N-210 Exam Blue Print 1 Columbia college

Art and science of how we relate to others. Complex, dynamic, nursing process, decision making, problem solving, meet client needs, analyze client responses.

the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations

Assessment, diagnosis, outcomes, identificaitoan, planning, implementation, and evaluation

the registered nurse collects comprehensice data pertinent to the patients health or the situation

the registered nurse analyzed the assessment data to determine the the diagnosis or issues

the registered nurse identifies expected outcomes for a plan individualized to the patien or the situation.

the registered nurse develops a plan that prescribes strategies and alternatives to attain expeted outcomes

the registered nurse implements the identified plan

the registered nurse evaluates progress towartd attainment of outcomes.

health is multidimensional , and may mean different things to different people. There is a relationship between health, wellness, and illness.

Government started setting goals for the health of the people back in 1979, and has continued to set goals about the health and wellness of our country

state of complete physical, mental and social well-being, not merely the absence of disease or infirmity (WHO, 1947)(changed the focus of healthcare to health promotion)

objectives for preventive services, health protection, and health promotion that addressed improvements in health status, risk reduction, prublic and professional awareness of prevention, health services, and protective measures, and surveillance and evaluation

goals to increase quality and years of healthy life and to eliminate health disparities. Promoting healthy and safe communities, improving systems for person al and publice health, and preventin and reducing diseases and disorders

a theoretical way of understanding a concept or idea, and repressent different ways of approaching complex issues

differences int he incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups

actualization of inherent and acquired human potential through goal directed behavior, competent self care and satisfying relationships with others while adjustments are made as needed to maintain strucutral integrity and harmony with the environement

Health belief model, health promotion model, basic human needs model, and holistic medicine model

a person's ideas, convictions, and attitudes about health and illness.

addresses the relationship between a person's beliefs and behaviors. a way of understanding and predicting how clients will behave in relation to their helath and how they will comply with therapies. Involves indv. perception of susceptibility, perception of seriousness, and perception of the benefits and barriers to taking action.

designed to be a complimentary couterpart to models of health promotion. defines health as a positve, dynamic state, not merely the absence of disease. Health promotion directed at increasing a clients level of well-being. Focus on indv. characteristics and experiences, behavior specific knowledge and affect and behavioral outcomes. Should result in improved health, enhanced functional ability, and better quality of life at all stages of development

basic human needs are elements aht atre necessary for human survival and health. based on Maslows heirarchy of needs, some needs are more basic for survival (air, water, food, sheltter, sleep, sex) and should be done first. 1 physiological, 2 safety and security, 3 love and belonging, 4 self esteem, 5 self actualization.

attempts to create conditions that promote optimal health. use nursing process consider clients the ultimate experts regarding their own health and respect clients subjective experience as relevant in maintaining health or assisting in healting. Looks at person as a whole, includes alternative therapies, considers person body, mind and spirit

variables influence how a person thinks and acts, and health beliefs can negatively or positively influecne health behaviro or health practices

Developmental stage, intellectual background, perception of functioning, emotional factors, spiritual factors

persons thought and behavior change throughout life. Must consider grown and development when using health beliefs and practices as a basis for planning care. Adapt planning to patient abilities

level of education and learning will impact what patient is able to understand and care must be adapted for patient level

a person's perception of their physical functioning affects health beliefs and practices

the clients degree of stress, depression, or fear can influence health beliefs and practives. How pt hands stress will influence reactionto illness

spirituality includes the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life

Family practices, socioeconomic factors, and cultural background

the way that clients families use health care services generlaly affects their health practices. (wellness exams, immunizations, etc)

may increase the risk for illness and influecne the way that a person defines and reacts to illness. Pyschosocial variables include stability of marital or intimate relationship, lifestyle habits, and occupational environments. Economic variables may impact either access or resources to seek care.

influences beliefs, values, and customs. influences approach to the healthcare system, personal health practices, and the nurse client relationship. Impact beliefs on cause of illness, and remedies

help clients maintain or enhance their present levels of health. (include immunization, exercise, nutrition,

education to teach people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self responsiblity. How to contol their lives and achieve new understanding

physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care.

the science and art of helping people change their lifestyle to move toward a state of optimal health.

Primary-true prevention that lowers the chances that a disease will develop; Secondary-focuses on those who have a disease or are risk to develop a disease; Tertiary-Occurs when a defect or disabiltiy is permanent or irreversibile

focuses on prevention, health education, good nutrition, personality development, housing, counseling, screenings, and selective examinations

used to prevent the worsening of illness or disease. early diagnosis and prompt treatment screenings, and treating early stages to limit disability and advancement

after defect or disability it permanent aimed at achieving the highest level of function with the ailment

any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident

Genetic and physiological factors-a physical functioning of the body or a genetic predisposition. Age- can increase or decrease susceptibility to certain illnesses. Environment- where we live and the conditions of the area which determine what we eat, how we live, and disease agents to which we are exposed. Lifestyle- activities, habits, and practices

identify risk factors in health promotion, wellness education, and illness prevention. implement risk modification, health promotion, or illness prevention activities

Precontemplation, contemplation, preparation, action, maintenance stage

not intending to make changes within the next 6 months ( not interested in information about change and could be defensive)

considering a change within the next 6 months (ambivalence present, more likely to accept information as develop belief for change)

making small changes in preparation for a change in the next month (believes advantages outweigh disadvantages of change, and may need assistance in planning)

Actively engaged in strategies to change behavior. This stage may last up to 6 months (be aware of previous habits, identify barriers and facilitators of change)

sustained change over time. Begins 6 months after action and continues indefinitely (changes are integrated into lifestyle)

a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

involves how people monitor their bodies, define and interpret their symptoms. Has both internal and external variables. Internal- perception of illness and nature of illness. External-visibility of symptoms, social group, cultural background, economics, and accessibility to health care.

illness impacts entire family. Behavioral and emotional changes, impact on body image, impact on self-concept, impact on family roles, impact on family dynamics

Is the essence and focus of nursing. Nurses are most trusted profession and is so by nurses caring. Need to show that we value and care for the client, putting the technology and skills to use in a way that is caring for the client

Caring-a universal phenomenon that influences the way we think, feel and behave.

Transpersonal Caring and Swanson's theory of caring

Madeline Leininger describes the concept of care as the essence and central, unifying and dominant domain that distinguishes nursing from other health disciplines. Caring is essential to human need, helps an individual or group improve human condition, helps protect, develop, nurture, and sustain people.

a holistic model for nursing that suggests that a conscious intention to care promotes healing and wholeness. Rejects the disease orientation to health care. Places care before a cure, and emphasizes the nurse-client relationship(model is transformative as it influences both nurse and client)

Kristen swanson- studied clients and nurses and stories were analyzed. Composite of 3 studies in perinatal unit. Defines caring as a nurturing way of relating to a valued other, toward whom one feels a personal sense of commitment and responsibility

Forming a human-altruistic value system, instilling faith-hope, cultivating a sensitivity to one's self and to others, promoting and expressing positive and negative feelings, using a creative problem solving caring process, promoting trans-personal teaching-learning, providing for supportive, protective, and/or corrective mental, physical, societal, and spiritual environment, meeting human needs, allowing for existential-phenomenological spiritual forces.

knowing- striving to understand an event as it has meaning in the life of the other. Being with- being emotionally present to the other. Doing for- doing for others as he or she would do for the self if possible. Enabling- Facilitating the others' passage through life transitions, and unfamiliar events. Maintaining belief- Sustaining faith in the others capacity to get through an event or transition and face a future with meaning.

Clients value: reassuring presence, recognizing an individual as unique, keeping a close and attentive eye on situation

Concerned with relationships between people and with a nurse character and attitude toward others. Places the nurse as the clients advocate, solving ethical dilemmas by attending to relationships and giving priority to each unique client.

Behaviors include being present, providing caring touch, and listening. Caring a product of culture, values, experiences, and relationships with others.

person-to-person encounter conveying a closeness and sense of caring. When presences is established through eye contact, body language, voice tone, listening, and having a positive and encouraging attitude an openness and understanding can be created.

comforting approach where the nurse reaches out to clients to communicate concern and support. Involves contact and non-contact. Contact is skin to skin, and non contact is eye contact. Can be protective or task oriented. Be aware of cultural sensitivities regarding touch

Conveys full attention and interest. Creates trust, open lines of communication, creates mutual relationship,allow time to take in, and interpret and understand

develops over time, core process of clinical decision making, aspects include: responses to therapy, routines, and habits, coping resources, and physical capacities and endurance. Builds a bond so that patients will trust enough to ask for what they need

Spiritual health is achieved when a person can find a balance between their life values, goals, and belief systems adn those of others. offers a sense of interpersonal (connected & know ourselves) and transpersonal (connection to higher power/God) connectedness

People experience life through relationship with others, caring does not occur in isolation from clients family, and family is an integral resource.

nursing has become task oriented, more technology, and high ratios nurse-to client, have to try to keep caring while dealing with these factors.

thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Consists of socially transmitted knowledge, behavioral patters, values, beliefs, norms, and lifestyles of a particular group that guides their world view and decision making

fits person's valued life patterns and set of meanings, requires specific knowledge, skills and attitudes in the delivery of culturally congruent care.

refers to shared identity related to social and cultural heritage such as values, language, geographical area, and racial characteristics.

Culture is learned, taught, adaptive, satisfying, difficult to articulate and exists at different levels.

Ethnocentrism, stereotyping, prejudice, discrimination, racism

a tendency to hold one's own way of life as superior to others. causes biases and prejudices that associate negative permanent characteristics

use own set of values and lifestyles as the absolute guide in dealing with clients and interpreting their behaviors

identify personal biases, attitudes, prejudices, and stereotypes, include cultural assessments, recognize the right to make own health care choices, convey respect, and cooperate with traditions

may be male or female head of household, value placed on children, gender roles, and family values, extended family, naming system are all impacted by culture

communication and culture are closely connected, verbal communication (what questions are asked, who interprets, etc), non verbal communication- what it means to patient and what is means to cultural group

most cultures have staple food, culture affects how food is prepared and what food prepared, food may be considered a remedy, and come religious practices may affect diet

note that cultures have different ways of dealing with things regarding rights of passage, pregnancy, childbirth, newborn, postpartum periods, and grief and loss

a systematic and comprehensive examination of the cultural care values, beliefs, and practices of the individual, families, and communication. Gathering information will help nurse provide culturally congruent care

ethnic heritage and ethnohistory, bio-cultural history, social organization, religious and spiritual beliefs, communication patters, time orientation, caring beliefs and practices, experiences with professional healthcare

become aware of own cultural heritage, clients culture as described by client, adaptation, the client made to lie in north American culture, for nursing plan that incorporates client culture

socialization into one's primary culture as a child

process of adapting to and adopting a new culture

results when an individual gradually adopts and incorporates the characteristics of the dominant culture

when an individual identifies equally with two or more cultures

cultural care preservation or maintenance, cultural care accommodation or negotiation, cultural care re-patterning or restructuring

the intra-familial system of support and structure that may extend beyond the walls of the household. (structure)

the ability of the family to cope with expected and unexpected stressors

attention to uniqueness

families are smaller, women are delaying childbirth, couples choosing to have no children, divorce rates tripled from 1950's, remarriage results in blended families, single parent families prevalent, homosexual couples are family units, america is aging

Changing economic status, homeless has increased, family violence, and acute or chronic illness, all of these trends take a toll on the family

a holistic model that guides the assessment and care for families. Has its own developmental stages

unattached young adult, joining of families through marriage: newly married couple, family with young children, family with adolescents, launching children and moving on, family in later life

structures is baled on organization-relationships are numerous and complex, function involves processes used by family to achieve goals. Process include goal setting, care giving conflict resolution, nurturing, and use of resources

crisis-proof or effective families are able to combine the need for stability with the need for growth and change. has a flexible structure that allows adaptation. Effective family has control over environment, influences the immediate environment of home, neighborhood, and school.

family as context, family as client, and family as system

primary focus is on the health and development of an individual member existing within a specific environment

family processes and relationships are the primary focus of nursing care. concentrate on patterns and processes that are consistent with reaching and maintaining both family and individual health

the use of both family as context and client used simultaneously.

the environment was the focus of nursing care

Nurse client relationship

help client perform 14 basic needs

the "unitary" human

Client's self-care needs

transcultural

the gal is to help the client adapt

philosophy of transpersonal caring

Person concern as an inherent feature of nursing practice

perspective of a profession

links science, philosophy, and theories accepted and applied by the discipline

includes four linkages- the person, health, environment, and nursing

the recipient of care

all possible conditions affecting the client and the setting of health care delivery

the diagnosis and treatment of human responses to actual or potential health problems

view client situations, organize data, analyze and interpret information

concepts, definitions, and assumptions or propositions

aspect of reality that people consciously sense or experience

ideas and mental images

activity necessary to measure the concepts, relationships, or variables

taken for granted statements

structural framework for broad, abstract ideas about nursing

address specific phenomena and reflect practice

describe, speculate, and describe consequences of phenomena

action oriented and test the validity and predictability of nursing interventions.

temperature 36-38 C or 96.8-100.4 F
Pulse 60-100/min, regular, strong
respirations 12-20/min, regular, even and unlabored
BP- <120-80
Pain- 0/10 or acceptable level
pulse ox->90%

affected by basal metabolic rate, muscular activity, thyroxine from thyroid gland, epinephrine/norepinephrine/sympathetic nervous system, fever (pyrexia)

Radiation-transfer without contact
Conduction-transfer with contact
Convection-dispersion by air currents
Vaporization-evaporation of moisture (happens with insensible heat loss)

hypothalamus in brain-negative feedback
sensors and effectors-muscles, blood vessels, adrenal glands, and skin
conscious changes (action), turn on air, put on coat

age-bvery young are labile(changeable), very old increased risk for hypothermia and hyperthermia. Daily rhythm-lowest in morning 4-6 am, highest in evening 8-12pm. Exercise-increase body temp increases BMR, Hormones-progesterone secretions increase temp, Stress-increase the BMR by sympathetic stimulation. Environment-war or cold air temperature

Pyrexia-increased temp. AKA-hyperthermia, fever, (we say febrile and afebrile when temp is not elevated)

intermittent-regular intervals, remittant-stays high, but fluctuates more than 3.5 degrees in 24 hours. Relapsing-days of fever alternating with days of normal. Constant-stays high

increased heart rate, increased RR and depth, shivering, pallid, cold skin, feeling of cold, cyanosis, gooseflesh appearance, no sweating

chills stop, skin feels warm, photosensitivity, glassy eyes, increased pulse and respiratory rates, increased thirst, mild/severe dehydration, drowsiness, restlessness, delirium, or convulsions, oral herpes outbreak, loss of appetite, malaise, weakness, muscle aches

a quick or sudden removal of cause for fever, gradual return of normal called lysis, skin flushed and feels warm, sweating returns, decrease or absence of shivering, dehydration possible

exposure to cold and unable to adapt, heat loss, impairment of hypothalamus, signs-decreased TPR and BP, severe shivering, feeling cold and chilled, skin pale, cool, waxy, decreased urine output, disorientation, drowsiness, death

C=5/9(f-32)

F=9/5C+32

wave of blodd through arteries (adult has 5 liters of blood in body), comes from left ventricular contraction, affected by age, gender, exercise, fever, stress, bleeding, medications

medulla and pons in the brain control, voluntary, chemoreceptors detect changes in oxygen, carbon dioxide, and hydrogen ions

pressure exerted by blood as it moves through the arteries. Systolic-pressure during ventricular contraction. Diastolic-pressure during ventricular relaxation, pule pressure-different between systolic and disatolic

increase bp, consistenty more than 140-90 either systolic or diastolic-caus unknow, usually asymptomatic

decreased BP, consistently less than 110

first described in 1905-
Cavitation-gases accumulate in flattened artery. Arterial Wall-sudden stretching produces noise. Turbulence-blood movement noise