Fundamentals of Nursing Exam #3

Exam 3 (Chapters 4, 11, 32,34,35)

Research is Important, Why?

• Promotes quality patient care

• Builds nursing knowledge

• Improves outcomes

• Supports professional development

Florence Nightingale

Used statistics to improve battlefield care

Mid-20th Century

Increased focus on nursing specific research

1970s-1980s

National Institution of Nursing Research was established

21st Century

• EBP

• Health Equity

• Social Determinants

• Translational Research

Characteristics of Nursing Research

• Focus on improving pt care

• Use physiological, sociological, economic, and cultural factors

• Must contribute to nursing knowledge

Evidence-Based Practice

Research evidence + clinical expertise + pt values

Step 1 in EBP Process

Ask clinical question

Step 2 in EBP Process

Acquire the best evidence

Step 3 in EBP Process

Assess the evidence

Step 4 in EBP Process

Apply to the practice

Step 5 in EBP Process

Evaluate the outcome

P in PICOT

Patient Population

I in PICOT

Intervention

C in PICOT

Comparison

O in PICOT

Outcome

T in PICOT

Time

Quantitative

• Use of numbers and statistics

• Controlled Settings

Qualitative

• Explores lived experiences

• Interviews/focus groups

Research

Guided by a theory or model

Problem Statement

Outlines variables and populations

Dissemination and Translation to Practice

Includes podium/poster, presentations, journals

Translation to practice

• Informs safe and effective interventions

• Keeps practice current

• Encourages critical thinking

• Improves patient satisfaction

Ethical considerations

• Informed consent

• Right to withdraw

• Confidentiality

• Institutional Review Board approval

HIPAA (Health Insurance Portability and Accountability Act)

Protects patient confidentiality during research

Protected Health Information (PHI)

Cannot be disclosed without patient consent

Nurses involved in research must

Follow both IRB and HIPPA regulations

Comparative Effectiveness Research (CER)

Evaluates 2 or more interventions to determine best outcome

Health

Complete physical, mental, and social well-being

Wellness

Balance of physical, emotional, social, and spiritual health

Illness

Disharmony in these dimensions

Holism

Interaction of body, mind, and spirit within the environment

Health Promotion

• Empower ppl to take control of their health

• Prevents illness through lifestyle and behavior changes

• High-level wellness = striving toward one’s potential

Clinical Model

Absence of disease

Health Belief

Beliefs influence actions

High-Level Wellness

Process of reaching highest potential

Holistic Health

Integration of body, mind, and spirit

Holistic

Involves body, mind, spirit, and environment

Positive & Affirming

Focuses on strengths and growth

Multicultural

Applies to people from all backgrounds

Dynamic

Continuously evolving with life changes

Optional Functioning

Living well within your current circumstances

Primary Prevention

Prevent illness before it occurs

Secondary Prevention

Detect and treat diseases early

Tertiary Prevention

Minimize effects of chronic disease

Health Promotion

• Encourage healthy behaviors

• Empowering pts

• Focus on long-term care not just illness treatment

Stress in Body

• Breathlessness

• Headache

• Frequent Infection

• Fatigue

Stress on Mind

• Nightmare

• Worrying

• Indecisions

• Muddled thinking

Stress on Emotions

• Depression

• Irritable

• Angry

• Anxiousness

Stress on Behavior

• Loss of s.e.x drive

• Over- or under-eating

• Sleeplessness

• Smoking or Drinking

Pre-contemplation

I hate dealing with money - I’ll just work until I die (Denial)

Contemplation

Wait my grandmother lived until 103

Preparation

How to save for 100th birthday party

Action

Just do it, build it

Maintenance

Kickback and monitor

Termination

Now I don’t even notice I’m saving- I just do it (Habit)

Integrative Healthcare (IHC)

• Allopathic and complementary therapies

• Emphasizes nutrition, stress management, and patient empowerment

• Evidence-Based and focuses on wellness

Allopathic Medicine

Conventional Western approaches

CAM

Complementary and Alternative Medicine

Traditional Medicine

Indigenous health systems

IHC

Holistic, evidence-based integration of CAM and allopathic care

Whole Medical Systems

Complete systems of theory and practice

• Ex: Homeopathy

Mind-Body Interventions

Techniques that enhance the mind’s capacity to affect bodily function

• Ex: meditation

Biologically Based Therapies

Natural substances

• Ex: Herbs

Manipulative/Body - Based Methods

Movement or manipulation of body parts

• Ex: massage

Energy Therapies

Use of energy fields

• Ex: Reiki

Pain

Top reason for IHC use

Pain Therapies

• Guided imagery

• Deep breathing

• Massage

• Acupuncture

• Energy therapies

Legal Issues

Must follow State Practice Act

Therapies

are supported by clinical research

Urinary System

• Regulates fluid and electrolytes

• Removes waste

• Provides hormones in red blood cell production

• Bone Metabolism

• Controls bp

Structure of the Urinary System

Kidneys, Ureters, Bladder, and Urethra

Location of Urinary System

Behind the abdomen, on either side of the spine

Structure of the Urinary System

Enclosed in the fibrous capsule and cushioned by fat

Nephron

The kidney’s functional unit that forms urine

• ~1 million per kidney

Glomerulus & Bowman’s Capsule

Start urine formation by filtering blood

Tubules, Loop of Henle, Collecting Ducts

Regulates fluid and electrolytes, directing urine to the ureters

Urinary System Functions

Urine Formation

• Filtration, Reabsorption, and Secretion

Urine Excretion

Urine Formation Filtration

• Starts in the Glomerulus

• Blood is filtered: water and small substances enter the renal tubule

Urine Formation Reabsorption

Substances like water, glucose, and salts that are taken back into the blood

Urine Formation Secretion

Waste and acids move from the blood to the tubule

Urine Excretion

Urine flows out (kidney → ureter → bladder → urethra)

Volume of urine _____ stretches detrusor muscle

~ 250 to 400 mL

Normal Volume of Urine

Avg amount per void 250 to 400 ml in adults

Normal Color of Urine

Light yellow to amber

• Could be cloudy, dark reddish-brown, or streaked with blood from menstruation

Normal Clarity of Urine

Fresh voided urine is clear without sediment

Normal Odor of Urine

Aromatic

Normal Specific Gravity of Urine

1.010-1.030

How many times do most adults void daily?

6-8 times a day

When does normal voiding commonly occur?

After waking, within an hour after a meal, and before bedtime

What factors directly affect routine voiding patterns?

Fluid intake

What is the normal total urine output in 24hrs?

1,200 - 1,500 mL per day

What is the average urine output per hour and per void?

About 30mL/hr; 200-500 mL per void

What happens to the urinary tract muscles with aging?

The ureters, bladder, and urethra lose muscle tone, reducing the bladder's ability to hold urine

How does fluid intake affect urinary elimination?

Increased fluid intake generally increases urine production

How does loss of body fluid affect urinary elimination?

Dehydration decreases urine production

How does nutrition affect urinary elimination?

Diet can affect urine production and its composition

How can substances affect urinary elimination?

Caffeine and alcohol can increase urine production

How does body position affect urinary elimination?

Position can affect the ability to empty the bladder

How does cognition affect urinary elimination?

Confusion or impaired awareness can interfere with recognizing the need to void