Fundamental of Nursing – 1st Year - 1st Term(2024-2025) PDF

Fundamental of Nursing – 1st year -1st term(20242025) PROFESSIONAL NURSE Out Line:  Introduction  Definitions; Nurse, Professional Nurse, Assisted Nurse.  Aims of Nursing profession  Characteristics / qualities of good professional nurse  Functions of professional nurse  Scope of care delivered by nurses  Available career opportunities. Introduction Nursing is the largest safety critical profession in health Fundamental of Nursing – 1st year -1st term(20242025) and social care. Nursing is a profession within the health care system focus on protection, promotion, and optimization of health, prevention of illness and injury, facilitation of healing, alleviation of suffering for individuals, families, communities and populations to maintain optimal health and quality of life. Professionalism in nursing means providing top-quality care to patients, while also upholding the values of accountability, respect, and integrity. Definitions; 1) Nurse The nurse is a person who has completed a program of basic, generalized nursing education. 2) Professional nurse: Is a health care provider identified by the law as registered nurse whether graduated from bachelor or diploma degree, been registered and licensed to practice nursing, and doesn't include assistant nurse. Registered nurses are decision makers. They use clinical judgment and problem-solving skills to manage and co-ordinate the complexity of health and social care systems to ensure people and their families are enabled to improve, maintain, or recover health. 3) Assisted nurse: Fundamental of Nursing – 1st year -1st term(20242025) A person who has completed a brief health care training program and who provides support services under supervision of registered nurse. Aspect Registered Nurse (RN) Nurse Assistant (NA) Education and Bachelor or Associate Degree in Approved training program. Training Nursing. Scope of Extensive and comprehensive Limited to basic patient care Practice (As administering medications, tasks. monitoring vital signs, performing diagnostic tests, and collaborating with other healthcare professionals to develop and implement patient care plans). Responsibilities Assessing, planning, and Assisting with activities of implementing patient care plans, daily living (as bathing, administering medications, and dressing, and feeding collaborating with healthcare patients), taking vital signs, professionals. and providing emotional support to patients. Aims of Nursing profession are to:- Maintain and promote wellness, prevent illness, care for and rehabilitate the disabled patients, and dying people Restoration of optimal functional level health following illness Provide comfort to the client during diseases process. Advocacy, promotion of a safe environment. Participation in shaping health policy and in patient and health systems management, research and education Fundamental of Nursing – 1st year -1st term(20242025) Characteristics / qualities of good professional nurse:  Personal qualities that describe a good nurse; - Good appearance (Posture, Grooming, hair, hygiene, and uniform), - Character; respectful, trustful, honest, empathy, emotional stability, confidentiality, patience, accuracy, punctuality and be role model. - Values (Justice, Prudence, Fortitude, Temperance),  Providing safe competent nursing care with good observation skills.  Knowledgeable in the nursing profession and applying the acquired knowledge to nursing practice. Skills needed to achieve these characteristics include communication, creating a healthy work environment, collaboration, shared decision-making, coaching, mentoring, and delegation. Functions of professional nurse: 1. Caregiver: nurse provides health care to patients in a variety of settings. 2. Clinical decision maker: to Fundamental of Nursing – 1st year -1st term(20242025) use critical thinking skills to make wise decisions, set goals, and promote outcomes for a patient. 3. Case manager 4. Communicator: The nurse has to communicate effectively with the patient and family members as well as other members of the healthcare team. 5. Administrator 6. Teacher 7. Rehabilitator 8. Researcher Scope of care provided by the nurse: Activities of the nurse vary according the practical setting as hospital departments, public health centers, etc. There are general nursing care can be provided by the nurse such as: 1- Providing Holistic care that emphasizes the whole person rather than the sum of their parts. This means that nurses address and meet all physical, psychosocial, cultural, and spiritual needs. 2- Performing comprehensive assessment including histories and physical exams and developing plan of care to meet patient needs according priorities. Fundamental of Nursing – 1st year -1st term(20242025) 3- Providing skilled nursing care through applying a systematic nursing process (assessment, diagnoses, plan, implementation, and evaluation). 4- Provide health promotion, counseling and education 5- Provides skilled nursing care. 6- Maintain nursing reports and legal documentation. 7- Analysis of patient records. 8- Plan for referral to specialists as nutritionist, psychiatrist, social worker, physiotherapist…etc. 9- Teach patients and their families about illness process, disease prevention, treatment modalities, lifestyle modification, and rehabilitation measures. 10- Participate in researches related to health problems to improve patient outcomes and quality of nursing care. Available career opportunities Hospitals (university, governmental and private) Health centers such as maternal, child health centers, family planning centers. Nursing Homes Schools Military Fundamental of Nursing – 1st year -1st term(20242025) Industries Wellness Centers Public Health agencies Home Health Care Agencie Fundamental of Nursing – 1st year -1st term(20242025) Fundamental of Nursing – 1st year -1st term(2024-2025) Basic human needs Introduction Basic human needs are the elements that required for survival and optimal mental, physical psychosocial well -being for all people, such as food, water, shelter, protection from environmental threats, and love. Any disturbance in the person's capacity to meet one or more needs affect the whole person and become at greater risk for illness. Definition of need: A need is a necessity or requirement must be met. Importance of studying basic human needs for nurses: 1. Providing holistic nursing care based on considering all dimensions that affect health as physical, psychological, social, spiritual factors and based on patient's needs according priorities 2. helping people to meet the needs they cannot meet by themselves because of age, illness, or injury. 3. helping people to avoid risks or threats to their health prevent complications before occurrence. 4. allows the nurse to provide individualized care plan 5. Nursing care is often directed toward meeting unmet or threatened needs. Fundamental of Nursing – 1st year -1st term(2024-2025) Categories of human needs Human needs had been categorized in several way, the most common classification is done by the most famous psychologist known Maslows (1943). Maslow's hierarchy of human needs  Maslow (1943) defined the basic human needs as a progression from primary physical needs (needed for survival ) to secondary needs are met to give quality to life. He called this progression a hierarchy of needs. In this hierarchy (Fig. 1) described five basic human needs for all people ranked by their importance to the individual’s survival from bottom to top. When one need is fulfilled a person seeks to fulfill the next one, and so on.  According to Maslow, basic physiologic needs must be met before a person can move toward higher-level needs, for example, person who hungry will not be concerned about cleanliness or learning until eating. Individuals in pain will not be concerned about personal appearance or relationships with others until pain is relieved. Those facing surgery will not be able to learn about the operation unless they feel safe and secure. Figure (1) Maslow's Hierarchy of needs Fundamental of Nursing – 1st year -1st term(2024-2025) In Maslow's hierarchy of needs, the first lower level is known as (survival needs) that includes physiological needs while the top levels termed as growth needs which includes psychological needs. and interactions with others for partial or complete fulfillment. Satisfying one’s needs often depends on the social and physical environment, especially one’s family and community. Fundamental of Nursing – 1st year -1st term(2024-2025) The five levels of needs developed by Maslow are: 1. Biological and Physiological needs - oxygen, food, drink, elimination, shelter, warmth, sex, sleep. 2. Safety needs - protection from elements, security, order, law, stability, freedom from fear. 3. Love and belongingness needs - friendship, intimacy, affection and love, - from work group, family, friends, romantic relationships. 4. Esteem needs - achievement, mastery, independence, status, success, prestige, self-respect, respect from others. 5. Self-Actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and gain experiences, creativity, achieving one's own capabilities. 1- Physiological needs: First-level needs are called physiologic needs, survival needs, or primary needs which having the highest priority Without them, a person will Fundamental of Nursing – 1st year -1st term(20242025) die. These include need for oxygen, water, food, temperature, elimination, sexuality, physical activity, and rest—must be met at least minimally to maintain life. Meeting physiologic needs is often a major part of the nursing care plan for young, old, disabled, and ill people who require assistance in meeting them. Physiological needs include the following: Need for Oxygen: takes priority than other physiological needs because all body cells require oxygen for survival. Need for water: is necessary to sustain life. The fluids in the body must be in balance, or homeostasis, to maintain health. Need for elimination: Elimination of the body’s waste products is essential for life and comfort. The body eliminates wastes in several ways. The lungs eliminate carbon dioxide and water; the skin eliminates water and sodium; the kidneys eliminate fluids and electrolytes; the intestines discharge solid wastes and fluids. If elimination altered this allow wastes to accumulate result in serious conditions. Need for activity and Exercise: Activity stimulates both the mind and body. Exercise helps maintain the body’s structural integrity and health by enhancing circulation and respiration. Mobility is not necessary for survival, but some form of exercise is needed to maintain optimum health. Need for rest and sleep: essential for optimal mental health, organs respite, allow the body to be free from stress. Several factors that influence sleep are age, environment, exercise, stress, and drug use. Fundamental of Nursing – 1st year -1st term(20242025) Needs for sexuality: is important but unlike other basic physiologic needs because it isn't vital for survival of the individual. Need for temperature Regulation: The body has internal mechanisms regulate body temperature to be within normal. Several factors can threaten the body’s need for temperature regulation, including exposure to excessive external heat or cold or internal fever in response to an infection. The nurse will assist clients to meet the need for temperature regulation in such cases. 2- Safety and Security Needs: The second level of Maslow’s hierarchy of needs that take the next priority after physiological needs. At this level People must feel safe and secure physically, emotionally, and financially. Characteristics of safety include predictability, stability, and familiarity. Physical safety and security: means being protected from potential or actual harm or danger. Nurses carry out a wide variety of activities to meet patients’ physical safety needs, such as: Using proper hand hygiene and sterile techniques to prevent infection Using electrical equipment properly, safe grand floor, proper light sources Administering medications knowledgeably.removing threats to safety from the client’s environment Using skill when moving and ambulating patients to prevent falling Teaching parents about household chemicals that are dangerous to children Fundamental of Nursing – 1st year -1st term(20242025) Emotional safety and security: involves trusting others and being free from fear, abuse, anxiety, and apprehension. Nurses can help meet such needs by:  Encouraging spiritual practices that are a source of strength and support  Allowing patient to participate in decision making regarding their own care.  Providing explanation about new and unfamiliar procedures and treatments. 3- Love and Belonging Needs After physiologic and safety and security needs, all humans have a basic need for love and belonging which include giving and receiving love, and the feeling of belonging to families, peers, friends, a neighborhood, and a community. People who have their love and belonging needs are unmet often feel lonely, isolated and developed psychological disturbances. 4- Self-Esteem Needs: Self-esteem means refer to the way person view himself or herself needs. Each. Person need to feel good about himself or herself, sense of self worth and acceptance, independence, and confidence and respect from others. Positive self-esteem essential for optimal psychosocial wellbeing. Self-esteem can be seriously altered when person’s responsibilities and relationships such as loss of job, loss of partner, change in body image, such as the loss of a breast or amputation. Fundamental of Nursing – 1st year -1st term(20242025) 5- Self-Actualization Needs  The highest level of Maslow 's hierarchy of needs is self- actualization needs, which include the need for individuals to reach their full potential through development of their unique capabilities.  The process of self-actualization is one that continues throughout life. Maslow lists several characteristics that indicate achievement of one’s potential (as acceptance of self and others as they are, ability to be objective, feelings of happiness and affection for others, respect for all people and creativity and problem solving abilities.  The nurse help patients to meet self-actualization needs through focusing on the person’s strengths and potentialities rather than on problems or disabilities, and finding ways to create hope. Fundamental of Nursing – 1st year -1st term(2024-2025) Respiration Outlines Definition of Respiration Definition of Breathing The basic activities occur during normal respiration Factors affecting respiration Assessment of respiratory functions Common nursing measures to promote Normal Respiration Introduction;  The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to deliver oxygen to all parts of the body. The respiratory system does this through breathing. Breathing is essential to life.  Oxygen is required by the body to release energy at cell level so that the individual can participate in activities. Without oxygen, for even short period, some of the body cells will suffer irreversible damage and quickly die. Oxygen intake and elimination of carbon dioxide is achieved through respiration. Pathway of air: alveoli (site of gas exchange) o Respiration: Is the gas exchange between the individual and the environmental air in which the individual takes in oxygen (inspiration) and eliminates carbon dioxide and water vapor (expiration). o Breathing (VENTILATION )is an active and the rhythmical 1 Fundamental of Nursing – 1st year -1st term(2024-2025) process of moving air into and out of the lungs (via inhalation and exhalation) to facilitate gas exchange with the internal environment, ( flush out carbon dioxide and bring in oxygen o Normal resting respirations are 12 to 20 breaths per minute, o Eupnea refers to easy respirations with a normal rate of breaths per minute that are age-specific. Average respiratory rates, by age: Infants: 20–40 breaths per minute Adults: 12–20 breaths per minute The basic activities occur during normal respiration 1. Ventilation 2. Diffusion 3. Perfusion 1- Ventilation o It consists of inspiration and expiration (respiratory cycle). o Ventilation occurs under the control of the autonomic nervous system o Normal breathing is slightly observable, effortless, quiet, automatic, and regular. It can be assessed by observing chest wall expansion and bilateral symmetrical movement of the thorax o Diaphragmatic (abdominal) breathing occurs when the diaphragm contracts and relaxes as observed by movement of the abdomen. During inspiration (Inhalation) o The external intercostals plus the diaphragm contract to bring about inspiration: 2 Fundamental of Nursing – 1st year -1st term(2024-2025) Contraction of external intercostal - to-back dimension of lungs During vigorous inhalation (at rates exceeding 35 breaths per minute), or in approaching respiratory failure, accessory muscles of respiration are recruited for support because forced inhalation aid in further expanding the thoracic cavity During expiration (Exhalation ) Natural elasticity of the lungs and relaxation of external intercostal - haled Exhalation is generally a passive process; however, active or forced exhalation is achieved by the abdominal and the internal intercostal muscles. During this process air is forced or exhaled out. 2- Diffusion of gases between the alveoli and the blood o It is the exchange of the gas from higher concentration area to low concentration area, as the exchange of carbon dioxide (CO2) and oxygen (O2) between the lung alveoli and the blood. O2 diffusing from the alveoli into the blood & CO2 from the blood into the alveoli. Diffusion requires a concentration gradient. 3 Fundamental of Nursing – 1st year -1st term(2024-2025) o Alveoli have very thin walls, but they have large surface area. This allows the oxygen in the alveoli to diffuse across the surface as much and as quickly as possible. o As gas exchange occurs, the acid-base balance of the body is maintained as part of homeostasis. 3-Transport of gases between blood and body cells (perfusion) It is the transport and utilization of oxygen by cells and the exchange of carbon dioxide or oxygen in the blood capillaries. The body cells utilize oxygen for the production of heat through oxidation and liberation of energy from food we eat. Respiratory Regulation (Control) The mechanism of respiration is controlled by 1- Nervous control: through the respiratory center in the medulla which initiate control and the action of respiratory muscles. 2- Chemical stimulation: The chemical regulator of respiration is the carbon dioxide level in the blood. As carbon dioxide accumulates in the blood, it has stimulating effect mainly on central chemoreceptors present in the medulla, and peripheral chemoreceptor present in the carotid bodies and aorta. This lead to stimulation of medullary respiratory center and so rate and depth of respiration is increased. Factors affecting respiration 1. Age: Rate of respiration is increased in infancy 40 c/m. 2. Gender: Females have more rapid rate. 3. Exercises: Cause temporary increase in respiratory rate. 4. During digestion: respiratory rate is increased. 4 Fundamental of Nursing – 1st year -1st term(2024-2025) 5. Emotion : increase respiratory rate and changes its depth 6. Discomfort and pain: increase respiratory rate. 7. Drugs: e.g. – Morphine, depress in respiratory rate. General anesthesia slow rate and depth of respiration. Co2, Caffeine and atropine stimulate respiration. 8. Changes in atmospheric pressure: In high places, respiratory rate is increased. 9. Hemorrhage: Increase respiratory rate. 10. Fever: Increase respiratory rate. cycles. Ideally, the respirations are observed for a full minute and reported as "RR=16 c/min." (meaning respiratory rate equals 16 respirations per minute). 11- The airway passage (nose, pharynx, trachea and bronchial tree) must remain clear and free from any obstruction such as: o Foreign body e.g. a piece of food, toy or any other small objects. o Liquid as in cases of drowning. o Secretion, tumor or edema in the respiratory tract and lung tissues. 12- The muscles of respiration (intercostal muscles and diaphragm) and abdominal muscles should be maintained in good condition, free from any abnormalities. 13- Adequate hydration is essential for respiratory function. 14- The circulatory system and blood which is the carrying system of oxygen should be in good condition and free from any abnormality. Assessment of respiratory functions It can be achieved through physical assessment and laboratory investigations. 5 Fundamental of Nursing – 1st year -1st term(2024-2025) Physical assessment: A) Assessment by observation: Normal respiration must be normal rate, depth and rhythm, noiseless, painless and without effort. 1- Respiratory rate Abnormalities of respiratory rate Tachypnea or It is a rapid breathing, the respiratory rate is above polynea the normal level Bradypnea It is a slow breathing. The respiratory rate is below normal level 2- Respiratory depth The depth is described as deep or shallow breathing depending on whether the volume of air taken in, is above or below normal. Normally the average volume of exchanged air is about 500 milliliter and depth of each respiration is the same. Abnormalities of respiratory depth Hyperpnea Increased depth of breathing with or without increase of its rate. 6 Fundamental of Nursing – 1st year -1st term(2024-2025) Abnormalities in rate and depth Hyperventilation Abnormal increase in rate and depth of respiration. Hypoventilation Abnormal decrease in rate and depth of respiration. Respiratory rhythm Normal respiration is rhythmic or regular e.g. time interval for each breath (inspiration, expiration and short period of rest) is equal approximately 4 seconds. Abnormalities of sound Stertorous Noisy respiration or snoring sound respiration. breathing Wheezy breathing Wheezy associated with each expiration or inspiration or both. This occurs when the air forced through narrow lumen (passage). Abnormalities related to effort Dyspnea Difficulty in breathing in any position. Orthopnea Difficulty in breathing in horizontal dorsal (lying) position. General appearance A person who has difficulty in breathing, attempts to find a position of comfort. Distress may be evident by facial expression. 7 Fundamental of Nursing – 1st year -1st term(2024-2025) Skin color Observe the color of skin and mucous membrane, Normally is pink. Cyanosis: blue discoloration of skin and mucous membrane. It is seen on lips, tips of the lopes of the ears, nail beds and at the ends of fingers or toes. It is due to defective oxygenation of the blood. Chest contour Notice whether chest contour is symmetrical right and left. A collapsed lung may be revealed by a smaller appearing chest cavity on that side or a deviated trachea. Fingertip Observe fingers. Clubbing may denote decrease oxygen assessment supply to the body cells. Speech People with normal respiratory function are able to finish pattern long sentences without pausing for breath. Breath odor Normally breath is odorless –Bad odor generally denote poor oral hygiene or respiratory infection. B-Assessment by palpation and percussion o By placing the palms of hands on the person’s chest: Normally, small vibration can be felt (fremitus); Due to air passage through the bronchi. When fluids is present, this vibration is increased. C- Assessment by auscultation : For listening to the sound of respiration and assessing the depth and rhythm. Normally respiration makes a quite sound. The nurse places the diaphragm of the stethoscope firmly against the chest wall as the patient breathes slowly and deeply through the mouth. 8 Fundamental of Nursing – 1st year -1st term(2024-2025) Investigation To determine any problems in the respiratory system such as: - Pulmonary function tests. -Blood gas analysis, PH. -Sputum culture. -Bronchoscopy. -A biopsy. -A radiograph of chest Common nursing measures to promote Normal Respiration Maintenance of normal oxygenation is important as a preventive measures for patients who have a tendency to respiratory difficulties e.g., inactive patients, post – operative patients, patients receiving certain drugs which affect respiration, patients in pain or individuals working in certain vocations. 1- Deep breathing exercises; This is done in the form of inhalation slowly and to the greatest chest expansion possible, holding breath for 3 seconds, and exhale slowly, this should be done frequently. 2- Effective Coughing; The nurse places the diaphragm of the stethoscope firmly against the chest wall as the patient breathes slowly and deeply through the mouth. 3- Proper positioning; Having patient assume a position that allow for free movement of the diaphragm and expansion of the chest wall, promotes easy respiration. As fowler, sitting, and semi-sitting positions. 4- Postural drainage; Gravity drainage of the lung by special positions depends on the area of the lung needs to be drained. 5- Percussion and vibration of the chest wall; To loosen the thick secretion from the bronchi. 9 Fundamental of Nursing – 1st year -1st term(2024-2025) 6- Adequate hydration An adequate or an above-normal fluid intake helps to minimize the viscosity of respiration secretions, thus make it watery and easily expelled out. 7- Humidification In some circumstances in which the air is dry, a humidification is necessary. Room humidification or direct humidification is used. Drug may be used. 10 Fundamental of Nursing – 1st year -1st term(2024-2025) 11 Fundamental of Nursing – 1st year -1st term(2024-2025) Pulse Definition Pulse, the expansion and recoiling of an artery, reflects the heartbeat. The pulse rate is a measurement of the heart rate; it is the number of times the heart beats in one minutes. Pulse occurs when the left ventricle of the heart contracts which pushes blood through the arteries, the arteries expand (stretch) with the flow of the blood. Pulse rate is an indirect measurement of cardiac output. Pulse Characteristics Pulse has characteristics of rhythm and strength, in addition to rate. The heart rhythm is generally noted as being regular when the beats occur at evenly spaced intervals or irregular when the beats are unevenly spaced. Even though irregular heartbeats may be benign, they may indicate potentially life-threatening cardiac dysfunction and should be reported to the physician to determine if more sophisticated monitoring or intervention is needed. The pulse strength is generally noted as strong, bounding/full, or weak. A strong pulse is normal. It can be palpated easily with mild pressure of the fingers and is not easily obliterated. A bounding or full pulse is even more pronounced and not easily obliterated with firm palpation. A weak pulse is one that is difficult to palpate and is easily obliterated with mild or light palpation. Weak pulses are also known as feeble or thready and may indicate a decreased stroke volume. The rate at which the heart beats per minute, usually measured to obtain a quick evaluation of a person’s health. 1 Fundamental of Nursing – 1st year -1st term(2024-2025) In addition to measuring the pulse to assess cardiac function, the quality of the pulse at peripheral sites can be used to assess local arterial perfusion. Normal radial and apical pulses are identical in rate. The stethoscope is used to auscultate the heart’s rate and rhythm. The stethoscope should be placed on the fifth intercostal space at the mid-clavicular line. Cardiac output (CO) is a measurement of the amount of blood pumped by each ventricle in one minute. To calculate this value, multiply stroke volume (SV), the amount of blood pumped by each ventricle, by heart rate (HR), in contractions per minute (or beats per minute, bpm). It can be represented mathematically by the following equation: CO = HR × SV SV can be measured using a specialized catheter, but this is an invasive procedure and far more dangerous to the patient. A mean SV for a resting 70-kg individual would be approximately 70 mL. Normal range for SV would be 55–100 mL. An average resting HR would be approximately 75 bpm but could range from 60–100 in some individuals. Pulse Assessment Pulse Rate: An average pulse rate for a resting adult is 72 bpm (beats per minute). Pulse Rhythm: means that beat are identical in force and separated by equal intervals and are evaluated as regular or irregular. When intervals between beats are constant, the pulse is regular, and when intervals are not constant, the pulse is described as irregular. Pulse Force refers to the pressure of the pulse wave as it expands the artery. Pulse force is determined as full or thread. When the pulse feels under fingertips weak and thin, the pulse is described as thread 2 Fundamental of Nursing – 1st year -1st term(2024-2025) Assessment of Pulse Normal Abnormal Rate 60-100 b/m Tachycardia or bradycardia Rhythm Regular Irregular Force Strong Weak Volume Full Empty A normal heart Rate for adults is between 60 and 100 beats per minute. A normal heart Rate for well-trained athlete, be closer to 40 beats Pulse Rhythm is the regularity of the heartbeat. It describes how evenly the heart is beating: regular (the beats are evenly spaced) or irregular (the beats are not evenly spaced). Dysrhythmia (arrhythmia) is an irregular rhythm caused by an early, late, or missed heartbeat. Pulse Volume is a measurement of the strength of force exerted by the ejected blood against the arterial wall with each contraction. It is described as normal (full, easily palpable), abnormal empty (thread and usually rapid), or strong (bounding). Resting Heart Rate Age Beats Per Minute (B.P.M.) Babies to Age 1 Year 100–160 Children Age 1 to 10 Years 60–140 Children Age 11 to 17 Years 60–100 3 Fundamental of Nursing – 1st year -1st term(2024-2025) Adults 60–100 Well-Conditioned Athletes 40–60 Common Sites for Palpating the Peripheral Pulse; 1. Radial Artery: At the wrist, is the most commonly used for palpating the pulse rate, because it is easily accessible and can be pressed against the radius bone. 2. The superficial temporal artery: in the temporal region. 3. The external carotid artery: in the neck. 4. The brachial artery: on the inner aspect of the upper arm, about halfway between the shoulder and the elbow. 5. The femoral artery: in the mid-groin. 6. The popliteal artery: behind the knee. 7. The dorsalis pedis artery: below the ankle on the dorsum of the food. 8. Posterior tibial: just behind the ankle bone 4 Fundamental of Nursing – 1st year -1st term(2024-2025) Apical Pulse: It is obtained by listening with a stethoscope over the apex of the heart on the fifth intercostal space about (8cm) to the left of the median line and slightly below the nipple. For more accurate estimate of the heartbeat, count the rate for a full minute. I – Pulse Rate Abnormalities - Tachycardia: The pulse rate is abnormally rapid. An adult is considered to have tachycardia when his pulse rate is 100 b/min. or more. - Bradycardia: The pulse rate is abnormally slow and below 60b/min. in an adult. II- Pulse Rhythm Abnormalities An irregular pulse rhythm is called arrhythmias Intermittent Pulse: a type of irregular pulse where a beat dropped either irregular or regular i.e. each 4beats there is a dropped beat or in the form of periods of normal rhythm broken by periods of abnormal rhythm. III- Abnormalities of Force and Volume Feeble, (Weak) Occurs when the volume of blood is very little and it is easy to stop the feel of blood wave with slight pressure of the finger tips. Bounding Pulse Occurs when it is very difficult to stop the feel of the pulse wave with mild pressure. A bounding pulse is a powerful and strong pulse which is experienced for a short period. Some bounding pulses can be seen and felt just underneath the skin if there is an artery located there. Under Normal Conditions, a bounding pulse can be caused by strenuous 5 Fundamental of Nursing – 1st year -1st term(2024-2025) exercise, anxiety, pregnancy, fever and alcohol use. The bounding pulse is generally a reflection of a rapid heartbeat. The sensation of a pulse is very obvious to the individual without even touching a pulse point. After a few minutes of rest, the pulse returns to normal, so this is not a cause for concern. Sometimes, however, a bounding pulse indicates serious medical conditions. The bounding pulse could mean that there is too much fluid in the circulatory system, this is called fluid overload. The bounding pulse is also an indicator of high blood pressure, aortic valve regurgitation, heart failure and chronic kidney failure. - Abnormalities of Pulse Rate and Force Thready Pulse: This type of pulse is weak in force and is of a rapid rate, it occurs in shock. Pulse Deficit: It is difference between a peripheral pulse rate and an apical pulse rate. If ventricular contractions are not strong or regular some of them may be so weak that the wave caused by the contraction does not reach the peripheral pulse site. In these instances the peripheral pulse counting is inaccurate. Therefore, apical rate should be counted before administering medication based on heart rate, such as digitals. Factors Affecting Pulse Rate: Although there is a normal range for the resting pulse rate, a number of factors, including age, time of day, gender, body build, 6 Fundamental of Nursing – 1st year -1st term(2024-2025) activity, stress, body temperature, blood volume, and anemia, as well as various medications, may alter this rate. 1) Sex; Women have a slightly faster pulse rate than men. 2) Age 3) Posture; a flat patient will have a slower heart rate than sitting or standing. The heart works harder against gravity. At the same time, the person is upright, so it speeds up its contractions to keep up with the increased demand. 4) Body temperature: The pulse rate increase about 10 b/m for each degree centigrade of temperature elevation. 5) Digestion: The increased metabolic rate during digestion will increase the pulse rate slightly. 6) Pain: Pain increases pulse rate. 7) Emotion: Fear, anger, anxiety, and excitement increase the pulse rate. 8) Exercise: The heart must beat faster during exercise to meet the increased demand for oxygen. 9) Blood pressure: In general, heart rate and blood pressure have an inverse relationship. When the blood pressure is low, there is an increase in pulse rate as the heart attempts to increase the output of blood from the heart (cardiac output). 10) Blood volume and anemia: When the blood volume decreases, heart rate increases to compensate. Heavy bleeding (due to trauma or illness) and dehydration are two common causes of decreased blood volume, which cause an increased heart rate. 11) Hormones: influence heart rate, especially epinephrine, norepinephrine, and thyroid hormones, all of which can increase the rate. 7 Fundamental of Nursing – 1st year -1st term(2024-2025) 12) Medications: For example, digitalis slows the rate, while epinephrine (Adrenalin) increases it. Caffeine can also cause palpitations or extra beats. 8 Fundamental of Nursing – 1st year -1st term(20242025) Blood Pressure Outlines 1. Definition of Blood Pressure. 2. Factors Controlling Blood Pressure. 3. Definition of Systolic Blood Pressure. 4. Definition of Diastolic Blood Pressure. 5. Normal Range of Blood Pressure. 6. Definition of Pulse Pressure. 7. Definition of the Abnormalities of Blood Pressure: Hypertension, Hypotension, and Postural Hypotension. 8. Factors Affecting Pulse and Blood Pressure. Fundamental of Nursing – 1st year -1st term(20242025) Blood Pressure Definition Blood pressure is the pressure of the blood against the walls of the arteries. Blood pressure results from two forces. One is created by the heart as it pumps blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow. Blood Pressure Numbers: Blood pressure (BP) is measured in millimetres of mercury (mmHg). If the first number is 120 and the second number is 80, this would be written as 120/80 mmHg, and call it ‘120 over 80’ BP varies between two readings of a maximum and a minimum pressure the reading is recorded as fraction Systolic Pressure 120 / Diastolic Pressure 80 mmHg The higher (systolic) number which is 120 represents the pressure while the heart contracts to pump blood to the body. The lower (diastolic) number which is 80 represents the pressure when the heart relaxes between beats. The measurement indicates the height to which the blood pressure can raise a column of mercury in cardiac cycle blood pressure reaches the peak. Blood pressure measured at a person's upper arm. It is measured on the inside of an elbow at the brachial artery, which is the upper arm's major blood vessel that carries blood away from the heart. Fundamental of Nursing – 1st year -1st term(20242025) Definition of Systolic Pressure It is the greatest amount of pressure exerted by the blood against the walls of arteries during maximum ventricular contraction. Definition of Diastolic Pressure It is the lowest amount of pressure exerted by the blood against the walls of arteries during the resting period of the heart i.e. during the relaxation of the ventricle (refractory period) just before a new ventricular contraction. NB. Resting period of the heart: is the time of coronary filling. It is known also as the refractory period. Blood Pressure Normal Range Systolic 120 ± 20 Normal Range of Blood Pressure: ‫ ــــــــــــ‬mm Hg. Diastolic 80 ±15 Pulse Pressure Is the difference between systolic and diastolic blood pressure. Pulse pressure =Volume of pulse beat. If blood pressure is 120/80 mm Hg. Pulse pressure is 120-80=40mm Hg. The pulse pressure is normally from 30-50 mm Hg. Abnormalities of Blood Pressure Hypertension: Abnormal elevation of blood pressure. The increase in blood pressure is symptom of a disease. It may bedue to increase in the force of the heart, peripheral Fundamental of Nursing – 1st year -1st term(20242025) vascular resistance, loss of elasticity of the blood vessel. The blood pressure is increased more than 120+20/80+15 mm Hg. Hypotension: Abnormal decrease in blood pressure, it may be due to hemorrhage, shock wasting or debilitating diseases. The blood pressure will be less than 120-20/ 80-15 mm Hg Postural Hypotension (Orthostatic Hypotension) Is a low blood pressure associated with weakness or fainting when rising to an erect position. It is the result of peripheral vasodilatation without a compensatory rise in cardiac output. This type of hypotension can usually be prevented by arising and moving the individual slowly especially after a period of bed rest. Classification of Blood Pressure for Adults Category Systolic, mmHg Diastolic, mmHg Hypotension < 90 < 60 Normal 90 – 119 60 – 79 Prehypertension 120 – 139 80 – 89 Stage 1 Hypertension 140 – 159 90 – 99 Stage 2 Hypertension ≥ 160 ≥ 100 Factors Controlling Blood Pressure 1- Pumping action of the heart (myocardial strength) - Weak pumping decrease in blood pressure. Fundamental of Nursing – 1st year -1st term(20242025) - Strong pumping action increase blood pressure +full and strong pulse. 2- Peripheral Vascular Resistance - Small blood vessel caliber increase blood pressure. - Large caliber of blood vessel decrease blood pressure, and decrease in volume of pulse. 3- Elasticity of Blood Vessels - Decreased elasticity increase blood pressure, as in old age and arteriosclerosis, and weak pulse. - Relaxation of arteries as in case of shock decrease in blood pressure and rapid weak pulse. 4- Blood Volume: Decrease volume as in hemorrhage decrease in blood pressure and weak pulse. 5- Viscosity of Blood Viscosity of blood increase in case of decreased blood volume. Increase in viscosity of the leads to increase in blood pressure. Factors Affecting Blood Pressure Exercise: Systolic pressure rises 20 to 30 mm Hg above baseline after moderate exercise as a result of an increase in contraction volume and pace. Moderate exercise often has little effect on diastolic pressure. This is Fundamental of Nursing – 1st year -1st term(20242025) because moderate exercise has little effect on peripheral resistance, which determines diastolic pressure. Systolic pressure increases by 40 to 50 mm Hg above baseline after intense muscular exertion. However, during intense muscular exertion, the peripheral resistance lowers, which causes the diastolic pressure to fall. Emotional Conditions: The release of adrenaline causes the blood pressure to rise during excitement or anxiety. Age: As people get older, their arterial blood pressure rises. Thus the risk of hypertension (high blood pressure) increases with age. Sex: Until menopause, arterial pressure in women is 5 mm Hg lower than the men belonging to the same age group. Females have increased pressure after menopause which is almost equivalent to that of men. Sleep: Usually, the pressure is lowered up to 15 to 20 mm Hg during deep sleep. However, it marginally rises while having dream-related sleep. Body Built: Obese people experience more pressure than thin people do. Also, after meals, there is an increase in cardiac output that causes a rise in arterial blood pressure for a short Day Time Variation typically lowest the in the early morning, It gradually rises during the morning and afternoon, peaking in late afternoon or evening. Fundamental of Nursing – 1st year -1st term(20242025) \Smoking: increase blood pressure, so refrain from smoking at least 30 minutes before having a blood pressure measurement taken. Assessment of Blood Pressure: Blood Pressure Measured The device used to measure blood pressure is a sphygmomanometer. It comprises a rubber armband and a cuff inflated by hand or machine pump. Once the cuff inflates enough to stop the pulse, it gives a reading either electronically or on an analog dial. The reading records the pressure exerted to move mercury around a tube against gravity. This is why blood pressure measurements use the unit millimeters of mercury (mm Hg). Typically, Measuring Blood Pressure does not cause any pain or discomfort. However, a person may feel a temporary sensation of tightness around the arm where the cuff inflates. Nursing Consideration for Auscultation: The best environment for blood pressure measurement by auscultation is a quiet room at comfortable temperature. Try to control the patient pain, anxiety or exertion and ask patient to refrain from eating or smoking before the assessment because these factors can cause false reading. Although the patient may lie or stand, sitting is the preferred position and according doctor orders Body Temperature OUTLINES Definition of Body Temperature Variations in Body Temperature Readings. Normal Body Temperature. Temperature Converting Formula Temperature Regulation Assessing Body Temperature Mechanisms of Heat Production and Heat Loss Alteration in Body Temperature Nursing Strategies to Lower and Raise Body Temperature 1 Fundamental of Nursing – 1st year -1st term (2024-2025) Body Temperature Definition Body temperature is the difference between the body's ability to generate and dissipate heat. Body temperature = Heat production – heat loss Core body temperature is higher than surface body temperature. For example, nurse has measured the body temperature for Mr. Ahmed at 6 pm at 2 sites in the same time, from axilla (i.e., body surface) was 36.5˚C, but from rectum (i.e., body core) was 37.5˚C Normal Body Temperature - The normal range of body temperature is 36.5˚C:37.5˚C - Temperature of 34˚C to 41˚C is the approximate range within which body cells can function. If body temperature decreased than 34˚C or increased than 41˚C body cells cannot function A Rectal or tympanic (ear) temperature reading is 0.5 to 1°F (0.3 to 0.6°C) higher than an oral temperature reading. A temperature taken in the armpit (axillary) is 0.5 to 1°F (0.3 to 0.6°C) lower than an oral temperature reading. Temperature Converting Formula To convert Fahrenheit to centigrade use the formula: °C =f-32÷1.8 To convert centigrade to Fahrenheit use the formula: F= (°C ×1.8) +32 2 Fundamental of Nursing – 1st year -1st term (2024-2025) Physiology of body temperature: The core body temperature is maintained within a constant range by the set point of the thermoregulatory center in the hypothalamus. The center receives messages from cold and warm thermal receptors located throughout the body, compares that information with its temperature set point, and initiates responses to either produce or conserve body heat or to increase heat loss. Temperature Regulation There are various regulating factors that affect body temperature, these are: 1. Physical Control. 2. Chemical Control. 3. Nervous System Control. 1- Physical Control The body gains heat from its environment, for example clothing, sun and ingestion of hot food 2- Chemical Control The body produces heat through the metabolism of food. Body metabolism increases in order to produce more heat for the body as necessary. The rate at which metabolism takes place affects and controls body temperature. An increase in the metabolism rate will result in an increase in body temperature and vice versa. 3- Nervous System Control Body temperature is maintained by the hypothalamus in the central nervous system, located at the base of the brain. The anterior portion of the hypothalamus is concerned with heat dissipation (loss), and the posterior portion of the hypothalamus governs heat conservation (gain). 3 Fundamental of Nursing – 1st year -1st term (2024-2025) Heat – Dissipating Mechanism The anterior part of the hypothalamus is stimulated by a very slight increase in the temperature of the blood above normal. It stimulates the sweat glands increase their rate of secretion. Evaporation of the large amount of sweat causes a greater heat loss which causes dilatation of surface blood vessels; so more heat is lost by radiation from the dilated skin vessels Body heat is lost through the (skin, lungs, and excretion of digestive and urinary tracts). The loss through the skin accounts about 85%of the total loss. Heat - Gaining Mechanism In a cold environment, the posterior portion of the hypothalamus is stimulated, this causes skin blood vessels constriction which decreases the volume of blood circulating near the surface and so decreases the heat loss by radiation. Mechanisms of Heat Production and Heat Loss The temperature control mechanisms of human are keeping the body's core temperature (temperature of the deep tissues) within the normal range. Mechanisms of heat production and heat loss: Heat Production Mechanisms Vasoconstriction Shivering Increase Activity Increase Metabolism Thyroxin and epinephrine (stimulating effects on metabolic rate) Heat Loss Mechanisms Radiation: Means the transfer of heat from surface to the surface of another object without contact between two objects. 4 Fundamental of Nursing – 1st year -1st term (2024-2025) Conduction: Means the transfer of heat from one object to another with direct contact. Convection: Means the transfer of heat away by air movement a fan promoting heat loss. Evaporation: Is the conversion of a liquid to a vapor evaporation about (600 to 900) ml evaporated through skin (sweating, diaphoresis Factors Affecting Heat Production Age - Infants and Young Children: Typically have higher average body temperatures and may show more significant fluctuations due to developmental factors. - Older Adults: Often have lower baseline temperatures due to changes in metabolism and thermoregulation. o Many older people, those over 75 yrs., are at risk of hypothermia (temperatures below 36°C, or 96.8°F) for a variety of reasons, such as; o Inadequate diet, o loss of subcutaneous fat o lack of activity o Reduced thermoregulatory efficiency. o Elders are also particularly sensitive to extremes in the environmental temp. due to decreased thermoregulatory controls Time Day Circadian Rhythm: Body temperature fluctuates throughout the day, generally lower in the morning and higher in the late afternoon and evening. 5 Fundamental of Nursing – 1st year -1st term (2024-2025) The point of highest body temperature is usually reached between 16.00 and 18.00 hours (4:00 PM and 6:00 PM) The lowest point is reached during sleep between 4:00 AM and 6:00 AM. Physical Activity - Exercise: Increases body temperature as muscles generate heat during activity. - Rest: Lower levels of activity can lead to a decrease in body temperature. Hormonal Changes Menstrual Cycle: Women may experience fluctuations in body temperature due to hormonal changes, particularly during ovulation and menstruation. Progesterone secretion at the time of ovulation raises body temperature by about 0.3°C to 0.6°C (0.5°F to 1.0°F) above basal temperature. Pregnancy: Increased hormone levels can raise baseline body temperature. Environmental Factors Ambient Temperature: High external temperatures can elevate body temperature, while cold environments may lower it. Extremes in environmental temperature can affect a person's temperature regulatory systems Time of Last Meal Food and Drink Intake: Eating can temporarily raise body temperature, especially with hot foods or beverages. Health Status Infections and Illness: Can cause fever, elevating body temperature as part of the immune response. Chronic Conditions: Certain medical conditions can alter baseline temperature or thermoregulation. 6 Fundamental of Nursing – 1st year -1st term (2024-2025) Medications Fever-Inducing Medications: Some medications can raise body temperature as a side effect. Antipyretics: Medications like acetaminophen can lower fever and thus body temperature. Stress and Emotions Physical and Emotional Stress: Can affect thermoregulation, sometimes leading to temporary increases in body temperature. Clothing and Insulation Clothing Type: Heavy Or Layered Clothing Can Trap Heat, Preventing Effective Heat Dissipation. Activity Level Engaging In Physical Activity While Wearing Insulating Clothing Can Elevate Body Temperature Thyroxin output: Increased thyroxin output increases the rate of cellular metabolism throughout the body. Epinephrine, norepinephrine, and sympathetic stimulation/stress response: These hormones immediately increase the rate of cellular metabolism in many body tissues. Epinephrine and norepinephrine directly affect liver and muscle cells, thereby increasing cellular metabolism. Sites to Measure Core Temperature: - Rectum - Tympanic membranes - Temporal artery - Pulmonary artery - Urinary bladder - Esophagus Sites to Surface temperature: - Oral 7 Fundamental of Nursing – 1st year -1st term (2024-2025) - Axillary Assessing Body Temperature Common Sites for Measuring Body Temperature: Oral, rectal, axillary, and the tympanic membrane and skin Oral Temperature Contra Indications of Oral Temperature include: - Can't close mouth for any reason (Breathing through mouth, persistent frequent coughing, Very old and weak patient who cannot close his mouth well). - Mouth is inflamed - Oral surgery/ broken jaw - Patient with seizure disorder. - Unconscious/agitated people - Infant or young children - After drinking hot fluids or cold fluids. Rectal Temperature: is considered to be very accurate. Contra Indications of Rectal Temperature; - Diarrhea. - Rectal surgery. - Hemorrhoids "pile" - Disease or inflammation of the rectum. Axillary Temperature Contraindications of Axillary Temperature; - Thin patient. - Local inflammation. - Unconsciousness, shocked patients - Axillary operation. - Constricted peripheral blood vessels. Types of Thermometers 1. Glass Thermometer (oral – rectal - axillary ) 2. Digital Thermometer 4-Electronic Thermometer 3. Chemical dot Thermometer 5-Infrared (Tympanic Thermometer) Alteration in Body Temperature - Hypothermia: Core temperature 37.8°C and is a normal response to infection, inflammation or drug therapy. Hypothalamus is functioning normally but the set point is raised beyond the normal level. - Hyperthermia: Core temperature > 40°C and body temperature is out of control. Associated with injury/damage to the head resulting in hypothalamic failure. - Heat Stroke: is a potentially serious condition produced by prolonged exposure to excessive temperatures, which can lead to coma and death, usually occurs around 41–42o C Fever Fever is characterized by an elevation of body temperature above the normal range of 36.5–37.5 °C (98– 100 °F) due to an increase in the temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering, causes unconsciousness and, if sustained leads to permanent brain damage. Emergency Treatment Body temperature over 105.8°F (41°C) in an adult is a medical emergency and requires immediate treatment. Signs and Symptoms of Fever -Pinkish (flushed) face. -Restlessness. -Poor appetite. -Eyes is sensitive to light. -Increased perspiration -Above normal pulse and respiration. -Disorientation and confusion. -Convulsion in infant and children. -Fever blister around nose or lips. Nursing Interventions for Hyperthermia Remove excess layers of clothing / bedding. Use a fan, reduce the room temperature or place the Patient near an open window Patient takes shower and dry well 9 Fundamental of Nursing – 1st year -1st term (2024-2025) An antipyretic may be prescribed after taken shower Increase fluid intake to help evaporation Monitor vital signs, Assess skin color and temperature, Measure intake and output Hypothermia The three physiologic mechanisms of hypothermia are: - Excessive heat loss - Inadequate heat production to counteract heat loss - Impaired hypothalamic thermoregulation The Clinical Signs of Hypothermia: - Decreased body temperature, pulse, and respiration, Severe shivering - Feelings of cold and chills - Pale, cool skin, Hypotension - Decreased urinary output - Lack of muscle coordination - Disorientation - Drowsiness progressing to coma Nursing Interventions for Hypothermia Add extra layers of thin clothing or bedding Encourage the Patient to wear a hat or cover the head, as most heat is lost through the scalp Give the Patient warm drinks Close any open windows and doors Increase the room temperature Monitor vital signs, Assess skin color and temperature, Measure intake and output. 10 Fundamental of Nursing – 1st year -1st term(20242025) Patient Centered Care Out lines: 1. Definition 2. Dimensions of Patient Centered Care 3. Common elements of effective patient-centered care plans 4. Benefits of Patient Centered Care 5. Patient Centered Care and Professional Nursing Practices Fundamental of Nursing – 1st year -1st term(20242025) Patient Centered Care Introduction: Patient-centered care (PCC) has become a key focus in the delivery of health care and providing care centered on patients' needs and expectations is a key attribute of quality care. The goal of patient centered care is to empower patients to become active participants in their care. Definition: PCC is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decision Dimensions of Patient Centered Care: Fundamental of Nursing – 1st year -1st term(20242025) 1. Respect for Patients’ Values, Preferences, and Expressed Needs  Accepting & respecting patient as a person  Involving patients in care decision-making  Listening and considering patients’ needs  Maintaining confidentiality to protect patients’ information 2. Coordination and Integration of Care  Working in multidisciplinary approach  Coordinating and integrating clinical care; ancillary and support services; and ‘frontline’ patient care  Involving patient and family in planning, decision-making and quality improvement processes at organizational level 3. Information and Education:  Providing accurate and understandable information to patients regarding their health status, treatment options, progress, and prognosis  Listening actively to the patient and family  Provide therapeutic touching and talking when necessary 4. Physical Comfort:  Promoting comfortable and supportive hospital environment (e.g., privacy, cleanliness, comforts, accessibility for visits)  Providing timely, tailored, and expert management of symptoms  Providing basic health care that supports and maintains normal body functions Fundamental of Nursing – 1st year -1st term(20242025) 5. Emotional Support and Alleviation of Fear and Anxiety  Listening to patient with undivided attention  Providing clear, timely and meaningful information regarding the illness  Caring with empathy 6. Involvement of Family and Friends  Respecting and acknowledging the family and friends’ support in patient care  Respecting the role of the person's advocate in decision making and supporting family members and friends as caregivers, and recognizing their needs as well  Providing with enough information regarding the patient’s illness 7. Continuity and Transition:  Providing clear information and education on dangers signs to watch, whom to contact if there are questions, what to do in emergency, how to handle treatments, dressing changes, and medications, physical restrictions, and nutrition.  Referring patient to appropriate health centre with clear discharge instructions 8. Access to Care  Patients should be assured about and made aware of their access to ambulatory care, access to specialists and specialty services when needed, health care settings and services, and availability of transportation. Fundamental of Nursing – 1st year -1st term(20242025)  Patients should be informed about scheduling process and availability of appointments Common elements of effective patient-centered care plans:  Care is collaborative, coordinated, and accessible.  The right care is provided at the right time and the right place.  Care focuses on physical comfort as well as emotional well-being.  Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected.  Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level.  The presence of family members in the care setting is encouraged and facilitated.  Information is shared fully and in a timely manner so that patients and their family members can make informed decisions. Benefits of Patient Centered Care:  Improved satisfaction among patients and their families.  Enhanced reputation of providers among health care consumers.  Better morale and productivity among clinicians and ancillary staff.  Improved resource allocation.  Reduced expenses and increased financial margins throughout the continuum of care. Fundamental of Nursing – 1st year -1st term(20242025) Patient Centered Care and Professional Nursing Practices:  The implementation of PCC among healthcare workers is an essential part in daily work  The nursing staff is 24 hours a day at the bedside of the patient; they play the most significant role in PCC implementation.  Currently health care organization focuses in shifting from the previous approach which was medically dominated and disease orientated to a patient centered approach.  One of the main nursing efforts is to identify patients' needs and problems. This requires that the patients' interpretations of nursing care be examined.  Certainly, patient centered care requires nurses to ask patients about their perception of care and the importance of prioritizing various nursing care activities.  It is important that nurses validate with the patients that their caring needs are being met. Moreover, nurses have to pay attentions to all aspects of nursing care that patients consider to be important.  Health care professional should be vital in the evaluation of patient centered care  One of the most important elements in PCC implementation is the training of nursing staff on PCC. The nursing training programs should provide nurses with tools to identify the unique needs of each patient, as well as provide tools for shared decision making. One of the important tools for this is advanced communication skills Fundamental of Nursing – 1st year -1st term(20242025)  Nurses should know the patients and adapt the plan of care to meet their, perspectives, beliefs, and values.  Furthermore, individualized comprehensive nursing care should respect and focuses on emphasizing views and wishes of patients. Nurses need to ensure that they are providing care according to what the patients want and not what the nurses want. Fundamental of Nursing – 1st year -1st term (2024-2025) Medical Asepsis Out Line  Introduction  Definition of terms.  Chain of infection  Body defenses against infection.  Breaking the chain of infection  Specific medical asepsis practice in health care settings  Isolation techniques  Guidelines for preventing blood born disease.  Common practice of medical asepsis in everyday living. Fundamental of Nursing – 1st year -1st term (2024-2025) Medical Asepsis Medical Asepsis: Is the state of being free from microorganisms causing disease. Medical asepsis is concerned with eliminating the spread of microorganisms. Medical asepsis includes all measures aimed to reducing number or spread of microorganisms. Medical Asepsis (clean technique) is the practices used to:  Remove or destroy pathogens  The number of pathogens is reduced.  Prevent pathogens from spreading from one person or place to another person or place Definition:- Medical Asepsis: Medical Asepsis called (clean technique) Practices that reduce possibility of disease by reducing the number, growth, transfer and spread of pathogenic microorganisms Surgical Asepsis Surgical Asepsis called (Sterile Technique) Practice that rendered to keep objects and areas free from all microorganisms, and spores. Sepsis: - Poisoning of body tissue, usually refer to blood borne organisms or their toxic products. Asepsis: - Freedom from infection or infectious material. Asepsis is being free from microbes producing disease. Nosocomial Infection: - (Hospital acquired infection) an infection acquired during Fundamental of Nursing – 1st year -1st term (2024-2025) hospitalization. Infectious Agent: - A microbial organism with the ability to cause disease. The greater the organism's virulence (ability to grow and multiply), invasiveness (ability to enter tissue), and pathogenicity (ability to cause disease), the greater the possibility that the organism will cause an infection. Infectious agents are Bacteria, Viruses, Fungi, and Parasites. Pathogen: Any disease produced by a microorganism. Disinfection: - refers to chemical or physical processes used to reduce the number of pathogens on an object surface. Disinfectant: - A chemical used on lifeless objects. They are used to kill and remove microorganisms from equipment’s, supplies, floors, and walls. Antiseptics: - A chemical used on living object. Chemical such as alcohol that inhibit the growth of but do not kill microorganisms are also known as bacteriostatic agents. Resident Microorganism: - generally non pathogens that are constantly present on the skin. Transient Microorganism: - Pathogen picked up during brief contact with contaminated reservoir. Isolation: - Techniques used to prevent or limit the spread of infection. Patients diagnosed with an infectious disease are placed on isolation to prevent the transmission of pathogens to others. Chain of Infection 1. Infectious Agent. 2. Reservoir. 3. Portal of Exit. 4. Means of Transmission. Fundamental of Nursing – 1st year -1st term (2024-2025) 5. Portal of Entry. 6. Susceptible Host. 1. Infectious Agent: Infectious agent are microorganisms that can be grouped into 5 classifications; viruses, bacteria, fungi, protozoa, and rickettsia. In order for an infection to occur, an infectious agent must be present. Safety: Cleansing, disinfection and sterilization can prevent spread of infection 2. Reservoir: Reservoirs are people, equipment, supplies, water, food and animals or insects '' known as vectors '' The second level in the chain of infection is the reservoir or the location of the infectious agent. Safety: hand washing, environmental hygiene, disinfection, sterilization 3. Portal of Exit: The infectious agent must leave the reservoir to infect another person; the portal of exit is Fundamental of Nursing – 1st year -1st term (2024-2025) the method by which an infectious agent leaves the reservoir Microorganisms may leave the human body with normally occurring body fluids such as excretions, secretions, skin cells, respiratory droplets, blood or any fluid Safety: standard precautions and transmission-based precautions are infection control methods based on the knowledge that exiting infectious diseases can be spread to another 4. Means of Transmission: Means of transmission are specific ways in which microorganisms travel from one place '' reservoir'' to another '' susceptible host'' Routes of transmission include: Direct contact: '' touching an infected person'' Airborne transmission:'' inhaling the microorganism into the susceptible host's respiratory system'' Blood born transmission: '' infected blood enters the susceptible host'' Ingestion: '' eating or drinking contaminated items'' Indirect contact: ''microorganisms are on a non-living object such as a table or piece of equipment that can absorb and transmit infection ''Vector: '' a carrier of the disease usually an insect'' Safety: standard based precaution, hand washing, sanitation, disinfection and sterilization 5. Portal of Entry: The portal of entry allows the agent access to the next person; common entrance sites to the human body include broken skin, mucous membranes and systems' respiratory, ingestion and sexual'' Safety: sterile wound care, aseptic technique and maintain skin integrity 6. Susceptible Host: Infectious microorganisms enter another person who is susceptible which means that the person is able to contract the pathogenic organism Safety: Identifying persons at risk for susceptibility treat their underling conditions if possible and isolate them from those reservoirs that could be hazardous. Fundamental of Nursing – 1st year -1st term (2024-2025) Susceptibility of the person depends on several factors: A. Number and specific type of pathogens B. Duration of exposure to the pathogens C. General physical condition D. Occupation and life style environment E. Presence of underling disease or conditions F. Youth or advanced age Microorganisms Microorganisms (MO) Comes from Micro = small and organism = body. Cannot be seen with the naked eye, only under the microscope. Are found everywhere, both inside and outside the body The main factors determine whether the pathogen successfully causes infection - Type and number of microorganisms (MO) - Characteristics of microorganisms - Ability to enter and survive in host - Person’s state of health (susceptibility of the host) - The presence of all elements of the infection chain Pathogens: They are microorganisms that can cause infectious diseases. Infection: It is the pathological state resulting from the invasion of the body by pathogenic microorganisms Body Defenses against Infection The body has natural physical, chemical, and cellular defenses against invasion by pathogens as viruses, bacteria or other agents of disease. First Line of Defense: Fundamental of Nursing – 1st year -1st term (2024-2025) Body parts and mechanisms that preventing the pathogen from entering to the body include; Skin (acts as a physical barrier against the entry of pathogens) Mucus Membranes (inhibit the growth of most pathogenic microbes). - Mucus and Cilia (Microorganisms are trapped in sticky mucus and expelled by cilia) - Tears and Saliva (wash bacteria away). - Coughing or Sneezing - PH of Body Areas Second Line of Defense (Non-Specific Response): If a pathogen get entrance into the body, the second line of defense takes place involving a range of defense mechanisms occur inside the body (Phagocytic white blood cells, inflammation and fever) as a response to the presence of any pathogen to inhibit or destroy it. This is called Active Immunity. The White Blood cells have key functions Break Chain of Infection Fundamental of Nursing – 1st year -1st term (2024-2025) Common Practices of Medical Asepsis in Everyday Living: The following practices are examples of good medical asepsis that should be maintained in everyday living 1. Cover the nose and mouth when coughing and sneezing. While coughing and sneezing large numbers of organisms from mouth. Nose and throat spread to the environment, where they may be inhaled by others. 2. Wash hands before handling food to prevent transferring organisms from your hands to the food 3. Use personal care items, such as towels, tooth brushes, combs, hair brushes, shaving gear and so on. This helps prevent spreading organisms from one person to another. 4. Wash hands after using bathroom to prevent spreading organisms found in excretions. 5. Use water fountains instead of public drinking cups to protect yourself and others from organisms lodged on cups 6. Use pasteurized milk that has had many organisms removed. 7. License food handlers and inspect public eating places for protection from people carrying diseases and from poor practices of hygiene. 8. Control pests that may spread diseases, such as rats and mosquitoes. 9. Have regulations for immigrants and visitors who may enter the country with infectious diseases that can spread to others. 10. Use refrigerator for keeping the remaining food. 11. Use a tong to lift food from common service trays in cafeterias. 12. Use of T.V, Radio, newspaper in health teaching regarding sources of disease and ways of prevention. 13. Family consultation for newly married couples. Fundamental of Nursing – 1st year -1st term (2024-2025) 14. Proper safe water supply. 15. Proper safe sewage disposable. 16. Control of air pollution. 17. Use of system of health insurance for every individual. 18. Pre-employment medical examination to detect early any source of disease. Common Practices of Medical Asepsis at Hospital: 1. Wash hands before and after giving nursing care and after handling equipment and supplies used for care. 2. Discard discharges promptly and according to agency policy. Bandages, dressing, tissues and cotton balls are commonly used to absorb discharges. They can easily spread organisms of not discarded properly. 3. Wrap damp or wet items such as dressings and bandages on a waterproof bag before discarding them so that handlers of garbage will not come in contact with body discharges. 4. Discard disposable equipment according to agency policy. All equipment used for patient care is considered contaminated after use. 5. Flush away content of bed pans and urinals promptly, safe to flush its content into sewage system. Sewage treatment destroys pathogens. 6. Use equipment and supplies for one patient only. If they are to reused by another patient, clean them thoroughly and then disinfect or sterilize them in the manner described later on, to prevent spreading organisms among patients. 7. Cover breaks in the skin with sterile dressing. Breaks in the skin are a good portal of entry for many organisms. 8. Keep soiled equipment and supplies, especially linens away from your uniform so that you do not carry organisms from patient to patient and yourself. Fundamental of Nursing – 1st year -1st term (2024-2025) 9. Consider the floor heavily contaminated. Discard any item if it fall to the floor, or clean it before using it. Also disinfect or sterilize it as necessary. 10. Avoid raising dust which can carry organisms, use a vacuum cleaner and dampened or treated cleaning to prevent organisms from being carried about with air currents. 11. Do not shake linens, this create drafts that will carry contaminated dust from pace to place. Clean the least soiled areas first and the most soiled area last. This prevents having cleaner area soiled even more by material from dirtier area. 12. Pour liquids to be discarded, such as bath water and mouth wash rinsing directly into a drain or toilet. 13. Avoid spilling and splashing these liquids on yourself, the floor or other equipment because they are very likely to contain pathogens. 14. Keep the patient's room as clean, bright, dry and airy as possible because organisms do not grow well in such an environment. 15. If in doubt about whether an item as clean or not, if necessary, sterile it in order to be safe and not use the item until you have cared for it properly to help prevent the spread of organisms. Isolation Technique Practices that limit to spread of communication pathogens. There are several common practices to help control the transmission organism by personal contact (hand washing – wearing gloves- gown – mask – hair & shoe covers). Types of Isolation Practices The centers of disease control (CDC) have categorized isolation techniques into groups to help health personnel use appropriate techniques for various communicable illnesses. Types of Isolation Fundamental of Nursing – 1st year -1st term (2024-2025) Strict Diphtheria Enteric Cholera, Poliomyelitis, and Typhoid Respiratory Measles, Mumps, and Meningitis Wound Skin infection, and wound infection Blood Malaria, Hepatitis, and AIDS caused by (Human Immunodeficiency Virus) Isolation: Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons. *Standard Personal Protective Equipment (PPE) uses according to Types of Isolation Body Substance Isolation (BSI) Body Substances include: – Blood – Urine – Feces – Wound drainage – Any other body product or tissue – Oral secretions Types of Isolation Technique: Strict Isolation Strict Isolation is used to prevent transmission of highly communicable diseases which can be spread by both the contact and airborne routes. Refer to the Isolation/Precaution Policy for diseases requiring Strict Isolation. Private Placement Patient placement in a private room is required. Ideally a room with an ante-chamber, and a negative-airflow setup should be used. The door(s) to the room must be kept closed at all times. Those who are kept in strict isolation are often kept in a special room at the facility designed for that purpose. Such rooms are equipped with a special lavatory (WC) Fundamental of Nursing – 1st year -1st term (2024-2025) and caregiving equipment, and a sink and waste disposal are provided for workers upon leaving the area Alert others Involved Placing a Strict Isolation sign on the door to the room, placing Strict Isolation Tape on the front of the patient's chart, and placing an Isolation Cart outside the patient's room. Create a Protective Barrier: All healthcare workers entering the room must wear masks, gloves and gowns. Change gloves after having contact with infective material, and always remove gloves prior to leaving room. Wash hands immediately. Clear the Way for Essential Transport: Prior to transporting a patient, notify the accepting unit of the patient's impending arrival. Have the patient wear a surgical mask, clean linens and clear the transport path and arrival area of other patients and visitors. Immediately place the patient in a private room or waiting area. Limit Visitors Visitation to patients on Strict Isolation should be limited to immediate family/caregivers. Visitors should follow the Strict Isolation Policy. Enteric Isolation Enteric isolation refers to the avoidance of any contact with bodily fluids of a patient due to pathogens or chemotherapy treatment that can be transmitted via these fluids. 1. Visitors must report to the nurses' station before entering the room. 2. Gowns must be worn by all persons having direct contact with the patient. 3. Masks are not necessary. Fundamental of Nursing – 1st year -1st term (2024-2025) 4. Gloves must be worn by all persons having direct contact with the patient or with articles contaminated with fecal material. 5. Special precautions are necessary for articles contaminated with urine and feces. Articles must be disinfected or discarded as typhoid, cholera, and poliomyelitis. Respiratory Isolation. 1. Visitors must report to t h e nurses' station before entering t h e room. 2. Door must be kept closed. 3. G o w n s are n o t necessary. 4. Masks m u s t be w o r n by any person entering t h e room unless that person is n o t susceptible to t h e disease 5. Hands must be washed on entering a n d leaving t h e room. 6. Gloves are n o t necessary. 7. Articles contaminated with secretions m u s t be disinfected as measles, mumps, and meningitis. Blood Isolation 1. Visitors must report to the nurses' station before entering the room. 2. Door must be kept closed. 3. Gowns must be worn by all persons entering the room. 4. Masks are not necessary 5. Hands must be washed on entering and leaving the room. 6. Gloves must be worn by all persons having direct contact with the patient. 7. Articles must be handled according to local Standard of Percussion as malaria, hepatitis, and aids. Fundamental of Nursing – 1st year -1st term (2024-2025) Wound and Skin Precautions 1. Visitors must report to t h e nurses' station before entering t h e room. 2. Gowns must be worn by all persons having direct contact with t h e infected wound. 3. Masks are n o t necessary except during dressing changes as wound infection, skin infection, and conjunctivitis. Fundamental of Nursing – 1st year -1st term (2024-2025) INTESTINAL ELIMINATION Introduction: Elimination is essential process to rid the body of wastes and materials that are harmful for body if it was accumulated. Elimination process is necessary to maintain high level of wellness and must continue during illness as in health. Physiology of the Digestive System The digestive system Composed of the gastrointestinal tract (GIT) or (Alimentary canal) and accessory organs. 1. Alimentary canal – mouth, pharynx, esophagus, stomach, small intestine, and large intestine 2. Accessory digestive organs – teeth, tongue, gallbladder, salivary glands, liver, and pancreas. Digestion: Refer to All those processes involved in breaking down large, complex, insoluble molecules into simple, soluble so that these substances can be absorbed quickly into the blood for transport to the cells that utilize them. Fundamental of Nursing – 1st year -1st term (2024-2025) Function of small and large intestines: The small intestine is where the vast majority of digestion takes place. Most food products are absorbed in the small intestine. The large intestine is responsible for absorption of water and excretion of solid waste materials. Food and waste materials are moved along the length of the intestine. Waste is solid because most of the water has been removed by the intestines. The Act of Defecation: Defecation: is an evacuation of the intestines and is referred to as a bowel movement. Fundamental of Nursing – 1st year -1st term (2024-2025) Factors Influencing Fecal Elimination: 1. Diet: It is one of the most important factors affecting -Changes in the secretion and motility of the alimentary canal. -The type and amount of bacteria entering the digestive system will affect the fecal characteristics. - Fluid intake has to do with stool consistency. 2. Psychological Factors: - In period of stress caused by fear, grief, or anger and depression, may increase or decrease muscle spasms or peristaltic activity result Diarrhea or constipation 3. Physical Activity: Physical activity influences elimination by promoting the development of muscle tone as well as by stimulating appetite and peristalsis. - Increased activity will stimulate the colon. - Immobility, changes in posture or sleep will depress the colon. 4. Neurogenic Conditions: Neurogenic conditions of the nervous system, such as, brain and cord tumors, and meningitis frequently leave a person with chronic constipation. 5. Muscular Condition: Abdominal, pelvic and diaphragmatic muscles play an important role in Fundamental of Nursing – 1st year -1st term (2024-2025) initiating and completing defection. Any Injuries or other conditions affecting the strength of tense muscles will therefore make evacuation difficult. 6. Mechanical Obstruction: Obstruction Actual physical blockage or narrowing of the intestines caused by neoplasm and inflammatory lesions. Result to constipation or distention. 7. Drugs: e.g. Laxatives excessive use lead to constipation. constipation may be caused by Certain medications, including pain medications, and diuretics. Common Problems of Intestinal Elimination (1) Constipation: The passage of unusually dry, hard stools produced by delay in the passage of feces. (2) Fecal Impaction A prolonged retention or an accumulation of fecal material which forms a hardened mass in the rectum. It may be of sufficient size to prevent the passage of normal stool. (3) Intestinal Distention (Tympanitis) Excessive formation and accumulation of gasses in the intestines Fundamental of Nursing – 1st year -1st term (2024-2025) (4) Diarrhea: The passage of loose, watery stool and an increase in the frequency of bowel movements (5) Fecal ( anal ) incontinence Inability of the anal sphincter to control the discharge of feces, i.e. loss of voluntary control over the act of defecation Fundamental of Nursing – 1st year -1st term (2024-2025) 1)Constipation: The passage of unusually dry, hard stools produced by delay in the passage of feces. Causes: 1. Poor elimination habits the feces become hard and dry because of increased water absorption. 2. Lack of sufficient roughage or bulk in diet. 3. Lack of enough fluid intakes. 4. Lack of muscle tone due to too much stimulation by irritating substances such as laxatives. 5. Emotional tension: May causer fecal content is not moved along the large intestine sufficiently well. 6. Pain associated with defecation, e.g. piles, fissures etc. 7. Lack of essential vitamins such as vitamin B, group or mineral as potassium. 8. Lack of exercise: Decrease peristaltic movement loss of muscle tone. Nursing Management of Constipation  Provide adequate fluid intake 1500 - 2000 cc/day.  Provide a well-balanced diet with enough roughage from fruits and vegetables and vitamins  Encourage regularity of time for defecation and prompt response to the desire of defecation.  Encourage regularity of meal's time.  Provide; adequate time for complete evacuation.  Provide privacy for patients to promote relaxation. Fundamental of Nursing – 1st year -1st term (2024-2025)  Provide posture (position) as close to normal as possible.  Provide physical and emotional comfort and alleviation of pain.  Provide physical exercises especially for abdominal muscles.  Consider the patient's habit in relation to defecation. Prevention of Constipation  Encourage exercise as walking  Avoid excessive emotional stress..  Establish regularity of meals and defecation time.  Discourage unnecessary use of laxatives  Intake of proper diet containing enough vegetables and vitamins.  Intake of sufficient fluids per day. (2) Diarrhea: Definition: The passage of loose, watery stool and an increase in the frequency of bowe1 movements. Diarrhea may or may not be accompanies by abdominal cramping. Causes: Due to several causes either organic disease or psychic factors: The most common types are due to irritation of the gastrointestinal tract: Fundamental of Nursing – 1st year -1st term (2024-2025)  Irritation by: bacteria (acute diarrhea): o e.g Salmonella , Ameba  Irritation by parasites  Irritation by mechanical means: o Excessive amount of coarse foods, Foreign body  1rritation by chemical means: o Poisons, Laxatives, Hot foods.  Allergic diarrhea.  Diarrhea due to inflammations of the intestines e.g. enteritis of small intestine or colitis Signs and symptoms:  Generalized abdominal pain which is spasmodic in nature due to strong peristaltic action.  Pains are accompanied by feeling of urgency in the need to defecate.  Complaints of tenesmus and may pass a small watery discharge,  Increase in the frequency in the number of stool (stool is watery in nature).  Signs and symptoms of dehydration may occur if diarrhea is very sever or over a long time such as: poor skin turgor, thirst, and acute weight loss. Fundamental of Nursing – 1st year -1st term (2024-2025)  General weakness and general malaise.  There may be nausea, vomiting, anorexia and sometimes increase body temperature. Nursing care of patients with diarrhea:  Assessment and observation of the patient, this include: o Assessment of the stool in terms of frequency, consistency, odor and presence of foreign matter as mucous, pus, blood or undigested food, o Observation of the patient for signs arid symptoms of the dehydration and electrolyte loss. With diarrhea there is acute loss of potassium' and sodium chloride.  Diet:- Provision of proper diet for maintenance of proper nutrition. o Diet : free from roughage , Rich in liquids, Free from irritants, low in fat, and rich in proteins such as: white meat (boiled chicken and other non-fatty meat).  If diarrhea is psychogenic, provide for psychological comfort and relaxation.  Provide for physical comfort and hygienic care  If diarrhea is due to infection, isolation technique must be followed.

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