BREATHING & ODORS Category TERM Kussmaul’s breathing Halitosis Acetone breath odor Ammonia odor Confabulation Flight of ideas DEFINITION Deep, rapid respiration characteristic of diabetic or other causes of acidosis Offensive odor of the breath Fruity or acetone breath odor in diabetic ketoacidosis; Life threatening Urine-like or fishy odor in chronic kidney failure Fabrication of information during unconscious encounters Rapid, loosely connected succession of thoughts. Constantly shifting, generally connected ideas; manic mood disorders SKIN & NAILS Category TERM DEFINITION Paleness of skin/mucosae; associated with anemia or shock Yellow discoloration of skin/eyes from liver disease Redness from capillary congestion (injury, infection, inflammation) Bluish discoloration of skin and mucosa membranes Gray-brown skin discoloration; generalized White patches in the skin surrounded by areas of normal pigmentation Generalized lack of pigmentation Curved nail shape Spoon nail (concave nail) Nails meet at 180° or greater Nail separates from nailbed Transverse ridges indicating halted nail growth (serious illness) Inflammation Flat, non-palpable lesion < 1 cm Flat, non-palpable lesion > 1 cm Palpable, raised superficial lesion < 1 cm Raised, superficial temporary lesion Palpable, Solid lesion with depth < 2 cm; cyst if fluid filled Palpable, Solid lesion with depth > 2 cm Palpable, Fluid-filled lesion < 1 cm Palpable, Fluid-filled lesion > 1 cm Palpable, Pus-filled lesion Hives White nails Athlete’s foot (fungal skin disease) Ringworm (fungal skin disease, anywhere) HAIR Category TERM SKULL & FACE Category TERM EYES Category TERM Pallor Jaundice Erythema Cyanosis Hemochromatosis Vitiligo Albinism Convex curvature Koilonychia Clubbing of fingers Onycholysis Beau’s lines Parenchyma Macule Patch Papule Wheal Nodule Tumor Vesicle Bullae Pustule Urticaria Leukonychia Tinea pedis Tinea corporis DEFINITION Hair thinning/loss Excessive hair growth Lice infestation on scalp (seen in children); nits attached to hair Alopecia Hirsutism Pediculosis capitis DEFINITION Normal head shape and size for age Protrusion of eyeball Cerebrospinal fluid (CSF) buildup in brain ventricles Bone enlargement (extremities, face, jaw) due to pituitary overactivity; chronic disease of adults Normocephalic Exophthalmos Hydrocephalus Acromegaly Ptosis Exophthalmos Ectropion Entropion Edema Arcus senilis Mydriasis Miosis PERRLA Strabismus Nystagmus Seborrhea Pterygium Pinguecula Anisocoria EARS Category TERM NOSE & SINUSES Category TERM MOUTH & OROPHARYNX Category TERM Macrotia Microtia Presbycusis Nasal polyps Sinusitis Deviated nasal septum Epistaxis Leukoplakia Exostoses Cheilisis Cheilosis Glossitis Black hair tongue Gingival/gum hyperplasia DEFINITION Dropped upper eyelids Sclera visible between iris and eyelid; setting-sun eyes Outward turning/sagging lower eyelid; exposed & dry Inversion of eyelid causing lashes to rub the globe of the eye Fluid accumulation Whitish arc on cornea Pupil dilation Pupil constriction Pupils Equal, Round, Reactive to Light & Accommodation Eyes unable to focus/gaze on same point/in space Involuntary rhythmic eye movement; oscillating Increase sebaceous secretion of gland; disorder Mass of tissue from conjunctiva over cornea; obstructs vision Elevated elastic tissue conjunctival deposit near cornea; not covering/not obstructing vision. Unequal pupil size DEFINITION Ears > 10 cm in adults Ears < 4 cm in adults Age-related hearing loss DEFINITION Elongated/rounded projections in nasal cavity; Benign Inflammation of sinuses; post-infection of upper respiratory (slight) Septal ingrowth in lower nasal septum Nosebleed DEFINITION White patches on mouth/tongue mucosa Bony growths in hard palate Lip inflammation, cracking & drying Fissures at mouth corners (vitamin B deficiency) Reddened, smooth painful tongue (± ulcers) Fungal overgrowth due to normal bacteria inhibition (from antibiotics) Gum enlargement (pregnancy, leukemia, Dilantin/phenytoin use) ASSESSING FOR VIOLENCE 30 years: Domesitc Violence as a significant issue Past: Foucsed on ensuring safety for women & children o Fleeing from violent partners Present: Include serious affects of domestic violence on children o Effects o What done/assist perpetrators of abuse o Needs: Social services, housing, legal, health services Concern of the aspects of Interpersonal violence o Impact on basic human rights o To live free of violence & abuse o Recent data: Violence against women remains a substantial problem within the community ROLE OF NURSES Large group of service providers Central role: Caring, Early intervention, and Health promotion Improve the health status of communities Significant role in prevention and early intervention of domestic violence DEFINITIONS Violence Domestic Violence – Physical force: To harm someone, property, etc. – Pattern; abusive behavior – To gain control; aka Intimate violence Family Violence – Coerce/Controls family members = to be fearful – Violent, threatening behavior, etc. Aggression – Forceful; To dominate, master, etc. Physical Abuse – Pushing, shoving, slapping, kicking, choking, punching, and burning – Holding, tying, use of household item or common weapon – Neglect to provide care if the victim is sick, injured Psychological – Aka Emotional abuse – Constant insults or criticism – Victim blaming; Threatening to hurts children or pets, – Isolation, deprivation, humiliation from support – Stalking, intimidation, manipulation such as suicide. Elder Mistreatment – Aka Elder abuse – Neglect, physical, sexual, financial, psychological abuse – Exploitation, abandonment, or prejudicial attitudes – Decrease quality of life; demeaning to over the age of 65 Intimate Partner Violence (IPV) – Physical, sexual, or psychological harm by a current or former partner or spouse. – Psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion TRAUMA IN CHILDREN AND ADOLESCENTS TRAUMATIC EVENT(s) American children are exposed to traumatic life event. Threatens injury & death of others; Victim feels horror, terror, helplessness • Loss, Suicide • Sexual abuse, Physical abuse • Domestic violence, Community/School • Medical, Motor vehicle accidents • Terrorism, War experiences, Natural & Man-made disasters In community: 2/3 children experience traumatic events by age 16 39% – 85% witnessing community violence; high as 66% Sexual abuse: 25% – 43% More common for a child to be expose to more than one traumatic event Exposure to chronic & pervasive trauma = Vulnerable to sb/c trauma SIGNS AND SYMPTOMS Varies but all express distress or behavioral change PRESCHOOLERS: - Thumb sucking, bedwetting - Clinging to parents - Sleep disturbance - Loss of appetite - Regression & Withdrawal ELEMENTARY-SCHOOL CHILDREN - Irritability, aggressiveness - Clinginess, nightmare - School avoidance, poor concentration ADOLESCENTS - Sleeping & eating disturbance - Agitation & poor concentration - Conflicts, physical complaints, & delq. Behavior RECOVERY Majority manifests resilience due aftermath of traumatic events o True to single-incident exposure Multiple Trauma = History of Anxiety, family adversity = Higher risk of Post traumatic stress TRAUMA PREDICTION - No perfect predictors; Impeded by: ▪ Individual and family factors ▪ The severity of ongoing life stressors ▪ Community stress ▪ Prior trauma exposure ▪ Psychiatric comorbidities ▪ Ongoing safety concerns ▪ Poverty and racism ▪ Caretaker responses to trauma - - Patient (Individual, family, cultural, and community) strengths can facilitate recovery and promote resilience. Social, community, and governmental support networks are critical for recovery; More prevalent when: o Natural Disaster = When entire community is affected Minority of children develop severe acute or ongoing psychological symptoms. Patient with traumatic exposure/trauma-related psychological symptoms are not identified = Do not receive any help. Recognized and identified = Varies in treatment Treatment of Trauma in Children & Adolescents • • Historically focused on adults; limited data for children/adolescents. • Evidence-based, trauma-focused treatments: o Allow trauma review in a safe, secure environment. o Conducted with guidance from specially trained mental health professionals. Cognitive–Behavioral Therapy (CBT) is effective for persistent trauma in youth. ROLE OF MENTAL HEALTH PROFESSIONALS • Key in supporting recovery for children, adolescents, and families post-trauma. • Involvement includes: o Collaborating with first responders & community organizations. o Assisting existing clients affected by trauma. o Outreach to local children and families exposed to trauma. o Conducting research to identify effective, evidence-based treatments. o Volunteering: ▪ Register with APA’s Disaster Response Network. ▪ Offer services through local Red Cross chapters. ROLE OF ASSESSMENTS • • Use of standardized, validated tools is essential. Benefits: o o o o Ensures accurate diagnosis & guides treatment planning. Tracks symptom progression & return to baseline. Identifies co-morbid conditions. Supports broad trauma screening during intake or in community/agency settings. Theories of DOMESTIC VIOLENCE = Leads to Violence/Violent Behavior 1.) Pshychopathology theory – Batterers suffer personality disorders. 2.) Social learning theory – Violence is a learned behavior from childhood. 3.) Biologic theory – Physiologic changes: Childhood trauma, head injuries, or heredity. 4.) Family systems theory – Violence grows: Family system function; – Criticize this theory as blaming the victim. 5.) Feminist theory – Male/Female inequity in patriarchal societies. WALKER’S CYCLE OF VIOLENCE: Tension → Building → Explosion model CENTER for Domestic Violence Model by Center of Hope & Safety Organization 1.) Abuse 2.) Guilt 3.) Rationalization 4.) Normal Behavior 5.) Fantasy 6.) Planning 7.) Set-Up Types of Family Violence • Physical Abuse • Psychological Abuse • Economic Abuse • Sexual Abuse • Abandonment • Physical And Emotional Neglect • Parental Substance Abuse Categories Of Family Violence • Intimate Partner Violence • Child Abuse • Elder Mistreatment Other Types • School Violence (Bullying And Punking) • Hate Crimes • Human Trafficking • War Crimes NURSING DIAGNOSIS RELATED TO VIOLENCE HEALTH PROMOTION DIAGNOSIS • Readiness For Enhance Family Relationship • Readiness For Enhances Family Health Management RISK DIAGNOSIS • Risk for ineffective parent/infant/child/family health management related to family violence • Risk for violence related to presence of poor coping mechanism and the misuse of alcohol and illegal drugs • Risk for infection related to participation in forced sexual relationship ACTUAL DIAGNOSIS • Dysfunctional grieving related to loss of ideal relationship as evidenced by refusal to discuss feelings and prolonged denial • Impaired parenting related to choosing to remain lining in the presence of an abusive marriage or intimate relationship • Disturbed personal identity related to inability to function effectively outside of a victimized abusive role. • Anxiety related to inconsistency of behaviors and instability of abusive spouse or parent.
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