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Client is able to express hope for the future with consider- ation of change in health status cheap fluticasone 250 mcg with amex. Psychiatric Home Nursing Care ● 355 Possible Etiologies (“related to”) Alterations in mental status Inability to engage in satisfying personal relationships Unaccepted social values Unaccepted social behavior Inadequate personal resources Immature interests Alterations in physical appearance Altered state of wellness Defining Characteristics (“evidenced by”) Expresses feelings of aloneness imposed by others Expresses feelings of rejection Developmentally inappropriate interests Inability to meet expectations of others Insecurity in public Absence of supportive significant other(s) Projects hostility Withdrawn; uncommunicative Seeks to be alone Preoccupation with own thoughts Sad order fluticasone 250mcg with mastercard, dull affect Goals/Objectives Short-term Goal Client will verbalize willingness to be involved with others. Long-term Goal Client will participate in interactions with others at level of abil- ity or desire. Be with the client to offer support during activities that may be frightening or difficult for him or her. Most individuals keep the same style of relationship development that they had in the past. Help the client identify present relationships that are satisfying and activities that he or she considers interesting. Only the cli- ent knows what he or she truly likes, and these personal pref- erences will facilitate success in reversing social isolation. Risk Factors Caregiver not developmentally ready for caregiver role Inadequate physical environment for providing care Unpredictable illness course or instability in the care receiver’s health Psychological or cognitive problems in care receiver Presence of abuse or violence Past history of poor relationship between caregiver and care receiver Marginal caregiver’s coping patterns Lack of respite and recreation for caregiver Addiction or codependency Caregiver’s competing role commitments Illness severity of the care receiver Duration of caregiving required Family/caregiver isolation Goals/Objectives Short-term Goal Caregivers will verbalize understanding of ways to facilitate the caregiver role. Long-term Goal Caregivers will demonstrate effective problem-solving skills and develop adaptive coping mechanisms to regain equilibrium. Ensure that caregivers are aware of available community sup- port systems from which they can seek assistance when re- quired. Examples include respite care services, day treatment centers, and adult day-care centers. Caregivers require relief from the pressures and strain of providing 24-hour care for their loved one. Studies have shown that abuse arises out of caregiving situations that place overwhelming stress on the caregivers. Release of these emotions can serve to prevent psychopathol- ogy, such as depression or psychophysiological disorders, from occurring. Encourage participation in support groups composed of members with similar life situations. American Association on Intellectual and Developmental Disabilities—(800) 424-3688 c. Alzheimer’s Association—(800) 272-3900 Hearing others who are experiencing the same problems discuss ways in which they have coped may help the caregiver adopt more adaptive strategies. Individuals who are experi- encing similar life situations provide empathy and support for each other. Caregivers demonstrate adaptive coping strategies for deal- ing with stress of caregiver role. Bellfield and Catalano (2009) have stated: Forensic nursing is an emerging field that forms an alliance between nursing, law enforcement, and the forensic sciences. Forensic nurses provide a continuum of care to victims and their families beginning in the emergency room or crime scene and lead- ing to participation in the criminal investigation and the courts of law (p. Nurses in general practice Clinical Forensic Nursing in Trauma Care Assessment Lynch, Roach, and Sadler (2006) have stated, “Forensic nurse specialists are specifically trained to deal with cases of sexual assault, child abuse, acute psychiatric emergencies, and death investigation” (p. All traumatic injuries in which liability is suspected are considered within the scope of forensic nurs- ing. Reports to legal agencies are required to ensure follow-up investigation; however, the protection of clients’ rights remains a nursing priority. Several areas of assessment in which the clinical forensic nurse specialist in trauma care may become involved include: 1. Evidence from both crime- related and self-inflicted traumas must be safeguarded in a 358 Forensic Nursing ● 359 manner consistent with the investigation. Evidence such as clothing, bullets, bloodstains, hairs, fibers, and small pieces of material such as fragments of metal, glass, paint, and wood should be saved and documented in all medical accident in- stances that have legal implications. Sharp-Force Injuries: Sharp-force injuries including stab wounds and other wounds resulting from penetration with a sharp object. Blunt-Force Injuries: Includes cuts and bruises resulting from the impact of a blunt object against the body. Dicing Injuries: Multiple, minute cuts and abrasions caused by contact with shattered glass (e. Patterned Injuries: Specific injuries that reflect the pattern of the weapon used to inflict the injury. Defense Wounds: Injuries that reflect the victim’s attempt to defend himself or herself from attack. Hesitation Wounds: Usually superficial, sharp-force wounds; often found perpendicular to the lower part of the body and may reflect self-inflicted wounds. Fast-Force Injuries: Usually gunshot wounds; may reflect various patterns of injury. When deaths oc- cur in the emergency department as a result of abuse or acci- dent, evidence must be retained, the death must be reported to legal authorities, and an investigation is conducted. It is therefore essential that the nurse carefully document the appearance, condition, and behavior of the victim upon ar- rival at the hospital.

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How might this knowledge influence and/or ethical/legal competencies are most your nursing practice? He is being transferred from the state home for children to the hospital for respiratory complications associated with pneu- monia buy fluticasone 250mcg cheap. His grandmother is present but refuses to sign the consent forms necessary to admit the boy order 500 mcg fluticasone otc. How might the admitting nurse respond to the grandmother’s refusal to sign consent forms? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Clinical skills are less important in a home care setting than in a hospital setting. The nurse should not make independent statements accurately describes a probable decisions about patient care. More complex services will be provided in infection control are all part of the nurse’s the home setting. The nurse must adapt to the patient’s envi- ronment instead of the patient adapting to Circle the letters that correspond to the best a strange environment. Which of the following are typical characteristics permission to adjust furniture or patient of a home health nurse? Place the bag on a clean hard surface when erally the coordinator of all other healthcare it is set down in a patient’s home. Which of the following home healthcare Part A with the appropriate example of that role services would be performed by a skilled in Part B. Medical social work insurance carrier that there is a need for continued home health services. Which of the following are eligibility require- ments for Medicare-covered home healthcare? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The nurse arranges for a physical therapist to visit a patient recovering from a broken True False hip. The nurse reports the condition of a patient responsible for independent decision making. The home care nurse is responsible for coor- Circle the word “true” or “false” that follows dinating the community resources needed by the statement. One of the changes in the healthcare industry the nurse develops rapport with the patient in the past 5 years has been a shift from and family, mutually determines desired community-based care to hospital-based care. The focus of hospice care is on improving quality of life as opposed to prolonging the True False length of life. Hospice care provides terminally ill patients a of all ages with acute healthcare needs. Home nursing agencies emerged in major patient’s home, the patient must adapt to the cities in the late 1800s to meet the needs of plan of care dictated by the nurse. Lillian Wald and William Rathbone opened True False the Henry Street Settlement House in New York City in 1893. True False Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Describe how teaching is designed and imple- mented in the home care situation: 1. Complete the table above describing the history of home care nursing from the 1800s to the present. Give an example of how you have used or wit- nessed the following characteristics of a home care nurse in your practice. Explain why the family is so important to the patient’s recovery as healthcare continues to shift from the hospital setting to community- b. What type of care and skills would a hospice following roles of the home health nurse. Think about nursing’s role in making necessary resources available to the patient and family. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A 76-year-old man with advanced cancer Scenario: Alphonse Califano is a 72-year-old is being sent home with a catheter and a widower who lives alone. He lives discharged from the hospital, where he had alone, but his son lives 45 minutes away been treated for diabetic foot ulcers.

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Sometimes discount fluticasone 250mcg overnight delivery, after extinction has taken place buy fluticasone 100 mcg cheap, the conditioned stimulus will produce the reflexive behavior without the uncondi- tioned stimulus, a process called spontaneous recovery. For example, people with allergies may rely on drugs that have unwanted side effects. Their allergies have been alleviated by pairing a unique odor (the conditioned stimulus) with the drug (the unconditioned stimulus). Over time, presentation of the odor by itself may alleviate the allergic symptoms. During potty training, children are conditioned to associate the urge to urinate with sitting on the toilet. He reasoned that the presence of the animal caretakers led the animals to an- ticipate the meat powder, so they began to salivate even Psychology has often been defined as the study of without the food. As such, psychologists have developed a di- verse array of methods for studying both human and ani- When classical conditioning occurs, an animal or mal activity. Two of the most commonly used techniques person initially responds to a naturally occurring stimulus are classical conditioning and operant conditioning. They have been used to study the process of learning, Then the food is systematically paired with a previously one of the key areas of interest to psychologists in the neutral stimulus (e. With repeated pairings, the natur- siderable significance to conditioning because it has al response occurs when the neutral stimulus appears. In his Nobel States, John Watson,the first widely known behaviorist, Prize-winning research on the digestive processes, he used the principles of classical conditioning in his research. On the other nant Russian model for the study of behaviorism, anoth- hand, when something positive is removed, this is called er form of conditioning took hold in the United States. In both forms of punishment, an This version, which became known as operant or instru- undesired behavior results in a negative consequence. As mental conditioning, initially developed from the ideas a result, the undesired behavior is less likely to recur in of the psychologist Edward Thorndike. Based on the problem solving of ment with punishment because the word “negative” con- these animals, he developed the Law of Effect,which in jures up the idea of punishment. In reality, a situation in- simple form states that a behavior that has a positive out- volving negative reinforcement involves the removal of a come is likely to be repeated. Similarly, his Law of Exer- negative stimulus, leading to a more satisfying situation. Beginning with Watson and Skinner, psychology in Operant conditioning was popularized by the psy- the United States adopted a behavioral framework in chologist B. His research and writings influ- which researchers began to study people and animals enced not only psychologists but also the general public. From the 1920s through the 1960s, Operant conditioning differs from classical conditioning many psychologists performed conditioning experiments in that, whereas classical conditioning relies on an or- with animals with the idea that what was true for animals ganism’s response to some stimulus in the environment, would also be true for humans. Psychologists assumed operant conditioning relies on the organism’s initiating that the principles of conditioning were universal. In psychologists’ terms, the behavior is rein- species has its own behavioral characteristics. Conse- forced; in everyday language, the person is satisfied with quently, although the principles of conditioning may gen- the outcome. As a result, the next time the person is hun- eralize from animals to humans, researchers must consid- gry, he or she is likely to repeat the behavior of putting er the differences across species as well. On the other hand, if the ma- See also Aversive conditioning; Classical condition- chine malfunctions and the person gets no food, that in- ing; Operant conditioning dividual is less likely to repeat the behavior in the future. Any time a behavior leads to a positive outcome that New York: Oxford University Press, 1983. Two types of reinforcement and punishment have been described: positive and negative. Positive reinforcement is generally regarded as syn- Conduct disorder onymous with reward: when a behavior appears, some- thing positive results. This leads to a greater likelihood A childhood antisocial behavior disorder charac- terized by aggressive and destructive actions that that the behavior will recur. Negative reinforcement in- harm other human beings, animals, or property, volves the termination of an unpleasant situation. Thus, if and which violate the socially expected behavior a person has a headache, taking some kind of pain reliev- for the child’s age. In the future, when the person has a headache, he or she is likely to take that pain Along with anxiety and depression, conduct disorder reliever again. In positive and negative reinforcement, is one of the most frequently diagnosed childhood psy- some behavior is likely to recur either because something chological disorders. Depending on the population, rates positive results or something unpleasant stops.

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