Essay, Pages 9 (2008 words)
Illness – is an event that manifests itself through observable/felt changes in the body. Illness is the state in which the physical, emotional, social, intellectual or spiritual functioning is diminished or impaired compared with previous experience. It is NOT synonymous with disease and may or may not be related to disease. Illness is highly subjective. Wellness – is the state of being healthy in both body and mind as the result of deliberate effort. Wellness is the state of well-being. It is an approach to healthcare that emphasizes preventing illness and prolonging life as opposed to emphasizing treating diseases.
Anspaugh et al propose 7 components of wellness: 1) Physical 2) Social 3) Emotional 4) Intellectual 5) Spiritual 6) Occupational and 7) Environmental. Well-being/Wellness is a subjective perception of vitality and feeling well which can be described objectively, experienced, and measured and can be plotted on a continuum. Dunn’s concept of high level wellness theorizes that wellness is the degree of illness/health modified by the environment. It says that it is an integrated method of functioning that is oriented towards maximizing the potential of which the person is capable.
It requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning. The patient’s perception of health, wellness and illness must be considered by the nurse in order to provide individualized, quality care. Lifestyle factors that influence health: (PP Health Promotion and Disease Prevention) Internal and external factors influence health status. Internal factors include Age, Genetics, Physiologic, Lifestyle, Health habits (smoking, drugs, alcohol, eating habits, exercise and stress).
External factors include: Environment (radiation, air pollution, H20 and sun exposure), Safety (seatbelts, riding on motorcycle), and Standard of living (less educated the poorer the health). How to take a patient’s temperature using different routes: (Lab & Kozier PP. 532-537) There are a number of body sites for measuring body temperature. The most common are oral, rectal, axillary, tympanic and temporal artery. Normal adult temperature is 37 degree C and 98. 6 degree F. In older adults ( > 70), temp is usually 36 degrees C or 96. 8 degrees F. Newborns- 1 yr old are usually 98. 2 degree F and 36. 8 degree C. Oral: Most common route.
Place thermometer underneath the tongue on either side of the frenulum. Do NOT take in someone with mouth lesions or if patient has had oral surgery. Be sure to ask if patient has had anything cold/hot to drink in last 30 minutes. Rectal: Most accurate route. Place Pt. in lateral or Sim’s position. Apply gloves and instruct patient to take a slow deep breath during insertion. Insert 1. 5 inches in adults. Do NOT take in Pt that has had rectal surgery, has lower GI problems, is immuno-suppressed, has a clotting disorder or Pt that has hemorrhoids. In some agencies taking rectal temps is contraindicated in patients who have had an MI.
It is believed that this can stimulate the Vagus nerve which can cause myocardial damage. Tympanic: Temps measured in this site are usually 1. 1-1. 5 degrees higher than oral. These are non invasive and quick. To measure temp, pull pinna slightly upward and back( adults) and point the probe slightly anteriorly, toward eardrum. Insert the probe slowly using a circular motion until snug. Axillary: The least accurate route but safest route. Dry arm pit if moist. Place thermometer bulb in center of axilla. In order to obtain a more accurate reading it must be left in place for a long time. Temporal Artery: Safe, noninvasive and very fast.
Equipment slightly more expensive, as it is a scanning infrared thermometer. The probe is placed in the middle of the forehead then drawn laterally to the hairline. If Pt has perspiration on forehead the probe is also touched behind earlobe. Levels of preventive health care: Three levels of preventative care are: Primary – focuses on health promotion and protection against specific health problems or health risks. Primary prevention precedes disease or dysfunction and is applied to generally healthy individuals or groups. Examples include: Immunizations; risk assessments for specific disease i. e. iabetes; health education about injury and poisoning prevention. Secondary- focuses on early identification of health problems and prompt intervention to alleviate health problems. Goal is to identify people in early stages of disease process and to limit future disability. It is curative in nature. It emphasizes health maintenance for people with health problems (i. e. someone with diabetes who has it under control). This level includes prevention of complications and disabilities. Examples include: Encouraging regular medical/ dental checkups; Teaching self exam of breast; screening surveys hypertension).
Tertiary- focuses on restoration and rehabilitation with the goal of returning the person to optimal level of functioning, within the constraints of the disability. This level of prevention occurs after an illness, when a defect is stabilized or fixed and determined to be irreversible. Examples include: caring for someone with a chronic disease; referring patient with colostomy to support group; teaching patient with diabetes to identify and prevent complications ( heart disease); referring patient with spinal cord injury to a rehab to receive training to maximize his remaining abilities.
Understand who the older adult is and physiological/psychological changes: Successful psychological aging is reflected in the older person’s ability to adapt to physical, social, and emotional losses and to achieve contentment, serenity, and life considerations. The older adult continues to learn and problems solve and intelligence and personality remain as they have always been. A person’s social ability does not change during the course of their life: if you were a young extrovert/introvert you will be an old extrovert/introvert. Wisdom increases as we age.
As a person becomes older they go through physiological and psychosocial changes. Some physical changes are visible and some are not. In general lean body mass decreases, fat tissue increases, and bone mass decreases. Intracellular fluid decreases which can cause dehydration. Skin becomes drier and less elastic and they become more susceptible to skin tears. Bony prominences may become visible. There is a loss of overall stature and osteoporosis can occur in people who have insufficient intake of calcium and in women who have been through menopause. There is a steady decrease in muscle fibers.
Reaction time slows. There is loss of visual acuity and progressive loss of hearing and reduced elasticity and increased rigidity of arteries and an increase in blood pressure. Orthostatic hypotension is common. GI changes include increase in indigestion and constipation. There is increase in frequency and urgency of urination and incontinence in many older adults. Decreased immune response and lowered resistance to infection is normal. Many older people have decreased thyroid function and increased insulin resistance. Respiratory efficiency is reduced with age.
Older adults may experience many health problems including physical injuries and chronic disabling disease, and dementia. Psychologically people have much to adapt to as they become older. Some of these things are 1) Retirement – this is often a difficult time of adjustment for people. Many have a sense of self worth from working and lose a sense of identity when they stop working. Income decreases sometimes by 35% during this time. 2) Economic Change- Decrease in finances related to retirement and lack of pension plans/savings. Health care costs skyrocket because of increase in illnesses.
This decrease in monetary resources can cause older people to become less independent. This causes them to lose self esteem and become depressed. 3) Grand-parenting: At this time in life older people become grandparents and are able to provide support to younger family members in a number of ways. 4) Relocating- many people move closer to their children for general support and supervision. This is a very big stressor. Older adults can either live with their children; live in assisted living, live at home with adult day care, live in a long term care facility or in private group homes. ) Maintaining Independence and Self Esteem- This is a big one. Elders thrive on independence and it is important for them to be able to maintain their self esteem. The more they can do for themselves the better. 5) Facing Death and Grieving – as people age the chance of their spouse dying increases. Friends and family members die and this is a period of adjustment and grieving. The older person has feelings of loss, emptiness and loneliness during this time. According to Erickson the developmental task at this time is ego vs. despair.
People who attain ego integrity view life with a sense of wholeness and derive satisfaction from past accomplishments. This is the time of life where many older people start focusing on their faith and spirituality. Most people start an internal life review and seriously start thinking about their own imminent death. Caregiver Role Strain…what is it? What nursing interventions would the nurse provide? (P. 137) Caregiver role strain is when they have physical, emotional, social, and financial burdens that can seriously jeopardize their own health and well-being.
Nursing intervention would be to encourage caregivers to express their feelings and at the same time convey understanding about the difficulties associated with caregiving and acknowledge the caregivers competence. Through conversation with the caregiver assess areas where assistance may be desired or need. Identify possible source of help. Like volunteer (family, neighbor, friends, church, caregiver support groups) or agency sources (home health aide, meals on wheels, day care, transportation, and counseling and social services. Remind the caregiver of the importance of caring for themselves.
Know about these nursing diagnoses: Coping Ineffective, Fear, Anxiety (PP. 1069-1070) NANDA diagnostic labels related to stress, adaptation, and coping: Anxiety: Vague, uneasy feeling of discomfort or dread accompanied by an automatic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by the anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with a threat. Fear: response to perceived threat is consciously recognized as a danger.
Ineffective Coping: Inability to from a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use resources. Terms associated with assessment of pulse (CHP 29, PP. 538-540) Assessment of pulse: Terms Locations: Temporal, carotid, apical, brachial, radial, femoral, popliteal, posterior tibial, pedal (dorsalis pedis) Pulse: wave of blood created by contraction of the left ventricle of the heart. Cardiac output: volume of blood pumped into the arteries by the heart and equals Stroke Volume (SV) X Heart Rate (HR) per minute.
Compliance: ability of the arteries to expand Peripheral pulse: pulse located away from the heart Apical Pulse: central pulse; apex of the heart (PMI) point of maximal impulse Palpation: feeling Auscultation: hearing DUS: Doppler ultrasound stethoscope Tachycardia: excessively fast heart rate ( over 100 BPM in an adult). Bradychardia: A heart rate less than 60 BPM in an adult. Pulse rhythm: pattern of the beats and the intervals between beats. Dysrhythmia/arrythmia: irregular rhythm. Pulse volume: pulse strength or amplitude, refers to the force of the blood with each beat.
Elasticity of the arterial wall: reflects its expansibility or its deformities. Perfusion: blood flow to a particular area of the body Understand different tools for therapeutic communication: (P. 469-470 box 26-2) Broad opening statement General leads Reflecting/paraphrasing Sharing observations Acknowledging feelings Silence Giving information Clarifying Implied verbal communication Summarizing Focusing (from power point #18 in communication) further information can be found on pg. 469 and 470 box 26-2 Different domains of learning: cognitive, affective, psychomotor: (P. 89) Cognitive domain – the “thinking” domain, includes six intellectual abilities and thinking processes beginning with knowing, comprehending, and applying to analysis, synthesis, and evaluation. Affective domain – the “feeling” domain is divided into categories that specify the degree of a “person’s depth of emotional response to tasks”. Psychomotor domain – the “skill” domain, includes motor skills such as giving an injection. Know normal vital signs for the adult and older adult. Average range for adults: (P. 529) 96. 8-100. 4. Older adults (>75) are at risk for hypothermia ( temperatures