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History of Nursing 1.

knowledge of the manner in which drugs Nursing in Philippines


should be prepared for administration
Brief History of Nursing 2. cleverness The Philippine Nurses Association (PNA)
3. devotedness to the patient established in 1922 was responsible in lobbying
In the early dawn of human history, diseases 4. purity of mind and body our government for the adoption of the
or illness were often related to superstitious recommendations made by the International
beliefs and the treatment also often involved Christian Benevolence- “love thy neighbor as Labor Organization in 1977 with regard the
magical cures. thyself” had a significant impact on the status of the economic and social welfare of our
development of Western Nursing. nursing personnel.
The Sumerian Civilization is believed to have The Professional Regulation Commission of the
recorded in a clay-tablet 4,000 years ago some The principle of “Good Samaritan” is the basis Philippines duly recognizes the PNA as the
healing prescriptions but did not specify the of caring for most Christians that eventually laid leading Association of nurses in the
illnesses. down some principles of nursing. country. In 1924, it published a standardized
curriculum for schools of nursing to adopt.
The Code of Hammurabi traceable to the During the time of the Roman Empire, rich The following were the first groups interested
Babylonian empire in 1900 BC documented matrons such as Fabiola used their wealth to and registered with the Philippine Nurses’
regulations pertaining to sanitation and provide houses of care and healing that served Association (PNA), to wit:
public health, the practice of surgery, as the early hospitals for the poor, sick and the
differentiation in the practice of human homeless. 1. Academy of Nursing of the Philippines, Inc.
against veterinary medicine, a table of (ANPHI)
fees for operations and penalties for The Time of Crusades ( Holy mission or pilgrim 2. Association of Deans & Principals of Schools
violation of the code. During these early to regain the Holy land by the Christians), and Colleges of Nursing of the Philippines
days, nursing practice was vaguely described as knights were trained to provide care for (ADPSCNP)
those who render comfort and support to the wounded soldiers in the battle – this is 3. Association of Nursing Administrators of the
patient. In the Old Testament, it made mention perhaps the earliest recognition of men Philippines ( ANSAP)
of women as nurses who provided care for providing nursing care. 4. Association of Private Duty Nurse
infants and children, the sick and dying. Practitioners of the Philippines (APDNPP)
Camillus De Lellis – considered the patron 5. Critical Care Nurses’ Association of the
The Greek and Roman empires related the saint of nurses was the founder of the Philippines (CCNAP)
care of the sick and those injured to the Nursing Order of the Ministries who 6. Catholic Nurses Guild of the Philippines
mythologies that they have created and provided care to the sick and the poor. (CGNP)
believed that the gods and goddesses 7. Golden Age Nurses Association (GANA)
possessed special healing powers. Hygeia, Florence Nigthangle born from a wealthy 8. Ministry of Health National League of Nurses
daughter of Greek god Asklepios, the chief family chose to dedicate her life in providing (MHNLN)
healer, was revered to be the embodiment of care for the sick and injured especially during 9. Occupational Health Nurses Association of the
the nurse. the Crimean War. She also started a school to Philippines (OHNAP)
train nurses in 1860, which eventually sparked 10. Operating Room Nurses Association of the
Ancient India – Nursing functions were being the development of Modern Nursing. Philippines (ORNAP)
carried out by male nurses provided they meet 11. Philippine Nurse Midwifery Society
the four qualifications: 12. Philippine Nursing Students Association
(PNSA) nursing define it as a science and an art that recovery (or to a peaceful death) that he would
13. Philippine Orthopedic Nurses Society focuses on promoting quality of life as defined perform unaided if he had the necessary strength,
14. Psychiatric Nursing Specialists Foundation of by persons and families, throughout their life will or knowledge. And to do this in such a way as
the Philippines, Inc. (PNSI) experiences from birth to care at the life. to help him gain independence as rapidly as
15. Philippine School Nurses Association (PSNA) possible."
* Nursing practice is primarily the caring
relationship between the nurse and the person Betty Neuman (1972, 1982, 1989, 1992)
The following are the later members of the PNA: in their care. In providing nursing care, nurses Nursing is a unique profession in that it is
are implementing the nursing care plan, which concerned with all the variables affecting an
1. Association of Diabetes Nurse Educators of is based on a nursing assessment. individual’s response to stressors.
the Philippines (ADNEP)
2. Graduate Nurses Christian Fellowship (GNCF) Myra Estrin Levine (1973) "nursing is
3. Integrated Nurses Association of the conserving or 'keeping together' the patient's
Philippines (IRNUP) energy and structural, personal, and social
4. National League of Philippine Government integrity as he/she struggles towards health and
Nurses (NLPGN) well-being to achieve a positive adaptation"
5. Maternal and Child Nurses Association of the
According to Nursing Theorists:
Philippines (MCNAP) Hildegard Peplau (1952) "nursing is a
6. Military Nurses Association of the Philippines Florence Nightingale (1860), the first nurse significant, therapeutic, interpersonal process that
(MNAP) theorist defines Nursing as "The act of utilizing functions cooperatively with other human
the environment of the patient to assist him in his
7. Philippine Oncology Nurses Association recovery" processes which make health possible for
(PONA) individuals"
8. Philippine Orthopedic Nurses Society (PONS)
(12 May 1820 – 13 August 1910) was a
celebrated English nurse, writer
Imogene M. King (1971, 1981)"nursing is an
Nature of Nursing and statistician.
interpersonal process of action, reaction,
She was dubbed "The Lady with the Lamp" interaction, and transaction whereby nurse and
* Nursing is derived from the Latin word “ after her habit of making rounds at night. patient share information about their perceptions
Nutrix” which means to nourish.
Nightingale laid the foundation of in the nursing situation"
professional nursing with the establishment,
* Nursing is also defined as an art and science. in 1860, of her nursing school at St Sister Callista Roy (1979)"as a science, nursing
It is an art for should have skills that require Thomas' Hospital in London, the first
is a developing system of knowledge about
proficiency and dexterity. It is Science because secular nursing school in the world.
The annual International Nurses Day is human beings used to observe, classify, and
it requires the systematic approach or
celebrated around the world on her birthday. relate the processes by which persons positively
application of the scientific knowledge.
affect their health status"

* Nursing is a profession focused on assisting Virginia Henderson (1955) The unique


Joyce Travelbee (1966, 1971)Nursing is an
individuals, families, and communities in function of the nurse is to assist the
interpersonal process whereby the professional
attaining, maintaining, and recovering optimal individual, sick or well, in the performance of
nurse practitioner assists an individual, family, or
health and functioning. Modern definitions of those activities contributing to health or its
community to prevent or cope with the
experience of illness and suffering, and if Policy Statement (1980) "Nursing is the diagnosis 1. Breathing normally
necessary, to find meaning in these experiences. and treatment of human responses to actual or 2. Eating and drinking adequately
potential health problems” 3. Eliminating body wastes
Martha Rogers (1970), A learned profession 4. Moving and maintaining desirable position
that is both science and art. The professional Scope of Nursing Practice: 5. Sleeping and resting
practice of nursing is creative and imaginative This involves 4 areas: 6. Selecting suitable clothes
and exists to serve people. 1.Promoting health and wellness 7. Maintaining body temperature within normal
2.Preventing illness range by adjusting clothing and modifying the
Jean Watson (1979) Nursing is a human science 3.Restoring Health environment
of people and human health; illness experiences 4.Care of Dying 8. Keeping the body clean and well-groomed to
that are mediated by professional, personal, protect the integument
scientific, aesthetic, and ethical human care Nursing Theories 9. Avoiding dangers in the environment and
transactions. avoiding injuring others
4 Concepts of Central Nursing: 10.Communicating with others in expressing
Ernestine Wiedenbach (1964)Nursing is the emotions, needs, fears, or opinions
nurse is a functional human being who acts, • Person 11.Worshipping according to one’s faith
thinks, and feels. All actions, thoughts, and • Environment 12.Working in such a way that one feels a sense
feelings underlie what the nurse does. • Nursing of accomplishment
• Health 13. Playing or participating in various forms of
Ida Jean Orlando (1961) Professional nursing is recreation
conceptualized as finding out and meeting the 14. Learning, discovering, or satisfying the
client’s immediate need for help. Nightangle’s Environmental theory – curiosity that leads to normal development and
Florence Nightangle, “the mother of modern health, and using available health facilities.
Lydia Hall (1964)Caring is the nurse’s primary nursing” esposed her theory focusing on the
function. Professional nursing is most important environment. She linked health with five Rogers’s Science of Unitary Human Beings
during the recuperative period. environmental factors: - Martha Rogers views the person as an
1. pure or fresh air irreducible whole, the whole being greater than
Professional definitions of nursing 2. pure water the sum of its parts. Her Key concepts in
3. efficient drainage describing the individual are energy fields,
International Council of Nurses (ICN) (1973) 4. cleanliness openness, pattern and organization, and
"the unique function of the nurse is to assist the 5. light multidimensionality.
individual, sick or well, in the performance of She described the Unitary Man as:
those activities contributing to his health, or its Henderson’s Definition of Nursing 1. Irreducible, four-dimensional energy field
recovery (or to peaceful death) that he would - The definition of nursing given by Virginia identified by pattern.
perform unaided if he had the necessary strength, Henderson in 1955 became a milestone in the 2. Manifesting characteristics different from the
will, or knowledge and do this in such a way as to development of nursing as discipline apart from sum of the parts
help him gain independence as rapidly as medicine. The focus on her Nursing Concept is 3. Interacts continuously and creatively with the
possible" to help individuals and families gain environment
independence in meeting the 14 fundamental 4. Behaving as a totality
American Nurses Association (ANA) Social needs; 5. Participating creatively in change
2. Interpersonal system concepts: the society.
Orem’s Self Care Deficit Theory interaction, communication, transaction, role,
– Dorothy Orem developed the self-care deficit and stress. Peplau’s Psychodynamic Nursing Theory-
theory that includes self-care, self-care deficit 3. Social system concepts: organization, Hildegard Peplau introduced and defined
and nursing system. She believed that the self- authority, power, status, and decision making. psychodynamic nursing as understanding one’s
care of the individuals and the self-care of own behavior to help others identify felt
dependents are learned behaviors that Neuman’s Health Care Systems Model difficulties and applying principles of human
individuals initiate and perform on their own – Betty Neuman views the client as an open relations to problems arising during the
behalf to maintain life, health, and well-being. system consisting of a basic structure or central experience. She also described the nurse-
core of energy resources (physiologic, patient relationship in four phases:
Three kinds of self-care requisites: psychologic, sociocultural, developmental, and 1. Orientation – patient seeks help and the
1. Universal requisites ( common to everybody spiritual) surrounded by two concentric nurse assists patient to understand the problem
like maintenance of air, water etc…) boundaries or rings referred to as lines of and the extent of need for help.
2. Developmental requisites resistance. She identified individual’s response 2. Identification - patient assumes a posture of
3. Health deviation requisites to stress and the nursing interventions to be dependence, interdependence, and
carried out on three preventive levels: independence in relation to the nurse
Roy’s Adaptation Model – Sister Callista 1. Primary prevention 3. Exploitation - patient uses available services
Roy focuses on the individual as a biophysical 2. Secondary prevention on the basis of self interest and needs
adaptive system. Both the individual and the 3. Tertiary Prevention 4. Resolution - old needs and goals are put
environment are sources of stimuli that require aside and new ones adopted.
modification to promote adaptation, an ongoing Johnson’s Behavioral System Model
purposive response. - Dorothy Johnson defines a system as a Leininger’s Transcultural Care Theory
whole that functions as a whole by virtue of the – Madeleine Leininger established the
3 classes of stimuli: interdependence of its parts. A behavioral transcultural nursing which she defined as a
1. Focal Stimulus: the internal or external system is patterned, repetitive and purposeful. major area of nursing that focuses on
stimulus most immediately confronting the Johnson’s key concepts describes the comparative study and analysis of different
person and confronting the behavior. individual as a behavioral system cultures and subcultures in the world, with
2. Contextual stimuli: all other internal or composed of seven subsystems: respect to their:
external stimuli present 1. Attachment-affiliative subsystem provides 1. Caring behavior
3. Residual Stimuli: beliefs, attitudes, or traits survival and security. 2. Nursing care
having an intermediate effect on the person’s 2. Dependency subsystem promotes helping 3. Health values
behavior but whose effects are not validated. behavior that calls for a nurturing response. 4. Beliefs
3. Ingestive system satisfies appetite. 5. Patterns
King’s Goal Attainment Theory – 4. Eliminative subsystem excretes body wastes.
Imogene King based her theory from the 5. Sexual subsystem functions dually for Watson’s Philosophy and Science of
conceptual framework of three dynamic procreation and gratification. Caring
interacting systems: 6. Achievement subsystem attempts to – Jean Watson believes the practice of caring is
1. personal system concepts: perception, manipulate the environment. central to nursing; it is a unifying focus for
self, body image, growth and development, 7. Aggressive subsystem protects and preserves practice.
space and time the self and society within the limits imposed by
According to her, there are two major
b. Communicator – communicate with the i. Case manager –managers work with the
assumptions that underlie human care client, support persons, other health multidisciplinary health care team to measure
(carative factors): professionals, and people in the community. the effectiveness of the case management plan
1. care and love constitute the primal and - identify client problems and then communicate and to monitor outcomes.
these verbally or in writing to other members of
universal psychic energy
the health team. The quality of a j. Research consumer – nurses often use
2. care and love are requisite for our survival nurse’scommunication is an important factor in research to improve client care. In a clinical
and the nourishment of the society nursing care. area nurses need to:

TRANSCULTURAL CONCEPTS c. Teacher –helps clients learn about their · Have some awareness of the process and
health and the health care procedures they language of research
HINDU – REINCARNATION , AUTOPSY , ORGAN need to perform to restore or maintain their · Be sensitive to issues related to protecting the
DONATION,CREMATION health. rights of human subjects
ISLAM – NO TO ORGAN DONATION , - assesses the client’s learning needs and · Participate in identification of significant
CREMATION AND AUTOPSY …..CONFESS AND readiness to learn, sets specific learning goals in researchable problems
TURN TO MECCA conjunction with the client, enacts teaching · Be a discriminating consumer of research
JUDAISM – WASHED strategies and measures learning. finding.
NATIVE AMERICAN – NOT TO AUTOPSY
BUDDIST – OK – EUTHANASIA AND WITH LAST d. Client advocate –acts to protect the client. Health
RITES - 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
HINDU- all meats and animal shortening -assist clients in exercising their rights and help
not merely the absence of disease or infirmity
ISLAM- pork , alcohol and beverages(extracts them speak up for themselves.
of lemon and vanilla) , animal shortening and President's commission - 1953 - Health is
gelatin made of pork e. Counselor –helping a client to recognize and
not a condition but an adjustment; not a state
JUDAISM – pork , fowl , shellfish and scavenger cope with stressful psychologic or social
but a process; the process adapts the individual
fish( without scales or fins) , blood by problems, to developed improved interpersonal
to the physical and social environment
ingestion(transfusion –o.k.), packed fods relationships, and to promote personal growth.
– kosher-properly presserved or fitting - providing emotional, intellectual, and
WHO definition - advantages:
KOSHER- no meat and milk altogether psychologic support.
holistic
Pareve – made without milk or meat items total person (physical, psych, social)
MORMON – alcohol, tobacco, beverages with f. Change agent –to make modifications in
health in context of environment - health
caffeine stimulants their own behavior.
influenced by everything they interact with (air,
7TH DAY ADVENTIST – pork , certain seafoods - act to make changes in a system such as
water, people)
including shelfish, fermented beverages , clinical care, if it is not helping a client return to
equates health with productive, creative living
vegetables are encouraged health.
YIN AND YANG – cold foods in hot illness , vice WHO definition - disadvantage:
versa g. Leader –influences others to work together
use of the concept "complete" health - R/T
Hot – rash , fever , sorethroat , surgery , ulcer , to accomplish a specific goal.
chronic illness
infection -requiring an understanding of the needs and
Cold – Ca , HA , stomach cramps and colds 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
ROLES AND FUNCTION OF A NURSE skills to influence others.
much as possible
-being active and able to do what they
a. Caregiver –assist the client physically and h. Manager – manages the nursing care of
want/must
psychologically while preserving the client’s individuals, families, and communities.
-being in good spirits most of the time
dignity. -delegates nursing activities to ancillary workers
HEALTH IS AN ONGOING PROCESS - A WAY OF
-encompasses the physical, psychosocial, and other nurses, and supervises and evaluates
LIFE!
developmental, cultural and spiritual levels. their performance.
Nurses must be aware of their own definition of · Leavell and Clark's "Agent, Host, Environment"
health - clients may have different definitions Model 2. emergent level wellness in an
Also called the ecological model unfavorable environment
Nurses must clarify their beliefs about health: - person knows about healthy lifestyle practices,
1. Nurse's definition of health largely Theory of multiple causes of disease but cannot implement due to family
determines the scope and nature of their responsibilities, job demands, etc.
practice (when health definition is broader than Contains 3 dynamic interactive elements:
physiologic, then scope of practice broadens) 3. Protected poor health in a favorable
2. People's health beliefs influence health 1. Agent - environmental factor/stressor that by environment
practices presence/absence can lead to disease. - person is ill but needs met by health care
eg: lack of essential nutrients, etc. system
Health - a complex phenomena
2. Host - person who may/may not be at risk of 4. Poor health in unfavorable environment
acquiring a disease - for example a starving child in a famine
Researchers - models: eg: family history, age, life-style stricken land; the working poor with health
problems
Smith's 4 models of health 3. Environment - Factors external to the host
that may/may not predispose person to Dunn - family wellness enhances individual
1. Clinical Model - narrowest - development of the disease. eg: living wellness; community wellness enhances family
People are physiologic systems conditions, economic status, etc. wellness, which enhances individual wellness
Health - an absence of signs/symptoms of illness
- not being sick Opposite of health Health is ever changing Travis's Illness/Wellness Continuum
-disease/injury Continuum ranges from high level wellness to
MD's often use the clinical model-- when signs & Health maintained when variables are in premature death
sxs of disease are no longer present in a person, balance 2 arrows point in opposite directions and are
the MD often considers that the person's health joined at a neutral point
is restored. Disease - when variables not in balance Movement to the right indicates increasing
health.
2. Role Performance Model Health-Illness Continua (Grids or Graduated Neutral point to left - progressive decline in
Health defined in terms of being able to fulfill Scales) health
your work role - used to measure a person's perceived level of
Sickness - inability to perform work wellness
· Dunn's High Level Wellness Grid Health & well-being are achieved in 3
3. Adaptive Model steps:
Health - a creative process Health axis and environmental axis awareness
Disease - a failure in adaptation (maladaptation) intersect education
Aim of Tx - help person adapt/cope Demonstrates the interaction of the growth
Good health - flexible adaptation to environment with the illness/wellness
environment and interaction with environment continuum. Can be physically ill but oriented toward
to maximal advantage wellness, or physically healthy and be
Health axis - from peak wellness to death functioning from an illness mentality.
4. Eudaemonistic Model - most Environmental axis - from very favorable to Important not only where you are but also what
comprehensive view of health very unfavorable direction you are facing
Health - a condition of actualization or This model considers not only the physical, but
realization of a person's potential (sounds like The intersection of the two axes forms also the spiritual, emotional, and intellectual
Maslow). A client would be considered healthy four health/wellness quadrants: aspects of wellness.
when he realized his full potential.
The highest aspiration of people - fulfillment and 1. wellness, environment Health Belief Models
complete development (actualization) - person is healthy and has resources to support · Rosenstock
Illness - a condition that prevents self this Originally intended to predict which people
actualization
would or would not use preventive health state of health, prevent illness/injury, reach 2. body image - how he perceives his physical
services maximal physical/mental potential self
(eg flu shot, HIV testing, hypertension (eg: anorexia) Affects how people view and
screening, etc.) Internal Factors Influencing Health: handle situations
Based on motivational theory 1. Biologic dimension 3. Cognitive dimension - intellectual factors
Assumption: good health is an objective · Genetic makeup - influences biologic · Life style choices: Patterns of eating; exercise;
common to all people characteristics, innate temperament, activity use of tobacco, alcohol, drugs; methods of
Individual perceptions: level, and susceptibility to specific diseases coping with stress
perceived susceptibility (diabetes, breast cancer) Problems: overeating, inactivity, abuse of
perceived seriousness · Race - predisposition to certain diseases (eg: alcohol/drugs, use of tobacco
perceived threat blacks - hypertension, sickle cell anemia; Native · Religious/Spiritual Beliefs: Jehovah's Witnesses
Americans - diabetes; Jewish - Tay Sachs - no blood transfusion
Modifying factors - (which modify the person's disease; Mediterranean and SE Asia - Some fundamentalists believe serious illness is
perceptions) thalassemia a punishment from God
· Sex - influences distribution of diseases "..in pain shall you bring forth children..."
Demographic variables - age, sex, race, Females/ Males: osteoporosis /stomach ulcers; Orthodox Jewish - circumcision on 8th day,
ethnicity autoimmune disorders/ abdominal hernias; Kosher dietary laws
Sociopsychological variables - social pressure, lupus /resp. diseases; rheum. arthritis/ ASHD;
peer group pressure anorexia/bulimia hemorrhoids;gallbladder disea External Factors Influencing Health
se/ TB; thyroid disease; obesity
Structural variables - knowledge about target · Age/developmental level Distribution of 1. Geography
disease and prior contact with it disease varies with age (ASHD - middle age Geography determines climate which effects
males, chicken pox - childhood Developmental health
Cues to action - mass media campaigns, advice level - strong influence on health (Infants - tropics - malaria
from others, newspaper/magazine articles, physiologically immature; toddlers - prone to climate – asthma
illness of family/friend accidents/injuries; Adolescent - risk taking
behaviors due to need to conform with peers; 2. Environment
Likelihood of action - perceived benefits of Elderly - declining physical and Pollution - air, water, soil
action, minus perceived barriers to action sensory/perceptual abilities limit ability to Carcinogens - asbestos
respond to environmental hazards falls, MVA's) Radiation - machines, UV
Pender: - 2 further considerations Acid rain - main component is sulfur dioxide of
1. Importance of health to person 2. Psychologic dimension - emotional factors industrial origin; thought to damage forests,
2. Perceived control - locus of control · Mind/body interaction - influences health lakes, rivers
positively or negatively. Emotions in response to Greenhouse effect - roof of greenhouse allows
What is YOUR personal definition of health?? stress affect body function ( eg anxious student heat of sun to penetrate, but resulting heat
prior to exam, family of hospitalized patient. cannot escape through glass;
CO2 in atmosphere acts as glass roof - therefore
Variables influencing health status, belief, and Prolonged emotional stress may increase earth's temp is increasing
practices susceptibility to organic disease Emotional Pesticides
distress may influence the immune system Chemicals
Definitions: through CNS and endocrine alterations Ozone layer
· Health status - state of health of a person at
a given time; describes one's problem in general Increasing attention being given to mind's 3. Standard of living - reflects occupation,
· Health beliefs - concepts about health that a ability to direct body's functioning income, and education
person believes to be true; may or may not be All relate to health, mortality, and morbidity (ex:
true; may be cultural (eg: hot/cold - not Relaxation - childbirth; Biofeedback - low income - generating & maintaining an
necessarily related to the temp of food/fluid, but hypertension, Meditation income are highest priority - illness prevention
rather its intrinsic qualities -- citrus and fowl are is a lower priority - often cannot afford regular
cold; meats and breads are hot) Self concept - how a person views himself medical exams, good housing, nutritional food -
· Health behavior - actions people take to Composed of: health may be defined in terms of work -
understand health status, maintain optimum 1. self esteem - how he sees himself reliance on medicaid - poor environment (poor
quality housing and neighborhoods) Complexity, side effects, and duration of
Occupational roles predispose some to illness prescribed therapy
black lung - coal miners Specific cultural heritage that makes Illness and Disease
asbestos, noise, repetitive motion injuries compliance difficult
Degree of satisfaction and quality and type of People may view them as the same
4. Family/cultural beliefs relationships with health care providers entity; health professionals view them
Family passes on patterns of daily living and life Overall cost of prescribed therapy differently
styles to offspring (ex: child abuse)
Cultural/social interactions influence how a When client does not follow regimen - find · Illness - a highly personal state in which the
person perceives, experiences, and copes with out WHY - then assist to comply: person feels unhealthy or ill; may/may not be
health and illness · Establish why R/T a disease. Can have a disease but not feel
Cultures have distinctive ideas about health, · Demonstrate caring ill...Can feel ill but not have a disease. Illness is
and these are transmitted from parents to · Encourage healthy behaviors through positive subjective - only the person can say if he/she ill
children reinforcement of what the person is doing right
Home remedies may be perceived as superior to · Use aids to reinforce teaching: videos, audio · Disease - alteration in body function resulting
conventional medicines cassette, print media, verbal instruction in reduction of capacity or shortening of normal
· Establish therapeutic relationships life span. Theories of disease - "forces", evil
5. Social support networks spirits. Later this belief was replaced by the
Family, friends, confidantes, co-workers WELLNESS AND WELL BEING single causation theory.
These influence a person's ability to avoid Wellness - a state of well being; engaging in
illness; can also help them confirm that an attitudes and behaviors that enhance quality of Causation of disease = etiology
illness exists; can provide stimulus to recovery life and maximize personal potential
Concepts of Wellness include: Classification of illness and disease:
Compliance - (also known as adherence) - the wellness is a choice & a way of life · Acute illness - severe symptoms, short duration,
extent to which an individual's behavior (ex- self responsibility sx appear suddenly & subside quickly, may/may
med taking, diet, lifestyle changes, etc) coincide an ultimate goal not require intervention by health care
with medical/health advice. a dynamic growing process professionals, may possibly be treated with OTC
wellness is the loving acceptance of yourself meds, after acute illness, most return to a normal
A client is "compliant" if he/she takes his DAILY decision making in the areas of level of wellness
medication, follows a prescribed diet, follows nutrition
instructions, etc. stress management · Chronic illness - duration usually 6 months or
A client is "noncompliant" if he/she does NOT do physical fitness longer, often for the rest of person's life, many do
these things. preventive health care not regard themselves as ill, slow onset, may have
emotional health remissions (symptoms disappear) & exacerbations
Extent of compliance can be measured on a other aspects of health (symptoms reappear)
continuum
total disregard «--------------» completely 5 dimensions of wellness; · Deviance - behaviors that go against societal
following advice for all aspects of the 1. Physical - ADL's (activities of daily living), norms - often considered chronic illnesses (ex:
therapeutic plan fitness, nutrition, body fat, no drugs, addictions)
moderate/no alcohol, no tobacco
Factors influencing compliance: 2. Social - interact successfully with others, Illness behaviors - activities undertaken by a
Client motivation to become well intimacy, respect, tolerance person who feels ill to define the state of his
Degree of lifestyle change necessary 3. Emotional - manage stress, express emotions, health and to discover a suitable remedy
Perceived severity of health care problems express feelings, accept limitations
Value placed on reducing risk of illness 4. Intellectual - learn; use information effectively Bauman - 3 criteria to determine illness: presence
Difficulty understanding/performing specific for personal, family, and career development; of symptoms, perception of how they feel, ability
behaviors continued growth to carry out ADL's
Degree of inconvenience of illness/performing 5. Spiritual - a force/Being that unites people Effects of illness
specific behaviors and gives meaning/purpose to life; Illness causes change in many normal behaviors
Belief that prescribed therapy or regimen morals/values/ethics 1. Privacy -
will/will not help when a person enters a health care facility,
immediate loss of privacy (bodily privacy, health habits; a variety of tools are available
personal space, informational) 1. Primary prevention - Generalized health (some are computer based)
Privacy is a personal internal state. It is a promotion and specific protection against
comfortable feeling reflecting a deserved degree disease; it precedes disease or dysfunction and 3. Life style and behavior change programs -
of social retreat or freedom from unauthorized is applied to generally healthy individuals, but geared to enhancing quality of life and
intrusion. may also be offered to clients regardless of their extending life span; examples include stress
2. Autonomy - health/illness status & age management, nutrition awareness, weight
ex) decisions about meals, hygiene, sleep decided Ex) Health education (accident prevention, control, smoking cessation, exercise
by staff. nutrition, growth & development,
Degree of sense of autonomy varies from person exercise, stress management, occupational 4. Worksite wellness programs - address
to person hazards, etc.) workplace issues (air quality, accident
3. Financial burden prevention, back saver); often hypertension
4. Lifestyle changes - definition - p 257 2. Secondary prevention - Emphasizes early screening also; may include health
Help clients adjust to this by: detection of disease, prompt intervention, and enhancement programs (fitness, relaxation)
Providing explanations about necessary health maintenance for individuals experiencing
adjustments health problems 5. Environmental controls programs - may
Try to accommodate their lifestyle as much as Ex) Screening (hypertension, cholesterol, include community groups concerned about
possible Denver Developmental); regular medical/dental toxic and nuclear wastes, nuclear power plants,
Encourage other health care professionals to checkups; air/water pollution, and herbicide/pesticide
become aware of lifestyles and teach breast/testicular self exam; assessing spraying
support positive aspects growth and development; nursing assessments
Reinforce desirable changes in client behavior and care provided in the home, hospital, or Nurse's Role In Health Promotion:
with a view to making them permanent part of other agencies to prevent complications 1. Model healthy lifestyle behaviors
lifestyle
5. Family changes - dependent on 3. Tertiary prevention – Begins after an illness, Modeling - observing the behaviors of other
the member of the family who is ill when a defect or disability is fixed, stabilized, or people who have achieved the goal the client
seriousness/length of illness irreversible; focus is to help rehabilitate has set for himself; it is NOT imitating; upon
cultural/social customs parents follow individuals and restore them to an optimal level observing a model, the client acquires ideas for
Types of changes that can occur in family: of functioning within the constraints of the behaviors and coping strategies for specific
role changes; task reassignment; stress R/T disability problems; nurses can serve as a model for
anxiety about outcome of illness for client and Ex) referring a colostomy client to a support wellness; once a nurse has assessed own
conflict about unaccustomed responsibilities; group; teaching a client withdiabetes to detect health, developed a plan, and made changes,
financial problems; loneliness as a result of and prevent complications; referral of a client and know firsthand about difficulties in changing
separation and pending loss; changes in social with spinal cord/head injury to rehab behaviors, they can work more effectively with
customs Wide variety of health promotion activities: work peers and clients; a client is more likely to
Trends in Health and Illness settings, schools, health care organizations, respect/trust a person who can personally relate
· Mortality - death rate community agencies, fire dept, police what worked
· Longevity - life expectancy
· Morbidity - illness/disease Types of health promotion programs: 2. Facilitate client involvement in assessment,
planning, implementation, and evaluation of
Promoting Health and Wellness 1. Information dissemination - raise health goals
knowledge/awareness; uses media to offer info Assessment - health history, physical exam,
Health promotion - any activity undertaken for about risks R/T certain behaviors, as well as nutritional assessment, health risk appraisal ,
the purpose of achieving a higher level of health benefits of changing behaviors; billboards, (Risk factors are life style behaviors that
and well being. brochures, newsletters, books, health fairs; increase the chance acquiring a specific
Health promotion activities are directed toward topics include ETOH, drug abuse, DWI, HIV/AIDS disease), life style assessment (life style and
developing client resources that maintain or habits that affect health - physical activity,
enhance well-being. 2. Health appraisal/wellness assessment eating habits, safety practices,stress
programs - used to apprise individuals of risk management, smoking, alcohol consumption,
Levels of prevention factors inherent in their lives to motivate them drug use), life stress review
to reduce specific risks and develop positive Planning - Plans need to be developed according
to the needs, desires, and priorities of client; the enhance relationships ii. External Stressors – originate outside a
client plans - the nurse acts as a resource; 4. Assist individuals/families/communities to person. E.g. change in family or social role, peer
emphasize small steps to behavioral change; increase their level of health pressure, marked change in environmental
review goals with client for realism, 5. Teach clients to be effective health care temperature
measurability, and acceptability. consumers
6. Assist clients/families/communities to develop b. Factors influencing response to stressors
Steps in planning: and choose health care options i. Physiological functioning
1. ID health goals (TOP 2 OR 3) 7. Guide clients' development in effective ii. Personality
2. ID what behavioral goals are necessary to problem solving and decision making iii. Behavioral characteristics
bring about desired outcomes 8. Reinforce the clients' personal and family iv. Nature of the stressor: integrity, scope,
3. Assign priorities to behavior changes health promoting behaviors duration, number, and nature of other stressors
4. Make a commitment to change behavior - 9. Advocate in the community for changes that
"behavioral contract" promote a healthy environment D. Homeostasis – Process of maintaining
5. ID effective reinforcements and rewards uniformity, stability and constancy with in the
6. Determine barriers to change living organisms. (from Greek word homotos –
7. Develop a schedule for implementing Concepts of Stress like, and stasis – position)
behavioral changes I. Stress (Theory by Hans Selye)
Non specific response of the body to nay E. Adaptation – Body’s adjustment to different
Short and long term goals/rewards demand made upon it circumstances and conditions. Process by the
Implementing - the "doing" part Any situation in which a non specific demand physiological or psychological dimensions
Nurse's role: requires an individual to respond or take action change in response to stress; attempt to
1. support person - ongoing, non judgmental, maintain optimal functioning
individual or group, possibly by telephone II. Characteristics of Stress
2. teacher - provides health education Stress is not nervous energy. Emotional F. Adaptation to Stress-Physiological Response
programs to groups, individuals, communities; reactions are common stressors (Hans Selye)
based on assessed health needs of people I. Local Adaptation Syndrome (LAS) – Response
3. counselor Stress is not always the result of damage to the of a body tissue, organ or part to the stress of
4. coordinator body trauma, illness or other physiological change
5. consultant a. Characteristics
6. facilitator Stress does not always result in feelings of i. The response is localized, it does not involve
7. enhancer of behavioral changes distress (harmful or unpleasant stress) entire body systems
ii. The response is adaptive, meaning that a
Must understand the change process Stress is a necessary part of life and is essential stressor is necessary to stimulate it
for normal growth and development iii. The response is short term. It does not
Lewin's Change Theory - the process of persist indefinitely
attitude and behavior change occurs in 3 Stress involves the entire body acting as a iv. The response is restorative, meaning that the
phases: whole and is an integrated manner LAS assists in restoringhomeostasis to the body
region or part
1. Unfreezing - As a result of change in person's Stress response is natural, productive and
equilibrium person ready to change attitudes adaptive b. Two Localized Responses
and behaviors; "unlearning", the most difficult i. Reflex Pain Response – is a localized response
and the most important!! III. Stressors – Factor or agent producing stress, of the central
2. Moving - individual acquires new maybe: physiological, psychological, social, nervous system to pain. It is an adaptive
attitudes/behaviors environmental, developmental, spiritual or response and protects tissue from further
3. Refreezing - client internalizes behavior cultural and represent an unmet needs damage. The response involves a sensory
changes and stabilizes at a new level of receptor, a sensory nerve from the spinal cord,
functioning a. Classification of Stressors and an effector muscle. An example would be
**Enhancing Behavior Changes** (see box on p i. Internal Stressors – originate from within the the unconscious, reflex removal of the hand
266) body. E.g. fever, pregnancy, from a hot surface.
3. Teach clients self care strategies to enhance menopause, emotion such as guilt
fitness, improve nutrition, manage stress, and ii. Inflammatory Response – is stimulated by
trauma or infection. This response localizes the ii. Bronchial dilation, which allows increased
inflammation, thus revenging its spread and oxygen intake Anxiety – a common reaction to stress. It is a
promotes healing. The inflammatory response iii. Increased blood clotting state of mental uneasiness, apprehension,
may produce localized pain, swelling, heat, iv. Increased cellular metabolism dread, or foreboding or a feeling of helplessness
redness and changes in functioning. v. Increased fat mobilization to make energy related to an impending or anticipated
available & to synthesize other compounds unidentified threat to self or significant
c. Three Phases of Inflammatory Response needed by the body. relationships. It can be experienced,
i. First Phase – Narrowing of blood subcutaneous or unconscious level. Can be
vessels occurs at the injury to control bleeding. G. Physiologic Indicators of Stress manifested on 4 LEVELS:
Then histamine is released at the injury, a. Pupils dilate to increase visual perception Fear – an emotion or feeling of apprehension
increasing the number of white blood cells to when serious threats to the body arise. aroused by impending or seeming danger, or
combat infection. other perceived threat. The object of fear may
b. Sweat production (diaphoresis) increases to or may not be based in reality.
ii. Second Phase – It is characterized by release control elevated body heat due to increased Anger – an emotional state consisting of a
of exudates from the wound metabolism. subjective feeling of animosity or strong
displeasure. People may feel guilty when they
iii. Third Phase – The last phase is repair of c. The heart rate & cardiac output increase feel anger because they have been taught that
tissue by regeneration or scar formation. to transport nutrients and by-products of to feel angry is wrong.
Regeneration replaces damaged cells with metabolism more efficiently. Depression – common reaction to events that
identical or similar cells. seem overwhelming or negative. It is an
d. Skin is pallid because of constriction of extreme feeling of sadness, despair, dejection,
II. General Adaptation Syndrome (GAS) or Stress peripheral vessels, an effect of norepinephrine. lack of worth or emptiness.
Syndrome – characterized by a chain or pattern
of physiologic events. e. Sodium & water retention increase due to Emotional symptoms can include: Feelings of
a. 3 Stages release of mineralocorticoids, which results in tiredness, sadness, emptiness, or numbness
i. Alarm Reaction – initial reaction of the body increased blood volume.
which alerts the body’s defenses. SELYE divided Behavioral signs include: Irritability, inability to
this stage into 2 parts: f. The rate & depth of respirations increase concentrate, difficulty making decisions, loss of
Ø The SHOCK PHASE because of dilation of the bronchioles, sexual desire, crying, sleep disturbance and
Ø The COUNTERSHOCK PHASE promoting hyperventilation. social withdrawal.
ii. Stage of Resistance – occurs when the body’s
adaptation takes place; the body attempts to g. Urinary output may increase or decreases. Physical signs include: Loss of appetite, weight
adjust with the stressor and to limit the stressor loss, constipation,headache and dizziness
to the smallest area of the body that can deal h. The mouth may be dry.
with it. I. Cognitive Indicators – are thinking responses
iii. Stage of Exhaustion – the adaptation that the i. Peristalsis of the intestines decreases, that include problem-solving, structuring,
body made during the second stage cannot be resulting in possible constipation and flatus. self-control or self-discipline, suppression and
maintained; the ways used to cope with the fantasy
stressors have been exhausted j. For serious threats, mental alertness
b. STRESSORS stimulate the sympathetic improves. a. Problem solving – involves thinking through
nervous system, which in turn stimulates the the threatening situation, using a specific steps
hypothalamus. The HYPOTHALAMUS releases k. Muscle tension increases to prepare for rapid to arrive at a solution
corticotrophin releasing hormone (CRH). During motor activity or defense.
times of stress, the ADRENAL MEDULLA b. Structuring – arrangement or manipulation of
secretes EPINEPHRINE & NOREPINEPHRINE in l. Blood sugar increases because of release of a situation so that threatening events do not
response to sympathetic stimulation. Significant glucocorticoids & gluconeogenesis. occur.
body responses toepinephrine include the
following: H. Psychologic Indicators of Stress – psychologic c. Self-Control (discipline) – assuming a manner
i. Increased myocardial contractility, which manifestations of stress include anxiety, fear, of facial expression that convey a sense of
increases cardiac output & blood flow to active anger, depression & unconscious ego being in control or in change.
muscles defensemechanisms.
d. Suppression – consciously and willfully can prevent or minimize illness and disability. 6. Primary care settings include
putting a thought or feeling out of mind 5. Disease prevention behaviors are behaviors a. Health Maintenance Organization(HMOs)
designed to decrease the likelihood/risk of b. public health departments
e. Fantasy – (daydreaming) – likened to make illness. c. occupational health clinics
believe. Unfulfilled wishes & desires are a. primary prevention d. schools
imagined as fulfilled, or a threatening I. health promotion and disease prevention e. nurse managed clinics
experience is reworked or replayed so that it II. applied to clients considered physically and f. collaborative practice settings
ends differently from reality. emotionally healthy E. Healthy People 2010
III. example: exercise programs, healthy diet 1. The US Department of Health and Human
b. secondary prevention Services released Healthy People 2010: National
Health Promotion I. early detection of illness Promotion and Disease Prevention Objectives
HEALTH II. focuses on individuals who are experiencing 2. Statement of national health objectives
A. Definitions of health vary health problems and illnesses and who are at designed to identify the most significant
1. Traditional definition: freedom from disease risk for complications preventable threats to health and to establish
2. 1958 World Health Organization defined III. activities are directed at diagnosis and national goals to reduce these threats
health as "state of complete physical, mental prompt treatment 3. The goals of the project are:
and social well-being and not merely the IV. example: breast a. increase quality and years of healthy life
absence of disease and infirmity" self examination, cholesterol screening b. eliminate health disparities
B. Health belief model c. tertiary prevention F. Health promotion model
1. Psychological and behavioral theory I. prevention of further deterioration in disease 1. Developed by Nola Pender
2. Attempts to explain individual health or disability 2. Health promotion depends on seven factors
behaviors II. occurs when a defect or disability is of cognition-perception
3. Health behaviors are based on three factors permanent and irreversible a. importance of health to the person
a. the individuals perception of susceptibility of III. activities are directed at rehabilitation b. perceived control of health
illness IV. example: alcoholics anonymous c. perceived self-efficacy
b. the individuals perception of seriousness of D. Primary health care d. definition of health
the illness 1. Accessible, community-based or work-based e. perceived health status
c. the likelihood that the person will take health care services based on principle of f. perceived health benefits from the health-
preventive action universal access, which ensures health care for promoting behavior
4. Modifying factors all individuals regardless of employment or g. perceived barriers to the health-promoting
a. cultural beliefs insurance status behavior
b. economics 2. Health Security Act of 1993 offered universal G. Risk factors - probability of acquiring a
c. political factors access to basic hospital, preventive, physician particular health problem
d. social factors and long-term services. It included these seven 1. Varies with age, race, ethnicity, gender
e. personal beliefs services: 2. Risk increases with certain lifestyle choices,
a. physical examinations such as smoking, occupation, diet, environment
b. screening tests 3. Modifiable risk factors include occupation and
Health Promotion c. diagnosis and treatment of common acute diet
illnesses 4. Non-modifiable risk factors include race and
C. Definitions d. management of chronic illnesses age
1. Health promotion behavior is behavior in e. liaison with community resources 5. Examples: risk factors are important in
which the client views health as a goal and f. provision of prenatal care a. coronary artery disease
engages in behaviors designed to achieve or g. identification of need for specialty referrals b. cancer
maintain that goal. 3. Providers include physicians, and advanced c. colon cancer
2. Health care includes prevention, early practice nurses, such as: nurse midwives and I. over 50 years of age
detection, treatment and rehabilitation for nurse practitioners II. family history of colon polyps or cancer
clients with potential for or existing illness or 4. Services provided through a managed care III. urban living
disability. model IV. diet high in fats and low in fiber
3. Healthy lifestyle can increase or maintain 5. Specialty services provided and reimbursed d. tuberculosis
client's level of wellness and functional ability. only after referral from the primary care I. history of exposure to person with TB
4. Health screening (for risk factors or illness) provider II. history of travel or living outside United
States a. personal meaning and perceptions: 1. Needs are universal.
III. history of prison time knowledge, values, beliefs, outcome 2. Needs may be met in different ways
IV. HIV infection expectations 3. Needs may be stimulated by external and
V. cancer chemotherapy b. social factors: environmental context, social internal factor
VI. malnutrition relationships, social support, societal norms, 4. Priorities may be deferred
VII. homelessness economic resources 5. Needs are interrelated
VIII. history of IV drug use c. deficiencies in the health care system:
IX. medical workers access, costs, wait time, monolingual services
e. diabetes: candidates for screening J. Noncompliance Communication in Nursing
I. strong family history of diabetes mellitus 1. An individual's informed decision not to
II. markedly obese adhere to a therapeutic recommendation
III. obstetrical history of babies weighing over 2. Individual unable or unwilling to alter habitual Modes of Communication:
nine pounds at birth behaviors or adopt new behaviors necessary to Verbal- spoken or written words
IV. obstetrical history of miscarriage or fetal a prescribed therapeutic regimen Non Verbal - gesture, facial expressions,
death
V. pregnant women between 24-28 weeks posture, gait, physical appearance
gestation Man and his Basic needs
VI. history of gestational diabetes Maslow’s Hierarchy of Basic Human Needs Characteristics of a Good Communiaction:
H. Screening recommendations Cholesterol - Physiologic
once every five years if normal age 45 and older Oxygen
1. In women: Mammography Fluids 1. Simplicity
2. In women: the first papanicolau smear at the Nutrition 2. Clarity
onset of sexual activity and/or over age 18, Body temperature 3. Timing and Relevance
annually Elimination
3. In men:PSA annually 50 years of age or at 4. Adaptibility
Rest and sleep
age 40 for those at risk Sex 5. Credibility
4. For colon cancer
a. digital rectal exam every year after the age of Safety and Security
Sender(encoder)--Message--Receiver(decoder)
40 Physical safety
b. quaiac test for occult blood every year after Psychological safety l__Response(feedback)___l
the age of 50 The need for shelter and freedom from harm
c. proctoscopy every three to five years after and danger Communication- basic component of human
the age of 50 after two negative annual exams Love and belonging
d. colonoscopy The need to love and be loved relationship and Nurse-client relationship
5. Tuberculosis skin tests: intradermal injection The need to care and to be cared for. Non-verbal-is more accurate
of antigen The need for affection: to associate or to belong -variety of feelings that can be expressed by a
6. Diabetes: fasting plasma glucose, ideally The need to establish fruitful and meaningful
single non- verbal expression
eight to 12 hours fast relationships with people,institution,
7. Vision: after age 39, medical eye exam every or organization -in assessing non verbal behaviors, cultural
three to five years Self-Esteem Needs influences must be considered.
8. Hearing: candidates for screening include: Self-worth Reciprocal Interaction -EFFECTIVE
a. family history of childhood hearing Self-identity
impairment Self-respect COMMUNICATION
b. perinatal infection (rubella, herpes,) Body image -this is a two way process
c. low birth weight infants Self-Actualization Needs -it is based on trust and aimed at identifying
d. chronic ear infection The need to learn, create and understand or
clients needs and developing mutual goalss
e. down syndrome comprehend
I. Compliance The need for harmonious relationships Trust- positive nursing patient relationship
1. Definition: adherence to primary or secondary The need for beauty or aesthetics Covert- inner feelings, uncomfortable to talk
prevention recommendations The need for spiritual fulfillment about and maybe revealed through non-verbal
2. Factors influencing compliance 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 problems the client has rather than the source III. PIE (Problems, Interventions, and
the following: of the information. Evaluation)
a. Vital signs a. Groups information in to three (3) categories
b. Administration of medications and treatments The four (4) basic components: b. This system consists of a client care
c. Preparation of diagnostic tests or surgery i. Database – consists of all information known assessment floe sheet & progress notes
d. Change in status about the client when the client first enters the c. FLOW SHEET – uses specific assessment
e. Admission, transfer, discharge or death of a health care agency. It includes the nursing criteria in a particular format, such as human
client assessment, the physician’s history, social & needs or functional health patterns
f. Treatment fro a sudden change in status family data d. Eliminate the traditional care plan &
V. Organization – the nurse communicate in a ii. Problem List – derived from the database. incorporate an ongoing care plan into the
logical format or order Usually kept at the front of the chart & serves as progress notes
VI. Confidentiality – a confidential an index to the numbered entries in the
communication is information given by one progress notes. Problems are listed in the order IV. Focus Charting
person to another with trust and confidence that in which they are identified & the list is a. Intended to make the client & client concerns
such information will not be disclosed continually updated as new problems are & strengths the focus of care
identified & others resolved b. Three (3) columns fro recording are usually
Documentation – anything written or printed iii. Plan of Care – care plans are generated by used: date & time, focus & progress notes
that is relied on as a record of proof fro the person who lists the problems. Physician’s
authorized persons. write physician’s orders or medical care plans; V. Charting by Exception
nurses write nursing orders or nursing care a. Documentation system in which only
Purposes of Records: plans abnormal or significant findings or exceptions to
I. Communication iv. Progress Notes – chart entry made by norms are recorded
II. Planning Client Care all health professionals involved in a client’s b. Incorporates three (3) key elements:
III. Auditing Health Agencies care; they all use the same type of sheet fro i. Flow sheets
IV. Research notes. Numbered to correspond to the problems ii. Standards of nursing care
V. Education on the problem list and may be lettered for the iii. Bedside access to chart forms
VI. Reimbursement type of data
VII. Legal Documentation VI. Computerized Documentation
VIII. Health Care Analysis Example: SOAP Format Or SOAPIE and SOAPIER a. Developed as a way to manage the huge
S – Subjective data volume of information required in contemporary
Documentation Systems O – Objective data health care
I. Source – Oriented Record A – Assessment b. Nurses use computers to store the client’s
a. The traditional client record P – Plan database, add new data, create & revise care
b. Each person or department makes notations I – Intervention plans & document client progress.
in a separate section or sections of the client’s E – Evaluation
chart R- Revision VII. Case Management
c. It is convenient because care providers from Advantages of POMR: a. Emphasizes quality, cost-effective care
each discipline can easily locate the forms on It encourages collaboration delivered within an established length of stay
which to record data and it is easy to trace the Problem list in the front of the chart alerts b. Uses a multidisciplinary approach to planning
information caregivers to the client’s needs & makes it & documenting client care, using critical
d. Example: the admissions department has an easier to track the status of each problem pathways.
admission sheet; the physician has a physician’s
order sheet, a physician’s history sheet & Disadvantages of POMR:
progress notes Caregivers differ in their ability to use the
e. NARRATIVE CHARTING is a traditional part of required charting format Nursing Care Plan (NCP)
the source-oriented record Takes constant vigilance to maintain an up-to- Two Types:
date problem list I. Traditional Care Plan – written fro each client;
II. Problem – Oriented Medical Somewhat inefficient because assessments & it has 3 columns: nursing diagnoses, expected
Record (POMR) interventions that apply to more than one outcomes & nursing interventions.
a. Established by Lawrence Weed problem must be repeated. II. Standardized Care Plan – based on an
b. The data are arranged according to the institution’s standards of practice; thereby
helping to provide a high quality of nursing care • It is a systematic, rational method of • 1. establish priorities
planning and providing individualized nursing
KARDEX widely used, concise method of • 2. writes patient goals/expected outcomes
care.
organizing & recording data about a client, and develops an evaluative strategy
making information quickly accessible to • a process that seeks to identify a client's
• 3. selects nursing interventions
all health professionals. Consists of a series of healthcare status, actual or potential health
cards kept in a portable index file or on problems, to establish plans to meet the client's • 4. communicates the plan of nursing care
computer generated forms. Information may be identified needs, and to deliver specific 4. implementing
organized into sections: nursinginterventions to address those needs 1. the nurse carries out of the plan of care
I. Pertinent information about the client • In 1955,Lydia Hall originated the term 2. during implementing, the nurse:
II. List of medications 1. carries out the plan of nursing care
Five Components:
III. List of IVF 2. continues data collection and modifies the
IV. List of daily treatments & procedures plan of care as needed
1. assessing
V. List of Diagnostic procedures 3. documents care
1. the systematic and continuous collection,
VI. Allergies validation, and communication of patient data
VII. Specific data on how the client’s physical 5. evaluating
2. during assessing, the nurse:
needs are to be met 1. the measuring of the extent to which patient
VIII. A problem list, stated goals & list of nursing goals have been met
approaches to meet the goals • 1. establishes a data base 2. during evaluating, the nurse:
• 2. continuously updates the data base
Nursing Discharge / Referral Summaries – • 1. measures the patient's achievement of
completed when the client is being discharged • 3. validates data
desired goals/expected outcomes
& transferred to another institution or to a home • 4. communicates data
setting where a visit by a community health • 2. identifies factors that contribute to the
2. diagnosing patient's success or failure
nurse is required. Regardless of format, it
1. the analysis of patient data to identify
include some or all of the following: • 3. modifies the plan of care, if indicated
data clusters that indicate actual or potential
I. Description of client’s physical, mental &
health problems, factors that contribute to or
emotional state
cause these problems, and coping pattern or Characteristics of the Nursing Process
II. Resolved health problems
strengths of the patient cyclical and dynamic--♣> components follow a
III. Unresolved continuing health problems
2. during diagnosing, the nurse: logical sequence but more than once
IV. Treatments that can be continued (e.g.
wound care, oxygen therapy) component may be involved at one time;
V. Current medications • 1. interprets and analyses patient data responds to the changing health status of the
VI. Restrictions that relate to activity, diet & client so there is no absolute beginning or end
• 2. identifies patient strengths and patient open and flexible--♣> meets the unique needs
bathing health problems
VII. Functional/self-care abilities of the client, family, group, or community
VIII. Comfort level • 3. formulates and validates nursing client-centered--♣> the plan of care is
IX. Support networks diagnoses organized according to the client’s health
X. Client education provided in relation to problems rather than nursing goals
• 4. develops a prioritized list of nursing
disease process interpersonal and collaborative--♣> to ensure
diagnoses
XI. Discharge destination delivery of quality nursing care, the
XII. Referral Services (e.g. social worker, home 3. planning nurse shares concerns and problems regarding
health nurse) 1. the establishment of patient goals/expected the client’s health status; rapport is developed
outcomes by the nurse, working with the and an open communication is established
patient, that prevent, reduce, or resolve between the client and the nurse to carry out
problems identified in the nursing diagnoses, the nursing process effectively
Nursing Process
and the determination of related planned♣
Definition:
nursinginterventions most likely to assist the goal directed♣
patient in achieving the goals allows client and nurse to devise ways to solve
2. during planning, the nurse:
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 The best time to assess respiration is PRINCIPLES of ASEPSIS and INFECTION
contractions of the left ventricles of immediately after taking client’s pulseν CONTROL
the Count respiration for 60 secondν A. Chain of Infection
heart. As you count the respiration, assess and record I. The chain of infection refers to those elements
Normal Pulse rate breath sound as stridor,ν that must be present to cause an infection from
1 year 80-140 beats/min wheezing, or stertor. a microorganism
2 years 80- 130 beats/min Respiratory rates of less than 10 or more than
6 years 75- 120 beats/min 40 are usually consideredν II. Basic to the principle of infection is to
10 years 60-90 beats/min abnormal and should be reported immediately interrupt this chain so that an infection from a
Adult 60-100 beats/min to the physician. microorganism does not occur in clients
Tachycardia – pulse rate of above 100 beats/min
Bradycardia- pulse rate below 60 beats/min IV. Blood Pressure III. Infectious agent; microorganisms capable of
Irregular – uneven time interval between beats. Adult – 90- 132 systolic causing infections are referred to as an
What you need: 60- 85 diastolic infectious agent or pathogen.
a. Watch with second hand Elderly 140-160 systolic
b. Stethoscope (for apical pulse) 70-90 diastolic IV. Modes of transmission:
c. Doppler ultrasound blood flow detector if a. Ensure that the client is rested the microorganism must have a means
necessary b. Use appropriate size of BP cuff. oftransmission to get from one location to
Radial Pulse c. If too tight and narrow- false high BP another, called direct and indirect
a. Wash your hand and tell your client that you d. If too lose and wide-false low BP
are going to take his pulse e. Position the patient on sitting or supine V. Susceptible host describes a host (human or
b. Place the client in sitting or supine position position animal) not possessing enough resistance
with his arm on his side or across f. Position the arm at the level of the heart, if against a particular pathogen to prevent disease
his the artery is below the heart or infection from occurring when exposed to the
chest level, you may get a false high reading pathogen; in humans this may occur if the
c. Gently press your index, middle, and ring g. Use the bell of the stethoscope since the person’s resistance is low because of poor
fingers on the radial artery, inside blood pressure is a low frequency nutrition, lack of exercise of a coexisting illness
the patient’s wrist. sound. that weakens the host.
d. Excessive pressure may obstruct blood flow h. If the client is crying or anxious, delay
distal to the pulse site measuring his blood pressure to VI. Portal of entry: the means of a pathogen
e. Counting for a full minute provides a more avoid false-high BP entering a host: the means of entry can be the
accurate picture of irregularities Electronic Vital Sign Monitor same as one that is the portal of exit
Doppler device a. An electronic vital signs monitor allows you to (gastrointestinal, respiratory, genitourinary
a. Apply small amount of transmission gel to continually tract a patient’s tract).
the ultrasound probe vital
b. Position the probe on the skin directly over a sign without having to reapply a blood pressure VII. Reservoir: the environment in which
selected artery cuff each time. the microorganism lives to ensure survival; it
c. Set the volume to the lowest setting b. Example: Dinamap VS monitor 8100 can be a person, animal, arthropod, plant, oil or
d. To obtain best signals, put gel between the c. Lightweight, battery operated and can be a combination of these things; reservoirs that
skin and the probe and tilt the attached to an IV pole support organism that are pathogenic to
probe 45 degrees from the artery. d. Before using the device, check the client7s humans are inanimate objects food and water,
e. After you have measure the pulse pulse and BP manually using the and other humans.
rate, clean the probe with soft cloth same arm you’ll using for the monitor cuff.
soaked in antiseptic. Do not immerse the probe e. Compare the result with the initial reading VIII. Portal of exit: the means in which the
from the monitor. If the results pathogen escapes from the reservoir and can
III. Respiration - is the exchange of oxygen differ call the supply department or the cause disease; there is usually a common
and carbon dioxide between the manufacturer’s representative. escape route for each type of microorganism; on
atmosphere humans, common escape routes are the
and the body gastrointestinal, respiratory and the
Assessing Respiration genitourinary tract.
Rate – Normal 14-20/ min in adultν
Modes of Transmission agent and the signs and symptoms of the c. After the antigen is gone, the lymphokines
1. Direct contact: describes the way in which disease disappear; the host, however, is more disappear
microorganisms are transferred from person to vulnerable to other pathogens at this time; an d. Some T-lymphocytes remain and keep a
person through biting, touching, kissing, or appropriate nursing diagnostic label related to memory of the antigen and are reactivated if
sexual intercourse; droplet spread is also a form this process would be Risk for Infection the antigen appears again.
of direct contact but can occur only if the source
and the host are within 3 feet from each other; C. Inflammation – The protective response of IV. Humoral response: the ability of the body
transmission by droplet can occur when a the tissues of the body toinjury or infection; the to develop a specific antibody to a specific
person coughs, sneezes, spits, or talks. physiological reaction to injury or infection is the antigen (antigen-antibody response)
2. Indirect contact: can occur through fomites inflammatory response; it may be acute or a. B-lymphocytes provide humoral immunity by
(inanimate objects or materials) or through chronic producing antibodies that convey specific
vectors (animal or insect, flying or crawling); the resistance to many bacterial and viral infections
fomites or vectors act as vehicle Body’s response
for transmission I. The “inflammatory response” begins with b. Active immunity is produced when the
3. Air: airborne transmission involves droplets or vasoconstriction that is followed by a brief immune system is activated either naturally or
dust; droplet nuclei can remain in the air for increase in vascular permeability; the blood artificially.
long periods and dust particles containing vessels dilate allowing plasma to escape into i. Natural immunity involves acquisition of
infectious agents can become airborne infecting the injured tissue immunity through developing the disease
a susceptible host generally through the ii. Active immunity can also be produced
respiratory tract II. WBCs (neutrophils, monocytes, and through vaccination by introducing into the
macrophages) migrate to the area of injury and body a weakened or killed antigen (artificially
B. Course of Infection attack and ingest the invaders (phagocytosis); acquired immunity)
this process is responsible for the signs iii. Passive immunity does not require a host to
I. Incubation: the time between initial contact of inflammation develop antibodies, rather it is transferred to
with an infectious agent until the first III. Redness occurs when blood accumulates in the individual, passive immunity occurs when a
signs of symptoms - - > the incubation period the dilated capillaries; warmth occurs as a result mother passes antibodies to a newborn or when
varies from different of the heat from the increased blood in the area, a person is given antibodies from an animal or
pathogens; microorganisms are growing and swelling occurs from fluid accumulation; the person who has had the disease in the form of
multiplying during this stage pain occurs from pressure orinjury to the local immune globulins; this type of immunity only
nerves. offers temporary protection from the antigen.
II. Prodromal Stage: the time period from the
onset of nonspecific symptoms to the D. Immune Response E. Nosocomial Infection
appearance of specific symptoms related to the I. The immune response involves specific I. Nosocomial Infections: are those that are
causative pathogen reactions in the body to antigens or foreign acquired as a result of a healthcare delivery
- - > symptoms range from being fatigued to material system
having a low-grade
- fever with malaise; during this phase it is still II. This specific response is the body’s attempt II. Iatrogenic infection: these
possible to transmit the pathogen to another to protect itself, the body protects itself by nosocomial infections are directly related to the
host activating 2 types of lymphocytes, the T- client’s treatment or diagnostic procedures; an
lymphocytes and B-lymphocytes example of an iatrogenic infection would be
III. Full Stage: manifestations of specific signs & a bacterial infection that results from an
symptoms of infectious agent; referred to as the III. Cell mediated immunity: T-lymphocytes are intravascular line or Pseudomonas aeruginosa
acute stage; during this stage, it may be responsible for cellular immunity pneumonia as a result of respiratory suctioning
possible to transmit the infectious agent to a. When fungi , protozoa, bacteria and some
another, depending on the virulence of the viruses activate T-lymphocytes, they enter the III. Exogenous Infection: are a result of the
infectious agent circulation from lymph tissue and seek out the healthcare facility environment or personnel; an
antigen example would be an upper respiratory
IV. Convalescence: time period that the host b. Once theantigen is found they produce infection resulting from contact with a caregiver
takes to return to the pre-illness stage; also proteins (lymphokines) that increase the who has an upper respiratory infection
called the recovery period; - - >the host defense migration of phagocytes to the area and keep
mechanisms have responded to the infectious them there to kill the antigen IV. Endogenous Infection: can occur from clients
themselves or as a reactivation of a previous elevation of serum cortisone is prolonged, it inflammatory drugs and surgery
dormant organism such as tuberculosis; an decreases the anti-inflammatory response and
example of endogenous infection would be depletes energy stores, thus increasing the risk G. Diagnostic Tests Used to Screen for
a yeast infection arising in a woman receiving of infection Infection
antibiotic therapy; the yeast organisms are I. Signs and symptoms related to infections are
always present in the vagina, but with the VI. Rest, exercise and personal health habits: associated with the area infected; for instance,
elimination of the normal bacterial flora, the altered rest and exercise patterns decrease the symptoms of a local infection on the skin or
yeast flourish. body’s protective, mechanisms and may cause mucous membranes are localized swelling,
physical stress to the body resulting in an redness, pain and warmth
F. Factors Increasing Susceptibility to increased risk of infection; personal health
Infection habits such as poor nutrition and unhealthy II. Symptoms related to systemic infections
I. Age: young infants & older adults are at lifestyle habits increase the risk of infectious include fever, increased pulse & respirations,
greater risk of infection because of reduced over time by altering the body’s response to lethargy, anorexia, and enlarged lymph nodes
defense mechanisms pathogens
a. Young infants have reduced defenses related III. Certain diagnostic tests are ordered to
to immature immune systems VII. Inadequate defenses: any physiological confirm the presence of an infection.
b. In elderly people, physiological changes occur abnormality or lifestyle habit can influence
in the body that make them more susceptible to normal defense mechanisms in the body,
infectious disease; some of these changes are: making the client more susceptible to infection; Nutrition Overview
i. Altered immune function (specifically, the immune system functions throughout the A.Food guidelines
decreased phagocytosis by the neutrophils and body and depends on the following: B. Essential nutrients
by the macrophages) a. Intact skin and mucous membranes C. Fluid and electrolyte balance
ii. Decreased bladder muscle tone resulting in b. Adequate blood cell production and
D. Normal and therapeutic diets
urinary retention differentiation
iii. Diminished cough reflex, loss of elastic recoil c. A functional lymphatic system and spleen E. Therapeutic Diets for specific conditions
by the lungs leading to inability to evacuate d. An ability to differentiate foreign tissue and
normal secretions pathogens from normal body tissue and flora; in Food guidelines
iv. Gastrointestinal changes resulting in autoimmune disease, the body has a problem 1. Nutritional needs through the life cycle
decreased swallowing ability and delayed with recognizing it’s own tissue and cells; a. infants: fluid and protein needs 2.5x
gastric emptying. people with autoimmune disease are at adults
increased risk of infection related to their b. breast milk or formula is adequate for
II. Heredity: some people have a genetic immune system deficiencies. first six months of life
predisposition or susceptibility to some
infectious diseases VIII. Environmental: an environment that i. whole milk is difficult for young infants
exposes individuals to an increased number of to digest
III. Cultural practices: healthcare beliefs and toxins or pathogens also increases the risk of ii. the first food introduced is cereal
practices, as well as nutritional and hygiene infection; pathogens grow well in warm moist c. childhood: gradual increasing of all
practices, can influence a person’s susceptibility areas with oxygen (aerobic) or without oxygen nutrients adults: unchanged except for
to infectious diseases (anaerobic) depending on the microorganism,
i. pregnancy: add per day: 300 calories,
an environment that increases exposure to toxic
15 mg iron, 30 g protein, 400 g calcium, and
IV. Nutrition: inadequate nutrition can make a substances also increases risk
200ug folic acid
person more susceptible to infectious diseases;
nutritional practices that do not supply the body IX. Immunization history: inadequately ii. lactation: add 500 calories, 2 quarts
with the basic components necessary to immunized people have an increased risk of extra fluid
synthesized proteins affect the way the body’s infection specifically for those diseases for b. elderly over age 65: adequate protein
immune system can respond to pathogens which vaccines have been developed. to maintain immune system
2. Factors affecting dietary patterns
V. Stress: stressors, both physical and X. Medications and medical therapies: examples
emotional, affect the body’s ability to protect of therapies and medications that increase a. health status
against invading pathogens; stressors affect the clients risk for infection includes radiation b. ability to chew, swallow, and drink
body by elevating blood cortisone levels; if treatment, anti-neo-plastic drugs, anti 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 iv. magnesium - normal constituent of bone; •decreased plasma volume
electrolytes remain relatively constant in the cofactor for enzymes in energy metabolism,
body neurochemical activities, muscular excitability •depleted potassium
2. Fluid balance and electrolyte balance is b. anions •psychological factors
interdependent 7. Maintenance of electrolyte balance
i. chloride
3. Body balances fluid and electrolytes a. aldosterone - hormone (mineralcorticoid)
primarily by adjusting output, and secondarily • most abundant anion in extracellular fluid
i. when extracellular fluid sodium decreases or
by adjusting intake. • helps balance sodium potassium levels increase
4. Fluid balance is also maintained • normal lab value for serum chloride is 100 to ii. adrenal cortex secretes aldosterone
by osmosis (illustration ) 106 mEq/L
iii. kidneys stimulated by aldosterone to increase
5. Major electrolytes ii. bicarbonate - part of bicarbonatebuffer system; reabsorbtion of sodium and decreased
a. cations limits the drop in pH by combining with an acid reabsorbtion of potassium
to form carbonic acid and a salt
i. sodium - most abundant cation in extracellular iv. results in water reabsorption and increased
fluid iii. phosphate - participates in cellular energy blood volume
metabolism, combines with calcium in bone,
• regulates cell size via osmosis b. parathyroid
assists in structure of genetic material
i. parathyroid secretes parthyroid hormone
• essential in maintaining water balance, 6. Maintenance of fluid
(PTH), also called parathormone
transmitting nerve impulses, and contracting volume
muscles ii. stimulates release of calcium from bone,
a. osmoreceptor
reabsorbtion in small intestine and kidney
• regulates acid-base balance by exchanging system
tubules
hydrogen ions for sodium ions in kidney i. balances fluid intake volume by the regulation
iii. when serum calcium level is low, PTH secretion
• normal lab value for serum sodium is 135 to of water output volume
increases
145 mEq/L ii. dehydration stimulates osmoreceptors which
iv. when serum calcium level rises, PTH secretion
activate the thirst control center; person feels
• sodium is regulated by salt intake, aldosterone, thirsty and seeks water falls
and urinary output v. high levels of active vitamin D inhibit PTH and
iii. also stimulates antidiuretic hormone (ADH)
• sources include table salt, processed meats, low levels or magnesium stimulate PTH
secretion which decreases urinary output by
snacks and canned food(illustration ) secretion
causing the reabsorption of water in the tubules
ii. potassium - most abundant cation of b. circulatory system
intracellular fluid
i. increases in fluid intake increase circulatory Normal and therapeutic diets
• potassium pump draws potassium into cell volume 1. Guidelines:
• essential for polarization and repolarization of ii. this increased volume stimulates the kidney for 1. dietary reference intakes (DRI's)- average
nerve andmuscle fibers an increased glomerular filtration rate daily nutrient intake of apparently healthy
iii. end result is an increase in urine output to people over time.
• regulates neuro muscular excitability and
muscle contraction decrease the initial curculatory volume
1. recommended dietary allowance (RDA)
increase Fluid intake ->increase Cardiac Output-
• sources include wholegrains, meat, legumes, 2. adequate intake (AI)
>increase BP->increaseGlomerular Filtration-
fruits and vegetables 3. tolerable upper intake level (UL)
>increase Urine Output->increaseBlood Volume
4. estimated average requirement (EAR)
• regulated by kidneys iv. thirst center
• normal lab value for serum potassium is 3.5 to v. located in hypothalamus 2. 2001 dietary guidlines for Americans
5.3 mEq/L vi. stimulated by 1. aim for fitness
iii. calcium - essential for cell membraneintegrity, 2. build a healthy base
•increased plasma osmolality
cardiac contraction, healthy bones and teeth, 3. choose sensibly
and functioning of nerves and muscles •angiotensin II
•dry pharyngeal muscous membranes
2. Therapeutic nutrition
1. modification of the nutritional needs based on 2. limit 400 mg per day instead of normal 800
disease condition mg i. high fiber
2. considerations for administering therapeutic
diets 3. restricts dried fruits and vegetables, shell used to correct constipation, lower risk of colon
1. condition of client - physical, emotional, fish, cheese, nuts cancer
mental ability of client to tolerate diet 30 to 40 gm fiber/day recommended
2. willingness of client to comply with diet e. acid ash diet increased intake of fruits, vegetables, bran
3. types of therapeutic diets cereals
1. prevents stone formation j. low residue
a. diabetic
2. restricts carbonated beverages, dried fruits, used for conditions such as diarrhea,
1. goal is maintenance of normal weight banana, figs, chocolate, nuts, olives, pickles diverticulitis
foods high in carbohydrates are usually low fiber
2. dietary ratio 5:2:1 (carbohydrates to fat to f. low purine diet increased use of ground meat, fish, broiled
protein) chicken without skin, white bread
1. prevents uric acid stone; used with gout
3. level of activity determines energy clients k. mechanical soft
requirements
2. lowers levels of purine, the precursor of uric 1. used with difficulty in chewing, such as poorly
4. non-insulin dependent diabetes mellitus acid fitted dentures or endentulous
(NIDDM) can usually be controlled by diet
therapy 3. restricts glandular meats, gravies, fowl, fish, 2. includes any foods which can be easily
and high meat quantities broken down by chewing
5. diet individualized according to client's age,
build, weight, and activity level 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 course ii. highest risk is from supine to standing position
swallow food, but GI tract intact 7. Measures to improve nutrition intake of client b. increased cardiac workload
2. tube inserted through nose into stomach or
i. reinforce for client to avoid bearing down or
small bowel; or inserted 1. frequent small feedings
valsalvar manuever
endoscopically; gastrostomy tube or PEG tube, 2. feeding assistance
jejunostomy tube 3. offering preferred foods ii. minimize coughing
3. types of tubes and feedings 4. ethnic foods iii. limit sitting in high Fowler's position to one to
1. small bore feeding tube: 8 to 12 Fr and 36 to two hours
43 inches long b. thrombus/emboli formation
* difficult to aspirate stomach contents Activity, Mobility and Exercise
* may be impossible to auscultate an air bolus; A. Prevent complications of immobility i. apply thigh or knee-high antiemboic stockings
or air bolus may be heard even when tube is not B. Types of exercise as ordered
in stomach C. Use of mechanical aids to promote mobility ii. turn every tow hours
* tubes may become displaced even when D. Prosthetic devices iii. monitor anticoagulation therapy, as indicated
securely taped E. Brace
iv. initiate ambulation or exercise of dorsi and
* hard to verify placement; best method is by
plantar flexion of the foot
xray Prevent complications of immobility
2. enteral tube feedings 1. Skin changes - decubitus ulcers v. limit sitting with feet in a dependent position to
* keep head of bed raised, to prevent aspiration 1 to 2 hours
a. turn client every two hours
* assess placement of tube 2. Urinary changes: renal, calculi, urinary tract
* inject ten ml air into nasogastric tube (ng b. use heel/elbow protectors
infection, glomerular nephritis
tube) and listen with stethoscope for rush of air c. use alternate pressure mattress or other skin
a. increase fluid intake (2000 - 3000 cc/day)
over stomach care devices
o aspirate gastric contents and check if pH is b. restrict foods that contribute to renal stone
d. do not massage reddened areas; doing so
acidic formation
increases damage to tissues
o radiologic confirmation 2. Psychosocial changes:
e. limit sitting in a chair to 2 to 4 hours or as
* administer enteral feeding a. provide stimuli to maintain orientation
tolerated with a shift in weight at least every 30
o continuous
to 60 minutes b. develop mutually with client, a schedule to
o to prevent bacterial growth, do not hang tube
2. Musculoskeletal changes-contractures maintain mental sharpness
feeding for longer than eight hours
* assess gastric residual a. do range of motion exercises to joints on a
o every four hours if continuous feeding or scheduled basis daily Types of exercise
o before you begin intermittent feedings 1. Passive - carried out by the health care
b. provide foot board and/or foot cradle or high-
3. tube feeding formulas provider without assistance from client; purpose
topped tennis shoes to prevent foot drop
* Vivonex, Isocal, Portagen, etc. is to retain joint mobility and blood circulation
4. complications c. reposition every 2 hours
2. Resistive - carried by the client working
* aspiration d. maintain correct body alignment against resistance; purpose is to increase
* gastrointestinal complications (diarrhea) 2. Respiratory changes - pneumonia, atelectasis muscular strength; enhance bone integrity
* electrolyte or metabolic problems
a. instruct client to cough and deep breathe every 3. Isometric - carried out by the client with
two hours, or more frequently no assistance by contracting muscle group for
5. Nutritional supplements/liquids ten seconds and then relaxing muscle group;
1. dehydration/diarrhea: b. turn every two hours purpose is to maintain muscular strength when
1. infants: Infalyte, Pedialyte, Ricelyte c. suction if needed the joint is immobilized
2. older children: sports electrolyte replacement
drinks d. chest physiotherapy (physical therapy) as 4. Range of motion (ROM) - joint is moved
3. infant formulas: standard and high-calorie ordered through entire range; purpose is to maintain
4. specialty formulas: 2. Cardiovascular system changes-decreased joint mobility
* predigested (e.g. Pregestamil, Nutramigen) cardiac output, clots,emboli
* high-calorie supplements (Scandishakes, a. orthostatic hypotension:
Carnation instant breakfasts) Use of mechanical aids to promote mobility
i. instruct client to change position slowly
6. Parenteral nutrition: see Lesson 6 of this
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