lucky08

thank you for your information! i am in ma. i will find a store to get it. i need tops for summer.

would you let me know when you get your order? thank you very much!

Hi, Would you recommend scrubs stores? I want to buy cheap top nurse scrubs? I heard only $5-7. If you know stores. Please let me know. Thank you very much:bowingpur!!

GO,Take a CNA class.If you work as a CNA you can improve your English fast. The same to me.When I came here in few year ago. Everything's hard to me. First year I took CNA class then I worked in subacute floor, a nursinghome. then I work in hospital. I am preparing for NCLEX-RN test now. My everything is going well. But my big problem is still in English.I have to study and work hard! It is never too old to learn!!

:ancong!:

good luck!!

psychiatric emergencies acute alcohol intoxication assessment: • drowsiness, slurred speech, tremor, impaired thinking ,nystagmus, nausea, vomiting, hypoglycemia, increased respiration, grandiosity, loss of inhibitions, depression nursing diagnosis: • injury , risk for nursing : • quiet environment ,allow to “sleep it off” • monitor vital signs • protect airway from aspiration • assess for injuries psychiatric emergencies hallucinogenic drug intoxication assessment : • eye: • red-marijuana; • dilated-lsd, mescaline, belladonna; • constricted-heroin and derivatives care plan: 1, talk down : * keep talking ,keep eyes open * focus on here and now, inanimate objects * use simple, concrete , repetitive statement, * repetitively orient to time, place * confidentiality; don’t moralize, challenge beliefs 2. medication * valium * lithium 3. hospitalization: (if more than 12-18hrs) psychiatric emergencies homicidal or assaultive reaction cause: * antisocial behavior, paranoid psychosis, previous violence, substance abuse, depression. intervention: * physically restrain if client has a weapon * separate from intended victims * approach: calm and unhurried * prevent suicidal behavior psychiatric emergencies suicidal • suicidal ideation • 1.concepts and principles related to suicide • 2.assessment of suicide • composite picture: male, older than 45 yrs, unemployed, divorced, living alone, depressed, history of substance abuse and suicide within family psychiatric emergencies----suicidal • 10 factors to predict potential suicide and assess risk: *age, sex and race: teenage, older age, more women make attempts, more men complete ; occurs in all races and socioeconomic groups. *recent stress related to loss. • clues to suicide: * verbal clues: direct “i am going to shoot myself ”; indirect: “this is the last time you’ll ever see me” * behavior clues: direct: pills, razor; indirect: sudden lifting of depression, buying a casket, giving away cherished belonging, writing a will. psychiatric emergencies----suicidal • suicide plan: the more details, the higher risk • previous suicidal behavior • medical and psychiatric status • communication: the risk reduced if the patient has talked about psychiatric emergencies----suicidal • style of life: such as substance abuse • alcohol: alcohol reinforce helpless and hopeless feeling • resources: the fewer resources, the higher risk psychiatric emergencies----suicidal nursing care plan • short-term goals * medical : gastric lavage, respiratory and vascular support, wound care • suicide precautions *one to one supervision at all time *check whereabout every 15 min *explain to client what you will be doing, and why accompany the client for tests, procedures *look through client’s belongs, remove any potentially harmful objects : pills, matches, belts, razors, glass, tweezers *allow visit, but maintain one-to-one supervision *check that visitors don’t leave potentially harmful objects *meal tray : contains no glass or metal silverware don’t discontinue without order psychiatric emergencies----suicidal • general approaches • observe closely at all times • be available ; empathy • avoid : extremes in your own mood • focus : directly on client’s self-destructive idea • make a contract: no suicide within 24 hrs; or call someone • point out client’s self-responsibility for suicidal act • support the part of the client that wants to live • remove sources of stress : make all decision when client is severe depression • prove hope: problem can be solved with help • provide with opportunity to be useful psychiatric emergencies pseudo suicide attempts: • cry for help • desire to manipulate others • need attention • self-punishment • wish to punish others • what will you do when you facing ~ ? crisis intervention • definition of crisis • sudden event in one’s life disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem a. maturational (internal, relate to developmental stages and associated role changes) b. situational (external, associate with a life event ) c. adventitious (relate to a disaster) crisis intervention • characteristic of crisis intervention: a. acute, sudden onset b. responsive to brief therapy with focus on immediate problem c. focus shifted from the psyche in the individual to the individual in the environment; deemphasis on intrapsychic aspects d. crisis is time limited (usually up to 6wk) crisis intervention nursing care plan: • goal: • return to precrisis level • focus here and how care plan: • encourage expressing • explore past coping skill and reinforce adaptive ones • set limit • use all resource domestic violence characteristics • 1.victims: feel helpless, powerless; blame themselves, ambivalent about leaving the relationship • 2. abusers: often blame the victims, use power to threaten and subject victims to their assault • 3.cycle of stages a. buildup of tension b. battering c. calm risk factors • learned responses • pregnant women and whose with one or more preschool children • women who fear punishments form abuser care plan a. provide safe environment; refer to community resources for shelter. b. treat physical injuries c. document injuries d. supportive, nonjudgmental approach e. encourage individual and family therapy for victim and abuser. rape-trauma syndrome assessment : • physical trauma • emotional trauma: tears, hyperventilation, anxiety, self-blame, anger, fears, phobia, sleeping and eating problem. nursing care: • acknowledge feeling, • handle legal matters and police contact • medical attention • notify family and friends • remain available and supportive • contraception discussing • explore guilt and shame feeling • maintain confidentiality and neutrality • health teaching : *avoid isolated areas and being helpful to strangers *how to resist attack : scream , run *teach what to do if pregnancy or std is outcome battered child clues in history: • delay in seeking medical care • discrepancies • multiple er visits • vague and contradictory story clue in physical examination: • child : withdrawn, apathetic, does not cry • child : doesn’t turn to parents for comfort; unusual desire to please parent; fear parents • child: poorly nourished • multiple bruises, old bruises in addition to fresh one • burns: cigarette burs, rope marks • clues in parent : exaggerate care and concern nursing : • report suspected child abuse • conduct assessment interview in private with child and parent separated • be supportive and nonjudgmental evaluation: • parents have agreed to seek help sexual abuse children assessment: (characteristic) • relationship: filling paternal role (uncle, grandfather, cousin) with unquestioned access to the child • methods of pressuring victim into sexual activity: offering material good, misrepresenting moral standards (“it is ok”) • methods of pressuring victim to secrecy : fearing of punishment ,no being believed, rejection, being blamed for the activity, abandonment disclosure: • direct visual or verbal confrontation and observation by others • verbalization of act by victim • visible clues : excess money and candy,, new clothes, pictures • sings and symptoms: bed-wetting; excessive bathing ,tears, avoiding school, somatic distress • overly solicitous parental attitude toward child sexual abuse children• child feeling: • guilty. • responsible for being a victim. • powerlessness nursing : • safe environment • encourage child to verbalize feeling • observe for symptoms: phobic reaction when hearing or seeing offender; sleep pattern changes, nightmares • look for silent reaction health teaching : * teach child that his (her) body is private * teach family elder abuse concepts: • elders who are currently being abused often abused their abusers • victim: diminished self-esteem, feeling responsibility for the abuse, isolated • abuser: physical or psychosocial stressors • legal : most states have mandatory laws to report elder abuse nursing : • early case finding , early treatment • report case to law enforcement agencies • provide elder with phone number • shelter • self help group sleep disturbance types of sleep : • rapid eye movement sleep • non-rem sleep • sleep cycle (90 min) • adolescents spend 30% rem of total sleep time; adults : 15% ; nursing care: • obtain sleep history • duplicate normal bedtime rituals • environment : quiet , dim lights, • encourage daytime exercise • allow uninterrupted sleep cycle: 90 min • back rub, warm milk, relaxation • taper off hypnotics • avoid caffeine and hyperstimulation at bedtime • what about taking a nap during daytime? eating disorders anorexia nervosa • anorexia nervosa is an illness of starvation related to a severe disturbance of body image and a morbid fear of obesity; it is an eating disorder, usually seen in adolescences. assessment: • body-image disturbance • ambivalence: hoards food; avoids food • low sex drive • pregnancy fears • self-punitive behavior leading to starvation • physical signs: *weight loss *amenorrhea and secondary sex organ atrophy *hyperactivity: compulsiveness, excessive gum chewing *constipation *hypotension, bradycardia, hypothermia *skin: dry, poor turgor bulimia • bulimia nervosa is another type of eating disorder (binge-purge syndrome) also encountered primarily in late adolescence or early adulthood. it is characterized by at least two binge-eating episodes of large quantities of high calories food over a couple of hours followed by disparaging self-criticism and depression, self-induced vomiting, abuse of laxatives, and abuse of diuretics are commonly associated． eating disorders analysis • a. altered nutrition, less than body requirements, and fluid volume deficit • b. risk for actual fluid deficit • c. risk for self-inflicted injury • d. altered eating • e. body –image disturbance/chronic low self esteem • f. compulsive behavior nursing care plan • help reestablish connections between body sensations (hunger) and responses (eating). *weigh regularly , at same time, with same amount of clothing , with back to scale *water drinking is avoided before weighing *one-to-one supervision during and after mealtime to prevent attempts to vomit food *monitor exercise program, set limits in physical activity • monitor physiological signs and symptoms • health teaching • explain normal sexual growth and development to improve knowledge and confront sexual fear • behavior modification to reestablish awareness of hunger • teach parents skills in communication evaluation: • attains and maintains minimal normal weight for age and height • regular meal • awareness hunger, talking about being hungry • increase self-esteem

mental and emotional disorders in children and adolescents • oral stage: ★ autistic spectrum disorders　　 • a. behave as through they cannot hear, see, etc. • b. don’t react to external stimulus • e. regression or fixation • f. can’t differentiates “me” from “not me” • g. very early onset, • h. bizarre, repetitive behavior • i. normal to above normal intelligence;failure to develop language or communication • etiology is unknown mental and emotional disorders in children and adolescents ★ asperger ’s syndrome: • speak at normal pace and have normal intelligence ,but have stunted social skills ,limited and obsessive interests • anal (1-3yr): • elimination disorders • constipation • encopresis(soiling) • intervention: avoid making an issue; avoid enemas; avoid rigid toilet training; toilet training: 18-24 mon • excessive rebelliousness (temper tantrums) • intervention: * avoid rigid limits; avoid inconsistency; avoid no limit set * temper : ignore it • enuresis • intervention: no problem: child under 4.5yr • shame • fluids restriction before bedtime • buzzer wakes using • oedipal(3-6yr) excessive fears assessment: • nightmares, sleep disturbances, fear of mutilation, afraid dark, • intervention: • night light, door open • avoid allowing the child to sleep with the parents • injection: cover, play out fears • excessive masturbation • regression • stuttering intervention: • avoid over reacting • develop other strategies for coping with anxiety and insecurity • latency(6-12yr) • attention deficit hyperactivity disorder • intervention: • medication: ritalin • special education • separation anxiety disorders (school phobia)—anxiety about school is accompanied by physical distress .usually observed with fear of leaving home, rejection by mother, fear of loss of mother, or history of separation from mother in early years. •intervention: • avoid allowing the child to stay home • avoid secondary gain during illness • conduct disorders-- include lying, stealing, running away ,truancy, substance abuse, sexual delinquency ,vandalism ,and fire setting; chief motivating force is either overt or covert hostility ;history of disturbed parent-child relations. • nursing care plan /implementation: • a. goals: behavior modification • b. help children gain self-awareness • c. impose limits on destructive behavior • d. counseling or therapy to resolve the underlying conflict mental health problems of the aged • need hope • have all right (decision; concerning their possessions ) • familiar objects in environment and familiar routines are important !!- tell stories about earlierà• fear to been unwanted, achievements • attention span and memory are short; loss recent memory • nocturnal delirium • insomnia • hypochondriasis • depression, high suicide rate • intellectual capacity • confabulation common behavioral problems anger • a definition • response to anxiety • assessment : • 1.degree of anger and frequency * anger * assertiveness * frustrationà *mild annoyance rage and fury • 2.mode of expression of anger 　* covert,passive expression of anger * overt ,active expression of anger • 3. physiological behaviors: epinephrine and sympathetic nervous (+) • cardiovascular • gastrointestinal • urinary • neuromuscular • nursing care plan • 1.prevent and control violence * unhurriedly * show acceptance: listen, refrain from arguing and criticizing * encourage expression • 2.limit setting * clearly state expectations and consequences of acts * encourage client to assume responsibility for behavior * explore reasons • 3.promote self-awareness and problem-solving abilities * accept self with a right to experience anger * alternatives for expressing anger: walking, sandbags combative-aggressive behavior nursing care plan: • immediate goal :prevent injury to self and others • calmly call for assistance, do not try to handle alone • approach cautiously: keep eye contact, keep distance • protect against self-injury~ • minimize stimuli • keep talking, divert attention • set limits (firm and consistent) on dangerous behavior • find the triggering cause, identify immediate problem • restraint as a last resort, place in quiet room • long-term goal: channel aggression—help person express feeling rather than act them out how to rechannel emotional energy? confusion/disorientation • a. definition: loss of orientation as to person, time, place, events, ideas. • b. assessment: note unusual behavior • make contact to reorient to reality * avoid startling * make sure person can see, hear, and talk to you, turn off tv, turn on night, put on client’s glasses, hearing aids… • use conversation to reduce confusion * call by name * introduce self by name * using simple concrete phases * keep your hand visible * allow time to concentrate • prevent confusion * explain what to expect * find out what meaning hospitalization has to client * room near nurse station * provide familiar objects * provide clock, calendar, radio * avoid using intercom * maintain routine demanding behavior assessment: • 1.attention-seeking behavior • 2.multiple requests • 3.frequent of questions • 4.lack of reasonableness analysis: • 1.feeling of powerlessness and fear • 2.a way of coping with anxiety • to : • * obtain satisfaction • * obtain control; self-esteem • * relief anxiety nursing care plan • 1. control own irritation • 2. anticipate and meet client’s needs; set time to discuss request • 3. confront with behavior; discuss reasons for behavior • 4.make plans with entire staff to set limits • 5.set up contract for brief, frequent, regular uninterrupted attention denial of illness dependence: assessment • 1. excessive need for advice and answers to problems • 2. lack of confidence in own decision-making ability and lack of confidence in self-sufficiency. • 3. too-trusting behavior • 4. helpless analysis • 1. chronic low self-esteem • 2. helplessness and hopelessness • 3.powerlessness nursing care plan • 1.long-term goal: increase self-esteem, confidence • 2.short-term goal :provide activities that promote independence. * limit setting: clear, firm, consistent * accept client but refuse to respond to demands * prevent cycle of dependence * give attention before demand exist * behavior-modification approaches : reward appropriate behavior * promote decision making hostility causes • a. anxiety • b. frustration, unmet need diagnosis • risk for violence (to self or others) related to a reaction to loss of self-esteem and powerlessness nursing care plan • 1.long-term goal: help alter response to fear, inadequacy ,frustration, threat • 2.short-term goal: express and explore feelings of hostility without injury to self or others * remain calm , nonthreatening * protect from self-harm, acting out * discourage hostile behavior while showing acceptance * avoid : arguing, giving advice (if i were you , i will …) * avoid : joking, teasing * avoid : words such as anger, hostility . using “upset, irriated” * avoid : physical contact * matter-of-factly (it sounds…; i can feel…; you look like …) * focus here-and-now * channel feeling into motor outlet manipulative assessment: • acting out sexually, physically • dawdles , always last minute • flattery, expects privileges • exploits generosity and fears of others • feels no guilt • plays one staff member against other • test limits • pretends to be helpless, lonely, tearful • plays on sympathy • offers many excuses, lacks insight • violates rules • betrays information • unable to learn from experience nursing care plan • 1. long-term goal: define relationship as a mutual experience in learning and trust rather than a struggle for power and control. • 2. short-term goals: increase awareness of self and others; increase self-control; learn to accept limitations. manipulative • set firm , realistic goal with clear, consistent limit • confront client • give positive reinforcement for nonmanipulation • ignore “wooden-leg behavior” • allow verbal anger, avoid irritating • set limit for destructive , aggressive behavior • keep staff informed , obtain staff consensus • don’t accept gifts, favors, flattery avoid: • a. labeling client as a “problem” • b. hostile, negative attitude • c. making a public issue of client’s behavior. • d. being excessively rigid or permissive, inconsistent or ambiguous, argumentative or accusatory.

:ancong!:

alzheimer’s disease • progressive, irreversible, loss of cerebral function due to cortical atrophy; > 65 yr; death : 8-10 yr assessment : • jocam : judgment ↓, orientation (confused, disoriented), confabulation, affect (unstable), memory (loss, especially name, recent events) • seizure • intellectual capacities ↓; especially abstract thought ; stay with familiar topics, repetition • personality changes : loss of ego flexibility, wandering away, hypochondriases ; aphasia, apraxia nursing diagnosis : • risk for trauma • altered thought processes • caregiver role strain related long-term illness nursing care: • long-term goal : minimize regression • short-term goal: provide structure and consistency to increase security • brief , frequent contacts, because attention span is short • allow clients time to talk and to complete • encourage review • concrete question • environment : same room , place, furniture, routine is important • confabulation : (how to deal with ) • recreational therapy :typing......

:ancong!:

Sorry,Sirisiri,I thought you know this book: Priortization,Delegation&Assignment by Linda A.LaCharity

It is good book.I bought this book which is a little bit hard then real nclex test. as a practice I used it.

psychosocial integrity • major theoretical models • psychodynamic model (freud) • psychosocial development model ( erikson, maslow, piaget, duvall) • erik erikson: eight stages of men • maslow: hierarchy of needs • piaget: cognitive and intellectual development • duvall: family development psychodynamic model (freud) • 1. structure of the mind : id, ego, superego; unconscious, preconscious conscious • • 2. stages of psychosexual development • oral (0-1yr ): dependency and oral gratification • anal (1-3yr): • phallic or oedipal 3-6yr • latency:6-12yr • genital 12-18 yr psychodynamic model (freud) • id • ego • superego erik erikson: eight stages of men • infancy ( 0-18 mo) : trust & mistrust • early childhood (18 mo-3 yr): autonomy & shame, doubt • late childhood (3-5 yr): initiative & guilt (always ask why, explore) • school age (5-12 yr): industry & inferiority • adolescence (12-18 yr): identity & role diffusion • young adulthood (18-25 yr): intimacy, solidarity & isolation • adulthood (25-60 yr) : generativity & self-absorption, stagnation • late adulthood (60 yr-death): ego integrity vs despair maslow: hierarchy of needs • physiological needs: abc • safety and security • love and belonging • self-esteem & esteem-of-others • self-actualization piaget: cognitive and intellectual development • infancy-2 yr: sensorimotor - solitary play • 2-4 yr: preconceptual-parallel play, imitation in play • 4-7 yr: intuitive –associative play (follow a leader) • ps: 2-7yr: • 7-11yr: concrete –cooperative play • 11 yr and older : formal operational thought community mental health model—level of prevention • a. primary prevention: low the risk of mental illness, increase the capacity; via providing guidance • b. secondary prevention: detect early signs to decrease disability, and reduce its severity • c. crisis intervention • d. tertiary prevention: rehabilitate to avoid permanent disorder four phases of body image crisis • 1.acute shock • 2.denial • 3.acknowledgment of reality • 4.resolution and adaptation body image disturbance caused by amputation • a. assessment 　　　 1. loss of self- esteem • 　　2. fear of abandonment may lead to appeals for sympathy • 　　3. feelings of castration • 　　4. existence of phantom pain • 　　5.lack of responsibility for use of disabled body parts • b.nursing care plan • 　1. not referring to client as the “ amputee ” • 　2.foster independence • 　3.help person set realistic short-term and long-term goals • 　4.health teaching body image disturbance in brain attack (stroke) • a.assessment • 1. feeling of shame • 2. body image boundaries disruppted • b.nursing care plan • 　1. reduce frustration due to communication problems by: • 　　a.rewarding all speech efforts. • 　　b. listening and observing for all nonverbal cues • 　　c. restating verbalization • 　　d. speaking slowly, using two- to three- word sentences • 　2. assist reintegration of body parts and function） • 　　a.tactile stimulation • 　　b.verbal reminders of existence of affected parts • 　　c.derect visual contact via mirrors and grooming • 　　d. use of safety features body image and obesity • definition: • body weight exceeding 20% above the norm for person ’ s age, sex, and height constitutes obesity.body mass index( bmi) is also used • the problem may not be difficulty in losing weight; reducing may not be the appropriate cure • nursing care plan: • 　1. encourage prevention of lifelong body image problems • 　　a.support breastfeeding b.help mothers to not overfeed the infant if formula- fed • 　　c.help mothers differentiate between hunger and other infant cries • 　3. assess current eating patterns　 • 　4. identify need to eat, and relate need to preceding events, hopes, fears, or feelings • 　5.employ behavior-modification techniques • 6.encourage outside interests not related to food or eating • 7.alleviate guilt • 　8.health teaching scope of human sexuality ----throughout the life cycle • components of sexual system • 　a.biological sexuality • 　b.sexual identity • 　c.gender identity • 　Ｄsex role behavior specific situations • 1. masturbation • 2. homosexuality • 3.sex and person who is disabled • 4.inappropriate sexual behavior :typing

good luck!!