APPRAISAL-HOW PEOPLE INTERPRET THE IMPACT OF STRESSORS EX.

, DAILY EVENTS, EXPERIENCES PERCEPTION-PERSON'S INDIVIDUAL INTERPRETATION OF THEIR SURROUNDINGS AND INFORMATION GAINED THROUGH THE SENSES CRISIS-STRESSOR IS PRESENT -SYMPTOMS PERSIST ONLY WHILE STRESSOR PERSISTS. TYPES OF CRISIS: DEVELOPMENTAL-NEW STAGES IN LIFE THAT CAUSE STRESSORS SITUATIONAL-EXTERNAL SOURCES OF STRESS TRAUMA-STRESSOR NO LONGER PRESENT BUT SYMPTOMS CONTINUE TO PERSIST STRESSORS-DISRUPTIVE FORCES OPERATING WITHIN OR ON ANY SYSTEM LINKS, EXTERNAL, ENVIROMENTAL DEMANDS WITH A PERSON'S PERCEPTION OF THOSE DEMANDS. MILD STRESS-HELPFUL BY STIMULATING THINKING AND KEEPING US ALERT TO OUR ENVIRONMENT. CAN STIMULATE GROWTH AND FACILITATE DEVELOPMENT. GENERAL ADAPTATION SYNDROME-FIGHT OR FLIGHT RESPONSESTRESSORS CAUSE SYMPATHETIC NERVOUS SYSTEM TO SIGNAL TO THE ADRENAL MEDULLAE - HORMONES RELEASED INTO BLOOD STREAM AND CAUSES REACTIONS IN MUTIPLE BODY PARTS. SYMPATHETIC NERVOUS SYSTEM -ACTIVATES DURING FIGHT OR FLIGHT RESPONSE- EVERYTHING SPEEDS UP AND IS STRONGER. (INCREASED BLOOD FLOW, HEART & RESPIRATORY RATE NEUROLOGICAL RESPONSE IN MEDULLA OBLONGATA, RETICULAR FORMATION AND PITUITARY GLAND. PARASYMPATHETIC NERVOUSE SYSTEM - EVERYTHING SLOWS DOWN AND RETURNS TO NORMAL. RELAXED HEART, RESPIRATORY & B!P RATES MEDULLA OBLONGATA-CONTROLS HEART RATE, BLOOD PRESSURE AND RESPIRATORY. PITUITARY GLAND-SMALL GLAND ATTACHED TO THE HYPOTHALMUS. IT PRODUCES HORMONES NECESSARY FOR ADAPTATION TO STRESS. THIS ALSO REGULATES SECRETION OF THYROID, GONADAL, AND PARATHYROID

HORMONES. GENERAL ADAPTATION SYNDROME (GAS)-A THREE STAGE REACTION TO STRESS (CAN BE TRIGGERED BY A PHYSICAL EVENT OR INDIRECTLY BY A PSYCHOLOGICAL EVENT. ALARM STAGE-(SYMPATHETIC STAGE NEURO ENDOCRINE ACTIVITY. RISING HORMONE LEVELS RESULT IN INCREASED BLOOD VOLUME, BLOOD GLUCOSE LEVELS, EPINEPHINE AND NOREPINEPHRINE AMOUNTS, HEART RATE, BLOOD FLOW TO MUSCHLES, OXYGENT INTAKE AND MENTAL ALERTNESS. RESISTANCE STAGE-(PARASYMPATHETIC STAGE NEURO ENDOCRINE ACTIVITY. HORMONE PRODUCTION RETURNS TO NORMAL. NERVOUS SYSTEM REGAINS CONTROL. BODY REPAIRS ANY DAMAGE. EXHAUSTION STAGE-OCCURS WHEN THE BODY IS NO LONGER ABLE TO RESIST THE EFFECTS OF THE STRESSOR AND HAS DEPLETED THE ENERGY NECESSARY TO OBTAIN ADAPTATION. MAY REST TO RECOVER OR DEATH CAN OCCUR.

NURSING ASSESSMENT-IDENTIFY ACTUAL OR POTENTIAL STRESSORS, OBTAIN DATA REGARDING CLIENTS PRIOR EXPERIENCE WITH STRESS. NURSING INTERVENTIONS- (" SHOULD BE CENTERED ON PRIMARY, SECONDARY, AND TERTIARY PREVENTIONS (# COLLABORATIVE CARE- THERAPIST GROUP THERAPY ($ IDENTIFY SUPPORT SYSTEMS LIKE FAMILY INVOLVEMENT & PRIORITI%E.

NEUMAN SYSTEM MODEL- BASED ON CONCEPTS OF STRESS AND REACTION TO STRESS. PRIMARY PREVENTION- PROMOTE WELLNESS BY STRESS PREVENTION AND REDUCTION OF RISK FACTORS. SECONDARY PREVENTION- AFTER SYMPTOMS APPEAR USE RESOURCES TO MEET NEEDSOF CLIENT (THROUGH ASSESSMENTS . TERTIARY PREVENTION- WHEN CLIENT BECOMES STABLE AND RECOVERS SUPPORT REHABILITATION MOVES CLIENT TOWARD WELLNESS AD THE PRIMARY PREVENTION LEVEL (THERAPY, FAMILY SUPPORT ETC.,

LEVELS OF HEALTHCARE: PRIMARY- FOCUSES ON IMPROVED HEALTH OUTCOMES FOR AN ENTIRE POPULATION. INITIAL SCREENINGS, IMMUNI%ATIONS, CHECK-UPS SECONDARY- DIAGNOSIS AND TREATMENT OF ILLNESSES ARE MOST COMMON SERVICES. ACUTE CARE (E!R, HOSPITAL , DIRECT CARE, SURGICAL PROCEDURE WOUND CARE ETC., TERTIARY- DIAGNOSIS AND TREATMENT OF ILLNESSES ARE MOST COMMON SERVICES. ACUTE CARE!ICU(MORE ADVANCED!SERIOUS SECONDARY CARE WOUND CARE ETC., RESORATIVE- HOMECARE, NURSING HOME, REHAB, RECOVERY FROM CVA!STROKE RECOVERY, THERAPY.

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CULTURAL IMPOSITION-IMPOSING PERSONAL VALUES AND LIFESTYLES WHEN DEALING WITH CLIENTS. ETHNOCENTRISM- TENDENCY TO HOLD ONE'S OWN BELIEFS OR WAY OF LIFE AS SUPERIOR INVISIBLE VALUE BELIEF SYSTEM-IS THE MA&OR DRIVING FORCE BEHIND VISIBLE PRACTICES. FOR EX. A MODEST PENTECOSTAL WOMEN DOES NOT WEAR MAKEUP OR CUT HER HAIR. NURSES CANNOT APPRECIATE THE MEANINGS AND BELIEFS ASSOCIATED WITH HER APPEARANCE WITHOUT FURTHER ASSESSMENT.

ACCULTURATION -IS A SECOND CULTURE LEARNING THAT OCCURS WHEN THE CULTURE OF A MINORITY IS GRADUALLY DISPLACED BY THE CULTURE OF THE DOMINANT GROUP.

ASSIMILATION-MEMBERS OF AN ETHNOCULTURAL COMMUNITY ARE ABSORBED INTO ANOTHER COMMUNITY AND LOSE THEIR UNI'UE CHARACTERISTICS SUCH AS LANGUAGE, CUSTOMS, AND ETHNICITY. THIS CAN BE SPONTANEOUS WHICH IS USUALLY THE CASE WITH IMMIGRANTS.

CULTURAL ASSESSMENT-IS A SYSTEMATIC AND COMPREHENSIVE EXAMINATION OF THE CULTURAL CARE VALUES, BELIEFS AND PRACTICES OF INDIVIDUALS, FAMILIES, AND COMMUNITIES. TRANSCULTURAL NURSING-COMMUNICATION SKILLS TO INTERPRET THE PATIENT'S BEHAVIOR WITHIN HIS OR HER OWN CONTEXT OF MEANINGS AND TO BEHAVE IN A CULTURALLY CONGRUENT WAY CULTURAL PAIN - CAUSED IF YOU DISRESPECT SOMEONE'S CULTURAL BELIEF LENINGER'S THEORY - CULTURAL CARE DIVERSITY LENINGER USED SUNRISE MODEL TO EXPLAIN CULTURALLY CONGRUENT NURSING CARE

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FAMILY-SET OF RELATIONSHIPS THAT THE CLIENT IDENTIFIES AS FAMILY OR AS A NETWORK OF INDIVIDUALS WHO INFLUENCE EACH OTHER'S LIVES WHETHER OR NOT THERE ARE BIOLOGICAL OR HAVE LEGAL TIES. NUCLEAR FAMILY-HUSBAND, WIFE (TWO PARENTS AND CHILD OR CHILDREN. EXTENDED FAMILY-RELATIVES (AUNTS, UNCLES, GRANDPARENTS, COUSINS SINGLE PARENT-ONE PARENT NOT PRESENT DUE TO DEATH, DIVORCE, DESERTION OR SINGLE PARENT ADOPTION. BLENDED FAMILY-TWO PARENTS BRING UNRELATED CHILDREN FROM PRIOR OR FOSTER PARENTING RELATIONSHIPS INTO NEW &OINT LIVING SITUATION. ALTERNATIVE PATTERNS OF RELATIONSHIPS-MULTI ADULT HOUSEHOLDS, COMMUNAL GROUPS, COHABITATION, ADULTS LIVING ALONE. EX., GRANDPARENTS RAISING GRANDCHILDREN, HOMOSEXUAL COUPLES, COHABITATING PARTNERS. DURABILITY-INTRA FAMILIAL SYSTEM OF SUPPORT AND STRUCTURE THAT EXTENDS BEYOND THE WALLS OF THE HOUSEHOLD. (FAMILY CAN GO THROUGH A LOT BUT WILL STILL STAY UNITED

RESILIENCY-ABILITY OF FAMILY TO COPE WITH EXPECTED AND UNEXPECTED STRESSORS -----------------------------------------------------------------FAMILY/CLIENT TEACHING GOALS-THE GOAL OF FAMILY NURSING IS TO HELP THE FAMILY AND ITS INDIVIDUAL MEMBERS REACH AND MAINTAIN MAXIMUM HEALTH THROUGHOUT AND BEYOND THE ILLNESS EXPERIENCE.

BARRIERS TO LEARNING: COGNITIVE BARRIER- IMPAIRED INTELLECTUAL BEHAVIORS!THINKING AFFECTIVE BARRIER- MOOD ... BAD!COMBATIVE MOOD COULD BE A BARRIER TO CAUSE SOMEONE NOT TO BE COOPERATIVE PSYCHOMOTOR BARRIER - IF THERE IS AN IMPAIRMENT TO MENTAL AND MUSCULAR ACTIVITY MOTIVATION BARRIER - IF CLIENT IS NOT WILLING TO LEARN ABILITY TO LEARN BARRIER - IF CLIENT HAS IMPAIRED PHYSICAL, COGNITIVE, DEVELOPMENTAL LEVELS IMPAIRED PHYSICAL WELLNESS AND THOUGHT PROCESSES. LEARNING ENVIRONMENT BARRIERS - WOULD INTERFERE WITH A PERSON'S ABILITY TO FOCUS ON OR ATTEND TO THE INSTRUCTOR ***STRESS, ANXIETY, PAIN, DISTRACTIONS, CULTURE, LANGUAGE BARRIERS, FAMILY INFLUENCES, SELF PERCEPTIONS(SELF EFFICACY) ALL IMPACT LEARNING AND CAN BE BARRIERS ---------------------------------------------------------------------

7 MA OR MINERALS (()*(+,-, ./01./020,1, 103+,-, .04)11+,-, (/*02+35, -)6751+,-, 1,*8,2 - THE RDA OF ALL MA&OR MINERALS IS MORE THAN "99MG!DAY !" TRACE MINERALS (10-5: +207, +03+75,:+7(, 15*57+,-,8*0,2+35 - THE RDA OF ALL TRACE MINERALS IS LESS THAN "99MG!DAY COEN#YMES/COFACTORS - REFERS TO THE MA&OR METABOLIC TASKS AND ROLES IN COEN%YME FACTORS OF ALL ; B-COMPLEX VITAMINS AND CHOLINE

()** <)452 10*,=*5 CALCIUM IS POORLY ABSORBED INTO THE BODY. IT NEEDS ACID TO BE ABSORBED AND AN ALKALINE ENVIRONMENT TO BE RETAINED. WE ONLY ABSORB $9->9? OF ALL THE CALCIUM WE TAKE IN. CALCIUM DEFICIENCIES ARE THE RESULT OF SEDENTARY LIFESTYLE, LOW CALCIUM DIET, ALCOHOL AND SMOKING INCREASES CALCIUM LISS TOO MUCH CALCIUM CAUSES CONSTIPATION AND KIDNEY STONES $ATER SOLUBLE VITAMINS - B-COMPLEX VITAMINS, B"#, FOLATE, VITAMIN C-THEY ABSORB DIRECTLY THROUGH THE INTESTINAL WALL. EXCESS IS FILTERED THROUGH THE KIDNEYS AND IS EXCRETED. WATER SOLUBLE VITAMINS ACT AS COEN%YMES FOR PRODUCTION OF ENERGY VITAMIN A MAINTAINS EYE HEALTH, SUPPORTS NORMAL BONE GROWTH, FIGHTS INFECTION DEFICIENCIES IN VITAMIN A CAN CAUSE DRYING OF EYES (XEROPHTHALMIA , DRYING OF MUCOUS MEMBRANES, FLATTENING AND HARDENING OF EPITHELIAL CELLS VITAMIN A TOXICITY CAN CAUSE BIRTH DEFECTS, &OINT PAIN AND HAIR LOSS. ...... VITAMIN A SOURCES: LIVER, FISH OILS, GREEN LEAFY VEGETABLES OSTEOMALASIA IS POOR CALCIUM ABSORBTION RIC%ETTS IS CAUSED BY LACK OF VITAMIN D AND POOR CALCIUM & PHOSPHOROUS METABOLISM... IT CAUSES SOFT LONG BONES THAT BEND(BOWLEGS AND PREVENTS CHILDREN FROM ATTAINING THEIR PEAK BONE MASS...RESULTING IN OSTEPOROSIS AND OSTEOMALASIA CALCITROL-ACTIVATED HORMONE FORM OF VITAMIN D VITAMIN E - ANTIOXIDANT. ITS STORED IN FAT TISSUE. THERE ARE ; DIFFERENT FORMS OF VITAMIN E (TOCOPHEROLS . VITAMIN PROTECTS RBC1, WORKS WITH SELENIUM TO DESTROY PEROXIDES, PROTECTS LUNGS FROM POLLUTANATS, DECREASES HEART DISEASE, BOOSTS IMMUNE FUNCTION, FIGHTS AL%HEIMERS.........VITAMIN E DEFICIENCY CAN CAUSE RBC1 TO BURST OPEN ( ERYTHROCYTEHEMOLYSIS , INTERFERES WITH BLOOD CLOTTING,THE ACTION OF VITAMIN K AND CAN LEAD TO HEMMORHAGE....

VITAMIN E SOURCES: FISH, EGGS AND FORTIFIED CEREAL F&'' --IRON $-@G STORED IN BODY. #!$ AS HEME IN HEMOGLOBIN AND "!$ AS FERRITIN. HELPS RBC1 CARRY OXYGEN TO TISSUES NEEDED FOR NEW CELLS. "9-"@? OF DIETARY IS ABSORBED. TOO MUCH IRON IS NOT GOOD FOR THE HEART. TOXICITY CAN RESULT IN POLYCYSTIC DISEASE, IRON POISONING SYMPTOMS: SHOCK, CONVULSIONS,COMA..... DEFICIENCIES CAN CAUSE ANEMIA , WEAKNESS, FATIGUE, HEADACHES. CAUSE PICA(COMPULSION TO EAT ICE , CLAY, DIRT ETC IRON SOURCES: LIVER, LEAN MEAT, BEANS, FORTIFIED CEREAL IODINE - MINIMUM NEEDED IS @9-A@MCG. RDA IS "@9MCG!DAY - HELPS TO CONTROL BASAL METABOLIC RATE. LACK OF IODINE CAN LEAD TO GOITERS, CRETENISM, MENTAL AND PHYSICAL DEVELOPMENT IMPAIRMENT, HYPO & HYPER THYROIDISM. TOXICITY CAN RESULT IN OCCULAR DAMAGE. IODINE FOOD SOURCES: SEAFOOD, TABLESALT MAGNESIUM IS A MACROELEMENT. CRITICAL TO THE OPERATION OF HUNDREDS OF EN%YMES. HOLDS CALCIUM IN TOOTH ENAMEL. DEFICIENCIES OCCUR FROM EXCESSIVE VOMITTING, ALCOHOL ABUSE, PROTEIN MALNUTRITION. DEFICIENCY CAN CAUSE HALLUCINATIONS (W! WITHDRAWAL OF ALCOHOL ABUSE AND PROLONGED MUSCLE CONTRACTIONS. MAGNESIUM SOURCES: GREEN LEAFY VEGETABLES, NUTS, LEGUMES, SEAFOOD, WHOLE GRAINS SODIUM - PRINCIPLE ELECTROLYTE IN ECF. MAINTAINS ACID BASE BALANCE, NERVE IMPULSE TRANSMISSION, INTESTINAL SECRETIONS. $@->@? OF SKELETON. SUGGESTED INTAKE IS #>99MG OR "999MG!"999KCALORIES. EXCESSIVE VOMITTING CAN CAUSE INCREASED SODIUM LOSS. SODIUM SOURCES: FOUND IN TABLE SALT, PROCESSED, INSTANT, CANNED, DRIED AND FRO%EN FOODS. ALSO FOUND IN MEATS, FISH, POULTY, EGGS, MILK AND CHEESE PRODUCTS. POTASSIUM - PRINCIPLE CATION IN INTRACELLULAR FUNCTION, MAINTAINS CELL INTEGRITY, KEEPS HEARTBEAT STEADY, ASSISTS IN CHOLESTEROL AND PROTEIN METABOLISM. DEATH CAN OCCUR FROM SEVERE DIARRHEA AND DIURESIS FROM POTASSIUM DEPLETION. HIGH POTASSIUM FOODS DECREASE RISK OF STROKE AND LOWER BLOOD PRESSURE. POTASSIUM SOURCES: BANANA, SPINACH, DRIED FRUITS, WHOLE GRAINS,

MILK, YOGURT HYPO%ALEMIA IS TOO LO$ POTASSIUM ( DEATH HYPER%ALEMIA - TOO HIGH POTASSIUM ( DEATH CONSUMERS OF HEALTHCARE: GOVERNMENT)S BIGGEST CONSUMER OF HEALTHCARE IS ELDERLY (MEDICARE INSURANCE)* LO$ INCOME FAMILIES AND INDIVIDUALS USE MEDICAID* LONG TERM CARE INSURANCE- PEOPLE ARE LIVING LONGER, COSTLY HEALTH INSURANCE* PRIVATE INSURANCE- VERY COSTLY USUALLY OBTAINED BY MEMBER)S EMPLOYER*

POTTER CH + , -:
NURSING AS A SCIENCE- IT IS RESEARCH, THEORIES, PARDIGM, CONCEPTS, AND ANATOMY & PHYSIOLOGY. NURSING AS AN ART- IS THE PHYSICAL DOING, THE EXPERIENCE & INTERACTION WITH CLIENT. INSERTING CATHETAR IS AN EXAMPLE OF NURSING AS AN ART.

GOAL OF DOROTHEA OREM)S THEORIES: OREMBS SELF CARE DEFICIT THEORY FOCUSES ON THE PATIENTBS SELF CARE NEEDS. OREM DEFINES SELF-CARE AS A LEARNED, GOAL ORIENTED ACTIVITY DIRECTED TOWARD THE SELF IN THE INTEREST OF MAINTAING LIFE, HEALTH, DEVELOPMENT AND WELL-BEING. THE GOAL OF OREMBS THEORY IS TO HELP THE PATIENT PERFORM SELF-CARE AND MANAGE HIS OR HEALTH PROBLEMS. SELFCARE AGENT- ABILITY TO TAKE CARE OF YOURSELF. DEPENDENT CARE AGENT- PERSON OTHER THAN THE INDIVIDUAL WHO PROVIDES CARE. $HOOLY COMPENSATORY- PATIENTS SELF-CARE AGENCY IS SO LIMITED THAT HE!SHE DEPENDS ON THE NURSE TO PERFORM THE NECESSARY CARE MEASURES.

PARTLY COMPENSATORY- THE PATIENT CAN MEET SOME SELF CARE RE'UISTES BUT ACCEPTS CARE AND ASSISTANCE FROM NURSE. SUPPORTIVE/EDUCATIVE- A PATIENT MEETS SELF CARE RE'UISITES BUT MAY NEED HELP IN DECISION MAKING, BEHAVIOR MODIFICATION OR KNOWLEDGE AC'UISTION (PATIENT TEACHING AND DECISION MAKING . NURSING PARADIGMS- NURSING !PERSON!HEALTH!ENVIROMENT. THIS CONTINUOLSY INTERACTS WITH ONE ANOTHER, CHANGES AND EVOLVES. EVIDENCE BASED NURSING PRACTICE- THE PRACTICE OF NURSING IN WHICH THE NURSE MAKES CLINICAL DECISIONS ON THE BASIS OF THE BEST AVAILABLE CURRENT RESEARCH EVIDENCE, HIS OR HER OWN CLINICAL EXPERTISE, AND THE NEEDS AND PREFERENCES OF THE PATIENT. PHARMACOLOGY CH -: LEGAL AND ETHICAL PRINCIPLES: AUTONOMY-SELF DETERMINATION AND THE ABILITY TO ACT ON ONEBS OWNC RELATED NURSING ACTIONS INCLUDE PROMOTING A PATIENTBS DECISION MAKING, SUPPORTING INFORMED CONSENT, AND ASSITING IN DECISIONS OR MAKING A DECISION WHEN A PATIENT IS POSING HARM TO HIMSELF OR HERSELF. CONFIDENTIALITY- THE DUTY TO RESPECT PRIVILGED INFORMATION ABOUT A PATIENTC RELATED NURSING ACTIONS INCLUDE NOT TALKING ABOUT A PATIENT IN PUBLIC OR OUTSIDE THE CONTEXT OF THE HEALTH CARE SETTINGS. TOLERANCE- BODY BECOMES ACCUSTOMED TO A DRUG OVER TIME AND LARGER DOSES ARE NEEDED TO ELICITY SAME EFFECT. CROSS TOLERANCE- BODY DEVELOPS TOLERANCE TO DRUGS WITHIN THE SAME CLASSIFICATION OR PHARMACOLOGICAL CLASS, EX., SMOKER DEVELOPS TOLERANCE OF NICOTINE, DRINKING COFFEE YOU WILL ALSO DEVELOP TOLERANCE OF CAFFEINE.