Professional Documents
Culture Documents
Medical asepsis
1. Includes all practices intended to confine a specific microorganism to a specific area
Contents
1.
1 Asepsis
2.
2 Infection
3.
3 Inflammation
4.
4 Immune Response
5.
5 Types of Immunity
6.
6 Nosocomial Infection
7.
8.
9.
10.
10 Standard Precautions
11.
11 Transmission-based Precautions
12.
13.
14.
14 Puncture/Laceration
Surgical asepsis
1.
Sterile technique
2.
3.
4.
2.
3.
Sterile items that are out of vision or below the waist level of the nurse
are considered unsterile.
4.
5.
6.
7.
8.
9.
Infection
Localized swelling
Localized redness
Loss of function of the body part affected, depending on the site and
extent of involvement
Fever
Alveolar macrophages
Tears
Peristalsis
NANDA Diagnosis
Risks factors
o
Related Diagnoses
Acute Pain
Anxiety
Environmental controls
Chain of Infection
1.
2.
3.
4.
5.
6.
7.
8.
Portal of exit: the means in which the pathogen escapes from the
reservoir and can cause disease; there is usually a common escape
route for each type of microorganism; on humans, common escape
routes are the gastrointestinal, respiratory and the genitourinary tract.
Reservoir (source)
Portal of exit
Method of transmission
Wearing masks and eye protection when in close contact with clients
who have infections transmitted by droplets from the respiratory tract
Wearing masks and eye protection when sprays of body fluid are
possible
Portal of entry
Susceptible host
Modes of Transmission
1. Direct contact: describes the way in which microorganisms are transferred from
person to person through biting, touching, kissing, or sexual intercourse; droplet
spread is also a form of direct contact but can occur only if the source and the host
are within 3 feet from each other; transmission by droplet can occur when a person
coughs, sneezes, spits, or talks.
2. Indirect contact: can occur through fomites (inanimate objects or materials) or
through vectors (animal or insect, flying or crawling); the fomites or vectors act as
vehicle for transmission
3. Air: airborne transmission involves droplets or dust; droplet nuclei can remain in the
air for long periods and dust particles containing infectious agents can become
airborne infecting a susceptible host generally through the respiratory tract
Course of Infection
1. Incubation: the time between initial contact with an infectious agent until the first
signs of symptoms the incubation period varies from different pathogens;
microorganisms are growing and multiplying during this stage
2. Prodromal Stage: the time period from the onset of nonspecific symptoms to the
appearance of specific symptoms related to the causative pathogen symptoms range
from being fatigued to having a low-grade fever with malaise; during this phase it is
still possible to transmit the pathogen to another host
3. Full Stage: manifestations of specific signs & symptoms of infectious agent; referred
to as the acute stage; during this stage, it may be possible to transmit the infectious
agent to another, depending on the virulence of the infectious agent
4. Convalescence: time period that the host takes to return to the pre-illness stage;
also called the recovery period; the host defense mechanisms have responded to the
infectious agent and the signs and symptoms of the disease disappear; the host,
however, is more vulnerable to other pathogens at this time; an appropriate nursing
diagnostic label related to this process would be Risk for Infection
Inflammation
The protective response of the tissues of the body to injury or infection; the
physiological reaction to injury or infection is the inflammatory response; it may be
acute or chronic
Bodys response
Immune Response
1. The immune response involves specific reactions in the body to antigens or foreign
material
2. This specific response is the bodys attempt to protect itself, the body protects itself
by activating 2 types of lymphocytes, the T-lymphocytes and B-lymphocytes
3. Cell mediated immunity: T-lymphocytes are responsible for cellular immunity
o
Once the antigen is found they produce proteins (lymphokines) that increase
the migration of phagocytes to the area and keep them there to kill the
antigen
Some T-lymphocytes remain and keep a memory of the antigen and are
reactivated if the antigen appears again.
4. Humoral response: the ability of the body to develop a specific antibody to a specific
antigen (antigen-antibody response)
o
Types of Immunity
Active Immunity
Duration lifelong
Reinforced by booster
Passive Immunity
Lasts 2 to 3 weeks
Nosocomial Infection
1. Nosocomial Infections: are those that are acquired as a result of a healthcare
delivery system
2. Iatrogenic infection: these nosocomial infections are directly related to the clients
treatment or diagnostic procedures; an example of an iatrogenic infection would be a
bacterial infection that results from an intravascular line or Pseudomonas aeruginosa
pneumonia as a result of respiratory suctioning
Iatrogenic infections
Compromised host
In elderly people, physiological changes occur in the body that make them
more susceptible to infectious disease; some of these changes are:
Strict isolation
Contact isolation
Respiratory isolation
Tuberculosis isolation
Enteric precautions
Drainage/secretions precautions
Obstruct the spread of bloodborne pathogens (hepatitis B and C viruses and HIV)
Blood
Urine
Feces
Wound drainage
Oral secretions
Standard Precautions
Used in the care of all hospitalized persons regardless of their diagnosis or possible
infection status
Apply to:
Blood
All body fluids, secretions, and excretions except sweat (whether or not blood
is present or visible)
Transmission-based Precautions
For known or suspected infections that are spread in one of three ways:
o
Airborne
Droplet
Contact
Agencies have specific policies and procedures for handling soiled reusable
equipment
Identification and documentation of the source individual when feasible and legal
Testing of the source for hepatitis B, C and HIV when feasible and consent is given
Making results of the test available to the source individuals health care provider
Testing of blood exposed nurse (with consent) for hepatitis B, C, and HIV please
check these to match style used in book fairly certain it should be caped
antibodies
Puncture/Laceration
Encourage bleeding
For high-risk exposure (high blood volume and source with a high HIV titer), three
drug treatment is recommended
For increased risk exposure (high blood volume or source with high HIV titer),
three-drug treatment is recommended
For low risk exposure (neither high blood volume nor source with a high HIV titer),
two-drug treatment is considered
Drug regimens vary and new drugs and regimens continuously being developed
HIV antibody tests should be done shortly after exposure (baseline), and 6 weeks, 3
months, and 6 months afterward
It includes the clients perceived needs, health problems, related experiences, health
practices, values and lifestyles.
Purpose
To establish a data base (all the information about the client):
physical assessment
results of laboratory & diagnostic tests material from other health personnel
Activities
1. Collection of data
2. Validation of data
3. Organization of data
4. Analyzing of data
5. Recording/documentation of data
Assessment
Collection of data
includes past health history of client (allergies, past surgeries, chronic diseases, use
of folk healing methods)
Types of Data
1. Subjective data
o
Information from the clients point of view or are described by the person
experiencing it.
2. Objective data
2. Observation
o
3. Examination
o
Source of data
1. Primary source data directly gathered from the client using interview and
physical examination.
2. Secondary source data gathered from clients family members, significant others,
clients medical records/chart, other members of health team, and related care
literature/journals.
o
Reason for visit/Chief complaint primary reason why client seek consultation
or hospitalization.
Family History reveals risk factors for certain disease diseases (Diabetes,
hypertension, cancer, mental illness).
Pattern of health care includes all health care resources: hospitals, clinics,
health centers, family doctors.
Validation of Data
Subjective or objective data observed by the nurse; it is what the client says, or
what the nurse can see, hear, feel, smell or measure.
Inferences
Example:
o
Organization of Data
Uses a written or computerized format that organizes assessment data systematically.
1. Maslows basic needs
2. Body System Model
3. Gordons Functional Health Patterns:
Gordons Functional Health Patterns
1. Health perception-health management pattern.
2. Nutritional-metabolic pattern
3. Elimination pattern
4. Activity-exercise pattern
5. Sleep-rest pattern
6. Cognitive-perceptual pattern
7. Self-perception-concept pattern
8. Role-relationship pattern
9. Sexuality-reproductive pattern
10. Coping-stress tolerance pattern
11. Value-belief pattern
Analyze data
Compare data against standard and identify significant cues. Standard/norm are
generally accepted measurements, model, pattern:
o
Communicate/Record/Document Data
nurse records all data collected about the clients health status
Record subjective data in clients word; restating in other words what client says
might change its original meaning.
Interview
1. The purpose of an interview is to gather and provide information, identify problems
of concerns, and provide teaching and support.
2. The goals of an interview are to develop a rapport with the client and to collect data
3. An interview has 3 major stages:
1. Opening: purpose is to establish rapport by creating goodwill and
trust; this is often achieved through a self introduction, nonverbal
gestures (a handshake), and small talk about the weather, local sports
team, or recent current event; the purpose of the interview is also
explained to the client at this time.
2. Body: during this phase, the client responds to open and closed-ended
questions asked by the nurse.
3. Closing: either the client or the nurse may terminate the interview, it
is important fro the nurse to try to maintain the rapport and trust that
was developed thus far during the interview process.
4. Types of questions
1. Closed questions used in directive interview
1. Re____ short factual answers; e.g. Do you have pain?
2. Answers usually reveal limited amounts of information
3. Useful with clients who are highly stressed and/or have difficulty
communicating
2. Open-ended questions used in nondirective interview
1. Encourage clients to express and clarify their thoughts and feelings;
e.g. How have you been sleeping lately?
Nursing History
1. Collection of information about the effect of the clients illness on daily functioning
and ability to cope with the stressor (the human response)
2. Subjective data
o
Objective data
Physical assessment
1. Systematic collection of information about the body systems through the use of
observation, inspection, auscultation, palpation and percussion
2. A body system format for physical assessment is found below:
o
General assessement
Integumentary system
Cardiovascular system
Nervous system
Genitourinary system
Reproductive system
Musculoskeletal system
Psychosocial assessment
1. Helpful framework for organizing data
2. A suggested format for psychosocial assessment is found below:
o
Vocation/education/financial
Sexual
Health Habits
Psychological
3. The developmental of Erickson, Freud, Havighurst, Kohlberg and Piaget may also be
helpful for guiding data collection
Consultation
1. The nurse collects data from multiple sources: primary (client) and secondary (family
members, support persons, healthcare professionals and records)
2. Consultation with individuals who can contribute to the clients database is helpful in
achieving the most complete and accurate information about a client
3. Supplemental information from secondary sources (any source other then the client)
can help verify information, provide information for a client who cannot do so, and
convey information about the clients status prior to admission
Review of literature
1. A professional nurse engages in continued education to maintain knowledge of
current information related to health care
2. Reviewing professional journals and textbooks can help provide additional data to
support or help analyze the client database
Bowel Elimination
The Large Intestine
Functions
Formation of feces
5. Fluid Intake
6. Activity
7. Psychological
8. Personal Habits
9. Pain
10. Medications
11. Surgery/Anesthesia
Developmental Considerations
Foods with laxative effectfruits and vegetables, bran, chocolate, alcohol, coffee
Antibioticsgreen-gray color
Examine anal area for cracks, nodules, distended veins, masses or polyps, fecal mass
Insert gloved finger into anus to assess sphincter tone & smoothness of mucosal
lining
Stool Collection
Obtain stool and package, label, and transport according to agency policy
get to lab quickly (30 min) if anything viable in sample ie. parasites, C-diff. etc
Esophagogastroduodenoscopy (EGD)
Colonoscopy
Sigmoidoscopy
Barium enema
2 barium studies (should precede UGI) make sure ALL barium is removed*
3 endoscopic examinations
Patient has a soft-formed bowel movement every 1-3 days without discomfort
The relationship between bowel elimination and diet, fluid, and exercise is explained
Patient should seek medical evaluation if changes in stool color or consistency persist
Nutrition
Abdominal settings
Thigh strengthening
Patients with central nervous system disease or local lesions that cause pain
Enemas
Rectal suppositories
Rectal catheters
Types of Enemas
Retention - oil
Retention Enemas
Sigmoid colostomy
Descending colostomy
Transverse colostomy
Ascending colostomy
Ileostomy
Colostomy Care
Keep the skin around the stoma site clean and dry
Normal-Appearing Stoma
Patient Teaching for Colostomies
Teach about odor control (intake of dark green vegetables helps control odor)
Comfort Measures
Charting
Purpose of Charting:
To make record of
1. The significant observation of the patients condition both mental and physical.
2. The medication, treatment, diets and nursing care given and the reaction of the
patient to this care.
3. The incident which might have some bearing on the patients condition.
Communication
Definition
Sender
Also called the encoder, is the person who initiates the interpersonal communication
or message
Message
Channels
It means, conveying messages such as through visual, auditory and tactile senses.
Receiver
Also called the decoder, is the person to whom the message is sent
Feedback
Modes of Communication
Verbal communication- uses the spoken or written word
1. Pace and Intonation
The manner of speech, as in the pace or rhythm and intonation, will modify the
feeling and impact of the message. For example, speaking slowly and softly to an
excited client may help calm the client.
2. Simplicity
Nurses need to learn to select appropriate, understandable terms based on the age,
knowledge, culture and education of the client. For example, instead of saying to a
client, the nurses will be catheterizing you tomorrow for a urinalysis, I would be
more appropriate to say, Tomorrow we need to get a sample of your urine, so we
will collect it by putting a small tube into your bladder.
A message that is direct and simple will be more effective. Clarity is saying precisely
what is meant, and brevity is using the fewest words necessary.
No matter how clearly or simply words are stated or written, the timing needs to be
appropriate to ensure that words are heard.
This involves sensitivity to the clients needs and concerns. E.g., a client who is
enmeshed in fear of cancer may not hear the nurses explanations about the
expected procedures before and after gallbladder surgery.
5. Adaptability
What the nurse says and how it is said must be individualized and carefully
considered. E.g., a nurse who usually smiles, appears cheerful, and greets his clients
with an enthusiastic Hi, Mrs. Jones! notices that the client is not smiling and
appears distressed. It is important for the nurse to then modify his tone of speech
and express concern in his facial expression while moving toward the client.
6. Credibility
Nurses should convey confidence and certainly in what they are saying, while being
to acknowledge their limitations (e.g., I dont know the answer to that, but I will
find someone who does.
7. Humor
The use of humor can be a positive and powerful tool in nurse- client relationship,
but it must be used with care. When using humor, it is important to consider the
clients perception of what is considered humorous.
When the symbolic meaning of an object is unfamiliar the nurse can inquire about its
significance, which may foster rapport with the client.
How a person dresses is often an indicator of how person feels. E.g. For acutely ill
clients n hospital or home care settings, a change in grooming habits may signal that
the client is feeling better. A man may request a shave, or a woman may request a
shampoo and some makeup.
The ways people walk and carry themselves are often reliable indicators of selfconcept, current mood, and health. Erect posture and an active, purposeful stride
suggest a feeling of well being. Slouched posture and slow, shuffling gait suggest
depression or physical discomfort.
The nurse clarifies the meaning of the observed behavior, e.g. You look like it really
hurts you to move. Im wondering how your pain is and if you might need something
to make you more comfortable?
3. Facial Expression
Although he face may express the persons genuine emotions, it is also possible to
control these muscles so the emotion expresses does not reflect what the person is
feeling. When the message is not clear, it is important to get feedback to be sure of
the intent of expression.
Nurses need to be aware of their own expressions and what they are communicating
to others. It is impossible to control all facial expression, but the nurse must learn to
control expressions of feelings such as fear or disgust in some circumstances.
4. Gesture
Hand and body gestures may emphasize and clarify the spoken word, or they may
occur without words to indicate a particular feeling or give a sign
Electronic Communication- many health care agencies are moving toward electronic
medical records where nurses document their assessments and nursing care.
E-mail
2. Gender
Girls tend to use language to seek confirmation, minimize differences, and establish
intimacy. Boys use language to establish independence and negotiate status within a
group.
Values are the standards that influence behavior, and perceptions are the personal
view of event.
4. Personal Space
Communication 4 distances:
a. Intimate: Touching to 1
b. Personal: 1 to 4 feet
c. Social: 4 to 12 feet
d. Public: 12 to 15 feet
5. Territoriality
Is a concept of the space and things that an individual considers as belonging to the
self
Choice of words, sentence structure, and tone of voice vary considerably from role to
role. (E.g. nursing student to instructor, client and primary care provider, or parent
and child).
7. Environment
8. Congruence
The verbal and nonverbal aspects of message match. E.g., when teaching a client
how to care for a colostomy, the nurse might say, You wont have any problem with
this. However, if the nurse looks worried or disgusted while saying this, the client is
less likely to trust the nurses words.
9. Interpersonal Attitudes
Attitudes convey beliefs, thoughts, and feelings about people and events.
Respect is an attitude that emphasizes the other persons worth and individuality. A
nurse coveys respect by listening open mindedly even if the nurse
disagrees.Acceptance emphasizes neither approval nor disapproval .The nurse
willingly receives the clients honest feelings.
Communication in Nursing
Communication
1. Is the means to establish a helping-healing relationship. All behavior communication
influences behavior.
2. Communication is essential to the nurse-patient relationship for the following
reasons:
3. Is the vehicle for establishing a therapeutic relationship.
4. It the means by which an individual influences the behavior of another, which leads
to the successful outcome of nursing intervention.
Modes of Communication
1. Verbal Communication use of spoken or written words.
2. Nonverbal Communication use of gestures, facial expressions, posture/gait,
body movements, physical appearance and body language
2. Clarity involves saying what is meant. The nurse should also need to speak slowly
and enunciate words well.
3. Timing and Relevance requires choice of appropriate time and consideration of
the clients interest and concerns. Ask one question at a time and wait for an answer
before making another comment.
4. Adaptability Involves adjustments on what the nurse says and how it is said
depending on the moods and behavior of the client.
5. Credibility Means worthiness of belief. To become credible, the nurse requires
adequate knowledge about the topic being discussed. The nurse should be able to
provide accurate information, to convey confidence and certainly in what she says.
Reports
Common reports
1.
2.
3.
4.
5.
Change-in-shift report
Telephone report
Telephone or verbal orders only RNs are allowed to accept telephone orders.
Transfer report
Incident report
Documentation
1. Is anything written or printed that is relied on as record or proof for authorized
person.
2. Nursing documentation must be:
o
accurate
comprehensive
3. Effective documentation ensures continuity of care saves time and minimizes the risk
of error.
4. As members of the health care team, nurses need to communicate information about
clients accurately and in timely manner
5. If the care plan is not communicated to all members of the health care team, care
can become fragmented, repetition of tasks occurs, and therapies may be delayed or
omitted.
6. Data recorded, reported, or communicated to other health care professionals are
CONFIDENTIAL and must be protected.
Confidentiality
1. Nurses are legally and ethically obligated to keep information about clients
confidential.
2. Nurses may not discuss a clients examination, observation, conversation, or
treatment with other clients or staff not involved in the clients care.
3. Only staff directly involved in a specific clients care has legitimate access to
the record.
4. Clients frequently request copies of their medical record, and they have the right to
read those records.
5. Nurses are responsible for protecting records from all unauthorized readers.
6. When nurses and other health care professionals have a legitimate reason to use
records for data gathering, research, or continuing education, appropriate
authorization must be obtained according to agency policy.
7. Maintaining confidentiality is an important aspect of profession behavior.
8. It is essential that the nurse safe-guard the client right to privacy by carefully
protecting information of a sensitive, private nature.
9. Sharing personal information or gossiping about others violates nursing ethical codes
and practice standards.
10. It sends the message that the nurse cannot be trusted and damages the
interpersonal relationships.
a. A record must contain descriptive, objective information about what a nurse sees, hears,
feels, and smells.
b. The use of vague terms, such as appears, seems, and apparently, is not acceptable
because these words suggest that the nurse is stating an opinion.
Example:
The client seems anxious (the phrase seems anxious is a conclusion without supported
facts.)
2. Accurate
a. The use of exact measurements establishes accuracy. (example: Intake of 350 ml of
water is more accurate than the client drank an adequate amount of fluid
b. Documentation of concise data is clear and easy to understand.
c. It is essential to avoid the use of unnecessary words and irrelevant details
3. Complete
a. The information within a recorded entry or a report needs to be complete,
containing appropriate and
essential information.
Example:
The client verbalizes sharp, throbbing pain localized along lateral side of right ankle,
beginning approximately 15 minutes ago after twisting his foot on the stair. Client rates
pain as 8 on a scale of 0-10.
4. Current
a. Timely entries are essential in the clients ongoing care. To increase accuracy and
decrease unnecessary duplication, many healthcare agencies use records kept near the
clients bedside, which facilitate immediate documentation of information as it is collected
from a client
5. Organized
a. The nurse communicates information in a logical order.
Example:
An organized note describes the clients pain, nurses assessment, nurses interventions,
and the clients response
Chart consecutively, line by line; if space is left, draw line horizontally through
it and sign your name at end.
If you perform orders known to be incorrect, you are just as liable for
prosecution as the physician is.
8. Avoid using generalized, empty phrases such as status unchanged or had good
day.
o
Begin each entry with time, and end with your signature and title.
Do not wait until end of shift to record important changes that occurred
several hours earlier. Be sure to sign each entry.
Once logged into the computer do not leave the computer screen unattended
Ethical Principles:
1. Autonomy the right/freedom to decide (the patient has the right to refuse despite
the explanation of the nurse) Example: surgery, or any procedure
2. Nonmaleficence the duty not to harm/cause harm or inflict harm to others (harm
maybe physical, financial or social)
3. Beneficence- for the goodness and welfare of the clients
4. Justice equality/fairness in terms of resources/personnel
5. Veracity - the act of truthfulness
6. Fidelity faithfulness/loyalty to clients
Moral Principles:
1. Golden Rule
2. The principle of Totality The whole is greater than its parts
3. Epikia There is always an exemption to the rule
4. One who acts through as agent is herself responsible (instrument to the crime)
5. No one is obliged to betray herself You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible
Law - Rule of conduct commanding what is right and what is wrong. Derived from an AngloSaxon term that meansthat which is laid down or fixed
Court - Body/agency in government wherein the administration of justice is delegated.
Plaintiff - Complainant or person who files the case (accuser)
Defendant - Accused/respondent or person who is the subject of complaint
Witness- Individual held upon to testify in reference to a case either for the accused or
against the accused.
Types of Contract:
1. Expressed when 2 parties discuss and agree orally or in writing the terms and conditions
during the creation of the
contract.
Example: nurse will work at a hospital for only a stated length of time (6
months),under stated conditions (as volunteer, straight AM shift, with
food/transportation allowance)
2. Implied one that has not been explicitly agreed to by the parties, but that the law
considers to exist.
Tort law
Is based on:
o
ACT OF OMMISION something that should have been done but was not.
Classification of Tort
Unintentional Tort
1. Negligence
Failure of an individual to provide care that a reasonable person would ordinarily use
in a similar circumstance.
An act of omission or commission wherein a nurse fails to act in accordance with the
standard of care.
Doctrines of Negligence:
a. Res ipsa loquitor the thing speaks for itself the injury is enough proof of negligence
b. Respondeat Superior let the master answer command responsibility
c. Force majuere unforeseen event, irresistible force
2. Malpractice
the standard of care expected in a situation was not observed by the nurse
something was done that should not have been done or nothing was done when it
should have been done
c. Foreseeability a link must exist between the nurses act and the injury suffered
d. Causation it must be proved that the harm occurred as a direct result of the nurses
failure to follow the
standard of care and the nurse should or could have known
that the failure to follow the standard of care could
result in such harm.
e. harm/injury physical, financial, emotional as a result of the breach of duty to the
client Example: physical injury,
medical cost/expenses, loss of wages, pain and
suffering
f. damages amount of money in payment of damage/harm/injury
Intentional Tort
Unintentional tort do not require intent bur do require the element of HARM
Assault
Example:
o
Nurse threatens a client with an injection after refusing to take the meds
orally.
Battery
Willful touching of a person, persons clothes or something the person is carrying that
may or may not cause harm but the touching was done without permission, without
consent, is embarrassing or causes injury.
Example:
o
A nurse threatens the patient with injection if the patient refuses his meds
orally. If the nurse gave the injection without clients consent, the nurse would
be committing battery even if the client benefits from the nurses action.
False Imprisonment
Occurs when clients are made to wrongful believe that they cannot leave the place
Example:
o
Invasion of Privacy
use of clients name for profit without consent using ones name, photograph for
advertisements of HC agency or provider without clients permission
2.
3.
Public disclosure of private facts private information is given to others who have no
legitimate need for that.
4.
Defamation
communication that is false or made with a careless disregard for the truth and
results in injury to the reputation of a person
Types:
1. Libel defamation by means of print, writing or picture
o
Example:
1. o writing in the chart/nurses notes that doctor A is incompetent
because he didnt respond immediately to a call
2. Slander defamation by the spoken word stating unprivileged (not legally protected)
or false word by which a reputation is damaged
o
Example:
1. Nurse A telling a client that nurse B is incompetent
2. Person defamed may bring the lawsuit
3. The material (nurses notes) must be communicated to a 3rd party in
order that the persons reputation maybe harmed
Public Law:
Criminal Law deals with actions or offenses against the safety and welfare of the public.
1. homicide self-defense
2. arson- burning or property
3. theft stealing
4. sexual harassment
5. active euthanasia
6. illegal possession of controlled drugs
Homicide killing of any person without criminal intent may be done as self-defense
Arson willful burning of property
Theft act of stealing
Health
Characteristics
1. A concern for the individual as a total system
2. A view of health that identifies internal and external environment
3. An acknowledgment of the importance of an individuals role in life
*A dynamic state in which the individual adapts to changes in internal and external
environment to maintain a state of well being
4. Health Belief Model Addresses the relationship between a persons belief and
behaviors. It provides a way of understanding and predicting how clients will behave in
relation to their health and how they will comply with health care therapies.
Four Components
Life events
Control perceptions
Viability emotions
Health outcomes
It organizes cues into pattern to explain likelihood of a clients participation healthpromotion behaviors
Illness
3 Stages of Illness
Rehabilitation
1. A dynamic, health oriented process that assists individual who is ill or disabled to
achieve his greatest possible level of physical, mental, spiritual, social and
economical functioning.
2. Abilities not disabilities are emphasized.
3. Begins during initial contact with the patient
4. Emphasis is on restoring the patient to independence or regain his preillness/predisability level of function as short a time as possible
5. Patient must be an active participant in the rehabilitation goal setting an din
rehabilitation process.
Focuses of Rehabilitation
1. Coping pattern
2. Functional ability focuses on self-care: activities of daily living (ADL); feeding,
bathing/hygiene, dressing/grooming, toileting and mobility
3. Mobility
4. Integrity of skin
5. Control of bowel and bladder function
Definition
Health
Individual definitions
Wellness
State of well-being
Self-responsibility
An ultimate goal
Well-being
Dimensions of Wellness
Physical Dimension
Achieve fitness
Maintain nutrition
Avoid abuses
Social Dimension
Interact successfully
Emotional Dimension
Intellectual Dimension
Ability to learn
Spiritual Dimension
Occupational Dimension
Environmental Dimension
Standard of living
Quality of life
Models of Health
Medical Model
Agent-Host-Environment Model
Health-Illness Continuum
Medical Model
Agent-Host-Environment Model
Physical Fitness
Stress Management
Determining the stress factors in one's life is one thing, but doing something about it is
another thing you could do to manage their stress levels
Meditation
positive visualization
listening to music
journal writing
Environmental Sensitivity
Living lightly on the earth, helping in anyway you can to keep the planet healthy is
important as personal wellness depends on planetary wellness.
Self- Responsibility
Ardell says, all dimensions of wellness are important, but self-responsibility seems
more equal than all the rest. Personal accountability for our own lifestyle is of utmost
importance
is based upon the belief that outcomes are the results of processes that can be
improved through:
Setting of goals and the Plan Do Study Act (PDSA) change process.
Statistical process control charts are used to track identified processes for stability
and response to improvement efforts. Measurement is focused on:
o
Growth
Effectiveness
Efficiency
Engagement
Innovation
Iceberg Model
The Iceberg Model shows us that our state of physical health or illness is only the
visible "tip" of the iceberg.
Spirituality (our inner life, our belief in a higher power and our degree of
acceptance and love of self and others).
Cognitive dimension (intellectual factors include lifestyle choices and spiritual and
religious beliefs)
External Variables
Physical environment
Standards of living
Client motivation
Degree of satisfaction and quality and type of relationship with the health care
providers
Illness
Disease
Acute Illness
Chronic Illness
Clients are not excused from certain social roles and tasks
Loss of autonomy
Depends on:
o
Role changes
Task reassignments
Financial problems
Illness
Disease
Stages of Illness
1. Symptoms Experience- experience some symptoms, person believes something is
wrong 3 aspects physical, cognitive, emotional
2. Assumption of Sick Role acceptance of illness, seeks advice
3. Medical Care Contact- Seeks advice to professionals for validation of real illness,
explanation of symptoms, reassurance or predict of outcome
4. Dependent Patient Role
o
The person becomes a client dependent on the health professional for help.
5. Recovery/Rehabilitation - Gives up the sick role and returns to former roles and
functions.
2. Age
o
3. Environment
o
The physical environment in which a person works or lives can increase the
likelihood that certain illnesses will occur.
4. Lifestyle
o
Lifestyle practices and behaviors can also have positive or negative effects on
health.
Classification of Diseases
1. According to Etiologic Factors
a. Hereditary due to defect in the genes of one or other parent which is transmitted to
the
i. offspring
b. Congenital due to a defect in the development, hereditary factors, or prenatal
infection
c. Metabolic due to disturbances or abnormality in the intricate processes of
metabolism.
d. Deficiency results from inadequate intake or absorption of essential dietary factor.
e. Traumatic- due to injury
f. Allergic due to abnormal response of the body to chemical and protein substances or
to physical stimuli.
g. Neoplastic due to abnormal or uncontrolled growth of cell.
h. Idiopathic Cause is unknown; self-originated; of spontaneous origin
i. Degenerative Results from the degenerative changes that occur in the tissue and
organs.
j. Latrogenic result from the treatment of the disease
2. According to Duration or Onset
Acute Illness An acute illness usually has a short duration and is severe. Signs
and symptoms appear abruptly, intense and often subside after a relatively short
period.
Chronic Illness chronic illness usually longer than 6 months, and can also affects
functioning in any dimension. The client may fluctuate between maximal functioning
and serious relapses and may be life threatening. Is characterized by remission and
exacerbation.
Remission- periods during which the disease is controlled and symptoms are
not obvious.
Sub-Acute Symptoms are pronounced but more prolonged than the acute disease.
Health Promotion
health education
marriage counseling
genetic screening
Specific Protection
avoidance to allergens
Secondary Prevention
Disability Limitations
Adequate treatment to arrest disease process and prevent further complication and
sequelae.
Tertiary Prevention
Occurs after a disease or disability has occurred and the recovery process has
begun; Intent is to halt the disease or injury process and assist the person in
obtaining an optimal health status. To establish a high-level wellness. To maximize
use of remaining capacities
Each individual has unique characteristics, but certain needs are common to all
people.
Physiologic
1. Oxygen
2. Fluids
3. Nutrition
4. Body temperature
5. Elimination
Self-Esteem Needs
1. Self-worth
2. Self-identity
3. Self-respect
4. Body image
Self-Actualization Needs
1. The need to learn, create and understand or comprehend
2. The need for harmonious relationships
3. The need for beauty or aesthetics
Moral Theories
Freud (1961)
Believed that the mechanism for right and wrong within the individual is the
superego, or conscience. He hypnotized that a child internalizes and adopts the
moral standards and character or character traits of the model parent through the
process of identification.
The strength of the superego depends on the intensity of the childs feeling of
aggression or attachment toward the model parent rather than on the actual
standards of the parent.
Erikson (1964)
Kohlberg
Suggested three levels of moral development. He focused on the reason for the
making of a decision, not on the morality of the decision itself.
1. At first level called the premolar or the preconventional level, children are responsive
to cultural rules and labels of good and bad, right and wrong. However children
interpret these in terms of the physical consequences of the actions, i.e., punishment
or reward.
2. At the second level, the conventional level, the individual is concerned about
maintaining the expectations of the family, groups or nation and sees this as right.
3. At the third level, people make postconventional, autonomous, or principal level. At
this level, people make an effort to define valid values and principles without regard
to outside authority or to the expectations of others. These involve respect for other
human and belief that relationships are based on mutual trust.
Peter (1981)
Also, Peters believed that some can be described as habits because they are in some
sense automatic and therefore are performed habitually, such as politeness, chastity,
tidiness, thrift and honesty.
Gilligan (1982)
Included the concepts of caring and responsibility. She described three stages in the
process of developing an Ethic of Care which are as follows.
She believed the human see morality in the integrity of relationships and caring. For
women, what is right is taking responsibility for others as self-chosen decision. On
the other hand, men consider what is right to be what is just.
Spiritual Theories
Fowler (1979)
Described the development of faith. He believed that faith, or the spiritual dimension
is a force that gives meaning to a persons life.
Jurisprudence
It embraces:
Nursing Jurisprudence
Defined as the department of law that comprises all the legal rules and principles
affecting the practice of nursing. It includes not only the study but also the
interpretation of all these rules and principles and their application in the regulation
of the practice of nursing.
It deals with:
1. The Constitution of the Republic of the Philippines, particularly the Bill of Rights.
2. Republic Act No. 7164 otherwise known as the Philippine Nursing Law of 1991.
3. Rules and regulations promulgated by the Board of Nursing and/or Professional
Regulation Commission pertaining to nursing practice.
4. Decisions of the Board of Nursing and/or Professional Regulation Commission on
nursing cases.
5. Decisions of the Supreme Court on matters relevant to nursing.
Nursing as a Profession
Profession
An occupation that requires advanced knowledge and skills and that it grows out of
societys needs for special services.
Professional Nursing
Criteria of Profession
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its members and make it possible to practice effectively.
Characteristics of a Profession
1. Education. A profession requires an extended education of its members, as well as
basic liberal foundation.
2. Theory. A profession has a theoretical body of knowledge leading to defined skills,
abilities and norms.
3. Service. A profession provides basic service.
4. Autonomy. Members of a profession have autonomy in decision making and in
practice.
5. Code of Ethics. The profession as a whole has a code of ethics for practice. A
profession has sufficient self-impelling power o retain its members throughout life. It
must not be a mere steppingstone to other occupations.
6. Caring. The most unique characteristic of nursing as a profession is that, it is a
CARING profession.
Nursing
Is a helping profession
Characteristics of Nursing
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organisms.
4. Nursing is committed to promoting individual, family, community, and national health
goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard to color,
creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.
Roles of a Professional
1. Caregiver/ Care provider
activities involves knowledge and sensitivity to what matters and what is important
to clients
show concern for client welfare and acceptance of the client as a person
2. Teacher
provides information and helps the client to learn or acquire new knowledge and
technical skills
3. Counselor
helps client to recognize and cope with stressful psychologic or social problems; to
develop an improve interpersonal relationships and to promote personal growth
Focuses on helping a client to develop new attitudes, feelings and behaviors rather
than promoting intellectual growth.
Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control.
4. Change agent
5. Client advocate
Involves concern for and actions in behalf of the client to bring about a change.
Promotes what is best for the client, ensuring that the clients needs are met and
protecting the clients right.
6. Manager
Plans, give direction, develop staff, monitor operations, give the rewards fairly and
represent both staff and administrations as needed.
7. Researcher