Fundamentals of nursing

Fundamentals of nursing Facts and tidbitsConcepts of health and illnessWorld health organizationIs the state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity Claude BernardIs the ability to maintain the internal milieu. Illness is the result or failure to maintain the internal environment Walter cannon Is the ability to maintain homeostasis or dynamic equilibriumHomeostasis is regulated by the negative feedback mechanism Florence nightingaleis being well and using ones power to the fullest extent Health is maintained through the prevention of diseases vie environmental health factorsVirginia Henderson Is viewed in terms of the individuals ability to perform 14 components of nursing care unaidedBreathe normally Eat and drink adequately Eliminate body wastes Move and maintain desirable postures Select suitable clothes/ dress and undress Maintain body temperature within normal range Keep the body clean and well-groomed and protect the integument Avoid dangers of the environment and avoid injuring others Communicate with others in expressing emotions, needs, fears, or opinions Worship according to ones faith Work in such a way that there is a sense of accomplishment Play or participate in various forms of recreation Learn, discover, or satisfy the curiosity that leads to normal development and health and the use the available health facilities Illness and disease Illness Is a personal state in which the person feels unhealthy Illness is a state in which the persons physical, emotional, intellectual, social, developmental and spiritual functioning is diminished or impaired compared with previous experience Illness in=s nit synonymous with disease Disease An alteration in body functions resulting in the reduction of capacities or a shortening of the normal life span Stage of illness Symptom experience Assumption of sick role Medical care contact Dependent patient role Recovery and rehabilitation Symptom experience Experience some of the symptomsPerson believes that something is wrong Assumption of sick role Acceptance of illness Seeks advice Medical care contact Seeks advice to professionals for validation of real illness, explanation of symptoms, reassurance or prediction of outcome Dependent patient role The person becomes a client dependent on the health professional for help Accepts/reject health professionals suggestions Becomes more positive and accepting

Recover and rehabilitation Gives up the sick role and returns to former roles and functions Conceptual and theoretical models of nursing practice Hildegard peplau Defined nursing as therapeutic, interpersonal process which strives to develop a nurse-patient relationship in which the nurse serves as a resource person Identified the four phases of the nurse-patient relationship Orientation the nurse and the client initially do not know each other. The client attempts to find difficulties and the amount of nursing help that is needed Identification the client responds to help professionals or the significant others who can meet their identified needs. Both the client and the nurse plan together and appropriate program to foster health Exploitation the clients utilize all available resources to move towards a goal of maximum health functionality Resolution refers to the termination phase of the nurse-client relationship. It occurs when the clients needs are met and he/she can move on to a new goal. Faye abdellah 21 nursing problems To maintain good hygiene and physical comfortTo promote optimal activity: exercise, rest, sleepTo promote safety through prevention of accident, injury, or other trauma and through prevention of the spread of infectionTo maintain good body mechanics and prevent and correct deformityTo facilitate the maintenance of a supply of oxygen to all body cellsTo facilitate the maintenance of nutrition for all body cellsTo facilitate the maintenance of eliminationTo facilitate the maintenance of fluid and electrolyte balanceTo recognize the physiologic responses of the body to disease conditionspathologic, physiologic, and compensatoryTo facilitate the maintenance of regulatory mechanisms and functionsTo facilitate the maintenance of sensory functionTo identify and accept positive and negative expressions, feelings, and reactionsTo identify and accept interrelatedness of emotions and organic illnessTo facilitate the maintenance of effective verbal and nonverbal communicationTo promote the development of productive interpersonal relationshipsTo facilitate progress toward achievement and personal spiritual goalsTo create or maintain a therapeutic environmentTo facilitate awareness of self as an individual with varying physical, emotional, and developmental needsTo accept the optimum possible goals in the light of limitations, physical and emotionalTo use community resources as an aid in resolving problems that arise from illnessTo understand the role of social problems as influencing factors in the cause of illnessMyra estrine Levine Four conservation principles Conservation of energy Conservation of structural integrity Conservation of personal integrity Conservation of social integrity Dorothy Johnson Behavioral systems model Ingestive Eliminative Affiliative Aggressive Dependence Achievement Sexual role identityMartha rogers Science of unitary human being Dorothea orem Self-care and self-care deficit theory Wholly compensatory system Partially compensatory system Supportive-educative Imogene king Goal attainment theory Betty Neumann Healthcare systems model Physiological Psychological Socio-cultural Spiritual Developmental Sister callista roy Adaptation theory Lydia hall Care, core, cureMadeleine leininger Transcultural nursing model Josephine Peterson and Loretta zderadHumanistic nursing practice theory Margaret newman Health as an expanding consciousness Patricia benner Novice Beginner with no experience Taught general rules to perform tasksRule-governed behavior is limited and inflexible Advanced beginner Demonstrates acceptable performance Principles based on experience begin to formulate guided actions Competent A nurse with 2-3 years experience in the same area More aware of long term goals gain perspective from planning own actions based on conscious, abstract and analytical thinkingPatricia benner Proficient Perceives and understands situations as whole parts More holistic understanding improves decision-making Learns from experience what to expect in certain situations and how to modify plans Expert No longer relies on principles or guidelines to connect situations and determine actions Much more background experience Has intuitive grasp of certain situations performance is now fluid, flexible and highly-proficient Roles and functions of the nurse CaregiverDecision makerProtector Client advocate Manager RehabilitatorComforterCommunicatorTeacher Counselor CoordinatorLeaderRole modle administratorCommunication in nursing Communication Is the means to establish a helping and healing relationship.All behavior communication influences behavior Is the vehicle for establishing a therapeutic relationship Is the means by which an individual influences the behavior of another, which leads to th successful outcome of the nursing intervention Basic elements of communication SenderMessages Receiver Feedback *medium Models of communication Verbal communication Nonverbal communication Characteristics of good communication Simplicity Clarity Timing and relevance adaptabilityCredibility The 10 rights of medication administration Right drug Right patient Right dose Right route Right time and frequency Right documentation Right history and assessment Right to refuse Right drug-drug interaction right education and information Pqrst pain assessment Precipitating factor Quality Radiation Severity Timing Medication administration Oral administration Advantages Easiest and most desirable way to administer medication Most convenient Safe and does not break the skin barrier Usually is less expensiveDisadvantages inappropriate if the client cannot swallow and if git has reduced motility Inappropraite for clients with nausea and vomiting Drug may have unpleasant tasteDrug may discolor the teeth Drug may irritate the gastric mucosa Drug forms of oral administration Solid tablet, capsule, pill, powder *sustained release or enteric-coated tabletsLiquid syrup, suspension, emulsion, elixir, milk and other alkaline substances Sublingual A drug that is placed under the tongue where it dissolves When the medication is in capsule and is ordered sublingually, the fluid must be aspirated from the capsule and placed under the tongue A medication given by the sublingual route should not e swallowed, or desired effects may not be achieved Buccal A medication that is held in the mouth against the mucous membranes of the cheek until the drug dissolves The medication should not be chewed, swallowed or placed under the tongue Client should be taught to alternate the cheeks with each subsequent dose to avoid mucosal irritation Topical Application of a medication to a circumscribed area of the body DermatologicOpthalmic OticNasal dermatologicIncludes lotions, liniment and ointments or powderBefore application, clean the skin thoroughly by washing the area gently with soap and water, soaking an involved site or washing away locally debriding tissue Use surgical asepsis when open wound is present Remove previous application before the next application Use gloves when applying a medication over a large surface Apply only a thin layer of medication to avoid systemic absorption

opthalmicinstillation to provide an eye medication that the client requires Irrigation to clear the eye of noxious or other foreign materialsInstill eye drops into the lower conjunctival sac Instill a maximum of 2 drops at a time. Wait for 5 minutes before additional drops are to be applied Avoid dropping a solution directly on the cornea because It causes discomfort Instruct the client to close the eyes gently. Shutting the eyes tightly will cause spillage of the medication Otic instillation To remove cerumen or pus or to remove a foreign body Warm the solution to body temperature. Failure to do so may cause vertigo, dizziness, nausea and pain Straighten the ear canalInstill the eardrops on the side of the auditory canal to allow the drops to flow in and continue to adjust the body temperature Ask the client to remain in side-lying position for about 5 minutes nasalNasal instillation are usually instilled for their astringent effects, to loosen secretions and facilitate drainage and treat infections of the nasal cavity and sinuses. (decongestants, steroids, calcitonin)Have the client blow the nose prior to nasal instillationAssume a back lying position, or sit up and lean back Elevate the nares by pressing the tip of the nose slightly with the thumb. While the client inhales, squeeze the bottle Keep head tilted back for 5 minutes after instillation of the nasal drops When the medication is used on a daily basis, alternate the nares to prevent irritation Inhalation Use of a nebulizer or a metered-dose inhaler Semi or high-fowlers or standing position to enhance the full expansion of the lungs allowing deeper inhalation of the medication Shake the canister several times to ensure uniform dosage delivery Position the mouthpiece 1 to 2 inches from the clients mouth. As the client starts inhaling, press the canister down to release one dose of the medication.