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Nursing

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FUNDAMENTALS OF NURSING

* Think about it…
* ABCDEFGHIJKLMNOPQRSTUVWXYZ
* Is represented as 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
* Then:
* H-A-R-D-W-O-R-K
* 8+1+18+4+23+15+18+11=98%
* K-N-O-W-L-E-D-G-E
* 11+14+15+23+12+5+4+7+5=96 %
* A-T-T-I-T-U-D-E
* 1+20+20+9+20+21+4+5=100 %
* And look how far the love of God will take you
* L-O-V-E-O-F-G-O-D
* 12+15+22+5+15+6+7+15+4=101 %

NURSING
* Is the extent to which an individual or group is able to realize aspirations and satisfy needs and change or cope with environment. It is the complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Major Nursing Goals
* Promotive – an action or measures designed to support behavior conducive to health
* Preventive – any actions or measures designed to protect individuals, families, groups, communities from harm to their health
* Curative – any actions or measures designed to correct or remove disease or any illness.
* Rehabilitative – any actions or measures designed to restore health and promote recovery from any alteration of health

Roles and Responsibilities of Nurses:

* Caregiver – helping clients promote, restore, and maintain dignity, health and wellness
* Communicator/Helper – central role of nurses in identifying needs of the client
* Educator/Teacher – involves nursing activities, health promotion, the primary concern
* Counselor – providing emotional, intellectual and psychological support
* Manager/Coordinator – manages the nursing care.

* Change agent – assists client to modify behavior
* Leader – influences other to work together towards a mutually envisioned goal.
* Clinician – use of technical expertise to administer nursing care
* Advocate – promotes what is best for the client, protects the client rights
* Researcher – participates in scientific investigation; uses research findings in practice
* Collaborator – initiates nursing action within the health team

NURSING THEORIES

Florence Nightingale
* mother of modern nursing
* developed and described the first theory of nursing
* environmental theory

Virginia Henderson
* defined nursing to assist the individual , sick or well, in the performance of those activities contributing to health or its recovery that he would [perform unaided if he ad the necessary strength, will or knowledge.
* introduced the nature nursing model
* identified fourteen (14) components of basic nursing

Faye Glenn Abdellah

* defined nursing as service to individuals, families and society.
* introduced patient-centered approaches to nursing model
* identified twenty one (21) nursing problems

Dorothy Johnson

* nursing’s primary goal is foster equilibrium within the individual, which allows for the practice with individuals at any point in the health-illness continuum.
* conceptualized the behavioral system model
* identified seven (7) behavioral subsystem

Hildegard Peplau

* defined nursing as a healing art of human relationship between an individual who is sick, or in need of health services, and a nurse to recognize and respond to the need for help.
* viewed nursing as an interpersonal process
* conceptualized four (4) sequential phases of interpersonal relationship
* characteristics of Interpersonal Relationship

Goal oriented Understanding, emphatic Concreteness Honest, open communication Acceptance, nonjudgmental attitude

Lydia Hall
* nursing is participation in care, core and cure aspects of patient care
* key concepts of three interlocking circles

Dorothea Orem
* nursing is needed when the self care demands are greater than the self care abilities
* defines three steps in nursing process
* key concepts of self care deficit theory of nursing
* identified three (3) classifications of nursing systems

Wholly compensatory – dependent on others
Partly compensatory – both nurse and patient perform care
Supportive-Educative – can perform but with assistance

Imogene King
* nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perception in the nursing situation
* postulated the Goal Attainment Theory

Martha Rogers
* nursing is an art and science that is humanistic and humanitarian
* conceptualized the science of unitary human beings and principles of homeodynamics

Jean Watson
* conceptualized the human caring model
* emphasized that nursing is the application of the art and human science through transpersonal caring transactions through self knowledge, self control, self care and self healing

Ida Jean Orlando
* conceptualized the dynamic nurse – patient relationship model
* advocated the three (3) elements composing nursing situation; client behavior, nurse reaction and nurse action.

Joyce Travelbee
* postulated interpersonal aspect of nursing model
* viewed that interpersonal process is a human to human relationship formed during illness and “experience of suffering”

NURSING PROCESS

Nursing Process
* the cornerstone of the nursing profession.
* it is synonymous to problem solving approach
* it is originated from the theory of Lydia hall, Dorothy Johnson and Ida Jean Orlando
* It is problem-oriented, goal-oriented, organized, systematic, humanistic care / interpersonal, dynamic, cyclical and universal

Assessment
* collecting, validating, organizing and recording data
* to establish data base
* collection of data
* methods of collection data
* making information is accurate
* clustering facts into groups of information

Diagnosing
* clinical art of identifying problems
* identify the client’s needs and to prepare diagnostic statements
* use PES format
* organize cluster or group data
* compare data against standards
* analyze data after comparing with standards.
* determine the client’s health problems, health risks and strength

Planning

* formulating and documenting client focused goals
* provide individualized care
* promote client participation
* allow involvement of support people
* establishing priorities
* short term goal and long term goal
* SMART well stated outcome criteria
* identify appropriate nursing interventions
* write a nursing care plan
Implementation

* skills performed competently
* perform in appropriate environment
* clients safety protected
* putting nursing care plan to action
* carry out planned nursing interventions to help attain goals and achieve optimal level of health
* to determine the order in which nursing interventions are carried out
* relevant documentations should be done

Evaluation
* assessing the client’s response to nursing interventions
* appraise the extent to which goals and outcome criteria of nursing care have been achieved
* analyze the reasons for the outcomes

MEDICATION

Pharmacokinetic Process
* Absorption
* Distribution
* Metabolism
* Excretion

Types of Doctor’s Order
* Standing Order
* Single Order
* STAT order
* PRN order

Therapeutic Actions of Drugs
* Palliative
* Curative
* Supportive
* Substitutive
* Chemotherapeutic
* Restorative

7 Rights of Medications

* Right Client
* Right Medication
* Right Dosage

* Adult Dose:

Oral Medication (Solid)

Desired dose = safe adult dose
Stock dose
Example 1:
An hypertensive agent, minoxidil (Loniten) 5 mg p.o. is ordered. Stock is 2.5 mg/tab. How many tablets should be administered?

Answer is: _______

Example 2:
An hypertensive agent, Captopril (Capoten) ½ grain p.o. is ordered. Stock is 60 mg/tab. How tablet will you give to your patient?
Answer is: _______

* Parenteral / Oral Medication (Liquid)

Desired dose X Quantity of Dilution = safe AD
Stock dose

Example 3:
The expectorant guiafenesin (Robitussin) 300 mg p.o. has been ordered. The bottle is lab 100 mg/ 5ml. How many milliliters should be given?
Answer is: ________

Example 4:
A patient is to receive NPH 50 u s.c. daily. Stock is 100 u/ml in 10 vial. How many milliliter should be administered?
Answer is: _______

Example 5:
The physician order reads “Administer 0.02 gram furosemide (Lasix) IM.” Stock is 20 mg /ml ampule. How many milliliters will you administer?
Answer is: ________

* Pediatric Dose:

A. Clark’s Rule

weight in lbs X usual adult dose = Safe CD 150 lbs

Example 6:
Baby Tina weighs 30 lbs and the adult dose 25 mg. What is the safest dose for Baby Tina?
Answer is: _______

B. Freid’s Rule

Age in months X usual adult dose = Safe CD 150 months

Example 7:

Baby Joey is now 11 months old, the adult dose is 50 mg. What is the safest child’s dose according to Freid’s rule?

Answer is: ________

C. Young’s Rule

Age in years X usual adult dose = Safe child’s dose
Age in years + 12

Example 8:

Baby Jay is 5 years old last December 16, 2007, the adult dose is 75 mg. What is the safe child’s dose?

Answer is: ________
4. Right Route

a. Oral

Advantages
Disadvantages
Drug Forms

b. Sublingual

Advantages
Disadvantages

c. Buccal

* Right Time
* Right Advise / Attitude / Approach
* Right Documentation / Recording

PRINCIPLES IN ADMINISTERING MEDICATIONS
* Observe the rights in giving medications.
* Practice asepsis.
* Nurses who administer medications are responsible for their action.
* Be knowledgeable about the medications that you administer.
* Keep narcotic in locked place.
* Use only medications that are clearly labeled containers.
* Do not leave the medications at the bed side.
* If the patient vomits after taking the medication, report.
* Preoperative medications are discontinued during the postoperative, unless ordered.
* When a medication is omitted for any reason, record with the reason.
* When a medication error is made, report it immediately.

NUTRITION

Carbohydrates
* provides energy; protein sparing
* cereal, fruits, vegetables, milk
* marasmus

Protein
* growth and repair of tissues
* maintain fluid and acid base balances
* meat, fish, dairy products, eggs, nuts, legumes, cereals
* kwashiorkor

Vitamin D
* calcium and phosphorous absorption, bone mineralization
* dairy products, eggs, yolks and fatty fish
* rickets (in children), osteomalacia (in adults)

Vitamin K
* blood clotting
* green vegetables
* hemorrhages

Calcium
* bone and tooth formation, muscle function and nerve transmission
* milk products, dark green leafy vegetable, salmon, orange juice, tofu
* stunted growth in children, osteoporosis in adult
* 99% is in the bone
* major component of renal calculi

Magnesium
* bone and tooth formation
* whole grain, nuts, legumes, dark green leafy vegetables
* growth failure in children

Potassium
* major intracellular cation
* fluid balance, nerve and muscle function
* meat, milk, vegetables, legumes, bananas

Iron
* components of hemoglobin
* red meat, organ meat, egg yolk
* anemia

Fluoride
* formation of bones and teeth
* fluoridated water and toothpastes
* higher frequency of tooth decay

Vitamin B1
* Thiamine
* muscle nerve function
* whole grains, pork, cereals, legumes, seeds and nuts
* Beriberi, poor coordination

Vitamin B3
* Niacin
* coenzyme for energy metabolism
* whole grains, meats, fish, nuts and eggs

Vitamin B9
* Folic acid
* aids in metabolism of genetic material (DNA, RNA)
* green leafy vegetables, nuts, legumes, grain products
* poor growth, birth defects

PHYSICAL ASSESSMENT

Methods Inspection Palpation Percussion Auscultation

Temperature

* 370C (98.6 F) - normal temperature
* Hypothalamus – thermoregulation center
* Pyrexia – temperature of 38-400C
* Hyperpyrexia – very high temperature as 410C
* Rectal – most accurate
* Rectal 2-3 minutes
* Oral 3-5 minutes
* Axillary 6-9 minutes

Types of Fever Intermittent fever – fever – no – fever – no

Remittent fever – fluctuates but remains above normal

Relapsing fever – elevated for few days then normal temp. for 1-2 days

Constant fever – fluctuates minimally and consistently high

Factors Affecting Heat Loss

Radiation – transfer of heat from the surface of the object without contact between two objects.

Conduction – transfer of heat from one surface to another.

Convection – transfer of heat by air currents

Evaporation – insensible heat loss

Conversion Centigrade to Fahrenheit
F = (Temperature in C) X 1.8 + 32

Example:
Convert 41 C to F: Answer is ________
Convert 38 C to F: Answer is ________
Convert 36.5 C to F: Answer is _______
Convert 39.4 C to F: Answer is _______
Conversion Fahrenheit to Centigrade

C = (Temperature in F ) – 32 / 1.8

Example:
Convert 105.8 F to C: Answer is _______
Convert 100.4 F to C: Answer is _______
Convert 97.7 F to C: Answer is ________
Convert 102.9 F to C: Answer is _______
Pulse 60-100 bpm Age Sex / Gender Exercise Fever Medications Hemorrhage Stress Position
Pulse sites

Temporal
Carotid
Apical
Brachial
Radial
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
Assessment of the Pulse

Rate Rhythm Volume

Pulse Deficit
Respiration

Ventilation
Inspiration and Expiration
Respiratory Center – pons and medulla oblongata
12 – 20 breaths per minute - normal
500 ml – normal tidal volume
Carbon dioxide – major chemical stimuli for respirations
Hering Breuer reflex – prevents the lungs from over expanding
Assessing Respirations

Rate – tachypnea, bradypnea, eupnea
Depth /Volume – Hyperventilation, Hypoventilation
Rhythm – Cheyne-Stokes, Kussmaul, Biots
Quality / Effort / Character - dyspnea, orthopnea, apnea
Chest movements

Intercostals retractions - ribs Substernal retractions – breastbone Suprasternal retractions – above the clavicle
Blood Pressure

Systolic pressure (100-130 mmHg)
Diastolic pressure (60-90mmHg)
Pulse pressure
Mean Arterial pressure
Korottkoff’s sound
Determinants of Blood Pressure

Pumping action of the heart (cardiac output) Peripheral Vascular Resistance Blood Volume Blood Viscosity Elasticity or Compliance of Blood Vessels
Factors Affecting Blood Pressure

Age Exercise Stress Race Obesity Gender / Sex Medications Diurnal Variations Disease Process

Assessing Blood Pressure ( common error)

HEAD
Skull, scalp, hair

EYES and VISION
PERRLA, Anisocoria, 3-7 mm, snellen chart, 20/20, 20/200, myopia, hyperopia, presbyopia, astigmatism, tonometry, perimetry, ophthamoscopy, genioscopy, Cranial Nerves 2, 3, 4, 6, comjunctiva, ishihara chart, peripheral fields

EARS and HEARING
3 divided parts, otoscope, tunning fork, up and back, down and back, weber test, rinne test, conductive hearing loss, schwabach test, cranial nerve 8, watch tick test

NOSE and PARANASAL SINUSES
Facial sinuses, nasal speculum, penlight, cranial nerve 1

MOUTH and PHARYNX

Firth teeth (central lower incisors) appear 5 to 8 months, 20 temporary teeth at 2 years old, losing them at 6-7 years old, replaced by 32 permanent teeth with appearance of wisdom tooth (3rd molar), buccal mucosa, 3 pairs of salivary glands, tonsils, uvula, cranial nerves 9, 10, 12

NECK

Occipital, Postauricural, preauricular, submandibular, submental, anterior cervical, posterior cervical, deep cervical, supraclavicular, trachea, thyroid gland, bruits, thyroid storm, jugular veins, sternocleidomastoid and trapezius, cranial nerve 11

THORAX and LUNGS

Barrel chest, Pigeon chest, Funnel chest, vesicular, bronchovesicular, bronchial, crackles, gurgles, friction rub, wheezes, resonant, dullness, hyper-resonance

CARDIOVASCULAR

Systole, Diastole, Aortic, Pulmonic, Erb’s point. Tricuspid, Mitral, S1, S2, Murmurs

ABDOMEN

Sequence IAPP, bowel sounds, borborygmi, light palpation, deep palpation, costovertebral angle tenderness, 4 quadrants, 9 regions, dullness

MUSCULOSKELETAL

Assessed for muscle strength, contractures, muscle tone, muscle strength, fasciculation, tremors, signs of inflammation, abnormal spinal curvature, flatness, active range of motion limitation, joints for swelling and tenderness,

SKIN
The first line of defense
Composed of the superficial epidermis and the true skin dermis
Pallor
Cyanosis
Jaundice
Erythema

NERVOUS SYSTEM

Mental status, level of consciousness, reflexes, DTR, superficial cutaneous reflexes, pathologic reflexes, motor functions, sensory function, stereognosis, graphesthesia, cerebellar function, cranial nerves

FEMALE and MALE GENITALS

History of menstruation, LMP, external genitalia, internal genitalia, history of voiding changes, pubic hair, penis, scrotum, inguinal areas, rectum
BASIC CONSIDERATIONS FOR BASIC NURSING PROCEDURES

HAND WASHING
Single most effective and least expensive method to prevent nosocomial infection
Part of every beginning and end of nursing procedures
Use warm running water
Apply soap and rub palms, wrists, and back of hand firmly with circular motion, interlace fingers and thumbs and rub with lather and friction mechanically loosen dirt.
Rinse hands and wrist with hands held lower that forearm
Dry with paper towel or blower, wiping from fingertips toward the forearm, turn off faucet with clean paper towel

COUGHING

Single most effective measure to control respiratory secretions upward
Splint incision, if any, with pillow
Patient to take a deep breath, hold for 3 seconds, and cough deeply 2 to 3 times
Perform 2 to 3 hours postoperatively
Contraindicated for eye surgery
DEEP BREATHING

Expands alveoli and mobilizes secretions
Place patient in fowler’s or sitting
Place client’s hands (palm) along the lower rib cage to feel diaphragm movement
Inhale fully through the nose, hold for 2 to 3 seconds
Exhale slowly through the mouth
PURSED LIP BREATHING

Allows a gradual decline in intrapulmonic pressure hence preventing lung collapse
Takes a deep breath, hold it for a moment then exhale slowly through a pursed lip
Builds pressure backwards keeping the airways open through out exhalation
More air escapes during exhalation and helps prevent air trapping
CHEST PHYSIOTHERAPY

Help clear excessive bronchial secretions from airways by shaking mucus from the walls of the airways and draining them from the lungs

Produce mechanical wave of energy that is transmitted through chest wall (Percussion)

With the use of hand placed on client’s chest with rapid and vigorous vibration as client exhale

Use of gravity to assist in the movement of secretion (postural drainage)
NASOGASTRIC TUBE FEEDING
Provide enteral nutrition for clients who cannot swallow, with esophageal obstruction, unconscious, and cannot consume oral feeding.
Measure the distance from the tip of the nose to earlobe through the bottom of the xiphoid process
Use water soluble jelly as lubricant
Advance tube forward, head bent forward closes the epiglottis and trachea

High fowler’s, if contraindicated place right side lying position with head slightly elevated to prevent aspiration.
Flush with 30-60 ml of water after feeding
If NGT is to removed, instruct client to exhale and remove tube with smooth, continuous pull
Inject 10 ml of air and auscultate for gurgling sound in the epigastrium.
Aspirate for residual stomach content (ph 1-3 of yellow to green)
Immerse tip of the NGT into water and observe for bubbling. X-ray confirms
FECAL IMPACTION REMOVAL

Prepare all materials (gown, gloves, bedpan, water soluble lubricant) in anticipation of strong odor and large quantity of stool.

Rule out contraindications related to vagal stimulation (innervating GIT, decreases PR and lead to dysryhtmia for weak and cardiac patients).

Side lying position, insert index finger with a gentle hooking position, careful as perforation may occur

Note for any signs of fatigue, pallor, diaphoresis, and changes in pulse rate.

Prepare for quick evacuation as hardened stool blocking the lumen is removed.

OXYGEN THERAPY
To reverse hypoxemia
To improve tissue oxygenation
Decrease work of breathing in dyspneic clients
Decreases myocardial workload

NURSING IMPLICATION

Oxygen is colorless, odorless, tasteless gas so leakage cannot be detected
Oxygen is a dry gas, it can irritate mucous membrane of the airways
Oxygen supports combustion, it can cause fire

OXYGEN THERAPY
Position the client in semi-fowler’s position
Insert flowmeter, with humidifier (oxygen dries up)
Regulate the prescribed flow rate (LPM)
Assess vital signs, oxygen saturation, color, breathing pattern and orientation
Oxygen Toxicity:
Retrolental fibroplasia – retinal damage leading to irreversible blindness due to exposure to 100% oxygen in adult and to high oxygen flow rate (40% or more) in neonate, especially premature (retinopathy of prematurity)

BLOOD GROUPS

Transfusion Reaction
Allergic Reaction
Flushing, urticaria, wheezing, rashes

Pyrogenic / Febrile Reaction
Fever and chills
Headache and body malaise

Hemolytic Reaction
Facial flushing, chills, low back pain, hypotension, hematuria leading to anaphylactic shock

CLEANSING ENEMA

Non-Retention Enema
Solutions used are as follows:
Tap water (500-1000 milliliters)
Soap suds (20 ml of soap in 500 - 1000 ml of water)
Normal Saline Solution (9 ml of NaCl to 1000 ml of water)
Hypertonic solution / fleet enema (90-120 ml)
Position:
Adult: left lateral position Infant/Children: dorsal recumbent

Sizes of rectal tube:
Adult - Fr 22-32
Children - Fr 14-18
Infant - Fr 12
Height of Solution: 18 inches above the rectum
Temperature of Solution: 115 – 125 F on preparation
Time of retention: 5 -10 minutes for better cleansing effect

Retention Enema
Solutions used are as follows:
Carminative Enema
Oil (90-120 ml of mineral, olive or cotton seed oil
Height of Solution: 12 inches above the rectum
Temperature of Solution: 105 – 110 F on preparation
Time of retention: 1 -3 hours until therapeutic effect is obtained
I.V. Therapy

Intravenous
Direct IV, IV Push, IV infusion
Most rapid route of absorption of medication
Route can be use for clients with compromised gastrointestinal function or peripheral circulation
Large doses of medication can be administered
Purposes:
Fluid and electrolytes imbalance
Provide food
Vehicle for medication
For blood transfusion

Equipments:
IV Fluid, IV set, Micropore, tourniquet, cotton balls, alcohol, splint
Complications of I.V. Therapy
Infiltration
Thrombophlebitis
Nerve damage
Circulatory Overload
Air Embolism
Speed shock
Drug Overload

IV Fluid Formula

Volume X Drop Factor Time 60

Example: The doctor ordered for 2 liters of D5LR to run for 18 hrs with drop factor of 20. How many drops per minute? Answer is :________

The doctor ordered for 1L of PNSS to run for 10 hrs with drop factor of 15. How many drops per minute? Answer is :________

The doctor ordered for 500ml of 0.45 NaCl to run for 6hrs with drop factor of 10. How many drops per minute? Answer is :________

The doctor ordered for 100ml of D5 water to run for 1hr with drop factor of 60mcgtts. How many drops per minute? Answer is :________

SUCTIONING
Use appropriate catheter size: F 5-8 for infants; F 8-10 for children; F 12-18 for adult

Position client fowlers (for those with intact gag reflex); side lying (for unconscious) to prevent aspiration

Adjust pressure:
Wall unit - 50-75 mmHg in infants, in children 95-100 mmHg, in adults 100-120 mmHg
Portable unit – 2-5 mmHg in infants, in children 5-10 mmHg, in adults 10-15 mmHg

Pre-oxygenate client

Lubricate Catheter

Exert suction by closing the open port, withdrawing catheter in rotating motion within 5-10 seconds only

Hyper-oxygenate for a full minute between subsequent suctioning. Encourage deep breathing

Urinary Catheterization – is the introduction of catheter through the urethra into the urinary bladder.

Purposes To relieve discomfort due to bladder distention. To assess the amount of residual urine if the bladder empties incompletely. To obtain urine specimen. To empty the bladder completely prior to surgery. To Facilitate accurate measurement of urinary output. To provide intermittent or continuous bladder drainage. To prevent urine from contacting an incision after perineal surgery. To manage incontinence when other measure have failed.

Position
Male : Supine, legs abducted and extended
Female : Dorsal Recumbent position

Location of urinary meatus
Male : at the tip of the glands penis
Female : between the clitoris and vaginal orifice

Size of Catheter
Male: Fr 16-18
Female : Fr 12-14

Length of catheter insertion
Male : 6-9 inches
Female : 3-4 inches

Assessment
Determine the most appropriate method of catheterization.
Use a straight catheter if only a spot urine specimen is needed.
Use indwelling/retention catheter if the bladder must remain empty/continuous urine measurement collection is needed.
Determine when the client last voided or was last catheterized.
Percuss the bladder to check for fullness or distention.
POSITIONING

Side lying position client lies on the side with weight on the hip and shoulder, with pillows support legs, arms, head and back. choice position for clients with pressure sore on bony prominence contraindicated post hip replacement and other orthopedic surgery tonsillectomy to promote drainage of secretions seizure to prevent backward falling of the tongue pyloric stenosis (right) after meals to facilitate entry of stomach contents into the intestines lumbar puncture (lateral – during the procedure) to facilitate the entry of the needle between L3-L4 hemorroidectomy to prevent pain liver biopsy (right) post procedure to prevent bleeding
Sims position client lies on the side with weight distributed toward the anterior ileum, humerus, and clavicle with pillows support on flexed arms and legs. choice position for clients with pressure sore on bony prominence contraindicated with spine or orthopedic condition
Fowler’s position sitting position raises client’s bed head to 90 degrees clients with DOB, eating and improvement of cardiac output contraindicated with post spine surgery placenta previa (sitting) to minimize bleeding pulmonary edema to facilitate breathing thoracentesis (during the procedure) to facilitate removal of fluid in the chest wall congestive heart failure to improve oxygenation autonomic dysreflexia to prevent hypertensive stoke
Semi-fowler’s position semi-sitting with head elevation of 30-45 degrees clients with DOB, eating and improvement of cardiac output contraindicated with post spine surgery abdominal aneurysm surgery to prevent pressure on the graft appendicitis (if ruptured) to prevent the upward spread of infection

bronchoscopy (post procedure) to prevent aspiration cataract (post op) to prevent edema on the operative sit cerebral aneurysm to prevent pressure in the aneurysm site supratentorial craniotomy to facilitate venous drainage from the head
CVA to reduce ICP hypophysectomy to prevent increased ICP laryngectomy to maintain patent airway and minimize edema

lobectomy to promote breathing paracentesis to facilitate removal of fluid in the abdominal cavity thyroidectomy to prevent hyperflexion and hyperextension of the neck, to prevent tension on the suture line myelogram (if water based dye – Amipague) to prevent upward dispersion of the dye hiatal hernia (after meals) to prevent reflux of the stomach contents

Dorsal recumbent client lies supine with legs flexed and rotated outward for vaginal examination
Knee chest position lies prone with buttocks elevated and knees drawn to the chest rectal procedures and examination contraindicated for arthritis and other joint deformity prolapsed cord to prevent pressure on the cord proctosigmoidoscopy to facilitate visualization
Trendelenburg
lies supine with head 30-40 degrees lower than the feet for postural drainage and promotion of venous return contraindicated may result in increase intracranial and intraocular pressure and may result hypotension. shock to promote venous return to the heart
TPN during tube insertion to prevent air embolism
DIAGNOSTIC EXAMINATIONS
AND
PROCEDURES

Mantoux Test

Chest X-ray

Bronchography

Bronchoscopy

Lung Scan

Sputum Examination

Lung and Lymph Node biopsy

Pulmonary Function Studies

Arterial Blood Gas Studies

Thoracentesis

Holter Monitoring

Magnetic Resonance Imaging

Computed Tomography

Upper Gastrointestinal Series / Barium Swallow

Lower Gastrointestinal Series / Barium Enema

Endoscopy

Proctosigmoidoscopy

Colonoscopy

Liver Biopsy

Paracentesis

Gastric Analysis

Bone Marrow Aspiration

Intravenous Pyelography

Angiography

Lumbar Puncture

Electroencephalogram

Electrocardiography

Endoscopic Retrograde Cholagiopancreotography (ERCP)

Close Thoracostomy Tube

Sengstaken Blakemore Tube

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...Journal of Nursing Administration, 38(5), 223-229. Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003, September 24). Educational levels of hospital nurses and surgical patient mortality, Journal of the American Medical Association, 290, 1617-1623. American Association of Colleges of Nursing (2012). 2011-2012 Enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: Author. American Association of Colleges of Nursing, American Organization of Nurse Executives, & National Association of Associate Degree Nursing (1995). A model for differentiated practice. Washington, DC: American Association of Colleges of Nursing. Available online at www.aacn.nche.edu/aacnpublications/position/joint-statement-academic-progression. American Association of Colleges of Nursing, American Organization of Nurse Executives, & National Association of Associate Degree Nursing (1995). A model for differentiated practice. Washington, DC: American Association of Colleges of Nursing. American Organization of Nurse Executives. (2005). Practice and education partnership for the future. Washington, DC: American Organization of Nurse Executives. Anderko, L., Robertson, J. & Lewis, P. (1999). Job satisfaction in a rural differentiated-practice setting. Journal of Nursing Connections, 12(1), 49-58. Anderko, L., Uscian, M. & Robertson, J.F. (1999). Improving client outcomes through differentiated practice: a rural nursing......

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...a professional nursing degree or an academic degree received after successfully completing a two year course of study, after which the student is qualified to take the NCEX-RN exam, when passed becomes a registered nurse. BSN is said to mean Bachelors of Science in nursing or Baccalaureate Degree in Nursing. It takes between four and five years for one to get a bachelor's degree in nursing. Associate’s degree happens to be the list level of education that is needed to enter into the graduate program as of now as a result registered nurses are encouraged to earn their BSN. It is believed that BSNs degree nurse are offered more job opportunities than AND nurses and most time nurses with a BSN is said to earn between $3000 and $8000 more annually than a nurse with just ADN. Many experts are predicting that all registered nurses will be required to have a BSN in the near future. It has been found that nursing is now very competitive and many employers are seriously in need of nurses who stand out from the group with more qualifying and higher educational level to hire. A licensed practical nurse (LPN), registered nurse (RN), nurse practitioner (NP) are all referred to as nurses it is only their educational qualifications and expertise that differentiate them degree (Will 2015). Differences in Competencies between ADN and BSN Nurses According to Robert J Rosseter, the American Association of Colleges of Nursing (AACN) and the national voice for baccalaureate and graduate......

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...Dynamics : NRS 430V June 29 , 2014 Meaning of Associate Degree Nurses versus Baccalaureate Nurses : A person can become an RN through three different routes. A 3 years Diploma program learned in hospitals. A three year ADN achieving from a community college and four year BSN from a college or university. Graduates of all these program must pass the NCLEX – RN licensing from one of the State Board of Nursing in order to work as a Registered Nurse in a hospital setting or Community Health centers or any other organizations. The main differences between all these nursing programs is the years to study in the school. ADN or Diploma Nursing programs mainly based on clinical skills and more task oriented. BSN program includes all of the course materials and practical in ADN or Diploma program. Which focus primarily the physical and social sciences, nursing research and management, public and community health. This will improve or enhances the nurses professional development, better understanding of the person, health, nursing and environment which are the main concepts in nursing. A Registered ADN or Diploma nurse works in hospital or outpatient facilities where they give direct care to the patient like administering medications, managing intravenous infusions, blood transfusions, observing and monitoring patient conditions like vital signs, maintaining health records and communicating with doctors with the updates of patient condition. Additionally they provide emotional......

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...Nursing, as described by the American Nurses Association, is the protection, promotion and optimization of health and abilities to prevent illnesses and injuries, alleviating suffering, through Diagnosis and treatment of human response and advocacy in care of individuals/family/communities and population. As nurses, we render care to our patients, recognizing that, as patients, they are always sick. We practice to treat, by protecting them from any further exposure that will prolong the illnesses. We promote good health by practicing infection control principles. Techniques, as the work, documented, from the pioneers, such as Florence Nightingale, our work is evidenced, by the continued decrease of hospitalization. By being educated as a nurse, we practice by using technologies learnt. As a result of the researches done, we gain that knowledge of how to prevent the spread of diseases, of how to prevent further illnesses. We promote wellness, by teaching the patients we serve, about the purpose of that particular medication. We teach and instruct them, on how the medication works, to help to cure the sickness, and the need to comply with the course of actions. Because of the knowledge gained, as a nurse to practice, we are able to help that patient, maintain their health, because, we are able to teach them that, that course of antibiotics, need to be taken for the full amount of days, even if they are feeling better. We practice the nursing process, by finding out......

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...Nursing is a unique profession in that there are numerous different types of nurses, yet they can all experience the beginning of life as well as the end of life. Both nurses in addition to community-based nurses can yield special bonds with patients and their families. To me nursing is a very worthwhile profession and to become any type of nurse is an award within itself. This paper will converse how effective the communication in nursing practice will ease a mutually satisfying therapeutic patient nurse and their family relationship. Nursing is a challenging profession and requires critical thinking and good communication skills. With the baby boomers getting older the need for nurses is more than ever. No matter the setting whether it is in the hospital or in a community, nurses receive the same reward of helping people. Nursing has come a long way since Florence Nightingale and will continue to evolve well beyond into the future. Communication mainly requires the mindful utilization of the spoken word, and even though accounting for only fifteen percent of all interpersonal communication, is the major means of stating factual information in relations among nurse, patient and patient’s family. At the same time as communication is a vital part of building the relationship among nurse, patient and patient family members it is also just as significant among nurse and coworker. A virtuous relationship is good to quality patient care, obviously both nurse and coworker have......

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...most likely require rehospitalization. It is imperative for nurses to avoid jargons and use simple language to get the message across. While Henderson’s theory supports nursing as a profession in assisting patients who are well or sick and ensuring 14 basic needs, Orem’s theory is more contemporary where a nurse engages patient in plan of care and guides the patient to be self-dependent in the acquisition of knowledge and skills. Orem’s theory supports that client has the primary responsibility of personal health, with the nurse acting as a guide. Furthermore as long as self-care abilities equal or exceed self-care demands, such patients have no need for nursing ( Hohdorf,2010). However, if self –care deficit is recognized ,nurses should individualize care based on patient situation and must clearly communicate in order to improve and coordinate patient care. In order to improve and coordinate patient care, decisions made by nurses must be individualized to the patient situation, information collected by nurses must be clearly communicated to other health care providers and nurses must actively intervene and suppor Hohdorf, M. (2010). Self-Care Deficit Nursing Theory in Ingolstadt -- an approach to practice development in nursing care. Self-Care, Dependent-Care & Nursing, 18(1), 19-25. is approximated that there are 90 million people in the United States who cannot read above a sixth grade level and nurses need to take this......

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...Highly Qualified Nursing Workforce Quality patient care hinges on having a well educated nursing workforce. Research has shown that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate degree levels. The American Association of Colleges of Nursing (AACN) is committed to working collaboratively to create a more highly qualified nursing workforce since education enhances both clinical competency and care delivery. This fact sheet looks at today’s nursing workforce; highlights research connecting education to outcomes; and outlines the capacity of four-year colleges to enhance the level of nursing education in the U.S. Snapshot of Today’s Nursing Workforce  According to the National Center for Health Workforce Analysis within the Health Resources and Services Administration (HRSA), approximately 2.8 million registered nurses (RNs) are currently working in nursing (HRSA, 2013). This count reflects an increase from the last National Sample Survey of Registered Nurses conducted by HRSA in 2008 which found that 2.6 million RNs were employed in nursing (out of a population of more than 3 million licensed RNs). HRSA’s 2013 report, titled The U.S. Nursing Workforce: Trends in Supply and Education, also found that 55% of the RN workforce held a baccalaureate or higher degree. In a separate study conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce......

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...Nursing Shortage and the Nurse to Patient Ratio Nursing Shortage Issues and the Nurse to Patient Ratio Throughout this paper the focus is going to be on nursing and how it is affected by a growing issue of shortages. The facility where I work has been affected by a nursing shortage; this is why I chose to focus on this topic. I have seen first-hand how everyone throughout the facility is affected by the shortage. I will talk about how the facility has handled the shortage as well as the type of structural organization that the company uses that has helped to keep it afloat. I have formed a null-hypothesis and an alternate hypothesis and formed an opinion based on my research. I hope to adequately inform you of all the issues surrounding the shortages. Since I work in a skilled nursing facility I will make it my main focus. Null Hypothesis: Shortages have not played a role in in-adequate care of others. Alternate Hypothesis: Shortages have played a role in in-adequate care of others. In today’s day and age women now have more career choices; back in the day it was common for women to become nurses, but now they can be just about anything. This affects the nursing field greatly. Not only do more career choices affect the nursing ratio, but an older and aging workforce is also part of the growing shortage. Some internal factors that I have noticed affecting the facility where I work is the......

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...Institute of Medicine (IOM) report: "The Future of Nursing: Leading Change, Advancing Health,": Transforming Practice, Transforming Education, and Transforming Leadership. Debra New Grand Cannon University September 6, 2015 The Future of Nursing: Leading Change, Advancing Health to understand how the 2010 Institute of Medicine (IOM) report impacts nursing we must first understand what it is. The IOM report is the result of a two-year project that was launched by the Robert Wood Johnson Foundation (RWJF) along with the Institute of Medicine. The report presents recommendations for an action plan for the future of nursing (Institute of Medicine, 2010 p.119). The report titled the “Future of Nursing” contained research that supported a formation for the envision on the way nursing will become. The central idea was to make sure the public would receive quality, affordable care where they would feel protected. The report was designed for nurses, policy makers, government officials, insurance companies and the public, all of which have a vested interested to ensure quality, safe, cost effective health care (Holzemer, 2010 p.119). The recommended changes in these areas of nursing serve as a fundamental part of attaining the goals set forth by the Affordable Care......

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...Philosophy of Nursing Why I Chose Nursing I chose nursing as my future profession because I believe nursing to be a rewarding and challenging career choice. I believe the desire to help people through nursing is a true calling, and I feel drawn toward helping those in need. I was first drawn to the area of professional nursing when my late sister became ill and was in the hospital for many months prior to her untimely death. This experience is what ultimately led me in the direction of pursuing a nursing education. Another reason I chose nursing is because the field offers a wide variety of career opportunities. A degree in nursing allows one to teach, conduct research, or perform direct patient care. I could elect to become an administrator, work in community or home health, and even travel worldwide. I can choose to work in childbirth centers, community health, emergency departments, geriatric wellness programs, intensive care units, mental health programs, occupational health, operating rooms, nursing research, school health, substance abuse treatment programs, and many more. With the national shortage of nurses, work schedules are flexible, pay is competitive, and openings are numerous. Jobs will be waiting for me the day after graduation anywhere in the world, and I will have a profession without additional training. The Core of Nursing Practice The core of nursing practice involves numerous factors that I believe to be of vital importance to being a great nurse....

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...nurse would treat a CHF patient. A specific patient case I reviewed, was readmitted to a hospital again within thirty days with a diagnosis of congestive heart failure. The ADN trained nurse could administer drugs, perform daily weights, ensure that the patient followed a cardiac diet, but was strictly task oriented (The Future of the Associate Degree in Nursing Program, 2013). The BSN trained nurse, would base the care provided using a more integrated system (Why the Push for BSN Nurses?, 2012). The focus of the BSN trained nurse would encompass more teaching, measuring compliance of instructions that were given, and ensure core measures would be met prior to discharge. The follow up care would include determining if the patient had access to meds, home health, understood the need to maintain dietary restrictions, and instruct the patient on keeping a daily weight log to ensure that weight trends would be monitored and recorded. ADN AND BSN DIFFERENCES 3 The college system today has defined an ADN nurse as technical and a BSN nurse as a professional nurse (The Future of the Associate Degree in Nursing Program, 2013). A nurse with an ADN degree, although important, can look at the degree as a stepping stone to advancing their career to attain the BSN. The ANA has been pushing for nurses to obtain their...

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...unique position as a profession dominated historically by women means that while gender balance has been sought in professions once closed to women, nursing has made little effort to do the same. Men have equality of access, so it would be wrong to paint this as discrimination. But is that enough when there has been a failure to challenge the view of nursing as a woman’s job? Allied health professions have made strides towards equality, yet nursing still uses the titles ‘matron’ and ‘sister’. Archaic practices Even in training, archaic practices continue. One university restricts its best nursing student award to female students. Is it any wonder just 10% of UK nurses are men and many wards remain staffed entirely by women? Women make up 90% of nursing students. Is it right in 2016 for wards that treat male patients (in some cases exclusively) to have no male nurses? Is it truly patient-centred care to have a profession so far removed from its patient demographic? Every year across the UK women apply in droves to enter nursing, and the issues that put off their male counterparts are not being addressed. It is essential that male recruits are encouraged from an early age, and the outdated attitudes that stop men pursuing a career in nursing are challenged. Other professions have changed while nursing has rested on its laurels. Physiotherapy has gone from 5% men to 20%, and while in primary schools only 12% of teachers are men, one in......

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