New content. The entire text has been revised and updated to reflect current medical and nursing practice. Skills. The skills are still grouped at the end of each chapter for easy access and to avoid interrupting the narrative and relegating related tables and boxes to places where they previously seemed out of context.
Fundamental Nursing Concepts
EXPLORING CONTEMPORARY NURSING 1 1 NURSING FOUNDATIONS 2
INTEGRATING BASIC CONCEPTS 33 3 LAWS AND ETHICS 34
Assessment of Stressors 68 Prevention of Stressors 68 Stress reduction techniques 68 Stress management techniques 68 6 CULTURE AND ETHNICITY 71.
FOSTERING COMMUNICATION 91
Fundamental Nursing Skills
- PERFORMING BASIC CLIENT CARE 133 10 ASEPSIS 134
- ASSISTING WITH BASIC NEEDS 287 15 NUTRITION 288
- ASSISTING THE INACTIVE CLIENT 515 23 BODY MECHANICS, POSITIONING,
- THE SURGICAL CLIENT 613 27 PERIOPERATIVE CARE 614
- MEDICATION ADMINISTRATION 767 32 ORAL MEDICATIONS 768
- INTERVENING IN EMERGENCY SITUATIONS 843 36 AIRWAY MANAGEMENT 844
- CARING FOR THE TERMINALLY ILL 875 38 END-OF-LIFE CARE 876
List four types of educational programs that prepare students for entry-level nursing practice. During the Middle Ages in Europe, religious groups took on many of the roles of nursing.
NURSING ORIGINS
Name one historical event that led to the death of nursing in England before the time of Florence Nightingale. THIS chapter traces the historical development of nursing from its disorganized beginnings to the current sophisticated practice.
THE NIGHTINGALE REFORMATION
S. Nursing Schools
How did Florence Nightingale convince the English and others that formal education of those who cared for the sick and injured was essential. Like England, the United States was engaged in a war without an organized or substantial workforce of trained nurses to care for the sick and wounded.
NURSING IN THE UNITED STATES
The Union government appointed Dorothea Lynde Dix, a social worker who had proven her worth by reforming healthcare for the mentally ill, to select and organize women volunteers to care for the troops. To clarify to the public and nurses themselves what nursing entails, several working definitions have been proposed.
THE EDUCATIONAL LADDER
Nurses modify unhealthy aspects of the environment to put the client in the best condition for nature to operate. Nightingale is credited with having said: "to stand still is to move backwards". The principle that learning is a lifelong process still applies.
FUTURE TRENDS
Health care officials hope that enrollment in all nursing programs and continuing education will improve to reduce the current and projected critical shortage of nurses. Coordinating nursing services across health care settings – i.e. discharge planning (managing transition needs and ensuring continuity).
UNIQUE NURSING SKILLS
At that time, the nurse uses comforting skills (interventions that provide stability and safety during a health-related crisis) (Figure 1-7). (c) the nurse asks the client to identify his current health problems; d) the nurse gives medication to a patient with pain.
DEFINITION OF THE NURSING PROCESS
Describe the concept mapping process as an alternative teaching strategy for students' clinical experiences. In even stronger terms, nurses are held accountable and responsible for providing client care that is safe and appropriate and that reflects currently accepted standards for nursing practice.
CHARACTERISTICS OF THE NURSING PROCESS
STEPS OF THE NURSING PROCESS
Therefore, the nurse shares the care plan with the members of the nursing team, the client, and the client's family. The client and one or more members of the care team are involved in implementing the plan.
CONCEPT MAPPING
By analyzing the client's response, evaluation helps determine the effectiveness of nursing care (Table 2-5). Before revising a care plan, it is important to discuss any lack of progress with the client.
USE OF THE NURSING PROCESS
Problem identification guides the nurse to select methods to maintain or restore the client's health. Documentation shows that the planned care has been completed and provides information about the client's progress.
REVIEWING WHAT YOU’VE LEARNED
Activity F: The nursing process is an organized sequence of problem-solving steps used to identify and manage clients' health problems. In the boxes below, write the correct sequence in which the actions of the nursing process should be performed.
APPLYING YOUR KNOWLEDGE
Initially, the client eagerly agreed to the treatment, but now tells the nurse that he would rather suffer the consequences of the disease than the side effects of the treatment. Full or partial return of function to the left limb is one of the long-term goals for this client, who will eventually receive occupational therapy.
GETTING READY FOR NCLEX
Discuss the purpose of nursing practice actions and the role of the state board of nursing. List five ways in which a nurse's professional liability can be limited in the event of a lawsuit.
LAWS
The Nursing Home Reform Act as part of the Budget Reconciliation Omnibus Act (OBRA) states that nursing home residents “have the right to be free from any restraints or psychoactive drugs administered for the purposes and that the facility shall ensure that no discipline or comfort, and it is not necessary to treat residents' medical symptoms.” This does not mean that restrictions cannot be used; rather, they should be used as a last resort. Breach of Duty – The nurse failed to provide adequate care or care was provided negligently, i.e. in a manner contrary to how others with similar training would have acted in the same set of circumstances.
PROFESSIONAL LIABILITY
11. The patient has the right to expect reasonable continuity of care when appropriate, and to be informed by physicians and other health care providers of available and realistic options for patient care when hospital care is no longer appropriate. 12. The patient has the right to be informed of the hospital's policies and practices relating to patient care, treatment and responsibilities.
HEALTH
A resource is a possession that is valuable because its supply is limited and there is no substitute. People often say, "as long as you have your health, you have everything" and "health is wealth".
WELLNESS
The client may explore philosophical and spiritual issues as he or she considers the potential for death. For example, in the case of the client with a heart attack, the nurse considers
ILLNESS
The nurse addresses other needs, such as assisting the client with a possible change in role performance or spiritual distress, after the client's health status has stabilized. Often, remissions and exacerbations are related to how well or poorly the immune system is functioning, the stressors the client is facing, and the client's general state of health (eg, nutrition, sleep, hydration).
HEALTH CARE SYSTEMLEADING CAUSES OF DEATH IN THE UNITED STATES IN 2004
The inequality in access to healthcare and the high costs prompted an evaluation of the entire healthcare system. Medicare (a federal program that finances the health care costs of individuals age 65 and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease) is funded primarily through BOX 4-1 ● Trends in Health and Healthcare.
NATIONAL HEALTH GOALS
Preferred provider organizations are agents for health insurance companies that control health care costs on a competitive basis. Subscriber customers can lower their health care costs by getting care from any of the preferred providers.
NURSING TEAM
The team leader is responsible for evaluating whether customer care goals are being met. One method used when providing client care is functional nursing (the model in which each nurse on a client unit is assigned specific tasks).
CONTINUITY OF HEALTH CARE
Managed Care Organization Continuity of care (maintenance of health care from one level of health to another and from one agency to another) ensures that the client navigates the complex health care system with maximum efficiency and minimum frustration. All too often, this happens when a healthcare provider fails to consult or communicate with others involved in the client's care.
HOMEOSTASIS
The autonomic nervous system consists of peripheral nerves that influence physiological functions that are largely automatic and beyond voluntary control. When a situation arises that the mind perceives as dangerous, the sympathetic nervous system prepares the body for fight or flight.
STRESS
Physiological exhaustion occurs when one or more adaptive or coping mechanisms can no longer protect the person experiencing the stressor. Therapeutic coping strategies usually help a person gain insight, gain confidence to face reality, and develop emotional maturity.
NURSING IMPLICATIONSCOPING MECHANISMS
Endorphins are produced in the pituitary gland, but are present in the blood and other tissues (Porth, 2007). Having to eat at different times than you usually do. Letting strangers sleep in the same room with you.
CULTURE
There are slightly more women than men in the United States, but women are considered a minority. By the year 2020, the number of Latinos and Asian Americans living in the United States is expected to triple, and the number of African Americans will double (Andrews, 2005).
ETHNICITY
Minority does not necessarily mean that there are fewer members of the group compared to others in society.
MINORITYRACE
Ethnocentrism continues to play a role in ethnic rivalries between Shiites, Sunnis, and Kurds in Iraq; Arabs and Jews in the Middle East; Tutsis and Hutus. To suggest that anyone living in the United States embraces the entirety of its culture, however, would be foolish.
CULTURE OF THE UNITED STATES
Although Anglo-American culture predominates in the United States, those of African, Asian, Hispanic, and Arab descent outnumber those originating in the United Kingdom and Western Europe. Madeline Leininger coined the term transcultural nursing. providing nursing care within the context of another's culture) in the 1970s.
TRANSCULTURAL NURSING
Care planning within the client's health trust system to achieve the best health outcomes. Use culturally sensitive techniques to improve interactions, such as sitting in the customer's comfort zone and making appropriate eye contact.
CULTURALLY SENSITIVE NURSING
What procedure should the nurse follow if the client does not want to stay in the facility. Which of the following actions would be appropriate for the nurse to take to ensure the client's safety.
NURSING ROLES WITHIN THE NURSE–CLIENT RELATIONSHIP
One of the main keys to creating and maintaining positive nurse-client relationships is the nurse's manner and communication style. The nurse also acts as a collaborator (one who works with others to achieve a common goal) (Fig. 7-1).
THE THERAPEUTIC NURSE–CLIENT RELATIONSHIP
The nurse-client relationship can also be called a therapeutic relationship, because the desired outcome of the collaboration is almost always in the direction of restored health. The termination phase (the period during which the relationship ends) occurs when the nurse and client mutually agree that the client's immediate health problems have improved.
COMMUNICATION
Confirms that the nurse is following the conversation. Repeats what the client said to demonstrate. By understanding the client's comfort zone, the nurse knows how spatial relationships influence nonverbal communication.
Avoid the "invisible customer syndrome". Talking to someone else in the room as if the customer isn't there shows disrespect. Ask if the client has any special needs and if he or she can hear you easily.
IMPORTANCE OF CLIENT TEACHING
The cognitive domain is a style of processing information by listening or reading facts and descriptions. One way to determine the client's preferred learning style is to ask a question such as: "When you were learning to add fractions, what helped you the most: hearing the teacher's explanation or reading about it in a math book, recognizing the value of the exercise, or actually working test problems?” Although most clients prefer one domain, nurses can optimize learning by presenting infor-.
ASSESSING THE LEARNER
To protect the client's self-esteem, the nurse might ask, "How do you learn best?" and plan accordingly. In order to be most effective and individualized, the nurse must gather relevant information from the client.
INFORMAL AND FORMAL TEACHING
TEACHING ADULT CLIENTS
Learning occurs more easily when the client can focus on the task at hand. Documentation provides a written record of the client's progress and prevents omissions or duplication during future learning sessions.
MEDICAL RECORDS
Show trends in the client's vital signs, weight, daily summary of fluid intake and output. A second type of customer record is the problem-oriented record. organized according to the client's health problems).
PROTECTING HEALTH INFORMATION
A single keystroke saves the information displayed on the monitor to the customer record (Fig. 9-5). There are some exceptions where health information may be disclosed without the prior consent of the client.
DOCUMENTING INFORMATION
Light boxes for examining x-rays or other diagnostic scans on which the client's name appears must be in private areas. For example, laboratory employees can obtain information from the medical orders, but they cannot see information in the customer's personal history.
COMMUNICATION FOR CONTINUITY AND COLLABORATION
MAKING ENTRIES IN A CLIENT’S RECORD
Why should the nurse document information he or she has learned and evidence that demonstrates the client's understanding. What actions should the nurse take when answering the phone and reporting information about the client's condition.
MICROORGANISMS
Intermediate fungal infections affect subcutaneous tissues such as fungal granuloma (an inflammatory lesion under the skin). Consequently, an intermediate life form, such as fleas, ticks, lice or mites, transmits rickettsial diseases to humans.
CHAIN OF INFECTION
Microorganisms thrive in reservoirs such as tissue in the superficial crevices of the skin, on hair shafts, in open wounds, in the blood, in the lower digestive tract and in the nasal passages. Receives cancer medications and anti-inflammatory medications such as corticosteroids that suppress the immune system.
ASEPSISMETHODS OF TRANSMISSION
After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. Their use is mandatory in some areas of the hospital - the children's room, the operating room and the delivery room.
NURSING IMPLICATIONS
When opening the sterile package, the nurse makes sure that the inside of the package and its contents remain sterile. Wearing sterile gloves ensures the sterile condition of the hands and gown cuffs.
The most important health teaching the nurse can provide to a client with an eye infection is to. If the nurse provides the following information to a person who has just had their earlobes pierced, which is most important to reduce the risk of infection.
Deficient Knowledge
- HANDWASHING
- PERFORMING A SURGICAL SCRUB SUGGESTED ACTION
- CREATING A STERILE FIELD AND ADDING STERILE ITEMS
- DONNING STERILE GLOVES
Pouring the desired amount into the container in the sterile field without spraying the surface of the field (Fig. F). The procedure that required the sterile field and the result of the procedure are documented (refer to the Sample Documentation accompanying Skill 10-4).
THE ADMISSION PROCESS
Additions or modifications to the procedure depend primarily on the client's condition and agency policies. The nurse revises the plan of care as more data is collected or the client's condition changes.
THE DISCHARGE PROCESS
The client signs and holds a sheet; the nurse attaches a copy to the client's medical record. After the client has left the health care agency, the nurse documents the discharge activities and the client's condition (see Skill 11-2).
THE TRANSFER PROCESS
Except in unusual circumstances, the housekeeping staff prepares the customer's room for the next admission. Carelessness can lead to the loss of the client's clothing or valuables and cause difficulty in returning them.
THE REFERRAL PROCESS
Home health care is health care provided in the home by a worker of a home health agency (Fig. 11-8). The number of clients receiving home health care continues to grow, in part as a result of limits placed by Medicare and insurance companies on the number of hospital and nursing home days for which they reimburse care.
