Nursing History & Health Determinants

Basics of Nursing

• Nursing has historical roots in ancient civilizations like Egypt, Greece, and Rome
• Historically, nursing was often provided by family or religious orders
• During the Middle Ages, monastic orders increasingly cared for the sick
• Modern nursing started in the 19th century with Florence Nightingale
• Nightingale established professional nursing standards through her work during the Crimean War
• She also established a nursing school at St. Thomas' Hospital in London
• These standards include sanitation, patient care, and nurse training

Health Determinants and Health Needs

• Health determinants include various biological, social, environmental, and behavioral factors
• Biological factors encompass genetics, age, and sex
• Social factors include education, socioeconomic status, and community support
• Environmental factors involve living conditions, pollution, and workplace hazards
• Behavioral factors are diet, exercise, and substance use
• Healthcare access involves the availability and quality of health services
• Health needs are met through preventive care, such as immunizations and screenings
• Primary care includes regular check-ups and chronic condition management
• Acute care offers immediate treatment for sudden illnesses or injuries
• Rehabilitative care provides support for recovery and rehabilitation
• Palliative care focuses on comfort and support for terminally ill patients

Development of Nursing Over Time

Past:

• Ancient and medieval nursing consisted of informal caregiving by women and religious factions
• The 19th century saw Florence Nightingale's reforms establish professional standards and training

Present:

• Nursing now utilizes advanced education and certification
• Technological integration is present with the use of electronic health records and telemedicine
• Specialization leads to varied roles such as nurse practitioners, clinical nurse specialists, and nurse anesthetists

Future:

• There will be increased autonomy with expanded roles in primary and specialized fields
• Nursing will see greater involvement in international health initiatives
• Continued integration of AI and robotics will be integrated

The Essence of Modern Nursing

• Modern nursing emphasizes patient-centered care, evidence practices, and continuous learning
• Modern nursing combines theoretical knowledge with practical skills
• Modern nursing cares holistically providing patient advocay

Contemporary Nursing: Theoretical and Practical Dimensions Theoretical Dimensions:

• Nursing theories are frameworks that guide nursing practice, education, and research
• Professional ethics require adherence to ethical standards and ensuring patient confidentiality
• Research and Evidence-Based Nursing Practice (EBNP) incorporate research findings into practice

Practical Dimensions:

• Nurses must have clinical skills with proficiency in medical procedures and patient care approaches
• Nurses should focus on patient interaction through communication, empathy, and education
• Nurses using interdisciplinary collaboration should work with other healthcare workers

Nursing Theories

Florence Nightingale:

• The theory emphasized cleanliness for patient recovery
• Emphasized the importance of systematic observation and record-keeping

Virginia Henderson:

• She defined assisting individuals with essential activities for health or peaceful death
• Focused on the 14 basic needs of patients

Dorothea Orem:

• She developed the Self-Care Deficit Nursing Theory
• Emphasized patient self-care as a critical component of healthcare

Callista Roy:

• Introduced the Adaptation Model, viewing patients as adaptive systems
• Focused on helping patients adapt to changes in environments

Betty Neuman:

• Created the Neuman Systems Model, emphasizing a holistic approach
• Considered stressors affecting patient wellness and preventive interventions

Types of Nursing Diagnoses

• Nursing diagnoses classify patient care depending on health conditions
• The North American Nursing Diagnosis Association (NANDA) provides diagnoses standardized catergorized into:
  • Actual Diagnoses: Current patient issues
  • Risk Diagnoses: Potential problems
  • Health Promotion Diagnoses: Focus on enhancing health and wellbeing

Differentiation of Nurse's Tasks

• Healthy patients: Health education, screenings, preventive care
• At-risk patients: Monitoring, risk reduction, early interventions
• Sick patients: Direct care, medication administration, treatment coordination
• Patients with unfavorable prognosis: Palliative care, emotional support, symptom management

Social and Professional Role of a Nurse

Social Role:

• Advocate: Representing patient needs and rights
• Educator: Informing patients and communities about health

Professional Functions:

• Care provider: Direct patient care and treatment
• Communicator: Effective information exchange with patients and healthcare teams
• Leader: Guiding and mentoring nursing staff

Evidence-Based Nursing Practice (EBNP)

• EBNP integrates clinical expertese with the best available research evidence and patient preferences
  • Assessing evidence means reviewing and evaluating research
  • Applying findings is implementing evidence-based interventions
  • Evaluating outcomes consists of measuring the impact of interventions on patient health

Nurse's Participation in Health Processes

• Nursing process: Assessment, diagnosis, planning, implementation, and evaluation
• Diagnosis: Identifying patient health issues
• Health promotion: Educating and empowering patients to maintain health
• Disease prevention: Implementing strategies to prevent illness
• Treatment: Administering therapies and medications
• Rehabilitation: Supporting patients in regaining independence and function

Nurse's Tasks in an Interdisciplinary Team

• Nurses play a vital role in healthcare teams, collaborating with doctors, therapists and other healthcare providers
  • Patient Advocacy: Representing and safeguarding patient interests
  • Care Coordination: Ensuring seamless care across different disciplines
  • Communication: Facilitating information exchange among team members
  • Assessment and Monitoring: Regularly assessing patient status and communicating
• Implementation of care plans is carrying out prescribed treatments and interventions
  • Education: Teaching patients and families about health conditions and care plans
  • Documentation: Maintaining accrate detailed patient records

Nursing Process

• The nursing process is a systematic and patient-centered approach
• Nursing process is designed to identify and address individual patient needs by using critical thinking and decision making

Stages of the Nursing Process

1. Assessment: Gathering information about the patient's health status through health hsitory, examinations and tests
2. Diagnosis: Analyzing assessment to identify health problems, needs and strengths
3. Planning: Setting goals, and individualizing care plans
4. Implementation: Executing the care plan by performing interventions and coordination
5. Evaluation: Analyzing the effectiveness of interventions of the patient and revising plans, if necessary

Principles of Application:

• Nurses should focus on the individual needs and preferences of the patient
• Nurses should follow a structured approach to comprehensive care
• Nurses should utilize current research and best practices in care
• Nurses should establish goals for patient outcomes
• Nurses should work with healthcare professionals to provide coordinated care

Analyzing Diagnostic Tests and Physical Examinations for Nursing Diagnosis Stages for Analysis: Data Collection > Interpret Findings > Identify Patterns > Formulate Diagnoses

Examples

• Lab Tests: Analyzing blood counts, electrolytes, and glucose levels to detect imbalances
• Imaging: Reviewing X-rays, MRIs, or CT scans for structural abnormalities
• Vital Signs: Monitoring changes in temperature, blood pressure, heart rate, or respiratory rate

Scope of Nurse's Professional Tasks Based on Patient Condition

Long-Term Immobilization:

• Prevention of pressure ulcers includes regular repositioning, skin care, and use of support surfaces
• Venous thromboembolism (VTE) prevention includes administering anticoagulants, encouraging leg exercises, and using compression devices
• Maintaining muscle function includes passive range of motion exercises

Pain Management:

• Assessment: Evaluating pain intensity, location, and characteristics using standardized tools
• Interventions: Administering analgesics, non-pharmacological pain relief methods

Fever Management:

• Monitoring: Regularly checking temperature and associated symptoms
• Interventions: Administering antipyretics, encouraging fluid intake, and maintaining a comfortable environment

Sleep Disorders:

• Assessment: Identifying causes of sleep disturbances through patient history
• Interventions: Creating a restful environment, promoting sleep hygiene, and handling medications

Basic Nursing Activities

• Basic nursing activities provide comfort
• Basic nursing activities aim to maintain and promote patient health including psychological and physical support

Indications and Contraindications:

• Basic nursing activities are indicated for basic health maintenance
• Contraindications rely on patient conditions, like allergies, mobility limitations, or states that needs tailored approaches
• There is a risk of transmitting infections during care activities causing injury

Applicable Rules and Structure:

1. Hand Hygiene: Perform handwashing before and after patient contact to prevent infection
2. Patient Identification: Verify that the patient's identity is valid
3. Communication: To Explain procedures to the patient and obtain consent
4. Safety measures: Confirm that the environment is safe and equipment is functioning correctly
5. Documentation: To Record all care activities accurately in the patient's medical record

Stages of basic nursing:

1. Preparation, making sure that instruments are available and setting them readily for the patient.
2. Execution, using appropriate techniques and maintaining patient dignity during the activity.
3. Continuous monitoring to observe the patients responses and manage complications if they arise. 4 Evaluation of follow-up and its effectiveness

Interview and Physical Examination of the Patient in Internal Diseases

Interview: Ask the patient what the main reason is for their visit

• History of Present Illness: Understand the symptoms, onset, duration, severity, and associated features.
• Medical History: Past medical conditions, surgeries, hospitalizations
• Medication History: All Current and past medication
• Family History: Knowing Genetic predispositions
• Social History: lifestyle factors (smoking, use of alcohol etc...)
• Review of Systems: Review each system of the body and write down any additional symptoms

Physical Examination:

• Obvserve Patient (consciousness, hygiene...)
• Vital Signs: Recording/Measuring blood pressure, pulse, respiratory rate, and temperature.
• Head and Neck Examination: Inspect and palpate for abnormalities.
• Cardiovascular Examination: Check heart sounds, rate, rhythm, and murmurs.
• Respiratory Examination: Inspect, palpate, percuss, and auscultate the lungs.
• Abdominal Examination: Inspect, auscultate, percuss, and palpate the abdomen.
• Neurological Examination: Assess mental status, cranial nerves, motor and sensory function, reflexes

Diagnostic Methods in Cardiology

• Measures electrical activity of the heart to identify
• arrythmias: ischemia, and infarction.
• Assess the structure and function of the heart with ultrasound
• Evaluate the function of the Evaluation of cardiac function after the use of exercise or
• pharmacological Agents: Invasive procedure to examine coronary arteries and heart
• Detect intermittent arrhythmias with a Holter Monitor: blood lipid profile, cardiac enzymes (troponin, CK-MB), and BNP for
• heart Failure: Blood tests that Include:

Risk Factors for Cardiovascular Diseases

Non-Modifiable:

• Age
• gender
• family history
• genetic predisposition
• Modifiable:
• the leading modify risk factor is to stop Tobacco Smoking
• Leads to High blood pressure damages arteries.
• High cholesterol levels contribute to Hyperlipidemia plaque formation.
• Increases risk of atherosclerosis and Diabetes
• Leads to hypertension, diabetes, and dyslipidemia, to Obesity
• Contributes to obesity and metabolic syndrome after periods of physical inactivity
• Consuming Diet: High-fat, high-sugar diets increase risk

Nurse's Role in Ischemic Heart Disease (IHD):

• Atherosclerosis is the Primary cause of IHD
• Reduced Oxygen Supply is caused by oxygen demands, ischemia

Treatment:

• Teach about risk factors, lifestyle and the impaccts
• Monitor blood pressure, cholesterol, glucose levels

Nursing Management in Acute Coronary Syndrome (ACS)

Initial Care:

• Monitor vital signs, ECG, and oxygen
• Administer nitroglycerin, morphine and maintain oxygenation
• Administer aspirin and heparin

Medical Care

• Signs of bleeding, infection, and stent
• Educate about lifestyle, medication adherence and follow-up appointments.
• Support physical activity

Emergency Nursing Management in Cardiology

Sudden Cardiac Arrest (SCA): Immediate cardiopulmonary resuscitation:

• Use of an automated external defibrillator (AED) and advanced life support

Acute Heart Failure:

• Monitor: dyspnea, edema, and fatigue and provide oxygen
• Administer diuretics, vasodilators

Hypertensive Crisis:

• Frequent blood pressure checks and administer antihypertensives.
• Maintain a calm, educate on medication
• Teach about risk factors, smoking, and screenings: Monitor BP/cholesterol/glucose

Selected Circulatory System Diseases

Ischemic Heart Disease and Essential Hypertension- the symptoms and what management to give.

• symptoms is dyspnea, fatigue
• Management would be Lifestyle changes.

Basic Heart Rhythm Disorders:

• The treatment will to Provide Anticoagulation, rate etc
• For immediate defibrillation use ventricular Tachycardia

Atherosclerosis

• The Prevention for this to stop smoking and continue medication
• Complications include heart attack, stroke, and peripheral artery disease

Treatment

• Teach about medicine, process and diet. Blood tests, signs of hypo- and hyperglycemia.
• Administer or educate on medicine for conditions to reduce.

Nursing Care for Digestive System Diseases Dietary Treatment, and Individualized Plans is best

Liver and Pancreas

• Avoid alcohol, manage complications, liver transplant
• Prevent the transmission by using antivirals

Nurse's Tasks Towards Patients with Urinary Tract Diseases

1. Assessment and Monitoring: including history taking and physical examinations.
2. Diagnostic Assistance by educate patients on proper sample taking
3. Patient education by teaching nutrition, medicine, and infections
4. Pain management by teaching to manage pain and Administer medicine

Interventions include all prevention methods