Highlighted Lecture day 1 (Chester’s Lecture)
A functional family copes by alternatives, weather or not u give a med when
communication
Caregivers are usually most organized with
complaints of discomfort
Value = an ideal or concept that gives
meaning to an individuals life
Value system = operates as a personal code
of conduct
Attitude = is a feeling of emotion, generally
including positive or negative judgment toward
people, objects, or ideas
Beliefs = refers to special class of
intellectual attitudes based primarily on faith, as
opposed to fact
Genogramhealth and illness through
generations (3)
Ecomap relationships and interactions
with social networks in a family
Family apgar questionaire emotional
attachments to pt., assesses satisfaction with
social support from adaptation, partnership,
growth, affection, resolve
Value = an ideal or concept that gives
meaning to an individuals life
Value system = operates as a personal code
of conduct
Attitude = is a feeling of emotion, generally
including positive or negative judgment toward
people, objects, or ideas
Beliefs = refers to special class of
intellectual attitudes based primarily on faith, as
opposed to fact
Aesthetics qualities of objects, events and
people that provide satisfaction
Altruism concern for the welfare of others
Equality having the same rights,
privileges or status
Freedom capacity to exercise choice
Human dignity inherent worth and
uniqueness of an individual
Truth faithfulness to fact and reality
Justiceupholding of moral and legal
principles
Morals PERSONAL standard of right and
wrong
Ethics a systematic inquiry into the
principles of right and wrong conduct, of virtue
and vie, and of good an evil as they relate to
conduct
Nursing Ethics a system of principles
governing the conduct of the nurse
Ethical dilemmas NO TRUE RIGHT OR
WRONG ANSWER, a puzzling moral problem,
requires a choice between 2 equally unfavorable
its against your better judgement
Ethical decision making using an orderly
process that considers ethical principles
Ethical distress knowing the right thing to
do but finding it almost impossible to execute,
when the doctor tells you you have to give the
med
Ethical uncertainty feeling troubled by a
situation but not knowing if it is an ethical
problem
Utilitarianism - most amount of good for the
greatest amount of people, health care reform,
value is determines by its usefulness, emphasis
on the outcome,
Deontology - traditional theory, it is the
principle on which an action is based that is the
morally decisive such as making and keeping a
promise
Princiipalism - primary principle of
bioethics, respect for autonomy, non-
malfeasance, beneficence, distributive justice
(social justice)
Communitarianism - hx, tradition and
concrete moral thinking should be the basis of
moral thinking and action 3 theries of this are…
virtue ethics, caring and the ethic of care,
feminist ethics.
Virtue Ethics - goal; enable persons to
flourish as human beings
Caring and Ethic of care - 2 voices in caring
the express 2 distinct concepts of morality and
the methods of expression
Feminist Ethics - supports critical thinking
and a focus on gender, power and socioeconomic
status, men and woman are equal
Advocacy is too promote and encourage the
pt to have a voice
Race  shared biological features
Ethnicity shared culture (american)
Enculturation - process of becoming a
member of a cultural group, assimulating into a
culture, can create conflict w/I a family
Migration - people migrate from state to
state as well as across county borders
Immigrants - name given to people who
cross national borders
Cultural Diversity - individuals exposed to
multiple world views
Culture shock - feeling of panic, anger,
depression, and denial and a sense of separation
from others
Assimilation - when minority groups living
within a dominant group lose the cultural
characteristics that once made them different
Prescriptive - things the individual should do
to have harmony
Restrictive - things the individual should not
to do have a positive outcome
Things that if done will have significant
negative outcomes
Linear time - straight line that can be
divided into parts with a begning and end.
Western health care providers see time as linear
Circular time - time is a never ending enitiy,
space is linked with issues of territoriality, living,
work, with health care arrangements, touch,
sound and smell
Space - encompases the concepts of
territoriality, density, and distance
Territoriality - to own space
Density - the number of people within a
given environmental space
Distance - the way cultures use space to
communicate
Intimate Zone  0 - 18 inches
Personal Zone  18 inches to 3 feet
Social Zone  3 feet to 6 feet
Rite - an event that marks change in status
from lower to higher level, bar mitzvah,
confirmation, baptism
Ritual - prescribed manner or process
closely related to a cultures ideology, such as
high school graduation, wedding, admission to
school
Spiritual healing - healing energy from
spiritual sources
Traditional oriental - complete system of
diagnostic and therapuetic approaches
Naturopathic medicine - supports natural
healing capacity of the individual
Chiropractic - adjustment and manipulation
of musculoskeletal articulations to treat
functional disorders
Orthomolecular - rebalance of individual
biochemistry
Home visits - The purpose of the visit is not
to provide care at all costs,
Hnd sanitizer uses 4 x then must use water
&soap
Wound infections should be scheduled after
visits to healthy or immune suppressed clints
An emergency situation is the nurses
professional and legal responsibility to address
and fix
Short frequent visits allow the nurse to deal
with 1 or 2 problems at a time
Written permission of clint , parent or
gardian of a minor that allows for the release and
receiving of client info from other agencies or
disciplines is a client consent
Building trust in an essential foundation for
a continued relationship, nurse identifies actual
and potential problems or concerns of family
members and members as a whole
Primary prevention - 1 LOP (level of
prevention) - altering susceptibility or reducing
the exposure of persons who are at risk for
teaching, nurse intervention
Secondary LOP - early detection and prompt
treatment to cure a disease or slow its
progression - screening programs
Tertiary - 3rd LOP limiting disability in
persons in the early stages of the disease and
providing rehabilitation, nursing interventions
are direct in this stage, nursing care is given as
well as referrals
Building trust is an essential foundation for
a continued relationship, nurse identifies actual
and potentia problems or concerns of family
members and members as a whole
1) preplanning phase - get phone number,
clarify who referred them and why, organize a
visit, gather initial pt data and share information
w/ pt
1) Introductory phase or initial phase - nurse
and family get to know one another and how the
family health problems are defined
1) Working phase or implementation phase -
nurse provides care and educates the family
1) Ending phase or termination phase -
summarizes the accomplishments of the visit,
discuss plan for next visit, leave identification of
self and agency with phone numbers
5 phases of home visits
1) Initiation phase - initial referral for care,
specific steps, clarify the source, clarify the
specific purpose, gather initial patient data, share
info with client
1) Previsit phase - initial contact, share
source of referral, set up appointment, review
method of payment, confirm visit, overcome
objections, establish goal of visit
1) In home phase - personal safety tips, lock
belongings in trunk, ask client to look for your
arrival, getr accurate directions, check with other
nurses, drive with windows up and oors locked,
be alert to your surroundings, park in a wekk
lighted location, have access to a phone, once
you arrive introduce yourself, proceed with
nursing process, build a therapeutic relationship
1) Termination phase - review the visit with
client, were goals met?, plan for future visit
1) Post visit phase - cocument the visit using
the nursing process, data base reflecting
assessment findings, nursing diagnosis and
problem list, plan of care, nursing interventions,
evaluations
State qualifications for practice - provided
consumer protection, practicing nurses have
completed and approved nursing programs,
nurses must pass boards
ANA - professional associations
qualifications for practice - ana, evaluates the
practice of its members and expects excellence
The term diagnosis was initiated in 1973
with the convening of the first national task
conference on nursing diagnosis
Negligence - decisions are made based on
standards of practice defined by the ana and the
individual state nursing practice.
Nursing diagnosis are clinical judgements
about individual , family or community
responses to actual and potential health
problems, life proceses, nursing diagnoises
provide the basis for selection of nursing
interventions to achieve outcomes for which the
nurse is accountable
Nursing diagnosis makes us valid!!
Policies and procedures guide what we as
nurses do
Policies and procedures/state law - the short
coming of this method is that the hospital’s
policy may be substandard.
Standards of care - substandard institutional
policies do not absolve the individual nurse of
responsibility to practice on the basis of
professional standard of care
Nurses have a legal duty to report suspected
risk or harm, must document any evidence
before making serious accusations against peer,
if you question someone’s actions it is wise to
communicate it directly to the person involved
first
Always follow chain of command
The psychiatric mental health nurse has a
duty to intervene when safety or wellbeing of the
client or other person is obviously at risk
Nurse is responsible for harm if she she
follows an order that is known to be correct
If the treating md does not appear willing to
consider your concerns, you need to intervene
through appropriate channels, such as your
supervisor, but always remember even though
you are the clients advocate you do not have a
right to interfere with the physician-client
relationship
The initial assessment is made by the
admitting phsychiatrist
Psychiatrist - serves as the leader of the
team, responsible for diagnosis and treatment of
mental disorders, performs psychotherapy,
prescribes medication, and other somatic
therapies
The idt meets w/I 48 hours of admission to
determine a comprehensive treatment plan and
goals of therapy to assign intervention of
therapies
SOAPIE - subjective, objective, assessment,
plan, implementation, evaluation format
Axis I - clinical disorders
Axis II - personality disorders, mental
retardation
Axis III - Medical conditions
Axis IV - Psychosocial and environmental
problems
Axis V - global assessment of functioning
Abuse is about power and control
Cycle of violence - 1 - tension building
phase, 2 - acute or serious battering incidence
can last 2 to 24 hrs, 3- honeymoon phase
Abuse is more current in the “sandwich
generation”
Munchausen symdrome - mother fabricated
an illness in child, first sign: signs and
symptoms occur in the presence of caretaker and
disappear when child separated from caretaker
Child abuse S & S - usually begins between
ages of 6-9 and starts by kissing and progresses
from there, abuser generally male, impaired
spousal relationship, male is domineering
impulsive and physically abusive
3 stages of recovery - 1. Initial stage pt
needs to feel safe and reassured, 2, Adaptation
phase or recoil phase - counciling groups, seeks
validation, 3 reconstruction or reorganization
phase - moving forward become a survivor
#1 nursing diagnosis with violence - risk for
self or other directed violence, this is payable by
insurance
Outcome - ensure that violence ceases,
ensure safety of all family members
Autonomy - presumes individuals are
always capable of making individual choices by
oneself
The right to refuse meds - if client presents a
danger to self or others in the institution the
client can be forcibly medicated. They have a
right to a hearing asap
 Clients have a right to least restrictive
treatments first
Pertinent medical info may be released in a
life threatening situation without consent
Informed consent - preservation and
protection of individual autonomy in
determining what will or will no happen to their
body
Restraints and seclusion - leather straps,
chemical restraints, seclusion
Nurse duties w/ restraints - observe q 15min,
circulation, respiration, nutrition, hydration
elimination document q 2 hrs
Voluntary commitment - client enters for
treatment of his free will, may sign out of facility
at any time
Involuntary - admitted to facility for
treatment that they did not willingly seek out,
must meet following criteria; dangerous to self
or others, observation and treament of mentally
ill persons, when an individual is unable to take
care of basic personal needs (gravely disabled)
Emergency commitment - are time limited
and court hearing for individual must be3
scheduled w/I a 72 hr period and if committed
another hearing will take place 7 to 21 days for
further commitment
Voluntary commitment must give a 72 hr
notice before we can let them go. This gives us
time to have a hearing if needed
Forensic nurse deals with interpersonal
violence , public health and safety,
correctional institution, Er trauma, pt care
facility
Sane nurse - psychosocial and physical
assessment, collect evidence, therapeutic
interventions to minimize trauma, provide
support groups, judicial process of sexual assault
Correctional nursing specialty - assess
document report info to police and collect and
preserve evidence,
Remember everyone claims innocents in jail
Common illnesses in correctional
institutions ; schitsophrenia, affective psychosis,
personality disorder, substance abuse, agitiation,
hullocination, detoxification
11 curative factors why groups help
1. Instillation of hope - see others who have
solved their problems
1. Universality - come to realize they are not
alone
1. The imparting of information - knowledge
is gained by sharing of advice and suggestions
1. Altruism - creates a positvie self image
1. The corrective recapitualtion of the
primary family group - attempts at resolution are
promoted by feedback and exploration
1. Development of socializing techniques -
able to correct maladaptive social behaviors and
learn and develop new social skill hope for +
1. Imitative behavior - will imitate selective
behaviors that they wish to develop in
themselves
1. Interpersonal learning - insight is gained
on how one is perceived
1. Group cohesiveness - members develop a
sense of belonging and are of value to each other
1. Catharsis - an open expression of feelings,
both negative nad positive, take place w/I A
group
1. Existential factors - helps individuals take
direction of their own lives and to accept
responsibility for the quality of their exisistance
Phases of group development -
1. Initial orientation phase - group activities,
goals are established, members are introduced,
rules are established, leader should orient
members to group processes, promote an
environment of trust, ensure that rules do not
interfere with fulfillment of goals members act
overly polite in fear of not being accepted by
the group, power struggles will occur, pecking
order is established
1. Middle or working phase - cohesiveness
has been established. Trust is established among
members, turn toward each other and less often
to the leader
1. Final or termination - termination of group
is talked about, members may act surprised over
termination of the group, face denial which
sometimes turns to anger
Autocratic leader - leaders have personal;
goals for the group, info may be withheld,
message is we will do it my way, my way is best,
members are dependent on leader for problem
solving, the approach is that of persuasion,
productivity is high
Democratic - leader focuses on members of
group, info is shared, members are encouraged to
problem solve, decide what must be done,
consider the alternatives, make a selection, and
proceed with actions to complete the task.
Productivity is low
Laissez Fairre - college style, leadership syle
allows members to do as they please, no
direction, no problem solving, members become
frustrated and confused, very low productivity
Within a group member complete tasks of
the group maintain or enhance group processess,
and fulfill personal or individual needs CCSSII Dexedrine causes obesity and
Psychodrama - roleplay narcolepsy and can cause anorexia, dry mouth,
Nurse in group therapy serves on or leads restlessness, insomnia, etc…
task groups that create policy, describe
procedures and plan client training, set in on
support groups and transition client to d/c.
Mieieu therapy - structures environment in
order to affect behavioral changes and to imprive
the psychological health and functioning of the
individual, the goal is to manipulate the
environment so that all aspects of the client’s
hospitalization are considered therapeutic
ECT - induces a grandmal seizure holdany
benzodiazepines or bartiturates used for sleep aid
the previous night or it could raise the siezure
threshold. Atropine is given to reduce risk of
aspiration, brevital is given iv for immediate
anesthesia, anatine given iv prevents a grandmal
seizure.
Who should not have ECT - recent mi,
recent cva, pt w/ angina, CHF, COPD, severe
osteoperosis, major bone fractures, glocoma,
retinal detachment, pregnancy
Typical phenothiazines - PST - Prolixen,
Stelazine, Throzine
Phenothiazines lower the seizure threshold
so an anticonvulsant may be necessary
Typical non phenothiazines - hmn - haldo,
moban, novan
Atypical - clozapine - tardive duskiness,
blood cell disorder decreased wbc
Antidepressants - decrease of monomine
neurotransmitters )nor epinephrine and
serotonin) in the brain
try cyclic - blocks the uptake of the
neurotransmitters nor epinephrine and serotonin
in the brain, the agents are Elavil, anafranil,
sideburn, tofranil, side effects are seizures,
dry mouth, tachycardia, sedation
SSRI - therabuetic effect takes 4 - 6 weeks,
cause insomnia so you would want to take them
at night.
Foods that cause hypertensive crisis (dnt
mix with maoi’s) cheese, bananas, raisings,
pickled foods, red wine, beer, cream, yogurt,
chocoalate, coffee, liver, yeast, soy sauce
Mood stabilizers for bipolar disorder 0
lithium - first used as salt subsitturenarrow
therapeutic range .8 - 1.5 causes wieght gain
Anticholinergic drugs - Cogentin is given
with antipsychotic
Cns stimulants - amphetamines - stimulate
the relase of the neurotranmitters, norepinephrin
and dopamine, they cause euphoria and alertness,