health promotion larry santiago, msn, rn. health care delivery and nursing practice nursing is...
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Health Promotion
Larry Santiago, MSN, RN
Health Care Delivery and Nursing Practice
• Nursing is defined as the “diagnosis and treatment of human responses to health and illness”.
Health Care Delivery and Nursing Practice 2
• Health is defined as a “state of complete physical, mental, and social well-being”.
Health Care Delivery and Nursing Practice 3
• Wellness “includes a conscious and deliberate approach to an advanced state of physical, psychological, and spiritual health”.
Maslow’s Hierarchy of Needs
Roles of the Nurse
Practitioner Role
Leadership Role
Roles of the Nurse 2
• Research Role
Health Education
• Goal of patient education is to encourage people to adhere to therapeutic regimens
Health Education 2
• Teaching techniques and methods enhance learning
Health Education 3
• Learning readiness
• Learning environment
Health Education 4
• People with disabilities
• Gerontologic considerations
Health Promotion
• Health Promotion encourages people to achieve as high a level of wellness as possible
Health Promotion 2
• Health Promotion principles include: self-responsibility, nutrition,stress
management
and exercise
Chronic Illness
Larry Santiago, MSN, RN
Chronic Conditions
• Medical conditions or health problems with associated symptoms or disabilities that require long-term management
Chronic Conditions 2
• Occur in every age
group
• Major and minor activity limitations
• Expensive
Phases of Chronic Illness
• 1) Pretrajectory phase – person is at risk for developing a chronic condition because of genetic factors or lifestyle
behaviors that increase
susceptibility to chronic
illness
Phases of Chronic Illness 2
• 2) Trajectory phase – characterized by the onset of symptoms or disability associated with a chronic condition
Phases of Chronic Illness 3
• 3) Stable phase – indicates that symptoms and disability are being managed adequately
Phases of Chronic Illness 4
• 4) Unstable phase – characterized by exacerbation of illness symptoms, development of complications, or reactivation of an illness in remission
Phases of Chronic Illness 5
• 5) Acute phase – characterized by sudden onset of severe or unrelieved symptoms that require hospitalization
Phases of Chronic Illness 6
• Crisis phase – characterized by a critical or life-threatening situation that requires emergency treatment or care
Phases of Chronic Illness 7
• Comeback phase – recovery after an acute period
• Downward phase – marks the worsening of a condition
• Dying phase – characterized by the gradual or rapid decline despite efforts to halt the disorder
Nursing Management
1. Identify trajectory phase• - assess the patient to determine the
specific phase
Nursing Management 2
2. Establish goals – should be a collaborative effort with the patient, family, and nurse working together
Nursing Management 3
• 3) Establish a plan to achieve desired outcomes
• 4) Identify factors that facilitate or hinder attainment of goals
Nursing Management 4
• 5) Implementing Interventions
• 6) Evaluating the
Effectiveness of
Interventions
End-of-Life Care
Larry Santiago, MSN, RN
Death and Dying
• Technology has prolonged life
Death and Dying 2
• Sociocultural Context
End of Life Care
• Palliative Care
End of Life Care 2
• Hospice Care
Advance Directives
• Written documents that allow the individual of sound mind to document preferences regarding end-of-life care
• Most common types:
- Living will
- Durable power of attorney for health care
Health Care of the Older Adult
Larry Santiago, MSN, RN
Health Care of the Older Adult
• Gerontology is the study of the aging process
Health Care of the Older Adult 2
• Demographics of Aging
Health Care of the Older Adult 3
• Health Care Costs of Aging
Health Care of the Older Adult 4
• Ageism is prejudice or discrimination against older adults
Age Related Changes
• Physical
Age Related Changes 2
• Psychosocial
Age Related Changes 3
• Cognitive
Age Related Changes 4
• Environmental
Age Related Changes 5
• Pharmacologic
Living Arrangements
–Own home
–Family home
–Continuing Care Retirement Communities
–Long term care
Geriatric Syndromes
• Impaired Mobility
• Urinary Incontinence
• Immunodeficiency
• Depression
• Delirium
• Dementia
Perspectives in Transcultural Nursing
Larry Santiago, MSN,RN
Culture
• Culture involves learned and transmitted knowledge about values, beliefs, rules of behavior, and lifestyle practices that guide groups in their thinking and actions
Culture 2
• Subcultures and minorities
Transcultural Nursing• Focus on cultural care values, beliefs, and practices of individuals from a particular culture (Giger & Davidhizar, 1999)
Transcultural Nursing 2
• Acculturation - process by which members of a cultural group adapt or learn how to take on the behaviors of another group
Transcultural Nursing 3
• Cultural blindness – inability of a person to recognize his/her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies
Transcultural Nursing 5
• Cultural imposition – tendency to impose one’s cultural beliefs, values, and patterns of behavior on a person/persons from a different culture
Transcultural Nursing 6
• Cultural taboos – those activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group
Culturally Competent Nursing Care
• Cross-Cultural Communication
Culturally Competent Nursing Care
• Culturally Mediated Characteristics
• - Space and Distance
Culturally Competent Nursing Care 2
• Eye Contact
Culturally Competent Nursing Care 3
• Time
Culturally Competent Nursing Care 4
• Touch
Culturally Competent Nursing Care 5
• Communication
Culturally Competent Nursing Care
• Diet
Acid-Base Disturbances
Larry Santiago, MSN, RN
Acid-Base Disturbances
• Identification of the specific acid-base imbalance is important in identifying the underlying cause of the disorder and in determining appropriate treatment
Kidneys
• Regulate the bicarbonate level in the ECF
• In respiratory acidosis and most metabolic acidosis, kidneys excrete hydrogen and conserve bicarbonate to help restore balance
• In respiratory and metabolic alkalosis, kidneys retain hydrogren and
excrete bicarb
Lungs
• Adjusts ventilation in response to the amount of CO2 in the blood
• In metabolic acidosis, respirations increase, causing greater elimination of CO2
• In metabolic alkalosis,
respiratory rate decreases,
causing CO2 to be retained
Metabolic Acidosis
• Clinical disturbance characterized by low pH, and low bicarbonate (HCO3) concentration
» Low pH Low HCO3»
Causes of Metabolic Acidosis
• Results from direct loss of bicarbonate
- Diarrhea
- Diuretics
- Early renal insufficiency
- TPN without bicarbonate
Clinical Manifestations of Metabolic Acidosis
• Headache
• Confusion
• Drowsiness
• Increased respiratory rate and depth
• Nausea and vomiting
• Increased BP
• Cold, clammy skin
Metabolic Alkalosis
• Clinical disturbance characterized by a high pH and a high bicarbonate
» high pH high HCO3
Causes of Metabolic Alkalosis
• Vomiting or gastric suction
• Pyloric stenosis
• Hypokalemia
• Hyperaldosteronism
• Cushing’s syndrome
• Causes decreased Calcium
Clinical Manifestations of Metabolic Alkalosis
• Related to hypocalcemia
- Tingling of the fingers and toes
- Dizziness
- Hypertonic muscles
- Depressed respirations
- Atrial tachycardia
Respiratory Acidosis
• Clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mmHg
• Always due to the inadequate excretion of CO2 with inadequate ventilation, resulting in elevated CO2 levels
low pH high PaCO2
Causes of Respiratory Acidosis
• Pulmonary edema
• Aspiration of a foreign object
• Atelectasis
• Pneumothorax
• Sedative overdose
• Sleep apnea
• Severe pneumonia
Clinical Manifestations of Respiratory Acidosis
• Increased pulse and respiratory rate
• Increased BP
• Mental cloudiness
• Feeling of fullness in the head
• Cerebrovascular vasodilation
Respiratory Alkalosis
• Arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg
high pH low PaCO2
Causes of Respiratory Alkalosis
• Always due to hyperventilation
• Excessive “blowing off” of CO2
- Extreme anxiety
- Hypoxemia
- Gram negative bacteremia
- Inappropriate ventilator settings
Clinical Manifestations of Respiratory Alkalosis
• Lightheadedness
• Inability to concentrate
• Tinnitus
• Loss of consciousness
• Tachycardia
• Ventricular/atrial
dysrhythmias
Normal values
• pH 7.35-7.45
• PaCO2 35-45
• HCO3 22-26