ANCC 2021/2022 study guide

History of NP Role Ford and SIlver in CO in 1965 state legislative statutes grant legal authority, the nurse practice act, may require collaborative agreement 00:24 02:03 collaborative agreement what types of drugs may be prescribed and of some oversight board statutory law rules differ for each state, further define scope of practice licensure agency of state grants permission to individuals accountable for the practice of a profession credentialing protect the pubic by ensuring minimum level of competence certification determines scope of practice, certifies that an individual has met certain standards scope of practice defines NP roles and action, varies from state to state standards of practice regarding the quality and type of practice, a way to judge the nature of care given confidentiality information is not disclosed, protected by Medical Record Confidentiality Act of 1996 HIPAA health care privacy act: educated about HIPAA, have access to medical records, request amendments, require their permission for disclosure Tarasoff principle 1976 - duty to warn victims of potential harm from client Justice doing what is fair, fairness in care Beneficence promoting well being and doing good nonmalfeasance doing no harm fidelity being true and loyal autonomy doing for self veracity telling the truth respect treating everyone with equal respect deontological theory action is judged based on the act itself teleological theory action is judged based on the consequences virtue ethics actions are chosen based on moral virtues of the person Four elements of malpractice duty, breach of duty, proximate cause, damages competency legal, not medical concept - determination that client can make reasonable judgments and decisions regarding treatment and health concerns primary prevention decreasing the incidence of mental disorders ex. stress management classes, smoking prevention, DARE secondary prevention aimed at decreasing prevalence ex. telephone hotlines, crisis intervention, disaster response tertiary prevention aimed at decreasing the disability and severity of mental disorder ex. day programs, housing, social skills training biological risk factors hx of mental illness, poor nutrition, poor health psychological risk factors poor self concept, external locus of control, poor ego defenses social risk factors stressful occupation, low socioeconomic status, poor level of social integration research utilization synthesizing, disseminating, and using research generated knowledge to make a change in practice evidence based practice integration of best research evidence with clinical expertise and patient values and needs evidence based practice model P - patient, population, problem I - intervention C- comparison treatment or placebo O - outcome internal validity the treatment caused a change in the outcome external validity the outcome is generalizable to the population IRB protects rights of participants in studies - the belmont report Trust v Mistrust 0-1 year ability to form relationships, hope, trust in others Autonomy v Shame and doubt 1-3 years self control, self esteem, will power Initiative v guilt 3-6 years self directed behavior, goal formation, sense of purpose Industry v inferiority 6-12 years ability to work, sense of competency and achievement Identity v role confusion 12-20 years personal sense of identity Intimacy v isolation 20-35 years committed relationships, capacity to love generativity v self absorption or stagnation 35-65 years ability to give time and talent to others, ability to grow and change integrity v despair 65 years fulfillment and comfort with life, willingness to face death, insight Psychodynamic theory Freud intrapsychic conflict among structures of mind Id (I want), ego (I think, I evaluate), superego (I should or ought) all behavior is purposeful and meaningful oral stage 0-18 months sucking, chewing, feeding linked to schizophrenia, substance abuse, paranoia anal stage 18 - 3 years sphincter control, expulsions, retentions linked to depressive disorders phallic stage 3-6 years exhibitionism, masturbation linked to sexual identity issues latency stage 6-puberty peer relationships, learning, socialization linked to issues forming relationships genital stage puberty and on integration and synthesis of behaviors from early stages, genital based sexuality linked to sexual perversion disorders Denial avoidance of unpleasant realities but ignoring them projection unconscious rejection of unacceptable personal beliefs or feelings by attributing them to others regression return to more comfortable thoughts, behaviors, or feelings in earlier stages of development repression unconscious exclusion of unwanted emotions or thoughts reaction formation overcompensation; opposite feeling is acted on rationalization justification of illogical ideas, feelings or actions by developing an acceptable explanation undoing attempting to make up for or undo an unacceptable behavior intellectualization attempts to master current stressor or conflict by expansion of knowledge suppression conscious analog of repression sublimination unconscious process of substitution of socially acceptable constructive activity for strong unacceptable impulse altruism meeting the needs of others in order to discharge drives cognitive theory piaget human development evolves through cognition, learning, and comprehending stages of development Sensorimotor birth - 2 years object permanence - objects have existence regardless of child's involvement preoperational 2-7 year extensive use of language, symbolism, magical thinking concrete operational 7-12 years reversibility conservation formal operational 12 and on ability to abstract, logical thinking Interpersonal theory Sullivan behavior occurs because of interpersonal dynamics; the self system is all components of personality when individuals need for satisfaction and security is interfered with by the self-system, mental illness occurs hierarchy of needs maslow health model certain needs are more important than others self actualization is highest health belief model becker healthy people do not always take advantage of screenings due to perception of susceptibility, benefits of tx, barriers to change etc trans-theorectical model of change change occurs in stages: precontemplation, contemplation, preparation, action, maintenance Self efficacy/social learning theory bandura behavior is the result of cognitive and environmental factors learn by observing others self-efficacy is the perception of one's ability to perform a certain task at a certain level Theory of cultural care Leininger regardless of culture, care is the focus of nursing, health can be predicted through cultural care Theory of self care Orem self care - activities that maintain life, health, and well being Human Becoming theory Parse individuals choose personal meaning in situations Health promotion theory Pender explains behaviors that enhances health and prevents disease Therapeutic Nurse-Client Relationship Theory/Interpersonal Theory Peplau nursing as interpersonal process in which all interventions occur within the context of nurse-client relationship phases of relationship - orientation, working, termination Theory of Adaptation Roy promotion of adaptive responses is the goal of nursing Caring Theory Watson caring is essential component of nursing Frontal Lobe voluntary motor movement, coordinates movement of multiple muscles, sensory input to trigger memory and decision making, working memory, reasoning, planning, insight, judgment, impulse control, intelligence, abstraction, expressive speech (broca), personality problems lead to personality, emotional, and intellectual change temporal lobe receptive speech/comprehension (wernicke), auditory area, memory, emotion, vision sensory integration problems lead to visual or auditory hallucinations, aphasia, and amnesia Occipital lobe visual cortex problems lead to blindness, visual hallucinations parietal lobe sensory area, taste, reading and writing problems lead to sensory perceptual disturbances and agnosia Cerebral cortex behavior that makes us human - speech, cognition, judgment, perception, and motor function limbic system regulation and modulation of emotions and memory; contains hypothalamus, thalamus, hippocampus (memory), amygdala (mood, fear emotions, and aggressions) basal ganglia aka corpus striatum feedback system to modulate and stabilize somatic motor activity movements learning actions EPS track involuntary movements contains caudate and putamen Reticulation formation system primitive brain involuntary movement, reflex, muscle tone, vital sign control, BP, RR Dopamine substantia nigra and VTA mesolimbic, mesocortical, nigrostriatal, tuberoinfndibular increase leads to schizophrenia, decrease to parkinson's, substance abuse norepinepherine locus ceruleus decrease leads to depression serotonin raphe nuclei decrease leads to depression, ocd, schizophrenia glutamate excitatory significant in bipolar and seizure d/o increase leads to psychosis and bpad GABA inhibitory decrease leads to anxiety acetylcholine basal nucleus of mynert decrease leads to alzheimers, impaired memory CT scan 3 dimensional view of brian structures inexpensive but not sensitive structural imaging MRI 2 dimensional images, can separate white and grey matter expensive, not for every patient structural EEG electrical function of CNS, least expensive functional MEG similar to EEG, more useful in psych disorders functional SPECT information on cerebral blood flow, expensive functional PET images of brain with radiographic dye is inserted; very expensive and rare functional incidence rate number of new cases occurring over specific time prevalence rate number of existing cases of a disorder at a specific time Cranial nerves Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Glossopharyngeal Vagus Accessory Hypoglossal FT4 0.8-2.8 increased: graves dz decreased: hypothyroidism TSH 2-10 increased: hypothyroidism along with decreases in T3 & T4; may mimic unipolar depression decreased: hyperthyroidism along with increases in T3 & T4; may mimic BPAD values can increase with lithium Calcium 8.8-10.5 hypocalcium causes confusion, hyperreflexia, seizures, prolonged QT, cramping hypercalcium causes fatigue, weakness, shortened QT, heart block Sodium 135-148 hyponatremia causes lethargy, confusion, headache, seizure, edema, jvd hypernatremia causes pulmonary edema, thirst, fever, tachycardia, restlessness Magnesium 1.3-2.1 hypomagnesmia causes depression, irritability, confusion, nystagmus, muscle weakness, ataxia hypermagnesmia causes n/v, muscle weakness, respiratory depression potassium 3.5-5.1 hyperkalemia causes muscle weakness, paralysis, tingling cramping, diarrhea, EKG changes tall, narrow T waves hypokalemia causes impaired renal function, polyuria, cardiac dysrhythmias, respiratory arrest ALT 5-35 liver disease, damage AST 5-40 liver disease, damage GGT 10-38 known or suspected etoh abusers, as levels will rise with only a slight elevation of alcohol Pharmacokinetics what the body does to the drug - absorption, distribution, metabolism, and excretion pharmacodynamics what the drug does to the body, target sites for action, receptors, etc. Protein bound drugs Drug binds to protein, only free part of the drug is active. so a drug that is 98% protein bound will have 2% available for distribution in the body those with low protein can experience toxicity Common induces tegretol, antifungals, rimfampin, dilantin, tripletal or topamax Common inhibitors tagamet, erythromycin, biaxin, fluoroquinolones, prozac, paxil medications that induce depression beta blockers, steroids, interferon, accutane, retrovirals, neoplastic, benzodiazepines, progesterone medications that induce mania steroids, antidepressants in those with bipolar, iNH, antabuse psychoanalytic therapy freud change through the development of insight and awareness of maladaptive defenses attends to past development that now shapes present issues cognitive therapy beck goal is to change client's negative beliefs and cognitive distortions behavioral therapy lazarus changing maladaptive behaviors by participating in active techniques such as exposure, relaxation, problem solving, and role playing DBT linehan used in BPD patients goals are to decrease suicidal behavior, decrease therapy interfering behavior, decrease emotional reactivity, decrease self invalidation, decrease crisis generating behavior, decrease active passivity, increase realistic decision making, increase active communication existential therapy frankl reflection on life and self-confrontation are encouraged; focuses on individuals accepting freedom and making responsible choices; focus on the present and personal responsibility humanistic therapy rogers aka person centered therapy concepts include self-directed growth and self actualization; people are born with the capacity to direct themselves toward actualization EMDR shapiro form of behavioral therapy integrating the use of rapid eye movements to treat traumatic stress and memories, used in ptsd group therapy increases self-insight, increases social skills, is cost effective, develops sense of community uses yalom's factors including ope, universality, altruism, increased social skills, imitative behaviors, interpersonal learning, group cohesiveness, catharsis, existential factors, corrective refocusing Reminiscence therapy progressive return of memories of past experiences used with the elderly enables participants to search for meaning in life, strive for resolution of conflicts family systems theory one can not understand any family member without understanding how all family members operate together clearly defined boundaries maintain individual separateness and belongingness rigid boundaries distant relationships and disengagement diffuse boundaries enmeshment circular causality ongoing feedback loop in which actions and reactions maintain a problem family homeostasis families resist change to maintain homeostasis morphogenesis family's tendency to adapt to change when changes are necessary morphostasis family's tendency to remain stable in the midst of change family systems therapy bowen - believes that an individual's problematic behavior may serve a function or purpose for the family or be a symptom of dysfunctional patterns focus is on chronic anxiety within families treatment is to increase family member's awareness of their function within the family and to increase self-differentiation triangles dyads that form triads to decrease stress; the lower the level of family adaptation the more likely a triangle will form nuclear family emotional system level of differentiation of the parents usually equal to the level of differentiation of the entire family multi-transmission process dysfunction present over many generations family projection process parents transmitting their own level of differentiation onto the most susceptible child emotional cutoffs attempting to break contact with family of origin sibling position influences interactions and personality characteristics structural family therapy minuchin - placed emphasis on how, when, and to whom family members relate to in order to understand and change family structure individual symptoms are rooted in the family; the symptom is a function of the health of the whole family and is maintained by structural problems family structure set of functional demands that organize the way members interact with each other; made up of subsets including martial, paternal, sibling, coalitions in which two members join forces against a third, and boundaries structural mapping genogram mapping relationships using symbols to represent hiearchies distribution of power experiential therapy satir behavior is determined by personal experience and not by external reality focus is on being authentic, freedom of choice, human validation, and experiencing the moment goal is to increase self worth of each family member - goal is growth rather than reduction of symptoms strategic therapy haley symptoms are viewed as metaphors and reflect problems in the hierarchal structure treatment goal is to help family members behave in ways that will not perpetuate the problem behavior interventions are problem focused; more symptom focuses than structural therapy solution focused therapy deshazer, o'hanlon, berg focus is to rework solutions that have previously worked goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths object loss theory fairbairn, winnicott, guntrip early psychological development issues lay the foundation for depressive responses in later life; the child is able to form relationships but then experiences a loss, usually maternal. dept of loss then produces responses including separation anxiety, grief, mourning, despair - predisposes child to react in similar ways to future losses aggression turned inward theory freudearly psychological development issues lay the foundation for depressive responses in later life ; the child is able to form relationships but then experiences a loss, real or imagined but unexpected, usually maternal. this loss can be death, illness, or lack of emotional availability, birth of sibling. the child feels angry but is afraid to express this anger, and may fear future loss if he/she does express anger, leading to the child to believe that anger is unacceptable. the child turns the anger inward and rationalizes that he or she was the cause of the abandonment, then develops guilt over the lost love. a similar reaction occurs as an adult in response to loss