MOD 1 ✓

• Self-concept – individual’s view of self

• Self-esteem – how one feels about oneself
• Erik Erikson: develop the psychosocial development theory
COMPONENTS OF SELF-CONCEPT
• Identity: internal sense of individuality
• Body image: attitudes related to physical appearance
• Role performance: inability to balance career and family
• Self-esteem
STRESSORS AFFECTING SELF-CONCEPT
• Identity stressors: occur during adolescence
• Role Performance Stressors: role conflict, ambiguity, strain, and
overload
• Body image stressors: affect appearance or body part
• Self-esteem stressors: vary by developmental stage
HEALTH CARE DELIVERY SYSTEM
U.S FIVE LEVELS OF CARE: disease prevention; health promotion;
and primary, secondary and tertiary health care
• Primary Care (Health Promotion): prenatal and well-baby care;
nutrition counseling, family planning, exercise, yoga, and mediation
classes
• Preventive Care: blood pressure and cancer screening;
immunizations; mental health counseling and crisis prevention
• Secondary Acute Care: emergency care; acute medical-surgical
care; radiological procedures
• Tertiary Care: intensive and subacute care
• Restorative Care: cardiovascular and pulmonary rehabilitation;
orthopedic rehabilitation and home care; sports medicine and
spinal cord injury programs
• Continuing Care: assisted living; psychiatric and older adult day
care
 MOD 2

Nursing: is an art and science

NURSING AS A PROFESSION
• Patient-centered care
• Professionalism
• Healthcare advocacy group
Nursing requires: current knowledge and practice standards,
insightful and compassionate approach, and critical thinking
BENNER’S STAGES OF NURSING PROFICIENCY
• Novice, Advanced Beginner, Competent, Proficient, Expert
STANDARDS OF PRACTICE
• Assessment
• Diagnosis
• Outcomes Identification: identifies expected outcomes of client
• Planning
• Evaluation
Nursing Process: foundation of clinical decision making
10 STANDARDS OF PROFESSIONAL PERFORMANCE
• Ethics
• Education
• Evidence-based practice and research
• Quality of practice
• Communication
• Leadership
• Collaboration
• Professional practice evaluation
• Resources
• Environmental Health
The Code of Ethics for Nurses with Interpretive Statements: guides
the nurse for carrying out responsibilities
PROFESSIONAL ROLES
• Autonomy: initiation of interdependent nursing interventions
• Caregiver: help patients regain their health
• Advocate: protect patient’s human and legal rights
• Educator: can be formal or informal
• Communicator: allows you to know your patient’s needs
• Manager: you will establish an environment for collaborative
patient-centered care
CAREER DEVELOPMENT
• Provider of care
• Advanced practice registered nurses
° Clinical Nurse Specialist: APRN who is an expert clinician in a
specialized area of practice
° Certified Nurse Practitioner: APRN who provides health care to a
group of patients
° Certified Nurse Midwife: APRN who is educated in midwifery
° Certified Registered Nurse Anesthetist: APRN with advanced
education from a nurse anesthesia-accredited program
Nurses: respond to patient’s needs
Florence Nightingale: first to practice epidemiologist
CIVIL WAR TO THE BEGINNING OF 20TH CENTURY
• Clara Barton: founder of American Red Cross
• Mother Bickerdyke: organized ambulance services
• Harriet Tubman: prominent female in the Underground Railroad
movement to free slaves
• Mary Mahoney: first professionally trained African-American
Nurse
• Lillian Wald & Mary Brewster: opened Henry Street Settlement
The Twentieth Century: movement toward scientific based practice
and defined body of knowledge
° 1906-Mary Adelaide Nutting: first nurse professor at Columbia
Teachers College
° Army and Navy Nurse Corps established
° 1920s: Nursing specialization began
The 21st Century: advances in technology and informatics
CONTEMPORARY INFLUENCES
• Importance of nurse’s self-care
° compassion fatigue, secondary traumatic stress, and burnout
impact the health and wellness of nurses
• Changes in society that lead to changes in nursing:
° Affordable care act
° Demographic changes
° Medically undeserved
TRENDS IN NURSING
• Evidence-based practice
• Quality and Safe Education for Nurses: prepare nurses with the
competencies needed in their work environment
• Impact of Emerging Technologies: rapidly change nursing practice
• Genomics: study of all genes in a person
• Public Perception of Nursing: nurses practice in all health care
settings
• Impact of Nursing in Politics & Health Society: nurses are
becoming more politically sophisticated
 MOD 3 ✓

Caring: central to nursing practice; ability of nurse to work with

patients
American Organization of Nurse Executives: describes caring and
knowledge as the core of nursing
Patricia Benner: received BSN from Pasadena College; caring is
essence of excellent nursing practice and determines what matter
to a person
Madeleine Leininger: founder of Transcultural Caring
Jean Watson: founder of Transpersonal Caring
WATSON’S 10 CARATIVE FACTORS
• Forming a human-altruistic value system
• Instilling faith-hope
• Cultivating a sensitivity to one’s self and to others
• Developing a helping, trusting and human caring relationship
• Promoting and expressing positive and negative feelings
• Using creative problem-solving
• Promoting transpersonal teaching-learning
• Providing for a supportive, protective, and spiritual environment
• Meeting human needs
• Allowing for existential-phenomenological spiritual forces
Kristen Swanson: founder of Theory of Caring
SWANSON’S FIVE CARING PROCESS
1. Knowing: striving to understand an event
2. Being with: being emotionally present to other
3. Doing for: doing for the other as they would do for their self
4. Enabling: facilitating other’s passage through life transitions
5. Maintaining belief: sustaining faith in the other’s capacity
 MOD 4 ✓

Sister Simone Roach: caring is human mode of being

FIVE NOTION OF CARING
1. Ontological: inquiry into the being of something
2. Anthropological: what does it mean to be a caring person?
3. Ontical: study of some entity in its actual relation with other
entities
4. Epistemological: concerned with ways of knowing
5. Pedagogical: concerned with teaching and learning to further
specific learning needs and goals
ATTRIBUTES OF CARING (6 C’s OF CARING)
1. Compassion: to be with another in their suffering
2. Competence: using evidence-based scientific and humanistic
knowledge and skill
3. Conscience: directs moral, ethical, and legal decision-making
4. Confidence: trust in one’s ability to care for others
5. Commitment: maintaining and elevating the standards of nursing
profession
6. Comportment: professional presentation of us as nurses
PATIENT’S PERSPECTIVE OF CARING
• Connecting with patients and their families
• Being present
• Respecting values, beliefs, and health care choices
CARING IN NURSING PRACTICE
1. Providing presence: person to person encounter conveying a
closeness
2. Touch: provides comfort and creates a connection
• Non-contact touch
• Contact touch
° Task-oriented touch: used when performing a task
° Caring touch: you hold a patient’s hand
° Protective touch: protects nurse and patient
3. Listening: understanding what the patient is saying
4. Knowing the patient: core process of clinical decision making
5. Spiritual Caring: achieved when a person can find a balance
between his life values
• Spirituality: sense of intrapersonal (when persons are connected
to themselves), interpersonal (one is connected with others and
environment), and transpersonal relationship (one is connected
with God)
6. Relieving Symptoms and Suffering: performing caring nursing
actions
 MOD 5 ✓

Joint Commission: promote effective communication for patient

and family-centered care
DEVELOPING COMMUNICATION SKILLS
1. Critical thinking: it is important to apply critical thinking and
reasoning skills when considering patient’s problems
2. Perseverance and Creativity: motivates the nurse to identify
innovative solutions
3. Self-confidence: patients respond more readily to a self-
confident attitude
4. Humility: necessary to recognize when you need to better
communicate with patients
5. Integrity: allows nurses to recognize when their opinions conflict
with those of their patients
Perceptual biases or stereotypes: interfere with accurately
perceiving and interpreting messages from others
Emotional intelligence: allows nurse to better understand the
emotions of themselves and others
COMMUNICATION THROUGHOUT NURSING PROCESS
° ADPIE
LEVELS OF COMMUNICATION
• Intrapersonal communication: powerful form of communication
• Interpersonal Communication: one-on-one interaction between a
nurse and another person
• Small-group Communication: interaction when a small number of
people meet
• Public Communication: interaction with an audience
• Electronic Communication: use of technology to create ongoing
relationships with patients and healthcare team
ELEMENTS OF COMMUNICATION PROCESS
Communication: ongoing changing process
FORMS OF COMMUNICATION
1. Verbal Communication
• Vocabulary: use spoken or written words
• Denotative and connotative meaning: individuals who use
common language share the denotative while connotative is the
interpretation of the meaning of a word
• Pacing: appropriate speed
• Intonation: tone of voice affects the meaning of a message
• Clarity and brevity: effective communication is simple, brief
• Timing and relevance: timing is critical in communication
2. Nonverbal Communication
• Personal appearance: physical characteristics, facial expression,
and manner of dress and grooming
• Posture and gait: manner or pattern of walking
• Facial expressions: convey emotions
• Eye contact: shows respect and willingness to listen
• Gestures: emphasize and clarify spoken word
• Sounds: sigh and moans communicate thoughts and feelings
• Territoriality and personal space: the needs to gain and defend
one’s right to space
Metacommunication: all factors that influence communication
A. Nurse-Patient Relationship: caring relationships are the
foundation of clinical nursing practice
C. Nurse-Family Relationship: many nursing situations require you
to form caring relationships with entire families
D. Nurse-Health Care Team Relationships: use of a common
language such as SBAR technique for communicating critical
information
E. Nurse-Community Relationships: nurses form relationships with
community groups by participating in local organizations
ELEMENTS OF PROFESSIONAL COMMUNICATION
• Appearance, demeanor, and behavior
• Use of names
• Autonomy and responsibility
• Courtesy
• Trustworthiness
• Assertiveness: allows you to express feelings and ideas without
judging or hurting others
× STANDARDS FOR PATIENT EDUCATION
Nurse Practice Acts: recognizes that patient teaching falls within
the scope of nursing practice
• Joint Commission: set the standards for patient and family
education
PURPOSE OF PATIENT EDUCATION
• Help individuals achieve optimal levels of health
Teaching: imparting knowledge
Learning: acquisition of new knowledge through experience
Patient Care Partnership of the American Hospital Association:
patients have the right to make informed decisions regarding their
care
The Joint Commission SPEAK UP Initiatives: help patients
understand their rights when receiving care
• Speak if you have question
• Pay attention to the care you get
• Educate yourself about your illness
• Ask a trusted family member to be your advocate
• Know which medicines you take and why
• Use a health care organization that has been carefully evaluated
• Participate in all decisions about your treatment
Teaching as Communication: parallels the communication process
DOMAINS OF LEARNING:
1. Cognitive: includes all intellectual behaviors and requires critical
thinking
2. Affective: deals with expression of feelings
3. Psychomotor: acquiring skills that require coordination
Cognitive Learning: encompasses the acquisition of knowledge
• Remembering: learning information and being able to recall them
• Understanding: ability to understand the meaning of learned
material
• Applying: using abstract in an actual situation
• Analyzing: breaking down information into organized parts
• Evaluating: ability to judge the value of something for a given
purpose
• Creating: ability to apply knowledge to create something new
Affective Learning: deals with expression of feels
• Receiving: learner needs only to pay attention
• Responding: requires active participation through listening
• Valuing: attaching value to the acquired knowledge
• Organizing: developing a value system by organizing values
according to their worth
• Characterizing: responding with a consistent value system
Psychomotor Learning: acquiring motor skills that require
coordination
• Perception: being aware of objects through senses
• Set: readiness to take a particular action
• Guided response: early stages of learning under the guidance of
instructor
• Mechanism: higher level of behavior
• Complex overt response: smoothly performing motor skill
• Adaptation: motor skills are well develop when unexpected
problems occur
• Origination: using existing psychomotor skills
TEACHING METHODS BASED ON DOMAINS OF LEARNING:
• Cognitive: discussion
• Affective: role play
• Psychomotor: demonstration
BASIC LEARNING PRINCIPLES:
1. Motivation to learn: addresses the patient’s willingness to learn
2. Ability to learn: depends on physical and cognitive abilities
3. Learning environment: allows a person to attend to instruction
MOTIVATION TO LEARN:
• Attentional set: allows the learner to focus on a learning activity
• Motivation: force that cause the person to behave in a particular
way
• Use of theory to enhance motivation and learning: theories focus
on how individuals learn
• Psychosocial adaptation to illness: grieving
• Active participation: eagerness to acquire knowledge
ABILITY TO LEARN:
• Developmental capability: cognitive development and prior
knowledge
• Learning in children: developmental stage
• Adult learning: self-directed and patient centered
• Physical capability: level of personal development, physical
health, and energy
TEACHING METHODS BASED ON PATIENT’S DEVELOPMENTAL
CAPACITY:
• Infant: keep routines consistent (feeding and bathing)
• Toddler: use play to teach activity (applying bandage to doll)
• Pre-school: use role play, imitation, and play
• School-age child: teach psychomotor skills needed to maintain
health (use syringe to take considerable practice)
• Adolescent: help adolescent learn about feelings and need for
self-expression
• Young or Middle Adult: encourage participation in teaching plans
by setting mutual goals
• Older Adult: teach when the patient is alert and rested
LEARNING ENVIRONMENT:
• Well lit, good ventilation, appropriate furniture, comfortable
temperature, quiet, and private
 MODULE 6

Nursing Process: provides a clinical decision-making to develop and

implement the plan of care
1. ASSESSMENT: assess each patient and analyzes findings
• Through the Patient’s Eyes: gather information, synthesize, and
apply critical thinking
FACTORS INFLUENCING COMMUNICATION
1. Psychophysiological Context (Internal Factors Affecting
Communication)
✓ Physiological status (pain, hunger, nausea)
2. Relational Context (Nature of the Relationship among
Participants)
✓ Social, helping, or working relationship
3. Situational Context (Reason for Communication)
✓ Information exchange
✓ Goal achievement
4. Environmental Context (Physical Surroundings in which
Communication Occurs)
✓ Privacy level
✓ Noise level
✓ Distraction level
5. Cultural Context (Sociocultural Elements that Affect an
Interaction)
✓ Education level of participants
✓ Customs and expectations
• Physical and Emotional Factors: many altered health states and
human responses limit communication
• Developmental Factors: aspect of a patient’s growth and
development influence nurse-patient interaction
TIPS FOR IMPROVED COMMUNICATION WITH OLDER ADULTS WHO
HAVE HEARING LOSS
✓ Make sure the patient knows that you are talking
• Sociocultural Factors: be aware of the typical patterns of
interaction that characterize various ethnic groups
Communication with Non-English-Speaking Patients: provide
language access services like interpreters
IMPLICATIONS FOR PATIENT-CENTERED CARE:
✓ Understand your own cultural values and biases
• Gender: influences how we think, act and communicate
° Men tend to use less verbal communication while women tend to
disclose more personal information
2. NURSING DIAGNOSIS
• Impaired verbal communication: patient with limited or no ability
to communicate verbally
ALTERED COMMUNICATION PATTERNS
✓ Anxiety, social isolation, ineffective coping, etc.
3. PLANNING
• Goals and outcomes: specific and measurable
• Setting of priorities: always maintain an open line of
communication
• Teamwork and collaboration: seek the services of speech
therapist if patients have problem with communication
4. IMPLEMENTATION
Therapeutic Communication Techniques: encourage the expression
of feelings and convey acceptance
• Active Listening: being attentive to what a patient is saying. Use
SOLER
° S (sitting): posture that you are interested in what the patient is
saying
° O (open): posture that you are open to what the patient is saying.
“Closed” position conveys a defensive attitude
° L (lean): posture that you are interested in the interaction
° E (establish): posture that you are willing to listen to what the
patient is saying
° R (relax): important to communicate a sense of being relax with
the patient. Restlessness: communicates to the patient pack of
interest
• Sharing observations: helps patient communicate without the
need for extensive questioning
• Sharing empathy: ability to understand another person’s reality
• Sharing hope: appropriate encouragement are important in
fostering hope
• Sharing humor: strategy that reduce anxiety
• Sharing feelings: emotions are subjective feelings that result from
one’s thought
• Using touch: touch is most potent and personal forms of
communication
• Using silence: silence prompts some people to talk
• Providing information: providing relevant information tells other
people what they need to know
• Clarifying: to check whether you understand a message, restate
an unclear message
• Focusing: centering a conversation on key elements of a message
• Paraphrasing: restating another’s message more briefly using
one’s own word
• Validation: use to recognize a patient’s thought
• Asking relevant questions: nurses seek information needed for
decision making
• Summarizing: concise view of key aspects of an interaction
 MODULE 8 ✓

MODELS OF HEALTH AND ILLNESS

• A model is theoretical way of understanding a idea
• Health beliefs: person’s ideas about health and illness
• Health behaviors
° Positive health behaviors: activities related to maintaining health
and preventing illness
° Negative health behaviors: include practices harmful to health
1. Health Belief Model: Rosenstock’s and Becker and Mailman
model addresses the relationship between a person’s beliefs and
behaviors; this model has three components: individual
perceptions, modifying factors and likelihood of action
2. Health Promotion Model: defines health as positive and dynamic
state; this model focus on three areas: individual’s characteristics
and experiences, behavior-specific knowledge and effect, and
behavioral outcomes
Maslow’s Hierarchy of Needs: use to understand the
interrelationships of basic human needs
1. Self-actualization
2. Self-esteem
3. Love and belonging needs
4. Safety and security: physical and psychological safety
5. Physiological: oxygen, fluids, nutrition, body temp, elimination,
shelter and sex
3. Holistic Health Model: promote optimal health
VARIABLES INFLUENCING HEALTH AND HEALTH BELIEFS AND
PRACTICE
Variables influence how a person thinks and acts
INTERNAL VARIABLES (DIPES)
• Developmental Stage
• Intellectual Background
• Perception of Functioning
• Emotional Factors
• Spiritual Factors
EXTERNAL VARIABLES
• Family Practices
• Socio-economic Factors
• Cultural Background
HEALTH PROMOTION, WELLNESS, AND ILLNESS PREVENTION
• Immunization Programs
• Routine Exercise, Good Nutrition
• Physical Awareness, Stress Management, Self-Responsibility
LEVELS OF PREVENTIVE CARE
1. Primary Prevention: lowers the chances that a disease will
develop
2. Secondary Prevention: focuses on those who have health
problems
3. Tertiary Prevention: occurs when a disability is permanent
Risk Factors: situation that increase the vulnerability of an
individual to an illness
RISK FACTORS INCLUDE:
° Genetic and physiological factors: being overweight, affects
physical functioning of the body
° Age: age affects person’s susceptibility to certain illnesses
° Environment: physical environment can increase the likelihood
that certain illnesses will occur
° Lifestyle
RISK FACTOR MODIFICATION
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance stage
• These stages ranges from:
° No intention to change (precontemplation)
° Considering a change within the next 6 months (contemplation)
° Making small changes (preparation)
° Actively engaging in strategies to change behavior (action) to
maintain a changed behavior (maintenance change)
Illness: a person’s physical functioning is impaired
• Acute illness: short duration and severe
• Chronic illness: persist longer than 6 months
Rehabilitative care: emphasizes the importance of assisting clients
to function adequately
Restoring health: focuses on the ill client
MOD 1 FUNDA RLE
Cleaning: removal of dust and dirt
Dust contains microorganisms which can be spread in the
environment and or by sweeping or dry dusting
DETERMINATION OF ENVIRONMENTAL PROCEDURES
° Frequency
° Method
° Process
“ Should be based on the risk of pathogen transmission”
THIS RISK IS A FUNCTION OF THE:
1. Probability of contamination
2. Vulnerability of patients to contamination
3. Potential for exposure (high touch vs. low touch surfaces)
“ Determine low, moderate, and high risk. Environmental cleaning
is required in areas with high risk”
RISK-BASED ENVIRONMENTAL CLEANING FREQUENCY PRINCIPLES
• Probability of contamination: heavily contaminated surfaces
require more frequent environmental cleaning than moderate
• Vulnerability of Patients to Infection: areas containing vulnerable
patients require more frequent environmental cleaning
• Potential for Exposure to Pathogens: high-touch surfaces require
more frequent environmental cleaning than low-touch surfaces
FACILITY SHOUKD DEVELOPED CLEANING SCHEDULES, INCLUDING:
* Identifying the person responsible
* Frequency
* Method (product, process)
* Detailed SOPs
GENERAL ENVIRONMENTAL CLEANING TECHNIQUES
• Conduct Visual Preliminary Site Assessment Status: proceed only
after a visual preliminary site assessment to determine if:
° patient status could pose a challenge to safe cleaning
° there is any need for additional PPE or supplies
° there are any obstacles that could pose a challenge to safe
cleaning
° there is broken furniture
• Proceed From Cleaner To Dirtier: to avoid spreading of dirt and
microorganisms
° Clean high-touch surfaces outside the patient zone before the
high-touch surfaces inside the patient zone
• Proceed From High To Low (Top To Bottom): to prevent dirt and
microorganisms from falling and contaminating already cleaned
areas
Examples:
• clean bed rails before bed legs
• clean environmental surfaces before cleaning floors
• clean floors last to collect dirt and microorganisms that may have
fallen
• Proceed in a Methodical, Systematic Manner: to avoid missing
areas. Ex: clockwise
HIGH TOUCH SURFACES: necessary for the development of cleaning
procedures
• bedrails
• IV poles
• sink handles
• bedside tables
• counters
• edges of privacy curtains
• patient monitoring equipment
• transport equipment
• call bells
• doorknobs
• light switches
Terminal Cleaning: performed when a patient with a transmissible
illness is discharged (isolation rooms). During terminal cleaning,
clean low-touch surfaces before high-touch surfaces.
Damp dusting: removal of dust from all surfaces above the floor
TYPES OF DUSTING
1. Low Dusting: done to all places easily reached by standing on the
floor; done daily
2. High Dusting: areas over windows, pipes, walls and ceiling
RULES FOR CLEANING
• Dry dusting is never advisable because it may spread disease
easily and should be done after sweeping only
EQUIPMENTS:
• Tray with basin of water
• Several pieces of dusting cloth
• Laundry soap
• Mineral oil
• Newspaper
• Whisk broom
ORDER OF DUSTING
• Bed
• Bedside tables
• Chair
• Wood works

• Evaluate the respiratory processes of diffusion and perfusion by

measuring the oxygen saturation of the blood
• The percent of hemoglobin that is bound with oxygen in the
arteries is the percent of saturation of hemoglobin (usually 95%
and 100%)
Pulse oximeter: measure the oxygen saturation
• A saturation of less than 90% is a clinical emergency
• SpO2 is a reliable estimate of SaO2 when the SaO2 is over 70%
FACTORS THAT AFFECT THE DETERMINATION OF PULSE OXYGEN
SATURATION (SpO2)
• Interference with Light Transmission
1. Outside light sources
2. Carbon monoxide
3. Patient motion
4. Jaundice
5. Intravascular eyes
6. Black or brown nail polish
7. Dark skin pigment
• Interference with Arterial Pulsations
1. Peripheral vascular disease
2. Hypothermia
3. Pharmacological vasoconstrictors
4. Low cardiac output and hypotension
5. Peripheral edema
6. Tight probe
PROFESSIONAL ROLE
1. Educator:
2. Patient Advocate: nirerespeto mo yung patient dahil rights nila
‘yon
3. Leader:
PATIENT’S RIGHTS (REDER)
1. Right to refuse
2. Right to educate
3. Right to documentation
4. Right to evaluate
5. Right to reason
PATIENT’S RESPONSIBILITY
1. Know the rights and responsibility of being a patient
2. Patient should provide accurate and complete information
3. Patient should report unexpected health changes
4. Patient need to understand the purpose and cause of treatment
5. Patient has the responsibility to settle financial obligation
LEGAL ISSUES IN NURSING
1. Intentional Tort: sinadya yung injury sa patient
• Battery: purposely touching a person w/o their consent w/
intention to make a harm
° Criminal Battery: intention to kill a person
° Civil Battery: no intention to kill a person
• Assault: attempt to harm a person
• False Imprisonment: intentionally restraining another person w/o
any legal right
2. Quasi-Intentional Tort: wrongful act based on speech committed
by a person
• Defamation: false statement about another person’s reputation
° Slander: oral defamation
° Libel: word defamation
• Fraud: deceiving another entity to obtain such services
• Invasion of Privacy: you disclose information
3. Unintentional Tort:
• Negligence:
• Malpractice: improper treatment to a person that results in injury
6 ELEMENTS TO PROVE MALPRACTICE
1. Duty
2. Breach of duty
3. Foreseeability
4. Causation
5. Harm or injury
6. Damages
Nonmaleficence: do not harm; moral principles of nurse
Florence Nightingale: lady with the lamp and founder of modern
nursing; optimum health
Nursing as a Science: nursing practice is based on a body of
knowledge
Professionalism: set of attributes that implies responsibility and
commitment
DIFFERENCE BETWEEN PROFESSION AND OCCUPATION
• Profession: there is ongoing research
• Occupation
SITUATION WERE YOU ARE NOT PERMITTED TO DISCLOSE THE
CLIENT’S INFORMATION
1. Patient is celebrity
2. Annulment/Divorce
3. Communicable disease
CRITERIA FOR BEING A PROFESSIONAL NURSE
• Has nursing code of ethics
• Undergo specialized training
• Member of PNA
HOW RO PROTECT INVASION OF PRIVACY
• Do not diclose private fact in public
• Reasonable intrusion
• Use clients name w/consent
• Do not put your patient in false life
IF GUSTO NG PATIENT MAGPA DISCHARGED
• Home Against Medical Advance
• Discharged Against Medical Advance
4 MAJOR CONCEPT IN NURSING THEORY
1. Nursing
2. Health
3. Environment
4. Person
BENNER’S STAGES OF NURSING PROFICIENCY
• Novice (0—1)
• Advanced Beginner (1—2)
• Competent (2—3)
• Proficient (4—5)
• Expert (more than 5)
ETHICAL PRINCIPLES
1. Autonomy: respect for an individual’s right to make a decisions
2. Beneficence: the quality of doing good
3. Fidelity: loyalty and promise to an individual
4. Justice: fair and equal treatment for all
5. Nonmaleficence: never doing harm to an individual
6. Veracity: honesty when dealing to an individual
Nursing Act of 2012: law that guide PRN by their professional code
of ethics and other nursing rules and regulations; taken from RA
9173
WHEN SHOULD BE THE ORGAN TRANSPLANT LEGAL?
1. Sign and consent
2. Legal age
3. Has knowledge capacity to give it as a gift

FUNDA RLE REVIEWER

PRINCIPLES OF BODY MECHANICS

• Weight is balanced best when the center of gravity is directly
above the base of support
• A person is more stable if the center of gravity is close to the base
of support
• The weight of the body can be used to assist in lifting or moving
Range of Motion: maximum amount of movement available at a
joint in one of the three planes of the body: sagittal, transverse, or
frontal

Gait: style of walking

• Scoliosis: lateral S- or C- shaped spinal column
• Kyphosis: increased convexity in curvature of thoracic spine
• Lordosis: exaggeration of anterior convex curve of lumbar spine

Labyrinthine sense: sense of position provided by the sensory

organs in the inner ear
Genu Valgum: inward legs
Genu Varum: outward legs
RESISTIVE ISOTONIC EXERCISES
• Push-ups
• Pushing feet against a footboard on the bed
Side-Lying/Lateral Position: this position is used to assess an
immobilized patient
Standard Fowler’s Position: 45-60 degrees

FOWLER’S POSITION
COMPLICATION TO BE SUGGESTED PREVENTIVE
PREVENTED ACTIONS
Flexion contracture of the wrist Support the hand on pillows so
that it is in natural alignment
with the
External rotation of the trochanter roll
hips/femur

Use Body Mechanics: application of mechanical laws with regards

to structure, functions and positions of the body
Trendelenberg position – the client is in supine, the head of the bed
is down and the entire body frame is tilted downward
• Postural drainage of the lungs
• Gynecologic surgery, suprapubic prostatectomies
• Prevent shock
• Postpartum hemorrhage
Note: When moving a patient, the top priority is the safety of
transferring
Orthopneic position: used in client with heart and respiratory
condition
Sims’ Position: or lateral recumbent position
PROPER BODY MECHANICS
• Flex hip and knees while lowering the patient into the chair
Blood Pressure: force exerted on the walls of an artery
Note: You have to wait 20-30 minutes before taking a blood
pressure to a patient who have coffee and smoking. Difference
between systolic and diastolic is pulse pressure. The first sound is
systolic and last is diastolic. Normal BP for adult is 120/80. Sounds
detected from stethoscope upon auscultation of BP is Korotkoff
sound. When taking a BP, the artery/pulse that you will palpate is
brachial pulse. When the BP is low: hypotension and when BP is
high: hypertension
Susceptible Host: infectious agent depends on an individual’s
degree of resistance to pathogens
Droplet: large particles that travel up to 3 feet during coughing
Illness Stage: interval when patient manifests signs and symptoms
specific to type of infection
Universal Precautions: treat all textiles which are contaminated
with blood and body fluids
Note: If you have diarrhea and you take sick leave, you need to
wait at least 48 to 72 hours from the last episode of diarrhea
Disinfection: process of eliminating all microorganisms except
bacterial spores
Hygienically Clean: rendering a textile tree pathogens
Hexogenous Infection: increase post-operative infection from
aspergelous
Donning: paglagay ng gloves/PPE
Dopping: pagtanggal ng gloves/PPE
Hand hygiene: part of protective equipment
TYPES OF CLEANING
• Terminal Cleaning: performed when a patient with a
transmissible illness is discharged
• Routine Cleaning: it includes mopping of floors and damp dusting
• Damp Dusting: method of dusting employed in areas which are
not upholstered
TYPE OF DUSTING
• Low Dusting: done to all places easily reached by standing on the
floor; done daily
• High Dusting: areas over windows, pipes, walls and ceiling
RISK FACTOR OF HYPERTENSION
• Smoker and alcohol drinker
Tachycardia: above 100 beats/min in adults
Bradycardia: below 60 beats/min in adults
Note: Normal pulse in adult is 60-100 while in pediatric, 100-180
Least route of taking temp: axilla
Most route of taking temp: oral
Location to get pulse: radial pulse
Respiratory rate is divided into expiration and inspiration
IMPORTANCE OF TAKING VITAL SIGNS
• Indicate the overall well being of patient
FACTORS THE INCREASE BLOOD PRESSURE
• Stress
• Obesity
• Smoking
• High fat diet
NORMAL TEMP: 36.4—37.5 in oral temp (minus 0.5 if axilla)
MECHANISM OF HEAT LOSS
• Evaporation: ex: perspiration

SITUATION

1. How will you ensure the safety of your patient before moving the
patient from a wheelchair?
Answer: Review the steps for transferring using the wheelchair in
the beginning
2. A nurse rocks a patient up to standing position on count of 3
while straightening hips and legs and keeping knees slightly flexed.
What is the rationale for the nurse’s actions?
Answer: Rocking motion gives patient’s body momentum and
requires less muscular effort to lift him
3. How to remove bed bugs?
Answer: Heat with temperature of 120 ° and wash at least 10 to 20
minutes
4. What laundry worker should do before transferring soiled linen
to the clean sites of laundry?
Answer: Remove all soiled linen and after that, practice hand
hygiene
5. What connect muscles to bone?
Answer: Tendon
6. Susceptible Host of infection is old people, children and persons
with chronic illness
7. To prevent microorganisms from dripping and contaminating
clean areas, what strategy should you observe?
Answer: High to low strategy
8. You observe a colleague cleaning a patient’s room where she
jumps from one area to another. What errors could unfortunately
happen?
Answer: She may miss some areas of the room
9. Why is it necessary for someone to wear appropriate PPEs even
when cleaning?
Answer: B and C
 MOD 9

Nursing Process: use to apply the available evidence to caregiving

• Nursing Assessment: gather information about the patient’s
condition
TWO STAGES OF ASSESSMENT
1. Collection and verification of data
2. Analysis of data
• SOURCES OF DATA
° Patient (best source of information)
° Family
° Health care team
° Medical records
° Scientific literature
• DATABASE
TYPES OF ASSESSMENT
° Patient-centered interview
° Physical Examination
° Periodic assessments
IMPORTANT DATA VS. TOTAL DATA YOU COLLECT
✓ Cue: information that you obtain through the use of senses
✓ Inference: your judgement on these cues
TYPES OF DATA
1. Subjective: patient’s verbal descriptions of their health problems
2. Objective: observations of a patient’s health status
THE PATIENT-CENTERED INTERVIEW
° Motivational interviewing
° Effective communication
° Interview preparation
° Phases of an interview
1. Orientation and setting an agenda
2. Working Phase
3. Termination
INTERVIEW TECHNIQUES (BOLDO)
° Back channeling
° Observation
° Leading questions
° Direct closed-ended questions
° Open-ended questions
COMPONENTS OF NURSING HEALTH HISTORY
° Biographical Information
° Chief complaint
° Family history
° Health history
° Patient Expectations
° Psychosocial history
° Present Illness
° Spiritual health
✓ Diagnostic and laboratory data: provide further explanation of
problems identified during health history
✓ Interpreting and validating assessment data: ensures collection
of complete database
✓ Data documentation: use clear appropriate terminology
✓ Concept mapping: allows you to graphically show the
connections among a patient’s many health problems
• Nursing Diagnosis: identify the patient’s problem
Collaborative problem: physiological complication that nurses
monitor
HISTORY OF NURSING DIAGNOSIS
✓ Introduced in 1950
✓ In 1953, Fry proposed the formulation of a nursing diagnosis
✓ In 1973, the first national conference was held
✓ In 1980 and 1995, the ANA included diagnosis as a separate
activity in its publication nursing: A Social Policy Statement
✓ In 1982, NANDA was founded
TYPES OF NURSING DIAGNOSES
° Problem-focused
° Risk
° Health promotion
Data cluster: set of cues gathered during assessment
Clinical Criterion: subjective or objective that leads to a diagnostic
conclusion
Data Interpretation: it is critical to select the correct diagnostic
label for a patient’s need
Formulating a Nursing Diagnosis Statement: identify the correct
diagnostic label with associated risk factor
THREE-PART NURSING DIAGNOSTIC LABEL
° Problem
° Etiology
° Symptoms
Concept Map: helps you critically think about a patient’s diagnosis
Diagnostic label: impaired physical mobility
Etiology: acute incisional pain
SOURCES OF DIAGNOSTIC ERROR
✓ Data collection
✓ Interpretation and analysis of data
✓ Clustering
✓ Diagnostic statement
Documentation and Informatics: once you identify a patient’s
nursing diagnosis, enter them on the written plan of care
° Computer: helps organize data into clusters
Application to Care Planning: care plan that help communicate the
patient’s health care problems to other professional

MOD 10
Implementation: constitutes the fourth step of nursing process
Nursing intervention: treatment that a nurse performs to enhance
patient outcomes
Direct care interventions: treatment performed through interaction
with patients
Indirect care interventions: treatments performed away from the
patient
STANDARD NURSING INTERVENTIONS
° Standardized interventions: set a level of clinical excellence for
practice
° Nurse and health care provider: initiated standardized
interventions
° Clinical practice guidelines and protocols: preprinted document
containing orders for the conduct of routine therapies
° Nursing interventions classification interventions: differentiate
nursing practice from other health care disciplines
° Standards of practice: used as evidence of the standard of care
° QSEN
Clinical Judgement: making appropriate conclusions about
interventions
IMPLEMENTATION PROCESS
° Reassessing a patient: continuous process with each patient
interaction
° Reviewing and revising the existing NCP: allows you to validate a
patient’s nursing diagnoses
° Preparing for implementation:
1. Time management
2. Equipment
3. Personnel
4. Environment
5. Patient
ANTICIPATING AND PREVENTING COMPLICATIONS
° Preventing complications: identify risks to the patient
° Identifying areas of assistance: seek information about a
procedure
IMPLEMENTATION SKILLS
° Cognitive, interpersonal and psychomotor skills
° Physical care techniques: safe and competent administration of
nursing procedures
Achieving Patient Goals: nurses implement care to meet patient
goals
Evaluation: final step of nursing process
Examine Results: you continuously examine results by gathering
subjective and objective data
Evaluative Measures: assessment skills and techniques
Compare Achieved Effect with Goals and Outcomes: compare
clinical data before implementation
Interpreting and Summarizing Findings: interpret relevant evidence
about patient’s condition
Recognize Errors: must have an open mind
Care Plan Revision
° Discontinuing a care plan
° Modifying a care plan
✓ Reassessment, redefining diagnoses, goals and expected
outcomes, and interventions
Standards for Evaluation
° Nursing care helps patients resolve actual health problems
° ANA: define standards
° Competencies include: being systematic and collaborating
° Collaborate and evaluate effectiveness of interventions: family,
health care team and document results
Documentation: produces a written account of pertinent patient
data
PURPOSE OF MEDICAL RECORD
✓ Reimbursement, education, communication, legal
documentation, auditing, and research
MISTAKES IN DOCUMENTATION
° Failing to record drug information, nursing actions, medication
administration, drug reactions, and failing to document
discontinued medications
SHIFT TO ELECTRONIC DOCUMENTATION
° HITECH promote the use of health information technology
° EHRs decrease cost and improve the quality of patient care
Confidentiality: nurses are legally obligated to keep all patient
information confidential
HIPAA: disclosure regarding health information are limited to the
minimum necessary
Privacy, Confidentiality, and Security Mechanisms: electronic
documentation has legal risk
Handling and Disposing of Information: you must safeguard any
information that is printed from the record for report purposes
Standards: know standards of your organization
GUIDELINES FOR QUALITY DOCUEMENTATION
° Factual
° Accurate
° Complete
° Current
° Organized
METHODS OF DOCUMENTATION
° Narrative: the traditional method
° Problem-oriented medical record
° SOAP: Subjective, objectives assessment, plan
° SOAPIE: subjective, objective, assessment, plan, intervention,
evaluation
° PIE: problem, intervention, evaluation
° Focus charting (DAR): data, action, response
METHODS OF REPORTING
° Charting by exception: focus on documenting deviations
° Case management plan: incorporate a multidisciplinary approach
to care
COMMON RECORD-KEEPING FORMS
° Admission nursing history form: guides the nurse through a
complete assessment
° Flowsheets and graphic records: help team members quickly see
patient trends over time
° Patient care summary
° Clinical Care Guidelines: established guidelines used to care for
patients
° Discharge summary forms
Acuity Rating System: determine the hours of care and number of
staff for every 24 hours
Documentation in the Home Health Care Setting: medicare has
specific guidelines for establishing eligibility for home care
Documentation in the Long-Term Health care Setting: governmental
agencies are instrumental in determining policies for
documentation
DOCUMENTING COMMUNICATION WITH PROVIDERS AND UNIQUE
EVENTS
° Telephone calls made to a provider: document every call
° Telephone and verbal orders
° Incident reports: used to document any event that is not
consistent with routine operation
Technology Informatics Guiding Education Reform: focused on
better preparing the clinical workforce
TIGER transformed to Healthcare Information and Management
System Society (HIMSS)
CLINICAL INFORMATION SYSTEMS
° Computerized provider order entry
° Clinical decision support systems: used to support decision making
NURSING CLINICAL INFORMATION SYSTEM
° Allows nurse to access computerized information at the patient’s
bedside
° Designs: nursing process and critical pathway
° Advantages
✓ Can check on laboratory results

MODULE 11
SCIENTIFIC KNOWLEDGE BASE: Environmental Safety: a patient’s
environment includes physical and psychosocial factors
• Physical Hazards: environment that threaten a person’s safety
° Fire, falls, poison, disaster, and motor vehicle accidents
NURSING KNOWLEDGE BASE: Factors Influencing Patient Safety
1. Patient’s developmental level
2. Mobility, sensory, and cognitive status
3. Lifestyle choices
4. Knowledge of common safety precautions
RISK AT DEVELOPMENTAL STAGES
1. School-age child
2. Adolescent
3. Older adult
4. Adult
5. Infant, toddler, and preschooler
INDIVIDUAL RISK FACTORS
1. Lifestyle
2. Impaired mobility
3. Lack of safety awareness
4. Sensory impairment
RISK IN HEALTH CARE AGENCY
1. Medical error
2. Environmental risks
3. National Quality Forum mission
4. TJC and CMS “SPEAK UP” campaign
5. Specific risks to a patient’s safety
Critical Thinking: successful critical thinking requires synthesis of
knowledge
NURSING DIAGNOSES FOR PATIENTS WITH SAFETY RISK
° Risk for: falls, injury, poisoning, suffocation, trauma, deficient
knowledge, and impaired home maintenance
Planning: goals and outcomes; prevent and minimize threats
IMPLEMENTATION: acute and restorative care
1. Fall prevention
° Follow fall protocols
° Patient-centered care
° Assistive aids
2. Restraints
° Physical
° Chemical
° Ongoing assessment
° Objectives
3. Side rails
° Increased patient mobility
° Used as restraint
° Can caused falls
4. Acute care safety
° Fires
° Electrical hazards
° Radiation
° Disaster
° Seizures
SCIENTIFIC KNOWLEDGE BASE: Nature of Infection
1. Infection: invasion of a susceptible host by pathogens
2. Colonization: growth of microorganisms within a host
3. Communicable disease: infectious process transmitted from one
person to another
4. Symptomatic: signs and symptoms are present
5. Asymptomatic: signs and symptoms are not present
CHAIN OF INFECTION
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Host
INFECTIOUS PROCESS
° Four stages:
1. Incubation period
2. Prodromal stage
3. Illness stage
4. Convalescence
° Localized versus systemic infection
DEFENSE AGAINST INFECTION
1. Normal Flora: microorganisms
2. Body System Defenses: organs
3. Inflammation: signs of local inflammation and infection are
identical
Health Care-Associated Infections: results from delivery of health
services in a health care facility
TYPES OF HAI INFECTION
1. Iatrogenic: from procedure
2. Exogenous: from microorganisms outside the individual
3. Endogenous: when the patient’s flora becomes altered
NURSING KNOWLEDGE BASE: Factors Influencing Infection
Prevention and Control
1. Age
2. Nutritional
3. Disease process
4. Stress
5. Treatments that compromise the immune response
Nursing Diagnosis: For infection
1. Risk for infection
2. Imbalanced nutrition
3. Risk for impaired skin integrity
4. Impaired oral mucous membrane
5. Social isolation
6. Readiness for enhanced immunization status
7. Impaired tissue integrity
Planning: common goals of care applicable to patients with
infection
IMPLEMENTATION
1. Health promotion: prevent an infection from spreading
2. Acute Care: treat an infectious process
3. Asepsis: absence of pathogenic microorganisms
4. Cleaning: the removal of all soil
Disinfection: eliminates microorganisms except bacterial spores
Sterilization: eliminate all microorganisms including spores
Isolation: separation of ill persons with contagious diseases
Surgical Asepsis: sterile technique prevents contamination of an
open wound
Medication: substance used in diagnosis of health problems
SCIENTIFIC KNOWLEDGE BASE: Safe and Accurate Administration of
Medications
1. Legal aspect of health care
2. Pharmacology
3. Pharmacokinetics
4. Life sciences
5. Pathophysiology
6. Human anatomy
7. Mathematics
MEDICATION LEGISLATION AND STANDARDS
• Federal regulation
• State and local regulation of medication
• Health care institutions and medication laws
• Medication regulations and nursing practice
PHARMACOLOGICAL CONCEPTS
1. Medication names:
• Chemical: provides the exact description of medication’s
composition
• Generic: manufacturer who first develops the drug assigns the
name
• Trade: aka brand name
2. Classification:
• Effect of medication on body system
• Symptoms the medication relieves
• Medication’s desired effect
3. Medication forms
• Solid, liquid, oral
• Topical
• Parenteral
• Instillation into body cavities
PHARMACOKINETICS AS THE BASIS OF MEDICATION ACTIONS
• Absorption: passage of medication molecules into the blood
• Distribution: occurs within the body to tissues
• Metabolism: metabolized into a less-potent form
• Excretion: medications exit the body through the kidney, liver,
bowel, lungs or exocrine gland
TYPES OF MEDICATION ACTION
• Therapeutic effect: expected physiological response
• Adverse effect: undesirable
1. Side effect: unavoidable secondary effect
2. Toxic effect: accumulation of medication in the bloodstream
3. Idiosyncratic reaction: overreaction from normal
• Allergic reaction: unpredictable response to a medication
• Medication interaction: when one medication modifies the action
of another
ROUTES OF ADMINISTRATION
• Oral
• Parenteral
• Other routes
• Routes usually limited to physicians
• Topical
• Inhalation
• Vaginal and rectal
• Intraocular
• Ear
HEALTH CARE PROVIDR’S ROLE
• Prescriber can be physician
• Orders can be written
• The use of abbreviation can cause errors
TYPES OF ORDERS IN ACUTE CARE AGENCIES
• Standing or routine: administer until the dosage is changed
• PRN: given when the patient requires it
• Single: given one time only
• STAT: given immediately in an emergency
• Now: when medication is need right away
• Prescription: medication to be taken outside of the hospital
SIX RIGHTS OF MEDICATION ADMINISTRATION
1. Right medication
2. Right dose
3. Right patient
4. Right route
5. Right time
6. Right documentation
MEDICATION ADMINISTRATION
• Pharmacist’s role: prepare and distributes medication
• Nurse’s role: determine if medications ordered are correct
• Distribution system: unit dose system
Allopathic or Traditional Western Medication: used to treat many
common conditions
COMPLEMENTARY, ALTERNATIVE, AND INTERGRATIVE
APPROACHES TO HEALTH
• CAM: array of health care approaches with a history of use
• Complementary: integrative therapies
• Alternative: replace allopathic medical care
• Whole medical systems: based on different philosophies
✓ The American Holistic Nurses Association: maintains Standards
of Holistic Nursing Practice
• Integrative nursing: advance health and well being
• Weight risk and benefits of each intervention
RELAXATION THERAPY
• Limitations
• Arousal reduction
• Progressive relaxation
• Passive relaxation
MEDITATION AND BREATHING
• Meditation: activity that limits stimulus input
• Clinical application: lower oxygen consumption
• Limitations: may become hypertensive
Imagery: use the conscious mind to create mental images
TRAINING-SPECIFIC THERAPHIES
• Biofeedback
1. Therapeutic touch
2. Traditional chinese medicine
• Acupuncture
1. Chiropractic therapy
2. Natural products and herbal therapies

MOD 13
International Association for the Study of Pain (IASP): unpleasant
sensory associated with tissue damage
Nature of pain: physical, emotional and cognitive components
Transduction: converts energy into electrical energy
Transmission: send impulse across sensory pain nerve fiber
Perception: person is aware of pain
Somatosensory cortex: identifies the location of pain
Association cortex: determine how a person feels about pain
Modulation: inhibits pain impulse
Gate-control theory: pain has emotional and cognitive components
Physiological Response: the stress response stimulates the ANS
Behavioral Response: clenching the teeth indicates acute pain
Knowledge, attitudes, and beliefs: attitude of health care providers
Assumption about patients in pain: biases based on culture
Acute/transient pain: pain that has short duration
Chronic/persistent non-cancer: pain that has no purpose
Chronic episodic: pain that occurs sporadically
Cancer: can be acute or chronic
Idiopathic: chronic pain without identifiable physical cause
Physiological: genes, neurological function, age, fatigue
Social: previous experiences, attention, family support
Psychological: anxiety
Pain tolerance: level of pain a person is willing to accept
Cultural: meaning of pain
Critical thinking: knowledge of pain physiology help you manage a
patient’s pain
O: no hurt
1: hurt little bit
2: hurt little more
3: hurt even more
4: hurt hurts lot
5: hurts worst
Pain-controlled Analgesia: allows patient to self-administer with
minimal risk of overdose
Physical dependence: manifested by drug class-specific withdrawal
syndrome
Addiction: primary disease with genetic factor
Drug tolerance: exposure to drug induces changes
Nutrition: basic component of health
Medical Nutrition Therapy: used nutrition therapy to manage
diseases
Basal metabolic rate: energy needed to maintain life-sustaining
activities
Resting energy expenditure: amount of energy needed to consume
over 24-hour of period
Nutrients: necessary for the normal function of body processes
Carbohydrates: main source of energy
Proteins: necessary for nitrogen balance
Fats: calorie dense
Digestion: mechanical breakdown
Absorption: the small intestine, lined with finger-like projections
called villi (primary absorption sites for nutrients)
Metabolism: all biochemical reactions within the cells of the body
Anabolism: building of more complex biochemical substance
Catabolism: breakdown of biochemical substance
Elimination: chyme moves by peristaltic action
Dietary reference intake: acceptable range of vitamins for each age
and gender
Ovo-lactovegetarian: avoid meat, fish and poultry but eat eggs and
milk
Lactovegetarian: drink milk but avoid eggs
Vegan: consume plant foods
Fruitarian: consume fruits, nuts, honey and olive oil
Critical thinking: synthesis of knowledge
Anthropometry: measurement system of size and makeup of the
body
Advancing diet: gradual progression of dietary intake
Enteral Nutrition: provides nutrition into the GI tract
Enteral Access Tube: when patients are unable to ingest food but
still able to digest nutrients
Parenteral Nutrition: nutrients are provided intravenously
Cardiovascular disease: balance calorie intake and exercise
Cancer and cancer treatment: malignant cells compete with normal
cells for nutrients
HIV/AIDS: body wasting and severe weight loss
Urinary Elimination: basic human function
Voiding: Bladder contraction + urethral sphincter and pelvic muscle
Urinary Retention: accumulation of urine
Urinary tract infection: results from catheterization
Urinary incontinence: involuntary leakage
Urinary diversion: diversion of urine to external source
Nephrostomy tubes: tube tunneled through the skin into the renal
pelvis
Incontinent diversion: changing a pouch
Antimuscarinics: treat nocturia
Bethanechol: treat urinary retention
Tamsulosin and silodosin: relax smooth muscle
Finasteride and dutasteride: shrink the prostate
Antibiotic: treat UTI
Bowel elimination: essential for normal body function
Constipation: infrequent stools that are difficult to eliminate
Impaction: results from unrelieved constipation
Diarrhea: an increase in the number of stools
Incontinence: inability to control passage of feces
Flatulence: accumulation of gas in intestines
Hemorrhoids: engorged veins
Type 1: separate hard lumps
Type 2: sausage shaped but lumpy
Type 3: like sausage but with cracks
Type 4: like sausage or snake
Type 5: soft blobs
Type 6: fluffy pieces with ragged edges
Type 7: watery, no solid pieces
Cathartics: have stronger effect on intestines that laxative
Fine: for enteral feeding
Large bore: for gastric decompression
McCaffery’s classic definition: Pain is whatever the experiencing
person says it is, existing whenever he says it does
PHYSIOLOGY OF PAIN
• Transduction
• Transmission
• Modulation
• Perception
• Gate Control Theory (Melzack and Wall)
TYPES OF PAIN
• Acute/transient pain
• Chronic/persistent non-cancer
• Chronic episodic
• Cancer
• Idiopathic
FACTORS INFLUENCING PAIN
• Physiological, psychological, and social
GUIDELINES THAT MANAGE PAIN
• National Guidelines Clearinghouse
• American Pain Society
• Sigma Theta Tau
CHARACTERISTICS OF PAIN
• Severity
• Aggrevating Factors
• Location
• Timing
• Quality
• Relief measures
NON-PHARMACOLOGICAL PAIN-RELIEF INTERVENTIONS
1. Cognitive approach
2. Relaxation
3. Distraction
4. Music
5. Cutaneous stimulation
6. CTHR
ACUTE CARE: PHARMACOLOGICAL PAIN THERAPHIES
• Analgesics
• Non-opioids
• Co-analgesics
• Opioids
PHARMACOLOGICAL PAIN THERAPHIES
• Perineural
• Epidural analgesia
• Local anesthesia
• Topical analgesics
IMPLICATIONS OF LOCAL AND REGIONAL ANESTHESIA
• Patient education
• Provide emotional support
• Protect patient
RESTORATIVE AND CONTINUING CARE
• The goal of palliative care is to learn how to live life fully with an
incurable condition
• ANA support aggressive treatment even it hastens a patient’s
death
BIOCHEMICAL UNITS OF NUTRITION
• Basal metabolic rate
• Resting energy expenditure
STORAGE OF NUTRIENTS
• Metabolism
• Anabolism
• Catabolism
DIETARY GUIDELINES
• DRIs
• Food guidelines
• Daily values
FACTORS INFLUENCING NUTRITION
• Environmental factors
• Developmental needs
VEGETARIAN DIET
• Ovo-lactovegetarian
• Lactovegetarian
• Vegan
• Zen macrobiotic
• Fruitarian
PROFESSIONAL STANDARDS
• DRIs
• USDA My Plate Guidelines
• Healthy People 2020
• American Heart Association
• American Diabetes Association
• American Cancer Society
• American Society for Parenteral and Enteral Nutrition
SURGICAL PLACEMENT
• Jejunostomy
• Gastrostomy
• Percutaneous endoscopic jejunostomy
• Percutaneous endoscopic gastrostomy
• Nasointestinal
MEDICAL NUTRITION THERAPY
• Gastrointestinal diseases
1. Peptic ulcer etiology
° Helicobacter pylori
° Stress and acid overproduction
2. Peptic ulcer treatment
° Avoid caffeine, spicy foods, aspirin, and NSAIDs, and consume
small meals
3. Inflammatory bowel disease
° Vitamins
° Elemental diet
° Parenteral nutrition
° Fiber increase
° FLL
• Diabetes mellitus
1. Type 1: insulin and dietary restriction
2. Type 2: exercise and diet therapy
FACTORS INFLUENCING URINATION
• Growth and development
• Sociocultural and Psychological Factors
• Personal habits
• Fluid intake
• PSMD
URINARY ELIMINATION PROBLEMS
• Urinary retention
• Urinary Tract Infection
• Urinary incontinence
• Urinary diversion
NURSING RESPONSIBILITIES BEFORE TESTING
• Administer bowel-cleansing agents
• Ensure that patient adheres appropriate pretest diet
COMMON TO PATIENT’S WITH URINARY ELIMINATION PROBLEMS
• Functional urinary incontinence
• Risk for infection
• Urge primary incontinence
• Impaired skin integrity
• Toileting self-care deficit
• Stress urinary incontinence
• IU
ALTERNATIVE TO CATHETERIZATION
° Suprapubic catheters
° External catheters
URINARY DIVERSIONS
° Incontinent diversion
° Continent diversion
° Orthotropic neobladder
MEDICATIONS
• Antimuscarinics
• Bethanechol
• Tamsulosin and silodosin
• Finasteride and dutasteride
• Antibiotics
FACTORS AFFECTING BOWEL ELIMINATION
• Diet
• Age
• Fluid intake
• Physical activity
• Psychological factors and habits
COMMON BOWEL ELIMINATION PROBLEMS
• Constipation
• Impaction
• Diarrhea
• Incontinence
• Flatulence
• Hemorrhoids
BOWEL DIVERSION
• Temporary opening in abdominal wall
° Stoma
• Surgical opening in colon
° Ileostomy
• Ostomies
° Sigmoid
° End
° Loop
° Transverse
° Ileostomy
• Other approaches
° Continent
° Antegrade
° Ileoanal
CLEANING ENEMAS
• Tap water, normal saline, hypertonic solution, and soapsuds
TYPES OF ENEMAS
• Carminative and kayexalate
CATEGORIES OF NASOGASTRIC TUBE
• Fine
• Large bore

MODULE 14
Oxygen: needed to sustain life
Blood: oxygenated through ventilation
Neural and chemical regulators: control the rate of respiration
Respiration: exchange of oxygen and carbon dioxide
Airway of lungs: transfer oxygen from atmosphere to alveoli
Diaphragm and external intercostal muscle: contract to create
negative pleural pressure
Ventilation: move gas in and out of the lungs
Perfusion: ability of cardiovascular to pump oxygenated blood to
tissue
Diffusion: exchange of respiratory gas in alveoli
Pulmonary circulation: moves blood to and from the alveolar
capillary membrane
Oxygen transport system: consist of lungs and cardiovascular
system
Carbon dioxide: product of cellular metabolism
Neural regulation: CNS controls the respiratory rate
Chemical regulation: maintains the rate of respiration based on
changes in the blood
Cardiopulmonary physiology: deliver deoxygenated blood to the
right side of the heart
Right ventricle: pumps deoxygenated blood
Myocardial pump: two atria and ventricles
Myocardial blood flow: unidirectional through four valves
Coronary artery circulation: supply the myocardium with nutrients
Systemic circulation: arteries and veins deliver nutrients and
oxygen
Cardiac output: amount of blood ejected each minute
Stroke volume: amount of blood ejected with each contraction
Preload: end-diastolic pressure
Afterload: resistance to left ventricular ejection
Conduction system: transmit electrical impulse
Normal sinus rhythm: originates at SA node
Hypoventilation: inadequate to meet the body’s oxygen demand
Hyperventilation: required to eliminate carbon dioxide produced by
cellular metabolism
Hypoxia: inadequate tissue oxygenation
Cyanosis: blue discoloration of skin
Disturbances in conduction: electrical impulses that do not
originate from SA node
Oropharyngeal & nasopharyngeal: used when the patient is unable
to clear secretion
Orotracheal & nasotracheal: used when the patient is unable to
manage secretion
Tracheal: used with an artificial airway
Oral airway: prevent obstruction of the trachea
Endotracheal and tracheal airway: short term; use to ventilate
upper airway obstruction
Tracheostomy: long term; surgical incision made into trachea
Positioning: reduces pulmonary stasis
Incentive spirometry: encourages voluntary deep breathing
Invasive mechanical ventilation: lifesaving technique used with
artificial airway
Noninvasive ventilation: maintain positive airway pressure
Oxygen therapy: prevent hypoxia
Simple face mask: mask for short therapy
Plastic face mask: for higher concentration of oxygen
Fluid: surrounds all the cells in the body
Fluid, electrolyte, and acid-base balance: maintain the health and
function of all body system
Thirst: important regulator of fluid intake
Hypernatremia: water deficit
Hyponatremia: water excess
Degree of acidity is reported is reported as pH
Buffers: chemicals that maintain normal pH
Lungs excrete carbonic acid while kidney excrete metabolic acid
Respiratory acidosis: from alveolar hypoventilation
Respiratory alkalosis: from alveolar hyperventilation
Metabolic acidosis: increase in acid or decrease in base
Metabolic alkalosis: increase in base or decrease in acid
Cardiovascular system: provides the transport mechanism
The exchange of respiratory gases occurs between the environment
and the blood
WORK OF BREATHING (SAICE)
• Surfactant
• Atelectasis
• Inspiration and expiration
• Compliance
• Effort
LUNG VOLUMES (TRF)
• Tidal
• Residual
• Forced vital capacity
REGULATION OF RESPIRATION
• Neural regulation
• Chemical regulation
BLOOD FLOW REGULATION (CSPA)
• Cardiac output
• Stroke volume
• Preload
• Afterload
NORMAL SINUS RHYTHM
• P wave
• PR interval
• QRS complex
• QT interval
FACTORS AFFECTING OXYGENATION
• Physiological factors (DHID)
1. Decreased oxygen-carrying capacity
2. Hypovolemia
3. Increased metabolic rate
4. Decreased inspired oxygen concentration
• Conditions affecting chest wall movement (NOMPC)
1. Neuromuscular disease
2. Obesity
3. Musculoskeletal abnormalities
4. Pregnancy
5. CNS alterations
• Influences of chronic disease
ALTERATIONS IN RESPIRATORY FUNCTIONING
• Hypoventilation
• Hyperventilation
• Hypoxia
• Cyanosis
ALTERATIONS IN CARDIAC FUNCTIONING
• Disturbances in conduction
1. Dysrhythmias
2. Ventricular dysrhythmias
3. Atrial fibrillation
4. Paroxysmal supraventricular tachycardia
• Altered cardiac output
1. Left-sided heart failure
2. Right-sided failure
• Impaired valvular function
• Myocardial ischemia
1. Angina
2. Myocardial infarction
PHYSICAL EXAMINATION (IPPerA)
DIAGNOSTIC TEST
• Blood specimen
• X-ray
• TB skin testing
SUCTIONING TECHNIQUES
• Oropharyngeal and Nasopharyngeal
• Orotracheal and Nasotracheal
• Tracheal
SUCTIONING METHODS (Open and Closed)
ARTIFICIAL AIRWAY
• Oral airway
• Endotracheal and tracheal airway
• Tracheotomy
PROMOTION OF LUNG EXPANSION
• Positioning
• Ambulation
• Noninvasive ventilation
• Invasive mechanical ventilation
• Chest tube (pneumothorax and hemothorax)
• Incentive spirometry
PROMOTION OF OXYGENATION
• Supply of oxygen
• Oxygen therapy
• Methods of oxygen delivery (nasal cannula oxygen mask)
• Safety precautions
OXYGEN MASK
• Simple face mask
• Plastic face mask
• Venturi mask
HOME OXYGEN THERAPY
• Arterial partial pressure of 55 or less
• Arterial oxygen saturation of 88 or less
RESTORATION OF CARDIOPULMONARY FUNCTIONING
• CPR
1. Circulation
2. Airway
3. Breathing
• Defibrillation
RESTORATIVE AND CONTINUING CARE
• Cardiopulmonary rehabilitation
• Respiratory muscle training
• Breathing exercise (pursed-lip and diaphragmatic breathing)
CHARACTERISTICS OF BODY FLUID
• Volume
• Osmolality
• pH
• Electrolyte
FLUID BALANCE CONSIST OF
• Intake: 2300 mL/day
• Distribution: extra and intracellular, vascular and interestitial
• Output: kidney, skin, lungs, and GI tract
° Hormonal Influences: ADH, RAAS, and ANPs
ECF IMBALANCES (Volume and Osmolality)
ELECTROLYTE BALANCE
• Intake and absorption
• Distribution
• Output
ELECTROLYTE IMBALANCES
• Potassium: Hypokalemia and Hyperkalemia
• Calcium: Hypocalcemia and Hypercalcemia
• Magnesium: Hypomagnesemia and Hypermagnesemia
pH SCALE (1.0 very acid to 14.0 very base)
pH of 7.0 is neutral (normal arterial blood is 7.35 to 7.45)
ACID PRODUCTION
• Carbon dioxide + water — carbonic acid — Hydrogen ion +
Bicarbonate
ACID BUFFERING
• Bicarbonate + Hydrogen ion — Carbonic acid
• Carbonic acid — Hydrogen ion + Bicarbonate
ACID-BASE IMBALANCES
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
Parenteral replacement of fluids (TPN, Crystalloids, and Colloids)
INITIATING IV THERAPY
• Maintaining the system
• Changing intravenous fluid container
• Complications
• Discontinuing peripheral IV access
BLOOD TRANSFUSION
• Groups and types
• Blood component therapy: IV administration of blood component
• Autologous transfusion
• Transfusing blood
• Transfusion reaction

MODULE 15

Stress and Coping: presence of physical and mental illness

Stress: process that evokes anxiety; physical demand
Stressors: tension-producing stimuli
Appraisal: how a person interprets the impact of stressor
PTSD: acute stress disorder that begins when a person experience
traumatic event
Acute: time-limited events that threaten a person
Chronic: occurs in stable condition
Developmental crises: person moves through the stages of life
Situational crises: provoked by external sources
Adventitious crises: created by natural of man-made disaster or
crime
Neuman system model: based on the concept of stress ad reaction
to stress
Pender’s health promotion model: focus on promoting health and
managing stress
Situational factors: arise from job changes, illness
Maturational factors: vary with life stages
Sociocultural factors: social, cultural, and environmental perceived
by children
Loss: inevitable part of life
Grief: bewildering cluster of ordinary human emotions
Critical thinking: be familiar with common experience response to
loss
Health promotion: cope and optimize health
Palliative care: help patients and families achieve possible quality
of life
Hospice care: care terminal ill patient
Therapeutic communication: help earn trust
Assist with end-of-life care: support patient and families as they
identify the best journey to the end of life

NEUROPHYSIOLOGICAL RESPONSES
• Medulla oblongata
• Reticular formation
• Pituitary gland
GENERAL ADAPTATION SYNDROME (TIR)
• Three-stage reaction to stress (ARE)
1. Alarm reaction
2. Resistance stage
3. Exhaustion stage
• Immune response
1. Stress response influences the immune system
• Reaction to psychological stress
1. Coping
2. Ego-defense mechanism
TYPES OF STRESS (PAC)
• PTSD
• Acute
• Chronic
TYPES OF CRISES (SAD)
• Situational
• Adventitious
• Developmental
ROLE OF STRESS
• Neuman system model
• Pender’s health promotion model
FACTORS INFLUENCING STRESS AND COPING
• Situational factors
• Maturational factors
• Sociocultural factors
DIAGNOSIS FOR STRESS (DAFSSPIR)
• Denial
• Anxiety
• Fear
• Situational low self-esteem
• Stress overload
• Powerlessness
• Ineffective coping
• Risk for post trauma syndrome
IMPLEMENTATION FOR STRESS (HRTPAGJRSM)
• Health promotion (LID)
1. Learn skill
2. Decrease stress situation
3. Increase resistance to stress
• Regular exercise
• Time management
• Progressive muscle relaxation therapies
• Assertiveness training
• Guided imagery
• Journal writing
• Restorative care
• Stress management
• MBSR
NECESSARY LOSSES
• Situational losses
• Maturational losses
GRIEF (CAND)
• Complicated
• Anticipatory
• Normal
• Disenfranchised
ORGANIZATIONS THAT ASSIST IN END-OF-LIFE CARE
• End of Life Nursing Consortium
• ANA
• American Society of Pain Management
• American Association of Critical Care
FACTORS INFLUENCING LOSS AND GRIEF
• Human development
• Hope
• Coping strategies
• Culture and ethnicity
• Socioeconomic status
• Spiritual and religious belief
• Nature of loss
• Personal relationship
PROFESSIONAL STANDARDS IN CRITICAL THINKING (AND)
• ANA Scope and Standards
• Nursing Code of Ethics
• Dying Person’s Bill of Rights
ASSESSMENT
• Through the patient’s eye (BUUA)
1. Be present
2. Use active listening
3. Use open communication
4. Ask Open-ended question
• Grief variables
• Grief reactions
DIAGNOSIS FOR LOSS
• Compromised family coping
• Complicated grieving
• Death anxiety
• Grieving
• Hopelessness
• Pain
• Risk for complicated grieving
• Spiritual distress
IMPLEMENTATION FOR LOSS (HHUMMPPPPPFACS)
• Health promotion
• Hospice care
• Use therapeutic communication
• Manage symptoms
• Maintain peaceful environment
• Palliative care
• Provide psychological care
• Promote dignity
• Promote spiritual comfort
• Protect against abandonment
• Facilitate mourning
• Assist with end-of-life decision making
• Care after death
• Support the grieving family

MOD 12

Personal hygiene: affect patient’s comfort

Skin: for protection, secretion, excretion, temperature regulation,
and sensation; account for 15% of total body weight; Vitamin D
synthesis
° Normal nail is transparent, smooth and convex with pink nail bed
and white tip
Oral cavity: lined with mucous membrane
° Normal oral mucosa is light pink, soft, moist, smooth, and without
lesions
Xerostomia: dry mouth
Gingivitis: inflammation of the gums
Dental caries: tooth decay
Hair shaft: lifeless
Sense of smell: important aid to appetite
° Hygiene care is never routine
Epidermis: top shield layer of skin
Dermis: inner layer of skin, consist of collagen
Dermal: separates epidermis and dermis
CLASSIFICATION OF PRESSURE ULCER
• Stage I: intact skin with nonblanchable redness
• Stage II: partial-thickness skin loss
• Stage III: full-thickness tissue loss with visible fat
• Stage IV: full-thickness tissue loss with exposed bone
Partial-thickness wound: shallow in depth
Full-thickness wound: extends into the subcutaneous layer
Partial-thickness wound repair: reestablishment of the epidermal
layer
Full-thickness wound repair: hemostasis, inflammatory
Medicare and Medicaid: no additional reimbursement for care in
stage 3 and 4
° Use Wound, Ostomy and Continence Nurse Society guidelines
when planning care
Mobility: person’s ability to move about freely; essential for self
defense
Body mechanics: coordinated efforts of musculoskeletal
Alignment and balance: posture
Gravity: weight force exerted on the body
Friction: occurs in a direction opposite to movement
Skeletal system: provides attachment for muscles and ligaments
Bones: long, short, flat
Skeletal muscle: working elements of movement
Nervous system: regulates movement
Endocrine system: helps maintain homeostasis
Immobile patients: high risk for developing pulmonary
complications
Contractures: develop in joints
Gait: style of walking
Exercise: physical activity for conditioning the body
Body alignment: determine normal physical change
Cardiovascular: reduce orthostatic hypotension
Musculoskeletal system: prevent muscle atrophy
Integumentary system: provide skin care
Elimination system: provide adequate hydration
Sleep: important to health; provides healing and restoration
Circadian rhythms: affected by light
Sleep regulation: regulated by a sequence of physiological states
Dreams: occur in NREM and REM sleep
Physical illness: can cause pain, physical discomfort
Insomnia: adjustment sleep disorder
Sleep apnea: primary central sleep apnea
Narcolepsy: cataplexy
Sleep deprivation: environmental disturbances
Parasomnias: somnambulism
Brushing: removes plaque and bacteria
Flossing: removes tartar
Rinsing: removes excess toothpaste

LAYERS OF SKIN
• Epidermis
• Dermis
• Subcutaneous tissue
DURING HYGIENE, ASSESS
• Healthcare education needs
• Health promotion practices
• Emotional status
FACTORS INFLUENCING HYGIENE
• Social practices
• Personal preference
• Body image
• Socioeconomic status
• Health beliefs
BATH GUIDELINES
• Provide privacy
• Maintain safety
• Promote independence
• Maintain warmth
ORAL HYGIENE
• Brushing
• Flossing
• Rinsing
RISK FACTORS FOR PRESSURE ULCER DEVELOPMENT
• Shear
• Impaired sensory perception
• Friction
• Alteration in LOC
• Impaired mobility
PROCESS OF WOUND HEALING
• Partial-thickness wound
• Full-thickness wound
WOUND REPAIR
• Partial-thickness wound repair
• Full-thickness wound repair
COMPLICATIONS OF WOUND HEALING
• Hemorrhage
• Infection
• Dehiscence
• Evisceration
FACTORS INFLUENCING PRESSURE ULCER FORMATION
• Tissue perfusion
• Infection
• Nutrition
• Age
• Psychosocial impact of wounds
PRESSURE ULCER SITES (SESISOHASESITATMMPLLLL)
• Scapula
• Occipital bone
• Spinous process
• Elbow
• Sacrum
• Iliac crest
• Achilles tendon
• Sole
• Ischium
• Shoulder
• Ear
• Trochanter
• Anterior iliac spine
• Thigh
• Medial knee
• Medial malleolus
• Posterior knee
• Lateral knee
• Lower leg
• Lateral malleolus
• Lateral edge of foot
TYPES OF DRESSINGS
• Gauze
• Transparent film
• Hydrocolloid
• Hydrogel
• Foam
• Composite
SECURING
• Tape
• Ties
• Binder
SUTURE CARE
• Staple removal
• Suture removal
FACTORS INFLUENCING HEAT AND COLD TOLERANCE (TEPA)
• Temperature
• Exposure time and skin
• Perception of sensory stimuli
• Age
NATURE OF MOVEMENT
• Body mechanics
• Alignment and balance
• Gravity
• Skeletal system
• Friction
PATHOLOGICAL INFLUENCES OF MOBILITY (PMMD)
• Posture abnormalities
• Muscle abnormalities
• Musculoskeletal trauma
• Damage to CNS
EFFECTS OF MUSCULAR DECONDITIONING
• Disuse atrophy
• Physiological
• Psychological
• Social
SYSTEMIC EFFECTS
• Metabolic
• Muscle effects
• Skeletal effects
• Musculoskeletal changes
• Urinary elimination
• Respiratory
• Cardiovascular
• Integumentary
CARDIOVASCULAR CHANGES
• Orthostatic hypotension
• Increased cardiac workload
• Thrombus formation
MUSCULOSKELETAL CHANGES
• Joint contracture
• Muscle weakness
• Lean body mass loss
• Disuse osteoporosis
URINARY ELIMINATION CHANGES
• Urinary stasis
• Renal calculi
• Infection
INTEGUMENTARY CHANGES
• Pressure ulcer
• Inflammation
• Older adults at greater risk
• Ischemia
PLANES OF THE BODY
• Sagittal
• Transverse
• Frontal
ACTIVITY TOLERANCE
• Physiological
• Emotional
• Developmental
BODY ALIGNMENT
• Standing
• Sitting
• Lying
POSITIONING
• Trochanter roll
• Hand roll
• Trapeze bar
• Supported Fowler’s
• Supine
• Side-lying
• Sims’ position
• Prone
Sleep cycle last to 90 to 100 minutes
SLEEP DISORDER
• Parasomnias
• Insomnia
• Narcolepsy
• Sleep apnea
• Sleep deprivation
NORMAL SLEEP REQUIREMENTS
• Neonates: 16 hours a day
• Infants: 8 to 10 hours
• Toddlers: 12 hours a day
• Preschoolers: 12 hours a night
• School age: 9 to 10 hours
• Adolescent: 7 ½ hours
• Young adult: 6 to 8 ½ hours
• Middle and Older adult: total number of hours declines
FACTORS INFLUENCING SLEEP
• Drugs and substances
• Usual sleep patterns
• Lifestyle
• Emotional stress
• Environment
H.L.N
 MOD 11

° Study all the CFU question

Portal of entry: element that can eliminate in preserving skin
integrity
Mode of transmission: how you transfer infection
Prodromal stage: stages of infection that symptoms occur and
continuing to replicate
Illness stage: if symptoms does not replicate
Incubation period: it is the time of exposure to the appearance of
symptom
PATIENT’S AT GREATER RISK FOR HAIs
• Compromised immune system
• Older adults
• Multiple illnesses
• Poorly nourished
Everything before mention: synonym for all of the above
FORMULA FOR DOSAGE CALCULATION
Q = Order ÷ Dose on hand
3500 ÷ 5000 = 1.42
° If there is a medication error, your top priority is the patient’s
safety

MOD 12
° Study number 1–18 question in CFU

MOD 13

PHYSIOLOGICAL FACTOR OF PAIN

• Fatigue
• Age
• Genes
NON-PHARMACOLOGICAL FACTOR OF PAIN
• Culture
• Tradition
Relaxation: mental and physical freedom from stress
Reducing pain perception: simple way to promote comfort
TYPES OF ANALGESICS
• Acetaminophen
• Opioids
• Adjuvants
Rectum: location of fecal impaction
What is the nursing diagnosis if the patient has alteration of
urinary function? Apply urinary catheter (risk in urinary catheter:
infection)
COMPONENTS OF PAIN ASSESSMENT
• Location, quality, and duration of pain
When you are caring the patient with urinary catheter, what
nursing intervention prevents the transfer of infection from the
patient to you? Hand washing or hand hygiene
Greatest risk related to enteral feeding? Aspiration
Sigmoid colostomy: located in the lower left area of the abdomen
Helicobacter pylori: bacteria that causes peptic ulcer
Carminative enema: to expel flatulence
Left Sim’s position: position when administering enema
Small intestine: absorbs food
What would be your top priority when administering local
anesthesia? Patient’s safety

MOD 14

Cardiovascular system: provides the transport and distribution of

oxygen
Hyperventilation: kind of ventilation that you have more than
required CO2
SEQUENCE OF PRIORITIZATION WHEN YOU ARE RESTORING
CARDIOPULMONARY FUNCTION THROUGH A CPR
• Circulation
• Airway
• Breathing
Tracheal: suctioning for tracheostomy
RISK FOR FLUID VOLUME DEFICIT
 MOD 15
Stress: make a one person uneasy
Stressor: causes stress which can be internal or external factors
Flight-or-Fight response

MOD 9
Nursing process: continuous and dynamic
Rationale: scientific principles
Question: The nurses teach the patient to use visualization to cope
with chronic pain. Which step of the nursing process is associated
with nursing intervention? Implementation
Collecting of data: primary goal of assessment
Nursing Diagnosis: defining characteristics support the
appropriateness of nursing diagnosis
Planning: it meet the needs of a patient
After you collect the data from the patient, your next thing to do
being the nurse is determine the significance of the data collected
What is the primary reason why nurse perform physical assessment
to newly admitted patient? To identify important information
about the patient
How to collect subjective data? By interviewing
 MOD 10
Evaluation: you are determining the outcomes of care
SYNONYMS
• Implementation: intervention, identify, and recognize
• Evaluation: outcome
• Assessment: analysis, observe, explore, and examine
NURSING ACTION ASSOCIATED WITH ASSESSMENT OR
ANALYZATION
• Identify the patient potential risk
• Categorizing the date in a meaningful relationship
 MOD 17

EVIDENCE-BASED CARE (RII)

• Reduce cost
• Increase nurse satisfaction
• Improves patient outcomes
SOURCES OF EVIDENCE (TCAQSIC)
• Textbooks
• Clinician’s expertise
• Articles from nursing literature
• Quality improvement
• Standards of care
• Infection control data
• Chart reviews
STEPS OF EVIDENCE-BASED PRACTICE (CASASEI)
1. Cultivate a spirit of inquiry
2. Ask a clinical question in PICOT format
3. Search for the most relevant evidence
4. Appraise the evidence you gather
5. Share the outcomes with others
6. Evaluate the outcomes of practice decisions
7. Integrate all evidence with your clinical expertise
EVIDENCE-BASED CLINICAL DECISION MAKING
• Research, theories, clinical experts and leader’s opinions
• Assessment and physical and health care resources
• Clinical expertise
• Patient preferences and values
DEVELOPING A PICOT QUESTION
• Patient population of interest
• Intervention of interest
• Comparison of interest
• Outcome
• Time
BEST EVIDENCE
• Experts (NARLS)
1. Nursing faculty
2. Advanced practice nurses
3. Risk managers
4. Librarian
5. Staff educators
• Medical librarian: identify the databases that are available to you
ELEMENTS OF AN ARTICLE (MAIL)
• Manuscript narrative (purpose statement, methods, results and
clinical implications)
• Abstract
• Introduction
• Literature review
INTEGRATE THE EVIDENCE
• Integrating evidence: assessment or documentation tools
• Applying evidence: consider setting
• Pilot study: conducted when evidence is not strong enough
SHARE THE OUTCOMES WITH OTHERS
• Clinical staff
• Clinicians
• Nursing practice council
• Professional conferences
Nursing research: way to identify new knowledge
Outcomes Research: help patients make informed decisions
Scientific method: foundation of research
NURSING PROCESS
• Assessment: identify area of interest
• Diagnosis: develop research questions
• Planning: determine how study will be conducted
• Implementation: conduct the study
• Evaluation: analyze the results of the study
QUANTITATIVE RESEARCH (SENE)
• Surveys
• Experimental
• Evaluation research
• Non-experimental
QUALITATIVE RESEARCH (PEG)
• Phenomenology
• Ethnography
• Grounded theory
REASEARCH PROCESS (HI)
• Human Research Terminology
• Institutional Review Board
Informed consent: participants complete review the information
• Confidentiality
EBP: use of information from research to determine safe nursing
care
Research: systematic inquiry answer questions
QI: improves local work processes

NOTES
Cultivate a Spirit of Inquiry: question what does not make sense to
you
Critically Appraise the Evidence: after critiquing all articles for a
PICOT question
Evaluate the Practice Decision: after applying evidence, evaluate
the outcome
Research: allows you to study nursing questions
3 CLASSIFICATION OF RESEARCH
• Basic research: real-life research
• Applied research: it results from present problems
• Action research: study of certain problems such as decisions
PURPOSE OF RESEARCH
• Solve problems
• Evaluate programs and methods
• Develop new programs, methods and product
• Decision making
2 CLASSIFICATION OF RESEARCH ACCORDING TO DESIGN
• Quantitative: descriptive, correlational, experimental and non-
experimental
• Qualitative: phenomenological, grounded theory, ethnographic,
historical case study
DIFFERENCE BET. QUALITATIVE AND QUANTITATIVE RESEARCH
QUALITATIVE QUANTITATIVE
Subjective Objective
Discovery Explanation
Whole is greater Parts is equal to
than parts whole
Multiple truths One truth
Large size Small size
Narrative Statistics
Separate Researcher is part of
the research
 MOD 18

Communication and Nursing Practice: lifelong learning process for

nurses
Therapeutic communication: promotes personal growth of
patient’s health related goals
Communication: establish healing relationships and has the power
to hurt or heal
COMMUNICATION INCLUDES (PEGWA)
• Posture
• Expressions
• Gestures
• Words
• Attitudes
DEVELOPING COMMUNICATION SKILLS (CHIPS)
• Critical thinking
• Humility
• Integrity
• Perseverance
• Self-confidence
THINKING IS INFLUENCED BY PERCEPTION (FEC)
• Five senses
• Education
• Culture
LEVELS OF COMMUNICATION (SIIPE)
• Small group
• Intrapersonal
• Interpersonal
• Public
• Electronic
ELEMENTS OF COMMUNICATION PROCESS (MISFERC)
• Message
• Interpersonal variables
• Sender and receiver
• Feedback
• Environment
• Referent
• Channel
FORMS OF COMMUNICATION
• Verbal (VDPICT)
° Vocabulary
° Intonation
° Clarity
• Non-verbal
° Personal appearance
° Eye contact
° Posture
• Metacommunication
Caring relationships: foundation of clinical nursing practice
Therapeutic relationship: promote psychological climate
NURSE-PATIENT RELATIONSHIP PHASE
1. Pre-interaction phase: occurs before meeting the patient
2. Orientation phase: when nurse and patient meet and get to
know one each other
3. Working Phase: when the nurse and patient work together to
solve problems
4. Termination phase: occurs at the end of relationship
Motivational Interviewing: holds promise for encouraging patients
to share their thoughts
PROFESSIONAL NURSING RELATIONSHIP
• Nurse-family relationship
• Nurse-health care team relationship
• Nurse-community relationship
ELEMENTS OF PROFESSIONAL COMMUNICATION (CUTAAA)
• Courtesy
• Use of names
• Trustworthiness
• Appearance
• Autonomy
• Assertiveness
DIAGNOSIS FOR COMMUNICATION (LIID)
• Lack of skills in attending
• Inability to articulate verbalization
• Difficulty for forming words
• Difficulty with comprehension
Therapeutic communication techniques: encourage the expression
of feelings
USE SOLER
• Sit
• Observe
• Lean
• Establish
• Relax
THERAPEUTIC COMMUNICATION TECHNIQUES
• Sharing humor
• Sharing empathy
• Sharing hope
• Sharing observations
• Sharing feelings
• Summarizing
• Self-disclosure
NON-THERAPEUTIC COMMUNICATION TECHNIQUES
• Asking personal questions
• Automatic responses
• Asking for explanations
• Approval or disapproval
• Arguing
ADAPTING COMMUNICATION TECHNIQUES
• Cognitive impairment
• Hearing impairment
• Visual impairment
• Unresponsive
• Patients who do not speak English
• Patients who cannot speak clearly

NOTES
• Referent: motivates one person to communicate with other
• Sender: encodes and delivers the message; Receiver: decodes and
receive the message
• Message: content of the communication
• Channels: means of sending and receiving messages through
visual
• Feedback: indicates whether the receiver understand the
meaning of the message
• Interpersonal variables: factors within both the sender and
receiver that influence communication
• Environment: setting for sender-receiver interaction
Active listening: being attentive to what the patient is saying
 MOD 22

Health disparity: health difference linked with social disadvantage

Social determinants of health: condition where people are born by
the distribution of money
Health care disparities: differences among populations in the
availability of health care services
Culture: norms, values, and traditions
Addressing Health Care Disparities: New Standards
• Focus on cultural competency
• Recognize that valuing each patient’s needs improves the overall
safety
Intersectionality: belonging simultaneously to multiple social
groups
Oppression: system of advantages and disadvantages
Transcultural nursing: comparative study of cultures
Culturally congruent care: care that fits a person’s life patterns
Illness: way that individuals react to disease
Disease: malfunctioning of biological processes
Cultural competency: enabling of health care providers to deliver
services
CULTURALLY COMPETENT ORGANIZATIONS (VICAM)
• Value diversity
• Institutionalized cultural knowledge
• Conduct a cultural self-assessment
• Adapt to diversity
• Manage the dynamics of difference
CAMPINHA-BACOTE
• Cultural desire
• Cultural encounter
• Cultural skills
• Cultural knowledge
• Cultural awareness
BLANCHET AND PEPIN
• Reinventing practice
• Building a relationship with others
• Working outside
LANDMARK REPORTS
• Crossing the Quality Chasm
• Unequal Treatment
Patient-centeredness: provides individualized care
Cultural competence: increase equity and reduce disparities
Bias: predisposition to see people in a certain light, either positive
or negative
World View: Emic and Etic
Iceberg analogy: most aspects of a person’s worldview are hidden
HOW TO DEVELOP OUR WORLD VIEW?
• Culture: shared experiences and commonalities
• Socialization: through family, friends, community
CULTURAL ASSESSMENT MODEL (TEO)
• Trust
• Explanatory model
• Open ended question
MNEMONICS
• LEARN: Listen, Explain, Acknowledge, Recommend, Negotiate
• RESPECT: Rapport, Empathy, Support, Partnership, Explanation,
Cultural Competence, Trust
• ETHNIC: Explanation, Treatment, Healers, Negotiate,
Intervention, Collaboration
• C-LARA: Calm, Listen, Affirm, Respond, Add
Cultural Encounters: nurse directly interacting with patients from
diverse backgrounds
Cultural Desire: motivation of health care professional to “want to”
not “have to”
Core Measures: help health care institutions improve performance
 MOD 21

° Patient is the center of your practice and it includes individuals,

families, and/or communities
Robert Wood Johnson Foundation Future of Nursing: Campaign for
Action: transform health care through nursing and a response to
the Institute of Medicine on the Future of Nursing
CAREER DEVELOPMENT (PANNN)
• Provider of care
• Advanced Practice Registered Nurse
• Nurse Educator
• Nurse Administrator
• Nurse Researcher
FOUR ROLES OF APRN
• Clinical nurse specialist
• Certified nurse practitioner
• Certified nurse midwife
• Certified registered nurse anesthetist
APRN: most independent functioning nurse; has advanced
education in pathophysiology, pharmacology, physical assessment,
and has certificate and expertise in a specialized area of practice
Nurse Educator: works in school of nursing
Nurse Administrator: manages patient care
Nurse Researcher: investigates problems to improve nursing care
° In U.S, the way to become a RN is through completion of either
associate or baccalaureate degree program. Graduates of both
program are eligible to take the National Council Licensure
Examination for Registered Nurses
° Associate degree program: 2 year program which focus on basic
science and theoretical and clinical courses
° Baccalaureate degree program: 4 years of study in college which
focus on basic science; theoretical and clinical courses; and courses
in the social sciences, arts, and humanities
° In Canada, BSN is equivalent to BSN in the U.S
Graduate education: emphasizes advanced knowledge in the basic
sciences and research-based clinical practice
Master’s degree: important for the roles of nurse educator and
administrator
Professional Doctoral Programs in Nursing: prepare graduates to
apply research findings
Doctor of Nursing Practice: practice-focused doctorate
Continuing and In-service Education: ways to continue education
and necessary for the practicing RN
NURSE PRACTICE ACTS (PRO)
• Protect public health, safety, and welfare
• Regulate scope of nursing practice
• Overseen by state Boards of Nursing
LICENSURE AND CERTIFICATION
• Licensure: NCLEX-RN examination
• Certification: requirements vary
NSNA and CSNA: organizations that consider issues of importance
to nursing students
 MOD 20

National Council of State Boards of Nursing (NCSBN): competencies

that registered and licensed nurses need to practice
ENTRY-LEVEL NURSE COMPETENCIES (PUMP)
1. Possess a system focus
2. Understand the environment to care
3. Manage the care of patients
4. Priotize basic patient care needs
Building a Nursing Team: strong nursing team works together to
achieve the best outcomes for patients
EFFECTIVE TEAM DEVELOPMENT REQUIRES
° Training
° Trust
° Communication
° Workplace
NURSE EXECUTIVE
° Transformational leadership
° TEEAMS (Time, Empowerment, Enthusiasm, Appreciation,
Management, Support) approach
Nurse Executive: clinical and business leader
CHARACTER OF AN EFFECTIVE LEADER (CERK)
° Consistent in managing conflict
° Effective communicator
° Role model for staff
° Knowledgeable
Transformational leadership: focused on change and innovation
through team development
TEEAMS (Time, Empowerment, Enthusiasm, Appreciation,
Management, Support) Approach: nurse manager spends time on
the unit with the staff sharing ideas
Work engagement: positive state of mind about work
MAGNET RECOGNITION’S FIVE MODEL (SENTE)
1. Structural empowerment
2. Exemplary professional practice
3. New knowledge
4. Transformational leadership
5. Empirical quality results
Magnet hospital: has clinical promotion system and evidence-
based practice programs
Nursing care delivery models: contain the common components of
nurse-patient relationship
Registered Nurse: leader who leads a team of other RNs
NAP: provide direct patient care
Primary nursing: supports philosophy regarding nurse and patient
relationship
TRADITIONAL MODELS
° Primary nursing
° Team nursing
TODAY’S MODELS
° Patient-centered care
° Total patient care
° Case management
PATIENT AND FAMILY-CENTERED CARE (PIRC)
° Participation
° Information sharing
° Respect and dignity
° Collaboration
Patient and Family-centered care: model of nursing care
CORE CONCEPTS
° Respect and dignity: ensuring that care provided is given
° Information sharing: health care providers communicate and
share information
° Participation: patients and families are encouraged and supported
° Collaboration: demonstrated by the health care leaders
collaborating with patients and families
Total patient care: emphasizes a high degree of collaboration with
other health care professionals
Case manager: APRN who helps improve patient outcomes
Case management: approach that coordinates health care services
to patients
Decision making: decentralized management means that decision
making occurs at the level of the staff; encompasses:
° Responsibility: activities an individual is employed to perform
° Autonomy: independent decisions about patient care
° Authority: legitimate power to give commands
° Accountability: answerable for the actions
RESPONSIBILITIES OF A NURSE MANAGER (HERM)
° Help staff establish annual goals
° Establish self as a role model
° Recruit new employees
° Monitor professional nursing standards
NURSING MANAGER SUPPORTS STAFF THROUGH:
° Staff education
° Staff communication
° Interprofessional rounding
Shared governance: promotes decision-making in nurse staff
Committee: ensure that all staff have participation on practice
issues
Interprofessional collaboration: critical to the delivery of quality,
safe patient care
COMPETENCIES NEEDED FOR EFFECTIVE INTERPERSONAL
COLLABORATION
° Communicate with patients and other health care professionals
° Use the knowledge of one’s own role
° Work with individuals of other professions
LEADERSHIP SKILLS FOR NURSING STUDENTS
° Clinical Care Coordination
° Team Communication
° Delegation
° Knowledge Building
CLINICAL CARE COORDINATION (COPUTE)
° Clinical decisions: apply the nursing process
° Organizational skills: do the right things
° Priority setting: determine which patient’s needs should be
addressed first
• High priority: immediate threat to patient survival
• Intermediate priority: non-life threatening
• Low priority: potential problems may be directly related to
patient’s illness
° Use of resources: important aspect of clinical care coordination
° Time management: remain goal oriented
PRINCIPLES OF TIME MANAGEMENT
• Goal setting: review patient’s goals and any goals you have for
activities
• Time analysis: reflect on how you use your time
• Priority setting: set the priorities that you have established for
patients
• Interruption control: everyone need time to socialize with
colleagues
• Evaluation: take time to think about how effectively you used
your time
° Evaluation: evaluate process
Team Communication: respect other’s ideas
TOOLS THAT IMPROVE COMMUNICATION
° Briefings
° Group rounds on patient
° Callouts
° Check backs
° CUS words (Concerned, Uncomfortable, don’t feel Safe)
° Use of SBAR
Delegation: transfer responsibility while remaining accountable for
outcomes
FIVE RIGHTS OF DELEGATION
1. Right Task: one that can be delegated for a specific patient
2. Right Circumstance: appropriate patient setting are considered in
determining the right circumstance
3. Right Person: delegating the right task to the right person
4. Right Direction: indicates that a clear, concise description of
takes is given
5. Right Evaluation: appropriate monitoring are provided
STEPS FOR EFFECTIVE DELEGATION
1. Communicate clearly
2. Assess the knowledge and skills of delegates
3. Listen attentively
4. March tasks to the delegate’s skills
5. Provide feedback
Knowledge Building: remain competent
NOTES
COMPONENTS OF MEDICAL RECORD (PMAMIMM)
• Pt profile
• Medication
• Admission date
• Medical Dx
• Informed consent
• Medical and interdisciplinary notes
• Medical Hx
 MOD 19

Documentation: produces written account of pertinent patient

data; constitutes a fundamental tenet of nursing care
PURPOSE OF MEDICAL RECORD (RECLAR)
• Research
• Education
• Communication
• Legal documentation
• Auditing
• Research
MISTAKES IN DOCUMENTATION THAT RESULTS IN MALPRACTICE
• Fail to record drug information
• Fail to record nursing actions
• Fail to record medication administration
• Fail to record drug reactions
• Incomplete records
• Fail to document discontinued medications
THE SHIFT TO ELECTRONIC DOCUMENTATION
HITECH: promote meaningful use of Health Information Technology
EHRs: decrease cost and improve the quality of patient care
Health Information Technology: improve the quality and value of
health care
Interprofessional Communication within the Medical Record: the
quality of patient care depends on your ability to communicate
with other members of health care team
Confidentiality: nurses are legally obligated to keep all patient
information confidential
Nurses: responsible for protecting records from all unauthorized
readers
HIPAA: request regarding health information are limited to the
minimum necessary
Privacy, Confidentiality, and Security Mechanism: electronic
documentation has legal risk
° Physical security measures includes placing computers in
restricted area
Handling and Disposing of Information: you must safeguard any
information that is printed from the record
Documentation needs to conform to standards of the National
Committee for Quality Assurance (NCQA) and TJC to maintain
institutional accreditation
° Assessment
° Nursing process
GUIDELINES FOR QUALITY DOCUMENTATION
• Factual
• Accurate
• Current
• Complete
• Organized
METHODS OF DOCUMENTATION
• Narrative: traditional method
• Problem-oriented Medical Record
° Database
° Problem list
° Care plan
° Progress notes
METHODS OF DOCUMENTATION IN PROGRESS NOTES
• SOAP: Subjective, Objective, Assessment, Plan
• SOAPIE: Subjective, Objective, Assessment, Intervention,
Evaluation
• PIE: Plan, Intervention, Evaluation
• Focus Charting: Data, Action, Response
METHODS OF REPORTING
• Charting by Exception: focus on documenting deviations
• Case management plan: incorporates a multidisciplinary approach
to care
COMMON RECORD-KEEPING FORMS
• Admission nursing history form: guides the nurse through a
complete assessment
• Flowsheets: health team members quickly see patient trends over
time
• Patient Care Summary
• Standardized Care Plans: used to care for patients who have
similar health problems
• Discharge summary forms
Acuity Rating System: determine the hours of care and number of
staff
Documentation in the Home Health Care Setting: guidelines for
establishing eligibility for home care
Documentation in the Long-Term Health Care Setting: government
agencies are instrument in determining standards for
documentation
Documentation: long-term care setting supports an
interprofessional approach
DOCUMENTING COMMUNICATION WITH PROVIDERS AND UNIQUE
EVENTS
• Telephone calls made to a provider
° Document every call
• Telephone and verbal orders
• Incident report: used to document any event that is not with the
routine operation
Technology Informatics Guiding Education Reform: focused on
better preparing workforce
° TIGER transformed to Healthcare Information and Management
System Society (HIMSS)
Nursing Informatics: the use of information and computer
technology to support all aspects of nursing practice
CLINICAL INFORMATION SYSTEM
• Computerized provider order entry (CPOE)
• Clinical decision support system (CDSS): used to support decision
making
Nursing Clinical Information System: allows nurses to access
computerized information at the patient bedside
 MOD 18

Intravenous Therapy: for clients who are unable to take substances

orally
B. TYPES OF SOLUTIONS
• Isotonic solutions: has a same osmolality as body fluids
• Hypotonic solutions: has a lower osmolality than body fluids
• Hypertonic solutions: has a higher osmolality than body fluids
• Colloids: plasma expanders
C. INTRAVENOUS DEVICES
A. IV Cannulas
1. Butterfly set: wing-tip needle with a metal cannula
2. Plastic cannulas: over-the-needle device
D. IV GAUGES (diameter of the lumen of the needle)
• For emergency fluid administration: 14-, 16-, 18-, or 19-gauge
• For peripheral fat infusions: 20- or 21- gauge
• For standard IV fluid: 22- or 24- gauge
• For very small veins: 24- to 25- gauge
E. IV CONTAINERS
• Glass or plastic
F. IV CHAMBERS
• Macro drip chamber: for thick solution (10 – 20 gtt/ml)
• Microdrip chamber: has vertical metal piece (60 gtt/ml)
 MOD 20

° Patients restricted to bed use bedpans for defecation

° Women use bedpans to pass both urine and feces, whereas men
use bedpans only for defecation
Regular bedpan (2 inch): bedpan made of plastic
Smaller fracture pan (1 inch): for patients with lower-extremity
fractures
° The shallow end of the pan fits under the buttocks toward the
sacrum; the deeper end goes just under the upper thighs
✓ NURSE TOP PRIORITY: Muscle strain and discomfort
° The proper position for the patient on a bedpan is with the head
of the bed elevated 30 to 45 degrees
ASSISTING PATIENT ON AND OFF A BEDPAN
EQUIPMENT (TAWS TAWS WCC)
° Toilet tissue
° Appropriate type of clean bedpan
° Specimen container
° Washcloths
° Towel
° Absorbent pads
° Waterproof
° Soap
° Washbasin
° Clean drawsheet
° Clean gloves
STEPS
°
Enema: installation of a solution into the rectum and sigmoid colon
Cleansing enemas: complete evacuation of feces from the colon
(includes tap water, normal saline, soapsuds solution, and low-
volume hypertonic saline)
Tap water: exerts an osmotic pressure lower than fluid
Normal saline: safest solution use in interstitial spaces
Hypertonic solutions: pulls fluids out of interstitial spaces
Soapsuds: create the effect of intestinal irritation to stimulate
peristalsis
° The terms high and low refer to the height from which the fluid is
delivered. High enemas cleanse more of the colon
Oil-retention enemas: lubricate the feces in the rectum and colon
Carminative enemas: provide relief from gaseous distention (ex:
MGW solution
TYPES OF MEDICATED ENEMA
• Kayexalate: used to treat patients with high serum potassium
levels
• Neomycin solution: used to reduce bacteria in the colon before
bowel surgery
Resin: exchanges sodium ions for potassium ions
Steroid medication: used for acute inflammation in the lower colon
ENEMA ADMINISTRATION
° Wear gloves
° Explain the procedure
° Give the enema with the patient positioned on the bedpan
Urinary catheterization: insertion of tube through urethra to the
bladder
PURPOSE OF URINARY CATHETERIZATION
° Empty the bladder, before, during or after a surgery
URINARY CATHETER SIZES (FR: used to denote catheter size)
° 8 and 10 FR: for children
° 14 and 16 FR: for female adults
° 20 and 22 FR: for male adults
TYPES OF URINARY CATHETER
• Single-lumen catheters: for intermittent catheterization
• Double-lumen catheters: for indwelling catheters (one lumen for
urinary drainage and second lumen is for inflating the balloon)
• Triple-lumen catheters: for continuous irrigation
PREPARING FOR A CATHETERIZATION
° EQUIPMENT
• Catheter
• 10 cc syringe
• Sterile water
• Cotton balls with betadine
• Lubricant
• Sterile gloves
• Urinary bag
• Anchoring tape
• Disposal bag
URINARY CATHETERIZATION IN MALE
Position: Supine position
1. Gather supplies
2. Wash Your Hands
3. Get in a Comfortable Position
4. Clean the Penis
5. Apply Lubricating Jelly
6. Insert the Catheter
7. Drain the Urine
8. Remove the Catheter
9. Wash Your Hands
10. Clean or Discard the Catheter
URINARY CATHETERIZATION IN FEMALE
Position: Dorsal recumbent position
1. Gather supplies
2. Wash Your Hands
3. Get in a Comfortable Position
4. Clean the Area Around the Urethra
5. Apply Lubricating Jelly
6. Insert the Catheter
7. Drain the Urine
8. Remove the Catheter
9. Wash Your Hands
10. Clean or Discard the Catheter
4 ETHICAL PRINCIPLES (BANJ)
• Beneficence
• Autonomy
• Non-maleficence
• Justice
ETHICAL RIGHTS OF PATIENT
• Right of personal dignity
• Right of individualized care
• Right to assistance towards independence
• Right to complaint
ROWSON ETHICAL FRAMEWORK (FAIR)
• Fidelity
• Autonomy
• Integrity
• Results
TYPES OF LAW
1. Public law
° Constitutional
° Administrative
° Criminal
2. Civil law
° Tort
° Contract
ELEMENTS OF MALPRACTICE (DBIP)
° Duty
° Breach of duty
° Injury
° Proximate cause
UNINTENTIONAL TORT
° Negligence
° Malpractice
INTENTIONAL TORT
° Assault
° Battery
QUASI-INTENTIONAL TORT
° Defamation
° Invasion of privacy
° Fraud
LEGAL ISSUES IN NURSING (MINAD)
° Malpractice
° Invasion of privacy
° Negligence
° Assault and battery
° Defamation of character
LEGAL SAFEGUARDS FOR NURSES (DIPPPG)
° Documentation
° Informed consent
° Physician order
° Patient education
° Privileged communication
° Good Samaritan Law