Nursing Exam Notes

Stages of Illness

• Symptoms Experience:

  • Person experiences some symptoms and believes something is wrong.

• Assumption of Sick Role:

  • Acceptance of illness and seeking advice.

• Medical Care Contact:

  • Seeking advice from professionals for validation, explanation of symptoms, reassurance, or outcome prediction.

• Dependent Patient Role:

  • Person becomes a client, dependent on healthcare professionals.

  • Accepts/rejects suggestions, becomes more passive.

• Recovery/Rehabilitation:

  • Giving up the sick role and returning to former roles and functions.

Risk Factors of a Disease

• Genetic and Physiological Factors

• Age

• Environment

• Lifestyle

Classification of Diseases According to Etiologic Factors

• Hereditary:

  • Due to defects in genes transmitted from parents to offspring.

• Metabolic:

  • Due to disturbances or abnormalities in metabolic processes.

• Congenital:

  • Due to defects in development, hereditary factors, or prenatal infection.

• Deficiency:

  • Results from inadequate intake or absorption of essential dietary factors.

• Traumatic:

  • Due to injury.

• Allergic:

  • Due to abnormal response to chemical and protein substances or physical stimuli.

• Neoplastic:

  • Due to abnormal or uncontrolled cell growth.

• Idiopathic:

  • Cause is unknown; self-originated; of spontaneous origin.

• Degenerative:

  • Results from degenerative changes in tissues and organs.

• Iatrogenic:

  • Results from treatment of a disease.

Common Diseases

• Cardiovascular diseases

• Stroke

• Diabetes

• Degenerative diseases

• Cancer

• Arthritis

• Obesity

• Sexual dysfunction

• Neurodegenerative diseases

Types of Allergies

• Food allergy

• Drug allergy

• Insect sting

• Latex allergy

• Respiratory diseases

• Mold allergy

• Pet allergy

• Pollen allergy

• Dust mites

• Platelet Aggregation and Thrombosis

Types of Vitamins

• A (Retinol)

• B1 (Thiamine)

• B2 (Riboflavin)

• B12 (Cyanocobalamin)

• C (Ascorbic acid)

• D (Calciferol)

• K (Phylloquinone)

Types of Minerals

• Calcium

• Phosphorus

• Iron

• Iodine

• Copper

Deficiency Diseases

• Night blindness (Vitamin A)

• Beri-beri (Vitamin B1)

• Retarded growth, bad skin (Vitamin B2)

• Anaemia (Vitamin B12, Iron, Copper)

• Scurvy (Vitamin C)

• Rickets (Vitamin D)

• Excessive bleeding due to injury (Vitamin K)

• Brittle bones, excessive bleeding (Calcium)

• Bad teeth and bones (Phosphorus)

• Goitre, enlarged thyroid gland (Iodine)

• Low appetite, retarded growth (Copper)

Urinary Tract Infections (UTIs)

• Causes:

  • Urinary catheters

  • Surgical procedures

  • Surgical site infections

• Types:

  • Most common: $Staphylococcus$ $aureus$

  • Other common pathogens: $Escherichia$ $coli$, $Enterococci$, $Candida$

• Prevention:

  • Frequent hand hygiene

  • Proper PPE use

  • Appropriate antimicrobial use

  • Routine disinfection

  • Remove indwelling devices ASAP

• Related Infections:

  • Central venous catheters leading to bloodstream infections

  • Mechanical ventilation leading to pneumonia

Classification of Diseases According to Duration or Onset

• Acute Illness:

  • Short duration and severe.

  • Signs and symptoms appear abruptly, intense, and subside quickly.

• Sub-Acute Illness:

  • Symptoms are pronounced but more prolonged than acute.

• Chronic Illness:

  • Usually longer than 6 months and affects functioning.

  • Fluctuates between maximal functioning and relapses.

  • May be life-threatening.

  • Characterized by remission and exacerbation.

    • Remission: Periods during which the disease is controlled.

    • Exacerbations: Disease becomes more active with recurrence of symptoms.

Classification of Diseases (Additional)

• Organic:

  • Results from changes in normal structure with anatomical changes in organs or tissues.

• Functional:

  • No anatomical changes observed; may result from abnormal response to stimuli.

• Occupational:

  • Results from factors associated with the patient's occupation.

• Venereal:

  • Usually acquired through sexual relations.

• Familial:

  • Occurs in several individuals of the same family.

• Epidemic:

  • Attacks a large number of individuals in the community at the same time (e.g., SARS).

• Endemic:

  • Presents continuously or recurs in a community (e.g., malaria, goiter).

• Pandemic:

  • An epidemic extremely widespread, involving an entire country or continent.

• Sporadic:

  • Occasional cases occur (e.g., dengue, leptospirosis).

Mental Disorders

• Organic:

  • Causes: Infections, brain injury, alcohol, cardiovascular disorders, and drug use.

• Functional Neurological Disorders

  • Influenced by thoughts, emotions, physical sensations and behavior. e.g., Surprise, Fear, Sleepy, Sadness.

  • Prediction: Confusion.

  • Coping resources: Depression, Paralysis, Collapse.

  • Unexpected: Stress, Chronic fatigue, Lack of energy, Tremor, Shiver, Dementia, Seizure, Anxiety, Low Motivation, Inhibition, Anger.

Leavell and Clark’s Three Levels of Prevention

• Primary Prevention:

  • Seeks to prevent a disease or condition at a pre-pathologic state.

  • Health Promotion:

  • Specific Protection:

    • Immunization, personal hygiene, environmental sanitation, protection against occupational hazards and accidents, use of specific nutrients, protection from carcinogens, avoidance of allergens.

• Secondary Prevention (Health Maintenance):

  • Seeks to identify specific illnesses early with prompt intervention to prevent or limit disability.

  • Early Diagnosis and Prompt Treatment:

  • Disability Limitations:

    • Adequate treatment to arrest disease and prevent complications.

    • Provision of facilities to limit disability and prevent death.

• Tertiary Prevention:

  • Occurs after a disease or disability has occurred and the recovery process has begun.

  • Intent is to halt the disease or injury process and assist in obtaining optimal health status.

  • "To maximize use of remaining capacities."

  • Restoration and Rehabilitation:

    • Work therapy in hospital, use of shelter colony.

Communication in Nursing

• Means to establish helping-healing relationships.

• All communication influences behavior.

• Essential for establishing a therapeutic relationship.

• Means by which an individual influences the behavior of another which leads to successful outcome.

Basic Elements of the Communication Process

• Sender: Person who encodes and delivers the message.

• Messages: Content of the communication (verbal, nonverbal, symbolic).

• Receiver: Person who receives and decodes the message.

• Feedback: Message returned by the receiver, indicating understanding.

Modes of Communication

• Verbal Communication:

  • Use of spoken or written words.

  • Effective verbal communication techniques:

    • Listen; avoid distractions; focus on non-verbal cues; be careful; do not interrupt; maintain eye contact; be confident; be open-minded; be clear while speaking; represent information in short.

• Nonverbal Communication:

  • Use of gestures, facial expressions, posture/gait, body movements, physical appearance, and body language.

7 Types of Nonverbal Communication

*Kinesics or Body Movements
*Personal Appearance
*Proxemics
*Chronemics
*Haptics
*Vocalics
*Physical Environment
Kinesics or Body Movements:
*Includes facial expression and eye contact
Vocalics or Paralanguage:
*Includes volume ,rate pitch and timbre
Our Physical Environment:
*Includes artifacts or objects that compose it.
Haptics:
*Refers to the way in which people and animals communicate and interact via the sense of touch.
Chronemics:
*Is a discipline concerned with the study of PERSON'S USE OF TIME
Proxemics or Personal Space
*Intimate Space (<1.5 feet) *Personal Space (1.5 to 4 feet) *Social Space (4 to 12 feet) *Public Space (>12 feet)

Characteristics of Good Communication

• Simplicity:

  • Use commonly understood words, brevity, and completeness.

• Credibility:

  • Means worthiness of belief. The nurse requires knowledge about the topic, conveys confidence, and is accurate.

• Clarity:

  • Saying what is meant, speaking slowly, and enunciating words well.

• Timing and Relevance:

  • Appropriate timing and consideration of the client’s interests and concerns.

• Adaptability:

  • Adjustments on what the nurse says and how it is said based on the client's moods and behavior.

Communicating with Clients Who Have Special Needs

• Clients Who Cannot Speak Clearly:

  • Listen attentively, be patient, and do not interrupt.

  • Ask simple questions that require “yes” and “no” answers.

  • Allow time for understanding and response.

  • Use visual cues (words, pictures, objects).

  • Allow only one person to speak at a time.

  • Do not shout or speak too loudly.

  • Use communication aids (pad and pen, magic slate, pictures, call bells).

• Clients Who Are Cognitively Impaired:

  • Reduce environmental distractions.

  • Get client’s attention prior to speaking.

  • Use simple sentences and avoid long explanations.

  • Ask one question at a time.

  • Allow time for client to respond.

  • Be an attentive listener.

  • Include family and friends in conversations.

• Clients Who Are Unresponsive:

  • Call client by name during interactions.

  • Communicate verbally and by touch.

  • Speak to client as though they can hear.

  • Explain all procedures and sensations.

  • Provide orientation to person, place, and time.

  • Avoid talking about client to others in their presence.

  • Avoid saying things client should not hear.

• Communicating with Hearing Impaired Client:

  • Establish a method of communication (pen/pencil and paper, sign language).

  • Pay attention to non-verbal cues.

  • Decrease background noise.

  • Always face the client when speaking.

  • Check with family on how to communicate with the client.

• Clients Who Do Not Speak English:

  • Speak to client in normal tone of voice.

  • Establish method for client to signal desire to communicate (call light or bell).

  • Provide an interpreter (translator) as needed.

  • Avoid using family members as interpreters.

  • Develop communication board, pictures, or cards.

  • Have dictionary available if client can read.

Common Reports

• Change-in-shift report

• Telephone report (only RNs allowed to accept telephone orders)

• Transfer report

• Incident report

Nursing Documentation

• Must be accurate, comprehensive, and flexible.

• Ensure continuity of care, saves time, and minimizes risk of error.

• Nurses need to communicate information about clients accurately and in a timely manner.

• If care plan is not communicated, care can become fragmented, repetitive, and therapies may be delayed or omitted.

Confidentiality

• Nurses are legally and ethically obligated to keep client information confidential.

• May not discuss a client’s examination, observation, conversation, or treatment with other clients or staff not involved.

• Only staff directly involved have legitimate access to the record.

• Clients have the right to read their records.

• Nurses are responsible for protecting records from unauthorized readers.

• Authorization must be obtained for data gathering, research, or continuing education.

• Maintaining confidentiality is an important aspect of profession behavior.

• Safeguard the client’s right to privacy by carefully protecting sensitive information.

• Sharing personal information or gossiping violates ethical codes and damages relationships.

Guidelines of Quality Documentation and Reporting

• Factual:

  • Record must contain descriptive, objective information about what a nurse sees, hears, feels, and smells.

  • Avoid vague terms (appears, seems, apparently).

  • Example: "The client seems anxious" is a conclusion without supported facts.

• Accurate:

  • Documentation of concise data is clear and easy to understand.

  • Avoid unnecessary words and irrelevant details.

  • Use exact measurements (e.g., "Intake of 350 ml of water").

• Complete:

  • Information needs to be complete, containing appropriate and essential details.

  • Example: Detailed description of pain, location, onset, and rating.

• Current:

  • Timely entries are essential.

  • Use records kept near the client’s bedside for immediate documentation.

• Organized:

  • Communicate information in a logical order.

  • For example, describe pain, assessment, interventions, and client’s response.

Legal Guidelines for Recording

• Record all entries legibly and in black ink.

  • Never use pencil or felt pen.

• Do not write retaliatory or critical comments about the client or care by others.

  • Enter only objective descriptions of client’s behavior; quote client’s comments.

• Correct all errors promptly.

  • Draw single line through error, write "error" above it, and sign your name or initials. Then record note correctly.

• Do not leave blank spaces in nurse’s notes.

  • Chart consecutively, line by line; if space is left, draw line horizontally through it and sign your name at end.

• If order is questioned, record that clarification was sought.

  • If you perform incorrect orders, you are just as liable for prosecution as the physician.

• For computer documentation, keep password confidential.

  • Maintain security and confidentiality.

  • Do not leave computer screen unattended.

• Chart only for yourself.

  • Never chart for someone else.

  • You are accountable for information you enter.

• Avoid using generalized, empty phrases such as “status unchanged” or “had good day”.

  • Begin each entry with time, and end with your signature and title.

  • Do not wait until end of shift to record important changes.

  • Be sure to sign each entry.

Nursing Process

• Systematic approach to problem-solving.

• Steps are closely interrelated.

• Patient-centered approach that allows for active patient participation.

• Input, throughput, and immediate feedback.

• Emphasis on the nurse's creativity.

Importance of the Nursing Process

• Important to both the client and the nurse.

• Nurses respond to consumer demands for quality service and seek improvement.

• Avoid duplication and omissions, resulting in unnecessary use of resources or cost containment.

Benefits of the Nursing Process

• For the Client:

  • Quality client care.

  • Continuity of care.

  • Participation in their health care.

• For the Nurse:

  • Consistent and systematic nursing education.

  • Job satisfaction.

  • Professional growth.

  • Avoidance of legal action.

  • Meeting professional standards.

  • Meeting standards of accredited hospitals.

Assessing (Assessment)

• Process of collecting, validating, organizing, and recording data about the client’s health status.

• Initial step in the nursing process and an ongoing component.

• Purpose:

  • To establish a database.

• Activities:

  • Collection of data.

• Data Types:

  • Subjective Data (Symptoms): Can be described only by the person experiencing it.

  • Objective Data (Signs): Observations or measurements made by the nurse.
    *What brought you to the hospital?
    *Let me have a look at that?
    *Describe how you are feeling?

Diagnosing (Nursing Diagnosis)

• Statement that describes a patient’s actual or potential problem which are potentially responsive to nursing therapy

• Phase in which the nurse analyzes data gathered during assessment and identifies problem areas for the client.

• American Nurses’ Association’s Definition:

  • A clinical judgment about the clients response to actual or potential health conditions or needs.

Four Elements of Nursing Diagnostic Process

Analysis & Interpretation
Clustering of Data
Identification of Patient's Problem
Formulating a Diagnoses

1. Data Analysis 2.Problem Identification

2. Formulation of nursing diagnosis
   *What is the problem?
   Importance of Nursing Diagnoses:
   *Nursing diagnoses are necessary for the formulation of nursing care plan to help the patient adapt to changes in health state or lifestyle modifications.
   *Help facilitate communication regarding patient care and can be useful for quality assurance and peer review process.
   *What is the cause/How do I know it

3 Components of Nursing Diagnosis PES / PEM / PER

1. Statement of the patient’s PROBLEM 2. Statement of causality (ETIOLOGY)

2. Signs and Symptoms (MANIFESTATIONS)

Types of Nursing Diagnoses

• Actual Diagnosis:

  • Client problem that is present at the time of the nursing assessment, based on S/S (e.g., Ineffective Breathing Pattern, Anxiety).

• Risk Diagnosis:

  • A clinical judgment that a problem does not exist, but is likely to develop without intervention (e.g., Risk for Infection).

• Wellness Diagnosis:

  • Describes human responses to levels of wellness with readiness for enhancement (e.g., Readiness for Enhanced Spiritual Well-Being).

• Possible Nursing Diagnosis:

  • Evidence about a health problem is incomplete or unclear, requiring more data to support or refute it (e.g., Possible Social Isolation R/T Unknown Etiology).

• Syndrome Diagnosis:

  • Diagnosis associated with a cluster of other diagnoses (e.g., Risk for Disuse Syndrome).

Planning

• Process of designing nursing strategies or interventions to prevent, reduce, or eliminate client health problems.

• Deliberative, systematic process critical to quality nursing care.

• Decision making and problem-solving are carried out.

• Uses data from assessing and diagnostic statements.

• Purpose:

  • To identify the clients goals and appropriate nursing interventions.

• Activities

  • Set goals & objectives in collaborations with the client, Goals maybe long term or short term

  • Identify alternatives of nursing care

  • Selecting nursing measures that will meet the objectives

  • Write nursing orders

  • Write the nursing care plan
    *What can I do about it
    *what is the most important
    *What do I want to happen, by When
    CHARACTERISTICS OF A WELL-STATED BEHAVIORAL OBJECTIVE:S-Specific, M-Measurable, A-Attainable, R-Realistic, T-Time Framed

Implementation

• Actual doing of the nursing interventions.

• The “doing” or action phase (execution of the plan).

• Involves completion of all actions necessary to fulfill the goals and objectives as delineated in the plan.
  *Implementation of the plan involves completion of all the actions necessary to fulfill the goals and objectives as delineated in the plan.
  *Five Activities of the Implementing PhaseReassessing the clientDetermining the nurse’s need for assistanceImplementing nursing interventionsSupervising delegated care*Documenting nursing activities

WHO IMPLEMENTS?

The NURSE; the CLIENT; the FAMILY MEMBERS; other HEALTH TEAM MEMBERSA combination of the above
IMPLEMENTING NURSING INTERVENTIONS
Evidence-based practice
Clearly understand interventions
Adapt activities to the individual client
Implement safe care
Provide teaching, support, and comfort
Be holistic
Respect the dignity of the client and enhance self esteem
Encourage active client participation

Evaluating Evaluation

*Depends on the effectiveness of phases that precede.
*ASSESSING AND NURSING DIAGNOSIS MUST BE ACCURATE. GOALS/DESIRED OUTCOME MUST BE STATED BEHAVIORALLY TO BE USEFUL FOR EVALUATING. COMPONENTS OF THE EVALUATION PROCESS
COLLECTING DATA RELATED TO THE DESIRED OUTCOMES (NOC INDICATORS)COMPARING THE DATA WITH OUTCOMESRELATING NURSING ACTIVITIES TO OUTCOMESDRAWING CONCLUSIONS ABOUT PROBLEM STATUS*CONTINUING, MODIFYING, OR TERMINATING THE NURSING CARE PLAN

MUST BE IN IMPLEMENTING PHASE, THERE WOULD BE NOTHING TO EVALUATE

Components of an Evaluation StatementConclusion*Supporting data

*CHECK WHETHER THE INTERVENTIONS WERE CARRIED OUT WAS UNREASONABLE
*MAKE NECESSARY MODIFICATIONS*IMPLEMENT THE MODIFIED PLANCollecting subjective and objective data
*Analyzing subjective and objective data to make a professional nursing judgement
*Determining outcome criteria and developing a plan
*Carrying out the plan
*Assessing whether outcome criteria have been met and revising the plan as necessary

Basic Concept of Oxygenation

InspirationDiaphragm and intercostal contactThoracic cavity size increasesVolume of lungs increasesIntrapulmonary pressure decreasesAir rushes into the lungs to equalize pressure
ExhalationDiaphragm and intercostal relaxVolume of the lungs decreasesIntrapulmonary pressure rises*Air is expelled

Gas Exchange## OCCURS AFTER THE ALVEOLI ARE VENTILATED

Pressure differences on each side of the respiratory membranes affect diffusionDiffusion of oxygen from the alveoli into the pulmonary blood vesselsDiffusion of carbon dioxide from pulmonary blood vessels into alveoli
Oxygen Transport: Transported from the lungs to the tissues97% of oxygen combines with hemoglobin in red blood cells and carried to tissues as oxyhemoglobinRemaining oxygen is dissolved and transported in plasma and cellsCO2 trasportMust be transported from the tissues to the lungsContinually produced in the process of cell metabolism65% is carried inside the red blood cells as bicarbonate30% Combines with hemoglobin as carbhemoglobin5% Transported in solution in plasma and as carbonic acid

Factors That Influence RespiratoryRate And Functions
Pain
Emotion
Resistance From Air Pasages
Fever
Elasticity Of The Lungs
Age
Altered Breathing Patterns
Obstructed Or Partially Obstructed Airway
Rapid Pulse
Rapid, Shallow Respirations
Increased Restlessness Or Lightheadedness
Cyanosis
Hypoxia vs Hypoxemia vs Ischemia
Orthopnea vs Dyspnea

Major Abnormal Breathing Patterns
Eupnea: Normal breathing rate and pattern
Tachypnea: Increased respiratory rate Causes: Fever, anxiety, exercise, shock.
Bradypnea: Decreased respiratory rate Causes: Sleep, drugs, metabolic disorder, head injury, stroke
Apnea: Absence of breathing Causes: Deceased patient, head injury, stroke
Hyperpnea: Normal rate, but deep respirations Causes: Emotional stress, diabetic ketoacidosis
Cheyne-Stokes: Gradual increases and decreases in respirations with periods of apnea Causes: Increasing intracranial pressure, brain stem injury
Biot's: Rapid, deep respirations (gasps) with short pauses between sets Causes: Spinal meningitis, many CNS causes, head injury
Kussmaul's: Tachypnea and hyperpnea Causes: Renal failure, metabolic acidosis, diabetic ketoacidosis
Apneustic: Prolonged inspiratory phase with shortened expiratory phase Causes: Lesion in brain stem

BASIC CONCEPT OF NUTRITION
ESSENTIAL NUTRIENTS AND SOURCESWhat are the most important:WaterCarbohydratesProteinFatsMicronutrients VitaminsMineralsWhy are they important in the body

Mouth pepsin: protein smallI pancreas smallI aminopeptidase intestineamino acids anabolismnitrogen

lipids fatsstomach smallI bile pancreas smallI intestinalcells energy triglyceridesI converts cells blood

ENERGY BALANCE IS THE RELATIONSHIPBETWEEN THE ENERGY DERIVED FROM FOOD AND THE ENERGY USED BY THE BODY.Caloric value is the amount of energy that nutrients or foods supply to the body.Basal metabolic rate (BMR) is the rate at which the body metabolizes food to maintain the energy requirements of a person who is awake and at rest.Resting energy expenditure (REE) is the amount of energy required to maintain basic body functions (calories required to maintain life)

• BODY MASS INDEX BMI
  $BMI = \frac{Weight (in kilograms)}{Height ^2 (in meters)}$
  Imperial System
  $BMI = 703 \times \frac{Weight (in pounds)}{Height ^2 (in inches)}$

• <18.5 UNDER WEIGHT

• 18.5-24.9 NORMAL

• 25.0-29.9 OVER WEIGHT

• 30.0-34.9 OBESE

• > 35.0 EXTREMELYOBESE
  DEVELOPMENTAL CONSIDERATIONSGENDERETHNICITY AND CULTUREBELIEFS ABOUT FOODPERSONAL PREFERENCESRELIGIOUS PREFERENCESLIFESTYLEECONOMICSMEDICATIONS AND THERAPYHEALTHALCOHOL CONSUMPTIONADVERTISING*PSYCOLOGIC FACTORS

Neonote - 1 year
Fluid and nutritional needs are met by breast milk or formulaAddition of solid food to the diet between 4 and 6 months of ageBy the age of 1, most infants can be completely fed on table food, and milk intake is about 20 ounces per dayToddlerCan eat most foods and adjust to three meals each dayBy the age of 3 is able to bite and chew adult table foodCaloric requirement is 900 to 1800 Kcal/dayNeed for adequate iron, calcium, and vitamins C and A are common deficienciesPreschooler Eat adult foodsVery active and often require snacks between mealsCheese, fruits, yogurt, raw vegetables, and milk are good choicesSchool-AgedRequire a balanced diet including 2400 Kcal/dayEat three meals a day and one or two nutritious snacksNeed a protein-rich food at breakfast to sustain the prolonged physical and mental effort required at schoolAdolescent Increased need for nutrient and calories during growth spurtsAdequate calcium intake (1200 to 1500 mg/day) Health snacks and limits on junk foodsAnorexia nervosa and bulimia may occurAdults Continue to eat a healthy diet, with special attention to protein, calcium, and limiting cholesterol and caloric intakeTwo or three liters of fluid should be included in the daily dietPostmenopausal women need to ingest sufficient calcium and vitamin D to reduce osteoporosisAntioxidants such as vitamin A, C, and E may be helpful in reducing the risks of heart disease in womenEldersRequire the same basic nutrition as the younger adultFewer calories are needed by elders because of the lower metabolic rate and the decrease in physical activitySome may need more carbohydrates for fiber and bulk, but most nutrient requirements remain relatively unchangedPhysical changes as tooth loss and impaired sense of taste and smell may affect eating habitsDecreased saliva and gastric juice secretion may also affect nutritionPsychosocial factors may also contribute to nutritional problems*
ELIMINATION*The act of elimination is a fundamental human process essential to life.Being able to meet clients’ elimination needs is therefore an essential nursing function and can help to both maintain and/or restore a client’s wellbeing and preserve life. The skills involved do, however, need to be applied sensitively, as many clients despair at the thought of being unable to manage their own toilet requirementsFACTORS THAT AFFECTS ELIMINATIONPHYSICALPSYCHOLOGICALSOCIOCULTURALENVIRONMENTALPOLITICO-ECONOMIC

Urinary Output Normal urinary output is approximately 1.5 litres in 24 hours and the usual frequency of micturition is between 5 and 10 times in that period. Urine normally consists of: 96% water 2% urea 2% uric acid, creatinine, sodium, potassium, chlorides, phosphates, sulphates, & oxalates.Bowel Movement Bowel habits are variable between individuals and are influenced by lifestyle, eating habits and mental stateNormal faces is made up of 75 percent water and 25 per cent solid constituents (cellulose, dead epithelial cells, bacteria, mucus and bile pigments). Skatole and indole arise from bacterial decomposition and give feces it characteristic odorVomitus Monitoring a client’s vomiting pattern along with the amount and consistency of the vomit can help in determining the nature of their condition as well as assisting in helping us determine a client’s potential for malnutrition and dehydration, and subsequently their replacement needs.

FACTORS Physical illness, infection, gender, age, metabolic ratePsychological emotion, stress and anxiety Sociocultural exercise, activity, recreational drugsEnvironmental time of day, severe heat or coldPolitico-economic lack of finances for heating or occupation most adults are unawareAdults are usually unaware of their body temperature because of their comfortable constant level*A special regulating center in the brain the hypothalamus it carefully balances the amount and produced and lost the body by is to sweat or shiver *Normal Body Temp
*Normal Range is 36C to 37C
*Pyrexia 38C to 40C
*Hyperpyrexia 40.1C and ABOVE
*Heat stroke usually occurs around 41C to 42C
*Hypothermia 35C and Below
*Death is at 20C

*BODY ALIGNMENT (POSTURE)Joint MOBILITY BALANCECOORDINATED MOVEMENT4 Basic ElementsOf Normal Movement
Body Alignment Optimal Balance Joint MobilityGenetic/Activity
Joint ROM varies and determined by:Genetics MakeUPDevelpmentalPatternsPresence Or Absence of DiseaseBalance Smooth, purposeful movement Cerebral Cortex :Initiates voluntary movementCerebellum Coordinates motor activityBasal ganglia Maintains postureCoordinated Movement ISOTONIC MUSCLE SHORTENS ISOMETRIC Setting MUSCLE CONTRACTION ISOKINETIC RESISTIVE MUSCLE CONTRACTION AEROBIC INCREASED VENTILATION

IMMMOBILITY:Decreased Cardiac reserve Increased USE of valsalvaOrthostatic HypotensionVenouvasodilation thrombusDisuse OsteoporisDisuse atrophyExercise:Maintain Size Joint Flex increaseHRHarmful Effects Of StressEffects On musculoskeletalEXERCISE: Shape Tone and strength nourish joints increase stability Effects On Resp.Immobility-Decreased RESP -Secretions Atelectasis PneumoniaExcerise IncreaseVentilation AND INTAKE -Prevents Pooling secretions MetabolismExercise: Rates And Levels Decrease Serum balanceEffects GI System Exercis increase BloodFlow Elevates moodPROBLEMS WITH OXYGEN TRANSPORTINADEQUATE RBCS*LOW HEMOGLOBIN *ABNORMAL HEMOGLOBINWhat can and should be done What the next steps?

Normal Hemoglobin Levels:For men, 13.5 to 17.5 grams per deciliter.For women, 12.0 to 15.5 grams per deciliter.

• ELECTRICAL IMPULSES. Electrical impales cause the atria and ventricles to contract, which forces blood to circulate.

• ELECTRICAL IMPULSES SINOATRIAL NODE SA NODE Nerve Pathways CARRY Signals ACROSS The CARDiac TISSUES Right Ventricle PORTAL VEIN Clinic
  Anterior vena cavaPulmonary arteryAortaPulmonary veinRight atriumRight ventriclePosterior vena cavaLEFT atrium*LEFT ventricle
  Functions Of The Cardiovascular SystemTransports Oxygen Nutrients Hormones To CellsTransports Wastes From TissuesRegulates Body Temperature Ph Fluid Volume Prevents Infection Blood Loss

Factors Influencing Cardiovascular FunctionCardinal Output (CO) SV *HRStroke Volume Sv 50-100MlHeart Rate Hr Contractsility PreLoad After Load
Risk Factors For Cornonary Artery Disease Elevated Serum Lipid Levels Modifiable Risk Factors Non Modifiable Genetics Heredity Smoke And Genetics

Myocardial Infarction Chest Pain Nausea Shortness Of Breath Diaphoresis Can Develop Irregular Short Rhythem Structural Heart Conditions Affecting Aorta
INCOMPETENT Venous Valvues May AllowBlood To pool Inthe Veins -Edema
** AtheroscierosisMost Common Cause Impaired Bood Flow Tissues-Distal Thrombi EmobolieConditions Of Affect Cardiacs Cardiac Output PULMONARY Embolism Decrease Hair -Pulses Peripheral Arteral Circulation-DecreasedAnemia Chronic - Fatigue PALLOR -Shortness 0f Breath Hemorrhage kidney Failure Fluid Retention-Fluid Retention *What is the best best way to handle this *18MosGenderStimuliParentsStimuliModestyGenderValuesDiminshAdulthood

• 121 Sexuality Sexuality Is An Aspect Of An Individual's Identity Composed Of Sex Family, Sexual Practice, And The Gender, That Affect Influence That Is Culture That Is On A Level That I Am Not Under Standing Sexuality

• 23 Sexual Dysfunction May Be Related Arousal Or Factors Drugs
  *Sexuality is as aspect of an individual’s identity composed of sex, gender, romantic & sexual attractions,and sexual practice.
  *INFLUENCES ON SEXUALITY: Family, Culture, Religion, Personal expectation and ethics.
  *VARIETIES OF SEXUALITY. Sexual Orientation (same or opposite gender).Erotic preferences (sexual Fantasies Cunnilingus).
  SEXUAL DYSFUNCTION
  *May be related past and current factors: Psychological,Cognitive,relationship problems,health. Medications,Sexual Desire and arousal disorders
  SEXUAL
  SEXUAL DESIRE DISORDERS
  Hypoactive Sexual DesireSexual Aversion Disordersarousal disorder
  *Female Sexual Arousal Disorder *Male Erectile Dysfunction
  *ORGASMIC DISORDER *Female Orgasmic Disorder,Male Orgasmic Disorder
  *SEXUAL PAIN DISORDER Dyspareunia, Vulvodynia .
  125 how to use nanda assessment to
  *OBJECTIVES AND SUBJECTIVE To Data.

SCREENING ASSESSMENTPOTENTIAL DIAGNOSESIN-DEPTH ASSESSMENTNURSING DIAGNOSISData collectionConsider all possible diagnoses that match information availableFocused data collectionDetermining priority nursing diagnosesData analysisClustering of informationData analysisConfirming