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    of 7
    acto} ‘Compensation Conversion Denial Displacement Dissociation Fiation Identification Intellectualization Introjection Projection Rationalization Reaction formation Regression Repression Resistance Sublimation Qverachleverment in one area to offset real or perceived deficiencies in another area ‘© Napoleon complex: diminutive man becoming emperor. ‘= Nurse with low self-esteem working double shifts so her supervisor will like her Expression of an emotional conflict through the development of a physical symptom, usual ‘sensorimotor in nature ‘© Teenager forbidden to see X-ratad movies is tempted to do so by friends and develops blindness, and the teenager is unconcerned about the loss of sight. Failure to acknowledge an unbearable condition; failure to admit the realty ofa situation or how ‘one enables the problem to continue ** Diabetic person eating chocolate candy * Spending money freely when broke + Waiting 3 days to seek help for severe abdominal pain \Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings ** Person who is mad at the boss yells at his or her spouse. ‘= Child who is harassed by a bully at schoo! mistreats a younger sibling Dealing with emotional conflict by a temporary alteration in consciousness or identity ‘= Amnesia that prevents recall of yesterday's auto accident ‘© Adult remembers nothing of childhood sexual abuse. Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage * Never learning to delay gratification + Lack of a clear sense of identity as an adult Modeling actions and opinions of influential athers while searching for identity, or aspiring to reach a personal, socal, or occupational goal ‘= Nursing student becoming a critical care nurse because this is the specialty of an instructor, sshe admires Separation of the emotions of a painful event or situation from the facts involved; acknowledg- ing the facts but not the emotions ** Person shows no emotional expression when discussing serious car accident. Accepting another person's attitudes, beliefs, and values as one's own + Person who dislikes guns becomes an avid hunter, just ike a bestfriend. Unconscious blaming of unacceptable inciinations or thoughts on an external object ‘© Man who has thought about same-gender sexual relationship, but never had one, beats 2 rman who is aay. + Person with many prejudices loudly identifies others as bigots. Excusing own behavior to avoid guilt, responsibilty, conflict, anxiety, or loss of self-respect + Student blames failure on teacher being mean ‘= Man says he beats his wife because she doesn’t isten to him. ‘Acting the opposite of what one thinks or feels ‘> Woman who never wanted to have children becomes a supermom. ‘= Person who despises the boss tells everyone what a great boss she is. Moving back to a previous developmental stage to feel safe or have needs met ‘= Five-year-ald asks for a bottle when new baby brother is being fed ‘© Man pouts lke a 4-year-old if he is not the center of his girfriend’s attention Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness ‘© Woman has no memory of the mugging she suffered yesterday. ‘© Woman has no memory before age 7, when she was removed from abusive parents. Overt or covert antagonism toward remembering or processing anxiety-producing information ** Nurse is too busy with tasks to spend time talking to a dying patient. ** Person attends court-ordered treatment for alcoholism but refuses to participate. Substituting a socially acceptable activity for an impue that is unacceptable ‘* Person who has quit smoking sucks on hard candy when the urge to smoke arises. ‘= Person goes for a 15-minute walk when tempted to eat junk food EGO DEFENSE MECHANISMS Continued Substitution Replacing the desired gratification with one that is more readily available ‘* Woman who would like to have her own children opens a day care center. Suppression Conscious exclusion of unacceptable thoughts and feelings from conscious awareness ‘Student decides not to think about a parent's illness to study for a test ‘* Woman tells a friend she cannot think about her son's death right now. Undoing Exhibiting acceptable behavior to make up for or negate unacceptable behavior * Person who cheats on a spouse brings the spouse a bouguet of roses ‘+ Man who is ruthless in business donates large amounts of money to charity Preconventional Level Birth to 7 years Promeral stage Birth to 2 years Cannek differentiate right from wrong Purishment and obedience orien- 2 to 3 years Demonstrates conforming behavior besed on fear of tatlon stage punishment Instrumental realistic orientation 4107 yeas Displays conforming behavior based on rewards stage Conventional Level Tito 12 years Interpersonal concordance orien- 7 to 10 years Evaluates behavior on tert and others’ reactions tation stage ‘Authority and social ordar mein- 10 to 12 years (bays out of respect for laws, authority taining orientation stage Posteonventional Level 42 years and older ‘Social contractor legalistic orien- 12 years through Believes lave should futher human values and express tation stage adolescence maority views Universal ethical principles orien- Adolescence through Defines right and wrong based on universal, comprehen- tation stage ‘adulthood sive, and consistent, yet persoral, ethical principles Presumptive Probable Positive ‘Sisx felt and observed by the | Signs observed by | Undeniable signs confirmed the members of the | _ by the use of instrument the di heaith care team First Breast changes Gooders sign Ultrasound Evidence trimester | Urinary changes Chadwick's sign Fatigue Hegar's sign Amenorthea Elevated BBT Morning sickness Positive HCG Enlarge uterus Second Chioasma Ballotement Trimester | Linea Nigra Enlarge Abdomen etal Heart Tone Increase Skin Pigmentation | Braxton Hicks etal movement Striae gravidarum Contraction etal outline Quickening etal parts palpable TABLE 20-3 Erikson’ Eight Stages of Development InpIcaToRS oF INDICATORS OF STAGE AGE CENTRAL TASK POSITIVE RESOLUTION NEGATIVE RESOLUTION Infancy Birth to 18 months Trust versusmistust Learning to trust others Mistrust, withdrawal, estrangement Eatly childhood 18 months to 3 yeers Autonomy versus shame Self-contal without loss of self- Compulsive selfsestraint or ‘and doubt fecteom compliance Abiity to cooperate andto. —_‘Wilfuiness and defiance exxtess onesell Late childhood 3 to 5 years, Initiative versus guilt Learning the degiee to which Lack of self-confidence assartiveness and purpose —_-Possimism, foar of influence the envronment wrongdoing Beginning ability to evaluate Overcontal and cene's own behavior overrestrition of own activity Schoolage 8 to 12 years Industry versus inferiority Beginning to create, develo, Loss of hope, sense of and manipulate being mediocre Adolescence 12 to 20 yeara ‘Young adulthood 18 to 25 years Adulthood 251065 years Maturity 65 years to death Identity versus role ‘confusion Intimacy versus isolation Generativity versus stagnation Integrity versus despair Developing sense of ‘competence and perseverance Coherent sonse of self Plans to actualize one’s abilities Intimate relationship with another person Commitment to work and relationships Creativity, productivity, concer for others ‘Acceptance of worth and Uniqueness of one's own life ‘Acceptance of death Withdrawal from schoot end peers Feelings of confusion, indacisiveness, and possible antisocial behavior Impersonal relationships Avoidance of relationship, career, orlifestyie commitments Selfndulgence, sel concer, lack of interests and commitments Sense of lass, contemet for others Tante 6-6 Stages of Piaget's Theory of Cognitive Development Sensorimotor Birth to 2 years Reflexive Birth to 1 month Demonstrates predictable, innate survival reflexes Primary circular reactions 1 to 4 months Responds purposefully to stimuli; initiates, respects satisfying behaviors ‘Secondary circular 40 8 months Leams from intentional behavior, motor skilishsion reactions coordinated; recognizes familiar objects Coordination of secondary 8 to 12 months Develops object permanence: anticipates others’ actions; schemes differentiates familian/unfaritiar Tertiary citcular reactions 12 to 18 months Interested in novelty, repetition; understands causality; solicits help from others Mental combinations 18 to 24 months Leams simple problem solving; imitates Preoperational 2 to 7 yoars Preconceptual 2 to 4 years Demonstrates egocentric thought and mental imagery; language increases Intuitive 4107 years Develops sophisticated language: egocentric thought decreases: play is reality-based Concrete operations 7 to 11 years Understands relationships, classiication, conservation, seriation, reversibility; logical reasoning limited; less egocentric thought Is capable of systematic, abstract thought Formal operations 11 years and older TABLE 20-2 Freud's Five Stages of Development STAGE AGE (CHARACTERISTICS IMPLICATIONS. Oral Birth to 11/2 years Mouthis the centar of pleasure (major source Feeding producas pleasure and sense of of giatfication and exploration). Security is __comfort and safety. Feeding should be primary need. Major conflict: weaning pleasurable and provided when required Anal 11/2 to3years_ Anus and bladder are the sources of pleasure Controlling and expelling feces provide ‘sonsua satisfaction, salfcontrll. Major pleasure and sense of contra. Toilet training conflict: toilet traning should be a pleasurable experiance, Phatic 4 to6 years The child's genitals ae the center of pleasure. The child identifies with the parent of the Mesturbation offers pleasure. Other activities can opposite sex and later takes on a love include fantasy, exoorimentation with poors, and relationship outside the family. Encourago ‘questioning of aduits ebout sexual topics. Major identity, conflict: the Oedinus or Electra comple, which resolves when the child idenuiies with parent of ‘same sex. (The Oedipus complex refers to the ‘male child's attraction for his mother and hostle attitudes toward his father The Electra complex refers to the female's attraction for her father and hostile attitudes toward her mother) Latency 6 years wpuberty Energy directed to physical and intalactual Encourage child with physical and intellectual activities. Sexual impulses tend to be pursuits. Encourage sports and other activities repressed. Develop wlationshivs between with same-sex peers. pears of the same sex Genital Puberty and after Energy s directed toward full sexual maturity Encoutage separation from patents, and function and development of skills needed to cope with the environment. achigvament of indapandanca, and decision meking, y=) ee atime Eel Saas NAMES AND ABBREVIATIONS MEASUREMENTS ‘logram (i, Ka) 10009 1gram(g, gn, 6, Gm) 1g 1 miligram |ma) 001 g 4 mierogram (reg) 000001 g 1 nanogram (ng) ‘coon000001 g ‘loiter (kl, KL) 1000 L ( iter (L 1L0) 1 militar (ml) 00 Lt) ‘kilometer kr) 1000 m ‘meter rn, M) 1m 1 centimeter (cn) 1 milimeter (mn) NOTE: 1 mL (milliter) = 1 ce (cubic centimeten. Values are the ‘same in drug and fluid therapy. 1 mg (milligram) = 1000 mog (micrograms) 2001 m HOUSEHOLD EQUIVALENTS IN FLUID VOLUME ‘8 OUNCES (oz) 8 ounces (02) 1. MEASURING CUP 1 madium-sze glass (tumbler size) 1 coffee cup (c} 1 ounce (oz) 1 tablespomn (7) | teaspoon {t) 1 drop (ath “Varies with viscosity of iqud end dropper opening. Temperature Scales Sometimes a nurse needs to convert a body temperature reading in Celsius (centigrade) to Fahrenheit, or vice versa Although the conversion can be accomplished using several different formulas, the most common is described here. To convert from Fahrenheit to Celsius, deduct 32 from the Fahrenheit reading and then multiply by the fraction 5I9; that is: C= (Fahrenheit temperature ~ 32) x 5/9 6 ounces oz) varies with cup size) 2 tablespoons (T) ‘3 teaspoons (t) {60 drops (att}* irre Pes ‘NEEDLE LENGTHS INCHES) HE 3H Lupe Lig FIGURE 140-10 Parts of a nocd Sree Pera) eras INTRACELLULAR FLUID. ‘Major Cations assur Magri ‘Sedum For example, when the Fahrenheit reading is 100: C= (100-32) x 5/9 = (68) x 5/9 = 37.8 ‘Tocomvert from Celsius to Fahrenheit, multiply the Celsius read- ing by the fraction 9/5 and then add 32; that is: F = (Celsius temperature x 9/5) + 32 For example, when the Celsius reading is 40: F = (40x 5) + 32 = (72 +32) = 104 Skill 29-1 explains how to measure body temperature. Calculating Intravenous Flow Rate Three different methods may be used to calculate IV flow rate (drops per minute, gtt/min). The nurse should select one method, memorize it, and consistently use it to calculate IV flow rate. Method II is usually the preferred method. Method I: Three-Step Amount of solution = milliliters per hour (ml/h) Hours to administer 2. Millliters per hour = milliliters per minute (mL/min) 3. Millliters per minute x drops per milliliter of IV set = drops/minute (gtt/min) Method Il: Two-Step Amount of fluid 1, Amount of fit = ili Fon oniniser = Mililiters per hour (ml/h) Milliliters per hour x Drops per milliliter (IV set) 60 minutes = drops/minute (gtt/min) Mothod Ill: One-Step Amount of fluid x Drops per milliliter (IV set) 1, Hours to administer x Minutes per hours (60) = drops/minute (gtt/min) BSA with the Square Root BSA can be calculated by using the square root and a fractional formula of height and weight divided by a constant. Now that calculators are really ‘atailablo, rossarch has shown that this mathod results in fower orors than drawing intersecting lines on a norrogram. The fomula for BSA using the square root is as follows: [eight ich > BS! ‘Sa ona Examples Order: melphalan (Alkeran) 16 ma/n? awk. Patient is ‘weighs 172 tb «a. Use the BSA inches and pounds formula, aca, mrt 3I3t i oe ‘aIat BSA=V973 BSA-1.9m b. 16max 1.9 m =30.4 mg/m or 30 mg/m. Patent should receive 30 mg ‘every 2 weeks. US ease hd The body weight (WV) method of calculation allows forthe indnidualiation of the drug dese and involves the following three ster 1. Convert pcunds to kilogams ifnecessary(Ib-+ 22 ~ ka} 2. Determine drug dose per BW by multolying as follows: ‘Drug dbs0>tody weight —pationt's dose por day 3. Follow the basic fomula, ratio and proportion, factional equation, or dimensional analysis method to calculate the drug dosage. Examples. 1. Order: fuorourail(5£U}, 12 mg/kg/day WV, not to exceed 800 mg/day. Tho adult woighs 132 Ib Convert pounds to kilograms by dividing the number of pounds by 22 (14g =22 1b) 132+22=60ko b. mg kg = patient's dose 12x60=720ma\V /day Answer Fluorouracil 12 mg/ka/day = 720 mg EXAMPLE ‘Order: 1000 mL. of 5% dextrose in water (D:W) with potassium chloride (KCI) 20 mEq in 8 h Available: 1000 mL of 5% dextrose in water. Potassiam. chloride 40 mEq/20 mL. ampule. IV set labeled 10 gt, Drug calculation: Use the basic formula, the ratio-and- proportion method, fractional equation, or dimen- sional analysis (refer to Section 148 if needed). Dy 2 a9 _ 400 a. BE XV =x 20= >= 10m of CL ba OH v Dik 4oméq = 20mL = 20mea > xml NS somlx2imBe Bolan ‘The calculation of IV flow rate is described using the three methods outlined previousy. However itis strongly recommended that only one method be selected to deter- mine IV flow rate. ©. DAsmL= 10 mL of KCl Method I 1000mL 8h =125m\/h 25mlMhs18 gm _ 125 2 22 _9-ngtnin Bin ae Method tt toto

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