History of Nursing
knowledge of the manner in which drugs
Brief History of Nursing
In the early dawn of human history, diseases
or illness were often related to superstitious
beliefs and the treatment also often involved
magical cures.
The Sumerian Civilization is believed to have
recorded in a clay-tablet 4,000 years ago some
healing prescriptions but did not specify the
illnesses.
The Code of Hammurabi traceable to the
Babylonian empire in 1900 BC documented
regulations pertaining to sanitation and
public health, the practice of surgery,
differentiation in the practice of human
against veterinary medicine, a table of
fees for operations and penalties for
violation of the code. During these early
days, nursing practice was vaguely described as
those who render comfort and support to
patient. In the Old Testament, it made mention
of women as nurses who provided care for
infants and children, the sick and dying.
The Greek and Roman empires related the
care of the sick and those injured to the
mythologies that they have created and
believed that the gods and goddesses
possessed special healing powers. Hygeia,
daughter of Greek god Asklepios, the chief
healer, was revered to be the embodiment of
the nurse.
Ancient India – Nursing functions were being
carried out by male nurses provided they meet
the four qualifications:
1.
Nursing in Philippines
should be prepared for administration
2. cleverness
3. devotedness to the patient
4. purity of mind and body
Christian Benevolence- “love thy neighbor as
thyself” had a significant impact on the
development of Western Nursing.
The principle of “Good Samaritan” is the basis
of caring for most Christians that eventually laid
down some principles of nursing.
During the time of the Roman Empire, rich
matrons such as Fabiola used their wealth to
provide houses of care and healing that served
as the early hospitals for the poor, sick and the
homeless.
The Time of Crusades ( Holy mission or pilgrim
to regain the Holy land by the Christians),
knights were trained to provide care for
the wounded soldiers in the battle – this is
perhaps the earliest recognition of men
providing nursing care.
Camillus De Lellis – considered the patron
saint of nurses was the founder of the
Nursing Order of the Ministries who
provided care to the sick and the poor.
Florence Nigthangle born from a wealthy
family chose to dedicate her life in providing
care for the sick and injured especially during
the Crimean War. She also started a school to
train nurses in 1860, which eventually sparked
the development of Modern Nursing.
The Philippine Nurses Association (PNA)
established in 1922 was responsible in lobbying
our government for the adoption of the
recommendations made by the International
Labor Organization in 1977 with regard the
status of the economic and social welfare of our
nursing personnel.
The Professional Regulation Commission of the
Philippines duly recognizes the PNA as the
leading Association of nurses in the
country. In 1924, it published a standardized
curriculum for schools of nursing to adopt.
The following were the first groups interested
and registered with the Philippine Nurses’
Association (PNA), to wit:
1. Academy of Nursing of the Philippines, Inc.
(ANPHI)
2. Association of Deans & Principals of Schools
and Colleges of Nursing of the Philippines
(ADPSCNP)
3. Association of Nursing Administrators of the
Philippines ( ANSAP)
4. Association of Private Duty Nurse
Practitioners of the Philippines (APDNPP)
5. Critical Care Nurses’ Association of the
Philippines (CCNAP)
6. Catholic Nurses Guild of the Philippines
(CGNP)
7. Golden Age Nurses Association (GANA)
8. Ministry of Health National League of Nurses
(MHNLN)
9. Occupational Health Nurses Association of the
Philippines (OHNAP)
10. Operating Room Nurses Association of the
Philippines (ORNAP)
11. Philippine Nurse Midwifery Society
12. Philippine Nursing Students Association
(PNSA)
13. Philippine Orthopedic Nurses Society
14. Psychiatric Nursing Specialists Foundation of
the Philippines, Inc. (PNSI)
15. Philippine School Nurses Association (PSNA)
The following are the later members of the PNA:
1. Association of Diabetes Nurse Educators of
the Philippines (ADNEP)
2. Graduate Nurses Christian Fellowship (GNCF)
3. Integrated Nurses Association of the
Philippines (IRNUP)
4. National League of Philippine Government
Nurses (NLPGN)
5. Maternal and Child Nurses Association of the
Philippines (MCNAP)
6. Military Nurses Association of the Philippines
(MNAP)
7. Philippine Oncology Nurses Association
(PONA)
8. Philippine Orthopedic Nurses Society (PONS)
Nature of Nursing
* Nursing is derived from the Latin word “
Nutrix” which means to nourish.
* Nursing is also defined as an art and science.
It is an art for should have skills that require
proficiency and dexterity. It is Science because
it requires the systematic approach or
application of the scientific knowledge.
* Nursing is a profession focused on assisting
individuals, families, and communities in
attaining, maintaining, and recovering optimal
health and functioning. Modern definitions of
nursing define it as a science and an art that
focuses on promoting quality of life as defined
by persons and families, throughout their life
experiences from birth to care at the life.
* Nursing practice is primarily the caring
relationship between the nurse and the person
in their care. In providing nursing care, nurses
are implementing the nursing care plan, which
is based on a nursing assessment.
According to Nursing Theorists:
Florence Nightingale (1860), the first nurse
theorist defines Nursing as "The act of utilizing
the environment of the patient to assist him in his
recovery"
(12 May 1820 – 13 August 1910) was a
celebrated English nurse, writer
and statistician.
She was dubbed "The Lady with the Lamp"
after her habit of making rounds at night.
Nightingale laid the foundation of
professional nursing with the establishment,
in 1860, of her nursing school at St
Thomas' Hospital in London, the first
secular nursing school in the world.
The annual International Nurses Day is
celebrated around the world on her birthday.
Virginia Henderson (1955) The unique
function of the nurse is to assist the
individual, sick or well, in the performance of
those activities contributing to health or its
recovery (or to a peaceful death) that he would
perform unaided if he had the necessary strength,
will or knowledge. And to do this in such a way as
to help him gain independence as rapidly as
possible."
Betty Neuman (1972, 1982, 1989, 1992)
Nursing is a unique profession in that it is
concerned with all the variables affecting an
individual’s response to stressors.
Myra Estrin Levine (1973) "nursing is
conserving or 'keeping together' the patient's
energy and structural, personal, and social
integrity as he/she struggles towards health and
well-being to achieve a positive adaptation"
Hildegard Peplau (1952) "nursing is a
significant, therapeutic, interpersonal process that
functions cooperatively with other human
processes which make health possible for
individuals"
Imogene M. King (1971, 1981)"nursing is an
interpersonal process of action, reaction,
interaction, and transaction whereby nurse and
patient share information about their perceptions
in the nursing situation"
Sister Callista Roy (1979)"as a science, nursing
is a developing system of knowledge about
human beings used to observe, classify, and
relate the processes by which persons positively
affect their health status"
Joyce Travelbee (1966, 1971)Nursing is an
interpersonal process whereby the professional
nurse practitioner assists an individual, family, or
community to prevent or cope with the
experience of illness and suffering, and if
necessary, to find meaning in these experiences.
Martha Rogers (1970), A learned profession
that is both science and art. The professional
practice of nursing is creative and imaginative
and exists to serve people.
Jean Watson (1979) Nursing is a human science
of people and human health; illness experiences
that are mediated by professional, personal,
scientific, aesthetic, and ethical human care
transactions.
Ernestine Wiedenbach (1964)Nursing is the
nurse is a functional human being who acts,
thinks, and feels. All actions, thoughts, and
feelings underlie what the nurse does.
Ida Jean Orlando (1961) Professional nursing is
conceptualized as finding out and meeting the
client’s immediate need for help.
Lydia Hall (1964)Caring is the nurse’s primary
function. Professional nursing is most important
during the recuperative period.
Professional definitions of nursing
International Council of Nurses (ICN) (1973)
"the unique function of the nurse is to assist the
individual, sick or well, in the performance of
those activities contributing to his health, or its
recovery (or to peaceful death) that he would
perform unaided if he had the necessary strength,
will, or knowledge and do this in such a way as to
help him gain independence as rapidly as
possible"
American Nurses Association (ANA) Social
Policy Statement (1980) "Nursing is the diagnosis
and treatment of human responses to actual or
potential health problems”
Scope of Nursing Practice:
This involves 4 areas:
1.Promoting health and wellness
2.Preventing illness
3.Restoring Health
4.Care of Dying
Nursing Theories
4 Concepts of Central Nursing:
• Person
• Environment
• Nursing
• Health
Nightangle’s Environmental theory –
Florence Nightangle, “the mother of modern
nursing” esposed her theory focusing on the
environment. She linked health with five
environmental factors:
1. pure or fresh air
2. pure water
3. efficient drainage
4. cleanliness
5. light
Henderson’s Definition of Nursing
- The definition of nursing given by Virginia
Henderson in 1955 became a milestone in the
development of nursing as discipline apart from
medicine. The focus on her Nursing Concept is
to help individuals and families gain
independence in meeting the 14 fundamental
needs;
1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within normal
range by adjusting clothing and modifying the
environment
8. Keeping the body clean and well-groomed to
protect the integument
9. Avoiding dangers in the environment and
avoiding injuring others
10.Communicating with others in expressing
emotions, needs, fears, or opinions
11.Worshipping according to one’s faith
12.Working in such a way that one feels a sense
of accomplishment
13. Playing or participating in various forms of
recreation
14. Learning, discovering, or satisfying the
curiosity that leads to normal development and
health, and using available health facilities.
Rogers’s Science of Unitary Human Beings
- Martha Rogers views the person as an
irreducible whole, the whole being greater than
the sum of its parts. Her Key concepts in
describing the individual are energy fields,
openness, pattern and organization, and
multidimensionality.
She described the Unitary Man as:
1. Irreducible, four-dimensional energy field
identified by pattern.
2. Manifesting characteristics different from the
sum of the parts
3. Interacts continuously and creatively with the
environment
4. Behaving as a totality
5. Participating creatively in change

Orem’s Self Care Deficit Theory
– Dorothy Orem developed the self-care deficit
theory that includes self-care, self-care deficit
and nursing system. She believed that the self-
care of the individuals and the self-care of
dependents are learned behaviors that
individuals initiate and perform on their own
behalf to maintain life, health, and well-being.
Three kinds of self-care requisites:
1. Universal requisites ( common to everybody
like maintenance of air, water etc…)
2. Developmental requisites
3. Health deviation requisites
Roy’s Adaptation Model – Sister Callista
Roy focuses on the individual as a biophysical
adaptive system. Both the individual and the
environment are sources of stimuli that require
modification to promote adaptation, an ongoing
purposive response.
3 classes of stimuli:
1. Focal Stimulus: the internal or external
stimulus most immediately confronting the
person and confronting the behavior.
2. Contextual stimuli: all other internal or
external stimuli present
3. Residual Stimuli: beliefs, attitudes, or traits
having an intermediate effect on the person’s
behavior but whose effects are not validated.
King’s Goal Attainment Theory –
Imogene King based her theory from the
conceptual framework of three dynamic
interacting systems:
1. personal system concepts: perception,
self, body image, growth and development,
space and time
2. Interpersonal system concepts:
interaction, communication, transaction, role,
and stress.
3. Social system concepts: organization,
authority, power, status, and decision making.
Neuman’s Health Care Systems Model
– Betty Neuman views the client as an open
system consisting of a basic structure or central
core of energy resources (physiologic,
psychologic, sociocultural, developmental, and
spiritual) surrounded by two concentric
boundaries or rings referred to as lines of
resistance. She identified individual’s response
to stress and the nursing interventions to be
carried out on three preventive levels:
1. Primary prevention
2. Secondary prevention
3. Tertiary Prevention
Johnson’s Behavioral System Model
- Dorothy Johnson defines a system as a
whole that functions as a whole by virtue of the
interdependence of its parts. A behavioral
system is patterned, repetitive and purposeful.
Johnson’s key concepts describes the
individual as a behavioral system
composed of seven subsystems:
1. Attachment-affiliative subsystem provides
survival and security.
2. Dependency subsystem promotes helping
behavior that calls for a nurturing response.
3. Ingestive system satisfies appetite.
4. Eliminative subsystem excretes body wastes.
5. Sexual subsystem functions dually for
procreation and gratification.
6. Achievement subsystem attempts to
manipulate the environment.
7. Aggressive subsystem protects and preserves
the self and society within the limits imposed by
the society.
Peplau’s Psychodynamic Nursing Theory-
Hildegard Peplau introduced and defined
psychodynamic nursing as understanding one’s
own behavior to help others identify felt
difficulties and applying principles of human
relations to problems arising during the
experience. She also described the nurse-
patient relationship in four phases:
1. Orientation – patient seeks help and the
nurse assists patient to understand the problem
and the extent of need for help.
2. Identification - patient assumes a posture of
dependence, interdependence, and
independence in relation to the nurse
3. Exploitation - patient uses available services
on the basis of self interest and needs
4. Resolution - old needs and goals are put
aside and new ones adopted.
Leininger’s Transcultural Care Theory
– Madeleine Leininger established the
transcultural nursing which she defined as a
major area of nursing that focuses on
comparative study and analysis of different
cultures and subcultures in the world, with
respect to their:
1. Caring behavior
2. Nursing care
3. Health values
4. Beliefs
5. Patterns
Watson’s Philosophy and Science of
Caring
– Jean Watson believes the practice of caring is
central to nursing; it is a unifying focus for
practice.
According to her, there are two major
assumptions that underlie human care
(carative factors):
1. care and love constitute the primal and
universal psychic energy
2. care and love are requisite for our survival
and the nourishment of the society
b. Communicator – communicate with the
client, support persons, other health
professionals, and people in the community.
- identify client problems and then communicate
these verbally or in writing to other members of
the health team. The quality of a
nurse’scommunication is an important factor in
nursing care.
i. Case manager –managers work with the
multidisciplinary health care team to measure
the effectiveness of the case management plan
and to monitor outcomes.
j. Research consumer – nurses often use
research to improve client care. In a clinical
area nurses need to:

TRANSCULTURAL CONCEPTS
HINDU – REINCARNATION , AUTOPSY , ORGAN
DONATION,CREMATION
ISLAM – NO TO ORGAN DONATION ,
CREMATION AND AUTOPSY …..CONFESS AND
TURN TO MECCA
JUDAISM – WASHED
NATIVE AMERICAN – NOT TO AUTOPSY
BUDDIST – OK – EUTHANASIA AND WITH LAST
RITES
HINDU- all meats and animal shortening
ISLAM- pork , alcohol and beverages(extracts
of lemon and vanilla) , animal shortening and
gelatin made of pork
JUDAISM – pork , fowl , shellfish and scavenger
fish( without scales or fins) , blood by
ingestion(transfusion –o.k.), packed fods
– kosher-properly presserved or fitting
KOSHER- no meat and milk altogether
Pareve – made without milk or meat items
MORMON – alcohol, tobacco, beverages with
caffeine stimulants
7TH DAY ADVENTIST – pork , certain seafoods
including shelfish, fermented beverages ,
vegetables are encouraged
YIN AND YANG – cold foods in hot illness , vice
versa
Hot – rash , fever , sorethroat , surgery , ulcer ,
infection
Cold – Ca , HA , stomach cramps and colds
ROLES AND FUNCTION OF A NURSE
a. Caregiver –assist the client physically and
psychologically while preserving the client’s
dignity.
-encompasses the physical, psychosocial,
developmental, cultural and spiritual levels.
c. Teacher –helps clients learn about their · Have some awareness of the process and
health and the health care procedures they language of research
need to perform to restore or maintain their · Be sensitive to issues related to protecting the
health. rights of human subjects
- assesses the client’s learning needs and · Participate in identification of significant
readiness to learn, sets specific learning goals in researchable problems
conjunction with the client, enacts teaching · Be a discriminating consumer of research
strategies and measures learning. finding.
d. Client advocate –acts to protect the client. Health
- represent the client’s needs and wishes to
other health professionals, such as relaying the
WHO - 1947 - Health is a state of complete
client’s wishes for information to the physician.
mental, physical, and emotional well being, and
-assist clients in exercising their rights and help
not merely the absence of disease or infirmity
them speak up for themselves.
President's commission - 1953 - Health is
e. Counselor –helping a client to recognize and
not a condition but an adjustment; not a state
cope with stressful psychologic or social
but a process; the process adapts the individual
problems, to developed improved interpersonal
to the physical and social environment
relationships, and to promote personal growth.
- providing emotional, intellectual, and
WHO definition - advantages:
psychologic support.
holistic
total person (physical, psych, social)
f. Change agent –to make modifications in
health in context of environment - health
their own behavior.
influenced by everything they interact with (air,
- act to make changes in a system such as
water, people)
clinical care, if it is not helping a client return to
equates health with productive, creative living
health.
WHO definition - disadvantage:
g. Leader –influences others to work together
use of the concept "complete" health - R/T
to accomplish a specific goal.
chronic illness
-requiring an understanding of the needs and
goals that motivate people, the knowledge to
Definitions of health
apply the leadership skills, and the interpersonal
- freedom from signs of disease and pain as
skills to influence others.
much as possible
-being active and able to do what they
h. Manager – manages the nursing care of
want/must
individuals, families, and communities.
-being in good spirits most of the time
-delegates nursing activities to ancillary workers
HEALTH IS AN ONGOING PROCESS - A WAY OF
and other nurses, and supervises and evaluates
LIFE!
their performance.
Nurses must be aware of their own definition of
health - clients may have different definitions
Nurses must clarify their beliefs about health:
1. Nurse's definition of health largely
determines the scope and nature of their
practice (when health definition is broader than
physiologic, then scope of practice broadens)
2. People's health beliefs influence health
practices
Health - a complex phenomena
Researchers - models:
Smith's 4 models of health
1. Clinical Model - narrowest -
People are physiologic systems
Health - an absence of signs/symptoms of illness
- not being sick Opposite of health
-disease/injury
MD's often use the clinical model-- when signs &
sxs of disease are no longer present in a person,
the MD often considers that the person's health
is restored.
2. Role Performance Model
Health defined in terms of being able to fulfill
your work role
Sickness - inability to perform work
3. Adaptive Model
Health - a creative process
Disease - a failure in adaptation (maladaptation)
Aim of Tx - help person adapt/cope
Good health - flexible adaptation to
environment and interaction with environment
to maximal advantage
4. Eudaemonistic Model - most
comprehensive view of health
Health - a condition of actualization or
realization of a person's potential (sounds like
Maslow). A client would be considered healthy
when he realized his full potential.
The highest aspiration of people - fulfillment and
complete development (actualization)
Illness - a condition that prevents self
actualization
· Leavell and Clark's "Agent, Host, Environment"
Model
Also called the ecological model
Theory of multiple causes of disease
Contains 3 dynamic interactive elements:
1. Agent - environmental factor/stressor that by
presence/absence can lead to disease.
eg: lack of essential nutrients, etc.
2. Host - person who may/may not be at risk of
acquiring a disease
eg: family history, age, life-style
3. Environment - Factors external to the host
that may/may not predispose person to
development of the disease. eg: living
conditions, economic status, etc.
Health is ever changing
Health maintained when variables are in
balance
Disease - when variables not in balance
Health-Illness Continua (Grids or Graduated
Scales)
- used to measure a person's perceived level of
wellness
· Dunn's High Level Wellness Grid
Health axis and environmental axis
intersect
Demonstrates the interaction of the
environment with the illness/wellness
continuum.
Health axis - from peak wellness to death
Environmental axis - from very favorable to
very unfavorable
The intersection of the two axes forms
four health/wellness quadrants:
1. wellness, environment
- person is healthy and has resources to support
this
2. emergent level wellness in an
unfavorable environment
- person knows about healthy lifestyle practices,
but cannot implement due to family
responsibilities, job demands, etc.
3. Protected poor health in a favorable
environment
- person is ill but needs met by health care
system
4. Poor health in unfavorable environment
- for example a starving child in a famine
stricken land; the working poor with health
problems
Dunn - family wellness enhances individual
wellness; community wellness enhances family
wellness, which enhances individual wellness
Travis's Illness/Wellness Continuum
Continuum ranges from high level wellness to
premature death
2 arrows point in opposite directions and are
joined at a neutral point
Movement to the right indicates increasing
health.
Neutral point to left - progressive decline in
health
Health & well-being are achieved in 3
steps:
awareness
education
growth
Can be physically ill but oriented toward
wellness, or physically healthy and be
functioning from an illness mentality.
Important not only where you are but also what
direction you are facing
This model considers not only the physical, but
also the spiritual, emotional, and intellectual
aspects of wellness.
Health Belief Models
· Rosenstock
Originally intended to predict which people
would or would not use preventive health
services
(eg flu shot, HIV testing, hypertension
screening, etc.)
Based on motivational theory
Assumption: good health is an objective
common to all people
Individual perceptions:
perceived susceptibility
perceived seriousness
perceived threat
Modifying factors - (which modify the person's
perceptions)
Demographic variables - age, sex, race,
ethnicity
Sociopsychological variables - social pressure,
peer group pressure
Structural variables - knowledge about target
disease and prior contact with it
Cues to action - mass media campaigns, advice
from others, newspaper/magazine articles,
illness of family/friend
Likelihood of action - perceived benefits of
action, minus perceived barriers to action
Pender: - 2 further considerations
1. Importance of health to person
2. Perceived control - locus of control
What is YOUR personal definition of health??
Variables influencing health status, belief, and
practices
Definitions:
· Health status - state of health of a person at
a given time; describes one's problem in general
· Health beliefs - concepts about health that a
person believes to be true; may or may not be
true; may be cultural (eg: hot/cold - not
necessarily related to the temp of food/fluid, but
rather its intrinsic qualities -- citrus and fowl are
cold; meats and breads are hot)
· Health behavior - actions people take to
understand health status, maintain optimum
state of health, prevent illness/injury, reach
maximal physical/mental potential
Internal Factors Influencing Health:
1. Biologic dimension
· Genetic makeup - influences biologic
characteristics, innate temperament, activity
level, and susceptibility to specific diseases
(diabetes, breast cancer)
· Race - predisposition to certain diseases (eg:
blacks - hypertension, sickle cell anemia; Native
Americans - diabetes; Jewish - Tay Sachs
disease; Mediterranean and SE Asia -
thalassemia
· Sex - influences distribution of diseases
Females/ Males: osteoporosis /stomach ulcers;
autoimmune disorders/ abdominal hernias;
lupus /resp. diseases; rheum. arthritis/ ASHD;
anorexia/bulimia hemorrhoids;gallbladder disea
se/ TB; thyroid disease; obesity
· Age/developmental level Distribution of
disease varies with age (ASHD - middle age
males, chicken pox - childhood Developmental
level - strong influence on health (Infants -
physiologically immature; toddlers - prone to
accidents/injuries; Adolescent - risk taking
behaviors due to need to conform with peers;
Elderly - declining physical and
sensory/perceptual abilities limit ability to
respond to environmental hazards falls, MVA's)
2. Psychologic dimension - emotional factors
· Mind/body interaction - influences health
positively or negatively. Emotions in response to
stress affect body function ( eg anxious student
prior to exam, family of hospitalized patient.
Prolonged emotional stress may increase
susceptibility to organic disease Emotional
distress may influence the immune system
through CNS and endocrine alterations
Increasing attention being given to mind's
ability to direct body's functioning
Relaxation - childbirth; Biofeedback -
hypertension, Meditation
Self concept - how a person views himself
Composed of:
1. self esteem - how he sees himself
2. body image - how he perceives his physical
self
(eg: anorexia) Affects how people view and
handle situations
3. Cognitive dimension - intellectual factors
· Life style choices: Patterns of eating; exercise;
use of tobacco, alcohol, drugs; methods of
coping with stress
Problems: overeating, inactivity, abuse of
alcohol/drugs, use of tobacco
· Religious/Spiritual Beliefs: Jehovah's Witnesses
- no blood transfusion
Some fundamentalists believe serious illness is
a punishment from God
"..in pain shall you bring forth children..."
Orthodox Jewish - circumcision on 8th day,
Kosher dietary laws
External Factors Influencing Health
1. Geography
Geography determines climate which effects
health
tropics - malaria
climate – asthma
2. Environment
Pollution - air, water, soil
Carcinogens - asbestos
Radiation - machines, UV
Acid rain - main component is sulfur dioxide of
industrial origin; thought to damage forests,
lakes, rivers
Greenhouse effect - roof of greenhouse allows
heat of sun to penetrate, but resulting heat
cannot escape through glass;
CO2 in atmosphere acts as glass roof - therefore
earth's temp is increasing
Pesticides
Chemicals
Ozone layer
3. Standard of living - reflects occupation,
income, and education
All relate to health, mortality, and morbidity (ex:
low income - generating & maintaining an
income are highest priority - illness prevention
is a lower priority - often cannot afford regular
medical exams, good housing, nutritional food -
health may be defined in terms of work -
reliance on medicaid - poor environment (poor
quality housing and neighborhoods)
Occupational roles predispose some to illness
black lung - coal miners
asbestos, noise, repetitive motion injuries
4. Family/cultural beliefs
Family passes on patterns of daily living and life
styles to offspring (ex: child abuse)
Cultural/social interactions influence how a
person perceives, experiences, and copes with
health and illness
Cultures have distinctive ideas about health,
and these are transmitted from parents to
children
Home remedies may be perceived as superior to
conventional medicines
5. Social support networks
Family, friends, confidantes, co-workers
These influence a person's ability to avoid
illness; can also help them confirm that an
illness exists; can provide stimulus to recovery
Compliance - (also known as adherence) - the
extent to which an individual's behavior (ex-
med taking, diet, lifestyle changes, etc) coincide
with medical/health advice.
A client is "compliant" if he/she takes his
medication, follows a prescribed diet, follows
instructions, etc.
A client is "noncompliant" if he/she does NOT do
these things.
Extent of compliance can be measured on a
continuum
total disregard «--------------» completely
following advice for all aspects of the
therapeutic plan
Factors influencing compliance:
Client motivation to become well
Degree of lifestyle change necessary
Perceived severity of health care problems
Value placed on reducing risk of illness
Difficulty understanding/performing specific
behaviors
Degree of inconvenience of illness/performing
specific behaviors
Belief that prescribed therapy or regimen
will/will not help
Complexity, side effects, and duration of
prescribed therapy
Specific cultural heritage that makes
compliance difficult
Degree of satisfaction and quality and type of
relationships with health care providers
Overall cost of prescribed therapy
When client does not follow regimen - find
out WHY - then assist to comply:
· Establish why
· Demonstrate caring
· Encourage healthy behaviors through positive
reinforcement of what the person is doing right
· Use aids to reinforce teaching: videos, audio
cassette, print media, verbal instruction
· Establish therapeutic relationships
WELLNESS AND WELL BEING
Wellness - a state of well being; engaging in
attitudes and behaviors that enhance quality of
life and maximize personal potential
Concepts of Wellness include:
wellness is a choice & a way of life
self responsibility
an ultimate goal
a dynamic growing process
wellness is the loving acceptance of yourself
DAILY decision making in the areas of
nutrition
stress management
physical fitness
preventive health care
emotional health
other aspects of health
5 dimensions of wellness;
1. Physical - ADL's (activities of daily living),
fitness, nutrition, body fat, no drugs,
moderate/no alcohol, no tobacco
2. Social - interact successfully with others,
intimacy, respect, tolerance
3. Emotional - manage stress, express emotions,
express feelings, accept limitations
4. Intellectual - learn; use information effectively
for personal, family, and career development;
continued growth
5. Spiritual - a force/Being that unites people
and gives meaning/purpose to life;
morals/values/ethics
Illness and Disease
People may view them as the same
entity; health professionals view them
differently
· Illness - a highly personal state in which the
person feels unhealthy or ill; may/may not be
R/T a disease. Can have a disease but not feel
ill...Can feel ill but not have a disease. Illness is
subjective - only the person can say if he/she ill
· Disease - alteration in body function resulting
in reduction of capacity or shortening of normal
life span. Theories of disease - "forces", evil
spirits. Later this belief was replaced by the
single causation theory.
Causation of disease = etiology
Classification of illness and disease:
· Acute illness - severe symptoms, short duration,
sx appear suddenly & subside quickly, may/may
not require intervention by health care
professionals, may possibly be treated with OTC
meds, after acute illness, most return to a normal
level of wellness
· Chronic illness - duration usually 6 months or
longer, often for the rest of person's life, many do
not regard themselves as ill, slow onset, may have
remissions (symptoms disappear) & exacerbations
(symptoms reappear)
· Deviance - behaviors that go against societal
norms - often considered chronic illnesses (ex:
addictions)
Illness behaviors - activities undertaken by a
person who feels ill to define the state of his
health and to discover a suitable remedy
Bauman - 3 criteria to determine illness: presence
of symptoms, perception of how they feel, ability
to carry out ADL's
Effects of illness
Illness causes change in many normal behaviors
1. Privacy -
when a person enters a health care facility,
immediate loss of privacy (bodily privacy,
personal space, informational)
Privacy is a personal internal state. It is a
comfortable feeling reflecting a deserved degree
of social retreat or freedom from unauthorized
intrusion.
2. Autonomy -
ex) decisions about meals, hygiene, sleep decided
by staff.
Degree of sense of autonomy varies from person
to person
3. Financial burden
4. Lifestyle changes - definition - p 257
Help clients adjust to this by:
Providing explanations about necessary
adjustments
Try to accommodate their lifestyle as much as
possible
Encourage other health care professionals to
become aware of lifestyles and
support positive aspects
Reinforce desirable changes in client behavior
with a view to making them permanent part of
lifestyle
5. Family changes - dependent on
the member of the family who is ill
seriousness/length of illness
cultural/social customs parents follow
Types of changes that can occur in family:
role changes; task reassignment; stress R/T
anxiety about outcome of illness for client and
conflict about unaccustomed responsibilities;
financial problems; loneliness as a result of
separation and pending loss; changes in social
customs
Trends in Health and Illness
· Mortality - death rate
· Longevity - life expectancy
· Morbidity - illness/disease
Promoting Health and Wellness
Health promotion - any activity undertaken for
the purpose of achieving a higher level of health
and well being.
Health promotion activities are directed toward
developing client resources that maintain or
enhance well-being.
Levels of prevention
1. Primary prevention - Generalized health
promotion and specific protection against
disease; it precedes disease or dysfunction and
is applied to generally healthy individuals, but
may also be offered to clients regardless of their
health/illness status & age
Ex) Health education (accident prevention,
nutrition, growth & development,
exercise, stress management, occupational
hazards, etc.)
2. Secondary prevention - Emphasizes early
detection of disease, prompt intervention, and
health maintenance for individuals experiencing
health problems
Ex) Screening (hypertension, cholesterol,
Denver Developmental); regular medical/dental
checkups;
teach breast/testicular self exam; assessing
growth and development; nursing assessments
and care provided in the home, hospital, or
other agencies to prevent complications
3. Tertiary prevention – Begins after an illness,
when a defect or disability is fixed, stabilized, or
irreversible; focus is to help rehabilitate
individuals and restore them to an optimal level
of functioning within the constraints of the
disability
Ex) referring a colostomy client to a support
group; teaching a client withdiabetes to detect
and prevent complications; referral of a client
with spinal cord/head injury to rehab
Wide variety of health promotion activities: work
settings, schools, health care organizations,
community agencies, fire dept, police
Types of health promotion programs:
1. Information dissemination - raise
knowledge/awareness; uses media to offer info
about risks R/T certain behaviors, as well as
benefits of changing behaviors; billboards,
brochures, newsletters, books, health fairs;
topics include ETOH, drug abuse, DWI, HIV/AIDS
2. Health appraisal/wellness assessment
programs - used to apprise individuals of risk
factors inherent in their lives to motivate them
to reduce specific risks and develop positive
health habits; a variety of tools are available
(some are computer based)
3. Life style and behavior change programs -
geared to enhancing quality of life and
extending life span; examples include stress
management, nutrition awareness, weight
control, smoking cessation, exercise
4. Worksite wellness programs - address
workplace issues (air quality, accident
prevention, back saver); often hypertension
screening also; may include health
enhancement programs (fitness, relaxation)
5. Environmental controls programs - may
include community groups concerned about
toxic and nuclear wastes, nuclear power plants,
air/water pollution, and herbicide/pesticide
spraying
Nurse's Role In Health Promotion:
1. Model healthy lifestyle behaviors
Modeling - observing the behaviors of other
people who have achieved the goal the client
has set for himself; it is NOT imitating; upon
observing a model, the client acquires ideas for
behaviors and coping strategies for specific
problems; nurses can serve as a model for
wellness; once a nurse has assessed own
health, developed a plan, and made changes,
and know firsthand about difficulties in changing
behaviors, they can work more effectively with
peers and clients; a client is more likely to
respect/trust a person who can personally relate
what worked
2. Facilitate client involvement in assessment,
planning, implementation, and evaluation of
health goals
Assessment - health history, physical exam,
nutritional assessment, health risk appraisal ,
(Risk factors are life style behaviors that
increase the chance acquiring a specific
disease), life style assessment (life style and
habits that affect health - physical activity,
eating habits, safety practices,stress
management, smoking, alcohol consumption,
drug use), life stress review
Planning - Plans need to be developed according
to the needs, desires, and priorities of client; the
client plans - the nurse acts as a resource;
emphasize small steps to behavioral change;
review goals with client for realism,
measurability, and acceptability.
Steps in planning:
1. ID health goals (TOP 2 OR 3)
2. ID what behavioral goals are necessary to
bring about desired outcomes
3. Assign priorities to behavior changes
4. Make a commitment to change behavior -
"behavioral contract"
5. ID effective reinforcements and rewards
6. Determine barriers to change
7. Develop a schedule for implementing
behavioral changes
Short and long term goals/rewards
Implementing - the "doing" part
Nurse's role:
1. support person - ongoing, non judgmental,
individual or group, possibly by telephone
2. teacher - provides health education
programs to groups, individuals, communities;
based on assessed health needs of people
3. counselor
4. coordinator
5. consultant
6. facilitator
7. enhancer of behavioral changes
Must understand the change process
Lewin's Change Theory - the process of
attitude and behavior change occurs in 3
phases:
1. Unfreezing - As a result of change in person's
equilibrium person ready to change attitudes
and behaviors; "unlearning", the most difficult
and the most important!!
2. Moving - individual acquires new
attitudes/behaviors
3. Refreezing - client internalizes behavior
changes and stabilizes at a new level of
functioning
**Enhancing Behavior Changes** (see box on p
266)
3. Teach clients self care strategies to enhance
fitness, improve nutrition, manage stress, and
enhance relationships
4. Assist individuals/families/communities to
increase their level of health
5. Teach clients to be effective health care
consumers
6. Assist clients/families/communities to develop
and choose health care options
7. Guide clients' development in effective
problem solving and decision making
8. Reinforce the clients' personal and family
health promoting behaviors
9. Advocate in the community for changes that
promote a healthy environment
Concepts of Stress
I. Stress (Theory by Hans Selye)
Non specific response of the body to nay
demand made upon it
Any situation in which a non specific demand
requires an individual to respond or take action
II. Characteristics of Stress
Stress is not nervous energy. Emotional
reactions are common stressors
Stress is not always the result of damage to the
body
Stress does not always result in feelings of
distress (harmful or unpleasant stress)
Stress is a necessary part of life and is essential
for normal growth and development
Stress involves the entire body acting as a
whole and is an integrated manner
Stress response is natural, productive and
adaptive
III. Stressors – Factor or agent producing stress,
maybe: physiological, psychological, social,
environmental, developmental, spiritual or
cultural and represent an unmet needs
a. Classification of Stressors
i. Internal Stressors – originate from within the
body. E.g. fever, pregnancy,
menopause, emotion such as guilt
ii. External Stressors – originate outside a
person. E.g. change in family or social role, peer
pressure, marked change in environmental
temperature
b. Factors influencing response to stressors
i. Physiological functioning
ii. Personality
iii. Behavioral characteristics
iv. Nature of the stressor: integrity, scope,
duration, number, and nature of other stressors
D. Homeostasis – Process of maintaining
uniformity, stability and constancy with in the
living organisms. (from Greek word homotos –
like, and stasis – position)
E. Adaptation – Body’s adjustment to different
circumstances and conditions. Process by the
physiological or psychological dimensions
change in response to stress; attempt to
maintain optimal functioning
F. Adaptation to Stress-Physiological Response
(Hans Selye)
I. Local Adaptation Syndrome (LAS) – Response
of a body tissue, organ or part to the stress of
trauma, illness or other physiological change
a. Characteristics
i. The response is localized, it does not involve
entire body systems
ii. The response is adaptive, meaning that a
stressor is necessary to stimulate it
iii. The response is short term. It does not
persist indefinitely
iv. The response is restorative, meaning that the
LAS assists in restoringhomeostasis to the body
region or part
b. Two Localized Responses
i. Reflex Pain Response – is a localized response
of the central
nervous system to pain. It is an adaptive
response and protects tissue from further
damage. The response involves a sensory
receptor, a sensory nerve from the spinal cord,
and an effector muscle. An example would be
the unconscious, reflex removal of the hand
from a hot surface.
ii. Inflammatory Response – is stimulated by
trauma or infection. This response localizes the
inflammation, thus revenging its spread and
promotes healing. The inflammatory response
may produce localized pain, swelling, heat,
redness and changes in functioning.
c. Three Phases of Inflammatory Response
i. First Phase – Narrowing of blood
vessels occurs at the injury to control bleeding.
Then histamine is released at the injury,
increasing the number of white blood cells to
combat infection.
ii. Second Phase – It is characterized by release
of exudates from the wound
iii. Third Phase – The last phase is repair of
tissue by regeneration or scar formation.
Regeneration replaces damaged cells with
identical or similar cells.
II. General Adaptation Syndrome (GAS) or Stress
Syndrome – characterized by a chain or pattern
of physiologic events.
a. 3 Stages
i. Alarm Reaction – initial reaction of the body
which alerts the body’s defenses. SELYE divided
this stage into 2 parts:
Ø The SHOCK PHASE
Ø The COUNTERSHOCK PHASE
ii. Stage of Resistance – occurs when the body’s
adaptation takes place; the body attempts to
adjust with the stressor and to limit the stressor
to the smallest area of the body that can deal
with it.
iii. Stage of Exhaustion – the adaptation that the
body made during the second stage cannot be
maintained; the ways used to cope with the
stressors have been exhausted
b. STRESSORS stimulate the sympathetic
nervous system, which in turn stimulates the
hypothalamus. The HYPOTHALAMUS releases
corticotrophin releasing hormone (CRH). During
times of stress, the ADRENAL MEDULLA
secretes EPINEPHRINE & NOREPINEPHRINE in
response to sympathetic stimulation. Significant
body responses toepinephrine include the
following:
i. Increased myocardial contractility, which
increases cardiac output & blood flow to active
muscles
ii. Bronchial dilation, which allows increased
oxygen intake
iii. Increased blood clotting
iv. Increased cellular metabolism
v. Increased fat mobilization to make energy
available & to synthesize other compounds
needed by the body.
G. Physiologic Indicators of Stress
a. Pupils dilate to increase visual perception
when serious threats to the body arise.
b. Sweat production (diaphoresis) increases to
control elevated body heat due to increased
metabolism.
c. The heart rate & cardiac output increase
to transport nutrients and by-products of
metabolism more efficiently.
d. Skin is pallid because of constriction of
peripheral vessels, an effect of norepinephrine.
e. Sodium & water retention increase due to
release of mineralocorticoids, which results in
increased blood volume.
f. The rate & depth of respirations increase
because of dilation of the bronchioles,
promoting hyperventilation.
g. Urinary output may increase or decreases.
h. The mouth may be dry.
i. Peristalsis of the intestines decreases,
resulting in possible constipation and flatus.
j. For serious threats, mental alertness
improves.
k. Muscle tension increases to prepare for rapid
motor activity or defense.
l. Blood sugar increases because of release of
glucocorticoids & gluconeogenesis.
H. Psychologic Indicators of Stress – psychologic
manifestations of stress include anxiety, fear,
anger, depression & unconscious ego
defensemechanisms.
Anxiety – a common reaction to stress. It is a
state of mental uneasiness, apprehension,
dread, or foreboding or a feeling of helplessness
related to an impending or anticipated
unidentified threat to self or significant
relationships. It can be experienced,
subcutaneous or unconscious level. Can be
manifested on 4 LEVELS:
Fear – an emotion or feeling of apprehension
aroused by impending or seeming danger, or
other perceived threat. The object of fear may
or may not be based in reality.
Anger – an emotional state consisting of a
subjective feeling of animosity or strong
displeasure. People may feel guilty when they
feel anger because they have been taught that
to feel angry is wrong.
Depression – common reaction to events that
seem overwhelming or negative. It is an
extreme feeling of sadness, despair, dejection,
lack of worth or emptiness.
Emotional symptoms can include: Feelings of
tiredness, sadness, emptiness, or numbness
Behavioral signs include: Irritability, inability to
concentrate, difficulty making decisions, loss of
sexual desire, crying, sleep disturbance and
social withdrawal.
Physical signs include: Loss of appetite, weight
loss, constipation,headache and dizziness
I. Cognitive Indicators – are thinking responses
that include problem-solving, structuring,
self-control or self-discipline, suppression and
fantasy
a. Problem solving – involves thinking through
the threatening situation, using a specific steps
to arrive at a solution
b. Structuring – arrangement or manipulation of
a situation so that threatening events do not
occur.
c. Self-Control (discipline) – assuming a manner
of facial expression that convey a sense of
being in control or in change.
d. Suppression – consciously and willfully
putting a thought or feeling out of mind
e. Fantasy – (daydreaming) – likened to make
believe. Unfulfilled wishes & desires are
imagined as fulfilled, or a threatening
experience is reworked or replayed so that it
ends differently from reality.
Health Promotion
HEALTH
A. Definitions of health vary
1. Traditional definition: freedom from disease
2. 1958 World Health Organization defined
health as "state of complete physical, mental
and social well-being and not merely the
absence of disease and infirmity"
B. Health belief model
1. Psychological and behavioral theory
2. Attempts to explain individual health
behaviors
3. Health behaviors are based on three factors
a. the individuals perception of susceptibility of
illness
b. the individuals perception of seriousness of
the illness
c. the likelihood that the person will take
preventive action
4. Modifying factors
a. cultural beliefs
b. economics
c. political factors
d. social factors
e. personal beliefs
Health Promotion
C. Definitions
1. Health promotion behavior is behavior in
which the client views health as a goal and
engages in behaviors designed to achieve or
maintain that goal.
2. Health care includes prevention, early
detection, treatment and rehabilitation for
clients with potential for or existing illness or
disability.
3. Healthy lifestyle can increase or maintain
client's level of wellness and functional ability.
4. Health screening (for risk factors or illness)
can prevent or minimize illness and disability.
5. Disease prevention behaviors are behaviors
designed to decrease the likelihood/risk of
illness.
a. primary prevention
I. health promotion and disease prevention
II. applied to clients considered physically and
emotionally healthy
III. example: exercise programs, healthy diet
b. secondary prevention
I. early detection of illness
II. focuses on individuals who are experiencing
health problems and illnesses and who are at
risk for complications
III. activities are directed at diagnosis and
prompt treatment
IV. example: breast
self examination, cholesterol screening
c. tertiary prevention
I. prevention of further deterioration in disease
or disability
II. occurs when a defect or disability is
permanent and irreversible
III. activities are directed at rehabilitation
IV. example: alcoholics anonymous
D. Primary health care
1. Accessible, community-based or work-based
health care services based on principle of
universal access, which ensures health care for
all individuals regardless of employment or
insurance status
2. Health Security Act of 1993 offered universal
access to basic hospital, preventive, physician
and long-term services. It included these seven
services:
a. physical examinations
b. screening tests
c. diagnosis and treatment of common acute
illnesses
d. management of chronic illnesses
e. liaison with community resources
f. provision of prenatal care
g. identification of need for specialty referrals
3. Providers include physicians, and advanced
practice nurses, such as: nurse midwives and
nurse practitioners
4. Services provided through a managed care
model
5. Specialty services provided and reimbursed
only after referral from the primary care
provider
6. Primary care settings include
a. Health Maintenance Organization(HMOs)
b. public health departments
c. occupational health clinics
d. schools
e. nurse managed clinics
f. collaborative practice settings
E. Healthy People 2010
1. The US Department of Health and Human
Services released Healthy People 2010: National
Promotion and Disease Prevention Objectives
2. Statement of national health objectives
designed to identify the most significant
preventable threats to health and to establish
national goals to reduce these threats
3. The goals of the project are:
a. increase quality and years of healthy life
b. eliminate health disparities
F. Health promotion model
1. Developed by Nola Pender
2. Health promotion depends on seven factors
of cognition-perception
a. importance of health to the person
b. perceived control of health
c. perceived self-efficacy
d. definition of health
e. perceived health status
f. perceived health benefits from the health-
promoting behavior
g. perceived barriers to the health-promoting
behavior
G. Risk factors - probability of acquiring a
particular health problem
1. Varies with age, race, ethnicity, gender
2. Risk increases with certain lifestyle choices,
such as smoking, occupation, diet, environment
3. Modifiable risk factors include occupation and
diet
4. Non-modifiable risk factors include race and
age
5. Examples: risk factors are important in
a. coronary artery disease
b. cancer
c. colon cancer
I. over 50 years of age
II. family history of colon polyps or cancer
III. urban living
IV. diet high in fats and low in fiber
d. tuberculosis
I. history of exposure to person with TB
II. history of travel or living outside United
States
III. history of prison time
IV. HIV infection
V. cancer chemotherapy
VI. malnutrition
VII. homelessness
VIII. history of IV drug use
IX. medical workers
e. diabetes: candidates for screening
I. strong family history of diabetes mellitus
II. markedly obese
III. obstetrical history of babies weighing over
nine pounds at birth
IV. obstetrical history of miscarriage or fetal
death
V. pregnant women between 24-28 weeks
gestation
VI. history of gestational diabetes
H. Screening recommendations Cholesterol -
once every five years if normal age 45 and older
1. In women: Mammography
2. In women: the first papanicolau smear at the
onset of sexual activity and/or over age 18,
annually
3. In men:PSA annually 50 years of age or at
age 40 for those at risk
4. For colon cancer
a. digital rectal exam every year after the age of
40
b. quaiac test for occult blood every year after
the age of 50
c. proctoscopy every three to five years after
the age of 50 after two negative annual exams
d. colonoscopy
5. Tuberculosis skin tests: intradermal injection
of antigen
6. Diabetes: fasting plasma glucose, ideally
eight to 12 hours fast
7. Vision: after age 39, medical eye exam every
three to five years
8. Hearing: candidates for screening include:
a. family history of childhood hearing
impairment
b. perinatal infection (rubella, herpes,)
c. low birth weight infants
d. chronic ear infection
e. down syndrome
I. Compliance
1. Definition: adherence to primary or secondary
prevention recommendations
2. Factors influencing compliance
a. personal meaning and perceptions: 1. Needs are universal.
knowledge, values, beliefs, outcome 2. Needs may be met in different ways
expectations 3. Needs may be stimulated by external and
b. social factors: environmental context, social internal factor
relationships, social support, societal norms, 4. Priorities may be deferred
economic resources 5. Needs are interrelated
c. deficiencies in the health care system:
access, costs, wait time, monolingual services
J. Noncompliance Communication in Nursing
1. An individual's informed decision not to
adhere to a therapeutic recommendation
2. Individual unable or unwilling to alter habitual Modes of Communication:
behaviors or adopt new behaviors necessary to Verbal- spoken or written words
a prescribed therapeutic regimen Non Verbal - gesture, facial expressions,
posture, gait, physical appearance
Man and his Basic needs
Maslow’s Hierarchy of Basic Human Needs Characteristics of a Good Communiaction:
Physiologic
Oxygen
Fluids 1. Simplicity
Nutrition 2. Clarity
Body temperature 3. Timing and Relevance
Elimination
4. Adaptibility
Rest and sleep
Sex 5. Credibility
Safety and Security
Sender(encoder)--Message--Receiver(decoder)
Physical safety
Psychological safety l__Response(feedback)___l
The need for shelter and freedom from harm
and danger Communication- basic component of human
Love and belonging
The need to love and be loved relationship and Nurse-client relationship
The need to care and to be cared for. Non-verbal-is more accurate
The need for affection: to associate or to belong -variety of feelings that can be expressed by a
The need to establish fruitful and meaningful
single non- verbal expression
relationships with people,institution,
or organization -in assessing non verbal behaviors, cultural
Self-Esteem Needs influences must be considered.
Self-worth Reciprocal Interaction -EFFECTIVE
Self-identity
Self-respect COMMUNICATION
Body image -this is a two way process
Self-Actualization Needs -it is based on trust and aimed at identifying
The need to learn, create and understand or
clients needs and developing mutual goalss
comprehend
The need for harmonious relationships Trust- positive nursing patient relationship
The need for beauty or aesthetics Covert- inner feelings, uncomfortable to talk
The need for spiritual fulfillment about and maybe revealed through non-verbal
Characteristics of Basic Human Needs
modes Communication e. use the same words and gestures for objects
A. Cross-cultural communication - f. keep background noise to a minimum
Validation- attempt to confirm the observers' guidelines g. do not shout or speak loudly
perceptions through feedback,interpretation 1. Findings of a lack of effective communication h. give the client time to understand and
and classification a. efforts to change the subject - client may not respond
understand what the nurse is saying i. if client has problems speaking ask "yes" or
b. lack of questions - client may not understand "no" questions
Therapeutic Communication-fundamental what was said D. Client with stroke
component in all phases of Nursing process c. nonverbal cues such as blank expression, lack 1. Approach client from side of intact field of
of eye contact vision
2. Nursing interventions 2. Remind client to turn head in direction of
1. attentive listening a. use simple sentence structure and visual loss to compensate for loss of visual field
2. paraphrasing or restating pantomime while talking 3. Explain location of object when placing it near
3. clarifying b. use visual aids the client
c. discuss one topic at a time 4. Always put client care items in same places
4. using open ended questions
d. use any words you know in the client's 5. Put objects within client's reach, and on
5. focusing language unaffected side
6. being specific e. ask among the client's family and friends if 6. Encourage client to repeat sounds of the
7. using touch and silence anyone could serve as interpreter alphabet
f. obtain phrase books or use flash cards 7. Speak slowly and clearly
8. offering self 3. Cultural interpretations 8. Use simple sentences with gestures
9. clarifying reality,time,sequence a. silence or pictures
10. acknowleding b. touch 9. Reorient client to time, place, and situation
c. eye contact 10. Provide familiar objects
11. providing general leads
B. Client with hearing loss 11. Minimize distractions
12. giving informations 1. Findings of hearing loss 12. Repeat and reinforce instructions
13. summarizing a. speech deterioration E. Client with dementia
b. indifference 1. Be calm and unhurried
c. social withdrawal 2. Keep conversations short and focused
Block Communication: d. suspicion 3. Do not ask the client to make decisions
e. tendency to dominate conversation 4. Be consistent
1. unwarranted reassurance 2. Nursing interventions 5. Avoid distractions
a. speak slowly and distinctly; do not shout 6. Use reality orientation techniques
2. agreeing/disagreeing b. face client directly
3. giving common advice c. make sure your face is clearly visible
4. stereotyping d. before the discussion, tell client the topic you DOCUMENTING and REPORTING
are going to discuss Guidelines for Good Documentation and
5. being defensive
e. insure that client has access to hearing aid Reporting
6. posing judgement and that it is functional I. Fact – information about clients and their care
7. challenging f. keep sentences short and simple must be factual. A record should contain
8. probing g. use written information to enhance spoken descriptive, objective information about what a
word nurse sees, hears, feels and smells
9. testing C. Client with aphasia II. Accuracy – information must be accurate so
10. rejecting 1. Injured cerebral cortex blocks some that health team members have confidence in it
11. changing topics/subjects language-related functions III. Completeness – the information within a
2. Nursing interventions record or a report should be complete,
a. face client and establish eye contact containing concise and thorough information
Effective Nurse Client Relationship b. avoid completing client's statements about a client’s care. Concise data are easy to
This is a helping relationship which is growth c. use gestures, pictures, and understand
facilitating and provides support and comfort. communication boards IV. Currentness – ongoing decisions about care
d. limit conversation to practical matters must be based on currently reported
information. At the time of occurrence include
the following:
a. Vital signs
b. Administration of medications and treatments
c. Preparation of diagnostic tests or surgery
d. Change in status
e. Admission, transfer, discharge or death of a
client
f. Treatment fro a sudden change in status
V. Organization – the nurse communicate in a
logical format or order
VI. Confidentiality – a confidential
communication is information given by one
person to another with trust and confidence that
such information will not be disclosed
Documentation – anything written or printed
that is relied on as a record of proof fro
authorized persons.
Purposes of Records:
I. Communication
II. Planning Client Care
III. Auditing Health Agencies
IV. Research
V. Education
VI. Reimbursement
VII. Legal Documentation
VIII. Health Care Analysis
Documentation Systems
I. Source – Oriented Record
a. The traditional client record
b. Each person or department makes notations
in a separate section or sections of the client’s
chart
c. It is convenient because care providers from
each discipline can easily locate the forms on
which to record data and it is easy to trace the
information
d. Example: the admissions department has an
admission sheet; the physician has a physician’s
order sheet, a physician’s history sheet &
progress notes
e. NARRATIVE CHARTING is a traditional part of
the source-oriented record
II. Problem – Oriented Medical
Record (POMR)
a. Established by Lawrence Weed
b. The data are arranged according to the
problems the client has rather than the source
of the information.
The four (4) basic components:
i. Database – consists of all information known
about the client when the client first enters the
health care agency. It includes the nursing
assessment, the physician’s history, social &
family data
ii. Problem List – derived from the database.
Usually kept at the front of the chart & serves as
an index to the numbered entries in the
progress notes. Problems are listed in the order
in which they are identified & the list is
continually updated as new problems are
identified & others resolved
iii. Plan of Care – care plans are generated by
the person who lists the problems. Physician’s
write physician’s orders or medical care plans;
nurses write nursing orders or nursing care
plans
iv. Progress Notes – chart entry made by
all health professionals involved in a client’s
care; they all use the same type of sheet fro
notes. Numbered to correspond to the problems
on the problem list and may be lettered for the
type of data
Example: SOAP Format Or SOAPIE and SOAPIER
S – Subjective data
O – Objective data
A – Assessment
P – Plan
I – Intervention
E – Evaluation
R- Revision
Advantages of POMR:
It encourages collaboration
Problem list in the front of the chart alerts
caregivers to the client’s needs & makes it
easier to track the status of each problem
Disadvantages of POMR:
Caregivers differ in their ability to use the
required charting format
Takes constant vigilance to maintain an up-to-
date problem list
Somewhat inefficient because assessments &
interventions that apply to more than one
problem must be repeated.
III. PIE (Problems, Interventions, and
Evaluation)
a. Groups information in to three (3) categories
b. This system consists of a client care
assessment floe sheet & progress notes
c. FLOW SHEET – uses specific assessment
criteria in a particular format, such as human
needs or functional health patterns
d. Eliminate the traditional care plan &
incorporate an ongoing care plan into the
progress notes
IV. Focus Charting
a. Intended to make the client & client concerns
& strengths the focus of care
b. Three (3) columns fro recording are usually
used: date & time, focus & progress notes
V. Charting by Exception
a. Documentation system in which only
abnormal or significant findings or exceptions to
norms are recorded
b. Incorporates three (3) key elements:
i. Flow sheets
ii. Standards of nursing care
iii. Bedside access to chart forms
VI. Computerized Documentation
a. Developed as a way to manage the huge
volume of information required in contemporary
health care
b. Nurses use computers to store the client’s
database, add new data, create & revise care
plans & document client progress.
VII. Case Management
a. Emphasizes quality, cost-effective care
delivered within an established length of stay
b. Uses a multidisciplinary approach to planning
& documenting client care, using critical
pathways.
Nursing Care Plan (NCP)
Two Types:
I. Traditional Care Plan – written fro each client;
it has 3 columns: nursing diagnoses, expected
outcomes & nursing interventions.
II. Standardized Care Plan – based on an
institution’s standards of practice; thereby
helping to provide a high quality of nursing care
KARDEX widely used, concise method of
organizing & recording data about a client,
making information quickly accessible to
all health professionals. Consists of a series of
cards kept in a portable index file or on
computer generated forms. Information may be
organized into sections:
I. Pertinent information about the client
II. List of medications
III. List of IVF
IV. List of daily treatments & procedures
V. List of Diagnostic procedures
VI. Allergies
VII. Specific data on how the client’s physical
needs are to be met
VIII. A problem list, stated goals & list of nursing
approaches to meet the goals
Nursing Discharge / Referral Summaries –
completed when the client is being discharged
& transferred to another institution or to a home
setting where a visit by a community health
nurse is required. Regardless of format, it
include some or all of the following:
I. Description of client’s physical, mental &
emotional state
II. Resolved health problems
III. Unresolved continuing health problems
IV. Treatments that can be continued (e.g.
wound care, oxygen therapy)
V. Current medications
VI. Restrictions that relate to activity, diet &
bathing
VII. Functional/self-care abilities
VIII. Comfort level
IX. Support networks
X. Client education provided in relation to
disease process
XI. Discharge destination
XII. Referral Services (e.g. social worker, home
health nurse)
Nursing Process
Definition:
• It is a systematic, rational method of
planning and providing individualized nursing
care.
• a process that seeks to identify a client's
healthcare status, actual or potential health
problems, to establish plans to meet the client's
identified needs, and to deliver specific
nursinginterventions to address those needs
• In 1955,Lydia Hall originated the term
Five Components:
1. assessing
1. the systematic and continuous collection,
validation, and communication of patient data
2. during assessing, the nurse:
• 1. establishes a data base
• 2. continuously updates the data base
• 3. validates data
• 4. communicates data
2. diagnosing
1. the analysis of patient data to identify
data clusters that indicate actual or potential
health problems, factors that contribute to or
cause these problems, and coping pattern or
strengths of the patient
2. during diagnosing, the nurse:
• 1. interprets and analyses patient data
• 2. identifies patient strengths and patient
health problems
• 3. formulates and validates nursing
diagnoses
• 4. develops a prioritized list of nursing
diagnoses
3. planning
1. the establishment of patient goals/expected
outcomes by the nurse, working with the
patient, that prevent, reduce, or resolve
problems identified in the nursing diagnoses,
and the determination of related
nursinginterventions most likely to assist the
patient in achieving the goals
2. during planning, the nurse:
• 1. establish priorities
• 2. writes patient goals/expected outcomes
and develops an evaluative strategy
• 3. selects nursing interventions
• 4. communicates the plan of nursing care
4. implementing
1. the nurse carries out of the plan of care
2. during implementing, the nurse:
1. carries out the plan of nursing care
2. continues data collection and modifies the
plan of care as needed
3. documents care
5. evaluating
1. the measuring of the extent to which patient
goals have been met
2. during evaluating, the nurse:
• 1. measures the patient's achievement of
desired goals/expected outcomes
• 2. identifies factors that contribute to the
patient's success or failure
• 3. modifies the plan of care, if indicated
Characteristics of the Nursing Process
cyclical and dynamic--♣> components follow a
logical sequence but more than once
component may be involved at one time;
responds to the changing health status of the
client so there is no absolute beginning or end
open and flexible--♣> meets the unique needs
of the client, family, group, or community
client-centered--♣> the plan of care is
organized according to the client’s health
problems rather than nursing goals
interpersonal and collaborative--♣> to ensure
delivery of quality nursing care, the
nurse shares concerns and problems regarding
the client’s health status; rapport is developed
and an open communication is established
between the client and the nurse to carry out
the nursing process effectively
planned♣
goal directed♣
allows client and nurse to devise ways to solve
identified health problems--♣> decision-making
is involved in every step of the
nursingprocess and nurses are not bound by Core temperature –temperature of the deep e. Do not force to insert the thermometer
standard responses; nurses can use their skills tissues of the body.→ Contraindications
and knowledge to assist the client attend to Surface body temperature→ Patient with diarrheaν
health-related goals Alteration in body Temperature Recent rectal or prostatic surgery
emphasizes feedback--♣> determines if there Pyrexia – Body temperature above normal orν injury because it may injure inflamed tissue
is a need to revise the nursing care plan range( hyperthermia)→ Recent myocardial infarctionν
universally applicable--♣> it can be used with Hyperpyrexia – Very high fever, 41ºC(105.8 F) Patient post headν injury
clients at any age and at any point in the and above→ 3. Axillary – safest and non-invasive
wellness-illness continuum and can be used in a Hypothermia – Subnormal temperature.→ a. Pat the axilla dry
variety of settings. Normal Adult Temperature Ranges b. Ask the patient to reach across his chest and
utilizes problem-solving techniques and the Oral 36.5 –37.5 ºC→ grasp his opposite shoulder.
systems theory--♣> decision-making is involved Axillary 35.8 – 37.0 ºC→ This promote skin contact with the thermometer
in every component of the nursing process c. Hold it in place for 9 minutes because the
Rectal 37.0 – 38.1 ºC→
thermometer isn’t close in a
Tympanic 36.8 – 37.9ºC→
body cavity
Methods of Temperature-Taking
Physical Assessment Note:
1. Ora l – most accessible and convenient
1. Purposes of the physical health Use the same thermometer for repeat
method.
examination a. Put on gloves, and position the tip of the temperature taking to ensure moreν
thermometer under the consistent result
2. Components of the physical health Store chemical-dot thermometer in a cool area
examination patients tongue on either of the frenulun as far
back as possible. It because exposure to heatν
3. Verbal explanations promotes contact to the superficial blood activates the dye dots.
vessels and ensure a more 4. Tympanic thermometer
4. Physical preparation
a. Make sure the lens under the probe
accurate reading.
5. Inspection b. Wash thermometer before use. is clean and shiny
c. Take oral temp 2-3 minutes. b. Stabilized the patient’s head; gently pull the
6. Palpation
ear straight back (for
d. Allow 15 min to elapse between client’s food
7. Percussion intake of hot or cold children up to age 1) or up and back (for
food, smoking. children 1 and older to adults)
8. Auscultation
c. Insert the thermometer until the entire ear
e. Instruct the patient to close his lips but not to
9. Instruments, equipment, and supplies bite down with his teeth canal is sealed
used during the physical examination to avoid breaking the thermometer in his d. Place the activation button, and hold it in
mouth. place for 1 second
10. TERMS to know 5. Chemical-dot thermometer
Contraindications
Young children an infantsν a. Leave the chemical-dot thermometer in place
for 45 seconds
Patients who are unconscious or disorientedν
Assessing Vital Signs b. Read the temperature as the last dye dot that
Who must breath through the mouthν
has change color, or fired.
Vital Signs or Cardinal Signs are: Seizure proneν Nursing Interventions in Clients with Fever
Body temperatureν Patient with N/Vν a. Monitor V.S
Pulseν Patients with oral lesions/surgeriesν b. Assess skin color and temperature
2. Rectal- most accurate measurement of c. Monitor WBC, Hct and other pertinent lab
Respirationν
temperature records
Blood pressureν
a. Position- lateral position with his top legs d. Provide adequate foods and fluids.
Painν flexed and drape him to provide e. Promote rest
privacy. f. Monitor I & O
I. Body Temperature b. Squeeze the lubricant onto a facial tissue to
The balance between the heat produced by the g. Provide TSB
avoid contaminating the h. Provide dry clothing and linens
body and the heat lossν lubricant supply. i. Give antipyretic as ordered by MD
from the body. c. Insert thermometer by 0.5 – 1.5 inches
Types of Body Temperature d. Hold in place in 2minutes
II. Pulse – It’s the wave of blood created by
contractions of the left ventricles of
the
heart.
Normal Pulse rate
1 year 80-140 beats/min
2 years 80- 130 beats/min
6 years 75- 120 beats/min
10 years 60-90 beats/min
Adult 60-100 beats/min
Tachycardia – pulse rate of above 100 beats/min
Bradycardia- pulse rate below 60 beats/min
Irregular – uneven time interval between beats.
What you need:
a. Watch with second hand
b. Stethoscope (for apical pulse)
c. Doppler ultrasound blood flow detector if
necessary
Radial Pulse
a. Wash your hand and tell your client that you
are going to take his pulse
b. Place the client in sitting or supine position
with his arm on his side or across
his
chest
c. Gently press your index, middle, and ring
fingers on the radial artery, inside
the patient’s wrist.
d. Excessive pressure may obstruct blood flow
distal to the pulse site
e. Counting for a full minute provides a more
accurate picture of irregularities
Doppler device
a. Apply small amount of transmission gel to
the ultrasound probe
b. Position the probe on the skin directly over a
selected artery
c. Set the volume to the lowest setting
d. To obtain best signals, put gel between the
skin and the probe and tilt the
probe 45 degrees from the artery.
e. After you have measure the pulse
rate, clean the probe with soft cloth
soaked in antiseptic. Do not immerse the probe
III. Respiration - is the exchange of oxygen
and carbon dioxide between the
atmosphere
and the body
Assessing Respiration
Rate – Normal 14-20/ min in adultν
The best time to assess respiration is
immediately after taking client’s pulseν
Count respiration for 60 secondν
As you count the respiration, assess and record
breath sound as stridor,ν
wheezing, or stertor.
Respiratory rates of less than 10 or more than
40 are usually consideredν
abnormal and should be reported immediately
to the physician.
IV. Blood Pressure
Adult – 90- 132 systolic
60- 85 diastolic
Elderly 140-160 systolic
70-90 diastolic
a. Ensure that the client is rested
b. Use appropriate size of BP cuff.
c. If too tight and narrow- false high BP
d. If too lose and wide-false low BP
e. Position the patient on sitting or supine
position
f. Position the arm at the level of the heart, if
the artery is below the heart
level, you may get a false high reading
g. Use the bell of the stethoscope since the
blood pressure is a low frequency
sound.
h. If the client is crying or anxious, delay
measuring his blood pressure to
avoid false-high BP
Electronic Vital Sign Monitor
a. An electronic vital signs monitor allows you to
continually tract a patient’s
vital
sign without having to reapply a blood pressure
cuff each time.
b. Example: Dinamap VS monitor 8100
c. Lightweight, battery operated and can be
attached to an IV pole
d. Before using the device, check the client7s
pulse and BP manually using the
same arm you’ll using for the monitor cuff.
e. Compare the result with the initial reading
from the monitor. If the results
differ call the supply department or the
manufacturer’s representative.
PRINCIPLES of ASEPSIS and INFECTION
CONTROL
A. Chain of Infection
I. The chain of infection refers to those elements
that must be present to cause an infection from
a microorganism
II. Basic to the principle of infection is to
interrupt this chain so that an infection from a
microorganism does not occur in clients
III. Infectious agent; microorganisms capable of
causing infections are referred to as an
infectious agent or pathogen.
IV. Modes of transmission:
the microorganism must have a means
oftransmission to get from one location to
another, called direct and indirect
V. Susceptible host describes a host (human or
animal) not possessing enough resistance
against a particular pathogen to prevent disease
or infection from occurring when exposed to the
pathogen; in humans this may occur if the
person’s resistance is low because of poor
nutrition, lack of exercise of a coexisting illness
that weakens the host.
VI. Portal of entry: the means of a pathogen
entering a host: the means of entry can be the
same as one that is the portal of exit
(gastrointestinal, respiratory, genitourinary
tract).
VII. Reservoir: the environment in which
the microorganism lives to ensure survival; it
can be a person, animal, arthropod, plant, oil or
a combination of these things; reservoirs that
support organism that are pathogenic to
humans are inanimate objects food and water,
and other humans.
VIII. Portal of exit: the means in which the
pathogen escapes from the reservoir and can
cause disease; there is usually a common
escape route for each type of microorganism; on
humans, common escape routes are the
gastrointestinal, respiratory and the
genitourinary tract.
Modes of Transmission
1. Direct contact: describes the way in which
microorganisms are transferred from person to
person through biting, touching, kissing, or
sexual intercourse; droplet spread is also a form
of direct contact but can occur only if the source
and the host are within 3 feet from each other;
transmission by droplet can occur when a
person coughs, sneezes, spits, or talks.
2. Indirect contact: can occur through fomites
(inanimate objects or materials) or through
vectors (animal or insect, flying or crawling); the
fomites or vectors act as vehicle
for transmission
3. Air: airborne transmission involves droplets or
dust; droplet nuclei can remain in the air for
long periods and dust particles containing
infectious agents can become airborne infecting
a susceptible host generally through the
respiratory tract
B. Course of Infection
I. Incubation: the time between initial contact
with an infectious agent until the first
signs of symptoms - - > the incubation period
varies from different
pathogens; microorganisms are growing and
multiplying during this stage
II. Prodromal Stage: the time period from the
onset of nonspecific symptoms to the
appearance of specific symptoms related to the
causative pathogen
- - > symptoms range from being fatigued to
having a low-grade
- fever with malaise; during this phase it is still
possible to transmit the pathogen to another
host
III. Full Stage: manifestations of specific signs &
symptoms of infectious agent; referred to as the
acute stage; during this stage, it may be
possible to transmit the infectious agent to
another, depending on the virulence of the
infectious agent
IV. Convalescence: time period that the host
takes to return to the pre-illness stage; also
called the recovery period; - - >the host defense
mechanisms have responded to the infectious
agent and the signs and symptoms of the
disease disappear; the host, however, is more
vulnerable to other pathogens at this time; an
appropriate nursing diagnostic label related to
this process would be Risk for Infection
C. Inflammation – The protective response of
the tissues of the body toinjury or infection; the
physiological reaction to injury or infection is the
inflammatory response; it may be acute or
chronic
Body’s response
I. The “inflammatory response” begins with
vasoconstriction that is followed by a brief
increase in vascular permeability; the blood
vessels dilate allowing plasma to escape into
the injured tissue
II. WBCs (neutrophils, monocytes, and
macrophages) migrate to the area of injury and
attack and ingest the invaders (phagocytosis);
this process is responsible for the signs
of inflammation
III. Redness occurs when blood accumulates in
the dilated capillaries; warmth occurs as a result
of the heat from the increased blood in the area,
swelling occurs from fluid accumulation; the
pain occurs from pressure orinjury to the local
nerves.
D. Immune Response
I. The immune response involves specific
reactions in the body to antigens or foreign
material
II. This specific response is the body’s attempt
to protect itself, the body protects itself by
activating 2 types of lymphocytes, the T-
lymphocytes and B-lymphocytes
III. Cell mediated immunity: T-lymphocytes are
responsible for cellular immunity
a. When fungi , protozoa, bacteria and some
viruses activate T-lymphocytes, they enter the
circulation from lymph tissue and seek out the
antigen
b. Once theantigen is found they produce
proteins (lymphokines) that increase the
migration of phagocytes to the area and keep
them there to kill the antigen
c. After the antigen is gone, the lymphokines
disappear
d. Some T-lymphocytes remain and keep a
memory of the antigen and are reactivated if
the antigen appears again.
IV. Humoral response: the ability of the body
to develop a specific antibody to a specific
antigen (antigen-antibody response)
a. B-lymphocytes provide humoral immunity by
producing antibodies that convey specific
resistance to many bacterial and viral infections
b. Active immunity is produced when the
immune system is activated either naturally or
artificially.
i. Natural immunity involves acquisition of
immunity through developing the disease
ii. Active immunity can also be produced
through vaccination by introducing into the
body a weakened or killed antigen (artificially
acquired immunity)
iii. Passive immunity does not require a host to
develop antibodies, rather it is transferred to
the individual, passive immunity occurs when a
mother passes antibodies to a newborn or when
a person is given antibodies from an animal or
person who has had the disease in the form of
immune globulins; this type of immunity only
offers temporary protection from the antigen.
E. Nosocomial Infection
I. Nosocomial Infections: are those that are
acquired as a result of a healthcare delivery
system
II. Iatrogenic infection: these
nosocomial infections are directly related to the
client’s treatment or diagnostic procedures; an
example of an iatrogenic infection would be
a bacterial infection that results from an
intravascular line or Pseudomonas aeruginosa
pneumonia as a result of respiratory suctioning
III. Exogenous Infection: are a result of the
healthcare facility environment or personnel; an
example would be an upper respiratory
infection resulting from contact with a caregiver
who has an upper respiratory infection
IV. Endogenous Infection: can occur from clients
themselves or as a reactivation of a previous
dormant organism such as tuberculosis; an
example of endogenous infection would be
a yeast infection arising in a woman receiving
antibiotic therapy; the yeast organisms are
always present in the vagina, but with the
elimination of the normal bacterial flora, the
yeast flourish.
F. Factors Increasing Susceptibility to
Infection
I. Age: young infants & older adults are at
greater risk of infection because of reduced
defense mechanisms
a. Young infants have reduced defenses related
to immature immune systems
b. In elderly people, physiological changes occur
in the body that make them more susceptible to
infectious disease; some of these changes are:
i. Altered immune function (specifically,
decreased phagocytosis by the neutrophils and
by the macrophages)
ii. Decreased bladder muscle tone resulting in
urinary retention
iii. Diminished cough reflex, loss of elastic recoil
by the lungs leading to inability to evacuate
normal secretions
iv. Gastrointestinal changes resulting in
decreased swallowing ability and delayed
gastric emptying.
II. Heredity: some people have a genetic
predisposition or susceptibility to some
infectious diseases
III. Cultural practices: healthcare beliefs and
practices, as well as nutritional and hygiene
practices, can influence a person’s susceptibility
to infectious diseases
IV. Nutrition: inadequate nutrition can make a
person more susceptible to infectious diseases;
nutritional practices that do not supply the body
with the basic components necessary to
synthesized proteins affect the way the body’s
immune system can respond to pathogens
V. Stress: stressors, both physical and
emotional, affect the body’s ability to protect
against invading pathogens; stressors affect the
body by elevating blood cortisone levels; if
elevation of serum cortisone is prolonged, it
decreases the anti-inflammatory response and
depletes energy stores, thus increasing the risk
of infection
VI. Rest, exercise and personal health habits:
altered rest and exercise patterns decrease the
body’s protective, mechanisms and may cause
physical stress to the body resulting in an
increased risk of infection; personal health
habits such as poor nutrition and unhealthy
lifestyle habits increase the risk of infectious
over time by altering the body’s response to
pathogens
VII. Inadequate defenses: any physiological
abnormality or lifestyle habit can influence
normal defense mechanisms in the body,
making the client more susceptible to infection;
the immune system functions throughout the
body and depends on the following:
a. Intact skin and mucous membranes
b. Adequate blood cell production and
differentiation
c. A functional lymphatic system and spleen
d. An ability to differentiate foreign tissue and
pathogens from normal body tissue and flora; in
autoimmune disease, the body has a problem
with recognizing it’s own tissue and cells;
people with autoimmune disease are at
increased risk of infection related to their
immune system deficiencies.
VIII. Environmental: an environment that
exposes individuals to an increased number of
toxins or pathogens also increases the risk of
infection; pathogens grow well in warm moist
areas with oxygen (aerobic) or without oxygen
(anaerobic) depending on the microorganism,
an environment that increases exposure to toxic
substances also increases risk
IX. Immunization history: inadequately
immunized people have an increased risk of
infection specifically for those diseases for
which vaccines have been developed.
X. Medications and medical therapies: examples
of therapies and medications that increase
clients risk for infection includes radiation
treatment, anti-neo-plastic drugs, anti
inflammatory drugs and surgery
G. Diagnostic Tests Used to Screen for
Infection
I. Signs and symptoms related to infections are
associated with the area infected; for instance,
symptoms of a local infection on the skin or
mucous membranes are localized swelling,
redness, pain and warmth
II. Symptoms related to systemic infections
include fever, increased pulse & respirations,
lethargy, anorexia, and enlarged lymph nodes
III. Certain diagnostic tests are ordered to
confirm the presence of an infection.
Nutrition Overview
A.Food guidelines
B. Essential nutrients
C. Fluid and electrolyte balance
D. Normal and therapeutic diets
E. Therapeutic Diets for specific conditions
Food guidelines
1. Nutritional needs through the life cycle
a. infants: fluid and protein needs 2.5x
adults
b. breast milk or formula is adequate for
first six months of life
i. whole milk is difficult for young infants
to digest
ii. the first food introduced is cereal
c. childhood: gradual increasing of all
nutrients adults: unchanged except for
i. pregnancy: add per day: 300 calories,
15 mg iron, 30 g protein, 400 g calcium, and
200ug folic acid
ii. lactation: add 500 calories, 2 quarts
extra fluid
b. elderly over age 65: adequate protein
to maintain immune system
2. Factors affecting dietary patterns
a. health status
b. ability to chew, swallow, and drink
c. culture and religion
d. socioeconomic status manufactured by the body when linoleic acid is i. water soluble (B1, B2, B6, B12, C)
e. personal preference available
• cannot be stored in body; require daily intake
f. psychological factors d. deficiencies lead to skin, blood
and arteryproblems ii. fat soluble (A, D, E, K)
g. alcohol and drugs
e. functions • can be stored in body
3. Energy needs
i. most concentrated source of energy (nine
a. basal metabolism – energy required for kcal/gram) 5. Minerals
ongoing internal processes such as heartbeat
ii. body’s major form of stored energy a. inorganic substances essential as catalysts in
b. basal metabolic rate (BMR) – influenced iii. insulation biochemical reactions
by gender, age, activity level, body composition. b. form most inorganic material in the body
iv. cell membrane component
v. carries fat-soluble vitamins A, D, E and K c. functions:
Essential nutrients
1. Carbohydrates
vi. recommended dietary intake: no more than i. catalyst for many body reactions such as
30% total caloric intake and low in saturated regulation of acid-base balance
a. include sugars, starches and cellulose fats ii. help cells metabolize, tissues absorb
b. simple sugars (monosaccharides) are most 3. Proteins nutrients, and heart muscle respond
easily metabolized
a. complex organic compounds comprised of iii. minerals work synergistically; a deficiency of
c. starches are more complex in structure and amino acids one mineral can disturb the action of other
metabolism minerals
b. body breaks protein down into 22 amino acids
d. functions of carbohydrates iv. types - grouped according to amount found in
c. all but eight amino acids are produced by the
i. quickest source of energy (4.1 kcal/gram) body body
ii. main source of fuel for brain, peripheral d. “complete protein” food contains the eight • major minerals - calcium, magnesium,
nerves, WBCs, RBCs, and healing wounds essential amino acids not produced by the body sodium, potassium, phosphorus, sulfur, chlorine;
iii. protein sparer (most meat, fish, poultry and dairy products) function known
e. dietary sources: plant foods, except for e. “incomplete protein” food lacks one or more
• trace minerals - iron, copper, iodine,
lactose of the eight amino acids (most vegetables and
manganese, cobalt, zinc and molybdenum;
f. recommended daily intake: fruits)
function unclear
i. factors influencing recommended intake of f. incomplete proteins can be combined to yield
a complete protein: for example, beans and rice • another group of trace minerals; found in even
carbohydrates include body structure, energy smaller amounts; function unclear
expenditure, basal metabolism and general g. functions of protein
health status 6. Water
i. secondary energy source (four kcal/gram)
ii. ideally, 50 to 60% of total calories should a. critical body component essential for cell
ii. essential for cell growth
be complex carbohydrates function
iii. efficiency can affect all of body - organs,
b. excessive carbohydrate calories are stored as b. accounts for 60 to 70% total body weight in
tissues, skin, muscles
fat adults; 70 to 75% children functions
iv. recommended protein intake: 0.42 grams per
2. Lipids c. provides normal turgor
0.4 kg of body weight
a. basic lipids are composed of triglycerides and d. regulates body temperature
v. the body's only source of nitrogen
fatty acids e. dietary sources: liquids and solids, such
vi. negative nitrogen balance can occur with asfresh fruits and vegetables
b. includes saturated fatty acids (from animal infection, burns, fever, starvation, and injury
sources) and unsaturated fatty acids f. deficiency: severe deficiency leads to
4. Vitamins
(vegetables, nuts and seeds) dehydration and death
a. organic substances essential for body growth
c. essential unsaturated fatty acids - linoleic acid g. fluid intake normally equals fluid output
and metabolism
is the only essential fatty acid in humans;
linolenic acid and arachidonic acid can be b. found only in plants and animals; body cannot
synthesize them; depends on dietary intake Fluid and electrolyte balance
c. types (according to their solvent)
 1. Total volume of fluid and amount of
electrolytes remain relatively constant in the
body
2. Fluid balance and electrolyte balance is
interdependent
3. Body balances fluid and electrolytes
primarily by adjusting output, and secondarily
by adjusting intake.
4. Fluid balance is also maintained
by osmosis (illustration )
5. Major electrolytes
a. cations
i. sodium - most abundant cation in extracellular
fluid
• regulates cell size via osmosis
• essential in maintaining water balance,
transmitting nerve impulses, and contracting
muscles
• regulates acid-base balance by exchanging
hydrogen ions for sodium ions in kidney
• normal lab value for serum sodium is 135 to
145 mEq/L
• sodium is regulated by salt intake, aldosterone,
and urinary output
• sources include table salt, processed meats,
snacks and canned food(illustration )
ii. potassium - most abundant cation of
intracellular fluid
• potassium pump draws potassium into cell
• essential for polarization and repolarization of
nerve andmuscle fibers
• regulates neuro muscular excitability and
muscle contraction
• sources include wholegrains, meat, legumes,
fruits and vegetables
• regulated by kidneys
• normal lab value for serum potassium is 3.5 to
5.3 mEq/L
iii. calcium - essential for cell membraneintegrity,
cardiac contraction, healthy bones and teeth,
and functioning of nerves and muscles
iv. magnesium - normal constituent of bone; •decreased plasma volume
cofactor for enzymes in energy metabolism,
neurochemical activities, muscular excitability •depleted potassium
b. anions •psychological factors
7. Maintenance of electrolyte balance
i. chloride
a. aldosterone - hormone (mineralcorticoid)
• most abundant anion in extracellular fluid
i. when extracellular fluid sodium decreases or
• helps balance sodium potassium levels increase
• normal lab value for serum chloride is 100 to ii. adrenal cortex secretes aldosterone
106 mEq/L
iii. kidneys stimulated by aldosterone to increase
ii. bicarbonate - part of bicarbonatebuffer system; reabsorbtion of sodium and decreased
limits the drop in pH by combining with an acid reabsorbtion of potassium
to form carbonic acid and a salt
iv. results in water reabsorption and increased
iii. phosphate - participates in cellular energy blood volume
metabolism, combines with calcium in bone,
b. parathyroid
assists in structure of genetic material
i. parathyroid secretes parthyroid hormone
6. Maintenance of fluid
(PTH), also called parathormone
volume
ii. stimulates release of calcium from bone,
a. osmoreceptor
reabsorbtion in small intestine and kidney
system
tubules
i. balances fluid intake volume by the regulation
iii. when serum calcium level is low, PTH secretion
of water output volume
increases
ii. dehydration stimulates osmoreceptors which
iv. when serum calcium level rises, PTH secretion
activate the thirst control center; person feels
thirsty and seeks water falls
v. high levels of active vitamin D inhibit PTH and
iii. also stimulates antidiuretic hormone (ADH)
low levels or magnesium stimulate PTH
secretion which decreases urinary output by
secretion
causing the reabsorption of water in the tubules
b. circulatory system
i. increases in fluid intake increase circulatory Normal and therapeutic diets
volume 1. Guidelines:
ii. this increased volume stimulates the kidney for 1. dietary reference intakes (DRI's)- average
an increased glomerular filtration rate daily nutrient intake of apparently healthy
iii. end result is an increase in urine output to people over time.
decrease the initial curculatory volume
1. recommended dietary allowance (RDA)
increase Fluid intake ->increase Cardiac Output-
2. adequate intake (AI)
>increase BP->increaseGlomerular Filtration-
3. tolerable upper intake level (UL)
>increase Urine Output->increaseBlood Volume
4. estimated average requirement (EAR)
iv. thirst center
v. located in hypothalamus 2. 2001 dietary guidlines for Americans
vi. stimulated by 1. aim for fitness
2. build a healthy base
•increased plasma osmolality
3. choose sensibly
•angiotensin II
•dry pharyngeal muscous membranes
2. Therapeutic nutrition
1. modification of the nutritional needs based on
disease condition
2. considerations for administering therapeutic
diets
1. condition of client - physical, emotional,
mental ability of client to tolerate diet
2. willingness of client to comply with diet
3. types of therapeutic diets
a. diabetic
1. goal is maintenance of normal weight
2. dietary ratio 5:2:1 (carbohydrates to fat to
protein)
3. level of activity determines energy
requirements
4. non-insulin dependent diabetes mellitus
(NIDDM) can usually be controlled by diet
therapy
5. diet individualized according to client's age,
build, weight, and activity level
2. limit 400 mg per day instead of normal 800
mg i. high fiber
3. restricts dried fruits and vegetables, shell used to correct constipation, lower risk of colon
fish, cheese, nuts cancer
30 to 40 gm fiber/day recommended
e. acid ash diet increased intake of fruits, vegetables, bran
cereals
1. prevents stone formation j. low residue
2. restricts carbonated beverages, dried fruits, used for conditions such as diarrhea,
banana, figs, chocolate, nuts, olives, pickles diverticulitis
foods high in carbohydrates are usually low fiber
f. low purine diet increased use of ground meat, fish, broiled
chicken without skin, white bread
1. prevents uric acid stone; used with gout
clients k. mechanical soft
2. lowers levels of purine, the precursor of uric 1. used with difficulty in chewing, such as poorly
acid fitted dentures or endentulous
3. restricts glandular meats, gravies, fowl, fish, 2. includes any foods which can be easily
and high meat quantities broken down by chewing
g. low cholesterol l. puree diet

6. keeping a regular schedule of meals and 1. used for cardiovascular disease, high · used with dysphagia or difficulty in chewing
snacks is essential serum cholesterol levels
· used for tube feedings, small babies
b. low protein diet 2. normal amount of cholesterol intake - 250 to
300 mg/day · food is blended to smooth consistency
1. for renal disease such as pyelonephritis,
uremia, kidney failure 3. restricts eggs, beef, liver, lobster, ice cream m. liquid diets

2. normal protein intake 40 to 60 gm/day h. low sodium clear liquid consisting of nonirritating easily
digested and absorbed liquids
3. restricted foods: meats and other foods high 1. used in congestive heart failure, hypertension full liquid
in protein such as legumes, fish, dairy
2. used for correcting the retention of sodium
c. high protein diet and water 3. Nutritional assessment: evaluate
1. weight change
1. for conditions such as burns, anemia, 3. levels of restriction 2. appetite
malabsorbtion syndromes, ulcerative colitis 3. food intolerance
4. mild (2 to 3 g sodium) 4. chewing and swallowing
2. include high quality proteins or protein 5. indigestion
supplements such as sustagen 5. moderate (1000 mg sodium) 6. elimination habits
7. eating behaviors
d. low calcium diet 6. strict (500 mg) 8. nutrient-drug interacions
9. anthropometric measurements
1. prevents formation of renal calculi 7. restricts table salt, canned vegetables, 4. Feeding tubes
smoked meats, butter, cheese
1. indications-inability to ingest, chew, or
swallow food, but GI tract intact
2. tube inserted through nose into stomach or
small bowel; or inserted
endoscopically; gastrostomy tube or PEG tube,
jejunostomy tube
3. types of tubes and feedings
1. small bore feeding tube: 8 to 12 Fr and 36 to
43 inches long
* difficult to aspirate stomach contents
* may be impossible to auscultate an air bolus;
or air bolus may be heard even when tube is not
in stomach
* tubes may become displaced even when
securely taped
* hard to verify placement; best method is by
xray
2. enteral tube feedings
* keep head of bed raised, to prevent aspiration
* assess placement of tube
* inject ten ml air into nasogastric tube (ng
tube) and listen with stethoscope for rush of air
over stomach
o aspirate gastric contents and check if pH is
acidic
o radiologic confirmation
* administer enteral feeding
o continuous
o to prevent bacterial growth, do not hang tube
feeding for longer than eight hours
* assess gastric residual
o every four hours if continuous feeding or
o before you begin intermittent feedings
3. tube feeding formulas
* Vivonex, Isocal, Portagen, etc.
4. complications
* aspiration
* gastrointestinal complications (diarrhea)
* electrolyte or metabolic problems
5. Nutritional supplements/liquids
1. dehydration/diarrhea:
1. infants: Infalyte, Pedialyte, Ricelyte
2. older children: sports electrolyte replacement
drinks
3. infant formulas: standard and high-calorie
4. specialty formulas:
* predigested (e.g. Pregestamil, Nutramigen)
* high-calorie supplements (Scandishakes,
Carnation instant breakfasts)
6. Parenteral nutrition: see Lesson 6 of this
course
7. Measures to improve nutrition intake of client
1. frequent small feedings
2. feeding assistance
3. offering preferred foods
4. ethnic foods
Activity, Mobility and Exercise
A. Prevent complications of immobility
B. Types of exercise
C. Use of mechanical aids to promote mobility
D. Prosthetic devices
E. Brace
Prevent complications of immobility
1. Skin changes - decubitus ulcers
a. turn client every two hours
b. use heel/elbow protectors
c. use alternate pressure mattress or other skin
care devices
d. do not massage reddened areas; doing so
increases damage to tissues
e. limit sitting in a chair to 2 to 4 hours or as
tolerated with a shift in weight at least every 30
to 60 minutes
2. Musculoskeletal changes-contractures
a. do range of motion exercises to joints on a
scheduled basis daily
b. provide foot board and/or foot cradle or high-
topped tennis shoes to prevent foot drop
c. reposition every 2 hours
d. maintain correct body alignment
2. Respiratory changes - pneumonia, atelectasis
a. instruct client to cough and deep breathe every
two hours, or more frequently
b. turn every two hours
c. suction if needed
d. chest physiotherapy (physical therapy) as
ordered
2. Cardiovascular system changes-decreased
cardiac output, clots,emboli
a. orthostatic hypotension:
i. instruct client to change position slowly
ii. highest risk is from supine to standing position
b. increased cardiac workload
i. reinforce for client to avoid bearing down or
valsalvar manuever
ii. minimize coughing
iii. limit sitting in high Fowler's position to one to
two hours
b. thrombus/emboli formation
i. apply thigh or knee-high antiemboic stockings
as ordered
ii. turn every tow hours
iii. monitor anticoagulation therapy, as indicated
iv. initiate ambulation or exercise of dorsi and
plantar flexion of the foot
v. limit sitting with feet in a dependent position to
1 to 2 hours
2. Urinary changes: renal, calculi, urinary tract
infection, glomerular nephritis
a. increase fluid intake (2000 - 3000 cc/day)
b. restrict foods that contribute to renal stone
formation
2. Psychosocial changes:
a. provide stimuli to maintain orientation
b. develop mutually with client, a schedule to
maintain mental sharpness
Types of exercise
1. Passive - carried out by the health care
provider without assistance from client; purpose
is to retain joint mobility and blood circulation
2. Resistive - carried by the client working
against resistance; purpose is to increase
muscular strength; enhance bone integrity
3. Isometric - carried out by the client with
no assistance by contracting muscle group for
ten seconds and then relaxing muscle group;
purpose is to maintain muscular strength when
the joint is immobilized
4. Range of motion (ROM) - joint is moved
through entire range; purpose is to maintain
joint mobility
Use of mechanical aids to promote mobility
 1. Crutches-support; balance feet, and legs iii. anticipatory loss a. unresolved
during walking -a loss that is experienced before the loss really 1. a grief
occurs reaction that is extended in length and severity
a. keep tips of crutches 12 to 16 inches to side
e.g., anticipation of the loss of a foot due to b. inhibited
of feet
gangrene toes 1. a grief
b. adjust handbars to allow 15 to 30 degrees of
elbow flexion Categories of loss reaction in which many of the normal symptoms
c. use well fitting shoes with nonslip soles Loss of external objects of grief are suppressed
d. use rubber suction tips on crutches c. stages of grief reactions
e.g., loss of a home in a fire
i. inspect weekly
Loss of a known environment i. Engel (1964)
ii. replace when worn
e. may be used temporarily or permanently e.g., a 6-year-old boy losing spending most of a. shock and
f. teach client crutch walking his day in his home environment when he disbelief
begins attending kindergarten 1. the
2. Cane-provides stability when walking and survivor either refuses to accept the loss or
relieves pressure on weight-bearing joints demonstrates intellectual acceptance of the loss
Loss of significant others
a. adjust cane with handle at level of greater but denies the emotional impact
trochanter, elbow flexed at 30 degree angle e.g., a wife losing her husband b. developing
b. teach client to hold cane close to body, and awareness
hold in hand on stronger side. Loss of an aspect of self 1. the
c. move cane at same time as the weaker leg.
e.g., a paraplegic man losing the function of his survivor becomes consciously aware of the
legs reality and meaning of the loss
3. Walker-assists in weight bearing and mobility
a. assists in weight bearing and mobility Loss of life c. restitution
b. teach client how to sit, stand and turn 1. the
survivor performs the work of mourning, which
Grief- the totality of the subjective response and
4. Gait belt is accomplished by observing rituals dictated by
behavioral process experienced related to a loss
a. leather or canvas belt around client's waist religion and/or culture
with handles d. resolving the loss
b. safety devices for ambulatory clients who bereavement is the subjective response
may have some balance problems 1.
experienced related to a loss
the survivor focuses energy on thoughts of the
deceased
Loss,Grieving,Dying and Death mourning is the behavioral process
e. idealization
experienced related to a loss
1. the
Loss- an actual or potential situation in which -is often influenced by culture, religious
survivor represses all negative feelings toward
something that is valued is changed, no longer experience, and custom
the decreased and, then, through identification,
available, or gone eg., a widow wears black at a funeral, Irish have incorporates certain characteristics of the
types of loss wakes after a funeral deceased into his or her own personality
i. actual loss b. types of grief reactions f. outcome
-a loss that can be identified by others i. conventional 1. the
e.g., loss of the ability to move legs due to a. abbreviated survivor diminishes psychological dependence
paralysis 1. a grief on the deceased and becomes interested in
ii. perceived loss reaction that is brief, but genuinely felt developing new relationships
- a loss that is perceived by one person but b. anticipatory ii. Kubler-Ross (1969)
cannot be verified by another. 1. a grief a. denial
e.g., loss of financial independence when a reaction that is experienced in advance of a loss 1. the
woman leaves employment to care for her child ii. dysfunctional individual refuses to believe that the loss is
at home happening
 a. se a. utilize therapeutic e. acceptance
rves as a buffer in helping the client mobilize communication skills 1. the
defenses to cope with the situation b. utilize individual comes to term with the reality of
b. anger attentive listening skills his/her eventual death
1. the iii. respect racial, cultural, religious, and personal b. signs of impending death
individual resists the loss values of the client and significant others in i. loss of muscle tone, e.g.:
a. an their expressions of grief
a. relaxation of facial
ger, behaviorally described as "acting out", is iv. assure the client that intense feelings and muscles
often directed at family and health care reactions are normal initially
b. difficulty speaking
providers v. provide information about the grieving process
c. difficulty
c. bargaining and what to expect
swallowing
1. the vi. encourage the client to express grief with
d. gradual loss of the
individual attempts to postpone the reality of significant others
gag reflex
the loss vii. acknowledge significant others in their own
e. decreased activity
a. se grief and desire to help the client
of the gastrointestinal tract
rves as a plea for an extension of life or the viii. encourage the development of new
chance to "make everything right" f. possible urinary
relationships
and rectal incontinence
d. depression ix. encourage the client to explore available
g. diminished body
1. the resources
movement
individual realizes the full impact of the loss x. encourage the client to explore support groups
ii. slowing of circulation, e.g.:
a. se forindividuals who have experienced a similar
rves as the preparation for the impending loss loss a. diminished
by working through the struggle of separation sensation
xi. assess client well-being
e. acceptance b. mottling and
xii. suggest that the client resume normal
cyanosis of extremities
1. the activities on aschedule that promotes physical
individual comes to term with the loss and psychologic health c. cold skin
a. se 2. Dying and death iii. changes in vital signs, e.g.:
rves as a form of detachment exemplified by a a. stages of dying and death a. decelerated and
void of emotion or interest in worldly activities weaker pulse
i. Kubler-Ross (1969)
d. signs of grief b. decreased blood
a. denial
i. repeated somatic distress pressure
1. the
ii. tightness in the chest c. rapid, shallow,
individual refuses to believe the reality of
irregular, or abnormally slow respirations
iii. choking or shortness of breath his/her eventual death
d. Cheyne-Stokes
iv. sighing b. anger
respirations
v. empty feeling in the abdomen 1. the
e. death rattle
vi. loss of muscular control individual resists his/her eventual death
iv. sensory impairment, e.g.:
vii. uncontrolled trembling c. bargaining
a. blurred vision
viii. loss of appetite 1. the
individual attempts to postpone the reality of b. impaired senses of
ix. sleep disturbance taste and smell
his/her eventual death
x. intense subjective distress c. definitions of death
d. depression
e. common interventions for grieving i. heart-lung death
1. the
clients individual realizes the full impact of his/her a. the irreversible
i. plan time to be available for the client eventual death cessation of spontaneous respiration and
ii. listen to the client’s grieving process circulation
 b. emerged from the remembering, judging, reasoning, acting, i. e.g., a wife, whose husband has an
historical idea that the flow of body fluids was enjoying, and worrying adequate pensionplan or insurance, will have
essential for life d. changes in the body after death more options for coping with widowhood
c. manifestations of i. rigor mortis g. cause of death
heart-lung death: i. e.g., a gay man’s mother and father may view
a. stiffening of the
1. no body their son’s death as a the result of acquired
spontaneous respirations immunodeficiency syndrome (AIDS) as
b. occurs about 2 - 4
2. no punishment for his homosexuality
hours after death
spontaneous heart beat 4. Common interventions for dying clients
ii. algor mortis
ii. whole brain death a. develop a trusting nurse-client
a. gradual decrease
a. the irreversible relationship with client and significant others
of body temperature after death
cessation of all functions of the entire brain, b. explain the client’s condition and
b. body temperature
including the brain stem treatment to both the client and significant
falls about 1° C (1.8° F) per hour until it reaches
b. emerged in the others
room temperature
1960s from the belief that neocortical c. if desired, teach client’s significant
iii. livor mortis
functioning is the key to the definition of a others how to assist in his/her care
human being a. discoloration of d. meet physiologic needs of dying
the skin due to breakdown of red blood cells and
c. manifestations of clients
release of their hemoglobin
whole brain death: i. provide personal hygiene measures, e.g.:
b. appears in the
1. unreceptiv a. mouth care
lowermost, or dependent, areas of the body
e and unresponsive to external stimuli
3. Factors influencing loss, grief, death, and b. clean, dry,
2. no wrinkle-free linen
dying
muscular movement
a. developmental state c. frequent changes
3. no of gown if diaphoretic
spontaneous respirations i. e.g., a 4-year girl, who would typically believe
that death is reversible, may assume that her ii. relieve respiratory difficulties, e.g.:
4. no
dead grandfather will "wake-up" and come back a. Fowler’s position
relfexes
to life b. pharyngeal
5. flat
b. significance of the loss suctioning
electroencephalogram (EEG) for 24 hours
i. e.g., a woman may view menopause not as a c. oxygen as needed
6. no
loss, but as providing more sexual spontaneity iii. assist with movement, nutrition, hydration, and
circulation to or within the brain evidenced by
due to freedom from unplanned pregnancies elimination, e.g.:
Doppler ultrasound for 24 hours
c. culture a. frequent changes
7. positive ap
nea test i. e.g., in Western society, the prevalent attitude of position
seems to be to view loss and death as dreaded b. antiemetics to
a. ap enemies to be fought and postponed
nea when off the respirator for four minutes stimulate appetite
with a PaCO2 of at least 60 mm Hg d. spiritual beliefs c. encourage fluids
iii. higher brain death i. e.g., in the Jewish religion, family and friends d. skin care if
sit Shiva with the survivors and the survivors incontinent
a. the irreversible unwrap the deceased’s headstone one year
loss of all "higher" brain functions, of cognitive iv. provide measures related to sensory changes,
after burial (Jarhzeit)
function e.g.:
e. sex-role
b. emerged in the a. touch
1970s from the belief that the brain is more i. e.g., men are socialized to "be strong" and
b. speak clearly and
important than the spinal cord and that the show very little emotion during grief
do not whisper (hearing is the last to go)
critical functions are the individual’s personality, f. socioeconomic status
c. brightly lit room
conscious life, uniqueness, capacity for
 v. relieve pain, e.g.: b. death as a state of f. wash the client if
a. provide eternal peace needed, honoring any religious or cultural rituals
pharmacologic, nonpharmocologic, and/or c. heaven as a g. comb and arrange
cognitive-behavioral pain management garden of flowers eternally in bloom the client’s hair
e. meet spiritual needs of dying v. final wishes and saying good-bye, e.g.: h. place pads under
clients a. preferences for the client’s hips and around the perineum to
i. if comfortable, a nurse can directly provide the funeral absorb feces and urine
spiritual care for the dying client b. burial i. clean up the
a. e.g., pray with the arrangements client’s room or unit
client, read scripture with the client, meditate c. wish to offer body j. prepare the client
with the client to science or organs for transplantation for transfer to either a morgue or funeral home
ii. if uncomfortable, a nurse should arrange g. meet needs of the significant 1. wrap the
access to individual(s) who can provide spiritual others of dying clients client in a shroud
care for the dying client 2. attach
i. listening to significant others’ concerns, e.g.:
a. e.g., priest, identification tags per agency policy
a. utilize therapeutic
minister, rabbi ii. care of the client’s significant others
communication skills
f. meet pyschologic needs of dying a. listening to
b. utilize attentive
clients significant others’ grieving process
listening skills
i. prevent loss of control and dependency 1. utilize
ii. remind significant others to care for
a. encourage the themselves, e.g.: therapeutic communication skills
client to make as many decisions as possible 2. utilize
a. get rest
about his/her care active listening skills
b. eat nutritiously
ii. prevent social isolation, e.g.: b. if desired, allow
iii. prepare significant others for the reality of
a. help the client significant others to see the body in private and
death, e.g.:
maintain involvement in established, significant perform any religious or cultural custom they
relationships a. explain the signs wish
of impending death
b. provide c. provide a private
meaningful environmental stimulation b. explain changes in place for significant others to begin the grieving
the body after death process
c. encourage
significant others to stay in communication c. explain the d. if requested,
through caring, silence, touch, and telling the grieving process notify the hospital chaplain or appropriate
client of their love h. provide postmortem care community religious leader
iii. life review and framing memories, e.g.: i. care of the client’s body iii. care of other clients
a. encourage the a. remove or cut all a. listening to other
client and significant others to talk about past tubes and lines according to health care agency clients’ grieving processes who were aware of
accomplishments, pleasures, and hardships policy the death of the client
b. ask the client to b. close the client’s iv. care of other nurses
give significant others meaningful information to eyes a. listening to other
pass on to future generations nurses’ grieving processes who were involved in
c. replace dentures
c. have significant or other dental appliances, if worn the client’s care
others share with the client what he/she means i. hospice care
d. straighten the
to them and their future aspirations client and lower the bed to a flat position i. focuses on support of the dying client and
iv. guided imagery, e.g.: family with the goal of facilitating a peaceful
e. place a pillow
a. self-chosen or under the client’s head and dignified death
instructor-suggested images of the hospital
room as a safe, comfortable place to die
 ii. based on holistic concepts that emphasize care D. Therapeutic massage
to improve the quality of remaining life rather 1. Manipulates the soft
than cure tissue of the body and assists with healing
iii. four key features of hospice: 2. Can be either relaxing or
a. interdisciplinary energizing
team 3. Is contraindicated for a
b. inclusion of family client with phlebitis, thrombosis, or infectious
as defined by the client skin diseases
c. pain management E. Aromatherapy
and symptom control, or palliation (lessening) 1. Uses oils produced by
d. individuality and plants for inhalation or topical application
dignity 2. Different scents are
thought to produce different responses in the
body
Alternative and Complementary Medicine E. Reflexology applies pressure to
A. Herbal therapy specific areas of the feet thought to correspond
1. Used as dried herbs in with all the different parts of the body
capsules or tablets, tinctures, teas, ointments F. Relaxation therapy
2. Use only products 1. Rhythmic breathing
standardized with a specific amount of active
2. Progressive relaxation
ingredients
E. Yoga
3. Some may interfere with
medications 1. Treatment of the mind-
body connection
B. Chiropractic treatment
Can tone the muscles that balance all parts of
1. Effective by manipulating
the body and control the emotions and mind
the musculosketal system
through correct posture and breathing
2. Manipulation to put the
vertebrae in proper alignment
B. Acupuncture and acupressure
1. Based on belief that
channels of energy are blocked causing
diseases or discomfort
2. Acupuncture is primary
treatment used by physicians of Chinese
medicine
a. insert fine needles
at specific points to open channels of energy
(meridians)
b. used to decrease
pain and to treat or prevent illness
3. Acupressure
a. uses gentle
pressure at specific points
b. used for
prevention and relief of muscle tension