1 * Chapter (2) Psychosocial, Nutritional and Sleep –Wakefulness Assessment Islamic University of Gaza faculty of Nursing

2 Psychosocial assessment *Involves, person's growth and development throughout his life *Discuss crises with the clients to assess relationship between health & illness. “ It depends on multiple G&D theories ”.

3 Infancy * Infancy 0-18months Early childhood 18moths- 6 years Middle childhood 6-10 years Preadolescence 9-12 years Adolescence years Young adulthood years Middle adulthood 40-65years Late adulthood 65 and more Stages of Age

4 Nutritional assessment *Nutrition plays a major role in the way an individual looks, feels,& behaves. *The body ability to fight disease greatly depends on the individual's nutritional status

5 Major goals of nutritional assessment 1.Identification of malnutrition. 2.Identification of over consumption 3.Identification of optimal nutritional status.

6 Components of Nutritional Assessment 1.Anthropometric measurement. 2.Biochemical measurement. 3.Clinical examination. 4.Dietary analysis.

7 Anthropometric measurement *Measurement of size, weight, and proportions of human body *Measurement includes: height, weight, skin fold thickness, and circumference of various body parts, including the head chest, and arm

8 Assess body mass index (BMI) to shows. High ratios of waist to hip circumference are associated with higher risk for illness & decreased life span. BMI = (wt. in kilograms) (High in meters) 2

9 Useful in indicating malnutrition or the development of diseases as a result of over consumption of nutrients. Serum and urine are commonly used for biochemical assessment. Biochemical Measurement

10 Clinical examination * Involves, close physical evaluation and may reveal signs suggesting malnutrition or over consumption of nutrients. *Examination alone doesn't permit definitive diagnosis of nutritional problem

11 Nutritional assessment technique Diet: Describe the type: regular or not, special, "e.g. teeth problem, sensitive mouth. Usual mealtimes: How many meals a day: when? Which are heavy meals? Appetite: "Good, fair, poor, too good". Weight: stable? How has it changed?

12 Usual eating places: Home, snack shops, restaurants. Ability to eat: describe inabilities, dental problems: "ill fitting dentures, difficulties with chewing or swallowing. Food preferences: e.g." prefers beef to other meats" Food dislike: What & Why? Culture related?

13 Elimination" urine & stool: nature, frequency problems Exercise & physical activity: how extensive or deficient Psycho social - cultural factors: Review any thing which can affect on proper nutrition

14 Taking Medications which affect the eating habits Laboratory determinations e.g.: "Hemoglobin, protein, albumin, cholesterol, urinalyses" Height, weight, body type "small, medium, large" Finally summarize your findings and determine the nutritional diagnosis and nutritional plan of care

15 Signs & symptoms of malnutrition dry and thin hair yellowish lump around eye, white rings around both eyes, and pale conjunctiva Redness and swelling of lips especially corners of mouth Teeth caries & abnormal missing of it

16 Dryness of skin (xerosis) sandpaper feels of skin Spoon shaped Nails "koilonychial“ Tachycardia, elevated blood pressure due to excessive sodium intake and excessive cholesterol, fat, or caloric intake Muscle weakness and growth retardation

17 Dietary analysis Food represent cultural and ethnic background and socio- economic status and have many emotional and psychological meaning

18 * Assessment includes usual foods consumed &habits of food * Ask the client to recall every thing consumed within the past 24 hour including all foods, fluid, vitamins, minerals or other supplements.

19 Don’t bias the client's response to question based on the interviewer's personal habits or knowledge

20 Diseases affected by nutritional problems 1- Obesity: excess of body fat. 2- Diabetes mellitus. 3- Hypertension. 4- Coronary heart disease. 5- Cancer.

21 Assessment of sleep- wakefulness patterns

22 Normal human has “homeostasis” (ability to maintain a relative internal constancy) Any person may complain of sleep-pattern disturbance as a primary problem or secondary due to another condition 1/4 of clients who seek health care complain of a difficulty related to sleep

23 Factors affecting length and quality of sleep 1.Anxiety related to the need to meat a task, such as waking at an early hour for work. 2. The promise of pleasurable activity such as starting a vacation. 3. The conditioned patterns of sleeping.

24 4. Physiologic wake up. 5. Age differences. 6. Physiologic alteration, such as diseases

25 Good sleep depends on the umber of awakenings and the total number of sleeping hours The nurse can assess sleep pattern by doing interview with the client or using special charts or by EEG

26 Disorders related to sleep 1.Sleep disturbances affects family life,employment, and general social adjustment 2. Feelings of fatigue, irritability difficulty in concentrating 3. Difficulty in maintaining orientation

27 4. Illusions, hallucination (visual & tactile ) 5. Decreased psychomotor ability with decreased incentive to work 6. Mild Nystagmus 7. Tremor of hands

28 8. Increase in gluco-corticoid and adrenergic hormone secretion 9. Increase anxiety with sense of tiredness 10. Insomnia "short end sleeping periods“

Sleep apnea "periodic cessation of breathing that occurs during sleep 12. Hypersomnia: "sleeping for excessive periods" the sleep period may be extended to hours a day 13. Peri-hypersomnia. "Condition that is described as an increased used for sleep "18-20 hours a day" lasts for only few days

Narcolepsy "excessive day time drowsiness or uncontrolled onset of sleep. 15. Cataplexy: abrupt weakness or paralysis of voluntary muscles e.g. arms, legs & face last from half second to 10 minutes, one or twice a year 16. Hypnagogic hallucinations: " Disturbing or frightening dream that occur as client is a falling a sleep

31 Assessment of sleep habits Let the client record the times of going to sleep and awakening periods, including naps. Allow client to described their sleep habits in their own words.

32 you can ask the following questions: How have you been sleeping?“ "Can you tell me your sleeping habits?“ "Are you getting enough rest?“ "Tell me about your sleeping problem"

33 History includes a general sleep history, psychological history, and a drug history

34 Questions?