402 Fundamentals Exam 1 (1).pdf

Week 1- 1,2,3,4,7 Chapter 1- Introduction to Nursing and Professional Formation Historical Perspective/Early Civilizations to the 16th Century #1 - Theory of animism - Good spirits brought health; evil spirits brought sickness and death - Roles of nurse and physician sep...

Week 1- 1,2,3,4,7 Chapter 1- Introduction to Nursing and Professional Formation Historical Perspective/Early Civilizations to the 16th Century #1 - Theory of animism - Good spirits brought health; evil spirits brought sickness and death - Roles of nurse and physician separate and distinct: - physician as medicine man - nurse as caring mother - Ancient Greek civilization - Temples became center of medical care - Nurses cared for the sick in the home and community; practiced as nurse-midwives Historical Perspective/Early Civilizations to the 16th Century #2 - Early Chrisitan period - Nursing role becomes more formal and clearly defined; deaconesses made visits to the sick - Male and female nursing orders were founded during the Crusades - 16th century - Shift from a religious orientation to an emphasis on warfare, exploration, and expansion of knowledge - Shortage of nurses led to the recruitment of female criminals to care for the sick; a time of poor reputation, low pay, and long work hours in unfavorable conditions Historical Perspective/ 19th-20th Centuries #1 - Social reforms changed the roles of nurses and of women in general - Nursing as we now know it began: based on many of the beliefs of Florence Nightingale(“lady with the lamp”, founder of modern nursing) - Nightingale challenged prejudices against women and elevated the status of all nurses - She established the 1st training school for nurses and wrote book about health care and nursing education Historical Perspective/ 19th-21th Centuries #2 - Hospital schools organized to provide more easily controlled and less expensive staff for the hospital - Female nurses were under the control of male hospital administrators and physicians - World War II - Large numbers of women worked outside the home and became more independent and assertive  - Explosion in medicine and technology broadened the role of nurses - Growth of nursing as a professional discipline Historical Perspective/1950s to Present - Nursing broadened in all areas - Efforts were directed at upgrading nursing education - Practice in a wide variety of health care settings - The development of a specific body of knowledge - The conduct and publication of nursing research - Recognition of the role of nursing in promoting health - Increased emphasis on nursing knowledge as the foundation for EBP led to growth of nursing as a professional discipline that operates independent of other disciplines Some Leaders in American Nursing (don’t memorize) - Clara Barton (1821-1912)- founded American Red Cross - Linda Richards (1841-1930)- First American trained nurse - Developed nurse’s notes - Mary Mahoney (1845-1926)- First African American Professional Nurse - Lillian Wald (1867-1940)-Founder of public health nursing. Henry St. Settlement - Lavinia Dock (1858-1956)- Women’s rights; - campaigned for legislation to allow nurses to control own practice - Margaret Sanger (1879-1966)- Public health nurse in NY, founder of Planned Parenthood - Mary Breckinridge (1881-1965)- established Frontier Nursing Service Definitions of Nursing - Originated from the Latin word nutrix (to nourish) - ICN definition—Promotion of health, prevention of illness, advocacy, promotion of a safe environment, research, participation in shaping health policy, and education - Patient is central focus of all definitions - Includes physical, emotional, social, and spiritual dimensions of the patient Nursing’s Aims - Promote health - Prevent illness - Restore health - Facilitate coping with disability or death 4 Blended Competencies - Cognitive - Technical - Interpersonal - Ethical/legal QSEN Competencies - Patient-centered care - Teamwork and collaboration - Quality improvement - Safety - Evidence-based practice - Informatics Interrelated Roles - Caregiver - Communicator - Teacher - Counselor - Leader - Researcher - Advocate - Collaborator Promoting Health - Identifying, analyzing, and maximizing each patient’s individual strengths as components of preventing illness, restoring health, and facilitating coping with disability or death - WHO (1974) definition: - Health is a state of complete physical, social, and mental well-being, and is not merely the absence of disease or infirmary Factors Affecting Health - Genetic inheritance - Cognitive abilities - Educational level - Race and ethnicity; culture - Age and biologic sex  - Developmental level - Lifestyle; environment - Socioeconomic status - Health Literacy Preventing Illness - Reducing the risk of illness, promoting good health habits, and maintaining optimal functioning - Nurses prevent illness primarily by teaching and by personal example - Educational programs in areas such as prenatal care for pregnant women, smoking-cessation programs, and stress-reduction seminars - Community programs and resources encouraging healthy lifestyles - Literature, TV, radio, or Internet information on healthy diet, exercise, and good health habits - Health assessments in institutions, clinics, and community settings that identify areas of strength and risks for illness Restoring Health - Focus on the person with an illness and are considered to be the nurse’s responsibility - Performing assessments that detect an illness - Referring questions and abnormal findings to other health care providers, as appropriate - Providing direct care to the person who is ill - Collaborating with other health care providers - Planning, teaching, and carrying out rehabilitation for illnesses - Working in mental health and chemical-dependency programs Facilitating Coping With Disability and Death - Maximizing person’s strengths and potentials - Patient teaching - Referral to community support systems - Providing end-of-care - Hospice programs Nursing as a Professional Discipline - Well-defined body of specific and unique knowledge - Strong service orientation - Recognized authority by a professional group - Code of ethics - Professional organization that sets standards  - Ongoing research - Autonomy and self-regulation Professional Formation - Role Socialization - Educational Preparation - Professional Nursing Organizations Guidelines for Nursing Practice - Standards of Nursing Practice- ANA’s Nursing Scope and Standards of Practice - Nurse Practice Acts and Licensure- State Boards of Nursing - Code of Ethics and Professional Values- ANA and AACN - Nursing Process & Other Clinical Judgment Models ANA Scope and Standards of Practice - Provides parameters for practice - It contains 17 national standards of practice and performance which define the: - Who - What - Where - When - Why - How of nursing practice - It outlines key aspects of nursing’s professional role and practice for any level, setting, population focus, or specialty. Nursing Practice Acts - Define legal scope of nursing practice - Create a state board of nursing to make and enforce rules and regulations - Define important terms and activities in nursing, including legal requirements and titles for RNs and LPNs - Establish criteria for the education and licensure of nurses Professional Licensure New York State - Registered Professional Nurse (RN) may: - diagnose and treat a patient’s unique responses to diagnosed health problems; - perform health assessments to identify new symptoms of possibly undiagnosed conditions or complications,  - teach and counsel patients about maintenance of health and prevention of illness or complications; - execute medical regimens as prescribed by licensed physicians, dentists, nurse practitioners, physician assistants, and podiatrists, and, - contribute as members of an interdisciplinary health care team and as consultants on health-related committees to plan and implement the health care needs of consumers Code of Ethics - Developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. - American Nurses Association (ANA): - https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics- for-nurses/ - As a nursing student you are held to the ANA code of ethics The 5 Core Professional Nursing Values (AACN) - Human Dignity - Integrity - Autonomy - Altruism - Social Justice Nursing Process 1. Assessment 2. Nursing diagnosis 3. Planning 4. Implementation 5. Evaluation Chapter 2- Theory, Research, and Evidence-Based Practice Framework of Nursing Theory - Theory: group of concepts that describe a pattern of reality - Can be tested, changed, or used to guide research - Concepts: abstract impressions organized into symbols of reality; describe objects, properties, and events and relationships among them - Conceptual framework or model—a group of concepts that follow an understandable pattern  - Nursing theory is developed to describe nursing and differentiates it from other disciplines and activities - Theories are derived through two principal methods: - Deductive reasoning - Look at general idea then considers specific actions/ideas - Inductive reasoning - Reverse: builds from specific ideas to - conclusions about general ideas Nursing Theories - Provides rational and knowledgeable reasons for nursing interventions - Descriptive: phenomenon, event, situation, relationship - Prescriptive: nursing interventions, consequences of interventions - Designed to control, promote, change clinical nursing practice Common Concepts in Nursing Theories - The person (patient) - The environment - Health - Nursing Research - Scientific inquiry: process that uses observable and verifiable information (data), collected in a systemic manner, to describe, explain, or predict events - Conducted to validate and refine current knowledge or to develop new knowledge - Goals of research - Develop explanations (in theories) - Find solutions to problems Goals of Nursing Research - Improve care of people in clinical setting - Study people and the nursing process - Education - Policy development - Ethics - Nursing history - Develop greater autonomy and strength as a profession - Provide evidence-based nursing practice Common Nursing Theories - Nightingale’s Environmental Theory - Central theme: meeting the personal needs of the pt within the environment - Application: concern for the environment of the pt, including cleanliness, ventilation, temp, light, diet, and noise - Peplau’s Goal Attainment Theory - Central theme: nursing is a therapeutic, interpersonal, and goal-oriented process - Application to clinical practice: nursing interventions are directed toward developing the patient’s personality for productive personal and community living - Henderson’s Nursing Need Theory - Central theme: the pt is a person who requires help to reach independence - Application to clinical practice: nursing practice is independent; autonomous nursing functions are identified, and self-help concepts are described - Orem’s Theory of Self-Care - Central theme: self-care is a human need; self-care deficits require nursing actions - Application: nursing is a human service, and nurses design interventions to provide or to manage self-care actions for sustaining health or recovering from illness or injury - Roy’s Adaptation Theory - Central theme: humans are biopsychosocial beings existing within an environment. Needs are created within interrelated adaptive modes: physiologic self-concept, role function, and interdependence - Application: nursing interventions are required when people demonstrate ineffective adaptive responses - Leininger’s Transcultural Caring Theory - Central theme: caring is the central theme of nursing care, knowledge, and practice - Application: this provides the foundation of transcultural nursing care. Caring improves human conditions and life processes - Watson’s Theory of Human Caring - Central theme: nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick  - Application: clinical nursing care is holistic to promote humanism, health, and quality of living. Caring is universal and is practiced through interpersonal relationships - Kolcaba’s Comfort Theory - Central theme: pt comfort exists in 3 forms: relief, ease, and transcendence. If a pt is comfortable, they will feel emotionally and mentally better which will aid in recovery - Application: the role of the nurse is to assess a patient’s comfort needs and create a nursing care to meet those needs Chapter 3- Health, Wellness and Health Disparities Levels of Health Promotion and Preventative Care #1 - Primary: directed toward promoting health and preventing the development of disease processes or injury - Examples are immunization clinics, family planning services, poison-control information, and accident-prevention education - Secondary: focus on screening for early detection of disease with prompt diagnosis and treatment of any found - Examples are assessing children for normal growth and development and encouraging regular medical, dental, and vision examinations Levels of Health Promotion and Preventative Care #2 - Tertiary: begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate patients to a maximum level of functioning - Examples include teaching a patient with diabetes how to recognize and prevent complications, using physical therapy to prevent contractures in a patient who has had a stroke or spinal cord injury, and referring a woman to a support group after removal of a breast because of cancer Models of Health and Illness - The health belief model - Focuses on what people perceive/believe to be true about themselves in relation to their health - Based on 3 components of individual perceptions of threat of a disease: - 1. Perceived susceptibility to a disease - Belief that 1 either will or will not contract a disease - Ranges from being afraid of developing to a disease to completely denying that certain behaviors may cause illness  - ex: smoker may believe they are at risk for lung cancer and may stop smoking, while another person may believe smoking poses no serious threat and continues to smoke - 2. Perceived seriousness of a disease - Person’s perception of the threat that disease poses to health and its effects on their lifestyle - Depends on how much the person knows about the disease and can result in a change in health behavior - ex: if smoker knows that lung cancer can cause physical disability or death and therefore affect their ability to work and care for the family, the person is more likely to stop smoking - 3. Perceived benefits of action - Person’s beliefs about how effectively measures will prevent illness - Influenced by the person’s conviction that carrying out a recommended action will prevent/modify the disease and by the person’s perception of the cost and unpleasant effects of performing the health behavior (compared with not taking any action) - Ex: person may believe that stopping smoking will prevent future breathing problems and that the initial withdrawals symptoms can be overcome; therefore, they may stop smoking - A person’s health beliefs are affected by modifying factors including demographic(age and sex assigned at birth), sociopsychological(personality and peer pressure), structural(knowledge, prior disease contact), cue to action - The health promotion model - Developed to illustrate how people interact with their environment as they pursue health - Incorporates individual characteristics, experiences, behavior-specific knowledge and beliefs, to motivate health-promoting behavior - Individual characteristics/experiences can be useful to predict if a person will incorporate and use health-related behaviors - If behavior has been used before and becomes habit, it is more likely to be used again - Ex: person with high-self esteem defines self as healthy, has money is less likely to use alcohol or tobacco and eat healthy and exercise compared to someone with low self-esteem  - Behavior- specific knowledge, beliefs, and relationships are considered major motivators for health-promoting behaviors - Revised health promotion model includes: activity-related affect, commitment to plan of action, immediate competing demands and preferences - The health–illness continuum - The agent–host–environment model - Stages of Change Model The Health Belief Model (Rosenstock) - Concerned with what people perceive to be true about themselves in relation to their health - Modifying factors for health include demographic, socio psychological, and structural variables - Based on three components of individual perceptions of threat of a disease: - Perceived susceptibility to a disease - Perceived seriousness of a disease - Perceived benefits of action The Health Promotion Model (Murdaugh) - Developed to illustrate how people interact with their environment as they pursue health - Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivate health-promoting behavior - Personal, biologic, psychological, and sociocultural factors are predictive of a certain health-related habit - Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan Revised Health Promotion Model - 3 additional variables: - Activity-related affect - Commitment to a plan of action - Immediate competing demands and preferences - Behaviors may induce either a positive or a negative subjective response or affect The Health–Illness Continuum - Conceptualizes a person’s level of health - Views health as a constantly changing state with high-level wellness and death on opposite sides of a continuum  - Illustrates the dynamic (ever-changing) state of health as a person adapts to changes in internal and external environments to maintain a state of well-being Agent–Host–Environment Model (Leavell and Clark) - Views the interaction between an external agent, a susceptible host, and the environment as causes of disease in a person - It is a traditional model that explains how certain factors place some people at risk for an infectious disease - These 3 factors are constantly interacting, and a combination of factors may increase the risk of illness - The use of this model is limited when dealing with noninfectious diseases Stages of Change Model (Prochaska and DiClemente) - Used by counselors addressing behaviors including injury prevention, addiction, and weight loss - Stages - Precontemplation - People are not thinking about trying to change their behavior - Di lists reasons the 4 Rs: reluctance, rebellion, resignation, and rationalization - Counselors validate lack of readiness to change and encourage self-exploration - Contemplation - ambivalently(mixed feelings) consider need to change problematic behavior - Counselors help by focusing on educating about pros and cons of behavior and change, and clarify decision to change is 1 that only individual can make - Determination: Commitment to Action - Decision to move forward and preparation ensues - Counselors are most helpful by helping people make realistic plans, with small steps that anticipate difficulties, and by identifying creative strategies to address difficulties - Helpful to affirm individual has ability to change behaviors - Action: Implementing the Plan - When someone publicly begins to implement the plan and begins to achieve success, it reinforces to decision to change behavior - If family, friends, and coworkers understand the person has decided to eat differently or stop drinking, they can become supporters  - Counselor help by reiterating long term benefits Chapter 4- Health of the Individual, Family, Community and Environment Characteristics of Basic Needs/Maslow: useful for understanding relationships among basic human needs and for establishing priorities of care. Hierarchy based on theory that something is a basic need if it has the following characteristics: - Their lack of fulfillment results in illness - Their fulfillment helps prevent illness or signals health - Meeting basic needs restores health - Fulfillment of basic needs takes priority over other desires and needs when unmet - A person feels something is missing when a need is unmet - A person feels satisfaction when a need is met Maslow’s Hierarchy of Human Needs Physiologic Needs - Must be met at least minimally to maintain life: - Oxygen, water, food - Balance between intake and elimination of fluids - Elimination - Temperature - Sexuality - Physical activity - Rest Safety and Security Needs - Second in priority - Have both physical and emotional components - Being protected from potential or actual harm - Examples of interventions to meet these needs: - Using proper hand hygiene to prevent infection - Using electrical equipment properly - Administering medications knowledgeably - Skillfully moving and ambulating patients Love and Belonging Needs - Third in priority; often called higher-level needs - Understanding and acceptance of others in both giving and receiving love  - The feeling of belonging to groups such as families, peers, friends, a neighborhood, and a community - Unmet needs produce loneliness and isolation - Example of interventions to meet these needs: - Including family and friends in care of a patient - Establishing a trusting nurse–patient relationship Self-Esteem Needs - Need for a person to feel good about oneself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments - Positive self-esteem facilitates the person’s confidence and independence - Factors affecting self-esteem: - Role changes - Body image changes Self-Actualization Needs - Highest level on the hierarchy - Need for people to reach full potential through development of unique capabilities - Each lower level of need must be met to some degree before this need can be satisfied - Maslow list following that indicate achievement of individual potential: - Acceptance of self and others as they are - Focus of interest on problems outside oneself - Ability to be objective - Feelings of happiness and affection for others - Respect for all people - Ability to discriminate between good and evil - Creativity as a guideline for solving problems and pursuing interests Chapter 7- Legal Dimensions of Nursing Practice HIPAA-Ensured Patient Rights - To see and copy their health record - To update their health record - To request correction of any mistakes - To get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations - To request a restriction on certain uses or disclosures - To choose how to receive health information Sentinel Events - An unexpected occurrence involving death or serious physical or psychological injury - Examples: - Wrong-site surgery - Suicide while admitted in a hospital Never Events - Serious reportable events that should never happen to a patient - Examples: - Retained surgical item - Discharging an infant to the wrong person Week 2- 25,26,27 Chapter 25- Asepsis and Infection Control Components of the Infection Cycle - Infectious agent: bacteria, viruses, fungi - Reservoir: natural habitat of the organism(place for growth) - Portal of exit: point of escape for the organism(respiratory, GI, GU tracts, blood, tissue) - Means of transmission: direct contact, indirect contact, airborne route - Portal of entry: point at which organisms enter a new host(skin, urinary, respiratory, GI) - Susceptible host: must overcome resistance mounted by host’s defenses(weakened stressed individual) The Infection Cycle: break cycle by handwashing, disinfecting, PPE, break chain to break cycle Infectious Agents - Bacteria: most significant and most prevalent in hospital settings - Virus: smallest of all microorganisms - Fungi: plant-like organisms present in air, soil, and water - Parasites: live on or in a host and rely on it for nourishment Factors Affecting an Organism’s Potential to Produce Disease - Number of organisms - Virulence: ability cause disease - Competence of person’s immune system - Length and intimacy of contact between person and microorganism Identification of Infection Agents - Endemic—occurs with predictability in one specific region or population: malaria in africa - Pandemic—global outbreaks of a new or not previously identified virus: covid Possible Reservoirs for Microorganisms - Other people - Animals - Soil - Food, water, milk - Inanimate objects Common Portals of Exits - Respiratory - Gastrointestinal - Genitourinary tracts - Breaks in skin - Blood and tissue Means of Transmission - Direct contract - Touching, kissing, sexual intercourse - Indirect contact - Vector: living creature transmit infectious agent to human like an insect - Fomite: inanimate object like countertops, stethoscopes - Droplet: greater than 5um - Airborne: smaller than 5um Stages of Infection - Incubation period: organisms growing and multiplying - Interval btw pathogen’s invasion of body and appearance of symptoms of infection - Length of incubation may vary - Prodromal stage: person is most infectious, vague and nonspecific signs of disease - Pt unaware of being contagious and don't take precautions so it spreads to others - Full stage of illness: presence of specific signs and symptoms of disease - Localized: limited/occur in only 1 body area - Systemic: symptoms manifested throughout entire body - Convalescent period: recovery from the infection - Risk of 2nd infection - Depending on infection type may be a temporary/permanent change in person’s previous health state Factors Affecting Risk for Infection - Intact skin and mucous membranes - Normal pH levels - Body’s white blood cells - Age, sex, and hereditary factors - Immunization, natural or acquired - Fatigue, climate, nutritional and general health status - Stress - Use of invasive or indwelling medical devices Laboratory Data Indicating Infection - Elevated white blood cell count—normal is 5,000 to 10,000/mm3 - Increase in specific types of white blood cells - Elevated erythrocyte sedimentation rate: increased infection RBC settle quickly to bottom of tube - Presence of pathogen in urine, blood, sputum, or draining cultures Outcome Identification and Planning/Infection Control - Demonstrate effective hand hygiene and good personal hygiene practices - Identify the signs of an infection - Maintain adequate nutritional intake - Demonstrate proper disposal of soiled articles - Use appropriate cleansing and disinfecting techniques - Demonstrate an awareness of the necessity of proper immunizations  - Demonstrate stress-reduction techniques Asepsis - Includes all activities to prevent infection or break the chain of infection - Medical asepsis - Clean technique to reduce number of pathogens - Hand hygiene and wearing gloves - Surgical asepsis - Sterile technique to keep area free from microorganisms - Inserting an indwelling urinary catheter or IV 5 Moments for Hand Hygiene(WHO) - Moment 1—Before touching a patient - Moment 2—Before a clean or aseptic procedure - Moment 3—After a body fluid exposure risk - Moment 4—After touching a patient - Moment 5—After touching patient surroundings Bacterial Flora - Transient: attached loosely on skin, removed with relative ease - Resident: found in creases in skin, requires friction with brush to remove Personal Protective Equipment (PPE) and Supplies - Gloves - Gowns - Masks - Protective eyewear Use of PPE: Gloves - Wear gloves, according to Standard Precautions, when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur. - Gloves are not a substitute for hand hygiene. - If your task requires gloves, perform hand hygiene prior to donning gloves, before touching the patient or the patient environment. - Perform hand hygiene immediately after removing gloves.  - Change gloves and perform hand hygiene during patient care, if: - gloves become damaged, - gloves become visibly soiled with blood or body fluids following a task, - moving from work on a soiled body site to a clean body site on the same patient or if another clinical indication for hand hygiene occurs - Never wear the same pair of gloves in the care of more than one patient - Carefully remove gloves to prevent hand contamination Use of PPE: Gowns - to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated - for direct patient contact if the patient has uncontained secretions or excretions - remove gown and perform hand hygiene before leaving the patient’s environment - do not reuse gowns, even for repeated contacts with the same patient Use of PPE: Mouth, nose, eye protection - activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions - select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed Standard Precautions - Used in the care of all hospitalized patients regardless of their diagnosis or possible infection status - Apply to blood, all body fluids, secretions, and excretions except sweat (whether or not blood is present or visible), non intact skin, and mucous membranes - New additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures PPE for Standard Precaution - Follow hand hygiene protocol - Wear appropriate PPE based on potential exposure to blood, body fluids, secretions, and/or excretions Transmission-Based Precautions - Used in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes - Don PPE when entering the room of a patient on transmission-based precautions, and to remove only when leaving the room - 3 types (airborne, droplet, or contact) may be used alone or in combination Sequence for Donning PPE - Perform hand hygiene prior to donning PPE - Gown - Mask or Respirator - Goggles or Face shield - Gloves https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf Sequence for Removing PPE.1 - Gloves - Goggles or Face shield - Gown - Mask or Respirator - Perform hand hygiene after removing PPE https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf Sequence for Removing PPE.2 - Gown and Gloves - Goggles or Face shield - Mask or Respirator - Perform hand hygiene after removing PPE https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf Patient Teaching for Medical Asepsis at Home - Wash hands before preparing or eating food - Prepare foods at high enough temperatures - Wash hands, cutting boards, and utensils before and after handling raw poultry and meat - Keep food refrigerated - Wash raw fruits and vegetables - Use pasteurized milk and fruit juices - Wash hands after using bathroom  - Use individual care items rather than sharing Evaluating Patient Goals - Correctly use techniques of medical asepsis - Identify health habits and lifestyle patterns promoting health - State signs and symptoms of an infection - Identify unsafe situations in the home environment Chapter 26- Vital Signs Vital Signs - Temperature (T) - Pulse (P) - Respiration (R) - Blood pressure (BP) - Pain (often included as fifth sign) - Pulse oximetry When to Assess Vital Signs - On admission to any health care facility or institution - Based on facility or institutional policy and procedures - Any time there is a change in the patient's condition - Any time there is a loss of consciousness - Before and after any surgical or invasive diagnostic procedure - Before and after activity that may increase risk, such as ambulation after surgery - Before administering medications that affect cardiovascular and respiratory function Normal Ranges for Vital Signs for Healthy Adults - Oral temperature: 35.8–37.5°C; 96.4–99.5°F - Pulse rate: 60 to 100 (80 average) - Respirations: 12 to 20 breaths/min - Blood pressure: