humour, tai chi, art therapy, and acupuncture. ○ Manipulative and body-based approaches: manipulating or moving one or more parts of the body. It can be used to treat pain, stress, anxiety, and depression. Physiotherapy and massage therapy and chiropractic therapy (Potter and Perry, 2019, p. 2718). ○ Energy Approaches: Approaches focus on the use of energy fields, such as magnetic and biofields, that are believed to surround and permeate the body. E.g., healing touch, therapeutic touch, Reiki, eternal qi gong, and magnets. ○ System of Care: Whole systems of care are built on theory and practice and often evolved apart from and earlier than Western medicine. Each has its own approaches and practices. E.g., traditional Chinese medicine, Ayurvedic medicine, naturopathy, and homeopathy. ○ Traditional Healers: Healers use methods from Indigenous theories, beliefs, and experiences. An example is the Indigenous healer or shamans 4.Complementary Manipulative and Body-based approaches and Alternative 1. Massage therapy: Manipulation of soft tissue do stroking, rubbing, or kneading increases the Medicine therapies body’s circulation and improves muscle tone and relaxation (e.g., deep tissue massage, trigger point massage) -stimulation of pressure receptors Members: Mind-body Intervention Yun-Chieh leu, Yoga: involves exercise, poses, regulated breathing (pranayama breathing, associated with yoga Mervi, Li Yang. practices), and meditation to attain physical and mental well-being through inner awareness and focus on the present moment and breathwork. The goal of yoga is to challenge oneself without becoming overwhelmed (Harvard Medical School, 2015). The practice focuses on the body's musculature, posture, breathing, and consciousness Some benefits of yoga are increased flexibility, increased muscle strength and tone, improved respiration, energy and vitality, maintaining a balanced metabolism, and weight reduction. Therapeutic touch: Practitioners direct balanced energies toward the energies of a patient by laying the hands on or close to a patient's body. ○ Promoting relaxation ○ Reduces anxiety ○ Changes the client's perception of pain ○ Fascinates the body's natural response ○ Supports the immune system 5. Unsafe Natural Heal Products Common Name Uses Comments Members: Ravneet, Comfrey Relieves cough, heavy menstrual Liver damage, contains large number of toxic Samuel, Julia (blackwort, periods, stomach problems, chest hepatotoxic pyrrolizidine alkaloids that can slippery root) pain, may be used to treat cancer cause cancer Country Mallow Asthma, cold and nasal Contains ephedrine similar to the stimulant (heartleaf, white congestion ephedra, which can cause heart attack and mallow seizure (unauthorized for sale as natural health product by health Canada). Ephedra (ma Weight loss, Athletic - Unsafe for people with hypertension, huang, herbal performance enhancer diabetes, or thyroid disease because of ecstasy) stimulant effects - Many interactions with herbs and drugs - Health Canada (2010) advisory against use of any product containing this substance Patient ○ Be cautious of Education on supplements that offer “cure” or natural health “secret formula” products: ○ Formula listed on labels should be reviewed by Health Canada (e.g. scientific name, quantity, concentration, expiry date, key ingredients) ○ Being cautious for mega doses of anything as excess of ingestion certain vitamins can be toxic ○ Ensure that the product is supported by published research and avoid “multi-ingredient” formulations because potential reactions with other medications will be hard to determine ○ Look for well-educated service staff who can answer consumer questions ○ Be skeptical about cheap herbal remedies (quality might be inferior)  6. Age Age Related Considerations: Complementary and Alternative Therapies Related ○ There is a higher risk of herb-drug interactions due to polypharmacy and changes in Consideration pharmacokinetics due to age (Scholz, Holmes & Marcus, 2008 cited in Lewis, 2024) ○ Slow metabolism and excretion of herbs and dietary supplements due to decreased kidney and Member: Sandra, liver function in older adults (Lewis, 2024) Anela, Ronnie. ○ Kidney function test: Creatinine and GFR ○ Liver Enzymes: ALT and AST ○ Nurse should encourage client to disclose information related to any herbal product or dietary supplement they are taking and discuss risks and benefits of herbal product usage (Lewis, 2024) Role of the nurse: (evolving) 1. Assessing the risks and benefits 2. Providing education with evidence for nurse and client, referral to other practitioners 3. Provide the client with other therapy, if trained to do so, such as acupuncture or massage 4. Remain non-judgmental What is the Western Biological Medical Model’s influence on nursing philosophy and practice? 7. Holistic ○ It directs the focus of nursing practice to the physical body and its physiological processes. Nursing Another influence is the use of evidence-based practices for health improvement (Lewis, 2013, pp. Practices 226). Members: List and Describe 5 Core Concepts of Holistic Nursing Practice. Alice, Aya, ○ Holistic Nursing: recognizing the physical person (humanism) while incorporating Kalisha mind–body–spirit principles (holism) to develop a caring–healing relationship with patients (Lewis, 2024) Core Concepts:(Lewis, 2024) ○ (a) the nurse accepts patients as they are, without judgement and with compassion ○ (b) the nurse’s care is based on holism and integrates mind–body–spirit principles; ○ (c) the nurse serves as a facilitator, recognizing the patient’s capacity for self-healing; ○ (d) the nurse incorporates self-care and self-responsibility, recognizing the greater interconnectedness of all individuals ○ (e) the nurse’s practice is guided by holistic education and research Expectations of Nurses: ○ Understand – Modalities in the context of human anatomy, physiology, and pathophysiology ○ Be responsible for ensuring that the patient has given consent for a given therapy. ○ Educate – Client on importance of ensuring all health care providers are aware of CAM use ○ Inform client of proposed benefit and any potential risks involved. ○ Provide – Objective evidence and education for patients. ○ should be aware of the evidence base that addresses the conditions for which the therapy is indicated, the effectiveness of the therapy, and the potential for adverse outcomes or synergistic effects. ○ Integrate – Complimentary methods into own practice following standards and scope of practice with appropriate training and education. 8. Indigenous Smudging - the goal is to heal the soul, sacred ceremony using the smoke from the sage for purifying Healing Practices and cleansing the soul of any form of negative energies. Typically uses a shell, sage, and an eagle feather to perform practice. Members: Faye, The person puts their hands in the smoke and carries it to their body, especially to areas that Mari, Sarah need spiritual healing (mind, heart, body). Has all the 4 elements: shell = water, medicine = earth, burning = fire, smoke = air Healing Circles - Meetings for physical, emotional and spiritual wounds. Symbolic objects are used such as a feather and is used as a vessel to speak, passing around a meeting circle to the next person who wishes to speak. (Ppt Class 3) Another example of a healing circle is a “Sacred Circle” which hold the same concept but held within prisons and “allow inmates to explore their soul wounds with Elders through individual counselling, group counselling” (First Peoples, 2013, p. 8-9) Potlatch - A feast ceremony integral to the governing structure, culture and spiritual traditions of various First Nations living on the Northwest Coast held to celebrate major events. The host distributes gifts according to the status of each guest which functions to redistribute wealth, confer status and rank between different groups (ppt class 3). Sweat Lodge- Sweat Lodge ceremonies are used to cleanse the mind, body and soul from any toxins, heal from substance abuse, and to allow self-reflection to become more balanced (Hyatt, 2013, pg44). This ceremony acts as a sauna, which is held in a tent covered with blankets or skins. A medicine man places hot stones in the centre of the lodge and then pours hot water over the stones to produce steam. (Ppt. Class 3) 9. Differences Cultural Incompetence: between traditional ○ This incorporates the two values stated in the title. Culture, which are the beliefs, values, and Indigenous cultures practices. And competency, or in this case, Incompetency, which is the inability to do something. In and mainstream this case, Cultural Incompetence refers to the lack of acknowledgment towards Western Culture. Example A- Members: ○ Assertiveness is non-communal vs Assertiveness is a basic social skill Matthew, Alexz, ○ Traditional culture (assertiveness in Indigenous people) is a belief on whether people are or Kristine should be encouraged to be assertive, aggressive, and tough. An example is when one experiences a cultural assertiveness that is different and feels discomfort. In western culture, assertiveness is the ability to express yourself openly and honestly while also reflecting a genuine concern for others. Culture incompetence consequences can involve understanding and knowledge of client family and community on nurses. The western culture assertiveness might look strange to the hearing of indigenous people. Example B ○ Aging is a source of Wisdom vs Aging is decay and loss ○ The traditional definition would be that aging is a positive, that with age comes benefits. In contrast, the Western definition is that there is primarily loss that comes with age and is viewed as a negative. ○ An example for traditional culture can be that with age comes experience and wisdom, values that are vital in passing down information to the next generations. As for western culture, we compare it more to the medical model, and that with age comes a decline in physical and psychological function, with is looked down upon. ○ As a nurse, it would culturally insensitive to look down upon age towards your clients and their families as it can be seen as a form of disrespect towards the elderly, which are already highly valued. This can result in a lack of trust between the clients and the health care worker Example C- ○ Silence is acceptable anywhere vs silence is waste of time ○ Traditional culture is not seeking help when you need it while the western definition would be seeking or asking for help when you need to. ○ ○ -Example: In the traditional culture, an illness such as depression is not treated or even considered as an illness, So, someone with depression would just be quiet about it and not seek for help while the western therapy would ask for help rather than being quiet or silent ○ This could be culturally insensitive if a nurse or healthcare worker were to impede on their understandings of disease or illness, therefore this could be perceived as a sense of subjugating the health care workers own beliefs, like that of colonization ○ The client might get offended and lose faith in the nurse for not acknowledging his belief. Example D ○ The world is understood mythically vs the world is understood scientifically for example in indigenous culture the focus is on connecting with spirit often not seen but felt to gain strength as a healing practice whereas the western therapy might focus on what is wrong with the person and the weakness in general. The focus is on the mind, not heart or spirit. A nurse can be culturally incompetent if she preaches against these practices and challenges the client's faith. The client and his family members might feel disrespected, and they might lose faith in the nurse. Example E - ○ Gifts in the traditional culture is seen as social glue, whereas in the western culture, gifts are regarded as holiday issues ○ An example of the traditional sense would be, as we have seen in the spirit doctor document, the use of tobacco to show a sign of respect and appreciation that strengthens the bond. It can also be used to heal a bond that has been broken, as referred to as the “social” aspect. In western culture, people see gifts as a materialistic item required during a holiday season, which is why its regarded as a “holiday issue” ○ As we have learned in the previous class of professional practice, as a nurse, we must insist on returning the gift as it goes against our principles in the BCCNM. While us doing our job, it may be culturally insensitive to decline this form of attempt at building trust between the healthcare worker and client  Class 4: Disruption in Homeostasis Topics/ Members Information 1A. Traumatic Fractures Classifications Injury (Part A) Open: protrusion in the skin, bone is exposed, resulting in soft tissue injury Closed: skin remains intact Members: Matthew, Complete: break straight through the bone Mari, Angel leu Incomplete: partial break of bone Non-displaced fracture: bone is still aligned (spiral, transverse, or greenstick) Displaced fracture: bone is not aligned (comminuted, or oblique) Directional: transverse, linear, oblique, longitudinal, spiral 2B. Traumatic Fracture Healing Injury 1.Fracture hematoma. (Part B) 1. Bleeding creates a hematoma, which surrounds the ends of the fragments. 2. The hematoma is extravasated blood that changes from a liquid to a semisolid clot Members: 3. Initial 72 hours (about 3 days) after injury Kristine, Jessa, 2.Granulation tissue. Luke 1. Active phagocytosis absorbs the products of local necrosis 2. The hematoma converts to granulation tissue. 3. During days 3 to 14 after injury. 3.Callus formation. 1. Callus is primarily composed of cartilage, osteoblasts, calcium, and phosphorus. 2. end of the second week after injury. 3. Can be verified by radiography. 4.Ossification. 1. Occurs from 3 weeks - 6 mo after fracture and continues until the fracture has healed. 2. Prevents movement at the fracture site when the bones are gently stressed 5.Consolidation. 1. As callus develops, the distance between bone fragments diminishes and eventually closes. 2. occur up to a year following injury. 6.Remodelling. 1. Excess bone tissue is reabsorbed in the final stage of bone healing, and union is completed. 2. Gradual return of the injured bone to its preinjury structural strength and shape occurs. 3. Bone remodels in response to physical loading stress. (Gallon, R. 2024) 3. Describe the Primary Intention (3 phases) types and phases of wound margins are neatly approximated (papercut/surgical incision) Wound Healing Secondary intention Wounds with wide or irregular margins, not approximated (venous leg ulcers) Members: Larger defect and gaping wound edges Jeanelle,alexz,julia Debris may need to be cleaned away (debrided) before healing can happen More granulation tissue, and the result is a much larger scar Same as primary intention but greater inflammatory response (more debris, cells, exudate) Tertiary intention Larger/deeper scar than primary or secondary Wound left intentionally open so healing isn’t impaired via contamination (i.e., animal bite or foreign body), infection or high risk of infection, edema, poor circulation, then surgically closed Delayed primary intention 3 Phases of Wound Healing for Primary Intention 1. Initial inflammatory phase (3-5 days) Approximation of incision edges Migration of epithelial cells Clot serves as meshwork for starting capillary growth 2. Granulation Proliferation Phase (5 days-4 weeks) Migration of fibroblast Secretion of collagen Abundance of capillary buds Fragility of wound 3. Maturation Phase & Scar Contraction (7 days-several months) Remodelling of collagen Strengthening of scar Types of tissues affected 1. Superficial wounds – only epidermis 2. Partial thickness wounds- extends to dermis 3. Full thickness wounds – involves subcutaneous tissue Sometimes extends to facia Sometimes extends to underlying structures – muscle, tendon, bone Ex. Pressure ulcers Factors delaying wound healing Infection – increase inflammatory response and tissue destruction Corticosteroid meds – impairs phagocytosis by WBCs, inhibits fibroblast proliferation and function, inhibits wound contraction Diabetes mellitus – decr collagen synthesis, impairs phagocytosis, reduces supply of O2 and nutrients; checked by lab work and hemoglobin A1C; inflammatory markers: C-RP, WBC and ESR 4. Describe and Worsens over time with repetitive movement and overuse provide an example Tissue changes into a less active form of Degeneration Examples: Injury - MS --> chronic, degenerative, autoimmune disorder Members: Faye, Li - Huntington’s Disease --> progressive, fatal, inherited Yang, Mervi 5. Describe and Ischemic: Compromised cell metabolism, acute or gradual cell death (Lewis, Table provide an example 14.1)-develop plaques in coronary arteries; decrease in blood flow; leads to hypoxia of Ischemic Injury When Blood flow to tissue is cut off Members: Olivia, E.g. Stroke, Blood clot, Thrombus, Pressure Injury, Frostbite Samuel, Aya 6. Describe and Redness provide Swelling inflammatory injury Heat Pain Loss of function Cell and tissue damaged Members: Inflammations are caused by pathogens, irritants, or chronic health, Ronnie, Kristina. ○ ex; COPD - obstruction of airways from the lungs caused by inflammation {emphysema chronic bronchitis}, asthma is an inflammation of airways. ○ chronic inflammation can be an autoimmune disease. 7. Describe agents capable of producing functional or structural damage to developing fetus”.e.g. Congenital Rubella virus (cause stillbirth & congenital anomalies. Teratogens Tetragons can develop from mother's exposure to drugs, meds, chemicals, infections, alcohol, smoking, toxic substances that can cross the placenta to developing fetus, incr risk for Members: Randi miscarriages, preterm birth, stillbirth (physical, neurological, functional impairments) and Amelia tetragon begins as infection, the WBCs fight against the tetragon start the inflammatory phase, affecting fetus + possible birth defects. (Cleveland clinic, 2022) “4 main teratogens of concern during pregnancy are : drugs, chemicals, infectious agents, and radiation” (Leifer, 2024,pg.134) 8. Infectious Inflammation: Biological response to cell injury injuries: UTI Modifiable factors: Hydration, catheterization, peri care Non- modifiable factors: age, sex, decr immunity Members: Anela, - E.coli is positive on urinalysis = stays in bladder(cystitis)= inflammation Sarah This will cause an inflammation response (redness swelling, heat, pain) Inflammation: 1. Not specific to target tissue - Causes harm to tissue Cell injury: vascular response + cellular response (see power point slide #11 or Lewis, 2019, p. 226) 9. Immunological Immunological Injury Type 1 DM (cancer is also an Immunological Injury) injury Type 1 DM Type 1 Diabetes Mellitus Appears younger in life (people are born with it) Members: Kalisha Patients/clients present as normal or lower BMI v Type 2 Diabetes and Emilie Autoimmune Disease Multisystem disease related to abno insulin production, impaired insulin utilization or both Results from progressive destruction of pancreatic B cells Autoantibodies present for months to years before clinical symptoms 10. Genetic Injury Genetic mutation – permanently changes the usual DNA sequence (Mutation) Mutation can be either inherited or acquired. Inherited/Germline- passed from parent->child; present in egg & sperm cells Members: Sandra, Acquired/somatic - occurs if a mistake is made as DNA replicates or environmental factors Shelly Factors (ultraviolet radiation) can damage DNA -> skin cancer, smoking, chemotherapy Some gene mutations may result in disease eg. Sickle cell disease, fortunately we have cells in our body that can repair most of the damage in the DNA or from environmental damage. However, seniors with Alzheimer disease their DNA repair does not work as effectively, so the disease worsens over time from the accumulation (Tyerman & Cobbett, 2020). 11. Injury from Injury from Immobility are: immobility Diabetic ulcers occur because of neuropathic changes related to diabetes Arterial ulcers (also called ischemic ulcers) are caused by inadequate blood flow to the Members: Alice , lower extremity. Ravneet Venous ulcers are superficial and irregular in shape. These wounds usually have a large amount of exudate caused by edema in the surrounding tissue Pressure Injuries examples coccyx Pneumonia because of immobility Constipation Skin degradation: friction, moisture. Muscle atrophy: loss or thinning of muscle tissue.