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Review-brief

Key principals of primary health care (hc): -participation of individuals & communities, -apropr. technology, -accessibility of health, - intersectoral collaboration, -health promotion.

Factors having impact on hc system: aging population, cultural diversity, new disease, advanced technologies, ↑ cost of hc, financial constraint, ↑alternative hc. + current reform of hc to reflect concept of primary hc.

Standards: -responsibility & accountability, -specialized body of knowledge,- competent application of knowledge, -provision of service to public, -self-regulation, -code of ethics (health & well-being, choice, dignity, confidentiality, fairness, accountability). Standard: desired and achievable level of performance against which an actual performance can be compared – makes clear what to expect from its members. Written standards: to protect public, to regulate profession, to evaluate, to provide basic for job description, for performance appraisal, for legal references, for public information

Orem self-care deficit nursing theory: nusrse can help clients achive optimal health by assisiting them in their own care.  self-care – actions we take to care for ourselves. → s-c actions → s-c actions performed to meet some basic requirements (s-c requisites) to promote and maintain health: -maintain an adequate intake of air, water, food, -care assoc-d with elimination, -maint. balance between rest & activity, -“-solitude & social interaction, -preventing hazards to life, f-ning & well-being, -promoting human f-ning & development

basic conditioning factors: age, gender, dev-nt state, family system factors, sociocultural orientation, patterns of living, material recourses, environmental f-rs, health state, hc system f-rs

S-c agency – ability to perform s-c demands. Capabilities: knowledge, skill, physical energy, motivation

S-c deficit – when a person actually or potentially lacks the s-c agency to engage in self-care because of knowledge, skill, energy, motivation or basic conditioning factors → need for nursing   it is the same as a nursing diagnosis

Process of helping clients meet their self-care demands is referred by Orem as planning and implementing a nursing system:

Nurse actions – acting for another,, guiding, supporting, teaching,  client actions – whatever client can do to address s-c deficit

Nursing process – approach used for problem solving, consist of assessment (incl. diagnosis), planning, implementation, evaluation. Nursing theory gives direction what to asses, how to plan, evaluate outcomes, etc.   Assess: collect data o basic cond factors, calculate s-c demand for each s-c requisite, determine the adequacy of s-c agency to meet s-c demand, define s-c deficit (diagnosis!)

Ethnicity: -ethnic groups have unique susceptibilities to various health problems, immigrants bring with them diseases and susceptibilities of their country of origin, +natives!

2 recent changes in hc: ↓ acute beds (shortage of funding and nurses), nursing - much earlier discharge from hospital

Primary hc is more than absence of disease – it is social construct derived from people’s own experience and understanding of their problems. It is linked to physical, social, economic environments in which people live

Staff mix influence nursing practice: competences of other staff members will affect what RN does,  -client best interest should always be considered, -if nurse delegate care to others s/he should have support to do so, -nurse should assess the individual being delegated the work, - responsibility & accountability for care should be clear and agreed upon

Factors that inhibit nurse’s role in health promotion: -time constraint- not enough materials/resources for patient teaching, lack of privacy and space for health teaching, few opportunities to evaluate effectiveness of health promotion efforts, lack of communication between hospital and community nurses

Practice professionally: compiled with code of ethics for nursing, --‘-with legal requirements, practice within parameters of agency’s philosophy and policies, recognize own limits, based n.practice on the standards of n.practice in BC, -accepted responsibility to be current in n. knowledge and skills, - communicated support of the profession within community

Development state – related to age, addresses cognitive and psychological changes in addition to physical changes. Development theories: psychosexual (Freud – stages: oral, anal, phallic, latency and genital), -psychosocial (Erikson), -Behavioral (how people learn to behave – Pavlov – stimuli-responses), -humanistic (humans are different), -cognitive (Jean Piaget – how we think, symbols), -evolutionary (Darwin), -genetic (Kogan)

Environmental factors – human environment understood in terms of physiochemical (pollution, weather, quakes), biological (animals, bacteria, etc), socioeconomic-cultural (incl. families) and community (incl. health services) features,   Socioeconomic factors – education, income, employment, social support

Health state and hc system factors – symptoms, projected course of illness, tests, treatments prescribed, services provided. They influence health requirements and s-c practices

Factors that influence the quality of hc services: -access to services, competent performance and satisfactory outcomes, cost effectiveness

Cell organelles:  plasma membrane - Serves as the boundary of the cell; protein and carbohydrate molecules on outer surface of plasma membrane perform various functions; for example, they serve as markers that identify cells of each individual or as receptor molecules for certain hormones, ribosomes - Synthesize proteins; a cell's "protein factories",  endoplasmic reticulum (ER) - Rough ER receives and transports synthesized proteins (from ribosomes); smooth ER synthesizes lipids and certain carbohydrates, Golgi apparatus - Chemically processes, then packages substances from the ER, mitochondria - ATP synthesis; a cell's "powerhouses", lysosomes-  cell's "digestive system", centrioles - function in cell reproduction, Nucleolus -  Plays an essential role in the formation of ribosomes, nucleus - dictates protein synthesis, thereby playing an essential role in other cell activities, - active transport, metabolism, growth, and heredity

cell transport processPassive: diffusion, osmosis, filtration,  Active: ion pump, phagocytosis, pinocytosis

Epithelial: simple squamous – alveoli (gas diffusion), stratified squamous – vessels (diffusion, osmosis, filtration), simple columnar – inside ЖКТ (protection), stratified transitional – urinary bladder (protection), pseudostratified –trachea (protection), simple cuboidal – glands, kidney tubules (secretion, absorption)

Connective: - areolar (glue), adipose (fat), fibrous (collagen - fascia), bone(osteones), cartilage (chondrocytes), blood, hemopoietic tissues

Muscle – skeletal (striated voluntary), cardiac (striated involuntary), smooth (nonstriated involuntary or visceral)

Health-physical, mental, and social well-being, not merely the absence of disease, Disease-an abnormality in body function that threatens health, Signs and symptoms-the objective and subjective abnormalities associated with disease, Endemic diseases are native to a local region, Epidemics occur when disease affects many people at the same time, Pandemics are widespread, perhaps global, epidemic  

Mechanisms of disease: Genetic, Pathogenic organisms, Tumors and cancer, Physical and chemical agents, Autoimmunity, Inflammation, Degeneration

Metabolism: process whereby the body alters chemical structure of ingested compounds.   Catabolism – chemical reactions that release energy from food molecules,

Anabolism – chemical reactions that build food molecules into more complex chemical compounds

Neural system A. Central  nervous  system  (CNS)-brain  and spinal cord  B. Peripheral nervous system (PNS)-all nerves   C. Autonomic nervous system (ANS)

Neurons   1. Consist of three main parts-dendrites: conduct impulses to cell body of neuron; cell body of neuron; and axon: conducts impulses away from cell body of neuron

 2. Neurons classified according to function-sensory: conduct impulses to the spinal cord and brain; motor: conduct impulses away from brain and spinal cord to muscles and glands; and interneurons: conduct impulses from sensory neurons to motor neurons

Glia-three main types of connective tissue cells of the CNS

1. Astrocytes-star-shaped cells that anchor small blood vessels to neurons

2. Microglia-small cells that move in inflamed brain tissue carrying on phagocytosis

3. Oligodendrocytes-form myelin sheaths on axons in the CNS

Disorders of nervous tissue  1. Multiple sclerosis-characterized by myelin loss in central nerve fibers and resulting conduction impairments    2. Tumors a. General name for nervous system tumors is neuroma  b. Most neuromas are gliomas, glial tumors  c.Multiple neurofibromatosis-characterized by numerous benign tumors that can progress to disfiguring, crippling soft tissue tumors

Blood: 1) plasma 55%, (proteins 7%, water 91%, solutes 2%) 2)formed elements – plates 250-400 th/mm2 , leukocytes -5-9 th/mm2 ,erytrocytes – 4-6 mln/mm2

Neutrophil – immune defense (phagocytosis), eosinophil – defense against parasites basophil – inflammatory response, b-lymphocyte – antibody production t-lymph – cellular immune response, monocytes – immune defense (fagocytosis), platelet – blood clotting

Urine formation: 1. filtration (water and dissolved substances from blood in glomeruli to Bowman capsule) 2. reabsorption of water and dissolved substances from kidney tubules back to blood,  3. secretion into urine – of H2 ions, ammonia, K+, drugs

Corpus luteum produces progesterone – stimulates secretory activity of uterine epithelium and assists estrogen in initiation menses,

Estrogen – development of secondary sex characteristics, produced in ovary

 

Absorption – move of drug from administration site into the blood,  Distribution – transport of drug from bloodstream to its site of action

Biologic variation – variations by which people respond to a set drug dosage. Influenced by age, sex, size and enzymes

Pharmacodynamics – study of how drugs produce biologic effects by interacting with specific targets at the drug’s site of action.    Affinity – strength of binding of compound to receptor,   efficacy – capability of stimulated receptor to some action

Pharmacokinetics – how drugs enter the body, reach their site of action and removed from body;   bioavailability – what proportion of administered drug is available to produce systematic effects. affected by drug dissolution, GI tract (food, acidity, etc), chemical properties of drug.    first-pass effect – metabolizing part of the drug by liver. Avoided by using other routes (sublingual, rectal, subcutaneous, etc.)

Factors of drug distribution thru body – high lipid solubility and low protein binding (high concentration of free drug) → diffusion of drug thru membranes.

Factors of drug metabolism biotransformation – ability of organisms to modify chemical structure of compounds. Phase 1 – oxidation, hydrolysis, reduction reaction. Phase 2 (conjugation)- combine drug or metabolite with other chemicals

Factors of Elimination – in faces, in urine, in urine after metabolized by liver

therapeutic index – TI = LD50 / ED50 (lethal dose in 50% of population to effective dose in 50% of population)

Intensity of effect

Minimum clinical response

 

Time course of action of single dose of drug. Drug administered at time T0, T0-T1 = onset of action of drug – time to reach concentration that produces a response     T2 = peak action,   T0-T2 = time for peak action, 

 T3 = drug response falls below minimum required for clinical effectiveness   T1-T3 = duration of action – time during which the drug is present in concentration large enough to produce a response. Onset and duration are determined by rates of absorption and elimination

Half-life – how long it takes for elimination process  to reduce blood concentration of drug by half

Plato principle  - concentration in blood fluctuates around a mean value which approaches plato after several half-lives

 

T0     T1   T2                   T3

 

Drug quality – 2 stages of testing (food and drug act), frequent inspections of manufacturing facilities + analyslis of samples by government + drug labeling monitoring

Drug classification: Nonprescription – proprietary and over the counter,   Prescription Drugs - Schedule F (hormones, antibiotics, tranquilizers),  G (amphetamines, barbiturates),  Narcotics,   Restricted drugs – Schedule H - only for research

5 rights – right medication, dose, route, time, client                6 errors – wrong client, wrong medication (or wrong form of medication) wrong dose, route, dose not given at all, time

contributing factors – inadequate knowledge about medication, errors in transcribing, illegible or erroneous orders, no five rights, interruption during preparation, packaging errors, failure to follow proper procedures and policies

Medication dispensing – selection, preparation, transfer of doses to a client for administration of medication

 

1 mg = 0.001 g   1 ng = 0.001 mg   1% = 10 mg/ml    0.5% = 5 mg/ml

 

allergic responses

- anaphylaxis  (systemic) – itching, hypotension, shock, bronchoconstriction, etc.

- angioedema – swelling caused by plasma leakage and blood vessels dilation in the skin (giant hives)

- asthma – spasm of bronchial smooth muscles

- eczema – inflammated areas on skin

- puprura – red spots on skin caused by blood from small vessels

- rhinitis  - inflammation of nasal mucus

- urticaria – hives which are large wheals caused by leakage of plasma + itching

 

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