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Maternal newborn notes from lecture

Lecture notes covering stages of pregnancy, labor and newborn care thr...
Course

Nurse Aide I (NUR-3240A)

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Academic year: 2021/2022
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Durham Technical Community College
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Concepts II Unit 1: Health Promotion and Comfort

Community Health:

What is Community Health?:

- The collective well-being of community members

- Populations often share health characteristics due to shared environmental and

socioeconomic condition.

- Refers to non-clinical approaches as well

Social Determinants of Health (SDOH):

- Five domains:

- Economic stability: job opportunities in an area. Working conditions, pay. Not always

safe environment. Average income and cost of living in an area

- Education access and quality: quality and safety of public schools. Presence of early

childhood education, vocational training availability. Health literacy; how much do they know about preventative healthcare and how to take care of self and availability of care. How many people have health insurance and can afford health insurance? Provider availability. Provider cultural competency; are providers culturally confident, can they approach population with empathy, respect and humility?

- Health care access and quality: Are the resources available good?

- Neighborhood and built environment: Is housing safe, is there access to public

transportation, how are neighbors, options for physically activities, parks, polluted air or water, are parks safe, access to nutritious food. Limited access to nutritious foods: food desert. Prevalence of hunger in the community.

- Discrimination, bias, prejudice. Exposed to racism, homophobia, transphobia,

xenophobia has impact on mental health and overall health may not be getting care deserve and need.

- Social and community context

- Healthy People 2030 Social Determinants of Health:

health/healthypeople/objectives-and-data/social-determinants-health

- Let’s Learn Public Health – Social Determinants of Health:

youtube/watch?v=8PH4JYfF4Ns

- Non-medical things that affect your health

-

Graphic: In order to have healthy people must have healthy community. In order to have healthy environment need health society. Exposure to racism, soceoeconmic status, environment, pollution, limited access for physical activity. Systemic issues: racism and discrimination in healthcare.

Community Health Nursing Theories:

  • Nightingale’s Theory of Environment: Health promotion behaviors like handwashing, foster clean environment to prevent spread of infection.

-

  • Heath Belief Model: A persons motivation for adopting health promoting behaviors. Likelihood that they will take a positive health action. Depends on modifying factors: education, culture, transportation. How does patient perceive benefits of actions taken. Perceived benefits of health actions vs. perceived risk of taking the action. Ex: Vaccinations (covid). Cues from the environment.
  • Public health nursing: disease prevention and empowering communities to adopt healthy behaviors. Some people have real, difficult barriers to adopt these behaviors.

Why is Community Health Important?

  • Addressing health disparities: Going into communities and acknowledging at risk population. Rural areas have less access to hospitals and resources.
  • Lowering healthcare costs: Community health centers help to address unmet needs. Often offer services that are free. Often unable to have access to Medicaid. Culturally competent care.
  • Enacting public health initiatives: Vital role in decreasing disease and infection.
  • Community health services and resources: About preventative healthcare and making sure chronic conditions do not develop or are managed if they do. Making sure people stay well as much as possible.
  • Community health centers: Provide health services and resources. Case management support. School
  • Public outreach programs: school nursing, home healthcare, high risk pregnant women without resources. Pop up clinics in community; A1C screenings, blood pressure, education on medications
  • Community mental health centers: Inpatient and outpatient mental health services

Primary, Secondary, & Tertiary Prevention:

  • Primary:
  • Aim stop prevent disease or injury before it occurs
  • Done by preventing exposure to hazards, altering behavior, and increasing resistance to disease/injury
  • Things like; Screen children for lead poisoning, smoking cessation, increasing exercise
  • Secondary:
  • Aim is to reduce impact of disease or injury that has already occurred
  • Done by detecting and treating disease as early as possible
  • Potentially curable disease, trying to stop it from getting worse. Identified issues that we want to prevent from getting worse.

- Medicare: Over age 65. Children and people who are permanently disabled. State

funding Graphic: Parts of Medicare A: hospital care, limited skill nursing facility care and home health (acute care) B: Outpatient, occupation C: Supplemental that can be paid extra for to expand coverage. Combines A & B and expands network, provided through private company D: Drug coverage

The Role of the Community Health Nurse:

-

Important Nursing Roles in the Community:

- What is community health nursing?: Takes into consideration cultural and sconomic

situations of community to make sure getting proper care. Cultural competency

- What are the goals of a community health nurse? Address needs of community. Must

go where people are to provide with adequate services. Reduce disparities, racial, cultural economic.

- Where do community health nurses work? Everywhere, hospitals, community health

centers, health departments, prison nursing, clinics, schools and government health agencies, travel nursing to remote, isolated areas. Usually work for some level of the government.

- What are some public health or community nurse specifications? Home care, case

management, clinical nursing (prenatal clinic in health department), occupational nursing, school nursing, pharmaceutical nursing

- How do you become a community health nurse? 1-2 years of bedside experience,

require BSN typically, require high level of cultural competence,

Key Elements of Community Health Nursing:

- Identifying public health concerns: within specific geographic area determines by

environmental or social factors

- Intervening to address resource gaps: establishing community health center, mobile

health

- Educating residents : behaviors that facilitate life changes positive

- Providing essential services : social support, counseling

- Helping residents gain access to resources : affordable dental care, mental health

services, transportation services, housing, food, education,

- Reducing the need for tertiary care: Stoping people from getting acutely ill.

- Advocating for at-risk populations: Advocating for improved care for populations,

lobbying to state and federal law makers

- Working with community agencies: to address needs and gaps

Community Health Nursing Ethics:

- Respect for Autonomy: Supporting patient having the right to make their own decisions

about their healthcare and future. Listen and support patient without judgement and empower them to make positive health choices for themselves

- Non-maleficence: Do good, whats best for patient. Maximize benefits in community

- Beneficence:

- Distributive justice: Equitable distribution of resources. Equity= giving people what

they need on a case to case basis based on situation

Developing a Community Health Plan

Graphic: Ensure equitable access to healthcare phases Evaluation: brainstorm what to do Assessment: what do they need Diagnoses: what is most important for community right now Planning: Interventions, establishing goals, delegating responsibilities Implementation: executing the plan Evaluation: did we solve the problem

Community Health Assessment:

- What is community health assessment? Systaltic way of identifying needs priorities and

resources of community and the health status of a community using data and information. Asking people within the community what they need. Informant interviews, community forums, public meeting, collection of secondary data: census, existing records, observing what is going on in community, focus groups, surveys.

- Why do a community health assessment?

- What should be assessed? People in the community, the environment

- Data Collection Methods:

- Informant interviews:

- Community forums:

- Participant observation:

- Focus groups:

- Surveys:

- Windshield survey: Driving around a community and looking through windshield to

look at people and places in community and making observations based on that. Signs of violence, mental illness, drug use, quality of housing, quality of healthcare resources, grocery resources, what are the schools like, parks, churches, Graphic (windshield surveys):

Characteristics of Health Communities:

  • Consultation provided that is concurrent with curative therapies
  • No specific time period limitations
  • Care is in the form of a consult visit by primary healthcare provider or healthcare team who makes recommendations
  • Comfort care. Any stage of life-threatening disease. Can be done in conjuction with curative treatments. Advanced cancer; pain management, emotional and mental support.

Legal and Ethical Considerations

  • Power of attorney: Someone who makes decisions for you when you cannot make them yourself
  • Advance directive: What the patient wants done in a situation when they are nearing death. Maybe medications but not chest compressions, not wanting ventilator but may want other things
  • DNR/DNAR: Do not resuscitate/Do not attempt resuscitation. No life saving measure if heart stops beating. Rapid: decompensating patient, call rapid response before they code
  • Allow natural death: Softer version of DNR. Pain killers are acceptable, palliative care.
  • Assisted suicide: Only legal in certain states; California, Colorado, Maine. Euthanasia. Alleviate suffering of a chronic condition
  • Euthanasia
  • Autopsy: Different post-mortem care. Leave all lines in
  • Organ donation: Post-mortem care differently to preserve organs. Nurse can never approach family or patient about organ donation. Glasgow coma scale less than 5 refer to Carolina donor services

Holistic Care:

  • Cultural aspects: What is important to them specifically. Any ceremonies, religious leader coming in, catholics read last rights by priest. Chaplains across different cultures, does not have to be spiritual
  • Spiritual aspects
  • Client wishes: Assess patient wishes and try to meet them and involve patient as much as possible in end of life decisions
  • Family-centered care: Make sure family is supported. Listening with care and compassion with lack of judgement. Just be there to listen with empathy and lack of judgement. Talk to them about their loved one, what were they like during their life

Physiological Changes:

  • Cardiac: Bradycardia, hypotension, perfusion decreases overall, decreased urine, skin; cyanotic

  • Respiratory: Dyspnea and air hunger (gasping may provide oxygen), Cheyne stokes breathing (periods of apnea followed by gasping, death is imminent)

  • GI: constipation, decreased appetite, nausea, vomiting

  • Neurologic: Altered, decreased consciousness, delirium, hallucinations, brief period of lucidity followed by decrease in consciousness

  • Pain: Common part because of decrease perfusion, malignancy/tumor, pain management is aggressive to be as pain free as possible. Up to patient how much management they want

Role of the Nurse

  • Assessment:
  • Physical changes: Is death imminent? Pay attention to changes to alert the family that death is coming soon
  • Psychosocial assessment: How is the patient coping, how is the family coping
  • Spiritual assessment:
  • Plans/Goals:
  • Must involve patients in their own goals: What do the patient and the family want
  • Nursing Diagnoses
  • Pain/symptom management: Grieving, chronic sorrow, impaired family coping,
  • Grieving
  • Chronic sorrow
  • Interventions: Managing comfort. Raise head of bed, side lying position, suctioning/oral care. Provide 2L nasal cannula to take edge off of air hunger, pain meds. Dehydration makes dying process less painful. Less pain medication with dehydration.
  • Focus on comfort, relieving symptoms of dying

Pain Management:

  • Pharmacologic; opioids, non-opioids: Morphine for moderate to severe pain. Provides some CNS suppression to decrease respiratory symptoms
  • Non-pharmacologic : Tylenol, motrin, massage, music therapy, aroma therapy, therapeutic touch,

Pediatric considerations:

  • Perinatal loss:
  • Miscarriage: Loss of fetus before viability
  • Intrauterine fetal demise: loss of fetus that reached age of viability
  • Neonatal death:
  • Loss of fetus or infant
  • Postpartum and L&D nurses are specially trained
  • SIDS:
  • Sudden and unexplained death of an infant up to 1 year

- Expressing: Expressing feelings- encourage family to do so. Helping them recall

memories good and bad

- Recalling: Recalling memories

- Meaning: Finding Meaning; some people want to find meaning in loss of a loved one.

How will this change who they are and the path they are taking without their loved one

Therapeutic Communication:

- Perfect your listening skills

- Encourage and accept expression of feelings

- Reassure it is not wrong to feel anger, relief, or other “unacceptable” feelings

- Respond to nonverbal cues with touch and eye contact

- Increase your self-awareness

- Continue to communicate, even in case of coma

Providing postmortem Care:

- Care of the body: Follow agency policies and respect cultural and spiritual preferences

Taking Care of You:

- It is normal for the nurse to feel grief when a client dies

- Support is available

- Use your resources to ask for help

Men’s Sexual Health:

- Erectile Dysfunction:

- Prostate disorders:

- Benign prostate hypertrophy:

- Prostate cancer

- Testicular cancer:

Erectile Dysfunction:

- Definition: inability to achieve or maintain an erection causing issues with pleasurable

intercourse. Impotence may or may not impact libido

- Pathophysiology:

- Incidence: Difficult to estimate because many do not reach out for treatment

Erectile Dysfunction/What causes it? Risk factors

- Disease process (pathological)

- Chemical substances:

- Medications: Vascular or neuromuscular; antihypertensives, psychotropic, excessive

alcohol use

  • Chemical substances: Smoking causes damage to blood vessel, smoking increase risk by 30-60%
  • Other:
  • Age: Risk increases with age but can occur at any age
  • Obesity: 30% higher risk
  • Psychosocial : stress, anxiety, depression, fear, guilt, fatigue

-

Diagnoses (ED)

  • CBC, blood chemistry, lipids, testosterone, PSA
  • Looking for cardiovascular, metabolic and endocrine
  • Nocturnal penile tumescence and rigidity (NPTR) monitoring: Monitoring for presence of erection during sleep. Documenting total number of erections that occur during REM sleep

Lifestyle Changes/Role of nurse/Health Promotion:

  • Smoking cessation
  • Control weight
  • DM management
  • Alcohol usage
  • Reduce stress

Pharmacological Treatments

  • Prototype drug: Sildenafil (Viagra)
  • Classification: (PDE-5) inhibitors
  • Contraindications:
  • Side effects/adverse effects:
  • Assessment data:
  • Implementation (special considerations/teaching):

Benign Prostatic Hyperplasia (BPH):

  • May be interchanged with hypertrophy

  • Age related nonmalignant enlargement of the prostate gland

  • Cause is unknown

  • Risk factors:

  • Age, Family history, Race, Diet high in meats/fats: If genetic component it may occur before the age of 60

  • Often non-malignant

  • Relationship between hormones and the abnormal tissue growth

  • Avoid caffeine/alcohol

  • Avoid certain over the counter meds: Make sure patient shares all medications they are taking

  • Frequent sexual intercourse: Following ejaculation, bacteria exits urethra and cleans it. Assists with release of prostatic fluid

  • Complementary therapy

  • Saw palmetto extract?: can interfere with NSAIDs and cause increased risk of bleeding

Medications (BPH):

  • 5-Alpha-reductase inhibitors—Finasteride (Proscar)
  • Adverse effects:
  • Nursing implications
  • Alpha 1 adrenergic blockers—Tamsulosin (Flomax)
  • Adverse effects:
  • Nursing implications:

Finasteride (Proscar):

  • 5 alpha reductase inhibitor
  • Interferes with testosterone metabolism—shrinks the prostate
  • Takes several months to work
  • Administration alerts
  • Not good for severe

Tamsulosin (Flomax):

  • Alpha 1 adrenergic blocker
  • Blocks alpha receptors in urethra and neck of bladder. Opens up (relaxes the smooth muscle) lumen and urethra
  • Helps improve urine flow within 1-2 weeks after starting
  • Watch for adverse reactions

Surgical Treatment Prostatectomy (BPH)

  • Minimally invasive
  • Transurethral resection of the prostate (TURP)
  • Open surgery
  • Laser Graphic (TURP):

Transurethral Resection of the Prostate (TURP):

  • Be aware of urine color throughout process following procedure. Likely to start out darker but should lighten into a pink and then normal yellow color over time

  • RJ has tried alternate therapies and is now going for TURP: low level radio frequency through twin needles, can remove obstructed tissues flushing it out

  • Preoperative care: Baseline lab values to guide throughout

  • Postoperative care: Catheter care, take home catheter instructions, pain management

  • Discharge teaching: Urine color, tolerable pain identification. Transurethral microwave therapy: Contact laser prostatectomy: Electrovaporization of the prostate: Page 1478 in textbook

Nursing Diagnoses – BPH:

Preoperative care: Postoperative care: Graphic (continuous bladder irrigation)

Resources for CBI:

  • Monitoring and care
  • Calculate fluid used to irrigate the bladder and catheter and subtract it from the volume of drainage
  • Rationale: This calculation determines accurate urinary output. Empty the drainage bag frequently to prevent the weight of the drained fluid from disconnecting the drainage system
  • Assess the characteristics of the output: viscosity, color and presence of clots
  • Rationale: Maintaining catheter patency ensures that the bladder empties freely. Observe the patient for signs or symptoms of infection, including fever, elevated WBCs, or cloudy, malodorous urine
  • Report catheter obstruction, sudden bleeding, infection, or increased pain to practitioner
  • Assess, treat, and reassess pain
  • Pay attention to bladder spasms, make sure there is continuous flow from catheter so prevent spasms

Prostate Cancer:

  • Most common type of cancer in men
  • Usually curable because it is usually caught early on due to regular screenings
  • Pathophysiology:
  • Androgens: testosterone and dihydrotestosterone: Cause proliferation and cancer cells respond
  • Patient may be asymptomatic for a long period of time

Risk Factors (PC):

Care of Patient (TC):

- Diagnoses: Ultrasound or CT

- Surgical removal of affected testicle

- Psychosocial support/teaching

- Sexual function

Gender Care:

ANA Code od Ethics:

- Nurses practice with:

- Compassion

- Respect for dignity

- Worth of every patient

LGBTQIA+:

- Lesbian

- Bisexual

- Transgender

- Queer/questioning

- Intersex

- Asexual/ally

Patient-Centered Terminology

- Gender identity: a person’s inner sense of maleness or femaleness; not related to

reproductive anatomy

- Biological (Natal) sex: A person’s genital anatomy present at birth

- Gender dysphoria: discomfort with one’s natal sex

- Transgender: describes person who self identifies as the opposite gender that does not

match their natal sex. (Only use this term as an adjective)

- Transexual: A person who has modified his or her natal body to match the appropriate

gender identity, either through cosmetic, hormonal, or surgical means. (Can be used as an adjective or noun) Have undergone transition surgically

Transgender Health Issues:

  • Psychosocial stressors
  • Job discrimination
  • Bias-related harassment
  • Posttraumatic stress disorder
  • Depression
  • Can lead to suicidal ideation or suicide attempts

Stress and Transgender Health

  • Lack of health insurance or denial of coverage for gender transition (if insured)
  • Lack of healthcare professional knowledge
  • Prior negative experience with healthcare provider

Need to improve transgender health care:

  • Healthy People 2030
  • IOM’s report on LGBT health
  • Joint commission field guide for care of LGBT patients
  • World professional Association for transgender standards of care
  • GLMA’s companion document

Role of the Nurse:

  • Assessment (noticing):
  • Identification:
  • Ask patient how he or she would like to be addressed
  • Use correct pronouns
  • History:
  • History of interventions, or plans to use in the future
  • Drug therapy
  • Surgical Hx
  • Physical Assessment:
  • Conduct with cultural sensitivity, nonjudgmental approach, respect
  • Explain why exam is important to their health care

Psychosocial Assessment:

  • Ask specific questions if gender and sexuality are relevant to the presenting health problem

  • Explain why this information is relevant to their treatment

  • Reassure that responses are confidential (however evidence of abuse must be reported by law)

  • Prevent mistakes in Surgery

  • No need to memorize

Reporting Safety Concerns

  • Patients and Families:
  • Joint commission
  • Nurses:
  • Safety Reporting Systems (SRS)

Immunizations:

  • Why are vaccines important? Immitate infection without causing disease to build immunity
  • Which vaccines are recommended in the:
  • Pediatric client? MMR, pertussis, varicella, HIB, Hep B
  • Adult Client? Tetanus, shingles, flu, pneumovax, Gardasil, Covid-
  • What are the Barriers to Immunizations? Cultural and religious beliefs, cancer patients, gian barre
  • What situations are NOT a contraindication to receiving a vaccine?: Pregnancy, egg allergies is not contraindicated anymore. Misconceptions: low grade fever, local reaction to previous immunization

Administering Immunizations:

  • Consider history and cultural beliefs of client
  • Each vaccine has insert with directions-route, storage, dosage
  • Some are combination vaccines
  • May administer multiple vaccines at once-use different sites
  • Live vaccines should not be given to immunocompromised clients
  • Assess for egg allergies---why?
  • Informed consent
  • Documentation
  • Patient education

Safety and Developmental Factors:

Poisoning:

  • Common in Toddler and Preschool Age
  • Poison Exposure:
  • Ingested or exposed?: Call poison control, get help, get information
  • Contact Poison Control:
  • They will follow up with the patient
  • They will follow up with the patient
  • They will provide recommendations for treatment and labs
  • The provider should:
  • Determine the source
  • Treat based on signs & symptoms
  • Perform a Quick & Accurate Assessment
  • Obtain Labs and Urine: Assess
  • Treatment:
  • Assess ABCDEF (Airway, breathing, circulation, disability: neurological status (LOC, PERRLA), Urine output (kidney function), exposure: Eyes on the patient, visualize posterior aspect, assess temperature, keep patient warm, F: Full vital signs )
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Maternal newborn notes from lecture

Course: Nurse Aide I (NUR-3240A)

3 Documents
Students shared 3 documents in this course

University: Durham Technical Community College

Was this document helpful?
Concepts II Unit 1: Health Promotion and Comfort
Community Health:
What is Community Health?:
-The collective well-being of community members
-Populations often share health characteristics due to shared environmental and
socioeconomic condition.
-Refers to non-clinical approaches as well
Social Determinants of Health (SDOH):
-Five domains:
-Economic stability: job opportunities in an area. Working conditions, pay. Not always
safe environment. Average income and cost of living in an area
-Education access and quality: quality and safety of public schools. Presence of early
childhood education, vocational training availability. Health literacy; how much do
they know about preventative healthcare and how to take care of self and availability
of care. How many people have health insurance and can afford health insurance?
Provider availability. Provider cultural competency; are providers culturally confident,
can they approach population with empathy, respect and humility?
-Health care access and quality: Are the resources available good?
-Neighborhood and built environment: Is housing safe, is there access to public
transportation, how are neighbors, options for physically activities, parks, polluted air
or water, are parks safe, access to nutritious food. Limited access to nutritious foods:
food desert. Prevalence of hunger in the community.
-Discrimination, bias, prejudice. Exposed to racism, homophobia, transphobia,
xenophobia has impact on mental health and overall health may not be getting care
deserve and need.
-Social and community context
-Healthy People 2030 Social Determinants of Health:
https://health.gov/healthypeople/objectives-and-data/social-determinants-health
-Let’s Learn Public Health – Social Determinants of Health:
https://www.youtube.com/watch?v=8PH4JYfF4Ns
-Non-medical things that affect your health
-
Graphic: In order to have healthy people must have healthy community. In order to have
healthy environment need health society. Exposure to racism, soceoeconmic status,
environment, pollution, limited access for physical activity. Systemic issues: racism and
discrimination in healthcare.

Students also viewed

Related documents