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
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