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Showing posts with label Fundamentals of Nursing. Show all posts
Showing posts with label Fundamentals of Nursing. Show all posts

Thursday, September 29, 2011

PRINCIPLES OF GROWTH AND DEVELOPMENT

GROWTH
- Physical change
- Increase in size
- Periods of very rapid growth rate: pre – natal, neonatal, infancy, adolescence

DEVELOPMENT
- Increase in complexity of function and skill progression
- The behavioral aspect of growth

PRINCIPLES OF DEVELOPMENT

1 Growth and development are continuous orderly, sequential process influenced by maturational environment and genetic factors
2. All humans follow the same pattern of growth
3. The sequence of each stage is predictable although the time of onset, the length of the stage and the effects of each stage vary with the person.
4. Growth and development occur in cephalocaudal direction.
5. Growth and development occur in a proximal to distal direction
6. Development occurs from simple to complex or from single acts to integrated acts.
7. Development becomes increasingly differentiated, begins with generalized response and progresses to a skilled specific response.
8. The pace of growth and development is asynchronous or uneven.


KOHLBERG’S STAGES OF MORAL DEVELOPMENT
LEVEL AND STAGE

Level I: Pre Conventional (Egocentric Focus)
Stage 1
Punishment and obedience orientation
(toddler – 7 years)
Stage 2
Instrumental – Relativist Orientation (4 – 12 years)

Level II: Conventional (Societal Focus)
Stage 3
Interpersonal concordance, good boy, nice girl (6 years thru adult years)
Stage 4
Law and order orientation (adolescent – adult)

Level III: Post Conventional or Principled Level (Universal Focus)
Stage 5
Social contract, legalistic orientation (middle age or older adult)



Stage 6
Universal ethical principles (middles age or older adult)


- Activity is wrong if one is punished, activity is right if one is not punished.

- Action is taken to satisfy ones needs.



- Action is taken to please another and gain approvals.

- Right behavior is obeying the law and follow the rules



- Standard of behavior is based on adhering laws that protect the welfare and rights of others: violating the rights of others is avoided: personal values and opinions are recognized.

- Universal moral principles are internalized, person respects other humans and believes that relationship are based on mutual trust.

 

TYPES OF OLDER ADULT

1. Young old (65 – 74) – adaptation to retirement and changing physical abilities, chronic illness may develop.
2. Middle old (75 – 84) – adaptation to decline in speed of movement, reaction time and sensory abilities: increasing dependence in others.
3. Old old (85 – over) – increase physical problems.


          DEVELOPMENTAL TASK AND WHOLISTIC APROACH BY ROBERT HAVIGHURST

AGE PERIOD
DEVELOPMENTAL TASK
Infancy and Early Childhood









Middle Childhood










Adolescence













Early Adulthood (20 – 40 yrs)







Middle Age (Emptiness Stage)









Late Maturity
- Learning to walk, to taste solid foods, to talk, to control elimination of body wastes, sex differences and sexual modes
- Learning to relate emotionally to parents, siblings and others
- Learning to distinguish right from wrong and developing a conscience
- Learning to form concepts of social and physical reality

- Learning physical skills for ordinary games
- Building wholesome attitude towards oneself
- Learning to get along with age mates
- Learning an appropriate masculine or feminine social role
- Developing fundamental skills in reading, writing and calculating
- Develop concepts necessary for everyday living
- Achieving personal independence

- Achieving new and more mature relations with age mates of both sexes
- Achieving masculine/feminine social role
- Accepting ones physique and using the body effectively
- Achieving emotional independence from parents
- Selecting and preparing for an occupation
- Preparing for marriage and family life
- Developing intellectual skills necessary for civic competence
- Acquiring a set of values and an ethical system as a guide to behavior

- Selecting a mate
- Learning to live with a partner
- Starting a family and rearing children
- Managing a home
- Getting started in an occupation
- Taking on civic responsibility
- Finding a congenial social group

- Achieving adult civic and social responsibility
- Establishing and maintaining an economic standard of living
- Assisting teenage children to become responsible and happy adults
- Developing adult leisure time activity
- Accepting and adjusting the physiologic changes of middle age
- Adjusting to aging parent

- Adjusting to decrease physical strength
- Adjusting to retirement and reduced income
- Adjusting to death of a spouse
- Meeting social and civic obligations
- Establishing satisfactory living arrangements

VITAL SIGNS

Temperature

1. Oral
- Most accessible and convenient
- Normal value: 37 o C – 98.6 o F
- 2 – 3 minutes
2. Rectal
- Most reliable
- Normal value: 37.7 o C – 99.6 o F
- 3 – 5 minutes
3. Axila
- Less accurate
- Normal value: 36.4 o C – 97.5 o F
- 5 – 10 minutes
4. Tympanic membrane
- Directly reflects core temperature
- Normal value: 37.7 o C – 99.9 o F
- Automatic results

CONVERSION

-       Fahrenheit to Celsius =  (F-32) x 5/9
-       Celsius to Fahrenheit =  (C x 9/5) + 32

PULSE SITE

1. Temporal             6. Femoral
2. Carotid                7. Popliteal
3. Apical                 8. Posterior tibial
4. Brachial               9. Dorsalis pedis
5. Radial
ü  When palpating for pulse use 2 – 3 fingers except when taking the apical pulse use stethoscope
ü  Apical pulse is in the 5th intercostals space
ü  Landmark is the angle of Louie
ü  4th intercostals space left mid clavicular line child apical pulse
ü  When using the stethoscope use the flat part when looking for high pitch sounds like (lung and bowel sounds) and use the bell for vascular or heart sounds

RESPIRATION
- Adult: 12 – 20 c/min
- Newborn – 30 – 60 c/min

ERRORS IN TAKING RESPIRATORY RATE

Patient Factor
ü  Insufficient rest before assessing
ü  Assessing immediately after a meal or while client smokes or has pain
Equipment Factor
ü  Stethoscope fits poorly or hearing impaired
ü  Bladder or cuff too wide
ü  Bladder or cuff too narrow
Errors in technique
ü  Arm unsupported
ü  Arm above heart level and not perpendicular to the body
ü  Cuff wrapped to loosely
ü  Deflating cuff to slowly
ü  Deflating cuff to quick
ü  Failure to identify auscultatory gap
Auscultatory gap
ü  Temporary cessation of sounds after initiation
ü  Gap of 10 – 40 mmHg
ü  Common among hypertensive
ü  Repeating assessment too quickly (wait for 2 – 3 minutes after taking again the bp, and maximum of 3 takes same arm and if still inaudible rest arm for 5 – 15 minutes)
ü  Multiple examiner using different Kortkoff sounds for diastolic readings
ü  Failure to use the same arm consistently Effects
ü  Erroneously high readings


                             False low systolic and false high diastolic
                            - False low reading
                            - False high reading
                            - Erroneously high readings
                            - Erroneously low readings
                            - False high readings
                           - False low diastolic reading
                           - False high diastolic reading
                           - False low systolic bp and diastolic bp
                           - False high systolic blood pressure, false low diastolic blood pressure 

ü  Inaccurate interpretation
ü  Inconsistent measurements
ü  For a client who’s blood pressure is to be taken for the first time, take the blood pressure of both arms
ü  Difference of blood pressure for both arms should only be 10 mm Hg
ü  Use higher value as baseline
PALPATORY SYSTOLIC PRESSURE
ü  Point of pulsation stops with the use of stethoscope
ü  Maximum pressure + 30 mmHg that is you limit when taking the blood pressure

KOROTKOFF SOUNDS
Phases
1. Characterized by a thud, thump and tapping sound
2. Swooshing, whoosing sound
3. Sound decrease in intensity when compared to Korotkoff one
4. Muffling sound
5. Disappearance of sound
      - in adults record Korotkoff 1 and Korotkoff 5 of able to hear Korotkoff 4 record also
      - in children record Korotkoff 1 and Korotkoff 4

HYPERTENSION
Average of 2 or more diastolic reading on at least 2 subsequent visits is 90 mmHg or higher or when an average of 2 or more systolic readings on at least 2 visits is higher than 140 mmHg


SYSTOLIC
DIASTOLIC
Optimal/ Normal
Above Normal
Hypertension
Grade 1 (Mild)
Grade 2 (Moderate)
             Grade 3 (Severe)
120 – 129
      130 – 139

140 – 159
160 – 179
Greater than 180
      Greater than 140Less 80
80 – 84
85 – 89

90 – 99
100 – 109
Greater than 110
       Less 90

NURSE – CLIENT RELATIONSHIP

PHASES OF NURSE – CLIENT RELATIONSHIP

Phase I: Pre Interaction
- No face-to-face interaction with client

Phase II: Introductory/Orientation
- Rapport setting, contract setting, sets tone for rest of relationship
- Testing behavior (orientation) resisting behavior (non compliance)

Phase III: Working
- Implementation of nursing care plans
- View as unique individuals
- Employ decision-making and technical skills and communication skills

Phase IV: Termination
- Characterized by ambivalence on both nurse and client
- Discharge phase
- Evaluation of care given by nurse

Therapeutic Communication

COMMUNICATION
- Human function that enables people to relate and interact with each other by means of a verbal and non verbal way.

MODES
Verbal         – spoken language
Non-Verbal – symbols, sign language


ELEMENTS OF COMMUNICATION
1. Stimulus – reason why people communicate, motivation with each other (object, ideas, feeling) referent
2. Message – idea, feelings and emotions
3. Sender – also known as encoder, one that sends the message
4. Channels – kinesthetic: tactile stimulus, visual: symbols, auditory: spoken language
5. Receiver – decoder
6. Feedback – answer to questions, whether receiver understood or not

FACTORS THAT AFFECT COMMUNICATION PROCESS

1. Ability of communicator – ability to speak, hear, see and comprehend stimulus
2. Perceptions – each has a unique trait, values, life experiences
3. Personal space – distance people prefer in interactions with one another
Four distances
a. Intimate
- Physical contact to 1 ½ feet characterized by body contact heightened sensation of body heat and smell, low vocalization
- Threatening to client
b. Personal
- 1 ½ feet to 4 feet
- Less overwhelming than intimate distance
- Usual distance between nurse and client
- Best distance
c. Social
- 4 feet to 12 feet
- Communication is non-formal
- Allows more activity and movement back and forth
- Often misused by nurse
d. Public
- 12 feet and beyond
- Individuality is lost
- Mass health education
4. Territoriality – concept of space and things that an individual considers as belonging to the self
5. Roles and Relationships
6. Time – events that precede and follow interactions
7. Environment – environment is comfortable, communication is more effective
8. Attitudes


























THERAPEUTIC COMMUNICATION and RATIONALE
Using silence
Accepting pauses or silences without interjecting any verbal response

Providing general leads
Using statements or questions that
     a. encourage client to verbalize
     b. choose a topic of conversation

Being specific and tentative
Statements that are specific rather than general and tentative rather than absolute

Using open ended questions
Specify only topic to be discussed and invite answers longer than one or two words

Using touch
Touch reinforces caring feelings; however the nurse should be sensitive to difference in attitude’s in every patient.

Restating/Rephrasing
Used when communication is rambling or when paraphrasing is difficult

Seeking clarification
Helping the client clarify an event situation or happening with respect to time

Clarifying time or Sequence
Helping the client clarify an event situation or happening with respect to time
Offering self
Suggesting ones presence, interest or wish to understand the client without making any demands that could make client comply to suggestion
Giving information
A simple and direct manner, specific factual information
Acknowledging
Giving recognition in a non judgmental way of
     a. change in behavior
     b. effort the client has made
     c. contribution to a communicator
Presenting reality
Helping client differentiate real from unreal
Focusing
 The focus may be an idea or a feeling. Directing ideas, feelings, questions or content back to clients to enable them to explore their own feelings
Reflecting
 Verifies meaning of specific words than overall meaning of a message

Summarizing and Planning
Perception checking
Stating the main points of discussion to clarify relevant parts discussed
Accepting pauses or silences without interjecting any verbal response





NON THERAPEUTIC COMMUNICATION
RATIONALE
Stereotyping


Agreeing and Disagreeing


Being defensive

Challenging


Probing


Testing

Changing topic

Unwarranted reassurance



Passing judgment


Giving common advice

Offering generalized and over simplified beliefs about groups of people

Akin to judgmental responses implies client is either right or wrong

Attempting to protect a person

Giving response that makes client prove their statement or point of view

Asking information chiefly out of curiosity rather than intent

Question than make a client admit something

 Directing communication into areas of self intent


Using clichés or comforting statements of advice as a means to reassure the client


Giving opinions and approving or disapproving response


Telling client what to do

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