Fundamental of Nursing (I) First Year 2024-2025 PDF

Fundamental of Nursing (I) FUNDAMENTALS OF NURSING 1 For First Year Nursing students First Semester by Teaching Staff Member School of Nursing BUA 2024 0 ...

Fundamental of Nursing (I) FUNDAMENTALS OF NURSING 1 For First Year Nursing students First Semester by Teaching Staff Member School of Nursing BUA 2024 0  Fundamental of Nursing (I) Fundamental of Nursing (1) ‫رمز‬ ‫توصيف المقرر‬ ‫اسم المقرر‬ ‫المقرر‬ ‫يهدف هرا انمقسز‬ This course aims to ‫إني تزويد انطالب‬ provide undergraduate ‫تانمهازاخ انتمسيضيح‬ students with special ‫تطثيق‬ ‫مع‬ skills related to ‫انعمهيح انتمسيضيح‬ nursing with the use ‫ألعطاء انطالب‬ of nursing process as a ‫انفسصح ألكتساب‬ framework and to give ‫انمهازاخ انتمسيضيح‬ students an ‫األساسيح مع تىفيس‬ opportunity to acquire ‫سثم األمان‬ basic nursing skills ‫نهمسيض وذنك مه‬ and to provide safety ‫أساسيات تمريض‬. ‫خالل انتدزية انمعمهي‬ to the patient through Nur 1 ‫شمم هره انمقسز‬ laboratory training. 1101 Fundamental :‫هرج انىحداخ‬ and this course of nursing 1 -.‫ طثيعح انتمسيض‬- includes the following ‫انمعتقداخ انصحيح و‬ units: the nature of.‫انممازسح‬ nursing, health beliefs ‫ انجاوة انمتكامم‬- and practice, integral.‫نهتمسيض‬ aspect of nursing, ‫ انسعايح انمتكامهح‬- integral components.‫نهمسضى‬ of patient care,.‫ تقييم انصحح‬- assessing health, and ‫ تعزيز انصحح‬- Promoting.‫انفسيىنىجيح‬ physiological health 1  Fundamental of Nursing (I) Course description - This course aims to provide undergraduate students with special skills related to nursing with the use of nursing process as a frame work and to give students an opportunity to acquire basic nursing skills and to provide safety to the patient through laboratory training. This course include: sustainable development ,patient health assessment , health, wellness, and illness, human need, urinary and bowel elimination , vital signs, activity and exercises, sleep and rest, pain management, oxygenation, circulation, fluid and electrolytes balance. 2  Fundamental of Nursing (I) Contents List of Topics No. of Page Weeks numbe r Introduction and orientation: - Orientation and introduction to course objectives 1st week 5 -Sustainability development - Patients health assessment 18 Unit 2 : Health beliefs and practice: 3rd week 22 - Health, Wellness, and Illness - Human need 34 Unit 3: Promoting physiological health 5 th week, -Urinary elimination 6th week 41 -Bowel elimination 48 Unit 5 : Assessing health 7,8th Vital signs week 62 Unit 6 : Promoting physiological health - Activity and exercises 101 - Sleep and rest 9,10,11,1 107 2,13,14 th 111 - Pain management week 118 - Oxygenation 127 - Circulation 131 - Fluid and electrolytes balance 3  Fundamental of Nursing (I) Introduction and orientation 4  Fundamental of Nursing (I) Foundation of Nursing Practice Introduction Nursing is an art and a science. As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each patient‘s dignity and personhood. As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations. Definition of nursing Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations. (ANA, 2018).This definition serves as the foundation for the following expanded descriptions of the Scope of Nursing Practice and the Standards of Professional Nursing Practice. Nursing is a learned profession built on a core body of knowledge that reflects its dual components of art and science. Nursing requires judgment and skill based on principles of the biological, physical, behavioral, and social sciences. Definition of a Nurse. 5  Fundamental of Nursing (I) The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. Aim of nursing: Four broad aims of nursing practice can be identified in the definitions of nursing: 1. To promote health 2. To prevent illness 3. To restore health 4. To facilitate coping with disability or death  To meet these aims, the nurse uses knowledge, skills, and critical thinking to give care in a variety of traditional and expanding nursing roles. The nursing profession and its characteristics: A variety of career opportunities are available in nursing, including clinical practice, education, research, management, administration, and even entrepreneurship. As a student it is important for you to understand the scope of professional nursing practice and how nursing influences the lives of your patients, their families, and their communities. The patient is the center of your practice. Professional Nursing’s Scope and Standards of Practice 6  Fundamental of Nursing (I) A professional organization has a responsibility to its members and to the public it serves to develop the scope and standards of practice for its profession. The American Nurses Association (ANA), the professional organization for all registered nurses, has long assumed the responsibility for developing and maintaining the scope of practice statement and standards that apply to the practice of all professional nurses and also serve as a template for evaluation of nursing specialty practice. Both the scope and standards do, however, belong to the profession and thus require broad input into their development and revision. Nursing: Scope and Standards of Practice, Third Edition describes a competent level of nursing practice and professional performance common to all registered nurses. Scope of practice is defined as services that a trained health professional is deemed competent to perform and permitted to undertake according to the terms of their professional nursing license (,2015). Nursing scope of practice provides a framework and structured guidance for activities one can perform based on their nursing license.As a nurse and a nursing student, is always important to consider: Just because your employer asks you to do a task…can you perform this task according to your scope of practice – or are you putting your nursing license at risk? Tenets Characteristic of Nursing Practice 7  Fundamental of Nursing (I) The conduct of nursing practice in all settings can be characterized by the following tenets that are reflected in language that threads throughout the scope of practice statement and standards of practice and professional performance.( ANA, 2018) 1. Caring and health are central to the practice of the registered nurse. Professional nursing promotes healing and health in a way that builds a relationship between nurse and patient (Watson, 2012). 2. Nursing practice is individualized. Nursing practice respects diversity and focuses on identifying and meeting the unique needs of the healthcare consumer or situation. Healthcare consumer is defined to be the patient, person, client, family, group, community, or population who is the focus of attention and to whom the registered nurse is providing services as sanctioned by the state regulatory bodies 3. Registered nurses use the nursing process to plan and provide individualized care for healthcare consumers. Nurses use theoretical and evidence-based knowledge of human experiences and responses to collaborate with healthcare consumers to assess, diagnose, identify outcomes, plan, implement, and evaluate care that has been individualized to achieve the best outcomes. 8  Fundamental of Nursing (I) Registered nurses (RNs) are individuals who are educationally prepared and licensed by a state, commonwealth, territory, government, or regulatory body to practice as a registered nurse. 4. Nurses coordinate care by establishing partnerships. The registered nurse establishes partnerships with persons, families, groups, support systems, and other providers, utilizing effective in- person and electronic communications, to reach a shared goal of delivering safe, quality health care to address the health needs of the healthcare consumer and the public. 5. A strong link exists between the professional work environment and the registered nurse’s ability to provide quality health care and achieve optimal outcomes. Professional nurses have an ethical obligation to maintain and improve healthcare practice environments conducive to the provision of quality health care. Extensive studies have demonstrated the relationship between effective nursing practice and the presence of a healthy work environment. Mounting evidence demonstrates that negative, demoralizing, and unsafe conditions in the workplace (unhealthy work environments) contribute to errors, ineffective delivery of care, workplace conflict and stress, and moral distress. The Standards of Professional Nursing Practice consist of the 9  Fundamental of Nursing (I) Standards of Practice and the Standards of Professional Performance. Standards of Practice The Standards of Practice describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. Standard 1. Assessment The registered nurse collects pertinent data and information relative to the healthcare consumer‘s health or the situation. Standard 2. Diagnosis The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues. Standard 3. Outcomes Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. Standard 4. Planning The registered nurse develops a plan that prescribes strategies to attain expected, measurable outcomes. Standard 5. Implementation The registered nurse implements the identified plan. Standard 5A. Coordination of Care The registered nurse coordinates care delivery. 10  Fundamental of Nursing (I) Standard 5B. Health Teaching and Health Promotion The registered nurse employs strategies to promote health and a safe environment. The Standards of Professional Performance It describe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice and research, quality of practice, professional practice evaluation, resource utilization, and environmental health. All registered nurses are expected to engage in professional role activities, including leadership, appropriate to their education and position. Registered nurses are accountable for their professional actions to themselves, their healthcare consumers, their peers, and ultimately to society. Standard 7. Ethics The registered nurse practices ethically. Standard 8. Culturally Congruent Practice The registered nurse practices in a manner that is congruent with cultural diversity and inclusion principles. Standard 9. Communication The registered nurse communicates effectively in all areas of practice. Standard 10. Collaboration The registered nurse collaborates with healthcare consumer and other key 11  Fundamental of Nursing (I) stakeholders in the conduct of nursing practice. Standard 11. Leadership The registered nurse leads within the professional practice setting and the profession. Standard 12. Education The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking. Standard 13. Evidence-based Practice and Research The registered nurse integrates evidence and research findings into practice. Standard 14. Quality of Practice The registered nurse contributes to quality nursing practice. Standard 15. Professional Practice Evaluation The registered nurse evaluates one‘s own and others‘ nursing practice. Standard 16. Resource Utilization The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, and fiscally responsible. Standard 17. Environmental Health The registered nurse practices in an environmentally safe and healthy manner. The role of the nurse and its functions 12  Fundamental of Nursing (I) Nurses provide care and comfort for patients in all health care settings and concern for meeting their patient‘s needs. These roles are described as the following: - 1- Direct care provider/ caregiver: As a caregiver, the nurse integrates the roles of communicator, teacher, counselor, leader, researcher, advocate, and collaborator to meet physical, emotional, intellectual, sociocultural, and spiritual needs for all patients. 2- Communicator: The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of healthcare settings. 3- Teacher/Educator: The use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families. 4- Counselor: The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate the patient‘s problem-solving and decision-making skills. 5- Leader: The assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups. 6- Researcher: The participation in or conduct of research to increase knowledge in nursing and improve patient care. 7- Advocate: The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives. 13  Fundamental of Nursing (I) 8-Collaborator: The effective use of skills in organization, communication, and advocacy to facilitate the functions of all members of the healthcare team as they provide patient care. 14  Fundamental of Nursing (I) Sustainability in health Learning objectives: At the end of this lecture the student will be able to:  Define sustainability.  Define sustainable health.  List the three broad themes relating to sustainability in health.  Enumerate the ten principles of sustainable health.  Identify the importance of a sustainable healthcare system.  Discuss the different ways in which a healthcare provider can turn more sustainable. 15  Fundamental of Nursing (I) Sustainability in health Sustainability is defined by the World Wildlife Fund for Nature (WWF) as ―an economic activity that meets the needs of the present generation without compromising the ability of future generations to meet their needs‖. Sustainability in a healthcare system can be defined as the "trade-off" between social, environmental and economic factors of working and living. Definition of Sustainable Health: Sustainable health is a personal commitment to maintaining and taking responsibility for own health, through preventative (proactive) means. 16  Fundamental of Nursing (I) This means not only having regular exercise, and taking care of what we eat, but also maintaining a healthy and balanced state of mind. Sustainable Health is:  A preventative approach  A balance of mind, body and spirit  Taking care of what we put into our bodies  Taking natural medicines to maintaining the health and hopefully preventing illnesses before they take shape.  Leading and maintaining a balanced life, by taking a ―middle road‖ approach. Not too little, not too much is the key. Broad themes relating to sustainability in health:  sustainable environments for a healthy lifestyle  implications of a changing climate  sustainability in health system performance and artificial intelligence. I. Sustainable environments for a healthy lifestyle In developed countries like Australia there are few visible indicators of the environmental impact on health, unlike in 17  Fundamental of Nursing (I) many developing countries where visible indicators include poor sanitation, litter, waste, smog and haze. Health is, in part, dependent on the natural and built environments. It is critical to foster environments that protect and promote the health and wellbeing of communities. II. Implications of a changing climate The climate is changing and is having recognizable effects on the health and wellbeing of all Victorians, though more acutely on those who are already vulnerable. Such effects include an upward trend in the average annual number of hot days and related deaths and hospitalizations, and an increase in the number and severity of bushfires and associated injury, death, respiratory hazards and mental health and wellbeing. III. Sustainability in health system performance and artificial intelligence. Due to the nature of the services they provide, health services use significant amounts of energy and water and generate large volumes of waste. The 18  Fundamental of Nursing (I) department‘s Sustainability in Healthcare - Environmental sustainability strategy 2018–19 to 2022–23 sets out the commitment for the next five years to further improve the environmental sustainability of the health system and to adapt the health system. The 10 principles of Sustainable Health: 1. Maintain a balanced life, (middle road approach) 2. Have a healthy diet 3. Exercise regularly 4. Sleep well 5. Maintain a regular rhythm in life. 6. Take preventative natural medicines to maintain health 7. Engage in spiritual practices manifested through meditation, mind training and raising personal consciousness 8. Learn to live and laugh more 9. Building discipline in our selves through mind training and raising awareness 10. Take a simpler approach to life The result of this will reduce the stress level and the impact of stress upon the health and body. 19  Fundamental of Nursing (I) The Importance of a Sustainable Healthcare System The World Health Organization (WHO) defines a Sustainable Healthcare System as a system that improves, maintains or restores health, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well- being of current and future generations. Four ways in which a healthcare provider can turn more sustainable: a) Practice Chemical Safety Chemicals used in LCD displays, fluorescent lamps, CRT monitors, flame-retardant mattresses, wheelchair cushions and even baby bottles can turn out to be hazardous. Hospitals must make conscious purchasing decisions and recycle toxic products periodically. b) Follow Waste Disposal Protocols Disinfecting medical waste can prove to be an energy intensive process known to release noxious fumes. Healthcare providers must consider moving to greener ways of waste disposal such as autoclaving, chemical treatment and microwaving. 20  Fundamental of Nursing (I) c) Save Energy Saving energy and carbon output may seem like impossible task, but not if the hospital reprograms their heating and cooling plants, re-engineers air handling systems and upgrades lighting systems to begin with. d) Preserve Water Healthcare providers can save over millions of gallons of water per year simply by replacing washroom toilets, faucets and showers with water-efficient alternatives and purchasing high-efficiency dishwashers. Every effort taken to strengthen environmental sustainability in healthcare systems can succeed only with the active engagement and collaboration of an engaged workforce. The system must actively engage health care workers in the process of creating, implementing and managing the environmental sustainability measures, while instilling a sense of ownership and responsibility in them. 21  Fundamental of Nursing (I) Climate change, global warming, and carbon footprint Global warming‖ refers to the rise in global temperatures due mainly to the increasing concentrations of greenhouse gases in the atmosphere.( Greenhouse gases: any gas that has the property of absorbing infrared radiation emitted from Earth‘s surface and reradiating it back to Earth‘s surface) ―Climate change‖ refers to the increasing changes in the measures of climate over a long period of time – including precipitation, temperature, and wind patterns A carbon footprint is the total amount of greenhouse gases (including carbon dioxide and methane) that are generated by our actions Influences of climate change and global warming on health 22  Fundamental of Nursing (I) Challenges for health care institutions in the context of global warming and climate changes Challenges Nursing actions Increasing number of patients due Increase capacity of intensive to heat waves, natural disasters care beds Mass casualties of patients due to Implement a ‗reserve‘ of staff and rapid weather changes, foods, beds, which can be easily heat attacks activated Increasing incidence of Provide sufficient capacities of ‗uncommon‘ infectious or non- patient isolation infectious diseases Instruct the emergency staff in the diagnosis and management of ‗uncommon‘ diseases Increasing number of Provide sufficient machines for nephropathy during heat waves renal replacement Artificial intelligence for nursing Artificial intelligence (AI) is an umbrella term used to describe techniques developed to teach computers to mimic human-like cognitive functions. Artificial intelligence (AI) is a transformational technology that will affect all healthcare providers. Some areas where AI is used in healthcare  Diagnosis and treatment design  Electronic health records electronic  Drug interactions and discovery drug interactions  Dermatology and radiology 23  Fundamental of Nursing (I) Nurses' practice and AI  Can assist in clinical decision-making, quality of care, and stratification for clinical trials.  Early detection and prediction of sepsis and better outcomes  Appropriate levels of sedation and analgesia are important for mechanical ventilation  Improving data with new technology 24  Fundamental of Nursing (I) Patient health assessment Learning Outcomes: After completion of this lecture, the student will be able to:  Identify purposes of the physical examination.  Explain the four techniques used in physical examination.  Identify the steps in head examination procedure. Definition: - A health assessment is a process that identifies the specific needs of a person and a way to address a way to meet their needs by the healthcare system Purpose of physical examination: To obtain baseline data about the client‘s functional abilities. To supplement, confirm data obtained in the nursing history. To obtain data that will help establish nursing diagnoses and plans of care. To evaluate the progress of a client‘s health problem. To identify areas for health promotion and disease prevention Types of Health Assessment  Initial assessment: Initial assessments are generally done by a physician or admitting nurse to have a thorough review of patient details like, previous medical issues, social history and any other required detail.  Focused assessment: focused assessment is a close examination of a particular problem or a disease. Focused assessments are done when it is suggested by a primary physician to proceed further with the expert‘s guidance.  Emergency assessment: When a patient is in severe suffering and needs urgent care and attention, they fall under the emergency assessment category. A team of healthcare 25  Fundamental of Nursing (I) professionals will perform emergency assessments from the time they enter the patient‘s room till the time the emergency is over.  On-going assessment: a healthcare professional takes care of a patient‘s physical and mental status for a longer period of time based on the initial information they have got from the patient. Techniques of Physical Assessment: Four primary techniques are used in the physical assessment: Inspection Palpation Percussion Auscultation  Inspection: Inspection is the visual assessment; by using the sense vision. The nurse inspects with the naked eye and with a lighted instrument. In addition to visual observations, the use of olfactory (smell) and auditory (hearing) senses to observe the condition of various body parts is considered inspection. Lighting must be sufficient for the nurse to see clearly. When using the auditory senses it is important to have a quiet environment for accurate hearing. Observe for color, size, location, odors, and sounds  Palpation: Palpation is the examination of the body using the sense of touch. The pads of the fingers are used because their concentration of nerve endings makes them highly sensitive to tactile discrimination. 26  Fundamental of Nursing (I) There are two types of palpation: light and deep. Light palpation (superficial palpation) should always precede deep palpation because heavy pressure on the fingertips can dull the sense of touch. For light palpation, the nurse extends the dominant hand‘s fingers parallel to the skin surface and presses gently while moving the hand in a circle. With light palpation, the skin is slightly depressed. If it is necessary to determine the details of a mass, the nurse presses lightly several times rather than holding the pressure. Deep palpation is usually not done during a routine examination and requires significant practitioner skill. It is performed with extreme caution because pressure can damage internal organs. It is usually not indicated in clients who have acute abdominal pain or pain that is not yet diagnosed. Deep palpation is done with one hand or with two. The top hand applies pressure while the lower hand remains relaxed to perceive the tactile sensations.  Percussion: Percussion is the act of striking the body surface to elicit sounds that can be heard or vibrations that can be felt. There are two types of percussion: direct and indirect. In direct percussion, the nurse strikes the area to be percussed directly with the pads of the fingers. The strikes are rapid, and the movement is from the wrist. 27  Fundamental of Nursing (I) Indirect percussion is the striking of a finger (usually the middle finger) held against the body area to be assessed. The motion comes from the wrist; the forearm remains stationary. The blows must be firm, rapid, and short to obtain a clear sound. Percussion is used to determine the size and shape of internal organs by establishing their borders. It indicates whether tissue is fluid filled, air filled, or solid. Flatness is an extremely dull sound produced by very dense tissue such a muscle or bone. Dullness is a thudlike sound produced by dense tissue such as the liver, spleen or heart. Resonance is a hollow sound such as that produced by lungs filled with air. Hyperresonance is not produced in the normal body. It is described as booming and can be heard over an emphysematous lung. Tympany is a musical or drumlike sound produced from an air-filled stomach  Auscultation: Auscultation is the process of listening to sounds produced within the body. In auscultation, the nurse uses both direct auscultation by listening to body sounds with the unaided ear, and indirect auscultation by using a stethoscope. The stethoscope has both a flat disc diaphragm and a bell-shaped amplifier. 28  Fundamental of Nursing (I) The diaphragm best transmits high-pitched sounds (e.g., bronchial sounds), and the bell best transmits low-pitched sounds such as some heart sounds. Auscultated sounds are described according to their pitch, intensity, duration, and quality. The pitch is the number of vibrations per second (frequency). The intensity (amplitude) refers to the loudness or softness of a sound. The duration of a sound is its length (long or short). The quality of sound is a subjective description of a sound, for example, whistling, gurgling, or snapping. Consequences of assessment from head to toe Skin, hair, and nails Inspect skin color :- Pale, white ashen appearance, i.e. Pallor, may be a sign of shock! - Bluish, gray skin, i.e. Cyanosis, shows poor oxygenation of the blood - Yellowish-orange skin, i.e. Jaundice, may be a sign of liver disease or blood disease Inspect scalp for lesions and hair and scalp for presence of lice and/or nits. Inspect nails for consistency, color, and capillary refill. Eyes check conjunctiva and sclera, pupils; check reactivity to light and ability to follow your finger or a light check eyes for drainage, pupil size, drainage may indicate infection, allergy, or injury; 29  Fundamental of Nursing (I) pupils are normally are the same size and react equally to light. Ears check if patient is using hearing aids check for pain speak in a whisper; can the patient hear you and comprehend? Nose check drainage, congestion, difficulty breathing, sense of smell Throat and Mouth check mucous membranes, any lesions, teeth or dentures, odor, swallowing, trachea, lymph nodes, tongue Throat and Mouth check mucous membranes, any lesions, teeth or dentures, odor, swallowing, trachea, lymph nodes, tongue Chest Ask the patient to breathe in and out normally through their mouth. Use diaphragm of stethoscope Anterior chest: auscultate from side to side and top to bottom. Auscultate over equivalent areas and compare the volume and character of the sounds and note any additional sounds. Compare sounds during inspiration and expiration and note location and quality. Posterior chest: auscultate from side to side and top to bottom. 30  Fundamental of Nursing (I) Assess vocal resonance. Ask the patient to say ‗ninety-nine, ninety-nine‘ and compare the sounds at equivalent positions on each side of the chest. Heart Assess pulse per minute using watch Auscultate blood pressure Check rhythm Abdomen as consequences 1. Inspect abdomen for distension, asymmetry 2. Auscultate bowel sounds 3. Percussion 4. Palpate four quadrants for pain and bladder/bowel distension (light palpation only) 5. Determine frequency and type of bowel movements. 31  Fundamental of Nursing (I) Extremities 1. Assess for temperature, capillary fill and ROM. 2. Palpate for pulses. 3. Note any edema, lesions, lumps or pain. Upper Extremities  Assess CWMS (color, warmth, movement, and sensation)  Check circulation: capillary refill - report if more than 3 seconds, radial pulses  Check motion / sensation: hand grasps  Push/pull Straight arm raise 32  Fundamental of Nursing (I) Lower Extremities Assess CWMS (color, warmth, movement,and sensation) Check circulation: Capillary refill, posterior tibial and dorsalis pedis pulses Check motion / sensation: Push/pull Leg raise 33  Fundamental of Nursing (I) Unit 2 Health Beliefs and Practices 34  Fundamental of Nursing (I) Health, Wellness, and Illness Learning objective: After completion of this unit, thy student will be able to: 1. Definition of terms 2. Differentiate health, wellness, and illness. 3. Describe seven dimensions of wellness. 4. Compare various models of health. 5. Describe factors affecting health care adherence. 6. Differentiate illness from disease 7. Differentiate acute illness from chronic illness. 8. Describe effects of illness on individuals' and family members' role and functions. Key terms - Health - Illness - Health care adherence - Wellness - Acute illness - Chronic illness 35  Fundamental of Nursing (I) Health, Wellness, and Illness Introduction: Nurses need to clarify their understanding of health and wellness because their definitions largely determine the scope and nature of nursing practice. Some people think of health and wellness as the same thing, or at the very least, as accompanying one another. Definition of Health: People often use the terms health and wellness interchangeably. Although a person cannot have one and not the other, they are two different concepts that are quite variable, and their meanings are different. World Health Organization (WHO) defines health as ―a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (illness).‖ WHO defines wellness as ―the optimal state of health of individuals and groups,‖ and wellness is expressed as ―a positive approach to living”. The primary difference between health and wellness is that health is the goal and wellness is the active process of achieving it. You truly cannot have health without first achieving wellness. Wellness has a direct influence on overall health, which is essential for living 36  Fundamental of Nursing (I) a robust, happy, and fulfilled life. Health versus wellness While you cannot choose the state of health, you can consciously choose wellness by living your life responsibly and taking proactive steps for your well-being. Health comprises the diagnosis of a disease/illness, predisposition to a disease, and any unexpected injury. Wellness is an active process of growth and change to reach your fullest health and well-being. It is associated with actively pursuing activities, making choices and lifestyle changes, controlling risk factors that can harm a person, focusing on nutrition, having a balanced diet, and following spiritual practices that lead to holistic health. Risk factors are actions or conditions that increase a person’s risk of illness or injury. Some of the risk factors that can be harmful to good health are as follows:  Smoking: It is a major risk factor for lung cancer and cardiovascular diseases.  Drinking alcohol: It can cause liver damage, stroke, heart diseases, and cancer. 37  Fundamental of Nursing (I)  Unprotected sex: It spreads sexually transmitted diseases including human immunodeficiency virus (HIV.)  Extreme physical activity/sports: This may lead to broken bones and other types of injuries. Dimension of wellness Wellness is more than just physical health; it is holistic and multidimensional. It comprises six dimensions that include: Physical, intellectual, emotional, environmental, social, and spiritual wellness. 1. Physical: Physical wellness increases physical fitness—by being physically fit, a person would have an enhanced ability to prevent illness and diseases. Exercise stimulates a healthy mind and body. A sedentary lifestyle can be avoided by increasing physical activity in everyday life such as walking, cycling, walking the dog, taking the steps, and hiking. Having good nutrition, eating a balanced diet, drinking sufficient water (eight glasses per day), and getting adequate sleep promotes a person‘s physical wellness. 2. Intellectual: Mental exercise and engagement through learning, problem-solving, and creativity support intellectual wellness and promote a better attitude. People who learn new 38  Fundamental of Nursing (I) things and challenge their mind can avoid mental health problems. The ability to learn & use information effectively for development (personal, family, career). It also involves striving for continued growth & learning to deal with new challenges effectively. 3. Emotional: A person with emotional wellness can deal with stressful situations. A person who is aware of their own feelings has good self-esteem, and has empathy toward others‘ feelings would have emotional wellness. The ability to manage stress & express emotions appropriately. It involves the ability to recognize, accept, & express feelings& to accept one's limitations. 4. Environmental: Awareness of the role we play in improving our natural environment rather than denigrating it and maintaining and living in a healthy physical environment free of hazards promotes wellness. the ability to promote health measures that improve the standard of living and quality y of life in the community. This includes influence such as food ,water and air 5. Social: : the ability to interact successfully with people & with the environment in which each person is a part of it, and 39  Fundamental of Nursing (I) maintaining long-term relationships with family and friends keep a person happier and healthier. 6. Spiritual: Spiritual wellness does not imply religion or faith of a person, but the search for meaning and purpose of human existence. Developing compassion, caring, forgiving, the belief of some force (nature, Science, religion) that serves to life. It also includes one's morals, values, & ethics. and having a purpose in life help in spiritual wellness. This can be achieved through meditation, volunteer work, spending time in nature, etc. Definition of Illness Illness is a state in which a person‘s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired. Cancer is a disease process, but one patient with leukemia who is responding to treatment may continue to function as usual, whereas another patient with breast cancer who is preparing for surgery may be affected in dimensions other than the physical. Acute and Chronic Illness Both acute and chronic illnesses have the potential to be life threatening. 40  Fundamental of Nursing (I) An acute illness is usually reversible, has a short duration, and is often severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period. A chronic illness persists, usually longer than 6 months, is irreversible, and affects functioning in one or more systems.  Characteristics of Acute and Chronic Illness 41  Fundamental of Nursing (I) Variables Influencing Health and Illness. Internal Variables 1. Developmental Stage. A person‘s thought and behavior patterns change throughout life. 2. Intellectual Background. A person‘s beliefs, knowledge, or incorrect information about body functions and illnesses, educational background, traditions, and past experiences. 3. Perception of Functioning. The way people perceive their physical functioning affects health beliefs and practices. 4. Emotional Factors. The patient‘s degree of stress, depression, or fear can influence health beliefs and practices. 5. Spiritual Factors. Spirituality including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. External Variables 1. Family Practices. The way that patients‘ families use health care services generally affects their health practices. Their 42  Fundamental of Nursing (I) perceptions of the seriousness of diseases and their history of preventive care behaviors. 2. Psychosocial and Socioeconomic Factors. Socioeconomic and psychosocial factors increase the risk for illness and influence the way that a person defines and reacts to illness. 3. Cultural Background. Cultural background influences beliefs , values, and customs.Health Promotion, Wellness, and Illness Prevention 4. Health promotion activities such as routine exercise and good nutrition help patients maintain or enhance their present levels of health. 5. Wellness education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self responsibility. 6. Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Levels of Preventive Care  Primary Prevention. Primary prevention is true prevention; it precedes disease or dysfunction and is applied to patients considered physically and 43  Fundamental of Nursing (I) emotionally healthy. Primary prevention aimed at health promotion includes health education programs, immunizations, nutritional programs, and physical fitness activities.  Secondary Prevention: Secondary prevention focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the patient to return to a normal level of health.  Tertiary Prevention Occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of a long-term disease or a disability by interventions directed at preventing complications and deterioration. Activities are directed at rehabilitation rather than diagnosis and treatment. health as early as possible. Healthy living with diseases: Definition: Practices that are known to promote health and 44  Fundamental of Nursing (I) wellness. Types of healthy living practices: 1. Eating three balanced meals a day and including foods according to the food guide pyramid. 2. Eating moderately to maintain a healthy weight. 3. Exercising moderately, following a regular routine. 4. Sleeping 7 to 8 hours each day. 5. Limiting / stop alcohol. 6. Eliminating / stop smoking. 7. Keeping sun exposure to a minimum 45  Fundamental of Nursing (I) Human Needs Learning objectives: At the end of the lecture; the student will be able to: 1. Identify human needs. 2. List the 7 Fundamental Human Needs 3. Discuss the 7 Basic human needs according to Maslow's Hierarchy 4. Identify human survival needs hierarchy? Key terms: - Survival - Safety - Belonging - Connection - Esteem Identity - Self-development - Self-actualization 46  Fundamental of Nursing (I) Introduction: Humans are complex organisms, influenced by and responsive to both internal and external environments. Our behaviors, feelings about ourselves and others, values, and the priorities we set for ourselves all relate to our physiologic and psychosocial needs. These needs are common to all people, and meeting these needs is essential for the health and survival of all people; therefore, they are called basic human needs. The Individual’s Basic Human Needs In nursing, we consider the physical, safety, psychosocial, and spiritual needs of each individual patient. Abraham Maslow (1968) developed a hierarchy of basic human needs that describes which needs of a person are the most important at any given time. Certain needs are more basic or essential than others and must be at least minimally met before other needs can be considered. 47  Fundamental of Nursing (I) 1. Physiologic needs—for oxygen, water, food, elimination, temperature sexuality, physical activity, and rest—must be met at least minimally to maintain life. These needs are the most basic in the hierarchy of needs and the most essential to life, and therefore have the highest priority. Most healthy children and adults meet their physiologic needs through self-care, but 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. 2. Safety and Security Needs Safety and security needs come next in priority after physiologic needs, and have both physical and emotional components. Physical safety and security means being protected from potential or actual harm. Nurses carry out a wide variety of activities to meet patients physical safety needs, such as the following:  Using proper hand hygiene and sterile techniques to prevent infection  Using electrical equipment properly  Administering medications knowledgeably  Skillfully moving and ambulating patients  Teaching parents about household chemicals that are dangerous to children Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. Patients entering the health care system often fear the unknown and may have significant emotional security needs. Nurses can help meet such needs by encouraging spiritual practices that provide strength and support, by allowing as much independent decision making and control as possible, and by carefully explaining new and unfamiliar procedures and treatments. 48  Fundamental of Nursing (I) 3. Love and Belonging Needs All humans have a basic need for love and belonging. After physiologic and safety and security needs, this is the next priority, and is often called a higher-level need. Love and belonging needs include the understanding and acceptance of others in both giving and receiving love, and the feeling of belonging to groups such as families, peers friends, a neighborhood, and a community. People who believe that their love and belonging needs are often feel lonely and isolated. They may withdraw physically and emotionally, or they may become overly demanding and critical. Often these behaviors signal that the person has unmet love and belonging needs. Nurses should always consider love and belonging needs when developing a care plan, including nursing interventions such as:  Including family and friends in the care of the patient  Establishing a nurse–patient relationship based on mutual understanding and trust (by demonstrating care, encouraging communication, and respecting privacy)  Referring patients to specific support groups (such as a cancer support group or Alcoholics Anonymous) 49  Fundamental of Nursing (I) 4. Self-Esteem Needs The next highest priority on the hierarchy is self-esteem needs, which include the need for a person to feel good about himself or herself, 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. Many factors affect self-esteem. When a person‘s role changes (e.g., through illness or the death of a spouse), self- esteem can be seriously altered because the person‘s responsibilities and relationships also change. A change in body image, such as the loss of a breast, an injury, or a growth spurt during puberty, may also affect self-esteem. Nurses must remember that the person‘s perception of the change—rather than the actual change itself—is what affects that person‘s self-esteem. Nurses can help meet patients‘ self-esteem needs by respecting their values and beliefs, encouraging patients to set attainable goals and facilitating support from family or significant others. These actions promote a sense of worth and self-acceptance. 5. Self-Actualization Needs The highest level on the hierarchy of needs is self- actualization needs, which include the need for people to reach their full potential through development of their unique capabilities. In general, each lower level of need must be met to some degree before this need can be satisfied. The process of self-actualization continues throughout life Maslow lists the following qualities that indicate achievement of one‘s 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 50  Fundamental of Nursing (I)  Respect for all people  Ability to discriminate between good and evil  Creativity as a guideline for solving problems and pursuing interests Human Dimensions and The Human Dimensions and Basic Human Needs 51  Fundamental of Nursing (I) Unit 3 Promoting physiological health 52  Fundamental of Nursing (I) Urinary Elimination Structure of urinary tract &Function of the organs in the urinary system: The urinary system is composed of: - 2 kidneys, - 2 ureters, - The bladder - and the urethra Fig.(10) front view of urinary tract The Kidneys: The right and left kidneys, they are complex organ whose chief function is the elimination of waste products of body metabolism and the control of concentration of the various constituents of the body fluid, including the blood. - Blood reaches the kidneys through the renal arteries and is filtered in the glomeration of the nephrons. The nephrons are the functioning unit of the kidney. It is estimated that each kidney has about one and half million nephrons. The filtrate contains water, the waste products of metabolism, electrolytes and glucose. This filtrate is known as urine. Kidney Functions: 53  Fundamental of Nursing (I) - Excretion of metabolic wastes (urea, uric acid, creatinine and amonia). Regulation of acid -base balance of the blood. - Regulation of the amount of extracellular fluid through elimination of excess fluid or fluid retention. - Regulation of osmotic pressure of extracellular fluid by regulating the amount of sodium chloride and water. - Regulation of extracellular electrolytes by either selective reabsorption of important electrolytes or excretion of excess such as glucose. - Regulation of blood pressure : The kidney produces an enzyme like substance called renin that can raise blood pressure. - Regulation of red blood cell production: Under stress, the kidney produces erythropoietin, which stimulates the production or red blood cells in bone marrow. - Control of water excretion: The reassertion of water in the tubules is controlled by pituitary and hypothalamic action. Ureters: Are 2 tubes, each one is connected to the pelvis of the kidney. Its chief function is to convey the urine formed in the kidney pelvis to the bladder. It is about 25 -30 cm long and it has a narrow diameter. The Bladder: Is a hollow, muscular organ that serves as a reservoir for urine. The bladder can retain urine until it can be excreted. The average adult bladder holds from 300 - 500 cc of urine. The Urethra: Is a short, hollow muscular tube approximately 3.7 cm. long in the female and 20 cm. in the male; the chief function of the urethra is to provide a passage -way through which urine can be voided from the bladder. The processes of urine elimination: 54  Fundamental of Nursing (I) Micturation or Voiding: It is the act by which urine is expelled from the bladder. The acts of initiating and stopping maturation are normally under voluntary control via external sphincter muscle. Fig.(11):normal micturition cycle Urine: Is the waste product of metabolism. It is a complex aqueous solution of organic and inorganic substances Characteristics of Normal Urine: Amount : 1200 - 1800 cc/24 h. the amount of urine per void is 200:500 mL (30 mL per hour) for catheterized patient. Colour : Clear, straw, amber yellow. Transparency : Transparent. Reaction: Slightly Acidic ph 4.5 - 6. Odor: Aromatic odor. Specific gravity: 1.005 -1.030 Constituents: Urine contains creatinine, uric acid, urea and a few white blood cells. Frequency of Voiding: The frequency of voiding varies with the bladder capacity, sensation, acceptability and availability of toilet facilities. Voiding 5-10 times a day is common. 55  Fundamental of Nursing (I) Factors which affect the individual's urinary elimination: 1. Age: Voluntary control of urinary elimination may begin at the age of 2.5:3 years and is constant throughout the adult years, with increasing age loss of muscle tone and the risk of loss of bladder control is increased. 2. Change in the patient's environment: Such as improper toilet facilities, unclean toilets or lack of privacy. The hospital routine might affect patient's habits. 3. Fluid intake: The amount of fluid intake affects the amount of urine. 4. Nutrition: High percentage of food with high water content increase urine volume. Salty foods without high water intake decrease urine output. Coffee, tea, cola, chocolate have diuretic effect and increase urine output. 5. Intake of drugs: Might lead to change color of urine, or can increase urinary out put (diuretics). 6. Surgery: Some patients have difficulty voiding postoperatively. Surgery involving urinary system, intestine, cause urinary retention. 7. Obstruction: Will cause stasis of urine. Obstruction may be due to congenital defect, calculi, tumor, etc. 8. Psychological factors: Such as stress, fear, anxiety and emotional factors. may cause urinary frequency and sometimes cause urinary retention. 9. Pathologic conditions: Such as fever, diabetes, infection of the urinary tract 10. Disease of the nervous system or injuries which might lead to urinary incontinence. 11. Physical activities: Such as immobility. 12. Blood pressure: Low blood pressure (Hemorrhage) lead to low production of urine. 56  Fundamental of Nursing (I) 13. Hormonal influences: Anti diuretic hormone secreted by the posterior lobe of pituitary gland and suppresses the amount of urine produced. Signs and Symptoms of Urinary Problem: 1. Polyuria: voiding a large amount of urine. 2. Oliguria: Voiding a scanty amount of urine. (Less than 600 cc/day) 3. Anuria: or urinary suppression: Total absence or marked deficiency i.e. absence of urine emerged from the kidneys. 4. Urinary incontinence: Involuntary voiding or constant dribbling of urine. 5. Urinary retention: is the inability to completely empty urine from the bladder. 6. Dysuria: Difficulty in voiding or pain in voiding. 7. Nocturia: It is the need to get up from sleep in order to void. 8. Enuresis: It is involuntary loss of urine at night (bed wetting). It persist in some children as late as 10 years old or more. 9. Urgency: Is the sensation that one must void. 10. Residual urine: When a bladder empties normally, it retains little amount of urine. Abnormal Findings of Urine: 1. Hematuria: Presence of blood in the urine. 2. Pyuria: Presence of pus in the urine. 3. Albuminuria: Presence of albumin in the urine. 4. Pale urine :Means diluted urine may be due to excessive fluid intake or intake of diuretics. 5. Glycosuria: Presence of sugar in the urine. 6. Casts: Presence of coagulated protein from the kidney tubule. 57  Fundamental of Nursing (I) 7. Dark urine: Means urine is concentrated, may be due to: - Dehydration, or low fluid intake, - Presence of bile pigments (urobilin or bilirubin) due to disease of the liver or gall bladder. - Intake of certain drugs such as antibiotics turns the colour of urine into orange or red. - Intake of certain food, vegetables and fruits such as carrots, and blackberries. - Presence of blood. Nursing interventions that promote normal urination: - Promoting Fluid intake: Normal intake (1500 cc ) daily. - Some patients need more fluids (vomiting, stomach suction, diarrhea, excessive sweating). - - Patient who at risk of urinary tract infection or renal stone. formation should consume 2000 – 3000 cc fluids daily. - Maintaining normal voiding habits. - Assisting with toileting. Nursing measures for Preventing urinary tract infections(UTI): - Drink 8 classes of water per day to flush bacteria out of urinary tract. - Practice frequent voiding (every 2 to 4 hours). - Avoid use of harsh soap - Avoid tight fitting pants Wear cotton rather than nylon underclothes (Accumulation of perineal moisture facilitate bacterial growth). - Girls and women should always wipe the perineal area from front to back following urination to prevent introduction of astrointestinal bacteria into urethra. Nursing measures for patient with urinary incontinence: 58  Fundamental of Nursing (I) - Skin care to prevent irritation and breakdown. - Cleanliness of linen and clothes. - Frequent turning of patient to prevent decubitus ulcer. - Perineal and abdominal exercises: Strengthening the abdominal muscle by using it to aid air inhalation, Tightening and relaxing the perineal muscles 10 times (3 times daily). - Bladder retraining programs (require that the patient postpone voiding, resist or inhibit the sensation of urgency, and void according to timetable rather than according to the urge to void). Adjusting the fluid intake schedule. - Applying external urinary drainage device (Condoms). - Emotional support. Measures to promote proper urinary elimination for patients Suffering from urinary retention: - Restrict fluid intake because urine is accumulated in the urinary bladder be aware of fluid intake of patient during the first 24 hours. - Provide privacy to the patient by using curtains or closed doors. - Help the patient to assume a sitting position to help him void. - Provide a bedside commode if the patient cannot use the bedpan or urinal. - Listening to the sound of running water, will help the patient to void. - Pour warm water over the perineum of the female patient, or help the patient to sit in a warm bath tub. - Provide a warm bedpan or urinal. - Supply a warm hot water bottle to the patient or lower abdomen. - Put the patient hands in warm water. 59  Fundamental of Nursing (I) - Catheterization: Should be ordered by the physician if the pervious Measures are not successful. Bowel elimination Learning Outcomes After completing this lecture, the student should be able to: 1. Define related terms (constipation, diarrhea, fecal impaction, fecal incontinence, and intestinal distension) 2. Describe the anatomical structure and function of the gastrointestinal tract 3. Describe the act of elimination or defecation. 4. Discuss factors that affect bowel elimination. 5. Identify characteristics of normal feces. 6. Discuss common bowel elimination problems. 7. Identify appropriate nursing assessment to assess bowel elimination problems. 8. Describe nursing interventions for patients experiencing alterations in bowel elimination. 60  Fundamental of Nursing (I) Bowel elimination The anatomical structure of the gastrointestinal tract: The gastrointestinal (GI) tract is a smooth-muscle tube approximately 10 m (30 ft) long, running through the body from the mouth to the anus. Its major functions are to digest and absorb the nutrients present in food and to eliminate food waste products as feces. The structures of the GI tract are the mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anus Fig.(12):gastrointestinal tract The large intestine: - It is a tube leading from "' the small intestine to the external skin and is about 150 -180 cm in length. The ileocecal valve separates the small intestine from the large intestine. It opens in one direction; prevent the passage of material in the opposite direction. - It is divided into: - The caucus: lies at the beginning of the large intestine. - The colon: lies between the caucus and the rectum and is divided into: The ascending colon goes up on the right side; - The transverse colon crosses the abdomen; - The descending colon goes down on the left side. 61  Fundamental of Nursing (I) - The sigmoid flexure ends at the rectum. - The rectum of the adult person is about 15-20 cm. Fig.(13):large intestine The anal canal: - It is about 2.5 cm, and has two sphincters. The internal sphincter and the external sphincter at the anus, the external sphincter has striated muscles and is under voluntary control. - It is innervated by autonomic nerve supply: - Stimulation of the parasympathetic system promotes peristalsis and increases muscle tone. Stimulation of the sympathetic nerves inhibits peristalsis and decreases tone. Fig.(14) There are two local-reflexes involved in bowel elimination:  The gastro colic reflex: peristalsis is stimulated by the intake of food enters the duodenum (about half an hour after-eating or drinking) a mass peristaltic action occurs in the large intestine which is called the gastro colic reflex, and the need to defecate is felt. 62  Fundamental of Nursing (I)  The rectal reflex ((defecating reflex)): is stimulated by the presence of waste products in the rectum which is producing mechanical pressure. This leads to stimulation of sensory receptors and the need to defecate is felt. The act of elimination or defecation: Fig.(15) Defecation: - Is an evacuation of the intestines and is often referred to as a bowel movement. When a certain amount of fecal matter accumulates in the rectum it becomes distended and the intra-rectal pressure rises. - Sensory nerve endings are stimulated (parasympathetic), the internal and external sphincter relaxes, and the colon contracts ,the result is a desire to defecate. - During the act of defecation several additional muscles help in the process: Voluntary contraction of the additional muscles and closing of the glottis and increasing intra- abdominal pressure that aids in expelling the feces. Simultaneously, the muscles of the pelvic floor contracts and aid in pushing the fecal mass out. 63  Fundamental of Nursing (I) Factors influencing fecal elimination: 1. Personal and sociocultural factors Privacy is important to most people, as is sufficient time to have a bowel movement without feeling the need to hurry. - Parents and caregivers of infants and toddlers may postpone their own toileting needs because of fear of leaving the children alone. - Some clients are embarrassed by the thought that anyone might realize they are having a bowel movement and will wait until they are entirely alone before even entering the bathroom. 2. Nutrition, hydration, and activity level - Foods and Fiber: Regular intake of food promotes peristalsis. People who eat on a regular schedule are likely to develop a regular pattern of defecation, whereas irregular eating creates irregular bowel elimination. - Adequate intake of high-fiber promotes peristalsis and defecation. - Bulky foods absorb fluids and increase stool mass. The increased mass stretches bowel walls, initiating peristalsis and the defecation reflex. - Some foods have specific effects in the bowel. For example, the active bacteria in yogurt stimulate peristalsis - Low-fiber foods, such as pasta and other simple carbohydrates and lean meats, slow peristalsis. Foods like broccoli, onions, spicy foods and beans lead to excess gas Dietary supplements: - Dietary supplements can also affect bowel function. For example, calcium supplements may cause constipation, whereas magnesium loosens stools. 64  Fundamental of Nursing (I) Supplemental vitamin C softens stools and, in high doses, may cause diarrhea in sensitive clients. Fluids : - A minimum of six to eight 8-ounce glasses (1,500 to 2,000 mL) of fluid per day is required to promote healthful bowel function. - Inadequate fluid intake or excessive fluid loss, as in diarrhea or vomiting, slows peristalsis and leads to dry, and hard stools. - Excessive fluid intake (especially beverages with high sugar content) may lead to soft or watery stools. - Different types of fluids have varying effects; For instance, consuming large amounts of milk may cause constipation. Coffee promotes peristalsis and may even cause loose stools. Activity: - Physical activity seems to stimulate peristalsis and bowel elimination. In addition, sedentary people are likely to have weaker abdominal muscles. - Clients with health concerns that limit activity (e.g., shortness of breath, pain, or required bed rest) often experience constipation. - Medications :Many medications may affect peristalsis. Examples include the following: - Antacids, often used for heartburn, neutralize stomach acid but may slow peristalsis. - Antibiotics given to combat infection decrease the normal flora in the colon. The result is often diarrhea. - Iron, a common mineral supplement, Iron has an astringent effect on the bowel and is notorious for causing constipation and changing stool color to black. 65  Fundamental of Nursing (I) - Pain medications, particularly opioids (narcotics),slow peristalsis and are associated with a high incidence of constipation. - Laxatives are used to treat constipation. In general, laxatives work by stimulating peristalsis. They are frequently abused by people who self-medicate, who may become dependent on them, requiring ever-increasing dosages until the intestine fails to work properly. 3. Surgery and procedures Anesthesia: General anesthesia & analgesics are slow bowel motility. Spinal anesthesia and epidural anesthesia are less likely to cause this effect. - Stress :Regardless of the type of anesthesia, most clients find surgery a stressful event. if stress activates the general adaptation syndrome (GAS), autonomic nervous system and endocrine responses ensue. Among those responses is a slowing of peristalsis. - Manipulation of the bowel during surgery Abdominal or pelvic surgery in which the bowel is manipulated may result in a paralytic ileus, a cessation of bowel peristalsis. - Decreased mobility After surgery, patients often experience discomfort that affects mobility. This further hinders GI motility and increases the risk for constipation. - Perineal surgery Patients who have had surgical interventions involving the perineal region (e.g., an episiotomy after childbirth) may fear pain or that their sutures will ―tear‖ or ―break‖ during bowel elimination, and therefore they resist the urge to evacuate their bowel. 66  Fundamental of Nursing (I) - Anal sphincter surgery Patients who have had surgery that disrupts the anal sphincter may experience uncontrolled rectal drainage after surgery. 4. Pregnancy: In early pregnancy, many women experience fluid loss due to ―morning sickness‖—periods of nausea and vomiting. As the pregnancy progresses, the increased level of progesterone slows intestinal motility. As a result, pregnant women often experience constipation 5. Pathological conditions - Several disorders affect bowel function. Among them are neurological disorders that affect innervation of the lower GI tract, cognitive conditions that limit the ability to sense the urge to defecate, pain or immobility that leads to sluggish peristalsis, and pathological conditions of the GI tract. As constipation and diarrhea. Other common disorders are food allergies, and food intolerances. - Food allergies: Some common food allergens include dairy products, egg whites, and shellfish. Immune responses to foods manifest as a variety of symptoms ranging from a mild rash to anaphylactic shock. Common GI symptoms suggesting food allergy include constipation, diarrhea. - Food intolerances In contrast to a food allergy, a food intolerance is specifically linked to the GI system. It produces such symptoms as GI discomfort, pain, gas, bloating, diarrhea, or constipation after the person consumes the food. An example is lactose intolerance Characteristics of normal feces: - Frequency: ranged from 1:2 per day or 1 every 2:3 days. - Color: brown. - Consistency: soft. 67  Fundamental of Nursing (I) - Shape: cylindrical. - Amount: 100:300/day. - Odor: aromatic Common problems of bowel elimination: 1. Constipation: is the infrequent and painful passage of [[ hard dry stool. Causes of constipation: - Poor elimination habits. If the desire for defecation is ignored repeatedly, the feces become hard and dry because of increased water absorption. - Lack of sufficient roughage or bulk in diet. - Lack of enough fluid intake. - Lack of muscle tone due to too much stimulation by irritating substances such as laxatives. - Emotional Tension may cause the gastrointestinal tract to become spastic and fecal content is not moved along the large intestine sufficiently well. - Interference with normal reflexes because of pain associated with defecation, e.g., piles, and fissure etc. - Lack of essential vitamins such as vitamin B. group or mineral as potassium. - Lack of exercise: o Decreased peristaltic movement. o Loss of muscle tone. Assessment of patient with constipation: - Passage of hard stools associated with a decrease in the usual frequency of defecation. - Feeling of rectal fullness. - Abdominal distension (the abdomen feels hard upon palpation) caused by accumulation of fecal matter as well as gases - Complaints of tenesmus (frequent painful straining in attempts to - defecate ). 68  Fundamental of Nursing (I) - General symptoms: e.g. headache, malaise, anorexia, and bad breath. Nursing management of constipation: 1. Provide adequate fluid intake 500 – 2000 cc/day. 2. Provide a well-balanced diet with enough roughage from fruits and vegetables and vitamins. 3. Encourage regularity of time for defecation and prompt response to the desire of defecation. 4. Encourage regularity of meal's time. 5. Provide adequate time for complete evacuation. 6. Provide privacy for patients to promote relaxation. 7. Provide posture (position) as close to normal as possible. 8. Provide physical and emotional comfort and alleviation of pain. 9. Provide physical exercises especially for abdominal muscles. 10. Consider the patient's habit in relation to defecation. Prevention of constipation: 1. Encourage exercise as walking. 2. Avoid excessive emotional stress. 3. Establish regularity of meals and defecation time. 4. Discourage unnecessary use of laxatives. 5. Intake of proper diet containing enough vegetables and vitamins 6. Intake of sufficient fluids per day. 2. Diarrhea: The passage of loose, watery stool and an increase in the frequency of bowel movements, diarrhea may or may not be accompanies by abdominal cramping. Causes of diarrhea: 1. Infectious agents 2. Mal absorption disorders. 3. Inflammatory bowel disease 4. Side effects of drugs. 5. Lifestyle changes. 69  Fundamental of Nursing (I) Nursing care of patients with diarrhea: 1. Assessment and observation of the patient, this includes: - Assessment of the stool in terms of frequency, consistency, odor and presence of foreign matter as mucous, pus, blood or undigested food. - Observation of the patient for signs and symptoms of the dehydration and electrolyte loss. With diarrhea there is acute loss of potassium and sodium chloride. 2. Diet: Provision of proper diet for maintenance of proper nutrition. - Diet free from roughage and Rich in liquids. - Free from irritants and low in fat. - Rich in proteins such as white meat boiled chicken and other. 3. If diarrhea is psychogenic, provide for psychological comfort and relaxation. 4. Provide for physical comfort and hygienic care. - Local irritation of the anal and region is common. Careful washing and drying after each movement is necessary. - Medicated creams will help prevent skin irritation, e.g., Zink oxide. 1. Intestinal distension (tympanitis): Excessive formation and accumulation of gases in the intestines Causes 1. Excessive intake of gas forming foods as (cabbage, onions, and legumes). 2. Prolonged constipation or impaction. 3. Inability of the small intestines to expel gases due to weakness e.g., in postoperative periods after abdominal surgery. 4. Swallowing large amount of air while eating or drink or tube feeding (in very old and children) or bacterial. 70  Fundamental of Nursing (I) Nursing intervention 1. Prevention of the cause. 2. Encourage exercises in bed or ambulate patients for short walk. 3. Avoid gas forming foods. 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 stools. Causes: 1. Prolonged constipation and poor habits of defecation. 2. Prolonged bed rest, vary in paralyzed or unconscious patients. 3. Prolonged use of anti-diarrheas drugs. 4. Following administration of Barium for x ray examination of the G.I.T. Nursing Management 1. Administration of mineral oil by mouth especially in cases of prolonged constipation for regulation of habits. 2. Oil retention enema followed by cleansing enema. 3. Digital manipulation of the fecal mass should be under physician order or supervision because it can stimulate vague nerve in the rectal wall which can slow patient's heart leading to cardiac arrhythmia, so observe patient's pulse rate, facial pallor and diaphoresis during manipulation. 3. Fecal incontinence: is the involuntary passing of bowel contents. Causes 1. Organic diseases causing weakness of the anal sphincter. 2. Impingent in the nerve supply to the anal sphincter. (i.e. relaxed external sphincter). 71  Fundamental of Nursing (I) Unit 4 Integral components of patient care 72  Fundamental of Nursing (I) Unit 5 Assessing health 73  Fundamental of Nursing (I) Vital Signs Learning objectives: At the end of the unit the student will be able to: 1. Define common terms regarding vital signs. 2. Determine timing for measuring vital signs. 3. Describe factors that affect the vital signs and accurate measurement of them. 4. Identify the normal ranges for each vital sign. 5. Identify the variations in normal body temperature, pulse, respirations, and blood pressure that occur from infancy to old age. 6. Identify nine sites used to assess the pulse and state the reasons for their use. 7. Describe the mechanics of breathing and the mechanisms that control respirations. 8. Describe methods and sites used to measure blood pressure. 74  Fundamental of Nursing (I) Key terms: - Vital signs - Afebrile - Pulse - Blood pressure - Body - Constant - Apical - Arterial temperature fever pulse blood pressure - Basal - Respiration - radial pulse - Cardiac metabolic output rate - Core - Apnea - Bradycardi - Diastolic temperature a pressure - Surface - Bradypnea - Dysrhythmi - Hypertensio temperature a n - Constance - (thoracic) - Peripheral - Hypotension fever breathing pulse - Radiation -Diaphragmat - Pulse rate - Orthostatic ic breathing hypotension - conduction - Dyspnea - Pulse - Pulse deficit pressure - Convection - Eupnoea - Pulse - Systolic rhythm pressure - Evaporation - Exhalation - Pulse - Tachypnea volume - Fever - External - Tachycardi - Inhalation respiration a - Hypothermi - Hyper- - Tidal - Relapsing a ventilation volume fever - Intermittent - Hypo- - Pulse - Internal fever ventilation oximeter respiration - Remittent fever 75  Fundamental of Nursing (I) Vital Signs Introduction: The traditional vital signs are body temperature, pulse respiration, and blood pressure. Many agencies such as the experts administration, American pain society and the joint commission have designated pain as a fifth vital signs, to be assessed at the same time as each of other four. Oxygen saturation is also commonly measured at the same time as the traditional vital sign. Definition of vital signs: Vital (cardinal) signs is an assessment tool for measurements of physiological functioning of the patient's body, specifically body temperature, pulse, respirations, ,blood pressure, pain ,pulse oximetry, urine output and level of conscious. When a nurse can check vital signs? 1. On admission to health care agency to obtain a baseline data. 2. When patient has a change in health status or reports symptoms such as chest pain or feeling hot. 3. Before & after surgery or any invasive procedure. 4. Before or after administration of medication that could affect the respiration, cardiovascular system (e.g. Digitalis). 5. Before & after any nursing intervention that could affect the vital signs (ambulating a patient who was in bed for a time). 76  Fundamental of Nursing (I) I. Body temperature Learning objectives: At the end of the lecture; the student will be able to: 1. Define common terms regarding body temperature. 2. Explain mechanism of regulating body temperature. 3. Differentiate between heat production and lost from the body. 4. List methods of heat lost from the body. 5. List the factors that cause variation in the body temperature. 6. List and describe common types of fever. 7. Discuss nursing intervention of hyper and hypothermia. 8. List the sites and indications for taking body temperature. 77  Fundamental of Nursing (I) Key Terms: - A febrile: absence of a fever. - Chemical thermogenesis: the stimulation of heat production in the body through increased cellular metabolism caused by increases in thyroxin output. - Hypothalamic integrator: the center in the brain that controls the core temperature; located in the preoptic area of the hypothalamus. - Body temperature: The balance between the heat produced by the body and the heat lost from the body. It's measured in heat units called degrees. Kinds of body temperature: 1. Core temperature: is the temperature of the deep tissues of the body (e.g. thorax, abdominal cavity, pelvic cavity). It remains relatively constant at 37° C (98.6° F). 2. Surface temperature: is the temperature of the skin, the subcutaneous tissue, & fat. It rises & falls in response to the environment. Physiological function: Heat production: Heat is produced in the body‘s cells through food metabolism that results in the release of energy. The body converts energy supplied by metabolized nutrients to energy forms that can be used directly by the body. One form of this energy is thermal energy for regulation of body temperature. This type of heat liberation is usually expressed as the metabolic rate and measured as the basal metabolic rate, or BMR (the rate of energy use in the body needed to maintain essential activities). 78  Fundamental of Nursing (I) - Body temperature is controlled by balancing metabolic heat production with heat loss. Most heat production comes from the deep tissue organs (brain, liver, and heart) and the skeletal muscles. - The skin, subcutaneous tissues, and fat of the subcutaneous tissues serve as heat insulators for the body. - Sweat glands in the dermis are innervated by sympathetic nerves of the autonomic nervous system and are controlled by the anterior hypothalamus to regulate sweating. Fig.(18): Regulation of body temperature 79  Fundamental of Nursing (I) Factors affecting body heat production: 1. Basal metabolic rate: is the rate of energy utilization in the body required to maintain essential activity such as breathing. Metabolic rate decrease with age. In general, the younger person the higher metabolic rate. 2. Muscle activity: Muscular activity also produces heat from the breakdown of carbohydrates and fats and through shivering. 3. Fever: increases the cellular metabolic rate and increases the body's temperature in the future. 4. Thyroxin output: The thyroid hormones thyroxin and triiodothyronine increase basal metabolism by breaking down glucose and fat. - Heat loss: Most body heat is lost from the skin‘s surface to the environment by the processes of radiation, conduction, convection, and evaporation. 80  Fundamental of Nursing (I) Characteristics Examples Method Radiation: is the All objects that are If the transfer of heat in not at absolute temperature of the form of waves; zero radiate heat the body is body heat is rays from the greater continually surface of one than the radiating into object to the surroundings, cooler surface of another heat is lost from surroundings. object that is not in the body to the physical contact environment. A with the first person in a room object. with normal temperature will lose about 60% of total loss by radiation. Conduction: Loss Heat is lost to Bathing a patient of heat to an object other objects that in cool or tepid in contact with theare cooler than the water will lower body skin. As much as the patient‘s 15% of temperature. the body‘s total heat loss is transferred to the air. Once the temperature of the air adjacent to the skin equals the skin temperature, there is no further loss of body heat. Convection: Convection The use of fans is the transfer of accompanies enhances heat through air conduction when convected 81  Fundamental of Nursing (I) currents; cool air the warmed air or heat loss by air. currents can cause water is replaced Water adjacent the body to lose with cooler to the skin can heat. elements. absorb far greater quantities of heat than can air. Clothing entraps air next to the skin, decreasing heat loss from the body by conduction and convection. Evaporation: It takes Insensible water Continuous approximately 0.58 loss is insensible water calories of heat for continuous. loss from the skin a gram of water to Insensible loss and lungs when evaporate. occurs water is converted regardless of from a liquid to a body gas temperature; thus, it is not a major regulator of temperature. 82  Fundamental of Nursing (I) Fig. (19): Body temperature represents a balance between heat produced and heat lost. Normal rage for body temperature: Normal body temperature for 5 years to adult is 36 °C to 37.5°C(96.80f to 99.5p0f), newborn & 1 year is 36.8°C (axillary) and older adult is 36°C. For example, if the Celsius reading is 37°: °F = (9/5 × 37) + 32 °F = 66.6 + 32 °F = 98.6°F (normal body temperature) Factors affecting body temperature: 1) Age: - Infants are greatly affected by the environment temperature & must be protected from extreme changes of temperature. 83  Fundamental of Nursing (I) - Old people (over 75 yr) are at risk of hypothermia (less than 36°) for many reasons, such as inadequate diet, loss of subcutaneous fat, and lack of activity). 2) Diurnal variations: - Body temperature normally changes throughout the day, varying as much as 1.0° between early morning & the late afternoon. - Highest body temperature point usually reached between 8pm & midnights. - Lowest body temperature point usually reached during sleep between 4am &6am. 3) Exercise: - Hard work or strenuous exercise, increases body temperature. 4) Hormones: - Women usually experience more hormones fluctuations than men. - Progesterone secretion at time of ovulation rises body temperature by about 0.3° - 0.6°. 5) Stress: - Stimulation of sympathetic nervous system can increase production of epinephrine & nor epinephrine leading to an increase of metabolic activity & heat production. 6) Environment: - Changes in environmental temperatures can affect a person's temperature regulating system. Alteration in body temperature: - Pyrexia: A body temperature above the usually range is called pyrexia, hyperthermia or (in late terms) fever. - Febrile (Fever, pyrexia & hyperthermia): pertaining to a fever; feverish, elevated body temperature above the usual range - Hyperpyrexia: an extremely high body temperature (eg,41°C[105.8 F]) 84  Fundamental of Nursing (I) Common types of fever are: 1. Intermittent fever: a body temperature that alternates at regular intervals between periods of fever and periods of normal or subnormal temperatures. 2. Remittent fever: the occurrence of a wide range of temperature fluctuations (more than 2C (3.6F) over the 24-hour period, all of which are above normal. 3. Relapsing fever :the occurrence short febrile periods of a few days interspersed with periods of 1 or 2 days of normal temperature. 4. Constant fever: a state in which the body temperature fluctuates minimally but always remains above normal constant. 5. Fever spike : a temperature that rises to fever level rapidly following a normal temperature and then returns to normal within a few hours. Clinical signs of fever: - Increased heart rate. - Increased respiratory rate. - Shivering. - Cold Skin. - Complaints of feeling cold. - Cyanotic nail beds. - "Goose Flesh" appearance of the skin - Cessation of sweating. Nursing interventions for patients with hyperthermia: 1- Monitor vital signs. 2- Assess skin color & temperature. 3- Monitor white blood cell count, & other laboratory reports for indications of infection or dehydration. 4- Remove excess blankets when patient feels warm. 5- Provide adequate nutrition & fluids to meet the increased metabolic demands & prevent dehydration. 6- Measure intake & output. 85  Fundamental of Nursing (I) 7- Reduce physical activity to limit heat production. 8- Administer antipyretics as ordered. 9- Provide oral hygiene to keep the mucous membranes moist. 10- Provide dry clothing and bed linens. People at risk of hyperthermia: - People with infection. - People with disease process of central nervous system that impair thermoregulation. 2) Hypothermia: Is a core body temperature below the usual normal range. Clinical signs of hypothermia: - Decreased body temperature, pulse, & respiration. - Sever shivering. - Feeling of cold & chills. - Pale, cool, waxy skin. - Hypotension. - Decreased urinary output. - Lack of muscle coordination. - Disorientation. - Drowsiness progressing to coma. Nursing interventions for patients with hypothermia: - Provide a warm environment (room temperature). - Provide dry clothing. - Apply warm blankets. - Keep limbs close to body. - Cover the patients scalp with a cap or turban. - Supply warm oral or intravenous fluids. - Apply warming pads. Patients at risk for hypothermia: - People who participate in a cold- weather sports. 86  Fundamental of Nursing (