Week 5 Absolutely — here’s a condensed study guide that keeps the major concepts (the stuff most likely to be tested), without all the extra detail. Infection Control & Body Defenses — Condensed Study Guide (Major Concepts) Chain of Infection (6 Links + how to break them) 1. Infectious agent (bacteria, viruses, fungi, parasites, prions) ○ Break it: disinfect/sterilize/clean; antimicrobials as ordered 2. Reservoir (where it lives: people/animals/insects; soil, water, food, equipment, IV fluids, feces) ○ Break it: hand hygiene, pre-op skin prep, environmental cleaning 3. Portal of exit (blood/body fluids, respiratory/GI tract, mouth/nose/ears, skin) ○ Break it: contain drainage/secretions (dressings, drains) 4. Mode of transmission ○ Main: contact, droplet, airborne (also vehicle, vector) ○ Break it: hand hygiene + PPE + disinfect shared equipment 5. Portal of entry (orifices, mucous membranes, breaks in skin; invasive devices) ○ Break it: aseptic technique, protect skin, sterile technique when needed 6. Susceptible host (risk depends on immunity/health) ○ Break it: immunizations, nutrition, hygiene, blood sugar control Virulence: how efficient an organism is at making people ill. Modes of Transmission (what to recognize) Contact ● Direct: person-to-person (ex: blood to open abrasion) ● Indirect: contaminated objects/PPE/equipment (ex: bed rails, shared devices) Droplet ● From coughing/sneezing/singing/talking; some procedures (CPR, intubation) ● Examples: influenza, pertussis, RSV, adenovirus, rhinovirus ● Respiratory etiquette + masking when out of room Airborne ● Small particles remain suspended; travel farther ● Requires private room; negative pressure (AIIR) preferred ● Examples: TB, measles (rubeola), varicella Vehicle / Vector ● Vehicle: contaminated food/water (ex: E. coli produce) ● Vector: insects/rodents (mosquitoes, rats) Body Defenses (3 Types) 1. Physical & chemical barriers ○ Skin (primary defense), mucous membranes/mucus, tears/sweat, cilia + cough, stomach acid, normal flora 2. Nonspecific immunity ○ Neutrophils + macrophages (phagocytes “eat and destroy”) 3. Specific immunity ○ Antibodies (immunoglobulins) + lymphocytes Inflammatory Response (key steps + signs) Steps: ● Pattern receptors recognize harmful stimuli ● Inflammatory pathway activated ● Markers released (ex: CRP) ● Inflammatory cells recruited (leukocytes → monocytes/lymphocytes) Signs of inflammation (local tissue): ● heat, redness, swelling, pain, loss of function Triggers can be infectious (viruses/bacteria) or noninfectious (trauma, burns, irritants, toxins, radiation, etc.). Stages of Infection (in order) 1. Incubation (exposure → first symptom; may have lab changes) 2. Prodromal (vague symptoms: malaise, fever, aches) 3. Acute illness (most severe; specific symptoms) 4. Decline (symptoms decrease) 5. Convalescence (recover/return to baseline) Local vs Systemic Infection ● Local: confined to one area (often topical/oral treatment) ● Systemic: enters bloodstream, affects whole body (often IV antibiotics + monitoring) Diagnostic Tests (high-yield) ● UA for UTI symptoms → if WBCs present, culture & sensitivity ● CXR confirms pneumonia/atelectasis but doesn’t tell viral vs bacterial ● CBC + differential ○ Expected WBC: 5,000–10,000/mm³ ○ “Left shift” = increased bands (immature neutrophils) → infection ● Nonspecific markers: CRP, ESR, Procalcitonin Asepsis & Precautions Hand hygiene (most important) ● Soap/water when visibly soiled and for C. diff spores ● Alcohol sanitizer works unless hands visibly soiled Medical asepsis (clean technique) ● reduces microbes; includes isolation precautions Surgical asepsis (sterile technique) ● prevents introducing microbes during invasive procedures; uses sterile supplies/fields Isolation Precautions (major takeaways) Standard precautions ● For all clients ● Protect from blood/body fluids, secretions, excretions, nonintact skin, mucous membranes ● PPE based on expected exposure Contact precautions ● Gown + gloves ● Examples: C. diff, VRE, norovirus, RSV, large draining wounds ● Remove PPE inside room Droplet precautions ● Surgical mask ● Examples: influenza, pertussis, RSV Airborne precautions ● N95 or higher, private room; AIIR/negative pressure preferred ● Examples: TB, measles, varicella Protective isolation (protective environment) ● For severely immunocompromised (ex: post-allogenic HSCT) ● Positive airflow + HEPA (goal: protect the client) Health Care–Associated Infections (HAIs) — the “big 4” ● CLABSI ● CAUTI ● SSI ● VAP Devices/lines/wounds create portals of entry → strict asepsis reduces risk. MDROs (major concept) MDROs = resistant bacteria (hard to treat) Examples: MRSA, VRE, VRSA, VISA, ESBL, MDRSP Prevention: hand hygiene, contact precautions per policy. If you want, I can turn this condensed guide into a 20-question practice quiz (ATI/NCLEX-style) focusing on chain links, precautions, PPE, labs, and transmission. Week 6 Here is a more condensed study guide that keeps all main concepts from your content (no major topics removed), just simplified and streamlined for studying. Condensed Study Guide: Novice to Expert + Nursing Communication I. Novice to Expert Nursing (Benner Model) Lifelong Learning & Collaboration ● Learning occurs through study and working with others ● Nurses grow by: ○ observing experienced nurses ○ sharing knowledge and best practices ● Respect all experience levels (years ≠ only indicator of knowledge) ● Leaders promote: ○ collaboration ○ mutual respect ○ teamwork culture Benner’s 5 Stages of Competence 1. Novice – no experience; relies on rules; struggles to prioritize 2. Advanced Beginner – recognizes patterns; still rule-focused; needs help setting priorities 3. Competent – uses past experience to prioritize; more organized but slower than proficient 4. Proficient – sees the big picture; adapts to changing situations 5. Expert – intuitive, confident, and highly skilled with complex care II. Communication Foundations Definition Communication = transfer of information that is always occurring, even without speaking. Includes: verbal words, body language, emotions, and technology. Why Communication Matters ● Key to client safety (Joint Commission goal) ● Miscommunication → medical errors ● Nurses must detect when clients don’t understand III. Communication Models (Core Concepts) Shannon–Weaver Model (Linear) Sender → Encoder → Channel → Decoder → Receiver + Noise (distractions interfering with message) Schramm Model (Feedback) ● Sender and receiver exchange messages ● Feedback confirms understanding ● No feedback = communication incomplete Newcomb ABX Model (Social) ● A (sender), B (receiver), X (topic affecting interaction) ● Focus on relationships and shared topic Berlo S-M-C-R Model (One-way) ● Sender → Message → Channel → Receiver ● No feedback loop IV. Forms of Communication Verbal Spoken communication (face-to-face or phone) Nonverbal (Body Language) ● Eye contact, posture, facial expressions ● When verbal and nonverbal conflict → nonverbal dominates Auditory What the receiver hears (tone, speed, clarity) Emotional Speaker’s emotional state influences how message is received Energetic Speaker’s presence/empathy affects perception of message V. Modes of Communication (4 Types) 1. Verbal – spoken conversation 2. Nonverbal – gestures, posture, appearance 3. Electronic – email, text, video (must be secure/HIPAA compliant) 4. Written – letters, emails, documents (may lack tone/body language) HIPAA & Electronic Communication Must include: ● secure messaging ● unique logins ● auto logoff ● encrypted/indecipherable PHI VI. Communication Styles Most effective: Assertive ● Passive: avoids conflict; agrees despite concerns ● Assertive: clear, respectful, confident; uses “I” statements ● Aggressive: blaming, hostile, controlling ● Passive-aggressive: indirect expression (sarcasm, avoidance) VII. Therapeutic Communication Purpose Build trust and provide patient-centered, empathetic care Cornerstones ● Compassion ● Caring ● Empathy Peplau’s Nurse-Client Relationship Phases 1. Orientation – client seeks help 2. Identification – relationship forms 3. Exploitation – active teaching/working phase 4. Resolution – issue resolved; relationship ends Watson’s Theory of Human Caring ● Authentic presence ● Protect dignity ● Loving-kindness ● “Healing moment” interactions VIII. Therapeutic Communication Techniques (Must Know) ● Active listening – attend to verbal + nonverbal cues ● Open-ended questions – encourage discussion (“Tell me more…”) ● Silence – allows client to reflect and share more ● Restating / summarizing – repeat message to confirm understanding ● Reflection – mirror feelings (“What do you think you should do?”) ● Accepting – acknowledge message without judgment ● Giving recognition – note change without compliment ● Focusing – gently redirect to important topic ● Offering self – sit with client and be present IX. Nontherapeutic Communication (Avoid) ● Giving advice ● False reassurance (“You’ll be fine”) ● Criticizing or challenging ● Asking “Why” questions ● Rejecting or disagreeing ● Probing irrelevant topics ● Changing the subject Effects: ● increased stress ● damaged trust ● poor outcomes X. Interprofessional Communication Importance Effective teamwork improves: ● client outcomes ● safety ● efficiency ● reduces errors IPEC Core Competencies 1. Mutual respect among team members 2. Use shared knowledge collaboratively 3. Communicate effectively as a team 4. Support team values and client-centered care XI. Motivational Interviewing (MI) Purpose Encourage behavior change (diabetes, obesity, substance use) OARS Technique ● Open-ended questions ● Affirmations (positive encouragement) ● Reflective listening ● Summarizing XII. Group vs Individual Communication ● Individual: new diagnosis, personal teaching ● Group: ongoing education, support groups XIII. Communication Barriers (Major Categories) Cognitive/Developmental ● dementia, stroke, autism Physiological ● hearing loss, vision impairment Cultural & Language ● language differences, cultural beliefs, lack of cultural competence Environmental/Situational ● noise, lighting, temperature ● fear, anxiety, fatigue, stress Technological ● poor reception, distractions, electronic errors XIV. Strategies to Overcome Barriers Universal Strategies ● show empathy and respect ● avoid interrupting ● use simple, clear language ● confirm understanding (summarize/reflect) Language Barriers (CLAS Standards) ● Use qualified medical interpreter ● Do NOT use family members or translation apps ● Required for federally funded facilities Hearing Impairment Strategies ● face the client ● speak clearly/moderate pace ● reduce background noise ● use written info or visual aids ● ensure hearing aids in place ● speak to client (not interpreter) if interpreter present Vision Impairment Strategies ● introduce yourself ● give clear directions (“door at 10 o’clock”) ● allow client to hold your arm ● provide large print/audio/Braille materials Cognitive/Developmental Strategies ● use simple words ● avoid jargon/slang ● speak slowly and clearly ● reduce noise/bright distractions ● ensure glasses/hearing aids available Key Takeaways (Exam Focus) ● Benner’s stages: Novice → Advanced Beginner → Competent → Proficient → Expert ● Communication must include feedback to be effective ● Nonverbal cues often outweigh verbal messages ● Best communication style = Assertive ● Core therapeutic techniques = active listening, open-ended questions, silence, reflection, summarizing ● Use qualified interpreter for language barriers (CLAS standard) ● Barriers include cognitive, physical, cultural, environmental, and emotional factors ● Effective communication improves client safety and outcomes Here is a condensed but complete study guide that keeps all concepts from the Safety lesson while removing extra wording. SAFETY & PATIENT PROTECTION – CONDENSED STUDY GUIDE I. Joint Commission National Patient Safety Goals (NPSGs) Purpose Annual goals to improve: ● Client safety ● Safe, effective care ● Prevention of adverse outcomes 1. Identify Clients Correctly ● Use two identifiers (name, DOB, MRN, etc.) ● Confirm before meds, procedures, treatments ● Ask open-ended questions ● Verify ID band & EMR ● Use barcode scanning ● ❌ Never use room number 2. Improve Staff Communication ● Report critical results immediately ● Critical results = life-threatening abnormal labs/diagnostics ● Facility policies define: ○ critical result criteria ○ reporting timeframe ○ documentation requirements ● Communicate directly (in person/phone), not voicemail (HIPAA) 3. Use Medications Safely Label medications ● Label all syringes/containers with name, dose, date/time ● Discard unlabeled meds Anticoagulant safety ● Examples: warfarin, heparin, enoxaparin ● Monitor labs, weight, interactions, dosing ● Educate on risks, food interactions, follow-up labs Medication reconciliation ● Compare home meds with new prescriptions ● Done on admission, transfer, discharge ● Resolve discrepancies 4. Use Alarms Safely ● Clinical alarms warn of patient events or equipment malfunction ● Examples: IV pumps, ventilators, monitors, bed/chair alarms ● Risk: alarm fatigue ● Nurse role: ○ know alarm priorities ○ respond promptly ○ help develop alarm policies 5. Prevent Hospital-Acquired Infections (HAIs) Common HAIs: ● CLABSI ● CAUTI ● SSI ● VAP Concern: MDROs (MRSA, VRE, C. diff) ⭐ Hand hygiene = most important prevention Compliance required with monitoring and action plans. 6. Identify Safety Risks: Suicide Prevention ● Screen behavioral health clients ≥12 yrs ● Positive screen → detailed suicide assessment ● Implement: ○ constant observation ○ removal of harmful items ○ environmental safety checks ○ staff competency training 7. Universal Protocol (Surgery Safety) Prevent wrong-site/procedure/client: 1. Two identifiers 2. Mark surgical site (if applicable) 3. Time-out before procedure 4. Verify consent & procedure with client 8. Improve Health Care Equity (2024 Goal) Assess social determinants: ● literacy ● housing ● transportation ● food access Continue assessment throughout hospitalization and discharge planning. II. Standards of Compliance Former NPSGs now routine standards: ● Medical error prevention ● Staff competency verification ● Client rights & education ● Infection control ● Medication management ● Emergency preparedness III. Culture of Safety Promotes: ● open communication ● reporting of errors & near misses ● nonpunitive environment ● improved outcomes & staff satisfaction Nurses play key role due to frequent client contact. IV. Transforming Care at the Bedside Initiative 1. Spend 70% of time in direct bedside care 2. Leadership development 3. Rapid Response Team (RRT) 4. Standardized communication (ISBARR) Benefits: ● fewer falls, HAIs, med errors ● improved outcomes and satisfaction V. Rapid Response Team (RRT) Interdisciplinary team (ICU nurse, RT, provider) for sudden deterioration. Call RRT for: ● sudden vital sign changes ● low O₂ despite intervention ● chest pain after nitro ● seizure ● sudden mental status change ● serious clinical concern VI. ISBARR Communication Tool 1. Identity 2. Situation 3. Background 4. Assessment 5. Recommendation 6. Read-back VII. Types of Unexpected Events ● Near miss: error caught before harm ● Client safety event: event with potential harm ● Adverse event: unexpected harm occurred ● Sentinel event: severe harm/death (never event) Examples sentinel: ● wrong-site surgery ● suicide in facility ● serious fall injury VIII. Occurrence (Incident) Reporting Purpose: improve systems, prevent future errors (not punishment) Report: ● falls/injuries ● wrong meds ● adverse reactions ● blood/body fluid exposure ● property damage ● unsafe behaviors/events IX. Safety Assessment & Agencies Regulated by: ● TJC ● CMS ● OSHA ● State boards & local agencies Nursing safety focus: ● falls ● meds & allergies ● restraints ● pressure injury prevention ● infection control ● sharps & pathogen exposure ● body mechanics ● fire, chemical, radiation safety X. Electrical Safety Check: ● frayed cords ● grounded 3-prong plugs ● GFCI outlets ● no wet handling ● avoid extension cords ● tag/remove faulty equipment XI. Chemical Safety Exposure routes: ● inhalation ● skin/eyes ● ingestion ● injection (needlestick) Use: ● SDS sheets ● PPE (gloves, masks, gowns, goggles) ● ventilation systems ● emergency eye wash/showers XII. Radiation Safety Risk proportional to: ● exposure time ● distance from source Principles: 1. Reduce time 2. Increase distance 3. Shield (lead aprons, barriers) Types: ● Alpha (least risk, short travel) ● Beta (moderate risk, small distance) ● Gamma (highest risk, penetrates tissue) Initial symptoms: ● nausea, vomiting, diarrhea ● burns, alopecia ● immunocompromise ● psychological effects XIII. Age-Related Safety Risks Infants/Preschoolers ● burns, poisonings, choking, drowning ● car seat safety ● smoke detectors & safe storage of toxins School-Age ● sports injuries, firearm safety, internet risks Adolescents ● substance use, risky driving, violence, suicide risk Adults/Older Adults ● chronic illness, frailty, mobility decline ● ⭐ Major risk: falls ● frailty → poorer outcomes XIV. Hospital-Acquired Injuries Include: ● SSIs, CAUTIs, CLABSIs ● falls, trauma ● pressure injuries ● DVT ● insulin errors ● transfusion reactions ● burns/electrical shock High-risk clients: ● neurologic disorders (stroke, MS, Parkinson’s) ● cognitive impairment, dementia ● communication disabilities ● visual deficits ● behavioral disorders XV. Screening Tools Used to identify early risk: ● Morse Fall Scale (fall risk) ● Braden Scale (pressure injury risk) ● Tools must be valid/reliable Positive results → detailed assessment + individualized care plan. XVI. Home Hazard Safety Bathroom: ● grab bars, non-slip mats, raised toilet, step-free showers Bedroom: ● low bed, alarms, hospital bed if needed Kitchen: ● reachable items, automatic stove shut-off, secure chemicals General: ● good lighting, remove loose rugs, secure cords, install handrails ● cordless blinds for child safety ● emergency numbers accessible XVII. Fire Safety RACE ● Rescue ● Alarm ● Contain (close doors/windows) ● Extinguish PASS ● Pull pin ● Aim at base ● Squeeze ● Sweep Fire extinguisher types: ● A: paper/wood ● B: liquids/oils ● C: electrical ● D: metals ● K: kitchen grease ● ABC: multipurpose Evacuation: ● Lateral = same floor (preferred) ● Vertical = different floor XVIII. Workplace Safety Bullying ● Repeated harassment/belittlement ● Leads to burnout, errors, poor retention Workplace Violence Includes verbal abuse to homicide Risk factors: ● violent clients ● staff shortages ● long wait times ● lack of training/security Active Shooter Response 1. Run 2. Hide 3. Fight (last resort) XIX. Emergency Preparedness Facilities must have: ● disaster plans ● staff training & drills ● defined staff roles Types of mass exposure: ● Radiation ● Biological (anthrax, Ebola, COVID) ● Chemical toxins Response: ● PPE ● decontamination (remove clothing, shower) ● monitor vitals & mental status XX. Injury Prevention Strategies ● hourly rounding ● video monitoring ● bedside sitters ● individualized safety plans ● prompt call-light response XXI. Fall Prevention Risk factors: ● weakness, gait issues, vision problems ● confusion, dementia, impulsiveness ● clutter, poor lighting ● high-risk meds (antihypertensives, antidepressants) ● incontinence, age Universal precautions: ● nonskid footwear ● low bed & locked wheels ● clutter-free room ● call light within reach ● hourly rounding & quick response Movement alarms = warning device Siderails: ● 2 rails for safety ● 4 rails = restraint (intent matters) XXII. Restraints & Seclusion Types: ● Physical: manual holding ● Mechanical: mitts, wrist, vest, 4-point ● Chemical: sedatives/antipsychotics ● Barrier: enclosures, lapboards, 4 rails ● Seclusion: locked room Use ONLY as last resort when: ● danger to self/others ● removing life-saving devices ● severe aggression Care of restrained client: ● frequent circulation, skin, respiratory checks ● ROM, hygiene, fluids, elimination ● reevaluate every 24 hrs ● discontinue ASAP XXIII. Seizure Precautions Preseizure ● suction & oxygen ready ● padded rails ● IV access ● remove restrictive clothing/jewelry During seizure ● call for help ● side-lying position ● protect head ● do NOT restrain ● monitor duration & movements ● give benzodiazepine if ordered Postseizure ● assess gag reflex before oral intake ● reassure client ● labs, EEG, imaging as ordered XXIV. Musculoskeletal Injury Prevention (Nurse Safety) Use assistive devices: ● Hoyer lift (ground lift) ● ceiling lift ● slide sheets ● sit-to-stand lift Safe handling: ● clear area ● use correct sling size ● have 2 staff assist ● lock brakes ● never leave client unattended XXV. Patient-Centered Care Focus: ● client as center of care ● collaboration & shared decision-making ● respect cultural, spiritual, religious needs ● holistic & individualized care ● include pastoral care support FINAL MEMORY CHECK (High-Yield Core Concepts) ● Two identifiers before any care ● Hand hygiene prevents HAIs ● Time-out before surgery ● ISBARR improves communication ● RRT for sudden deterioration ● Fall prevention + restraints last resort ● RACE & PASS fire response ● Run–Hide–Fight for active shooter ● Time–distance–shielding for radiation safety ● Screening tools identify early risks Here is a fully condensed study guide that includes ALL major topics and concepts from your lesson (patient-centered care, caring theories, cultural care, spirituality, advocacy, sleep & rest) without leaving anything out. CONDENSED STUDY GUIDE: PATIENT-CENTERED CARE, CARING, CULTURE, ADVOCACY & SLEEP I. Patient-Centered Care Definition Patient-centered care = placing the client at the center of all care, focusing on preferences, culture, and holistic needs rather than just tasks or documentation. Key Concepts ● Improves client satisfaction and outcomes ● Involves caring, preferences, cultural respect, and shared decision-making ● Holistic care: physical, emotional, spiritual needs II. Caring in Nursing Definition Caring = nurturing another person with responsibility and commitment; core of professionalism. Holistic Caring Includes ● Healing environment ● Kindness, empathy, compassion ● Addressing physical, emotional, and spiritual needs III. Caring Theories A. Watson’s Theory of Human Caring Holistic model focusing on mind-body-spirit harmony through transpersonal (human-to-human) caring relationships. Core Ideas ● Caring moments foster healing and self-restoration ● Nurse must achieve inner balance and spirituality ● Establish trusting presence and relationships 10 Caritas Processes 1. Loving-kindness and compassion 2. Authentic presence and honoring beliefs 3. Sensitivity to self and others 4. Trusting caring relationships 5. Expression of feelings 6. Creative problem-solving through caring 7. Transpersonal teaching/learning 8. Healing environment (comfort, dignity, peace) 9. Reverent assistance with basic needs 10. Openness to spirituality and miracles B. Swanson’s Theory of Caring Caring improves well-being through empowerment, dignity, and respect. Five Caring Processes 1. Maintaining belief – instill hope and meaning 2. Knowing – understand client’s situation/perception 3. Being with – emotional and physical presence 4. Doing for – perform needed tasks for client 5. Enabling – guide and support through events/transitions IV. Caring Behaviors 1. Listening ● Active, empathetic listening ● Observe verbal and nonverbal cues ● Key for holistic assessment and trust 2. Touch ● Used for procedures and expressive caring ● Requires permission; consider culture, trauma, gender ● Can reduce anxiety and increase well-being 3. Being Present ● Physical and emotional availability ● Reduces loneliness and improves comfort ● Reflects “being with” (Swanson) 4. Providing Comfort ● Pharmacologic and nonpharmacologic comfort measures ● Examples: pillows, blankets, hygiene, music, temperature control ● Represents “doing for” 5. Showing Compassion ● Recognize suffering and act to relieve it ● View client as person, not diagnosis ● Requires self-awareness and adequate staffing V. Client Preferences in Care Clients are full members of the health care team and experts on their own experiences. Benefits ● Increased trust and satisfaction ● Improved healing and outcomes ● Greater sense of control Ways to Include Preferences 1. Endorsing participation – empower involvement 2. Promoting understanding – correct misinformation 3. Sharing information – two-way communication Barriers ● Power imbalance ● Medical jargon ● Weakness, fatigue, cognitive impairment ● Poor collaboration and language barriers VI. Cultural Competence Definition Evidence-based care aligned with client’s cultural values, beliefs, and practices. Influencing Factors ● Socioeconomic status ● Health literacy ● Racism experiences ● Sexual orientation ● Acculturation (adapting to another culture) Five Elements of Cultural Competence 1. Cultural awareness – self-examine biases 2. Cultural knowledge – learn client values/beliefs 3. Cultural skill – assess cultural needs accurately 4. Cultural encounters – interact with diverse cultures 5. Cultural desire – motivation to connect with cultures Cultural Assessment Includes ● Cultural/spiritual affiliation ● Health beliefs and practices ● Spiritual rituals ● Dietary preferences/prohibitions ● Care preferences to increase comfort VII. Age-Related (Generational) Care Preferences Generation Preferences Silent (1928–1945) Formal, face-to-face, written communication Baby Boomers Team-oriented, sincere, in-person communication Gen X Direct, independent, questions providers Millennials Tech-based communication, frequent feedback Gen Z Digital natives, prefer texting/email Gen Alpha Tech-savvy children; family-centered care VIII. Spiritual Nursing Care Spiritual Well-Being Feeling of meaning, purpose, and connection to higher power → improves quality of life. Spiritual Assessment Questions ● Source of spiritual strength? ● Meaning-of-life concerns? ● Relationship with higher power? ● Spiritual practices? ● Fear of dying? ● Relationship concerns? Assessment Tools FICA: ● Faith ● Importance ● Community ● Address in care HOPE: ● Hope sources ● Organized religion ● Personal spirituality/practices ● Effects on care/end-of-life issues IX. Spiritual Distress Definition Questioning life meaning or beliefs causing despair, anger, fear, uncertainty. Nursing Interventions ● Listen and be present ● Encourage spiritual expression ● Provide prayer, texts, pastoral referral ● Address emotional and spiritual needs X. Pastoral Care Provides: ● Ethical, religious, and spiritual support ● Counseling, prayer, rituals ● End-of-life and grief support ● Support for families and staff Chaplains assist all clients regardless of religion. XI. Access to Care Barriers ● Lack of insurance ● Transportation problems ● Limited providers/facilities (rural areas) ● Restricted clinic hours ● Medication cost barriers Solutions ● Telemedicine: remote diagnosis/testing ● Telehealth: broader remote clinical and nonclinical services ● Improves access, especially rural areas XII. Client Advocacy Definition Protect client autonomy, rights, and safety; act as client’s voice. Clients Needing Advocacy ● Unconscious ● Children ● Fearful/intimidated clients ● Uninformed about diagnosis/rights Advocacy Steps 1. Assess needs, values, cognition, resources 2. Verify client goals/preferences 3. Implement plan and communicate with team 4. Evaluate outcomes and self-determination Related Concepts ● Medically futile: treatment unlikely to cure or extend life ● Potentially inappropriate treatment: works but may not improve quality of life ● Palliative care: symptom relief + quality of life ● Quality of life: personal meaning, independence, relationships XIII. Sleep and Rest Importance of Sleep Supports: ● Memory, learning, concentration ● Immune system and tissue repair ● Hormone balance (ghrelin, leptin, cortisol) ● Mood, reaction time, coordination ● Prevention of obesity, diabetes, cardiovascular disease XIV. Physiology of Sleep Key Brain Structures ● Cerebral cortex: sensory processing & memory ● Brainstem: controls REM and muscle relaxation ● Hypothalamus: autonomic control, circadian rhythm (SCN) ● Thalamus: sensory filtering during sleep ● Pineal gland: produces melatonin XV. Sleep Regulation Mechanisms 1. Circadian rhythm – 24-hour internal sleep–wake cycle influenced by light and temperature 2. Sleep–wake homeostasis – pressure to sleep increases with sleep deprivation Factors affecting sleep: ● Light exposure ● Stress ● Medications ● Caffeine/food ● Environment XVI. Stages of Sleep NREM Sleep Stage 1: Light sleep; easily awakened (5%) Stage 2: Deeper sleep; decreased HR/temp; memory consolidation (50%) Stage 3: Deep sleep; delta waves; immune strengthening and tissue repair (15%) REM Sleep ● Dream stage ● Irregular breathing and increased HR ● Muscle atonia (prevents acting out dreams) ● Occurs ~90 minutes after sleep onset Sleep cycles repeat 4–6 times per night. XVII. Sleep Patterns by Age ● Newborns: multiple cycles, high REM ● Adults: 2–5% stage 1, 45–55% stage 2, 10–20% stage 3, 20–25% REM ● Older adults: less deep sleep, more awakenings XVIII. Sleep Deprivation Types ● Total: no sleep for extended period ● Partial: reduced sleep hours ● Chronic: ongoing insufficient sleep ● Selective: loss of specific sleep stage Effects ● Impaired judgment and memory ● Mood swings, depression ● Increased accidents and chronic illness risk ● Poor glucose control and obesity XIX. Promoting Sleep Nonpharmacologic Interventions ● Avoid caffeine, nicotine, alcohol before bed ● Keep room dark, quiet, cool ● Establish bedtime routine ● Consistent sleep schedule ● Exercise regularly (not right before bed) ● Limit naps (<30 minutes) ● Remove electronics/TV from bedroom XX. Sensory Overload in Hospital Definition: Excess stimuli beyond brain’s processing ability → sleep disruption. Nursing Interventions ● Lower noise and alarms ● Dim lights ● Provide earplugs/eye masks ● Cluster care tasks ● Control pain and medication effects XXI. Sleep Disorders Insomnia Difficulty falling/staying asleep → fatigue, poor concentration, mood changes Sleep Apnea ● Central: brain fails to signal breathing ● Obstructive: airway collapse; snoring; daytime sleepiness Treatment: CPAP, weight loss, avoid alcohol/smoking Narcolepsy Sudden sleep attacks; possible cataplexy (loss of muscle tone) Hypersomnia Excessive daytime sleepiness despite adequate sleep Restless Legs Syndrome (RLS) Urge to move legs; worsens at night; disrupts sleep Night Terrors Non-REM parasomnia causing panic and no recall; common in children XXII. Pharmacologic Sleep Therapies ● Benzodiazepines (GABA agonists): sedative but dependency risk ● Nonbenzodiazepine hypnotics (most common) ● Melatonin: low-risk first-line option ● Antihistamines: OTC but cause side effects XXIII. Nonpharmacologic Sleep Therapies ● Massage, acupuncture, thermotherapy ● Guided imagery, meditation, music therapy ● Yoga and relaxation techniques ● Sleep diaries to identify patterns and personalize care FINAL KEY POINT Patient-centered nursing integrates: ● Caring theories ● Cultural competence ● Spiritual support ● Client advocacy ● Sleep and comfort promotion Goal: provide holistic care that supports physical healing, emotional well-being, spiritual meaning, autonomy, and optimal quality of life. Week 7 Absolutely—here’s a more condensed study guide that still includes every concept you were given. CONDENSED STUDY GUIDE: ELIMINATION (ALL CONCEPTS) 1) Big Picture ● Elimination (urine + stool) is continuous and essential. Patterns vary, but changes require assessment + intervention to restore usual patterns or establish a new baseline. 2) Urinary System Basics Functions: excrete waste/fluid → urine, regulate electrolytes, support RBC production, help regulate BP, support bone health. Pathway: kidneys → ureters → bladder → urethra → urination. Control: internal sphincter + external sphincter + pelvic floor muscles prevent leakage. Urination: elimination of urine via urethra. 3) Urine Production & Assessment Normal: clear, light yellow, minimal odor. Typical daily amount: ~1–2 quarts/day (varies). Expected output by age: infant ~2 mL/kg/hr; toddler ~1.5; teen ~1; adult ~0.5. Color clues: ● Dark yellow/amber = need fluids ● Dark brown = dehydration/kidney/liver concern ● Red/pink = blood or foods (beets, blackberries, rhubarb) Diet/med effects: ● Fluids ↑ volume, lighter color ● Asparagus ↑ odor ● Dyes can turn blue/green ● Alcohol + caffeine ↑ urine output (can dehydrate if not balanced) Aging urinary changes: ↓ nephrons/kidney function, ↓ bladder tone → incontinence/retention risks. 4) GI System Basics Organs: mouth → esophagus → stomach → small intestine → large intestine → rectum → anus. Peristalsis: contractions that move contents through GI tract. Feces formation: digestion + absorption (small intestine), water absorption + stool formation (large intestine), bacteria help + make vitamin K, rectum stores stool until BM. Bristol Stool Chart: ● Types 1–2 = constipation ● Types 3–4 = expected ● Types 5–7 = diarrhea Aging GI changes: ↓ peristalsis/muscle tone → constipation; ↑ PUD risk (NSAIDs), ↓ elasticity/emptying changes, possible ↓ absorption/bacterial overgrowth, ↓ lactase → lactose intolerance; lifestyle factors (inactivity, low fiber/fluids, meds) contribute. 5) Expected Elimination ● Urine: clear, light yellow, varies with intake/activity/diuretics. ● Stool: frequency varies widely; should be soft/formed, easy to pass without straining. 6) Altered Urinary Elimination Urinary Incontinence (UI) Involuntary urine loss. Can cause skin breakdown + distress. Types: ● Stress: cough/sneeze/exertion ● Urge: sudden urge, leak before toilet ● Reflex: nerve damage, no warning ● Overflow: incomplete emptying → overfill/leak ● Functional: can’t reach toilet (mobility/dexterity issues) ● Nocturnal enuresis: nighttime (kids; adults w alcohol/caffeine/meds) Management: lifestyle changes (↓ caffeine/alcohol, smoking cessation, address constipation), pelvic floor exercises, bladder training, meds/devices/surgery; skin protection (pads/briefs, cleanser, barrier cream). Urinary Retention Incomplete bladder emptying (acute or chronic). Causes: BPH, cystocele/prolapse, obstruction (stones/lesions). Findings: hesitancy, weak stream, frequency, distention, pain, leakage. Risks: UTI, bladder/kidney damage. 7) Altered Bowel Elimination Constipation <3 BMs/week + hard/lumpy stools, difficult to pass. Risks: pregnancy/postpartum, older adults, low fiber/fluids, meds, GI disorders, immobility. Red flags: fever, GI bleeding, severe pain, vomiting, weight loss. Complication: fecal impaction/obstruction (liquid stool may leak around impaction). Tx: fiber + fluids + exercise + bowel training; meds; enema/manual removal; surgery if complete obstruction. Diarrhea Frequent loose/watery stools: acute (1–2d), persistent (>2w <4w), chronic (>4w). Risks: infection, meds, GI disorders, diet. Dangers: dehydration, malabsorption. Adult urgent follow-up: fever ≥102°F, >2 days, ≥6/day, severe pain, blood/black stool. Tx: rehydration; OTC (loperamide/bismuth) if appropriate; antibiotics/probiotics if infectious cause. Bowel Incontinence Urge (can’t reach toilet) most common; passive (unaware leakage). Leads to skin issues + reduced self-esteem. Children: encopresis. 8) Medications That Affect Elimination Constipation: antacids (Al/Ca), anticholinergics/antispasmodics, antiseizure meds, Ca-channel blockers, diuretics, iron, antiparkinsonian, opiates, antidepressants. Diarrhea: antibiotics, magnesium antacids; consider C. diff if severe/persistent after antibiotics. 9) Conditions Altering Urinary Patterns ● Dehydration: thirst, dry mouth, fatigue, dizziness, dark urine; severe needs IV fluids. ● UTI: dysuria, urgency/frequency; can progress to pyelonephritis (fever, flank pain, N/V, hematuria). Tx antibiotics + fluids. Higher risk: females, retention, obstruction, catheters, diabetes, menopause. ● Kidney stones: severe flank pain radiating to groin, hematuria, dysuria, fever/chills, N/V. Tx fluids, pain meds, strain urine, ESWL/surgery. ● Kidney failure: waste/fluid buildup → ↓ urine, HTN, anemia, itching; Tx dialysis or transplant. ● BPH: urethral constriction → retention, nocturia, weak stream; can cause UTIs/damage; Tx meds/surgery. 10) Conditions Altering Bowel Patterns ● Diverticulosis: pouches; Diverticulitis: inflamed/infected pouch → pain/bleeding; risk perforation → peritonitis. Prevent: fiber; nuts/seeds no longer restricted. Tx antibiotics + liquid/soft diet. ● IBS: pain + diarrhea/constipation (IBS-C, IBS-D, IBS-M); Tx diet (fiber/probiotics, avoid triggers), stress reduction, sleep/exercise, meds. ● Bowel obstruction: blockage → N/V, distention, severe constipation; NG decompression + surgical consult. ● Ileus: decreased/absent motility (often post-op/illness/meds) → absent bowel sounds, distention, N/V; Tx NPO, NG tube, IV fluids; consider TPN if prolonged. ● Ulcerative colitis: colon inflammation/ulcers → bloody diarrhea, fatigue, anemia; Tx meds; surgery if refractory/cancer risk. ● Crohn’s: inflammation anywhere (often small intestine) → diarrhea, weight loss, anemia; complications fistulas/abscess/obstruction; Tx meds + possible surgery. 11) Diversions & Ostomies Urinary Diversions ● Catheterization (temporary) ● Ureteral stent ● Ileal conduit/urostomy (stoma + pouch) ● Nephrostomy (kidney → external bag) ● Neobladder (internal reservoir, may need catheter) ● Continent cutaneous reservoir (internal pouch + valve; catheter to empty) ● Cystostomy (catheter directly into bladder) Complications: UTIs, kidney infection, skin breakdown; psychosocial concerns. Fecal Diversions ● Ileostomy ● Colostomy (+ irrigation option for some permanent colostomies) ● J-pouch (internal ileal reservoir connected to anus; often temporary ileostomy first) ● Kock pouch (continent ileostomy; catheter to empty) Complications: skin irritation, hernia/prolapse/stenosis, blockage, diarrhea, bleeding, electrolyte imbalance, infection, leakage. WOC nurse supports education + supplies + skin/stoma care. 12) Diagnostics & Specimen Collection Urinary ● Urodynamics: uroflowmetry, postvoid residual, cystometric test, leak point pressure, EMG, video urodynamics, pressure-flow study ● Scopes: cystoscopy, ureteroscopy ● Urinalysis: visual + dipstick + microscopic (WBC, RBC, bacteria, casts, crystals) ● Urine culture: clean catch midstream; grows organism + susceptibility testing (correct antibiotic; reduces resistance) ● 24-hour urine: collect all urine, refrigerate, avoid certain foods/meds Urine collection methods: clean catch vs catheter (sterile technique for intermittent/indwelling). GI ● Tests: celiac testing, colonoscopy, ERCP, sigmoidoscopy, upper/lower GI series, upper endoscopy ● FOBT: dietary/med restrictions to prevent false positives (ex: beets, red meat, some veggies; aspirin/ibuprofen/Vit C) ● Stool culture: for severe/persistent diarrhea (travel, contaminated food/water, antibiotics) 13) Nursing Interventions Promote Urinary Elimination ● Bedpan/urinal assistance + measure output + privacy + skin check ● Bladder irrigation (ordered; pain is NOT expected → report) ● Lifestyle: avoid bladder irritants; appropriate fluids; weight loss; stop smoking ● Bladder training + elimination journal ● Bladder scan to avoid unnecessary catheterization ● Catheters: intermittent, indwelling, external male condom, external female wick ● CAUTI prevention: sterile insertion for indwelling/intermittent; daily hygiene; handwashing; keep system clean Promote Bowel Elimination ● Fiber, hydration, activity, respond to urge, stress management ● Bowel training (may use laxatives) ● Enemas: cleansing vs retention; solutions hypotonic/isotonic/hypertonic (tap water can cause electrolyte shifts) ● Laxatives: ○ Bulk-forming ○ Surfactant (stool softener) ○ Stimulant ○ Osmotic ● Rectal tubes/fecal management systems for severe incontinence Skin Care for Incontinence ● Clean promptly, rinse, pat dry ● Moisturize (alcohol-free) ● Barrier ointments/pastes/sealants ● Assess for nonblanchable redness, blisters, wounds/ulcers NG Decompression (for obstruction/ileus) Measure nose → ear tragus → xiphoid, advance with swallowing, confirm placement (x-ray/capnography/pH per policy), secure + suction as ordered. If you want, I can also turn this into a 1-page “exam cram” sheet (still including every concept, just in ultra-compact bullets). Condensed Study Guide: Main Concepts (Elimination + Sensory Perception) 1) ELIMINATION (URINARY + BOWEL) Urinary system basics ● Organs: kidneys → ureters → bladder → urethra ● Kidneys: filter blood, remove waste/fluid, regulate electrolytes & BP hormones, support RBC production. ● Normal urine: clear, light yellow, minimal odor. ○ Dark yellow/amber: dehydration. ○ Red/pink: blood or foods (beets). ○ Brown: severe dehydration/liver/kidney issues or certain foods. Expected urine output (high-yield) ● Adults: ~0.5 mL/kg/hr ● Output generally decreases with age (↓ nephrons, ↓ renal blood flow). Urinary alterations Urinary incontinence = can’t control urination Types: ● Stress: cough/sneeze/exertion → leak ● Urge: sudden strong urge → can’t reach toilet ● Overflow: bladder overfills from incomplete emptying → dribbling/leak ● Reflex: nerve damage → unpredictable leakage ● Functional: can’t get to toilet in time (mobility/dexterity issues) ● Nocturnal enuresis: nighttime bedwetting Key nursing focus: skin protection (barrier creams, briefs/pads), reduce irritants, bladder training, pelvic floor exercises. Urinary retention = can’t empty bladder fully ● Causes: BPH, prolapse (cystocele), obstruction (stones), neuro issues. ● Findings: hesitancy, weak stream, frequency, distention, pain, leakage. ● Risks: UTI, bladder/kidney damage. ● Interventions: identify cause, drain bladder if needed, bladder scan, catheterization if ordered. Common urinary conditions ● Dehydration: thirst, dry mouth, dizziness, dark urine, low urine; severe → IV fluids. ● UTI: dysuria, urgency/frequency; untreated → pyelonephritis (fever, flank pain, N/V). Treat: antibiotics + fluids. ● Kidney stones: severe flank pain radiating to groin, hematuria, N/V; treat pain + fluids, strain urine, possible lithotripsy/surgery. ● Kidney failure: ↓ urine, HTN, anemia, itching; treat dialysis/transplant. ● BPH: frequency/nocturia, weak stream, retention/incontinence; treat meds/surgery. Bowel system basics ● GI tract: mouth → esophagus → stomach → small intestine → large intestine → rectum → anus ● Peristalsis moves contents forward. ● Stool: should be soft/formed, easy to pass (no straining). Bristol Stool Chart (quick) ● 1–2: constipation (hard/lumpy) ● 3–4: ideal/normal ● 5–7: diarrhea (loose/watery) Bowel alterations ● Constipation: <3 BMs/week + hard stool/straining ○ Risks: impaction/obstruction (esp immobile/neuro injury). ○ Tx: fiber, fluids, activity, bowel training, stool softeners/laxatives; impaction → enema/manual removal. ● Diarrhea: frequent loose watery stools ○ Danger: dehydration, electrolyte imbalance; red flags: blood/black stool, fever, severe pain, lasts >2 days. ○ Tx: rehydration, remove irritants; meds like loperamide (if appropriate); infection → meds/probiotics as ordered. ● Bowel incontinence: urge (can’t reach toilet) vs passive (leak without awareness). ○ Nursing: skin care, scheduled toileting, bowel training, protect dignity. Diversions (know names + purpose) Urinary diversions ● Catheterization: intermittent or indwelling ● Ureteral stent: keeps ureter open ● Urostomy/ileal conduit: urine exits through stoma into pouch ● Nephrostomy: kidney → external drainage ● Cystostomy (suprapubic): catheter directly into bladder ● Neobladder/continent reservoir: internal storage; may need catheter to empty Complications: infection, skin breakdown, psychosocial stress. Fecal diversions ● Ileostomy: ileum → stoma (often liquid stool) ● Colostomy: colon → stoma (more formed depending on location) ● J-pouch: internal ileal reservoir connected to anus ● Kock pouch: continent ileostomy; catheter to empty Complications: skin irritation, leaks, hernia/prolapse, blockage, diarrhea, electrolyte issues. Diagnostic tests/specimens (high-yield) Urinary ● Urinalysis: dipstick + microscopic ● Urine culture: clean catch; susceptibility testing picks the right antibiotic ● 24-hr urine: measures substances over time ● Urodynamics: bladder function (uroflowmetry, PVR, cystometrics, etc.) ● Cystoscopy/ureteroscopy: visualize urinary tract GI ● FOBT: check hidden blood (avoid foods/meds that cause false positives) ● Stool culture: severe/persistent diarrhea, travel, prolonged antibiotics ● Colonoscopy, sigmoidoscopy, upper GI endoscopy, ERCP, GI series as indicated Nursing priorities (elimination) ● Assess: amount, frequency, color/odor, pain, stool type. ● Prevent skin breakdown: cleanse, dry, barrier creams, frequent checks. ● Promote normal patterns: hydration, fiber, activity, timed toileting, privacy, proper equipment (bedpan/urinal). ● Reduce infection risk: sterile technique for invasive catheters; minimize indwelling catheter days (CAUTI prevention). 2) SENSORY PERCEPTION (ALL MAIN CONCEPTS) Big picture ● Stimulus → sensory organ → CNS/cranial nerves → brain interprets → response ● Problems can be in reception, perception, or response. Key terms ● Sensory deficit: reduced function (vision/hearing/touch/etc.) ● Sensory deprivation: too little stimulation ● Sensory overload: too much stimulation → anxiety/confusion ● SPD: detects stimuli but brain misprocesses → oversensitive/overwhelmed Cranial nerves (only what’s essential) ● I smell, II vision, III/IV/VI eye movement ● V facial sensation/jaw ● VII facial expression + taste (front tongue) ● VIII hearing/balance ● IX/X swallowing/gag/voice ● XI shoulder shrug/head turn ● XII tongue movement Vision: most tested disorders ● Refractive errors: myopia, hyperopia, astigmatism, presbyopia ● Cataracts: cloudy lens → blurry/hazy, ↓ color ● Diabetic retinopathy: retinal vessel damage → floaters/blur → blindness risk ● Glaucoma: ↑ intraocular pressure → loss of peripheral vision (irreversible) ● Macular degeneration: loss of central vision (older adults) Tests: Snellen/Tumbling E; slit lamp; fluorescein angiography; visual field test; intraocular pressure; Amsler grid. Hearing ● Anatomy: outer → middle (ossicles) → inner (cochlea) → CN VIII. ● Tinnitus: ringing/buzzing without sound. ● Types of loss: ○ Sensorineural: inner ear/nerve (aging = presbycusis, loud noise, ototoxic meds) ○ Conductive: sound can’t travel (wax, otitis media, perforation, otosclerosis) ○ Mixed: both Tests: Rinne, pure-tone audiometry; ABR/OAE (screening). Speech/Aphasia (stroke-related high yield) ● Broca/expressive: understands but can’t produce words well (“telegraphic” speech) ● Wernicke/fluent: lots of words, no meaning; poor comprehension ● Global: severe impairment of both Touch ● Hypersensitivity / defensiveness (painful to normal touch) vs hyposensitivity (reduced pain/temp). ● Major causes: peripheral neuropathy (diabetic), spinal cord injury. ● Testing: neuro exam, sensation checks, nerve conduction, EMG, MRI. Smell & taste (often linked) ● Taste disorders: hypogeusia (↓ taste), ageusia (no taste), dysgeusia (metallic/rancid), phantom taste ● Smell disorders: anosmia (no smell), hyposmia (reduced), parosmia (distorted), phantosmia (smell not real) ● Causes: URIs, sinus disease, head injury, smoking, meds, zinc deficiency, neuro disorders. Aging effects (must know) ● Vision & hearing decline most. ● Vision: smaller pupils, less lens flexibility, weaker extraocular muscles, ↓ tears/dry eyes. ● Hearing: high-frequency loss, cerumen impaction, tinnitus. ● Taste/smell: ↓ taste buds + ↓ saliva → ↓ appetite → malnutrition risk. ● Touch: ↓ circulation → ↓ temperature/pain sensitivity. Nursing priorities (sensory) ● Safety + independence + emotional support ● Vision: lighting, corrective lenses, remove clutter, orient to room, fall prevention. ● Hearing: face client, reduce background noise, check hearing aids, use written info/interpreter. ● Speech: allow time, don’t finish sentences, use boards/paper/tablet. ● Touch: injury prevention (diabetic foot care, protective footwear, daily inspection). ● Smell/taste: oral hygiene, season foods, smoke/CO detectors, avoid smoking. If you want, I can turn this into a one-page “test-ready” version (even shorter, like only definitions + red flags + key interventions). Condensed Study Guide: Complementary & Integrative Health (CIH) / CAM / Holistic Nursing 1) Key Terms (know the differences) ● Conventional (Western) medicine: Evidence-based diagnosis & treatment (meds, surgery, radiation). Also called mainstream, allopathic, biomedicine, orthodox. ● Complementary therapy: Used with conventional care (ex: aloe + NSAID for sunburn). ● Alternative therapy: Used instead of conventional care. ● Integrative health: Combines conventional + complementary + alternative in a coordinated plan (mind–body–spirit). ● Holistic nursing: Client-centered care treating the whole person (physical, emotional, spiritual, social, cultural, environment). Focus is healing + wellness, not just curing disease. 2) NCCIH Categories (how CIH is “delivered”) Nutritional approaches ● Herbs/botanicals, supplements, vitamins/minerals, probiotics, dietary therapies ● Usually OTC and labeled as dietary supplements Psychological (mind–body) approaches ● Relaxation, meditation, mindfulness/MBSR, guided imagery, biofeedback, hypnosis, prayer Physical approaches ● Hands-on body structures/systems: massage, chiropractic, osteopathy, spinal manipulation, heat/cold, reflexology Bioenergetic (energy) therapies ● Veritable energy = measurable EM fields/light/magnets ● Putative energy (biofields) = subtle energy concepts ● Examples: Healing Touch, Therapeutic Touch, Reiki, Tai Chi, qi gong, acupressure Whole medical systems ● Complete systems separate from Western medicine: ○ Ayurveda, Traditional Chinese Medicine (TCM), Unani, Kampo ○ Also: Homeopathy, Naturopathy, Functional medicine (root-cause focus) Combined approaches ● Blends multiple categories: yoga, mindfulness eating, dance/art/music therapy 3) Why it matters (nursing relevance) ● Many clients use CIH (often alongside prescriptions). Nurses must: ○ Assess what clients use ○ Prevent interactions/harms ○ Provide culturally congruent care ○ Support self-care + empowerment ● Holistic nursing priorities ○ Promote wellness, honor caring–healing relationship ○ Respect subjective experience of illness/healing ○ Encourage informed decisions + active participation ○ Incorporate cultural beliefs/folk practices safely 4) High-yield Mind–Body Therapies (what they do) ● Deep breathing: control rate/depth → ↓ anxiety/stress ● Meditation: quiet mind/focused attention → ↓ BP/HR, ↓ stress effects ● Mindfulness: present-moment awareness; can reduce stress and improve coping ● Guided imagery: mental visualization → relaxation, pain/anxiety reduction ● Prayer: spiritual coping/connection (client-defined) ● Progressive relaxation: systematically tense/relax muscle groups ● Yoga (meditative movement): poses + breathing ± meditation → stress, sleep, anxiety; also pain (back/neck) support ● Aromatherapy: essential oils (inhaled/topical) → relaxation, anxiety relief; some evidence for nausea (ex: ginger/lavender/peppermint blends) ● Acupuncture/acupressure: stimulates points/meridians → pain, nausea, fatigue, anxiety support ● Hypnotherapy: focused attention + suggestion → phobias, anxiety, pain, habits (smoking) ● Biofeedback: device-assisted control of body functions (HR, tension) → stress, headaches, rehab, pain 5) Manual Therapies (hands-on) ● Massage: manipulates soft tissues → pain/anxiety/insomnia support ○ Precautions: avoid over clots/tumors/prostheses; caution with anticoagulants/low platelets (bruising/bleeding); older adults risk (rare) fractures ● Reflexology: foot/hand zones thought to correspond to body functions ● Chiropractic: spinal manipulation + structural focus; no surgery/Rx meds ● Osteopathic medicine: structure-function relationship; osteopathic manipulation used by trained physicians 6) Bioenergetic / Movement Therapies ● Tai Chi / Qi gong: meditative movement; balance, function, stress reduction ● Alexander Technique: posture/neck-spine alignment awareness → chronic pain support ● Feldenkrais: mindful movement retraining → pain + mobility ● Rolfing/Structural integration: deep tissue/fascia work → posture/function ● Pilates: core/torso control, posture → balance, flexibility, pain relief ● Therapeutic Touch / Healing Touch / Reiki: energy-based touch; may support relaxation, pain reduction, agitation (ex: dementia) 7) Traditional / Indigenous Practices (cultural competence) ● Traditional medicine (WHO concept): culture-based knowledge/practices for prevention/diagnosis/treatment—often includes spirituality. ● Examples: Native healing practices (prayer, drumming, storytelling, sacred rituals), herbal use, cupping, etc. ● Nursing: respect beliefs, ask what practices are important, integrate safely. 8) Whole Medical Systems (quick ID) ● Ayurveda: balance mind–body–spirit; doshas; cleansing + diet + herbs + yoga/meditation ● TCM: acupuncture, Tai Chi/qi gong, herbs; balance yin/yang + qi flow ● Naturopathy: “body heals itself” supported by diet, lifestyle, herbs, supplements, homeopathy, etc. ● Homeopathy: “like cures like,” highly diluted remedies ● Functional medicine: root-cause, systems-based approach 9) Natural Products: BIG SAFETY POINTS (test favorites) FDA/supplements ● FDA regulates supplements, but manufacturers are responsible for quality/claims → variability exists. ● “Natural” ≠ safe. Must-do nursing action ● Always ask about herbs/supplements/vitamins OTC. ● Encourage a current med + supplement list shared with provider/pharmacist before starting anything new. Common interaction themes ● Bleeding risk (esp with anticoagulants like warfarin): ○ Garlic, ginger, ginkgo, cranberry (large amounts), evening primrose oil, etc. ● Serotonin syndrome risk when mixing certain herbs with antidepressants: ○ St. John’s wort + antidepressants (ex: duloxetine) ● CNS depression/sedation combos: ○ Valerian + sedatives/alcohol/antihistamines ● Vitamin K decreases warfarin effect: ○ Leafy greens (consistency matters) Specific high-yield herbal cautions ● Ephedra (ma huang): banned in U.S. supplements → serious CVA/MI risk (worse with caffeine) ● Kava: can cause liver damage ● Black cohosh: possible liver injury risk ● Tea tree oil: toxic if ingested ● Licorice root: ↑ BP, can lower K+ (esp with diuretics); avoid in pregnancy ● St. John’s wort: many interactions (reduces effectiveness of multiple meds) + photosensitivity Probiotics (basic) ● Support healthy gut flora; can help inhibit harmful bacteria (ex: Lactobacillus) 10) Vitamins & Minerals (core test facts) Vitamins ● Water-soluble: B-complex + C (not stored well → need regular intake) ● Fat-soluble: A, D, E, K (stored in fat/liver → toxicity risk if too much) Vitamin K newborn note: doesn’t cross placenta well; newborns get IM vitamin K to prevent bleeding. B-complex quick purpose (big picture) ● Mostly metabolism/energy, neuro function, RBC formation ● B12: neuro + RBCs (deficiency → anemia, fatigue, neuro changes) Minerals (core roles) ● Needed for: enzyme function, nerve/muscle contraction, fluid balance, bone/teeth ● Examples: ○ Calcium: bones + clotting + nerve impulses ○ Sodium: extracellular fluid, nerve/muscle ○ Potassium: nerve/muscle; high/low can cause arrhythmias ○ Magnesium: metabolic processes; low with alcohol use disorder/DM ○ Iron: oxygen transport; deficiency → anemia Food-drug/nutrient interactions (quick) ● Vitamin C ↑ non-heme iron absorption ● Coffee/tea/wine (polyphenols) + phytic acid (legumes/nuts) ↓ iron absorption Quick “Exam-Style” Reminders ● Complementary = with conventional; Alternative = instead; Integrative = coordinated blend. ● Nursing role: assess use, prevent interactions, educate, support self-care, respect culture. ● Biggest safety issue: herb/supplement interactions (bleeding, serotonin syndrome, sedation, warfarin/vit K). If you want, paste any practice questions from this lesson and I’ll answer them using only what’s in your notes

Week 5

Absolutely — here’s a condensed study guide that keeps the major concepts (the stuff most likely to be tested), without all the extra detail.

Infection Control & Body Defenses — Condensed Study Guide (Major Concepts)

Chain of Infection (6 Links + how to break them)

1.      Infectious agent (bacteria, viruses, fungi, parasites, prions)

○       Break it: disinfect/sterilize/clean; antimicrobials as ordered

2.      Reservoir (where it lives: people/animals/insects; soil, water, food, equipment, IV fluids, feces)

○       Break it: hand hygiene, pre-op skin prep, environmental cleaning

3.      Portal of exit (blood/body fluids, respiratory/GI tract, mouth/nose/ears, skin)

○       Break it: contain drainage/secretions (dressings, drains)

4.      Mode of transmission

○       Main: contact, droplet, airborne (also vehicle, vector)

○       Break it: hand hygiene + PPE + disinfect shared equipment

5.      Portal of entry (orifices, mucous membranes, breaks in skin; invasive devices)

○       Break it: aseptic technique, protect skin, sterile technique when needed

6.      Susceptible host (risk depends on immunity/health)

○       Break it: immunizations, nutrition, hygiene, blood sugar control

Virulence: how efficient an organism is at making people ill.

Modes of Transmission (what to recognize)

Contact

●       Direct: person-to-person (ex: blood to open abrasion)

●       Indirect: contaminated objects/PPE/equipment (ex: bed rails, shared devices)

Droplet

●       From coughing/sneezing/singing/talking; some procedures (CPR, intubation)

●       Examples: influenza, pertussis, RSV, adenovirus, rhinovirus

●       Respiratory etiquette + masking when out of room

Airborne

●       Small particles remain suspended; travel farther

●       Requires private room; negative pressure (AIIR) preferred

●       Examples: TB, measles (rubeola), varicella

Vehicle / Vector

●       Vehicle: contaminated food/water (ex: E. coli produce)

●       Vector: insects/rodents (mosquitoes, rats)

Body Defenses (3 Types)

1.      Physical & chemical barriers

○       Skin (primary defense), mucous membranes/mucus, tears/sweat, cilia + cough, stomach acid, normal flora

2.      Nonspecific immunity

○       Neutrophils + macrophages (phagocytes “eat and destroy”)

3.      Specific immunity

○       Antibodies (immunoglobulins) + lymphocytes

Inflammatory Response (key steps + signs)

Steps:

●       Pattern receptors recognize harmful stimuli

●       Inflammatory pathway activated

●       Markers released (ex: CRP)

●       Inflammatory cells recruited (leukocytes → monocytes/lymphocytes)

Signs of inflammation (local tissue):

●       heat, redness, swelling, pain, loss of function

Triggers can be infectious (viruses/bacteria) or noninfectious (trauma, burns, irritants, toxins, radiation, etc.).

Stages of Infection (in order)

1.      Incubation (exposure → first symptom; may have lab changes)

2.      Prodromal (vague symptoms: malaise, fever, aches)

3.      Acute illness (most severe; specific symptoms)

4.      Decline (symptoms decrease)

5.      Convalescence (recover/return to baseline)

Local vs Systemic Infection

●       Local: confined to one area (often topical/oral treatment)

●       Systemic: enters bloodstream, affects whole body (often IV antibiotics + monitoring)

Diagnostic Tests (high-yield)

●       UA for UTI symptoms → if WBCs present, culture & sensitivity

●       CXR confirms pneumonia/atelectasis but doesn’t tell viral vs bacterial

●       CBC + differential

○       Expected WBC: 5,000–10,000/mm³

○       “Left shift” = increased bands (immature neutrophils) → infection

●       Nonspecific markers: CRP, ESR, Procalcitonin

Asepsis & Precautions

Hand hygiene (most important)

●       Soap/water when visibly soiled and for C. diff spores

●       Alcohol sanitizer works unless hands visibly soiled

Medical asepsis (clean technique)

●       reduces microbes; includes isolation precautions

Surgical asepsis (sterile technique)

●       prevents introducing microbes during invasive procedures; uses sterile supplies/fields

Isolation Precautions (major takeaways)

Standard precautions

●       For all clients

●       Protect from blood/body fluids, secretions, excretions, nonintact skin, mucous membranes

●       PPE based on expected exposure

Contact precautions

●       Gown + gloves

●       Examples: C. diff, VRE, norovirus, RSV, large draining wounds

●       Remove PPE inside room

Droplet precautions

●       Surgical mask

●       Examples: influenza, pertussis, RSV

Airborne precautions

●       N95 or higher, private room; AIIR/negative pressure preferred

●       Examples: TB, measles, varicella

Protective isolation (protective environment)

●       For severely immunocompromised (ex: post-allogenic HSCT)

●       Positive airflow + HEPA (goal: protect the client)

Health Care–Associated Infections (HAIs) — the “big 4”

●       CLABSI

●       CAUTI

●       SSI

●       VAP
Devices/lines/wounds create portals of entry → strict asepsis reduces risk.

MDROs (major concept)

MDROs = resistant bacteria (hard to treat)
Examples: MRSA, VRE, VRSA, VISA, ESBL, MDRSP
Prevention: hand hygiene, contact precautions per policy.

Condensed Study Guide: Novice to Expert + Nursing Communication

I. Novice to Expert Nursing (Benner Model)

Lifelong Learning & Collaboration

●       Learning occurs through study and working with others

●       Nurses grow by:

○       observing experienced nurses

○       sharing knowledge and best practices

●       Respect all experience levels (years ≠ only indicator of knowledge)

●       Leaders promote:

○       collaboration

○       mutual respect

○       teamwork culture

Benner’s 5 Stages of Competence

1.      Novice – no experience; relies on rules; struggles to prioritize

2.      Advanced Beginner – recognizes patterns; still rule-focused; needs help setting priorities

3.      Competent – uses past experience to prioritize; more organized but slower than proficient

4.      Proficient – sees the big picture; adapts to changing situations

5.      Expert – intuitive, confident, and highly skilled with complex care

II. Communication Foundations

Definition

Communication = transfer of information that is always occurring, even without speaking.
Includes: verbal words, body language, emotions, and technology.

Why Communication Matters

●       Key to client safety (Joint Commission goal)

●       Miscommunication → medical errors

●       Nurses must detect when clients don’t understand

III. Communication Models (Core Concepts)

Shannon–Weaver Model (Linear)

Sender → Encoder → Channel → Decoder → Receiver + Noise (distractions interfering with message)

Schramm Model (Feedback)

●       Sender and receiver exchange messages

●       Feedback confirms understanding

●       No feedback = communication incomplete

Newcomb ABX Model (Social)

●       A (sender), B (receiver), X (topic affecting interaction)

●       Focus on relationships and shared topic

Berlo S-M-C-R Model (One-way)

●       Sender → Message → Channel → Receiver

●       No feedback loop

IV. Forms of Communication

Verbal

Spoken communication (face-to-face or phone)

Nonverbal (Body Language)

●       Eye contact, posture, facial expressions

●       When verbal and nonverbal conflict → nonverbal dominates

Auditory

What the receiver hears (tone, speed, clarity)

Emotional

Speaker’s emotional state influences how message is received

Energetic

Speaker’s presence/empathy affects perception of message

V. Modes of Communication (4 Types)

1.      Verbal – spoken conversation

2.      Nonverbal – gestures, posture, appearance

3.      Electronic – email, text, video (must be secure/HIPAA compliant)

4.      Written – letters, emails, documents (may lack tone/body language)

HIPAA & Electronic Communication

Must include:

●       secure messaging

●       unique logins

●       auto logoff

●       encrypted/indecipherable PHI

VI. Communication Styles

Most effective: Assertive

●       Passive: avoids conflict; agrees despite concerns

●       Assertive: clear, respectful, confident; uses “I” statements

●       Aggressive: blaming, hostile, controlling

●       Passive-aggressive: indirect expression (sarcasm, avoidance)

VII. Therapeutic Communication

Purpose

Build trust and provide patient-centered, empathetic care

Cornerstones

●       Compassion

●       Caring

●       Empathy

Peplau’s Nurse-Client Relationship Phases

1.      Orientation – client seeks help

2.      Identification – relationship forms

3.      Exploitation – active teaching/working phase

4.      Resolution – issue resolved; relationship ends

Watson’s Theory of Human Caring

●       Authentic presence

●       Protect dignity

●       Loving-kindness

●       “Healing moment” interactions

VIII. Therapeutic Communication Techniques (Must Know)

●       Active listening – attend to verbal + nonverbal cues

●       Open-ended questions – encourage discussion (“Tell me more…”)

●       Silence – allows client to reflect and share more

●       Restating / summarizing – repeat message to confirm understanding

●       Reflection – mirror feelings (“What do you think you should do?”)

●       Accepting – acknowledge message without judgment

●       Giving recognition – note change without compliment

●       Focusing – gently redirect to important topic

●       Offering self – sit with client and be present

IX. Nontherapeutic Communication (Avoid)

●       Giving advice

●       False reassurance (“You’ll be fine”)

●       Criticizing or challenging

●       Asking “Why” questions

●       Rejecting or disagreeing

●       Probing irrelevant topics

●       Changing the subject

Effects:

●       increased stress

●       damaged trust

●       poor outcomes

X. Interprofessional Communication

Importance

Effective teamwork improves:

●       client outcomes

●       safety

●       efficiency

●       reduces errors

IPEC Core Competencies

1.      Mutual respect among team members

2.      Use shared knowledge collaboratively

3.      Communicate effectively as a team

4.      Support team values and client-centered care

XI. Motivational Interviewing (MI)

Purpose

Encourage behavior change (diabetes, obesity, substance use)

OARS Technique

●       Open-ended questions

●       Affirmations (positive encouragement)

●       Reflective listening

●       Summarizing

XII. Group vs Individual Communication

●       Individual: new diagnosis, personal teaching

●       Group: ongoing education, support groups

XIII. Communication Barriers (Major Categories)

Cognitive/Developmental

●       dementia, stroke, autism

Physiological

●       hearing loss, vision impairment

Cultural & Language

●       language differences, cultural beliefs, lack of cultural competence

Environmental/Situational

●       noise, lighting, temperature

●       fear, anxiety, fatigue, stress

Technological

●       poor reception, distractions, electronic errors

XIV. Strategies to Overcome Barriers

Universal Strategies

●       show empathy and respect

●       avoid interrupting

●       use simple, clear language

●       confirm understanding (summarize/reflect)

Language Barriers (CLAS Standards)

●       Use qualified medical interpreter

●       Do NOT use family members or translation apps

●       Required for federally funded facilities

Hearing Impairment Strategies

●       face the client

●       speak clearly/moderate pace

●       reduce background noise

●       use written info or visual aids

●       ensure hearing aids in place

●       speak to client (not interpreter) if interpreter present

Vision Impairment Strategies

●       introduce yourself

●       give clear directions (“door at 10 o’clock”)

●       allow client to hold your arm

●       provide large print/audio/Braille materials

Cognitive/Developmental Strategies

●       use simple words

●       avoid jargon/slang

●       speak slowly and clearly

●       reduce noise/bright distractions

●       ensure glasses/hearing aids available

Key Takeaways (Exam Focus)

●       Benner’s stages: Novice → Advanced Beginner → Competent → Proficient → Expert

●       Communication must include feedback to be effective

●       Nonverbal cues often outweigh verbal messages

●       Best communication style = Assertive

●       Core therapeutic techniques = active listening, open-ended questions, silence, reflection, summarizing

●       Use qualified interpreter for language barriers (CLAS standard)

●       Barriers include cognitive, physical, cultural, environmental, and emotional factors

●       Effective communication improves client safety and outcomes

Here is a condensed but complete study guide that keeps all concepts from the Safety lesson while removing extra wording.

SAFETY & PATIENT PROTECTION – CONDENSED STUDY GUIDE

I. Joint Commission National Patient Safety Goals (NPSGs)

Purpose

Annual goals to improve:

●       Client safety

●       Safe, effective care

●       Prevention of adverse outcomes

1. Identify Clients Correctly

●       Use two identifiers (name, DOB, MRN, etc.)

●       Confirm before meds, procedures, treatments

●       Ask open-ended questions

●       Verify ID band & EMR

●       Use barcode scanning

●       ❌ Never use room number

2. Improve Staff Communication

●       Report critical results immediately

●       Critical results = life-threatening abnormal labs/diagnostics

●       Facility policies define:

○       critical result criteria

○       reporting timeframe

○       documentation requirements

●       Communicate directly (in person/phone), not voicemail (HIPAA)

3. Use Medications Safely

Label medications

●       Label all syringes/containers with name, dose, date/time

●       Discard unlabeled meds

Anticoagulant safety

●       Examples: warfarin, heparin, enoxaparin

●       Monitor labs, weight, interactions, dosing

●       Educate on risks, food interactions, follow-up labs

Medication reconciliation

●       Compare home meds with new prescriptions

●       Done on admission, transfer, discharge

●       Resolve discrepancies

4. Use Alarms Safely

●       Clinical alarms warn of patient events or equipment malfunction

●       Examples: IV pumps, ventilators, monitors, bed/chair alarms

●       Risk: alarm fatigue

●       Nurse role:

○       know alarm priorities

○       respond promptly

○       help develop alarm policies

5. Prevent Hospital-Acquired Infections (HAIs)

Common HAIs:

●       CLABSI

●       CAUTI

●       SSI

●       VAP

Concern: MDROs (MRSA, VRE, C. diff)
⭐ Hand hygiene = most important prevention
Compliance required with monitoring and action plans.

6. Identify Safety Risks: Suicide Prevention

●       Screen behavioral health clients ≥12 yrs

●       Positive screen → detailed suicide assessment

●       Implement:

○       constant observation

○       removal of harmful items

○       environmental safety checks

○       staff competency training

7. Universal Protocol (Surgery Safety)

Prevent wrong-site/procedure/client:

1.      Two identifiers

2.      Mark surgical site (if applicable)

3.      Time-out before procedure

4.      Verify consent & procedure with client

8. Improve Health Care Equity (2024 Goal)

Assess social determinants:

●       literacy

●       housing

●       transportation

●       food access
Continue assessment throughout hospitalization and discharge planning.

II. Standards of Compliance

Former NPSGs now routine standards:

●       Medical error prevention

●       Staff competency verification

●       Client rights & education

●       Infection control

●       Medication management

●       Emergency preparedness

III. Culture of Safety

Promotes:

●       open communication

●       reporting of errors & near misses

●       nonpunitive environment

●       improved outcomes & staff satisfaction

Nurses play key role due to frequent client contact.

IV. Transforming Care at the Bedside Initiative

1.      Spend 70% of time in direct bedside care

2.      Leadership development

3.      Rapid Response Team (RRT)

4.      Standardized communication (ISBARR)

Benefits:

●       fewer falls, HAIs, med errors

●       improved outcomes and satisfaction

V. Rapid Response Team (RRT)

Interdisciplinary team (ICU nurse, RT, provider) for sudden deterioration.

Call RRT for:

●       sudden vital sign changes

●       low O₂ despite intervention

●       chest pain after nitro

●       seizure

●       sudden mental status change

●       serious clinical concern

VI. ISBARR Communication Tool

1.      Identity

2.      Situation

3.      Background

4.      Assessment

5.      Recommendation

6.      Read-back

VII. Types of Unexpected Events

●       Near miss: error caught before harm

●       Client safety event: event with potential harm

●       Adverse event: unexpected harm occurred

●       Sentinel event: severe harm/death (never event)

Examples sentinel:

●       wrong-site surgery

●       suicide in facility

●       serious fall injury

VIII. Occurrence (Incident) Reporting

Purpose: improve systems, prevent future errors (not punishment)

Report:

●       falls/injuries

●       wrong meds

●       adverse reactions

●       blood/body fluid exposure

●       property damage

●       unsafe behaviors/events

IX. Safety Assessment & Agencies

Regulated by:

●       TJC

●       CMS

●       OSHA

●       State boards & local agencies

Nursing safety focus:

●       falls

●       meds & allergies

●       restraints

●       pressure injury prevention

●       infection control

●       sharps & pathogen exposure

●       body mechanics

●       fire, chemical, radiation safety

X. Electrical Safety

Check:

●       frayed cords

●       grounded 3-prong plugs

●       GFCI outlets

●       no wet handling

●       avoid extension cords

●       tag/remove faulty equipment

XI. Chemical Safety

Exposure routes:

●       inhalation

●       skin/eyes

●       ingestion

●       injection (needlestick)

Use:

●       SDS sheets

●       PPE (gloves, masks, gowns, goggles)

●       ventilation systems

●       emergency eye wash/showers

XII. Radiation Safety

Risk proportional to:

●       exposure time

●       distance from source

Principles:

1.      Reduce time

2.      Increase distance

3.      Shield (lead aprons, barriers)

Types:

●       Alpha (least risk, short travel)

●       Beta (moderate risk, small distance)

●       Gamma (highest risk, penetrates tissue)

Initial symptoms:

●       nausea, vomiting, diarrhea

●       burns, alopecia

●       immunocompromise

●       psychological effects

XIII. Age-Related Safety Risks

Infants/Preschoolers

●       burns, poisonings, choking, drowning

●       car seat safety

●       smoke detectors & safe storage of toxins

School-Age

●       sports injuries, firearm safety, internet risks

Adolescents

●       substance use, risky driving, violence, suicide risk

Adults/Older Adults

●       chronic illness, frailty, mobility decline

●       ⭐ Major risk: falls

●       frailty → poorer outcomes

XIV. Hospital-Acquired Injuries

Include:

●       SSIs, CAUTIs, CLABSIs

●       falls, trauma

●       pressure injuries

●       DVT

●       insulin errors

●       transfusion reactions

●       burns/electrical shock

High-risk clients:

●       neurologic disorders (stroke, MS, Parkinson’s)

●       cognitive impairment, dementia

●       communication disabilities

●       visual deficits

●       behavioral disorders

XV. Screening Tools

Used to identify early risk:

●       Morse Fall Scale (fall risk)

●       Braden Scale (pressure injury risk)

●       Tools must be valid/reliable
Positive results → detailed assessment + individualized care plan.

XVI. Home Hazard Safety

Bathroom:

●       grab bars, non-slip mats, raised toilet, step-free showers
Bedroom:

●       low bed, alarms, hospital bed if needed
Kitchen:

●       reachable items, automatic stove shut-off, secure chemicals
General:

●       good lighting, remove loose rugs, secure cords, install handrails

●       cordless blinds for child safety

●       emergency numbers accessible

XVII. Fire Safety

RACE

●       Rescue

●       Alarm

●       Contain (close doors/windows)

●       Extinguish

PASS

●       Pull pin

●       Aim at base

●       Squeeze

●       Sweep

Fire extinguisher types:

●       A: paper/wood

●       B: liquids/oils

●       C: electrical

●       D: metals

●       K: kitchen grease

●       ABC: multipurpose

Evacuation:

●       Lateral = same floor (preferred)

●       Vertical = different floor

XVIII. Workplace Safety

Bullying

●       Repeated harassment/belittlement

●       Leads to burnout, errors, poor retention

Workplace Violence

Includes verbal abuse to homicide
Risk factors:

●       violent clients

●       staff shortages

●       long wait times

●       lack of training/security

Active Shooter Response

1.      Run

2.      Hide

3.      Fight (last resort)

XIX. Emergency Preparedness

Facilities must have:

●       disaster plans

●       staff training & drills

●       defined staff roles

Types of mass exposure:

●       Radiation

●       Biological (anthrax, Ebola, COVID)

●       Chemical toxins

Response:

●       PPE

●       decontamination (remove clothing, shower)

●       monitor vitals & mental status

XX. Injury Prevention Strategies

●       hourly rounding

●       video monitoring

●       bedside sitters

●       individualized safety plans

●       prompt call-light response

XXI. Fall Prevention

Risk factors:

●       weakness, gait issues, vision problems

●       confusion, dementia, impulsiveness

●       clutter, poor lighting

●       high-risk meds (antihypertensives, antidepressants)

●       incontinence, age

Universal precautions:

●       nonskid footwear

●       low bed & locked wheels

●       clutter-free room

●       call light within reach

●       hourly rounding & quick response

Movement alarms = warning device
Siderails:

●       2 rails for safety

●       4 rails = restraint (intent matters)

XXII. Restraints & Seclusion

Types:

●       Physical: manual holding

●       Mechanical: mitts, wrist, vest, 4-point

●       Chemical: sedatives/antipsychotics

●       Barrier: enclosures, lapboards, 4 rails

●       Seclusion: locked room

Use ONLY as last resort when:

●       danger to self/others

●       removing life-saving devices

●       severe aggression

Care of restrained client:

●       frequent circulation, skin, respiratory checks

●       ROM, hygiene, fluids, elimination

●       reevaluate every 24 hrs

●       discontinue ASAP

XXIII. Seizure Precautions

Preseizure

●       suction & oxygen ready

●       padded rails

●       IV access

●       remove restrictive clothing/jewelry

During seizure

●       call for help

●       side-lying position

●       protect head

●       do NOT restrain

●       monitor duration & movements

●       give benzodiazepine if ordered

Postseizure

●       assess gag reflex before oral intake

●       reassure client

●       labs, EEG, imaging as ordered

XXIV. Musculoskeletal Injury Prevention (Nurse Safety)

Use assistive devices:

●       Hoyer lift (ground lift)

●       ceiling lift

●       slide sheets

●       sit-to-stand lift

Safe handling:

●       clear area

●       use correct sling size

●       have 2 staff assist

●       lock brakes

●       never leave client unattended

XXV. Patient-Centered Care

Focus:

●       client as center of care

●       collaboration & shared decision-making

●       respect cultural, spiritual, religious needs

●       holistic & individualized care

●       include pastoral care support

FINAL MEMORY CHECK (High-Yield Core Concepts)

●       Two identifiers before any care

●       Hand hygiene prevents HAIs

●       Time-out before surgery

●       ISBARR improves communication

●       RRT for sudden deterioration

●       Fall prevention + restraints last resort

●       RACE & PASS fire response

●       Run–Hide–Fight for active shooter

●       Time–distance–shielding for radiation safety

●       Screening tools identify early risks

Here is a fully condensed study guide that includes ALL major topics and concepts from your lesson (patient-centered care, caring theories, cultural care, spirituality, advocacy, sleep & rest) without leaving anything out.

CONDENSED STUDY GUIDE: PATIENT-CENTERED CARE, CARING, CULTURE, ADVOCACY & SLEEP

Patient-Centered Care

Definition

Patient-centered care = placing the client at the center of all care, focusing on preferences, culture, and holistic needs rather than just tasks or documentation.

Key Concepts

●       Improves client satisfaction and outcomes

●       Involves caring, preferences, cultural respect, and shared decision-making

●       Holistic care: physical, emotional, spiritual needs

Caring in Nursing

Definition

Caring = nurturing another person with responsibility and commitment; core of professionalism.

Holistic Caring Includes

●       Healing environment

●       Kindness, empathy, compassion

●       Addressing physical, emotional, and spiritual needs

Caring Theories

A. Watson’s Theory of Human Caring

Holistic model focusing on mind-body-spirit harmony through transpersonal (human-to-human) caring relationships.

Core Ideas

●       Caring moments foster healing and self-restoration

●       Nurse must achieve inner balance and spirituality

●       Establish trusting presence and relationships

10 Caritas Processes

1.      Loving-kindness and compassion

2.      Authentic presence and honoring beliefs

3.      Sensitivity to self and others

4.      Trusting caring relationships

5.      Expression of feelings

6.      Creative problem-solving through caring

7.      Transpersonal teaching/learning

8.      Healing environment (comfort, dignity, peace)

9.      Reverent assistance with basic needs

10.    Openness to spirituality and miracles

B. Swanson’s Theory of Caring

Caring improves well-being through empowerment, dignity, and respect.

Five Caring Processes

1.      Maintaining belief – instill hope and meaning

2.      Knowing – understand client’s situation/perception

3.      Being with – emotional and physical presence

4.      Doing for – perform needed tasks for client

5.      Enabling – guide and support through events/transitions

IV. Caring Behaviors

1. Listening

●       Active, empathetic listening

●       Observe verbal and nonverbal cues

●       Key for holistic assessment and trust

2. Touch

●       Used for procedures and expressive caring

●       Requires permission; consider culture, trauma, gender

●       Can reduce anxiety and increase well-being

3. Being Present

●       Physical and emotional availability

●       Reduces loneliness and improves comfort

●       Reflects “being with” (Swanson)

4. Providing Comfort

●       Pharmacologic and nonpharmacologic comfort measures

●       Examples: pillows, blankets, hygiene, music, temperature control

●       Represents “doing for”

5. Showing Compassion

●       Recognize suffering and act to relieve it

●       View client as person, not diagnosis

●       Requires self-awareness and adequate staffing

Client Preferences in Care

Clients are full members of the health care team and experts on their own experiences.

Benefits

●       Increased trust and satisfaction

●       Improved healing and outcomes

●       Greater sense of control

Ways to Include Preferences

1.      Endorsing participation – empower involvement

2.      Promoting understanding – correct misinformation

3.      Sharing information – two-way communication

Barriers

●       Power imbalance

●       Medical jargon

●       Weakness, fatigue, cognitive impairment

●       Poor collaboration and language barriers

Cultural Competence

Definition

Evidence-based care aligned with client’s cultural values, beliefs, and practices.

Influencing Factors

●       Socioeconomic status

●       Health literacy

●       Racism experiences

●       Sexual orientation

●       Acculturation (adapting to another culture)

Five Elements of Cultural Competence

1.      Cultural awareness – self-examine biases

2.      Cultural knowledge – learn client values/beliefs

3.      Cultural skill – assess cultural needs accurately

4.      Cultural encounters – interact with diverse cultures

5.      Cultural desire – motivation to connect with cultures

Cultural Assessment Includes

●       Cultural/spiritual affiliation

●       Health beliefs and practices

●       Spiritual rituals

●       Dietary preferences/prohibitions

●       Care preferences to increase comfort

VII. Age-Related (Generational) Care Preferences

Spiritual Nursing Care

Spiritual Well-Being

Feeling of meaning, purpose, and connection to higher power → improves quality of life.

Spiritual Assessment Questions

●       Source of spiritual strength?

●       Meaning-of-life concerns?

●       Relationship with higher power?

●       Spiritual practices?

●       Fear of dying?

●       Relationship concerns?

Assessment Tools

FICA:

●       Faith

●       Importance

●       Community

●       Address in care

HOPE:

●       Hope sources

●       Organized religion

●       Personal spirituality/practices

●       Effects on care/end-of-life issues

Spiritual Distress

Definition

Questioning life meaning or beliefs causing despair, anger, fear, uncertainty.

Nursing Interventions

●       Listen and be present

●       Encourage spiritual expression

●       Provide prayer, texts, pastoral referral

●       Address emotional and spiritual needs

Pastoral Care

Provides:

●       Ethical, religious, and spiritual support

●       Counseling, prayer, rituals

●       End-of-life and grief support

●       Support for families and staff

Chaplains assist all clients regardless of religion.

Access to Care

Barriers

●       Lack of insurance

●       Transportation problems

●       Limited providers/facilities (rural areas)

●       Restricted clinic hours

●       Medication cost barriers

Solutions

●       Telemedicine: remote diagnosis/testing

●       Telehealth: broader remote clinical and nonclinical services

●       Improves access, especially rural areas

Client Advocacy

Definition

Protect client autonomy, rights, and safety; act as client’s voice.

Clients Needing Advocacy

●       Unconscious

●       Children

●       Fearful/intimidated clients

●       Uninformed about diagnosis/rights

Advocacy Steps

1.      Assess needs, values, cognition, resources

2.      Verify client goals/preferences

3.      Implement plan and communicate with team

4.      Evaluate outcomes and self-determination

Related Concepts

●       Medically futile: treatment unlikely to cure or extend life

●       Potentially inappropriate treatment: works but may not improve quality of life

●       Palliative care: symptom relief + quality of life

●       Quality of life: personal meaning, independence, relationships

Sleep and Rest

Importance of Sleep

Supports:

●       Memory, learning, concentration

●       Immune system and tissue repair

●       Hormone balance (ghrelin, leptin, cortisol)

●       Mood, reaction time, coordination

●       Prevention of obesity, diabetes, cardiovascular disease

Physiology of Sleep

Key Brain Structures

●       Cerebral cortex: sensory processing & memory

●       Brainstem: controls REM and muscle relaxation

●       Hypothalamus: autonomic control, circadian rhythm (SCN)

●       Thalamus: sensory filtering during sleep

●       Pineal gland: produces melatonin

Sleep Regulation Mechanisms

1.      Circadian rhythm – 24-hour internal sleep–wake cycle influenced by light and temperature

2.      Sleep–wake homeostasis – pressure to sleep increases with sleep deprivation

Factors affecting sleep:

●       Light exposure

●       Stress

●       Medications

●       Caffeine/food

●       Environment

Stages of Sleep

NREM Sleep

Stage 1: Light sleep; easily awakened (5%)
Stage 2: Deeper sleep; decreased HR/temp; memory consolidation (50%)
Stage 3: Deep sleep; delta waves; immune strengthening and tissue repair (15%)

REM Sleep

●       Dream stage

●       Irregular breathing and increased HR

●       Muscle atonia (prevents acting out dreams)

●       Occurs ~90 minutes after sleep onset

Sleep cycles repeat 4–6 times per night.

Sleep Patterns by Age

●       Newborns: multiple cycles, high REM

●       Adults: 2–5% stage 1, 45–55% stage 2, 10–20% stage 3, 20–25% REM

●       Older adults: less deep sleep, more awakenings

Sleep Deprivation

Types

●       Total: no sleep for extended period

●       Partial: reduced sleep hours

●       Chronic: ongoing insufficient sleep

●       Selective: loss of specific sleep stage

Effects

●       Impaired judgment and memory

●       Mood swings, depression

●       Increased accidents and chronic illness risk

●       Poor glucose control and obesity

Promoting Sleep

Nonpharmacologic Interventions

●       Avoid caffeine, nicotine, alcohol before bed

●       Keep room dark, quiet, cool

●       Establish bedtime routine

●       Consistent sleep schedule

●       Exercise regularly (not right before bed)

●       Limit naps (<30 minutes)

●       Remove electronics/TV from bedroom

Sensory Overload in Hospital

Definition: Excess stimuli beyond brain’s processing ability → sleep disruption.

Nursing Interventions

●       Lower noise and alarms

●       Dim lights

●       Provide earplugs/eye masks

●       Cluster care tasks

●       Control pain and medication effects

Sleep Disorders

Insomnia

Difficulty falling/staying asleep → fatigue, poor concentration, mood changes

Sleep Apnea

●       Central: brain fails to signal breathing

●       Obstructive: airway collapse; snoring; daytime sleepiness
Treatment: CPAP, weight loss, avoid alcohol/smoking

Narcolepsy

Sudden sleep attacks; possible cataplexy (loss of muscle tone)

Hypersomnia

Excessive daytime sleepiness despite adequate sleep

Restless Legs Syndrome (RLS)

Urge to move legs; worsens at night; disrupts sleep

Night Terrors

Non-REM parasomnia causing panic and no recall; common in children

Pharmacologic Sleep Therapies

●       Benzodiazepines (GABA agonists): sedative but dependency risk

●       Nonbenzodiazepine hypnotics (most common)

●       Melatonin: low-risk first-line option

●       Antihistamines: OTC but cause side effects

. Nonpharmacologic Sleep Therapies

●       Massage, acupuncture, thermotherapy

●       Guided imagery, meditation, music therapy

●       Yoga and relaxation techniques

●       Sleep diaries to identify patterns and personalize care

FINAL KEY POINT

Patient-centered nursing integrates:

●       Caring theories

●       Cultural competence

●       Spiritual support

●       Client advocacy

●       Sleep and comfort promotion

Goal: provide holistic care that supports physical healing, emotional well-being, spiritual meaning, autonomy, and optimal quality of life.

Week 7

Absolutely—here’s a more condensed study guide that still includes every concept you were given.

CONDENSED STUDY GUIDE: ELIMINATION (ALL CONCEPTS)

1) Big Picture

●       Elimination (urine + stool) is continuous and essential. Patterns vary, but changes require assessment + intervention to restore usual patterns or establish a new baseline.

2) Urinary System Basics

Functions: excrete waste/fluid → urine, regulate electrolytes, support RBC production, help regulate BP, support bone health.
Pathway: kidneys → ureters → bladder → urethra → urination.
Control: internal sphincter + external sphincter + pelvic floor muscles prevent leakage.

Urination: elimination of urine via urethra.

3) Urine Production & Assessment

Normal: clear, light yellow, minimal odor.
Typical daily amount: ~1–2 quarts/day (varies).
Expected output by age: infant ~2 mL/kg/hr; toddler ~1.5; teen ~1; adult ~0.5.

Color clues:

●       Dark yellow/amber = need fluids

●       Dark brown = dehydration/kidney/liver concern

●       Red/pink = blood or foods (beets, blackberries, rhubarb)

Diet/med effects:

●       Fluids ↑ volume, lighter color

●       Asparagus ↑ odor

●       Dyes can turn blue/green

●       Alcohol + caffeine ↑ urine output (can dehydrate if not balanced)

Aging urinary changes: ↓ nephrons/kidney function, ↓ bladder tone → incontinence/retention risks.

4) GI System Basics

Organs: mouth → esophagus → stomach → small intestine → large intestine → rectum → anus.
Peristalsis: contractions that move contents through GI tract.

Feces formation: digestion + absorption (small intestine), water absorption + stool formation (large intestine), bacteria help + make vitamin K, rectum stores stool until BM.

Bristol Stool Chart:

●       Types 1–2 = constipation

●       Types 3–4 = expected

●       Types 5–7 = diarrhea

Aging GI changes: ↓ peristalsis/muscle tone → constipation; ↑ PUD risk (NSAIDs), ↓ elasticity/emptying changes, possible ↓ absorption/bacterial overgrowth, ↓ lactase → lactose intolerance; lifestyle factors (inactivity, low fiber/fluids, meds) contribute.

5) Expected Elimination

●       Urine: clear, light yellow, varies with intake/activity/diuretics.

●       Stool: frequency varies widely; should be soft/formed, easy to pass without straining.

6) Altered Urinary Elimination

Urinary Incontinence (UI)

Involuntary urine loss. Can cause skin breakdown + distress.
Types:

●       Stress: cough/sneeze/exertion

●       Urge: sudden urge, leak before toilet

●       Reflex: nerve damage, no warning

●       Overflow: incomplete emptying → overfill/leak

●       Functional: can’t reach toilet (mobility/dexterity issues)

●       Nocturnal enuresis: nighttime (kids; adults w alcohol/caffeine/meds)

Management: lifestyle changes (↓ caffeine/alcohol, smoking cessation, address constipation), pelvic floor exercises, bladder training, meds/devices/surgery; skin protection (pads/briefs, cleanser, barrier cream).

Urinary Retention

Incomplete bladder emptying (acute or chronic).
Causes: BPH, cystocele/prolapse, obstruction (stones/lesions).
Findings: hesitancy, weak stream, frequency, distention, pain, leakage.
Risks: UTI, bladder/kidney damage.

7) Altered Bowel Elimination

Constipation

<3 BMs/week + hard/lumpy stools, difficult to pass.
Risks: pregnancy/postpartum, older adults, low fiber/fluids, meds, GI disorders, immobility.
Red flags: fever, GI bleeding, severe pain, vomiting, weight loss.
Complication: fecal impaction/obstruction (liquid stool may leak around impaction).
Tx: fiber + fluids + exercise + bowel training; meds; enema/manual removal; surgery if complete obstruction.

Diarrhea

Frequent loose/watery stools: acute (1–2d), persistent (>2w <4w), chronic (>4w).
Risks: infection, meds, GI disorders, diet.
Dangers: dehydration, malabsorption.
Adult urgent follow-up: fever ≥102°F, >2 days, ≥6/day, severe pain, blood/black stool.
Tx: rehydration; OTC (loperamide/bismuth) if appropriate; antibiotics/probiotics if infectious cause.

Bowel Incontinence

Urge (can’t reach toilet) most common; passive (unaware leakage). Leads to skin issues + reduced self-esteem.
Children: encopresis.

8) Medications That Affect Elimination

Constipation: antacids (Al/Ca), anticholinergics/antispasmodics, antiseizure meds, Ca-channel blockers, diuretics, iron, antiparkinsonian, opiates, antidepressants.
Diarrhea: antibiotics, magnesium antacids; consider C. diff if severe/persistent after antibiotics.

9) Conditions Altering Urinary Patterns

●       Dehydration: thirst, dry mouth, fatigue, dizziness, dark urine; severe needs IV fluids.

●       UTI: dysuria, urgency/frequency; can progress to pyelonephritis (fever, flank pain, N/V, hematuria). Tx antibiotics + fluids. Higher risk: females, retention, obstruction, catheters, diabetes, menopause.

●       Kidney stones: severe flank pain radiating to groin, hematuria, dysuria, fever/chills, N/V. Tx fluids, pain meds, strain urine, ESWL/surgery.

●       Kidney failure: waste/fluid buildup → ↓ urine, HTN, anemia, itching; Tx dialysis or transplant.

●       BPH: urethral constriction → retention, nocturia, weak stream; can cause UTIs/damage; Tx meds/surgery.

10) Conditions Altering Bowel Patterns

●       Diverticulosis: pouches; Diverticulitis: inflamed/infected pouch → pain/bleeding; risk perforation → peritonitis. Prevent: fiber; nuts/seeds no longer restricted. Tx antibiotics + liquid/soft diet.

●       IBS: pain + diarrhea/constipation (IBS-C, IBS-D, IBS-M); Tx diet (fiber/probiotics, avoid triggers), stress reduction, sleep/exercise, meds.

●       Bowel obstruction: blockage → N/V, distention, severe constipation; NG decompression + surgical consult.

●       Ileus: decreased/absent motility (often post-op/illness/meds) → absent bowel sounds, distention, N/V; Tx NPO, NG tube, IV fluids; consider TPN if prolonged.

●       Ulcerative colitis: colon inflammation/ulcers → bloody diarrhea, fatigue, anemia; Tx meds; surgery if refractory/cancer risk.

●       Crohn’s: inflammation anywhere (often small intestine) → diarrhea, weight loss, anemia; complications fistulas/abscess/obstruction; Tx meds + possible surgery.

11) Diversions & Ostomies

Urinary Diversions

●       Catheterization (temporary)

●       Ureteral stent

●       Ileal conduit/urostomy (stoma + pouch)

●       Nephrostomy (kidney → external bag)

●       Neobladder (internal reservoir, may need catheter)

●       Continent cutaneous reservoir (internal pouch + valve; catheter to empty)

●       Cystostomy (catheter directly into bladder)

Complications: UTIs, kidney infection, skin breakdown; psychosocial concerns.

Fecal Diversions

●       Ileostomy

●       Colostomy (+ irrigation option for some permanent colostomies)

●       J-pouch (internal ileal reservoir connected to anus; often temporary ileostomy first)

●       Kock pouch (continent ileostomy; catheter to empty)

Complications: skin irritation, hernia/prolapse/stenosis, blockage, diarrhea, bleeding, electrolyte imbalance, infection, leakage.
WOC nurse supports education + supplies + skin/stoma care.

12) Diagnostics & Specimen Collection

Urinary

●       Urodynamics: uroflowmetry, postvoid residual, cystometric test, leak point pressure, EMG, video urodynamics, pressure-flow study

●       Scopes: cystoscopy, ureteroscopy

●       Urinalysis: visual + dipstick + microscopic (WBC, RBC, bacteria, casts, crystals)

●       Urine culture: clean catch midstream; grows organism + susceptibility testing (correct antibiotic; reduces resistance)

●       24-hour urine: collect all urine, refrigerate, avoid certain foods/meds

Urine collection methods: clean catch vs catheter (sterile technique for intermittent/indwelling).

GI

●       Tests: celiac testing, colonoscopy, ERCP, sigmoidoscopy, upper/lower GI series, upper endoscopy

●       FOBT: dietary/med restrictions to prevent false positives (ex: beets, red meat, some veggies; aspirin/ibuprofen/Vit C)

●       Stool culture: for severe/persistent diarrhea (travel, contaminated food/water, antibiotics)

13) Nursing Interventions

Promote Urinary Elimination

●       Bedpan/urinal assistance + measure output + privacy + skin check

●       Bladder irrigation (ordered; pain is NOT expected → report)

●       Lifestyle: avoid bladder irritants; appropriate fluids; weight loss; stop smoking

●       Bladder training + elimination journal

●       Bladder scan to avoid unnecessary catheterization

●       Catheters: intermittent, indwelling, external male condom, external female wick

●       CAUTI prevention: sterile insertion for indwelling/intermittent; daily hygiene; handwashing; keep system clean

Promote Bowel Elimination

●       Fiber, hydration, activity, respond to urge, stress management

●       Bowel training (may use laxatives)

●       Enemas: cleansing vs retention; solutions hypotonic/isotonic/hypertonic (tap water can cause electrolyte shifts)

●       Laxatives:

○       Bulk-forming

○       Surfactant (stool softener)

○       Stimulant

○       Osmotic

●       Rectal tubes/fecal management systems for severe incontinence

Skin Care for Incontinence

●       Clean promptly, rinse, pat dry

●       Moisturize (alcohol-free)

●       Barrier ointments/pastes/sealants

●       Assess for nonblanchable redness, blisters, wounds/ulcers

NG Decompression (for obstruction/ileus)

Measure nose → ear tragus → xiphoid, advance with swallowing, confirm placement (x-ray/capnography/pH per policy), secure + suction as ordered.

If you want, I can also turn this into a 1-page “exam cram” sheet (still including every concept, just in ultra-compact bullets).

Condensed Study Guide: Main Concepts (Elimination + Sensory Perception)

1) ELIMINATION (URINARY + BOWEL)

Urinary system basics

●       Organs: kidneys → ureters → bladder → urethra

●       Kidneys: filter blood, remove waste/fluid, regulate electrolytes & BP hormones, support RBC production.

●       Normal urine: clear, light yellow, minimal odor.

○       Dark yellow/amber: dehydration.

○       Red/pink: blood or foods (beets).

○       Brown: severe dehydration/liver/kidney issues or certain foods.

Expected urine output (high-yield)

●       Adults: ~0.5 mL/kg/hr

●       Output generally decreases with age (↓ nephrons, ↓ renal blood flow).

Urinary alterations

Urinary incontinence = can’t control urination

Types:

●       Stress: cough/sneeze/exertion → leak

●       Urge: sudden strong urge → can’t reach toilet

●       Overflow: bladder overfills from incomplete emptying → dribbling/leak

●       Reflex: nerve damage → unpredictable leakage

●       Functional: can’t get to toilet in time (mobility/dexterity issues)

●       Nocturnal enuresis: nighttime bedwetting

Key nursing focus: skin protection (barrier creams, briefs/pads), reduce irritants, bladder training, pelvic floor exercises.

Urinary retention = can’t empty bladder fully

●       Causes: BPH, prolapse (cystocele), obstruction (stones), neuro issues.

●       Findings: hesitancy, weak stream, frequency, distention, pain, leakage.

●       Risks: UTI, bladder/kidney damage.

●       Interventions: identify cause, drain bladder if needed, bladder scan, catheterization if ordered.

Common urinary conditions

●       Dehydration: thirst, dry mouth, dizziness, dark urine, low urine; severe → IV fluids.

●       UTI: dysuria, urgency/frequency; untreated → pyelonephritis (fever, flank pain, N/V). Treat: antibiotics + fluids.

●       Kidney stones: severe flank pain radiating to groin, hematuria, N/V; treat pain + fluids, strain urine, possible lithotripsy/surgery.

●       Kidney failure: ↓ urine, HTN, anemia, itching; treat dialysis/transplant.

●       BPH: frequency/nocturia, weak stream, retention/incontinence; treat meds/surgery.

Bowel system basics

●       GI tract: mouth → esophagus → stomach → small intestine → large intestine → rectum → anus

●       Peristalsis moves contents forward.

●       Stool: should be soft/formed, easy to pass (no straining).

Bristol Stool Chart (quick)

●       1–2: constipation (hard/lumpy)

●       3–4: ideal/normal

●       5–7: diarrhea (loose/watery)

Bowel alterations

●       Constipation: <3 BMs/week + hard stool/straining

○       Risks: impaction/obstruction (esp immobile/neuro injury).

○       Tx: fiber, fluids, activity, bowel training, stool softeners/laxatives; impaction → enema/manual removal.

●       Diarrhea: frequent loose watery stools

○       Danger: dehydration, electrolyte imbalance; red flags: blood/black stool, fever, severe pain, lasts >2 days.

○       Tx: rehydration, remove irritants; meds like loperamide (if appropriate); infection → meds/probiotics as ordered.

●       Bowel incontinence: urge (can’t reach toilet) vs passive (leak without awareness).

○       Nursing: skin care, scheduled toileting, bowel training, protect dignity.

Diversions (know names + purpose)

Urinary diversions

●       Catheterization: intermittent or indwelling

●       Ureteral stent: keeps ureter open

●       Urostomy/ileal conduit: urine exits through stoma into pouch

●       Nephrostomy: kidney → external drainage

●       Cystostomy (suprapubic): catheter directly into bladder

●       Neobladder/continent reservoir: internal storage; may need catheter to empty

Complications: infection, skin breakdown, psychosocial stress.

Fecal diversions

●       Ileostomy: ileum → stoma (often liquid stool)

●       Colostomy: colon → stoma (more formed depending on location)

●       J-pouch: internal ileal reservoir connected to anus

●       Kock pouch: continent ileostomy; catheter to empty

Complications: skin irritation, leaks, hernia/prolapse, blockage, diarrhea, electrolyte issues.

Diagnostic tests/specimens (high-yield)

Urinary

●       Urinalysis: dipstick + microscopic

●       Urine culture: clean catch; susceptibility testing picks the right antibiotic

●       24-hr urine: measures substances over time

●       Urodynamics: bladder function (uroflowmetry, PVR, cystometrics, etc.)

●       Cystoscopy/ureteroscopy: visualize urinary tract

GI

●       FOBT: check hidden blood (avoid foods/meds that cause false positives)

●       Stool culture: severe/persistent diarrhea, travel, prolonged antibiotics

●       Colonoscopy, sigmoidoscopy, upper GI endoscopy, ERCP, GI series as indicated

Nursing priorities (elimination)

●       Assess: amount, frequency, color/odor, pain, stool type.

●       Prevent skin breakdown: cleanse, dry, barrier creams, frequent checks.

●       Promote normal patterns: hydration, fiber, activity, timed toileting, privacy, proper equipment (bedpan/urinal).

●       Reduce infection risk: sterile technique for invasive catheters; minimize indwelling catheter days (CAUTI prevention).

2) SENSORY PERCEPTION (ALL MAIN CONCEPTS)

Big picture

●       Stimulus → sensory organ → CNS/cranial nerves → brain interprets → response

●       Problems can be in reception, perception, or response.

Key terms

●       Sensory deficit: reduced function (vision/hearing/touch/etc.)

●       Sensory deprivation: too little stimulation

●       Sensory overload: too much stimulation → anxiety/confusion

●       SPD: detects stimuli but brain misprocesses → oversensitive/overwhelmed

Cranial nerves (only what’s essential)

●       I smell, II vision, III/IV/VI eye movement

●       V facial sensation/jaw

●       VII facial expression + taste (front tongue)

●       VIII hearing/balance

●       IX/X swallowing/gag/voice

●       XI shoulder shrug/head turn

●       XII tongue movement

Vision: most tested disorders

●       Refractive errors: myopia, hyperopia, astigmatism, presbyopia

●       Cataracts: cloudy lens → blurry/hazy, ↓ color

●       Diabetic retinopathy: retinal vessel damage → floaters/blur → blindness risk

●       Glaucoma: ↑ intraocular pressure → loss of peripheral vision (irreversible)

●       Macular degeneration: loss of central vision (older adults)

Tests: Snellen/Tumbling E; slit lamp; fluorescein angiography; visual field test; intraocular pressure; Amsler grid.

Hearing

●       Anatomy: outer → middle (ossicles) → inner (cochlea) → CN VIII.

●       Tinnitus: ringing/buzzing without sound.

●       Types of loss:

○       Sensorineural: inner ear/nerve (aging = presbycusis, loud noise, ototoxic meds)

○       Conductive: sound can’t travel (wax, otitis media, perforation, otosclerosis)

○       Mixed: both

Tests: Rinne, pure-tone audiometry; ABR/OAE (screening).

Speech/Aphasia (stroke-related high yield)

●       Broca/expressive: understands but can’t produce words well (“telegraphic” speech)

●       Wernicke/fluent: lots of words, no meaning; poor comprehension

●       Global: severe impairment of both

Touch

●       Hypersensitivity / defensiveness (painful to normal touch) vs hyposensitivity (reduced pain/temp).

●       Major causes: peripheral neuropathy (diabetic), spinal cord injury.

●       Testing: neuro exam, sensation checks, nerve conduction, EMG, MRI.

Smell & taste (often linked)

●       Taste disorders: hypogeusia (↓ taste), ageusia (no taste), dysgeusia (metallic/rancid), phantom taste

●       Smell disorders: anosmia (no smell), hyposmia (reduced), parosmia (distorted), phantosmia (smell not real)

●       Causes: URIs, sinus disease, head injury, smoking, meds, zinc deficiency, neuro disorders.

Aging effects (must know)

●       Vision & hearing decline most.

●       Vision: smaller pupils, less lens flexibility, weaker extraocular muscles, ↓ tears/dry eyes.

●       Hearing: high-frequency loss, cerumen impaction, tinnitus.

●       Taste/smell: ↓ taste buds + ↓ saliva → ↓ appetite → malnutrition risk.

●       Touch: ↓ circulation → ↓ temperature/pain sensitivity.

Nursing priorities (sensory)

●       Safety + independence + emotional support

●       Vision: lighting, corrective lenses, remove clutter, orient to room, fall prevention.

●       Hearing: face client, reduce background noise, check hearing aids, use written info/interpreter.

●       Speech: allow time, don’t finish sentences, use boards/paper/tablet.

●       Touch: injury prevention (diabetic foot care, protective footwear, daily inspection).

●       Smell/taste: oral hygiene, season foods, smoke/CO detectors, avoid smoking.

If you want, I can turn this into a one-page “test-ready” version (even shorter, like only definitions + red flags + key interventions).

Condensed Study Guide: Complementary & Integrative Health (CIH) / CAM / Holistic Nursing

1) Key Terms (know the differences)

●       Conventional (Western) medicine: Evidence-based diagnosis & treatment (meds, surgery, radiation). Also called mainstream, allopathic, biomedicine, orthodox.

●       Complementary therapy: Used with conventional care (ex: aloe + NSAID for sunburn).

●       Alternative therapy: Used instead of conventional care.

●       Integrative health: Combines conventional + complementary + alternative in a coordinated plan (mind–body–spirit).

●       Holistic nursing: Client-centered care treating the whole person (physical, emotional, spiritual, social, cultural, environment). Focus is healing + wellness, not just curing disease.

2) NCCIH Categories (how CIH is “delivered”)

Nutritional approaches

●       Herbs/botanicals, supplements, vitamins/minerals, probiotics, dietary therapies

●       Usually OTC and labeled as dietary supplements

Psychological (mind–body) approaches

●       Relaxation, meditation, mindfulness/MBSR, guided imagery, biofeedback, hypnosis, prayer

Physical approaches

●       Hands-on body structures/systems: massage, chiropractic, osteopathy, spinal manipulation, heat/cold, reflexology

Bioenergetic (energy) therapies

●       Veritable energy = measurable EM fields/light/magnets

●       Putative energy (biofields) = subtle energy concepts

●       Examples: Healing Touch, Therapeutic Touch, Reiki, Tai Chi, qi gong, acupressure

Whole medical systems

●       Complete systems separate from Western medicine:

○       Ayurveda, Traditional Chinese Medicine (TCM), Unani, Kampo

○       Also: Homeopathy, Naturopathy, Functional medicine (root-cause focus)

Combined approaches

●       Blends multiple categories: yoga, mindfulness eating, dance/art/music therapy

3) Why it matters (nursing relevance)

●       Many clients use CIH (often alongside prescriptions). Nurses must:

○       Assess what clients use

○       Prevent interactions/harms

○       Provide culturally congruent care

○       Support self-care + empowerment

●       Holistic nursing priorities

○       Promote wellness, honor caring–healing relationship

○       Respect subjective experience of illness/healing

○       Encourage informed decisions + active participation

○       Incorporate cultural beliefs/folk practices safely

4) High-yield Mind–Body Therapies (what they do)

●       Deep breathing: control rate/depth → ↓ anxiety/stress

●       Meditation: quiet mind/focused attention → ↓ BP/HR, ↓ stress effects

●       Mindfulness: present-moment awareness; can reduce stress and improve coping

●       Guided imagery: mental visualization → relaxation, pain/anxiety reduction

●       Prayer: spiritual coping/connection (client-defined)

●       Progressive relaxation: systematically tense/relax muscle groups

●       Yoga (meditative movement): poses + breathing ± meditation → stress, sleep, anxiety; also pain (back/neck) support

●       Aromatherapy: essential oils (inhaled/topical) → relaxation, anxiety relief; some evidence for nausea (ex: ginger/lavender/peppermint blends)

●       Acupuncture/acupressure: stimulates points/meridians → pain, nausea, fatigue, anxiety support

●       Hypnotherapy: focused attention + suggestion → phobias, anxiety, pain, habits (smoking)

●       Biofeedback: device-assisted control of body functions (HR, tension) → stress, headaches, rehab, pain

5) Manual Therapies (hands-on)

●       Massage: manipulates soft tissues → pain/anxiety/insomnia support

○       Precautions: avoid over clots/tumors/prostheses; caution with anticoagulants/low platelets (bruising/bleeding); older adults risk (rare) fractures

●       Reflexology: foot/hand zones thought to correspond to body functions

●       Chiropractic: spinal manipulation + structural focus; no surgery/Rx meds

●       Osteopathic medicine: structure-function relationship; osteopathic manipulation used by trained physicians

6) Bioenergetic / Movement Therapies

●       Tai Chi / Qi gong: meditative movement; balance, function, stress reduction

●       Alexander Technique: posture/neck-spine alignment awareness → chronic pain support

●       Feldenkrais: mindful movement retraining → pain + mobility

●       Rolfing/Structural integration: deep tissue/fascia work → posture/function

●       Pilates: core/torso control, posture → balance, flexibility, pain relief

●       Therapeutic Touch / Healing Touch / Reiki: energy-based touch; may support relaxation, pain reduction, agitation (ex: dementia)

7) Traditional / Indigenous Practices (cultural competence)

●       Traditional medicine (WHO concept): culture-based knowledge/practices for prevention/diagnosis/treatment—often includes spirituality.

●       Examples: Native healing practices (prayer, drumming, storytelling, sacred rituals), herbal use, cupping, etc.

●       Nursing: respect beliefs, ask what practices are important, integrate safely.

8) Whole Medical Systems (quick ID)

●       Ayurveda: balance mind–body–spirit; doshas; cleansing + diet + herbs + yoga/meditation

●       TCM: acupuncture, Tai Chi/qi gong, herbs; balance yin/yang + qi flow

●       Naturopathy: “body heals itself” supported by diet, lifestyle, herbs, supplements, homeopathy, etc.

●       Homeopathy: “like cures like,” highly diluted remedies

●       Functional medicine: root-cause, systems-based approach

9) Natural Products: BIG SAFETY POINTS (test favorites)

FDA/supplements

●       FDA regulates supplements, but manufacturers are responsible for quality/claims → variability exists.

●       “Natural” ≠ safe.

Must-do nursing action

●       Always ask about herbs/supplements/vitamins OTC.

●       Encourage a current med + supplement list shared with provider/pharmacist before starting anything new.

Common interaction themes

●       Bleeding risk (esp with anticoagulants like warfarin):

○       Garlic, ginger, ginkgo, cranberry (large amounts), evening primrose oil, etc.

●       Serotonin syndrome risk when mixing certain herbs with antidepressants:

○       St. John’s wort + antidepressants (ex: duloxetine)

●       CNS depression/sedation combos:

○       Valerian + sedatives/alcohol/antihistamines

●       Vitamin K decreases warfarin effect:

○       Leafy greens (consistency matters)

Specific high-yield herbal cautions

●       Ephedra (ma huang): banned in U.S. supplements → serious CVA/MI risk (worse with caffeine)

●       Kava: can cause liver damage

●       Black cohosh: possible liver injury risk

●       Tea tree oil: toxic if ingested

●       Licorice root: ↑ BP, can lower K+ (esp with diuretics); avoid in pregnancy

●       St. John’s wort: many interactions (reduces effectiveness of multiple meds) + photosensitivity

Probiotics (basic)

●       Support healthy gut flora; can help inhibit harmful bacteria (ex: Lactobacillus)

10) Vitamins & Minerals (core test facts)

Vitamins

●       Water-soluble: B-complex + C (not stored well → need regular intake)

●       Fat-soluble: A, D, E, K (stored in fat/liver → toxicity risk if too much)

Vitamin K newborn note: doesn’t cross placenta well; newborns get IM vitamin K to prevent bleeding.

B-complex quick purpose (big picture)

●       Mostly metabolism/energy, neuro function, RBC formation

●       B12: neuro + RBCs (deficiency → anemia, fatigue, neuro changes)

Minerals (core roles)

●       Needed for: enzyme function, nerve/muscle contraction, fluid balance, bone/teeth

●       Examples:

○       Calcium: bones + clotting + nerve impulses

○       Sodium: extracellular fluid, nerve/muscle

○       Potassium: nerve/muscle; high/low can cause arrhythmias

○       Magnesium: metabolic processes; low with alcohol use disorder/DM

○       Iron: oxygen transport; deficiency → anemia

Food-drug/nutrient interactions (quick)

●       Vitamin C ↑ non-heme iron absorption

●       Coffee/tea/wine (polyphenols) + phytic acid (legumes/nuts) ↓ iron absorption

Quick “Exam-Style” Reminders

●       Complementary = with conventional; Alternative = instead; Integrative = coordinated blend.

●       Nursing role: assess use, prevent interactions, educate, support self-care, respect culture.

●       Biggest safety issue: herb/supplement interactions (bleeding, serotonin syndrome, sedation, warfarin/vit K).

If you want, paste any practice questions from this lesson and I’ll answer them using only what’s in your notes.